Aims. The aim of this study was to report the long-term follow-up of cemented short Exeter femoral components when used in primary total hip arthroplasty (THA). Methods. We included all primary 394 THAs with a cemented short Exeter femoral component (≤ 125 mm) used in our tertiary referral centre between October 1993 and December 2021. A total of 83 patients (21%) were male. The median age of the patients at the time of surgery was 42 years (interquartile range (IQR) 30 to 55). The main indication for THA was a childhood hip disease (202; 51%). The median follow-up was 6.7 years (IQR 3.1 to 11.0). Kaplan-Meier survival analyses were performed to determine the rates of survival with femoral revision for any indication, for
Aims. The purpose of this study was to compare the clinical outcomes, mortalities, implant survival rates, and complications of total knee arthroplasty (TKA) in patients with or without hepatitis B virus (HBV) infection over at least ten years of follow-up. Methods. From January 2008 to December 2010, 266 TKAs were performed in 169 patients with HBV (HBV group). A total of 169 propensity score–matched patients without HBV were chosen for the control group in a one-to-one ratio. Then, the clinical outcomes, mortalities, implant survival rates, and complications of TKA in the two groups were compared. The mean follow-up periods were 11.7 years (10.5 to 13.4) in the HBV group and 11.8 years (11.5 to 12.4) in the control group. Results. The mean Knee Society scores in the HBV and control groups improved from 37.1 (SD 5.6) and 38.4 (SD 5.4) points preoperatively to 78.1 (SD 10.8) and 81.7 (SD 10.2) points at final follow-up (p = 0.314), while the mean function scores in the HBV and control groups improved from 36.2 and 37.3 points preoperatively to 77.8 and 83.2 points at final follow-up (p = 0.137). Nine knees in the HBV group required revision surgery, including seven due to
In this study of 41 patients, we used proteomic, Western blot and immunohistochemical analyses to show that several reactive oxygen species scavenging enzymes are expressed differentially in patients with primary osteoarthritis and those with non-loosening and aseptic loosening after total hip replacement (THR). The patients were grouped as A (n = 16, primary THR), B (n = 10, fixed THR but requiring revision for polyethylene wear) and C (n = 15, requiring revision due to aseptic loosening) to verify the involvement of the identified targets in aseptic loosening. When compared with Groups A and B, Group C patients exhibited significant up-regulation of transthyretin and superoxide dismutase 3, but down-regulation of glutathione peroxidase 2 in their hip synovial fluids. Also, higher levels of superoxide dismutase 2 and peroxiredoxin 2, but not superoxide dismutase 1, catalase and glutathione perioxidase 1, were consistently detected in the hip capsules of Group C patients. We propose that dysregulated reactive oxygen species-related enzymes may play an important role in the pathogenesis and progression of aseptic loosening after THR.
Aims. This study reports updates the previously published two-year clinical, functional, and radiological results of a group of patients who underwent transfibular total ankle arthroplasty (TAA), with follow-up extended to a minimum of five years. Methods. We prospectively evaluated 89 patients who underwent transfibular TAA for end-stage osteoarthritis. Patients’ clinical and radiological examinations were collected pre- and postoperatively at six months and then annually for up to five years of follow-up. Three patients were lost at the final follow-up with a total of 86 patients at the final follow-up. Results. A total of 86 patients were evaluated at a mean follow-up of 65.4 months (60 to 90). At five-year follow-up, statistically significant improvements (p < 0.001) were found in the mean American Orthopaedic Foot & Ankle Society Ankle Hindfoot Score (from 33.8 (SD 14.3) to 86.1 (SD 8.8)), visual analogue scale for pain (from 8.5 (SD 1.7) to 1.5 (SD 1.2)), Short Form-12 Physical and Mental Component Scores (from 29.9 (SD 6.7) and 43.3 (SD 8.6) to 47.3 (SD 7.5) and 52.2 (SD 8.0), respectively), and mean ankle dorsiflexion and plantarflexion (from 6.2° (SD 5.5°) and 9.6° (SD 5.8°) to 23.9° (SD 7.7°) and 16.9° (SD 7.2°), respectively). Radiologically, the implants maintained neutral alignment without subsidence. Tibial or talar radiolucency was found in eight patients, but none of these patients was symptomatic. At five-year follow up, 97.7% of implants (95% confidence interval 91.2 to 99.4) were free from revision or removal with 84 implants at risk. We recorded two cases (2.3%) of failure for
Although data on uncemented short stems are available, studies on cemented short-stemmed THAs are limited. These cemented short stems may have inferior long-term outcomes and higher femoral component fracture rates. Hence, we examined the long-term follow-up of cemented short Exeter stems used in primary THA. Within the Exeter stem range, 7 stems have a stem length of 125 mm or less. These stems are often used in small patients, in young patients with a narrow femoral canal or patients with anatomical abnormalities. Based on our local database, we included 394 consecutive cemented stems used in primary THA (n=333 patients) with a stem length ≤125 mm implanted in our tertiary referral center between 1993 and December 2021. We used the Dutch Arthroplasty Registry (LROI) to complete and cross-check the data. Kaplan-Meier survival analyses were performed to determine 20-year survival rates with stem revision for any reason, for
Aims. The aim of this meta-analysis was to compare the outcome of total elbow arthroplasty (TEA) undertaken for rheumatoid arthritis (RA) with TEA performed for post-traumatic conditions with regard to implant failure, functional outcome, and perioperative complications. Materials and Methods. We completed a comprehensive literature search on PubMed, Web of Science, Embase, and the Cochrane Library and conducted a systematic review and meta-analysis. Nine cohort studies investigated the outcome of TEA between RA and post-traumatic conditions. The preferred reporting items for systematic reviews and meta-analysis (Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)) guidelines and Newcastle-Ottawa scale were applied to assess the quality of the included studies. We assessed three major outcome domains: implant failures (including aseptic
Aims. The purpose of this study is to report our updated results at a minimum follow-up of 30 years using a first generation uncemented tapered femoral component in primary total hip arthroplasty (THA). Methods. The original cohort consisted of 145 consecutive THAs performed by a single surgeon in 138 patients. A total of 37 patients (40 hips) survived a minimum of 30 years, and are the focus of this review. The femoral component used in all cases was a first-generation Taperloc with a non-modular 28 mm femoral head. Clinical follow-up at a minimum of 30 years was obtained on every living patient. Radiological follow-up at 30 years was obtained on all but four. Results. Seven femoral components (18%) required revision, and none for
THA in patients with acetabular bone defects is associated with a high risk of dislocation. Dual mobility (DM) cups are known to prevent and treat chronic instability. The aim of this study was to evaluate the dislocation rate and survival of jumbo DM cups. This was a retrospective, continuous, multicenter study of all the cases of jumbo DM cup implantation between 2010 and 2017 in patients with acetabular bone loss (Paprosky 2A: 46%, 2B: 32%, 2C: 15% and 3A: 6%). The indications for implantation were revisions for aseptic loosening of the cup (n=45), aseptic loosening of the femoral stem (n=3), bipolar
The reconstruction of peri-acetabular defects after severe bone loss or pelvic resection for tumor is among the most challenging surgical intervention. The Lumic® prosthesis (Implantcast, Buxtehude, Germany) was first introduced in 2008 in an effort to reduce the mechanical complications encountered with the classic peri-acetabular reconstruction techniques and to improve functional outcomes. Few have evaluated the results associated with the use of this recent implant. A retrospective study from five Orthopedic Oncology Canadian centers was conducted. Every patient in whom a Lumic® endoprosthesis was used for reconstruction after peri-acetabular resection or severe bone loss with a minimal follow-up of three months was included. The charts were reviewed and data concerning patients’ demographics, peri-operative characteristics and post-operative complications was collected. Surgical and functional outcomes were also assessed. Sixteen patients, 11 males and five females, were included and were followed for 28 months [3 – 60]. Mean age was 55 [17–86], and mean BMI reached 28 [19.6 – 44]. Twelve patients (75%) had a Lumic® after a resection of a primary sarcoma, two following pelvic metastasis, one for a benign tumor and one after a comminuted acetabular fracture with bone loss. Twelve patients (75%) had their surgery performed in one stage whereas four had a planned two-stage procedure. Mean surgical time was 555 minutes [173-1230] and blood loss averaged 2100 mL [500-5000]. MSTS score mean was 60.3 preoperatively [37.1 – 97] and 54.3 postoperatively [17.1-88.6]. Five patients (31.3%) had a cemented Lumic® stem. All patients got the dual mobility bearing, and 10 patients (62.5%) had the largest acetabular cup implanted (60 mm). In seven of these 10 patients the silver coated implant was used to minimize risk of infection. Five patients (31.3%) underwent capsular reconstruction using a synthetic fabric aiming to reduce the dislocation risk. Five patients had per-operative complications (31.3%), four were minor and one was serious (comminuted iliac bone fracture requiring internal fixation). Four patients dislocated within a month post-operatively and one additional patient sustained a dislocation one year post-operatively. Eight patients (50%) had a post-operative surgical site infection. All four patients who had a two-stage surgery had an infection. Ten patients (62.5%) needed a reoperation (two for fabric insertion, five for wash-outs, and three for implant exchange/removal). One patient (6.3%) had a
