ORCID Profile
0000-0001-7283-626X
Current Organisations
Curtin University
,
Fiona Stanley Hospital
,
Orthopaedic Research Foundation of Western Australia
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Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.ARTH.2017.07.046
Abstract: The benefits vs risk of pharmacological prophylaxis for thromboembolic disease in orthopedic patients remain controversial. Pharmacological thromboprophylaxis regimes are commonly used in this patient group. Few studies specifically examine wound complications attributable to this therapy. In this prospective trial, we investigated the effect of various regimens on postoperative wounds. A prospective, observational, multicenter study involving patients undergoing elective hip or knee arthroplasty was undertaken. Patients were ided into 3 groups depending on thromboprophylaxis: no anticoagulation, aspirin, or low molecular weight heparin (LMWH) (enoxaparin). Surgical wounds were evaluated for each regime using the South ton Wound Assessment Score. Over a 12-month period, 327 patients were enrolled with a mean age of 68.1 years (±11.2 years). There were 105 patients in the no anticoagulation group (32.1%), 97 patients in the aspirin group (29.7%), and 125 patients in the LMWH group (38.2%). Wound scores were evaluated for evidence and amount of discharge. The use of LMWH conferred a 4.92 times greater risk and aspirin a 3.64 times greater risk of wound discharge than no pharmacological thromboprophylaxis (P < .0001). There were no significant differences in the incidence of deep vein thrombosis or pulmonary embolus between groups either as an inpatient or postdischarge. There is a significant increase in the risk of wound discharge when aspirin or LMWH is used in arthroplasty patients. As potential complications of wound problems are significant, a more balanced view of risk vs benefit needs to be taken when prescribing thromboprophylaxis for this patient group.
Publisher: SAGE Publications
Date: 2020
Abstract: Deep vein thrombosis (DVT) and pulmonary embolism (PE) cause significant morbidity and mortality following arthroplasty. A seasonal variation in the rate of PE in arthroplasty patients in the northern hemisphere has been reported. We hypothesized that there would be a similar seasonal variation in arthroplasty patients in Australia. We performed a retrospective review of all patients who received primary and/or revision arthroplasty of the hip or knee over a 15-year period (2000–2015) across Western Australia. We identified all patients who were diagnosed with DVT and/or PE according to International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification codes. The incidence of venous thromboembolic (VTE) disease was calculated as the proportion of operations that led to this complication per 3-month seasonal period. A total of 12,507 total hip arthroplasties (THAs) and 8899 total knee arthroplasties (TKAs) were recorded during the study period. There was a total of 274 DVT and/or PE among the combined total of 21,406 hip and knee arthroplasties performed between 2000 and 2015. There was a significantly higher rate of VTE for females than males (odds ratio (OR): 1.33, 95% confidence interval (CI): 1.03–1.71, p = 0.0293), for TKA than THA (OR: 1.60, 95% CI:1.26–2.03, p 0.0001) and in winter than other seasons (OR: 1.51, 95% CI: 1.14–2.01, p = 0.0047). There is a statistically significant increase in the incidence of VTE in arthroplasty patients during the winter months in Western Australia. This finding is the first of its kind for patients in the southern hemisphere and corroborates previous studies in the northern hemisphere.
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 08-2020
DOI: 10.1302/2633-1462.18.BJO-2020-0089.R1
Abstract: A proximal femur fracture (PFF) is a common orthopaedic presentation, with an incidence of over 25,000 cases reported in the Australian and New Zealand Hip Fracture Registry (ANZHFR) in 2018. Hip fractures are known to have high mortality. The purpose of this study was to determine the utility of the Clinical Frailty Scale (CFS) in predicting 30-day and one-year mortality after a PFF in older patients. A retrospective review of all fragility hip fractures who met the inclusion/exclusion criteria of the ANZHFR between 2017 and 2018 was undertaken at a single large volume tertiary hospital. There were 509 patients included in the study with one-year follow-up obtained in 502 cases. The CFS was applied retrospectively to patients according to their documented pre-morbid function and patients were stratified into five groups according to their frailty score. The groups were compared using t-test, analysis of variance (ANOVA), and the chi-squared test. The discriminative ability of the CFS to predict mortality was then compared with American Society of Anaesthesiologists (ASA) classification and the patient’s chronological age. A total of 38 patients were deceased at 30 days and 135 patients at one year. The 30-day mortality rate increased from 1.3% (CFS 1 to 3 1/80) to 14.6% (CFS ≥ 7 22/151), and the one-year mortality increased from 3.8% (CFS 1 to 3 3/80) to 41.7% (CFS ≥ 7 63/151). The CFS was demonstrated superior discriminative ability in predicting mortality after PFF (area under the curve (AUC) 0.699 95% confidence interval (CI) 0.651 to 0.747) when compared with the ASA (AUC 0.634 95% CI 0.576 to 0.691) and chronological age groups (AUC 0.585 95% CI 0.523 to 0.648). The CFS demonstrated utility in predicting mortality after PFF fracture. The CFS can be easily performed by non-geriatricians and may help to reduce age related bias influencing surgical decision making. Cite this article: Bone Joint Open 2020 -8:443–449.
