We present the extended follow-up (≥ 20 years)
of a series of fully hydroxyapatite-coated femoral components used in
72 primary total hip replacements (THRs). Earlier results of this
cohort have been previously published. All procedures were performed
between 1986 and 1991. The series involved 45 women and 15 men with
12 bilateral procedures. Their mean age at the time of surgery was
60 years (46 to 80) and the mean duration of follow-up was 22.5
years (20 to 25). At final follow-up, the mean Merle d’Aubigné and
Postel hip scores were 5.5 (4.5 to 6), 3.8 (3.5 to 5) and 3.3 (3.0
to 5.0) for pain, mobility and function, respectively. Of the patients
92% were very satisfied at the time of final follow-up. There were seven revisions: six of the acetabular component for
aseptic loosening and one of both the stem and the acetabular component
for loosening due to deep infection. The survival of this prosthesis
at 22.5 years with revision for any reason as the endpoint was 91.7%
(95% confidence interval (CI) 84 to 99). Survival with aseptic loosening
of the stem as the endpoint was 100% (95% CI 90 to 100). This prosthesis provides pain relief in the long term. Survival
of this component is comparable to the best results for primary
THR with any means of fixation. Cite this article:
The ideal method of fixation for femoral components in total hip arthroplasty (THA) is unknown. While good results have been reported for cemented and uncemented components, there is relatively little published prospective data with twenty years or more of follow up. Results of the Furlong femoral component have been presented at an average of 17 years follow up. We have extended this follow up period to an average of 22.5 years with a minimum of 22 years and a maximum of 25 years. This study included all patients treated using the Furlong femoral component between 1986 and 1991. Patients were reviewed preoperatively and then at 6, 12, 26 and 52 weeks post operatively and annually thereafter. They were assessed clinically and radiographically and the Merle d'Aubigne Postel hip score was calculated at each visit. A Visual Analog Score (VAS) was also recorded to assess patient satisfaction with their procedure. A Kaplan Meier survival analysis was performed.Introduction
Methods
There is increasing interest in the use of Total Hip Replacement (THR) for reconstruction in patients who have suffered displaced intracapsular hip fractures. Patient selection is important for good outcomes but criteria have only recently been clearly defined in the form of national guidelines. This study aims to investigate patient reported outcomes and satisfaction after Total Hip Replacement (THR) undertaken for displaced hip fractures and to compare these with a matched cohort of patients undergoing contemporaneous THR for osteoarthritis in order to assess the safety and effectiveness of national clinical guidelines. 100 patients were selected for treatment of displaced hip fractures using THR between 1 January 2007 and 31 December 2009. These patients were selected using national guidelines and were matched for age and gender with 300 patients who underwent contemporaneous THR as an elective procedure for osteoarthritis.Background
Methods
In this review, we present the data of one of the largest non-designer, mid- to long-term follow ups of the AGC. We present a total of 1538 AGC knees during a 15 year period, of which 902 were followed up by postal or telephone questionnaire focused on Oxford Knee Scores, Visual analogues of function and pain and survival analyses performed. Mean length of follow up was 10.4 years. 85.7% of patients had an Oxford knee score of between 0 and 40, with 71.2% scoring between 0–30. 65.6% of patients responded with a Visual Analogue Score (VAS) of 0 or 1 at rest (minimum pain 0) and 53.9% reporting VA scores of 0 or 1 while walking. 87.5% of patients reported Excellent or good functional reports at final follow up and 90.3% reporting excellent or good pain control compared to per-operative levels. Survival analysis confirms excellent survivorship. This large cohort and multi-surgeon trial reproduces the excellent results as demonstrated by the designer centre (Ritter et al.). Mid to long term outcome sows excellent function and analgesia. Complication rates are low and the necessity for revision remains low.
