A range of different total knee arthroplasty (TKA) designs have been developed, each specifically designed to relieve pain and restore knee function with the greatest possible patient satisfaction. The purpose of this study was to compare a posterior stabilized design and a cruciate-retaining design. We hypothesized that a cruciate-retaining design would have a higher Forgotten Joint Score (FJS) than a posterior stabilized design. Ninety-two patients were used in our analysis (46 patients in each group) involving TKA (Attune, Depuy-Synthes) between January 2014 and March 2015. We excluded patients with valgus alignment, post-traumatic arthritis, rheumatoid arthritis and major previous surgery on the knee. We compared the FJS, the Oxford Knee Score (OKS) and their ceiling effects. FJS was significantly higher in the fixed-bearing cruciate-retaining group (P=0.043). The mean (-SD) FJS for the cruciate-retaining group was 78,4-25.1 compared to 67.6-27.6 for the posterior stabilized group. No significant difference in OKS was detected. The total ceiling effect for FJS and OKS was 32.2% and 45.5%, respectively. In conclusion, patients with cruciate-retaining TKA showed a better FJS in comparison to posterior stabilized TKA. FJS has a higher discriminatory power compared to OKS.

BackgroundAlthough carpal tunnel syndrome (CTS) is the most common form of peripheral entrapment neuropathy, its pathogenesis remains largely unknown. An estimated heritability index of 0.46 and an increased familial occurrence indicate that genetic factors must play a role in the pathogenesis.Methods and resultsWe report on a family in which CTS occurred in subsequent generations at an unusually young age. Additional clinical features included brachydactyly and short Achilles tendons resulting in toe walking in childhood. Using exome sequencing, we identified a heterozygous variant (c.5009T>G; p.Phe1670Cys) in the fibrillin-2 (FBN2) gene that co‐segregated with the phenotype in the family. Functional assays showed that the missense variant impaired integrin-mediated cell adhesion and migration. Moreover, we observed an increased transforming growth factor-β signalling and fibrosis in the carpal tissues of affected individuals. A variant burden test in a large cohort of patients with CTS revealed a significantly increased frequency of rare (6.7% vs 2.5%–3.4%, p<0.001) and high-impact (6.9% vs 2.7%, p<0.001) FBN2 variants in patient alleles compared with controls.ConclusionThe identification of a novel FBN2 variant (p.Phe1670Cys) in a unique family with early onset CTS, together with the observed increased frequency of rare and high-impact FBN2 variants in patients with sporadic CTS, strongly suggest a role of FBN2 in the pathogenesis of CTS.

Primary bone and soft tissue tumours are rare in a non-referral teaching department. The incidence varies greatly among the different subtypes and every Orthopaedic surgeon will encounter one or more benign or malignant lesions during their careers. History, clinical examination and technical investigations are of great importance, but basic knowledge and basic principles are necessary for a correct clinical practice. It was the purpose of this study to raise awareness towards such pathology by exemplifying our cases from a two-year period in our community-based hospital and if necessary, to refer patients to specialised sarcoma centres.

Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty in isolated medial arthritis. UKA restores native tibial and femoral joint surfaces and corrects pre-disease limb alignment, by which natural knee biomechanics are restored, ensuring effective functional recovery. Proper patient selection and accurate surgical technique contribute to good functional outcome and long-term survival. The key steps of the procedure (as well as multiple tips and tricks) are demonstrated in the video article: (1) preoperative assessment and planning; (2) patient positioning and setup; (3) exposure; (4) instrument options and surgical technique; (5) distal femoral resection; (6) proximal tibial resection; (7) assessment of alignment and gaps; (8) finishing the femur—sizing, position, and posterior resection; (9) finishing the tibia—sizing and position; (10) trialing the implant; (11) implanting final components—cementing technique; (12) closure; and (13) rehabilitation. Following these surgical steps and principles will lead to excellent functional long-term results with a low revision rate and a minimum of complications.

Background: Functional outcome scores are often used to measure results of Total Hip Replacement (THR). Most current scoring systems were designed for use in Europe or North America and seem not optimally suited for a general West African setting. We introduce a cross-cultural adaptation of the Lequesne index as a new score. Method: A new functional hip score, adapted to the West African setting and based on the Lequesne Index was introduced. To evaluate this score, the score questionnaire was completed by a group of patients in the Paul VI Hospital in Ouagadougou, Burkina Faso, who were possible candidates for hip replacement. Patients with hip fractures were excluded. Double scores acquired with a minimal interval of four weeks were analysed and test-retest reliability was assessed using intra-class correlation coefficient. Results: Mean patient age was 43,3 years. All patients were able to answer all questions. Double scores were available in 21 patients. Intra-class correlation coefficient was 0.896 indicating very good correlation. Conclusion: The current study has shown that the cross-cultural adaptation of the Lequesne Index, used as Ouaga Score. It can be obtained easily and is reliable in a general West African patient population. We recommend the use of the Ouaga Score for functional evaluation and follow-up of THR in West Africa. Keywords: THR, Hip, Africa, Functional score, Hip replacement, Arthroscopy

The purpose of this study was to evaluate the safety and the effectiveness of a new modified anconeus transfer technique in revision surgery for refractory lateral epicondylitis of the elbow. A modified anconeus muscle transfer was performed in nine patients with persistent symptoms after previous surgical release of the common extensor origin. The original technique was modified by using only half of the anconeus muscle. Patients were clinically evaluated, including quickDASH score and grip strength measurement. At a mean follow up period of 36 months, 4 patients had an excellent result, 3 a good result and 1 a poor result. All patients rated their clinical situation as better than before surgery. All but one patient said to be happy with the result and they would undergo the procedure again. The mean quickDash score at the follow up was 10.6 (SD 14.4). No complications were observed. The modified Anconeus muscle transfer is a safe and effective procedure in patients with persistent lateral epicondylitis complaints after a previous surgical release.

We report on our experience of a THR program set up in Ouagadougou, Burkina Faso (BF). As THR is not performed on a regular basis in this country, we had to start it up completely. We work in BF during a 2 weeks period in December each year. We do this in cooperation with a local surgeon who makes a preselection of THR candidates in advance. This surgeon is trained by us to do the necessary follow up and can contact us all year round in case of specific problems. From 2004 until 2009 we performed 104 operations; these consisted of 98 THR, 2 bipolar hip replacements and 4 revisions. 3 of these revisions were of hip replacements performed by us; 1 revision was of a THR performed in France. Mean age at operation was 48,4 years. All operations were performed by an anterolateral approach with use of cemented implants. Reason for operation was degenerative arthritis in 31 (29,8%), AVN in 39 (37,5%), fracture in 30 (28,9%). Fractures were more than several months old in most cases. Reason for the revision operations was aseptic loosening in 3 cases and periprosthetic fracture in 1. For every operation, technical problems were recorded, if applicable. These problems were not necessarily complicatons. We recorded 50 technical problems in 31 patients. 73 operations (70,2%) were performed without any note of technical problem. Most frequently recorded problems were important shortening of the leg (6), very narrow femoral canal (6), difficult reduction (5), peroperative femoral fracture (4-excluding trochanter maior fracture), extensive fibrosis (4), blocked femoral canal (3). Flexible reamers were used in 5 cases. There were 2 peri-operative deaths: one patient died after a postoperatieve sickle cell crisis with hemolysis. One patient developed a pulmonary embolism. Both patients were Hb SC. We recorded 21 complications in 16 patients. The majority were osseous complications. These were 4 femoral fractures of which 3 had clinical repercussion, 4 trochanteric fractures without any clinical repercussion and 4 peroperative perforations of the femoral canal, all without postoperative clinical repercussion. Other complications were infection (2), paralysis of femoral nerve (1), burn injury by diathermia plate (1), postoperative hemolysis (1), pulmonary embolism (1) and dislocation (2). One infection and dislocation was found in the same patient. This was the patient with revision of a initial THR performed in France. The indications for THR in BF differ significantly form the indications we find in Belgium. We also find the average case in BF more challenging. During the years we have developed specific strategies and schemes based on our experience and the technical problems encountered during the operations. Specific tips and tricks regarding patient selection, technique and equipment will be presented. This can be a good opportunity to learn from our experience for anyone who wants to set up a similar program.