Aims

In 2015, we published the results of our ceramic-on-metal (CoM) total hip arthroplasties (THAs) performed between October 2007 and July 2009 with a mean follow-up of 34 months (23 to 45) and a revision rate of 3.1%. The aim of this paper is to present the longer-term outcomes.

Vitamin E-doped cross-linked polyethylene (VEPE) has encouraged the use of larger heads in thinner liners in total hip arthroplasty (THA). However, there are concerns about wear and mechanical failure of the thin liner, especially when metal heads are used. The aim of this randomized controlled trial was to investigate if the use of a large metal head in a thin VEPE liner would increase polyethylene wear compared with a standard 32-mm metal head and to compare periacetabular radiolucencies and patient-reported outcomes in THA. 96 candidates for uncemented THA were randomly allocated to either the largest possible metal head (36–44 mm) that could be fitted in the thinnest available VEPE liner (intervention group) or a standard 32-mm metal head (control group). The primary outcome was proximal head penetration (PHP) measured with model-based radiostereometric analysis (RSA). Secondary outcomes were periacetabular radiolucencies and patient-reported outcomes. The mid-term results of the trial at 5 years are presented. Median total PHP (interquartile range) was -0.04 mm (−0.12 to 0.02) in the intervention group and -0.03 mm (=0.14 to 0.05) in the control group (p=0.691). The rates of periacetabular radiolucencies were 1/44 and 4/42 (p=0.197), respectively. Patient-reported hip function and health-related quality of life did not differ between the groups, but participants in the intervention group reported a higher level of activity (median UCLA rank 7 vs 6, p=0.020). There were 5 revisions caused by dislocations (2), periprosthetic fracture (1), stem subsidence (1), or iliopsoas impingement (1). Large metal heads in thin VEPE liners did not increase liner wear and were not associated with liner failure 5 years after THA

Aims

Conflicting clinical results are reported for the ATTUNE Total Knee Arthroplasty (TKA). This randomized controlled trial (RCT) evaluated five-year follow-up results comparing cemented ATTUNE and PFC-Sigma cruciate retaining TKAs, analyzing component migration as measured by radiostereometric analysis (RSA), clinical outcomes, patient-reported outcome measures (PROMs), and radiological outcomes.

Aims. The aim of this study was to evaluate medium- to long-term outcomes and complications of the Stanmore Modular Individualised Lower Extremity System (SMILES) rotating hinge implant in revision total knee arthroplasty (rTKA) at a tertiary unit. It is hypothesized that this fully cemented construct leads to satisfactory clinical outcomes. Methods. A retrospective consecutive study of all patients who underwent a rTKA using the fully cemented SMILES rotating hinge prosthesis between 2005 to 2018. Outcome measures included aseptic loosening, reoperations, revision for any cause, complications, and survivorship. Patients and implant survivorship data were identified through both prospectively collected local hospital electronic databases and linked data from the National Joint Registry/NHS Personal Demographic Service. Kaplan-Meier survival analysis was used at ten years. Results. Overall, 69 consecutive patients (69 knees) were included with a median age of 78 years (interquartile range 69 to 84), and there were 46 females (66.7%). Indications were septic revisions in 26 (37.7%), and aseptic aetiology in the remining 43 (62.3%). The mean follow-up was 9.7 years (4 to 18), and the overall complication was rate was 7.24%, all with patellofemoral complications. Failure rate with ‘any cause revision’ was 5.8%. There was one case of aseptic loosening of the femoral component. At ten years, 17/69 patients (24.63%) had died, and implant survivorship was 92.2%. Conclusion. In our experience, the SMILES rotating hinge prosthesis achieves satisfactory long-term outcomes with ten-year implant survivorship of 92.2% and a patellofemoral complication rate of 7.24%. Cite this article: Bone Jt Open 2023;4(10):776–781

