We report the outcome of 320 primary Total Hip Arthroplasties (THA) with minimum 10-year follow-up (range 10–17 years, mean 12.6 years), performed by a single surgeon in Tauranga New Zealand, with the Exeter Contemporary Flanged all-polyethylene cup and Exeter femoral stem via a posterior approach. The aim of the study is to compare the results with the published results from the design centre and create a baseline cohort for further outcomes research in this centre. All patients were prospectively followed at 6 weeks, 1 year, 5 years, 10 years, (and 15 years when available). Of 333 cases that matched the inclusion criteria, 13 procedures in 12 patents were excluded because of concomitant bone grafting and/or supplementary cage fixation, leaving 320 primary THA procedures in 280 patients, including 26 bilateral procedures in 13 patients. Mean follow-up of the surviving cases was 12.6 (range 5.0-17.1) years. There were 12 revisions – 2 for fracture, 5 for instability, 1 for impingement pain and 4 for infection. There were no revisions for aseptic cup loosening. Kaplan-Meier survivorship with revision for aseptic loosening as the endpoint was 100% at 15.0 years (with minimum 40 cases remaining at risk). All-cause acetabular revision in 12 cases result in a
Open debridement and Outerbridge and Kashiwagi debridement arthroplasty (OK procedure) are common surgical treatments for elbow arthritis. However, the literature contains little information on the long-term survivorship of these procedures. The purpose of this study was to determine the survivorship after elbow debridement techniques until conversion to total elbow arthroplasty and revision surgery. We performed a retrospective chart review of patients who underwent open elbow surgical debridement (open debridement, OK procedure) between 2000 and 2015. Patients were diagnosed with primary elbow osteoarthritis, post-traumatic arthritis, or inflammatory arthritis. A total of 320 patients had primary surgery including open debridement (n=142) and OK procedure (n=178), and of these 33 patients required a secondary revision surgery (open debridement, n=14 and OK procedure, n=19). The average follow-up time was 11.5 years (5.5 - 21.5 years). Survivorship was analyzed with Kaplan-Meier curves and Log Rank test. A Cox proportional hazards model was used assess the likelihood of conversion to total elbow arthroplasty or revision surgery while adjusting for covariates (age, gender, diagnosis). Significance was set p<0.05.
Open debridement and Outerbridge and Kashiwagi debridement arthroplasty (OK procedure) are common surgical treatments for elbow arthritis. However, the literature contains little information on the long-term survivorship of these procedures. The purpose of this study was to determine the survivorship after elbow debridement techniques until conversion to total elbow arthroplasty and revision surgery. We performed a retrospective chart review of patients who underwent open elbow surgical debridement (open debridement, OK procedure) between 2000 and 2015. Patients were diagnosed with primary elbow osteoarthritis, post-traumatic arthritis, or inflammatory arthritis. A total of 320 patients had primary surgery including open debridement (n=142) and OK procedure (n=178), and of these 33 patients required a secondary revision surgery (open debridement, n=14 and OK procedure, n=19). The average follow-up time was 11.5 years (5.5 - 21.5 years). Survivorship was analyzed with Kaplan-Meier curves and Log Rank test. A Cox proportional hazards model was used assess the likelihood of conversion to total elbow arthroplasty or revision surgery while adjusting for covariates (age, gender, diagnosis). Significance was set p<0.05.
Aim. There is a lack of data supporting the use of doxycycline as a single agent after removing infected orthopaedic metalwork. We evaluated the efficacy and safety of doxycycline compared with other single antibiotic regimens used at our specialist orthopaedic hospital. Methods. A retrospective observational study including all adult patients diagnosed with an orthopaedic metalwork infection due to staphylococci. All patients were managed with the removal of metalwork, and multiple intraoperative samples were sent for culture, followed by the administration of at least four weeks of oral antibiotics. Antibiotic selection was on the recommendation of an infection consultant. Infection outcome was assessed as the proportion of patients meeting the OVIVA Trial definition of definite failure at follow-up. The probability of definite failure for doxycycline and the alternatives group was estimated using the
Increased femoral head size reduces the rate of dislocation after total hip arthroplasty (THA). With the introduction of highly crosslinked polyethylene (HXLPE) liners in THA there has been a trend towards using larger size femoral heads in relatively smaller cup sizes, theoretically increasing the risk of liner fracture, wear, or aseptic loosening. Short to medium follow-up studies have not demonstrated a negative effect of using thinner HXLPE liners. However, there is concern that these thinner liners may prematurely fail in the long-term, especially in those with thinner liners. The aim of this study was to evaluate the long-term survival and revision rates of HXLPE liners in primary THA, as well as the effect of liner thickness on these outcomes. We hypothesized that there would be no significant differences between the different liner thicknesses. We performed a retrospective database analysis from a single center of all primary total hip replacements using HXLPE liners from 2010 and earlier, including all femoral head sizes. All procedures were performed by fellowship trained arthroplasty surgeons. Patient characteristics, implant details including liner thickness, death, and revisions (all causes) were recorded. Patients were grouped for analysis for each millimeter of PE thickness (e.g. 4.0-4.9mm, 5.0-5.9mm).
The Adams-Berger reconstruction is an effective technique for treating distal radioulnar joint (DRUJ) instability. Graft preparation techniques vary amongst surgeons with insufficient evidence to support one technique over another. Our study evaluated the biomechanical properties of four graft preparation techniques. Extensor tendons were harvested from fresh frozen porcine trotters obtained from a local butcher shop and prepared in one of three configurations (n=5 per group): tendon only; tendon prepared with non-locking, running suture (2-0 FiberLoop, Arthrex, Naples, FL) spaced at 6 mm intervals; and tendon prepared with suture spaced at 12 mm intervals. A fourth configuration of suture alone was also tested. Tendons were allocated in a manner to ensure comparable average diameters amongst groups. Biomechanical testing occurred using custom jigs simulating radial and ulnar tunnels attached to a Bose Electroforce 3510 mechanical testing machine (TA Instruments). After being woven through the jigs, all tendons were sutured end-to-end with 2-0 PROLENE suture (Ethicon). Tendons then underwent a staircase cyclic loading protocol (5-25 Newtons [N] at 1 hertz [Hz] for 1000 cycles, then 5-50 N at 1 Hz for 1000 cycles, then 5-75 N at 1 Hz for 1000 cycles) until graft failure; if samples did not fail during the protocol, they were then loaded to failure. Samples were visually inspected for mode of failure after the protocol. A one-way analysis of variance was used to compare average tendon diameter; post-hac Tuhey tests were used to compare elongation and elongation rate. Survival to cyclic loading was analyzed using
Aim. We evaluated the efficacy and safety of treatment regimens in a pathogen and surgery specific mode according to a standardized algorithm for the treatment of periprosthetic joint infection (PJI) based on combinations with 15g/d intravenous fosfomycin followed by oral antibiotics for totally 12 weeks. Method. Consecutive patients with PJI caused by at least one of the following isolates were prospectively included: staphylococci (MIC ≤32 mg/l), streptococci (MIC ≤128 mg/l), enterococci (MIC ≤128 mg/l), Enterobacteriaceae (MIC ≤32 mg/l) and Pseudomonas spp. (MIC ≤128 mg/l). PJI was defined by the proposed European Bone and Joint Infection Society (EBJIS) criteria. Follow up with clinical (joint function and quality of life scores), laboratory and radiological evaluation at 3, 12 and 24 months after last surgery is performed. Infection outcome was assessed as the proportion of infection-free patients. The probability of infection-free survival was estimated using the
Introduction. Innovations in surgical robotics and navigation have significantly improved implant placement accuracy in total knee arthroplasty (TKA). However, many comparative studies have not been shown to substantially improve revision rates or other clinical outcome scores. We conducted a simulation study based on the reported distribution of patient-specific characteristics and estimated potential effect of coronal plane alignment (CPA) on risk of revision to evaluate the hypothesis that most published study designs in this area have been too underpowered to detect improvements in revision rates. Methods. To model previously reported studies, we generated a series of simulated TKA patient populations, assigning each patient a set of patient-specific factors (age at index surgery, BMI, and sex (Fig.1a)), as well as one surgeon-controlled factor (CPA) (Fig.1b) based on registry data and published literature. We modelled the survival probability for an individual patient at time t as a Gaussian function (exp[-(t/(k∗τ. max. )). 2. ]), where τ. max. (99.5 years) is selected to ensure the mean survival probability of the patient population matched 92% at 15 years. The value of k was adjusted for simulated patients within a range of 0 to 1 as a function of their patient and surgeon-specific factors (Fig.2). To evaluate power associated with a study design, we ran a Monte Carlo simulation generating 10,000 simulated populations of ten different cohort sizes. We divided the patient population into two groups: one group was assigned CPAs governed by the precision of a navigated/robotic approach (σ=1.5°), and the other CPAs governed by the precision of a conventional approach (σ=3°). We then simulated the time to failure for each patient, computed the corresponding
Chronic massive irreparable rotator cuff tears represent a treatment challenge and the optimal surgical technique remains controversial. Superior capsular reconstruction (SCR) has been proposed as a means to provide superior stability to the glenohumeral joint, thus facilitating restoration of shoulder function. However, despite the growing use of SCR there is a paucity of data evaluating the outcomes when performed using a dermal allograft. The purpose of this study was to (1) report the overall survival rate (reoperation and clinical failure) of SCR (2) evaluate for pre-operative factors predicting reoperation and clinical failure. From January 1, 2015 to November 31, 2017, 65 patients were diagnosed with irreparable rotator cuff tears and consented for a superior capsular reconstruction. These surgeries were performed by 6 surgeons, all fellowship trained in either sports or shoulder and elbow fellowships. Outcomes were graded as excellent, satisfactory, or unsatisfactory using the modified Neer scale. An unsatisfactory result was defined as a clinical “failure”. The
In our center the cup cage reconstruction is our most common technique where a cage is used, especially if there is a pelvic discontinuity. Cup Cage Construct – in this construct there must be enough bleeding host bone to stabilise the ultraporous cup which functions like a structural allograft supporting and eventually taking the stress off the cage. This construct is ideal for pelvic discontinuity with the ultraporous cup, i.e., bridging and to some degree distracting the discontinuity. If, however, the ultra-porous cup cannot be stabilised against some bleeding host bone, then a conventional stand-alone cage must be used. Acetabular bone loss and presence of pelvic discontinuity were assessed according to the Gross classification. Sixty-seven cup cage procedures with an average follow-up of 74 months (range, 24–135 months; SD, 34.3 months) were identified; 26 of 67 (39%) were Gross Type IV and 41 of 67 (61%) were Gross Type V (pelvic discontinuity). Failure was defined as revision surgery for any cause, including infection. The 5-year
Introduction. At a minimum 12 years follow-up the Authors performed a matched paired study between 2 groups: Bi-Unicompartimental (femoro-tibial) versus Total Knee Replacements, both navigated, they hypothesised that Bi-UKR guarantees a clinical score and patient satisfaction at least similar to TKR without differences in survivorship. Materials and Methods. 19 BI-UKR (1999–2003) were included in the study (group A). Every single patients in group A was matched to a computer-assisted TKR implanted in the same period (group B). The clinical outcome was evaluated using the Knee Society Score, the GIUM Score and the WOMAC Arthritis Index. Radiographically the HKA angle and the Frontal Tibial Component angle (FTC) were. Statistical analysis of the results was performed and Kaplan-Meir survival rate was assessed in both the groups. Results. No statistically significant difference was seen for the Knee Society, Functional and GIUM scores between the 2 groups. Statistically significant better WOMAC Function and Stiffness indexes were registered for the Bi-UKR group. All the TKR implants still remained positioned within 4 degrees of an ideal HKA angle of 180° and ideal FTC angle of 90° with a statistically significant better alignment compared to the Bi-UKR group. The
Purpose. Unicompartmental Knee Arthroplasty (UKA) has been indicated for inactive elderly patients over 60, but for young and active patients less than 60 years old, it has been regarded as a contraindication. The purpose of this study is to evaluate the usefulness of UKA performed on young Asian patients under 60 years of age by analyzing clinical outcomes, complications and survival rate. Materials and Methods. The subjects were 82 cases, which were followed up for at least 5 years (from 5 to 12 years). Only Oxford phase III® (Biomet Orthopedics, Inc, Warsaw, USA) prosthesis was used for all cases. The clinical evaluation was done by the range of motion, Knee society score (KSS), WOMAC score. The radiographic evaluation was performed on weight bearing long-leg radiographs, AP and lateral view of the knee and skyline view of the patella. The survival rate was estimated by Kaplan-Meier survival analysis. Results. Three bearing dislocations, one medial tibial collapse and one lateral osteoarthritis occurred, so the complication rate was 6.1% (5/82). Among the 3 cases of bearing dislocation, 2 cases were resolved by replacing with a thicker bearing and 1 case was converted to TKA due to repeated dislocation. One case of medial tibia collapse and one lateral osteoarthritis were converted to total knee arthroplasty (TKA). All clinical outcomes measured by KSS scores and WOMAC score showed a statistically significant difference (p<0.001). The 10 year cumulative survival rate using
