The aim of this study was to analyze the prevalence of culture-negative periprosthetic joint infections (PJIs) when adequate methods of culture are used, and to evaluate the outcome in patients who were treated with antibiotics for a culture-negative PJI compared with those in whom antibiotics were withheld. A multicentre observational study was undertaken: 1,553 acute and 1,556 chronic PJIs, diagnosed between 2013 and 2018, were retrospectively analyzed. Culture-negative PJIs were diagnosed according to the Muskuloskeletal Infection Society (MSIS), International Consensus Meeting (ICM), and European Bone and Joint Society (EBJIS) definitions. The primary outcome was recurrent infection, and the secondary outcome was removal of the prosthetic components for any indication, both during a follow-up period of two years.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
The aim of this study was to assess the clinical and radiological outcomes of an antiprotrusio acetabular cage (APC) when used in the surgical treatment of periacetabular bone metastases. This retrospective cohort study using a prospectively collected database involved 56 patients who underwent acetabular reconstruction for periacetabular bone metastases or haematological malignancy using a single APC between January 2009 and 2020. The mean follow-up was 20 months (1 to 143). The primary outcome measure was implant survival. Postoperative radiographs were analyzed for loosening and failure. Patient and implant survival were assessed using a competing risk analysis. Secondary parameters included primary malignancy, oncological treatment, surgical factors, length of stay in hospital, and postoperative complications.Aims
Methods
Aims. To report our experience with trunnion corrosion following metal-on-polyethylene
total hip arthroplasty, in particular to report the spectrum of
presentation and determine the mean time to presentation. Patients and Methods. We report the presenting symptoms and signs, intraoperative findings,
and early results and complications of operative treatment in nine
patients with a mean age of 74 years (60 to 86). The onset of symptoms
was at a mean of seven years (3 to 18) after index surgery. Results. Patients presented with a variety of symptoms including pain,
limp and rash. The preoperative mean serum cobalt level was 7.1 ppb
(2.2 to 12.8) and mean serum chromium level was 2.2 ppb (0.5 to
5.2). Metal artifact reduction sequence (MARS) MRI showed fluid
collection and possible pseudotumour formation in five hips, fluid
collection in two hips, and synovitis/debris in one hip, with no
MRI in one patient. Acetabular revision was performed in three patients,
six patients underwent liner and head exchange only. The postoperative
metal levels decreased in all patients: mean cobalt 0.5 ppb (0 to
1.8) and mean chromium 0.9 ppb (0 to 2.6) at a mean of five months
(3 to 8) postoperatively. Seven patients had good pain relief and
no complications at one year. There were two major complications
requiring
Aims. The aim of this study was to report the mid-term clinical outcome
of cemented unlinked J-alumina ceramic elbow (JACE) arthroplasties
when used in patients with rheumatoid arthritis (RA). Patients and Methods. We retrospectively reviewed 87 elbows, in 75 patients with RA,
which was replaced using a cemented JACE total elbow arthroplasty
(TEA) between August 2003 and December 2012, with a follow-up of
96%. There were 72 women and three men, with a mean age of 62 years
(35 to 79). The mean follow-up was nine years (2 to 14). The clinical condition
of each elbow before and after surgery was assessed using the Mayo
Elbow Performance Index (MEPI, 0 to 100 points). Radiographic loosening
was defined as a progressive radiolucent line of >1 mm that was
completely circumferential around the prosthesis. Results. The mean MEPI scores significantly improved from 40 (10 to 75)
points preoperatively to 95 (30 to 100) points at final follow-up
(p < 0.0001). Complications were noted in ten elbows (ten patients;
11%). Two had an intraoperative humeral fracture which was treated
by fixation and united. One had a postoperative fracture of the
olecranon which united with conservative treatment and one had a
radial neuropathy which resolved. Further surgery was required for
one with a dislocation, three with an ulnar neuropathy and one with
a postoperative humeral fracture. Revision with removal of the components
was performed in one elbow due to deep infection. There was no radiographic evidence
of loosening around the components.With any
Aims. We present a case series of ten metal-on-polyethylene total hip
arthroplasties (MoP THAs) with delayed dislocation associated with
unrecognised adverse local tissue reaction due to corrosion at the
trunnion and pseudotumour formation. . Methods. The diagnosis was not suspected in nine of the ten patients (six
female/four male; mean age 66 years), despite treatment in a specialist
unit (mean time from index surgery to revision was 58 months, 36
to 84). It was identified at
Total hip arthroplasties (THAs) are performed by surgeons at various stages in training with varying levels of supervision, but we do not know if this is safe practice with comparable outcomes to consultant-performed THA. Our aim was to examine the association between surgeon grade, the senior supervision of trainees, and the risk of revision following THA. We performed an observational study using National Joint Registry (NJR) data. We included adult patients who underwent primary THA for osteoarthritis, recorded in the NJR between 2003 and 2016. Exposures were operating surgeon grade (consultant or trainee) and whether or not trainees were directly supervised by a scrubbed consultant. Outcomes were all-cause revision and the indication for revision up to ten years. We used methods of survival analysis, adjusted for patient, operation, and healthcare setting factors.Aims
Methods
Aims. The use of a noninvasive growing endoprosthesis in the management
of primary bone tumours in children is well established. However,
the efficacy of such a prosthesis in those requiring a revision
procedure has yet to be established. The aim of this series was
to present our results using extendable prostheses for the revision
of previous endoprostheses. Patients and Methods. All patients who had a noninvasive growing endoprosthesis inserted
at the time of a revision procedure were identified from our database.
A total of 21 patients (seven female patients, 14 male) with a mean
age of 20.4 years (10 to 41) at the time of revision were included.
The indications for revision were mechanical failure, trauma or infection
with a residual leg-length discrepancy. The mean follow-up was 70
months (17 to 128). The mean shortening prior to revision was 44 mm
(10 to 100). Lengthening was performed in all but one patient with
a mean lengthening of 51 mm (5 to 140). Results. The mean residual leg length discrepancy at final follow-up of
15 mm (1 to 35). Two patients developed a deep periprosthetic infection,
of whom one required amputation to eradicate the infection; the
other required two-stage revision. Implant survival according to
Henderson criteria was 86% at two years and 72% at five years. When considering
revision for any cause (including revision of the growing prosthesis
to a non-growing prosthesis), revision-free implant survival was
75% at two years, but reduced to 55% at five years. Conclusion. Our experience indicates that
This study reports updates the previously published two-year clinical, functional, and radiological results of a group of patients who underwent transfibular total ankle arthroplasty (TAA), with follow-up extended to a minimum of five years. We prospectively evaluated 89 patients who underwent transfibular TAA for end-stage osteoarthritis. Patients’ clinical and radiological examinations were collected pre- and postoperatively at six months and then annually for up to five years of follow-up. Three patients were lost at the final follow-up with a total of 86 patients at the final follow-up.Aims
Methods
Dislocation following total hip arthroplasty (THA) is a well-known and potentially devastating complication. Clinicians have used many strategies in attempts to prevent dislocation since the introduction of THA. While the importance of postoperative care cannot be ignored, particular emphasis has been placed on preoperative planning in the prevention of dislocation. The strategies have progressed from more traditional approaches, including modular implants, the size of the femoral head, and augmentation of the offset, to newer concepts, including patient-specific component positioning combined with computer navigation, robotics, and the use of dual-mobility implants. As clinicians continue to pursue improved outcomes and reduced complications, these concepts will lay the foundation for future innovation in THA and ultimately improved outcomes. Cite this article:
The aim of this study was to determine satisfaction rates after hip and knee arthroplasty in patients who did not respond to postoperative patient-reported outcome measures (PROMs), characteristics of non-responders, and contact preferences to maximize response rates. A prospective cohort study of patients planned to undergo hip arthroplasty (n = 713) and knee arthroplasty (n = 737) at a UK university teaching hospital who had completed preoperative PROMs questionnaires, including the EuroQol five-dimension health-related quality of life score, and Oxford Hip Score (OHS) and Oxford Knee Score (OKS). Follow-up questionnaires were sent by post at one year, including satisfaction scoring. Attempts were made to contact patients who did not initially respond. Univariate, logistic regression, and receiver operator curve analysis was performed.Aims
Methods
Return to sport following undergoing total (TKA) and unicompartmental knee arthroplasty (UKA) has been researched with meta-analyses and systematic reviews of varying quality. The aim of this study is to create an umbrella review to consolidate the data into consensus guidelines for returning to sports following TKA and UKA. Systematic reviews and meta-analyses written between 2010 and 2020 were systematically searched. Studies were independently screened by two reviewers and methodology quality was assessed. Variables for analysis included objective classification of which sports are safe to participate in postoperatively, time to return to sport, prognostic indicators of returning, and reasons patients do not.Aims
Methods
Aims. To investigate the longevity of uncemented fixation of a femoral
component in total hip arthroplasty (THA) in patients with Dorr
type C proximal femoral morphology. Patients and Methods. A total of 350 consecutive uncemented THA in 320 patients were
performed between 1983 and 1987, by a single surgeon using the Taperloc
femoral component. The 63 patients (68 hips) with Dorr type C proximal
femoral morphology were the focus of this review. The mean age of
the patients was 69 years (24 to 88) and mean follow-up was 16.6
years (ten to 29). Survival analysis included eight patients (eight
hips) who died without undergoing
Aims. Early evidence has emerged suggesting that ceramic-on-ceramic
articulations induce a different tissue reaction to ceramic-on-polyethylene
and metal-on-metal bearings. Therefore, the aim of this study was
to investigate the tissue reaction and cellular response to ceramic
total hip arthroplasty (THA) materials in vitro,
as well as the tissue reaction in capsular tissue after revision
surgery of ceramic-on-ceramic THAs. Patients and Methods. We investigated tissue collected at
