Aims

While cementless fixation offers potential advantages over cemented fixation, such as a shorter operating time, concerns linger over its higher cost and increased risk of periprosthetic fractures. If the risk of fracture can be forecasted, it would aid the shared decision-making process related to cementless stems. Our study aimed to develop and validate predictive models of periprosthetic femoral fracture (PPFF) necessitating revision and reoperation after elective total hip arthroplasty (THA).

Short-stem total hip arthroplasty (THA) may have bone sparing properties, which could be advantageous in a younger population with high risk of future revision surgery. We used data from the AOANJRR, LROI and SAR to compare survival rates of primary THA, stems used in the first-time revision procedures as well as the overall survival of first-time revisions between a cohort of short-stem and standard-stem THA. Short-stem THAs (designed as a short stem with mainly metaphyseal fixation) between 2007 and 2021 were identified (n=16,258). A propensity score matched cohort (1:2) with standard THAs in each register was identified (n=32,515). The cohorts were merged into a research dataset. Overall survival at 12 years follow-up was calculated using Kaplan-Meier survival analyses. Stem revisions (short-stem THA n=239, standard-stem THA n=352) were identified. The type of revision stem was classified as standard (<160 mm) or long (>160 mm). The survival rate of all first-time revisions in the two groups was calculated using any type of revision as outcome. The 12 year- overall survival rate (all revisions, all causes) for primary short-stem THAs was 95.3% (CI 94.5–95.9%), which was comparable to 95.2% (CI 94.7–95.7%) for standard-stem THAs. In the short-stem THA group, a standard stem (<160 mm) was more often (59%) used in the first-time revision than in the standard-stem group (47%, p=0.004). The overall survival of the first-time revisions did not differ between cases primarily operated with a short or a standard stem. In our multi-national register study, the overall survival rate of short stems was similar to that of standard stems. In short stem revisions there was a higher likelihood of using a standard-length stem for the revision compared with first-time revisions of standard stems. This finding might indicate bone-sparing properties with short-stemmed THAs

Aims

Our primary aim was to assess reoperation-free survival at one year after the index injury in patients aged ≥ 75 years treated with internal fixation (IF) or arthroplasty for undisplaced femoral neck fractures (uFNFs). Secondary outcomes were reoperations and mortality analyzed separately.

Introduction and Aims: A phenotypic and proteomic approach has identified novel targets for the development of a DNA vaccine to prevent Staphylococcus aureus infection in orthopaedics. Approximately 1% of joint replacement operations are complicated by infection. Thirty percent of these infections are due to S.aureus, which is often difficult to treat because of antibiotic resistance. As treatment of these infections is challenging, prevention with a vaccine is a very attractive option. Method: To infect a joint replacement, bacteria must first adhere to its surface. This adherence is mediated by specific adhesion proteins; the expression of which is controlled by virulence regulator genes within the bacterial cell. A DNA vaccine is being developed which targets this regulatory apparatus, thus preventing bacterial adhesion, allowing the immune system to rapidly clear any potential S.aureus infection. Results: Mutations of the agr,sar and sae virulence regulator genes have been made. Their properties have been explored using a flow cell system, which uses a scanning confocal laser microscope and image analysis software to accurately provide quantitative data in real-time of biofilm formation. We have shown that the sae mutant does not form biofilm in the same was as wild-type S.aureus. We have also shown that it does not adhere to steel as well as its wild-type counterpart. Conclusion: For such a dramatic difference in biofilm forming properties to be evident, there must be a difference in the adhesion proteins produced by the wild-type and the mutant bacteria. Gel-electrophoresis has compared protein expression of sae mutant and wild-type bacteria and identified differences. Those proteins which are not expressed in the non-biofilm-forming mutant are sequenced and from the protein sequences, DNA sequences are identified that will form part of the candidate DNA vaccine

Aims

Perthes’ disease is a condition leading to necrosis of the femoral head. It is most common in children aged four to nine years, affecting around one per 1,200 children in the UK. Management typically includes non-surgical treatment options, such as physiotherapy with/without surgical intervention. However, there is significant variation in care with no consensus on the most effective treatment option.