Introduction: Although
Introduction. Corrosion products from modular taper junctions of hip prostheses have been implicated in adverse local tissue reactions after
Background. As the number of ceramic
Introduction: Total hip replacement (THR) and total knee replacement (TKR) are widely accepted as effective surgical procedures to alleviate chronic joint pain and improve functional ability. Clinical evidence suggests that joint replacement results in excellent outcomes. Traditionally, reporting of outcomes has been focused on implant survivorship and surgeon based assessment of objective outcomes, such as range of motion, knee stability and radiographic results. However, because there is a discrepancy between patient and clinician ratings of health, patient-reported outcome measures have been validated to allow patients to rate their own health, thereby placing them at the centre of outcome assessment. The aim of this study was to compare the mid-term functional outcomes of TKR and
The current, most popular recommendation for cup orientation, namely the Lewinnek box, dates back to the 70's, that is to say at the stone age of hip arthroplasty. Although Lewinnek's recommendations have been associated with a reduction of dislocation, some complications, either impingement or edge loading related, have not been eliminated. Early dislocations are becoming very rare and most of them probably occur in “outlier” patients with atypical pelvic/hip kinematics. Because singular problems usually need singular treatments, those patients need a more specific personalised planning of the treatment rather than a basic systematic application of Lewinnek recommendations. We aim in this review to define the potential impacts that the spine-hip relations (SHRs) have on hip arthroplasty. We highlight how recent improvements in hip implants technology and knowledge about SHRs can substantially modify the planning of a
The current, most popular recommendation for cup orientation, namely the Lewinnek box, dates back to the 70's, that is to say at the stone age of hip arthroplasty. Although Lewinnek's recommendations have been associated with a reduction of dislocation, some complications, either impingement or edge loading related, have not been eliminated. Early dislocations are becoming very rare and most of them probably occur in “outlier” patients with atypical pelvic/hip kinematics. Because singular problems usually need singular treatments, those patients need a more specific personalised planning of the treatment rather than a basic systematic application of Lewinnek recommendations. We aim in this review to define the potential impacts that the spine-hip relations (SHRs) have on hip arthroplasty. We highlight how recent improvements in hip implants technology and knowledge about SHRs can substantially modify the planning of a
Introduction:. Ankle arthritis is a leading cause of pain and disability. The effect of this condition on physical and mental health is similar to end stage hip arthritis. There is paucity of literature on PROMS following total ankle replacements (TAR) in comparison to total hip replacement (THR) or knee replacement (TKR). We aimed to study 5 year outcomes of TAR in comparison with TKR and
Aims: Elevated serum cobalt and chromium ion levels associated with carcinogenesis and chromosomal damage in animals has raised concerns that metal-on-metal (MOM) total hip replacement (THR) in humans may produce the same effects over time. Considering that the risks may be related to the level of these ions in the body, this study compared the serum cobalt and chromium ion levels in patients with unilateral versus bilateral 28 mm diameter MOM
Introduction: Outcome reporting following
In order to enhance the acceptance of computer assisted surgery in joint replacement, a development-cooperation with BrainLAB, Germany was set up to develop a user-friendly handheld navigation device. A sterile draped Apple® IPod-Touch which is placed into a hardcover cradle, is used as navigation monitor and touchscreen control. Different instruments, such as navigation-pointer are attached to the cradle. In addition the workflows for TKR and
Introduction. A recent report based on the NARA database (Nordic Arthroplasty Register Association) found that the 10-year survivorship of patients under 50 with traditional total hip arthroplasty was only 83% in 14,600 cases. The purpose of this study was to compare our experience using metal-on-metal hip resurfacing arthroplasty (HRA) to treat these patients. Methods. from May 2001 to Feb 2012, a single surgeon performed 1029 metal-on-metal HRA in 855 patients younger than 50 years old. Three different implants were used in consecutive groups of patients, first the Corin hybrid HRA (182); then the Biomet hybrid HRA (306); and finally the Biomet uncemented HRA (541). The primary diagnoses were OA (707); dysplasia (125); osteonecrosis (98); post-trauma (28); Legg-Calve-Perthes (27) and others (44). The average age was 43±6 years; 74% were men; the average BMI was 27±4; mean femoral component size was 50±4 (range 40–62); the average T-score was 0±1. 37% of our patients reported a UCLA Activity level of 9 or 10 (impact sports). Six died with causes unrelated to their HRAs. The rate of follow-up was 94%. Our patients were not selected by any criteria except the surgeon's technical ability to perform an HRA. Results. There were a total 42 failures: acetabular component loosening in 15 cases (8 before two years) femoral component loosening in 9 cases; femoral neck fracture in 5 cases; adverse wear related failure (AWRF) in 4 cases; deep infection in 3 cases; recurrent dislocation in 1 case; other causes in 5 cases. With revision of any component as the end point, the Kaplan-Meier survivorship rate was 94.9% at 8 years and 92.5% at 10 years for the entire group. We compared survivorship between groups at shorter follow-up intervals to determine if results were improving. The survivorship rate at 8 years for Biomet Hybrid group was 95.8%, which was significantly better than 89.1% for the earlier Corin Hybrid group; the survivorship rate at 5 years for the latest Biomet Uncemented HRA group was 98.7%, also better than 96.5% for the prior Biomet Hybrid group. (P=0.0001). Conclusion. Metal-on-metal hip resurfacing has less than half the 10-year failure rate of
