The risk of mechanical failure of modular revision hip stems is frequently mentioned in the literature, but little is currently known about the actual clinical failure rates of this type of prosthesis. The current retrospective long-term analysis examines the distal and modular failure patterns of the Prevision hip stem from 18 years of clinical use. A design improvement of the modular taper was introduced in 2008, and the data could also be used to compare the original and the current design of the modular connection. We performed an analysis of the Prevision modular hip stem using the manufacturer’s vigilance database and investigated different mechanical failure patterns of the hip stem from January 2004 to December 2022.Aims
Methods
This study reports the ten-year wear rates, incidence of osteolysis, clinical outcomes, and complications of a multicentre randomized controlled trial comparing oxidized zirconium (OxZr) versus cobalt-chrome (CoCr) femoral heads with ultra-high molecular weight polyethylene (UHMWPE) and highly cross-linked polyethylene (XLPE) liners in total hip arthroplasty (THA). Patients undergoing primary THA were recruited from four institutions and prospectively allocated to the following treatment groups: Group A, CoCr femoral head with XLPE liner; Group B, OxZr femoral head with XLPE liner; and Group C, OxZr femoral head with UHMWPE liner. All study patients and assessors recording outcomes were blinded to the treatment groups. The outcomes of 262 study patients were analyzed at ten years’ follow-up.Aims
Methods
Orthopaedic and reconstructive surgeons are faced with large defects after the resection of malignant tumours of the sacrum. Spinopelvic reconstruction is advocated for resections above the level of the S1 neural foramina or involving the sacroiliac joint. Fixation may be augmented with either free vascularized fibular flaps (FVFs) or allograft fibular struts (AFSs) in a cathedral style. However, there are no studies comparing these reconstructive techniques. We reviewed 44 patients (23 female, 21 male) with a mean age of 40 years (SD 17), who underwent en bloc sacrectomy for a malignant tumour of the sacrum with a reconstruction using a total (n = 20), subtotal (n = 2), or hemicathedral (n = 25) technique. The reconstructions were supplemented with a FVF in 25 patients (57%) and an AFS in 19 patients (43%). The mean length of the strut graft was 13 cm (SD 4). The mean follow-up was seven years (SD 5).Aims
Methods
The aims of this study were to validate the outcome of total elbow arthroplasty (TEA) in patients with rheumatoid arthritis (RA), and to identify factors that affect the outcome. We searched PubMed, MEDLINE, Cochrane Reviews, and Embase from between January 2003 and March 2019. The primary aim was to determine the implant failure rate, the mode of failure, and risk factors predisposing to failure. A secondary aim was to identify the overall complication rate, associated risk factors, and clinical performance. A meta-regression analysis was completed to identify the association between each parameter with the outcome.Aims
Methods
This study aimed to determine if macrophages can attach and directly affect the oxide layers of 316L stainless steel, titanium alloy (Ti6Al4V), and cobalt-chromium-molybdenum alloy (CoCrMo) by releasing components of these alloys. Murine peritoneal macrophages were cultured and placed on stainless steel, CoCrMo, and Ti6Al4V discs into a 96-well plate. Cells were activated with interferon gamma and lipopolysaccharide. Macrophages on stainless steel discs produced significantly more nitric oxide (NO) compared to their control counterparts after eight to ten days and remained elevated for the duration of the experiment.Aims
Methods
Aseptic loosening is a major cause of failure in cemented endoprosthetic reconstructions. This paper presents the long-term outcomes of a custom-designed cross-pin fixation construct designed to minimize rotational stress and subsequent aseptic loosening in selected patients. The paper will also examine the long-term survivorship and modes of failure when using this technique. A review of 658 consecutive, prospectively collected cemented endoprosthetic reconstructions for oncological diagnoses at a single centre between 1980 and 2017 was performed. A total of 51 patients were identified with 56 endoprosthetic implants with cross-pin fixation, 21 of which were implanted following primary resection of tumour. Locations included distal femoral (n = 36), proximal femoral (n = 7), intercalary (n = 6), proximal humeral (n = 3), proximal tibial (n = 3), and distal humeral (n = 1).Aims
Patients and Methods
The aim of this study was to report the outcomes of different treatment options for glenoid loosening following reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years. We retrospectively studied the records of 79 patients (19 men, 60 women; 84 shoulders) aged 70.4 years (21 to 87) treated for aseptic loosening of the glenosphere following RSA. Clinical evaluation included pre- and post-treatment active anterior elevation (AAE), external rotation, and Constant score.Aims
Patients and Methods
Free vascularised fibular grafting has been used for the treatment
of large bony defects for more than 40 years. However, there is
little information about the risk factors for failure and whether
newer locking techniques of fixation improve the rates of union.
The purpose of this study was to compare the rates of union of free
fibular grafts fixed with locking and traditional techniques, and
to quantify the risk factors for nonunion and failure. A retrospective review involved 134 consecutive procedures over
a period of 20 years. Of these, 25 were excluded leaving 109 patients
in the study. There were 66 men and 43 women, with a mean age of
33 years (5 to 78). Most (62) were performed for oncological indications,
and the most common site (52) was the lower limb. Rate of union
was estimated using the Kaplan-Meier method and risk factors for
nonunion were assessed using Cox regression. All patients were followed
up for at least one year.Aims
Patients and Methods
If a modular convertible total shoulder system
is used as a primary implant for an anatomical total shoulder arthroplasty,
failure of the prosthesis or the rotator cuff can be addressed by
converting it to a reverse shoulder arthroplasty (RSA), with retention
of the humeral stem and glenoid baseplate. This has the potential
to reduce morbidity and improve the results. In a retrospective study of 14 patients (15 shoulders) with a
mean age of 70 years (47 to 83) we reviewed the clinical and radiological
outcome of converting an anatomical shoulder arthroplasty (ASA)
to a RSA using a convertible prosthetic system (SMR system, Lima,
San Daniele, Italy). The mean operating time was 64 minutes (45 to 75). All humeral
stems and glenoid baseplates were found to be well-fixed and could
be retained. There were no intra-operative or early post-operative
complications and no post-operative infection. The mean follow-up was 43 months (21 to 83), by which time the
mean visual analogue scale for pain had decreased from 8 pre-operatively
to 1, the mean American Shoulder and Elbow Surgeons Score from 12
to 76, the mean Oxford shoulder score from 3 to 39, the mean Western
Ontario Osteoarthritis of the Shoulder Score from 1618 to 418 and
the mean Subjective shoulder value from 15 to 61. On radiological review, one patient had a lucency around the
humeral stem, two had stress shielding. There were no fatigue fractures
of the acromion but four cases of grade 1 scapular notching. The use of a convertible prosthetic system to revise a failed
ASA reduces morbidity and minimises the rate of complications. The
mid-term clinical and radiological results of this technique are
promising. Cite this article:
When fracture of an extensively porous-coated
femoral component occurs, its removal at revision total hip arthroplasty
(THA) may require a femoral osteotomy and the use of a trephine.
The remaining cortical bone after using the trephine may develop
thermally induced necrosis. A retrospective review identified 11
fractured, well-fixed, uncemented, extensively porous-coated femoral
components requiring removal using a trephine with a minimum of
two years of follow-up. The mean time to failure was 4.6 years (1.7 to 9.1, standard
deviation ( A total of four patients (36.4%) required further revision: three
for instability and one for fracture of the revision component.
There was no statistically significant difference in the mean Harris
hip score before implant fracture (82.4; These findings suggest that removal of a fractured, well-fixed,
uncemented, extensively porous-coated femoral component using a
trephine does not compromise subsequent fixation at revision THA
and the patient’s pre-operative level of function can be restored.
However, the loss of proximal bone stock before revision may be associated
with a high rate of dislocation post-operatively. Cite this article:
The incidence of periprosthetic fractures of
the ankle is increasing. However, little is known about the outcome
of treatment and their management remains controversial. The aim
of this study was to assess the impact of periprosthetic fractures
on the functional and radiological outcome of patients with a total
ankle arthroplasty (TAA). A total of 505 TAAs (488 patients) who underwent TAA were retrospectively
evaluated for periprosthetic ankle fracture: these were then classified
according to a recent classification which is orientated towards
treatment. The outcome was evaluated clinically using the American
Orthopedic Foot and Ankle Society (AOFAS) score and a visual analogue
scale for pain, and radiologically. A total of 21 patients with a periprosthetic fracture of the
ankle were identified. There were 13 women and eight men. The mean
age of the patients was 63 years (48 to 74). Thus, the incidence
of fracture was 4.17%. There were 11 intra-operative and ten post-operative fractures,
of which eight were stress fractures and two were traumatic. The
prosthesis was stable in all patients. Five stress fractures were
treated conservatively and the remaining three were treated operatively. A total of 17 patients (81%) were examined clinically and radiologically
at a mean follow-up of 53.5 months (12 to 112). The mean AOFAS score
at follow-up was 79.5 (21 to 100). The mean AOFAS score in those
with an intra-operative fracture was 87.6 (80 to 100) and for those
with a stress fracture, which were mainly because of varus malpositioning,
was 67.3 (21 to 93). Periprosthetic fractures of the ankle do not
necessarily adversely affect the clinical outcome, provided that
a treatment algorithm is implemented with the help of a new classification
system. Cite this article:
Non-modular tapered fluted, titanium stems are
available for use in femoral revision. The combination of taper
and flutes on the stem provides axial and rotational stability,
respectively. The material and surface properties of the stem promotes
bone on-growth. If the surgeon is confident and reasonably experienced
in the surgical use of this sort of design and the case is relatively
straightforward, a non-modular design is effective. It also potentially reduces
implant inventory, and circumvents the potential problems of taper
junction corrosion and
Acetabular bone loss is a challenging problem
facing the revision total hip replacement surgeon. Reconstruction
of the acetabulum depends on the presence of anterosuperior and
posteroinferior pelvic column support for component fixation and
stability. The Paprosky classification is most commonly used when
determining the location and degree of acetabular bone loss. Augments
serve the function of either providing primary construct stability
or supplementary fixation. When a pelvic discontinuity is encountered we advocate the use
of an acetabular distraction technique with a jumbo cup and modular
porous metal acetabular augments for the treatment of severe acetabular
bone loss and associated chronic pelvic discontinuity. Cite this article:
Epidemiological studies enhance clinical practice
in a number of ways. However, there are many methodological difficulties
that need to be addressed in designing a study aimed at the collection
and analysis of data concerning fractures and other injuries. Most
can be managed and errors minimised if careful attention is given
to the design and implementation of the research. Cite this article:
Back pain is a common symptom in children and
adolescents. Here we review the important causes, of which defects
and stress reactions of the pars interarticularis are the most common
identifiable problems. More serious pathology, including malignancy
and infection, needs to be excluded when there is associated systemic
illness. Clinical evaluation and management may be difficult and
always requires a thorough history and physical examination. Diagnostic
imaging is obtained when symptoms are persistent or severe. Imaging
is used to reassure the patient, relatives and carers, and to guide
management. Cite this article:
We investigated a new intramedullary locking
nail that allows the distal interlocking screws to be locked to
the nail. We compared fixation using this new implant with fixation
using either a conventional nail or a locking plate in a laboratory
simulation of an osteoporotic fracture of the distal femur. A total
of 15 human cadaver femora were used to simulate an AO 33-A3 fracture
pattern. Paired specimens compared fixation using either a locking
or non-locking retrograde nail, and using either a locking retrograde
nail or a locking plate. The constructs underwent cyclical loading
to simulate single-leg stance up to 125 000 cycles. Axial and torsional
stiffness and displacement, cycles to failure and modes of failure
were recorded for each specimen. When compared with locking plate
constructs, locking nail constructs had significantly longer mean
fatigue life (75 800 cycles ( The new locking retrograde femoral nail showed better stiffness
and fatigue life than locking plates, and superior fatigue life
to non-locking nails, which may be advantageous in elderly patients. Cite this article:
Following the recall of modular neck hip stems
in July 2012, research into femoral modularity will intensify over
the next few years. This review aims to provide surgeons with an
up-to-date summary of the clinically relevant evidence. The development
of femoral modularity, and a classification system, is described.
The theoretical rationale for modularity is summarised and the clinical
outcomes are explored. The review also examines the clinically relevant problems
reported following the use of femoral stems with a modular neck. Joint replacement registries in the United Kingdom and Australia
have provided data on the failure rates of modular devices but cannot
identify the mechanism of failure. This information is needed to
determine whether modular neck femoral stems will be used in the
future, and how we should monitor patients who already have them implanted. Cite this article:
Revision total hip arthroplasty (THA) is projected
to increase by 137% from the years 2005 to 2030. Reconstruction of
the femur with massive bone loss can be a formidable undertaking.
The goals of revision surgery are to create a stable construct,
preserve bone and soft tissues, augment deficient host bone, improve
function, provide a foundation for future surgery, and create a
biomechanically restored hip. Options for treatment of the compromised femur
include: resection arthroplasty, allograft prosthetic composite
(APC), proximal femoral replacement, cementless fixation with a
modular tapered fluted stem, and impaction grafting. The purpose
of this article is to review the treatment options along with their
associated outcomes in the more severe femoral defects (Paprosky types
IIIb and IV) in revision THA.
We describe three cases of infantile tibia vara
resulting from an atraumatic slip of the proximal tibial epiphysis
upon the metaphysis. There appears to be an association between
this condition and severe obesity. Radiologically, the condition
is characterised by a dome-shaped metaphysis, an open growth plate
and disruption of the continuity between the lateral borders of
the epiphysis and metaphysis, with inferomedial translation of the
proximal tibial epiphysis. All patients were treated by realignment
of the proximal tibia by distraction osteogenesis with an external
circulator fixator, and it is suggested that this is the optimal
method for correction of this complex deformity. There are differences
in the radiological features and management between conventional
infantile Blount’s disease and this ‘slipped upper tibial epiphysis’
variant.