Hip international : the journal of clinical and experimental research on hip pathology and therapy
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Infection is a devastating complication of total hip arthroplasty (THA). Risk factors have been recognised and prevention is possible. ⋯ Available data in the current literature is of poor quality and there is a lack of data comparing different techniques. Referral of patients to dedicated departments with the appropriate facilities may be more appropriate.
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Attempts to resurface the hip joint date back to the 1930s. Throughout the last century many designs failed due to defective materials or fixation (or a combination). ⋯ Ultimately, a much narrower range of indications emerged - large, young males appear to be the ideal recipients. Implant design features and component orientation are crucial to the survivorship of these implants.
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Resurfacing arthroplasty has fallen out of favour in recent years due to unfavourable survivorship in joint registries and alarming reports of soft tissue reactions around metal on metal prostheses. Our aim was to assess the effect of head size, implant design and component positioning on metal production by resurfacing arthroplasties. We measured whole blood cobalt and chromium and component position in matched populations implanted with two designs of resurfacing arthroplasty over a two-year period. ⋯ Small diameter metal resurfacing components result in increased metal generation compared with larger components. As increased metal generation has been correlated to wear and therefore failure, caution must be used on implantation of smaller components and indeed, in those who require smaller components, alternative bearing materials should be considered. These results contrast with recent findings which have demonstrated early failure for larger diameter stemmed metal-on-metal prostheses.
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Comparative Study
Cementless bipolar hemiarthroplasty using a rectangular cross-section stem for unstable intertrochanteric fractures.
The purpose of this study was to compare the clinical and radiographic results for elderly patients sustaining unstable intertrochanteric fractures treated with an uncemented bipolar hemiarthroplasty using a double-tapered, rectangular cross-section stem. Thirty-seven patients (21 females, 16 males; mean age 73.5 years, range 65-88 years) who underwent bipolar hemiarthroplasty with a standard (double-tapered, rectangular cross-section) uncemented stem were followed up for a minimum of two years. At final follow-up, 27 patients (72.9%) had recovered their daily living ability (Barthel index), and 28 patients (75.6%) had recovered all walking ability at a community level (Koval's category).
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Comparative Study
Incidence of adverse wear reactions in hip resurfacing arthroplasty: a single surgeon series of 2,600 cases.
A single surgeon performed 2,559 metal-on-metal hip resurfacing arthroplasties in 2,109 patients. The Corin Cormet 2000 (393 cases) and Biomet Recap implants (2,166 cases) were used in our series. In this study, the adverse wear failure (AWF) rate was 0.27%. ⋯ All had severe metallosis found at the time of revision. Six of the seven AWF cases were in women. There were no failures from pseudotumours without AWF (metallosis) in this series.