Introduction. The aim of this study was to analyze the results of our series of female patients treated with <48 mm MOMHR devices at a minimum follow-up of 5 years, to understand which is the most important aspects affecting the results and to define if the metal ions dosage has to be indicated as a routinely follow-up. Methods. This is a retrospective clinical study; the cohort included 198 consecutive MOMHR implanted in 181 female patients (17 bilateral procedures). All operations were performed between 2002 and 2011. All operations were performed by the senior surgeon. Indications to MOMHR included primary or secondary osteoarthritis (OA), rheumatoid arthritis and avascular necrosis. Contraindications included poor proximal femoral bone stock (T-score<−2.5sd in BMD of the femoral neck) or severely distorted hip anatomy. All patients were advised to underwent clinical and radiological review with the operating surgeon at 5 weeks, 3, 6 and 12 months postoperatively and then every subsequent 2 years.182 patients answered to our phone calls; 4 patients died (one of them was operated bilaterally) for causes not related to the study, and in 11 cases the phone number was expired. The minimum follow-up was 5.0 years (mean 7.5, maximum 13.2, sd 0.11). Results. Fourteen devices were revised (7%) in 14 patients: 2 of them were operated bilaterally and the controlateral implant is still fine; thus, the
Acetabular cages are necessary when an uncemented or cemented cup cannot be stabilised at the correct anatomic level. Impaction grafting with mesh for containment of bone graft is an alternative for some cases in centers that specialise in this technique. At our center we use three types of cage constructs –. (A). Conventional cage ± structural or morselised bone grafting. This construct is used where there is no significant bleeding host bone. This construct is susceptible to cage fatigue and fracture, This reconstruction is used in young patients where restoration of bone stock is important. (B). Conventional cage in combination with a porous augment where contact with bleeding host bone can be with the ilium and then by the use of cement that construct can be unified. The augment provides contact with bleeding host bone and if and when ingrowth occurs, the stress is taken off the cage. (C). Cup-Cage Construct – in this construct there must be enough bleeding host bone to stabilise the ultra-porous cup which functions like a structural allograft supporting and eventually taking the stress off the cage. This construct is ideal for pelvic discontinuity with the ultra-porous cup, i.e., bridging and to some degree distracting the discontinuity. If, however, the ultra-porous cup cannot be stabilised against some bleeding host bone, then a conventional stand-alone cage must be used. In our center the cup-cage reconstruction is our most common technique where a cage is used, especially if there is a pelvic discontinuity. Acetabular bone loss and presence of pelvic discontinuity were assessed according to the Gross classification. Sixty-seven cup-cage procedures with an average follow-up of 74 months (range, 24–135 months; SD, 34.3) months were identified; 26 of 67 (39%) were Gross Type IV and 41 of 67 (61%) were Gross Type V (pelvic discontinuity). Failure was defined as revision surgery for any cause, including infection. The 5-year
Purpose. The aim of the current study was to evaluate the clinical and radiographic results of primary total hip arthroplasty (THA) performed with the Alloclassic Variall system (a modified version of the Alloclassic Zweymüller system) and to compare them with those in the literature for the original system. Methods. Between January 2001 and December 2002, 273 consecutive primary THAs were performed in 259 patients at a single centre with the study system, using ceramic-on-ceramic (81.7%) or ceramic-on-highly-crosslinked-polyethylene (18.3%) articulations. Results. At the time of this study, 28 patients (29 hips; 10.6%) had died and 40 (43 hips; 15.8%) were lost to follow-up. 17 patients (19 hips; 7.0%) could be reached only by telephone. There were four revisions in four patients (1.5%), all involving only the femoral component. Ten-year
Acetabular cages are necessary when an uncemented or cemented cup cannot be stabilised at the correct anatomic level. Impaction grafting with mesh for containment of bone graft is an alternative for some cases in centers that specialise in this technique. At our center we use three types of cage constructs –. (A) Conventional cage ± structural or morselised bone grafting. This construct is used where there is no significant bleeding host bone. This construct is susceptible to cage fatigue and fracture. This reconstruction is used in young patients where restoration of bone stock is important. (B) Conventional cage in combination with a porous augment where contact with bleeding host bone can be with the ilium and then by the use of cement that construct can be unified. The augment provides contact with bleeding host bone and if and when ingrowth occurs, the stress is taken off the cage. (C) Cup Cage Construct – in this construct there must be enough bleeding host bone to stabilise the ultra-porous cup which functions like a structural allograft supporting and eventually taking the stress off the cage. This construct is ideal for pelvic discontinuity with the ultra-porous cup, i.e., bridging and to some degree distracting the discontinuity. If, however, the ultra-porous cup cannot be stabilised against some bleeding host bone, then a conventional stand-alone cage must be used. In our center the cup cage reconstruction is our most common technique where a cage is used, especially if there is a pelvic discontinuity. Acetabular bone loss and presence of pelvic discontinuity were assessed according to the Gross classification. Sixty-seven cup-cage procedures with an average follow-up of 74 months (range, 24–135 months; SD, 34.3) months were identified; 26 of 67 (39%) were Gross Type IV and 41 of 67 (61%) were Gross Type V (pelvic discontinuity). Failure was defined as revision surgery for any cause, including infection. The 5-year
The purpose of this study was to determine the survivorship for a MOM implant series performed by a single community surgeon followed using a practical clinical model. A retrospective cohort of 104 primary MOM THA procedures (94 patients) were all performed by one surgeon at three local hospitals now with 10–13 years follow-up. Sixteen patients are deceased and 16 patients have been lost to follow-up. In the remaining 62 patients, 8 are bilateral providing a total of 70 THA for study. The clinical follow-up model included: hip scores, X-rays, ultrasound, and metal ion concentrations (Co, Cr, Ti). Due to the diversity of patient location, a variety of clinical labs were utilized for metal ions. Statistical methods included
Surgery performed in low-volume centres has been associated with longer operating time, longer hospital stays, lower functional outcomes, and higher rates of revision surgery, complications, and mortality. This has been reported consistently in the arthroplasty literature, but there is a paucity of data regarding the relationship between surgical volume and outcome following anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to compare the ACL reconstruction failure rate between hospitals performing different annual surgical volumes. The hypothesis was that ACL reconstructions performed at low-volume hospitals would be associated with higher failure rates than those performed at high-volume centres. This level-II cohort study included all patients from the Norwegian Knee Ligament Registry that underwent isolated primary autograft ACL reconstruction between 2004 and 2016. Hospital volume was divided into quintiles based on the number of ACL reconstructions performed annually, defined arbitrarily as: 1–12 (V1), 13–24 (V2), 25–49 (V3), 50–99 (V4), and ≥100 (V5) annual procedures.
Background. KAR™ prosthesis was introduced following the success of Corail® femoral stem to tackle difficult revision cases (Paprosky type1, 2a, 2b and 3a). The ARTO group reported a success rate of 94% at 17 years follow-up. Only two independent studies reported similar success rate to date. Purpose. To analyse the short-term performance of the KAR™ prosthesis used in our unit. Methods. This was a retrospective study of all KAR™ prosthesis between 2005 and 2013. Basic demographic, stem size, indications, failures and complications were recorded. X-rays were analysed for evidence of implant failure and distal cortical hypertrophy. Results. A total of 83 cases were analysed. The mean age was 68 (range 38–88 years) with an average follow-up was 3 years (range 1–8 years). The main indications for revision were aseptic loosening (83.7%), and periprosthetic fractures (7%).
To report mid-term results of PJI treated with uncemented stems. : 80 hips of PJI after THA were treated with uncemented stems from 01/1993 to 12/2012 and followed prospectively. Selection occurred for one- (n=27) or two-stage (n=53) exchange according to the Liestal algorithm. Surgical approaches were transfemoral (n=58), transgluteal (n=9) or transtrochanteric (n=13). A monoblock (Wagner SL, n=58) or modular (Revitan, n=22) revision stem was implanted. On the acetabular side 44 Müller rings, 33 Burch-Schneider cages (combined with a cemented PE-cup) and 3 press-fit cups were used.
