Frozen shoulder: overview of clinical presentation and review of the current evidence base for management strategies.

Adhesive capsulitis of the shoulder (ACS) is a condition with significant clinical and economic implications. The etiology of adhesive capsulitis is not clearly understood and there remains lack of consensus in clinical management for this condition. It can occur as a primary idiopathic condition or secondary to medical conditions or trauma. The hallmarks of ACS are pain and stiffness, caused by formation of adhesive or scar tissue in the glenohumeral joint. Management strategies vary depending on stage of presentation, patient factors and clinician preferences, and can range from conservative options to surgical intervention. The aim of this review is to summarize the pathophysiology and clinical presentation of ACS and to discuss the evidence base for various management strategies employed today.

Minimum ten-year follow-up of a randomized trial comparing acetabular component fixation of two porous in-growth surfaces using radiosteriometric analysis.

AIMS: To compare the in vivo long-term fixation achieved by two acetabular components with different porous ingrowth surfaces using radiostereometric analysis (RSA). METHODS: This was a minimum ten-year follow-up of a prospective randomized trial of 62 hips with two different porous ingrowth acetabular components. RSA exams had previously been acquired through two years of follow-up. Patients returned for RSA examination at a minimum of ten years. In addition, radiological appearance of these acetabular components was analyzed, and patient-reported outcome measures (PROMs) obtained. RESULTS: In all, 15 hips were available at ten years. There was no statistically significant difference in PROMS between the two groups; PROMs were improved at ten years compared to preoperative scores. Conventional radiological assessment revealed well-fixed components. There was minimal movement for both porous surfaces in translation (X, Y, Z, 3D translation in mm (median and interquartile range (IQR)), StikTite (Smith and Nephew, Memphis, Tennessee, USA): 0.03 (1.08), 0.12 (0.7), 0.003 (2.3), 0.37 (0.30), and Roughcoat (Smith and Nephew): -0.6 (0.59),-0.1 (0.49), 0.1 (1.12), 0.48 (0.38)), and rotation (X, Y, Z rotation in degrees (median and IQR), (Stiktite: -0.4 (3), 0.28 (2), -0.2 (1), and Roughcoat: - 0.4 (1),-0.1 (1), 0.2 (2)). There was no statistically significant difference between the two cohorts (p-value for X, Y, Z, 3D translation - 0.54, 0.46, 0.87, 0.55 and for X, Y, Z rotation - 0.41, 0.23, 0.23 respectively) at ten years. There was significant correlation between two years and ten years 3D translation for all components (r = 0.81(p =< 0.001)). CONCLUSION: Both porous ingrowth surfaces demonstrated excellent fixation on plain radiographs and with RSA at ten years. Short-term RSA data are good predictors for long-term migration data.

First metatarsophalangeal joint arthrodesis with two orthogonal two hole plates.

OBJECTIVE: First MTP joint fusion is a reliable procedure for advanced arthritis for the first MTP joint. There are many techniques described. The purpose of our study is to report clinical, radiological, functional outcomes and complications of first metatarsophalangeal joint fusion with hand preparation of the joint and fixation with two orthogonal locking plates without a compression screw. METHODS: 32 feet in 26 consecutive patients under went first metatarsophalangeal joint fusion with above technique. There were 23 women and 3 men. Mean age was 64 years and mean follow-up was 49 months. 21 patients had osteoarthritis, 10 had rheumatoid arthritis and one had psoriatic arthritis. Clinical, radiological, American Orthopaedic Foot and Ankle Score and Foot and Ankle Disability Index clinical rating scales were used for evaluation. RESULTS: Fusion was achieved in 27 feet. The incidence of radiological non-union was 15.7%. Mean AOFAS score improved from 37.1 to 80.7 (p < 0.0001) and mean FADI score improved from 40.3 to 86.9 postoperatively (p < 0.0001). Two patients with osteoarthritis and three with Rheumatoid arthritis did not unite. Four of these patients were managing hence revision surgery was not carried out but had low AOFAS and FADI scores. One patient with symptomatic non-union declined further surgery. One patient needed plate removal for a low grade infection and reoperation rate was 3.1%. CONCLUSIONS: In our experience, first metatarsophalangeal joint arthrodesis using two orthogonal two hole plates without a compression screw is associated with a higher non-union rate in our cohort hence we do not recommend this technique. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Radiographic methods of wear analysis in total hip arthroplasty.

Polyethylene wear is an important factor in failure of total hip arthroplasty (THA). With increasing numbers of THAs being performed worldwide, particularly in younger patients, the burden of failure and revision arthroplasty is increasing, as well, along with associated costs and workload. Various radiographic methods of measuring polyethylene wear have been developed to assist in deciding when to monitor patients more closely and when to consider revision surgery. Radiographic methods that have been developed to measure polyethylene wear include manual and computer-assisted plain radiography, two- and three-dimensional techniques, and radiostereometric analysis. Some of these methods are important in both clinical and research settings. CT has the potential to provide additional information on component orientation and enables assessment of periprosthetic osteolysis, which is an important consequence of polyethylene wear.

The Birmingham mid-head resection arthroplasty--minimum two year clinical and radiological follow-up: an independent single surgeon series.

We report the results of the Birmingham Mid-Head Resection Arthroplasty (BMHR) for patients with poor femoral head bone quality where standard hip resurfacing is contraindicated. This is a clinical and radiological follow-up of the first 35 consecutive procedures (34 patients, 16 male, 18 female) performed by an independent surgeon. The mean follow-up was 2.8 years (2.1 to 4.1) and no patients were lost to follow-up. The mean age at the time of surgery was 50.4 years (23.8 to 69.4). There were no failures. The mean HHS improved from 46.6 (25 to 70) pre-operatively to 96.1 (72 to 100) post-operatively. The mean OHS was 36.4 (19 to 53) pre-operatively and 14.2 (12 to 34) post-operatively. The mean WOMAC score was 45.6 (7 to 92) pre-operatively and 4.3 (0 to 28) post-operatively. The mean UCLA activity score was 4.5 (1 to 9) pre-operatively and 7.6 (5 to 10) post-operatively. Radiographic analysis did not show any adverse features such as stress shielding, loosening or femoral neck narrowing. The BMHR provides an excellent alternative to conventional total hip arthroplasty in patients with poor femoral head bone quality who are not suitable for standard resurfacing.

Radiology of the resurfaced hip.

Hip resurfacing arthroplasty is an increasingly common procedure for osteoarthritis. Conventional radiographs are used routinely for follow-up assessment, however they only provide limited information on the radiological outcome. Various complications have been reported in the scientific literature although not all are fully understood. In an effort to investigate problematic or failing hip resurfacings, various radiological methods have been utilized. These methods can be used to help make a diagnosis and guide management. This paper aims to review and illustrate the radiographic findings in the form of radiography, computerized tomography (CT), magnetic resonance imaging (MRI), and ultrasound of both normal and abnormal findings in hip resurfacing arthroplasty. However, imaging around a metal prosthesis with CT and MRI is particularly challenging and therefore the potential techniques used to overcome this are discussed.

Is consent for hip fracture surgery for older people adequate? The case for pre-printed consent forms.

UNLABELLED: OJECTIVES: Low energy hip fractures are one of the greatest causes of morbidity and mortality in orthopaedics. This study aims to evaluate written consent forms with respect to basic standards as set out in the Good Practice in Consent Initiative. In particular the stated risks and benefits of each procedure were assessed. METHODS: 100 consecutive consent forms were reviewed prospectively. The stated procedure, side and complications were recorded. Appropriate signature and legibility was assessed. 13 consultant orthopaedic surgeons were surveyed to identify what risks and benefits they thought should be stated. RESULTS: Of 100 consent forms, 31 were for patients who are unable to consent. All 100 consent forms were correctly filled in with patient details and signed. 98% were legible. All stated the side of the operation. The number of complications listed per form ranged from 4 to 11. Infection, bleeding and thromboembolic complications were stated in the majority of consent forms. In total, 30 different complications were recorded; some were only stated once. DISCUSSION AND CONCLUSIONS: This work suggests consent forms are completed well with respect to patient identifiers, legibility and procedure. The variability of complications stated is vast. We suggest standard pre-printed consent forms containing risks and benefits should be used as this may improve standards of informed consent. This has also been recently supported by the British Orthopaedic Association.

How many orthopedic surgeons does it take to write a research article? 50 years of authorship proliferation in and internationalization of the orthopedic surgery literature.

Publications are considered to indicate academic achievement and can lead to various rewards, including job opportunities and research funding. Recent years have seen a rising trend in the number of articles published, multiple authorship, and internationalization of the biomedical literature. The goal of this study was to analyze the trends in authorship over the past 50 years to determine whether the orthopedic literature parallels trends seen in other areas of the biomedical literature. We performed an observational study with analysis of the number of authors and geographic origin of articles published in the Journal of Bone and Joint Surgery British Volume (JBJS) and Clinical Orthopaedics and Related Research (CORR). We analyzed 2776 articles (CORR, n=1809; JBJS, n=967) published between 1958 and 2008 at 10-year intervals. There has been a significant increase in the mean number of authors per article from 1.638 to 4.08 (P<.0001) and 1.633 to 4.540 (P<.0001) for CORR and JBJS, respectively between 1958 and 2008. There has been a significant increase in the international contribution to both journals (P<.0001). The number of countries contributing to articles increased from 5 to 39 and from 17 to 33 for CORR and JBJS, respectively. These findings are similar to other areas of the biomedical literature. The reasons for this proliferation are multifactorial, including multicenter trials and inappropriate authorship. Guidelines for authorship and preparation of manuscripts from the International Committee of Medical Journal Editors or from individual journals are widely available, and every effort should be made to adhere to them to prevent inappropriate authorship proliferation in the future.

What is the midterm survivorship and function after hip resurfacing?

BACKGROUND: Hip resurfacing arthroplasty is a common procedure that improves functional scores and has a reported survivorship between 95% and 98% at 5 years. However, most studies are reported from the pioneering rather than independent centers or have relatively small patient numbers or less than five years followup. Various factors have been implicated in early failure. QUESTIONS/PURPOSES: Our purposes were to determine: (1) the midterm survival of the BHR; (2) the function in patients treated with hip resurfacing; and (3) whether age, gender, BMI, or size of components related to failure. METHODS: We reviewed the first 302 patients (329 hips) on whom we performed resurfacing arthroplasty. We assessed the survivorship, change in functional hip scores (HHS, OHS, WOMAC, UCLA), and analyzed potential risk factors (age, gender, BMI, component size) for failure. The mean age at the time of surgery was 56.0 years (range, 28.2-75.5 years). The minimum followup was 5 years (mean, 6.6 years; range, 5-9.2 years). RESULTS: Kaplan-Meier analysis showed survival of 96.5% (95% CI, 94.7-98.4) at 9 years taking revision for any cause as the endpoint. All functional hip scores (HHS, OHS, WOMAC, UCLA) improved. Survivorship was higher in men compared with women. The component sizes and body mass index were smaller in the revised group compared with the nonrevised group. CONCLUSIONS: Medium-term survivorship and functional scores of hip resurfacing are comparable to those from the pioneering center. Hip resurfacing remains a good alternative to THA, particularly in the younger male population with relatively large femoral head sizes.