Hip reconstruction after resection of a periacetabular chondrosarcoma is complex and associated with a high rate of complications. Previous reports have compared no reconstruction with historical techniques that are no longer used. The aim of this study was to compare the results of tantalum acetabular reconstruction to both historical techniques and no reconstruction. We reviewed 66 patients (45 males and 21 females) with a mean age of 53 years (24 to 81) who had undergone acetabular resection for chondrosarcoma. A total of 36 patients (54%) underwent acetabular reconstruction, most commonly with a saddle prosthesis (n = 13; 36%) or a tantalum total hip arthroplasty (THA) (n = 10; 28%). Mean follow-up was nine years (SD 4).Aims
Methods
The most common reasons for revision of unicompartmental
knee arthroplasty (UKA) are
The aims of this systematic review were to assess the learning curve of semi-active robotic arm-assisted total hip arthroplasty (rTHA), and to compare the accuracy, patient-reported functional outcomes, complications, and survivorship between rTHA and manual total hip arthroplasty (mTHA). Searches of PubMed, Medline, and Google Scholar were performed in April 2020 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included “robotic”, “hip”, and “arthroplasty”. The criteria for inclusion were published clinical research articles reporting the learning curve for rTHA (robotic arm-assisted only) and those comparing the implantation accuracy, functional outcomes, survivorship, or complications with mTHA.Aims
Methods
Aims. 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. Patients and Methods. 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). Results. The mean proximal translation and sagittal rotation were significantly
higher in Group B than in Group A from three months onwards (p <
0.02). Proximal translation >
1.0 mm within 24 months had a positive
predictive value (PPV) of 90% and a specificity of 94%, but a sensitivity
of 64%. Proximal translation >
1.0 mm within the first 24 months correctly
identified 76 of 94 (81%) of components to be either loose or not
loose. However, ten components in Group B (24%) did not migrate
proximally above 1.0 mm within the first 60 months. Conclusion. The high PPV of EBRA-Cup measurements of proximal translation
(90%) shows that this can be used in early follow-up to identify
patients at risk of aseptic
In the last decade, interest in partial knee arthroplasties and bicruciate retaining total knee arthroplasties has increased. In addition, patient-related outcomes and functional results such as range of movement and ambulation may be more promising with less invasive procedures such as bicompartmental arthroplasty (BCA). The purpose of this study is to evaluate clinical and radiological outcomes after a third-generation patellofemoral arthroplasty (PFA) combined with a medial or lateral unicompartmental knee arthroplasty (UKA) at mid- to long-term follow-up. A total of 57 procedures were performed. In 45 cases, a PFA was associated with a medial UKA and, in 12, with a lateral UKA. Patients were followed with validated patient-reported outcome measures (Oxford Knee Score (OKS), EuroQol five-dimension questionnaire (EQ-5D), EuroQoL Visual Analogue Scale (EQ-VAS)), the Knee Society Score (KSS), the Forgotten Joint Score (FJS), and radiological analysis.Aims
Methods
Aims. The number of revision total knee arthroplasties (TKA) that are
performed is expected to increase. However, previous reports of
the causes of failure after TKA are limited in that they report
the causes at specific institutions, which are often dependent on
referral patterns. Our aim was to report the most common indications
for re-operations and revisions in a large series of posterior-stabilised
TKAs undertaken at a single institution, excluding referrals from
elsewhere, which may bias the causes of failure. Patients and Methods. A total of 5098 TKAs which were undertaken between 2000 and 2012
were included in the study. Re-operations, revisions with modular
component exchange, and revisions with non-modular component replacement
or removal were identified from the medical records. The mean follow-up
was five years (two to 12). Results. The Kaplan-Meier ten-year survival without a re-operation, modular
component revision and non-modular component revision was 95.7%,
99.3% and 95.3%, respectively. The most common indications for a
re-operation were: post-operative stiffness (58%), delayed wound healing
(21%), and patellar clunk (11%). The indications for isolated modular
component revision were acute periprosthetic joint infection (PJI)
(64%) and instability (36%). The most common indications for non-modular
component revision were chronic PJI (52%), aseptic
Aims. The optimal method of tibial component fixation remains uncertain
in total knee arthroplasty (TKA). Hydroxyapatite coatings have been
applied to improve bone ingrowth in uncemented designs, but may
only coat the directly accessible surface. As peri-apatite (PA)
is solution deposited, this may increase the coverage of the implant
surface and thereby fixation. We assessed the tibial component fixation
of uncemented PA-coated TKAs versus cemented TKAs. Patients and Methods. Patients were randomised to PA-coated or cemented TKAs. In 60
patients (30 in each group), radiostereometric analysis of tibial
component migration was evaluated as the primary outcome at baseline,
three months post-operatively and at one, two and five years. A
linear mixed-effects model was used to analyse the repeated measurements. Results. After five years of follow-up, one (cemented) component was revised
due to ligament instability. Overall, uncemented PA-coated tibial
components migrated significantly more
(p = 0.003), with the mean maximum total point motion (MTPM) at
five years being 0.62 mm (95% confidence intervals (CI) 0.49 to
0.76) for cemented tibial components and 0.97 mm (95% CI 0.81 to
1.15) for PA-coated tibial components in TKA. However, between three
months and five years the cemented TKAs migrated significantly more
(p = 0.02), displaying a MTPM of 0.27 mm (95% CI, 0.19 to 0.36) versus 0.13
mm (95% CI, 0.01 to 0.25) for PA-coated tibial components. One implant
in each group was considered at risk for aseptic
Many surgeons choose to perform total knee arthroplasty (TKA) surgery with the aid of a tourniquet. A tourniquet is a device that fits around the leg and restricts blood flow to the limb. There is a need to understand whether tourniquets are safe, and if they benefit, or harm, patients. The aim of this study was to determine the benefits and harms of tourniquet use in TKA surgery. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled trials, and trial registries up to 26 March 2020. We included randomized controlled trials (RCTs), comparing TKA with a tourniquet versus without a tourniquet. Outcomes included: pain, function, serious adverse events (SAEs), blood loss, implant stability, duration of surgery, and length of hospital stay.Aims
Methods
Periprosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA). Two-stage revision has traditionally been considered the gold standard of treatment for established infection, but increasing evidence is emerging in support of one-stage exchange for selected patients. The objective of this study was to determine the outcomes of single-stage revision TKA for PJI, with mid-term follow-up. A total of 84 patients, with a mean age of 68 years (36 to 92), underwent single-stage revision TKA for confirmed PJI at a single institution between 2006 and 2016. In all, 37 patients (44%) were treated for an infected primary TKA, while the majority presented with infected revisions: 31 had undergone one previous revision (36.9%) and 16 had multiple prior revisions (19.1%). Contraindications to single-stage exchange included systemic sepsis, extensive bone or soft-tissue loss, extensor mechanism failure, or if primary wound closure was unlikely to be achievable. Patients were not excluded for culture-negative PJI or the presence of a sinus.Aims
Methods
We evaluated the long-term results of 116 total hip replacements with a superolateral shelfplasty in 102 patients with osteoarthritis secondary to developmental dysplasia of the hip. After a mean follow-up of 19.5 years (11.5 to 26.0), 14 acetabular components (12%) had been revised. The cumulative survival at 20 years was 78%, with revision for
It has been hypothesized that proximal radial neck resorption (PRNR) following press-fit radial head arthroplasty (RHA) is due to stress-shielding. We compared two different press-fit stems by means of radiographs to investigate whether the shape and size of the stems are correlated with the degree of PRNR. The radiographs of 52 RHAs were analyzed both at 14 days postoperatively and after two years. A cylindrical stem and a conical stem were implanted in 22 patients (group 1) and 30 patients (group 2), respectively. The PRNR was measured in the four quadrants of the radial neck and the degree of stem filling was calculated by analyzing the ratio between the prosthetic stem diameter (PSD) and the medullary canal diameter (MCD) at the proximal portion of the stem (level A), halfway along the stem length (level B), and distally at the stem tip (level C).Aims
Methods
Aims. Promising medium-term results from total shoulder arthroplasty
(TSA) have been reported for the treatment of primary osteoarthritis
in young and middle-aged patients. The aim of this study was to
evaluate the long-term functional and radiological outcome of TSA
in the middle-aged patient. Patients and Methods. The data of all patients from the previous medium-term study
were available. At a mean follow-up of 13 years (8 to 17), we reviewed
21 patients (12 men, nine women, 21 shoulders) with a mean age of
55 years (37 to 60). The Constant-Murley score (CS) with its subgroups
and subjective satisfaction were measured. Radiological signs of implant
loosening were analysed. Results. Two shoulders (two patients) were revised and in two shoulders
of two different patients, revision surgery was recommended. The
mean CS increased from 23.3 (10 to 45) pre-operatively to 56.5 (26
to 81; p <
0.0001), but with a decrease in CS from 62.8 (38 to
93) to 56.5 (26 to 81) between medium- and long-term follow-up (p
= 0.01). Without revision surgery, 18 patients (95%) rated their
result as good or very good. The mean radiolucent line score for the glenoid components increased
from 1.8 (0 to 6) to 8.2 (2 to 18) between medium- and long-term
follow-up (p <
0.001). . Conclusion. TSA in young and middle-aged patients leads to improvement in
clinical function and a relatively high satisfaction rate. However,
clinical or radiological glenoid
Upper limb amputations, ranging from transhumeral to partial hand, can be devastating for patients, their families, and society. Modern paradigm shifts have focused on reconstructive options after upper extremity limb loss, rather than considering the amputation an ablative procedure. Surgical advancements such as targeted muscle reinnervation and regenerative peripheral nerve interface, in combination with technological development of modern prosthetics, have expanded options for patients after amputation. In the near future, advances such as osseointegration, implantable myoelectric sensors, and implantable nerve cuffs may become more widely used and may expand the options for prosthetic integration, myoelectric signal detection, and restoration of sensation. This review summarizes the current advancements in surgical techniques and prosthetics for upper limb amputees. Cite this article:
There is no diagnostic, non-invasive method for the early detection of
Aims. We carried out a further study of the long-term results of the
cemented Exeter femoral component in patients under the age of 40
with a mean follow-up of 13.6 years (10 to 20). Patients and Methods. We reviewed our original cohort of 104 cemented Exeter stems
in 78 consecutive patients with a mean age of 31 years (16 to 39).
Only one patient was lost to radiological follow-up. Results. A total of six patients (eight hips) had died for reasons unrelated
to their surgery. There had been one further periprosthetic fracture
from a fall and one fractured femoral stem. No revisions for aseptic
loosening were undertaken during the whole study period. Overall, 11 hips had progressive radiolucent lines in one or
more zones. The Kaplan Meier survival percentages at ten and 17 years were
97.1% (95% confidence interval (CI) 91.3 to 99.1) and 92.1% (95%
CI 74.1 to 97.8) with revision for any reason as the endpoint, and
100% at both ten and 17 years with aseptic
Short uncemented humeral stems can preserve humeral
bone stock and facilitate revision surgery but may be prone to malalignment
or
Calprotectin (CLP) is produced in neutrophils and monocytes and released into body fluids as a result of inflammation or infection. The aim of this study was to evaluate the utility of blood and synovial CLP in the diagnosis of chronic periprosthetic joint infection (PJI). Blood and synovial fluid samples were collected prospectively from 195 patients undergoing primary or revision hip and knee arthroplasty. Patients were divided into five groups: 1) primary total hip and knee arthroplasty performed due to idiopathic osteoarthritis (OA; n = 60); 2) revision hip and knee arthroplasty performed due to aseptic failure of the implant (AR-TJR; n = 40); 3) patients with a confirmed diagnosis of chronic PJI awaiting surgery (n = 45); 4) patients who have finished the first stage of the PJI treatment with the use of cemented spacer and were qualified for replantation procedure (SR-TJR; n = 25), and 5) patients with rheumatoid arthritis undergoing primary total hip and knee arthroplasty (RA; n = 25). CLP concentrations were measured quantitatively in the blood and synovial fluid using an immunoturbidimetric assay. Additionally, blood and synovial CRP, blood interleukin-6 (IL-6), and ESR were measured, and a leucocyte esterase (LE) strip test was performed.Aims
Methods
Objectives. Metal-on-metal hip resurfacing (MOMHR) is available as an alternative
option for younger, more active patients. There are failure modes
that are unique to MOMHR, which include
Iliopsoas pathology is a relatively uncommon cause of pain following total hip arthroplasty (THA), typically presenting with symptoms of groin pain on active flexion and/or extension of the hip. A variety of conservative and surgical treatment options have been reported. In this retrospective cohort study, we report the incidence of iliopsoas pathology and treatment outcomes. A retrospective review of 1,000 patients who underwent THA over a five-year period was conducted, to determine the incidence of patients diagnosed with iliopsoas pathology. Outcome following non-surgical and surgical management was assessed.Aims
Methods