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
This paper describes the methodology, validation and reliability
of a new computer-assisted method which uses models of the patient’s
bones and the components to measure their migration and polyethylene
wear from radiographs after total hip arthroplasty (THA). Models of the patient’s acetabular and femoral component obtained
from the manufacturer and models of the patient’s pelvis and femur
built from a single computed tomography (CT) scan, are used by a
computer program to measure the migration of the components and
the penetration of the femoral head from anteroposterior and lateral radiographs
taken at follow-up visits. The program simulates the radiographic
setup and matches the position and orientation of the models to
outlines of the pelvis, the acetabular and femoral component, and
femur on radiographs. Changes in position and orientation reflect
the migration of the components and the penetration of the femoral
head. Validation was performed using radiographs of phantoms simulating
known migration and penetration, and the clinical feasibility of
measuring migration was assessed in two patients.Aims
Materials and Methods
The primary aim of this independent prospective randomised trial
was to compare serum metal ion levels for ceramic-on-metal (CoM)
and metal-on-metal (MoM) bearing surfaces in total hip arthroplasty
(THA). Our one-year results demonstrated elevation in metal ion
levels above baseline with no significant difference between the
CoM and MoM groups. This paper reviews the five-year data. The implants used in each patient differed only in respect to
the type of femoral head (ceramic or metal). At five-year follow-up
of the 83 enrolled patients, data from 67 (36 CoM, 31 MoM) was available
for comparison.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
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 determination of the volumetric polyethylene wear on explanted material requires complicated equipment, which is not available in many research institutions. Our aim in this study was to present and validate a method that only requires a set of polyetheretherketone balls and a laboratory balance to determine wear. The insert to be measured was placed on a balance, and a ball of the appropriate diameter was inserted. The cavity remaining between the ball and insert caused by wear was filled with contrast medium and the weight of the contrast medium was recorded. The volume was calculated from the known density of the liquid. The precision, inter- and intraobserver reliability, were determined by four investigators on four days using nine inserts with specified wear (0.094 ml to 1.626 ml), and the intra-class correlation coefficient was calculated. The feasibility of using this method in routine clinical practice and the time required for measurement were tested on 84 explanted inserts by one investigator.Objectives
Methods
To determine whether there is any association between glomerular
filtration rate (GFR) and blood cobalt (Co) and chromium (Cr) levels
in patients with metal-on-metal (MoM) hip arthroplasty. We identified 179 patients with a unilateral 36 mm diameter head
as part of a stemmed Summit-Pinnacle MoM hip arthroplasty. GFR was
calculated using the Modification of Diet in Renal Disease formula.Aims
Patients and Methods
The National Hip Fracture Database (NHFD) publishes hospital-level risk-adjusted mortality rates following hip fracture surgery in England, Wales and Northern Ireland. The performance of the risk model used by the NHFD was compared with the widely-used Nottingham Hip Fracture Score. Data from 94 hospitals on patients aged 60 to 110 who had hip fracture surgery between May 2013 and July 2013 were analysed. Data were linked to the Office for National Statistics (ONS) death register to calculate the 30-day mortality rate. Risk of death was predicted for each patient using the NHFD and Nottingham models in a development dataset using logistic regression to define the models’ coefficients. This was followed by testing the performance of these refined models in a second validation dataset.Objectives
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
The objective of this study was to assess all evidence comparing the Thompson monoblock hemiarthroplasty with modular unipolar implants for patients requiring hemiarthroplasty of the hip with respect to mortality and complications. A literature search was performed to identify all relevant literature. The population consisted of patients undergoing hemiarthroplasty of the hip for fracture. The intervention was hemiarthroplasty of the hip with a comparison between Thompson and modular unipolar prostheses. Pubmed, Embase, CINAHL, Web of Science, PROSPERO and the Cochrane Central Register of Controlled Trials. The study designs included were randomised controlled trials (RCTs), well designed case control studies and retrospective or prospective cohort studies. Studies available in any language, published at any time until September 2015 were considered. Studies were included if they contained mortality or complications.Objectives
Methods
The aim of this study was to assess the reproducibility and validity
of cross table radiographs for measuring the anteversion of the
acetabular component after total hip arthroplasty (THA) and to compare
it with measurements using CT scans. A total of 29 patients who underwent THA between June 2010 and
January 2016 were included. There were 17 men and 12 women. Their
mean age was 43 years (26 to 65). Seven patients underwent a bilateral
procedure. Thus, 36 THAs were included in the study. Lateral radiographs
and CT scans were obtained post-operatively and radiographs repeated
three weeks later. The anteversion of the acetabular component was
measured using the method described by Woo and Morrey and the ischiolateral
method described by Pulos et al and these were compared with the
results obtained from CT scans.Aims
Patients 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
The purpose of this study was to evaluate the existing literature from 2005 to 2016 reporting on the efficacy of surgical management of patients with femoroacetabular impingement (FAI) secondary to slipped capital femoral epiphysis (SCFE). The electronic databases MEDLINE, EMBASE, and PubMed were searched and screened in duplicate. Data such as patient demographics, surgical technique, surgical outcomes and complications were retrieved from eligible studies.Objectives
Methods
The injured anterior cruciate ligament (ACL) is thought to exhibit an impaired healing response, and attempts at surgical repair have not been successful. Connective tissue growth factor (CTGF) is reported to be associated with wound healing, probably through transforming growth factor beta 1 (TGF-β1). A rabbit ACL injury model was used to study the effect of CTGF on ligament recovery. Quantitative real-time PCR (qRT-PCR) was performed for detection of changes in RNA levels of TGF-β1, type 1 collagen (COL1), type 2 collagen (COL2), SRY-related high mobility group-box gene9 (SOX9), tissue inhibitor of metalloproteinase-1 (TIMP-1) and matrix metallopeptidase 13 (MMP-13). Expression of related proteins was detected by Western blotting.Objectives
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
The aim of this study was to compare the incidence of aseptic
loosening after the use of a cemented acetabular component and a
Trabecular Metal (TM) acetabular component (Zimmer Inc., Warsaw,
Indiana) at acetabular revision with bone impaction grafting. A total of 42 patients were included in the study. Patients were
randomised to receive an all- polyethylene cemented acetabular component
(n = 19) or a TM component (n = 23). Radiostereometric analysis
and conventional radiographic examinations were performed regularly
up to two years post-operatively or until further revision.Aims
Patients and Methods
A contact patch to rim (CPR) distance of <
10 mm has been
associated with edge-loading and excessive wear. However, not all
arthroplasties with a low CPR distance show problems with wear.