Publisher: Springer Science and Business Media LLC
Date: 20-06-2018
DOI: 10.1007/S00264-018-4014-8
Abstract: The purpose of this study was to evaluate whether the presence of hip osteoarthritis at the time of hip fracture increases treatment failure rates when using either a sliding hip screw (SHS) or proximal femoral nail (PFN) for fracture fixation. A retrospective study of a consecutive series of 455 women and 148 men (median age, 83.8 years) treated with SHS or PFN was performed. Osteoarthritis was evaluated based on pre-operative radiographs using the Kellgren and Lawrence grading system. Treatment failure, which was defined as non-union, avascular necrosis, backing out of the implant, cut out of the proximal screws, peri-prosthetic fracture, implant breakage, or conversion to hemi- or total hip arthroplasty, was evaluated for a follow-up period of four to seven years. Optimal placement of the implant (tip-apex distance (TAD) and 3-point fixation) and the effects of age, sex, the quality of reduction, implant type, fracture stability, fracture type, and time to failure were considered confounders of the relationship between failure and osteoarthritis (OA). Among the 32 cases (5.3%) of treatment failure, 12 (2%) showed evidence of osteoarthritis. After controlling for age, sex, the quality of reduction, implant type, fracture stability, fracture type, and TAD, osteoarthritis was associated a greater than threefold increase in treatment failure compared with that of patients without pre-operative evidence of osteoarthritis (OR, 3.26 95% CI, 1.4-7.65 P = 0.006). After adjusting for potential confounding factors, radiographic evidence of hip osteoarthritis at the time of hip fracture increases the incidence of treatment failure.
Publisher: Elsevier
Date: 2006
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 06-2019
DOI: 10.1302/0301-620X.101B6.BJJ-2018-1455.R1
Abstract: Custom flange acetabular components (CFACs) are a patient-specific option for addressing large acetabular defects at revision total hip arthroplasty (THA), but patient and implant characteristics that affect survivorship remain unknown. This study aimed to identify patient and design factors related to survivorship. A retrospective review of 91 patients who underwent revision THA using 96 CFACs was undertaken, comparing features between radiologically failed and successful cases. Patient characteristics (demographic, clinical, and radiological) and implant features (design characteristics and intraoperative features) were collected. There were 74 women and 22 men their mean age was 62 years (31 to 85). The mean follow-up was 24.9 months (sd 27.6 0 to 116). Two sets of statistical analyses were performed: 1) univariate analyses (Pearson’s chi-squared and independent-s les Student’s t-tests) for each feature and 2) bivariable logistic regressions using features identified from a random forest analysis. Radiological failure and revision rates were 23% and 12.5%, respectively. Revisions were undertaken at a mean of 25.1 months (sd 26.4) postoperatively. Patients with radiological failure were younger at the time of the initial procedure, were less likely to have a diagnosis of primary osteoarthritis (OA), were more likely to have had ischial screws in previous surgery, had fewer ischial screw holes in their CFAC design, and had more proximal ischial fixation. Random forest analysis identified the age of the patient and the number of locking and non-locking screws used for inclusion in subsequent bivariable logistic regression, but only age (odds ratio 0.93 per year) was found to be significant. We identified both patient and design features predictive of CFAC survivorship. We found a higher rate of failure in younger patients, those whose primary diagnosis was not OA, and those with more proximal ischial fixation or fewer ischial fixation options. Cite this article: Bone Joint J 2019 -B(6 Supple B):68–76.
Publisher: Wiley
Date: 30-07-2020
DOI: 10.1111/ANS.16115
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.FOOT.2012.06.001
Abstract: The clinical presentation of acute Charcot arthropathy in the diabetic population usually follows the Eichenholtz classification. We present three usual cases of Charcot arthropathy presenting with rapid primary bone resorption in the absence of subluxation, dislocation and/or fracture. A review of the literature was performed. To our knowledge Charcot arthropathy has not been previously described as primary bone resorption. Three cases encountered at our specialist multidisciplinary High Risk Foot Clinic (HRFC) presented with primary bony resorption without features of subluxation, dislocation and/or fracture. Aggressive primary bone resorption was initially thought due to infection a diagnostic dilemma that delayed optimal treatment. Late bone resorption in typical Charcot is linked to unregulated proinflammatory cytokines (IL-1β, IL-6 and TNFα) that lead to increased osteoclastic activity. The pathophysiology of osteolysis in aggressive primary bony resorption may relate to a disturbance in the balance between RANK-L and OPG. Primary resorption of bone without subluxation, dislocation and/or fracture can represent an active Charcot process. Prudent use of serial radiography and early MRI to look for the widespread bone and soft tissue oedema is recommended.
Publisher: Elsevier BV
Date: 08-2023
Publisher: Springer Science and Business Media LLC
Date: 16-06-2017
DOI: 10.1007/S00256-017-2689-3
Abstract: Ossifying subperiosteal haematoma is an exceedingly rare manifestation of Neurofibromatosis type 1 (NF-1). We report an interesting case of plexiform neurofibroma causing a rapidly growing tibial mass as a result of subperiosteal haemorrhage, in an 11-year-old girl with previously undiagnosed NF-1. This reflects a precursor of the more mature periosteal ossification seen in cases traditionally termed "subperiosteal cysts". A previously well young girl was referred by her general practitioner with an increasingly large, mildly tender, soft lump on the anterior aspect of her right tibia. Plain radiographs demonstrated soft tissue thickening overlying the anterior tibia, without appreciable periosteal ossification. Magnetic resonance imaging (MRI) illustrated a single central fluid-fluid level and periosteal elevation with saucerisation of the anterior tibial cortex and mild surrounding oedema. Histopathology revealed a large plexiform neurofibroma. Interestingly, this was associated with haemorrhagic change and a peripheral rim of florid reactive new bone formation. This unusual presentation was discussed at a multidisciplinary bone and soft tissue tumour meeting, where in combination with the clinical history of café au lait spots and positive family history, a consensus diagnosis of NF-1 was made. To date, there have only been limited case reports of this rare pathological process. In summary, this case report accounts an acute presentation of this rare osseous manifestation of NF-1, being the first to clearly demonstrate a timeline of subperiosteal haematoma with subsequent subperiosteal bone proliferation. The clinical reasoning and radiological features for such a presentation are also described.
Publisher: SAGE Publications
Date: 2023
DOI: 10.1177/10225536231153232
Abstract: Since its introduction in 1988, the double-tapered polished Exeter cemented stem has been widely adopted in primary total hip arthroplasty (THA). Despite the results coming from the arthroplasty registries have proven great survivorship, the aim of this study was to dig deeper and describe the modes of failure of the Exeter stem at 15 years follow-up while reporting the clinical and radiographic outcomes. A search of PubMed, MEDLINE, and Embase was performed using the Preferred Reporting Items for Systematic Review and Meta-Analyses since inception of database to January 2022. A meta-analysis was performed on stem’s failure rates and clinical outcomes using random effects models. Publication bias was assessed with funnel plots. Overall, ten studies met the inclusion criteria with 2167 hips at mean 14.8 ± 4.1 years follow-up. The meta-effect estimate for revision rate for stem-related reasons was 3.8% (CI 95% 2.1–5.6, p 0.01). The meta-effect for revision rate for stem aseptic loosening (AL) was 0.22% (CI 95% 0–0.4, p = 0.048) and for periprosthetic fracture was 0.6% (CI95% 0.3–0.9, p 0.001). The meta effect estimate for Oxford Hip Score (OHS) at final follow-up was 32.4 (moderate CI 95% 23.2–41.6, p .001) with and heterogeneity among the studies of I 2 0%. Radiolucent lines were reported in 5.5% of cases, with 1.0% of cases (21 hips) reported to be progressive. Current evidence suggests that the Exeter cemented stem not only has proven long-term outstanding reliability with a revision rate of 3.8%, but also incredibly low revision rates for AL (0.22%) and periprosthetic fracture (0.6%). It is suitable for a variety of indications, and the consistent radiological appearances indicate durable fixation and load transmission while being associated with a remarkably low stem-related complication rate.
Publisher: Elsevier BV
Date: 09-2018
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 12-2017
DOI: 10.1302/0301-620X.99B12.BJJ-2016-0462.R2
Abstract: We present a retrospective review of patients treated with extracorporeally irradiated allografts for primary and secondary bone tumours with the mid- and long-term survivorship and the functional and radiographic outcomes. A total of 113 of 116 (97.4%) patients who were treated with extracorporeally irradiated allografts between 1996 and 2014 were followed up. Forms of treatment included reconstructions, prostheses and composite reconstructions, both with and without vascularised grafts. Survivorship was determined by the Kaplan-Meier method. Clinical outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system, the Toronto Extremity Salvage Score (TESS) and Quality of Life-C30 (QLQ-30) measures. Radiographic outcomes were assessed using the International Society of Limb Salvage (ISOLS) radiographic scoring system. There were 61 (54%) men with a mean age of 22 years (6 to 70) and 52 (46%) women with a mean age of 26 years (3 to 85). There were 23 deaths. The five-year patient survivorship was 82.3% and the ten-year patient survivorship was 79.6%. The mean follow-up of the 90 surviving patients was 80.3 months (2 to 207). At the last follow-up, 105 allografts (92.9%) were still in place or had been at the time of death eight (7%) had failed due to infection, local recurrence or fracture. Outcome scores were comparable with or superior to those in previous studies. The mean outcome scores were: MSTS 79% (sd 8) TESS 83% (sd 19) QLQ 82% (sd 16) ISOLS 80.5% (sd 19). Pearson correlation analysis showed a strong relationship between the MSTS and ISOLS scores (r = 0.71, p 0.001). This study shows that extracorporeal irradiation is a versatile reconstructive technique for dealing with large defects after the resection of bone tumours with good functional and radiographic outcomes. Functional outcomes as measured by MSTS, TESS and QLQ-30 were strongly correlated to radiographic outcomes. Cite this article: Bone Joint J 2017 -B:1681–8
Publisher: Elsevier BV
Date: 04-2008
DOI: 10.1016/J.ARTHRO.2007.10.003
Abstract: This study aimed to assess the ability of the laser scanning confocal arthroscope (LSCA) to evaluate cartilage microstructure, particularly in differentiating stages of human osteoarthritis (OA) as classified by the International Cartilage Repair Society (ICRS) OA grade definitions. Ten tibial plateaus from total knee arthroplasty patients were obtained at the time of surgery. Cartilage areas were visually graded based on the ICRS classification, imaged by use of a 7-mm-diameter LSCA (488-nm excitation with 0.5% [wt/vol] fluorescein, 20-minute staining period), and then removed with underlying bone for histologic examination with H&E staining. The 2 imaging techniques were then compared for each ICRS grade to ascertain similarity between the methods and thus gauge the techniques' diagnostic resolution. Cartilage surface degeneration was readily imaged and OA severity accurately gauged by the LSCA and confirmed by histology. LSCA and histologic images of specimens in the late stages of OA were seen to be mutually related even though they were imaged in planes that were orthogonal to each other. Useful and comparable diagnostic resolution was obtained in all imaged specimens from subjects with various stages of OA. This study showed the LSCA's ability to image detailed cartilage surface morphologic features that identify grade 1 through 4 of the ICRS OA grading system. The LSCA's imaging potential was best shown by its ability to resolve the fine collagen network present under the lamina splendens. The incorporation of high-magnification confocal technology within the confines of an arthroscopic probe has proved to provide the imaging requirements necessary to perform detailed cartilage condition assessment. In comparison to video arthroscopy, LSCA provides increased magnification along with improved contrast and resolution.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-01-2021
Publisher: Elsevier BV
Date: 12-2007
DOI: 10.1016/J.JOCA.2007.05.003
Abstract: Osteoarthritis (OA) inflicts an enormous burden upon sufferers and healthcare systems worldwide. Continuing efforts to elucidate the aetiology of OA have indicated the need for non-destructive methods of in vivo microstructural assessment of articular cartilage (AC). In this study, we describe the first use of a recently developed laser scanning confocal arthroscope (LSCA) to image the cartilage of a fresh frozen cadaveric knee from a patient with OA. Using an adaptation of the International Cartilage Repair Society (ICRS) joint mapping protocol, the joint was ided into three discrete regions (femoral condyle, patella and tibial plateau) for grading according to the ICRS (Outerbridge) system. The LSCA was used to generate images from each area within the three regions. Following imaging, the joint was sectioned and histology was performed on the corresponding sites with histological grading (modified-Mankin). Quantitative results of ICRS, LSCA and histological OA assessment were compared using intraclass correlation (ICC) and Pearson correlation analysis. The LSCA enabled visualisation of chondrocyte morphology and cell density, with classical OA changes such as chondrocyte clustering, surface fibrillation and fissure formation evident. Obvious qualitative similarities between LSCA images and histology were observed, with fair to moderate agreement (P<0.05) demonstrated between modalities. In this study, we have shown the viability of the LSCA for non-destructive imaging of the microstructure of OA knee cartilage. LSCA technology is potentially a valuable research and clinical tool for the non-destructive assessment of AC microstructure in early to late OA.
Publisher: Elsevier BV
Date: 05-2019
Publisher: Georg Thieme Verlag KG
Date: 12-02-2014
Publisher: Wiley
Date: 03-2008
DOI: 10.1002/JOR.20502
Abstract: The assessment of cartilage repair has largely been limited to macroscopic observation, magnetic resonance imaging (MRI), or destructive biopsy. The aims of this study were to establish an ovine model of articular cartilage injury repair and to examine the efficacy of nondestructive techniques for assessing cartilage regeneration by matrix-induced autologous chondrocyte implantation (MACI). The development of nondestructive assessment techniques facilitates the monitoring of repair treatments in both experimental animal models and human clinical subjects. Defects (Ø 6 mm) were created on the trochlea and medial femoral condyle of 21 sheep randomized into untreated controls or one of two treatment arms: MACI or collagen-only membrane. Each group was ided into 8-, 10-, and 12-week time points. Repair outcomes were examined using laser scanning confocal arthroscopy (LSCA), MRI, histology, macroscopic ICRS grading, and biomechanical compression analysis. Interobserver analysis of the randomized blinded scoring of LSCA images validated our scoring protocol. Pearson correlation analysis demonstrated the correlation between LSCA, MRI, and ICRS grading. Testing of overall treatment effect independent of time point revealed significant differences between MACI and control groups for all sites and assessment modalities (Asym Sig < 0.05), except condyle histology. Biomechanical analysis suggests that while MACI tissue may resemble native tissue histologically in the early stages of remodeling, the biomechanical properties remain inferior at least in the short term. This study demonstrates the potential of a multisite sheep model of articular cartilage defect repair and its assessment via nondestructive methods.
Publisher: Informa UK Limited
Date: 10-2022
DOI: 10.2147/ORR.S294369
Publisher: Elsevier BV
Date: 09-2020
Publisher: Springer Science and Business Media LLC
Date: 11-05-2022
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 2019
DOI: 10.1302/0301-620X.101B1.BJJ-2018-0506.R1
Abstract: Instability continues to be a troublesome complication after total hip arthroplasty (THA). Patient-related risk factors associated with a higher dislocation risk include the preoperative diagnosis, an age of 75 years or older, high body mass index (BMI), a history of alcohol abuse, and neurodegenerative diseases. The goal of this study was to assess the dislocation rate, radiographic outcomes, and complications of patients stratified as high-risk for dislocation who received a dual mobility (DM) bearing in a primary THA at a minimum follow-up of two years. We performed a retrospective review of a consecutive series of DM THA performed between 2010 and 2014 at our institution (Hospital for Special Surgery, New York, New York) by a single, high-volume orthopaedic surgeon employing a single prosthesis design (Anatomic Dual Mobility (ADM) Stryker, Mahwah, New Jersey). Patient medical records and radiographs were reviewed to confirm the type of implant used, to identify any preoperative risk factors for dislocation, and any complications. Radiographic analysis was performed to assess for signs of osteolysis or remodelling of the acetabulum. There were 151 patients who met the classification of high-risk according to the inclusion criteria and received DM THA during the study period. Mean age was 82 years old (73 to 95) and 114 patients (77.5%) were female. Mean follow-up was 3.6 years (1.9 to 6.1), with five patients lost to follow-up and one patient who died (for a reason unrelated to the index procedure). One patient (0.66%) sustained an intraprosthetic dislocation there were no other dislocations. At mid-term follow-up, the use of a DM bearing for primary THA in patients at high risk of dislocation provided a stable reconstruction option with excellent radiographic results. Longer follow-up is needed to confirm the durability of these reconstructions.
Publisher: Elsevier BV
Date: 04-2022
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 2019
DOI: 10.1302/0301-620X.101B1.BJJ-2018-0434.R1
Abstract: Between 15% and 20% of patients remain dissatisfied following total knee arthroplasty (TKA). The SAIPH knee system (MatOrtho, Surrey, United Kingdom) is a medial ball and socket TKA that has been designed to replicate native knee kinematics in order to maximize the range of movement, stability, and function. This system is being progressively introduced in a stepwise fashion, with this study reporting the mid-term clinical and radiological outcomes. A retrospective review was undertaken of the first 100 consecutive patients with five-year follow-up following SAIPH TKA performed by the senior authors. The data that were collected included the demographics of the patients, clinical findings, the rate of intraoperative ligamentous release, patient-reported outcome measures (PROMS), radiological assessment, complications, and all-cause revision. Revision data were cross-checked with a national registry. A total of 100 TKAs in 92 patients were included. Three patients died (three TKAs) and a further two TKAs were revised. Of the remaining 95 TKAs, five-year follow-up data were available for 81 TKAs (85%) in 87 patients. There were significant improvements in all PROMs and high satisfaction. The mean ROM at final follow-up was from 0° (full extension) to 124° flexion. There were seven major complications (7%): one infection, two deep vein thromboses, one cerebrovascular event, and two patients with stiffness requiring a manipulation under anaesthesia. Two patients required a lateral retinacular release to optimize patellar tracking in valgus knees no additional ligament releases were performed in any patient. Radiological analysis demonstrated no evidence of implant-related complications. These results demonstrate satisfactory clinical and radiological outcomes at five years following a medial ball and socket TKA. The complication and revision rates are consistent with those previously reported for patients undergoing TKA. These results demonstrate the safety and efficacy of the SAIPH Knee TKA system and support its wider use.
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.ARTH.2019.02.012
Abstract: Antibiotic cement spacers are used during 2-stage revision total hip arthroplasty for prosthetic joint infection. Complications including dislocation and periprosthetic fracture have been reported but a large cohort comparing spacer design features is lacking. We aimed to determine if spacer design is associated with perioperative complications. We performed a retrospective review of antibiotic cement spacers implanted between 2004 and 2014. Radiographic assessment included leg length, offset, and bone loss (Paprosky classification). Clinical outcomes included dislocation, periprosthetic fracture, spacer fracture, infection cure, and overall reoperation rate. Univariate analysis, Student's t-test, chi-squared test, or Kruskal-Wallis test was employed (P 5 mm (P = .033) and increased bone loss (P = .01). Spacer fracture occurred in 8% (14/185) 12% (12/97) molded versus 8% (2/23) handmade (P = .02). Periprosthetic femur fracture was associated with increased offset >5 mm (P = .01) and extended trochanteric osteotomy (P = .001). During 2-stage total hip arthroplasty, antibiotic-loaded cement spacers had an overall complication rate of 26%. Spacer design, acetabular and femoral bone loss, and offset restoration were significantly associated with perioperative complications. We recommend the optimization of antibiotic-loaded cement spacer placement to minimize potential complications by focusing on restoration of leg-length and offset, ensuring adequate femoral fixation and paying attention to selection of an appropriate head/neck ratio.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.ARTH.2018.09.080
Abstract: Prior studies have found that greater proximal tibial varus was associated with increased external femoral rotation at time of total knee arthroplasty. These works suggest that measuring the tibial plateau-tibial shaft (TPTS) angle on preoperative weight-bearing long leg radiographs could predict significant variations in the posterior condylar angle. A minimum of 68 patients were needed to reach 80% power. Patients were included if they had primary medial compartment osteoarthritis and excluded if they had a valgus mechanical axis. The clinical posterior condylar angle (cPCA) was defined as the angle between the anatomic transepicondylar axis and posterior condylar line. Correlation analyses were performed to test for any relationship between the TPTS and cPCA. Two patient groups were created based on TPTS angle: TPTS ≤4° (mild varus) and TPTS >4° (moderate varus). Mechanical axis and rotational measurements were compared between the groups using independent t-tests. The mean mechanical axis and TPTS angle were 6.9° and 4.8° of varus, respectively. The mean cPCA was 5.0° (standard deviation [SD], 1.4° range, 2.4°-7.9°). No correlation was found between the TPTS angle and cPCA (P = .15). The mean cPCA in the mild varus group (n = 28 patients) was 5.2° (SD, 1.5° range, 2.7°-7.9°), and the mean cPCA in the moderate varus group (n = 45 patients) was 4.4° (SD, 1.7° range, 0.6°-7.5°). These groups were not statistically significantly different from each other (P = .62). The present study does not support the conclusions of previous works and suggests that the amount of distal femoral rotation cannot be predicted by tibial varus alignment measured on preoperative long leg radiographs. Consequently, we believe that proximal tibial varus should not be used to preoperatively predict external rotation of the femoral component in patients with isolated medial compartment osteoarthritis.
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.ARTH.2018.01.027
Abstract: Computer-assisted surgical (CAS) navigation has been developed with the aim of improving the accuracy and precision of total knee arthroplasty (TKA) component positioning and therefore overall limb alignment. The historical goal of knee arthroplasty has been to restore the mechanical alignment of the lower limb by aligning the femoral and tibial components perpendicular to the mechanical axis of the femur and tibia. Despite over 4 decades of TKA component development and nearly 2 decades of interest in CAS, the fundamental question remains does the alignment goal and/or the method of achieving that goal affect the outcome of the TKA in terms of patient-reported outcome measures and/or overall survivorship? The quest for reliable and reproducible achievement of the intraoperative alignment goal has been the primary motivator for the introduction, development, and refinement of CAS navigation. Numerous proprietary systems now exist, and rapid technological advancements in computer processing power are stimulating further development of robotic surgical systems. Three categories of CAS can be defined: image-based large-console navigation imageless large-console navigation, and more recently, accelerometer-based handheld navigation systems have been developed. A review of the current literature demonstrates that there are enough well-designed studies to conclude that both large-console CAS and handheld navigation systems improve the accuracy and precision of component alignment in TKA. However, missing from the evidence base, other than the subgroup analysis provided by the Australian Orthopaedic Association National Joint Replacement Registry, are any conclusive demonstrations of a clinical superiority in terms of improved patient-reported outcome measures and/or decreased cumulative revision rates in the long term. Few authors would argue that accuracy of alignment is a goal to ignore therefore, in the absence of clinical evidence, many of the arguments against the use of large-console CAS navigation center on the prohibitive cost of the systems. The utilization of low-cost, handheld CAS navigation systems may therefore bridge this important gap, and over time, further clinical evidence may emerge.
Publisher: Elsevier BV
Date: 11-2021
Publisher: Elsevier BV
Date: 08-2021
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.JHSA.2017.10.002
Abstract: This study investigates the loss of compression when 3 commonly used headless compression screws are backed out (reversed), and assesses the ability to re-establish compression with screws of greater diameter. Two investigators tested 3 screw designs (Acutrak 2, Synthes HCS, Medartis SpeedTip CCS) in 2 diameters and lengths. Each design had 10 test cycles in a polyurethane foam bone model with compression recorded using a washer load cell. A 28-mm screw of the narrower diameter was inserted until 2 mm recessed and then reversed 30°, 60°, 90°, 180°, 270°, 360°, and 720°. After this the screw was removed completely and a 24-mm screw of greater diameter inserted until recessed 2 mm with the compressive force again recorded. All screws showed an immediate, statistically significant loss of compression at 30° of reversing. The Acutrak 2 Micro screw demonstrated not only the greatest mean compressive force, but also the fastest compressive loss. Insertion of the shorter screw of greater diameter was associated with re-establishment of compression to levels comparable with the original screw. This study reaffirms the importance of establishing the correct screw length before insertion due to the immediate loss of compression with reversal of these devices. If a headless compression screw penetrates the far joint surface, the screw should be completely removed and replaced with a shorter screw of greater diameter.
