Search

Purpose: The purpose of this study was to investigate if patient's gender significantly affected the long-term outcome of patients undergoing total knee arthroplasty (TKA) and to provide a cross-gender comparison of a large patient sample from a single regional register., Methods: The Registry of Prosthetic Orthopedic Implant of Emilia Romagna (RIPO) investigated all primary TKAs performed from July 2000 to December 2020 by collecting data of men and women separately. Primary bicompartmental and tricompartmental TKAs were included. The survival rates and the reasons for revision were assessed to check if any other factor could have influenced implant failure., Results: In total, 66,032 TKAs were included and analysed, comprising 46,774 women and 19,258 men. The 15-year Kaplan-Meier survival percentage was 93.6% for women and 92.5% for men (p = 0.001). Men exhibited a higher revision risk following primary TKA (p = 0.012), particularly when the primary diagnosis was arthritis resulting from rheumatic disorders (p = 0.018) and arthritis following high-tibial osteotomy (p = 0.024). Failure risk was also higher for men below the age of 60 years (p = 0.038)., Conclusion: The long-term outcome in TKA showed significant differences between men and women, with a significantly lower survival rate in men at 15 years, especially when they are under 60 years old or with a diagnosis of rheumatic disorders or arthritis following high-tibial osteotomy. It is necessary to design specific studies to have relevant data concerning gender differences in prosthetic surgery and to customise treatments to improve outcome and patient satisfaction., Level of Evidence: Level III., (© 2024 The Authors. Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Introduction: Optimal bearing size in total hip arthroplasty (THA) has not been clearly ascertained, but large diameter ceramic balls may improve function and implant stability, with minimal concerns for wear. Delta ceramic-on-ceramic (COC) THA were stratified based on head diameter (32, 36 and 40 mm), aiming to assess: 1) survival rates, reasons for revision and hazard ratios for failure; 2) survival rates and hazard ratios for aseptic loosening, dislocation/primary instability, liner failure., Materials and Methods: A regional arthroplasty registry was enquired about Delta COC THA performed for primary osteoarthritis, stratified by head size. 13,161 primary cementless THAs were included in the study, with a mean follow-up of 5.7 years (range: 0-17): 3980 (30.2%) 32 mm balls, 8327 (63.3%) 36 mm heads, 854 (6.5%) 40 mm heads., Results: The three cohorts achieved similar survival rates (p = 0.99) and adjusted hazard ratios (p > 0.05). No revisions for head breakage or metallosis occurred. When revision for cup aseptic loosening was the endpoint, the survival rates of three cohorts (p = 0.08) and the adjusted hazard ratios (p > 0.05) were similar. The three cohorts achieved comparable survival rates when revision for dislocation/primary instability was the endpoint (p = 0.08). When the endpoint was revision for liner breakage, 32 mm cohort showed higher rates of revision (p = 0.01). No liner failure was detected in the 40 mm cohort., Conclusions: 32 mm, 36 mm and 40 mm provided similar 10-year survival rates in Delta COC THA. 40 mm heads emerged as safe options but did not lower the revisions for dislocations/primary instability., Level of Evidence: IV (therapeutic study)., Competing Interests: Declarations Conflicts of interest The authors received no financial or material support for the research, authorship, and/or publication of this article. Ethical approval Institutional board review was waived, as registry collects data as a standard practice and using data anonymization., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Vancouver B2 and B3 periprosthetic fractures (PFF) are associated with stem instability and often require a demanding stem implant revision (SR) or internal fixation (ORIF). This latter surgery is increasingly performed in the last few years instead of SR, but it is unclear which is the best treatment to manage PFF patients. The aim of this study is the compare the outcomes of B2/B3 PFF managed by either ORIF or SR, by performing a systematic review and meta-analysis of current literature., Materials and Methods: Cochrane Database, PubMed, Google Scholar and MEDLINE were examined to find out relevant publications dealing with the different outcomes of SR vs. ORIF in B2/B3 PFF of the hip. The effect model (EM) was calculated using Cohen´s d index., Results: Fifteen studies were included, reporting on a total of 1629 patients (564 ORIF and 1065 SR). The pooled random EM estimates for reoperation was 0.87 (95% CI, 0.39-1.96; I2 = 78%) in favor of ORIF surgery; EM for complications was 1.01 (95% CI, 0.45-2.27; I2 = 85%) without difference among procedures. The EM for transfusion was 0.72 (95% CI, 0.46-1.12; I2 = 62%) in favor of fixation., Conclusion: ORIF and SR were both suitable and effective options in PFF patients, being associated to similar complications rates. Our results show that ORIF performance in PFF patients is associated to significantly less in blood loss, surgical time and in-hospital stay. These advantages are particularly appealing in patients with multiple comorbidities., (© 2024. The Author(s).)

Purpose: The patients with femoral metastasis in the inter- or subtrochanteric area could be treated with intramedullary nailing or prosthetic reconstruction, however, it is controversial which surgical treatment could offer less complications and implant failure. Our purpose was to define the risk of complications and implant survival in patients treated with intramedullary nailing or prosthetic reconstruction., Methods: We analyzed studies reporting the risk of complications, reoperations and removal of the implant in patients treated with intramedullary nailing, hemiarthroplasty, arthroplasty or megaprosthesis., Results: We analyzed 27 studies (1346 patients) reporting patients treated with intramedullary nail (51%), hemiarthroplasty (15%), arthroplasty (2%), megaprosthesis with (25%) or without (7%) acetabular component. No difference was found in the overall risk of complications between patients treated with intramedullary nailing 6%, hemiarthroplasty or total hip arthroplasty 7% and megaprosthesis 11% (p = 0.23). However, patients treated with megaprosthesis had increased risk of reoperation due to infection (70%), compared to the patients treated with intramedullary nail (13%), and patients treated with hemiarthroplasty or total hip arthroplasty (23%) (p = 0.02). Revision due to disease progression was required in 61% of the patients treated with intramedullary nail, but not in patients treated with hemiarthroplasty, total arthroplasty, and megaprosthesis (p = 0.03)., Conclusion: Patients treated with megaprosthesis had higher risk of reoperation due to infection, while patients treated with intramedullary nailing had higher risk of revision due to disease progression. Regarding patients treated with megaprosthesis, the risk of reoperation due to dislocation was higher in those treated with acetabular component., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Introduction: Recurrent dislocations are still the most frequent reason for revision in total hip arthroplasty (THA). The impact of bearing surfaces on dislocations is still controversial. We hypothesized that: (1) bearing surfaces influence the revisions due to dislocations; (2) ceramic-on-ceramic reduced the revisions for dislocations in adjusted models; (3) Delta-on-Delta bearings reduced the revisions for dislocations in comparison to surfaces with cross-linked polyethylene., Materials and Methods: The regional arthroplasty registry was enquired about bearing surfaces and revisions for dislocations and instability. Unadjusted and adjusted rates were provided, including sex, age (<65 years or ≥65 years), head diameter (≤28 mm or >28 mm; <36 mm or ≥36 mm) as variables. 44,065 THAs were included., Results: The rate of revisions for dislocations was significantly lower in ceramic-on-ceramic and metal-on-metal bearings (unadjusted rates). After adjusting for age, sex, and head size (36 and 28 mm), hard-on-hard bearings were protective (p < 0.05): ceramic-on-ceramic had a lower risk of revisions due to dislocation than ceramic-on-polyethylene (HR 1.6, 95% CI 1.2-2.2 p = 0.0009). The rate of revisions for dislocation was similar in bearings with cross-linked polyethylene and Delta-on-Delta articulations, in unadjusted and adjusted models., Conclusion: Bearings with conventional polyethylene were more predisposed to dislocations. Currently adopted bearings exerted no significant influence on revisions due to dislocations. These findings could be primarily related to wear, but due to the time distribution, soft tissue envelopes and surface tension may also play a role. Pre-clinical biomechanical evaluations and prospective matched cohort studies are required to draw definitive conclusions., (© 2021. The Author(s).)

Background: Fourth-generation ceramic-on-ceramic couplings were developed to improve ceramic toughness and strength. Encouraging outcomes in primary total hip arthroplasty were reported. This coupling was proposed as an attractive option even in the case of revision procedures, particularly in younger patients with a longer life expectancy. However, the pertinent literature is scarce. Thus, a registry study was conducted to investigate the midterm survival rates and reasons for re-revision of the fourth-generation ceramic-on-ceramic bearing surfaces in revision hip arthroplasties., Methods: A total of 327 revision implants (all the components were exchanged) with BIOLOX Delta couplings were investigated using the regional orthopedic registry RIPO. The demographics, the survival rates, and the reasons for re-revision were assessed. Revisions with bearings other than Delta were compared., Results: Delta bearings achieved a survival rate of 90.5% at 7 years, with stable results. Twenty-six (8%) re-revisions occurred at a mean follow-up of 4.1 years. And 2.8% of the re-revisions were due to recurrent dislocations; 1.5% of the cases were due to cup aseptic loosening. Septic loosening occurred in 1.6% of the cases. No ceramic fractures were reported. When compared to revisions with bearings other than Delta-on-Delta, Delta coupling cohort achieved similar performances at 5 and 7 years. Lower, nonsignificant rates of aseptic and septic loosening were reported in Delta cohort., Conclusion: Delta-on-Delta couplings demonstrated to be reliable bearing surfaces in revision settings at a midterm follow-up. Clinical studies and longer follow-ups are required to investigate potential adverse effects, like squeaking and fractures, and confirm these preliminary findings., Level of Evidence: Level III, therapeutic study., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: The incidence of total knee replacements (TKRs) in young patients is increasing. Few reports described encouraging results and acceptable survival rates. However, many concerns still persist, in particular about the high rates of infection and aseptic loosening. Aim of this article was to investigate the survival of TKRs in patients aged 45 years or younger in a registry population., Methods: The Emilia-Romagna registry RIPO was enquired about TKRs in patients ≤45 years; 238 TKRs were evaluated at a mean follow-up of 5.4 years (range 0-15.6 years), examining the features of the patients involved, the survival rate, and the reasons for revision of the knee implants., Results: The TKRs were generally performed in men, in private hospitals, and almost in half of the cases for other causes rather than primary osteoarthritis. The mean age was 40 years. Bicompartmental, cemented posterior-stabilized implants with fixed bearing were preferred. The survival rate was higher than 90% in the first 7 years, and then it decremented. The choice of implant did not apparently influence the survivorship. The final outcomes were acceptable, substantially in line with the previous literature about young patients. Twenty-one revisions occurred (8.8%), in particular 8 cases for aseptic loosening and 7 TKRs for infection. The rate of revision was higher than in overall population and even in some young cohorts., Conclusion: TKRs in patients aged 45 years or younger seem a promising procedure, although the high rates of septic and aseptic loosening should be carefully evaluated. Prospective, well-designed studies are required to confirm and investigate these preliminary findings., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Introduction: The current strategy for modular neck failures in total hip arthroplasty (THA) is calibrated on CrCo neck failures. Stem revision is usually required, but the procedure is challenging and achieves modest outcomes (up to 20% of re-revisions at short-term). No study reports revision strategies and outcomes after Ti neck failures. Aims of the study were to evaluate: (1) demographic and implant features of the cohort to be revised, (2) intra-operative findings and surgical revision strategies and (3) clinical and radiological post-revision outcomes. Materials and methods: Hospital database was enquired about revisions due to Ti neck failures in primary THAs. Sixty-five revisions were enrolled (all with the same modular system). Neck exchange was attempted as the first-line treatment. Patients were clinically and radiographically evaluated after revision. Results: The revision cohort encompassed fatigue neck fractures occurred 4.4 ± 2.6 years after THA: patients < 65 years and/or > 80 kg (98.5%) were predominant. Fifty-three neck exchanges were performed (81.5%). Eleven failures required stem revisions (16.9%), generally due to demanding neck extraction. Six complications occurred after neck exchange (11.3%), among them 2 acute infections requiring surgery (3.8%). Among stem revisions, one aseptic loosening and one neck re-fracture (18.5%) required re-revisions. At a mean follow-up of 7.1 ± 4 years, the neck exchange cohort achieved a mean HHS of 89.1 ± 6.3 (stem revisions: 84.1 ± 10.9). Conclusions: Revisions for Ti neck failures were predominantly performed due to fatigue fractures. In case of failures, neck exchange is a feasible procedure in most of the cases, with good outcomes at 7 years. Level of evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

Introduction: This registry study aims to assess the prevalence and demographic characteristics of patients with lumbar spine (LS) surgical procedures who undergo total hip arthroplasty (THA), to compare the long-term survival and causes of failure of THA in patients who previously underwent LS fusion and non-fusion surgical procedures, and to evaluate the risk of undergoing a revision LS surgery after THA. Materials and methods: Patients who underwent LS surgery followed by THA were identified by cross-referencing data from the Orthopedic Prosthetic Implants Registry and the Regional Hospital Discharge Database. Three groups of THA patients were identified: patients who underwent previous lumbar surgery with fusion (LS fusion-THA), without fusion (LS non-fusion-THA), and a control group with only THA (No LS surgery–THA). Demographic data, THA survival, number and causes of failure, and data on revision procedures on THA and LS were collected. Results: Of the total of 79,984 THA, 2.2% of patients had a history of LS procedures. THA only patients showed better results, while patients in the LS fusion-THA group had worse implant survival at 5-year follow-up. In the LS fusion-THA and LS non-fusion-THA, mechanical THA failures were more frequent in the first two years after implantation. There were no differences between groups regarding the risk of undergoing LS revision surgery. Conclusions: LS surgery negatively affects THA survivorship. In patients who previously underwent LS fusion and non-fusion surgical procedures, most THA failure occurs in the first two years after implant. The study contributes to the understanding of the relationship between the hip and the LS and provides useful guidance for clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: The use of reverse total shoulder arthroplasty has increased over the last decade. Like any other implant it is associated with complications sometimes leading to revision. We carried out a registry-based study in order to find possible risk factors associated with the need of revision surgery. Methods: The RIPO registry was analyzed from July 2008 to December 2018 collecting available data. Two groups (degenerative or fracture) were formed and compared to determine possible risk factors difference in revision surgery. Results: A total of 7,966 shoulder prosthesis were implanted. There was a 1.5% intra or peri-operative complication rate. The revision rate was 4.0% at a mean follow-up of 4.4 years. A total of 3,073 reverse total shoulder prosthesis were implanted and available for follow-up. An increase of revision rate (the most frequent causes being aseptic loosening, infection and instability) was found in patients younger than 65 years and in male patients. Two groups were then formed on the basis of the primary diagnosis: osteoarthritis and proximal humerus fracture. Comparison between the two groups showed an increase in instability requiring revision in the fracture group. Conclusion: Reverse shoulder prosthesis is a valid treatment option both in the elective and in the trauma settings, but young and male patients should be informed of the inherently increased risk of revision and prosthesis used in the fracture setting should be evaluated more thoroughly to prevent instability. [ABSTRACT FROM AUTHOR]

