Introduction. Dislocation after primary total hip arthroplasty (THA) is a devastating and frequent postoperative complication. Many risk factors for dislocation have been identified, however, thus far there has been no consensus whether inflammatory arthritis is a risk factor for dislocation or not. We carried out a prospective study assessing the prevalence of dislocation within 2 years after primary total hip arthroplasty for osteoarthrosis and inflammatory arthritis. Patients and Methods. Between 1996 and 1999 312 patients (342 hips) with either a primary or a posttraumatic osteoarthrosis (OA group) and 59 patients (69 hips) with rheumatoid arthritis or other forms of inflammatory arthritis (IA group) were operated. One single type of prosthesis was implanted (EPF-PLUS. ®. cup and SL-PLUS. ®. stem) using an anterior approach. All dislocations in the two years following surgery were recorded. Both diagnostic groups were compared for known risk factors such as old age, female gender, prior hip surgery, and experience of the surgeon. Radiographs were examined for avulsion fractures of the tip of the trochanter and signs of loosening. The abduction and anteversion angles of the acetabular component were measured. Statistical analysis was performed with the Chi-square test and Student’s t-test. Results. The dislocation rate for inflammatory arthritis patients was significantly greater than that in patients with osteoarthrosis: 10. 1% (7 hips) in the IA group, 2. 9% (10 hips) in the OA group (p = 0. 006). There were no other differences in risk factors favouring dislocation in the IA group, such as old age, female gender, prior hip surgery, experience of the surgeon, trochanteric fractures or malposition of the prosthetic components. All dislocations in the IA group were posterior and occurred without any kind of trauma. In contrast, nearly half of the dislocations in the OA group were anterior and two were of traumatic origin. Discussion. Taking into account the fact that there are no differences in known risk factors for dislocation between our two groups and no differences in complication rate, except for dislocation, we can say that inflammatory arthritis has to be considered an independent risk-factor for dislocation after primary total hip arthroplasty. It may be that inferior quality of the (pseudo) capsule and the muscles stabilising the hip joint due to inflammatory arthritis leads to inadequate soft tissue tension. Another factor can be the concomitant impairments in rheumatoid patients, such as impairments of the upper extremity, ipsilateral knee or contralateral hip, leading to hyperflexion in the operated hip causing a posterior dislocation without trauma

Introduction. Total hip arthroplasty (THA) is the only successful treatment for patients in whom the hip joint is destroyed by inflammatory arthritis. Due to the effects of both the disease and its treatment elevated rates of complications and of aseptic loosening have been described. Whether with modern uncemented hip prostheses the results can be improved is not fully known. Therefore, we decided to carry out a prospective study. Material and methods. At the introduction of a new press-fit acetabular component a prospective study on the results of uncemented THA was started. From 1995 to 1999 85 primary THAs were carried out in 72 patients (57 women, 15 men) suffering from inflammatory arthritis. Diagnosis: RA 76, adult-onset Still 4, JIA 3, miscellaneous 2. Mean age at operation was 60 years (SD 15. 9). Clinically, the Harris Hip Score was used for evaluation. Radiographically, the Larsen classification was used and at follow-up radiolucencies and signs of migration were registered. The implants used in this study were the EPF-PLUS® acetabular component and the SL-PLUS® femoral component (PLUS Endoprothetik AG, Rotkreuz-CH). The EPF-PLUS® acetabular component is a novel modular press-fit cup. Its shell has a triple radius profile on cross-section, thereby creating a gradual lowering of the polar part of the cup. This produces a small gap of about 2 mm. between the acetabulum and the pole of the cup. Therefore, forces are mainly transmitted to the peripheral part of the acetabulum, leading to an enhanced primary stability. Originally, the shell had a gritblasted surface for osseointegration. Since 1996, the outer surface of the cup has been coated with a ground layer of pure titanium and a superficial layer of a crystalline hydroxyapatite (Ti-HA). The gritblasted version was used in 14 hips (1995–1996), the Ti-HA coated version in 71 hips. In 68 hips the cup was implanted by press-fit fixation, in 17 screws were added. Results. Larsen classification was as follows: 0-1: 6; 3: 17; 4: 60; 5: 2. At follow-up, 5 patients (6 THAs) were deceased. Deep infection required revision in one hip. Another revision was carried out for recurrent dislocations. One grit-blasted cup developed late subsidence and was revised almost 4 years postoperatively. One Ti-HA coated cup failed early due to severe acetabular bone loss. Finally, one femoral component developed a varus tilt and became symptomatic 2 years after implantation, requiring revision. In all 62 patients with 74 THAs in follow-up cup and stem are functioning well, both clinically and radiographically. Harris Hip Score increased from 36. 6 (SD 17. 7) to 87. 9 (SD 11. 8). Discussion. The medium-term results of the EPF®-PLUS cup show that its primary stability is good and that, as the polar gap rapidly disappears, osseointegration is secure. Only severe acetabular deficiency appears to be a contra-indication for this implant. Also, the SL-PLUS® stem performs well in inflammatory arthritis

Introduction. Multiple factors contributing to an elevated risk for dislocation after total hip arthroplasty (THA) have been identified. Patient-related risk factors that have been identified are prior hip surgery, old age and female gender. However, there have been no prospective reports whether inflammatory arthritis (IA) is an independent risk factor. Material and methods. From January 1996 to December 1999 427 primary total hip arthroplasties were carried out using one type of uncemented prosthesis: a hydroxyapatite coated EPF-PLUS. ®. cup and a SL-PLUS. ®. stem (PLUS Endoprothetik AG, Rotkreuz-CH). A 28 mm. ball head was used in every hip. To evaluate whether IA is a risk factor for dislocation the incidence and cause of early (< 2 year post-surgery) dislocation in IA hips was compared with those carried out for osteoarthrosis (OA). There were 341 THAs in 311 patients with OA and 69 THAs in 59 patients with IA (mainly rheumatoid arthritis) included in this study. The remaining 17 THAs were for various other reasons and excluded from this study. Statistical analysis of the dichotomous variables was carried out by the chi-square test and the Fisher’s exact test, Student’s t-test was used for the analysis of continuous variables. Results and discussion. Both groups were comparable with respect to the following risk factors: gender, approach (either straight-lateral or anterolateral), position of the acetabular component and experience of the surgeon. Mean age was lower in the IA group than in the OA group: 61. 0 vs 68. 1 years. Furthermore, the incidence of prior hip surgery was higher in the OA group. The incidence of dislocation was 7 out of 69 (10. 1%) in IA hips and 10 out of 341 (2. 9%) in OA hips (p=0. 006). All dislocations in IA where posterior, in OA 5 were posterior and 4 were anterior (1 unknown). No other mechanical factors leading to an increased instability of the hip in IA, such as trochanteric fractures, could be identified. Due to the relatively small numbers a statistical difference in the direction of dislocation could be identified (p= 0. 088). So, IA has to be considered as an independent risk factor for dislocation after THA. Both the polyarticular impairments and the lower quality of the soft tissues in IA could explain this elevated risk. To reduce the incidence of dislocation in IA it therefore seems advisable to pay detailed attention the soft tissues and the position of the prosthetic components in IA at the time of surgery. Also, consideration should be given to the use of an acetabular component with an elevated rim

Metal on metal hip resurfacing was introduced in 1992 by Derek McMinn initially using an all cementless device and then an all cemented device. A hybrid resurfacing with a cemented femoral component and a cementless acetabular component was introduced in 1994. The manufacturer of the hybrid hip resurfacing was changed in 1996. Since 1997 the Birmingham hip resurfacing has been in continuous use. The device is approved by NICE (National Institute for Clinical Excellence) for use within the NHS in patients with Osteoarthritis of the hip. The device is not yet approved for use in patients with Rheumatoid Arthritis and other types of inflammatory arthritis. There are concerns regarding bone quality in rheumatoid patients, which may result in a high incidence of component loosening or femoral neck fracture. Conventional total hip replacement is a successful procedure in inflammatory arthritis however with modern treatments producing increased activity levels there are concerns about polyethylene wear. The author has performed metal on metal hip resurfacing in patients with inflammatory arthritis over the past 12 years. A total of 170 patients have been operated on with 198 resurfacings. 33% of patients have a diagnosis of some type of inflammatory arthritis. The outcomes have been assessed using Oxford hip scores and long term clinical and radiological review. Our results indicate that there is a minimal risk of femoral neck fracture and a minimal risk of component loosening when the device is used with this approach in patients with inflammatory arthritis

Introduction: Hip Resurfacing has always been an attractive concept for the treatment of hip arthritis in young patients. Excellent early and medium-term results have been reported with the Birmingham Hip Resurfacing (BHR) device in single and multi-surgeon all-diagnoses and OA series. In the present report we present the results of BHR in inflammatory arthritis. Methods: This is a single-surgeon consecutive series. There were 15 consecutive hips (12 patients) including 2 women (2 hips) with ankylosing spondylitis (AS) operated at a mean age of 41.7 years (range 29.5 to 54.3 years). Fortytwo hips (31 patients) with seronegative or rheumatoid (RA) arthritis treated with a BHR at a mean age of 40 (13 to 64) years and a follow-up of 2 to 9 (mean 5.9) years were also studied. One patient died 5 years later. Revision for any reason was the end-point and unrevised patients were assessed with Oxford hip scores and reviewed clinico-radiologically with AP and lateral radiographs. Results: In the RA group there was one failure from femoral neck fracture two months after operation giving a failure rate of 2.4%. There were no failures in this cohort at a follow-up of 1.8 to 8.8 (mean 4.9) years. As a combined group the failure rate of BHRs in inflammatory arthritis is 1.75% and the cumulative survivorship at 9 years is 98.2% (figure). Discussion: The good results of Birmingham Hip Resurfacing in inflammatory arthritis in this relatively young cohort of patients make this a viable treatment option for these patients. Selection of patients with a reason-able bone quality and adherence to precise operative technique are vital to the success of this procedure

Introduction. Serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and synovial fluid white blood cell (WBC) count and differential are effective in diagnosing periprosthetic joint infection (PPJI); however their utility in patients with inflammatory arthritis is unknown. The purpose of this study is to determine the utility of these tests in patients with inflammatory arthritis. Methods. 934 Consecutive revision hip and knee arthroplasties were prospectively evaluated for PPJI. 202 Cases were excluded due to acute post-operative or hematogenous infection. 690 Patients had non-inflammatory and 42 had inflammatory arthritis. Receiver operating characteristic (ROC) curves were used to establish optimal ESR, CRP, WBC, and % neutrophil values for diagnosis of PPJI, and the area under the curve (AUC) was calculated to determine the overall accuracy. Results. The optimal thresholds for predicting PPJI were ESR 30mm/hr, CRP 17mg/L, WBC 2667, and differential 75% neutrophils in inflammatory arthritis, and ESR 32mm/hr, CRP 15mg/L, WBC 4000, and 78% neutrophils in non-inflammatory arthritis. The efficacy of these tests was similar in both populations (AUC for inflammatory ESR=86.2%, CRP=86.2%, WBC=93.8, 93.6% neutrophils; AUC for non-inflammatory ESR=85.2%, CRP=90.2%, WBC=94.5, 95% neutrophils); there was no significant difference between groups (ESR p = 0.861, CRP p= 0.549, WBC p=0.8315, % neutrophils p=0.7021). The rate of PPJI was significantly higher in patients with inflammatory (33.3%) than non-inflammatory (18.8%) arthritis (p-value=0.013). Conclusions. These results suggest that the ESR and CRP are useful in diagnosing PPJI in patients with inflammatory as well as non-inflammatory arthritis with similar optimal cut-off values

Introduction. Total knee replacement has been well-established form of treatment both for osteoarthritis and inflammatory arthritis. Both cemented and uncemented TKR have been used successfully. Since 1977 low contact stress (LCS) mobile bearing knee replacement has been in extensive use. Most of the intermediate and long term results reported are in osteoarthritis1–7. Though there are several studies reporting short term performance of TKR in rheumatoid arthritis8–19 there have been rare reports31 of intermediate to long-term performance of LCS uncemented TKR in rheumatoid arthritis. Methods. Retrospective, non-randomised and consecutive study. Case notes and radiological assessment done. Kaplan meyer survival analysis used. Radiological assessment between initial and final xrays done using T test statistics. Assessement done by two independent observer. Results. 108 knees in 67 patients are collected. 21 patients with 36 knees have died. Only 65 knees in 42 patients had both case notes and xrays which are included in this study. Of this 11 knees in 7 patients were dead. All 65 knees in 42 patients are sero-positive rheumatoid arthritis. Pre-operative bone loss was seen only in 4 knees. Bone loss was in the medial side in 3 knees (4,5 and 8mm respectively) and lateral in 1 knee (1 cm). None of these bone loss needed bone grafting or any special procedures. There was no subsidence in any of the 65 knees. Survival of uncemented LCS TKR in inflammatory arthritis patients is 100%. Aseptic failure is 0%. No infective failure. There is no significant change in the implant position. This is the longest follow for uncemented TKR in inflammatory arthritis ever reported in the literature. Conclusion and Discussion. In conclusion, our study has uniformity, as a single surgeon performed/supervised with senior trainees all the operations and all patients received the same level of post-operative care. Survival of LCS uncemented TKR in inflammatory arthritis patients is 100% up to 15years. This is the longest follow up in this patient population ever reported in the literature. Our study shows excellent survival and comparable to other cemented TKRs in this patient population reported in the literature. This study proves contrary to the general belief that uncemented TKR do poor in inflammatory arthritis due to osteoporotic bone

Aims: Patient-related risk factors of dislocation after total hip arthroplasty (THA) that have been identified are previous hip surgery, old age and female gender. However, there have been no prospective reports whether inflammatory arthritis (IA) is an independent risk factor. Methods: Prospective evaluation of the incidence of early (< 2 year post-surgery) dislocation in a consecutive series of primary THA. From January 1996 to December 1999 341 THAs in 311 patients with osteoarthrosis (OA) and 69 THAs in 59 patients with IA (mainly rheumatoid arthritis) were included in this study. One type of prosthesis having a 28 mm. ball head was implanted in every hip through an anterior appoach. Results: Both groups were comparable with respect to the following risk factors: gender, position of the acetabular component and experience of the surgeon. Average age was lower in the IA group than in the OA group: 61.0 vs 68.1 years. Furthermore, the incidence of previous hip surgery was higher in the OA group. Despite the presence of these risk factors in the OA group, the incidence of dislocation was higher in IA than in OA: 10.1% vs. 2.9% (p=0.006). All dislocations in IA where posterior, in OA 5 were posterior and 4 were anterior (1 unknown). No other mechanical factors leading to an increased instability of the hip in IA, such as trochanteric fractures, could be identified. Conclusions: Inflammatory arthritis is an independent risk factor of dislocation after THA. Both the polyarticular impairments and the lower quality of the soft tissues in IA could explain this increased risk

The purpose of this study is to assess the improvement in pain and function of the ankle when arthrodiastasis is used for end stage juvenile idiopathic arthritis [JIA] in the paediatric population. All patients treated with ankle arthrodiastasis, 2009–2013 were studied. Clinical, radiological and survivorship data were examined. The Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) and Parents (OxAFQ-P), along with the American Orthopaedic Foot and Ankle Society (AOFAS) Clinical rating system for Ankle-Hindfoot were recorded pre-operatively and at 6 months. Eight patients (9 ankles) with severe tibiotalar JIA, refractory to medical management were treated. Average age at surgery was 14.5 years (range 8–19). Average length of arthrodiastasis was 3.5 months. Length of follow-up averaged 13 months (range 5–28 months). All scores showed an improvement at 6 months. OxAFQ-C scores (out of 60) improved on average from 23 to 43. OxAFQ-P scores also improved from19 to 39. The largest improvement was found for the physical subsection. AOFAS Ankle-Hindfoot score (out of 100) averaged 34 pre-op and 74 at 6 months. Pain scored out of 10 decreased from an average of 7.4 to 4.3 at 6 months. All patients and parents were satisfied with the surgery and would have the procedure performed again. Radiological studies demonstrated cartilage regeneration, joint restoration and deformity correction with arthrodiastasis. Survivorship was good (75%) at 36 months, but 2 patients (3 ankles) had subsequent surgery in the adult sector for progression of disease despite initial improvement following arthrodiastasis. This case series demonstrates the efficacy of ankle arthrodiastasis as a surgical option in severe end-stage ankle inflammatory arthritis in paediatric patients in the short to midterm. It improved functional scores and pain scores which should delay the need for more radical joint fusion or replacement procedures in this challenging surgical condition

Introduction. Synovectomy in children with juvenile rheumatoid arthritis (JRA) and psoriatic arthritis (PSA) is still subject of controversial discussion. Our results of arthroscopic synovectomy of the knee in children with chronic inflammatory joint disease are presented. Material. From 1989–1997 27 synovectomies were performed in 27 children with inflammatory arthritis (15 JRA, 12 PSA). Average age at surgery was 12. 5 y (2. 9–17. 8 y). Mean follow-up was 4. 9 years. Methods. Onset of disease and conservative therapy was documented. Each patient was physically and radiologically examined preoperatively and 24 children postoperatively (mean follow-up 4. 9 years). For arthroscopic shaver-assisted synovectomy of the knee we used minimum 4 portals and normally 6 portals (2 anterior, 2 suprapatellar and 2 posterior portals). In addition to the physical examination we used a special clinical score (Laurin 1974). We compared the pre- and postoperative limits of active and passive knee movement. We performed sonographs and radiographs of the infected joint. Radiography was classified following the Larsen-Scale. Patient and parents gave their opinion whether the operation was successful. Before surgery all children had intensive drug and physical therapy for 8–62 months (42 month). In the course of conservative treatment, knees had local joint treatment with triamcinolonhex-acetomid (THA), normally for three times before surgery. Preoperative X-rays showed Larsen stage I in 3 knee joints and Larsen stage 0 in the other knees. Results. In 85% of the children, we found good or excellent surgical outcome. 2 joints achieved fair and 2 joints poor outcome. Concerning subjective outcome 22 (82%) children had been very satisfied (56%) or satisfied (26%). 25 of the children’s parents would agree in the same surgical procedure again. In 6 knee joints we found recurrent synovitis. 2 of these knee joints were reoperated (30 and 22 month postoperatively with satisfying result), the other 4 joints were treated with THA i. a.. The 2 reoperations were regarded as poor result. We had no postoperative complications and the normal hospitalisation was 15 days. Prior to surgery, 12 knee joints had an average deficit of active knee extension of 10° (5–20°). Postoperatively, no extension deficit was found anymore in 25 of the knees. Compared to the contralateral knees, a flexion deficit of 10° (5–15°) was obtained postoperatively. At sonography, no joint effusion could be revealed. Postoperative X-rays showed no progression in Larsen stage. Outcome in children with oligoarthritis was better than in those with polyarthritic disease. Discussion. Early arthroscopic synovectomy of the knee in children with chronic inflammatory joint disease is, in case of failure of conservative treatment, a useful method of treatment. We propose early synovectomy of the knee joint as an essential part of the treatment scheme for children with inflammatory joint disease

Aim of study

The thrust plate prosthesis is an implantat with metaphyseal fixation at the proximal femur, which leaves the diaphyseal bone untouched. Therefore this implant preferably is employed in younger patients. It is dependent on a good bone quality in the proximal femur. Because bone quality is reduced in patients with polyarthritis, this kind of endoprosthesis may have a higher failer rate than conventional stemmed endoprostheses in these patients. Therefore in patients with polyarthritis even short- end midterm results of the thrust plate prosthesis should be analyzed.

Material and Methods

47 thrust plate prostheses were implanted in 42 patients with polyarthritis (29 with rheumatoid arthritis, 6 with juvenile chronic arthritis and 7 patients with spondarthritis) and followed prospectively. The average age at the operation was 40. 8 ± 10. 7 years. Each patient was clinically and radiologically examined preoperative, 3 and 6 months after the operation and at the end of each postoperative year. The mean follow-up was 26. 1 ± 10. 7 months. The clinical findings were evaluated using the Harris-Hip-Score. Radiologically 8 different zones at the thrust plate prosthesis were analyzed for radiolucencies.

Results

During the first year the Harris-Hip-Score rose continuously from the preoperative average of 42. 4 ± 6. 5 points to 78. 8 ± 10. 3 points 3 months postoperatively, 82. 3 ± 9. 8 points 6 months postoperatively, and 86. 8 ± 10. 1 points 1 year after the operation. The following examinations showed Harris-Hip-Scores at the same level. 5 patients (5 joints, 10. 6%) had to undergo a revision of the thrust plate prosthesis due to aseptic loosening in 3 cases and septic loosening in 2 cases. 6 prostheses (12. 6 %) showed radiolucencies, mostly below the thrust plate in zone 1 and 2. 2 of these prostheses were certainly radiologically loose which raised the failure rate to 7 of 47 (14. 8 %).

Conclusion

The thrust plate prosthesis improves function and pain in patients with polyarthritis to a satisfactory degree. Concerning the failure rate this type seems to yield slightly worse results than cementless stemmed endoprostheses in the same patient group. Due to the preservation of the diaphysial bone of the femur and the possibility of an unproblematic change to a stemmed endoprosthesis the thrust plate prosthesis keeps its indication in younger patients with polyarthritis.

Aims: To evaluate the results of a novel modular press-þt acetabular cup in primary total hip arthroplasty (THA) for osteoarthrosis (OA) and inßammatory arthritis (IA). Methods: From February 1996 to June 1999 in 324 patients (249 women, 75 men) 355 THA using a novel cup has been carried out. The shell is non-hemispherical on cross-section and has a hydroxyapatite coating on porous titanium for osseointegration. Diagnosis was: osteoarthrosis (OA) 236, developmental dysplasia (DDH) 21, post-traumatic arthrosis 27, avascular necrosis 6, IA 65 Ð mainly rheumatoid arthritis (RA). Average age at operation was 65.8 years. The patients were studied prospectively using Harris Hip Score (HHS), by measuring any radiolucency around the cup and by looking for signs of migration. Results: Median follow-up was 4.5 years. At follow-up, 21 patients had deceased. Revision for deep infection was carried out in 5 hips (3 low-grade infections). No septic loosening occurred with low-grade infection. Recurrent dislocations required revision of 1 cup and exchange of 2 inserts. Only 1 cup in a RA patient with severe superior bone loss became unstable after a fall 4 months postoperatively. Survival with aseptic loosening of the cup as endpoint was 1 in OA and 0.98 in IA. In all 290 patients with 318 THA in follow-up the cup was functioning well, both clinically and radiographically. HHS increased from 44.5 to 90.3. Conclusion: Press-þt þxation using a modern acetabular component is an excellent treatment option in primary total hip arthroplasty for all diagnostic groups.

This study aimed to evaluate the month-to-month prevalence of antibiotic dispensation in the 12 months before and after total knee arthroplasty (TKA) and total hip arthroplasty (THA) and to identify factors associated with antibiotic dispensation in the month immediately following the surgical procedure. In total, 4,115 THAs and TKAs performed between April 2013 and June 2019 from a state-wide arthroplasty referral centre were analysed. A cross-sectional study used data from an institutional arthroplasty registry, which was linked probabilistically to administrative dispensing data from the Australian Pharmaceutical Benefits Scheme. Multivariable logistic regression was carried out to identify patient and surgical risk factors for oral antibiotic dispensation. Oral antibiotics were dispensed in 18.3% of patients following primary TKA and 12.0% of patients following THA in the 30 days following discharge. During the year after discharge, 66.7% of TKA patients and 58.2% of THA patients were dispensed an antibiotic at some point. Patients with poor preoperative health status were more likely to have antibiotics dispensed in the month following THA or TKA. Older age, undergoing TKA rather than THA, obesity, inflammatory arthritis, and experiencing an in-hospital wound-related or other infectious complications were associated with increased antibiotic dispensation in the 30 days following discharge. A high rate of antibiotic dispensation in the 30 days following THA and TKA has been observed. Although resource constraints may limit routine wound review for all patients by a surgeon, a select cohort may benefit from timely specialist review postoperatively. Several risk factors identified in this study may aid in identifying appropriate candidates for such changes to follow-up care

Introduction. This is a multi-centre, prospective, observational study of 503 INFINITY fixed bearing total ankle arthroplasties. We report the minimum two-year results of this prosthesis which was introduced to the UK Market in 2014 and is now the most used ankle arthroplasty in the National Joint Registry of England and Wales. Methods. Patients were recruited from 11 centres in the United Kingdom between June 2016 and November 2019. Demographic, radiographic, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Foot Ankle Questionnaire and Euroquol 5D-5L) were collected preoperatively, at 6 months, 1 year and 2 years and 5 years. The average age was 67.8 (range 23.9 to 88.5) and average BMI 29.3 (18.9 to 48.0). The COFAS grading system was used to stratify deformity. There were 261 (51.9%) COFAS Type 1, 122 (24.2%) COFAS Type 2, 31 (6.2%) COFAS 3 and 89 (17.7%) COFAS type 4. 38 patients (7.6%) presented with inflammatory arthritis. 99 (19.7%) implantations utilised patient specific instrumentation. Complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts and/or subsidence. Results. The mean follow up was 34.2 months (range 24–64). 15 patients have died, 8 withdrawn and 3 lost to follow up. 8 implants (1.6%) have been revised. According to the Glazebrook classification there were low grade complications in 6.6%, medium grade in 1.4% and high grade in 1.6%. There have been an additional 13 non revision re-operations (2.6%) at the latest follow up. There was a significant (p < 0.01) improvement across all functional outcome scores at a minimum of 2yr follow up. Discussion and conclusion. This large cohort has shown a low early revision rate and high functional outcomes with a low-profile fixed bearing prosthesis

Higher uric acid levels or hyperuricemia is a product of more uric acid production, dysfunctional renal excretion, or a combination of both leading to deposition of urate crystals in the joints and kidneys and has been strongly linked with the development of gout, that is, acute inflammatory arthritis. Uric acid levels have been suggested to depend on multiple factors including lifestyle, diet, alcohol consumption, etc. As these are risk parameters for hyperuricemia and since lifestyle choices vary amongst different Indian communities, we sought to study the prevalence of hyperuricemia in these communities. Also, large-scale data (in terms of gender, age, lifestyle, community) on the prevalence of hyperuricemia in subjects amongst different community populations, Hindu, Muslim, Sikh, and Christian was generated. In a retrospective study conducted at Dr. D. Y. Patil School of Medicine & Research Centre, Navi Mumbai from April 2018 to May 2021, information was gathered from four major communities on a range of indicators including serum uric acid levels followed by a thorough multilevel logistic analysis. We evaluated uric acid levels in 10,378 patients of four different communities. Outcomes were assessed biochemically as well as clinically based on the levels of serum uric acid. The mean serum uric acid levels were highest in Sikhs (7.6 mg%, n=732) followed by Christians (7.3 mg%, n=892) and then by Hindus (5.9 mg%, n=6846) and Muslims (5.6 mg%, n=1908). About 83.7% of Christians consumed meat in a non-vegetarian diet followed by 45.7% Muslims. Percentage of Christians who binge drink were highest whereas percentage of Sikh people in the heavy drinkers’ category were 5.2%. Further, 9.5% Hindus were current smokers followed by 7.8% Sikhs who smoked at present. Overall, our study of 10,378 patients demonstrated that the serum uric acid levels varied from one Indian community to another due to varying external factors like diet, age, lifestyle, and addictions. Thus, lifestyle modification in communities with higher serum uric acid levels is highly advocated and this may reduce the healthcare burden of gouty arthritis in these communities

Open debridement and Outerbridge and Kashiwagi debridement arthroplasty (OK procedure) are common surgical treatments for elbow arthritis. However, the literature contains little information on the long-term survivorship of these procedures. The purpose of this study was to determine the survivorship after elbow debridement techniques until conversion to total elbow arthroplasty and revision surgery. We performed a retrospective chart review of patients who underwent open elbow surgical debridement (open debridement, OK procedure) between 2000 and 2015. Patients were diagnosed with primary elbow osteoarthritis, post-traumatic arthritis, or inflammatory arthritis. A total of 320 patients had primary surgery including open debridement (n=142) and OK procedure (n=178), and of these 33 patients required a secondary revision surgery (open debridement, n=14 and OK procedure, n=19). The average follow-up time was 11.5 years (5.5 - 21.5 years). Survivorship was analyzed with Kaplan-Meier curves and Log Rank test. A Cox proportional hazards model was used assess the likelihood of conversion to total elbow arthroplasty or revision surgery while adjusting for covariates (age, gender, diagnosis). Significance was set p<0.05. Kaplan-Meier survival curves showed open debridement was 100.00% at 1 year, 99.25% at 5 years, and 98.49% at 10 years and for OK procedure 100.00% at 1 year, 98.80% at 5 years, 97.97% at 10 years (p=0.87) for conversion to total elbow arthroplasty. There was no difference in survivorship between procedures after adjusting for significant covariates with the cox proportional hazard model. The rate of revision for open debridement and OK procedure was similar at 11.31% rand 11.48% after 10 years respectively. There were higher rates of revision surgery in patients with open debridement (hazard ratio, 4.84 CI 1.29 – 18.17, p = 0.019) compared to OK procedure after adjusting for covariates. We also performed a stratified analysis with radiographic severity as an effect modifier and showed grade 3 arthritis did better with the OK procedure compared to open debridement for survivorship until revision surgery (p=0.05). However, this difference was not found for grade 1 or grade 2 arthritis. This may suggest that performing the OK procedure for more severe grade 3 arthritis could decrease reoperation rates. Further investigations are needed to better understand the indications for each surgical technique. This study is the largest cohort of open debridement and OK procedure with long term follow-up. We showed that open elbow debridement and the OK procedure have excellent survivorship until conversion to total elbow arthroplasty and are viable options in the treatment of primary elbow osteoarthritis and post traumatic cases. The OK procedure also has lower rates of revision surgery than open debridement, especially with more severe radiographic arthritis

Open debridement and Outerbridge and Kashiwagi debridement arthroplasty (OK procedure) are common surgical treatments for elbow arthritis. However, the literature contains little information on the long-term survivorship of these procedures. The purpose of this study was to determine the survivorship after elbow debridement techniques until conversion to total elbow arthroplasty and revision surgery. We performed a retrospective chart review of patients who underwent open elbow surgical debridement (open debridement, OK procedure) between 2000 and 2015. Patients were diagnosed with primary elbow osteoarthritis, post-traumatic arthritis, or inflammatory arthritis. A total of 320 patients had primary surgery including open debridement (n=142) and OK procedure (n=178), and of these 33 patients required a secondary revision surgery (open debridement, n=14 and OK procedure, n=19). The average follow-up time was 11.5 years (5.5 - 21.5 years). Survivorship was analyzed with Kaplan-Meier curves and Log Rank test. A Cox proportional hazards model was used assess the likelihood of conversion to total elbow arthroplasty or revision surgery while adjusting for covariates (age, gender, diagnosis). Significance was set p<0.05. Kaplan-Meier survival curves showed open debridement was 100.00% at 1 year, 99.25% at 5 years, and 98.49% at 10 years and for OK procedure 100.00% at 1 year, 98.80% at 5 years, 97.97% at 10 years (p=0.87) for conversion to total elbow arthroplasty. There was no difference in survivorship between procedures after adjusting for significant covariates with the cox proportional hazard model. The rate of revision for open debridement and OK procedure was similar at 11.31% rand 11.48% after 10 years respectively. There were higher rates of revision surgery in patients with open debridement (hazard ratio, 4.84 CI 1.29 - 18.17, p = 0.019) compared to OK procedure after adjusting for covariates. We also performed a stratified analysis with radiographic severity as an effect modifier and showed grade 3 arthritis did better with the OK procedure compared to open debridement for survivorship until revision surgery (p=0.05). However, this difference was not found for grade 1 or grade 2 arthritis. This may suggest that performing the OK procedure for more severe grade 3 arthritis could decrease reoperation rates. Further investigations are needed to better understand the indications for each surgical technique. This study is the largest cohort of open debridement and OK procedure with long term follow-up. We showed that open elbow debridement and the OK procedure have excellent survivorship until conversion to total elbow arthroplasty and are viable options in the treatment of primary elbow osteoarthritis and post traumatic cases. The OK procedure also has lower rates of revision surgery than open debridement, especially with more severe radiographic arthritis