Deep vein thrombosis(DVT) and pulmonary embolism(PE) are well-recognised complications following lower limb arthroplasty (Cohen et al, 2001). The National Institute for Clinical Excellence and British Orthopaedic Association recommend the use of both mechanical and chemical prophylaxis. At our institute regimens have changed reflecting new developments in the use of thombo-prophylaxis. Our aim was to assess the efficacy of these methods in preventing complications. Since moving from Aspirin and compression stockings (TEDS) only, three different treatment methods were prospectively audited. Regimen 1 consisted of Aspirin (150 mg OD) and TEDS for 6 weeks (n=660). Regimen 2 used Clexane 40mg OD (n=448). Regimen 3 used Rivaroxaban (n=100) as licensed and Regimen 4 Dabigatran (n=185) as licensed. We looked at rates of venous thromboembolism (VTE), rates of post op bleeding/haematoma and wound complications. Patients were reviewed prior to discharge, and at a six-week follow-up. Any casualty attendances were also recorded up to 12 weeks post-operatively.Introduction
Methods
A reduced range of movement post total knee replacement (TKR) surgery is a well recognised problem. Manipulation under anaesthesia (MUA) is a commonly performed procedure in the stiff post operative TKR. Long term results have been variable in the literature. We prospectively followed up 48 patients since 1996 from one centre, over an average of 7.5 years, (range 1 to 10 years) and report on the long term results. The mean time to MUA post TKR was 12.3 weeks (range 3 to 48). Pre MUA, the mean flexion was 53°. The mean immediate passive flexion post MUA was 97°, an improvement of 44° (Range 10° to 90°, CI < 0.05). By one year, the mean flexion was 87°, improvement of 34°, (range −15° to 70°, CI< 0.05). At ten years the mean flexion was 86°. We found no difference between those knees manipulated before or after 12 weeks. In addition there was no difference found in those knees which had a pre TKR flexion of greater or less than 90°. There were no complications as a result of MUA. However, one patient was eventually revised at two years secondary to low grade infection. Our findings show that MUA is safe and effective method at improving the range of motion in a stiff post operative TKR. The improvement is maintained in the long term irrespective of time to MUA and range of motion pre TKR
In this review, we present the data of one of the largest non-designer, mid- to long-term follow-ups of the AGC carried out by surgeons of differing grades and sub-specialty. We present a total of 1538 AGC knees during a 15 year period, of which 902 were followed up by postal or telephone questionnaire focused on Oxford Knee Scores, Visual analogues of function and pain and survival analyses performed. 85.7% of patients had an Oxford knee score of between 0 and 40, with 71.2% scoring between 0 - 30. 65.6% of patients responded with a Visual Analogue Score (VAS) of 0 or 1 at rest (minimum pain = 0) and 53.9% reporting VA scores of 0 or 1 while walking. 87.5% of patients reported Excellent or good functional reports at final follow up and 90.3% reporting excellent or good pain control compared to per-operative levels. There is a survivorship of 95.88% at 15years. This large cohort and multi-surgeon & multi-experience level trial reproduces the excellent results as demonstrated by the designer centre (Ritter et al.) and is better than most others in the literature. Mid to long term outcome shows excellent function and analgesia. Complication rates are low and the necessity for revision remains low.Purpose of Study
Summary of methods and Results
To compare a randomised group of patients undergoing UKA to investigate the advantages of the minimal invasive approach in the early post-operative stage. 100 patients on the waiting list for UKA were recruited into the trial. Patients were prospectively randomised into 2 groups: Group 1 – longitudinal skin incision with dislocation of the patella, Group 2 – the minimally invasive approach. Standard milestones were recorded post-operatively: time to achieve IRQ, independent stair climbing and to discharge. Additionally, patients were scored with the AKSS and Oxford knee questionnaire pre-operatively, at 6 weeks, 6 months and 1 year. No significant differences were found between the 2 groups in the measured parameters.Aims
Results
Hydroxyapatite (HA) coated femoral stems require a press fit for initial stability prior to osteointegration occurring. However this technique can lead to perioperative femoral fracture. 506 consecutive patients under 72 years who underwent primary total hip replacements (THR) under 72 years were investigated for perioperative femoral fractures. All patients were independently assessed pre- and post-operatively in a research clinic. Assessment was made by Merle d'Aubigné and Postel (MDP) hip scores and radiographs. Between 1995 and 2001 patients were randomised to a partially HA coated, Osteonics Omnifit or fully HA coated Joint Replacement Instrumentation Furlong stem. Between 2001 and 2004 all patients received an Anatomique Benoist Girard (ABG II) stem partially coated. Fractures were identified from check radiographs and operative notes. The type of fracture was classified according to the modified Vancouver classification. The incidence of revision was also recorded.Introduction
