Introduction. Revision type arthroplasties for the treatment of knee osteoarthritis is an effective and secure procedure. It has different indications, but the most relevant is the revision of a failured primary arthroplasty. In our study, we reviewed the results of another indication, the implantation of a revision type arthroplasty as a primary procedure in cases of severe deformities. Objectives. To assess the radiological, clinical and functional situation and the quality of life of those patients in whom a revision knee arthroplasty had been implanted in the past years. Materials and Methods. We did a retrospective study of 108 knee arthroplasties (80% women) implanted between 1999 and 2005 with a mean follow up of 7.8 years. The mean age of the patients at the time of surgery was 75 years old (60–87). The most frequent indication for a revision type arthroplasty was an important valgum deformity osteoarthritis. We assess the functional and clinical situation using the Knee Society Score, both clinical and functional; the radiological situation using the Knee Society Roentgenographic evaluation and the quality of life using the Short Form 12 (SF12). We have analyzed the survivorship rate of our arthroplasties as well. Results. We could contact 75 patients. 20 had died in the past years without any new surgeries in the knee; we could not contact 13 patients due to lost of follow up. The survivalship rate of the arthroplasties is 91% at the time of follow up. In the cases of severe valgum or varum malalignment, a phisiological valgum angle (5.47°) was achieved in all of the patients. 77.4% of the patients declared themselves as satisfied or very satisfied in the last follow up. The results of the KSS-Clinical were excellent or good in 87.1% of the patients while in the KSS- Functional was 77.5%. The mean SF12 score was 20.68 out of 60 points. Conclusions. The clinical and functional results are overall good or very good, as well as the quality of life, in those patients in which a revision arthroplasty had been implanted instead of a conventional primary arthroplasty, when it was correctly indicated. So a revision type arthroplasty should be considered for the treatment of knee osteoarthritis in cases of severe bone deformities or severe malalignment

Aims. Uncemented mobile bearing designs in medial unicompartmental knee arthroplasty (UKA) have seen an increase over the last decade. However, there are a lack of large-scale studies comparing survivorship of these specific designs to commonly used cemented mobile and fixed bearing designs. The aim of this study was to evaluate the survivorship of these designs. Methods. A total of 21,610 medial UKAs from 2007 to 2018 were selected from the Dutch Arthroplasty Register. Multivariate Cox regression analyses were used to compare uncemented mobile bearings with cemented mobile and fixed bearings. Adjustments were made for patient and surgical factors, with their interactions being considered. Reasons and type of revision in the first two years after surgery were assessed. Results. In hospitals performing less than 100 cases per year, cemented mobile bearings reported comparable adjusted risks of revision as uncemented mobile bearings. However, in hospitals performing more than 100 cases per year, the adjusted risk of revision was higher for cemented mobile bearings compared to uncemented mobile bearings (hazard ratio 1.78 (95% confidence interval 1.34 to 2.35)). The adjusted risk of revision between cemented fixed bearing and uncemented mobile bearing was comparable, independent of annual hospital volume. In addition, 12.3% of uncemented mobile bearing, 20.3% of cemented mobile bearing, and 41.5% of uncemented fixed bearing revisions were for tibial component loosening. The figures for instability were 23.6%, 14.5% and 11.7%, respectively, and for periprosthetic fractures were 10.0%, 2.8%, and 3.5%. Bearing exchange was the type of revision in 40% of uncemented mobile bearing, 24.3% of cemented mobile bearing, and 5.3% cemented fixed bearing revisions. Conclusion. The findings of this study demonstrated improved survival with use of uncemented compared to cemented mobile bearings in medial UKA, only in those hospitals performing more than 100 cases per year. Cemented fixed bearings reported comparable survival results as uncemented mobile bearings, regardless of the annual hospital volume. The high rates of instability, periprosthetic fractures, and bearing exchange in uncemented mobile bearings emphasize the need for further research. Cite this article: Bone Joint J 2021;103-B(7):1261–1269

The April 2023 Hip & Pelvis Roundup. 360. looks at: Do technical errors determine outcomes of operatively managed femoral neck fractures in younger adults?; Single-stage or two-stage revision for hip prosthetic joint infection (INFORM); Fixation better than revision in type B periprosthetic fractures of taper slip stems; Can you maximize femoral head size at the expense of liner thickness?; Plasma D-dimer for periprosthetic joint infection?; How important is in vivo oxidation?; Total hip arthroplasty for HIV patients with osteonecrosis

