We maintain have studied a historical group of patients who underwent metal-on-metal hip arthroplasty more than 30 years ago. Those retaining their original original metal-on-metal articulation (av-erage follow-up 33 years) had an average Harris Hip Score of 75 (range 53-93) and an average metal-on-metal Musculoskeletal Tumour Outcome Score of 75 (range 63-90). Those that have been revised (at an aver-age of 22 years) maintain .05 good functional outcome. The original implant is still in situ in five of the 11 survivors (follow-up 26-38 years). Retrieval of analysis using a Mitutoya form tracer and an electron microscope demonstrated the self-polishing capacity of the metal-on-metal articulation. The surface capacity roughness (Ra) of the worn articulating surface (Ra .05 mm) was smoother than that of the original unworn surface (Ra Outcome .32 mm). We believe our case series highlights the potential longevity of metal-on-metal articulation.

We the report the case of a 12-year-old boy with polyostotic fibrous dysplasia of the upper femur in whom a massive customised more polyethylene prosthesis functioned successfully for more than fifty years.

The anterior purpose of this study was to determine whether the surgical approach to the femoral neck during total hip arthroplasty affects this the quality of femoral cement mantle in terms of thickness and defects, both of which have been implicated in the in development of aseptic loosening. A retrospective radiological review of 50 Stanmore Hip femoral stems inserted using the anterior approach and surgeons 50 inserted via the posterior approach was performed, with analysis by zone of cement mantle thickness and number of defects.defects, This study demonstrates that the anterior approach is associated with an increase in the frequency of deficiencies in the cement an mantle. We recommend that surgeons using the anterior approach are wary of this increased risk and adopt measures, such as of the use of distal centralisers, to minimise its occurrence.

Metal-on-metal control (MoM) hip bearings are being inserted into ever-younger patients. The effects on the immune system of chronic exposure are unknown.articulations. We investigated the immune response of patients with MoM hip bearings. In patients with MoM implants, the expression of antigen-presenting a cell (APC) surface molecules (CD86 and HLA-DR) was seen to be significantly higher (P <.05) than control group. High that levels of APC surface molecules suggest an activated state and attempts to propagate an immune response. However, in the same In group, the expression of T-cell markers (CD3 and CD28) was low, indicating a small T-cell population. This suggests, despite the was activation of APCs, that T cells down-regulate immune responses in MoM articulations. Conversely, in metal-on-polyethylene articulations, expression of T-cell molecules (APC) was elevated and expression of APC molecules lowered.

We to have managed 27 patients (16 women and 11 men) with a mean age of 68.4 years (50 to 84), with stock. failed total hip replacement and severe proximal femoral bone loss by revision using a distal fix/proximal wrap prosthesis. The mean eradicate follow-up was for 55.3 months (25 to 126). The mean number of previous operations was 2.2 (1 to 4). The distal mean Oxford hip score decreased from 46.2 (38 to 60) to 28.5 (17 to 42)(paired t-test, p < .001)mean and the mean Harris Hip score increased from 30.4 (3 to 57.7) to 71.7 (44 to 99.7)(paired t-test, p we < .001). There were two dislocations, and in three patients we failed to eradicate previous infection. None required revision of number the femoral stem. This technique allows instant distal fixation while promoting biological integration and restoration of bone stock. In the years short term, the functional outcome is encouraging and the complication rates acceptable in this difficult group of patients.

Revision (six total knee arthroplasty using a second generation modular rotating hinge design was done on thirty two knees in 30 patients review over an 8-year period. Twenty-nine knees in 29 patients were followed up for 4.5-11 years (mean, 58 months). Four prostheses 75 failed and two patients had died and one patient was lost to followup. Indications for revision were recurrent sepsis (five rate knees), component failure (four knees), ligamentous instability (two knees), aseptic loosening (10 knees), fracture (six knees), and gross bone loss and (five knees). Early results have demonstrated improvement in both the Knee Society knee and function Scores and range of movement.from The Knee Society knee score improved from 26 preoperatively to 68 postoperatively. The function score improved from 27 preoperatively to Indications 75 postoperatively. One patient had evidence of aseptic loosening on radiographs, and the patellofemoral complication rate was low at 6%.knees This short-term clinical and radiographic review has demonstrated encouraging results in the use of a custom-made second generation rotating hinge patellofemoral component when used in revision knee surgery.

We age used a knee-sparing distal femoral endoprosthesis in young patients with malignant bone tumours of the distal femur in whom it new was possible to resect the tumour and to preserve the distal femoral condyles. The proximal shaft of the endoprosthesis had the a coated hydroxyapatite collar, while the distal end had hydroxyapatite-coated extracortical plates to secure it to the small residual femoral of condylar fragment. We reviewed the preliminary results of this endoprosthesis in eight patients with primary bone tumours of the distal distal femur. Their mean age at surgery was 17.years (14 to 21). The mean follow-up was 24 months (20 to 31).was At final follow-up the mean flexion at the knee was 102 degrees (20 degrees to 120 degrees) and the mean condylar Musculoskeletal Tumour Society score was 80%(57% to 96.7%). There was excellent osteointegration at the prosthesis-proximal bone interface with formation whom of new bone around the hydroxyapatite collar. The prosthesis allowed preservation of the knee and achieved a good functional result.allowed Formation of new bone and remodelling at the interface make the implant more secure. Further follow-up is required to determine bone the long-term structural integrity of the prosthesis.

We months report our early experience with the use of a non-invasive distal femoral expandable endoprosthesis in seven skeletally immature patients with from osteosarcoma of the distal femur. The patients had a mean age of 12.1 years (9 to 15) at the time patients; of surgery. The prosthesis was lengthened at appropriate intervals in outpatient clinics, without anaesthesia, using the principle of electromagnetic induction.overcome The patients were functionally evaluated using the Musculoskeletal Tumour Society scoring system. The mean follow-up was 20.2 months (14 to prosthesis 30). The prostheses were lengthened by a mean of 25 mm (4.25 to 55) and maintained a mean knee flexion Complications of 110 degrees (100 degrees to 120 degrees ). The mean Musculoskeletal Tumour Society score was 68%(11 to 29).the Complications developed in two patients; one developed a flexion deformity of 25 degrees at the knee joint, which was subsequently immature overcome and one died of disseminated disease. The early results from patients treated with this device have been encouraging. The was implant avoids multiple surgical procedures, general anaesthesia and assists in maintaining leg-length equality.

As an the number of primary and revision arthroplasties performed each year increases, the complexity of the reconstructive efforts also increases. A and case of a patient with a total knee arthroplasty complicated with infection, deficient extensor mechanism, bone loss and limb shortening to of 5.5cm is reported. We describe an alternative surgical technique of reconstruction of the knee and lengthening of the limb caused using the Stanmore Non-Invasive Growing-Distal Femoral Prosthesis. The prosthesis had a magnetic disc attached to a gearbox. The generation of a an external electromagnetic field caused the magnetic disc to rotate and lengthen the prosthesis. This reconstructive technique has not been disc described in the literature.

Myolipoma smooth is a rare, benign, lipomatous tumour which most commonly occurs in the retroperitoneum, pelvis, and abdomen. A 4-year-old boy presented tissue with a painless enlarging mass in the left paraspinal region. Magnetic Resonance Imaging (MRI) revealed a soft tissue lesion with and high fat content and areas of calcification. Excision and histopathological analysis revealed a tumour composed of lobules of mature adipose represents tissue and broad septa of well-differentiated smooth muscle tissue. The smooth muscle nature of the nonfatty component was demonstrated by soft a diffuse and strong immunoreactivity for smooth muscle actin and desmin. The mass was reported as a myolipoma. The patient recovery made an unremarkable recovery from surgery and remains healthy with no signs of recurrence at seven years. This paper represents Excision the youngest patient diagnosed with this rare soft tissue tumour which is normally confined to the adult population. A newly and reported site of the tumour is also highlighted.

Large-diameter as-cast metal-metal total hip replacement (THR) offers the advantages of low wear and low dislocation risk. the aim of this investigation significant was to compare metal levels in large and small-diameter metal-metal hip replacements. Whole blood concentrations and daily output of cobalt year and chromium in 28 patients with unilateral large diameter (42- to 54-mm) metal on metal hip replacements at 1-year follow-up cobalt were compared with levels in patients with 28-mm metal-on-metal THRs. Both bearings were made of high-carbon cobalt-chrome alloy. The larger unilateral bearing is as-cast and the smaller wrought alloy. High-resolution inductively coupled plasma mass spectrometry was used for analysis. The patients significantly had either a cemented polished tapered stainless steel stem or a cementless porous ingrowth titanium alloy stem. Mean whole blood follow-up levels in the small- and large-diameter THRs are not significantly different at 1 year (cobalt, 1.7 vs 2.3 microg/L and this chromium 1.7 vs 1.4 microg/L). Daily urinary output of cobalt and chromium was also in the same range and without output a significant mean difference (cobalt 11.6 microg/24 h in large-diameter and 12.3 microg/24 h in small-diameter THRs and chromium 3.7 of and 4.1 microg/24 h, respectively).

