To review prospectively collected data on patients undergoing femoral revision arthroplasty for failed cemented or cementless primary stems.

Aim

This prospective randomised controlled trial aims to compare the clinical and radiological outcomes of ceramic on ceramic, cobalt chrome on ultra-high molecular weight polyethylene, and cobalt chrome on highly cross-linked polyethylene bearing surfaces at a minimum of five years.

We designed this study to determine the clinical evidence to support use of the five degree tibial extra-medullary cutting block over the zero degree cutting block.

We identified three groups of patients from the databases and clinical notes at St Michaels Hospital, Toronto. Group one were primary total knees performed using the five degree cutting block, group two were primary total knees performed using the zero degree cutting block and the third group were computer navigated primary total knees. Patients in all three groups were age and sex matched. The senior author advocating use of the five degree block aimed to obtain a five degree posterior slope. The senior author who advocated the use of computer navigation, or the traditional zero degree cutting block, aimed to obtain a three degree posterior slope. All operations were performed by residents or clinical fellows, under the supervision of the senior authors. Patient radiographs were assessed to obtain the optimal direct lateral view obtained and they were saved on a database. Two independent blinded researchers assessed the posterior slope using Siemens Magicweb Software Version VA42C_0206. Two methods were used and the results averaged. The average posterior slope for the navigated total knee replacements was 0.1 degrees (−2 to 4). The average posterior slope for the five degree cutting block was 5.2 degrees (−2 to 16). The average posterior slope for the zero degree block was 3.79 degrees (−2 to 13). Computer navigated knee arthroplasty patients had significantly less variation in outlier measurements compared to the traditionally jigged arthroplasty patients. They were however, less accurate. The five degree cutting block tended to provide a more consistent posterior slope angle, but both the five degree and zero degree cutting blocks had variability in outliers. Computer Navigated Total Knee replacement provides a more consistent and reproducible tibial cut with less variability in alignment than extra-medullary jigs. The traditional five degree cutting block tended to provide a more reliable five degree posterior slope than the zero degree block, but was still subject to outliers.

The purpose of this study was to evaluate total hip arthroplasty (THA) in the treatment of post-traumatic arthritis following acetabular fracture and to compare the long-term outcome of THA after previous open reduction and internal fixation (ORIF) or conservative treatment of the acetabular fracture.

Thirty-four patients (thirty-six hips) underwent total hip arthroplasty for arthritis resulting from acetabular fractures. There were twenty-six males (27 hips) and eight females (9 hips). The mean age at the time of hip arthroplasty was 49 years (range, 25-78 years). The mean follow-up was eight years and nine months (range, 4-17 years). The mean interval from fracture to arthroplasty was 7.5 years (range, 5 months-29 years). Two patients died of unrelated causes and two patients were lost to follow-up. Thirty patients (32 hips) were available for latest follow-up. Twenty-one hips had been previously treated by open reduction internal fixation and 11 hips had conservative treatment.

Sixteen patients achieved and maintained a good to excellent result over the course of the follow-up. There was no difference in improvement of mean Harris Hip Score between both groups (p>0.05). Ten out of 32 hips required revision; 9 acetabular components were revised because of aseptic loosening (3), osteolysis/excessive wear (4), instability (1) and infection (1) with a total revision rate of 28%. Eight patients needed acetabular revision alone, one femoral revision alone and one revision of both components. There was no significant difference in bone grafting, heterotopic bone formation, revision rate, operative time and blood loss between the two groups (p> 0.05).

Those patients initially treated conservatively had similar long term results compared to those treated primarily by open reduction internal fixation. At long term follow-up the main problem identified was osteolysis and acetabular wear.

We aimed to identify whether patients in lower socioeconomic groups had worse function prior to total knee arthroplasty and to establish whether these patients had worse post-operative outcome following total knee arthroplasty.

Data were obtained from the Kinemax outcome study, a prospective observational study of 974 patients undergoing primary total knee arthroplasty for osteoarthritis. The study was undertaken in thirteen centres, four in the United States, six in the United Kingdom, two in Australia and one in Canada. Pre-operative data were collected within six weeks of surgery and patients were followed for two years post-operatively. Pre-operative details of the patient's demographics, socioeconomic status (education and income), height, weight and co-morbid conditions were obtained. The WOMAC and SF-36 scores were also obtained. Multivariate regression was utilised to analyse the association between socioeconomic status and the patient's pre-operative scores and post-operative outcome. During the analysis, we were able to control for variables that have previously been shown to effect pre-operative scores and post-operative outcome.

Patients with a lower income had a significantly worse pre-operative WOMAC pain (p=0.021) and function score (p=0.039) than those with higher incomes. However, income did not have a significant impact on outcome except for WOMAC Pain at 12-months (p=0.014). At all the other post-operative assessment times, there was no correlation between income and WOMAC Pain and WOMAC Function. Level of education did not correlate with pre-operative scores or with outcome at any time during follow-up. This study demonstrates that across all four countries, patients with lower incomes appear to have a greater need for total knee arthroplasty. However, level of income and educational status did not appear to affect the final outcome following total knee arthroplasty. Patients with lower incomes appear able to compensate for their worse pre-operative score and obtain similar outcomes post-operatively.