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 peri-prosthetic fractures, one Vancouver C distal femur fracture treated conservatively and three Vancouver B1 fractures, two treated conservatively and one treated with open reduction internal fixation. There was breakage of one constrained ring with no adverse effects and one superficial wound infection requiring oral antibiotics only.

This series demonstrated that despite the elderly and complex nature of these patients’ clinical situations, constrained acetabular inserts offer a useful and pragmatic solution, with relatively low complications, including in our series a cup failure rate of 3% and peri-prosthetic fracture rate of 3%.

Introduction: We present the results of the Ankle Evolution System (AES) total ankle replacements with a minimum follow up of four years.

Methods: Forty-five consecutive patients who had AES ankle replacement were included in the study. The mean age at operation was 64.6 (50–77). Pain and function were assessed using the AOFAS score. Patients had standardised AP and lateral weight bearing radiographs and were assessed for loosening and alignment. Patients’ satisfaction and complications were recorded. The survival of the implant was constructed using the Kaplan-Meier survival curve.

Results: The mean follow up for our patients who were alive and available for follow up at the final clinical review (40 patients) was 57.8 months (48–80). A total of 2 patients were revised (One patient sustained talar fracture and was converted to arthrodesis at three years postoperatively. The second patient had revision of the tibial component because of aseptic loosening at 4 years postoperatively). The mean total AOFAS score was 88.1 (53–100). For pain the mean score was 35.8 (20–40). Nine patients showed osteolysis only 2 were considered as significant. Those patients had minimal symptoms that were not progressing and further surgery was not justified. Ten patients presented with edge loading of which nine had corrective surgery. Our cohort showed high patients’ satisfaction. Our cumulative survival rate at 6 years was 94.7% with revision or decision to revise as the endpoint

Conclusion: The medium term results of the mobile AES total ankle replacement in terms of survivorship, functional outcome and patients’ satisfaction are satisfactory but we have our concerns about the high rate of osteolysis. The long-term benefit of this procedure has yet to be determined.

Purpose of the study: To investigate whether autologous blood transfusion (ABT) drains and peri-operative cell salvage reduce allogeneic transfusion requirements for scoliosis surgery in our unit.

Methods: Prospective data collection on transfusion requirements of patients undergoing scoliosis surgery between January 2006 and February 2008. Cases were split into three groups, representing recent stepwise changes in transfusion practice. Group A received ‘traditional treatment’ of allogeneic red cell transfusion (ARCT) in response to intra- or post-operative anaemia (Hb< 8g/dL or symptomatic anaemia). Group B received peri-operative cell salvage in addition to ‘traditional treatment’. In group C, ABT wound drains were used alongside peri-operative cell salvage and ‘traditional treatment’.

Results: ARCT was required for 23 of the 35 procedures (66%) in group A, 22 of 37 (59%) in group B and 10 of 20 (50%) in group C. Where patients required ARCT, those in group C received fewer units (mean 2.6) than group B (mean 3.1) and group A (mean 3.7). There was no difference in mean preoperative haemoglobin levels (A – 13.56g/dL SD 1.36; B – 13.35g/dL SD 1.46; C – 13.94g/dL SD 1.25). Mean length of inpatient stay was lowest in group C (9.11 days), and lower in group B (12.02) than group A (13.75).

Conclusion: Use of ABT drains and peri-operative cell salvage lead to reduced allogeneic transfusion needs for scoliosis surgery in our unit. Lowest transfusion rates were seen when both were used together, leading to a 16% reduction in the need for ARCT.

Ethics approval: None

Interest Statement: None

Introduction: We present the results of 35 patients following Ankle Evolution System (AES) total ankle replacements (TAR) with a minimum follow up of four years.

Methods: We retrospectively reviewed 39 consecutive total ankle replacements. Two patients died, and two emigrated. Thirty-five patients were available for clinical and radiological assessment. All patients underwent standardised radiographs. Complications and failures were recorded. Patient satisfaction and functional outcome of all patients was determined using the American orthopaedic foot and ankle society (AOFAS) score.

Results: All ankles were examined at a mean of 4.7 years postoperatively. The mean age at operation was 64 years. In 18 ankles the indication for the operation was primary osteoarthritis (OA), in 13 ankles post-traumatic OA, in three ankles rheumatoid arthritis and in one ankle psoriatic arthropathy. One patient had revision of the tibial component because of loosening. Sixteen patients recorded their satisfaction as excellent postoperatively, 15 patients as much better, three as better and only one patient recorded that he was worse off. The mean AOFAS score was 88.9 (confidence interval 85.7–92.1). The mean walking distance for our cohort is two miles. Thirteen ankles had radiological osteolysis; in two ankles this was more that 2cms.

Conclusion: The medium term results after implantation of the AES ankle prosthesis are encouraging. With the correct indication, a high rate of pain reduction and patient satisfaction can be achieved. The long-term benefit of this procedure has yet to be determined. The rate of osteolysis is of some concern.

We present the outcomes in 38 consecutive patients who had total ankle replacement using the Ankle Evolution System with a minimum follow-up of four years. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and regular standardised anteroposterior and lateral weight-bearing radiographs were obtained. Patient satisfaction and complications were recorded and the survival of the implants was demonstrated by the Kaplan-Meier method.

The mean follow-up was for 57.8 months (48 to 80). The cumulative survival rate at six years was 94.7% (95% confidence interval 80.3 to 98.7). The mean total AOFAS score was 88.1 (53 to 100). The mean score for pain was 35.8 (20 to 40). Ten patients presented with edge-loading of whom nine had corrective surgery. Two ankles were revised, one to an arthrodesis and the other to replace the tibial component. Nine patients showed radiological evidence of osteolysis. They had minimal non-progressive symptoms and further surgery was not undertaken. Nevertheless, the concerns about osteolysis led to the implant being withdrawn by the manufacturer.

The medium-term results of the ankle evolution system ankle replacement are satisfactory with high patient satisfaction, but the rate of osteolysis is of some concern. The long-term benefit of this procedure has yet to be determined.