Direct anterior approach (DAA) arthroplasty has generated great interest because of its minimally invasive and muscle sparing nature. Obese patients are reported to be associated with greater incidence of complications in primary joint replacement. The purpose of this study was to compare patient outcomes and complication rates between obese and non-obese patients undergoing primary total hip arthroplasty (THA) through a Bikini direct anterior incision. This retrospective, single surgeon study compared the outcome of 258 obese patients and 200 non-obese patients undergoing DAA THA using a Bikini incision, over a 7-year period. The average follow-up was 4.2 years (range 2.6-7.6 years). There were no statistically significant differences in the complication rate between the two groups. The obese group recorded 2 major (venous thromboembolism and peri-prosthetic fracture) and 2 minor complications (superficial wound infection), compared with the non-obese group, which recorded 2 major (deep-wound infection and peri-prosthetic fracture) and 1 minor complication (superficial wound infection). Patient-reported outcomes (WOMAC and Harris Hip Scores) showed significant post-operative improvements (p < 0.001) and did not differ between the two groups. Bikini DDA THA does not increase the complication rate in obese patients and offers similar clinical improvements compared to non-obese patients. (200 words)
The purpose of this study was to report all complications during the first consecutive 865 cases of bikini incision direct anterior approach (DAA) total hip arthroplasty (THA) performed by a single surgeon. The secondary aims of the study are to report our clinical outcomes and implant survivorship. We discuss our surgical technique to minimize complication rates during the procedure. We undertook a retrospective analysis of our complications, clinical outcomes and implant survivorship of 865 DAA THA's over a period of 6 years (mean = 5.1yrs from 2.9 to 9.4 years). The complication rates identified in this study were low. Medium term survival at minimum 2-year survival and revision as the end point, was 99.53% and 99.84% for the stem and acetabular components respectively. Womac score improved from 49 (range 40-58) preoperatively to 3.5(range 0-8.8) and similarly, HHS scores improved from 53(range 40-56) to 92.5(range 63-100) at final follow-up (mean = 5.1 yrs) when compared to preoperative scores. These results suggest that bikini incision DAA technique can be safely utilised to perform THA.
The Woodpecker pneumatic broaching system facilitates femoral preparation to achieve optimal primary fixation of the stem in direct anterior hip replacement using a standard operating table. The high-frequency axial impulses of the device reduce excess bone tension, intraoperative femoral fractures and overall operating time. The Woodpecker device provides uniformity and enhanced control while broaching, optimizing cortical contact between the femur and implant and thereby maximizing prosthetic axial stability and longevity. This study aims to describe a single surgeon's experience using the Woodpecker pneumatic broaching system in 649 cases of direct anterior approach (DAA) total hip arthroplasties to determine the device's safety and efficacy. All consecutive patients undergoing elective anterior bikini total hip arthroplasties (THA) performed by a single surgeon between July 2013 and June 2018 were included. Patients undergoing a THA with the use of the Woodpecker device through a different surgical approach, revision THA or arthroplasties for a fractured neck of femur were excluded (n=219). The pneumatic device was used for broaching the femoral canal in all cases. Pre-operative and post-operative Harris Hip Scores (HHS) and post-operative radiographs were analyzed to identify femoral fractures and femoral component positioning at 6 weeks, 6 months and 12 months post-operative. Any intra-operative or post-operative surgical complications and component survivorship until most recent follow up were recorded in the clinical notes.INTRODUCTION
METHODOLOGY
The primary goal of THA or TKA is to relieve pain and restore mobility. The success is determined by the longevity of prostheses and early return to routine activities, such as driving. With enhanced recovery regimens, patients are being discharged within 24–48hrs post-op.. The aim of this study was to determine when our patients returned to driving after anterior hip replacements and patient specific knee replacements. This study included 207 soft tissue sparing anterior bikini THA and 146 patient specific instrumented (PSI) TKAs between Feb 2017 and March 2018. All patients included drove before surgery. Non-drivers were excluded. A detailed questionnaire was sent to all patients 3 to 6 weeks after surgery to record their driving status. 50 patients were randomly selected to assess flexion at the hip, knee, and ankle joints whilst seated in the driver's seat of their vehicle.INTRODUCTION
METHODOLOGY
We conducted this study to determine if the pre-surgical patient specific instrumented planning based on Computed tomography scans can accurately predict each of the femoral and tibial resections. The technique helps in optimization of component positioning and hence overall alignment thereby reducing errors. This makes it less invasive, more efficient and cost effective. The surgical plan in combination with the cutting guides determine the resection thickness, component size, femoral rotation and femoral and tibial component alignment. Several clinical studies have shown that PSI is safe, accurate and reproducible in primary TKA. Accurate preparation of the femoral and tibial surfaces will determine alignment and component positioning and this in turn reflects on function and longevity The study was conducted prospectively between May 2016 and December 2017 in our institution. Patients admitted over a period of these twenty months were included in the study. Patients with primary or secondary osteoarthritis (OA) and inflammatory arthritis who were suitable to undergo patient-specific TKA were included in the study. Patients with conventional instrumented TKR and those with significant deformities requiring constrain including valgus or varus of greater than 20 degrees with incompetent lateral or medial collateral ligaments were excluded from the study along with revisions of partial knee to TKA using PSI blocks. Prophecy® Preoperative Navigation 3D printed Guides were used for the Evolution Medial Pivot knee replacement system ( The senior author (IN) also designed markings on the tibial cutting blocks to improve accurate placement on the tibia and further markings on the femoral cutting blocks to ensure accurate positioning and rotational alignment improving accuracy of the cuts and femoral rotation. Further markings by senior surgeon (IN) on the pre-operative plans included tibial rotational plans in relation to the tibial tubercle.BACKGROUND
METHODS
The observation of elevated heavy metal ions in arthroplasty patients in association with complications has led to concern on the part of patients and surgeons. The aim of this study was to determine the levels of cobalt chromium ions in three compartments, the joint fluid, plasma, and CSF. Patients were divided into 3 groups:
239 without any implant(M132F108) 50 having a supplementary implant, with a well performing contralateral THR.
– 16 large head MoM arthroplasty (Birmingham modular M7F9) – 44 a Birmingham resurfacing(M39F5) 6 revisions of MoM bearings(M3F3) Blood and CSF specimens were harvested at the time of induction of anaesthesia. Joint fluid was aspirated before the surgical incision was made under sterile conditions. Cobalt was assayed using an Agilent7500ce inductively coupled plasma mass spectrometer. Chromium was assayed with a graphite furnace atomic absorption spectrometer (Varian240zlGFAAS). Bivariate correlations were used to determine similarities between groupIntroduction
Method
Periprosthetic joint infection (PJI) is a devastating diagnosis that carries a significant rate of associated mortality and places a large burden on health care systems. Treatment protocols often include combined intravenous antibiotics and staged revision surgery with locally-delivered antibiotics via PMMA cement spacers and/or beads. One disadvantage of PMMA is the need for later removal. Antibiotic releasing Calcium Sulphate beads (CaSO4) have had promising results in revision joint surgery and are absorbable, making later removal unnecessary. We report on use in a tertiary referral centre in the UK and present our initial findings. CaSO4 beads containing 1 gram of Vancomycin and 240 mg of tobramycin per 10 cc was implanted in 12 patients between August 2012 and December 2012, all having undergone revision joint surgery for PJI. Of these patients; 7 were men and 5 women, mean age was 57 years (range 39–72) with a mean ASA grade of 2 (1–4). Indications were infected Total Hip Replacement (n = 7), infected Total Knee Replacement (n = 4) and infected metal on metal hip resurfacing (n = 1). Three procedures were emergencies, with the remainder being semi-elective procedures. One patient had single-stage revision THR. At latest follow up 10 patients had made a full recovery, with normal function and inflammatory markers. Two patients were awaiting a second stage revision procedure. Mean follow up was 2 months (1–4).Introduction:
Methods & Results:
