Twenty-three-year outcome of the porous coated anatomic total hip replacement: a concise follow-up of a previous report.

We previously reported the ten to fourteen-year results for 311 Porous Coated Anatomic total hip replacements that had been inserted by two surgeons in 279 patients. The purpose of the present report is to update that study and to report the outcome beyond twenty years. The patients were followed prospectively with clinical assessment with use of the Harris hip score and radiographic analysis, and the results were collected in a database.

Comparison of total hip arthroplasty performed with and without cement: a randomized trial. A concise follow-up, at twenty years, of previous reports.

Total hip arthroplasty has been associated with excellent implant survival rates, but debate remains concerning the best fixation method for the components. A randomized controlled trial, which included 250 patients (mean age, sixty-four years) with osteoarthritis who were managed with total hip arthroplasty between October 1987 and January 1992, was conducted to compare the results of fixation with and without cement. Patients were followed for a mean of twenty years (range, seventeen to twenty-one years).

Total knee arthroplasty following medial opening wedge tibial osteotomy: technical issues early clinical radiological results.

Medial opening wedge high tibial osteotomy is a popular treatment option for medial compartment osteoarthritis of the knee. One of the proposed advantages is easier conversion to a total knee replacement compared to lateral closing wedge osteotomies, although there are few studies to support this. We reviewed the technical considerations in 36 knees in which conversion of a medial opening wedge osteotomy to total knee arthroplasty was performed, and contrasted these to previously reported studies of knee arthroplasty after closing lateral wedge or dome osteotomies.

What works best, a cemented or cementless primary total hip arthroplasty?: minimum 17-year followup of a randomized controlled trial.

Background: Total hip arthroplasty (THA) has been associated with high survival rates, but debate remains concerning the best fixation mode of THA.

Questions/purposes: We conducted a randomized controlled trial (RCT) with 250 patients with a mean age of 64 years between October 1987 and January 1992 to compare the results of cementless and cemented fixation.

Patients And Methods: Patients were evaluated for revision of either of the components.

Proximally versus fully porous-coated femoral stems: a multicenter randomized trial.

Unlabelled: There are two broad-based categories of cementless femoral component designs: proximally porous-coated and fully porous-coated. While both have been widely used, there remains debate regarding differences in clinical outcome scores, relative incidence of thigh pain, and development of stress shielding. We investigated these variables in a multicenter prospective randomized blinded clinical trial of 388 patients from three centers: 198 patients had a proximally porous-coated tapered cementless femoral component and 190 patients had a fully porous-coated cementless femoral component.

Factors affecting perioperative blood loss and transfusion rates in primary total joint arthroplasty: a prospective analysis of 1642 patients.

BACKGROUND: In recent years, the use of low molecular weight heparins such as dalteparin has become attractive because of their ease of administration and superiority in preventing venous thromboembolism (VTE) compared with traditional agents. The primary purpose of our study was to evaluate the impact of dalteparin use on blood loss and transfusion rates in patients undergoing primary total joint arthroplasty. We also evaluated the effect of patient sex, releasing the tourniquet in knee arthroplasty and the turnover of house staff.

Acetabular polyethylene wear and acetabular inclination and femoral offset.

Unlabelled: Restoration of femoral offset and acetabular inclination may have an effect on polyethylene (PE) wear in THA. We therefore assessed the effect of femoral offset and acetabular inclination (angle) on acetabular conventional (not highly cross-linked) PE wear in uncemented THA. We prospectively followed 43 uncemented THAs for a minimum of 49 months (mean, 64 months; range, 49-88 months).

Wear rate of highly cross-linked polyethylene in total hip arthroplasty. A randomized controlled trial.

Background: Highly cross-linked polyethylene was introduced for clinical use in total hip arthroplasty with the expectation that it would exhibit less wear when compared with conventional polyethylene. The purpose of this study was to report the clinical and radiographic results, after a minimum of five years of follow-up, of a randomized, blinded, controlled trial comparing a conventional polyethylene with a first-generation highly cross-linked polyethylene.

Methods: One hundred patients were enrolled in a prospective, randomized controlled study comparing highly cross-linked and conventional polyethylene acetabular liners in total hip arthroplasty.

The cemented inset biconvex patella in revision knee arthroplasty.

Evaluation of a cemented biconvex inset patellar component used in revision knee arthroplasty at minimum five year follow-up was undertaken. Of the initial cohort of 89 knees in 85 patients, two patellar implants were revised for aseptic loosening following a transverse fracture of the patella associated with avascular necrosis. A further four implants were judged radiographically loose.

The John Insall Award: gender-specific total knee replacement: prospectively collected clinical outcomes.

Unlabelled: Gender-specific total knee replacement design is a recent and debated topic. We determined the survivorship and clinical outcomes of a large primary total knee arthroplasty cohort, specifically assessing any differences between gender groups. A consecutive cohort of 3817 patients with 5279 primary total knee replacements (3100 female, 2179 male) with a minimum of 2 years followup were evaluated.

The impact of morbid obesity on patient outcomes after total knee arthroplasty.

Five hundred fifty patients who underwent primary total knee arthroplasty between 1987 and 2004 with a primary diagnosis of osteoarthritis and 1-year outcome data (Western Ontario and McMaster Osteoarthritis Index [WOMAC]) were evaluated. Patients were stratified into body mass index categories based on the World Health Organization classification of obesity. Patients were dichotomized into a class III morbidly obese group and a non-morbidly obese group.

Tibial tubercle osteotomy in total knee arthroplasty surgery.

