Mean Oxford Hip Score Research Articles

Long-term results of metal on metal total hip arthroplasty in younger patients (

IntroductionMetal on Metal (MoM) hip arthroplasty saw a new era of popularity with development of its second generation bearing surfaces, in the first decade of this century. However, by the end of that decade, concerns had been raised due to metal debris related complications.We aimed to determine the survival of MoM stemmed hip replacement in younger population. We also studied the rate of revision related to adverse reaction to metal debris (ARMD) along with reviewing the clinical and radiological progress of MoM hip arthroplasty in younger age (<55 yrs) group. Patients & MethodsThis is a retrospective cohort study of patients 55 yrs old or younger, who had metal on metal (MoM) hip arthroplasty for osteoarthritis. We had 109 procedures performed on 90 patients with a mean follow up of 10 years. All patients were reviewed as per MHRA guidelines in planned follow-up clinics. Data analyses were performed using SPSS. ResultsSurvival of implant in our younger cohort was 88.1% at a mean age if 10 years, with revision for any cause as an endpoint. Most of the patients were happy with the outcome of their hip replacement as they were able to perform activities of daily living and work without compromise. Mean Oxford hip score was 43.Altogether, there were 12 revisions, 7 of these were for metallosis and associated symptoms. Average time to revision was 7 years. Other analysis revealed mean acetabular cup inclination angle to be 49 degrees but no significant correlation was found between this angle and serum metal ion levels. Serum Chromium and Cobalt levels were significantly higher in revision group. DiscussionMetal on metal hip arthroplasty prime popularity time has gone. In younger population, although revision rates are higher, the surviving implants give a very good outcome in terms of patient satisfaction. Most of the patients report a desired outcome of ‘forgotten hip’.

Good function and high patient satisfaction at mean 2.8 years after dual mobility THA following femoral neck fracture: a cross-sectional study of 124 patients.

AimsOur aim was to investigate function, health status and satisfaction in patients treated with primary dual mobility (DM) total hip arthroplasty (THA) after displaced femoral neck fracture (FNF).Patients and methodsFrom 2005–2011, 414 consecutive FNF patients received Saturne DM THA. At a minimum of 1-year follow-up, 124 (95 women) were evaluated with Oxford Hip Score (OHS), Harris Hip Score (HHS), health-related quality of life (HRQoL) measure (EQ-5D) and two functional tests: Timed Up and Go (TUG) and Sit to Stand 10 times (STS). The FNF patients were matched 1:2 by age, sex and surgery date with patients receiving THA due to osteoarthrosis (OA group) and 1-year OHS and EQ5D were compared. FNF patients were matched by age and sex with the general population index (GPI) for EQ-5D comparison.ResultsPatient age at surgery after FNF was mean 74.8 (range 30–92) years. At mean follow-up of 2.8 (range 1.0–7.7) years, mean EQ-5D score was 0.79 (SD 0.15) in the FNF group, which was similar to the matched GPI (p = 0.4), but lower (p = 0.014) compared to the OA group. Mean OHS was 36.4 (SD 9.5) in the FNF group and 38.4 (SD 7.2) in the OA group (p = 0.18). HHS in the FNF group was 78.7 (SD 15.5). Mean TUG time was 13.5 (SD 4.9) secs, and mean STS was 37.9 (SD 15.3) secs. Eighty nine percent (n = 111) of FNF patients were satisfied with the operation result.ConclusionDM THA following displaced FNF provides a good functional result and quality of life in addition to high patient satisfaction.

Tritanium Acetabular Cup in Revision Hip Replacement: A Six to Ten Years of Follow-Up Study

BackgroundThe use of highly porous acetabular components has shown to produce good results in revision acetabular surgery. Their surface characteristics enhance initial fixation and bone ingrowth which are prerequisites for adequate osseointegration. The purpose of this study is to analyze the mid-term to long-term survival, clinical and radiological outcomes using the Tritanium cup (Stryker, Mahwah, NJ) in revision hip surgery. MethodsThis is a retrospective review of all patients who underwent acetabular revision surgery using “Tritanium revision cup” between April 2007 and November 2010 at our institution. Sixty-two patients were included with a mean age of 67.5 years (32-86). According to Paprosky classification, 10 patients had type I defect, 8 had type IIA, 27 had type IIB, 7 had type IIC, and 10 suffered from type IIIA defect. A Kaplan-Meier analysis was used to determine the survival of the cup. Functional outcomes were assessed using Oxford Hip Score. Plain radiographs were performed to assess implant fixation and osseointegration. ResultsThe acetabular cup aseptic survivorship was 98.4% at a mean follow-up of 87.6 months. The mean Oxford Hip Score improved from 14.5 (3-31) preoperatively to 38.5 (12-48) at the final follow-up. Two cups were revised (3.2%): 1 for aseptic loosening and 1 for infection. ConclusionTritanium revision acetabular cup has shown excellent mid-term to long-term clinical and radiographic results with low failure rate and minimal complications. Longer term follow-up would be of value to assess the ongoing survival of this implant construct.

Labral augmentation with ligamentum capitis femoris: presentation of a new technique and preliminary results.

ABSTRACTPreservation of an intact labrum and reconstruction of a deficient or worn acetabular labrum are accepted techniques in modern hip surgery. If the remaining labrum is very thin, its intact tip can be preserved and its volume restored with a ligamentum teres graft. Technique and preliminary results of this augmentation technique are presented. Labral augmentation was performed in 16 hips (11 rights) in 16 patients (7 males, mean age 29 years) during surgical dislocation for treatment of femoroacetabular impingement. The acetabular index, lateral center edge angle, asphericity angle and acetabular retroversion index were determined on preoperative X-rays and magnetic resonance imaging. The pre- and postoperative Merle d’Aubigné and Postel score (MdA) was calculated and the Oxford Hip Score (OHS) obtained after 1 year. There were seven Grade 1 and nine Grade 0 hips (Tönnis classification). Mean lateral center edge was 29°. The mean acetabular index was 1.85°. Mean asphericity angle was 62.5°. Mean acetabular retroversion index was 23.4%. Mean MdA improved from 14.5 preoperatively to 17 at 1 year (P < 0.0001). Mean OHS after 1 year was 42. Previous surgery was a risk factor for inferior results: OHS was 44.5 in hips without versus 26 in hips with previous surgery. Mean MdA improved from 15 to 17.5 in patients without previous surgery versus 14 to 16 for the group with previous surgery. Augmentation of the labrum using ligamentum teres shows good clinical results after 1 year. Patients with previous hip surgery had inferior results.

R3 Cup Does Not Have a High Failure Rate in Conventional Bearings: A Minimum of 5-Year Follow-Up

BackgroundThe R3 cementless acetabular system was first marketed in Australia and Europe in 2007. Previous papers have shown high failure rates of the R3 cup with up to 24% with metal-on-metal bearing. There are currently no medium term clinical results on this cup. The aim of the study is to review our results of the R3 acetabular cup with conventional bearings with a minimum of 5-year follow-up. MethodsPatients who were implanted with the R3 acetabular cup were identified from our center's arthroplasty database. A total of 293 consecutive total hip arthroplasties were performed in 286 patients. The primary outcome was revision. The secondary outcomes were the Oxford Hip Scores (OHS) and radiographic evaluation. ResultsThe mean age of the patients was 69.4 years. The mean preoperative OHS was 23 (range 10-34) and the mean OHS was 40 (range 33-48) at the final follow-up. Radiological evaluation showed an excellent ARA score in all patients at 5 years. None of the R3 cups showed osteolysis at the final follow-up. There were 3 revisions in our series, of which 2 R3 cups were revised. The risk of revision was 1.11% at 5 years. ConclusionOur experience of using the R3 acetabular system with conventional bearings showed high survivorship and is consistent with the allocated Orthopaedic Data Evaluation Panel rating of 5A* as rated in 2015 in the United Kingdom.

Clinical Outcome of Massive Endoprostheses Used for Managing Periprosthetic Joint Infections of the Hip and Knee

BackgroundEndoprosthetic replacement (EPR) is an option for management of massive bone loss resulting from infection around failed lower limb implants. The aim of this study is to determine the mid-term outcome of EPRs performed in the treatment of periprosthetic joint infection (PJI) and infected failed osteosyntheses around the hip and knee joint and identify factors that influence it. MethodsWe retrospectively reviewed all hip and knee EPRs performed between 2007 and 2014 for the management of chronic infection following complex arthroplasty or fracture fixation. Data recorded included indication for EPR, number of previous surgeries, comorbidities, and organism identified. Outcome measures included PJI eradication rate, complications, implant survival, mortality, and functional outcome (Oxford Hip or Knee Score). ResultsSixty-nine EPRs (29 knees and 40 hips) were performed with a mean age of 68 years (43-92). Polymicrobial growth was detected in 36% of cases, followed by coagulase-negative staphylococci (28%) and Staphylococcus aureus (10%). Recurrence of infection occurred in 19 patients (28%): 5 were treated with irrigation and debridement, 5 with revision, 1 with above-knee amputation, and 8 remain on long-term antibiotics. PJI eradication was achieved in 50 patients (72%); the chance of PJI eradication was greater in hips (83%) than in knees (59%) (P = .038). The 5-year implant survivorship was 81% (95% confidence interval 74-88). The mean Oxford Hip Score and Oxford Knee Score were 22 (4-39) and 21 (6-43), respectively. ConclusionThis study supports the use of EPRs for eradication of PJI in complex, multiply revised cases. We describe PJI eradication rate of 72% with acceptable functional outcome.

Functional outcome of debridement, antibiotics and implant retention in periprosthetic joint infection involving the hip: a case-control study.

Advocates of debridement, antibiotics and implant retention (DAIR) in hip periprosthetic joint infection (PJI) argue that a procedure not disturbing a sound prosthesis-bone interface is likely to lead to better survival and functional outcome compared with revision. This case-control study aims were to compare outcome of DAIRs for infected primary total hip arthroplasty (THA) with outcomes following primary THA and two-stage revision of infected primary THAs. We retrospectively reviewed all DAIRs, performed for confirmed infected primary hip arthropasty (n = 82) at out institution, between 1997 and 2013. Data recorded included full patient information and type of surgery. Outcome measures included complications, mortality, implant survivorship and functional outcome. Outcome was compared with two control groups matched for gender and age; a cohort of primary THAs (n = 120) and a cohort of two-stage revisions for infection (n = 66). Mean age at DAIR was 69 years (33 to 87) and mean follow-up was eight years (2 to 17; standard deviation (sd) 5). A total of 52 (63%) of DAIRs were for early PJI (less than six weeks). Greater success in the eradication of infection with DAIR was identified with early PJI, comprising an interval less than a week between onset of symptoms and exchange of modular components with the DAIR procedure. Eradication of infection, complications and re-operation rates were similar in the DAIR and two-stage revision groups. For hips with successful eradication of infection with DAIR, the five-year survival (98%; 95% confidence interval (CI) 94 to 100) was similar to the primary THA group (98%; 95% CI 95 to 100) (n = 43; p = 0.3). The DAIR group had inferior mean Oxford Hip Scores (OHS) (38; 12 to 48) compared with the primary THA group (42; 15 to 48) (p = 0.02) but a significantly better mean OHS compared with the two-stage revision group (31; 0 to 48) (p = 0.008). Patients who required only one DAIR for eradication of infection had a similar mean OHS (41; 20 to 48) to the primary THA group (p = 0.2). The DAIR procedure is associated with a similar complication rate and ability to eradicate infection as two-stage revision. This study emphasises the need for exchange of modular components for improved chances of eradication of infection. This is the first study showing that DAIR is better than a two-stage revision regarding functional outcome. Cite this article: Bone Joint J 2017;99-B:614-22.

Management of massive acetabular bone defects in revision arthroplasty of the hip using a reconstruction cage and porous metal augment.

It may not be possible to undertake revision total hip arthroplasty (THA) in the presence of massive loss of acetabular bone stock using standard cementless hemispherical acetabular components and metal augments, as satisfactory stability cannot always be achieved. We aimed to study the outcome using a reconstruction cage and a porous metal augment in these patients. A total of 22 acetabular revisions in 19 patients were performed using a combination of a reconstruction cage and porous metal augments. The augments were used in place of structural allografts. The mean age of the patients at the time of surgery was 70 years (27 to 85) and the mean follow-up was 39 months (27 to 58). The mean number of previous THAs was 1.9 (1 to 3). All patients had segmental defects involving more than 50% of the acetabulum and seven hips had an associated pelvic discontinuity. Three failures were observed in two hips, both of which had undergone a previous resection of a tumour affecting the acetabulum. Other complications included a late arterial injury, a sciatic nerve palsy, a dislocation treated with a femoral revision, a deep infection treated with irrigation and debridement and a fracture of the greater trochanter treated conservatively. The mean Oxford Hip Score significantly increased from 13.9 (2 to 23) to 28.7 (13 to 38) (p < 0.00001). The mean vertical distance between the centre of rotation of the hip and its normal location decreased from 30 mm to 10 mm. Acceptable early survivorship can be achieved using this novel technique, but it may be unsuitable for use in patients who have previously undergone the resection of a tumour involving the acetabulum. Cite this article: Bone Joint J 2017;99-B:607-13.

Patient-reported quality of life and hip function after 2-stage revision of chronic periprosthetic hip joint infection: a cross-sectional study.

Very limited information is available regarding patient-reported health-related quality of life (HRQoL) and hip function following treatment for chronic periprosthetic hip joint infection (PJI). Patient-reported outcome measures provide essential information to clinicians of the impact a treatment have on patient's lives. The purpose of this study was to examine patient reported HRQoL and hip function after a completed re-implantation in a 2-stage revision. 82 patients were identified retrospectively in the National Patient Register. 57 patients were alive and asked to complete the questionnaires EuroQol-5D (EQ-5D) and Oxford Hip Score (OHS) in November 2014. Results were compared to normative population data for EQ-5Dindex. Patients re-infected after a completed 2-stage revision were compared with not re-infected. 45 patients completed the questionnaires. Mean time since re-implantation was 8.2 years (95% CI [confidence interval], 7.7-0.87). The EQ-5D index mean for the 2-stage group was 0.71 (0.64; 0.77) whereas the general population mean is 0.85 (0.84-0.85), p = 0.0004. The 2-stage revision patients scored significantly lower on every EQ-5D dimension. The re-infected group mean EQ-5D index score was significantly lower compared to the not re-infected group, p = 0.003. The EQ-VAS mean score was 58.2 (57.3-68.3) and the mean OHS for the group was 29.2 (25.4-33.0). Patients who undergo 2-stage revision after a PJI have lower scores on HRQoL than the general population. Patients who are re-infected following revision have a lower HRQoL score than patients not re-infected. Future research should focus on optimising patient-reported outcomes after treatment for PJI.

Patient-reported health outcomes after total hip and knee surgery in a Dutch University Hospital Setting: results of twenty years clinical registry

BackgroundPatient-Reported Outcome (PRO) measurement is a method for measuring perceptions of patients on their health and quality of life. The aim of this paper is to present the results of PRO measurements in total hip and knee replacement as routinely collected during 20 years of surgery in a university hospital setting.MethodsData of consecutive patients between 1993 and 2014 were collected. Health outcomes were measured pre-surgery and at 3, 6, and 12 months post-surgery. Outcomes for hip replacement were measured with the Harris Hip Score (HHS) and Oxford Hip Score (OHS). Outcomes for knee replacement were measured with the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Knee Society Score (KSS). A Visual Analog Scale (VAS) for pain was used. Absolute and relative Minimal Clinically Important Differences (MCID) were estimated. Generalized estimating equation analysis was used for estimating mean outcomes. Trends over time were analyzed.ResultsThe database contained 2,089 patients with hip replacement, and 704 patients with knee replacement. Mean HHS and OHS scores in primary hip replacement at 12 months post-surgery were 86.7 (SD: 14.5) and 41.1 (SD: 7.5) respectively. Improvements on the HHS based on absolute MCID was lower for revisions compared to primary hip replacements, with 72.4% and 87.0% respectively. Mean WOMAC and KSS scores in knee replacement at 12 months post-surgery were 21.5 (SD: 18.2) and 67.0 (SD: 26.4) respectively. Improvements based on absolute MCID were lowest for the KSS (62.6%) and highest for VAS pain (85.6%). Trend analysis showed a difference in 1 out of 24 comparisons in hip replacement and in 2 out of 9 comparisons in knee replacement.ConclusionsThe functional status of a large cohort of patients significantly improved after hip and knee replacement based on routine data collection. Our study shows the feasibility of the routine collection of PRO data in patients with total hip and knee replacement. The use of PRO data provides opportunities for continuous quality improvement.

The Morscher Press-Fit Acetabular Component: An Independent Long-Term Review at 18-22 Years

BackgroundThere are relatively few 20-year results of uncemented acetabular components, and most of these are modular designs. This study reports the 20-year results of a monoblock press-fit acetabular component. MethodsA total of 122 total hip arthroplasties (111 patients) using the Morscher cup were reviewed at a mean of 19.7 years. The average age at implantation was 57.3 years (range, 36-74 years), and 81 (66%) were men. ResultsTwenty-two patients (25 hips) had died. Seven hips were revised, including 5 acetabular revisions. Six patients (6 hips) declined to participate but were known not to have been revised. The mean Oxford hip score was 41.1 (range, 22-48), and the mean reduced Western Ontario and McMaster Universities Osteoarthritis Index score was 5.7/48 (range, 0-24). Eccentric wear was seen in 13 (15.7%) and major osteolysis in 14 (17%) of 82 surviving hips with radiographs. The all-cause revision rate was 0.32 per 100 observed component years (95% confidence interval [CI], 0.13-0.66). The 20-year Kaplan-Meier survival was 93.4% (CI, 86.6-96.8) for all-cause revisions, 95.5% (CI, 89.4-98.1) for any acetabular revision, and 97.1% (CI, 91.2-99.1) for acetabular aseptic loosening, wear, or osteolysis. ConclusionThe Morscher acetabular component has continued to perform well at 20 years despite using conventional polyethylene with results that match or surpass other cementless acetabulae.

Outcome of revision arthroplasty for failed metal-on-metal total hip replacements; is there a relation with metal ions?

We aimed to assess the early outcome following revision arthroplasty for failed metal-on-metal (MoM) total hip replacements (THR) due to adverse reaction to metal debris (ARMD). We reviewed 106 consecutive revision arthroplasties. Case notes and radiological investigations were reviewed to assess the complications. Oxford Hip Score (OHS) and Euroqol (EQ-5D-3L) scores were used to assess the functional outcome and improvement of quality of life. At a mean follow-up of 20 months (12-48 months), the mean OHS was 28.7. Pain improved in 61% patients. A majority of patients were in level 2 for all the EQ-5D-3L dimensions. The overall complication rate was 16%. Survivorship free from further revision for any cause was 94.3% at 48 months. There was no correlation between pre-revision blood metal ions and the final outcome. Revision surgery for failed MoM hip replacement due to ARMD is associated with a relatively higher rate of complications and risk of chronic pain. There is poor correlation between serum metal ions and development of ARMD and outcome following revision surgery.

Excellent Mid-Term Results of a New Polished Tapered Modular Cemented Stem: A Study of 113 Hip Replacements with Minimum 5-Year Follow-Up

BackgroundThis prospective cohort study reports the medium-term clinical and radiographic results of 113 hips treated with a hybrid total hip replacement (THR) with a new cemented tapered cobalt-chrome (Co-Cr) stem with a titanium (Ti) modular neck (ProfemurXm®).MethodBetween October 2008 and December 2010 we performed 115 consecutive hybrid THR with the ProfemurXm® in 105 patients.ResultsSurvivorship of the implant (stem and modular neck) at a mean of 6.5 years (min 5-max 8) was 100% with the endpoint revision for any reason. No implant was at risk for revision or showed signs of loosening. The mean Harris Hip Score was 89/100, mean Oxford Hip Score was 43/48, mean WOMAC was 91/100. No patient had thigh pain, no patient reported squeaking. There were no dislocations in this cohort. No implant showed development of radiolucent lines (RLL), either at the stem-cement or cement-bone interface. No hip showed osteolysis or calcar resorption. The mean femoral subsidence of the stem within the cement mantel was 0.31 mm (range 0-0.6 mm) after 6.5 years. With the use of this modular stem, 93% of hips showed no measurable leg length difference after THR, and leg length could be restored within a 5-mm limit in 99% of hips.ConclusionsThe mid-term results of this new polished stem were excellent, without adverse effects from the use of modularity.

Medium-term patient-reported outcomes after total hip replacement for displaced hip fractures.

The aim of the present study was to define the medium-term outcomes following total hip replacement (THR) for hip fracture. We prospectively followed up 92 patients who underwent THR for a displaced hip fracture over a 3-year period between 2007 and 2010. These patients were followed up at 5years using the Oxford Hip Score, Short-Form 12 (SF-12) questionnaire and satisfaction questionnaire. These outcomes were compared to the short-term outcomes previously reported at 2years to determine any significant differences. Mean follow-up was at 5.4years with a mean age at follow-up of 76.5years. Seventy-four patients (80%) responded. Patients reported excellent functional outcomes and satisfaction (mean Oxford Hip Score 40.3; SF-12 Physical Health Composite Score 44.0; SF-12 Mental Health Composite Score 46.2; mean satisfaction 90%). The rates of dislocation (2%), deep infection (2%) and revision (3%) were comparable to those quoted for elective THR. When compared with 2-year follow-up, there were no statistically significant adverse changes in outcome parameters. Medium-term outcomes for THR after hip fracture in fit older patients are excellent, and these results demonstrate that the early proven benefits of this surgery are sustained into the midterm.

What is the fate of the neck after a collum femoris preserving prosthesis? a nineteen years single center experience.

The aim of our study is to evaluate long-term outcomes from a cohort of patients treated with collum femoris preserving (CFP) stem correlating neck resorption with comorbidities, clinical outcomes, and complications. One hundred seventy-six patients (194 hips) were retrospectively reviewed with a minimum follow-up (f.u.) of tenyears. Demographic and surgical data were collected. Clinical and radiological evaluation was performed at the last follow up. We calculated a neck resorption ratio (NRR) for each patient. Main complications were recorded. A p-value of <0.05 was considered significant. The mean Harris hip score (HHS) was 89.1 ± 5.7. The mean visual analogue scale (VAS) and Oxford hip score (OHS) values were 1.1 ± 1 and 41.3 ± 5.1, respectively. The mean leg length discrepancy was 1.5 mm ± 1.9. The mean NRR was 0.35. We observed six cases of aseptic loosening, two cases of infection, one implant revision for recurrent dislocation, and one stem revision after periprosthetic femoral fracture. The overall survival rate of the stem was 94.8%. Statistically significant associations were found between NRR and steroid therapy/stem malposition. Correlation between aseptic loosening and NRR was also statistically significant. Correlations between NRR and HHS/OHS were -0.34 and -0.28 respectively. Odds ratio for aseptic loosening were: 4.6 if NRR > 0.25; 16.9 if > 0.50 and 24.1 if > 0.75. CFP hip stem provided excellent long-term outcomes. NRR is correlated to steroid therapy and stem malposition. The risk of stem aseptic loosening rises according to NRR increase. Patients with an NRR > 0.5, especially if under steroid therapy or with stem malposition, should be strictly monitored.

Five-year outcome of proximal femoral endoprosthetic arthroplasty for non-tumour indications.

A possible solution for the management of proximal femoral bone loss is a modular femoral endoprosthesis (EPR). Although the outcome of EPRs in tumour surgery has been well described, the outcome of their use in revision hip surgery has received less attention. The aim of this study was to describe the outcome of using EPR for non-neoplastic indications. A retrospective review of 79 patients who underwent 80 EPRs for non-neoplastic indications was performed, including the rates of complication and survival and the mean Oxford Hip Scores (OHS), at a mean of five years post-operatively. The mean age at the time of surgery was 69 years (28 to 93) and the mean number of previous operations on the hip was 2.4 (0 to 17). The most common indications for EPR implantation were periprosthetic joint infection (PJI) (n = 40), periprosthetic fracture (n = 12) and failed osteosynthesis of a proximal femoral fracture or complex trauma (n = 11). Salvage was achieved in all patients. A total of 25 patients (25 EPRs, 31.6%) had a complication, the most common being infection (n = 9) and dislocation (n = 3). Further surgery was required for 18 EPRs (22%), nine of which were revision procedures. The five year survival of the EPR was 87% (95%CI: 76% to 98%). The mean OHS was 28 (4 to 48). Inferior survival and outcomes were seen in EPRs which were performed for the treatment of infection. However, the eradication of infection was achieved in 33 of the 40 (82.5%) which were undertaken for this indication. We recommend the continued use of proximal femoral EPRs for non-neoplastic indications, including PJI. Cite this article: Bone Joint J 2016;98-B:1463-70.

Nonmodular Tapered Fluted Titanium Stems Osseointegrate Reliably at Short Term in Revision THAs.

The ideal femoral component for revision THA is undecided. Cylindrical nonmodular stems have been associated with stress shielding, whereas junctional fractures have been reported with tapered fluted modular titanium stems. We have used a tapered fluted nonmodular titanium femoral component (Wagner Self-locking [SL] femoral stem) to mitigate this risk. This component has been used extensively in Europe by its designer surgeons, but to our knowledge, it has not been studied in North America. Added to this, the design of the component has changed since early reports. We asked: (1) Does the Wagner SL stem have low rates of rerevision and other complications at a minimum 2 years after surgery? (2) Is the Wagner SL stem associated with high levels of patient function and pain relief at a minimum 2 years after surgery? (3) Does the Wagner SL stem have low rates of subsidence at a minimum 2 years after surgery? (4) Is the Wagner SL stem associated with proximal femoral bone remodeling at a minimum 2 years after surgery? Between May 2011 and December 2012, we performed 198 femoral revisions, of which 104 (53%) were performed using the Wagner SL femoral stem; during that period, our institution gradually shifted toward increasing use of these stems for all but the most severe revisions, in which modular fluted stems and proximal femoral replacements still are used on an occasional basis. Median followup in this retrospective study was 32 months (range, 24-46 months), and one patient was lost to followup before the 2-year minimum. The femoral deformities in this series were Paprosky Type I (10 hips), Paprosky Type II (26), Paprosky Type IIIA (52), Paprosky Type IIIB (nine), and Paprosky Type IV (two). Functional assessment was performed using the Oxford Hip Score (OHS), WOMAC, SF-12, and the University of California Los Angeles (UCLA) activity score. All complications and cases of revision were documented. All patients had radiographs performed within 1 year of the latest followup. These were assessed by two surgeons for signs of proximal femoral bone remodeling and subsidence. Complete preoperative scores were available for 98 patients (98 of 104; 94%). The mean OHS preoperatively and at final followup were 39 (SD, 15) and 87 (SD, 19), respectively (p < 0.001; mean difference, 48; 95% CI, 43-53). Average WOMAC scores were 44 (SD, 15) and 87 (SD, 20), respectively (p < 0.001; mean difference, 43; 95% CI, 38-48). At final followup, signs of restoration of proximal femoral bone stock was noted in 45 of 103 hips (44%). Six (six of 104; 6%) patients had subsidence of 10 mm to 15 mm. In the remainder (98 of 104; 94%), the mean subsidence was 2 mm (range, 0-9 mm). One revision was performed for loosening associated with infection. The Wagner SL stem is a viable option for patients with Paprosky Types II and III defects undergoing revision THA. This component provides high levels of patient function with low revision rates and low rates of subsidence during the early postoperative phase. They provide a viable alternative to modular components for treatment of Types II and III defects without the risk of junctional fractures. They can be used for very selected Type IV defects, however this extent of bone loss is most easily addressed with other techniques such as a proximal femoral replacement. Level IV, therapeutic study.

Midterm results of 36 mm metal-on-metal total hip arthroplasty.

Background:Despite the many perceived benefits of metal-on-metal (MoM) articulation in total hip arthroplasty (THA), there have been growing concerns about metallosis and adverse reaction to metal debris (ARMD). Analysis of size 36 mm MoM articulation THAs is presented. These patients were evaluated for patient characteristics, relationship between blood metal ions levels and the inclination as well as the version of acetabular component, cumulative survival probability at final followup and functional outcome at final followup.Materials and Methods:288, size 36 mm MoM THAs implanted in 269 patients at our institution from 2004 to 2010 were included in this retrospective study. These patients were assessed clinically for hip symptoms, perioperative complications and causes of revision arthroplasty were analysed. Biochemically, blood cobalt and chromium metal ions level were recorded and measurements of acetabular inclination and version were examined. Radiological evaluation utilizing Metal Artefact Reduction Sequence (MARS) MRI was undertaken and implant cumulative survivorship was evaluated.Results:The mean followup was 5 years (range 2–7 years), mean age was 73 years and the mean Oxford hip score was 36.9 (range 5–48). Revision arthroplasty was executed in 20 (7.4%) patients, of which 15 patients underwent single-stage revision THA. The causes of revision arthroplasty were: ARMD changes in 6 (2.2%) patients, infection in 5 (1.9%) patients and aseptic loosening in 5 (1.9%) patients. Three (1.1%) patients had their hips revised for instability, 1 (0.3%) for raised blood metal ions levels. The implant cumulative survival rate, with revision for any reason, was 68.9% at 7 years.Conclusions:Although medium-sized MoM THA with a 36 mm head has a marginally better survivorship at midterm followup, compared to larger size head MoM articulating THA, our findings nonetheless are still worryingly poor in comparison to what has been quoted in the literature. Furthermore, ARMD-related revision remains the predominant cause of failure in this cohort with medium-sized MoM articulation. No correlation was found between blood metal ions levels and the inclination as well as the version of acetabular component.

Cementless Total Hip Replacement for the Management of Severe Developmental Dysplasia of the Hip in the Middle Eastern Population: A Prospective Analysis.

In the Middle East, severe developmental dysplasia of the hip with subsequent high dislocation is often seen. We assessed the efficiency of total hip replacement (THR) with subtrochanteric shortening femoral osteotomy and trochanteric advancement in this population. This prospective study assessed 25 female patients with symptomatic and severe (Crowe IV). Pre- and postoperative Harris hip score (HHS) and Oxford hip score (OHS) were performed alongside assessment of leg length discrepancy (LLD) and the ability to sit in a cross-legged position. The mean HHS and OHS improved pre-operatively at 1 and 10 years, respectively (p-value < 0.001). The mean postoperative LLD was 3 mm (0-8 mm). Functionally, 22/25 patients were able to sit cross-legged. None of the 25 hips underwent revision during this period. Total hip replacement with subtrochanteric shortening osteotomy in combination with trochanteric advancement is sufficient for the management of Crowe type IV hips in this population.

English

Abstract The number of patients requiring arthroplasty increases annually. Joint replacement surgery can improve a patient's (QOL) quality of life. The effectiveness of this care from a patient's own perspective assessed by patient reported outcome measures is just as important as the clinical measures. The aim of our study was to evaluate patients' satisfaction following total joint replacement procedures. A cross-sectional study was performed in a major regional hospital, (Port-of-Spain General Hospital, Trinidad). Between September 1(st) 2013 and December 31(st) 2014, Seventy-three patients were enrolled in the study. Two groups were created: a pre-operative group (with thirty-nine patients) and a post- operative group (of thirty-four patients). The postoperative group of patients received either total hip replacement or total knee replacement surgery from at least three months post procedure. The main outcome measures reported were: (i) orthopaedic patient reported outcome measures, oxford hip and knee scores. (ii) health related quality of life instrument, short form 12 (SF12) for mental and physical components of health gained (MCS and PCS). (iii) visual analogue scores to assess current pain. (iv). Patient's satisfaction levels with peri-operative management. (v) Fulfillment of patients' expectations with respect to pain, mobility and independence. The pre-operative group had a mean oxford hip score (OHS) score of 18.71, standard deviation (SD) 10.09. The postoperative group had a statistically significant higher level of functionality in terms of a mean Oxford hip score (OHS) 41.45, standard deviation (SD) 7.42. The pre-operative group had more disability (lower function) in terms of a mean oxford knee score (OKS) of 15.52, SD 7.10. The post- operative group's mean oxford knee score (OKS) was 37.27, SD 7.32.With respect to the short form 12 (SF12) quality of life assessment tool, the difference in mean PCS between groups was significant, pre op 28.57 (SD 7.52), post op 40.12.27 (SD 11.16). The difference in mean MCS between groups was also significant, pre op 48.76 (SD 9.02), post op 53.76 (SD 6.77). The difference in mean pain scores (VAS) between groups was significant, pre-op eight (SD 1.86), post-op 1.42 (SD 2.19). Postoperative patients were generally satisfied with their peri-operative management. Patient expectations were met in terms of pain, mobility and independence (92.31%, 94.87% and 94.87%, respectively). Although multiple factors impact on patient satisfaction with respect to TJR surgery, statistically significant results showed increased function (improved Oxford scores), decreased pain (VAS) and general improvement in mental and physical health gained (SF12) between independent pre and post- operative groups. Clinically significant results indicate that postoperative patients were satisfied with peri-operative management and fulfillment of ex.