Background. Cephalomedullary nails are widely used for fixation of unstable pertrochanteric fractures. In 2018, the Depuy Synthes Trochanteric Fixation Nail - Advanced (TFNA) implant was introduced at a level I academic trauma center. Thereafter, the TFNA swiftly replaced the older implant models used at the time. Subsequently, clinical concerns were raised about the use of the TFNA due to reports of nail breakage. The purpose of this study was to investigate whether the concerns raised about the performance of the TFNA were valid and to assess long-term outcomes. Methods. The data consisted of 2397 patients who had undergone a proximal femoral hip fracture procedure between 2014 and 2020. Data were handpicked from patient records. TFNA was compared with TFN, PFNA, Gamma3, and Intertan regarding nail breakage, breakage time and long-term outcomes. Results. After exclusion a total of 23/1667 (1.4%) nails broke during the follow-up period. The TFNA broke the most often with 15 cases (2.0%), followed by the Gamma3 with five cases (1.1 %) and the PFNA with three cases (1.3%). Overall, the mean (SD) nail breakage time was 233 (147.8) days. However, for the TFNA, PFNA, and Gamma3, the mean breakage times were 176.8 days (109.9), 419 days (108.6), and 291.8 (153.4), respectively. In cox regression analysis we observed significant reduction in nail breakage when using PFNA with adjusted hazard risk of 0.081 [95% Ci, 0.011-0.576, p=0.011]. Conclusions. In our data, the TFNA had a slightly higher risk for nail breakage when compared to the PFNA and the Gamma3, with a risk difference of 0.7% and 0.9%, respectively. On average, the TFNA broke nearly four months earlier than the Gamma3 and more than eight months earlier than the PFNA. It should be noted, however, that implant breakage is a relatively infrequent complication

We previously reported the five to ten-year results of the Birmingham Hip Resurfacing (BHR) implant. The purpose of this study was to evaluate the survivorship, radiographic results, and clinical outcomes of the BHR at long-term follow-up.

We retrospectively reviewed 250 patients from the original cohort of 324 BHRs performed from 2006 to 2013 who met contemporary BHR indications. Of these, 4 patients died and 4 withdrew. From the 242 patients, 224 patients (93%) were available for analysis. Modified Harris hip score (mHHS) and University of California, Los Angeles (UCLA) scores were collected and compared to a matched total hip arthroplasty (THA) cohort. Mean follow-up was 14 years.

Survivorship free of aseptic revision was 97.4% and survivorship free of any revision was 96.0% at 15 years. Revisions included 3 periprosthetic joint infections, 2 for elevated metal ions and symptomatic pseudotumor, 2 for aseptic femoral loosening, and 1 for unexplained pain. The mean mHHS was 93 in BHR patients at final follow-up, similar to the THA cohort (p=0.44). The UCLA score was significantly higher for BHR patients (p=0.02), however there were equal proportions of patients who remained highly active (UCLA 9 or 10) in both groups, 60.5% and 52.2% (p=0.45) for BHR and THA respectively. Metal ion levels at long term follow-up were low (mean serum cobalt 1.8±1.5 ppb and mean serum chromium 2.2±2.0 ppb).

BHR demonstrated excellent survivorship in males less than 60 years of age at time of surgery. Clinical outcomes and activity levels were similar to THA patients. Failures related to the metal-on-metal bearing were rare and metal levels were low at long-term follow-up.

Level of evidence: III

Keywords: survivorship; hip arthroplasty; activity; metal-on-metal

Surface Replacement Arthroplasty demonstrates low revision rates and similar activity level compared to total hip arthroplasty at long-term follow-up.

The relative advantages and disadvantages of two-stage versus one-stage management of infected total hip arthroplasties are the current subject of intense debate. To understand the merits of each approach detailed information on the short and, importantly, longer-term outcomes of each must be known. The purpose of this study was to assess the long-term results of two-stage exchange arthroplasty for THAs in one of the largest series to date.

We identified 331 infected THAs treated with a two-stage exchange arthroplasty between 1993 and 2021 at a single institution. Patients were excluded if they had prior treatment for infection. Mean age at reimplantation was 66 years, 38% were female, and mean BMI was 30 kg/m². PJI diagnosis was based on the 2011 MSIS criteria. A competing risk model accounting for death was utilized. Mean follow up was 8 years.

The cumulative incidence of reinfection was 7% at 1 year and 11% at 5 and 10 years. Factors predictive of reinfection included BMI>30 kg/m² (HR 2; p=0.049), and need for a spacer exchange (HR 3.2; p=0.006). The cumulative incidence of any revision was 13% at 5 and 10 years. The cumulative incidence of aseptic revision was 3% at 1 year, 7% at 5 years, and 8% at 10 years. Dislocation occurred in 33 hips (11% at 10 years; 45% required revision). Factors predictive of dislocation were female sex (HR 2; p=0.047) and BMI<30 kg/m² (HR 3; p=0.02). The mean HHS improved from 54 to 75 at 10 years.

In this series of 331 two-stage exchange arthroplasties performed for infected hips, we found a low aseptic revision rate (8%) and a low rate of reinfection (11%) at 10 years. These long-term mechanical and infection data must be kept in mind when considering a paradigm shift to one-stage exchanges.

Level of Evidence: Level III

Background

Iatrogenic hallux varus is a rare complication after hallux valgus surgery. Operative treatment comprises a wide variety of techniques, of which the reversed transfer of the abductor hallucis tendon is the most recent described technique.

Abstract

The use of rotating hinge (RH) prostheses for severe primary as well as revision arthroplasty is widely established. Aim of this study was to investigate long term results of a new RH prosthesis (EnduRo®, B Braun, Germany), which uses carbon-fiber reinforced poly-ether-ether-ketone (CFR PEEK) as a new bearing material, first time used in knee arthroplasty.

Fifty-six consecutive patients, who received the EnduRo® RH prosthesis were included in this prospective study: 21 patients (37.5%) received the prosthesis as a primary total knee arthroplasty (TKA) and 35 patients (62.5%) underwent revision total knee arthroplasties (rTKA). Clinical and radiographic examinations were performed preoperatively as well as postoperatively after 3 and 12 months and annually thereafter. Min. Follow up was 7 and mean follow up 9,3 years. Clinical examination included Knee Society Score (KSS), Western Ontario and McMaster Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), and range of motion (ROM). Competing risk analysis was assessed for survival with respect to indication and failure mode.

KSS, WOMAC, OKS, and ROM significantly improved from the preoperative to the follow up investigations (p < 0.0001). There was no difference in clinical outcome between the primary and the revision group. The overall cumulative incidence for revision for any reason was 23.6% and the cumulative incidence for complications associated with failure of the prothesis was 5.6% at 7 years, respectively. Complications occurred more frequently in the revision group (p = 0.002).

The evaluated RH prosthesis provided reliable and durable results with a minimum follow-up of 7 years. Prosthesis survival was successful considering the complexity of cases. The use of this RH system in primary patients showed high survival rates. Long-term functional and clinical results proved to be satisfying in both revision and primary cases. No adverse events were associated with the new bearing material CFR-PEEK.

Aim

Excision of chronic osteomyelitis (cOM) creates a dead space which must be managed to avoid early recurrence of infection. Systemic antimicrobials cannot penetrate this space in high concentration so local therapy has become an attractive adjunct to surgery. This study presents the mid- long-term results of local therapy with gentamicin in a bioabsorbable ceramic carrier.

To compare complications, survivorship and results in 2 groups of Furlong-HAP Active, one with ceramic-ceramic and the other with metal-XLPE friction pair

Prospective, non-randomized, comparison of 2 series of JRI uncemented prosthesis, implanted with identical protocol by 1 surgeon in 1 hospital from 2006 to 2014. Friction pair was ceramic (Biolox Forte or Delta) in 35 patients of 53.7+/−10.6 years (25–69) (21 males, 60%), and CrCo-XLPE in 65 cases of 69.0+/−8.9 years (42–81) (36 males, 55%); there were significant differences in age (p<0.00001) but not in sex (p=0.6565).

