Increased femoral head size reduces the rate of dislocation after total hip arthroplasty (THA). With the introduction of highly crosslinked polyethylene (HXLPE) liners in THA there has been a trend towards using larger size femoral heads in relatively smaller cup sizes, theoretically increasing the risk of liner fracture, wear, or aseptic loosening. Short to medium follow-up studies have not demonstrated a negative effect of using thinner HXLPE liners. However, there is concern that these thinner liners may prematurely fail in the long-term, especially in those with thinner liners. The aim of this study was to evaluate the long-term survival and revision rates of HXLPE liners in primary THA, as well as the effect of liner thickness on these outcomes. We hypothesized that there would be no significant differences between the different liner thicknesses. We performed a retrospective database analysis from a single center of all primary total hip replacements using HXLPE liners from 2010 and earlier, including all femoral head sizes. All procedures were performed by fellowship trained arthroplasty surgeons. Patient characteristics, implant details including liner thickness, death, and revisions (all causes) were recorded. Patients were grouped for analysis for each millimeter of PE thickness (e.g. 4.0-4.9mm, 5.0-5.9mm). Kaplan-Meier survival estimates were estimated with all-cause and aseptic revisions as the endpoints. A total of 2354 patients (2584 hips) were included (mean age 64.3 years, min-max 19-96). Mean BMI was 29.0 and 47.6% was female. Mean follow-up was 13.2 years (range 11.0-18.8). Liner thickness varied from 4.9 to 12.7 mm. Seven patients had a liner thickness <5.0mm and 859 had a liner thickness of <6.0mm. Head sizes were 28mm (n=85, 3.3%), 32mm (n=1214, 47.0%), 36mm (n=1176, 45.5%), and 40mm (n=109, 4.2%), and 98.4% were metal heads. There were 101 revisions, and in 78 of these cases the liner was revised. Reason for revision was instability/dislocation (n=34), pseudotumor/aseptic lymphocyte-dominant vasculitis associated lesion (n=18), fracture (n=17), early loosening (n=11), infection (n=7), aseptic loosening (n=4), and other (n=10). When grouped by liner thickness, there were no significant differences between the groups when looking at all-cause revision (p=0.112) or aseptic revision (p=0.116). In our cohort, there were no significant differences in all-cause or aseptic revisions between any of the liner thickness groups at long-term follow-up. Our results indicate that using thinner HXPE liners to maximize femoral head size in THA does not lead to increased complications or liner failures at medium to long term follow-up. As such, orthopedic surgeons can consider the use of larger heads at the cost of liner thickness a safe practice to reduce the risk of dislocation after THA when using HXLPE liners

Purpose. Long-term clinical and radiographic results and survival rates were compared between closed-wedge high tibial osteotomy (HTOs) and fixed-bearing unicompartmental knee arthroplasty (UKA) in patients with similar demographics. Methods. Sixty HTOs and 50 UKAs completed between 1992 and 1998 were retrospectively reviewed. There were no significant differences in preoperative demographics. The mean follow-up period was 10.7 ±5.7 years for HTO and 12.0 ±7.1 years for UKA (n.s.). The Knee Society knee and function scores, WOMAC, and range of motion (ROM) were investigated. The mechanical axis and femorotibial angle were evaluated. Kaplan–Meier survival analysis was performed (failure: revision to TKA), and the failure modes were investigated. Results. Most of the clinical and radiographic results were not different at the last follow-up, except ROM; ROM was 135.3 ±12.3° in HTO and 126.8 ±13.3° in UKA (p=0.005). The 5-, 10-, 15-, and 20-year survival rates were 100%, 91.0%, 63.4%, and 48.3% for closed-wedge HTO, respectively, and 90.5%, 87.1%, 70.8%, and 66.4% for UKA (n.s.). The survival rate was higher than that for UKA until 12 years postoperatively but was higher in UKAs thereafter, following a remarkable decrease in HTO. The most common failure mode was degenerative osteoarthritic progression of medial compartment in HTO and femoral component loosening in UKA. Conclusions. Long-term survival did not differ significantly between closed-wedge HTO and fixed-bearing UKA in patients with similar preoperative demographics and knee conditions. The difference in postoperative ROM and failure mode should be considered when selecting a procedure

Purpose: The aim of this study is to compare the long-term survival results of TKA in patients under the age of 60, using. revision surgery and. poor functional outcome as the end-points. Method: From our knee database we identified a cohort of 60 total knee replacements that had been performed over 15 years previously. We identified those who had died, those who had been revised and established the Oxford Knee Score (OKS) for all those still surviving. Results Using the following endpoint criteria the cumulative 15-year survival was (A) revision surgery alone = 78% (CI 12), (B) revision surgery or an OKS less than or equal to 24 (50% of total OKS) = 63% (CI 13), and (C) revision surgery or moderate pain = 48% (CI 14). Conclusion The functional survival of TKA in patients under the age of 60 decreases in the second decade following implantation with a significant number of prostheses failing the patient due to knee pain

Aim: Hip fracture is the most devastating outcome of osteoporosis with high early mortality. Less is known about men in terms of long-term survival and fracture risk, information of outmost importance in terms of strategies for fracture prevention. The aim of this study was to evaluate long-term survival, new fractures and residual life time risk of fracture in a cohort of men with hip fracture in different ages. This is the first study with a follow-up above 10 years. Methods: All men above 20 yrs of age suffering a hip fracture 1984–1985 in Malmö, Sweden were identified and followed up to 22 years or death. All new radiographic examinations related to musculoskeletal trauma with or without fracture were individually registered. Survival and fractures were evaluated in 5-year age bands and age-groups (< 75, 75–84 and ≥85 years). Kaplan Meier survival analyses were used to evaluate mortality and fracture risk. Results: 263 men (74.2 yrs, range 33–101) with an index hip fracture due to low energy trauma were identified. 56% had cervical fractures and 44% trochanteric with 6% having concomitant fractures. 10 % had suffered a previous hip fracture. After 22 years 94% were dead; 32 % within 1 yr, 62% within 5 yrs and 79% within 10yrs. Mean age at death was 80.1 yr (range 41–101), equal to a mean of 5.8 yrs above the mean age for fracture. The 50% survival in respectively age groups < 75, 75–84 and ≥ 85 years was 7 yrs, 2 yrs and 3 months. 74/263 (28%) suffered totally 131 fractures (1.8, range 1–7 fractures/patient) at 121 occasions. The majority suffered only a new fracture at one occasion (n=48, 65%). 14% of the fracture occasions occurred within 1 yr and half of the fractures occurred within 3.2 yrs. Mortality adjusted life time risk of fracture was 62% and 10-year risk of fracture was 47%. Conclusion: In this study we report fracture risk and mortality in a residual life time perspective in men after hip fracture. Men suffer hip fractures earlier in life and have, compared to women from the same cohort, higher early mortality (32% resp 21% (1 yr)) and lower residual lifetime risk of fracture (28% resp 45%). 1. The high early mortality probably mirrors a higher morbidity among male hip fracture patients. The consequence is that fracture preventing strategies need to consider both gender, age and mortality

Introduction. Joint preserving procedures have gained popularity in an attempt to delay arthroplasty in young, dysplastic hips. Excellent results can be achieved with peri-acetabular osteotomy (PAO) in congruent non-arthritic hips. The role of salvage procedures such as the Shelf acetabuloplasty remains undefined. This study aims to determine the long-term survival and functional outcome following Shelf acetabuloplasty and to identify factors that influence outcome. Patients/Materials & Methods. This is a retrospective, consecutive, multi-surgeon, case series from a UK referral centre. 125 Shelf procedures were performed between 1987–2013 on 117 patients for symptomatic hip dysplasia. Mean age was 33 years (15–53). Mean follow-up was 10 years (1–27). Radiographic parameters measured included pre-operative arthritis, acetabular-index, centre-edge-angle, joint congruency, subluxation and femoral sphericity. Oxford Hip and UCLA scores were collected at follow-up. Failure was defined as conversion to arthroplasty or OHS<20. Results. The acetabular index and centre-edge angles have been improved from 23° (SD:9) and 12° (SD:8) pre-operatively to 10° (SD:9) and 45° (SD:11) post-operatively. By follow-up, 63 hips (50%) had converted to arthroplasty. The mean OHS and UCLA scores were 33 (SD:12) and 6 (SD:3), respectively. Survival rates were 82% at 5 years, 60% at 10 years and 43% at 15 years. The only factor influencing 10-yr survival was minimal pre-op arthritis (65% Vs 40%, p=0.02). Optimal functional outcome was seen when post-operative centre-edge angle was between 20–40° (p=0.01). Discussion. This largest long-term series of Shelf acetabuloplasties reported to-date emphasises the value of this procedure in patients that pose treatment dilemmas as they are symptomatic, too young for arthroplasty but have features that make them unsuitable for PAO. Never-the-less, in 60% of cases a Shelf acetabuloplasty will delay arthroplasty for 10 years. If performed in patients with minimal arthritis and congruent joint 10-year survival is 85%. Conclusion. Shelf acetabuloplasty is a simple, reliable procedure with good mid- to long-term results

Purpose. Rotationplasty was first described in 1930 by Borggreve for treatment of limb shortening with knee ankylosis after tuberculosis. In 1948, Van Nes described its use for management of congenital defects of the femur and in the 1980s, Kotz and Salzer reported on patients with malignant bone tumors around the knee treated by rotationplasty as an alternative to above-knee amputation. Currently, rotationplasty is one of the options for surgical management of lower extremity bone sarcomas in skeletally immature patients but alternative limb salvage techniques, such as the use of expandable endoprosthesis, are also available. Despite rather satisfactory functional results have been uniformly associated with rotationplasty, concern still exists about the potential psychological impact of the new body imagerelated to the strange appearance of the rotated limb. Results of rotationplasty for sarcomas of the distal femur over a 20-year period were analyzed, focusing on long-term survival, function, quality of life and mental health. Method. Retrospective study of 73 children who had a rotationplasty performed at two institutions between 1984 and 2007 for a bone sarcoma of the distal femur; 42 males and 31 females, mean age at surgery 8.7 yrs (range 3–17). Four patients were converted to transfemoral amputation due to early vascular complication; 25 eventually died of their disease (mean survival 34 months, range 4–127). The 46 remaining survivors were evaluated for updated clinical outcome, MSTS score, gait analysis, SF-36 score, quality of life interview and psychological assessment at mean follow-up of 15 yrs (range 3–23). Results. Overall survival was 64%. All the survivors were disease-free at last follow-up. Four patients required hardware revision for nonunion and subsequently healed. Three patients refused participation in the long-term follow-up study. Mean MSTS score was 79 (range 64–88). SF-36 score was obtained in 35 patients (age > 16); male patients showed a trend toward greater activity and vitality. Compared to age-group norms, rotationplasty scores were lower for physical activity level (p <0.05) and higher for general health perception (p = 0.05) and mental health (p < 0.05). Conclusion. Rotationplasty remains a durable reconstructive option with good long-term function and acceptable psychological impact for children with bone sarcomas of the distal femur

