Total hip arthroplasty (THA) is one of the most successful surgical procedures. The objectives of this study were to define whether there is a correlation between socioeconomic status (SES) and surgical complications after elective primary unilateral THA, and investigate whether access to elective THA differs within SES groups. We conducted a retrospective, population-based cohort study involving 202 hospitals in Ontario, Canada, over a 17-year period. Patients were divided into income quintiles based on postal codes as a proxy for personal economic status. Multivariable logistic regression models were then used to primarily assess the relationship between SES and surgical complications within one year of index THA.Aims
Methods
Total hip arthroplasty (THA) is a very successful and cost-effective operation, yet debate continues about the optimum fixation philosophy in different age groups. The concept of the 'cementless paradox' and the UK 'Getting it Right First Time' initiative encourage increased use of cemented fixation due to purported lower revision rates, especially in elderly patients, and decreased cost. In a high-volume, tertiary referral centre, we identified 10,112 THAs from a prospectively collected database, including 1,699 cemented THAs, 5,782 hybrid THAs, and 2,631 cementless THAs. The endpoint was revision for any reason. Secondary analysis included examination of implant survivorship in patients aged over 70 years, over 75 years, and over 80 years at primary THA.Aims
Methods
Periprosthetic joint infections (PJIs) are rare, but represent a great burden for the patient. In addition, the incidence of methicillin-resistant For this purpose, sterilized steel implants were implanted into the femur of 77 rats. The metal devices were inoculated with suspensions of two different MRSA strains. The animals were divided into groups and treated with vancomycin, linezolid, cotrimoxazole, or rifampin as monotherapy, or with combination of antibiotics over a period of 14 days. After a two-day antibiotic-free interval, the implant was explanted, and bone, muscle, and periarticular tissue were microbiologically analyzed.Aims
Methods
Simultaneous bilateral total knee arthroplasty (TKA) has been used due to its financial advantages, overall resource usage, and convenience for the patient. The training model where a trainee performs the first TKA, followed by the trainer surgeon performing the second TKA, is a unique model to our institution. This study aims to analyze the functional and clinical outcomes of bilateral simultaneous TKA when performed by a trainee or a supervising surgeon, and also to assess these outcomes based on which side was done by the trainee or by the surgeon. This was a retrospective cohort study of all simultaneous bilateral TKAs performed by a single surgeon in an academic institution between May 2003 and November 2017. Exclusion criteria were the use of partial knee arthroplasty procedures, staged bilateral procedures, and procedures not performed by the senior author on one side and the trainee on another. Primary clinical outcomes of interest included revision and re-revision. Primary functional outcomes included the Oxford Knee Score (OKS) and patient satisfaction scores.Aims
Methods
The aim of this study was to investigate whether wear and backside deformation of polyethylene (PE) tibial inserts may influence the cement cover of tibial trays of explanted total knee arthroplasties (TKAs). At our retrieval centre, we measured changes in the wear and deformation of PE inserts using coordinate measuring machines and light microscopy. The amount of cement cover on the backside of tibial trays was quantified as a percentage of the total surface. The study involved data from the explanted fixed-bearing components of four widely used contemporary designs of TKA (Attune, NexGen, Press Fit Condylar (PFC), and Triathlon), revised for any indication, and we compared them with components that used previous generations of PE. Regression modelling was used to identify variables related to the amount of cement cover on the retrieved trays.Aims
Methods
The outcome of 219 revision total hip arthroplasties
(THAs) in 98 male and 121 female patients, using 137 long length
and 82 standard length cemented collarless double-taper femoral
stems in 211 patients, with a mean age of 72 years (30 to 90) and
mean follow-up of six years (two to 18) have been described previously.
We have extended the follow-up to a mean of 13 years (8 to 20) in
this cohort of patients in which the pre-operative bone deficiency Paprosky
grading was IIIA or worse in 79% and 73% of femurs with long and
standard stems, respectively. For the long stem revision group, survival to re-revision for
aseptic
Aims. Loss or absence of proximal femoral bone in revision total hip
arthroplasty (THA) remains a significant challenge. While the main
indication for the use of proximal femoral replacements (PFRs) is
in the treatment of malignant disease, they have a valuable role
in revision THA for
The aim of this study was to investigate the outcome of periprosthetic fractures of the humerus and to assess the uniformity of the classifications used for these fractures (including those around elbow and/or shoulder arthroplasties) by performing a systematic review of the literature. A systematic search was conducted using the National Institute for Health and Care Excellence Healthcare Databases Advance Search. For inclusion, studies had to report clinical outcomes following the management of periprosthetic fractures of the humerus. The protocol was registered on the PROSPERO database.Aims
Methods
Aims. We present our experience of using a metal-backed prosthesis and autologous bone graft to treat gross glenoid bone deficiency. Patients and Methods. A prospective cohort study of the first 45 shoulder arthroplasties using the SMR Axioma Trabecular Titanium (TT) metal-backed glenoid with autologous bone graft. Between May 2013 and December 2014, 45 shoulder arthroplasties were carried out in 44 patients with a mean age of 64 years (35 to 89). The indications were 23 complex primary arthroplasties, 12 to revise a hemiarthroplasty or resurfacing, five for aseptic
Aims. Compared with primary total hip arthroplasty (THA), revision
surgery can be challenging. The cement-in-cement femoral revision
technique involves removing a femoral component from a well-fixed
femoral cement mantle and cementing a new stem into the original
mantle. This technique is widely used and when carried out for the
correct indications, is fast, relatively inexpensive and carries
a reduced short-term risk for the patient compared with the alternative
of removing well-fixed cement. We report the outcomes of this procedure
when two commonly used femoral stems are used. Patients and Methods. We identified 1179 cement-in-cement stem revisions involving
an Exeter or a Lubinus stem reported to the Swedish Hip Arthroplasty
Register (SHAR) between January 1999 and December 2015. Kaplan-Meier
survival analysis was performed. Results. Survivorship is reported up to six years and was better in the
Exeter group (91% standard deviation (. sd). 2.8% versus 85% . sd. 5.0%)
(p = 0.02). There was, however, no significant difference in the
survival of the stem and risk of re-revision for any reason (p =
0.58) and for aseptic
Aims. Femoral impaction bone grafting was first developed in 1987 using
morselised cancellous bone graft impacted into the femoral canal
in combination with a cemented, tapered, polished stem. We describe
the evolution of this technique and instrumentation since that time. . Patients and Methods. Between 1987 and 2005, 705 revision total hip arthroplasties
(56 bilateral) were performed with femoral impaction grafting using
a cemented femoral stem. All surviving patients were prospectively
followed for a mean of 14.7 years (9.8 to 28.3) with no loss to
follow-up. By the time of the final review, 404 patients had died. Results. There were 76 further revisions (10.8%) involving the stem; seven
for aseptic
Aims. We present the clinical and radiological results at a minimum
follow-up of five years for patients who have undergone multiple
cement-in-cement revisions of their femoral component at revision
total hip arthroplasty (THA). Patients and Methods. We reviewed the outcome on a consecutive series of 24 patients
(10 men, 14 women) (51 procedures) who underwent more than one cement-in-cement
revision of the same femoral component. The mean age of the patients was
67.5 years (36 to 92) at final follow-up. Function was assessed using the original Harris hip score (HHS),
Oxford Hip Score (OHS) and the Merle D’Aubigné Postel score (MDP). Results. The mean length of follow-up was 81.7 months (64 to 240). A total
of 41 isolated acetabular revisions were performed in which stem
removal facilitated access to the acetabulum, six revisions were
conducted for
The aim of this study was to compare any differences in the primary outcome (biphasic flexion knee moment during gait) of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) at one year post-surgery. A total of 76 patients (34 bi-UKA and 42 TKA patients) were analyzed in a prospective, single-centre, randomized controlled trial. Flat ground shod gait analysis was performed preoperatively and one year postoperatively. Knee flexion moment was calculated from motion capture markers and force plates. The same setup determined proprioception outcomes during a joint position sense test and one-leg standing. Surgery allocation, surgeon, and secondary outcomes were analyzed for prediction of the primary outcome from a binary regression model.Aims
Methods
The outcome following the development of neurological complications after corrective surgery for scoliosis varies from full recovery to a permanent deficit. This study aimed to assess the prognosis and recovery of major neurological deficits in these patients, and to determine the risk factors for non-recovery, at a minimum follow-up of two years. A major neurological deficit was identified in 65 of 8,870 patients who underwent corrective surgery for scoliosis, including eight with complete paraplegia and 57 with incomplete paraplegia. There were 23 male and 42 female patients. Their mean age was 25.0 years (SD 16.3). The aetiology of the scoliosis was idiopathic (n = 6), congenital (n = 23), neuromuscular (n = 11), neurofibromatosis type 1 (n = 6), and others (n = 19). Neurological function was determined by the American Spinal Injury Association (ASIA) impairment scale at a mean follow-up of 45.4 months (SD 17.2). the patients were divided into those with recovery and those with no recovery according to the ASIA scale during follow-up.Aims
Methods
Wear of the polyethylene (PE) tibial insert of total knee arthroplasty (TKA) increases the risk of revision surgery with a significant cost burden on the healthcare system. This study quantifies wear performance of tibial inserts in a large and diverse series of retrieved TKAs to evaluate the effect of factors related to the patient, knee design, and bearing material on tibial insert wear performance. An institutional review board-approved retrieval archive was surveyed for modular PE tibial inserts over a range of in vivo duration (mean 58 months (0 to 290)). Five knee designs, totalling 1,585 devices, were studied. Insert wear was estimated from measured thickness change using a previously published method. Linear regression statistical analyses were used to test association of 12 patient and implant design variables with calculated wear rate.Aims
Methods
Aims. We present a minimum 20-year follow-up study of 382 cemented
Exeter Universal total hip arthroplasties (350 patients) operated
on at a mean age of 66.3 years (17 to 94). Patients and Methods. All patients received the same design of femoral component, regardless
of the original diagnosis. Previous surgery had been undertaken
for 33 hips (8.6%). During the study period 218 patients with 236
hips (62%) died, 42 hips (11%) were revised and 110 hips (29%) in
96 patients were available for review. The acetabular components
were varied and some designs are now obsolete, however they were
all cemented. Results. With an endpoint of revision for aseptic
