Introduction.
High complication rates and poor outcomes have been widely reported in patients undergoing revision of large head
Introduction. This study reports outcomes of 35 revisions of a recalled
BACKGROUND. We originally performed metal-on-metal hip resurfacing using a Townley designed Vitallium Total Articular Replacement Arthroplasty (TARA) curved stemmed prosthesis. Neither the acetabular or femoral components were cemented or had porous coating. The bearing surfaces were consistently polar bearing. The surgical objectives were to preserve bone stock, maintain normal anatomy and mechanics of the hip joint and to approximate the normal stress transmission to the supporting femoral bone. The functional objectives were better sports participation, less thigh pain and limp, less perception of a leg length difference and a greater perception of a normal hip.
Impact relief ability of
Introduction. When following patients with
The aim of this study is to investigate whether
Purpose. Use of a large femoral head
Introduction. Failure rates of
Soft tissue reactions following
Introduction. Large head total hip arthroplasty (THA) reduces dislocation rates and provides a theooretically larger range of motion. We hypothesised that this would translate into greater improvement in functional scores when compared to 28mm metal-on-polyethylene THA at 5 years. We believe ours to be the first in vivo comparison study. Methods. A multi-surgeon case-control study in a District General Hospital. The study group consisted of 427 patients with 452 hips, the 38mm uncemented
Performance of
This study aims to investigate femoral blood flow during
Background:. Failed
Introduction. This study reports outcomes of primary and revision total hip arthroplasties of a recalled
Purpose.
Introduction. High early failure rates have been reported with certain metal-metal surface arthroplasties and good results have been reported with others. This is a minimum 10-year review of the first 1000 consecutive resurfacings including all ages and diagnoses from one centre. Methods. The first 1000 surface arthroplasties (892 patients) were followed-up with postal questionnaires. Of these the first 402 hips (350 patients) were also invited for a clinico-radiological review. 54 patients (63 hips) died 6.7 years (0.7–12.6) later due to unrelated causes. Mean follow-up is 12.2 years (range 10.8–13.7). Radiographs were assessed independently by a senior musculoskeletal radiologist. Results. There were 33 revisions at a mean of 7 years (0–11.6) following operation, 15 femoral failures (0.6%), 6 infections (1.5%) and 12 wear-related failures (1.2%) including 7 pseudotumours (0.7%). With revision for any reason as the end-point Kaplan-Meier survival analysis showed 97.5% survival at 10 years and 96.5% at 13 years. Single zone socket lucencies were found in 2.7% and 5.7% on the femoral side and two zone lucencies in 2.1% on the acetabular side only. No 3-zone lucencies or component migration were seen. Discussion and Conclusion. Our study shows that the performance of modern
Between April 2008 and February 2012, we implanted 159 large-diameter MOM stemmed THA with head diameters of 38–50mm. There were 6–38mm, 22–40mm, 42–42mm, 42–44mm, 24–46mm, 13–48mm, 4–50mm, 5–52mm, and one-54mm heads implanted in 138 patients (21 males and 117 females). The pre-operative diagnoses included: 120 OAs, 12 IONs, 4 femoral neck fractures, one RA, and one post-traumatic OA. Their ages were 40–86 years (avg. 63.6 yrs). Follow up was 4 to 67 months post implantation (avg. 40.4 months). All implants were manufactured by one company (Wright Medical Technology, Arlington, TN, USA). The stems were of a standard titanium-aluminum alloy, either 44 ANCA-FIT or 115 PROFEMUR Z non-cemented stems. Acetabular components were all CONSERVE PLUS cobalt-chromium monoblock shells. Heads were also fabricated out of cobalt-chromium alloy, with modular junctions. Patients with complaints of groin pain and/or swelling or hip instability underwent MRI examination in order to detect the presence of fluid collections or soft tissue masses. The statistical correlation between abnormal findings on MRI and age, gender, head diameter, component position and duration post-surgery was performed. 35 hips in 31 patients (22.0%) were found to have either a fluid collection or “pseudotumor” on MRI. These were in 5 males and 26 female patients. According to Hart's MRI classification, they were classified 21 hips in Type 1, twelve hips in Type 2, and two hips in Type 3 (Fig. 1, 2 and 3). 8 hips in 8 patients who had any pseudotumors were undergone revision THA (Fig. 4, 5 and 6). All hips had corrosions at head-neck taper junctions (Fig. 7). There was no difference in age between these two groups of patients (63.7 vs. 63.6 yrs.), but a significant difference in duration from the time of implantation of two groups (23.9 vs. 44.8 months). There appeared to be no significant difference between the mean head diameter of the two groups, 43.2mm and 44.0mm respectively. There was no statistical difference between the two groups with regard to implant orientation: cup inclination 18–70 degrees (41.8 vs. 43.6 degrees); cup anteversion −13–49 degrees (15.1 vs. 14.7 degrees); stem anteversion 2–48 degrees (20.1 vs. 23.3 degrees); and stem offset 17.5–56.2mm (38.2 vs. 37.8mm). Furthermore, according to Lewinnek's safe zone, there was no difference in cup orientation between the two groups (Fig. 8). When we investigated the types of modular neck, the hips having any pesudotumors tended to have long or varus necks. In this study, it is important to emphasize that the appearance of symptoms and development of a pseudotumor occurred early after a MOM THA in some patients. Also it will be important to subject all patients to MRI examination to evaluate the possibility of “silent” fluid collections and pseudotumors. In large-diameter head