We report the effectiveness of revision of total elbow replacement by re-cementing. Between 1982 and 2004, 53 elbows in 52 patients were treated with re-cementing of a total elbow replacement into part or all of the existing cement mantle or into the debrided host-bone interface, without the use of structural bone augmentation or a custom prosthesis. The original implant revision was still in situ and functional in 42 of 53 elbows (79%) at a mean of 94.5 months (26 to 266) after surgery. In 31 of these 42 elbows (74%) the Mayo Elbow Performance Score was good or excellent. Overall, of the 53 elbows, 18 (34%) required re-operation, ten (19%) for loosening. A classification system was developed to identify those not suitable for revision by this technique, and using this we have showed that successful re-implantation is statistically correlated to properly addressing the bone deficiency for both the humeral (p = 0.005) and the ulnar (p = 0.039) components.

The purpose of this study is to report our experience with revision of total elbow arthroplasty by exchange cementation. Between 1982 and 2004 at our institution, forty six elbows were treated with exchange cementation of a total elbow arthroplasty into the existing cement mantle or debrided bone interface, without the use of an osteotomy, bone graft or prosthetic augmentation. Indications for the procedure were aseptic loosening (17), second stage after septic loosening (14), instability (7), prosthetic fracture (4), periprosthetic fracture (2), failed hemiarthroplasty (1) and ulnar component wear (1). Both components were exchanged in 18 elbows, the humerus alone in 25 and the ulna in 3. Mean follow up was 90.5 months (10 to 266 months);18 patients had died with the prosthesis in situ. Complications were noted in 22 elbows; periprosthetic fracture of ulna (6) and humerus (2), humeral component fracture (1), aseptic loosening (4), non-union (1), heterotrophic ossification (2), soft tissue contracture (2) and soft tissue failure (2), delayed wound healing (1) and bushing failure (1). Reoperation was required in 10 elbows for revision of both components (2), ulna (3), humerus (1), bushing revision (2), soft tissue debridement (1) and soft tissue repair (1). There were no septic recurrences in previously infected elbows; however the reoperation rate in this group was 29% versus 19% after re-cementation for other causes. Revision of total elbow arthroplasty by exchange cementation is a reasonable treatment for those elbows with adequate bone stock for secure prosthetic fixation; however careful consideration should be given to augmentation of the ulna due to the high rate of periprosthetic fracture in this series. Re-cementation following débridement for infection is effective despite having a higher rate of revision operation compared to re-cementation in the aseptic elbow

Aims

Biofilm-related infection is a major complication that occurs in orthopaedic surgery. Various treatments are available but efficacy to eradicate infections varies significantly. A systematic review was performed to evaluate therapeutic interventions combating biofilm-related infections on in vivo animal models.

Background: A continuing controversy in total knee arthroplasty is the question whether the posterior cruciate ligament should be retained or substituted. This report reviews a series of total knee arthroplasties with a fixed bearing posterior cruciate ligament retaining implant (Nex Gen. ©. CR, Zimmer Inc., Warsaw, IN). Methods: Between May 1997 and April 2001 197 patients were provided with 218 primary implants. There were 142 females and 55 males with an average age of 71 years (range 53–88 years) and a BMI of 28,9 kg/m. 2. (range 19,1–41,2 kg/m. 2. ). The diagnosis was osteoarthritis in 212 patients, 3 cases of aseptic osteonecrosis, 1 fracture of the tibia plateau, 1 prior infection and 1 psoriatic arthritis. 84 knees had prior operations including high tibial osteotomies and menisectomies. The operations were performed by 11 surgeons, with more than 80% done by 5 surgeons. 162 (74%) femur components and 181 (83%) tibia components were cemented. Patella resurfacing was performed in 135 (62%) cases. We evaluated the results prospectively with a clinical inspection, radiographs (AP and lateral, longleg standing, patella sunrise view), and the use of the Knee Society Score, Quality-of-Life Short Form-36 and WOMAC rating score. 149 patients were examined at a mean follow up of 5,9 years (range 4,1–8,2 years). 29 were questioned on the telephone, 29 deceased, 7 revisions had to be performed and 4 (2%) were lost to follow up. Results: The range of motion improved from 101° to 115° (range 80°–140°). All knees had sufficient antero-posterior and mediolateral stability. The Knee society score improved from 35 to 83 (good result) and the function score improved from 52 to 76 (good result). Early complications included 12 haematoma, 10 wound healing problems, 5 early infections, 2 thrombosis and 1 non lethal pulmonary embolism. 7 revisions had to be performed: 3 late infections (2 one-stage revisions with synovectomy and exchange of polyethylene inlay, one two-stage revision with semi-constrained implant LCCK© Zimmer Inc.), 3 patella resurfacing due to anterior knee pain and 1 exchange of cemented tibia plateau due to aseptic loosening. Survivorship at 6 years including any reason of failure was 96,5%. Conclusion: At a mid term follow up of 6 years this fixed bearing posterior cruciate retaining implant achieved a reasonable survivorship with good clinical results, kinematics and patient satisfaction