Purpose: The management of degenerative arthritis of the knee in the younger, active patient often presents a challenge to the orthopaedic surgeon. Surgical treatment options include: high tibial osteotomy (HTO), uni-compartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). The purpose of this study was to examine the long-term survival of closing wedge HTO in a large series of patients 8–19 years after surgery. Method: The results of 458 consecutive patients undergoing lateral closing wedge HTO for medial compartment osteoarthritis (MCOA) between 1990 and 2001 were reviewed. Between 2008–2009, patients were contacted via telephone and assessment included: incidence of further surgery, Oxford Knee Score, and British Orthopaedic Association (BOA) Patient Satisfaction Scale. Failure was defined as the need for revision HTO or conversion to UKA or TKA. Survival analysis was completed using the Kaplan-Meier method. Results: We were able to contact 400/458 (87%) patients for follow-up via telephone interview. Five patients (1%) who declined participation were excluded. Fifty-eight patients (13%) were lost to follow-up. Of the 395 patients, 12 (3%) had died of unrelated causes and 124 (31%) required further knee surgery. The remaining 259 (66%) completed the BOA patient satisfaction score and Oxford Knee Score. The probability of survival for HTO at 5, 10 and 15 years was 95%, 79% and 55% respectively. Multivariate regression analysis showed that only age < 50 years (p< 0.001) was associated with significantly longer survival. Mean Oxford Knee Score was 40/48 (range 17–60). Ninety-two percent (239/259 patients) were enthusiastic or satisfied and 90% (234/259 patients) would undergo HTO again at mean 11 years follow-up. Complications included: 5 pulmonary embolisms, 8 deep vein thromboses, 1 non-union, 1 post-operative subarachnoid hemorrhage and 1 transient peroneal nerve palsy. Conclusion: To our knowledge, we have reported the long-term follow-up of lateral closing wedge HTO in the largest group of patients in the literature. We found that the results of HTO do deteriorate over time but that HTO can be effective for as long as 19 years. In appropriately selected patients and circumstances, HTO gives high patient satisfaction and affords patients unrestricted activity for many years

Abstract

Introduction

Total Hip Arthroplasty (THA) in patients after proximal femoral osteotomy remains a major challenge. Inferior survival for both cementless and cemented THA has been reported in this subgroup of patients.

Purpose of the study: The rate of failure can be high for massive reconstruction prostheses after tumor resection. We studied the causes and possible factors of failure.

Material and methods: The series included 91 patients who underwent surgery from 1972 to 1994 for resection of a bone tumor involving the knee joint. A GUEPAR prosthesis was implanted in all cases for reconstruction (megaprosthesis in 58 cases and composite prosthesis in 33). The extensor system had to be reconstructed in 37 patients. A GUEPAR II implant was used in 73 patients; 48 of these implants had an antirotation system. The analysis was retrospective. Outcome was studied in terms of survival and independent factors predictive of failure unrelated to the tumor.

Results: Mean follow-up was 72 months. At last follow-up, 68 patients were living disease free. There were nine cases of rupture of the extensor system. Preservation of a continuous extensor system at the time of bone resection reduced the risk of rupture (p=0.036). Seven allografts fractured, two loosened, and six became infected. Use of an allograft did not reduce the risk of loosening (p=0.17). Intraxial laxity was observed in 17 patients. Use of an antirotation system was a factor of risk of intraxial laxity (p=0.0023) but not of aseptic loosening. Aseptic loosening was observed in 18 patients: 10 femur reconstruction and 8 tibia reconstruction. The difference was not significant (p=0.6). In all, 104 revisions were required in 53 patients; 36 revisions of the prosthesis, 23 of them for mechanical causes. Overall median survival, excepting tumor-related causes, was 130 months. It was 130 months for femur reconstructions and 117 for tibia reconstructions (p=0.57). Age, length of resection, tumor location, use of an allograft, and use of an antirotation system were not found to be significant prognostic factors for implant survival.

Discussion: As reported by many others, we found that the rate of failure of massive prostheses for infectious and mechanical causes remained high in patients treated for bone tumors involving the knee joint. Survival of massive implants is much lower than that of gliding prostheses.

Conclusion: Technical progress is required to improve the survival of massive implants used for the treatment of bone tumors involving the knee joint.

Introduction:

Distal femoral replacement is recognised as the optimum treatment for malignant distal femoral tumours. Aseptic loosening is known to be a major cause for failure in these implants. Studies have indicated that the HA coated collar promotes osteointegration and bony in growth. This study compares long term aseptic loosening in implants with HA coated collars to those without in the immature skeleton.

Aims. Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and pelvic tumour resection procedures. Accurate CTAC positioning is essential to successful surgical outcomes. While prior studies have explored CTAC positioning in rTHA, research focusing on tumour cases and implant flange positioning precision remains limited. Additionally, the impact of intraoperative navigation on positioning accuracy warrants further investigation. This study assesses CTAC positioning accuracy in tumour resection and rTHA cases, focusing on the differences between preoperative planning and postoperative implant positions. Methods. A multicentre observational cohort study in Australia between February 2017 and March 2021 included consecutive patients undergoing acetabular reconstruction with CTACs in rTHA (Paprosky 3A/3B defects) or tumour resection (including Enneking P2 peri-acetabular area). Of 103 eligible patients (104 hips), 34 patients (35 hips) were analyzed. Results. CTAC positioning was generally accurate, with minor deviations in cup inclination (mean 2.7°; SD 2.84°), anteversion (mean 3.6°; SD 5.04°), and rotation (mean 2.1°; SD 2.47°). Deviation of the hip centre of rotation (COR) showed a mean vector length of 5.9 mm (SD 7.24). Flange positions showed small deviations, with the ischial flange exhibiting the largest deviation (mean vector length of 7.0 mm; SD 8.65). Overall, 83% of the implants were accurately positioned, with 17% exceeding malpositioning thresholds. CTACs used in tumour resections exhibited higher positioning accuracy than rTHA cases, with significant differences in inclination (1.5° for tumour vs 3.4° for rTHA) and rotation (1.3° for tumour vs 2.4° for rTHA). The use of intraoperative navigation appeared to enhance positioning accuracy, but this did not reach statistical significance. Conclusion. This study demonstrates favourable CTAC positioning accuracy, with potential for improved accuracy through intraoperative navigation. Further research is needed to understand the implications of positioning accuracy on implant performance and long-term survival. Cite this article: Bone Jt Open 2024;5(4):260–268

Aims. The aim of this study was to evaluate the survival of a collarless, straight, hydroxyapatite-coated femoral stem in total hip arthroplasty (THA) at a minimum follow-up of 20 years. Methods. We reviewed the results of 165 THAs using the Omnifit HA system in 138 patients, performed between August 1993 and December 1999. The mean age of the patients at the time of surgery was 46 years (20 to 77). Avascular necrosis was the most common indication for THA, followed by ankylosing spondylitis and primary osteoarthritis. The mean follow-up was 22 years (20 to 31). At 20 and 25 years, 113 THAs in 91 patients and 63 THAs in 55 patients were available for review, respectively, while others died or were lost to follow-up. Kaplan-Meier analysis was performed to evaluate the survival of the stem. Radiographs were reviewed regularly, and the stability of the stem was evaluated using the Engh classification. Results. A total of seven stems (4.2%) were revised during the study period: one for aseptic loosening, three for periprosthetic fracture, two for infection, and one for recurrent dislocation. At 20 years, survival with revision of the stem for any indication and for aseptic loosening as the endpoint was 96.0% (95% confidence interval (CI) 92.6 to 99.5) and 98.4% (95% CI 96.2 to 100), respectively. At 25 years, the corresponding rates of survival were 94.5% (95% CI 89.9 to 99.3) and 98.1% (95% CI 95.7 to 99.6), respectively. There was radiological evidence of stable bony fixation in 86 stems (76.1%) and evidence of loosening in four (3.5%) at 20 years. All patients with radiological evidence of loosening were asymptomatic. Conclusion. The Omnifit HA femoral stem offered promising long-term survival into the third decade. Cite this article: Bone Joint J 2024;106-B(3 Supple A):110–114

Abstract. Background. To determine the long-term survival outcomes of Copeland Resurfacing Hemiarthroplasty (CRHA) performed by a single surgeon series. Methods. A retrospective cohort study which looked at patients who underwent CRHA over 6 years. Re-operations including revisions with component exchange taking place in our hospital and at local centres were reviewed. Oxford Shoulder Score (OSS) was used to assess their functional outcomes pre- and post-CRHA. Results. 80 CRHAs were performed in 72 patients between 2007 and 2013 with a mean follow-up of 6.5 years. The mean follow-up was 79 months (50–122). The primary indication for CRHA was osteoarthritis (76.3%), cuff tear arthropathy (16.3%), rheumatoid arthritis (5%) and post-trauma (1.3%). The mean pre-operative OSS was 16, which doubled following CRHA surgery. Fifteen patients underwent revision surgery due to ongoing glenoid pain with a mean revision time following primary CRHA being 49 months. Projected survival at the endpoints 5,7 and 10 years were 83, 81 and 79% respectively. Conclusion. This study provides us with a much longer average follow-up period in comparison to many other studies published. Previous studies, support resurfacing as a useful implant in reducing pain and improving function in the short-term; but this series demonstrates over the medium-term a relatively high revision rate of about 20% in comparison with other arthroplasty options, despite the revision rate seeming to plateau from the 5-year mark onwards

Advances in total hip and knee replacement technologies have heretofore been largely driven by corporate marketing hype with each seeming advancement accompanied by a cost increase often out in front of peer-reviewed reports documenting their efficacy or not. As example, consider the growing use of ceramic femoral heads in primary total hip arthroplasty (THA). The question to consider is “Can an upcharge of $350 for a ceramic femoral head in primary THA be justified?” The answer to this question lies in an appreciation of whether the technology modifies the potential for costly revision arthroplasty procedures. Peer-Reviewed Laboratory & Clinical Review - According to the 2022 Australian National Joint Replacement Registry, the four leading causes of primary THA failure requiring revision are: 1.) infection, 2.) dislocation/instability, 3.) periprosthetic fracture and 4.) loosening, which constitute 87.5% of the reported reasons for revision. Focusing on these failure modes, hip simulator findings report that ceramic femoral heads dramatically reduce wear debris generation, decreasing the potential for osteolytic response leading to loosening. Further, ceramic materials enable the utilization of larger head sizes, avoiding the potential for dislocation. The overall mid- to long-term survival rate reported in the peer-reviewed, clinical literature for these bearings has exceeded 95% with virtually no osteolysis. Also, could bearing surface choice influence periprosthetic joint infection (PJI)? A study on a total of more than 10,500 primary THA procedures reported a confirmed PJI incidence of 2.4% for cobalt-chrome and 1.6% for ceramic femoral heads, suggesting that the employ of a ceramic bearing surface may also play a role in decreasing the potential for infection. Review of the clinical data available for ceramic bearings justifies that it is better to “pay me now than to pay orders of magnitude later”, if in fact a revision THA can be avoided, significantly reducing the overall financial burden to the healthcare system

Previous studies have reported excellent results with tapered, titanium alloy, porous plasma-sprayed components in patients undergoing uncemented primary total hip arthroplasty (THA). The purpose of this study was to examine survival and clinical results at minimum 25-year follow-up. We reviewed all patients who underwent primary THA at our center through 1995 with a specific femoral component, the Mallory-Head Porous (MHP; Zimmer Biomet, Warsaw, IN). This device, marketed in the U.S. until December 2021, was essentially unchanged since its 1984 introduction, except the porous coating was continued circumferentially along the lateral aspect in 1987, a hydroxyapatite-coated option was offered in 1988, and an offset option was added in 1999 after the study period. Three hundred thirty-two patients (396 THA) had a minimum of 25-year follow-up. Mean age at surgery was 47.6 years (range, 21–70 years). Mean follow-up in non-failed patients was 28.7 years (range, 25 to 37 years). There were 31 femoral revisions (7.8%): 9 infection, 3 failure of ingrowth, 5 aseptic loosening, 8 osteolysis revised well-fixed, 2 periprosthetic fracture, 2 polyethylene wear with trochanteric avulsion, 1 component breakage, and 1 malalignment well-fixed. Kaplan-Meier survival with endpoint of stem revision for all causes was 94.8% (95% CI: ±0.9%) at 36.7 years, and survival with endpoint of aseptic loosening/failure of ingrowth was 98.7% (95% CI: ±0.5) at 36.7 years. Harris hip scores improved significantly from 43 preoperatively to 76 most recently. This tapered, titanium, porous plasma spray-coated femoral component continues to demonstrate high long-term survival with a low rate of femoral component revision for any reason or aseptic loosening/failure of ingrowth

The Accolade®TMZF is a taper-wedge cementless metaphyseal coated femoral stem widely utilized from 2002-2012. In recent years, there have been reports of early catastrophic failure of this implant. Establishing a deeper understanding of the rate and causes of revision in patients who developed aseptic failure in stems with documented concerns about high failure rates is critical. Understanding any potential patient or implant factors which are risk factors for failure is important to inform both clinicians and patients. We propose a study to establish the long-term survival of this stem and analyze patients who underwent aseptic revision to understand the causes and risk factors for failure. A retrospective review was undertaken of all patients who received a primary total hip arthroplasty with an Accolade® TMZF stem at a high-volume arthroplasty center. The causes and timing of revision surgery were documented and cross referenced with the Canadian Institute of Health Information Discharge Abstract Database to minimize loss to follow-up. Survivorship analysis was performed with use of the Kaplan-Meier curves to determine the overall and aseptic survival rates at final follow-up. Patient and implant factors commonly associated with aseptic failure were extracted and Cox proportional hazards model was used. A consecutive series of 2609 unilateral primary THA patients implanted with an Accolade®TMZF femoral hip stem were included. Mean time from primary surgery was 12.4 years (range 22 days to 19.5 years). Cumulative survival was 96.1% ± 0.2 at final follow-up. One hundred and seven patients underwent revision surgery with aseptic loosening of the femoral component was the most common cause of aseptic failure in this cohort (33/2609, 1.3%). Younger age and larger femoral head offset were independent risk factors for aseptic failure. To our knowledge, this is the largest series representing the longest follow-up of this taper-wedge cementless femoral implant. Despite early concerns, the Accolade® TMZF stem has excellent survivorship in this cohort. Trunnionosis as a recognized cause for revision surgery was rare. Younger age and larger femoral head offset were independent risk factors for aseptic failure

Survival of sepsis has been documented worldwide, but little is documented about the long-term health outcomes of multifocal sepsis from acute musculoskeletal infection - the first study of its kind in New Zealand. Children admitted to the Paediatric Intensive Care Unit (PICU) from 1. st. January 2002 to 31. st. December 2017 with a musculoskeletal focus of infection were identified from hospital coding data. Notes review from discharge to present day determined survival and morbidity. Present-day clinical assessment of the musculoskeletal and respiratory systems along with questionnaires on health-related quality of life, mental health and sleep were performed. Seventy patients were studied. Seven children died acutely (five Pasifika and two Māori children) indicating 10% mortality. Long-term survival was favourable with no recorded deaths after discharge. Recurrence/chronic infection occurred in 23%, a mean of 1.1 year after discharge. Growth disturbance occurred in 18%, a mean of 3 years after discharge. The hip joint and proximal femur have the worst complications. Children under 2 years are most at risk of long-term disability. No patients had chronic respiratory illness beyond 90 days. Fifteen children had symptoms of acute neurological impairment, three of whom had permanent brain injury. Twenty-six survivors (41%) were assessed a mean of 8.2 years after discharge. Health-related quality of life scores were on par with normative data. Six patients and eight parents screened positive for moderate to severe post-traumatic stress disorder. Paediatric multifocal musculoskeletal sepsis can result in complex illness with long hospital stay and multi-organ complications. Māori and Pasifika children, those under two and those involving the proximal femur/or hip are most at risk. Other outcomes are favourable with no evidence of chronic lung disease or poor quality of life. A period of rehabilitation for children with identified acquired brain injury should be part of discharge planning

The purpose of this study was to determine long-term survival free from all-cause revision and stem-related failure, as well as radiographic and functional outcomes of the ZMR stem in revision THA. We retrospectively identified all patients in our institutional database who underwent revision THA using the ZMR Revision Hip system from the year 2000 to 2007 (minimum two-year follow-up). Of the 112 ZMR hips (110 patients) identified, a total of 106 hips (104 patients) met inclusion criteria. The mean study follow-up 13.9 years (range 2–22). Indications for index ZMR revision included aseptic loosening (72.1%), periprosthetic joint infection (17.3%), periprosthetic fracture (9.6%), and stem fracture (1.0%). Kaplan-Meier analysis was used to determine the all-cause and stem-related failure revision-free survival. Validated patient reported outcomes were collected and available radiographs were reviewed to determine implant stability. A total of 17 hips (16.0%) underwent a re-revision of any component. The indications for re-revision were stem failure (35.3%), infection (29.4%), instability (29.4%), and aseptic loosening of the acetabular component (5.9%). The five- and 15-year all-cause survivorship was 89.5% (95% CI 86.5–92.5) and 83.0% (95% CI 79.2–86.8), respectively. There were six re-revisions for stem failure (5.7%); five for stem fracture and one for aseptic loosening. The average time to stem failure was 4.6 years (range 1.3–8.2). The five- and 15-year survivorship free from stem-related failure was 97.2% (95% CI 95.6–98.8) and 93.9% (95% CI 91.5–96.3), respectively. At final follow-up the mean Oxford hip score was 36.9 and all surviving ZMR stems were well fixed on radiographs. Femoral revision with the ZMR stem offers satisfactory long-term survivorship and promising clinical outcomes. Although uncommon, stem fracture was the most common reason for stem-related failure

Aims. Medial unicompartmental knee arthroplasty (mUKA) is an advised treatment for anteromedial knee osteoarthritis. While long-term survival after mUKA is well described, reported incidences of short-term surgical complications vary and the effect of surgical usage on complications is less established. We aimed to describe the overall occurrence and treatment of surgical complications within 90 days of mUKA, as well as occurrence in high-usage centres compared to low-usage centres. Methods. mUKAs performed in eight fast-track centres from February 2010 to June 2018 were included from the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Database. All readmissions within 90 days of surgery underwent chart review and readmissions related to the surgical wound or the prosthesis were recorded. Centres were categorized as high-usage centres when using mUKA in ≥ 20% of annual knee arthroplasties. The occurrence of complications between high- and low-usage centres were compared using Fisher’s exact test. Results. We included 3,757 mUKAs: 2,377 mUKAs from high-usage centres and 1,380 mUKAs from low-usage centres. Surgical complications within 90 days occurred in 69 cases (1.8%), 45 (1.9%) in high-usage centres and 24 (1.7%) in low-usage centres (odds ratio (OR) 1.1 (95% confidence interval (CI) 0.65 to 1.8)). The most frequent complications were periprosthetic joint infections (PJIs) (n = 18; 0.48%), wound-related issues (n = 14; 0.37%), and periprosthetic fractures (n = 13; 0.35%). Bearing dislocations (n = 7; 0.19%) occurred primarily in procedures from high-usage centres. In high-usage centres, seven periprosthetic fractures (0.29%) occurred compared to six (0.43%) in low-usage centres (OR 0.68 (95% CI 0.20 to 2.0)). In high-usage centres, nine PJIs (0.38%) occurred compared to nine (0.65%) in low-usage centres (OR 0.58 (95% CI 0.22 to 1.6)). Conclusion. Surgical complications are rare after fast-track mUKA surgery and with no difference in overall occurrence of surgical complications between high- and low-usage centres, although the risk of some specific surgical complications may favour high-usage centres. Cite this article: Bone Jt Open 2023;4(6):457–462