Introduction: The tribiological properties of bearing surfaces are one of the main topics in discussion in the orthopaedic research. Hard-on-hard bearings are one of the ways to reduce wear rates. Modern hard-on-hard bearing low wear rates depend on the correct pairing of bearing surfaces and strict manufacturing tolerances in surface roughness, clearance, and roundness.

There have been some concerns in using ceramic bearings, particularly regarding the fracture rate and their subsequent management. Hence, we present here 2 similar cases that highlight the catastrophic failure of metal head when used subsequently to treat the complication of ceramic fractures in Total Hip Arthroplasty (THA).

Case Details: Two patients underwent primary THA at different centres with ceramic-on-ceramic bearing. After an initial asymptomatic period of 2 years, ceramic fracture occurred in both the cases, which were subsequently replaced by metal-on-polyethylene bearings by the primary surgeons. One year after the revision of bearings, both the patients developed severe pain and discomfort, which on further investigation revealed massive metallosis, wear of the metal head and aseptic loosening of the acetabular components with cavitation in acetabulum.

Both the patients underwent revision THA under the senior author at our tertiary centre-Wrightington Hospital. Intraoperatively near total erosion of the metal head was noted with more than one litre of black, dense material collection in and around the hip joint revealing extensive metallosis. The acetabular cup was grossly loose and significant loss of bone stock was noted due to metallosis.

Single stage revision surgery was performed with impaction bone grafting for deficient acetabulum and cemented components were used. At one-year follow-up none of the cases have shown any further wear or complications.

Conclusion: One of the main objectives of successful THA is to improve implant longevity. To achieve this understanding the mechanisms of wear between the interacting surfaces is extremely important. The use of ceramic head is good, but there is always a risk of fracture. We do not recommend using metal heads in cases with prior ceramic fractures, as the wear of metal is most likely to occur as it is an ongoing process due to the residual ceramic debris. Hence in these difficult scenarios we recommend usage of ceramic-on-polyethylene as a safe option to prevent catastrophic erosion of metal head and improve implant longevity.

Introduction: Extensive bone loss associated with revision hip surgery is a significant orthopaedic challenge. Acetabular reconstruction with the use of impaction bone grafting and a cemented polyethylene cup is a reliable and durable technique in revision situations with cavitatory acetabular bone defects. Slooff et al. (1996) reported the use of cancellous graft alone. Brewster et al. (1999) morselised the whole femoral head after removal of articular cartilage. This paper asks, is it really necessary to use pure cancellous graft?

Methods: 42 acetabular revisions using impacted morselised bone graft without removal of articular cartilage and a cemented cup were studied retrospectively. The mean follow up was 2.6 years (1–5yrs). Clinical and radiographic assessment was made using the Oxford Hip score, Hodgkinson’s criteria (1988) for socket loosening and Gie classification (1993) for evaluation of allograft consolidation and remodelling.

Results: 40(95%) sockets were considered radiologically stable (Type 0, 1, 2 demarcations). 2(5%) sockets were radiologically loose (Type 3 demarcation). There was no socket migration in our series. 27(64%) cases showed good trabecular remodelling (grade 3). 12(29%) cases showed trabecular incorporation (grade 2). Only 3(7%) cases showed poor allograft incorporation (grade 1). Average pre operative Oxford hip score was 41 and postoperative hip score was 27. There have been no socket re-revisions (100% survival) at an average of 2.6 years.

Conclusion: Early radiological and clinical survival results with retaining articular cartilage of femoral head allograft are similar and comparable to other major studies for acetabular impaction bone grafting in revisions. Minimal loss of allograft mass is 40% in obtaining pure cancellous graft. When there is a limited supply and demand of allograft, saving up to 40 % of the material is a valuable and cost effective use of scarce resources.

Aims & Objectives: To assess whether the incidence of infection in Primary Total knee Arthroplasty is increased as a result of previous steroid infiltration into the knee joint.

Introduction: Steroid injection into the arthritic joint is a well-known modality of treatment of the arthritic joints. Its efficacy is well documented. Increased incidence of Infection secondary to steroid injection as compared to uninjected joints is reported in recent literature.

Material & Methods: 440 patients underwent Total Knee replacement (PFC SIGMA-Depuy) by senior author during 1997–2005 at Wrightington hospital. 90 patients had intraarticular steroid injection prior to surgery of which 45 patients had injection with in 1 year prior to surgery. All patients had at least one year follow up. Infection rate was assessed by case note, x-rays and microbiology review till last follow up.180 patients of a matched cohort who had total knee replacement without steroid injection were compared for infection rate.

Results: 2 cases of superficial infection were noted in Injection group and 5 cases of superficial infection in Non Injection group. No cases of Deep infection noted in either group. Stastical analysis showed no significant difference in incidence of infection in either group.

Conclusion: Steroids are useful adjuncts in the management of patients with arthritic joints. This study shows no increased incidence of infection in patients given steroid injection prior to arthroplasty.

To assess the incidence of infection in cases of Primary Total Knee Arthroplasty with prior steroid injection into the knee joint.

Steroid injection into the arthritic joint is a well-known modality of treatment of arthritic joints. Its efficacy is well-documented. Increased incidence of infection secondary to steroid injection as compared to uninjected joints is reported in recent literature.

A retrospective study was conducted. Four hundred and forty patients underwent Total Knee Replacement by the senior author during 1997–2005 at Wrightington hospital. Ninety patients had intraarticular steroid injection prior to surgery of which 35 patients had injection within 1 year prior to surgery. All patients had at least one year follow-up. Infection rate was assessed by case note, x-rays and microbiology review till last follow-up. One hundred and eighty patients of matched cohort who had Total Knee Replacement without steroid injection were compared for infection rate.

Two cases of superficial infection were noted in the infection group and 5 cases of superficial infection in the non-injection group. No case of deep infection was noted in either group. Statistical analysis showed no significant difference in incidence of infection in either group.

Steroids are useful adjuncts in the management of patients with arthritic joints. This study shows no increased incidence of infection in patients who were given steroid injection prior to arthroplasty.

Introduction: Steroid Infiltration into arthritic joints are a common means of treating pain. They are also sometimes done to differentiate pain in the hip from the low back or knee. There are recent reports which suggest that the rate of infection in hip arthroplasty after injection is higher than in previously uninjected joints.

Methods: We performed a retrospective review of the notes of all patients who underwent hip replacements in Wrightington Hospital under the care of the senior author from 1997 to 2004. We identified all patients who had at least one year follow up after the procedure. The infection rates in the patients who had an injection of steroid into the joint prior to hip replacement were compared to those who had no such intervention.

Results: There were 589 patients who had a hip replacement in this period. Of these, 72 had a prior injection of steroid into the joint. In the injected group, there was no incidence of infection during the period of follow up. There was one case of infection in a patient who did not have an injection prior to the arthroplasty.

Discussion: Steroid injections are a valuable adjunct in the management of patients with arthritic joints. This review clearly identifies no increased risk of infection in patients who had the injection prior to the operation.