Our aim was to evaluate the radiographic characteristics of patients
undergoing total hip arthroplasty (THA) for the potential of posterior
bony impingement using CT simulations. Virtual CT data from 112 patients who underwent THA were analysed.
There were 40 men and 72 women. Their mean age was 59.1 years (41
to 76). Associations between radiographic characteristics and posterior
bony impingement and the range of external rotation of the hip were
evaluated. In addition, we investigated the effects of pelvic tilt
and the neck/shaft angle and femoral offset on posterior bony impingement.Aims
Patients and Methods
The mucopolysaccharidoses (MPS) are a group of
inherited lysosomal storage disorders with clinical manifestations relevant
to the orthopaedic surgeon. Our aim was to review the recent advances
in their management and the implications for surgical practice. The current literature about MPSs is summarised, emphasising
orthopaedic complications and their management. Recent advances in the diagnosis and management of MPSs include
the recognition of slowly progressive, late presenting subtypes,
developments in life-prolonging systemic treatment and potentially
new indications for surgical treatment. The outcomes of surgery
in these patients are not yet validated and some procedures have
a high rate of complications which differ from those in patients
who do not have a MPS. The diagnosis of a MPS should be considered in adolescents or
young adults with a previously unrecognised dysplasia of the hip.
Surgeons treating patients with a MPS should report their experience
and studies should include the assessment of function and quality
of life to guide treatment. Cite this article:
The purpose of the present study was to evaluate the impact of
intravenous tranexamic acid on the reduction of blood loss, transfusion
rate, and early post-operative clinical outcome in total shoulder
arthroplasty. A randomised, placebo-controlled trial which included 54 patients
undergoing unilateral primary stemless anatomical or stemmed reverse
total shoulder arthroplasty was undertaken. Patients received either
100 ml saline (placebo, n = 27), or 100 ml saline together with
1000 mg of tranexamic acid (TXA, n = 27) intravenously prior to
skin incision and during wound closure. Peri-operative blood loss
via an intra-articular drain was recorded and total blood loss was
calculated. The post-operative transfusion rate was documented.
Assessment of early clinical parameters included the visual analogue
scale for pain (VAS), documentation of haematoma formation and adverse events.Aims
Patients and Methods
The purpose of this study was to assess early physical function
after total hip or knee arthroplasty (THA/TKA), and the correlation
between patient-reported outcome measures, physical performance
and actual physical activity (measured by actigraphy). A total of 80 patients aged 55 to 80 years undergoing THA or
TKA for osteoarthritis were included in this prospective cohort
study. The main outcome measure was change in patient reported hip
or knee injury and osteoarthritis outcome score (HOOS/KOOS) from
pre-operatively until post-operative day 13 (THA) or 20 (TKA). Secondary measures
were correlations to objectively assessed change in physical performance
(paced-walk, chair-stand, stair-climb tests) at day 14 (THA) or
21 (TKA) and actual physical activity (actigraphy) measured at day
12 and 13 (THA) or 19 and 20 (TKA). Aims
Patients and Methods
The high revision rates of the DePuy Articular Surface Replacement (ASR) and the DePuy ASR XL (the total hip arthroplasty (THA) version) have led to questions over the viability of metal-on-metal (MoM) hip joints. Some designs of MoM hip joint do, however, have reasonable mid-term performance when implanted in appropriate patients. Investigations into the reasons for implant failure are important to offer help with the choice of implants and direction for future implant designs. One way to assess the performance of explanted hip prostheses is to measure the wear (in terms of material loss) on the joint surfaces. In this study, a coordinate measuring machine (CMM) was used to measure the wear on five failed cementless Biomet Magnum/ReCap/ Taperloc large head MoM THAs, along with one Biomet ReCap resurfacing joint. Surface roughness measurements were also taken. The reason for revision of these implants was pain and/or adverse reaction to metal debris (ARMD) and/or elevated blood metal ion levels.Objectives
Methods
To assess the responsiveness and ceiling/floor effects of the Forgotten Joint Score -12 and to compare these with that of the more widely used Oxford Hip Score (OHS) in patients six and 12 months after primary total hip arthroplasty. We prospectively collected data at six and 12 months following total hip arthroplasty from 193 patients undergoing surgery at a single centre. Ceiling effects are outlined with frequencies for patients obtaining the lowest or highest possible score. Change over time from six months to 12 months post-surgery is reported as effect size (Cohen’s d).Objectives
Methods
Fractures of the distal femur can be challenging to manage and
are on the increase in the elderly osteoporotic population. Management
with casting or bracing can unacceptably limit a patient’s ability
to bear weight, but historically, operative fixation has been associated
with a high rate of re-operation. In this study, we describe the outcomes
of fixation using modern implants within a strategy of early return
to function. All patients treated at our centre with lateral distal femoral
locking plates (LDFLP) between 2009 and 2014 were identified. Fracture
classification and operative information including weight-bearing
status, rates of union, re-operation, failure of implants and mortality
rate, were recorded.Aims
Patients and Methods
Studies reporting specifically on squeaking in total hip arthroplasty have focused on cementless, and not on hybrid, fixation. We hypothesised that the cement mantle of the femur might have a damping effect on the sound transmitted through the metal stem. The objective of this study was to test the effect of cement on sound propagation along different stem designs and under different fixation conditions. An Objectives
Methods
Recently, the use of metal-on-metal articulations
in total hip arthroplasty (THA) has led to an increase in adverse
events owing to local soft-tissue reactions from metal ions and
wear debris. While the majority of these implants perform well,
it has been increasingly recognised that a small proportion of patients
may develop complications secondary to systemic cobalt toxicity
when these implants fail. However, distinguishing true toxicity
from benign elevations in cobalt ion levels can be challenging. The purpose of this two part series is to review the use of cobalt
alloys in THA and to highlight the following related topics of interest:
mechanisms of cobalt ion release and their measurement, definitions
of pathological cobalt ion levels, and the pathophysiology, risk factors
and treatment of cobalt toxicity. Historically, these metal-on-metal
arthroplasties are composed of a chromium-cobalt articulation. The release of cobalt is due to the mechanical and oxidative
stresses placed on the prosthetic joint. It exerts its pathological
effects through direct cellular toxicity. This manuscript will highlight the pathophysiology of cobalt
toxicity in patients with metal-on-metal hip arthroplasties. Take home message: Patients with new or evolving hip symptoms
with a prior history of THA warrant orthopaedic surgical evaluation.
