Cement-in-cement stem revision for Vancouver type B periprosthetic femoral fractures after total hip arthroplasty: A 3-year follow-up of 23 cases

Background and purpose Revision surgery for periprosthetic femoral fractures around an unstable cemented femoral stem traditionally requires removal of existing cement. We propose a new technique whereby a well-fixed cement mantle can be retained in cases with simple fractures that can be reduced anatomically when a cemented revision is planned. This technique is well established in femoral stem revision, but not in association with a fracture

Effective curricula for at-risk students in vocational education:a study of teachers’ practice

Abstract Background This study focused upon a curriculum for at-risk students in vocational education aimed at enhancing students’ motivation and engagement for learning. The study explored teachers’ view on effective curricular characteristics and teachers’ strategies to create positive learning experiences for students. Methods Qualitative research has been conducted regarding four curricula for at-risk students; data were collected and examined by means of 16 focus group interviews with teachers and analysis of relevant documents. Results Teachers pointed out the central position of the student, resulting in individual trajectories. Teachers used peer group dynamics, job orientation and sports as tool for student development. Teachers regarded themselves as coaches, as experts in sport activities and as group managers. For positive learning experiences two key curricular characteristics have been identified: (1) equality in the relationship between student and teacher, (2) a positive fit between the curriculum and the students

The use of a modified posterior approach (SPAIRE) may be associated with an increase in return to pre-injury level of mobility compared to a standard lateral approach in hemiarthroplasty for displaced intracapsular hip fractures. A single-centre study of the first 285 cases over a period of 3.5 years

This is the final version. Available on open access from Springer via the DOI in this recordBackground and purpose. A tendon-sparing modification of the posterior approach to the hip joint was introduced in the specialist hip unit at our institution in 2016. The SPAIRE technique - acronym for “Saving Piriformis And Internus, Repair of Externus” preserves the insertions of gemellus inferior, obturator internus, gemellus superior and piriformis intact. We compare the results of the first 285 hip hemiarthroplasty patients, unselected but preferentially treated by our hip unit surgeons using the SPAIRE technique, with 567 patients treated by all orthopaedic surgeons (including the hip unit) in the department over the same 3.5 year period using the standard lateral approach. We report length of stay, return to pre-injury level of mobility, place of residence and mortality at 120 days. Patients and Methods. The review included all hemiarthroplasty patients. Prefracture mobility and place of residence, surgical approach, grade of senior surgeon in theatre, stem modularity, acute and overall length of stay, mobility, place of residence, reoperations and mortality at 120 days were recorded. Data were obtained from the National Hip Fracture Database that included a telephone followup at 120 days and from electronic patient records. Results. The odds of returning to pre-injury level of mobility were higher in the SPAIRE technique group than in the standard lateral group; adjusted odds ratio (95% confidence interval (CI)) 1.7 (1.1 to 2.7, p = 0.01). Interpretation. When used in hip hemiarthroplasty, the SPAIRE technique appears safe and may confer benefit in maintaining the pre-injury level of mobility over the standard lateral approach

The long-term results of the original exeter polished cemented femoral component - a follow-up report

We present a long-term follow-up report of the results of the original Exeter polished cemented stems inserted between November 1970 and the end of 1975 at our institution by surgeons of widely differing experience, utilising crude cementing techniques. The results of this series were reported in 1988 [1] and again in 1993 [2]. There have been no failures from aseptic femoral component loosening since the 1993 report. From the original series of 433 hips there were, at the end of 2003, 26 living patients with 33 hips. Of the latter, there were 25 hips in 20 patients with their original femoral components still in situ. 28 hips (6.46%) from the original series have been lost to follow-up, though none since 1992. With the end-point re-operation for aseptic stem loosening, the survivorship is 93.5% (95% CI: 90.0% to 97.0%).The re-operation rate for aseptic femoral component loosening is 3.23% into the 33rd year of follow-up

Benefits of using modern cementing techniques in the acetabulum: the Rim Cutter

Purpose. To compare radiological records of 90 consecutive patients who underwent cemented total hip arthroplasty (THA) with or without use of the Rim Cutter to prepare the acetabulum. Methods. The acetabulum of 45 patients was prepared using the Rim Cutter, whereas the device was not used in the other 45 patients. Postoperative radiographs were evaluated using a digital templating system to measure (1) the positions of the operated hips with respect to the normal, contralateral hips (the centre of rotation of the socket, the height of the centre of rotation from the teardrop, and lateralisation of the centre of rotation from the teardrop) and (2) the uniformity and width of the cement mantle in the 3 DeLee Charnley acetabular zones, and the number of radiolucencies in these zones. Results. The study group showed improved radiological parameters and were closer to the anatomic centre of rotation both vertically (1.5 vs. 3.7 mm, p<0.001) and horizontally (1.8 vs. 4.4 mm, p<0.001) and had consistently thicker and more uniform cement mantles (p<0.001). There were 2 radiolucent lines in the control group but none in the study group. Conclusion. The Rim Cutter resulted in more accurate placement of the centre of rotation of a cemented prosthetic socket, and produced a thicker, more congruent cement mantle with fewer radiolucent lines

Investigating Human Hip Dislocation Using a Three-Dimensional Finite Element Human Hip Model

Hip dislocations are created by the large sudden applied dynamic forces like motor vehicle accidents or the pedestrian struck by automobiles [1] or even during some athletic activities [2]. Diagnosing and treating this, required to analyse how these dislocations can affect other tissues to understand its behaviour, form and function in different daily activities. For this purpose, a three-dimensional hip model was created from the MRI scans of one human subject based on constructing the entire pelvis and femur. The ball and socket joint was modelled between the hip’s acetabulum and the femoral head to analyse the multiaxial loads applied in the hip joint. The three key ligaments that reinforce the external surface of the hip to help to stabilise the joint were also modelled which are the intertrochanteric line, the pubofemoral and the ischiofemoral ligament. Each of these ligaments wraps around the joint connection to form a seal over the synovial membrane, a line of attachment around the head of the femur. Major muscles, the Iliopsoas, Gluteus Medius and Maximus, Piriformis, Obturator Internus and Externus muscles and also the femoral insertion of the Gluteus Maximus, were modelled to simulate the muscle loads. The selection of these muscles is due to their importance in the movement of the hip joint, mapping these muscles in a finite element model is crucial to gain a realistic analysis of the hip joint, its movement and the mechanical properties of the joint itself. After the MRI data set was acquired from a 20-year-old female subject with no medical issue involving the spine or the hip, 360 images of the right-side hip were used to construct the bio-realistic structures of the aforementioned human hip tissue. The developed finite element model is an asset for further research in investigating new methods of total hip arthroplasty, to minimise the recurrence of dislocations and discomfort in the hip joint, as well as increasing the range of movement available to a patient after surgery. The developed finite element model was tested for different loading and boundary conditions to analyse their sensitivities; while the initially assigned material properties and loading values on different model tissues were obtained from the literature

The Exeter Hip: 40 Years of Innovation in Total Hip Arthroplasty

* Propoerties and use of acrylic cement * Design and biomechaniscs of a cemented hip replacement * The science of loosening, lysis and wear * Preparation of patients for surgery * Potential complications and their avoidance * Modern primary surgical techniques and new developments * Complex primary hip replacement and specialist techniques * Outcomes of cemented hip replacement * Principles of revision hip replacement * Basic science of bone grafting in revision surgery * Femoral acetabular impaction bone grafting techniques * Results of revision with bone graft and cemen