Aims. With increasing burden of
Aims. The purpose of this study was to evaluate unexpected positive cultures in total hip arthroplasty (THA) revisions for presumed aseptic loosening, to assess the prevalence of low-grade infection using two definition criteria, and to analyze its impact on implant survival after revision. Methods. A total of 274 THA revisions performed for presumed aseptic loosening from 2012 to 2016 were reviewed. In addition to obtaining intraoperative tissue cultures from all patients, synovial and sonication fluid samples of the removed implant were obtained in 215 cases (79%) and 101 cases (37%), respectively. Histopathological analysis was performed in 250 cases (91%). Patients were classified as having low-grade infections according to institutional criteria and Musculoskeletal Infection Society (MSIS) International Consensus Meeting (ICM) 2013 criteria. Low-grade infections according to institutional criteria were treated with targeted antibiotics for six weeks postoperatively. Implant failure was defined as the need for re-revision resulting from periprosthetic joint infection (PJI) and aseptic reasons. The mean follow-up was 68 months (26 to 95). Results. Unexpected positive intraoperative samples were found in 77 revisions (28%). Low-grade infection was diagnosed in 36 cases (13%) using institutional criteria and in nine cases (3%) using MSIS ICM 2013 criteria. In all, 41 patients (15%) had single specimen growth of a low-virulent pathogen and were deemed contaminated. Coagulase-negative Staphylococcus and anaerobes were the most commonly isolated bacteria. Implant failure for PJI was higher in revisions with presumed contaminants (5/41, 12%) compared to those with low-grade infections (2/36, 6%) and those with negative samples (5/197, 3%) (p = 0.021). The rate of all-cause re-revision was similar in patients diagnosed with low-grade infections (5/36, 14%) and those with presumed contaminants (6/41, 15%) and negative samples (21/197, 11%) (p = 0.699). Conclusion. Our findings suggest that the presumption of culture contamination in aseptic
Aims. The aim of this study was to perform a systematic review of the evidence for the use of intraoperative cell salvage in patients undergoing
Revision arthroplasty of the hip is expensive
owing to the increased cost of pre-operative investigations, surgical implants
and instrumentation, protracted hospital stay and drugs. We compared
the costs of performing this surgery for aseptic loosening, dislocation,
deep infection and peri-prosthetic fracture. Clinical, demographic
and economic data were obtained for 305 consecutive revision total
hip replacements in 286 patients performed at a tertiary referral
centre between 1999 and 2008. The mean total costs for revision
surgery in aseptic cases (n = 194) were £11 897 (
The aim of this study was to systemically review the evidence for the use of intra-operative cell salvage (ICS) among patients undergoing
The rising prevalence of osteoarthritis, associated with an ageing population, is expected to deliver increasing demand across Scotland for arthroplasty services in the future. Understanding the scale of potential change to operative workflow is essential to ensure adequate provision of services and prevent prolonged waiting times that can cause patient harm. This future service demand for primary and
Total hip arthroplasty (THA) has proved to be an effective treatment modality for sickle-cell hip arthropathy (mosaic-like dense bone due to infarcts). However, mode of failure, survival rates and challenges associated with
The management of severe acetabular bone defects poses a complex challenge in
Aims. We investigated the long-term performance of the Tripolar Trident acetabular component used for recurrent dislocation in revision total hip arthroplasty. We assessed: 1) rate of re-dislocation; 2) incidence of complications requiring re-operation; and 3) Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain and functional scores. Patients and Methods. We retrospectively identified 111 patients who had 113 revision tripolar constrained liners between 1994 and 2008. All patients had undergone
Aims. This study describes the variation in the annual volumes of
Introduction. Patients with osteonecrosis of the femoral head are typically younger, more active, and often require high rates of revision following primary total hip arthroplasty. However, outcomes of
Chronic pelvic discontinuity (CPD) during
The in-cement technique for
Introduction There are no reports on the epidemiology of
Revision of the femoral component during
This study was performed to assess the relationship between patients’ pre-operative symptoms and their expectations at the time of
This study evaluates the association between consultant and hospital volume and the risk of re-revision and 90-day mortality following first-time revision of primary hip replacement for aseptic loosening. We conducted a cohort study of first-time, single-stage
Introduction. Previous reports have investigated the correlation between time to
Introduction: The purpose of this study was to assess the efficacy and complications associated with
Aim: To evaluate the medium term results of
Aim: We audited medical complications after
Introduction &
Aims:
Introduction. The aim of this study is to report the results of
Aim We have prospectively investigated the effect of tranexamic acid in reducing blood loss and transfusion requirements in primary and revision total hip arthroplasty in a comparative study. Patients and Methods In the study group, tranexamic acid was given half an hour before the skin incision. (10 mg/kg as an intravenous bolus, followed by 10 mg/kg as intravenous infusion over 6 hours). We recorded the haemoglobin level preoperatively and prior to discharge, and number of units of blood transfused. The total peri-operative blood loss and the fall in haemoglobin after surgery was calculated in consultation with our haematologist. There were 9 primary and 17
Revision of the femoral component during
Introduction: Freezing and storage of fresh frozen femoral heads destined for use in
We have followed a consecutive series of
