To evaluate the impact of negative pressure wound therapy (NPWT) on the odds of having deep infections and health-related quality of life (HRQoL) following open fractures. Patients from the Fluid Lavage in Open Fracture Wounds (FLOW) trial with Gustilo-Anderson grade II or III open fractures within the lower limb were included in this secondary analysis. Using mixed effects logistic regression, we assessed the impact of NPWT on deep wound infection requiring surgical intervention within 12 months post-injury. Using multilevel model analyses, we evaluated the impact of NPWT on the Physical Component Summary (PCS) of the 12-Item Short-Form Health Survey (SF-12) at 12 months post-injury.Aims
Methods
Aims. Adverse local tissue reactions associated with abnormal wear considerably slowed down the general use of metal-on-metal (MoM) hip resurfacing arthroplasty (HRA), now limited to a few specialized centres. In this study, we provide the clinical results of 400 consecutive MoM HRAs implanted more than 20 years ago in one such centre. Methods. A total of 355 patients (400 hips) were treated with Conserve Plus HRA between November 1996 and November 2000. There were 96 female (27%) and 259 male patients (73%). Their mean age was 48.2 years (SD 10.9). The University of California, Los Angeles (UCLA) hip scores and
Aims. This prospective study reports longitudinal, within-patient, patient-reported outcome measures (PROMs) over a 15-year period following cemented single radius total knee arthroplasty (TKA). Secondary aims included reporting PROMs trajectory, 15-year implant survival, and patient attrition from follow-up. Methods. From 2006 to 2007, 462 consecutive cemented cruciate-retaining Triathlon TKAs were implanted in 426 patients (mean age 69 years (21 to 89); 290 (62.7%) female). PROMs (12-item Short Form Survey (SF-12), Oxford Knee Score (OKS), and satisfaction) were assessed preoperatively and at one, five, ten, and 15 years. Kaplan-Meier survival and univariate analysis were performed. Results. At 15 years, 28 patients were lost to follow-up (6.1%) and 221 patients (51.9%) had died, with the mean age of the remaining cohort reducing by four years. PROMs response rates among surviving patients were: one-year 63%; five-year 72%; ten-year 94%; and 15-year 59%. OKS and
Aims. It has been generally accepted that open fractures require early skeletal stabilization and soft-tissue reconstruction. Traditionally, a standard gauze dressing was applied to open wounds. There has been a recent shift in this paradigm towards negative pressure wound therapy (NPWT). The aim of this study was to compare the clinical outcomes in patients with open tibial fractures receiving standard dressing versus NPWT. Methods. This multicentre randomized controlled trial was approved by the ethical review board of a public sector tertiary care institute. Wounds were graded using Gustilo-Anderson (GA) classification, and patients with GA-II to III-C were included in the study. To be eligible, the patient had to present within 72 hours of the injury. The primary outcome of the study was patient-reported Disability Rating Index (DRI) at 12 months. Secondary outcomes included quality of life assessment using 12-Item Short-Form Health Survey questionnaire (SF-12), wound infection rates at six weeks and nonunion rates at 12 months. Logistic regression analysis and independent-samples t-test were applied for secondary outcomes. Analyses of primary and secondary outcomes were performed using SPSS v. 22.0.1 and p-values of < 0.05 were considered significant. Results. A total of 486 patients were randomized between January 2016 and December 2018. Overall 206 (49.04%) patients underwent NPWT, while 214 (50.95%) patients were allocated to the standard dressing group. There was no statistically significant difference in DRI at 12 months between NPWT and standard dressing groups (mean difference 0.5; 95% confidence interval (CI) -0.08 to 1.1; p = 0.581). Regarding
Aims. Minimally invasive fixation of pelvic fragility fractures is recommended to reduce pain and allow early mobilization. The purpose of this study was to evaluate the outcome of two different stabilization techniques in bilateral fragility fractures of the sacrum (BFFS). Methods. A non-randomized, prospective study was carried out in a level 1 trauma centre. BFFS in 61 patients (mean age 80 years (SD 10); four male, 57 female) were treated surgically with bisegmental transsacral stablization (BTS; n = 41) versus spinopelvic fixation (SP; n = 20). Postoperative full weightbearing was allowed. The outcome was evaluated at two timepoints: discharge from inpatient treatment (TP1; Fitbit tracking, Zebris stance analysis), and ≥ six months (TP2; Fitbit tracking, Zebris analysis, based on modified Oswestry Disability Index (ODI), Majeed Score (MS), and the
Aims. It has been suggested that the direct anterior approach (DAA) should be used for total hip arthroplasty (THA) instead of the posterior approach (PA) for better early functional outcomes. We conducted a value-based analysis of the functional outcome and associated perioperative costs, to determine which surgical approach gives the better short-term outcomes and lower costs. Methods. This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and the Cochrane Handbook. Several online databases were searched. Non-stratified and stratified meta-analyses were conducted to test the confounding biases in the studies which were included. The mean cost and probability were used to determine the added costs of perioperative services. Results. The DAA group had significantly longer operating times (p < 0.001), reduced length of hospital stay by a mean of 13.4 hours (95% confidence interval (CI) 9.12 to 18; p < 0.001), and greater blood loss (p = 0.030). The DAA group had significantly better functional outcome at three (p < 0.001) and six weeks (p = 0.006) postoperatively according to the Harris Hip Score (HHS). However, there was no significant difference between the groups for the HHS at six to eight weeks (p = 0.230), 12 weeks (p = 0.470), six months (p = 0.740), and one year (p = 0.610), the
Aims. Cementless total knee arthroplasty (TKA) offers the potential for strong biological fixation compared with cemented TKA where fixation is achieved by the mechanical integration of the cement. Few mid-term results are available for newer cementless TKA designs, which have used additive manufacturing (3D printing). The aim of this study was to present mid-term clinical outcomes and implant survivorship of the cementless Stryker Triathlon Tritanium TKA. Methods. This was a single institution registry review of prospectively gathered data from 341 cementless Triathlon Tritanium TKAs at four to 6.8 years follow-up. Outcomes were determined by comparing pre- and postoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) scores, and pre- and postoperative 12-item Veterans RAND/Short Form Health Survey (VR/SF-12) scores. Aseptic loosening and revision for any reason were the endpoints which were used to determine survivorship at five years. Results. At mid-term follow-up, the mean KOOS JR score improved significantly from 33.14 (0 t0 85, standard deviation (SD) 21.88) preoperatively to 84.12 (15.94 to 100, SD 20.51) postoperatively (p < 0.001), the mean VR/
Aims. Total knee arthroplasty is an established treatment for knee osteoarthritis with excellent long-term results, but there remains controversy about the role of uncemented prostheses. We present the long-term results of a randomized trial comparing an uncemented tantalum metal tibial component with a conventional cemented component of the same implant design. Methods. Patients under the age of 70 years with symptomatic osteoarthritis of the knee were randomized to receive either an uncemented tantalum metal tibial monoblock component or a standard cemented modular component. The mean age at time of recruitment to the study was 63 years (50 to 70), 46 (51.1%) knees were in male patients, and the mean body mass index was 30.4 kg/m. 2. (21 to 36). The same cruciate retaining total knee system was used in both groups. All patients received an uncemented femoral component and no patients had their patella resurfaced. Patient outcomes were assessed preoperatively and postoperatively using the modified Oxford Knee Score, Knee Society Score, and 12-Item Short-Form Health Survey questionnaire (SF-12) score. Radiographs were analyzed using the American Knee Society Radiograph Evaluation score. Operative complications, reoperations, or revision surgery were recorded. A total of 90 knees were randomized and at last review 77 knees were assessed. In all, 11 patients had died and two were lost to follow-up. Results. At final review all patients were between 11 and 15 years following surgery. In total, 41 of the knees were cemented and 36 uncemented. There were no revisions in the cemented group and one revision in the uncemented group for fracture. The uncemented group reported better outcomes with both statistically and clinically significant (p = 0.001) improvements in knee-specific Oxford and Knee Society scores compared with the cemented group. The global
This prospective study presents the ten-year (5 to 16) clinical and radiological results of 55 primary total hip replacements (THR) using a cementless modular femoral component (S-ROM). All patients had a significant anatomical abnormality which rendered the primary THR difficult. The mean Harris hip score was 36 (12 to 72) pre-operatively, 83 (44 to 100) at five years, and 85 (45 to 99) at ten years. The Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and short-form (SF)-12 scores were recorded from the year 2000. The mean
Aims. Complex total hip arthroplasty (THA) with subtrochanteric shortening osteotomy is necessary in conditions other than developmental dysplasia of the hip (DDH) and septic arthritis sequelae with significant proximal femur migration. Our aim was to evaluate the hip centre restoration with THAs in these hips. Methods. In all, 27 THAs in 25 patients requiring THA with femoral shortening between 2012 and 2019 were assessed. Bilateral shortening was required in two patients. Subtrochanteric shortening was required in 14 out of 27 hips (51.9%) with aetiology other than DDH or septic arthritis. Vertical centre of rotation (VCOR), horizontal centre of rotation, offset, and functional outcome was calculated. The mean followup was 24.4 months (5 to 92 months). Results. The mean VCOR was 17.43 mm (9.5 to 27 mm) and horizontal centre of rotation (HCOR) was 24.79 mm (17.2 to 37.6 mm). Dislocation at three months following acetabulum reconstruction required femoral shortening for offset correction and hip centre restoration in one hip. Mean horizontal offset was 39.72 (32.7 to 48.2 mm) compared to 42.89 (26.7 to 50.6 mm) on the normal side. Mean Harris Hip Score (HHS) of 22.64 (14 to 35) improved to 79.43 (68 to 92). Mean pre-operative shortening was 3.95 cm (2 to 8 cm). Residual limb length discrepancy was 1.5 cm (0 to 2 cm). Sciatic neuropraxia in two patients recovered by six months, and femoral neuropraxia in one hip recovered by 12 months. Mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was 13.92 (9 to 19). Mean
Aims. The primary aim of this study was to compare the knee-specific functional outcome of patellofemoral arthroplasty with total knee arthroplasty (TKA) in the management of patients with patellofemoral osteoarthritis. Patients and Methods. A total of 54 consecutive Avon patellofemoral arthroplasties were identified and propensity-score-matched to a group of 54 patients undergoing a TKA with patellar resurfacing for patellofemoral osteoarthritis. The Oxford Knee Score (OKS), the 12-Item Short-Form Health Survey (SF-12), and patient satisfaction were collected at a mean follow up of 9.2 years (8 to 15). Survival was defined by revision or intention to revise. Results. There was no significant difference in the mean OKS (p > 0.60) or
Aims. We conducted a randomised controlled trial to assess the accuracy
of positioning and alignment of the components in total knee arthroplasty
(TKA), comparing those undertaken using standard intramedullary
cutting jigs and those with patient-specific instruments (PSI). Patients and Methods. There were 64 TKAs in the standard group and 69 in the PSI group. The post-operative hip-knee-ankle (HKA) angle and positioning
was investigated using CT scans. Deviation of >
3° from the planned
position was regarded as an outlier. The operating time, Oxford
Knee Scores (OKS) and Short Form-12 (SF-12) scores were recorded. Results. There were 14 HKA-angle outliers (22%) in the standard group
and nine (13%) in the PSI group (p = 0.251). The mean HKA-angle
was 0.5° varus in the standard group and 0.2° varus in the PSI group
(p = 0.492). The accuracy of alignment in the coronal and axial
planes and the proportion of outliers was not different in the two
groups. The femoral component was more flexed (p = 0.035) and there
were significantly more tibial slope outliers (29% versus 13%)
in the PSI group (p = 0.032). Operating time and the median three-month
OKS were similar (p = 0.218 and p = 0.472, respectively). Physical
and mental
Up to 20% of patients are not satisfied with the outcome following total knee replacement (TKR). This study investigated the pre- and post-operative predictors of dissatisfaction in a large cohort of patients undergoing TKR. We assessed 1217 consecutive patients between 2006 and 2008 both before operation and six months after, using the Short-form (SF)-12 health questionnaire and the Oxford Knee Score. Detailed information concerning comorbidity was also gathered. Satisfaction was measured at one year when 18.6% (226 of 1217) of patients were unsure or dissatisfied with their replacement and 81.4% (911 of 1217) were satisfied or very satisfied. Multivariate regression analysis was performed to identify independent predictors of dissatisfaction. Significant (p <
0.001) predictors at one year included the pre-operative SF-12 mental component score, depression and pain in other joints, the six-month
Aims . This is the first prospective study to report the pre- and post-operative
patient reported outcomes and satisfaction scores following excision
of interdigital Morton’s neuroma. Patients and Methods. Between May 2006 and April 2013, we prospectively studied 99
consecutive patients (111 feet) who were to undergo excision of
a Morton’s neuroma. There were 78 women and 21 men with a mean age
at the time of surgery of 56 years (22 to 78). Patients completed
the Manchester-Oxford Foot Questionnaire (MOXFQ), Short Form-12
(SF-12) and a supplementary patient satisfaction survey three months
pre-operatively and six months post-operatively. Results. Statistically significant differences were found between the
mean pre- and post-operative MOXFQ and the physical component of
the
Primary arthroplasty may be denied to very elderly patients based upon the perceived outcome and risks associated with surgery. This prospective study compared the outcome, complications, and mortality of total hip (TKR) and total knee replacement (TKR) in a prospectively selected group of patients aged ≥ 80 years with that of a control group aged between 65 and 74 years. There were 171 and 495 THRs and 185 and 492 TKRs performed in the older and control groups, respectively. No significant difference was observed in the mean improvement of Oxford hip and knee scores between the groups at 12 months (0.98, (95% confidence interval (CI) −0.66 to 2.95), p = 0.34 and 1.15 (95% CI −0.65 to 2.94), p = 0.16, respectively). The control group had a significantly (p = 0.02 and p = 0.04, respectively) greater improvement in the physical well being component of their
We assessed the effect of social deprivation
upon the Oxford knee score (OKS), the Short-Form 12 (SF-12) and patient
satisfaction after total knee replacement (TKR). An analysis of
966 patients undergoing primary TKR for symptomatic osteoarthritis
(OA) was performed. Social deprivation was assessed using the Scottish
Index of Multiple Deprivation. Those patients that were most deprived
underwent surgery at an earlier age (p = 0.018), were more likely
to be female (p = 0.046), to endure more comorbidities (p = 0.04)
and to suffer worse pain and function according to the OKS (p <
0.001). In addition, deprivation was also associated with poor mental
health (p = 0.002), which was assessed using the mental component
(MCS) of the
To determine whether platelet-rich plasma (PRP) injection improves outcomes two years after acute Achilles tendon rupture. A randomized multicentre two-arm parallel-group, participant- and assessor-blinded superiority trial was undertaken. Recruitment commenced on 28 July 2015 and two-year follow-up was completed in 21 October 2019. Participants were 230 adults aged 18 years and over, with acute Achilles tendon rupture managed with non-surgical treatment from 19 UK hospitals. Exclusions were insertion or musculotendinous junction injuries, major leg injury or deformity, diabetes, platelet or haematological disorder, medication with systemic corticosteroids, anticoagulation therapy treatment, and other contraindicating conditions. Participants were randomized via a central online system 1:1 to PRP or placebo injection. The main outcome measure was Achilles Tendon Rupture Score (ATRS) at two years via postal questionnaire. Other outcomes were pain, recovery goal attainment, and quality of life. Analysis was by intention-to-treat.Aims
Methods
The aim of this study was to explore the functional results in a fitter subgroup of participants in the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial to determine whether there was an advantage of total hip arthroplasty (THA) versus hemiarthroplasty (HA) in this population. We performed a post hoc exploratory analysis of a fitter cohort of patients from the HEALTH trial. Participants were aged over 50 years and had sustained a low-energy displaced femoral neck fracture (FNF). The fittest participant cohort was defined as participants aged 70 years or younger, classified as American Society of Anesthesiologists grade I or II, independent walkers prior to fracture, and living at home prior to fracture. Multilevel models were used to estimate the effect of THA versus HA on functional outcomes. In addition, a sensitivity analysis of the definition of the fittest participant cohort was performed.Aims
Methods
Using data from the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial, we sought to determine if a difference in functional outcomes exists between monopolar and bipolar hemiarthroplasty (HA). This study is a secondary analysis of patients aged 50 years or older with a displaced femoral neck fracture who were enrolled in the HEALTH trial and underwent monopolar and bipolar HA. Scores from the Western Ontario and McMaster University Arthritis Index (WOMAC) and 12-Item Short Form Health Survey (SF-12) Physical Component Summary (PCS) and (MCS) were compared between the two HA groups using a propensity score-weighted analysis.Aims
Methods
Robotic-assisted unicompartmental knee arthroplasty (R-UKA) has been proposed as an approach to improve the results of the conventional manual UKA (C-UKA). The aim of this meta-analysis was to analyze the studies comparing R-UKA and C-UKA in terms of clinical outcomes, radiological results, operating time, complications, and revisions. The literature search was conducted on three databases (PubMed, Cochrane, and Web of Science) on 20 February 2024 according to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Inclusion criteria were comparative studies, written in the English language, with no time limitations, on the comparison of R-UKA and C-UKA. The quality of each article was assessed using the Downs and Black Checklist for Measuring Quality.Aims
Methods
In cases of severe periprosthetic joint infection (PJI) of the knee, salvage procedures such as knee arthrodesis (KA) or above-knee amputation (AKA) must be considered. As both treatments result in limitations in quality of life (QoL), we aimed to compare outcomes and factors influencing complication rates, mortality, and mobility. Patients with PJI of the knee and subsequent KA or AKA between June 2011 and May 2021 were included. Demographic data, comorbidities, and patient history were analyzed. Functional outcomes and QoL were prospectively assessed in both groups with additional treatment-specific scores after AKA. Outcomes, complications, and mortality were evaluated.Aims
Methods
The open Latarjet procedure is a widely used treatment for recurrent anterior instability of the shoulder. Although satisfactory outcomes are reported, factors which influence a patient’s experience are poorly quantified. The aim of this study was to evaluate the effect of a range of demographic factors and measures of the severity of instability on patient-reported outcome measures in patients who underwent an open Latarjet procedure at a minimum follow-up of two years. A total of 350 patients with anterior instability of the shoulder who underwent an open Latarjet procedure between 2005 and 2018 were reviewed prospectively, with the collection of demographic and psychosocial data, preoperative CT, and complications during follow-up of two years. The primary outcome measure was the Western Ontario Shoulder Instability Index (WOSI), assessed preoperatively, at two years postoperatively, and at mid-term follow-up at a mean of 50.6 months (SD 24.8) postoperatively. The secondary outcome measure was the abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. The influence of the demographic details of the patients, measurements of the severity of instability, and the complications of surgery were assessed in a multivariate analysis.Aims
