There are no recent studies comparing cable with wire for the fixation of osteotomies or fractures in total hip replacement (THR). Our objective was to evaluate the five-year clinical and radiological outcomes and complication rates of the two techniques. We undertook a review including all primary and revision THRs performed in one hospital between 1996 and 2005 using cable or wire fixation. Clinical and radiological evaluation was performed five years post-operatively. Cables were used in 51 THRs and wires in 126, and of these, 36 THRs with cable (71%) and 101 with wire (80%) were evaluated at follow-up. The five-year radiographs available for 33 cable and 91 wire THRs revealed rates of breakage of fixation of 12 of 33 (36%) and 42 of 91 (46%), respectively. With cable there was a significantly higher risk of metal debris (68% vs 9%; adjusted relative risk (RR) 6.6; 95% confidence interval (CI) 3.0 to 14.1), nonunion (36% vs 21%; adjusted RR 2.0; 95% CI 1.0 to 3.9) and osteolysis around the material, acetabulum or femur (61% vs 19%; adjusted RR 3.9; 95% CI 2.3 to 6.5). Cable breakage increased the risk of osteolysis to 83%. There was a trend towards foreign-body reaction and increased infection with cables. Clinical results did not differ between the groups.

In conclusion, we found a higher incidence of complications and a trend towards increased infection and foreign-body reaction with the use of cables.

Introduction

Large diameter metal on metal cups have been used in total hip arthroplasty advocating superior results with respect to dislocation rates, range of motion and long term survival. The Durom cup used as part of the Durom hip resurfacing system has been incriminated with poor short term results sometimes correlated to incorrect positioning of either the femoral or acetabular component. Our objective was to evaluate short term results of the Durom cup used in conjunction with standard stems.

Introduction

The prosthetic impingement occurs if the range of motion of the hip exceeds implant mobility or in case of component malorientation. This retrieval study was designed to assess the frequency and the risk factors of this phenomenon.

Purpose of the study: The objectives of this work were to assess the stability of outcome achieved after Duquennoy procedure to tighten the lateral capsule-ligament structures of the ankle joint. To do this, we reviewed the same series of patients at 3 and 25 years follow-up to analyse the very long-term stability, laxity, and stiffness of the ankle joint and any osteoarthritic degradation.

Material and methods: From 1975 to 1986, we performed 75 Duquennoy procedures on the lateral capsule and ligament structures of the ankle joint. At mean 25 years follow-up (2007) we were able to review 28 ankles (27 patients) with the same method as applied in 1980 (3 years follow-up). The function outcome was assessed with the Good, Karlsson, Duquennoy and Tegner scores. Clinically, other than joint range of motion, were noted varus laxity or anterior drawer. Static x-rays were obtained to search for signs of osteoarthritis and stress images to measure talocrural laxity, in comparison with the preoperative figures and the 1980 data.

Results: There were two early technique failures (one persistent talocrural instability, one subtalar instability). Good and Karlsson scores were good or excellent in 92% of cases. Patients were very satisfied with the operation and the VAS was 8.9/10. Pain and occasional instability were reported by 27% of patients. There was no talocrural no subtalar stiffness at last follow-up. Radiographic laxity declined significantly between the preoperative value and the last review. Only one patient presented a narrow talocrural space (less than 50% narrowing). Eight patients had osteophytes whose presence was not correlated with poor functional outcome. These osteophytes were also present on the controlateral side. Importantly, there was no significant difference in the mean function scores between 3 and 25 years follow-up (Duquennoy score). Similarly joint range of motion and radiographic laxity remained stable over time.

Discussion: The Duquennoy procedure to tighten the lateral capsule and ligament structures is a simple technique with rare complications which provides excellent results both in terms of ligament stability and in terms of preservation from degenerative osteoarthritis. These results remain stable over time. Conversely, the technique has no action on the subtalar joint and should not be proposed as treatment for associated subtalar laxity, if diagnosed.

Implantation of a large-diameter femoral head prosthesis with a metal-on-metal bearing surface reduces the risk of dislocation, increases the range of movement, minimises the risk of impingement and, in theory, results in little wear.

Between February 2004 and March 2007 we implanted 100 consecutive total hip replacements with a metal-on-metal bearing and a large femoral head into 92 patients. There were 51 men and 41 women with a mean age of 50 years (18 to 70) at the time of surgery.

Outcome was assessed using the Western Ontario McMaster University osteoarthritis index and the Harris hip score as well as the Devane activity score. These all improved significantly (p < 0.0001). At the last follow-up there were no cases of dislocation, no impingement, a good range of movement and no osteolysis, but seven revisions, two for infection and five for aseptic loosening. The probability of groin pain increased if the other acetabular component inclination exceeded 50° (p = 0.0007). At 4.8 years of follow-up, the projected survival of the Durom acetabular component, with revision for any reason, was 92.4% (sd 2.8) (95% confidence interval 89.6 to 95.2).

The design of the component made it difficult both to orientate and seat, which when combined with a poor porous coating, produced unpredictable fixation and a low survival at five years.