To evaluate mid-to long-term patient-reported outcome measures (PROMs) of endoprosthetic reconstruction after resection of malignant tumours arising around the knee, and to investigate the risk factors for unfavourable PROMs. The medical records of 75 patients who underwent surgery between 2000 and 2020 were retrospectively reviewed, and 44 patients who were alive and available for follow-up (at a mean of 9.7 years postoperatively) were included in the study. Leg length discrepancy was measured on whole-leg radiographs, and functional assessment was performed with PROMs (Toronto Extremity Salvage Score (TESS) and Comprehensive Outcome Measure for Musculoskeletal Oncology Lower Extremity (COMMON-LE)) with two different aspects. The thresholds for unfavourable PROMs were determined using anchor questions regarding satisfaction, and the risk factors for unfavourable PROMs were investigated.Aims
Methods
Adverse reaction to wear and corrosion debris
is a cause for concern in total hip arthroplasty (THA). Modular junctions
are a potential source of such wear products and are associated
with secondary pseudotumour formation. We present a consecutive series of 17 patients treated at our
unit for this complication following metal-on-highly cross-linked
polyethylene (MoP) THA. We emphasise the risk of misdiagnosis as
infection, and present the aggregate laboratory results and pathological
findings in this series. The clinical presentation was pain, swelling or instability.
Solid, cystic and mixed soft-tissue lesions were noted on imaging
and confirmed intra-operatively. Corrosion at the head–neck junction
was noted in all cases. No bacteria were isolated on multiple pre-
and intra-operative samples yet the mean erythrocyte sedimentation
rate was 49 (9 to 100) and C-reactive protein 32 (0.6 to 106) and
stromal polymorphonuclear cell counts were noted in nine cases. Adverse soft–tissue reactions can occur in MoP THA owing to corrosion
products released from the head–neck junction. The diagnosis should
be carefully considered when investigating pain after THA. This
may avoid the misdiagnosis of periprosthetic infection with an unidentified
organism and mitigate the unnecessary management of these cases
with complete single- or two-stage exchange. Cite this article:
Proper initial fixation of the stem in the femoral canal is important to achieve successful long-term clinical results in total hip arthroplasty (THA) and bipolar hemiarthroplasty (BHA). However, this factor fully relies on surgeon's experience and skill during the hammering process. The goal of this study is to evaluate the frequency of the stem hammering sound which enables the achievement of proper stem fixation and avoiding femoral bone fracture. 57 patients who received BHA as a result of femoral neck fracture were evaluated. Intraoperative images of stem hammering were recorded using a digital video camera (Everio GZ-MG275, Victor, Japan). The frequency of the hammering sound was analyzed using a digital audio editor, GoldWave (GoldWave Inc.) (Figure 1). The frequency change during hammering was categorized into two groups, convergent and non-convergent, according to the frequency change pattern (Figure 2). The definition of “convergent group” is as follows: in the last five hammering sounds to finish the stem insertion, 1) Three consecutive hammering frequency shape and distribution 2) Formant peak frequency within the range of 3,000 Hz. Two types of cementless stems, SYNERGY SELECT II (tapered) and ECHELON TITANIUM (cylindrical, both from Smith & Nephew, Inc.) were used. Stem hammering was conducted using the same stem inserter. Canal Flare Index (CFI), Cortical Index (CI), Singh Index (SI), canal filling ratio, and the total number of stem-cortex contact zones were evaluated on x-ray images. The Mann-Whitney U-test was used for statistical analysis.Introduction
Materials and methods
