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Purpose: To compare the short-term outcomes of surgical management of failed ankle arthroplasty with revision ankle arthroplasty and conversion to arthrodesis. Methods: Single-centre retrospective review of revision procedures for failed ankle arthroplasty between January 2012 and June 2019. Implant survival, union rates, and PROMS data—Pain Visual Analogue Score (VAS), Ankle Osteoarthritis Score (AOS) and Manchester-Oxford Foot Questionnaire (MOxFQ)—were compared between the two groups. Results: Twenty-nine patients (31 ankles) underwent surgical management for failed ankle arthroplasty, with either revision arthroplasty (n = 21) or arthrodesis (n = 10). Revision arthroplasty had 87% survival at four years. Arthrodesis had an overall union rate of 80%. Two-year PROMS showed greater results for the revision arthroplasty group compared with that for arthrodesis group (Pain VAS 10 vs 50, p = 0.03; total AOS 12 vs 87, p = 0.04; average MOxFQ 17 vs 73.5, p 0.02). Conclusion: Revision arthroplasty demonstrates good short-term survival data with improvements in PROMS compared with arthrodesis. Further long-term follow-up is required to monitor if these benefits continue. [ABSTRACT FROM AUTHOR]

Purpose: Our primary aim was to describe the re-intervention and revision rates after primary reverse shoulder arthroplasty (RSA) documented in a local shoulder arthroplasty registry. We also identify the main indication for revision and re-intervention, which may be relevant for patient outcome post-RSA. Methods: Since July 2006, RSAs are consecutively documented in our clinic registry and prospectively controlled with follow-ups. Any intervention after primary RSA requiring a return to the operating room for any shoulder-related indication was termed a re-intervention. Revisions were defined as surgeries involving any exchange, removal, or addition of at least one component. The study endpoints were survival rates at two, five and ten years follow-up for both definitions. Results: Until July 2017, 63 from a total of 1480 primary RSAs required at least one re-intervention and 33 patients had a revision. Open reduction and internal fixation for fractures around the implant (n = 14) were the predominating indications for re-intervention. The re-intervention rate for instability was 0.5%. For re-interventions, survival rates were 97.7, 95.4 and 90.8% at two, five and ten years, respectively, and the respective rates for revisions were 98.7, 97.5 and 95.3%. Conclusion: The revision rate after primary RSA for our patient registry is low. A relevant number of additional interventions were noted that did not require any component revision but may impair the final outcome post-RSA. By only reporting revision rates, the number of post-RSA re-interventions is clearly underestimated. We recommend the documentation of all events leading to any re-intervention in arthroplasty registries. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess survival rate, functional and radiological outcomes when using a hydroxyapatite-ceramic fully coated primary femoral stem in revision total hip arthroplasty. Methods: Patients who underwent revision total hip arthroplasty using the Furlong hydroxyapatite-ceramic (HAC)-coated (Joint Replacement Instrumentation Ltd., Sheffield, UK) primary stem were retrospectively identified between 2013 and 2017. A total of 30 hips in 27 patients were identified and the mean follow-up duration was 44 months. Post-operative radiographs were scrutinized for signs of component loosening by two independent assessors. Patient's functional outcomes were assessed using the Oxford hip score and compared pre- and post-operatively. The prevalence of thigh pain was assessed at the latest follow-up. Results: The most common cause of revision was adverse reactions to metal debris (ARMD) (46.6%). The overall complication rate was 13.3%. Results at final follow-up demonstrated 100% survival rate and no reported incidence of thigh pain. Using paired t test, all patients had a statistically significant (P < 0.05) improvement in post-operative mean Oxford hip score of 35 compared to a mean pre-operative score of 14. Radiographic analysis of the latest follow-up radiographs revealed no signs of component loosening or component subsidence. Conclusion: With a 100% survival rate and excellent reported functional outcomes, we believe that our experience and results support the use of primary cementless stems in selected revision cases. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess patients treated for interprosthetic femoral fractures (IFFs).Method: Based on our database, we performed a retrospective single-center analysis of patients who underwent surgery for the treatment of IFFs. We evaluated patient demographics, fracture patterns, type of surgery, revision, and mortality for a minimum of one year after treatment. Outcomes were assessed via telephone using the Parker score.Results: Fifty consecutive patients were enrolled. An analysis of fracture patterns revealed three different types: proximal (n = 19), intermediate (n = 13), and distal (n = 18). Treatment included internal fixation for stable components and revision arthroplasty for loose implants; and a lateral locking plate was the most commonly applied device. The mean follow-up time of the total sample was 5.7 years after the operation. The total revision rate was 22%, and the highest revision rate was documented for revision arthroplasty. The one year mortality rate for the sample was 14%, and fracture patterns and treatment revealed no effects on mortality. Living patients (n = 23) were followed up for an average of 4.9 years after treatment. Only six patients reported the best Parker score (mean, 5.0; range 0-9).Conclusion: IFFs can be divided into three groups irrespective of the type of stem or bone quality, but fixation (stable or loose) must also be considered to determine the treatment. Fracture patterns and treatment revealed no effects on mortality. There are many treatment options but no single solution for IFFs. [ABSTRACT FROM AUTHOR]

Purpose: There is no consensus regarding systematic screening for infection in aseptic revision total hip arthroplasty (THA). The rationale for systematic intra-operative samples is to increase the sensitivity of latent infections detection, which may require specific treatment. However, the incidence of occult infection in revision THAs is not precisely known. As such, the aim of the study was to evaluate the incidence of occult infection in presumed aseptic revision THAs and identify associated risk factors.Method: Bacteriological samples from 523 aseptic THA revisions performed for five years were analyzed. Revisions performed for periprosthetic joint infection (PJI) or clinical suspicion of PJI were excluded. Microbiological cultures were performed using tissue samples in 505 cases (97%), synovial fluid in blood culture vials in 158 (30%), and in dry tubes in 263 (50%). Implants were sent for sonication in 12 cases (2.6%). The mean number of microbiological samples per patient was 3.6 (range, 1-15). Histology samples were collected for 300 patients (57%).Results: The incidence of occult infection was 7% (36 cases) and contamination 8% (42 cases). Among occult infections, the primary reasons for revision were dislocation (42%), aseptic loosening (25%), fracture (19%), and others (14%). The infection rate in the dislocation group was significantly higher than that of other reasons for revision (p < 0.001). Among the patients determined with PJI, the revision THA was performed less than a year after primary in 19 (53%).Conclusion: The incidence of occult PJI justifies systematic intraoperative sampling. A short time between primary arthroplasty and revision or an early postoperative dislocation is a factor to suspect infections. [ABSTRACT FROM AUTHOR]

Background: The aim of this retrospective study was to evaluate the clinical, radiologic, and survival results of dual mobility (DM) sockets in revision total hip arthroplasty (THA) performed for instability versus revision THAs performed for other reasons.Methods: From a computerized database, we identified 84 revision THAs using a modern DM socket performed in 81 patients with a mean age of 71 years. Indication for revision was recurrent dislocation in 47 hips, and other reasons in the remaining 37 hips. A survivorship analysis according to the actuarial method was carried out on the entire series using revision for any cause, revision for dislocation, and radiological cup loosening revised or not, as the end points.Results: Of the 81 patients, twelve died, six were lost to follow-up, eight had been revised, and 55 patients (58 hips) were unrevised and alive at a mean follow-up of 6.4 years. Dislocation occurred in four of the 47 (8.5%) hips for which indication for revision was dislocation versus one of the remaining 37 (2.7%) hips [odds ratio = 3.4 (0.4-31.3), p = 0.07]. According to our criteria, three acetabular components of which one was revised were considered as loosened. When using revision for dislocation as the end-point, the survival rate at seven years was 90.4 ± 5.3% (IC95%, 79.9-100) in the 47 hips for which the indication for revision was dislocation versus 100% in the remaining 37 hips (log-rank, p = 0.5).Conclusions: The current study indicated that DM sockets represent an interesting solution to prevent dislocation in revision THAs at mid-term follow-up. [ABSTRACT FROM AUTHOR]

Background: Cementless femoral stems are currently used in revision total hip arthroplasty (THA) with the surgeon choosing between various fixation modes. The outcomes are good in the medium term; however, some failures have been attributed to technical errors during implantation. When the decision has been made to use a press-fit implant, the impact of the surgeon's technique on the functional outcomes have not been explored in-depth. This led us to carry out a retrospective study on a large population of total hip arthroplasty patients which aims were achieved press-fit to (1) determine the impact of the type of primary fixation (with and without press-fit) on the functional outcomes; (2) specify the effect of stem length on the functional scores when diaphyseal press-fit is achieved and (3) analyse the main reasons why a true press-fit effect was not achieved (three-point fixation).Hypothesis: There is a relationship between the primary fixation method by press-fit of a revision femoral stem and the functional outcomes.Patients and Methods: We performed a retrospective analysis of a continuous cohort of 244 THA revision cases with a mean follow-up of 6.1 ± 3.5 years (range, 2-18). The femoral area in which close contact was achieved (shared interface between the bone and implant) was used to define various types of press-fit fixation. The functional outcomes were determined using the Harris Hip Score (HHS) and the Merle d'AubignéPostel score (MAP score) out of 12 points (pain and walking items).Results: The post-operative HHS averaged 90.83 ± 7.51 for proximal press-fit and 80.14 ± 14.93 with no press-fit (p = 0.01). The MAP averaged 10.83 ± 1.03 for proximal press-fit and 9.75 ± 2.09 with no press-fit (p = 0.09). The MAP score was worse for long diaphyseal press-fit than for short press-fit (p = 0.02). Use of a long stem with an endofemoral route or an overly small femoral window in patients with a curved femur is the main reason that three-point fixation occurred instead of press-fit.Conclusions: While press-fit is an effective concept, it is a demanding one that requires the surgeon to choose the correct surgical strategy for the patient's anatomy. A meticulous surgical technique is required to achieve proximal press-fit or at a minimum, short diaphyseal press-fit. [ABSTRACT FROM AUTHOR]

Purpose: Acetabular revision of failed total hip arthroplasty (THA) is often associated with severe bone loss. Therefore, a variety of revision implant systems has been developed during recent years, with the augment-and-modular-cage system being one of the newest additions to this portfolio. Together with biologic downsizing by means of impaction bone grafting, this uncemented system promises a high modularity and versatility to treat all acetabular defects up to Paprosky types IIIa and IIIb without pelvic discontinuity. The aim of the present study was to evaluate first short-term results of its clinical application, both clinical functional and patient-reported as well as radiographic.Methods: Forty-four patients (28 female, 16 male, mean age 70.9 ± 11.5 years) could be followed for a mean of 26 ± 10 months after acetabular revision with a novel augment-and-modular-cage system. Indications for revision included aseptic loosening (68%), septic loosening (16%), or others (16%) with bone loss Paprosky IIa up to IIIb without discontinuity. The modified Harris Hip Score (mHHS) served as a primary outcome parameter. In addition, a number of patient-reported outcome measurements (PROMs) were collected including the Short Form 36 (SF-36), Hip disability and Osteoarthritis Outcome Score (HOOS), and Visual Analogue Scale for Hip Pain (VAS Hip) as well as overall satisfaction. Radiographic changes between the pre- and postoperative center of rotation (COR) and various criteria of implant failure served as secondary outcome parameters.Results: No patients were lost to follow-up. Two implant-associated complications (partial flange breakage) without a need for revision surgery were detected, which represent a failure rate of 4.5%. Functional outcome as measured by mHHS increased from 49.4 ± 2.9 pre-operatively to 74.4 ± 3.1 at the latest follow-up (p < 0.001). PROMs showed significant improvements in all pain-related categories, while other quality-of-life measurements only exhibited positive tendencies towards improvement. VAS Hip significantly improved from 6.5 ± 0.7 pre-operatively to 2.2 ± 0.6 at the latest follow-up (p < 0.001). Radiographic evaluation showed that reconstruction of the COR was possible, referenced to the contralateral side. The COR could be lateralized by 5.0 mm (n.s.) and caudalized by 10.3 mm (p < 0.001) comparing pre-operative and post-operative states, with complete osseointegration in 95% of the cases.Conclusions: Treatment with the augment-and-modular-cage system significantly improved clinical functional and patient-reported outcomes in cases of acetabular revision after failed THA. In addition, a good reconstruction of the COR could also be achieved. Therefore, this highly modular system can be considered as an effective treatment option in almost all cases of acetabular bone loss except for those of pelvic discontinuity. It offers the unique possibility of intra-operative implant customization according to the existing bone defect and host bone quality. [ABSTRACT FROM AUTHOR]

Introduction: In the last three decades, total hip replacement in young patient became a habitual procedure. Principles of bone preservation are pushing many surgeons to implant conservative femoral components in patient younger than 65 years. Despite an overall good survivorship and clinical outcomes of conservative implants, failed cases are reported and the need to revise a conservative femoral component became an occasional procedure (with high prevalence of failed resurfacing implants).Methods: During conservative femoral component revisions, we analyzed proximal bone stock preservation, considering the type of original component removed, etiology of failure, timing of revision, and femoral explantation technique.Results: We identified four patterns of proximal femoral changes (types I-IV). We suggest, for each of them, a revision strategy directed toward a "conservative revision procedure" using conservative or primary component. Out of our 21 cases, none underwent further revision due to mechanical failure (follow-up ranging from 6 to 152 months, mean 54 months). We had two case of re-operation: one for early septic loosening and one for prosthetic modular neck fracture.Conclusions: If literature offers well-established guidelines to femoral revision of conventional stems, there is, on the other hand, a lack of data about revision strategies in presence of failed conservative implants. Although the mean follow-up of our procedures is still too short (4.5 years) to give final conclusions, we would leave a message: a conservative hip arthroplasty is not a "one-time" opportunity for young and active people. A "conservative revision" is a valid option for at least a part of them, when an early failure of primary procedure occurred. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess the clinical outcomes, complications, and survival of a long cementless titanium femoral stem in revision total hip arthroplasty (THA) at a minimum five year follow-up. Methods: Between 2000 and 2010, 114 patients (116 hips), with a mean age of 68 ± 12 years, underwent revision THA using a KAR® stem (DePuy, Leeds, UK). The main reasons for revision were aseptic loosening (82%), periprosthetic joint infections (PJI) (11%), and periprosthetic fractures (6%). Mean follow-up was ten ± three years (range, 5–16). Harris Hip Score (HHS), Oxford Hip Score (OHS), and Postel-Merle d'Aubigné (PMA) score were recorded. Radiographic analysis assessed stem osseointegration and subsidence. Survival was analyzed using the Kaplan-Meier (KM) method and cumulative incidence function (CIF). Results: Post-operative HHS was 83 ± 15 (range, 35–99) and OHS was 37 ± 8 (range, 8–48). PMA score significantly increased from 12 ± 2 (range, 5–18) pre-operatively to 14.6 ± 2 (range, 9–18) post-operatively (p = 0.0004). The radiographic Engh score was 15 ± 8 (range, 7–22). Stem subsidence was observed in two cases (3%). At ten years, five stems had been revised, three for infections and two for periprosthetic fractures. Using the KM method, ten year survival free of stem revision for aseptic loosening was 100%, free of revision for any reason 95%, and free of any re-operation 81%. Conclusions: The present study reported satisfactory outcomes and survival of a long tapered unlocked cementless femoral stem in revision THA at a minimum follow-up of five years. [ABSTRACT FROM AUTHOR]

Purpose: Proximal femoral replacements (PFRs) have been recently utilized in complex revision arthroplasties where proximal femoral bone is compromised. The purpose of this study is to evaluate the clinical outcomes, complications, and survivorship of PFRs as a salvage treatment for severe bone loss after non-oncologic revision total hip arthroplasty.Methods: This is a retrospective review of all patients who underwent femoral revision surgery using a single design PFR between 2004 and 2013 at our institution. Forty patients (41 hips) were included with a mean age of 64 years (29-90). According to Paprosky classification, 15 femurs had type IIIB defect, and 26 had type IV defect. Patients were followed for a mean of five years (2-10). The average length of reconstruction was 150 mm (81-261). A Kaplan-Meier analysis was used to determine the survival of the PFR.Results: A total of nine patients (9 PFRs, 22%) were re-operated upon. Three re-operations were for infection, two for dislocation, two for aseptic loosening, and two for periprosthetic fracture. The survivorship at five years was 95.1% for revision of the femoral stem for aseptic loosening. We did not find length of the segmental reconstruction or the indication for revision, to be a risk factor for implant failure or re-revision.Conclusions: Proximal femoral replacements have shown an acceptable survivorship in non-oncologic revision hip arthroplasties for severe proximal femoral bone loss. The frequent use of constrained liners may decrease the risk of dislocation due to the loss of the abductor mechanism encountered in these complex reconstructions. [ABSTRACT FROM AUTHOR]

Introduction: Instability is a major complication in revision total hip arthroplasty (THA). Dual mobility (DM) cups were shown to reduce the risk of post-operative implant dislocation. Few case-series studies assessed the outcomes of cemented DM cups when associated to acetabular reconstruction antiprotrusio cages. No published comparative studies were found to look for outcome differences between standard cups (SC) and DM cups in first revision THA associated with a Kerboull plate (KP) and acetabular bone grafting.Materials and Methods: This is a retrospective comparative study of two groups of patients in two institutions. All cases were first revision THA with KP reconstruction; a cemented standard cup (SC) was used in one institution (THA-SC group) while a cemented DM cup was used in the second institution (THA-DM group). The posterolateral approach and the same technique for KP placement, the cross technique, were performed in both groups. Primary outcomes were dislocation and revision rates. Survivorship and clinical and radiological results were set to be secondary outcomes. There were ten patients (13 hips) in the first group and 16 patients (16 hips) in the second with a mean follow-up clinical and radiological evaluation of 74.2 ± 47.9 months.Results: Besides age, no significant demographic differences were present between both groups. There were three dislocations (23%) in the first group treated with close reduction compared to none in the second (p = 0.04). No further episode of dislocation or revision surgery occurred until the last follow-up in both groups. The mean Harris Hip Scores for the THA-SC and THA-DM groups were 87.5 ± 10.9 and 87.4 ± 12.1, respectively. When present, radiolucent lines were less than 1 mm thick and were non-progressive in both groups. In all patients, complete trabeculation remodeling or cortical repair of the graft was observed.Conclusion: The cup type was the single variable which could account for the observed dislocation rate difference. The mid-term results of using DM cups with KP in first revision THA seem very encouraging. Our findings add to the previously published results on the excellent outcomes in terms of stability in revision THA when using DM cups. [ABSTRACT FROM AUTHOR]

Purpose: In revision hip arthroplasty, custom-made implants are one option in patients with acetabular Paprosky III defects.Methods: In a retrospective analysis, we identified 11 patients undergoing cup revision using a custom-made implant. The accuracy of the intended position of the implant was assessed on post-operative 3D CT and compared to the pre-operative 3D planning in terms of inclination, anteversion, and centre of rotation. In addition, the accuracy of post-operative plain radiographs for measuring implant position was evaluated in relation to the 3D CT standard.Results: We found a mean deviation between the planned and the final position of the custom-made acetabular implant on 3D CT of 3.6° ± 2.8° for inclination and of - 1.2° ± 7.0° for anteversion, respectively. Restoration of center of rotation succeeded with an accuracy of 0.3 mm ± 3.9 mm in the mediolateral (x) direction, - 1.1 mm ± 3.8 mm in the anteroposterior (y) direction, and 0.4 mm ± 3.2 mm in the craniocaudal (z) direction. The accuracy of the post-operative plain radiographs in measuring the position of the custom-made implant in relation to 3D CT was 1.1° ± 1.7° for implant inclination, - 2.6° ± 1.3° for anteversion and 1.3 mm ± 3.5 mm in the x-direction, and - 0.9 mm ± 3.8 mm in the z-direction for centre of rotation.Conclusion: Custom-made acetabular implants can be positioned with good accuracy in Paprosky III defects according to the pre-operative planning. Plain radiographs are adequate for assessing implant position in routine follow-up. [ABSTRACT FROM AUTHOR]

Background: Severe glenoid bone loss remains a surgical challenge. This condition is known to be associated with high rates of glenoid component failure.Purpose: The objective of this study was to evaluate clinical and radiological outcomes of a lateralized metal-backed 15.2-mm keeled baseplate prolonged by a thin 24.8-mm metallic post fixed directly in the subscapularis fossa in primary cases of reverse shoulder arthroplasty (RSA) for severe glenoid bone loss and in revision cases.Materials and Methods: Between January 2011 and December 2014, 51 shoulders (50 patients) underwent primary or revision RSA using this baseplate. Forty-five shoulders in 44 patients were followed for a minimum of two years (mean, 33 months; range, 24-60 months). The mean age of the patients was 76 years (range, 55-93 years). Outcome measures included pain, range of motion, Constant Score, and complications.Results: The complication rate was 12% in primary cases and 25% in revision cases. One glenoid implant (4%) failed in primary cases and one glenoid implant (5%) failed in revision cases. Pain and range of motion were significantly improved in both groups. The mean Constant Score improved from 24 (± 7) to 62 (± 9) in primary cases and from 24 (± 10) to 58 (± 12) in revision cases.Conclusion: A lateralized metal-backed 15.2-mm keeled baseplate prolonged by a thin 24.8-mm metallic post fixed directly in the subscapularis fossa may provide satisfactory mid-term outcomes in patients with large glenoid bone defects where initial press-fit of a regular baseplate is impossible to obtain. [ABSTRACT FROM AUTHOR]

Purpose: The purposes of the present study were to assess the levels of prosthetic constraint chosen during revision total knee arthroplasty (TKA) and to identify factors influencing the choice of a constrained prosthesis.Methods: We retrospectively reviewed data on 274 revision TKAs. The mean follow-up period after revision TKA was 7.2 years. The femorotibial angle (FTA), joint line height (JLH), and Insall-Salvati ratio (ISR) were radiographically evaluated. Factors affecting the extent of constraint chosen were evaluated in terms of age, gender, body mass index, primary diagnosis, the cause of revision TKA, the Anderson Orthopedic Research Institute (AORI) classification, and changes in the JLH and ISR.Results: Totals of 247 (90.1%), 11 (4.0%), and 9 (3.4%) knees received posteriorly stabilized prostheses, constrained condylar knees, and rotating hinge prostheses, respectively. On multivariate analysis, the cause of revision TKA including loosening and instability and the changes in the JLH and ISR affected independently the choice of a constrained prosthesis.Conclusions: The frequency of implantation of constrained prostheses was 7.4% in the present study. Consideration of various factors including the cause of revision TKA and changes in the JLH and ISR will aid the TKA surgeon in selecting prostheses with appropriate constraints when performing revision TKAs. [ABSTRACT FROM AUTHOR]

Background: Total elbow arthroplasty (TEA) is considered a successful treatment for several conditions, including rheumatoid arthritis and comminuted fractures. However, failure rates as high as 62% have been reported, with many patients requiring surgical revision. Causes of failure requiring revision can be classified as infected or non-infected. This study evaluated the clinical and radiologic outcomes of TEA revision surgery according to causes of failure.Methods: Twenty patients undergoing revision TEAs in 2010-2015 were retrospectively evaluated. Mean follow-up was 52.7 months. Patients were categorized into infected and non-infected groups based on radiologic and serologic tests. Clinical outcomes included range of motion (ROM) and Mayo Elbow Performance Score (MEPS), and radiological outcomes included loosening signs on anteroposterior (AP) and lateral plain radiographs at final follow-up. Complications were assessed in both groups.Results: Overall, mean MEPS was 79.7, and mean ROM arc was 97.9° at final follow-up. Nine patients underwent revision due to infection, and 11 due to non-infectious causes. Mean MEPS in these two groups was 75.6 and 83.5, respectively, and mean ROM arc for flexion-extension was 89.4° and 108°, respectively. Two (22%) of the nine patients in the infection group required second revision surgery due to recurrent infection. No patient in the non-infected group underwent second revision surgery. The most frequent complication in the infected group was osteolysis, observed in five patients, including four with symptomatic aseptic loosening and one with non-symptomatic osteolysis. Two patients in the non-infected group demonstrated a non-progressive radiolucent line, which was asymptomatic at final follow-up.Conclusion: Revision TEA provided clinical improvement in elbow function and resulted in satisfactory outcomes. Outcomes were worse in the infected than in the non-infected groups. Comorbidities and older age were apparent risk factors for infected TEA. [ABSTRACT FROM AUTHOR]

Purpose: Recently, there has been increasing interest in the use of dual mobility systems in the treatment of hip instability. The aim of this study was to investigate the re-revision rate of dual mobility cup compared to different surgical concepts when used for first-time hip revisions due to recurrent dislocations.Methods: The data were derived from the Lithuanian Arthroplasty Register. For survival analysis, we used both re-revision for all reasons and for dislocations as an end-point. Cox proportional hazards models were used to analyze the influence of various covariates (age, gender, and implant concept).Results: A total of 1388 revisions were recorded from 2011 to 2015, of which 362 were performed due to recurrent dislocation. Of the revisions, 247 were performed using dual mobility cups, while 115 were performed using a variety of other surgical constructs including constrained acetabular cups, conventional cups, femoral head exchanges, stem exchanges or anti-luxation rings. There were 27 re-revisions of which 15 were for additional dislocations. There were only 2% re-revisions due to dislocation with dual mobility vs 9% when using other surgical constructs. Cox regression adjusting for age and gender showed that in the short-term, dual mobility cup had a lower risk of revision due to dislocation as well as for all reasons compared to the other surgical constructs.Conclusion: In revision of total hip arthroplasties for dislocation, significantly lower short-term re-revision rate was observed for patients revised with dual mobility cup. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the outcomes of total hip arthroplasty (THA) revision with cementless stems using a numeric global radiological score (GRxS) that summarizes two previously validated scores: secondary bone stock (SBS) and osseointegration-secondary stability (O-SS).Method: One hundred fifty cases of THA were evaluated at a mean follow-up of 6.5 ± 3.7 years. The GRxS combines the SBS, which evaluated cortical bone thickness, bone density and bone defects in each Gruen zone and the O-SS, which evaluated the location and extent of a single radiolucent line. To calculate the GRxS, the SBS and O-SS were each expressed on a 10-point scale and given equal weighing. The final result was a number out of 20. The GRxS was used to assign a radiological grade to each THA case: very good (20), good (18-15), average (13-12), or poor (≤ 10). The numerical mean (Nm) was calculated for each grade. The inter- and intra-observer reproducibility was evaluated.Results: The inter-observer reproducibility was good (0.8) and the intra-observer reproducibility was very good (0.9). The GRxS was considered very good in 46 cases (Nm 20), good in 57 cases (Nm 16.6), average in 25 cases and poor in 22 cases. There was a significant relationship between the GRxS and the Harris Hip and Postel Merle d'Aubigné scores (p < 0.0001), and the initial bone stock (p = 0.0001).Conclusions: The GRxS is reliable and reproducible. This information can be used by surgeons to adapt the surgical technique to bone characteristics (especially during revision cases) and to compare the outcomes of different implant designs. [ABSTRACT FROM AUTHOR]

Purpose: Revision of failed modular metal-on-metal total hip replacement (MoM-THA) can be technically difficult. A dual mobility liner can help to salvage a well-fixed acetabular component. The present paper reports the clinical and radiographic outcome of revision of failed Birmingham modular MoM-THA using a dual mobility liner.Methods: The present study reports on ten patients (3 female and 7 male) with 11 revision THAs. Patients underwent revision an average of 51 months (range 40-73 months) after index procedure. Mean follow-up after the revision was 31 months (range 24-37 months) and all patients underwent an MRI with metal artifact reduction software (MARS) at least two years after revision to assess for local polyethylene wear and osteolysis.Results: The Harris Hip score improved from 92.2 (range 63.0-100.0) to 100.0 (p = 0.072). One patient had a one-time dislocation within seven days of surgery. No patient required additional surgeries. Radiographs showed no signs of component loosening and osteolysis and MRI imaging revealed no evidence of polyethylene wear or osteolysis.Conclusion: A dual mobility liner in an existing Birmingham cup can provide excellent clinical and radiological short-term results without MRI evidence of increased polyethylene wear. Post-operative hip precautions should be enforced. [ABSTRACT FROM AUTHOR]

Purpose: Removal of an infected prosthesis was considered the gold standard for eradication of infection. However, removal of well-fixed components can result in structural bone damage and compromised reconstruction. In these situations we questioned whether the infection after the total hip arthroplasty could be treated effectively and retain the well-fixed implant in a single-stage exchange.Methods: A retrospective analysis which included 31 patients with chronic infected THA who underwent major partial single-stage revision, including routinely exchanged femoral head and liner components, aggressive soft tissue debridement, removal of the femoral stem or acetabular cup and retention of the well-fixed component, thorough exposed component brushing, and adequate surgical soaking. Powdered Vancomycin was poured into the surgical area and the infection control rate and clinical outcomes were evaluated. The failure to treat the infection was defined as a recurrence of infection in the same hip. The average follow-up was five years (2-15 years).Result: There were four (12.9 %) failures during the study period at an average of 15 months (9-21 months) after partial single-stage revision. Of the 31 patients, 27 (87.1 %) patients had a satisfactory outcome and required no additional surgical or medical treatment for recurrence of infection. Acetabular cups were revised in 22 patients and femoral stems in nine patients. The mean post-operative Harris hip score at the most recent assessment was 74.6 (68-82).Conclusions: Treatment of chronic infected THA with retention of the well-fixed implant in a single-stage exchange can be fairly effective in the treatment of infection and achieving acceptable functional outcomes, which indicated that this may be an attractive alternative in highly selected patients.Level Of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

The potential advantages of contemporary MoM THA implants include less volumetric wear with subsequent reduction of polyethylene wear-induced osteolysis and greater component stability with use of large-diameter femoral heads. However, there have been concerns regarding significantly elevated revision rates in MoM THA due to MoM-related complications such as adverse local tissue reaction (pseudotumour) formation. The increased failure rate in MoM hip arthroplasty is associated with the generation of biologically active, nanometer sized metal particles from the MoM bearing surfaces and taper junctions, which result in the development of a localized, adverse periprosthetic soft tissue response. The focus of this article is to provide an update on (1) implant, surgical and patient factors associated with adverse local tissue reactions (pseudotumours) and (2) the clinical systematic evaluation and management of patients with MoM hip arthroplasty based on the currently available evidence. There should be a low threshold to conduct a systematic clinical evaluation of patients with MoM hip arthroplasty as early recognition and diagnosis will allow the initiation of prompt and appropriate treatment. As a symptomatic MoM total hip arthroplasty may have intrinsic and extrinsic causes, patients should be evaluated systematically, utilizing risk stratification algorithms. Although specialized laboratory tests such as metal ion levels and cross sectional imaging modalities such as MARS MRI can be used to facilitate clinical decision making, over-reliance on any single investigative tool in the clinical decision-making process should be avoided. Further research is required to obtain a better understanding of implant and patient risk factors associated with tribocorrosion in MoM total hip arthroplasty. [ABSTRACT FROM AUTHOR]

Introduction: Recent studies have reported short-term favourable results of tantalum-made components in acetabular revisions with bone loss. However, there is a lack of information regarding the mid to long-term results of such components.Objectives: The objective of this study was to analyse the outcome and survivorship of acetabular revision hip arthroplasty using tantalum components for loosening associated with bone loss at a minimum of five-year follow-up.Methods: We retrospectively reviewed 51 consecutive patients (51 hips) who had an acetabular revision using porous tantalum components at a minimum follow-up of five years. The mean age was 64 years (range, 31-87). There were 27 males and 24 females, 47 right hips and four left hips. Twenty-five (49 %) included a femoral revision. According to Paprosky's classification 18 hips were classified type 2A, 11 type 2B, ten type 2C, seven type 3A and five type 3B. No bone grafting was performed. Sixteen hips (31.3 %) required the use of additional tantalum-made augments stabilized by screws and cement at the cup-augment interface.Results: At a mean followup of 6.8 years (range, 5.1-10 years), the Harris hip score improved from 44 pre- operatively (range, 23-72) to 84 post-operatively (range, 33-98). The mean post-operative hip centre position in relation to the teardrop was 29 mm (range, 20-43 mm) horizontally and 21 mm (range, 8-36 mm) vertically. The mean acetabular inclination was 42° (range, 17-60°). Six hips (11.7 %) required a re-operation without component revision (two for chronic instability, one ossification removal, one haematoma, one deep infection and one periprosthetic femoral fracture). One patient required a cup re-revision for septic loosening. No aseptic loosening occurred. At last followup the radiological analysis showed one evolutive osteolysis and one screw breakage. The global survivorship was 92.3 % at 64 months. If only aseptic loosening was defined as the end-point the survivorship was 100 % at 64 months.Conclusions: When facing an acetabular revision with severe bone loss, tantalum-made components can provide a stable fixation. This study at a minimum five-year follow-up compares favourably with other reconstruction techniques, but longer follow-up is still required. [ABSTRACT FROM AUTHOR]

Purpose: To obtain detailed information on the outcomes of patients with rheumatoid arthritis (RA) undergoing reverse shoulder arthroplasty (RSA) METHODS: A literature search was conducted for studies reporting on the use of RSA in RA patients from 1990 to 2014. The inclusion criteria were a report of sufficient information on pre-operative status and surgical outcome allowing evaluation of the therapeutic potential of RSA in RA. The literature search resulted in 586 hits, but only five studies that met the inclusion criteria were assessed.Results: There were 100 shoulders that had been operated on, of which 87 were followed for a mean of 55.4 months, the longest follow-up being 11.9 years Most patients had glenohumeral erosive lesions of Larsen Grade III or IV. The Delta III prosthesis was implanted in most cases and in three studies bone graft was used for severe glenoid lesions. The main outcome measures employed were the Constant score (Cs) and ASES questionnaire. The mean increase in Cs and ASES score after surgery was 42.4 and 54 points, respectively. The mean post-operative forward elevation was 120.6°, the average increment being 51° and the mean increase of abduction was 58.5°. The mean prevalence of scapular notching was 35.4 %. The rate of adverse events was 31 %, but the vast majority were of minor severity. Eight prostheses underwent revision, due to infection in four.Conclusions: RSA implanted in RA patients would appear to give similar results to those obtained in massive cuff tears with or without arthropathy. [ABSTRACT FROM AUTHOR]

Background: The complication rate after total elbow arthroplasties is higher than for other arthroplasties.Purpose: The purpose of this study was to evaluate the complications and revision rate after 100 semi-constrained total elbow arthroplasties from various types of aetiologies performed in our university hospital.Methods: One hundred linked semiconstrained total elbow arthroplasties were performed and were reviewed with 24-months minimum follow-up. Indications were rheumatoid arthritis (45), trauma (33), revisions (16) and others (6).Results: At five years average follow-up (range, 2-11), the complication rate was 37 %. Most frequent complications were ulnar nerve involvement (9 %) and triceps insufficiency (7 %). Five implants were aseptically loosed. The infection rate was 4 % with loosening of the implant in two. Four fractures were observed, including three at the ulna and one at the humerus proximal or distal to the stem. The radial nerve was injured in two cases. Failure of the locking system of the prosthesis was noted in one case and a fracture of the ulnar component was found in another patient. A revision surgery was performed in 13 cases (13 %). At follow-up 94 prostheses were still in place and the survival rate was 98 % at five years and 86 % at ten years.Conclusion: Total elbow arthroplasty remains a difficult procedure with sometimes a high rate of complications necessitating revision procedures. Selection of the patients, a rigorous surgical technique, and a systematic follow-up are prerequisite to limit this incidence.Type Of Study/level Of Evidence: Therapeutic IV. [ABSTRACT FROM AUTHOR]

Purpose: Recently, concerns have arisen about metal-on-metal (MoM) total hip arthroplasty (THA). Therefore, the purpose of this cross-sectional cohort study was to describe the incidence of pain, pseudotumours, revisions and the relation between elevated metal ion levels, functional outcome and quality of life after MoM THA. Methods: In 351 patients, 377 MoM THA with a fixed-size 38-mm head were evaluated with a mean follow-up of 30 months (range 11-58). Evaluation included pain, serum metal ions, patient-reported questionnaires (Short Form-36 [SF-36], Hip disability and Osteoarthritis Outcome Score [HOOS] and the Oxford Hip Score [OHS]) and radiological imaging. Sixteen patients did not participate in the screening. Results: One hundred and eighteen (35 %) patients reported pain and showed significantly higher cobalt and chromium levels compared to patients without pain. Median serum cobalt levels were 4.4 μg/l (interquartile range [IQR] 6.6) and chromium levels were 3.6 μg/l (IQR 4.8). Patients with cobalt levels of ≤5 μg/l reported significantly better outcome on the SF-36 and HOOS. Fifty-seven pseudotumours were identified in 227 THAs. A revision rate of 19 % was observed. Conclusions: In conclusion, 35 % of the patients experienced pain after MoM THA. These patients showed significantly higher serum metal ion levels. The patient-reported questionnaires indicated significantly better outcome in patients with cobalt levels ≤5 μg/l. [ABSTRACT FROM AUTHOR]