High-demand Patients Research Articles

Results of Anterior Cruciate Ligament Reconstruction with and without Lateral Extra-Articular Tenodesis between High Demand Patients: Randomized Controlled Trial

Abstract Background Rupture of the anterior cruciate ligament (ACL) is a serious and common injury among recreational sport players and high demand patients as manual workers. One of the causes of recurrent graft failure and need to revision surgery is persistent anterolateral instability following traditional ACLR surgery. Patients and Method This is a prospective, randomized clinical trial comparing the failure rate of an arthroscopic anatomical single-bundle ACLR with or without LET performed using Lemaire technique in a comparable patient population of high demand patient with isolated ACL tear. Patients 40 years or younger with an ACL-deficient knee were included and also had to meet the following 3 criteria: (1) high demand patients (athlete, manual worker,…), (2) isolated ACL tear, (3) and grade 2 pivot shift or greater. The primary outcome was ACLR clinical failure, a composite measure of rotatory laxity or a graft rupture. Patients were reviewed at 3, 6 and 12months postoperatively. Results From December 2020 till December 2022, 41 patients were included in our study. The patients randomized in two groups. Group A included 20 patients who underwent arthroscopic anatomical single bundle ACLR combined with LET by modified Lemaire technique. Group B included 21 patients underwent anatomical single bundle ACLR only. There were 2 patients lost during follow up excluded from statistical analysis in group B. So, in total 20 patients in group A and 19 patients in group B were available for follow for 12 months. In comparison between both groups regarding rotatory laxity assessed by Pivot shift test, all patients in group A (20/20) showed negative pivot shift tests, while (18/19) patients in group B (94.74%) showed negative pivot shift. Only one patient (1/19, 5.26%) (failed case) examination showed grade 2 pivot shift test. Regarding antero-posterior laxity measured by KT1000, there are statistically insignificant differences in favor to group A than group B during follow up at 3,6,9,12 months. However, Patients included in group A showed statistically significant improvement of side-to-side KT1000 difference at 12 months follow than patients included in group B (P = 0.002). Regarding failure rate, no failed cases included in group A. while, there was only one case (1/19) failed in group B (5.26% failure rate) with no statistically significant difference between the 2 groups. Conclusion The addition of the modified Lemaire LAET technique to anatomical single bundle ACLR showed statistically significant improvement in side-to-side anteroposterior laxity measure by KT1000 Lachmeter. While there is no statistically significant reduction in the failure rate between combined and isolated ACLR.

Inlay Dynamic Anterior Stabilization With the Long Head of the Biceps Tendon and Remplissage Procedure for Patients With Subcritical Glenoid Bone Loss and On-Track Hill-Sachs Lesion

Augmented Bankart with dynamic anterior stabilization (DAS) using the long head of the biceps tendon (LHBT) aims to address anteroinferior glenohumeral instability but does not specifically target Hill-Sachs lesions. The remplissage technique, “filling” the Hill-Sachs lesion, is popular for off-track lesions. The proposed combined approach seeks to stabilize the humeral head without sacrificing the coracoid, making it suitable for high-risk patients prone to recurrent shoulder instability, such as patients with subcritical glenoid bone loss. The operative technique includes patient preparation, creation of arthroscopic portals, confirmation of glenoid bone loss and other injuries, LHBT preparation and tenodesis to the anterior glenoid, and completion of the remplissage procedure. Postoperative protocols involve wearing a sling, self-mobilization, and gradual return to sports. The method aims to improve stability and outcomes in patients with complex shoulder instability issues. The DAS and remplissage is a rational choice for high-demand patients with subcritical glenoid bone loss and on-track Hill-Sachs lesions because it may provide better stability than isolated Bankart repair or Bankart plus remplissage procedures.

Clinical Outcomes After Mini-Open Subpectoral Biceps Tenodesis

Background Long head of the biceps tendon pathology is a common cause of shoulder pain. Current surgical treatment options for long head of the biceps tendon disorders include tenotomy and tenodesis. Younger and high-demand patients are usually treated with tenodesis since tenotomy is associated with increased biceps pain and cramping, cosmetic deformity and patient dissatisfaction. Previous studies have shown biomechanical advantages of subpectoral open approach over arthroscopic suprapectoral approach, with less biceps over tension and increased ultimate load to failure. Despite this, there is a lack of consensus in the literature regarding the management of biceps-related pathology. Methods We retrospectively reviewed all patients who underwent subpectoral biceps tenodesis with unicortical endo-button fixation between January 2015 and December 2019. Only patients who had a minimum of 24 months follow-up were included in the study. We reviewed patient demographics. The American Shoulder and Elbow Surgeons and Visual Analogue score were assessed and complications were recorded. Results A total of thirty-two patients were enrolled in this study. 15 were young patients and sports athletes with SLAP (Superior Labrum from Anterior to Posterior) lesions or isolated biceps instability and the remaining 17 were middle-age patients with degenerative biceps disease and concomitant pathology. The mean follow-up time was 36 months. SLAP lesions group average age was 24,3 and degenerative group average age was 53,8. The ASES score and the VAS score and were statically significative better in the isolated subpectoral tenodesis due to SLAP lesions 99,8 and 0,1 respectively in comparison with the degenerative group, 85,7 and 1,5 respectively. We recorded two complications. One case of superficial infection and one case of a patient that was concomitant submitted to arthroscopic rotator cuff tear repair with persisting shoulder pain. There was no case of failure of fixation or associated Popeye deformity. Conclusions Subpectoral biceps tenodesis with unicortical endo-button fixation is a viable treatment option for patients with symptomatic biceps disease. Anterior shoulder pain and biceps symptoms were resolved with this technique. Patients with coexistent rotator cuff lesion may have less favorable outcomes.

Poster 297: Clinical Outcomes and Return to Sports After Revision ACL Reconstruction With Lateral Extraarticular Tenodesis: Comparison to A Control Group of ACL Reconstruction Only at a Minimum 2-Year Follow-Up

Objectives: Lateral extraarticular tenodesis (LET) has been shown to decrease failure rate in settings of revision anterior cruciate ligament (ACL) reconstruction in young, high-demand patients. However, there is a paucity of literature comparing clinical outcomes and return to sports after patients who undergo revision ACL reconstruction LET compared to those without LET (control group). Methods: All patients who underwent revision ACL reconstruction with and without LET between January 2018 and February 2020 were queried at our institutional registry. The LET group was compared to the control group (revision ACL reconstruction without LET) were followed for a minimum of 24 months postsurgery to evaluate patients reported outcome measures, satisfaction, return to sports, rate of reoperation, and psychological readiness for return to sports (using the ACL-Return to Sport After Injury Scale, ACL-RSI). Results: A total of 81 patients with a mean follow-up of 2.75 years were included. The LET group contained 37 patients (76% female) with a mean age of 26.6 years and body mass index (BMI) of 23.5 kg/m^2 compared to 44 patients (80% female) with mean age of 28.2 years and BMI of 26.9 kg/m^2. There were no significant differences between the LET and control groups with respect to mean postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (47.7 vs 48.3, p = 0.46) and PROMIS Mobility scales (53.3 vs 52.9, p = 0.97). In addition, there were no differences in postoperative International Knee Documentation Committee (78.9 vs 78.3, p=0.45), Marx (7.9 vs 7.2, p = 0.64), or Single Assessment Numeric Evaluation (73.1 vs 74.2, p = 0.38) scores. The same held true with regards to postoperative ACL-RSI scores between the groups (43.3 vs 50.1, p = 0.38). Return to play rates after revision ACL were similar in the LET group compared to the control group (55% vs 45%, p = 0.40) with similar confidence to play their pre-injury sport (scale out of 100, 58.2 vs 56.2, p = 0.82). Lastly, overall reoperation rates were similar between the groups with the LET group having a rate of 21.2% compared to 19.4% for the control group. When isolated for revision due to graft tear, the LET group had a re-revision rate of 13.5% compared to 6.8% in the control group (p = 0.31). Conclusions: Satisfaction and patient reported outcome scores after revision ACL reconstruction are good with or without LET. While both groups have similar rates of return to play and reoperation at greater than 2- year follow-up, these results suggest the addition of LET may provide similar outcomes in high-risk patients when compared to isolated revision ACL reconstruction.

Open Reduction and Internal Fixation with Plate and Screw versus Triplanar External Fixation in the Surgical Treatment of Calcaneal Fractures: A Retrospective Cohort Study.

Background: The treatment of displaced intra-articular calcaneal fractures (DIACF) is debated. This study compares open reduction and internal fixation (ORIF) with minimally invasive osteosynthesis (MIOS). Methods: We conducted a retrospective study on 70 patients with DIACF treated between January 2018 and September 2022, divided into ORIF (n = 50) and MIOS (n = 20) groups. Functional outcomes were assessed using the Maryland Foot Score (MFS) and the Creighton-Nebraska Health Foundation Assessment Scale (CNHFAS). Radiographic outcomes, complication rates, and reintervention rates were evaluated. A chi-square analysis examined the correlation between Sanders classification and treatment choice. Results: The chi-square analysis indicated no significant correlation between the complexity of the fracture and the type of treatment chosen (χ2 = 0.175, p = 0.916). Additionally, the Cochran-Armitage test for trend showed no significant trend in the choice of treatment based on fracture complexity (statistic = 0.048, p = 0.826). A Kaplan-Meier analysis showed a longer time to reintervention for MIOS (p = 0.029). Complication rates were similar, with specific complications varying between groups. Quality-of-life outcomes were comparable. Conclusions: ORIF is preferable for high-demand patients due to better anatomical outcomes, while MIOS suits high-risk patients by reducing reinterventions and complications. Further randomized trials are needed to confirm these findings.

A prospective randomized control trial comparing outcomes of casting, pinning, and plating for distal end of radius fractures (AO type A2, A3, C1, or C2) in the elderly population.

With this prospective randomized control trial (RCT), we aim to provide the outcome analyses of the three most used treatment modalities for distal end of radius (DER) fracture management in the elderly. A prospective randomized control trial was performed. Fifty-two patients with DER fractures (AO A2, A3, C1, or C2) were randomized to the casting (n = 17), percutaneous pinning (n = 18), and the volar plating group (n = 17). Radiological measurements measured were radial inclination (RI), radial height (RH), volar tilt (VT), and ulnar variance (UV). The outcome was measured based on range-of-motion, grip strength, Patient-Related-Wrist-Evaluation (PRWE) score, and the Quick-Disabilities-of-the-Arm-Shoulder-Hand (QDASH) score. Immediate post-operative and 1-year-follow-up X-rays showed a significant difference measurement between the groups (p < 0.05). Pairwise comparisons of the casting and pinning groups (p < 0.05) and the casting and plating groups (p < 0.05) revealed significant differences at the 1-year follow-up, but not the pinning and plating groups (p > 0.05). The analysis found significant differences in clinical outcomes after 1 month of follow-up, with the plating group outperforming the other two (p > 0.05). However, after a year of follow-up, all groups had comparable outcomes; however, the plating group showed improved palmar flexion (p < 0.001), radial deviation (p < 0.001), and a lower PRWE score (p < 0.05), indicating better wrist function. Complications were more in casting group. The study found a radiologically significant difference between groups throughout the follow-up, but it did not affect functional results. Clinical outcomes were similar across the groups, with plating showing better palmar flexion and radial deviation. Grip strength was also better in the plating group, but statistically insignificant. The study suggests plating should be chosen over other treatments for high-demand patients.

Routine 6-Week Outpatient Radiography and Visit in Patients with Conservatively Treated Multiple Rib Fractures: Valuable or a Waste of Resources?

This study investigated the incidence and clinical consequences of abnormal radiological and clinical findings during routinely performed 6-week outpatient visits in patients treated conservatively for multiple (3 or more) rib fractures. A retrospective analysis was conducted among patients with multiple rib fractures treated conservatively between 2018 and 2021 (Opvent database). The primary outcome was the incidence of abnormalities on chest X-ray (CXR) and their clinical consequences, which were categorized as requiring intervention or additional clinical/radiological examination. The secondary focus was the incidence of deviation from standard treatment in response to the findings (clinical or radiological) at the routine 6-week outpatient visit. In total, 364 patients were included, of whom 246 had a 6-week visit with CXR. The median age was 57 years (interquartile range, 46-70 years) and the median Injury Severity Score was 17 (interquartile range, 13-22). Forty-six abnormalities (18.7%) were found on CXR. These abnormalities resulted in additional outpatient visits in 4 patients (1.5%) and in chest drain insertion in 2 (0.8%). Only 2 patients (0.8%) with an abnormality on CXR presented without symptoms. None of the 118 patients who had visits without CXR experienced problems. Routine 6-week outpatient visits for patients with conservatively treated multiple rib fractures infrequently revealed abnormalities requiring treatment modifications. It may be questioned whether the 6-week outpatient visit is even necessary. Instead, a more targeted approach could be adopted, providing follow-up to high-risk or high-demand patients only, or offering guidance on recognizing warning signs and providing aftercare through a smartphone application.

An assessment of the clinical relevance of coracoid graft osteolysis following the Latarjet procedure: a clinical and radiological review

The Latarjet procedure was developed for the treatment of anterior shoulder instability in young, high-demand patients with attritional glenoid bone loss, whose risk of redislocation following primary dislocation may exceed 90%. Coracoid graft osteolysis and prominent screws are commonly observed in late computed tomography (CT) scans of patients who re-present following the procedure, but the clinical relevance of osteolysis in the overall Latarjet cohort is undetermined. We aimed to evaluate clinical and radiological outcomes in patients who underwent the Latarjet procedure, and to determine if severe coracoid graft osteolysis compromised clinical outcomes. This was a retrospective analysis of patients who underwent the open Latarjet procedure. Patients were invited via an e-questionnaire that contained a Western Ontario Shoulder Instability Index (WOSI), and queried about redislocation and reoperation since index surgery. Preoperative glenoid bone loss was calculated on CT using the best-fit circle method. Osteolysis was graded (0, screw head buried in graft; 1, screw head exposed; 2, threads exposed; 3, complete resorption/severe osteolysis) at the level of the proximal and distal screws respectively, on axial CT scans performed ≥ 12 months postoperatively. Between 2011 and 2022, a single surgeon performed 442 Latarjet procedures. One hundred fifty eight patients responded to the questionnaire at median (interquartile range [IQR]) 44 (27-70) months postoperatively, among whom the median (IQR) WOSI score was 352 (142-666) points (0=best, 2100=worst). Recurrent anterior instability occurred in 3/158 (2%) patients. One patient required reoperation for this indication. Among patients who had CT scans ≥ 12 months postoperatively (median [IQR] 40 [29-69] months), 1 patient developed severe osteolysis around both screws (WOSI=90), 17/62 (27%) patients developed severe osteolysis around 1 screw, all of which were proximal (median [IQR] WOSI=235 [135-644]), and 44/62 (71%) patients did not develop severe osteolysis around either screw (median [IQR] WOSI=487 [177-815]). There were no statistically significant differences in WOSI scores between groups based on the presence of severe osteolysis. The Latarjet is reliable procedure that has a low rate of redislocation and reoperation. Severe coracoid graft osteolysis occurs with time, and always affects the proximal graft first. The presence of severe osteolysis did not compromise clinical outcomes.

Interposition arthroplasty and bidirectional stabilization of the elbow: a novel surgical technique

Management of elbow arthritis in younger and higher demand patients is challenging. Interposition arthroplasty of the distal humerus is a well-described procedure whose results are highly dependent on elbow stability. We propose an interposition technique that employs an Achilles allograft as both an interposition material as well as a source of simultaneous bidirectional ligament reconstruction. By resurfacing one articulating surface and re-stabilizing the elbow, longevity may be improved. This technique may be indicated for treatment of post-traumatic or primary osteoarthritis of the elbow. The step-by-step instructions for surgical implantation of this interposition arthroplasty are described and illustrated.

Joint-preserving treatment for global irreparable rotator cuff tears: combined anterior Latissimus dorsi and Teres major tendon transfer.

Treating global irreparable rotator cuff tears (GIRCTs) that involve both antero-and postero-superior cuff tendon tears could be a challenging problem. There has been limited joint-preserving treatment options in high-demand patients with minimal glenohumeral arthritis. The study aims to assess the clinical outcome of combined anterior latissimus dorsi and teres major tendon (aLDTM) transfer for patients with both GIRCTs and minimal glenohumeral arthritis. This retrospective study included patients who underwent combined aLDTM transfer for GIRCTs between 2018 May and 2020 October. Clinical outcomes include pain VAS, Constant, American Shoulder and Elbow Society (ASES), University of California Los Angeles (UCLA), activities of daily living requiring active internal rotation (ADLIR) score, active range of motion (aROM), strength, rates of pseudoparalysis or pseudoparesis reversal and return to work. Radiographic assessment included the acromiohumeral distance (AHD), Hamada grade, and transferred tendon integrity at final follow-up. 23 patients (mean age: 64.7 ± 5.9years [55-74]) were included and the mean follow-up period was 28.2 ± 4.3 [24‒36] months. Postoperatively, VAS, Constant, ASES, UCLA, and ADLIR scores significantly improved at final follow-up (P < .001). Postoperative aROM was significantly improved in forward elevation (FE) to 129° ± 29°, abduction (ABD) to 105° ± t3°, and internal rotation (IR) at back to 5.9 ± 2.5. Strength of both FE and IR were also significantly improved (P < .001). Patients with preoperative pseudoparalysis (2 of 4 patients) and pseudoparesis (6 of 6 patients) experienced a reversal. No significant change in AHD and hamada grade was confirmed at final follow-up. 3 patients experienced partial tear of the transferred tendon. In this study, we found significant improvement in clinical outcomes with no significant progression of arthritis by final follow-up. The aLDTM transfer could be an alternative choice of joint-preserving treatment option for young and active patients with GIRCTs and minimal glenohumeral arthritis. However, large and long-term studies should be conducted to establish its adequacy. Case series. IV.

Total Shoulder Arthroplasty is associated With Less Pain and Better Functional Outcomes, but Humeral Head Resurfacing may be Preferred in Younger, Higher Demand Patients: A Short-Term Outcomes Study in Patients with Glenohumeral Osteoarthritis.

This study aimed to compare short-term outcomes following Total Shoulder Arthroplasty (TSA) and Humeral Head Resurfacing (HHR) in patients with glenohumeral osteoarthritis (GHOA). A retrospective analysis included patients who had undergone either TSA or HHR for GHOA at a single institution. Baseline demographics, complications, range of motion (active forward flexion, FF and active external rotation, ER), visual analog scores (VAS), and Subjective Shoulder Values (SSV) were collected. A total of 69 TSA and 56 HHR patients were analyzed. More HHR patients were laborers (44% versus 21%, P=0.01). There were more smokers in the TSA group (25% versus 11%, P=0.04) and more cardiovascular disease in the HHR cohort (64% versus. 6%, p<0.0001). Postoperative FF was similar, but ER was greater in the HHR (47° ± 15°) vs. TSA group (40° ± 12°, P = 0.01). VAS was lower after TSA vs. HHR (median 0, IQR 1 versus median 3.7, IQR 6.9, p<0.0001), and SSV was higher after TSA (89% ± 13% vs. 75% ± 20% after HHR; p<0.0001). Post-operative impingement was more common after HHR (32% vs. 3% for TSA, p<0.0001). All other complications were equivalent. While younger patients and heavy laborers had improved ER following HHR, their pain relief was greater after TSA. Decisions on surgical technique should be based on patient-specific demographic and anatomic factors.

Dual fixation for coracoid fracture with acute acromioclavicular joint disruption: a case series

Abstract Introduction The management of acute disruption of the acromioclavicular joint (ACJ) in conjunction with a concomitant coracoid fracture has been discussed. This combined orthopedic injury is uncommon because radiographs alone may not always be enough to identify the coracoid component clearly. There are different options for management, ranging from nonsurgical, single, or double fixation strategy. The purpose of this study was to evaluate the results of a clavicular hook plate combined with a coracoid screw fixation in patients who engage in high-demand activities and athletes over a minimum of a year of follow-up. Patients and methods Following the dual fixation strategy, seven patients were followed clinically and radiologically with a mean follow-up 16 weeks, through which a rehabilitation program was adhered to. The range of motion around the shoulder, American Shoulder &amp; Elbow Surgeons, and constant scores were utilized to evaluate patients clinically during their last follow-up visit. Furthermore, radiological assessment of the reduction of the ACJ according to coracoclavicular distance (CCD) and CCD ratio. Results The findings in this study showed a statistically significant improvement between the 3, 6, and 12-month American Shoulder &amp; Elbow Surgeons scores, which were 39.1 ± 14, 67.4 ± 1, and 86.7 ± 5, respectively (P&lt;0.001). The mean range of motions for active shoulder abduction and forward elevation was 171.4 ± 6.3° and 156.4 ± 12.8°, respectively. 9 ± 0.9 mm was the mean CCD, and 1.07% was the mean CCD ratio. Conclusion A stable fixation construct with significant functionality can be successfully achieved through the dual fixation strategy using a coracoid screw and hook plate with no coracoclavicular ligament reconstruction in the treatment of concomitant coracoid fracture and acute ACJ injuries in athletes and high-demand patients.

