The aim of this systematic review was to report the rate of dislocation
following the use of dual mobility (DM) acetabular components in
primary and revision total hip arthroplasty (THA). A systematic review of the literature according to the Preferred
Reporting Items for Systematic Reviews and Meta-analyses guidelines
was performed. A comprehensive search of Pubmed/Medline, Cochrane
Library and Embase (Scopus) was conducted for English articles between
January 1974 and March 2016 using various combinations of the keywords “dual
mobility”, “dual-mobility”, “tripolar”, “double-mobility”, “double
mobility”, “hip”, “cup”, “socket”. The following data were extracted
by two investigators independently: demographics, whether the operation
was a primary or revision THA, length of follow-up, the design of
the components, diameter of the femoral head, and type of fixation
of the acetabular component.Aims
Materials and Methods
Ceramic-on-ceramic (CoC) bearings in total hip arthroplasty (THA)
are commonly used, but concerns exist regarding ceramic fracture.
This study aims to report the risk of revision for fracture of modern
CoC bearings and identify factors that might influence this risk,
using data from the National Joint Registry (NJR) for England, Wales, Northern
Ireland and the Isle of Man. We analysed data on 223 362 bearings from 111 681 primary CoC
THAs and 182 linked revisions for bearing fracture recorded in the
NJR. We used implant codes to identify ceramic bearing composition
and generated Kaplan-Meier estimates for implant survivorship. Logistic
regression analyses were performed for implant size and patient specific
variables to determine any associated risks for revision.Aims
Patients and Methods
Tibiofemoral alignment is important to determine the rate of
progression of osteoarthritis and implant survival after total knee
arthroplasty (TKA). Normally, surgeons aim for neutral tibiofemoral
alignment following TKA, but this has been questioned in recent
years. The aim of this study was to evaluate whether varus or valgus
alignment indeed leads to increased medial or lateral tibiofemoral
forces during static and dynamic weight-bearing activities. Tibiofemoral contact forces and moments were measured in nine
patients with instrumented knee implants. Medial force ratios were
analysed during nine daily activities, including activities with
single-limb support (e.g. walking) and double-limb support (e.g.
knee bend). Hip-knee-ankle angles in the frontal plane were analysed
using full-leg coronal radiographs. Aims
Patients and Methods
The intra-articular administration of tranexamic acid (TXA) has
been shown to be effective in reducing blood loss in unicompartmental
knee arthroplasty and anterior cruciate reconstruction. The effects
on human articular cartilage, however, remains unknown. Our aim,
in this study, was to investigate any detrimental effect of TXA
on chondrocytes, and to establish if there was a safe dose for its
use in clinical practice. The hypothesis was that TXA would cause
a dose-dependent damage to human articular cartilage. The cellular morphology, adhesion, metabolic activity, and viability
of human chondrocytes when increasing the concentration (0 mg/ml
to 40 mg/ml) and length of exposure to TXA (0 to 12 hours) were
analyzed in a 2D model. This was then repeated, excluding cellular
adhesion, in a 3D model and confirmed in viable samples of articular cartilage.Aims
Materials and Methods
To determine the outcomes following revision surgery of metal-on-metal
hip arthroplasties (MoMHA) performed for adverse reactions to metal
debris (ARMD), and to identify factors predictive of re-revision. We performed a retrospective observational study using National
Joint Registry (NJR) data on 2535 MoMHAs undergoing revision surgery
for ARMD between 2008 and 2014. The outcomes studied following revision were
intra-operative complications, mortality and re-revision surgery.
Predictors of re-revision were identified using competing-risk regression
modelling.Aims
Patients and Methods
We report on the outcome of the Synergy cementless femoral stem
with a minimum follow-up of 15 years (15 to 17). A retrospective review was undertaken of a consecutive series
of 112 routine primary cementless total hip arthroplasties (THAs)
in 102 patients (112 hips). There were 60 female and 42 male patients
with a mean age of 61 years (18 to 82) at the time of surgery. A
total of 78 hips in the 69 patients remain Aims
Patients and Methods
Few studies have assessed outcomes following non-metal-on-metal hip arthroplasty (non-MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD). We assessed outcomes following non-MoMHA revision surgery performed for ARMD, and identified predictors of re-revision. We performed a retrospective observational study using data from the National Joint Registry for England and Wales. All non-MoMHAs undergoing revision surgery for ARMD between 2008 and 2014 were included (185 hips in 185 patients). Outcome measures following ARMD revision were intra-operative complications, mortality and re-revision surgery. Predictors of re-revision were identified using Cox regression.Objectives
Methods
Few reconstructive techniques are available for patients requiring
complex acetabular revisions such as those involving Paprosky type
2C, 3A and 3B deficiencies and pelvic discontinuity. Our aim was
to describe the development of the patient specific Triflange acetabular
component for use in these patients, the surgical technique and
mid-term results. We include a description of the pre-operative
CT scanning, the construction of a model, operative planning, and
surgical technique. All implants were coated with porous plasma
spray and hydroxyapatite if desired. A multicentre, retrospective review of 95 complex acetabular
reconstructions in 94 patients was performed. A total of 61 (64.2%)
