Scielo RSS <![CDATA[SA Orthopaedic Journal]]> http://www.scielo.org.za/rss.php?pid=1681-150X20110001&lang=en vol. 10 num. 1 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Change</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2011000100001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Blood transfusion in orthopaedic surgery</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2011000100002&lng=en&nrm=iso&tlng=en <![CDATA[<b>11<sup>th</sup> International Federation of Societies for Surgery of the Hand Congress, Seoul, South Korea</b>: <b>31 october - 4 november 2010</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2011000100003&lng=en&nrm=iso&tlng=en <![CDATA[<b>Cervical PEEK cage standalone fusion</b>: <b>the issue of subsidence</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2011000100004&lng=en&nrm=iso&tlng=en <![CDATA[<b>Surgery for myelopathy in spinal deformity</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2011000100005&lng=en&nrm=iso&tlng=en AIM: To review surgical management and outcome in patients with myelopathy as the presenting complaint due to an underlying spinal deformity. METHODS: A retrospective review of 15 patients over an eight-year period (2002-2009) was performed. The duration and severity of symptoms were recorded, the deformity assessed by radiological measures and surgical management and neurological outcome was reviewed. RESULTS: The average age at surgery was 18.2 years with the average duration of recognised deformity being 60.3 months. Myelopathic symptoms were present for an average of 8 months before surgery with only two patients presenting acutely. Seven patients had congenital spinal deformities, three previous tuberculosis, two neurofibromatosis, one diastrophic dysplasia, one adolescent idiopathic scoliosis and one previously fused myelomeningocoele with pseudarthrosis. Two patients had severe scoliotic curves, three had moderate kyphosis (45-60º), five had severe kyphosis (>90º), and five complicated multi-planar helical deformities. The surgical procedures included one posterior only, two anterior only, five staged anterior and posterior procedures, four combined anterior and posterior procedures and three posteriorly-based circumferential vertebral column resection procedures. Two patients deteriorated neurologically and 13 remained the same or improved: three ASIA B to B/C/D, three C to E, seven D to D/E. Other complications included two aborted anterior procedures due to impossible access, one revision for incomplete decompression, one revision for graft displacement, one deep wound infection and one wound breakdown. CONCLUSION: This heterogeneous group of patients represents an extreme surgical challenge. Once neurological compromise develops, recovery or improvement with surgery is possible, but with associated risk of complete paralysis. However, deterioration is inevitable without surgery. High thoracic deformities are a frequent cause and should be identified and referred early. In this scenario, we currently recommend surgical management by means of a posteriorly based, circumferential decompression and corrective fusion. <![CDATA[<b>Acute traumatic cervical spinal cord injuries</b>: <b>correlating MRI findings with neurological outcome</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2011000100006&lng=en&nrm=iso&tlng=en STUDY DESIGN: Retrospective, observational, cohort study. OBJECTIVES: To evaluate whether quantitative and qualitative magnetic resonance imaging (MRI) assessments after acute traumatic cervical spinal cord injuries (SCI) correlate with the patient's neurological status and if they are predictive of outcome at long-term follow-up. MATERIALS AND METHODS: Eighty-eight patients (77 male, 11 female) with traumatic cervical spinal cord injuries who were admitted to the spinal unit, were evaluated over a period of five years (Jan 2004-Dec 2008). Neurological impairment was classified using the Frankel classification both on admission and discharge. MR imaging was done on all patients using both T1-and T2-weighted sagittal scans, axial T2-weighted scans and axial gradient recalled echo imaging (for evaluation of haemorrhage). Three quantitative imaging parameters (maximum spinal cord compression [MSCC], maximum canal compromise [MCC], and length of lesion) as well as five qualitative parameters (intramedullary haemorrhage, cord oedema, cord swelling, disc herniation and soft tissue injury) were evaluated and correlated to the patients' neurological outcome. RESULTS: Patients with a complete motor and sensory SCI (Frankel A) had higher frequencies of intramedullary haemorrhage (p<0.001), cord swelling (p=0.002) and cord oedema (p<0.001) compared to the incomplete SCI (Frankel grade B, C and D) and those without any neurology (Frankel grade E). Patients with complete SCI also had a more substantial MSCC (p=0.008), MCC (p=0.009) and lesion length (p=0.001) compared to the other two groups. The length of lesion (p=0.019) and intramedullary haemorrhage (p=0.001) correlate with baseline