Aims. Despite multiple trials and case series on hip hemiarthroplasty designs, guidance is still lacking on which implant to use. One particularly deficient area is long-term outcomes. We present over 1,000 consecutive cemented Thompson’s hemiarthroplasties over a ten-year period, recording all accessible patient and implant outcomes. Methods. Patient identifiers for a consecutive cohort treated between 1 January 2003 and 31 December 2011 were linked to radiographs, surgical notes, clinic letters, and mortality data from a national dataset. This allowed charting of their postoperative course, complications, readmissions, returns to theatre, revisions, and deaths. We also identified all postoperative attendances at the Emergency and Outpatient Departments, and recorded any subsequent skeletal injuries. Results. In total, 1,312 Thompson’s hemiarthroplasties were analyzed (mean age at surgery 82.8 years); 125 complications were recorded, necessitating 82 returns to theatre. These included 14 patients undergoing aspiration or manipulation under anaesthesia, 68 reoperations (5.2%) for debridement and implant retention (n = 12), haematoma evacuation (n = 2), open reduction for dislocation (n = 1), fixation of periprosthetic fracture (n = 5), and 48 revised stems (3.7%), for infection (n = 13), dislocation (n = 12), aseptic loosening (n = 9), persistent pain (n = 6), periprosthetic fracture (n = 4), acetabular erosion (n = 3), and metastatic bone disease (n = 1). Their status at ten years is summarized as follows: 1,180 (89.9%) dead without revision, 34 (2.6%) dead having had revision, 84 (6.6%) alive with the stem unrevised, and 14 (1.1%) alive having had revision. Cumulative implant survivorship was 90.3% at ten years; patient survivorship was 7.4%. Conclusion. The Thompson’s stem demonstrates very low rates of complications requiring reoperation and revision, up to ten years after the index procedure. Fewer than one in ten patients live for ten years after fracture. This study supports the use of a cemented Thompson’s implant as a cost-effective option for frail hip fracture patients. Cite this article: Bone Jt Open 2022;3(9):710–715

Revision Total Knee Arthroplasty (rTKA) is predicted to increase by more than 600% between 2005 and 2030. The survivorship of primary TKA has been extensively investigated, however more granular information on the risks of rTKA is needed. The aim of the study was to investigate the incidence of re-revision TKA, with explanatory variables of time from primary to revision, and indication (aseptic vs septic). Secondary aim was to investigate mortality. This is an analysis of the Scottish Arthroplasty Project data set, a national audit prospectively recording data on all joint replacements performed in Scotland. The period from 2000 to 2019 was studied. 4723 patients underwent revision TKA. The relationship between time from primary to revision TKA and 2nd revision was significant (p<0.001), with increasing time lowering probability of re-revision (OR 0.99 95% CI 0.987 to 0.993). There was no significant association in time to first revision on time from 1st revision to re-revision (p>0.05). Overall mortality for all patients was 32% at 10 years (95% CI 31-34), Time from primary TKA to revision TKA had a significant effect on mortality: p=0.004 OR 1.03 (1.01-1.05). Septic revisions had a reduced mortality compared to aseptic, OR 0.95 (0.71-1.25) however this was not significant (p=0.69). This is the first study to demonstrate time from primary TKA to revision TKA having a significant effect on probability of re-revision TKA. Furthermore the study suggests mortality is increased with increasing time from primary procedure to revision, however decreased if the indication is septic rather than aseptic

