^{11th International Conference on}
Osteoporosis, Arthritis and Musculoskeletal Disorders

Biography:

Cathleen J O'Neill is currently employed as a Senior House Officer. She is Core Trainee in Year 1 in the Department of Orthopaedics, Cork University Hospital, Cork, Ireland. She has completed her BSc Physics in 2004. She did her MSc Medical Physics in 2005. She did her MRCS in 2017 and currently working as Senior House Officer in Cork University Hospital in Ireland.

Abstract:

Introduction: Robotic technology is increasingly being employed in the orthopaedic operating theatre. The adoption of this new technology will have a significant impact on patients, surgeons and hospital resources. As with the advent of any new surgical technology, it is imperative that robotics is introduced in a responsible fashion and that patient safety and outcome is not compromised during the learning process. We describe our initial MAKOplasty experience.

Methods: Data was collected prospectively on the combined first 50 cases performed by 5 surgeons. Twenty-nine males and 21 females with a mean age of 63years (range 52-82) were analyzed. Times were recorded pertaining to set-up, surgical procedure, burring, tourniquet use and total theatre usage. Wound length and estimated blood loss were also recorded. Intra-operative surgical difficulties along with post-operative complications and length of stay were recorded. Pre- and post-operative Oxford scores were compared using a paired student’s t- test.

Results: The set-up time averaged 36 mins and operative (“skin to skin”) time 101 mins. The total theatre utilization was 143 mins for single and 255 mins for bilateral cases. The mean burr time was 18 mins and the mean tourniquet time 90 mins. Wound length was 106 mm and mean estimated blood loss 46 ml. Mean length of hospital stay was 1.4 days for single and 2.4 days for bilateral cases. The mean Oxford score improved from 24.5 pre-operatively to 38.3 post-operatively p<0.0001. No robotic procedures were abandoned. There was one deep venous thrombosis and no deep infections.

Conclusion: Our data confirms the safe introduction of robotic technology. No trend was observed in terms of reduction in operative times. This may indicate that the plateau for institutional learning has not yet been reached. Further analysis of individual surgeon learning curves may show a reduction in operative times as case load increases. No serious adverse events were recorded.

Recent Publications:

1. Fives C, O'Neill C J, Murphy R, Corrigan M A, O'Sullivan M J, Feeley L, Bennett M W, O'Connell F and Browne T J (2016) When pathological and radiological correlation is achieved, excision of fibroadenoma with lobular neoplasia on core biopsy is not warranted. Breast 30:125-129.

2. Brennan SA, O'Neill CJ, Tarazi M and Moran R (2013) Bilateral neck of femur fractures secondary to seizure Practical Neurology doi: 10.1136/practneurol-2013-000754.

3. Brennan S A, Devitt B M, O'Neill C J and Nicholson P (2012) Periprosthetic fractures in the resurfaced hip-A case report and review of the literature. Injury 44(2):263-265.

Biography:

Dewei Zhao is a President of Affiliated Zhongshan Hospital of Dalian University, and President of Chinese Association of Microsurgery Surgeons. He dedicates in the treatment of osteonecrosis of femoral head (ONFH) for nearly three decades. Based on anatomical and clinical study, he has made original series surgical techniques for reconstruction of the necrotic femoral head, and these techniques can be applied in every stage of ONFH. He is the editor of nine academic journals. He has published more than 200 papers in basic and clinical research of ONFH, the new finding of circulation of femoral head, new metal biomaterials and their clinical application. His work is especially important for younger patients with symptomatic ONFH.

Abstract:

Purposes: To explore the characteristics and interconnections of the intraosseous vessel system between different areas of the femoral head and the possible blood supply compensatory mechanism after femoral neck fracture (FNF).

Methods: The 3-D structures of the extra- and intraosseous arteries in 30 uninjured normal human femoral heads were reconstructed and quantified using angiography methods and micro CT scans, AMIRA and MIMICS. We also evaluated the residual blood supply of femoral heads in 27 patients with FNF before surgery by analyzing digital subtraction angiography (DSA) data. The number of affected and unaffected groups of retinacular arteries with different Garden types of fractures were recorded and analyzed to reflect the affected degrees of these three groups of retinacular arteries in patients after FNF.

