We carried out a protocol driven study of 30 consecutive patients who had an infected hip arthroplasty and were treated with two stage uncemented revision hip surgery. There were 23 males (average age 65 years) and 50% of the patients were obese. Radical debridement of hip was performed to achieve control of infection at first stage surgery. Twenty patients grew one organism and 10 patients had multiple organisms grown. The predominant organism was Staphylococcus epidermidis. Eight patients had MRSA/MRSE. All patients were treated with antibiotics for at least three months. The mean time to reimplantation was 4.7 months. In 15 patients, allograft was used for reconstruction in the second stage. All patients were followed up clinically and radiologically and mean follow up was 4.2 years. No patient was lost to follow up. Rate of eradication of deep infection was 100%. Two patients required re-debridement for stitch abscesses which healed without sequeale. Only two patients (6%) had poor result as assessed by Harris Hip score, Merled Aubigne score and SF12 score. Sixty-seven percent of patients had good to excellent result and 27% had fair outcome. The poor results correlated to the old age and other significant co-morbidities in these patients. One patient died due to unrelated cause after eight years of surgery. Radiographically, all but one implant were well fixed at review. One patient had a radiolucent line around the acetabulum and was radiologically and clinically loose. There is no clinical or haematological evidence of infection. Twelve patients had heterotopic ossification and four patients had trochanteric non-union but no pain. One patient developed sciatic nerve palsy and one patient had recurrent dislocation. This medium term review has revealed that a satisfactory outcome of a difficult problem can be achieved by using a standardised treatment protocol and uncemented implants.
The purpose of our study was to evaluate the initial results of this new technique of acetabular revision. Osseointegration and cup stability were assessed by our musculoskeletal radiologist with radiographs at 2 years following surgery, and patients’ clinical outcomes were reviewed. We retrospectively reviewed the clinical records and radiographs of all patients who underwent acetabular revision between 2003 to 2005. Patient’s clinical outcomes and records were extracted from Orthowave and Statwave software. Radiographs were digitised and evaluated by our radiologist on E-film workstation. Between January 2003 to May 2005, 62 consecutives patients with 65 acetabulum revisions (3 bilateral) were performed by a single surgeon. All acetabular shells were revised to revision tantalum shells with ancillary screws fixation. Fenestrated tantalum augments and wedges of different sizes and shapes were used to address bone defect in our series. 30.7% were Paprosky grade 3 and worse, 21.5% were Paprosky grade 2C. Radiologic review showed none of the cups had a change of 3° or more for cup inclination. There was no migration of the cups of 2 mm or greater both in the vertical direction and horizontal direction from our reference lines during the 2 year period. There were no new radiolucencies in any cases, and all the 9 cups with radiolucent lines post op either filled up or remain unchanged. Postoperative review mean HHS was 79.09 ± 16.16 (Range 33–100). There were 3 cases (4.6%) of dislocation. There were 9 fractures (13.9%) in our series. In our series of 65 revisions, the porous tantalum revision system has performed well, despite being used to reconstruct fairly significant defects (Paprosky 2C and worse) in 52.3% of our cases. The clinical improvement, stability of the cup at 2 years, and acceptable complication rates would suggest that this porous tantalum system can be an alternative to a more traditional acetabular reconstruction.
We investigated the early results of modular porous metal components used in 23 acetabular reconstructions associated with major bone loss. The series included seven men and 15 women with a mean age of 67 years (38 to 81), who had undergone a mean of two previous revisions (1 to 7). Based on Paprosky’s classification, there were 17 type 3A and six type 3B defects. Pelvic discontinuity was noted in one case. Augments were used in 21 hips to support the shell and an acetabular component-cage construct was implanted in one case. At a mean follow-up of 41 months (24 to 62), 22 components remained well fixed. Two patients required rerevision of the liners for prosthetic joint instability. Clinically, the mean Harris Hip Score improved from 43.0 pre-operatively (14 to 86) to 75.7 post-operatively (53 to 100). The mean pre-operative Merle d’Aubigné score was 8.2 (3 to 15) and improved to a mean of 13.7 (11 to 18) post-operatively. These short-term results suggest that modular porous metal components are a viable option in the reconstruction of Paprosky type 3 acetabular defects. More data are needed to determine whether the system yields greater long-term success than more traditional methods, such as reconstruction cages and structural allografts.
A prospective consecutive series of uncemented, hydroxyapatite coated primary hip replacements utilizing two different types of alumina ceramic inserts and alumina ceramic heads is reported. Clinical and radiological results together with complications and reoperations are detailed. 193 hips followed up to 39 months using the Secur fit cup with ABC liner (Stryker). 40 hips using the Trident AD shell with the Trident titanium wrapped liner are reported up to 18 months. Clinical scores (Harris and Postel Merle D’Aubigne) are similar to metal polyethylene at early review. SF 12 physical scores improved post operation. 100% bony ingrowth was seen radiologically (Engh and ARA scores). Liner rim surface chips on insertion were seen in 1.4% of the ABC liners and none occurred after the 20th hip. No chips were seen in the Trident liners. One ABC liner sustained extensive surface rim chips in a heavy fall at 24 months. This is the first report of such a liner fracture. One Secur fit ABC cup was revised for recurrent subluxation. The importance of early revision of ceramic fractures and the re use of shells is discussed. The addition of a titanium sandwich wrap to the ceramic liner is likely to eliminate the early chips.
Thirty-five patients with habitual dislocation of the patella in flexion were reviewed; eight were bilaterally affected. Each had undergone quadricepsplasty with an average follow-up of 6 years 9 months. Bands or contractures, most commonly in vastus lateralis, the iliotibial tract and rectus femoris were seen in each. Redislocation was seen in 12 knees. At review, 79% of the knees were normal. Quadriceps lengthening is an essential part of treatment and must be performed proximally. Causes for failure include reformation of contractures and failure to correct the initial abnormality fully.
