Biological repair of acetabular bone defects after impaction bone grafting (IBG) in total hip arthroplasty could facilitate future re-revisions in case of failure of the reconstruction again using the same technique. Few studies have analysed the outcome of these acetabular re-revisions. We analysed 34 consecutive acetabular re-revisions that repeated IBG and a cemented cup in a cohort of 330 acetabular IBG revisions. Fresh-frozen femoral head allografts were morselized manually. All data were prospectively collected. Kaplan-Meier survivorship analysis was performed. The mean follow-up after re-revision was 7.2 years (2–17). Intraoperative bone defect had lessened after the first failed revision. At the first revision there were 14 hips with Paprosky 3A and 20 with Paprosky type 3B. At the re-revision there were 5 hips with Paproky 2B, 21 with Paprosky type 3A and 8 with type 3B. Lateral mesh was used in 19 hips.Introduction
Patients and Methods
Introduction. Acetabular component loosening with associated bone loss is a challenge in revision hip arthroplasty. Trabecular Metal (TM) by Zimmer Biomet has been shown to have greater implant survivorship for all-cause acetabular revision in small cohort retrospective studies. Our study aims to review outcomes of acetabular TM implants locally. Method. This is a retrospective observational study using data from Auckland City and North Shore Hospitals from 1st of January 2010 to 31st of December 2020. Primary outcome is implant survivorship (re-revision acetabular surgery for any cause) demonstrated using Kaplan-Meier analysis. Secondary outcome is indication for index revision and
Background. Two-stage revision arthroplasty is the standard treatment for chronic hip and knee periprosthetic joint infections (PJI). Accurate diagnosis of persistent infections at 2nd stage using established biomarkers and diagnostic criteria is of paramount importance. This study aimed to evaluate the diagnostic value of synovial calprotectin and alpha-defensin, and compare established diagnostic criteria from the International Consensus Meeting (ICM 2018) and the European Bone and Joint Infection Society (EBJIS 2021) to determine persistent PJI at the 2nd stage of a two-stage revision arthroplasty. Methods. We retrospectively analyzed 97 patients who underwent 100 two-stage revisions (hip: 39, knee: 61). Synovial fluid samples were assessed for calprotectin and alpha-defensin levels. ICM 2018 and EBJIS 2021 were applied to all patients undergoing 2nd stage revision. Receiver operating characteristic (ROC) curves and Youden Index were utilized to determine optimal cut-off values, and correlations between biomarkers were evaluated. The microbiological spectrum was analyzed at 2nd stage and
Aim. In severe cases of postoperative spinal implant infections (PSII) multiple revision surgeries may be needed. Little is known if changes of the microbiological spectrum and antibiotic resistance pattern occur between revision surgeries. Therefore, the aim of this study was to analyze the microbiological spectrum and antibiotic resistance pattern in patients with multiple revision surgeries for the treatment of PSII. Furthermore, changes of the microbiological spectrum, distribution of mono vs. polymicrobial infections, and changes of the antimicrobial resistance profile in persistent microorganisms were evaluated. Method. A retrospective analysis of a prospectively maintained single center spine infection database was performed with a minimum follow-up of 3 years. Between 01/2011 and 12/2018, 103 patients underwent 248 revision surgeries for the treatment of PSII. Overall, 20 patients (6 male/14 female) underwent 82 revisions for PSII (median 3; range 2–12). There were 55/82 (67.1%) procedures with a positive microbiological result. Microbiological analysis was performed on tissue and implant sonication fluid. Changes in microbial spectrum and antibiotic resistance pattern between surgeries were evaluated using Chi-Square and Fisher's exact test. Results. In total, 74 microorganisms (83.3% gram-positive; 10.8% gram-negative) were identified. The most common microorganisms were Staphylococcus epidermidis (18.9%) and Cutibacterium acnes (18.9%). All S. epidermidis identified were methicillin-resistant (MRSE). Overall, there were 15/55 (27.3%) polymicrobial infections. The microbiological spectrum changed in 57.1% (20/35) between the revision stages over the entire PSII period. In 42.9% (15/35) the microorganism persisted between the revision surgeries stages. Overall, changes of the antibiotic resistance pattern were seen in 17.4% (8/46) of the detected microorganisms comparing index revision and all subsequent re-revisions. Moreover, higher resistance rates were found for moxifloxacin and for ciprofloxacin at first
Aim. Little is known about microbiological spectrum and resistance patterns as well as the clinical outcome in patients who undergo a repeat first stage procedure as part of a 2-stage revision arthroplasty for the treatment of periprosthetic hip and knee joint infections. Methods. Between 2011 and 2019, a total of 327 2-stage revision arthroplasties were performed on 312 patients with PJI of the knee and hip at our institution. We performed a retrospective analysis of all patients, who underwent a repeat first stage procedure regarding re-revision rate, host factors, culture negative and positive stages, monomicrobial and polymicrobial infections as well as microbiological spectrum and antimicrobial resistance patterns. Results. Overall, 52/312 (16.7%) patients (27 knee/25 hip) underwent a repeat first stage procedure. There were 35/52 (67.3%) culture positive first, 17/52 (32.7%) culture positive repeat first and 12/52 (23.1%) culture positive second stage procedures. In 13/52 (25%) patients a
Background. Postoperative dislocation is one of the main surgical complications and the primary cause for revision surgery after 2-stage implant exchange due to periprosthetic infection of a total hip arthroplasty. Objective. The aims of our study were (1) to determine the incidence of dislocation after two-stage THA reimplantation without spacer placement, (2) to evaluate relevant risk factors for dislocation and (3) to assess the final functional outcome of those patients. Method. We prospectively analyzed 187 patients who underwent a two-stage total hip arthroplasty (THA) revision after being diagnosed with periprosthetic joint infection (PJI) from 2013 to 2019. The mean duration of follow-up was 54.2 ± 24.9 months (>36 months). The incidence of postoperative dislocation and subsequent revision was estimated through Kaplan-Meier curves and potential risk factors were identified using Cox hazard regression. The functional outcome of the patients was assessed using the modified Harris Hip Score (mHHS). Results. The estimated cumulative dislocation-free survival was 87.2% (95% CI: 81.2%-91.3%) with an estimated 10% and 12% risk for dislocation within the first 6 and 12 months, respectively. The use of a dual-mobility construct had no significant impact on the dislocation rate. Increasing body mass index (BMI) (HR=1.11, 95% CI: 1.02-1.19, p=0.011), abductor mechanism impairment (HR=2.85, 95% CI: 1.01-8.01, p=0.047), the extent of elongation of the affected extremity between stages (HR=1.04, 95% CI: 1.01-1.07, p=0.017), the final leg length discrepancy (HR=1.04, 95% CI: 1.01-1.08, p=0.018) and PJI recurrence (HR=2.76, 95% CI: 1.00-7.62, p=0.049) were found to be significant risk factors for dislocation. Overall revision rates were 17% after THA reimplantation. Dislocated hips were 62% more likely to undergo
Aim. Analysis of microbiological spectrum and resistance patterns as well as the clinical outcome of patients who underwent a Debridement, antibiotics and implant retention (DAIR) procedure in the early phase following failed two-stage exchange arthroplasty of the knee and hip. Method. Of 312 patients treated with two-stage exchange arthroplasty between January 2011 and December 2019, 16 (5.1%) patients (9 knee, 7 hip) underwent a DAIR procedure within 6 months following second stage. We retrospectively analyzed the microbiological results as well as changes in the microbiological spectrum and antibiotic resistance patterns between stages of two-stage exchange arthroplasties and DAIR procedures. Patient's re-revision rates after a minimum follow-up of 12 months following DAIR procedure were evaluated. Moreover, differences between knee and hip and between infected primary total joint replacement (TJRs) and infected revision TJRs as well as patient's host factors and microbiological results regarding the outcome of DAIR were analyzed. Results. In 7/16 (43.8%) patients the first and second stage procedure was culture positive, in 5/16 (31.2%) patients the first and second stage procedure was culture negative and in 4/16 (25%) patients the first stage procedure was culture positive, and the second stage procedure was culture negative. Moreover, 6 (37.5%) out of 16 DAIR procedures showed a positive microbiological result. In 5/7 (71.4%) patients with culture positive second stage procedure a different microorganism compared to first stage procedure was detected. In 6/6 (100%) patients with culture positive DAIR procedure, the isolated microorganisms were not detected during first or second stage procedure. An additional
Aim.
