Aims

The aim of this study was to investigate whether the use of antibiotic-loaded bone cement influenced the risk of revision surgery after primary total hip arthroplasty (THA) for osteoarthritis.

The case histories of 361 subcapital fractures of the femoral neck in 354 patients treated by primary replacement with the cemented Thompson prosthesis were reviewed, and 156 survivors were seen at follow-up. The average age was eighty-one years. Three hundred and thirty fractures occurred in women and thirty-one in men. The antero-lateral approach to the hip was used at all operations because it allows immediate and unrestricted mobilisation after operation. It is considered that this method is the best treatment in the rehabilitation of elderly patients after high femoral neck fractures, because of its low morbidity and high success rate in returning the geriatric orthopaedic patient to independence. The results after an average of just over three years were available for 161 hips in 156 patients studied at follow-up. Of these, 132 (82 per cent) were satisfactory. Most of the unsatisfactory results were in patients under seventy-five years of age. Out of the whole group of 361 hips treated the important early complications were wound infections in seventeen hips 4-7 per cent), all of which resolved, and dislocation in seven hips (2 per cent). Forty-six patients (12-9 per cent) died during the first four weeks after operation, their average age being eighty-five. One hundred and seventy-one patients (47-4 per cent) were discharged from hospital within under four weeks of the operation. Acetabular erosion and loosening are shown to be the important later complications. Three patients had late sepsis

A study of a collected series of femoral neck fractures in seventy-one children observed for one to nineteen years shows:. 1. This injury is rare but occurs in children of all ages from three to sixteen years old. 2. The fractures may be classified as transepiphysial, transcervical (the commonest), basal and pertrochanteric. Displacement was frequent. 3. The fracture usually followed severe violence, especially falls from a height or motor accidents. 4. Complications were frequent and included avascular necrosis, delayed union (seventeen cases), non-union (seven cases) and disturbances of growth at both the upper and lower ends of the femur. 5. Avascular necrosis occurred in thirty patients (42 per cent). Three patterns of necrosis are described : diffuse, localised and confined to the femoral neck. The radiographic appearances of avascular necrosis after this fracture are different from those of pseudocoxalgia (Legg-Calvé-Perthes' disease). 6. Non-union did not occur after adequate primary internal fixation or after primary subtrochanteric osteotomy. 7. The management of an undisplaced fracture presented no great problem and the results were good. A plaster spica is recommended for treatment of this fracture. Exceptionally, avascular necrosis developed. 8. Treatment of the displaced fractures (forty-nine cases) was less satisfactory. A good result was obtained from primary treatment in only fifteen patients. 9. The value of different methods of primary treatment is discussed, including manipulative reduction and immobilisation in a plaster spica, manipulative reduction and internal fixation, and primary subtrochanteric osteotomy. Manipulative reduction and immobilisation in a plaster spica is not recommended. 10. Salvage operations were required in nineteen patients. Late subtrochanteric osteotomy is of value in the management of some of these problems

Aims

The aim of this study was to explore whether time to surgery affects functional outcome in displaced proximal humeral fractures

Aims

The diversity of femoral morphology renders femoral component sizing in total hip arthroplasty (THA) challenging. We aimed to determine whether femoral morphology and femoral component filling influence early clinical and radiological outcomes following THA using fully hydroxyapatite (HA)-coated femoral components.

Aims

Vancouver type B periprosthetic femoral fractures (PFF) are challenging complications after total hip arthroplasty (THA), and some treatment controversies remain. The objectives of this study were: to evaluate the short-to-mid-term clinical outcomes after treatment of Vancouver type B PFF and to compare postoperative outcome in subgroups according to classifications and treatments; to report the clinical outcomes after conservative treatment; and to identify risk factors for postoperative complications in Vancouver type B PFF.

The successful management of femoral neck fractures is obviously based upon many factors. The forces acting upon the proximal end of the femur are believed to be mainly compressive in nature, and the low-angle nail by stabilising the fully reduced fracture in the line of these forces is held to allow weight bearing to take place. Low-angle nailing is believed to offer many advantages over conventional methods of treatment but only in the presence of stability. Stable reduction is the essential preliminary to any form of treatment, and low-angle fixation with early weight bearing in the absence of stability is regarded as futile. It is suggested that those subcapital separations which follow trivial injury may originate as stress fractures accompanying the process of bone remodelling in the aged, and that many of these fractures may remain unrecognised and heal spontaneously. With rare exceptions, subcapital fractures are regarded as being of the same essential pattern, and their varying radiological appearance is considered to be due to the different degrees of displacement to which they have been subjected. A new classification based on this premise has been suggested. In a series of eighty subcapital fractures the incidence of avascular necrosis was not adversely affected by early weight bearing, but reduction in the extreme valgus position was invariably followed by this disaster. This is probably also true of any malposition in extreme rotation which must stretch and obliterate the vessels in the ligamentum teres. A rough alignment index of reduction was found to provide an almost infallible guide to the prognosis both in regard to union and to avascular change. It may therefore be possible to base prognosis on the quality of reduction before the fixation appliance has been inserted. The unsatisfactory results in those cases apparently destined to non-union or avascular necrosis may then be avoided by alternative means of treatment at an early stage. Whether this will prove to be true must depend upon a much longer experience of low-angle fixation, and, in common with almost every communication on this subject, premature publication must largely offset the value of the present findings

Aims

Arthrodesis is rarely used as a salvage procedure for patients with a chronically infected total knee arthroplasty (TKA), and little information is available about the outcome. The aim of this study was to assess the reliability, durability, and safety of this procedure as the definitive treatment for complex, chronically infected TKA, in a current series of patients.

