Scielo RSS <![CDATA[SA Orthopaedic Journal]]> vol. 11 num. 3 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>Osteoporosis</b>: <b>are we doing the right thing?</b>]]> <![CDATA[<b>Academic orthopaedics in South Africa - what is the future?</b>]]> <![CDATA[<b>The results of a cementless acetabular component combined with impaction bone grafting in patients with acetabular protrusion</b>]]> We undertook this study to determine the results of acetabular fixation using the Duraloc 300 uncemented acetabular component combined with impaction bone grafting in patients with acetabular protrusion. Forty-two consecutive total hip replacements using a Duraloc 300 cup in patients with acetabular protrusion requiring impaction bone grafting were reviewed at an average of 6.3 years. In no cases were structural graft, wire mesh or cages utilised. Pre-operative X-rays were analysed for degree of protrusion. Post-operative X-rays were analysed for cup placement including centre of rotation and interface gaps. Follow-up films were analysed for graft incorporation, lucent lines, osteolysis, wear and migration. Kaplan-Meier survivorship analysis was performed. All components were found to be stable. Two components moved in the immediate post-operative period, but both components stabilised within six months of surgery and have remained stable for seven and eight years respectively. Incorporation and remodelling of the bone graft occurred in all cases. Mean rate of wear was 0.19mm per year. One case of pelvic osteolysis was seen. The Duraloc 300 cup provides excellent fixation in patients with acetabular protrusion and impaction bone grafting and fixation can be achieved without the use of structural graft, wire mesh or cages. We are therefore optimistic that the durability of fixation should equal that of primary hip surgery without protrusion. <![CDATA[<b>Revision total hip arthroplasty</b>: <b>addressing acetabular bone loss</b>]]> Managing deficient acetabular bone in primary and revision total hip arthroplasty requires thought and planning. This paper focuses on the management of bone loss in revision arthroplasty and presents an overview of the literature, the careful pre-operative assessment required prior to surgery and the surgical options available to achieve an optimal outcome. <![CDATA[<b>Bone loss in shoulder replacement surgery: a review of current management</b>]]> Hemiarthroplasty was first introduced in 1951 by Boron and Sevin and the first series of total shoulder replacements (TSR) was reported in 1974 by Neer.¹ The primary indications for the use of these implants have been non-reconstructable fractures and arthritis. The reverse TSR was first introduced in the 1970s, but had minimal clinical success due to poor design. It has since been redesigned and received approval from the US Food and Drug Administration for use in 2003 and now is commonly used for rotator cuff arthropathy, massive rotator cuff tears, arthritis and fractures.² Bone loss may be encountered in primary and revision surgery. It is a difficult problem to manage and may even be a contraindication to surgery when severe. Bone loss may affect both the glenoid and humeral side of the joint. Multiple studies have shown component loosening and osseous deficiency to be much more common on the glenoid side than the humerus.3-7 <![CDATA[<b>Bone loss in total knee replacement</b>: <b>a rational approach to management</b>]]> Dealing with bone defects in primary and revision knee arthroplasty is challenging and requires careful planning to define and quantify the deficiency. Pre-operative clinical, radiological and intra-operative assessment facilitates the classification of the defect and instructs in the appropriate bone replacement and implant strategy. This paper reviews the assessment and treatment options. <![CDATA[<b>Fibromatosis</b>: <b>Where are we now?</b>]]> PURPOSE OF THE STUDY: Fibromatosis is a benign but locally aggressive tumour. A high rate of recurrence was noted in a number of patients treated by the senior author at a tumour and sepsis unit despite the fact that a wide surgical excision had been performed. The question was raised whether there are any alternate treatment modalities with a higher success rate available currently. A retrospective study and review of the literature was performed in order to ascertain whether new treatment modalities which can prevent recurrence more successfully have been developed recently. MATERIALS AND METHODS: A retrospective study was performed. The files of all patients who presented at an orthopaedic practice with confirmed fibromatosis on histological examination in the past 19 years were reviewed. The following was looked at: age of the patient at first presentation; gender; tumour site; surgery performed; histological results; first line of treatment and recurrence rate. Patients were also contacted telephonically in order to ascertain whether any recurrence managed by another orthopaedic surgeon had been attended to. RESULTS: We evaluated 17 patients of which eight were males and nine females. The mean age was 25.87 years (range 2-52years). All of the primary sites were extra-abdominal. Median follow up was 3.9 years (0-9) with a mean recurrence rate of 2.3 times. All the patients were treated with a wide marginal surgical excision without adjuvant therapy. CONCLUSION: Fibromatosis has a high recurrence rate using current surgical treatment modalities. Complete surgical excision does not lead to a good outcome. The literature review revealed that a wide variety of treatment modalities, both surgical and non-surgical, are