At the end of the follow up period, 11 of the 70 acetabular components (polyethylene liner or the acetabular shell) had been revised. The cumulative survival was 94.0% (95% confidence interval 88.4–99.7) with revision of the metal shell as the end point, and 84.0% (95% confidence interval 74.5–93.5) with revision surgery of the acetabular shell or liner due to any reason as an end point. Radiologically, 4 patients require acetabular revision and 22 patients had femoral osteolysis in gruen zone 7, indicative of polyethylene failure. This gave a combined revision, impending revision and zone 7 osteolysis cumulative survival of 55.3% (95% confidence interval 40.6–70.0).
We examined the effect of age, gender, body mass index (BMI), medical co-morbidity as represented by the American Society of Anaesthesiologists (ASA) grade, social deprivation, nursing practice, surgical approach, length of incision, type of prosthesis and duration of surgery on length of stay after primary total hip arthroplasty (THA). Data was collected on 675 consecutive patients in a regional orthopaedic centre in South West England. The length of stay varied from 2 to 196 days and was heavily skewed. Data were therefore analysed by non parametric methods. To permit comparison of short with protracted length of stay, data were arbitrarily reduced to 2 groups comprising 2 to 14 days for short stays and 15 to 196 for long. These data were analysed by Chi-squared and Fisher’s exact test in univariate and by Logistic regression for multivariate analysis The mean length of stay was 11.4 days, an over-estimate compared to the median length of stay of 8 days which more correctly reflects the skewed nature of the distribution. 81.5% of patients left hospital within 2 weeks, 13.6% within 2 and 4 and 4.9% after 4. On univariate analysis age above 80 years, age between 70 and 79 years, Body Mass Index >
35, ASA grades 3 and 4, transgluteal approaches, long incisions, cemented cups and prolonged operations were associated with longer stays. On multivariate analysis, age above 80, age between 70 and 80, ASA grades 3 and 4, prolonged operations and long incisions were highly significantly associated with hospital stay of over 2 weeks. This is the first study to record all the published variables associated with length of stay prospectively and to subject the data to multivariate analysis. Prolonged stay after THA is pre-determined by case mix but slick surgery through limited incisions may reduce the length of admission.
Metal-on-metal resurfacing offers an alternative strategy to hip replacement in the young active patient with severe osteoarthritis of the hip. The functional outcomes, failure rates and impending revisions in hybrid total hip arthroplasties (THAs) and Birmingham hip resurfacings (BHRs) were compared after 5–7 years. We studied the clinical and radiological results of the BHR with THA in two groups of 54 hips each, matched for sex, age, BMI and activity. Function was excellent in both groups as measured by the Oxford hip score (median 13 in the BHRs and 14 in the THAs, p=0.14), but the resurfacings had higher UCLA activity scores (median 9 v 7, p=0.001) and better EuroQol quality of life scores (0.90 v 0.78, p=0.003). The THAs had a revision or intention to revise rate of 8% and the BHRs 6%. Both groups demonstrated impending failure on surrogate end-points. 12% of THAs had polyethylene wear and osteolysis and there was femoral component migration in 8% of resurfacings. Polyethylene wear was present in 48% of hybrid hips without osteolysis. Of the femoral components in the resurfacing group which had not migrated, 66% had radiological changes of unknown significance. In conclusion, the early to mid-term results of resurfacing with the BHR appear at least as good as those of hybrid THA.
We investigated the effect of neck dimension upon cervical range of movement. Data relating to 100 subjects healthy subjects aged between 20 and 40yrs was recorded with respect to age, gender and ranges of movement in three planes. Additionally two commonly used methods of measuring neck motion, chin-sternal distance and uniplanar goniometer, were assessed against a validated measurement tool the CROM goniometer (Performance Attainment Associates, Roseville, MN). Using multiple linear regression analysis it was determined that sagittal flexion (P= 0.0021) and lateral rotation (P<
0.0001) were most closely related to neck circumference alone whereas lateral flexion (P<
0.0001) was most closely related to a ratio of circumference and length. The uniplanar goniometer has some usefulness when assessing neck motion, comparing favourably to chin-sternal distance that has almost no role. Neck dimension should be incorporated into cervical functional assessment. One should be wary about recorded values for neck motion from non-validated measurement tools.
We examined the effect of age, gender, body mass index (BMI), medical comorbidity as represented by the American Society of Anaesthesiologists (ASA) grade, social deprivation, nursing practice, surgical approach, length of incision, type of prosthesis and duration of surgery on length of stay after primary total hip arthroplasty (THA). Data was collected on 675 consecutive patients in a regional orthopaedic centre in South West England. The length of stay varied from 2 to 196 days and was heavily skewed. Data were therefore analysed by non parametric methods. To permit comparison of short with protracted length of stay, data were arbitrarily reduced to 2 groups comprising 2 to 14 days for short stays and 15 to 196 for long. These data were analysed by Chi-squared and Fisher’s exact test in univarate and by Logistic regression for multivariate analysis. The mean length of stay was 11.4 days, an over-estimate compared to the median length of stay of 8 days which more correctly reflects the skewed nature of the distribution. 81.5% of patients left hospital within 2 weeks, 13.6% within 2 and 4 and 4.9% after 4. On univarate analysis age above 80 years, age between 70 and 79 years, Body Mass Index >
35, ASA grades 3 and 4, transgluteal approaches, long incisions, cemented cups and prolonged operations were associated with longer stays. On multivariate analysis, age above 80, age between 70 and 80, ASA grades 3 and 4, prolonged operations and long incisions were highly significantly associated with hospital stay of over 2 weeks. This is the first study to record all the published variables associated with length of stay prospectively and to subject the data to multivariate analysis. Prolonged stay after THA is pre-determined by case mix but slick surgery through limited incisions may reduce the length of admission.
The success of total hip replacement in the young has consistently been worse both radiologically and clinically when compared to the standard hip replacement population. Methods: We describe the clinical and radiological outcome of 58 consecutive polished tapered stems (PTS) in 47 patients with a minimum of 10 years follow up (mean 12 years 6 months) and compared this to our cohort of standard patients. There were 22 CPT stems and 36 Exeter stems. Results: Three patients with 4 hips died before 10 years and one hip was removed as part of a hindquarter amputation due to vascular disease. None of these stems had been revised or shown any signs of failure at their last follow-up. No stems were lost to follow up and the fate of all stems is known. Survivorship with revision of the femoral component for aseptic loosening as the endpoint was zero and 4% (2 stems) for potential revision. The Harris hip scores were good or excellent in 81% of the patients (mean score 86). All the stems subsided within the cement to a mean total of 1.8mm (0.2–8) at final review. There was excellent preservation of proximal bone and an extremely low incidence of loosening at the cement bone interface. Cup failure and cup wear with an associated periarticular osteolysis was a serious problem. 19% of the cups (10) were revised and 25% of the hips (13) had significant periarticular osteolysis associated with excessive polyethylene wear. Discussion: The outcome of polished tapered stems in this age group is as good as in the standard age group and superior to other non PTS designs in young patients. This is despite higher weight and frequent previous surgery. Cup wear and cup failure were significantly worse in this group, with a higher incidence of periarticular osteolysis.
The collarless polished tapered stem (CPT) is a double tapered, cemented femoral component designed for primary hip replacement and as a revision stem for impaction bone grafting. We report outcome at a minimum of 10 years (mean 11 years 1 month). Of 191 consecutive primary hip replacements in 174 patients, implanted using contemporary cementing techniques, 63 patients died before 10 years (68 hips). None of these stems had been revised or had radiological signs of failure at their last follow-up. Only one patient (two hips) was lost to radiological follow-up, hence complete radiological data was available on 121 hips and clinical follow-up on 123 hips. The fate of all the hips is known. Survivorship with revision of the femoral component for aseptic loosening as the endpoint was 100%. The Harris hip scores were good or excellent in 75% of the patients with a mean of 86. All the stems subsided vertically within the cement mantle at a mean rate of 0.18mm per year, stabilising to a mean total of 1.95 mm (0.21–24 mm) after a mean of 11 years 1 month. Unlike Exeter stems there was no change in the alignment of the stems. There was excellent preservation of proximal bone and an extremely low (<
2%) incidence of loosening at the cement bone interface. The study confirms that the CPT subsides within the cement mantle, but without failing. It performs at-least as well as the best stems currently available.
Intramedullary pressures were better in all zones, for all cement modes, with proximal occlusion. The highest pressures were seen with Palacos-R at 4 minutes 30 seconds with proximal thumb occlusion. Stem insertion into Palacos-R at 4 minutes or 4 minutes 30 seconds, gave higher pressures than Simplex-P, with or without any form of occlusion. With Simplex-P, intramedullary pressures were higher, with Collar rather than thumb occlusion.
53 patients underwent closed reduction and longitudinal k-wiring of displaced Colles’ fractures and were reviewed after a mean of 26 months. Radiographs taken at the time of injury, after reduction and k-wiring, and at fracture union were compared for radial shortening and dorsal angulation. Manipulation significantly improved fracture position (p<
0.001). Dorsal angulation was successfully corrected by manipulation in 98%, and this position was maintained to fracture union in all cases. 73% of fractures manipulated for radial shortening >
2mm were adequately reduced, but 41% of these fractures subsequently lost position to malunite. The mean shortening between reduction and fracture union was 1.6mm. This did not correlate with Frykman Class or radial shortening at injury. Closed Reduction and k-wire stabilisation is an attractive technique because it is relatively non-invasive compared with plating or external fixation. However, a degree of radial shortening between reduction and fracture union must be anticipated. Fractures reduced inadequately to allow for this loss of radial length, are more likely to malunite. This may compromise functional outcome.