Cementless stem designs in total hip arthroplasty differ in relation to geometry and area of fixation. We utilised radiostereometric analysis (RSA) to evaluate the 2-year migration of a novel, short, proximally coated femoral stem. 30 participants undergoing primary total hip replacement for any cause (rheumatoid or inflammatory arthritis, osteoarthritis) were prospectively recruited in this study. Osteoporotic patients and cases of suspected infection were excluded. All patients received a short blade stem, proximally coated with a reduced lateral shoulder and narrow triple taper geometry to minimise bone removal. RSA radiographs were performed post-operatively and at 6 weeks, 6 months, 1- and 2 years. The Harris Hip Score (HHS), Oxford Hip Score (OHS) and EQ-5D were collected at baseline and at 2 years post-operatively. The stability of implants and complications were captured during each follow-up visit. A total of 14 female and 16 male patients were recruited with a mean age of 64.8 (range 47 to 75). At two years the mean subsidence of the stem was 0.34 mm (SD 0.62) and the total migration 0.74 mm (SD 0.60). The mean medial translation at two years was 0.059 (0.24) and the mean anterior translation 0.12 (0.59) respectively. Baseline PROM scores improved significantly at 2-years from pre-operatively (median and interquartile range): HHS from 33 (18.25) to 92 (19), EQ5D from 0.5 (0.35) to 0.94 (0.17), OHS from 21 (18.25) to 42 (4.25). P-value for all comparisons was <0.001. 2-year follow up data revealed no complications. There were no stem revisions in study participants and no heterotopic ossifications were identified on radiographs. 2-year migration results of a cementless, short blade, proximally coated tapered femoral stem using RSA, showed the stem exhibits a predictable migration pattern and achieves initial stability. This is highly likely to translate to mid and long-term stability, which needs to be corroborated by long-term outcome studies. Furthermore, participants demonstrated excellent clinical, patient reported and radiological outcomes after 2 years of follow up to support expansion in the use of this prosthesis.
We are a high-volume arthroplasty unit performing over 800 primary THRs annually at an approximate reimbursement of £6.5 million to the Trust. 70% are hybrid and we have been using the Taperfit - Trinity combination (Corin, Cirencester) since March 2016. We aimed to investigate the potential cost-savings and clinical benefits of instrument rationalisation using this system following GIRFT principles. Taperfit (ODEP 10A) is a polished, collarless, double tapered stem available in multiple sizes/offsets. Trinity is a hemispherical porous titanium cementless shell. A prospective audit of implant size was performed for the first 50 cases. Based on these findings, instruments were reduced to a single tray per component based on predicted size, named ‘Corin Hip for the Osteoarthritic Patient’ (CHOP). A further re-audit was performed to confirm correct tray constituent sizes. Financial data were calculated using known TSSU costs of approximately £50 per tray.Introduction
Methods
The Best Practice Tariff (BpT) for primary THR / TKR was established in 2014 and rewards good clinical practice with a £550 uplift on the £5000 basic reimbursement. For an ‘average unit’ performing 220 primary THR and 260 eligible knee surgeries (NJR data) this equates to £265,000 per year or over £1million since its inception. The aim of this study was to investigate why Chelsea & Westminster Hospital NHS Trust was not receiving this reimbursement. BpT is dependent on four factors (NHS England, PROMS): (i) the provider not having an average health gain significantly below the national average, (ii) a minimum National Joint Registry compliance rate of 85%, (iii) an NJR unknown consent rate below 15%, and (iv) a PROMs participation rate of 50%.Introduction
Materials & Methods
Slipped upper femoral epiphysis (SUFE) predominantly affects males in early adolescence. Severe slips occur with an estimated incidence of 1 per 100,000 children. Controversy exists over optimal treatment of severe slips with debate between in-situ fixation versus corrective surgery. We report on our management of a large series of such patients using a sub-capital cuneiform osteotomy. Between 2001–2011, 57 patients (35M: 22F) with an average age of 13.1 years were referred to our tertiary referral institution with a severe slip. This was defined as an epiphyseal-metaphyseal displacement greater than half the width of the femoral neck on a Billing lateral radiograph. The affected limb was rested in slings and springs prior to corrective surgery which was performed via an anterior Smith-Petersen approach. More recently our series has included pre-operative MRI to look for avascular necrosis of the epiphysis. Data was analysed to compare complication rate with time to surgery and surgeon's experience.Introduction
Patients/Methods
Proximal femoral bony deficits present a surgical and biomechanical challenge to implant longevity in revision hip arthroplasty. This work finds comparable primary stability when a distally fixing tapered fluted stem was compared with a conical design in cadaveric tests. Proximal bony deficits complicate revision hip surgery and compromise implant survival. Longer distally fixing stems which bypass such defects are therefore required to achieve stability compatible with bony ingrowth and implant longevity.Summary Statement
Introduction
Revision hip arthroplasty is a technically challenging operation as proximal bony deficits preclude the use of standard implants. Longer distally fixing stems are therefore required to achieve primary stability. This work aims to compare the primary stability and biomechanical properties of a new design of tapered fluted modular femoral stem (Redapt®, Smith & Nephew) to that of a conical fluted stem (Restoration®, Stryker). It is hypothesized that the taper will provide improved rotational stability under cyclical loading.Introduction
Aims
Somatosensory evoked potential (SSEP) monitoring allows for assessment of the spinal cord and susceptible structures during complex spinal surgery. It is well validated for the detection of potential neurological injury but little is known of surgeon's responses to an abnormal trace and its effect on neurological outcome. We aimed to investigate this in spinal deformity patients who are particularly vulnerable during their corrective surgery. Our institutional neurophysiology database was analysed between 1st October 2005 and 31st March 2010. Monitoring was performed by a team of trained neurophysiology technicians who were separate from the surgical team. A significant trace was defined as a 50% reduction in trace amplitude or a 10% increase in signal latency. Patients suffering a significant trace event were examined post-operatively by a Consultant Neurologist who was separate from the surgical team.Introduction
Methods
The number of revision hip arthroplasty procedures is rising annually with 7852 such operations performed in the UK in 2010. These are expensive procedures due to pre-operative investigation, surgical implants and instrumentation, protracted hospital stay, and pharmacological costs. There is a paucity of robust literature on the costs associated with the common indications for this surgery. We aim to quantify the cost of revision hip arthroplasty by indication and identify any short-fall in relation to the national tariff.Introduction
Objective
Evidence suggests that intra-operative spinal cord monitoring is sensitive and specific for detecting potential neurological injury. However, little is known about surgeons' responses to trace changes and the resultant neurological outcome. To examine the role of intra-operative somatosensory evoked potential (SSEP) monitoring in the prevention of neurological injury, specifically sensitivity and specificity, and whether the abnormalities were reversible.Introduction
Objective
A new conservative hip stem has been designed to address the complex problem of total hip arthroplasty in the younger population. To assess the stability and strain distribution of a new conservative hip stem.Introduction
Objectives
