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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_7 | Pages 40 - 40
1 Jul 2022
Prodromidis A Chloros G Thivaios G Sutton P Veysi V Giannoudis P Charalambous C
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Abstract

Introduction

Higher than expected rates of tibial loosening with the ATTUNE® total knee arthroplasty (TKA) implant has been reported. Component loosening can be associated with the development of radiolucency lines (RLL) and our study aim was to systematically assess the reported rates of these.

Methodology

A systematic search was undertaken using the Cochrane methodology in four online databases. Identified studies were assessed and screened against predetermined inclusion criteria. Meta-analysis was conducted using a random-effects model.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_9 | Pages 36 - 36
1 May 2018
Jain S Magra M Dube B Veysi V Whitwell G Aderinto J Emerton M Stone M Pandit H
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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.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IV | Pages 15 - 15
1 Mar 2012
Metcalf R Thambapillay S Veysi V Stone M
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Our aim was to highlight that there is a sub-group of patients with disabling symptoms after leg lengthening at primary hip replacement who benefit from revision surgery.

Most patients with an over lengthened limb after total hip arthroplasty are either asymptomatic or find it an inconvenience which can often be treated with a shoe raise. A minority, however, find this severely debilitating, patients describing that the leg “feels long”, with pain felt around the hip, difficulty sitting and limited function. It is this sub-group of patients that we feel benefit from revision surgery to equalise leg lengths.

We report on 8 cases (6 female; 2 male) that underwent revision surgery for leg lengthening over a 7 year period . The mean leg length difference was 14.3mm (range 10-20mm). Five patients had revision of the stem only and the remaining 3 both cup and stem. Time to revision varied from 8 months to 3 years. We outline our method of radiological measurement of leg length after total hip arthroplasty, using the centre of hip rotation as the reference point. Individual cases are discussed with radiographs highlighting the typical clinical features and this radiological technique.

All patients reported an immediate improvement in their symptoms following revision surgery and have remained pleased with the outcome at their latest follow up.

Leg lengthening as a result of total hip arthroplasty is well recognised but its treatment remains controversial. There is a sub-group of patients who are particularly sensitive to over lengthening, often of short stature. We reiterate that this revision surgery is beneficial to the patient with a lengthened leg ONLY if they have significant symptoms and limitation of function. Our small series emphasises the need to recognise this group of patients who can achieve a successful outcome after revision surgery.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_I | Pages 36 - 37
1 Jan 2011
Giannoudis P Veysi V Paliobeis C Kanakaris N Barlow I
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Our aim was to investigate the incidence and outcome of chest injuries after blunt trauma in patients admitted in a level I trauma centre over a 6-year period. This is a review of prospectively collected data (1996–2002); part of the (TARN-UK) data. Patients divided in 6 subgroups based on the chest AIS. Univariate analysis identified factors predicting mortality and a backward stepwise logistic regression multivariate analysis determined relationships with outcome.

There were 1,164 patients with chest injuries. The mean overall severity of chest injuries was 3.15+/−1.01. The commonest mechanism of injury was RTAs (57.01%). Rib fractures were the most common injuries (395 patients, 34%) associated with lung contusions in 12.9%. Admission GCS was highest in chest-AIS subgroup 2 and was significantly higher in groups 1 and 3. Complications, invasive operations, and investigations were more common with increasing chest-AIS. The ICU-admissions and the mean length-of-stay were similar for chest-AIS1 and 2, but significantly higher for the rest. Half of the AIS1 patients had associated head injuries; the lowest percentage was in subgroup 2 (18.8%). There was a variable correlation of abdominal injury severity with severity of chest injury. There was a significant difference in mortality rates between group 2 and group 1 and -3. The average time to death in those with chest-AIS1 was significantly lower than the average time in those with AIS4 and 5.

Patients in the higher AIS groups had both a higher overall ISS and mortality rate. Minimal chest injury severity (AIS1) showed higher ISS and significantly higher mortality compared with chest-AIS2,3. This has been attributed to the fact that the chest is spare as most of the impact during the course of the accident is been absorbed by the head (head injury). This theory also explains the shorter time period of death seen in patients belonging to the chest AIS1 group.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 537 - 537
1 Aug 2008
Veysi V Metcalf R Shutt D Gillespie P Stone M
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Introduction: We present our results of the first 413 Charnley arthroplasties performed by and under the supervision of the senior surgeon, using the posterior approach.

Methods: This is a prospective study of clinical and radiographic outcomes. Four hundred and thirteen hip replacements were performed in 380 patients (215 female and 165 male) between 1992 and 1996. The mean age at the time of primary surgery was 67 years (28 – 91 years).

Results: The primary aetiology in 297 of the hips was osteoarthritis. Eighty-two had rheumatoid arthritis.

Eleven patients (3%) had one or more episodes of dislocation.

There were 22 revisions. Three of the revisions were carried out for infection, and a further 2 for recurrent dislocation. Aseptic loosening was the cause of failure in the remaining 17.

Thirty three patients (36 hips, 9%) could not be traced at the time of the final follow-up. There was significant and maintained improvement in pain and function scores.

One hundred and thirty eight patients (146 hips) had died at the time of the final follow-up.

The best and worst case survivorship figures at 10 years were 93 +/− 2% and 83 +/− 2%, and those at 14 years were 88 +/− 4% and 78 +/− 4%, respectively, with revision for any reason as the end-point.

Discussion: Excellent results for the Charnley hip are possible using the posterior approach and surgeons of varying experience. The results presented compare favourably with the published data and confirm that the Charnley remains the gold-standard for longevity in hip arthroplasty. The newer and more costly implants not only need to reproduce these results but also match the cost effectiveness of this prosthesis.