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The Bone & Joint Journal
Vol. 95-B, Issue 4 | Pages 467 - 471
1 Apr 2013
Sandiford N Doctor C Rajaratnam SS Ahmed S East DJ Miles K Butler-Manuel A Shepperd JAN

We present the extended follow-up (≥ 20 years) of a series of fully hydroxyapatite-coated femoral components used in 72 primary total hip replacements (THRs). Earlier results of this cohort have been previously published. All procedures were performed between 1986 and 1991. The series involved 45 women and 15 men with 12 bilateral procedures. Their mean age at the time of surgery was 60 years (46 to 80) and the mean duration of follow-up was 22.5 years (20 to 25). At final follow-up, the mean Merle d’Aubigné and Postel hip scores were 5.5 (4.5 to 6), 3.8 (3.5 to 5) and 3.3 (3.0 to 5.0) for pain, mobility and function, respectively. Of the patients 92% were very satisfied at the time of final follow-up.

There were seven revisions: six of the acetabular component for aseptic loosening and one of both the stem and the acetabular component for loosening due to deep infection. The survival of this prosthesis at 22.5 years with revision for any reason as the endpoint was 91.7% (95% confidence interval (CI) 84 to 99). Survival with aseptic loosening of the stem as the endpoint was 100% (95% CI 90 to 100).

This prosthesis provides pain relief in the long term. Survival of this component is comparable to the best results for primary THR with any means of fixation.

Cite this article: Bone Joint J 2013;95-B:467–71.


Bone & Joint Research
Vol. 1, Issue 8 | Pages 167 - 173
1 Aug 2012
Jack CM Rajaratnam SS Khan HO Keast-Butler O Butler-Manuel PA Heatley FW

Objectives

To assess the effectiveness of a modified tibial tubercle osteotomy as a treatment for arthroscopically diagnosed chondromalacia patellae.

Methods

A total of 47 consecutive patients (51 knees) with arthroscopically proven chondromalacia, who had failed conservative management, underwent a modified Fulkerson tibial tubercle osteotomy. The mean age was 34.4 years (19.6 to 52.2). Pre-operatively, none of the patients exhibited signs of patellar maltracking or instability in association with their anterior knee pain. The minimum follow-up for the study was five years (mean 72.6 months (62 to 118)), with only one patient lost to follow-up.


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 1 | Pages 27 - 30
1 Jan 2008
Rajaratnam SS Jack C Tavakkolizadeh A George MD Fletcher RJ Hankins M Shepperd JAN

Between 1986 and 1991 we implanted 331 consecutive Furlong hydroxyapatite-coated femoral components of a total hip replacement in 291 patients. A cemented acetabular prosthesis was used in 217 hips and a hydroxyapatite-coated component in 114. We describe the long-term clinical and radiological survival of the femoral component at a mean follow-up of 17.5 years (15 to 21). Only two patients (0.68%) were lost to follow-up. With revision of the femoral component for any reason as the endpoint, the survival at a mean of 17 years was 97.4% (95% confidence interval 94.1 to 99.5), and with revision for aseptic loosening as the endpoint it was 100%. The survival at a maximum of 21 years with revision of the femoral component for any reason as the endpoint was 97.4% (95% confidence interval 81.0 or 99.5). These results compare favourably with the best long-term results of cemented or uncemented femoral components used in total hip replacement.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_III | Pages 334 - 334
1 Nov 2002
Rajaratnam SS Selmon GPF Mueller M Shepperd JAN Mulholland RC
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Objective: To present early results of a new technique of dynamic stabilisation of the lumbo-sacral spine.

Design: Prospective study

Subjects: Between September 2000 and December 2001, 43 patients underwent posterior spinal stabilisation using the Dynamic Neutralisation System (DYNESYS) (Sulzer Medica).

Outcome Measures: Oswestry Disability indices, complications, visual analogue pain scores, patient satisfaction.

Results: The perceived indications were isolated degenerative disc disease (26), spondylolisthesis (8), degenerate adult scoliosis (4), failed Graf stabilisation (1), lumbar canal stenosis (3) and traumatic compression fracture (1).

Fixation was at one level in 14, two levels in 23, and three or four levels in 6 patients. Thirty-seven had Dyne-sys fixation alone and six had additional procedures at the same operation.

Complications included facet fracture (1), broken pedicle screw (1), apparent screw loosening (1) and discitis (1). At average follow-up of eight months (range 2–14 months), the average Oswestry disability score had fallen from 52 to 32 and the visual analogue pain score from 7.5 to 1.7. 65% of patients were pleased or better with their result.

Conclusions: The Dynesys system seems to be a safe alternative to conventional operative treatment for degenerative disorders of the lumbar spine without the need for rigid fusion. The anatomic re-stabilisation may allow the spinal segment to recover. The early results are encouraging. It is hoped that longer term follow-up will clarify the groups of patients who will benefit most from this procedure.