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Background Total knee arthroplasty (TKA) is a common orthopedic procedure with 975,739 performed in the UK between 2003 and 2016. The two most common prosthetics used are P.F.C. Sigma and NexGen. The aim of this study is to compare the experience of a single fellowship-trained arthroplasty surgeon at a single dedicated orthopedic hospital using both of these prosthetics over a 17-year period. Methods This study was carried out as a retrospective review. Information was gathered from a database of primary TKAs and revision TKAs, as well as medical records, correspondence and operative notes. Results A total of 1,511 TKAs were performed between 1999 and 2015 – with a further follow-up period of 2 years. There were 1,161 consecutive P.F.C. primary TKAs done from 1999 to April 2013, after which, 350 consecutive NexGen primary TKAs were performed. Between 2015 and 2017, 26 NexGen revisions were required. 23 (6.6%) of the NexGen knees were carried out for aseptic loosening. The average time for revision from the NexGen index surgery was 30.4 months. The failures all presented similarly – with the tibial component having collapsed into varus and radiographic lucency noted under the implant. Conclusion In spite of changes in orthopedic practice and advances in implant technology over the time period of this study, we would not expect this level of implant failure from a surgeon who had no previous significant issues with aseptic loosening using a different prosthetic. Usage of the NexGen knee has been discontinued at this center.

Proximal femoral osteotomy is a well-accepted joint preserving treatment option in young patients with early symptomatic degenerative hip disease [1]. The main goal of this procedure is to halter the progression of osteoarthritic joint changes and to relieve pain mainly through the realignment of the articular surfaces and redistribution of joint forces [2]. Additionally it preserves bone stock and delay THA and its harmful possible complications especially in young patients [1, 2].

peer-reviewed Prosthetic joints and other orthopaedic implants have improved quality of life for patients world-wide and the use of such devices is increasing. However, while infection rates subsequent to associated surgery are relatively low (

Synchronous quadriceps tendon rupture is rare. A 29-year-old man, an amateur weight lifter, taking androgenic-anabolic steroids (AAS), developed sudden onset bilateral pain and swelling of his anterior thighs when attempting to squat 280 kg (620 lb). Examination revealed gross swelling superior to the patella and palpable gaps in both quadriceps tendons. He underwent successful operative repair. MRI revealed a partial tear of the anterior cruciate ligament (ACL) of the right knee. This was not reconstructed. Only a few case reports of the association between AAS and quadriceps rupture exist in the literature, with none to the best of our knowledge in the past 10 years. ACL rupture coexisting is very rare, with only two reported cases.

Total hip replacement produces significant postoperative pain. Psoas compartment block is the most effective block of the lumbar plexus in terms of pain relief and reduced blood loss. It is a proven regional technique for analgesia and anaesthesia during and after total hip replacement conferring a number of benefits to the patient. However, traditional techniques used to produce this block require increased theatre time and are associated with a number of serious complications. We present a surgeon-delivered technique for producing a lumbar plexus block using direct injection into the iliopsoas muscle when it is visible intraoperatively. This study shows a cadaveric model using methylene blue and radiopaque contrast produces injectate spread in a fashion which would produce a successful lumbar plexus block. This novel technique for lumbar plexus block affords the benefits of psoas compartment block with reduced complications and reduced administration time.

Background Acetabular defect reconstruction in revision hip arthroplasty may be achieved with acetabular impaction bone grafting (AIBG) or porous trabecular metal (TM) implantation. We sought to compare clinical and radiological outcomes of both methods at a single institution. Methods 36 patients that were revised using AIBG and 17 patients that were revised with TM were retrospectively reviewed from local joint registry data. 82% of the TM group and 64% of the AIBG group were ≥ Paprosky 2c. Rerevision was considered failure. Radiographs demonstrating 5 mm of migration of femoral head and 5° of acetabular component inclination change were considered loose. Results Age at surgery was earlier in the AIBG group (median 68 years vs. 74 years). Median follow-up was 5.9 years for AIBG and 5.4 years for TM. Harris Hip Scores improved significantly for both groups (mean improvement: 32 vs. 31). There were 4 failures (11%) in the AIBG group and none in the TM group. 3 of the 4 AIBG failures occurred following second-stage revision for prosthetic joint infection. 4 (11%) and 2 (12%) hip reconstructions demonstrated radiological evidence of loosening in AIBG and TM groups respectively. Conclusions AIBG and TM acetabular defect reconstructions achieve good clinical outcome but there is greater success with TM in higher grades of acetabular deficiency regardless of prior infection.

We present our experience over 6 years with the use of uncemented total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) with a mean follow-up of 3 years. In a 6-year period, 26 THAs were performed in 19 patients with Hartofilakidis grades 2 and 3 dislocation of the hips. Out of 19 patients, seven had bilateral dislocations. Uncemented acetabular and femoral components were used in all patients. Patients with a minimum follow-up of 1 year were included in the study. The average age at the time of surgery was 38 (range 20–69) years. Approaches used include trochanteric osteotomy in 14 (54%) patients and a lateral approach in 12 (46%) patients. In addition, subtrochanteric osteotomy was performed in four (15%) patients. A Mallory-head femoral stem was used in 15 (58%) patients; a DDH femoral stem was in nine (35%), and the S-ROM femoral prosthesis in two (8%). A Mallory head acetabular shell was used in all cases, a 22.2-mm chrome cobalt head was used in 18 (69%), and a 28-mm chrome cobalt head was used in eight (31%). The average follow-up was 3 (range 1–6) years. The Harris hip score (HHS) improved in the cohort from a mean preoperative score of 51 to a mean postoperative score of 86 (p

A 68 year old man underwent a femoral neck ostectomy as a palliative procedure for pain in the right hip secondary to an extensive acetabular metastasis from renal cell carcinoma. Excellent pain relief was achieved and he remained mobile until shortly before his death 8 months later. Copyright 2003, Elsevier Science (USA). All rights reserved.

Context : Infection of following total hip arthroplasties can be classified based on the timing of infection. Late infections with Actinomyces israelii are extremely rare with only 3 previously reported cases in literature. We present another case of a late infection with Actinomyces israelii in a total hip arthroplasty 9 years following implantation. Case Report : A 71-year-old male with diabetes mellitus presented with right hip pain 9 years following a total hip arthroplasty. Physical examination revealed localised pain and biochemical investigations showed elevated inflammatory markers. X-rays were suspicious for infection and a collection around the prosthesis was confirmed by MRI scan. The patient underwent debridement and removal of prosthesis. Peri-operative specimen cultures isolated Actinomyces israelii . The patient responded to a combination of vancomycin followed by ciprofloxacin and linezolid therapy before undergoing a successful second-stage reimplantation surgery. Conclusion : This is the first reported case of late haematogenous infection by Actinomyces israelii in a total hip arthroplasty in a patient with diabetes mellitus as the only risk factor. The patient was successfully treated with antibiotic therapy and two-stage reimplantation arthroplasty.

Background Patients post total hip arthroplasty (THA) remain at high risk of developing Deep Vein Thrombosis (DVT) during the recovery period following surgery despite the availability of effective pharmacological and mechanical prophylactic methods. The use of calf muscle neuromuscular electrical stimulation (NMES) during the hospitalised recovery period on this patient group may be effective at preventing DVT. However, the haemodynamic effectiveness and comfort characteristics of NMES in post-THA patients immediately following surgery have yet to be established. Methods The popliteal veins of 11 patients, who had undergone unilateral total hip replacement surgery on the day previous to the study, were measured using Doppler ultrasound during a 4 hour neuromuscular electrical stimulation (NMES) session of the calf muscles. The effect of calf muscle NMES on peak venous velocity, mean venous velocity and volume flow were compared to resting values. Comfort was assessed using a 100mm non-hatched visual analogue scale taken before application of NMES, once NMES was initiated and before NMES was withdrawn. Results In the operated limb NMES produced increases in peak venous velocity of 99% compared to resting. Mean velocity increased by 178% compared to resting and volume flow increased by 159% compared to resting. In the un-operated limb, peak venous velocity increased by 288%, mean velocity increased by 354% and volume flow increased by 614% compared to basal flow (p

Many of the devices used in the internal fixation of femoral neck fractures are cannulated and require the initial placement of one or more guidewires for accurate positioning. These wires are occasionally advanced inadvertently through the hip joint and the acetabulum. Pelvic visceral damage may follow. To assess this risk, we inserted three guidewires to a depth of 16 cm into each femoral neck of ten cadavers and explored the pelvis during autopsy. Thirty-two of the 60 guidewires had penetrated a pelvic organ. The literature on intrapelvic injuries associated with hip surgery is reviewed, and suggestions are offered on the avoidance of pelvic penetration during hip fracture fixation.