Aims. The purpose of this study was to evaluate whether an innovative
templating technique could predict the need for acetabular augmentation
during primary total hip arthroplasty for patients with dysplastic
hips. Patients and Methods. We developed a simple templating technique to estimate acetabular
component coverage at
There is widespread concern regarding the incidence of adverse soft-tissue reactions after metal-on-metal (MoM) hip replacement. Recent National Joint Registry data have shown clear differences in the rates of failure of different designs of hip resurfacing. Our aim was to update the failure rates related to metal debris for the Articular Surface Replacement (ASR). A total of 505 of these were implanted. Kaplan-Meier analysis showed a failure rate of 25% at six years for the ASR resurfacing and of 48.8% for the ASR
There is little evidence on the cost effectiveness
of different brands of hip prostheses. We compared lifetime cost effectiveness
of frequently used brands within types of prosthesis including cemented
(Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite
Plus Ogee), cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed)
and hybrid (Exeter V40 Trilogy, Exeter V40 Trident, and CPT Trilogy).
We used data from three linked English national databases to estimate
the lifetime risk of revision, quality-adjusted life years (QALYs)
and cost. . For women with osteoarthritis aged 70 years, the Exeter V40 Elite
Plus Ogee had the lowest risk of revision (5.9% revision risk, 9.0
QALYs) and the CPT Trilogy had the highest QALYs (10.9% revision
risk, 9.3 QALYs). Compared with the Corail Pinnacle (9.3% revision
risk, 9.22 QALYs), the most commonly used brand, and assuming a
willingness-to-pay of £20 000 per QALY gain, the CPT Trilogy is
most cost effective, with an incremental net monetary benefit of £876.
Differences in cost effectiveness between the hybrid CPT Trilogy
and Exeter V40 Trident and the cementless Corail Pinnacle and Taperloc
Exceed were small, and a cautious interpretation is required, given
the limitations of the available information. However, it is unlikely that cemented brands are among the most
cost effective. Similar patterns of results were observed for men
and other ages. The gain in quality of life after
In order to assess current opinions on the long-term outcome after primary total hip replacement, we performed a multicentre, cross-sectional survey in 22 centres from 12 European countries. Different patient characteristics were categorised into ‘decreases chances’, ‘does not affect chances’, and ‘increases chances’ of a favourable long-term outcome, by 304 orthopaedic surgeons and 314 referring practitioners. The latter were less likely to associate age older than 80 years and obesity with a favourable outcome than orthopaedic surgeons (p <
0.001 and p = 0.006, respectively) and more likely to associate age younger than 50 years with a favourable outcome (p = 0.006). Comorbidity, rheumatoid arthritis, and poor bone quality were thought to be associated with a decreased chance of a favourable outcome. We found important differences in the opinions regarding long-term outcome after
We report a case of sciatic nerve palsy following
Our aim was to determine the success rate of repeated debridement and two-stage cementless revision arthroplasty according to the type of infected
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
Aims. We present the clinical and radiological results at a minimum
follow-up of five years for patients who have undergone multiple
cement-in-cement revisions of their femoral component at revision
total hip arthroplasty (THA). Patients and Methods. We reviewed the outcome on a consecutive series of 24 patients
(10 men, 14 women) (51 procedures) who underwent more than one cement-in-cement
revision of the same femoral component. The mean age of the patients was
67.5 years (36 to 92) at final follow-up. Function was assessed using the original Harris hip score (HHS),
Oxford Hip Score (OHS) and the Merle D’Aubigné Postel score (MDP). Results. The mean length of follow-up was 81.7 months (64 to 240). A total
of 41 isolated acetabular revisions were performed in which stem
removal facilitated access to the acetabulum, six revisions were
conducted for loosening of both components and two were isolated
stem revisions (each of these patients had undergone at least two revisions). There was significant improvement in the OHS (p = 0.041), HHS
(p = 0.019) and MDP (p = 0.042) scores at final follow-up There
were no stem revisions for aseptic loosening. Survival of the femoral
component was 91.9% (95% confidence intervals (CI) 71.5 to 97.9)
at five years and 91.7% (95% CI 70 to 97) at ten years (number at
risk 13), with stem revision for all causes as the endpoint. Conclusion. Cement-in-cement revision is a viable technique for performing
multiple revisions of the well cemented femoral component during
revision
Avascular necrosis of the femoral head creates considerable morbidity in successful renal transplant recipients who are generally young and expect active lifestyles.
We present a series of 30 uncemented
Osteonecrosis of the femoral head is a severely disabling complication of steroid immunosuppression in renal transplant patients. We report 31
The aim of this study was to develop a novel computational model for estimating head/stem taper mechanics during different simulated assembly conditions. Finite element models of generic cobalt-chromium (CoCr) heads on a titanium stem taper were developed and driven using dynamic assembly loads collected from clinicians. To verify contact mechanics at the taper interface, comparisons of deformed microgroove characteristics (height and width of microgrooves) were made between model estimates with those measured from five retrieved implants. Additionally, these models were used to assess the role of assembly technique—one-hit versus three-hits—on the taper interlock mechanical behaviour.Aims
Methods
Tranexamic acid is a fibrinolytic inhibitor which reduces blood loss in total knee replacement. We examined the effect on blood loss of a standardised intravenous bolus dose of 1 g of tranexamic acid, given at the induction of anaesthesia in patients undergoing
Despite advances in contemporary hip and knee
arthroplasty, blood loss continues to be an issue. Though blood transfusion
has long been used to treat post-operative anemia, the associated
risks are well established. The objective of this article is to
present two practical and effective approaches to minimising blood
loss and transfusion rates in hip and knee arthroplasty: the use
of antifibrinolytic medications such as tranexamic acid and the
adoption of more conservative transfusion indications.
Comparison of the safety and efficacy of bilateral simultaneous
The angle of inclination of the acetabular component in
Aims. The aim of this study was to examine the efficacy and safety
of multiple boluses of intravenous (IV) tranexamic acid (TXA) on
the hidden blood loss (HBL) and inflammatory response following
primary
Aims. It is important to consider sagittal pelvic rotation when introducing
the acetabular component at
We prospectively studied 217 patients who underwent 234 Elite Plus
This study reports on ceramic-on-metal (CoM) bearings in