The reconstruction of peri-acetabular defects after severe bone loss or pelvic resection for tumor is among the most challenging surgical intervention. The Lumic® prosthesis (Implantcast, Buxtehude, Germany) was first introduced in 2008 in an effort to reduce the mechanical complications encountered with the classic peri-acetabular reconstruction techniques and to improve functional outcomes. Few have evaluated the results associated with the use of this recent implant. A retrospective study from five Orthopedic Oncology Canadian centers was conducted. Every patient in whom a Lumic® endoprosthesis was used for reconstruction after peri-acetabular resection or severe bone loss with a minimal follow-up of three months was included. The charts were reviewed and data concerning patients’ demographics, peri-operative characteristics and post-operative complications was collected. Surgical and functional outcomes were also assessed. Sixteen patients, 11 males and five females, were included and were followed for 28 months [3 – 60]. Mean age was 55 [17-86], and mean BMI reached 28 [19.6 – 44]. Twelve patients (75%) had a Lumic® after a resection of a primary sarcoma, two following pelvic metastasis, one for a benign tumor and one after a comminuted acetabular fracture with bone loss. Twelve patients (75%) had their surgery performed in one stage whereas four had a planned two-stage procedure. Mean surgical time was 555 minutes [173-1230] and blood loss averaged 2100 mL [500-5000]. MSTS score mean was 60.3 preoperatively [37.1 – 97] and 54.3 postoperatively [17.1-88.6]. Five patients (31.3%) had a cemented Lumic® stem. All patients got the dual mobility bearing, and 10 patients (62.5%) had the largest acetabular cup implanted (60 mm). In seven of these 10 patients the silver coated implant was used to minimize risk of infection. Five patients (31.3%) underwent capsular reconstruction using a synthetic fabric aiming to reduce the dislocation risk. Five patients had per-operative complications (31.3%), four were minor and one was serious (comminuted iliac bone fracture requiring internal fixation). Four patients dislocated within a month post-operatively and one additional patient sustained a dislocation one year post-operatively. Eight patients (50%) had a post-operative surgical site infection. All four patients who had a two-stage surgery had an infection. Ten patients (62.5%) needed a reoperation (two for fabric insertion, five for wash-outs, and three for implant exchange/removal). One patient (6.3%) had a
The aim of the study to analyze the circulating white blood cells including the intensity expression of surface receptors and cytoplasmic molecules in patients underwent total hip replacement, with either aseptic or
Aims. Prosthetic joint infection (PJI) and aseptic loosening in total hip arthroplasty (THA) can present with pain and osteolysis. The Musculoskeletal Infection Society (MSIS) has provided criteria for the diagnosis of PJI. The aim of our study was to analyze the utility of F18-fluorodeoxyglucose (FDG) positron emission tomography (PET) CT scan in the preoperative diagnosis of
Aims: The symptoms of aseptic and septic prosthetic joint loosening may be similar, and identification of low-grade prosthetic infection based only on clinical history and physical examination has a reported low sensitivity. In a prospective study we explored to what extent a thorough examination of the patient’s history of sickness and a standardized preoperative clinical examination could help the surgeon to identify cases of
INTRODUCTION. Conventional surgical exposures are usually inadequate for 2-stage revision knee replacement ofinfected implants. Reduced range of motion, extensor mechanism stiffness, peripatellar contracture and soft tissue scarring make patellar eversion difficult and forced eversion places the integrity of the extensor mechanism at risk. On the contrary, a wide exposure is fundamental to allow complete cement spacer removal, soft tissue balancing, management of bone loss and reimplantation without damaging periarticular soft tissues. OBJECTIVES. To compare the long-term clinical, functional and radiographic results and the reinfection rate of the quadriceps snip approach and the tibial tubercle osteotomy in 2-stage revision knee replacement performed for
Introduction. Revision TKA can be a difficult and complex procedure. Bone quality is commonly compromised and stem fixation is required in many cases to provide stability of the prosthetic construct. However, utilization of diaphyseal engaging stems adds complexity to the case and can present technical challenges to the surgeon. Press fit metaphyseal sleeves can provide stable fixation of the construct without the need for stems and allows for biologic ingrowth of the prosthesis. Metaphyseal sleeves simplify the revision procedure by avoiding the need to prepare the diaphysis for stems, alleviating the need for offset stems and decreasing the risk of intra-operative complications. The ability to obtain biologic fixation in the young patient is also appealing. This study reports on the author's mid-term experience with this novel technique. Methods. Between May 2007 and June 2009 the author performed 17 revisions TKA that utilized press-fit metaphyseal sleeves without stems on either the tibial side of the joint, the femoral side of the joint or both. Twenty six sleeves were implanted altogether (13 tibial, 13 femoral). Patients were limited to touch down weight bearing for 6 weeks post-operatively. The patients were followed prospectively with clinical and radiographic follow-up at routine intervals. Results. Average clinical and radiographic F/U for the cohort was 57 months (range 30 – 77). Fourteen of seventeen patients had a minimum of 4 years F/U. Average age at the time of surgery was 58 years (range 46–72) and average BMI was 32.4. Indications for the index revision included nine knees with aseptic loosening and / or osteolysis, two knees for
We present an update of the clinical and radiological results of 62 consecutive acetabular revisions using impacted morsellised cancellous bone grafts and a cemented acetabular component in 58 patients, at a mean follow-up of 22.2 years (20 to 25). The Kaplan-Meier survivorship for the acetabular component with revision for any reason as the endpoint was 75% at 20 years (95% confidence interval (CI) 62 to 88) when 16 hips were at risk. Excluding two revisions for
We evaluated the outcome of 104 consecutive primary cemented Exeter femoral components in 78 patients (34 men, 44 women) under the age of 40 years who underwent total hip replacement between October 1993 and May 2004. The mean age at operation was 31 years (16 to 39). No hip was lost to follow-up, but three patients (four hips) died. None of the deaths were related to the surgery. At a mean follow-up of 6.2 years (2 to 13), three femoral components had been revised for
We prospectively reviewed 1000 consecutive patients who underwent a cementless, hydroxyapatite-coated, stemless, total knee replacement over a period of nine years. Regular post-operative clinical follow-up was performed using the Knee Society score. The mean pre-operative score was 96, improving to 182 and 180 at five and ten years, respectively. To date, there have been seven (0.5%) cases which required revision, primarily for
At our institution between 1994 and 2003 a total of 36 revision total elbow Arthroplasties were performed in 34 patients. We clinically reviewed 25 patients and reviewed the notes and x-rays of all of them. Of eleven who were not reviewed clinically seven had died from an unrelated cause and four were unable to attend because of illness but we were able to include them as sufficient data were available in the notes. There were 24 female and 12 male, Average age was 67 years and twelve had elbow Arthroplasty in a non-dominant side. The average follow up was 6 years (range 5–13 years). The mean period between the primary and revision surgery was sixty three months (range 3–240 months). The indication for surgery was mainly for aseptic loosening in 15 cases, followed by
Girdlestone’s arthroplasty is often used to treat
Introduction: Hip replacement prosthesis infection is a severe complication of ever increasing incidence. Currently there is controversy as to whether prosthetic revision surgery should be carried out in one or two stages and whether cemented or uncemented prostheses should be used. Materials and methods: This is a retrospective study of 17 cases of chronic infections of hip replacements that were revised in one-stage procedures between 1996 and 2005 in our center. Mean follow-up is 3.4 years. We analyzed the functional status of the hips before and after revision using the Merle D’Aubigne scale, x-rays, and supplementary tests for diagnosis and decisions on treatment. Results: The functional score at the end of the follow-up was 16.17 (Merle D’Aubigne scale). The most common pathogen is coagulase-negative staphylococci. Acute phase reactive elements reached normal levels. X-ray control does not show any alterations or signs of loosening. No subsequent revisions have been performed. Conclusions: The diagnosis and treatment of prosthetic revision requires correct preoperative assessment and planning. Differential diagnosis of aseptic versus
Numerous techniques are used for the fusion of failed TAR. We wish to report our results of the revision of failed TAR to fusion. Between July 2005 and February 2011 the senior author had performed 20 arthrodeses in 19 patients (13 male and 6 female) who had failed total ankle arthroplasty (TAR). Their mean age was 63.5 years. All of them had the AES total ankle replacement. (Biomet UK). The mean period from the original TAR to fusion was 51 months (6 to72). The indication for revision of TAR to fusion was
Aims: To test the outcome of acetabular revisons with impacted morsellized bone grafts and a cemented cup at a minimum follow-up of 15 years. Methods: Between 1979–1986 62 acetabular revisions (58 patients) were performed with impacted bone grafts and a cemented cup. Two cases (2 hips) were lost to FU. The average age at operation was 59.1 years. The indication was aseptic in 56 and
Aim. In two-stage replacements for