Therefore, CPR distance may not be the only variable affecting the
post-operative metal ion concentrations. We used multiple logistic regression to determine what variables
differed between the patients who had high and low cobalt (CoS)
and chromium (CrS) serum ion concentrations within a cohort of patients
with low (<
10 mm) CPR distances. A total of 56 patients treated
with unilateral hip resurfacing arthroplasty (HRA) had CoS and CrS
ion studies performed more than one year after surgery. The mean
age of the patients at the time of surgery was 51.7 years (29 to
70), with 38 women (68%) and 18 men (32%).Aims
Patients and Methods
There is no consensus about the best method of achieving equal
leg lengths at total hip arthroplasty (THA) in patients with Crowe
type-IV developmental dysplasia of the hip (DDH). We reviewed our
experience of a consecutive series of patients who underwent THA
for this indication. We retrospectively reviewed 78 patients (86 THAs) with Crowe
type-IV DDH, including 64 women and 14 men, with a minimum follow-up
of two years. The mean age at the time of surgery was 52.2 years
(34 to 82). We subdivided Crowe type-IV DDH into two major types
according to the number of dislocated hips, and further categorised
them into three groups according to the occurrence of pelvic obliquity
or spinal curvature. Leg length discrepancy (LLD) and functional
scores were analysed.Aims
Patients and Methods
To determine the effect of a change in design of a cementless
ceramic acetabular component in fixation and clinical outcome after
total hip arthroplasty We compared 342 hips (302 patients) operated between 1999 and
2005 with a relatively smooth hydroxyapatite coated acetabular component
(group 1), and 337 hips (310 patients) operated between 2006 and
2011 using a similar acetabular component with a macrotexture on
the entire outer surface of the component (group 2). The mean age of
the patients was 53.5 (14 to 70) in group 1 and 53.0 (15 to 70)
in group 2. The mean follow-up was 12.7 years (10 to 17) for group
1 and 7.2 years (4 to 10) for group 2.Aims
Patients and Methods
The aim of this study was to evaluate the long-term clinical
and radiographic outcomes of the Birmingham Interlocking Pelvic
Osteotomy (BIPO). In this prospective study, we report the mid- to long-term clinical
outcomes of the first 100 consecutive patients (116 hips; 88 in
women, 28 in men) undergoing BIPO, reflecting the surgeon’s learning
curve. Failure was defined as conversion to hip arthroplasty. The
mean age at operation was 31 years (7 to 57). Three patients (three
hips) were lost to follow-up.Aims
Patients and Methods
We conducted a prospective study of a delta ceramic total hip
arthroplasty (THA) to determine the rate of ceramic fracture, to
characterise post-operative noise, and to evaluate the mid-term
results and survivorship. Between March 2009 and March 2011, 274 patients (310 hips) underwent
cementless THA using a delta ceramic femoral head and liner. At
each follow-up, clinical and radiological outcomes were recorded.
A Kaplan-Meier analysis was undertaken to estimate survival.Aims
Patients and Methods
We used the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) to investigate the risk of revision due to prosthetic joint infection (PJI) for patients undergoing primary and revision hip arthroplasty, the changes in risk over time, and the overall burden created by PJI. We analysed revision total hip arthroplasties (THAs) performed due to a diagnosis of PJI and the linked index procedures recorded in the NJR between 2003 and 2014. The cohort analysed consisted of 623 253 index primary hip arthroplasties, 63 222 index revision hip arthroplasties and 7585 revision THAs performed due to a diagnosis of PJI. The prevalence, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression.Objectives
Methods
The aims of this study were to describe the prevalence of previous
lumbar surgery in patients who undergo total hip arthroplasty (THA)
and to investigate their patient-reported outcomes (PROMs) one year
post-operatively. Data from the Swedish Hip Arthroplasty Register and the Swedish
Spine Register gathered from 2002 to 2013 were merged to identify
a group of patients who had undergone lumbar surgery before THA
(n = 997) and a carefully matched one-to-one control group. We investigated
differences in the one-year post-operative PROMs between the groups.
Linear regression analyses were used to explore the associations
between previous lumbar surgery and these PROMs following THA. The
prevalence of prior lumbar surgery was calculated as the ratio of
patients identified with previous lumbar surgery between 2002 and
2012, and divided by the total number of patients who underwent
a THA in 2012.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 most effective surgical approach for total hip arthroplasty
(THA) remains controversial. The direct anterior approach may be
associated with a reduced risk of dislocation, faster recovery,
reduced pain and fewer surgical complications. This systematic review
aims to evaluate the current evidence for the use of this approach
in THA. Following the Cochrane collaboration, an extensive literature
search of PubMed, Medline, Embase and OvidSP was conducted. Randomised
controlled trials, comparative studies, and cohort studies were
included. Outcomes included the length of the incision, blood loss,
operating time, length of stay, complications, and gait analysis.Aims
Materials and Methods
It may not be possible to undertake revision total hip arthroplasty
(THA) in the presence of massive loss of acetabular bone stock using
standard cementless hemispherical acetabular components and metal
augments, as satisfactory stability cannot always be achieved. We
aimed to study the outcome using a reconstruction cage and a porous
metal augment in these patients. A total of 22 acetabular revisions in 19 patients were performed
using a combination of a reconstruction cage and porous metal augments.
The augments were used in place of structural allografts. The mean
age of the patients at the time of surgery was 70 years (27 to 85)
and the mean follow-up was 39 months (27 to 58). The mean number
of previous THAs was 1.9 (1 to 3). All patients had segmental defects
involving more than 50% of the acetabulum and seven hips had an
associated pelvic discontinuity. Aims
Patients and Methods
The stability of cementless acetabular components is an important
factor for surgical planning in the treatment of patients with pelvic
osteolysis after total hip arthroplasty (THA). However, the methods
for determining the stability of the acetabular component from pre-operative
radiographs remain controversial. Our aim was to develop a scoring
system to help in the assessment of the stability of the acetabular
component under these circumstances. The new scoring system is based on the mechanism of failure of
these components and the location of the osteolytic lesion, according
to the DeLee and Charnley classification. Each zone is evaluated
and scored separately. The sum of the individual scores from the
three zones is reported as a total score with a maximum of 10 points.