Background. Highly porous acetabular components are widely used in revision hip surgery. The purpose of this study is to compare the mid-term survivorship, clinical and radiological outcomes of a hemispherical cup (Stryker Tritanium Revision component) and a peripherally expanded cup (Zimmer TM modular component) in revision hip surgery. Methods. Between 2010 and 2017, 30 patients underwent revision hip replacement using a hemispherical cup and 54 patients using a peripherally expanded cup. The surgery was carried out by two arthroplasty surgeons, both fellowship-trained in revision hip surgery. Kaplan-Meier analysis was used to determine the survivorship of the components. Clinical outcomes were measured using the Oxford Hip Score. Radiographs were analysed for the presence of radiolucent lines in the DeLee and Charnley zones. Results. Follow up of both components ranged from 2 – 8 years. All the hemispherical cups were reinforced with screws whilst 86% of the peripherally expanded cups required screws. Four (13%) of the hemispherical cups required
Introduction. Solid or cystic pseudotumour is a potentially destructive complication of metal on metal (MoM) couples, usually needing revision surgery. However, complete clearance of the pseudotumour is unlikely at times. This prospective case-controlled study reports cases which had recurrence after revision surgery for pseudotumour related to metal on metal hip couples. Methods. A total of 37 hips (33 MoM hip resurfacing and four big head MoM total hip arthroplasty (THA)) were revised for pseudotumour during the last 10 years. The patient demographics, time to revision, cup orientation, operative and histological findings were recorded for this cohort. Patients were divided into two groups - group R (needing re-revision for disease progression) and group C (control - no evidence of disease progression). Oxford hip scores (OHS, 0–48, 48 best outcome) were used to assess clinical outcome. The diagnosis of disease progression was based on recurrence of clinical symptoms, cross-sectional imaging, operative and histological findings. Results. Nine of 37 (24%) patients identified with worsening symptoms, eight underwent further
Isolated liner and head exchange procedure has been an established treatment method for polyethylene wear and osteolysis when the acetabular component remains well-fixed. In this study, its mid-term results were evaluated retrospectively in 34 hips. Among the consecutive patients operated upon from September 1995, 2 patients (3 hips) were excluded because of inadequate follow-up and the results of remaining 34 hips of 34 patients were evaluated. They were 20 men and 14 women with a mean age of 49 years at the time of index surgery. Conventional polyethylene liner was used in 26 cases and highly cross-linked polyethylene liner was used in 8 cases. In 3 cases, liner was cemented in the metal shell because compatible liner could not be used. After a minimum follow-up of 5 years (range, 5∼20.2),
Introduction. Highly cross-linked polyethylene has been introduced to decrease osteolysis secondary to polyethylene wear debris generation, but there are few long-term data on revision total hip arthroplasty using highly cross-linked polyethylene liners. The purpose of this study was to report the long-term radiographic and clinical outcomes of a highly cross-linked polyethylene liner in revision total hip arthroplasty. Materials & Methods. We analyzed 63 revision total hip arthoplasties that were performed in 63 patients using a highly cross-linked polyethylene liner between April 2000 and February 2005. Of these, nine died and four were lost to follow-up before the end of the 10-year evaluation. Thus, the final study cohort consisted of 50 patients (50 hips). There were 26 males and 24 females with a mean age at time of revision total hip arthoplasty of 53 years (range, 27–75 years). Mean duration of follow-up was 11 years (range, 10–14 years). Results. Mean Harris hip score improved from 44 points preoperatively to 85 points at final follow-up. No radiographic evidence of osteolysis was found in any hip. One hip required
