Survival rates and local control after resection of a sarcoma of the pelvis compare poorly to those of the limbs and have a high incidence of complications. The outcome for patients who need a hindquarter amputation (HQA) to treat a pelvic sarcoma is poor. Our aim was to evaluate the patient, tumour, and reconstructive factors that affect the survival of the patients who undergo HQA for primary or recurrent pelvic sarcoma. We carried out a retrospective review of all sarcoma patients who had undergone a HQA in a supraregional sarcoma unit between 1996 and 2018. Outcomes included oncological, surgical, and survival characteristics.Aims
Methods
Custom flange acetabular components (CFACs) are a patient-specific option for addressing large acetabular defects at revision total hip arthroplasty (THA), but patient and implant characteristics that affect survivorship remain unknown. This study aimed to identify patient and design factors related to survivorship. A retrospective review of 91 patients who underwent revision THA using 96 CFACs was undertaken, comparing features between radiologically failed and successful cases. Patient characteristics (demographic, clinical, and radiological) and implant features (design characteristics and intraoperative features) were collected. There were 74 women and 22 men; their mean age was 62 years (31 to 85). The mean follow-up was 24.9 months (Aims
Patients and Methods
Preclinical data showed poly(methyl methacrylate) (PMMA) loaded with microsilver to be effective against a variety of bacteria. The purpose of this study was to assess patient safety of PMMA spacers with microsilver in prosthetic hip infections in a prospective cohort study. A total of 12 patients with prosthetic hip infections were included for a three-stage revision procedure. All patients received either a gentamicin-PMMA spacer (80 g to 160 g PMMA depending on hip joint dimension) with additional loading of 1% (w/w) of microsilver (0.8 g to 1.6 g per spacer) at surgery 1 followed by a gentamicin-PMMA spacer without microsilver at surgery 2 or vice versa. Implantation of the revision prosthesis was carried out at surgery 3.Objectives
Methods
Vancouver type B periprosthetic femoral fractures (PFF) are challenging complications after total hip arthroplasty (THA), and some treatment controversies remain. The objectives of this study were: to evaluate the short-to-mid-term clinical outcomes after treatment of Vancouver type B PFF and to compare postoperative outcome in subgroups according to classifications and treatments; to report the clinical outcomes after conservative treatment; and to identify risk factors for postoperative complications in Vancouver type B PFF. A total of 97 consecutive PPFs (49 males and 48 females) were included with a mean age of 66 years (standard deviation (SD) 14.9). Of these, 86 patients were treated with surgery and 11 were treated conservatively. All living patients had a minimum two-year follow-up. Patient demographics details, fracture healing, functional scores, and complications were assessed. Clinical outcomes between internal fixation and revisions in patients with or without a stable femoral component were compared. Conservatively treated PPFs were evaluated in terms of mortality and healing status. A logistic regression analysis was performed to identify risk factors for complications.Aims
Methods
Although good clinical outcomes have been reported for monolithic tapered, fluted, titanium stems (TFTS), early results showed high rates of subsidence. Advances in stem design may mitigate these concerns. This study reports on the use of a current monolithic TFTS for a variety of indications. A multi-institutional retrospective study of all consecutive total hip arthroplasty (THA) and revision total hip arthroplasty (rTHA) patients who received the monolithic TFTS was conducted. Surgery was performed by eight fellowship-trained arthroplasty surgeons at four institutions. A total of 157 hips in 153 patients at a mean follow-up of 11.6 months (SD7.8) were included. Mean patient age at the time of surgery was 67.4 years (SD 13.3) and mean body mass index (BMI) was 28.9 kg/m2 (SD 6.5). Outcomes included intraoperative complications, one-year all-cause re-revisions, and subsidence at postoperative time intervals (two weeks, six weeks, six months, nine months, and one year).Aims
Methods
Osteolysis, secondary to local and systemic physiological effects, is a major challenge in total hip arthroplasty (THA). While osteolytic defects are commonly observed in long-term follow-up, how such lesions alter the distribution of stress is unclear. The aim of this study was to quantitatively describe the biomechanical implication of such lesions by performing subject-specific finite-element (FE) analysis on patients with osteolysis after THA. A total of 22 hemipelvis FE models were constructed in order to assess the transfer of load in 11 patients with osteolysis around the acetabular component of a THA during slow walking and a fall onto the side. There were nine men and two women. Their mean age was 69 years (55 to 81) at final follow-up. Changes in peak stress values and loads to fracture in the presence of the osteolytic defects were measured.Aims
Patients and Methods
While previously underappreciated, factors related to the spine contribute substantially to the risk of dislocation following total hip arthroplasty (THA). These factors must be taken into consideration during preoperative planning for revision THA due to recurrent instability. We developed a protocol to assess the functional position of the spine, the significance of these findings, and how to address different pathologies at the time of revision THA. Prospectively collected data on 111 patients undergoing revision THA for recurrent instability from January 2014 to January 2017 at two institutions were included (protocol group) and matched 1:1 to 111 revisions specifically performed for instability not using this protocol (control group). Mean follow-up was 2.8 years. Protocol patients underwent standardized preoperative imaging including supine and standing anteroposterior (AP) pelvis and lateral radiographs. Each case was scored according to the Hip-Spine Classification in Revision THA.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:
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
The primary objective of this study was to compare accuracy in restoring the native centre of hip rotation in patients undergoing conventional manual total hip arthroplasty (THA) This prospective cohort study included 50 patients undergoing conventional manual THA and 25 patients receiving robotic-arm assisted THA. Patients undergoing conventional manual THA and robotic-arm assisted THA were well matched for age (mean age, 69.4 years (Objectives
Materials and Methods
Multimodal infiltration of local anaesthetic provides effective
control of pain in patients undergoing total knee arthroplasty (TKA).
There is little information about the added benefits of posterior
capsular infiltration (PCI) using different combinations of local
anaesthetic agents. Our aim was to investigate the effectiveness
of the control of pain using multimodal infiltration with and without
infiltration of the posterior capsule of the knee. In a double-blind, randomised controlled trial of patients scheduled
for unilateral primary TKA, 86 were assigned to be treated with
multimodal infiltration with (Group I) or without (Group II) PCI.
Routine associated analgesia included the use of bupivacaine, morphine,
ketorolac and epinephrine. All patients had spinal anaesthesia and patient-controlled
analgesia (PCA) post-operatively. A visual analogue scale (VAS)
for pain and the use of morphine were recorded 24 hours post-operatively.
Side effects of the infiltration, blood loss, and length of stay
in hospital were recorded.Aims
Patients and Methods
In the time since Letournel popularised the surgical
treatment of acetabular fractures, more than 25 years ago, there
have been many changes within the field, related to patients, surgical
technique, implants and post-operative care. However, the long-term
outcomes appear largely unchanged. Does this represent stasis or
have the advances been mitigated by other negative factors? In this
article we have attempted to document the recent changes within
the surgery of patients with a fracture involving the acetabulum,
outline contemporary management, and identify the major problem
areas where further research is most needed. Cite this article:
This study reports the mid-term results of total hip arthroplasty (THA) performed using a monoblock acetabular component with a large-diameter head (LDH) ceramic-on-ceramic (CoC) bearing. Of the 276 hips (246 patients) included in this study, 264 (96%) were reviewed at a mean of 67 months (48 to 79) postoperatively. Procedures were performed with a mini posterior approach. Clinical and radiological outcomes were recorded at regular intervals. A noise assessment questionnaire was completed at last follow-up.Aims
Patients and 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
For this retrospective cohort study, patients aged ≤ 30 years
(very young) who underwent total hip arthroplasty (THA) were compared
with patients aged ≥ 60 years (elderly) to evaluate the rate of
revision arthroplasty, implant survival, the indications for revision,
the complications, and the patient-reported outcomes. We retrospectively reviewed all patients who underwent primary
THA between January 2000 and May 2015 from our institutional database.
A total of 145 very young and 1359 elderly patients were reviewed.
The mean follow-up was 5.3 years (1 to 18). Logistic generalized
estimating equations were used to compare characteristics and the revision
rate. Survival was evaluated using Kaplan–Meier curves and hazard
rates were created using Cox regression.Aims
Patients and Methods
The classical longitudinal incision used for the direct anterior
approach (DAA) to the hip does not follow the tension lines of the
skin and can lead to impaired wound healing and poor cosmesis. The
purpose of this retrospective study was to determine the satisfaction
with the scar, and functional and radiographic outcomes comparing
the classic longitudinal incision with a modified skin crease ‘bikini’
when the DAA is used for total hip arthroplasty (THA). A total of 964 patients (51% female; 59% longitudinal, 41% ‘bikini’)
completed a follow-up questionnaire between two and four years postoperatively,
including the Oxford Hip Score (OHS), the University of North Carolina
‘4P’ scar scale (UNC4P) and two items for assessing the aesthetic
appearance of the scar and symptoms of numbness. The positioning
of the components, rates of heterotopic ossification (HO) and rates
of revision were assessed.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
Few reconstructive techniques are available for patients requiring
complex acetabular revisions such as those involving Paprosky type
2C, 3A and 3B deficiencies and pelvic discontinuity. Our aim was
to describe the development of the patient specific Triflange acetabular
component for use in these patients, the surgical technique and
mid-term results. We include a description of the pre-operative
CT scanning, the construction of a model, operative planning, and
surgical technique. All implants were coated with porous plasma
spray and hydroxyapatite if desired. A multicentre, retrospective review of 95 complex acetabular
reconstructions in 94 patients was performed. A total of 61 (64.2%)
were female. The mean age of the patients was 66 (38 to 85). The
mean body mass index was 29 kg/m2 (18 to 51). Outcome
was reported using the Harris Hip Score (HHS), complications, failures
and survival.Aims
Patients and Methods
Large bone defects remain a tremendous clinical challenge. There is growing evidence in support of treatment strategies that direct defect repair through an endochondral route, involving a cartilage intermediate. While culture-expanded stem/progenitor cells are being evaluated for this purpose, these cells would compete with endogenous repair cells for limited oxygen and nutrients within ischaemic defects. Alternatively, it may be possible to employ extracellular vesicles (EVs) secreted by culture-expanded cells for overcoming key bottlenecks to endochondral repair, such as defect vascularization, chondrogenesis, and osseous remodelling. While mesenchymal stromal/stem cells are a promising source of therapeutic EVs, other donor cells should also be considered. The efficacy of an EV-based therapeutic will likely depend on the design of companion scaffolds for controlled delivery to specific target cells. Ultimately, the knowledge gained from studies of EVs could one day inform the long-term development of synthetic, engineered nanovesicles. In the meantime, EVs harnessed from
