Publications by authors named "James Harty"

49 Publications

Femoral head penetration in Vitamin-E polyethylene liner versus conventional liners in total hip arthroplasty: systematic review and meta-analysis of randomised control trials.

SICOT J 2021 10;7:47. Epub 2021 Sep 10.

Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork T12DFK4, Ireland.

Background: Debate encompasses the use of Vitamin E Polyethylene or conventional Polyethylene liner in primary hip arthroplasty. Does the Inclusion of Vitamin E in PE give adequate protection from oxidation and maintains lower rates of wear?

Patients And Methods: We performed this study following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA) and the Cochrane Handbook for systematic reviews and meta-analysis. Studies were included from any region, written in any language. We had only the randomised control trials comparing the femoral head penetration between Vitamin-E diffused highly cross-linked polyethylene (VEPE) liner and conventional liners in primary total hip arthroplasty.

Results: We included 10 studies in this meta-analysis. We conducted them using Review Manager V.5.0. We computed the risk ratio to measure the treatment effect, considering the heterogeneity. We used Random-effect models. VEPE had insignificant marginal advantages for FHP within three months post-operative. Additionally, VEPE showed significantly less FHP after two and five years. After one year, it showed significantly less FHP with the VEPE group versus the UHMWPE cohort and a non-significant difference between the VEPE and XLPE group.

Conclusions: In terms of FHP, this metanalysis shows less FHP for the VEPE than conventional PE. A longer follow-up period is required to evaluate whether the oxidation protection gained by Vitamin E results in lower wear rates, less osteolysis, and aseptic loosening compared to the conventional PE in the long term.
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http://dx.doi.org/10.1051/sicotj/2021045DOI Listing
September 2021

Does bicompartmental knee arthroplasty hold an advantage over total knee arthroplasty? Systematic review and meta-analysis.

SICOT J 2021 9;7:38. Epub 2021 Jul 9.

Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork T12DFK4, Ireland.

Introduction: The role of bicompartmental knee arthroplasty (BKA) in the treatment of medial patellofemoral osteoarthritis (MPFOA) has been debated by orthopaedic surgeons for years. The BKA is a cruciate ligament retaining prosthesis designed to mimic the kinematics of the native knee that requires resurfacing of only two knee compartments. In this study, we aim to assess the patient recorded outcome measures (PROMs), range of motion (ROM), perioperative morbidity, and implant revision rate in patients undergoing BKA and compare them to those undergoing total knee arthroplasty (TKA) for bicompartmental knee osteoarthritis (OA).

Patients And Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA). Articles from any country and written in any language were considered. We included all randomized control trials and retrospective cohort studies examining BKA versus TKA for bicompartmental knee OA. The primary outcome measure was knee society score (KSS) at one year and the secondary outcome measures were Oxford knee score (OKS) and short-form survey (SF-)12 at six and twelve months.

Results: We included five studies in our meta-analysis. In terms of OKS, KSS, and SF-12, our meta-analysis suggests better short-term results for the TKA compared with the BKA. TKA was also associated with a shorter operative time and a lower revision rate. The BKA implant did however result in marginally less intraoperative blood loss and slightly better post-operative ROM.

Conclusions: BKA did not prove to be an equivalent alternative to TKA in bicompartmental knee OA. It was associated with inferior KSS, OKS, and SF-12 at short-term follow-up and a higher revision rate.
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http://dx.doi.org/10.1051/sicotj/2021036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269451PMC
July 2021

The partial femoral condyle focal resurfacing (HemiCAP-UniCAP) for treatment of full-thickness cartilage defects, systematic review and meta-analysis.

Acta Orthop Belg 2021 Mar;87(1):93-102

Knee osteochondral defects are a common problem among people, especially young and active patients. So effective joint preserving surgeries is essential to prevent or even delay the onset of osteoarthritis for these group of patients. This study aims to critically appraise and evaluate the evidence for the results and effectiveness of femoral condyle resurfacing (HemiCAP/ UniCAP) in treatment of patients with focal femoral condyle cartilage defect. Using the search terms : HemiCAP, UniCAP, Episurf, focal, femoral, condyle, inlay and resur-facing, we reviewed the PubMed and EMBASE and the Cochrane Database of Systematic Reviews (CDSR) to find any articles published up to March 2020. The short term follow-up of the HemiCAP shows (6.74 %) revision rate. However, 29.13 % loss of follow up let us consider these results with caution especially if the revision rate progressively increased with time to 19.3 % in 5-7 years with no enough evidence for the long term results except the data from the Australian Joint Registry 2018, where the cumulative revision rate was 40.6 % (33.5, 48.4) at ten years. The UniCAP that used for defect more than 4 cm 2 has a high revision rate (53.66 %) which is considered unacceptable revision rate in com-parison to another similar prosthesis such as Uni-Knee Arthroplasty (UKA). The evidence from published studies and our meta- analysis suggests that partial resurfacing of the femoral condyle (HemiCAP) doesn't support its usage as a tool to treat the focal cartilage defect in middle- aged patients. The UniCAP as femoral condyle resurfacing has very high revision rate at 5-7 years (53.66 %) which make us recommend against its usage.
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March 2021

Nontraumatic Tibial Polyethylene Insert Cone Fracture in Rotating-Platform Total Knee Arthroplasty.

Arthroplast Today 2021 Apr 8;8:283-288.e1. Epub 2021 Apr 8.

Department of Orthopaedic Surgery, Bon Secours Hospital, College Road, Cork, Ireland.

We report a case of a fracture through the polyethylene (PE) insert cone in a rotating-platform (RP) primary total knee arthroplasty (TKA) implant. This is the first reported case of cone fracture with this particular implant. This case highlights a 65-year-old female presenting with a 4-month history of knee pain and symptoms of instability 10 years after primary RP TKA. At the time of revision surgery, the PE insert cone was found to be fractured 10 mm from the inferior surface of the PE liner. Analysis suggests that the cone fracture occurred by fatigue failure which caused loosening of the tibial tray. Clinicians should be aware that this is a potential cause of failure with an RP TKA in the setting of symptoms including instability and pain.
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http://dx.doi.org/10.1016/j.artd.2021.02.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167323PMC
April 2021

The decline of hip fracture incidence rates over a 10-year period: A single centre experience.

Injury 2021 Jul 16;52(7):1807-1812. Epub 2021 Apr 16.

Department of Orthopaedic Surgery, Cork University Hospital, Wilton, Co. Cork, Ireland.

Aims: Accurate epidemiological hip fracture data is essential for healthcare planning and targeted prevention strategies. Limited reports of hip fracture incidence rates in the Republic of Ireland (ROI) exist. The aim is to calculate the current age- and gender-specific incidence of hip fractures in a level 1 Trauma Centre in the ROI, and the difference in these rates over a 10 year period.

Materials And Methods: This was a retrospective, population-based, observational study. The local Hospital In-Patient Enquiry (HIPE) database was used to generate data for analysis; capturing all patients admitted for hip fracture in three time periods over 10 years. Patients < 55 years old, pathological fractures, and periprosthetic fractures were excluded. Age- and gender-specific incidence rate was calculated using HIPE and national census data.

Results: Absolute number of hip fractures rose by 8.5% between 2008/09 (n = 800) and 2018/19 (n = 868) time periods. Cervical hip fractures dominated in all 3 time periods. The average age of patients remained at 80 years but length of stay for patients was reduced by 16% 5 years later and by 21% 10 years later from the initial study point. Both the entire and susceptible (> 55 years) population numbers increased by 13% and 30%, respectively, yet overall hip fracture incidence rate declined 10 years on. Hip fracture incidence rate in the entire population fell by 3.23 per 100,000 population, and by 65.11 per 100,000 population in the susceptible population. The majority of both male and female age groups exhibited declining annual incidence rates over the 10 year study period.

Conclusion: Results are consistent with the global experience of declining overall incidence rate of hip fractures, despite rising susceptible population numbers. This report adds to the sparse hip fracture incidence data available in the ROI which can be applied in future healthcare planning strategies.
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http://dx.doi.org/10.1016/j.injury.2021.04.051DOI Listing
July 2021

Midterm results of modern patellofemoral arthroplasty versus total knee arthroplasty for isolated patellofemoral arthritis: systematic review and meta-analysis of comparative studies.

Arch Orthop Trauma Surg 2021 Apr 7. Epub 2021 Apr 7.

Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Wilton, Cork, Ireland.

Background: Both Patellofemoral Arthroplasty (PFA) and Total Knee Arthroplasty (TKA) are accepted surgical options for end-stage isolated patellofemoral osteoarthritis (PFOA). We performed a systematic review and meta-analysis to compare outcomes of PFA and TKA by evaluation of the patient-reported outcome measures (PROMs).

Methods: We systematically identified publications reporting on patients that underwent either TKA or modern PFA for isolated PFOA. Meta-analysis software was used to screen for potential articles with at least two years' follow-up. Data were extracted and analysed for all PROMs operating time, postoperative inpatient time, complications and cost. We included five studies in our cumulative meta-analysis and reviewed them using Review Manager V.5.0. We computed the risk ratio as a measure of the treatment effect, taking into account heterogeneity. We used random-effect models.

Results: No significant difference was found between both TKA and PFA in the context of operating time. No significant difference after five years' follow-up was found between the two treatment options in terms of UCLA score and patient satisfaction. PFA showed significant improvement in WOMAC score at five-year follow-up, less postoperative inpatient time, better cost-effectiveness and significantly less blood loss.

Conclusion: PFA seems to be a viable alternative to TKA for treatment of isolated PFOA in appropriately selected patients. PFA showed less postoperative inpatient time and blood loss with similar PROMs to the TKA. Moreover, it is an economically beneficial joint-preserving procedure.
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http://dx.doi.org/10.1007/s00402-021-03882-4DOI Listing
April 2021

Harrington rods for periacetabular pathological lesion: is it an option?

Ir J Med Sci 2021 Feb 15. Epub 2021 Feb 15.

Trauma and Orthopaedics Department, Trauma and Orthopaedics Department, Cork University Hospital, Cork, Ireland.

Advancement in cancer treatment has prolonged the survival of cancer patients; as a result, there are an increased number of patients with bone metastases and pathological fractures referred to orthopaedic surgeons for surgical intervention for a better quality of life. Metastasis around the hip joint can be painful and intervene with patients' daily activity, and reconstruction of the hip joint with periacetabular metastasis is complex and challenging especially longer cancer survivals might out-live their fixation. Several acetabular reconstruction techniques and implants have been described to overcome this problem; acetabular reconstruction and total hip arthroplasty still remains the standard surgical treatment, to relief pain and to improve function and quality of life. Harrington reconstruction of periacetabular metastatic disease combined with hip arthroplasty is one of the options that can address this clinical scenario safely; it is reproducible and cost-effective. In this review, we present case series of patients treated in our institution using Harrington rod technique for acetabular pathological lesions with good outcome.
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http://dx.doi.org/10.1007/s11845-021-02538-xDOI Listing
February 2021

Polyethylene liner dissociation in a DePuy pinnacle cup with a manufacturer analysis of the failed component.

BMJ Case Rep 2021 Feb 4;14(2). Epub 2021 Feb 4.

Orthopaedics, Cork University Hospital Group, Cork, Munster, Ireland.

A 74-year-old patient presented to the emergency department with acute atraumatic hip pain 9 years after her primary left total hip arthroplasty (THA). Plain radiographic imaging demonstrated lateralisation of the femoral head within the acetabular shell-indicating an issue with the polyethylene liner. The patient required revision of the acetabular component and the femoral head, as well as a new polyethylene liner. A detailed analysis of the components removed was performed by DePuy Synthes Engineering. Between 2009 and 2020, 8 publications have documented 52 cases of liner dissociation with the Pinnacle acetabular component and Marathon polyethylene liner. Various theories have been proposed in the literature as all of these components appear to fail in the same way, with shearing of the locking tabs in the polyethylene liner. In spite of a manufacturer analysis of the components, no root cause was identified as to why the polyethylene liner failed.
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http://dx.doi.org/10.1136/bcr-2020-238333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868248PMC
February 2021

Trabecular Metal Augments for Severe Acetabular Defects in Revision Hip Arthroplasty: A Long-Term Follow-Up.

J Arthroplasty 2021 05 29;36(5):1740-1745. Epub 2020 Dec 29.

Dept. of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland; University College Cork, Cork, Ireland.

Background: Paprosky type IIIa and IIIb acetabular defects remain technically challenging during revision hip arthroplasty. Numerous surgical options exist to counter extensive acetabular bone loss with high postoperative complication and revision rates reported. Our aim was to report comprehensive long-term outcomes of our experience with Trabecular Metal (TM) augments for these difficult cases.

Methods: 38 patients underwent revision total hip arthroplasty at our institution from 2009 to 2014 where a TM augment was used for acetabular deficiency. Prospective radiographic and Patient-Reported Outcome Measures were recorded and analyzed to a mean of 7.3 years (range: 5.4 to 10.8).

Results: No patient was excluded or lost to follow-up. Complications included 3 intraoperative fractures, 1 early infection requiring washout with implant retention, 1 early revision due to allograft resorption, and 6 patients who required late repeat revision surgery: 3 for late infection, 2 for aseptic loosening with augment fracture or dislocation, and 1 for recurrent dislocation. The estimated mean implant survivorship was 8.99 years. 93.5% of augments remaining were well osseointegrated while 97% of the acetabular shells were osseointegrated. Hip center of rotation was restored by a mean of 14 mm inferiorly without significant medialization. Short Form-12 (SF-12) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were significantly reduced postoperatively to a level comparable to the average individual.

Conclusion: This long-term study details our experience of TM augments for the most severe acetabular defects. For such cases, no excellent surgical solution exists; in comparison to alternative methods, we advocate that this technique is reasonably safe and effective.
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http://dx.doi.org/10.1016/j.arth.2020.12.033DOI Listing
May 2021

Perioperative dexamethasone administration reduces 'on-demand' opioid requirements in bilateral total hip arthroplasty.

Ir J Med Sci 2021 Jan 13. Epub 2021 Jan 13.

Department of Orthopaedics, Cork University Hospital, Wilton, Cork, Ireland.

Background: Bilateral joint arthroplasty is currently not common, but its usage is expected to increase in the future. This may result in larger amounts of opioids being consumed by patients due to anticipated increased pain and prolonged recovery from this procedure.

Aim: We describe the impact of perioperative steroid administration in a cohort of bilateral total hip arthroplasties (THAs) (44 hips) in relation to post-operative opioid consumption.

Methods: We report a single-surgeon consecutive case series of simultaneously performed bilateral THAs. Nine patients received two doses of 8 mg IV dexamethasone in the perioperative setting. There were 13 patients in the control group that received no dexamethasone. The primary outcome measure was post-operative analgesic requirements (mg/mcg). Secondary outcomes included post-operative pain according to the visual analogue score (VAS), anti-emetic requirements (mg) and length of stay (days).

Results: The mean 'on-demand' Oxynorm® (IR oxycodone) usage in the 'steroid' group was lower than the 'non-steroid' group (47 mg vs 111 mg) (p = 0.005). There was also a significant decrease in the mean consumption of pregabalin in the 'steroid' group when compared with the 'non-steroid' group-464 mg versus 570 mg (p = 0.000). There was no reduction in the requirement of 'regularly' prescribed opioid analgesic medications. VAS analysis demonstrated no significant difference between the two groups at any timepoint. The 'steroid' group did have a trend towards a lower total LOS at 4.6 days compared with 5.5 days in the 'non-steroid' group (p = 0.0503).

Conclusions: We recommend the use of perioperative steroids in bilateral THA to reduce the consumption of potentially problematic opioid-based analgesics.
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http://dx.doi.org/10.1007/s11845-020-02486-yDOI Listing
January 2021

Perioperative steroid administration improves knee function and reduces opioid consumption in bilateral total knee arthroplasty.

J Orthop 2020 Nov-Dec;22:449-453. Epub 2020 Oct 7.

Cork University Hospital, Wilton, Cork, Ireland.

Introduction: The benefits of steroid usage have been well described for unilateral total knee arthroplasty (TKA), however it's benefits in bilateral TKA has not been well published in the literature. We describe the impact of perioperative steroid administration in a cohort of bilateral TKAs (74 knees) with regard to immediate postoperative knee function, postoperative knee strength and opioid consumption.

Materials And Methods: We report on a single-surgeon consecutive case series of simultaneously-performed bilateral TKAs. Eighteen patients received 2 doses of 8 mg IV dexamethasone in the perioperative setting. There were 19 patients in the control group. Primary outcome measures were day 1 postoperative knee flexion (degrees), knee strength and postoperative analgesic requirements (mg/mcg). Morphine dose equivalents (MDE) were calculated to compare all opioid-based analgesics. Secondary outcomes included post-operative pain according to the VAS (at 24, 48 and 72 h), anti-emetic requirements (mg) and length of stay (days).

Results: The mean knee flexion achieved day 1 in the steroid group was 70.1°(σ = 17.64, 95% CI 64.1-76.0) compared to 55.8° in the non-steroid group (σ = 19.8, 95% CI 49.2-62.3) (p = 0.0008). Regarding the straight leg raise, 88.9% of the steroid group were able to achieve this compared to only 55.2% of the non-steroid group (p = 0.002). There was a reduction in the MDE requirement per patient across all medications for the 'steroid' group. Both Targin® (p = 0.03) () and Fentanyl (p = 0.01) requirements were significantly reduced in the 'steroid' group.

Conclusion: We recommend the use of perioperative steroids in bilateral TKA to allow accelerated rehabilitation, improved immediate knee function and an overall reduction in the consumption of potentially problematic opioid-based analgesics.
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http://dx.doi.org/10.1016/j.jor.2020.10.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557967PMC
October 2020

Pediatric Trauma and the COVID-19 Pandemic: A 12-Year Comparison in a Level-1 Trauma Center.

HSS J 2020 Oct 6:1-5. Epub 2020 Oct 6.

Cork University Hospital, Wilton, Cork, Ireland.