Introduction: In case of massive bone defect, femoral stem revision may cause significant problems to the orthopaedic surgeons. The periprosthetic infection introduces a further element of complication which often leads to complex surgical strategies. The aim of this study was to assess the preliminary results of femoral revision with modular resection femoral stems in a selected group of patients with infected total hip arthroplasty and extensive bone defect. Materials and Methods: The study group included five patients (three women – two men) with an average age of 72 years (range 62–81 years). From 2006 to 2008 the patients underwent a prosthetic femoral revision with resection modular stems to treat a
Purpose: We report a series of 78 total hip arthroplasty revisions using a locked femoral stem, Ultime. Material and methods: These patients presented aseptic loosening (88%) and
The Kent hip is a distally-locked femoral stem which was developed to address severe proximal bone loss, severe bony deformity and peri-prosthetic fracture. We reviewed the results of 145 consecutive Kent hips implanted into 141 patients between 1987 and 2000. The indications for implantation were aseptic loosening (75 hips),
Purpose: The aim of this work was to assess retrospectively osteofixation and survival of a long custom-made femoral stem with complete hydroxyapatite coating and without locking for replacement of the femoral implant. Material and methods: From 1990 to 1999, 89 stems were implanted for revision total hip arthroplasty. Seventy-five hips were reviewed at one to ten years (mean four years). Radiographic analysis searched for bone damage, osteofixation and implant migration. All measures were taken on the AP views postoperatively and at last follow-up. Results: Revision was performed for aseptic loosening in 75%, for
Purpose: The purpose of this work was to assess the quality of the bone reconstruction in contact with the long hydroxyapatite-coated locked femoral stem used in a consecutive series of patients undergoing revision total hip arthroplasty (RTHA). Material and methods: This series of 20 patients underwent RTHA for aseptic loosening (n=15) or
Total hip arthroplasty (THA) in patients under 30 years remains a challenge. The long-term survival data are often disappointing. In our institution, we have always used cemented components in all patients under 30 years, combined with acetabular impaction bone grafting (IBG), if necessary. We reviewed 139 consecutive patients (180 hips) treated between 1986 to 2014. Mean age at time of surgery was 24 (13–30.0) years. Acetabular IBG was applied in 127 (71%) cases. AAOS cavitary defect was seen in 26 (14%) cases, a AAOS segmental defect in 51 (28%) and a combination in 17 (9%). The mean preoperative HHS improved from 47 (20–81) to 87 (28–100) at review. During follow-up 26 hips have been revised (23 cups and 11 stems). Indications for revision were aseptic
The advent of trabecular metal (TM) augments has revolutionized the management of severe bone defects during acetabular reconstruction. The purpose of this study was to evaluate patients undergoing revision total hip arthroplasty (THA) with the use of TM augments for reconstruction of Paprosky 3A, 3B defects and defects associated with pelvic discontinuity. A retrospective study was conducted of the cases performed at four centers between August 2007 and January 2015. Patients treated with TM augments for Paprosky 3A, 3B or chronic pelvic discontinuity were included in the study. All surgeries were performed through a posterior approach. A total of 57 patients (Male 34 (69%), Female 23(31%)), mean age 54 years (range, 28–94 years), with minimum follow up of one-year were included and evaluated using intention to treat analysis. There were 44 (77%) patients with a 3A defect, 11(19%) patients with a 3B defect (6 had an associated pelvic discontinuity), and 2 (3.5%) with a 2C defect and associated pelvic discontinuity. The mean follow-up was 37 months (range, 12–96 months). One (2%) patient died after 8 years of unrelated causes. Three (5.5%) patients had acetabular component loosening requiring revision; Two failures were (3.5%) due to aseptic loosening and one (2%) due to
We reviewed 25 patients in whom a MUTARS megaprosthesis with a conical fluted stem had been implanted. There were three types of stem: a standard stem was used in 17 cases (three in the proximal femur, nine in the distal femur and five proximal tibia), a custom-made proximal femoral stem in four cases and a custom-made distal femoral stem in four cases. The mean age of the patients was 40.1 years (17 to 70) and the mean follow-up was for 2.5 years (0.9 to 7.4). At follow-up two patients had died from their disease: one was alive with disease and 22 were disease-free. One of 23 prostheses had been removed for infection and another revised to a cemented stem. The mean Musculoskeletal Tumor Society score was 24.9 (12 to 30) and the mean Karnofsky index was 82% (60% to 100%). There was no radiological evidence of loosening or subsidence. Stem stress shielding was seen in 11 patients and was marked in five of these. There were five complications, rupture of the extensor mechanism of the knee after extra-articular resection in two patients, deep venous thrombosis in one,
With increasing burden of revision hip arthroplasty, one of the major challenge is the management of bone loss associated with previous multiple surgeries. Proximal femoral replacement (PFR) has already been popularised for tumour surgeries. The inherent advantages of PFR over allograft –prosthesis system, which is the other option for addressing severe bone loss include, early weight bearing and avoidance of non-union and disease transmission. Our study explores PFR as a possible solution for the management of complex hip revisions. Thirty consecutive hips (29 patients) that underwent PFR between January 2009 and December 2015 were reviewed retrospectively for their clinical and radiological outcomes. The Stanmore METS system was used in all these patients. Mean age at the index surgery (PFR) was 72.69 years (range 50–89) with number of previous hip arthroplasties ranging from 1–5. At mean follow up of 32.27 months, there were no peri-prosthetic fractures and no mechanical failure of the implants. Clearance of infection was achieved in 80% of cases. There was 1 early failure due to intra-operative perforation of femoral canal needing further revision and two were revised for deep infection. Instability was noted in 26.7% (8) of the hips, of which, 87.5% (7) needed further revision with constrained sockets. Out of these 8 hips with instability, 5 had pre-operative infection. Deep infection was noted in 20% (6) of the hips, of which, 5 were primarily revised with PFR for
The main causes of total hip arthroplasty (THA) revisions are loosening and instability. Use of a dual mobility cup cemented in a acetabular reconstruction cage device limits the risk of instability and does not hinder the acetabular fixation during THA revisions. The objective of this study was to analyse a retrospective series of 123 THA revisions with antiprotusio cage and dual mobility socket. Patients and methods: At a mean follow-up of 10 years, we analysed a continuous series of 123 revisions using a reconstruction device (87 Kerboull cross-plates, 12 Burch-Schneider antiprotrusio cages, 24 custom-fit Novae ARM cages associated in all cases with a Novae Stick dual mobility cup cemented into the cage). There were 80 women and 43 males. The mean age at the surgery was 69.2 years old. PMA score increased from 9.6 +/− 3.06 preoperatively to 14.2 +/− 2. at the follow-up. 9 early dislocations occurred and one late dislocation. At the last follow-up, the X-rays showed nine hardware failures, including one cross-plate fracture, one hook fracture, and one flange fracture. Analysis of the radiological position of the cup showed a mean lowering of 13 mm and a 7 mm lateralisation compared to the preoperative position. 2 revisions for aseptic loosening and 3 for
The aim of this study was to determine the outcome of all primary total hip arthroplasties (THAs) and their subsequent revision procedures in patients aged under 50 years performed at our institution. All 1,049 primary THAs which were undertaken in 860 patients aged under 50 years between 1988 and 2018 in our tertiary care institution were included. We used cemented implants in both primary and revision surgery. Impaction bone grafting was used in patients with acetabular or femoral bone defects. Kaplan-Meier analyses were used to determine the survival of primary and revision THA with the endpoint of revision for any reason, and of revision for aseptic loosening.Aims
Methods
Pelvic discontinuity is a rare but increasingly common complication of total hip arthroplasty (THA). This single-centre study evaluated the performance of custom-made triflange acetabular components in acetabular reconstruction with pelvic discontinuity by determining: 1) revision and overall implant survival rates; 2) discontinuity healing rate; and 3) Harris Hip Score (HHS). Retrospectively collected data of 38 patients (39 hips) with pelvic discontinuity treated with revision THA using a custom-made triflange acetabular component were analyzed. Minimum follow-up was two years (mean 5.1 years (2 to 11)).Aims
Methods
Introduction. The mid- or long-term results of acetabular revision total hip arthroplasty (THA) in Korea are rare. The purpose of this study is to report the mid-term radiographic results (> 5 years) of acetabular revision THA with porous-coated cementless Trilogy. ®. cup (Zimmer, Warsaw, IN, USA). Materials and Methods. Between 1999 and 2010, 77 patients (79 hips) had underwent acetabular revision THA with Trilogy. ®. cup. Eight patients (8 hips) were excluded due to death before 5-year follow-up, and 22 patients (23 hips) were excluded due to less than 5-year follow-up or follow-up loss. Forty-seven patients (48 hips) were included in our study. The mean age was 57.9 years (range, 36 to 76 years) and the mean follow-up was 9.8 years (range 5.0 to 16.2 years). The causes of revision were aseptic loosening in 40 hips, and
