Outcomes of Dual Mobility Versus Fixed Bearing Components in Revision Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.

AIMS: Dual mobility (DM) implants have received increasing interest in revision surgery due to their increased stability. The aim of this systematic review was to compare outcomes of DM versus conventional fixed bearing (FB) implants in revision Total Hip Arthroplasty (r-THA). METHODS: A comprehensive search was performed using the PubMed, Embase, and MEDLINE databases between January 2000 and 2023. Outcome measures included re-revision due to dislocation, re-revision for other causes, all-cause re-revision, total complication rate, and functional outcome measures. The Methodological Index for Non-Randomized Studies (MINORS) assessment tool was used to evaluate methodological quality and the risk of bias. A pooled meta-analysis was conducted, with an assessment of heterogeneity using the Chi-square and Higgins I2 tests. A further sub-group analysis was performed between DM implants and larger femoral head (> 36 mm) FB implants. RESULTS: A total of 13 studies met the final inclusion criteria, with an overall number of 5,004 r-THA hips included (2,108 DM and 2,896 FB). The DM implants had significantly lower odds of re-revision due to dislocation (OR [odds ratio] 0.38, P < 0.001), aseptic loosening (OR 0.54, P = 0.004), and all-cause re-revision (OR 0.55, P < 0.001) compared to FB implants. No significant difference was seen in the odds of re-revision due to periprosthetic joint infection (PJI) (OR 0.99, P = 0.94) or periprosthetic fracture (OR 0.59, P = 0.13) between the two groups. The total number of complications showed an odds benefit in favor of DM implants (OR 0.43, P < 0.001). In the subgroup analysis, there was no significant difference in the odds of re-revision due to dislocation (OR 0.69, P = 0.11) between DM and larger femoral head FB implants. CONCLUSION: Based upon current literature, it appears DM implants are an effective modality for reducing dislocation following r-THA with lower complication rates compared to FB implants. However, further prospective randomized controlled trials (RCTs) with longer term follow up are required.

Bone cement in total hip arthroplasty - Is it really green?

BACKGROUND: Total hip replacement (THR)is typically cemented, cementless or hybrid depending on patient factors and surgeon preference. To date no studies have evaluated waste generated with each of these procedures in relation to implant choice, and particularly waste related to consumables. We aimed to quantify the volume; type and ability to recycle this waste and suggest potential strategies for reducing the overall waste related to consumables in THR. METHOD: This was a prospective review of all waste related to consumables in THR. The waste was weighed using a Salter 1066 BKDR15 scale, accurate to the nearest 1 â€‹g. The primary outcome was the amount of waste generated per case depending on implant choice (cemented vs. uncemented). Secondary outcomes included: proportion of clinical waste and proportion of recyclable waste. RESULTS: Cemented THR generated a total of 1.89 â€‹kg of waste compared to 775 â€‹g for an uncemented THR. Cemented THR generated significantly more sterile (hazardous) waste than uncemented THR both as overall volume and as a proportion 763 â€‹g (40%) vs 76 â€‹g (10%). Significantly more of the waste related to uncemented THR was amenable to being recycled through conventional waste streams with simple changes in theatre 672 â€‹g (86%) compared to 989 â€‹g (52%) with cemented THR. Between 20 and 30% of waste packaging for both types of surgery compromised information booklets. CONCLUSION: Cemented hip replacement generates significantly more waste from consumables than uncemented and a greater amount of this waste is hazardous requiring intensive processing. For both implants a significant proportion of waste can be recycled with simple process changes in theatre. Industry partners have a responsibility to minimise unnecessary packaging and work with surgeons to improve sustainability.

Open Subpectoral Tenodesis for Isolated Traumatic Long Head of Biceps Tendon Rupture Provides Excellent Functional Outcomes in Active Male Patients.

BACKGROUND:  For many years the long head of biceps tendon (LHBT) rupture has been described and is commonly identified by weakness, cramping, and the so-called "Popeye" sign. Traditionally, this was treated non-operatively, likely reflecting patient factors and the technical difficulty in reattaching a degenerative and shortened tendon. In contrast, traumatic distal biceps rupture is now commonly repaired despite historically being managed non-operatively. The advent of a convenient and reproducible surgical technique led to an increase in the rate of fixation, thereby improving the cramping and weakness associated with non-operative treatment. Given recent surgical advances within this field, many techniques are now present for LHBT pathology. We describe results from a cohort of patients suffering traumatic LHBT rupture who sought a surgical solution to improve their symptoms. METHODS:  Over four years, 18 male patients underwent surgical intervention for isolated traumatic LHBT rupture. The technique used involved an open subpectoral tenodesis with fixation of the LHBT into the bicipital groove. Postoperative immobilization using a sling was recommended for six weeks prior to a progressive rehabilitation program. Patients were assessed with pre- and postoperative visual analog scores (VAS) for pain and American Shoulder and Elbow Society (ASES) scores. RESULTS: The mean patient age at the time of surgery was 49 years (range: 26-65 years). The mean time to surgery was nine weeks (range: 2-24 weeks). All patients showed an improvement following surgery with a mean pre-op ASES score of 33 (range: 10-60) compared to a post-op score of 92.6 (range: 85-100). All patients were able to return to work and sport, with all but one returning to the same functional demand level of work. The mean pre-op pain VAS was 6.3 (out of 10) compared to 0.2 post-op. All patients had a requirement for analgesia pre-operatively and none had postoperatively. No surgical complications were observed. No correlation was observed between the time to surgery and the outcome. DISCUSSION:  LHBT rupture is often treated non-operatively as few studies within the literature describe the surgical technique and outcomes from surgical intervention. When treated non-operatively, patients complain of pain, cramping, and cosmetic deformity known as the "Popeye" sign. Following a traumatic rupture of the LHBT, we have demonstrated excellent outcomes using a standard approach and common fixation technique that has the potential to improve the functional outcome for symptomatic patients. CONCLUSION:  Open subpectoral biceps tenodesis is associated with excellent outcomes in symptomatic patients following isolated LHBT rupture.