The TPP is a bone conserving Total Hip Replacement (THR). Originally designed in 1977, two modifications have been made since then and in its current form has been available since 1981. We have used the TPP with a metal-on-metal articulation for active “younger” patients. The acetabular component has been the Armor cup. 48 TPPs have been performed in 41 patients since 1995. The age of the patients was 48 (21–54) years at the time of the operation. There were 17 females and 24 male patients. All patients are kept on an annual review. At the last review, one patient (2 THR) had died at eight weeks from a pulmonary embolism; one patient was lost to follow-up; one patient had required a revision for aseptic loosening. We believe that this THR may offer a viable alternative for the younger patient, though it is a technically demanding procedure.
The Armor cup is a Titanium shell designed to press-fit into the acetabulum. It has 2 additional screw holes for screw fixation. The liner is polyetylene with a metal-on-metal articulation bearing surface. We have performed 194 Total Hip Replacements (THR) in 167 patients using the Armor cup from 1994 to 2001. 83 THRs were performed using an uncemented stem (46 Thrust Plate Prostheses, 28 Wagner Cones and 15 Zwyemullers) and 111 THRs were carried using the cemented, polished, cannulated CF30 stem. The patient age was 54 (22–77) years at the time of the operation. All patients are under annual review. At the last review, 3 patients had died (6 THRs); 4 patients required revision – 2 for the CF30 stem where Boneloc cement had been used, 1 for a periprosthetic fracture and 1 for a dislocated Armor cup. 1 patient was lost to follow-up. We have therefore found the Armor cup with a metal-on-metal articulation to be a satisfactory componenet in the short to medium term. 26 patients are now over 60 months following implantation.
A modified Bosworth technique was used in all patients. The shoulders were immobilised in collar and cuff slings for six weeks. The screws were removed after six to eight weeks. The patients were assessed using the modified Constant Score. The average follow up was 35.2 months (range: seven to 60 months).
Using the modified Constant score:
– Twenty-six patients (74%) scored 100; – Five patients (14%) scored between 90 and 99 and – One patient (3%) scored 87 (against a score of 96 on the other side) – Three patients scored poorly.
We concluded that this technique produced good to excellent functional results and we would recommend its use for Tossy III ACJ dislocations. The technique is not obsolete!
We have performed 466 metal-on-metal total hip replacements (THR) in our hospital, since November 1993. Forty-seven of these have been the TPP (Thrust plate prosthesis - Sulzer Medica). We present here the results of our experience with this prosthesis when used for the “younger” patient. Forty-two patients received 47 THRs The age was 40 years (range: 21 – 53 years) There were 25 female patients. At the latest review: one patient (with two THRs) had died from a pulmonary embolus one patient had a revision for an aseptic loosening (one hip) one patient was lost to follow-up (one hip). The remainder were satisfactory although two hips had subsided into a varus position. The early results were satisfactory in this high-demand group of patients.
This retrospective study was carried out to study the outcome of the modified Bosworth technique for Tossy Type III Acromioclavicular Joint (ACJ) dislocation; good or excellent results were obtained in 91% of cases. Thirty-six patients were operated for Tossy Type III ACJ dislocations over a period of five years. Thirty-five patients were available for follow-up, one was lost to follow-up. All patients were operated upon using a modified Bosworth technique. Through a strap incision medial to the ACJ, the subperiosteal flaps of trapezius and deltoid were raised along the longitudinal axis of the clavicle. The ACJ was reduced and a partially threaded, cancellous, screw with washer was used under vision to lag clavicle to the coracoid process. The shoulder was immobilised in a collar and cuff sling for six weeks. The screw was removed at between six and eight weeks in 94% cases and the shoulder was mobilised. Patients were assessed using the modified Constant Score (muscle power assessed clinically using Medical Research Council’s grading). Thirty-one patients were operated upon acutely (with in an average of eight days), two sub acutely at four and seven weeks and two chronically at 15 and 24 months. The average follow up was 35 months (range: seven to 60 months). The average age was 35 years (range: 25– 62 years). Using the modified Constant score: 26 patients (74%) scored 100; five patients (14%) scored 90–99 and one patient (3%) scored 87 (against a score of 96 on the other side due to gross obesity). Three patients (9%) scored poorly. The first patient scored 49 and she needed reinsertion of the screw at two weeks as following a fall the screw loosened and backed out. She underwent a coracoacromial ligament transfer and another lag screw at 12 months. The second patient scored 59; however, this patient was on oxygen therapy, corticosteroid therapy and heparin for asthma. The third patient scored 79 but also suffers from cervical spondylitis and is an intravenous drug abuser. In our experience the modified Bosworth technique has proven to be a reliable method for treating Tossy III dislocations of the ACJ. This has applied to all ages and both acute and chronic dislocations. We conclude that this technique can produce good to excellent functional results and hence we recommend its use for Tossy Type III ACJ dislocation.
We found no statistically significant difference between the Lysholm-11 scores and the IKDC scores between the two groups.
