Introduction. Total hip arthroplasties (THAs) in young patients are associated with high failure rates. We always use cemented total hip implants, however, in cases with acetabular bone stock loss we perform bone impaction grafting. Our purpose was to evaluate the outcome of 69 consecutive primary cemented total hips in patients younger than 30 years followed between 2 to 18 years. Methods. Between 1988 and 2004, 69 consecutive primary cemented THAs (mainly Exeters) were performed in 48 patients (32 women, 16 men) younger than thirty years. Average age at time of operation was 25 years (range, 16 to 29 years). Twenty-nine hips (42%) underwent acetabular bone impaction grafting because of acetabular bone loss. Mean follow-up was 10 years (range, 2 to 18 years). Revisions were determined, Harris Hip Score (HHS), and Oxford Hip Questionnaire Score (OHQS) were obtained and radiographs were analyzed. Survival was calculated using the Kaplan-Meier method. Results. No patients were lost to follow-up, but 3 patients (4 hips) died during follow-up, none of whom had underwent revision. Eight revisions were performed: 3 septic loosenings (6, 7, and 8 years post-operative) and 5 aseptic cup loosenings (2, 3, 4, 5, and 9 years post-operative). No stems were loose. The average HHS and OHQS at follow-up were 89 points (range, 55 to 100 points) and 19 points (range, 12 to 42 points), respectively. Using Kaplan-Meier analysis, the cumulative survival with revision for any reason as end point was 83% (95% CI, 69 - 92%) at 10 years. Excluding the infections, the survival rate was 90% (95% CI, 77 - 96%) with revision for aseptic loosening. The outcome of the patients who underwent acetabular bone impaction grafting was comparable to the primary cemented hips with a survival of 89% (95% CI, 62 - 97%) with revision for any reason as an end point. Excluding the infections, the survival rate was 95% (95% confidence interval, 72 - 99%) at ten years with revision for aseptic loosening as the end point. Conclusion. Primary cemented total hip arthroplasties in very young patients show satisfactory medium-term results, however, in cases with acetabular bone stock loss, a reconstruction with bone impaction grafting is advisable

Introduction and Objective. Ceramic on Ceramic bearings in Total Hip Arthroplasty (THA) afford a low friction coefficient, low wear rates and extreme hardness. Significant complications include hip squeak, ceramic fracture and poor polyethylene performance in revision procedures due to imbedding of abrasive microscopic ceramic fragments. We report on the results of this bearing at a minimum of 10 years. Materials and Methods. A single-centre retrospective review of 449 THAs was performed. Primary outcome measures included aseptic revision and all-cause revision rates at a minimum of 10 years post operatively. Evaluation of functionality was performed with WOMAC and SF-36 scores which were performed pre-operatively and at intervals of 6 months, one year, 2 years, 5 years and 10 years post operatively. Results. There was a 6.2% (n=28) all-cause and 5.3% (n=24) aseptic revision rate for ceramic on ceramic total hip arthroplasty at minimum of 10 years with a mean time to revision 4.8 years (range 2 months − 11.6 years). Notably, there were 2 revisions for ceramic head fracture, one for ceramic liner fracture, 3 for aseptic loosening and 3 revisions for squeaking. Pain of unknown origin was the most common reason for revision. There was an improvement in postoperative WOMAC scores from a mean of 59.8 (range 15–95) pre-operatively to a mean of 15.6 (range 0–78) at 10 years. Conclusions. This study showed good functional outcomes but high revision rates for CoC THA at a minimum of 10 years. The role for CoC bearings in THA has been called into question in recent years and may continue to decline in popularity, even in younger patients. Further large scale studies are important to assess the long-term outcomes of this bearing surface