Background and objectives: Total hip arthroplasty (THA) in obese patients (BMI > 30) is considered technically demanding, and it is associated with higher rates of general and specific complications including infections, component malpositioning, dislocation, and periprosthetic fractures. Classically, the Direct Anterior Approach (DAA) has been considered less suitable for performing THA surgery in the obese patient, but recent evidence produced by high-volume DAA THA surgeons suggests that DAA is suitable and effective in obese patients. At the authors' institution, DAA is currently the preferred approach for primary and revision THA surgery, accounting for over 90% of hip surgeries without specific patient selection. Therefore, the aim of the current study is to evaluate any difference in early clinical outcomes, perioperative complications, and implant positioning after primary THAs performed via DAA in patients who were divided according to BMI. Material and methods: This study is a retrospective review of 293 THA implants in 277 patients that were performed via DAA from 1 January 2016 to 20 May 2020. Patients were further divided according to BMI: 96 patients were normal weight (NW), 115 were overweight (OW), and 82 were obese (OB). All the procedures were performed by three expert surgeons. The mean follow-up was 6 months. Patients' data, American Society of Anesthesiologists (ASA) score, surgical time, days in rehab unit, pain at the second post-operative day recorded by using a Numerical Rating Scale (NRS), and number of blood transfusions were recorded from clinical charts and compared. Radiological evaluation of cup inclination and stem alignment was conducted on post-operative radiographs; intra- and post-operative complications at latest follow-up were recorded. Results: The average age at surgery of OB patients was significantly lower compared to NW and OW patients. The ASA score was significantly higher in OB patients compared to NW patients. Surgical time was slightly but significantly higher in OB patients (85 ± 21 min) compared to NW (79 ± 20 min, p = 0.05) and OW patients (79 ± 20 min, p = 0.029). Rehab unit discharge occurred significantly later for OB patients, averaging 8 ± 2 days compared to NW patients (7 ± 2 days, p = 0.012) and OW patients (7 ± 2 days; p = 0.032). No differences in the rate of early infections, number of blood transfusions, NRS pain at the second post-operative day, and day of post-operative stair climbing were found among the three groups. Acetabular cup inclination and stem alignment were similar among the three groups. The perioperative complication rate was 2.3%; that is, perioperative complication occurred in 7 out of 293 patients, with a significantly higher incidence of surgical revisions required in obese patients compared to the others. In fact, OB patients showed a higher revision rate (4.87%) compared to other groups, with 1.04% for NW and 0% for OW (p = 0.028, Chi-square test). Causes for revision in obese patients were aseptic loosening (2), dislocation (1), and clinically significant post-operative leg length discrepancy (1), with a revision rate of 4/82 (4.87%) during follow-up. Conclusions: THA performed via DAA in obese patients could be a solid choice of treatment, given the relatively low rate of complications and the satisfying clinical outcomes. However, surgical expertise on DAA and adequate instrumentation for this approach are required to optimise the outcomes. [ABSTRACT FROM AUTHOR]

Total hip arthroplasty (THA) is one of the most common surgical procedures in orthopedics; however, it is subjected to different kinds of failures, one of them being dislocation. Many different prosthetic designs have been developed to overcome this problem, such as dual mobility coupling. The main purpose of this article is to determine whether there are differences regarding the revision surgery of unstable THA comparing the risk of failure between dual mobility cup (DMC) implants, standard implants, and among different head sizes. A registry-based population study has been conducted by analyzing data collected by the Emilia Romagna Registry of Orthopedic Prosthetic Implants (RIPO), including a total of 253 implants failed for dislocation and instability that were operated on by cup revision surgery between 2000 and 2019. The selected population has been divided into two groups based on the insert type: standard and DMC. The age at revision surgery was significantly lower in the standard cup group with respect to DMC (p = 0.014 t-test), with an average age of 71.2 years (33–96 years range) for the standard cups and 74.8 years (48–92 years range) for the DMC group. The cumulative survival of DMC implants was 82.0% at 5-years, decreasing to 77.5% at a 10-year follow-up, which is not significantly different from standard cups (p = 0.676, Log-Rank test). DMC implants showed a significantly lower risk of re-revision for dislocation compared to standard cups (p = 0.049). Femoral heads ≥36 mm had a higher overall survival compared to smaller femoral heads (p = 0.030). This study demonstrated that DMC or femoral heads ≥36 mm are a valid choice to manage THA instability and to reduce the revision rate for dislocation at a mid-term follow-up; in those selected and targeted