Aims

The aims of this study were to describe the demographic, socioeconomic, and educational factors associated with core surgical trainees (CSTs) who apply to and receive offers for higher surgical training (ST3) posts in Trauma & Orthopaedics (T&O).

Introduction. Acetabular component loosening with associated bone loss is a challenge in revision hip arthroplasty. Trabecular Metal (TM) by Zimmer Biomet has been shown to have greater implant survivorship for all-cause acetabular revision in small cohort retrospective studies. Our study aims to review outcomes of acetabular TM implants locally. Method. This is a retrospective observational study using data from Auckland City and North Shore Hospitals from 1st of January 2010 to 31st of December 2020. Primary outcome is implant survivorship (re-revision acetabular surgery for any cause) demonstrated using Kaplan-Meier analysis. Secondary outcome is indication for index revision and re-revision surgery. Multivariate analysis used to identify statistically significant factors for re-revision surgery. Results. 225 cases used acetabular TM implants (shells and/or augments) over 10 years. Indications include aseptic loosening (63%), instability (15%) and infection (13%). Of these, 12% (n=28) had further re-revision for infection (54%) and instability (21%). Median time to re-revision was 156 days (range 11 – 2022). No cases of re-revision were due to failure of bony ingrowth or acetabular component loosening. Ethnicity, smoking status, and age were not risk factors for re-revision procedures. Additionally, previous prosthetic joint infection, ethnicity, sex and age were not significant risk factors for re-revision due to infection. Implant survivorship was 80% at 1 year, 71% at 5 years and 64% at 10 years. Discussion. Main indications for re-revision were infection and instability. Demographic factors and co-morbidities did not correlate with increased re-revision risk. Survivorship is poorer compared to cumulative survivorship reported by the New Zealand Joint Registry (NZJR). Explanations are multifactorial and possibly contributed by underestimation of true revision rates by registry data. Conclusions. We need to identify alternate causes for poorer survivorship and review the role of TM implants in acetabular revision within our specified population

Periprosthetic joint infection (PJI) is a devastating complication of total hip arthroplasty (THA). According to registry-based studies, some bearing couples are associated with an increased risk of PJI. The recent International Consensus on Periprosthetic Joint Infection stated that metal-on-metal (MOM) bearing surface appeared to be associated with a higher incidence of PJI. Based on emerging reports, the incidence of PJI appears to be different among different bearing surfaces. We conducted a multi-institutional study attempting to study this exact issue. The purpose of the study was to determine whether there was any difference in the incidence of PJI in two commonly used bearing couples (metal- on-polyethylene versus ceramic-on-polyethylene). Based on a retrospective multi-institutional query all patients who received primary THA with MOP or COP bearing surfaces performed during 2005–2009 in two high-volume arthroplasty centers were identified. Demographic factors, comorbidities, length of hospital stay, complications and other relevant information were extracted. PJI was defined based on the MSIS (International Consensus) criteria. Multivariate analysis was performed to determine whether bearing coupling was independently correlated with PJI. In our data, 25/2,921 (0.9%) patients with MOP and 11/2,643 (0.4%) patients with COP developed PJI. This difference was statistically significant (p=0.01). After the multivariate analysis, controlling for potential confounders (age, body mass index and length of hospital stay, Charlson comorbidity index), MOP bearing surface was found to be an independent factor correlating with higher incidence of PJI (odds ratio: 2.6, 95% confidence interval: 1.02–6.54, p=0.04). The finding of this study, and others from centers in Europe, suggest that the bearing surface may have an influence on the incidence of PJI. Although, we had originally thought that ceramic bearing surfaces may be used in younger and healthier patients, the multivariate analyses that controlled for all these variables confirms that use of metal femoral head is an independent risk factor for development of PJI. The finding of this study is compelling and begs for future basic science mechanistic investigations

Extensor mechanism disruption in total knee arthroplasty (TKA) occurs infrequently but often requires surgical intervention. We compared two cohorts undergoing extensor mechanism allograft reconstruction, one group had an extensor mechanism rupture, and the other had a recurrent ankylosed knee. Thirteen consecutive patients with extensor mechanism disruption or ankylosis after TKA were treated. Two different types of extensor mechanism allografts were used: quadriceps tendon-patella-patella tendon-tibial tubercle, and Achilles tendon allograft(Fig1). Demographic factors, diagnosis at extensor failure, Knee Society clinical rating scores, radiographs, and patient satisfaction were recorded. The average time from extensor mechanism disruption to surgery was 6.6 months (range, 1-24 months). At a mean followup of 24 months (range, 6-46 months), all patients were community ambulators. None of the patients showed a postoperative extensor lag. Average postoperative maximum flexion was 97° (90-115°) for the ruptured group and 80° (75-90) for the ankylosed grup. All patients thought their functional status had improved, and 87% were satisfied with the results of the allograft reconstruction (Fig 2, 3, 4, 5). One patient had allograft failure due to recurrent infection after re-revision for sepsis. The total extensor mechanism allograft and Achilles tendon allograft both were successful in the treatment of the failed extensor mechanism and showed promising results for the treatment of the ankylosed knee