In metal-on-metal (MoM) hip arthroplasties and resurfacings, mechanically induced corrosion can lead to elevated serum metal ions, a local inflammatory response, and formation of pseudotumours, ultimately requiring revision. The size and diametral clearance of anatomical (ADM) and modular (MDM) dual-mobility polyethylene bearings match those of Birmingham hip MoM components. If the acetabular component is satisfactorily positioned, well integrated into the bone, and has no surface damage, this presents the opportunity for revision with exchange of the metal head for ADM/MDM polyethylene bearings without removal of the acetabular component. Between 2012 and 2020, across two centres, 94 patients underwent revision of Birmingham MoM hip arthroplasties or resurfacings. Mean age was 65.5 years (33 to 87). In 53 patients (56.4%), the acetabular component was retained and dual-mobility bearings were used (DM); in 41 (43.6%) the acetabulum was revised (AR). Patients underwent follow-up of minimum two-years (mean 4.6 (2.1 to 8.5) years).Aims
Methods
The aim of this study was to perform a systematic review of the evidence for the use of intraoperative cell salvage in patients undergoing revision hip arthroplasty, and specifically to analyze the available data in order to quantify any associated reduction in the use of allogenic blood transfusion, and the volume which is used. An electronic search of MEDLINE (PubMed), Embase, Scopus, and the Cochrane Library was completed from the date of their inception to 24 February 2022, using a search strategy and protocol created in conjunction with the PRISMA statement. Inclusion criteria were patients aged > 18 years who underwent revision hip arthroplasty when cell salvage was used. Studies in which pre-donated red blood cells were used were excluded. A meta-analysis was also performed using a random effects model with significance set at p = 0.05.Aims
Methods
The aim of this modified Delphi process was to create a structured Revision Hip Complexity Classification (RHCC) which can be used as a tool to help direct multidisciplinary team (MDT) discussions of complex cases in local or regional revision networks. The RHCC was developed with the help of a steering group and an invitation through the British Hip Society (BHS) to members to apply, forming an expert panel of 35. We ran a mixed-method modified Delphi process (three rounds of questionnaires and one virtual meeting). Round 1 consisted of identifying the factors that govern the decision-making and complexities, with weighting given to factors considered most important by experts. Participants were asked to identify classification systems where relevant. Rounds 2 and 3 focused on grouping each factor into H1, H2, or H3, creating a hierarchy of complexity. This was followed by a virtual meeting in an attempt to achieve consensus on the factors which had not achieved consensus in preceding rounds.Aims
Methods
The aim of this study was to assess medium-term improvements following total hip arthroplasty (THA), and to evaluate what effect different preoperative Oxford Hip Score (OHS) thresholds for treatment may have on patients’ access to THA and outcomes. Patients undergoing primary THA at our institution with an OHS both preoperatively and at least four years postoperatively were included. Rationing thresholds were explored to identify possible deprivation of OHS improvement.Aims
Methods
Periprosthetic fractures (PPFs) around cemented taper-slip femoral prostheses often result in a femoral component that is loose at the prosthesis-cement interface, but where the cement-bone interface remains well-fixed and bone stock is good. We aim to understand how best to classify and manage these fractures by using a modification of the Vancouver classification. We reviewed 87 PPFs. Each was a first episode of fracture around a cemented femoral component, where surgical management consisted of revision surgery. Data regarding initial injury, intraoperative findings, and management were prospectively collected. Patient records and serial radiographs were reviewed to determine fracture classification, whether the bone cement was well fixed (B2W) or loose (B2L), and time to fracture union following treatment.Aims
Methods
The aim of this study was to report the initial results of the
Exeter V40 stem, which became available in 2000. A total of 540 total hip arthroplasties (THAs) were performed
in our unit using this stem between December 2000 and May 2002.
