Aims

Proximal humeral fractures (PHFs) are common. There is increasing evidence that most of these fractures should be treated conservatively. However, recent studies have shown an increase in use of operative treatment. The aim of this study was to identify the trends in the incidence and methods of treatment of PHFs in Finland.

MHRA guidance for patients with metal on metal hip replacements (MOM) was provided in 2012 and updated in 2017 to assist in the early detection of soft tissue reactions due to metal wear debris. A large number of metal on metal hip replacements were undertaken at our trust. A program of recall for all patients with metal on metal hip replacements was undertaken and MHRA guidelines implemented.

Identification and recall of all patients from 2001 with MOM hip replacements using theatre logs, patient records and consultant log books. Two consultant review of X-rays and patient records. Postal questionnaires and GP requests for cobalt & chromium blood tests. Two consultant led MOM review clinics undertaken with metal artefact reduction scans (MARS) performed following consultation in 2017.

674 patients, 297 available for review. 59 refused follow up. 87 moved out of area, 36 untraceable, 26 not MOM, 147 RIP, 22 already revised. From 297 patients 126 female, 171 male, age range 39 – 95 yrs. 126 resurfacing, 171 MOM THR. 26 patients with elevated metal ions, MARS performed of which 17 positive, 9 negative. Of 17 positive scans 10 patients asymptomatic, 7 waiting revision.

A time consuming effort and additional resource was needed and supported by the trust. From 297 hips 17 positive MARs were identified (5.7%). A new database registry has been developed to track MOM patients, clinics set up for ongoing follow up with radiological protocols for imaging. An arthroplasty advanced nurse practitioner (ANP) is now trained reviewing patients independently.

Orthopedic surgery is one of the most blood-consuming surgeries. Currently there has been a radical change in transfusion policies, developing a series of therapeutic measures essentially created to minimize the use of allogeneic blood.

On the one hand, the safety of our patients must be even more our main objective. On the other hand, our economic resources are more restricted and therefore we must evaluate our surgical techniques and proceedings in order to be safer and more cost-effective.

The aim of this study is to report our results of the blood lost, the percentage of blood loss, the necessity of transfussions and how many blood pakages are needed.

From a sample of 2400 total knee arthroplasties proceedings, we analyze some surgical proceedings such as lligament balance, patelar traking, artrotomy, ischemia, femoro-tibial axis and type of arthroplasty.

We also examine the total blood lost and the percentage of total blood loss after 4 hours, after 24hours and after 48 hour of the total knee arthoplasty surgery.

We made a statistical analysis with t-test or anova test when it was necesassary.

The outcome of our investigation show that the blood loss when the ischemia is less than 50 minutes is 1470 cc and 1603 cc when is more than 50 minuntes (p<0.05). If we use the medial arthrotomy, the total bleeding is 1563cc, but with subvastus arthrotomy is 1294cc (p<0.05). If we use a primary rotational total knee arthroplasty the bleeding is 953cc, but if we use a PS or PCR the bleeding is 874cc (p<0.05).

As a conclusion we should know that our patients have more blood loss when the ischemia is more than fifty minutes, the bleeding is higher when we make a medial arthrotomy and when we use a rotational knee primary arthroplasty.

Expectations of patients requiring knee arthroplasty surgery have become higher than in the past, with more strain being put on modern prostheses by fitter and younger patients. The objective of this study was to analyse the survivorship of primary knee arthroplasties at a minimum of ten years, with end points of revision and death. Patients who had a total (TKA) or unicompartmental (UKA) knee arthroplasty performed at a university teaching hospital were identified from the local arthroplasty database. Electronic and operative records were analysed to determine parameters including operative indication, subsequent revision surgery, and patient mortality. Results were collated and analysed using PASW software.

A total of 1023 patients were recruited, with 566 (55%) female and 457 (45%) male. Minimum follow up was 10.1 years, with an average of 12.1 years (S.D 0.87). 64.9% of patients were alive at follow up, with an average age of 79.7 years (S.D 8.7). 92.8% were operated on for osteoarthritis (OA), 6.6% for rheumatoid arthritis (RA) and 0.6% for other indications. Kaplan–Meier analysis estimated survival of 94% (S.D 0.008) at eleven years, with no statistical difference found in survivorship of knees operated on for OA or RA. Similarly no statistical difference was found between survivorship of UKA or TKA implants. Of those that died by follow up, 95.2% did so with their original implant.

We conclude that both TKA and UKA offer a lasting solution for patients, with excellent outcomes achieved in both rheumatoid and osteoarthritic patients.

Introduction

The purpose of this study was to compare the clinical outcomes and complications following bilateral simultaneous total knee arthroplasty in high body mass index (BMI) patients(>30kg/m²) to those of patients with a BMI<30 kg/m².

A review of current literature describes varying 10-year survival rates for the Oxford Unicompartmental Knee Replacement (Biomet Orthopedics Inc, Warsaw, Ind). Application of rigorous indications and meticulous surgical technique are two factors considered to reduce revision rates.

A retrospective case-note review was conducted for 96 patients (128 knees) aged 42–89 (mean 57) who had an Oxford unicompartmental knee replacement for medial compartment osteoarthritis between January 2000 and January 2011. All procedures were performed, or directly supervised, by one 5 surgeons. The aim of the study was to ascertain the rate of revision to bicompartmental knee replacement and any associated contributory factors.

Of the 128 unicompartmental knees, 10.9% were revised to either mobile- or fixed-bearing total knee replacements due to septic (0.5%) and aseptic (1.5%) loosening, patello-femoral pain (3.9%), periprosthetic fracture (0.8%) and bearing dislocation (3.1%). Of those knees requiring revision, mean patient age was 73 years, 50% had wound complications and 42% were performed by senior trainees. All patients had intact ACL and medial osteoarthritis. Mean time to revision was 2.7 years.

In conclusion, revision of the unicompartmental knee was related to patient age > 65 years and early post-operative complications; grade of operating surgeon had little apparent effect.

Purpose

to analyze the survivorship of the RSA with a minimum 10 years follow up.

Introduction

A recent review of the literature on metal-on-metal total hip arthroplasties (THA) revealed the lack of comparative clinical studies with a sufficient sample size and the inclusion of patient-reported outcomes as well as patient activity levels.

Understanding the cause of failure of total knee arthroplasties (TKA) is essential in guiding clinical decision making and adjusting treatment concepts for revision surgery. The purpose of the study was to determine current mechanisms of failure of TKA and to describe changes and trends in revision surgery over the last 10 years.

A retrospective review was done on all patients who had revision total knee arthroplasty during a 10-year period (2000–2009) at one institution. The preoperative evaluation in conjunction with the intraoperative findings was used to determine causes of failure. All procedures were categorizes as Sharkey et al. described previously. The data was analyzed regarding the cause of failure and displaying the incidence and trends over the last 10 years.

1225 surgeries were done in the time period with a steady increase of procedures per year (34 procedures in 2000 to 196 in 2009). The most common cause of revision TKA was aseptic failure in 65% and septic failure in 31% of the reviewed cases. However, we could observe a steady proportional increase of the septic classified revisions over the time. Both categories could be subdivided to specific causes of failure including aseptic loosening (24%), anterior knee pain (20%), instability (6,4%), arthrofibrosis (4,9%), PE wear (3,6%), malpositioning/malrotation (2,7%) periprosthetic fracture (2,0%) and other (4,6%), or in early (12,9%), late (15,4%) or low-grade infection (3,3%), respectively. Complementary to the classification Sharkey et al. described in 2002 we identified new subcategories of failure: malrotation (since 2003), Low-Grade-Infection (since 2006), allergic failure/loosening (since 2006), Mid-Flexion-Instability (since 2007), soft tissue impingement (since 2009). The incidence of the classic aseptic loosening due to PE wear shows a clear decrease in the last 10 years whereas we could observe an increase of the new diagnosis of instability, malrotation or low-grade-infection as determined cause of failure.

The detailed analysis of the failure mechanism in total knee arthroplasty is important to understand the clinical problem and to adjust treatment strategies. We were able to complement present classifications and give a first overview on the incidence for specific causes of failure. Our data shows changes in the indication for surgery over the time and compared to the collective of Sharkey et al. from 1997–2000. This might be due to new diagnostic methods and better implant materials as well as to a generally increased awareness of the specific mechanism of TKA failure.

Objective

To describe demographic data, clinical outcome and short-term survival after shoulder arthroplasty.

Introduction

Revision type arthroplasties for the treatment of knee osteoarthritis is an effective and secure procedure. It has different indications, but the most relevant is the revision of a failured primary arthroplasty. In our study, we reviewed the results of another indication, the implantation of a revision type arthroplasty as a primary procedure in cases of severe deformities.

In a randomized study of 60 patients allergic reactions are evaluated in three joint prosthesis groups, a resurfacing arthroplasty (ReCap), a non-cemented, large metal-on-metal head (Bimetric Magnum) and a non-cemented, alumina ceramic-on-ceramic bearing in a titanium shell (Bimetric C2a).

The inclusion criteria were osteoarthritis, ASA I–II, MRI-scan without caput necrosis, DXA-scan without osteoporosis. The exclusion criteria were short neck (<2cm.), large cysts (>1cm.), medical treatment affecting the bone metabolism, severe deformity of the femoral head, impaired kidney function and inability to co-operate.

Blood samples were drawn prior to and 6 weeks, 6 months, 1 year, and 3 years after surgery; two tubes from which plasma was prepared, and two tubes for serum. From the last included 20 patients in each group was also taken blood one and three years after surgery for an in vitro lymphocyte assay for scoring of possible hypersensitivity to prosthesis metals. The isolated lymphocytes were subjected to measurement of proliferation and expression of CD69 by flow cytometry and measurement of the Migration Inhibitory Factor (MIF) by ELISA. Plasma concentrations of the cytokines IL-1, IL-4, IL-6, IL-8, IL-12p70, IL-15, interferon-and osteoprotegerin were determined by multiplex-immunoassay. Serum concentrations of chromium and cobalt were determined by graphite furnace atomic absorption spectrometry.

The serum concentrations of chromium and cobalt were lowest in patients with the C2a implant and highest with Magnum, some of these differences were significant at 6 weeks, 6 months, and 1 year after surgery. No patient had a very high serum metal concentration. The values of the variables measured in the in vitro lymphocyte assay mainly changed in the expected direction depending on the concentration of the same metal in the serum sample drawn at the same time, but no significant correlation was seen. One patient had uncertain symptoms of metal hypersensitivity and relatively high serum metal concentrations 3 years after arthroplasty with a Magnum prosthesis and was assessed extraordinarily, and elicited the marginally highest MIF responses in the lymphocyte assay. A strong correlation was found between the plasma concentrations of most cytokines, but the cytokine concentrations were not correlated to contemporary metal concentrations.

Revision hip surgery is reportedly rising inexorably yet not all units report this phenomenon. The outcome of 1143 consecutive Corin TaperFit primary hip arthroplasties (957 patients) performed between 1995 and 2010 is presented. The implants were cemented under pressurisation and combined the TaperFit stem with Ogee flanged cups.

Data was gathered from local arthroplasty database and case note review of revised joints. 13 hips have been revised (1.1%). Cumulative prosthesis survival is 0.99 +/− 0.0. Two femoral stems were revised (0.2%); one at 6 months for sepsis, one at 14 days after dislodgment during reduction of dislocation. No revisions were undertaken for aseptic loosening of the stem or cup, nor for thigh pain. 32 patients (32 hips) ≥15 year follow up, 13 survive today and none have been revised (0%). Of the 471 with ≥10 year follow up, 38 were aged ≤50 at time of surgery and 1/38 has been revised to date (PLAD for dislocation).

The strong population stability in this region, supported by independent investigation by Scottish Arthroplasty Project, endorses the accuracy of the data quoted. The low incidence of revision in this cohort, and absence of revision for aseptic loosening (mean follow up 8.03 years +/− SD 3.94; range 18 months to 16yrs 2 months), substantially supports the longevity and use of cemented, double-taper, polished, collarless femoral stems in combination with cemented polyethylene cups in primary hip arthroplasty in all patient age groups.

Background. Metal on metal hip resurfacing has become popular worldwide for younger patients because of perceived advantages in function and ease of revision, due to bone conservation. Joint Registry data have shown increased risk of early failure, particularly in younger females. There have been few studies comparing the outcome of resurfacing to cemented total hip arthroplasty (THA). Methods. 715 Hip Resurfacings (HR) performed between 2000 and 2010 with up to 10 years follow-up were compared with 2210 Exeter cemented Total Hip Arthroplasties (THA) performed for all diagnoses during the same period within our region. Survivorship was recorded using revision for any cause as the end point. Harris Hip Scores were collected pre-operatively and at 1,3,5 and 7 year review. Prospective independent analysis was carried out using Kaplan Meier survivorship, and non-parametric testing to investigate the effect of age (under 55 and over 55) and gender on revision rate and Harris Hip Score. Results. Over the 10 year period survival of Exeter THA was better than HR overall. Revision rate 2% for THA and 7% for HR; P < 0.0001. There was no significant difference in risk of revision between THA and HR in males at any age. In females there was a significantly increased revision rate with HR. Under 55 Revision rates: THA 0%; HR 6.7%. 55 & over Revision rates: THA 1.3%, HR 5.9%, P < 0.0001. Harris Hip Scores were significantly better overall in the HR group. Sub-group analysis showed that Harris Hip Scores were not significantly different for males under 55. In all other groups (males over 55 and females under and over 55) Harris Hip Scores were better after HR compared with THA. Conclusions. In this series survivorship and functional scores for HR are at least as good as for THA in males. The increased risk of revision after HR in females should be weighed against advantages of bone conservation and better post-op hip scores

Aims

The aim of this study was to describe variation in hip fracture treatment in Norway expressed as adherence to international and national evidence-based treatment guidelines, to study factors influencing deviation from guidelines, and to analyze consequences of non-adherence.