The aim of this systematic literature review was to assess the clinical level of evidence of commercially available demineralised bone matrix (DBM) products for their use in trauma and orthopaedic related surgery. A total of 17 DBM products were used as search terms in two available databases: Embase and PubMed according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement. All articles that reported the clinical use of a DBM-product in trauma and orthopaedic related surgery were included.Objectives
Methods
To assess the extent of osteointegration in two designs of shoulder
resurfacing implants. Bony integration to the Copeland cylindrical
central stem design and the Epoca RH conical-crown design were compared. Implants retrieved from six patients in each group were pair-matched.
Mean time to revision surgery of Copeland implants was 37 months
(standard deviation (Aims
Patients and Methods
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). 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).Aims
Patients and Methods
The purpose of this study was to determine the sensitivity, specificity
and predictive values of previously reported thresholds of proximal
translation and sagittal rotation of cementless acetabular components
used for revision total hip arthroplasty (THA) at various times
during early follow-up. Migration of cementless acetabular components was measured retrospectively
in 84 patients (94 components) using Ein-Bild-Rontgen-Analyse (EBRA-Cup)
in two groups of patients. In Group A, components were recorded
as not being loose intra-operatively at re-revision THA (52 components/48
patients) and Group B components were recorded to be loose at re-revision
(42 components/36 patients).Aims
Patients and Methods
Preservation of posterior condylar offset (PCO) has been shown to correlate with improved functional results after primary total knee arthroplasty (TKA). Whether this is also the case for revision TKA, remains unknown. The aim of this study was to assess the independent effect of PCO on early functional outcome after revision TKA. A total of 107 consecutive aseptic revision TKAs were performed by a single surgeon during an eight-year period. The mean age was 69.4 years (39 to 85) and there were 59 female patients and 48 male patients. The Oxford Knee Score (OKS) and Short-form (SF)-12 score were assessed pre-operatively and one year post-operatively. Patient satisfaction was also assessed at one year. Joint line and PCO were assessed radiographically at one year.Objectives
Methods
The conventional method for reconstructing acetabular
bone loss at revision surgery includes using structural bone allograft.
The disadvantages of this technique promoted the advent of metallic
but biocompatible porous implants to fill bone defects enhancing
initial and long-term stability of the acetabular component. This
paper presents the indications, surgical technique and the outcome
of using porous metal acetabular augments for reconstructing acetabular
defects. Cite this article:
Revision total hip arthroplasty (THA) is challenging
when there is severe loss of bone in the proximal femur. The purpose
of this study was to evaluate the clinical and radiographic outcomes
of revision THA in patients with severe proximal femoral bone loss
treated with a fluted, tapered, modular femoral component. Between
January 1998 and December 2004, 92 revision THAs were performed
in 92 patients using a single fluted, tapered, modular femoral stem
design. Pre-operative diagnoses included aseptic loosening, infection
and peri-prosthetic fracture. Bone loss was categorised pre-operatively
as Paprosky types III-IV, or Vancouver B3 in patients with a peri-prosthetic
fracture. The mean clinical follow-up was 6.4 years (2 to 12). A
total of 47 patients had peri-operative complications, 27 of whom
required further surgery. However, most of these further operations
involved retention of a well-fixed femoral stem, and 88/92 femoral
components (97%) remained Revision THA in patients with extensive proximal femoral bone
loss using the Link MP fluted, tapered, modular stem led to a high
rate of osseointegration of the stem at mid-term follow-up. Cite this article:
The aims of this study were to evaluate the clinical and radiological
outcomes of the Universal-2 total wrist arthroplasty (TWA) in patients
with rheumatoid arthritis. This was a retrospective review of all 95 Universal-2 TWAs which
were performed in our institution between 2003 to 2012 in patients
with rheumatoid arthritis. A total of six patients were lost to
follow-up and two died of unrelated causes. A total of ten patients
had bilateral procedures. Accordingly, 75 patients (85 TWAs) were
included in the study. There were 59 women and 16 men with a mean
age of 59 years (26 to 86). The mean follow-up was 53 months (24
to 120). Clinical assessment involved recording pain on a visual
analogue score, range of movement, grip strength, the Quick Disabilities
of the Arm, Shoulder and Hand (DASH) and Wrightington wrist scores.
Any adverse effects were documented with particular emphasis on
residual pain, limitation of movement, infection, dislocation and
the need for revision surgery. Radiographic assessment was performed pre-operatively and at
three, six and 12 months post-operatively, and annually thereafter.
