Aims. Improvements in functional results and long-term survival are variable following conversion of hip fusion to total hip arthroplasty (THA) and complications are high. The aim of the study was to analyze the clinical and functional results in patients who underwent conversion of hip fusion to THA using a consistent technique and uncemented implants. Methods. A total of 39 hip fusion conversions to THA were undertaken in 38 patients by a single surgeon employing a consistent surgical technique and uncemented implants. Parameters assessed included Harris Hip Score (HHS) for function, range of motion (ROM), leg length discrepancy (LLD), satisfaction, and use of walking aid. Radiographs were reviewed for loosening, subsidence, and heterotopic ossification (HO). Postoperative complications and implant survival were assessed. Results. At mean 12.2 years (2 to 24) follow-up, HHS improved from mean 34.2 (20.8 to 60.5) to 75 (53.6 to 94.0; p < 0.001). Mean postoperative ROM was flexion 77° (50° to 95°), abduction 30° (10° to 40°), adduction 20° (5° to 25°), internal rotation 18° (2° to 30°), and external rotation 17° (5° to 30°). LLD improved from mean -3.36 cm (0 to 8) to postoperative mean -1.14 cm (0 to 4; p < 0.001). Postoperatively, 26 patients (68.4%) required the use of a walking aid. Complications included one (2.5%) dislocation, two (5.1%) partial sciatic nerve injuries, one (2.5%) deep periprosthetic joint infection, two instances of (5.1%) acetabular component aseptic loosening, two (5.1%) periprosthetic fractures, and ten instances of HO (40%), of which three (7.7%) were functionally limiting and required excision. Kaplan-Meier Survival was 97.1% (95% confidence interval (CI) 91.4% to 100%) at ten years and 88.2% (95% CI 70.96 to 100) at 15 years with implant revision for aseptic loosening as endpoint and 81.7% (95% CI 70.9% to 98.0%) at ten years and 74.2% (95% CI 55.6 to 92.8) at 15 years follow-up with implant revision for all cause failure as endpoint. Conclusion. The use of an optimal and consistent surgical technique and cementless implants can result in significant functional improvement, low complication rates, long-term implant survival, and high patient satisfaction following conversion of hip fusion to THA. The possibility of requiring a walking aid should be discussed with the patient before surgery. Cite this article: Bone Joint J 2021;103-B(7 Supple B):129–134

Aims. The aim of this retrospective study was to evaluate the rate of conversion to surgical release after a steroid injection in patients with a trigger finger, and to analyze which patient- and trigger finger-related factors affect the outcome of an injection. Methods. The medical records of 500 patients (754 fingers) treated for one or more trigger fingers with a steroid injection or with surgical release, between 1 January 2016 and 1 April 2020 with a follow-up of 12 months, were analyzed. Conversion to surgical release was recorded as an unsuccessful treatment after an injection. The effect of patient- and trigger finger-related characteristics on the outcome of an injection was assessed using stepwise manual backward multivariate logistic regression analysis. Results. Treatment with an injection was unsuccessful in 230 fingers (37.9%). Female sex (odds ratio (OR) 1.87 (95% confidence interval (CI) 1.21 to 2.88)), Quinnell stage IV (OR 16.01 (95% CI 1.66 to 154.0)), heavy physical work (OR 1.60 (95% CI 0.96 to 2.67)), a third steroid injection (OR 2.02 (95% CI 1.06 to 3.88)), and having carpal tunnel syndrome (OR 1.59 (95% CI 0.98 to 2.59)) were associated with a higher risk of conversion to surgical release. In contrast, an older age (OR 0.98 (95% CI 0.96 to 0.99)), smoking (OR 0.39 (95% CI 0.24 to 0.64)), and polypharmacy (OR 0.39, CI 0.12 to 1.12) were associated with a lower risk of conversion. The regression model predicted 15.6% of the variance found for the outcome of the injection treatment (R. 2. > 0.25). Conclusion. Factors associated with a worse outcome following a steroid injection were identified and should be considered when choosing the treatment of a trigger finger. In women with a trigger finger, the choice of treatment should take into account whether there are also one or more patient- or trigger-related factors that increase the risk of conversion to surgery. Cite this article: Bone Joint J 2022;104-B(10):1142–1147

Patients with longstanding hip fusion are predisposed to symptomatic degenerative changes of the lumbar spine, ipsilateral knee and contralateral hip. 1. In such patients, conversion of hip arthrodesis to hip replacement can provide relief of such symptoms. 2 – 4. However, this is a technically demanding procedure associated with higher complication and failure rates than routine total hip replacement. The aim of this study was to determine the functional results and complications in patients undergoing hip fusion conversion to total hip replacement, performed or supervised by a single surgeon. Twenty-eight hip fusions were converted between 1996 and 2016. Mean follow up was 7 years (3 to 18 years). The reasons for arthrodesis were trauma 11, septic arthritis 10, and dysplasia 7. The mean age at conversion was 52.4 years (26 to 77). A trochanteric osteotomy was performed in all hips. Uncemented components were used. A constrained liner was used in 7 hips. Heterotopic ossification prophylaxis was not used in this series. HHS improved a mean of 27 points (37.4 pre-op to 64.3 post-op). A cane was used in 30% of patients before conversion and 80% after. Heterotopic ossification occurred in 12 (42.9%) hips. There was 2 peroneal nerve injuries, 1 dislocation, 1 GT non-union and 1 infection. There have been 5 revisions; 2 for aseptic loosening, 1 for infection, 1 for recurrent dislocation and 1 for leg length discrepancy. Conversion of hip fusion to hip replacement carries an increased risk of heterotopic ossification and neurological injury. We advise prophylaxis against heterotropic ossification. When there is concern about hip stability we suggest that the use of a constrained acetabular liner is considered. Despite the potential for complications, this procedure had a high success rate and was effective in restoring hip function

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 failed internal fixation for femoral neck fracture. Methods. We retrospectively included 340 patients who underwent conversion THA after internal fixation for femoral neck fracture from January 2008 to September 2020. Those patients constituted two groups: noninfected patients and patients diagnosed with FRI according to the 2013 International Consensus Meeting Criteria. Receiver operating characteristic (ROC) curves were used to determine maximum sensitivity and specificity of these two preoperative ratios. The diagnostic performance of the two ratios combined with preoperative CRP or ESR was also evaluated. Results. The numbers of patients with and without FRI were 19 (5.6%) and 321 (94.4%), respectively. Areas under the ROC curve for diagnosing FRI were 0.763 for MLR, 0.686 for NLR, 0.905 for CRP, and 0.769 for ESR. Based on the Youden index, the optimal predictive cutoffs were 0.25 for MLR and 2.38 for NLR. Sensitivity and specificity were 78.9% and 71.0% for MLR, and 78.9% and 56.4% for NLR, respectively. The combination of CRP with MLR showed a sensitivity of 84.2% and specificity of 94.6%, while the corresponding values for the combination of CRP with NLR were 89.5% and 91.5%, respectively. Conclusion. The presence of preoperative FRI among patients undergoing conversion THA after internal fixation for femoral neck fracture should be determined. The combination of preoperative CRP with NLR is sensitive tool for screening FRI in those patients. Cite this article: Bone Joint J 2021;103-B(9):1534–1540

Hip arthrodesis remains a viable surgical technique in well selected patients, typically the young manual labourer with isolated unilateral hip disease. Despite this, its popularity with patients and surgeons has decreased due to the evolution of hip replacement, and is seldom chosen by young adult patients today. The surgeon is more likely to encounter a patient who requests conversion to total hip replacement (THR). The most common indications are a painful pseudarthrosis, back pain, ipsilateral knee pain or contralateral hip pain. Occasionally the patient will request conversion because of difficulty with activities of daily living, body image and perceived cosmesis. The technique of conversion and a discussion of the results are presented. Cite this article: Bone Joint J 2013;95-B, Supple A:114–19