Methods
To map literature on prognostic factors related to outcomes of revision total knee arthroplasty (rTKA), to identify extensively studied factors and to guide future research into what domains need further exploration. We performed a systematic literature search in MEDLINE, Embase, and Web of Science. The search string included multiple synonyms of the following keywords: "revision TKA", "outcome" and "prognostic factor". We searched for studies assessing the association between at least one prognostic factor and at least one outcome measure after rTKA surgery. Data on sample size, study design, prognostic factors, outcomes, and the direction of the association was extracted and included in an evidence map.Aims
Methods
The aims of this study were to determine the
functional impact and financial burden of isolated and recurrent dislocation
after total hip arthroplasty (THA). Our secondary goal was to determine
whether there was a difference between patients who were treated
non-operatively and those who were treated operatively. . We retrospectively reviewed 71 patients who had suffered dislocation
of a primary THA. Their mean age was 67 years (41 to 92) and the
mean follow-up was 3.8 years (2.1 to 8.2). . Because patients with recurrent dislocation were three times
more likely to undergo operative treatment (p <
0.0001), they
ultimately had a significantly higher mean Harris Hip Score (HHS)
(p = 0.0001), lower mean Western Ontario and McMaster Universities
Arthritis Index (WOMAC) scores (p = 0.001) and a higher mean SF-12
score (p <
0.0001) than patients with a single dislocation. Likewise,
those who underwent operative treatment had a higher mean HHS (p
<
0.0001), lower mean WOMAC score (p <
0.0001) and a higher
mean
To identify the responsiveness, minimal clinically important difference (MCID), minimal clinical important change (MIC), and patient-acceptable symptom state (PASS) thresholds in the 36-item Short Form Health Survey questionnaire (SF-36) (v2) for each of the eight dimensions and the total score following total knee arthroplasty (TKA). There were 3,321 patients undergoing primary TKA with preoperative and one-year postoperative SF-36 scores. At one-year patients were asked how satisfied they were and “How much did the knee arthroplasty surgery improve the quality of your life?”, which was graded as: great, moderate, little (n = 277), none (n = 98), or worse.Aims
Methods
To investigate the impact of the Charlson and Elixhauser comorbidity indices on patient-reported outcomes measures (PROMs) following shoulder arthroplasty. Patients undergoing total shoulder arthroplasty (TSA), reverse shoulder arthroplasty (RSA), or hemiarthroplasty (HA) from 2016 to 2018 were identified, along with the Charlson and Elixhauser comorbidities listed as their secondary diagnoses in the electronic medical records. Patients were matched to our institution’s registry to obtain their PROMs, including shoulder-specific (American Shoulder and Elbow Society (ASES) and Shoulder Activity Scale (SAS)) and general health scales (12-Item Short Form Survey (SF-12) and Patient-Reported Outcomes Measurement Information System-Pain Interference). Linear regression models adjusting for age and sex were used to evaluate the association between increasing number of comorbidities and PROM scores. A total of 1,817 shoulder arthroplasties were performed: 1,017 (56%) TSA, 726 (40%) RSA, and 74 (4%) HA. The mean age was 67 years (SD 10), and 936 (52%) of the patients were female.Aims
Methods
This study reports updates the previously published two-year clinical, functional, and radiological results of a group of patients who underwent transfibular total ankle arthroplasty (TAA), with follow-up extended to a minimum of five years. We prospectively evaluated 89 patients who underwent transfibular TAA for end-stage osteoarthritis. Patients’ clinical and radiological examinations were collected pre- and postoperatively at six months and then annually for up to five years of follow-up. Three patients were lost at the final follow-up with a total of 86 patients at the final follow-up.Aims
Methods
Our objective was to conduct a systematic review and meta-analysis, to establish whether differences arise in clinical outcomes between autologous and synthetic bone grafts in the operative management of tibial plateau fractures. A structured search of MEDLINE, EMBASE, the online archives of Bone & Joint Publishing, and CENTRAL databases from inception until 28 July 2021 was performed. Randomized, controlled, clinical trials that compared autologous and synthetic bone grafts in tibial plateau fractures were included. Preclinical studies, clinical studies in paediatric patients, pathological fractures, fracture nonunion, or chondral defects were excluded. Outcome data were assessed using the Risk of Bias 2 (ROB2) framework and synthesized in random-effect meta-analysis. The Preferred Reported Items for Systematic Review and Meta-Analyses guidance was followed throughout.Aims
Methods
To compare the in vivo long-term fixation achieved by two acetabular components with different porous ingrowth surfaces using radiostereometric analysis (RSA). This was a minimum ten-year follow-up of a prospective randomized trial of 62 hips with two different porous ingrowth acetabular components. RSA exams had previously been acquired through two years of follow-up. Patients returned for RSA examination at a minimum of ten years. In addition, radiological appearance of these acetabular components was analyzed, and patient-reported outcome measures (PROMs) obtained.Aims
Methods
The aims of this systematic review were to assess the learning curve of semi-active robotic arm-assisted total hip arthroplasty (rTHA), and to compare the accuracy, patient-reported functional outcomes, complications, and survivorship between rTHA and manual total hip arthroplasty (mTHA). Searches of PubMed, Medline, and Google Scholar were performed in April 2020 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included “robotic”, “hip”, and “arthroplasty”. The criteria for inclusion were published clinical research articles reporting the learning curve for rTHA (robotic arm-assisted only) and those comparing the implantation accuracy, functional outcomes, survivorship, or complications with mTHA.Aims
Methods
The management of symptomatic osteochondral lesions of the talus (OLTs) can be challenging. The number of ways of treating these lesions has increased considerably during the last decade, with published studies often providing conflicting, low-level evidence. This paper aims to present an up-to-date concise overview of the best evidence for the surgical treatment of OLTs. Management options are reviewed based on the size of the lesion and include bone marrow stimulation, bone grafting options, drilling techniques, biological preparations, and resurfacing. Although many of these techniques have shown promising results, there remains little high level evidence, and further large scale prospective studies and systematic reviews will be required to identify the optimal form of treatment for these lesions. Cite this article:
The current study aimed to compare robotic arm-assisted (RA-THA), computer-assisted (CA-THA), and manual (M-THA) total hip arthroplasty regarding in-hospital metrics including length of stay (LOS), discharge disposition, in-hospital complications, and cost of RA-THA versus M-THA and CA-THA versus M-THA, as well as trends in use and uptake over a ten-year period, and future projections of uptake and use of RA-THA and CA-THA. The National Inpatient Sample was queried for primary THAs (2008 to 2017) which were categorized into RA-THA, CA-THA, and M-THA. Past and projected use, demographic characteristics distribution, income, type of insurance, location, and healthcare setting were compared among the three cohorts. In-hospital complications, LOS, discharge disposition, and in-hospital costs were compared between propensity score-matched cohorts of M-THA versus RA-THA and M-THA versus CA-THA to adjust for baseline characteristics and comorbidities.Aims
Methods
Cement-in-cement revision of the femoral component represents a widely practised technique for a variety of indications in revision total hip arthroplasty. In this study, we compare the clinical and radiological outcomes of two polished tapered femoral components. From our prospectively collated database, we identified all patients undergoing cement-in-cement revision from January 2005 to January 2013 who had a minimum of two years' follow-up. All cases were performed by the senior author using either an Exeter short revision stem or the C-Stem AMT high offset No. 1 prosthesis. Patients were followed-up annually with clinical and radiological assessment.Aims
Methods
Acetabular fractures in older adults lead to a high risk of mortality and morbidity. However, only limited data have been published documenting functional outcomes in such patients. The aims of this study were to describe outcomes in patients aged 60 years and older with operatively managed acetabular fractures, and to establish predictors of conversion to total hip arthroplasty (THA). We conducted a retrospective, registry-based study of 80 patients aged 60 years and older with acetabular fractures treated surgically at The Alfred and Royal Melbourne Hospital. We reviewed charts and radiological investigations and performed patient interviews/examinations and functional outcome scoring. Data were provided by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Survival analysis was used to describe conversion to THA in the group of patients who initially underwent open reduction and internal fixation (ORIF). Multivariate regression analyses were performed to identify factors associated with conversion to THA.Aims
Methods
The primary aim of this study was to assess whether pain in the contralateral knee had a clinically significant influence on the outcome of total knee arthroplasty (TKA) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Secondary aims were to: describe the prevalence of contralateral knee pain; identify if it clinically improves after TKA; and assess whether contralateral knee pain independently influences patient satisfaction with their TKA. A retrospective cohort of 3,178 primary TKA patients were identified from an arthroplasty database. Patient characteristics, comorbidities, and WOMAC scores were collected preoperatively and one year postoperatively for the index knee. In addition, WOMAC pain scores were also collected for the contralateral knee. Overall patient satisfaction was assessed at one year. Preoperative contralateral knee pain was defined according to the WOMAC score: minimal (> 78 points), mild (59 to 78), moderate (44 to 58), and severe (< 44). Multivariate regression analysis was used to adjust for confounding.Aims