Arthroplasties were assessed for distal row intercarpal fusion and
loosening. Radiolucent zones around the components were documented
according to a system developed at our institution.Aims
Patients and Methods
The role of high tibial osteotomy (HTO) is being questioned by
the use of unicompartmental knee arthroplasty (UKA) in the treatment
of medial compartment femorotibial osteoarthritis. Our aim was to
compare the outcomes of revision HTO or UKA to a total knee arthroplasty
(TKA) using computer-assisted surgery in matched groups of patients. We conducted a retrospective study to compare the clinical and
radiological outcome of patients who underwent revision of a HTO
to a TKA (group 1) with those who underwent revision of a medial
UKA to a TKA (group 2). All revision procedures were performed using
computer-assisted surgery. We extracted these groups of patients
from our database. They were matched by age, gender, body mass index,
follow-up and pre-operative functional score. The outcomes included
the Knee Society Scores (KSS), radiological outcomes and the rate
of further revision.Aims
Patients and Methods
One goal of total hip arthroplasty is to restore normal hip anatomy.
The aim of this study was to compare displacement of the centre
of rotation (COR) using a standard reaming technique with a technique
in which the acetabulum was reamed immediately peripherally and
referenced off the rim. In the first cohort the acetabulum was reamed to the floor followed
by sequentially larger reamers. In the second cohort the acetabulum
was only reamed peripherally, starting with a reamer the same size
as the native femoral head. Anteroposterior pelvic radiographs were
analysed for acetabular floor depth and vertical and horizontal position
of the COR.Aims
Patients and Methods
The August 2014 Shoulder &
Elbow Roundup360 looks at: Myofibroblasts perhaps not implicated in post-traumatic elbow stiffness; olecranon tip biomechanically sound for coranoid reconstruction; obesity and elbow replacement don’t mix; single column plating successful for extra-articular distal humeral fractures; satisfaction not predictable in frozen shoulder; tenodesis and repair both acceptable in Grade II SLAP tears; glenoid bone grafting is effective and glenohumeral articular lesions best seen with an arthroscope.
The February 2015 Hip &
Pelvis Roundup360 looks at: Hip arthroplasty in Down syndrome; Bulk femoral autograft successful in acetabular reconstruction; Arthroplasty follow-up: is the internet the solution?; Total hip arthroplasty following acetabular fracture; Salvage arthroplasty following failed hip internal fixation; Bone banking sensible financially and clinically; Allogenic blood transfusion in arthroplasty.
An international faculty of orthopaedic surgeons
presented their work on the current challenges in hip surgery at
the London Hip Meeting which was attended by over
400 delegates. The topics covered included femoroacetabular impingement, thromboembolic
phenomena associated with hip surgery, bearing surfaces (including metal-on-metal
articulations), outcomes of hip replacement surgery and revision
hip replacement. We present a concise report of the current opinions
on hip surgery from this meeting with appropriate references to
the current literature.
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:
Tapered, fluted, modular, titanium stems have
a long history in Europe and are increasing in popularity in North America.
We have reviewed the results at our institution looking at stem
survival and clinical outcomes. Radiological outcomes and quality
of life assessments have been performed and compared to cylindrical
non-modular cobalt chromium stems. Survival at five years was 94%.
This fell to 85% at ten years due to stem breakage with older designs.
Review of radiology showed maintenance or improvement of bone stock
in 87% of cases. Outcome scores were superior in tapered stems despite
worse pre-operative femoral deficiency. Tapered stems have proved
to be a useful alternative in revision total hip arthroplasty across
the spectrum of femoral bone deficiency.
Trabecular metal (TM) augments are a relatively
new option for reconstructing segmental bone loss during acetabular
revision. We studied 34 failed hip replacements in 34 patients that
were revised between October 2003 and March 2010 using a TM acetabular
shell and one or two augments. The mean age of the patients at the
time of surgery was 69.3 years (46 to 86) and the mean follow-up
was 64.5 months (27 to 107). In all, 18 patients had a minor column
defect, 14 had a major column defect, and two were associated with
pelvic discontinuity. The hip centre of rotation was restored in
27 patients (79.4%). The Oxford hip score increased from a mean
of 15.4 points (6 to 25) before revision to a mean of 37.7 (29 to
47) at the final follow-up. There were three aseptic loosenings
of the construct, two of them in the patients with pelvic discontinuity.
One septic loosening also occurred in a patient who had previously
had an infected hip replacement. The augments remained stable in
two of the failed hips. Whenever there was a loose acetabular component
in contact with a stable augment, progressive metal debris shedding
was evident on the serial radiographs. Complications included another
deep infection treated without revision surgery. Good clinical and
radiological results can be expected for bone-deficient acetabula
treated by a TM cup and augment, but for pelvic discontinuities
this might not be a reliable option. Cite this article:
