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The Bone & Joint Journal
Vol. 100-B, Issue 6 | Pages 822 - 827
1 Jun 2018
Pollet V Van Dijk L Reijman M Castelein RMC Sakkers RJB

Aims

Open reduction is required following failed conservative treatment of developmental dysplasia of the hip (DDH). The Ludloff medial approach is commonly used, but poor results have been reported, with rates of the development of avascular necrosis (AVN) varying between 8% and 54%. This retrospective cohort study evaluates the long-term radiographic and clinical outcome of dislocated hips treated using this approach.

Patients and Methods

Children with a dislocated hip, younger than one year of age at the time of surgery, who were treated using a medial approach were eligible for the study. Radiographs were evaluated for the degree of dislocation and the presence of an ossific nucleus preoperatively, and for the degree of AVN and residual dysplasia at one and five years and at a mean of 12.7 years (4.6 to 20.8) postoperatively. Radiographic outcome was assessed using the Severin classification, after five years of age. Further surgical procedures were recorded. Functional outcome was assessed using the Pediatric Outcomes Data Collection Instrument (PODCI) or the Hip Disability and Osteoarthritis Outcome Score (HOOS), depending on the patient’s age.


Bone & Joint 360
Vol. 8, Issue 1 | Pages 25 - 27
1 Feb 2019


The Bone & Joint Journal
Vol. 100-B, Issue 6 | Pages 725 - 732
1 Jun 2018
Gibon E Barut N Courpied J Hamadouche M

Aims

The purpose of this retrospective study was to evaluate the minimum five-year outcome of revision total hip arthroplasty (THA) using the Kerboull acetabular reinforcement device (KARD) in patients with Paprosky type III acetabular defects and destruction of the inferior margin of the acetabulum.

Patients and Methods

We identified 36 patients (37 hips) who underwent revision THA under these circumstances using the KARD, fresh frozen allograft femoral heads, and reconstruction of the inferior margin of the acetabulum. The Merle d’Aubigné system was used for clinical assessment. Serial anteroposterior pelvic radiographs were used to assess migration of the acetabular component.


The Bone & Joint Journal
Vol. 99-B, Issue 6 | Pages 841 - 848
1 Jun 2017
Hipfl C Stihsen C Puchner SE Kaider A Dominkus M Funovics PT Windhager R

Aims

Pelvic reconstruction after the resection of a tumour around the acetabulum is a challenging procedure due to the complex anatomy and biomechanics. Several pelvic endoprostheses have been introduced, but the rates of complication remain high. Our aim was to review the use of a stemmed acetabular pedestal cup in the management of these patients.

Patients and Methods

The study involved 48 patients who underwent periacetabular reconstruction using a stemmed pedestal cup (Schoellner cup; Zimmer Biomet Inc., Warsaw, Indiana) between 2000 and 2013. The indications for treatment included a primary bone tumour in 27 patients and metastatic disease in 21 patients. The mean age of the patients at the time of surgery was 52 years (16 to 83).


The Bone & Joint Journal
Vol. 98-B, Issue 1_Supple_A | Pages 64 - 67
1 Jan 2016
Lachiewicz PF Watters TS

The ‘jumbo’ acetabular component is now commonly used in acetabular revision surgery where there is extensive bone loss. It offers high surface contact, permits weight bearing over a large area of the pelvis, the need for bone grafting is reduced and it is usually possible to restore centre of rotation of the hip. Disadvantages of its use include a technique in which bone structure may not be restored, a risk of excessive posterior bone loss during reaming, an obligation to employ screw fixation, limited bone ingrowth with late failure and high hip centre, leading to increased risk of dislocation. Contraindications include unaddressed pelvic dissociation, inability to implant the component with a rim fit, and an inability to achieve screw fixation. Use in acetabulae with < 50% bone stock has also been questioned. Published results have been encouraging in the first decade, with late failures predominantly because of polyethylene wear and aseptic loosening. Dislocation is the most common complication of jumbo acetabular revisions, with an incidence of approximately 10%, and often mandates revision. Based on published results, a hemispherical component with an enhanced porous coating, highly cross-linked polyethylene, and a large femoral head appears to represent the optimum tribology for jumbo acetabular revisions.

Cite this article: Bone Joint J 2016;98-B(1 Suppl A):64–7.


The Bone & Joint Journal
Vol. 98-B, Issue 9 | Pages 1208 - 1214
1 Sep 2016
Cowling PD Akhtar MA Liow RYL

Objectives

A variety of operative techniques have been described as under the term ‘Bristow-Latarjet’ procedure. This review aims to define the original procedure, and compare the variation in techniques described in the literature, assessing any effect on clinical outcomes.

Materials and Methods

A systematic review of 24 studies was performed to compare specific steps of the technique (coracoid osteotomy site, subscapularis approach, orientation and position of coracoid graft fixation and fixation method, additional labral and capsular repair) and detect any effect this variability had on outcomes.


Bone & Joint 360
Vol. 6, Issue 6 | Pages 14 - 16
1 Dec 2017


The Bone & Joint Journal
Vol. 99-B, Issue 11 | Pages 1450 - 1457
1 Nov 2017
vanWinterswijk PJTS Whitehouse SL Timperley AJ Hubble MJW Howell JR Wilson MJ

Aims

We report the incidence of radiolucent lines (RLLs) using two flanged acetabular components at total hip arthroplasty (THA) and the effect of the Rim Cutter.

Patients and Methods

We performed a retrospective review of 300 hips in 292 patients who underwent primary cemented THA. A contemporary flanged acetabular component was used with (group 1) and without (group 2) the use of the Rim Cutter and the Rimfit acetabular component was used with the Rim Cutter (group 3). RLLs and clinical outcomes were evaluated immediately post-operatively and at five years post-operatively.


Bone & Joint 360
Vol. 5, Issue 4 | Pages 20 - 22
1 Aug 2016


The Bone & Joint Journal
Vol. 97-B, Issue 8 | Pages 1038 - 1045
1 Aug 2015
Solomon LB Costi K Kosuge D Cordier T McGee MA Howie DW

The outcome of 219 revision total hip arthroplasties (THAs) in 98 male and 121 female patients, using 137 long length and 82 standard length cemented collarless double-taper femoral stems in 211 patients, with a mean age of 72 years (30 to 90) and mean follow-up of six years (two to 18) have been described previously. We have extended the follow-up to a mean of 13 years (8 to 20) in this cohort of patients in which the pre-operative bone deficiency Paprosky grading was IIIA or worse in 79% and 73% of femurs with long and standard stems, respectively.

For the long stem revision group, survival to re-revision for aseptic loosening at 14 years was 97% (95% confidence interval (CI) 91 to 100) and in patients aged > 70 years, survival was 100%. Two patients (two revisions) were lost to follow-up and 86 patients with 88 revisions had died. Worst-case analysis for survival to re-revision for aseptic loosening at 14 years was 95% (95% CI 89 to 100) and 99% (95% CI 96 to 100) for patients aged > 70 years. One additional long stem was classified as loose radiographically but not revised.

For the standard stem revision group, survival to re-revision for aseptic loosening at 14 years was 91% (95% CI 83 to 99). No patients were lost to follow-up and 49 patients with 51 hips had died. No additional stems were classified as loose radiographically.

Femoral revision using a cemented collarless double-taper stem, particularly with a long length stem, and in patients aged > 70 years, continues to yield excellent results up to 20 years post-operatively, including in hips with considerable femoral metaphyseal bone loss.

Cite this article: Bone Joint J 2015;97-B:1038–45.


The Bone & Joint Journal
Vol. 98-B, Issue 3 | Pages 291 - 297
1 Mar 2016
Rogmark C Leonardsson O

This review summarises the evidence for the treatment of displaced fractures of the femoral neck in elderly patients. Results from randomised clinical trials and national register studies are presented when available.

The advantages of arthroplasty compared with internal fixation are supported by several studies. A number of studies contribute to the discussions of total hip arthroplasty (THA) versus hemiarthroplasty and unipolar versus bipolar hemiarthroplasty, but no clear-cut evidence-based recommendation can be made. THA may be particularly advantageous for active, lucid patients with a relatively long life expectancy. For patients who are physiologically older, hemiarthoplasty is probably satisfactory, and for the oldest patients with more comorbidities, unipolar implants are considered to be sufficient. If the hospital can support emergency THA surgery in sufficient numbers and quality, there may be few patients who warrant bipolar hemiarthroplasty.

The direct lateral approach reduces the risk of dislocation compared with the posterior approach. Cemented implants lower the risk of periprosthetic fracture and its subsequent morbidity and mortality. As the risk of peri-operative death related to bone cement can be reduced by adequate measures, cemented implants are recommended in fracture cases.

Take home message: There remains a great variation in the surgical management of patients with a hip fracture, and an evidence-based approach should improve the outcomes for this vulnerable patient group.

Cite this article: Bone Joint J 2016;98-B:291–7.


The Bone & Joint Journal
Vol. 100-B, Issue 4 | Pages 485 - 492
1 Apr 2018
Gauci MO Bonnevialle N Moineau G Baba M Walch G Boileau P

Aims

Controversy about the use of an anatomical total shoulder arthroplasty (aTSA) in young arthritic patients relates to which is the ideal form of fixation for the glenoid component: cemented or cementless. This study aimed to evaluate implant survival of aTSA when used in patients aged < 60 years with primary glenohumeral osteoarthritis (OA), and to compare the survival of cemented all-polyethylene and cementless metal-backed glenoid components.

Materials and Methods

A total of 69 consecutive aTSAs were performed in 67 patients aged < 60 years with primary glenohumeral OA. Their mean age at the time of surgery was 54 years (35 to 60). Of these aTSAs, 46 were undertaken using a cemented polyethylene component and 23 were undertaken using a cementless metal-backed component. The age, gender, preoperative function, mobility, premorbid glenoid erosion, and length of follow-up were comparable in the two groups. The patients were reviewed clinically and radiographically at a mean of 10.3 years (5 to 12, sd 26) postoperatively. Kaplan–Meier survivorship analysis was performed with revision as the endpoint.


The Bone & Joint Journal
Vol. 99-B, Issue 4 | Pages 489 - 493
1 Apr 2017
Sadamasu A Yamaguchi S Nakagawa R Kimura S Endo J Akagi R Sasho T

Aims

The purposes of this study were to clarify first, the incidence of peroneal tendon dislocation in patients with a fracture of the talus and second the factors associated with peroneal tendon dislocation.

Patients and Methods

We retrospectively examined 30 patients (30 ankles) with a mean age of 37.5 years, who had undergone internal fixation for a fracture of the talus. Independent examiners assessed for peroneal tendon dislocation using the pre-operative CT images. The medical records were also reviewed for the presence of peroneal tendon dislocation. The associations between the presence of dislocation with the patient characteristics or radiological findings, including age, mechanism of injury, severity of fracture, and fleck sign, were assessed using Fisher’s exact tests.


The Bone & Joint Journal
Vol. 97-B, Issue 12 | Pages 1623 - 1627
1 Dec 2015
Mounsey EJ Williams DH Howell JR Hubble MJ

Revision of a cemented hemiarthroplasty of the hip may be a hazardous procedure with high rates of intra-operative complications. Removing well-fixed cement is time consuming and risks damaging already weak bone or perforating the femoral shaft. The cement-in-cement method avoids removal of intact cement and has shown good results when used for revision total hip arthroplasty (THA). The use of this technique for the revision of a hemiarthroplasty to THA has not been previously reported.

A total of 28 consecutive hemiarthroplasties (in 28 patients) were revised to a THA using an Exeter stem and the cement-in-cement technique. There were four men and 24 women; their mean age was 80 years (35 to 93). Clinical and radiographic data, as well as operative notes, were collected prospectively and no patient was lost to follow-up.

Four patients died within two years of surgery. The mean follow up of the remainder was 70 months (25 to 124). Intra-operatively there was one proximal perforation, one crack of the femoral calcar and one acetabular fracture. No femoral components have required subsequent revision for aseptic loosening or are radiologically loose.

Four patients with late complications (14%) have since undergone surgery (two for a peri-prosthetic fracture, and one each for deep infection and recurrent dislocation) resulting in an overall major rate of complication of 35.7%.

The cement-in-cement technique provides reliable femoral fixation in this elderly population and may reduce operating time and rates of complication.

Cite this article: Bone Joint J 2015;97-B:1623–7.


The Bone & Joint Journal
Vol. 99-B, Issue 1_Supple_A | Pages 14 - 17
1 Jan 2017
Carlson SW Liu SS Callaghan JJ

Aims

The aim of this study was to compare the survivorship and radiographic outcomes at ten-year follow-up of three prospective consecutive series of patients each of which received a different design of cementless femoral components for total hip arthroplasty (THA).

Patients and Methods

In Cohort 1, 91 consecutive patients (100 hips) underwent THA with a cementless porous-coated anatomic femoral stem (PCA) between October 1983 and January 1986. In Cohort 2, 86 consecutive patients (100 hips) underwent THA with an extensively porous-coated cementless femoral stem (Prodigy) between June 1994 and October 1997. In Cohort 3, 88 consecutive patients (100 hips) underwent THA with a proximally porous-coated triple-tapered cementless stem (Summit) between April 2002 and October 2003. All three groups underwent prospective clinical and radiographic evaluation.


