A modular femoral head–neck junction has practical
advantages in total hip replacement. Taper fretting and corrosion
have so far been an infrequent cause of revision. The role of design
and manufacturing variables continues to be debated. Over the past
decade several changes in technology and clinical practice might
result in an increase in clinically significant taper fretting and
corrosion. Those factors include an increased usage of large diameter
(36 mm) heads, reduced femoral neck and taper dimensions, greater
variability in taper assembly with smaller incision surgery, and
higher taper stresses due to increased patient weight and/or physical
activity. Additional studies are needed to determine the role of
taper assembly compared with design, manufacturing and other implant
variables. Cite this article:
Despite a lack of long-term follow-up, there
is an increasing trend towards using femoral heads of large diameter
in total hip replacement (THR), partly because of the perceived
advantage of lower rates of dislocation. However, increasing the
size of the femoral head is not the only way to reduce the rate
of dislocation; optimal alignment of the components and repair of
the posterior capsule could achieve a similar effect. . In this prospective study of 512 cemented unilateral THRs (Male:Female
230:282) performed between 2004 and 2011, we aimed to determine
the rate of dislocation in patients who received a 22 mm head on
a 9/10
Hip implant retrieval analysis is the most important
source of insight into the performance of new materials and designs
of hip arthroplasties. Even the most rigorous in vitro testing will
not accurately simulate the behavior of implant materials and new
designs of prosthetic arthroplasties. Retrieval analysis has revealed
such factors as the effects of gamma-in-air sterilisation of polyethylene,
fatigue failure mechanisms of polymethylmethacrylate bone cement,
fretting corrosion of
The aim of this study was to investigate the feasibility of application of a 3D-printed megaprosthesis with hemiarthroplasty design for defects of the distal humerus or proximal ulna following tumour resection. From June 2018 to January 2020, 13 patients with aggressive or malignant tumours involving the distal humerus (n = 8) or proximal ulna (n = 5) were treated by en bloc resection and reconstruction with a 3D-printed megaprosthesis with hemiarthroplasty, designed in our centre. In this paper, we summarize the baseline and operative data, oncological outcome, complication profiles, and functional status of these patients.Aims
Methods
The use and variety of stemless humeral components in anatomical total shoulder arthroplasty (TSA) have proliferated since their advent in 2004. Early outcomes are reassuring but independent mid-term results are scarce. This independent study reports a consecutive series of 143 Eclipse stemless shoulder prostheses with a minimum five-year (5 to 10) follow-up. Outcomes of 143 procedures undertaken for all indications in 131 patients were reviewed, with subset analysis of those for osteoarthritis (OA) (n = 99). The primary outcome was the Oxford Shoulder Score (OSS) at a minimum of five years. Secondary outcomes were ranges of motion and radiological analysis of humeral radiolucency, rotator cuff failure, and glenoid loosening.Aims
Methods
Ceramic bearings have several desirable properties, such as resistance to wear, hardness, and biocompatibility, that favour it as an articulating surface in hip arthroplasty. However, ceramic fracture remains a concern. We have reviewed the contemporary literature, addressing the factors that can influence the incidence of ceramic bearing surface fracture. Cite this article:
The purpose of this study was to compare clinical results, long-term survival, and complication rates of stemless shoulder prosthesis with stemmed anatomical shoulder prostheses for treatment of osteoarthritis and to analyze radiological bone changes around the implants during follow-up. A total of 161 patients treated with either a stemmed or a stemless shoulder arthroplasty for primary osteoarthritis of the shoulder were evaluated with a mean follow-up of 118 months (102 to 158). The Constant score (CS), the Disabilities of the Arm, Shoulder and Hand (DASH) score, and active range of motion (ROM) were recorded. Radiological analysis for bone adaptations was performed by plain radiographs. A Kaplan-Meier survivorship analysis was calculated and complications were noted.Aims
