Aims. When a total ankle arthroplasty (TAA)
Aims. Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA)
Aims. Periprosthetic joint infections (PJIs) with prior multiple
Aims. To determine the likelihood of achieving a successful closed reduction (CR) of a dislocated hip in developmental dysplasia of the hip (DDH) after
Aims. The outcome of repeat septic revision after a
Aims. Cephalomedullary nails (CMNs) are commonly used for the treatment of intertrochanteric hip fractures. Total hip arthroplasty (THA) may be used as a salvage procedure when fixation
Aims. Patients with a
Aims. To compare complication-related reoperation rates following primary arthroplasty for proximal humerus fractures (PHFs) versus secondary arthroplasty for
Aims. Failure of irrigation and debridement (I&D) for prosthetic joint infection (PJI) is influenced by numerous host, surgical, and pathogen-related factors. We aimed to develop and validate a practical, easy-to-use tool based on machine learning that may accurately predict outcome following I&D surgery taking into account the influence of numerous factors. Methods. This was an international, multicentre retrospective study of 1,174 revision total hip (THA) and knee arthroplasties (TKA) undergoing I&D for PJI between January 2005 and December 2017. PJI was defined using the Musculoskeletal Infection Society (MSIS) criteria. A total of 52 variables including demographics, comorbidities, and clinical and laboratory findings were evaluated using random forest machine learning analysis. The algorithm was then verified through cross-validation. Results. Of the 1,174 patients that were included in the study, 405 patients (34.5%)
Advances in the design of the components for total ankle replacement have led to a resurgence of interest in this procedure. Between January 1999 and December 2004, 16 patients with a
The peri-prosthetic tissue response to wear debris
is complex and influenced by various factors including the size, area
and number of particles. We hypothesised that the ‘biologically
active area’ of all metal wear particles may predict the type of
peri-prosthetic tissue response. . Peri-prosthetic tissue was sampled from 21 patients undergoing
revision of a small diameter metal-on-metal (MoM) total hip arthroplasty
(THA) for aseptic loosening. An enzymatic protocol was used for
tissue digestion and scanning electron microscope was used to characterise
particles. Equivalent circle diameters and particle areas were calculated.
Histomorphometric analyses were performed on all tissue specimens.
Aspirates of synovial fluid were collected for analysis of the cytokine
profile analysis, and compared with a control group of patients
undergoing primary THA (n = 11) and revision of a
Aims. The aim of this study was to evaluate the outcomes of a salvage procedure using a 95° angled blade plate for
We present a series of 16 patients treated between 1993 and 2006 who had a
There are many reasons why a total knee replacement
(TKR) may
Aims. Monocyte-lymphocyte ratio (MLR) or neutrophil-lymphocyte ratio (NLR) are useful for diagnosing periprosthetic joint infection (PJI), but their diagnostic values are unclear for screening fixation-related infection (FRI) in patients for whom conversion total hip arthroplasty (THA) is planned after
The aim of this study was to examine causes of the
Metal particles detached from metal-on-metal hip prostheses (MoM-THA) have been shown to cause inflammation and destruction of tissues. To further explore this, we investigated the histopathology (aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL) score) and metal concentrations of the periprosthetic tissues obtained from patients who underwent revision knee arthroplasty. We also aimed to investigate whether accumulated metal debris was associated with ALVAL-type reactions in the synovium. Periprosthetic metal concentrations in the synovia and histopathological samples were analyzed from 230 patients from our institution from October 2016 to December 2019. An ordinal regression model was calculated to investigate the effect of the accumulated metals on the histopathological reaction of the synovia.Aims
Methods
Introduction:. We report the outcomes of salvage procedures in total ankle replacement (TAR) in a single surgeon series. Methods:. This study was a retrospective review of patients who had undergone salvage procedures with tibio-talo-calcaneal (TTC) fusion for
Previous studies of failure mechanisms leading
to revision total knee replacement (TKR) performed between 1986 and
2000 determined that many
Aims. The aim of this prospective study was to evaluate the intermediate-term
outcomes after revision anatomical ankle ligament reconstruction
augmented with suture tape for a
Objectives. T-cells are considered to play an important role in the inflammatory response causing arthroplasty failure. The study objectives were to investigate the composition and distribution of CD4+ T-cell phenotypes in the peripheral blood (PB) and synovial fluid (SF) of patients undergoing revision surgery for
Between 1999 and 2005, 23
Failed internal fixation of a fracture of the
proximal humerus produces many challenges with limited surgical options.
The aim of this study was to evaluate the clinical outcomes after
the use of a reverse shoulder arthroplasty under these circumstances.
Between 2007 and 2012, 19 patients (15 women and four men, mean
age 66 years; 52 to 82) with
Arthrodesis is rarely used as a salvage procedure for patients with a chronically infected total knee arthroplasty (TKA), and little information is available about the outcome. The aim of this study was to assess the reliability, durability, and safety of this procedure as the definitive treatment for complex, chronically infected TKA, in a current series of patients. We retrospectively identified 41 patients (41 TKAs) with a complex infected TKA, who were treated between 2002 and 2016 using a deliberate, two-stage knee arthrodesis. Their mean age was 64 years (34 to 88) and their mean body mass index (BMI) was 39 kg/m2 (25 to 79). The mean follow-up was four years (2 to 9). The extensor mechanism (EM) was deficient in 27 patients (66%) and flap cover was required in 14 (34%). Most patients were host grade B (56%) or C (29%), and limb grade 3 (71%), according to the classification of McPherson et al. A total of 12 patients (29%) had polymicrobial infections and 20 (49%) had multi-drug resistant organisms; fixation involved an intramedullary nail in 25 (61%), an external fixator in ten (24%), and dual plates in six (15%).Aims
Methods
Forty
We present the histological findings of bone retrieved from beneath the femoral components of
There are few medium- and long-term data on the outcome of the use of proximal femoral structural allografts in revision hip arthroplasty. This is a study of a consecutive series of 40 proximal femoral allografts performed for
Aims. To evaluate the hypothesis that
Salvage of a
We reviewed 25 patients with rheumatoid arthritis who had failure of 26 primary total elbow arthroplasties causing pain and loss of function. Most revision cases required special custom implants to treat varying bone loss and soft-tissue disruption. Assessment showed satisfactory functional results in the patients treated by revision at a mean follow-up period of 35 months. Our review suggests that revision surgery produces short- to medium-term painfree function, and is the treatment of choice for a
SUMMARY. We report a prospective study of clinical data collected pre, intra and post operation to remove both cup and head components of 118
Twenty consecutive patients treated by arthrodesis for
There are many methods for analysing wear volume in
We compared the radiographic results of secondary total hip replacements, 99 following
Satisfactory selection criteria are essential for the successful outcome of unicompartmental knee arthroplasty (UCA). We report the frequency of revision of the Oxford medial unicompartmental arthroplasty in knees previously treated for anteromedial osteoarthritis by high tibial osteotomy (HTO). The combined results from three sources were used to allow statistical analysis of this uncommon subgroup. In the combined series of 631 knees (507 patients) which had medial unicompartmental replacement, 613 were primary procedures and 18 were for a
Previous studies examined failure mechanisms for revision TKA performed between 1986 and 2000. These studies demonstrated that a majority of failures occurred in the first few years, with a disproportionate amount for infection and implant-associated failure mechanisms. Since these studies were published, efforts have been made to improve implant performance and instruct surgeons towards best practice total knee arthroplasty techniques. Recently our center participated in a multi-center evaluation of revision TKA cases during 2010 and 2011. The purpose was to report a detailed analysis of the failure mechanism and the time to failure to determine whether the failure mechanism of primary TKA has changed over the past 10–15 years. Further, we evaluated the effect of failure mechanism on extent of revision and whether revision surgery was performed at the same location as the index procedure. We identified 844 revisions of
Arthrodesis of the knee is sometimes needed for
We evaluated the outcome of treatment of nonunion
of an intracapsular fracture of the femoral neck in young patients
using two cannulated screws and a vascularised bone graft. A total
of 32 patients (15 women and 17 men, with a mean age of 36.5 years;
20 to 50) with
