The aim of this study was to measure the effect of hospital case volume on the survival of revision total hip arthroplasty (RTHA). This is a retrospective analysis of Scottish Arthroplasty Project data, a nationwide audit which prospectively collects data on all arthroplasty procedures performed in Scotland. The primary outcome was RTHA survival at ten years. The primary explanatory variable was the effect of hospital case volume per year on RTHA survival. Kaplan-Meier survival curves were plotted with 95% confidence intervals (CIs) to determine the lifespan of RTHA. Multivariate Cox proportional hazards were used to estimate relative revision risks over time. Hazard ratios (HRs) were reported with 95% CI, and p-value < 0.05 was considered statistically significant. From 1999 to 2019, 13,020 patients underwent RTHA surgery in Scotland (median age at RTHA 70 years (interquartile range (IQR) 62 to 77)). In all, 5,721 (43.9%) were female, and 1065 (8.2%) were treated for infection. 714 (5.5%) underwent a second revision procedure. Co-morbidity, younger age at index revision, and positive infection status were associated with need for re-revision (p<0.001). The ten-year survival estimate for RTHA was 93.3% (95% CI 92.8 to 93.8). Adjusting for sex, age, surgeon volume, and indication for revision, high hospital case volume was not significantly associated with lower risk of re-revision (HR1, 95% CI 1.00 to 1.00, p 0.073)). The majority of RTHA in Scotland survive up to ten years. Increasing yearly hospital case volume cases is not independently associated with a significant risk reduction of re-revision

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Despite multiple trials and case series on hip hemiarthroplasty designs, guidance is still lacking on which implant to use. One particularly deficient area is long-term outcomes. We present over 1,000 consecutive cemented Thompson’s hemiarthroplasties over a ten-year period, recording all accessible patient and implant outcomes.

Introduction. Infection after total hip arthroplasty is a severe complication. Controversies still exist as to the use of cemented or uncemented implants in the revision of infected THAs. Based on the data in the Norwegian Arthroplasty Register (NAR) we have studied this topic. Material and Methods. During the period 2002–2008 45.724 primary THAs were reported to NAR. Out of these 459 were revised due to infection (1,0%). The survival of the revisions with uncemented prostheses were compared to revisions with cemented prostheses with antibiotic loaded cement and to cemented prostheses with plain cement. Only prostheses with the same fixation both in acetabulum and in femur were included in the study. Cox-estimated survival and relative revision risks were calculated with adjustments for differences among groups in gender, type of surgical procedure, type of prosthesis, and age at revision. Results. 92 (23%) of all the revisions were performed with uncemented prostheses, 286 (71%) with cemented prostheses with antibiotic loaded cement, and 25 (6%) with plain cement. Compared to uncemented prostheses and with all reasons for revision as endpoint in the Cox-analyses, prostheses fixed with antibiotic loaded cement had 3.0 (1.4–6.3) times increased risk for re-revision (p=0.004) and prostheses with plain cement 1.9 (0.4–9.3) times increased risk (p=0.44). With infection as endpoint, prostheses with antibiotic loaded cement had 2.8 (1.2–6.4) times increased risk for re-revision (p=0.02) and prostheses with plain cement 2.6 (0.5–13.7) times increased (p=0.26). 77% of the re-revisions (48 of 60) were performed due to infection. Conclusion. Data in the Norwegian Arthroplasty Registry indicate that uncemented prostheses should be used in the revision of infected total arthroplasties

INTRODUCTION. The introduction of hard-on-hard bearings and the consequences of increased wear due to edge-loading have renewed interest in the importance of acetabular component orientation for implant survival and functional outcome following hip arthroplasty. Some studies have shown increased dislocation risk when the cup is mal-oriented which has led to the identification of a safe-zone1. The aims of this prospective, multi-centered study of primary total hip arthroplasty (THA) were to: 1. Identify factors that influence cup orientation and 2. Describe the effect of cup orientation on clinical outcome. METHODS. In a prospective study involving seven UK centers, patients undergoing primary THA between January 1999 and January 2002 were recruited. All patients underwent detailed assessment pre-operatively as well as post-op. Assessment included data on patient demographics, clinical outcome, complications and further surgery/revision. 681 primary THAs had adequate radiographs for inclusion. 590 hips received cemented cups. The primary functional outcome measure of the study was the change between pre-operative and at latest follow up OHS (OHS). Secondary outcome measures included dislocation rate and revision surgery. EBRA was used to determine acetabular inclination and version. The influence of patient's gender, BMI, surgeon's grade and approach on cup orientation was examined. Four different zones tested as possibly ± (Lewinnek Zone, Callanan's described zone and zones ± 5 and ±10 about the study's mean inclination and anteversion) for a reduced dislocation risk and an optimal functional outcome. RESULTS. There were 21 dislocations (3.1%) and 8 (1.2%) patients required revision at a mean follow up of 7 years. Experienced surgeons (2=0.047) and those operating with the patient in the lateral decubitus position (p=0.04) were more likely to achieve a cup orientation within any of the tested zones. Surgical approach (2=0.14) and patient's BMI (2=0.93) had no influence on whether a cup was within or outside any zone. There was no difference in dislocation rate between the posterior and anterio-lateral approaches (2=0.88). None of the zones tested had a significantly reduced dislocation risk (2=0.13), nor revision risk (2=0.55). OHS was not different for patients with cups within or outside any of the zones tested (p=0.523). DISCUSSION. There was a wide variation in cup orientation. Despite the wide scatter in cup orientation, no safe zone could be identified that would reduce dislocation and revision rate, nor improve patient reported outcome (OHS). Hence, these data suggest that acetabular component orientation should not be considered predictive of patients' early/mid-term complication/revision rate and outcome following THA

Aims

The aim of this study was to investigate mortality and risk of intraoperative medical complications depending on delay to hip fracture surgery by using data from the Norwegian Hip Fracture Register (NHFR) and the Norwegian Patient Registry (NPR).

Aims

The aim of this study was to inform a definitive trial which could determine the clinical effectiveness of the X-Bolt Dynamic Hip Plating System compared with the sliding hip screw for patients with complex pertrochanteric fragility fractures of the femur.

We compared a new fixation system, the Targon Femoral Neck (TFN) hip screw, with the current standard treatment of cannulated screw fixation. This was a single-centre, participant-blinded, randomised controlled trial. Patients aged 65 years and over with either a displaced or undisplaced intracapsular fracture of the hip were eligible. The primary outcome was the risk of revision surgery within one year of fixation. A total of 174 participants were included in the trial. The absolute reduction in risk of revision was of 4.7% (95% CI 14.2 to 22.5) in favour of the TFN hip screw (chi-squared test, p = 0.741), which was less than the pre-specified level of minimum clinically important difference. There were no significant differences in any of the secondary outcome measures. We found no evidence of a clinical difference in the risk of revision surgery between the TFN hip screw and cannulated screw fixation for patients with an intracapsular fracture of the hip. Cite this article: Bone Joint J 2014;96-B:652–7

Fractures of the proximal femur are one of the greatest challenges facing the medical community, constituting a heavy socioeconomic burden worldwide. Controversy exists regarding the optimal treatment for independent patients with displaced intracapsular fractures of the proximal femur. The recognised alternatives are hemiarthroplasty and total hip replacement. At present there is no established standard of care, with both types of arthroplasty being used in many centres. The principal advantages of total hip replacement are a functional benefit over hemiarthroplasty and a reduced risk of revision surgery. The principal criticism is the increased risk of dislocation. We believe that an alternative acetabular component may reduce the risk of dislocation but still provide the functional benefit of total hip replacement in these patients. We therefore propose to investigate the dislocation risk of a dual-mobility acetabular component compared with standard polyethylene component in total hip replacement for independent patients with displaced intracapsular fractures of the proximal femur within the framework of the larger WHiTE (Warwick Hip Trauma Evaluation) Comprehensive Cohort Study.

Cite this article: Bone Joint Res 2013;2:210–13.

Fractures of the proximal femur are one of the greatest challenges facing the medical community, constituting a heavy socioeconomic burden worldwide. Controversy exists regarding the optimal treatment for patients with unstable trochanteric proximal femoral fractures. The recognised treatment alternatives are extramedullary fixation usually with a sliding hip screw and intramedullary fixation with a cephalomedullary nail. Current evidence suggests that best results and lowest complication rates occur using a sliding hip screw. Complications in these difficult fractures are relatively common regardless of type of treatment. We believe that a novel device, the X-Bolt dynamic plating system, may offer superior fixation over a sliding hip screw with lower reoperation risk and better function. We therefore propose to investigate the clinical effectiveness of the X-bolt dynamic plating system compared with standard sliding hip screw fixation within the framework of a the larger WHiTE (Warwick Hip Trauma Evaluation) Comprehensive Cohort Study.

Cite this article: Bone Joint Res 2013;2:206–9.

Using data from the Norwegian Hip Fracture Register, 8639 cemented and 2477 uncemented primary hemiarthroplasties for displaced fractures of the femoral neck in patients aged > 70 years were included in a prospective observational study. A total of 218 re-operations were performed after cemented and 128 after uncemented procedures. Survival of the hemiarthroplasties was calculated using the Kaplan-Meier method and hazard rate ratios (HRR) for revision were calculated using Cox regression analyses. At five years the implant survival was 97% (95% confidence interval (CI) 97 to 97) for cemented and 91% (95% CI 87 to 94) for uncemented hemiarthroplasties. Uncemented hemiarthroplasties had a 2.1 times increased risk of revision compared with cemented prostheses (95% confidence interval 1.7 to 2.6, p < 0.001). The increased risk was mainly caused by revisions for peri-prosthetic fracture (HRR = 17), aseptic loosening (HRR = 17), haematoma formation (HRR = 5.3), superficial infection (HRR = 4.6) and dislocation (HRR = 1.8). More intra-operative complications, including intra-operative death, were reported for the cemented hemiarthroplasties. However, in a time-dependent analysis, the HRR for re-operation in both groups increased as follow-up increased. This study showed that the risk for revision was higher for uncemented than for cemented hemiarthroplasties