Survivorship, clinical outcomes and indications for revision in uncemented unicompartmental knee arthroplasty: systematic review.

Modern uncemented unicompartmental knee arthroplasty (UKA) relies on the mechanics of the implant design and a biological bond at the bone-implant interface to create a secure fixation of its components. The aim of this systematic review was to determine implant survivorship, clinical outcomes and indications for revision in uncemented UKAs. A search strategy was employed using keywords related to UKAs and uncemented fixation to identify suitable studies. Both prospective and retrospective studies with a minimum of two year mean follow-up were included. Data was gathered on study design, implant type, patient demographics, survivorship, clinical outcome scores and the indications for revision. Methodological quality was assessed using a ten-point risk of bias scoring tool. Eighteen studies were included in the final review. The mean follow-up of studies ranged between 2-11 years. The primary outcome of survival demonstrated 5 year survivorship ranged between 91.7-100.0% and 10-year survivorship between 91.0-97.5%. Clinical and functional outcome scores were found to be excellent in the majority of studies with the remaining reporting good results. Revisions represented 2.7% of the total operations performed. There were 145 revisions with an overall revision rate of 0.8 per 100 observed component years. Osteoarthritis disease progression (30.2%) and bearing dislocations (23.8%) were the most common causes of implant failure. This review finds uncemented UKAs demonstrate comparable survivorship, clinical outcomes and safety profile to cemented UKAs to consider this fixation a suitable alternative in clinical use.

Does exchange arthroplasty of an infected shoulder prosthesis provide better eradication rate and better functional outcome, compared to a permanent spacer or resection arthroplasty? a systematic review.

BACKGROUND: The best surgical modality for treating chronic periprosthetic shoulder infections has not been established, with a lack of randomised comparative studies. This systematic review compares the infection eradication rate and functional outcomes after single- or two-stage shoulder exchange arthroplasty, to permanent spacer implant or resection arthroplasty. METHODS: Full-text papers and those with an abstract in English published from January 2000 to June 2014, identified through international databases, such as EMBASE and PubMed, were reviewed. Those reporting the success rate of infection eradication after a single-stage exchange, two-stage exchange, resection arthroplasty or permanent spacer implant, with a minimum follow-up of 6 months and sample size of 5 patients were included. RESULTS: Eight original articles reporting the results after resection arthroplasty (n = 83), 6 on single-stage exchange (n = 75), 13 on two-stage exchange (n = 142) and 8 papers on permanent spacer (n = 68) were included. The average infection eradication rate was 86.7 % at a mean follow-up of 39.8 months (SD 20.8) after resection arthroplasty, 94.7 % at 46.8 months (SD 17.6) after a single-stage exchange, 90.8 % at 37.9 months (SD 12.8) after two-stage exchange, and 95.6 % at 31.0 months (SD 9.8) following a permanent spacer implant. The difference was not statistically significant (p = 0.650). Regarding functional outcome, patients treated with single-stage exchange had statistically significant better postoperative Constant scores (mean 51, SD 13) than patients undergoing a two-stage exchange (mean 44, SD 9), resection arthroplasty (mean 32, SD 7) or a permanent spacer implant (mean 31, SD 9) (p = 0.029). However, when considering studies comparing pre- and post-operative Constant scores, the difference was not statistically significant. CONCLUSION: This systematic review failed to demonstrate a clear difference in infection eradication and functional improvement between all four treatment modalities for established periprosthetic shoulder infection. The relatively low number of patients and the methodological limitations of the studies available point out the need for well designed multi-center trials to further assess the best treatment option of peri-prosthetic shoulder infection.

Reconstruction of failed acetabular component in the presence of severe acetabular bone loss: a systematic review.

Acetabular revision especially in the presence of severe bone loss is challenging. There is a paucity of literature critiquing contemporary techniques of revision acetabular reconstruction and their outcomes. The purpose of this study was to systematically review the literature and to report clinical outcomes and survival of contemporary acetabular revision arthroplasty techniques (tantalum metal shells, uncemented revision jumbo shells, reinforced cages and rings, oblong shells and custom-made triflange constructs). Full-text papers and those with an abstract in English published from January 2001 to January 2016 were identified through international databases. A total of 50 papers of level IV scientific evidence, comprising 2811 hips in total, fulfilled the inclusion criteria and were included. Overall, patients had improved outcomes irrespective of the technique of reconstruction as documented by postoperative hip scores. Our pooled analysis suggests that oblong cups components had a lower failure rate compared with other different materials considered in this review. Custom-made triflange cups had one of highest failure rates. However, this may reflect the complexity of revisions and severity of bone loss. The most common postoperative complication reported in all groups was dislocation. This review confirms successful acetabular reconstructions using diverse techniques depending on the type of bone loss and highlights key features and outcomes of different techniques. In particular, oblong cups and tantalum shells have successful survivorship.

Outcome of surgical management of stress fractures in high demand individuals.

Stress fractures represent one-fifth of overuse injuries in sport. Successful healing of stress fractures in high demand individuals is important to prevent complications upon early return to activity. This article reviews the literature on outcomes of surgical management of stress fractures in high demand individuals. An online literature search was carried out for articles published up to and including January 2017. Twenty five papers were reviewed. In the majority of studies, no complications were reported, clinical and radiographic healing was achieved, and patients returned to their premorbid level of activity. Current literature suggests good outcomes after surgical management of stress fractures in high demand individuals, particularly those in whom conservative treatment has failed. Further studies comparing surgical techniques are necessary to demonstrate the most efficacious.

Early performance-based and patient-reported outcomes of a contemporary taper fit bone-conserving short stem femoral component in total hip arthroplasty.

AIMS: The aim of this study was to compare early functional and health related quality of life outcomes (HRQoL) in patients who have undergone total hip arthroplasty (THA) using a bone conserving short stem femoral component and those in whom a conventional length uncemented component was used. Outcome was assessed using a validated performance based outcome instrument as well as patient reported outcome measures (PROMs). PATIENTS AND METHODS: We prospectively analysed 33 patients whose THA involved a contemporary proximally porous coated tapered short stem femoral component and 53 patients with a standard conventional femoral component, at a minimum follow-up of two years. The mean follow-up was 31.4 months (24 to 39). Patients with poor proximal femoral bone quality were excluded. The mean age of the patients was 66.6 years (59 to 77) and the mean body mass index was 30.2 kg/m2 (24.1 to 41.0). Outcome was assessed using the Oxford Hip Score (OHS) and the University College Hospital (UCH) hip score which is a validated performance based instrument. HRQoL was assessed using the EuroQol 5D (EQ-5D). RESULTS: There were no major peri-operative complications. There was no difference in the mean post-operative OHS, EQ-5D or function subscale of the UCH hip scores between the two groups. The mean pre-operative OHS and EQ-5D scores improved significantly (all p < 0.001). The mean functional component of the UCH hip score at final follow-up was 42.5 and 40.6 in the short stem and conventional stem groups, respectively. There was no statistically significant difference between the groups (p = 0.42). A total of seven patients (21.2%) in the short stem group and nine (16.98%) in the conventional group achieved a ceiling effect using the OHS; none did using the function subscale of the UCH hip score. CONCLUSION: The proximally porous coated tapered short stem femoral component achieves comparable short-term functional outcomes when compared with a conventional longer stem uncemented femoral component when THA is undertaken in patients with good bone quality. Cite this article: Bone Joint J 2017;99-B(4 Supple B):49-55.

The direct anterior approach in total hip arthroplasty: a systematic review of the literature.

AIMS: The most effective surgical approach for total hip arthroplasty (THA) remains controversial. The direct anterior approach may be associated with a reduced risk of dislocation, faster recovery, reduced pain and fewer surgical complications. This systematic review aims to evaluate the current evidence for the use of this approach in THA. MATERIALS AND METHODS: Following the Cochrane collaboration, an extensive literature search of PubMed, Medline, Embase and OvidSP was conducted. Randomised controlled trials, comparative studies, and cohort studies were included. Outcomes included the length of the incision, blood loss, operating time, length of stay, complications, and gait analysis. RESULTS: A total of 42 studies met the inclusion criteria. Most were of medium to low quality. There was no difference between the direct anterior, anterolateral or posterior approaches with regards to length of stay and gait analysis. Papers comparing the length of the incision found similar lengths compared with the lateral approach, and conflicting results when comparing the direct anterior and posterior approaches. Most studies found the mean operating time to be significantly longer when the direct anterior approach was used, with a steep learning curve reported by many. Many authors used validated scores including the Harris hip score, and the Western Ontario and McMaster Universities Arthritis Index. These mean scores were better following the use of the direct anterior approach for the first six weeks post-operatively. Subsequently there was no difference between these scores and those for the posterior approach. CONCLUSION: There is little evidence for improved kinematics or better long-term outcomes following the use of the direct anterior approach for THA. There is a steep learning curve with similar rates of complications, length of stay and outcomes. Well-designed, multi-centre, prospective randomised controlled trials are required to provide evidence as to whether the direct anterior approach is better than the lateral or posterior approaches when undertaking THA. Cite this article: Bone JointJ 2017;99-B:732-40.

[Interactions between solvents and noise: state of the art]. / Interazione tra solventi e rumore: stato dell'arte.

There are several environmental and occupational scenes where a co-exposure of noise and solvents occurs, therefore between a neurotoxic and a ototoxic agent. Epidemiological and experimental studies with simultaneous exposure to noise and solvents like toluene, styrene and carbon disulfide have been analysed. These studies investigate possible ototoxic effects through audiometry, auditory brainstem response, potential recall and reflex decay test. The current available data show that with high exposure levels, that are responsible for tissue damage by themselves, the interaction between noise and solvents could occur. The present knowledge can not permit a conclusion for low exposure levels.