Total ankle arthroplasty (TAA) surgery is complex and attracts a wide variety of complications. The literature lacks consistency in reporting adverse events and complications. The aim of this article is to provide a comprehensive analysis of each of these complications from a literature review, and to compare them with rates from our Unit, to aid clinicians with the process of informed consent. A total of 278 consecutive total ankle arthroplasties (251 patients), performed by four surgeons over a six-year period in Wrightington Hospital (Wigan, United Kingdom) were prospectively reviewed. There were 143 men and 108 women with a mean age of 64 years (41 to 86). The data were recorded on each follow-up visit. Any complications either during initial hospital stay or subsequently reported on follow-ups were recorded, investigated, monitored, and treated as warranted. Literature search included the studies reporting the outcomes and complications of TAA implants.Aims
Patients and Methods
There are limited published data detailing the volumetric material loss from tapers of conventional metal-on-polyethylene (MoP) total hip arthroplasties (THAs). Our aim was to address this by comparing the taper wear rates measured in an explanted cohort of the widely used Exeter THA with those measured in a group of metal-on-metal (MoM) THAs. We examined an existing retrieval database to identify all Exeter V40 and Universal MoP THAs. Volumetric wear analysis of the taper surfaces was conducted using previously validated methodology. These values were compared with those obtained from a series of MoM THAs using non-parametric statistical methodology. A number of patient and device variables were accounted for using multiple regression modelling.Aims
Patients and Methods
Calcium sulphate has traditionally been used as a filler of dead space arising during surgery. Various complications have been described following the use of Stimulan bio-absorbable calcium sulphate beads. This study is a prospective observational study to assess the safety profile of these beads when used in revision arthroplasty, comparing the complication rates with those reported in the literature. A total of 755 patients who underwent 456 revision total knee arthroplasties (TKA) and 299 revision total hip arthroplasties (THA), with a mean follow-up of 35 months (0 to 78) were included in the study.Aims
Methods
The aim of this study was to determine the stability of a new
short femoral stem compared with a conventional femoral stem in
patients undergoing cementless total hip arthroplasty (THA), in
a prospective randomized controlled trial using radiostereometric
analysis (RSA). A total of 53 patients were randomized to receive cementless
THA with either a short femoral stem (MiniHip, 26 patients, mean
age: 52 years, nine male) or a conventional length femoral stem
(MetaFix, 23 patients, mean age: 53 years, 11 male). All patients
received the same cementless acetabular component. Two-year follow-up
was available on 38 patients. Stability was assessed through migration
and dynamically inducible micromotion. Radiographs for RSA were
taken postoperatively and at three, six, 12, 18, and 24 months.Aims
Patients and Methods
Patellofemoral arthroplasty (PFA) has experienced significant
improvements in implant survivorship with second generation designs.
This has renewed interest in PFA as an alternative to total knee
arthroplasty (TKA) for younger active patients with isolated patellofemoral
osteoarthritis (PF OA). We analysed the cost-effectiveness of PFA We used a Markov transition state model to compare cost-effectiveness
between PFA and TKA. Simulated patients were aged 60 (base case)
and 50 years. Lifetime costs (2015 United States dollars), quality-adjusted
life year (QALY) gains and incremental cost-effectiveness ratio
(ICER) were calculated from a healthcare payer perspective. Annual rates
of revision were derived from the National Joint Registry for England,
Wales, Northern Ireland and the Isle of Man. Deterministic and probabilistic
sensitivity analysis was performed for all parameters against a
$50 000/QALY willingness to pay. Aims
Patients and Methods
We aimed to assess the comparability of data in joint replacement
registries and identify ways of improving the comparisons between
registries and the overall monitoring of joint replacement surgery. We conducted a review of registries that are full members of
the International Society of Arthroplasty Registries with publicly
available annual reports in English. Of the six registries which
were included, we compared the reporting of: mean age, definitions
for revision and re-operation, reasons for revision, the approach
to analysing revisions, and patient-reported outcome measures (PROMs)
for primary and revision total hip arthroplasty (THA) and hip resurfacing
arthroplasty (HRA).Aims
Materials and Methods
This study aimed to evaluate implant survival of reverse hybrid
total hip arthroplasty (THA) at medium-term follow-up. A consecutive series of 1082 THAs in 982 patients with mean follow-up
of 7.9 years (5 to 11.3) is presented. Mean age was 69.2 years (21
to 94). Of these, 194 (17.9%) were in patients under 60 years, 663
(61.3%) in female patients and 348 (32.2%) performed by a trainee.
Head size was 28 mm in 953 hips (88.1%) or 32 mm in 129 hips (11.9%).
Survival analysis was performed and subgroups compared using log
rank tests.Aims
Patients and Methods
The primary aim of this study was to determine the surgical team’s
learning curve for introducing robotic-arm assisted unicompartmental
knee arthroplasty (UKA) into routine surgical practice. The secondary
objective was to compare accuracy of implant positioning in conventional
jig-based UKA versus robotic-arm assisted UKA. This prospective single-surgeon cohort study included 60 consecutive
conventional jig-based UKAs compared with 60 consecutive robotic-arm
assisted UKAs for medial compartment knee osteoarthritis. Patients
undergoing conventional UKA and robotic-arm assisted UKA were well-matched
for baseline characteristics including a mean age of 65.5 years
(Aims
Patients and Methods
The aim of this study was to identify predictors of return to
work (RTW) after revision lower limb arthroplasty in patients of
working age in the United Kingdom. We assessed 55 patients aged ≤ 65 years after revision total
hip arthroplasty (THA). There were 43 women and 12 men with a mean
age of 54 years (23 to 65). We also reviewed 30 patients after revision
total knee arthroplasty (TKA). There were 14 women and 16 men with
a mean age of 58 years (48 to 64). Preoperatively, age, gender,
body mass index, social deprivation, mode of failure, length of
primary implant survival, work status and nature, activity level
(University of California, Los Angeles (UCLA) score), and Oxford
Hip and Knee Scores were recorded. Postoperatively, RTW status,
Oxford Hip and Knee Scores, EuroQol-5D (EQ-5D), UCLA score, and
Work, Osteoarthritis and Joint-Replacement Questionnaire (WORQ)
scores were obtained. Univariate and multivariate analysis was performed.Aims
Patients and Methods
Surgical site infection (SSI) is a common complication of surgery
with an incidence of about 1% in the United Kingdom. Sutures can
lead to the development of a SSI, as micro-organisms can colonize
the suture as it is implanted. Triclosan-coated sutures, being antimicrobical,
were developed to reduce the rate of SSI. Our aim was to assess
whether triclosan-coated sutures cause a reduction in SSIs following
arthroplasty of the hip and knee. This two-arm, parallel, double-blinded study involved 2546 patients
undergoing elective total hip (THA) and total knee arthroplasty
(TKA) at three hospitals. A total of 1323 were quasi-randomized
to a standard suture group, and 1223 being quasi-randomized to the
triclosan-coated suture group. The primary endpoint was the rate
of SSI at 30 days postoperatively.Aims
Patients and Methods
To present a surgically relevant update of trunnionosis. Systematic review performed April 2017.Aims
Materials and Methods
Anatomical total knee arthroplasty alignment
The aim of this independent multicentre study was to assess the
mid-term results of mobile bearing unicondylar knee arthroplasty
(UKA) for isolated lateral osteoarthritis of the knee joint. We retrospectively evaluated 363 consecutive, lateral UKAs (346
patients) performed using the Oxford domed lateral prosthesis undertaken
in three high-volume knee arthroplasty centres between 2006 and
2014. Mean age of the patients at surgery was 65 years (36 to 88)
with a mean final follow-up of 37 months (12 to 93)Aims
Patients and Methods
The aim of this study was to investigate the outcomes of Vancouver
type B2 and B3 fractures by performing a systematic review of the
methods of surgical treatment which have been reported. A systematic search was performed in Ovid MEDLINE, Embase and
the Cochrane Central Register of Controlled Trials. For inclusion,
studies required a minimum of ten patients with a Vancouver type
B2 and/or ten patients with a Vancouver type B3 fracture, a minimum
mean follow-up of two years and outcomes which were matched to the type
of fracture. Studies were also required to report the rate of re-operation
as an outcome measure. The protocol was registered in the PROSPERO
database. Aims
Materials and Methods
The National Institute for Health and Care Excellence
has issued guidelines that state fusion for non-specific low back
pain should only be performed as part of a randomised controlled
trial, and that lumbar disc replacement should not be performed.
Thus, spinal fusion and disc replacement will no longer be routine
forms of treatment for patients with low back pain. This annotation
considers the evidence upon which these guidelines are based. Cite this article:
The primary aim of this independent prospective randomised trial
was to compare serum metal ion levels for ceramic-on-metal (CoM)
and metal-on-metal (MoM) bearing surfaces in total hip arthroplasty
(THA). Our one-year results demonstrated elevation in metal ion
levels above baseline with no significant difference between the
CoM and MoM groups. This paper reviews the five-year data. The implants used in each patient differed only in respect to
the type of femoral head (ceramic or metal). At five-year follow-up
of the 83 enrolled patients, data from 67 (36 CoM, 31 MoM) was available
for comparison.Aims
Patients and Methods
The number of arthroplasties being performed
increases each year. Patients undergoing an arthroplasty are at
risk of venous thromboembolism (VTE) and appropriate prophylaxis
has been recommended. However, the optimal protocol and the best
agent to minimise VTE under these circumstances are not known. Although
many agents may be used, there is a difference in their efficacy
and the risk of bleeding. Thus, the selection of a particular agent relies
on the balance between the desire to minimise VTE and the attempt
to reduce the risk of bleeding, with its undesirable, and occasionally
fatal, consequences. Acetylsalicylic acid (aspirin) is an agent for VTE prophylaxis
following arthroplasty. Many studies have shown its efficacy in
minimising VTE under these circumstances. It is inexpensive and
well-tolerated, and its use does not require routine blood tests.
It is also a ‘milder’ agent and unlikely to result in haematoma
formation, which may increase both the risk of infection and the
need for further surgery. Aspirin is also unlikely to result in persistent
wound drainage, which has been shown to be associated with the use
of agents such as low-molecular-weight heparin (LMWH) and other
more aggressive agents. The main objective of this review was to summarise the current
evidence relating to the efficacy of aspirin as a VTE prophylaxis
following arthroplasty, and to address some of the common questions
about its use. There is convincing evidence that, taking all factors into account,
aspirin is an effective, inexpensive, and safe form of VTE following
arthroplasty in patients without a major risk factor for VTE, such
as previous VTE. Cite this article:
The National Hip Fracture Database (NHFD) publishes hospital-level risk-adjusted mortality rates following hip fracture surgery in England, Wales and Northern Ireland. The performance of the risk model used by the NHFD was compared with the widely-used Nottingham Hip Fracture Score. Data from 94 hospitals on patients aged 60 to 110 who had hip fracture surgery between May 2013 and July 2013 were analysed. Data were linked to the Office for National Statistics (ONS) death register to calculate the 30-day mortality rate. Risk of death was predicted for each patient using the NHFD and Nottingham models in a development dataset using logistic regression to define the models’ coefficients. This was followed by testing the performance of these refined models in a second validation dataset.Objectives
Methods