In spite of its incidence decreasing to 1% nowadays, prosthesis-related infections remain a research, diagnostic, therapeutic and cost-related problem. Early diagnosis, selection of an appropriate surgical strategy, accurate identification of the responsible microorganisms and construction of an appropriate antibiotic regimen are essential elements of any management strategy. Our study aim was firstly to compare the diagnostic accuracy of conventional periprosthetic tissue culture and culture of fluid derived from vortexing and bath sonication of the explanted hardware and secondly to investigate the role of possible metabolic factors affecting the sensitivity of the sonication method. We investigated 70 patients undergoing revision hip or knee arthroplasty because of loosening of the prostheses, at our institution, between October 2011 and November 2013. Patients’ medical history and demographic characteristics were recorded. We compared the culture of samples obtained by sonication of explanted hip and knee prostheses with conventional culture of periprosthetic tissue for the microbiological diagnosis of prosthetic-joint infection. Infectious Diseases Society of America (IDSA) Guidelines were used for the definition of prosthetic-joint infection. Thirty-two patients had
The aim of this study was to evaluate the survival of a collarless, straight, hydroxyapatite-coated femoral stem in total hip arthroplasty (THA) at a minimum follow-up of 20 years. We reviewed the results of 165 THAs using the Omnifit HA system in 138 patients, performed between August 1993 and December 1999. The mean age of the patients at the time of surgery was 46 years (20 to 77). Avascular necrosis was the most common indication for THA, followed by ankylosing spondylitis and primary osteoarthritis. The mean follow-up was 22 years (20 to 31). At 20 and 25 years, 113 THAs in 91 patients and 63 THAs in 55 patients were available for review, respectively, while others died or were lost to follow-up. Kaplan-Meier analysis was performed to evaluate the survival of the stem. Radiographs were reviewed regularly, and the stability of the stem was evaluated using the Engh classification.Aims
Methods
Failure of the femoral component after a primary or revision THA is commonly associated with some degree of femoral bone loss. Depending on the quantity and quality of the remaining host bone, femoral stem revision can be challenging. Twenty patients with severe proximal femoral bone loss due to prosthetic loosening were treated by Wagner cementless self-locking revision stems with a mean follow up of 24 months (range 18–36 months). The indication of revision surgery was aseptic loosening in 16 patients and
Introduction. The legacy constrained condylar knee prosthesis (LCCK, Zimmer.) is designed for primary and revision total joint arthroplasties that need additional stability due to ligament deficiency and to compensate for bone defects. In this follow-up we present our mid term results. Methods and Material. Between November 1999 and January 2006 59 patients were provided with 67 LCCK knee endoprotheses. 38 prostheses were implanted in cases of revision surgery and 29 as primary implants. The mean patient age was 76 years (range 22–93). Indications for revisions were 20 aseptic loosenings, 11 late infections, 7 instabilities (5 cases due to polyethylene wear). Indications for primary arthroplasties were 16 severe valgus and 7 severe varus deformities, 5 cases of osteoarthritis after infection and 1 posttraumatic deformity. 36 femur components (54%) and 34 tibia components (51%) were augmented. 31 stems were fixed cementless, 15 stems were cemented (6 with an intermedullary plug). We evaluated the results prospectively with a clinical inspection and x-ray. Clinical rating systems used were the Knee society, SF-36 Quality of life and Womac score. The mean follow up was 5.6 years. 42 patients were examined, 10 questioned on the telephone, 3 deceased, 12 had to be revised and 2 were lost for follow-up. Results. We had an increase in ROM from 93° to 110°. The Knee Society score improved from 40 to 75 and the function score improved from 46 to 72. The early complications included 1 peroneal lesion, 1 intraoperative fracture, 7 limitations in movement, 10 wound healing problems and 1 thrombosis. 12 revisions had to be performed. 1
The aim of this study is to report the long-term outcomes of instrumented femoral revisions with impaction allograft bone grafting (IBG) using the X-change femoral revision system at 30 years after introduction of the technique. We updated the outcomes of our previous study, based on 208 consecutive revisions using IBG and the X-change femoral revision system in combination with a cemented polished stem, performed in our tertiary care institute between 1991 and 2007. Kaplan-Meier survival analyses were used to determine the survival rate of the revisions with endpoint revision for any reason and aseptic loosening. Secondary outcomes were radiological loosening and patient-reported outcome measures.Aims
Methods
Safety concerns surrounding osseointegration are a significant barrier to replacing socket prosthesis as the standard of care following limb amputation. While implanted osseointegrated prostheses traditionally occur in two stages, a one-stage approach has emerged. Currently, there is no existing comparison of the outcomes of these different approaches. To address safety concerns, this study sought to determine whether a one-stage osseointegration procedure is associated with fewer adverse events than the two-staged approach. A comprehensive electronic search and quantitative data analysis from eligible studies were performed. Inclusion criteria were adults with a limb amputation managed with a one- or two-stage osseointegration procedure with follow-up reporting of complications.Aims
Methods
The aim of this study is to report the implant survival and factors associated with revision of total elbow arthroplasty (TEA) using data from the Dutch national registry. All TEAs recorded in the Dutch national registry between 2014 and 2020 were included. The Kaplan-Meier method was used for survival analysis, and a logistic regression model was used to assess the factors associated with revision.Aims
Methods
INTRODUCTION. Wear, aseptic loosening, dislocation, corrosion and prosthetic joint infection (PJI) are major factors leading to revision of THA. The effect of using ceramic components to address these issues was investigated to determine their behaviour and potential benefit. METHODS. a) Wear determination in off-normal conditions. A series of CoC articulations (32mm) was evaluated using a hip simulator (ISO 14242) up to 4 million cycles in presence of fine alumina particles (48mg/ml). Wear was measured gravimetrically. b) Friction moment determination. Friction moments were measured in a hip simulator with 25% newborn calf serum as lubricant. CoC, CoPE, MoPE, MoXLPE and CoXLPE with articulating diameters ranging between 28 and 40mm were used. The cup was inclined to a constant angle of 33° and rotated ±20° sinusoidally around a horizontal axis at 1Hz. Peak friction moments were measured around the cup rotation axis during a constant joint force period of 1700N between 200 and 210 seconds. c) Infections. Four databases were analysed and additionally data from registers and literature were reviewed to determine the risk of revision for prosthetic joint infection (PJI) dependence on the bearing. Only data for cementless THA were used. Several studies also included analysis of several confounding factors like age at surgery, BMI, pathology, etc. using Cox multivariate analysis. RESULTS. a) Wear determination in off-normal conditions. Loading the test medium with alumina particles didn't produces detectable wear. Opaque areas appeared only after 3 million load cycles, but the wear-rate remained within the gravimetric measurement detection limit (about 0.1–0.2mg) indicating the still extremely low wear-rate of the tested couplings. b) Friction moment determination. The highest moments were measured for metal heads; the lowest for CoC bearings. 40mm CoC bearing showed a similar friction moment like 28mm bearings when coupled with a XLPE liner. c) Infections. The rate of revisions for PJI for 500'749 patients from various studies was in the range of 0.2 to 1.1%. Age at surgery and BMI did not influence
Introduction. The dual mobility cup was introduced in the 1970s to allow extensive range of motion associated with great stability thanks to double articulation; the first between the head and polyethylene, the second between the polyethylene and the cup. The original plan was to install a stainless-steel uncemented cup coated with a thin layer of alumina and a metal head of 22,2 mm with a polyethylene liner of first generation. Long term follow-up case studies are cited in the literature showing excellent results in reducing dislocations; however wearing and aseptic loosening are noted. The new dual-mobility cups, with reticular polyethylene and titanium and hydroxyapatite coating are proving as reliable as the older ones in terms of stability whilst they appear to be more durable. Furthermore, cemented dual-mobility cups are available, these are the topic of this study. One of the most frequent complications in the major revisions of hip replacement is dislocation. This study summarises our experience gathered in the use of dual-mobility cups during revisions of complex cases (GIR III-IV femoral or acetabular). Materials and Methods. Between July 2014 to March 2015, we have implanted 13 cemented cups with dual-mobility (Avantage® Biomet) each in different patients, who have undergone revision with severe ostheolysis (GIR III-IV femoral or acetabular). The mean age of patients was 71.5 years old (46 to 89). Indications for revisions were: aseptic loosening in 7 patients (two at third surgery), recurrent dislocation in 3 patients, 1
Trabecular metal (TM) augments are a relatively
new option for reconstructing segmental bone loss during acetabular
revision. We studied 34 failed hip replacements in 34 patients that
were revised between October 2003 and March 2010 using a TM acetabular
shell and one or two augments. The mean age of the patients at the
time of surgery was 69.3 years (46 to 86) and the mean follow-up
was 64.5 months (27 to 107). In all, 18 patients had a minor column
defect, 14 had a major column defect, and two were associated with
pelvic discontinuity. The hip centre of rotation was restored in
27 patients (79.4%). The Oxford hip score increased from a mean
of 15.4 points (6 to 25) before revision to a mean of 37.7 (29 to
47) at the final follow-up. There were three aseptic loosenings
of the construct, two of them in the patients with pelvic discontinuity.
