Neglected Achilles tendon rupture with central insertional plantaris tendon hypertrophy: two cases

A neglected Achilles tendon rupture is often characterized by muscle weakness and an overlengthened repair by scar tissue. Reconstructive surgery is usually performed taking into account the patient’s required level of function. Two surgical cases of neglected Achilles tendon rupture are presented in this article. In both instances it was expected that central fibrosis, possibly after neglected tendon rupture, would be found. However, after longitudinal opening of the tendons, a thickened plantaris tendon was evident at the insertion on the calcaneus in both cases. This hypertrophic tendon occupied most of the diameter of the Achilles tendon. Due to partial or complete rupture of the Achilles tendon, there was notable weakening and tendon transfer-augmentation was performed. A thickened plantaris tendon as a reaction to a neglected rupture of the Achilles tendon is a rare presentation. It can be detected preoperatively by MRI and subsequently preoperative planning can be optimized

Excellent results with the cemented Lubinus SP II 130-mm femoral stem at 10 years of follow-up

Background and purpose - The Lubinus SP II stem is well documented in both orthopedic registries and clinical studies. Worldwide, the most commonly used stem lengths are 150 mm and 170 mm. In 1995, the 130-mm stem was introduced, but no outcome data have been published. We assessed the long-term survival of the Lubinus SP II 130-mm stem in primary total hip arthroplasty.Patients and methods - In a retrospective cohort study, we evaluated 829 patients with a Lubinus SP II primary total hip arthroplasty (932 hips). The hips were implanted between 1996 and 2001. The primary endpoint was revision for any reason. The mean follow-up period was 10 (5-15) years.Results - Survival analysis showed an all-cause 10-year survival rate of the stem of 98.7% (95% CI: 99.7-97.7), and all-cause 10-year survival of the total hip arthroplasty was 98.3% (95% CI: 99.3-97.3).Interpretation - Excellent long-term results can be achieved with the cemented Lubinus SP II with the relatively short 130-mm stem. This stem has potential advantages over its 150-mm and 170-mm siblings such as bone preservation distal to the stem, better proximal filling around the prosthesis, and easier removal.</p

Quantitative analysis of orthopedic metal artefact reduction in 64-slice computed tomography scans in large head metal-on-metal total hip replacement, a phantom study

Purpose: Quantification of the effect of O-MAR on decreasing metal artefacts caused by large head metal on metal total hip arthroplasty (MoM THA) in a dedicated phantom setup of the hip. Background: Pathological reactions of the hip capsule on Computed tomography (CT) can be difficult to diagnose due to different metal artefacts. The O-MAR algorithm deploys an iterative loop where the metal sinogram is identified, extracted, and subsequently serves as a mask to correct the measured sinogram. Main goal of this study is to quantify the ability of the O-MAR technique to correct deviation in medullary bone attenuation caused by streak artefacts from the large-head MoM THA embedded in a phantom. Secondary goal is to evaluate the influence of O-MAR on CNR. Methods: The phantom was designed as a Perspex box (PMMA) containing water and a supplementary MOM THA surrounded by Perspex columns comprising calibrated calcium pellets. Each column contains 200 mg of hydroxyapatite/calcium carbonate to simulate healthy bone tissue. Scans were obtained with and without a MoM THA at different dose levels. Different reconstructions were made with filter A, iDose(4) level 5 and with and without O-MAR. The scans without the prosthesis were used as the baseline. Information about the attenuation in Hounsfield units, image noise in standard deviation within the ROI's were extracted and the CNR was calculated. Results: Pellet L0 and R0 (proximal of the MoM THA) were defined as reference, lacking any disturbance by metal artefacts; L5, L6 and L8 were respectively visually categorized as 'light' 'medium' and 'heavy disturbance'. Significant improvements in attenuation deviation caused by metal artefact were 43, 68 and 32 %, for respectively pellet L5, L6 and L8 (p <0.001). Significant CNR improvements were present for L5 and L6 and were respectively 72 and 52 % (p <0.001). O-MAR showed no improvement on CNR for L8. Conclusion: This phantom study significantly increases image quality by the use of O-MAR in the presence of metal artefacts by significantly reducing metal artefacts subsequently and increasing CNR on a 64 slice CT system in light and medium disturbance of the imag

Dutch orthopedic thromboprophylaxis: a 5-year follow-up survey

Background and purpose Previous surveys in the Netherlands have revealed that guidelines regarding orthopedic thromboprophylaxis were not followed and that a wide variation in protocols exists. This survey was performed to assess the current use of thromboprophylactic modalities and to compare it with the results of a previous survey

The learning environment and resident burnout:a national study

Introduction Concerns exist about the negative impact of burnout on the professional and personal lives of residents. It is suggested that the origins of burnout among residents are rooted in the learning environment. We aimed to evaluate the association between the learning environment and burnout in a national sample of Dutch residents. Methods We conducted a cross-sectional online survey among all Dutch residents in September 2015. We measured the learning environment using the three domain scores on content, organization, and atmosphere from the Scan of Postgraduate Educational Environment Domains (SPEED) and burnout using the Dutch version of the Maslach Burnout Inventory (UBOS-C). Results Of 1,231 responding residents (33 specialties), 185 (15.0%) met criteria for burnout. After adjusting for demographic (age, gender and marital status) and work-related factors (year of training, type of teaching hospital and type of specialty), we found a consistent inverse association between SPEED scores and the risk of burnout (aOR 0.54, 95% CI 0.46 to 0.62, p <0.001). Discussion We found a strong and consistent inverse association between the perceived quality of the learning environment and burnout among residents. This suggests that the learning environment is of key importance in preventing resident burnout

