Optimising Soft-Tissue Balancing in Hip Hemiarthroplasty Surgery Using a Simple Planning Protocol.

Introduction Intracapsular neck of the femur fractures are some of the most common fragility fractures with significant morbidity and mortality. Cemented hemiarthroplasty is the standard treatment in most cases. Restoring the horizontal offset and leg length is important to optimize the outcome of hip hemiarthroplasty. Preoperative templating based on a scaled radiograph is common prior to total hip arthroplasty surgery to achieve optimum offset and leg length. It is not routine to have scaled radiographs available prior to a hemiarthroplasty surgery. Our simple non-scaled radiograph templating protocol (NSRTP) was introduced to help establish the correct offset and leg length in the absence of scaled radiographs. Methods A retrospective, comparative, case-control study was carried out in an acute hospital setting. Scaled radiographs were not available for any patients in the study, as is usual for hemiarthroplasty patients in our hospital. One group had surgery without any templating. The other group had surgery using the NSRTP. The NSRTP determined optimal ipsilateral offset based on preoperative measurement of the contralateral hip offset and ipsilateral head diameter on unscaled radiographs together with intraoperative measurement of the diameter of the ipsilateral femoral head removed at surgery. To help achieve the correct length, the NSRTP also included assessment and restoration of the contralateral greater trochanter tip-to-head relationship. The neck cut was tailored to restore the correct relationship. Results Twenty-three patients underwent hemiarthroplasty surgery without any templating and 23 had surgery using the NSRTP. The implants used were C-STEM™ (DePuy Synthes, Raynham, Massachusetts, United States) and SPECTRON (Smith & Nephew plc, London, United Kingdom); stems were used together with monopolar heads. The stems were available in standard and high offset versions and with a variety of neck lengths, allowing the correct combination to be selected to restore offset. When the NSRTP was used, horizontal offset and leg length were restored to within 2 mm of the contralateral hip in 22 patients out of 23. There was a statistically significant improvement in restoration of offset and leg length when the NSRTP was used, compared to the control group. Conclusion Restoration of the offset and leg length is important to maximize the outcome of hip arthroplasty surgery. Preoperative templating is helpful to achieve offset and leg length in total hip replacement. In the absence of scaled radiographs, NSRTP enables restoration of offset and leg length to within 2 mm of normal in more than 96% of patients. This protocol requires knowledge of the offset of the hemiarthroplasty stems being used, which is easily available from the relevant manufacturer.

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.

Medium term results of the Miller-Galante knee arthroplasty with 10 year survivorship.

Seventy-four Miller-Galante unicompartmental knee arthroplasty procedures were performed in 69 patients between 1990 and 2003. All patients underwent regular prospective clinical and radiological followup. Their average age at the time of surgery was 63.9 years (range: 47-80 years). Seventeen patients died during the period of follow-up. At a mean of 10.7 years follow-up the average Knee Society Score was 79.9 (range: 51-95) and the average functional score was 75.5 (range : 45-90). On the basis of clinical knee scoring, 48 knees (85.7%) were graded as excellent or good. The average amount of flexion at final follow-up was 115.9 degrees (range : 90-140 degrees). Arthritic progression in the opposite compartment was seen in 13 knees (23.2%). Two such knees underwent revision to total knee replacement (TKR) and 3 other knees were revised to TKR for persistent pain or infection. Ten-year survivorship with "revision due to progression of arthritis in the opposite compartment" as the end point was 973% and with "revision due to any cause" as the end point was 94.6%.

A technique for the fabrication of a reinforced moulded articulating cement spacer in two-stage revision total hip arthroplasty.

We describe an inexpensive method of producing a reinforced articulating cement spacer using a commercially available hip cement mould. We have a cohort of 15 consecutive patients in whom this novel cement spacer has been used. All patients were able to at least partially weight bear and none of the spacers fractured. Thirteen have been explanted at second stage operation after a minimum of eight weeks in situ. Two patients have been unable to undergo a second stage due to unrelated death and medical problems precluding further surgery. The articulating cement spacer described is produced using a technique that is simple, reproducible and allows a reinforced spacer to be created inexpensively without the need for special equipment.