were female. The mean age of the patients was 66 (38 to 85). The
mean body mass index was 29 kg/m2 (18 to 51). Outcome
was reported using the Harris Hip Score (HHS), complications, failures
and survival.Aims
Patients and Methods
Femoral stems with exchangeable (modular) necks were introduced
to offer surgeons an increased choice when determining the version,
offset and length of the femoral neck during total hip arthroplasty
(THA). It was hoped that this would improve outcomes and reduce
complications, particularly dislocation. In 2010, the Australian Orthopaedic
Association National Joint Replacement Registry (AOANJRR) first
reported an increased rate of revision after primary THA using femoral
stems with an exchangeable neck. The aim of this study was to provide
a more comprehensive up-to-date analysis of primary THA using femoral
stems with exchangeable and fixed necks. The data included all primary THA procedures performed for osteoarthritis
(OA), reported to the AOANJRR between 01 September 1999 and 31 December
2014. There were 9289 femoral stems with an exchangeable neck and
253 165 femoral stems with a fixed neck. The characteristics of
the patients and prostheses including the bearing surface and stem/neck
metal combinations were examined using Cox proportional hazard ratios
(HRs) and Kaplan-Meier estimates of survivorship. Aims
Materials and Methods
The number of arthroplasties of the hip and knee
is predicted to increase rapidly during the next 20 years. Accompanying
this is the dilemma of how to follow-up these patients appropriately.
Current guidelines recommend long-term follow-up to identify patients
with aseptic loosening, which can occur more than a decade postoperatively.
The current guidelines and practices of orthopaedic surgeons vary
widely. Existing models take up much clinical time and are expensive.
Pilot studies using ‘virtual’ clinics and advanced-practice physiotherapists
have shown promise in decreasing the time and costs for orthopaedic surgeons
and patients. This review discusses current practices and future trends in
the follow-up of patients who have an arthroplasty. Cite this article:
The outcome of total knee arthroplasty (TKA) is not always satisfactory.
The purpose of this study was to identify satisfaction and biomechanical
features characterising the gait of patients who had undergone TKA
with either an anatomical single radius design or a medial pivot
design. We hypothesised that the latter would provide superior function. This is a study of a subset of patients recruited into a prospective
randomised study of a single radius design Aims
Patients and Methods
The aim of this study was to compare the post-operative radiographic
and clinical outcomes between kinematically and mechanically aligned
total knee arthroplasties (TKAs). A total of 60 TKAs (30 kinematically and 30 mechanically aligned)
were performed in 60 patients with varus osteoarthritis of the knee
using a navigation system. The angles of orientation of the joint
line in relation to the floor, the conventional and true mechanical
axis (tMA) (the line from the centre of the hip to the lowest point
of the calcaneus) were compared, one year post-operatively, on single-leg
and double-leg standing long leg radiographs between the groups.
The range of movement and 2011 Knee Society Scores were also compared
between the groups at that time.Aims
Patients and Methods
Patients with neuromuscular imbalance who require
total hip arthroplasty (THA) present particular technical problems
due to altered anatomy, abnormal bone stock, muscular imbalance
and problems of rehabilitation. In this systematic review, we studied articles dealing with THA
in patients with neuromuscular imbalance, published before April
2017. We recorded the demographics of the patients and the type
of neuromuscular pathology, the indication for surgery, surgical
approach, concomitant soft-tissue releases, the type of implant
and bearing, pain and functional outcome as well as complications
and survival. Recent advances in THA technology allow for successful outcomes
in these patients. Our review suggests excellent benefits for pain
relief and good functional outcome might be expected with a modest
risk of complication. Cite this article:
The aim of this study was to determine whether patients with
metal-on-metal (MoM) arthroplasties of the hip have an increased
risk of cardiac failure compared with those with alternative types
of arthroplasties (non-MoM). A linkage study between the National Joint Registry, Hospital
Episodes Statistics and records of the Office for National Statistics
on deaths was undertaken. Patients who underwent elective total
hip arthroplasty between January 2003 and December 2014 with no
past history of cardiac failure were included and stratified as
having either a MoM (n = 53 529) or a non-MoM (n = 482 247) arthroplasty.
The primary outcome measure was the time to an admission to hospital
for cardiac failure or death. Analysis was carried out using data
from all patients and from those matched by propensity score.Aims
Patients and Methods
Little biomechanical information is available about kinematically aligned (KA) total knee arthroplasty (TKA). The purpose of this study was to simulate the kinematics and kinetics after KA TKA and mechanically aligned (MA) TKA with four different limb alignments. Bone models were constructed from one volunteer (normal) and three patients with three different knee deformities (slight, moderate and severe varus). A dynamic musculoskeletal modelling system was used to analyse the kinematics and the tibiofemoral contact force. The contact stress on the tibial insert, and the stress to the resection surface and medial tibial cortex were examined by using finite element analysis.Objectives
Materials and Methods
