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Morison Z, Vicente M, Schemitsch EH, McKee MD. The treatment of atrophic, recalcitrant long-bone nonunion in the upper extremity with human recombinant bone morphogenetic protein-7 (rhBMP-7) and plate fixation: A retrospective review. Injury 2016; 47:356-63. [PMID: 26763298 DOI: 10.1016/j.injury.2015.11.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/12/2015] [Accepted: 11/22/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Recombinant Human Bone Morphogenetic Protein-7 (rhBMP-7) has been shown to promote fracture healing in both clinical studies and basic science models, however, there is little information from large-scale studies of its use for human nonunion. The purpose of this study was to determine the safety and efficacy of rhBMP-7 in the treatment of atrophic human long-bone nonunions in the upper extremity. PATIENTS AND METHODS This was a single center, retrospective, longitudinal cohort study of patients treated with compression plating and the application of rhBMP-7 in isolation to a long-bone nonunion. Patients over sixteen years of age with an atrophic, aseptic nonunion of a humerus, radius, ulna or clavicle were eligible for inclusion. RESULTS We identified seventy eligible patients who were treated with rhBMP-7 for a long-bone nonunion between July 1997 and April 2012. The mean age of the patients at the time of treatment with rhBMP-7 was 50.7 years (range, 20-92 years). Five patients were lost to follow-up prior to definitive clinical or radiographic union. During the one-year post-operative period fifty-six patients had achieved union and two patients developed a stable fibrous union after the index procedure. Two patients had early implant failure and five patients had persistent nonunion. Thus, the union rate following initial surgery was 89% (58/65) and four of the five nonunion patients went on to heal following revision open reduction and internal fixation. CONCLUSION We found that the application of rhBMP-7 for upper extremity nonunion was an effective method (89% union rate) of treating this challenging pathology. Additionally, if not initially successful, further reconstruction was not compromised by rhBMP-7 use.
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Affiliation(s)
- Zachary Morison
- Investigation conducted at St Michael's Hospital, Toronto, Canada
| | - Milena Vicente
- Investigation conducted at St Michael's Hospital, Toronto, Canada
| | | | - Michael D McKee
- Investigation conducted at St Michael's Hospital, Toronto, Canada
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Hoskinson S, Morison Z, Shahrokhi S, Schemitsch EH. Managing AVN following internal fixation: treatment options and clinical results. Injury 2015; 46:497-506. [PMID: 25548114 DOI: 10.1016/j.injury.2014.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/05/2014] [Accepted: 11/17/2014] [Indexed: 02/02/2023]
Abstract
Avascular necrosis (AVN) after internal fixation of intracapsular hip fractures is a progressive multifactorial disease that ultimately results in local ischemia with ensuing osteocyte necrosis and structural compromise. This disease can cause significant clinical morbidity and affects patients of any age, including young and active patients. Effective treatment of this condition among young adults is challenging due to their high functional demands. The aim of managing AVN is to relieve pain, preserve range of movement and improve function. Treatment methods vary depending on the stage of the disease and can be broadly categorised into two options, hip preserving surgery and hip arthroplasty. Although, hip preserving techniques are attractive in the young adult, they may alter the morphology of the proximal femur and make subsequent arthroplasty more challenging. Conversely, arthroplasty in the young adult may require repeat revision procedures throughout the patient's life. Current evidence suggests that modifications of prevailing treatments, in addition to new technologies, have led to the development of management strategies that may be able to alter the course of femoral head osteonecrosis. This review aims to summarise the options available for treatment of AVN in the young adult and review the clinical results.
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Affiliation(s)
- Simon Hoskinson
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Canada M5C 1R6
| | - Zachary Morison
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Canada M5C 1R6
| | - Shahram Shahrokhi
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Canada M5C 1R6
| | - Emil H Schemitsch
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Canada M5C 1R6.
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Olsen M, Al Saied M, Morison Z, Sellan M, Waddell JP, Schemitsch EH. The impact of proximal femoral morphology on failure strength with a mid-head resection short-stem hip arthroplasty. Proc Inst Mech Eng H 2014; 228:1275-80. [PMID: 25515228 DOI: 10.1177/0954411914562872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mid-head resection short-stem hip arthroplasty is a conservative alternative to conventional total hip replacement and addresses proximal fixation challenges in patients not suitable for hip resurfacing. It is unclear whether proximal femoral morphology impacts the ultimate failure load of mid-head resection implanted femurs, thus the aim of this study was to investigate the effect of native neck-shaft angle (NSA) and coronal implant alignment on proximal femoral strength. In total, 36 synthetic femurs with two different proximal femoral morphologies were utilized in this study. Of them, 18 femurs with a varus NSA of 120° and 18 femurs with a valgus NSA of 135° were each implanted with a mid-head resection prosthesis. Femurs within the two different femoral morphology groups were divided into three equal coronal implant alignment groups: 10° valgus, 10° varus or neutral alignment. Prepared femurs were tested for stiffness and to failure in axial compression. There was no significant difference in stiffness nor failure load between femurs implanted with valgus-, varus- or neutrally aligned implants in femurs with a NSA of 120° (p = 0.396, p = 0.111, respectively). Femurs implanted in valgus orientation were significantly stiffer and failed at significantly higher loads than those implanted in varus alignment in femurs with a NSA of 135° (p = 0.001, p = 0.007, respectively). A mid-head resection short-stem hip arthroplasty seems less sensitive to clinically relevant variations of coronal implant alignment and may be more forgiving upon implantation in some femoral morphologies, however, a relative valgus component alignment is recommended.
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Affiliation(s)
- Michael Olsen
- Martin Orthopaedic Biomechanics Laboratory, Li Ka Shing Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Mohamed Al Saied
- Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Zachary Morison
- Martin Orthopaedic Biomechanics Laboratory, Li Ka Shing Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Michael Sellan
- Martin Orthopaedic Biomechanics Laboratory, Li Ka Shing Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - James P Waddell
- Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Emil H Schemitsch
- Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
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Mehra A, Morison Z. Infrapatellar fat pad: an aid in revision total knee arthroplasty. Ann R Coll Surg Engl 2014; 96:316-7. [PMID: 24780032 DOI: 10.1308/rcsann.2014.96.4.316a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Mehra
- Alexandra Hospital, Redditch, UK
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Atrey A, Morison Z, Waite J, Young SK. A method for the placement of the ceramic liner in an uncemented cup. Ann R Coll Surg Engl 2014; 96:250. [PMID: 24780810 DOI: 10.1308/rcsann.2014.96.3.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Atrey
- 1South Warwickshire NHS Foundation Trust, UK.
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Atrey A, Waite J, Hart A, Meswania J, Morison Z, Carr R, Young SK. Failure of a Ceramic-on-Ceramic Hip Resurfacing Due to Metallosis: A Case Report. JBJS Case Connect 2014; 4:1-6. [PMID: 29252513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Amit Atrey
- Lower Limb Research Unit, Warwick Hospital, Lakin Road, Warwick, CV34 5BW, United Kingdom. E-mail address for A. Atrey: . E-mail address for J. Waite: . E-mail address for R. Carr: . E-mail address for S.K. Young:
| | - Jon Waite
- Lower Limb Research Unit, Warwick Hospital, Lakin Road, Warwick, CV34 5BW, United Kingdom. E-mail address for A. Atrey: . E-mail address for J. Waite: . E-mail address for R. Carr: . E-mail address for S.K. Young:
| | - Alistair Hart
- John Scales Centre for Biomedical Engineering, UCL Institute of Orthopaedics & Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP. E-mail address for A. Hart: . E-mail address for J. Meswania:
| | - Jay Meswania
- John Scales Centre for Biomedical Engineering, UCL Institute of Orthopaedics & Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP. E-mail address for A. Hart: . E-mail address for J. Meswania:
| | - Zachary Morison
- Department of Orthopaedics, St. Michael's Hospital, Toronto, ON, Canada. E-mail address:
| | - Richard Carr
- Lower Limb Research Unit, Warwick Hospital, Lakin Road, Warwick, CV34 5BW, United Kingdom. E-mail address for A. Atrey: . E-mail address for J. Waite: . E-mail address for R. Carr: . E-mail address for S.K. Young:
| | - Steve Kendrick Young
- Lower Limb Research Unit, Warwick Hospital, Lakin Road, Warwick, CV34 5BW, United Kingdom. E-mail address for A. Atrey: . E-mail address for J. Waite: . E-mail address for R. Carr: . E-mail address for S.K. Young:
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Atrey A, Waite J, Hart A, Meswania J, Morison Z, Carr R, Young SK. Failure of a Ceramic-on-Ceramic Hip Resurfacing Due to Metallosis: A Case Report. JBJS Case Connect 2014; 4:e28. [PMID: 29252622 DOI: 10.2106/jbjs.cc.m.00128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Amit Atrey
- Lower Limb Research Unit, Warwick Hospital, Lakin Road, Warwick, CV34 5BW, United Kingdom. . . .
| | - Jon Waite
- Lower Limb Research Unit, Warwick Hospital, Lakin Road, Warwick, CV34 5BW, United Kingdom. . . .
| | - Alistair Hart
- John Scales Centre for Biomedical Engineering, UCL Institute of Orthopaedics & Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP. .
| | - Jay Meswania
- John Scales Centre for Biomedical Engineering, UCL Institute of Orthopaedics & Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP. .
| | - Zachary Morison
- Department of Orthopaedics, St. Michael's Hospital, Toronto, ON, Canada.
| | - Richard Carr
- Lower Limb Research Unit, Warwick Hospital, Lakin Road, Warwick, CV34 5BW, United Kingdom. . . .
| | - Steve Kendrick Young
- Lower Limb Research Unit, Warwick Hospital, Lakin Road, Warwick, CV34 5BW, United Kingdom. . . .
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Atrey A, Morison Z, Waddell JP, Schemitsch E. A technique for avoiding notching of the anterior femur in total knee arthroplasty. Ann R Coll Surg Engl 2013; 95:530. [PMID: 24112506 DOI: 10.1308/003588413x13781990150491d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Atrey
- St Michael's Hospital, Toronto, Canada
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Morison Z, Olsen M, Higgins GA, Zdero R, Schemitsch EH. The biomechanical effect of notch size, notch location, and femur orientation on hip resurfacing failure. IEEE Trans Biomed Eng 2013; 60:2214-21. [PMID: 23481682 DOI: 10.1109/tbme.2013.2251745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
For hip resurfacing, this is the first biomechanical study to assess anterior and posterior femoral neck notching and femur flexion and extension. Forty-seven artificial femurs were implanted with the Birmingham hip resurfacing (BHR) using a range of notch sizes (0, 2, and 5 mm), notch locations (superior, anterior, and posterior), and femur orientations (neutral stance, flexion, and extension). Implant preparation was done using imageless computer navigation, and mechanical tests measured stiffness and strength. For notch size and location, in neutral stance the unnotched group had 1.9 times greater strength than the 5-mm superior notch group (4539 N versus 2423 N, p=0.047), and the 5-mm anterior notch group had 1.6 times greater strength than the 5-mm superior notch group, yielding a borderline statistical difference (3988 N versus 2423 N, p = 0.056). For femur orientation, in the presence of a 5-mm anterior notch, femurs in neutral stance had 2.2 times greater stiffness than femurs in 25° flexion (1542 N/mm versus 696 N/mm, p = 0.000). Similarly, in the presence of a 5-mm posterior notch, femurs in neutral stance had 2.8 times greater stiffness than femurs in 25° extension (1637 N/mm versus 575 N/mm, p = 0.000). No other statistical differences were noted. All femurs failed through the neck. The results have implications for BHR surgical techniques and recommended patient activities.
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Affiliation(s)
- Zachary Morison
- Martin Orthopaedic Biomechanics Laboratory, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
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Morison Z, Mehra A, Olsen M, Donnelly M, Schemitsch E. Computer navigation experience in hip resurfacing improves femoral component alignment using a conventional jig. Indian J Orthop 2013; 47:585-90. [PMID: 24379464 PMCID: PMC3868140 DOI: 10.4103/0019-5413.121585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The use of computer navigation has been shown to improve the accuracy of femoral component placement compared to conventional instrumentation in hip resurfacing. Whether exposure to computer navigation improves accuracy when the procedure is subsequently performed with conventional instrumentation without navigation has not been explored. We examined whether femoral component alignment utilizing a conventional jig improves following experience with the use of imageless computer navigation for hip resurfacing. MATERIALS AND METHODS Between December 2004 and December 2008, 213 consecutive hip resurfacings were performed by a single surgeon. The first 17 (Cohort 1) and the last 9 (Cohort 2) hip resurfacings were performed using a conventional guidewire alignment jig. In 187 cases, the femoral component was implanted using the imageless computer navigation. Cohorts 1 and 2 were compared for femoral component alignment accuracy. RESULTS All components in Cohort 2 achieved the position determined by the preoperative plan. The mean deviation of the stem-shaft angle (SSA) from the preoperatively planned target position was 2.2° in Cohort 2 and 5.6° in Cohort 1 (P = 0.01). Four implants in Cohort 1 were positioned at least 10° varus compared to the target SSA position and another four were retroverted. CONCLUSIONS Femoral component placement utilizing conventional instrumentation may be more accurate following experience using imageless computer navigation.
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Affiliation(s)
- Zachary Morison
- Department of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada,Address for correspondence: Ms. Zachary Morison, Division of Orthopaedic Surgery St. Michael's Hospital, 55 Queen Street East, Suite 800, Toronto, Ontario M5C 1R6, Canada. E-mail:
| | - Akshay Mehra
- Department of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Michael Olsen
- Department of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Michael Donnelly
- Department of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Emil Schemitsch
- Department of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Atrey A, Morison Z, Tosounidis T, Tunggal J, Waddell JP. Complications of closing wedge high tibial osteotomies for unicompartmental osteoarthritis of the knee. Bone Joint Res 2012; 1:205-9. [PMID: 23610692 PMCID: PMC3626211 DOI: 10.1302/2046-3758.19.2000084] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 07/02/2012] [Indexed: 11/26/2022] Open
Abstract
We systematically reviewed the published literature
on the complications of closing wedge high tibial osteotomy for
the treatment of unicompartmental osteoarthritis of the knee. Publications
were identified using the Cochrane Library, MEDLINE, EMBASE and
CINAHL databases up to February 2012. We assessed randomised (RCTs), controlled
group clinical (CCTs) trials, case series in publications associated
with closing wedge osteotomy of the tibia in patients with osteoarthritis
of the knee and finally a Cochrane review. Many of these trials
included comparative studies (opening wedge versus closing
wedge) and there was heterogeneity in the studies that prevented
pooling of the results.
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Affiliation(s)
- A Atrey
- St Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
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