Managing infection in the revision total hip replacement patient.

Deep infection is one of the most devastating complications in total hip replacement. This dreaded complication is presented in considerable detail with special emphasis on prevention, diagnosis, and various methods of surgical and antibiotic treatment. Basic fundamentals of antibiotic therapy are reviewed. In addition, guidelines are given for the indications of surgical intervention, the type and staging of operative procedures, with detailed techniques of the various operative procedures used to treat the infected total hip implant patient.

Use of the Charnley mini-offset bore acetabular component in severe acetabular dysplasia. A preliminary report.

Nine total hip arthroplasties were performed in seven patients using the Charnley mini-offset bore acetabular component to assess its effectiveness in cases of severe deficiency of acetabular bone "stock." Preoperative diagnoses included seven chronically dislocated hips and two previously failed arthroplasties. The follow-up period averaged 49 months. Pain relief was dramatic in all patients, and all had increased ambulatory capacity after operation. No clinical loosenings or deep infections were encountered. The small outside diameter (36 mm) of this acetabular component requires only minimal bone removal from the acetabular bed. Its eccentrically positioned bore allows for adequate polyethylene thickness in the weight-bearing area. It also takes advantage of the low frictional torque of a small femoral head system.

Long-term results of low-friction arthroplasty in patients 30 years of age or younger.

The long-term results of 49 Charnley low-friction arthroplasties performed in patients 30 years of age or younger at the time of surgery was reviewed, with special emphasis placed on the radiologic evaluation of the acetabular and femoral components with average follow-up period of nearly ten years and the longest follow-up period of 15.5 years. Fifty-three percent of the sockets had no cement-bone demarcation and 28.6% had only a small line in the upper outer quadrant of the socket. Of the seven sockets that failed (14.3%), six had very deficient bone stock at operation. There were only two cases of femoral loosening. The rate of wear was 1.7 mm at ten years, which is not much greater than in older patients. Most of these cases were patients with conditions causing built-in restraints against over activity.

Prospective analysis of Sheehan total knee arthroplasty.

In a prospective study, the clinical results of 64 Sheehan total knee arthroplasties (TKA) were reviewed in 52 patients, with an average follow-up period of five and one-half years. Like most prosthetic designs in use in 1975, the Sheehan prosthesis did not incorporate patellar resurfacing. The initial clinical success achieved without patello-femoral replacement may become less acceptable with longer follow-up periods. Seventy-four percent of the patients in this study had complete relief of pain or mild discomfort not requiring analgesics. With patellar resurfacing as a secondary procedure in three additional cases, the percent successful results increased to 81%. Five knees (12%) required additional surgery, one because of infection, two because of secondary component failure, and two for loosening. The lack of patellofemoral replacement and prospective failure of both tibial and femoral components, possibly due to high stress-loading in a relatively small surface area, have led to the use of other newer TKA designs.

Rate of wear in total hip replacement.

The wear of high molecular weight polyethylene sockets was measured on radiographs, over a period of 9 to 10 years, in a group of patients whose ages averaged 73.3 years at the end of the period. The average rate of wear was 0.15 mm/year and 68 per cent of patients followed this pattern. Wear more than 2.5 mm in 10 years occurred in 15 per cent. There was a diminution in the rate of wear with the passage of time; in the second 5 years the rate of wear was approximately 40 per cent less than in the first 5 years. Body weight and physical activity did not appear to have any relationship to the final amount of wear. In a second series of very disabled subjects under 30 years of age (33 patients, 59 hips, followed only for an average of 38.4 months) the wear was rather more than in the previous series. Most remarkable was the performance of 4 patients, below the age of 50, who were considered completely normal for their age (category A); three of these wore less than the average for the main series.

Results of low friction arthroplasty in patients thirty years of age or younger.

The results of total hip replacement in 39 patients 30 years old or younger were evaluated including 67 Charnley low-friction arthroplasties and one McKee total hip arthroplasty. The average age was 25.9 years with an average follow-up of 39 months, the longest being 8 years, 3 months. The diagnoses included rheumatoid arthritis, ankylosing spondylitis, CDH, Still's disease, and a miscellaneous group. Over-all function did not improve as greatly as in the 9 to 10 year series, but this was due to a higher proportion of patients with severely disabling rheumatoid polyarthritis, hemiplegia, severe obesity, or cardiovascular disease. Wear did not seem to be any greater in this younger age group as compared to previous studies in older patients.

A review of the Bristow operation for recurrent anterior shoulder dislocation in athletes.

Twenty-four recurrent dislocating shoulders, in patients ranging from 15 to 26 years, were evaluated after surgical treatment using the Bristow procedure. The operative procedure is discussed in detail recommending the use of an A-O malleolar compression screw, because of ease in insertion, to fix the caroacoid process to the anterior scapular neck. The Bristow procedure as described is an effective operation for achieving shoulder stability while maintaining nearly a complete range of motion in most cases. There was one case of recurrent dislocation after surgery which is described in detail. Six of 24 shoulders demonstrated some loss of external rotation, with the maximum being only 10 degrees. Five of 9 patients had some difficulty in throwing when the dominant extremity was treated. This did not appear to be related to any possible decrease in external rotation.