The prevalence of malnutrition in patients requiring total joint arthroplasty in a South African tertiary hospital
Total joint arthroplasty (TJA) is one of the most successful surgical procedures, with 95% survivorship for total hip arthroplasty (THA) and total knee arthroplasty (TKA) at ten years. It has been described as the gold standard surgical procedure for endstage degenerative joint disease of the hip and knee joints. More than 2 million primary TJAs were estimated to be performed globally in 2011. According to various national joint registries, the annual volume of THA ranges between 9 150 and 630 200, and for TKA ranges between 8 290 and 911 300, with the United States of America (USA) reporting the highest volumes. With our increasingly ageing population and a rise in obesity, the volume of arthroplasty surgery has been increasing and is projected to increase further in the future. Sloan et al. predicted the volume of primary THA and TKA to rise 145% and 147%, respectively, by 2030.
Radiographic and clinical outcomes in adolescent idiopathic scoliosis corrective fusion surgery: a one-year follow-up
Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional deformity of the spine characterised by a coronal Cobb angle of at least ten degrees. It is the most common type of scoliosis affecting 2–4% of adolescents, involving children between 10 and 18 years of age. The overall prevalence of AIS is 0.47–5.2%. The femaleto- male ratio ranges from 1.5:1 to 3:1, and increases substantially with age. The two major groups of scoliosis are idiopathic and nonidiopathic, and the diagnosis of idiopathic scoliosis is made if nonidiopathic scoliosis has been excluded.
Closed intra-articular tibial plafond fractures managed with circular external fixation: clinical outcomes at a South African tertiary hospital
Tibial plafond fractures are complex injuries involving the distal tibiotalar articular cartilage, representing 1% of all lower limb fractures and 5–7% of tibial fractures. The aetiology is commonly high-energy trauma involving axial compression, which drives the talus into the plafond, resulting in articular impaction of the distal tibia. Due to the limited muscle coverage and vascularity in this region, soft tissue compromise occurs, which results in a prolonged treatment course and frequently, repeat hospitalisation.
Microbiology of unresolved bone infection: is it recurrence or recalcitrance?
Bone infection is a dreaded complication following orthopaedic trauma surgery, and remains a challenge to orthopaedic surgeons. Unresolved bone infection is defined as the persistence or re-emergence of bone infection after index infection eradication surgery. Additionally, the term ‘treatment failure’ can be synonymous with ‘unresolved bone infection’. The term ‘treatment failure’ has been described by multiple studies; however, variability in the definition depends on the clinical context. Lu et al. defined treatment failure as the recurrence in infection or amputation. Tsang et al., on the other hand, defined treatment failure as the inability to achieve either fracture union or the resolution of infection.
Current concepts: approach to spondylolysis
Lumbar spondylolysis is an acquired defect of the pars interarticular process (‘isthmus’) due to the human species’ erect posture. Anatomical and load factors play a role. With lumbar extension, the superior vertebra’s inferior articular process drives down dorsally on the inferior pars, causing a ventral tensile stress, bone oedema, fracture, and ultimately nonunion in some. The population incidence is around 6%, where most are inconsequential as they are asymptomatic and have a favourable natural history.