This study aims to determine the lifetime risk of revision surgery after primary knee arthroplasty (KA). The Scottish Arthroplasty Project dataset was utilised to identify all patients undergoing primary KA during the period 1998–2019. The cumulative incidence function for revision and death was calculated and adjusted analyses utilised cause-specific Cox regression modelling to determine the influence of patient-factors. The lifetime risk was calculated for patients aged between 45–99 years using multiple decrement lifetable methodology. The lifetime risk of revision ranged between 32.7% (95% Confidence Interval (CI) 22.62–47.31) for patients aged 45–49 years and 0.63% (95%CI 0.1–4.5) for patients aged over 90 years. Adjusted analyses demonstrated the converse effect of age on revision (Hazard Ratio (HR) 0.5, 95%CI 0.5–0.6) and death (HR 3.5, 95%CI 3.4–3.7). Male sex was associated with increased risks of revision (HR 1.1, 95%CI 1.1–1.2) and death (HR 1.4, 95%CI 1.3–1.4). Patients with inflammatory arthropathy had a higher risk of death (HR 1.7, 95%CI 1.7–1.8), but were less likely to be revised (HR 0.85, 95%CI 0.74–0.98) than those treated for osteoarthritis. Patients with greater number of comorbidities and greater levels of socio-economic deprivation were at increased risk of death, but neither increased the risk of revision. The lifetime risk of revision knee arthroplasty varies depending on patient sex, age at surgery and underlying diagnosis. Patients aged between 45 and 49 years have a one in three probability of revision surgery within their lifetime. Conversely, patients aged 90 years or over were very unlikely to experience revision

Introduction. Unicompartmental arthroplasty is still a controversial issue in knee replacement, mainly due to a marked variation in published survival rates of the implants. The aim of this study was to analyse possible risk factors for revision following Oxford unicompartmental knee arthroplasties (OUKA). Material and methods. Since 1997 data for all patients with primary and revision knee arthroplasties performed in our department have been stored in a database. Selected for the present study was all primary OUKA performed in the period 1997–2006 as well as any revision following these operations until the end of 2008. We got information from The National Health Register and the CPR register about any revision performed at other institutions and date in case of death. Primary OUKA were grouped in three categories according to the experience of the surgeon: 1 for operation done by a surgeon who had performed less than 20 OUKA, 2 for operation by a surgeon who had performed 20–40, and 3 for operation by a surgeon who had performed more than 40. Risk of revision was analysed by Cox regression. Revisions due to pain as the only reason were excluded from the analyses. Age and gender of the patients, previous surgical intervention, operation time, and the experience of the surgeon were included as possible risk factors in the analysis. Results. 445 primary Oxford knee arthroplasties were included. These were followed by 46 revisions. The indications for the revisions were: aseptic loosening 16 knees, progression of the osteoarthritis to the lateral compartment 7 knees, dislocation of the polyethylene meniscus 5 knees, varus-valgus instability 3 knees, fracture of the medial tibia condyle 3 knees, collision of the polyethylene meniscus and the femur condyle 1 knee, and pain as the only reason 11 knees. Age and gender of the patients as well as previous surgical intervention in the knee in question were not correlated to the risk of revision. Operation time was correlated to risk of revision with decreasing risk with increasing operation time (p=0,001). The experience of the surgeon was also correlated to risk of revision with decreasing risk with increasing experience (p=0,02). The 6 years survival rate for an experienced surgeon using an operation time at 90 min. or more was 97,5 % compared to a survival rate at 78,7 % for an inexperienced surgeon with an operation time less than 90 min. Conclusion. OUKA performed by an inexperienced surgeon and OUKA performed with short operation time had marked reduced survival rates. This seems to be an essential information to institutions performing OUKA

Revision hip arthroplasty presents a challenge in the setting of femoral bone loss. Tapered stems are susceptible to subsidence which leads to leg length inequality, hip instability and may necessitate repeat femoral revision surgery. The purpose of this study was to compare radiographic outcomes in two modular tapered revision systems with different distal stem geometries. We sought to establish the minimum postoperative stem bi-cortical contact length that predicts subsidence for tapered stems. This study examined revision total hip arthroplasties between 2009 and 2016 in a European university affiliated major trauma center. Modular stem A has a taper of 3 degrees whereas modular stem B has a taper of 2 degrees. Radiologic assessment compared x-rays at two time points: immediately post-surgery and most recent x-ray available at a minimum follow up of two years. Leg length discrepancy, subsidence and postoperative bi cortical contact was assessed. Descriptive summary statistics calculated clinical factors (i.e. age, gender, Paprosky classification). 122 arthroplasties were completed. Complete data was available for 112. Revisions were carried out for Paprovski grade 3a/ 3b femoral deficits. Post-operative bi-cortical contact of the proximal stem < 20mm was associated with higher subsidence rates (P = 0.047). Subsidence rates for implant A and B system were 4.27mm (0.12–25.62mm) and 3.43 mm (0.3–11.1 mm) respectively. Significant subsidence was noted in 9.8% (n=8) in implant A and 5.2%(n=2) in implant B. We conclude that immediate postoperative bi-cortical stem contact of <20mm was associated with significantly higher subsidence rates in this study

