Aims

This study aimed to evaluate implant survival of reverse hybrid total hip arthroplasty (THA) at medium-term follow-up.

Introduction: Aseptic loosening is the leading cause of failure in total hip arthroplasty. We present our long-term results of cemented revision of failed total hip replacements.

Materials And Methods: All patients requiring revision for aseptic loosening were prospectively followed up to assess the patterns of failure as well as the clinical and radiological outcomes of revision. There were 102 cases between 1992 and 2000. The mean age at revision was 67.4 (36–88). There were 60 male and 42 female patients. At the time of the final follow-up 26 patients had died and 10 had further surgery. Of the remainder, 64 patients attended the final assessment and 2 could not be traced.

Results: The mean time to follow-up was 6.8 years (5–13 years).

53 patients required revision of both components. There were 49 stem only revisions.

4 patients were re-revised for recurrent loosening and 2 for infection.

There were 14 dislocations. Of these, 4 required secondary stabilisation and 2 underwent Girdlestone’s excision arthroplasty for recurrent dislocation.

46 of the 64 patients who attended final follow-up had no changes in their X-ray appearances compared to the immediately post-operative films. 9 of the stems and 9 of the cups had signs of progressive lucent lines around the cement mantle.

This gives a survivorship of 89% at ten years with reoperation for any cause as the end-point.

Discussion: Initial reported results of cemented revisions were variable. These have been improving with more recent publications including those from the Scandinavian hip registries. Our results confirm the latter findings of excellent survivorship in cemented revisions.

Introduction: Patients’ demands from hip arthroplasty are changing. Bigger bearings with alternative bearing surfaces are marketed to meet these demands. The aim of this study is to investigate the level of function achieved by patients with the larger hard-on-hard hip replacements in the short term.

Methods: Three groups of patients were identified from the arthroplasty register. The two study groups were those who received a 36mm ceramic-on-ceramic hip replacement (28 patients) and those who received larger metal-on-metal hip replacements (56 patients). The control group (25 patients) was age matched patients receiving 28mm hip replacements with a polyethylene acetabular component.

All patients received postal questionnaires comprising the Oxford Hip Score, the HOOS score and a satisfaction score. Routine yearly radiological examination was also undertaken. Demographic data are shown in Table 1.

Results: All three groups showed significant improvement in the oxford hip score after hip arthroplasty. Those with the larger head sizes had significantly lower scores than those with 28mm.

Activity scores in the HOOS hip survey were not significantly different in the three groups.

There was no difference in satisfaction scores and whether patients would have the same operation again.

Discussion: Our findings suggest that in the short term, functional levels achieved following hip replacement are not influenced by the size of bearing. Should these results be reproduced in larger and longer term studies use of these costly implants may have to be questioned.

Purpose: We report the 10 to 13 year results of the PFC knee system at our institution.

Method/Results: Between 1992 and 1995 97 PFC primary knee arthroplasties were performed consecutively in 82 patients. 32 patients have subsequently died (37 knees) and four (4 knees) are lost to follow-up. Clinical and radiological review of 46 patients (56 knees) was performed at a mean of 11.1 years post-operatively. Outcome was assessed using the Charnley modification of the Merle D’Aubigne score, with a median of 5 for pain and 4 for function. Radiological failure was defined as progressive radiolucency (1 case), lysis (1 case) or subsidence (1 case). Polyethylene wear was detectable in 10 cases, with > 50% in two. There was 100% survivorship with revision for aseptic loosening as an endpoint. There has been one revision for infection and one patella resurfacing, giving a 98% survivorship with no re-operation. In addition one periprosthetic fracture above a well fixed femoral component, required a supracondylar nail.

Conclusions: The PFC gives excellent outcome and survivorship at 13 years, regardless of the experience of the operating surgeon. This demonstrates that with careful training the PFC is a reliable knee replacement in the long-term for trainers and trainees alike.

Purpose: The aim of the study was to evaluate whether the recognition rates of ACL injuries had improved in the decade following the original paper published by the senior author.

Methods: Prospective data collection using a standard questionnaire on all patients presenting to a dedicated soft tissue knee injury clinic. There were 103 patients with a median age of 31.

Results: 94 out of the 103 patients gave a typical history of an ACL injury. The mean time to referral to this specialist clinic was 92 weeks. The commonest mechanism of ACL injuries was sports (88/103), with soccer making up the vast majority. The correct diagnosis was made by 13% of A& E staff, 30% of GPs and 57% of Orthopaedic surgeons.

Of the 11 patients who had an arthroscopy, 4 were told that they had an ACL injury. None of the 15 who had an MRI scan were told that they had an ACL injury.

Conclusion: Despite the increasing incidence and changes in management, there appears to have been very little improvement in the detection of the ACL injured knee in the last 10 years.

Aim: To evaluate the medium term results of revision hip replacements using the ‘Furlong’(© JRI, London) HAC covered total hip replacement system.

Methods: The first one hundred revision hip replacements were identified from the arthroplasty register of the senior author. The notes and x-rays at presentation were retrospectively analysed to ascertain the clinical and radiological state pre-operatively. The surgical findings were also noted. The final clinical and radiological states were obtained from the latest outpatient appointment. Modified Harris Hip Score was used to discern the clinical state. SPSS © vol 11.0 was used for statistical analysis.

Results: There were one hundred revision hip replacements performed in 97 patients between 1991 and 2000 by the senior author. There were 72 cemented and 18 uncemented prosthesis revised. 9 of the revisions were for infection. 79 were revised for aseptic loosening of one or both of the components. There were 4 recurrent dislocators and one revision was carried out for a peri-prosthetic fracture.

The median to follow up was 3 years (mean 3.8, range 1–8).The changes in the clinical state of the patient at the last follow up are shown in the table: At the time of the latest follow-up 74 of the cups and 69 of the stems showed definite radiological signs of osseointegration.

Discussion: Our results show that clinical results of revision surgery using this system give good results in the short to medium term. Radiological results are less easy to interpret as osseointegration can take a long time to become visible on x-rays. The need for longer term follow-up is highlighted by the results.