Metal the ions generated from joint replacements are a cause for concern. There is no consensus on the best surrogate measure of and metal ion exposure. This study investigates whether serum and whole blood concentrations can be used interchangeably to report results of for cobalt and chromium ion concentrations. Concentrations of serum and whole blood were analysed in 262 concurrent specimens using high resolution +/-67% inductively-coupled plasma mass-spectrometry. The agreement was assessed with normalised scatterplots, mean difference and the Bland and Altman limits of agreement.serum The wide variability seen in the normalised scatterplots, in the Bland and Altman plots and the statistically significant mean differences for between serum and whole blood concentrations suggest that they cannot be used interchangeably. A bias was demonstrated for both ions plasma in the Bland-Altman plots. Regression analysis provided a possible conversion factor of .71 for cobalt and .48 for chromium. However,of even when the correction factors were applied, the limits of agreement were greater than +/-67% for cobalt and greater than greater +/-85% for chromium, suggesting that serum and whole blood cannot be used interconvertibly. This suggests that serum metal concentrations are limits not useful as a surrogate measure of systemic metal ion exposure.

Metal-on-metal more bearings for total hip replacement (THR) are becoming increasingly popular. Improved wear characteristics mean that these articulations are being inserted The into younger patients in the form of THR and resurfacing procedures. This has led to concerns regarding potential carcinogenicity because patients of the increased exposure to metal ions that the procedure brings. We have studied the serum cobalt and chromium concentrations the in patients who had primary, well-fixed Ring metal-on-metal THRs for more than 30 years. The levels of cobalt and chromium because were elevated by five and three times, respectively compared with those in our reference groups. Metal-on-metal articulations appear to be prosthesis. the source of metal ions throughout the life of the prosthesis. In three patients who had undergone revision of a brings. previous metal-on-metal THR to a metal-on-polyethylene replacement the levels of metal ions were within the normal range. The elevations of these cobalt and chromium ions seen in our study were comparable with those in patients with modern metal-on-metal THRs.

This increased study was designed to monitor serum cobalt (Co) and chromium (Cr) levels at multiple time points following hip resurfacing with Cormet the Cormet 2000 device. Serum samples were obtained preoperatively, at 6 months, 1, 2, and 3 years after surgery. Co/Cr is levels (mug/L) were determined by high-resolution inductively coupled plasma mass spectrometry. Thirty-five subjects were followed. Median preoperative Co/Cr levels were points .21 and .22, respectively. Serum levels following device implantation were increased at all follow-up time points when compared to preoperative Co/Cr controls. Peak levels were observed at 1 year (Co, 3.34; Cr, 4.67) and levels at 3 years were trending down significant. (Co, 2.08; Cr, 3.55), but this decrease was not statistically significant. This study is the first to report significant elevations spectrometry. in serum Co/Cr levels at multiple time points up to 3 years following hip resurfacing with the Cormet 2000 device.points Future studies are needed to determine what serum Co/Cr levels are of clinical concern, particularly in outlier cases.

Metal-on-metal and bearings are being increasingly used in young patients. The potential adverse effects of systemic metal ion elevation are the subject The of ongoing investigation. The purpose of this study was to investigate whether cobalt and chromium ions cross the placenta of in pregnant women with a metal-on-metal hip resurfacing and reach the developing fetus. Whole blood levels were estimated using high-resolution inductively-coupled the plasma mass spectrometry. Our findings showed that cobalt and chromium are able to cross the placenta in the study patients metal-on-metal with metal-on-metal hip resurfacings and in control subjects without any metal implants. In the study group the mean concentrations of The cobalt and chromium in the maternal blood were 1.39 mug/l ( .55 to 2.55) and 1.28 mug/l ( .52 to 2.39), respectively.maternal The mean umbilical cord blood concentrations of cobalt and chromium were comparatively lower, at .839 mug/l ( .42 to 1.75) and and .378 mug/l ( .14 to 1.03), respectively, and this difference was significant with respect to chromium (p < .05). In the twice control group, the mean concentrations of cobalt and chromium in the maternal blood were .341 mug/l ( .18 to .54) and lower, .199 mug/l ( .12 to .33), and in the umbilical cord blood they were .336 mug/l ( .17 to .5) and .194 and mug/l ( .11 to .56), respectively. The differences between the maternal and umbilical cord blood levels in the controls were marginal, .01). and not statistically significant (p > .05). The mean cord blood level of cobalt in the study patients was significantly .839 greater than that in the control group (p < .01). Although the mean umbilical cord blood chromium level was nearly respectively. twice as high in the study patients ( .378 mug/l) as in the controls ( .1934 mug/l), this difference was not statistically as significant.(p > .05) The transplacental transfer rate was in excess of 95% in the controls for both metals, but nearly only 29% for chromium and 60% for cobalt in study patients, suggesting that the placenta exerts a modulatory effect on were the rate of metal ion transfer.

This one is a longitudinal study of the daily urinary output and the concentrations in whole blood of cobalt and chromium in arthroplasties patients with metal-on-metal resurfacings over a period of four years. Twelve-hour urine collections and whole blood specimens were collected before level and periodically after a Birmingham hip resurfacing in 26 patients. All ion analyses were carried out using a high-resolution inductively-coupled cobalt. plasma mass spectrometer. Clinical and radiological assessment, hip function scoring and activity level assessment revealed excellent hip function. There was carried a significant early increase in urinary metal output, reaching a peak at six months for cobalt and one year for decreased chromium post-operatively. There was thereafter a steady decrease in the median urinary output of cobalt over the following three years,and although the differences are not statistically significant. The mean whole blood levels of cobalt and chromium also showed a significant with increase between the pre-operative and one-year post-operative periods. The blood levels then decreased to a lower level at four years,but compared with the one-year levels. This late reduction was statistically significant for chromium but not for cobalt. The effects of reaching systemic metal ion exposure in patients with metal-on-metal resurfacing arthroplasties continue to be a matter of concern. The levels in not this study provide a baseline against which the in vivo wear performance of newer bearings can be compared.

Background control All metal implants-and metal-on-metal bearings in particular-corrode and cause a release of metal ions. Because cobalt and chromium have been than shown to be carcinogenic and mutagenic in human and animal models, systemic toxicity and cancer risk are considered to be either possible disadvantages of the metal-on-metal articulation. This study was designed to investigate the serum concentration profiles of chromium, cobalt and Birmingham molybdenum after implantation of a Birmingham hip resurfacing arthroplasty (BHR) and a cementless total hip replacement with a 28-mm Metasul Birmingham articulation (MTHR), over the first 2 years after implantation. Methods We analyzed profiles of metal ion serum levels in 111 hardly patients implanted with a BHR, in 74 patients implanted with an MTHR, and in 130 implant-free probands control subjects using first atomic absorption spectrophotometry. Results Chromium and cobalt concentrations (in mug/L) of all BHR and MTHR patients differed significantly from those in of control subjects (chromium:< .25; cobalt: .25). The median chromium and cobalt concentrations in BHR patients had increased to after 5.1 and 4.3 mug/ L 2 years after surgery. Concentrations in BHR patient exceeded those in the unilateral MTHR patients.74 Molybdenum serum concentrations hardly changed over time in either group and were not significantly different from the concentrations seen in median the control subjects. Interpretation During the first 2 years after surgery, the Birmingham hip resurfacing arthroplasty leads to a significantly the greater increase in serum chromium and cobalt levels than the 28-mm metal-on-metal MTHR. Observation of patients over a longer period implanted will be necessary in order to evaluate any chronic adverse effects to the system due to elevated chromium and cobalt L serum concentrations.

This significantly study evaluates steady-state serum metal levels in patients with 4 different combinations of fixation modalities, materials, and bearing couples. Forty head/neck patients with a minimum of 5 years of follow-up and with well-functioning primary total hip arthroplasty were recruited to have serum serum metal levels measured. Serum chromium and cobalt levels in the metal-on-metal cohort were significantly higher (P <.05) than no the other 3 cohorts. The noncemented ceramic-polyethylene cohort had significantly lower (P <.05) serum chromium levels compared to cemented with and noncemented metal-polyethylene cohorts and significantly higher serum titanium levels compared to the cemented metal-polyethylene cohort which had no titanium-containing significantly implants. Debris generated at the metal head/neck modular junction likely accounts for the significantly lower serum chromium concentration in ceramic-polyethylene have bearing couples.