No abstract

PurposeOver 2 million Triathlon single-radius total knee arthroplasties (TKAs) have been implanted worldwide. This study reports the 10-year survival and patient-reported outcome of the Triathlon TKA in a single independent centre.MethodsFrom 2006 to 2007, 462 consecutive cruciate-retaining Triathlon TKAs were implanted in 426 patients (median age 69 (21–89), 289 (62.5%) female). Patellae were not routinely resurfaced. Patient-reported outcome measures (SF-12, Oxford Knee Scores (OKS), satisfaction) were assessed preoperatively and at 1, 5 and 10 years when radiographs were reviewed. Forgotten Joint Scores (FJS) were collected at 10 years. Kaplan–Meier survival analysis was performed.ResultsAt 10–11.6 years, 123 patients (128 TKAs) had died and 8 TKAs were lost to follow-up. There were four aseptic failures (two cases of tibial loosening, two cases of instability) and four septic failures requiring revision. Symptomatic aseptic radiographic loosening was present in three further cases at 11 years. Four (1%) patellae were secondarily resurfaced. OKS score improved by 17.7 ± 9.7 points at 1 year (p < 0.001), and was maintained at 34.7 ± 9.6 at 10 years with FJS 48.5 ± 31.4. Patient satisfaction was 88% at each timepoint. Ten-year survival was 97.9% (95% confidence interval 96.5–99.3) for revision for any reason, 98.9% (97.7–100) for mechanical failure, and 98.6% (97.4–99.8) for aseptic loosening (symptomatic radiographic or revised).ConclusionThe Triathlon TKA continues to show excellent longer-term results with high implant survivorship, low rates of aseptic failure, consistently maintained PROMs and excellent patient satisfaction rates of 88% at 10 years.Level of evidenceII, Prospective cohort study.

Objectives: To identify risk factors for fixation failure, report patient outcomes and advise on modifications to the surgical technique for fibula nail stabilisation of unstable ankle fractures.Design: Retrospective review.Setting: Orthopaedic trauma unit serving a capital city.Patients: All 342 patients were identified retrospectively from a prospectively collected singlecentre trauma database over a nine-year period.Intervention: Unstable ankle fractures managed surgically with a fibula nail. Main Outcome Measurements:The primary short-term outcome was failure, defined as any case that required revision surgery due to an inadequate mechanical construct. The mid-term outcomes included the Olerud-Molander Ankle Score (OMAS) and the Manchester-Oxford Foot Questionnaire (MOXFQ).Results: Twenty failures occurred (6%), of which seven (2%) were due to device failure and 13 (4%) due to surgeon error. Of the surgeon errors, eight consisted of inappropriate weight bearing after syndesmotic diastasis and five were due to inadequate fracture reduction or poor nail placement.Proximal locking screw (PLS) pull-out was the cause of all device failures. Positioning the PLS >20mm above the plafond significantly increased failure risk (p=0.003). At a mean follow-up of 5.1 years (range, 8 months -8 years) the median OMAS and MOXFQ were 80 (interquartile range, 45) and 10.94 (interquartile range, 44.00) respectively. Patient outcome was not negatively affected by the requirement for revision surgery. Conclusion:The fibula nail offers secure fixation and good patient reported outcomes for unstable ankle fractures. Appropriate post-operative management and surgical technique, including careful placement of the PLS is essential to minimise construct failure risk.

We performed a case-control study to compare the rates of further surgery, revision and complications, operating time and survival in patients who were treated with either an uncemented hydroxyapatite-coated Corail bipolar femoral stem or a cemented Exeter stem for a displaced intracapsular fracture of the hip. The mean age of the patients in the uncemented group was 82.5 years (53 to 97) and in the cemented group was 82.7 years (51 to 99) We used propensity score matching, adjusting for age, gender and the presence or absence of dementia and comorbidities, to produce a matched cohort receiving an Exeter stem (n = 69) with which to compare the outcome of patients receiving a Corail stem (n = 69). The Corail had a significantly lower all-cause rate of further surgery (p = 0.016; odds ratio (OR) 0.18, 95% CI 0.04 to 0.84) and number of hips undergoing major further surgery (p = 0.029; OR 0.13, 95% CI 0.01 to 1.09). The mean operating time was significantly less for the Corail group than for the cemented Exeter group (59 min [12 to 136] vs 70 min [40 to 175], p = 0.001). The Corail group also had a lower risk of a peri-prosthetic fracture (p = 0.042; OR 0.19, 95% CI 0.01 to 1.42) . There was no difference in the mortality rate between the groups. There were significantly fewer complications in the uncemented group, suggesting that the use of this stem would result in a decreased rate of morbidity in these frail patients. Whether this relates to an improved functional outcome remains unknown.

Introduction:The aim was to compare surgical and nonsurgical management for adults with humeral shaft fractures in terms of patientreported upper limb function, health-related quality of life, radiographic outcomes, and complications.Methods: MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PubMed, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, International Clinical Trials Registry, and OpenGrey (Repository for Grey Literature in Europe) were searched in September 2021. All published prospective randomized trials comparing surgical and nonsurgical management of humeral shaft fractures in adults were included. Of 715 studies identified, five were included in the systematic review and four in the meta-analysis. Data were extracted by two independent reviewers according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Methodological quality was assessed using the revised Cochrane riskof-bias tool for randomized trials. Pooled data were analyzed using a random-effects model. Results:The meta-analysis comprised 292 patients (mean age 41 [18 to 83] years, 67% male). Surgery was associated with superior Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley scores at 6 months (mean DASH difference 7.6, P = 0.01; mean Constant-Murley difference 8.0, P = 0.003), but there was no difference at 1 year (DASH, P = 0.30; Constant-Murley, P = 0.33). No differences in health-related quality of life or pain scores were found. Surgery was associated with a lower risk of nonunion (0.7% versus 15.7%; odds ratio [OR] 0.13, P = 0.004). The number needed to treat with surgery to avoid one nonunion was 7. Surgery was associated with a higher risk of transient radial nerve palsy (17.4% versus 0.7%; OR 8.23, P = 0.01) but not infection (OR 3.57, P = 0.13). Surgery was also associated with a lower risk of reintervention (1.4% versus 19.3%; OR 0.14, P = 0.04).