Purpose. Clinical outocome of revision total elbow arthroplasty(TEA) in rheumatoid arthritis(RA) patients were evaluated. Methods. Clinical outocome of revision TEA that underwent between 2005 and 2013 were evaluated. Causes of revision, implanted revised prosthesis, a clinical score (the Japanese Orthopaedic Association (JOA) elbow assessment score), the arc of motion and complications were investigated. Totally, 6 patients underwent revision TEA. The patients were females with a mean age of 60.4 years (range, 32 to 72). Results. Seventy-two primary TEAs were done in corresponding period. Six out of 72 (8.3%) TEAs were revised. Causes of revision were loosening, instability (dislocation) and breakage of a component in 3, 2 and 1 cases, respectively. A mean duration from initial TEA to revision surgery was 10.3 years (range, 1 to 13). Semi-constrained arthroplasties (5 Coonrad-Morrey, 1 Discovery) were used for revision surgery. A mean JOA elbow assessment score improved from 59 to 81 point at the time of follow up. The mean ROM, flexion was improved 125 degrees, to 131 degrees. Extension, supination and pronation was not changed. A fracture at the time of implant withdrawal occurred as an intraoperative complication. The fractures were recovered by wiring with autologous bone graft from the ilium and a good bone union was achieved in 2 out of 3 cases. However, a
The purpose of the following study was to present the general strategy for preserving the lower extremity by knee arthrodesis and to analyze the outcome of knee arthrodeses performed by a special modular system. Between 2009 and 2014 35 knee arthrodeses were performed. 23 patients were male, 12 female. The average age was 66 years (42 to 83 years). The patients underwent an average of 6 operations because of infected knee arthroplasties previous to the knee arthrodesis. The main pathogen was S. epidermidis followed by MRSA. The arthrodeses system included a non cemented femoral and tibial stem (press fit application plus two static locking screws). These were connected by a special stem to stem clamp. Immediate postoperative full weight-bearing was possible in 32 of 35 patients. We saw 4 recurrent infections (all connected to the patients, who did not show a full weight bearing after knee arthrodesis). In two cases
Introduction. We present the outcome of 297 acetabular revisions using bone grafting and cemented acetabular components in 297 patients, with a mean follow-up of 8 years 3 months (5–20 years). Methods. All patients underwent acetabular revision with allograft bone grafting and insertion of cemented acetabular components. Of the 297 patients, 134 patients (45%) were male and 163 (55%) were female. The mean age of undergoing revision surgery with bone grafting was 60 years (25–87 years). The mean weight at revision surgery was 71.9 kg (40–128 kg). Post-operatively, all patients were reviewed regularly in out-patients, where they were examined clinically for any complications and their radiographs were examined for evidence of graft union, radiological lucency and cup migration. Results. Post-operatively, 61 patients suffered from early complications, which were defined as complications within one year of surgery. These included 15 dislocations (5%), 12 trochanteric non-unions (4%), 2 deep infection (0.7%), and 32 medical complications (11%). Thirty six patients (12%) have subsequently undergone
The clinical results of the cemented Exeter stem in primary hip surgery have been excellent. The Exeter ‘philosophy’ has also been extended into the treatment of displaced intracapsular hip fractures with ‘cemented bipolars’ and the Exeter Trauma Stem (Howmedica). We have identified an increase in the number of periprosthetic fractures that we see around the Exeter stem. We have also identified a particular group of patients with comminuted fractures around ‘well fixed’ Exeter stems after primary hip surgery that present a particular difficult clinical problem. Prior to fracture, the stems are not loose, the cement mantle remains sound and bone quality surrounding the reconstruction is good, i.e. classifying it as a Vancouver B1. However the comminuted nature of the fracture makes reduction and fixation with traditional methods difficult. Therefore in these particular circumstances it is often better to manage these as B2 or even B3 fractures, with distal bypass and uncemented reconstruction. Over an eleven-year period since 1999, 185 patients have been admitted to Nottingham University Hospitals with a periprosthetic femoral fracture around a hip replacement. These patients were identified from a prospective database of all trauma patients admitted to the institution. Of these patients we have identified a cohort of 21 patients (11%) with a periprosthetic fracture around an Exeter polished stem. Hospital notes were independently reviewed and data retrieved. Outcome data was collected with end points of fracture union,
