Multiple devices can stabilise the MTP joint for arthrodesis. The ideal implant should be easy to use, provide reproducible and high quality results, and ideally enable early rehabilitation to enable faster return to function, whilst lessening soft tissue irritation. We prospectively evaluated the combination of the IO-Fix (Extremity Medical, NJ, USA) device which consists of an intra-osseous post and lag screw that offers these features with full bearing of weight after surgery. 67 feet in 65 patients were treated over 31 months. After excluding patients lost to follow-up, undergoing revision arthrodesis, or concomitant first ray procedures, there were 54 feet in 52 patients available with a minimum 12 month follow-up with clinical and radiographic outcomes. All patients were treated using a similar operative technique with immediate bearing of weight in a rigid soled shoe.Abstract
Background
Methods
Partial facetectomies with pedicle screw instrumentation is widespread and a well described technique for achieving posterior correction of scoliosis. Newton et al. first described the use of the UBS in the posterior correction of AIS in 2014. The aim of this study was to compare the effectiveness of the UBSPO in achieving posterior correction in Type1 AIS as compared to the traditional partial facetectomies. Aim of this study was to assess the effectiveness of USBPO in achieving posterior correction in Type 1 AIS as compared to partial facetectomies. A retrospective review of 40 patients with type 1 AIS who had undergone a posterior correction of scoliosis between 2010 and 2016 was performed. Group A (n=20) consisted of consecutive patients that had partial facetectomies while Group B (n=20) consisted of consecutive patients having UBSPO. Both groups were matched for demographic parameters. Pre and post-operative radiographic parameters and operative data in both groups were compared. The Mann-Whitney U test was used for statistical analysis.Background
Methods
Cone beam CT allows cross-sectional imaging of the tibiofibular syndesmosis while the patient bears weight. This may facilitate more accurate and reliable investigation of injuries to, and reconstruction of, the syndesmosis but normal ranges of measurements are required first. The purpose of this study was to establish: 1) the normal reference measurements of the syndesmosis; 2) if side-to-side variations exist in syndesmotic anatomy; 3) if age affects syndesmotic anatomy; and 4) if the syndesmotic anatomy differs between male and female patients in weight-bearing cone beam CT views. A retrospective analysis was undertaken of 50 male and 50 female patients (200 feet) aged 18 years or more, who underwent bilateral, simultaneous imaging of their lower legs while standing in an upright, weight-bearing position in a pedCAT machine between June 2013 and July 2017. At the time of imaging, the mean age of male patients was 47.1 years (18 to 72) and the mean age of female patients was 57.8 years (18 to 83). We employed a previously described technique to obtain six lengths and one angle, as well as calculating three further measurements, to provide information on the relationship between the fibula and tibia with respect to translation and rotation.Aims
Patients and Methods
Acute Achilles tendon (AT) rupture management remains debatable but non-operative functional regimes are beginning to dominate current treatment algorithms. The aim of this study was to identify predictors of functional outcome in patients with AT ruptures treated non-operatively with an immediate weight bearing functional regime in an orthosis. Analysis of prospectively gathered data from a local database of all patients treated non-operativelyat our institution with anAT rupture was performed. Inclusion criteria required a completed Achilles Tendon Rupture Score (ATRS) at a minimum of 8 months post rupture. The ATRS score was correlated against age, gender, time following rupture, duration of treatment in a functional orthoses (8- and 11-week regimes) and complications. 236 patients of average age 49.5 years were included. The mean ATRS on completion of rehabilitation was 74 points. The mean ATRS was significantly lower in the 37 females as compared to the 199 males, 65.8 vs 75.6 (p = 0.013). Age inversely affected ATRS with a Pearsons correlation of −0.2. There was no significant difference in the ATRS score when comparing the two different treatment regime durations. There were 12 episodes of VTE and 4 episodes of re-rupture. The ATRS does not change significantly after 8 months of rupture. Patients with AT ruptures treated non-operatively with a functional rehabilitation regime demonstrate good function with low re-rupture rates. Increasing age and female gender demonstrate inferior functional outcomes.
