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The practice of maxillofacial surgery is rapidly developing and the demand for such services is increasing. Currently, the oral and maxillofacial surgery unit at Morriston Hospital in Swansea is small, but this book will be of huge benefit to those new to the specialty, to those training in the UK and to those practising in the United States and other countries around the world.
This is a major contribution to the teaching literature of this important and rapidly growing speciality. It is a major and timely update to the classic text by Dr. Bowman and is, therefore, a real pleasure to work with. Over the past 10 years, the National Joint Registry in the UK has captured data on more than 8,500 primary and revision joint replacements among patients over a long follow-up period. As a result, a body of evidence has been generated in support of revision surgery, particularly for primary replacements with a 10-year survival rate of 82% [23], 89% [24], 90% [25], 96% [26], and 93% [27]. However, the evidence of failure and revision in the UK is limited to retrospective and observational studies, and the effects of this new evidence on clinical practice remain questionable. The available evidence, however, indicates that the risk of revision after primary replacements are much higher in conjunction with malposition or defects in the bearing surfaces, and loosening of the connection between the femoral and tibial components. These could be addressed by opting for revision surgery early on. But, there is little evidence for the effect of early revision surgery on survival in patients with loosening of the bearings (Figure 3.1). Likewise, the causes of failure among revision procedures included material or design failures, inadequate preparation of the bone and component loosening and wear causing migration of the component. In addition, Revision of a joint prosthesis under revision might be associated with wear and other complications of the osteoarthritis that is a result of the primary replacement and sometimes counteracted by revision surgery. The potential for complications of revision surgery include recurrent dislocation, incisional hernia of the scar, infection, leg length discrepancy, hardware failure, particularly the loosening of the screw-plate fixation of the femoral component (Figure 3.2), malalignment of the implant, disruption of soft tissue balance, and bone fracture of the femur or tibia. d2c66b5586