Partial knee arthroplasty (PKA), either medial
or lateral unicompartmental knee artroplasty (UKA) or patellofemoral arthroplasty
(PFA) are a good option in suitable patients and have the advantages
of reduced operative trauma, preservation of both cruciate ligaments
and bone stock, and restoration of normal kinematics within the
knee joint. However, questions remain concerning long-term survival.
The goal of this review article was to present the long-term results
of medial and lateral UKA, PFA and combined compartmental arthroplasty
for multicompartmental disease. Medium- and long-term studies suggest
reasonable outcomes at ten years with survival greater than 95% in
UKA performed for medial osteoarthritis or osteonecrosis, and similarly
for lateral Cite this article:
A fracture of the hip is the most common serious orthopaedic
injury, and surgical site infection (SSI) is one of the most significant
complications, resulting in increased mortality, prolonged hospital
stay and often the need for further surgery. Our aim was to determine
whether high dose dual antibiotic impregnated bone cement decreases the
rate of infection. A quasi-randomised study of 848 patients with an intracapsular
fracture of the hip was conducted in one large teaching hospital
on two sites. All were treated with a hemiarthroplasty. A total
of 448 patients received low dose single-antibiotic impregnated
cement (control group) and 400 patients received high dose dual-antibiotic impregnated
cement (intervention group). The primary outcome measure was deep
SSI at one year after surgery.Aims
Patients and Methods
This review examines the future of total hip arthroplasty, aiming to avoid past mistakes
There is uncertainty regarding the optimal means of thromboprophylaxis
following total hip and knee arthroplasty (THA, TKA). This systematic
review presents the evidence for acetylsalicylic acid (aspirin)
as a thromboprophylactic agent in THA and TKA and compares it with
other chemoprophylactic agents. A search of literature published between 2004 and 2014 was performed
in accordance with Preferred Reporting Items for Systematic Reviews
and Meta-Analyses guidelines. A total of 13 studies were eligible
for inclusion.Aims
Materials and Methods
Total hip replacement causes a short-term increase
in the risk of mortality. It is important to quantify this and to identify
modifiable risk factors so that the risk of post-operative mortality
can be minimised. We performed a systematic review and critical
evaluation of the current literature on the topic. We identified
32 studies published over the last 10 years which provide either
30-day or 90-day mortality data. We estimate the pooled incidence
of mortality during the first 30 and 90 days following hip replacement
to be 0.30% (95% CI 0.22 to 0.38) and 0.65% (95% CI 0.50 to 0.81),
respectively. We found strong evidence of a temporal trend towards
reducing mortality rates despite increasingly co-morbid patients.
The risk factors for early mortality most commonly identified are
increasing age, male gender and co-morbid conditions, particularly
cardiovascular disease. Cardiovascular complications appear to have
overtaken fatal pulmonary emboli as the leading cause of death after
hip replacement. Cite this article:
An evidence-based radiographic Decision Aid for meniscal-bearing
unicompartmental knee arthroplasty (UKA) has been developed and
this study investigates its performance at an independent centre. Pre-operative radiographs, including stress views, from a consecutive
cohort of 550 knees undergoing arthroplasty (UKA or total knee arthroplasty;
TKA) by a single-surgeon were assessed. Suitability for UKA was
determined using the Decision Aid, with the assessor blinded to
treatment received, and compared with actual treatment received, which
was determined by an experienced UKA surgeon based on history, examination,
radiographic assessment including stress radiographs, and intra-operative
assessment in line with the recommended indications as described
in the literature.Aims
Patients and Methods
The use of large-diameter metal-on-metal (MoM)
components in total hip arthroplasty (THA) is associated with an increased
risk of early failure due to adverse local tissue reaction to metal
debris (ARMD) in response to the release of metal ions from the
bearing couple and/or head-neck taper corrosion. The aim of this
paper was to present a review of the incidence and natural history
of ARMD and the forms of treatment, with a focus on the need for
and extent of resection or debulking of the pseudotumour. An illustrative
case report is presented of a patient with an intra-pelvic pseudotumour
associated with a large diameter MoM THA, which was treated successfully
with revision of the bearing surface to a dual mobility couple and
retention of the well-fixed acetabular and femoral components. The
pseudotumour was left Cite this article:
Despite excellent results, the use of cemented
total hip replacement (THR) is declining. This retrospective cohort study
records survival time to revision following primary cemented THR
using the most common combination of components that accounted for
almost a quarter of all cemented THRs, exploring risk factors independently associated
with failure. All patients with osteoarthritis who had an Exeter
V40/Contemporary THR (Stryker) implanted before 31 December 2010
and recorded in the National Joint Registry for England and Wales
were included in the analysis. Cox’s proportional hazard models
were used to analyse the extent to which risk of revision was related
to patient, surgeon and implant covariates, with a significance
threshold of p <
0.01. A total of 34 721 THRs were included in
the study. The overall seven-year rate of revision for any reason
was 1.70% (99% confidence interval (CI) 1.28 to 2.12). In the final
adjusted model the risk of revision was significantly higher in
THRs with the Contemporary hooded component (hazard ratio (HR) 1.88,
p <
0.001) than with the flanged version, and in smaller head
sizes (<
28 mm) compared with 28 mm diameter heads (HR 1.50,
p = 0.005). The seven-year revision rate was 1.16% (99% CI 0.69
to 1.63) with a 28 mm diameter head and flanged component. The overall
risk of revision was independent of age, gender, American Society
of Anesthesiologists grade, body mass index, surgeon volume, surgical
approach, brand of cement/presence of antibiotic, femoral head material
(stainless steel/alumina) and stem taper size/offset. However, the
risk of revision for dislocation was significantly higher with a
‘plus’ offset head (HR 2.05, p = 0.003) and a hooded acetabular component
(HR 2.34, p <
0.001). In summary, we found that there were significant differences
in failure between different designs of acetabular component and
sizes of femoral head after adjustment for a range of covariates.
The aim of this study was to inform a definitive trial which
could determine the clinical effectiveness of the X-Bolt Dynamic
Hip Plating System compared with the sliding hip screw for patients
with complex pertrochanteric fragility fractures of the femur. This was a single centre, participant blinded, randomised, standard-of-care
controlled pilot trial. Patients aged 60 years and over with AO/ASIF
A2 and A3 type femoral pertrochanteric fractures were eligible.Aims
Patients and Methods
We aimed to determine whether there is evidence of improved patient
outcomes in Major Trauma Centres following the regionalisation of
trauma care in England. An observational study was undertaken using the Trauma Audit
and Research Network (TARN), Hospital Episode Statistics (HES) and
national death registrations. The outcome measures were indicators
of the quality of trauma care, such as treatment by a senior doctor
and clinical outcomes, such as mortality in hospital.Aims
Patients and Methods
The National Institute for Health and Clinical
Excellence (NICE) has thus far relied on historical data and predominantly
industry-sponsored trials to provide evidence for venous thromboembolic
(VTE) prophylaxis in joint replacement patients. We argue that the
NICE guidelines may be reliant on assumptions that are in need of
revision. Following the publication of large scale, independent
observational studies showing little difference between low-molecular-weight
heparins and aspirin, and recent changes to the guidance provided
by other international bodies, should NICE reconsider their recommendations? Cite this article:
As the number of younger and more active patients
treated with total knee arthroplasty (TKA) continues to increase,
consideration of better fixation as a means of improving implant
longevity is required. Cemented TKA remains the reference standard
with the largest body of evidence and the longest follow-up to support
its use. However, cementless TKA, may offer the opportunity of a
more bone-sparing procedure with long lasting biological fixation
to the bone. We undertook a review of the literature examining advances
of cementless TKA and the reported results. Cite this article:
Osteoporosis and abnormal bone metabolism may prove to be significant
factors influencing the outcome of arthroplasty surgery, predisposing
to complications of aseptic loosening and peri-prosthetic fracture.
We aimed to investigate baseline bone mineral density (BMD) and
bone turnover in patients about to undergo arthroplasty of the hip
and knee. We prospectively measured bone mineral density of the hip and
lumbar spine using dual-energy X-ray absorptiometry (DEXA) scans
in a cohort of 194 patients awaiting hip or knee arthroplasty. We
also assessed bone turnover using urinary deoxypyridinoline (DPD),
a type I collagen crosslink, normalised to creatinine.Aims
Methods
This study investigated the influence of body mass index (BMI)
on the post-operative fall in the level of haemoglobin (Hb), length
of hospital stay (LOS), 30-day re-admission rate, functional outcome
and quality of life, two years after total knee arthroplasty (TKA). A total of 7733 patients who underwent unilateral primary TKA
between 2001 and 2010 were included. The mean age was 67 years (30
to 90). There were 1421 males and 6312 females. The patients were
categorised into three groups: BMI <
25.0 kg/m2 (normal);
BMI between 25.0 and 39.9 kg/m2 (obese); and BMI ≥ 40.0
kg/m2 (morbidly obese).Aims
Patients and Methods
The purpose of this study was twofold: first,
to determine whether the five-year results of hip resurfacing arthroplasty
(HRA) in Canada justified the continued use of HRA; and second,
to identify whether greater refinement of patient selection was
warranted. This was a retrospective cohort study that involved a review
of 2773 HRAs performed between January 2001 and December 2008 at
11 Canadian centres. Cox’s proportional hazards models were used
to analyse the predictors of failure of HRA. Kaplan–Meier survival
analysis was performed to predict the cumulative survival rate at
five years. The factors analysed included age, gender, body mass
index, pre-operative hip pathology, surgeon’s experience, surgical
approach, implant sizes and implant types. The most common modes
of failure were also analysed. The 2773 HRAs were undertaken in 2450 patients: 2127 in men and
646 in women. The mean age at operation was 50.5 years ( The failure rates of HRA at five years justify the ongoing use
of this technique in men. Female gender is an independent predictor
of failure, and a higher failure rate at five years in women leads
the authors to recommend this technique only in exceptional circumstances
for women. Cite this article:
In this study, we aimed to determine whether designation as a
major trauma centre (MTC) affects the quality of care for patients
with a fracture of the hip. All patients in the United Kingdom National Hip Fracture Database,
between April 2010 and December 2013, were included. The indicators
of quality that were recorded included the time to arrival on an
orthopaedic ward, to review by a geriatrician, and to operation.
The clinical outcomes were the development of a pressure sore, discharge
home, length of stay, in-hospital mortality, and re-operation within
30 days. Aims
Patients and Methods
The most common reasons for revision of unicompartmental
knee arthroplasty (UKA) are loosening and pain. Cementless components
may reduce the revision rate. The aim of this study was to compare
the fixation and clinical outcome of cementless and cemented Oxford
UKAs. A total of 43 patients were randomised to receive either a cemented
or a cementless Oxford UKA and were followed for two years with
radiostereometric analysis (RSA), radiographs aligned with the bone–implant
interfaces and clinical scores. The femoral components migrated significantly during the first
year (mean 0.2 mm) but not during the second. There was no significant
difference in the extent of migration between cemented and cementless
femoral components in either the first or the second year. In the
first year the cementless tibial components subsided significantly
more than the cemented components (mean 0.28 mm ( As second-year migration is predictive of subsequent loosening,
and as radiolucency is suggestive of reduced implant–bone contact,
these data suggest that fixation of the cementless components is
at least as good as, if not better than, that of cemented devices. Cite this article: