Short term analysis of total hip replacement done with constrained acetabular component - functional and radiological outcome

<p class="abstract"><strong>Background:</strong> Dislocation remains at the forefront of complications after primary total hip arthroplasty (THA). In our study, we talk about the use of constrained liners and its outcomes in an unstable hip.</p><p class="abstract"><strong>Methods:</strong> The total number of patients included in the study was 15. The total number of hips in the study were 15. The age group of the patients varied between 51 years and 89 years with mean age group of 73 years. The most common indication in our study was dislocation contributing 60% (n=9) of the hips.<strong></strong></p><p class="abstract"><strong>Results:</strong> The post-operative mean Harris hip score (HHS) at immediate post-operative was 67.6. There was a gradual improvement in the HHS through 6 months (77.6), one year (83.3), two years (86.7) and 3 years (90.33). There were no cases with post-operative septic or aseptic loosening in the radiological analysis. The mean cup inclination was 34.3. Out of the 13 hips, in eight hips the femoral stem was in varus. Five hips had a centrally placed femoral stem. Stability management in THA have seen the component design take centre stage, primarily with the use of larger diameter femoral heads and the rise in popularity of constrained acetabular liners (CAL). Several authors have done studies which talk about the stability of this implant design and the reliability of this implant in unstable hips and in hips where instability was expected.</p><p class="abstract"><strong>Conclusions:</strong> In our study, proximal femur tumours, dislocated total hips, abductor insufficiencies and aseptic loosening all showed good results.</p>

Total hip arthroplasty in Cambodia – Our experience of two hundred and fifty six consecutive total hip arthroplasties in a low-income country & the challenge of service delivery in this setting

The Children's Surgical Centre has performed 256 THAs since 2007, We aim to assess the outcome of arthroplasty in a LMIC. Primary outcome: all cause of re-operation, Secondary outcome: any other complication. A retrospective review of all consecutive THA since 2007 was conducted. Electronic and physical case notes were reviewed. Statistical analysis was performed using MedCalc. 256 THA. Mean age: 43, gender M2:1F. Common pathologies include (1) AVN (44%), (2) OA (11%) and (3) DDH (11%). Revision rate 13%. Time to revision was 2.8 years (0–9). Common revision reasons: (1) stem fracture (5.8%), (2) aseptic loosening (4.8%) and (3) infection (2.7%). Complications were identified in 85 patients (33.2%). Common complications included (1) aseptic loosening (10.5%) (2) stem fracture (5.8%) and (3) dislocation (5.8%). Patients at CSC benefit from THA, the complication rates at CSC are declining suggesting the apex of the ‘learning curve’ has passed. Cheap poorly manufactured implants continue to cause catastrophic failure.

Primary Cement Debris After Total Knee Arthroplasty

Polyethylene wear is accelerated by third body cement debris and contributes to aseptic loosening after knee arthroplasty. Saline irrigation with pulse lavage is expected to render the joint free of such particles. The purpose of this study is to qualitatively characterize such primary cement debris remaining in the knee joint after cemented total knee arthroplasty and briefly discuss ways to decrease it further.

Enteropathogenic Escherichia coli Mediates CoCrMo Particle-Induced Peri-Implant Osteolysis by Increasing Peripheral 5-HT

The human gut microbiota has been proven to have great effects on the regulation of bone health. However, the association between gut microbiota and particle-induced osteolysis, which is the primary cause of aseptic loosening, is still unknown. In this study, we used a combination of wide-spectrum antibiotics to eliminate the majority of gut microbiota and found that reduction of gut commensal bacteria significantly alleviated the progression of osteolysis, in which anaerobe was the biggest culprit in the exacerbation of osteolysis. Furthermore, colonization of enteropathogenic Escherichia coli (EPEC), a subspecies of anaerobe, could promote the development of particle-induced osteolysis by increasing the secretion of peripheral 5-hydroxytryptamine (5-HT) from the colon. Elevated 5-HT level decreased the phosphorylation of CREB and inhibited the proliferation of osteoblasts. Collectively, these results indicated EPEC colonization suppressed the bone formation and aggravated particle-induced osteolysis in vivo. Thus, clearance of EPEC is expected to become a potential preventive approach to treat debris-induced osteolysis and aseptic loosening.

Ten-year survival of ceramic-on-ceramic total hip arthroplasty in patients younger than 60 years: a systematic review and meta-analysis

Background Total hip arthroplasty (THA) with ceramic-on-ceramic (CoC) was created to minimise wear debris and aseptic loosening. A decade ago, a meta-analysis showed a 10-year survival rate of just 89%. Based on the excellent tribology of the current CoC, significant improvement of implant survivorship is expected. In patients younger than 60, we conducted a meta-analysis to assess 10-year survival and complications after using current primary CoC THA. Materials and methods PubMed, Scopus, EMBASE, Virtual Health Library, and Cochrane Library were used to scan for published trials that met the inclusion criteria until January 2019. The qualified studies were subjected to a systematic review and proportional analysis, and the randomised controlled trials (RCTs) were included in a comparison meta-analysis. Results Thirteen studies were included 156 findings. The total number of hips was 2278. Nine studies were cohort, and four were RCTs between ceramic and polyethylene cups. The analysis revealed an average age of 44 years (range 24–54). The 10-year survival 96% (95% CI; 95.4–96.8%), aseptic loosening rate 0.516. (95% CI; 0.265–0.903), ceramic fracture rate 0.620 (95% CI; 0.34–1.034) and squeaking rate 2.687 (95% CI; 1.279–4.593). A comparison meta-analysis revealed the risk ratio (RR) for revision was 0.27 (95% CI; 0.15–0.47), and for aseptic loosening 0.15 (0.03–0.70) favouring CoC, while RR for component fracture was 1.62 (95% CI; 0.27–9.66) favouring the polyethylene. Conclusion In patients under sixty, current CoC THAs are correlated with better 10-year outcomes than before and have high survivorship rates. Level of evidence: Level I.

