Long-term results of metal on metal total hip arthroplasty in younger patients (<55yrs).

INTRODUCTION: Metal on Metal (MoM) hip arthroplasty saw a new era of popularity with development of its second generation bearing surfaces, in the first decade of this century. However, by the end of that decade, concerns had been raised due to metal debris related complications.We aimed to determine the survival of MoM stemmed hip replacement in younger population. We also studied the rate of revision related to adverse reaction to metal debris (ARMD) along with reviewing the clinical and radiological progress of MoM hip arthroplasty in younger age (<55 yrs) group. PATIENTS & METHODS: This is a retrospective cohort study of patients 55 yrs old or younger, who had metal on metal (MoM) hip arthroplasty for osteoarthritis. We had 109 procedures performed on 90 patients with a mean follow up of 10 years. All patients were reviewed as per MHRA guidelines in planned follow-up clinics. Data analyses were performed using SPSS. RESULTS: Survival of implant in our younger cohort was 88.1% at a mean age if 10 years, with revision for any cause as an endpoint. Most of the patients were happy with the outcome of their hip replacement as they were able to perform activities of daily living and work without compromise. Mean Oxford hip score was 43.Altogether, there were 12 revisions, 7 of these were for metallosis and associated symptoms. Average time to revision was 7 years. Other analysis revealed mean acetabular cup inclination angle to be 49 degrees but no significant correlation was found between this angle and serum metal ion levels. Serum Chromium and Cobalt levels were significantly higher in revision group. DISCUSSION: Metal on metal hip arthroplasty prime popularity time has gone. In younger population, although revision rates are higher, the surviving implants give a very good outcome in terms of patient satisfaction. Most of the patients report a desired outcome of 'forgotten hip'.

Conversion of coal mine drainage ochre to water treatment reagent: Production, characterisation and application for P and Zn removal.

Coal mine drainage ochre is a ferruginous precipitate that forms from mine water in impacted watercourses and during treatment. With thousands of tonnes per annum of such ochre arising from mine water treatment in the UK alone, management of these wastes is a substantive issue. This paper demonstrates that the ochre from both active and passive treatment of coal mine drainage can be transformed into an effective water treatment reagent by simple acid dissolution and that the reagent can be used for the removal of dissolved phosphorous from municipal wastewater and zinc from non-coal mine waters. Ochre is readily soluble in H2SO4 and HCl. Ochre is more soluble in HCl with solubilities of up to 100 g/L in 20% (w/w) HCl and 68 g/L in 10% (w/w) H2SO4. For four of the eight tested ochres solubility decreased in higher concentrations of H2SO4. Ochre compositional data demonstrate that the coal mine ochres tested are relatively free from problematic levels of elements seen by other authors from acid mine drainage-derived ochre. Comparison to British Standards for use of iron-based coagulants in drinking water treatment was used as an indicator of the acceptability of use of the ochre-derived reagents in terms of potentially problematic elements. The ochre-derived reagents were found to meet the 'Grade 3' specification, except for arsenic. Thus, for application in municipal wastewater and mine water treatment additional processing may not be required. There was little observed compositional difference between solutions prepared using H2SO4 or HCl. Ochre-derived reagents showed applicability for the removal of P and Zn with removals of up to 99% and 97% respectively measured for final pH 7-8, likely due to sorption/coprecipitation. Furthermore, the results demonstrate that applying a Fe dose in the form of liquid reagent leads to a better Fe:P and Fe:Zn removal ratio compared to ochre-based sorption media tested in the literature.

Anterior knee pain: an unusual presentation of renal cell carcinoma.

Metastasis of any kind to the patella is rare. Metastasis to the patella causing symptoms representing the first presentation of underlying malignancy is rarer still. We report the case of a previously fit and well 74-year-old male presenting with left anterior knee pain. The initial diagnosis was osteoarthritis but after continued symptoms a diagnosis of solitary patella metastasis from a primary renal cell carcinoma was confirmed.

Outcomes of Geriatric Hip Fractures Treated with AFFIXUS Hip Fracture Nail.

Geriatric hip fractures are one of the commonest fractures worldwide. The purpose of this study was to report the outcomes of a series of unstable geriatric hip fractures treated with AFFIXUS hip fracture nail. A retrospective study of 100 unstable geriatric hip fractures treated with AFFIXUS hip fracture nail is presented. The mean follow-up duration was 8 months (range 3-32). Of the patients 83% were female. The average age was 85 years. The fracture was treated by closed reduction and intramedullary fixation. The mean acute hospital stay was 17.6 days. Systemic complications occurred in 29 patients (29%) and local complications in 3 patients (3%) including lag screw cutout in one patient (1%), lag screw backout in one patient (1%), and deep infection in one patient (1%). Mechanical failures and periprosthetic fractures were not observed in our series. Fractures united in all patients. Preinjury activity level was recovered in 78% of the patients. The results of AFFIXUS hip fracture nail were satisfactory in most elderly patients. The unique design of the lag screw and its thread spacing had effectively reduced cut-out rate.

Non-union of Weber B distal fibula fractures: a case series.

Non-union of distal fractures of the fibula type Weber B is rare. Undisplaced and minimally displaced isolated lateral malleolar fractures (Weber B) usually unite without operative intervention. We present three cases of lateral malleolus non-union in healthy individuals. Two were treated with internal fixation plus bone grafting. The third patient remained asymptomatic and therefore did not undergo surgery for the fracture.

Wound infection in the management of hip fractures: a comparison between low-molecular weight heparin and mechanical prophylaxis.

A review of 205 consecutive patients was carried out to determine the association of low molecular weight heparin (LMWH) and the development of wound infection in patients having undergone surgery for a femoral neck fracture: 114 patients treated with LMW Heparin (Group A) and 91 patients with mechanical prophylaxis (Group B). The wounds were assessed using the ASEPSIS Score. Deep vein thrombosis (DVT) and pulmonary embolism (PE) were also noted. Twenty-two patients (19%) in group A developed infection; 9 patients (8%) showed severe infection. Eight patients (8%) in group B developed infection; one patient (1%) showed severe infection. The differences between these two groups regarding infection (p < 0.034) and severity of the infection (p < 0.001) were statistically significant. None of the patients developed PE; however 9 patients were diagnosed with a DVT. Based on these findings, it appears that the use of LMWH for DVT prophylaxis may increase the likelihood of developing a severe wound infection.