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Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_1 | Pages 62 - 62
1 Jan 2016
Burns S Soler JA Cuffolo G Sharma A Kalairajah Y
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Introduction

Acetabular revision for cavitary defects in failed total hip replacement remains a challenge for the orthopaedic surgeon. Bone graft with cemented or uncemented revision is the primary solution; however, there are cases where structural defects are too large. Cup cage constructs have been successful in treating these defects but they do have their problems with early loosening and metalwork failure.

Recently, highly porous cups that incorporate metal augments have been developed to achieve greater intra-operative stability showing encouraging results.

Methods

Retrospective analysis of twenty-six consecutive acetabular revisions with Trabecular Titanium cups. Inclusion criteria included aseptic cases, adult patients, end-stage disease with signs of loosening, no trauma nor peri-prosthetic fractures.

Data was obtained for patient demographics, Paprosky classification, use of bone graft, use of acetabular augment, and Moore index of osseointegration.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_4 | Pages 28 - 28
1 Jan 2016
Stirling P Mannambeth RV Soler JA Batta V Malhotra RK Kalairajah Y
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Introduction

Increased accuracy of pre-operative imaging in patient-specific instrumentation (PSI) can result in longer-term savings, and reduced accumulated dose of radiation by eliminating the need for post-operative imaging or revision surgery. The benefits and drawbacks of CT vs MRI for use in PSI is a source of ongoing debate. This study reviews all currently available evidence regarding accuracy of CT vs MRI for pre-operative imaging in PSI.

Methods

The MEDLINE and EMBASE databases were searched between 1990 and 2013 to identify relevant studies. As most studies available focus on validation of a single technique rather than a direct comparison, the data from several clinical studies was assimilated to allow comparison of accuracy. Overall accuracy of each modality was calculated as proportion of outliers >3 % in the coronal plane.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 212 - 212
1 May 2011
Patel S Haddad F Soler JA Tahmassebi J Wardle N Hossain F
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Introduction: The bearing surface of total hip arthroplasty (THA) is a key factor in implant survivorship. Ceramic bearings have enhanced wear properties though are prone to fracture and thus Oxinium has been developed as an alternative. The aim of our study was to compare the its wear properties against cobalt-chrome which is currently the most widely used femoral head bearing surface in THA.

Methods: We prospectively randomized 270 consecutive patients undergoing THA at one institution into three groups: Groups I, II and III. Group I received a cobalt-chrome femoral head and cross-linked poly-ethylene (XLPE) liner; Group II received an oxinium femoral head and ultrahigh molecular weight polyeth-ylene (UHMWPE) liner; Group III received an oxinium femoral head and cross-linked polyethylene liner. 32 mm heads were used in all the cases. Patients were longitidunally followed up with clinical evaluation and standardised radiographs of the pelvis and hip. Using DICOMeasure software, we calculated the linear and volumetric wear rate for each group to determine if a difference existed.

Results: The demographics and comorbid conditions were similar between the groups. The survivorship of all components was 100% in all groups at 2 years. No patients were lost to follow-up. After the first 6 months of creep, the rate of linear wear over 2 years was 0.16mm for Group I, 0.10mm for Group II, and 0.06mm for Group III. ANOVA testing demonstrates statistical significance between the groups (P < 0.05).

Discussion and Conclusion: Our results demonstrate that the wear rate using 32mm Oxinium heads is significantly lower than that for cobalt-chrome heads and this effect is dramatically enhanced when used in combination with highly cross linked polyethylene.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 548 - 548
1 Aug 2008
Soler JA Haddad F Barrack RL
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Introduction: Third generation fixation systems allow for the retightening of cables, and are associated with high rates of trochanteric union. This is a prospective study undertaken to evaluate the outcome of the first 40 patients treated with a third generation cable plate and trochanteric hook system.

Methods: 36 patients treated by two revision hip arthroplasty surgeons using a third generation cable plate system were enrolled and followed up. These included 28 females and 12 males with an average age of 64 (range: 48–91). Large hooks were used in 30 with an average of 4.8 cables (range: 4–9). The need to retighten cables intra-operatively was noted. Clinical and radiographic follow-up was undertaken at 2 years.

Results: A third generation fixation system was used for 16 peri-prosthetic fractures, 6 trochanteric non unions, 5 structural femoral allografts, 6 complex revisions and for trochanteric advancement in 3 cases. The first cable tightened was loose by the end of the procedure in the majority of cases and had to be retightened. There were no cases of fretting or cable breakage. Two further trocanteric non unions needed re-fixation and bone grafting in a further procedure

Discussion and Conclusion: Third generation cable system allow for re-tightening, as the cable is not damaged by the crimping mechanism. This facility appears critical as some retightening is invariably required in the process of applying this type of device. There were only 2 re-operations for trochanteric non unions, but the overall outcomes were otherwise excellent, with no fretting or cable breakage. Modern cable systems afford improved, more flexible trochanteric fixation possibilities.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 353 - 353
1 Jul 2008
Soler Fernandez JA Gidwani S Dinah F Curtis M
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Shoulder rotator cuff tears can be very debilitating and painful. Whilst massive tears may defy attempts at surgical repair due to the size of the defect, various biological materials have been proposed to reinforce tenuous repairs; initial results have been promising. It has been suggested that these materials may be used to bridge defects in the rotator cuff as a ‘patch’ or ‘interposition implant’ to provide pain relief and even offer some hope of functional recovery. A porcine dermal collagen implant (Permacol ©) has been engineered and introduced for the repair and reconstruction of soft tissues in the human body. In orthopaedics, it has been successfully used in the reinforcement and augmentation of rotator cuff repairs by suturing it over the repaired tendon. Proper et al reported good short term results in using this implant to bridge defects in massive rotator cuff tears and suggested it was good solution for this group of patients, reporting improvement in all aspects of the Constant Score. We have used Permacol © to reinforce cuff repairs with satisfactory results and thus considered its use as a salvage procedure to bridge massive rotator cuff defects, both of traumatic and degenerate origins. Unfortunately, we have seen with great concern that our results have been less than satisfactory. In a cohort of 20 patients who underwent Permacol © interposition / rotator cuff repair, 4 of these have failed, despite a promising initial recovery phase with good pain relief. We believe that use of this and similar implants to bridge a defect in the cuff is not indicated; MRI and dynamic ultrasound examination showed an inflammatory response in the shoulder, and resulting weakness/failure of the implant. We present clinical, radiographic, and histological findings of our experience and a discussion as to the probable cause for the failure of this implant in this particular group of patients.