Technical note: acetabular augmentation with customisable cementless all-polyethylene insert.

Acetabular augmentation is a challenge for complex primary and revision hip surgery. Several methods exist to recreate a supportive, hemispherical acetabulum where a defect exists, however, these can be complex, expensive, time consuming, and limited by available size and shape. We present a simple, inexpensive, quick and customisable method of acetabular augmentation using cementless polyethylene with titanium coating. The first case is presented with follow-up up to 8 years.

Long-term Outcomes of Revision Total Hip Arthroplasty Using a Modular Fluted Conical Femoral Stem.

BACKGROUND: This study presents minimum 6-year follow-up data on the survival and satisfaction of an uncemented modular revision femoral system, following on from our previously published earlier results. METHODS: We retrospectively reviewed all revision hip arthroplasties performed at our institution between January 2005 and October 2012, using a single modular femoral revision system. Patient-reported outcomes were collected (satisfaction score and Oxford Hip Score). Preoperative and postoperative radiographs were reviewed for stem subsidence, and Kaplan-Meier analysis was performed for survival. A total of 115 femoral revisions were performed in 106 patients. RESULTS: All-cause survival was 82% (95% confidence interval 74 to 91%) at 10.8 years, and 96% (95% confidence interval 90 to 100%) excluding septic failure. Of the 19 cases requiring reoperation, 16 were for infection, 2 for aseptic loosening, and 1 for mechanical failure. At final follow-up, 88.5% of patients were "satisfied" or "very satisfied". CONCLUSIONS: This study showed excellent clinical results of a commonly used revision hip stem with at least 10 years follow-up. Satisfaction rates were high, with few aseptic failures. Stem subsidence was more common in revisions for infection, but did not correlate with lower satisfaction scores.

Fulfilment of preoperative expectations and postoperative patient satisfaction after total knee replacement. A prospective analysis of 200 patients.

BACKGROUND: In total knee arthroplasty (TKA), the association between preoperative patient expectations, their postoperative fulfilment, and satisfaction is not well understood. The aim of this study was to quantify these relationships in a cohort of TKA patients with differing socio-economic backgrounds from across Scotland. METHODS: Expectations of 200 patients undergoing TKA were assessed using the Hospital for Special Surgery Knee Replacement Expectation Score. Postoperatively, expectation fulfilment was assessed at six weeks and one year. Satisfaction was measured using a five-point Likert scale. Preoperative and postoperative scores were compared across satisfaction groups. Relationships between individual and overall expectation fulfilment, satisfaction, and demographics were analysed. RESULTS: At six weeks, 30% of expectations were fulfilled, increasing to 48% at one year. Corresponding satisfaction rates were 84% and 89%. Higher fulfilment scores were associated with greater satisfaction. Fulfilment of pain and mobility expectations were most predictive of satisfaction. Expectations of kneeling, squatting, paid work and sexual function went unfulfilled. Preoperative expectations were not related to postoperative satisfaction. Males had higher postoperative fulfilment scores. CONCLUSIONS: This study showed a clear association between fulfilment of preoperative expectations and patient satisfaction following TKA. However, less than 50% of patient expectations were completely fulfilled. While higher fulfilment scores were predictive of greater satisfaction, low overall fulfilment score did not preclude satisfaction. The high correlation of pain and function expectation fulfilment with satisfaction emphasises the need to relate these as appropriate preoperative expectations, while awareness of unfulfilled expectations may allow engagement with and resolution of ongoing concerns and disappointments.

The assessment of instability in the osteoarthritic knee.

Patient-reported instability is a common complaint amongst those with knee arthritis.Much research has examined the assessment of self-reported instability in the knee; however, no definitive quantitative measure of instability has been developed.This review focuses on the current literature investigating the nature of self-reported instability in the arthritic knee and discusses the possibilities of further investigation. Cite this article: EFORT Open Rev 2019;4:70-76. DOI: 10.1302/2058-5241.4.170079.

Variations in pelvic dimensions: An anatomical and computed tomography study.

The anterior pelvic plane (APP) is a useful anatomical reference with both clinical and research applications in orthopedic surgery and rehabilitation medicine. It is used as a marker for computer-assisted total hip replacement and image-guided assessment of the hip center in clinical gait analysis. Despite its common use, no published data exist on the variations in height and width in an adult population. The aim of this study was to determine the range of dimensions for the anterior pelvic plane found in the Scottish adult population. Thirty-five human cadavers and 100 pelvic computed tomography (CT) scans were examined. Pelvic height and width were measured, and the ratios were determined. The mean width and height for combined cadaver and CT pelves were found to be 238.0 mm (SD 20.1, range 188.3-273.8) and 92.7 mm (SD 10.5, range 71.2-114.7), respectively. The mean width-to-height ratio for all pelves was 2.59 (SD 0.31, range 1.73-3.50). There were no statistically significant differences in means between males and females. The variations of APP dimensions within an adult population are presented. These will be of value in the validation of algorithms for computer navigation and hip joint center calculation in total hip arthroplasty and gait analysis. Furthermore, differences in dimensions between cadaveric and CT measurements have been shown which may have implications for further research and the validity of reference data dependent on data-point acquisition. Clin. Anat. 31:981-987, 2018. © 2018 Wiley Periodicals, Inc.