To evaluate the outcomes of cemented total hip arthroplasty (THA)
following a fracture of the acetabulum, with evaluation of risk
factors and comparison with a patient group with no history of fracture. Between 1992 and 2016, 49 patients (33 male) with mean age of
57 years (25 to 87) underwent cemented THA at a mean of 6.5 years
(0.1 to 25) following acetabular fracture. A total of 38 had undergone
surgical fixation and 11 had been treated non-operatively; 13 patients
died at a mean of 10.2 years after THA (0.6 to 19). Patients were
assessed pre-operatively, at one year and at final follow-up (mean
9.1 years, 0.5 to 23) using the Oxford Hip Score (OHS). Implant
survivorship was assessed. An age and gender-matched cohort of THAs
performed for non-traumatic osteoarthritis (OA) or avascular necrosis
(AVN) (n = 98) were used to compare complications and patient-reported outcome
measures (PROMs).Aims
Patients and Methods
British Orthopaedic Association (BOA) Guidelines recommend clinical and radiological follow-up after Total Hip Arthroplasty (THA) at 1 year, 5 years and every 5 years thereafter to detect asymptomatic failure. To evaluate the importance of routine follow-up appointments (OPAs) in detecting failing implants the presentation of patients undergoing revision THA was reviewed. 176 patients who received 183 first-time revision THAs over a seven-year period (2003-2010) were identified from an arthroplasty database. A preliminary study sampled 46 THAs in 45 patients. Retrospective chart review recorded symptoms and mode of presentation. Follow-up OPA costs were calculated to estimate savings. All patients had symptoms at the time of revision (pain 96%, decreased mobility 76%, limp 35%, stiffness 26%, night pain 24%). Route of presentation was 80% new referrals (GP 63%, in-patient 9%, A&E 4%, Rheumatology 4%) vs 20% routine orthopaedic follow-up. The minimum cost for a routine follow-up OPA was £35. Assuming discharge after the earliest review when the patient has returned to full normal activities the estimated saving for the 2009 cohort of 377 primary THAs performed in our hospital is £13195 at 1 year and £52780 over the lifespan of the implants (assuming average 15 year survival). Following uncomplicated primary cemented THA in our hospital asymptomatic implant failure is unlikely. Symptomatic patients tend to present mainly to their GP and other specialities, rather than orthopaedic follow-up OPAs. Early discharge after return to full normal activities would be safe and lead to significant financial savings.
Malalignment of some designs of stem is associated with an increased risk of aseptic loosening and revision. We investigated whether the alignment of the cemented polished, double-taper design adversely affected outcome, in a multicentre prospective study. A multicentre prospective study of 1189 total hip replacements was undertaken to investigate whether there is an association between surgical outcome and femoral stem alignment. All patients underwent a primary THR with the Exeter femoral stem (Stryker Howmedica Osteonics, Mahwah, NJ) and a variety of acetabular components. The primary outcome measure was the Oxford hip score (OHS) and change in OHS at five years. Secondary outcomes included rate of dislocation and revision. Radiographic evaluation of the femoral component was also undertaken. The long axis of the Exeter femoral component and the long axis of the femoral canal were located, and the angle at the point of intersection measured. The cementing quality was determined as defined by Barrack et al. Radiolucent lines at the cement-stem and cement-bone interface in the five year radiographs were defined using the zones described by Gruen et al. Subsidence was measured as the vertical dimension of the radiolucency craniolateral to the shoulder of the stem in Gruen zone 1 as described by Fowler et al. Cement fractures were recorded.Introduction
Methods
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). 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.Background
Methods
