Introduction: The clinical results of the modular Charnley Elite total hip system have been the subject of some interest in recent years. Some studies have shown significant subsidence and rotational instability in some stems when used with low-viscosity cement. These unstable stems have been shown to fail early. This purpose of this study is to demonstrate our conflicting clinical results.

Materials and Methods: 616 modular Charnley Elite total hip arthroplasties were inserted between 1995 and 2002 at Wrightington Hospital, which is a tertiary referral centre and centre of excellence for joint replacement in United Kingdom. Both Consultants and trainees performed operations and a variety of surgical approaches were used. Normal viscosity bone cement was used in all patients. All patients were followed up prospectively.

Results: At mean follow-up of 8 years (range 5–12), 471 hips were available for review. 87 patients had died and 12 were lost to follow-up. 2.7% (13 cases) of femoral components and 2.9% (14 cases) of acetabular components had been revised for aseptic loosening. 10 hips (2.1%) underwent revision for deep infection and 2 (0.04%) for recurrent dislocation. The overall survival with aseptic loosening as an end point was 97% and for revision for any reason was 94.5%.

Conclusion: Our results show acceptable clinical survivor-ship for this implant when used with standard viscosity cement. This contrasts with the lower survivorship rates published by other centres. Our result should reassure patients and surgeons alike that this prosthesis can be associated with acceptable results in the medium term.

Introduction: Total hip replacement (THR) in young patients is a controversial subject due to high failure rates reported in the literature. The purpose of this study was to show our short term results of primary total hip replacement in patients younger than 30 years of age.

Methods: Patients who underwent THR prior to the age of 30 years between 1998 and 2007 were identified and records of all patients were reviewed together with the radiographs till the last follow up.

Results: Forty three THRs were performed on 36 patients with an average age of 24.4 years (range, 17–30) and an average follow up period of 47 months (range, 7–109 months). There were 5 cases of Juvenile chronic arthritis, 2 Rheumatoid arthritis, 11 DDH, 2 septic arthritis, 1 pseudoachondroplasia, 4 Perthes disease, 2 seronegative arthitides, 2 SUFE and 7 AVN [alcohol, leukaemia, fracture, SLE (2), mannosidosis, idiopathic].

Thirty cemented THRs and 13 hybrid THRs were performed through trochanteric osteotomy approach (23), posterior approach (17), Hardinge approach (2) and anterior approach (1). In the cemented group there were 3 cases of superficial wound discharges, 1 recurrent dislocation, 1 complete femoral nerve palsy, 2 cases of neuropraxia and 1 case with persistent hip pain but no cases of infection. In the hybrid group there was one case of partial femoral nerve palsy. None of the patients has undergone any revision surgery till the latest follow up. Radiologically only one case showed aseptic loosening in both femoral and acetabular components, which is not revised as the patient is asymptomatic.

Discussion: THR is an elegant procedure and should be certainly considered in young patients suffering with disabling arthritic conditions affecting the hip joint. Our results show that THR - both cemented and hybrid types - is a successful and durable treatment.

Introduction: “Force-closed”, tapered, polished, collarless stems, (e.g. C-stem, Exeter), are designed to subside in response to a gradual expansion of the cement/bone complex.

Above a certain threshold, distal migration may predict medium-to-long-term failure of “shape-closed” (collared, textured) stems. However, no such threshold exists for “force-closed” stems, and these may continue to migrate after 3 years. We believe that the tendency towards stabilisation 2–3 years postoperatively could be the best predictor of good long-term performance.

Method: Twenty OA patients (12F, mean age 66.6 years) were recruited for primary hip replacement with beaded C-Stem femoral components. Tantalum marker beads were injected into the proximal femur, and stems were inserted using CMW1 cement and the latest generation cementing technique via: a posterior approach (17), and a lateral, trochanteric approach (3). RSA X-ray examinations were performed at 1 week, 6 weeks, and at 3, 6, 12, 24 and 36 months postoperatively. The UmRSA system was used to measure and analyse the radiographs.

Results: By 36M the mean stem subsidence (1.05 mm) had levelled off to a low rate, and the mean internal rotation (2.5°) had not significantly changed during the final year (p = 0.08). The mean posterior migration of the stem centroid was 0.54 mm and posterior migration of the femoral head was 1.66 mm (0.25 mm/y during final year).

