Aims. Stemmed tibial components are frequently used in revision total knee arthroplasty (TKA). The purpose of this study was to evaluate patient satisfaction, overall pain, and diaphyseal tibial pain in patients who underwent revision TKA with cemented or
Aims. The primary aim of this study is to assess the survival of the
Aims. Total knee arthroplasty is an established treatment for knee osteoarthritis with excellent long-term results, but there remains controversy about the role of
Aims. After failed acetabular fractures, total hip arthroplasty (THA) is a challenging procedure and considered the gold standard treatment. The complexity of the procedure depends on the fracture pattern and the initial fracture management. This study’s primary aim was to evaluate patient-reported outcome measures (PROMs) for patients who underwent delayed
We reviewed the outcome of 69
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
We performed a case–control study to compare
the rates of further surgery, revision and complications, operating time
and survival in patients who were treated with either an uncemented
hydroxyapatite-coated Corail bipolar femoral stem or a cemented
Exeter stem for a displaced intracapsular fracture of the hip. The
mean age of the patients in the
A consecutive series of patients with a hydroxyapatite-coated
uncemented total knee replacement (TKR) performed by a single surgeon
between 1992 and 1995 was analysed. All patients were invited for
clinical review and radiological assessment. Revision for aseptic
loosening was the primary outcome. Assessment was based on the Knee
Society clinical score (KSS) and an independent radiological analysis.
Of 471 TKRs performed in 356 patients, 432 TKRs in 325 patients
were followed for a mean of 16.4 years (15 to 18). The 39 TKRs in
31 patients lost to follow-up had a mean KSS of 176 (148 to 198)
at a mean of ten years. There were revisions in 26 TKRs (5.5%),
of which 11 (2.3%) were for aseptic loosening. Other further surgery
was carried out on 49 TKRs (10.4%) including patellar resurfacing
in 20, arthrolysis in 19, manipulation under anaesthetic in nine
and extensor mechanism reconstruction in one. Survivorship at up to 18 years without aseptic loosening was
96% (95% confidence interval 91.9 to 98.1), at which point the mean
KSS was 176 (134 to 200). Of 110 knees that underwent radiological
evaluation, osteolysis was observed in five (4.5%), one of which
was revised. These data indicate that
Despite advances in the treatment of paediatric hip disease, adolescent and young adult patients can develop early onset end-stage osteoarthritis. The aims of this study were to address the indications and medium-term outcomes for total hip arthroplasty (THA) with ceramic bearings for teenage patients. Surgery was performed by a single surgeon working in the paediatric orthopaedic unit of a tertiary referral hospital. Databases were interrogated from 2003 to 2017 for all teenage patients undergoing THA with a minimum 2.3 year follow-up. Data capture included patient demographics, the underlying hip pathology, number of previous surgeries, and THA prostheses used. Institutional ethical approval was granted to contact patients for prospective clinical outcomes and obtain up-to-date radiographs. In total, 60 primary hips were implanted in 51 patients (35 female, 16 male) with nine bilateral cases. The mean age was 16.7 years (12 to 19) and mean follow-up was 9.3 years (2.3 to 16.8).Aims
Methods
Aims. Dislocation remains a leading cause of failure following revision total hip arthroplasty (THA). While dual-mobility (DM) bearings have been shown to mitigate this risk, options are limited when retaining or implanting an
Joint registries suggest a downward trend in the use of
Periprosthetic femur fracture (PFF) is a major complication following total hip arthroplasty (THA) that carries significant morbidity, mortality, and economic burden. Currently,
Aims.