Introduction. There has been renewed interest in the unicompartmental knee arthroplasty with reports of good long term outcomes. Advantages over a more extensive knee replacement include: preservation of bone stock, retention of both cruciate ligaments, preservation of other compartments and better knee kinematics. However, a number of authors have commented on the problem of osseous defects requiring technically difficult revision surgery. Furthermore, a number of recent national register studies have shown inferior survivorship when compared to total knee arthroplasty. The purpose of this study was to review the cases of our patients who had a revision total knee arthroplasty for failed unicompartmental knee arthroplasty. To determine the reason for failure, describe the technical difficulties during revision surgery and record the clinical outcomes of the revision arthroplasties. Methods. Between 2003 and 2009 our institute performed thirty three revisions of a unicompartmental knee arthroplasty on thirty two patients. The time to revision surgery ranged from 2 months to 159 months with a median of 19 months. Details of the operations and complications were taken form case notes. Patient assessment included range of motion, need for walking aids and the functional status of the affected knee in the form of the Oxford knee score questionnaire. Results. The reasons for failure were aseptic loosening of tibial component, persistent pain, dislocated meniscus, mal-alignment and osteoarthritis in another compartment. Of the 33 revision knee arthroplasties 18 required additional intra-operative constructs. 11 knees required a long tibial stem while 1 required a long femoral stem. 10 knees required medial wedge augmentation and bone graft was used in 6. Mean 1 year Oxford knee scores for failed unicompartmental knee replacements was 29 compared to 39 for primary total knee replacements performed at the same institute. Of the revision knee replacements 2 required further revision due to infection and loosening. Conclusion. From the evidence of our group of failed unicompartmental knee replacements, revision surgery is technically difficult and often requires intra-operative constructs. Clinical outcome of revision total knee arthroplasty following failed unicompartmental knee arthroplasty is not comparable to primary total knee arthroplasty

Introduction. Infection after total hip arthroplasty is a severe complication. Controversies still exist as to the use of cemented or uncemented implants in the revision of infected THAs. Based on the data in the Norwegian Arthroplasty Register (NAR) we have studied this topic. Material and Methods. During the period 2002–2008 45.724 primary THAs were reported to NAR. Out of these 459 were revised due to infection (1,0%). The survival of the revisions with uncemented prostheses were compared to revisions with cemented prostheses with antibiotic loaded cement and to cemented prostheses with plain cement. Only prostheses with the same fixation both in acetabulum and in femur were included in the study. Cox-estimated survival and relative revision risks were calculated with adjustments for differences among groups in gender, type of surgical procedure, type of prosthesis, and age at revision. Results. 92 (23%) of all the revisions were performed with uncemented prostheses, 286 (71%) with cemented prostheses with antibiotic loaded cement, and 25 (6%) with plain cement. Compared to uncemented prostheses and with all reasons for revision as endpoint in the Cox-analyses, prostheses fixed with antibiotic loaded cement had 3.0 (1.4–6.3) times increased risk for re-revision (p=0.004) and prostheses with plain cement 1.9 (0.4–9.3) times increased risk (p=0.44). With infection as endpoint, prostheses with antibiotic loaded cement had 2.8 (1.2–6.4) times increased risk for re-revision (p=0.02) and prostheses with plain cement 2.6 (0.5–13.7) times increased (p=0.26). 77% of the re-revisions (48 of 60) were performed due to infection. Conclusion. Data in the Norwegian Arthroplasty Registry indicate that uncemented prostheses should be used in the revision of infected total arthroplasties

The Low Contact Stress (LCS) mobile-bearing total knee replacement (TKR) was designed to minimize polyethylene wear, aseptic loosening and osteolysis. However, registry data suggests there is a significantly greater revision rate associated with the LCS TKR. The primary aim of this study was to assess long-term survivorship of the LCS implant. Secondary aims were to assess survival according to mechanism of failure and identify predictors of revision. We retrospectively identified 1091 LCS TKRs that were performed between 1993 and 2006. There was incomplete data available 33 who were excluded. The mean age of the cohort was 69 (SD 9.2) years and there were 577 TKRs performed in females and 481 in males. Mean follow up was 14 years (SD 4.3). There were 59 revisions during the study period: 14 for infection, 18 for instability, and 27 for polyethylene wear. 392 patients died during follow up. All cause survival at 10-year was 95% (95%CI 91.7–98.3) and at 15-year was 93% (95%CI 88.6–97.8). Survival at 10-years according to mechanism of failure was: infection 99% (95%CI 94–100%), instability 98% (95%CI 94–100%), and polyethylene wear 98% (95%CI92–100). Of the 27 with polyethylene wear only 19 had associated osteolysis requiring component revision, the other 8 had simple polyethylene exchanges. Cox regression analysis, adjusting for confounding variables, identified younger age was the only predictor of revision (hazard ratio 0.96, 95%CI 0.94–0.99, p=0.003). The LCS TKR demonstrates excellent long-term survivorship with a low rate of revision for osteolysis, however the risk is increased in younger patients

Background. A number of studies have reported on the early failure of the Oxford unicompartmental knee arthroplasty. However, less evidence is available regarding the outcome following revision of failed unicompartmental knee prostheses to total knee arthroplasty. The aims of this study were to determine the time to failure for the Oxford unicompartmental knee arthroplasty and to assess the short-term outcome following revision surgery. Methods. Details of consecutive patients undergoing revision of an Oxford unicompartmental knee arthroplasty to a total knee arthroplasty at our centre between January 2000 and December 2009 were collected prospectively. Data was collected on patient demographics, indication for revision surgery, and time to revision from the index procedure. Clinical and radiological outcome following revision arthroplasty was also assessed. Results. During the study period 22 (4.5%) of 494 Oxford unicompartmental knee arthroplasties were revised to a total knee arthroplasty. Mean age at the time of revision surgery was 61.8 yr and 13 (59%) patients were male. Mean time to revision surgery from the primary procedure was 3.0 yr (range 0.6–6.2 yr). The commonest reasons for revision were aseptic loosening of the femoral (n=9) or tibial component (n=2), and undiagnosed (n=5) or patellofemoral pain (n=2). All patients were revised to a cemented total knee arthroplasty with most not requiring bone grafts. During follow-up (range 0.5–4.5 yr) no further surgery was performed in the 22 patients. In addition, there were no major postoperative complications and no evidence of radiological failure. Discussion. The present study demonstrates most failures of the Oxford unicompartmental knee arthroplasty occur within three to four years following the index procedure and are due to aseptic component loosening. These findings are consistent with other published reports regarding the early failure of this particular prosthesis. The short-term outcome following revision surgery appears to be good, however longer follow-up periods are required to determine if these good results continue

The posterior approach to the hip avoids violating abductors and has presumed functional advantages. The anterolateral approach risks abductor damage, but has reportedly lower dislocation rate. To determine effects of surgical approach on function and dislocation after primary and revision THR 3274 primary THRs and 66 first time revision THRs were investigated from the arthroplasty database (2000–2008). 2682 (82%) primary THRs were via anterolateral approach, 592 (18%) by posterior. Post primary dislocation rate was 50/2682 (1.9%) for anterolateral and 26/592 (4.4%) for posterior. Posterior approach had significantly better Harris Hip Scores: 91 vs 88 (P = 0.000) and function: 40 vs 37 (P = 0.000). Of the 66 revisions THRs, 30 were anterolateral and 36 posterior. Dislocation rates were 2/30 (6.7%) and 4/36 (11.1%) respectively. There was no significant difference in Harris Hip Score or Harris Hip Function 1 year after revision based on revision surgery approach. However there was a significant difference in Harris Hip Function 1 year after revision based on the approach for primary surgery (Anterolateral 30 vs Posterior 37, P=0.008) and a similar trend in Harris Hip Score (Anterolateral 79 vs Posterior 85, P = 0.198) and patients who had posterior approach for both primary and revision had the best scores overall. The clinical relevance of the modest, but statistically significant difference in Harris hip score after primary THR is unclear. That primary approach has an impact on function after revision suggests the posterior approach should be considered in younger patients likely to require revision in the future