Methods
Recent studies have suggested that corticosteroid injections into the knee may harm the joint resulting in cartilage loss and possibly accelerating the progression of osteoarthritis (OA). The aim of this study was to assess whether patients with, or at risk of developing, symptomatic osteoarthritis of the knee who receive intra-articular corticosteroid injections have an increased risk of requiring arthroplasty. We used data from the Osteoarthritis Initiative (OAI), a multicentre observational cohort study that followed 4,796 patients with, or at risk of developing, osteoarthritis of the knee on an annual basis with follow-up available up to nine years. Increased risk for symptomatic OA was defined as frequent knee symptoms (pain, aching, or stiffness) without radiological evidence of OA and two or more risk factors, while OA was defined by the presence of both femoral osteophytes and frequent symptoms in one or both knees. Missing data were imputed with multiple imputations using chained equations. Time-dependent propensity score matching was performed to match patients at the time of receving their first injection with controls. The effect of corticosteroid injections on the rate of subsequent (total and partial) knee arthroplasty was estimated using Cox proportional-hazards survival analyses.Aims
Methods
Hip resurfacing arthroplasty (HRA) is typically indicated for young and active patients. Due to the longevity of arthroplasty, these patients are likely to undergo revision surgery during their lifetime. There is a paucity of information on the long-term outcome of revision surgeries performed after failed HRA. The aim of our study was to provide survivorship data as well as clinical scores after HRA revisions. A total of 42 patients (43 hips) were revised after HRA at our centre to a variety of devices, including four HRA and 39 total hip arthroplasties (THAs). In addition to perioperative complications, University of California, Los Angeles (UCLA) hip scores and 12-Item Short-Form Health Survey questionnaire (SF-12) quality of life scores were collected at follow-up visits after the primary HRA and after revision surgery.Aims
Methods
Bone demonstrates good healing capacity, with a variety of strategies being utilized to enhance this healing. One potential strategy that has been suggested is the use of stem cells to accelerate healing. The following databases were searched: MEDLINE, CENTRAL, EMBASE, Cochrane Database of Systematic Reviews, WHO-ICTRP, ClinicalTrials.gov, as well as reference checking of included studies. The inclusion criteria for the study were: population (any adults who have sustained a fracture, not including those with pre-existing bone defects); intervention (use of stem cells from any source in the fracture site by any mechanism); and control (fracture healing without the use of stem cells). Studies without a comparator were also included. The outcome was any reported outcomes. The study design was randomized controlled trials, non-randomized or observational studies, and case series.Aims
Methods
It is unusual, if not unique, for three major research papers concerned with the management of the fractured neck of femur (FNOF) to be published in a short period of time, each describing large prospective randomized clinical trials. These studies were conducted in up to 17 countries worldwide, involving up to 80 surgical centers and include large numbers of patients (up to 2,900) with FNOF. Each article investigated common clinical dilemmas; the first paper comparing total hip arthroplasty versus hemiarthroplasty for FNOF, the second as to whether ‘fast track’ care offers improved clinical outcomes and the third, compares sliding hip with multiple cancellous hip screws. Each paper has been deemed of sufficient quality and importance to warrant publication in The Lancet or the New England Journal of Medicine. Although ‘premier’ journals, they only occationally contain orthopaedic studies and thus may not be routinely read by the busy orthopaedic/surgical clinician of any grade. It is therefore our intention with this present article to accurately summarize and combine the results of all three papers, presenting, in our opinion, the most important clinically relevant facts. Cite this article:
The primary aim of this study was to establish the cost-effectiveness of the early fixation of displaced midshaft clavicle fractures. A cost analysis was conducted within a randomized controlled trial comparing conservative management (n = 92) Aims
Patients and Methods
Flexor hallucis longus (FHL) tendon transfer is a well-recognized
technique in the treatment of the neglected tendo Achillis (TA)
rupture. We report a retrospective review of 20/32 patients who had undergone
transtendinous FHL transfer between 2003 and 2011 for chronic TA
rupture. Their mean age at the time of surgery was 53 years (22
to 83). The mean time from rupture to surgery was seven months (1
to 36). The mean postoperative follow-up was 73 months (29 to 120).
Six patients experienced postoperative wound complications.Aims
Patients and Methods
The aim of this study was to characterize the factors leading to transfemoral amputation after total knee arthroplasty (TKA), as well as the rates of mortality and functional independence after this procedure in these patients. This was a multicentre retrospective review with a prospective telephone survey for the assessment of function. All patients with a TKA who subsequently required transfemoral amputation between January 2001 and December 2015 were included. Demographic information, medical comorbidities, and postoperative mortality data were collected. A 19-item survey was used for the assessment of function in surviving patients.Aims
Patients and Methods
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
As the population ages, there is projected to be an increase in the level of demand for total knee arthroplasty (TKA) in octogenarians. We aimed to explore whether those aged ≥ 80 years achieved similar improvements in physical function to younger patients while also comparing the rates of length of stay (LOS), discharge to rehabilitation, postoperative complications, and mortality following TKA in older and younger patients. Patients from one institution who underwent primary elective TKA between 1 January 2006 and 31 December 2014 were dichotomized into those ≥ 80 years old (n = 359) and those < 80 years old (n = 2479) for comparison. Multivariable regression was used to compare the physical status component of the 12-Item Short-Form Health Survey (SF-12), LOS, discharge to rehabilitation, complications, and mortality between the two groups.Aims
Patients and Methods
Intra-articular 90Yttrium (90Y) is an adjunct
to surgical treatment by synovectomy for patients with diffuse-type tenosynovial
giant-cell tumour (dtTGCT) of the knee, with variable success rates.
Clinical information is, however, sparse and its value remains unclear.
We investigated the long-term outcome of patients who underwent synovectomy
with and without adjuvant treatment with 90Yttrium. All patients with dtTGCT of the knee who underwent synovectomy
between 1991 and 2014 were included in the study. Group A patients
underwent synovectomy and an intra-articular injection of 90Yttrium
between six and eight weeks after surgery. Group B patients underwent
surgery alone.Aims
Patients and Methods
The surgical challenge with severe hindfoot injuries is one of technical feasibility, and whether the limb can be salvaged. There is an additional question of whether these injuries should be managed with limb salvage, or whether patients would achieve a greater quality of life with a transtibial amputation. This study aims to measure functional outcomes in military patients sustaining hindfoot fractures, and identify injury features associated with poor function. Follow-up was attempted in all United Kingdom military casualties sustaining hindfoot fractures. All respondents underwent short-form (SF)-12 scoring; those retaining their limb also completed the American Academy of Orthopaedic Surgeons Foot and Ankle (AAOS F&A) outcomes questionnaire. A multivariate regression analysis identified injury features associated with poor functional recovery.Objectives
Methods
To examine the mid-term outcome and cost utility of the BioPro
metallic hemiarthroplasty for the treatment of hallux rigidius. We reviewed 97 consecutive BioPro metallic hemiarthroplasties
performed in 80 patients for end-stage hallux rigidus, with a minimum
follow-up of five years. There were 19 men and 61 women; their mean
age was 55 years (22 to 74). No patient was lost to follow-up.Aims
Patients and Methods
The primary aim of this study was to assess whether patient satisfaction
one year after total knee arthroplasty (TKA) changed with longer
follow-up. The secondary aims were to identify predictors of satisfaction
at one year, persistence of patient dissatisfaction, and late onset
dissatisfaction in patients that were originally satisfied at one year. A retrospective cohort consisting of 1369 patients undergoing
a primary TKA for osteoarthritis that had not undergone revision
were identified from an established arthroplasty database. Patient
demographics, comorbidities, Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC) scores, and Short Form 12 (SF-12) questionnaire
scores were collected preoperatively, and one and five years postoperatively.
In addition, patient satisfaction was assessed at one and five years
postoperatively. Logistic regression analysis was used to identify
independent predictors of satisfaction at one and five years.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
Controversy remains whether the contralateral
hip should be fixed in patients presenting with unilateral slipped capital
femoral epiphysis (SCFE). This retrospective study compares the
outcomes and cost of those patients who had prophylactic fixation
with those who did not. Between January 2000 and December 2010 a total of 50 patients
underwent unilateral fixation and 36 had prophylactic fixation of
the contralateral hip. There were 54 males and 32 females with a
mean age of 12.3 years (9 to 16). The rate of a subsequent slip
without prophylactic fixation was 46%. The risk of complications
was greater, the generic health measures (Short Form-12 physical
(p <
0.001) and mental (p = 0.004) summary scores) were worse.
Radiographic cam lesions in patients presenting with unilateral
SCFE were only seen in patients who did not have prophylactic fixation.