Total Hip Arthroplasty in Patients Under 50 Years of Age: A Demographic and Treatment Outcome Study at Five Years Follow-Up

Introduction: The indications for a total hip arthroplasty have expanded to younger, higher-demand patients with the advances and availability of durable biomaterials and improved accuracy and surgical techniques of prosthesis implantation. We present our data on the mid-term (five years) follow-up of a cohort of younger patients who underwent THA at our institution. Methodology: A retrospective study with prospective measurement of functional and patient satisfaction outcomes was conducted for patients under 50 years of age who had undergone a primary THA for any cause from 2010 to 2020. Study variables included demographic profile, etiology, prosthesis details, pre-and post-Harris Hip Scores (HHS), and the short-form SF-12 questionnaire. Results: Of 206 THAs performed during the study period, 62 (30.09%) THAs met the inclusion criteria. There were 60 patients with 62 hips, including 38 (63.33%) males and 22 (36.67%) females. The mean age was 39.2±7.92 years. The mean pre-operative HHS was 40.10±5.96. The mean follow-up period was 5.14±2.57 years. At the final evaluation, the mean HHS was 90.42±6.35, and SF-12 scores for physical (PS) and mental (MS) domains were 46.98±5.76 and 54.22±4.35, respectively. The HHS was excellent in 45 (72.58%) hips, good in 13 (20.96%) hips, fair in 2 (3.23%) hips, and poor in 2 (3.23%) hips. Conclusion: Good to excellent functional results were seen in 94% of patients at five years follow-up. Uncemented prostheses and ceramic-on-polyethylene bearing surfaces were preferred. Keywords: Adult, Arthroplasty, Hip, Replacement

Primary Arthrodesis of Non-thumb Metacarpophalangeal Joints of the Hand: Clinical and Patient-Reported Outcomes.

Metacarpophalangeal (MCP) joint arthritis is common secondary to a variety of inflammatory, degenerative, and traumatic causes. Although MCP arthroplasty is more common for the second to fifth digits, primary arthrodesis can be used for high-demand patients with arthritis or unsalvageable fractures of the MCP joint. There has been limited recent studies on the outcomes of these patients. A retrospective review of 38 fingers in 27 patients with primary arthrodesis from 1990 to 2020 was conducted. The major outcomes were complications, reoperations, radiographic union, and time to union. Patient-reported outcomes including the Michigan Hand Outcomes Questionnaire and a questionnaire specific to the operative MCP joint were collected. Rate of radiographic union was 84% including revisions. The average time to union was 3.6 months. Rates of complications, reoperation, and amputation were 26%, 16%, and 7%, respectively. Arthrodesis as part of emergent trauma reconstruction was significantly more likely to result in reoperation (50% vs 7%) and complication (63% vs 17%) than chronic arthritis. Patient-reported outcomes were fair to good with improvement in pain (79%), function (66%), and appearance (40%). Sixty-six percent (66%) of patients were satisfied with their surgery, and 73% would repeat the surgery. Arthrodesis for unsalvageable MCP fractures was associated with higher rates of reoperation and complication than inflammatory or degenerative arthritis. Excluding emergent trauma, MCP fusion was reliable with a reoperation rate of 7% and a modest complication rate of 17%. Patients rated reasonable levels of satisfaction and willingness to repeat the procedure despite complications.

Unilateral Technique for Interposition Arthroplasty of the Elbow—A Technical Note

Stiffness and pain secondary to end-stage dysfunctional osteoarthritis of the elbow can pose a therapeutic dilemma. Although total elbow arthroplasty is successful in older patients with low functional demand, alternatives to joint replacement must be found in the younger, more active individual. Interposition arthroplasty provides a salvage option for young, high-demand patients who hope to minimize functional restrictions of the affected extremity. The procedure traditionally involves release of both collateral ligaments and the joint capsule, resulting in a higher risk for postoperative instability and complications. The present unilateral technique demonstrates an approach maintaining the integrity of the medial or lateral collateral ligament while still allowing secure graft fixation. Stability can usually be preserved without ligament reconstruction or hinged external fixation if the elbow was stable before surgery.