Proximal femoral replacements are commonly used in oncologic limb salvage procedures. Recently, these megaprostheses have been utilized in complex revision arthroplasties where proximal femoral bone is compromised. The purpose of this study is to evaluate the clinical and radiographic survivorship of proximal femoral replacements as a salvage treatment for bone loss after hip arthroplasty. We retrospectively reviewed the clinical and radiographic outcomes of 31 proximal femoral replacements of a single design between 2004 and 2013 at a single institution. The mean age at time of index surgery was 62 years, 58% were female, and mean BMI was 28.1 Kg/m. 2. The indications and complications associated with megaprosthesis implantation were collected. Average follow-up was 60 months (range 24–120 months). Kaplan-Meier survivorship assessed clinical and radiographic survivorship. Indication for revision, use of a constrained liner and construct length were assessed as risk factors for construct failure. The indications for proximal femoral replacement were periprosthetic infection (n=12, 38.7%), aseptic loosening (n=10, 32.3%), periprosthetic fracture (n=6, 19.3%), and non-union (n=3, 9.7%). A constrained liner was used in 22 hips (71%). The average length of bone resection was 148 cm (range 81–240 cm). There were nine revisions (29.2%): 3 for infection (9.7%) 2 for dislocation (6.5%), 2 for aseptic loosening (6.5%), and 2 for periprosthetic fracture (6.5%). Two of the 3 infections were in patients treated for infection. Overall survivorship was at 70.8%. There was no relation between the length of the bone resection, indication for revision and failure rate. Proximal femoral replacement in non-oncologic
Aim: To review the early complications associated with staged
Reconstruction of severe acetabular defects during
In revision hip surgery, a solidly cemented femoral component may obstruct access to the acetabulum, may be poorly orientated, or may have inadequate offset and head diameter. These problems can be addressed by revising the femoral component. The object of this study was to determine the outcome of cementing a polished, tapered, modular implant into the retained cement mantle. Benefits of cement within cement revision of a femoral stem include simplicity, reduced theatre time, and potentially reduced complication rates. A consecutive series of 36 patients (11 men, 25 women) age range 35 to 90 years (mean age 70) underwent c stem cement in cement
Background. Highly porous acetabular components are widely used in revision hip surgery. The purpose of this study is to compare the mid-term survivorship, clinical and radiological outcomes of a hemispherical cup (Stryker Tritanium Revision component) and a peripherally expanded cup (Zimmer TM modular component) in revision hip surgery. Methods. Between 2010 and 2017, 30 patients underwent
Background. Over 96% of primary total hip replacements (THR) recorded in the National Joint Registry (NJR) are performed through a posterior or lateral surgical approach. There is no high quality evidence available to support the use of one approach over the other in primary THR and even less evidence when the outcome of revision THR is considered. Methods. Questionnaires were sent to 267 patients who had
Purpose. To evaluate the radiographic long-term result of femoral
Patients report similar or better pain and function before
We reviewed 19
We have used the Oxford hip score to monitor the progress of 1908 primary and 279
We present a new method of trochanter stabilisation designed for use in difficult
We have followed a consecutive series of forty-nine
Introduction:
Aims: The aims of our study were:. to measure the total metal content in cell saver blood recovered during
The best type of stem fixation for
The duration of systemic antibiotic therapy following first-stage surgery is contentious. Our Institution's philosophy is to perform an aggressive debridement, use high concentration targeted antibiotics through cement beads and systemic prophylactic antibiotics alone. In the presence of significant soft tissue infection or microbiological diagnostic uncertainty; systemic antibiotics may be prescribed for 5 days whilst awaiting tissue culture results. The aim of this study was to assess the success of our philosophy in the management of PJI of the hip using our two-stage protocol. A retrospective review of our Institution's prospectively-collected database was performed to identify those patients who were planned to undergo a two-stage hip revision procedure for PJI. All patients had a confirmed diagnosis of PJI as per the major criteria of MSIS 2013, a minimum 5-years follow up and were assessed at the time of review using the MSIS working group outcome-reporting tool (2018). They were then grouped into “successful” or “unsuccessful” (suppressive antibiotics, further revision for infection, death within 1 year).Aim
Method
The duration of systemic antibiotic treatment following first-stage revision surgery for periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is contentious. Our philosophy is to perform an aggressive debridement, and to use a high local concentration of targeted antibiotics in cement beads and systemic prophylactic antibiotics alone. The aim of this study was to assess the success of this philosophy in the management of PJI of the hip using our two-stage protocol. The study involved a retrospective review of our prospectively collected database from which we identified all patients who underwent an intended two-stage revision for PJI of the hip. All patients had a diagnosis of PJI according to the major criteria of the Musculoskeletal Infection Society (MSIS) 2013, a minimum five-year follow-up, and were assessed using the MSIS working group outcome-reporting tool. The outcomes were grouped into ‘successful’ or ‘unsuccessful’.Aims
Methods
Femoral impaction grafting with cancellous bone and cement is an important technique in reconstituting deficient bone stock in
This study reports the results of hybrid stem fixation in difficult
To determine mortality risk after first revision total hip arthroplasty (THA) for periprosthetic femoral fracture (PFF), and to compare this to mortality risk after primary and first revision THA for other common indications. The study cohort consisted of THAs recorded in the National Joint Registry between 2003 and 2015, linked to national mortality data. First revision THAs for PFF, infection, dislocation, and aseptic loosening were identified. We used a flexible parametric model to estimate the cumulative incidence function of death at 90 days, one year, and five years following first revision THA and primary THA, in the presence of further revision as a competing risk. Analysis covariates were age, sex, and American Society of Anesthesiologists (ASA) grade.Aims
Methods
Purpose: The aims of our study were: (i) to measure the total metal content in cell saver blood recovered during