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1.  Socio-economic impact of Birmingham hip resurfacing on patient employment after ten years 
International Orthopaedics  2010;35(10):1467-1470.
Birmingham hip resurfacing is an attractive option for treatment of arthritis in young and active patients. The aim of this study was to assess the socio-economic impact of Birmingham hip resurfacing on their employment and work intensity at ten years. A cohort of 90 consecutive patients with 100 Birmingham hip resurfacing, performed by single surgeon, were reviewed prospectively. The mean age was 51 years at surgery. Prospective review was undertaken from surgery until the tenth post-operative year. Overall, 90% of patients were in the same employment following surgery. Two patients who were employed before surgery were unemployed. Three patients had to decrease their work intensity but were still employed. Three out of five disabled patients regained employment following surgery. Seventy-eight patients were able to continue their employment with no or minimal restriction. Birmingham hip resurfacing allows the majority of patients to continue their same employment at similar intensity ten years following surgery.
PMCID: PMC3174309  PMID: 21113593
2.  Use of porous trabecular metal augments with impaction bone grafting in management of acetabular bone loss 
Acta Orthopaedica  2012;83(4):347-352.
The use of impaction grafting in revisions with larger acetabular bone defects has mixed outcomes and sometimes high failures rates.
Patients and methods
This prospective, single-center study involved a consecutive series of 24 patients who underwent complex reconstruction of the acetabulum using a trabecular metal augment, impaction bone grafting, and a cemented high-density polyethylene cup. Patients were followed for median 5 (3–7) years.
The 2-year WOMAC pain, function, and stiffness scores improved, as did certain components (bodily pain, physical function, role physical, role emotional, physical component score, and social function) of the SF-36 (p < 0.05). 23 of the patients were very satisfied with the overall outcome of the surgery and would have undergone the surgery again for a similar problem, and 19 reported great improvement in their quality of life after surgery. Radiographs at the latest follow-up revealed incorporation of the augment with mean change in acetabular component inclination of less than 1 degree (p > 0.05) and cup migration of less than 5 mm in both horizontal and vertical axes (p > 0.05). 1 patient required further revision at 13 months and was found to have a fractured augment at re-revision.
This study shows that trabecular metal augments are effective in filling the bone defect and provide a stable foundation for impaction bone grafting. We found satisfactory clinical and radiographic results using this technique, with low failure rate at a median follow-up time of 5 years.
PMCID: PMC3427624  PMID: 22900910
3.  Bone density of the femoral neck following Birmingham hip resurfacing 
Acta Orthopaedica  2009;80(6):660-665.
Background Resurfacing is a popular alternative to a standard hip replacement in young arthritic patients. Despite bone preservation around the femoral component, there is little information regarding the bone quality.
Patients and methods 32 patients underwent consecutive Birmingham hip resurfacing. The bone density of the femoral neck was measured preoperatively and then at 6 weeks, 3 months, 1 year, and 2 years. The femoral neck was divided into regions of interest. Results were available for 27 hips in 26 patients.
Results The overall femoral neck bone density showed a trend towards a decrease at 6 weeks and 3 months but returned to the preoperative level at 1 year, and was maintained at 2 years. The combined superior regions of the neck showed a statistically significant decrease in bone density at 6 weeks and 3 months. This returned to preoperative levels at 1 year and was maintained at 2 years.
Interpretation Bone density appears to decrease at 6 weeks and 3 months, suggesting that care is necessary until bone density begins to recover.
PMCID: PMC2823310  PMID: 19995316

Results 1-3 (3)