The medial periosteal hinge plays a key role in fractures of the
In the native hip, the hip capsular ligaments tighten at the limits of range of hip motion and may provide a passive stabilizing force to protect the hip against edge loading. In this study we quantified the stabilizing force vectors generated by capsular ligaments at extreme range of motion (ROM), and examined their ability to prevent edge loading. Torque-rotation curves were obtained from nine cadaveric hips to define the rotational restraint contributions of the capsular ligaments in 36 positions. A ligament model was developed to determine the line-of-action and effective moment arms of the medial/lateral iliofemoral, ischiofemoral, and pubofemoral ligaments in all positions. The functioning ligament forces and stiffness were determined at 5 Nm rotational restraint. In each position, the contribution of engaged capsular ligaments to the joint reaction force was used to evaluate the net force vector generated by the capsule.Aims
Methods
The issues surrounding raised levels of metal
ions in the blood following large
We present a retrospective series of 170 cemented titanium straight-stem femoral components combined with two types of femoral head: cobalt-chromium (CoCr) alloy (114 heads) and alumina ceramic (50 heads). Of the study group, 55 patients (55 stems) had died and six (six stems) were lost to follow-up. At a mean of 13.1 years (3 to 15.3) 26 stems had been revised for aseptic loosening. The mean follow-up time for stable stems was 15.1 years (12.1 to 16.6). Survival of the stem at 15 years was 75.4% (95% confidence interval (CI) 67.3 to 83.5) with aseptic failure (including radiological failure) as the end-point, irrespective of the nature of the
Aims. The purpose of this retrospective study was to evaluate the minimum
five-year outcome of revision total hip arthroplasty (THA) using
the Kerboull acetabular reinforcement device (KARD) in patients
with Paprosky type III acetabular defects and destruction of the
inferior margin of the acetabulum. Patients and Methods. We identified 36 patients (37 hips) who underwent revision THA
under these circumstances using the KARD, fresh frozen allograft
femoral
Bi-unicondylar arthroplasty (Bi-UKA) is a bone and anterior cruciate ligament (ACL)-preserving alternative to total knee arthroplasty (TKA) when the patellofemoral joint is preserved. The aim of this study is to investigate the clinical outcomes and biomechanics of Bi-UKA. Bi-UKA subjects (n = 22) were measured on an instrumented treadmill, using standard gait metrics, at top walking speeds. Age-, sex-, and BMI-matched healthy (n = 24) and primary TKA (n = 22) subjects formed control groups. TKA subjects with preoperative patellofemoral or tricompartmental arthritis or ACL dysfunction were excluded. The Oxford Knee Score (OKS) and EuroQol five-dimension questionnaire (EQ-5D) were compared. Bi-UKA, then TKA, were performed on eight fresh frozen cadaveric knees, to investigate knee extensor efficiency under controlled laboratory conditions, using a repeated measures study design.Aims
Methods
The aim of this study was to determine the association between knee alignment and the vertical orientation of the femoral neck in relation to the floor. This could be clinically important because changes of femoral neck orientation might alter chondral joint contact zones and joint reaction forces, potentially inducing problems like pain in pre-existing chondral degeneration. Further, the femoral neck orientation influences the ischiofemoral space and a small ischiofemoral distance can lead to impingement. We hypothesized that a valgus knee alignment is associated with a more vertical orientation of the femoral neck in standing position, compared to a varus knee. We further hypothesized that realignment surgery around the knee alters the vertical orientation of the femoral neck. Long-leg standing radiographs of patients undergoing realignment surgery around the knee were used. The hip-knee-ankle angle (HKA) and the vertical orientation of the femoral neck in relation to the floor were measured, prior to surgery and after osteotomy-site-union. Linear regression was performed to determine the influence of knee alignment on the vertical orientation of the femoral neck.Aims
Methods
Anchorage of pedicle screw rod instrumentation in the elderly spine with poor bone quality remains challenging. Our study aims to evaluate how the screw bone anchorage is affected by screw design, bone quality, loading conditions, and cementing techniques. Micro-finite element (µFE) models were created from micro-CT (μCT) scans of vertebrae implanted with two types of pedicle screws (L: Ennovate and R: S4). Simulations were conducted for a 10 mm radius region of interest (ROI) around each screw and for a full vertebra (FV) where different cementing scenarios were simulated around the screw tips. Stiffness was calculated in pull-out and anterior bending loads.Aims
Methods
A 70-year-old man with an uncemented metal-on-polyethylene
total hip prosthesis underwent revision arthroplasty 33 months later
because of pain, swelling and recurrent dislocation. There appeared
to be corrosion and metal release from the prosthetic
The practice of removing a well-fixed cementless
femoral component is associated with high morbidity. Ceramic bearing
couples are low wearing and their use minimises the risk of subsequent
further revision due to the production of wear debris. A total of
165 revision hip replacements were performed, in which a polyethylene-lined acetabular
component was revised to a new acetabular component with a ceramic
liner, while retaining the well-fixed femoral component. A titanium
sleeve was placed over the used femoral trunnion, to which a ceramic
head was added. There were 100 alumina and 65 Delta bearing couples
inserted. . The mean Harris hip score improved significantly from 71.3 (9.0
to 100.0) pre-operatively to 91.0 (41.0 to 100.0) at a mean follow
up of 4.8 years (2.1 to 12.5) (p <
0.001). No patients reported
squeaking of the hip. There were two fractures of the ceramic