Outcomes following large joint arthroplasty are influenced by the accuracy of implant placement. Patient specific (PS) technology has been used in knee arthroplasty surgery however, its application in total hip arthroplasty remains relatively unexplored. We investigated whether conventional or PS guides, resulted in a more accurate reconstruction of the pre-operative head centre position.Introduction
Aims
Oxidised zirconium (OxZi) has been developed
as an alternative bearing surface for femoral heads in total hip arthroplasty
(THA). This study has investigated polyethylene wear, functional
outcomes and complications, comparing OxZi and cobalt–chrome (CoCr)
as part of a three-arm, multicentre randomised controlled trial.
Patients undergoing THA from four institutions were prospectively
randomised into three groups. Group A received a CoCr femoral head
and highly cross-linked polyethylene (XLPE) liner; Group B received
an OxZi femoral head and XLPE liner; Group C received an OxZi femoral
head and ultra-high molecular weight polyethylene (UHMWPE) liner.
At five years, 368 patients had no statistically significant differences
in short-form-36 (p = 0.176 mental, p = 0.756 physical), Western
Ontario and McMaster Universities Osteoarthritis Index (p = 0.847),
pain scores
(p = 0.458) or complications. The mean rate of linear wear was 0.028
mm/year (standard deviation ( Cite this article:
Chronic low back pain (CLBP) can be constant or episodic. Fluctuations are common. We present two different pictures of the CLBP experience; timelines illustrating back pain over time and ‘web diagrams’ showing a snapshot of a phase in time. Semi structured interviews from 34 participants from the UK BeST trial included timelines drawn collaboratively by the researcher and participant. Symptoms, events, treatment and consultations were arranged chronologically along a timeline. Initial thematic analysis on 63 interviews gave bio-psychosocial themes that were spoken about in an integrated way. Further analysis explored these interactions between themes. Interactions were classified as; helpful to recovery, unhelpful or mixed. Web diagrams were drawn for each interview and classified as Dense- mostly unhelpful interactions, Open – a combination of helpful and unhelpful interactions and Sparse – mostly helpful interactions.Background and Purpose
Methods
The routine use of patient reported outcome measures
(PROMs) in evaluating the outcome after arthroplasty by healthcare
organisations reflects a growing recognition of the importance of
patients’ perspectives in improving treatment. Although widely embraced
in the NHS, there are concerns that PROMs are being used beyond
their means due to a poor understanding of their limitations. This paper reviews some of the current challenges in using PROMs
to evaluate total knee arthroplasty. It highlights alternative methods
that have been used to improve the assessment of outcome. Cite this article:
Accurate, reproducible outcome measures are essential
for the evaluation of any orthopaedic procedure, in both clinical
practice and research. Commonly used patient-reported outcome measures (PROMs) have
drawbacks such as ‘floor’ and ‘ceiling’ effects, limitations of
worldwide adaptability and an inability to distinguish pain from
function. They are also unable to measure the true outcome of an
intervention rather than a patient’s perception of that outcome. Performance-based functional outcome tools may address these
problems. It is important that both clinicians and researchers are
aware of these measures when dealing with high-demand patients,
using a new intervention or implant, or testing a new rehabilitation
protocol. This article provides an overview of some of the clinically-validated
performance-based functional outcome tools used in the assessment
of patients undergoing hip and knee surgery. Cite this article:
The available treatments for NSLBP (Non-Specific Low Back Pain) provide, typically, small to moderate average benefits to patients. The aim of this pilot cluster RCT was to test the hypothesis that the use of a patient decision aid together with an informed shared decision making consultation would produce better outcomes in satisfaction with treatment at four month follow-up. We developed a DSP (Decision Support Package). We randomised the physiotherapists and trained those in the intervention arm in informed shared decision making and communication. Participants were recruited from a local physiotherapy department and those allocated to an appointment with an intervention therapist were sent a copy of the DSP in the post. Participants then attended their appointment as usual.Background
Methods
