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The Bone & Joint Journal
Vol. 95-B, Issue 5 | Pages 636 - 642
1 May 2013
Gøthesen Ø Espehaug B Havelin L Petursson G Lygre S Ellison P Hallan G Furnes O

We evaluated the rates of survival and cause of revision of seven different brands of cemented primary total knee replacement (TKR) in the Norwegian Arthroplasty Register during the years 1994 to 2009. Revision for any cause, including resurfacing of the patella, was the primary endpoint. Specific causes of revision were secondary outcomes. Three posterior cruciate-retaining (PCR) fixed modular-bearing TKRs, two fixed non-modular bearing PCR TKRs and two mobile-bearing posterior cruciate-sacrificing TKRs were investigated in a total of 17 782 primary TKRs. The median follow-up for the implants ranged from 1.8 to 6.9 years. Kaplan-Meier 10-year survival ranged from 89.5% to 95.3%. Cox’s relative risk (RR) was calculated relative to the fixed modular-bearing Profix knee (the most frequently used TKR in Norway), and ranged from 1.1 to 2.6. The risk of revision for aseptic tibial loosening was higher in the mobile-bearing LCS Classic (RR 6.8 (95% confidence interval (CI) 3.8 to 12.1)), the LCS Complete (RR 7.7 (95% CI 4.1 to 14.4)), the fixed modular-bearing Duracon (RR 4.5 (95% CI 1.8 to 11.1)) and the fixed non-modular bearing AGC Universal TKR (RR 2.5 (95% CI 1.3 to 5.1)), compared with the Profix. These implants (except AGC Universal) also had an increased risk of revision for femoral loosening (RR 2.3 (95% CI 1.1 to 4.8), RR 3.7 (95% CI 1.6 to 8.9), and RR 3.4 (95% CI 1.1 to 11.0), respectively). These results suggest that aseptic loosening is related to design in TKR. Cite this article: Bone Joint J 2013;95-B:636–42


The Journal of Bone & Joint Surgery British Volume
Vol. 80-B, Issue 4 | Pages 591 - 594
1 Jul 1998
Allain J Le Mouel S Voiçin MC Delepine G Goutallier D

A 65-year-old man presented with a painful hip five years after a cemented replacement. Histological examination of a biopsy taken from tissue surrounding the femoral implant showed infiltration of a squamous-cell carcinoma. Further investigation revealed a primary growth in the left lung. This rare example of a metastasis in relation to a joint replacement illustrates the necessity for histological examination of the tissue adjacent to a loose prosthesis


The Journal of Bone & Joint Surgery British Volume
Vol. 75-B, Issue 5 | Pages 693 - 696
1 Sep 1993
Ling R Timperley A Linder L

We report the histology of a femur retrieved 3.5 years after a cemented revision of a hip replacement in which impaction allografting had been used to fill two large cortical defects. The allograft chips had largely been replaced by viable cortical bone, and the interface between cement and tissue resembled that seen after primary cemented arthroplasty


The Journal of Bone & Joint Surgery British Volume
Vol. 88-B, Issue 8 | Pages 1065 - 1070
1 Aug 2006
Appleton P Moran M Houshian S Robinson CM

Although the use of constrained cemented arthroplasty to treat distal femoral fractures in elderly patients has some practical advantages over the use of techniques of fixation, concerns as to a high rate of loosening after implantation of these prostheses has raised doubts about their use. We evaluated the results of hinged total knee replacement in the treatment of 54 fractures in 52 patients with a mean age of 82 years (55 to 98), who were socially dependent and poorly mobile. Within the first year after implantation 22 of the 54 patients had died, six had undergone a further operation and two required a revision of the prosthesis. The subsequent rate of further surgery and revision was low. A constrained knee prosthesis offers a useful alternative treatment to internal fixation in selected elderly patients with these fractures, and has a high probability of surviving as long as the patient into whom it has been implanted


The Journal of Bone & Joint Surgery British Volume
Vol. 80-B, Issue 4 | Pages 600 - 606
1 Jul 1998
Garellick G Malchau H Herberts P

We assessed 100 patients with a primary total hip replacement using the Harris hip score and the Nottingham Health Profile at one, three and five years after operation. They were derived from two prospective randomised series of cemented and uncemented replacements. Both scoring systems correlated highly and were each heavily influenced by the system of functional classification defined by Charnley. After five years both reflected the function of the implant and the general state of the patient. A higher degree of sensitivity is needed to show differences in the performance of an implant in the short and medium term. We do not yet have an ideal system of clinical assessment and the overall function must always be properly assessed


The Journal of Bone & Joint Surgery British Volume
Vol. 74-B, Issue 1 | Pages 57 - 62
1 Jan 1992
Athanasou N Quinn J Bulstrode C

The role of inflammatory cells in aseptic loosening and failure of cemented joint replacements is unclear. Inflammatory cells from the revision joint capsule of four failed hip arthroplasties were examined to determine their nature and resorptive capacity. The capsules contained numerous macrophages and abundant foreign-body macrophage polykaryons, distinguished from osteoclasts by their antigenic phenotype and lack of response to calcitonin. When cultured on cortical bone slices in vitro, both macrophages and macrophage polykaryons produced small resorption pits and were associated with areas of superficial resorption of the bone surface. These results indicate that foreign-body induced macrophages and macrophage polykaryons are capable of a type of low-grade bone resorption which may be of pathogenic significance in the loosening of cemented joint prosthetic components


The Journal of Bone & Joint Surgery British Volume
Vol. 76-B, Issue 1 | Pages 73 - 77
1 Jan 1994
Jasty M Bragdon C Lee K Hanson A Harris W

Fifty-four cobalt-chrome alloy femoral heads were retrieved at revision surgery or at post-mortem; 23 came from uncemented, eight from hybrid and 23 from cemented hip arthroplasties. The uncemented and hybrid implants had porous coating, metal backing and modular femoral heads; with one exception none of the cemented implants had any of these. Twenty-five of the 31 heads from uncemented and hybrid arthroplasties, and 11 of the 23 heads from cemented arthroplasties showed surface damage involving more than 25% of the surface. Scanning electron microscopy revealed multidirectional fine scratches 1 micron to 10 microns in depth and width which appeared to have been made by fine, hard particles. There was a higher rate of such damage in the uncemented and hybrid arthroplasties than in the cemented implants, suggesting that the abrasive particles were mainly released from the metal, rather than from the cement or polyethylene components of the implants


The Journal of Bone & Joint Surgery British Volume
Vol. 63-B, Issue 3 | Pages 342 - 353
1 Aug 1981
Buchholz H Elson R Engelbrecht E Lodenkamper H Rottger J Siegel A

Exchange operation is recommended as the treatment of choice for most deep infections involving a total hip replacement. This revision arthroplasty comprises, in one stage, excision of soft tissue, removal of implant and cement, replacement with an appropriate implant using Palacos R acrylic cement loaded with an appropriate antibiotic and, more recently, systemic antibiotics. During our first 10 years without systemic antibiotics we have achieved an overall 77 per cent success rate from a first attempt in 583 patients and a 90 per cent success rate after subsequent exchange procedures. Morbidity is significant but acceptable. Success is defined as control of infection, no loosening, and useful function. The factors associated with failures include, in particular, specific infections (Pseudomonas group, Streptococcus group D, Proteus group, and Escherichia coli), delay in operation and inadequate antibiotic dosage in the cement


The Bone & Joint Journal
Vol. 101-B, Issue 6_Supple_B | Pages 9 - 15
1 Jun 2019
Wyles CC Hevesi M Osmon DR Park MA Habermann EB Lewallen DG Berry DJ Sierra RJ

Aims

The aims of this study were to characterize antibiotic choices for perioperative total knee arthroplasty (TKA) and total hip arthroplasty (THA) prophylaxis, assess antibiotic allergy testing efficacy, and determine rates of prosthetic joint infection (PJI) based on perioperative antibiotic regimen.

Patients and Methods

We evaluated all patients undergoing primary TKA or THA at a single academic institution between January 2004 and May 2017, yielding 29 695 arthroplasties (22 705 patients), with 3411 arthroplasties in 2576 patients (11.5%) having undergone preoperative allergy testing. A series of institutional databases were combined to identify allergy consultation outcomes, perioperative antibiotic regimen, and infection-free survivorship until final follow-up.


The Journal of Bone & Joint Surgery British Volume
Vol. 74-B, Issue 3 | Pages 380 - 384
1 May 1992
Lee J Salvati E Betts F DiCarlo E Doty S Bullough P

Reports of differing failure rates of total hip prostheses made of various metals prompted us to measure the size of metallic and polyethylene particulate debris around failed cemented arthroplasties. We used an isolation method, in which metallic debris was extracted from the tissues, and a non-isolation method of routine preparation for light and electron microscopy. Specimens were taken from 30 cases in which the femoral component was of titanium alloy (10), cobalt-chrome alloy (10), or stainless steel (10). The mean size of metallic particles with the isolation method was 0.8 to 1.0 microns by 1.5 to 1.8 microns. The non-isolation method gave a significantly smaller mean size of 0.3 to 0.4 microns by 0.6 to 0.7 microns. For each technique the particle sizes of the three metals were similar. The mean size of polyethylene particles was 2 to 4 microns by 8 to 13 microns. They were larger in tissue retrieved from failed titanium-alloy implants than from cobalt-chrome and stainless-steel implants. Our results suggest that factors other than the size of the metal particles, such as the constituents of the alloy, and the amount and speed of generation of debris, may be more important in the failure of hip replacements


The Journal of Bone & Joint Surgery British Volume
Vol. 84-B, Issue 4 | Pages 566 - 570
1 May 2002
Kim Y Kim J

We have evaluated prospectively the incidence and location of deep-vein thrombosis (DVT), the risk factors for pulmonary embolism, and the natural history of thrombosis after total knee replacement (TKR) in patients who did not receive prophylactic or therapeutic treatment for DVT. We studied 227 patients who underwent primary TKR; 116 had one-stage bilateral and 111 unilateral procedures. Coagulation assays, the full blood count and blood typing tests for the serum chemical profile were undertaken in all patients on three separate occasions. Bilateral simultaneous or unilateral venograms were carried out at six or seven days after operation. Perfusion lung scanning was undertaken before and at seven or eight days after operation. Bilateral simultaneous or unilateral venograms were repeated six months after operation in all patients who had thrombi. In the 116 patients with a bilateral replacement, 97 of 232 venograms (41.8%) were positive for fresh thrombi while there were 46 positive venograms (41.4%) in the 111 patients with a unilateral replacement (p = 1.000). Of the 116 venograms in knees with a cemented replacement, 45 (38.8%) were positive for thrombi while 52 of the 116 venograms (44.8%) were positive in those with a cementless replacement (p = 0.675). Further venograms at six months after operation in all 143 limbs which had thrombi showed that all had completely resolved regardless of the size or location. No pulmonary embolism occurred as shown by negative perfusion lung scans and the absence of symptoms. Although the current prevailing opinion is that patients with thrombosis in the proximal veins should receive anticoagulant treatment, our study has shown that all thrombi regardless of their size or location resolved without causing pulmonary embolism


The Bone & Joint Journal
Vol. 100-B, Issue 12 | Pages 1626 - 1632
1 Dec 2018
Medellin MR Fujiwara T Tillman RM Jeys LM Gregory J Stevenson JD Parry M Abudu A

Aims

The aim of this paper was to investigate the prognostic factors for local recurrence in patients with pathological fracture through giant cell tumours of bone (GCTB).

Patients and Methods

A total of 107 patients presenting with fractures through GCTB treated at our institution (Royal Orthopaedic Hospital, Birmingham, United Kingdom) between 1995 and 2016 were retrospectively studied. Of these patients, 57 were female (53%) and 50 were male (47%).The mean age at diagnosis was 33 years (14 to 86). A univariate analysis was performed, followed by multivariate analysis to identify risk factors based on the treatment and clinical characteristics.


Bone & Joint Research
Vol. 7, Issue 5 | Pages 357 - 361
1 May 2018
Shin T Lim D Kim YS Kim SC Jo WL Lim YW

Objectives

Laser-engineered net shaping (LENS) of coated surfaces can overcome the limitations of conventional coating technologies. We compared the in vitro biological response with a titanium plasma spray (TPS)-coated titanium alloy (Ti6Al4V) surface with that of a Ti6Al4V surface coated with titanium using direct metal fabrication (DMF) with 3D printing technologies.

Methods

The in vitro ability of human osteoblasts to adhere to TPS-coated Ti6Al4V was compared with DMF-coating. Scanning electron microscopy (SEM) was used to assess the structure and morphology of the surfaces. Biological and morphological responses to human osteoblast cell lines were then examined by measuring cell proliferation, alkaline phosphatase activity, actin filaments, and RUNX2 gene expression.


Bone & Joint Research
Vol. 7, Issue 1 | Pages 103 - 104
1 Jan 2018
Young PS Patil S Meek RMD


The Bone & Joint Journal
Vol. 98-B, Issue 8 | Pages 1086 - 1092
1 Aug 2016
de Vos MJ Wagener ML Hannink G van der Pluijm M Verdonschot N Eygendaal D

Aims

Revision total elbow arthroplasty (TEA) is often challenging. The aim of this study was to report on the clinical and radiological results of revision arthroplasty of the elbow with the Latitude TEA.

Patients and Methods

Between 2006 and 2010 we used the Latitude TEA for revision in 18 consecutive elbows (17 patients); mean age 53 years (28 to 80); 14 women. A Kudo TEA was revised in 15 elbows and a Souter-Strathclyde TEA in three.

Stability, range of movement (ROM), visual analogue score (VAS) for pain and functional scores, Elbow Functional Assessment Scale (EFAS), the Functional Rating Index of Broberg and Morrey (FRIBM) and the Modified Andrews’ Elbow Scoring System (MAESS) were assessed pre-operatively and at each post-operative follow-up visit (six, 12 months and biennially thereafter). Radiographs were analysed for loosening, fractures and dislocation. The mean follow-up was 59 months (26 to 89).


The Bone & Joint Journal
Vol. 99-B, Issue 2 | Pages 250 - 254
1 Feb 2017
Tol MCJM van den Bekerom MPJ Sierevelt IN Hilverdink EF Raaymakers ELFB Goslings JC

Aims

Our aim was to analyse the long-term functional outcome of two forms of surgical treatment for active patients aged > 70 years with a displaced intracapsular fracture of the femoral neck. Patients were randomised to be treated with either a hemiarthroplasty or a total hip arthroplasty (THA). The outcome five years post-operatively for this cohort has previously been reported. We present the outcome at 12 years post-operatively.

Patients and Methods

Initially 252 patients with a mean age of 81.1 years (70.2 to 95.6) were included, of whom 205 (81%) were women. A total of 137 were treated with a cemented hemiarthroplasty and 115 with a cemented THA. At long-term follow-up we analysed the modified Harris Hip Score (HHS), post-operative complications and intra-operative data of the patients who were still alive.


The Bone & Joint Journal
Vol. 98-B, Issue 3 | Pages 291 - 297
1 Mar 2016
Rogmark C Leonardsson O

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) versus hemiarthroplasty and unipolar versus bipolar hemiarthroplasty, but no clear-cut evidence-based recommendation can be made. THA may be particularly advantageous for active, lucid patients with a relatively long life expectancy. For patients who are physiologically older, hemiarthoplasty is probably satisfactory, and for the oldest patients with more comorbidities, unipolar implants are considered to be sufficient. If the hospital can support emergency THA surgery in sufficient numbers and quality, there may be few patients who warrant bipolar hemiarthroplasty.

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: Bone Joint J 2016;98-B:291–7.


The Bone & Joint Journal
Vol. 97-B, Issue 6 | Pages 721 - 722
1 Jun 2015
Haddad FS Waddell J


The Bone & Joint Journal
Vol. 98-B, Issue 8 | Pages 1062 - 1068
1 Aug 2016
Singh G Deutloff N Maertens N Meyer H Awiszus F Feuerstein B Roessner A Lohmann CH

Aims

Tissue responses to debris formed by abrasion of polymethylmethacrylate (PMMA) spacers at two-stage revision arthroplasty for prosthetic joint infection are not well described. We hypothesised that PMMA debris induces immunomodulation in periprosthetic tissues.

Patients and Methods

Samples of tissue were taken during 35 two-stage revision arthroplasties (nine total hip and 26 total knee arthroplasties) in patients whose mean age was 67 years (44 to 85). Fourier transform infrared microscopy was used to confirm the presence of PMMA particles. Histomorphometry was performed using Sudan Red and Haematoxylin-Eosin staining. CD-68, CD-20, CD-11(c), CD-3 and IL-17 antibodies were used to immunophenotype the inflammatory cells. All slides were scored semi-quantitatively using the modified Willert scoring system.


The Bone & Joint Journal
Vol. 98-B, Issue 8 | Pages 1014 - 1019
1 Aug 2016
Bryson DJ Morris DLJ Shivji FS Rollins KR Snape S Ollivere BJ

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: Bone Joint J 2016;98-B:1014–19.