Background: The treatment of deep infection following total hip arthroplasty (THA) is long and costly. However, there are few studies in the literature analysing the cost of total hip arthroplasty revision, especially for infection. The purpose of this study was to determine the cost of THA revision performed for infection and to compare it with the cost of revision for aseptic loosening on one hand, as well as the cost of primary THA, on the other hand. Methods: From January to December 2006, we performed in our hospital 474 primary THA, 57 revisions for aseptic loosening and 40 revisions for infection. We identified for each procedure areas of cost: preoperative evaluation, surgical procedure, medical procedure including intravenous antimicrobial therapy during hospitalization, post-operative follow-up and physiotherapy. For the costs of preoperative evaluation, we used the refunding rate of the CNAM (the public health insurance company) applicable since September 2005. The total cost of the treatment includes direct and indirect costs, corresponding to the expenses of medical and surgical entities involved in the procedure, the operating charges of the hospital and the net expenses of general services. The cost of primary total hip arthroplasty was used as the reference cost. Results: The average duration of hospital stay was 6 days for a primary THA, 8 days for a revision for aseptic loosening and 24 days for septic revision. The rate of transfer to a hospital for care-following and physiotherapy was 55% for a primary THA, 70% for aseptic revision and 65% for septic revision. Moreover, the rate of the hospitalization at home for the septic revision after the surgery was 30%. The cost of the revision of THA for aseptic loosening was 1.4 fold the cost of primary THA. In case of septic revision, the cost was 3.3 fold. Discussion: The economic impact of the deep infection following THA is important. The additional cost is due to a longer duration of hospital stay and rehabilitation requiring more human and material resources. Conclusions: The cost of revision THA for infection is high. The procedures of care must be optimized in order to increase the treatment success rate and minimise the total cost

BACKGROUND PURPOSES. dislocation is a classical complication in total hip arthroplasty (THA) revision. Cup fixation is the second concern. Since 1998 we routinely use cementless Dual mobility cup (DMC) in revision surgery. In order to know outcomes at 2 years, we followed a prospective series of 78 patients treated in our institution. Purpose is to demonstrate that DMC used in revision THA is safe as regards dislocation risk and bone fixation. MATERIAL METHODS. from January 2010 to January 2012 we collected cohort of 79 cases on 78 patients. Patients have been followed with a clinical and radio graphical standard examination. Mean delay between index surgery and revision was 12,9 years. Mean age at revision was 75,5 years. Two different types of DMC were used: standard DMC in 68 cases. In severe bone loss, a specific revision cup was used in 11 cases. RESULTS. at 2 years follow up, 65 patients have been reviewed. 5 patients are definitely lost to follow up. 8 patients deceased. One patient dislocated her hip at 1 month. Two early mechanical failures occurred. DISCUSSION. purpose of this short term follow up study is to emphasize low risk of dislocation and trustable fixation of a cementless DMC used in revision THA. THA. Instability is the leading cause of failure. In our series dislocation rate is 1,2%‥ 2 patients presented an early mechanical cup failure (2.5%). CONCLUSION. considering outcomes of this series, we may assess that in in THA revision surgery, DMC can be recommended

