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Introduction As the research landscape evolves, we sought to investigate the current most cited Orthopaedic Surgery articles and compare these to previously cited articles. Methods Web of Science database screened orthopaedic journal articles with comparison to previous data using multivariate regression analysis. Results Rate of citations increased 172% within the last decade. Previous rank and citations within the last decade had a greater effect on contemporary rank (p = 0.084, p = 0.002, respectively). Conclusion Trends in investigative research can shift by the next decade. Previous citation rank and citations in last decade contributed most to current rank.

Purpose To propose a gunshot wound-related hip injury algorithm and improve patient outcomes. Methods Multiple online databases were queried to identify studies reporting on management of gunshot-wound hip injury. Results Of 47 papers included, 5 and 14 studies recommended surgical intervention for the treatment of low- and high-velocity gunshot wounds, respectively, and 1 paper advocated the use of prophylactic antibiotics in the treatment of high-velocity injuries. All remaining papers had mixed and conflicting results. Conclusion Various therapeutic strategies have been used for the management of gunshot wound-related hip injuries but further prospective studies are necessary to determine the optimal therapeutic modality.

This paper briefly reviews the different methodology, technology, challenges, and outcomes of various studies related to TAR prosthesis based on numerical and experimental techniques. Very less in-vitro experimental studies on TAR have been found than finite element (FE) studies. Due to the invasive nature of the experimental approach, inadequacy and less clinical information, computational modelling has been widely used by the researchers. This paper critically examines the part related to FE modelling and experimental analysis. Some recommendation related to modelling of bones, cartilages, ligaments, muscles, and implant-bone interface condition were discussed for better understanding the results and better clinical significance.

Introduction Supercross is characterized by fast and skillful movements, with high concentration being required on an indoor competition circuit, due to the demanding jumps and short distances to the next obstacle. The injuries can turn out to be diverse, including polytraumatization. This paper aims to evaluate the accidents and possible injuries in a single Supercross competition. To what extent is the presence of medical staff required? Methods During the 17th International Supercross Event in Chemnitz, 93 participants started in 5 classes. Severe injuries were treated at the track, through the emergency department and hospital stay to their discharge. Results Overall 5 participants (4.65%) had to be admitted to the clinic: Conclusion Injuries from risky jumps at relatively high speed can range from minor contusions to fractures and serious injuries. The permanent readiness of medical staff and emergency doctors at the site is therefore justified and required. The variety of injuries in a Supercross event can affect the head and face, the upper- and lower extremities, thoracal- and abdominal traumas and especially the spine. In addition, a special training concept in terms of preventive measures to prevent falls would be desirable.

Instability is an increasingly common cause and symptom of failure of Total Knee Arthroplasty (TKA). Patients seek ‘Functional Stability’, which is the sum of both a balanced joint and, if necessary, mechanical constraint. The objective of this paper is to classify the different types of TKA instability and their causes. Based on this classification, the authors give methodical recommendations for instability management. Instability classification Instability in revision TKA can be classified into 3 types based on the management of bone loss and ligamentous deficiency which directs the level of constraint required to achieve functional stability. Type 1 Bone deficiency: Revision with restoration of joint line and rebuilding the bony anatomy results in a balanced joint. No increased constraint is needed. Type 2 Ligament and soft tissue deficiency: Requires increased constraint to overcome instability Type 3 Composite (Total) deficiency: (combined Type 1 and 2). The multiple causes of instability are outlined for each Instability type along with an algorithm for restoring the joint line and adding titrated constraint to restore functional stability.

Component dissociation secondary to trunnionosis is rare, and its causes are multifactorial. It is a major complication of total hip replacement, in most cases requiring revision arthroplasty. In this paper, we present a case of taper/head modular interface dissociation in a metal-on-metal total hip replacement. We review the literature of both trunnionosis, as well as a systematic review of modular dissociation of the femoral component in total hip arthroplasty, identifying commonalities with our own case.

Objective IS (idiopathic scoliosis) is a common spinal condition occurring in otherwise completely healthy adolescents. The root cause of IS remains unclear. This systematic review will focus on an update of genetic factors and IS etiology. Though it is generally accepted that the condition is not due to a single gene effect, etiology studies continue looking for a root cause including genetic variants. Though susceptibility from multiple genetic components is plausible based on known family history data, the literature remains unclear regarding multifactorial genetic influences. The objective of this study was to critically evaluate the evidence behind genetic causes (not single gene) of IS through a systematic review and strength-of-study analysis of existing genetic and genome-wide association studies (GWAS). We used the protocol of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Methods PubMed was searched for the terms IS, scoliotic, spinal curve, genetic, gene, etiology, polymorphisms. Articles were assessed for risk-of-bias. Level-of-evidence grading was completed via Oxford Centre for Evidence-Based Medicine criteria. The assessment scores factor strength of a study in determining a positive or negative association to a gene etiology. Results After screening of 36 eligible papers, 8 relevant studies met inclusion criteria at this time, 3 were in favor of a genetic factor for IS, whereas 5 studies were against it. Conclusion Based on the literature analyzed, there is moderate evidence with a low risk-of-bias that does not clarify a genetic cause of IS. The 2 studies in favor of a genetic etiology were completed in homogeneous populations, limiting their generalizability. Relying on a genetic etiology alone for IS may over simplify its multifactorial nature and limit appreciation of other influences.

Background Bone marrow edema (BME) is a radiological term which can be found in many conditions with varied pathogenesis and histopathological images. It usually presents with pain in the affected joint and is diagnosed with MRI. Subchondroplasty (SCP) and core decompression (CD) are the surgical methods that are available to achieve pain relief and functional improvement. Both surgical methods have their own indications and are used depending on the patient's history. The aim of this literature review article is to discuss the surgical modalities for the management of bone marrow edema focusing on the knee joint. Such topic which analyzes both surgical methods for treatment of bone marrow edema of the knee joint has never been described in a review article before. Materials and methods For the purpose of our manuscript we thoroughly searched electronic databases such as Pubmed and Medline to acquire the appropriate material for our review paper. Only English articles were used in this review. In our study we included every article that had described the surgical management of BME of the knee by CD and SCP. In the discussion we included 18 studies (9 CD and 9 SCP) with a total number of patients equal to 397, while 206/397 had undergone surgical intervention (169 underwent SCP and 37 CD). Results Follow-up of 180 patients out of 206 were available for our review. A total number of 166 patients (92.2%) were successfully treated. Specifically, 29 (100%) patients were treated by CD and 137 (90.7%) by SCP. In a study, 10 patients who underwent SCP for BME secondary to advanced osteoarthritis (OA) yielded poor results. In other studies, pain persistency was observed in 2 patients, 1 patient had postoperative infection and another patient eventually underwent total knee arthroplasty (TKA). 70% prevention of TKA was achieved by SCP in a study of 66 patients with BME secondary to advanced OA. Thus, a total number of 166 patients were considered as clinical success and 14 patients as clinical failure. Conclusions The included studies that have been published referred to the surgical methods of CD or SCP for the management of BME of the knee but none of that summarizes all current studies on both methods. Those studies seem that CD is a surgical technique that is proposed to perform in patients without findings of OA that usually fail to respond to conservative treatment. On the other hand, the option of SCP technique is carried out in patients with varied stage of OA associated with subchondral BME. Both methods aim to reduce the pain and to improve function in the setting of subchondral BME. Nevertheless it is not clear in literature which method is the best according to the criteria of the use. This literature review shows a lack of standardized guidelines with respect to diagnosis and surgical treatment.

Predicting personalized outcome after arthroplasty improves shared decision-making. The aim of this paper was to determine predictors of functional outcome measured by the Hip disability and Osteoarthritis Outcome Score - Physical function Shortform (HOOS-PS) or Knee injury and Osteoarthritis Outcome Score - Physical function Shortform (KOOS-PS) in patients undergoing total hip (n = 79) or total knee arthroplasty (n = 90) respectively. Patients were assessed at baseline and following arthroplasty. A multiple regression analysis showed that the included variables predicted the change score in HOOS-PS limited (F (8,66) = 3.139, p = 0.005, adjusted R2 = 0.188) and the KOOS-PS not significantly (F (8,73) = 0.837, p = 0.573, adjusted R2 = −0.016). Concluding, baseline characteristics cannot be used for personalized prediction using the KOOS-PS and HOOS-PS.

Purpose Studies assessing intraoperative pain during surgery with wide-awake local anesthesia typically use a unidimensional pain scale, which provides a limited view of the pain experience. The present paper describes two studies that assessed qualitative aspects of intraoperative pain using a multidimensional pain measure. Methods The first study was a retrospective survey of 24 patients who received a variety of foot and ankle procedures under wide-awake local anesthesia. Patients completed a copy of the Short-Form McGill Pain Questionnaire (SF-MPQ) through the mail an average of six months following surgery. The second study was a prospective assessment of 40 patients receiving forefoot procedures under the same anesthesia. Patients completed a copy of the SF-MPQ directly after the surgery. Results Patients in the first study selected an average of 1.17 pain descriptors (SD = 3.02) on the SF-MPQ, whereas patients in the second study selected an average of 1.90 pain descriptors (SD = 1.82). In general, both studies found that sensory descriptors of pain (e.g., sharp, shooting, tender) were more common than affective descriptors. However, mean intensity ratings were low for all descriptors. Conclusion The results of these studies provide a more comprehensive understanding of the patient experience during surgery with wide-awake local anesthesia.

PURPOSE: Intertrochanteric (IT) hip fractures can be treated with sliding hip screws (SHS) or cephalomedullary nails (CMN) based on the stability of the fracture. This stability is affected by the initial impaction of the fracture which can be difficult to assess. The aim of this paper is to develop specific pre-operative computed tomography (CT) measurements of IT fractures which are predictive of post-operative shortening. METHODS: A retrospective review was performed of 141 patients with AO/OTA 31A1 or 31A2 fracture patterns, who had pre-operative radiographs and CT scans, and who were treated with a SHS or a CMN. Pre-operative and post-operative imaging of IT fractures were analyzed for those fractures that shortened ≥15 mm post-fixation. RESULTS: 11 fractures shortened ≥15 mm with CMN being protective of shortening (6/36 SHS versus 5/105 CMN, p = 0.0268). A novel measurement made on the pre-operative CT scan called the cortical thin point (CTP) detected differences between patients with

Irreparable posterosuperior rotator cuff tears are a challenging treatment problem. Several tendon transfers have been described for the treatment of irreparable tears. Recently the lower trapezius (LT) tendon transfer has grown in popularity. This procedure has shown promise in biomechanical studies, improving the external rotation moment arm at the side. This transfer may be done in several ways, including an open approach with an acromial osteotomy, mini-open, and arthroscopic-assisted. The purpose of this paper is to review the current evidence and rationale for the use of the LT transfer and to describe the available techniques.

Objectives Falls occur frequently in patients with impaired ambulation and may dramatically affect the elderly population. Aim was to document the incidence of falls in knee osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA), and to identify factors and treatments that may influence the risk of falls. Methods A systematic literature search was conducted on three medical electronic databases, PubMed, PeDRO, and Cochrane Collaboration. The Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used. Risk of bias analysis and best evidence synthesis were performed. The main aspects related to falls were analyzed: prevalence, risk factors, correlation with clinical outcome, effect of treatments. Results The systematic review identified 11 papers on 1237 patients. Pre-operative fall prevalence ranged from 23% to 63%, while post-operative values ranged from 12% to 38%. Moderate evidence was found on no influence of clinical scales, no BMI differences between “faller” and “non-faller”, and on influence of limited pre-operative range of motion. Conflicting evidence was found for sex, history of previous falls, age, kyphosis, muscle weakness, fear of falling, depression, balance, gait impairment. No evidence was found for the effectiveness of surgical or rehabilitative strategies on falls reduction. Conclusions OA patients undergoing TKA are at high risk of falls, which is reduced but still present after surgery. Although some risk factors were identified, there are no studies demonstrating the possibility of reducing the incidence of this deleterious event, which warrants further research efforts to better manage this fragile population of elderly patients.

Background We conducted a retrospective study to assess the clinical outcome, failure rate, and reason for failure of a large consecutive series of 36 mm MoM Corail/Pinnacle total hip replacements (THRs). Methods Between 2006 and 2011, 601 consecutive 36 mm MoM THRs were performed (585 patients). Patients were followed according to the UK Medicines and Healthcare Products Regulatory Agency (MHRA) guidelines. All patients were accounted for and 469 patients (78%) were clinically and radiographically assessed. 328 females and 141 males with a median age of 73 (range 36–94 years) and a median follow up of 7.2 years (range 5.2–9.7 years) were followed. Clinical data included blood cobalt and chromium, Oxford Hip Score (OHS), plain radiograph, ultrasound of hip and intra-operative findings in those patients who had revision surgery. Results 56 patients died of causes unrelated to their hip replacement. The mean survivorship of the implant was 92.8% (range 91.6–94%, 95% CI) at a median time to follow up of 84 months (62–113 months). The functional outcome was good with a median OHS of 38 out of 48 (23–44). The dislocation rate was 0.99%, with all these 6 cases requiring revision. 476 patients had blood tests. 100 patients (21%) had elevated levels of either cobalt above MHRA guidelines of 7 parts per billion (120 and 135 nmol/L respectively for cobalt and chromium). Cobalt was elevated independently of chromium in 75% of the cases (but never vice versa). The mean cup inclination angle was 42°. Each incremental stem size increase resulted in a decrease in cobalt by 11 nmol/L. The most common reason for revision was adverse reaction to metal debris (ARMD) (12 cases). Conclusion This paper is the largest and longest follow up of 36 mm MoM THRs. Using the MHRA guidelines for follow up, the revision rates of this cohort has remained low compared to other studies, but unacceptably higher than that of other bearing surfaces. Level of evidence III.

Purpose To describe the epidemiology of thoracolumbar fractures and associated injuries in blunt trauma patients. Methods A systematic review and metaanalysis was performed based on a MEDLINE database search using MeSH terms for studies matching our inclusion criteria. The search yielded 21 full-length articles, each sub-grouped according to content. Data extraction and multiple analyses were performed on descriptive data. Results The rate of thoracolumbar fracture in blunt trauma patients was 6.90% (±3.77, 95% CI). The rate of spinal cord injury was 26.56% (±10.70), and non-contiguous cervical spine fracture occurred in 10.49% (±4.17). Associated injury was as follows: abdominal trauma 7.63% (±9.74), thoracic trauma 22.64% (±13.94), pelvic trauma 9.39% (±6.45), extremity trauma 18.26% (±5.95), and head trauma 12.96% (±2.01). Studies that included cervical spine fracture with thoracolumbar fracture had the following rates of associated trauma: 3.78% (±5.94) abdominal trauma, 21.65% (±16.79) thoracic trauma, 3.62% (±1.07) pelvic trauma, 18.36% (±4.94) extremity trauma, and 15.45% (±11.70) head trauma. A subgroup of flexion distraction injuries showed an associated intra-abdominal injury rate of 38.70% (±13.30). The most common vertebra injured was L1 at a rate of 34.40% (±15.90). T7 was the most common non-junctional vertebra injured at 3.90% (±1.09). Burst/AO type A3 fractures were the most common morphology 39.50% (±16.30) followed by 33.60% (±15.10) compression/AO type A1, 14.20% (±8.08) fracture dislocation/AO type C, and 6.96% (±3.50) flexion distraction/AO type B. The most common etiology for a thoracolumbar fracture was motor vehicle collision 36.70% (±5.35), followed by high-energy fall 31.70% (±6.70). Conclusions Here we report the incidence of thoracolumbar fracture in blunt trauma and the spectrum of associated injuries. To our knowledge, this paper provides the first epidemiological road map for blunt trauma thoracolumbar injuries.

In current scenario there is an emerging trend to consider osteoarthritis (OA) phenotypes based on their risk factors and therefore offering potential for targeted therapies. OA prevalence with other coexistence diseases, such as systemic arterial hypertension, cardiovascular disease, diabetes, and dyslipidemia are increasing. Majority of OA associated with MetS, despite overweight of patients, the occurrence of OA in joints do not bear load suggest, the chronic inflammation status existing in patients with MetS can alter the metabolism of cartilage, regardless of excessive weight. This paper indicates that factors responsible for metabolic syndrome has clear role in cartilage degeneration and further degradation.

Purpose We performed a systematic review of the studies including clinical/functional outcomes and complications of bone grafting for glenoid defects in reverse total shoulder arthroplasty (RTSA). Methods The PubMed and Cochrane databases were searched for relevant papers. Results Thirteen articles were included. The mean clinical/functional subjective scores significantly improved postoperatively. The implant revision rate for primary and revision RTSA was 3.1% and 21.1% respectively. The reoperation rate was 3.5% and 24.4% respectively. Conclusions There was moderate evidence that bone grafting is effective for glenoid defects in primary RTSA. Further high-quality research is required about revision RTSA for moderate-to-severe glenoid defects.

Introduction Peer-reviewed research helps to advance many aspects of medical and surgical practice. This paper determines the main contributors tos joint arthroplasty research in terms of quantity and quality. Methods A search of the Web of Science™ platform was conducted to identify arthroplasty articles published between 2001 and 2016. The number of articles and citations per article were analysed to assess the quantity and quality of research from individual countries. Results were standardised according to the country's populations and Gross Domestic Product (GDP). Results In total, 43,470 arthroplasty articles were published worldwide from January 2001 through December 2016. There was a 4.5-fold increase in global output during this time period. Twenty-two countries contributed at least 1% to the total number of publications. The United States of America published the most articles (35.40%), followed by England (10.31%) and Germany (10.03%). The USA had the highest absolute number of citations (50,777). Denmark had the highest average citation per item (8.76). When number of articles was normalized to population, Switzerland ranked the highest. When adjusted by GDP, Scotland ranked highest. When standardised according to GDP per capita, the People's Republic of China rated highest. The Journal of Arthroplasty produced the highest number of publications related to arthroplasty with 10.9% of total volume. Conclusion There has been a substantial increase in worldwide publications relating to arthroplasty. The USA has produced the largest volume whilst Denmark has produced the highest quality publications. When output was normalized according to population and GDP, Switzerland and Scotland ranked highest.

In this paper, an innovative design of nail, conceived to heal fractures of long bones has been investigated. Its functioning is based essentially on sliding of conical surfaces located in a spindle and in a series of holding pins radially disposed around it. Spindle and holding pins are connected together by means of a sleeve. Medial and distal screws are not necessary. Rotational and longitudinal motions of the spindle are transformed in a radial expansion of the holding pins by the sliding of conical surfaces. A complete numerical FE model of an implanted femur was realized and analyzed by the mean of two loading configurations: LC1 by imposing a vertical load of 980 N, and LC2 by considering resultants of the muscle actions. Analyses confirmed results, in terms of mechanical performances, comparable with the others traditional systems of prosthesis.