In the past orthopaedic surgeons have kept their hands off from spontaneous or artificial fused hips, because those hips were painless, and the result of any further surgical procedure would be doubtful. In our days the need for conversion hip arthroplasty became a demand of patients having a better quality of life. In this paper we report on our results and the perioperative complications following conversion surgery. Between 1993 and 2002 thirty-one hips of twentyfive patients (18 males, 7 females) were converted from totally stiff hip to total hip arthroplasty in the two most frequented orthopaedic hospitals in Budapest, Hungary (Semmelweis University, Medical School, Dept. of Orthopaedics & Hospital of Hospitaller Brothers of St.John of God, Dept. of Orthopaedics). The mean age of the patients was 47.2 years (ranging from 14 to 75 years) at the time of surgery. The average follow up was 50.7 months (2–176). At our 25 patients the hips became stiff 15.7 years ago as an average (3–61). Spontaneous fusion occured in 14 cases due to Bechterews disease (spondylitis ankylopoetica). In 4 cases fused hips were converted following arthrodesis procedures. There was no significant difference between each groups, spontaneous ankylosis and surgical fusion were similar, they were evaluated as stiff hips on the same way. The indication for surgery was in most cases a painful lumbar spine or osteoarthritic knee joint on the ipsilateral side. The surrounding joints are obviously overloaded and overused because of the stiff hip joint, even though if the hip is painless. 27 cemented and 4 uncemented hip prostheses were implanted. The mean duration of conversion arthroplasties was 110 minutes, the perioperative blood loss was 1019 ml. Additional surgical procedures may be used, like intertrochanteric wedge resection, osteotomy of greater trochanter, muscle release from the iliac bone, tenotomy of the hip adductors or knee flexors. The Harris Hip Score increased significantly from 34.2 to 81.3 (p< 0.01). The leg length discrepancy decreased from 4.0 cm to 1.2 cm, the difference of thigh circumference changed from 4.3 cm to 2.7 cm, all results as an average. Trendelenburgs gait was detected at 25 hips pre-op, and at 5 hips at the time of follow up. Five cases were reoperated due to haematoma formation, there was one prosthesis disclocation and one early septic complication. Based upon the good clinical results at the follow up, we recommend to change the orthopaedic surgeons’ mind considering conversion arthroplasties. The surgical procedure can be performed securely, but it is technically challenging for each surgeon. The intraoperative use of fluoroscopy and preoperative planning are mandatory in conversion arthroplasty. Conversion arthroplasty is performed prior to severe degenerative changes in the surrounding joints

Patients with longstanding hip fusion are predisposed to symptomatic degenerative changes of the lumbar spine, ipsilateral knee and contralateral hip. In such patients, conversion of hip arthrodesis to hip replacement can provide relief of such symptoms. However, this is a technically demanding procedure associated with higher complication and failure rates than routine total hip replacement. The aim of this study was to determine the early functional results and complications in patients undergoing hip fusion conversion to total hip replacement, performed or supervised by a single surgeon, using a standardised approach and uncemented implants. We hypothesised that a satisfactory functional improvement can be achieved in following conversion of hip fusion to hip replacement. Eighteen hip fusions were converted to total hip replacements. A constrained acetabular liner was used in 3 hips. Mean follow up was 5 years (2 to 15 years). Two (11%) hips failed, requiring revision surgery and two patients (11%) had injury to the peroneal nerve. Heterotopic ossification developed in 7 (39%) hips, in one case resulting in joint ankylosis. No hips dislocated. Conversion of hip fusion to hip replacement carries an increased risk of heterotopic ossification and neurological injury. We advise prophylaxis against heterotopic ossification. When there is concern about hip stability we suggest that the use of a constrained acetabular liner is considered. Despite the potential for complications, this procedure had a high success rate and was effective in restoring hip function

Thru purpose of this study was to evaluate the clinical outcomes of a consecutive series of conversion total hip arthroplasty (cTHA) following previous hip fractures. A retrospective chart review of patients who underwent cTHAs from 2008–2017 at an urban academic teaching institution was performed. Eighty-eight patients were included in this study. The mean age at the cTHA was 66 years (range 27 to 89). 67% of the patients wre women. The mean BMI was 28 kg/m. 2. (range 17 to 41). The mean Charlson Comorbidity Index was 3 (range 0 to 9). The mean follow-up was 49 months (range 24 to 131). The mean duration from the hip fracture fixation to the cTHA was 51 months (range 10 to 144). The mean operating time was 188 minutes, (range 71 to 423) with a mean estimated blood loss of 780 ml (range 300 to 2500). Revision-type (long-stem) designs were used in 65% of the cases. The mean length of hospital stay was 8 days (range 2 to 61). The readmission rate was 37% within 90 days after the CTHAs. Of these, 57% were due to non-orthopaedic complications. There were 10 orthopaedic complications: 7 PJIs, all of which required I&D and 3 required staged revision. There were 2 dislocations treated with closed reduction and 1 case of intraoperative periprosthetic femur fracture during femoral component insertion. There was no revision for aseptic loosening within the follow-up period. The one-year mortality rate was 0%. cTHAs were associated with longer operating time, more blood loss, longer length of hospital stay, and higher readmission rates than the primary THAs in our institutional database. We believe utilizing a multi-disciplinary care protocol to optimize these patients is needed to reduce the high rate of readmissions, and the complications in this patient population

Introduction. Total hip arthroplasty (THA) is the most common surgery performed for complications of bipolar arthroplasty. The present study evaluated the functional results and complications associated with this surgery. Patients and Methods. Forty eight hips (48 patients) who had conversion of bipolar arthroplasty to THA between 1998 June and 2013 June, and who were followed-up for more than one year were evaluated. Twenty one hips had conversion surgery to THA using a Fitmore cup with metal-on-metal articulation (28 mm head). Six hips had surgery using the SecurFit cup and three hips, using the Lima LTO cup with ceramic-on-ceramic articulation (28 mm or 32 mm head). Eighteen hips had surgery using a large head metal-on-metal bearing: –MMC (seven hips), ACCIS (six hips) and Magnum (five hips). The average time of follow-up duration was 3.9 years (range, 1.0–11.3). There were 22 men and 26 women between the ages of 28 and 80 years (average, 68.9 years) at the time of conversion surgery. Conversion arthroplasty was performed for acetabular erosion without femoral stem loosening in 19 hips, acetabular cartilage erosion with femoral stem loosening in 13 hips, periprosthetic fracture in 12 hips, and recurrent dislocation in four hips. Results were evaluated using Harris hip score (HHS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) score. The radiographs were analyzed for evidence of acetabular and femoral osteolysis or loosening. The complications were evaluated. Results. The time interval between hemiarthroplasty and conversion total hip prosthesis was 6.7 years on average (range, 5 months to 12 years). Pain was the leading sign in all patients. Average HHS improved from 42 preoperatively (range, 34–67) to 86 (range, 65 – 97) postoperatively. The average total WOMAC score improved from 47 (range, 32–67) to 22 (range, 9–44) postoperatively. All the patients operated for groin pain reported significant improvement in their symptoms. Radiological evaluation showed good bony ingrowth and stability of all the femoral components. None of the acetabular component showed migration, loosening, wear, or osteolysis at last follow-up. Complications occurred in five hips. One dislocation and one recurrent dislocation were encountered in isolated acetabular revision hips; whereas one single dislocation, one recurrent dislocation, and one trochanteric nonunion occurred in the hips with revision of both components. All dislocations were occurred in hips with a femoral head size of 28 mm. Dislocations were managed by closed reduction, and none of the patients required revision for dislocation. Conclusions. Conversion THA after symptomatic bipolar arthroplasty can offer reliable pain relief and functional improvement. The perioperative complications approximate those of revision THAs