Fifteen-year survival analysis of an oxidised zirconium total knee arthroplasty

BackgroundEarly studies have found Oxidised Zirconium (OxZr-Nb) total knee arthroplasties to have a low incidence of failure in young, high demand patients. Theoretically this is because they are low friction and hard wearing. However, there are a paucity of studies reporting on the outcome of these implants beyond ten years. The purpose of our study was to present an in-depth 15-year survival analysis of a cemented OxZr-Nb knee arthroplasty. MethodsData was collected prospectively and survival analysis undertaken with multiple strict end-points. Complication rates and patient reported outcomes were measured post-operatively. ResultsSix hundred and seventeen knee arthroplasties were analysed. Forty-nine patients required a reoperation for various reasons. Aseptic tibial loosening was the most common cause of failure (32.7%), occurring, on average, 2.8 years after the primary procedure. There was only one oxidised zirconium femoral failure recorded. Cumulative survivorship for reoperation for any reason was 91.52% at 15-years. On average, WOMAC (Western Ontario and McMaster University) score improved by 21.2 points at one-year post-surgery, which is beyond the considered minimum clinically important difference. ConclusionThis study presents a 15-year survival analysis of a cemented oxidised zirconium knee arthroplasty showing good survivorship over a range of analyses.

Lower Revision Rates and Improved Stability With a Monoblock Ceramic Acetabular Cup

BackgroundMonoblock ceramic cups are designed to accommodate large-diameter femoral heads. This has the potential to offer the advantages of an increased range of motion and enhanced joint stability. These features could benefit younger and high-demand patients in need of total hip arthroplasty. The aim of this study was to assess the survival rate and the reasons for revision of the DeltaMotion cup. MethodsData from the AOANJRR were analyzed for all patients who had undergone a primary conventional THA performed between January 1, 2001 and December 31, 2021. Only prostheses with ceramic/ceramic, ceramic/XLPE, metal/XLPE, or CM/XLPE bearing surfaces were included. The primary outcome measure was the cumulative percent revision for all causes. Secondary outcome measures were revision for dislocation/instability, ceramic breakage, or noise. A subanalysis for cup size was also performed. ResultsThere were 486,946 primary conventional THA procedures undertaken for any reason. Of these, 4,033 used the DeltaMotion cup and 482,913 were modular designs. The DeltaMotion cup had the lowest CPR for all diagnoses compared to the modular bearings at all time points, had a significantly lower revision rate for prosthesis dislocation and no revisions for squeaking compared to other modular bearings. There were 175 ceramic breakages recorded in the modular bearing group and 1 ceramic breakage in the DeltaMotion group. ConclusionsThe DeltaMotion cup had a low rate of all-cause revision, and for dislocation, ceramic breakage, and noise. Although this cup is no longer manufactured, ongoing follow-up of newer monoblock ceramic cups will determine their suitability for younger and more active patients.

Hip resurfacing: case closed? A bibliometric analysis of the past 10 years.

Hip resurfacing (HR) was introduced as a potential alternative to total hip arthroplasty (THA), indicated predominantly for younger, high demand patients. The modern metal-on-metal implant was popularized in the 1990s and early 2000s and promised greater wear resistance. However, its popularity waned due to increased rates of complications related to metal toxicity including pseudo-tumors as well as the recall of many resurfacing implants. The purpose of this study was to conduct a bibliometric analysis and investigate the current trends in hip resurfacing literature. Using the keywords "hip resurfacing," publications between 2012 and 2022 were identified on Web of Science Core Collection of Clarivate Analytics. Results were screened for relevance by three independent reviewers using title, abstract, and full text. The retrieved data were evaluated by the bibliometric method. Included articles were imported into CiteSpace 5.7.R1, 64-bit (Drexel University, Philadelphia, PA, USA), VOSviewer 1.6.15 (Leiden University, Leiden, the Netherlands), and the Online Analysis Platform of Literature Metrology to identify trends in publication. Search terms yielded 1200 results and 724 were included in final analysis. A steady decrease of publications was noted over the past decade with less than 40 articles published in 2020 and 2021. The Journal of Hip Arthroplasty (92), Hip International (74), and Clinical Orthopaedics and Related Research (54) published the most articles. Authors from the United States and the United Kingdom published the most studies. High-frequency keywords in co-occurrence and co-cited cluster analysis were metal-on-metal, metal ions, wear, pseudo-tumor, and revision, demonstrating that long-term concerns have been the focus of most recent studies. In conclusion, our bibliometric analysis allowed novel exploration and identification of the current research trends, contributions, and the distribution of publications exploring HR. The understanding of HR and the poor long-term outcomes of some resurfacing implants has improved significantly over the past decade, with the most recent focus on failure rates and long-term complications from metal debris. However, the breadth of literature has steadily declined in the past decade, and ultimately demonstrates the decline of scientific interest and focus on novel areas in hip resurfacing and a potential reached consensus.

