We report on a series of long-stemmed femoral components used in revision total hip replacements which fractured, and were subsequently revised. All explanted stems were analysed in respect of the reasons for failure. The patient's serial radiographs and clinical records were also analysed. All stems demonstrated some fixation distally. They all showed little proximal osteo-integration. A biomechanical analysis confirmed the vulnerability of these long stemmed modular prostheses in respect of mechanical failure. The resultant unprotected lever-arms led to local stresses in the prosthesis constructs which were above the failure threshold resulting in prosthesis fractures. These fractures all occurred at points where the prostheses were structurally most vulnerable.Methods
Results
Antibiotic loaded polymethyle methacrylate spacers are commonly used in the management of septic hip replacements. The aim of this study was to determine wear patterns on the articulating surfaces of these spacers, as well as to determine the extent of PMMA particulate debris generation.Introduction
Aim
Using the EOL+ cup, 25 operations were performed between December 1999 and February 2003. Most of them were salvage procedures for recurrent dislocations following primary and revision hip surgery. The 18 women and seven men (mean age 65 years) had experienced a total of about 50 dislocations and 20 previous revision procedures. One patient had seven recorded dislocations, three had each had three previous revisions, and three cases had each had two previous revisions. The mean follow-up was 22 months. No redislocations have occurred. One patient was revised to another EOL+ cup. This cup presents an alternative salvage solution in problem cases, including those due to poor musculature, which do not respond to conventional solutions.
Using the EOL cup, we performed 15 operations between December 1999 and January 2001. Most of them were salvage procedures after recurrent dislocation of total hip arthroplasty and subsequent revision surgery. The six men and nine women (mean age 63 years) had experienced a total of 42 dislocations and 16 previous revision procedures. The mean follow-up was 10 months. No redislocation has occurred. We believe the EOL cup is an alternative salvage solution for problem cases.
Using the EOL cup, 15 operations were performed between December 1999 and January 2001. Most of them were salvage procedures after recurrent dislocations of total hip replacement and their revisions. The six men and nine women (mean age 63 years) had experienced a total of 42 dislocations and 16 previous revision procedures. One patient had seven recorded dislocations, two cases each had three previous revisions, and three cases each had two previous revisions. The mean follow-up was 10 months. No redislocations have occurred. This cup presents an alternative salvage solution for problem cases.
Between 1997 and 2000, internal arthrodiastasis procedures (endo-apparatus), using an internal skeletal distraction device, were performed on 33 young patients who had reached the point of total hip arthroplasty or arthrodesis. The mean age of the 20 males and 13 females was 19 years (range 11 to 51 years). We removed 19 implants, eight after completion of treatment or because they had outlived their usefulness, and 11 because no improvement in the hip disorder had been achieved. Good results were achieved in two thirds of the patients, including patients suffering from avascular necrosis of the femoral head, old Perthes’ disease and contained hip dysplasia with joint space narrowing and pain. Chondrolysis and stiffness of the hip appear to be contraindications for this type of treatment. The three post-traumatic hip disorders were probably also not ideal cases. In young patients, the results of total hip arthroplasty after trauma are poor, and the indications for internal arthrodiastasis should be redefined.
