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Article ; Online: Risk factors for femoral stem fracture following total hip arthroplasty: a systematic review and meta analysis.

Turnbull, Gareth S / Soete, Sam / Akhtar, Muhammad Adeel / Ballantyne, James Anderson

Archives of orthopaedic and trauma surgery

2024 Volume 144, Issue 5, Page(s) 2421–2428

Abstract: Background: Femoral stem fracture following total hip arthroplasty (THA) is an infrequent but nevertheless devastating complication, with an increasing worldwide prevalence as demand for primary THA continues to increase. The aim of this study was to ... ...

Abstract	Background: Femoral stem fracture following total hip arthroplasty (THA) is an infrequent but nevertheless devastating complication, with an increasing worldwide prevalence as demand for primary THA continues to increase. The aim of this study was to perform a systematic review and meta-analysis of risk factors for femoral stem fracture to help identify at risk patients. Methods: A systematic search was conducted on EMBASE, MEDLINE and AMED to identify relevant studies. Data regarding study design, source, population, intervention, and outcomes was collated. Data extraction was performed on a custom form generated using Cochrane recommended methodology and analysis of risk factors performed including odds ratios (ORs) with 95% confidence intervals (CIs). Results: A total of 15 studies reporting a total of 402 stem fractures in 49 723 THAs were identified. The median time from index procedure to stem fracture was 68 months (IQR 42.5-118) whilst mean age at index surgery was 61.8 years (SD 6.9). Male gender (OR = 3.27, 95% CI = 2.59-4.13, p < 0.001), patient weight above 80 kg (OR = 3.55, 95% CI = 2.88-4.37, p < 0.001), age under 63 years (OR = 1.22, 95% CI = 1.01-1.49, p < 0.001), varus stem alignment (OR = 5.77, 95% CI = 3.83-8.7, p < 0.001), use of modular implants (OR = 1.95, 95% CI = 1.56-2.44, p < 0.01) and undergoing revision arthroplasty (OR = 3.33, 95% CI = 2.70-4.1, p < 0.001) were significant risk factors for prosthetic stem fracture. A risk window of 15 years post-surgery was identified. Conclusions: This review concludes that patient weight, younger age, male sex, varus stem alignment, revision arthroplasty and use of modular stems are significant risk factors for femoral stem fracture. Modifying these risk factors where possible may help reduce incidence of femoral stem fracture in at risk patients.
MeSH term(s)	Humans ; Arthroplasty, Replacement, Hip/adverse effects ; Risk Factors ; Femoral Fractures/surgery ; Femoral Fractures/epidemiology ; Femoral Fractures/etiology ; Male ; Prosthesis Failure ; Female ; Hip Prosthesis/adverse effects ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Middle Aged
Language	English
Publishing date	2024-04-12
Publishing country	Germany
Document type	Journal Article ; Systematic Review ; Meta-Analysis ; Review
ZDB-ID	80407-1
ISSN	1434-3916 ; 0003-9330 ; 0344-8444
ISSN (online)	1434-3916
ISSN	0003-9330 ; 0344-8444
DOI	10.1007/s00402-024-05281-x
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Article ; Online: Experience of an Anatomic Femoral Stem in a United Kingdom Center - Excellent Survivorship and Negligible Periprosthetic Fracture Rates at Mean 12 Years Following Primary Total Hip Arthroplasty.

Turnbull, Gareth S / Akhtar, Muhammad A / Dunstan, Edward R R / Ballantyne, James A

The Journal of arthroplasty

2023 Volume 39, Issue 1, Page(s) 187–192

Abstract: Background: As the clinical burden of periprosthetic fractures (PPFs) continues to increase, it has been suggested that the use of anatomical femoral stems may help reduce PPF risk. The primary aim of this study was to determine the survivorship and PPF ...

Abstract	Background: As the clinical burden of periprosthetic fractures (PPFs) continues to increase, it has been suggested that the use of anatomical femoral stems may help reduce PPF risk. The primary aim of this study was to determine the survivorship and PPF rate of an anatomical femoral stem in a single center at minimum 10-year follow-up. Methods: A total of 1,000 consecutive total hip arthroplasties (THAs) performed using an anatomical femoral stem were identified from a prospectively collected arthroplasty database. Patient radiographs were reviewed finally at a mean of 12 years (range, 10 to 16 years) following surgery to identify any revision surgery, dislocations or PPFs. Mean patient age at surgery was 69 years (range, 24 to 93). There were 634 women (63%). Osteoarthritis was the operative indication in 946 patients (95%). Results: All-cause THA survivorship was 99.1% (95% confidence interval (CI), 99.0-99.3%) at 10 years and 97.9% (CI, 97.8 - 98.0%) at 15 years. Stem survivorship at 10 years was 99.6% (CI, 99.5-99.7%) and at 15 years was 98.2% (CI, 98.1-98.3%). The 15-year stem survival for aseptic loosening was 100% with no cases of significant lysis found (lucent line >2mm). Implant survivorship was not significantly impacted by patient sex (P = .65), body mass index (P = .49), deprivation level (P = .284), operative indication (P = .33), or American Society of Anesthesiologists class (P = .374). There were 3 PPFs identified (0.3%) at mean 12-year follow-up and 15 dislocations (1.5%). Conclusion: This anatomical femoral stem demonstrated excellent survivorship and negligible PPF rates at mean 12-year follow-up following primary THA.
MeSH term(s)	Humans ; Female ; Young Adult ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/adverse effects ; Periprosthetic Fractures/epidemiology ; Periprosthetic Fractures/etiology ; Periprosthetic Fractures/surgery ; Hip Prosthesis/adverse effects ; Survivorship ; Treatment Outcome ; Prosthesis Design ; Reoperation/adverse effects ; Prosthesis Failure ; Retrospective Studies
Language	English
Publishing date	2023-07-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2023.07.009
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Article ; Online: Trauma theatre productivity - Does the individual surgeon, anaesthetist or consultant presence matter?

Turnbull, Gareth S / Hakimi, Mounir / McLauchlan, George J

Injury

2018 Volume 49, Issue 5, Page(s) 969–974

Abstract: Introduction: With rising NHS clinical and financial demands, improving theatre efficiency is essential to maintain quality of patient care. Consistent teams and consultant presence have been shown to improve outcomes and productivity in elective ... ...

Abstract	Introduction: With rising NHS clinical and financial demands, improving theatre efficiency is essential to maintain quality of patient care. Consistent teams and consultant presence have been shown to improve outcomes and productivity in elective orthopaedic surgery. The aim of this study was to investigate the impact on trauma theatre productivity of different surgeons and anaesthetists working together in a Major Trauma Centre. The influence of consultant presence and weekend operating on productivity was also considered. Methods: Data relating to a single orthopaedic trauma theatre was gathered retrospectively for a two-year period. Variables including orthopaedic and anaesthetic consultant presence, number and complexity of operations performed and procedure start times were collected for daily trauma lists. Individual anaesthetic and orthopaedic consultants were compared by productivity outcomes. The impact of surgeons operating more frequently with one anaesthetist was also examined. Results: Data relating to 2384 patients undergoing a total of 2787 procedures was collected. Orthopaedic consultant presence at the first surgical case (p < 0.05) and for 50% or greater of cases (p < 0.05) lead to higher mean number of cases performed per list and reduced turnaround time. Despite working with a significantly higher number of different consultant anaesthetists (p < 0.001) in year two, the productivity of surgeons as judged by list start time, total cases per list and total operating time was not significantly affected. Significantly earlier start times (p < 0.001) and shorter turnaround times (p < 0.001) at weekends led to maintained productivity despite shorter theatre time. No significant difference in productivity was found when comparing individual anaesthetic and orthopaedic consultants. Productivity was not significantly increased by surgeons operating more frequently with one individual anaesthetist. Conclusion: In the setting of an acute trauma theatre, orthopaedic consultant presence led to increased productivity. Furthermore, individual surgeon and anaesthetist pairings had no effect on overall productivity. Future efforts to improve productivity should focus on achieving earlier start times, consultant supervision of lists and reduced turnaround times between cases.
MeSH term(s)	Adolescent ; Adult ; Aged, 80 and over ; Anesthetists ; Child ; Consultants ; Efficiency, Organizational/economics ; Female ; Humans ; Male ; Middle Aged ; Operating Rooms ; Orthopedics/economics ; Orthopedics/standards ; Retrospective Studies ; State Medicine/economics ; Surgeons ; Time Management ; Trauma Centers/economics ; United Kingdom
Language	English
Publishing date	2018-02-12
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2018.02.015
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Zs.A 778: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: The Olympia anatomic polished cemented stem is associated with a high survivorship, excellent hip-specific functional outcome, and high satisfaction levels: follow-up of 239 consecutive patients beyond 15 years.