The purpose was to determine the lifetime risk of re-operation due to specific complications related to dual mobility using re-operation as a competing risk, excluding loosening, periprosthetic fracture, and infection. 1503 mono-block dual mobility total hip arthroplasty (DM-THAs). Defining the re-operation when anesthesia (for dislocation) and revision when the implant changed. Surgery (801 for primary, 702 for revision with 201 for recurrent dislocation and 501 for loosening) performed between 1990 and 2020 in average 81-year-old (range 50–102) patients, with 522 living patients at 10 years follow-up. During the first month, outer dislocation (60 cases; 4%) was the cause re-operation (1% among primary and 6 % among revisions). Twenty-four intra-prosthetic dislocations (IPD) were an iatrogenic consequence of a failed closed reduction (reduction maneuver dissociating the inner head) with 1.6% revision. Between 1 month and 1 year, 22 new outer dislocations, while 25 of the 60 “first month” dislocations had recurrent dislocation. Fifteen other IPDs as iatrogenic consequences were observed. At one year, the cumulative revision was 3% (49 of 82 dislocations). Between 1- 10-year FU, 132 other dislocations, and 45 other revisions for dislocations were observed. Corrosion was another cause of revision (37 cases): between the cobalt-chromium shell and the femoral neck (23 hips), or 14 crevice corrosion between the trunnion and the metal head (trunnion damage). In summary, at 10-year: dislocation first cause of re-operation (214 anesthesia, 14%), while among 131 revisions (8.9 %) the 55 iatrogenic intra-prosthetic dislocations were the first revision cause before 39 recurrent dislocations and 37 corrosions. The 522 patients followed ten years or more had a 15% risk revision due to DM specific complications during their lifetime and 10% more risk associated with loosening (6%), periprosthetic fracture (2%) and infection (2%)

The Norwegian Arthroplasty Register (NAR) started collecting data on total hip arthroplasty (THA) in 1987. Very long-term results of implants for THA are scarce. We aimed to show long-term results for the three most used femoral stems, operated from 1987. We included the uncemented Corail femoral stem (n=66,309) and the cemented Exeter stem (n=35,050) both of which are currently in frequent use. In addition, we included the Charnley stem (n=32,578, in use until 2014). To ensure comparable conditions, stems fixated with low viscosity cement and stems revised due to infections were excluded. Differences in risk of revision (all reasons and stem revisions) were assessed with Kaplan-Meier and Cox regression analyses with adjustment for possible confounding from age, sex and diagnosis (OA, other). Stem revision was defined as a revision caused by loosening of the stem, dislocation, osteolysis in the femur, or periprosthetic femur fracture, and in which the femoral component was removed or exchanged. The median and max follow-up for Corail, Exeter and Charnley were 6.3 (33.1), 8.0 (34.2) and 13.1 (34.3) respectively. Thirty years survival estimates for Corail, Exeter and Charnley stems were 88.6% (CI:85.8–90.9%), 86.7% (83.7–89.2%) and 87.1% (85.4–88.5%) respectively with stem revision as endpoint, and 56.1% (CI:53.1–59.1%), 73.3% (70.5–76.1%) and 80.2% (78.4–82.0%) with all THA revisions as endpoint. Compared to the Corail, the Exeter (HRR=1.3, CI:1.2–1.4) and the Charnley (HRR=1.9, CI:1.7–2.1) had a significant higher risk of stem revision. Women 75 years and older had better results with the cemented stems. Analyses accounting for competing risk from other causes of revision did not alter the findings. The uncemented Corail stem performed well in terms of stem revisions for stem-related revision causes compared to two frequently used cemented stems with very long follow-up. The differences between the three stems were small

Aims

Pelvic discontinuity is a rare but increasingly common complication of total hip arthroplasty (THA). This single-centre study evaluated the performance of custom-made triflange acetabular components in acetabular reconstruction with pelvic discontinuity by determining: 1) revision and overall implant survival rates; 2) discontinuity healing rate; and 3) Harris Hip Score (HHS).

Aim. Previous publications have suggested that the incidence of revisions due to infection after THA is increasing. We performed updated time-trend analyses of risk and timing of revision due to infection after primary THAs in the Nordic countries during the period 2004–2018. Methods. 569,463 primary THAs reported to the Nordic Arthroplasty Register Association from 2004 through 2018 were studied. We estimated adjusted hazard ratios (aHR) with 95% confidence interval by Cox regression with the first revision due to infection after primary THA as endpoint. The risk of revision was investigated. In addition, we explored changes in the time span from primary THA to revision due to infection. Results. 5,653 (1.0%) were revised due to infection. The risk of revision due to infection increased through the study period. Compared to the period 2004–2008, the aHRs were 1.4 (95%CI 1.3–1.5) for 2009–2013, and 1.9 (1.7–2.0) for 2014–2018. We found an increased risk in all four Nordic countries. Compared to 2004–2008, the aHR due to infection 0–30 days after THA was 2.5 (2.1–2.9) for 2009–2013 and 3.4 (3.0–3.9) for 2013–2018. The aHR of revision due to infection 31–90 days after THA was 1.5 (1.3–1.9) for 2009–2013 and 2.5 (2.1–3.0) for 2013–2018, compared to 2004–2008. Beyond 91 days after THA, the risk of revision due to infection was stable over the whole study period. Interpretation. The risk of revision due to deep infection after THA nearly doubled throughout the period 2004–2018. This increase was mainly due to an increased risk of early revisions. The cause for these changes may be multifactorial (patient selection, diagnostics, revision strategy, completeness of reporting, etc.), are not possible to disclose in the present study, and warrants further research

Aims

Despite multiple trials and case series on hip hemiarthroplasty designs, guidance is still lacking on which implant to use. One particularly deficient area is long-term outcomes. We present over 1,000 consecutive cemented Thompson’s hemiarthroplasties over a ten-year period, recording all accessible patient and implant outcomes.

