We cross-matched the Swedish Hip and Knee Arthroplasty Registers (SHAR and SKAR) to study the incidence of knee or hip arthroplasty in any of the remaining hip or knee joints.

177835 THR (55.8% females, mean age, SD: 68.5 10.1 years) and 128162 primary TKR (59.8% females, 69.4 9.0 years) procedures in patients with primary osteoarthritis, performed 1992–2014 were studied. Mean and maximum follow up were 7.7 and 23 years.

At the index operation more patients were operated on their right side for both locations (hip and knee). Patients who at the index operation had been operated with a TKR and especially on the left side most frequently (32.5%) received one or several additional TKR or THR. For patients who had a THR at their index operation and underwent a second operation of any of the remaining three joints the mean time to this second procedure was 4.0 years (SD: 3.9). In patients who were operated with a TKR this time period was shorter (3.1, 3.2, p<0.0005).

In patients who had undergone their first (index) operation of either hip the probability of not being subjected to further arthroplasty operations during the following 20 years amounted to 64.0±0.3%. The corresponding probability for patients who at the index operation had received a TKR was somewhat lower (58.4±0.4%). Decreasing age (HR: 1.029, 95% confidence interval: 1.028–1.0292), female gender (1.13 1.12–1.15), TKR at index operation (1.34 1.32–1.36) and left-sided index operation (1.12 1.10–1.13) were associated with higher probability for at least one additional primary joint replacement in the hip or the knee.

During our period of observation 25 to 33 percent of the patients who received their first total hip or knee replacement underwent at least one additional replacement of either the hip or the knee. Knee osteoarthritis more frequently results in staged bilateral joint replacement than in patients who primarily are suffering from osteoarthritis of the hip.

Introduction: There has been a proliferation of newer fluted tapered grit-blasted titanium stems in hip revision arthroplasty. However, only a limited number of clinical series have so far been reported in the literature. Moreover, all reports have only a short-term clinical and radiographical follow-up (< 5 years). Medium-term and long-term follow-up studies are lacking. Therefore, the aim of this study was to review a series of a cementless modular tapered revision femoral component (MP Link hip reconstruction prosthesis) with a minimum 5 year follow-up.

Patients and Methods: This study includes 90 consecutive cases (87 patients) with the MP stem. We documented the Harris hip score (HHS) and the Visual analogue scale (VAS) was used to assess pain at rest and movement. Survivorship was calculated using Kaplan-Meier survival analysis. The 95% confidence intervals (CI) for the cumulative 5 year survival were calculated. Radiographs made immediately after the index operation were compared with those at follow-up examination in order to classify the restoration of femoral bone and vertical migration of the implant.

Results: Of the original 90 cases, 24 (27%) died prior to clinical and radiographical review, 2 (2%) had a stem revision and 1 (1%) was lost to follow-up. Patients who died and were lost to follow-up were included in the survival analysis. For those patients, all data concerning complications and revisions were extracted from journal files and the Swedish Hip Register which collects all information on reoperations after hip revision surgery.

The median follow-up time was 6 (5–11) years. The median VAS for pain for the affected hip was 0 (0–5) at rest and 0 (0–9) at movement. The median HHS at follow-up was 78 (16–100) points.

17 (19%) patients dislocated their hips during follow-up. A prosthesis head size of 22 mm was present in 6/17 (35%) patients with dislocation and in 11/73 (15%) patients without dislocation (P = 0.055).

The cumulative 5 year survival rate was 98% (95% CI: 94–100%) with stem removal and 90% (95% CI: 85–96%) with any reoperation as the endpoint.

At follow-up, we noted subjectively that 17% of the cases had evidence of proximal bone restoration, whereas 44% had constant defects. In 39% the quality of the proximal bone appeared to be declining. If present, this was mostly seen around the lesser trochanter. The median vertical stem migration was 2.7 (0–30) mm

Discussion: This is the first report with a clinical and radiographical medium-term follow-up of patients with a cementless modular tapered distally fixated hip revision stem. In our study, we found a discrepancy between a high implant survivorship and good pain relief on one hand and a high dislocation rate on the other hand.

Introduction: Femoral shaft fractures are commonly thought to be primarily associated with high energy trauma in young persons. Only limited attention has be given to low energy violence as a cause of these fractures among the elderly. National epidemiological data on characteristics of patients with femoral shaft fractures are lacking. So the purpose of this study was to analyse the incidence, admissions, causes of fracture and operations for these fractures on a nationwide basis in Sweden during 1998–2004.

Patients and Methods: Data on all femoral shaft fractures were extracted from the Swedish National Hospital Discharge Registry. Sex- and age-specific fracture incidence, hospital admissions, mechanisms of injury and surgical procedures were analysed using descriptive analysis, linear-regression analysis and other methods as appropriate.

Results: Over a period of 7 years, 6,409 patients with femoral shaft fractures were identified, corresponding to an annual incidence rate of 10 per 100,000 person-years. Men had a younger median age (27 years, IQR 12–68) than women (79 years, IQR 62–86) (p< 0.001). Females (54%) generated more admissions than males (46%). The incident rate ratio between men and women was 0.9 (p< 0.001). Most hospital admissions were generated among females by the 80–89 years age-group and among males < 10 years of age. 2% of the fractures were open shaft fractures. The total number of hospital admissions was stable during 1998–2004. The two major mechanisms of injury were falls on the same level (50%) and transport accidents (17%). A significant number of fractures occured among elderly patients after low-energy trauma. Osteosynthesis with femoral nail (54%) was the prefered operation, followed by osteosynthesis with plate and screws (16%), skeletal traction (14%) and external fixation (6%).