Materials and Methods
The most common indication for knee arthrodesis is pain and instability in an unreconstructable knee following an infected knee arthroplasty. In this study, we compare the use of the Mayday arthrodesis nail (Ortho-dynamics, Christchurch, UK) versus external fixation, Orthofix (Berkshire UK) and Stryker Hoffman II (County Cork, Ireland). All patients in this study underwent arthrodesis between 1995 and 2006 at Conquest Hospital, Hastings. In group A, 11 patients underwent arthrodesis with a Mayday nail. In all cases, the indications were infected total knee replacements (TKR). Three of these patients previously had failed attempts at arthrodesis with external fixation devices. In group B, seven patients underwent arthrodesis using external fixation. In six patients, the indication was infected TKRs. Results were reviewed retrospectively, with union assessed both clinically and radiologically. The mean inpatient stay for the Mayday nail group was 23 days (range 8 – 45 days) compared with 76 days (range 34 – 122) for the external fixation group (p<
0.01, CI 95). Ten patients in group A went on to confirmed primary arthrodesis. One patient underwent revision arthrodesis with a Mayday nail and subsequently united. In group B only two patients achieved union. The rate of union was significantly greater in the Mayday nail group than the external fixation group (91% vs 29%, p<
0.01). Of those patients that achieved union, there was no difference in the time to fusion between groups. Our study supported the existing literature and found that the Mayday nail appeared more effective than monoaxial external fixators for arthrodesis in the management of infected total knee replacements.
There have been no major surgical complications. In particular, there have been no failures of acetabular fixation, dislocations or deep infections.
No significant differences were found between the 2 groups in the measured parameters.
The 98 % 10-year survivorship of cemented AGC TKR is regarded as gold standard.( The aim of this trial is to determine if the type of fixation also influences outcome. Participants were randomly allocated to either a cemented or cementless hydroxyapatite-coated AGC prosthesis. All patients were assessed with the Hospital for Special Surgery Score (HSS) and radiographs pre- and post-operatively at six weeks, six months and annually. 223 knees were studied with a mean follow-up of 53.4 months (max.10 years). There were no significant differences between the two groups in post-operative HSS scores or in improvement of HSS scores. There has been no observable migration in either group. There has been 1 case requiring revision from the HAC group and 2 patellar buttons were revised following traumatic separation. The early results are equally good for both groups with no significant difference in outcome or complication rate between cemented and HA coated fixation.
In relation to the conduct of this study, one or more the authors have received, or are likely to receive direct material benefits.
The aim of this study was to assess the outcome of patients who underwent ElmslieTrillat antero-medial tibial tubercle transfer for treatment of persistent symptomatic anterior knee pain due to chondromalacia patellae. We performed a prospective analysis of 23 patients who underwent Elmslie-Trillat antero-medial tibial tubercle transfers over a five year period for chronic anterior knee pain and an arthroscopic diagnosis of chondromalacia patellae. All patients who presented with anterior knee pain underwent an initial period of physiotherapy and all patients whose symptoms persisted following physiotherapy underwent arthroscopic assessment. Patients who continued to experience debilitating symptoms despite this initial treatment and who also had a diagnosis of chondromalacia patellae from arthroscopic assessment were listed for an Elmslie-Trillat tibial tubercle anteromedialisation. Patients who gave a history of instability or dislocation were excluded. The average age of patients undergoing surgery was 34 years (21–48 years) and the average time between arthroscopic diagnosis and surgery was 14 months. All patients who underwent surgery had pre and post operative KuJala patellofemoral scoring. The average pre-operative score was 54 (30–78) and post operative score 76 (46–100). The average post operative assessment was 25 months (6–62 months). Twenty one patients had improved post operative scores with one having a worse score and one score remaining unchanged following surgery. Nineteen patients felt that their symptoms had improved, three felt that there had been no change and one felt that they were worse after surgery. When asked if the improvement in symptoms had been worthwhile nineteen stated that they would undergo surgery again if in the same situation and four stated that they would not. The treatment of symptomatic chondromalacia patellae remains a challenge. Although a more selective approach to individuals with anterior knee pain is widely advocated in the literature this study demonstrates that good results can still be achieved in patients treated empirically with a tibial tubercle anteromedialisation.