The primary aim of this study was to compare the knee specific functional outcome of partial compared with total knee replacement (TKR) for the management of patellofemoral osteoarthritis. Fifty-four consecutive Avon patellofemoral replacements were identified and propensity score matched to a group of 54 patients undergoing a TKR with patella resurfacing for patellofemoral osteoarthritis. The Oxford knee score (OKS), the Short Form (SF-) 12 and patient satisfaction were collected (mean follow up 9.2 years). Survival was defined by revision or intention to revise. There was no significant difference in the OKS (p>0.60) or SF-12 (p>0.28) between the groups. The TKR group was significantly less likely to be satisfied with their knee (95.1% versus 78.3%, OR 0.18, p=0.03). Length of stay was significantly (p=0.008) shorter for the Avon group (difference 1.8 days, 95% CI 0.4 to 3.2). The 10 year survival for the Avon group was 92.3% (95% CI 87.1 to 97.5) and for the TKR group was 100% (95% CI 93.8 to 100). There was no statistical difference in the survival rate (Log Rank p=0.10). The Avon patellofemoral replacement have a shorter length of stay with a functional outcome and satisfaction rate that is equal to that of TKR. The benefits of the Avon need to be balanced against the increased rate of revision when compared with TKR

Introduction. Numerous types of graft can be used for revision of anterior cruciate ligament (ACL) reconstruction. The goal of our studies was to analyze mid term outcomes of revision of anterior cruciate ligament reconstructions conducted by means of ipsilateral bone -patellar tendon -bone (B-PT-B) transplant. Materials and methods. We conducted a retrospective study on a consecutive series of 44 patients. All patients were operated on by the same senior surgeon in our institution between 2003 and 2009. All patients had undergone a first ACL reconstruction with B-PT-B transplant. They all had ACL revision under arthroscopic assistance and by means of ipsilateral B-PT-B transplant after a minimum of 18 months after primary surgery. At time of ACL revision, the mean patients age was 28 years (range, 17–49 years). The average postoperative follow up after revision was 55 months (range, 12–88 months). We had no patient lost to follow up. All patients were evaluated by an independent observer using IKDC scoring system and KT 2000. Results. The postoperative IKDC score averaged 78.2 (range, 41,4–97,7). 10 patients (22.7%) had their knee graded A, 25 patients (56.8%) grade B, 8 patients (18.2%) grade C and one patient (2.3%) grade D. The post operative maxi manual differential KT 2000 averaged 1,52 mm (range, −1mm/12mm). The identified aetiologies for poor clinical outcomes were menisectomy in the first ACL reconstruction (p<0.01) and articular cartilage lesions (ICRS grade III and IV) found during ACL revision. In most cases, return to sport activities was achieved but not at the same level. We had no specific complication after second harvesting of the patellar tendon. Discussion. The type of graft used in revision of ACL reconstructions is a controversy. In the literature, many studies reported the results of revision of ACL reconstructions but with poor methodology and few data for every type of graft. In our study, we found clinical results comparable to those classically reported in the literature. Clinical evaluation showed good control of the laxity and no specific patellar tendon complication. Conclusion. The clinical results of revision of ACL reconstructions is lower than in primary surgery. We did not noticed specific patellar tendon complication after second harvesting of BPTB transplant. The revision of ACL reconstruction with ipsilateral BPTB transplant showed good clinical results and good control of the anteroposterior laxity