Our objective was to examine revision rates and patient reported outcome scores (PROMS) for cemented and
Source of the study: University of Auckland, Auckland, New Zealand. Unicompartmental knee arthroplasty (UKA) is effective for patients with isolated compartment osteoarthritis, however the procedure has higher revision rates. Long-term survivorship and accurate characterisation of revision reasons are limited by a lack of long-term data and standardised revision definitions. We aimed to identify survivorship, risk factors and revision reasons in a large UKA cohort with up to 20 years follow-up. Patient, implant and revision details were recorded through clinical and radiological review for 2,137 consecutive patients undergoing primary medial UKA across Auckland, Canterbury, Counties Manukau and Waitematā DHB between 2000 and 2017. Revision reasons were determined from review of clinical, laboratory, and radiological records for each patient using a standardised protocol. To ensure complete follow-up data was cross-referenced with the New Zealand Joint Registry to identify patients undergoing subsequent revision outside the hospitals. Implant survival, revision risk and revision reasons were analysed using Cox proportional-hazards and competing risk analyses. Implant survivorship at 15 years was comparable for cemented fixed-bearing (cemFB; 91%) and
Multiple joint registries have reported better implant survival for patients aged >75 years undergoing total hip arthroplasty (THA) with cemented implant combinations when compared to hybrid or
Periprosthetic fractures (PPF) of the femur following total hip arthroplasty represent a significant complication with a rising incidence. The commonest subtype is Vancouver B2 type, for which revision to a long
Introduction. Revision total knee arthroplasty (TKA) is becoming increasingly common in the United States as the population ages and larger numbers of primary TKA are performed in younger individuals. Cemented or
Background. In recent years, ‘Get It Right First Time (GIRFT)’ have advocated cemented replacements in femoral part of Total hip arthroplasty (THA) especially in older patients. However, many studies were unable to show any difference in outcomes and although cemented prostheses may be associated with better short-term pain outcomes there is no clear advantage in the longer term. It is not clear when and why to do cemented instead of cementless. Aim. To assess differences in patient reported outcomes in
Aims. The aim of this study was to determine if
Aims. “Get It Right First Time” (GIRFT) and NHS England’s Best Practice Tariff (BPT) have published directives advising that patients over the ages of 65 (GIRFT) and 69 years (BPT) receiving total hip arthroplasty (THA) should receive cemented implants and have brought in financial penalties if this policy is not observed. Despite this, worldwide,
Aim: The objective of this study was to compare the initial stability of an
Aims. This single-centre observational study aimed to describe the results of extensive bone impaction grafting of the whole acetabular cavity in combination with an
Aims. We evaluated a large database with mechanical failure of a single
Aims. To compare long-term survival of all-cemented and hybrid total hip arthroplasty (THA) using the Exeter Universal stem. Methods. Details of 1,086 THAs performed between 1999 and 2005 using the Exeter stem and either a cemented (632) or
We present the results of a prospective longitudinal follow-up study of Dual X-ray Absorptiometry (DXA) measurements of the evolution of bone mineral density (BMD) of acetabulum and femur in 86 patients who underwent total hip arthroplasty (THA). A standard
Uncemented total hip arthroplasty (THA) implants have become the standard for younger patients on account of increased implant survivorship and multiple other advantages. Nevertheless,
Introduction. Gram-negative prosthetic joint infections (GN-PJI) present unique challenges in management due to their distinct pathogenesis of biofilm formation on implant surfaces. The purpose of this study is to establish a clinically representative GN-PJI model that can reliably recapitulate biofilm formation on titanium implant surface in vivo. We hypothesized that biofilm formation on an implant surface will affect its ability to osseointegrate. Methods. The model was developed using 3D-printed titanium hip implants, to replace the femoral head of male Sprague-Dawley rats. GN-PJI was induced using two bioluminescent Pseudomonas aeruginosa strains: a reference strain (PA14-lux) and a mutant biofilm-defective strain (ΔflgK-lux). Infection was monitored in real-time using the in vivo imaging system (IVIS) and Magnetic Resonance Imaging (MRI). Bacterial loads on implant surface and in periprosthetic tissues were quantified utilizing viable-colony-count. Field-emission scanning-electron-microscopy of the explanted implants was used to visualize the biofilm formation at the bone-implant-interface. The implant stability, as an outcome, was directly assessed by quantifying the osseointegration in vitro using microCT scan, and indirectly assessed by identifying the gait pattern changes using DigiGait. TM. system in vivo. Results. Localized infection was established within the hip joint and was followed by IVIS in real-time. There was a quantitative and qualitative difference in the bacterial load and biofilm formation between PA14-lux and ΔflgK-lux. This difference in the ability to persist in the model between the two strains was reflected in the gait pattern and implant osseointegration. Conclusions. We developed a novel
Preventing infections in joint replacements is a major ongoing challenge, with limited effective clinical technologies currently available for
