Aims. Despite multiple trials and case series on hip hemiarthroplasty designs, guidance is still lacking on which implant to use. One particularly deficient area is long-term outcomes. We present over 1,000 consecutive cemented
The carpometacarpal joint of the thumb is one of the most common locations of degenerative arthritis. Surgical options include trapezio-metacarpal fusion, replacement or resection arthroplasty with or without interposition. We report the medium term results of a Modified
We have performed a prospective review of 590 consecutive patients treated for a displaced intracapsular femoral neck fracture with a Thompson hemiarthroplasty. 113 patients had the prosthesis cemented, 477 had no cement. The outcome at 12 months was obtained for every patient still alive as regards to pain, mobility, re-operation rate and residential status. There was no significant difference between the 2 groups as regards pain (p = 0.482), decrease in mobility or re-operation rate (p = 0.168). The main determination of poor outcome was increasing age at time of injury and whether the patient was already in institutional care at the time of the injury. The use of cement had no bearing on outcome. This study is of clinical interest because patients who have undergone uncemented hemiarthroplasty have been shown to have similar out come to cemented hemiarthroplasty in terms of function. In addition possible but preventable complications associated with cementing can be minimized. We now believe there is no primary indication to cement the Thompsons hemiarthroplasty in this group of patients. There have been smaller studies looking at this, but we believe this to be the largest and most comprehensive to date.
Current evidence suggests that we should be moving away from
Current evidence suggests that we should be moving away from
The cement in cement technique for revision total hip arthroplasty (THA) has shown good results in selected cases. However, results of its use in the revision of hemiarthroplasty to THA has not been previously reported. Between May 1994 and May 2007 28 (20
Following the recommendation of NICE guidelines (CG124) we have recently started using cemented smooth tapered stem hemiarthroplasty as our standard management of intra-capsular neck of femur fractures. Prior to publication of the above guidelines the standard implant utilised was Thompson Hemiarthroplasty prosthesis. The cost implications of this change have not been fully appreciated and the benefit of these changes in ASA grade 3–4 patients has not previously been analysed. We identified a cohort of 89 patients admitted with displaced intra-capsular neck of femur fracture with an ASA grade 3–4. These underwent hip hemiarthroplaties at our centre over a period of 12 months (before and after guideline implementation). Data regarding in-hospital mortality, dislocation, reoperation and place of discharge were retrospectively collected and analysed. Our cohort included 46 patients who underwent a Thompsons Hemiarthroplasty, 30 patients who had a cemented smooth tapered stem hemiarthroplasty and 13 patients who had an Austin-moore Hemiarthroplasty. In-patient mortality rates were highest in the Austin-moore group, followed by the Thompsons group compared to none in the smooth tapered stem group. However, this was not statistically significant. One patient in the Thompsons group and one patient in the smooth tapered group had multiple dislocations and re-operations, compared with none in the Austin-moore group. In terms of percentage of patients who were discharged home from hospital the smooth tapered stem group had a percentage that was more than twice that of the
The cement in cement technique for revision total hip arthroplasty (THA) has shown good results in selected cases. However results of its use in the revision of hemiarthroplasty to THA has not been previously reported. Between May 1994 and May 2007 28 (20
In 2006 the standard prosthesis for hip hemiarthroplasty in our unit was changed from the traditional Thompson prosthesis used for over 20 years to the monobloc Exeter Trauma Stem (ETS). The principle anticipated advantages were ease of stem implantation, improvement of orientation positioning and a consistency with modern proven femoral THR stem design. All patients selected for hemiarthroplasty replacement for a displaced subcapital fracture of the hip were eligible for inclusion. Failed previous surgical cases were excluded. The last 100
Introduction. Following National patient safety alert on cement use in hip fracture surgery, we investigated the incidence and pattern of 72 hours peri-operative mortality after hip fracture surgery in a District General Hospital. Methods. We reviewed all patients who had hip fracture surgery between 2005-April, 2010. We recorded demographic variables, type of fracture, implant used, medical co-morbidity, seniority of operating surgeon and anaesthetist, peri-operative haemodynamic status, time and cause of death. Results. Over a 64 month period 15 cases were identified. Peri-operative death (PAD) was 1% (15/1402). 4/15 patients died intra-operatively. PAD was highest following Exeter Trauma Stem (ETS) implantation (5/85, 6%) and nil following Bipolar arthroplasty, Austin-Moore arthroplasty (AMA) or Cannulated screw fixation. PAD following total hip arthroplasty was 4% (1/25),
Fractures of the femoral neck in the elderly are associated with significant morbidity and mortality. In the UK, patients with these fractures occupy 20% of orthopaedic beds. Between September 1999 and August 2000 a prospective study was conducted to evaluate the outcome in 36 patients, 24 of them women, with femoral neck fractures treated by uncemented
Introduction: Fractures of the forearm bones are not uncommon and every orthopedic surgeon has his share in treating these cases. The general consensus in the treatment of fractures of both bones forearm in adults is operative and there are various modes of internal fixations available, the choice of which rests on the treating surgeon. No matter what the implants are used the goal is to obtain sound union with excellent functional outcome and early mobilization. The aim of this paper is to demonstrate the combination of ulnar nailing and radial plating in the management of fractures both bones of forearm. Materials and method: We are presenting our series of 237patients with fractures of both bones forearm during the period 1995 to 2000 treated ulna with Talwarkar’s square nail and radius -AO narrow DCP. Under G.A / brachial block first retrograde ulnar nailing with minimal exposure and minimal periosteal stripping followed by radial plating through
This study examines patient characteristics, indications for conversion, surgical and anaesthetic technique, peri-operative management and complications of surgery in this small and challenging group of patients. In the six years from 1994 to 1999, 33 conversion arthroplasties were performed for failed femoral hemiarthroplasty. The average age at conversion surgery was 75.5 years (range 65–90). The female to male ratio was 6:1. Primary hemiarthroplasties comprised 24 Austin-Moore, 6 Thompson &
3 Bipolar prostheses. The average interval from primary to conversion surgery was 50 months (6 months to 17 years). The average age at primary surgery was 71.2 years (62–88) – AMP:71.4 years,
Background:Displaced sub-capital fractures of the femur are traditionally treated by hip arthroplasty (hemi or total joint replacement). Total hip arthroplasty (THA) was formerly disfavored due to presumed higher peri-operative complications, higher costs and higher incidence of dis-location. Lately, this procedure regained acceptance as a suitable solution for active elderly patients. The use of monopolar hemi-arthroplasty implants (Austin-Moore’
Approximately half of all hip fractures are displaced intracapsular fractures. The standard treatment for these fractures is either hemiarthroplasty or total hip arthroplasty. The recent National Institute for Health and Care Excellence (NICE) guidance on hip fracture management recommends the use of ‘proven’ cemented stem arthroplasty with an Orthopaedic Device Evaluation Panel (ODEP) rating of at least 3B (97% survival at three years). The Thompsons prosthesis is currently lacking an ODEP rating despite over 50 years of clinical use, likely due to the paucity of implant survival data. Nationally, adherence to these guidelines is varied as there is debate as to which prosthesis optimises patient outcomes. This study design is a multi-centre, multi-surgeon, parallel, two arm, standard-of-care pragmatic randomised controlled trial. It will be embedded within the WHiTE Comprehensive Cohort Study (ISRCTN63982700). The main analysis is a two-way equivalence comparison between Hemi-Thompson and Hemi-Exeter polished taper with Unitrax head. Secondary outcomes will include radiological leg length discrepancy measured as per Bidwai and Willett, mortality, re-operation rate and indication for re-operation, length of index hospital stay and revision at four months. This study will be supplemented by the NHFD (National Hip Fracture Database) dataset.Background
Design
Interleukin 18 (IL-18) is a regulatory cytokine that degrades the disc matrix. Bone morphogenetic protein-2 (BMP-2) stimulates synthesis of the disc extracellular matrix. However, the combined effects of BMP-2 and IL-18 on human intervertebral disc degeneration have not previously been reported. The aim of this study was to investigate the effects of the anabolic cytokine BMP-2 and the catabolic cytokine IL-18 on human nucleus pulposus (NP) and annulus fibrosus (AF) cells and, therefore, to identify potential therapeutic and clinical benefits of recombinant human (rh)BMP-2 in intervertebral disc degeneration. Levels of IL-18 were measured in the blood of patients with intervertebral disc degenerative disease and in control patients. Human NP and AF cells were cultured in a NP cell medium and treated with IL-18 or IL-18 plus BMP-2. mRNA levels of target genes were measured by real-time polymerase chain reaction, and protein levels of aggrecan, type II collagen, SOX6, and matrix metalloproteinase 13 (MMP13) were assessed by western blot analysis.Objectives
Methods