The study involved 96 revision procedures which were undertaken
for wear or osteolysis in 91 patients between July 2002 and December
2012. Pre-operative anteroposterior pelvic radiographs and Judet
views were reviewed. The stability of the acetabular component was
confirmed intra-operatively.Aims
Patients and Methods
To determine ten-year failure rates following 36 mm metal-on-metal
(MoM) Pinnacle total hip arthroplasty (THA), and identify predictors
of failure. We retrospectively assessed a single-centre cohort of 569 primary
36 mm MoM Pinnacle THAs (all Corail stems) followed up since 2012
according to Medicines and Healthcare Products Regulation Agency
recommendations. All-cause failure rates (all-cause revision, and
non-revised cross-sectional imaging failures) were calculated, with predictors
for failure identified using multivariable Cox regression.Aims
Patients and Methods
Lumbar fusion is known to reduce the variation in pelvic tilt
between standing and sitting. A flexible lumbo-pelvic unit increases
the stability of total hip arthroplasty (THA) when seated by increasing
anterior clearance and acetabular anteversion, thereby preventing
impingement of the prosthesis. Lumbar fusion may eliminate this protective
pelvic movement. The effect of lumbar fusion on the stability of
total hip arthroplasty has not previously been investigated. The Medicare database was searched for patients who had undergone
THA and spinal fusion between 2005 and 2012. PearlDiver software
was used to query the database by the International Classification
of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedural
code for primary THA and lumbar spinal fusion. Patients who had
undergone both lumbar fusion and THA were then divided into three
groups: 1 to 2 levels, 3 to 7 levels and 8+ levels of fusion. The
rate of dislocation in each group was established using ICD-9-CM codes.
Patients who underwent THA without spinal fusion were used as a
control group. Statistical significant difference between groups
was tested using the chi-squared test, and significance set at p
<
0.05.Aims
Patients and Methods
Advocates of debridement, antibiotics and implant retention (DAIR)
in hip periprosthetic joint infection (PJI) argue that a procedure
not disturbing a sound prosthesis-bone interface is likely to lead
to better survival and functional outcome compared with revision.
This case-control study aims were to compare outcome of DAIRs for
infected primary total hip arthroplasty (THA) with outcomes following
primary THA and two-stage revision of infected primary THAs. We retrospectively reviewed all DAIRs, performed for confirmed
infected primary hip arthropasty (n = 82) at out institution, between
1997 and 2013. Data recorded included full patient information and
type of surgery. Outcome measures included complications, mortality,
implant survivorship and functional outcome. Outcome was compared with
two control groups matched for gender and age; a cohort of primary
THAs (n = 120) and a cohort of two-stage revisions for infection
(n = 66).Aims
Patients and Methods
Favourable results for collarless polished tapered stems have been reported, and cement creep due to taper slip may be a contributing factor. However, the ideal cement thickness around polished stems remains unknown. We investigated the influence of cement thickness on stem subsidence and cement creep. We cemented six collarless polished tapered (CPT) stems (two stems each of small, medium and large sizes) into composite femurs that had been reamed with a large CPT rasp to achieve various thicknesses of the cement mantle. Two or three tantalum balls were implanted in the proximal cement in each femur. A cyclic loading test was then performed for each stem. The migration of the balls was measured three-dimensionally, using a micro-computed tomography (CT) scanner, before and after loading. A digital displacement gauge was positioned at the stem shoulder, and stem subsidence was measured continuously by the gauge. Final stem subsidence was measured at the balls at the end of each stem.Objectives
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
Fractures of the proximal femur are a common clinical problem, and a number of orthopaedic devices are available for the treatment of such fractures. The objective of this study was to assess the rotational stability, a common failure predictor, of three different rotational control design philosophies: a screw, a helical blade and a deployable crucifix. Devices were compared in terms of the mechanical work (W) required to rotate the implant by 6° in a bone substitute material. The substitute material used was Sawbones polyurethane foam of three different densities (0.08 g/cm3, 0.16 g/cm3 and 0.24 g/cm3). Each torsion test comprised a steady ramp of 1°/minute up to an angular displacement of 10°.Objectives
Methods
The objective of this five-year prospective, blinded, randomised
controlled trial (RCT) was to compare femoral head penetration into
a vitamin E diffused highly cross-linked polyethylene (HXLPE) liner
with penetration into a medium cross-linked polyethylene control
liner using radiostereometric analysis. Patients scheduled for total hip arthroplasty (THA) were randomised
to receive either the study E1 (32 patients) or the control ArComXL
polyethylene (35 patients). The median age (range) of the overall
cohort was 66 years (40 to 76).Aims
Patients and Methods
Modular or custom-made femoral components have been preferred
for total hip arthroplasty (THA) in patients with a history of Perthes’
disease because of the distortion in the anatomy of the proximal
femur. However, it has not been established whether a monobloc cementless
stem will fit the distorted proximal femur or whether the results
of the procedure are satisfactory in this group of patients. We reviewed 68 consecutive patients who had undergone THA for
childhood Perthes’ disease between June 2003 and December 2008.
There were 35 men and 33 women with a mean age of 48 years (16 to
73) at the time of index arthroplasty. Their mean body mass index
was 24.4 (18.3 to 32.9). Of the 68 hips, 32 were classified as Stulberg
class III and 36 as class IV. The mean pre-operative shortening
of the affected leg was 17.2 mm (5 to 34). The minimum follow-up
was five years (mean 8.5 years; 5.2 to 10).Aims
Patients and Methods
This study aimed to determine the diagnostic performance of radiographic
criteria to detect aseptic acetabular loosening after revision total
hip arthroplasty (THA). Secondary aims were to determine the predictive
values of different thresholds of migration and to determine the
predictive values of radiolucency criteria. Acetabular component migration to re-revision was measured retrospectively
using Ein-Bild-Rontgen-Analyse (EBRA-Cup) and manual measurements
(Sutherland method) in two groups: Group A, 52 components (48 patients) found
not loose at re-revision and Group B, 42 components (36 patients)
found loose at re-revision between 1980 and 2015. The presence and
extent of radiolucent lines was also assessed.Aims
Patients and Methods
Recently, there has been considerable interest in quantifying
the associations between bony abnormalities around and in the hip
joint and osteoarthritis (OA). Our aim was to investigate the relationships
between acetabular undercoverage, acetabular overcoverage, and femoroacetabular
impingement (FAI) with OA of the hip, which currently remain controversial. A total of 545 cadaveric skeletons (1090 hips) from the Hamann-Todd
osteological collection were obtained. Femoral head volume (FHV),
acetabular volume (AV), the FHV/AV ratio, acetabular version, alpha
angle and anterior femoral neck offset (AFNO) were measured. A validated
grading system was used to quantify OA of the hip as minimal, moderate,
or severe. Multiple linear and multinomial logistic regression were
used to determine the factors that correlated independently with
the FHV, AV, and the FHV/AV ratio. Aims
Materials and Methods
The aim of this study was to investigate the outcomes of Vancouver
type B2 and B3 fractures by performing a systematic review of the
methods of surgical treatment which have been reported. A systematic search was performed in Ovid MEDLINE, Embase and
the Cochrane Central Register of Controlled Trials. For inclusion,
studies required a minimum of ten patients with a Vancouver type
B2 and/or ten patients with a Vancouver type B3 fracture, a minimum
mean follow-up of two years and outcomes which were matched to the type
of fracture. Studies were also required to report the rate of re-operation
as an outcome measure. The protocol was registered in the PROSPERO
database. Aims
Materials and Methods
The aim of this study was to examine the real time A total of 50 patients (83 hips) underwent 4D dynamic CT scanning
of the hip, producing real time osseous models of the pelvis and
femur being moved through flexion, adduction, and internal rotation.
The location and size of the cam deformity and its relationship
to the angle of flexion of the hip and pelvic tilt, and the position
of impingement were recorded.Aims
Patients and Methods
Our first aim was to determine whether there are significant
changes in the level of metal ions in the blood at mid-term follow-up,
in patients with an Articular Surface Replacement (ASR) arthroplasty.
Secondly, we sought to identify risk factors for any increases. The study involved 435 patients who underwent unilateral, metal-on-metal
(MoM) hip resurfacing (HRA) or total hip arthroplasty (THA). These
patients all had one measurement of the level of metal ions in the
blood before seven years had passed post-operatively (early evaluation)
and one after seven years had passed post-operatively (mid-term evaluation).
Changes in ion levels were tested using a Wilcoxon signed-rank test.
We identified subgroups at the highest risk of increase using a
multivariable linear logistic regression model.Aims
Patients and Methods
The aim of this study was to compare early functional and health
related quality of life outcomes (HRQoL) in patients who have undergone
total hip arthroplasty (THA) using a bone conserving short stem
femoral component and those in whom a conventional length uncemented
component was used. Outcome was assessed using a validated performance
based outcome instrument as well as patient reported outcome measures
(PROMs). We prospectively analysed 33 patients whose THA involved a contemporary
proximally porous coated tapered short stem femoral component and
53 patients with a standard conventional femoral component, at a
minimum follow-up of two years. The mean follow-up was 31.4 months
(24 to 39). Patients with poor proximal femoral bone quality were
excluded. The mean age of the patients was 66.6 years (59 to 77)
and the mean body mass index was 30.2 kg/m2 (24.1 to
41.0). Outcome was assessed using the Oxford Hip Score (OHS) and
the University College Hospital (UCH) hip score which is a validated
performance based instrument. HRQoL was assessed using the EuroQol
5D (EQ-5D).Aims
Patients and Methods
To evaluate the hypothesis that failed osteosynthesis of periprosthetic
Vancouver type B1 fractures can be treated successfully with stem
revision using a transfemoral approach and a cementless, modular,
tapered revision stem with reproducible rates of fracture healing,
stability of the revision stem, and clinically good results. A total of 14 patients (11 women, three men) with a mean age
of 72.4 years (65 to 90) undergoing revision hip arthroplasty after
failed osteosynthesis of periprosthetic fractures of Vancouver type
B1 were treated using a transfemoral approach to remove the well-fixed
stem before insertion of a modular, fluted titanium stem which obtained
distal fixation. These patients were clinically and radiologically
followed up for a mean 52.2 months (24 to 144).Aims
Patients and Methods
The Sliding Hip Screw (SHS) is commonly used to treat trochanteric hip fractures. Fixation failure is a devastating complication requiring complex revision surgery. One mode of fixation failure is lag screw cut-out which is greatest in unstable fracture patterns and when the tip-apex distance of the lag screw is > 25 mm. The X-Bolt Dynamic Hip Plating System (X-Bolt Orthopaedics, Dublin, Ireland) is a new device which aims to reduce this risk of cut-out. However, some surgeons have reported difficulty minimising the tip-apex distance with subsequent concerns that this may lead to an increased risk of cut-out. We measured the tip-apex distance from the intra-operative radiographs of 93 unstable trochanteric hip fractures enrolled in a randomised controlled trial (Warwick Hip Trauma Evaluation, WHiTE One trial). Participants were treated with either the sliding hip screw or the X-Bolt dynamic hip plating system. We also recorded the incidence of cut-out in both groups, at a median follow-up time of 17 months.Objectives
Patients and Methods
The World Health Organization (WHO) and the Centre
for Disease Control and Prevention (CDC) recently published guidelines
for the prevention of surgical site infection. The WHO guidelines,
if implemented worldwide, could have an immense impact on our practices
and those of the CDC have implications for healthcare policy in
the United States. Our aim was to review the strategies for prevention of periprosthetic
joint infection in light of these and other recent guidelines. Cite this article:
The purpose of this study was to evaluate whether an innovative
templating technique could predict the need for acetabular augmentation
during primary total hip arthroplasty for patients with dysplastic
hips. We developed a simple templating technique to estimate acetabular
component coverage at total hip arthroplasty, the True Cup: False
Cup (TC:FC) ratio. We reviewed all patients with dysplastic hips
who underwent primary total hip arthroplasty between 2005 and 2012.
Traditional radiological methods of assessing the degree of acetabular dysplasia
(Sharp’s angle, Tönnis angle, centre-edge angle) as well as the
TC:FC ratio were measured from the pre-operative radiographs. A
comparison of augmented and non-augmented hips was undertaken to
determine any difference in pre-operative radiological indices between
the two cohorts. The intra- and inter-observer reliability for all
radiological indices used in the study were also calculated.Aims
Patients and Methods
The aim of this study was to identify patient- and surgery-related
risk factors for sustaining an early periprosthetic fracture following
primary total hip arthroplasty (THA) performed using a double-tapered
cementless femoral component (Bi-Metric femoral stem; Biomet Inc.,
Warsaw, Indiana). A total of 1598 consecutive hips, in 1441 patients receiving
primary THA between January 2010 and June 2015, were retrospectively
identified. Level of pre-operative osteoarthritis, femoral Dorr
type and cortical index were recorded. Varus/valgus placement of
the stem and canal fill ratio were recorded post-operatively. Periprosthetic
fractures were identified and classified according to the Vancouver
classification. Regression analysis was performed to identify risk
factors for early periprosthetic fracture.Aims
Patients and Methods
The purpose of this study was to determine the sensitivity, specificity
and predictive values of previously reported thresholds of proximal
translation and sagittal rotation of cementless acetabular components
used for revision total hip arthroplasty (THA) at various times
during early follow-up. Migration of cementless acetabular components was measured retrospectively
in 84 patients (94 components) using Ein-Bild-Rontgen-Analyse (EBRA-Cup)
in two groups of patients. In Group A, components were recorded
as not being loose intra-operatively at re-revision THA (52 components/48
patients) and Group B components were recorded to be loose at re-revision
(42 components/36 patients).Aims
Patients and 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
Post-operative migration of cemented acetabular components as
measured by radiostereometric analysis (RSA) has a strong predictive
power for late, aseptic loosening. Also, radiolucent lines predict
late loosening. Migration has been reduced by systemic bisphosphonate
treatment in randomised trials of hip and knee arthroplasty. Used
as a local treatment, a higher local dose of bisphosphonate can
be achieved without systemic exposure. We wished to see if this
principle could be applied usefully in total hip arthroplasty (THA). In this randomised placebo-controlled, double-blinded trial with
60 participants, we compressed gauze soaked in bisphosphonate solution
(ibandronate) or saline against the acetabular bone bed immediately
before cementing the acetabular component. RSA, classification of
radiolucent lines, the Harris Hip Score (HHS) and the Western Ontario McMasters
Universities Osteoarthritis Index (WOMAC) were carried out at three-,
six-, 12-, and 24-month follow-up.Aims
Patients and Methods
Joint-preserving surgery of the hip (JPSH) has evolved considerably
and now includes a number of procedures, including arthroscopy,
surgical dislocation, and redirectional osteotomies of the femur
and acetabulum. There are a number of different factors which lead
to failure of JPSH. Consequently, it is of interest to assess the
various modes of failure in order to continue to identify best practice
and the indications for these procedures. Using a retrospective observational study design, we reviewed
1013 patients who had undergone JPSH by a single surgeon between
2005 and 2015. There were 509 men and 504 women with a mean age
of 39 years (16 to 78). Of the 1013 operations, 783 were arthroscopies,
122 surgical dislocations, and 108 peri-acetabular osteotomies (PAO).
We analysed the overall failure rates and modes of failure. Re-operations
were categorised into four groups: Mode 1 was arthritis progression
or organ failure leading to total hip arthroplasty (THA); Mode 2
was an Incorrect diagnosis/procedure; Mode 3 resulted from malcorrection
of femur (type A), acetabulum (type B), or labrum (type C) and Mode 4
resulted from an unintended consequence of the initial surgical
intervention.Aims
Patients and Methods
The aim of this study was to compare the design of the generic
OptiStem XTR femoral stem with the established Exeter femoral stem. We obtained five boxed, as manufactured, implants of both designs
at random (ten in total). Two examiners were blinded to the implant
design and independently measured the mass, volume, trunnion surface
topography, trunnion roughness, trunnion cone angle, Caput-Collum-Diaphyseal
(CCD) angle, femoral offset, stem length, neck length, and the width
and roughness of the polished stem shaft using peer-reviewed methods.
We then compared the stems using these parameters.Aims
Materials and Methods
To analyse the effectiveness of debridement and implant retention
(DAIR) in patients with hip periprosthetic joint infection (PJI)
and the relationship to patient characteristics. The outcome was
evaluated in hips with confirmed PJI and a follow-up of not less
than two years. Patients in whom DAIR was performed were identified from our
hip arthroplasty register (between 2004 and 2013). Adherence to
criteria for DAIR was assessed according to a previously published
algorithm.Aims
Patients and Methods
Loss or absence of proximal femoral bone in revision total hip
arthroplasty (THA) remains a significant challenge. While the main
indication for the use of proximal femoral replacements (PFRs) is
in the treatment of malignant disease, they have a valuable role
in revision THA for loosening, fracture and infection in patients
with bone loss. Our aim was to determine the clinical outcomes,
implant survivorship, and complications of PFRs used in revision
THA for indications other than malignancy. A retrospective review of 44 patients who underwent revision
THA using a PFR between 2000 and 2013 was undertaken. Their mean
age was 79 years (53 to 97); 31 (70%) were women. The bone loss
was classified as Paprosky IIIB or IV in all patients. The mean
follow-up was six years (2 to 12), at which time 22 patients had
died and five were lost to follow-up.Aims
Patients and Methods
Transtrochanteric rotational osteotomy (TRO) is performed for
young patients with non-traumatic osteonecrosis of the femoral head
(ONFH) to preserve the hip. We aimed to investigate the long-term
outcomes and the risk factors for failure 15 years after this procedure. This study included 95 patients (111 hips) with a mean age of
40 years (21 to 64) who underwent TRO for ONFH. The mean follow-up
was 18.2 years (3 to 26). Kaplan–Meier survivorship analyses were
performed with conversion to total hip arthroplasty (THA) and radiological
failure due to secondary collapse of the femoral head or osteoarthritic changes
as the endpoint. Multivariate analyses were performed to assess
risk factors for each outcome.Aims
Patients and Methods
The pelvis rotates in the sagittal plane during daily activities.