Furthermore, prophylactic fixation of the contralateral hip was
found to be a cost-effective procedure, with a cost per quality
adjusted life year gained of £1431 at the time of last follow-up. Prophylactic fixation of the contralateral hip is a cost-effective
operation that limits the morbidity from the complications of a
further slip, and the diminished functional outcome associated with
unilateral fixation. Cite this article:
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
Preservation of posterior condylar offset (PCO) has been shown to correlate with improved functional results after primary total knee arthroplasty (TKA). Whether this is also the case for revision TKA, remains unknown. The aim of this study was to assess the independent effect of PCO on early functional outcome after revision TKA. A total of 107 consecutive aseptic revision TKAs were performed by a single surgeon during an eight-year period. The mean age was 69.4 years (39 to 85) and there were 59 female patients and 48 male patients. The Oxford Knee Score (OKS) and Short-form (SF)-12 score were assessed pre-operatively and one year post-operatively. Patient satisfaction was also assessed at one year. Joint line and PCO were assessed radiographically at one year.Objectives
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 prospective study assessed the effect of social deprivation on the Oxford hip score at one year after total hip replacement. An analysis of 1312 patients undergoing 1359 primary total hip replacements for symptomatic osteoarthritis was performed over a 35-month period. Social deprivation was assessed using the Carstairs index. Those patients who were most deprived underwent surgery at an earlier age (p = 0.04), had more comorbidities (p = 0.02), increased severity of symptoms at presentation (p = 0.001), and were not as satisfied with their outcome (p = 0.03) compared with more affluent patients. There was a significant improvement in Oxford scores at 12 months relative to pre-operative scores for all socioeconomic categories (p <
0.001). Social deprivation was a significant independent predictor of mean improvement in Oxford scores at 12 months, after adjusting for confounding variables (p = 0.001). Deprivation was also associated with an increased risk of dislocation (odds ratio 5.3, p <
0.001) and mortality at 90 days (odds ratio 3.2, p = 0.02). Outcome, risk of dislocation and early mortality after a total hip replacement are affected by the socioeconomic status of the patient
Hip resurfacing arthroplasty (HRA) is an alternative to conventional
total hip arthroplasty for patients with osteonecrosis (ON) of the
femoral head. Our aim was to report the long-term outcome of HRA,
which is not currently known. Long-term survivorship, clinical scores and radiographic results
for 82 patients (99 hips) treated with HRA for ON over a period
of 18 years were reviewed retrospectively. The mean age of the 67
men and 15 women at the time of surgery was 40.8 years (14 to 64).
Patients were resurfaced regardless of the size of the osteonecrotic
lesion.Aims
Patients and Methods
Patient expectations and their fulfilment are
an important factor in determining patient-reported outcome and satisfaction
of hip (THR) and knee replacement (TKR). The aim of this prospective
cohort study was to examine the expectations of patients undergoing
THR and TKR, and to identify differences in expectations, predictors
of high expectations and the relationship between the fulfilment
of expectations and patient-reported outcome measures. During the
study period, patients who underwent 346 THRs and 323 TKRs completed
an expectation questionnaire, Oxford score and Short-Form 12 (SF-12)
score pre-operatively. At one year post-operatively, the Oxford
score, SF-12, patient satisfaction and expectation fulfilment were
assessed. Univariable and multivariable analysis were performed.
Improvements in mobility and daytime pain were the most important
expectations in both groups. Expectation level did not differ between
THR and TKR. Poor Oxford score, younger age and male gender significantly
predicted high pre-operative expectations (p <
0.001). The level
of pre-operative expectation was not significantly associated with
the fulfilment of expectations or outcome. THR better met the expectations
identified as important by patients. TKR failed to meet expectations
of kneeling, squatting and stair climbing. High fulfilment of expectation
in both THR and TKR was significantly predicted by young age, greater
improvements in Oxford score and high pre-operative mental health
scores. The fulfilment of expectations was highly correlated with satisfaction.
The October 2015 Research Roundup360 looks at: Wasted implants; Biofilms revisited; Peri-operative anticoagulation not required in atrial fibrillation; Determinants in outcome following orthopaedic surgery; Patient ‘activation’ and outcomes; Neuroplasticity and nerve repair; KOOS Score in predicting injury?
The purpose of this study was to compare clinical
outcomes of total knee arthroplasty (TKA) after manipulation under
anaesthesia (MUA) for post-operative stiffness with a matched cohort
of TKA patients who did not requre MUA. In total 72 patients (mean age 59.8 years, 42 to 83) who underwent
MUA following TKA were identified from our prospective database
and compared with a matched cohort of patients who had undergone
TKA without subsequent MUA. Patients were evaluated for range of
movement (ROM) and clinical outcome scores (Western Ontario and
McMaster Universities Arthritis Index, Short-Form Health Survey,
and Knee Society Clinical Rating System) at a mean follow-up of
36.4 months (12 to 120). MUA took place at a mean of nine weeks
(5 to 18) after TKA. In patients who required MUA, mean flexion
deformity improved from 10° (0° to 25°) to 4.4° (0° to 15°) (p <
0.001),
and mean range of flexion improved from 79.8° (65° to 95°) to 116°
(80° to 130°) (p <
0.001). There were no statistically significant
differences in ROM or functional outcome scores at three months,
one year, or two years between those who required MUA and those
who did not. There were no complications associated with manipulation At most recent follow-up, patients requiring MUA achieved equivalent
ROM and clinical outcome scores when compared with a matched control
group. While other studies have focused on ROM after manipulation,
the current study adds to current literature by supplementing this
with functional outcome scores. Cite this article:
We compared the outcome of arthroscopic repair of the rotator cuff in 32 diabetic patients with the outcome in 32 non-diabetic patients matched for age, gender, size of tear and comorbidities. The Constant-Murley score improved from a mean of 49.2 (24 to 80) pre-operatively to 60.8 (34 to 95) post-operatively (p = 0.0006) in the diabetic patients, and from 46.4 (23 to 90) pre-operatively to 65.2 (25 to 100) post-operatively (p = 0.0003) in the non-diabetic patients at six months. This was significantly greater (p = 0.0002) in non-diabetic patients (18.8) than in diabetics (11.6). There was no significant change in the mean mental component of the Short-Form 12, but the mean physical component increased from 35 to 41 in non-diabetics (p = 0.0001), and from 37 to 39 (p = 0.15) in diabetics. These trends were observed at one year. Patients with diabetes showed improvement of pain and function following arthroscopic rotator cuff repair in the short term, but less than their non-diabetic counterparts.
The February 2015 Trauma Roundup360 looks at: Evaluating the syndesmosis in ankle fractures; Calcaneal fracture management an ongoing problem; Angular stable locking in low tibial fractures did not improve results; Open fractures: do the seconds really count?; Long-term outcomes of tibial fractures; Targeted performance improvements in pelvic fractures
There has been debate about the role of unicompartmental knee replacement in the presence of radiologically identifiable degenerative changes of the patellofemoral joint. We studied 195 knees in 163 patients in whom an Oxford unicompartmental knee replacement had been performed for medial osteoarthritis between January 2004 and July 2007. The mean age of the patients was 66 years (51 to 93). The degree of degenerative change of the patellofemoral joint was assessed using Jones’ criteria. Functional outcome was assessed at a mean of 3.4 years (2 to 7) post-operatively, using the Oxford knee score and the Short-form 12 score. Degenerative changes of the patellofemoral joint were seen pre-operatively in 125 knees (64%) on the skyline radiographs. There was no statistically significant difference in the Oxford knee or Short-form 12 scores between those patients who had patellofemoral osteoarthritis pre-operatively and those who did not (p = 0.22 and 0.54, respectively). These results support the opinion expressed at the designer’s hospital that degenerative changes of the patellofemoral joint in isolation should not be considered to be a contraindication to medial Oxford unicompartmental knee replacement.
The ideal bearing surface for young patients
undergoing total hip replacement (THR) remains controversial. We report
the five-year results of a randomised controlled trial comparing
the clinical and radiological outcomes of 102 THRs in 91 patients
who were <
65 years of age. These patients were randomised to
receive a cobalt–chrome on ultra-high-molecular-weight polyethylene,
cobalt–chrome on highly cross-linked polyethylene, or a ceramic-on-ceramic
bearing. In all, 97 hip replacements in 87 patients were available
for review at five years. Two hips had been revised, one for infection
and one for peri-prosthetic fracture. At the final follow-up there were no significant differences
between the groups for the mean Western Ontario and McMaster Universities
osteoarthritis index (pain, p = 0.543; function, p = 0.10; stiffness,
p = 0.99), Short Form-12 (physical component, p = 0.878; mental
component, p = 0.818) or Harris hip scores (p = 0.22). Radiological
outcomes revealed no significant wear in the ceramic group. Comparison of standard and highly cross-linked polyethylene,
however, revealed an almost threefold difference in the mean annual
linear wear rates (0.151 mm/year
We evaluated the outcome of primary total hip replacement (THR) in 3290 patients with the primary diagnosis of osteoarthritis at a minimum follow-up of two years. They were stratified into categories of body mass index (BMI) based on the World Health Organisation classification of obesity. Statistical analysis was carried out to determine if there was a difference in the post-operative Western Ontario and McMaster Universities osteoarthritis index, the Harris hip score and the Short-Form-12 outcome based on the BMI. While the pre- and post-operative scores were lower for the group classified as morbidly obese, the overall change in outcome scores suggested an equal if not greater improvement compared with the non-morbidly obese patients. The overall survivorship and rate of complications were similar in the BMI groups although there was a slightly higher rate of revision for sepsis in the morbidly obese group. Morbid obesity does not affect the post-operative outcome after THR, with the possible exception of a marginally increased rate of infection. Therefore withholding surgery based on the BMI is not justified.
The August 2014 Trauma Roundup360 looks at: On-table CT for calcaneal fractures; timing of femoral fracture surgery and outcomes; salvage arthroplasty for failed internal fixation of the femoral neck; screw insertion in osteoporotic bone; fibular intramedullary nailing on the ascendant; posterior wall acetabular fractures not all that innocent; bugs, plating and resistance and improving outcomes in olecranon tension band wiring.
We hypothesised that the removal of the subchondral
bone plate (SCBP) for cemented acetabular component fixation in
total hip arthroplasty (THA) offers advantages over retention by
improving the cement-bone interface, without jeopardising implant
stability. We have previously published two-year follow-up data
of a randomised controlled trial (RCT), in which 50 patients with
primary osteoarthritis were randomised to either retention or removal
of the SCBP. The mean age of the retention group (n = 25, 13 males)
was 70.0 years ( Cite this article:
The ideal acetabular component is characterised by reliable, long-term fixation with physiological loading of bone and a low rate of wear. Trabecular metal is a porous construct of tantalum which promotes bony ingrowth, has a modulus of elasticity similar to that of cancellous bone, and should be an excellent material for fixation. Between 2004 and 2006, 55 patients were randomised to receive either a cemented polyethylene or a monobloc trabecular metal acetabular component with a polyethylene articular surface. We measured the peri-prosthetic bone density around the acetabular components for up to two years using dual-energy x-ray absorptiometry. We found evidence that the cemented acetabular component loaded the acetabular bone centromedially whereas the trabecular metal monobloc loaded the lateral rim and behaved like a hemispherical rigid metal component with regard to loading of the acetabular bone. We suspect that this was due to the peripheral titanium rim used for the mechanism of insertion.
The April 2014 Knee Roundup360 looks at: mobile compression as good as chemical thromboprophylaxis; patellar injury with MIS knee surgery; tibial plateau fracture results not as good as we thought; back and knee pain; metaphyseal sleeves may be the answer in revision knee replacement; oral tranexamic acid; gentamycin alone in antibiotic spacers; and whether the jury is still out on unloader braces.
In this randomised controlled trial, we evaluated
the role of elastic compression using ankle injury stockings (AIS)
in the management of fractures of the ankle. A total of 90 patients
with a mean age of 47 years (16 to 79) were treated within 72 hours
of presentation with a fracture of the ankle, 31 of whom were treated
operatively and 59 conservatively, were randomised to be treated
either with compression by AIS plus an Aircast boot or Tubigrip
plus an Aircast boot. Male to female ratio was 36:54. The primary
outcome measure was the functional Olerud–Molander ankle score (OMAS).
The secondary outcome measures were; the American Orthopaedic Foot
and Ankle Society score (AOFAS); the Short Form (SF)-12v2 Quality
of Life score; and the frequency of deep vein thrombosis (DVT). Compression using AIS reduced swelling of the ankle at all time
points and improved the mean OMAS score at six months to 98 (95%
confidence interval (CI) 96 to 99) compared with a mean of 67 (95%
CI 62 to 73) for the Tubigrip group (p <
0.001). The mean AOFAS
and SF-12v2 scores at six months were also significantly improved
by compression. Of 86 patients with duplex imaging at four weeks,
five (12%) of 43 in the AIS group and ten (23%) of 43 in the Tubigrip
group developed a DVT (p = 0.26). Compression improved functional outcome and quality of life following
fracture of the ankle. DVTs were frequent, but a larger study would
be needed to confirm that compression with AISs reduces the incidence
of DVT. Cite this article:
The August 2013 Hip &
Pelvis Roundup360 looks at: are we getting it right first time?; tantalum augments in revision hip surgery; lower wear in dual mobility?; changing faces changes outcomes; synovial fluid aspiration in MOM hips; taper disease: the new epidemic of hip surgery; the super-obese and THR; and whether well fixed stems can remain in infected hips
Orthopaedic outcome measures are used to evaluate the effect of operative interventions. They are used for audit and research. Knowledge of these measures is becoming increasingly important with league tables comparing surgeons and hospitals being made accessible to the profession and the general public. Several types of tool are available to describe outcome after hip surgery such as generic quality-of-life questionnaires, disease-specific quality-of-life questionnaires, hip-specific outcome measures and general short-term clinical measures. We provide an overview of the outcome measures commonly used to evaluate hip interventions.
A soft-tissue defect over an infected total knee
replacement (TKR) presents a difficult technical problem that can
be treated with a gastrocnemius flap, which is rotated over the
defect during the first-stage of a revision procedure. This facilitates
wound healing and the safe introduction of a prosthesis at the second
stage. We describe the outcome at a mean follow-up of 4.5 years
(1 to 10) in 24 patients with an infected TKR who underwent this procedure.
A total of 22 (92%) eventually obtained a satisfactory result. The
mean Knee Society score improved from 53 pre-operatively to 103
at the latest follow-up (p <
0.001). The mean Western Ontario
and McMaster Universities osteoarthritis index and Short-Form 12
score also improved significantly (p <
0.001). This form of treatment can be used reliably and safely to treat
many of these complex cases where control of infection, retention
of the components and acceptable functional recovery are the primary
goals. Cite this article:
The June 2013 Knee Roundup360 looks at: knee arthroplasty in diabetic patients; whether TKR is a timebomb; the use of antidepressants for knee OA; trochleoplasty; articulated spacers; mental health and joint replacement; and the use of physiotherapy for meniscal tear.
This study assessed the effect of concomitant
back pain on the Oxford knee score (OKS), Short-Form (SF)-12 and patient
satisfaction after total knee replacement (TKR). It involved a prospectively
compiled database of demographics and outcome scores for 2392 patients
undergoing primary TKR, of whom 829 patients (35%) reported back
pain. Compared with those patients without back pain, those with
back pain were more likely to be female (odds ratio (OR) 1.5 (95%
confidence interval (CI) 1.3 to 1.8)), have a greater level of comorbidity,
a worse pre-operative OKS (2.3 points (95% CI 1.7 to 3.0)) and worse
SF-12 physical (2.0 points (95% CI 1.4 to 2.6)) and mental (3.3
points (95% CI 2.3 to 4.3)) components. One year post-operatively, those with back pain had significantly
worse outcome scores than those without with a mean difference in
the OKS of 5 points (95% CI 3.8 to 5.4), in the SF-12 physical component
of 6 points (95% CI 5.4 to 7.1) and in the mental component of
4 points (95% CI 3.1 to 4.9). Patients with back pain were less
likely to be satisfied (OR 0.62, 95% CI 0.5 to 0.78). After adjusting for confounding variables, concomitant back pain
was an independent predictor of a worse post-operative OKS, and
of dissatisfaction. Clinicians should be aware that patients suffering
concomitant back pain pre-operatively are at an increased risk of
being dissatisfied post-operatively. Cite this article:
We prospectively assessed the efficacy of a ceramic-on-metal
(CoM) hip bearing with uncemented acetabular and femoral components
in which cobalt–chrome acetabular liners and alumina ceramic heads
were used. The cohort comprised 94 total hip replacements (THRs) in 83 patients
(38 women and 45 men) with a mean age of 58 years (42 to 70). Minimum
follow-up was two years. All patients had pre- and post-operative
assessment using the Western Ontario and McMaster Universities osteoarthritis
index (WOMAC), Oxford hip score and Short-Form 12 scores. All showed
a statistically significant improvement from three months post-operatively
onwards (all p <
0.001). After two years whole blood metal ion levels were measured and
chromosomal analysis was performed. The levels of all metal ions
were elevated except vanadium. Levels of chromium, cobalt, molybdenum
and titanium were significantly higher in patients who underwent
bilateral THR compared with those undergoing unilateral THR (p <
0.001).
Chromosomal analysis demonstrated both structural and aneuploidy
mutations. There were significantly more breaks and losses than
in the normal population (p <
0.001). There was no significant
difference in chromosomal aberration between those undergoing unilateral
and bilateral procedures (all analyses p ≥ 0.62). The use of a CoM THR is effective clinically in the short-term,
with no concerns, but the significance of high metal ion levels
and chromosomal aberrations in the long-term remains unclear. Cite this article:
The role of modular tibial implants in total knee replacement is not fully defined. We performed a prospective randomised controlled clinical trial using radiostereophotogrammetric analysis to compare the performance of an all-polyethylene tibia with a metal-backed cruciate-retaining condylar design, PFC-∑ total knee replacement for up to 24 months. There were 51 patients who were randomised into two treatment groups. There were 10 subsequent withdrawals, leaving 21 all-polyethylene and 20 metal-backed tibial implants. No patient was lost to follow-up. There were no significant demographic differences between the groups. At two years one metal-backed implant showed migration >
1 mm, but no polyethylene implant reached this level. There was a significant increase in the SF-12 and Oxford knee scores after operation in both groups. In an uncomplicated primary total knee replacement the all-polyethylene PFC-∑ tibial prosthesis showed no statistical difference in migration from that of the metal-backed counterpart. There was no difference in the clinical results as assessed by the SF-12, the Oxford knee score, alignment or range of movement at 24 months, although these assessment measures were not statistically powered in this study.
