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.

Mortality and morbidity of neck of femur fractures: A comparison between Orange and peripheral centres.

OBJECTIVE: The aim of this study is to examine and compare the mortality and morbidity of patients with neck of femur (NOF) fracture who presented initially to either Orange Health Service (OHS), a secondary orthopaedic referral centre or to a peripheral hospital and subsequently transferred to OHS. DESIGN, SETTING AND PARTICIPANTS: This study is designed as a retrospective review of medical records of 151 patients with NOF fractures who were treated operatively between March 2013 and March 2014 at OHS. Patients were divided into OHS group and 'Other' group based on their initial presenting location. MAIN OUTCOME MEASURES: Mortality, unplanned intensive care unit/high dependency unit admissions, ischemic heart/cerebral events, infection rates and length of stay. RESULTS: There was no statistically significant difference in mortality and morbidity proportions between both groups. There were significant differences between lengths of stay in the acute setting which was shorter in the 'Other' group. CONCLUSION: Contrary to the literature, this study found that the morbidity and mortality outcomes of patients with NOF fracture who presented initially to rural hospitals were equivalent to those who presented to a secondary orthopaedic referral centre. However, those who first presented to rural hospitals had a shorter duration of stay in the acute setting.

Positive Epstein-Barr virus and cytomegalovirus IgM assays in primary HIV infection.

We report three cases with misleading cytomegalovirus (CMV) or Epstein-Barr virus (EBV) immunoglobulin M (IgM) results during primary human immunodeficiency virus (HIV) infection. We determined the rate of positive anti-CMV IgM assays or anti-EBV capsid antigen IgM assays in sera from a group of well-characterized subjects with primary HIV infection as 2.9% (1/35; 95%CI: 0.15-16.6%) for each infection. The rate of positive anti-EBV capsid antigen IgM assays in subjects with positive hepatitis A virus IgM assays was 30% (6/20; 95%CI: 14.6-51.9%). Clinicians need to consider the limitations of IgM assays for diagnosis of herpesvirus infections, and consider testing for other infections with overlapping clinical manifestations.