Total Hip Arthroplasty (THA) is one of the most successful and cost-effective treatments available for painful hip arthritis. Unfortunately, dislocation following primary THA is one of the most common complications, occurring in approximately 0.50–10percnt; cases. However, there is little literature that investigates the effects that dislocation has on the patient's overall function and satisfaction. We reviewed 229 THA patients that had sustained dislocation from a prospective database, consisting 156 single dislocations and 73 with two or more. Patient outcomes were compared with a matched control group of 196 patients without dislocation in the same follow-up period. Harris Hip Score (HHS) and patient satisfaction were recorded pre-operatively and at one, five and ten years post-operatively. Mann-Whitney test compared HHS between control and dislocation groups, Chi-Square test compared patient satisfaction and implant survival. Total HHS and functional component were significantly lower in the dislocation group at one, five and ten years (p<0.05). HHS Pain component revealed a significant difference but only at one and three years (p<0.05). Patient satisfaction only showed a significant difference at one-year review. Dislocation rates were significantly higher in females. Implant survivorship was significantly lower in the dislocation group at 15-years. Hip-function and implant survival is significantly reduced following prosthesis dislocation, however patient satisfaction and pain levels appear unaffected at long-term follow-up.
The use of Birmingham hip resurfacing (BHR) remains controversial due to the increased revision rate in female patients. We compared the outcomes of BHR in female patients to an age matched total hip arthroplasty(THA) cohort. We reviewed the pain, function and total Harris Hip Scores(HHS), and Kaplan-Meir survivorship for BHR and THA cohorts from a prospective regional arthroplasty database. There were 234 patients in each cohort, with mean age of 51 years. The BHR cohort had significantly better function and total HHS at all points of the 5-year study, but not for the post-operative pain score. The 5-year revision rate for the BHR cohort was significantly higher than the THA cohort (6.8% vs 3.4%, p=0.001). The main reason for revision in the BHR cohort was aseptic loosening (n=8), followed by metallosis (n=3). The 5-year Kaplan-Meier survivorship was 92.6% (95% CI±1.7%) and 96.4% (95% CI±1.3%) for the BHR and THA cohort (p=0.001). BHR can give significantly better functional outcomes than THA. The vast majority of female patients were happy with BHR and did not need further surgery at the 5-year stage. This is somewhat at odds with the recent reputation of the procedure. The 10-year result of the same cohort is warranted to provide further data. Our study is not a recommendation to still offer BHR to female patients, but rather to inject a note of realism into the debate. There are implications for future implant development in that these results do validate resurfacing as a functionally valuable option for active patients.
Functional scores are used to clinically assess total hip arthroplasty (THA) and for comparative purposes in orthopaedic literature. Previous pilot work has highlighted patient comorbidity as a potential source of bias in addition to the often-examined factors of age, gender and underlying diagnosis. We analysed prospectively collected data relating to 217 primary THAs (Tayside Arthroplasty Audit Group database). Sample size was calculated from previous pilot data (significance level 5%, power 80%, effect size 0.25). Proportional stratified sampling was performed including all patient age groups (≤40, 41–55, 56–65, >65) and four fixation classes (cemented, hybrid, uncemented and Birmingham resurfacing). Five year Harris Hip Function Score (HHFS) was the dependent variable; age, sex, underlying diagnosis, BMI, pre-operative HHFS and comorbidity (Functional Comorbidity Index; range 0–8) were co-variates/co-factors. In univariate analysis, FCI accounted for 11% of the variation in HHFS at 5 years. Regarding patients with FCI 0–1 as a reference group, patients with greater comorbidity had lower HHFS at 5 years (FCI 2–3: −3.95; FCI 4–5: −7.21, FCI ≥6: −6.92). In a multivariable model of HHFS at 5 years, FCI group, diagnosis, pre-operative HHFS, patient age and BMI were significant. HHFS at 5 years was significantly higher in FCI group 0–1 than any other category (2–3 P=0.006, 4–5 P<0.001, ≥6 P=0.002). In total, the model accounted for 29% of variability in HHFS at 5 years. This is the first statistically robust study to examine the effect of comorbidity on THA function. These results strongly suggest that increasing patient comorbidity is associated with poorer THA function when measured using HHS. Two significant conclusions can be drawn:
Patient comorbidity should be taken into account pre-operatively when considering potential future THA function. When comparing across implants, failure to give specific consideration to comorbidity of patient groups will limit relevance and weight of findings.
Numbness around the surgical scar can be a source of discomfort in patients undergoing Total Knee Arthroplasty (TKA). Literature reports wide variation in its prevalence. The consequence of numbness on the functional outcome is not clear. We aimed to investigate the prevalence of numbness, along with factors affecting it, and assess its effect on the outcome of TKA. 258 patients who underwent TKA were included in the prospective cross sectional patient reported outcome measure (PROM) study. Demographic details, approach, length of incision, and the pre-operative and one year post-operative Knee Society Score (KSS) were recorded. A Dundee numbness classification was developed and used for the assessment and localization of numbness using e-Ruler® and Matlab® computer software.Background of study
Materials and methods
Numbness around the surgical scar can be a source of discomfort or dissatisfaction in a proportion of patients undergoing Total Knee Arthroplasty (TKA). Literature reports wide variation in its prevalence and the consequence of numbness on the outcome of TKA is not clear. We aimed to investigate the prevalence of numbness, along with contributing factors, and assess its effect on the functional outcome of TKA. A total of 258 patients were included in this prospective cross sectional patient reported outcome measure study. Demographic details, type and length of incision, and pre-operative and one year post-operative Knee Society Scores (KSS) were recorded and compared. A Dundee knee numbness classification was developed for the assessment of numbness. The prevalence of numbness at one year was 53%, with a female preponderance. Patients above 70 years were less affected. The BMI, laterality and incision length did not affect its occurrence. Discomfort due to numbness was recorded in 8.7% of patients, 75% of which were females. The incision length and numb area positively correlated. The KSS did not correlate with the presence or area of numbness. Our findings indicate a high prevalence of numbness after TKA. Nevertheless, numbness does not affect the functional outcome.
Pigmented Villonodular Synovitis (PVNS) is a rare inflammatory disorder of the synovium, bursa and tendon sheath. The objective of this study was to evaluate the long-term outcomes and morbidity associated with operative management of PVNS of the hand. Histological databases were retrospectively interrogated. All patients between 2003–2008 with confirmed PVNS of the hand were included in the study.Introduction:
Methods:
Endoprosthetic replacement of the proximal femur is common in the management of bone tumours and failed revision arthroplasty. This study seeks to compare those patients undergoing acetabular resurfacing at the time of femoral replacement with those patients where the native acetabulum was preserved. All proximal femoral replacements from 2004 to 2009 with a five year follow up were included. Case files were interrogated to identify those that had either revision surgery or dislocation of the hip.Introduction:
Methods:
Distal femoral replacement is recognised as the optimum treatment for malignant distal femoral tumours. Aseptic loosening is known to be a major cause for failure in these implants. Studies have indicated that the HA coated collar promotes osteointegration and bony in growth. This study compares long term aseptic loosening in implants with HA coated collars to those without in the immature skeleton. To assess the effect of HA coated collars on aseptic loosening in extendable distal femoral replacement prosthesis in the immature skeleton.Introduction:
Objectives:
There is conflicting evidence about the merits
of mobile bearings in total knee replacement, partly because most randomised
controlled trials (RCTs) have not been adequately powered. We report
the results of a multicentre RCT of mobile There was no significant difference between the groups pre-operatively:
mean OKS was 17.18 ( In this appropriately powered RCT, over the first five years
after total knee replacement functional outcomes, re-operation rates
and healthcare costs appear to be the same irrespective of whether
a mobile or fixed bearing is used. Cite this article:
Recent studies have indicated that healthy and willing patients above 80 years have similar outcomes as younger patients following arthroplasty. We wished to investigate the outcomes in a cohort of patients above 80 years who underwent medial unicompartment knee replacement (UKA). 46 patients (51 knees) with UKA aged 80 or more formed the study group. For comparison rest of the UKA patients in the database were divided into groups according to their age. Patients were reviewed and KSS, complication rates and patient satisfaction information was collected. Revision for any cause was considered an endpoint. Significance was set at < 0.05.Introduction
Material/methods
Although total hip arthroplasty (THA) has been shown to be a cost-effective means of treating hip arthritis, there is some ambiguity within the literature as to its success in those over 80 years of age. With the rapid expansion of this population group and an estimated 40% rise in THA figures expected by 2026, this study aims to review the results of primary THA in the octogenarian population. A series of 510 consecutive cases was obtained from the local arthroplasty database, consisting of all patients aged 80 years and over who underwent primary THA between 1994 and 2004. A control group of 3404 individuals under 80 years was also established using the same database and inclusion criteria. Mean follow-up for the octogenarian group was 5.9 years. Pain scores were comparable five years post-operatively in both groups (P=0.479); in particular 81.5% of octogenarians and 80.2% of the control noted no pain. Pre-operatively, the mean Harris Hip Function and Harris Hip Score were significantly lower in the octogenarian group by 4.3 and 4.2 points (P< 0.001), respectively, and at five years follow-up were also lower by 8.4 and 8.0 points, respectively (P< 0.001). Median hospital stay was three days longer in the elderly population (12 cf 9, P< 0.001). More complications occurred in the octogenarian group (38.1% cf 28.7% of controls, P< 0.001) however fewer cases of revision were noted (1.4% cf 3.8%, P=0.005). Kaplan-Meier analysis found implant survival time to revision to be comparable in both groups (mean 16.4 years in control cf 14.3 years in octogenarian, P=0.17). Patient satisfaction was also similar (97.8% in octogenarians and 98.1% in controls, P=0.741). This study suggests that individuals over 80 years of age have comparable pain improvement and overall satisfaction, low revision rates, reduced functional improvement and are more prone to complications compared to younger patients.
Surgical site infection (SSI) is an important outcome indicator. It is estimated that 70% of post-operative infections present after discharge. A reliable post-discharge surveillance (PDS) method is yet to be described. The aim of this prospective cohort study was to assess the reliability of patient self-diagnosis. Telephone questionnaires were used following hip and knee prosthetic surgery. A trained validation nurse checked the wounds of all patients reporting problems and a sample of those who did not. 376 elective hip and knee arthroplasty procedures from 363 patients were included. In-patient infection rate was 3.1% (13 of 422 procedures) and post-discharge infection rate was 5.2% (22 of 422 procedures). Results suggest that patients can reliably self diagnose SSI. The sensitivity of the procedure (the probability that the telephone surveillance will detect an infection given that the patients has an infection) was 90.9%. The specificity (the probability that the telephone surveillance will report no infection given that no infection is present) was 76.6%. Hence telephone PDS of SSI is a valuable means of identifying accurate rates of hospital acquired infection following surgery. In this study population, 41% of infections were diagnosed post discharge, which is lower than has previously been estimated. PDS of SSI is necessary if accurate rates of hospital acquired infection following surgery are to be available.
Post-discharge surveillance of surgical site infection is necessary if accurate rates of infection following surgery are to be available. We undertook a prospective study of 376 knee and hip replacements in 366 patients in order to estimate the rate of orthopaedic surgical site infection in the community. The inpatient infection was 3.1% and the post-discharge infection rate was 2.1%. We concluded that the use of telephone interviews of patients to identify the group at highest risk of having a surgical site infection (those who think they have an infection) with rapid follow-up by a professional trained to diagnose infection according to agreed criteria is an effective method of identifying infection after discharge from hospital.
