We compared the risks of re-revision and mortality between two-stage and single-stage revision surgeries among patients with infected primary hip arthroplasty. Patients with a periprosthetic joint infection (PJI) of their primary arthroplasty revised with single-stage or two-stage procedure in England and Wales between 2003 and 2014 were identified from the National Joint Registry. We used Poisson regression with restricted cubic splines to compute hazard ratios (HRs) at different postoperative periods. The total number of revisions and re-revisions undergone by patients was compared between the two strategies. In total, 535 primary hip arthroplasties were revised with single-stage procedure (1,525 person-years) and 1,605 with two-stage procedure (5,885 person-years). All-cause re-revision was higher following single-stage revision, especially in the first three months (HR at 3 months = 1.98 (95% confidence interval (CI) 1.14 to 3.43), p = 0.009). The risks were comparable thereafter. Re-revision for PJI was higher in the first three postoperative months for single-stage revision and waned with time (HR at 3 months = 1.81 (95% CI 1.22 to 2.68), p = 0.003; HR at 6 months = 1.25 (95% CI 0.71 to 2.21), p = 0.441; HR at 12 months = 0.94 (95% CI 0.54 to 1.63), p = 0.819). Patients initially managed with a single-stage revision received fewer revision operations (mean 1.3 (SD 0.7) vs 2.2 (SD 0.6), p < 0.001). Mortality rates were comparable between these two procedures (29/10,000 person-years vs 33/10,000). The risk of unplanned re-revision was lower following two-stage revision, but only in the early postoperative period. The lower overall number of revision procedures associated with a single-stage revision strategy and the equivalent mortality rates to two-stage revision are reassuring. With appropriate counselling, single-stage revision is a viable option for the treatment of hip PJI.

Aims

We compared the risks of re-revision and mortality between two-stage and single-stage revision surgeries among patients with infected primary hip arthroplasty.

Background

Venous thromboembolism deterrent (TED) stockings are recommended for all orthopaedic patients. Clinical evidence supporting their use is limited and the risk of DVT increases four-fold if pressure gradients are reversed. This study aims to investigate the efficacy of TED stockings and their application using pressure gradients as the outcome measure.

We report the use of a 15° face-changing cementless acetabular component in patients undergoing total hip replacement for osteoarthritis secondary to developmental dysplasia of the hip. The rationale behind its design and the surgical technique used for its implantation are described. It is distinctly different from a standard cementless hemispherical component as it is designed to position the bearing surface at the optimal angle of inclination, that is, < 45°, while maximising the cover of the component by host bone.

Loss of bone stock is a major problem in revision surgery of the hip. Impaction bone grafting of the femur is frequently used when dealing with deficient bone stock. In this retrospective study a consecutive series of 68 patients (69 hips) who had revision of a hip replacement with femoral impaction grafting were reviewed. Irradiated bone allograft was used in all hips. Radiological measurement of subsidence of the stem, incorporation of the graft and remodelling was carried out and showed incorporation of the graft in 26 of 69 hips (38%). However, there was no evidence of trabecular remodelling. Moderate subsidence of 5 mm to 10 mm occurred in ten hips (14.5%), and massive subsidence of > 10 mm in five (7.2%).

The results of this study are less favourable than those of others describing studies of revision of the femoral stem using impaction bone grafting. The absence of the characteristic changes of graft remodelling noted in other series raises the question as to whether irradiated bone graft may be a significant factor influencing the post-operative outcome.

The use of arthroplasty registers was initiated by Sweden in 1979. The practice has been adopted globally as best practice for recording the outcome of joint replacement surgery and for identifying early problems. The Trent and Wales Arthroplasty Audit Group began in 1990 and have recently produced outcome results. We have analysed the short-term outcomes of arthroplasty procedures at a DGH in order to assess comparability to this “gold-standard”.

In 2004, 231 primary arthroplasties were performed, by the two senior authors, at Musgrove Park Hospital (149 THR, 82 TKR). There was an overall complication rate of 8.7%. There was 1 periprosthetic infection in a THR that required revision (0.043%). 9 patients developed wound complications, principally superficial infections and haematoma formation. 2 patients, both THR developed, thromboembolic complications, one DVT and one pulmonary embolus. There was one periprosthetic fracture around a THR. The dislocation rate for THR was 3.35% (5/149). 3 of these were performed through a posterior approach and 2 through an anterolateral. 3 have required revision surgery.

We have demonstrated comparable results following joint arthroplasty to published teaching hospital series. We have shown that adequate infrastructure can exist in smaller units to accurately record outcome data following arthroplasty surgery.

Introduction (Statement of purpose): Majority of the hips that are borderline on ultrasound progress to normal development subsequently, making the use of routine radiographs in follow up unnecessary. We present our experience in the last 5 years at the Musgrove Park Hospital in the management of borderline DDH

Materials and Methods: We studied 1452 patients who underwent an ultrasound examination for suspected DDH at Musgrove Park Hospital between January 1998 and December 2003. Ultrasound examination is performed in babies at a high risk for DDH or those who have abnormal hips on clinical examination at birth.42 babies were diagnosed to have dislocated or dislocatable hips and were treated with a harness. 239 babies, who had borderline dysplasia, had a repeat ultrasound at 6 weeks. Those with persistent borderline dysplasia had a radiographic and clinical examination at 6 months

Results: 60 patients were reported as borderline on follow-up ultrasound and underwent radiographs at 6 months.49 cases had normal radiographs and were asymptomatic.3 patients had mild dysplasia and were followed up for 18 months before being discharged as normal.3 patients were lost to follow up.4 cases presented late and had to undergo surgical procedures

Conclusion: No patients having borderline dysplasia on ultrasound developed symptomatic hip dysplasia. Routine radiographs are probably unnecessary in the follow-up of babies with borderline dysplasia on ultrasound except Graf 2c stages, which are important to recognise. Selective ultrasound screening is likely to fail in picking up some cases in the population (0.016%)

Aim: To assess the results of aseptic and aseptic cases using the PFC/TC3 system, and to correlate this with the restoration of joint line height.

Method: 148 patients underwent revision TKR using the PFC/TC3 system. No re-revision cases were included in this series. Data was prospectively collected (using the Bristol Knee Score) pre-operatively and at a mean of 4.2 years post-revision. 31 revisions were for infection and 53 revisions were for aseptic loosening. Revision for infection was done as a two-stage procedure and aseptic as a single operation. Measurements of the joint line height were made pre and post-operatively using Figgie’s method. The cases were divided into 3 groups on the basis of joint line restoration:

Lowered by more than 5 mm

Results: The mean pre-op total score for the infection group was 35/100 and 40/100 for the aseptic loosening group. The total score post-operatively was 67 for the infection group and 73 for the aseptic loosening group. The joint line was restored in 50% of infected cases and in 60% of aseptic loosening cases.

Conclusion: although the overall results were slightly less satisfactory for the infected revision group, there was no significant difference between the two groups either in total BKS scores or in reproduction of the joint line. The average outcome was much less good than for primary TKR.