Mary Nugent

Aims Joint registries typically use revision of an implant as an endpoint and report survival rates after a defined number of years. However, reporting lifetime risk of revision may be more meaningful, especially in younger patients. We aimed to assess lifetime risk of revision for patients in defined age groups at the time of primary surgery. Methods The New Zealand Joint Registry (NZJR) was used to obtain rates and causes of revision for all primary total hip arthroplasties (THAs) performed between January 1999 and December 2016. The NZJR is linked to the New Zealand Registry of Births, Deaths and Marriages to obtain complete and accurate data. Patients were stratified by age at primary surgery, and lifetime risk of revision calculated according to age, sex, and American Society of Anesthesiologists (ASA) classification. The most common causes for revision were also analyzed for each age group. Results The overall, ten-year implant survival rate was 93.6% (95% confidence interval ...

Aims The success of total knee arthroplasty (TKA) is usually measured using functional outcome scores and revision-free survivorship. However, reporting the lifetime risk of revision may be more meaningful to patients when gauging risks, especially in younger patients. We aimed to assess the lifetime risk of revision for patients in different age categories at the time of undergoing primary TKA. Methods The New Zealand Joint Registry database was used to obtain revision rates, mortality, and the indications for revision for all primary TKAs performed during an 18-year period between January 1999 and December 2016. Patients were stratified into age groups at the time of the initial TKA, and the lifetime risk of revision was calculated according to age, sex, and the American Society of Anesthesiologists (ASA) grade. The most common indications for revision were also analyzed for each age group. Results The overall ten-year survival rate was 95.6%. This was lowest in the youngest age g...

Background: Arthroscopic meniscectomy often results in rapid recovery and return to preinjury activities; however, postoperative hemarthrosis and swelling can lead to pain, decreased range of motion, and delayed return to work and leisure activities. Tranexamic acid (TXA) is a lysine-based inhibitor of plasminogen to plasmin that has gained popularity in arthroplasty surgery for reducing blood loss and, more recently, in anterior cruciate ligament reconstruction by reducing postoperative hemarthrosis, swelling, and pain while increasing function in the short term. Purpose: To determine whether there is a role for TXA in improving the short-term results of swelling, pain, and function following arthroscopic meniscectomy. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: We performed a prospective double-blinded randomized controlled trial in 41 patients undergoing arthroscopic meniscectomy by comparing patients treated with intravenous TXA with those treated w...

MicroRNAs (miRNAs) are small molecules found to have major regulatory roles in many biological processes. This review aims to provide an overview of the recent advances in knowledge of the role of miRNAs in fracture healing and bone repair. A search of the published literature was performed (using the PubMed database) to include all relevant studies published in English. These studies were then reviewed and the results condensed into this review paper. MiRNAs have now been shown to have significant alterations in expression levels in bone tissue in the presence of fractures. This is thought to be related to the process of fracture healing through effects on osteoblasts and bone growth factors. These small molecules are also detectable in the circulation where their expression appears to be altered by the presence of fractures. Although further research is required in this area, miRNAs may present an opportunity for future clinical applications in fracture management.

Abnormal anthropometry including comparably lower weight and body mass index (BMI) in the adolescent idiopathic scoliosis (AIS) population is increasingly recognised, however, no study has examined postoperative weight loss or its clinical relevance in these relatively thin patients. This study aimed to assess perioperative nutritional status as well as clinically severe involuntary weight loss and its impact on outcomes in patients with AIS undergoing posterior spinal fusion (PSF). A further objective was to compare preoperative anthropometric measurements of the current AIS cohort with healthy controls. Seventy-seven consecutive and eligible patients with AIS who underwent PSF were prospectively followed up from hospital admission (January 2010-April 2012). Pre- and postoperative anthropometric measurements were collected (weight, height, BMI), and clinically severe unintentional weight loss computed, defined as loss of >10 % body weight from admission to hospital discharge. Th...

Unexpected early loosening was noted in some patients who had bipolar hemiarthroplasties using aspecific combination of head and stem. A review of all patients who had received this implant combination was performed to establish whether there was a higher than expected failure rate and to identify those patients who had evidence of early loosening requiring further intervention or monitoring. Theatre records were reviewed to identify those who had undergone bipolar hemiarthroplasty using these products. All surviving patients were contacted and offered an appointment at which they underwent clinical and radiological review. Following review, revision rates were compared to published Australian joint registry data. Of 247 eligible for recall, 139 attended for clinical and radiological review. The cumulative revision rate was 6.8 % at 4 years, with a mean time to revision of 26 months; however, there was a significantly higher revision rate of 12.1 % in those aged under 75 years at the time of surgery (p = 0.01). This is significantly higher than rates quoted for bipolar hemiarthroplasties in Australian joint registry data. Overall, higher than expected revision rates due to early loosening were seen for this product combination,especially in patients aged\75 years at the time of the initial surgery.

