Aims. Waiting times for arthroplasty surgery in Northern Ireland are among the longest in the NHS, which have been further lengthened by the onset of the COVID-19 global pandemic in March 2020. The Department of Health in Northern Ireland has announced a new Elective Care Framework (ECF), with the framework proposing that by March 2026 no patient will wait more than 52 weeks for inpatient/day case treatment. We aimed to assess the feasibility of achieving this with reference to
Aims. The aims of this study were to determine the clinical and radiographic
outcomes, implant survivorship, and complications of patients with
a history of poliomyelitis undergoing
There is little evidence on the cost effectiveness
of different brands of hip prostheses. We compared lifetime cost effectiveness
of frequently used brands within types of prosthesis including cemented
(Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite
Plus Ogee), cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed)
and hybrid (Exeter V40 Trilogy, Exeter V40 Trident, and CPT Trilogy).
We used data from three linked English national databases to estimate
the lifetime risk of revision, quality-adjusted life years (QALYs)
and cost. . For women with osteoarthritis aged 70 years, the Exeter V40 Elite
Plus Ogee had the lowest risk of revision (5.9% revision risk, 9.0
QALYs) and the CPT Trilogy had the highest QALYs (10.9% revision
risk, 9.3 QALYs). Compared with the Corail Pinnacle (9.3% revision
risk, 9.22 QALYs), the most commonly used brand, and assuming a
willingness-to-pay of £20 000 per QALY gain, the CPT Trilogy is
most cost effective, with an incremental net monetary benefit of £876.
Differences in cost effectiveness between the hybrid CPT Trilogy
and Exeter V40 Trident and the cementless Corail Pinnacle and Taperloc
Exceed were small, and a cautious interpretation is required, given
the limitations of the available information. However, it is unlikely that cemented brands are among the most
cost effective. Similar patterns of results were observed for men
and other ages. The gain in quality of life after
Aims. We report on the outcome of the Exeter Contemporary flanged cemented
all-polyethylene acetabular component with a mean follow-up of 12
years (10 to 13.9). This study reviewed 203 hips in 194 patients.
129 hips in 122 patients are still in situ; 66
hips in 64 patients were in patients who died before ten years,
and eight hips (eight patients) were revised. Clinical outcome scores
were available for 108 hips (104 patients) and radiographs for 103
hips (100 patients). Patients and Methods. A retrospective review was undertaken of a consecutive series
of 203 routine primary cemented
Aims. Achieving accurate implant positioning and restoring native hip biomechanics are key surgeon-controlled technical objectives in
The aim of this study was to investigate whether the use of antibiotic-loaded bone cement influenced the risk of revision surgery after primary total hip arthroplasty (THA) for osteoarthritis. The study involved data collected by the National Joint Registry (NJR) for England and Wales, Northern Ireland and the Isle of Man between 1 September 2005 and 31 August 2017. Cox proportional hazards were used to investigate the association between use of antibiotic-loaded bone cement and the risk of revision due to prosthetic joint infection (PJI), with adjustments made for the year of the initial procedure, age at the time of surgery, sex, American Society of Anesthesiologists (ASA) grade, head size, and body mass index (BMI). We looked also at the association between use of antibiotic-loaded bone cement and the risk of revision due to aseptic loosening or osteolysis.Aims
Methods
The Hospital (Trust) guidelines generally recommend 40mg of Low molecular weight heparin (LMWH) twice daily (BD) for all patients over 100kg for those undergoing total hip (THR) and knee replacements (TKR) respectively. British National Formulary (BNF) recommends 40mg of LMWH once daily (OD) for all patients regardless of their overall weight or body mass index (BMI). We evaluated the outcome of prophylactic LMWH dosage for patients undergoing THR and TKR by monitoring surgery related venous-thromboembolic events up to a minimum of three months after surgery. A retrospective audit was carried out after obtaining institutional approval and all consecutive elective patients weighing over 100kg and undergoing THR and TKR were included. All patients were followed up for a minimum of 3 months after their operation to investigate the dose of prophylactic LMWH received, and whether they had developed any venous thromboembolic events (VTE) post operatively. This was done using a combination of electronic notes, drug charts and deep venous thrombosis (DVT) or computed tomography pulmonary angiogram (CTPA) reports on the hospital/trust database. A total of 53 patients underwent elective THR (18) and TKR (35) between the period of March 2017 and September 2017. Forty-four patients received 40 mg OD and 9 patients had 40 mg BD. None of the patients developed a confirmed DVT or pulmonary embolism in the 3 months following surgery regardless of the dose received. We demonstrate that there is no clinical benefit in having patients over 100kg on twice daily LMWH with the aim of preventing post-op thromboembolic complications. This conclusion is in line with the BNF recommendations for VTE prophylaxis.
