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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 72 - 72
1 Sep 2012
Fujita H Katayama N Iwase T Otsuka H
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Purpose. Exeter stem was introduced to Japanese market at 1996. Since then, owing to its excellent clinical results, the number of the stem used has been increased year by year and more than 2000 stems have been implanted during the year 2009. The present study aims to prove its efficacy for Japanese patients by evaluating short term results of four major dedicated hip centers. Method. We present the short-term multi-center results of primary THA with Exeter stem combined with modern cementing technique in 881 patients (1000 hips). The average age of the patients at operation was 62.3years (ranging 23 to 89 years). Mean postoperative follow up period was 4.0 (ranging 2 to 9) years. Results. Intraoperative complications such as femoral fracture were observed in 6 hips. Postoperative cementing grade using Barrack's classification was judged as A for 735 hips, as B for 246 hips, and as C for 4 hips, respectively. Twenty-four patients died with unrelated disease and 52 patients were lost during follow-up period. Follow-up ratio was 94.8%. Thirty postoperative complications which include 9 infections, 14 dislocations, 5 deep vein thrombosis, and 2 sciatic nerve palsies were observed. Symptomatic pulmonary embolization or femoral fracture was not observed. Re-operations for infection and dislocation were performed for 8 and 6 hips, respectively. At the final follow-up, no radiolucent line at bone-cement interface was observed. Cortical hypertrophy was observed in 9.6% at Gruen zone 2 to 6. Kaplan-Meier survivorship analysis predicted a rate of survival at 5 years of 100% with radiolucent line at bone-cement interface of the femur as the endpoint, and of 98.8% when re-operation for any reason was used. Conclusion. The present study revealed excellent short-term result was obtained using Exeter stem combined with modern cementing technique for primary THAs in Japan


The Bone & Joint Journal
Vol. 106-B, Issue 1 | Pages 69 - 76
1 Jan 2024
Tucker A Roffey DM Guy P Potter JM Broekhuyse HM Lefaivre KA

Aims. Acetabular fractures are associated with long-term morbidity. Our prospective cohort study sought to understand the recovery trajectory of this injury over five years. Methods. Eligible patients at a level I trauma centre were recruited into a longitudinal registry of surgical acetabular fractures between June 2004 and August 2019. Patient-reported outcome measures (PROMs), including the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS), were recorded at baseline pre-injury recall and six months, one year, two years, and five years postoperatively. Comparative analyses were performed for elementary and associated fracture patterns. The proportion of patients achieving minimal clinically important difference (MCID) was determined. The rate of, and time to, conversion to total hip arthroplasty (THA) was also established. Results. We recruited 251 patients (253 fractures), with a 4:1 male to female ratio and mean age of 46.1 years (SD 16.4). Associated fracture patterns accounted for 56.5% of fractures (n = 143). Trajectory analysis showed all timepoints had significant disability versus baseline, including final follow-up (p < 0.001). Elementary fractures had higher SF-36 PCS at six months (p = 0.023) and one year (p = 0.007) compared to associated fractures, but not at two years (p = 0.135) or five years (p = 0.631). The MCID in SF-36 PCS was observed in 37.3% of patients (69/185) between six months and one year, 26.9% of patients (39/145) between one and two years, and 23.3% of patients (20/86) between two and five years, highlighting the long recovery potential of these injuries. A significant proportion of patients failed to attain the MCID after five years (38.1%; 40/105). Conversion to THA occurred in 13.1% of patients (11/110 elementary and 22/143 associated fractures). Approximately two-thirds of THAs (21/33 patients; 63.6%) were performed within two years of index surgery. Conclusion. Acetabular fractures significantly impact physical function. Recovery trajectory is often elongated beyond one year, with two-thirds of our patients displaying persistent clinically relevant long-term disability. Cite this article: Bone Joint J 2024;106-B(1):69–76


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_3 | Pages 3 - 3
1 Feb 2020
Jenkinson M Arnall F Meek R
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National guidelines encourage the use of total hip arthroplasty (THA) to treat intracapsular neck of femur fractures. There have been no population based studies appraising the surgical outcomes for this indication across an entire population. This study aims to calculate the complication rates for THA when performed for a fractured neck of femur and compare them to THA performed for primary osteoarthritis in the same population. The Scottish Arthroplasty Project identified all THAs performed in Scotland for neck of femur fracture and osteoarthritis between 1st of January 2009 and 31st December 2014. Dislocation, periprosthetic infection and revision rates at 1 year were calculated. The rate of dislocation, periprosthetic infection and revision at 1 year were all significantly increased among the fracture neck of femur cohort. In total 44046 THAs were performed, 38316 for OA and 2715 for a neck of femur fracture. 2.1% of patients (n=57) who underwent a THA for a neck of femur fracture suffered a dislocation in the 1st year postoperatively, compared to 0.9% (n=337) when the THA was performed for osteoarthritis. Relative Risk of dislocation: 2.4 (95% C.I. 1.8077–3.1252, p value <0.0001). Relative Risk of infection: 1.5 (95% C.I. 1.0496–2.0200, p value 0.0245) Relative Risk of revision: 1.5 (95% C.I. 1.0308–2.1268, p value 0.0336). This is the first time a dislocation rate for THA performed for a neck of femur fracture has been calculated for an entire population. As the number of THAs for neck of femur fracture increases this dislocation rate will have clinical implications


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 363 - 363
1 Sep 2012
Lübbeke A Garavaglia G Roussos C Barea C Peter R Hoffmeyer P
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Introduction. A recent review of the literature on metal-on-metal total hip arthroplasties (THA) revealed the lack of comparative clinical studies with a sufficient sample size and the inclusion of patient-reported outcomes as well as patient activity levels. Methods. We conducted a prospective cohort study including all metal-on-metal and conventional polyethylene (PE)-ceramic THAs with an uncemented cup (Morscher press-fit cup), a 28mm head and operated upon via a lateral approach at our University hospital between 1/1999 and 12/2008. Only THAs for primary osteoarthritis were included. The study population is part of the Geneva Hip Arthroplasty Registry, a prospective cohort followed since 1996. The following outcomes were compared between the two groups (metal-on-metal=group 1 vs. PE-ceramic bearing=group 2): (1) Complication rates with respect to infection, dislocation and revision, (2) Radiographic outcomes (presence of linear or focal femoral osteolysis, loosening), and (3) Clinical outcomes (Harris Hip score increase, SF-12, activity and patient satisfaction evaluation, presence of groin pain). Patients operated between 1/1999 and 12/2004 were evaluated five years postoperatively by an independent assessor. Cox regression analysis was used to compare incidence rates while adjusting for differences in baseline characteristics. Results. 1988 THAs were included, 544 with a metal-on-metal and 1444 with a PE-ceramic bearing. The two groups differed significantly with respect to gender distribution (men 56% vs. 41%), mean age (66 vs. 73 years), co-morbidities and type of stem (uncemented 16% vs. 2%). Crude incidence rates for complications were: 0.16 vs. 0.11 cases/100 person-years for infection; 0.37 vs. 0.35 cases/100 person-years for dislocation; and 0.29 vs. 0.16 cases/100 person-years for all-cause revision (incidence rate ratio 1.8, 95% CI 0.7; 4.6). After adjusting for baseline differences the slightly higher risks for infection and revision in group 1 were attenuated. Osteolytic lesions were found in 3.7% of metal-on-metal vs. 4.7% of PE-ceramic THAs. After adjustment for age, gender and activity the OR was 0.6 (95% CI 0.2;2.1). Five years postoperative, 176 THAs of group 1 and 695 THAs of group 2 were seen at follow-up. Clinical outcomes were similar among the two groups with a mean Harris Hip score increase of 39.2 vs. 40.9 points. SF-12 mental and physical health, patient satisfaction (9.3 vs. 8.9 on visual analogue scale) as well as the incidence of groin pain (1.7% vs. 1.2%) was also similar among the two groups. The activity level was significantly higher in group 1 (6.4 vs. 5.4, p<0.001). Conclusion. Mid-term results with respect to complications, revision rates, presence of osteolysis and clinical outcomes were similar among patients with metal-on-metal and PE-ceramic total hip arthroplasties


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 169 - 169
1 Sep 2012
Repantis T Aroukatos P Bravou V Repanti M Korovessis P
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Background. An increased incidence of periprosthetic osteolysis, resulting in loss of biologic fixation, has been recently reported in contemporary THAs with low-carbide metal-on-metal compared to metal-on-polyethylene couple bearings. A hypersensitivity reaction due to Co and Cr debris is reported as a potential cause for failure of THAs with high-carbide bearings, but there are no evidence-based data for this reaction in low-carbide metal-on-metal bearings. Questions/purposes. We investigated whether there were differences in immunologic hypersensitivity reactions in retrievals from revised THAs with COP versus MOM bearing couples. Patients and Methods. We compared newly formed capsule and periprosthetic interface membranes retrieved from revision surgery due to aseptic failure in 20 patients with low-carbide bearings and 13 patients with ceramic-on-polyethylene bearings. For control tissue we obtained samples from the hip capsule during the primary THA implantation in 13 patients with low-carbide bearings and seven with ceramic-on-polyethylene. We examined the tissues with conventional histologic and immunohistochemical methods. Results. Compared to the controls and the tissue from patients with ceramic-on-polyethylene bearings, the tissues from patients with low-carbide metal-on-metal bearings were associated with (1) extensive necrosis and fibrin exudation in the newly formed hip capsule and (2) diffuse and perivascular lymphocytic infiltration of a higher degree than in the ceramic-on-polyethylene hips in conventional histologic examination and (3) more T than B cells. Conclusions. The conventional histologic and immunohistochemical findings in tissues retrieved from failed THAs with low-carbide metal-on-metal bearings are consistent with a link between hypersensitivity and osteolysis with low-carbide bearing couple THA


The Bone & Joint Journal
Vol. 105-B, Issue 2 | Pages 180 - 189
1 Feb 2023
Tohidi M Mann SM Groome PA

Aims

This study aimed to describe practice variation in the use of total hip arthroplasty (THA) for older patients with femoral neck fracture and to determine the association between patient, surgeon, and institution factors and treatment with THA.

Methods

We performed a cross-sectional analysis of 49,597 patients aged 60 years and older from Ontario, Canada, who underwent hemiarthroplasty or THA for femoral neck fracture between 2002 and 2017. This population-based study used routinely collected healthcare databases linked through ICES (formerly known as the Institute for Clinical Evaluative Sciences). Multilevel logistic regression modelling was used to quantify the association between patient, surgeon, and institution-level variables and whether patients were treated with THA. Variance partition coefficient and median odds ratios were used to estimate the variation attributable to higher-level variables and the magnitude of effect of higher-level variables, respectively.


Bone & Joint Open
Vol. 3, Issue 9 | Pages 710 - 715
5 Sep 2022
Khan SK Tyas B Shenfine A Jameson SS Inman DS Muller SD Reed MR

Aims

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.

Methods

Patient identifiers for a consecutive cohort treated between 1 January 2003 and 31 December 2011 were linked to radiographs, surgical notes, clinic letters, and mortality data from a national dataset. This allowed charting of their postoperative course, complications, readmissions, returns to theatre, revisions, and deaths. We also identified all postoperative attendances at the Emergency and Outpatient Departments, and recorded any subsequent skeletal injuries.


The Bone & Joint Journal
Vol. 99-B, Issue 10 | Pages 1399 - 1408
1 Oct 2017
Scott CEH MacDonald D Moran M White TO Patton JT Keating JF

Aims. To evaluate the outcomes of cemented total hip arthroplasty (THA) following a fracture of the acetabulum, with evaluation of risk factors and comparison with a patient group with no history of fracture. . Patients and Methods. Between 1992 and 2016, 49 patients (33 male) with mean age of 57 years (25 to 87) underwent cemented THA at a mean of 6.5 years (0.1 to 25) following acetabular fracture. A total of 38 had undergone surgical fixation and 11 had been treated non-operatively; 13 patients died at a mean of 10.2 years after THA (0.6 to 19). Patients were assessed pre-operatively, at one year and at final follow-up (mean 9.1 years, 0.5 to 23) using the Oxford Hip Score (OHS). Implant survivorship was assessed. An age and gender-matched cohort of THAs performed for non-traumatic osteoarthritis (OA) or avascular necrosis (AVN) (n = 98) were used to compare complications and patient-reported outcome measures (PROMs). Results. The mean time from fracture to THA was significantly shorter for patients with AVN (2.2 years) or protrusio (2.2 years) than those with post-traumatic OA (9.4 years) or infection (8.0 years) (p = 0.03). Nine contained and four uncontained defects were managed with autograft (n = 11), bulk allograft (n = 1), or trabecular metal augment (n = 1). Initial fracture management (open reduction and internal fixation or non-operative), timing of THA (> /< one year), and age (> /< 55 years) had no significant effect on OHS or ten-year survival. Six THAs were revised at mean of 12 years (5 to 23) with ten-year all-cause survival of 92% (95% confidence interval 80.8 to 100). THA complication rates (all complications, heterotopic ossification, leg length discrepancy > 10 mm) were significantly higher following acetabular fracture compared with atraumatic OA/AVN and OHSs were inferior: one-year OHS (35.7 versus 40.2, p = 0.026); and final follow-up OHS (33.6 versus 40.9, p = 0.008). . Conclusion . Cemented THA is a reasonable option for the sequelae of acetabular fracture. Higher complication rates and poorer PROMs, compared with patients undergoing THA for atraumatic causes, reflects the complex nature of these cases. Cite this article: Bone Joint J 2017;99-B:1399–1408


Bone & Joint Open
Vol. 4, Issue 5 | Pages 378 - 384
23 May 2023
Jones CS Eardley WGP Johansen A Inman DS Evans JT

Aims

The aim of this study was to describe services available to patients with periprosthetic femoral fracture (PPFF) in England and Wales, with focus on variation between centres and areas for care improvement.

Methods

This work used data freely available from the National Hip Fracture Database (NHFD) facilities survey in 2021, which asked 21 questions about the care of patients with PPFFs, and nine relating to clinical decision-making around a hypothetical case.


The Bone & Joint Journal
Vol. 106-B, Issue 4 | Pages 394 - 400
1 Apr 2024
Kjærvik C Gjertsen J Stensland E Dybvik EH Soereide O

Aims

The aims of this study were to assess quality of life after hip fractures, to characterize respondents to patient-reported outcome measures (PROMs), and to describe the recovery trajectory of hip fracture patients.

Methods

Data on 35,206 hip fractures (2014 to 2018; 67.2% female) in the Norwegian Hip Fracture Register were linked to data from the Norwegian Patient Registry and Statistics Norway. PROMs data were collected using the EuroQol five-dimension three-level questionnaire (EQ-5D-3L) scoring instrument and living patients were invited to respond at four, 12, and 36 months post fracture. Multiple imputation procedures were performed as a model to substitute missing PROM data. Differences in response rates between categories of covariates were analyzed using chi-squared test statistics. The association between patient and socioeconomic characteristics and the reported EQ-5D-3L scores was analyzed using linear regression.


Bone & Joint Open
Vol. 5, Issue 4 | Pages 294 - 303
11 Apr 2024
Smolle MA Fischerauer SF Vukic I Leitner L Puchwein P Widhalm H Leithner A Sadoghi P

Aims

Patients with proximal femoral fractures (PFFs) are often multimorbid, thus unplanned readmissions following surgery are common. We therefore aimed to analyze 30-day and one-year readmission rates, reasons for, and factors associated with, readmission risk in a cohort of patients with surgically treated PFFs across Austria.

Methods

Data from 11,270 patients with PFFs, treated surgically (osteosyntheses, n = 6,435; endoprostheses, n = 4,835) at Austrian hospitals within a one-year period (January to December 2021) was retrieved from the Leistungsorientierte Krankenanstaltenfinanzierung (Achievement-Oriented Hospital Financing). The 30-day and one-year readmission rates were reported. Readmission risk for any complication, as well as general medicine-, internal medicine-, and surgery/injury-associated complications, and factors associated with readmissions, were investigated.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIII | Pages 6 - 6
1 Jul 2012
Lawton R Silverwood R Barnett K Finlayson D
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British Orthopaedic Association (BOA) Guidelines recommend clinical and radiological follow-up after Total Hip Arthroplasty (THA) at 1 year, 5 years and every 5 years thereafter to detect asymptomatic failure. To evaluate the importance of routine follow-up appointments (OPAs) in detecting failing implants the presentation of patients undergoing revision THA was reviewed. 176 patients who received 183 first-time revision THAs over a seven-year period (2003-2010) were identified from an arthroplasty database. A preliminary study sampled 46 THAs in 45 patients. Retrospective chart review recorded symptoms and mode of presentation. Follow-up OPA costs were calculated to estimate savings. All patients had symptoms at the time of revision (pain 96%, decreased mobility 76%, limp 35%, stiffness 26%, night pain 24%). Route of presentation was 80% new referrals (GP 63%, in-patient 9%, A&E 4%, Rheumatology 4%) vs 20% routine orthopaedic follow-up. The minimum cost for a routine follow-up OPA was £35. Assuming discharge after the earliest review when the patient has returned to full normal activities the estimated saving for the 2009 cohort of 377 primary THAs performed in our hospital is £13195 at 1 year and £52780 over the lifespan of the implants (assuming average 15 year survival). Following uncomplicated primary cemented THA in our hospital asymptomatic implant failure is unlikely. Symptomatic patients tend to present mainly to their GP and other specialities, rather than orthopaedic follow-up OPAs. Early discharge after return to full normal activities would be safe and lead to significant financial savings


The Bone & Joint Journal
Vol. 104-B, Issue 8 | Pages 987 - 996
1 Aug 2022

Aims

The aim of this study was to describe the demographic details of patients who sustain a femoral periprosthetic fracture (PPF), the epidemiology of PPFs, PPF characteristics, and the predictors of PPF types in the UK population.

Methods

This is a multicentre retrospective cohort study including adult patients presenting to hospital with a new PPF between 1 January 2018 and 31 December 2018. Data collected included: patient characteristics, comorbidities, anticoagulant use, social circumstances, level of mobility, fracture characteristics, Unified Classification System (UCS) type, and details of the original implant. Descriptive analysis by fracture location was performed, and predictors of PPF type were assessed using mixed-effects logistic regression models.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 177 - 177
1 Sep 2012
Christofilopoulos P Lübbeke A Berton C Lädermann A Berli M Roussos C Peter R Hoffmeyer P
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Introduction. Large diameter metal on metal cups have been used in total hip arthroplasty advocating superior results with respect to dislocation rates, range of motion and long term survival. The Durom cup used as part of the Durom hip resurfacing system has been incriminated with poor short term results sometimes correlated to incorrect positioning of either the femoral or acetabular component. Our objective was to evaluate short term results of the Durom cup used in conjunction with standard stems. Methods. We prospectively followed all patients with a large diameter metal-on-metal articulation (Durom) and a standard stem operated upon between 9/2004 and 9/2008. Patients were seen at follow-up for a clinical (Harris hip score=HHS, UCLA scale and patient satisfaction), radiographic and questionnaire assessment. Results. 89 primary THAs in 80 patients (74% men) with a mean age of 52 (±12) years were included. Main diagnoses were primary osteoarthritis in 47% and aseptic necrosis in 35%. An uncemented stem was used in 79%. Overall, 80 THAs were controlled at a mean follow-up of 39 months (range 16–67 months), 4 patients were lost to follow-up and 5 patients refused or were unable to attend the visit. However, none of the 5 underwent revision. Overall, 8 THAs (8/85, 9.4%) were revised in mean 28 months (range 8–60) after the operation. One additional patient was awaiting revision for aseptic loosening of both cup and stem. The reasons for revision were aseptic loosening in three cases, presence of a granuloma (histological diagnosis of ALVAL) in three, deep infection in one and impingement in one case. Radiographic analysis revealed linear (n=2) and focal (n=3) osteolysis as well as early cup migration (n=2). In 5 revised patients no radiographic changes were found. 56 (70%) of the 80 patients with follow-up had a HHS between 80 and 100. Among those who were not revised, the mean HHS improved from 55.2 to 88.4 (mean increase 33.2, 95% CI 27.7; 38.7). The mean activity level (UCLA scale) at follow-up was 6.4 (±1.8). Overall, mild to severe pain was reported in 14 cases and occasional pain in 22. Groin pain was present in 18 patients (22.5%), 7 of them belonged to the revised group. 61 (76.3%) of the 80 patients with follow-up were satisfied. Mean patient satisfaction on the VAS scale among those who were not revised was 9.0 (±1.3). Conclusion. This study confirms the increased short-term revision rate of the large diameter metal-on-metal couple (Durom) reported by others. In all revision cases the retrieved cups showed no osteo-integration and were removed easily. The operative indication for revision was based upon groin pain and patient dissatisfaction. Radiographic signs of implant loosening were not always present even though in all revised cases except for one the cup was found loose


The Bone & Joint Journal
Vol. 99-B, Issue 1_Supple_A | Pages 50 - 59
1 Jan 2017
Carli AV Negus JJ Haddad FS

Aims. Periprosthetic femoral fractures (PFF) following total hip arthroplasty (THA) are devastating complications that are associated with functional limitations and increased overall mortality. Although cementless implants have been associated with an increased risk of PFF, the precise contribution of implant geometry and design on the risk of both intra-operative and post-operative PFF remains poorly investigated. A systematic review was performed to aggregate all of the PFF literature with specific attention to the femoral implant used. Patients and Methods. A systematic search strategy of several journal databases and recent proceedings from the American Academy of Orthopaedic Surgeons was performed. Clinical articles were included for analysis if sufficient implant description was provided. All articles were reviewed by two reviewers. A review of fundamental investigations of implant load-to-failure was performed, with the intent of identifying similar conclusions from the clinical and fundamental literature. Results. In total 596 articles were initially identified, with 34 being eligible for analysis. Aggregate analysis of 1691 PFFs in 342 719 primary THAs revealed a significantly higher number of PFFs with cementless femoral implants (p < 0.001). Single-wedge and double-wedge (fit-and-fill) femoral implants were associated with a threefold increase in PFF rates (p < 0.001) compared with anatomical, fully coated and tapered/rounded stems. Within cemented stems, loaded-taper (Exeter) stems were associated with more PFFs than composite-beam (Charnley) stems (p = 0.004). Review of the fundamental literature revealed very few studies comparing cementless component designs. Conclusion. Very few studies within the PFF literature provide detailed implant information. Cementless implants, specifically those of single-wedge and double-wedge, have the highest PFF rates in the literature, with most investigations recommending against their use in older patients with osteoporotic bone. This review illustrates the need for registries and future PFF studies to record implant name and information for future analysis. Furthermore, future biomechanical investigations comparing modern implants are needed to clarify the precise contribution of implant design to PFF risk. Cite this article: Bone Joint J 2017;99-B(1 Supple A):50–9


The Bone & Joint Journal
Vol. 104-B, Issue 7 | Pages 884 - 893
1 Jul 2022
Kjærvik C Gjertsen J Stensland E Saltyte-Benth J Soereide O

Aims

This study aimed to identify risk factors (patient, healthcare system, and socioeconomic) for mortality after hip fractures and estimate their relative importance. Further, we aimed to elucidate mortality and survival patterns following fractures and the duration of excess mortality.

Methods

Data on 37,394 hip fractures in the Norwegian Hip Fracture Register from January 2014 to December 2018 were linked to data from the Norwegian Patient Registry, Statistics Norway, and characteristics of acute care hospitals. Cox regression analysis was performed to estimate risk factors associated with mortality. The Wald statistic was used to estimate and illustrate relative importance of risk factors, which were categorized in modifiable (healthcare-related) and non-modifiable (patient-related and socioeconomic). We calculated standardized mortality ratios (SMRs) comparing deaths among hip fracture patients to expected deaths in a standardized reference population.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 334 - 334
1 Sep 2012
Engesaeter L Dale H Hallan G Schrama J Lie S
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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


