The use of allograft struts and cerclage wire, possibly augmented by plate fixation, for the treatment of Vancouver type-B1
Tapered, fluted, modular, titanium stems are
increasingly popular in the operative management of Vancouver B2 and
selected B3 peri-prosthetic femoral fractures. We have reviewed
the results at our institution looking at stem survival and clinical
outcomes and compared this with reported outcomes in the literature.
Stem survival at a mean of 54 months was 96% in our series and 97%
for combined published cases. Review of radiology showed maintenance
or improvement of bone stock in 89% of cases with high rates of
femoral union. Favourable clinical outcome scores have reported
by several authors. No difference in survival or clinical scores
was observed between B2 and B3 fractures. Tapered stems are a useful
option in revision for femoral fracture across the spectrum of femoral
bone deficiency. Cite this article:
Constrained acetabular inserts provide a solution for both complex primary and revision hip arthroplasty, but there have been ongoing concerns for high risk of failure and their longevity. The Stryker® Trident acetabular insert is pre-assembled with its constrained ring. We believe this to be the largest series of constrained acetabular inserts with a minimum of 5 year follow-up. We retrospectively reviewed all Stryker® Trident ‘All-Poly’ constrained acetabular inserts cemented into bone in our unit between 2008 and 2016. We collated demographic details and reviewed all patients’ radiographs and clinical notes. Indications for surgery, latest Oxford Hip Scores (OHS) and clinical and radiographic complications were identified. 117 consecutive Stryker® Trident ‘All-Poly’ constrained inserts were cemented into bone in 115 patients during the study period with a mean age of 80 (47–97). Most common indications for surgery were recurrent dislocation (47), complex primary arthroplasty (23), revision arthroplasty (19) and failed hemiarthroplasty (12). 41 patients required revision of the acetabular component only. Follow-up was a minimum of 5 years (mean 8.6, range 5–13). There were three 30-day mortalities and six 1-year mortalities. The mean latest OHS was 37 (24–45). Four cups failed in three patients, one at the cement-bone interface, two at the cement-prosthesis interface and one at the bipolar interface. These were treated conservatively in three patient and with excision arthroplasty in one patient. There were four
We determined the midterm survival, incidence
of
Arthroplasty in patients who are intravenous drug abusers presents a complex challenge, frequently requiring intervention at a younger age. The cohort suffer increased complication rates due to significant co-morbidities and poor engagement in medical services, in comparison to other patients undergoing lower limb arthroplasty. Multiple small studies show arthroplasty in this patient cohort is associated with high complication and mortality rates. A search of electronic databases were undertaken with the assistance of the library services from the Rotherham NHS Foundation Trust, including Chocraine, SCOPUS and PubMed. Abstracts were reviewed and relevant studies extracted for full review. Full text articles were reviewed based on strict inclusion and exclusion criteria. Searches identified Two thousand and forty-four papers; twenty-seven studies were identified for full review of the paper based on the inclusion criteria above. From this, nine studies were deemed appropriate to for data extraction. These nine papers present one hundred and thirty-two cases of lower limb arthroplasty, fifty nine Total Knee Arthroplasty and seventy three Total Hip Arthroplasty. From this the authors examined incidences of implant failure due to infection, revision, mortality, dislocation, aseptic loosening,
Post-operative peri-prosthetic femoral fracture (PO-PPFF) is one of the most relevant complications in primary Total Hip Arthroplasty (pTHA), accountable for a significant clinical and socio-economic burden both in revision and fixation settings. We retrospectively reviewed of our series of 1586 cementless total hip arthroplasty performed between 1999 and 2019 (achieving a minimum of 5-years follow-up) with different short stems. We have observed a cumulative low incidence of PO-PPFF of 0,33% (5 cases): we divided Po-PPFF in two groups: fracture occurred around a short stem (A) and around a standard shortened stem (B), according to French Hip & Knee Classification of Short Stems. Despite the length of observed period (mean follow-up 12 years, min 5 years max 24 years) a total of 1512 cases (mean age at surgery 61 years, max 74, min 40 years) were available to clinical and radiographic follow-up, being this population enrolled in elective surgery clinical protocols. Our data exceed the low incidence of post-operative femoral fracture around bone -preserving previously reported by Kim in 2018 (12 fracture out of 1089 cases:1.1%). No correlation have been observed among occurrence of PO-PPF age of the patient and no fracture occurred around cemented short stems despite patient's characteristics were unfavourable in term of age and bone quality. This result is not unexpected, giving the lower incidence of
