International orthopaedics
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Scientific evidence for the treatment of osteochondral lesions (OCLs) of the talus is limited. The aim of this study was an evaluation of the clinical outcome after a one-step autologous subchondral cancellous bone graft and autologous matrix-induced chondrogenesis (AMIC) in medial OCLs of the talus and the assessment of the repair tissue (RT). ⋯ The one-step autologous subchondral cancellous bone grafting and AMIC leads to a significant reduction in postoperative pain and satisfying postoperative functional outcome in mid-term follow-up. Magnetic resonance imaging (MRI) assessment demonstrated a good quality of regenerative tissue similar to the MRI ultrastructure of the surrounding cartilage.
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Resurfacing as a percentage of total hip arthroplasty rose from 5.6 % in 2001 to 8.9 % in 2005 in Australia. During the same period the resurfacing to conventional prosthesis rose from 19.6 % to 29 % in the younger age group (less than 55 years). Long term (more than ten years) functional results of BHR are sparingly documented. Among the literatures available, the patient selection criteria vary from osteoarthritis, avascular necrosis, and dysplastic hip to slipped capital femoral epiphysis. The objective of the current study is to evaluate long term survivorship and functional outcome of Birmingham hip resurfacing surgery in osteoarthritic hip patients performed by a single surgeon. ⋯ If patient selection is judiciously done and surgical technique is meticulously followed, hip resurfacing offers acceptable survivorship, satisfactory range of motion and enables patients to resume high demand activities including sports. Future improvements in the bearing surfaces, and possibly in the design, might alleviate concerns posed by high serum metal level and provide options that continue to benefit younger patients in future.
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The purpose of this study is to assess safety and feasibility of intradiscal bone marrow concentrate (BMC) injections to treat discogenic pain as an alternative to surgery. ⋯ This study provides evidence of safety and feasibility in the non-surgical treatment of discogenic pain with autologous BMC, with durable pain relief (71 % VAS reduction) and ODI improvements (> 64 %) through two years.
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Comparative Study
Fluoroscopy assessment during anterior minimally invasive hip replacement is more accurate than with the posterior approach.
Acetabular component position is important for stability and wear. Fluoroscopy can improve the accuracy of acetabular component placement in the posterior approach and the direct anterior approach (DAA). The purpose of this study was to determine if the direct anterior approach in the supine position facilitates the accurate use of fluoroscopy and improves acetabular component position. ⋯ Using fluoroscopy in the direct anterior approach, we achieved better intra-operative assessment of cup orientation resulting in decreased variability of acetabular cup anteversion than when used in the posterior approach. At least some of the improvement was due to the fact that the fluoroscopic image in the supine position was more accurate as measured against the postoperative standing AP pelvis. This study may influence the choice of approach in total hip replacement.
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Comparative Study
Arthroplasty for unstable pertrochanteric hip fractures may offer a lower re-operation rate as compared to cephalomedullary nailing.
Cephalomedullary (CM) nailing is widely used for the treatment of pertrochanteric hip fractures. Fixation failures with CM nailing tend to occur in unstable fracture patterns often necessitating revision surgery. The purpose of this study was to compare the complications and clinical outcomes of primary arthroplasty to CM nailing for the treatment of unstable pertrochanteric hip fractures. ⋯ Arthroplasty is a viable option for treatment of unstable pertrochanteric fractures in an elderly population. Arthroplasty may offer a lower re-operation rate in the treatment of unstable pertrochanteric hip fractures as compared to CM nailing.