Notes

Combination involving Furo[3,2-c]benzopyrans via an Intramolecular [4 + 2] Cycloaddition Reaction of o-Quinonemethides.
Furthermore, proximal bone loss of the femur should be considered as a potential cause of failure. © 2019 Delhi Orthopedic Association. All rights reserved.Objective Cup-cage reconstruction has emerged as a possible solution for managing massive acetabular defects with a few existing studies reporting encouraging results at mid-term follow-up. We present our experience with this unitised construct. Method Six patients (7 hips) with a mean age of 76 years (73-81) were revised due to catastrophic aseptic failure of a primary cup implanted 10-19 years previously, having a Paprosky type 3B acetabular defect. Results At a mean follow-up of 72 months (63-140) no cases have required re-revision. Oxford Hip Scores improved from an average of 8 (1-17) preoperatively to an average of 36 (18-45) at the last follow-up. WOMAC scores preoperatively averaged 76 (49-96) and postoperatively averaged 26.5 points (0-69) at the last follow-up. SF-12 scores improved in both components. One patient showed non-progressive osteolysis around the ischial flange and one had less than 5 mm migration of the construct. One patient died of unrelated causes. Conclusion Our study presents one of the longest follow-up of cup-cage construct and supports the previously reported good results; it encourages the use of this construct in reconstruction of massive acetabular defect, with or without pelvic discontinuity. © 2019 Delhi Orthopedic Association. All rights reserved.Background Revision of failed total hip arthroplasty (THA) presents great challenge to any orthopaedic surgeon especially in the presence of acetabular defects where the main goal is to achieve durable fixation of prosthetic components to bone which is the key to successful revision surgery. Methods Seventeen patients (17 hips) with mean age of 52 (40-61) years had revision surgery for aseptic failure of Furlong hydroxyapatite-ceramic-coated (HAC) prosthesis using cementless jumbo cups. Patients were reviewed clinically and radiographically with mean follow-up of 3.5 years (2-6). No patient was lost to follow up. Results All revised acetabular components showed polyethylene wear, severe metallosis, with acetabular defects IIB (4/17), and IIIA (13/17) according to Paprosky classification. The femoral component was well fixed in all cases but one patient had stem revision for femoral fracture mal-union. There was one early post-operative infection; there was no postoperative dislocation, sciatic nerve injury, periprosthetic fracture or deep venous thrombosis. At last follow-up, no progressive radiolucencies or acetabular migration was identified. The mean Harris hip score improved from 42 (24-59) pre-operatively to 85 (72-92). Conclusion Good clinical results and radiographic stability were obtained at short term follow up after acetabular revision using cementless jumbo cups, which justify its use in revision surgery even in the face of major acetabular defects. Furlong HAC femoral component gives excellent long-term survival in young and active patients with a survival rate of 94% at 18.6 years. © 2018.Revision of a well-fixed cemented femoral stem is technically challenging. The Exeter Short Revision Stem (SRS) was developed to facilitate cement-in-cement revision mitigating some of these challenges. We present the short to mid-term results of 50 cement-in-cement revisions performed with this implant. A retrospective review of all cement-in-cement revision with the Exeter SRS, at our institution, over a seven-year period between 2007 and 2014 was conducted. Records were assessed for radiological and clinical component loosening at greater than 12 months follow-up and for revision and complications at all time points. An Oxford Hip Score (OHS) and Numeric Rating Scale (NRS) for groin and thigh pain at rest and initial mobilisation were obtained. 50 implants in 46 patients were identified. Radiographic and clinical follow-up was available for 42 and 38 implants respectively at greater than 12 months. Mean radiographic follow-up was 5.1 years and clinical 4.9 years. There was no radiographic or clinical evidence of loosening. 3 revisions were performed, one for each of recurrent dislocation, infection and stem breakage. Median OHS was 39 (IQR 12) and mean NRS for groin pain at rest and initial mobilisation was 1.7 and 1.7 respectively and NRS for thigh pain at rest and initial mobilisation was 1.3 and 1.6 respectively with mean follow-up of 6.9 years. The Exeter SRS provides a viable option for cement-in-cement stem revision, with low revision, complication and loosening rates and good patient reported outcomes at short to mid-term follow up. © 2019 Delhi Orthopedic Association. All rights reserved.Introduction The epidemiology of re-revision total hip arthroplasty (THA) is not yet well-understood. We aim to investigate the epidemiology and risk-factors that are associated with re-revision THA. Methods 288 revision THA were analyzed between 1/2012 and 12/2013. Patients who underwent two or greater revision THA were included. Hips with first-revision due to periprosthetic joint infection (PJI) were excluded. Failure was defined as reoperation. Results 51 re-revision patients were available. Mean age was 59.6 (±14.2 years), 32 (67%) females, average BMI of 28.8 (±5.4), and median ASA 2 (23; 55%). The most common re-revision indications were acetabular component loosening (15; 29%), PJI (13; 25%) and instability (9; 18%). The most common indications for first revision in the re-revision population were acetabular component loosening (11; 27%), polyethylene wear (8; 19%) and instability (8; 19%). There was an increased risk of re-revision failure if the re-revision involved exchanging only the head and polyethylene liner (RR = 1.792; p = 0.017), instability was the first-revision indication (RR = 3.000; p  less then  0.001), and instability was the re-revision indication (RR = 1.867; p = 0.038). If isolated femoral component revision was indicated during the re-revision, there was a decreased risk of failure (RR = 0.268, p = 0.046). 1-year re-revision survival was 54% (23/43). Discussion Acetabular component loosening, instability, and PJI were the most common indications for re-revision. Revision due to instability is a recurrent problem that leads to re-revision failure. There was a higher infection rate in the re-revision population compared to published revision PJI. Selleckchem CW069 A better understanding of the indications and patient factors that are associated with re-revision failures can help align surgeon and patient expectations in this challenging population. © 2018.
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