Aims

In patients with a “dry” aspiration during the investigation of prosthetic joint infection (PJI), saline lavage is commonly used to obtain a sample for analysis. The aim of this study was to investigate prospectively the impact of saline lavage on synovial fluid analysis in revision arthroplasty.

Between 1965 and 1973 a total of 808 McKee-Farrar metal-on-metal cemented total hip arthroplasties were performed in the Norfolk and Norwich Hospital. Of these, 230 surviving arthroplasties have been reviewed at average follow-up of 13.9 years. There were good or excellent results in 49% of the arthroplasties as judged by the Harris hip score with 78% of these having little or no pain. A comprehensive radiographic analysis was undertaken and a survivorship study of 81% of the total number of prostheses is presented

Aims

It is not known whether change in patient-reported outcome measures (PROMs) over time can be predicted by factors present at surgery, or early follow-up. The aim of this study was to identify factors associated with changes in PROM status between two-year evaluation and medium-term follow-up.

The Birmingham hip resurfacing (BHR) arthroplasty is a metal-on-metal prosthesis for which no medium- or long-term results have been published. Despite this, it is increasing in popularity as an alternative to stemmed prostheses for younger patients. Since the fixation of the socket is conventional, the major concern is long-term failure of the femoral component. This can be predicted by the use of roentgen stereophotogrammetric analysis (RSA). We have therefore undertaken such a study of the BHR femoral component over a period of two years. Twenty patients (22 hips) underwent a standard BHR procedure. Migration of the femoral component was measured by RSA at intervals of three, six, 12 and 24 months. At 24 months the total three-dimensional migration of the head was 0.2 mm. This was not statistically significant. Previous studies have shown that implants which loosen quickly have rapid early migration. Our results therefore suggest that the BHR femoral component is an inherently stable device which is likely to perform well in the long term

1. A thousand arthritic hips have been replaced by an uncemented metal-on-metal prosthesis, and 942 followed by annual review. The mortality of the operation has been 1·1 per cent, the rate of deep-seated infection 0·7 per cent and the incidence of dislocation 0·3 per cent. 2. Of 169 hips replaced by an earlier type of the prosthesis and followed for five to eight years, 45 per cent have remained excellent and 29 per cent good, but 14 per cent have required revision, mainly for loosening of the femoral component. 3. The current types of prosthesis, now used for five years, have given excellent results in 69 per cent and good results in 21 per cent of 535 patients followed for one to five years. Revision for loosening has been necessary in 2 per cent. 4. The improvement in results has been obtained by the introduction of a tapered screw thread on the pelvic component, and by a range of femoral components that ensures a good cortical fit

A prospective study of allergic contact dermatitis after metal-on-plastic total hip replacement was undertaken in 69 patients, of whom 54 were available for review after operation. Before operation six patients were metal sensitive, but only one remained so afterwards; this patient had given a clear history of metal sensitivity and a titanium prosthesis had therefore been used. In all six patients the result of the operation was good and no case of loosening occurred. Sixty-three patients had negative patch tests before operation; in none of these was metal sensitivity detected after operation. Cutaneous sensitivity to various metals is well documented after the insertion of metal-on-metal prostheses and in failed prostheses. We have not found any such increased sensitivity after metal-on-plastic hip replacement. There is little evidence of a direct causal relationship between metal sensitivity and subsequent loosening. The cutaneous sensitivity may be the consequence of loosening rather than its cause. Our results suggest that, providing metal-on-plastic prostheses are used, routine patch testing before hip replacement is no longer required

Metal-on-metal (MOM) bearings for hip arthroplasty are increasing in popularity. Concern remains, however, regarding the potential toxicological effects of the metal ions which these bearings release. The serum levels of cobalt and chromium in 22 patients who had undergone MOM resurfacing arthroplasty were compared with a matched group of 22 patients who had undergone 28 mm MOM total hip arthroplasty (THA). At a median of 16 months (7 to 56) after resurfacing arthroplasty, we found the median serum levels of cobalt and chromium to be 38 nmol/l (14 to 44) and 53 nmol/l (23 to 165) respectively. These were significantly greater than the levels after 28 mm MOM THA which were 22 nmol/l (15 to 87, p = 0.021) and 19 nmol/l (2 to 58, p < 0.001) respectively. Since the upper limit for normal patients without implants is typically 5 nmol/l, both groups had significantly raised levels of metal ions. MOM bearings of large diameter, however, result in a greater systemic exposure of cobalt and chromium ions than bearings of small diameter. This may be of relevance for potential long-term side-effects. It is not known to what extent this difference is due to corrosion of the surfaces of the component or of the wear particles produced

Aims

The aim of this study was to assess the functional gain achieved following hip resurfacing arthroplasty (HRA).

Aims

Leucocyte esterase (LE) has been shown to be an accurate marker of prosthetic joint infection (PJI), and has been proposed as an alternative to frozen section (FS) histology for intraoperative diagnosis. In this study, the intraoperative assessment of LE was compared with FS histology for the diagnosis of prosthetic hip infection.

Aims

We compared implant and patient survival following intraoperative periprosthetic femoral fractures (IOPFFs) during primary total hip arthroplasty (THA) with matched controls.

Aims

Surface replacement arthroplasty (SRA), compared with traditional total hip arthroplasty (THA), is more expensive and carries unique concern related to metal ions production and hypersensitivity. Additionally, SRA is a more demanding procedure with a decreased margin for error compared with THA. To justify its use, SRA must demonstrate comparable component survival and some clinical advantages. We therefore performed a systematic literature review to investigate the differences in complication rates, patient-reported outcomes, stress shielding, and hip biomechanics between SRA and THA.

Aims

The aim of this study was to evaluate the prosthesis characteristics and associated conditions that may modify the survival of total femoral endoprosthetic replacements (TFEPR).

Aims

Cardiac magnetic resonance (CMR) was used to assess whether cardiac function or tissue composition was affected in patients with well-functioning metal-on-metal hip resurfacing arthroplasties (MoMHRA) when compared with a group of controls, and to assess if metal ion levels correlated with any of the functional or structural parameters studied.