Journal of Orthopaedic Surgery and Research (J Orthop Surg Res)

Publications in this journal

• Article: Maquet III procedure: what remains after initial complications - long-term results.

  Fernando Fonseca, João Pedro Oliveira, Pinho Marques
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  ABSTRACT: BACKGROUND: Maquet III procedure, unloved due to its complications (2% to 59%), has been progressively abandoned. At long-term follow-up, what happens to patients with complications that exceeded the initial ones (Acta Orthop Scand 60:20, 1989)? We retrospectively studied patients who were submitted to Maquet III procedure, by functional and radiologic long-term outcomes, in order to determine if this surgery has or has not fulfilled its initially proposed objectives. From 1970 to 1991, 116 patients benefit from the Maquet III procedure. From this, we were able to review in 2011, 23 patients (25 knees) who went through a single Maquet III procedure. Of these patients, 52% were males. Age at surgery was 39.7 +/- 11.4, with a postoperative follow-up of 27.2 +/- 3.1 years. METHODS: A questionnaire has been prepared for collecting data, and it has been supplemented by clinical records. We evaluated the preoperative complaints, postoperative complications, and range of motion during the recovery time, as well as the postoperative pain-absence period. All patients underwent an objective assessment using the visual analog scale (VAS) at rest and activity, and the Kujala patellofemoral scoring system. A radiological assessment was also made in order to evaluate the arthrosis degree. The bicondylo-patellar angle described by Delgado-Martins (Arch Orthop Traumat Surg 96:303--304, 1980) was used to measure patellar tilt, and the Caton-Deschamps index to calculate the patellar height. RESULTS: Only one knee had benefited from a total knee arthroplasty (20 years after the Maquet III procedure). Preoperative complains were mainly anterior knee pain, crepitus, and patellar instability. Nowadays, 10 patients (40%) still are pain free. Others had an average period without pain of 19.1 +/- 6.1 years. VAS at rest was 1.7 +/- 0.7 and in activity 4.4 +/- 3.0. KPS was 61.9 +/- 22.3 points. X-ray shows that 40% had a Kellgren-Lawrence grade of 1 at the patellofemoral joint. CONCLUSION: Maquet proposed this technique for knee-pain relief, maintenance of the knee range of motion, and for slowly progressive osteoarthritic development. Viewed in a dispassionately way, we could notice that the initial objectives of this procedure were completely achieved. A part of 80% of the initial population was lost during follow-up, which may compromise the conclusions, perhaps, it is time to reflect again on this solution, so unloved by so many.
  Journal of Orthopaedic Surgery and Research 05/2013; 8(1):11.
• Article: Comparison of short term results of single injection of autologous blood and steroid injection in tennis elbow: a prospective study.

  Nipun Jindal, Yusuf Gaury, Ramesh C Banshiwal, Ravinder Lamoria, Vikas Bachhal
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  ABSTRACT: BACKGROUND: It has been recently reported that local injection of autologous blood in tennis elbow offers a significant benefit by virtue of various growth factors contained therein. The objective of our study was assessment of efficacy of autologous blood injection versus local corticosteroid injection in the treatment of tennis elbow.Methods and trial design: A single blinded, prospective parallel group trial was undertaken. 50 consecutive patients of untreated lateral epicondylitis were enrolled. Randomisation was done on alternate basis and two groups were constituted, first one receiving steroid injection and second one injection of autologous blood. Both groups were evaluated at 2 and 6 weeks for pain relief and stage of disease. RESULTS: Baseline evaluation showed no difference between the two groups (chi square test, P > 0.05). Between group analysis at 2 weeks showed no difference in pain relief and Nirschl stage (unpaired t test, P > 0.05). Evaluation at 6 weeks demonstrated a significant decrease in pain levels and stage of disease in blood group (unpaired t test, p < 0.05). CONCLUSIONS: Autologous blood injection was more effective than steroid injection in the short term follow up in tennis elbow.
  Journal of Orthopaedic Surgery and Research 04/2013; 8(1):10.
• Article: Shoulder injuries in professional rugby: a retrospective analysis.

  Ian G Horsley, Elizabeth M Fowler, Christer G Rolf
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  ABSTRACT: BACKGROUND: In the literature, little is known about the level and pattern of rugby injuries. Of the shoulder injuries reported, 51% of these are caused during a tackle, and 65% of all match injuries affected the shoulder. OBJECTIVE: The study aims to describe a sport-specific unique intra-articular shoulder pathology of professional rugby players, who presented with persistent pain and dysfunction despite physiotherapeutic treatment and rest. METHOD: This study is a retrospective analysis set at a university sports medicine clinic. Eighty-seven professional rugby players, referred by their professional medical team since they could no longer play, underwent shoulder arthroscopy between June 2001 and October 2007 due to persistent shoulder pain and dysfunction. All were full-time professional male rugby union and rugby league players. They all had failed conservative treatment for their complaint, and the diagnosis was unclear. Arthroscopic findings were used as a measure of main outcome. RESULTS: The primary mechanism of injury was reported as direct tackling (56%; n = 49) followed in succession by falling onto the arm (10%; n = 8). However, in 30% of the cases, no definite injury could be recalled. The main operative finding was that most patients exhibited multiple shoulder pathologies, with 75% of cases presenting with two or more pathologies. A superior labrum anterior to posterior (SLAP) lesion was evident at arthroscopy in 72 of the 87 cases (83%), while rotator cuff tears were evident in 43% of cases (n = 37). One-third of all cases had a Bankart tear (n = 29), despite none of them reporting previous dislocations, while other labral tears, excluding SLAP tears, to the inferior or posterior labrum were present in 34% (n = 30) of the cohort. CONCLUSIONS: Repeated tackling, which is clearly rugby specific, is most likely to be responsible for most of these shoulder injuries, which upon arthroscopic examination, showed signs of mixed pathology. We suggest that an early arthroscopic investigation is valuable in this population in order to confirm treatable diagnosis on the painful shoulder and expedite a safe return to play.
  Journal of Orthopaedic Surgery and Research 04/2013; 8(1):9.
• Article: Assessment of cup orientation in hip resurfacing: a comparison of TraumaCad and computed tomography.

  Daniel J Westacott, John McArthur, Richard J King, Pedro Foguet
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  ABSTRACT: Purpose: The orientation of the acetabular component in metal-on-metal hip resurfacing arthroplasty affects wear rate and hence failure. This study aimed to establish if interpretation of pelvic radiographs with TraumaCad software can provide a reliable alternative to CT in measuring the acetabular inclination and version. METHODS: TraumaCad was used to measure the acetabular orientation on AP pelvis radiographs of 14 painful hip resurfacings. Four orthopaedic surgeons performed each measurement twice. These were compared with measurements taken from CT reformats. The correlation between TraumaCad and CT was calculated, as was the intra- and inter-observer reliability of TraumaCad. RESULTS: There is strong correlation between the two techniques for the measurement of inclination and version (p <0.001). Intra- and inter-observer reliability of TraumaCad measurements are good (p <0.001). Mean absolute error for measurement of inclination was 2.1[degree sign]. TraumaCad underestimated version compared to CT in 93% of cases, by 12.6 degrees on average. CONCLUSIONS: When assessing acetabular orientation in hip resurfacing, the orthopaedic surgeon may use TraumaCad in the knowledge that it correlates well with CT and has good intra- and inter-observer reliability but underestimates version by 12[degree sign] on average.
  Journal of Orthopaedic Surgery and Research 04/2013; 8(1):8.
• Article: An in-vitro biomechanical study of different fixation techniques for the extended trochanteric osteotomy in revision THA.

  Zhonglin Zhu, Hui Ding, Hongyi Shao, Yixin Zhou, Guangzhi Wang
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  ABSTRACT: BACKGROUND: The wire fixation and the cable grip fixation have been developed for the extended trochanteric osteotomy (ETO) in the revision of total hip arthroplasty (THA). Many studies reported the postoperative performance of the patients, but with little quantitative biomechanical comparison of the two fixation systems. METHODS: An in-vitro testing approach was designed to record the loosening between the femoral bed and the greater trochanter after fixations. Ten cadaveric femurs were chosen in this study. Each femur underwent the THA, revision by ETO and fixations. The tension to the greater trochanter was from 0 to 500N in vertical and lateral direction, respectively. The translation and rotation of the greater trochanter with respect to the bony bed were captured by an optical tracking system. RESULTS: In the vertical tension tests, the overall translation of the greater trochanter was observed 0.4 mm in the cable fixations and 7.0 mm in the wire fixations. In the lateral tension tests, the overall motion of the greater trochanter was 2.0 mm and 1.2[degree sign] in the cable fixations, while it was 6.2 mm and 5.3[degree sign] in the wire fixations. The result was significantly different between the two fixation systems. CONCLUSIONS: The stability of the proximal femur after ETO using different fixations in the revision THA was investigated. The cable grip fixation was significantly more stable than the wire fixation.
  Journal of Orthopaedic Surgery and Research 04/2013; 8(1):7.
• Article: Changes in leg pain after bilateral fasciotomy to treat chronic compartment syndrome: a case series study.

  Jan Roar Orlin, Jarle Oen, John Roger Andersen
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  ABSTRACT: BACKGROUND: Intracompartmental pressure (ICP) as the diagnostic gold standard in the management of chronic compartment syndrome (CCS) is debated. We present a diagnostic protocol in which the decision to operate can be based upon clinical findings alone. The aim of this study was to examine whether patients who underwent surgery for CCS based on clinical findings experienced significant long-term pain relief. METHODS: A standardized clinical examination, including skin sensitivity, was performed in patients with bilateral leg pain and/or cramps. Before and after a symptom-provoking step test, ICPs were measured. The primary outcome was self-reported leg pain measured on a visual analogue scale. Secondary outcomes were satisfaction with the treatment result and health-related quality of life (HRQL) measured with the SF-8 questionnaire. Postoperative data were collected after 2 years. RESULTS: Follow-up was completed for 37 of 40 patients. ICP was increased in 80.5% of the compartments examined before surgery, but did not correlate with the degree of leg pain. The remaining compartments were diagnosed as CCS based on clinical findings, despite ICPs below the threshold. Leg cramps occurred in 32 of 37 (86.5%) patients during physical activity and at night. Leg pain improved from a score of 8.0 +/- 1.5 to 2.3 +/- 2.1, P < 0.001. Satisfaction with the treatment result was reported by 81.1% of the patients, accompanied by normalized HRQL. CONCLUSIONS: The diagnostic protocol led to a fasciotomy in all compartments of both legs, which was associated with substantial and sustained relief of leg pain, improved HRQL, and patient satisfaction.
  Journal of Orthopaedic Surgery and Research 04/2013; 8(1):6.
• Article: Effect of haemarthrosis on the rehabilitation of anterior cruciate ligament reconstruction- single bundle versus double bundle.

  Vibhu Bahl, Ankit Goyal, Vineet Jain, Deepak Joshi, Deepak Chaudhary
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  ABSTRACT: BACKGROUND: Haemarthrosis and pain adversely affects the functional outcome of ACL reconstruction, especially in case of DB ACL reconstruction due to more extensive procedure. The purpose of the study was to evaluate the effect of haemarthrosis on the rehabilitation of DB ACL reconstruction versus SB ACL reconstruction. METHODS: 100 patients were divided into two groups, of SB ACL and DB ACL reconstruction consisting of 50 patients each. An intra-articular drain was put in every patient. The pain was evaluated till week 8 using VAS (Visual Analog Scale). The Functional outcomes were evaluated using the Isokinetic Dynamometer at 3 and 6 months in both the groups. Muscle bulk and Range of motion were also noted in each group. RESULTS: The results showed that there was statistically significant difference between the drain amount (n = 60.3 ml in SB ACL group vs. n = 94.2 ml in the DB ACL group) and haemarthrosis (n = 0.7 in SB ACL vs n = 1.5 in DB ACL) at week 1 post-operatively. Also the pain outcome improved on SB ACL after day 3 (VAS, n = 1.8) as compared to the DB ACL group (VAS, n = 3.7). The isokinetic muscle strength was found to be statistically significantly (p value < 0.05) better in the SB ACL group in the quadriceps muscle (both concentric and eccentric) at the end of the 3rd month. In the SB ACL group the Quadriceps Concentric strength deficit was 22.32% as compared to 34.12% in the DB ACL group. Both the groups had comparable flexor muscle strength at end of 3rd month. Both the groups had comparable muscle strength after 6 months of post-operative rehabilitation in both quadriceps and Hamstring muscle group. CONCLUSION: We noted that rehabilitation of DB ACL reconstruction group lags behind that of SB ACL reconstruction during the first 3 months due to post-operative haemarthrosis & its effects, but show comparable results after 6 months. The muscle strength measured isokinetically and the muscle bulk were found to be greater in the SB ACL group initially after 3 months but was found to be similar after 6 months.
  Journal of Orthopaedic Surgery and Research 03/2013; 8(1):5.
• Article: Valgus sliding subtrochanteric osteotomy for neglected fractures of the proximal femur; surgical technique and a retrospective case series.

  Ashok S Gavaskar, Naveen T Chowdary
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  ABSTRACT: BACKGROUND: Conventional technique of valgus osteotomy of the proximal femur involves removal of a partial or full thickness lateral based wedge from the peritrochanteric region. The purpose of this article is to describe a novel technique of valgus subtrochanteric osteotomy for proximal femur nonunion. METHODS: 11 patients with proximal femur nonunions {intracapsular fractures -- 7, extracapsular fractures -- 4} were treated using a new technique of sliding subtrochanteric osteotomy and DHS fixation. Outcomes analysed include radiological outcome in terms of improvement in Pauwel's angle, neck-shaft angle and evidence of radiological union at the nonunion site and osteotomy site. Other outcomes analysed include, measurement of limb length discrepancy and functional outcome assessment with Oxford hip score. RESULTS: Union at the nonunion site and the osteotomy site was achieved in all patients. There were significant improvements in the postoperative Pauwel's angle, neck shaft angle and Oxford hip score. Limb length discrepancy improved to less than 1 cm in all patients. There was no x ray evidence of avascular necrosis of the femoral head at one year follow-up. CONCLUSIONS: The sliding osteotomy technique is simple, does not need extensive pre operative planning or removal of bone from the proximal femur.
  Journal of Orthopaedic Surgery and Research 03/2013; 8(1):4.
• Article: Haemodynamic performance of neuromuscular electrical stimulation (NMES) during recovery from total hip arthroplasty.

  Barry J Broderick, Oisin Breathnach, Finbarr Condon, Eric Masterson, Gearóid Olaighin
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  ABSTRACT: BACKGROUND: Patients post total hip arthroplasty (THA) remain at high risk of developing Deep Vein Thrombosis (DVT) during the recovery period following surgery despite the availability of effective pharmacological and mechanical prophylactic methods. The use of calf muscle neuromuscular electrical stimulation (NMES) during the hospitalised recovery period on this patient group may be effective at preventing DVT. However, the haemodynamic effectiveness and comfort characteristics of NMES in post-THA patients immediately following surgery have yet to be established. METHODS: The popliteal veins of 11 patients, who had undergone unilateral total hip replacement surgery on the day previous to the study, were measured using Doppler ultrasound during a 4 hour neuromuscular electrical stimulation (NMES) session of the calf muscles. The effect of calf muscle NMES on peak venous velocity, mean venous velocity and volume flow were compared to resting values. Comfort was assessed using a 100mm non-hatched visual analogue scale taken before application of NMES, once NMES was initiated and before NMES was withdrawn. RESULTS: In the operated limb NMES produced increases in peak venous velocity of 99% compared to resting. Mean velocity increased by 178% compared to resting and volume flow increased by 159% compared to resting. In the un-operated limb, peak venous velocity increased by 288%, mean velocity increased by 354% and volume flow increased by 614% compared to basal flow (p<0.05 in all cases). There were no significant differences observed between the VAS scores taken before the application of NMES, once NMES was initiated and before NMES was withdrawn (p=.211). CONCLUSIONS: NMES produces a beneficial hemodynamic response in patients in the early post-operative period following orthopaedic surgery. This patient group found extended periods of calf-muscle NMES tolerable.Trial registration: ClinicalTrials.gov NCT01785251http://www.clinicaltrials.gov/ct2/show/NCT01785251?term=NMES+Galway&rank=1.
  Journal of Orthopaedic Surgery and Research 03/2013; 8(1):3.
• Article: Posterolateral inter-transverse lumbar fusion in a mouse model.

  Justin Bobyn, Anton Rasch, David G Little, Aaron Schindeler
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  ABSTRACT: BACKGROUND: Spinal fusion is a common orthopaedic procedure that has been previously modeled using canine, lapine, and rodent subjects. Despite the increasing availability of genetically modified mouse strains, murine models have only been infrequently described.Purpose: To present an efficient and minimally traumatic procedure for achieving spinal fusion in a mouse model and determine the optimal rhBMP-2 dose to achieve sufficient fusion mass. METHOD: MicroCT reconstructions of the unfused mouse spine and human spine were compared to design a surgical approach. In phase 1, posterolateral lumbar spine fusion in the mouse was evaluated using 18 animals allocated to three experimental groups. Group 1 received decortication only (n = 3), Group 2 received 10mug rhBMP-2 in a collagen sponge bilaterally (n = 6), and Group 3 received 10mug rhBMP-2 + decortication (n = 9). The surgical technique was assessed for intra-operative safety, efficacy, access and reproducibility. Spines were harvested for analysis at 3 weeks (Groups 1, 2) and 1, 2, and 3 weeks (Group 3). In phase 2, a dose response study was carried out in an additional 18 animals with C57BL6 mice receiving sponges containing 0, 0.5, 1, 2.5, 5 mug of rhBMP-2 per sponge bilaterally. RESULTS: The operative procedure via midline access was rapid and reproducible, and fusion of the murine articular processes was found to be analogous to the human procedure. Unlike reports from other species, decortication alone (Group 1) yielded no novel bone formation. Addition of rhBMP-2 (Groups 2 and 3) yielded a significant bone mass that bridged the L4-L6 vertebrae. The subsequent dose response experiment revealed that 0.5mug rhBMP-2 per sponge was sufficient to create a fusion mass. CONCLUSION: We describe a new approach for mouse lumbar spine fusion that is safe, efficient, and highly reproducible. The technique we employed is analogous to the human midline procedure and may be highly suitable for genetically modified mouse models.
  Journal of Orthopaedic Surgery and Research 01/2013; 8(1):2.
• Article: Recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) in posterolateral lumbar spine fusion: complications in the elderly.

  Martin F Hoffmann, Clifford B Jones, Debra L Sietsema
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  ABSTRACT: Study design: Retrospective cohort study of 1430 patients undergoing lumbar spinal fusion from 2002 - 2009. Objective: The goal of this study was to compare and evaluate the number of complications requiring reoperation in elderly versus younger patients.Summary of background data: rhBMP-2 has been utilized off label for instrumented lumbar posterolateral fusions for many years. Many series have demonstrated predictable healing rates and reoperations. Varying complication rates in elderly patients have been reported.Materials and methods: All patients undergoing instrumented lumbar posterolateral fusion of <= 3 levels consenting to utilization of rhBMP-2 were retrospectively evaluated. Patient demographics, body mass index, comorbidities, number of levels, associated interbody fusion, and types of bone void filler were analyzed. The age of patients were divided into less than 65 and greater than or equal to 65 years. Complications related to the performed procedure were recorded. RESULTS: After exclusions, 482 consecutive patients were evaluated with 42.1% males and 57.9% females. Average age was 62 years with 250 (51.9%) < 65 and 232 (48.1%) >= 65 years. Patients >= 65 years of age stayed longer (5.0 days) in the hospital than younger patients (4.5 days) (p=0.005).Complications requiring reoperation were: acute seroma formation requiring decompression 15/482, 3.1%, bone overgrowth 4/482, 0.8%, infection requiring debridement 11/482, 2.3%, and revision fusion for symptomatic nonunion 18/482, 3.7% . No significant differences in complications were diagnosed between the two age groups. Statistical differences were noted between the age groups for medical comorbidities and surgical procedures. Patients older than 65 years underwent longer fusions (2.1 versus 1.7 levels, p=0.001). DISCUSSION: Despite being older and having more comorbidities, elderly patients have similar complication and reoperation rates compared to younger healthier patients undergoing instrumented lumbar decompression fusions with rhBMP-2.
  Journal of Orthopaedic Surgery and Research 01/2013; 8(1):1.
• Article: "Internal fixation of proximal humeral fractures using the Polarus intramedullary nail: our institutional experience and review of the literature"

  Peter V Giannoudis, Fragiskos N Xypnitos, Rozalia Dimitriou, Nick Manidakis, Roger Hackney
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  ABSTRACT: BACKGROUND: The purpose of this study is to evaluate the functional outcome, union and complication rates after surgical treatment of unstable or displaced proximal humeral fractures using the Polarus intramedullary nail, by reviewing our institutional experience and the relevant current literature. METHODS: Twenty-seven patients were treated operatively for proximal humeral fracture using the Polarus nail. Fractures were classified according to Neer's classification. A number of parameters including patient demographics, mechanism of injury, operative time, time to union and complications were recorded. Functional outcome was evaluated using the Constant Shoulder Score. A comparison among functional outcomes in patients >60 years in relation to the younger ones was performed. Moreover, a review of the literature was carried out to evaluate the overall union and complication rates. RESULTS: Two patients lost to follow-up were excluded from the analysis. For the twenty-five patients (mean age: 61 years), the mean follow-up was 36 months. There were 7 complications (28%), including one fixation failure, four protruded screws, one superficial infection and one case of impingement. The union rate was 96% (mean time to union: 4.2 months). The mean Constant score was 74.5 (range: 48--89). Patients under the age of 60 had a better functional outcome compared to patients >60 years of age (p<0.05). From the literature review and from a total of 215 patients treated with a Polarus nail, the mean union rate was 95.8%, the overall reported complication rate, including both minor and major complications, ranged widely from 9.3% up to 70%. CONCLUSIONS: The Polarus nail was found to be an effective implant for stabilisation of proximal humeral fractures. Functional outcome is for the vast majority of the cases excellent or good, but in elderly patients a lower Constant score can be expected.
  Journal of Orthopaedic Surgery and Research 12/2012; 7(1):39.
• Article: Hyaluronan production and chondrogenic properties of primary human chondrocyte on gelatin based hematostatic spongostan scaffold.