Results: Epiphyseal arterial network is the most widely distributed and the primary network structure in the femoral head; the main stems of the epiphyseal arteries which were located on the periphery of the intraosseous vascular system have fewer anastomoses than the central region. The DSA of the 27 patients with hip fractures indicated that the inferior retinacular arterial system had a high likelihood of being unaffected after FNF.

Conclusions: The epiphyseal arterial network and inferior retinacular arterial system appear to be two important structures for maintaining the femoral head blood supply after FNF. Increased efforts to protect these key structures during surgery, such as drilling and placing internal implants closer to the central region of the femoral head, might be helpful to reduce the effect of iatrogenic injury of the intraosseous vascular system.

Recent Publications:

1. Zhao D, Qiu X and Wang B, et al. (2017) Epiphyseal arterial network and inferior retinacular artery seem critical to femoral head perfusion in adults with femoral neck fractures. Clin Orthop Relat Res. 475(8):2011-2023.

2. Kamada T, Mashima N and Nakashima Y, et al. (2015) Mid-term clinical and radiographic outcomes of porous tantalum modular acetabular components for hip dysplasia. Journal of Arthroplasty 30(4):607-10.

3. Paton RW (2017) Screening in Developmental Dysplasia of the Hip (DDH). Surgeon 15(5):290-296.

4. Clohisy JC (2017) Developmental dysplasia of the hip: contemporary concepts and treatment innovations. Journal of Arthroplasty 32(9S): S18-S19.

5. Tarpada S P, Girdler S J and Morris M T (2017) Developmental dysplasia of the hip: a history of innovation. Journal of Pediatric Orthopaedics. Doi: 10.1097/BPB.0000000000000463.

Biography:

Jamie L Baisden is a Professor of Neurosurgery at the Medical College of Wisconsin specializing in Complex Spine. She has completed fellowships in Complex Spinal Surgery and Spinal Cord Medicine and has a Master’s in Medical Management from USC. Her research interests include spinal biomechanics, spinal trauma, and evidence based medicine guideline development for spinal disorders.

Abstract:

Statement of the Problem: Artificial cervical discs (ACDs) have been used, instead of the conventional ACDF in the military. ACDs have potential advantages of motion preservation and reduction of adjacent segment degeneration. Disc implants are classified as constrained, semi-constrained, and unconstrained device types. There have been independent reports of anterior migration and, sometimes disintegration, of non-constrained artificial discs. In vivo studies investigating the potential migration of the artificial disc are limited.

Purpose: The objective of this study is to examine the migration aspects in cervical discs using an in vivo model capable of simulating the axial load on the neck, and this mimics the human.

Methods: C3-C4 ACD was performed with commercial implants in twelve adult alpine caprines. There were three groups: Group A received constrained; group B received semi-constrained; group C received unconstrained ACD. Intra- and postoperative radiographs were performed to confirm hardware position. Goats were monitored for six months postoperatively. All goats tolerated cervical arthroplasty well and had satisfactory placement of the ACD implant on intra-operative radiography. There was no migration of the implants in Groups A and B. Complete anterior extrusion of the inferior plate out of the disc space and disintegration of the implant occurred within one week after surgery in three goats in Group C. The fourth goat had anterior extrusion at five weeks.

Conclusions & Significance: Biomechanical responses under flexion/extension loading depend on the type of the ACD. Unconstrained ACD implants rely on axial loading and limited range of motion of the disc segment to preserve integrity. Unconstrained ACD implants may not be the most efficacious in individuals with a hypermobile neck and/or occupation involving head supported mass/ helmets resulting in additional axial loads and repetitive motions of the cervical spinal column regions.

Recent Publications:

1. Alvin MD, et al. (2014) Cervical arthroplasty: a critical review of the literature. The Spine Journal 14 (9):2231-2245.

2. Ozbek Z, et al. (2017) Implant migration in cervical disk arthroplasty. World Neurosurgery 97:390-397.

3. Tsermoulas G and Bhattathiri PS (2013) Anterior migration of prosthesis following cervical arthroplasty. British Journal of Neurosurgery 27(1):132-133.

4. Wagner S C, et al. (2014) Implant migration after Bryan cervical disc arthroplasty. The Spine Journal 14(10):2513-2514.

5. Wagner S C, et al. (2016) Traumatic migration of the bryan cervical disc arthroplasty. Global Spine Journal 6(1): e15-20.

Biography:

Mohammed A Almustafa has his expertise evaluation in Orthopedics and Trauma Surgery. He had his training in Trauma and Orthopaedics in the East of England Deanery. Presently, he is working at the Department of Trauma and Orthopedics, Stockport NHS Foundation Trust, Stockport.

Abstract:

Background: Prosthetic joint infection (PJI) is a catastrophic complication following knee arthroplasty. Appropriate diagnosis and management are crucial to maintain a patient’s function and reduce morbidity.

Aim: Assess the outcome of three management strategies: revision of implant (1 or 2 stage); debridement and implant retention (DAIR); long-term suppressive therapy (including initial aspiration/washout).

Methods: 72 patients were identified as having a PJI within a knee replacement presenting to a single centre between January 2000 and October 2014. Case records were reviewed to assess management and outcome of treatment, including success determined by avoidance of further surgery/relapse.

Results: Two patients underwent only the first of a two-stage revision; one ankylosed without symptoms; one declined the second stage due to satisfactory function with a cement spacer still functioning well at four years. Conclusion: Revision (1 or 2 stage) of all implants remains the gold standard of care for PJI following knee replacement. Long-term suppressive therapy provided acceptable rates of infection control in patients unfit for revision surgery and was more effective than DAIR in our cohort. Patients unfit for surgical management of their PJI have an extremely high one-year mortality rate. Implications: Suppressive therapy is an acceptable treatment strategy for the surgical unfit patient with PJI of a knee replacement.

Recent Publications:

1. N C Sciberras, M Almustafa, B R K Smith, A H Deakin, D J Allen and F Picard (2016) A randomized controlled trial to compare component placement in navigated total knee arthroplasty using original and streamlined registration processes. Arthroplasty Today 3(2):111-117

2. A M Ewen, M Almustafa, J V Clarke and F Picard (2015) Infection rate and risk factors following primary total hip arthroplasty. The Bone and Joint Journal 97-B (SUPP 12) 50.

3. M Almustafa, A M Ewen, A H Deakin and F Picard. Risk Factors and Infection Rates Following Total Knee Replacement at the Golden Jubilee National Hospital 2009 – 2010.

Biography:

Yasser Allam has his expertise evaluation in Orthopedic Surgery. His open and contextual evaluation model based on responsive constructivists creates new pathways for improving healthcare. He has built this model after years of experience in research, evaluation, teaching and administration both in hospital and education institutions. He started his experience with a case of infected non-united femoral shaft fracture and he got a job as a Scientific Office Director for the agent of Russian Ilizarov Scientific Center, Kurgan in Egypt.

Abstract:

Introduction: Fracture of the heel bone is one if challenging injury whatever its type closed or open. There are many ways and studies for the treatment of this fracture either open reduction and internal fixation with plate and screws or with screws only or closed reduction and casting or percutaneous Pinning or external fixation either uniplanar or multiple planers or even with Ilizarov fixator. In all the above methods of treatment, the patient is not allowed to walk or to do weight bearing over affected limb until the fracture is healed completely and this may take about 12 to16 weeks.

Aim: The aim of this study is how to make the patient with fracture calcaneus (heel bone) able to walk and to do weight bearing not only as early as possible but even directly in the next day after surgery.

Method: Ilizarov frame was designed especially for this fracture composed if tow complete rings at the tibia and foot U-shape ring to the heel and foot and one distal flying complete ring. The complete rings of the tibia are fixed to it with two wires for each ring, the proximal ring is fixed to the upper third of the tibia about 8 centimeters distal to tibial tuberosity and the distal ring is fixed to the distal third of the tibia about 8 centimeters above the ankle joint and the heel U shape ring is fixed to the calcaneus with multiple olive wires which enable us to do reduction of all the fracture fragments in all directions and the two limbs of U shape ring is fixed with one or two wires to the distal third of metatarsal bones by this we did foot frame and fracture had been reduced and fixed but still the patient cannot walk or stand on the fractured limb and this is the aim of this study. So, we add the flying distal ring to the frame to act as a metallic heel instead of the fractured one. And to avoid fracture mechanical loading to fracture fragments which will lead to displacement we connect the flying ring with rods to the tibial rings by passing the heel ring this mean that all mechanical loads and stresses of weight bearing will be transmitted directly to the tibia and will not disturb the fracture reduction and healing.

Results: 23 fractures if the calcaneus treated with this method, 15 were unilateral and four patients were the bilateral calcaneal fracture. Tow from the bilateral calcaneal fracture had fracture spine which treated with spine team by fixation. All the patients including those with fracture spine and bilateral fracture calcaneus could move and ambulate in the next day of surgery. The healing time range is from 12 to 16 weeks. Follow up from five years to one year, No osteoarthritis noticed at ankle or subtalar 3D computed tomography post healing revealed healing in excellent anatomical position.

Recent Publications:

1. Karasick D (2004) Nursemaid elbow revisited and a review of congenital radioulnar synostosis. Radiographics. 24(6):1068– 1610.

2. Salter R B and Zaltz C (1971) Anatomic investigations of the mechanism of injury and pathologic anatomy of “pulled elbow” in young children. Clinical Orthopaedics and Related Research 77:134–143.

3. Macias C G, Bothner J and Wiebe R (1998) A comparison of supination/flexion to hyperpronation in the reduction of radial head subluxations. Pediatrics 102(1): e10.

4. Kaplan R E and Lillis K A (2002) Recurrent nursemaid’s elbow (annular ligament displacement) treatment via telephone. Pediatrics 110(1 Pt 1):171–174.

5. Krul M, van der Wouden J C, Koes B W, Schellevis F G, van Suijlekom-Smit LWA (2010) Nursemaid’s elbow: its diagnostic clues and preferred means of reduction. Journal of Family Practice 59(1): E5–E7.

Biography:

Stefan Beekhuizen is a Resident in Orthopaedic Surgery. His first study was “Long-term results of hemiarthroplasty compared to arthrodesis for osteoarthritis of the first metatarsophalangeal joint”. In future, he would like to dedicate himself for orthopaedic care in the Third World.

Abstract:

If operative treatment is opted for grade III and IV osteoarthritis of the first metatarsophalangeal joint, arthrodesis is considered standard care. However, if preservation of joint mobility is preferred, implant arthroplasty could be favored. Previous studies suggest hemiarthroplasty might result in less pain, better function and higher patient satisfaction compared to arthrodesis. However, these studies only evaluated short-term (range 2.2-6.6 years) results. The aim of our study was to determine whether patients treated with hemiarthroplasty showed better postoperative outcomes compared to those treated with arthrodesis after a period of at least 5 years after surgery. The American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal (AOFASHMI) scale score was measured as primary outcome. Secondary outcomes addressed satisfaction rates, recommendation of the performed procedure and number of unplanned surgical repeat procedures. We also addressed influence of the procedures on daily activities (work as well as sports), influence of smoking on postoperative results and costs for both procedures. A total of 47 primary arthrodesis and 31 hemiarthroplasties performed between January 2005 and December 2011 were evaluated. After a mean followup of 8.3 years (range 5-11.8) the mean AOFAS-HMI scale score after arthrodesis and after hemiarthroplasty were 72.8±14.5 and 89.7±6.6, respectively (p=0.001). Patients were significantly more pleased after hemiarthroplasty (p<0.001) and this procedure was better recommended (p<0.001). The number of unplanned repeat surgical procedures did not differ between the two groups. Patients resumed sports activities significantly sooner after hemiarthroplasty (p=0.002). Overall costs were similar for both procedures. Our study shows more favorable post-operative results for hemiarthroplasty compared to arthrodesis as operative treatment for osteoarthritis of the first metatarsophalangeal joint after a mean follow-up of 8.3 years.

Recent Publications:

1. Voskuijl T and Onstenk R (2015) Operative Treatment for Osteoarthritis of the First Metatarsophalangeal Joint: Arthrodesis Versus Hemiarthroplasty. Journal of Foot and Ankle Surgery 54(6):1085-1088.

2. Simons K H, van der Woude P, Faber FWM, van Kampen PM and Thomassen BJ (2015) Short-term Clinical Outcome of Hemiarthroplasty Versus Arthrodesis for End-Stage Hallux Rigidus. Journal of Foot and Ankle Surgery 54(5):848-851.

3. Kim P J, Hatch D, Didomenico L A, Lee M S, Kaczander B, Count G and Kravette M (2012) A multicenter retrospective review of outcomes for arthrodesis, hemi-metallic joint implant, and resectional arthroplasty in the surgical treatment of end-stage hallux rigidus Journal of Foot and Ankle Surgery 51(1):50-56.

