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.

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.

Revision arthroplasty for infected hip arthroplasty creates a challenging scenario to surgeons. Either a single stage or more traditionally a two-stage revision is performed. Most surgeons utilise an antibiotic loaded cement spacer, but the implant is often rotationally unstable predisposing to dislocation, acetabular bone loss and fracture of the spacer. Pain and discomfort on mobilisation also often occur. We would like to introduce an alternative approach to this challenging scenario with the use of a two-stage revision with an extended trochanteric osteotomy and loosely cemented hip arthroplasty as the first stage spacer.

Surgical Technique: The first stage involves removal of metal ware with all infected tissue and cement performed through an extended trochanteric osteotomy. Circlage wires reduce the osteotomy and a long stem femoral component is inserted with antibiotic infused cement limited to the calcar region. The acetabulum is similarly removed and replaced with a loosely cemented polyethylene liner. The second stage is delayed until the infection is settled and the osteotomy is healed. Removal of the metalware is performed with relative ease, without need for an osteotomy. Reinsertion of an uncemented femoral and acetabular component is then performed. However a second stage is not always required in some patients.

We report a single surgeon series comprising 10 patients from December 2003 to June 2007. The most common organism isolated was Staphylococci species. All operations were performed via a posterior approach. 9 patients were clinically assessed and the Harris hip score calculated. All patients were radiologically assessed. Osteotomies healed in all patients. Only 6 patients underwent a second stage and radiographs show good osseous integration of both components. Two patients are awaiting a second stage revision, while the other two are asymptomatic and not interested in undertaking the second stage.

No dislocations, bony erosions or reinfection was noted in our series.

We recommend this alternative approach to the conventional one or two staged revision arthroplasty. The extended trochanteric ostoetomy ensures rapid and complete removal of all foreign and infected material. The loosely cemented spacer effectively delivers local antibiotic and provides a stable, asymptomatic hip whilst awaiting the second stage, which may not be required.

Moderate to severe acetabular bone loss in revision hip arthroplasty is challenging. Various treatment options are available but the medium to long term results have not been encouraging. The porus tantalum uncemented cup may be used successfully to address moderate to severe bone loss in acetabulum revision surgery.

We report a single surgeon series. Between December 2003 and June 2007, 39 patients (43 hips) underwent hip revision surgery. There were 17 men and 23 women with a mean age at surgery of 71.9 years (range 36–96). The mean follow up was 40 months (range 24–66). A porus tantulum modular multi hole uncemented cup was used in all cases. At time of assessment 6 patients had died, 2 patients developed dementia and another 2 patients were not contactable. All 10 patients had no significant clinical or radiological concerns at their last orthopaedic review. The remaining 29 alive patients (33 hips) were available for clinical evaluation. Harris hip score of these 33 hips showed, 24 excellent or good, 7 fair and 2 poor. Radiological results: All 39 patient’s (43 hips) radiographs were reviewed. The acetabular defect was quantified according to Paprosky.

Classification taking into account the intra operative findings and pre operative imaging. The horizontal (x-axis), vertical (y-axis) distance from the ipsilateral tear drop and abduction angle were measured in both the pre-operative and post-operative radiographs. According to Paprosky’s classification there were two 2A, ten 2B, six 2C, fourteen 3A and eleven 3B defects. All 43 hips showed good osseous integration. No loosening was noticed in our series. No significant improvement was noticed in the abduction angle and x-axis but significant improvement was noticed in the y-axis indicating more anatomical positioning of the cup within the acetabulum.

One deep infection. 2 of the 5 dislocations were recurrent and successfully managed with a constrained liner. We recommend the Porus tantulum uncemented cup as a very useful implant in often very difficult situation. The mechanical properties of the trabecular metal certainly helps to positively encourages osseous integration providing a sound biological fixation and the high co-efficient of friction helps to implant these cup with as little as 30% host bone contact.

We retrospectively reviewed 27 patients who underwent an uncemented total Moje ceramic arthroplasty of hallux rigidus.

Out of 33 patients who had the above procedure, 27 were available for review. Clinical and functional outcome were assessed using the American orthopaedic foot and ankle society (AOFAS) fore-foot score, and the SF-36 health assessment score. All patients had an antero-posterior and a lateral weight bearing radiograph

The primary pathology was oesteo-arthritis (Hallux Rigidus). All procedures were performed by the senior author or under his supervision.

All patients were female with an average age at surgery of 52.6 years (range 45.8–64.7). The average follow up was 39.5 months (range 14–46).

The average post-operative AOFAS forefoot score was 80/100 (range 40–100). The average subscore for pain was 29.39/40 (range 10–40). Twenty five patients 92.5% were satisfied with the outcome, and 22 (81%) were able to wear high heel foot wear.

The functional outcome as assessed using the SF-36 health score was compatible with an age matched population.

The alignments of component were measured in relation to the shaft of the metatarsal and to the proximal phalange. There was no statistical correlation between the alignment and the functional scores.

Although, arthrodesis remains the gold standard procedure, total ceramic first MTP joint arthroplasty has a place in the management of some cases of advanced but not end stage hallux rigidus. Careful patient selection is essential to achieve a favourite outcome.

We retrospectively reviewed 31 patients who underwent reconstruction procedure for PTT D (Type II Johnson). The surgery was mostly performed by the senior author.

Fifty patients underwent 55 procedures, 31 patients were available for review (34 procedures)

Clinical and functional outcome were assessed using AOFAS hindfoot score, and the SF-36 health assessment score.

The patients had a calcaneal medialising (chevron) osteotomy to correct heel valgus, with or without a calcaneal lengthening osteotomy, and transfer of the FDL tendon to the navicular. All patients were immobilized in non-weight (to partial) bearing POP for 5 weeks, followed by CAM for 6 weeks.

There were 7 males and 24 female, with an average age of 60.5 years. The average follow up was 54 months (range 11.5–111.2). The average hindfoot valgus deformity was 15 degrees preoperatively.

Eight patients had and additional procedures including (TA lengthening, Lapidus). Four patients required bone graft for calcaneal column lengthening, and in 5 patients the posterior screw was removed due to continuous discomfort.

The average AOFAS hindfoot score was 74 (47–100), the average pain score was 31/40 and the average subscore of the heel alignment was 7.9/10.

Nineteen patients (61%) were able to perform single heel raise, and 27 patients (87%) were able to perform bilateral heel raise. 26 patients (83.8%) had no lateral impingement pain post operatively.

The SF-36 health assessment showed similar functional outcome with age matched population. Two patients had superficial wound infection required oral antibiotics.

Hindfoot and midfoot reconstructive surgery for type II PTTD after failed orthotic treatment is well established. However, the post operative care and rehabilitation period is lengthy and protracted. This must be emphasized during informed consent in order to fulfil realistic expectations.

We retrospectively reviewed 27 patients who underwent an uncemented total Moje ceramic arthroplasty of hallux rigidus.

Out of 33 patients who had the above procedure, 27 were available for review. Clinical and functional outcome were assessed using the American orthopaedic foot and ankle society (AOFAS) fore-foot score, and the SF-36 health assessment score. All patients had an anteroposterior and a lateral weight bearing radiograph

The primary pathology was oesteo-arthritis (Hallux Rigidus). All procedures were performed by the senior author or under his supervision.

All patients were female with an average age at surgery of 52.6 years (range 45.8–64.7). The average follow up was 39.5 months (range 14–46).

The average post-operative AOFAS forefoot score was 80/100 (range 40–100). The average subscore for pain was 29.39/40 (range 10–40). Twenty five patients 92.5% were satisfied with the outcome, and 22 (81%) were able to wear high heel foot wear.

The functional outcome as assessed using the SF-36 health score was compatible with an age matched population.

The alignments of component were measured in relation to the shaft of the metatarsal and to the proximal phalange. There was no statistical correlation between the alignment and the functional scores.

Although, arthrodesis remains the gold standard procedure, total ceramic first MTP joint arthroplasty has a place in the management of some cases of advanced but not end stage hallux rigidus. Careful patient selection is essential to achieve a favourite outcome.

Objective: To analyze pattern of work related injuries sustained by patients admitted to The Orthopaedic Department of Hospital Ipoh. All patients admitted to Hospital Ipoh, Perak, Malaysia for acute injuries sustained during their work was analyzed prospectively. The period of this study was 1 year.

Parameters assessed were patients’ nationality, nature of occupation, duration of working experience, time of injury, adequacy of safely measures provided by the employer, whether normal duty or overtime, mechanism and type of injuries sustained and treatment given. Disability caused by the injury, outcome of the treatment and duration of sick leave were not analyzed. During this period, 386 patients were admitted (343 males and 43 females). Ages were ranging from 17 years to 78 years. Most of the patients were less than 25 years old (n=106) and only 3 patients were above 75 years of age. Malaysians were 80.8% (n=312) and foreigners were 19.2% (n=74). Among the foreigners, Bangladeshi were the highest 43.2% (n=32) and the least were from Pakistan, Nepal and Burma, 1.4% (n=1) each. Mostly were unskilled workers (labourer) comprising 50.8% (n=196). Largest group of patients have working experience of between 2 to 5 years 23.8% (n=92). On hourly analyses, highest number of accidents took place between 10am to 11am comprising 11.4% (n=44). 60.6% of patient (n=234) claims they were not provided with adequate safety gears.