Staged Revision Hip Arthroplasty With Femoral Impaction Bone Grafting for Prosthetic Joint Infections: Radiostereometric Analyses and Clinical Outcomes at Minimum 5-Year Follow-Up.

Background: There are ongoing concerns regarding the use of bone graft following prosthetic joint infection and subsequent implant subsidence. The aim of this study was to determine whether the use of a cemented stem combined with femoral impaction bone grafting (FIBG) at second stage revision for infection results in stable femoral stem fixation, determined by accurate methods, and good clinical results.

Methods: A prospective cohort of 29 patients underwent staged revision total hip arthroplasty for infection using an interval prosthesis followed by FIBG at the final reconstruction.

The effect of weight compared to BMI on patient reported outcomes at long term follow up of primary total hip arthroplasty.

Introduction: Obesity has been linked to the development of osteoarthritis meaning that a large portion of arthroplasty patients are overweight or obese. Whilst the short-term complications associated with obesity are well described there is a paucity of evidence on the effect of weight compared to BMI for long term functional outcomes of total hip replacements (THR). The aim of this study was to investigate the influence of BMI and weight on long-term patient reported outcome measures following primary THR.

Long-Term Outcomes of Staged Revision Surgery for Chronic Periprosthetic Joint Infection of Total Hip Arthroplasty.

Periprosthetic joint infection (PJI) is a serious complication of total hip arthroplasty. Staged revision surgery is considered effective in eradicating PJI. We aimed to determine the rate of infection resolution after each stage of staged revision surgery (first stage, repeat first stage, second stage, excision arthroplasty, and reimplantation) and to assess functional outcomes and the mortality rate at ten years in a consecutive series of 30 chronic PJI of total hip arthroplasties.

The variation in hip stability measurements between supine and standing radiographs of dysplastic hips.

Aims: The aims of this study were to compare clinically relevant measurements of hip dysplasia on radiographs taken in the supine and standing position, and to compare Hip2Norm software and Picture Archiving and Communication System (PACS)-derived digital radiological measurements.

Methods: Preoperative supine and standing radiographs of 36 consecutive patients (43 hips) who underwent periacetabular osteotomy surgery were retrospectively analyzed from a single-centre, two-surgeon cohort. Anterior coverage (AC), posterior coverage (PC), lateral centre-edge angle (LCEA), acetabular inclination (AI), sharp angle (SA), pelvic tilt (PT), retroversion index (RI), femoroepiphyseal acetabular roof (FEAR) index, femoroepiphyseal horizontal angle (FEHA), leg length discrepancy (LLD), and pelvic obliquity (PO) were analyzed using both Hip2Norm software and PACS-derived measurements where applicable.

Vancouver B2 Peri-Prosthetic Fractures in Cemented Femoral Implants can be Treated With Open Reduction and Internal Fixation Alone Without Revision.

Background: The aim of this study is to assess the outcomes of 52 consecutive Vancouver B2 peri-prosthetic fractures around cemented polished double-tapered stems treated by open reduction and internal fixation in 2 trauma centers in 2 countries.

Methods: Outcomes included modified Harris Hip Score (mHHS), Harris Pain Score, and return to pre-injury mobility. Fracture healing was assessed; implant subsidence measured and complications including re-operations reported.

Structured-mentorship Program for Periacetabular Osteotomy Resulted in Few Complications for a Low-volume Pelvic Surgeon.

Background: The Bernese periacetabular osteotomy (PAO) is a complex surgical procedure with a substantial learning curve. Although larger hospital and surgeon procedure volumes have recently been associated with a lower risk of complications, in geographically isolated regions, some complex operations such as PAO will inevitably be performed in low volume. A continuous structured program of distant mentoring may offer benefits when low numbers of PAOs are undertaken, but this has not been tested.

Proximal translation of > 1 mm within the first two years of revision total hip arthroplasty correctly predicts whether or not an acetabular component is loose in 80% of cases: a case-control study with confirmed intra-operative outcomes.

Aims: The purpose of this study was to determine the sensitivity, specificity and predictive values of previously reported thresholds of proximal translation and sagittal rotation of cementless acetabular components used for revision total hip arthroplasty (THA) at various times during early follow-up.

Patients And Methods: Migration of cementless acetabular components was measured retrospectively in 84 patients (94 components) using Ein-Bild-Rontgen-Analyse (EBRA-Cup) in two groups of patients. In Group A, components were recorded as not being loose intra-operatively at re-revision THA (52 components/48 patients) and Group B components were recorded to be loose at re-revision (42 components/36 patients).

The diagnostic performance of radiographic criteria to detect aseptic acetabular component loosening after revision total hip arthroplasty.

Aims: This study aimed to determine the diagnostic performance of radiographic criteria to detect aseptic acetabular loosening after revision total hip arthroplasty (THA). Secondary aims were to determine the predictive values of different thresholds of migration and to determine the predictive values of radiolucency criteria.

Patients And Methods: Acetabular component migration to re-revision was measured retrospectively using Ein-Bild-Rontgen-Analyse (EBRA-Cup) and manual measurements (Sutherland method) in two groups: Group A, 52 components (48 patients) found not loose at re-revision and Group B, 42 components (36 patients) found loose at re-revision between 1980 and 2015.

Advantages in Using Cemented Polished Tapered Stems When Performing Total Hip Arthroplasty in Very Young Patients.

Background: The risk of revision following primary total hip arthroplasty (THA) is increased in young patients who undergo THA for pathologies other than primary osteoarthritis. We report the results of primary THA performed with cemented polished stems in patients aged 40 years and younger for pathologies other than primary osteoarthritis.

Methods: We investigated 52 patients (65 hips) who underwent primary THA for secondary osteoarthritis with a cemented tapered polished stem between 1990 and 2007.

Revision total hip arthroplasty using cemented collarless double-taper femoral components at a mean follow-up of 13 years (8 to 20): an update.

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 loosening at 14 years was 97% (95% confidence interval (CI) 91 to 100) and in patients aged > 70 years, survival was 100%.

Validity and reliability of the Paprosky acetabular defect classification.

Background: The Paprosky acetabular defect classification is widely used but has not been appropriately validated. Reliability of the Paprosky system has not been evaluated in combination with standardized techniques of measurement and scoring.

Questions/purposes: This study evaluated the reliability, teachability, and validity of the Paprosky acetabular defect classification.

Progression of periacetabular osteolytic lesions.

Background: The development of three-dimensional computed tomography (CT) imaging techniques has enabled the detection, accurate measurement, and monitoring of periprosthetic osteolytic lesions. The aim of this study was to track the progression in size of osteolytic lesions and to determine those factors that are associated with the risk of progression. A secondary aim was to investigate whether progression in size of osteolytic lesions could be monitored with use of radiographs.

Femoral bone is preserved using cemented polished stems in young patients.

Background: Techniques that ensure femoral bone preservation after primary THA are important in younger patients who are likely to undergo revision surgery.

Questions/purposes: We examined femoral stem survival, bone deficiency at revision arthroplasty, and radiographic bone loss in hips implanted with a cemented polished double-taper stem in a cohort of patients younger than 55 years.

Methods: We reviewed 197 hips (median patient age, 47 years; range, 16-54 years) after a minimum followup of 2 years (median, 7 years; range, 2-19 years) since primary THA.

Mentoring in complex surgery: minimising the learning curve complications from peri-acetabular osteotomy.

Purpose: The aim of this study was to determine whether a complex surgical procedure such as peri-acetabular osteotomy could be safely learnt by using a programme involving mentoring by a distant expert. To determine this, we examined the incidence of intra-operative complications, the acetabulum correction achieved, the late incidence of re-operation and progressive degenerative arthritis.

Methods: Between 1992 and 2004, peri-acetabular osteotomy was performed in 26 hips in 23 patients.

Degenerative spondylolisthesis in patients with neurogenic claudication effects functional performance and self-reported quality of life.

Study Design: The effect of degenerative spondylolisthesis on functional performance and self reported quality of life in patients with lumbar spinal stenosis was compared to patients with lumbar spinal stenosis and no degenerative spondylolisthesis.

Objective: To define the relationship degenerative spondylolisthesis shares with functional performance and self reported quality of life in patients with symptomatic lumbar spinal stenosis.

Summary Of Background Data: Neurogenic claudication is a clinical syndrome that reflects symptoms caused by anatomic spinal stenosis.

Long-term survival and reason for revision of Wagner resurfacing hip arthroplasty.

The long-term survival of 270 Wagner resurfacing hip arthroplasties was determined. Two patients were lost to follow-up. Eleven hips remained unrevised at 15 to 22 years.

Metal-on-metal resurfacing versus total hip replacement-the value of a randomized clinical trial.

This article describes a randomized clinical trial in young patients, comparing metal-on-metal cemented resurfacing hip replacement with cemented total hip replacement. The trial was stopped early, mainly because of a high incidence of failure of the cemented resurfacing acetabular component. The results reinforce the importance of clinical trials for evaluating the safety and efficacy of prosthesis designs before being used in a large cohort of patients.

The long-term wear of retrieved McKee-Farrar metal-on-metal total hip prostheses.

Twenty-four cobalt-chrome alloy McKee-Farrar matching acetabular and femoral components were retrieved at revision total hip arthroplasty. The average time in situ was 16 years. Wear and loss of sphericity was very low.

Ultimate tensile strength of a Leeds-Keio/autograft ACL reconstruction utilizing PLLA tibial staple fixation.

An ovine model of anterior cruciate ligament reconstruction was utilized to evaluate the biomechanical and histological response of a polylactic acid tibial fixation staple (Gunze Ltd., Japan/Zimmer, Japan). This was performed in a comparison with metallic staples, currently utilized for this procedure.

Effects of design changes on cemented tapered femoral stem fixation.

The effects of matte finish and modularity on loosening of tapered stems using the same cementing technique were studied prospectively. In 80 patients, 82 cemented Exeter primary stems were implanted at total hip revision by one surgeon using the same surgical and cementing technique throughout the series. The polished stems behaved differently than the matte surfaced stems behaved.

Loosening of matt and polished cemented femoral stems.

We have compared prospectively the incidence of loosening of 20 femoral stems with a matt surface with that of 20 polished stems of an otherwise identical tapered, non-modular design of Exeter hip replacement. The stems were inserted using the same technique at operation and radiographs showed no difference in the adequacy of the cement mantle or of fixation. All the patients were reviewed regularly and none was lost to follow-up.