Aims

The aim of this study is to report the implant survival and factors associated with revision of total elbow arthroplasty (TEA) using data from the Dutch national registry.

Source of the study: University of Auckland, Auckland, New Zealand. Unicompartmental knee arthroplasty (UKA) is effective for patients with isolated compartment osteoarthritis, however the procedure has higher revision rates. Long-term survivorship and accurate characterisation of revision reasons are limited by a lack of long-term data and standardised revision definitions. We aimed to identify survivorship, risk factors and revision reasons in a large UKA cohort with up to 20 years follow-up. Patient, implant and revision details were recorded through clinical and radiological review for 2,137 consecutive patients undergoing primary medial UKA across Auckland, Canterbury, Counties Manukau and Waitematā DHB between 2000 and 2017. Revision reasons were determined from review of clinical, laboratory, and radiological records for each patient using a standardised protocol. To ensure complete follow-up data was cross-referenced with the New Zealand Joint Registry to identify patients undergoing subsequent revision outside the hospitals. Implant survival, revision risk and revision reasons were analysed using Cox proportional-hazards and competing risk analyses. Implant survivorship at 15 years was comparable for cemented fixed-bearing (cemFB; 91%) and uncemented mobile-bearing (uncemMB; 91%), but lower for cemented mobile-bearing (cemMB; 80%) implants. There was higher incidence of aseptic loosening with cemented implants (3–4% vs. 0.4% uncemented, p<0.01), osteoarthritis (OA) progression with cemMB implants (9% vs. 3% cemFB/uncemMB; p<0.05) and bearing dislocations with uncemMB implants (3% vs. 2% cemMB, p=0.02). Compared with the oldest patients (≥75 years), there was a nearly two-fold increase in risk for those aged 55–64 (hazard ratio 1.9; confidence interval 1.1-3.3, p=0.03). No association was found with gender, BMI or ASA. Cemented mobile-bearing implants and younger age were linked to lower implant survivorship. These were associated with disease progression and bearing dislocations. The use of cemented fixed-bearing and uncemented mobile-bearing designs have superior comparable long-term survivorship

Aims

Robotic-assisted unicompartmental knee arthroplasty (R-UKA) has been proposed as an approach to improve the results of the conventional manual UKA (C-UKA). The aim of this meta-analysis was to analyze the studies comparing R-UKA and C-UKA in terms of clinical outcomes, radiological results, operating time, complications, and revisions.

Introduction: Periprosthetic fractures occurring during implantation of non-cemented Total Hip Arthroplasty (THA) are considered major surgical complications. As a shot-term disadvantage, patients are required to partially weight-bear. Additionally, high risks of stem migration and joint luxation can be assumed. On the other hand, in fear of fracture surgeons may undersize stems and subsequently trigger failure rates in THA. As the long-term consequences of Vancouver A and B1 fractures are not fully known, the goal of this study now was to analyze the postoperative performance of non-cemented THA with respect to perioperative fractures. Materials and Methods: Between 1997 and 2003 41 peri-operative hip fractures were monitored in 1216 primary Total Hip Arthroplasties using the non-cemented Bicon-tact THA stem. Pre-OP and after a follow-up period of 2,2 (+−3,1) years patients were examined clinically and radiographically. Investigation parameters were Harris-Hip-Scores, SF-36 scores, function score, hospitalization, implant survival /revisions and radiographic parameters (stem migration, trochanter migration, osteolysis, bone union, callus formation and bone quality). Fractures were graded using the Vancouver and Mont+Maar classifications. Patients were compared to a comparable collective of THA patients without perioperative fractures. Pooled data of both groups were compared using non-parametric Kruskal-Wallis tests. Results: Results showed a significant increase in Harris-Hip scores for all THA of 36 (+−17,7) points. There were no differences in function scores (2,3; score 1–6), postoperative pain (4,8; score 1–10), and time of hospitali-sation (21,3d; +−3,7 range, 14 – 32). The non-union rate was 13%, with 85% of trochanteric fractures showing migration. 47% of the Patients in the fracture group were instructed to maintain restricted weight bearing for 6 weeks. No Trendelenburg signs were observed in the fracture group. Stem migration of mean 0,6 cm (+−0,4) was observed in 13% of Vancouver A and B1 patients (6,4% of A, 20,1% of B1). Long-term cerclage wire failure was observed in 20%. Joint luxation was observed in 1 patient. No hips were revised during the follow-up period. Discussion: Follow-ups of perioperative fractures classes Vancouver A and B1 during non-cemented THA using the Bicontact stem show associations with stem migration, long-term stabilization implant failure and non-union. However, none of these observations seem to be influencing the overall THA performance and patient satisfaction. Specifically, complications commonly associated with perioperative primary prosthetic fractures as luxation and limping were not signifi-cant. At a short-term perspective, perioperative THA fractures prohibit early weight-bearing. However at a mid to long-term perspective, no disadvantages were apparent in comparison to primary THA without fracture complications

[Background]. Bipolar hemiarthroplasty (following BHA) have historically had poor results in patients with idiopathic osteonecrosis of femoral head (OFNH). However, most recent report have shown excellent results with new generation BHA designs that incorporate advances in bearing technology. These optimal outcomes with bipolar hemiarthroplasty will be more attractive procedure for young patients who need bone stock for future total arthroplasty. The purpose of the current study was to evaluate the clinical and radiographic finding of this procedure for the treatment of OFNH at our institution after 7-to 21years follow-up. [Subjects and Methods]. We retrospectively reviewed a consecutive series of 29 patients (40 hips) who underwent primary bipolar hemiarthroplasty for ION (36 hips with stage III and 4 hips with stage IV) with a cementless femoral component between 1992 and 2006. Osteonecrosis was associated with corticosteroid use (23 patients), alcohol (16 patients), idiopathic (one patients). The mean follow-up duration was approximately 12 (range 7 to 21) years. Patients were evaluated according to the Japan Orthopaedic Association (JOA) hip score. We evaluate osteolysis and bone response of acetabulum or femur, and migration distance of outer head were calculated at the latest follow-up. Kaplan-Meier survivorship rate was investigated to examine implant failure rate. [Results]. The average the Japan Orthopedic Association (JOA) hip score significantly improved from 53.9±16.0 points (preoperative) to 89.6±8.0 points (final follow-up). At the time of the final follow-up, one patients (one hips) had undergone revision to total hip arthroplasty because of groin pain without mechanical failure and migration. The rate of implant survival, with revision because of any reason as the end point, was 100% for femoral components and 97.5% for bipolar head components at a average 12 years (139.9±51.1 months) respectively. A complication that include dislocation and disassembly was not occurred in this study group. Radiographically, all cases is acquired bone ingrowth fixation. Stress shielding of femoral-component was observed 13 cases (32.5%). No femoral-component loosening and osteolysis of femur and acetabular was occurred at final follow-up. Bipolar head shift greater than 2mm is 3cases (7.5%) at final follow-up point, but progressive outer head migration was not occurred (0 %). [Discussion]. Survivorship determined in our study was more favorable than that of previous studies. The our long-term postoperative clinical results of up to Stage3 without the acetabular cartilage surface damage showed more superior to those previously reported for BHA. Recently, larger oscillation angle, proximal porous coating, highly cross-linked PE liner, improved these BHA design concept. Thus, the current BHA can be one of reliable procedure. Based on our results, The BHA for stage III ION, with appropriate surgical indications, may be a good option

Aim. To assess the survival of revision knee replacements at our institution and to identify prognostic factors that predict failure in revision knee surgery. Materials and methods. This was a retrospective review of 52 patients who had undergone revision knee surgery as identified by hospital clinical coding. Patient demographics, physiological parameters, reason for revision, type of revision implant and last date of follow up were recorded from the medical records. Implant survival was analysed both from the index primary procedure to revision and from definitive reconstruction at revision to re-operation for any cause. Results. The median time from index primary to first revision was 1428 days (331-5000). A P value of 0.05 was set as the significance level. Patients with a diagnosis of inflammatory arthropathy had a significantly shorter time to revision compared to those with osteoarthritis. Time to revision was not significantly different for those being revised for infection and those not infected. Following reconstruction, there was no significant difference in the reoperation rates for infected vs non-infected implants. The 5-year implant survival for all revision knee replacements with re-operation for any cause as the end point was 72.2% (95%CI 52.3-87.9). At 5 years there was no significant difference in implant survival of infected and non-infected revisions. Conclusion. The implant survival of revision knee replacements for all causes in our institute was 72.2% at 5 years. There was no significant difference in 5-year survival between infected and non-infected revisions. Patients with an inflammatory arthropathy had a significantly shorter time to revision compared to those with osteoarthritis

Background. Hip resurfacing has resurged in the last decade due to a renewed interest in metal on metal bearing. One of the proposed advantages is ease of revision of the femoral component. Short term functional results after femoral revision are similar to those after conventional total hip replacement. Survival and function after revision of the acetabular component only or of both components have not been reported. We aimed to assess hip function and implant survival after revision of the acetabular component for failed Birmingham hip resurfacing (BHR). Methods. The Oswestry Outcome Centre collected data prospectively on 5000 patients who underwent hip resurfacing between 1997 and 2002. Of these, 182 hips were revised: 42% had revision of the femoral component only, 8% revision of the acetabular component only, and 50% revision of both components. This study analyzed patients who had revision of the acetabular component, either in isolation or in combination with the femoral component. Results. In the isolated acetabular revision group the median Harris Hip Score was 74 at a mean of 4.5 years post-revision. In the both components revision group the median Harris hip score was 85 at a mean of 4 years. There was no significant difference in function between the groups. Kaplan-Meier survivor ship analysis after revision showed an average survival of 91% at 10 years. There was a significant difference between survival of isolated acetabular revision (75%) and both component revision (96%). Conclusions. Revision total hip replacement subsequent to failure of hip resurfacing has good outcome and good midterm survival. Isolated acetabular revision and revision of both components had similar function but survival was significantly worse in the isolated acetabular revision group

Introduction. We aim to assess the functional outcome, patient perceived satisfaction and implant survival at a mean follow up of 13[10–16] years following revision knee replacement. Patients and Methods. Between 1995 and 2001, 243 revision knee replacements were performed in 230 patients using Endolink [Link, Hamburg] or TC3 [Depuy, Leeds] prosthesis at Wrightington hospital, Wrightington, were consented to take part in this study. Data was collected prospectively which includes complications and functional assessment by Oxford knee score, WOMAC, HSS, UCLA, SF12 scores, and patient satisfaction questioner. The scores were obtained pre-operatively and post-operatively at 1 year, 5 years and at the latest follow-up. The mean age was 69 yrs, 51% were males, TC3 prosthesis as used in 175 and Endolink in 68, the revision was for Infection in 71[29%], 53 patients had intra-operative positive culture, 35 had 2 stage revision. Results. At a mean follow up of 13 years [10–16] the survival of revision knee replacement in our patient group is 86%. Further surgery was performed in 35[14%], which includes 5 patients who had above knee amputation. The re-revision rate in the non-infected group [13%] was significantly lower compared to the re-revision in infected group [18%]. The Oxford scores improved at 1 year which continued to improve up to 5 years following which there was a gradual deterioration in the scores. There was no significant improvement in the generic HSQ, SF12 and UCLA scores following surgery. The functional scores improved to a lesser extent in patients with proven infection. Discussion and Conclusion. At a mean follow up of 13 years the implant survival for revision knee replacement using endolink or TC3 prosthesis is 86%. The non-infected group had lower re-revision rates. The improvement in functional scores is lower following revision for infection

Introduction. We aim to assess the functional outcome, patient satisfaction and implant survival at a mean follow up of 13[10–16] years following revision for infected total knee replacement. Patients and Methods. Between 1995 and 2001, 71 revision knee replacements were performed for infection, at Wrightington hospital, Wrightington. Data was collected prospectively which includes intra-operative cultures, complications and functional assessment by Oxford knee score, WOMAC, HSS, UCLA, SF12 scores, and patient satisfaction questioner. The scores were obtained pre-operatively and post-operatively at 1 year, 5 years and at the latest follow-up. Mean age was 69 yrs, 70% were Females, 31[44%] had 2 stage revisions and intra-operative culture was positive in 53 patients. Most common organism was staphylococcus aureus in 30% and staphylococcus epidermides in 18%. Results. At a mean follow up of 13[10–16] years, the survival of revision knee replacement for infection in our patient group is 82%. 4 patients had above knee amputation 4 had conversion to Pseudo, 1 had Arthrodesis, further revisions in 4 patients 2 for wear and 2 for loosening. Two patients have chronic infection and are on long term suppressive antibiotics. The Oxford scores improved at 1 year which continued to improve up to 5 years following which there was a gradual deterioration in the scores. There was no significant improvement in the generic HSQ, SF12 and UCLA scores following surgery. There was a significant improvement in HSS scores, Oxford scores and patient satisfaction following surgery. There was no difference in functional outcome between the single stage revision and 2 stage revision group. Discussion and Conclusion. In our study group the implant survival for revision of infected total knee replacement is 82%. There was an improvement in functional scores following surgery; however the total scores are still low suggesting lower levels of function

Purpose: The purpose of this retrospective study was to evaluate the clinical and radiological results of Charnley-Keroboull total hip arthroplasty performed in patients aged less than 50 years. We searched for factors which might affect wear and sustained fixation. Material and methods: Among the 2,804 arthroplasties performed in patients aged less than 50 years between 1975 and 1995, we selected randomly 287 (10% of the annual operations). These prostheses were implanted in 222 patients (144 women and 78 men), mean age 40.1±8 years (15–50). All of the arthroplasties were inserted via a transtrochanteric approach. Charnley-Kerboull implants were cemented in all patients using a metal polyethylene bearing. Functional outcome was assessed with the Postel-Merle-d’Aubigné score. Cup wear was measured with the Chevrot technique. The actuarial method was used to calculate prosthesis survival. Results: At last follow-up, 155 patients (210 hips) were living and had not had a revision procedure at mean 16.1±4.6 years, 23 patients (25 hips) required revision of the acetabular or femoral element, ten patients (10 hips) had died, and 34 patients (42 hips) were lost to follow-up. The mean preoperative functional score was 9.6±2.5 (9–15) versus 17.2±0.8 (9–18) at last follow-up (Wilcoxon rank test p< 0.001). For the acetabular element, there was certain loosening in 15 hips and possible loosening in 24. For the femoral element, loosening was certain for 12 implants and possible for four. Twentyfive hips required revision, including 17 for aseptic loosening. Mean wear was 0.12±0.21 mm (0–2.23). Among the 287 hips, 196 had wear measured at less than 0.1 mm/yr (mean 0.02 mm/yr). Mean overall implant survival, defining revision as failure, was 85.4±5.0% at twenty years (95%CI 78.4–92.4). Among the factors tested, only abnormally rapid wear (> 0.1 mm/yr) was predictive of failure. Discussion: The results of this series allow us to conclude that total hip arthroplasty using a Charnley-Kerboull implant remains the best solution for young patients in terms of implant survival

Aims

Controversy about the use of an anatomical total shoulder arthroplasty (aTSA) in young arthritic patients relates to which is the ideal form of fixation for the glenoid component: cemented or cementless. This study aimed to evaluate implant survival of aTSA when used in patients aged < 60 years with primary glenohumeral osteoarthritis (OA), and to compare the survival of cemented all-polyethylene and cementless metal-backed glenoid components.

Aims

To determine the outcomes following revision surgery of metal-on-metal hip arthroplasties (MoMHA) performed for adverse reactions to metal debris (ARMD), and to identify factors predictive of re-revision.