  Jeerawan Klangjorhor, Puwapong Nimkingratana, Jongkolnee Settakorn, Dumnoensun Pruksakorn, Taninnit Leerapun, Olarn Arpornchayanon, Sattaya Rojanasthien, Prachya Kongtawelert, Peraphan Pothacharoen
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  ABSTRACT: Background Autologous chondrocyte transplantation is a promising technique for treatment of cartilage defects. Three dimensional chondrocyte cultures on a scaffold are widely used to retain the chondrogenic phenotype. Using a biodegradable gelatin scaffold is one option for the cell delivery system, but molecular and histological studies of the method have not yet been done.Methods We evaluated the chondrogenic property of the primary human chondrocyte on a gelatin scaffold as compared to a collagen scaffold over a period of 21 days. We examined the production of glycosaminoglycan by quantitative and histological analysis. Gene expression of cartilage-associated molecules was assessed by quantitative RT-PCR.Results The gelatin scaffold showed the ability to promote chondrocyte expansion, chondrogenic phenotype retention at molecular and mRNA levels.Conclusions This scaffold is thus suitable for use as an in vitro model for chondrocyte 3D culture.
  Journal of Orthopaedic Surgery and Research 12/2012; 7(1):40.
• Article: Clinical outcome for patients with dedifferentiated chondrosarcoma: a report of 9 cases at a single institute.

  Kazuya Yokota, Akio Sakamoto, Yoshihiro Matsumoto, Shuichi Matsuda, Katsumi Harimaya, Yoshinao Oda, Yukihide Iwamoto
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  ABSTRACT: BACKGROUND: Dedifferentiated chondrosarcomas consist of two distinguishable components: low-grade chondrosarcoma components and high-grade dedifferentiated components.Materials and methods: Nine cases (4 males, 5 females) of dedifferentiated chondrosarcoma were treated in our institute. The average age was 58.6 (range, 37--86) years. The tumor location was the long bone in 7 cases (femur, n=5; humerus, n=1; tibia, n=1) and the pelvic bone in 2 cases. The average time from appearance of symptoms to treatment was 9.4 (range, 1--40) months. RESULTS AND DISCUSSION: On plain radiographs, matrix mineralization was seen in all 9 cases (100%). Bone destruction was observed in 5 of 9 cases (56%), while pathological fracture was seen in one femur case (11%). Lung metastasis was observed in all cases (initially in 5 cases; during the treatment course in 4 cases). Surgery was performed in 8 cases, with local recurrence occurring in 2 of those cases (time to recurrence, 2 and 10 months). Chemotherapy was administered in 4 cases, but did not result in significant improvement. All 9 cases died of lung metastases, with a median survival time of 10 (range, 3.4-18.8) months. The presence of initial metastasis at diagnosis was a significant unfavorable prognostic factor. CONCLUSION: The prognosis of dedifferentiated chondrosarcoma is dismal. With the lack of convincing evidence of the benefit of chemotherapy, complete surgical excision is the initial recommended treatment.
  Journal of Orthopaedic Surgery and Research 12/2012; 7(1):38.
• Article: An ovine in vitro model for chondrocyte-based scaffold-assisted cartilage grafts.

  Michaela Endres, Katja Neumann, Bei Zhou, Undine Freymann, David Pretzel, Marcus Stoffel, Raimund W Kinne, Christian Kaps
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  ABSTRACT: BACKGROUND: Scaffold-assisted autologous chondrocyte implantation is an effective clinical procedure for cartilage repair. From the regulatory point of view, the ovine model is one of the suggested large animal models for pre-clinical studies. The aim of our study was to evaluate the in vitro re-differentiation capacity of expanded ovine chondrocytes in biomechanically characterized polyglycolic acid (PGA)/fibrin biomaterials for scaffold-assisted cartilage repair. METHODS: Ovine chondrocytes harvested from adult articular cartilage were expanded in monolayer and re-assembled three-dimensionally in PGA-fibrin scaffolds. De- and re-differentiation of ovine chondrocytes in PGA-fibrin scaffolds was assessed by histological and immuno-histochemical staining as well as by real-time gene expression analysis of typical cartilage marker molecules and the matrix-remodelling enzymes matrix metalloproteinases (MMP) -1, -2 and -13 as well as their inhibitors. PGA scaffolds characteristics including degradation and stiffness were analysed by electron microscopy and biomechanical testing. RESULTS: Histological, immuno-histochemical and gene expression analysis showed that dedifferentiated chondrocytes re-differentiate in PGA-fibrin scaffolds and form a cartilaginous matrix. Re-differentiation was accompanied by the induction of type II collagen and aggrecan, while MMP expression decreased in prolonged tissue culture. Electron microscopy and biomechanical tests revealed that the non-woven PGA scaffold shows a textile structure with high tensile strength of 3.6 N/mm2 and a stiffness of up to 0.44 N/mm2, when combined with gel-like fibrin. CONCLUSION: These data suggest that PGA-fibrin is suited as a mechanically stable support structure for scaffold-assisted chondrocyte grafts, initiating chondrogenic re-differentiation of expanded chondrocytes.
  Journal of Orthopaedic Surgery and Research 11/2012; 7(1):37.
• Article: The effectiveness of acupuncture in treating chronic non-specific low back pain: a systematic review of the literature.

  Amanda J Hutchinson, Simon Ball, Jeremy C Andrews, Gareth G Jones
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  ABSTRACT: BACKGROUND: Low back pain is a common musculoskeletal disorder defined as pain and soreness, muscle tension, or stiffness in the lumbosacral area of the spine which does not have a specific cause. Low back pain results in high health costs and incapacity to work causing an economic burden to society. The optimal management of non-specific low back pain appears to be undecided. Recently published guidelines support the use of acupuncture for treating non-specific low back pain and it has become a popular alternative treatment modality for patients with low back pain. METHODS: A comprehensive systematic literature search was conducted through Medline using Ovid and Medical Subject Headings for randomized controlled trials published in the last 10 years. The outcomes scored were subjective pain scores and functional outcome scores. RESULTS: Eighty two randomized studies were identified, of which 7 met our inclusion criteria. Three studies found a significant difference in pain scores when comparing acupuncture, or sham acupuncture, with conventional therapy or no care. Two studies demonstrated a significant difference between acupuncture treatment and no treatment or routine care at 8 weeks and 3 months. Three studies demonstrated no significant difference between acupuncture and minimal/sham acupuncture with no difference in pain relief or function over 6 to 12 months. CONCLUSIONS: This review provides some evidence to support acupuncture as more effective than no treatment, but no conclusions can be drawn about its effectiveness over other treatment modalities as the evidence is conflicting.
  Journal of Orthopaedic Surgery and Research 10/2012; 7(1):36.
• Article: Surgical treatment of lumbar spinal stenosis with microdecompression and interspinous distraction device insertion. A case series.

  Avraam Ploumis, Pavlos Christodoulou, Dimitrios Kapoutsis, Ioannis Gelalis, Vasilios Vraggalas, Alexander Beris
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  ABSTRACT: BACKGROUND: Interspinous distraction devices (IPDD) are indicated as stand-alone devices for the treatment of spinal stenosis. The purpose of this study is to evaluate the results of patients undergoing surgery for spinal stenosis with a combination of unilateral microdecompression and interspinous distraction device insertion. METHODS: This is a prospective clinical and radiological study of minimum 2 years follow-up. Twenty-two patients (average age 64.5 years) with low-back pain and unilateral sciatica underwent decompressive surgery for lumbar spinal stenosis. Visual Analogue Scale, Oswestry Disability Index and walking capacity plus radiologic measurements of posterior disc height of the involved level and lumbar lordosis Cobb angle were documented both preoperatively and postoperatively. One-sided posterior subarticular and foraminal decompression was conducted followed by dynamic stabilization of the diseased level with an IPDD (X-STOP). RESULTS: The average follow-up time was 27.4 months. Visual Analogue Scale and Oswestry Disability Index improved statistically significantly (p<0.001) in the last follow-up exam. Also, the walking distance increased in all patients but two. Posterior intervertebral disc height of the diseased level widened average 1.8mm in the postoperative radiograph compared to the preoperative. No major complication, including implant failure or spinous process breakage, has been observed. CONCLUSIONS: The described surgical technique using unilateral microdecompression and IPDD insertion is a clinically effective and radiologically viable treatment method for symptoms of spinal stenosis resistant to non-operative treatment.
  Journal of Orthopaedic Surgery and Research 10/2012; 7(1):35.
• Article: Biomechanical effects of steroid injections used to treat pyogenic flexor tenosynovitis.

