Aims. The COVID-19 pandemic has disrupted the provision of
Revision total hip replacement (THR) for young
patients is challenging because of technical complexity and the potential
need for subsequent further revisions. We have assessed the survivorship,
functional outcome and complications of this procedure in patients
aged <
50 years through a large longitudinal series with consistent treatment
algorithms. Of 132 consecutive patients (181 hips) who underwent
revision THR, 102 patients (151 hips) with a mean age of 43 years
(22 to 50) were reviewed at a mean follow-up of 11 years (2 to 26)
post-operatively. We attempted to restore bone stock with allograft
where indicated. Using further revision for any reason as an end point,
the survival of the acetabular component was 71% (. sd. 4)
and 54% (. sd. 7) at ten- and 20 years. The survival of the
femoral component was 80% (. sd. 4) and 62% (. sd. 6)
at ten- and 20 years. Complications included 11 dislocations (6.1%),
ten periprosthetic fractures (5.5%), two deep infections (1.1%),
four sciatic nerve palsies (2.2%; three resolved without intervention,
one improved after exploration and freeing from adhesions) and one
vascular injury (0.6%). The mean modified Harris Hip Score was 41
(10 to 82) pre-operatively, 77 (39 to 93) one year post-operatively
and 77 (38 to 93) at the latest review. This overall perspective on the mid- to long-term results is
valuable when advising young patients on the prospects of revision
surgery at the time of primary
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
The aims of this retrospective study were to
compare the mid-term outcomes following revision total knee replacement
(TKR) in 76 patients (81 knees) <
55 years of age with those
of a matched group of primary TKRs based on age, BMI, gender and
comorbid conditions. We report the activity levels, functional scores,
rates of revision and complications. Compared with patients undergoing
primary TKR, those undergoing revision TKR had less improvement
in the mean Knee Society function scores (8.14 (–55 to +60) Young patients undergoing revision TKR should be counselled that
they can expect somewhat less improvement and a higher risk of complications
than occur after primary TKR. Cite this article:
Aims. Arthroplasties of the elbow, including total elbow arthroplasty, radial head arthroplasty, distal humeral hemiarthroplasty, and radiocapitellar
Aims. It has been well documented in the
Aims. To compare complication-related reoperation rates following primary
Metal and ceramic humeral head bearing surfaces are available choices in anatomical shoulder arthroplasties. Wear studies have shown superior performance of ceramic heads, however comparison of clinical outcomes according to bearing surface in total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) is limited. This study aimed to compare the rates of revision and reoperation following metal and ceramic humeral head TSA and HA using data from the National Joint Registry (NJR), which collects data from England, Wales, Northern Ireland, Isle of Man and the States of Guernsey. NJR shoulder arthroplasty records were linked to Hospital Episode Statistics and the National Mortality Register. TSA and HA performed for osteoarthritis (OA) in patients with an intact rotator cuff were included. Metal and ceramic humeral head prostheses were matched within separate TSA and HA groups using propensity scores based on 12 and 11 characteristics, respectively. The primary outcome was time to first revision and the secondary outcome was non-revision reoperation.Aims
Methods
This study describes the variation in the annual volumes of revision hip arthroplasty (RHA) undertaken by consultant surgeons nationally, and the rate of accrual of RHA and corresponding primary hip arthroplasty (PHA) volume for new consultants entering practice. National Joint Registry (NJR) data for England, Wales, Northern Ireland, and the Isle of Man were received for 84,816 RHAs and 818,979 PHAs recorded between April 2011 and December 2019. RHA data comprised all revision procedures, including first-time revisions of PHA and any subsequent re-revisions recorded in public and private healthcare organizations. Annual procedure volumes undertaken by the responsible consultant surgeon in the 12 months prior to every index procedure were determined. We identified a cohort of ‘new’ HA consultants who commenced practice from 2012 and describe their rate of accrual of PHA and RHA experience.Aims
Methods
Aims. The aim of this study was to estimate time to
This annotation reviews current concepts on the three most common surgical approaches used for proximal interphalangeal joint
We aim to explore the potential technologies for monitoring and assessment of patients undergoing