patients, these options should be taken into consideration because they are associated with better outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Total hip arthroplasty (THA) is the standard procedure for post-traumatic osteoarthritis (OA) of the hip after acetabular fracture. However, it is not as simple as a primary THA, challenging the surgeon with anatomical deformity and intra and postoperative complications. In the current literature, there is a lack of studies reporting long-term results. May ceramic-on-ceramic (CoC) bearings provide good clinical and radiological outcomes at a long-term follow-up in patients undergoing THA following acetabular fracture? Materials and methods: We retrospectively analyzed 68 patients (mean age 47 years [range 22–75)] who underwent cementless modular neck stem THA, all implants CoC bearings (50 previously operatively treated and 18 non-operatively treated) after a specific CT study protocol at our Institute since 2000–2008. Clinical outcomes, prosthetic components' osseointegration, survival rate, and reasons for revision were analyzed. Minimum clinical and radiological follow-up was 10 years. Results: HHS improved significantly after surgery from 37.6 ± 14.1 to 88.4 ± 11.6. 8 revision surgeries were performed, none for infection: we reported 2 stem aseptic loosening, 2 periprosthetic femoral fractures and 4 modular neck fractures. One implant noise (third-generation ceramic coupling) was described. Cup osseointegration was present (according to Moore the presence of at least 3 radiological criteria defines an effective osseointegration) in 67 patients (98.5%). After a 10 years follow-up, survival rate resulted 88.4%, sensibly higher than most of results reported in the current literature. Conclusion: The high survival rate may be related to CoC: no osteolysis and no infections were reported. Also acetabular cup loosening incidence was sensibly lower (1.47%) among loosening rate described by other authors. Clinical and radiological outcomes were decent, probably due to modular prosthesis design. Modular necks are a solution which can help achieving a proper functional reconstruction of the hip (offset, center of rotation), but should be avoided in young and overweight patients because of the high risk of fracture. CoC bearings in THAs in post-traumatic OA after acetabular fracture showed good results despite the fact that specific ceramic-related issues have to be considered. [ABSTRACT FROM AUTHOR]

Introduction: Articular surface replacement (ASR) XL implants exhibit higher-than-expected revision rates, blood ion concentrations and soft tissue lesions, making revisions troublesome and potentially unsatisfying. Appropriate techniques and outcomes in ASR XL revisions are rarely documented. The aims of this study were the assessments of pre-revision data, post-revision clinical and radiographic outcomes and ion levels in isolated acetabular ASR XL revisions performed using highly porous titanium cups and Delta ceramic articulations. Methods: 18 isolated acetabular ASR XL revisions in 16 patients were performed using Ti-Por cups (Adler Ortho, Milan, Italy) and Delta bearings (CeramTec, Plochingen, Germany). Pre-revision demographic, clinical, radiological and implant-related features were assessed. Clinical and radiographic parameters (cup positioning, osseointegration) after revisions were evaluated at a minimum follow-up of 5 years. Ion concentrations in blood and urine were collected in pre-revision setting and 1 year after revision. Results: 4 complications occurred in 3 different revisions (16.7%), 1 dislocation, 2 infections, 1 psoas impingement. No re-revision was performed at 5 years (1 scheduled arthroscopy). Good clinical outcomes were achieved (HHS score: 88.3 ± 9.2). All the cups showed reassuring signs of osseointegration (>3 parameters). Blood ion concentrations significantly decreased: patients with Co blood ion concentration over the threshold (7 μg/l) decreased from 76.5% to 0%. No pre-revision or intraoperative data influenced the revision outcomes. Conclusions: Highly porous titanium cups and Delta ceramic articulations provided reliable mid-term clinical and radiographic outcomes in isolated acetabular ASR XL revisions. Ion concentrations significantly decreased. Multicentre prospective controlled studies are required to confirm these preliminary outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Late chronic periprosthetic infections (LCPIs) are worrisome complications of primary hip arthroplasties. The gold standard procedure is the 2-stage revision. 1-stage exchange is gaining popularity in order to reduce the invasivity of the former technique. A partial 2-stage exchange technique, retaining fixed components, may overcome some of the drawbacks of the previous techniques, allowing a much easier reconstruction step. Methods: 28 patients with a LCPI after a primary total hip arthroplasty underwent a first removal stage: the loosened component was removed (23 cups and 5 stems) and the fixed component, with no local signs of infection, was retained. An antibiotic hand molded spacer was positioned in 16 cases. After a mean time of 8 months and a tailored antimicrobial therapy, the spacer was removed and the implant was revised. Results: The mean follow-up was 5 years. The HHS score was 82.7. 4 cases failed (2 patients presenting a septic relapse after revision and 2 patients undergoing Girdlestone arthroplasty), achieving a survival rate of 83.4% at 5 years. 2 patients were unwilling to perform a further procedure and did not proceed to the second stage. All the other patients had no clinical, radiological, laboratory signs of septic relapse. Conclusions: The partial 2-stage approach seems a promising technique for LCPI in selected cases, with good infection control. It allows an easier revision by sparing the fixed components. Larger case series and longer follow-ups are needed to confirm the results and identify the limits of this approach. [ABSTRACT FROM AUTHOR]

Background and purpose — Little is known about the role of retained trunnions in revision hip arthroplasties, i.e., when only the femoral head is substituted. Wear (fretting corrosion) and ceramic head fractures are 2 poorly understood concerns related to use, and the role of adapter sleeves has not been defined. In this registry study we assessed the influence of sleeve interposition on re-revision rates in revision hip arthroplasties with retained stems. Confounding factors (demographics, implant-related features) and failures were also analyzed. Patients and methods — We conducted a registry study on 1,127 revised implants (retained trunnion and head exchange). In 26% of implants an adapter sleeve was interposed; in 74% no adapter sleeve was implanted. Demographic and implant-related features were investigated including a descriptive analysis of failures. Results — The mean follow-up of revised implants with and without the use of an adapter sleeve was 3.3 and 5.1 years, respectively. The implant survival without an adapter sleeve was significantly higher, 98.4% (95% CI 96.9–99.8) vs. 95.2% (CI 93.2–96.6) with an adapter sleeve at 5 years. No re-revisions due to adverse local tissue reactions or ceramic head fractures were reported. In order to overcome the different distribution of head materials and head sizes in the two cohorts, only Delta balls were investigated. Interpretation — Adapter sleeve interposition had a minor influence on the revision rates. No adverse local tissue reactions or head fractures occurred. [ABSTRACT FROM AUTHOR]

Purpose: Periprosthetic hip infection (PHI) is a devastating complication. The association between PHI and bearing surfaces as well as patient-related factors has been recently investigated, with contradictive outcomes. The dataset of Emilia-Romagna region Registry for Orthopaedic Prosthetic Implants (RIPO) has been assessed to investigate, if the bearing choice influenced the risk of septic loosening occurrence.Methods: RIPO data about 39,206 cementless total hip arthroplasties (THA), collected since 2003, were analysed. Age, gender, BMI, diabetes and bearing surfaces were evaluated. The end point of the study was the revision of at least a single component due to sepsis.Results: Adjusted and unadjusted survival rates showed that ceramic-on-ceramic (COC) implants had the lower incidence of PHIs, whereas metal-on-metal (MOM) THAs were significantly more prone to infection. In MOM cohort, stemmed implants were involved in 28 out of 30 cases. Among the demographical features and comorbid conditions, only diabetes statistically influenced the rate of sepsis.Conclusions: Bearing surfaces influenced the rate of PHI; in particular, stemmed MOM implants were at higher risk, probably due to metal debris consequent to taperosis. Despite the preliminary results, stemmed MOM THAs should be used with care, and diabetic patients should be warned about increased septic risks. [ABSTRACT FROM AUTHOR]

The article focuses on the revision of a total hip arthroplasty due to a fractured ceramic component. Information on the fracture rate of ceramic components is provided. It notes that this problem can be attributed to the growing use of ceramic total hip replacements. The failure rate associated with this kind of revision arthroplasty is 31%.