Abstract. Background. Oxidized zirconium (OxZr) has been introduced as an alternative bearing for femoral components in Total Knee Arthroplasty (TKA). It has a ceramic-like zirconium oxide outer layer with a low coefficient of friction. Early studies have found OxZr TKA to have a low incidence of early failure in young high demand patients. Currently no study has reported on the outcome of these implants beyond ten years. Objectives. The purpose of our study was to present an in-depth 15-year survival analysis of cemented Profix II OxZr TKA. Study Design & Methods. Data was collected prospectively and survival analysis undertaken with multiple strict end points. Complication rates were recorded and patient reported outcomes were measured. Results. 617 Profix II OxZr TKAs were performed over four years. Forty-nine patients underwent reoperation. Aseptic tibial loosening was the most common cause of failure (32.7%) on average occurring 2.8 years post primary procedure. There was one recorded failure due to loosening of the zirconium femoral component. Revision rate at 15-years was 6.38%. Cumulative survivorship was 91.52% with failure considered to be reoperation for any reason. WOMAC score improved in 86% of patients by year 1. The average score improved by 21.2 points and met the standard for minimum clinically important difference. Conclusions. This study presents the first 15-year survival analysis of cemented Profix II OxZr TKA. Our data supports current literature on the long-term survivorship of oxidised zirconium total knee replacements

Unicompartmental knee osteoarthritis can be treated with either Total Knee Arthroplasty (TKA) or Unicompartmental Knee Arthroplasty (UKA) and controversy remains as to which treatment is best. UKA has been reported to offer a variety of advantages, however many still see it as a temporary procedure with higher revision rates. We aimed to clarify the role of UKA and evaluate the long-term and revision outcomes. We retrospectively reviewed the pain, function and total Knee Society Score (KSS) for 602 UKA and 602 TKA in age and gender matched patients over ten years. The total pre-operative KSS scores were not significantly different between UKA and TKA (42.67 vs 40.54 P=0.021). KSS (pain) was significantly better in the TKA group (44.39 vs 41.38 P= 0.007) at one year and at five years post-operatively (45.33 vs 43.12 P=0.004). There was no statistically significant difference for KSS (total) in TKA and UKA during the study period. 16.3% of UKA and 20.1% of TKA had a documented complication. 79 UKA (13%) and 36 TKA (6%) required revision surgery. Despite the higher revision rate, pre-operative KSS (total) before revision was not significantly different between UKA and TKA (42.94 vs 42.43 P=0.84). Performance for UKAs was inferior to TKAs in Kaplan-Meier cumulative survival analysis at 10 years (P<0.001). Both UKA and TKA are viable treatment options for unicompartmental knee osteoarthritis, each with their own merits. UKA is associated with fewer complications whereas TKA provides better initial pain relief and is more durable and less likely to require revision

Background: Publications concerning recurrent disc disease quote percentage recurrence without regard to the times of recurrence and the influence of longer follow-up. Objective: To assess the use of survival analysis to measure revision rate after lumbar microdiscectomy. Design: A retrospective analysis of the hospital records of all patients undergoing lumbar microdiscectomy over a nine-year period was undertaken. Patients who had a repeat microdiscectomy at the same level as the index procedure were designated ‘revisions’. The overall revision rate was calculated for the average length of follow-up. A survival analysis was then carried out using the life table method, as described by Murray et al for follow-up of hip arthroplasty. Subjects: Seven hundred and twenty-nine patients underwent primary microdiscectomy during this time period, average age 40 years. Results: Twenty-seven patients had a revision microdiscectomy during the study period. This gave an overall revision rate of 3.7% at average follow up of five years, one month. Using survival analysis the revision rate was 5.5% at eight years of follow up, number at risk 51. Conclusions: Survival analysis gives a more accurate estimation of the true recurrence rate for patients undergoing lumbar microdiscectomy. The method would allow better comparison between different interventions for intervertebral disc herniation

