We wished to quantify the extent of soft-tissue damage sustained
during minimally invasive total hip arthroplasty through the direct
anterior (DA) and direct superior (DS) approaches. In eight cadavers, the DA approach was performed on one side,
and the DS approach on the other, a single brand of uncemented hip
prosthesis was implanted by two surgeons, considered expert in their
surgical approaches. Subsequent reflection of the gluteus maximus
allowed the extent of muscle and tendon damage to be measured and
the percentage damage to each anatomical structure to be calculated.Aims
Materials and Methods
The increased The proximal penetration of the femoral head five years post-operatively
was measured for 15 patients using radiostereometric analysis (RSA).Aims
Patients and Methods
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). 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.Aims
Patients and Methods
Our aim was to determine whether, based on the current literature,
bariatric surgery prior to total hip (THA) or total knee arthroplasty
(TKA) reduces the complication rates and improves the outcome following
arthroplasty in obese patients. A systematic literature search was undertaken of published and
unpublished databases on the 5 November 2015. All papers reporting
studies comparing obese patients who had undergone bariatric surgery
prior to arthroplasty, or not, were included. Each study was assessed
using the Downs and Black appraisal tool. A meta-analysis of risk ratios
(RR) and 95% confidence intervals (CI) was performed to determine
the incidence of complications including wound infection, deep vein
thrombosis (DVT), pulmonary embolism (PE), revision surgery and
mortality.Aims
Methods
The aims of this retrospective study were to report the feasibility
of using 3D-printing technology for patients with a pelvic tumour
who underwent reconstruction. A total of 35 patients underwent resection of a pelvic tumour
and reconstruction using 3D-printed endoprostheses between September
2013 and December 2015. According to Enneking’s classification of
bone defects, there were three Type I lesions, 12 Type II+III lesions,
five Type I+II lesions, two Type I+II+III lesions, ten type I+II+IV
lesions and three type I+II+III+IV lesions. A total of three patients
underwent reconstruction using an iliac prosthesis, 12 using a standard
hemipelvic prosthesis and 20 using a screw-rod connected hemipelvic
prosthesis.Aims
Patients and Methods
A possible solution for the management of proximal femoral bone
loss is a modular femoral endoprosthesis (EPR). Although the outcome
of EPRs in tumour surgery has been well described, the outcome of
their use in revision hip surgery has received less attention. The
aim of this study was to describe the outcome of using EPR for non-neoplastic
indications. A retrospective review of 79 patients who underwent 80 EPRs for
non-neoplastic indications was performed, including the rates of
complication and survival and the mean Oxford Hip Scores (OHS),
at a mean of five years post-operatively. The mean age at the time
of surgery was 69 years (28 to 93) and the mean number of previous operations
on the hip was 2.4 (0 to 17). The most common indications for EPR
implantation were periprosthetic joint infection (PJI) (n = 40),
periprosthetic fracture (n = 12) and failed osteosynthesis of a
proximal femoral fracture or complex trauma (n = 11).Objectives
Methods
Modular junctions are ubiquitous in contemporary hip arthroplasty. The head-trunnion junction is implicated in the failure of large diameter metal-on-metal (MoM) hips which are the currently the topic of one the largest legal actions in the history of orthopaedics (estimated costs are stated to exceed $4 billion). Several factors are known to influence the strength of these press-fit modular connections. However, the influence of different head sizes has not previously been investigated. The aim of the study was to establish whether the choice of head size influences the initial strength of the trunnion-head connection. Ti-6Al-4V trunnions (n = 60) and two different sizes of cobalt-chromium (Co-Cr) heads (28 mm and 36 mm; 30 of each size) were used in the study. Three different levels of assembly force were considered: 4 kN; 5 kN; and 6 kN (n = 10 each). The strength of the press-fit connection was subsequently evaluated by measuring the pull-off force required to break the connection. The statistical differences in pull-off force were examined using a Kruskal–Wallis test and two-sample Mann–Whitney U test. Finite element and analytical models were developed to understand the reasons for the experimentally observed differences.Objectives
Materials and Methods
We aimed to assess the comparability of data in joint replacement
registries and identify ways of improving the comparisons between
registries and the overall monitoring of joint replacement surgery. We conducted a review of registries that are full members of
the International Society of Arthroplasty Registries with publicly
available annual reports in English. Of the six registries which
were included, we compared the reporting of: mean age, definitions
for revision and re-operation, reasons for revision, the approach
to analysing revisions, and patient-reported outcome measures (PROMs)
for primary and revision total hip arthroplasty (THA) and hip resurfacing
arthroplasty (HRA).Aims
Materials and Methods
Periprosthetic fracture (PF) after primary total hip arthroplasty
(THA) is an uncommon but potentially devastating complication. This
study aims to investigate the influence of cemented stem designs
on the risk of needing a revision for a PF. We analysed data on 257 202 primary THAs with cemented stems
and 390 linked first revisions for PF recorded in the National Joint
Registry (NJR) of England, Wales and Northern Ireland to determine
if a cemented femoral stem brand was associated with the risk of
having revision for a PF after primary THA. All cemented femoral
stem brands with more than 10 000 primary operations recorded in
the NJR were identified. The four most commonly used cemented femoral
stems were the Exeter V40 (n = 146 409), CPT (n = 24 300), C-Stem
(n = 15 113) and Charnley (n = 20 182). We compared the revision risk ratios due to PF amongst the stems
using a Poisson regression model adjusting for patient factors.