We have developed a LBP (low back pain) repository with IPD (individual patient data) from therapist-delivered intervention RCT's from various institutions, nationally and internationally (19 trials, 9328 patients). We will perform IPD meta-analyses to identify and determine the most effective and cost-effective treatments for subgroups of patients. Disability due to LBP is a key outcome of interest. However, there was no common disability measurement that was used in all the RCT's. We report here our assessment as to whether different disability measures are sufficiently comparable to allow pooling across trials. We used data from seven trials (n = 5015 patients) that had at least two of the following measurements: RMDQ (Roland Morris Disability Questionnaire), MVK (Modified Von Korff disability score), physical component scale of SF-12/36, Patient Specific Functional Scale, and Hannover Functional Ability Questionnaire. Within each trial, the change score between baseline and short-term follow-up was computed. These change scores were then converted from one outcome measure to another with linear regression and ridge-reroughed linear models. They were also tested for correlation and responsiveness (the ability to detect changes in condition, measured by standardised response means).Background
Method
Yellow flags are psychosocial indicators which are associated with a greater likelihood of progression to persistent pain and disability and are referred to as obstacles to recovery. It is not known how effective clinicians are in detecting them. Our objective was to determine if clinicians were able to detect them in secondary care. 111 new referrals in a specialist spine clinic completed the Oswestry Disability Index (ODI) and a range of other validated questionnaires including the yellow flag questionnaire adapted from the psychosocial flags framework. Clinicians blinded to the patient data completed a standardized form to determine which and how many yellow flags they had identified.Introduction
Methods
In Total Hip Arthroplasty (THA), polyethylene wear reduction is key to implant longevity. Oxidized Zirconium (OxZi) unites properties of a ceramic bearing surface and metal head, producing less wear in comparison to standard Cobalt-Chromium (CoCr) when articulating with Cross-linked polyethylene (XLPE) in vitro. This study investigates in vivo polyethylene (PE) wear, outcomes and complications for these two bearing couples in patients at 5 year follow-up 400 patients undergoing THA across four institutions were prospectively randomised into three groups. Group I received a cobalt-chrome (CoCr) femoral head/ cross-linked polyethylene (XLPE) liner; Group II received an OxZi femoral head/ ultrahigh molecular weight polyethylene (UHMWPE) liner; Group III received an OxZi femoral head/XLPE liner. All bearing heads were 32 mm. Linear wear rate was calculated with Martell computer software. Functional outcome and complications were recorded.Introduction
Methods
There is growing concern that current outcome measures of back pain trials do not comprehensively capture what is important to patients. Some researchers believe we need to incorporate patients in the development of ‘next-generation’ outcomes. As a preliminary step to patient-interviews, we aimed to articulate ‘important change’ from the patients' perspective, as represented in reports of qualitative investigations inadvertently or directly exploring this. We adopted a multi-strand search of electronic databases, and citation and reference tracking. Two researchers identified qualitative investigations relating to low back pain. Data were abstracted and synthesised using meta-ethnographic processes. Provisional results, based on 41 studies, indicate few studies have directly addressed this issue, but that data regarding experience and expectations may be useful. Whilst results suggest that practically, patients are concerned with (re-)engagement in meaningful activities, the more experientially focused literature suggests that patients want to be believed and have validated their experiences and identity as someone ‘doing battle’ with pain. Patients seek not only diagnoses, treatment and cure, but simultaneously reassurance of the absence of pathology. In the absence of tenable diagnoses, some feel they must not adopt a ‘sick role’. Some struggle, but manage to meet others' expectations; thereby undermining the credibility of their pain/disability claims. Others withdraw, fearful of disapprobation and unable or unwilling to accommodate social demands. Patients generally seek to regain their pre-pain healthy, and emotionally robust state.Study purpose and background
Summary of methods used and results