Arthroscopy of ankle is becoming a common procedure for the diagnosis and treatment of ankle pain. Little information exists regarding the long term prognosis following ankle arthroscopy, particularly in avoiding further major surgery. The purpose of this study is to evaluate the prognosis of arthroscopic ankle treatment, based on survival analysis. Also we will formalise the relationship between the arthroscopic treatment and time for a further major ankle surgery. Type of study. Consecutive Case Series study using prospectively gathered data. Methods. Eighty consecutive patients (80 ankles) having ankle arthroscopy (between 1998 and 2000) with the finding of OA or impingement were identified and their outcome at five years ascertained. Results. Fifty-five (69%) patients had soft tissue impingement, and 25 (31%) patients had osteoarthritic degenerative changes. Seven (9%) patients had further major surgery (arthrodesis or arthroplasty) and 6 (8%) had repeat arthroscopy. The surgery was required for 7 arthritic ankles within five years of arthroscopic procedure. Survival analysis showed no statistical significance between those under 50 and those over 50 years in the OA group. Seven (28%) of osteoarthritic patients progress to major ankle surgery, within 5 years of arthroscopic treatment. None of the patients with impingement symptoms required further major surgery. Conclusion. Arthroscopically treated impingement ankles have an excellent prognosis, while osteoarthritic ankles have a less favoured prognosis, with a high proportion requiring further major surgery. Age does not affect prognosis in the OA group

Objective: The purpose of this study is to evaluate the prognosis of arthroscopic ankle treatment. Also we will formalise the relationship between the arthroscopic treatment and time for a further major ankle surgery. Patients and Methods: Consecutive Case Series study using prospectively gathered database. Between January 1997 to December 2000, Eighty consecutive patients (80 ankles) having ankle arthroscopy with the finding of Osteoarthritis (OA) or impingement were identified and their outcome at five years ascertained. Arthroscopic procedure involved pre operative skin markings. Ankle distraction is used. An anterior approach used with standard Anteromedial and antero-lateral portals. Treatment: debridement of osteochondral lesions, removal of loose bodies, curettage, drilling, synovec-tomy, and abrasion of the subchondral bone. All ankle joints had wash out. Results: Results were examined using Kaplan Meier survival analysis. Statistical analysis of the results was done using Chi squared test. Fifty five (69%) patients had soft tissue impingement, and 25 (31%) patients had osteoarthritic degenerative changes. Seven (9%) patients had further major surgery and 6 (8%) had repeat arthroscopy. The surgery was required for 7 arthritic ankles (7/25). Survivorship: Survival analysis. 28% of osteoarthritic patients progress to major ankle surgery, within 5 years of arthroscopic treatment. None of patients with impingement symptoms required further major surgery. No statistical significance between those under 50 and those over 50 years in OA group. Conclusion: Arthroscopically treated impingement Ankles has an excellent prognosis, while osteoarthritic ankles have less favoured prognosis, with high proportion requiring further major surgery. Age does not affect prognosis in O.A group. Arthroscopy for OA, is likely to fail within 18 months

Introduction: Osteogenic Sarcoma is one of the most common malignant bone tumors in the younger population. The advances in chemotherapy in conjunction with surgery has improved the survival rates from less than 20% in 1970s to more than 70% in 1990s. Advanced imaging, better histopathological techniques, availability of bone banks and newer chemotherapeutic agents have made limb salvage surgery a viable option even in advanced stages of the disease. We reviewed the outcome and analysed the complications of patients with Osteogenic Sarcoma at our institution. Materials and methods: The objective of our study was to evaluate our experience with the treatment of osteogenic sarcoma and to do a survival analysis. It was a retrospective study consisting of 20 patients who were treated between 1990–1998. Mean age was 17 years with equal distribution of males and females. Of all the patients, 18 had stage II b disease and 2 patients had stage III disease. The quetionnaire focused on the initial mode of presentation of the patients, their stage of disease, the type of neo-adjuvent chemotherapy used and the type of surgery they underwent. Results: Majority of the patients presented at least six months after the onset of symptoms with pain and swelling being the most common modes of presentation. Majority of our patients had open biopsies done outside our hospital and received non-uniform neo-adjuvant chemotherapy. Distal femur was involved in 60% of the cases followed by proximal and distal tibia. Limb salvage surgery was performed in 90% of the cases, while the rest had primary amputation due to the extent of the disease. Autoclaved bone, allografts, free fibular grafts and custom made prostheses were used to reconstruct the intercalary defects left by the resection of the tumor. Polyuria was our main early post operative complication followed by wound infection. Only one patient had a local recurrence and 7/20 had distant metastasis in our follow-up (mean 2.5 years). Mortality rate was 25% in our study. Conclusion: Limb salvage surgery was performed quite successfully with only one local recurrence in all of our patients with stage II b disease. Most of our patients who developed late distant metastasis had a non-uniform and uncontrolled chemotherapy protocol which could have adversely affected our final outcome