Background: The effect of COVID-19 on pediatric trauma rates is still largely under investigation. With the potential need to reallocate human and financial resources at this challenging time, it will be useful to have detailed descriptions of the rates of pediatric trauma and understanding of how the pandemic affects these rates.

Questions/purposes: We sought to describe the effect of the COVID-19 pandemic on the number of acute pediatric trauma admissions and procedures performed in a level-I trauma center in Cork University Hospital, Ireland.

Methods: We compared the number of acute traumatic pediatric admissions and procedures that occurred during the first 4 weeks of a nationwide lockdown due to COVID-19 with that of the same 4-week period in each of the preceding 11 years. Seasonal variables were measured and controlled for using multivariate regression analysis.

Results: A total of 545 pediatric patients (under 16 years of age) were included. Over 12 years, the lowest number of acute traumatic pediatric admissions and procedures was recorded during the 2020 pandemic. There was a significant correlation between the number of school days and the number of acute traumatic admissions, as well as the procedures performed. The relationship between the number of school days and the number of trauma procedures was evident even when controlling for confounder variables of seasonal variation.

Conclusion: The COVID-19 pandemic significantly reduced the number of acute traumatic pediatric admissions and procedures performed in our level-I trauma center, likely because of a reduction in school days. With the reopening of schools, playgrounds, and sporting events, an increase in pediatric trauma admissions is anticipated. The results of this study can help prepare institutions and regulatory bodies to plan appropriately for this new phase.
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http://dx.doi.org/10.1007/s11420-020-09807-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537984PMC
October 2020

Patellar stabilization surgeries in cases of recurrent patellar instability: a retrospective clinical and radiological audit.

Ir J Med Sci 2021 May 19;190(2):647-652. Epub 2020 Aug 19.

Department of Orthopaedic Surgery, Cork University Hospital & South Infirmary Victoria University Hospital, Cork, Ireland.

Background: Patellar instability is a disabling condition that limits the functional ability and physical aspirations of patients. There are multiple anatomical structures which stabilize the patella and surgical treatment is tailored to repair the underlying aetiology.

Aims: To evaluate the clinical and radiological outcome of patellar stabilization procedures in patients with recurrent patellar instability.

Methods: We analysed 34 patients (36 knees) (mean age, 26.6) with recurrent patellar instability who underwent patellar stabilization surgery from June 2009 to September 2014. Type of procedure was dependent on the concomitant aetiological factors; tibial tuberosity osteotomy (61.76%), medial patellofemoral ligament reconstruction (67.64%), lateral release (5.88%) and trochleoplasty (2.94%). Mean follow-up was 3 years (range 9 months-6 years).

Results: At follow-up, 77% of patients were satisfied with the overall outcome of the procedure. The mean IKDC was 66.7, Lysholm 74.9. Mean patellar height decreased significantly (P < .05) to anatomical values. Pre-operatively, the mean tibial tuberosity-trochlear groove distance was 14.66 mm (55.6% at borderline/abnormal level) and 81% showed evidence of trochlear dysplasia. Complications were found in 3 patients (8.33%), 2 of which had further episodes of instability.

Conclusions: Patellar stabilization surgery is an effective method of treating patellar instability, resulting in stability of the knee in 94.4%. Despite this, patient dissatisfaction rates are quite high suggesting that this patient group, whilst mostly stable, remains significantly symptomatic from their knee. These positive results which are reflected in the recent literature represent a strong case for consideration of primary surgical stabilization in cases of patellar instability.
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http://dx.doi.org/10.1007/s11845-020-02344-xDOI Listing
May 2021

Polyethylene spinout in the Attune® Cruciate-Retaining Rotating-Platform (CR RP) total knee arthroplasty performed with a cruciate-sacrificing and measured-resection technique.

Knee Surg Relat Res 2020 Jul 22;32(1):36. Epub 2020 Jul 22.

Department of Trauma and Orthopaedic Surgery, Cork University Hospital/South Infirmary Victoria University Hospital, Wilton, Cork, T12 DC4A, Republic of Ireland.

Introduction: Polyethylene (PE) spinout is a known but uncommon complication when using a mobile-bearing (MB) total knee arthroplasty (TKA) design. Sacrificing the posterior cruciate ligament (PCL) is within the manufacturer's recommendations for the Attune® Cruciate-Retaining Rotating-Platform (CR RP) knee design.

Aim: To discuss the potential aetiology and prevention of spinout in the Attune® CR RP knee.

Methods: We used a retrospective radiological review from two centres reporting a higher rate of spinout in the Attune® CR RP knee using a cruciate-sacrificing and measured-resection technique when compared to a gap-balancing technique. Three hundred and thirty-two patients were evaluated over a 3-year period.

Results: There were 8 out of 279 (2.86%) cases of spinout in our first cohort of patients using a measured-resection technique. There were 0 out of 53 cases of spinout in our second cohort of patients where a gap-balancing technique was used. One spinout was reduced closed, the other seven were initially revised to a thicker RP insert of the same design. Of these seven, three underwent a further revision TKA and one patient required a knee fusion/arthrodesis.

Conclusions: This study reports a higher incidence of PE spinout in the Attune® CR RP TKA when a measured-resection technique in combination with PCL resection is performed. We recommend a gap-balancing technique with conservative soft-tissue release if the surgeon is planning to sacrifice the PCL in the Attune® CR RP.
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http://dx.doi.org/10.1186/s43019-020-00057-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374844PMC
July 2020

Follow-up study on transphyseal ACL reconstruction in Irish adolescents with no cases of leg length discrepancy or angular deformity.

Ir J Med Sci 2020 Nov 22;189(4):1323-1329. Epub 2020 May 22.

University College Cork, Cork University Hospital, South Infirmary Victoria University Hospital, Cork, Ireland.

Background: The rate of ACL injury in adolescents has been rising in recent years. Surgical options include transphyseal and physeal-sparing ACL reconstruction.

Aims: In this study, we performed a transphyseal ACL reconstruction and followed up patients to assess functional outcomes and to assess for growth disturbance.

Method: There were 22 patients seen at follow-up between the age of 12 and 16. Skeletal age assessment was performed using an MRI atlas with an average skeletal age of 14.7 (range 12-16). The mean follow-up time was 36 months (range 14-63 months). Clinical examination was performed to assess for leg length discrepancy, and leg length radiographs were used to assess for angular deformity. Patients' post-surgery functionality was assessed with the IKDC score and the Tegner Lysholm score.

Results: The mean IKDC and Lysholm scores at follow-up were found to be 91 and 94, respectively. The median Tegner score prior to injury was 8.5 and postoperatively was 7.5. There were no cases of leg length discrepancy found on clinical examination, and there were no cases of significant angular deformity. Four patients ruptured again and went on to have repeat ACL reconstruction.

Conclusions: Midterm results at an average follow-up of 3 years after the surgery showed good functional outcomes using the transphyseal ACL reconstruction technique with good return to activity. There were no cases of leg length discrepancy or angular deformity. Transphyseal ACL reconstruction is a viable method of treatment for adolescent ACL tears.
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http://dx.doi.org/10.1007/s11845-020-02259-7DOI Listing
November 2020

Bicortical Contact Predicts Subsidence of Modular Tapered Stems in Revision Total Hip Arthroplasty.

J Arthroplasty 2020 08 1;35(8):2195-2199. Epub 2020 Apr 1.

Department of Orthopaedics, Cork University Hospital, Wilton, Cork, Co. Cork, Ireland.

Background: We describe the intraoperative parameters that affect stem subsidence rates in tapered modular femoral stems for revision total hip arthroplasty (THA). We also determine the effect of the stem bicortical contact on subsidence rates and whether there is a minimum threshold bicortical contact that must be achieved to avoid the complication of subsidence.

Methods: This is a retrospective cohort study consisting of 109 hips in 105 patients (53 males and 52 females) at a minimum of 2 years of follow-up. All revisions were carried out for Paprosky type 3A and 3B femoral deficits. Clinical outcomes included the indication for revision, aseptic re-revision surgery, specifications of the stem inserted, and specifications of the femoral head and acetabular components implanted. Radiographic outcome measures included subsidence (mm) and bicortical contact (mm).

Results: Using multivariate regression analysis, 3 parameters were associated with an increased rate of stem subsidence. A reduced bicortical contact distance (P < .001) and a stem length of ≤155 mm (P < .001) were both associated with higher subsidence rates. We also demonstrated a novel threshold of 20-mm bicortical contact which must be achieved to significantly reduce subsidence rates in these modular femoral stems for revision THA.

Conclusion: Subsidence rates of modular tapered femoral stems for revision THA can be significantly reduced by increasing the initial bicortical contact of the stem within the diaphysis and the overall length of the femoral stem >155 mm. We describe a minimum threshold bicortical contact distance of 20 mm that should ideally be exceeded to significantly reduce the risk of stem subsidence within the femoral canal.
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http://dx.doi.org/10.1016/j.arth.2020.03.047DOI Listing
August 2020

History, treatment and analysis of a rare form of Exeter stem fracture.

BMJ Case Rep 2019 Dec 30;12(12). Epub 2019 Dec 30.

Orthopaedics, Cork University Hospital Group, Cork, Munster, Ireland.

The Exeter stem by Stryker has become one of the most successful and widely used stems in modern cemented hip arthroplasty. We present a case of a rare stem fracture which was treated by 'cement-in-cement' revision arthroplasty technique. The patient, an 87-year-old man, presented with left hip pain and an inability to weight bear following a cracking sensation when he was standing to dress himself. The patient denied history of fall or trauma. On examination he was noted to have a shortened externally rotated left lower limb without neurovascular compromise. On pelvic radiograph he was noted to have an incomplete stem fracture of his left-sided total hip replacement. He was treated with a cement-in-cement revision. Postoperatively the stem was sent for analysis in the London Implant Retrieval Centre. This is an example of a rare form of stem fatigue failure treated with a well-described technique in revision arthroplasty.
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http://dx.doi.org/10.1136/bcr-2019-231422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954763PMC
December 2019

Arthroplasty and global research output: A bibliometric analysis.

J Orthop 2020 Jan-Feb;17:187-192. Epub 2019 Jun 12.

Department of Orthopaedics, Cork University Hospital, Wilton, Cork, Ireland.

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.
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http://dx.doi.org/10.1016/j.jor.2019.06.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6919359PMC
June 2019

Virtual Mechanical Testing Based on Low-Dose Computed Tomography Scans for Tibial Fracture: A Pilot Study of Prediction of Time to Union and Comparison with Subjective Outcomes Scoring.

J Bone Joint Surg Am 2019 Jul;101(13):1193-1202

Departments of Radiology (M.M.M.) and Orthopaedic Surgery (S.A.M.B. and J.A.H.), Cork University Hospital, University College Cork, Wilton, Cork, Ireland.

Background: Quantitative outcomes assessment remains a persistent challenge in orthopaedic trauma. Although patient-reported outcome measures (PROMs) and radiographic assessments such as Radiographic Union Scale for Tibial Fractures (RUST) scores are frequently used, very little evidence has been presented to support their validity for measuring structural bone formation or biomechanical integrity.

Methods: In this pilot study, a sequential cohort of patients with a tibial shaft fracture were prospectively recruited for observation following standard reamed intramedullary nailing in a level-I trauma center. Follow-up at 6, 12, 18, and 24 weeks included radiographs and completion of PROMs (EuroQol 5-Dimension [EQ-5D] and pain scores). Low-dose computed tomography (CT) scans were also performed at 12 weeks. Scans were reconstructed in 3 dimensions (3D) and subjected to virtual mechanical testing via the finite element method to assess torsional rigidity in the fractured limb relative to that in the intact bone.

Results: Patients reported progressive longitudinal improvement in mobility, self-care, activity, and health over time, but the PROMs were not correlated with structural bone healing. RUST scoring showed moderate intrarater agreement (intraclass coefficient [ICC] = 0.727), but the scores at 12 weeks were not correlated with the time to union (R = 0.104, p = 0.193) and were only moderately correlated with callus structural integrity (R = 0.347, p = 0.010). In contrast, patient-specific virtual torsional rigidity (VTR) was significantly correlated with the time to union (R = 0.383, p = 0.005) and clearly differentiated 1 case of delayed union (VTR = 10%, union at 36 weeks) from the cases in the normally healing cohort (VTR > 60%; median union time, 19 weeks) on the basis of CT data alone.

Conclusions: PROMs provide insight into the natural history of the patient experience after tibial fracture but have limited utility as a measure of structural bone healing. RUST scoring, although reproducible, may not reliably predict time to union. In contrast, virtual mechanical testing with low-dose CT scans provides a quantitative and objective structural callus assessment that reliably predicts time to union and may enable early diagnosis of compromised healing.

Level Of Evidence: Therapeutic Level IV. Please see Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.2106/JBJS.18.01139DOI Listing
July 2019

Virtual structural analysis of tibial fracture healing from low-dose clinical CT scans.

J Biomech 2019 01 20;83:49-56. Epub 2018 Nov 20.

Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, PA, USA.

Quantitative assessment of bone fracture healing remains a significant challenge in orthopaedic trauma research. Accordingly, we developed a new technique for assessing bone healing using virtual mechano-structural analysis of computed tomography (CT) scans. CT scans from 19 fractured human tibiae at 12 weeks after surgery were segmented and prepared for finite element analysis (FEA). Boundary conditions were applied to the models to simulate a torsion test that is commonly used to access the structural integrity of long bones in animal models of fracture healing. The output of each model was the virtual torsional rigidity (VTR) of the healing zone, normalized to the torsional rigidity of each patient's virtually reconstructed tibia. This provided a structural measure to track the percentage of healing each patient had undergone. Callus morphometric measurements were also collected from the CT scans. Results showed that at 12 weeks post-op, more than 75% of patients achieved a normalized VTR (torsional rigidity relative to uninjured bone) of 85% or above. The predicted intact torsional rigidities compared well with published cadaveric data. Across all patients, callus volume and density were weakly and non-significantly correlated with normalized VTR and time to clinical union. Conversely, normalized VTR was significantly correlated with time to union (R = 0.383, p = 0.005). This suggests that fracture scoring methods based on the visual appearance of callus may not accurately predict mechanical integrity. The image-based structural analysis presented here may be a useful technique for assessment of bone healing in orthopaedic trauma research.
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http://dx.doi.org/10.1016/j.jbiomech.2018.11.020DOI Listing
January 2019

Factors in Pulmonary Embolus Diagnosis CT Pulmonary Angiogram in Patients Undergoing Repair of Proximal Femur Fractures.

Open Orthop J 2018 19;12:236-251. Epub 2018 Jul 19.

Mater Misercordae University Hospital, Radiology Eccles St, Dublin, Ireland.

Background: As imaging technology improves small Pulmonary Emboli (PE) of debatable clinical relevance are increasingly detected leading to higher numbers of patients receiving anticoagulation. Although PE are an important cause of morbidity and mortality in patients undergoing repair of proximal femur fractures, this cohort of patients are at increased falls risk and are therefore largely unsuitable for long term anticoagulant therapy.

Objective: 1. To review sequential Computed Tomography Pulmonary Angiograms (CTPA) performed in patients who underwent repair of proximal femur fractures at our institution. 2. To establish the perioperative CT imaging performed.

Design: A retrospective cross sectional study of all patients undergoing proximal femur fracture repair at a single tertiary referral.

Methods: The theatre database was interrogated to reveal all patients undergoing proximal femur fracture repair over a 28 month period from 01/01/12 to 07/04/14 inclusive. This was cross-referenced with the Picture Archiving Communication System (PACS) to establish all imaging undertaken in the perioperative period. CTPA studies performed within the time period of 1 week prior to and 6 months post proximal femur fixation were included. CTPA studies and reports were assessed for quality and findings. D-Dimer results, if performed within 72 hours of the CTPA study, were recorded.

Results: 1388 patients underwent neck of femur fracture repair in the 28-month study period. Of this cohort 71 CTPA studies were performed in 71 patients (5.2%) with a mean age of 77.8 years (range 38 - 100). 53 (74.6%) of studies were negative for embolus and 17 (23.9%) studies revealed clot in a pulmonary artery (1 saddle embolus, 2 main pulmonary artery emboli, 7 lobar vessel emboli, 2 segmental artery emboli, 5 subsegmental emboli). Overall PE detection rate was 1.2% of our total study population. In all 71 studies, Houndsfield Unit (HU) in the main pulmonary artery (PA) was >200; which is considered to be of satisfactory quality to assess for segmental pulmonary emboli. 32% of patients had D Dimer levels performed, however no relationship with presence of PE on CTPA was demonstrated.

Conclusion: The rate of positive CTPA studies in patients undergoing proximal femur fracture repair is 23.9% in our patient population, comparing favorably to published data. This is likely to reflect good compliance with prevention measures at ward level. D-Dimer results are unreliable for PE prediction.
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http://dx.doi.org/10.2174/1874325001812010236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6062902PMC
July 2018

A comparison of clinical- and patient-reported outcomes of the cemented ATTUNE and PFC sigma fixed bearing cruciate sacrificing knee systems in patients who underwent total knee replacement with both prostheses in opposite knees.

J Orthop Surg Res 2018 Mar 15;13(1):54. Epub 2018 Mar 15.

MRCSI FRCSI (Trauma and Orthopaedics) Consultant Orthopaedic Surgeon, Cork University Hospital Group, Cork, Ireland.

Background: The ATTUNE Knee by DePuy Synthes was introduced in 2013. It is designed to provide better range of motion and address patient-reported instability. The PFC Sigma Knee, an earlier prosthesis by DePuy Synthes, is a common knee replacement with a strong clinical track record. Our aim is to compare the outcomes after primary total knee replacement for end-stage knee osteoarthritis of the PFC and ATTUNE knee systems in 21 patients who each have prosthesis in opposite knees using WOMAC, Oxford Knee and SF-12 scores and evaluation of range of motion.

Methods: A review was carried out on 21 patients who underwent primary total knee replacement with both the ATTUNE and PFC knee systems. These were staged operations performed in the same institution and by the same surgeon. All cases were followed up for a minimum of 6 months. WOMAC, Oxford Knee and SF-12 scores, as well as knee range of motion were recorded preoperatively and at 6 months postoperatively.

Results: There was a significant difference in pre- to 6-month post-operative outcomes in PFC and ATTUNE groups with regard to improvement in range of motion (10° ± 8 and 13° ± 11, respectively). There was also a significant improvement in WOMAC scores (PFC group) and Oxford Knee Scores (ATTUNE group) (8.9 ± 7.7 and 12.1 ± 8.4, respectively). There was a significant improvement in SF-12 Score in both groups (10.1 ± 9.3 for PFC and 15.8 ± 13.3 for ATTUNE). The minimum clinically important difference (MCID) in scoring systems at 6 months was reached by 6 patients in the PFC group and 12 in the ATTUNE group.

Conclusion: A significant difference was demonstrated in clinical outcome at 6 months postoperatively between PFC and ATTUNE knee systems in patients who underwent total knee arthroplasty with both prostheses. Superior results were recorded for the ATTUNE knee system.
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http://dx.doi.org/10.1186/s13018-018-0757-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5856217PMC
March 2018

Acetabular Revision Using Trabecular Metal Augments for Paprosky Type 3 Defects.

J Arthroplasty 2018 03 6;33(3):823-828. Epub 2017 Dec 6.

Department of Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.

Background: Trabecular Metal (TM) augments are one option when reconstructing bone loss during acetabular side revision surgery.

Methods: We studied 38 consecutive patients with Paprosky type 3 defects that were revised using a TM shell and one or more augments over a 6-year period. There were 29 Paprosky type 3A defects and 9 Paprosky type 3B defects. The mean age of the patients at the time of surgery was 68.2 years (range 48-84). The mean length of follow-up was 36 months (range 18-74).

Results: The mean preoperative short form 12 health survey improved from 27.7 before operation to 30.1 at the time of final follow-up (P = .001). The mean Western Ontario and McMaster Universities Osteoarthritis Index score improved from 53 preoperatively to a mean of 78.8 at final follow-up (P < .0001). There was evidence of radiographic loosening in 7 of the cup-augment constructs. One patient developed a deep infection requiring re-revision. Two patients required revision for aseptic loosening.

Conclusion: The use of TM in complex acetabular reconstruction is associated with good outcome in the short to medium term.
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http://dx.doi.org/10.1016/j.arth.2017.10.031DOI Listing
March 2018

The impact of trabecular metal on hip centre of rotation in revision and complex primary hip arthroplasty, a radiological review.

Hip Int 2017 Sep 1;27(5):500-504. Epub 2017 Jul 1.

 Department of Orthopaedics, Cork University Hospital, Cork - Republic of Ireland.

Introduction: Total hip arthroplasty (THA) is a very successful procedure. Revision THA is becoming increasingly common. Recent developments to improve outcomes include the development of large trabecular metal (TM) acetabular cups and augments. There is a paucity of data on the benefit of these new techniques.

Methods: A single-centre retrospective review consisting of a radiological review of post-op revision THA anteroposterior pelvis. Data collection was performed using the Irish National Orthopaedic Register (INOR) and from a previous project. We used a technique developed by Fessy et al in 1999 to measure the centre of rotation (COR) of the hip. We then compared our study to that of a study measuring the COR of healthy native hips.

Results: 127 revision THA analysed. Native COR calculated by Fessy et al showed a mean horizontal (x) axis 33.6 mm (standard deviation [SD] 5.74) and a vertical (y) axis 16.4 mm (SD 4.67). Non-TM revisions showed a mean x axis of 29 mm (SD 3.9) and y axis 17.9 (SD 5.9). TM Augments had a mean x axis 29.2 mm (SD 7.9) and y axis of 21.5 (SD 8.4). TM Cups alone had a mean x axis 27 mm (SD 6.9) and y axis 22 mm (SD 10.18).

Conclusions: COR of TM implants showed considerable deviation from the norm. Non-TM implants showed a COR within acceptable physiological range. TM components consistently failed to restore a natural COR in our cohort. The implications of this remain uncertain but must be considered in any decision to use TM.
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http://dx.doi.org/10.5301/hipint.5000503DOI Listing
September 2017

Role of the fibula in the stability of diaphyseal tibial fractures fixed by intramedullary nailing.

Clin Biomech (Bristol, Avon) 2016 10 17;38:42-9. Epub 2016 Aug 17.

Medical Engineering Design and Innovation Centre, Department of Biomedical Engineering, Cork Institute of Technology, Rossa Avenue, Bishopstown, Cork, Ireland. Electronic address:

Background: For tibial fractures, the decision to fix a concomitant fibular fracture is undertaken on a case-by-case basis. To aid in this clinical decision-making process, we investigated whether loss of integrity of the fibula significantly destabilises midshaft tibial fractures, whether fixation of the fibula restores stability to the tibia, and whether removal of the fibula and interosseous membrane for expediency in biomechanical testing significantly influences tibial interfragmentary mechanics.

Methods: Tibia/fibula pairs were harvested from six cadaveric donors with the interosseous membrane intact. A tibial osteotomy fracture was fixed by reamed intramedullary (IM) nailing. Axial, torsion, bending, and shear tests were completed for four models of fibular involvement: intact fibula, osteotomy fracture, fibular plating, and resected fibula and interosseous membrane.

Findings: Overall construct stiffness decreased slightly with fibular osteotomy compared to intact bone, but this change was not statistically significant. Under low loads, the influence of the fibula on construct stability was only statistically significant in torsion (large effect size). Fibular plating stiffened the construct slightly, but this change was not statistically significant compared to the fibular osteotomy case. Complete resection of the fibula and interosseous membrane significantly decreased construct torsional stiffness only (large effect size).

Interpretation: These results suggest that fixation of the fibula may not contribute significantly to the stability of diaphyseal tibial fractures and should not be undertaken unless otherwise clinically indicated. For testing purposes, load-sharing through the interosseous membrane contributes significantly to overall construct mechanics, especially in torsion, and we recommend preservation of these structures when possible.
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http://dx.doi.org/10.1016/j.clinbiomech.2016.08.007DOI Listing
October 2016

Automated measurement of fracture callus in radiographs using portable software.

J Orthop Res 2016 07 18;34(7):1224-33. Epub 2016 Jan 18.

Department of Mechanical and Biomedical Engineering, Boise State University, 1910 University Drive, Boise, Idaho, 83725-2085.

The development of software applications that assist the radiographic evaluation of fracture healing could advance clinical diagnosis and expedite the identification of effective treatment strategies. A radiographic feature regularly used as an outcome measure for basic and clinical fracture healing research is new bone growth, or fracture callus. In this study, we developed OrthoRead, a portable software application that uses image-processing algorithms to detect and measure fracture callus in plain radiographs. OrthoRead utilizes an optimal boundary tracking algorithm to semi-automatically segment the cortical surface, and a novel iterative thresholding selection algorithm to then automatically segment the fracture callus. The software was validated in three steps. First, algorithm accuracy and sensitivity were analyzed using surrogate models with known callus size. Second, the callus area of distal femur fractures measured using OrthoRead was compared to callus area manually outlined by orthopaedic surgeons. Third, the callus area of ovine tibial fractures was measured using OrthoRead and compared to callus volume measured from micro-CT. The software had less than a 5% error in measuring surrogate callus, and was insensitive to changes in image resolution, image rotation, and the size of the analyzed region of interest. Strong positive correlations existed between OrthoRead and clinicians (R(2)  = 0.98), and between 2D callus area and 3D callus volume (R(2)  = 0.70). The average run time for OrthoRead was 3 s when using a 2.7 GHz processor. By being accurate, fast, and robust, OrthoRead can support prospective and retrospective clinical studies investigating implant efficacy, and can assist research on fracture healing mechanobiology. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1224-1233, 2016.
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http://dx.doi.org/10.1002/jor.23146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5166988PMC
July 2016

Preclinical TSPO Ligand PET to Visualize Human Glioma Xenotransplants: A Preliminary Study.

PLoS One 2015 30;10(10):e0141659. Epub 2015 Oct 30.

Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, TN, United States of America; Vanderbilt-Ingram Cancer Center (VICC), Vanderbilt University Medical Center, Nashville, TN, United States of America; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America; Program in Chemical and Physical Biology, Vanderbilt University Medical Center, Nashville, TN, United States of America; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States of America.

Current positron emission tomography (PET) imaging biomarkers for detection of infiltrating gliomas are limited. Translocator protein (TSPO) is a novel and promising biomarker for glioma PET imaging. To validate TSPO as a potential target for molecular imaging of glioma, TSPO expression was assayed in a tumor microarray containing 37 high-grade (III, IV) gliomas. TSPO staining was detected in all tumor specimens. Subsequently, PET imaging was performed with an aryloxyanilide-based TSPO ligand, [18F]PBR06, in primary orthotopic xenograft models of WHO grade III and IV gliomas. Selective uptake of [18F]PBR06 in engrafted tumor was measured. Furthermore, PET imaging with [18F]PBR06 demonstrated infiltrative glioma growth that was undetectable by traditional magnetic resonance imaging (MRI). Preliminary PET with [18F]PBR06 demonstrated a preferential tumor-to-normal background ratio in comparison to 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG). These results suggest that TSPO PET imaging with such high-affinity radiotracers may represent a novel strategy to characterize distinct molecular features of glioma growth, as well as better define the extent of glioma infiltration for therapeutic purposes.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0141659PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4627825PMC
June 2016

Radiographic findings after pubic symphysiotomy: mean time to follow-up of 41.6 years.

J Bone Joint Surg Am 2014 Jan;96(1):e3

Department of Trauma and Orthopaedic Surgery (J.G.G., J.F.B., P.F., and J.A.H.) and Department of Radiology (K.P.M. and N.M.), Cork University Hospital, Wilton, Cork, Ireland. E-mail address for J.A. Harty:

Background: Pubic symphysiotomy is a rarely performed procedure in which the pubic symphysis is divided to facilitate vaginal delivery in cases of obstructed labor. Recently, many obstetricians have shown renewed interest in this procedure. The purpose of this paper is to report the long-term radiographic findings for patients who had undergone pubic symphysiotomy compared with the radiographic appearance of a group of age-matched and parity-matched controls.

Methods: This was a retrospective case-control study. Twenty-five women who had previously undergone pubic symphysiotomy for childbirth were compared with twenty-five age-matched and parity-matched controls. The radiographic parameters recorded included pubic symphysis width, pubic symphysis translation, grade of sacroiliac joint osteoarthritis, and presence of parasymphyseal degeneration.

Results: The mean time to follow-up after symphysiotomy was 41.6 years (range, twenty-two to fifty-five years). The symphysiotomy group had a significantly higher proportion of patients (80%) with high-grade sacroiliac joint osteoarthritis (Grade 3 or 4 according to the Kellgren and Lawrence osteoarthritis scoring system) than the control group (16%) (p < 0.001). Within the symphysiotomy group, patients with high-grade sacroiliac joint osteoarthritis tended to be older, have a longer time to follow-up, and have a larger pubic symphysis width. The control group had a higher prevalence of parasymphyseal degeneration than did the symphysiotomy group (p = 0.011).

Conclusions: Late-onset sacroiliac joint osteoarthritis secondary to pelvic instability was a major finding in this study and, to our knowledge, has not been discussed previously in the literature regarding pubic symphysiotomy.
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http://dx.doi.org/10.2106/JBJS.L.01732DOI Listing
January 2014

Cerebrovascular infarction following bilateral total knee arthroplasty and tranexamic acid administration.

Acta Orthop Belg 2013 Jun;79(3):351-4

Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Wilton, Cork, Ireland.

Tranexamic acid has been shown to reduce perioperative blood loss without increasing the risk of venous thromboembolism after total knee replacement. However studies to date were designed to assess efficacy as the primary outcome and were not powered to assess safety. We report the case of a 65-year-old male with a previously undiagnosed patent foramen ovale who suffered pulmonary emboli and cerebrovascular infarction after synchronous bilateral total knee replacement during which tranexamic acid was administered intravenously.
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June 2013
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