Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 18 de 18
Filter
1.
Bone Joint J ; 100-B(8): 1002-1009, 2018 08.
Article in English | MEDLINE | ID: mdl-30062940

ABSTRACT

Aims: The aim of this study was to report the initial results of the Exeter V40 stem, which became available in 2000. Patients and Methods: A total of 540 total hip arthroplasties (THAs) were performed in our unit using this stem between December 2000 and May 2002. Our routine protocol is to review patients postoperatively and at one, five, and ten years following surgery. Results: A total of 145 patients (26.9%) died before ten years and of the remaining 395 stems, 374 (94.7%) remain in situ. A total of 21 well-fixed stems (5.3%) were revised. Ten were exchanged using a cement-in-cement technique to facilitate acetabular revision. Three were revised for infection, one for instability, one for fracture of the stem, and six following a periprosthetic fracture. An additional 16 acetabular components (4.1%) were revised; five for aseptic loosening and 11 for instability. There were no revisions for aseptic loosening of the stem, and no evidence of aseptic loosening in any hip. The fate of every stem is known and all patients remain under review. Survivorship, with revision of the stem for aseptic loosening as the endpoint, was 100%. At 13.5 years, the Kaplan-Meier survival rate for all-cause revision of the stem was 96.8% (95% confidence interval (CI) 94.8 to 98.8) and all-cause revision (including acetabular revision, infection, and instability) was 91.2% (95% CI 88.3 to 94.1). Conclusion: Conclusion No stem was revised for aseptic loosening in this series. The contemporary Exeter V40 stem continues to perform well, and survival has remained comparable with that of the Exeter Universal stem. Cite this article: Bone Joint J 2018;100-B:1002-9.


Subject(s)
Arthroplasty, Replacement, Hip/instrumentation , Hip Prosthesis , Adult , Aged , Cementation , Female , Follow-Up Studies , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Periprosthetic Fractures/etiology , Periprosthetic Fractures/surgery , Prosthesis Design , Prosthesis Failure/etiology , Prosthesis-Related Infections/etiology , Prosthesis-Related Infections/surgery , Recurrence , Reoperation/statistics & numerical data
2.
Bone Joint J ; 99-B(11): 1450-1457, 2017 Nov.
Article in English | MEDLINE | ID: mdl-29092983

ABSTRACT

AIMS: We report the incidence of radiolucent lines (RLLs) using two flanged acetabular components at total hip arthroplasty (THA) and the effect of the Rim Cutter. PATIENTS AND METHODS: We performed a retrospective review of 300 hips in 292 patients who underwent primary cemented THA. A contemporary flanged acetabular component was used with (group 1) and without (group 2) the use of the Rim Cutter and the Rimfit acetabular component was used with the Rim Cutter (group 3). RLLs and clinical outcomes were evaluated immediately post-operatively and at five years post-operatively. RESULTS: There was no significant difference in the incidence of RLLs on the immediate post-operative radiographs (p = 0.241) or at five years post-operatively (p = 0.463). RLLs were seen on the immediate post-operative radiograph in 2% of hips in group 1, in 5% in group 2 and in 7% in group 3. Five years post-operatively, there were RLLs in 42% of hips in group 1, 41% in group 2 and in 49% in group 3. In the vast majority of hips, in each group, the RLL was present in DeLee and Charnley zone 1 only (86%, 83%, 67% respectively). Oxford and Harris Hip scores improved significantly in all groups. There was no significant difference in these scores or in the change in scores between the groups, with follow-up. CONCLUSION: Despite the Rim Cutter showing promising results in early laboratory and clinical studies, this analysis of the radiological and clinical outcome five years post-operatively does not show any advantage over and above modern cementing techniques in combination with a well performing cemented acetabular component. For this reason, we no longer use the Rim Cutter in routine primary THA. Cite this article: Bone Joint J 2017;99-B:1450-7.


Subject(s)
Arthroplasty, Replacement, Hip/instrumentation , Bone Cements , Hip Prosthesis , Osteoarthritis, Hip/surgery , Prosthesis Failure , Adult , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , Osteoarthritis, Hip/diagnostic imaging , Radiography , Retrospective Studies , Treatment Outcome
3.
Bone Joint J ; 99-B(2): 199-203, 2017 Feb.
Article in English | MEDLINE | ID: mdl-28148661

ABSTRACT

AIMS: We present the clinical and radiological results at a minimum follow-up of five years for patients who have undergone multiple cement-in-cement revisions of their femoral component at revision total hip arthroplasty (THA). PATIENTS AND METHODS: We reviewed the outcome on a consecutive series of 24 patients (10 men, 14 women) (51 procedures) who underwent more than one cement-in-cement revision of the same femoral component. The mean age of the patients was 67.5 years (36 to 92) at final follow-up. Function was assessed using the original Harris hip score (HHS), Oxford Hip Score (OHS) and the Merle D'Aubigné Postel score (MDP). RESULTS: The mean length of follow-up was 81.7 months (64 to 240). A total of 41 isolated acetabular revisions were performed in which stem removal facilitated access to the acetabulum, six revisions were conducted for loosening of both components and two were isolated stem revisions (each of these patients had undergone at least two revisions). There was significant improvement in the OHS (p = 0.041), HHS (p = 0.019) and MDP (p = 0.042) scores at final follow-up There were no stem revisions for aseptic loosening. Survival of the femoral component was 91.9% (95% confidence intervals (CI) 71.5 to 97.9) at five years and 91.7% (95% CI 70 to 97) at ten years (number at risk 13), with stem revision for all causes as the endpoint. CONCLUSION: Cement-in-cement revision is a viable technique for performing multiple revisions of the well cemented femoral component during revision total hip arthroplasty at a minimum of five years follow-up. Cite this article: Bone Joint J 2017;99-B:199-203.


Subject(s)
Arthroplasty, Replacement, Hip/methods , Femur/surgery , Hip Joint/surgery , Adult , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/adverse effects , Cementation , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prosthesis Failure , Reoperation , Retrospective Studies , Treatment Outcome
4.
Bone Joint J ; 98-B(11): 1441-1449, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27803218

ABSTRACT

AIMS: We present a minimum 20-year follow-up study of 382 cemented Exeter Universal total hip arthroplasties (350 patients) operated on at a mean age of 66.3 years (17 to 94). PATIENTS AND METHODS: All patients received the same design of femoral component, regardless of the original diagnosis. Previous surgery had been undertaken for 33 hips (8.6%). During the study period 218 patients with 236 hips (62%) died, 42 hips (11%) were revised and 110 hips (29%) in 96 patients were available for review. The acetabular components were varied and some designs are now obsolete, however they were all cemented. RESULTS: With an endpoint of revision for aseptic loosening or lysis, survivorship of the stem at 22.8 years was 99.0% (95% confidence interval (CI) 97.0 to 100). One stem was revised 21 years post-operatively in a patient with Gaucher's disease and proximal femoral osteolysis. Survivorship with aseptic loosening or lysis of the acetabular component or stem as the endpoint at 22.8 years was 89.3% (95% CI 84.8 to 93.8). With an endpoint of revision for any reason, overall survivorship was 82.9% (95% CI 77.4 to 88.4) at 22.8 years. Radiological review showed excellent preservation of bone stock at 20 to 25 years, and no impending failures of the stem. CONCLUSION: The Exeter femoral stem continues to perform well beyond 20 years. Cite this article: Bone Joint J 2016;98-B:1441-9.


Subject(s)
Arthroplasty, Replacement, Hip/instrumentation , Hip Prosthesis , Adolescent , Adult , Aged , Aged, 80 and over , Bone Cements , Cementation , Female , Femur/diagnostic imaging , Femur/surgery , Follow-Up Studies , Gaucher Disease/diagnostic imaging , Gaucher Disease/surgery , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Osteolysis/diagnostic imaging , Osteolysis/surgery , Prosthesis Design , Prosthesis Failure , Radiography , Reoperation , Severity of Illness Index , Young Adult
5.
Bone Joint J ; 97-B(12): 1623-7, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26637675

ABSTRACT

Revision of a cemented hemiarthroplasty of the hip may be a hazardous procedure with high rates of intra-operative complications. Removing well-fixed cement is time consuming and risks damaging already weak bone or perforating the femoral shaft. The cement-in-cement method avoids removal of intact cement and has shown good results when used for revision total hip arthroplasty (THA). The use of this technique for the revision of a hemiarthroplasty to THA has not been previously reported. A total of 28 consecutive hemiarthroplasties (in 28 patients) were revised to a THA using an Exeter stem and the cement-in-cement technique. There were four men and 24 women; their mean age was 80 years (35 to 93). Clinical and radiographic data, as well as operative notes, were collected prospectively and no patient was lost to follow-up. Four patients died within two years of surgery. The mean follow up of the remainder was 70 months (25 to 124). Intra-operatively there was one proximal perforation, one crack of the femoral calcar and one acetabular fracture. No femoral components have required subsequent revision for aseptic loosening or are radiologically loose. Four patients with late complications (14%) have since undergone surgery (two for a peri-prosthetic fracture, and one each for deep infection and recurrent dislocation) resulting in an overall major rate of complication of 35.7%. The cement-in-cement technique provides reliable femoral fixation in this elderly population and may reduce operating time and rates of complication.


Subject(s)
Arthroplasty, Replacement, Hip/methods , Bone Cements , Cementation/methods , Hemiarthroplasty/methods , Adult , Aged , Aged, 80 and over , Female , Femur/surgery , Follow-Up Studies , Humans , Male , Middle Aged , Prosthesis Failure , Reoperation/methods , Retrospective Studies
6.
Bone Joint J ; 96-B(2): 188-94, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24493183

ABSTRACT

Impaction bone grafting for the reconstitution of bone stock in revision hip surgery has been used for nearly 30 years. Between 1995 and 2001 we used this technique in acetabular reconstruction, in combination with a cemented component, in 304 hips in 292 patients revised for aseptic loosening. The only additional supports used were stainless steel meshes placed against the medial wall or laterally around the acetabular rim to contain the graft. All Paprosky grades of defect were included. Clinical and radiographic outcomes were collected in surviving patients at a minimum of ten years after the index operation. Mean follow-up was 12.4 years (sd 1.5) (10.0 to 16.0). Kaplan-Meier survival with revision for aseptic loosening as the endpoint was 85.9% (95% CI 81.0 to 90.8) at 13.5 years. Clinical scores for pain relief remained satisfactory, and there was no difference in clinical scores between cups that appeared stable and those that appeared radiologically loose.


Subject(s)
Acetabulum/surgery , Arthroplasty, Replacement, Hip/methods , Bone Cements , Bone Transplantation/methods , Femur Head/transplantation , Forecasting , Hip Prosthesis , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prosthesis Failure , Reoperation/methods , Retrospective Studies , Treatment Outcome
7.
J Bone Joint Surg Br ; 94(11): 1482-6, 2012 Nov.
Article in English | MEDLINE | ID: mdl-23109626

ABSTRACT

The technique of femoral cement-in-cement revision is well established, but there are no previous series reporting its use on the acetabular side at the time of revision total hip replacement. We describe the technique and report the outcome of 60 consecutive acetabular cement-in-cement revisions in 59 patients at a mean follow-up of 8.5 years (5 to 12). All had a radiologically and clinically well-fixed acetabular cement mantle at the time of revision. During the follow-up 29 patients died, but no hips were lost to follow-up. The two most common indications for acetabular revision were recurrent dislocation (46, 77%) and to complement femoral revision (12, 20%). Of the 60 hips, there were two cases of aseptic loosening of the acetabular component (3.3%) requiring re-revision. No other hip was clinically or radiologically loose (96.7%) at the latest follow-up. One hip was re-revised for infection, four for recurrent dislocation and one for disarticulation of a constrained component. At five years the Kaplan-Meier survival rate was 100% for aseptic loosening and 92.2% (95% CI 84.8 to 99.6), with revision for any cause as the endpoint. These results support the use of cement-in-cement revision on the acetabular side in appropriate cases. Theoretical advantages include preservation of bone stock, reduced operating time, reduced risk of complications and durable fixation.


Subject(s)
Acetabulum/surgery , Arthroplasty, Replacement, Hip/methods , Bone Cements/therapeutic use , Hip Joint/surgery , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged , Reoperation , Survival Rate , Treatment Outcome
8.
J R Nav Med Serv ; 98(2): 3-5, 2012.
Article in English | MEDLINE | ID: mdl-22970637

ABSTRACT

Femoral neck stress fractures (FNSF) represent 3.5%-8% of stress fractures in military recruits; potentially resulting in medical discharge and/or complications. The incidence of displaced FNSF in the British Army has been reported as 1.8 in 10,000 recruits. We aimed to review the incidence and outcome of displaced FNSF in Royal Marine recruits. Retrospective review identified 6 recruits who sustained a displaced FNSF from 2001 to 2011 representing an incidence of 9.3 in 10,000 recruits. All were treated urgently by internal fixation. There were no cases of avascular necrosis, no surgical complications and no further procedures required. All united with a mean time to union of 11 months. 50% had a union time greater than 1 year. These fractures are slow to unite but with urgent surgical intervention and stable fixation 100% union was achieved. Awareness of this guides the management and rehabilitation whilst avoiding the risks of unnecessary secondary surgical interventions.


Subject(s)
Femoral Neck Fractures/surgery , Fractures, Stress/surgery , Military Personnel , England , Femoral Neck Fractures/diagnostic imaging , Fracture Fixation, Internal , Fractures, Stress/diagnostic imaging , Humans , Radiography , Retrospective Studies , Treatment Outcome
9.
J Bone Joint Surg Br ; 94(3): 322-7, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22371537

ABSTRACT

The removal of all prosthetic material and a two-stage revision procedure is the established standard management of an infected total hip replacement (THR). However, the removal of well-fixed femoral cement is time-consuming and can result in significant loss of bone stock and femoral shaft perforation or fracture. We report our results of two-stage revision THR for treating infection, with retention of the original well-fixed femoral cement mantle in 15 patients, who were treated between 1989 and 2002. Following partial excision arthroplasty, patients received local and systemic antibiotics and underwent reconstruction and re-implantation at a second-stage procedure, when the infection had resolved. The mean follow-up of these 15 patients was 82 months (60 to 192). Two patients had positive microbiology at the second stage and were treated with six weeks of appropriate antibiotics; one of these developed recurrent infection requiring further revision. Successful eradication of infection was achieved in the remaining 14 patients. We conclude that when two-stage revision is used for the treatment of peri-prosthetic infection involving a THR, a well-fixed femoral cement mantle can be safely left in situ, without compromising the treatment of infection. Advantages of this technique include a shorter operating time, reduced loss of bone stock and a technically more straightforward second-stage procedure.


Subject(s)
Arthroplasty, Replacement, Hip/methods , Bone Cements/therapeutic use , Prosthesis-Related Infections/surgery , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Bacterial Infections/microbiology , Bacterial Infections/surgery , Cementation , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prosthesis Failure , Prosthesis-Related Infections/drug therapy , Prosthesis-Related Infections/microbiology , Recurrence , Reoperation/adverse effects , Reoperation/methods , Treatment Outcome
10.
J Bone Joint Surg Br ; 93(1): 34-8, 2011 Jan.
Article in English | MEDLINE | ID: mdl-21196540

ABSTRACT

We evaluated all cases involving the combined use of a subtrochanteric derotational femoral shortening osteotomy with a cemented Exeter stem performed at our institution. With severe developmental dysplasia of the hip an osteotomy is often necessary to achieve shortening and derotation of the proximal femur. Reduction can be maintained with a 3.5 mm compression plate while the implant is cemented into place. Such a plate was used to stabilise the osteotomy in all cases. Intramedullary autograft helps to prevent cement interposition at the osteotomy site and promotes healing. There were 15 female patients (18 hips) with a mean age of 51 years (33 to 75) who had a Crowe IV dysplasia of the hip and were followed up for a mean of 114 months (52 to 168). None was lost to follow-up. All clinical scores were collected prospectively. The Charnley modification of the Merle D'Aubigné-Postel scores for pain, function and range of movement showed a statistically significant improvement from a mean of 2.4 (1 to 4), 2.3 (1 to 4), 3.4 (1 to 6) to 5.2 (3 to 6), 4.4 (3 to 6), 5.2 (4 to 6), respectively. Three acetabular revisions were required for aseptic loosening; one required femoral revision for access. One osteotomy failed to unite at 14 months and was revised successfully. No other case required a femoral revision. No postoperative sciatic nerve palsy was observed. Cemented Exeter femoral components perform well in the treatment of Crowe IV dysplasia with this procedure.


Subject(s)
Arthroplasty, Replacement, Hip/methods , Hip Dislocation, Congenital/surgery , Hip Prosthesis , Osteotomy/methods , Adult , Aged , Cementation/methods , Female , Follow-Up Studies , Hip Dislocation, Congenital/diagnostic imaging , Hip Joint/diagnostic imaging , Hip Joint/physiopathology , Humans , Male , Middle Aged , Prosthesis Design , Prosthesis Failure , Radiography , Range of Motion, Articular , Reoperation , Treatment Outcome
11.
J Bone Joint Surg Br ; 92(10): 1351-5, 2010 Oct.
Article in English | MEDLINE | ID: mdl-20884970

ABSTRACT

We report the outcome of the flangeless, cemented all-polyethylene Exeter acetabular component at a mean of 14.6 years (10 to 17) after operation. Of the 263 hips in 243 patients, 122 prostheses are still in situ; 112 patients (119 hips) have died, 18 hips have been revised, and three patients (four hips) were lost to follow-up. Radiographs at the final review were available for 110 of the 122 surviving hips. There were acetabular radiolucent lines in 54 hips (49%). Two acetabular components had migrated but neither patient required revision. The Kaplan-Meier survivorship at 15 years with 61 hips at risk with revision for any cause as the endpoint was 89.9% (95% confidence interval (CI) 84.6 to 95.2) and for aseptic loosening of the acetabular component or lysis 91.7% (95% CI 86.6 to 96.8). In 210 hips with a diagnosis of primary osteoarthritis, survivorship with revision for any cause as the endpoint was 93.2% (95% CI 88.1 to 98.3), and for aseptic loosening of the acetabular component 95.0% (95% CI 90.3 to 99.7). The cemented all-polyethylene Exeter acetabular component has an excellent long-term survivorship.


Subject(s)
Acetabulum/surgery , Arthroplasty, Replacement, Hip/methods , Hip Prosthesis , Acetabulum/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged , Osteoarthritis, Hip/surgery , Polyethylene , Prosthesis Design , Prosthesis Failure , Radiography , Reoperation , Survival Analysis , Treatment Outcome , Young Adult
12.
J Bone Joint Surg Br ; 91(6): 730-7, 2009 Jun.
Article in English | MEDLINE | ID: mdl-19483224

ABSTRACT

The first 325 Exeter Universal stems (309 patients) implanted at the originating centre were inserted between March 1988 and February 1990 by a group of surgeons with differing experience. In this report we describe the clinical and radiological results at a mean of 15.7 years (14.7 to 17.3) after operation with no loss to follow-up. There were 97 patients (108 hips) with replacements still in situ and 31 (31 hips) who had undergone a further procedure. With an endpoint of revision for aseptic loosening, the survivorship at 17 years was 100% and 90.4% for the femoral and acetabular component, respectively. The mean Merle D'Aubigné and Postel scores at review were 5.4 (SD 0.97) for pain and 4.5 (SD 1.72) for function. The mean Oxford score was 38.4 (SD 9.8) (0 to 48 worst-to-best scale) and the mean combined Harris pain and function score was 73.2 (SD 16.9). Radiological review showed excellent preservation of bone stock in the proximal femur and no failures of the femoral component.


Subject(s)
Arthroplasty, Replacement, Hip/methods , Hip Joint/surgery , Hip Prosthesis/standards , Prosthesis-Related Infections/surgery , Adult , Aged , Aged, 80 and over , Cementation/methods , Equipment Failure Analysis , Female , Follow-Up Studies , Hip Joint/diagnostic imaging , Humans , Male , Middle Aged , Pain Measurement , Prosthesis-Related Infections/diagnostic imaging , Radiography , Time Factors , Treatment Outcome , Young Adult
13.
J Bone Joint Surg Br ; 91(5): 577-82, 2009 May.
Article in English | MEDLINE | ID: mdl-19407288

ABSTRACT

The removal of well-fixed bone cement from the femoral canal during revision of a total hip replacement (THR) can be difficult and risks the loss of excessive bone stock and perforation or fracture of the femoral shaft. Retaining the cement mantle is attractive, yet the technique of cement-in-cement revision is not widely practised. We have used this procedure at our hospital since 1989. The stems were removed to gain a better exposure for acetabular revision, to alter version or leg length, or for component incompatibility. We studied 136 hips in 134 patients and followed them up for a mean of eight years (5 to 15). A further revision was required in 35 hips (25.7%), for acetabular loosening in 26 (19.1%), sepsis in four, instability in three, femoral fracture in one and stem fracture in one. No femoral stem needed to be re-revised for aseptic loosening. A cement-in-cement revision of the femoral stem is a reliable technique in the medium term. It also reduces the risk of perforation or fracture of the femoral shaft.


Subject(s)
Arthroplasty, Replacement, Hip/methods , Bone Cements/therapeutic use , Cementation/methods , Hip Prosthesis , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , Femur/surgery , Hip Joint/diagnostic imaging , Hip Joint/surgery , Humans , Male , Middle Aged , Prosthesis Failure , Radiography , Reoperation/methods , Treatment Outcome
14.
J Bone Joint Surg Br ; 88(2): 206-7, 2006 Feb.
Article in English | MEDLINE | ID: mdl-16434525

ABSTRACT

It has been suggested that arthrodesis of the ankle leads to osteoarthritis of the joints of the ipsilateral hind- and midfoot. We believe these studies overlooked the presence of osteoarthritic changes in these joints before the arthrodesis. We reviewed the pre-operative radiographs of 70 patients with osteoarthritis of the ankle who underwent 71 ankle arthrodeses (one was bilateral). The talonavicular, calcaneocuboid, subtalar and naviculocuneiform joints were given an osteoarthritis score according to Kellgren and Lawrence. The mean age at operation was 54.9 years and the most common indication was for post-traumatic osteoarthritis (52 cases). A total of 68 patients showed pre-existing arthritis in either the hind- or mid-foot, with the subtalar joint the most commonly affected. Ipsilateral hind- and mid-foot arthritis is almost universally present in patients with arthritis of the ankle requiring arthrodesis. The presence of such changes may not be a consequence of this arthrodesis.


Subject(s)
Ankle Joint/surgery , Arthrodesis/adverse effects , Foot Diseases/etiology , Osteoarthritis/etiology , Osteoarthritis/surgery , Tarsal Joints/diagnostic imaging , Adult , Aged , Aged, 80 and over , Ankle Joint/diagnostic imaging , Female , Humans , Male , Middle Aged , Osteoarthritis/diagnostic imaging , Radiography , Severity of Illness Index , Subtalar Joint/diagnostic imaging
15.
J Arthroplasty ; 12(5): 535-40, 1997 Aug.
Article in English | MEDLINE | ID: mdl-9268793

ABSTRACT

The incidence of massive early subsidence (subsidence greater than 10 mm) following impaction grafting of the femur in revision surgery is reported. The first 79 consecutive revision total hip arthroplasties using morselized allograft, polymethyl methacrylate cement, and a double-tapered, polished, collarless stem were reviewed. Nine (11%) of the 79 revision femoral prostheses showed massive subsidence, with another nine hips subsiding to a lesser degree. Further elucidation of the critical factors contributing to the initial stability of the biologic composite is required.


Subject(s)
Bone Transplantation/methods , Hip Prosthesis , Osteolysis/etiology , Postoperative Complications , Adult , Aged , Aged, 80 and over , Bone Cements , Female , Femur , Humans , Male , Middle Aged , Prosthesis Failure , Reoperation , Time Factors
16.
Br J Hosp Med ; 55(7): 432-6, 1996.
Article in English | MEDLINE | ID: mdl-8730569

ABSTRACT

The treatment of the patient with a failed total hip replacement has become an ever increasing problem. The incidence and aetiology of failure, and its clinical presentation, are reviewed. The planning and performance of complex revision surgery, including the use of modern bone grafting techniques and specialist implants, are outlined. Postoperative rehabilitation, current research and predictions for the future are also discussed.


Subject(s)
Hip Prosthesis , Acetabulum/surgery , Bone Transplantation , Femur Head/surgery , Forecasting , Hip Prosthesis/rehabilitation , Humans , Incidence , Patient Care Planning , Prosthesis Design , Prosthesis Failure , Reoperation
17.
J Hosp Infect ; 32(1): 1-7, 1996 Jan.
Article in English | MEDLINE | ID: mdl-8904367

ABSTRACT

Bacterial shedding, wound contamination and clinical-infection rates in clean wounds are influenced by operating-theatre dress. The aim of this study was to clarify the relative contribution of hats, masks and clothing to the control of wound contamination in both ultraclean (enclosed vertical laminar-flow) and conventional (plenum ventilated) airflow theatres. Personnel wore varying combinations of dress in both types of theatre. Colony forming units (cfus) were measured on settle plates at head and waist height, and in the air by a centrifugal air sampler. Bacterial counts in conventional theatres were consistently high and were not significantly influenced by theatre dress. There was a 22-fold increase in cfus on settle plates at waist height when neither hat nor mask were worn, a 15-fold increase when a hat but no mask was worn and a fourfold increase with a mask but no hat in vertical laminar airflow enclosures, although air sample counts remained low. When balloon-cotton clothing was worn, rather than cuffed polyester with microfilament barrier-fabric gowns, cfu counts rose by a factor of six. The bacterial inoculum in conventionally ventilated theatres, or in ultraclean theatres if hat or mask are omitted or balloon-cotton clothing worn, is theoretically sufficient to infect a prosthetic arthroplasty. Theatre-air sampling alone does not reflect local contamination when a surgeon stands over a wound in a vertical laminar-flow enclosure, and both hats and masks are an important part of dress in such environments.


Subject(s)
Environment, Controlled , Head Protective Devices/standards , Masks/standards , Operating Rooms , Protective Clothing/standards , Surgical Wound Infection/microbiology , Air Microbiology , Colony Count, Microbial , Environmental Monitoring , Humans , Infection Control , Personnel, Hospital
SELECTION OF CITATIONS
SEARCH DETAIL
...