Aims: In this study, data from previously published survival analysis life tables of primary total condylar type TKRs has been combined to enable comparison of different design features. In particular, does posterior stabilisation or metal backing of the tibial component improve the longevity of primary cemented þxed bearing condylar type TKRs?Methods: To be included, the article had to give 5 or more years results of a primary cemented þxed bearing condylar type TKRs including a survival analysis life table. Series performed on a selected patient group (for example young age, elderly or rheumatoid arthritis) were excluded to reduce possible bias. When 2 series of the same implant from the same institution were available, the most recent article with the longest follow up was used. Results: Survival analysis data from 16 papers (5950 knees) was combined to compare design features. There was no difference in survival between posterior stabilised implants and those that were not or between metal-backed and all-polyethylene tibial components. Those all-polyethylene tibial components that were not stabilised had signiþcantly better survival than metal-backed, non stabilised tibial components and posterior stabilised, metalbacked components (p< 0.05) but not posterior stabilised, all-polyethylene components. Conclusions: Using the currently available literature, posterior stabilisation or metal backing of the tibial component does not improve the longevity of primary cemented þxed bearing condylar type TKRs

Objectives. To examine patient mortality, implant survivorship, and complication profiles of proximal femoral replacement (PFR) as compared to revision total hip arthroplasty (REV) or open reduction internal fixation (ORIF) in the treatment of acute periprosthetic fractures of the proximal femur. Methods. We performed a retrospective controlled chart review at our tertiary center from from 2000–2010, identifying 97 consecutive acute periprosthetic proximal femoral fractures. Patients were stratified into three treatment groups: PFR (n=21), REV (n=19), and ORIF (n=57). Primary outcome measures included death, implant failure, and reoperation. We also recorded patient demographics, medical comorbidities, fracture type, treatment duration, time to treatment, and complication profiles. Statistical analyis included competing risks survival, which allows independent survival analysis of competing failure mechanisms such as death and implant failure. Results. Competing Risks survival analysis of overall mortality during the mean 35-month follow-up showed no difference between the three groups (p=0.65; 12 and 60 month mortality for PFR: 37%, 45%; REV: 16%, 46%; ORIF: 14%, 100%). Implant survival was worse for the PFR group (p=0.03, 12 and 60-month implant failure rate for PFR: 5%, 39%; REV: 93%, 93%; ORIF 98%, 98%). Comparing PFR to REV and ORIF, PFR had a trend towards higher dislocation (19% vs. 5% vs. 4%, p=0.06). There was no difference between groups with regard to summary non-death complications including DVT, infection, dislocation, and other measures (30% vs. 40% vs. 34%, p=0.80). Operative times were not different between groups (172 min. vs. 162 min. vs. 168 min, p=0.92). Conclusions. In treating difficult periprosthetic fractures, PFR as compared with REV or ORIF has worse medium-term implant survival, primarily due to instability and dislocation. The groups had similar perioperative complication rates, similar short and long term mortality, and similar operative times

