Restoration of native Coronal Plane Alignment of the Knee (CPAK) phenotype is a strategy suggested to achieve better satisfaction. The aim of this study was to investigate the influence of changes in CPAK classification on patient-reported outcome measures (PROMs) and survivorship in a large cohort of manual mechanically aligned (MA) cemented TKAs. A retrospective analysis of 1062 consecutive cemented TKAs using MA philosophy at a single institution. Pre- and post-operative hip-knee-ankle radiographs were classified using the CPAK classification. Oxford Knee Score (OKS) and patient satisfaction (4-point-Likert scale) were collected prospectively. Implant survival data was obtained from our national arthroplasty database. We compared the outcomes of patients who maintained or changed their CPAK classification following TKA. Satisfaction was analysed using chi-square test, and OKS was analysed using Mann-Whitney test. Pre-operatively, most patients were CPAK type-I (38.8%). 85.5% of patients changed their CPAK type post-operatively, with CPAK type-V observed in 41.2% of these. Significantly better satisfaction (p=0.033) and OKS (p=0.021) were observed at one-year follow-up in patients who changed CPAK type, although the difference was below OKS minimally important clinical difference. There was no difference in satisfaction (p=0.73) and OKS (p=0.26) at one year between CPAK-V and non-V classifications. Post-operative CPAK type had no correlation with satisfaction and OKS. 12 TKAs (1.1%) were revised within 10 years (3 septic). In this large cohort of MA-TKA, excellent survivorship was observed at 10 years, with no demonstrable difference in outcome related to the final CPAK phenotype or change in phenotype

Aims

The outcomes of patients with unexpected positive cultures (UPCs) during revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) remain unknown. The objectives of this study were to establish the prevalence and infection-free implant survival in UPCs during presumed aseptic single-stage revision THA and TKA at mid-term follow-up.

The October 2024 Shoulder & Elbow Roundup360 looks at: Proximal humeral fractures with vascular compromise; Outcomes and challenges of revision arthroscopic rotator cuff repair: a systematic review; Evaluating treatment effectiveness for lateral elbow tendinopathy: a systematic review and network meta-analysis; Tendon transfer techniques for irreparable subscapularis tears: a comparative review; Impact of subscapularis repair in reverse shoulder arthroplasty; Isolated subscapularis tears strongly linked to shoulder pseudoparesis; Nexel and Coonrad-Morrey total elbow arthroplasties show comparable revision rates in New Zealand study; 3D MRI matches 3D CT in assessing bone loss and shoulder morphology in dislocation cases.

Aims

The aims of this study were to: 1) report on a cohort of skeletally mature patients with native hip and knee septic arthritis over a 14-year period; 2) to determine the rate of joint failure in patients who had experienced an episode of hip or knee septic arthritis; and 3) to assess the outcome following septic arthritis relative to the infecting organism, whether those patients infected by Staphylococcus aureus would be more likely to have adverse outcomes than those infected by other organisms.

Aims

The optimal bearing surface design for medial unicompartmental knee arthroplasty (UKA) remains controversial. The aim of this study was to compare outcomes of fixed-bearing (FB) and mobile-bearing (MB) UKAs from a single high-volume institution.

Aims. Endoprosthetic reconstruction following distal femur tumour resection has been widely advocated. In this paper, we present the design of an uncemented endoprosthesis system featuring a short, curved stem, with the goal of enhancing long-term survivorship and functional outcomes. Methods. This study involved patients who underwent implantation of an uncemented distal femoral endoprosthesis with a short and curved stem between 2014 and 2019. Functional outcomes were assessed using the 1993 version of the Musculoskeletal Tumour Society (MSTS-93) score. Additionally, we quantified five types of complications and assessed osseointegration radiologically. The survivorship of the endoprosthesis was evaluated according to two endpoints. A total of 134 patients with a median age of 26 years (IQR 16 to 41) were included in our study. The median follow-up time was 61 months (IQR 56 to 76), and the median functional MSTS-93 was 83% (IQR 73 to 91) postoperatively. Results. Overall, 21 patients (16%) encountered complications, and the rate of aseptic loosening was 7% (9/134). The survival rate up to 8.5 years was 93% for aseptic loosening as the endpoint, and 88% for any reason as the endpoint, retrospectively. Conclusion. The use of an uncemented distal femoral endoprosthesis with a short, curved stem demonstrated a low incidence of aseptic loosening and achieved long-term survivorship of up to nine years. Meanwhile, aseptic loosening typically occurs in the early stage postoperatively. Cite this article: Bone Joint J 2024;106-B(9):1000–1007