Head diameter: Ce-Ce with 19 of 28mm, 9 of 32 and 7 of 36mm; Me-PE with 63 of 28mm, 1 of 32 and 1 of 36. Follow-up averaged 10.5+/−3.1 years (1–15) in ceramic and 9.8+/−3.8 years (2–15) in XLPE group. Pearson, Fisher, Kolmogorov-Smirnov, Student, Mann-Whitney, calculated with the informatic tools Microsoft Excel 2007 and https://www.socscistatistics.com/tests/.

Complications in ceramic joints: 2 late infections (Fisher exact test=0.6101) (1 DAIR, 1 one-stage exchange); 1 dislocation (Fisher exact test=0.2549) (closed reduction); 1 Vancouver C fracture (ORIF) (Fisher exact test=0.6548). Complications in Me-XLPE joints: 2 late infections (Fisher=0.6101) (1 DAIR, 1 two-stage exchange); 7 dislocations (Fisher=0.2549) (2 early, open reduction) (5 late: 3 closed reduction, 1 cup revision, 1 constrained cup); 4 Vancouver B fractures (Fisher=0.6548) (2 intraoperative, cerclages; 2 late, exchange).

Final follow-up: Harris Hip Score averaged 93.2+/−13.7 (23–100) in ceramic and 94.3+/−8.7 (65–100) in XLPE joints (p=0.64552).

Wear: 0.06+/−0.38mm (0–1.5) in ceramic and 0.16+/−0.5mm (0–2) in Me-PE THAs (p=0.30302).

Osteolysis in Charnley-De Lee zones: 8 zones (6 patients) (17%) in ceramic cups, 25 zones (15 patients) (23%) in XLPE cups (p=0.980127).

Survivorship without any surgery or closed reduction after 15 years: 91.0% in ceramic joints, 83.8% in Me-XLPE joints.

Survivorship without component exchange after 15 years: 93.9% in ceramic joints, 93.6% in Me-XLPE joints.

At least after 10 years follow-up of Furlong-HAP Active, metal-XLPE and ceramic-ceramic joints present no significant differences in complications, clinical score, wear, acetabular osteolysis, or survivorship without component exchange. On the contrary, survivorship without any surgery or closed reduction is different because of the high rate of dislocation in 28mm metal-poly joints.

Aims. We aimed to establish the short- and long-term efficacy of corticosteroid injection for coccydynia, and to determine if betamethasone or triamcinolone has the best effect. Methods. During 2009 to 2016, we treated 277 patients with chronic coccydynia with either one 6 mg betamethasone or one 20 mg triamcinolone cortisone injection. A susequent injection was given to 62 (26%) of the patients. All were reviewed three to four months after injection, and 241 replied to a questionnaire a mean of 36 months (12 to 88) after the last injection. No pain at the early review was considered early success. When the patient had not been subsequently operated on, and indicated on the questionnaire that they were either well or much better, it was considered a long-term success. Results. At the three- to four-month review, 22 (9%) reported that they had no pain. The long-term success of one injection was 15% and rose to 29% after a second injection. Logistic regression tests showed that both early success (odds ratio (OR) 5.5, 95% confidence interval (CI) 2.1 to 14.4; p = 0.001) and late success (OR 3.7, 95% CI 1.7 to 8.3; p = 0.001) was greater with triamcinolone than with betamethasone. Late success was greater for patients with symptoms for less than 12 months (OR 3.0, 95% CI 1.4 to 6.7; p = 0.006). We saw no complications of the injections. Conclusion. We conclude that the effect of corticosteroid injection for coccygodynia is moderate, possibly because we used modest doses of the drugs. Even so, they seem worthwhile as they are easily and quickly performed, and complications are rare. If the choice is between injections of betamethasone or triamcinolone, the latter should be selected. Cite this article: Bone Joint Open 2020;1-11:709–714

The use of intramedullary implants in Osteogenesis Imperfecta (OI) patients to treat and prevent fractures, non-unions and limb deformities has been well established. To serve this purpose different implants are available from non-telescoping rods such as Rush rods and Kirschner wires, to telescoping rods such as the Dubow-Bailey rod, the Sheffield rod and the Fassier-Duval (FD) rod (Pega Medical, Laval, Quebec, Canada). The purpose of this study is to report on the long-term results of the femoral Fassier-Duval rod.

A retrospective chart review of all patients with OI who underwent a femoral intramedullary Fassier-Duval rodding between 2002 and 2017 and followed for an average of 12 years at the Shriner's Hospital, Montreal, Quebec, Canada was performed.

A total of 81 patients underwent femoral FD rodding between 2002 and 2017. Twenty-seven children undergoing 83 procedures had completed a minimum 10-year follow up with complete charts and these were included here. The average follow up time was 12 years (10–15 years). Fifty procedures were initial rodding surgeries and 30 (36.1%) were revision surgeries. A total of 69 complications were reported in the medical record and confirmed on x-ray. The 3 most common complications were a bent rod 24 (34.8%), femur fracture 16 (23.2%) and loss of telescoping in 12 (17.4%) of patients. The 3 most common cause of revision were femur fracture 16 (53.3%), broken rod 5 (16.7%) and coxa vara in 3 (10%) of patients. The average time from initial surgery to the first revision was 5.9 years.

Long term performance of femoral FD rodding shows that despite improved functioning with these rods, certain complications are to be expected, most commonly a risk of femoral fracture requiring revision surgery.

Fully constrained liners are used to treat recurrent dislocations or patients at high risk after total hip replacements. However, they can cause significant morbidities including recurrent dislocations, infections, aseptic loosening and fractures. We examine long term results of 111 patients with tripolar constrained components to assess their redislocation and failure rate.

The purpose of this study was to assess survivorship, complications and functional outcomes at a minimum 10 years after the constrained tripolar liners used in our institute.

We retrospectively identified 111 patients who had 113 revision tripolar constrained liners between 1998 and 2008. Eighty-nine were revised due to recurrent dislocations, 11 for pseudotumor with dysfunctional abductors, and 13 for periprosthetic infection with loss of soft tissue stabilizers. All patients had revision hip arthroplasty before the constrained liner was used: 13 after the first revision, 17 after the second, 38 after the third, and 45 had more than 3 revisions. We extracted demographics, implant data, rate of dislocations and incidence of other complications. Kaplan Meier curves were used to assess dislocation and failure for any reason. WOMAC was used to assess quality of life.

At 10 years, the survival free of dislocation was 95.6% (95%CI 90- 98), and at 20 years to 90.6% (95% CI 81- 95.5). Eight patients (7.1%) had dislocations of their constrained liners: 1 patient had simultaneous periprosthetic infection identified at the time of open reduction, and 1 patient sustained stem fracture 3 months prior to the liner dislocation. At 10 years, the survival to any further surgery was 89.4% (95% CI 82–93.8), and at 20 years, this was 82.5 (95% CI 71.9–89.3). Five patients (4.4%) had deep infection: 4 of these had excision arthroplasty due to failure to control infection, while 1 patient was treated successfully with debridement, exchange of mobile components and intravenous antibiotics. Two patients (1.8%) had dissociated rings that required change of liner, ring and head. Two patients (1.8%) had periprosthetic femoral fractures that were treated by revision stems and exchange of constrained liners. The mean WOMAC functional and pain scores were 66.2 and 75.9 of 100, respectively.

Constrained tripolar liners in our institute provided favourable results in the long term for recurrent dislocation hip arthroplasty with dysfunctional hip stabilizers. Infection in these patients can prove to be difficult to treat due to their poor soft tissue conditions from repeated surgeries. Comparing long terms results from other types of constrained liners is essential to evaluate these salvage liners.

Introduction

Hip resurfacing arthroplasty (HRA) lost its popularity because of excessive wear of the ASR M/M design. Now that causes of wear have been identified, it remains an attractive treatment option for young patients because of its bone-conserving nature, the preservation of bone mineral density, a low dislocation rate, and its biomechanical precision.

Introduction

Primary total knee arthroplasties (TKA) performed in younger patients raise concerns regarding the potential for accelerated polyethylene wear, aseptic loosening, and thus revision TKA at a younger age. The purpose of this study was to determine the long-term implant survivorship, functional outcomes, and pain relief of primary TKA performed in patients under 35 years of age.

Object

Although single-radius designs have theoretical advantages in some aspects, there has been a paucity of evaluation studies. The purpose of this study was to compare 10-year clinical, radiological, survivorship outcomes of single radius and multi radius posterior stabilized prosthesis in total knee arthroplasty(TKA) with Rheumatoid Arthritis (RA).

Aims

Spontaneous osteonecrosis of the knee (SONK) mainly affects the medial femoral condyle, would be a good indication for UKA. The primary aim of this study was to assess the clinical, functional and radiographic outcomes at middle to long-term follow-up, of a consecutive series of fifty UKA used for the treatment of SONK. The secondary aim was to assess the volume of necrotic bone and determine if this influenced the outcome.

Background

Fully constrained liners are used to treat recurrent dislocations or patients at high risk after total hip replacements. However, they can cause significant morbidities including recurrent dislocations, infections, aseptic loosening and fractures. We examine long term results of 111 patients with tripolar constrained components to assess their redislocation and failure rate.

Ceramic-on-ceramic bearings are considered in several European and Asian countries a reliable alternative to metal-on-polyethylene, ceramic-on-polyethylene, or metal-on-metal (with small diameter heads) for total hip arthroplasty (THA) management. Reduced joint wear and limited peri-prosthetic osteolytic changes are the main reasons supporting the use of ceramic. So far, the available observational data show a low rate of revision following the use of Ceramic-on-Ceramic bearings, but concern remains regarding the risk of fracture and the prevalence of squeaking noises from the joint.

The objective of this study was to use a national arthroplasty registry to assess whether the choice of bearings – metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), ceramic-on-ceramic (CoC), or metal-on-metal (MoM) – is associated with differences in the risk of revision.

Data from primary THAs were extracted from the New Zealand Joint Registry over a 15-year period. 97,889 hips were available for analysis. The mean age of patients was 68 years (SD +/− 11 years), and 52% were women. The median followup period in this patient population was 9 years (range, 1 to 15 years).

The primary endpoint was revision for any reason. Inclusion criteria were degenerative joint disease (84,894), exclusion criteria were previous surgery, trauma, and any other diagnosis (12,566). We also excluded patients operated on with a Ceramic-on-Metal THA, because of the small recorded number (429).

There were 54,409 (64.1%) MoP, 16,503 (19.4%) CoP, 9,051 (10.7%) CoC and 4,931 (5.8%) MoM hip arthroplasties. 3,555 hips were revised during the 15-year observation period. A multivariate assessment was carried out including the following risks factors available for analysis: age, gender, surgeon experience, use of cement.

Analysis of bearing surface type and revision showed a statistically significant lower risk for CoC hips (265 THAs, p≤0.01) when compared with CoP (537 THAs, HR 1.07, CI 0,92–1,26), MoP (2186 THAs, HR 1.39, CI 1.19–1,62), and MoM (576 THAs, HR 2.15, CI 1.84–2.51). The 15-year follow-up Kaplan-Meier survival analysis shows a 92% revision-free rate for CoC THAs (Figure 1). In particular, CoC THAs showed the lowest rates of revision for dislocation and for deep infection, when compared with the other bearings.

This registry study showed that the bearing surface is associated with the risk of revision. MoM bearing surfaces showed a high rate of revisions, while CoC THAs showed the lowest rate of revision compared to other bearing surfaces. Low wear and less osteolysis are the possible reasons for reduced risk of revision for aseptic loosening. We postulate that the healthy, fibrotic synovial-like pseudocapsule found in CoC THAs preserves the long-term stability of the joint and reduces the bio-burden for late deep infection. Future studies with larger data sets and longer follow-up should continue to investigate this query.

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Porous tantalum is a highly osteoinductive biomaterial, initially introduced in orthopedics in 1997, with a subsequent rapid evolution of orthopedic applications. The use of porous tantalum for the acetabular component in primary total hip arthroplasty (THA) has demonstrated excellent short-term and mid-term results. However, long term data are scarce. The purpose of this prospective study is to report the long-term clinical and radiological outcome following use of an uncemented porous tantalum acetabular component in primary THA with a minimum follow-up of 17.5 years, in a previously studied cohort of patients.

We prospectively followed 128 consecutive primary THAs in 140 patients, between November 1997 and June 1999. A press-fit porous tantalum monoblock acetabular component was used in all cases. The presence of initial gaps in the polar region, as sign of incomplete seating of the monoblock cup, was assessed on the immediate postoperative radiographs. All patients were followed clinically and radiographically at 6, 12, and 24 weeks and 12 months and then at 2, 5, 8, 10, and 19 years, for a mean of 18.1 years (range 17.5 – 19 years). Periacetabular dome gap filling, acetabular cup migration and polyethylene wear were assessed by the EBRA digital measurement system, until 2 years postoperatively.

Mean age of patients at the time of operation was 60.4 years old (range 24 – 72). Harris hip score, Oxford Hip Score and range of motion (ROM) were dramatically improved in all cases (p < 0.001). In the initial postoperative radiographs, periacetabular dome gaps were observed in the 15% of cases, and were progressively filled within 6 months. In 2 years postoperatively, the mean component migration, as shown in EBRA study, was 0.67 mm. At last follow-up, all cups were radiographically stable with no evidence of migration, gross polyethylene wear, progressive radiolucencies, osteolytic lesions or acetabular fractures. The survivorship with re-operation for any reason as end point was 92.8%, whereas the survivorship for aseptic loosening as an end point was 100%. Upon visual inspection, two removed acetabular components due to recurrent dislocation and infection, respectively, showed extensive bone osseointegration.

In our primary THA series, the porous tantalum monoblock cup demonstrated excellent clinical and radiographic outcomes with no failures because of aseptic loosening at a mean follow-up of 18.1 years. Porous tantalum acetabular components showed excellent initial stability, produced less wear debris and revealed a great potential for bone ingrowth. Due to its unique osteoinductive properties and elliptical shape, porous tantalum monoblock cups have demonstrated superior short and long-term survivorship compared to other press fit prostheses in the market.

Introduction

Data on the outcome of THA in patients under the age of 30 years is sparse. There is a perceived reluctance to offer surgery to young patients on the basis of potential early failure of the implant. We aim to review our experience with THA in this group of patients to establish outcomes in a high volume specialist arthroplasty unit.

Introduction. The optimal bearing for hip arthroplasty is still a matter of debate. in younger and more active patients ceramic-on-polyethylene (CoP) bearings are frequently chosen over metal-on-polyethylene (MoP) bearings to reduce wear and increase biocompatibility. However, the fracture risk of ceramic heads is higher than that of metal heads. This can cause serious issue, as ceramic fractures pose a serious complication often necessitating major revision surgery – a complication more frequently seen in ceramic-on-ceramic bearings. To date, there are no long-term data (> 20 years of follow-up) reporting fracture rates of the ceramic femoral heads in CoP bearings. Patients and Methods. We retrospectively evaluated the clinical and radiographic results of 348 cementless THAs treated with 2nd generation Biolox® Al2O3 Ceramic-on-Polyethylene (CoP) bearings, which had been consecutively implanted between January 1985 and December 1989. At implantation the mean patient age was 57 years. The cohort was subsequently followed for a minimum of 20 years. At the final follow-up 111 patients had died, and 5 were lost to follow-up (Fig. 1). A Kaplan-Meier survivorship analysis was used to estimate the cumulative incidence of ceramic head fractures over the long-term. Results. (Figs. 2, 3):. After 22-years the cumulative incidence of ceramic head fracture was estimated at 0.3% (95%-CI, 0–2.4%; 38 hips at risk). No impending failures could be noted on radiographic analysis at final follow-up. Discussion. The fracture rate of second-generation ceramic heads using a CoP articulation remains very low into the third decade after cementless THA; ceramic heads appear to be a safe alternative to metal femoral heads. Summary. This study evaluates the long-term (20–25 year) survivorship of cement on polyethylene bearings in uncemented THA