Gram-negative prosthetic joint infections (GN-PJI) present unique challenges in management due to their distinct pathogenesis of biofilm formation on implant surfaces. To date, there are no animal models that can fully recapitulate how a biofilm is challenged in vivo in the setting of GN-PJI. The purpose of this study is to establish a clinically representative GN-PJI in vivo model that can reliably depict biofilm formation on titanium implant surface. We hypothesized that the biofilm formation on the implant surface would affect the ability of the implant to be osseointegrated. The model was developed using a 3D-printed, medical-grade titanium (Ti-6Al-4V), monoblock, cementless hemiarthroplasty hip implant. This implant was used to replace the femoral head of a Sprague-Dawley rat using a posterior surgical approach. To induce PJI, two bioluminescent Pseudomonas aeruginosa (PA) strains were utilized: a reference strain (PA14-lux) and a mutant strain that is defective in biofilm formation (DflgK-lux). PJI development and biofilm formation was quantitatively assessed in vivo using the in vivo imaging system (IVIS), and in vitro using the viable colony count of the bacterial load on implant surface. Magnetic Resonance Imaging (MRI) was acquired to assess the involvement of periprosthetic tissue in vivo, and the field emission scanning electron microscopy (FE-SEM) of the explanted implants was used to visualize the biofilm formation at the bone-implant interface. The implant stability, as an outcome, was directly assessed by quantifying the osseointegration using microCT scans of the extracted femurs with retained implants in vitro, and indirectly assessed by identifying the gait pattern changes using DigiGaitTM system in vivo. A localized prosthetic infection was reliably established within the hip joint and was followed by IVIS in real-time. There was a quantitative and qualitative difference in the bacterial load and biofilm formation between PA14 and DflgK. This difference in the ability to persist in the model between the two strains was reflected on the gait pattern and implant osseointegration. We developed a novel
Aims. To report early (two-year) postoperative findings from a randomized controlled trial (RCT) investigating disease-specific quality of life (QOL), clinical, patient-reported, and radiological outcomes in patients undergoing a total shoulder arthroplasty (TSA) with a second-generation
Controversy persists over whether cemented or
We have reviewed the rate of revision of fully cemented, hybrid and
Introduction. Primary fixation in
Introduction:. Studies have demonstrated both clinical and radiological success of reverse shoulder arthroplasty (RTSA), with follow-up approaching 10-years. To date, most RTSA studies involve cemented fixation of the humeral components, and most involving
Aims. The primary objective of this study was to compare the five-year tibial component migration and wear between highly crosslinked polyethylene (HXLPE) inserts and conventional polyethylene (PE) inserts of the
Using meta-analysis we compared the survival and clinical outcomes of cemented and
Short
Peri-prosthetic femoral fracture after total hip replacement (THR) is associated with a poor outcome and high mortality. However, little is known about its long-term incidence after
Based on numerous national registries, cemented hip replacements have globally better long-term results than uncemented hip replacements. For example, following data have been published in national registries:. These registries demonstrated clearly that cemented fixation should be definitively preferred than
Background and aim. Recent proposals have been introduced to modify stem design and/or femoral fixation in total hip replacement (THR). New designs need to consider previous design features and their results. The aim of this study has been to evaluate the clinical and radiological results of six different designs of tapered
The protective effect of lipped polyethylene
During revision THR, the surgery is often difficult and compromised due to lack of patient's bone especially in the pelvis. Any extra bone in the acetabulum is expected to be of advantage to the patient and the surgeon. The aim of this study was to see if preservation of medial acetabular osteophyte in
Background and aim. Recent proposals have been introduced to modify stem design and/or femoral fixation in total hip replacement (THR). New designs need to consider previous design features and their results. The aim of this study has been to evaluate the clinical and radiological results of six different designs of tapered
Background. Reduced dislocation rates using lipped polyethylene (PE) liners in modular
Introduction. Long-term success of the cementless acetabular component has been depends on amount of bone ingrowth around porous coated surface of the implant, which is mainly depends on primary stability, i.e. amount of micromotion at the implant-bone interface. The accurate positioning of the
Total knee replacement (TKR) is an established treatment for end stage joint disease of the knee. Trabecular metal is one of the design experiments seeking to improve the bone-implant interface and wear patterns in order to increase the longevity of primary joint replacements and reduce the revision burden.
The primary stability of an
Introduction. Infection after total hip arthroplasty is a severe complication. Controversies still exist as to the use of cemented or
Goals of femoral revision arthroplasty are to achieve stability of the femoral component, to restore biomechanical function of the hip joint and to restore the femoral bone stock. In order to accomplish such an ideal revision arthroplasty, several points should be reminded before and during the revision arthroplasty such as exposure, removal of the failed component, restoration of bone loss, placement of the new component and hip stability. Appropriate options of femoral components for revision depend on the degree of femoral bone loss. When the bone loss is minimum, a standard length component can be used like in primary total hip arthroplasty (THA). When it is moderate or severe, special components and techniques would be necessary. Loss of bone stock is the most difficult problem in femoral revision surgery. It increases a risk of complications during operation such as fracture or perforation, and also results in difficulty to achieve stability of the component. Even when the bone defect is moderate or severe, immediate fixation of the femoral component should be mainly supported by native bone. Additionally, in the remaining bone loss, bone tissue is grafted as much as possible. Survival rate of revision arthroplasty is low comparing with that of primary THA. In addition to the present revision, a possible next operation in the future should be considered when we plan revision surgery. Cemented femoral revision has a disadvantage of removal of the prosthesis when it is failed. Removal of cemented component has a high possibility of complications including perforation and fracture. During revision arthroplasty of a cemented femoral component using a modern cement technique, removal of the cement mantle is difficult, time-consuming and hazardous. The cement mass distal to the tip of the femoral component is the most difficult to be removed since it is often well fixed. The removal procedure has a high risk of causing femoral perforation or fracture. Furthermore, in re-revision, the cement fixation will be often beyond the isthmus and into distal bone defect. And revised cemented femoral components would be more difficult to be removed. On the contrary, loosened