The economic benefit of hip replacement: a 5-year follow-up of costs and outcomes in the Exeter Primary Outcomes Study

To assess changes in quality of life and costs of patients undergoing primary total hip replacement using the Exeter prosthesis compared with a hypothetical 'no surgery' group

Early Development of Total Hip Replacement

Annotated and edited transcript of a Witness Seminar held on 14 March 2006. Introduction by Dr Francis Neary and Professor John Pickstone. First published by the Wellcome Trust Centre for the History of Medicine at UCL, 2007. ©The Trustee of the Wellcome Trust, London, 2007. All volumes are freely available online at: www.history.qmul.ac.uk/research/modbiomed/wellcome_witnesses/Annotated and edited transcript of a Witness Seminar held on 14 March 2006. Introduction by Dr Francis Neary and Professor John Pickstone,Annotated and edited transcript of a Witness Seminar held on 14 March 2006. Introduction by Dr Francis Neary and Professor John Pickstone,Annotated and edited transcript of a Witness Seminar held on 14 March 2006. Introduction by Dr Francis Neary and Professor John Pickstone,Annotated and edited transcript of a Witness Seminar held on 14 March 2006. Introduction by Dr Francis Neary and Professor John Pickstone,Annotated and edited transcript of a Witness Seminar held on 14 March 2006. Introduction by Dr Francis Neary and Professor John Pickstone,Annotated and edited transcript of a Witness Seminar held on 14 March 2006. Introduction by Dr Francis Neary and Professor John Pickstone,Total hip replacement effectively began in the UK in 1938 and has led to widely used, commercially successful, mass-produced devices that relieve pain for an ever increasing period. The Witness Seminar, chaired by Mr Alan Lettin, discussed the remarkable postwar collaboration of British surgeons, engineers and manufacturing firms in the development of efficient alloys, surgical procedures, instruments and the implementation of clean, bacteria-reduced air in enclosed operating theatres, as illustrated by successful prostheses and techniques developed in Norwich (Kenneth McKee), Wrightington (Sir John Charnley), Stanmore (John Scales), Redhill (Peter Ring), and Exeter (Robin Ling and Clive Lee). Early failures - such as loosening from infection, osteolysis, and wear debris - stimulated the search for improved materials and fixation methods, as well as the addition of antibiotics to bone cement to reduce infection. National hip registers that record the survival of different implants were adopted in Europe in the 1970s (2003 in the UK), and they pinpoint the successful devices, as measured by survival and low rates of revision. An introduction to the volume by Dr Francis Neary and Professor John Pickstone, and appendices on materials by Professor Alan Swanson; on international standards by Mr Victor Wheble; and of details of selected prosthesis supplement the transcript. Contributors include: Lady Charnley, the late Mr Harry Craven, Mr Graham Deane, Professor Duncan Dowson, Mr Reg Elson, Dr Alex Faulkner, Professor Michael Freeman, Mrs Phyllis Hampson, Mr Kevin Hardinge, Mr Mike Heywood-Waddington, Mr John Kirkup, Mr Krishna (Ravi) Kunzru, Miss Betty Lee, Mr Alan Lettin (chair), Mr John Older, Mr John Read, Mr Peter Ring, Mr Ian Stephen, Mr Malcolm Swann, Professor Alan Swanson, Sir Rodney Sweetnam, Mr Keith Tucker, Mr Victor Wheble and Professor Michael Wroblewski. Reynolds L A, Tansey E M. (eds) (2007) Early development of total hip replacement, Wellcome Witnesses to Twentieth Century Medicine, vol. 29. London: The Wellcome Trust Centre for the History of Medicine at UCL.The Wellcome Trust Centre for the History of Medicine at UCL is funded by the Wellcome Trust, which is a registered charity, no. 210183

A Mendelian Randomization Study Provides Evidence That Adiposity and Dyslipidemia Lead to Lower Urinary Albumin-to-Creatinine Ratio, a Marker of Microvascular Function

This is the author accepted manuscript. The final version is available from American Diabetes Association via the DOI in this record Urinary albumin-creatinine ratio is a marker of diabetic nephropathy and microvascular damage. Metabolic-related traits are observationally associated with ACR but their causal role is uncertain. Here, we confirmed ACR as a marker of microvascular damage and tested whether metabolic-related traits have causal relationships with ACR.The association between ACR and microvascular function (responses to acetylcholine and sodium nitroprusside) were tested in the SUMMIT study. Two sample Mendelian randomization (MR) was used to infer the causal effects of eleven metabolic risk factors, including glycemic, lipid and adiposity traits on ACR. MR was performed in up to 440,000 UK Biobank and 54,451 CKDGen participants.ACR was robustly associated with microvascular function measures in SUMMIT. Using MR we inferred that higher triglyceride and LDL-cholesterol levels caused elevated ACR. A one standard deviation (SD) higher triglyceride and LDL-C level caused a 0.062 [95%CI: 0.040, 0.083] and a 0.026 [95%CI: 0.008, 0.044] SD higher ACR respectively. There was evidence that higher body fat and visceral body fat distribution caused elevated ACR, whilst a metabolically "favourable adiposity" phenotype lowered ACR.ACR is a valid marker for microvascular function. MR suggested that 7 traits have causal effects on ACR, highlighting the role of adiposity related traits in causing lower microvascular function.Innovative Medicines Initiativ

Outcomes of total hip arthroplasty, as a salvage procedure, following failed internal fixation of intracapsular fractures of the femoral neck: a systematic review and meta-analysis.

AIMS: The optimal management of intracapsular fractures of the femoral neck in independently mobile patients remains open to debate. Successful fixation obviates the limitations of arthroplasty for this group of patients. However, with fixation failure rates as high as 30%, the outcome of revision surgery to salvage total hip arthroplasty (THA) must be considered. We carried out a systematic review to compare the outcomes of salvage THA and primary THA for intracapsular fractures of the femoral neck. PATIENTS AND METHODS: We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) compliant systematic review, using the PubMed, EMBASE and Cochrane libraries databases. A meta-analysis was performed where possible, and a narrative synthesis when a meta-analysis was not possible. RESULTS: Our analyses revealed a significantly increased risk of complications including deep infection, early dislocation and peri-prosthetic fracture with salvage THA when compared with primary THA for an intracapsular fracture of the femoral neck (overall risk ratio of 3.15). Functional outcomes assessment using EuroQoL (EQ)-5D were not significantly different (p = 0.3). CONCLUSION: Salvage THA carries a significantly higher risk of complications than primary THA for intracapsular fractured neck of femur. Current literature is still lacking well designed studies to provide a full answer to the question. TAKE HOME MESSAGE: Salvage THA is associated with more complications than primary THA for intracapsular neck of femur fractures

Movement pattern of the Exeter femoral stem: A radiostereometric analysis of 22 primary hip arthroplasties followed for 5 years

Background The design of the Exeter stem may facilitate distal migration, but radiostereometric analysis (RSA) studies have been limited to 2 years of follow-up. Patients and methods We followed migration of the Exeter femoral stems in 22 primary hip arthroplasties for 5 years with RSA. Results All stems migrated distally and the median migration at 2 years was 1.34 mm, while at 5 years it was 1.77 mm. 7 stems migrated above accuracy between 3 and 5 years. (RSA) evaluation of the cement mantle could be performed in 14 cases, and in 5 slight migration was found. Most of the stems rotated towards retroversion and the median rotation at 2 years was 1.2°, while at 5 years it was 1.6°. We found 1 patient with impending clinical failure but no deviation in the RSA migration pattern, and 1 patient with unstable migration pattern but no clinical symptoms. Interpretation We found a greater distal migration of the Exeter stem for longer periods of time than seen with other types of cemented implants

Is there evidence for accelerated polyethylene wear in uncemented compared to cemented acetabular components? A systematic review of the literature

