Scielo RSS <![CDATA[SA Orthopaedic Journal]]> vol. 18 num. 1 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Imperfect regulation of implants</b>]]> <![CDATA[<b>Big data and medicine</b>]]> <![CDATA[<b>Body mass index and Blount's disease: a single academic hospital experience</b>]]> BACKGROUND: Blount's disease is a developmental disorder of the proximal tibia with progressive varus, flexion and internal rotation deformity. It is often seen in overweight children and strongly associated with obesity. As the prevalence of childhood obesity is increasing worldwide, the incidence of Blount's disease has been noted to be on the increase as well. In the South African population, most children are malnourished with high levels of undernutrition compared to other middle-income countries. We hypothesised that in our institution, patients with Blount's disease have a body mass index (BMI) lower than reported in studies from mainly developed countries. The aim of the study was to investigate the relationship between BMI and Blount's disease in a South African academic institution METHODS: All clinical and radiological records of patients with Blount's disease at a tertiary hospital in South Africa over a six-year period were retrospectively reviewed. Five patients did not meet inclusion criteria and were excluded from the study. Data collected included patients' demographics, weight, height and radiological investigations. A control group of randomly selected paediatric orthopaedic patients was studied RESULTS: A total of 39 Blount's patients (19 females, 20 male) were studied. All the Blount's patients were of black ethnicity. There were nine patients with early-onset and 30 patients with late-onset Blount's disease. The mean BMIs for Blount's disease and control groups were 26 kg/m2 and 20 kg/m2 respectively (p<0.001). There was no statistical difference in sex, laterality, BMI and BMI-percentiles (BMI%) between early-onset and late-onset Blount's disease. There was no relationship between BMI and severity of Blount's disease deformities CONCLUSION: High BMI is associated with Blount's disease in the cohort studied. There was no relationship between increasing BMI and severity of Blount's deformities. No relationship was found between sex, onset or laterality and Blount's disease in our study Level of evidence: Level 4 <![CDATA[<b>Reactivation of chronic haematogenous osteomyelitis in HIV-infected patients</b>]]> BACKGROUND: The aim of the study is to determine the prevalence of HIV infection among adult patients with reactivation of haematogenous chronic osteomyelitis METHODS: A retrospective analysis of prospectively collected data from 143 adult patients with chronic osteomyelitis RESULTS: A total of 143 patients were included in the study group, with a mean age of 38 years (range 14-78 years). Twenty-two per cent (n=31) of patients were diagnosed with reactivation of chronic haematogenous osteomyelitis, while 78% of patients had contiguous chronic osteomyelitis (29% [n=42] post-operative and 49% [n=70] post-traumatic, respectively). Forty (28%) patients were found to be HIV positive with a mean CD4 count of 414 cells/mm³ (range 13-1 034 cells/mm³). Twenty-four (60%) of patients with HIV were on antiretroviral therapy at time of diagnosis. The prevalence of HIV infection among patients with contiguous (post-operative or post-traumatic) infections was 32%, in comparison to 13% in the group with reactivation of chronic haematogenous infections (p=0.04; OR 3.2; 95% CI 1.0-9.8 CONCLUSION: The prevalence of HIV infection among patients with reactivation of chronic haematogenous osteomyelitis appeared to be lower than that seen in patients with chronic osteomyelitis from other causes and lower than that seen in the general population in South Africa Level of evidence: Level 4 <![CDATA[<b>Burden and profile of spinal pathology at a major tertiary hospital in the Western Cape, South Africa</b>]]> BACKGROUND: Spinal pathology in the Western Cape is managed at three tertiary level hospitals, including Tygerberg Hospital. The Tygerberg Hospital Orthopaedic Spinal Unit is responsible for the management of spinal pathology for the 3.4 million people in the hospital's catchment area. However, the unit's overall burden of disease and associated resource use is currently unclear AIM: The first aim was to investigate the overall burden and clinical profile of spinal pathology presenting to the Tygerberg Hospital Spinal Unit over a one-year period. The second aim was to determine resource use associated with spine pathology admissions METHODS: Overall burden was investigated by performing a retrospective review of all patients admitted to the Spine Unit between 1 October 2016 and 30 September 2017. Demographic and clinical data was collected, and patients were assigned to one of Ave spinal pathology sub-groups. Resource use was determined by length of hospital stay, waiting times, advanced imaging and theatre usage RESULTS: Overall burden comprised 349 individual patients and 376 admissions, including readmissions. Trauma (51%) and infection (24%) accounted for the majority of admitted pathology with degenerative (10%), deformity (7%) and malignancy (7%) representing fewer admissions. Motor vehicle accidents were the primary mechanism of injury, accounting for 48% of spine trauma. Tuberculosis was the causative organism in 87% of spinal infections with 44% HIV co-infection. Hospital resource use was considerable with 92% of spine patients requiring advanced imaging, a median operating time of 3 h 36 min and a median hospital stay of 19 days. Infection and malignancy sub-groups had the longest waiting times for advanced imaging and theatre with a median wait of 14-16 