Nanotopographical cues on Ti have been shown to elicit different cell responses such as cell differentiation and selective growth. Bone remodelling is a constant process requiring specific cues for optimal bone growth and implant fixation. Moreover, biofilm formation and the resulting infection on surgical implants is a major issue. Our aim is to identify nanopatterns on Ti surfaces that would be optimal for both bone remodelling and for reducing risk of bacterial infection. Primary human osteoblast/osteoclast co-cultures were seeded onto Ti substrates with TiO2 nanowires grown under alkaline conditions at 240 °C for different times (2, 2.5 or 3 h). Cell growth and behaviour was assessed by scanning electron microscopy (SEM), immunofluorescence microscopy, histochemistry and quantitative RT-PCR methods. Bacterial colonisation of the nanowire surfaces was also assessed by confocal microscopy and SEM. From the three surfaces tested the 2 h nanowire surface supported osteoblast and to a lesser extent osteoclast growth and differentiation. At the same time bacterial viability was reduced. Hence the 2 h surface provided optimal bone remodeling in vitro conditions while reducing infection risk, making it a favourable candidate for future implant surfaces.

A 13-year-old boy, right hand dominant, presented acutely to the casualty department having injured both elbows following a fall from height. The patient had been climbing a 7 ft fence and had caught his shoelace at the top, falling onto his outstretched hands. There was obvious deformity bilaterally at the elbow with painful restriction of movement. There was no neurovascular deficit at this time. Aside from a minor head injury, with no sequelae, there were no other associated injuries.Radiographs confirmed bilateral posterior dislocation of the elbows (Figs. 1 and 2). Closed reduction under adequate sedation and analgesia was performed. The right elbow was reduced upon the first attempt (Fig. 3). The left elbow required two attempts to obtain reduction. Check radiographs of this elbow revealed a fracture of the coronoid process (Fig. 4).Bilateral above elbow plaster of paris backslabs were applied and the patient was admitted overnight for analgesia, elevation and observations.The patient was discharged the next day and reviewed at fracture clinic 10 days post injury. At this point the backslabs were discarded and the patient was encouraged to mobilise both elbows. As the left elbow was more painful at this point, a collar and cuff was retained on that side.Two weeks later both elbows were markedly stiff with a range of movement from 45 to 1008 bilaterally. Urgent physiotherapy was instituted at this point consisting of a limited session of passive exercise followed immediately by active training.Four weeks later, the right elbow had improved significantly, with a good range of movement and no instability. Examination of the left elbow revealed a firm mass of scar tissue palpable over the medial collateral ligament. There was no instability but the range of movement was limited slightly, the elbow lacking approximately 108 of full extension.At further review, 5 months later, radiographs were taken (Figs. 5 and 6), and showed Grade II heterotopic ossification 2 around the right elbow, and Grade IV heterotopic ossification 2 around the left elbow. Bone biochemistry was normal. Despite this, right and left elbows achieved a range of movement of 40-1008 and 30-1108, respectively, with well preserved pronation and supination in both forearms. This represents a marked deterioration of elbow function compared to previous review. The patient, however, was satisfied with the range of movement and was not keen on operative intervention. He was therefore treated conservatively.

No abstract

Aims The aim of this study was to surveil whether the standard operating procedure created for the NHS Golden Jubilee sufficiently managed COVID-19 risk to allow safe resumption of elective orthopaedic surgery. Methods This was a prospective study of all elective orthopaedic patients within an elective unit running a green pathway at a COVID-19 light site. Rates of preoperative and 30-day postoperative COVID-19 symptoms or infection were examined for a period of 40 weeks. The unit resumed elective orthopaedic services on 29 June 2020 at a reduced capacity for a limited number of day-case procedures with strict patient selection criteria, increasing to full service on 29 August 2020 with no patient selection criteria. Results A total of 2,373 cases were planned in the 40-week study period. Surgery was cancelled in 59 cases, six (10.2%) of which were due to having a positive preoperative COVID-19 screening test result. Of the remaining 2,314, 996 (43%) were male and 1,318 (57%) were female. The median age was 67 years (interquartile range 59.2 to 74.6). The median American Society of Anesthesiologists grade was 2. Hip and knee arthroplasties accounted for the majority of the operations (76%). Six patients tested positive for COVID-19 preoperatively (0.25%) and 39 patients were tested for COVID-19 within 30 days after discharge, with only five patients testing positive (0.22%). Conclusion Through strict application of a COVID-19 green pathway, elective orthopaedic surgery could be safely delivered to a large number of patients with no selection criteria. Cite this article: Bone Jt Open 2021;2(11):951–957.

Total knee replacements (TKR) are often deemed successful when patients recover and maintain their functionality both in the short and long term. The other main indicator for success is the revision rate following TKR. This study analyses the long term results of navigated TKR based on patient related outcomes in terms of patient satisfaction, Oxford Knee Score (OKS) and also knee revision rates.The retrospective data of all patients who underwent navigated Columbus TKR from the author’s institution from 2005 to 2011 was analysed and compared to the national database. The overall cohort size was 1679 with a mean age of 68.81yrs (sd 8.46). The OKS, satisfaction scores, complication and revision rates were compiled and evaluated up to ten years post-operatively. Patient reported outcomes were recorded six weeks, one, two, five and ten years post-operatively.The results from the OKS and satisfaction scores demonstrated marked improvement throughout recovery to the ten year time point. The OKS had a mean improvement of 16.6 from the pre-operative score at the 10 year time point and the satisfaction scores improved at each follow-up and remained high at the 10 year time point. A total of 61 complications and 36 revisions recorded, with infection being the major cause for revisions.This survey has identified and established that the majority of patients undergoing knee arthoplasty using the Columbus total knee system and computer navigation function reasonably well in the long term and the revision and complication rates in this hospital are compare well with national levels..