Why are revision knee replacements failing?

AIM: The number of knee revisions worldwide has been steadily increasing. While being complex and expensive operations, a high percentage of knee revisions fail early. This study was conducted to evaluate the causes of failure of revision knee replacements. PATIENTS AND METHODS: This study retrospectively evaluated 95 patients following knee revision surgery and who underwent further knee revision operations. Indications for index revision as well as the reason for re-revision were recorded. Follow-up was from 30 to 97 months (mean 62 months). RESULTS: The main cause of failure of revision knee replacements was infection (31 of 95, 32.6%) followed by aseptic loosening (30.5%). Indications for re-revision were instability in 12.6%, persistent stiffness in 10.5%, ongoing pain in 7.3%, extensor mechanism problems in 5.2%, and suspected metal allergy in one. CONCLUSION: Infection and loosening continue to be the main reasons for failure of knee revisions. Improving outcomes for infection management and improved fixation methods may help reduce failed knee revisions.

Advancement of the Harrington technique for reconstruction of pathological fractures of the acetabulum.

A 59-year-old man presented with hip pain secondary to metastatic prostate carcinoma affecting multiple sites, including his left acetabulum. The patient's prognosis was good, he was active, independent, with a good quality of life, so was offered surgical reconstruction. The Harrington method involves passing metal rods from the ileum to the ischium and pubis to create a scaffold for hip replacement. This is the gold standard for reconstruction of acetabular metastatic defects. However, this method is prone to failure by medialisation of the construct in the long term. We present our technique of employing a novel modification to the Harrington reconstruction that offers additional support medially with a suprapectineal plate. This construct is strong and durable enough to facilitate immediate weight-bearing and prevent long-term medialisation.

Management of the Infected Total Hip Arthroplasty.

In the United Kingdom approximately 80,000 total hip arthroplasties are undertaken on an average each year. The popularity and demand for this operation are continually increasing. Our understanding of arthroplasty surgery and its complications has evolved greatly, and as a result infection rates are undeniably at an all-time low. The increasing volume of operations being performed does, however, mean that we still continue to see an increased number of cases of infection. There is no doubt that periprosthetic joint infection (PJI) poses a complex clinical and diagnostic predicament to clinicians. Delay in the diagnosis and treatment of PJI can not only be detrimental in terms of patient morbidity, but it also poses a significant financial burden to health care institutions. It is therefore in the best interest of the patient, surgeon, and institution to optimize the diagnosis and treatment of this devastating complication. There remains considerable variability in terms of approach to diagnosis and treatment of PJI among orthopedic surgeons. In this review, we will, therefore, examine in detail the current body of evidence available on PJI. We will discuss the most robust and up-to-date methods of diagnosis and offer a comparison of management strategies.