4. Taranow W S, Moutsatson M J and Cooper J M (2012) Contemporary Approaches to Stage II and III Hallux Rigidus: The role of Metallic Hemiarthroplasty of the Proximal Phalanx. Foot and Ankle Clinics 10(4):713-728.

5. Clement N D, MacDonald D, Dall G F, Ahmed I, Duckworth A D, Shalaby H S and McKinley J (2016) Metallic hemiarthroplasty fort the treatment of end-stage hallux rigidus. Bone and Joint Journal 98:945-951.

Biography:

T E Snijders is a Researcher working in Department of Orthopedics at Clinical Orthopedic Research Center – (CORC-mN). He is a Professor in Diakonessenhuis Zeist in Netherlands. His research interests are Orthopedics and Trauma.

Abstract:

Background: Acetabular cup orientation plays a key role in implant stability and success rate of total hip arthroplasty (THA). To date, the orientation is measured with different imaging modalities and definitions, leading to lack of consensus on optimal orientation. A three-dimensional (3-D) concept, which measures orientation in the three anatomical perpendicular planes and describes their mathematical relationship, enables universal definitions and quantifies cup orientation around the transverse axis in the sagittal plane. The latter is important, because high-risk movements for dislocation are mainly around the transverse axis in the sagittal plane.

Purpose: To test the legitimacy and reliability of a 3-D concept to establish acetabular cup orientation.

Material & Methods: Twenty computed tomographic scans of patients with twenty-two primary THA in situ were systematically collected. On multiplanar reconstructions, three observers independently measured cup orientation in terms of coronal inclination, sagittal tilt and transverse version. The angles measured in two anatomical planes were used to calculate the angle in the third plane via a trigonometric algorithm. For correlation and reliability analyses, intra- and interobserver differences between measured and calculated angles were evaluated using the intra-class correlation coefficient (ICC).

Results: Measured and calculated angles had an ICC of 0.974 for coronal inclination, 0.993 for sagittal tilt and 0.993 for transverse version. Intra- and interobserver reliability had an ICC of 0.987 and 0.987 for coronal inclination, 0.979 and 0.981 for sagittal tilt and 0.992 and 0.978 for transverse version, respectively.

Conclusion: The 3-D concept with its trigonometric algorithm is a legitimate and reliable measurement tool. This 3-D concept can be used to determine the transverse version of acetabular cups from coronal inclination and sagittal tilt measurements. This offers the opportunity to have universal definitions whatever imaging modality is used and introduces the sagittal tilt, that comprehends the orientation of the cup around the transverse axis. Therefore, this straightforward 3-D concept can provide improved insight in optimal cup orientation.

Recent Publications:

1. Snijders T, van Gaalen S M and de Gast A (2017) Precision and accuracy of imageless navigation versus freehand implantation of total hip arthroplasty: A systematic review and meta-analysis. International Journal of Medical Robotics and Computer Assisted Surgery doi: 10.1002/rcs.1843.

2. Alessandro Liberati et al., (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med6(7): e1000100.

Biography:

Alireza Sadeghpour is an Associate Professor and Chair of Orthopedic Surgery department at Tabriz University of Medical Sciences. Sadeghpour is also currently serving as a Director and Chairman of Shohada University Hospital. He received his M.D. degree in 1992 and his Iranian Board Certificate of Orthopedic Surgery in 2000. His research interests are in Pelvis and Hip Surgery including Arthroplasty, hip preserving Surgery and Trauma.

Abstract:

Rheumatoid Arthritis (RA) is a chronic systemic inflammatory disease that influence on joints and muscles and can result in noticeable disruption of joint structure and function. Early diagnosis of RA is very crucial in preventing disease's progression. However, it is a complicated task for General Practitioners (GPs) due to the wide spectrum of symptoms, and progressive changes in disease's direction over time. The aim of this presentation is to summarize our work in development of a decision support tools for GPs in early diagnosis of RA and describes a small-scale test which has been conducted at Shohada University Hospital, Iran, for evaluating the accuracy of the proposed tool. This study proposed an advanced decision support tool based on consultations with a group of experienced medical professionals (i.e. orthopedic surgeons and rheumatologists), and using a well-known soft computing method called Fuzzy Cognitive Maps (FCMs). Briefly, considering obtained results in real practice, we believe that this tool can be useful in assisting GPs in early diagnosis of patients with Rheumatoid Arthritis. Indeed, in the lights of the proposed decision support tool: (i) GPs can evaluate patients' RA disease's severity more accurately and easily, (ii) the required time for patients' diagnosis could be decreased, (iii) quality of life of patients and quality of care may be improved, and more importantly (iv) the risks that could threaten patients due to the wrong or late diagnosis will be diminished.

Biography:

Szpalski Marek is the President of the Orthopedic Surgery and Traumatology Department at Iris South Teaching Hospital/ Moliere Longchamp in Brussels (Belgium). He is a Professor of Orthopedic at Libre University of Brussels and Professor of Orthopedic at New York University. He is Co-Inventor of the study device, Y-STRUT®.

Abstract:

An innovative implant, Y-STRUT® (Hyprevention, France), was developed to provide prophylactic reinforcement of the proximal femur in patients suffering from a first hip fracture due to osteoporosis. We present our clinical experience on the first 10 patients implanted between February 2013 and December 2016. Prophylactic consolidations were performed under the same anesthesia of a hip fracture surgical treatment in the opposite side for patients at high risk of contralateral fracture. A multicenter prospective pilot study is ongoing on a planned cohort of 15 osteoporotic patients. Mid-term tolerance and safety of the studied device are assessed with several criteria, such as walking recovery, pain, radiographic control and adverse events. Clinical efficacy is evaluated through the occurrence of fractures. Ten elderly patients (mean 82±7 yrs.) were implanted because of a severe osteoporosis (mean T-score -3.64±0.8) resulting in first hip fractures. Follow-up ranges from 4 to 46 months and in all patients, wound healing was achieved, with no case of wound infection, bleeding, or inflammation. Radiographic exams performed at 3-month-follow-up revealed that the device was well integrated in the bone. No hospitalization lengthening was needed and all patients recovered walking and no pain was reported at 3 weeks (mean VAS was 0.9±0.7). Several post-operative falls were reported and no post-operative fracture was observed. Preliminary results from this study demonstrated the tolerance and safety as well as the short-term clinical efficacy of the studied device. Additional data need to be recorded on a greater number of subjects and longer follow-up to confirm the clinical benefits of Y-STRUT® implantation.

Biography:

Liang Wang has completed his PhD from the Second Affiliated Hospital of Soochow University. He is an Orthopedic Surgeon and he has published lots of papers in this field.

Abstract:

Vascularization is fundamental for bone formation and bone tissue homeostasis. However, in human subjects, a direct molecular relationship has not been identified between angiogenesis and agents that promote bone disease or factors related to age. Osteopenia is a condition in which bone mineral density (BMD) is lower than normal, and it represents a sign of normal aging. Here, we tested whether the type H vessel, which was recently identified as strongly positive for CD31 (also known as PECAM1, platelet/endothelial cell adhesion molecule 1) and endomucin (CD31hiEmcnhi) in mice, is an important indicator of aging and osteopenia in human subjects. We found that age-dependent losses of type H vessels in human bone sections conform to the observations in aged mice. The abundance of human type H vessels and osteoprogenitors may be relevant to changes in the skeletal microarchitecture and advanced osteopenia. Furthermore, ovariectomized mice, a widely used model for postmenopausal osteoporosis, exhibited significantly reduced type H vessels accompanied by reduced osteoprogenitors, which is consistent with impaired bone microarchitecture and osteoporosis, suggesting that this feature is an indicator of bone mass independent of aging. More importantly, oral administration of desferrioxamine (DFO) led to significantly increased bone mass via enhanced angiogenesis and increased type H vessels in ovariectomized mice. Altogether, these data represent a novel finding that type H vessels are regulated in aged and osteopenia subjects. The abundance of human type H vessels is an early marker of bone loss and represents a potential target for improving bone quality via the induction of type H vessels.

Biography:

Cunyi Fan is a Professor of Orthopedic Surgery. Currently, he is working in 6th People's Hospital as an Orthopedic Surgeon and working as a Professor in Shanghai Jiaotong University, China. His articles are published in PubMed, and respective journals.

Abstract:

Introduction: Elbow stiffness is one of the most common elbow disorders because of its nature being vulnerable to contracture. The conservative treatment should be recommended firstly, then the surgical intervention is indicated after the failure of the conservative attempt. From 2010 to 2015, we have treated 258 cases of post-traumatic elbow stiffness in our center.