Cementless stem designs in total hip arthroplasty differ in relation to geometry and area of fixation. We utilised radiostereometric analysis (RSA) to evaluate the 2-year migration of a novel, short, proximally coated femoral stem. 30 participants undergoing primary total hip replacement for any cause (rheumatoid or inflammatory arthritis, osteoarthritis) were prospectively recruited in this study. Osteoporotic patients and cases of suspected infection were excluded. All patients received a short blade stem, proximally coated with a reduced lateral shoulder and narrow triple taper geometry to minimise bone removal. RSA radiographs were performed post-operatively and at 6 weeks, 6 months, 1- and 2 years. The Harris Hip Score (HHS), Oxford Hip Score (OHS) and EQ-5D were collected at baseline and at 2 years post-operatively. The stability of implants and complications were captured during each follow-up visit. A total of 14 female and 16 male patients were recruited with a mean age of 64.8 (range 47 to 75). At two years the mean subsidence of the stem was 0.34 mm (SD 0.62) and the total migration 0.74 mm (SD 0.60). The mean medial translation at two years was 0.059 (0.24) and the mean anterior translation 0.12 (0.59) respectively. Baseline PROM scores improved significantly at 2-years from pre-operatively (median and interquartile range): HHS from 33 (18.25) to 92 (19), EQ5D from 0.5 (0.35) to 0.94 (0.17), OHS from 21 (18.25) to 42 (4.25). P-value for all comparisons was <0.001. 2-year follow up data revealed no complications. There were no stem revisions in study participants and no heterotopic ossifications were identified on radiographs. 2-year migration results of a cementless, short blade, proximally coated tapered femoral stem using RSA, showed the stem exhibits a predictable migration pattern and achieves initial stability. This is highly likely to translate to mid and long-term stability, which needs to be corroborated by long-term outcome studies. Furthermore, participants demonstrated excellent clinical, patient reported and radiological outcomes after 2 years of follow up to support expansion in the use of this prosthesis

Introduction: etiology of late infection after arthroplasty can be difficult to establish. Histology is the gold standard for infection in patients without inflammatory arthritis but diagnosis in inflammatory arthritis depends on culture (Atkins et al). Real-time PCR offers a rapid and direct assessment for staphylococci and enterococci infection but has not been widely assessed. The aims of this study were. to develop the Roche lightcycler Staphylococcal and Enterococcal PCR kits to facilitate diagnosis of hip and knee prosthetic infections. To analyse results together with bacteriological and histological findings. Methods: uplicate, multiple tissue samples were taken (with separate sterile instruments) at the 1. st. stage of revision after informed consent. One set were cultured and results interpreted by the Oxford criteria. The second set were extracted using the Qiagen DNA kit, purified (in-house method) and tested using the Roche lightcycler kits. Results:53 patients undergoing 2 stage revision for suspected infection were recruited.15 (28.3%) had negative histology and no inflammatory arthritis; 3 with single positive cultures and negative PCR – considered contaminants. 29 patients had non-inflammatory arthritis. 14/18 (77.8%) with positive cultures had staphylococci +/or enterococci isolated and 10 PCR results correlated. The other 11 patients had negative cultures. 9 patients had inflammatory arthritis. Six were culture negative and of the other three, 2 were positive for staphylococci on culture with 1 positive by PCR. Discussion: Negative staphylococcal PCR correlates with the isolation of staphylococci from only one sample. This agrees with the Oxford criteria that such samples may be considered contaminants. Additional positives detected by staphylococcal PCR alone are rare. Enterococcal PCR confirmed culture positivity in 2/3 patients. An additional 5 positive PCR’s were obtained from patients’ culture negative for enterococci. It is not clear if these are false positives or more sensitive detection of enterococcal isolation

Study Objective: To determine the proportion of patients proceeding to elective total knee arthroplasty with pre-operative anaemia. Background: Over 60,000 primary total knee replacements are performed in England and Wales each year. Blood transfusion can be associated with serious complications. A pre-operative haemoglobin of less than 12 g/dl increases the likelihood of blood transfusion in the peri-operative period by threefold [. 1. ]. Published BOA guidelines recommend patients with pre-operative haemoglobins of 12 g/dl or below in males or 11 g/dl or below in females should have their anaemia investigated and treated prior to total knee arthroplasty. Methods: Patients having elective total knee arthroplasty at our hospital over three-months formed the study population. Data were collected on age, sex, pre- and postoperative haemoglobin, transfusion requirements in the peri-operative period, and whether the patient had inflammatory arthritis. Patients were classified according to the recommended BOA guidelines for deferring elective surgery using pre-operative haemoglobin levels. Post-operative haemoglobin drop was also calculated. Results: Fifteen patients (7%) out of 212 had pre-operative haemoglobins below guideline thresholds. The age range of these patients was 59–84 yr. Nine patients were female. Pre-operative haemoglobin ranged from 9.2–12.0 g/dl. Post-operative haemoglobin drop ranged from 0.5–4.3 g/dl. Six patients received blood transfusion in the peri-operative period (maximum of three units). One patient had a diagnosis of inflammatory arthritis. Discussion: Pre-operative anaemia is common in patients having elective total knee arthroplasty. In this study most anaemic patients did not have anaemias attributable to inflammatory arthritis. Using cell salvage techniques did not prevent peri-operative blood transfusion in anaemic patients. Conclusion: Anaemic patients wanting arthroplasty in favour of surgical deferral and treatment of their anaemia must be made fully aware of the serious complications associated with blood transfusions