This study examines patient characteristics, indications for conversion, surgical and anaesthetic technique, peri-operative management and complications of surgery in this small and challenging group of patients. In the six years from 1994 to 1999, 33 conversion arthroplasties were performed for failed femoral hemiarthroplasty. The average age at conversion surgery was 75.5 years (range 65–90). The female to male ratio was 6:1. Primary hemiarthroplasties comprised 24 Austin-Moore, 6 Thompson & 3 Bipolar prostheses. The average interval from primary to conversion surgery was 50 months (6 months to 17 years). The average age at primary surgery was 71.2 years (62–88) – AMP:71.4 years, Thompson’s: 74.2 years, Bipolar: 63.5 years. All hemiarthroplasties were performed for fractured femoral necks. 62% of patients came from the Eastern Health Board area, while 38% were tertiary are referrals from other Health Boards. The average length of stay was 17.5 days (3–24). Indications for conversion included gross loosening/acetabular erosion in 9 cases, suspected infection in 4 cases and abscess/septicaemia in 1 case. All but 3 patients had significant pain (night pain etc.) and/or severely impaired mobility. We also looked at anaesthetic and analgesic practice, surgical technique and prostheses used. Post-operatively, mean total blood loss was 1430 ml (420–2280) with an average of 1.4 units of blood transfused (0–5). Intraoperative complications included acetabular & femoral perforation, periprosthetic fracture and cement reactions. Complications post-op (in hospital) included cardiac arrhythmia’s, cerebrovascular accidents, pulmonary embolus, myocardial infarct, respiratory & urinary tract infections, constipation, nausea & vomiting. The elderly nature of these patients and the physiological stress of what is major surgery allied with multiple co-morbidities make their care especially challenging. A conversion arthroplasty is a procedure with a significant risk of considerable morbidity. Primary total hip replacement or bipolar hemiarthroplasty are options which, therefore, should be seriously considered in the case of fractured femoral necks to minimise the need for further surgery in the future, with all its attendant risks

Purpose of the study:. To determine the outcomes of cases converted from an external fixator to an internal fixation device in the management of limb reconstructions and deformity corrections. Method:. A retrospective review of 18 patients, that underwent a conversion procedure to internal fixation following long term external fixation use, was done. This comprised 24 limbs. Inclusion criteria: All cases of long term external fixator use converted to internal fixation over a 5 year period. Average external fixation time, pin site care, conversion timing, surgical device used as well as outcome were documented. Results:. The mean treatment time in an external fixator was 185 days (61–370). The reasons for conversion included patient dissatisfaction, pin tract sepsis and a refracture. The conversion procedures included 8 intramedullary nail fixations and 16 plate and screw fixations. An acute conversion was identified as an internal fixation that was done in the same sitting as external fixator removal. A delayed conversion was any internal stabilisation that was done thereafter. In total, the complication rate associated with conversion to internal fixation following long term external fixation was 25%, mainly due to persistent non-union or sepsis. In the 8 conversions to intramedullary nails, 7 were acute: 4 had good outcomes with sepsis free union being achieved. 3 had poorer outcomes with a non-union and 2 amputations being documented. The single delayed nailing achieved union. In the 16 conversions to plate fixation, 13 achieved union. 10 were acute conversions and 3 were delayed. The remaining 3 that developed complications included 2 acute conversions with septic non-unions and a single delayed conversion which resulted in sepsis. Conclusion:. Conversion of an external fixator to an internal fixator in a non-acute reconstructive setting has a 75% success rate. In the acute conversion group (19 cases), plate and screw fixation had a superior outcome. In the delayed conversion group (5 cases), intramedullary fixation was favoured

Aims. The reasons for failure of a hemirthroplasty (HA) when used to treat a proximal humeral fracture include displaced or necrotic tuberosities, insufficient metaphyseal bone-stock, and rotator cuff tears. Reverse total shoulder arthroplasty (rTSA) is often the only remaining form of treatment in these patients. The aim of this study was to evaluate the clinical outcome after conversions from a failed HA to rTSA. Material and Methods. A total of 35 patients, in whom a HA, as treatment for a fracture of the proximal humerus, had failed, underwent conversion to a rTSA. A total of 28 were available for follow-up at a mean of 61 months (37 to 91), having been initially reviewed at a mean of 20 months (12 to 36) postoperatively. Having a convertible design, the humeral stem could be preserved in nine patients. The stem was removed in the other 19 patients and a conventional rTSA was implanted. At final follow-up, patients were assessed using the American Shoulder and Elbow Surgeons (ASES) score, the Constant Score, and plain radiographs. Results. At final follow-up, the mean ASES was 59 (25 to 97) and the mean adjusted Constant Score was 63% (23% to 109%). Both improved significantly (p < 0.001). The mean forward flexion was 104° (50° to 155°) and mean abduction was 98° (60° to 140°). Nine patients (32%) had a complication; two had an infection and instability, respectively; three had a scapular fracture; and one patient each had delayed wound healing and symptomatic loosening. If implants could be converted to a rTSA without removal of the stem, the operating time was shorter (82 minutes versus 102 minutes; p = 0.018). Conclusion. After failure of a HA in the treatment of a proximal humeral fracture, conversion to a rTSA may achieve pain relief and improved shoulder function. The complication rate is considerable. Cite this article: Bone Joint J 2018;100-B:761–6

Introduction: ‘Revisability’ has been touted as one of the major advantages of resurfacing arthroplasty of the hip. However, this theoretical advantage has never been clearly demonstrated. The objective of the present study was to test the hypothesis that a failed, modern generation metal-on-metal resurfacing arthroplasty (MMRA) can be converted to a total hip (THA) as easily and with comparable results as a primary (THA). Methods: Twenty-two failed MMRA’s in 21 patients with an average age of 49.5 years (23 – 72 years) were converted to a THA. In 18 hips, the acetabular component was retained, and in 4 hips both components were revised. The control group of primary THA’s, implanted during the same time period by the same surgeon, consisted of 64 patients with an average age of 50.8 years (27 – 64 years). Results: There was no significant difference in operative time, blood loss and complication rates between the conversions and the controls. The average follow-up was 47 months (12 – 113 months) for the conversions and 57 months (24 – 105 months) for the controls. Clinical outcomes measures were comparable with average Harris Hip Scores of 92.7 and 90.3 for the MMRA conversions and primary THA’s, respectively. The UCLA activity scores were 6.6 and 6.4 in the conversion group and THA group, respectively. There have been no cases of aseptic loosening of the femoral or acetabular components in either group, and there have been no dislocations after MMRA conversion. Conclusion: Conversion of failed MMRA to a THA appears to be as safe and effective as a primary THA

Recently, there has been a reluctance to perform hip arthrodesis. The number of patients requiring the conversion from hip arthrodesis to arthroplasty has also decreased. We present the functional results following conversion of hip arthrodesis to total hip arthroplasty at a specialist hip centre. 76 patients who underwent conversion of hip arthrodesis to total hip arthroplasty between 1963 and 2000 at the Centre for Hip Surgery, Wrightington Hospital, were included in this retrospective study. 9 patients died of unrelated causes and 7 patients were lost to follow up. The functional scoring was performed using the Merle d’Aubigné and Postel score. The mean age at the time of surgical hip arthrodesis was 16.7 years and at the time of conversion was 48.7 years. Back pain is the most common indication for the conversion. All the patients were pleased with the clinical outcome following conversion to Arthroplasty. 6 patients had postoperative complications. The mean Merle d’Aubigné and Postel score increased from 8.97 to 13.46 at the latest follow-up. The mean wear rate was 0.06 mm/year. Survival of hip arthroplasty was 92.78 % at 18 years. Conclusion: Our series demonstrates good outcome and patient satisfaction and high survival of the arthroplasty following the conversion from arthrodesis. Hip arthrodesis could be considered as a holding procedure in selected group of young patients with a later successful conversion to arthroplasty