Compared with the Exeter V40, the age, gender and ASA grade adjusted
revision rate ratio was 3.89 for the cemented CPT stem (95% confidence
interval (CI) 3.07 to 4.93), 0.89 for the C-Stem (95% CI 0.57 to
1.41) and 0.41 for the Charnley stem (95% CI 0.24 to 0.70).Aims
Patients and Methods
The last decade has seen a considerable increase
in the use of in total ankle arthroplasty (TAA) to treat patients
with end-stage arthritis of the ankle. However, the longevity of
the implants is still far from that of total knee and hip arthroplasties. The aim of this review is to outline a diagnostic and treatment
algorithm for the painful TAA to be used when considering revision
surgery. Cite this article:
Accurate placement of the acetabular component during total hip
arthroplasty (THA) is an important factor in the success of the
procedure. However, the reported accuracy varies greatly and is
dependent upon whether free hand or navigated techniques are used.
The aim of this study was to assess the accuracy of an instrument
system that incorporates 3D printed, patient-specific guides designed
to optimise the placement of the acetabular component. A total of 100 consecutive patients were prospectively enrolled
and the accuracy of placement of the acetabular component was measured
using post-operative CT scans.Aims
Patients and Methods
Tantalum (Ta) trabecular metal components are increasingly used
to reconstruct major bone defects in revision arthroplasty surgery.
It is known that some metals such as silver have antibacterial properties.
Recent reports have raised the question regarding whether Ta components
are protective against infection in revision surgery. This laboratory
study aimed to establish whether Ta has intrinsic antibacterial
properties against planktonic bacteria, or the ability to inhibit
biofilm formation. Equal-sized pieces of Ta and titanium (Ti) acetabular components
were sterilised and incubated with a low dose inoculum of either Aims
Materials and Methods
The widely used and well-proven Palacos R (a.k.a. Refobacin Palacos
R) bone cement is no longer commercially available and was superseded
by Refobacin bone cement R and Palacos R + G in 2005. However, the
performance of these newly introduced bone cements have not been
tested in a phased evidence-based manner, including roentgen stereophotogrammetric
analysis (RSA). In this blinded, randomised, clinical RSA study, the migration
of the Stanmore femoral component was compared between Refobacin
bone cement R and Palacos R + G in 62 consecutive total hip arthroplasties.
The primary outcome measure was femoral component migration measured
using RSA and secondary outcomes were Harris hip score (HHS), Hip
disability and Osteoarthritis Outcome Score (HOOS), EuroQol 5D (EQ-5D)
and Short Form 36 (SF-36).Aims
Patients and Methods
We sought to determine whether cobalt-chromium alloy (CoCr) femoral
stem tapers (trunnions) wear more than titanium (Ti) alloy stem
tapers (trunnions) when used in a large diameter (LD) metal-on-metal
(MoM) hip arthroplasty system. We performed explant analysis using validated methodology to
determine the volumetric material loss at the taper surfaces of
explanted LD CoCr MoM hip arthroplasties used with either a Ti alloy
(n = 28) or CoCr femoral stem (n = 21). Only 12/14 taper constructs
with a rough male taper surface and a nominal included angle close
to 5.666° were included. Multiple regression modelling was undertaken
using taper angle, taper roughness, bearing diameter (horizontal
lever arm) as independent variables. Material loss was mapped using
a coordinate measuring machine, profilometry and scanning electron
microscopy.Aims
Patients and Methods
We present a minimum 20-year follow-up study of 382 cemented
Exeter Universal total hip arthroplasties (350 patients) operated
on at a mean age of 66.3 years (17 to 94). All patients received the same design of femoral component, regardless
of the original diagnosis. Previous surgery had been undertaken
for 33 hips (8.6%). During the study period 218 patients with 236
hips (62%) died, 42 hips (11%) were revised and 110 hips (29%) in
96 patients were available for review. The acetabular components
were varied and some designs are now obsolete, however they were
all cemented.Aims
Patients and Methods
Given the increasing number of total hip arthroplasty
procedures being performed annually, it is imperative that orthopaedic
surgeons understand factors responsible for instability. In order
to treat this potentially complex problem, we recommend correctly
classifying the type of instability present based on component position, abductor
function, impingement, and polyethylene wear. Correct classification
allows the treating surgeon to choose the appropriate revision option
that ultimately will allow for the best potential outcome. Cite this article: