We allocated randomly 27 patients undergoing 28 primary uncemented total hip replacements (THR) to receive prosthetic components of similar design with either plasma-sprayed titanium alloy (Ti) coating (n = 13) or hydroxyapatite (HA) coating (n = 15). After some exclusions, 15 of the patients (15 THR; 7 with HA- and 8 with Ti-coating) were followed by roentgen stereophotogrammetric analysis at 3, 6 and 12 months to measure migration of the femoral component. Twenty-six of the patients (26 THR) were followed clinically and by conventional radiography. All the femoral components had migrated at 3 months. From 3 to 12 months, the migration of Ti-coated components continued whereas the HA-coated components had stabilised. At 12 months there was significantly less migration of the HA-coated components (p < 0.05). The maximum subsidence was 0.2 mm in both groups. The Harris hip score was equal in the two groups preoperatively but at follow-up it was better in the HA-coated group (p < 0.05) and visual analogue scale scores showed that they had less pain (p < 0.05).

Lumbar posterolateral fusion with pedicle screw fixation increases the operation time, blood loss, and reoperation rate, and leads to a significant risk of nerve injury. The functional outcome improves significantly with high patient satisfaction, with or without instrumentation. No significant differences were observed between the two groups in functional outcome and fusion rate. The only gain in functional outcome from instrumentation was found in the daily activity category in patients with supplementary neural decompression. The results of this study do not justify the general use of pedicle screw fixation alone as an adjunct to posterolateral lumbar fusion.

In a prospective study, 41 consecutive patients with a partial tear of the anterior cruciate ligament, diagnosed by arthroscopy, were reviewed after an average of 17 months, having been in plaster for six weeks after injury. Their average age was 29 years and review included clinical examination, measurement of anterior and posterior laxity with the Stryker knee laxity tester as well as evaluation of knee function and activity level. Twenty-one patients had unstable knees at follow-up; the mean total anteroposterior laxity for these patients was 12.6 +/- 3.9 mm compared with 7.1 +/- 4.3 mm for the normal knee. Most patients had few symptoms, but there was a significant reduction in the mean level of activity in the unstable group.

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Purpose To summarize the recommendations from the national clinical guideline published by the Danish Health Authority regarding surgical and nonsurgical interventions in treatment of lumbar spinal stenosis in patients above the age of 65 years. Methods A multidisciplinary working group formulated recommendations based on the GRADE approach. Results Seven of the recommendations were based on randomized controlled trials and three on professional consensus. The guideline recommends surgical decompression for symptomatic lumbar spinal stenosis. Supervised exercise and postsurgical supervised exercise are recommended due to the general beneficial effects of training on general health, even though there was no evidence on an effect on neurogenic pain. The guideline does not recommend manual therapy, paracetamol, NSAIDs, opioids, neurogenic pain medication, muscle relaxants, and decompression combined with instrumented fusion as there was no evidence of the beneficial effect. Conclusion The recommendations are based on low to very low quality of evidence or professional consensus as well as patient preferences and positive or harmful effects of the intervention. The true treatment effect may therefore be different from the estimated effects, which is why the results should be interpreted with caution. The working group recommends intensified research in relation to all aspects of management of lumbar spinal stenosis. Graphical abstractThese slides can be retrieved under Electronic Supplementary Material. Key points 1. A multidisciplinary work group developed a Danish national clinical guideline for non-surgical and surgical treatment in patients over 65 years of age with lumbar spinal stenosis 2. The recommendations were all based on either weak evidence or professional consensus. 3. High-quality RCTs on all aspects of treatment of lumbar spinal stenosis are needed to move the field of research forward. Rousing R, Krüger Jensen R, Fruensgaard S, Strøm J, Brøgger HA, Degn JDM, Andersen MO (2019) Danish National Clinical Guidelines for surgical and non-surgical treatment of patients with lumbar spinal stenosis. Eur Spine J; PICO questionsShould patients with lumbar spinal stenosis be: 1. advised to supervised exercise rather than usual care? 2. offered spinal manual therapy as compared to usual care? 3. be offered paracetamol rather than no treatment with pain medication? 4. offered non-steroidal anti-inflammatory medicine (NSAID) rather than no pain medication? 5. offered opioids in addition to treatment with non-opioid pain medication? 6. offered muscle relaxants in addition to treatment with weak pain medication? 7. offered medication for neurogenic pain in addition to treatment with weak pain medication? 8. offered surgical decompression in case of insufficient effect of non-surgical treatment? 9. offered stabilization procedure (with or without instrumentation) in addition to decompression? 10. offered supervised exercise following surgery for lumbar spinal stenosis rather than no supervision?Rousing R, Krüger Jens...