Pre-operative Assessment: Patient history including the incision, internal fixation, and nerve intervention would guide the plan of surgery. An overall physical examination should be emphasized including extension and flexion deficiency, rotation limitation, stability, skin contracture, and nerve symptoms. Radiographic assessment aims to address the heterotrophic ossification, malunion, joint space, and target pathologies such as synovium.

Surgical Techniques: A single lateral or medial approach is sufficient for moderate elbow stiffness. We recommend the combined medial and lateral approaches to treat severe stiff elbows. General release and clearance should cover the hypertrophic capsule, humeroradial joint, triceps, olecranon fossa, coronoid fossa, and HO. The anterior bundle of the medial collateral ligament and lateral ulnar collateral ligament should be left intact to prevent instability while we further release the ligament contracture. Ulnar nerve anterior transposition is routinely performed to prevent ulnar nerve symptoms. We believe it reasonable and helpful to adopt a hinged external fixator in severe cases. It provides extra stability and security for repaired ligaments, facilitate rehabilitation, and a less painful situation leads to more effective outcoming.

Postoperative Rehabilitation: A prolonged and rigorous rehabilitation protocol after elbow release is important for preserving the arc of motion achieved during surgery. The exercises consist of active, assisted, and passive elbow flexion and extension movements. During the interval of each exercise session, a compressive cryotherapy device is applied to relieve pain. The applying of drains and indomethacin aims to reduce the pain as well as the incidence of edema and heterotopic ossification.

Recent Publications:

1. Han B, Xue F, Fan C and Mo X (2017) Surface heparinization and blood compatibility modification of small intestinal submucosa (SIS) for small-caliber vascular regeneration. Bio-Medical Materials and Engineering 28(3):213-222.

2. Chen S, Jiang S, Zheng W, Tu B, Liu S, Ruan H and Fan C (2017) RelA/p65 inhibition prevents tendon adhesion by modulating inflammation, cell proliferation, and apoptosis. Cell Death and Disease 8(3): e2710.

3. Liu S, Chen H, Wu T, Pan G, Fan C, Xu Y and Cui W (2017) Macrophage infiltration of electrospun polyester fibers. Biomaterials Science 5(8):1579-1587

4. Yu S, Chen M and Fan C (2017) Team approach: elbow contracture due to heterotopic ossification. JBJS Reviews 5(1).

5. Sun Y, Cai J, Yu S, Chen S, Li F and Fan C (2016) MiR-630 inhibits endothelial-mesenchymal transition by targeting slug in traumatic heterotopic ossification. Scientific Reports 6:22729.

Biography:

Ahmed Bakr has his expertise evaluation in Orthopaedics and Trauma Surgery. He was graduated from ASU Cairo, Egypt and completed Rotatory Foundation year in ASU Hospitals. Currently, he is working as Senior House Officer of General Surgery at North Manchester General Hospital. His research interest includes Metal Total Hip Replacements.

Abstract:

Background: Patients with metal on metal hip replacements are currently reviewed according to the Medicines and Healthcare Products Regulatory Agency (MHRA) guidelines. Certain implants such as ASR system have been found to have higher revision rates than others. We present the results of multiple brands of metal on metal hip replacement implants used at our institution since 2001.

Methods: We retrospectively reviewed all the records of patients who had metal on metal hip replacements at North Manchester General Hospital. Their metal ions level (cobalt and chromium) and MRI scans were also looked at.

Results: There were 215 patients. Majority were males (162 patients). 50 patients had resurfacing implants. Most implants used were Zimmer Durom Hip systems (85 patients). Other brands included Smith & Nephew BHR, Biomet Recap Magnum and DePuy ASR hip systems. 45 patients (21%) have had revision surgery due to reasons such as raised metal ions level, positive MRI scans or clinical symptoms. The revision rate in each brand or system was comparable to each other. We have now stopped doing metal on metal hip replacement surgery. The last surgery was in 2011.

Conclusion: The revision rate is high (21%) in patients with metal on metal hip replacements done at our institution. The lack of significant difference in revision rates between brands of implants implies metal on metal bearings as a common denominator in causing metallosis.

Implications: Regardless of brands or hip systems, metal on metal hip replacements have higher revision rates than other types of hip replacements at our institution.