Femoral side-only revision options for the Birmingham resurfacing arthroplasty.

BACKGROUND: The Birmingham Hip Resurfacing (BHR) system (Smith and Nephew) was developed as an alternative to conventional total joint replacement for younger, more active patients. Among other complications exists the risk for femoral component failure. The only marketed revision option for such a complication involves exchange of all components for a total replacement arthroplasty. This presents as a considerable and potentially unnecessary operative burden where revision of only the femoral prosthesis would suffice. We have analysed revision options for BHR in the context of periprosthetic femoral fractures with a stable acetabular component. METHODS: Technical details of dual mobility hip systems available in Australia were collated and analysed to assess for potential 'off label' use with an existing BHR acetabular component. These data were then compared with the custom-made Smith and Nephew dual mobility implant with respect to clearance and sizing. RESULTS: Two dual mobility articulation modalities from two companies were identified as appropriate for potential usage with four products analysed in detail. These two demonstrated acceptable sizing and clearance measurements. CONCLUSION: Comparison between readily available dual mobility prostheses with custom-made implants showed off label dual mobility prosthetic use to be a viable alternative for femoral-only revisions with in situ BHR. Single component revision has several advantages which include: a less complex surgical procedure, shorter operative time, decreased blood loss and the expectation of resultant lower morbidity. Furthermore, this less complex revision surgery should give comparable results to that of primary total hip arthroplasty.

Anatomic Pyrocarbon Hemiarthroplasty for Thumb Carpometacarpal Osteoarthritis in Patients under 65 Years: Mid Term Results.

BACKGROUND: To assess the midterm outcome of patients under 65 who underwent anatomic pyrocarbon hemiarthroplasty for thumb carpometacarpal (CMC) osteoarthritis. METHODS: A prospective analysis was performed of a consecutive series of active patients, less than 65 years of age, with symptomatic osteoarthritis who had undergone a CMC hemiarthroplasty using a stemmed metacarpal based, anatomic pyrolytic carbon resurfacing with an additional one third flexor carpi radialis (FCR) tendon transfer to maintain stability. The Wrightington Hand Score, Disability Arm Shoulder and Hand (DASH) Score, and the Patient Rated Wrist Evaluation Score (PRWE) were utilised. Clinical data was obtained for grip strength, pinch strength, and range of motion. RESULTS: The MEAN age was 57.6 years. MEAN follow up was 6.5 years. All patients had improvement in pain, grip strength and function. There was no significant difference in grip and pinch strengths between the individual's left and right hand. All patients stated that they would undergo the procedure again. There was one revision following a traumatic trapezium fracture. One patient underwent a neurolysis of a superficial radial nerve neuroma associated with an impinging trapezial osteophyte. CONCLUSIONS: Active patients, under 65 years of age with Eaton-Littler stage III osteoarthritis of the thumb CMC joint who are treated with anatomic pyrolytic carbon resurfacing hemiarthroplasty and stabilisation may achieve sustained improvement in pain and hand function for up to 6.5 years.

Systematic review of preclinical and clinical studies on scaffold use in knee ligament regeneration.

BACKGROUND: The management and treatment of ligamentous injuries within an orthopaedic population has continued to evolve throughout the last several decades. Limitations with autograft, allograft and synthetics have led to research into tissue engineering using scaffolds and mesenchymal stem cells. OBJECTIVES: This systematic review aims to examine and summarise the pre clinical in-vivo studies and limited clinical studies on the use of scaffolds in the treatment of ligamentous injuries Data sources: DATABASES: PubMed, CINAHL, Web of science, Medline, Cochrane library and Embase. The following key words and search terms were used: scaffolds, ligament, mesenchymal stem cells, tissue engineering, clinical, and preclinical. METHODS: A total of 118 articles were reviewed. 19 articles were identified as relevant for the purpose of this systematic literature review. An additional 2 articles were sourced from the reference list of reviewed articles. RESULTS: Three tables of studies were constructed: pre clinical biological scaffolds, pre clinical synthetic scaffolds and clinical scaffolds. CONCLUSIONS: There is a large body of pre clinical evidence that the use of scaffolds combined with mesenchymal stem cells can be a viable option in the regeneration of ligamentous structures with biological and mechanical properties suitable for function. There is, however, limited clinical evidence supporting the use of recently developed scaffolds and historical evidence of synthetic scaffolds failing in the management of anterior cruciate ligament repairs. There appears to be no consensus in the literature as to the nature of the scaffold material that is most suitable for clinical trials. No randomised control trials have yet been conducted.