Our routine protocol is to review patients postoperatively and at
one, five, and ten years following surgery.Aims
Patients and Methods
We report the incidence of radiolucent lines (RLLs) using two
flanged acetabular components at total hip arthroplasty (THA) and
the effect of the Rim Cutter. We performed a retrospective review of 300 hips in 292 patients
who underwent primary cemented THA. A contemporary flanged acetabular
component was used with (group 1) and without (group 2) the use
of the Rim Cutter and the Rimfit acetabular component was used with
the Rim Cutter (group 3). RLLs and clinical outcomes were evaluated
immediately post-operatively and at five years post-operatively.Aims
Patients and Methods
We present the clinical and radiological results at a minimum
follow-up of five years for patients who have undergone multiple
cement-in-cement revisions of their femoral component at revision
total hip arthroplasty (THA). We reviewed the outcome on a consecutive series of 24 patients
(10 men, 14 women) (51 procedures) who underwent more than one cement-in-cement
revision of the same femoral component. The mean age of the patients was
67.5 years (36 to 92) at final follow-up. Function was assessed using the original Harris hip score (HHS),
Oxford Hip Score (OHS) and the Merle D’Aubigné Postel score (MDP).Aims
Patients and Methods
We present a minimum 20-year follow-up study of 382 cemented
Exeter Universal total hip arthroplasties (350 patients) operated
on at a mean age of 66.3 years (17 to 94). All patients received the same design of femoral component, regardless
of the original diagnosis. Previous surgery had been undertaken
for 33 hips (8.6%). During the study period 218 patients with 236
hips (62%) died, 42 hips (11%) were revised and 110 hips (29%) in
96 patients were available for review. The acetabular components
were varied and some designs are now obsolete, however they were
all cemented.Aims
Patients and Methods
Revision of a cemented hemiarthroplasty of the
hip may be a hazardous procedure with high rates of intra-operative complications.
Removing well-fixed cement is time consuming and risks damaging
already weak bone or perforating the femoral shaft. The cement-in-cement
method avoids removal of intact cement and has shown good results
when used for revision total hip arthroplasty (THA). The use of
this technique for the revision of a hemiarthroplasty to THA has
not been previously reported. A total of 28 consecutive hemiarthroplasties (in 28 patients)
were revised to a THA using an Exeter stem and the cement-in-cement
technique. There were four men and 24 women; their mean age was
80 years (35 to 93). Clinical and radiographic data, as well as
operative notes, were collected prospectively and no patient was
lost to follow-up. Four patients died within two years of surgery. The mean follow
up of the remainder was 70 months (25 to 124). Intra-operatively
there was one proximal perforation, one crack of the
femoral calcar and one acetabular fracture. No femoral components
have required subsequent revision for aseptic loosening or are radiologically loose. Four patients with late complications (14%) have since undergone
surgery (two for a peri-prosthetic fracture, and one each for deep
infection and recurrent dislocation) resulting in an overall major
rate of complication of 35.7%. The cement-in-cement technique provides reliable femoral fixation
in this elderly population and may reduce operating time and rates
of complication. Cite this article:
Impaction bone grafting for the reconstitution
of bone stock in revision hip surgery has been used for nearly 30 years.
Between 1995 and 2001 we used this technique in acetabular reconstruction,
in combination with a cemented component, in 304 hips in 292 patients
revised for aseptic loosening. The only additional supports used
were stainless steel meshes placed against the medial wall or laterally
around the acetabular rim to contain the graft. All Paprosky grades
of defect were included. Clinical and radiographic outcomes were
collected in surviving patients at a minimum of ten years after
the index operation. Mean follow-up was 12.4 years ( Cite this article:
The technique of femoral cement-in-cement revision
is well established, but there are no previous series reporting its
use on the acetabular side at the time of revision total hip replacement.
We describe the technique and report the outcome of 60 consecutive
acetabular cement-in-cement revisions in 59 patients at a mean follow-up
of 8.5 years (5 to 12). All had a radiologically and clinically
well-fixed acetabular cement mantle at the time of revision. During
the follow-up 29 patients died, but no hips were lost to follow-up.
The two most common indications for acetabular revision were recurrent
dislocation (46, 77%) and to complement femoral revision (12, 20%). Of the 60 hips, there were two cases of aseptic loosening of
the acetabular component (3.3%) requiring re-revision. No other
hip was clinically or radiologically loose (96.7%) at the latest
follow-up. One hip was re-revised for infection, four for recurrent
dislocation and one for disarticulation of a constrained component.
At five years the Kaplan-Meier survival rate was 100% for aseptic
loosening and 92.2% (95% CI 84.8 to 99.6), with revision for any cause
as the endpoint. These results support the use of cement-in-cement revision on
the acetabular side in appropriate cases. Theoretical advantages
include preservation of bone stock, reduced operating time, reduced
risk of complications and durable fixation.
The removal of all prosthetic material and a
two-stage revision procedure is the established standard management of
an infected total hip replacement (THR). However, the removal of
well-fixed femoral cement is time-consuming and can result in significant
loss of bone stock and femoral shaft perforation or fracture. We
report our results of two-stage revision THR for treating infection,
with retention of the original well-fixed femoral cement mantle
in 15 patients, who were treated between 1989 and 2002. Following
partial excision arthroplasty, patients received local and systemic
antibiotics and underwent reconstruction and re-implantation at
a second-stage procedure, when the infection had resolved. The mean follow-up of these 15 patients was 82 months (60 to
192). Two patients had positive microbiology at the second stage
and were treated with six weeks of appropriate antibiotics; one
of these developed recurrent infection requiring further revision.
Successful eradication of infection was achieved in the remaining
14 patients. We conclude that when two-stage revision is used for the treatment
of peri-prosthetic infection involving a THR, a well-fixed femoral
cement mantle can be safely left
We evaluated all cases involving the combined use of a subtrochanteric derotational femoral shortening osteotomy with a cemented Exeter stem performed at our institution. With severe developmental dysplasia of the hip an osteotomy is often necessary to achieve shortening and derotation of the proximal femur. Reduction can be maintained with a 3.5 mm compression plate while the implant is cemented into place. Such a plate was used to stabilise the osteotomy in all cases. Intramedullary autograft helps to prevent cement interposition at the osteotomy site and promotes healing. There were 15 female patients (18 hips) with a mean age of 51 years (33 to 75) who had a Crowe IV dysplasia of the hip and were followed up for a mean of 114 months (52 to 168). None was lost to follow-up. All clinical scores were collected prospectively. The Charnley modification of the Merle D’Aubigné-Postel scores for pain, function and range of movement showed a statistically significant improvement from a mean of 2.4 (1 to 4), 2.3 (1 to 4), 3.4 (1 to 6) to 5.2 (3 to 6), 4.4 (3 to 6), 5.2 (4 to 6), respectively. Three acetabular revisions were required for aseptic loosening; one required femoral revision for access. One osteotomy failed to unite at 14 months and was revised successfully. No other case required a femoral revision. No postoperative sciatic nerve palsy was observed. Cemented Exeter femoral components perform well in the treatment of Crowe IV dysplasia with this procedure.
We report the outcome of the flangeless, cemented all-polyethylene Exeter acetabular component at a mean of 14.6 years (10 to 17) after operation. Of the 263 hips in 243 patients, 122 prostheses are still The cemented all-polyethylene Exeter acetabular component has an excellent long-term survivorship.
The first 325 Exeter Universal stems (309 patients) implanted at the originating centre were inserted between March 1988 and February 1990 by a group of surgeons with differing experience. In this report we describe the clinical and radiological results at a mean of 15.7 years (14.7 to 17.3) after operation with no loss to follow-up. There were 97 patients (108 hips) with replacements still in situ and 31 (31 hips) who had undergone a further procedure. With an endpoint of revision for aseptic loosening, the survivorship at 17 years was 100% and 90.4% for the femoral and acetabular component, respectively. The mean Merle D’Aubigné and Postel scores at review were 5.4 (
The removal of well-fixed bone cement from the femoral canal during revision of a total hip replacement (THR) can be difficult and risks the loss of excessive bone stock and perforation or fracture of the femoral shaft. Retaining the cement mantle is attractive, yet the technique of cement-in-cement revision is not widely practised. We have used this procedure at our hospital since 1989. The stems were removed to gain a better exposure for acetabular revision, to alter version or leg length, or for component incompatibility. We studied 136 hips in 134 patients and followed them up for a mean of eight years (5 to 15). A further revision was required in 35 hips (25.7%), for acetabular loosening in 26 (19.1%), sepsis in four, instability in three, femoral fracture in one and stem fracture in one. No femoral stem needed to be re-revised for aseptic loosening. A cement-in-cement revision of the femoral stem is a reliable technique in the medium term. It also reduces the risk of perforation or fracture of the femoral shaft.
We describe a patient with cerebral palsy, of normal intelligence, who could not walk but who by the age of 16 had been successfully managed with a staged bilateral total hip arthroplasty using a constrained liner.