Ireland is currently in the process of establishing a National Joint Registry. We aim to determine which implants and surgical techniques are currently being used by Irish orthopaedic surgeons and to examine the impact that a National Joint Registry may have on arthroplasty practice in Ireland. The study consisted of a postal questionnaire sent to all public service consultant orthopaedic surgeons in The Republic of Ireland. We had a response rate of 76.6 %. Of this 76.6, 86.4 % regularly perform total hip arthroplasty (THA) and 84.7 % perform total knee arthroplasty. Of those who perform THA, 86.3 % use different implants in younger patients. Thirteen different femoral implants are used, and seven different knee implants. We conservatively estimate that at least 3,918 total hip arthroplasties and 2,604 total knee arthroplasties are performed in Ireland each year. At present we have no way to precisely monitor the number of arthroplasty procedures being performed, and we have no way of accurately monitoring the short- or long-term outcomes of the many implants used. The establishment of a National Joint Registry for Ireland would benefit the Irish orthopaedic community, and given the large number of procedures being performed, may also be of benefit to the international orthopaedic community.

Abnormal anthropometry including comparably lower weight and body mass index (BMI) in the adolescent idiopathic scoliosis (AIS) population is increasingly recognised, however, no study has examined postoperative weight loss or its clinical relevance in these relatively thin patients. This study aimed to assess perioperative nutritional status as well as clinically severe involuntary weight loss and its impact on outcomes in patients with AIS undergoing posterior spinal fusion (PSF). A further objective was to compare preoperative anthropometric measurements of the current AIS cohort with healthy controls. Seventy-seven consecutive and eligible patients with AIS who underwent PSF were prospectively followed up from hospital admission (January 2010-April 2012). Pre- and postoperative anthropometric measurements were collected (weight, height, BMI), and clinically severe unintentional weight loss computed, defined as loss of >10 % body weight from admission to hospital discharge. Th...

MicroRNA molecules have a variety of roles in cellular development and proliferation processes, including normal osteogenesis. These effects are exerted through post-translational inhibition of target genes. Altered miRNA expression has been demonstrated in several cancers, both in the tumor tissue and in the peripheral circulation. This may influence carcinogenesis if the specific miRNA targets are encoded by tumor suppressor genes or oncogenes. To date, most research investigating the role of microRNAs and primary bone tumors has focused on osteosarcoma and Ewing sarcoma. Several microRNAs including the miR-34 family have been implicated in osteosarcoma tumorigenesis via effects on the Notch signaling pathway. Progression, invasion, and metastasis of osteosarcoma tumor cells is also influenced by microRNA expression. In addition, microRNA expression may affect the response to chemotherapy in osteosarcoma and thus hold potential for future use as either a prognostic indicator or a therapeutic target. The EWS-FLI1 fusion protein produced in Ewing sarcoma has been shown to induce changes in miRNA expression. MicroRNA expression profiling may have some potential for prediction of disease progression and survival in Ewing sarcoma. There is limited evidence to support a role for microRNAs in other primary bone tumors, either malignant or benign; however, early work is suggestive of involvement in chondrosarcoma, multiple osteochondromatosis, and giant cell tumors of bone.

TITLE: Postoperative weight loss and its clinical significance in patients with adolescent idiopathic scoliosis who undergo spinal fusion INTRODUCTION Several studies demonstrate a comparably lower preoperative weight and body mass index (BMI) in adolescents with idiopathic scoliosis (AIS); however, no study has quantified unintentional postoperative weight loss, or established its impact on outcomes, in this already ‘thin’ patient population after major spinal deformity surgery. METHODS Seventy seven consecutive and eligible patients with AIS who underwent posterior spinal fusion (PSF) were prospectively follow-up from hospital admission (Jan 2010-April 2012). Pre- and postoperative anthropometric measurements were collected (weight, height, BMI) and unintentional weight loss from admission to hospital discharge recorded. Clinically severe involuntary weight loss during the hospital stay was defined as >10% loss of initial body weight from admission to hospital discharge. Sociod...

Micro ribonucleic acids (miRNAs) are small non-coding RNA segments that have a role in the regulation of normal cellular development and proliferation including normal osteogenesis. They exert their effects through inhibition of specific target genes at the post-transcriptional level. Many miRNAs have altered expression levels in cancer (either increased or decreased depending on the specific miRNA). Altered miRNA expression profiles have been identified in several malignancies including primary bone tumors such as osteosarcoma and Ewing's sarcoma. It is thought that they may function as tumor suppressor genes or oncogenes and hence when dysregulated contribute to the initiation and progression of malignancy. miRNAs are also thought to have a role in the development of bone metastases in other malignancies. In addition, evidence increasingly suggests that miRNAs may play a part in determining the response to chemotherapy in the treatment of osteosarcoma. These molecules are readily detectable in tissues, both fresh and formalin fixed paraffin embedded and, more recently, in blood. Although there are fewer published studies regarding circulating miRNA profiles, they appear to reflect changes in tissue expression. Thus miRNAs may serve as potential indicators of disease presence but more importantly, may have a role in disease characterization or as potential therapeutic targets. This review gives a brief overview of miRNA biochemistry and explores the evidence to date implicating these small molecules in the pathogenesis of bone tumors.