Patients need to know the benefits, risks and alternatives to any proposed treatment. Surgeons discussing the risk of a revision procedure becoming necessary, after a hip replacement can draw upon the orthopaedic literature and arthroplasty registries for long-term implant survival. However, early revision is required in a minority of cases. We have investigated the probability for revision hip replacement patients in terms of time-point and indication for revision. Of the 9,411 Primary Total Hip Replacements (THR), undertaken by 22 surgeons, over an eleven-year period, between January 2004 and March 2015, 1.70% (160) were subsequently reported to the National Joint Registry (NJR) as revised. Each revision case was reviewed under the supervision of senior hip specialist consultants. The modes of failure of were identified through clinical, laboratory and imaging (x-rays, CT, MRI and Isotope scans) studies. The revision rate for THRs was 0.58% in the first year. This was statistically higher than all subsequent years, P-Value <0.001. There was no statistical difference between any pair of subsequent years. Thereafter, the average revision rate was 0.30% per annum. The odds ratio for revision during the first post–operative year against the subsequent year average was 1.67. The indications for the early hip revisions in the first three years were infection, dislocation and peri-prosthetic fracture. The data from this study can help better inform patients of the revision rates after a primary THR and allow surgeons to develop implant surveillance strategies among high-risk patients.
Despite an ageing population and a rise in the number of joint replacements being performed, the mean age of patients undergoing surgery remains static. One explanation for this is continued concern over the risks of performing surgery on the very elderly. We aim to investigate the outcome of Total Knee Replacement (TKR) in a nonagenarian population. The Elective Orthopaedic Centre, Epsom has an established patient reported outcome measures (PROMs) programme into which all patients are routinely enrolled. We retrospectively reviewed our data set for a cohort of nonagenarians undergoing primary TKR, between April 2008 and October 2011. Post-operative complications, mortality rates and functional outcomes were compared to those of a time matched 70–79 year old cohort. Only patients with a primary diagnosis of osteoarthritis were included whereas an exclusion criterion consisted of patients undergoing revision surgery, simultaneous bilateral replacements or conversion from a Unicompartmental Knee replacement.Background
Methods
Despite an ageing population and a rise in the number of joint replacements being performed, the mean age of patients undergoing surgery remains static. One explanation for this is continued concern over the risks of performing surgery on the very elderly. The Elective Orthopaedic Centre, Epsom has an established patient reported outcome measures (PROMs) programme into which all patients are routinely enrolled. Post-operative complications, Oxford scores and Euro-Quol (EQ5-D) are collected to the second post-operative year. We retrospectively reviewed our data set for a cohort of nonagenarians undergoing primary total hip replacement (THR) between April 2008 and October 2011. Post-operative complications, mortality rates and functional outcomes were compared to those of a time matched 70–79 year old cohort. Only patients with a primary diagnosis of osteoarthritis were included whereas an exclusion criterion consisted of patients undergoing revision surgery, simultaneous bilateral replacements or conversion from a dynamic hip screw. We identified 38 nonagenarian patients (12 men and 26 women), with a mean age of 92.18 (90–99) and the control group consisted of 55 patients (21 men and 34 women), with a mean age of 74.69 (70–79). We found that nonagenarians requiring a THR presented with lower pre-operative Oxford Hip Score (OHS) (p=0.02) but made a greater improvement in the first post-operative year than the younger cohort (p=0.040). The nonagenarians had a greater risk of requiring a blood transfusion following THR (p= 0.0265; CI 1.11 to 5.75), and also required a longer stay than their younger counterparts (p=0.001). Mortality rates were higher in the nonagenarian cohort, but these were in keeping with the life expectancy projections identified by the Office for National Statistics (ONS).Introduction
Methods and Results
Alpha angles have been used to identify the precise area on the femoral head/neck junction that causes cam-type FAI. Now, computer programs are available to calculate the precise motion pattern of a hip joint and identify areas of FAI, dysplasia and other morphological abnormalities. We hypothesise that one cannot rely on the alpha angle alone to predict the precise area of resection required to remove cam impingement. We used Clinical Graphics software to analyse a cohort of 142 hips. We recorded the alpha angle at 12, 1, 2 and 3 o'clock and whether resection was recommended by the software at these points. We then removed the patients with acetabular influences on potential FAI (pure cam group).Introduction
Methods
The Metasul articulation was introduced in the early 1990's. It comprises a 28mm forged, cobalt-chrome head and a forged metal inlay, set into the polyethylene element of the acetabular component. During the 1990's and early 2000's anatomic sized MoM articulations were re-introduced for hip resurfacing and stemmed implant designs. Adverse tissue reactions to metal debris and corrosion products subsequently led to a decline in MoM usage. Between January 1995 and December 1998, 133 hips underwent primary THR using the Metasul 28mm bearing. Patients were routinely sent an annual postal Oxford Hip Score (OHS) and radiographs were obtained from the second post-operative year. We have retrospectively reviewed the clinical and radiographic dataset following the 15 year follow-up time point.Introduction
Materials & Methods
