Early failure modalities in hip resurfacing

2005 ◽  
Vol 15 (3) ◽  
pp. 155-158
Author(s):  
S. Cutts ◽  
A. Datta ◽  
K. Ayoub ◽  
H. Rahman ◽  
T. Lawrence
Keyword(s):  
Revision Surgery ◽  
Deep Infection ◽  
Hip Resurfacing ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Primary Surgery ◽  
Mechanism Of Failure ◽  
Lost To Follow Up ◽  
Acetabular Components

Between 1996 and 2002, we treated 60 patients (65 hips) by hip resurfacing. The notes and radiographs of these cases were studied retrospectively and the modalities of failure identified. At a mean follow-up of 51 months, 14 of these cases (22%) required revision surgery. One patient had died from unrelated causes and one was lost to follow-up. At the time of primary surgery, the mean age of the patients in our series was 55 years. The commonest mechanism of failure in our series was fractured neck of femur (six cases). Four of these occurred in females over the age of 60. None of the fractured necks of femur were associated with trauma. There were four cases of loose acetabular components and one case of progressive AVN (avascular necrosis). Two patients required revision surgery for ongoing hip pain and one required a two-stage revision for early deep infection.

Extended Routine Follow-up of Primary Uncomplicated Hip and Knee Arthroplasty is not Necessary

2019 ◽  
Vol 13 (1) ◽  
pp. 266-271
Author(s):  
Georgina Kakra Wartemberg ◽  
Thomas Goff ◽  
Simon Jones ◽  
James Newman
Keyword(s):  
Aseptic Loosening ◽  
Revision Surgery ◽  
Revision Arthroplasty ◽  
Cost Effective ◽  
Face To Face ◽  
Primary Surgery ◽  
Effective System ◽  
Knee Revision Surgery ◽  
Knee Revision

Aims: To create a more effective system to identify patients in need of revision surgery. Background: There are over 160,000 total hip and knee replacements performed per year in England and Wales. Currently, most trusts review patients for up to 10 years or more. When we consider the cost of prolonged reviews, we cannot justify the expenditure within a limited budget. Study Design & Methods: We reviewed all patients' notes that underwent primary hip and knee revision surgery at our institution, noting age, gender, symptoms at presentation, referral source, details of the surgery, reason for revision and follow up history from primary surgery. Results: There were 145 revision arthroplasties (60 THR and 85 TKR) that met our inclusion criteria. Within the hip arthroplasty group, indications for revision included aseptic loosening (37), dislocation (10), and infection (3), periprosthetic fracture, acetabular liner wear and implant failure. All thirty-seven patients with aseptic loosening presented with pain. Twenty-five were referred from general practice with new symptoms. The remaining were clinic follow-ups. The most common reason for knee revision was aseptic loosening (37), followed by infection (21) and then progressive osteoarthritis (8). Most were referred from GP as a new referral or were clinic follow-ups. All patients were symptomatic. Conclusion: All the patients that underwent revision arthroplasty were symptomatic. Rather than yearly follow up, we recommend a cost-effective system. We are implementing a 'non face-to-face' system. Patients would be directly sent a questionnaire and x-ray form. The radiographs and forms will be reviewed by an experienced arthroplasty surgeon. The concerning cases will be seen urgently in a face-to-face clinic.

scholarly journals Clinical and radiological outcomes of acetabular revision surgery with trabecular titanium cups in Paprosky type II and III bone defects

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Loris Perticarini ◽  
Stefano Marco Paolo Rossi ◽  
Marta Medetti ◽  
Francesco Benazzo
Keyword(s):  
Revision Surgery ◽  
Case Series ◽  
Bone Defects ◽  
Harris Hip Score ◽  
Type Ii ◽  
Level Of Evidence ◽  
Kaplan Meier ◽  
Prospective Case Series ◽  
Acetabular Components

Abstract Background This prospective study aims to evaluate the mid-term clinical outcomes and radiographic stability of two different types of cementless trabecular titanium acetabular components in total hip revision surgery. Methods Between December 2008 and February 2017, 104 cup revisions were performed using trabecular titanium revision cups. Mean age of patients was 70 (range 29–90; SD 11) years. The majority of revisions were performed for aseptic loosening (86 cases, 82.69%), but in all the other diagnoses (18 cases), a significant bone loss (Paprosky type II or III) was registered preoperatively. Bone defects were classified according to Paprosky acetabular classification. We observed 53 type II defects and 42 type III defects. Cups were chosen according to the type of defect. Results Average follow-up was 91 (range 24–146) months. Mean Harris Hip Score (HHS) improved from 43.7 (range 25–70; SD 9) preoperatively to 84.4 (range 46–99; SD 7.56) at last follow-up. One (1.05%) cup showed radiographic radiolucent lines inferior to 2 mm and was clinically asymptomatic. One (1.05%) cup was loose and showed periacetabular allograft reabsorption. Kaplan–Meier survivorship was assessed to be 88.54% (95% CI 80.18–93.52%) at 71 months, with failure of the cup for any reason as the endpoint. Conclusion Trabecular titanium revision cups showed good clinical and radiographic results at mid-term follow-up in Paprosky type II and III bone defects. Level of evidence Level IV prospective case series

Open Capsulorrhaphy with Suture Anchors for Recurrent Anterior Dislocation of the Shoulder

1998 ◽  
Vol 26 (5) ◽  
pp. 625-629 ◽  
Author(s):  
Andrea Ferretti ◽  
Angelo De Carli ◽  
Michele Calderaro ◽  
Fabio Conteduca
Keyword(s):  
Surgical Technique ◽  
Suture Anchor ◽  
Recurrent Dislocation ◽  
Deep Infection ◽  
Anterior Dislocation ◽  
Suture Anchors ◽  
Rating Systems ◽  
Lost To Follow Up ◽  
Recurrent Anterior Dislocation

Forty of 42 consecutive open capsulorrhaphies with suture anchors for treatment of traumatic recurrent anterior dislocation of the shoulder were reviewed after a minimum follow-up of 2 years. Two patients were lost to follow-up. Follow-up was conducted according to the rating systems of Rowe and the Society of American Shoulder and Elbow Surgeons. The surgical outcome was satisfactory in 38 patients (95%). Eighteen of the 22 patients who were involved in competitive overhead or collision sports before surgery returned to their preoperative sports levels. One patient, whose operation was unsuccessful, experienced recurrent dislocation. In one patient, a deep infection that occurred as a complication of the surgical technique healed after suture anchor removal. Although a longer follow-up is necessary, this technique appears to have encouraging results as it avoids the risks related to the use of screws and staples.

scholarly journals CSF goes astray no matter what is in the way: occipital intradiploic pseudomeningocele and de novo syringomyelia following foramen magnum decompression for Chiari I malformation in a pediatric patient

2020 ◽  
Vol 25 (5) ◽  
pp. 529-534
Author(s):  
Arthur R. Kurzbuch ◽  
Shailendra Magdum
Keyword(s):  
Revision Surgery ◽  
De Novo ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Foramen Magnum Decompression ◽  
Dural Closure ◽  
First Case ◽  
Chiari I ◽  
Lost To Follow Up

Nontraumatic intradiploic pseudomeningoceles and de novo syringomyelia formation are very rare entities. The authors have previously reported the case of a 4-year-old girl who underwent foramen magnum decompression without dural closure for Chiari I malformation. Three years after the operation an intradiploic pseudomeningocele was documented, but the patient was lost to follow-up without undergoing revision surgery. Four years later, at the age of 11 years, the patient returned for treatment of intensifying symptoms. Radiological imaging then showed an increase in the size of the intradiploic pseudomeningocele and a new cervical syrinx. The patient underwent a first revision surgery in which a part of the internal layer of the occipital bone was removed and arachnoid scar lysis was performed. Two months later the syrinx had worsened, and in a second revision surgery a pseudomeningocele-peritoneal shunt was placed. Here, the authors describe what is to their knowledge the first case of an intradiploic pseudomeningocele and de novo syringomyelia formation following Chiari I decompressive surgery.

Primary reverse shoulder arthroplasty in patients older than 80 years of age

2019 ◽  
Vol 101-B (12) ◽  
pp. 1520-1525 ◽  
Author(s):  
Nicholas J. Clark ◽  
Brian T. Samuelsen ◽  
Eduard Alentorn-Geli ◽  
Andrew T. Assenmacher ◽  
Robert H. Cofield ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Shoulder Arthroplasty ◽  
Surgical Complications ◽  
Reverse Shoulder Arthroplasty ◽  
Medical Complications ◽  
Time To Death ◽  
One Year ◽  
And Function ◽  
Lost To Follow Up

Aims Reverse shoulder arthroplasty (RSA) reliably improves shoulder pain and function for a variety of indications. However, the safety and efficacy of RSA in elderly patients is largely unknown. The purpose of this study was to report the mortality, morbidity, complications, reoperations, and outcomes of primary RSA in patients aged > 80 years. Patients and Methods Between 2004 and 2013, 242 consecutive primary RSAs were performed in patients aged > 80 years (mean 83.3 years (sd 3.1)). Of these, 53 were lost to follow-up before two years and ten had died within two years of surgery, leaving 179 for analysis of survivorship, pain, motion, and strength at a minimum of two years or until revision surgery. All 242 patients were considered for the analysis of 90-day, one-year, and overall mortality, medical complications (90-day and overall), surgical complications, and reoperations. The indications for surgery included rotator cuff arthropathy, osteoarthritis, fracture, the sequela of trauma, avascular necrosis, and rheumatoid arthritis. A retrospective review of the medical records was performed to collect all variables. Survivorship free of revision surgery was calculated at two and five years. Results One patient (0.4%) died within the first 90 days. A total of 45 patients (19%) were known to have died at the time of the final follow-up, with a median time to death of 67.7 months (interquartile range 40.4 to 94.7) postoperatively. Medical complications occurred in six patients (3%) and surgical complications occurred in 21/179 patients (12%). Survivorship free from revision was 98.9% at two years and 98.3% at five years; survivorship free from loosening was 99.5% at final follow-up. The presence of peripheral vascular disease correlated with a higher complication rate. Conclusion Primary RSA was safe and effective in patients aged > 80 years, with a relatively low rate of medical and surgical complications. Thus, age alone should not be a contraindication to primary RSA in patients aged > 80 years. However, a careful evaluation of comorbidities is required in this age group when considering primary RSA. Cite this article: Bone Joint J 2019;101-B:1520–1525

Headless screw fixation through the dorsal rough surface for proximal-pole scaphoid-nonunion: a report of 15 patients

2020 ◽  
Vol 45 (9) ◽  
pp. 965-973
Author(s):  
JungJun Hong ◽  
Yun-Rak Choi ◽  
Il-Hyun Koh ◽  
Won-Taek Oh ◽  
Jucheol Shin ◽  
...  
Keyword(s):  
Rough Surface ◽  
Revision Surgery ◽  
Screw Fixation ◽  
Scaphoid Nonunion ◽  
Fixation Technique ◽  
Level Of Evidence ◽  
Primary Surgery ◽  
Iliac Bone Graft ◽  
History Of

Clinical outcomes of the dorsal-retrograde headless screw-fixation technique in 15 patients with proximal scaphoid nonunion are presented. In this technique, screws are inserted from the dorsal rough surface of the scaphoid, located between the dorsal ridge and scaphoid-trapezium-trapezoid joint. Fifteen patients underwent osteosynthesis with this technique with iliac bone graft. Seven patients required primary surgery, and eight patients with a history of failed operation required revision surgery. Among 15 patients, 13 achieved union and two with persistent nonunion were asymptomatic with average follow-up of 24 months (range 14–57). Mean time to union was 20 weeks (range 12–40). Our experience with the dorsal-retrograde headless screw fixation technique has shown encouraging results for the treatment of proximal-scaphoid nonunion, especially in revision surgery wherein secure fixation of the small proximal fragments can be difficult using conventional anterograde techniques. Level of evidence: IV

Serial Head Circumference and Neurodevelopmental Screening after Surgical Correction for Single- and Multiple-Suture Craniosynostosis

2012 ◽  
Vol 49 (2) ◽  
pp. 177-184 ◽  
Author(s):  
Michael P. Carlisle ◽  
Sagar T. Mehta ◽  
Kevin J. Sykes ◽  
Virender K. Singhal
Keyword(s):  
Revision Surgery ◽  
Head Circumference ◽  
Revision Rate ◽  
Surgical Revision ◽  
Z Score ◽  
Retrospective Assessment ◽  
Primary Surgery ◽  
Before And After ◽  
Single Suture

Objective To evaluate serial head circumference (HC) measurements and neurodevelopmental (ND) screening before and after surgical revision for craniosynostosis. Design Retrospective assessment. Setting Tertiary institutional. Patients, Participants All children treated with single-stage frontal-orbital advancement or total calvarial expansion for single-suture (SS) or multiple-suture (MS) craniosynostosis over a 7-year period. Main Outcome Measures Changes in ND and HC were measured over postoperative visits after the primary surgery. More importantly, ND and HC changes were measured prerevision and postrevision. Results Of 183 patients undergoing primary surgery, complete records and adequate follow-up were available for 112 patients. The overall revision rate was 21% (n = 23). Postrevision follow-up was adequate for 18 of the 23 revisions. After primary surgery, but prior to revision, children demonstrated a larger decline in HC(z-score, median = -1) along with higher ND findings (median = 2) from one postoperative visit to the next than those who did not go on revision (HC z-score median = 0, ND median = 0). After revision, patients demonstrated a significant improvement in ND screening findings (median AND findings = -2) compared with prerevision ND (p < .001). Head circumference also significantly increased by a z-score of +1 postrevision (p = .001). Conclusions Patients chosen for revision surgery display not only a larger decline in HC but also more ND findings prior to revision. Furthermore, surgical revision has a significant association with both improved ND screening and HC.

scholarly journals Acute retrograde tibiotalocalcaneal nailing in osteoporotic periarticular ankle fractures

2020 ◽  
Vol 14 (2) ◽  
pp. 117-122
Author(s):  
Mario Herrera-Perez ◽  
Pablo Martín-Vélez ◽  
Diego Rendón-Díaz ◽  
José Luis Pais-Brito
Keyword(s):  
Case Series ◽  
Deep Infection ◽  
Ankle Fractures ◽  
Assistive Device ◽  
Short Term ◽  
Level Of Evidence ◽  
The Mean ◽  
Fracture Level ◽  
Lost To Follow Up

Objective: This study aimed to report the short-term results of retrograde tibiotalocalcaneal (TTC) nailing in a selected series of patients with fragility ankle fractures. Methods: This study included 17 patients who underwent primary retrograde TTC nailing from January 2016 to April 2019. The Olerud-Molander ankle score (OMAS) was recorded preoperatively and at the final follow-up. Results: Mean patient age was 81.5 years (range, 67-91 years), and mean follow-up duration was 20.9 months (range, 8-50 months). No patient was lost to follow-up. Eleven patients had diabetes. Thirteen patients were able to walk with an assistive device, and 4 with help from another person. Two patients died at 8 and 9 months after treatment. Radiographic healing was observed in 100% of the fractures. No deep infection or scarring problems were recorded. Two patients were wheelchair bound after treatment, whereas 15 recovered their previous autonomy. The mean OMAS score changed from 64.1 (range, 55-75) preoperatively to 55.3 (range, 45-65) postoperatively. Conclusion: Our results suggest that primary retrograde TTC nailing is a valid option in selected patients with fragility ankle fractures, multiple comorbidities, poor soft tissue condition, and difficulty in walking before the fracture. Level of Evidence IV; Therapeutic Studies, Case Series.

scholarly journals Double Axis Cephalocondylic Fixation of Stable and Unstable Intertrochanteric Fractures: Early Results in 60 Cases with the Veronail System

2014 ◽  
Vol 8 (1) ◽  
pp. 60-68 ◽  
Author(s):  
Α. Kouzelis ◽  
A. Kravvas ◽  
S. Mylonas ◽  
D. Giannikas ◽  
A. Panagopoulos
Keyword(s):  
Young Patients ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Deep Infection ◽  
Harris Hip Score ◽  
Control Group ◽  
Primary Surgery ◽  
Early Results ◽  
Duration Of Surgery

Introduction:This prospective case-series, without control group, study presents our early experience in the treatment of both stable and unstable peri-trochanteric fractures with a new cephalocondylic implant; the Veronail system.Materials & Methods:Enrolment in our study was from January 2008 through September 2009, with follow-up until October 2011 (at least 1 year). During this period 65 consecutively patients with a fracture in the trochanteric region of the femur (31.A1, A2 and A3 according to AO classification) were surgically managed and prospectively followed up for at least one year. Average age was 78 years old (range 42 to 93) with 40 female and 25 male patients. All patients were surgically treated using the Veronail system. Demographic and nursery data such as pre-existing illness, previous ambulatory status, type of anaesthesia, duration of surgery, volume of blood loss, transfusions, length of hospital stay, time to union and overall complications were systematically recorded and analysed.Results:Mean follow up was 17 months (range, 12 to 23 months). Radiological evaluation was performed at 1, 3, 6 and 12 months postoperatively, as well as at the last follow up visit. Clinical outcome was assessed using the parameters of Harris Hip score. Solid union was achieved in 57/60 patients (95%) at a mean time of 12.5 weeks. Two fractures did not progress to union. There were 3 superficial infections and 1 deep infection; all were successfully managed with appropriate antibiotic treatment. The Harris hip score at the last follow up visit was excellent or good in 46 (77%) of the patients.Conclusions:In the face of the good clinical and radiological results we consider the Veronail system to be of particular interest and perfectly adapted in primary surgery for both elderly and young patients.

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