Increased awareness of the range of systemic symptoms associated
with cobalt toxicity, coupled with prompt orthopaedic intervention, may
forestall the development of further complications. Cite this article:
Static radiostereometric analysis (RSA) using implanted markers is considered the most accurate system for the evaluation of prosthesis migration. By using CT bone models instead of markers, combined with a dynamic RSA system, a non-invasive measurement of joint movement is enabled. This method is more accurate than current 3D skin marker-based tracking systems. The purpose of this study was to evaluate the accuracy of the CT model method for measuring knee joint kinematics in static and dynamic RSA using the marker method as the benchmark. Bone models were created from CT scans, and tantalum beads were implanted into the tibia and femur of eight human cadaver knees. Each specimen was secured in a fixture, static and dynamic stereoradiographs were recorded, and the bone models and marker models were fitted to the stereoradiographs.Objectives
Methods
Compared with primary total hip arthroplasty (THA), revision
surgery can be challenging. The cement-in-cement femoral revision
technique involves removing a femoral component from a well-fixed
femoral cement mantle and cementing a new stem into the original
mantle. This technique is widely used and when carried out for the
correct indications, is fast, relatively inexpensive and carries
a reduced short-term risk for the patient compared with the alternative
of removing well-fixed cement. We report the outcomes of this procedure
when two commonly used femoral stems are used. We identified 1179 cement-in-cement stem revisions involving
an Exeter or a Lubinus stem reported to the Swedish Hip Arthroplasty
Register (SHAR) between January 1999 and December 2015. Kaplan-Meier
survival analysis was performed.Aims
Patients and Methods
The use of ceramic femoral heads in total hip arthroplasty (THA) has increased due to their proven low bearing wear characteristics. Ceramic femoral heads are also thought to reduce wear and corrosion at the head-stem junction with titanium (Ti) stems when compared with metal heads. We sought to evaluate taper damage of ceramic compared with metal heads when paired with cobalt chromium (CoCr) alloy stems in a single stem design. This retrieval study involved 48 total hip arthroplasties (THAs) with CoCr V40 trunnions paired with either CoCr (n = 21) or ceramic (n = 27) heads. The taper junction of all hips was evaluated for fretting/corrosion damage and volumetric material loss using a roundness-measuring machine. We used linear regression analysis to investigate taper damage differences after adjusting for potential confounding variables.Objectives
Methods
Implant-related infection is one of the most devastating complications in orthopaedic surgery. Many surface and/or material modifications have been developed in order to minimise this problem; however, most of the We describe a method for the study of bacterial adherence in the presence of preosteoblastic cells. For this purpose we mixed different concentrations of bacterial cells from collection and clinical strains of staphylococci isolated from implant-related infections with preosteoblastic cells, and analysed the minimal concentration of bacteria able to colonise the surface of the material with image analysis.Objectives
Methods
Older patients with multiple medical co-morbidities
are increasingly being offered and undergoing total joint arthroplasty
(TJA). These patients are more likely to require intensive care
support, following surgery. We prospectively evaluated the need
for intensive care admission and intervention in a consecutive series
of 738 patients undergoing elective hip and knee arthroplasty procedures.
The mean age was 60.6 years (18 to 91; 440 women, 298 men. Risk
factors, correlating with the need for critical care intervention,
according to published guidelines, were analysed to identify high-risk
patients who would benefit from post-operative critical care monitoring.
A total of 50 patients (6.7%) in our series required critical care
level interventions during their hospital stay. Six independent
multivariate clinical predictors were identified (p <
0.001)
including a history of congestive heart failure (odds ratio (OR)
24.26, 95% confidence interval (CI) 9.51 to 61.91), estimated blood
loss >
1000 mL (OR 17.36, 95% CI 5.36 to 56.19), chronic obstructive
pulmonary disease (13.90, 95% CI 4.78 to 40.36), intra-operative
use of vasopressors (OR 8.10, 95% CI 3.23 to 20.27), revision hip
arthroplasty (OR 2.71, 95% CI 1.04 to 7.04) and body mass index
>
35 kg/m2 (OR 2.70, 95% CI 123 to 5.94). The model was
then validated against an independent, previously published data
set of 1594 consecutive patients. The use of this risk stratification
model can be helpful in predicting which high-risk patients would
benefit from a higher level of monitoring and care after elective
TJA and aid hospitals in allocating precious critical care resources. Cite this article:
