In recent years articulating cement spacers have been used to treat infected knee arthroplasty. The aim has been to better maintain tissue planes and joint mobility thereby improving second stage re-implantation surgery. Two groups of patients treated for infected knee arthroplasty were reviewed. Twenty-six patients with articulating and forty patients with static antibiotic-impregnated methyl-methacrylate spacers were compared. The articulating spacers demonstrated easier surgical exposure at second stage and improved range of knee motion after re-implantation. There was no compromise in the rate of infection eradication with articulating spacers. Bone loss at revision was independent of spacer type.

To compare the results of patients treated with articulating versus static antibiotic-impregnated spacers for infected knee arthroplasty.

Articulating cement spacers facilitate re-implantation surgery by maintaining tissue planes and joint mobility without compromising joint stability or eradication rate of infection. Patients demonstrate better range of motion and less complications related to the extensor mechanism with the articulated spacer.

Antibiotic impregnated methyl-methacrylate spacers have become a mainstay in two-stage revision arthroplasty for sepsis. It is thought that articulating cement spacers facilitate prosthesis re-insertion by better maintaining tissue planes and joint mobility between stages.

In the articulating group fewer extensile exposure methods were required at second stage prosthesis reimplantation (19% vs 36 %). No tibial tuberosity osteotomies have been required since using the articulating spacer. The articulating group demonstrated a significantly improved range of flexion compared to the static group(106 vs 97 degrees- p=0.045) and had fewer patients with significant loss of extension or quadriceps lag. Eradication of infection was improved in the articulating group (92% vs 82%) but at shorter average follow-up. The need for augments and stabilized prostheses at revision surgery as a measure of bone loss was no different between the groups but was related to the number of prior surgical procedures.

Twenty-six patients treated with articulating spacers were compared to a matched consecutive group of forty patients treated with static spacers. Minimum follow-up was twelve months from second stage re-implantation (average twenty-two months articulating, forty months static)

Funding: No direct funding from any commercial source has been received for this study. The primary author’s fellowship position is partially funded by Smith and Nephew Richards Inc.

Constrained acetabular components are a useful adjunct for the potentially unstable hip arthroplasty. There have been concerns over implant failure and early acetabular component loosening secondary to the increased implant constraint. We report the results of a constrained ace-tabular component used as treatment for dislocating hips and as prophylaxis against dislocation in high risk primary and revision hip arthroplasty. At average 3.1 years follow-up only one insert of eighty-nine inserted had failed. No cups have demonstrated radiographic or clinical evidence of loosening. We conclude this implant is safe and effective for both the prevention and treatment of hip instability.

To review the effectiveness and durability of a constrained acetabular component used to treat and prevent recurrent dislocation after total hip arthroplasty

Constrained acetabular components of this type provide both an excellent treatment and preventative option in total hip arthroplasty. There is no evidence of accelerated cup loosening and the implant failure rate remains acceptable despite the increased constraint.

Constrained acetabular components have been mainly used as a salvage option for dislocating hip arthroplasty. There have been concerns over implant failure and early acetabular component loosening secondary to the increased implant constraint. Use of this implant can prevent dislocation in high risk patient groups (eg: revision surgery) without compromising implant longevity. This significantly reduces the potential morbidity associated with hip instability.

Eighty-nine patients received the tripolar constrained acetabular component. Fifteen were inserted for recurrent dislocation whilst seventy-two were inserted in patients felt to be at high risk of dislocation (forty-nine for intra-operative instability at revision surgery, twenty-five for primary THA in patients with poor compliance, neurological conditions or deficient abductor mechanism). One implant failed by component dissociation at eighteen months. All other recurrent dislocators remained stable. There was no evidence of accelerated component loosening at medium term review (range twelve – eighty three months, average thirty-seven months)

Radiographic and clinical data was prospectively collected on eighty-nine patients who had the constrained acetabular component inserted.

Funding: The primary author’s fellowship position is partially funded by Smith and Nephew Richards Inc.

In recent years articulating cement spacers have been used to treat infected knee arthroplasty. The aim has been to better maintain tissue planes and joint mobility thereby improving second stage re-implantation surgery. Two groups of patients treated for infected knee arthroplasty were reviewed. Twenty-six patients with articulating and forty patients with static antibiotic-impregnated methyl-methacrylate spacers were compared. The articulating spacers demonstrated easier surgical exposure at second stage and improved range of knee motion after re-implantation. There was no compromise in the rate of infection eradication with articulating spacers. Bone loss at revision was independent of spacer type.

