Prospective data on 6905 consecutive
Since 1996 more than one million metal-on-metal
articulations have been implanted worldwide. Adverse reactions to
metal debris are escalating. Here we present an algorithmic approach
to patient management. The general approach to all arthroplasty
patients returning for follow-up begins with a detailed history,
querying for pain, discomfort or compromise of function. Symptomatic
patients should be evaluated for intra-articular and extra-articular
causes of pain. In large head MoM arthroplasty, aseptic loosening
may be the source of pain and is frequently difficult to diagnose.
Sepsis should be ruled out as a source of pain. Plain radiographs
are evaluated to rule out loosening and osteolysis, and assess component
position. Laboratory evaluation commences with erythrocyte sedimentation
rate and C-reactive protein, which may be elevated. Serum metal
ions should be assessed by an approved facility. Aspiration, with
manual cell count and culture/sensitivity should be performed, with
cloudy to creamy fluid with predominance of monocytes often indicative
of failure. Imaging should include ultrasound or metal artifact
reduction sequence MRI, specifically evaluating for fluid collections
and/or masses about the
1. The examination of fifty-one infants presenting signs of unilateral dysplasia (preluxation) of the
Between September 2004 and December 2005 we carried out a prospective study of all cases of sepsis of the
Proximal femoral resection (PFR) is a proven
pain-relieving procedure for the management of patients with severe cerebral
palsy and a painful displaced
This conversation represents an attempt by several
arthroplasty surgeons to critique several abstracts presented over
the last year as well as to use them as a jumping off point for trying
to figure out where they fit in into our current understanding of
multiple issues in modern
Traumatic posterior dislocation of the
Aims. To investigate the bone penetration of intravenous antibiotic
prophylaxis with flucloxacillin and gentamicin during
The Capital
Developmental dysplasia of the hip (DDH) should
be diagnosed as early as possible to optimise treatment. The current
United Kingdom recommendations for the selective screening of DDH
include a clinical examination at birth and at six weeks. In Northern
Ireland babies continue to have an assessment by a health visitor
at four months of age. As we continue to see late presentations
of DDH, beyond one year of age, we hypothesised that a proportion had
missed an opportunity for earlier diagnosis. We expect those who
presented to our service with Tonnis grade III or IV
Over an eight-month period we prospectively enrolled 122 patients who underwent arthroscopic surgery of the
The October 2012
The National Institute for Health and Clinical
Excellence (NICE) guidelines from 2011 recommend the use of cemented
hemi-arthroplasty for appropriate patients with an intracapsular
hip fracture. In our institution all patients who were admitted
with an intracapsular
We evaluated radiological
The Oxford
Femoral stem version has a major influence on
impingement and early post-operative stability after total
We retrospectively examined the long-term outcome of 96 asymptomatic
Using a rat model the characteristics of the sensory neurones of the dorsal-root ganglia (DRG) innervating the
Open reduction of the prominence at the femoral head-neck junction in femoroacetabular impingement has become an established treatment for this condition. We report our experience of arthroscopically-assisted treatment of femoroacetabular impingement secondary to paediatric