  Blake R Turvey, Paul Weinhold, Reid W Draeger, Donald K Bynum, Laurence E Dahners
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  ABSTRACT: BACKGROUND: A recent study from our laboratory has demonstrated improved range of motion in the toes of broiler chickens afflicted with pyogenic flexor tenosynovitis when treated with local antibiotic and corticosteroid injections, without surgical drainage. However, the use of corticosteroids as an adjunct treatment raised peer concern, as steroids are thought to have deleterious effects on tendon strength. The purpose of this study was to compare the tensile strength of the aforementioned steroid treated tendons, to a group of tendons administered with the current standard treatment: systemic antibiotics, surgical drainage and no corticosteroids. METHODS: Twenty-three tendons' structural and material properties were investigated (fifteen receiving the standard treatment, eight receiving the steroid treatment). The measurements from each group were interpreted via Student's unpaired t-test and a post-hoc power analysis. RESULTS: The steroid treated tendons did demonstrate a trend toward decreased mechanical properties when compared with the standard treatment group, but the results were not statistically significant. CONCLUSIONS: Treatment of septic tenosynovitis with local corticosteroid and local antibiotic injections resulted in better digital motion, without a significant loss of tendon strength, over a twenty-eight day recovery period.
  Journal of Orthopaedic Surgery and Research 10/2012; 7(1):34.
• Article: Extramedullary versus intramedullary tibial cutting guides in megaprosthetic total knee replacement.

  Vikas Karade, Bhalamudi Ravi, Manish Agarwal
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  ABSTRACT: BACKGROUND: In a standard total knee replacement, tibial component alignment is a key factor for the long term success of the surgery. The purpose of this study is to compare the accuracy of extramedullary and intramedullary tibial cutting guides used in indigenous and imported implants respectively, in positioning of the tibial components in megaprosthetic knee replacements. METHODS: A comparative study of the accuracy of extramedullary and intramedullary tibial cutting guides was carried out in 92 megaprosthetic knee replacements for distal femoral tumors. For the proximal tibia cut for tibial component placement, an extramedullary guide was used in 65 patients and an intramedullary guide was used in 27 patients. Tibial component alignment angles were measured in postoperative X-rays with the help of CAD software. RESULTS: There was more varus placement in coronal plane with extramedullary cutting guide (-1.18 +/- 2.4 degrees) than the intramedullary guide (-0.34 +/- 2.31 degrees) but this did not reach statistical significance. The goal of 90 +/- 2 degrees alignment of tibial component was achieved in 54% of patients in the extramedullary group versus 67% in the intramedullary group. In terms of sagittal plane alignment, extramedullary guide showed less accurate results (2.09 +/- 2.4 degrees) than intramedullary guide (0.50 +/- 3.80 degrees) for tibial component alignment, though 78% of patients were aligned within the goal of 0--5 degrees of tibial slope angle in extramedullary group versus 63% in intramedullary group. The mean error in the measurements due to rotation of the knee during taking the X-rays was less than 0.1 degrees and distribution of the X-rays with the rotation of knee was similar in both the groups. CONCLUSIONS: Overall, in megaprosthetic knee replacement intramedullary guides gave more accurate results in sagittal plane and exhibited similar variability as of extramedullary guides in coronal plane.
  Journal of Orthopaedic Surgery and Research 10/2012; 7(1):33.
• Article: Intra-articular injection of tranexamic acid via a drain plus drain-clamping to reduce blood loss in cementless total knee arthroplasty.

  Hirotaka Mutsuzaki, Kotaro Ikeda
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  ABSTRACT: BACKGROUND: Patients undergoing cementless total knee arthroplasty (TKA) sometimes suffer large blood loss. In a retrospective study, we explored whether postoperative intra-articular retrograde injection of tranexamic acid (TA) and leaving a drain clamp in place for 1 h reduced blood loss.Patients and methodsPatients (n = 140) treated with unilateral primary cementless TKA (posterior cruciate ligament retained) were divided into two groups: those who had an intra-articular injection of TA (1000 mg) and drain clamping for 1 h postoperatively (study group, n = 70) and those who were not given TA and did not undergo clamping of their drains (control group, n = 70). Postoperative total blood loss, volume of drainage, hemoglobin level, transfusion amounts and rates, D-dimer level at postoperative day (POD) 7, and complications were recorded. RESULTS: Total blood loss, total drainage, mean transfusion volume, and transfusion rates were lower in the study group than in controls (P < 0.001). Hemoglobin levels on PODs 1 and 14 were similar in the groups, but on POD 7 the hemoglobin level was higher in the study group than in controls (P < 0.001). D-dimer level on POD 7 was lower in the study group than in controls (P < 0.05). There were no complications in either group. CONCLUSIONS: Immediately postoperative intra-articular retrograde injection of TA and 1 h of drain-clamping effectively reduced blood loss and blood transfusion after cementless TKA. We believe that this method is simple, easy, and suitable for these patients.
  Journal of Orthopaedic Surgery and Research 09/2012; 7(1):32.