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Bristol, United Kingdom

Harvie P.,Royal Perth Hospital | Torres-Grau J.,The Avon Orthopaedic Center | Beaver R.J.,Royal Perth Hospital
Knee | Year: 2012

Pseudotumours about the hip as a result of metal-on-metal wear debris are now widely reported. Nerve palsies associated with such lesions are less commonly described. To our knowledge no previous reports exist which describe pseudotumours about a total knee arthroplasty. The case of a metal-on-metal debris-induced pseudotumour about a total knee arthroplasty with an associated common peroneal nerve palsy is presented. The use of serum ion levels is discussed, specifically for the early detection and diagnosis of full-thickness polyethylene liner wear and subsequent revision options. © 2011 Elsevier B.V.


Berstock J.R.,The Avon Orthopaedic Center | Baker R.P.,The Avon Orthopaedic Center | Bannister G.C.,The Avon Orthopaedic Center | Case C.P.,The Avon Orthopaedic Center
HIP International | Year: 2014

The histological specimens from 29 failed metal-on-metal (MoM) hip arthroplasties treated at our institution were reviewed. Five patients had a failed MoM total hip arthroplasty (THA), and 24 patients a failed hip resurfacing. Clinical and radiographic features of each hip were correlated with the histological findings. We report three major histological subtypes. Patients either have a macrophage response to metal debris, a lymphocytic response (ALVAL) or a mixed picture of both. In addition we observe that the ALVAL response is located deep within tissue specimens, and can occur in environments of low wear debris. The macrophage response is limited to the surface of tissue specimens, with normal underlying tissue. Patients with subsequently confirmed ALVAL underwent revision surgery sooner than patients whose histology confirms a macrophage response (3.8 vs. 6.9 years p<0.05). Both histological subtypes (ALVAL and macrophage dominant) are responsible for abnormal soft tissue swellings. © 2014 Wichtig Publishing.


Metcalfe A.J.,The Avon Orthopaedic Center | Metcalfe A.J.,Royal Infirmary | Clark D.A.,The Avon Orthopaedic Center | Clark D.A.,Royal Infirmary | And 4 more authors.
Operative Techniques in Sports Medicine | Year: 2015

Trochlea dysplasia is a developmental condition in which the normal trochlear groove fails to form that can be associated with patella instability. In cases of recurrent patella instability associated with severe trochlea dysplasia, a trochleoplasty can be an effective solution. In this article, a surgical technique based on the Swiss Bereiter trochleoplasty is described, which the senior author has developed over a 12-year period. The technique is challenging and requires experience as well as an adequate case volume, but can produce excellent results in what can often be a difficult patient population. © 2015 Elsevier Inc.

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