Publisher: Wiley
Date: 08-2012
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.ARTH.2019.10.020
Abstract: Joint stability is one of the goals of any joint replacement. The contribution of prosthesis design to sagittal stability in total knee arthroplasty (TKA) has emerged as an area of interest. The purpose of this study was to evaluate the sagittal stability of four prosthesis types and determine the effect on patient reported outcome measures (PROMs). A matched-cohort cross-sectional study was performed on 60 patients after TKA at 1-year follow-up. Three surgeons performed 10 medially stabilized (MS) TKA and 10 non-MS TKA. Sagittal stability was assessed by a blinded observer using a KT-1000 arthrometer, Lachman's test, and the anterior drawer test. PROMs (Oxford, Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten joint score) and visual analog scale assessed function and satisfaction. MS TKA had significantly decreased translation on KT-1000 and improved stability compared with non-MS TKA (P < .05). Increased PROMs were demonstrated in the MS TKA group compared with the non-MS TKA group (P < .05). When ided based on objective stability, regardless of the prosthesis type, patients with a stable knee had superior PROMs (P < .05), particularly in sport-related questions. The MS TKA had significantly greater sagittal stability, improved PROMs, and satisfaction compared with non-MS TKA. Independent of prosthesis design, patients with greater sagittal stability demonstrated improved PROMs.
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 12-2022
DOI: 10.1302/2633-1462.312.BJO-2022-0146.R1
Abstract: Leg length discrepancy (LLD) is a common pre- and postoperative issue in total hip arthroplasty (THA) patients. The conventional technique for measuring LLD has historically been on a non-weightbearing anteroposterior pelvic radiograph however, this does not capture many potential sources of LLD. The aim of this study was to determine if long-limb EOS radiology can provide a more reproducible and holistic measurement of LLD. In all, 93 patients who underwent a THA received a standardized preoperative EOS scan, anteroposterior (AP) radiograph, and clinical LLD assessment. Overall, 13 measurements were taken along both anatomical and functional axes and measured twice by an orthopaedic fellow and surgical planning engineer to calculate intraoperator reproducibility and correlations between measurements. Strong correlations were observed for all EOS measurements (r s 0.9). The strongest correlation with AP radiograph (inter-teardrop line) was observed for functional-ASIS-to-floor (functional) (r s = 0.57), much weaker than the correlations between EOS measurements. ASIS-to-ankle measurements exhibited a high correlation to other linear measurements and the highest ICC (r s = 0.97). Using anterior superior iliac spine (ASIS)-to-ankle, 33% of patients had an absolute LLD of greater than 10 mm, which was statistically different from the inter-teardrop LLD measurement (p 0.005). We found that the conventional measurement of LLD on AP pelvic radiograph does not correlate well with long leg measurements and may not provide a true appreciation of LLD. ASIS-to-ankle demonstrated improved detection of potential LLD than other EOS and radiograph measurements. Full length, functional imaging methods may become the new gold standard to measure LLD. Cite this article: Bone Jt Open 2022 (12):960–968.
Publisher: Elsevier BV
Date: 08-2018
Publisher: Elsevier BV
Date: 05-2005
DOI: 10.1016/J.PROGHI.2005.02.001
Abstract: Confocal laser scanning microscopy (CLSM) is a type of high-resolution fluorescence microscopy that overcomes the limitations of conventional widefield microscopy and facilitates the generation of high-resolution 3D images from relatively thick sections of tissue. As a comparatively non-destructive imaging technique, CLSM facilitates the in situ characterization of tissue microstructure. Images generated by CLSM have been utilized for the study of articular cartilage, bone, muscle, tendon, ligament and menisci by the foremost research groups in the field of orthopaedics including those teams headed by Bush, Errington, Guilak, Hall, Hunziker, Knight, Mow, Poole, Ratcliffe and White. Recent evolutions in techniques and technologies have facilitated a relatively widespread adoption of this imaging modality, with increased "user friendliness" and flexibility. Applications of CLSM also exist in the rapidly advancing field of orthopaedic implants and in the investigation of joint lubrication.
Location: Australia
No related grants have been discovered for Christopher Jones.