Introduction: Arthodesis provides a durable, painless and stable hip. Conversion to arthroplasty was has been recommended to relieve the excessive stresses in the neighbouring joints. We present the long term results following conversion of hip athrodesis to total hip artho-plasty at specialist hip centre. Method and material: 67 patients underwent the conversion between 1963 and 2000 at the centre for hip surgery, wrightington hospital were included in the study. 45 patients are available for the evaluation. Merle d’ Aubigne and Postel as modified by Charnley was used for clinical scoring. The most recent radiograph in patients with surviving arthoplasty was analysed. Results: The mean age at the time of arthodesis was 16.8 years. The conversion to hip arthroplasty was performed after a mean period of 32.3 years (range 12 to 54 years). The mean folowup was 16.37years (range 2–28). The mean Merle d’ Aubigne and Postel score increased from 7.95 to 13.45 postoperatively. All the patients were delighted with the conversion. 7 patients had revision and 1 had pseudoarthrosis. Conclusion: Hip arthrodesis is a useful holding procedure for young persons with painful hip. This could be successfully converted to Hip arthroplasty after an interval of relatively high physical activity during young adult life

Purpose. The purpose of this study was to determine the functional outcome, imaging and complications of conversion of hip fusion to uncemented total hip replacement. Method. The study group comprised eighteen patients who had undergone conversion of unilateral hip fusion to total hip replacement between 1996 and 2007. There were five men and 13 women. The diagnosis prior to fusion was traumatic injury in eight patients, developmental dysplasia in three patients, and septic arthritis in seven patients. Four of the patient who had septic arthritis in childhood had spontaneous hips fusion while the other underwent surgical arthrodesis. The mean age at the time of conversion was 53 years (range, 21–77) and the mean time between fusion and conversion to hip replacement was 33 years (range, 11–60). Mean follow up was five years (range 2–15 years). Data was collected by retrospective review of a prospective database. Uncemented acetabular components were used in all cases and uncemented femoral components were used in all but two patients. In three patients with abductor and soft tissue deficiency an intraoperative decision was made to use a constrained acetabular liner. Results. The Harris hip score increased from a mean of 49 pre operatively to 75 at a mean of five years p<0.001. There was poor correlation between patient age, duration of hip fusion and hip scores at six months, 12 months and at final follow-up at a mean of five years. Heterotopic ossification developed in seven of the 18 (39%) patients. It was grade one in four patients, grade two in one patient, grade three in one patient and grade four in one patient. Four complications occurred in four of the 18 (22%) patients. Two patients (11%) had neurological injury in the common peroneal nerve distribution. In one patient heterotopic ossification resulted in joint ankylosis. This patient underwent reoperation to excise the heterotopic ossification 16 months after the initial hip replacement procedure. One patient developed a deep venous thrombosis. There were no hip dislocations. One acetabular component was loose and had migrated at 15 years follow up. Conclusion. Conversion of hip fusion to hip replacement carries an increased risk of heterotopic ossification and neurological injury. We advise prophylaxis against heterotopic ossification. When there is concern about hip stability we suggest that the use of a constrained acetabular liner is considered. Despite the potential for complications, this procedure had a high success rate and was effective in restoring hip function

Aims

Robotic arm-assisted surgery offers accurate and reproducible guidance in component positioning and assessment of soft-tissue tensioning during knee arthroplasty, but the feasibility and early outcomes when using this technology for revision surgery remain unknown. The objective of this study was to compare the outcomes of robotic arm-assisted revision of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) versus primary robotic arm-assisted TKA at short-term follow-up.