Total hip and knee arthroplasty (THA, TKA) are largely successful procedures; however, both have variable outcomes, resulting in some patients being dissatisfied with the outcome. Surgeons are turning to technologies such as robotic-assisted surgery in an attempt to improve outcomes. Robust studies are needed to find out if these innovations are really benefitting patients. The Robotic
Aims. Proximal femoral endoprosthetic
Aims. To our knowledge, no study has compared the long-term results of cemented and hybrid total hip arthroplasty (THA) in patients with osteoarthritis (OA) secondary to congenital hip disease (CHD). This is a demanding procedure that may require special techniques and implants. Our aim was to compare the long-term outcome of cemented low-friction
Periprosthetic joint infection (PJI) is one of the most dreaded complications after
Aims. We present our experience of using a metal-backed prosthesis and autologous bone graft to treat gross glenoid bone deficiency. Patients and Methods. A prospective cohort study of the first 45 shoulder arthroplasties using the SMR Axioma Trabecular Titanium (TT) metal-backed glenoid with autologous bone graft. Between May 2013 and December 2014, 45 shoulder arthroplasties were carried out in 44 patients with a mean age of 64 years (35 to 89). The indications were 23 complex primary
There is little information about the management
of peri-prosthetic fracture of the humerus after total shoulder replacement
(TSR). This is a retrospective review of 22 patients who underwent
a revision of their original shoulder replacement for peri-prosthetic
fracture of the humerus with bone loss and/or loose components.
There were 20 women and two men with a mean age of 75 years (61
to 90) and a mean follow-up 42 months (12 to 91): 16 of these had
undergone a previous revision TSR. Of the 22 patients, 12 were treated
with a long-stemmed humeral component that bypassed the fracture.
All their fractures united after a mean of 27 weeks (13 to 94).
Eight patients underwent resection of the proximal humerus with
endoprosthetic
Aims. There is concern that aggressive target pricing in the new Bundled Payment for Care Improvement Advanced (BPCI-A) penalizes high-performing groups that had achieved low costs through prior experience in bundled payments. We hypothesize that this methodology incorporates unsustainable downward trends on Target Prices and will lead to groups opting out of BPCI Advanced in favour of a traditional fee for service. Methods. Using the Centers for Medicare and Medicaid Services (CMS) data, we compared the Target Price factors for hospitals and physician groups that participated in both BPCI Classic and BPCI Advanced (legacy groups), with groups that only participated in BPCI Advanced (non-legacy). With rebasing of Target Prices in 2020 and opportunity for participants to drop out, we compared retention rates of hospitals and physician groups enrolled at the onset of BPCI Advanced with current enrolment in 2020. Results. At its peak in July 2015, 342 acute care hospitals and physician groups participated in Lower Extremity Joint
Aims. The purpose of this study was to determine the access to and ability to use telemedicine technology in adult patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), and to determine associations with the socioeconomic characteristics of the patients, including age, sex, race, and education. We also sought to understand the patients’ perceived benefits, risks, and preferences when dealing with telemedicine. Methods. We performed a cross-sectional survey involving patients awaiting primary THA and TKA by one of six surgeons at a single academic institution. Patients were included and called for a telephone-administered survey if their surgery was scheduled to be between 23 March and 2 June 2020, and were aged > 18 years. Results. The response rate was 52% (189 of 363 patients). A total of 170 patients (90.4%) reported using the internet, 177 (94.1%) reported owning a device capable of videoconferencing, and 143 (76.1%) had participated in a video call in the past year. When asked for their preferred method for a consultation, 155 (82.8%) and 26 (13.9%) ranked in-person and a videoconference as their first choice, respectively. The perceived benefits of telemedicine consultations included reduced travel to appointments (165 (88.2%) agreed) and reduced cost of attending appointments (123 (65.8%) agreed). However, patients were concerned that they would not establish the same patient-physician connection (100 (53.8%) agreed), and would not receive the same level of care (52 (33.2%) agreed) using telemedicine consultations compared with in-person consultations. Conclusion. Most patients undergoing