To conduct a meta-analysis for intertrochanteric hip fractures comparing in terms of efficacy and safety short versus long intralomedullary nails. A pubmed search of the last 10 years for intertrochanteric fracture 31A1-31A3 according to the AO/OTA classification was performed. Baseline characteristics of each article were obtained, complication measures were analyzed: Peri-implant fracture, reoperations, deep/superficial infection, and mortality. Clinical variables consisted of blood loss (mL), length of stay (days), time of surgery (min) and nº of transfusions. Functional outcomes were also recorded. A meta-analysis was performed with Review Manager 5.4. Twelve studies were included, nine were retrospective. The reoperations rate was lower in the short nail group and the peri-implant fracture rate was lower in the long nail group (OR 0.58, 95% CI 0.38 to 0.88) (OR 1.88, 95% CI 1.04 to 3.43). Surgery time and blood loss was significantly higher in the long nail group (MD −12.44, 95% CI −14.60 to −10.28) (MD −19.36, 95% CI −27.24 to −11.48). There were no differences in functional outcomes. The short intramedullary nail has a higher risk of peri-implant fracture; however, the reoperation rate is lower compared to the long nail. Blood loss and surgery time was higher in the long nail group

X-Linked Hypophosphataemia (XLH) is a rare, progressive, hereditary phosphate-wasting disorder characterised by excessive activity of fibroblast growth factor 23. The International XLH Registry was established to provide information on the natural history of XLH and impact of treatment on patient outcomes. The cross-sectional orthopaedic data presented are from the first interim analysis. The XLH Registry (NCT03193476) was initiated in August 2017, aims to recruit 1,200 children and adults with XLH, and will run for 10 years. At the time of analysis (Last Patient In: 30/11/2020; Database Lock: 29/03/2021) 579 subjects diagnosed with XLH were enrolled from 81 hospital sites in 16 countries (360 (62.2%) children, 217 (37.5%) adults, and 2 subjects of unknown age). Of subjects with retrospective clinical data available, skeletal deficits were the most frequently self-reported clinical problems for children (223/239, 93.3%) and adults (79/110, 71.8%). Retrospective fracture data were available for 183 subjects (72 children, 111 adults); 50 had a fracture (9 children, 41 adults). In children, fractures tended to occur in tibia/fibula and/or wrist; only adults reported large bone fractures. Joint conditions were noted for 46 subjects (6 children, 40 adults). For adults reporting osteoarthritis, knees (60%), hips (42.5%), and shoulders (22.5%) were the most frequently affected joints. Retrospective orthopaedic surgery data were collected for 151 subjects (52 children, 99 adults). Osteotomy was the most frequent surgery reported (n=108); joint replacements were recorded for adults only. This is the largest set of orthopaedic data from XLH subjects collected to date. Longitudinal information collected during the 10-year Registry duration will generate real-world evidence which will help to inform clinical practice. Authors acknowledge the contribution of all International XLH Registry Steering Committee members

First-time revision acetabular components have a 36% re-revision rate at 10 years in Australia, with subsequent revisions known to have even worse results. Acetabular component migration >1mm at two years following revision THA is a surrogate for long term loosening. This study aimed to measure the migration of porous tantalum components used at revision surgery and investigate the effect of achieving press-fit and/or three-point fixation within acetabular bone. Between May 2011 and March 2018, 55 patients (56 hips; 30 female, 25 male) underwent acetabular revision THR with a porous tantalum component, with a post-operative CT scan to assess implant to host bone contact achieved and Radiostereometric Analysis (RSA) examinations on day 2, 3 months, 1 and 2 years. A porous tantalum component was used because the defects treated (Paprosky IIa:IIb:IIc:IIIa:IIIb; 2:6:8:22:18; 13 with pelvic discontinuity) were either deemed too large or in a position preventing screw fixation of an implant with low coefficient of friction. Press-fit and three-point fixation of the implant was assessed intra-operatively and on postoperative imaging. Three-point acetabular fixation was achieved in 51 hips (92%), 34 (62%) of which were press-fit. The mean implant to host bone contact achieved was 36% (range 9-71%). The majority (52/56, 93%) of components demonstrated acceptable early stability. Four components migrated >1mm proximally at two years (1.1, 3.2, 3.6 and 16.4mm). Three of these were in hips with Paprosky IIIB defects, including 2 with pelvic discontinuity. Neither press-fit nor three-point fixation was achieved for these three components and the cup to host bone contact achieved was low (30, 32 and 59%). The majority of porous tantalum components had acceptable stability at two years following revision surgery despite treating large acetabular defects and poor bone quality. Components without press-fit or three-point fixation were associated with unacceptable amounts of early migration

