We studied the risk of recurrent dislocation in 121 primary and 39 revision Charnley or Charnley hybrid total hip arthroplasties which had been treated for a primary dislocation between 1979 and 1995. Only 35% of these hips had no further dislocation or a revision for instability within one year. The rates of survival gradually declined with time or if a second, third or fourth dislocation occurred. The risk of recurrence was greater in men, but was not related to age, diagnosis, time of the first dislocation or whether the index operation had been a primary or a revision procedure. Operative treatment included 15 reoperations leaving intact components, 50 revisions, and permanent removal of the femoral stem in seven patients. The operation was successful in four patients with reoperations and in 36 who had an exchange procedure within two years. Treatment was successful in 35 of 49 hips in which it was possible to correct a technical error compared with 5 out of 16 hips in which malposition of the components was not seen (p = 0.007).
Total femoral arthroplasty (TFA) is a rare procedure used in cases of significant femoral bone loss, commonly from cancer, infection, and trauma. Low patient numbers have resulted in limited published work on long-term outcomes, and even less regarding TFA undertaken for non-oncological indications. The aim of this study was to evaluate the long-term clinical outcomes of all TFAs in our unit. Data were collected retrospectively from a large tertiary referral revision arthroplasty unit’s database. Inclusion criteria included all patients who underwent TFA in our unit. Preoperative demographics, operative factors, and short- and long-term outcomes were collected for analysis. Outcome was defined using the Musculoskeletal Infection Society (MSIS) outcome reporting tool.Aims
Methods
Breast cancer survivors have known risk factors that might influence the results of total hip arthroplasty (THA) or total knee arthroplasty (TKA). This study evaluated clinical outcomes of patients with breast cancer history after primary THA and TKA. Our total joint registry identified patients with breast cancer history undergoing primary THA (n = 423) and TKA (n = 540). Patients were matched 1:1 based upon age, sex, BMI, procedure (hip or knee), and surgical year to non-breast cancer controls. Mortality, implant survival, and complications were assessed via Kaplan-Meier methods. Clinical outcomes were evaluated via Harris Hip Scores (HHSs) or Knee Society Scores (KSSs). Mean follow-up was six years (2 to 15).Aims
Methods
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common orthopaedic procedures requiring postoperative radiographs to confirm implant positioning and identify complications. Artificial intelligence (AI)-based image analysis has the potential to automate this postoperative surveillance. The aim of this study was to prepare a scoping review to investigate how AI is being used in the analysis of radiographs following THA and TKA, and how accurate these tools are. The Embase, MEDLINE, and PubMed libraries were systematically searched to identify relevant articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews and Arksey and O’Malley framework were followed. Study quality was assessed using a modified Methodological Index for Non-Randomized Studies tool. AI performance was reported using either the area under the curve (AUC) or accuracy.Aims
Methods
To determine the trajectories of patient reported pain and functional disability over five years following total hip arthroplasty (THA) or total knee arthroplasty (TKA). A prospective, longitudinal cohort sub-study within the National Joint Registry (NJR) was undertaken. In all, 20,089 patients who underwent primary THA and 22,489 who underwent primary TKA between 2009 and 2010 were sent Oxford Hip Score (OHS) and Oxford Knee Score (OKS) questionnaires at six months, and one, three, and five years postoperatively. OHS and OKS were disaggregated into pain and function subscales. A k-means clustering procedure assigned each patient to a longitudinal trajectory group for pain and function. Ordinal regression was used to predict trajectory group membership using baseline OHS and OKS score, age, BMI, index of multiple deprivation, sex, ethnicity, geographical location, and American Society of Anesthesiologists grade.Aims
Methods
The aims of this study were to report the efficacy of revision surgery for patients with co-infective bacterial and fungal prosthetic joint infections (PJIs) presenting to a single institution, and to identify prognostic factors that would guide management. A total of 1189 patients with a PJI were managed in our bone infection service between 2006 and 2015; 22 (1.85%) with co-infective bacterial and fungal PJI were included in the study. There were nine women and 13 men, with a mean age at the time of diagnosis of 64.5 years (47 to 83). Their mean BMI was 30.9 kg/m2 (24 to 42). We retrospectively reviewed the outcomes of these PJIs, after eight total hip arthroplasties and 14 total knee arthroplasties. The mean clinical follow-up was 4.1 years (1.4 to 8.8).Aims
Patients and Methods
Recently, several synovial biomarkers have been introduced into
the algorithm for the diagnosis of a prosthetic joint infection
(PJI). Alpha defensin is a promising biomarker, with a high sensitivity
and specificity, but it is expensive. Calprotectin is a protein
that is present in the cytoplasm of neutrophils, is released upon
neutrophil activation and exhibits anti-microbial activity. Our
aim, in this study, was to determine the diagnostic potential of
synovial calprotectin in the diagnosis of a PJI. In this pilot study, we prospectively collected synovial fluid
from the hip, knee, shoulder and elbow of 19 patients with a proven
PJI and from a control group of 42 patients who underwent revision
surgery without a PJI. PJI was diagnosed according to the current diagnostic criteria
of the Musculoskeletal Infection Society. Synovial fluid was centrifuged
and the supernatant was used to measure the level of calprotectin
after applying a lateral flow immunoassay. Aims
Patients and Methods
The Unified Classification System (UCS) was introduced
because of a growing need to have a standardised universal classification
system of periprosthetic fractures. It combines and simplifies many
existing classification systems, and can be applied to any fracture
around any partial or total joint replacement occurring during or
after operation. Our goal was to assess the inter- and intra-observer
reliability of the UCS in association with knee replacement when
classifying fractures affecting one or more of the femur, tibia
or patella. We used an international panel of ten orthopaedic surgeons with
subspecialty fellowship training and expertise in adult hip and
knee reconstruction (‘experts’) and ten residents of orthopaedic
surgery in the last two years of training (‘pre-experts’). They
each received 15 radiographs for evaluation. After six weeks they
evaluated the same radiographs again but in a different order. The reliability was assessed using the Kappa and weighted Kappa
values. The Kappa values for inter-observer reliability for the experts
and the pre-experts were 0.741 (95% confidence interval (CI) 0.707
to 0.774) and 0.765 (95% CI 0.733 to 0.797), respectively. The weighted
Kappa values for intra-observer reliability for the experts and
pre-experts were 0.898 (95% CI 0.846 to 0.950) and 0.878 (95% CI
0.815 to 0.942) respectively. The UCS has substantial inter-observer reliability and ‘near
perfect’ intra-observer reliability when used for periprosthetic
fractures in association with knee replacement in the hands of experienced
and inexperienced users. Cite this article:
We evaluated the duration of hospitalisation,
occurrence of infections, hip dislocations, revisions, and mortality following
primary hip and knee replacement in 857 patients with Parkinson’s
disease and compared them with 2571 matched control patients. The
data were collected from comprehensive nationwide Finnish health
registers. The mean follow-up was six years (1 to 13). The patients
with Parkinson’s disease had a longer mean length of stay (21 days
[1 to 365] Cite this article:
In this systematic review, our aim was to explore
whether or not patients are able to return to athletic activity
following lower limb joint replacement. We also investigated any evidence
as to whether participation in athletic activity post-joint replacement
increases complications and reduces implant survival. A PubMed, Embase and Sports Discus search was performed using
the MeSH terms ‘Sport’, ‘Athletic’, ‘Athlete’, ‘Physical’, ‘Activity’,
‘Arthroplasty’, ‘Total Hip Replacement’, ‘Hip Resurfacing’, ‘Total
Knee Replacement’, ‘Unicompartmental Knee Replacement’ and ‘Unicondylar
Knee Replacement’. From this search, duplications were excluded,
the remaining abstracts were reviewed and any unrelated to the search
terms were excluded. The remaining abstracts had their full papers
reviewed. Following joint replacement, participation in sporting activity
is common principally determined by pre-operative patient activity
levels, BMI and patient age. The type of joint replaced is of less
significance. Total time spent performing activity does not change
but tends to be at a lower intensity. There is little evidence in
the literature of an association between high activity levels and
early implant failure. Cite this article:
In order to compare the effect of oral apixaban
(a factor Xa inhibitor) with subcutaneous enoxaparin on major venous
thromboembolism and major and non-major clinically relevant bleeding
after total knee and hip replacement, we conducted a pooled analysis
of two previously reported double-blind randomised studies involving 8464
patients. One group received apixaban 2.5 mg twice daily (plus placebo
injection) starting 12 to 24 hours after operation, and the other
received enoxaparin subcutaneously once daily (and placebo tablets)
starting 12 hours (± 3) pre-operatively. Each regimen was continued
for 12 days ( Apixaban 2.5 mg twice daily is more effective than enoxaparin
40 mg once daily without increased bleeding.
