Aims

The aim of this study was to present a series of patients with aseptic failure of a total ankle arthroplasty (TAA) who were treated with fusion of the hindfoot using a nail.

We reviewed 12 patients six years after they had undergone total hip replacement with a cementless prosthesis, the Ribbed Hip System (Waldemar Link GmbH & Co, Hamburg, Germany). Aseptic loosening of one or both components had necessitated revision surgery in seven patients, in five within two years of operation. In view of our experience we question the wisdom of allowing the uncontrolled use of new prosthesis without postoperative surveillance

Threaded acetabular components are widely used in cementless total hip replacement, despite a poor understanding of the nature of the bone-implant interface. We have examined one case in which the threaded titanium ring appeared to be well incorporated with no discernible radiolucency. Microradiography and histology surprisingly showed that the threads were entirely encapsulated in fibrous tissue. This raises doubt about the relevance of plain radiography to the analysis of the acetabular interface

Our study has determined the response of C-reactive protein (CRP) after total knee replacement (TKR). The peak level occurs on the second postoperative day and is significantly greater than that after total hip replacement (THR). The level returns to normal at similar times after both procedures. The physiological response to TKR as measured by the area under the CRP/ time curve is significantly greater than that after THR. Rising CRP levels after the third postoperative day may indicate a complication of surgery such as infection

Aims

The number of patients undergoing arthroscopic surgery of the hip has increased significantly during the past decade. It has now become an established technique for the treatment of many intra- and extra-articular conditions affecting the hip. However, it has a steep learning curve and is not without the risk of complications. The purpose of this systematic review was to determine the prevalence of complications during and following this procedure.

Discrepancy in leg length after total hip replacement has been associated with patient dissatisfaction. We prospectively studied 200 consecutive patients undergoing unilateral Charnley hip replacements to identify whether there is a demonstrable association between such disparity and postoperative function. Radiological measurements between defined points on the pelvis and femur of the operated hip were compared with the same points on the contralateral joint. A lengthening index was derived and statistical analysis used to compare this with validated functional outcome scores (Harris hip score and the SF36 Health Survey) and patient satisfaction. Our results showed no statistical association between leg-length discrepancy after hip arthroplasty and functional outcome or patient satisfaction

We reviewed histologically the incidence and pathogenesis of the deposition of calcium pyrophosphate dihydrate (CPPD) crystals in the pseudocapsule, femoral and acetabular membranes and periprosthetic tissue at revision of 789 cases of failed total hip replacement. In 13, periprosthetic tissues were found to have deposits of CPPD crystals in areas of cartilaginous metaplasia; four also showed evidence of localised deposition of amyloid. None of the patients had a history of chondrocalcinosis in the hip or other joints. Cartilaginous metaplasia and other changes in periprosthetic tissues may predispose to the deposition of CPPD and associated localised amyloid

Increasing innovation in rapid prototyping (RP) and additive manufacturing (AM), also known as 3D printing, is bringing about major changes in translational surgical research.

This review describes the current position in the use of additive manufacturing in orthopaedic surgery.

Cite this article: Bone Joint J 2018;100-B:455-60.

Radiological assessment of the cement mantle is used routinely to determine the outcome of total hip replacement. We performed a simulated replacement arthroplasty on cadaver femora and took standard postoperative radiographs. The femora were then sectioned into 7 mm slices starting at the calcar, and high-resolution faxitron radiographs were taken of these sections. Analysis of the faxitron images showed that defects in the cement mantle were observed up to 100 times more frequently than on the standard films. We therefore encourage the search for a better technique in assessing the cement mantle

We describe the clinical and radiological results of 38 total hip replacements (THR) using the JRI Furlong hydroxyapatite-ceramic (HAC)-coated femoral component in patients younger than 50 years. The mean age at the time of operation was 42 years (22 to 49) and the mean length of follow-up was ten years (63 to 170 months). All patients receiving a Furlong HAC THR were entered into the study regardless of the primary pathology including patients who had undergone previous hip surgery. The mean Harris hip score improved from 44 before operation to 92 at the last postoperative review. After 12 years the cumulative surivival for the stem was 100% (95% confidence interval 89 to 100). No femoral component was revised. Our results show that the Furlong HAC implant gives excellent long-term results in young patients with high demands

Between 1965 and 1973 a total of 808 McKee-Farrar metal-on-metal cemented total hip arthroplasties were performed in the Norfolk and Norwich Hospital. Of these, 230 surviving arthroplasties have been reviewed at average follow-up of 13.9 years. There were good or excellent results in 49% of the arthroplasties as judged by the Harris hip score with 78% of these having little or no pain. A comprehensive radiographic analysis was undertaken and a survivorship study of 81% of the total number of prostheses is presented

Two patients are described, each with a fracture-dislocation of the hip combined with a fracture of the neck of the same femur. Open reduction combined with internal fixation was performed in both cases. Eight years later one patient had developed avascular necrosis of the femoral head; no signs of avascular necrosis or associated arthritis have appeared in the other patient after four years. A plea is made for considering this more conservative type of operation for these serious injuries before resorting to total hip replacement

Since 1964, 3573 uncemented Ring total hip replacements of all types have been performed; 194 (5.4%) have required revision for infection, loosening or breakage. Of these, 102 were available for review; 81 had satisfactory results five years after operation. These results are better than many of those reported after revision of cemented hip replacements. It is suggested that the absence of cement makes revision easier because bone erosion rarely occurs

Following total hip arthroplasty (THA) and total knee arthroplasty (TKR) only the ‘visible’ measured blood loss is usually known. This underestimates the ‘true’ total loss, as some loss is ‘hidden’. Correct management of blood loss should take hidden loss into account. We studied 101 THAs and 101 TKAs (with re-infusion of drained blood). Following THA, the mean total loss was 1510 ml and the hidden loss 471 ml (26%). Following TKA, the mean total loss was 1498 ml. The hidden loss was 765 ml (49%). Obesity made no difference with either operation. THA involves a small hidden loss, the total loss being 1.3 times that measured. However, following TKA, there may be substantial hidden blood loss due to bleeding into the tissues and residual blood in the joint. The true total loss can be determined by doubling the measured loss

We tested the accuracy of MRI for the precise quantification of the volume of osteonecrosis in 30 hips (stage III). The values were compared with direct anatomical measurements of the femoral heads obtained after total hip replacement. When the area of osteonecrosis was determined visually, and manually outlined on each slice, the accuracy of the measurement of volume was satisfactory, and the mean absolute deviation between MRI and anatomical measurements was similar to that between two MRI data sets. For ten of the hips which were measured by MRI, both before and after collapse, the volume did not appear to change significantly. Our findings suggest that the volume of osteonecrosis can be determined with accuracy by MRI, both before and after collapse

We reviewed the records and radiographs of 387 cemented revisions of aseptic loose sockets after total hip replacement at a mean follow-up of 5.5 years. The clinical results were satisfactory, but at the last radiological assessment 38 sockets (9.8%) had a continuous zone of demarcation greater than 1 mm thick and another 35 (9%) showed migration. Poor acetabular bone stock had a profound influence on the outcome of revision surgery, but the results of cemented revision were comparable to those reported for cementless revision at similar mean follow-up

1. A study of fifty-nine patients with protrusion of the acetabulum showed that they fell into three age groups: those in their teens, those aged thirty-five to fifty years, and those presenting from fifty-one years onwards. 2. The juvenile age group was investigated clinically and biochemically but no causative metabolic factor was found. 3. The familial incidence was confirmed by radiological and biochemical surveys of several families. 4. The results of treatment show that when conservative treatment is insufficient a total hip replacement gives the best result from operation

A computer-based image analysis system has been developed as a research tool in total hip replacement. The system has been programmed to take multiple measurements from coronal plane radiographs. Poor quality radiographic images can be enhanced and standardised. The measurements which can be obtained include stem subsidence, cup migration, cup wear, and stem loosening. Reproducibility and accuracy were +/- 0.01 mm and +/- 0.5 mm respectively. The present application is in retrospective research, but prospective monitoring of radiographs is planned