Cup-cage construct for massive acetabular defect in revision hip arthroplasty- A case series with medium to long-term follow-up.

OBJECTIVE: Cup-cage reconstruction has emerged as a possible solution for managing massive acetabular defects with a few existing studies reporting encouraging results at mid-term follow-up. We present our experience with this unitised construct. METHOD: Six patients (7 hips) with a mean age of 76 years (73-81) were revised due to catastrophic aseptic failure of a primary cup implanted 10-19 years previously, having a Paprosky type 3B acetabular defect. RESULTS: At a mean follow-up of 72 months (63-140) no cases have required re-revision. Oxford Hip Scores improved from an average of 8 (1-17) preoperatively to an average of 36 (18-45) at the last follow-up. WOMAC scores preoperatively averaged 76 (49-96) and postoperatively averaged 26.5 points (0-69) at the last follow-up. SF-12 scores improved in both components. One patient showed non-progressive osteolysis around the ischial flange and one had less than 5 mm migration of the construct. One patient died of unrelated causes. CONCLUSION: Our study presents one of the longest follow-up of cup-cage construct and supports the previously reported good results; it encourages the use of this construct in reconstruction of massive acetabular defect, with or without pelvic discontinuity.

10-year results of ReCap hip resurfacing arthroplasty: a non-designer case series.

INTRODUCTION: We present the 10-year results of the ReCap Magnum HRA system in a consecutive single surgeon's series from a non-designer centre. PATIENTS AND METHODS: Hip resurfacing arthroplasty (HRA) was performed in active males under 65 years and in pre-menopausal females with adequate bone density proven by a DEXA scan. Clinical follow-up; annual Oxford hip scoring, UCLA scoring and whole blood metal ion level measurement. Kaplan-Meier method was used to determine survivorship with revision as the end point. Radiographs were analysed for; acetabular inclination, notching, neck thinning and change in implant position. 72 HRAs were performed in 66 patients with a mean age of 45.7 years. The mean follow-up was 10.63 ± 0.54 years (range 10-11.75 years). RESULTS: The survivorship of the cohort at minimum 10 years was 97.22% (95% confidence interval 94.14-99.01). There was a significant improvement in the Oxford Hip Score from 15.77 ± 4.33 to 45.67 ± 4.43 (p < 0.001) and the UCLA score from 3.14 ± 0.74 to 7.07 ± 1.16 (p < 0.001). Mean whole blood cobalt and chromium levels were 28.83 ± 8.42 nmol/l and 39.93 ± 9.64 nmol/l respectively. There were 2 revisions, due to avascular necrosis and implant failure. In our series the implant has performed well with <1% failure per year. We did not note any difference between the genders, since all the females in our series had been screened for osteopenia using a DEXA scan. All our patients returned to an active lifestyle which was maintained at final follow-up. CONCLUSION: Strict selection criteria and a well-designed implant result in good long-term functional and radiological results with hip resurfacing.

Femoral Head-Trunnion Dissociation Secondary to Corrosion of a Modular Total Hip Replacement: A Case Report.

CASE: We report a rare case of modular femoral head-trunnion dissociation. The patient presented with a sudden onset of groin pain and an inability to bear weight. Intermittent clunking was reported to have started around five years after implantation of the hip replacement. The duration of symptoms, radiographic findings, and analysis of the retrieved components support the theory of chronic trunnion failure due to corrosion. CONCLUSION: This is, to our knowledge, the first case of dissociation of the femoral head from the trunnion in which substantial macroscopic wear of the trunnion was observed and likely contributed to the dissociation. A new onset of clicking or clunking should be investigated as it may be a harbinger of head-neck dissociation.

Surgical treatment of hallux valgus: the Gibson-Piggott technique revisited.

More than 130 surgical procedures have been described to treat hallux valgus deformity. The "spike" first distal metatarsal osteotomy was first described by Gibson and Piggott in 1962. Despite having the advantage of using only patient's "material", this technique has been abandoned by most orthopaedic surgeons, due to fear of complications such as breaking of the bony peg and loosening of fixation at the osteotomy site. A group of surgeons at our hospital have performed 422 Gibson-Piggott procedures between 1985 and 2005 with consistently good results. This fact convinced us to "revisit" the procedure. Thirty seven consecutive patients (43 feet) who had surgery between July 2000 and December 2002 were randomly selected as "sample". A Questionnaire based on the American Orthopaedic Foot and Ankle Society (AFOS) Score was used for evaluation. Thirty three patients (36 feet), i.e. 89% responded to our survey. Average follow-up after surgery was 47 months (between 31 and 63 months). Results showed that 30 patients (91%) had no or only mild pain, 29 patients (88%) had no or only slight limitation in activities of daily living and 31 patients (94%) were able to use fashionable or comfortable shoes with no problems. When using numerical evaluation, 28 patients (85%) scored 65 or more points (from a total of 95 points), representing a good postoperative result, comparable with other "modern" distal metatarsal osteotomies. In conclusion, the Gibson-Piggott procedure was shown to be a valuable technique in the treatment of mild or moderate hallux valgus deformity.