To develop a decision aid - Decision Support Package (DSP) - that will provide low back pain (LBP) patients, and their treating physiotherapists with information on the treatment options available to the patients To develop a training package for physiotherapists on how to use the DSP To encourage and evaluate the informed shared decision making (ISDM) process between patients and physiotherapists during consultation. We developed a DSP informed by existing research and collaboration with physiotherapists, patients and experts in the field of decision aids and LBP. We did six pieces of exploratory work: literature review; 2009 NICE LBP guidelines review; qualitative screening of transcripts of interviews of LBP patients; focus groups (patients); nominal group (physiotherapists), and Delphi study (experts). We collated these data to develop the DSP. We also developed a training package for physiotherapists.Aims
Method
Patellar instability is a complex, multi-factorial disorder. Radiological assessment is regarded as an important part of the management of this population. The purpose of this study was to determine the intra- and inter-rater reliability of common radiological measurements used to evaluate patellar instability. One hundred and fifty x-rays from 51 individuals were reviewed by five reviewers: two orthopaedic trainees, a radiological trainee, a consultant radiologist and an orthopaedic physiotherapist. Radiological measurements assessed included patellar shape, sulcus angle, congruence angle, lateral patellofemoral angle (LPA), lateral patellar displacement (LPD), lateral displacement measurement (LDM), boss height, and patellar height ratios (Caton-Deschamps, Blackburne-Peel, Insall-Salvati). All assessors were provided with a summary document outlining the method of assessing each measurement. Bland-Altman analyses were adopted to assess intra- and inter-rater reliability.Background
Methods
Radiological assessment of total and unicompartmental
knee replacement remains an essential part of routine care and follow-up.
Appreciation of the various measurements that can be identified
radiologically is important. It is likely that routine plain radiographs
will continue to be used, although there has been a trend towards
using newer technologies such as CT, especially in a failing knee,
where it provides more detailed information, albeit with a higher
radiation exposure. The purpose of this paper is to outline the radiological parameters
used to evaluate knee replacements, describe how these are measured
or classified, and review the current literature to determine their
efficacy where possible.
Failure of a primary anterior cruciate ligament (ACL) reconstruction is associated with poor functional outcomes even after revision surgery. The aim of this study is to identify early predictors for failure, so that it may aid in recognition of at-risk patients. An observational study was conducted of 623 patients undergoing primary ACL reconstruction by a single surgeon over a 72 month period. Patient and procedure related parameters including age, gender, BMI, time to surgery, graft size, fixation methods, meniscal and chondral injuries, meniscal surgery, radiological parameters and post-operative IKDC scores. Logistic regression modeling was employed to identify those factors which were statistically significant for failure.AIM
METHOD
To evaluate the results and complications of bone transport in the treatment of massive tibial bone defects, using the Ilizarov method. 15 patients underwent bone transport using the Ilizarov technique to treat massive tibial bone defects. The average age of the patients was 8.7 years (3–24 years) and the mean bone defect was 10.8 cms. Following a latent period of 1 week, distraction of the transport doughnut was commenced at 1mm/24 hours in 4 quarterly turns. A docking procedure was performed in 7 cases which involved freshening of the bone ends and autogenous bone grafting from the iliac crest. Following docking the fixator was removed once the regenerate had consolidated.Aim
Methods
Unicondylar knee replacements (UKR) may be more effective compared to Total knee replacements (TKR) in unicompartmental arthritis. We report patient outcomes & satisfaction data in an age matched cohort of patients with either a UKR or TKR. A single unit and single surgeon series of patients were recruited. Data was retrospectively collated for 68 patients with more than 24 months follow-up. UKR was undertaken in patients with isolated medial compartment osteoarthritis; stable ACL and less than grade 3 lateral patellar changes of the Outerbridge classification. TKR was undertaken for the rest. The patients were assessed with validated knee scores including the Total Knee Function Questionnaire (TKFQ) which focuses on recreational & sporting outcomes as well as activities of daily living (ADL). Patient satisfaction and perception of knee normality was measured on a visual analogue scale.Introduction
Method