Aims. Adverse spinal motion or balance (spine mobility) and adverse pelvic mobility, in combination, are often referred to as adverse spinopelvic mobility (SPM). A stiff lumbar spine, large posterior standing pelvic tilt, and severe sagittal spinal deformity have been identified as risk factors for increased hip instability. Adverse SPM can create functional malposition of the acetabular components and hence is an instability risk. Adverse pelvic mobility is often, but not always, associated with abnormal spinal motion parameters. Dislocation rates for dual-mobility articulations (DMAs) have been reported to be between 0% and 1.1%. The aim of this study was to determine the early survivorship from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) of patients with adverse SPM who received a DMA. Methods. A multicentre study was performed using data from 227 patients undergoing primary total hip arthroplasty (THA), enrolled consecutively. All the patients who had one or more adverse spine or pelvic mobility parameter had a DMA inserted at the time of their surgery. The mean age was 76 years (22 to 93) and 63% were female (n = 145). At a mean of 14 months (5 to 31) postoperatively, the AOANJRR was analyzed for follow-up information. Reasons for revision and types of revision were identified. Results. The AOANJRR reported two revisions: one due to infection, and the second due to femoral component loosening. No revisions for dislocation were reported. One patient died with the prosthesis in situ. Kaplan-Meier survival rate was 99.1% (95% confidence interval 98.3 to 100) at 14 months (number at risk 104). Conclusion. In our cohort of patients undergoing primary THA with one or more factor associated with adverse SPM, DM bearings conferred stability at two years’ follow-up. Cite this article: Bone Joint J 2022;104-B(7):820–825

Adverse spinopelvic mobility (SPM) has been shown to increase risk of dislocation of primary total hip arthroplasty (THA). In patients undergoing THA, prevalence of adverse SPM has been shown to be as high as 41%. Stiff lumbar spine, large posterior standing pelvic tilt and severe sagittal spinal deformity have been identified as risk factors for increased hip instability. Dislocation rates for dual mobility articulations have been reported to be 0% to 1.1%. The aim of this study was to determine the early survivorship from the Australian National Joint Replacement Registry (AOANJRR) of patients with adverse SPM who received a dual mobility articulation. A multicentre study was performed using data from 229 patients undergoing primary THA, enrolled consecutively. All the patients who had one or more adverse spine or pelvic mobility parameters had a dual mobility articulation inserted at the time of their surgery. Average age was 76 (22 to 93) years and 63% were female. At a mean of 2.1 (1 – 3.3) years post-op, the AOANJRR was analysed for follow-up. Reasons for revision and types of revision were identified. The AOANJRR reported two revisions. One due to infection and the second due to femoral component loosening. No revisions for dislocation were reported. One patient died with the prosthesis in situ. Kaplan Meier survival was 99.3% (CI 98.3% − 100%) at 2 years. DM bearings reduce the risk of dislocation of primary THA in patients with adverse spine and pelvic mobility

Aims

The aim of this study was to compare open reduction and internal fixation (ORIF) with revision surgery for the surgical management of Unified Classification System (UCS) type B periprosthetic femoral fractures around cemented polished taper-slip femoral components following primary total hip arthroplasty (THA).

Aims

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.

Aims

The aim of this study is to report the implant survival and factors associated with revision of total elbow arthroplasty (TEA) using data from the Dutch national registry.

The Unified Classification System (UCS), or Vancouver system, is a validated and widely used classification system to guide the management of periprosthetic femoral fractures. It suggests that well-fixed stems (type B1) can be treated with fixation but that loose stems (types B2 and B3) should be revised. Determining whether a stem is loose can be difficult and some authors have questioned how to apply this classification system to polished taper slip stems which are, by definition, loose within their cement mantle. Recent evidence has challenged the common perception that revision surgery is preferable to fixation surgery for UCS-B periprosthetic fractures around cemented polished taper slip stems. Indications for fixation include an anatomically reducible fracture and cement mantle, a well-fixed femoral bone-cement interface, and a well-functioning acetabular component. However, not all type B fractures can or should be managed with fixation due to the risk of early failure. This annotation details specific fracture patterns that should not be managed with fixation alone.

Cite this article: Bone Joint J 2023;105-B(5):481–486.

Aims

The aims of this study were to determine the success of a reconstruction algorithm used in major acetabular bone loss, and to further define the indications for custom-made implants in major acetabular bone loss.

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In the last decade, perioperative advancements have expanded the use of outpatient primary total knee arthroplasty (TKA). Despite this, there remains limited data on expedited discharge after revision TKA. This study compared 30-day readmissions and reoperations in patients undergoing revision TKA with a hospital stay greater or less than 24 hours. The authors hypothesized that expedited discharge in select patients would not be associated with increased 30-day readmissions and reoperations.

Aims

There are limited long-term studies reporting on outcomes of the Zimmer Modular Revision (ZMR) stem, and concerns remain regarding failure. Our primary aim was to determine long-term survival free from all-cause revision and stem-related failure for this modular revision stem in revision total hip arthroplasty (THA). Secondary aims included evaluating radiological and functional outcomes.

Aims

There is little information in the literature about the use of dual-mobility (DM) bearings in preventing re-dislocation in revision total hip arthroplasty (THA). The aim of this study was to compare the use of DM bearings, standard bearings, and constrained liners in revision THA for recurrent dislocation, and to identify risk factors for re-dislocation.

Aims

The aim of this study was to identify variables associated with time to revision, demographic details associated with revision indication, and type of prosthesis employed, and to describe the survival of hinge knee arthroplasty (HKA) when used for first-time knee revision surgery and factors that were associated with re-revision.

Aims

To systematically review the predominant complication rates and changes to patient-reported outcome measures (PROMs) following osteochondral allograft (OCA) transplantation for shoulder instability.

Introduction. Computer-assisted hip navigation offers the potential for more accurate placement of hip components, which is important in avoiding dislocation, impingement, and edge-loading. The purpose of this study was to determine if the use of computer-assisted hip navigation reduced the rate of dislocation in patients undergoing revision THA. Methods and Materials. We retrospectively reviewed 72 patients who underwent computer-navigated revision THA [Fig. 1] between January 2015 and December 2016. Demographic variables, indication for revision, type of procedure, and postoperative complications were collected for all patients. Clinical follow-up was performed at 3 months, 1 year, and 2 years. Dislocations were defined as any episode that required closed or open reduction or a revision arthroplasty. Data are presented as percentages and was analyzed using appropriate comparative statistical tests (z-tests and independent samples t- tests). Results. All 72 patients (48% female; 52% male) were included in the final analysis [Fig. 2]. Mean age of patients undergoing revision THA was 70.4 ± 11.2 years. Mean BMI was 26.4 ± 5.2 kg/m. 2. The most common indications for revision THA were instability (31%), aseptic loosening (29%), osteolysis/eccentric wear (18%), infection (11%), and miscellaneous (11%). During revision procedure, polyethylene component was most commonly changed (46%), followed by femoral head (39%), and acetabular component (15%). At 3 months, 1 year, and final follow-up, there were no dislocations among all study patients (0%). Compared to preoperative dislocation values, there was a significant reduction in the rate of dislocation with the use of computer-assisted hip navigation (31% vs. 0%; p<0.05). Discussion. Our study demonstrates a significant reduction in the rate of dislocation following revision THA with the use of computer navigation. Although the cause of postoperative dislocation is often multifactorial, the use of computer-assisted surgery may help to curtail femoral and acetabular malalignment in revision THA

Aims

Registry studies on modified acetabular polyethylene (PE) liner designs are limited. We investigated the influence of standard and modified PE acetabular liner designs on the revision rate for mechanical complications in primary cementless total hip arthroplasty (THA).

Aims

One of the main causes of tibial revision surgery for total knee arthroplasty is aseptic loosening. Therefore, stable fixation between the tibial component and the cement, and between the tibial component and the bone, is essential. A factor that could influence the implant stability is the implant design, with its different variations. In an existing implant system, the tibial component was modified by adding cement pockets. The aim of this experimental in vitro study was to investigate whether additional cement pockets on the underside of the tibial component could improve implant stability. The relative motion between implant and bone, the maximum pull-out force, the tibial cement mantle, and a possible path from the bone marrow to the metal-cement interface were determined.

As the number of patients who have undergone total hip arthroplasty rises, the number of patients who require surgery for a failed total hip arthroplasty is also increasing. Reconstruction of the failed femoral component in revision total hip arthroplasty can be challenging from both a technical perspective and in preoperative planning. With multiple reconstructive options available, it is helpful to have a classification system which guides the surgeon in selecting the appropriate method of reconstruction. We have developed a classification of femoral deficiency and an algorithmic approach to femoral reconstruction is presented. Type I: Minimal loss of metaphyseal cancellous bone with an intact diaphysis. Often seen when conversion of a cementless femoral component without biological ingrowth surface requires revision. Type II: Extensive loss of metaphyseal cancellous bone with an intact diaphysis. Often encountered after the removal of a cemented femoral component. Type IIIA: The metaphysis is severely damaged and non-supportive with more than four centimeters of intact diaphyseal bone for distal fixation. This type of defect is commonly seen after removal of grossly loose femoral components inserted with first generation cementing techniques. Type IIIB: The metaphysis is severely damaged and non-supportive with less than four centimeters of diaphyseal bone available for distal fixation. This type of defect is often seen following failure of a cemented femoral component that was inserted with a cement restrictor and cementless femoral components associated with significant distal osteolysis. Type IV: Extensive meta-diaphyseal damage in conjunction with a widened femoral canal. The isthmus is non-supportive

Aims

The modified Radiological Union Scale for Tibia (mRUST) fractures score was developed in order to assess progress to union and define a numerical assessment of fracture healing of metadiaphyseal fractures. This score has been shown to be valuable in predicting radiological union; however, there is no information on the sensitivity, specificity, and accuracy of this index for various cut-off scores. The aim of this study is to evaluate sensitivity, specificity, accuracy, and cut-off points of the mRUST score for the diagnosis of metadiaphyseal fractures healing.