In total hip arthroplasty (THA), cementless cup without screw holes has the putative benefits of maximizing host bone contact and reducing osteolysis by eliminating channels to backside wear particles. However, supplemental trans-acetabular screws cannot be used. 74 hips in 60 patients receiving same model of cementless cup without screw holes (Depuy Duraloc 100 HA cup) from 6/1999 to 3/2003 were prospectively followed up. All patients were allowed to have immediate full weight bearing. Age at THA was 53 ± 13 (range 24–74) years. Osteonecrosis was the leading hip disease (45% of hips). Survivorship was assessed using revision of the cup as the end point. Radiological parameters, including lateral opening angle, vertical and horizontal migration distances of the cups were measured. Paired t-test was used to compare between the measurements in early postoperative period and at final follow up. 51 hips were assessed at minimum 20 years follow-up. The mean follow-up was 22.6 (range 21 – 25) years. All the cups were well fixed. There were two cup revisions. Conventional polyethylene (PE) was used in both hips; osteolysis occurred 17 and 18 years later. Both cups were well fixed but were revised, one due to cup mal-positioning, one due to need in upsizing the articulation. 14 other hips were revised but these cups were well fixed and not revised; 9 loosened stems (most were cemented Elite plus stems), 5 PE wear and osteolysis (all were conventional PE). At 20 years, the survivorship of cups was 96.1%. Changes in lateral opening angle, vertical and horizontal migration distances were 0.44±1.59°, 0.01±1.52mm and -0.32±1.47mm respectively, without statistical significance. This study provided evidence of excellent long-term survivorship of cementless cup without screw holes. Immediate postoperative weight-bearing also did not lead to cup migration in the long-term

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

Hip resurfacing arthroplasty (HRA) is being offered as a viable alternative to total hip arthroplasty (THA). For very young patients (under 30 years old), THA achieves fair results but with high revision and complication rates. This retrospective study was designed to evaluate the results of HRA performed in patients under 30 years old with a long follow-up. During the inclusion period (2007–2021), we collected in a single operator database, all HRA performed in patients under 30 with a minimum follow up of 2 years. 103 HRA in 93 patients (77 male / 16 females; a mean age at operation 27.7 years (18 to 29.9)) were included. The two mean preoperative diagnoses were osteoarthritis in 54 HRA (52.5%) and DDH or hip dislocation in 19.4% (20 cases). No patient was lost to follow-up and 3 patients (5 HRA) deceased. There were 2 revisions (one for femoral aseptic loosening and one infection recurrence (pediatric osteoarthritis)). No dislocation and adverse wear-related failures were found. At a mean follow-up of 10.4 years (2–17.4), mean UCLA activity and Oxford Hip score improved respectively from 5.4 (1 to 7) and 39.9 (25–55) pre-operatively to 7.9 (3 to 10) and 15.8 (12–34) post-operatively (p<0.001). Mean Harris hip score increased from 41.6 (22–63) to 91.8 (72–100) (p<0.001). There were no radiological cases exhibiting lysis while two cases displayed limited partial radiolucency around the femoral stem. Kaplan-Meier survival analysis, with the endpoint revision for any reason, showed a 10.8-year survival rate of 98% (95% expected with NICE guidelines). This cohort of HRA performed under 30 is the longest follow-up ever reported in the literature. Despite a challenging cohort of patients, HRA exceeds the stricter NICE survivorship criteria. HRA remains an effective treatment with excellent functional outcomes and a very low rate of complications

Developmental dysplasia of the hip can cause pain and premature osteoarthritis. However, the risk factors and timing for disease progression in young adults are not fully defined. This study identified the incidence and risk factors for contralateral hip pain and surgery after periacetabular osteotomy (PAO) on an index dysplastic hip. Patients followed for 2+ years after unilateral PAO were grouped by eventual contralateral pain or no-pain, based on modified Harris Hip Score, and surgery or no-surgery. Univariate analysis tested group differences in demographics, radiographic measures, and range-of-motion. Kaplan-Meier survival analysis assessed pain development and contralateral hip surgery over time. Multivariate regression identified pain and surgery risk factors. Pain and surgery predictors were further analyzed in Dysplastic, Borderline, and Non-dysplastic subcategories, and in five-degree increments of lateral center edge angle (LCEA) and acetabular inclination (AI). 184 patients were followed for 4.6±1.6 years, during which 51% (93/184) reported hip pain and 33% (60/184) underwent contralateral surgery. Kaplan-Meier analysis predicted 5-year survivorship of 49% for pain development and 66% for contralateral surgery. Painful hips exhibited more severe dysplasia than no-pain hips (LCEA 16.5º vs 20.3º, p<0.001; AI 13.2º vs 10.0º p<0.001). AI was the sole predictor of pain, with every 1° AI increase raising the risk by 11%. Surgical hips also had more severe dysplasia (LCEA 14.9º vs 20.0º, p<0.001; AI 14.7º vs 10.2º p<0.001) and were younger (21.6 vs 24.1 years, p=0.022). AI and a maximum alpha angle ≥55° predicted contralateral surgery. 5 years after index hip PAO, 51% of contralateral hips experience pain and 34% percent are expected to need surgery. More severe dysplasia, based on LCEA and AI, increases the risk of contralateral hip pain and surgery, with AI being a predictor of both outcomes. Knowing these risks can inform patient counseling and treatment planning

Angular proximal femoral deformities increase the technical complexity of primary total hip arthroplasties (THAs). The goals were to determine the long-term implant survivorship, risk factors, complications, and clinical outcomes of contemporary primary THAs in this difficult cohort. Our institutional total joint registry was used to identify 119 primary THAs performed in 109 patients with an angular proximal femoral deformity between 1997 and 2017. The deformity was related to previous femoral osteotomy in 85%, and developmental or metabolic disorders in 15%. 53% had a predominantly varus angular deformity. The mean age was 44 years, mean BMI was 29 kg/m. 2. , and 59% were female. An uncemented metaphyseal fixation stem was used in 30%, an uncemented diaphyseal fixation stem in 28%, an uncemented modular body stem with metaphyseal fixation sleeve in 24%, and a cemented stem in 18%. Simultaneous corrective femoral osteotomy was performed in 18%. Kaplan-Meier survivorships and Harris hip scores were reported. Mean follow-up was 8 years. The 10-year survivorships free of femoral loosening, aseptic femoral revision, any revision, and any reoperation were 95%, 93%, 90% and 88%, respectively. Revisions occurred in 13 hips for: aseptic femoral component loosening (3), stem fracture (2), dislocation (2), aseptic acetabular loosening (2), polyethylene liner exchange (2), and infection (2). Preoperative varus angular deformities were associated with a higher risk of any revision (HR 10, p=0.03), and simultaneous osteotomies with a higher risk of any reoperation (HR 3.6, p=0.02). Mean Harris hip scores improved from 52 preoperatively to 82 at 10 years (p<0.001). In the largest series to date of primary THAs in patients with angular proximal femoral deformities, we found a good 10-year survivorship free from any revision. Varus angular deformities, particularly those treated with a simultaneous osteotomy due to the magnitude or location of the deformity, had a higher reoperation rate. Keywords: Proximal femoral deformity; dysplasia; femoral osteotomy; survivorship; revision. Level of evidence: Level III, comparative retrospective cohort

Chronic pelvic discontinuity (CPD) during revision hip arthroplasty is a challenging entity to address. The aim of this study was to evaluate the clinical and radiologic outcomes, and complications of the “acetabular distraction technique” for the management of CPD during revision hip arthroplasty. Patients with CPD, who underwent acetabular revision between 2014 and 2022 at two tertiary care centres, using an identical distraction technique, were evaluated. Demographic parameters, pre-operative acetabular bone loss, duration of follow-up, clinical and radiologic outcomes, and survivorship were evaluated. In all, 46 patients with a mean follow-up of 34.4 (SD=19.6, range: 24–120) months were available for evaluation. There were 25 (54.3%) male, and 21 (45.7%) female patients, with a mean age of 58.1 (SD=10.5, range: 40–81) years at the time of revision surgery. Based on the Paprosky classification of acetabular bone loss, 19 (41.3%), 12 (26.1%), and 15 (32.6%) patients had type 3b, 3a, and 2c defects. All patients were managed using the Trabecular Metal™ Acetabular Revision System; 16 patients required additional Trabecular Metal™ augments. The mean HHS improved from 50.1 (SD=7.6, range: 34.3 – 59.8) pre-operatively, to 86.6 (SD=4.2, range: 74.8 -91.8) at the last follow-up. Two patients (4.3 %) developed partial sciatic nerve palsy, two (4.3%) had posterior dislocation, and one (2.2%) required re-revision for aseptic loosening. Radiologically, 36 (78.3%) patients showed healing of the pelvic discontinuity. The Kaplan-Meier construct survivorship was 97.78% when using re-revision for aseptic acetabular loosening as an endpoint. The acetabular distraction technique has good clinical and radiologic outcomes in the management of CPD during revision hip arthroplasty

This study evaluates patient reported outcome measurement information system (PROMIS) scores after total hip arthroplasty (THA) and total ankle arthroplasty (TAA) in matched cohorts, while simultaneously evaluating implant survivorship and 90-day hospital utilization. It is hypothesized that while both procedures would yield similar PROMIS score improvements, THA would demonstrate superior mid-term implant survivorship. Primary THA and TAA patients from 2015–2022 with minimum one-year follow-up were retrospectively reviewed. After applying exclusion criteria, 2,092 THAs and 478 TAAs were included for analysis. Demographics, pre- and post-operative patient reported outcome measures (PROMs), revision surgeries, ED visits, and re-admissions were collected. THA and TAA patients were then propensity score matched at 2:1 ratio for age, sex, race, BMI, ASA, and comorbidities, resulting in a final cohort of 844 THAs and 455 TAAs for comparison. There were similar pre-operative PROMIS Pain Interference (PI) scores between THA and TAA, with both showing improvement at six weeks. However, THA patients exhibited lower PI scores at one year (53.0 versus 54.0; p=0.009). Pre-operative PROMIS Physical Function (PF) was worse in THA patients but showed greater improvement compared to TAA patients at both six weeks (p<0.001) and one year (p<0.001). Pre-operative PROMIS depression scores were similar and improved similarly in both groups. Joint-specific PROMs (HOOS for THA and FAAM for TAA) improved in both cohorts. THA demonstrated superior survivorship free of all-cause revision at five years compared to TAA (95% versus 77%; p<0.0001). Patients undergoing THA or TAA experienced significant improvements in their general and joint-specific PROMs post-operatively. However, patients undergoing THA demonstrated higher PROMIS PI and PF scores at one-year when compared to TAA, as well as improved survivorship. Generic PRO instruments enable comparison of medical treatments in different anatomic sites to the patients overall health

Dislocation following revision THA remains a leading cause of failure. Integrity of the abductor muscles is a major contributor to stability. Large diameter heads (LDH), Dual Mobility (DM) and Constrained Acetabular Liners (CAL) are enhanced stability options but the indication for these choices remains unclear. We assessed an algorithm based on Gluteus Medius (GM) deficiency to determine bearing selection. Default choice with no GM damage was a LDH. GM deficiency with posterior muscle intact received DM and CAL for GM complete deficiency with loss of posterior muscle. Consecutive revision THA series followed to determine dislocation, all-cause re-revision and Oxford Hip Score (OHS). 311 revision THA with mean age 70 years (32–95). At a mean follow-up of 4.8 years overall dislocation rate 4.1% (95%CI 2.4–7.0) and survivorship free of re-revision 94.2% (95%CI 96.3–91.0). Outcomes:. Group 1 - LDH (36 & 40mm) n=164 / 4 dislocations / 7 re-revisions. Group 2 - DM n=73 / 3 dislocations / 4 re-revisions. Group 3 - CAL n=58 / 5 dislocations / 7 re-revisions. Group 4 - Other (28 & 32mm) n=16 / 1 dislocation / no re-revisions. Mean pre-op OHS: 19.6 (2–47) and mean post-op OHS: 33.9 (4–48). Kaplan-Meier analysis at 60 months dislocation-free survival was 96.1% (95% CI: 93.0–97.8). There was no difference between survival distributions comparing bearing choice (p=0.46). Decision making tools to guide selection are limited and in addition soft tissue deficiency has been poorly defined. The posterior vertical fibres of GM have the greatest lateral stabiliser effect on the hip. The algorithm we have used clearly defined indication & implant selection. We believe our outcomes support the use of an enhanced stability bearing selection algorithm