The choice to use alumina in the manufacture of a low-wear
Introduction: Hip resurfacing has been promoted as a procedure that results in a better outcome in sporting and work activity after surgery compared to total hip replacement (THR). Recently more standard THRs have offered the same large metal on metal joint articulation but using a standard stem. Method: Questionnaires were analysed from 125 metal on metal total hip replacement (THR) and 108 hip resurfacing (HR) patients regarding participation in sport and returning to work at a minimum of a year after surgery. Results: The two groups had similar mean age (61 vs 60) and pre-operative Oxford hip scores (41 vs 38). Seventy-one of 125
There is a critical need for safe innovation in total joint replacements to address the demands of an ageing yet increasingly active population. The development of robust implant designs requires consideration of uncertainties including patient related factors such as bone morphology but also activity related loads and the variability in the surgical procedure itself. Here we present an integrated framework considering these sources of variability and its application to assess the performance of the femoral component of a total hip replacement (THR). The framework offers four key features. To consider variability in bone properties, an automated workflow for establishing statistical shape and intensity models (SSIM) was developed. Here, the inherent relationship between shape and bone density is captured and new meshes of the target bone structures are generated with specific morphology and density distributions. The second key feature is a virtual implantation capability including implant positioning, and bone resection. Implant positioning is performed using automatically identified bone features and flexibly defined rules reflecting surgical variability. Bone resection is performed according to manufacturer guidelines. Virtual implantation then occurs through Boolean operations to remove bone elements contained within the implant's volume. The third feature is the automatic application of loads at muscle attachment points or on the joint contact surfaces defined on the SSIM. The magnitude and orientation of the forces are derived from models of similar morphology for a range of activities from a database of musculoskeletal (MS) loads. The connection to this MS loading model allows the intricate link between morphology and muscle forces to be captured. Importantly, this model of the internal forces provides access to the spectrum of loading conditions across a patient population rather than just typical or average values. The final feature is an environment that allows finite element simulations to be run to assess the mechanics of the bone-implant construct and extract results for e.g. bone strains, interface mechanics and implant stresses. Results are automatically processed and mapped in an anatomically consistent manner and can be further exploited to establish surrogate models for efficient subsequent design optimization. To demonstrate the capability of the framework, it has been applied to the femoral component of a
Background: Resurfacing is becoming increasingly popular as an option for primary hip arthroplasty. However, there is minimal documentation of objective post-operative outcomes which support the perceived benefits of resurfacing over traditional stemmed
Introduction: The hip resurfacing in younger patients is being performed more frequently in the UK. At the same time conventional Total Hip Replacement (THR) is also being performed.. We carried out a study to compare the patient satisfaction and outcome following Birmingham Hip Resurfacing (BHR) and Total Hip Replacement (THR) in patients below the age of 55 years. Methods: There were 93 BHR in 73 patients and 74
Summary Statement. This data may help explain the variability in physical function after primary TKR as compared to primary
Introduction. The benefits of femoral head-neck modularity in hip surgery have been recognized for decades. However, reports of head/neck taper fretting & corrosion has led to research being conducted, yet the clinical effect of these processes remains unclear. Whilst femoral head size, material and the characteristics of the taper have been a focus of research, potential contributing variables such as in vivo head-neck assembly technique on the performance of these connections is not clear. We performed an observational study to investigate variation in femoral head-neck taper assembly during surgery, with the initial focus being the number of head impactions. Methods. From May 2013 to October 2014, nineteen surgeons who specialized in hip surgery from a wide demographic (North America, Europe and Asia) participated in a video review on current surgical practice in total hip arthroplasty (THA). The surgeons were unaware of any specific parameter, including taper assembly, which would subsequently be analyzed. Twenty-seven THA surgeries were reviewed against a specific set of questions relating to factors in the modular femoral head-neck assembly process. The focus of the current study was the number of impaction blows to seat the modular femoral head on the implanted stem. Results. Variation occurred in the number of observed impactions used to assemble the components with an impaction range from 1 to 11 (Figure 1). The two most favored number of impaction strikes were a single strike (37% of reviewed cases) and three strikes (22% of reviewed cases). Further variability was observed between individual surgeon cases where number of strikes was different in each observed case. This occurred on two occasions with two different surgeons. The impaction number was found to be independent of the side operated on (left or right) and also with the surgeons region of origin. However, a higher proportion of European surgeons favored 1–3 impactions (92% of European cases) compared to their North American (28.5% of North American Cases) and Asian (42.8% of Asian cases) counterparts. The impaction number variation was also independent of the material of the femoral head, with both metal and ceramic heads demonstrating this observed variation (Figure 2). Discussion. This observational review into the current surgical practice of femoral head assembly has shown that there is clear variation in this aspect of the
