Periprosthetic hip infection: Current concepts and the Wrightington experience.

Total hip arthroplasty (THA) is a highly successful operation performed worldwide in increasing numbers for a wide range of indications. There has been a corresponding rise in the incidence of periprosthetic joint infection of the hip (PJIH), which is a devastating complication. There is a significant variation in the definition, diagnosis and management of PJIH largely due to a lack of high-level evidence.

A comparison of mortality rates following revision hip arthroplasty for periprosthetic fracture, infection or aseptic loosening.

Background: Mortality following revision hip surgery for periprosthetic fracture (PPF) is comparable to neck of femur fractures. Our institution provides a regional "PPF Service". The aim of this study was to determine the time to surgery and mortality rate for PPF, compared to revision for infection or aseptic loosening.

Outcomes of acute fix and replace in complex hip posterior fracture dislocations with acetabular fractures : a minimum of 3 years follow-up.

Simultaneous open reduction and internal fixation of acetabular fractures combined with total hip replacement (THR) have some potential advantages over the more traditional approach in specific patient subgroups. The aim of this study was to evaluate the outcomes of patients who had the "fix and replace" construct for complex posterior hip fracture dislocation treated at our tertiary referral pelvic unit. This was a retrospective review of prospectively collected data for patients who underwent this procedure between 2011-2018 with a minimum of 3 year follow up.

Early Functional Outcomes After Evolutionary Total Knee Arthroplasty: A Randomized Controlled Trial. Is New Always Better?

Unlabelled: Total knee replacement (TKR) designs continue to evolve with the aim of improving patient outcomes; however, there remains a significant patient dissatisfaction rate. We report the early functional outcomes of an evolutionary knee design in the context of a single-blinded, noninferiority, randomized controlled trial.

Methods: Patients were randomized to receive either the P.

Periprosthetic fractures: the next fragility fracture epidemic? A national observational study.

Objectives: Periprosthetic fractures have considerable clinical implications for patients and financial implications for healthcare systems. This study aims to determine the burden of periprosthetic fractures of the lower and upper limbs in England and identify any factors associated with differences in treatment and outcome.

Design: A national, observational study.

Study to Assess the Rate of Adverse Reaction to Metal Debris in Hip Resurfacing at a Minimum 13-year Follow-up.

Background: Hip Resurfacing (HR), although reducing in popularity, is still used in the younger male population. Excellent medium-term results have been published; however, the use of metal on metal has reduced with increased awareness of adverse reactions to metal debris (ARMD). ARMD has been shown to often be clinically "silent" following large Head MoM total hip replacement (THR).

Is Preoperative Identification of the Infecting Organism Essential Before Single-Stage Revision Hip Arthroplasty for Periprosthetic Infection?

Background: It is commonly stated that identification of the infecting organism is a prerequisite to single-stage revision arthroplasty of the hip for deep infection. We have performed single-stage revision in a series of patients where the organism was not identified preoperatively. The aim of this study is to investigate whether the rate of infection eradication following single-stage revision was affected by preoperative knowledge of the infecting organism.

Custom triflange revision acetabular components for significant bone defects and pelvic discontinuity: Early UK experience.

Aims: We report our early experience in acetabular reconstruction for significant bone loss and pelvic discontinuity using custom triflange acetabular components.

Patients And Methods: Retrospective consecutive review of all patients treated at our specialist tertiary unit with significant acetabular defects () and pelvic discontinuity who were reconstructed with custom triflange implants. The primary outcomes were radiographic failure and complications.

Preoperative pain catastrophisation may predict worse patient-reported outcomes after primary hip arthroplasty: A pilot study.

Aim: to investigate the relationship between pain catastrophising and patient-reported clinical outcomes following primary total hip arthroplasty.

Materials And Methods: prospective consecutive study of 103 patients who completed preoperative Pain Catastrophisation Score (PCS), preoperative and 12-month postoperative Oxford Hip Score (OHS). Correlation analysis was carried out between the improvement in OHS (mean difference between pre- and postoperative scores) and the mean preoperative PCS score using the Multiple linear regression was then performed using the postoperative OHS as the outcome variable against a number of predictor variables.

Wear rate and medium-term survival of a cemented, moderately cross-linked polyethylene acetabular prosthesis.

Introduction: The moderately cross-linked Depuy Marathon® cemented acetabular component was introduced into the UK in 2007. The wear rate for the previously introduced Marathon® uncemented acetabular component has been reported to range from 0.06 to 0.

The Beit CURE Classification of Childhood Chronic Haematogenous Osteomyelitis--a guide to treatment.

Background: The Beit CURE (BC) classification is a radiographic classification used in childhood chronic haematogenous osteomyelitis. The aim of this study is to assess correlation between this classification and the type and extent of treatment required.

Methods: We present a retrospective series of 145 cases of childhood chronic haematogenous osteomyelitis classified using the BC classification.

Complications of total hip arthroplasty: periprosthetic fractures of the acetabulum.

Periprosthetic fractures of the acetabulum are a rare but potentially disastrous complication of total hip arthroplasty. Such fractures occur either as early perioperative complications or late complications when they are associated with either significant trauma or as a result of the loss of the structural integrity of the bone supporting the prosthesis, such as aseptic osteolysis. The incidence of such fractures appears to be increasing with the increased use of uncemented acetabular components.

A new technique for radiographic measurement of acetabular cup orientation.

Accurate radiographic measurement of acetabular cup orientation is required in order to assess susceptibility to impingement, dislocation, and edge loading wear. In this study, the accuracy and precision of a new radiographic cup orientation measurement system were assessed and compared to those of two commercially available systems. Two types of resurfacing hip prostheses and an uncemented prosthesis were assessed.

Long stem cemented revision arthroplasty for aseptic loosening in elderly patients produces good results, despite significant bone loss.

We assessed the results of long cemented stems in patients over 65 undergoing a first time revision hip arthroplasty for aseptic loosening. 103 patients were followed up for a minimum of five years after revision surgery; 45% had EndoKlinik C grade preoperative bone loss. At final follow-up 31 patients had died, all but one with the prosthesis in situ.

Metal ion levels not sufficient as a screening measure for adverse reactions in metal-on-metal hip arthroplasties.

This study aims to assess the accuracy of metal ion analysis in the diagnosis of adverse reaction to metal debris (ARMD) in patients with metal-on-metal hip arthroplasties by comparing the cobalt and chromium levels in 57 patients (62 hips) to findings on metal artifact reduction magnetic resonance imaging (MRI). An ARMD was detected using MRI in 18 (29%) of the hips. Forty patients had cobalt levels less than 7 μg/L, and 33 had chromium levels less than 7 μg/L, but 8 of these had an ARMD on MRI and only minimal symptoms (Oxford Hip Score ≥ 44/48).

Revision of medial Oxford unicompartmental knee replacement to a total knee replacement: similar to a primary?

Unicompartmental knee replacement (UKR) is an option for the treatment of isolated medial compartment osteoarthritis. A commonly perceived potential advantage is that revision of a UKR is straightforward. The purpose of this study was to determine the early outcomes and the level of complexity of revisions of Oxford UKRs performed at our hospital.

Silent soft tissue pathology is common with a modern metal-on-metal hip arthroplasty.

Background And Purpose: Adverse reactions to metal debris have been reported to be a cause of pain in metal-on-metal hip arthroplasty. We assessed the incidence of both symptomatic and asymptomatic adverse reactions in a consecutive series of patients with a modern large-head metal-on-metal hip arthroplasty.

Methods: We studied the early clinical results and results of routine metal artifact-reduction MRI screening in a series of 79 large-head metal-on-metal hip arthroplasties (ASR; DePuy, Leeds, UK) in 68 patients.

Radiologic classification of chronic hematogenous osteomyelitis in children.

Background: Childhood hematogenous chronic osteomyelitis remains a serious cause of morbidity throughout the developing world. The aim of our study was to develop a reliable and clinically useful classification system for this condition in children.

Methods: The case notes and radiographs of 87 children with chronic hematogenous osteomyelitis of one or more long bone were reviewed to devise a classification system.

Fluid temperatures during arthroscopic subacromial decompression using a radiofrequency probe.

Our aim was to investigate the temperatures reached in the subacromial space during radiofrequency ablation of the subacromial bursa, in order to see if the probes generate sufficiently high temperatures to cause chondrolysis of the articular surfaces in the glenohumeral joint. We recorded the maximum temperatures in the subacromial space during arthroscopic subacromial decompression on 30 consecutive patients using a sterile digital temperature probe (Series 400, DeRoyal, TN, USA). Both the mean (27.

Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails.

We performed a retrospective review of 101 patients sustaining 102 traumatic, non-pathological subtrochanteric fractures treated with cephalo-medullary nailing over a period of 6 years from 1999 to 2005. Mean follow up was 24 weeks (range: 6-96). Twenty patients were lost to follow up and 21 died, whilst 57 of 60 fractures were followed to union.

Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures.

The purpose of this meta-analysis was to compare the fixation outcome between the sliding hip screw (SHS) and intramedullary nails (IMN) in stable and unstable extracapsular proximal femoral fractures. All randomised controlled studies comparing IMNs with a SHS were considered for inclusion. Data was independently extracted and trial methodology assessed.

Postoperative autologous blood salvage drains--are they useful in primary uncemented hip and knee arthroplasty? A prospective study of 186 cases.

There are nearly 43,000 hip replacements and 33,000 knee replacements performed each year in the United Kingdom. Many of these require a blood transfusion. However, there has been increased public concern about the safety of blood transfusion and various techniques are used to decrease the need for allogenic transfusion.