The February 2013 Foot &
Ankle Roundup360 looks at: replacement in osteonecrosis of the talus; ankle instability in athletes; long-term follow-up of lateral ankle ligament reconstruction; an operation for Stage II TPD; whether you should operate on Achilles tendon ruptures; Weil osteotomies and Freiberg’s disease; MRI scanning not sensitive for intra-articular lesions; and single-stage debridement and reconstruction in Charcot feet.
The purpose of this study was to examine the
complications and outcomes of total hip replacement (THR) in super-obese
patients (body mass index (BMI) >
50 kg/m2) compared
with class I obese (BMI 30 to 34.9 kg/m2) and normal-weight
patients (BMI 18.5 to 24.9 kg/m2), as defined by the
World Health Organization. A total of 39 THRs were performed in 30 super-obese patients
with a mean age of 53 years (31 to 72), who were followed for a
mean of 4.2 years (2.0 to 11.7). This group was matched with two
cohorts of normal-weight and class I obese patients, each comprising
39 THRs in 39 patients. Statistical analysis was performed to determine differences
among these groups with respect to complications and satisfaction
based on the Western Ontario and McMaster Universities (WOMAC) osteoarthritis
index, the Harris hip score (HHS) and the Short-Form (SF)-12 questionnaire. Super-obese patients experienced significantly longer hospital
stays and higher rates of major complications and readmissions than
normal-weight and class I obese patients. Although super-obese patients
demonstrated reduced pre-operative and post-operative satisfaction
scores, there was no significant difference in improvement, or change in
the score, with respect to HHS or the WOMAC osteoarthritis index. Super-obese patients obtain similar satisfaction outcomes as
class I obese and normal-weight patients with respect to improvement
in their scores. However, they experience a significant increase
in length of hospital stay and major complication and readmission
rates. Cite this article:
We describe the experience with the first consecutive 230 Birmingham hip resurfacings at our centre. At a mean follow-up of three years (25 to 52 months) survivorship was 99.14% with revision in one patient for a loose acetabular component and one death from unrelated causes. One patient developed a fracture of the femoral neck at six weeks which united unremarkably after a period of non-weight-bearing. The Harris hip score improved from a mean of 62.54 (8 to 92) to 97.74 (61 to 100). The mean flexion improved from 91.52° (25 to 140) to 110.41° (80 to 145). Most patients (97%) considered the outcome to be good or excellent. Our preliminary experience with this implant is encouraging and the results are superior to the earlier generation of resurfacings for the same length of follow-up.
Mobile-bearing (MB) total knee replacement (TKR)
was introduced to reduce the risk of aseptic loosening and wear of
polyethylene inserts. However, no consistent clinical advantages
of mobile- over fixed-bearing (FB) TKR have been found. In this
study we evaluated whether mobile bearings have an advantage over
fixed bearings with regard to revision rates and clinical outcome
scores. Furthermore, we determined which modifying variables affected
the outcome. A systematic search of the literature was conducted to collect
clinical trials comparing MB and FB in primary TKR. The primary
outcomes were revision rates for any reason, aseptic loosening and
wear. Secondary outcomes included range of movement, Knee Society
score (KSS), Oxford knee score (OKS), Short-Form 12 (SF-12) score
and radiological parameters. Meta-regression techniques were used
to explore factors modifying the observed effect. Our search yielded 1827 publications, of which 41 studies met
our inclusion criteria, comprising over 6000 TKRs. Meta-analyses
showed no clinically relevant differences in terms of revision rates,
clinical outcome scores or patient-reported outcome measures between
MB and FB TKRs. It appears that theoretical assumptions of superiority
of MB over FB TKR are not borne out in clinical practice. Cite this article:
We report on the use of the Ilizarov method to
treat 40 consecutive fractures of the tibial shaft (35 AO 42C fractures and
five AO 42B3 fractures) in adults. There were 28 men and
12 women with a mean age of 43 years (19 to 81). The series included
19 open fractures (six Gustilo grade 3A and 13 grade 3B) and 21
closed injuries. The mean time from injury to application of definitive
Ilizarov frame was eight days (0 to 35) with 36 fractures successfully
uniting without the need for any bone-stimulating procedure. The
four remaining patients with nonunion healed with a second frame.
There were no amputations and no deep infections. None required
intervention for malunion. The total time to healing was calculated
from date of injury to removal of the frame, with a median of 166
days (mean 187, (87 to 370)). Minor complications included snapped
wires in two patients and minor pin-site infections treated with
oral antibiotics in nine patients (23%). Clinical scores were available
for 32 of the 40 patients at a median of 55 months (mean 62, (26
to 99)) post-injury, with ‘good’ Olerud and Molander ankle scores
(median 80, mean 75, (10 to 100)), ‘excellent’ Lysholm knee scores
(median 97, mean 88, (29 to 100)), a median Tegner activity score
of 4 (mean 4, (0 to 9)) (comparable to ‘moderately heavy labour
/ cycling and jogging’) and Short Form-12 scores that exceeded the
mean of the population as a whole (median physical component score
55 (mean 51, (20 to 64)), median mental component score 57 (mean
53, (21 to 62)). In conclusion, the Ilizarov method is a safe and
reliable way of treating complex tibial shaft fractures with a high
rate of primary union.
We assessed the effect of mental disability on
the outcome of total knee replacement (TKR) and investigated whether
mental health improves post-operatively. Outcome data were prospectively
recorded over a three-year period for 962 patients undergoing primary
TKR for osteoarthritis. Pre-operative and one year Short-Form (SF)-12 scores
and Oxford knee scores (OKS) were obtained. The mental component
of the SF-12 was stratified into four groups according to level
of mental disability (none ≥ 50, mild 40 to 49, moderate 30 to 39,
severe <
30). Patients with any degree of mental disability had
a significantly greater subjective physical disability according
to the SF-12 (p = 0.06) and OKS (p <
0.001). The improvement
in the disease-specific score (OKS) was not affected by a patient’s
mental health (p = 0.33). In contrast, patients with mental disability
had less of an improvement in their global physical health (SF-12)
(p <
0.001). However, patients with any degree of mental disability
had a significant improvement in their mental health post-operatively
(p <
0.001). Despite a similar improvement in their disease-specific scores
and improvement in their mental health, patients with mental disability
were significantly more likely to be dissatisfied with their TKR
at one year (p = 0.001). Patients with poor mental health do benefit
from improvements in their mental health and knee function after
TKR, but also have a higher rate of dissatisfaction. Cite this article:
Techniques for fixation of fractures of the lateral
malleolus have remained essentially unchanged since the 1960s, but
are associated with complication rates of up to 30%. The fibular
nail is an alternative method of fixation requiring a minimal incision
and tissue dissection, and has the potential to reduce the incidence
of complications. We reviewed the results of 105 patients with unstable fractures
of the ankle that were fixed between 2002 and 2010 using the Acumed
fibular nail. The mean age of the patients was 64.8 years (22 to
95), and 80 (76%) had significant systemic medical comorbidities.
Various different configurations of locking screw were assessed
over the study period as experience was gained with the device.
Nailing without the use of locking screws gave satisfactory stability
in only 66% of cases (4 of 6). Initial locking screw constructs
rendered between 91% (10 of 11) and 96% (23 of 24) of ankles stable.
Overall, seven patients had loss of fixation of the fracture and
there were five post-operative wound infections related to the distal
fibula. This lead to the development of the current technique with
a screw across the syndesmosis in addition to a distal locking screw.
In 21 patients treated with this technique there have been no significant
complications and only one superficial wound infection. Good fracture
reduction was achieved in all of these patients. The mean physical
component Short-Form 12, Olerud and Molander score, and American Academy
of Orthopaedic Surgeons Foot and Ankle outcome scores at a mean
of six years post-injury were 46 (28 to 61), 65 (35 to 100) and
83 (52 to 99), respectively. There have been no cases of fibular
nonunion. Nailing of the fibula using our current technique gives good
radiological and functional outcomes with minimal complications,
and should be considered in the management of patients with an unstable
ankle fracture.
We report a prospective analysis of clinical
outcome in patients treated with medial patellofemoral ligament
(MPFL) reconstruction using an autologous semitendinosus graft.
The technique includes superolateral portal arthroscopic assessment
before and after graft placement to ensure correct graft tension
and patellar tracking before fixation. Between October 2005 and
October 2010, a total of 201 consecutive patients underwent 219 procedures.
Follow-up is presented for 211 procedures in 193 patients with a
mean age of 26 years (16 to 49), and mean follow-up of 16 months
(6 to 42). Indications were atraumatic recurrent patellar dislocation
in 141 patients, traumatic recurrent dislocation in 50, pain with
subluxation in 14 and a single dislocation with persistent instability
in six. There have been no recurrent dislocations/subluxations.