Uncemented femoral components have been used in total hip arthroplasties (THAs) for over three decades. Data on long-term performance of hydroxyapatite-coated femoral stems is however limited. This study reports the survivorship of a collarless, straight, hydroxyapatite-coated femoral stem (Omnifit HA, Osteonic) with a minimum of 20 years of follow-up. We reviewed the results of 165 THAs using Omnifit HA in 138 patients performed between August 1993 and December 1999. The mean age at surgery was 46 years (range 20 – 77 years). Avascular necrosis was the most common cause of THA, followed by ankylosing spondylitis and primary osteoarthritis. The mean follow-up was 22 years (range 20–31 years). At 20 and 25 years, 113 arthroplasties (91 patients) and 63 arthroplasties (55 patients) were available for follow-up respectively, while others had deceased or were lost to follow-up. Kaplan-Meier survivorship analysis was performed to evaluate the survival of the femoral component. Radiographs were reviewed at regular intervals, and implant stability was evaluated using Engh classification. Seven out of 165 stems were revised upon the latest follow-up; that included one case of aseptic loosening with revision done at 15 years, three
Contemporary acetabular reconstruction in major acetabular bone loss often involves the use of porous metal augments, a cup-cage construct or custom implant. The aims of this study were: To determine the reproducibility of a reconstruction algorithm in major acetabular bone loss. To determine the subsequent success of reconstruction performed in terms of re-operation, all-cause revision and Oxford Hip Score (OHS) and to further define the indications for custom implants in major acetabular bone loss. Consecutive series of Paprosky Type III defects treated according to a reconstruction algorithm. IIIA defects were planned to use a superior augment and hemispherical cup. IIIB defects were planned to receive either augment and cup, cup-cage or custom implant. 105 procedures in cohort 100 patients (5 bilateral) with mean age 73 years (42–94). IIIA defects (50 cases) − 72.0% (95%CI 57.6–82.1) required a porous metal augment the remainder treated with a hemispherical cup alone. IIIB defects (55 cases) 71.7% (95%CI 57.6–82.1) required either augments or cup-cage. 20 patients required a hemispherical cup alone and 6 patients received a custom-made implant. Mean follow up of 7.6 years. 6 re-revisions were required (4 PJI, 2
Dual mobility (DM) is most often used by surgeons to reduce instability in high risk patients. NJR data on DM has not demonstrated a reduction in all cause revision and has reported an increase in revision for
Introduction: Revision hip arthroplasty for aseptic loosening of femoral component is successfully treated with impaction bone grafting technique. Owing to easier technique and shorter operative time, distally fixed non-cemented long stems have gained popularity in the present era. However, use of long stems could make subsequent re-revision difficult due to further bone loss. The standard length stem has been often critiqued due to apprehension of
Revision arthroplasty of the hip is expensive
owing to the increased cost of pre-operative investigations, surgical implants
and instrumentation, protracted hospital stay and drugs. We compared
the costs of performing this surgery for aseptic loosening, dislocation,
deep infection and
The Kent hip is a distally-locked femoral stem which was developed to address severe proximal bone loss, severe bony deformity and
Introduction. The Corail stem is a fully HA coated tapered implant that has demonstrated long-term success. On the NJR it has become one of the most commonly used implants in the UK. The aim of our study was to document our experience of the revision of this implant together highlighting some important technical considerations. Patients/Materials & Methods. A retrospective review of a consecutive case series of revision procedures where the Corail stem was extracted. We considered time since implantation, collared or uncollared design, indication for revision, Paprosky classification of femoral deficiency, endo-femoral reconstruction or extended approach/osteotomy, subsequent reconstruction either further primary type implant (cemented or cementless) or revision femoral implant. Results. 49 patients required extraction of Corial Stem as part of revision THA. Mean time to extraction 5.2 years (range 1.1 to 10.5 years). Indication for revision in 27 cases ARMD, 7 aseptic loosening, 7 PJI, 6
Introduction. Historically, the most common indications for re-revision of a total hip arthroplasty (THA) have been aseptic loosening, instability, infection, and
Introduction. Cemented femoral fixation has been shown to carry a lower risk of
Introduction. Previous reports have investigated the correlation between time to revision hip arthroplasty (rTHA) and reason for revision, but little is known regarding the impact of timing on outcomes following rTHA. The purpose of this study is to evaluate the effect of time to rTHA on both indication and outcomes of rTHA. Methods. This retrospective observational study reviewed patients who underwent unilateral, aseptic rTHA at an academic orthopedic specialty hospital between January 2016 and April 2019 with at least 1-year of follow-up. Patients were early revisions if they were revised within 2 years of primary THA (pTHA) or late revisions if revised after greater than 2 years. Patient demographics, surgical factors, and post-operative outcomes were compared between the groups. Post-hoc power analysis was performed (1-β=0.991). Results. 188 cases were identified, with 61 hips undergoing early revision and 127 undergoing late revision. There were no differences in demographics and comorbidities between the groups. Type of revision differed between the groups, with early revisions having a greater proportion of femoral revisions (54.1% vs.20.5%) and late revisions having a greater proportion of both component (10.2% vs.6.6%), acetabular (30.7% vs.26.2%), or head/liner (38.6% vs. 13.1%;p< 0.001) revisions. Indication for index revision differed between the groups, with early revisions having a greater proportion for dislocation/instability (21.3% vs. 10.2%) and
An 81-year-old woman presented with a fracture
in the left femur. She had well-fixed bilateral hip replacements
and had received long-term bisphosphonate treatment. Prolonged bisphosphonate
use has been recently linked with atypical subtrochanteric and diaphyseal
femoral fractures. While the current definition of an atypical fracture
of the femur excludes
Revision total hip arthroplasty (THA) is challenging
when there is severe loss of bone in the proximal femur. The purpose
of this study was to evaluate the clinical and radiographic outcomes
of revision THA in patients with severe proximal femoral bone loss
treated with a fluted, tapered, modular femoral component. Between
January 1998 and December 2004, 92 revision THAs were performed
in 92 patients using a single fluted, tapered, modular femoral stem
design. Pre-operative diagnoses included aseptic loosening, infection
and
Continued controversy exists between cemented versus uncemented hemiarthroplasty for an intracapsular hip fracture. To assist in resolving this controversy, 400 patients were randomised between a cemented polished tapered stem hemiarthroplasty and an uncemented Furlong hydroxyapatite coated hemiarthroplasty. Follow-up was by a nurse blinded to the implant used for up to three years from surgery. Results indicate no difference in the pain scores between implants but a tendency to an improved regain of mobility for those treated with the cemented arthroplasty (1.2 score versus 1.7 at 6 months, p=0.03). There was no difference in early mortality but a tendency to a higher later mortality for the uncemented implants (29% versus 24% at one year, p=0.3). Later
Patients need to know the benefits, risks and alternatives to any proposed treatment. Surgeons discussing the risk of a revision procedure becoming necessary, after a hip replacement can draw upon the orthopaedic literature and arthroplasty registries for long-term implant survival. However, early revision is required in a minority of cases. We have investigated the probability for revision hip replacement patients in terms of time-point and indication for revision. Of the 9,411 Primary Total Hip Replacements (THR), undertaken by 22 surgeons, over an eleven-year period, between January 2004 and March 2015, 1.70% (160) were subsequently reported to the National Joint Registry (NJR) as revised. Each revision case was reviewed under the supervision of senior hip specialist consultants. The modes of failure of were identified through clinical, laboratory and imaging (x-rays, CT, MRI and Isotope scans) studies. The revision rate for THRs was 0.58% in the first year. This was statistically higher than all subsequent years, P-Value <0.001. There was no statistical difference between any pair of subsequent years. Thereafter, the average revision rate was 0.30% per annum. The odds ratio for revision during the first post–operative year against the subsequent year average was 1.67. The indications for the early hip revisions in the first three years were infection, dislocation and