Introduction:. Total knee replacement (TKR) and total hip replacement (THR) reliably relieve pain, restore function, and ensure mobility in patients with advanced joint arthritis; however these results are not uniform across all patient populations. Moreover, it is well established that knee replacement patients have outcomes inferior to those undergoing hip replacement procedures with lower rates of dissatisfaction with post-operative function and pain relief. We compared baseline demographic and symptom profiles in patients from a US national cohort undergoing primary TKR and
Introduction: Metal on metal Hip Resurfacing Arthroplasty (MoMHRA) has gained popularity due to its perceived advantages of bone conservation and relative ease of revision to a conventional
Introduction. Mechanically-assisted corrosion of the head-neck junction present a dilemma to surgeons at revision
Introduction: The goal of the study was to compare the squeaking frequencies of Ceramic-on-Ceramic
The management of patients with displaced intra-capsular hip fractures is usually a hip hemiarthoplasty procedure. NICE guideline 124 published in 2011 suggested that Total Hip Replacement (THR) surgery should be considered in a sub group of patients with no cognitive impairment, who walk independently and are medically fit for a major surgical procedure. The Royal Devon and Exeter Hospital manages approximately 550 patients every year who have sustained a fracture of neck of femur, of which approximately 90 patients fit the above criteria. Prior to the guideline less than 20% of this sub-group were treated with a
Background: Whether to cross match or simply group and save for a primary
Introduction and Aims: Minimal Invasive Surgery (MIS) in
Introduction: In the Swedish health care system waiting time for
Background: Metal-on-metal (MOM) bearing surfaces with low diametric clearance possess a surface tension that prevents easy separation of the surfaces when lubricated. Potentially this ‘suction-fit’ may increase the torque required for dislocation. This study assessed the protective role of a MOM bearing surface as a single risk factor for dislocation. Method: Prospective data was recorded on a series of 229 patients undergoing 249 primary
Pelvic osteolysis secondary to polyethylene wear is a major complication following
Metal on Metal Hip Resurfacing Arthroplasty (MoMHRA) has gained popularity due to its perceived advantages of bone conservation and relative ease of revision to a conventional
The Birmingham Hip Resurfacing (BHR) has become increasingly popular for young active patients with severe OA of the hip. Although it has been in use in the UK since 1991, none were performed in NZ until late 2004. We have reviewed our initial results &
have compared them to a similar group of patients who received conventional total hip replacement (THR) with ceramic-on-ceramic bearings. All patients aged 65 years or less undergoing either BHR or ceramic-on-ceramic
The choice to use alumina in the manufacture of a low-wear
Hypothesis. The Synergy femoral component was introduced in 1996 as a second generation titanium proximally porous-coated tapered stem with dual offsets to help better restore femoral offset at
There is a lack of properly undertaken comparative studies of total hip replacement (THR). A randomised trial was established to examine the hypothesis that there are no important differences in clinical outcome at 2 years and at long-term follow-up between cemented and uncemented primary
Purpose. The purpose of the study was to determine the rate of conversion from RSA to
We undertook a retrospective audit to assess the effectiveness of use of Quixil in reducing the amount of blood transfusion requirements following revision
Introduction: The Birmingham Hip Resurfacing (BHR) system comprises both a BHR femoral head and a large modular femoral head for use should a total hip replacement be required. The modular femoral head has identical material chemistry, microstructure, spherical form, and surface roughness of the bearing surfaces of resurfacing femoral head and both BHR and
Purpose: A retrospective database analysis was conducted to. determine the extent to which the American College of Chest Physicians (ACCP) guidelines for VTE prophylaxis are followed after total hip replacement (THR) and total knee replacement (TKR) and. evaluate the incidence of VTE for patients receiving and not receiving prophylaxis according to ACCP guidelines (‘ACCP’ and ‘non-ACCP’, respectively). Method: A claims database associated with a large US health plan was linked to the Premier database, which provides details of in-patient medication use. Patients ≥18 years undergoing TKR/
Introduction: The tissue sparing direct anterior approach (DAA/MicroHip) has been developed to improve patients’ rehabilitation and long-term function. But there was no long term evaluation up to now. The approach is aligned along the interneural plane of Smith-Peterson, with complete preservation of the musculotendinous structures. The femoral neck oeteotomy is performed without dislocation or resection of the joint capsule. Because we perform the DAA without traction table no additional traction was applied to the soft tissues. Methods: 55 patients underwent traditional
Purpose: The Synergy femoral component was introduced in late 1996 as a second generation titanium proximally porous-coated tapered stem with dual offsets (standard &