We have evaluated the clinical effectiveness
of a metal resurfacing inlay implant for osteochondral defects of
the medial talar dome after
Management of the
Reports of differing failure rates of total hip prostheses made of various metals prompted us to measure the size of metallic and polyethylene particulate debris around
Knee arthrodesis is a potential salvage procedure
for limb preservation after failure of total knee arthroplasty (TKA) due
to infection. In this study, we evaluated the outcome of single-stage
knee arthrodesis using an intramedullary cemented coupled nail without
bone-on-bone fusion after
The objective of this study was to determine the kinematic factor(s) underlying the reduction in walking velocity displayed by total hip arthroplasty (THA) patients in comparison to healthy controls during walking gait. Eleven patients with well-functioning THA (71 ± 8 years, Oxford Hip Score = 46 ± 3) and ten healthy controls (61 ± 5 years) participated within this study. Sagittal plane lower limb kinematics were captured using a 10 camera Qualisys motion capture system, sampling at 200Hz, as participants walked overground at a self-selected pace. Bivariate linear regression was used to explore the relationship between walking velocity and a number of kinematic variables in a deterministic manner. Kinematic variables significantly associated with walking velocity were compared between THA and healthy groups utilising independent samples t-tests.Abstract
Objectives
Methods
From 1969 through 1982, 305 hips in 290 patients had total hip arthroplasty for
We reviewed 1039 revision total hip replacements where an angle-bore acetabular component was used. After a mean follow-up of nine years (0 to 20.6), the incidence of revision for dislocation was 2.1% (22 revisions), a success rate of 97.9%. In 974 revisions, where the indication was other than dislocation, the success rate was 98.5%. Of the 65 revisions for dislocation, 58 (89.2%) were successful after the first revision and a further five after the second revision, an overall success of 96.9%. Two patients elected to have their implants removed. Dislocation after revision of
We studied, ten patients (11 elbows) who had
undergone 14 allograft-prosthesis composite reconstructions following
failure of a previous total elbow replacement with massive structural
bone loss. There were nine women and one man with a mean age of
64 years (40 to 84), who were reviewed at a mean of 75 months (24
to 213). One patient developed a deep infection after 26 months
and had the allograft-prosthesis composite removed, and two patients
had mild pain. The median flexion-extension arc was 100° (95% confidence
interval (CI) 76° to 124°). With the exception of the patient who
had the infected failure, all the patients could use their elbows
comfortably without splints or braces for activities of daily living.
The mean Mayo Elbow Performance Index improved from 9.5 (95% CI
4.4 to 14.7) pre-operatively to 74 (95% CI 62.4 to 84.9) at final
review. Radiologically, the rate of partial resorption was similar in
the humeral and ulnar allografts (three of six and four of eight,
respectively; p >
0.999). The patterns of resorption, however, were
different. Union at the host-bone-allograft junction was also different
between the humeral and ulnar allografts (one of six and seven of
eight showing union, respectively; p = 0.03). At medium-term follow-up, allograft-prosthesis composite reconstruction
appears to be a useful salvage technique for
We reviewed 54 patients at a mean follow-up of 4 years 4 months after rerevisions for failure of Charnley low-friction arthroplasty. Rerevision for aseptic loosening in 26 hips was satisfactory; there were no clinical failures and at the latest radiological assessment only one stem and three sockets showed signs of loosening. By contrast, nine of 20 multiple revisions for recurrent dislocation
There are a number of periprosthetic femoral fracture (PFF) fixation failures. In several cases the effect of fracture configuration on the performance of the chosen fixation method has been underestimated. As a result, fracture movement within the window that seems to promote callus formation has not been achieved and fixations ultimately
Seven psoas bursae filled with purulent fluid and inspissated debris were revealed at revision operations for
The management of