Tibial tubercle osteotomy (TTO) is a recognized technique for improving exposure when performing total knee arthroplasty surgery. Forty-two patients were reviewed at a mean of 8 years after TTO. Preoperatively, mean extension was 8 degrees +/- 14 degrees , mean flexion 74 degrees +/- 30 degrees , and Knee Society score 73 +/- 37.

Development of an RSA calibration system with improved accuracy and precision.

In this study, a new radiostereometric analysis (RSA) calibration cage was developed with the aim of improving the accuracy and precision of RSA. This development consisted of three steps: a numerical simulation technique was first used to design the new cage; a synthetic imaging method was then implemented to predict the performance of the designed cage before it was actually fabricated; and an experimental phantom test was finally conducted to verify the actual performance of the new cage and compare with two currently widely used cages. Accuracy was calculated as the 95% prediction intervals from regression analyses between the measured and actual displacements, and precision was defined as the standard deviation of repeated measurements.

The operation of the century: total hip replacement.

In the 1960s, total hip replacement revolutionised management of elderly patients crippled with arthritis, with very good long-term results. Today, young patients present for hip-replacement surgery hoping to restore their quality of life, which typically includes physically demanding activities. Advances in bioengineering technology have driven development of hip prostheses.

What would you do? Challenges in knee surgery.

Evaluation and management of 4 challenging knee case scenarios were discussed in an interactive session with a moderator and 5 experts in knee reconstruction. Case-based discussion included total knee arthroplasty in the presence of femoral deformity, deficient patellar bone, and patella baja, and treatment of infected total knee arthroplasty.

The twenty to twenty-five-year outcomes of the Harris design-2 matte-finished cemented total hip replacement. A concise follow-up of a previous report.

Unlabelled: We previously reported the ten to fifteen-year results for 195 matte-finished Harris Design-2 total hip replacements that had been inserted with cement by two surgeons in 166 patients with osteoarthritis. The purpose of the present report is to update that study and report the twenty to twenty-five-year outcomes. The patients were followed prospectively on the basis of clinical assessment with use of the Harris hip score and radiographic analysis.

The mid-term results of a dual offset uncemented stem for total hip arthroplasty.

The Synergy stem is a third-generation proximal in-growth, tapered titanium alloy uncemented stem, with standard and high offset versions. Two hundred ten primary hip arthroplasties were performed using the Synergy stem in 193 patients. There were 124 males and 69 females with an average age of 58 years (range, 22-85 years).

Wear and osteolysis around total knee arthroplasty.

Osteolysis induced by wear debris of ultra-high-molecular-weight polyethylene has emerged as a significant problem after total knee arthroplasty. The generation of polyethylene wear and the development of osteolysis around total knee arthroplasty are caused by a combination of patient, implant, and surgical factors. Activity level over time may be the most important patient factor affecting the loads placed on a total knee replacement, but it is the most difficult to manage.

Factors affecting survival of uncemented total hip arthroplasty in patients 50 years or younger.

Providing a long-lasting total hip arthroplasty for patients younger than 50 years remains one of the greatest challenges for modern arthroplasty surgery. We retrospectively reviewed 221 patients younger than 50 years who underwent 299 uncemented total hip arthroplasties from 1983 to 2000. We assessed 5- to 15-year survival with revision as the endpoint.

Managing bone loss in revision total hip arthroplasty: the acetabulum.

Osteolysis is the greatest threat to the viability of modern acetabular implants. The etiology and natural history of osteolysis remain unknown. Patients with cementless implants who have osteolysis are challenging to treat.

Tapered hydroxyapatite-coated press-fit stems: any added value?

This study compares the efficacy of hydroxyapatite (HA)-coated press-fit stems versus porous coated press-fit stems with a minimum 2-year follow up. Of the 1152 patients in the study, 69 had an HA-coated grit blasted cemented stem inserted (6%), whereas 1083 (94%) had a porous coated stem inserted. A detailed clinical and radiographic analysis demonstrated that there was no clinical difference at an average 4-year follow up.

Cost effectiveness of revision total knee arthroplasty.

Unlabelled: Total knee arthroplasty now exceeds total hip arthroplasty as the most commonly performed joint replacement. Projections suggest the need for revision knee arthroplasty in the future will produce an immense economic burden. The excellent cost effectiveness of primary knee arthroplasty has been well established.

Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial.

Background: Postoperative analgesia with the use of parenteral opioids or epidural analgesia can be associated with troublesome side effects. Good perioperative analgesia facilitates rehabilitation, improves patient satisfaction, and may reduce the hospital stay. We investigated the analgesic effect of locally injected drugs around a total knee prosthesis.

Arthroplasty options for the young patient: Oxinium on cross-linked polyethylene.

Our purpose was to determine whether metal femoral heads scratch with in vivo use, to characterize the scratching that occurs, and to determine whether this scratching affected polyethylene wear. Assessment of 133 consecutive retrieved femoral heads showed that metal femoral heads do scratch with in vivo use, that cobalt-chromium femoral heads are more scratch resistant than titanium alloy heads, and that scratching seems to be time dependent. Profilmetry studies showed that all roughness parameters (average roughness, maximum peak to lowest valley distance, mean peak height above the mean surface line, estimate of small peaks above the main plateau of the surface, and estimate of the depth of the valleys below the mean plateau of the surface with the exception of the symmetry of the profile about its mean line) showed increased roughness with time of use.

The mini-incision direct lateral approach in primary total hip arthroplasty.

Unlabelled: Patients are inquiring about mini-incision primary total hip arthroplasty with increasing frequency. There are no published randomized controlled trials to substantiate claims that the mini-incision direct lateral approach is better than a standard approach. The purpose of our study was to review our initial experience with the mini-incision technique through the direct lateral approach, with the intent of implementing a randomized controlled trial if the approach could be shown as safe and effective.