high) to help better restore femoral offset at
Introduction: Although there is evidence that laminar flow operating theatres (LFOTs) can reduce the incidence of wound infection over standard operating theatres (STOTs) when no routine peri-operative antibiotics were used, the evidence for the use with concurrent parenteral antibiotics is less compelling. A number of prior studies have compared the bacterial load observed in LFOTs and STOTs by wound culture and air sampling during surgery. However many organisms responsible for low grade infection after
Introduction:. Femoral head surface roughness has been recognized as an important determinant of linear and volumetric polyethylene (UHMWPE) wear in total hip replacement (THR), particularly for metal heads. Fisher et al. 1. found that a 2- μm scratch with a 1- μm buildup of metal debris produced a 70-fold increase in the wear rate. Ceramic materials and hard-on-hard bearing couples have been introduced to provide more scratch resistance. However,
Metal-on-metal articulations are increasingly used in
Studies using roentgen stereophotogrammetric analysis (RSA) have shown that the femoral components of cemented total hip replacements (THR) migrate distally relative to the bone, but it is not clear whether this occurs at the cement-implant or the cement-bone interface or within the cement mantle. Our aim was to determine where this migration occurred, since this has important implications for the way in which implants function and fail. Using RSA we compared for two years the migration of the tip of the stem with that of the cement restrictor for two different designs of
Background. It is hypothesised that good torsional resistance of the acetabular cement mantle can increase the stability and longevity of cemented
Introduction: Implant loosening/pseudartrhosis after
From 01/1988 to 04/2001 224
Dislocation is the most relevant early complication after primary total hip replacement (THR) in literature. Many factors have been advocated for dislocation, either surgeon-related either patient-related. Component positioning seems to be of major importance in determining dislocation. We evaluated 152 randomised
A multicentre retrospective study of 879 total hip replacements (THR) was undertaken to investigate any differences in outcome between trainee surgeons and consultants. The effect of trainee supervision was also assessed. The primary outcome measures were survivorship and the Harris Hip Score (HHS). Length of stay was a secondary outcome. Patients were evaluated pre-operatively and at 1, 3, 5, 7 and 10 years post-operatively. Surgical outcome was compared between junior trainees, senior trainees and consultants. The effect of supervision was determined by comparing supervised and unsupervised trainees. There was no significant difference in post-operative HHS among consultants, senior and junior trainees at 1 year (p=0.122), at 3 years (p=0.282), at 5 years (p=0.063), at 7 years (p=0.875), or at 10 years (p=0.924) follow up. Additionally there was no significant difference in HHS between supervised and unsupervised trainees at 1 year (p=0.220), 3 years (p=0.0.542), 5 years (p=0.880), 7 years (p=0.953) and 10-year (p=0.787) follow-up. Comparison of surgical outcome between the supervised and unsupervised trainees also shows no significant difference in hospital stay (p=0.989), or implant survival years (p=0.257). This study provides evidence that when trainees are appropriately supervised, they can obtain equally good results compared with consultants when performing
Aim. The purpose of this study was to perform a randomised controlled trial (RCT) to compare the >20 year outcomes of cemented versus cementless Mallory Head total hip replacements (THRs). Methods. Two hundred and fifty patients with unilateral osteoarthritis of their hip, a mean age of 64 years and 48% of whom were female were randomised to receive either a cemented (n=124) or cementless (n=126)
We want to show our results of infected
Introduction. There is a paucity of research investigating the effect of the experience of the operating surgeon on the long term function and survivorship of total hip replacements (THR). With the advent of individualised surgeon data being available to patients via the National Joint Registry, the desire to avoid complications and poor performance grows. This potentially reduces the availability of operative opportunities for trainees as consultants seek to ensure good results. Method & Results. A multicentre retrospective study of 879
Autologous drains are used frequently in total knee replacement surgery but not in total hip replacement surgery (THR). Previous studies have shown that these drains are not cost effective in
The world’s clinical experience of highly cross-linked UHMWPE cups (HCLPE) lies in the cemented
Objectives. To investigate psychosocial and biomedical outcomes following
total hip replacement (THR) and to identify predictors of recovery
from
Introduction: The Scottish Arthroplasty Project (SAP) publishes an annual report including infection rates post-arthroplasty having obtained their results from the patients’ ICD-10 codes. The aim of this project was to validate the
Introduction. The first highly crosslinked and melted polyethylene acetabular component for use in total hip arthroplasty was implanted in 1998 and femoral heads larger than 32mm in diameter introduced 2004. The purpose of this study was to re-assemble a previous multi-center patient cohort in order to evaluate the radiographic and wear analysis of patients receiving this form of highly crosslinked polyethylene articulating against large diameter femoral heads at a minimum of 10 years follow-up. Methods. Two centers contributed patients to this ongoing clinical study. Inclusion criteria for patients was: primary
Introduction. The first highly crosslinked and melted polyethylene acetabular component for use in total hip arthroplasty was implanted in 1998. Numerous publications have reported reduced wear rates and a reduction in particle induced peri-prosthetic osteolysis at short to mid-term follow-up. The purpose of this study was to re-assemble a previous multi-center patient cohort in order to evaluate the radiographic and wear analysis of patients receiving this form of highly crosslinked polyethylene articulating against 32mm femoral heads or less at a minimum of 13 years follow-up. Methods. Inclusion criteria for patients was a primary
Manual postoperative CT calculation of anteversion and inclination of the acetabular cup can be inaccurate and depends on the observer's experience. The aim of this study is to describe and present a validation of a new CT-image-based dedicate software (EGIT) for calculation of the acetabular component placement. The software principle is based on a three-dimensional reconstruction of a patient's bones from anatomical data collected postoperatively on the patient's CT scan. 15 Patient to be operated for
Of 960 first-revision total hip replacements (THR) because of deep infection identified in the Swedish Hip Arthroplasty Registry, 16.9% were treated with a permanent implant extraction, while a staged or direct reconstruction revision protocol were employed in 56.2% and 26.9% respectively. The majority of the interventions were performed more than one year after index
Introduction. Silicon nitride (SiN) is a recently introduced bearing material for
The purpose of this research is to propose CT-free cup orientator using tilt sensors without expensive point tracking devices in total hip replacement. In the case of using a mechanical guide, the accuracy of cup orientation can be sacrificed because of change of the patient’s posture during procedure. Several navigation systems have been introduced to secure an accurate position and orientation of the implant in
Summary Statement. In young, active patients cementless
This preliminary study concerns the results of
This is a minimum 15 year follow up of a cohort of 58 patients (30 men and 28 women) who underwent 62 non-cemented
Introduction A review of hip replacements performed in our hospital between 1991 and 2000 has identified a group of post-operative patients in whom recurrent dislocation has been deemed untreatable because of medical comorbidity. We tried to identify a group of patients at risk of recurrent dislocations. This paper presents our experience with the Kasselt cup in these patients. Methods We have used the Kasselt cup with indications being: a) prophylaxis, in patients with perceived greater risk of recurrent dislocation and b) treatment of recurrent (three or more) dislocations following
The timing of total hip replacement (THR) in
patients with active tuberculosis (TB) of the hip is controversial, because
of the potential risk of reactivation of infection. There is little
information about the outcome of
Total hip replacement (THR) has been shown to
be a cost-effective procedure. However, it is not risk-free. Certain conditions,
such as diabetes mellitus, are thought to increase the risk of complications.
In this study we have evaluated the prevalence of diabetes mellitus
in patients undergoing
This presentation introduces a new tool to be used in the cementing of acetabular components in total hip arthroplasty, the ‘Rim Cutter’. The Rim Cutter is designed to cut a ledge in the rim of the acetabulum into which a flanged cup can be cemented. The flange is trimmed such that it fits precisely into the ledge cut in the acetabulum. We present the in vitro pilot study of the effect of using this tool on the intra-acetabular cement mantle pressure during cup insertion and also the effect on the depth of cement penetration as the cup is inserted. A significant improvement in both cement pressure and cement penetration over conventional flanged and unflanged cups is noted. Improved cement penetration around the rim of the acetabulum in
Component migration after
The current decade has seen a marked rise in popularity of minimally invasive hip replacement, done through a variety of surgical approaches. A specific downside to the direct anterior approach includes the significant difficulty getting a “straight shot” down the femoral canal for either straight, nonflexible reaming or broaching as with standard approaches. Improper alignment in the femoral canal can lead to sub-optimal load transfer and thus compromised fixation. The femoral broach and stem insertion path for this approach is best described as a curved one, rather than the typical straight path. Some femoral components appear to be more suitable to this technique due to their geometries. The purpose of the study was to describe the effects that the single geometric parameter, stem length, has on its insertion path into the femoral canal. Due to the potential introduction of human error associated with repetitively performing a specific motion, both a physical study and a computer generated analysis were conducted. For the physical portion of the study, a femoral implant body of generic fit and fill geometry was designed and manufactured. The length of the stem was varied from 40 mm to 100 mm in 10 mm increments. A medium sized synthetic femur (Sawbones, Pacific Labs, Seattle, WA) was machined to match the volume of the full length stem. The insertion path constraints were defined such that the stem had to maintain the greatest allowable insertion angle while still making contact on both the medial and lateral side of the canal during translation in the X direction. To reduce the variability in applying the constraints, a single author conducted the insertion procedure for each length stem while the path was videotaped from a fixed position directly in front of the setup. The most proximal lateral point of the stem was tracked through the insertion path and the X, Y coordinates were recorded at a frequency of 2 FPS. The area under this curve, referred to as the minimum insertion area (MIA), was calculated. For the computer generated portion of the study, a CAD model of the standard length Omnifit. ®. (Stryker Orthopaedics) was utilized. The stem was modified to create 5 additional models where the length was progressively shortened to 65%, 55%, 45%, 35%, and 25% of original length or 91mm, 77mm, 63mm, 49mm, and 35mm respectively. The femur was created from a solidified mesh of a computed tomography (CT) scan with the canal virtually broached for a full length stem. The models were each virtually assembled within the femoral canal with the similar constraints as the physical study. Again, the most proximal lateral point of the stem was tracked through the insertion path with the coordinates recorded and the MIA was calculated. There was a non-linear relationship between stem length and the MIA with the rate of change decreasing as the stem length decreased. That is, the greatest decrease in MIA was between the standard length and next longest length in the computer simulation. It was noted that marked change in MIA began to subside between the 77mm and 63mm stems and continued this trend of having less influence onward through to the shorter lengths. Although the results of the physical study showed a higher variability than the computer generated portion, it does confirm the results of the computer generated study. Minimizing the trauma associated with
Introduction: Patients who develop proximal femoral growth arrest present a typical deformity of short femoral neck, high riding greater trochanter, and caput valgum. This is seen usually seen in Perthes, AVN due to treatment of CDH, and sometimes in epiphyseal dysplasia. Method: We present a series of 34 cases (34 hips) treated at the above institutes. The cases treated in Berne were prior to 2002. Twenty patients were females. There were 24 patients with Perthes, nine with old healed and treated DDH, and one with epipyhseal dysplasia. All had Trendelenburg or delayed Trendelenburg sign. They had an average shortening of 3.5 cms, and their age range was 14 yrs to 64 yrs. Pre-op assessement was done with plain radiographs, CT scan, and or MRI scan. Results: Their Merle D’Aubigne score improved from 13 (10 to 15) to 17 (15 to 18) at the latest follow up. Twenty four (70%) had good to excellent result. Five have since undergone a total hip replacement, and five have some pain but can do reasonable amount of activity. The follow-up is 6 years (2 to 13 years). There was one trochanteric non-union, but no cases of AVN. Discussion: We describe the technique of biomechanically improving the moment arm and muscle length with this procedure. This helps the soft tissues to strengthen, improve force vectors in the correct direct in the hip, perhaps improve the longevity of the joint and also prepare the hip soft tissues for future
Introduction: Wear, and the resultant loosening and revision, of Total Hip Replacements (THRs) remains the limiting factor in the long term success of the prosthesis. Over 1 million Total Hip Replacements (THRs) are implanted each year, of which about 15% are revisions, most of which are a consequence of loosening of either femoral or acetabular components. This is frequently caused by either the mechanical (. Wroblewski, 1986. ) or biological (. Besong et al, 1997. ) response to the wear of ultra-high molecular weight polyethylene (UHMWPE) acetabular component. In a previous study . Bennett (2002. , . 2000. ) has demonstrated that the walking patterns of
Introduction:. Total Hip Replacement (THR) is a proven and effective surgical procedure. One of the main limiting factors of the longevity of
There is little in the literature on the level
of participation in sports which patients undertake after total
hip replacement (THR). Our aims in this study were to determine
first, the level of sporting activity, second, the predictive factors
for returning to sporting activity, and third, the correlation between
participation in sports and satisfaction after
Total hip replacement (THR) after acetabular
fracture presents unique challenges to the orthopaedic surgeon.
The majority of patients can be treated with a standard
United Kingdom National Institute for Health
and Clinical Excellence guidelines recommend the use of total hip replacement
(THR) for displaced intracapsular fractures of the femoral neck
in cognitively intact patients, who were independently mobile prior
to the injury. This study aimed to analyse the risk factors associated
with revision of the implant and mortality following
Introduction: Patient specific cementless femoral components for
Rivaroxiban is a factor Xa inhibitor and is a newer oral alternative for thromboprophylaxis after joint replacements. Its major advantage is its oral administration and hence better patient compliance. However there are some doubts about its efficacy compared to dalteparin/heparin. We have recently changed over from using dalteparin injections to rivaroxiban tablets for thromboprophylaxis after hip replacements. We assessed our results to find efficacy and specificity of its action in patients undergoing
The new technology using femoral heads with sleeves allows conservative procedures for revision hip arthroplasty. The implantation of classical ceramic heads on a previously used femoral taper is not recommanded. When there is no loosening of the femoral implant, the use of sleeves is a good solution for using an alumine on alumine couple, specially in young and active patients. Material and methods: 25 hips in 25 patients were included. In 12 cases the cause of revision was an acetabular osteolysis with or without loosening in metal on metal cimented
This is a report on the first 100
Pre-operative planning for total hip replacement
(THR) is challenging in hips with severe acetabular deformities, including
those with a hypoplastic acetabulum or severe defects and in the
presence of arthrodesis or ankylosis. We evaluated whether a Rapid
Prototype (RP) model, which is a life-sized reproduction based on
three-dimensional CT scans, can determine the feasibility of THR
and provide information about the size and position of the acetabular component
in severe acetabular deformities.
Introduction: Historically, it has been accepted that the pain associated with arthritis of the hip is usually located in the groin, anterior and lateral thigh with occasional radiation to the anterior knee. Patients complaining of thigh pain that extends below the knee are often considered to have a degenerative lumbar spine as the cause for their lower limb symptoms and total hip replacement (THR) may not be offered. Following review of data regarding the preoperative distribution of pain in 2000 patients attending for hip replacement, it was noted that 40% of these patients had complained of pain at or below the knee. We proposed to prospectively investigate the severity and location of pain in patients attending for
Introduction. Many tests have been published which measure frictional torque [1–4] in
With greater numbers of younger patients undergoing
total hip replacement (THR), the effect of patient age on the diameter
of the femoral canal may become more relevant. This study aimed
to investigate the relationship between the diameter of the diaphysis
of the femoral canal with increasing age in a large number of patients
who underwent
Studies of patients having primary
Introduction This study reviews the mid to long term results of revision
Introduction and Aims: The purpose of the present study was to review the early results and clinical performance of FDA approved large unipolar heads (36mm and greater) used with a metal-on-metal (MM) bearing. Method: Fourteen stem type prostheses were implanted in 14 patients. There were eight primary THA, and six conversions of surface arthroplasties in which thin-walled (5mm) porous coated MM sockets were maintained. Mean age was 55.4 years (range 30–72 years). There were nine males and five females. Dislocation precautions were discontinued after capsular healing (six weeks). The initial etiology was OA in 78%. Results: The median head size was 44mm (36–52) and socket size 54mm. Mean follow-up time was 29.1 months (range 12–81). UCLA hip scores improved for pain, walking, function, and activity from 4.8, 6.2, 6.1, and 4.8 pre-operatively to 9.3, 8.5, 7.5, and 5.4 postoperatively. Range of motion normalised. There were no complications. Conclusion: This investigation shows excellent clinical results, and suggests that dislocation can be avoided by an anatomical
We have used total hip replacement combined with cemented intramedullary nailing to treat a selected group of nine patients with pathological fractures of the proximal femur and impending fractures of the shaft due to metastases. One patient died from cardiopulmonary failure on the third postoperative day, but the others were able to walk within the first week after operation. Complications included one recurrent dislocation of the
Objectives. To define Patient Acceptable Symptom State (PASS) thresholds
for the Oxford hip score (OHS) and Oxford knee score (OKS) at mid-term
follow-up. Methods. In a prospective multicentre cohort study, OHS and OKS were collected
at a mean follow-up of three years (1.5 to 6.0), combined with a
numeric rating scale (NRS) for satisfaction and an external validation
question assessing the patient’s willingness to undergo surgery
again. A total of 550 patients underwent total hip replacement (THR)
and 367 underwent total knee replacement (TKR). Results. Receiver operating characteristic (ROC) curves identified a PASS
threshold of 42 for the OHS after
Introduction: Patients following resurfacing frequently remark about the natural feel of the resurfaced hip joint in contrast to those with total hip arthroplasty. Possible reasons for this include the larger femoral head size, conservation of bone and superior biomechanics of the implant with more accurate restoration of femoral offset, leg length and femoral anteversion. Our aim was to assess femoral offset and leg length following hip resurfacing and hybrid
Although the Western Ontario and McMaster Universities
(WOMAC) osteoarthritis index was originally developed for the assessment
of non-operative treatment, it is commonly used to evaluate patients
undergoing either total hip (THR) or total knee replacement (TKR).