Dual mobility (DM) bearings are an attractive treatment option to obtain hip stability during challenging primary and revision total hip arthroplasty (THA) cases. The purpose of this study was to analyze data submitted to the American Joint Replacement Registry (AJRR) to characterize utilization trends of DM bearings in the USA. All primary and revision THA procedures reported to AJRR from 2012 to 2018 were analyzed. Patients of all ages were included and subdivided into DM and traditional bearing surface cohorts. Patient demographics, geographical region, hospital size, and teaching affiliation were assessed. Associations were determined by chi-squared analysis and logistic regression was performed to assess outcome variables.Aims
Methods
Abstract. Objectives. Hip instability following
Introduction:
Aims. The aim of this study was to explore the functional results in a fitter subgroup of participants in the Hip Fracture Evaluation with Alternatives of
Aims. A significant reduction in wear at five and ten years was previously reported when comparing Durasul highly cross-linked polyethylene with nitrogen-sterilized Sulene polyethylene in
Aims. Iliopsoas impingement occurs in 4% to 30% of patients after undergoing
The objectives of our study were to compare patient reported outcome measures between manual and robotic-assisted
Aims. Conventional patient-reported surveys, used for patients undergoing
Aims.
Aims. This study aimed to describe practice variation in the use of
Aims. Manual impaction, with a mallet and introducer, remains the standard method of installing cementless acetabular cups during
Aims. The aims of this systematic review were to assess the learning curve of semi-active robotic arm-assisted
Aims. The aim of this study was to evaluate the survival of a collarless, straight, hydroxyapatite-coated femoral stem in
Aims. Leg length discrepancy (LLD) is a common pre- and postoperative issue in
Aims. Femoral component anteversion is an important factor in the success of
Surgical management of acetabular fractures in older patients remains controversial. The purpose of this study is to compare outcomes of primary THA with outcomes after THA for acute acetabular fractures (aTHA) as well as outcomes following delayed THA (dTHA) following prior acetabular fracture. We analyzed data from a large, national administrative claims database containing diagnostic, procedural, and demographic records from over 157 million patients. We identified all patients undergoing primary total hip arthroplasty THA continuously enrolled in the database at least 2 years prior and after the index procedure. Patients with an initial diagnostic code for acetabular fracture occurring the same day as the THA were classified as acute acetabular fractures. Patients with an initial acetabular fracture diagnostic code occurring at least 6 months before THA were classified as chronic acetabular fractures. The comparator group was patients undergoing THA with no history of acetabular fracture. There were 426,734 patients undergoing primary THA, 235 patients undergoing aTHA and 1,255 patients undergoing dTHA. Patients with an aTHA had higher complication rates, including revisions (9.8% vs 5.6%,), dislocations (8.9% vs 6.4%), and periprosthetic fracture (5.1% vs 2.3%) compared to dTHA. After adjusting for age, sex, region, and comorbidities, receiving an aTHA increased the odds of revision (OR = 3.65 [95% CI: 2.30–5.49]), dislocation (OR = 4.09 [95% CI: 2.53–6.27]), and periprosthetic fracture (OR = 4.29 [95% CI: 2.26–7.36]) compared to primary THA. Receiving a dTHA significantly increased the odds of revision (adjusted OR = 1.80 [95% CI: 1.40–2.27]), dislocation (adjusted OR = 2.50 [95% CI: 1.97–3.13]), and periprosthetic fracture (adjusted OR = 1.99 [95% CI: 1.34–2.83]) compared to primary THA. Patients undergoing aTHA in the treatment of an acetabular fracture have significantly increased rates of revision, periprosthetic fracture, and dislocation compared to dTHA and primary THA.