Clinical implantation represents the ultimate experiment of any component and often demonstrates areas of strengths and weaknesses not predicted from in vitro testing. Mobile bearing knees incorporate an additional articulating interface between the flat distal PE insert and a highly polished metal tibial tray. This can allow the proximal interface to retain high conformity whilst leading to reduced stresses at the bone – prosthesis interface by permitting complex distal interface compensatory motion to occur (rotation and/or translation). Retrieval reports on many of the new generation of mobile bearing implants remains scarce. This study presented a retrieval analysis of 9 mobile bearing inserts that had be in situ for less than 24 months. Nine cemented mobile bearing implants (6 AP Glide, 1 LCS, 1 MBK and 1TRAK) were received into our Implant Retrieval Program. The femoral component, tibial tray and PE insert were macroscopically examined under a stereo-zoom microscope for evidence of damage. The PE inserts were graded for wear based on optical and SEM assessments. The proximal and distal surfaces of the PE inserts were subsequently assessed for surface roughness following ISO 97 (Ra and Rp) using a Surfanalyzer 5400 (Federal Products, Providence, RI). Virgin, unused PE inserts were analysed and served as a comparison to the retrieved implants. Time in situ time for these implants ranged from 6 months to 24 months (mean 18.6). The implants were revised for instability and pain (AP glide) or dislocation (TRAK). Damage to the femoral components, in general, was minimal with some evidence of a transfer film of PE. The proximal surface of the tibial trays presented evidence of PE transfer as well as some scratches but in general were intact. The proximal PE and distal PE articulating surfaces demonstrated significant areas of damage due to third body wear which was identified on EDAX to be PMMA. Areas of burnishing were also present at the proximal and distal interface. The damage, in part, correlated with the complex kinematics of each design.
both a modified Hungerford and Kenna knee rating system and Insall and Crosby grading system, and asking whether surgery had been worthwhile and whether they would go through it again. Serial radiographs were assessed for patellar malalignment, mechanical failure and progressive arthritic change in the knee, and failure was defined as a fairlpoor knee score or revision.
Preoperatively 17 knees had undergone arthroscopy. 36 Lubinus, 17 Cartier and 2 PFV prostheses were used. 5 patients died with 8 PF arthroplasties in situ, 1 patient lost to follow up (these patients are not included further in the analysis). 48 Patellofemoral arthroplasty knees were reviewed. 38 knees were classed as good or excellent, 10 had unsatisfactory results, and 7 were revised. 5 implants were revised to TKR and 2 were revised to PF arthroplasty (for maltracking). Subjectively 41 patients felt they were better, 5 unchanged and 2 worse. Overall we had 69% good or excellent results, 18% poor, and 12% revised. There were no infections, no revision for loosening, and no documented difficulty in revisions. The worst results were obtained in patients with evidence of tiblo-femoral OA preoperatively and in patients with tracking problems.
Pyomyositis is rarely seen in temperate climates. Typically, it presents with the formation of an abscess requiring surgical drainage and it has been reported as a differential diagnosis for septic arthritis of the hip. We describe the occurrence of pyomyositis of the iliacus muscle in a ten-year-old girl which was diagnosed by MRI and blood culture. Formation of an abscess did not occur despite marked focal inflammation and swelling of the muscle. Conservative treatment with antibiotics alone led to complete clinical and radiological resolution of the infection. We could find no previous description of pyomyositis in a child in the British orthopaedic literature. Orthopaedic surgeons, particularly those with a paediatric interest, should be aware of this condition and its presentation, diagnosis and treatment.