We assessed the importance of the 17 WOMAC function items from the perspective
of 1198 patients who underwent either
Aims: In 1979 a national observation study of total hip arthroplasties was started in Sweden. The Swedish Hip Register describes the epidemiology of primary and revision surgery and identifies risk factors for failure. Every unit reports details concerning implants, surgical and cementing technique and revision procedures online via the Internet home page (. www.jru.orthop.gu.se. ). Methods: Currently the register contains 203 625 primary total hip arthroplasties performed during 1979–2001 and 18 067 revision procedures. Revision is the failure endpoint definition and modified Kaplan-Meier statistics and Poisson models are used for survival analysis. Each hospital receive their results annually providing a system for continuous improvement. Results: The results show that serious complications have declined significantly despite an increasing number of patients at risk. The revision burden for cemented
Aims: In younger patients with dysplastic hip we come to the polemic Ð
In fall 2004 we started with minimal invasive hip surgery at our clinic. Our requirements: Use of our standard implant system (Bicon threaded cup and Zweymüller stem), fast realization of the minimal invasive procedure through the continuation of the used, anterolateral Watson-Jones approach, modified for this technique, retaining the supine position with unchanged orientation concerning the positioning of the implant parts. Our expectations: Reduction in operative trauma through lower blood loss with less post-operative pain, less limping especially during the first weeks, less trochanter pain through the preservation of the gluteal muscle tendons, fewer posterior dislocations by preservation of the dorsal capsule, and a better cosmetic result. The patient is placed in supine position on the standard OR table with the option of tilting the legs down. The contralateral leg lies on a leg holder in extended position, flexed by approx. 20 degrees. This allows to bring the leg in hyperextension (without hyperlordosis of the lumbar spine), adduction and external rotation during broaching the femur. The main criterion of the minimal invasivness is the preservation of the gluteal tendons and not primarily the reduction of the length of the skin incision. An extensive capsular release with partial dissection of the rectus tendon for exposure of the acetabulum is necessary. For the stem implantation a notching of the piriformis can be necessary in addition to this. During the stem preparation the soft tissues should not influence the axial entrance of the rasps into the femoral canal otherwise there is a danger of a dorsolateral perforation. Right-left-lateral-double-offset rasps and the use of manipulation rasps as trial prostheses have worked satisfactorily. Retrospective analyses of numerous peri- and post-operative data were accomplished, as well as radiological evaluations regarding the optimal position of the implanted joints, and compared with a conventional control group. After a learning curve the OP duration was the same in both groups. The development of the haemoglobin and hematocrit levels were identical, 1/3 of the patients needed blood subsitution (autologous or stored blood). 90% of the analysed postoperative x-rays in standing position showed equal bilateral leg length corresponding to the preoperative planning, the planned offset was achieved in 93%. Deviations of the remaining were without clinical relevance. The complication rate was 2,5%. Conclusions: The anterolaterale approach in supine position is standardised for the minimal invasive
Purpose: The original AML prosthesis was fully coated and later the manufacturer switched it to 5/8ths coating. The second generation Prodigy femoral component was developed to return to full coating of the prosthesis and to provide a medial relief to decrease bone stress shielding. The purpose of this study was to evaluate the minimum ten year results using this device and to compare the results to the same surgeon’s results at 10 years using a first generation proximally coated device. Method: 100 consecutive primary total hip replacements were performed by a single surgeon in 86 patients using the Prodigy (DePuy, Warsaw, Indiana) femoral component between 1994 and 1997. The components were mated with 80 HGI and 20 Duraloc acetabular components. Patients were evaluated with WOMAC ratings, need for revision and radiographic loosening. The same parameters had been evaluated at minimum 10-year follow-up for the same surgeon’s initial 100 consecutive PCA (Stryker, New Jersey) primary
Patient expectations and their fulfilment are
an important factor in determining patient-reported outcome and satisfaction
of hip (THR) and knee replacement (TKR). The aim of this prospective
cohort study was to examine the expectations of patients undergoing
THR and TKR, and to identify differences in expectations, predictors
of high expectations and the relationship between the fulfilment
of expectations and patient-reported outcome measures. During the
study period, patients who underwent 346 THRs and 323 TKRs completed
an expectation questionnaire, Oxford score and Short-Form 12 (SF-12)
score pre-operatively. At one year post-operatively, the Oxford
score, SF-12, patient satisfaction and expectation fulfilment were
assessed. Univariable and multivariable analysis were performed.
Improvements in mobility and daytime pain were the most important
expectations in both groups. Expectation level did not differ between
THR and TKR. Poor Oxford score, younger age and male gender significantly
predicted high pre-operative expectations (p <
0.001). The level
of pre-operative expectation was not significantly associated with
the fulfilment of expectations or outcome.
Introduction: We perform MIS since 2004 and have done 1257
It has recently been reported that the transverse
acetabular ligament (TAL) is helpful in determining the position
of the acetabular component in total hip replacement (THR). In this
study we used a computer-assisted navigation system to determine
whether the TAL is useful as a landmark in
The debate whether to use cemented or uncemented
components in primary total hip replacement (THR) has not yet been
considered with reference to the cost implications to the National
Health Service. We obtained the number of cemented and uncemented components
implanted in 2009 from the National Joint Registry for England and
Wales. The cost of each component was established. The initial financial
saving if all were cemented was then calculated. Subsequently the
five-year rates of revision for each type of component were reviewed
and the predicted number of revisions at five years for the actual
components used was compared with the predicted number of revisions
for a cemented
Autologous retransfusion and no-drainage are
both blood-saving measures in total hip replacement (THR). A new combined
intra- and post-operative autotransfusion filter system has been
developed especially for primary