Introduction. Reverse hybrid total hip replacement (THR) offers significant theoretical benefits but is uncommonly used. Our primary objective was to evaluate implant survival with all cause revision and revision for aseptic loosening of either component as endpoints. Patients/Materials & Methods. Data was collected prospectively on 1, 088 (988 patients) consecutive reverse hybrid THRs. Mean patient age was 69.3 years (range, 21–94) and mean follow-up was 8.2 years (range, 5–11.3). No patients were lost to follow-up. Overall, 194 (17.8%) procedures were performed in patients under 60 years, 666 (61.1%) were performed in female patients and 349 (32.1%) were performed by a trainee. Acetabular components were ultra-high molecular weight polyethylene in 415 (38.1%) hips, highly cross-linked polyethylene in 669 (61.5%) hips and vitamin E stabilised polyethylene in 4 (0.4%) hips. Femoral stems were collared in 757 (69.7%) hips and collarless in 331 (30.3%) hips. Femoral head sizes were 28 mm in 957 (87.9%) hips and 32 mm in 131 (12.1%) hips. Survival analysis was performed using Kaplan Meier methodology. Log rank tests were used to asses differences in survival by age, gender, head size and surgeon grade. Results. Ten-year implant survival (122 hips at risk) was 97.2% (95% CI 95.8–98.1%) for all cause revision (Figure 1), 100% for aseptic acetabular loosening and 99.6% (95% CI 99.0–99.9%) for aseptic stem loosening (Figure 2). There was no difference in implant survival by age (p = 0.39), gender (p = 0.68), head size (p = 0.76) or surgeon grade (p = 0.20) for all cause revision. There was no difference in survival by gender (p = 0.12), head size (p = 0.38) or surgeon grade (p = 0.76) for stem revision. Four (0.4%) stems failed at mean 2.5 years (range, 0.6–4.8) because they were undersized. These were associated with patient age under 60 years (p = 0.015). Discussion. This is the largest reported study on the outcomes of reverse hybrid THR in a consecutive series of patients at medium to long term follow-up. Cemented acetabular components are less costly than uncemented cups and offer other significant benefits such as improved fixation in osteoporotic or pathological bone, reduced risk of intraoperative periprosthetic fracture, easier revision and local antibiotic delivery which can reduce deep infection rates. Advantages of uncemented stems over cemented stems include biological fixation, shorter operating times, fewer adverse pulmonary events and reduced proximal stress shielding. Our results indicate high implant survival rates at ten-year follow-up with low rates of aseptic loosening (0.4%). Meticulous surgical technique is required to avoid stem undersizing which may lead to early failure particularly in younger patients. Conclusion. This study confirms that reverse hybrid THR offers highly successful outcomes, irrespective of age, gender, head size and surgeon grade. For any figures and tables, please contact the authors directly

Introduction: Unicompartmental osteoarticular defects of the knee are challenging due to demands of stability and function of this weight-bearing joint. Prostheses reconstruction often requires sacrificing the uninvolved compartment. Osteoarticular allograft reconstruction can restore the anatomy, and allows reattaching soft tissue structures such as meniscus and ligaments from the host. The purpose of this study was to perform a survival analysis of unicompartimental osteoarticular allografts of the knee and evaluate their complications. Material and Methods: Forty unicompartmental osteo-articular allograft of the knee performed in 38 patients during the period 1962–2001, were followed for a mean of 11 years. In 36 patients, the bone defect was created by the resection of a tumor (33 giant cell tumors, 1 osteogenic sarcoma, 1 chondrosarcoma and 1 malignant fibrous histiocytoma) and in the remaining two by an open fracture. Twenty nine transplants were located at the femur that includes 11 medial and 18 lateral condyles. Eleven transplants were located at the tibia, including 4 medial and 7 lateral tibial plateaus. According to the reconstructed compartment, host meniscus and ligaments were reattached to the graft. Rigid internal fixation with plates and screws were used in each patient. Allografts survival from the date of implantation to the date of revision or the time of the latest follow-up was determined with the use of the Kaplan-Meier method. Complications as local recurrence, fracture, articular collapse and infection were analyzed. Results: The global rate of allograft survival was 85% at five years. There were 8 complications in 6 patients: 2 local recurrences, 2 infections, 1 fracture, 1 massive resorption and 2 articular collapses. In 6 patients the allograft was removed and they were considered as failures. All these patients required a second allograft that included 2 unicompartmental and 4 bicompartimental reconstructions. The two patients with articular collapses required a regular total knee resurfacing prosthesis. Discussion: Although the incidence of reoperations due to allograft complications may be high, the allograft survivor rate at five years was 85%. Unicondylar allografts, appear to be an alternative in those situations in which the massive osteoarticular bone loss to be reconstructed, is limited to one knee compartment