Turnbull, Gareth S / Marshall, Claire / Nicholson, Jamie A / MacDonald, Deborah J / Clement, Nicholas D / Breusch, Steffen J

Archives of orthopaedic and trauma surgery

2021 Volume 142, Issue 9, Page(s) 2361–2370

Abstract: Introduction: The Olympia femoral stem is a stainless steel, anatomically shaped, polished and three-dimensionally tapered implant designed for use in cemented total hip arthroplasty (THA). The primary aim of this study was to determine the long-term ... ...

Abstract	Introduction: The Olympia femoral stem is a stainless steel, anatomically shaped, polished and three-dimensionally tapered implant designed for use in cemented total hip arthroplasty (THA). The primary aim of this study was to determine the long-term survivorship, radiographic outcome, and patient-reported outcome measures (PROMs) of the Olympia stem. Patients and methods: Between May 2003 and December 2005, 239 patients (264 THAs) underwent a THA with an Olympia stem in our institution. Patient-reported outcome measures were assessed using the Oxford Hip Score (OHS), EuroQol-5 dimensions (EQ-5D) score, and patient satisfaction at mean 10 years following THA. Patient records and radiographs were then reviewed at a mean of 16.5 years (SD 0.7, 15.3-17.8) following THA to identify occurrence of complications or revision surgery for any cause following surgery. Radiographs were assessed for lucent lines and lysis according to Gruen's zones RESULTS: Mean patient age at surgery was 68.0 years (SD 10.9, 31-93 years). There were 156 women (65%, 176 THAs). Osteoarthritis was the indication for THA in 204 patients (85%). All cause stem survivorship at 10 years was 99.2% (95% confidence interval [CI], 97.9%-100%) and at 15 years was 97.5% (94.6%-100%). The 15-year stem survival for aseptic loosening was 100%. Analysis of all-cause THA failure demonstrated a survivorship of 98.5% (96.3%-100%) at 10 years and 95.9% (92.4%-99.4%) at 15 years. There were 9 THAs with non-progressive lucent lines in a single Gruen zone and 3 had lines in two zones, and no patient demonstrated signs for lysis. At a mean of 10-year (SD 0.8, 8.7-11.3) follow-up, mean OHS was 39 (SD 10.3, range 7-48) and 94% of patients reported being very satisfied or satisfied with their THA. Conclusions: The Olympia stem demonstrated excellent 10-year PROMs and very high rates of stem survivorship at final follow-up beyond 15 years.
MeSH term(s)	Arthroplasty, Replacement, Hip/adverse effects ; Female ; Follow-Up Studies ; Gold Alloys ; Hip Prosthesis/adverse effects ; Humans ; Patient Satisfaction ; Personal Satisfaction ; Prosthesis Design ; Prosthesis Failure ; Reoperation ; Retrospective Studies ; Survivorship ; Treatment Outcome
Chemical Substances	Gold Alloys ; olympia (71714-89-1)
Language	English
Publishing date	2021-07-25
Publishing country	Germany
Document type	Journal Article
ZDB-ID	80407-1
ISSN	1434-3916 ; 0003-9330 ; 0344-8444
ISSN (online)	1434-3916
ISSN	0003-9330 ; 0344-8444
DOI	10.1007/s00402-021-03992-z
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Article ; Online: Gender and Preoperative Function Predict Physical Activity Levels After Revision Total Knee Arthroplasty.

Turnbull, Gareth S / Scott, Chloe E H / MacDonald, Deborah J / Breusch, Steffen J

The Journal of arthroplasty

2019 Volume 34, Issue 5, Page(s) 939–946

Abstract: Background: The incidence of revision total knee arthroplasty (TKA) is projected to increase 6-fold worldwide by 2030. As the number of younger, physically active revision TKA patients increases in future, understanding factors influencing postoperative ...

Abstract	Background: The incidence of revision total knee arthroplasty (TKA) is projected to increase 6-fold worldwide by 2030. As the number of younger, physically active revision TKA patients increases in future, understanding factors influencing postoperative function will be increasingly important to help counsel patients. The primary aim of this study was to examine factors influencing return to physical activity following revision TKA. Methods: Patients who had undergone tibiofemoral revision between 2003 and 2013 at a single UK teaching hospital were retrospectively identified from a prospectively collected arthroplasty database. Preoperative activity level (University of California, Los Angeles [UCLA] score), patient demographics, indication, implant used, and Oxford Knee Scores (OKSs) were recorded in the database. At a mean follow-up of 3.9 years (standard deviation, 2.2), UCLA score, OKS, EuroQol-5 Dimension Score (EQ-5D), satisfaction, complications, and WORQ scores (Work, Osteoarthritis and Joint-Replacement Questionnaire) were sampled via postal questionnaire. Patient experience of complications and related surgery was also identified from healthcare records. Univariate and multivariate analyses were performed. Results: Responses were received from 112 revision TKAs (112 patients; mean age, 71 years). Mean UCLA activity scores improved from preoperative levels (P < .001): activity levels improved in 47% of patients with 58% engaging in moderate or more intensive activities (UCLA score ≥5). Postoperative activity level was independently predicted by male gender (P = .042) and preoperative UCLA score (P < .001). Increasing social deprivation was associated with inferior UCLA (P = .005), EQ-5D (P < .005), and OKS (P = .006) scores. Indication, implant type, and patient body mass index did not affect functional outcome or satisfaction (P > .05). Patients <65 years old were more likely to be dissatisfied (P = .009), and patients aged ≤55 years were more likely to report difficulties with WORQ criteria (P < .05). Conclusion: Although 90% of patients maintain activity levels following revision TKA, less than half increase levels and this is predicted by male sex and pre-revision activity level.
MeSH term(s)	Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/methods ; Body Mass Index ; Exercise ; Female ; Humans ; Male ; Middle Aged ; Osteoarthritis, Knee/physiopathology ; Osteoarthritis, Knee/surgery ; Postoperative Period ; Preoperative Period ; Recovery of Function ; Reoperation ; Retrospective Studies ; Sex Factors ; Treatment Outcome
Language	English
Publishing date	2019-01-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2019.01.040
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Article ; Online: Return to Work Following Total Knee and Hip Arthroplasty: The Effect of Patient Intent and Preoperative Work Status.

Al-Hourani, Khalid / MacDonald, Deborah J / Turnbull, Gareth S / Breusch, Steffen J / Scott, Chloe E H

The Journal of arthroplasty

2020 Volume 36, Issue 2, Page(s) 434–441

Abstract: Background: The ability of total knee and hip arthroplasty (TKA/THA) to facilitate return to work (RTW) when it is the patient's preoperative intent to do so remains unclear. We aimed at determining whether TKA/THA facilitated RTW in patients of working ...

Abstract	Background: The ability of total knee and hip arthroplasty (TKA/THA) to facilitate return to work (RTW) when it is the patient's preoperative intent to do so remains unclear. We aimed at determining whether TKA/THA facilitated RTW in patients of working age who intended to return. Methods: This is a prospective cohort study of 173 consecutive patients <65 years of age, undergoing unilateral TKA (n = 82: median age 58; range, 39-65; 36 [43.9%] male) or THA (n = 91: median age 59; range, 34-65; 42 [46.2%] male) during 2018. Oxford knee/hip scores, Oxford-Activity and Participation Questionnaire, and EuroQol-5 dimension (EQ-5D) scores were measured preoperatively and at 1 year when an employment questionnaire was also completed. Results: Of patients who intended to RTW, 44 of 52 (84.6%) RTW by 1 year following TKA (at mean 14.8 ± 8.4 weeks) and 53 of 60 (88.3%) following THA (at mean 13.6 ± 7.5 weeks). Failure to RTW despite intent was associated with job physicality for TKA (P = .004) and negative preoperative EQ-5D for THA (P = .01). In patients unable to work before surgery due to joint disease, fewer RTW: 4 of 21 (19.0%) after TKA; and 6 of 17 (35.3%) after THA. Preoperative Oxford knee score >18.5 predicted RTW with 74% sensitivity (P < .001); preoperative Oxford hip score >19.5 predicted RTW with 75% sensitivity (P < .001). Preoperative EQ-5D indices were similarly predictive (P < .001). Conclusion: In this United Kingdom study, preoperative intent to RTW was the most powerful predictor of actual RTW following TKA/THA. Where patients intend to RTW following TKA/THA, 85% RTW following TKA and 88% following THA.
MeSH term(s)	Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Humans ; Male ; Middle Aged ; Prospective Studies ; Return to Work ; United Kingdom
Language	English
Publishing date	2020-08-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2020.08.012
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Article ; Online: Return to activity following revision total hip arthroplasty.

Turnbull, Gareth S / Scott, Chloe E H / MacDonald, Deborah J / Breusch, Steffen J

Archives of orthopaedic and trauma surgery

2018 Volume 139, Issue 3, Page(s) 411–421

Abstract: Background: Demand for revision total hip arthroplasty (RTHA) continues to grow worldwide and is expected to more than double within the next 1-2 decades. The primary aim of this study was to examine return to function following revision THA in a UK ... ...

Abstract	Background: Demand for revision total hip arthroplasty (RTHA) continues to grow worldwide and is expected to more than double within the next 1-2 decades. The primary aim of this study was to examine return to function following revision THA in a UK population. Patients and methods: We assessed 118 patients (132 RTHAs, mean age 65 years SD 13, range 23-88) at a mean follow-up of 7.9 years (SD 4.4) postoperatively. Preoperative age, gender, BMI, social deprivation, operative indication, comorbidities, activity level (UCLA score) and Oxford Hip Scores (OHS) were recorded. Postoperative UCLA score, OHS, EQ-5D, satisfaction levels and performance in activities of daily living (ADLs) were obtained and univariate and multivariate analysis performed. Results: Mean UCLA activity score improved following RTHA (p < 0.001): UCLA activity score improved in 37% and was unchanged in 50%; 49% of patients engaged in at least moderate level activities (UCLA score ≥ 6). Patient BMI, gender, age and reason for revision did not influence levels of pain, stiffness or activity at follow-up. Preoperative UCLA activity scores (p < 0.001) independently predicted long-term UCLA scores. Independent predictors (p < 0.05) of poor hip-specific function (OHS) following revision included social deprivation, revision for periprosthetic fracture and lower preoperative OHS. Difficulties with ADLs were associated with increasing deprivation, ≥ 3 comorbidities, and revision for periprosthetic fracture or infection (p < 0.05). Overall, 79% of patients remained satisfied or very satisfied following revision THA. Following RTHA, 10% suffered a dislocation and 13% required reoperation for complications. Conclusion: Revision THA facilitates long-term return to preoperative levels of physical activity in the majority of patients, though activity levels increase in one-third only. Overall over three-quarters are satisfied with their outcome, but revision for periprosthetic fracture or dislocation gives the worse overall outcomes and lower satisfaction levels.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/adverse effects ; Arthroplasty, Replacement, Hip/statistics & numerical data ; Exercise ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Reoperation/adverse effects ; Reoperation/statistics & numerical data ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2018-12-07
Publishing country	Germany
Document type	Journal Article
ZDB-ID	80407-1
ISSN	1434-3916 ; 0003-9330 ; 0344-8444
ISSN (online)	1434-3916
ISSN	0003-9330 ; 0344-8444
DOI	10.1007/s00402-018-3090-y
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