One
Background. Revision THA presents significant challenges for the surgeon when the proximal femur is deficient or mechanically unreliable. The aim of this study is to assess the clinical and functional results of the use of tumor enndoprosthesis to reconstruct the proximal femur when there is massive bone loss. Patients and Methods. A prospective study was conducted involving 10 cases. The follow up of the cases ranged from 12 months to 30 months with a mean period of an average of 23months. The indications for revision surgery were aseptic loosening in 9 cases and
Introduction. Total hip arthroplasty in young patients is still associated with high failure rates, especially at the acetabular side. Purpose of this study was to evaluate the long-term results of the Alloclassic cementless Zweymüller total hip prosthesis in patients younger than 50 years at the time of surgery. Methods. Between 1987 and 1994, 73 Zweymüller total hip arthroplasties with a titanium threaded cup were placed in 67 patients younger than 50 years. Mean age at surgery was 43 years (23–49 years). Patients were followed clinically with use of the HHS, revisions were determined and radiographs were analyzed. Kaplan-meier analysis was used to determine survival for different endpoints. Results. Three hips were revised for
Background:. Until recently, there has been no consensus of the best approach to dIfferentiating aseptic from
Introduction. Titanium nitride (TiN) coatings are used in total hip arthroplasty to reduce friction of bearing couples or to decrease the allergic potential of orthopaedic alloys. Little is known about performance of currently manufactured implants, since only few retrieval studies were performed, furthermore they included a small number of implants manufactured over 15 years ago. Aim of study. To examine wear and degradation of retrieved TiN coated femoral heads articulating with ultra-high molecular weight polyethylene (UHMWPE). Methods. We included eight femoral heads with a made od TiAl6V4 alloy and coated with TiN using Physical Vapour Deposition (PVD). All heads (28 and 32 mm) were retrieved after at least 12 months of use (range 12–56). The reason for revision was aseptic loosening in 6 cases,
INTRODUCTION. Since July 2008 we are experimenting a new cup with iliac screw fixation, developed on the idea of Ring and Mc Minn. Iliac fixation is permitted by a polar screw of large diameter, coated by HA, which allows a compression to bone and a firm primary stability. Moreover it's possible to increase primary stability with further smaller peripherals screws. We present this new cup and report the preliminary results. MATERIALS AND METHOD. Since July 2008 to April 2010, 51 cups were implanted. The diagnosis was aseptic loosening in 36 cases,
Introduction. With increasing numbers of primary total ankle replacements being performed, the number of revision ankle surgeries is expected to rise also. We present the results of the revision procedures for failed Scandinavian total ankle replacements. Patients and methods. We retrospectively reviewed all the Scandinavian TAR done by the senior author from March 1999 till Jan 2006. Patients who underwent revision surgery were identified and their data was collected including indications for revision surgery, procedure performed, symptoms and the overall outcome. Results. 25 patients underwent revision of Scandinavian TARs between April 2000 and April 2012 out off a total of 213 primary STARs (11%). Average age was 68 years (45 to 82), with male to female ratio of 4:1. The causes of failure of primary implants included broken polyethylene inserts in 12 patients, aseptic loosening in 6 and ankle instability in 7 patients. No
Introduction. Total hip arthroplasties in younger patients often requires revision because these patients frequently have acetabular deficiencies, which hamper proper implantation of the cup essential for good long-term prosthesis survival. For 30 years, we have used a biological acetabular-reconstruction technique with bone-impaction grafting in all patients <50 years with an acetabular deficiency at surgery, always in combination with a cemented total hip implant. Methods. We evaluated all 150 consecutive patients (177 hips) < 50 years with an acetabular reconstruction by bone-impaction grafting surgically-treated from 1978–2004 at our clinic. Mean follow-up was 10.3 (range, 2.0–28.3) years with no patient lost to follow-up. Mean index surgery age was 38.1 (range, 16–49) years. Clinical, radiological, and statistical analysis of all patients was performed. Results. Twenty-eight of 177 hips were revised at a mean of 10.5 years (range, 5 days to 23.2 years). Reasons for revision were: aseptic
Introduction: Arthroplasty plays a growing role in our society today. Due to scientific and medical progress there are an increasing number of viable candidates and the improvement of quality of life thereafter speaks for itself. Even though the operations are largely successful, complications after joint replacement surgery occur frequently. Approximately 10% of lower limb arthroplasties need surgical revision, of which 70% are due to loosening. The purpose of this study was to assess the feasibility of 18-fluorodeoxyglucose positron emission tomography (18FFDG–PET) in detecting septic and aseptic endoprosthetic loosening of hip and knee endoprostheses. Materials and Methods: Thirty-three patients (age range: 45–90y) with lower limb arthroplasty complaints (74 prostheses) were studied preoperatively with 18F-FDG-PET. All patients underwent surgery at a later stage with microbiological culturing to differentiate aseptic and
The use of a porous metal shell supported by two augments with the ‘footing’ technique is one solution to manage Paprosky IIIB acetabular defects in revision total hip arthroplasty. The aim of this study was to assess the medium-term implant survival and radiological and clinical outcomes of this technique. We undertook a retrospective, two-centre series of 39 hips in 39 patients (15 male, 24 female) treated with the ‘footing’ technique for Paprosky IIIB acetabular defects between 2007 and 2020. The median age at the time of surgery was 64.4 years (interquartile range (IQR) 54.4 to 71.0). The median follow-up was 3.9 years (IQR 3.1 to 7.0).Aims
Methods
Fatigue fractures which originate at stress-concentrating voids located at the implant-cement interface are a potential cause of
The purpose of this study is to present early results, common pitfalls and management in in cases of revision hip arthroplsty in patients with congenital disease of the hip. From 2001 to 2006, 36 consecutive cemented THAs with a history of congenital hip disease were revised due to aseptic loosening (31 cases), stem fracture (3 cases),
This study presents the clinical and radiological results of 62 consecutive acetabular revisions in 58 patients, at a mean of 16.5 years follow-up (15 to 20). The Kaplan-Meier survivorship for the cup with end-point revisions for any reason, was 79% at 15 years (95% confidence interval (CI); 67 to 91). Excluding two revisions for
Background. A lot of discussion persists whether obesity negatively influences the outcome of hip arthroplasty. Current literature does not answer this question, since manuscripts showing a worse outcome and those showing a similar outcome can both be found. We performed a meta-analysis with the primary research question whether obesity has a negative influence on short and long term outcome of total hip arthroplasty. Methods. A search of the literature was performed and studies comparing the outcome of hip arthroplasty in different weight groups were included. Methodology of the included studies was scored according to the Cochrane guidelines. Data extraction and pooling of the data was performed. For continuous data a weighted mean difference and for dichotomous variables a weighted Odds ratio was calculated. Heterogeneity was calculated using I2 statistics. Results. A total of 15 studies were available for data-extraction. Dislocation occurred more often in obese with an Odds ratio of 0.54 (95%CI: 0.38–0.75) (10 studies, n = 8634). Aseptic loosening occured more often in obese with an Odds ratio of 0.64 (95% CI 0.43–0.96)(6 studies, n = 5137). Infection occured more often in obese with an Odds Ratio of 0.3 (95%CI: 0.19–0.49) (10 studies, n = 7500). Venous thromboembolism occured more often in obese with an Odds Ratio of 0.56 (95%CI: 0.32–0.98) (7 studies, n = 3716). For
Aims: The objective of this study was to clinically assess the outcome of CADCAM femoral components in the revision hip replacement. Methods: Between 1991 and 2000, 125 revision total hip replacements using CAD-CAM femoral components were performed. Clinical assessment was performed using the Harris Hip score, by direct patient consultation, and telephone or postal questionnaire. Survivorship was defined as the requirement for revision. Results: The patients were reviewed at a mean of 5.2 yrs (1 to 10). The mean Harris hip score increased from 44 points (range, 27 to 71 points) preoperatively to 71 points (range, 21 to 98 points) at the time of the most recent follow-up. 9 patients required subsequent revision; 4 for aseptic loosening, 1 for
Aims. To assess the early subsidence rate of the femoral stem for patients who had collarless Corail total hip replacement. Methods. Consecutive data was collected retrospectively between August 2007 and December 2009 for patients who had collarless Corail total hip replacement. Radiographic assessment of the degree of subsidence, calcar resorption, stem angulation, canal fill ratio and loosening of the stem were measured. Post operative pain, dislocation and stem revision surgery were also evaluated. Results. 48 patients were identified, providing 51 hips for the study. There were 22 male and 26 female. The mean age 64.2 years (range 38-77). Post-operative radiographs were taken at day 1, 6 weeks and one year post-operatively (range 10-18 months, mean 12.7). Significant subsidence was defined as 3 or more millimetres, we identified two patients with subsidence between 3-5mm, one patient with 6mm and two patients with 10mm subsidence at one year post-operatively. In the 5 patients with subsidence post-operatively, all significant subsidence occurred within the first 6 weeks. Canal fill ratio was measured in all patients; in the non-subsided group the ratio was an average of 72% in the lower third of the stem and 84% in the middle third. In the subsided group 75% in the lower third of the stem and 81% in the middle third, which we felt was clinically insignificant. There was no dislocation or revision for