Aims. Professional dancers represent a unique patient population in the setting of hip arthroplasty, given the high degree of hip strength and mobility required by their profession. We sought to determine the clinical outcomes and ability to return to professional dance after
Abstract. Cemented
Patients who are Jehovah's witnesses do not accept blood transfusions. Thus,
Aims. Adult patients with history of childhood infection pose a surgical challenge for
Aims. Computer-assisted 3D preoperative planning software has the potential to improve postoperative stability in
Aims. The volume of ambulatory
Aims. Young adults undergoing
Given the increasing number of total hip arthroplasty
procedures being performed annually, it is imperative that orthopaedic
surgeons understand factors responsible for instability. In order
to treat this potentially complex problem, we recommend correctly
classifying the type of instability present based on component position, abductor
function, impingement, and polyethylene wear. Correct classification
allows the treating surgeon to choose the appropriate revision option
that ultimately will allow for the best potential outcome. Cite this article:
Aims. Postoperative length of stay (LOS) and discharge dispositions following arthroplasty can be used as surrogate measurements for improvements in patients’ pathways and costs. With the increasing use of robotic technology in arthroplasty, it is important to assess its impact on LOS. The aim of this study was to identify factors associated with decreased LOS following robotic arm-assisted
Aims. Obesity is associated with an increased risk of hip osteoarthritis, resulting in an increased number of
Aims. The aim of this study was to evaluate the reliability and validity of a patient-specific algorithm which we developed for predicting changes in sagittal pelvic tilt after
Aims. Osteoporosis is common in
Aims. Patients with femoral neck fractures (FNFs) treated with
As
Aims. Our study aimed to 1) Describe the changes in spinopelvic mobility when transitioning from standing, to ‘relaxed-seated’ and thereafter to ‘deep-seated’ position and 2) Determine the change in spinopelvic mobility types 1 year post-THA compared to preoperatively. Methods. This prospective diagnostic cohort study followed 100 consecutive patients 1 year post-THA. Preoperatively and one year postoperatively, radiographic measurements were performed for the lumbar-lordosis-angle, pelvic tilt and pelvic-femoral-angle on lateral radiographs in the standing, ‘relaxed-seated’ and ‘deep-seated’ position (torso maximally leaning forward). Patients were classified according to their spinopelvic mobility type, according to the change in PT between the standing and relaxed-seated position (stiff:ΔPT<±10°, normal:10°≤ΔPT≤30°, hypermobile:ΔPT>±30°). Results. Compared to preoperatively, when moving from a standing to a relaxed-seated position, hip flexion increased by 10°±18, leading to less posterior pelvic tilt by 6°±11 and reduced lumbar spine flexion by 6°±11 (all p<0.001). Similarly, when moving from the standing to deep-seated position, hip flexion improved by a mean of 8°±22, leading to reduced lumbar spine flexion by a mean of 5°±8, whereas the change in pelvic tilt did not change compared to preoperatively (p=0.016, p<0.001, p=0.46). The distribution of spinopelvic mobility types 1 year postoperatively was significantly different compared to preoperatively, as the percentage of patients with stiff spinopelvic mobility increased from 16% to 43% (p<0.001). Conclusion. Hip flexion improved by 10° on average 1 year after
Aims. A revision for periprosthetic joint infection (PJI) in
Our unit historically performed
The current evidence favors replacement for the treatment of displaced femoral neck fractures in the older patients. Controversies remain whether
Aims. Excessive posterior pelvic tilt (PT) may increase the risk of anterior instability after
This was a randomised controlled trial studying
the safety of a new short metaphyseal fixation (SMF) stem. We hypothesised
that it would have similar early clinical results and micromovement
to those of a standard-length tapered Synergy metaphyseal fixation
stem. Using radiostereometric analysis (RSA) we compared the two
stems in 43 patients. A short metaphyseal fixation stem was used
in 22 patients and a Synergy stem in 21 patients. No difference
was found in the clinical outcomes pre- or post-operatively between
groups. RSA showed no significant differences two years post-operatively
in mean micromovement between the two stems (except for varus/valgus tilt
at p = 0.05) (subsidence 0.94 mm ( Cite this article:
Aims. The primary aim of this study was to compare the hip-specific functional outcome of robotic assisted
Dual mobility (DM)
Aims.