Joint arthroplasty registries show an increased rate of aseptic loosening in uncemented acetabular components as compared to cemented acetabular components. Since loosening is associated with particulate wear debris, we postulated that uncemented acetabular components demonstrate a higher polyethylene wear rate than cemented acetabular components in total hip arthroplasty. We performed a systematic review of the peer-reviewed literature, comparing the wear rate in uncemented and cemented acetabular components in total hip arthroplasty. Studies were identified using MEDLINE (PubMed), EMBASE and the Cochrane Central Register of Controlled Trials. Study quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The search resulted in 425 papers. After excluding duplicates and selection based on title and abstracts, nine studies were found eligible for further analysis: two randomised controlled trials, and seven observational studies. One randomised controlled trial found a higher polyethylene wear rate in uncemented acetabular components, while the other found no differences. Three out of seven observational studies showed a higher polyethylene wear in uncemented acetabular component fixation; the other four studies did not show any differences in wear rates. The available evidence suggests that a higher annual wear rate may be encountered in uncemented acetabular components as compared to cemented components

Orthotic management of cerebral palsy : recommendations from a consensus conference

An international multidisciplinary group of healthcare professionals and researchers participated in a consensus conference on the management of cerebral palsy, convened by the International Society for Prosthetics and Orthotics. Participants reviewed the evidence and considered contemporary thinking on a range of treatment options including physical and occupational therapy, and medical, surgical and orthotic interventions. The quality of many of the reviewed papers was compromised by inadequate reporting and lack of transparency, in particular regarding the types of patients and the design of the interventions being evaluated. Substantial evidence suggests that ankle-foot orthoses (AFOs) that control the foot and ankle in stance and swing phases can improve gait efficiency in ambulant children (GMFCS levels I-III). By contrast, little high quality evidence exists to support the use of orthoses for the hip, spine or upper limb. Where the evidence for orthosis use was not compelling consensus was reached on recommendations for orthotic intervention. Subsequent group discussions identified recommendations for future research. The evidence to support using orthoses is generally limited by the brevity of follow-up periods in research studies; hence the extent to which orthoses may prevent deformities developing over time remains unclear. The full report of the conference can be accessed free of charge at www.ispoint.org

Economic inequalities in burden of illness, diagnosis and treatment of five long-term conditions in England: panel study

We compared the distribution by wealth of self-reported illness burden (estimated from validated scales, biomarker and reported symptoms) for angina, cataract, depression, diabetes and osteoarthritis, with the distribution of self-reported medical diagnosis and treatment. We aimed to determine if the greater illness burden borne by poorer participants was matched by appropriately higher levels of diagnosis and treatment

Hip revision using the Exeter stem, impacted morselized allograft bone and cement: A consecutive 5-year radiostereometric and radiographic study in 15 hips

Background: Impaction grafting in hip revision surgery is widely used but studies with mid- and long-term follow-up are scarce. Patients, methods and results A 5-year radiostereometric (RSA) follow-up of 15 hip revisions with the Exeter stem, morselized impacted allograft bone and cement revealed that 3 stems had not migrated between 2 and 5 years after revision, 11 stems had migrated to a minor degree in at least 1 direction, and 1 stem was loose according to RSA but without any radiographic signs of loosening or pain. The pain score was comparable to primary arthroplasties. Interpretation From a 5-year perspective, first-time hip revisions for aseptic loosening with impacted morselized allograft bone and cement appear to yield good clinical results, although stem migration continues to a minor degree 2 years after revision

Towards a working methodology for using total hip and knee joint replacements to support identification

Hip and knee prostheses have occasionally been used to support identification of unknown persons along with other medical devices and implants. This paper looks at the specific issues around using hip and knee implants, suggesting a working methodology for their use in supporting identification during and after a post-mortem. The value of Total Knee Replacements (TKR) and Total Hip Replacements (THR) as a means of identification along with other implants is a very recent area of interest in Forensic Science considering the long history of implants. This together with the recent introduction of Joint Replacement Registries means that using hip and knee implants to support identification is likely to become automatic in the future but is not currently automatic. The paper looks at the accumulative collection of evidence as well as the range of issues including; the types and changes in early prostheses, examination of the body for external indications of implants, radiological recording prior to autopsy for confirmation of identification using matching of features with ante-mortem images, actual harvesting and collection of all parts of the joint replacement including cement and any other components, specific differences between TKR and THR. In developing an approach to the problems associated with identifications using TKRs and THRs a stepwise process and the full recording of all of the features associated with the implant as well as manufacturers details and identification numbers is suggested so that the cumulative nature of these features will help to narrow down possibilities towards a more certain identification and confirmation of that identification