Ashley W Blom

A comparison of the reliability and validity of bone stock loss classification systems used for revision hip surgery

Three femoral (Paprosky, American Academy of Orthopaedic Surgeons [AAOS], and Endo-Klinik) and 2 acetabular (Paprosky, AAOS) bone stock loss classification systems were evaluated for reliability. Four observers (2 consultants, 2 registrars) graded the bone loss in 25 patients using preoperative radiographs. Grading was repeated after a minimum of 2 weeks. Interobserver and intraobserver reliability was investigated. The kappa statistic was used to assess levels of agreement. Intraobserver agreement ranged from poor to good. Interobserver agreement ranged from fair to moderate. The validity of the Paprosky classification system was evaluated, comparing preoperative bone stock loss assessment with intraoperative findings. Agreement levels of moderate (femoral classification system) to good (acetabular classification system) were achieved. Bone stock loss classification systems are shown to be inconsistent and unreliable.

Medial subvastus versus the medial parapatellar approach for total knee replacement

Twenty randomized controlled trials comprising 1893 primary total knee replacements were included in this review. The subvastus approach conferred superior results for mean difference (MD) in time to regain an active straight leg raise (1.7 days, 95% confidence interval [CI] 1.0 to 2.3), visual analogue score for pain on day one (0.8 points on a scale out of 10, 95% CI 0.2 to 1.4) and total range of knee movement at one week (7°, 95% CI 3.2 to 10.7). The subvastus approach also resulted in fewer lateral releases (odds ratio 0.4, 95% CI 0.2 to 0.7) and less peri-operative blood loss (MD 57 mL, 95% CI 10.5 to 106.4) but prolonged surgical times (MD 9.7 min, 95% CI 3.9 to 15.6). There was no difference in Knee Society Score at six weeks or one year, or the rate of adverse events including superficial or deep infection, deep vein thrombosis or knee stiffness requiring manipulation under anaesthesia. This review demonstrates evidence of early post-operative benefits following the subvastus approach with equivalence between approaches thereafter. Cite this article: EFORT Open Rev 2018;3:78-84. DOI: 10.1302/2058-5241.3.170030.

Apley & Solomons System of Orthopaedics and Trauma

Part 1: General Orthopaedics. Diagnosis in Orthopaedics. Infection. Inflammatory Rheumatic Disorders. Crystal Deposition Disorders. Osteoarthritis and Related Disorders. Osteonecrosis and Osteochondritis. Metabolic and Endocrine Bone Disorders. Genetic Disorders, Skeletal Dysplasias and Malformations. Tumours. Neuromuscular Disorders. Peripheral Nerve Disorders. Principles of Orthopaedic Operations. Part 2: Regional Orthopaedics. The Shoulder and Pectoral Girdle. The Elbow. The Wrist. The Hand. The Neck. The Back. The Hip. The Knee. The Ankle and Foot. Part 3: Trauma. The Management of Major Injuries. Principles of Fractures. Injuries of the Shoulder and Upper Arm. Injuries of the Elbow and Forearm. Injuries of the Wrist. Hand Injuries. Injuries of the Spine. Injuries of the Pelvis. Injuries of the Hip and Femur. Injuries of the Knee and Leg. Injuries of the Ankle and Foot.