Steve Young

The articular surface replacement implant recall: a United Kingdom district hospital experience

We present our experience of the articular surface replacement (ASR) hip and the implant recall process. One hundred and twenty-one ASR components were implanted (21 resurfacing hip arthroplasty (RHA) and 100 ASR/XL modular total hip replacements). At the time of the implant recall in August 2010 there were 111 surviving hips (92%) with a mean follow-up of 44 months. Nine hips had been revised and one had been listed for revision surgery. Ninety-two percent of surviving implants were reviewed in the recall clinics, and blood metal ion levels or ultrasound scans were indicated in 38 hips (34%). Immediately after the recall process seven hips (6 ASR/XL and 1 RHA) were listed for revision and a further 9 were kept under close surveillance. One year after completion of the recall process 23 hips (19 ASR/XL and 4 RHAs) had been revised. A diagnosis of adverse reaction to metal debris (ARMD) was made at surgery in all but two hips. Our current revision rate for ASR RHA is 19% (mean follow-up 62 months, range 29–80) and for the ASR/XL is 19% (mean follow-up 53 months, range 10–80). The 5-year cumulative survival rates with revision for any reason for the ASR/XL, was 80.8% (95% confidence interval 72.0 – 89.5). Given experience elsewhere we expect this rate may increase significantly with time.

Early discharge after hip arthroplasty with home support: experience at a UK District General Hospital

One hundred and thirty-eight consecutive patients undergoing hip arthroplasty and accelerated discharge at our institution over 6 months were reviewed. Our protocol included transfer to a dedicated home support team. No minimal incision techniques or special anaesthetic/analgesic techniques were used. 66% of patients having primary joint replacements went home by the third post operative day and 91% by the fourth day. Re-admission rates were under 1% whilst under the care of the home support team. Patient satisfaction was high. 94% said they would use the service again. This protocol has saved over 1500 bed days per year whilst maintaining standards of care.

Spectral analysis of the sound produced during femoral broaching and implant insertion in uncemented total hip arthroplasty.

Preparation of the proximal femur using incremental broaches to create the ideal cancellous bone envelope is an important technique to perfect in uncemented hip arthroplasty. To guide broaching adequacy and final implant position, the surgeon can use audible pitch changes produced by the femoral broach and definitive implant. The aim of this study was to characterise these pitch changes by analysing the sound spectra created by the first broach, last broach and implant using spectral analysis software. The last broach and implant introduction spectra demonstrated low-frequency (400–1200 Hz) spectral peaks that were not detected when using the first broach. These frequencies corresponded to the natural resonant frequency of a standing sound wave within the femoral bone canal (~894 Hz) that was estimated using acoustic physics theory. The remaining spectral peaks were associated with transverse vibration modes produced by striking the metal broach handle and implant introducer and were a function of the constructs geometry and material properties.

The Corail ® Hip Stem

Corail® implants suit most femoral anatomies (Dorr-types A, B and C). Nevertheless, in all cases the indications need to be planned carefully taking account of the specifi c demands of the individual patient. It is important for the surgeon to understand the principle of ‘compaction broaching’ and the mechanism of fi xation using a fully hydroxyapatite-coated (HAC) stem as well as the correct implantation technique in order to achieve the best possible result for all patients. Even then, the surgeon needs to be aware that there might be some rare situations in which a different surgical technique is needed.

Failure of a Ceramic-on-Ceramic Hip Resurfacing Due to Metallosis

The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A fifty-two-year-old woman with a presumed metal allergy presented with severe and constant right-sided hip, groin, and buttock pain four years after a unilateral cementless large-diameter ceramic-on-ceramic hip implant (ESKA, Lubeck, Germany) had been used for resurfacing for severe osteoarthritis (Fig. 1). The hip had a 52-mm acetabular component and a 44-mm modular head; both articular surfaces consisted of a femoral component of a cobalt-chrome structure upon which was a “ceramicized” coating, while the acetabular component was a porous-coated titanium shell with a thin ceramic insert. Fig. 1 Anteroposterior (left) and lateral (right) pelvic radiographs of the hip resurfacing. The patient had experienced three years of symptom-free mobility and then noticed a “painful clunk.” The pain subsequently became constant and severe, and she walked with the aid of a crutch. According to visual analogue scales, the hip pain was reported to be 6/10 at rest and 8/10 with activity. The range of flexion prior to revision was 0° to 65° for the right hip and 0° to 120° for the left hip. There was no mass palpable in the right groin, buttock, or trochanteric area. Serum metal iron levels were 320 nmol/L and 300 nmol/L for cobalt and chrome, respectively (the upper limit of normal is 120 for cobalt and 135 for chrome, as recommended by the Medicines and Healthcare products Regulatory Agency, United Kingdom). The C-reactive protein level was less than 3 mg/L (normal range, 0-2 mg/L). An ultrasound confirmed a fluid-containing mass (measuring 5 cm × 2 cm) just anterior to the proximal aspect of the femur and communicating with the hip joint. The femoral component was appropriately positioned with a neck-shaft angle of 144°; the cup had an inclination angle of …