INTRODUCTION

Historically, the clinical performance of novel implants was usually reported by designer surgeons who were the first to acquire clinical data. Regional and national registries now provide rapid access to survival data on new implants and drive ODEP ratings. To assess implant performance, clinical and radiological data is required in addition to implant survival. Prospective, multi-surgeon, multi-centre assessments have been advocated as the most meaningful. We report the preliminary results of such a study for the MiniHip™femoral component and Trinity™ acetabular component (Corin Ltd, UK).

Introduction

Proximal short stems have gained in popularity for perceived bone preservation but more recently, physiological loading. We report the medium term success of a calcar loading, short stem in a large cohort from a single unit with multiple surgeons.

The ODEP (Orthopaedic Data Evaluation Panel) rating system should offer a surgeon and patient extra information when making a choice on which implant to use. However, in the current economic environment, ratings may also influence implant choice by contracting bodies. Our aim was to determine the performance of commonly used Acetabular and femoral components in our unit and compare these to their published ODEP ratings (or absence of rating).

We analysed all of the following primary THR components (12,792) for revision for any reason, using same date ranges as ODEP where more than 100 implantations had occurred. Hip components: Trinity (3A in 2013), Trilogy (10A* in 2016), Atlas (10A in 2013), Trilogy TMT (10A 2010) Durom (not rated), BHR (10A, 2010), ACCIS (not rated); Femoral components: Taperfit (10A in 2013), Taperloc (10A* in 2016), Metafix (3A in 2013), CPT (10A in 2012), Ecofit (not Rated), ESOP (not rated), Minihip (3A 2013), Durom (not rated), BHR (10A 2010), ACCIS (not rated).

Analysis of Kaplan Meier survival curves was undertaken for all components. The rated components and non-rated components were compared using HR and logrank tests for all time groups when ratings were introduced. No statistical difference was observed in any group except for the Trinity cup which had a 98.2% (1344 cups) survival at 6 years.

Component survival in our unit was better than ODEP suggested failure for A category of not more than 1% per year, for all components.

Whilst we applaud the intention to improve data available for prostheses, the present ODEP system does not distinguish between performances of different implants in our unit. We therefore recommend care when relying upon ODEP ratings to make clinical or contracting decisions.

Press-fit fixation of uncemented acetabular components is increasingly being used for total hip replacement (THR) surgery. This study was aimed to analyse the survival of an established, un-cemented flexible metal backed cup with non-highly cross-linked polyethylene in primary and simple revision THR.

We assessed the outcome of 1703 consecutive cementless elastic acetabular cups (Atlas, FH France) with non-highly cross-linked polyethylene (GUR1030) in total hip replacement surgery. There were 1582 patients (513 males and 1079 females) with mean age of 74 years (36–97 years). Seventeen senior operating surgeons accounted for 88.5% of cases from a single arthroplasty unit. Survival analysis was calculated using the Kaplan Meier Estimator. At 184 months post surgery the survivorship was 92.4% (95% CI 88.3–94.7) with cup revision for any cause as an endpoint. Three patients died within first month of surgery and 268 patients (17.13%) died due to unrelated causes.

Overall, 59 patients had revisions (3.5%), Thirty eight patients (2.3%) were due to acetabular causes such as: aseptic loosening in 6 patients (0.35%); hip instability in 13 patients (0.76%); and deep infection in 11 patients (0.64%).

We believe the cementless elastic acetabular cup on in total hip replacement is tolerant of technique and patient variation and continues to give excellent long-term results and its continued widespread use can be recommended.

National Institute of Clinical Excellence (NICE) recommended total hip replacement (THR) surgery for fit patients with fracture neck of femur (NOF) in 2011. Our hospital implemented hip fracture program to follow these recommendations the same year. However, the increased incidence of further procedures compared with those undergoing the THR for osteoarthritis alone has led to concern regarding dislocation and other complications when using THR treatment for fracture NOF particularly with the posterior approach.

We introduced dual mobility implant for THR for hip fracture program patients to minimize risk of hip instability but allowing the use of the posterior approach which is recognised as giving a faster recovery than the Hardinge type approaches in this patient group. The Arthroplasty database for hip fracture program was reviewed from September 2011 to September 2015 for appropriateness of this treatment. During this period, 120 Dual Mobility THRs were carried out in 119 patients (36 males, 84 females) with mean age at 78 years (42–94) and average follow-up of 24 months (2–56 months). All patients were either operated by a fellowship trained arthoplasty surgeons or the senior surgeons using posterior approach. All patients undergoing THR for NOF were found to meet the NICE guidelines criteria for THR. No post-operative dislocation, infection, hetotropic ossification or lysis was recorded. Mean Harris Hip Score (HHS) at 19 months was 82 (54–98). In this cohort 112 patients (94.3%) were able to ambulate in non-trendlenburg gait pattern. One patient developed deep vein thrombosis in early post-operative period.

This study emphasises beneficial use the dual mobility implant combined with the posterior approach in THR for fracture NOF patients and highlights the areas of improvements in hip fracture management.

Purpose

Late stage medial unicompartmental osteoarthritic disease of the knee can be treated by either Total Knee Replacement (TKR) or Unicompartmental Replacement (UKR). As a precursor to the TOPKAT study this work tested the postulate that individual surgeons show high variation in the choice of treatment for individual patients.

Aim

This controlled study uses gait analysis to evaluate patients' pre- and post-ankle arthroplasty, post-ankle arthrodesis and compares the results with a healthy control group to assess whether these theoretical benefits are borne out in clinical practice.

We present the results of 228 consecutive Charnley low friction arthroplasties, inserted in 193 patients between July 1972 and December 1976. All hips were inserted by the posterior approach without trochanteric osteotomy. All patients were enrolled into a prospective study and pre-and post-operative findings recorded. This series was reviewed in 1985 and once again in 2002.

The pre-and peri-operative findings are similar to contemporary series. Due to our stable population only two patients were lost to follow-up. Our survivorship results show a 10-year survival of 93%, 20-year survivorship of 84% deteriorating to a 30-year survival of 73%.

Of the 26 hips revised 6 were for recurrent dislocations and these were satisfactorily stabilised using acetabular augments. There were 8 revisions for fracture of the femoral component (all flatbacks), 8 revisions for aseptic loosening of the femoral component and 6 revisions for aseptic loosening of the acetabulum. There was one revision for deep infection and the remaining 3 were for periprosthetic fractures.

The survivors were scored clinically using the Merle d’Aubign-Postel score with a mean value of 12. None of the survivors were on the waiting list for revision arthroplasty or felt that it was indicated.

Overall our results are comparable to other studies and vindicate the choice of approach, which at the time was a source of some controversy

Study design: Prospective cohort study.

Objective: To investigate association between recovery from low back pain (LBP) and body mass index (BMI) in patients with LBP undergoing physiotherapy.

Introduction: The relationship between obesity and LBP has long been debated. There are no published studies examining the influence of BMI on recovery from LBP.

Methods: One hundred and forty patients with chronic LBP and no neurological deficit underwent a back-specific physiotherapy programme. BMI and recovery parameters such as pain intensity (visual analogue scale scores), and self-experienced impairment and disability scores were measured. The range of motion of the lumber spine was also recorded. These variables were compared pre and post treatment. Statistical analysis was performed using paired t tests, Spearman’s rank correlation coefficients and ANCOVA.

Results: Mean age was 38 years (range 18–67) with 62% males and 38% females. The treatment resulted in significant improvements in all the recovery parameters (P < 0.005, paired t test). No significant association was detected between the BMI of subjects and % changes in pain intensity, self-experienced impairment and disability, and range of motion of the lumbar spine. A comparative analysis of the after treatment recovery parameter scores in normal (BMI ≤24.9), overweight (BMI 25–29.9) and obese (BMI ≥ 30) revealed no significant differences in the mean pain intensity and mean self-experienced impairment and disability scores.

