International Orthopaedics

There are some key figures in medical history whose achievements can be regarded as crucial in the definition of new knowledge and in setting new standards for clinical practice. This manuscript depicts the lives and work of three eminent physicians who were forerunners in the foundation of orthopaedics as an independent medical specialty. They are: Nicholas Andry, Jean-Andrè Venel, and John Ball Brown. The first was the inventor of the name of our discipline, whereas the other two, besides being renowned practitioners, were also the founders, respectively, of the first orthopaedic institutions in Europe and the United States. Therefore, they can be included among the illustrious fathers of modern orthopaedic practice.

In the original publication, the following authors have been omitted due to a technical error in the original article:

The amount of blood loss in a primary cemented total knee arthroplasty (TKA) seems to vary in different reported studies. We carried out a prospective study to determine the factors affecting the peri-operative blood loss, hidden blood loss and blood transfusion requirements in a primary cemented total knee arthroplasty. The factors analysed were gender, diagnosis, tourniquet time and body mass index (BMI). We included a total of 66 consecutive patients who underwent primary TKA by a single surgeon (A.M). There was significantly more peri-operative blood loss in male patients than in females (p=0.001, Student’s t test). The patients with rheumatoid arthritis did not show any statistical difference in peri-operative blood loss compared with that in patients with osteoarthritis. The tourniquet time and the surgical time showed a positive correlation with peri-operative blood loss. The BMI did not show any correlation with peri-operative blood loss. The incidence of blood transfusion was significantly higher in patients with rheumatoid knees as their pre-operative haemoglobin value was low. The amount of hidden blood loss in our series was 38%. We concluded that gender and tourniquet time plays a role in blood loss in TKA, but diagnosis (advanced osteoarthritis [OA] or rheumatoid arthritis (RA) does not. The blood transfusion depends on both pre-operative haemoglobin value and intra-operative blood loss. The post-operative transfusion trigger can be brought to 8.0 g% in a haemodynamically stable patient.

The study is a prospective case-series analysis to demonstrate a new double bundle technique for anterior cruciate ligament (ACL) reconstruction with the use of hamstring tendons through a single tibial tunnel, a double femoral socket with implant-free femoral fixation and interference screw for tibial fixation. Twenty-one patients were treated with the same technique. Hamstring tendons were not removed from the tibial side, and using a single tibial and a double femoral tunnel of 8 and 6 mm, respectively, anatomic ACL reconstruction was performed. Graft passage was performed from the tibial side to the posterolateral femoral tunnel and was looped back to the anteromedial femoral tunnel to be fixed on the tibial tunnel with an interference screw and additional extracortical fixation. Follow-up of the study group was performed for a two-year period, documenting standard clinical and radiographic parameters. Post-operative follow-up (mean 24 months) revealed radiological widening of tibial tunnel (mean 133.6%) in all patients and minor femoral tunnels widening (119.4% and 117.5%). Clinical evaluation showed no signs of instability, and knee evaluation using the IKDC score was performed. The manuscript describes a novel technique in ACL reconstruction, and reports the radiographic results of tunnel widening and clinical scores. Implant-free femoral fixation led to minor tunnel widening similar to previously published data. Further studies need to be performed to compare the long-term results with different published techniques of cost-effective implant-free ACL reconstruction.

Between 1974 and 1987, 276 intertrochanteric osteotomies were performed in 217 patients. In 48 hips the osteotomy was done for idiopathic osteoarthritis. In 166 hips the osteoarthritis was secondary to acetabular dysplasia, in 23 to trauma, in 14 to slipped capital femoral epiphysis, in five to Legg–Calvé–Perthes' disease and in 20 to avascular necrosis of the femoral head. Good results were achieved in young females with mild osteoarthritis secondary to acetabular dysplasia, and in patients with posttraumatic osteoarthritis. All other indications showed a poorer long-term survival. Our study shows that acetabular dysplasia and posttraumatic arthritis remain valid indications for intertrochanteric osteotomy.

Treatment for hallux valgus (HV) remains challenging. Third-generation percutaneous procedures try to reproduce chevron-type osteotomies to replicate their benefits, such as intrinsic stability and reproducibility. We report the first results using a percutaneous, intra-articular, chevron osteotomy (PeICO) technique that mimics the classic intra-articular open chevron procedure, associated with a percutaneous adductor tendon release (PATR) for the treatment of mild-to-moderate HV. From May 2015 to October 2018, a total of consecutive 114 feet (74 patients) were included. Primary outcome measures included radiographic (hallux valgus and intermetatarsal angles) and clinical parameters such as visual analog scale (VAS), FAAM Activities of Daily Living (ADL), and FAAM Sport, AOFAS Score, and MOXFQ, preoperatively and at final follow-up (Minimum 18 months). A patient satisfaction survey was also performed. Pronation and length of the first metatarsal were also assessed. Secondary outcomes included fluoroscopic time, length of surgery, complications, recurrence, and re-operation rates. At 24.09 months on average, the AOFAS score improved from 52.1 points preoperatively to 91.1 (p < 0.001) at the latest follow-up. VAS decreased from 6.3 to 1. Also, FAAM ALD, FAAM Sport, and MOXFQ showed statistically significant differences (p < 0.001) when comparing pre-operative and post-operative periods. Patients found the procedure to be excellent in 82% and very good in 13.5% of cases. Our global complication and re-operation rates were 5.26% and 3.5% (screw removal), respectively. PeICO combined with PATR proved to be a safe, reliable, and effective technique for the correction of mild-to-moderate HV deformity.

This study was carried out to examine the relationship between rest, activity, and nighttime pain and grip and isokinetic muscle strength of the wrist muscles in individuals with lateral epicondylitis. Fifty-six sedentary individuals aged between 18 and 65 years diagnosed with unilateral lateral epicondylitis volunteered to participate in the study. The level of rest, activity, and nighttime pain was evaluated with visual analog scale (VAS). The grip strengths of both arms were evaluated by averaging a maximum of three grip strength measurements using a hand dynamometer. The strength of both wrist flexor and extensor muscles were evaluated with isokinetic dynamometer at angular velocities of 60 and 180°/s with five and 15 concentric repetitions respectively. There was no significant relationship found between the affected side’s grip strength and isokinetic muscle strength with rest, activity and nighttime pain (all P > 0.05). However, there was a difference observed between the affected and unaffected side in grip strength and isokinetic strength measurements of all wrist muscles (all P < 0.05); the unaffected side values were found to be higher. The result of this study found no correlation between the stated level of pain and the true muscle strength in the affected hand. In line with these findings, we think that assessments involving strength can be made in other musculoskeletal problems where pain is present. However, the findings may not reflect the true muscle strength which will tend to be underrated.

Minimal-incision surgery for hip arthroplasty and intensive post-op physiotherapy have both been shown to allow early mobilisation and to reduce hospital stay. Forty-five patients undergoing primary total hip arthroplasty using a standard posterior approach were compared with 51 patients using a minimal incision. In both groups, physiotherapy involved either a routine or intensive regime. Patients were matched in age, sex and body mass index. There was no significant difference in blood loss, post-operative stay and change in Oxford hip scores at one year between the mini- and standard-incision groups. There was a significant difference (P=0.003) in length of stay between routine- and intensive-physiotherapy groups (11.4 vs. 7.9 days). The dislocation rate was higher in the mini-incision group. This study suggests that in a standard UK setting, intensive physiotherapy can significantly decrease in-patient stay, but reducing the incision length does not.