The results of total hip arthroplasty (THA) revisions to correct leg length discrepancy (LLD) are not clear, with only two former limited series (< 25 patients). Therefore, we conducted a retrospective study of THA revisions for LLD to determine: 1) the change in LLD, 2) the function outcomes and whether obtaining equal leg lengths influenced function, 3) the complication and survival rates. This multicenter study included 57 patients: 42 THA revisions for limb shortening and 15 revisions for limb lengthening. LLD was measured on conventional radiographs and EOS. The Oxford-12 and FJS outcome scores were collected and the number of patients achieving the Oxford-12 MCID. The revisions were carried out a mean of 2.8 years after the index THA. The median LLD decreased from 7.5 mm (IQR: [5;12]) to 1 mm (IQR: [0.5;2.5]) at follow-up (p=0.0002). Overall, 55 of 57 patients (96%) had < 5 mm LLD at follow-up and 12 patients (21%) had equal leg lengths. The complication rate was 25%: 12 mechanical complications (8 periprosthetic femoral fractures, 2 stem loosening and 1 cup loosening, 1 dislocation) and 1 periprosthetic infection. The patient satisfaction was high with a median FJS of 79.2/100 and 77% of patients reached the Oxford-12 MCID. Lengthening procedures had significantly worst function than shortening (38% vs 91% of patients achieving the Oxford-12 MCID (p=0.0004)). Survivorship was 85% (95% CI: 77.9 – 92.5) at 2 years and 77% (95% CI: 66.3 – 87.1) at 4.6 years when using re-revision for any reason as the endpoint. When LLD after THA does not respond to conservative management, revision THA should be considered. Although revision THA for LLD improved medium-term functional outcomes with a high patient satisfaction rate, especially for shortening procedures, the complication rate was high, particularly related to periprosthetic femoral fracture

In 1997 the Birmingham Hip Resurfacing was introduced to address the needs of young active patients. Alternative designs were introduced to try and improve wear performance. The aim of this study was a comparative cohort study of two types of metal-on-metal bearing to determine the mechanism of failure at 15 years. The study reviewed 91 Brimingham Hip Resurfacings (BHR) (Smith and Nephew) and 715 DUROM hip resurfacing (Zimmer) procedures in prior to 2009. Failure was defined as revision of either component for any reason. Kaplan-Meyer survivorship analysis performed. Routine follow-up with serum metal ion levels and radiographs. Mean follow-up was 17.9 years (range 15.2 – 25.1). The mean age at operation was 51.6 years (SD 8.6, range 20.7 to 70.2), including 299 women (37.1%). The Birmingham resurfacing demonstrated 92.3% survivorship at 15 years (SE 2.8, 95% CI 3.9 – 7.8) and 90.0% at latest follow-up (SE 3.5, 95% CI 4.9 to 9.4). By comparison, the DUROM survivorship at 15 years was 89.1% at 15 years (SE 1.2, 95% CI 2.0 to 2.5) and 87.4% (SE 1.3, 95% CI 2.5 to 2.3) at latest follow-up. There was no statistically significant difference in survivorship between groups (p= 0.32). Survival in male patients was 92.7% compared to 80.0% in females. The reported failures occurred from Adverse Reaction to Metal Debris (32 patients), periprosthetic femoral neck fracture (6) and aseptic loosening (41), PJI (12) and undiagnosed pain (6). The mean cobalt and chromium levels at last follow-up were 33.4 nmol/L and 36.5 nmol/L respectively. This study demonstrates two differently designed metal-on-metal hip resurfacing provided a durable alternative to total hip replacement, particularly in younger male patients with osteoarthritis. Differences in design did determine the reason for revision with acetabular fixation being one of the principal failure mechanisms for the DUROM compared to elevated ion levels

Objective. The purpose of this study was to determine the outcomes of revision ankle replacements, using the Invision implant and impaction allograft for massive talar dome defects following primary ankle replacement failure. Outcomes were assessed in terms of bone graft incorporation; improvement in patient reported outcome measures (PROMs); and survivorship of the revision ankle arthroplasty. Methods. A retrospective review of prospectively collected data identified eleven patients who had massive bone cysts and underwent revision of a failed primary total ankle replacement to the Invision revision system, combined with impaction grafting using morselized femoral head allograft. These revisions occurred at a single high volume ankle arthroplasty centre. Computed tomography (CT) scans were used to assess bone graft incorporation and the Manchester-Oxford Foot Questionnaire (MOXFQ) and EQ-5D scores were used pre and post operatively to assess PROMs. Results. The mean follow up was 18 months (12–48months). In all eleven patients, improvement was reported in the post-operative MOXFQ and EQ-5D scores. CT scans showed bone graft incorporation in all cases. None of the patients have required further surgery and are continue to do well clinically at latest follow up. Conclusions. In the short term, this study confirms revision ankle replacements with the Invision prosthesis and impaction with morselized femoral head allograft is a suitable revision option for primary ankle replacement failure with massive talar bone loss. Long term follow up continues of these complex patients

Introduction. Charcot neuroarthropathy is a debilitating condition that frequently leads to skeletal instability, and has an increased risk of ulceration leading to infection and amputation. However, surgical reconstruction may offer limb salvage and restauration of an ulcer-free, plantigrade stable foot for functional weight-bearing. We report on our case series according to a prospective protocol and analyse factors leading to a favourable outcome. Methods. We report a prospective follow-up of 62 patients undergoing Charcot reconstruction, May 2014- Jan 2022, by two surgeons. Peripheral vascular disease was routinely assessed using Duplex scan and major arterial disease was treated before reconstruction. Utilising 3D modelling, pre-operative planning and standardised osteotomies, we performed anatomical correction with radiological evidence. Definitive fixation was undertaken with internal fixation to stabilise the hindfoot. Multivariant analysis was performed to assess risk factors for failure (P>0.05 statistical significance). Results. 59 feet were included, 3 patients did not progress to definitive surgery and 3 patients had bilateral surgery. 62.7% patients were male with an average age of 56, 88.13% had Type 2 diabetes, 56% were hypertensive, 14% were on dialysis. Twenty (54.1%) single stage reconstructions had pre-operative ulceration, 3 pts had ischaemic heart disease and 36 pts had evidence of peripheral arterial disease. 81% of patients achieved normalisation of the 3 out of 4 anatomical angles (P<0.05). Two patients (3.1%) required metalwork removal for infection and limb salvage, 11 (18.6%) had delayed wound healing. Survivorship was 97% at 3yrs, and 94% at 6yrs, however if pre-existing vascular disease was present, it was 94% at 3yrs 85.3% at 6yrs. All patients were mobile at a 3 years mean follow up. Conclusion. Careful patient selection, multidisciplinary team and anatomic reconstruction led to predictable outcomes and functional limb salvage. Pre-operative vascular compromise led to a slight reduction in survivorship, but no major amputation

Introduction. Despite the increasing numbers of ankle replacements that are being performed there are still limited studies on the survival of ankle replacements and comparisons between different implants. The primary aim of this study is to link NJR data with NHS digital data to determine the true failure rates of ankle replacements. Secondary outcomes include analysis risk factors for failure, patient demographics and outcomes of individual prosthesis. Methods. A data linkage study combined National Joint Registry Data and NHS Digital data. The primary outcome of failure is defined as the removal or exchange of any components of the implanted device inserted during ankle replacement surgery. Life tables and Kaplan Meier survival charts demonstrated survivorship. Cox proportional hazards regression models with the Breslow method used for ties were fitted to compare failure rates. Results. 5,562 primary ankle replacement were recorded on the NJR. The 1-year survivorship was 98.8% (95% CI 98.4%–99.0%), 5-year survival in 2725 patients was 90.2% (95% CI 89.2%–91.1%), and 10-year survival in 199 patients was 86.2% (95% CI 84.6%–87.6%). When using a Cox regression model for all implants with over 100 implantations using the Infinity as the reference, only the Star (Hazard ratio 1.60 95% CI 0.87–2.96) and Inbone (HR 0.38 95% CI 0.05–2.84) did not produce significantly worse survivorship. Conclusion. Ankle replacements have increased in numbers over the past decade, and the currently used implants have lower failure rates than older prosthesis. It is expected that in the future the outcomes of ankle replacements will continue to improve

The June 2024 Knee Roundup³⁶⁰ looks at: The estimated lifetime risk of revision after primary knee arthroplasty influenced by age, sex, and indication; Should high-risk patients seek out care from high-volume surgeons?; Stability and fracture rates in medial unicondylar knee arthroplasties; Rethinking antibiotic prophylaxis for dental procedures post-arthroplasty; Evaluating DAIR: a viable alternative for acute periprosthetic joint infection; The characteristics and predictors of mortality in periprosthetic fractures around the knee; Patient health-related quality of life deteriorates significantly while waiting six to 12 months for total hip or knee arthroplasty; The importance of looking for diversity in knee implants.