Aims. Prior cost-effectiveness analyses on osseointegrated
Aims. Safety concerns surrounding osseointegration are a significant barrier to replacing socket
Introduction. Clione Anchored Replacement
Aims. The aim of this study was to evaluate medium- to long-term outcomes and complications of the Stanmore Modular Individualised Lower Extremity System (SMILES) rotating hinge implant in revision total knee arthroplasty (rTKA) at a tertiary unit. It is hypothesized that this fully cemented construct leads to satisfactory clinical outcomes. Methods. A retrospective consecutive study of all patients who underwent a rTKA using the fully cemented SMILES rotating hinge
Aims. The aim of this study was to identify variables associated with time to revision, demographic details associated with revision indication, and type of
Introduction: Design of the
Purpose of the study: This retrospective analysis compared surgical treatments of femoral neck fractures in patients aged over 80 years. Material and methods: Two hundred femoral neck fractures (Garden 3 and 4) were treated in three different manners: total
Introduction. Post-meniscectomy syndrome is broadly characterised by intractable pain following the partial or total removal of a meniscus. There is a large treatment gap between the first knee pain after meniscectomy and the eligibility for a TKA. Hence, there is a strong unmet need for a solution that will relieve this post-meniscectomy pain. Goal of this first-in-man study was to evaluate the safety and performance of an anatomically shaped artificial medial meniscus
Aims. The Mathys Affinis Short is the most frequently used stemless total shoulder
Background. The literature on the outcome of revision total ankle arthroplasty (TAA) remains limited. We aim to report the clinical and radiological outcomes of revision TAA at a high-volume centre in the UK. Methods. Retrospective review of 28 patients that underwent 29 revision TAA procedures using INBONE II
A common location for radius fracture is the proximal radial head. With the arm in neutral position, the fracture usually happens in the anterolateral quadrant (Lacheta et al., 2019). If traditional surgeries are not enough to induce bone stabilization and vascularization, or the fracture can be defined grade III or grade IV (Mason classification), a radial head
Constrained implants with intra-medullary fixation are expedient for complex TKA. Constraint is associated with loosening, but can correction of deformity mitigate risk of loosening?. Primary TKA's with a non-linked constrained
Prosthetic joint infections represent complications connected to the implantation of biomedical devices, they have high incidence, interfere with osseointegration, and lead to a high societal burden. The microbial biofilm, which is a complex structure of microbial cells firmly attached to a surface, is one of the main issues causing infections. Biofilm- forming bacteria are acquiring more and more resistances to common clinical treatments due to the abuse of antibiotics administration. Therefore, there is increasing need to develop alternative methods exerting antibacterial activities against multidrug-resistant biofilm-forming bacteria. In this context, metal-based coatings with antimicrobial activities have been investigated and are currently used in the clinical practice. However, traditional coatings exhibit some drawbacks related to the insufficient adhesion to the substrate, scarce uniformity and scarce control over the toxic metal release reducing their efficacy. Here, we propose the use of antimicrobial silver-based nanostructured thin films to discourage bacterial infections. Coatings are obtained by Ionized Jet Deposition, a plasma-assisted technique that permits to manufacture films of submicrometric thickness having a nanostructured surface texture, allow tuning silver release, and avoid delamination. To mitigate interference with osseointegration, here silver composites with bone apatite and hydroxyapatite were explored. The antibacterial efficacy of silver films was tested in vitro against gram- positive and gram-negative species to determine the optimal coatings characteristics by assessing reduction of bacterial viability, adhesion to substrate, and biofilm formation. Efficacy was tested in an in vivo rabbit model, using a multidrug-resistant strain of Staphylococcus aureus showing significant reduction of the bacterial load on the silver
Aim. Due to medical and organizational factors, it occurs in everyday practice that spacers are left in place longer than originally planned during a two-stage
The place of the myo-electric
Purpose: A spacer can be used for two-phase replacement of an infected total hip
Previous scientific studies have highlighted how coupling is an important element affecting total hip arthroplasty's survival. This study aims to evaluate whether metal-on-metal (MOM) coupling could be a statistically significant risk factor. The data from the regional joint registry (Registro dell'Impiantologia Protesica Ortopedica, RIPO) was used for analysis. The data collection accuracy of this registry was 97.2% in 2017. We retrospective evaluate all MOM total hip arthroplasties (THAs) implanted in our department between January 01st 2000 and December 31st 2011. We used a control group composed by all other
Coronoid fractures account for 2 to 15% of the cases with elbow dislocations and usually occur as part of complex injuries. Comminuted fractures and non-unions necessitate coronoid fixation, reconstruction or replacement. The aim of this biomechanical study was to compare the axial stability achieved via an individualized 3D printed
Revision total hip arthroplasty (rTHA) in the presence of femoral defects can be technically challenging. Reconstruction with long stems is widely accepted as the standard. However long stems can be difficult to insert and can compromise distal bone stock for future revisions. The aims of this study were to identify whether there was a difference in survival and outcomes following rTHA using a long versus standard or short femoral stem. A comprehensive systematic review was performed according to PRISMA guidelines using the MEDLINE, EMBASE, Chochrane Library and Web of Science databases. Inclusion criteria were (i) adult patients >18 years; (ii) randomised controlled trials, joint registry, or cohort studies; (iii) single or staged rTHA for Paprosky 1–3B femoral defects. Exclusion criteria were (i) mixed reporting without subgroup analysis for revision stem length; (ii) ex-vivo studies. Screening for eligibility and assessment of studies was performed by the authors. Out of 341 records, 9 studies met criteria for analysis (including 1 study utilising joint registry data and 1 randomised controlled trial). Across studies there were 3102 rTHAs performed in 2982 patients with a mean age of 67.4 years and a male: female ratio of 0.93. Revision prostheses were long-stemmed in 1727 cases and short or standard in 1375 cases with a mean follow up of 5 years (range, 0-15 years). On subgroup analysis the use of a long cemented stem compared to a long cementless
The aim of this study was to compare the biomechanical models of two frequently used techniques for reconstructing severe acetabular defects with pelvic discontinuity in revision total hip arthroplasty (THA) – the Trabecular Metal Acetabular Revision System (TMARS) and custom triflange acetabular components (CTACs) – using virtual modelling. Pre- and postoperative CT scans from ten patients who underwent revision with the TMARS for a Paprosky IIIB acetabular defect with pelvic discontinuity were retrospectively collated. Computer models of a CTAC implant were designed from the preoperative CT scans of these patients. Computer models of the TMARS reconstruction were segmented from postoperative CT scans using a semi-automated method. The amount of bone removed, the implant-bone apposition that was achieved, and the restoration of the centre of rotation of the hip were compared between all the actual TMARS and the virtual CTAC implants.Aims
Methods
The management of femoral bone loss is challenging during revision hip arthroplasty. In patients with Paprosky grade IIIB and IV defects, obtaining fixation and rotational stability using traditional surgical constructs is difficult. The use of a custom-made internal proximal femoral replacement prostheses has been proposed as a solution in patients, with severe femoral bone stock loss. However, there is a paucity in the literature on their use and long-term outcomes. We report on the clinical and radiological results of our cohort. We retrospectively reviewed all patients who underwent internal proximal femoral replacement for revision hip arthroplasty between April 1996 and April 2019. All patients had at least 2 years of follow-up time. 160 patients underwent limb salvage at our institution using internal proximal femoral replacement. The mean follow-up was 79.7 months (S.D 41.3). Indications for revision included periprosthetic fractures, aseptic loosening, and deep infection. The mean Oxford hip score increased from 13.8 (0–22) to 31.5 (18–43) (paired t-test, p < 0.001). Kaplan-Meier
The purpose of this study was to elucidate kinematic change according to the implant's specific femoral rotation by using orthosensor (Verasense) implant with three degrees external rotation of femoral rotation rebuilt (Genesis-II) and traditional TKA implant without rebuilt of the femoral rotation (Anthem). Twenty-eight patients (34 knees) underwent TKA using Anthem (Smith & Nephew, Memphis, TN, USA) and 16 patients (22 knees) underwent TKA using Genesis-II (Smith & Nephew, Memphis, TN, USA). Patients were followed up for at least 1 year. Mean age of patients was 71.1 years (range, 60 to 80 years) at the time of surgery. After implantation of femur and tibial components, we applied Verasense, the orthosensor system, to evaluate femoral rollback of the new artificial joint. Femoral rollback was analyzed using digitized screenshot function of Verasense.Purpose
Methods
Purpose: The purpose of this work was to evaluate the quality of cemented humeral stem fixation. We analysed the incidence and influence of humeral lucent lines and loosening after implantation of a shoulder
Aim. A significant number of patients undergoing shoulder arthroplasty surgery have C acnes contamination at the end of the primary surgery. The objective of this study is to determine whether patients with C acnes contamination at the end of their primary shoulder surgery have a worse prognosis than those who end up without C. acnes contamination. Method. Prospective study including all patients who underwent a reverse shoulder
Introduction. Studies have shown that increased implant conformity in total knee arthroplasty (TKA) has been linked to increased constraint and thus rotational torque at the bone/implant interface. Anterior stabilized (AS) tibial inserts were designed to compensate for excessive AP motion in less-conforming cruciate-retaining (CR) tibial inserts. However, increased constraint may affect implant loading. Therefore, the purpose of this study is to model rotational
Purpose of the study: The purpose of this study was to compare mid-term results after total shoulder arthroplasty (TSA) versus simple humeral arthroplasty (SHA) for the treatment of primary centered osteoarthritic degeneration of the shoulder joint. Material and methods: The series included 41 Aequalis prostheses (27 TSA, 14 SHA) implanted by the same surgeon. TSA was performed in 21 women and six men, mean age 68.3 years (range 51–78). SHA was performed in nine women and five men, mean age 68.3 years (range 58–83). The glenoid cavity presented concentric wear (type A) in 70% and asymmetric wear (type B) in 30% of patients undergoing TSA. Type A wear was observed in 57% of the patients undergoing SHA and type B (or C) wear in 43% of them. Mean follow-up was 35 months (range 24–49) for TSA and 37 months (24–59) for SHA. The Constant score and the Neer classification were noted. The position of the implants and lucent lines was noted on plain x-rays. Results: For the TSA patients, the mean non-weighted Constant score was 82/100 points (gain of 48 points), anterior elevation was 151° (gain 54°), and active external rotation 44° (gain 29°). For the SHA patients, the mean non-weighted Constant score was 71/100 points (gain 41 points), active anterior elevation 135° (ain 46°), and active external rotation 43° (gain 28°). The Neer classification demonstrated excellent or satisfactory outcome for 93% of the TSA patients and 86% of the SHA patients. TSA was more effective than SHA for pain relief (p=0.045). Periglenoid lucent lines were observed for 63% of the TSA but with no loosening or complication for the glenoid component at last follow-up. Discussion: Compared with a simple humeral
Aim. Patellofemoral Arthroplasty (PFA)
Aims. The Intraosseous Transcutaneous Amputation
The Thompson hemiarthroplasty is a common treatment option for acute neck of femur fractures in the elderly population. Our department noted a significant number of patients returning with thigh pain, radiographic loosening and femoral osteolysis following cemented implantation of the titanium alloy version of the Thompson hemiarthroplasty. We are not aware of any previous reports documenting complications specific to the titanium Thompson implant and a retrospective cohort study was therefore initiated following clinical governance approval. 366 titanium alloy Thompson prostheses were implanted for hip fracture treatment between 2017 and 2020. As of February 2023, 6 of these have been revised at our hospital. 5 were revised for symptomatic femoral osteolysis and 1 presented with an acute periprosthetic fracture. All revised cases were determined to be aseptic. 32 living patients were excluded from recall on compassionate grounds due to permanent nursing home residence. 47 living patients were identified of which 33 attended for xray. 28 deceased and/or nursing home resident patients who had pelvis x-rays in the previous 12 months were also included in the analysis. Including the 6 index hips already revised, a total of 61 hip xrays were analysed, of which 19 hips (31.1%) showed radiographic evidence of femoral osteolysis or loosening. We conclude that there is a concerning incidence of femoral osteolysis and implant loosening associated with the titanium Thompson implant. We have discontinued use of the implant and reported our experience to the MHRA. We encourage other Scottish Health-Boards who use this implant to consider enhanced follow-up.
Total ankle replacement (TAR) is contraindicated in patients with significant talar collapse due to AVN and in these patients total talus body
Aim. In surgeries on patients with advanced ligament instabilities or severe bone defects modern-generation of rotating hinged knee prostheses are one of the main options. The objective of our study is to evaluate the mid-term functional results and complications of several surgeries using this form of
Orthopaedic implants, such as femoral heads, sockets and stems, are manufactured with a high degree of smoothness and very low form error in order to function as low wear bearings. The surfaces are subject to both wear and damage during in vivo use. Articulating surfaces naturally wear during normal use. Aseptic loosening associated with osteolysis and release of wear particles is the main reason for revision of total hip arthroplasty (THA). Damage of femoral heads is well known to increase the wear rate at the articulating surface and is vulnerable to scratching during the maneuver of positioning the femoral component into the acetabulum component either in primary as in revision total hip arthroplasties. The findings emphasize the importance of achieving and maintaining good surface finish of the femoral head component. The author presents a very simple and “zero cost” method of preventing scratching of the femoral head of any kind of total hip
In 2011, approximately 1.6 million total hip arthroplasties (THAs) were conducted in 27 of the 34 member countries in the Organization for Economic Cooperation and Development (OECD) However, approximately 10–15% of patients still require revision surgery every year. Therefore, new technologies are required to increase the life-spam of the
Aims. To explore the effect of different types of articulating antibiotic-loaded cement spacers in two-stage revision for chronic hip prosthetic joint infection (PJI). Methods. A retrospective cohort study was performed involving 36 chronic PJI patients treated with different types of articulating antibiotic-loaded cement spacers between January 2014 and December 2017. The incidence of complications and the therapeutic effects of different types of antibiotic-loaded articulating cement spacers were compared. Results. A total of 36 patients with chronic hip PJI were included. Of these, 13 patients were treated with spacers with Kirschner wires as an endoskeleton (group I), ten patients were treated with spacers with a cemented femoral
Modulus femoral
Aims. The aim of this study was to compare the cost-effectiveness of
treatment with an osseointegrated percutaneous (OI-) prosthesis
and a socket-suspended (S-)
Aims. Extendible endoprostheses have been available for more than 30
years and have become more sophisticated with time. The latest generation
is ‘non-invasive’ and can be lengthened with an external magnetic
force. Early results have shown a worryingly high rate of complications
such as infection. This study investigates the incidence of complications
and the need for further surgery in a cohort of patients with a
non-invasive growing endoprosthesis. Patients and Methods. Between 2003 and June 2014, 50 children (51 prostheses) had a
non-invasive growing
Patients with transfemoral amputation (TFA) often
experience problems related to the use of socket-suspended prostheses.
The clinical development of osseointegrated percutaneous prostheses
for patients with a TFA started in 1990, based on the long-term
successful results of osseointegrated dental implants. Between1999 and 2007, 51 patients with 55 TFAs were consecutively
enrolled in a prospective, single-centre non-randomised study and
followed for two years. The indication for amputation was trauma
in 33 patients (65%) and tumour in 12 (24%). A two-stage surgical
procedure was used to introduce a percutaneous implant to which
an external amputation
We determined the short-term clinical outcome
and migration within the bone of the humeral cementless component
of the Instrumented Bone Preserving (IBP) total elbow replacement
in a series of 16 patients. There were four men and 12 women with
a mean age at operation of 63 years (40 to 81). Migration was calculated
using radiostereometric analysis. There were no intra-operative
complications and no revisions. At two-year follow-up, all patients
showed a significant reduction in pain and functional improvement
of the elbow (both p <
0.001). Although ten components (63%)
showed movement or micromovement during the first six weeks, 14
(88%) were stable at one year post-operatively. Translation was
primarily found in the proximal direction (median 0.3 mm (interquartile range
(IQR) -0.09 to 0.8); the major rotational movement was an anterior
tilt (median 0.7° (IQR 0.4° to 1.6°)). One malaligned component
continued to migrate during the second year, and one component could
not be followed beyond three months because migration had caused
the markers to break off the
Introduction. In rheumatoid patients the use of a long intramedullary stem in ipsilateral shoulder and elbow replacement carries the risk of humeral fracture of the small area of unviolated bone between the implants. Healing may be compromised. Because of this a short stemmed humeral head
The Exeter V40 cemented polished tapered stem system has demonstrated excellent long-term outcomes. This paper presents a systematic review of the existing literature and reports on a large case series comparing implant fractures between the Exeter V40 series; 125 mm and conventional length stem systems. A systematic literature search was performed adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. In parallel, we performed a retrospective single centre study of Exeter V40 femoral stem prosthetic fractures between April 2003 and June 2020.Aims
Methods
Extensive and severe bone loss of the femur may be a result of a failed total hip arthroplasty (THA) or total knee arthroplasty (TKA) with multiple revision surgeries which may be caused by factors such as infection, periprosthetic fracture or osteolysis. The aim of this study was to assess outcomes of using the “Push-Through Total Femoral Prosthesis” (PTTF) for revision of a total hip replacement with extreme bone loss. Fourteen patients who had extensive bone defects of the femur due to failed THR's and were treated with PTTF between 2012 and 2020 were included in this study. Primary functional outcomes were assessed using Harris Hip Score (HHS), Toronto Extremity Salvage Score (TESS) and Musculoskeletal Tumor Society (MSTS) scores. Range of motion, complications, and ambulatory status were also recorded to assess secondary outcomes. Two of 14 patients underwent surgery with PTTF for both knee and hip arthroplasty revision. The mean time between index surgery and PTTF was 15 years (3 to 32 yrs.). Acetabular components were revised in six of 14 patients. After a mean follow-up of 5.9 years, hip dislocations occurred in 3 patients. All dislocated hips were in patients with retained non-constrained acetabular bearings. Patient satisfaction was high (MSTS: 67%, HHS: 61.2%, TESS 64.6%) despite a high re-operation rate and minor postoperative problems. PTTF is a unique alternative that may be considered for a failed THA revision procedure in patients with an extreme femoral bone defect. Patients are able to ambulate pain free relatively well. Routine usage of constrained liners should be considered to avoid hip dislocation which was our main problem following the procedure.
Introduction. This study reports outcomes of 35 revisions of a recalled metal-on-metal (MOM) monoblock
Background. The use of reverse total shoulder arthroplasty considerably increased since first introduced by Paul Grammont in the late 1980s. Over the past few years, results from several mid- and long-term clinical studies have demonstrated good functional outcomes and pain relief. However, several complications, especially inferior glenoid notching, and high revision rates were reported in the literature. Improvements in
Purpose of the study: Revision shoulder arthroplasty is generally considered to be a difficult procedure yielding modest improvement. Material and methods: We report a prospective study of 45 patients, aged 69.8 years (range 49–85 years). Thirty-two patients had a simple humeral
Summary. Revision TKA using CCK
Aim. Shoulder
Purpose. This study compares outcomes in patients with complete congenital fibula absence, associated with severe lower limb deformity, treated with an amputation protocol to those using an extension
Summary Statement. The constraint behavior of total knee arthroplasty (TKA)
Introduction. Ultra-high molecular weight polyethylene (UHMWPE) is the sole polymeric material currently used for weight- bearing surfaces in total joint replacement. However, the wear of UHMWPE in the human body after total joint replacement causes serious clinical and biomechanical reactions. Therefore, the wear phenomenon of UHMWPE is now recognized as one of the major factors restricting the longevity of artificial joints. In order to minimize the wear of UHMWPE and to improve the longevity of artificial joints, it is necessary to clarify the factors influencing the wear mechanism of UHMWPE. Materials and Methods. In a previous study (Cho et al., 2016), it was found that roundness (out-of-roundness) of the retrieved UHMWPE acetabular cup liner [Figure 1(a)] had a tendency to increase with increasing roundness of the retrieved metal femoral head [Figure 1(b)]. It appears that roundness of the femoral head contributes to increase of wear of the polyethylene liners. We focused on the roundness of femoral head as a factor influencing the wear of polyethylene liner in hip