Durability of the cemented femoral stem in patients 60 to 80 years old

The importance of surface roughness and durability of fixation of the cemented femoral stem were examined. Three cohorts of patients approximately 60 to 80 years old, had cemented total hip replacements: Charnley (1978-1983) with first-generation cement technique consisting of canal-plugging and digital packing; Omnifit (1986-1991), and Ranawat-Burstein (R-B) Interlok (1992-1994) with modified third-generation cement technique. Kaplan-Meier survivorships, using failure for all causes (best case) were 90% +/- 5.1% at 20 years for the Charnley 95.1%+/- 3.4% at 15 years for the Omnifit and 99.5% +/- 0.5% at 9 years for the R-B Interlok prosthesis. Log rank test with paired data showed no significant differences between the groups for mechanical failure as an end point. Comparisons of survivorship curves for failure from all causes showed significant differences between the Charnley compared with the Omnifit and Interlok series respectively, with no significant differences between the Omnifit and R-B Interlok series. The cemented femoral stem, with a good cement mantle and surface roughness ranging from 30 to 150 microinches, did not show any significant differences in mechanical failure. Other variables such as stem centralization and low polyethylene wear need additional evaluation in survivorship of cemented total hip replacements.     

Pressure sore prevention pads as an infective source in orthopaedic theatres

Current theatre practice and protocol involves the use of pressure sore prevention pads in the positioning and support of all patients undergoing orthopaedic surgery. Microbiological swabs were taken from those pads placed adjacent to the operative field immediately before implant surgery. Eleven out of the 13 pads sampled yielded bacterial growth capable of causing deep-seated infection. The transfer of these pads between the designated orthopaedic theatres and the rest of the theatre complex was also noted. We recommend that the use of these pads should be closely reviewed. They should either be used with stricter guidelines for decontamination between use or disposable 'clean' alternatives sought.     

3D Printed Acetabular Components for Complex Revision Arthroplasty

Recent studies have shown high early failure rates with Cup Cage constructs in complex revision surgery for Paprosky 3B acetabular defects. As a result, the use of 3D printed custom-made acetabular components has become more common. In this case series, we present two cases that demonstrate the latest advancement in 3D printed implants for severe acetabular bone loss. The follow up was 3 and 7 years. Neither patient has undergone revision surgery of the acetabular component to date. One patient sustained a femoral peri-prosthetic fracture requiring plate fixation. This case study demonstrates that 3D printed implants have excellent intraoperative and immediate postoperative outcomes in revision surgery for severe acetabular bone defects.     

The press-fit condylar modular total knee system with a posterior cruciate-substituting design. A concise follow-up of a previous report

The purpose of the present study was to determine the long-term results of a series of 150 consecutive primary posterior stabilized modular knee arthroplasties that had been performed in 118 patients with use of a circumferential tibial insert capture as described in a previous report, published in 1997. The patients were evaluated with use of a patient-administered questionnaire; Knee Society clinical, functional, and radiographic scoring systems; and Kaplan-Meier survivorship analysis. A good to excellent result was confirmed in seventy-six (90%) of the eighty-four patients (105 knees) with a mean duration of follow-up of twelve years (range, ten to thirteen years). At twelve years, the survival rate was 94.6% +/- 4.0% with failure for any reason as the end point and 98.3% +/- 2.4% with mechanical failure as the end point. Revision surgery was performed in five knees because of infection (two knees), dislocation (one knee), and substantial polyethylene wear with femoral osteolysis (two knees). We concluded that, while fixation failure is rare, polyethylene wear and osteolysis are emerging as important causes of failure.     

Total hip replacement in patients with ankylosing spondylitis with involvement of the hip.

Twenty-three patients with ankylosing spondylitis underwent thirty-four total hip arthroplasties with an average follow-up of 42.5 months. The over-all results were rated good in all but two patients. Significant benefit was obtained in posture and function so that these patients could be gainfully employed. Improvement in the sum total range of motion was 96.1 degrees in patients with bone ankylosis and 150 degrees in those with fibrous ankylosis. The preoperative sum total range of motion was maintained or improved in hips with a painful arc of motion. Most of the limited motion in patients with ankylosed hips was due to myositis ossificans.     

Total hip replacement in congenital dislocation and dysplasia of the hip.

The results of thirty-one total hip replacements in twenty-four patients with either severe congenital dysplasia or dislocation, after an average follow-up of four years, were excellent in eleven, good in sixteen, fair in one, and poor in one.The operative technique included superolateral bone grafts to increase the acetabular coverage in six hips. Twenty-seven hips required smaller and straighter femoral components than normal. The incidence of major complications was 19 per cent.