scholarly journals A comparative study of patients presenting for planned and unplanned revision hip or knee arthroplasty

2022 ◽  
Vol 104-B (1) ◽  
pp. 59-67
Author(s):  
Sarah R. Kingsbury ◽  
Lindsay K. Smith ◽  
Farag Shuweihdi ◽  
Robert West ◽  
Carolyn Czoski Murray ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Healthcare Use ◽  
Multilevel Regression ◽  
Cross Sectional ◽  
Hip Revision ◽  
Primary Surgery ◽  
Metal On Metal ◽  
Observational Cohort

Aims The aim of this study was to conduct a cross-sectional, observational cohort study of patients presenting for revision of a total hip, or total or unicompartmental knee arthroplasty, to understand current routes to revision surgery and explore differences in symptoms, healthcare use, reason for revision, and the revision surgery (surgical time, components, length of stay) between patients having regular follow-up and those without. Methods Data were collected from participants and medical records for the 12 months prior to revision. Patients with previous revision, metal-on-metal articulations, or hip hemiarthroplasty were excluded. Participants were retrospectively classified as ‘Planned’ or ‘Unplanned’ revision. Multilevel regression and propensity score matching were used to compare the two groups. Results Data were analyzed from 568 patients, recruited in 38 UK secondary care sites between October 2017 and October 2018 (43.5% male; mean (SD) age 71.86 years (9.93); 305 hips, 263 knees). No significant inclusion differences were identified between the two groups. For hip revision, time to revision > ten years (odds ratio (OR) 3.804, 95% confidence interval (CI) (1.353 to 10.694), p = 0.011), periprosthetic fracture (OR 20.309, 95% CI (4.574 to 90.179), p < 0.001), and dislocation (OR 12.953, 95% CI (4.014 to 41.794), p < 0.001), were associated with unplanned revision. For knee, there were no associations with route to revision. Revision after ten years was more likely for those who were younger at primary surgery, regardless of route to revision. No significant differences in cost outcomes, length of surgery time, and access to a health professional in the year prior to revision were found between the two groups. When periprosthetic fractures, dislocations, and infections were excluded, healthcare use was significantly higher in the unplanned revision group. Conclusion Differences between characteristics for patients presenting for planned and unplanned revision are minimal. Although there was greater healthcare use in those having unplanned revision, it appears unlikely that routine orthopaedic review would have detected many of these issues. It may be safe to disinvest in standard follow-up provided there is rapid access to orthopaedic review. Cite this article: Bone Joint J 2022;104-B(1):59–67.

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 Synthetic Bone Grafting in Aseptic Loosening of Acetabular Cup: Good Clinical and Radiological Outcomes in Contained Bone Defects at Medium-Term Follow Up

2020 ◽  
Vol 17 (15) ◽  
pp. 5624
Author(s):  
Paolo Domenico Parchi ◽  
Matteo Simonetti ◽  
Enrico Bonicoli ◽  
Nicola Piolanti ◽  
Michelangelo Scaglione
Keyword(s):  
Revision Surgery ◽  
Disease Transmission ◽  
Bone Grafting ◽  
Bone Substitute ◽  
Porous Ceramic ◽  
Acetabular Cup ◽  
Hip Revision ◽  
Radiolucent Lines ◽  
Hip Revision Surgery

Restoring bone loss is one of the major challenges when facing hip revision surgery. To eliminate the risk of disease transmission and antigenicity of allografts and donor-morbidity of autografts, the use of synthetic bioceramics has become popular in the last decade. Our study investigated the effectiveness of impaction bone grafting (IBG) of contained acetabular defects (Paprosky 2 and 3a) using a porous ceramic-based hydroxyapatite bone substitute (Engipore, provided by Finceramica Faenza S.p.A., Faenza, Italy) mixed with a low percentage of autologous bone (obtained from reaming when available). We retrospectively assessed 36 patients who underwent acetabular revision using IBG using a porous ceramic-based hydroxyapatite bone substitute with cementless implants with a mean follow-up of 4.4 years. We evaluated, at regular intervals, patients clinically (using the Hip Harris Score and Oxford Score) and radiologically to evaluate the rate of incorporation of the graft, the presence of radiolucent lines or migrations of the cup. Clinical scores significantly improved (WOMAC improved from 49.7–67.30, and the HSS from 56–89). The rate of implants’ survival was 100% at our medium follow-up (4.4 years). We reported five cases of minor migration of the cup, and radiolucent lines were visible in seven patients at the last-follow up. The graft was well-incorporated in all patients. The results presented in this study suggest the HA bone substitute is an effective and safe bone graft when facing hip revision surgery; thus, longer follow-up studies are required.

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

scholarly journals Auditory and Visual Health after Ten Years of Exposure to Metal-on-Metal Hip Prostheses: A Cross-Sectional Study Follow Up

PLoS ONE ◽  
2014 ◽  
Vol 9 (3) ◽  
pp. e90838 ◽  
Author(s):  
Jennifer R. Prentice ◽  
Christopher S. Blackwell ◽  
Naz Raoof ◽  
Paul Bacon ◽  
Jaydip Ray ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Hip Prostheses ◽  
Metal On Metal ◽  
Visual Health

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 Management of periprosthetic fractures of knee arthroplasty with revision surgery

2020 ◽  
Author(s):  
Ahmad Kamal ◽  
Ren Jiang Dong ◽  
Rafiq Shah ◽  
Cao Li
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Primary Total Knee Arthroplasty ◽  
Primary Treatment ◽  
Revision Total Knee Arthroplasty ◽  
Periprosthetic Fractures ◽  
Successful Operation ◽  
Total Knee

Abstract Objective : As periprosthetic knee fractures are becoming common with the increase in incidence of primary and revision total knee arthroplasty, their management and treatment have become important. The current study aims to evaluate the revision knee arthroplasty carried out due to the failure of primary treatment of periprosthetic femoral fractures.Methods: The study was conducted from May 2012 to September 2019 at Orthopedics department of Xinjiang Medical University; out of 21 patients 11 were women and 10 men aged 44 to 80 (mean, 70.76±8.31) years who underwent revision surgery for periprosthetic fractures of 19 distal femur, 1 patellar, and 1 proximal tibial fracture. Nineteen cases had definite trauma history leading to periprosthetic fracture, and 2 cases had fracture during post-operative functional exercise. All patients had revision surgery with extended stems with either constrained or limited condylar knee prosthesis.Results : The duration of follow-up averaged 4.3 years. The Hospital for Special Surgery (HSS) knee score before fracture averaged 91 + 7.01 points (89 - 95 points) and 85.5 + 6.18 points (81 - 90 points) at the last follow-up. The average range of motion of knee joint before fracture was 115.7 [+7.6] (110 [~126]), and 101.3 [+9.8] (85 [~115]) at the last follow-up. There was no significant statistical difference. No complications such as infection, component loosening or nonunion. 2 patients had lower extremity vein thrombosis.Conclusion Revision surgery of the knee for the periprosthetic fractures with proper prosthetic selection can attain good outcomes after primary total knee arthroplasty. Reasonable and correct procedure is the main principle for a successful operation. The benefits and applicability of revision TKA is the reconstructive solution for the issues of prosthetic knee fractures, is highly recommended.

scholarly journals Revision of Metal-on-metal Hip Arthroplasty with Well Fixed and Positioned Acetabular Component Using a Dual-mobility Head and Review of Literature

2016 ◽  
Vol 10 (1) ◽  
pp. 512-521 ◽  
Author(s):  
Guillem Figueras ◽  
Ramón Vives Planell ◽  
Ramón Serra Fernàndez ◽  
Joan Camí Biayna
Keyword(s):  
Femoral Component ◽  
Acetabular Component ◽  
Young Patients ◽  
Bone Stock ◽  
Cobalt Chromium ◽  
Hip Revision ◽  
Dual Mobility ◽  
Metal On Metal ◽  
Hip Arthroplasties

Background: As a consequence of use of metal-on-metal hip arthroplasties some patients have precised revision for pain or metal hipersensivity reactions among other causes. We propose to salvage monoblock acetabular component and femoral component using a dual-mobility head and perform a lower morbidity operation in young patients preserving host bone stock in cases with well fixed and positioned components. Objective: (1) What clinical problems have been reported in patients with Metal-on-metal hip arthroplasties? (2) Could the tribocorrosion potentially cause a fracture of neck femoral component? (3) Can be the dual-mobility head a recourse in metal-on-metal hip revision? Methods: Ten patients were revised for pain or/and raised Cobalt/Chromium levels between August 2012 and December 2015. In three cases femoral neck component was fractured and femoral revision was necessary. In four hips, acetabular and femoral components could be maintained. Age, body index mass, ion levels, acetabular position, size of acetabular component and femoral head, approach, blood transfunsion and time of hospitalization were analized. Results: At a mean follow-up of 25,6 months (6 to 45) the mean postoperative HHS was 92. It was not statistically significant because several patients were low sintomatic before surgery, but had raised Cobalt/Chromium levels in the blood. All patients had near-normal levels of Cobalt/Chromium during the first 6 months after revision surgery. No relevant complications were reported. Conclusion: The use of dual-mobility head can be an acceptable option to revise metal-on-metal arthroplasties correctly oriented with abscence of loosening or infection signs and keeping bone stock in young patients.

scholarly journals The role of antibiotic-loaded bone cement in complicated knee arthroplasty: relevance of gentamicin allergy and benefit from revision surgery, a case control follow-up study and algorithmic approach

2020 ◽  
Author(s):  
Benjamin Thomas ◽  
Maria Benedikt ◽  
Ali Alamri ◽  
Florian Kapp ◽  
Rainer Bader ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Cement ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Symptom Relief ◽  
Revision Arthroplasty ◽  
Positive Patch Test ◽  
Total Knee ◽  
Significant Symptom

Abstract Background Antibiotic-loaded (particularly gentamicin) bone cement (BC) is widely used in total joint arthroplasty (TJA) to prevent periprosthetic infections (PPIs), but may itself cause implant failure. In light of a complete lack in literature, the objective was to assess the clinical relevance of gentamicin allergy for failure of cemented total knee arthroplasties in 25 out of 250 patients with positive patch test reactions to gentamicin and otherwise unexplained symptoms by evaluating benefits from revision with change to gentamicin-free cement. Methods 15 of these 25 patients and their treating orthopaedic surgeons agreed to a re-assessment. They were surveyed regarding interim course of therapy and symptoms, including re-assessment of the Knee Injury and Osteoarthritis Outcome Score (KOOS), and underwent follow-up clinical and radiographic investigations. The initial use of gentamicin-loaded BC was reaffirmed by review of the primary implantation operative reports and respective implant passports. Primary and follow-up KOOS scores were analyzed regarding benefits from revision surgery by comparing nine patients with revision to six without revision. Results Mean follow-up time was 38 months. The entirety of patients experienced an improvement of self-reported symptoms, with revision surgery (i.e. switching to gentamicin-free BC or uncemented total knee arthroplasty) yielding significantly greater improvement (p=0.031): the nine revised patients reported a significant symptom relief (p=0.028), contrary to the six unrevised patients (p=0.14). Interestingly, the decision to proceed with revision surgery was significantly correlated with higher symptom severity (p=0.05). Conclusion In symptomatic total knee arthroplasty with gentamicin allergy, uncemented revision arthroplasty or change to gentamicin-free BC provides significant symptom relief.

Mid-term results of lateral unicondylar mobile bearing knee arthroplasty

2018 ◽  
Vol 100-B (1) ◽  
pp. 42-49 ◽  
Author(s):  
T. Walker ◽  
N. Zahn ◽  
T. Bruckner ◽  
M. R. Streit ◽  
G. Mohr ◽  
...  
Keyword(s):  
At Risk ◽  
Los Angeles ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Oxford Knee Score ◽  
Mobile Bearing ◽  
Dislocation Rate ◽  
Number Of Patients ◽  
Mid Term Results

Aims The aim of this independent multicentre study was to assess the mid-term results of mobile bearing unicondylar knee arthroplasty (UKA) for isolated lateral osteoarthritis of the knee joint. Patients and Methods We retrospectively evaluated 363 consecutive, lateral UKAs (346 patients) performed using the Oxford domed lateral prosthesis undertaken in three high-volume knee arthroplasty centres between 2006 and 2014. Mean age of the patients at surgery was 65 years (36 to 88) with a mean final follow-up of 37 months (12 to 93) Results A total of 36 (10.5%) patients underwent revision surgery, giving a survival rate of 90.1% at three years (95% confidence intervals (CI) 86.1 to 93.1; number at risk: 155) and 85.0% at five years (95% CI 77.9 to 89.9; number at risk: 43). Dislocation of the mobile bearing occurred in 18 patients (5.6%) at three years (95% CI 1.0 to 16.4; number at risk: 154) and in 20 patients (8.5%) at five years (95% CI 1.0 to 27.0; number at risk: 42). There were no significant differences in the dislocation rate between the participating centres or the surgeons. We were not able to identify an effect of each surgeon’s learning curve on the dislocation rate of the mobile bearing. The clinical outcome in patients without revision surgery at final follow-up was good to excellent, with a mean Oxford knee score of 40.3 (95% CI 39.4 to 41.2), a mean Tegner activity score of 3.2 (95% CI 3.1 to 3.3) and a mean University of California, Los Angeles score of 5.7 (95% CI 5.5 to 5.9). Conclusion Our data, which consists of a high number of patients treated with mobile bearing UKA in the lateral compartment, indicates a high revision rate of 15% at five years with dislocation of the mobile bearing being the main reason for implant failure. Despite the good functional and clinical results and the high patient satisfaction in our study group, we therefore discontinued using mobile-bearing lateral UKA in favour of a fixed-bearing component. Cite this article: Bone Joint J 2018;100-B:42–9.

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