A Judet-type arthroplasty of the hip was performed. The patient died fourteen days after the operation. The upper end of the femur was examined and showed extensive necrosis surrounding the stem of the prosthesis

The Souter-Strathclyde prosthesis was used in 52 revisions of total elbow replacements (TERs) between August 1986 and May 1997. Of these, 50, carried out in 45 patients, were prospectively followed for a mean of 53 months (14 to 139). The procedure produced reliable relief of pain, and the range of movement was preserved. There was a considerable incidence of adverse events associated with revision (30%), and 12 further procedures have been required. Nonetheless, a revision is the preferred salvage procedure for failed primary arthroplasty in the absence of sepsis

At the end of this short study we have to sum up our views about the use of the acrylic prosthesis for arthroplasty of the hip. Some fatalities and a proportion of bad or poor results make this operation one to be undertaken only by surgeons well trained in the surgery of the hip and only on patients who really need it. However, the tolerance of the tissues to acrylic resin and the fixation of the stem in the neck of the femur promise to be lasting. We know that a much longer time is necessary to confirm these general statements, which proceed from an experience of only five years and the study of six hundred cases

1. The various surgical procedures in common use for the treatment of the osteoarthritic hip are briefly reviewed and compared with the operation of replacement of both the acetabulum and head of the femur by a metal prosthesis, that is, a complete artificial hip joint. 2. The development, description and technique of insertion of this artificial hip joint are given in detail. 3. The results of the first fifty cases of this operation show a success rate of over 90 per cent. The few failures are analysed in detail. The revision procedure has been the insertion of another artificial hip joint. 4. The essential details necessary for success are stressed and the indications and aims of the operation given

The early failure and revision of bimodular primary total hip arthroplasty prostheses requires the identification of the risk factors for material loss and wear at the taper junctions through taper wear analysis. Deviations in taper geometries between revised and pristine modular neck tapers were determined using high resolution tactile measurements. A new algorithm was developed and validated to allow the quantitative analysis of material loss, complementing the standard visual inspection currently used. The algorithm was applied to a sample of 27 retrievals (in situ from 2.9 to 38.1 months) of the withdrawn Rejuvenate modular prosthesis. The mean wear volumes on the flat distal neck piece taper was 3.35 mm. 3. (0.55 to 7.57), mainly occurring in a characteristic pattern in areas with high mechanical loading. Wear volume tended to increase with time to revision (r² = 0.423, p = 0.001). Implant and patient specific data (offset, stem size, patient’s mass, age and body mass index) did not correlate with the amount of material loss observed (p >  0.078). Bilaterally revised implants showed higher amounts of combined total material loss and similar wear patterns on both sides. The consistent wear pattern found in this study has not been reported previously, suggesting that the device design and materials are associated with the failure of this prosthesis. Cite this article: Bone Joint J 2015;97-B:1350–7

In a frail elderly patient a pathological fracture of the femur at the lower end of a loose femoral stem was treated by the retrograde insertion of an intramedullary nail over the tip of the prosthesis

A prospective, randomised and independently assessed trial of the Ring UPM total hip replacement showed that the quality of the early result was better if the femoral prosthesis was cemented than if it was not. More patients with cemented prostheses were painfree at four months (58% cemented:42% uncemented) and at one year (63% cemented:50% uncemented), but at two years pain relief was equal in both groups. At two years significantly more patients with cemented prostheses could walk without support (96% cemented:62% uncemented, p = 0.01 to 0.05). There is a need for more similar trials to compare the results of contemporary designs of cemented and uncemented total hip prostheses

We have reviewed 29 patients (30 hips) who had undergone revision total hip arthroplasty using a Freeman metal-backed acetabular component and acetabular impaction allografting. The mean follow-up was for 15.3 years (12 to 17). Five patients (5 hips) died with the prosthesis in situ and four (4 hips) were lost to follow-up. Twelve hips had failed and in the remaining nine there were minor symptoms. The mean time to failure requiring further surgery was nine years. Excluding patients who were lost to follow-up or had died, 72% of the hips were radiologically loose at the last review. The commonest pattern in those requiring revision was failure of the reinforcement ring in adduction with remodelling of the medial wall. Of the nine patients who had not undergone revision, one with bilateral replacements had no current radiographs and only three of the remaining seven replacements had no radiological signs of loosening. The short-term results for this technique have been reported to be satisfactory, but in the long term they are not. The factors associated with failure include the design of the prosthesis, which has been implicated in disappointing long-term results when used in primary arthroplasty, but not with the frequency of failure found in this series. It seems that the reliance on peripheral screw fixation over a bed of allograft without bridging the graft does not provide sufficient stability to allow incorporation of the graft

Before proceeding to longer-term studies, we have studied the early clinical results of a new mobile-bearing total knee prosthesis in comparison with an established fixed-bearing device. Patients requiring bilateral knee replacement consented to have their operations under one anaesthetic using one of each prosthesis. They also agreed to accept the random choice of knee (right or left) and to remain ignorant as to which side had which implant. Outcomes were measured using the American Knee Society Score (AKSS), the Oxford Knee Score (OKS), and determination of the range of movement and pain scores before and at one year after operation. Preoperatively, there was no systematic difference between the right and left knees. One patient died in the perioperative period and one mobile-bearing prosthesis required early revision for dislocation of the meniscal component. At one year the mean AKSS, OKS and pain scores for the new device were slightly better (p < 0.025) than those for the fixed-bearing device. There was no difference in the range of movement. We believe that this is the first controlled, blinded trial to compare early function of a new knee prosthesis with that of a standard implant. It demonstrates a small but significant clinical advantage for the mobile-bearing design

A reversed Delta III total shoulder prosthesis was retrieved post-mortem, eight months after implantation. A significant notch was evident at the inferior pole of the scapular neck which extended beyond the inferior fixation screw. This bone loss was associated with a corresponding, erosive defect of the polyethylene cup. Histological examination revealed a chronic foreign-body reaction in the joint capsule. There were, however, no histological signs of loosening of the glenoid base plate and the stability of the prosthetic articulation was only slightly reduced by the eroded rim of the cup

We undertook a study on eight arms from fresh cadavers to define the clinical usefulness of the lesser sigmoid notch as a landmark when reconstructing the length of the neck of the radius in replacement of the head with a prosthesis. The head was resected and its height measured, along with several control measurements. This was compared with in situ measurements from the stump of the neck to the proximal edge of the lesser sigmoid notch of the ulna. All the measurements were performed three times by three observers acting independently. The results were highly reproducible with intra- and interclass correlations of > 0.99. The mean difference between the measurement on the excised head and the distance from the stump of the neck and the lesser sigmoid notch was −0.02 mm (−1.24 to +0.97). This difference was not statistically significant (p = 0.78). The proximal edge of the lesser sigmoid notch provides a reliable landmark for positioning a replacement of the radial head and may have clinical application

We report the clinical and operative details of seven cases of fracture of the femoral stem of the Ring TiMESH cementless hip prosthesis (two were cemented and five uncemented). Six fractures occurred in the proximal one-third of the stem and one at mid-stem. The failures are attributed mainly to two defects in stem design, the narrowness of the anteroposterior dimensions and the depth of the recess for the titanium mesh pads. Great difficulty was experienced in removing the osseo-integrated distal fragments of the broken stems

The case histories of 361 subcapital fractures of the femoral neck in 354 patients treated by primary replacement with the cemented Thompson prosthesis were reviewed, and 156 survivors were seen at follow-up. The average age was eighty-one years. Three hundred and thirty fractures occurred in women and thirty-one in men. The antero-lateral approach to the hip was used at all operations because it allows immediate and unrestricted mobilisation after operation. It is considered that this method is the best treatment in the rehabilitation of elderly patients after high femoral neck fractures, because of its low morbidity and high success rate in returning the geriatric orthopaedic patient to independence. The results after an average of just over three years were available for 161 hips in 156 patients studied at follow-up. Of these, 132 (82 per cent) were satisfactory. Most of the unsatisfactory results were in patients under seventy-five years of age. Out of the whole group of 361 hips treated the important early complications were wound infections in seventeen hips 4-7 per cent), all of which resolved, and dislocation in seven hips (2 per cent). Forty-six patients (12-9 per cent) died during the first four weeks after operation, their average age being eighty-five. One hundred and seventy-one patients (47-4 per cent) were discharged from hospital within under four weeks of the operation. Acetabular erosion and loosening are shown to be the important later complications. Three patients had late sepsis