A body-fixed-sensor based analysis of compensatory trunk movements during unconstrained walking

This paper presents a body-fixed-sensor (BFS) based approach for quantifying compensatory trunk movements during unconstrained walking. Orientation of trunk segments was calculated by fusing low-pass filtered accelerometer data and high-pass filtered data from gyroscopes. To evaluate accuracy, frontal plane angular movements of the pelvis during different treadmill walking conditions were compared to results based on a high-accuracy camera system. Mean differences between the two methods remained within 0.31 degrees, standard deviations of differences within 1.4 degrees and error percentages within 17.7%. Correlations ranged from 0.87 to 0.99. To test, whether the method could discriminate between hip arthroplasty patients with and without compensatory trunk movements, the BFS based method was applied to patients and healthy controls during overground walking. Within a walking speed range of 0.40-1.10 m/s, the peak-to-peak amplitudes of trunk movements ranged from 5.7 degrees to 7.9 degrees in healthy subjects and from 13.5 degrees to 26.3 degrees versus 7.4 degrees to 13.8 degrees in patients with and without compensatory trunk movements, respectively. The presented BFS based approach can be used to assess spatio-temporal gait parameters and trunk movements and thus to objectively monitor gait function in hip arthroplasty patients in a clinical setting, (c) 2007 Elsevier B.V. All rights reserved

First experiences with the direct anterior approach in lateral decubitus position: learning curve and 1 year complication rate

The direct anterior approach (DAA) in supine position for hip arthroplasty has been reported to suffer from high complication rates initially. The DAA with the patient in lateral decubitus position is believed to provide better visibility and especially femoral accessibility with potential fewer complications. The first cohort of total hip prostheses, which were implanted by a single surgeon using DAA in lateral decubitus position more than 1 year ago, was analysed retrospectively. In total 182 hip prostheses (172 patients) were analysed. Three consecutive time periods based on equal number of surgical procedures were compared. The technical complication rate and operating time improved significantly between the 3 consecutive groups. The 1 year infection rate was 0.5% and survival rate of 98.9%. This is the first series of patients that were subjected to a hip replacement based on the direct anterior approach in a lateral decubitus position in which decreasing complication rates suggest the presence of a learning curve in surgeons conducting this type of surgery. Initial complication rate was high but decreased significantly in time and was acceptable certainly in the third group of our cohort. An unacceptable complication rate with the straight uncemented stem forced us to discontinue this configuration after only 7 surgical procedures. Complication, infection and revision rates were acceptable for the all cemented hip replacements using a curved anatomical stem

Factors that influence femoral neck length. Analysis of 1543 patients with advanced osteoarthritis of the hip

<p>Background and purpose: There is little known about the relationship between patient characteristic and the variance in geometrical properties of the femoral neck. The length of the femoral neck is relevant when considering a femoral neck preserving hip replacement. Based on surgical experience we hypothesised that femoral neck length (FNL) decreased with age. We investigated whether certain patient characteristics were related to FNL and the femoral head diameter/FNL ratio.</p><p>Patients and methods: The femoral neck length of 1543 patients with osteoarthritis grade 3 and 4 was measured on calibrated pelvic radiographs.</p><p>Results: Increasing age and height were associated positively, while increasing CCD angle and femoral head diameter were associated negatively with femoral neck length. Female gender and height were associated negatively and CCD angle positively with the femoral head diameter/FNL ratio. The FNL in 10 year older individuals was on average 0.2 mm (1%) longer Moreover, every 10 extra degrees in CCD coincided with a neck length decrease of 1.5 mm (8%) in our population.</p><p>Interpretation: It seems justified to conclude that age is not a clinical relevant factor in the indication for femoral neck preserving hip arthroplasty. In this respect, CCD angle seems the most clinical relevant factor. Severe valgus angled hips are not a very suitable indication for femoral neck preserving prosthesis.</p>

Deep vein thrombosis after arthroscopic anterior cruciate ligament reconstruction: a prospective cohort study of 100 patients

To establish the incidence of venous thromboembolic complications as detected by bilateral complete compression ultrasonography (CCUS) after arthroscopic anterior cruciate ligament (ACL) reconstruction without thromboprophylaxis. We performed a prospective cohort study to establish the incidence of venous thromboembolic complications after arthroscopic ACL reconstruction, as detected by bilateral CCUS at 14 days (range, 11 to 17 days) postoperatively. One hundred consecutive patients underwent bilateral extended ultrasonography. One hundred predominantly European patients with a mean age of 30 ± 10 years and mean body mass index of 25 ± 4 underwent ACL reconstruction with a mean operative duration of 68 ± 23 minutes and a tourniquet time of 76 ± 23 minutes. In 84% of patients an autologous hamstring graft was used, in 14% a bone-patellar tendon-bone graft was used, and 2 patients received an allograft. Of 100 patients, 9 (incidence, 9%; 95% confidence interval, 4.2 to 16.4) showed asymptomatic proximal or distal deep vein thrombosis on CCUS, of whom 4 (incidence, 4%; 95% confidence interval, 1.1 to 9.9) were symptomatic. A nonfatal pulmonary embolus developed in 1 patient during the 8-week follow-up period. This study shows that the incidence of venous thromboembolism after arthroscopic ACL reconstruction is relatively high; a 9% incidence of asymptomatic proximal or distal deep vein thrombosis was found, whereas 4% of patients were symptomatic. Further research is recommended to assess the need for thromboprophylaxis in patients undergoing ACL reconstruction, especially when risk factors are present. Level IV, case serie