ORCID Profile
0000-0003-1656-5762
Current Organisations
Australian Orthopaedic Association
,
Epworth Freemasons
,
Epworth Richmond
,
Royal Australasian College of Surgeons
,
Royal Melbourne Hospital Royal Park Campus
,
Saint Vincent's Hospital Melbourne
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Publications
The long leg radiograph is a reliable method of assessing alignment when compared to computer-assisted navigation and computer tomography
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.KNEE.2012.07.009
Abstract: The mechanical alignment of the knee is an important factor in planning for, and subsequently assessing the success of a knee replacement. It is most commonly measured using a long-leg anteroposterior radiograph (LLR) encompassing the hip, knee and ankle. Other modalities of measuring alignment include computer tomography (CT) and intra-operative computer navigation (Cas). Recent studies comparing LLRs to Cas in measuring alignment have shown significant differences between the two and have hypothesized that Cas is a more accurate modality. This study aims to investigate the accuracy of the above mentioned modalities. A prospective study was undertaken comparing alignment as measured by long-leg radiographs and computer tomography to intra-operative navigation measurements in 40 patients undergoing a primary total knee replacement to test this hypothesis. Alignment was measured three times by three observers. Intra- and inter-observer correlation was sought between modalities. Intra-observer correlation was excellent in all cases (>0.98) with a coefficient of repeatability 0.960 using LLRs and >0.970 using CT with coefficient of repeatability 0.893), than when comparing either of these modalities with Cas (>0.643 and >0.671 respectively). Pre-operative values had the greatest variability. Given its availability and reduced radiation dose when compared to CT, LLRs should remain the mainstay of measuring the mechanical alignment of the lower limb, especially post-operatively. II.
Standard, Large-Head, Dual-Mobility, or Constrained-Liner Revision Total Hip Arthroplasty for a Diagnosis of Dislocation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-10-2020
Abstract: Dislocation remains a leading cause of revision following primary and revision total hip arthroplasty (THA). The aim of the present study was to compare the rate of second revision THA following a major first revision for the treatment of dislocation using an implant with a standard, large head, dual-mobility, or constrained acetabular liner. Data were obtained from the Australian Orthopaedic Association National Joint Replacement Registry from September 1999 through December 2018. All primary THAs that had been performed for the treatment of osteoarthritis and subsequently revised for dislocation were included. All revision THA prostheses with a standard head (≤32 mm), large head (≥36 mm), dual-mobility, or constrained acetabular liner that were used for the first revision procedure were identified. The primary outcome measures were the cumulative rates of second revisions for all causes and for a subsequent diagnosis of dislocation for the 4 different constructs used in the first revision. A total of 1,275 hips underwent a major first revision because of prosthesis dislocation, with 203 of these hips going on to have a second revision. The rate of all-cause second revision was significantly higher in the standard-head group compared with the constrained-acetabular-liner group (hazard ratio [HR], 1.53 [95% confidence interval (CI), 1.01 to 2.30] p = 0.044). There was no difference in the rates of revision between other articulations. The most common cause of second revision for all implants was dislocation. There were a total of 91 second revisions for a diagnosis of dislocation. Standard heads had a higher rate of second revision compared with constrained acetabular liners (HR, 2.44 [95% CI, 1.30 to 4.60] p = 0.005), dual-mobility implants (HR, 2.04 [95% CI, 1.03 to 4.01] p = 0.039), and large heads (HR, 1.80 [95% CI, 1.09, 2.99] p = 0.022). There was no difference in the rates of second revision between other articulations. Surgeons have a number of options for prostheses when performing a first revision for the treatment of dislocation following a primary THA. The most common cause of a second revision is recurrent dislocation. The use of constrained acetabular liners, dual-mobility liners, and large heads (≥36 mm) are options for reducing subsequent dislocation. Standard head sizes have a higher rate of second revision for further dislocation. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
The Effect of Surgical Approach and Femoral Prosthesis Type on Revision Rates Following Total Hip Arthroplasty
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 14-10-2021
Subtrochanteric fracture: The effect of cerclage wire on fracture reduction and outcome
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.INJURY.2015.07.001
Abstract: Subtrochanteric neck of femur fractures are a challenge to treat due to anatomical and biomechanical factors. Poor reduction, varus deformity, nonunion and return to theatre risks are high. A cerclage wire can augment an intramedullary nail to help fracture reduction and construct stability. Concerns exist regarding the use of cerclage wire on fracture zone vascularity. The aim of this study was to assess the benefits and adverse outcomes associated with the use of cerclage wiring. A 7-year retrospective review of all subtrochanteric fractures at a Level 1 trauma centre was performed. Pathological fractures, those associated with bisphosphonate use and segmental fractures were excluded. A clinical and radiographic review was performed. Our primary outcome measure was a composite of the major complications of this surgery, defined as either return to theatre for fixation failure, nonunion or implant failure. Fracture displacement, angulation and quality of reduction were measured as secondary outcome measures. Specific complications of the use of cerclage wiring were also reported. One hundred and thirty four cases met the inclusion criteria for primary outcome. Reduction was achieved closed in 51.9% (n=70), open in 33.3% (n=45) and open with cerclage wire in 14.8% (n=20). Overall there were a total of 13 (9.7%) major complications. No cases with cerclage wire had a return to theatre. If cerclage wire was not used the major complication rate was 11.4%. Fracture displacement (11.0mm vs. 7.69mm) and distraction were related to return to theatre (p<0.05). Cerclage wire use improved fracture displacement (3.2mm vs. 8.8mm), angulation and quality of reduction (p<0.05). Anatomical reduction is the key to success of subtrochanteric fractures. Cerclage wire use results in better fracture reduction. Some subtrochanteric fractures can be successfully treated with indirect reduction alone. If fractures cannot be reduced closed, reduction should be achieved by open methods. If a fracture is opened, a cerclage wire should be used, if the fracture pattern allows.