These rotations have a direct effect on the functional orientation
of the acetabulum. The aim of this study was to quantify changes
in pelvic tilt between different functional positions. Pre-operatively, pelvic tilt was measured in 1517 patients undergoing
total hip arthroplasty (THA) in three functional positions – supine,
standing and flexed seated (the moment when patients initiate rising
from a seated position). Supine pelvic tilt was measured from CT
scans, standing and flexed seated pelvic tilts were measured from standardised
lateral radiographs. Anterior pelvic tilt was assigned a positive
value.Aims
Patients and Methods
We present the clinical and radiological results at a minimum
follow-up of five years for patients who have undergone multiple
cement-in-cement revisions of their femoral component at revision
total hip arthroplasty (THA). We reviewed the outcome on a consecutive series of 24 patients
(10 men, 14 women) (51 procedures) who underwent more than one cement-in-cement
revision of the same femoral component. The mean age of the patients was
67.5 years (36 to 92) at final follow-up. Function was assessed using the original Harris hip score (HHS),
Oxford Hip Score (OHS) and the Merle D’Aubigné Postel score (MDP).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
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
The purpose of our study is to summarise the current scientific
findings regarding the impact of obesity on total hip arthroplasty
(THA); specifically the influence of obesity on the timing of THA,
incidence of complications, and effect on clinical and functional
outcomes. We performed a systematic review that was compliant with the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines to identify prospective studies from the PubMed/Medline,
Embase, and Cochrane Library databases that evaluated primary THA
in obese (body mass index (BMI) ≥ 30 kg/m2) patients.Aims
Materials and Methods
The aim of this study was to compare the survivorship and radiographic
outcomes at ten-year follow-up of three prospective consecutive
series of patients each of which received a different design of
cementless femoral components for total hip arthroplasty (THA). In Cohort 1, 91 consecutive patients (100 hips) underwent THA
with a cementless porous-coated anatomic femoral stem (PCA) between
October 1983 and January 1986. In Cohort 2, 86 consecutive patients
(100 hips) underwent THA with an extensively porous-coated cementless
femoral stem (Prodigy) between June 1994 and October 1997. In Cohort
3, 88 consecutive patients (100 hips) underwent THA with a proximally
porous-coated triple-tapered cementless stem (Summit) between April
2002 and October 2003. All three groups underwent prospective clinical
and radiographic evaluation.Aims
Patients and Methods
Posterior tilt of the pelvis with sitting provides biological
acetabular opening. Our goal was to study the post-operative interaction
of skeletal mobility and sagittal acetabular component position. This was a radiographic study of 160 hips (151 patients) who
prospectively had lateral spinopelvic hip radiographs for skeletal
and implant measurements. Intra-operative acetabular component position
was determined according to the pre-operative spinal mobility. Sagittal
implant measurements of ante-inclination and sacral acetabular angle were
used as surrogate measurements for the risk of impingement, and
intra-operative acetabular component angles were compared with these.Aims
Materials 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
This review summarises the technique of impaction
grafting with mesh augmentation for the treatment of uncontained
acetabular defects in revision hip arthroplasty. The ideal acetabular revision should restore bone stock, use
a small socket in the near-anatomic position, and provide durable
fixation. Impaction bone grafting, which has been in use for over
40 years, offers the ability to achieve these goals in uncontained
defects. The precepts of modern, revision impaction grafting are
that the segmental or cavitary defects must be supported with a
mesh; the contained cavity is filled with vigorously impacted morselised
fresh-frozen allograft; and finally, acrylic cement is used to stabilise
the graft and provide rigid, long-lasting fixation of the revised
acetabular component. Favourable results have been published with this technique. While
having its limitations, it is a viable option to address large acetabular
defects in revision arthroplasty. Cite this article:
It has been suggested that cemented fixation of total hip arthroplasty
(THA) is associated with an increased peri-operative mortality compared
with cementless THA. Our aim was to investigate this through a nationwide
matched cohort study adjusting for age, comorbidity, and socioeconomic
background. A total of 178 784 patients with osteoarthritis who underwent
either cemented or cementless THA from the Swedish Hip Arthroplasty
Register were matched with 862 294 controls from the general population.
Information about the causes of death, comorbidities, and socioeconomic
background was obtained. Mortality within the first 90 days after
the operation was the primary outcome measure.Aims
Patients and Methods
Nerve palsy is a well-described complication
following total hip arthroplasty, but is highly distressing and
disabling. A nerve palsy may cause difficulty with the post-operative
rehabilitation, and overall mobility of the patient. Nerve palsy
may result from compression and tension to the affected nerve(s)
during the course of the operation via surgical manipulation and
retractor placement, tension from limb lengthening or compression
from post-operative hematoma. In the literature, hip dysplasia,
lengthening of the leg, the use of an uncemented femoral component, and
female gender are associated with a greater risk of nerve palsy.
We examined our experience at a high-volume, tertiary care referral
centre, and found an overall incidence of 0.3% out of 39 056 primary
hip arthroplasties. Risk factors found to be associated with the
incidence of nerve palsy at our institution included the presence
of spinal stenosis or lumbar disc disease, age younger than 50,
and smoking. If a nerve palsy is diagnosed, imaging is mandatory
and surgical evacuation or compressive haematomas may be beneficial.
As palsies are slow to recover, supportive care such as bracing,
therapy, and reassurance are the mainstays of treatment. Cite this article:
Several studies have reported the safety and efficacy of subcapital
re-alignment for patients with slipped capital femoral epiphysis
(SCFE) using surgical dislocation of the hip and an extended retinacular
flap. Instability of the hip and dislocation as a consequence of
this surgery has only recently gained attention. We discuss this
problem with some illustrative cases. We explored the literature on the possible pathophysiological
causes and surgical steps associated with the risk of post-operative
instability and articular damage. In addition, we describe supplementary
steps that could be used to avoid these problems.Aims
Materials and Methods
We evaluated the short-term functional outcome and prevalence
of bearing-specific generation of audible noise in 301 patients
(336 hips) operated on with fourth generation (Delta) medium diameter
head, ceramic-on-ceramic (CoC) total hip arthroplasties (THAs). There were 191 female (63%) and 110 male patients (37%) with
a mean age of 61 years (29 to 78) and mean follow-up of 2.1 years
(1.3 to 3.4). Patients completed three questionnaires: Oxford Hip
Score (OHS), Research and Development 36-item health survey (RAND-36)
and a noise-specific symptom questionnaire. Plain radiographs were also
analysed. A total of three hips (0.9%) were revised. Aims
Patients and Methods
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
Periacetabular osteotomy is an effective way of treating symptomatic
hip dysplasia. We describe a new minimally invasive technique using
a modification of the Smith-Peterson approach. We performed a prospective, longitudinal cohort study to assess
for any compromise in acetabular correction when using this approach,
and to see if the procedure would have a higher complication rate
than that quoted in the literature for other approaches. We also
assessed for any improvement in functional outcome. From 168 consecutive patients (189 hips) who underwent acetabular
correction between March 2010 and March 2013 we excluded those who
had undergone previous pelvic surgery for DDH and those being treated
for acetabular retroversion. The remaining 151 patients (15 men,
136 women) (166 hips) had a mean age of 32 years (15 to 56) and the
mean duration of follow-up was 2.8 years (1.2 to 4.5). In all 90%
of cases were Tönnis grade 0 or 1. Functional outcomes were assessed
using the Non Arthritic Hip Score (NAHS), University of California,
Los Angeles (UCLA) and Tegner activity scores.Aims
Patients and Methods
Osteosynthesis of anterior pubic ramus fractures using one large-diameter screw can be challenging in terms of both surgical procedure and fixation stability. Small-fragment screws have the advantage of following the pelvic cortex and being more flexible. The aim of the present study was to biomechanically compare retrograde intramedullary fixation of the superior pubic ramus using either one large- or two small-diameter screws. A total of 12 human cadaveric hemipelvises were analysed in a matched pair study design. Bone mineral density of the specimens was 68 mgHA/cm3 (standard deviation (Objectives
Materials and Methods
One goal of total hip arthroplasty is to restore normal hip anatomy.
The aim of this study was to compare displacement of the centre
of rotation (COR) using a standard reaming technique with a technique
in which the acetabulum was reamed immediately peripherally and
referenced off the rim. In the first cohort the acetabulum was reamed to the floor followed
by sequentially larger reamers. In the second cohort the acetabulum
was only reamed peripherally, starting with a reamer the same size
as the native femoral head. Anteroposterior pelvic radiographs were
analysed for acetabular floor depth and vertical and horizontal position
of the COR.Aims
Patients 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 aimed to quantify the relative contributions of the medial
femoral circumflex artery (MFCA) and lateral femoral circumflex
artery (LFCA) to the arterial supply of the head and neck of the
femur. We acquired ten cadaveric pelvises. In each of these, one hip
was randomly assigned as experimental and the other as a matched
control. The MFCA and LFCA were cannulated bilaterally. The hips
were designated LFCA-experimental or MFCA-experimental and underwent
quantitative MRI using a 2 mm slice thickness before and after injection
of MRI-contrast diluted 3:1 with saline (15 ml Gd-DTPA) into either
the LFCA or MFCA. The contralateral control hips had 15 ml of contrast
solution injected into the root of each artery. Next, the MFCA and
LFCA were injected with a mixture of polyurethane and barium sulfate
(33%) and their extra-and intra-arterial course identified by CT
imaging and dissection.Aims
Materials and Methods
Femoral impaction bone grafting was first developed in 1987 using
morselised cancellous bone graft impacted into the femoral canal
in combination with a cemented, tapered, polished stem. We describe
the evolution of this technique and instrumentation since that time. Between 1987 and 2005, 705 revision total hip arthroplasties
(56 bilateral) were performed with femoral impaction grafting using
a cemented femoral stem. All surviving patients were prospectively
followed for a mean of 14.7 years (9.8 to 28.3) with no loss to
follow-up. By the time of the final review, 404 patients had died.Aims
Patients and Methods
Our aim was to report survivorship data and lessons learned with
the Corail/Pinnacle cementless total hip arthroplasty (THA) system. Between August 2005 and March 2015, a total of 4802 primary cementless
Corail/Pinnacle THAs were performed in 4309 patients. In March 2016,
we reviewed these hips from a prospectively maintained database.Aims
Patients and Methods
We investigated whether blood metal ion levels could effectively
identify patients with bilateral Birmingham Hip Resurfacing (BHR)
implants who have adverse reactions to metal debris (ARMD). Metal ion levels in whole blood were measured in 185 patients
with bilateral BHRs. Patients were divided into those with ARMD
who either had undergone a revision for ARMD or had ARMD on imaging
(n = 30), and those without ARMD (n = 155). Receiver operating characteristic
analysis was used to determine the optimal thresholds of blood metal
ion levels for identifying patients with ARMD.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
The purpose of this study was to determine the lifetime risk
of revision surgery for patients undergoing Charnley cemented total
hip arthroplasty (THA), with 40-year follow up, using death as a
competing risk. We retrospectively reviewed 2000 cemented Charnley THAs, with
51 living hips available at 40 years. Aims
Materials and Methods
Total hip arthroplasty (THA) has well known subjective benefits,
but little is known objectively about the recovery of mobility in
the early post-operative period. A total of 33 patients aged >
60 years who underwent elective
primary THA had their activity monitored for 30 days post-operatively
using an at-home (Fitbit) ankle accelerometer. Their mean age was
70.7 years (61 to 86); 15 (45.5%) were female. The rate of compliance
and the mean level of activity were determined. Comparisons between subgroups
based on age, body mass index (BMI), surgical approach, and the
destination of the patients when discharged were also performed.Aims
Patients and Methods
The purpose of this study was to compare the thickness of the hip capsule in patients with surgical hip disease, either with cam-femoroacetabular impingement (FAI) or non-FAI hip pathology, with that of asymptomatic control hips. A total of 56 hips in 55 patients underwent a 3Tesla MRI of the hip. These included 40 patients with 41 hips with arthroscopically proven hip disease (16 with cam-FAI; nine men, seven women; mean age 39 years, 22 to 58) and 25 with non-FAI chondrolabral pathology (four men, 21 women; mean age 40 years, 18 to 63) as well as 15 asymptomatic volunteers, whose hips served as controls (ten men, five women; mean age 62 years, 33 to 77). The maximal capsule thickness was measured anteriorly and superiorly, and compared within and between the three groups with a gender subanalysis using student’s Objectives
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
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
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
The influence of identifiable pre-operative factors on the outcome
of eccentric rotational acetabular osteotomy (ERAO) is unknown.
We aimed to determine the factors that might influence the outcome,
in order to develop a scoring system for predicting the prognosis
for patients undergoing this procedure. We reviewed 700 consecutive ERAOs in 54 men and 646 women with
symptomatic acetabular dysplasia or early onset osteoarthritis (OA)
of the hip, which were undertaken between September 1989 and March
2013. The patients’ pre-operative background, clinical and radiological
findings were examined retrospectively. Multivariate Cox regression
analysis was performed using the time from the day of surgery to
a conversion to total hip arthroplasty (THA) as an endpoint. A risk
score was calculated to predict the prognosis for conversion to
THA, and its predictive capacity was investigated.Aims
Patients and Methods
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
We hypothesised that the synovial white blood cell (WBC) count
in patients with a late periprosthetic joint infection (PJI) of
the hip would depend on the duration of a patient’s symptoms, and
that the optimal diagnostic threshold would also depend on this
period of time. The synovial WBC count and percentage of polymorphonuclear cells
(%PMN), and the serum CRP and ESR levels obtained >
six weeks after
primary THA were compared between 50 infected and 88 non-infected
THAs, and in patients with symptoms for more than or less than two
weeks. Diagnostic thresholds for the synovial WBC count were calculated
using area under the curve calculation.Aims
Patients 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 annual incidence of hip fracture is 620 000 in the European Union. The cost of this clinical problem has been estimated at 1.75 million disability-adjusted life years lost, equating to 1.4% of the total healthcare burden in established market economies. Recent guidance from The National Institute for Health and Clinical Excellence (NICE) states that research into the clinical and cost effectiveness of total hip arthroplasty (THA) as a treatment for hip fracture is a priority. We asked the question: can a trial investigating THA for hip fracture currently be delivered in the NHS? We performed a contemporaneous process evaluation that provides a context for the interpretation of the findings of WHiTE Two – a randomised study of THA for hip fracture. We developed a mixed methods approach to situate the trial centre within the context of wider United Kingdom clinical practice. We focused on fidelity, implementation, acceptability and feasibility of both the trial processes and interventions to stakeholder groups, such as healthcare providers and patients.Objectives
Methods
The primary purpose of this meta-analysis was to determine whether statin usage could reduce the risk of glucocorticoid-related osteonecrosis in animal models. A systematic literature search up to May 2015 was carried out using the PubMed, Ovid, EBM reviews, ISI Web of Science, EBSCO, CBM, CNKI databases with the term and boolean operators: statins and osteonecrosis in all fields. Risk ratio (RR), as the risk estimate of specific outcome, was calculated along with 95% confidence intervals (CI). The methodological quality of individual studies was assessed using a quantitative tool based on the updated Stroke Therapy Academic Industry Roundtable (STAIR) recommendations.Objectives
Methods
One method of femoral head preservation following avascular necrosis
(AVN) is core decompression and insertion of a tantalum rod. However,
there may be a high failure rate associated with this procedure.
The purpose of this study was to document the clinical and radiological
outcomes following total hip arthroplasty (THA) subsequent to failed
tantalum rod insertion. A total of 37 failed tantalum rods requiring total hip arthroplasty
were identified from a prospective database. There were 21 hips
in 21 patients (12 men and nine women, mean age 37 years, 18 to
53) meeting minimum two year clinical and radiographic follow-up
whose THAs were carried out between November 2002 and April 2013
(mean time between tantalum rod implantation and conversion to a
THA was 26 months, 6 to 72). These were matched by age and gender
to individuals (12 men, nine women, mean age 40 years, 18 to 58)
receiving THA for AVN without prior tantalum rod insertion.Aims
Patients and Methods
The spinopelvic relationship (including pelvic incidence) has been shown to influence pelvic orientation, but its potential association with femoroacetabular impingement has not been thoroughly explored. The purpose of this study was to prove the hypothesis that decreasing pelvic incidence is associated with increased risk of cam morphology. Two matching cohorts were created from a collection of cadaveric specimens with known pelvic incidences: 50 subjects with the highest pelvic incidence (all subjects > 60°) and 50 subjects with the lowest pelvic incidence (all subjects < 35°). Femoral version, acetabular version, and alpha angles were directly measured from each specimen bilaterally. Cam morphology was defined as alpha angle > 55°. Differences between the two cohorts were analysed with a Student’s Objectives
Methods
Femoroacetabular impingement (FAI) has been highlighted and well
documented primarily in Western countries and there are few large
studies focused on FAI-related morphological assessment in Asian
patients. We chose to investigate this subject. We assessed the morphology of the hip and the prevalence of radiographic
FAI in Japanese patients by measuring predictors of FAI. We reviewed
a total of 1178 hips in 695 men and 483 women with a mean age of
58.2 years (20 to 89) using CT images that had been obtained for
reasons unrelated to symptoms from the hip. We measured the lateral
centre edge angle, acetabular index, crossover sign, alpha angle
and anterior femoral head-neck offset ratio.Aims
Patients and Methods
In total hip arthroplasty (THA), the cementless, tapered-wedge stem design contributes to achieving initial stability and providing optimal load transfer in the proximal femur. However, loading conditions on the femur following THA are also influenced by femoral structure. Therefore, we determined the effects of tapered-wedge stems on the load distribution of the femur using subject-specific finite element models of femurs with various canal shapes. We studied 20 femurs, including seven champagne flute-type femurs, five stovepipe-type femurs, and eight intermediate-type femurs, in patients who had undergone cementless THA using the Accolade TMZF stem at our institution. Subject–specific finite element (FE) models of pre- and post-operative femurs with stems were constructed and used to perform FE analyses (FEAs) to simulate single-leg stance. FEA predictions were compared with changes in bone mineral density (BMD) measured for each patient during the first post-operative year.Objectives
Patients and Methods
We compared the outcome of total hip arthroplasty (THA) in obese
patients who previously underwent bariatric surgery and those who
did not, in a matched cohort study. There were 47 THAs in the bariatric group (42 patients), and
94 THAs in the comparison group (92 patients). The mean age of the
patients was 57 years in both groups (24 to 79) and 57% of the patients
in both groups were women. The mean time between bariatric surgery
and THA was five years (four months to 12 years) in the bariatric group.
The mean follow-up after THA was three years (2 to 9). Aims
Patients and Methods
Alarm over the reported high failure rates for metal-on-metal (MoM) hip implants as well as their potential for locally aggressive Adverse Reactions to Metal Debris (ARMDs) has prompted government agencies, internationally, to recommend the monitoring of patients with MoM hip implants. Some have advised that a blood ion level >7 µg/L indicates potential for ARMDs. We report a systematic review and meta-analysis of the performance of metal ion testing for ARMDs. We searched MEDLINE and EMBASE to identify articles from which it was possible to reconstruct a 2 × 2 table. Two readers independently reviewed all articles and extracted data using explicit criteria. We computed a summary receiver operating curve using a Bayesian random-effects hierarchical model.Objectives
Methods
This study aimed to characterise and qualitatively grade the severity of the corrosion particles released into the hip joint following taper corrosion. The 26 cases examined were CoC/ABG Modular (n = 13) and ASR/SROM (n = 13). Blood serum metal ion levels were collected before and after revision surgery. The haematoxylin and eosin tissue sections were graded on the presence of fibrin exudates, necrosis, inflammatory cells and corrosion products. The corrosion products were identified based on visible observation and graded on abundance. Two independent observers blinded to the clinical patient findings scored all cases. Elemental analysis was performed on corrosion products within tissue sections. X-Ray diffraction was used to identify crystalline structures present in taper debris.Objectives
Methods
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
Using a systematic review, we investigated whether there is an
increased risk of post-operative infection in patients who have
received an intra-articular corticosteroid injection to the hip
for osteoarthritis prior to total hip arthroplasty (THA). Studies dealing with an intra-articular corticosteroid injection
to the hip and infection following subsequent THA were identified
from databases for the period between 1990 to 2013. Retrieved articles
were independently assessed for their methodological quality.Aims
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 wished to investigate the influence of metal debris exposure
on the subsequent immune response and resulting soft-tissue injury
following metal-on-metal (MoM) hip arthroplasty. Some reports have
suggested that debris generated from the head-neck taper junction
is more destructive than equivalent doses from metal bearing surfaces. We investigated the influence of the source and volume of metal
debris on chromium (Cr) and cobalt (Co) concentrations in corresponding
blood and hip synovial fluid samples and the observed agglomerated
particle sizes in excised tissues using multiple regression analysis
of prospectively collected data. A total of 199 explanted MoM hips
(177 patients; 132 hips female) were analysed to determine rates
of volumetric wear at the bearing surfaces and taper junctions. Aims
Patients and Methods