The DePuy Proxima (TM) short stem for total hip arthroplasty

Purpose: Metaphyseal, proximally anchored uncemented stems for total hip arthroplasty provide bone preservation and decrease the incidence of proximal stress shielding and thigh pain. Our study investigated the clinical and radiological outcome of the DePuy Proxima (TM) short stem at a minimum of 7 years. Methods: Eighty-one consecutive patients (86 procedures) under the age of 70 undergoing primary total hip replacement at two arthroplasty centres were enrolled. Follow-up was clinical (Harris Hip Score (HHS), thigh pain and satisfaction) and radiological (subsidence, malalignment and loosening) at 6 months and yearly thereafter. Results: Average age was 50 (range 32-65) with 79% (68 of 86) being male. Preoperative diagnosis included primary osteoarthritis (OA) 36%, avascular necrosis of femoral head 51%, dysplasia 9% and post-traumatic OA 4%. HHS improved 51 points at latest follow-up (from 40 to 91). We had 3.5% (3 of 86) periprosthetic fractures, one requiring revision. We had one dislocation, no infections and no thigh pain. Malalignment rate (>= 5 degrees off neutral) was 12% (10 of 86), not affecting clinical results. Conclusion: Overall stem survival was over 97% at 7 years. The DePuy Proxima provides excellent clinical results at a minimum of 7 years post-operatively

Successful treatment of late Salmonella infections in total hip replacement - report of two cases

Abstract Background Salmonella species can be rarely isolated from periprosthetic joint infections, however when present, are usually part of a severe septic clinical picture. Case presentations Two patients presented with late infected hip replacements to our institution. The first patient with multiple comorbidities had a confirmed Salmonella Enteridis infection with an abscess in the groin, with loosening of both components. He underwent a successful one stage cemented revision hip replacement, followed by 6 weeks of antibiotic therapy (ciprofloxacin). He had no recurrence or complications. The second patient was admitted in a septic condition with ARDS to the Intensive Care Unit 7 years following an uncemented total hip replacement. From an ultrasound guided hip aspirate Salmonella cholerae-suis was isolated. He underwent a successful a two-stage revision hip replacement. Conclusions Successful treatment of such potentially life threatening infections is achievable using modern orthopaedic techniques and close collaboration with the infectious diseases specialists.</p