We present the extended follow-up (≥ 20 years) of a series of fully hydroxyapatite-coated femoral components used in 72 primary total hip replacements (THRs). Earlier results of this cohort have been previously published. All procedures were performed between 1986 and 1991. The series involved 45 women and 15 men with 12 bilateral procedures. Their mean age at the time of surgery was 60 years (46 to 80) and the mean duration of follow-up was 22.5 years (20 to 25). At final follow-up, the mean Merle d’Aubigné and Postel hip scores were 5.5 (4.5 to 6), 3.8 (3.5 to 5) and 3.3 (3.0 to 5.0) for pain, mobility and function, respectively. Of the patients 92% were very satisfied at the time of final follow-up.

There were seven revisions: six of the acetabular component for aseptic loosening and one of both the stem and the acetabular component for loosening due to deep infection. The survival of this prosthesis at 22.5 years with revision for any reason as the endpoint was 91.7% (95% confidence interval (CI) 84 to 99). Survival with aseptic loosening of the stem as the endpoint was 100% (95% CI 90 to 100).

This prosthesis provides pain relief in the long term. Survival of this component is comparable to the best results for primary THR with any means of fixation.

Cite this article: Bone Joint J 2013;95-B:467–71.

Introduction

Typical UK patients spend 5–7 days in hospital following total hip replacement (THR). Decreasing length of stay (LOS) increases throughput and reduces cost. We have developed a short stay THR programme (SSP), which has been used in all patients since May 2006; we present the first 100.

Introduction

The ideal method of fixation for femoral components in total hip arthroplasty (THA) is unknown. While good results have been reported for cemented and uncemented components, there is relatively little published prospective data with twenty years or more of follow up.

Results of the Furlong femoral component have been presented at an average of 17 years follow up. We have extended this follow up period to an average of 22.5 years with a minimum of 22 years and a maximum of 25 years.

In this review, we present the data of one of the largest non-designer, mid- to long-term follow ups of the AGC.

We present a total of 1538 AGC knees during a 15 year period, of which 902 were followed up by postal or telephone questionnaire focused on Oxford Knee Scores, Visual analogues of function and pain and survival analyses performed. Mean length of follow up was 10.4 years.

85.7% of patients had an Oxford knee score of between 0 and 40, with 71.2% scoring between 0–30.

65.6% of patients responded with a Visual Analogue Score (VAS) of 0 or 1 at rest (minimum pain 0) and 53.9% reporting VA scores of 0 or 1 while walking.

87.5% of patients reported Excellent or good functional reports at final follow up and 90.3% reporting excellent or good pain control compared to per-operative levels.

Survival analysis confirms excellent survivorship.

This large cohort and multi-surgeon trial reproduces the excellent results as demonstrated by the designer centre (Ritter et al.). Mid to long term outcome sows excellent function and analgesia. Complication rates are low and the necessity for revision remains low.

Introduction

The Oxford Total Meniscal Knee (TMK by Biomet), is a total knee replacement with a multidirectional mobile bearing. As part of the evaluation of the TMK we compared our group of TMK knee replacements with an equivalent cohort of AGC total knee replacements.

Introduction

Debate continues regarding the relative advantages of ceramic-on-ceramic (CoC) and metal-on-polyethylene (MoP) articulations in total hip arthroplasty (THA). Perceived benefits of CoC include longevity, and low wear - in turn limiting the effects of particulate wear debris. However, CoC bearings cost significantly more, and concern remains over the risk of ceramic fracture; a complication not seen with MoP bearings, which are also cheaper.

Introduction

Deep vein thrombosis(DVT) and pulmonary embolism(PE) are well-recognised complications following lower limb arthroplasty (Cohen et al, 2001). The National Institute for Clinical Excellence and British Orthopaedic Association recommend the use of both mechanical and chemical prophylaxis. At our institute regimens have changed reflecting new developments in the use of thombo-prophylaxis. Our aim was to assess the efficacy of these methods in preventing complications.

A reduced range of movement post total knee replacement (TKR) surgery is a well recognised problem. Manipulation under anaesthesia (MUA) is a commonly performed procedure in the stiff post operative TKR. Long term results have been variable in the literature.

We prospectively followed up 48 patients since 1996 from one centre, over an average of 7.5 years, (range 1 to 10 years) and report on the long term results.

The mean time to MUA post TKR was 12.3 weeks (range 3 to 48). Pre MUA, the mean flexion was 53°. The mean immediate passive flexion post MUA was 97°, an improvement of 44° (Range 10° to 90°, CI < 0.05). By one year, the mean flexion was 87°, improvement of 34°, (range −15° to 70°, CI< 0.05). At ten years the mean flexion was 86°.

We found no difference between those knees manipulated before or after 12 weeks. In addition there was no difference found in those knees which had a pre TKR flexion of greater or less than 90°. There were no complications as a result of MUA. However, one patient was eventually revised at two years secondary to low grade infection.

Our findings show that MUA is safe and effective method at improving the range of motion in a stiff post operative TKR. The improvement is maintained in the long term irrespective of time to MUA and range of motion pre TKR

Purpose of Study

In this review, we present the data of one of the largest non-designer, mid- to long-term follow-ups of the AGC carried out by surgeons of differing grades and sub-specialty.

Introduction: Minimally Invasive Hip surgery has been described using several different surgical techniques. These can be divided into two broad groups, those that utilise smaller incision version of a conventional approach (mini-posterior) and those that use a muscle-sparing technique (direct anterior). The muscle-sparing technique has been promoted as the only true Minimally-invasive Total Hip Replacement (MISTHR) as it intuitively appears more minimally invasive with less soft tissue disruption. We have therefore carried out a prospective analysis of 60 consecutive direct anterior MISTHRs case-matched to 60 mini-posterior MISTHRs.

Materials and Methods: We prospectively analysed 60 consecutive, direct anterior approach patients with case-matched mini-posterior approach patients. Functional outcome was assessed with the Visual Analogue Pain Score (VAS), Merle d’Aubigne Postel (MDP), the Oxford Hip (OHQ) and SF-36 questionnaires at 6 weeks and 6 months post-operatively. Peri-operative blood loss, length of surgery and length of stay were recorded.

Results: (table removed)

Conclusions: Our conclusions are that both approaches are safe, with low complication rates and offer excellent clinical outcomes. However, there is no significant difference between the two approaches justifying the more technically difficult, but muscle-sparing anterior approach.

The most common indication for knee arthrodesis is pain and instability in an unreconstructable knee following an infected knee arthroplasty. In this study, we compare the use of the Mayday arthrodesis nail (Ortho-dynamics, Christchurch, UK) versus external fixation, Orthofix (Berkshire UK) and Stryker Hoffman II (County Cork, Ireland).

All patients in this study underwent arthrodesis between 1995 and 2006 at Conquest Hospital, Hastings. In group A, 11 patients underwent arthrodesis with a Mayday nail. In all cases, the indications were infected total knee replacements (TKR). Three of these patients previously had failed attempts at arthrodesis with external fixation devices. In group B, seven patients underwent arthrodesis using external fixation. In six patients, the indication was infected TKRs. Results were reviewed retrospectively, with union assessed both clinically and radiologically.

The mean inpatient stay for the Mayday nail group was 23 days (range 8 – 45 days) compared with 76 days (range 34 – 122) for the external fixation group (p< 0.01, CI 95). Ten patients in group A went on to confirmed primary arthrodesis. One patient underwent revision arthrodesis with a Mayday nail and subsequently united. In group B only two patients achieved union. The rate of union was significantly greater in the Mayday nail group than the external fixation group (91% vs 29%, p< 0.01). Of those patients that achieved union, there was no difference in the time to fusion between groups.

Our study supported the existing literature and found that the Mayday nail appeared more effective than monoaxial external fixators for arthrodesis in the management of infected total knee replacements.

Introduction: Debate continues regarding the optimal timing of surgery for patients requiring bilateral knee arthroplasty; we reviewed the costs, clinical and functional outcomes of 116 patients undergoing simultaneous or staged bilateral surgery using 3 different prostheses.

Method: Data were retrospectively collected from 116 consecutive patients undergoing 232 knee replacements over 10 years, either simultaneously or over 2 hospital admissions (staged). Post-operative complication rate, total cost of treatment (calculated from pros-theses, theatre time, days in hospital and number of clinic attendances) and functional (HSS) score at 1 year were the outcome measures.

Results: 54 patients underwent Oxford unicondylar knee replacements, 41 simultaneously, 13 staged; respective mean total costs were £9890 and £13,553 (p< 0.001). 42 patients were treated with AGC prostheses; 14 simultaneously, 28 staged, with respective total costs of £12,187 and £16,920 (p< 0.001). 10 TMK patients had simultaneous surgery (mean total cost £14,812), 10 were staged (£20,191); p< 0.001. For all 3 prostheses, there was no significant difference in complication rate or 1 year functional outcome between simultaneous and staged groups.

Discussion: Some authors advocate replacing both knees simultaneously as safe and cost-effective; others report significant increases in medical and surgical morbidity. Our series shows significant cost savings with no increase in complication rate.