days, accounting for approximately 62% of the typical total hospital stay CONCLUSIONS: The Spine Unit experienced a substantial patient burden requiring significant hospital resources. Reduced in-patient waiting times and upskilling of orthopaedic services at secondary hospitals represent key areas for health system strengthening. However, multi-sectoral strategies would be required to effectively address our high burden of largely preventable spinal pathology Level of evidence: Level 4 <![CDATA[<b>Minimally invasive CT-guided excision of osteoid osteoma and other small benign bone tumours: a single centre case series in South Africa</b>]]> BACKGROUND: The management of osteoid osteoma (OO) and other small primary benign lesions of bone has evolved over the past 50 years from open surgery with wide resection margins to less invasive surgical techniques such as image-guided intralesional excision and percutaneous radiofrequency ablation. We aim to evaluate the outcomes of patients treated with computerised tomography (CT-guided) intralesional excision and bone grafting of small benign lesions of bone METHOD: A retrospective folder review of patients treated in a large academic hospital in Cape Town, South Africa, between March 2012 and May 2016 was performed. Patient demographics, details of presentation, clinical information and outcome following treatment were analysed descriptively. Pre-operative diagnosis based on radiological examination was compared with histological diagnosis RESULT: Eleven patients (Ave male) with a median age of 16 years (range 5-33) were included. Pain was the most common presenting feature. A histological diagnosis of OO was confirmed in Ave of nine patients with a suspected diagnosis of OO pre-operatively. Of the four patients whose diagnosis changed after the procedure, the diagnoses included a benign spindle cell lesion, a benign fibrous histiocytoma, subacute osteitis and an osteochondral defect with geode cyst formation. Of the two patients where OO was not suspected pre-operatively, chondroblastoma was confirmed in one while a benign spindle cell lesion was reported in the other. Overall histological yield was thus 100%. There were no complications or repeat procedures at a median follow-up of 42 months (range 30-52 months CONCLUSION: CT-guided intralesional curettage is a safe and minimally invasive technique. This is especially useful in less accessible regions of the skeleton as it provides a means of accurately locating the lesion with minimal risk of complications and morbidity to the patient. We consider this to be the optimal method of treatment in our setting as it provides high success rates, few complications and a histological diagnosis without the need for any additional and expensive equipment Level of evidence: Level 4 <![CDATA[<b>Incidence and risk factors for extended post-operative length of stay following primary hip arthroplasty in a South African setting</b>]]> BACKGROUND: This study sought to determine the incidence of extended post-operative length of stay (EPLoS) and its associated risk factors in South African primary hip arthroplasty patients METHODS: This was a retrospective chart review study of 185 adults who underwent primary hip arthroplasty at a quaternary South African hospital. Data related to patient, clinical, and surgical characteristics were collected. Post-operative length of stay was calculated as the time (in days) between the dates of surgery and discharge from hospital. We defined EPLoS as any length of stay &gt;75th percentile obtained for the entire study population. Data were analysed using univariate and multivariate statistical methods RESULTS: The incidence of EPLoS was 28.1% (95% confidence interval - CI: 22.1-35.0%). Risk factors for EPLoS included: female sex (odds ratio - OR: 4.63, 95% CI: 1.74-12.34; p=0.002), patient's maximum walking distance <100 m (OR: 3.05, 95% CI: 1.05-8.89; p=0.041) and extended duration of surgery (OR: 3.62, 95% CI: 1.31-10.01; p=0.013 CONCLUSION: We provide a report of EPLoS and several associated risk factors in South African primary hip arthroplasty patients Level of evidence: Level 4 <![CDATA[<b>Pharmaceutical management of bone catabolism: the bisphosphonates</b>]]> BACKGROUND: Conditions associated with catabolism of bone are common and progress sub-clinically with devastating skeletal consequences. Over the past two decades, bisphosphonates have become increasingly popular for the preventative management of the skeleton in these conditions METHODS: Recent literature pertaining to the mechanisms of action, clinical indications and complications of bisphosphonate therapy was retrieved using Google Scholar and Pubmed. AIMS OF STUDY: To provide an overview of the mechanisms of action, indications, contraindications and complications of the bisphosphonates available for clinical use in South Africa. RESULTS: Despite the availability of alternative management regimens, bisphosphonates remain the pharmaceuticals of choice for the management of hypercalcaemia and generalised catabolic skeletal disorders such as osteoporosis, skeletal metastatic disease, Paget's disease of bone, glucocorticoid bone disease and osteogenesis imperfecta. Although adverse complications such as tachycardia, bowel and oesophageal irritation, pain, jawbone necrosis and atypical femur fractures are well documented, information remains limited on the long-term effects of bisphosphonate therapy on skeletal health. This manuscript provides an update on the mechanisms of action, principles applied to the selection of the most appropriate management regimen, monitoring of the response and complications of the bisphosphonates marketed in South Africa Level of evidence: Level 5