Survival analysis and functional outcome of the Oxford unicompartmental knee replacement up to 11 years follow up at a District General Hospital.

BACKGROUND: There have been several large originator studies reporting excellent results with this prosthesis but far fewer large independent studies. We present, to our knowledge, the largest independent series documenting excellent survivorship rates and good functional outcomes at a mean follow up of 5.5 years post implantation of the Oxford unicompartmental knee replacement. METHODS: Our prospective study looks at the survivorship and the functional outcome of 364 Oxford UKRs performed in a district general hospital at a mean follow up of 5.5 years (range 5-11 years). Post operatively knees were assessed in a research clinic using the Oxford knees score (as well as the American Knee Society Score and the Hospital for Special Surgery Score). Maximal flexion was also measured. RESULTS: There were 26 revisions of 364 knees giving a survivorship, with revision as the end point, of 93% at a mean of 5.5 years post op (range 5-11 years). We achieved an Oxford score of 37.5, a mean AKSS of 161 (divided as American knee functional score 75.75/American knee objective score 85.4 (excellent)). The mean HSS score was 84.5. We achieved 'Excellent' Oxford knee scores in 137 knees (48%), 'Good' in 75 (26%), 'Moderate' in 51 (17%) and 'Poor' in only 27 (9%) of knees. Mean improvement in functional scores were: Oxford score (14.4), AKSS (71) and HSS (26.3). Mean maximal flexion was 123° range (110-140). CONCLUSIONS: We have confirmed that good medium to long-term function and survival can be obtained following Oxford medial knee replacement for treating anteromedial osteoarthritis, in our large independent series.

Primary total hip arthroplasty with a proximally HA-coated titanium femoral component: results at 10-15-year follow-up.

INTRODUCTION: Registries in both the United Kingdom and Sweden suggest that the popularity of uncemented femoral components is increasing. As this trend progresses, long-term survival data for such components are becoming increasingly more important. We present the results of a cohort of patients treated with the Omnifit (Stryker, Mahwah, NJ) femoral component with the follow-up of 10-15 years. METHODS: A prospective study was performed in our unit between 1996 and 2001. Patients were reviewed pre-operatively and then at 6, 12, 26 and 52 weeks post-operatively and annually thereafter. They were assessed clinically and radiographically, and the Merle d'Aubigne Postel (MDP) hip score was calculated at each visit. A visual analogue scale (VAS) score and satisfaction score were also recorded to assess patient satisfaction with their procedure. Specific enquiry was made regarding anterior thigh pain. Statistical calculations were performed using the Student's t test. Kaplan-Meier survival analysis was performed. RESULTS: One hundred and four patients (113 hips) were included (48 males, 56 females). Bilateral procedures were performed in nine patients. Mean age was 60.4 years (33-72 years). Mean follow-up was 12.9 years (10-15 years). Mean pre-operative MDP score was 8.8 (3-16) and VAS score 7.8 (1-10) with ten representing the most severe symptoms. At final follow-up, the average MDP and VAS scores were 16.9 (13-18) and 2.1 (0-6), respectively. High levels of satisfaction were reported by 96.1% of patients. Two dislocations and two cases of anterior thigh pain occurred. Four patients required revision surgery. Survival of the femoral component with revision for any reason as the end point was 96%. CONCLUSION: This prosthesis provides symptom relief, return to function and high levels of patient satisfaction in the long term. Survival of this component is comparable to the best results for primary total hip arthroplasty with any means of fixation.

Primary total hip arthroplasty with hydroxyapatite coated titanium femoral stems. Does design philosophy influence long term outcome?: Results of a prospective randomised controlled trial with follow-up of 10-15 years.

We present results of a prospective randomised controlled trial examining two cohorts of patients treated with proximally (Group A) and fully coated (Group B) femoral components with long term follow up. Patients were reviewed preoperatively and 6, 12, 26 and 52 weeks post operatively then annually. The Merle d'Aubigne Postel (MDP) hip score was used to assess clinical outcome. A Visual Analog Score (VAS) was also recorded. Statistical calculation was performed using the student's t- test and Kaplan Meier survival analysis. One hundred and four patients were included in group A and 103 patients in group B. Mean age was 60.4 years and 60.8 years respectively. Mean follow- up was 12.9 years. Mean pre-operative MDP scores were 8.8 and 9.5 in Groups A and B respectively. Mean pre-operative VAS score 7.8 and 7.4 respectively. At final follow up mean MDP and VAS were 16.9, 16.6 and 2.1, 2.4 respectively. Three femoral revisions occurred in Group A. Seven revisions occurred in Group B. Survival of the femoral component with revision for any reason as the end point was 96% in Group A and 94.8% in Group B. Both components produced symptomatic relief and similar revision rates. Thigh pain occurred only in Group A.

Primary total hip replacement with a Furlong fully hydroxyapatite-coated titanium alloy femoral component: Results at a minimum follow-up of 20 years.

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.

Pyomyositis of the iliacus muscle in a child.

Pyomyositis is rarely seen in temperate climates. Typically, it presents with the formation of an abscess requiring surgical drainage and it has been reported as a differential diagnosis for septic arthritis of the hip. We describe the occurrence of pyomyositis of the iliacus muscle in a ten-year-old girl which was diagnosed by MRI and blood culture. Formation of an abscess did not occur despite marked focal inflammation and swelling of the muscle. Conservative treatment with antibiotics alone led to complete clinical and radiological resolution of the infection. We could find no previous description of pyomyositis in a child in the British orthopaedic literature. Orthopaedic surgeons, particularly those with a paediatric interest, should be aware of this condition and its presentation, diagnosis and treatment.

The Hungerford shooting incident.

Thirty people sustained gunshot injuries on one afternoon in Hungerford, a small rural town in Berkshire. Fourteen people died at the scene of the shootings and three of the 16 patients who were admitted to hospital subsequently died. We describe the management of the 14 patients admitted to Princess Margaret Hospital, Swindon.

An inherent design fault in a deep fat fryer.

We wish to report on a design fault in the lid of a deep fat fryer which may lead to the unwary sustaining scalds of the hand.