Aims

In previous studies, we identified multiple factors influencing the survivorship of hip resurfacing arthroplasties (HRAs), such as initial anatomical conditions and surgical technique. In addition, the University of California, Los Angeles (UCLA) activity score presents a ceiling effect, so a better quantification of activity is important to determine which activities may be advisable or detrimental to the recovered patient. We aimed to determine the effect of specific groups of sporting activities on the survivorship free of aseptic failure of a large series of HRA.

Aims

Osseointegrated prosthetic limbs allow better mobility than socket-mounted prosthetics for lower limb amputees. Fractures, however, can occur in the residual limb, but they have rarely been reported. Approximately 2% to 3% of amputees with socket-mounted prostheses may fracture within five years. This is the first study which directly addresses the risks and management of periprosthetic osseointegration fractures in amputees.

1. Practical experience has shown that subcapital fractures of the femur unite freely if reduction is stable and fixation is secure. 2. Stable reduction is obtained when the muscular and gravitational forces tending to redisplace the fracture are opposed by equal and opposite counterforces, and inherent stability is believed to depend upon the integrity of the flared cortical buttress at the postero-inferior junction of the femoral neck and head. 3. In the stable subcapital fracture a state of equilibrium is reached when the forward and upward thrust of the fixation appliance in the femoral head is opposed by the counterthrust of the closely applied and cleanly broken fragments at the postero-inferior aspect of the fracture. When the postero-inferior cortical buttress is comminuted, inherent stability is lost, lateral rotation deformity recurs and the fixation device is avulsed from the cancellous bone of the head. 4. Stability may be restored by reduction in the "valgus" position, by various forms of osteotomy, by refashioning the fracture fragments or by a postero-inferiorly positioned bone graft. Theoretically, stability may also be obtained by a double lever system of fixation in which an obliquely placed fixation device or bone graft is combined with a horizontally disposed wire, pin, nail or screw crossing it anteriorly. Multilever fixation by three or more threaded wires or pins inserted at different angles and lying in contact at their point of crossing may likewise provide stability. 5. Fixation by two crossed screws has been chosen for clinical trial in 100 displaced subcapital fractures. Imperfect positioning of the screws in seven patients has been followed by early breakdown of reduction and non-union, but satisfactory positioning has been associated with radiological union in fifty patients who have been observed for twelve months or more. 6. Ultimate breakdown in some of these fractures is certain to follow avascular necrosis, and this complication has already been seen in a few patients treated by cross screw fixation more than two years ago. It is also expected that non-union will occur in some of those patients still under observation for less than a year. Even so, these preliminary findings indicate a percentage of union far greater than that obtained by previous methods of treatment, and, although statistically inadequate, they are presented in support of the belief that it should no longer be considered impossible to achieve the same percentage of union in subcapital fractures of the femur as we are accustomed to expect in the treatment of fractures elsewhere. It is not implied, however, that this ideal will be reached merely by the adoption of some form of double or multilever fixation, and much will continue to depend upon the quality of the radiographic services, the precision of reduction and the perfection of operative technique. 7. Every advance in our understanding of what is meant by "perfection of operative technique" lends increasing support to the ultimate truth of Watson-Jones's (1941) dictum: "A perfect result may be expected from a technically perfect operation; an imperfect result is due to imperfect technique." But the simple and foolproof method of fixation which will end the search for technical perfection in the treatment of the displaced subcapital fracture has yet to be evolved, and many questions remain to be answered about this injury. Nevertheless, it is clear that the surgeon should now be prepared to attribute early mechanical failure in the treatment of femoral neck fractures to his own shortcomings, and the temptation to blame capital ischaemia for every disaster should be resisted

Aims

The aim of this study was to assess the feasibility of conducting a full-scale, appropriately powered, randomized controlled trial (RCT) comparing internal fracture fixation and distal femoral replacement (DFR) for distal femoral fractures in older patients.

Objectives

Modern metal-on-metal (MoM) hip resurfacing arthroplasty (HRA), while achieving good results with well-orientated, well-designed components in ideal patients, is contraindicated in women, men with head size under 50 mm, or metal hypersensitivity. These patients currently have no access to the benefits of HRA. Highly crosslinked polyethylene (XLPE) has demonstrated clinical success in total hip arthroplasty (THA) and, when used in HRA, potentially reduces metal ion-related sequelae. We report the early performance of HRA using a direct-to-bone cementless mono-bloc XLPE component coupled with a cobalt-chrome femoral head, in the patient group for whom HRA is currently contraindicated.