Postoperative infection is a difficult complication affecting total hip arthroplasty. It is painful, disabling, costly and it lacks definitive treatment guidelines. Klebsiella spp. are uncommon causes of Total Hip Arthroplasty. The aim of this case report was to document an effective treatment algorithm for a multidrug resistant Klebsiella spp infection after THA. We report a case of a 56-year-old male who has performed a THA in 2007 at our institution. After 4 admissions due to posterior hip dislocations it was performed an Acetabular Revision in May 2014. The periprothesic infection was suspected by delayed wound healing with inflammatory signals and both abnormal values of Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The patient was submitted to two hip arthrocenteses, one before and the other after antibiotic therapy (EV). The intra-articular cultures revealed a Klebsiella Pneumoniae infection only carbapenem-sensitive. We decided to performed a two-stage total hip arthroplasty revision approach. After the First Acetabular revision, ESR and CRP were augmented. X-rays and CT scans were performed, but inconclusive for infection. The patient completed longterm ertapenem therapy after the results of intra-articular cultures. We repeated arthrocentesis and the result was positive for the same bacteria. After 3 months of the Acetabular procedure we performed a Girldstone. We continued with Ertapenem and after 4 months we performed a Total Revision Arthroplasty. Final intra-articular cultures were negative for infection and ESR and CRP were both normal. After 5 months of follow-up the patient is pain-free and has good ROM. The infection risk is greater with the number of revision surgeries. Our institution has good outcomes with 2-stage procedure for multi drug infections. The best diagnosis tools were ESR and CRP, and intra-articular cultures. Two-stage revision surgery is a good choice for multi-resistent infections, and proper indications must be followed

Ceramic-on-ceramic (CoC) articulations in total hip arthroplasty (THA) have low wear, but the unique risk of fracture. After revision for CoC fracture, ceramic third bodies can lead to runaway wear of cobalt chrome (CoCr) causing extremely elevated blood cobalt. We present five cases of ceramic liner fractures revised to a CoCr head associated with the rapid development of severe cobalt toxicity.

We identified 5 cases of fractured CoC THA treated with revision to CoCr on highly cross-linked polyethylene (HXLPE) – three to conventional bearings and two to modular dual mobility bearings (CoCr acetabular liner, CoCr femoral head, and HXLPE). Mean follow up was 2.5 years after CoCr/HXLPE re-revision.

Symptoms of cobalt toxicity occurred at average 9.5 months after revision for ceramic fracture (range 6–12). All patients developed vision and hearing loss, balance difficulties, and peripheral neuropathy. Several had cardiomyopathy, endocrinopathy, and local skin discoloration. Two reported hip pain. Re-revision for cobalt toxicity occurred at an average of 22 months (range 10–36) after revision for ceramic fracture. Average serum cobalt level at re-revision was 991 μg/L (range 734–1302, normal <1 μg/L). All CoCr heads exhibited massive wear with asphericity; deep tissues exhibited prominent metallosis. Treatment consisted of debridement and revision to a ceramic head with HXLPE. Serum cobalt improved to an average of 25 μg/L at final follow up. All patients reported partial improvement in vision and hearing; peripheral neuropathy and balance did not recover.

Systemic cobalt toxicity is a rare but devastating complication of ceramic fracture in THA treated with cobalt-alloy bearings. Cobalt alloy bearings should be avoided in this setting. The diagnosis of systemic cobalt toxicity requires a high index of suspicion and was typically delayed following systemic symptoms. Debridement and revision to a ceramic-on-HXLPE leads to improvement but not resolution of cobalt toxicity complications.

Introduction

Historically, US arthroplasty revision rates are based on CMS data that cannot verify initial surgery date in patients under 65 years or laterality of revision. We calculated US one-year revision rates for primary total hip replacement (THR) using a representative cohort. Reasons for revision were documented.

We describe the results of 81 consecutive revision total hip replacements with impaction grafting in 79 patients using a collared polished chrome–cobalt stem, customised in length according to the extent of distal bone loss. Our hypothesis was that the features of this stem would reduce the rate of femoral fracture and subsidence of the stem.

The mean follow-up was 12 years (8 to 15). No intra-operative fracture or significant subsidence occurred. Only one patient suffered a post-operative diaphyseal fracture, which was associated with a fall. All but one femur showed incorporation of the graft. No revision for aseptic loosening was recorded.

The rate of survival of the femoral component at 12 years, using further femoral revision as the endpoint, was 100% (95% confidence interval (CI) 95.9 to 100), and at nine years using re-operation for any reason as the endpoint, was 94.6% (95% CI 92.0 to 97.2).

These results suggest that a customised cemented polished stem individually adapted to the extent of bone loss and with a collar may reduce subsidence and the rate of fracture while maintaining the durability of the fixation.

Aim. Aseptic loosening is the leading cause of revision of total hip arthroplasty (THA). It is well recognized that an occult infection is the underlying cause of some aseptic revisions. Intraoperative cultures are central to the diagnosis of prosthetic joint infection (PJI). However, the diagnostic and prognostic value of unexpected positive intraoperative cultures remains unclear. The aim was to study whether first-time aseptic revision of a total hip arthroplasty with unexpected bacterial growth in cultures of intraoperatively taken biopsies have an increased risk of secondary revision due to all causes and increased risk of PJI revision, specifically. Method. Cases reported as first-time aseptic loosening revisions to the Danish Hip Arthroplasty Register (DHR) performed during January 1. st. , 2010, to May 15. th. , 2016, were included. DHR data were merged with the Danish Microbiology Database, which contains data from all intraoperatively obtained cultures in Denmark. Included first-time revisions were grouped based on the number of positive cultures growing the same bacteria genus: ≥2, 1 and 0 cultures. Revisions were followed until secondary revision, death, or end of follow-up period after one year. Relative risk for secondary revision due to all causes and PJI was estimated. Results. We included 2,305 first-time aseptic revisions. Unexpected growth was found in 282 (12%) of which 170 (60%) cases showed growth of the same bacteria in only one culture. Coagulase-negative staphylococcus accounted for 121 (71%). Secondary revision was performed in 163 (7%) cases, with PJI being the indication for revision in 43 (26%) cases. The relative risk of secondary revision was significantly higher for cases of one positive culture growing the same bacteria compared to culture negative cases, both for revision due to all causes; 1.73 (95%CI 1.07; 2.80) and PJI exclusively; 2.63 (1.16; 5.96). Cases of 2 or more biopsies culturing the same bacteria had a relative risk of all cause revision of 1.52 (0.82; 2.80). Conclusions. First-time aseptic loosening THA revisions with unexpected growth in only one biopsy culture had an increased risk of secondary revision, both due to all causes and PJI. Our findings indicate that some cases of unexpected growth of bacteria should likely be regarded as clinically significant and not sample contamination, underlining the need for more awareness and better strategies when treating patients with unexpected positive intraoperative cultures. The improved diagnosis of occult PJI in clinically aseptic THA is of great importance for future care of this large and growing patient group

Aim: To evaluate the outcome of uncemented femoral revision after total hip arthroplasty using the CLS system at Southland Hospital, Invercargill, between 1995 and 2001. Methods: A retrospective study of 28 hips, representing the total experience of Southland Hospital with the CLS femoral prosthesis for revision surgery. For evaluation we used the Harris Hip Score and reviewed the radiographs. Results: Twenty-eight hips(23 male and five female),with an average age of 66 years(33 years to 82 years). The mean interval from the primary surgery to the revision was 7.6 years (range one day to 24 years). The majority (60%) of the revisions was for aseptic loosening, 10% for infection, 10% for periprosthetic fracture and the remainder for recurrent dislocation. There was one case of a mismatch of the femoral and acetabular components requiring revision on the same day. The majority of patients reported a favourable outcome, two experienced serious complications, neither requiring revision. Conclusions: Our results suggested that the CLS stem was a very useful method of correction following failure of total hip arthroplasty, with a high level of patient satisfaction

Numerous studies have evidenced cement-in-cement techniques as reliable in revision arthroplasty. The original cement mantle is commonly reshaped to aid accurate placement of the new stem.

Ultrasonic devices selectively remove cement, preserve host bone and have lower cortical perforation rates than other techniques. As far as the authors are aware, their impact on final cement-cement bonds has not been investigated. This study assessed the impact of cement removal using OSCAR (Orthosonics System for Cemented Arthroplasty Revision, ORTHOSONICS) on final cement-cement bonds.

Twenty-four specimens were manufactured by pouring cement (Simplex P Bone Cement, Stryker) into stainless-steel moulds with a central rod polished to Stryker Exeter V40 specifications. After cement curing, rods were removed and eight specimens allocated to each of three internal surface preparation groups: 1) burr; 2) OSCAR; or 3) no treatment. Internal holes were re-cemented, then each specimen was cut into 5mm discs. Shear testing of discs was completed by a technician blinded to original grouping (Instron 5567, UK), recording ultimate shear strengths.

The mean shear strength for OSCAR-prepared specimens (17 MPa, 99% CI 14.9 to 18.6, SD=4.0) was significantly lower than that measured for the control (23 MPa, 99% CI 22.5 to 23.7, SD=1.4) and burr (23 MPa, 99% CI 22.1 to 23.7, SD=1.9) groups (P<0.001, one-way ANOVA with Tukey's post-hoc analysis). There was no significant difference between control and burr groups (P>0.05).

Results show that cement removal technique impacts on final cement-cement bonds. This in vitro study shows a significantly weaker bond when using OSCAR prior to re-cementation into an old cement mantle, compared to cement prepared with a burr or no treatment.

These results have implications for surgical practice and decision-making about specific cement removal techniques used during cement-in-cement revision arthroplasty, suggesting that the risks and benefits of ultrasonic cement removal need careful consideration.

Aims

We investigated the long-term performance of the Tripolar Trident acetabular component used for recurrent dislocation in revision total hip arthroplasty. We assessed: 1) rate of re-dislocation; 2) incidence of complications requiring re-operation; and 3) Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain and functional scores.

The objective of this study was to determine whether the bearing surface is a risk factor for revision after late dislocation in total hip arthroplasty (THA).

Data from primary THAs were extracted from the New Zealand Joint Registry over a 13-year period. The mean age of patients was 68.9 years; 53.2% were female. The surgical approach used was posterior in 66% of THAs, lateral in 29% and anterior in 5%. There were 53,331 (65.1%) metal-on-polyethylene THAs, 14,093 (17.2%) ceramic-on-polyethylene, 8,177 (10.0%) ceramic-on-ceramic, 461 (0.5%) ceramic-on-metal, 5910, and (7.2%) metal-on-metal.

The primary endpoint was late revision for dislocation, with ‘late’ defined as greater than one year post-operatively. 73,386 hips were available for analysis. The overall revision rate was 4.3% (3,130 THAs), 1.1% (836) were revised for dislocation. Only 0.65% (470) hips were revised for dislocation after the first post-operative year.

The unadjusted hazard ratios (HR) showed significantly higher rates of revision for dislocation in ceramic-on-polyethylene (HR 2.48; p=0.001) and metal-on-polyethylene (HR 2.00; 95% p =0.007) compared to ceramic-on-ceramic. However, when adjusted for head size, age and surgical approach, only ceramic-on-polyethylene (HR 2.10; p=0.021) maintained a significantly higher rate of revision, whereas metal-on-polyethylene approached significance (HR 1.76; 95% p = 0.075).

In New Zealand, dislocation is the most common reason for revision, ahead of aseptic loosening of the acetabular component. The relationships between bearing materials and risk of revision for late dislocation is controversial. However, in this study ceramic-on-ceramic shows lower risk rates for revision than other bearing surface combinations. Low wear and less debris, limited peri-articular inflammatory reaction and an healthy fibrotic pseudo-capsule are potential factors determining long-term stability of the hip joint.

One of the most serious complications of THA is deep infection.

Charnley realised the problem. This led to the development of clean air enclosure, total body exhaust suits and the introduction of the instrument tray system. Subsequently antibiotics were used both systematically and also as an addition to the acrylic cement. Occasional deep infection requires further intervention, either by removing the implant, or performing one or two stage revision. It has been the senior author’s practice to undertake one-stage revision provided the bone stock was of sufficiently good quality to ensure reasonable quality of component fixation. The technique is based on the accepted principle of infection management: Removal of all foreign body material and infected tissues, application of local antiseptics/antibiotics, closure of cavities, ensuring stability, drainage, rest, continuation of antibiotics.

Between January 1974 and December 2001, 185 one-stage revisions were carried out by the senior author: 162 had a minimum follow-up of 5 years with a mean of 12.3 years (5.1–27.6 years). 138 cases (85.2%) were free from infection. Presence of a sinus at revision did not affect the outcome adversely – on the contrary – 90.4% were infection free as compared with 82.7% of those without a sinus.

Attention to detail was the essential part of the operation.

Implant fracture of modular revision stems is a major complication after total hip arthroplasty revision (rTHA). Studies looking at specific modular designs report fracture rates of 0.3% to 0.66% whereas fractures of monobloc designs are only reported anecdotally. It is unclear whether the overall re-revision rate of modular designs is higher and if, whether stem fractures or other revision reasons are responsible for this elevation. All revisions within 5 years after implantation of a revision stems (n. 0. =13,900; n. 5. =2506) were analysed using Cox regression with design (modular: n=17, monobloc: n=27), BMI, Sex and Elixhauser Score as independent variables. One stage and two stage revisions were analysed separately (1-stage: modular n= 7,102; monobloc n= 4,542; 2-stage: 1,551 / 704). The revision volume of the hospitals was also considered (low: <20 revisions, medium: 21–50 revisions, high: >50 revisions). For the 1-stage revisions, the re-revision risk after 4 years was 14,3% [13.2%, 15.5%] for monobloc and 17.4% [16.40%, 18.40%] for modular stems (p< 0.001). Stem fracture was the reason for re-revision in 2.4% of the modular (fracture rate 0.42%) and 0.6% of the monobloc revisions. The difference in re-revision rates between the designs was mainly due to differences in dislocation and stem loosening. For the 2-stage revisions, the revision risks for either design were similar (21.7% [18,5%, 25.4%] vs. 23.0% [20.8%, 25.4%]; p=0.05). Patient characteristics influenced the comparison between the two designs in the 1-stage group but very little in the 2-stage group. Modular revision stem fractures only contribute very minor to re-revision risk. In 2-stage revisions, no difference in overall re-revision rates between designs was observed. This might indicate that the differences observed for 1-stage procedures are due to differences between the patient cohorts, not reflected by the parameters available or surgeon choice

The results of total hip arthroplasty (THA) revisions to correct leg length discrepancy (LLD) are not clear, with only two former limited series (< 25 patients). Therefore, we conducted a retrospective study of THA revisions for LLD to determine: 1) the change in LLD, 2) the function outcomes and whether obtaining equal leg lengths influenced function, 3) the complication and survival rates. This multicenter study included 57 patients: 42 THA revisions for limb shortening and 15 revisions for limb lengthening. LLD was measured on conventional radiographs and EOS. The Oxford-12 and FJS outcome scores were collected and the number of patients achieving the Oxford-12 MCID. The revisions were carried out a mean of 2.8 years after the index THA. The median LLD decreased from 7.5 mm (IQR: [5;12]) to 1 mm (IQR: [0.5;2.5]) at follow-up (p=0.0002). Overall, 55 of 57 patients (96%) had < 5 mm LLD at follow-up and 12 patients (21%) had equal leg lengths. The complication rate was 25%: 12 mechanical complications (8 periprosthetic femoral fractures, 2 stem loosening and 1 cup loosening, 1 dislocation) and 1 periprosthetic infection. The patient satisfaction was high with a median FJS of 79.2/100 and 77% of patients reached the Oxford-12 MCID. Lengthening procedures had significantly worst function than shortening (38% vs 91% of patients achieving the Oxford-12 MCID (p=0.0004)). Survivorship was 85% (95% CI: 77.9 – 92.5) at 2 years and 77% (95% CI: 66.3 – 87.1) at 4.6 years when using re-revision for any reason as the endpoint. When LLD after THA does not respond to conservative management, revision THA should be considered. Although revision THA for LLD improved medium-term functional outcomes with a high patient satisfaction rate, especially for shortening procedures, the complication rate was high, particularly related to periprosthetic femoral fracture

Aims. In UK there are around 76,000 hip fractures occur each year 10% to 15% of which are undisplaced intracapsular. There is considerable debate whether internal fixation is the most appropriate treatment for undisplaced fractures in older patients. This study describes cannulated hip screws survivorship analysis for patients aged ≥ 60 years with undisplaced intra-capsular fractures. Methods. This was a retrospective cohort study of consecutive patients aged ≥ 60 years who had cannulated screws fixation for Garden I and II fractures in a teaching hospital between March 2013 and March 2016. The primary outcome was further same-side hip surgery. Descriptive statistics were used and Kaplan-Meier estimates calculated for implant survival. Results. A total of 114 operations were performed on 112 patients with a mean age of 80.2 years (SD 8.9). The 30-day and one-year mortality were 1% (n = 1) and 13% (n = 15), respectively. Median follow-up was 6.6 years (interquartile range 6.0 to 7.3). Kaplan-Meier estimates showed a survivorship of 95% at one year and 90% at five years (95% confidence interval 84% to 95%) for cannulated screws. Nine patients underwent further hip surgery: four revision to total hip arthroplasty, one revision to hemiarthroplasty, three removals of screws, and one haematoma washout. Posterior tilt was assessable in 106 patients; subsequent surgery was required in two of the six patients identified with a posterior angle > 20° (p = 0.035 vs angle < 20°). Of the 100 patients with angle < 20°, five-year survivorship was 91%, with seven patients requiring further surgery. Conclusion. This study of cannulated hip screw fixation for undisplaced fractures in patients aged ≥ 60 years reveals a construct survivorship without further operation of 90% at five years. Cannulated screws can be considered a safe reliable treatment option for Garden I and II fractures. Caution should be taken if posterior tilt angle on lateral view exceeds 20°, due to a higher failure rate and reoperation, and considered for similar management to Garden III and IV injuries. Cite this article: Bone Jt Open 2022;3(3):182–188

Revision is a key negative outcome of joint replacements. The purpose of this abstract is to present revision risk curves for hip and knee replacements based on the most recently available national data sources. Having a better understanding of determinants of revision risk can help inform clinical and health care system improvements. We explored revision risk of primary joint replacement stratified by key clinical, prosthesis, and surgeon-level factors using data from three databases managed by CIHI: the Canadian Joint Replacement Registry (CJRR), the Discharge Abstract Database, and the National Ambulatory Care Reporting System. To investigate early revisions, we used Kaplan-Meier analysis stratified by demographic factors to determine the risk of revision within up to five years of primary surgery. This analysis identified the primary cohort from the CJRR from April 1, 2012 to March 31, 2017 and was limited to mandatory reporting provinces (British Columbia, Manitoba and Ontario) to ensure maximal coverage of prosthesis information. Bearing surface was obtained from the International Prosthesis Library maintained by the International Consortium of Orthopaedic Registries (ICOR) and the International Society of Arthroplasty Registers (ISAR). The total revision risk cohort contained 283,620 primary surgeries, of which 5,765 (2%) had at least one revision. For total hip arthroplasties, revision risk at the end of the follow-up period did not differ by age, by sex or across bearing surface (metal on cross-linked polyethylene [XLPE], ceramic on XLPE, ceramic on ceramic, metal on non-cross-linked polyethylene). For hemiarthroplasties in hip fracture patients, cement fixation was significantly associated with decreased revision risk. Surgeon volume had a positive effect on survivorship with cementless fixation (2.7% at one year [95% CI 2.3%, 3.1%] for high-volume vs 3.2% [2.7%, 3.7%] for low-volume). However, surgeon volume did not have an effect on survivorship with cemented fixation (2% at one year [95% CI 1.3%, 2.6%] for high-volume vs. 2% [1.4%, 2.6%] for low-volume). For total knee replacements, revision risk increased with decreasing age and male sex. For patients aged 75 and older, four-year revision risks were 1.5% (95% CI 1.3%, 1.7%) for women and 2.0% (1.7%, 2.3%) for men, but for patients under 55 years old, they were 4.3% (3.7%, 5%) for women and 5.9% (4.9%, 6.9%) for men. Additional results from the upcoming 2019 CJRR annual report, including data up to March 31, 2018, will be presented. Revisions represent a key failure of the primary replacement, they are costly to the health care system and negatively affect patients' quality of life. CJRR's coverage is currently 72%, increased coverage and follow-up time will allow increasingly comprehensive reporting on hip and knee prostheses in Canada. Future work in this area involves exploring additional prosthesis attributes for stratification of revision risk curves and calculation of hazards ratios adjusted by age and sex

Aims. The purpose of this study was to evaluate unexpected positive cultures in total hip arthroplasty (THA) revisions for presumed aseptic loosening, to assess the prevalence of low-grade infection using two definition criteria, and to analyze its impact on implant survival after revision. Methods. A total of 274 THA revisions performed for presumed aseptic loosening from 2012 to 2016 were reviewed. In addition to obtaining intraoperative tissue cultures from all patients, synovial and sonication fluid samples of the removed implant were obtained in 215 cases (79%) and 101 cases (37%), respectively. Histopathological analysis was performed in 250 cases (91%). Patients were classified as having low-grade infections according to institutional criteria and Musculoskeletal Infection Society (MSIS) International Consensus Meeting (ICM) 2013 criteria. Low-grade infections according to institutional criteria were treated with targeted antibiotics for six weeks postoperatively. Implant failure was defined as the need for re-revision resulting from periprosthetic joint infection (PJI) and aseptic reasons. The mean follow-up was 68 months (26 to 95). Results. Unexpected positive intraoperative samples were found in 77 revisions (28%). Low-grade infection was diagnosed in 36 cases (13%) using institutional criteria and in nine cases (3%) using MSIS ICM 2013 criteria. In all, 41 patients (15%) had single specimen growth of a low-virulent pathogen and were deemed contaminated. Coagulase-negative Staphylococcus and anaerobes were the most commonly isolated bacteria. Implant failure for PJI was higher in revisions with presumed contaminants (5/41, 12%) compared to those with low-grade infections (2/36, 6%) and those with negative samples (5/197, 3%) (p = 0.021). The rate of all-cause re-revision was similar in patients diagnosed with low-grade infections (5/36, 14%) and those with presumed contaminants (6/41, 15%) and negative samples (21/197, 11%) (p = 0.699). Conclusion. Our findings suggest that the presumption of culture contamination in aseptic revision hip arthroplasty may increase the detection of PJI. In this cohort, the presence of low-grade infection did not increase the risk of re-revision. Further studies are needed to assess the relevance of single specimen growth and the benefits of specific postoperative antibiotic regimens. Cite this article: Bone Joint J 2021;103-B(6):1070–1077

Aims

Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and pelvic tumour resection procedures. Accurate CTAC positioning is essential to successful surgical outcomes. While prior studies have explored CTAC positioning in rTHA, research focusing on tumour cases and implant flange positioning precision remains limited. Additionally, the impact of intraoperative navigation on positioning accuracy warrants further investigation. This study assesses CTAC positioning accuracy in tumour resection and rTHA cases, focusing on the differences between preoperative planning and postoperative implant positions.

Aims

The primary aim of this prospective, multicentre study is to describe the rates of returning to golf following hip, knee, ankle, and shoulder arthroplasty in an active golfing population. Secondary aims will include determining the timing of return to golf, changes in ability, handicap, and mobility, and assessing joint-specific and health-related outcomes following surgery.