To compare the results of patients treated with articulating versus static antibiotic-impregnated spacers for infected knee arthroplasty.

Articulating cement spacers facilitate re-implantation surgery by maintaining tissue planes and joint mobility without compromising joint stability or eradication rate of infection. Patients demonstrate better range of motion and less complications related to the extensor mechanism with the articulated spacer.

Antibiotic impregnated methyl-methacrylate spacers have become a mainstay in two-stage revision arthroplasty for sepsis. It is thought that articulating cement spacers facilitate prosthesis re-insertion by better maintaining tissue planes and joint mobility between stages.

In the articulating group fewer extensile exposure methods were required at second stage prosthesis reimplantation (19% vs 36 %). No tibial tuberosity osteotomies have been required since using the articulating spacer. The articulating group demonstrated a significantly improved range of flexion compared to the static group(106 vs 97 degrees- p=0.045) and had fewer patients with significant loss of extension or quadriceps lag. Eradication of infection was improved in the articulating group (92% vs 82%) but at shorter average follow-up. The need for augments and stabilized prostheses at revision surgery as a measure of bone loss was no different between the groups but was related to the number of prior surgical procedures.

Twenty-six patients treated with articulating spacers were compared to a matched consecutive group of forty patients treated with static spacers. Minimum follow-up was twelve months from second stage re-implantation (average twenty-two months articulating, forty months static)

Funding: No direct funding from any commercial source has been received for this study. The primary author’s fellowship position is partially funded by Smith and Nephew Richards Inc.

Introduction and Aims: To compare the results of patients treated with articulating versus static antibiotic-impregnated spacers for infected knee arthroplasty.

Method: All patients undergoing two-stage revision knee arthroplasty for sepsis in the last five years were reviewed. Twenty-six patients had been treated with articulating spacers. This group was compared to 36 patients treated with static spacers. The articulating spacer technique had been adopted more recently than the static technique. Minimum follow-up was 12 months from second stage re-implantation (average 22 months articulating, 40 months static). Patients were compared in terms of the need for extensile exposures required for re-implantation, range of motion at most recent review, eradication of infection and augmentation required on revision implants.

Results: In the articulating group, fewer extensile exposure methods were required at second-stage prosthesis re-implantation (19% vs 36%). No tibial tuberosity osteotomies have been required since using the articulating spacer. The articulating group demonstrated a significantly improved range of flexion compared to the static group (106 vs 97 degrees – p=0.045) and had fewer patients with significant loss of extension or quadriceps lag. Eradication of infection was improved in the articulating group (92% vs 82%) but at shorter average follow-up. The need for augments and stabilised prostheses at revision surgery as a measure of bone loss was no different between the groups but was related to the number of prior surgical procedures.

Conclusion: Articulating cement spacers facilitate reimplantation surgery by maintaining tissue planes and joint mobility without compromising joint stability or eradication rate of infection. Patients demonstrate better range of motion and less complications related to the extensor mechanism with the articulated spacer.

Repair of large rotator cuff tears can be a demanding technical exercise, particularly when patients are elderly and tissue quality for repair is poor. In 25 patients we have used a method of tying rotator cuff sutures over a screw fixation post at the level of the surgical neck to secure the torn cuff to the greater tuberosity while healing occured. This study reports the results of these patients. 25 patients (27 shoulders) of average age 68.5 years were reviewed at an average of 22 months post surgery (range 3– 52 months). 4 patients (6 shoulders) were workers compensation injuries. The Constant method of shoulder assessment and visual analogue pain scores were used. Constant scores improved from an average of 30.6 pre-operatively to 75.2 post operatively. Pain scores improved from an average of 7.2 pre-operatively to 2.2 post operatively.

Over 80 % of patients reported being very satisfied with the results of their procedure. 2 patients reported being unsatisfied with their procedure. Workers compensation patients had poorer results for pain and function than the group average but still reported good satisfaction with the procedure. 4 complications occurred. 2 patients had re- tears of their cuff after falls. One was repaired with side to side suturing and the other was re-repaired to the post. 1 wound infection occurred requiring arthroscopic shoulder lavage and final removal of the implant.

This shoulder subsequently healed with good function. One patient had significant shoulder pain requiring surgery and removal of the fixation post. There were no other cases of screw irritation and no axillary nerve palsy or deltoid avulsions were found.

Conclusions: This method of fixation is simple, strong, safe and gives results at least equivalent to if not better than other reported methods. The technique is a useful one to have in the surgical repertoire when dealing with large rotator cuff tears in older patients.