Arthroscopic Broström-Gould Repair Has Comparable Radiological and Clinical Outcomes Compared to Traditional Open Broström-Gould Repair in High-Demand Patients

Category: Arthroscopy; Sports Introduction/Purpose: This study sought to confirm whether traditional open Broström–Gould repair and arthroscopic Broström–Gould repair for chronic ankle instability (CAI) would produce comparable radiological and clinical outcomes in high- demand patients. Methods: This retrospective case–cohort study included high-demand patients, as determined by a pre-injury Tegner Activity Level ≥ 6, who underwent Broström–Gould repair and were followed up for ≥ 2 years. Patients were divided into the arthroscopic Broström–Gould repair group (AS Group) and the open Broström–Gould repair group (Open Group). Perioperative radiological assessments were performed. The Tegner Activity Levels, Foot and Ankle Outcome Scores (FAOSs), Karlsson and Peterson (K– P) scores, and American Orthopaedic Foot and Ankle Society ankle–hindfoot (AOFAS) scores were evaluated clinically. Results: A total of 65 patients (31 from the AS Group and 34 from the Open Group) were included in the study. There were no differences in age, sex, body mass index, preoperative anterior talar translation, talar tilt, signal-to-noise ratio, FAOS, K–P score, or AOFAS score between the two groups (n.s.). The preinjury median Tegner Activity Level was 7 and unchanged at the final follow-up in both groups. Postoperative stress radiographs showed improvement; however, the groups did not differ significantly. The FAOS, K–P scores, and AOFAS scores improved in each group (P &lt; 0.001). However, the clinical scores did not differ between the groups (all n.s.). Conclusion: Traditional open and arthroscopic Broström–Gould repair for CAI in high-demand patients had comparable radiological and clinical outcomes. Clinically, arthroscopic Broström–Gould repair may represent a viable surgical alternative to open Broström–Gould repair in high-demand patients.

A 15-YEAR SURVIVAL ANALYSIS OF OXIDIZED ZIRCONIUM TOTAL KNEE ARTHROPLASTY

AbstractBackgroundOxidized zirconium (OxZr) has been introduced as an alternative bearing for femoral components in Total Knee Arthroplasty (TKA). It has a ceramic-like zirconium oxide outer layer with a low coefficient of friction. Early studies have found OxZr TKA to have a low incidence of early failure in young high demand patients. Currently no study has reported on the outcome of these implants beyond ten years.ObjectivesThe purpose of our study was to present an in-depth 15-year survival analysis of cemented Profix II OxZr TKA.Study Design &amp; MethodsData was collected prospectively and survival analysis undertaken with multiple strict end points. Complication rates were recorded and patient reported outcomes were measured.Results617 Profix II OxZr TKAs were performed over four years. Forty-nine patients underwent reoperation. Aseptic tibial loosening was the most common cause of failure (32.7%) on average occurring 2.8 years post primary procedure. There was one recorded failure due to loosening of the zirconium femoral component. Revision rate at 15-years was 6.38%. Cumulative survivorship was 91.52% with failure considered to be reoperation for any reason. WOMAC score improved in 86% of patients by year 1. The average score improved by 21.2 points and met the standard for minimum clinically important difference.ConclusionsThis study presents the first 15-year survival analysis of cemented Profix II OxZr TKA. Our data supports current literature on the long-term survivorship of oxidised zirconium total knee replacements.