The National Joint Registry (NJR) for England & Wales provides a useful reference for hospitals to assess and compare their current practice with national figures. We aimed to identify patient and surgical factors at time of primary total knee arthroplasty (TKA) responsible for the revision. A retrospective case note review was performed of all revision TKAs performed at Musgrove Park Hospital 2005–2010. Exclusion criteria included primary TKA performed elsewhere. 38 TKAs and 13 unicompartmental knee arthroplasties (UKAs) were revised. Mean time to revision was 1.8 years and 2.1 years respectively. Reason for revision was pain or disease progression in 54% revised UKAs and infection in 53% revised TKAs. 35% infected cases were therapeutically anticoagulated, 75% ASA 3 and 50% had a BMI >30. No problems were identified with surgeon grade or level of supervision. 5 cases of revision were of a trial primary prosthesis. There were large numbers of high risk patients (increased BMI, ASA grade or on anticoagulants), which may contribute to increased infection rates and subsequent revision. We suggest avoiding trial prostheses and recommend delaying anticoagulation reintroduction until the wound is fully healed. This information may be useful for aiding with patient selection and consent.
The aim of this study was to determine the medium term survivorship and function of the Exeter Universal Hip Replacement when used in younger patients, a group that is deemed to place high demands on their arthroplasties. Since 1988 The Exeter Hip Research Unit has prospectively gathered data on all patients who have had total hip replacements at the Princess Elizabeth Orthopaedic Hospital. There were 130 Exeter Universal total hip replacements (THR) in 107 patients who were 50 years or younger at the time of surgery and whose surgery was performed at least 10 years before. Mean age at surgery was 42 years (range 17-50 years.) Six patients who had 7 THRs had died, leaving 123 THRs for review. Patients were reviewed at an average of 12.5 years (range 10-17 years). No patient was lost to follow-up. At review, 12 hips had been revised. Of these, 9 were for aseptic loosening of the acetabular component and one cup was revised for focal lysis and pain. One hip was revised for recurrent dislocation. One femoral component required revision in 1 case of infection. Radiographs showed that a further 11 (10%) of the remaining acetabular prostheses were loose but that no femoral components were loose. Survivorship of stem and cup from all causes was 94%, at an average of 12.5 years. Survivorship of stem only from all causes was 99% and from aseptic loosening was 100%.Aim
Results