Methods
Aseptic loosening is a major cause of failure in cemented endoprosthetic reconstructions. This paper presents the long-term outcomes of a custom-designed cross-pin fixation construct designed to minimize rotational stress and subsequent aseptic loosening in selected patients. The paper will also examine the long-term survivorship and modes of failure when using this technique. A review of 658 consecutive, prospectively collected cemented endoprosthetic reconstructions for oncological diagnoses at a single centre between 1980 and 2017 was performed. A total of 51 patients were identified with 56 endoprosthetic implants with cross-pin fixation, 21 of which were implanted following primary resection of tumour. Locations included distal femoral (n = 36), proximal femoral (n = 7), intercalary (n = 6), proximal humeral (n = 3), proximal tibial (n = 3), and distal humeral (n = 1).Aims
Patients and Methods
We evaluated a large database with mechanical failure of a single uncemented modular femoral component, used in revision hip arthroplasty, as the end point and compared them to a control group treated with the same implant. Patient- and implant-specific risk factors for implant failure were analyzed. All cases of a fractured uncemented modular revision femoral component from one manufacturer until April 2017 were identified and the total number of implants sold until April 2017 was used to calculate the fracture rate. The manufacturer provided data on patient demographics, time to failure, and implant details for all notified fractured devices. Patient- and implant-specific risk factors were evaluated using a logistic regression model with multiple imputations and compared to data from a previously published reference group, where no fractures had been observed. The results of a retrieval analysis of the fractured implants, performed by the manufacturer, were available for evaluation.Aims
Methods
Aims
Patients and Methods
We present the medium-term clinical results of a reverse total
shoulder arthroplasty with a trabecular metal glenoid base plate. We reviewed 125 consecutive primary reverse total shoulder arthroplasties
(RTSA) implanted in 124 patients for rotator cuff arthropathy. There
were 100 women and 24 men in the study group with a mean age of
76 years (58 to 89). The mean follow-up was 32 months (24 to 60).
No patient was lost to follow-up.Aim
Patients and Methods
Ceramic-on-ceramic (CoC) bearings in total hip arthroplasty (THA)
are commonly used, but concerns exist regarding ceramic fracture.
This study aims to report the risk of revision for fracture of modern
CoC bearings and identify factors that might influence this risk,
using data from the National Joint Registry (NJR) for England, Wales, Northern
Ireland and the Isle of Man. We analysed data on 223 362 bearings from 111 681 primary CoC
THAs and 182 linked revisions for bearing fracture recorded in the
NJR. We used implant codes to identify ceramic bearing composition
and generated Kaplan-Meier estimates for implant survivorship. Logistic
regression analyses were performed for implant size and patient specific
variables to determine any associated risks for revision.Aims
Patients and Methods
We reviewed the initial post-operative radiographs of the Trident acetabulum and identified a problem with seating of the metal-backed ceramic liner. We identified 117 hips in 113 patients who had undergone primary total hip replacement using the Trident shell with a metal-backed alumina liner. Of these, 19 (16.4%) were noted to have incomplete seating of the liner, as judged by plain anteroposterior and lateral radiographs. One case of complete liner dissociation necessitating early revision was not included in the prevalence figures. One mis-seated liner was revised in the early post-operative period and two that were initially incompletely seated were found on follow-up radiographs to have become correctly seated. There may be technical issues with regard to the implanting of this prosthesis of which surgeons should be aware. However, there is the distinct possibility that the Trident shell deforms upon implantation, thereby preventing complete seating of the liner.
The aim of this systematic review was to report the rate of dislocation
following the use of dual mobility (DM) acetabular components in
primary and revision total hip arthroplasty (THA). A systematic review of the literature according to the Preferred
Reporting Items for Systematic Reviews and Meta-analyses guidelines
was performed. A comprehensive search of Pubmed/Medline, Cochrane
Library and Embase (Scopus) was conducted for English articles between
January 1974 and March 2016 using various combinations of the keywords “dual
mobility”, “dual-mobility”, “tripolar”, “double-mobility”, “double
mobility”, “hip”, “cup”, “socket”. The following data were extracted
by two investigators independently: demographics, whether the operation
was a primary or revision THA, length of follow-up, the design of
the components, diameter of the femoral head, and type of fixation
of the acetabular component.Aims
Materials and Methods
The last decade has seen a considerable increase
in the use of in total ankle arthroplasty (TAA) to treat patients
with end-stage arthritis of the ankle. However, the longevity of
the implants is still far from that of total knee and hip arthroplasties. The aim of this review is to outline a diagnostic and treatment
algorithm for the painful TAA to be used when considering revision
surgery. Cite this article:
To determine the effect of a change in design of a cementless
ceramic acetabular component in fixation and clinical outcome after
total hip arthroplasty We compared 342 hips (302 patients) operated between 1999 and
2005 with a relatively smooth hydroxyapatite coated acetabular component
(group 1), and 337 hips (310 patients) operated between 2006 and
2011 using a similar acetabular component with a macrotexture on
the entire outer surface of the component (group 2). The mean age of
the patients was 53.5 (14 to 70) in group 1 and 53.0 (15 to 70)
in group 2. The mean follow-up was 12.7 years (10 to 17) for group
1 and 7.2 years (4 to 10) for group 2.Aims
Patients and Methods
We describe our technique and rationale using
hybrid fixation for primary total hip arthroplasty (THA) at the Hospital
for Special Surgery. Modern uncemented acetabular components have
few screw holes, or no holes, polished inner surfaces, improved
locking mechanisms, and maximised thickness and shell-liner conformity. Uncemented
sockets can be combined with highly cross-linked polyethylene liners,
which have demonstrated very low wear and osteolysis rates after
ten to 15 years of implantation. The results of cement fixation
with a smooth or polished surface finished stem have been excellent,
virtually eliminating complications seen with cementless fixation
like peri-operative femoral fractures and thigh pain. Although mid-term
results of modern cementless stems are encouraging, the long-term
data do not show reduced revision rates for cementless stems compared
with cemented smooth stems. In this paper we review the conduct
of a hybrid THA, with emphasis on pre-operative planning, surgical
technique, hypotensive epidural anaesthesia, and intra-operative
physiology. Cite this article:
Custom-made intercalary endoprostheses may be used for the reconstruction of diaphyseal defects following the resection of bone tumours. The aim of this study was to determine the survival of intercalary endoprostheses with a lap joint design, and to evaluate the clinical results, complications and functional outcome. We retrospectively reviewed six consecutive patients, three of whom underwent limb salvage with intercalary endoprostheses of the tibia, two of the femur, and one of the humerus. Their mean age was 42 years (28 to 64). The mean follow-up was 21.6 months (9 to 58). The humeral prosthesis required revision at 14 months owing to aseptic loosening. There were no implant-related failures. Musculoskeletal Tumour Society functional outcome scores indicated that patients achieved 90% of premorbid function. Custom intercalary endoprostheses result in reconstructions comparable with, if not better than, those of allografts. Using this design of implant reduces the incidence of early complications and difficulties experienced with previous versions.
We report the use of the reverse shoulder prosthesis in the revision of a failed shoulder hemiarthroplasty in 19 shoulders in 18 patients (7 men, 11 women) with severe pain and loss of function. The primary procedure had been undertaken for glenohumeral arthritis associated with severe rotator cuff deficiency. Statistically significant improvements were seen in pain and functional outcome. After a mean follow-up of 44 months (24 to 89), mean forward flexion improved by 26.4° and mean abduction improved by 35°. There were six prosthesis-related complications in six shoulders (32%), five of which had severe bone loss of the glenoid, proximal humerus or both. Three shoulders (16%) had non-prosthesis related complications. The use of the reverse shoulder prosthesis provides improvement in pain and function for patients with failure of a hemiarthroplasty for glenohumeral arthritis and rotator cuff deficiency. However, high rates of complications were associated with glenoid and proximal humeral bone loss.