A Short Femoral Stem in Revision Total Hip Replacement: An Alternative Solution for Prosthetic Fracture: A Case Report.

CASE: A 65-year-old farmer re-presented 5 years after sustaining a midshaft prosthetic fracture of a previous long-stem revision hip replacement. He was treated with a proximal-loading short femoral stem, and did not require an extended trochanteric osteotomy for removal of the well-fixed distal implant. He was able to fully bear weight immediately postoperatively, and he remained pain-free without functional loss at the 42-month follow-up. CONCLUSION: This use of a modern short-stem prosthesis is a treatment option for a potentially complex prosthetic fracture in highly active patients, and it reduces intraoperative complexity.

Our early experience of the Corin Minihip prosthesis.

PURPOSE: Although there have been several varieties of short-stem hip prosthesis in the market, there have been no published clinical results of the Corin MiniHip (Corin, Cirencester, UK) to date. The aim of this study is to describe our early results and experience of this stem in a nondesigner, single-surgeon series; calculate 5-year survival with stem revision as an endpoint; evaluate complications and early revisions; and assess radiolucency and stem subsidence at the latest follow-up review. METHODS: Over a 5-year period, 275 MiniHip were implanted in 239 patients. The mean age of the patients was 63 years (range 20-84); mean follow-up was 37 months (range 12-72 months). RESULTS: The mean Harris Hip Score and Oxford Hip Score improved significantly to 87 (range 49-100) and 41 (range 32-48) at the final follow-up (p = 0.038; p = 0.017). There were 9 intraoperative calcar fractures (3%) of which only 1 required cerlage wiring. 10 patients died in our series and none were lost to follow-up. 2 patients had their stem revised for failure of fixation (secondary to possible undersizing) and sink. The risk of revision was 0.73% at 5 years. The Kaplan Meier estimate of survivorship of cumulative failure gave an implant survival rate of 99.3% (95% confidence interval [CI], 27.0-100) at 5 years for revision for any reason as the endpoint. CONCLUSIONS: This novel, short-stem prosthesis has shown good survival in the short term, similar to other short-stem prostheses currently available. We describe the largest series in the literature of this prosthesis.

Long-term results with the Atlas IIIp elastic cementless acetabular component in total hip replacement.

PURPOSE: Modular cementless elastic acetabular systems have advantages over cemented and hard shell cementless acetabular systems. There are few reports on the medium-term and long-term follow up of this particular type of implant. This study describes our experience with the Atlas IIIp modular acetabular system, which is a thin shell cementless elastic acetabular implant for total hip replacement commercialized under this name in many countries. METHODS: We prospectively followed 244 patients treated with Atlas IIIp acetabular system between 2001 and 2004. Minimum ten year follow up was available for 148 hips (139 patients) from the original cohort of 263 hips (244 patients). One hundred five patients had died from unrelated causes and were excluded from the results. Post-operative and follow up radiographs of patients were assessed; and Harris hip scores were used as clinical outcome. Revision for any reason was defined as the end point for survivorship analysis. RESULTS: The mean pre-operative Harris hip score was 48 (S.D. 16) and the average post-operative score was 82 (S.D. 12). The mean follow up in our series was 11.5 years, ranging from ten to 13.5 years. Thirteen hips required further surgery in our cohort; of which ten cases required cup revision. The 13-years cumulative implant survival was 91.2 % and the risk of implant revision was 8.8 % at 13 years in 148 hips (139 patients). Kaplan-Meier analysis showed the implant survival rate of 95.2 % at ten years for revision for any reason and 99.4 % for aseptic loosening. CONCLUSIONS: Our clinical experience with this acetabular cup suggests good long-term survival rates that are similar to other cups on the market. The clinical experience in this study shows long-term survival rates that are consistent, acceptable and good results achieved with a low revision rate. LEVEL OF EVIDENCE: Therapeutic III; therapeutic study.

Group C streptococcal septic arthritis of a prosthetic hip joint following dental treatment.

We report a case of a prosthetic joint infection occurring secondary to group C Streptococcus following dental treatment in a 66-year-old woman. This patient presented 11 years following a right hip resurfacing procedure with increasing pain and difficulty mobilising the right hip. An ultrasound and MRI scan identified a collection in the right hip joint, which was subsequently aspirated. Cultures revealed a group C Streptococcus. Extensive washout and surgical debridement of the hip joint was undertaken and the patient was treated with a protracted course of antibiotics. At 1 year follow-up, the patient demonstrated no evidence of recurrent infection. We discuss the evidence underlying prophylactic antibiotic usage regarding dental procedures in the prevention of septic arthritis in patients with prosthetic joints. We also review the spectrum of diseases caused by this organism.

Medium-term outcome of titanium nitride, mobile bearing total knee replacement.

This retrospective study examined the medium term outcome of 305 Titanium Nitride (TiN) Mobile bearing total knee. At ten years after the start of the study, there was a significant improvement (p < 0.0001) in the post-operative knee scores. The ten year survival with revision for any reason as the end point was 95.1% (95% CI 92.4 to 97.8). The ten year survival rate with revision for aseptic loosening as the end point was 99.1% (95% CI 97.8 to 100%). A total of 15 knees (4.9%, overall) required revision. No cases were revised due to sepsis. Based on these results, the surface Titanium Nitride ceramic, mobile-bearing total knee replacement has proved to be a reliable implant at 10 years when used in primary knee replacement.

Sciatic nerve palsy--a complication of posterior approach using enhanced soft tissue repair for total hip arthroplasty.

Sciatic nerve palsy is a rare but well recognised complication of total hip replacement. There are a variety of potential causes of sciatic nerve palsy and its prevalence with different approaches has been mentioned in the literature.(1-5) The posterolateral or 'Southern' approach with some form of enhanced soft tissue repair is a commonly used approach for primary total hip arthroplasty. However, the sciatic nerve is recognised to be in close proximity to the surgical field. We report a case of sciatic nerve palsy after this approach as a result of a surgical suture used for soft tissue repair.

Achieving the required medial offset and limb length in total hip arthroplasty.

The magnitude of the medial offset and limb length discrepancy after a total hip arthroplasty (THA) significantly affects the biomechanics of the hip. If both of these components are not properly restored, the rate of dislocation may increase. In addition limb length inequality can be a cause for legal problems. We have used a method of intraoperative assessment to restore both the length and the medial offset, and assessed this by comparing the medial offset and leg length in the pre- and post-operative radiographs in 39 consecutive THAs. The median medial offset was 93.9% (range: 85 to 100) preoperatively and 94.2% (range: 85 to 110) postoperatively, compared with the unaffected contralateral side. The median limb length discrepancy was improved from a preoperative -4.84 mm (range: 0 to -30) to a postoperative -0.06 mm (range: -9 to +16). In conclusion, this technique is a simple, accurate and reliable way of restoring the medial femoral offset and correcting the limb length inequality.