neurology. MSCC (p=0.063), length of lesion (p=0.011) and intramedullary haemorrhage (p=0.036) were predictive of a poor neurological outcome. CONCLUSION: The study demonstrated MR imaging to be a useful tool in prognosticating a patient's potential for neurological recovery. It indicated that MSCC, length of lesion and intramedullary haemorrhage are associated with a poor prognosis for neurological recovery. <![CDATA[<b>Thirty three years of clinical experience with crosslinking of polyethylene in cemented total hip replacement</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2011000100007&lng=en&nrm=iso&tlng=en In response to the realisation, in the early 70s, that polyethylene debris emerged as an important cause of osteolysis and implant looseness, a new hip implant was designed and developed in Pretoria. Although this was a Charnley lookalike, one of its most important goals was to reduce polyethylene wear and particle disease to the absolute minimum. A programme to gamma-crosslink pre-manufactured polyethylene cups was undertaken under the expert guidance of the third author. The process was unique in the sense that surface crosslinking was augmented in the presence of acetylene as mediating gas in the crosslinking chamber. In vitro mechanical tests were promising and were published extensively locally and abroad. From 1977 to 1983 a cohort of 2200 hip replacements was performed by the first and second authors combine. This publication acknowledges the Johannesburg cohort, but will focus on the 1775 cases performed by the Pretoria practice, with valuable co-operation and comparisons with the Johannesburg group. From our 1775 operations, we were able to follow up 272 hips at 10 years, and 97 operations for 10-33 years (mean 20.2 years) and this follow-up process is still ongoing. It was concluded that there was an almost seven to eight times improvement in the polyethylene cup wear, from the international figure of ± 0.1mm per year down to 0.015 mm per year. Not only the longevity, but also the arthroplasty quality was greatly improved. Polyethylene crosslinking has now reached international acceptance in the written as well as the electronic press. <![CDATA[<b>Longterm evaluation of polyethylene wear in total hip replacement</b>: <b>a statistical analysis of the <i>association</i> between the degree of wear versus pain, interface change, osteolysis and implant failure</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2011000100008&lng=en&nrm=iso&tlng=en With over 3.5 decades dedicated exclusively to total joint replacement, our arthroplasty unit has repeatedly identified and reported a clear correlation between cup wear on the one hand, and pain, interface widening and osteolytic failure on the other. However, in view of the fact that this statement has sparked some controversy, clarification of this correlation became imperative, particularly in view of important clinical consequences. Materials and methods were provided by a potentially long-lasting gamma crosslinked cup. The arthroplasty follow-up ranged from 10-33 years. Objective clinical, radiographic and pathological evaluations were backed by computer analysis through the Department of Statistics at the University of Pretoria. We are able to conclude that the statistical correlation between wear, on the one hand, versus pain, interface effects and osteolysis on the other, was no coincidence but instead proved to be clearly conclusive. Of great importance is the fact that this study allowed us to set new objective criteria for true failure as well as impending failure, thus guiding us towards sensible decision-making in terms of revision surgery in these complex issues. Cup wear was thus clearly identified as the overwhelming leading variable in long-term prognosis in this type of total hip replacement. <![CDATA[<b>Analysis of wear-related <i>failures</i> in long-term follow-up of crosslinked polyethylene hip sockets</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2011000100009&lng=en&nrm=iso&tlng=en The publication of our longterm hip replacement followup study computer analysis has clearly demonstrated the association between polyethylene (polyethylene/UHMWPE) wear on the one hand and pain, interface widening and osteolysis on the other. From a total of 97 cases, seven had true failure and needed ultimate revision. These seven cases formed the nucleus of the current study (Group 1). The course of events could then be analysed in great detail, and compared with the other 90 cases (Groups 2, 3, and 4). The purpose of this paper was to confirm the role of polyethylene wear (the independent variable) in the limitation of longevity of the implant; furthermore to identify the cutoff point of wear that is considered acceptable. At the same time quantification of P, I, O (pain, interface widening and osteolysis) was studied (the dependent variables). Once again, computer analysis provided us with detailed values that would constitute the cutoff points for acceptance. These findings then enabled us to categorise the 97 cases into four groups. Of special interest was Group 2: 'impending failure'. Even though none of the nine cases in Group 2 were revised, this study clearly demonstrated that they should be classified as failures and managed accordingly. In this study some other controversial issues were addressed: the degree of wear proved important as opposed to the tempo, which was not! Equally unimpressive were the patients' age, activity and body mass, which according to digital analysis had little effect on implant longevity. <![CDATA[<b>Ultrasound and the shoulder surgeon</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2011000100010&lng=en&nrm=iso&tlng=en Sonography is an effective tool in the evaluation and management of shoulder problems. The utility of shoulder sonography extends across the entire spectrum of shoulder pathology; although most soft tissue structures can be visualised using appropriate techniques, consistent and reliable recognition of pathology requires a reasonable level of skill and experience. Magnetic resonance imaging (MRI) offers an operator-independent and reliable alternative to sonography; however, sonography provides a low-cost office-based imaging method, and both static and dynamic techniques can be performed and interpreted instantly. A concise description of the diagnostic and therapeutic applications of shoulder ultrasonography, as performed by the authors, is presented here. <![CDATA[<b>What about the right to a good name?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2011000100011&lng=en&nrm=iso&tlng=en Sonography is an effective tool in the evaluation and management of shoulder problems. The utility of shoulder sonography extends across the entire spectrum of shoulder pathology; although most soft tissue structures can be visualised using appropriate techniques, consistent and reliable recognition of pathology requires a reasonable level of skill and experience. Magnetic resonance imaging (MRI) offers an operator-independent and reliable alternative to sonography; however, sonography provides a low-cost office-based imaging method, and both static and dynamic techniques can be performed and interpreted instantly. A concise description of the diagnostic and therapeutic applications of shoulder ultrasonography, as performed by the authors, is presented here. <![CDATA[<b>Do some of the newer COX-2 inhibitors cross-react with sulfonamide antibiotics?</b> <b>An overview</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2011000100012&lng=en&nrm=iso&tlng=en The professional information leaflets of three locally available specific cyclooxygenase-2 inhibitors indicate that these drugs are contraindicated in persons with a known allergy to sulfonamides. There are many concerns about cross-allergenicity between sulfonamide antibiotics and non-antibiotic sulfonamide-containing drugs including the sulfones, and these concerns continue to complicate drug therapy. Several elegant investigations have demonstrated lack of interaction between the sulfonamide group and either cellular or humoral immunity. The immunologic determinant of type I immunologic responses to sulfonamide antibiotics are the N1 heterocyclic ring, and non-antibiotic sulfonamides including the sulfones lack this structural feature. Reactive sulfonamide metabolites contribute many non-type I hypersensitivity responses to sulfonamide antibiotics. Metabolite formation demonstrates stereospecificity to the N4 amino nitrogen of the sulfonamide antibiotics, a structure not found on any non-antibiotic sulfonamide drugs and is also lacking in the sulfones. Apparent cross-reactivity responses to sulfonamide-containing drugs likely represent multiple concurrent, rather than linked, drug hypersensitivities. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2011000100013&lng=en&nrm=iso&tlng=en The professional information leaflets of three locally available specific cyclooxygenase-2 inhibitors indicate that these drugs are contraindicated in persons with a known allergy to sulfonamides. There are many concerns about cross-allergenicity between sulfonamide antibiotics and non-antibiotic sulfonamide-containing drugs including the sulfones, and these concerns continue to complicate drug therapy. Several elegant investigations have demonstrated lack of interaction between the sulfonamide group and either cellular or humoral immunity. The immunologic determinant of type I immunologic responses to sulfonamide antibiotics are the N1 heterocyclic ring, and non-antibiotic sulfonamides including the sulfones lack this structural feature. Reactive sulfonamide metabolites contribute many non-type I hypersensitivity responses to sulfonamide antibiotics. Metabolite formation demonstrates stereospecificity to the N4 amino nitrogen of the sulfonamide antibiotics, a structure not found on any non-antibiotic sulfonamide drugs and is also lacking in the sulfones. Apparent cross-reactivity responses to sulfonamide-containing drugs likely represent multiple concurrent, rather than linked, drug hypersensitivities.