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 202 - 202
1 Sep 2012
Roussos C Lübbeke A Koehnlein W Hoffmeyer P
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Introduction. Orthopaedic surgeons are frequently asked to perform a revision total hip arthroplasty (THA) in patients over 80 years of age. Our objective was to evaluate the outcomes after revision THA in patients 80 years or older and compare them to a cohort of patients less than 80 years of age. Methods. We reviewed all revision THAs performed in our institution from 3/1996 to 12/2008. We compared intra- and post-operative complications (medical and orthopaedic), mortality, clinical outcomes and patient satisfaction between the two age groups. Peri-operative information and complications were collected prospectively, and clinical outcome data were obtained both pro- and retrospectively. The Merle d'Aubigné score, Harris Hip score, general health (SF-12) and patient satisfaction (visual analog scale) were assessed. Results. Overall, 325 revision THAs were included, 84 (25.8%) in patients 80 years and 241 in patients <80 years. In both groups the reason for revision was aseptic loosening in 62% of the patients (mean interval primary THA - revision 142 vs. 97 months). The older group was more often revised for periprosthetic fractures and recurrent dislocation. Mean follow-up time was 4.3 years. Mortality (80 vs. <80 years) was 6% vs. 0% 3 months postoperative, 9.5% vs. 1.2% 1 year postoperative, and 31% vs. 8.3% 5 years postoperative. 3 (3.6%) re-revisions were performed in patients 80 years compared to 24 (10%) in the younger group. Postoperative medical complications developed in 22.6% compared to 6.6% in the younger group. There were one infection and 13 dislocations in patients 80 years vs. 12 infections and 22 dislocations in the other group. The Merle d'Aubigné score improved from 9.6 to 13.7 (p=0.001) in patients 80 years or older vs. 10.3 to 14.3 (p<0.001), and the Harris Hip score at last follow-up was 74.2 vs. 78.5. Patient satisfaction was significantly higher in the older group (8.4 vs. 7.5, mean difference 0.9, 95% CI 0.2;1.8). Conclusion. Revision THA in patients over 80 years was associated with substantial clinical improvement, and patient satisfaction was greater than among the younger group. However, the medical complication rate and the 3-months-mortality were substantially higher


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_17 | Pages 12 - 12
1 Dec 2015
Torkington M Davison M Wheelwright E Jenkins P Lovering A Blyth M Jones B
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Cephalasporin antibiotics have been commonly used for prophylaxis against surgical site infection. To prevent Clostridium difficile, the preferential use of agents such as flucloxacillin and gentamicin has been recommended. The aim of this study was to investigate the bone penetration of these antibiotics during hip and knee arthroplasty, and their efficacy against Staphylococcus aureus and S. epidermidis. Bone samples were collected from 21 patients undergoing total knee arthroplasty (TKA) and 18 patients undergoing total hip replacement (THA). The concentration of both antibiotics was analysed using high performance liquid chromatography. Penetration was expressed as a percentage of venous blood concentration. The efficacy against common infecting organisms was measured using the epidemiological cut-off value for resistance (ECOFF). The bone penetration of gentamicin was higher than flucloxacillin. The concentration of both antibiotics was higher in the acetabulum than the femoral head or neck (p=0.007 flucloxacillin; p=0.021 gentamicin). Flucloxacillin concentrations were effective against S. aureus and S. epidermis in all THAs and 20 (95%) TKAs. Gentamicin concentrations were effective against S.epidermis in all bone samples. Gentamicin was effective against S. aureus in 11 (89%) femoral samples. Effective concentrations of gentamicin against S. aureus were only achieved in 4 (19%) femoral and 6 (29%) tibial samples in TKA. Flucloxacillin and gentamicin was found to effectively penetrate bone during arthroplasty. Gentamicin was effective against S. epidermidis in both THA and TKA, while it was found to be less effective against S. aureus during TKA. Bone penetration of both antibiotics was less in TKA than THA


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 412 - 412
1 Sep 2012
Merle C Streit M Inmann M Gotterbarm T Aldinger P
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Introduction. Total Hip Arthroplasty (THA) in patients after proximal femoral osteotomy remains a major challenge. Inferior survival for both cementless and cemented THA has been reported in this subgroup of patients. Methods. We retrospectively evaluated the clinical and radiographic results of a consecutive series of 48 THAs (45 Patients) who had undergone conversion THA for failed intertrochanteric osteotomy after a mean of 12 years (2–33 years) using a cementless, grit-blasted, double-tapered femoral stem. Mean follow-up was 20 years (range, 15–25 years), mean age at surgery was 47 years (range, 13–55 years). Clinical results were evaluated using the Harris Hip Score. Kaplan-Meier survivorship analysis was performed to determine long-term outcomes for different end points. Results. At follow-up, 10 patients (11 hips) had died, and 1 patient (1 hip) was lost to follow-up. Five patients (5 hips) underwent femoral revision, 2 for infection and 3 for aseptic loosening of the stem. Overall stem survival was 91% at 20 years (95%-CI: 78%–97%); survival with femoral revision for aseptic loosening as end point was 93% (95%-CI: 80%–98%). Discussion and Conclusion. The long-term results with this type of cementless femoral component in young patients with failed intertrochanteric osteotomy are encouraging and compare well to those achieved in patients with regular femoral anatomy