Discussion: This nationwide study on femoral shaft fractures provides an update on incidence, admissions, external causes and surgical procedures. This information assists health care providers in planning hospital beds, surgical interventions and risk preventions. Moreover, these data can be used for power calculations for further clinical studies.

Introduction: Proximal bone loss in patients undergoing femoral hip revision surgery is a challenging and complex problem, as it is often impossible to implant a proximally anchored prosthesis in such cases. Fluted tapered cementless prosthesis stems, such as the Link MP reconstruction prosthesis represent a distal fixation option, allowing axial and rotational control of the implant in the femoral diaphysis.

The manufacturer of the MP hip stem recommends a distal femoral implant/bone anchorage of at least 80 mm to gain implant stability. However, there are no in vivo studies showing that this fixation length is achieved in clinical practice and that this distance is needed for clinical satisfying results. Therefore, the aim of this study was to assess the distal femoral fixation length of the MP reconstruction prosthesis by using computer assisted tomography (CT).

Patients and Methods: To evaluate stem anchorage of the MP reconstruction stem, we performed CT-scans on 14 patients at a median follow-up of 12 months (IQR 12–25) after surgery. All CT-scans were separately analysed by 2 blinded radiologists. Clinical outcome was assessed by VAS for pain and Harris Hip Score (HHS) both at 12 (IQR 12–25) and 68 (IQR 61–73) months after surgery.

Results: We found the CT-scans of good quality and almost free from disturbing metal artefacts, which made it easy to interpret the images. Intraclass correlation between the measurements of the two blinded radiologists was 0.935 corresponding to an outstanding inter-rater reliability.

The median length of femoral stem/bone anchorage was 33 mm (IQR 10–60) which was too short according to the manufacturer’s guidelines. Still, all patients were fully weight-bearing and only 1/14 complaint about mild thigh pain. 7/14 patients did not experience any pain at rest or movement in the affected hip.

The patients reached median 85 (IQR 77–94) points in the HHS, corresponding to a good result. At 62 months follow-up, the patients described the same pain scores and the HHS had still a good result with 81 (IQR 62–92) points.

Discussion: We could show that it is possible to analyse the distal stem/bone anchorage of cementless femoral implants by using CT. Moreover, we could show a clear discrepancy between the manufacturer’s guidelines and clinical practice concerning anchorage of the MP reconstruction prosthesis. It is difficult to achieve femoral stem/bone anchorage of at least 80 mm, which otherwise is not necessary to achieve stability and clinically satisfying results.

Objectives. To evaluate the effects of ankle/hindfoot arthrodesis in rheumatoid arthritis (RA) patients on gait pattern of the knee and hip.

Methods. In this prospective follow-up study 14 RA patients scheduled for ankle/hindfoot arthrodesis were included. Three-dimensional gait analyses of joint angles, moments and work were performed at the index operation and after 13 months of follow-up. Each patient underwent clinical assessments of pain while walking, overall evaluation of disease activity, Health Related Quality of Life Questionnaire (EQ-5D), activity limitations, maximum walking distance, difficulty with walking surface and gait abnormality. For comparisons of pre- versus post-operative conditions, Wilcoxon’s matched pairs test and Friedman ANOVA by rank test were used.

Results. At follow-up after ankle/hindfoot fusion surgery, RA patients demonstrated a statistically significant improvement in mean range of joint motions, moments and work in the overlying joints such as the knee and hip. Moreover, there was significantly less pain, disease activity, activity limitation, difficulty with walking surface and gait abnormality. EQ-5D and maximum walking distance were also significantly improved at follow-up.

Conclusions. Our results demonstrate that ankle/hindfoot arthrodesis in RA is an effective intervention to reduce pain and to improve Health Related Quality of Life and functional ability. Moreover, the overlying leg joints experience an improvement in joint motion, muscle-generated joint moments and work during walking. Three-dimensional gait analysis may assist future investigations of the effects of orthopaedic surgery on functional mobility in RA to prevent irreversible disablement.

Aims: The aim of the study was to determine the efþcacy of jet lavage in comparison to syringe lavage with respect to cement penetration and stability of the poly-ethylene patellar component after patellar resurfacing in total knee arthroplasty. Methods: In a cadaver study, we prepared 37 fresh frozen human patella pairs. The retropatellar bed was randomly cleaned with either jet lavage or a bladder syringe. The polyethylene component was cemented using Palacos R. For 12 patella pairs, sagittal sections were obtained at predeþned levels using a diamond saw. Mikroradiograms were digitised and analysed with respect to cement penetration. For the remaining 25 patella pairs, pullout tests were performed on patellar components using a traction-compression device. Results: Cement penetration was signiþcantly greater (P< 0.0001) in the jet lavage specimens compared to the syringe lavage specimens. The maximum force required to cause mechanical failure was signiþcantly greater (P< 0,0001) in jet lavage specimens compared to syringe lavage specimens. Conclusions: Our results support the routine use of jet lavage for cleansing the patellar bed prior to cement application in cemented patellar resurfacing.