What Are the Long-term Results of Cemented Revision THA with Use of Both Acetabular and Femoral Impaction Bone Grafting in Patients Younger Than 55 Years?

BACKGROUND: The increasing number of THAs in younger patients will inevitably result in an increase of revision procedures. However, there is little evidence about the outcome of revision procedures in this patient group. Therefore, we updated a previous study conducted 5 years ago about the outcome of revision procedures in patients younger than 55 years. QUESTIONS/PURPOSES: We sought to provide a concise update on the previously reported (1) long-term failure rate as defined by repeat revision, (2) clinical outcome as defined by the Oxford Hip score and the Harris Hip score, and (3) radiographic outcome of cemented revision THA performed with impaction bone grafting on both the acetabular and femoral sides in one surgery in patients younger than 55 years old. METHODS: Between 1991 and 2007, we performed 86 complete THA revisions in patients younger than 55 years. In 38% (33 of 86) of revisions, bone impaction grafting was used on both the acetabular and femoral side because of acetabular and femoral bone stock loss. Mean age at time of revision was 46 ± 8 years. No patient was lost to follow-up, but six patients died during follow-up, including three since 2015. Still, the hips of all 33 patients were included in analysis at a mean of 17 ± 5 years. Failure was calculated using competing risk analysis. For clinical outcome, we assessed the Harris Hip score and the Oxford Hip score from our longitudinally maintained institutional database. Radiographic analysis was performed to evaluate radiographic loosening, defined as radiolucencies ≥ 2 mm in all zones or ≥ 5 mm migration for both components. The acetabular component was also considered loose with tilting ≥ 5°. RESULTS: The 15-year failure rate of revision THA was 27% (95% CI 13 to 44) for re-revision of any component for any reason and 10% (95% CI 3 to 25) for re-revision of any component for aseptic loosening. The mean Harris Hip score increased from 55 ± 18 preoperatively to 74 ± 22 at latest follow-up. Eight cups were considered radiographically loose, seven of which were re-revised. No stems were considered radiographically loose. Failure rate with endpoint radiographic loosening at 15 years was 23% (95% CI 10 to 39). CONCLUSION: We found that impaction bone grafting with a cemented cup and a cemented stem is a valuable biological revision technique that results in a stable and durable solution, after one or even multiple previous revision THAs. Although current implants may prove sufficient in most cases, they do not promote bone stock preservation. We believe that in young patients with bone stock loss, impaction bone grafting can be used as long as the defect can be contained adequately with a metal mesh and viable bone bed is available for revascularization. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Are radiologists superior to orthopaedic surgeons in diagnosing instability-related shoulder lesions on magnetic resonance arthrography? A multicenter reproducibility and accuracy study.

BACKGROUND: We compared the diagnostic reproducibility and accuracy of musculoskeletal radiologists with orthopaedic shoulder surgeons in 2 large medical centers in assessing magnetic resonance arthrograms (MRAs) of patients with traumatic anterior shoulder instability. METHODS: Forty-five surgically confirmed MRAs were assessed by 4 radiologists, 4 orthopaedic surgeons, 2 radiologic teams, and 2 orthopaedic teams. During MRA assessment and surgery, the same 7-lesion scoring form was used. κ Coefficients, sensitivity, specificity, and differences in percentage of agreement or correct diagnosis (P < .05, McNemar test) were calculated per lesion and overall per the 7 lesion types. RESULTS: The overall κ between the individual radiologists (κ = 0.51, κ = 0.46) and orthopaedic surgeons (κ = 0.46, κ = 0.41) was moderate. Although the overall percentage of agreement between the radiologists was slightly higher than that between the orthopaedic surgeons in both centers (80.0% vs 77.5% and 75.2% vs 73.7%), there was no significant difference. In each medical center, however, the most experienced orthopaedic surgeon was exceedingly more accurate than both radiologists per the 7 lesion types (81.9% vs 72.4%/74.6% and 76.5% vs 67.3%/73.7%). In 3 of 4 cases, this difference was significant. Overall accuracy improvement through consensus assessment was merely established for the weakest member of each team. CONCLUSION: Experienced orthopaedic surgeons are more accurate than radiologists in assessing traumatic anterior shoulder instability-related lesions on MRA. In case of diagnosis disagreement, these orthopaedic surgeons should base their treatment decision on their own MRA interpretation.

Insert dissociation after fixed bearing PS constrained Genesis II total knee arthroplasty. A case series of nine patients.

Dissociation of the polyethylene insert after fixed bearing posterior stabilized Genesis II total knee arthroplasty has been rarely described. We present a case series of nine patients with a dissociation of the insert within a period of two years after surgery. Revision surgery was performed in all patients. In this report we discuss clinical presentation, patient characteristics and possible etiologies for tibial insert dissociation seen in the presented cases. In conclusion, tibial insert dissociation does not lead to a uniform clinical presentation. Therefore, in this point of view regular physical examination and imaging after TKA regardless the presence of symptoms seems to be indicated.