Trabecular titanium implants are 3D printed with a high-friction ingrowth surface that is continuous with the rest of the acetabular shell. The ability to “face-change” following optimum seating of the component allows unprecedented levels of versatility in acetabular orientation. Bolt-on augments enable rapid trialling and definitive insertion of a monobloc construct. The use of these implants has rapidly increased in the National Joint Registry over the last three years with little published outcome data. We present one of the largest studies using this material. This study assesses the early stability, ingrowth and clinical outcome of revision acetabular reconstruction with trabecular titanium.Introduction
Objectives
Bone loss in the distal femur and proximal tibia is frequently encountered with both complex primary and revision knee replacement surgery. Metaphyseal sleeves provide a good option for enhanced fixation in managing such defects on both the tibia and femur. We present our results in 48 patients (50 knees) with a minimum 12 month follow up (range 12 to 45). 48 patients (50 knees) who had revision knee arthroplasty for either septic or aseptic loosening. All were graded Type II or III using the Anderson Orthopaedic Research Institute (AORI) grading system of both femoral and tibial defects. A large portion of aseptic loosening revisions were for extreme osteolysis of a bicondylar knee prosthesis.Introduction
Methods
Enhanced recovery programmes (ERP) have recently been adopted in the UK, enabling patients to recover quickly and return home sooner. Choice of anaesthetic is an important factor effecting post-operative outcome; studies show regional anaesthesia is more cost-effective, decreasing the incidence of venous thromboembolic events and reducing intra-operative blood loss, the need for transfusion and the length of hospital stay. The objective of this study was to compare the short-term outcome of patients enrolled in our ERP who underwent either general or spinal +/− epidural anaesthesia.Introduction
Objectives
Rivaroxiban is a direct inhibitor of factor Xa, a licensed oral thromboprophylactic agent that is increasingly being adopted for lower limb arthroplasty. Rivaroxiban has been NICE-approved for use in primary hip and knee arthroplasty following the RECORD 4 trials; proving it more effective in preventing venous thrombo-embolic (VTE) events compared to enoxaparin. Enhanced Recovery Programmes (ERP) are designed to enable patients to recover quickly and return home safely within a few days. We prospectively studied 1223 patients (age- and sex-matched) who underwent lower-limb arthroplasty enrolled in our ERP between March 2010 and December 2011; 454 patients (Group 1) received enoxaparin, 769 patients (Group 2) received rivaroxiban. Patients wore thrombo-embolic stockings for six weeks post surgery. Patients were monitored for thrombo-embolic events and wound-related complications for 42 days post-operatively.Introduction
Methods
Obesity is a direct contributor to degenerative joint disease, and as the prevalence of obesity increases globally it is likely that more overweight patients will present for hip replacement surgery. There are reports that overweight patients in the UK's National Health Service, typically with a Body Mass Index (BMI) over 30 (BMI 30–39 obese, BMI≥40 morbidly obese), are being denied operations on the premise that they are at risk of significant complications. Enhanced Recovery Programmes (ERP) are designed to enable patients to recover quickly and return home safely within a few days. The aim of this study was to compare the outcome of hip replacements in obese and non-obese patients enrolled in our ERP. We prospectively studied 350 patients who underwent primary and revision total hip replacements and were treated through our ERP form March 2010 to January 2011. The mean age was 68 (range 23–92 years). 130 patients (37%) were considered obese with a BMI of >30. 11 patients (3%) were considered morbidly obese with a BMI >40. They were age & sex-matched with the non-obese patients. Outcomes measured included: Length of stay, wound complications (including surgical site infections), deep vein thrombosis and blood transfusion requirements. Data was collected to 42 days following discharge.Introduction
Methods
The need for hip and knee replacement surgery is increasing. Enhanced recovery programmes, where patients mobilise quickly and safely after surgery, have been adopted now in many hospitals. There are anecdotal reports of Primary Care Trusts raising thresholds for referral for surgery based on patients' Body Mass Index (BMI). The aim of this study was to evaluate the early outcome of hip and knee arthroplasty in obese patients (BMI>30) enrolled in the enhanced recovery programme. Between March 2010 and January 2011, 672 patients were enrolled in our enhanced recovery programme. 316 patients (47%) were classified as obese (BMI>30, range 30-39). There was no significant difference in the length of stay: 4.58 days in the obese patients and 4.44 days in the non-obese. There was also no difference in the rates of superficial infections or oozy wounds. Knee replacements was performed more commonly than hip replacements in the obese group There was no significant difference in the early outcome of hip and knee replacement surgery in patients with a higher Body Mass Index when undergoing lower limb arthroplasty through the enhanced recovery programme. These patients should continue to be offered surgery when clinically indicated.