A Comparison of Revision Rates and Dislocation After Primary Total Hip Arthroplasty with 28, 32, and 36-mm Femoral Heads and Different Cup Sizes
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 16-06-2022
Abstract: This article was updated on August 17, 2022, because of previous errors, which were discovered after the preliminary version of the article was posted online. On page 1462, in the first sentence of the Abstract section entitled “Results,” the phrase that had read “and 36-mm heads had fewer dislocations than 28-mm (HR = 0.33 [95% CI, 0.16 to 0.68] p = 0.003), but more dislocations than 32-mm heads (HR for weeks = 2.25 [95% CI, 1.13 to 4.49] p = 0.021)” now reads “and 36-mm heads had fewer dislocations than 28-mm (HR = 0.33 [95% CI, 0.16 to 0.68] p = 0.003) and 32-mm heads (HR for ≥2 weeks = 0.44 [95% CI, 0.22 to 0.88] p = 0.021).” On page 1468, in the last sentence of the section entitled “Acetabular Components with a Diameter of mm,” the phrase that had read “and HR for ≥2 weeks = 2.25 [95% CI, 1.13 to 4.49 p = 0.021]) (Fig. 3)” now reads “and HR for ≥2 weeks = 0.44 [95% CI, 0.22 to 0.88 p = 0.021]) (Fig. 3).” Finally, on page 1466, in the upper right corner of Figure 3, under “32mm vs 36mm,” the second line that had read “2Wks+: HR=2.25 (1.13, 4.49), p=0.021” now reads “2Wks+: HR=0.44 (0.22, 0.88), p= 0.021.” The acetabular component diameter can influence the choice of femoral head size in total hip arthroplasty (THA). We compared the rates of revision by femoral head size for different acetabular component sizes. Data from the Australian Orthopaedic Association National Joint Replacement Registry were analyzed for patients undergoing primary THA for a diagnosis of osteoarthritis from September 1999 to December 2019. Acetabular components were stratified into quartiles by size: mm, 51 to 53 mm, 54 to 55 mm, and 56 to 66 mm. Femoral head sizes of 28 mm, 32 mm, and 36 mm were compared for each cup size. The primary outcome was the cumulative percent revision (CPR) for all aseptic causes and for dislocation. The results were adjusted for age, sex, femoral fixation, femoral head material, year of surgery, and surgical approach and were stratified by femoral head material. For acetabular components of mm, 32-mm (hazard ratio [HR] = 0.75 [95% confidence interval (CI), 0.57 to 0.97] p = 0.031) and 36-mm femoral heads (HR = 0.58 [95% CI, 0.38 to 0.87] p = 0.008) had a lower CPR for aseptic causes than 28-mm heads and 36-mm heads had fewer dislocations than 28-mm (HR = 0.33 [95% CI, 0.16 to 0.68] p = 0.003), and 32-mm heads (HR for ≥2 weeks = 0.44 [95% CI, 0.22 to 0.88] p = 0.021). For 51 to 53-mm, 54 to 55-mm, and 56 to 66-mm-diameter acetabular components, there was no difference in the CPR for aseptic causes among head sizes. A femoral head size of 36 mm had fewer dislocations in the first 2 weeks than a 32-mm head for the 51 to 53-mm acetabular components (HR for weeks = 3.79 [95% CI, 1.23 to 11.67] p = 0.020) and for the entire period for 56 to 66-mm acetabular components (HR = 1.53 [95% CI, 1.05 to 2.23] p = 0.028). The reasons for revision differed for each femoral head size. There was no difference in the CPR between metal and ceramic heads. There is no clear advantage to any single head size except with acetabular components of mm, in which 32-mm and 36-mm femoral heads had lower rates of aseptic revision. If stability is prioritized, 36-mm femoral heads may be indicated. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
Is the Revision Rate for Femoral Neck Fracture Lower for Total Hip Arthroplasty Than for Hemiarthroplasty?
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-07-2022
Abstract: When arthroplasty is indicated for a femoral neck fracture (FNF), it is unclear whether total hip arthroplasty (THA) or hemiarthroplasty (HA) is best. This study compares data from the Australian Orthopaedic Association National Joint Replacement Registry using contemporary surgical options. Patients from 60 to 85 years old who were treated with arthroplasty for FNF, between September 1999 and December 2019, were included if the femoral stems were cemented. Only THAs with femoral heads of ≥36 mm or dual-mobility articulations were included. Patients who had monoblock HA were excluded. Rates of revision for all aseptic failures and dislocation were compared. Competing risks of revision and death were considered using the cumulative incidence function. Subdistribution hazard ratios (HRs) for revision or death from a Fine-Gray regression model were used to compare THA and HA. Interactions of procedure with age group and sex were considered. Secondary analysis adjusting for body mass index (BMI) and American Society of Anesthesiologists (ASA) classification was also considered. There were 4,551 THA and 29,714 HA procedures included. The rate of revision for THA was lower for women from 60 to 69 years old (HR = 0.58 [95% confidence interval (CI), 0.39 to 0.85]) and from 70 to 74 years old (HR = 0.65 [95% CI, 0.43 to 0.98]) compared with HA. However, women from 80 to 85 years old (HR = 1.56 [95% CI, 1.03 to 2.35]) and men from 75 to 79 years old (HR = 1.61 [95% CI, 1.05 to 2.46]) and 80 to 85 years old (HR = 2.73 [95% CI, 1.89 to 3.95]) had an increased rate of revision when THA was undertaken compared with HA. There was no difference in the rate of revision for dislocation between THA and HA for either sex or age categories. When contemporary surgical options for FNF are used, there is a benefit with respect to revision outcomes for THA in women who are years old and a benefit for HA in women who are ≥80 years old and men who are ≥75 years old. There is no difference in dislocation rates. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
AO Surgery Reference: a comprehensive guide for management of fractures.
Publisher: BMJ
Date: 18-08-2016
Early Rate of Revision of Total Hip Arthroplasty Related to Surgical Approach
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-08-2020
Abstract: Background: A number of surgical approaches are available for total hip arthroplasty (THA), but there are limited large-volume, multi-surgeon data comparing the rates of early revisions following these approaches. The aim of this study was to compare the rate of revision of primary conventional THA related to surgical approach. Methods: Data from the Australian Orthopaedic Association National Joint Replacement Registry were analyzed for all patients who had undergone a primary THA for osteoarthritis from January 2015 to December 2018. The primary outcome measure was the cumulative percent revision (CPR) for all causes. Secondary outcome measures were major revision (a revision procedure requiring change of the acetabular and/or femoral component) and revision for specific diagnoses: fracture, component loosening, infection, and dislocation. Age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, femoral head size, and femoral fixation were assessed as potential confounders. Results: There was a total of 122,345 primary conventional THAs for which the surgical approach was recorded in the registry 65,791 were posterior, 24,468 were lateral, and 32,086 were anterior. There was no difference in the overall CPR among approaches, but the anterior approach was associated with a higher rate of major revisions. There were differences among the approaches with regard to the types of revision. When adjusted for age, sex, ASA score, BMI, femoral head size, and femoral fixation, the anterior approach was associated with a higher rate of femoral complications—i.e., revision for periprosthetic fracture and femoral loosening. There was a lower rate of revision for infection after the anterior approach compared with the posterior approach in the entire period, and compared with the lateral approach in the first 3 months. The posterior approach was associated with a higher rate of revision for dislocation compared with both the anterior and the lateral approach in all time periods. The anterior approach was associated with a lower rate of revision compared with the lateral approach in the first 6 months only. Conclusions: There was no difference in the overall early CPR among the surgical approaches, but the anterior approach was associated with a higher rate of early major revisions and femoral complications (revisions for periprosthetic fracture and femoral loosening) compared with the posterior and lateral approaches and with a lower rate of dislocation and infection. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Related Funding Activities
No related grants have been discovered for Roger Bingham.