Conclusion: Although a BMI within normal range is desirable for prevention of many health conditions including LBP, it does not influence the overall recovery from low back pain in patients undergoing physiotherapy treatment.

Introduction: Avascular necrosis (AVN) is a devastating complication of slipped capital femoral epiphysis (SCFE) and is difficult to treat. The incidence of AVN in this condition varies considerably and is reported to appear in 3–47% of patients. The aims of the treatment of AVN are to maintain range of movement of the hip whilst preventing collapse of the femoral head. Clear treatment guidelines of this condition do not currently exist and the treatment of this condition can be difficult and unrewarding.

Method: Dynamic arthrograms were used to assess of cases of AVN in order to determine the method of treatment. We present 20 sequential cases of AVN in patients presenting to our unit with SCFE and report the long-term results of treatment with a mean follow-up in excess of 10 years.

Results: In 100 consecutive cases of SUFE there were 20 cases of AVN. There were 18 cases of salvage surgery and one patient refused surgery. Of the 18, there were 2 acetabuloplasty procedures, 12 proximal valgus osteotomies and 4 arthrodeses. At a later date there were 3 proximal femoral osteotomies and 5 total hip replacements.

Discussion: There is a good functional result in the majority of cases and a logical approach delays the need of total hip replacement in the majority of cases. The management depends on the radiography, the arthogram and the EUA. If there is early AVN with no collapse the treatment is a shelf procedure. If there is hinge abduction the treatment is a valgus femoral osteotomy. If there is instable movement and the hip is not congruent the treatment is hip arthrodesis.

Introduction and Aims: We present the results of 228 consecutive Charnley low-friction arthroplasties, inserted in 193 patients between July 1972 and December 1976. Unusually for this time, all hips were inserted by the posterior approach without trochanteric osteotomy.

Method: All patients were enrolled into a prospective study and pre- and post-operative findings recorded. This series was reviewed in 1985 and once again in 2002. The survivors were scored clinically using the Merle d’Aubigné-Postel score with a mean value of 12. The reason for revision was also recorded and analysed.

Results: The pre- and peri-operative findings are similar to contemporary series. Due to our stable population, only two patients were lost to follow-up. Our survivor-ship results show a 10-year survival of 93%, deteriorating to a 30-year survival of 73%.

Conclusion: Overall our results are comparable to other studies and really vindicate the choice of approach, which at the time was a source of some controversy.

Wound breakdown and implant exposure is the most serious complication of total knee arthroplasty. In some patients after removal of the implant, a soft tissue defect remains that is not amenable to closure in any conventional manner as patient co morbidity precludes further major surgery. In addition the risk factors for infection post surgery are the same as those leading to the failure of flap coverage. It is in this group of patients that we have employed the vacuum dressing.

In none of our patients so far has the prosthesis been felt to be amenable for salvage, therefore the first step was a radical debridement of the wound and removal of the prosthesis. Stability of the bone end was then obtained using a Charnley clamp or other external fixator. The vacuum dressing system was inserted and the wound left to heal by granulation. The dressing was changed every 24 to 48 hours depending on wound healing. This resulted in a large amount of healthy granulation tissue and the elimination of residual infection. The resulting wound was then closed either directly or using a split skin graft thereby negating the need for further major surgical interventions.

So far treatment of five patients has been completed. All our patients had significant co morbidity. The mean age was 74 years with a range of 68 to 86 years. These cases were all operated on within six months of their knee replacement. Limb salvage was successful in 4 out of the 5 patients who have completed treatment so far, and these patients have returned to the level of function they had prior to their total knee arthroplasty.

In conclusion, the technique of negative pressure wound dressing and subsequent wound coverage is an effective addition to management options in these difficult cases, and is certainly preferable to amputation.