Biofilm formation is intrinsic to prosthetic joint infection (PJI). In the current study, we evaluated the effects of silver-containing hydroxyapatite (Ag-HA) coating and vancomycin (VCM) on methicillin-resistant Pure titanium discs (Ti discs), Ti discs coated with HA (HA discs), and 3% Ag-HA discs developed using a thermal spraying were inoculated with MRSA suspensions containing a mean in vitro 4.3 (SD 0.8) x 106 or 43.0 (SD 8.4) x 105 colony-forming units (CFUs). Immediately after MRSA inoculation, sterile phosphate-buffered saline or VCM (20 µg/ml) was added, and the discs were incubated for 24 hours at 37°C. Viable cell counting, 3D confocal laser scanning microscopy with Airyscan, and scanning electron microscopy were then performed. HA discs and Ag HA discs were implanted subcutaneously in vivo in the dorsum of rats, and MRSA suspensions containing a mean in vivo 7.2 (SD 0.4) x 106 or 72.0 (SD 4.2) x 105 CFUs were inoculated on the discs. VCM was injected subcutaneously daily every 12 hours followed by viable cell counting.Aims
Methods
The early diagnosis of aseptic
We reviewed 120 consecutive primary total hip replacements in 109 patients in whom a Freeman uncemented metal-backed component had been used. Acetabular components were used with a Freeman neck-retaining stem in one of three configurations: cemented smooth stem, uncemented smooth stem or uncemented ridged stem. After a mean follow up of 72 months (62 to 113) there were nine cases of aseptic
Mechanical alignment has been a fundamental tenet of total knee arthroplasty (TKA) since modern knee replacement surgery was developed in the 1970s. The objective of mechanical alignment was to infer the greatest biomechanical advantage to the implant to prevent early
In 2012 we reviewed a consecutive series of 92
uncemented THRs performed between 1986 and 1991 at our institution
using the CLS Spotorno stem, in order to assess clinical outcome
and radiographic data at a minimum of 21 years. The series comprised
92 patients with a mean age at surgery of 59.6 years (39 to 77)
(M:F 43;49). At the time of this review, seven (7.6%) patients had died and
two (2.2%) were lost to follow-up. The 23-year Kaplan–Meier survival
rates were 91.5% (95% confidence intervals (CI) 85.4% to 97.6%;
55 hips at risk) and 80.3% (95% CI, 71.8% to 88.7%; 48 hips at risk)
respectively, with revision of the femoral stem or of any component
as endpoints. At the time of this review, 76 patients without stem
revision were assessed clinically and radiologically (mean follow-up
24.0 years (21.5 to 26.5)). For the 76 unrevised hips the mean Harris
hip score was 87.1 (65 to 97). Femoral osteolysis was detected in
five hips (6.6%) only in Gruen zone 7. Undersized stems were at
higher risk of revision owing to aseptic
We report a multicentre prospective consecutive
study assessing the long-term outcome of the proximally hydroxyapatite
(HA)-coated ABG II monobloc femoral component in a series of 1148
hips in 1053 patients with a mean age at surgery of 64.77 years
(22 to 80) at a mean follow-up of 10.84 years (10 to 15.25). At
latest follow-up, the mean total Harris hip score was 94.7 points
(. sd. ; 6.87; 49 to 100), and the mean Merle d’Aubigné–Postel
score was 17.6 points (. sd. 1.12; 7 to 18). The mean total
Engh radiological score score was 21.54
(. sd. 5.77; 3.5 to 27), with 95.81% of ‘confirmed ingrowth’,
according to Engh’s classification. With aseptic
Review of the radiographs of 882 consecutive metal-to-polyethylene hip replacements after a mean follow-up of 6.8 years showed 72 cases (8%) of aseptic femoral
Complex displaced osteoporotic acetabular fractures in the elderly are associated with high levels of morbidity and mortality. Surgical options include either open reduction and internal fixation alone, or combined with total hip arthroplasty (THA). There remains a cohort of severely comorbid patients who are deemed unfit for extensive surgical reconstruction and are treated conservatively. We describe the results of a coned hemipelvis reconstruction and THA inserted via a posterior approach to the hip as the primary treatment for this severely high-risk cohort. We have prospectively monitored a series of 22 cases (21 patients) with a mean follow-up of 32 months (13 to 59).Aims
Methods
We made a retrospective study of 55 primary total hip arthroplasties in 53 patients with a history of previous acetabular fracture. The mean follow-up was 7.5 years and the average age at fracture was 48.7 years. The incidence of radiographic femoral
We reviewed at a minimum elapsed time of five years a consecutive series of 143 primary Exeter hip replacements in which matt-surfaced femoral stems had been used. Twenty-five patients had died and six stems and two sockets had been revised before follow-up. The remaining 110 hips were all examined clinically and radiographically. In 15 hips there were radiographic signs of definite
We have implanted 76 biaxial total wrist prostheses as a primary procedure in patients with rheumatoid arthritis of the wrist. A total of 66 was reviewed at a mean follow-up time of 52 months. Pain was relieved in 67% of the surviving wrist replacements. On the basis of the Hospital for Special Surgery scoring system, 49 wrists (74%) were graded as fair to excellent. More than half of the 27 patients who had an arthrodesis on the contralateral wrist would have preferred a second arthroplasty. Five replacements were revised or fused because of
Patellofemoral complications are common after
total knee replacement (TKR). Leaving the patellar unsurfaced after
TKR may lead to complications such as anterior knee pain, and re-operation
to surface it. Complications after patellar resurfacing include
patellar fracture, aseptic
We report on 397 consecutive revision total hip
replacements in 371 patients with a mean clinical and radiological follow-up
of 12.9 years (10 to 17.7). The mean age at surgery was 69 years
(37 to 93). A total of 28 patients (8%) underwent further revision,
including 16 (4%) femoral components. In all 223 patients (56%,
233 hips) died without further revision and 20 patients (5%, 20
hips) were lost to follow-up. Of the remaining patients, 209 (221
hips) were available for clinical assessment and 194 (205 hips)
for radiological review at mean follow-up of 12.9 years (10 to 17.7). The mean Harris Hip Score improved from 58.7 (11 to 92) points
to 80.7 (21 to 100) (p <
0.001) and the mean Merle d’Aubigné and
Postel hip scores at final follow-up were 4.9 (2 to 6), 4.5 (2 to
6) and 4.3 (2 to 6), respectively for pain, mobility and function.
Radiographs showed no lucencies around 186 (90.7%) femoral stems
with stable bony ingrowth seen in 199 stems (97%). The survival
of the S-ROM femoral stem at 15 years with revision for any reason as
the endpoint was 90.5% (95% confidence interval (CI) 85.7 to 93.8)
and with revision for aseptic
We evaluated the clinical results and complications
after extra-articular resection of the distal femur and/or proximal
tibia and reconstruction with a tumour endoprosthesis (MUTARS) in
59 patients (mean age 33 years (11 to 74)) with malignant bone or
soft-tissue tumours. According to a Kaplan–Meier analysis, limb
survival was 76% (95% confidence interval (CI) 64.1 to 88.5) after
a mean follow-up of 4.7 years (one month to 17 years). Peri-prosthetic infection
was the most common indication for subsequent amputation (eight
patients). Survival of the prosthesis without revision was 48% (95%
CI 34.8 to 62.0) at two years and 25% (95% CI 11.1 to 39.9) at five years
post-operatively. Failure of the prosthesis was due to deep infection
in 22 patients (37%), aseptic
Metaphyseal tritanium cones can be used to manage the tibial bone loss commonly encountered at revision total knee arthroplasty (rTKA). Tibial stems provide additional fixation and are generally used in combination with cones. The aim of this study was to examine the role of the stems in the overall stability of tibial implants when metaphyseal cones are used for rTKA. This computational study investigates whether stems are required to augment metaphyseal cones at rTKA. Three cemented stem scenarios (no stem, 50 mm stem, and 100 mm stem) were investigated with 10 mm-deep uncontained posterior and medial tibial defects using four loading scenarios designed to mimic activities of daily living.Aims
Methods