The purpose is to present our experiences with the conversion of external fixation to an intramedullary nail in the treatment of open fractures and fractures in polytraumatised patients. These are traumatological cases where primary use of an intramedullary nail is difficult or impossible. References in the world literature to the two-stage treatment of the fractures of the tibial shaft are more than 2O years old and are considered as unsuccessful. However, later papers presented conversion as an advantageous procedure. A higher stability of the fracture and better comfort of the patient are acquired by the use of conversion. From 1995 to 1999 in the Orthopedic Clinic Bulovka in Prague, Czech Republic, ten patients (8 male, 2 female) were treated by the method of conversion of external fixation to an intramedullary nail. The group of patients was composed of eight open fractures: one Gustillo-Anderson 1, two Gustillo-Anderson 2, three Gustillo-Anderson 3A, two Gustillo-Anderson 3B, one closed fracture Tscherne CIII, and one closed fracture Tscherne CII in a polytraumatised patient. Conversion was performed from 6 to 48 days after primary stabilisation by external fixation (mean 21.2 days). We currently use the UNI-fix clamp external fixator. Conversion by standard procedure is performed up to the 21st day to the 28th day after primary stabilisation. Injury of soft tissues and skin covering must be solved at the time of conversion. Analysis of the results in the ten cases was made from three months to 4.5 years. All of the cases were subjectively classified as excellent or very good. There were no deep infections. In three cases there was prolonged secretion from the screw holes of the external fixator. For one patient, bone grafting into a fracture bone defect was necessary after six months. ROM of the knee and ankle joint was without reduction of function. When the period of follow-up was more than one year, all patients had perfect healing of the fractures. This method gives very satisfactory therapeutic results with a minimum of complications, and covers the spectrum of the treatment of complicated fractures of the tibial shaft. However, the indications are very strict. If conversion is not able to be performed before the 21st to the 28th day after primary stabilisation, it is more advantageous to continue with treatment by external fixation because of the risk of deep infection. After the 28th day following primary stabilisation, conversion to an intramedullary nail is not indicated

Renewed interest in UKA necessitates further investigation into the ramifications of conversion to TKA due to either implant failure or progressive joint disease. The purpose of this study was to compare the depth of tibial resection at UKA and the resulting implications for conversion to TKA using two different UKA techniques and implant designs. A radiographic review of 42 UKA’s from a single surgeon was performed. Sixteen cases utilized a standard all-polyethylene tibial onlay UKA marketed as a minimally invasive resurfacing implant. The other 26 employed a novel robotically assisted technique and a tibial inlay implant design. Measurement techniques were developed to determine the depth of medial tibial plateau resection at initial UKA as well as potential tibial cuts and implant components required at conversion. Average depth of bony medial plateau resection was significantly greater in the standard technique onlay design group (8.5 ± 2.26 mm) compared to the robotically assisted inlay group (4.4 ± 0.93 mm) (p< .0001). At conversion to a standard TKA, the proposed tibial osteotomy would require medial augmentation/revision components in 75% of the onlay group as compared to 4% of the robotically assisted inlay group (p< .0001). Robotically assisted UKA using a tibial inlay design appears to be a truly resurfacing procedure with respect to the tibia, resulting in significantly less tibial bone resection at UKA as well as simpler conversion to TKA when compared to conventional onlay techniques

Purpose. The purpose of this study is to know the peri-operative morbidity, clinical and radiographical outcomes of conversion THA from failed transtrochanter rotational osteotomy (TRO). Patients and methods. From 2003 January to 2009 January, there were 18 hips(18 patients) who underwent conversion THA from TRO for osteonecrosis of the femoral head (ONFH) (Group I). The mean duration from TRO to conversion THA was 2.6 years. We made a matched control group of 18 primary THA for ONFH (Group II) and we evaluated perioperative morbidity and complications in each group. For the clinical evaluation, we checked Harris hip score (HHS) and WOMAC score. For the radiographical evaluation, we evaluated implant position, stability and osteolysis. Results. There was no significant differences in operation time, blood loss, hospital stay between two groups. In clinical results, there was no significant difference in postoperative HHS (p=0.986), but there was significant difference in postoperative WOMAC score. There was more significant postoperative internal rotation limitation in the Group II (p<0.001). In radiographical evaluation, there was no significant difference between two groups, except the preoperative leg length discrepancy (p=0.015). Conclusion. According to our study, there was no significant difference between conversion THA after TRO and primary THA in terms of perioperative morbidity and radiographical out come. But primary THA showed better postoperative internal rotation and better WOMAC score than conversion THA after previous TRO for ONFH