Background. Increasing evidence suggests a link between the bearing surface used in
Aims. Mechanical impingement of the iliopsoas (IP) tendon accounts for 2% to 6% of persistent postoperative pain after
Introduction. Transfemoral osseointegration (TFOI) for amputees has substantial literature proving superior quality of life and mobility versus a socketed prosthesis. Some amputees have hip arthritis that would be relieved by a
Local anatomical abnormalities vary in congenital hip disease patients. Authors often present early to mid-term
Aims. We aimed to evaluate the long-term outcome of highly cross-linked polyethylene (HXLPE) cemented acetabular components and assess whether any radiolucent lines (RLLs) which arose were progressive. Methods. We retrospectively reviewed 170 patients who underwent 187
Aims. Traditionally,
Aims. Osteoporosis can determine surgical strategy for
Aims. The primary aim of our study was to assess the influence of age on hip-specific outcome following
Aims. Despite higher rates of revision after
Aims. Surgery is often delayed in patients who sustain a hip fracture and are treated with a
Aims. Although CT is considered the benchmark to measure femoral version, 3D biplanar radiography (hipEOS) has recently emerged as a possible alternative with reduced exposure to ionizing radiation and shorter examination time. The aim of our study was to evaluate femoral stem version in postoperative
Aims. Oxidized zirconium (OxZi) and highly cross-linked polyethylene (HXLPE) were developed to minimize wear and risk of osteolysis in
Aims. This study was designed to develop a model for predicting bone mineral density (BMD) loss of the femur after
Aims.
Aims. Dual-mobility acetabular components (DMCs) have improved
We sought to determine the relationship between patient preoperative psychological factors and postoperative THA outcomes. We performed an electronic search up to December 2021 using the following terms: “(mental OR psychological OR psychiatric) AND (function OR trait OR state OR predictor OR health) AND (outcome OR success OR recovery OR response) AND total joint arthroplasty)”. Peer-reviewed, English language studies regarding THA outcomes were analyzed for preoperative patient mental health metrics and objective postoperative results regarding pain, functionality and surgical complications. We extracted study data, assessed the risk of bias of included studies, grouped them by outcome measure and performed a GRADE assessment. Seventeen of 702 studies fulfilled inclusion criteria and were included in the review. Overall, compared to cohorts with a normal psychological status, patients with higher objective measures of preoperative depression and anxiety reported increased postoperative pain, decreased functionality and greater complications following THA. Additionally, participants with lower self-efficacy or somatization were found to have worse functional outcomes. Following surgery, both early and late pain scores remained higher in patients with preoperative depression and anxiety. Preoperative depression and anxiety may negatively impact patient reported postoperative pain, physical function and complications following THA. A meta-analysis was not performed because of the heterogeneity of studies, specifically the use of differing pain scales and measures of physical and psychological function as well as varied follow-up times. Future research could test interventions to treat pre-operative depression or anxiety and explore longitudinal outcomes in THA patients. Surgeons should consider the preoperative psychological status when counseling patients regarding expected surgical outcomes and attempt to treat a patient's depression or anxiety prior to undergoing
Aims. Pelvic discontinuity is a rare but increasingly common complication of
Cannulated hip screws are frequently used in the management of hip fractures. There have been concerns over the failure rate of the technique and the outcomes of those that subsequently require conversion to
Non-optimal clinical alignment of components in
Introduction and Objective. Ceramic on Ceramic bearings in
Aims. Spinopelvic mobility plays an important role in functional acetabular component position following
Aims. There is evidence that morbidly obese patients have more intra- and postoperative complications and poorer outcomes when undergoing
Aims. The aim of this study was to determine whether
The purpose of this modified Delphi study was to obtain consensus on wound closure (including best practices for each tissue layer of closure) and dressing management in
Aims. It is not known whether preservation of the capsule of the hip positively affects patient-reported outcome measures (PROMs) in
The interest in day-case hip arthroplasty is increasing; however, there are conflicting results regarding readmission risk, and little is known about patients’ attitude towards day-case surgery. We aimed to investigate differences in 30-day readmission rates between day-case patients and single-overnight-stay patients following
Displaced femoral neck fractures can have devastating impacts on quality of life and patient function. Evidence for optimal surgical approach is far from definitive. The Hip Fracture Evaluation with Alternatives of
Aims. The aim of this study was to identify the minimal clinically important difference (MCID), minimal important change (MIC), minimal detectable change (MDC), and patient-acceptable symptom state (PASS) in the Forgotten Joint Score (FJS) according to patient satisfaction six months following
Superior teamwork in the operating theatre is associated with improved technical performance and clinical outcomes. Yet modern rota patterns, workforce shortages, and increasing complexity of surgery, means that there is less familiarity between staff and the required choreography. Immersive Virtual Reality (iVR) can successfully train surgical staff individually, however iVR team training has yet to be investigated. We aimed to design a multiplayer iVR platform for anterior approach
Aims. The current study aimed to compare robotic arm-assisted (RA-THA), computer-assisted (CA-THA), and manual (M-THA)
Elective orthopaedic procedures, and particularly
Aims. The aim of this investigation was to compare risk of infection in both cemented and uncemented hemiarthroplasty (HA) as well as in
Dislocation following
Polyimide (MP-1, MMATech, Haifa, Israel), is a high performance aerospace thermoplastic used for its lubricity, stability, inertness and radiation resistance. A wear resistant thin robust bearing is needed for
Aims. We aimed to assess the cumulative risk of
Aims. This study aims to answer the following questions in patients with hip osteoarthritis (OA) who underwent
Aims. After failed acetabular fractures,
Aims. Pelvic incidence (PI) is a position-independent spinopelvic parameter traditionally used by spinal surgeons to determine spinal alignment. Its relevance to the arthroplasty surgeon in assessing patient risk for
The aim of this study was to investigate the
relationship between the geometry of the proximal femur and the incidence
of intra-operative fracture during uncemented total hip arthroplasty
(THA). We studied the pre-operative CT scans of 100 patients undergoing
THA with an uncemented femoral component. We measured the anteroposterior
and mediolateral dimensions at the level of division of the femoral
neck to calculate the aspect ratio of the femur. Wide variations
in the shape of the femur were observed, from round, to very narrow
elliptic. The femurs of women were narrower than those of men (p
<
0.0001) and small femurs were also narrower than large ones.
Patients with an intra-operative fracture of the calcar had smaller
and narrower femurs than those without a fracture (p <
0.05)
and the implanted Corail stems were smaller in those with a fracture
(mean size 9 The variability of the shape of the femoral neck at the level
of division contributes to the understanding of the causation of
intra-operative fractures in uncemented THA. Cite this article:
The use of
To date, the literature has not yet revealed superiority of Minimally Invasive (MI) approaches over conventional techniques. We performed a systematic review to determine whether minimally invasive approaches are superior to conventional approaches in
This study compared the pullout forces of the initial implantation and the “cement-in-cement” revision technique for short and standard-length (125 mm vs. 150 mm) Exeter. ®. V40 femoral stems used in
Range of Motion (ROM) assessments are routinely used during joint replacement to evaluate joint stability before, during and after surgery to ensure the effective restoration of patient biomechanics. This study aimed to quantify axial torque in the femur during ROM assessment in
The purpose of this study was to report all complications during the first consecutive 865 cases of bikini incision direct anterior approach (DAA)
Aims. It is important to analyze objectively the hammering sound in cup press-fit technique in
Aims. It is important to analyze objectively the hammering sound in cup press-fit technique in
Background. A few patients undergoing a
Competitive dancers represent a unique patient population in the setting of hip arthroplasty given the high degree of hip strength and mobility required by their profession. We sought to determine the clinical outcomes and ability to return to competitive dance after
Simultaneous bilateral
Aims. In metal-on-polyethylene (MoP)
NICE Guidelines suggest patients should be offered a
In health care, several studies have suggested worse outcomes in African-Americans. Our objective was to study the relationships of race with outcomes in a series of
Osteoarthritis (OA) of the hip is the most common indication for
LCPD can cause femoral head deformity and osteoarthritis requiring