Introduction: Prevention of infection after THA is very important. One of the modalities used to decrease the incidence of postoperative infection is skin scrubbing with antiseptics including betadine and chlorhexidine. This study was performed to compare the antiseptic efficacies of betadine and chlorhexidine in decreasing the risk of infection after THA. Methods: In this double-blind clinical trial, 102 patients underwent THA were assigned randomly to two equal groups. In the first group, betadine was used to scrub the skin preoperatively. In the second group, chlorhexidine was utilized. The incidence of postoperative wound complications were compared between two groups. Results: Two groups were the same in term of age and sex. There were 3 (two superficial and 1 deep) and 1 patients (superficial) with postoperative wound infection in betadine and chlorhexidine group, respectively. The Fisher’s exact test revealed that there is no statistically difference (p=0.617). The signs of infection included secretion, erythema, fever and blisters. Conclusion: The current study showed that both betadine and chlorhexidine are effective substances to scrub the skin before THA to reduce the risk of postoperative infection.

Introduction: Periprosthetic joint infection (PJI) remains a serious complication following THA. The management of PJI via a two-stage exchange presents a challenge for surgeons often due to mechanical complications associated with spacer implantation during first stage revision. The purpose of this study was to analyse the outcomes of using 3D spacers in Paprosky Type IIIA-B acetabular defects after first-stage periprosthetic hip infection revision. Methods: We retrospectively reviewed 24 patients who developed PJI after THA and had undergone two-stage revision arthroplasty between 2017 and 2020. Average age at the time of surgery was 60.5 years. Seven of the 24 patients (29.2%) had Type IIIA bone defects and seventeen patients (70.8%) had Type IIIB bone defects. We divided the patients into two groups: patients who received non-3D articulating spacer in the first group, and patients who received custom-made 3D articulating spacer in the second group. Results: In the first group, the mean score in the VAS was 3.3 (± 1.4); 51.3 (± 9.4) in Harris Hip Score; and 42.9 (± 5.9) in the WOMAC scale. In the second group, the mean score in the VAS was 1.3 (± 0.9); 69.7 (± 3.6) in Harris Hip Score; and 30.1 (± 2.4) in the WOMAC scale. Findings indicated statistically significant functional improvement in the second group (p <0.05). Conclusion: This study suggests that a properly implanted custom-made 3D articulating spacer after first stage revision of infected complex acetabular bone defects offers better functional outcomes and improvement in the quality of life of the patients.

Periprosthetic hip infections with severe proximal femoral bone loss may require the use of limb salvage techniques, but no agreement exists in literature regarding the most effective treatment. Aim of this study is to analyze the infection eradication rate and implant survival at medium-term follow-up in patients treated with megaprostheses for periprosthetic hip infections with severe bone loss. Twenty-one consecutive patients were retrospectively reviewed at a mean 65-month follow-up (24-124). Functional and pain scores, microbiological, radiological and intraoperative findings were registered. Kaplan Meier was used for implant survival analysis. In 9 patients, antibacterial-coatings were used to protect the megaprosthesis: silver (PorAg®) in 7 cases, antibiotic-loaded hydrogel DAC® in 1 case and both in another one. Three patients were treated with one-stage revisions and 18 with two-stage procedures. The infection eradication rate was 95.2%. Only two patients required major implant revisions for aseptic implant loosening. The most frequent complication was dislocation (38.1%). The major revision-free survival of implants was 95.2% (95%CI 70.7-99.3) at 2 years and 87.9% (95%CI 58.5-96.9) at 5 years. The minor revision-free survival was 82.4% (95%CI 54.7-93.8) both at 2 and 5 years. The mean MSTS clinical score at last follow up was 20.6 (8-30). Proximal femoral arthroplasty is useful to treat periprosthetic hip infections with severe bone loss, providing good functional results with high infection eradication rates and rare major revisions at medium-term follow-up.

Introduction: Recalcitrant hip infection is difficult to treat definitively with respect to symptomatic control and infection resolution. Girdlestone arthroplasty is a known operative intervention to limit infective clinical manifestations, but can result in a sizable tissue defect that can harbour resistant infection. We describe our experience with amplified vastus interposition myoplasty and evaluate the functional outcomes of this procedure. Methods: We retrospectively reviewed 8 Girdlestone arthroplasty with interposition myoplasty procedures performed in 7 patients between November 2014 and March 2020 at a UK level 1 trauma centre. Indications included periprosthetic infection (n=3), chronic native hip infection (n=4) and severe chronic hip pain (n=1). Patients were evaluated for wound healing, post-operative complications, pain, and functional outcomes including sitting tolerance, perineal care and overall satisfaction. Results: All patients were male with mean age of 54 years (range 26-80) and mean American Society of Anesthesiologists score of 2.88. Infection was present in 88% (n=7) of hips pre-operatively. All flaps healed satisfactorily, and none required revision. Infection resolution was achieved in 71% (n=5) of cases. Mean pain score improved from 8.0 pre-operatively to 4.0 post-operatively. Sitting tolerance and perineal care improved or stayed the same in 88% (n=7) of cases. Overall, satisfactory functional outcome was achieved in 75% (n=6) of cases. Conclusion: Our experience shows that Girdlestone arthroplasty with vastus interposition myoplasty is a viable salvage option, which can provide good functional outcomes and should be considered as a definitive interventional procedure for recalcitrant hip infection or in patients at high risk for infection.

Introduction: Periprosthetitc joint infection is the most devastating complication of hip replacement surgery. The two-stage-revision is tought to be the gold standard treatment. However, in acute cases, debridement and antibiotic treatment can be performed with implant retention (DAIR). Results are controversial, reported success rate varies between 0-90 percent. The aim of this study to present the mid-term results using DAIR. Methods: Between 2006 and 2019, 22 patients were treated with acute periprosthetic hip joint infection. All of them underwent DAIR. Patients were evaluated retrospectively. The mean follow-up was 5.5 years. Results: 18 of 22 patients developed infection in the early postoperative period after the primary hip replacement (mean 12 days postop), 4 of 22 patients showed late-onset acute infection (mean 2,3 years postop). DAIR proved to be succesfull in 15 of 22 patients. 1 patient has a septic cup loosening, still waiting for revision surgery. 6 patients required further surgeries due to recurrence of the infection, but all the 6 ended-up with definitive removal of the implants. Higher CRP level and leaving intact the exchangeable prosthesis components (head and liner) showed a coincidence with failure. Conclusions: success rate of DAIR was 68%. Lower CRP level and exchanging the modular components of the prosthesis may favour the healing. Reinfection after DAIR was reluctant to further treatment in all the cases. Strict criterias are needed for selecting patients eligible for DAIR.

Introduction: This study seeks to evaluate Crohn's disease as a risk factor for postoperative outcomes in primary total hip arthroplasty (THA) patients. Methods: Utilizing the Statewide Planning and Research Cooperative System (SPARCS) database from 2009-2013, primary THA patients with ICD-9 code 8151 were obtained. Patients with THA performed after 2011 were excluded, as well other hip-related procedures, including revision, arthrotomy and tenotomy. Based on the presence of Crohn’s disease, patients were grouped into two cohorts. Patient demographics, hospital/operative variables and postoperative outcomes, including surgical complications, medical complications, readmissions, reoperations, and mortality during hospitalization were compared. Logistic regression analysis with covariates was performed to evaluate whether Crohn’s disease was a significant predictor of postoperative outcomes after THA surgery. Results: 30427 primary THA patients were identified with 115 having Crohn’s disease and 30312 without Crohn’s disease. Regarding the demographics between the cohorts, there were statistically significant differences found in race, mean total hospital length of stay, and mean total surgical charges (all, p<0.05). As for postoperative outcomes, there were significant differences found in sepsis rate, pulmonary embolism, deep vein thrombosis rates (all, p<0.05). Crohn’s disease was found to be a significant predictor of developing sepsis (2.8 [1.4-5.9]; p=0.005), pulmonary embolism (3.2 [1.2-8.9]; p=0.022), and deep vein thrombosis (3.3 [1.4-7.5]; p=0.005) after THA surgery. Conclusion: This retrospective study found that in 2-year minimum follow-up THA patients, Crohn’s disease was found to be a significant predictor of increased rates of postoperative medical complications.

The efficacy of tranexamic acid (TXA) has been studied in patients undergoing hip hemiarthroplasty but relatively few studies have focused on its role in dynamic hip screw surgery(DHS).The aim of this study was to review the utilisation and efficacy of TXA in both DHS and hip hemiarthroplasty patients. We have included 205 consecutive patients who were treated by either of these surgical procedure between July and December 2020.Demographics, preop and post-op haemoglobin(Hb) and transfusion rates were reviewed and compared among the two groups.82 patients (55F:27M) with mean age of 82.2 years(range 47-98 years) were treated by DHS and 123 patients (83F: 40M) with a mean age of 81.4 years(range 58-99 years) were treated by hip hemiarthroplasty. TXA was used in 56% of the hemiarthroplasty cases and only in 47.5% of the DHS patients. The proportion of DHS patients receiving at least 1 unit of erythrocytes was lower in the TXA group(28%) than in the control group(32.5%). The decrease of transfusion rates was more significant in the hemiarthroplasty group where the use of TXA has reduced it from 22.2% to 8.7%.Postoperative Hb drop was also reduced in both the DHS (26.37 g/dL vs 19.56 g/dL) and hemiarthroplasty groups (22.29 g/dL Vs 17.85 g/dL) following the use of TXA. Although the perioperative use of TXA in DHS is not as popular as in hemiarthroplasty, TXA can effectively reduce Hb drop and blood transfusion requirements in both procedures. High-quality randomised controlled trials are still required for further investigation as our study is limited.

BACKGROUND/INTRODUCTION: Day case arthroplasty has gained increased traction in recent years, freeing up hospital beds and reducing healthcare costs whilst maintaining excellent outcomes. The Coronavirus pandemic has forced a rethink of elective surgery in order to minimise inpatient stays and address the backlog of patients on waiting lists. Our aim has been to facilitate the restart of lower limb arthroplasty surgery during the pandemic by introducing day case surgery at our average-sized district general hospital.
METHODS: Criteria were outlined to identify patients that may be suitable for day case arthroplasty surgery. Appropriate patients were counselled in the outpatient clinic, given preoperative instructions and listed accordingly. Preoperative narcotics were ceased, and patients commenced on anti-inflammatories and neuropathic analgesia 2 days prior to admission along with high calorie drinks. Patients were discharged on a predetermined analgesic combination based on their bodyweight. Followup was made by telephone the same night and later in the week, and in person at 6 weeks.
RESULTS: Between October and December 2020, all total hip replacements (THR) that were planned as day cases went ahead successfully, representing 54% of THR cases and 37.5% of all Joint replacements performed by senior author. Total length of stay ranged from 9 to 12 hours. There were no readmissions, good pain control and excellent patient satisfaction. No patients contracted Coronavirus during their hospital journey.
CONCLUSIONS: Our experience of introducing day case surgery at our hospital has thus far been successful and will be expanding to include total knee replacements in near future.

Introduction: Optimum cup inclination could expand the longevity of THA and reducing the dislocation rate. This study objective was to investigate the efficacy of using intraoperative smartphone applications to adjust the cup abduction angle during THA by a less experienced surgeon by comparing the results with two more experienced surgeons working at the same unit. Methods: between September 2018 to August 2019, cup inclination angle measured in the postoperative AP pelvis radiograph was compared between three groups, 30 consecutive patients in each. A surgeon in his first year of independent practice operated on (group 1) where he used smartphone apps as an assistant tool intraoperatively to guide cup abduction angle placement, (Group 2) and (Group 3) were operated by a 5-year and a more than 15-year experience surgeons respectively using manual cup placement instrument. Results: In (group 1) 93% of the cups were placed within the inclination safe zone with a mean angle of 43.47° (SD ± 4.89) compared to 70% in (group 2) with a mean angle of 46.90° (SD ± 7.40), the difference was statistically insignificant (p-value = 0.306). In group 3, 97% of the cups were placed within the safe zone with a mean of 39.56° (SD ± 4.58) which was significantly better than group 1 and group 2 (p-value= 0.05 and 0.001 respectively). Conclusion: Using smartphone applications during THA enabled a less experienced surgeon to obtain a cup inclination within the Lewinnek safe zone and comparable to more experienced surgeons.

Introduction: We report a consecutive series of total hip replacements (THR) using either cemented UHMWPE Ogee (DePuy) or Opera (Smith & Nephew) acetabular components. The components’ similarities included: a long posterior wall, wire marker, flange and, manufacturing from the same resin and techniques. The only difference was sterilisation method, the Opera with ethylene oxide and Ogee gamma irradiated. Methods: Data was collected prospectively on 352 consecutive THR, between March 2000 and July 2004, at a single centre by 4 surgeons. A posterior approach was used with a cemented C-Stem femoral component (DePuy) in all. The acetabulum was prepared with keyholes and pulse lavage, with Palacos-R cement containing Gentamicin and using a pressuriser. Patients were reviewed clinically and radiologically with minimum 15 year follow-up. Results: There were 191 Opera (54.3%) and 161 Ogee (45.7%) components. In the Opera group, average age was 66.2, BMI 28.5, acetabular angle (AA) 45.8°, and 111 were female (58%). There were 27 implant failures, and 14 have been revised (7.33%). 74.6% were Hodgkinson Grade 0 or 1 at 15 years. In the Ogee group, average age was 69.8, BMI 29.1, AA 46.3°, and 106 were female (66%). There were 3 implant failures, all of which were revised (1.86%) and 100% were Hodgkinson Grade 0 or 1 at 15 years. Conclusion: We report increased rates of revision, loosening and failure with the Opera component compared to the Ogee. The key difference is the sterilisation method, and we recommend ongoing clinical and radiological surveillance of the Opera implants.

Elective orthopaedic surgery was cancelled early in the COVID-19 pandemic and is currently running at significantly reduced capacity in most institutions. This has resulted in a significant back log to treatment, with some hospitals projecting that waiting times for joint replacement is three times the Pre-COVID duration. There is significant concern that the patient group requiring joint replacement are often older and have more medical co-morbidities – the same group of patients advised they are at higher risk of mortality from catching COVID.
Our institution re-instated elective operations using a “Blue stream” pathway which involves isolation before and after surgery, COVID testing pre-admission and separation of ward and theatre pathways for “blue” patients. A register of all joint replacements was taken and their clinical course and investigations recorded.
During a 7-month time period 340 elective joint replacements were performed. There was zero mortality. One patient had a positive swab for COVID-19 whilst an inpatient however they were asymptomatic. There were 2 readmissions within a 12-week period for dislocation. Patients had a mean age of 68(28-90), BMI of 30(19-45.6) and ASA of 2(1-3).
Results show no increased morbidity or mortality in this cohort of patients compared to national averages from pre-COVID Scottish arthroplasty project report.
We conclude the screened pathway for elective patients is effective in ensuring patients can be safely operated on electively in an acute hospital. This study should reassure clinicians and patients that joint replacements can be carried out safely when the appropriate precautions are in place.