Aims. The purpose of the present study was to examine the long-term
fixation of a cemented fixed-bearing polished titanium tibial baseplate
(Genesis ll). . Patients and Methods. Patients enrolled in a previous two-year prospective trial (n
= 35) were recalled at ten years. Available patients (n = 15) underwent
radiostereometric analysis (RSA) imaging in a supine position using
a conventional RSA protocol. Migration of the tibial component in
all planes was compared between initial and ten-year follow-up.
Outcome scores including the Knee Society Score, Western Ontario
and McMaster Universities Arthritis Index, 12-item Short Form Health
Survey, Forgotten Joint Score, and University of California, Los
Angeles Activity Score were recorded. Results. At ten years, the mean migration of the tibial component was
less than 0.1 mm and 0.1° in all planes relative to the post-operative
RSA exam. Maximum total point movement increased with time (p =
0.002) from 0.23 mm (. sd. 0.18) at six weeks to 0.42 mm (. sd. 0.20)
at ten years. Conclusion. The low level of tibial baseplate migration found in the present
study correlates to the low rate of
The dysplasia cup, which was devised as an adjunct to the Birmingham Hip Resurfacing system, has a hydroxyapatite-coated porous surface and two supplementary neutralisation screws to provide stable primary fixation, permit early weight-bearing, and allow incorporation of morcellised autograft without the need for structural bone grafting. A total of 110 consecutive dysplasia resurfacing arthroplasties in 103 patients (55 men and 48 women) performed between 1997 and 2000 was reviewed with a minimum follow-up of six years. The mean age at operation was 47.2 years (21 to 62) and 104 hips (94%) were Crowe grade II or III. During the mean follow-up of 7.8 years (6 to 9.6), three hips (2.7%) were converted to a total hip replacement at a mean of 3.9 years (2 months to 8.1 years), giving a cumulative survival of 95.2% at nine years (95% confidence interval 89 to 100). The
Excision of the proximal femur for tumour with
prosthetic reconstruction using a bipolar femoral head places a considerable
load on the unreplaced acetabulum. . We retrospectively reviewed the changes which occur around the
affected hip joint by evaluating the post-operative radiographs
of 65 consecutive patients who underwent proximal prosthetic arthroplasty
of the femur, and in whom an acetabular component had not been used.
There were 37 men and 28 women with a mean age of 57.3 years (17
to 93). Radiological assessment included the extent of degenerative
change in the acetabulum, heterotopic ossification, and protrusio
acetabuli. . The mean follow-up was 9.1 years (2 to 11.8). Degenerative changes
in the acetabulum were seen in three patients (4.6%), Brooker grade
1 or 2 heterotopic ossification in 17 (26%) and protrusion of the
prosthetic head in nine (13.8%). . A total of eight patients (12.3%) needed a
Recent events have highlighted the importance
of implant design for survival and wear-related complications following
metal-on-metal hip resurfacing arthroplasty. The mid-term survival
of the most widely used implant, the Birmingham Hip Resurfacing
(BHR), has been described by its designers. The aim of this study
was to report the ten-year survival and patient-reported functional
outcome of the BHR from an independent centre. In this cohort of 554 patients (646 BHRs) with a mean age of
51.9 years (16.5 to 81.5) followed for a mean of eight years (1
to 12), the survival and patient-reported functional outcome depended
on gender and the size of the implant. In female hips (n = 267)
the ten-year survival was 74% (95% confidence interval (CI) 83 to
91), the ten-year
Limb salvage in bone tumour patients replaces the bone with massive segmental prostheses where achieving bone integration at the shoulder of the implant through extracortical bone growth has been shown to prevent loosening. This study investigates the effect of multidrug chemotherapy on extracortical bone growth and early radiological signs of aseptic loosening in patients with massive distal femoral prostheses. A retrospective radiological analysis was performed on adult patients with distal femoral arthroplasties. In all, 16 patients were included in the chemotherapy group with 18 patients in the non-chemotherapy control group. Annual radiographs were analyzed for three years postoperatively. Dimensions of the bony pedicle, osseointegration of the hydroxyapatite (HA) collar surface, bone resorption at the implant shoulder, and radiolucent line (RLL) formation around the cemented component were analyzed.Aims
Methods
We evaluated the long-term fixation of 64 press-fit cemented stems of constrained total knee prostheses in 32 young patients with primary malignant bone tumours. Initial stable fixation, especially in rotation, was achieved by precise fit of the stem into the reamed endosteum, before cementation. Complementary fixation, especially in migration and rotation, was obtained by pressurised antibiotic-loaded cement. The mean age at operation was 33 years (13 to 61). No patient was lost to follow-up; 13 patients died and the 19 survivors were examined at a mean follow-up of 12.5 years (4 to 21). Standard
The aim of this paper is to describe the impact of COVID-19 on spine surgery services in a district general hospital in England in order to understand the spinal service provisions that may be required during a pandemic. A prospective cohort study was undertaken between 17 March 2020 and 30 April 2020 and compared with retrospective data from same time period in 2019. We compared the number of patients requiring acute hospital admission or orthopaedic referrals and indications of referrals from our admission sheets and obtained operative data from our theatre software.Aims
Methods
Previous studies have reported an increased risk for postoperative complications in the Medicaid population undergoing total hip arthroplasty (THA). These studies have not controlled for the surgeon’s practice or patient care setting. This study aims to evaluate whether patient point of entry and Medicaid status plays a role in quality outcomes and discharge disposition following THA. The electronic medical record at our institution was retrospectively reviewed for all primary, unilateral THA between January 2016 and January 2018. THA recipients were categorized as either Medicaid or non-Medicaid patients based on a visit to our institution’s Hospital Ambulatory Care Center (HACC) within the six months prior to surgery. Only patients who had been operated on by surgeons (CML, JV, JDS, RS) with at least ten Medicaid and ten non-Medicaid patients were included in the study. The patients included in this study were 56.33% female, had a mean age of 60.85 years, and had a mean BMI of 29.14. The average length of follow-up was 343.73 days.Aims
Methods
High body mass index (BMI) is associated with increased rates of complications in primary total hip arthroplasty (THA), but less is known about its impact on cost. The effects of low BMI on outcomes and cost are less understood. This study evaluated the relationship between BMI, inpatient costs, complications, readmissions, and utilization of post-acute services. A retrospective database analysis of 40,913 primary THAs performed between January 2013 and December 2017 in 29 hospitals was conducted. Operating time, length of stay (LOS), complication rate, 30-day readmission rate, inpatient cost, and utilization of post-acute services were measured and compared in relation to patient BMI.Aims
Methods
The April 2015 Knee Roundup360 looks at: Genetic determinants of ACL strength; TKA outcomes influenced by prosthesis; Single- or two-stage
Aims. The aim of this study was to identify risk factors for prosthetic
joint infection (PJI) following total knee arthroplasty (TKA). . Patients and Methods. The New Zealand Joint Registry database was analysed, using revision
surgery for PJI at six and 12 months after surgery as primary outcome
measures. Statistical associations between
To systematically review the outcomes and complications of cosmetic stature lengthening. PubMed and Embase were searched on 10 November 2019 by three reviewers independently, and all relevant studies in English published up to that date were considered based on predetermined inclusion/exclusion criteria. The search was done using “cosmetic lengthening” and “stature lengthening” as key terms. The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles.Aims
Methods
This is a 15-year follow-up observational study of 4390 patients with 4606 primary total knee replacements (TKRs) implanted in the Trent health region between 1990 and 1992. The operations were performed in 21 hospitals, including both district general and teaching hospitals, with 77 different surgeons as named consultant. The main objective was to analyse the survival of the patients and of the prostheses, and to evaluate what impact different variables have on survival. In addition, the 1480 patients (33.7%) (1556 TKRs) alive at 15 years following operation were sent a self-administered questionnaire which examined their level of satisfaction, of pain, and their quality of life at 15 years. Completed responses were received from 912 TKRs (58.6%). Three survival curves were constructed: a best-case scenario based on the patients entered into the life tables, another included failures not reported in the
An extensive review of the spinal and arthroplasty
literature was undertaken to evaluate the effectiveness of local
antibiotic irrigation during surgery. The efficacy of antibiotic
irrigation for the prevention of acute post-operative infection
after total joint arthroplasty was evaluated retrospectively in
2293 arthroplasties (1990 patients) between January 2004 and December
2013. The mean follow-up was 73 months (20 to 139). One surgeon
performed all the procedures with minimal post-operative infection. . The intra-operative protocol included an irrigation solution
of normal saline with vancomycin 1000 mg/l and polymyxin 250 000
units/l at the rate of 2 l per hour. No patient required re-admission
for primary infection or further antibiotic treatment. Two morbidly obese
patients (two total hip arthroplasties) developed subcutaneous fat
necrosis requiring debridement and one was revised because the deep
capsular sutures were contaminated by the draining subcutaneous
haematoma. One patient who had undergone total knee arthroplasty
had unrecognised damage to the lateral superior geniculate artery
and developed a haematoma that became infected secondarily four
months after the surgery and underwent
