Introduction

Hip and knee replacements are predictable orthopaedic procedure with excellent clinical outcomes. Discharging or leaking wounds affect length of hospital stay, affect bed planning and predispose to superficial and potentially deep wound infection. Predictable wound healing therefore remains the first hurdle. This trial aims to study the effectiveness of portable disposable incisional negative pressure wound therapy (NPWT) dressings in hip and knee replacements.

This trial aims to study the effectiveness of portable disposable incisional negative pressure wound dressings in hip and knee replacements and the impact on wound healing, length of stay and wound complications.

To analyze the evolution of “Tsukayama type IV” infections (unexpected positive intraoperative cultures in hip arthroplasty -THA- exchange because of supposedly mechanical failure) treated with an extended protocol of combined oral antibiotics. Prospective cohort: 14 patients, 66.9+/−10.9 years (40–85), 11 males (78.6%). Eleven suffered isolated cup exchange: 6/14 first cup-exchange, 4/14 second (one with a 1st Slooff impaction-grafting reconstruction and 2 with a 2nd Slooff reconstruction), 1/14 third cup-exchange. Two were operated of isolated stem exchange. One patient received a complete exchange. Cultures identified 10 epidermidis (5 methicillin-resistant -MR-), 4 aureus (3 MR), 1 Propionibacterium, 1 Enterococcus, 1 Escherichia, 1 Streptococcus, 1 Corynebacterium, and 1 Ruminococcus. Patients received 2 oral combined intracellular and biofilm-effective antibiotics for 6 months: ciprofloxacin (8 patients), rifampin (6), amoxicillin-clavulanic (3), levofloxacin (2), clindamycin (3), trimethoprim-sulfamethoxazole (2), fosfomicin (2). Follow-up: 4.5+/−4.3 years (1–14). Healing: absence of clinical, serological and radiographic signs of infection along all followup. Infection reappeared in 1/14 patients (7.1%) with pain, distance limitation and elevated ESR&CRP; patient rejected surgery and was treated with a 2nd cycle of oral antibiotics, disappearing symptoms and serological abnormality along the following 7 years. The other 13 cases maintained normal ESR&CRP along follow-up. At the end of follow-up, 4/14 hips remain asymptomatic and with no limitation of function, 11/14 present no pain, 10/14 walk over 1Km without support, 1/11 uses a cane, 1/14 two crutches, and 2/14 a walker. In conclusión, oral combined antibiotics may be a useful alternative therapy for Tsukayama type IV hip arthroplasty infections

Aims

The aim of this study was to examine the results of the acetabular distraction technique in achieving implantation of a stable construct, obtaining biological fixation, and producing healing of chronic pelvic discontinuity at revision total hip arthroplasty.

Acetabular bone loss is a challenging problem facing the revision total hip replacement surgeon. Reconstruction of the acetabulum depends on the presence of anterosuperior and posteroinferior pelvic column support for component fixation and stability. The Paprosky classification is most commonly used when determining the location and degree of acetabular bone loss. Augments serve the function of either providing primary construct stability or supplementary fixation.

When a pelvic discontinuity is encountered we advocate the use of an acetabular distraction technique with a jumbo cup and modular porous metal acetabular augments for the treatment of severe acetabular bone loss and associated chronic pelvic discontinuity.

Cite this article: Bone Joint J 2014;96-B(11 Suppl A):36–42.

We evaluated all cases involving the combined use of a subtrochanteric derotational femoral shortening osteotomy with a cemented Exeter stem performed at our institution. With severe developmental dysplasia of the hip an osteotomy is often necessary to achieve shortening and derotation of the proximal femur. Reduction can be maintained with a 3.5 mm compression plate while the implant is cemented into place. Such a plate was used to stabilise the osteotomy in all cases. Intramedullary autograft helps to prevent cement interposition at the osteotomy site and promotes healing. There were 15 female patients (18 hips) with a mean age of 51 years (33 to 75) who had a Crowe IV dysplasia of the hip and were followed up for a mean of 114 months (52 to 168). None was lost to follow-up. All clinical scores were collected prospectively. The Charnley modification of the Merle D’Aubigné-Postel scores for pain, function and range of movement showed a statistically significant improvement from a mean of 2.4 (1 to 4), 2.3 (1 to 4), 3.4 (1 to 6) to 5.2 (3 to 6), 4.4 (3 to 6), 5.2 (4 to 6), respectively. Three acetabular revisions were required for aseptic loosening; one required femoral revision for access. One osteotomy failed to unite at 14 months and was revised successfully. No other case required a femoral revision. No postoperative sciatic nerve palsy was observed.

Cemented Exeter femoral components perform well in the treatment of Crowe IV dysplasia with this procedure.

We describe the experience with the first consecutive 230 Birmingham hip resurfacings at our centre. At a mean follow-up of three years (25 to 52 months) survivorship was 99.14% with revision in one patient for a loose acetabular component and one death from unrelated causes. One patient developed a fracture of the femoral neck at six weeks which united unremarkably after a period of non-weight-bearing. The Harris hip score improved from a mean of 62.54 (8 to 92) to 97.74 (61 to 100). The mean flexion improved from 91.52° (25 to 140) to 110.41° (80 to 145).

Most patients (97%) considered the outcome to be good or excellent. Our preliminary experience with this implant is encouraging and the results are superior to the earlier generation of resurfacings for the same length of follow-up.