Mid-term clinical results of the cementless R3 cup and Polarstem total hip arthroplasty.

BACKGROUND: There has been a shift from cemented to uncemented hip arthroplasty. One popular uncemented combination is the R3 acetabular cup with Polarstem, having the lowest revision rate in the UK National Joint Registry. However, there are no medium-term clinical outcomes on this combination in the literature. The aim of this study is to review our centre's outcomes with this combination using conventional bearings with a minimum of 7-year follow-up. METHODS: Using our centre's arthroplasty database, we identified all patients that underwent a total hip arthroplasty using these implants from August 2009 to December 2010. One hundred and forty-four procedures were performed. The primary outcome was revision rate, and the secondary outcomes were clinical and radiological evaluation. RESULTS: The mean cohort age at surgery was 68.3 years. There were three revisions, of which only one underwent a cup revision. The mean Oxford Hip Score at 7-year follow-up was 38. Radiological evaluation of both acetabular and stem component did not show any radiolucency at 7-year follow-up. Kaplan-Meier survivorship analysis showed an implant survival rate of 97.69% at 7 years using revision for all causes as endpoint. The risk of revision was 1.47% at 7 years. CONCLUSION: Our revision rates are comparable to the UK's National Joint Registry, with excellent clinical and radiological outcome. Our results correlate with the allocated rating of 7A* by the Orthopaedic Data Evaluation Panel for both R3 acetabular cup and Polarstem.

A Comparative Study Between Uncemented and Hybrid Total Hip Arthroplasty in Octogenarians.

BACKGROUND: The aim of this prospective cohort study is to evaluate the outcome of octogenarian patients undergoing uncemented total hip arthroplasty (THA) with a control group of similarly aged patients undergoing hybrid THA with a minimum 5-year follow-up. METHODS: Clinical outcomes including intraoperative and postoperative complications, blood transfusion, revision rate, and mortality were recorded. Radiological analysis of preoperative and postoperative radiographs assessed bone quality, implant fixation, and any subsequent loosening. RESULTS: One hundred forty-three patients (mean age 86.2 years) were enrolled in the study. Seventy-six patients underwent uncemented THA and 67 underwent hybrid THA. The uncemented cohort had a significantly lower intraoperative complication rate (P = .017) and also a lower transfusion rate (P = .002). Mean hospital stay (P = .27) was comparable between the 2 groups. Two patients underwent revision surgery in each cohort. CONCLUSION: Our study demonstrates that uncemented THA is safe for the octogenarian patient and we recommend that age should not be a barrier to the choice of implant. However, intraoperative assessment of bone quality should guide surgeons to the optimum decision regarding uncemented and hybrid implants. LEVEL OF EVIDENCE: 3.

R3 Cup Does Not Have a High Failure Rate in Conventional Bearings: A Minimum of 5-Year Follow-Up.

BACKGROUND: The R3 cementless acetabular system was first marketed in Australia and Europe in 2007. Previous papers have shown high failure rates of the R3 cup with up to 24% with metal-on-metal bearing. There are currently no medium term clinical results on this cup. The aim of the study is to review our results of the R3 acetabular cup with conventional bearings with a minimum of 5-year follow-up. METHODS: Patients who were implanted with the R3 acetabular cup were identified from our center's arthroplasty database. A total of 293 consecutive total hip arthroplasties were performed in 286 patients. The primary outcome was revision. The secondary outcomes were the Oxford Hip Scores (OHS) and radiographic evaluation. RESULTS: The mean age of the patients was 69.4 years. The mean preoperative OHS was 23 (range 10-34) and the mean OHS was 40 (range 33-48) at the final follow-up. Radiological evaluation showed an excellent ARA score in all patients at 5 years. None of the R3 cups showed osteolysis at the final follow-up. There were 3 revisions in our series, of which 2 R3 cups were revised. The risk of revision was 1.11% at 5 years. CONCLUSION: Our experience of using the R3 acetabular system with conventional bearings showed high survivorship and is consistent with the allocated Orthopaedic Data Evaluation Panel rating of 5A* as rated in 2015 in the United Kingdom.

Popliteal Artery Pseudoaneurysm After Total Knee Arthroplasty.

BACKGROUND: Popliteal artery pseudoaneurysm is a rare complication after total knee arthroplasty. Early recognition is imperative in its management to prevent the subsequent development of compartment syndrome and soft tissue ischemia. The aim of this study was to evaluate the complication rate, recognition, and management of symptomatic popliteal artery pseudoaneurysm after total knee arthroplasty. METHODS: Between January 2004 and October 2014, 7937 consecutive total knee arthroplasties were identified from the Theatre Management (Ormis) System and cross-referenced against 1304 radiology reports containing the key words "popliteal" and "aneurysm' identified from the Patient Archiving Communication System. RESULTS: Seven patients (0.088%) were found to have had a symptomatic popliteal artery pseudoaneurysm. The median (range) interval between total knee arthroplasty and the radiological diagnosis of a pseudoaneurysm was 15 (7-27) days. Popliteal artery pseudoaneurysm was diagnosed on duplex imaging (n = 4), arteriogram (n = 2), and computed tomography angiogram (n = 1). Fasciotomies were undertaken in 3 patients. CONCLUSION: The complication rate of popliteal artery pseudoaneurysm was comparable to the literature. Recognition was identified as a problem. An appreciation of the mechanisms of injury and an awareness of this potential complication among orthopedic surgeons are imperative in reducing the complication rate and interval to diagnosis. Popliteal artery pseudoaneurysm should be included in the differential diagnosis for patients with a clinical presentation of postoperative compartment syndrome or deep vein thrombosis, and examination of the popliteal pulse should be undertaken early.

Early failure of the Polarstem total hip arthroplasty--can the Australian NJR tell us the full story?

The Australian NJR 2012 has reported that the Polarstem/R3 Total hip arthroplasty has a higher than anticipated revision rate with a three year cumulative percentage of 3%. Out of the 733 Polarstem femoral components, 18 had to be revised within 3 years. Our unit has been using this system since 2009. The aim of this prospective study is to report the clinical outcome of the PolarStem in our cohort of 646 stems with 100% follow up, compared to the Australian registry. Of the 646 hips, 5 returned to theater for a further operation for any reason. The cumulative 3 year survival rate was 99.7%, with revision for any reason as the endpoint. Our 3 year cumulative revision rate for all revisions in the Polarstem femoral stem is 0.15%, which is 20 times less as compared to the 3% reported by the Australian registry.

Can we reduce the number of MRSA screening site swabs in elective orthopedic patients?

BACKGROUND: Deep infection after routine elective orthopedic procedures can be catastrophic, leading to further surgery, loss of limb, disability, and risk of mortality. Ring-fencing elective orthopedic ward has been shown to significantly reduce the incidence of all postoperative infections especially with methicillin-resistant Staphylococcus aureus (MRSA). Our hospital's current MRSA screening is a four-site MRSA swabs. OBJECTIVES: This study evaluates the possibility of reducing the number of MRSA swab sites as part of a quality improvement project. STUDY DESIGN AND METHODS: Patients on the waiting list for elective orthopedic procedure in our trust who had an MRSA-positive swab from either four sites were analyzed over the time period from January 2012 to December 2014. Those without swabs from all four areas (nose, throat, axilla, and groin) were excluded. Positive swabs of different regions were recorded and compared. RESULTS: There were 138 MRSA-positive patients, giving an incidence of 31 per 10,000 screen/year over that time period. Some patients ( n = 31, 22.5%) had a positive swab in more than one site. The positive sites were as follows: nose (69.60%, n = 96), groin (26.10%, n = 36), throat (25.30%, n = 35), and axilla (8.70%, n = 12). In our cohort, we would miss a significant proportion of positive patients if we change it to a two swab screening policy (26.8% for nose and axilla combination; 18.10% for nose and groin combination; and 15.20% for nose and throat). However, we would only miss 2.2% of cases for a nose, groin, and throat three-swab policy. There were also 11 instances, where a previously negative site become positive in the next swab. CONCLUSION: A three-swab combination of nasal, throat, and groin swabs improves pickup rate of MRSA significantly compared to a two-swab policy and misses only 2.2% compared to a four-swab policy. Axilla swabbing does not make a significant difference to the results. Based on this study, the policy has now been changed from a four-swab to three-swab screening in our trust. This has now been audited four times and they were all negative. This has helped to reduce cost in terms of staff time and resources. We would not recommend screening only the previous positive site for the next repeat screening swabs as there is an 8% chance of missing MRSA carrier status.