Discussion: At 36M the mean subsidence rate was very low, and the mean posterior migration was about one third of that reported by Sundberg et al. (BHS Meeting, 2007). Although the mean internal rotation was greater than that reported for the Exeter stem, it had stabilised during the final year. These low rates of migration at 3 years are consistent with the good results found in clinical studies of this femoral component.

Introduction: The clinical results of the modular Charnley Elite total hip system have been the subject of some interest in recent years. Some studies have shown significant subsidence and rotational instability in stems when used with low-viscosity cement. These unstable stems have been shown to fail early. The purpose of this study is to demonstrate our conflicting clinical results.

Materials and Methods: 616 modular Charnley Elite total hip arthroplasties were inserted between 1995 and 2002 at Wrightington Hospital, which is a tertiary referral centre and centre of excellence for joint replacement in United Kingdom. Both Consultants and trainees performed operations and a variety of surgical approaches were used. Normal viscosity bone cement was used in all patients. All patients were followed up prospectively.

Results: At mean follow-up of 8 years (range 5–12), 471 hips were available for review. 87 patients had died and 12 were lost to follow-up. 2.7% (13 cases) of femoral components and 2.9% (14 cases) of acetabular components had been revised for aseptic loosening. 10 hips (2.1%) underwent revision for deep infection and 2 (0.04%) for recurrent dislocation. The overall survival with aseptic loosening as an end point was 97% and for revision for any reason was 94.5%.

Conclusion: Our results show acceptable clinical survivor-ship for this implant when used with standard viscosity cement. This contrasts with the lower survivorship rates published by other centres. Our result should reassure patients and surgeons alike that this prosthesis can be associated with acceptable results in the medium term.

In situ fixation of mild slips of the slipped capital femoral epiphysis (SCFE) is a safe and reliable method of treatment. Hardware failure and fractures are reported at the time of pin retrieval. Difficulty in removing these pins is well reported. Major problems can be expected when arthroplasty is necessary years later, if the pins are still inside the proximal femur. Hence we have come up with a novel technique to remove these pins during Primary Total hip arthroplasty.

The hip is exposed through posterior approach, dislocated and the neck is then cut at the usual site. It is then segmented in both sagittal and coronal planes into approximately eight to ten pieces and removed piecemeal. The pins are thus exposed, cleared of any bony debris and hammered retrograde.

By using our simple and novel technique to remove these pins we feel it avoids unnecessary trauma to the outer cortex of femur and also reduces the operating time significantly.

Introduction: Hip Resurfacing has increased in popularity, particularly in young, active patients. However, concerns remain regarding metal ion levels, hypersensitivity leading to aseptic lymphocytic-vasculitis-associated lesions(ALVAL) and AVN. The purpose of this study was to document our experience of revising resurfacing arthroplasty for ALVAL.

Methods: All patients undergoing conversion of hip resurfacing to total hip replacement at our institution were reviewed. The notes were reviewed for the reason for revision, the make of the implant, time interval between primary procedure and revision and final diagnosis. Radiographs were reviewed to assess for implant alignment, signs of loosening, neck thinning and AVN.

Results: Out of the 34 patients who had revision surgery 13 were revised for suspected ALVAL, with mean age of 58.8 years at a mean 42.9 months following primary surgery. Of the 13 resurfacings revisions 11 were Birmingham resurfacing and 1 each of Cormet and ASR resurfacing. Groin pain was the presenting complaint in all patients, 5 patients developed their symptoms immediately postoperatively whilst 8 developed symptoms at mean 28.25 months. Haematological investigations were non-diagnostic. Radiographs were normal in 4 patients, whilst 4 demonstrated a loose cup. Thinning of femoral neck and vertical cup alignment were present in 2 patients each while 1 patient had both vertical cup and thinning of femoral neck. All revisions were achieved with primary implants and all patients had immediate pain relief after surgery. Implants and tissue were sent for laboratory analysis. 3 patients had a confirmed histological diagnosis of ALVAL, the remaining cases had identical operative findings and are presumed ALVAL.

Discussion: ALVAL accounts for nearly 1/3 of all our revisions for failed resurfacing arthroplasty. Unexplained pain in patients with resurfacing arthroplasty should be considered for a diagnosis of ALVAL and investigated appropriately. Symptoms tend to resolve reliably following conversion to total hip arthroplasty.

Introduction: The Birmingham Hip Resurfacing(BHR) has shown encouraging early to medium term results. It has tended to be used in patients wishing to achieve high functional activity. However there is little data available to support this notion. The purpose of the study was to report the functional levels of patients following BHR.

Methods: Since February 2000, 313 patients have undergone resurfacing by the senior author. Two hundred and sixty four patients with a minimum 12 month follow-up were assessed for functional activity using the modified UCLA activity score. Patients were asked to score their activity level during the pre-symptomatic period as well as pre-operatively and during follow-up.

Results: The mean age at surgery was 55.7 years. The mean follow-up period was 46.72 months. The revision rate for any reason was 3.8%. The mean pre-symptomatic, pre-operative, one year post-operative and final follow-up UCLA scores were 7.9, 3.7, 6.6 and 7.0 respectively. At one year 89% (235 patients) had improved by at least one activity grade from pre-operative levels and 35% (93 Patients) achieved functional scores the same as, or better than their pre-symptomatic levels. This increased to 45% at final follow-up. Of the 242 patients previously involved in moderate activity(UCLA> =5), 31% regained this activity level at one year, rising to 40% at last follow-up. Only 19% of the 180 patients participating in very active/impact sports(UCLA> =8) obtained these levels at one year, rising to 30% at last follow-up.

Conclusion: This is the first assessment of function after BHR comparing pre-symptomatic scores with those obtained during follow-up. Functional scores continue to improve beyond one year in all groups. Significant numbers of patients can achieve functional levels at least as good as before they developed symptoms from their hip, however, the proportion of patients achieving this goal reduces with increasing pre-symptomatic activity.

Introduction: We previously reported our results of 98 Charnley Low-Friction Arthroplasty in 76 patients with Paget’s disease of the hip at an average follow-up of 10.4 years. The current report presents the outcome of this procedure at 15 to 30 years.

Methods: A total of 98 Charnley low-friction arthroplasties were performed on 76 patients, 27 men (37 hips) and 49 women (61 hips) with an average age of 67.4 years (range 51–79 years). All operations were performed by the trans-trochanteric or antero-lateral approach.

Results: When component revision was used as the endpoint, the survivorship of the acetabular component was 93% at 15 years (CI, 81% to 98%), 83% at 20 years (CI, 59% to 93%), 72% at 25 years (CI, 41% to 89%) and 36% at 30 years (CI, 2% to 78%). The survival of the femoral component was 91% at 15 years (CI, 80% to 96%), 84% at 20 years (CI, 60% to 94%), 84% at 25 years (CI, 60% to 94%) and 72% at 30 years (CI, 38% to 89%). The survival of both components was 89% at 15 years (CI, 76% to 95%), 81% at 20 years (CI, 56% to 92%), 81% at 25 years (CI, 56% to 92%) and 81% at 30 years (CI, 56% to 92%).

When component failure was used as the endpoint, the survivorship of the acetabular component was 78% at 15 years (CI, 64% to 87%), 66% at 20 years (CI, 48% to 80%), 43% at 25 years (CI, 21% to 62%) and 12% at 30 years (CI, 2% to 32%). The survival of the femoral component was 76% at 15 years (CI, 62% to 85%), 67% at 20 years (CI, 48% to 80%), 47% at 25 years (CI, 25% to 67%) and 7% at 30 years (CI, 1% to 26%). The survival of both components was 74% at 15 years (CI, 59% to 83%), 64% at 20 years (CI, 44% to 78%), 43% at 25 years (CI, 20% to 64%) and 7% at 30 years (CI, 1% to 27%).

Discussion and Conclusion: Long term results using Charnley’s Low Friction Arthroplasty achieved in this patient group are comparable to general arthroplasty population.

(Previous report: Charnley low-friction arthroplasty for Paget’s disease of the hip.

J Arthroplasty. 2000 Feb;15(2):210–9).

Aim: PFC Sigma total knee was introduced in 1997 incorporating a number of design changes. We report our medium-term results of a consecutive series of PFC sigma knees performed between Nov 1997 and Dec 1998.

Method: Between November 1997 and December 1998 a consecutive series of 166 TKAs (156 patients)were carried out using the PFC Sigma total knee replacement system at Wrightington Hospital. Out of the 156 patients 9 were lost to follow-up. This left 147 patients (156 knees) with a mean follow-up of 90 months (range 84 – 96 months). 137 patients (88%) had primary osteoarthritis, 14(9%) had R.A and 5(3%) had post-traumatic arthritis. The mean age was 70 yrs (53 – 88 yrs).85 were female and 62 male. All patients were followed at 3 months, 6 months,1 year and then yearly. Clinical evaluation was done by American Knee Society and Oxford knee scores. Knee society score was used to assess the postoperative radiographs.

Results: The mean Knee society score improved from the preoperative mean of 45 (range 30 – 65) to postoperative mean of 84 points(range 45 – 92). The mean preoperative functional score was 38(range 25 –5) and mean postoperative functional score was 73 points(range 50–95). According to the final scoring 90 % of the knees were rated excellent, 4% good, 4 % fair and 2 % poor. The mean preoperative Oxford knee score was 43 (range 33–52) and mean postoperative score was 17 (14–29). Range of motion improved from a mean of 90(range 50–125) to 105(range 65–130). There was no significant difference (p = 0.03) in the American Knee Society score and Oxford knee score when comparing patients with and without resurfacing of the patella and PCL-retaining with PCL-substituting implants.1 knee (0.6%) was revised within 18 months due to aseptic loosening.1 knee(0.6%) had superficial wound infection which cleared with oral antibiotics.2 patients(2 knees) developed deep infection out of which one resolved following early debridement, the other developed chronic infection requiring long term suppressive antibiotics. 3 patients had proven below knee deep venous thrombosis; one of them developed a non-fatal pulmonary embolism. Radiological review using radiological knee society scoring showed radiolucent lines under 35 % of the tibial components(56 knees)and 11 % of Femoral components(18 knees). For survivorship analysis, the actuarial life- table method was used with calculation of the numbers at risk and the survival rates at annual intervals. The 95% confidence limits were calculated by the method of Rothman. The survivorship at the end of eight year follow-up was 99.40. None of the patellar components failed.

Conclusion: Our study shows excellent clinical results of PFC Sigma Total knee replacement after almost eight years follow-up. We plan to continue monitoring this cohort of patients for long-term results.

Introduction: We performed a retrospective case control study in 80 patients who under went revision hip surgery at our unit.

Methodology: Group A (40 patients), received tranexamic acid and intra-operative cell salvage. Group B (40 patients) a matched control did not receive these treatments. Each group was divided into 4 sub groups; revision of both components, revision of components + bone grafting, revision acetabular component +/− bone grafting and revision femoral component +/− bone graft.

Results: In group A the total number of units transfused was 139 compared to 52 in group B. This represents a reduction in blood usage of 37%. The mean amount of blood transfused from cell salvage in each group was 858mls, 477mls, 228mls and 464mls. There was a significant difference in the amount of blood returned between the groups (p< 0.0001). In the control group 37 patients needed transfusion, in the study group 22 (p< 0.0001). At our unit a cost analysis calculation has shown total revenue saving of £88,000 and a potential saving throughout the trust of £316,688 per year.

Discussion: To our knowledge this is the first study to examine the use of cell salvage and tranexamic acid in revision hip surgery. Our results show that a significant reduction in blood transfusion can be made using this technique. It is vital that blood conserving strategies are developed so that future revision surgery can continue.

Total hip replacement is a successful and reliable procedure for the relief of pain, but the results achieved have been reported to be less successful in younger patients who tend to be relatively more active and place greater demands on prostheses than older patients.

Between 1966 and 1978, 226 Charnley low friction arthroplasties (LFAs) were implanted in young patients with an average age at operation of 31.7 years. Initial results were presented at an average of 19.7 years. We have performed a further retrospective analysis of this cohort at 10 years on from the time of data collection of the original study. Of the original cohort, 112 patients are alive and either under follow-up at our hospital or have been traced to other hospitals. 16 have been lost to follow-up. Mean follow-up was 26.4 years. At the time of final follow-up or death, rate of aseptic loosening of the stem was approximately 80%. Acetabular components proved to be less successful with less than 60% remaining well fixed. Differences in survival were apparent between subgroups with differing original pathology with stem survival greater in those with DDH as opposed to rheumatoid or degenerative arthritis and the opposite being true for socket survival.

This study adds to the available knowledge of the longevity of cemented total hip replacement as performed with unsophisticated cementation techniques and how it may perform in differing patients groups.

Introduction: Some reports have suggested an unacceptable failure rate of Elite Plus stem in the medium term. We have previously argued that other measurements must be made in addition to RSA in order to assess reasons for abnormal migrations. This 3-year RSA study of Elite Plus stems assessed the migration pattern and factors that influenced it.

Method: Twenty five patients (23 OA, 2 RA, mean age 60.4 years (37–81)) underwent Elite Plus THR (single surgeon). A-P radiographs were assessed for cementing technique, and measurements (canal widths, stem orientation, cement thickness etc) were taken using CAD software. Activity score and BMI were also recorded. Multiple factors were assessed for correlation with the main components of migration.

Results: One patient’s stem centroid migrated proximally (due to valgus rotation about the shoulder) and the mean subsidence of the others was 0.297 mm at 36 months. Mean internal rotation and posterior head migration (25 patients) at that time were: 1.42° (CI: 0.99° to 1.86°) and 0.801 mm (CI: 0.526 mm to 1.076 mm), neither being significantly different from migrations at 24 months. One patient’s stem migrated continuously. By 36 months, it had subsided 1.279 mm and internally rotated 4.2°. Some significant correlations (p < 0.05, rho > 0.6) were 3M and 36M subsidence with proximal-medial cement thickness; effective offset with 36M medial migration.

Discussion: The one patient with continuous high migration had the highest activity level. This was corroborated by a wear measurement of 3.5 mm in the contralateral (Charnley) hip which had been in place for 9 years (assuming the head was not scratched). If RSA, 3 years postoperatively, can predict future outcome, the 4% failure rate is similar to the ten year results of the Charnley hip.

A secure bone cement interface between the acetabulum and the cement mantle of the hip socket is an important requirement for the long-term success of a cemented hip arthroplasty. Cement pressurisation after bone bed cleaning enables cement to penetrate interstices of cancellous bone forming a superior fixation strength.

We designed an in-vitro experiment to evaluate the performance of the Exeter, Depuy T-handle and a plunger-type pressurisers using two parameters: cement penetration and cement pressurisation.

The deformation of the flexible pressure head of the DePuy model produced a cement mantle, which is thick at the pole but tapered at its rim and variable in the amount of penetration produced (range 2–8mm) for an estimated similar force. Pressures of up to 60KPa were generated throughout the model acetabulum. The Exeter pressuriser was found to produce cement mantles more compatible with a socket. However, the test results show a wide variation in cement penetration occurring for what was estimated to be a similar applied force (3mm to 9mm at the pole and 5mm to 9mm at the rim). It was also shown to have the disadvantage of causing widely dissimilar pressures at the pole and the rim. The plunger protrusion required to produce 5mm cement penetration was found to be 7.5mm. Since this protrusion can be monitored and controlled by the operator, a cement intrusion of 5mm +/−1mm was found to be reproducible with the plunger-type device. The maximum variation in intrusion between rim and pole was 1 mm. Maximin pressures of 70KPa were generated.

We have presented experimental evidence that suggests that a plunger type of acetabular cement pressuriser may provide a more consistently reproducible level of pressurisation leading to optimal cement penetration.

3610 primary and revision total knee replacements were performed at our hospital between 1969 and 1995. We conducted a survivorship analysis of 3234 primary total knee replacements to construct life tables and calculate survival curves. Each knee replacement was entered once only. Revision was defined as the end point. Data was collected both from patient records and by postal questionnaire. Eight types of knee prostheses were evaluated with best-case and worst-case scenarios compared over a 5, 10 and 15 year period.

The evidence suggests that certain types of prosthesis are more liable than others to fail or to fail early. The “Condylar type devices” which include the Total Condylar, Press Fit Condylar (PFC), Kinematic, Kinemax and Anatomic Modular Knee (AMK) have very similar survivorship curves and in the main have performed well up to a 10 year period. The LCS mobile bearing knee performed extremely well at 5 years. The Attenborough knee had an inferior result while the Load Angle Inlay (LAI) which was a very early resurfacing arthroplasty had the poorest results in terms of survivorship.

Restoration of the mechanical axis is thought to be a critical factor in determining the Outcome of knee replacement surgery. There is strong theoretical evidence that reproduction of this axis improves mechanical loading and hence longevity of the implant. Clinical studies are small in number.

Per-operative use of intra-and-extra-medullary alignment jigs help to determine the distal femoral and proximal tibial cuts. Studies have shown large margins of error using the standard jigs provided with most total knee replacement systems. On this basis computer assisted guidance systems are being introduced such as Orthopilot and BrainLab. These systems allow more accurate placement of the bony cuts and hence improve overall lower limb alignment.

No study has shown conclusively that accurately reproducing the mechanical axis of the lower limb improves survivorship of the implant. Prior to investing in these systems we felt it would be prudent to investigate how critical reproduction of the mechanical axis was in the primary total knee replacement.

We assessed 100 primary kinematic total knee replacements performed in 1990. All case notes were reviewed looking for basic demographics, pathology and clinical outcome.

All cases had a long leg film weight-bearing alignment film taken post-operatively. These were digitised and then analysed using Design CAD 97 software and from this the mechanical axis calculated.

Using these data the patients were divided into two groups. The first were within 3 degrees varus/valgus of the mechanical axis. The second were outside this range. These two groups were then correlated to clinical outcome.

Conclusions: Our results suggest that accurate reproduction of the lower limb alignment and the mechanical axis improves clinical outcome and survivorship of the implant using revision as an endpoint. Our data would support the introduction and use of intra operative computer aided guidance systems.

Fifty-seven revision total knee arthroplasties were performed in our hospital using the TC3 system between 1995 and 1997. Twelve patients died. Forty-five patients were followed up for an average of 5.6 years (range 4 – 7 years). No patients were lost to follow-up.

All patients were clinically and radiologically evaluated. A postal patient satisfaction questionnaire was completed. Two patients were revised; one for infection and one for instability. Survivorship using revision as the end point was 93.3% at 7 years.

Indications for revision were infection (4;9%), instability (38;84%), pain and stiffness (3;7%). 32 (71%) patients were satisfied with their outcome, 7 (16%) were noncommittal and 6 (13%) were disappointed at 5 years. We have analysed the 13 dissatisfied patients and highlight the lessons learned.

Pain and stiffness are not good indications for revision; insert thickness of more than 17.5mm is suggestive of elevation of the joint-line; instead the femoral component should be distalised; step wedges should be used in preference to angular wedges; Always long stem the tibial implant if augments are used; stems should be canal filling with adequate grip on the diaphysis.

We suggest the above lessons we have learned from our initial revision arthroplasty learning curve may correlate to the clinical outcome of this small group of dissatisfied patients.

Aim We have prospectively investigated the effect of tranexamic acid in reducing blood loss and transfusion requirements in primary and revision total hip arthroplasty in a comparative study.

Patients and Methods In the study group, tranexamic acid was given half an hour before the skin incision. (10 mg/kg as an intravenous bolus, followed by 10 mg/kg as intravenous infusion over 6 hours). We recorded the haemoglobin level preoperatively and prior to discharge, and number of units of blood transfused. The total peri-operative blood loss and the fall in haemoglobin after surgery was calculated in consultation with our haematologist. There were 9 primary and 17 revision hip replacements in the study group. We compared the results with a control group of 10 primary and 20 revisions performed during a similar period, without tranexamic acid, recording identical parameters. Thrombo-embolic and wound complications were recorded.

Results Patients receiving tranexamic acid had a mean fall in haemoglobin level of 3.1 g/dl and mean blood loss of 4.1 litres. The control group operated without tranexamic acid had a mean fall in the level of haemoglobin of 3.7 g/dl, and the mean blood loss 5.4 litres. The average number of units of blood transfusion required was 0.77 per patient in the study group compared to 2.03 per patient in the control group. The differences were significant (p value of 0.05). There was no increase in the incidence of complications such as deep vein thrombosis, pulmonary embolism, or wound problems in the study group.

Conclusion Tranexamic acid given prior to surgery reduces blood loss and need for blood transfusion, not only in primary but also in revision hip arthroplasty, without any increase in the rate of thrombo-embolic complications.

Aim: To review the results and complications of revision of the socket in total hip arthroplasty using rim mesh and impaction allograft for reconstruction of segmental and complex defects

Patients & Methods: 43 patients who underwent a revision of the socket in 47 total hip replacements were retrospectively reviewed over a 3 ½ year period. All the patients had segmental or complex bone loss around the acetabulum which was reconstructed using Stryker Howmedica rim mesh, impaction bone grafting and a cemented cup through the posterior approach. Final analysis included clinical review at latest follow-up, radiological evaluation to assess graft incorporation and socket migration and any other complications.

Results: All patients were followed up for a mean period of 14.2 months (range: 2 months-33 months). The mean age at surgery was 58.2 yrs. There were 14 males and 29 females. This was a re-revision in 5 patients. The most common indication for revision was aseptic socket loosening with migration in 39 patients. One patient had a two stage revision for infection, one had socket fracture, and two patients had collapse of bulk graft and socket migration. Superior segmental defect of varying sizes were present in all patients, in addition to which there were central deficiencies, anterior and/or posterior column deficiencies and complex defects. 4 patients had post-operative dislocation, 1 had significant limb length discrepancy, 1 had infection and 1 had transient sciatic nerve palsy. At the latest follow-up all patients had good graft incorporation and no socket migration.

Conclusion: Rim mesh helps in containing a segmental defect of acetabulum provides good immediate support for impacted graft and socket and has produced good early results. However, long term follow-up is necessary to determine the outcome of this construct.

Aim: To undertake clinical and radiological assessment of the TCIII prosthesis for Revision total knee arthroplasty with survivorship analysis.

Methods: We reviewed the clinical and radiological outcome of 57 Total Condylar III (TCIII) prostheses used for revision knee arthroplasty performed between December1995 and December1997 at Wrightington hospital. Twelve patients (12 knees) had died. At a mean follow-up of 6.75 years (range, 5–8years) 45 knees in 43 patients were available for review. None were lost to follow-up. There were 23 women and 20 men, with a mean age of 73 years. Radiographs were analysed for component position, alignment and bone-cement radio-lucencies.

Results: The reason for revision was instability in 38 knees, infection in 4 knees, pain in 2 knees and stiffness in one knee. The mean preoperative Hospital for Special Surgery HSS score was 36, improving to 70 after revision at latest review(p=< 0.001). The mean postoperative range of movement was 95 degrees. 2 prostheses were revised, one for infection and another for instability, Survival analysis using the Kaplan Meier method provided a cumulative survival rate of 95.56 % at 8 years.

Conclusion: The clinical and radiological results of our study support the continued use of the TCIII prostheses in revision total knee arthroplasty with satisfactory outcome in the medium term.

Aim: To undertake clinical and radiological assessment of the TCIII prosthesis for Revision total knee arthroplasty with minimum 5 year follow-up.

Methods: We reviewed 57 Total Condylar III (TCIII) prostheses used for revision knee arthroplasty performed between December1995 and December1997 at Wrightington hospital. Twelve patients (12 knees) had died. At a mean follow-up of 6.75 years (range, 5–8years) 45 knees in 43 patients were available for review. None were lost to follow-up. There were 23 women and 20 men, with a mean age of 73 years. Radiographs were analyzed for component position, alignment and bone-cement radiolucencies.

Results: The reason for revision was instability in 38 knees, infection in 4 knees, pain in 2 knees and stiffness in one knee. The mean preoperative Hospital for Special Surgery HSS score was 36, improving to 70 after revision at latest review (p=< 0.001). The mean postoperative range of movement was 95 degrees. 2 prostheses were revised; one for infection and another for instability. Survival analysis using the Kaplan Meier method provided a cumulative survival rate of 95.56 % at 8 years.

Conclusion: Our study supports the continued use of the TCIII prostheses in revision total knee arthroplasty, wherein the ligaments can be balanced, with satisfactory outcome in the medium term.