We have tested the axial and torsional stability of femoral components after revision arthroplasty in a cadaver model, using impacted morsellised cancellous graft and cement. Each one of six matched pairs of fresh frozen human femora had either a primary or a
Loss of bone stock is a major problem in revision surgery of the hip. Impaction bone grafting of the femur is frequently used when dealing with deficient bone stock. In this retrospective study a consecutive series of 68 patients (69 hips) who had
We report a prospective study of 57 one-stage cemented
We report a clinical and radiological survival analysis of 148 consecutive
We performed revision surgery for infected arthroplasty in 98 hips (96 patients). In 28 hips infection persisted. Of the remaining 70 hips, 61 (87%) were reviewed after a mean interval of 5.9 years (1 to 17). Infection occurred in 10% of these after three years and in 26% after ten years. The infection rate after initially successful
We reviewed 54 patients at a mean follow-up of 4 years 4 months after rerevisions for failure of Charnley low-friction arthroplasty. Rerevision for aseptic loosening in 26 hips was satisfactory; there were no clinical failures and at the latest radiological assessment only one stem and three sockets showed signs of loosening. By contrast, nine of 20 multiple
We present the results of 506 consecutive Howse hip arthroplasties with a minimum follow-up of 10 years. The mortality within one month of surgery was 0.79%. The early dislocation rate was 1.38%, two hips requiring
We reviewed the records and radiographs of 387 cemented
We reviewed retrospectively the outcome of the treatment by impaction grafting of periprosthetic femoral fractures around loose stems in 106 patients with Vancouver type-B2 and type-B3 fractures. Eighty-nine patients had a cemented
Glenoid replacement is technically challenging. Removal of a cemented glenoid component often results in a large osseous defect which makes the immediate introduction of a
Trabecular metal (TM) augments are a relatively
new option for reconstructing segmental bone loss during acetabular
revision. We studied 34 failed hip replacements in 34 patients that
were revised between October 2003 and March 2010 using a TM acetabular
shell and one or two augments. The mean age of the patients at the
time of surgery was 69.3 years (46 to 86) and the mean follow-up
was 64.5 months (27 to 107). In all, 18 patients had a minor column
defect, 14 had a major column defect, and two were associated with
pelvic discontinuity. The hip centre of rotation was restored in
27 patients (79.4%). The Oxford hip score increased from a mean
of 15.4 points (6 to 25) before
Fifty-nine cases of trochanteric wire
We evaluated the impact of pre-coating the tibial
component with polymethylmethacrylate (PMMA) on implant survival
in a cohort of 16 548 primary NexGen total knee replacements (TKRs)
in 14 113 patients. In 13 835 TKRs a pre-coated tray was used while
in 2713 TKRs the non-pre-coated version of the same tray was used.
All the TKRs were performed between 2001 and 2009 and were cemented.
TKRs implanted with a pre-coated tibial component had a lower cumulative
survival than those with a non-pre-coated tibial component (p =
0.01). After adjusting for diagnosis, age, gender, body mass index,
American Society of Anesthesiologists grade, femoral coupling design, surgeon
volume and hospital volume, pre-coating was an independent risk
factor for all-cause aseptic
We report the mid-term results of femoral impaction grafting which was used in 53 patients during the second stage of a two-stage
We present a review of 553 patients who underwent surgery for intractable sciatica ascribed to prolapsed lumbar intervertebral disc. One surgeon in one institution undertook or supervised all the operations over a period of 16 years. The total number of primary discectomies included in the study was 531, of which 42 subsequently required a second operation for recurrent sciatica, giving a
Impacted morcellised bone allograft and a Charnley stem was used to revise 59 loose femoral components in 57 consecutive patients. Femoral bone loss was rated as Endo-Klinik grade 2 in nine patients, grade 3 in 41, and grade 4 in nine. The immediate postoperative radiographs and those taken at the most recent follow-up were compared for radiolucencies, subsidence and incorporation of the graft. One patient was lost to follow-up and two were not available for radiological analysis. The mean clinical follow-up in 58 procedures was 56.7 months (24 to 144) and the mean radiological review of 56 reconstructions was 54.4 months (24 to 144). An intraoperative femoral fracture occurred in one patient (1.7%) and was successfully treated by strut grafting and cerclage wiring. Extrusion of cement through perforations or incomplete hoop fractures was detected in the postoperative radiographs of ten procedures (17%); none of these patients sustained a complete fracture. Three patients had dislocations (5%) and two (3.5%) developed painful subsidence of the stem which required a further
Between April 1992 and November 1998 we used 34 massive proximal femoral allografts for femoral reconstruction at
We developed a method of applying vibration to the impaction bone grafting process and assessed its effect on the mechanical properties of the impacted graft. Washed morsellised bovine femoral heads were impacted into shear test rings. A range of frequencies of vibration was tested, as measured using an accelerometer housed in a vibration chamber. Each shear test was repeated at four different normal loads to generate stress-strain curves. The Mohr-Coulomb failure envelope from which shear strength and interlocking values are derived was plotted for each test. The experiments were repeated with the addition of blood in order to replicate a saturated environment. Graft impacted with the addition of vibration at all frequencies showed improved shear strength when compared with impaction without vibration, with 60 Hz giving the largest effect. Under saturated conditions the addition of vibration was detrimental to the shear strength of the aggregate. The civil-engineering principles of particulate settlement and interlocking also apply to impaction bone grafting. Although previous studies have shown that vibration may be beneficial in impaction bone grafting on the femoral side, our study suggests that the same is not true in acetabular