The Bone & Joint Journal
Vol. 99-B, Issue 4 | Pages 465 - 474
1 Apr 2017
Kim YS Abrahams JM Callary SA De Ieso C Costi K Howie DW Solomon LB

Aims

The purpose of this study was to determine the sensitivity, specificity and predictive values of previously reported thresholds of proximal translation and sagittal rotation of cementless acetabular components used for revision total hip arthroplasty (THA) at various times during early follow-up.

Patients and Methods

Migration of cementless acetabular components was measured retrospectively in 84 patients (94 components) using Ein-Bild-Rontgen-Analyse (EBRA-Cup) in two groups of patients. In Group A, components were recorded as not being loose intra-operatively at re-revision THA (52 components/48 patients) and Group B components were recorded to be loose at re-revision (42 components/36 patients).


The Bone & Joint Journal
Vol. 99-B, Issue 2 | Pages 267 - 275
1 Feb 2017
Liang H Ji T Zhang Y Wang Y Guo W

Aims

The aims of this retrospective study were to report the feasibility of using 3D-printing technology for patients with a pelvic tumour who underwent reconstruction.

Patients and Methods

A total of 35 patients underwent resection of a pelvic tumour and reconstruction using 3D-printed endoprostheses between September 2013 and December 2015. According to Enneking’s classification of bone defects, there were three Type I lesions, 12 Type II+III lesions, five Type I+II lesions, two Type I+II+III lesions, ten type I+II+IV lesions and three type I+II+III+IV lesions. A total of three patients underwent reconstruction using an iliac prosthesis, 12 using a standard hemipelvic prosthesis and 20 using a screw-rod connected hemipelvic prosthesis.


Bone & Joint 360
Vol. 4, Issue 3 | Pages 10 - 12
1 Jun 2015

The June 2015 Hip & Pelvis Roundup360 looks at: neuraxial anaesthesia and large joint arthroplasty; revision total hip arthoplasty: factors associated with re-revision surgery; acetabular version and clinical outcomes in impingement surgery; hip precautions may be ineffective; implant selection and cost effectiveness; femoroacetabular impingement in the older age group; multiple revision in hip arthroplasty


The Bone & Joint Journal
Vol. 98-B, Issue 12 | Pages 1642 - 1647
1 Dec 2016
Badge R Kailash K Dickson DR Mahalingam S Raza A Birch A Nuttall D Murali SR Hayton MJ Talwalkar S Watts AC Trail IA

Aims

The aims of this study were to evaluate the clinical and radiological outcomes of the Universal-2 total wrist arthroplasty (TWA) in patients with rheumatoid arthritis.

Patients and Methods

This was a retrospective review of all 95 Universal-2 TWAs which were performed in our institution between 2003 to 2012 in patients with rheumatoid arthritis. A total of six patients were lost to follow-up and two died of unrelated causes. A total of ten patients had bilateral procedures. Accordingly, 75 patients (85 TWAs) were included in the study. There were 59 women and 16 men with a mean age of 59 years (26 to 86). The mean follow-up was 53 months (24 to 120). Clinical assessment involved recording pain on a visual analogue score, range of movement, grip strength, the Quick Disabilities of the Arm, Shoulder and Hand (DASH) and Wrightington wrist scores. Any adverse effects were documented with particular emphasis on residual pain, limitation of movement, infection, dislocation and the need for revision surgery.

Radiographic assessment was performed pre-operatively and at three, six and 12 months post-operatively, and annually thereafter. Arthroplasties were assessed for distal row intercarpal fusion and loosening. Radiolucent zones around the components were documented according to a system developed at our institution.


The Bone & Joint Journal
Vol. 99-B, Issue 1 | Pages 44 - 50
1 Jan 2017
Salo PP Honkanen PB Ivanova I Reito A Pajamäki J Eskelinen A

Aims

We evaluated the short-term functional outcome and prevalence of bearing-specific generation of audible noise in 301 patients (336 hips) operated on with fourth generation (Delta) medium diameter head, ceramic-on-ceramic (CoC) total hip arthroplasties (THAs).

Patients and Methods

There were 191 female (63%) and 110 male patients (37%) with a mean age of 61 years (29 to 78) and mean follow-up of 2.1 years (1.3 to 3.4). Patients completed three questionnaires: Oxford Hip Score (OHS), Research and Development 36-item health survey (RAND-36) and a noise-specific symptom questionnaire. Plain radiographs were also analysed. A total of three hips (0.9%) were revised.