Short-term results of rotator cuff repair using GraftJacket as an interpositional tissue-matched thickness graft.

We report outcomes of using GraftJacket to repair massive rotator-cuff-tears. Twenty patients with a mean age of 64.6y over 12-month duration were reviewed. Two patients had a single GraftJacket repair (group1), whilst 18 had the GraftJacket sheet doubled (group2). Pre and post oxford shoulder scores (OSS) and patient related outcome measures were evaluated. A statistically significant improvement of OSS was demonstrated in-group 2 from a mean of 22 to 45.5 (p < 0.00148) over a follow up of 18 months. GraftJacket is a safe and effective procedure to use as an interpositional graft and doubling the graft may improve outcomes.

Results of displaced subcapital fractures treated by primary total hip replacement.

We present morbidity, mortality and functional outcome in mobile, socially independent and alert patients with displaced subcapital hip fractures, treated by primary total hip replacement (THR). Fifty-one consecutive socially independent and mentally alert patients with displaced subcapital fractures were treated by primary THR, from April 1997 to March 2000, at a single hospital. Most patients were female (45/51) with an average age of 74 years. Patient hospital records were reviewed and patients interviewed by telephone. Functional outcome was assessed using Oxford hip score (OHS), short form 12 (SF12), and patient satisfaction. This study had a mean follow-up of 33 months (range 20-54). One patient with early dislocation went on to have recurrent dislocations. Two patients underwent revision surgery. Three patients died within 1 year of sustaining fracture. Function was comparable to elective THR in osteoarthritic patients. OHS correlated well with both SF12 and patient satisfaction. This study has the lowest reported dislocation rate (2%) and an acceptable 1-year mortality (6%) confirming the place of primary THR in treatment of these selected patients with a displaced hip fracture. The OHS proved a valuable instrument to assess function following THR in fracture patients.

Pigmented villonodular synovitis of the elbow.

Pigmented villonodular synovitis (PVNS) is a monoarticular condition with a variable prognosis. The first account of it was given by Chassaignac in 1852. The condition was given its name by Jaffe in 1941. In separate studies Miller in 1982 and Flandry et al. in 1994 determined the overall incidence of PVNS varied between 1 and 3 per 1,000,000. The joint most commonly involved is the knee, and according to Dorwart et al. the elbow is rarely affected. Seventeen other cases of PVNS of the elbow have been reported, and very scant information exists about optimal treatment or outcome.

Axial rotation of the prosthetically replaced knee.

Meniscal total knee replacement differs from total condylar designs in that it allows free axial rotation. This reduces torque forces on the tibial component and may help to prevent aseptic loosening. The amount of rotation occurring in patients with meniscal total knee replacement was an average range of 6 degrees. The average movement of the polyethylene 'menisci' is 3 mm.

Measuring outcome of total knee replacement using quality of life indices.

A series of 26 patients was studied before and after total knee replacement to determine the change in their quality of life, expressed as a gain in Quality Adjusted Life Years (QALYs). Global health status was assessed using the Nottingham Health Profile, disability by the Harris scale, pain by the McGill Pain Questionnaire, and anxiety and depression by the Hospital Anxiety and Depression Scale. Substantial reductions were found in pain, anxiety and depression, and a significant improvement was found in mobility. These data were used to generate a 'QALY' (Quality Adjusted Life Year) comparable to the measure used by Williams (1) in his comparative evaluation of medical and surgical treatments. A gain of only 0.42 QALY was found for knee replacement, which is about one-tenth the figure given by Williams for hip replacement. The difference appears to be attributable not to differences in the success of the operations, but rather to the scope that QALY calculations give for allocating comparable patients to different quality of life states. Tighter criteria are needed if QALYs are to be used to guide resource allocation.

Supracondylar fractures of the humerus in childhood: range of movement following the posterior approach to open reduction.

The posterior approach for open reduction of supracondylar fractures of the humerus has been condemned for causing decreased elbow movement. This study investigates this by comparing the range of movement in children treated by posterior open reduction and Kirschner wiring with those treated by closed reduction and immobilization. A total of 65 children with severely displaced supracondylar humeral fractures have been reviewed. There was some loss of movement in 66 per cent of the open reduction group and 42 per cent of the closed reduction group. The proportion losing more than 10 degrees of movement was the same in both groups. The difference between the two groups was due to the increased numbers in the open reduction group who lost less than 10 degrees of motion. Posterior open reduction of childhood supracondylar fractures is not associated with an important loss of elbow movement and need not be avoided on this account.

Wear of cross-linked polyethylene against itself: a material suitable for surface replacement of the finger joint.

Cross-linking of polyethylene (XLPE) has dramatically improved its properties in industrial applications, and it may also have some application in the field of human joint replacement. Additionally it has the advantage of permitting a lower molecular weight base material to be used, so that components may be injection moulded rather than machined. This study therefore investigates the wear resistance of medical grade cross-linked polyethylene (XLPE), cross-linked by a silane-grafting process, with a molecular weight between cross links of 5430 g mol(-1). This first report investigates the wear resistance of XLPE against itself, because for certain joints, such as the metacarpo-phalangeal joint, the material may have a high enough wear resistance to allow both bearing surfaces to be made from it. Tests were carried out both on a reciprocating pin and plate machine with pins loaded at 10 and 40 N and also on a new finger joint simulator, which simulates the loads applied to and the movements of, the metacarpo-phalangeal joint. An average wear rate of 1.8 x 10(-6) mm3 N-1 m-1 was found (range 0.9-2.75 x 10(-6) mm3 N-1 m-1). This is about six times greater than the wear rate of non-cross-linked ultra high molecular weight polyethylene (UHMWPE) against stainless steel, but for applications with low loading, such as the metacarpo-phalangeal joint, this material is shown to have adequate wear resistance. The coefficient of friction was 0.1, which is similar to that of UHMWPE on stainless steel.

Fixation of a surface replacement endoprosthesis of the metacarpophalangeal joint.

Surface replacement of the metacarpophalangeal joint would provide many benefits over current conservative treatment or the use of hinged spacers in excision arthroplasty. One of the main problems in surface replacement is securing adequate fixation of the prosthesis, especially if cement is not to be used. The direction and size of the forces that cause loosening have been described and a series of experiments in cadaveric bone have been used to elucidate the best shape of the component and stem to resist these forces. A 5 mm square section stem of 30 mm length gave the best overall result when combined with a flat on the palmar aspect of the inner bearing surface.