Mid- to long-term results of the Cone-Conical modular system in revision hip arthroplasty.

BACKGROUND: Modular design in revision hip surgery allows some flexibility intra-operatively to address leg length discrepancy, version, and offset while allowing the surgeon to bypass a deficient proximal femur and achieve axial and rotational stability distally. The purpose of this study was to analyze the mid-term to long-term survival and clinical and radiological outcomes using a conical fluted stem and a cone-shaped hydroxyapatite-coated proximal body "The Cone-Conical modular system (Stryker)" in revision hip surgery. METHODS: We retrospectively reviewed all the patients who underwent hip revision surgery using Cone-Conical modular system between January 2006 and January 2015 at our institution. Seventy patients (72 hips) were included with a mean age of 71.3 years. We had a mean follow-up period of 8.6 years (range 5-15). All patients had a minimum follow-up of five years. A Kaplan-Meier analysis was used to determine the survival of the implant. Functional outcomes were assessed using Oxford Hip Score. Plain radiographs were performed to assess implant fixation and osseointegration. RESULTS: The mean OHS improved significantly from 12 pre-operatively to 34 at the final follow-up (P < .001). The Cone-Conical system survivorship for aseptic loosening as an end point was 100%. The all-cause survivorship was 97.2%. Two hips had revisions for recurrence of infection. CONCLUSIONS: The Cone-Conical femoral modular revision system has demonstrated excellent mid-term to long-term clinical and radiographic results with low failure rate and minimal complications. Longer-term follow-up would be of value to assess the ongoing survival of this implant.

Effectiveness, Patient Satisfaction, and Cost Reduction of Virtual Joint Replacement Clinic Follow-Up of Hip and Knee Arthroplasty.

BACKGROUND: Total hip and knee arthroplasties are increasingly performed operations, and routine follow-up places huge demands on orthopedic services. This study investigates the effectiveness, patients' satisfaction, and cost reduction of Virtual Joint Replacement Clinic (VJRC) follow-up of total hip arthroplasty and total knee arthroplasty patients in a university hospital. VJRC is especially valuable when in-person appointments are not advised or feasible such as during the COVID-19 pandemic. METHODS: A total of 1749 patients who were invited for VJRC follow-up for knee or hip arthroplasty from January 2017 to December 2018 were included in this retrospective study. Patients were referred to VJRC after their 6-week postoperative review. Routine VJRC postoperative review was undertaken at 1 and 7 years and then 3-yearly thereafter. We evaluated the VJRC patient response rate, acceptability, and outcome. Patient satisfaction was measured in a subgroup of patients using a satisfaction survey. VJRC costs were calculated compared to face-to-face follow-up. RESULTS: The VJRC had a 92.05% overall response rate. Only 7.22% required further in-person appointments with only 3% being reviewed by an orthopedic consultant. VJRC resulted in an estimated saving of £42,644 per year at our institution. The patients' satisfaction survey showed that 89.29% of the patients were either satisfied or very satisfied with VJRC follow-up. CONCLUSION: VJRC follow-up for hip and knee arthroplasty patients is an effective alternative to in-person clinic assessment which is accepted by patients, has high patient satisfaction, and can reduce the cost to both health services and patients.

Tritanium Acetabular Cup in Revision Hip Replacement: A Six to Ten Years of Follow-Up Study.

BACKGROUND: The use of highly porous acetabular components has shown to produce good results in revision acetabular surgery. Their surface characteristics enhance initial fixation and bone ingrowth which are prerequisites for adequate osseointegration. The purpose of this study is to analyze the mid-term to long-term survival, clinical and radiological outcomes using the Tritanium cup (Stryker, Mahwah, NJ) in revision hip surgery. METHODS: This is a retrospective review of all patients who underwent acetabular revision surgery using "Tritanium revision cup" between April 2007 and November 2010 at our institution. Sixty-two patients were included with a mean age of 67.5 years (32-86). According to Paprosky classification, 10 patients had type I defect, 8 had type IIA, 27 had type IIB, 7 had type IIC, and 10 suffered from type IIIA defect. A Kaplan-Meier analysis was used to determine the survival of the cup. Functional outcomes were assessed using Oxford Hip Score. Plain radiographs were performed to assess implant fixation and osseointegration. RESULTS: The acetabular cup aseptic survivorship was 98.4% at a mean follow-up of 87.6 months. The mean Oxford Hip Score improved from 14.5 (3-31) preoperatively to 38.5 (12-48) at the final follow-up. Two cups were revised (3.2%): 1 for aseptic loosening and 1 for infection. CONCLUSION: Tritanium revision acetabular cup has shown excellent mid-term to long-term clinical and radiographic results with low failure rate and minimal complications. Longer term follow-up would be of value to assess the ongoing survival of this implant construct.

Mid-Term Results of Graft Augmentation Prosthesis II Cage and Impacted Allograft Bone in Revision Hip Arthroplasty.

BACKGROUND: Several techniques have been described for management of severe acetabular bone defects during revision hip surgery including reconstructive cages. The purpose of this study is to analyze the survival and the mid-term clinical and radiological outcome using the Graft Augmentation Prosthesis (GAP II cage) (Stryker Orthopaedics, Mahwah, NJ) in addition to impaction grafting for acetabular defects in revision hip surgery. METHODS: This is a retrospective review of all patients who underwent acetabular revision hip replacement using GAP II cage and impaction bone grafting between 2009 and 2013 at our institution. Twenty-six patients were included with a mean age of 71 years (49-91). According to Paprosky classification, 2 patients had type IIB defect, 4 had type IIC, and 12 had type IIIA, while 8 suffered from type IIIB defect. The clinical outcome was assessed using Oxford Hip Score. Plain radiographs were used to assess preoperative bone loss, postoperative implant migration, and the incorporation of the bone graft to host bone. RESULTS: The average Oxford Hip Score improved from 11.3 (2-22) preoperatively to 32.2 (20-48) postoperatively. The revision free survivorship of this construct was 100% at mean follow-up of 49 months (30-78). Three hips had radiological failure of the implant with no clinical consequences. CONCLUSION: The use of GAP II cage with impaction bone grafting to reconstruct severe acetabular defects had encouraging mid-term results with low failure rate. Graft incorporation with restoration of bone stock may be beneficial should further revision surgery be needed.

Midterm results with Birmingham Hip Resurfacing/Synergy stem modular metal-on-metal total hip arthroplasty.

Large head modular metal-on-metal total hip replacement (MoMTHR) has been shown to have increased revision rates in the National joint registry and in literature. We reviewed 41 consecutive patients with 44 hips who had large head MoM THR using a Birmingham Hip Resurfacing (BHR) cup/Synergy stem combination between June 2005 and Nov 2009 with a mean followup of 59.5 months. In this series we had a revision rate of 6.8% (3/44) for adverse reaction to metal debris (ARMD), persistent groin pain and instability. Kaplan-Meier analysis showed a mean cumulative survival rate of 79.2% (95% CI: 75.5%-82.9%) In addition there is a subset of 5/44 patients (113%) with mild grade groin pain who may need revision in the future. Based on these findings, we do not recommend performance of large head MoMTHR in the future.

Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement: early patient reported outcomes.

Many surgical techniques have been described for femoroacetabular impingement (FAI) surgery to help with improvement of pain and function in symptomatic patients. The aim of this study was to evaluate early patient reported outcomes and complications using combined hip arthroscopy and limited open osteochondroplasty technique. We retrospectively analysed 27 hips in 26 patients. Outcomes were assessed using the nonarthritic hip score (NAHS), UCLA score and Visual analogue scale (VAS) pain score. The average age of patients was 31.3 years and they were followed up for an average of 22.3 months. Average improvement of NAHS score was 39.55 points (p<.0001), 18 patients (72%) had at least 30 points increase in NAHS. There was 3 points average improvement in UCLA score (p<.0001). 17 patients (68%) had UCLA activity level of 6 and above. The average improvement of VAS pain score was 27.5 points (p<.0001). Minor complications included neuropraxia of the lateral femoral cutaneous nerve in three patients who recovered at three months with no sequelae, while one patient developed asymptomatic heterotopic ossification Brooker grade I. One patient had neuropraxia of the sciatic nerve which recovered completely within six months. One patient had a conversion to THR at 12 months. This is an effective technique to treat FAI for reducing pain and improving function at short term follow-up and has a low complication rate without appearing to have a significant learning curve. The failure rate can be reduced if proper case selection is done.