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 optimal method of tibial component fixation remains uncertain
in total knee arthroplasty (TKA). Hydroxyapatite coatings have been
applied to improve bone ingrowth in uncemented designs, but may
only coat the directly accessible surface. As peri-apatite (PA)
is solution deposited, this may increase the coverage of the implant
surface and thereby fixation. We assessed the tibial component fixation
of uncemented PA-coated TKAs Patients were randomised to PA-coated or cemented TKAs. In 60
patients (30 in each group), radiostereometric analysis of tibial
component migration was evaluated as the primary outcome at baseline,
three months post-operatively and at one, two and five years. A
linear mixed-effects model was used to analyse the repeated measurements.Aims
Patients and Methods
To compare the outcomes for trochanteric fractures treated with
a sliding hip screw (SHS) or a cephalomedullary nail. A total of 400 patients with a trochanteric hip fracture were
randomised to receive a SHS or a cephalomedullary nail (Targon PFT).
All surviving patients were followed up to one year from injury.
Functional outcome was assessed by a research nurse blinded to the
implant used.Aims
Patients and Methods
Patients with diabetes are at increased risk of wound complications
after open reduction and internal fixation of unstable ankle fractures.
A fibular nail avoids large surgical incisions and allows anatomical
reduction of the mortise. We retrospectively reviewed the results of fluoroscopy-guided
reduction and percutaneous fibular nail fixation for unstable Weber
type B or C fractures in 24 adult patients with type 1 or type 2
diabetes. The re-operation rate for wound dehiscence or other indications
such as amputation, mortality and functional outcomes was determined.Aims
Patients and Methods
The aims of this study were to determine the proportion of patients
with outlier varus or valgus alignment in kinematically aligned
total knee arthroplasty (TKA), whether those with outlier varus
or valgus alignment have higher forces in the medial or lateral
compartments of the knee than those with in-range alignment and
whether measurements of the alignment of the limb, knee and components
predict compartment forces. The intra-operative forces in the medial and lateral compartments
were measured with an instrumented tibial insert in 67 patients
who underwent a kinematically aligned TKA during passive movement.
The mean of the forces at full extension, 45° and 90° of flexion
determined the force in the medial and lateral compartments. Measurements
of the alignment of the limb and the components included the hip-knee-ankle
(HKA) angle, proximal medial tibial angle (PMTA), and distal lateral
femoral angle (DLFA). Measurements of the alignment of the knee
and the components included the tibiofemoral angle (TFA), tibial
component angle (TCA) and femoral component angle (FCA). Alignment was
measured on post-operative, non-weight-bearing anteroposterior (AP)
scanograms and categorised as varus or valgus outlier or in-range
in relation to mechanically aligned criteria.Aims
Patients and Methods
Prophylactic antibiotics can decrease the risk
of wound infection and have been routinely employed in orthopaedic surgery
for decades. Despite their widespread use, questions still surround
the selection of antibiotics for prophylaxis, timing and duration
of administration. The health economic costs associated with wound
infections are significant, and the judicious but appropriate use
of antibiotics can reduce this risk. This review examines the evidence behind commonly debated topics
in antibiotic prophylaxis and highlights the uses and advantages
of some commonly used antibiotics. Cite this article:
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) 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:
