Background. Thigh pain following a well-fixed total hip arthroplasty (THA) remains problematic and a source of patient dissatisfaction. The purpose of this study is to evaluate if the development of
Limb Length discrepancy after total hip replacement has been reported to happen in 1–27% of cases with differences up to 70mm. Occasionally revision THR has been used to achieve limb length equalisation, especially when patients are symptomatic with hip/back pain, neurologic symptoms or instability. However, in presence of a well-functioning, pain free hip without hip symptoms, revision THR for shortening can lead to problems with decrease in offset or stability. An option in these cases would be a distal shortening osteotomy of femur. From 2005 to 2014 five shortening osteotomies were done for LLD with limb lengthening of ipsilateral side following THR. All patients had well-functioning THRs with and no complications as dislocations or nerve symptoms. A distal metaphyseal shortening osteotomy, fixed using a 95 degree blade plate, was chosen for better healing at this level and ease of surgery.Introduction
Materials and Methods
Early micromotion of hip implants measured with radiostereometric analysis (RSA) is a predictor for late aseptic loosening. Computed Tomography Radiostereometric Analysis (CT-RSA) can be used to determine implant micro-movements using low-dose CT scans. CT-RSA enables a non-invasive measurement of implants. We evaluated the precision of CT-RSA in measuring early stem migration. Standard marker-based RSA was used as reference. We hypothesised that CT-RSA can be used as an alternative to RSA in assessing implant micromotions. We included 31 patients undergoing Total Hip Arthroplasty (THA).
Femoral cement-in-cement revision is a well described technique to reduce morbidity and complications in hip revision surgery. Traditional techniques for septic revision necessitate removal of all bone cement from the femur. In our two institutions, we have been using a cement-in-cement technique, leaving the
Traditional mechanical debridement can only remove visibly infected tissue and is unable to completely clear all the biofilm that hides within muscle crevices and nerves. This study aims to determine the results of single-stage revision using noncontact low frequency ultrasonic debridement in treating chronic periprosthetic joint infections (PJI). A prospective study of consecutive patients requiring single-stage revision for chronic PJI was performed since August 2021. After mechanical debridement, an 8‑mm handheld non‑contact low‑frequency ultrasound probe was used for ultrasonic debridement at a frequency of (25±5) kHz and power of 90% for 5 minutes. Each ultrasound lasted 10 seconds with 3‑seconds intervals. The probe was repeatedly sonicated among all soft tissue and bsingle interface. The
Aims. To evaluate how abnormal proximal femoral anatomy affects different femoral version measurements in young patients with hip pain. Methods. First, femoral version was measured in 50 hips of symptomatic consecutively selected patients with hip pain (mean age 20 years (SD 6), 60% (n = 25) females) on preoperative CT scans using different measurement methods: Lee et al, Reikerås et al, Tomczak et al, and Murphy et al. Neck-shaft angle (NSA) and α angle were measured on coronal and radial CT images. Second, CT scans from three patients with femoral retroversion, normal femoral version, and anteversion were used to create 3D femur models, which were manipulated to generate models with different NSAs and different cam lesions, resulting in eight models per patient. Femoral version measurements were repeated on manipulated femora. Results. Comparing the different measurement methods for femoral version resulted in a maximum mean difference of 18° (95% CI 16 to 20) between the most proximal (Lee et al) and most distal (Murphy et al) methods. Higher differences in proximal and
Aims. Femoral cement-in-cement revision is a well described technique to reduce morbidity and complications in hip revision surgery. Traditional techniques for septic revision of hip arthroplasty necessitate removal of all bone cement from the femur. In our two centres, we have been using a cement-in-cement technique, leaving the
Safe and meticulous removal of the femoral cement mantle and cement restrictor can be a challenging process in revision total hip arthroplasty (rTHA). Many proximal femoral osteotomies have been described to access this region however they can be associated with fracture, non-union and revision stem instability. The aim of this study is to report outcomes of our previously unreported vascularised anterior window to the proximal femur. We report on a cohort of patients who underwent cemented single and staged rTHA at our single institution by the same surgeon between 2012 and 2017 using a novel vascularised anterior window of the femur to extract the cement mantle and restrictor safely under direct vision. We describe our technique, which maintains the periosteal and muscular attachments to the osteotomised fragment, which is then repaired with a polymer cerclage cable. In all revisions a polished, taper slip, long stem Exeter was cemented. Primary outcome measures included the time taken for union and the patient reported WOMAC score. Thirty-two rTHAs were performed in 29 consecutive patients (13 female, 16 male) with a mean age of 63.4 years (range, 47–88). The indications for revision included infection, aseptic loosening and implant malpositioning. Mean follow up was 5.3 (range, 3.2–8 years). All femoral windows achieved radiographic union by a mean of 7.2 weeks. At the latest point in follow-up the mean WOMAC score was 21.6 and femoral component survivorship was 100%. There were no intraoperative complications or additional revision surgery. Our proposed vascularised anterior windowing technique of the femur is a safe and reproducible method to remove the
The coronal plane lower limb alignment plays an important role in the occurrence and progression in knee osteoarthritis. There have been reports of the valgus knee in patients with unilateral developmental hip dislocation (UDHD) with the relatively small sample size. Besides, few studies have analyzed the lower limb alignment of the contralateral side. The purpose of our study was to identify the coronal plane alignment of both the ipsilateral and the contralateral lower limb in patients with UDHD and find out the difference between patients with Hartofilakidis type II and III. The radiographic data of all UDHD patients who met the inclusion criteria from March 2011 to February 2017 were retrospectively reviewed, including the hip-knee-ankle angle (HKA), mechanical lateral
Introduction. We studied free (= local powder) tobramycin and doxycycline, and controlled release (= local lipid bilayer) doxycycline formulations in a rat model representing a generic joint infection. We . hypothesized. that evidence of infection (quantitative colony forming units (CFU), qualitative SEM, histopathology) (1a) would be reduced with local vs. systemic antibiotic, (1b) any antibiotic would be superior to control (2) there would be a difference among antibiotics, and (3) antibiotic would not be detectable in serum at 4-week euthanasia. Methods. Study groups. included infected and non-infected (1) control, (2) systemic ceftriaxone (daily), (3) local tobramycin, (4) local doxycycline and (5) controlled release doxycycline. With IACUC approval, (10 rats/group; power =0.8), 50-μl, 10×4 CFU Staphylococcus aureus, slowly injecting into
Instability is a common cause of failure after total hip arthroplasty. A novel reverse total hip has been developed, with a femoral cup and acetabular ball, creating enhanced mechanical stability. The purpose of this study was to assess the implant fixation using radiostereometric analysis (RSA), and the clinical safety and efficacy of this novel design. Patients with end-stage osteoarthritis were enrolled in a prospective cohort at a single centre. The cohort consisted of 11 females and 11 males with mean age of 70.6 years (SD 3.5) and BMI of 31.0 kg/m2 (SD 5.7). Implant fixation was evaluated using RSA as well as Western Ontario and McMaster Universities Osteoarthritis Index, Harris Hip Score, Oxford Hip Score, Hip disability and Osteoarthritis Outcome Score, 38-item Short Form survey, and EuroQol five-dimension health questionnaire scores at two-year follow-up. At least one acetabular screw was used in all cases. RSA markers were inserted into the innominate bone and proximal femur with imaging at six weeks (baseline) and six, 12, and 24 months. Independent-samples Aims
Methods
This study reports the results of 38 total hip arthroplasties (THAs) in 33 patients aged less than 50 years, using the JRI Furlong hydroxyapatite ceramic (HAC)-coated femoral component. We describe the survival, radiological, and functional outcomes of 33 patients (38 THAs) at a mean follow-up of 27 years (25 to 32) between 1988 and 2018.Aims
Methods
The aim of this study is to report the long-term outcomes of instrumented femoral revisions with impaction allograft bone grafting (IBG) using the X-change femoral revision system at 30 years after introduction of the technique. We updated the outcomes of our previous study, based on 208 consecutive revisions using IBG and the X-change femoral revision system in combination with a cemented polished stem, performed in our tertiary care institute between 1991 and 2007. Kaplan-Meier survival analyses were used to determine the survival rate of the revisions with endpoint revision for any reason and aseptic loosening. Secondary outcomes were radiological loosening and patient-reported outcome measures.Aims
Methods
Periprosthetic joint infections (PJIs) with prior multiple failed surgery for reinfection represent a huge challenge for surgeons because of poor vascular supply and biofilm formation. This study aims to determine the results of single-stage revision using intra-articular antibiotic infusion in treating this condition. A retrospective analysis included 78 PJI patients (29 hips; 49 knees) who had undergone multiple prior surgical interventions. Our cohort was treated with single-stage revision using a supplementary intra-articular antibiotic infusion. Of these 78 patients, 59 had undergone more than two prior failed debridement and implant retentions, 12 patients had a failed arthroplasty resection, three hips had previously undergone failed two-stage revision, and four had a failed one-stage revision before their single-stage revision. Previous failure was defined as infection recurrence requiring surgical intervention. Besides intravenous pathogen-sensitive agents, an intra-articular infusion of vancomycin, imipenem, or voriconazole was performed postoperatively. The antibiotic solution was soaked into the joint for 24 hours for a mean of 16 days (12 to 21), then extracted before next injection. Recurrence of infection and clinical outcomes were evaluated.Aims
Methods
We used a trochanteric slide osteotomy (TSO) in 94 consecutive revision total hip arthroplasties (90 with replacement of both the cup and stem). This technique proved to be adequate for removing the components, with few complications (two minor fractures), and for implanting acetabular allografts (18%) and reinforcement devices (23%). Trochanteric union was obtained in most patients (96%), even in those with septic loosening (18/19), major femoral osteolysis (32/32), or previous trochanteric osteotomy (17/18). TSO is versatile, since it can be extended by a femoral flap (four cases) or a
One-stage revision hip arthroplasty for periprosthetic joint infection (PJI) has several advantages; however, resection of the proximal femur might be necessary to achieve higher success rates. We investigated the risk factors for resection and re-revisions, and assessed complications and subsequent re-revisions. In this single-centre, case-control study, 57 patients who underwent one-stage revision arthroplasty for PJI of the hip and required resection of the proximal femur between 2009 and 2018 were identified. The control group consisted of 57 patients undergoing one-stage revision without bony resection. Logistic regression analysis was performed to identify any correlation with resection and the risk factors for re-revisions. Rates of all-causes re-revision, reinfection, and instability were compared between groups.Aims
Methods
The prevalence of ipsilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) is rising in concert with life expectancy, putting more patients at risk for interprosthetic femur fractures (IPFFs). Our study aimed to assess treatment methodologies, implant survivorship, and IPFF clinical outcomes. A total of 76 patients treated for an IPFF from February 1985 to April 2018 were reviewed. Prior to fracture, at the hip/knee sites respectively, 46 femora had primary/primary, 21 had revision/primary, three had primary/revision, and six had revision/revision components. Mean age and BMI were 74 years (33 to 99) and 30 kg/m2 (21 to 46), respectively. Mean follow-up after fracture treatment was seven years (2 to 24).Aims
Methods
This study evaluates risk factors influencing fracture characteristics for postoperative periprosthetic femoral fractures (PFFs) around cemented stems in total hip arthroplasty. Data were collected for PFF patients admitted to eight UK centres between 25 May 2006 and 1 March 2020. Radiographs were assessed for Unified Classification System (UCS) grade and AO/OTA type. Statistical comparisons investigated relationships by age, gender, and stem fixation philosophy (polished taper-slip (PTS) vs composite beam (CB)). The effect of multiple variables was estimated using multinomial logistic regression to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Surgical treatment (revision vs fixation) was compared by UCS grade and AO/OTA type.Aims
Methods
There is a paucity of long-term studies analyzing risk factors for failure after single-stage revision for periprosthetic joint infection (PJI) following total hip arthroplasty (THA). We report the mid- to long-term septic and non-septic failure rate of single-stage revision for PJI after THA. We retrospectively reviewed 88 cases which met the Musculoskeletal Infection Society (MSIS) criteria for PJI. Mean follow-up was seven years (1 to 14). Septic failure was diagnosed with a Delphi-based consensus definition. Any reoperation for mechanical causes in the absence of evidence of infection was considered as non-septic failure. A competing risk regression model was used to evaluate factors associated with septic and non-septic failures. A Kaplan-Meier estimate was used to analyze mortality.Aims
Methods
Periprosthetic fractures (PPFs) around cemented taper-slip femoral prostheses often result in a femoral component that is loose at the prosthesis-cement interface, but where the cement-bone interface remains well-fixed and bone stock is good. We aim to understand how best to classify and manage these fractures by using a modification of the Vancouver classification. We reviewed 87 PPFs. Each was a first episode of fracture around a cemented femoral component, where surgical management consisted of revision surgery. Data regarding initial injury, intraoperative findings, and management were prospectively collected. Patient records and serial radiographs were reviewed to determine fracture classification, whether the bone cement was well fixed (B2W) or loose (B2L), and time to fracture union following treatment.Aims
Methods