We implanted 300 uncoated cementless PM prostheses into 271 patients and followed 251 (92.6%) of them for four to seven years. By then 37 had already been revised for aseptic and three for
Introduction. To report the short to medium term results of acetabular reconstruction using reinforcement/reconstruction ring, morcellised femoral head allograft and cemented metal on metal cup. Methods. Single centre retrospective study of 6 consecutive patients who underwent acetabular reconstruction for revision hip surgery. The acetabulum was reconstructed using morcellised femoral head allograft and reinforcement or reconstruction ring fixed with screws. The Birmingham cup – designed for cementless fixation, was cemented into the ring in all cases. The uncemented Echelon stem with metal on metal modular head was used for reconstructing the femur. Data from our previous in-vitro study had shown good pull out strength of a cemented Birmingham cup. Results. There were 2 men and 4 women with a mean age of 75 years(57-83). Revision was performed for aseptic loosening in 2,
Introduction: Arthroplasty plays a growing role in our society today. Due to scientific and medical progress there are an increasing number of viable candidates and the improvement of quality of life thereafter speaks for itself. Even though the operations are largely successful, complications after joint replacement surgery occur frequently. Approximately 10% of lower limb arthroplasties need surgical revision, of which 70% are due to loosening. The purpose of this study was to assess the feasibility of 18-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) in detecting septic and aseptic endoprosthetic loosening of hip and knee endoprostheses. Materials and Methods: Thirty-three patients (age range: 45 – 90y) with lower limb arthroplasty complaints (74 prostheses) were studied preoperatively with 18F-FDG-PET. All patients underwent surgery at a later stage with microbiological culturing to differentiate aseptic and
Background. These days, total hip arthroplasties (THA) are more implanted in young patients. Due to the expected lifespan of a THA and the life expectancy of young patients, a future revision is inevitable. Indirectly increasing the number of revisions in these patients. Therefore we evaluated the results of revision THA in patients under the age of 60 years. However, we used a unique protocol in which we used in all cases of acetabular and/or femoral bone deficiencies reconstruction with bone impaction grafting. Methods. To determine the mid- to longterm results of cemented revision total hip arthroplasties in patients under the age of 60, all clinical data and radiographs were analyzed of patients operated between 1992 and 2005. Patients with multiple previous revisions were also included. Only cemented components were used. During this period 146 consecutive revision total hip arthroplasties were implanted in 129 patients. This included 124 cup and 106 stem revisions. The average age at index surgery was 47 years. No case was lost. Mean follow-up was 7.6 (range, 2.0–16.7) years. Results. Outcome of clinical questionnaires improved significantly after revision THA. During follow-up 19% (28 hips) needed a repeat revision (aseptic
Introduction. The following study start from an idea of the evaluation of the osteointegration in the bone cage of the Equinoxe Reverse shoulder prosthesis. The aim of the study is to assess the values of Bone Mineral Density (BMD) in periprosthetic areas, in patients undergoing shoulder arthroplasty with implants of the Equinoxe system by Excatech, Inc. To better understand the steps of osteointegration time of the bone cage with the glenoid. The objectives of the work are not only expanded to the value of osteointegration, but could also be useful for the evaluation of both mechanical and
Reverse polarity total shoulder arthroplasty (RTSA) has gained popularity over recent years for the treatment of the painful cuff deficient shoulder. Although proposed over 20 years ago and despite good clinical outcomes the RTSA has struggled to gain popularity due to reported high levels of complications. One such complication is post-operative instability with frequencies of up to 30% (De Wilde 2002). The Bayley-Walker RTSA was designed specifically for patients with difficult reconstruction problems in whom an unconstrained prosthesis would not offer sufficient stability. It is a reverse anatomy fixed fulcrum constrained prosthesis. The glenoid component has a long HA-coated tapered helical screw, with large pitch and depth, fixation is augmented by a grooved HA coated glenoid plate. The purpose of this study was to review the clinical experience from The Royal National Orthopaedic Hospital Stanmore and to ascertain the rate of glenoid component loosening. We also carried out a radiographic review to correlate loosening with patterns of lucency on post-operative radiographs. One hundred and five B-W TSRs in 103 patients were included, 24% of which were performed as revision of previous failed arthroplasty. In total, 8/105 glenoids required revision. Of those eight patients, two were cases of
Introduction: The histology of prosthetic tissue is a gold standard for the diagnosis of prosthetic joint infection. However, the specificity and sensitivity of histology has never been 100% and this could be due to several causes. A possible cause for inconsistencies in histological results could be the type of specimen submitted to laboratory. The majority of authors obtain specimens from pseudocapsule, interface membrane and any tissue area suspicious of infection. Aim: The objective of our study was to elucidate which is the most accurate specimen for histological diagnosis of prosthetic joint infection. Methods: Prospective study including all revision arthroplasties performed in Hospital Clinic of Barcelona (Spain) from January 2007 to June of 2009. Specimens from pseudocapsule and from interface membrane were obtained from each patient. Definitive diagnosis of infection was considered when ≥2 cultures were positive for the same microorganism or the presence of pus around the prosthesis. Patients were classified in two groups:. patients submitted to hip revision arthroplasty due to an aseptic loosening in whom cultures (at least 5) obtained during surgery were negative and. patients submitted to hip revision arthroplasty due to a
Aims: To reconstruct acetabular bone stock loss in revision hip surgery, from 1979 on we have used a biologic reconstruction method with tightly impacted cancellous allografts in combination with a cemented polyethylene cup. Methods: This studies presents the clinical and radiological results of 62 consecutive acetabular revisions in 58 patients at a mean of 16.5 years (15–20 years) followup. The Kaplan-Meier survivorship for the cup with end-point revisions for any reason was 79% at fifteen years followup (95% C.I.: 67–91%). Results: Excluding two revisions for
The use of a total hip arthroplasty with alumina on alumina bearing couple should limit the risk of wear and secondary osteolysis. From June 1999 to December 2002, we have realised a continuous series of 265 ABGII cementless THA with Alumina bearing. The average age was 58 years (22–78 years). The main causes were osteoarthritis (81%) and osteonecrosis (13%). The operation was performed through a posterior standard approach. In all cases, an anatomic cementless ABG II stem and an acetabular cementless ABG II cup were implanted. The bearing couple was always Alumina Biolox Forte with a 28 mm femoral head in 99% of cases. To date, 12 patients died and 17 patients were lost to follow up (6.4%). 224 patients (232 hips) had a regular clinical and radiological follow-up. The mean follow up was 8.5 years (5–11 years). 9 patients were revised for
We retrospectively reviewed 56 patients (71 hips) treated by total replacement for severe disability after pelvic irradiation. Symptoms were associated with various radiological lesions due to irradiation, including atraumatic femoral-neck fracture, osteonecrosis of the femoral head or of the acetabulum, and radiation osteitis of the whole pelvis. From 1970 to 1982 we used standard cemented components in 49 hips and had a high rate of acetabular loosening (52%) at a mean follow-up of 69 months. This was probably due to the mechanical insufficiency of irradiated periacetabular bone. From 1983 to 1990 we routinely used acetabular reinforcement rings. The rate of aseptic acetabular loosening in 22 hips at a mean follow-up of 40 months was 19%, but there were two
Customization makes it possible to fulfill design requirements during MIS-THA procedures, and has helped define the parameters of fit and fill. This study describes the results of using customization techniques to develop a femoral implant for utilization. CT-based design criteria for femoral implants has-been developed and used for primary, cement-less, non-minimally invasive THA surgery. Over 1000 procedures performed with these devices have been associated with displaced femoral fractures, and have been revised for
We review our first 100 LCS rotating platform total knee arthroplasty (TKA) procedures. Done between July 1993 and December 1996, they are currently at four to seven year follow-up. The sample includes 100 TKAs done in 88 patients as unilateral or bilateral procedures. At operation the mean age of patients, 51% of whom were female and 49% male, was 67 years (47 to 84). The right side was replaced in 54% of cases and the left in 46%. Preoperative diagnoses included degenerative and post-traumatic osteoarthritis in 95 knees and rheumatoid arthritis in five. Two assessments are currently being carried out. They include the American Knee Society Clinical Rating Score, functional ability and radiographic evaluation of knee alignment and radiolucencies. Mean clinical and functional Knee Society ratings were 38 and 57 (sum 95 points) preoperatively and 88 and 84 (sum 172 points) postoperatively. Radiographs showed valgus alignment in 90 rays and varus alignment (1° to 7°) in 10. Limited areas of radiolucency were seen around three tibial components. Two cases have required revision, one for
Background: Total elbow prostheses are broadly classified into linked and the unlinked categories. We have looked at long-term results of unlinked Kudo 5 total elbow replacement used in the treatment of patients with rheumatoid arthritis in 2 hospitals. Methods: 87 Kudo 5 Total elbow replacements in 70 patients with adult rheumatoid arthritis were performed at Wexham Park Hospital, Slough and City Hospital, Nottingham by 2 specialist elbow surgeons, the senior authors. 16 patients had died and 8 patients were lost to follow up. 62 elbow replacements in 46 patients were evaluated at a mean follow up of 79 months [29–137 months] using the Mayo Clinic Performance Index. Postoperative radiographs were also reviewed for loosening using standard anteroposterior and lateral films. Results: Preoperatively 6 had moderate pain and 56 had severe pain. Postoperatively the pain was rated as none or mild by 58 and moderate by 4. The average Mayo Elbow Score improved from 37 preoperatively to 86 postoperatively. The mean arc of flexion/extension improved from 60 to 99 degrees. There were 14 complications including ulnar neuropraxia, fracture, dislocation, triceps rupture and loosening. 4 cases were revised, 2 for aseptic and 2 for
Although total elbow arthroplasty is undertaken in far smaller numbers than total hip and knee arthroplasty a recent review of the world literature indicated that aseptic loosening radiologically occurred in 17.2% whilst clinical loosening was present in 6.4%. In addition, infections were noted in 8.1%. With both aseptic and
Aims: Prospective multi-center study to evaluate the mid-term results of 280 uncemented femoral stem revisions using the modular MRP-Titan system. Methods: 273 patients with 280 MRP-Titan systems, follow-up for a mean time of 3 years (1 to 8 years). Harris hip score for clinical evaluation, bony defect classification according to Paprosky [163 cases (58%) with type 2B, 2C and 3]. Results: Three aseptic loosenings (1%), three
The purpose of this study is to present the clinical and radiological evaluation of 632 resurfacing total knee arthroplasties of Foundation-Solution type, performed in 550 patients (437 women and 113 men), from 1994 to 2003. In the majority of cases (569 knees) the operation was performed because of degenerative osteoarthritis. Cement-free implantation was performed in 209, cemented in 117 and hybrid implantation in 306 procedures. We were able to retrospectively review 442 (80.4%) of the patients (498 knees), for a follow-up time of 6 months to 10 years. The Knee Insall Rating Scale was improved from 60 points (34–70) preoperatively, to 92 points (74–100) postoperatively. The range of flexion at the latest follow-up was between 75 to 130 degrees (mean 98 degrees). Extension lag more than 10 degrees was found in 3 patients (0.68%). The radiological evaluation was performed according to Knee Society Röentgenographic Evaluation and Scoring System. Partial periprothetic radiolucent lines (<
1mm) were observed in 35 knees (7%), with no statistical significant difference between the three groups and no progression during the follow-up. No further clinical and radiological evidence of mechanical failure and no significant loss of the mechanical axis were noticed. There was a case of fatal pulmonary embolism, and a case of peroneal nerve palsy that fully recovered. Three knees were revised as a result of
We identified 1305 femoral impaction bone grafting revisions using the Exeter stem performed between 1989 and 2002 in 30 hospitals throughout Sweden. There were 1188 patients with a mean age of 71 years (29 to 94) followed up for between five and 18 years. The participating departments reported 70 further revisions in total, of which 57 could also be identified on the Swedish National Arthroplasty Registry. Kaplan-Meier survivorship for all causes of failure was 94.0% (95% confidence interval (CI) 92 to 96) for women and 94.7% (95% CI, 92 to 96) for men at 15 years. Survivorship at 15 years for aseptic loosening was 99.1% (95% CI 98.4 to 99.5), for infection 98.6% (95% CI 97.6 to 99.2), for subsidence 99.0% (95% CI 98.2 to 99.4) and for fracture 98.7% (95% CI 97.9 to 99.2). Statistically significant predictors of failure were the year in which revision was conducted (p <
0.001). The number of previous revisions was slightly above the level of signifance (p = 0.056). Age, gender, the length of the stem and previous
Aims: To report medium term results of Beuchal Pappas total ankle replacement carried out at Corbett hospital. Methods: We report a series of 15 patients who underwent this procedure at the Corbett hospital in Dudley between February 95 and March 01. One patient died of an unrelated cause and 14 were followed for an average of 4 years. All patients received the New Jersey total ankle replacement performed by one senior consultant orthopaedic surgeon (SA). The patients were invited to attend a special follow up clinic for clinical and radiological review. The Kitioka ankle scoring system was used to assess outcome. Results: The average age was 64 years. There were 8 women and 6 men. The preoperative diagnosis was advanced post-traumatic arthritis in all patients. Two underwent revision of tibial component- one at 3 years post operative for
Surgeon who used the uncemented cup must choose between two kids of cups: the porous coated (press fit) and the threaded. Many authors present several discouraging results. Nevertheless satisfactory results have also been obtained using threaded cups and the explanation lays in the design the alloy and the surface characteristics of the acetabular component. We describe the clinical and radiological outcome of 93 THA in 81 patients using a screw-in cup (Link- type) performed between 1994–2000. Our follow-up time was and the average age of the patients was 68y,all were primary THA(78 OIA,15 sub-capital fractures).Clinical evaluation was perfomed using the Merle d’ Aubigne hip score. Results: We had good results in 90,3%. Migtation of 2mm of the treaded ring was present in 9 (nine) THA. Although only one has been revised up to now the future of the others remain uncertain. There was no revision of the femoral stem but we had one
We used a trochanteric slide osteotomy (TSO) in 94 consecutive revision total hip arthroplasties (90 with replacement of both the cup and stem). This technique proved to be adequate for removing the components, with few complications (two minor fractures), and for implanting acetabular allografts (18%) and reinforcement devices (23%). Trochanteric union was obtained in most patients (96%), even in those with
Background: Total elbow prostheses are broadly classified into linked and the unlinked categories. We have looked at long-term results of unlinked Kudo 5 total elbow replacement used in the treatment of patients with rheumatoid arthritis in 2 hospitals. Methods: 87 Kudo 5 Total elbow replacements in 70 patients with adult rheumatoid arthritis were performed at Wexham Park Hospital, Slough and City Hospital, Nottingham by 2 specialist elbow surgeons, the senior authors. 16 patients had died and 8 patients were lost to follow up. 62 elbow replacements in 46 patients were evaluated at a mean follow up of 79 months [29–137 months] using the Mayo Clinic Performance Index. Postoperative radiographs were also reviewed for loosening using standard anteroposterior and lateral films. Results: Preoperatively 6 had moderate pain and 56 had severe pain. Postoperatively the pain was rated as none or mild by 58 and moderate by 4. The average Mayo Elbow Score improved from 37 preoperatively to 86 postoperatively. The mean arc of flexion/extension improved from 60 to 99 degrees. There were 14 complications including ulnar neuropraxia, fracture, dislocation, triceps rupture and loosening. 4 cases were revised, 2 for aseptic and 2 for
Introduction: The objective of the study was to test the hypothesis that revision total hip arthoplasty in cases with extensive acetabular bone defects performed with a newly developed, conical, titanium, ribbed shaft socket designed for cementless press-fit into the dorsocranial ilium would not demonstrate inferior outcomes using literature controls. Methods: 38 consecutive hips had an acetabular revision with a pedestal cup. All of the patients had a type IIIa or IIIb defect according the Paprosky-classification. There was an average follow-up of 4.2 years, with a range of 3 to 6 years. Two patients died, one patient was lost to follow-up. All patients were evaluated radiographically, by CT-Scan and clinically. Results: At the time of follow-up, 32 (91.4%) cups were stable. Aseptic loosenings occured in one case,
Purpose of the study: The pertinence of locking for major femoral revision remains a controversial issue. We conducted a retrospective multicentric study to assess the benefit and potential clinical and radiographic complications after using a long locked stem entirely coated with hydroxyapatite. Material and methods: Our series included 77 patients (42 women, 35 men), mean age 71 years (range 34–90) reviewed at minimum one year. A modular implant was used; the long curved stem allowed total integration. Screws guaranteed distal locking. There were 71 revision THA on trochanteric-shaft fractures, three shaft nonunions, 34 aseptic
Purpose of the study: Restrained implants with intrinsic stability guaranteed by a large central stem have been developed for revision knee arthroplasty, irrespective of the underlying cause. Successful restraint implies excellent fixation of the prosthetic implants which can be obtained using press-fit centromedullary stems. The purpose of this work was to assess the long-term results of this mode of fixation in this indication and to search for clinical correlations with potential radiological images around the stems. Material and methods: We report 46 cases of Sigma. ®. PFC TC3 revision total knee prostheses reviewed retrospectively at two years with a mean follow-up of eight years. Mean age at surgery was 68 years. Revision was indicated for aseptic loosening (n=24) and
The purpose of this study is to report our experience with revision of total elbow arthroplasty by exchange cementation. Between 1982 and 2004 at our institution, forty six elbows were treated with exchange cementation of a total elbow arthroplasty into the existing cement mantle or debrided bone interface, without the use of an osteotomy, bone graft or prosthetic augmentation. Indications for the procedure were aseptic loosening (17), second stage after
Infection after total joint arthroplasty can present a diagnostic challenge. No preoperative tests are consistently 100% sensitive and specific, so the diagnosis of infection depends on the surgeon’s judgment with respect to the clinical presentation and examination and interpretation of the results of investigations. The consequences of misdiagnosis are severe. Reimplantation of a prosthesis into an infected host bed is likely to result in persistent infection. Preoperative investigations include haematological screening tests (white blood cell count, ESR, and C-reactive protein), joint aspiration and arthrography, radiography, and radionuclide imaging studies. Intraoperative investigations include analysis of synovial fluid, gram-staining of tissue that appears inflamed, histological evaluation of frozen sections of inflamed tissue, and culture of periprosthetic tissue. The exclusion of infection as a cause of failure is imperative to determine the management of patients who need revision total joint replacement. The key to making the correct diagnosis is using not a single investigation but rather a correct combination of investigations. From 2001 to 2004 we studied 46 patients referred from various centres with prosthesis loosening. The patients had technetium and gallium scintigraphy. In 32 patients, scintigraphic studies suggested
We performed a retrospective analysis of the clinical and radiological outcomes of total hip replacement using an uncemented femoral component proximally coated with hydroxyapatite. Of 136 patients, 118 who had undergone 124 primary total hip replacements were available for study. Their mean age was 66.5 years (19 to 90) and the mean follow-up was 5.6 years (4.25 to 7.25). At the final follow-up the mean Harris hip score was 92 (47.7 to 100). Periprosthetic femoral fractures, which occurred in seven patients (5.6%), were treated by osteosynthesis in six and conservatively in one. We had to revise five femoral components, one because of aseptic loosening, one because of
Background: This report presents the long term (over 20 years) experience with the use of a grit-blasted, press-fit femoral prosthesis. Methods: The first 300 consecutive primary THA procedures using a collarless, three-dimensional tapered, straight, titanium alloy stem with a grit-blasted surface (performed in 299 patients) were evaluated up to twentytwo years. A cementless all-polyethylene socket in 80 percent of the cases, were used. Radiographic evaluation, performed by an independent observer using a zonal analysis method, included assessment of component migration, Engh’s implant-bone femoral fixation score, implant-bone demarcations, and periprosthetic osteolysis. The average duration of long-term radiographic follow-up was 12.6 years (range; 10 to 16 years). Results: At last examination only five hips were lost to follow-up and 84 patients were deceased. The femoral revision rate was 7 percent (two hips for aseptic loosening, five hips for
Introduction: The Wagner SL Stem is a well established implant to bridge proximal femoral defects in hip revision surgery. The tapered shape offers the possibility of press-fit anchorage distal to the bone defect. There are missing long term results with absolute follow-up over ten years. The goal of the study was to observe the subsidence and the restoration of the proximal bony stock within ten years. Patients and Methods: From 1988 until 2005 198 Wagner Stems were implanted in our hospital. 50% of the indications were due to aseptic loosening, 25 % due to
Extensive bone deficiencies in proximal femur remains a significant challenge in hip surgery. In such a situation, one alternative is to use a proximal femoral allograft-prosthesis composite (APC) to restore the mechanical integrity and bone stock. The current study was performed to analyze the results of APC in the treatment of femoral bone deficiency. From January 1996 to June 2006, 12 patients who received 15 APC (3 of them received repeated APC), were followed for a mean of 4.2 years (range 2.0 to 9.8 years) by one surgeon. 5 were males and 7 were females and the mean age of the patients was 60.9 years (range 32 to 84 years). 6 patients were diagnosed with
Periprosthetic joint infections (PJIs) are rare, but represent a great burden for the patient. In addition, the incidence of methicillin-resistant For this purpose, sterilized steel implants were implanted into the femur of 77 rats. The metal devices were inoculated with suspensions of two different MRSA strains. The animals were divided into groups and treated with vancomycin, linezolid, cotrimoxazole, or rifampin as monotherapy, or with combination of antibiotics over a period of 14 days. After a two-day antibiotic-free interval, the implant was explanted, and bone, muscle, and periarticular tissue were microbiologically analyzed.Aims
Methods
Introduction. Total hip arthroplasties (THAs) in young patients are associated with high failure rates. We always use cemented total hip implants, however, in cases with acetabular bone stock loss we perform bone impaction grafting. Our purpose was to evaluate the outcome of 69 consecutive primary cemented total hips in patients younger than 30 years followed between 2 to 18 years. Methods. Between 1988 and 2004, 69 consecutive primary cemented THAs (mainly Exeters) were performed in 48 patients (32 women, 16 men) younger than thirty years. Average age at time of operation was 25 years (range, 16 to 29 years). Twenty-nine hips (42%) underwent acetabular bone impaction grafting because of acetabular bone loss. Mean follow-up was 10 years (range, 2 to 18 years). Revisions were determined, Harris Hip Score (HHS), and Oxford Hip Questionnaire Score (OHQS) were obtained and radiographs were analyzed. Survival was calculated using the Kaplan-Meier method. Results. No patients were lost to follow-up, but 3 patients (4 hips) died during follow-up, none of whom had underwent revision. Eight revisions were performed: 3
INTRODUCTION. Management of neglected residually displaced acetabular fractures is a big challenge. ORIF is often doomed to failure so a primary total hip replacement is usually kept in mind as a method of choice. However THR is a technically difficult and results are quiet unpredictable. OBJECTIVE. To present our experience with THR in maltreated grossly displaced acetabular fractures and to discuss operative technique and prognostic factors in that complicated surgery. MATERIAL. THR was applied in 14 patients (11 males and 3 females, mean age 51 years) with at least three-months old and significantly displaced acetabular fractures. In 12 cases preceding treatment was conservative, and in 2 it was operative. Fracture nonunion was recognized in 5 cases, old hip dislocation in 4 and protusion in 3. Large interfragmentary gaps and local bone defect were detected in almost all cases. METHOD. THR was performed 3–31 months after injury. Extensile iliofemoral or Y-shaped approach with trochanteric osteothomy was used in most cases. Depending of particular situation a variety of techniques were applied to provide adequate bone stock for the cup, such as an approximate ORIF, periacetabular osteotomy, structural or morcelised bone grafting. Reinforcement ring was used in 6 cases. The cup fixation was cemented in 12 procedures and uncemented in 2. Cemented stem was introduced in 10 cases and uncemented in 4. Preoperative selective embolisation of superior gluteal artery was carried out in 1 patient. RESULTS. The operative duration was 3–7 hours and blood loss was 850–2200 ml. The only intraoperative accidentwas jatrogenic lesion of superior gluteal artery required embolisation. The follow up was a 16–94 months. Average postoperative Harris Hip Score was 78, compared with 54 before surgery (P<0.01). There was 2 aceptic and 1
Aims: To evaluate the results of a novel modular press-þt acetabular cup in primary total hip arthroplasty (THA) for osteoarthrosis (OA) and inßammatory arthritis (IA). Methods: From February 1996 to June 1999 in 324 patients (249 women, 75 men) 355 THA using a novel cup has been carried out. The shell is non-hemispherical on cross-section and has a hydroxyapatite coating on porous titanium for osseointegration. Diagnosis was: osteoarthrosis (OA) 236, developmental dysplasia (DDH) 21, post-traumatic arthrosis 27, avascular necrosis 6, IA 65 Ð mainly rheumatoid arthritis (RA). Average age at operation was 65.8 years. The patients were studied prospectively using Harris Hip Score (HHS), by measuring any radiolucency around the cup and by looking for signs of migration. Results: Median follow-up was 4.5 years. At follow-up, 21 patients had deceased. Revision for deep infection was carried out in 5 hips (3 low-grade infections). No
Introduction: The operation method selected for acetabular revisions depends on the type of deþciency; Type 1: contained cavitary; the acetabular rim is preserved and thus supportive. Type 2: non-contained deþciencies; the acetabular rim and the peripheral zones are non- supportive defects. In non-contained, rim non-supportive defects acetabular reinforcement rings are used as a rule. Material and methods: Between July 1988 and December 1997 465 acetabular revisions with 229 Reinforcement Rings and 236 Press- Fit Cups (4 bilaterally) were performed. A 7.5 (5.0–10.8) year clinical and radiological follow-up of the Press-Fit Cup inserted in 130 women and 102 men was effected. Mean age at revisions surgery was 70 in women and 73 in men. 39 patients (17%) died without needing a re-revision, and 17 (7%) could only be interviewed by phone. One patient was lost to follow-up. Of the remaining 175 patients (75%) with 179 hips (76%) were available for complete evaluation. Results: The clinical results (according to Merle dñAubignŽ) was excellent and good in 82% 143 pts), moderate in 17% (30 pts) and poor in 1% (2 pts). 22 (9%) reinterventions were noted during the observation period: 12 for dislocations, 5 for aseptic stem loosening, 1 for
There exist 4 methods for femoral fixation of hip spacers:. a simple insertion,. a partial/full cementation,. the “glove”-technique, and,. a cement bridge in case of large osseous defects of the proximal femur. To our knowledge, it is still unknown which of these methods provides the best stability. Between 01.01.1999–31.12.2008, 84 hip spacer implantations in 78 patients have been performed in our department. All patients have been treated with the same kind of spacer. 24 spacers have been fixed with the “glove”-technique, 18 with a partial cementation onto the proximal femur, 21 with a simple insertion, and 4 with a cement bridge. In 17 cases with an isolated
The use of monoblock tapered stems has shown very good results in hip revision surgery, particularly in case of severe proximal femur bone deficiency. However a too valgus neck, a short offset, may result in a high risk of dislocation. In addiction monoblock stems make the control of limb length difficult, and potentially increase the risk of subsidence or intraoperative fracture. Different types of modular tapered stems with distal fixation have been developed to allow a more user-friendly restoration of limb-lenght discrepancy and an indipendent proximal control of offset and anti-retroversion. We assessed 64 hip revisions performed on 63 patients (mean age 62 years). Indication for treatment was: aseptic loosening (42 cases)