available. Non-surgical treatment modalities include: hormones; non-steroidal anti-inflammatory drugs; chemotherapy; radiotherapy. Wide surgical excision remains the mainstay of treatment but a multidisciplinary approach is necessary in order to optimise the efficacy of this treatment. LEVEL OF EVIDENCE: Level III <![CDATA[<b>Metal-on-metal arthroplasty using the Metasul prosthesis with a minimum ten-year follow-up</b>]]> Despite concern in recent literature about the adverse effects and complications of metal-on-metal total hip replacements, we have obtained excellent results ten to 15 years after metal-on-metal total hip arthroplasty in 11 out of 12 patients (91.66%) that were available for clinical follow-up. We could trace 15 out of a total of 18 patients (88.33%). Three patients died between the nine- and ten-year follow-up. All our available patients were clinically examined using the Harris Hip Score; hip radiographs; ultrasound and blood investigations. Only one patient (8.33%) needed revision surgery. This information can be used to reassure both orthopaedic surgeons and patients who had metal-on-metal total hip arthroplasty performed in the past that not all metal-on-metal total hip replacements need to be revised. We would advise that if patients present with symptoms or signs they should be thoroughly examined clinically and radiologically, and undergo laboratory investigations, before considering revision surgery. <![CDATA[<b>The effect of joint line restoration on kneeling ability after primary total knee replacement</b>]]> BACKGROUND: Total knee replacement (TKR) surgery has become one of the commonest orthopaedic procedures undertaken. Pain relief and restoration of function are two major expectations following knee arthroplasty. Kneeling is a knee function required for many types of occupation and activities of daily living, making its restoration following knee arthroplasty essential. Restoration of joint line position is a surgical factor that has been reported to have an important impact on functional outcome after TKR. MATERIALS AND METHODS: We reviewed 100 (43 males and 57 females; with a mean patient age of 71 years) consecutive cemented Kinemax Plus TKRs (Stryker, Newbury, UK) performed in our unit with a minimum follow-up of two years. Joint line measurements were made on the pre-operative and post-operative X-rays. The kneeling ability component of the Oxford Knee Score questionnaire was analysed for all patients. The pre- and post-operative Oxford Knee Scores were prospectively recorded. Patients' ranges of movement (ROM) were measured. RESULTS: The mean pre-operative ROM for the group was 82° (std ± 15). Post-operatively, the mean ROM for the whole group was 109° (std ± 8). A joint line within ± 5 mm of the pre-operative measurement was considered 'restored' and more than 5 mm was considered 'elevated. Seventy-five per cent of patients had the joint line restored within 5 mm of their native joint line post-operatively. The mean ROM for restored and elevated groups was 116° and 108° respectively. This difference was statistically significant (P < 0.01). However, there was no significant difference in the total Oxford Knee Score between the groups. CONCLUSION: Seventy-five per cent of cases in this study showed a restored joint line position. In this group, the ROM was better than in the group with elevated joint line (116° for restored joint line versus 108° for elevated joint line). This study showed that restoring the joint line had a positive impact on the post-operative ROM and kneeling ability. However, kneeling ability can be affected by other factors and further studies are necessary to fully investigate this complex function of the knee joint. <![CDATA[<b>Infantile tuberculous osteomyelitis of the proximal tibia involving the growth plate</b>]]> With an ever-increasing prevalence of tuberculosis (TB) in Sub-Saharan Africa it is now more important than ever to consider tuberculosis when drawing up a list of differentials in musculoskeletal disease. We present a case of infantile tuberculous osteomyelitis of the proximal tibia involving the growth plate. <![CDATA[<b>Bilateral anterior glenohumeral fracture dislocation</b>]]> Bilateral anterior dislocation of the glenohumeral (shoulder) joint is uncommon. Incidences of bilateral anterior fracture dislocation of the shoulder are relatively rare. About 16 cases are reported in the world literature. We report a case of bilateral anterior dislocation of the shoulder with bilateral avulsion fractures of the greater tuberosities of the humerus following seizure or convulsion due to electric shock. <![CDATA[<b>The contralateral hip in SCFE</b>: <b>prophylactic pinning complicated by a subtrochanteric fracture</b>]]> The management of the contralateral unaffected hip in the unilateral slipped capital femoral epiphysis (SCFE) remains controversial. This is a report of two cases of subtrochanteric femoral fracture following prophylactic pinning. These two cases illustrate that prophylactic pinning is not devoid of complications as the literature might suggest, and should be highlighted as a potential post-operative complication. <![CDATA[<b>Informed consent</b>]]> The management of the contralateral unaffected hip in the unilateral slipped capital femoral epiphysis (SCFE) remains controversial. This is a report of two cases of subtrochanteric femoral fracture following prophylactic pinning. These two cases illustrate that prophylactic pinning is not devoid of complications as the literature might suggest, and should be highlighted as a potential post-operative complication.