There was a statistically significant improvement between available pre-
and post-operative outcome scores for 193 patients (all p <
0.001).
Female patients with a history of atraumatic recurrent dislocation
and all patients with history of previous surgery had a significantly
worse outcome (all p <
0.05). The indication for surgery, degree
of dysplasia, associated patella alta, time from primary dislocation
to surgery and evidence of associated cartilage damage at operation
did not result in any significant difference in outcome. This series adds considerably to existing evidence that MPFL
reconstruction is an effective surgical procedure for selected patients
with patellofemoral instability.
Abnormal knee kinematics following reconstruction
of the anterior cruciate ligament may exist despite an apparent resolution
of tibial laxity and functional benefit. We performed upright, weight-bearing
MR scans of both knees in the sagittal plane at different angles
of flexion to determine the kinematics of the knee following unilateral reconstruction
(n = 12). The uninjured knee acted as a control. Scans were performed
pre-operatively and at three and six months post-operatively. Anteroposterior
tibial laxity was determined using an arthrometer and patient function
by validated questionnaires before and after reconstruction. In
all the knees with deficient anterior cruciate ligaments, the tibial
plateau was displaced anteriorly and internally rotated relative
to the femur when compared with the control contralateral knee,
particularly in extension and early flexion (mean lateral compartment displacement:
extension 7.9 mm ( Our results show that despite improvement in laxity and functional
benefit, abnormal knee kinematics remain at six months and actually
deteriorate from three to six months following reconstruction of
the anterior cruciate ligament.
We undertook a randomised controlled trial to
compare the piriformis-sparing approach with the standard posterior approach
used for total hip replacement (THR). We recruited 100 patients
awaiting THR and randomly allocated them to either the piriformis-sparing
approach or the standard posterior approach. Pre- and post-operative
care programmes and rehabilitation regimes were identical for both
groups. Observers were blinded to the allocation throughout; patients
were blinded until the two-week assessment. Follow-up was at six
weeks, three months, one year and two years. In all 11 patients
died or were lost to follow-up. There was no significant difference between groups for any of
the functional outcomes. However, for patients in the piriformis-sparing
group there was a trend towards a better six-minute walk test at
two weeks and greater patient satisfaction at six weeks. The acetabular
components were less anteverted (p = 0.005) and had a lower mean
inclination angle (p = 0.02) in the piriformis-sparing group. However,
in both groups the mean component positions were within Lewinnek’s
safe zone. Surgeons perceived the piriformis-sparing approach to
be significantly more difficult than the standard approach (p =
0.03), particularly in obese patients. In conclusion, performing THR through a shorter incision involving
sparing piriformis is more difficult and only provides short-term
benefits compared with the standard posterior approach.
The aim of this study was to review the number of patients operated on for traumatic disruption of the pubic symphysis who developed radiological signs of movement of the anterior pelvic metalwork during the first post-operative year, and to determine whether this had clinical implications. A consecutive series of 49 patients undergoing internal fixation of a traumatic diastasis of the pubic symphysis were studied. All underwent anterior fixation of the diastasis, which was frequently combined with posterior pelvic fixation. The fractures were divided into groups using the Young and Burgess classification for pelvic ring fractures. The different combinations of anterior and posterior fixation adopted to stabilise the fractures and the type of movement of the metalwork which was observed were analysed and related to functional outcome during the first post-operative year. In 15 patients the radiographs showed movement of the anterior metalwork, with broken or mobile screws or plates, and in six there were signs of a recurrent diastasis. In this group, four patients required revision surgery; three with anterior fixation and one with removal of anterior pelvic metalwork; the remaining 11 functioned as well as the rest of the study group. We conclude that radiological signs of movement in the anterior pelvic metalwork, albeit common, are not in themselves an indication for revision surgery.
We reviewed the results at nine to 13 years of 125 total hip replacements in 113 patients using the monoblock uncemented Morscher press-fit acetabular component. The mean age at the time of operation was 56.9 years (36 to 74). The mean clinical follow-up was 11 years (9.7 to 13.5) and the mean radiological follow-up was 9.4 years (7.7 to 13.1). Three hips were revised, one immediately for instability, one for excessive wear and one for deep infection. No revisions were required for aseptic loosening. A total of eight hips (7.0%) had osteolytic lesions greater than 1 cm, in four around the acetabular component (3.5%). One required bone grafting behind a well-fixed implant. The mean wear rate was 0.11 mm/year (0.06 to 0.78) and was significantly higher in components with a steeper abduction angle. Kaplan-Meier survival curves at 13 years showed survival of 96.8% (95% confidence interval 90.2 to 99.0) for revision for any cause and of 95.7% (95% confidence interval 88.6 to 98.4) for any acetabular re-operation.
We have studied the natural history of a first episode of dislocation after primary total hip replacement (THR) to clarify the incidence of recurrent dislocation, the need for subsequent revision and the quality of life of these patients. Over a six-year period, 99 patients (101 hips) presented with a first dislocation of a primary THR. A total of 61 hips (60.4%) had dislocated more than once. After a minimum follow-up of one year, seven patients had died. Of the remaining 94 hips (92 patients), 47 underwent a revision for instability and one awaits operation (51% in total). Of these, seven re-dislocated and four needed further surgery. The quality of life of the patients was studied using the Oxford Hip Score and the EuroQol-5 Dimension (EQ-5D) questionnaire. A control group of patients who had not dislocated was also studied. At a mean follow-up of 4.5 years (1 to 20), the mean Oxford Hip Score was 26.7 (15 to 47) after one episode of dislocation, 27.2 (12 to 45) after recurrent dislocation, 34.5 (12 to 54) after successful revision surgery, 42 (29 to 55) after failed revision surgery and 17.4 (12 to 32) in the control group. The EuroQol-5 dimension questionnaire revealed more health problems in patients undergoing revision surgery.
Narrowing of the femoral neck after resurfacing arthroplasty of the hip has been described previously in both cemented and uncemented hip resurfacing. The natural history of narrowing of the femoral neck is unknown. We retrospectively measured the diameter of the femoral neck in a series of 163 Birmingham hip resurfacings in 163 patients up to a maximum of six years after operation to determine the extent and progression of narrowing. There were 105 men and 58 women with a mean age of 52 years (18 to 82). At a mean follow-up of five years, the mean Harris hip score was 94.8 (47 to 100) and the mean flexion of the hip 112.5° (80° to 160°). There was some narrowing of the femoral neck in 77% (125) of the patients reviewed, and in 27.6% (45) the narrowing exceeded 10% of the diameter of the neck. A multiple logistic regression analysis showed a significant association (chi-squared test (derived from logistic regression) p = 0.01) of narrowing with female gender and a valgus femoral neck/shaft angle. There was no significant association between the range of movement, position or size of the component or radiological lucent lines and narrowing of the neck (chi-squared test; p = 0.10 (flexion), p = 0.08 (size of femoral component), p = 0.09 (size of acetabular component), p = 0.71 (femoral component angulation), p = 0.99 (lucent lines)). There was no significant difference between the diameter of the neck at a mean of three years (2.5 to 3.5) and that at five years (4.5 to 5.5), indicating that any change in the diameter of the neck had stabilised by three years (sign rank test, p = 0.60). We conclude that narrowing of the femoral neck which is found with the Birmingham hip resurfacing arthroplasty is in most cases associated with no adverse clinical or radiological outcome up to a maximum of six years after the initial operation.
A prospective cohort of 222 patients who underwent revision hip replacement between April 2001 and March 2004 was evaluated to determine predictors of function, pain and activity level between one and two years post-operatively, and to define quality of life outcomes using validated patient reported outcome tools. Predictive models were developed and proportional odds regression analyses were performed to identify factors that predict quality of life outcomes at one and two years post-operatively. The dependent outcome variables were the Western Ontario and McMaster Osteoarthritis Index (WOMAC) function and pain scores, and University of California Los Angeles activity scores. The independent variables included patient demographics, operative factors, and objective quality of life parameters, including pre-operative WOMAC, and the Short Form-12 mental component score. There was a significant improvement ( Predictors of quality of life outcomes after revision hip replacement were established. Although some patient-specific and surgery-specific variables were important, age, gender, Charnley class and pre-operative WOMAC function score had the most robust associations with outcome.
We report an independent prospective review of the first 230 Birmingham hip resurfacings in 212 patients at a mean follow-up of five years (4 to 6). Two patients, one with a loose acetabular component and the other with suspected avascular necrosis of the femoral head, underwent revision. There were two deaths from unrelated causes and one patient was lost to follow-up. The survivorship with the worst-case scenario was 97.8% (95% confidence interval 95.8 to 99.5). The mean Harris hip score improved significantly (paired On radiological review at five years, one patient had a progressive lucent line around the acetabular component and six had progressive lucent lines around the femoral component. A total of 18 femoral components (8%) had migrated into varus and those with lucent lines present migrated a mean of 3.8° (1.02° to 6.54°) more than the rest. Superolateral notching of the femoral neck and reactive sclerosis at the tip of the peg of the femoral component were associated with the presence of lucent lines (chi-squared test, p <
0.05), but not with migration of the femoral component, and are of unknown significance. Our results with the Birmingham hip resurfacing continue to be satisfactory at a mean follow-up of five years.