It has been shown by mechanical analysis that by using cement to bond the stem of a femoral head prosthesis to bone two advantages are obtained when the conditions are compared with conventional methods. 1. "Fretting" between the implant and the living bone is eliminated. This source of persistent relative movement is probably the most important starting point for the progressive loosening of weight-bearing implants. 2. When cement is used the bond with the bone is exposed to stresses which are of an order three hundred times less than the shear strength of bone. The conventional prostheses expose the bond to compressive stresses which are near to the failure limits of the compressive strength of bone, especially in elderly patients with atrophic cortical bone in the femoral neck

This paper reports a singular case of pathological fracture through a large osteolytic lesion of the mid-femur consequent on reaction to a hip prosthesis. Not only metal particles but also polyethylene fibres were found at this site, some 15 cm from the prosthesis. The case sheds an interesting light on the reaction to prostheses

The indications for reverse shoulder arthroplasty (RSA) continue to be expanded. Associated impairment of the deltoid muscle has been considered a contraindication to its use, as function of the RSA depends on the deltoid and impairment of the deltoid may increase the risk of dislocation. The aim of this retrospective study was to determine the functional outcome and risk of dislocation following the use of an RSA in patients with impaired deltoid function. Between 1999 and 2010, 49 patients (49 shoulders) with impairment of the deltoid underwent RSA and were reviewed at a mean of 38 months (12 to 142) post-operatively. There were nine post-operative complications (18%), including two dislocations. The mean forward elevation improved from 50° (sd 38; 0° to 150°) pre-operatively to 121° (sd 40; 0° to 170°) at final follow-up (p < 0.001). The mean Constant score improved from 24 (sd 12; 2 to 51) to 58 (sd 17; 16 to 83) (p < 0.001). The mean Single Assessment Numeric Evaluation score was 71 (sd 17; 10 to 95) and the rate of patient satisfaction was 98% (48 of 49) at final follow-up.

These results suggest that pre-operative deltoid impairment, in certain circumstances, is not an absolute contraindication to RSA. This form of treatment can yield reliable improvement in function without excessive risk of post-operative dislocation.

Cite this article: Bone Joint J 2013;95-B:1106–13.

The results of thirty-one Manchester knee arthroplasties performed on twenty-eight patients are reviewed. There were sixteen patients with rheumatoid arthritis all of whom were satisfactory at the time of follow-up. Of the fifteen patients with osteoarthritis over half the arthroplasties failed after between twelve and thirty-six months. We suggest that resurfacing arthroplasty of the knee using the Manchester prosthesis should be used only for rheumatoid patients

Aims

The aim of this study was to evaluate blood metal ion levels, leucocyte profiles, and serum cytokines in patients with a total hip arthroplasty (THA) involving modular dual-mobility components.

1. A lateral intermuscular approach to the hip joint is described for replacement of the head of the femur by a prosthesis. 2. Advantages claimed for it are that it is attended by little or no shock, because the operation is rapid and relatively bloodless; that adequate exposure can be gained without dividing muscle or tendon; and that muscle function is unimpaired and so walking can be allowed early. The exposure is easily extended if unexpected difficulty is encountered. 3. Prosthetic replacement of the femoral head through this incision is advocated as a primary measure for elderly or unfit patients with fractured femoral neck

Arthrodesis after the removal of a knee prosthesis is often hampered by the small area of contact of the bony surfaces and by pre-existing infection. Conventional systems of external fixation and compression frequently fail to achieve stability but the addition of the Wagner leg-lengthening apparatus applied anteriorly and adjusted to give compression ensures rigid external fixation. Four knees in four patients were treated using this technique; the treatment followed the removal of infected prostheses in three knees and painful fibrous ankylosis after the removal of the prosthesis in the other. All obtained a sound arthrodesis