Jacobsonmcallister6666

Equinus contracture is the most common deformity at clubfoot relapse and causes pain and functional limitation. It presents a challenge to the orthopaedic surgeon throughout childhood.A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were (i) original articles, (ii) investigating management of relapsed idiopathic clubfoot, (iii) with at least a partial study population of primarily equinus deformity, and (iv) a paediatric study population of independent walking age.Nine studies were included with a total of 163 patients (207 feet). Studies presented five management paradigms gastrocnemius-soleus complex release, extensive posterior soft tissue and joint release, anterior distal tibial hemi-epiphysiodesis, distal tibial osteotomy, and circular frame distraction.All approaches reported success in at least one of our selected outcome domains plantigrade status, range of motion, clinical outcome scores, functional status, radiographic outcomes, patient-reported outcomes, and complications. Younger children tend to be managed with soft tissue release while older children tend to require more extensive bone/joint procedures. Relapse in surgically treated feet is harder to treat.Comparison across treatment approaches is limited by the small size and low evidence level of the literature, as well as a lack of consistent outcome reporting. It is therefore not possible to recommend any one treatment option in any age group.This review highlights the need for a validated core outcome set to enable high-quality research into the management of equinus deformity. Cite this article EFORT Open Rev 2021;6354-363. DOI 10.1302/2058-5241.6.200110.Modular dual-mobility (MDM) constructs can be used to reduce dislocation rates after total hip replacement (THR). However, there are concerns about adverse reaction to metal debris (ARMD) as a result of fretting corrosion between the metal liner and shell. This systematic review reports outcomes following THR using MDM components. Sotorasib datasheet It was registered with PROSPERO and conducted in line with Cochrane and PRISMA recommendations.Sixteen articles were included overall, with meta-analysis performed on relevant subsets using a random intercept logistic regression model. Estimated median incidence of ARMD requiring revision surgery within study follow-up period was 0.3% (95% CI 0.1 - 1.8%, from 11 cohort studies containing 1312 cases).Serum metal ion levels were mildly raised in 7.9% of cases, and significantly raised in 1.8%, but there was no correlation with worse clinical hip function scores within studies. Dislocation rate was 0.8%. Revision rate was 3.3%.There are mixed reports of wear on the backside of the metal liner from the acetabular shell and screw heads. Both implant design and component malseating are implicated, but currently it is unclear to what extent each factor is responsible.Studies were poor quality with high risk of confounding, especially from trunnion corrosion. We have made recommendations for further work. In the meantime, surgeons should be aware of the potential risk of ARMD when considering using an MDM prosthesis, and, if selecting one, must ensure proper seating of the liner and screws intraoperatively. Cite this article EFORT Open Rev 2021;6343-353. DOI 10.1302/2058-5241.6.200146.The literature was reviewed to establish the levels of stem subsidence for both double and triple-tapered implants in order to determine whether there were any differences in subsidence levels with regard to the methods of measurement, the magnitude and rate of subsidence and clinical outcomes.All studies reporting subsidence of polished taper-slip stems were identified. Patient demographics, implant design, radiological findings, details of surgical technique, methods of measurement and levels of subsidence were collected to investigate which factors were related to increased subsidence.Following application of inclusion and exclusion criteria, 28 papers of relevance were identified. The studies initially recruited 3090 hips with 2099 being available for radiological analysis at final follow-up. Patient age averaged 68 years (42-70), 60.4% were female and the average body mass index (BMI) was 27.4 kg/m2 (24.1-29.2).Mean subsidence at one, two, five and 10 years was 0.97 mm, 1.07 mm, 1.47 mm and 1.61 mm respectively. Although double-tapered stems subsided more than triple-tapered stems at all time points this was not statistically significant (p > 0.05), nor was the method of measurement used (p > 0.05).We report the levels of subsidence at which clinical outcomes and survivorship remain excellent, but based on the literature it was not possible to determine a threshold of subsidence beyond which failure was more likely.There were relatively few studies of triple-tapered stems, but given that there were no statistically significant differences, the levels presented in this review can be applied to both double and triple-tapered designs. Cite this article EFORT Open Rev 2021;6331-342. DOI 10.1302/2058-5241.6.200086.Thumb carpometacarpal joint (CMCJ) arthritis is a common and painful condition. Thumb CMCJ prosthetic replacement aims to restore thumb biomechanics and improve pain and function. Early reviews demonstrated a lack of high-quality studies, but more recently a significant number of higher-quality studies have been published. This review provides a concise and systematic overview of the evidence to date.A systematic review of several databases was conducted according to PRISMA guidelines. Studies evaluating the outcomes of thumb CMCJ prosthetic total joint replacement were included. Data extracted included patient-reported outcome measures (PROMs), pain scores, range of motion, strength, survival rates and complications.A total of 56 studies met all inclusion criteria and were analysed. There was one randomized controlled trial, three prospective comparative cohort studies, five retrospective comparative cohort studies, and 47 descriptive cohort studies. The reported studies included 2731 patients with 3048 thumb total CMCJ prosthetic joint replacements.