Abstract. Objectives. Epiphysiodesis is a commonly used treatment for lower limb angular deformities. However, in recent years, distal tibial growth modulation using ‘eight plates’ or screws has emerged as an alternative treatment for paediatric foot and ankle disorders, such as CTEV. Our objective was to assess the efficacy of distal tibial modulation in correcting various paediatric foot and ankle disorders. Methods. This retrospective study analysed 205 cases of paediatric foot and ankle disorders treated between 2003 and 2022, including only cases where the eight plate or screw was fixed on the anterior surface of the distal tibia. Our aim was to measure post-operative changes in dorsiflexion, the distal tibial angle, and the tibiocalcaneal angle by examining clinical records and radiology reports. Results. We identified nine cases (nine feet) meeting the full inclusion criteria, comprising seven cases of CTEV, one case of arthrogryposis, and one case of cavovarus foot. The cohort consisted of five male and four female patients, with a mean age of 10 years and 9 months at the time of surgery. Seven cases involved the left tibia, and two cases involved the right tibia. The mean time between pre-operative X-ray to surgery was 168 days, and the mean turnaround time between surgery and post-operative X-ray was 588 days. A mean change in the distal tibial angle of 4.33 degrees was noted. However, changes in dorsiflexion were documented in only one case, which showed a change of 13 degrees. Notably, our average distal tibial angle was significantly lower than reported in the literature, at 4.33 degrees. Additionally, some studies in the literature used the Oxford Ankle Foot Questionnaire for Children to assess pre- and post-operative outcomes, but it is important to note that it is validated only for children aged 5 to 16. Furthermore, most cases reported an improved tibiocalcaneal angle except for an anomaly of 105 degrees. We assessed satisfactory patient outcomes using patient notes. Out of the 6 procured notes, one has been discharged. The rest are still under yearly or 6-monthly review and are at various stages, such as physiotherapy, removing the eight plate, or requiring further surgery. The most common presentations at review are plantaris deformity and pain. Conclusions. Our study suggests that distal tibial growth modulation can be an effective treatment option for selected paediatric foot and ankle disorders. However, due to the limited number of cases in our study, the lack of documentation of changes in dorsiflexion, and a lack of pre- and post-operative outcomes using a standardised method, further research is needed to investigate this procedure's long-term outcomes and potential complications. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Glenoid and humeral head bone defects have long been recognized as major determinants in recurrent shoulder instability as well as main predictors of outcomes after surgical stabilization. However, a universally accepted method to quantify them is not available yet. The purpose of the present study is to describe a new CT method to quantify bipolar bone defects volume on a virtually generated 3D model and to evaluate its reproducibility. A cross-sectional observational study has been conducted. Forty CT scans of both shoulders were randomly selected from a series of exams previously acquired on patients affected by anterior shoulder instability. Inclusion criterion was unilateral anterior shoulder instability with at least one episode of dislocation. Exclusion criteria were: bilateral shoulder instability; posterior or multidirectional instability, previous fractures and/or surgery to both shoulders; congenital or acquired inflammatory, neurological, or degenerative diseases. For all patients, CT exams of both shoulders were acquired at the same time following a standardized imaging protocol. The CT data sets were analysed on a standard desktop PC using the software 3D Slicer. Computer-based reconstruction of the Hill-Sachs and glenoid bone defect were performed through Boolean subtraction of the affected side from the contralateral one, resulting in a virtually generated bone fragment accurately fitting the defect. The volume of the bone fragments was then calculated. All measurements were conducted by two fellowship-trained orthopaedic shoulder surgeons. Each measurement was performed twice by one observer to assess intra-observer reliability. Inter and intra-observer reliability were calculated. Intraclass Correlation Coefficients (ICC) were calculated using a two-way random effect model and evaluation of absolute agreement. Confidence intervals (CI) were calculated at 95% confidence level for reliability coefficients. Reliability values range from 0 (no agreement) to 1 (maximum agreement). The study included 34 males and 6 females. Mean age (+ SD) of patients was 36.7 + 10.10 years (range: 25 – 73 years). A bipolar bone defect was observed in all cases. Reliability of humeral head bone fragment measurements showed excellent intra-observer agreement (ICC: 0.92, CI 95%: 0.85 – 0.96) and very good interobserver agreement (ICC: 0.89, CI 95%: 0.80 – 0.94). Similarly, glenoid bone loss measurement resulted in excellent intra-observer reliability (ICC: 0.92, CI 95%: 0.85 – 0.96) and very good inter-observer agreement (ICC: 0.84, CI 95%:0.72 – 0.91). In conclusion, matching affected and intact contralateral humeral head and glenoid by reconstruction on a computer-based virtual model allows identification of bipolar bone defects and enables quantitative determination of bone loss

Femoral impaction bone grafting (IBG) may be used to restore bone stock in revision total hip arthroplasty (THA) and allow use of a shorter, than otherwise, length prosthesis. This is most beneficial in young patients who are more likely to require further revision surgery. This study aimed to assess the results of femoral IBG for staged revision THA for infection. A prospective cohort of 29 patients who underwent staged revision THA for infection with femoral IBG and a cemented polished double-tapered (CPDT) stem at the final reconstruction was investigated. The minimum follow-up was two years (2 – 10 years, median 6 years). Stem subsidence was measured with radiostereometric analysis. Clinical outcomes were assessed with the Harris Hip, Harris Pain, and and Société Internationale de Chirurgie Orthopédique et de Traumatologie Activity (SICOT) Scores. The original infection was eradicated in 28 patients. One patient required a repeat staged revision due to re-infection with the same organism. At two-year follow-up, the median subsidence at the stem-bone interface was −1.70 mm (−0.31 to −4.98mm). The median Harris Hip Score improved from 51 pre-operatively to 80 at two years (p=0.000), the Harris Pain Score from 20 to 44 (p=0.000) and the SICOT Score from 2.5 to 3 (p=0.003). As successful eradication of infection was achieved in the majority of patients and the stem migration was similar to that of a primary CPDT stem, this study supports the use of femoral IBG during the final reconstruction of the femur after staged revision THA for infection

We have undertaken a series of clinical trials over the last 20 years to look at different bearing surface combinations in young adults. We continue to follow these patients well beyond the planned duration of the trials and new information is constantly becoming available. The first trial compared ceramic-on-ceramic with ceramic-on-standard-polyethylene. These patients have now been followed for 20 years with significant wear in the polyethylene group but virtually identical revision rates. The second trial ceramic-on-ceramic, cobalt-chrome-on-standard-polyethylene and cobalt-chrome-on-cross-linked-polyethylene. In this group the ceramic-on-ceramic patients have the lowest revision rate; the ceramic-on-polyethylene group demonstrates a lower wear rate than cobalt-chrome-on-polyethylene. The third trial looks at cobalt-chrome versus zirconium on either cross-linked polyethylene or conventional polyethylene. At 10 years there remains no evidence of improved performance from the zirconium surface as compared to cobalt-chrome. The cross-linked polyethylene group is clearly outperforming the conventional polyethylene in terms of wear rate but at 10 years the revision rates remain the same in all groups. Cross liked polyethylene appears to be the major determining factor in prosthetic longevity and appears to be more important than the counter face material

The development of an algorithm that provides accurate individualised estimates of revision risk could help patients make informed surgical treatment choices. This requires building a survival model based on fixed and modifiable risk factors that predict outcome at the individual level. Here we compare different survival models for predicting prosthesis survivorship after hip replacement for osteoarthritis using data from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. In this comparative study we implemented parametric and flexible parametric (FP) methods and random survival forests (RSF). The overall performance of the parametric models was compared using Akaike information criterion (AIC). The preferred parametric model and the RSF algorithm were further compared in terms of the Brier score, concordance index (C index) and calibration. The dataset contains 327 238 hip replacements for osteoarthritis carried out in England and Wales between 2003 and 2015. The AIC value for the FP model was the lowest. The averages of survival probability estimates were in good agreement with the observed values for the FP model and the RSF algorithm. The integrated Brier score of the FP model and the RSF approach over 10 years were similar: 0.011 (95% confidence interval: 0.011–0.011). The C index of the FP model at 10 years was 59.4% (95% confidence interval: 59.4%–59.4%). This was 56.2% (56.1%–56.3%) for the RSF method. The FP model outperformed other commonly used survival models across chosen validation criteria. However, it does not provide high discriminatory power at the individual level. Models with more comprehensive risk adjustment may provide additional insights for individual risk

The aim of this study was to report the procedure survival and patient-reported outcomes in a consecutive series of patients <50yrs at the time of hip arthroplasty with a metal-on-metal hip resurfacing system who have progressed to a minimum of 10yrs follow-up. Patients presenting for treatment of degenerative conditions of the hip electing to undergo hip resurfacing were included in a clinical registry (N=226 patients; 238 procedures). Procedure survival was confirmed by crosschecking to the Australian Orthopaedic Association National Joint Replacement Registry and comparing to all procedures by other surgeons nationwide. Kaplan-meier survival curves with 95% confidence intervals were constructed, while patient-reported outcome measures were compared with t-tests and postoperative scores assessed with anchor analysis to age and gender-matched normative data. At mean follow up of 12 years, six cases were revised with a cumulative survival rate of 96.8% (95%CI 94.2–99.4) at 15 years. Majority of revisions were early (<3yrs) and occurred in females (N=4). Patient-reported general health, disease state, hip function and activity level maintained large improvements beyond 10 years post-implantation and were equal to or exceeded age and gender-matched normative data. Metal-on-metal hip resurfacing in males and females aged <50 years at time of surgery demonstrated a high rate of cumulative survival beyond 10 years follow up. The results demonstrate excellent outcomes in this age group

This was a retrospective study of registry data from a National Orthopaedic Hospital for all THRs with 10-year follow-up data. Inclusion criteria were all THRs with a minimum of 10-year follow-up data. All metal-on-metal (MoM) THRs and MoM resurfacings were excluded from the analysis due to the high rate of revision associated with these bearings. Univariate and multivariate analyses controlling for confounding variables were performed to compare outcomes. A total of 1,697 THRs were performed in 1,553 patients. The four significant predictors for revision were fixation type (p<0.01), surface bearing type (p<0.01), age (P<0.05) and head size (p<0.05). Gender, BMI and approach had no effect on revision rates. The lowest 10-year all-cause revision rates were seen in cemented THRs at 1.7%. Ceramic-on-poly bearings had the lowest revision rate at only 1.2%. Metal-on-poly bearings had a 1.7% revision rate. Ceramic on ceramic bearings had a 7.1% revision rate with 1 revision for squeak and 1 revision for ceramic head fracture. The causes for revision in order of decreasing frequency were as follows: Infection (n=13, 0.7%), dislocation (n=7, 0.4%), periprosthetic fracture (n=3, 0.2%) and aseptic loosening (n=2, 0.1%). There were 2 re-revisions at 10 years in total. The smaller 22.225mm head sizes had a significantly lower revision rate than other head sizes (p<0.05). Ceramic-on-poly bearings, cemented fixation and smaller head sizes perform better in the experience of this registry. However, with multivariate analysis, these differences were shown to be insignificant

Introduction. Durable bone fixation of uncemented porous-coated acetabular cups can be observed at a long-term, however, polyethylene (PE) wear and osteolysis may affect survivorship. Accurate wear measurements correlated with clinical data may offer unique research information of clinical interest about this highly debated issue. Objetive. We assessed the clinical and radiological outcome of a single uncemented total hip replacement (THR) system after twenty years analysing polyethylene wear and the appearance of osteolysis. Materials and Methods. 82 hips implanted between 1992 and 1995 were prospectively evaluated. The mean follow-up was 20.6 years (range, 18 to 23). A hemispherical porous-coated acetabular cup matched to a proximally hydroxyapatite-coated anatomic stem and a 28 mm standard PE liner, sterilised by gamma irradiation in air, was used in all hips. Radiological position and the possible appearance of loosening and osteolysis were recorded over time. Penetration of the prosthetic head into the liner was measured by the Roentgen Monographic Analysis (ROMAN) Tool at 6 weeks, 6 months, one year and yearly thereafter. Results. Six cups were revised due to wear and four due to late dislocation. All cups were radiographically well-fixed and all stems showed radiographic ingrowth. Six un-revised hips showed osteolysis on the acetabular side and two on the proximal femoral side. Creep at one year was 0.30 (±0.23) mm. Mean total femoral head penetration was 1.23 mm at 10 years, 1.52 mm at 15 years and 1.92 mm at 23 years. Overall mean wear was 0.12 (± 0.1) mm/year and 0.09 (±0.06) mm/year after the creep period. Mean wear was 0.08 (± 0.06) mm/year in hips without osteolysis and 0.14 (±0.03) mm/year in revised hips or with osteolysis (p<0.001). Conclusions. Although continued durable fixation can be observed with a porous-coated cups and a proximally hydroxyapatite-coated anatomic stem, true wear continues to increase at a constant rate over time. PE wear remains as the main reason for revision surgery and osteolysis in uncemented THR and does not stop after twenty years

Introduction. The purpose of this study was to investigate the long-term outcome of Sugioka's transtrochanteric rotational osteotomy (TRO) for nontraumatic osteonecrosis of the femoral head. Methods. Seventy-eight patients (87 hips) were consecutively treated by TRO from 1989 to 1994. All patients followed 15 years or more were included. Four patients (4 hips) with traumatic osteonecrosis and five patients (5 hips) followed less than 15 years were excluded. A total of 69 patients (78 hips) were included. Average age at the time of operation was 42 years. There were 51 men (57 hips) and 18 women (21 hips). The average follow-up was 17 years (range, 15 to 20 years). Type of osteonecrosis was as follows: Type B; 2 hips, Type C1; 50 hips, and Type C2; 26 hips. Stage was as follows: stage 2; 29 hips, stage 3A; 34 hips, stage 3B; 13 hips, and stage 4; 2 hips. Transtrochanteric anterior rotational osteotomy was performed in 76 hips and posterior rotational osteotomy was performed in 2 hips. Clinical evaluation was evaluated by Harris hip score. Kaplan-Meier survivorship analysis was performed based on the end point of conversion to total hip arthroplasty (THA) or re-collapse. Results. Twenty-nine hips (37.2%) were converted to THA, and 38 hips (48.7%) were re-collapsed. Average Harris hip score before operation was improved from 67 to 82 points at final follow-up. The reasons for conversion to THA within five years after osteotomy were cervical fracture or fixation failure, and 10 years after osteotomy progression of osteoarthritis due to re-collapse. Kaplan-Meier survivorship at 10 years after surgery was 69.2% (95% confidence interval: 58.8-79.6) and 15 years after surgery was 61.3% (95% CI: 49.9-72.7) with THA as the end-point. Kaplan-Meier survivorship at 10 years after surgery 50.0% (95% CI: 38.6-61.4) and at 15 years after surgery 50.0% (95% CI: 38.6-61.4) when re-collapse was defined as the end point. Type C1 was significantly better than Type C2. There was no significant difference between the corticosteroid-induced and non-corticosteroid-induced patients. There was no significant difference between the patients with early and late stage. Conclusion. The long-term outcome of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head was excellent. Sixty-three percent of the hips were not converted to THA. Type C2 was a significant risk factor for TRO

Background. This survey was conducted to gain information about how surgeons use scientific literature and how this is influenced by their knowledge of evidence-based medicine. The results were compared to a survey conducted 10 years previously. Where appropriate, the same questions as in the 2003 survey were used. Methods. We administered a voluntary questionnaire to participants at the AO Foundation courses in Davos, Switzerland, in December 2013. We surveyed, amongst other topics, the surgeons’ levels of education in Evidence-Based Medicine (EBM), how they implement EBM in daily practice and their publication record. Results. A total of 330 surgeons completed the 27 question survey. 49% (159/322) had learned about EBM in medical school. However, 69% (110/159) of those with EBM education had taken only one semester or less on the subject. 54% of participants (170/317) correctly identified a definition of EBM in surgery. This compares to 45% in the 2003 survey (130/288 respondents) of a subset who said they have previously heard of evidence-based orthopaedic surgery. When it came to applying EBM in their daily work, 45% of respondents (143/320) claim to always practice it (2003 figure: 28%, 113/404), while 26% (84/320) only use EBM for difficult or controversial cases (2003 figure: 26%, 104/404). 27% (88/323) have never published a manuscript as an author or co-author (2003 figure: 14%, 121/453), 53% (170/323) have been involved in 1–10 publications (2003 figure: 59%, 269/453), and 20% (65/323) have published more than 10 times (2003 figure: 27%, 63/453). Conclusions. While at face value there appears to be a greater understanding and utilisation of EBM among AO course participants who completed the 2013 survey compared to the 2003 study, several outcomes do not show any great variation in the intervening decade. Level of Evidence. professional survey

Background. Inflammation and chemokines play a pivotal role in aseptic loosening (AL) and prosthetic joint infection (PJI) of total joint arthroplasty (TJA). Recently, the Duffy antigen receptor for chemokines (DARC) on erythrocytes was identified as a potent chemokine receptor able to bind and carry without deactivating a wide range of CXC and CC chemokines from circulation to tissues. The role of DARC and its functional polymorphism (SNP) influencing the number of the DARC molecules on the erythrocytes in AL/PJI has not been studied yet. Methods. We genotyped functional polymorphism in the DARC gene (rs12075) using MassArray technology (Agena Bioscience) in 354 patients with TJA (hip and knee arthroplasties). Patients were further subdivided into those with a complication (AL, n = 110; PJI, n = 126) and a control group without complications for at least 10 years (n = 118). Statistics was performed by Plink 1.07 and relative entropy. Results. Among our TJA patients, the rs12075 *G allele was more frequent in patients with a failure (46.6%) compared to those without complications (36.0%, P = 0.007, OR = 1.55, 95%CI = 1.13–2.14). The rs12075 *G allele was overrepresented mainly in patients with AL (49.5%, P = 0.004, OR = 1.74, 95%CI = 1.20–2.54), a trend was observed in PJI (44.0%, P = 0.071, OR =1.40, 95%CI = 0.97–2.01). This SNP is located in a coding region in the DARC gene, and the *G allele is associated with more DARC molecules on erythrocytes, thus able to bind and transport more CCL2, CCL5, CCL18 involved in the pathogenesis of AL/PJI from circulation to the periprosthetic tissue. Conclusions. Our data nominate erythrocyte DARC as a novel molecule in pathogenesis of aseptic loosening of TJA. The hypothesis that DARC may serve as a chemokine reservoir and shuttle chemokines from circulation to the joint surroundings should be investigated in future studies. Level of evidence IV. Evidence from well-designed case-control and cohort studies. The study was approved by the Ethical Committee of Palacky University and Faculty

Highly cross-linked polyethylene (HXLPE) is now a common used bearing surface in total hip arthroplasty. Current studies report superior wear rates with the use of HXLPE in total hip arthroplasty. However, there are few studies to support its long term use. The aim of this study is to measure the long term wear of HXLPE and evaluate patient satisfaction at more than 10 years follow up. 44 total hip arthroplasties were performed through a direct lateral approach by a single surgeon. All patients received the same uncemented acetabular component, mean liner thickness was 6.91mm (SD= 0.68). 16 of the femur components were cemented. Outcomes analysed include wear rates, osteolysis, revision rates, SF12 and Oxford hip scores. Wear rate was calculated using computer software (Polyware®) using edge detection software. Mean age at surgery was 58.9 years (SD= 11.67). The mean follow up was 11.3 years (SD= 1.19). There was no evidence of osteolysis and none had undergone revision surgery. Mean two dimensional wear was 0.38mm (SD= 0.25) and mean wear rate per year was 0.03mm (SD= 0.02, range 0.009 to 0.078). Oxford hip score at last follow up indicated satisfactory joint function (mean= 42 SD= 6.2). Our results support the use of highly cross-linked polyethylene in primary total hip replacements. The absence of osteolysis and need for revision surgery over a mean of 11.3 years is very encouraging

Cheilectomy of the big toe is offered in the early stages of arthritis affecting the big toe MTPJ, with the understanding that if it fails then a more definitive surgical treatment (e.g. MTPJ fusion or replacement) may be required. When considering treatment options, patients want to know how long will a cheilectomy procedure last. There is limited evidence available about the long term results after cheliectomy, particularly with regards to time to revision surgery. Our aim was to establish the long-term results of cheilectomy with regards to revision surgery and patient-satisfaction over a period of 10 years. A retrospective review of big toe MTPJ cheilectomies was performed at our institute from 2002 to 2012. The patients were identified using a combination of medical coding system, clinical records, operative log, and radiographs. A systemic review of chielectomy by Roukis (2010) was identified as the clinical standard and revision surgery after cheilectomy, average time to revision and patient satisfaction was assessed. 204 cheilectomies were identified in 192 patients over a period of 10 years. Majority had grade 2 OA (n = 106, 54 %) with grade 3 (n= 65, 33 %) and grade 1 (n= 24, 12 %). The mean follow-up was 4 yrs. (range 6 m to 9 yrs. and 8 m). The overall revision rate to any surgery was 4.4% (n=9), and revision to MTPJ arthrodesis was 3.4% (n =7). The average time to revision was 1 yr. 4 m. 101 patients (55%) were contactable over the phone, and majority (82 %) of them were satisfied with the clinical outcome. This study shows slightly better overall revision rate (4.4% vs. 8.8%), with revision to arthrodesis being similar (3.4% vs. 3.25%) as compared to the clinical standard. It also suggests that cheilectomy of the big toe can last for a minimum of up to 4 years in 95 % of cases. The 5 % of cases that may require revision surgery are likely to present within the first 2 years. This information is very useful to a patient who wants to know “how long will my cheilectomy last?” whilst making an informed choice

Background. The pattern of appearance of secondary ossification centers in the elbow has been based on historical studies and is popularly referred to with the mnemonic CRITOL. However the six secondary ossification centers can be variable in their presentation and pose a challenge in assessment of children with elbow injuries. Furthermore limited studies available in the current literature have reported an aberration to the sequence of appearance especially with the ossification centers of trochlea and olecranon. Aims. The aim of the study was to evaluate the relative sequence of appearance of secondary ossification centers for the trochlea and olecranon. Methods. Children between 8 and 10 years of age who had radiographs of elbow following trivial trauma between July 2013 and Feb 2015 were identified using the hospital PACS database. Cases with radiographic markers of significant trauma ie. fat pad sign, displaced fracture were excluded. Anteroposterior and lateral views of elbow were reviewed for the presence of the six ossification centers. Results. A total of 114 radiographs were reviewed of which 51 were boys and 63 were girls with a mean age of 9.03 years (±0.59). 60 radiographs were of right elbow and 54 were of the left elbow. The capitulum, radial head and medial epicondyle ossification centers were present in all patients. Both trochlea and olecranon ossification centers were noted in 51/114 (44.7%) children. 12/114 (10.5%) of the children were noted to have trochlea ossification center with no olecranon ossification center. Of these 12 children 7 were boys and 5 were girls. On the other hand 19/114 (16.7%) of the children had an olecranon ossification center but without a trochlea ossification center. Amongst these 7 were boys and 12 were girls. Discussion and Conclusions. The results of this limited cross sectional study demonstrate that the CRITOL sequence may not followed in 16.7% of cases and more so in girls. Historical studies were based on conventional radiographs. However the current digital radiographs with image enhancement tools help in accurate identification of relatively small ossification centers which may not be apparent on conventional radiographs. The current study has helped to quantify the violators to CRITOL sequence. Level of Evidence. Level III (Cross-sectional study among non-consecutive patients)

Total ankle replacement (TAR) has a mean survivorship of 77% at 10 years which is poor compared to other types of joint arthroplasty. Osteolysis and aseptic loosening are commonly cited TAR failure modes, the mechanisms of which are unknown. Retrieval analyses of TAR devices may reveal mechanisms of failure similar or dissimilar to other joint replacements. This study investigated whether TAR explants exhibit similar damage modes to those recognised in other total joint replacements. 22 Ankle Evolution System TARs (Transystème, Nimes, France) were implanted and retrieved by the same surgeon. Mean implantation time was 7.8 yrs (5.3 to 12.1 range). Pain and/or loosening were the indications for revision. Macro photography, an Alicona Infinite microscope and the Hood/Wasielewski scale were used to classify damage modes on the polyethylene insert. Scanning electron microscopy with energy dispersive X-ray spectroscopy was used to determine the composition of third body debris and to image the fixation surface of the tibial components. Mean damage score was 185.4 (± 40.0 SD). Damage modes common to total knee replacements were identified on both the superior and inferior insert surfaces, these included: burnishing, scratching, pitting and abrasion. Titanium particles, hydroxyapatite fragments and bone debris were embedded in the insert surfaces. Fixation surface delamination was identified by the ongrowth of tissue between the cobalt chromium substrate and titanium alloy coating. Damage modes indicative of high levels of wear and deformation were evident. Pitting caused by third body debris was abundant and suggested fixation surface wear and failure