Introduction. In the early 2000s hip resurfacing became an established bone conserving hip arthroplasty option particularly for the fit and active patient cohort. The performance of second-generation metal-on-metal bearings had led to the reintroduction of hip resurfacing. The Birmingham Hip resurfacing (BHR) was introduced in 1997. This was followed by a number of different designs of the hip resurfacing. The Durom hip resurfacing was introduced in 2001. These two designs had different metallurgical properties, design parameters particularly clearance and different implantation techniques. Data from joint registries show that both prosthesis perform well. Objectives. Our objective was to perform a retrospective survival analysis comparing the Birmingham to the Durom hip resurfacing and analyse the mode of failures of the cases revised. Methods. Data was collected prospectively but analysed retrospectively. The two cohorts comprised patients treated by two senior surgeons at different units. The follow up range was 1 to 14 years with a mean of 10 years. The end-point was revision for any cause. However this was further substratified. Results. The outcome of all patients was known. The two cohorts exhibited no significant difference in demographics. No failures in either cohort were attributed to adverse reaction to metal debris. Revision for any cause was analysed by plotting Kaplan-Meier Survival curves. The Durom cohort (n=273) had 5 deaths and 9 revisions. The Birmingham cohort (n=567) had 5 deaths and 22 revisions. The Kaplan-Meier survival curves for the two resurfacing designs were different. The Durom cohort demonstrated a concave curve with more early failures. This was contrary to the BHR's convex curve with higher incidence of late failures. We analysed the data by substratifying into failure of femoral or acetabular component and neck fractures. Conclusions. The Kaplan-Meier survival analysis demonstrates that the Durom hip resurfacings had a higher rate of early failure. However extrapolation of the curves suggests that the Durom may have a superior long term survival compared to the BHR. We postulate that this may be due to the femoral implantation technique with less late failures in Duroms and an apparent acceleration of failures in BHR cohort around the ten year stage. Joint registry data also reflect this pattern

Introduction

Both mobile bearing and fixed bearing unicompartmental knee arthroplasty (UKA) have demonstrated clinical success. However, much debate persists about the superiority of a single design. Currently most clinical data is based on high volume centers data, however to reduce bias, we undertook a through review of retrospective national joint registries. In this study, we aim to investigate UKA implant utilization and survivorship between 2000 and 2018.

Aims: Analyze the long-term survival of cementless meniscal bearing total knee arthroplasty (TKA). Methods: Two hundred and thirty-two consecutive cementless primary meniscal bearing Low Contact Stress TKA were performed on 203 patients in our institution from November 1988 to June 1996. The diagnosis was osteoarthritis in 192 knees (83%) and rheumatoid arthritis in 40 cases (17%). Mean age at surgery was 66.5 years (range:16–90). Cruciate retaining prosthesis was implanted in 81% and a cruciate sacrificing prosthesis in 19%. Twenty patients died and ten patients (4,3%) were lost to follow-up. The remaining 202 knees (87%) had an average follow-up of 116.7 months (range:70–165). Survival analysis was done using as end point revision surgery or recommended revision. Results: Twenty-six TKAs (11.2%) required revision: infection (3), patelar failure (2), tibial/femoral loosening (2) and polyethylene failure (19). Age, gender, diagnosis and sacrificing cruciate ligaments were not related with prosthesis failure (p> 0.05). The Kaplan-Meier survival analysis showed a mean of 155 months (95%CI:150–159). The life table survival estimate at 10 years was 90.4% (85–95). The cumulative survival rate for patellar failure was 99% (98–100), for mechanical loosening 99% (98–100) and 91.3% (87–96) for polyethylene failure. The Log Rank Test was significant for poliethylene failure (p=0.0005). Conclusions: In our experience overall long-term survival of cementless meniscal bearing TKAwas acceptable. Mobile bearing knee prosthesis satisfactorily resolved problems related with patellar failure or tibial/femoral loosening. Polyethylene failure continues to be the main problem in long-term survival of knee prosthesis

The purpose of this study was to establish the long-term clinical outcome of the Oxford Medial Unicompartmental Knee Arthroplasty (UKA). Methods: A continuous series of 420 patients underwent medial Oxford UKA. Indications were anteromedial osteoarthritis with full thickness lateral compartment cartilage, a functioning anterior cruciate ligament and correctable varus deformity. Survival analysis with all cause revision as the endpoint was carried out for the entire group. At the time of this study 121 were still alive at 10 years and pre/post-operative 10-year clinical data had been prospectively recorded for them from which the AKS and HSS scores were calculated. Results: Seventeen patients required revision (4%) and the fifteen year survival rate was 94.3% (95% CI 85.6 - 100%). At ten years AKS and HSS scores were: AKSS (Knee) pre 30 / post 90, AKSS (Function): pre 42/ post 69 and HSS pre 56/ post 86. The differences were statistically significant (p< 0.01). Discussion and Conclusion: We conclude that providing careful patient selection is maintained, meniscal bearing medial unicompartmental knee arthroplasty has clinical and survival results comparable to modern total knee arthroplasty. The advantages of lower morbidity and earlier return to function, enhanced by the introduction of minimally invasive techniques may make this the treatment of choice for suitable patients with anteromedial osteoarthritis of the knee

Purpose: The purpose of this study was to report the mid-term survival results of Oxford UKAs in patients of 50 years of age or less, using (1) revision surgery and (2) Oxford Knee Scores (OKS) as outcome measures. Method: A literature review identified studies of Oxford mobile bearing UKAs containing individuals 1) 50 years old or less with 2) medial osteoarthritis and 3) 2 years or longer follow-up. Authors were approached to participate in a multi-centre survival analysis by submitting all their patients, 50 years of age or less, who received a medial UKA for osteoarthritis. Patients who had died, been lost to follow-up or who underwent revision were identified. OKS were established for all patients with surviving implants. Results: Seven centres submitted 107 patients. The mean age was 47 years (range 32–50). The average follow-up was 4 years (range 1–25). Forty-seven patients had follow-up into their fifth year or longer. The cumulative 7-year survival using revision as the endpoint was 96% (CI 8). The mean post-operative OKS for surviving implants was 38 (CI 2) out of a possible 48. Conclusion: While early survival rates and function are encouraging, long-term follow-up is required before concluding UKA is a viable treatment option in young patients with unicompartmental knee arthritis

Introduction. We have carried out a 15 year survival analysis of a prospective, randomised trial comparing cemented with cementless fixation of press-fit condylar primary total knee replacements. Methods. A consecutive series of 501 PFC knee replacements received either cemented (219 patients, 277 implants) or cementless (177 patients, 224 implants) fixation. No patients were lost to follow up. Revision was defined as further surgery, irrespective of indication, that involved replacement of any of the three originally inserted components (Femur, Tibia, Patella). Results. Altogether 44 patients underwent revision surgery (24 cemented group Vs 20 cementless group). 11 cases were revised secondary to infection (7 cemented, 4 cementless, mean time to revision=5.1 years) and 26 were revised due to aseptic loosening (14 cemented, 12 cementless, mean time to revision=9.2 years). 7 cases were revised for other reasons (Instability, Anterior knee pain, polyethylene wear, patellar malallignment). For cemented knees 15-year survival=80.7% (95%CI, 71.5-87.4), 10-year survival=91.7 (95%CI, 87.1-94.8). For cemented knees 15-year survival=75.3% (95% CI, 63.5-84.3), 10-year survival=93.3% (95%CI, 88.4-96.2). When comparing the covariates (operation, sex, age, diagnosis, side), there was no significant difference between operation type (Hazard ratio=0.83 (95%CI, 0.45-1.52) p=0.545), side of operation (HR=0.58 (95%CI, 0.32-1.05) p=0.072), age (HR=0.97 (95%CI, 0.93-1.01) p=0.097), diagnosis (OA vs non OA, (HR=1.25 (95%CI, 0.38-4.12) p=0.718). However, there was a significant gender difference (Males vs Females, HR=2.48 (95%CI, 1.34-4.61) p=0.004). Conclusion. This single surgeon series, with no loss to follow up, provides reliable data of the revision rates of the most commonly used total knee replacement. The survival of the press-fit condylar total knee replacement remains good at 15 years irrespective of the method of fixation. This information is useful for strategic health authorities when establishing future requirements for revision knee surgery

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

Results in patients undergoing total hip arthroplasty (THA) for femoral head osteonecrosis (ON) when compared with primary osteoarthritis (OA) are controversial. Different factors like age, THA type or surgical technique may affect outcome. We hypothesized that patients with ON had an increased revision rate compared with OA. We analysed clinical outcome, estimated the survival rate for revision surgery, and their possible risk factors, in two groups of patients.

In this retrospective cohort analysis of our prospective database, we assessed 2464 primary THAs implanted between 1989 and 2017. Patients with OA were included in group 1, 2090 hips; and patients with ON in group 2, 374 hips. In group 2 there were more men (p<0.001), patients younger than 60 years old (p<0.001) and with greater physical activity (p<0.001). Patients with lumbar OA (p<0.001) and a radiological acetabular shape type B according to Dorr (p<0.001) were more frequent in group 1. Clinical outcome was assessed according to the Harris Hip Score and radiological analysis included postoperative acetabular and femoral component position and hip reconstruction. Kaplan-Meier survivorship analysis was used to estimate the cumulative probability of not having revision surgery for different reasons. Univariate and multivariate Cox regression models were used to assess risk factors for revision surgery.

Clinical improvement was better in the ON at all intervals. There were 90 hips revised, 68 due to loosening or wear, 52 (2.5%) in group 1, and 16 (4.3%) in group 2. Overall, the survival rate for revision surgery for any cause at 22 years was 88.0 % (95% CI, 82-94) in group 1 and 84.1% (95% CI, 69 – 99) in group 2 (p=0.019). Multivariate regression analysis showed that hips with conventional polyethylene (PE), compared with highly-cross linked PEs or ceramic-on-ceramic bearings, (p=0.01, Hazard Ratio (HR): 2.12, 95% CI 1.15-3.92), and cups outside the Lewinnek´s safe zone had a higher risk for revision surgery (p<0.001, HR: 2.57, 95% CI 1.69-3.91).

Modern highly-cross linked PEs and ceramic-on-ceramic bearings use, and a proper surgical technique improved revision rate in patients undergoing THA due to ON compared with OA.

We aim to describe mortality in orthopaedic patients with Clostridium difficile associated diarrhoea (CDAD), to identify prognostic factors for 30 day mortality, and to modify a CDAD risk score to fit to orthopaedic patients.

This was a two centre, retrospective, observational study including consecutive patients with a first episode of CDAD between 2005–2007. 79 patients were identified, comprising 11 elective patients (14%) and 68 emergency patients (86%). 73 patients (92%) underwent surgery and all but two patients received broad spectrum antibiotics prior to CDAD. The overall 30 day mortality was 29% (n=26). The predominant diagnosis was a fractured femoral neck (66%, n=52).

The most significant multivariable model in predicting 30 day mortality comprised increasing white cell count (WCC, OR 1.20 [for 10% variable increase]; 95% CI 1.06–1.36 p=0.003) and decreasing albumin (OR 0.86 [for single unit decrease]; 0.86–0.95, p=0.003), with adjustment for age ł80 years (OR 6.39, 1.15–35.52, p=0.04). CRP was found to be not significant. Based on this, modification of the previously described Clostridium difficile prognostic index leads to a point awarded for WCC ł20, albumin Ł20, age ł80, urea ł15 or clinically severe disease (peritonitis, sepsis, ł10 episodes of diarrhoea per day). This produces low (0–1 points), medium (2–3 points) and high (4–5 points) risk of death groups, with mortalities of 15%, 47% and 75% respectively for all orthopaedic patients, and 14%, 41% and 67% respectively in only the validation cohort.

CDAD in orthopaedic patients mainly affects emergency patients, in particular those with fractured femoral neck. Inpatient mortality is high, and a high white count and low albumin are significant predictors of mortality. Modification of an easily remembered scoring system based on this can help identify orthopaedic patients likely to die from an episode of CDAD, allowing early aggressive therapy and early objective referral to gastrointestinal teams.

Introduction

Hallux Rigidus affects 2–10% of population, usually treated with cheilectomy or arthrodesis, however, for the subclass of patients who refuse to undergo fusion, Arthroplasty is an alternative solution, it maintain some degree of motion and provide pain relief. Toefit; is one of the prostheses being used. It is a total joint replacement with polyethylene insert.

The aim of this study is to find clinical and radiological outcomes of Toefit arthroplasty.