The Globulin, A/G and NLR do not Perform better than CRP and ESR in PJI Diagnosis

Objective: To test the significance of serum C-reactive protein (CRP), the erythrocyte sedimentation rate (ESR), globulin(GLN) , albumin to globulin ratio (A/G), and neutrophil to lymphocyterate (NLR) in periprosthetic joint infection (PJI) diagnosis. Methods: We retrospectively analyzed the clinical data of 115 patients diagnosed from January 2017 to December 2020 with PJI (PJI group, median age 71.00 years [range, 41-94 years], 24 males, 29 females), and aseptic loosening (aseptic group, median age 68.50 years [range, 34–85 years], 32 male, 30 female) in our department. Demographic data and thesensitivity and specificity of preoperative CRP, ESR, GLB,A/G, and NLR in PJI diagnosis were compared. Results: There were no significant differences when the demographic data of the two groups were compared. The expression level of CRP (24.89 mg/L([IQR], 0.1 to 200)), ESR (3 mm/h([IQR], 6 to 120)), GLB (31.70 g/L ( [IQR], 18.50 to 60.60)), and NLR (2.51([IQR], 0.93 to 12.23)) in the PJI group were higher than in the aseptic loosening group (CRP: 2.245 mg/L([IQR], 0.2 to 111.94);ESR: 16 mm/h ([IQR], 2 to 76); GLB: 26.60 g/L([IQR], 17.90 to 68.20); NLR: 1.85([IQR], 0.63 to 9.09)). The expression level of A/G (1.15([IQR], 0.55 to 2.16)) in the PJI group was lower than in the aseptic loosening group (1.51([IQR], 0.71 to 2.40)). Receiver operating characteristic (ROC) curve analysis demonstrated that the areas under the ROC curve (AUC) for CRP, ESR, GLB,A/G, and NLR were 0.841 (95% confidence interval, 0.761-0.903), 0.850 (0.771-0.910),0.747(0.658-0.824),0.779(0.692–0.851), and 0.708 (0.616–0.789), respectively. When GLB > 26.6g/L, A/G ＜1.32, and NLR >2.1 were set as the threshold values for the diagnosis of PJI, The sensitivity of GLB and A/G (90.57%, 81.13%) is higher than CRP (71.70%) and ESR (79.25%), but the specificity (GLB: 51.61%, A/G: 72.58%) was significantly lower than of CRP (87.10%) and ESR (75.81%). The ROC analysis of NLR showed that its sensitivity (73.58%) and specificity (70.97) had no significant advantages over CRP and ESR. Conclusion: globulin, A/G and NLR do not perform better than CRP and ESR in PJI diagnos is.

Varus-valgus constrained insert with posterior-stabilized femoral components in complex primary total knee arthroplasties

Aims Varus-valgus constrained (VVC) devices are typically used in revision settings, often with stems to mitigate the risk of aseptic loosening. However, in at least one system, the VVC insert is compatible with the primary posterior-stabilized (PS) femoral component, which may be an option in complex primary situations. We sought to determine the implant survivorship, radiological and clinical outcomes, and complications when this VVC insert was coupled with a PS femur without stems in complex primary total knee arthroplasties (TKAs). Methods Through our institution’s total joint registry, we identified 113 primary TKAs (103 patients) performed between 2007 and 2017 in which a VVC insert was coupled with a standard cemented PS femur without stems. Mean age was 68 years (SD 10), mean BMI was 32 kg/m2 (SD 7), and 59 patients (50%) were male. Mean follow-up was four years (2 to 10). Results The five-year survivorship free from aseptic loosening was 100%. The five-year survivorship free from any revision was 99%, with the only revision performed for infection. The five-year survivorship free from reoperation was 93%. The most common reoperation was treatment for infection (n = 4; 4%), followed by manipulation under anaesthesia (MUA; n = 2; 2%). Survivorship free from any complication at five years was 90%, with superficial wound infection as the most frequent (n = 4; 4%). At most recent follow-up, two TKAs had non-progressive radiolucent lines about both the tibial and femoral components. Knee Society Scores improved from 53 preoperatively to 88 at latest follow-up (p < 0.001). Conclusion For complex primary TKA in occasional situations, coupling a VVC insert with a standard PS femur without stems proved reliable and durable at five years. Longer-term follow-up is required before recommending this technique more broadly. Cite this article: Bone Jt Open 2021;2(11):921–925.