Aims

Femoral cement-in-cement revision is a well described technique to reduce morbidity and complications in hip revision surgery. Traditional techniques for septic revision of hip arthroplasty necessitate removal of all bone cement from the femur. In our two centres, we have been using a cement-in-cement technique, leaving the distal femoral bone cement in selected patients for septic hip revision surgery, both for single and the first of two-stage revision procedures. A prerequisite for adoption of this technique is that the surgeon considers the cement mantle to be intimately fixed to bone without an intervening membrane between cement and host bone. We aim to report our experience for this technique.

Aims

The aim of this study was to determine if uncemented acetabular polyethylene (PE) liner geometry, and lip size, influenced the risk of revision for instability or loosening.

Aims

Use of the direct anterior approach (DAA) for total hip arthroplasty (THA) has increased in recent years due to proposed benefits, including a lower risk of dislocation and improved early functional recovery. This study investigates the dislocation rate in a non-selective, consecutive cohort undergoing THA via the DAA without any exclusion or bias in patient selection based on habitus, deformity, age, sex, or fixation method.

Aims

The main aims were to identify risk factors predictive of a radiolucent line (RLL) around the acetabular component with an interface bioactive bone cement (IBBC) technique in the first year after THA, and evaluate whether these risk factors influence the development of RLLs at five and ten years after THA.

Aims

During revision procedures for aseptic reasons, there remains a suspicion that failure may have been the result of an undetected subclinical infection. However, there is little evidence available in the literature about unexpected positive results in presumed aseptic revision spine surgery. The aims of our study were to estimate the prevalence of unexpected positive culture using sonication and to evaluate clinical characteristics of these patients.

Ceramic-on-polyethylene (COP) bearings have traditionally been reserved for younger patients that were at high risk of polyethylene wear requiring revision. With the 1999 advent of highly crosslinked polyethylene (XLP), wear with XLP has not been a cause for revision. Simulator studies have not shown a difference in wear comparing COP to metal-on-polyethylene (MOP). Therefore, and considering the additional cost of COP, we have until recently not needed COP. However, a 2012 report of 10 cases that developed an adverse reaction to metal debris generated by head neck corrosion has resulted in COP becoming the most common bearing surface as reported by the American Joint Replacement Registry. This reactionary change has occurred despite the fact that we do not understand the cause, do not know the frequency, if it is more common in some implants than others, and we do not know the additional cost or markup of ceramic heads. One study reported a 3.2% revision prevalence caused by mechanically assisted crevice corrosion (MACC) at the head neck junction of a single manufacturer's implant. Other studies have estimated the frequency to be less than 5%. COST IS THE CONCERN in a value based healthcare environment. Models for and against the wholesale use of COP have been proposed and are based on variables that are unknown, including estimated frequency of the problem and the incrementally higher cost of a ceramic head. I use COP in younger patients that I believe will use their hip for more than 15 years. This is based on my personal experience. I have prospectively followed a series of MOP patients for 5 years and not seen cobalt elevations. I have placed new metal femoral heads on corroded femoral tapers without subsequent failure. I have evaluated the taper junctions of postmortem retrievals and found them virtually free of corrosion. A query of our institutional database for MOP primary hips identified 3012 cases between 2006–2017. Eighty revisions (2.7%) were identified. 2 of the 80 were for MACC representing 2.5% of revisions done on our own patients and 0.07% of our MOP cases. Further, evaluating our most recent all cause 350 revisions (7/2015–10/2017) there were 3 revisions for MACC (0.9%). Each one of us needs to EVALUATE OUR OWN PRACTICE AND MAKE AN EDUCATED, VALUE BASED DECISION whether or not to use COP in all patients

Ceramic-on-polyethylene (COP) bearings have traditionally been reserved for younger patients that were at high risk of polyethylene wear requiring revision. With the 1999 advent of highly crosslinked polyethylene (XLP), wear with XLP has not been a cause for revision. Simulator studies have not shown a difference in wear comparing COP to metal-on-polyethylene (MOP). Therefore, and considering the additional cost of COP, we have until recently not needed COP. However, a 2012 report of 10 cases that developed an adverse reaction to metal debris generated by head neck corrosion has resulted in COP becoming the most common bearing surface as reported by the American Joint Replacement Registry. This reactionary change has occurred despite the fact that we do not understand the cause, do not know the frequency, if it is more common in some implants than others, and we do not know the additional cost or markup of ceramic heads. One study reported a 3.2% revision prevalence caused by mechanically assisted crevice corrosion (MACC) at the head neck junction of a single manufacturer's implant. Other studies have estimated the frequency to be less than 5%. COST IS THE CONCERN in a value based health care environment. Models for and against the wholesale use of COP have been proposed and are based on variables that are unknown, including estimated frequency of the problem and the incremental cost of a ceramic head. I use COP in younger patients that I believe will use their hip for more than 15 years. This is based on my personal experience. I have prospectively followed a series of MOP patients for 5 years and not seen cobalt elevations. I have placed new metal femoral heads on corroded femoral tapers without subsequent failure. I have evaluated the taper junctions of postmortem retrievals and found them virtually free of corrosion. A query of our institutional database for MOP primary hips identified 3012 cases between 2006–2017. Eighty revisions (2.7%) were identified. Two of the 80 were for MACC representing 2.5% of revisions done on our own patients and 0.07% of our MOP cases. Further, evaluating our most recent all cause 350 revisions (7/2015-10/2017) there were 3 revisions for MACC (0.9%). Each one of us needs to EVALUATE OUR OWN PRACTICE AND MAKE AN EDUCATED, VALUE BASED DECISION whether or not to use COP in all patients

Background. Substance abuse and dependence is thought to have a strongly negative impact on surgical outcomes. The purpose of this study was to determine the effects of drug misuse on total knee arthroplasty (TKA) revision incidence, revision causes, and time to revision by analyzing the Medicare database between 2005–2012. Methods. A retrospective review of the Medicare database within the PearlDiver Supercomputer (Warsaw, IN) for TKA and revisions was performed utilizing Current Procedural Terminology (CPT) and International Classification of Disease (ICD) ninth revision codes. Drug misuse was subdivided into cocaine, cannabis, opioids, sedative/hypnotic/anxiolytic, amphetamines, and alcohol. Time to revision, age, and gender were also investigated. Results. Our query returned 2159221 TKAs and 193024 (8.9%) revisions between 2005–2012. Drug misuse was prevalent in 173513 (8%). Cocaine had the highest revision incidence (13.9%). Cannabis had the fastest average (636.1 days) and median (457 days) time to revision. At 30 and 90 days, cannabis had the greatest rate of revision at 6% and 12% respectively. At 6 months and 1 year, amphetamine had the greatest revision risk at 25% and 40.5% respectively. Infection was the most common cause of revision among all substances. Conclusion. Cocaine misuse holds the highest risk for revision. However cannabis misuse is more likely to require revision sooner, particularly at the 30 and 90 day intervals. Infection was the most common cause of revision regardless of substance misused. Thus it is important to obtain a detailed social history on drug misuse and to be vigilant for postoperative infections in these patients

Aims

We present the clinical and radiological results at a minimum follow-up of five years for patients who have undergone multiple cement-in-cement revisions of their femoral component at revision total hip arthroplasty (THA).

Aims

The aims of this study were to evaluate the clinical and radiological outcomes of the Universal-2 total wrist arthroplasty (TWA) in patients with rheumatoid arthritis.

Total hip arthroplasty (THA) is a common and extremely beneficial procedure that is being performed more often as the population ages. Current THA follow-up guidelines require large amounts of resources and may not justify their cost with increased patient outcomes. Most problems that would require THA revision will cause symptoms. Late-presenting asymptomatic THAs that are found to require revision are complicated and expensive to address and often lead to poor patient outcomes. Follow-up visits for THA patients are essentially a screening tool to identify asymptomatic THAs that require revision. The rate of asymptomatic THA revision and the subsequent cost of screening for them is not well reported in the literature. Given the relative shortage of orthopaedic resources, efficient use of clinic time should be a priority and inefficient practices should be identified and changed. We calculated the rate of asymptomatic hip revisions over the first twenty years of THA ownership. We further calculated the cost of a single visit to the orthopaedic clinic for follow up of a THA. Finally, we calculated the cost savings of decreasing the follow-up schedule to a total of three visits. The cost savings of foregoing the screening to identify one asymptomatic THA requiring revision is CAD $1.2 million. Asymptomatic THAs requiring revision are rare and, as such, require a large amount of follow up to diagnose. As a screening tool, regular orthopaedic follow up of THA is an inefficient use of resources. Current follow-up guidelines are cost-prohibitive and should be made much less frequent in order to save resources