Total hip arthroplasty (THA) in patients with post-polio residual paralysis (PPRP) is challenging. Despite relief in pain after THA, pre-existing muscle imbalance and altered gait may cause persistence of difficulty in walking. The associated soft tissue contractures not only imbalances the pelvis, but also poses the risk of dislocation, accelerated polyethylene liner wear, and early loosening. In all, ten hips in ten patients with PPRP with fixed pelvic obliquity who underwent THA as per an algorithmic approach in two centres from January 2014 to March 2018 were followed-up for a minimum of two years (2 to 6). All patients required one or more additional soft tissue procedures in a pre-determined sequence to correct the pelvic obliquity. All were invited for the latest clinical and radiological assessment.Aims
Methods
The purpose of this study was to compare clinical results, long-term survival, and complication rates of stemless shoulder prosthesis with stemmed anatomical shoulder prostheses for treatment of osteoarthritis and to analyze radiological bone changes around the implants during follow-up. A total of 161 patients treated with either a stemmed or a stemless shoulder arthroplasty for primary osteoarthritis of the shoulder were evaluated with a mean follow-up of 118 months (102 to 158). The Constant score (CS), the Disabilities of the Arm, Shoulder and Hand (DASH) score, and active range of motion (ROM) were recorded. Radiological analysis for bone adaptations was performed by plain radiographs. A Kaplan-Meier survivorship analysis was calculated and complications were noted.Aims
Methods
Hip arthroplasty does not always restore normal anatomy. This is due to inaccurate surgery or lack of stem sizes. We evaluated the aptitude of four total hip arthroplasty systems to restore an anatomical and medialized hip rotation centre. Using 3D templating software in 49 CT scans of non-deformed femora, we virtually implanted: 1) small uncemented calcar-guided stems with two offset options (Optimys, Mathys), 2) uncemented straight stems with two offset options (Summit, DePuy Synthes), 3) cemented undersized stems (Exeter philosophy) with three offset options (CPT, ZimmerBiomet), and 4) cemented line-to-line stems (Kerboul philosophy) with proportional offsets (Centris, Mathys). We measured the distance between the templated and the anatomical and 5 mm medialized hip rotation centre.Aims
Methods
There have been only a few small studies of patients
with an infected shoulder replacement treated with a single-stage
exchange procedure. We retrospectively reviewed 35 patients (19 men
and 16 women) with a peri-prosthetic infection of the shoulder who
were treated in this way. A total of 26 were available for clinical
examination; three had died, two were lost to follow-up and four
patients had undergone revision surgery. The mean follow-up time was
4.7 years (1.1 to 13.25), with an infection-free survival of 94%. The organisms most commonly isolated intra-operatively were Staphylococcus
epidermidis and Propionibacterium acnes;
two patients developed a recurrent infection. Three different types
of prosthesis were used: a hemiarthroplasty, a hemiarthroplasty
with a bipolar
The aim of this study is to develop a core set of outcome domains that should be considered and reported in all future trials of childhood limb fractures. A four-phase study was conducted to agree a set of core outcome domains. Identification of candidate outcome domains were identified through systematic review of trials, and outcome domains relevant to families were identified through semi-structured interviews with 20 families (parent-child pairing or group). Outcome domains were prioritized using an international three-round Delphi survey with 205 panellists and then condensed into a core outcome set through a consensus workshop with 30 stakeholders.Aims
Methods
Aims. We conducted a prospective study of a delta ceramic total hip
arthroplasty (THA) to determine the rate of ceramic fracture, to
characterise post-operative noise, and to evaluate the mid-term
results and survivorship. Patients and Methods. Between March 2009 and March 2011, 274 patients (310 hips) underwent
cementless THA using a delta ceramic femoral head and liner. At
each follow-up, clinical and radiological outcomes were recorded.
A Kaplan-Meier analysis was undertaken to estimate survival. Results. Four patients (four hips) died and 18 patients (20 hips) were
lost to follow-up within five years. The remaining 252 patients
(286 hips) were followed for a mean of 66.5 months (60 to 84). There
were 144 men (166 hips) and 108 women (120 hips) with a mean age
of 49.7 years (16 to 83) at surgery. The mean pre-operative Harris
Hip Score of 47.1 points improved to 93.8 points at final follow-up.
Six patients reported squeaking in seven hips; however, none were
audible. Radiolucent lines involving Gruen zones one and/or seven
were seen in 52 hips (18.2%). No hip had detectable wear, focal
osteolysis or signs of loosening. One hip was revised because of
fracture of the ceramic liner, which occurred due to an undetected
malseating of the ceramic liner at the time of surgery. One hip
was revised for a periprosthetic fracture of the femur, and one
hip was treated for periprosthetic joint infection. The six-year survivorship
with re-operation for any reason as the endpoint was 99.0% (95%
confidence interval 97.8% to 100%). Discussion. The rate of delta ceramic fracture was 0.3% (one of 286). While
ceramic
Bone marrow-derived mesenchymal stem cells obtained from bone marrow aspirate concentrate (BMAC) with platelet-rich plasma (PRP), has been used as an adjuvant to hip decompression. Early results have shown promise for hip preservation in patients with osteonecrosis (ON) of the femoral head. The purpose of the current study is to examine the mid-term outcome of this treatment in patients with precollapse corticosteroid-induced ON of the femoral head. In all, 22 patients (35 hips; 11 males and 11 females) with precollapse corticosteroid-induced ON of the femoral head underwent hip decompression combined with BMAC and PRP. Mean age and BMI were 43 years (SD 12) and 31 kg/m² (SD 6), respectively, at the time of surgery. Survivorship free from femoral head collapse and total hip arthroplasty (THA) and risk factors for progression were evaluated at minimum five-years of clinical follow-up with a mean follow-up of seven years (5 to 8).Aims
Methods