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Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_15 | Pages 12 - 12
1 Mar 2013
Beaver R Sloan K Gill I
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As part of a prospective RSA study into a new design of short-stem, trabecular metal, Co-Cr femoral components with modular necks and metal on polyethylene articulation, three patients presented with almost identical symptoms of pain and a large avascular mass within the operated hip. All three cases came to exploration and similar findings of a solid pseudotumour within the hip joint were found in all thee cases. Infection was not present. All cases were submitted to histology and reviewed by a pathologist with specific interest in tissue reactions to foreign materials. All three cases showed histological features classical of published descriptions of ALVAL (Aseptic Lymphocyte-dominated Vasculitis Associated Lesion). A consistent finding was fretting corrosion of the neck-stem junction. These cases demonstrate that Co and Cr ions can provoke adverse tissue reactions even in the absence of metal/metal articulations. This has design implications for all modular Co-Cr necks. The stem used in this study has been voluntarily withdrawn from the Australian market but is still being implanted in Europe. We make recommendations that modular trunnion-style Co-Cr necks not be used and alternative materials and design solutions be sought.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 3 - 3
1 Jan 2013
Gill I Shafafy R Park D Gougoulias N Halliwell P
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Introduction

Lisfranc joint injuries account for only 0.2% of all fractures but early diagnosis improves the chances of a better outcom]. Radiographic signs, such as diastasis (>2mm) of the 1–2 interspace, are subtle and. often missed, leading to a poorer outcome. We present a new radiographic sign, less likely to result in missed diagnoses. Null nypothesis: The intermetarsal angle remains unchanged in Lisfranc injuries.

Method

A series of radiographs demonstrating Lisfranc injury were interspersed with normal and postoperative cases. Evidence of fixation was obscured. A selection of Foundation and Core Trainee medical staff measured the intermetatarsal angle (IMA) on two separate occasions. The measuring technique was demonstrated with no explanation for the reason behind the measurement.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXV | Pages 75 - 75
1 Jun 2012
Gill I Krishnan M Reed M Partington P
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Introduction

To report the short to medium term results of acetabular reconstruction using reinforcement/reconstruction ring, morcellised femoral head allograft and cemented metal on metal cup.

Methods

Single centre retrospective study of 6 consecutive patients who underwent acetabular reconstruction for revision hip surgery.

The acetabulum was reconstructed using morcellised femoral head allograft and reinforcement or reconstruction ring fixed with screws. The Birmingham cup – designed for cementless fixation, was cemented into the ring in all cases. The uncemented Echelon stem with metal on metal modular head was used for reconstructing the femur.

Data from our previous in-vitro study had shown good pull out strength of a cemented Birmingham cup.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXV | Pages 74 - 74
1 Jun 2012
Gill I Krishnan M Reed M Partington P
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Introduction

The aim of this study is to report the results of Revision hip arthroplasty using large diameter, metal on metal bearing implants- minimum 2 year follow up.

Methods

A single centre retrospective study was performed of 22 consecutive patients who underwent acetabular revision surgery using metal on metal bearing implants between 2004 and 2007. Birmingham hip resurfacing (BHR) cup was used in all patients - monoblock, uncemented, without additional screws in 16 cases and cemented within reinforcement or reconstruction ring in 6 cases.

Femoral revisions were carried out as necessary.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IV | Pages 93 - 93
1 Mar 2012
Gill I Kolimarala V Montgomery R
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Aim

To analyse the results of the use of Recombinant Bone Morphogenic Protein (BMP-7) for treatment of fracture nonunions at our institution.

Material and methods

From 2001 to 2006, 23 patients with fracture nonunion were treated with BMP-7 for bone healing. There were 14 male and 9 females. The mean age of patients was 45 years (Range 21-76 yrs). There were 11 femoral, 9 tibial and 3 humerus fractures. There were 4 open injuries. The average number of operations before BMP-7 insertion was 2.66 (Range 0-6). The mean time between the injury and BMP insertion was 54 months (Range 5-312). 9 patients had previous autologous bone graft inserted without union.