Two stage revision for infection is considered the gold standard with a success rate of 80–90%. Overall functional outcomes of these patients are commonly overlooked. There is a trend towards single stage revision to improve functional outcomes. We examined the functional scores of 2 stage revision for total hip arthroplasty (THR) and total knee arthroplasty (TKR). 72 revisions were identified over 9 years: 30 THR and 42 TKR. Two year survivorship was 96% in THR revision and 88% TKR revision. Five year survival was 83% and 84% respectively. 50 patients (without recurrence of infection) had recorded functional scores at a minimum of 1 year. The mean Harris-hip score (HHS) of THR was 75 (21 patients) prior to developing symptoms of infection. Once infected, the mean score fell to 46. At 1 year post revision it returned to 77. At 3 years HHS of 78 (12 patients) and at 5 yrs 62 (3 patients). The mean knee society score (KSS) of TKR was 66 (29 patients) prior to developing symptoms of infection. Once infected, the mean score fell to 34. At 1 year post revision it returned to 73. At 3 years KSS of 76 (16 patients) and at 5 years 62 (10 patients). We conclude that functional scores of staged revisions of infected THR and TKR return to pre-morbid levels within a year of completing the second stage. Although single stage revision may have a quicker return to function, by 1 year, staged revision has comparable results

Introduction. Acetabular bone deficiency presents one of the most challenging problems during revision hip arthroplasty. A variety of surgical options and techniques are available including impaction bone grafting. We present our medium to long-term experience of 68 consecutive hips in 64 patients who had acetabular revision using impacted cancellous bone grafting with bone cement with a mean follow up of 10.5 ±3.75) years (range 5.1 to 17.7 years). Methods. Patients' undergoing acetabular bone grafting during revision hip arthroplasty prior to insertion of a cemented cup between 1993 and 2000 were evaluated. Pre-operative, immediate post-operative, 1 year post-op and final follow-up radiographs were evaluated. The pre-operative bone loss was graded according to the AAOS and Paprosky classifications. The presence of radiolucencies, alignment and incorporation of bone graft were evaluated. The Harris Hip Score (HHS) was used to assess clinical outcome. 13 patients who were unable to attend the department were contacted for a telephone interview. Analysis of the Data was carried out using SPSS17 [SPSS Inc. Chicago, Illinois]. Results. 64 consecutive patients (68 hips) were evaluated with an average age of 69.9 (± 10.24) years. At the mean follow up of 10.5 years [5.1–17.7 years] Kaplan-Meier survivorship analysis predicted a rate of survival of the acetabular component of 95.5% (95% confidence interval (CI) 92 to 99) at 10 years, with revision for any reason as the endpoint. The median Harris hip score at final follow up was 79.5 [IQR 67.9–80.45]. Neither the extent of initial defect or acetabular inclination were related to clinical outcome or predicted further revision. Progression of the radiololucent zones between the cement bone interface was a predictor of loosening and further revision. Discussion. Our findings have shown that acetabular revision using impacted cancellous bone graft and a cemented acetabular component remains a reliable and successful technique for patients with poor femoral bone stock

Introduction. Revision type arthroplasties for the treatment of knee osteoarthritis is an effective and secure procedure. It has different indications, but the most relevant is the revision of a failured primary arthroplasty. In our study, we reviewed the results of another indication, the implantation of a revision type arthroplasty as a primary procedure in cases of severe deformities. Objectives. To assess the radiological, clinical and functional situation and the quality of life of those patients in whom a revision knee arthroplasty had been implanted in the past years. Materials and Methods. We did a retrospective study of 108 knee arthroplasties (80% women) implanted between 1999 and 2005 with a mean follow up of 7.8 years. The mean age of the patients at the time of surgery was 75 years old (60–87). The most frequent indication for a revision type arthroplasty was an important valgum deformity osteoarthritis. We assess the functional and clinical situation using the Knee Society Score, both clinical and functional; the radiological situation using the Knee Society Roentgenographic evaluation and the quality of life using the Short Form 12 (SF12). We have analyzed the survivorship rate of our arthroplasties as well. Results. We could contact 75 patients. 20 had died in the past years without any new surgeries in the knee; we could not contact 13 patients due to lost of follow up. The survivalship rate of the arthroplasties is 91% at the time of follow up. In the cases of severe valgum or varum malalignment, a phisiological valgum angle (5.47°) was achieved in all of the patients. 77.4% of the patients declared themselves as satisfied or very satisfied in the last follow up. The results of the KSS-Clinical were excellent or good in 87.1% of the patients while in the KSS- Functional was 77.5%. The mean SF12 score was 20.68 out of 60 points. Conclusions. The clinical and functional results are overall good or very good, as well as the quality of life, in those patients in which a revision arthroplasty had been implanted instead of a conventional primary arthroplasty, when it was correctly indicated. So a revision type arthroplasty should be considered for the treatment of knee osteoarthritis in cases of severe bone deformities or severe malalignment

Methicillin Resistant Staphylococcus Aureus (MRSA) screening has reduced rates of MRSA infection in primary total hip (THR) and total knee (TKR) replacements. There are reports of increasing methicillin resistance (MR) in Coagulase Negative Staphylococci (CNS) causing arthroplasty infections. We examined microbiological results of all 2-stage THR/TKR revisions in Tayside from 2001–2010. 72 revisions in 67 patients were included; 30 THRs and 42 TKRs. Mean ages at revision were 89 and 72 years respectively. Male: female ratio 1.4:1.2-year survivorship for all endpoints: 96% in THRs and 88% in TKRs. 5-year survival: 83% and 84% respectively. The most common organisms were SA (30%) and CNS (29%). Antibiotic resistance was more common amongst CNS. 72% of CNS were resistant to Methicillin versus 20% of SA. 80% of CNS were resistant to Gentamicin OR Methicillin versus 20% of SA. 32% (8/72 cases or 11% overall) of CNS were resistant to BOTH Gentamicin AND Methicillin, the primary arthroplasty antibiotic prophylaxis in our region, versus 4% of SA. Harris Hip Scores and Knee Society Scores were lower post primary, prior to symptoms of infection in patients who had MR organisms cultured compared with those who had methicillin sensitive organisms. One-year post revision both groups recovered to similar scores. Our data suggest MR-CNS cause significantly more arthroplasty infections than MRSA. Patients developing MR infections tend to have poorer post-primary knee and hip scores before symptoms of infection fully develop. 32% of CNS causing arthroplasty infections in our region are resistant to current routine primary antibiotic prophylaxis

AIM

Failure of a primary anterior cruciate ligament (ACL) reconstruction is associated with poor functional outcomes even after revision surgery. The aim of this study is to identify early predictors for failure, so that it may aid in recognition of at-risk patients.

Aims. The aim of this study was to investigate the rate of revision for distal femoral arthroplasty (DFA) performed as a primary procedure for native knee fractures using data from the Australian Orthopaedic Association National Joint Arthroplasty Registry (AOANJRR). Methods. Data from the AOANJRR were obtained for DFA performed as primary procedures for native knee fractures from 1 September 1999 to 31 December 2020. Pathological fractures and revision for failed internal fixation were excluded. The five prostheses identified were the Global Modular Arthroplasty System, the Modular Arthroplasty System, the Modular Universal Tumour And Revision System, the Orthopaedic Salvage System, and the Segmental System. Patient demographic data (age, sex, and American Society of Anesthesiologists grade) were obtained, where available. Kaplan-Meier estimates of survival were used to determine the rate of revision, and the reasons for revision and mortality data were examined. Results. The AOANJRR identified 153 primary DFAs performed for native knee fractures in 151 patients during the study period, with 63.3% of these (n = 97) performed within the last five years. The median follow-up was 2.1 years (interquartile range 0.8 to 4.4). The patient population was 84.8% female (n = 128), with a mean age of 76.1 years (SD 11.9). The cumulative percent revision rate at three years was 10%. The most common reason for revision was loosening, followed by infection. Patient survival at one year was 87.5%, decreasing to 72.8% at three years postoperatively. Conclusion. The use of DFA to treat native knee fractures is increasing, with 63.3% of cases performed within the last five years. While long-term data are not available, the results of this study suggest that DFA may be a reasonable option for elderly patients with native knee fractures where fixation is not feasible, or for whom prolonged non-weightbearing may be detrimental. Cite this article: Bone Joint J 2022;104-B(7):894–901

The aim of this study was to measure the effect of hospital case volume on the survival of revision total hip arthroplasty (RTHA). This is a retrospective analysis of Scottish Arthroplasty Project data, a nationwide audit which prospectively collects data on all arthroplasty procedures performed in Scotland. The primary outcome was RTHA survival at ten years. The primary explanatory variable was the effect of hospital case volume per year on RTHA survival. Kaplan-Meier survival curves were plotted with 95% confidence intervals (CIs) to determine the lifespan of RTHA. Multivariate Cox proportional hazards were used to estimate relative revision risks over time. Hazard ratios (HRs) were reported with 95% CI, and p-value < 0.05 was considered statistically significant. From 1999 to 2019, 13,020 patients underwent RTHA surgery in Scotland (median age at RTHA 70 years (interquartile range (IQR) 62 to 77)). In all, 5,721 (43.9%) were female, and 1065 (8.2%) were treated for infection. 714 (5.5%) underwent a second revision procedure. Co-morbidity, younger age at index revision, and positive infection status were associated with need for re-revision (p<0.001). The ten-year survival estimate for RTHA was 93.3% (95% CI 92.8 to 93.8). Adjusting for sex, age, surgeon volume, and indication for revision, high hospital case volume was not significantly associated with lower risk of re-revision (HR1, 95% CI 1.00 to 1.00, p 0.073)). The majority of RTHA in Scotland survive up to ten years. Increasing yearly hospital case volume cases is not independently associated with a significant risk reduction of re-revision

Aims. The aim of this study was to describe the management and associated outcomes of patients sustaining a femoral hip periprosthetic fracture (PPF) in the UK population. Methods. This was a multicentre retrospective cohort study including adult patients who presented to 27 NHS hospitals with 539 new PPFs between 1 January 2018 and 31 December 2018. Data collected included: management strategy (operative and nonoperative), length of stay, discharge destination, and details of post-treatment outcomes (reoperation, readmission, and 30-day and 12-month mortality). Descriptive analysis by fracture type was performed, and predictors of PPF management and outcomes were assessed using mixed-effects logistic regression. Results. In all, 417 fractures (77%) were managed operatively and 122 (23%) conservatively. The median time to surgery was four days (interquartile range (IQR) 2 to 7). Of those undergoing surgery, 246 (59%) underwent revision and/or fixation and 169 (41%) fixation alone. The surgical strategy used differed by Unified Classification System for PPF type, with the highest rate of revision in B2/B3 fractures (both 77%, 176/228 and 24/31, respectively) and the highest rate of fixation alone in B1- (55/78; 71%) and C-type (49/65; 75%) fractures. Cemented stem fixation (odds ratio (OR) 2.66 (95% confidence interval (CI) 1.42 to 4.99); p = 0.002) and B2/B3 fracture type (OR 7.56 (95% CI 4.14 to 13.78); p < 0.001) were predictors of operative management. The median length of stay was 15 days (IQR 9 to 23), 12-month reoperation rate was 5.6% (n = 30), and 30-day readmission rate was 8.4% (n = 45). The 30-day and 12-month mortality rates were 5.2% (n = 28) and 21.0% (n = 113). Nonoperative treatment, older age, male sex, admission from residential or nursing care, and sustaining the PPF around a revision prosthesis were significant predictors of an increased 12-month mortality. Conclusion. Femoral hip PPFs have mortality, reoperation, and readmission rates comparable with hip fracture patients. However, they have a longer wait for surgery, and surgical treatment is more complex. There is a need to create a national framework for data collection for this heterogeneous group of patients in order to understand the outcomes of different approaches to treatment. Cite this article: Bone Joint J 2022;104-B(8):997–1008