Science.gov

Sample records for cemented acetabular replacements

  1. Revision total hip replacement using the cement-in-cement technique for the acetabular component: technique and results for 60 hips.

    PubMed

    Brogan, K; Charity, J; Sheeraz, A; Whitehouse, S L; Timperley, A J; Howell, J R; Hubble, M J W

    2012-11-01

    The technique of femoral cement-in-cement revision is well established, but there are no previous series reporting its use on the acetabular side at the time of revision total hip replacement. We describe the technique and report the outcome of 60 consecutive acetabular cement-in-cement revisions in 59 patients at a mean follow-up of 8.5 years (5 to 12). All had a radiologically and clinically well-fixed acetabular cement mantle at the time of revision. During the follow-up 29 patients died, but no hips were lost to follow-up. The two most common indications for acetabular revision were recurrent dislocation (46, 77%) and to complement femoral revision (12, 20%). Of the 60 hips, there were two cases of aseptic loosening of the acetabular component (3.3%) requiring re-revision. No other hip was clinically or radiologically loose (96.7%) at the latest follow-up. One hip was re-revised for infection, four for recurrent dislocation and one for disarticulation of a constrained component. At five years the Kaplan-Meier survival rate was 100% for aseptic loosening and 92.2% (95% CI 84.8 to 99.6), with revision for any cause as the endpoint. These results support the use of cement-in-cement revision on the acetabular side in appropriate cases. Theoretical advantages include preservation of bone stock, reduced operating time, reduced risk of complications and durable fixation. PMID:23109626

  2. The long-term outcome of the cemented Weber acetabular component in total hip replacement using a second-generation cementing technique.

    PubMed

    de Jong, P T; de Man, F H R; Haverkamp, D; Marti, R K

    2009-01-01

    We report the long-term outcome of a modified second-generation cementing technique for fixation of the acetabular component of total hip replacement. An earlier report has shown the superiority of this technique assessed by improved survival compared with first-generation cementing. The acetabular preparation involved reaming only to the subchondral plate, followed by impaction of the bone in the anchorage holes. Between 1978 and 1993, 287 total hip replacements were undertaken in 244 patients with a mean age of 65.3 years (21 to 90) using a hemispherical Weber acetabular component with this modified technique for cementing and a cemented femoral component. The survival with acetabular revision for aseptic loosening as the endpoint was 99.1% (95% confidence interval 97.9 to 100 after ten years and 85.5% (95% confidence interval 74.7 to 96.2) at 20 years. Apart from contributing to a long-lasting fixation of the component, this technique also preserved bone, facilitating revision surgery when necessary. PMID:19092001

  3. Damage evolution in acetabular replacements under long-term physiological loading conditions.

    PubMed

    Wang, J-Y; Heaton-Adegbile, P; New, A; Hussell, J G; Tong, J

    2009-05-29

    Damage development in cemented acetabular replacements has been studied in bovine pelvic bones under long-term physiological loading conditions, including normal walking, stair climbing and a combined block loading with representative routine activities. The physiological loading conditions were achieved using a specially designed hip simulator for fixation endurance testing. Damage was detected and monitored using micro-CT scanning at regular intervals of the experiments, and verified by microscopic studies post testing. The results show that debonding at the bone-cement interface defined the failure of cement fixation in all cases, and debondings initiated near the dome of the acetabulum in the superior-posterior quadrant, consistent with the high-stress region identified from the finite element analysis of implanted acetabular models Zant, N.P., Heaton-Adegbile, P., Hussell, J.G., Tong, J., 2008b. In-vitro fatigue failure of cemented acetabular replacements-a hip simulator study. Journal of Biomechanical Engineering, Transactions of the ASME, 130, 021019-1-9]; [Tong, J., Zant, N.P., Wang, J-Y., Heaton-Adegbile, P., Hussell, J.G., 2008. Fatigue in cemented acetabulum. International Journal of Fatigue, 30(8), 1366-1375]. PMID:19345357

  4. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hip joint (hemi-hip) acetabular metal cemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3370 Hip joint (hemi-hip) acetabular metal cemented prosthesis. (a) Identification. A hip joint (hemi-hip)...

  5. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hip joint (hemi-hip) acetabular metal cemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3370 Hip joint (hemi-hip) acetabular metal cemented prosthesis. (a) Identification. A hip joint (hemi-hip)...

  6. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hip joint (hemi-hip) acetabular metal cemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3370 Hip joint (hemi-hip) acetabular metal cemented prosthesis. (a) Identification. A hip joint (hemi-hip)...

  7. Displacement and Stress Analysis around the Artificial Acetabular Cup in a Total Hip Replacement

    NASA Astrophysics Data System (ADS)

    Kakunai, Satoshi; Tachibana, Hiroyuki; Sakamoto, Tohru; Abo, Masayoshi; Ikeda, Daisaku; Fujiwara, Hiroo

    In order to improve the service life of the artificial acetabular cup in a total hip replacement, it is important to determine the best material and design, and to assess the mechanical behavior around the cup. In this study, electronic speckle interferometry (ESPI) and the two-dimensional finite element method (FEM) are employed to investigate the mechanical behavior. The influence of the cancellous bone and cup thickness on mechanical behavior around the cup was investigated. Good agreement of the cup model was found between the ESPI measurements and FEM predictions. The following results were obtained. (1) Cancellous bone with a porous structure can be measured by the ESPI method. (2) There are discontinuities of the displacement distribution in the transverse direction in each boundary region of the cup, bone cement and cancellous bone. (3) The maximum shear stress exists in the boundary region of the cup and bone cement.

  8. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... for use with bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice of completion of a PDP is required. A PMA or a notice of completion of a PDP is required to be filed with the... metal (hemi-hip) acetabular metal cemented prosthesis shall have an approved PMA or a declared...

  9. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... for use with bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice of completion of a PDP is required. A PMA or a notice of completion of a PDP is required to be filed with the... metal (hemi-hip) acetabular metal cemented prosthesis shall have an approved PMA or a declared...

  10. Cement as a locking mechanism for screw heads in acetabular revision shells - a biomechanical analysis.

    PubMed

    Laflamme, G Y; Alami, G B; Zhim, F

    2008-01-01

    In acetabular revisions, polyethylene (PE) liners are often cemented into metal shells on top of acetabular screw heads. This study investigates the possibility of using this technique to obtain fixed-angle acetabular screws Eth a concept that has not yet been reported in the literature. Two groups of screws (n=8) were inserted into Trabecular Metal revision shells (Zimmer), into which PE liners were then cemented. Screws in Group 1, inserted in the shell's pre-fabricated holes, were countersunk, whereas screws in Group 2 were inserted in custom-drilled holes that make their heads protrude into, and interdigitate with, the overlying cement mantle. Perpendicular loading was then applied to the screw shafts both statically to failure and cyclically. A greater stiffness was observed for the protruding screws upon static loading; and while the countersunk screws all failed at the screw-cement junction (53.44 + or - 8.33 N), the protruding screws all failed at the screw shaft (1049.79 + or - 32.12 N) a 20-fold difference (p< 0.05). Under cyclic loading, only the protruding screw head specimen did not fail, undergoing an overall displacement within the limits of osseointegration.These results support the hypothesis that the protrusion of an acetabular screw head into an overlying cement mantle significantly increases its angular stability. Provided other variables are favorable, this locking effect may increase the initial stability of the whole implant, thus improving the ultimate success of complex acetabular revisions. PMID:18645971

  11. Assessment of failure of cemented polyethylene acetabular component due to bone remodeling: A finite element study.

    PubMed

    Ghosh, Rajesh

    2016-09-01

    The aim of the study is to determine failure of the cemented polyethylene acetabular component, which might occur due to excessive bone resorption, cement-bone interface debonding and fatigue failure of the cement mantle. Three-dimensional finite element models of intact and implanted pelvic bone were developed and bone remodeling algorithm was implemented for present analysis. Soderberg fatigue failure diagram was used for fatigue assessment of the cement mantle. Hoffman failure criterion was considered for prediction of cement-bone interface debonding. Results indicate fatigue failure of the cement mantle and implant-bone interface debonding might not occur due to bone remodeling. PMID:27408485

  12. Using acetabular fossa as a guide for anticipated inclination of uncemented cup in total hip replacement

    PubMed Central

    Li, Junwei; Gao, Xu; Yang, Guanghui; Zhang, Yanru

    2015-01-01

    Positions of acetabular implant generally are considered to be major causative factors of dislocation. Accurate and consistent achievement of the preoperatively anticipated orientation of the acetabular cup is a great challenge in total hip replacement (THR). In the present study, we investigated the surgical application of acetabular fossa as a guide for anticipated inclination of uncemented cup, and evaluated its accuracy as an anatomic reference for achieving the preoperatively anticipated abduction of the acetabular cup in comparison with traditional device method on cadaveric specimens. Sixteen normal adult pelvic cadaveric specimens were collected. On each of the sixteen normal adult pelvic cadaveric specimens, acetabular fossa related anatomic sites were marked and studied on pelvic radiographs. Our results showed that there is close correlation between most medial aspect of acetabular sourcil and central axis of the acetabular cup at anticipated inclination of 40° ± 5°. And the fossa group can achieve the preoperatively anticipated cup abduction more accurately than the device group. The current results demonstrated that acetabular fossa can be a reasonable alternative, or as a complement to the currently used methods guiding total hip replacement. PMID:25784987

  13. The results of acetabular impaction grafting in 129 primary cemented total hip arthroplasties.

    PubMed

    Wilson, Matthew J; Whitehouse, Sarah L; Howell, Jonathan R; Hubble, Matthew J W; Timperley, A John; Gie, Graham A

    2013-09-01

    Between 1995 and 2003, 129 cemented primary THAs were performed using full acetabular impaction grafting to reconstruct acetabular deficiencies. These were classified as cavitary in 74 and segmental in 55 hips. Eighty-one patients were reviewed at mean 9.1 (6.2-14.3) years post-operatively. There were seven acetabular component revisions due to aseptic loosening, and a further 11 cases that had migrated >5mm or tilted >5° on radiological review - ten of which reported no symptoms. Kaplan-Meier analysis of revisions for aseptic loosening demonstrates 100% survival at nine years for cavitary defects compared to 82.6% for segmental defects. Our results suggest that the medium-term survival of this technique is excellent when used for purely cavitary defects but less predictable when used with large rim meshes in segmental defects. PMID:23523217

  14. The effect of cup outer sizes on the contact mechanics and cement fixation of cemented total hip replacements.

    PubMed

    Hua, Xijin; Li, Junyan; Wang, Ling; Wilcox, Ruth; Fisher, John; Jin, Zhongmin

    2015-10-01

    One important loosening mechanism of the cemented total hip arthroplasty is the mechanical overload at the bone-cement interface and consequent failure of the cement fixation. Clinical studies have revealed that the outer diameter of the acetabular component is a key factor in influencing aseptic loosening of the hip arthroplasty. The aim of the present study was to investigate the influence of the cup outer diameter on the contact mechanics and cement fixation of a cemented total hip replacement (THR) with different wear penetration depths and under different cup inclination angles using finite element (FE) method. A three-dimensional FE model was developed based on a typical Charnley hip prosthesis. Two acetabular cup designs with outer diameters of 40 and 43 mm were modelled and the effect of cup outer diameter, penetration depth and cup inclination angle on the contact mechanics and cement fixation stresses in the cemented THR were studied. The results showed that for all penetration depths and cup inclination angles considered, the contact mechanics in terms of peak von Mises stress in the acetabular cup and peak contact pressure at the bearing surface for the two cup designs were similar (within 5%). However, the peak von Mises stress, the peak maximum principal stress and peak shear stress in the cement mantle at the bone-cement interface for the 43 mm diameter cup design were predicted to be lower compared to those for the 40 mm diameter cup design. The differences were predicted to be 15-19%, 15-22% and 18-20% respectively for different cup penetration depths and inclination angles, which compares to the clinical difference of aseptic loosening incidence of about 20% between the two cup designs. PMID:26343226

  15. The biological approach in acetabular revision surgery: impaction bone grafting and a cemented cup.

    PubMed

    Colo, Ena; Rijnen, Wim H C; Schreurs, Berend Willem

    2015-01-01

    Acetabular impaction bone grafting (IBG) in combination with a cemented cup in revision total hip arthroplasty (THA) is a proven and well-recognised technique which has been used in clinical practice for more than 35 years. Nowadays, with cemented prostheses tending to lose a larger part of the THA market every year in primary and revision cases, and many young surgeons being only trained in implanting uncemented prostheses, this technique is considered by many as technically demanding and time consuming, making its use less appealing. Despite this image and many new innovative techniques using uncemented implants in acetabular revisions over the last 25 years, IBG with a cemented cup is still one of the few techniques that really can reconstitute bone and respects human biology. In this era of many biologically-based breakthroughs in medicine, it is hard to explain that the solution of most orthopaedic surgeons for the extensive bone defects as frequently seen during acetabular revision surgery, consists of implanting bigger and larger metal implants. This review aims to put the IBG method into a historical perspective, to describe the surgical technique and present the clinical results. PMID:26044533

  16. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hip joint metal/metal semi-constrained, with a... Devices § 888.3320 Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented...

  17. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/metal semi-constrained, with a... Devices § 888.3320 Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented...

  18. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hip joint metal/metal semi-constrained, with a... Devices § 888.3320 Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented...

  19. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hip joint metal/metal semi-constrained, with a... Devices § 888.3320 Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented...

  20. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hip joint metal/metal semi-constrained, with a... Devices § 888.3320 Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented...

  1. Evaluation of ranges of motion of a new constrained acetabular prosthesis for canine total hip replacement

    PubMed Central

    2013-01-01

    Background Total hip replacement (THR) is considered to be the most effective treatment option for advanced osteoarthritis of the hip in large breed dogs. However, a proportion of post-THR patients suffer prosthesis dislocation for various reasons, which may be addressed by a constrained acetabular prosthesis design. The study proposed a new THR with constrained acetabular component that aimed to decrease the incidence of postoperative dislocation while maintaining the necessary range of motion (ROM); and, through computer-simulated implantations, evaluated the ROM of the THR with and without malpositioning of the acetabular component. Methods A new THR with a constrained acetabular component that had an inward eccentric lining and a 60° cut-out on the dorsal side was designed, and its computer-aided design models were implanted into the pelvic and femoral models reconstructed from the computed tomography data of six healthy Labrador Retriever dogs. The allowable and functional ROM of the implanted THR were determined via computer simulations. The contact patterns between the bone or the prosthetic components at extreme positions of the THR were analyzed. Influence of malpositioning of the acetabular component on the ROM was assessed. Results The means (SD) of the functional ranges for flexion, extension, adduction, abduction, internal rotation and external rotation were 51.8° (6.6°), 163.3° (7.3°), 33.5° (5.7°), 74.0° (3.7°), 41.5° (8.3°) and 65.2° (9.9°), respectively. Malpositioning of the acetabular component by 20° in one direction was found to reduce ROM in other directions (reducing lateral opening: flexion: 12°, adduction: 20°, internal/external rotations: < 20°; increasing lateral opening: extension and abduction: < 16°; reducing retroversion: extension: < 20°, abduction: 15°, external rotation: < 20°; increasing retroversion: flexion: < 20°, abduction, adduction and internal rotation: 20°). Conclusions From the computer

  2. Development of a non-invasive diagnostic technique for acetabular component loosening in total hip replacements.

    PubMed

    Alshuhri, Abdullah A; Holsgrove, Timothy P; Miles, Anthony W; Cunningham, James L

    2015-08-01

    Current techniques for diagnosing early loosening of a total hip replacement (THR) are ineffective, especially for the acetabular component. Accordingly, new, accurate, and quantifiable methods are required. The aim of this study was to investigate the viability of vibrational analysis for accurately detecting acetabular component loosening. A simplified acetabular model was constructed using a Sawbones(®) foam block. By placing a thin silicone layer between the acetabular component and the Sawbones block, 2- and 4-mm soft tissue membranes were simulated representing different loosening scenarios. A constant amplitude sinusoidal excitation with a sweep range of 100-1500 Hz was used. Output vibration from the model was measured using an accelerometer and an ultrasound probe. Loosening was determined from output signal features such as the number and relative strength of observed harmonic frequencies. Both measurement methods were sufficient to measure the output vibration. Vibrational analysis reliably detected loosening corresponding to both 2 and 4 mm tissue membranes at driving frequencies between 100 and 1000 Hz (p < 0.01) using the accelerometer. In contrast, ultrasound detected 2-mm loosening at a frequency range of 850-1050 Hz (p < 0.01) and 4-mm loosening at 500-950 Hz (p < 0.01). PMID:26054805

  3. Measurement of polyethylene wear in acetabular components inserted with and without cement. A randomized trial.

    PubMed

    Devane, P A; Robinson, E J; Bourne, R B; Rorabeck, C H; Nayak, N N; Horne, J G

    1997-05-01

    We measured the three-dimensional wear of polyethylene after total hip arthroplasty with a titanium metal-backed Mallory-Head prosthesis that was inserted with cement in sixty-nine patients (sixty-nine hips) and with a press-fit titanium metal-backed Mallory-Head prosthesis that was inserted without cement in seventy patients (seventy hips). A modular titanium femoral head was used in all of the hips. The patients in the present study were part of a larger double-blind randomized trial comparing the result of total hip arthroplasty performed with cement with that of the same procedure performed without cement in 250 patients. The criterion for inclusion in the study of polyethylene wear was a minimum duration of follow-up of four years, which was met by 148 patients. As adequate radiographs for digitization were not available for nine patients, 139 patients were included in the present study. The age of the patient, the postoperative Harris hip score, the diameter of the femoral head, the thickness of the liner in the polar region of the acetabular component, and the duration of follow-up were similar for the two groups. The mean rate of volumetric wear of the polyethylene was significantly greater in the prostheses that had been inserted without cement than in those that had been inserted with cement (155.1 cubic millimeters per year compared with 98.5 cubic millimeters per year; p = 0.000008). Thirty-four (49 per cent) of the seventy hips in which the prosthesis had been inserted without cement had evidence of osteolysis on radiographs, compared with twelve (17 per cent) of the sixty-nine hips in the other group (p = 0.0002). Osteolysis was associated with an increased rate of polyethylene wear only in the hips in which the prosthesis had been inserted without cement. PMID:9160940

  4. Early catastrophic acetabular failure in Furlong total hip replacements

    PubMed Central

    Hamilton, Steven W.; Wardlaw, Douglas; Gibson, Peter H.

    2009-01-01

    The use of uncemented hip arthroplasty prostheses with ceramic articulations are popular, especially in the young, because of a perceived reduction in wear. We highlight a complication of ceramic on polyethylene articulating couples not previously described in the Furlong replacement. Despite widespread metalosis and particulate debris, osteolysis was not initially seen. The contamination compromised subsequent revision. PMID:19384635

  5. Early catastrophic acetabular failure in Furlong total hip replacements.

    PubMed

    Knox, David; Hamilton, Steven W; Wardlaw, Douglas; Gibson, Peter H

    2009-03-01

    The use of uncemented hip arthroplasty prostheses with ceramic articulations are popular, especially in the young, because of a perceived reduction in wear. We highlight a complication of ceramic on polyethylene articulating couples not previously described in the Furlong replacement. Despite widespread metalosis and particulate debris, osteolysis was not initially seen. The contamination compromised subsequent revision. PMID:19384635

  6. Radiographic evaluation of HDPE cemented and cementless Lord and An.C.A. screwed acetabular models.

    PubMed

    Toni, A; Sudanese, A; Viceconti, M; Montina, P P; Ciaroni, D; Calista, F; Terzi, S; Giunti, A

    1992-01-01

    A total of 187 alumina screwed porous-ceramic coated sockets (An.C.A.), 48 screwed smooth-surfaced Lord sockets, and 251 cemented polyethylene sockets were radiographically evaluated at an average follow-up of 30, 51 and 96 months respectively. After 6 years the Lord prostheses revealed a 38% incidence of loosening, similar to that observed for cemented sockets 10-12 years after surgery. The An.C.A. prostheses revealed radiographic loosening equal to 12% (6 cases) in the first 50 implants, and only 0.7% in the remaining 137 cases: overall, the An.C.A. acetabular prosthesis revealed an index of radiographic loosening equal to 3.3% (7/187). To guarantee "osteointegration" of the porous coating of An.C.A. sockets optimal stability must be obtained when the prosthesis is screwed in. Because the mid-term follow-up for this clinical experience is relatively short (30 months), an opinion on the reliability of the screwed "porous" sockets must await confirmation. PMID:1297574

  7. The effect of the Rim Cutter on cement pressurization and penetration on cemented acetabular fixation in total hip arthroplasty: an in vitro study.

    PubMed

    Smith, B N; Lee, A J C; Timperley, A J; Whitehouse, S L; Crawford, R W

    2010-01-01

    The Rim Cutter (Stryker Orthopedics, Mahwah, New Jersey) is a tool designed to cut a ledge inside the rim of the acetabulum, onto which a precisely trimmed, cemented, flanged cup can be fitted. The aim was to investigate the effect of the Rim Cutter on the intra-acetabular cement mantle pressure and the depth of cement penetration during cup insertion. The study had two parts. In the first part, hemi-pelvis models were fitted with pressure sensors. Pressure in the acetabulum was measured on insertion of a conventional cemented flanged cup with and without the use of a Rim Cutter to prepare the rim of the acetabulum. The second part assessed cement penetration when the same cups were inserted into a foam shell model. The shell was mounted in a jig and had holes drilled in it; the distance that cement penetrated into the holes was measured. A significant increase in cement pressure at the apex (p = 0.04) and the rim (p = 0.004) is seen when the Rim Cutter is used. Cement penetration in the Rim Cutter group was significantly increased at the rim of the acetabulum (p = 0.003). Insertion of a flanged cup after the acetabulum is prepared with the Rim Cutter leads to a significant increase in cement pressure and penetration during cup insertion in vitro when compared with conventional flanged cups. PMID:21053777

  8. Survival of ceramic bearings in total hip replacement after high-energy trauma and periprosthetic acetabular fracture.

    PubMed

    Salih, S; Currall, V A; Ward, A J; Chesser, T J S

    2009-11-01

    Surgeons remain concerned that ceramic hip prostheses may fail catastrophically if either the head or the liner is fractured. We report two patients, each with a ceramic-on-ceramic total hip replacement who sustained high-energy trauma sufficient to cause a displaced periprosthetic acetabular fracture in whom the ceramic bearings survived intact. Simultaneous fixation of the acetabular fracture, revision of the cementless acetabular prosthesis and exchange of the ceramic bearings were performed successfully in both patients. Improved methods of manufacture of new types of alumina ceramic with a smaller grain size, and lower porosity, have produced much stronger bearings. Whether patients should be advised to restrict high-impact activities in order to protect these modern ceramic bearings from fracture remains controversial. PMID:19880903

  9. Total hip replacement through a posterior approach using a 22 mm diameter femoral head : the role of the transverse acetabular ligament and capsular repair in reducing the rate of dislocation.

    PubMed

    Kumar, V; Sharma, S; James, J; Hodgkinson, J P; Hemmady, M V

    2014-09-01

    Despite a lack of long-term follow-up, there is an increasing trend towards using femoral heads of large diameter in total hip replacement (THR), partly because of the perceived advantage of lower rates of dislocation. However, increasing the size of the femoral head is not the only way to reduce the rate of dislocation; optimal alignment of the components and repair of the posterior capsule could achieve a similar effect. In this prospective study of 512 cemented unilateral THRs (Male:Female 230:282) performed between 2004 and 2011, we aimed to determine the rate of dislocation in patients who received a 22 mm head on a 9/10 Morse taper through a posterior approach with capsular repair and using the transverse acetabular ligament (TAL) as a guide for the alignment of the acetabular component. The mean age of the patients at operation was 67 years (35 to 89). The mean follow-up was 2.8 years (0.5 to 6.6). Pre- and post-operative assessment included Oxford hip, Short Form-12 and modified University of California Los Angeles and Merle D'Aubigne scores. The angles of inclination and anteversion of the acetabular components were measured using radiological software. There were four dislocations (0.78%), all of which were anterior. In conclusion, THR with a 22 mm diameter head performed through a posterior approach with capsular repair and using the TAL as a guide for the alignment of the acetabular component was associated with a low rate of dislocation. PMID:25183591

  10. Acetabular revision with impaction bone grafting and a cemented polyethylene acetabular component: comparison of the Kaplan-Meier analysis to the competing risk analysis in 62 revisions with 25 to 30 years follow-up.

    PubMed

    Te Stroet, M A J; Keurentjes, J C; Rijnen, W H C; Gardeniers, J W M; Verdonschot, N; Slooff, T J J H; Schreurs, B W

    2015-10-01

    We present the results of 62 consecutive acetabular revisions using impaction bone grafting and a cemented polyethylene acetabular component in 58 patients (13 men and 45 women) after a mean follow-up of 27 years (25 to 30). All patients were prospectively followed. The mean age at revision was 59.2 years (23 to 82). We performed Kaplan-Meier (KM) analysis and also a Competing Risk (CR) analysis because with long-term follow-up, the presence of a competing event (i.e. death) prevents the occurrence of the endpoint of re-revision. A total of 48 patients (52 hips) had died or had been re-revised at final review in March 2011. None of the deaths were related to the surgery. The mean Harris hip score of the ten surviving hips in ten patients was 76 points (45 to 99). The KM survivorship at 25 years for the endpoint 're-revision for any reason' was 58.0% (95% confidence interval (CI) 38 to 73) and for 're-revision for aseptic loosening' 72.1% (95% CI 51 to 85). With the CR analysis we calculated the KM analysis overestimates the failure rate with respectively 74% and 93% for these endpoints. The current study shows that acetabular impaction bone grafting revisions provide good clinical results at over 25 years. PMID:26430007

  11. Performance of Non-Cemented, Hemispherical, Rim-Fit, Hydroxyapatite Coated Acetabular Component.

    PubMed

    John, Thomas K; Ghosh, Gaurav; Ranawat, Chitranjan S; Ranawat, Amar S; Meftah, Morteza

    2015-12-01

    The purpose of this study was to assess the durability of a non-cemented, hemispherical rim-fit, hydroxyapatite coated cup with a highly cross-linked polyethylene in 223 total hip arthroplasties. At 6-years follow-up (range, 5-9), there were no cup revisions for osteolysis or loosening. Radiologic evidence of osseointegration was based on presence of Stress Induced Reactive Cancellous Bone and radial trabeculae, seen in 47% and 93% of cups, respectively; both were most prevalent in Zone 1. There was no interference demarcation in any zones. Two cups were revised (0.9%): one for dislocation and another for infection. The Kaplan-Meier survivorship for cup revision for any failure (infection, dislocation) was 99% and for mechanical failure (osteolysis, loosening) was 100%. This design has excellent safety, efficacy and durability. PMID:26235521

  12. Porous titanium particles for acetabular reconstruction in total hip replacement show extensive bony armoring after 15 weeks

    PubMed Central

    Walschot, Lucas H B; Aquarius, René; Verdonschot, Nico; Buma, Pieter

    2014-01-01

    Background and purpose — The bone impaction grafting technique restores bone defects in total hip replacement. Porous titanium particles (TiPs) are deformable, like bone particles, and offer better primary stability. We addressed the following questions in this animal study: are impacted TiPs osteoconductive under loaded conditions; do released micro-particles accelerate wear; and are systemic titanium blood levels elevated after implantation of TiPs? Animals and methods — An AAOS type-III defect was created in the right acetabulum of 10 goats weighing 63 (SD 6) kg, and reconstructed with calcium phosphate-coated TiPs and a cemented polyethylene cup. A stem with a cobalt chrome head was cemented in the femur. The goats were killed after 15 weeks. Blood samples were taken pre- and postoperatively. Results — The TiP-graft layer measured 5.6 (SD 0.8) mm with a mean bone ingrowth distance of 2.8 (SD 0.8) mm. Cement penetrated 0.9 (0.3–1.9) mm into the TiPs. 1 reconstruction showed minimal cement penetration (0.3 mm) and failed at the cement-TiP interface. There were no signs of accelerated wear, metallic particle debris, or osteolysis. Median systemic titanium concentrations increased on a log-linear scale from 0.5 (0.3–1.1) parts per billion (ppb) to 0.9 (0.5–2.8) ppb (p = 0.01). Interpretation — Adequate cement pressurization is advocated for impaction grafting with TiPs. After implantation, calcium phosphate-coated TiPs were osteoconductive under loaded conditions and caused an increase in systemic titanium concentrations. However, absolute levels remained low. There were no signs of accelerated wear. A clinical pilot study should be performed to prove that application in humans is safe in the long term. PMID:25238431

  13. Mechanical properties of femoral cortical bone following cemented hip replacement.

    PubMed

    Ni, G X; Lu, W W; Chiu, P K Y; Wang, Y; Li, Z Y; Zhang, Y G; Xu, B; Deng, L F; Luk, K D K

    2007-11-01

    Femoral bone remodeling following total hip replacement is a big concern and has never been examined mechanically. In this study, six goats underwent unilateral cemented hip hemiarthroplasty with polymethyl methacrylate (PMMA) bone cement. Nine months later animals were sacrificed, and the femoral cortical bone slices at different levels were analysed using microhardness testing and microcomputed tomography (micro-CT) scanning. Implanted femurs were compared to contralateral nonimplanted femurs. Extensive bone remodeling was demonstrated at both the proximal and middle levels, but not at the distal level. Compared with the nonimplanted side, significant decreases were found in the implanted femur in cortical bone area, bone mineral density, and cortical bone hardness at the proximal level, as well as in bone mineral density and bone hardness at the middle level. However, no significant difference was observed in either variable for the distal level. In addition, similar proximal-to-distal gradient changes were revealed both in cortical bone microhardness and bone mineral density. From the mechanical point of view, the results of the present study suggested that stress shielding is an important mechanical factor associated with bone adaptation following total hip replacement. PMID:17506504

  14. Complications With Long Cemented Stems in Proximal Femoral Replacement.

    PubMed

    Naik, Amish A; Lietman, Steven A

    2016-05-01

    This study attempted to determine whether patients undergoing cemented long-stem proximal femoral replacement had: (1) an increased short-term mortality rate; (2) greater intraoperative hemodynamic instability; (3) a greater need for resuscitation; and (4) a decreased risk of periprosthetic fracture. The current study reviewed intraoperative and short-term events related to clinical outcomes in 24 consecutive patients who were treated at a single institution over a 5-year period. These patients underwent primary long-stem (≥250 mm, n=13) vs short-stem (<250 mm, n=11) cemented proximal femoral replacement. Other than stem length, the 2 groups were not significantly different in terms of patient age, sex, height, weight, body mass index, diagnosis, or preoperative American Society of Anesthesiologists functional score. Primary outcomes were intraoperative death, blood loss, blood transfusions, fluid resuscitation, hypotension, oxygen desaturation, mortality up to 1 year, and need for revision surgery. At 1 year, a significantly increased mortality rate (77% vs 27%, P=.03) was noted in patients receiving long-stem vs short-stem arthroplasty. Patients who received longer stems also required more intraoperative blood transfusions and fluid resuscitation (P=.04) for greater hypotension (P=.04) and oxygen desaturation (P=.04). Two intraoperative deaths occurred in the long-stem group, and none occurred in the short-stem group. The findings suggest that there is an increased risk of intraoperative hemodynamic instability with long-stem vs short-stem proximal femoral replacement, with a need for greater resuscitative efforts and an increased risk of mortality at 1 year. [Orthopedics. 2016; 39(3):e423-e429.]. PMID:27064780

  15. Clinical and radiographic outcomes of acetabular impaction grafting without cage reinforcement for revision hip replacement: a minimum ten-year follow-up study.

    PubMed

    Gilbody, J; Taylor, C; Bartlett, G E; Whitehouse, S L; Hubble, M J W; Timperley, A J; Howell, J R; Wilson, M J

    2014-02-01

    Impaction bone grafting for the reconstitution of bone stock in revision hip surgery has been used for nearly 30 years. Between 1995 and 2001 we used this technique in acetabular reconstruction, in combination with a cemented component, in 304 hips in 292 patients revised for aseptic loosening. The only additional supports used were stainless steel meshes placed against the medial wall or laterally around the acetabular rim to contain the graft. All Paprosky grades of defect were included. Clinical and radiographic outcomes were collected in surviving patients at a minimum of ten years after the index operation. Mean follow-up was 12.4 years (sd 1.5) (10.0 to 16.0). Kaplan-Meier survival with revision for aseptic loosening as the endpoint was 85.9% (95% CI 81.0 to 90.8) at 13.5 years. Clinical scores for pain relief remained satisfactory, and there was no difference in clinical scores between cups that appeared stable and those that appeared radiologically loose. PMID:24493183

  16. A randomised controlled trial comparing highly cross-linked and contemporary annealed polyethylene after a minimal eight-year follow-up in total hip arthroplasty using cemented acetabular components.

    PubMed

    Langlois, J; Atlan, F; Scemama, C; Courpied, J P; Hamadouche, M

    2015-11-01

    Most published randomised controlled trials which compare the rates of wear of conventional and cross-linked (XL) polyethylene (PE) in total hip arthroplasty (THA) have described their use with a cementless acetabular component. We conducted a prospective randomised study to assess the rates of penetration of two distinct types of PE in otherwise identical cemented all-PE acetabular components. A total of 100 consecutive patients for THA were randomised to receive an acetabular component which had been either highly XL then remelted or moderately XL then annealed. After a minimum of eight years follow-up, 38 hips in the XL group and 30 hips in the annealed group had complete data (mean follow-up of 9.1 years (7.6 to 10.7) and 8.7 years (7.2 to 10.2), respectively). In the XL group, the steady state rate of penetration from one year onwards was -0.0002 mm/year (sd 0.108): in the annealed group it was 0.1382 mm/year (sd 0.129) (Mann-Whitney U test, p < 0.001). No complication specific to either material was recorded. These results show that the yearly linear rate of femoral head penetration can be significantly reduced by using a highly XLPE cemented acetabular component. PMID:26530645

  17. Constrained captive acetabular cup for recurrent dislocation of hemiarthroplasty in elderly: A case series

    PubMed Central

    Rajeev, Aysha; Banaszkiewicz, Paul

    2016-01-01

    Introduction Hemiarthroplasty of the hip is one of the commonest procedures done for intracapsular fractures of the neck of femur in elderly. Dislocation of the hemiarthroplasty is a recognised and significant complication. This is associated with considerable morbidity and mortality. The treatment options include closed manipulation, skin and skeletal traction, conversion to total hip replacement, exploration and open reduction and leaving it out of the acetabulum. Presentation of case A retrospective review of ten patients with recurrent and failed closed manipulative reduction of hemiarthroplasty who underwent revision using a cemented captive acetabular cup and cement to cement revision of femoral component with Exeter CDH stem was carried out. The follow up period was two years and the functional outcomes were assessed using Harris hip scores. Discussion The management of recurrent dislocations of hemiarthroplasty in elderly patient are very challenging. Even though various treatment options are described most of them are associated with increased morbidity and mortality and prevent these patients from early mobilisation. The use of captive acetabular avoid repeated dislocations, prolonged bed rest, wearing of a brace and all the complications associated with sustained immobilization. The drawbacks of using constrained cups are hip pain, limited hip movements and loosening. Conclusion We describe a new method of treatment of this difficult condition with a cemented constrained acetabular captive cup and cement to cement revision using a CDH femoral stem. This method prevents further dislocations and will give good functional outcomes thus reducing the high morbidity and mortality. PMID:27129135

  18. The effect of fly ash and coconut fibre ash as cement replacement materials on cement paste strength

    NASA Astrophysics Data System (ADS)

    Bayuaji, R.; Kurniawan, R. W.; Yasin, A. K.; Fatoni, H. AT; Lutfi, F. M. A.

    2016-04-01

    Concrete is the backbone material in the construction field. The main concept of the concrete material is composed of a binder and filler. Cement, concrete main binder highlighted by environmentalists as one of the industry are not environmentally friendly because of the burning of cement raw materials in the kiln requires energy up to a temperature of 1450° C and the output air waste CO2. On the other hand, the compound content of cement that can be utilized in innovation is Calcium Hydroxide (CaOH), this compound will react with pozzolan material and produces additional strength and durability of concrete, Calcium Silicate Hydrates (CSH). The objective of this research is to explore coconut fibers ash and fly ash. This material was used as cement replacement materials on cement paste. Experimental method was used in this study. SNI-03-1974-1990 is standard used to clarify the compressive strength of cement paste at the age of 7 days. The result of this study that the optimum composition of coconut fiber ash and fly ash to substitute 30% of cement with 25% and 5% for coconut fibers ash and fly ash with similar strength if to be compared normal cement paste.

  19. Characterization and utilization of cement kiln dusts (CKDs) as partial replacements of Portland cement

    NASA Astrophysics Data System (ADS)

    Khanna, Om Shervan

    The characteristics of cement kiln dusts (CKDs) and their effects as partial replacement of Portland Cement (PC) were studied in this research program. The cement industry is currently under pressure to reduce greenhouse gas (GHG) emissions and solid by-products in the form of CKDs. The use of CKDs in concrete has the potential to substantially reduce the environmental impact of their disposal and create significant cost and energy savings to the cement industry. Studies have shown that CKDs can be used as a partial substitute of PC in a range of 5--15%, by mass. Although the use of CKDs is promising, there is very little understanding of their effects in CKD-PC blends. Previous studies provide variable and often conflicting results. The reasons for the inconsistent results are not obvious due to a lack of material characterization data. The characteristics of a CKD must be well-defined in order to understand its potential impact in concrete. The materials used in this study were two different types of PC (normal and moderate sulfate resistant) and seven CKDs. The CKDs used in this study were selected to provide a representation of those available in North America from the three major types of cement manufacturing processes: wet, long-dry, and preheater/precalciner. The CKDs have a wide range of chemical and physical composition based on different raw material sources and technologies. Two fillers (limestone powder and quartz powder) were also used to compare their effects to that of CKDs at an equivalent replacement of PC. The first objective of this study was to conduct a comprehensive composition analysis of CKDs and compare their characteristics to PC. CKDs are unique materials that must be analyzed differently from PC for accurate chemical and physical analysis. The present study identifies the chemical and physical analytical methods that should be used for CKDs. The study also introduced a method to quantify the relative abundance of the different

  20. Effect of strontium-containing hydroxyapatite bone cement on bone remodeling following hip replacement.

    PubMed

    Ni, Guo X; Lin, Jian H; Chiu, Peter K Y; Li, Zhao Y; Lu, William W

    2010-01-01

    It is uncertain whether the use of bioactive bone cement has any beneficial effect on local bone adaptation following hip replacement. In this study, twelve goats underwent cemented hip hemiarthroplasty unilaterally, with either PMMA bone cement or strontium-containing hydroxyapatite (Sr-HA) bioactive bone cement. Nine months later, the femoral cortical bones at different levels were analyzed by microhardness testing and micro-CT scanning. Extensive bone remodeling was found at proximal and mid-levels in both PMMA and Sr-HA groups. However, with regard to the differences of bone mineral density, cortical bone area and bone hardness between implanted and non-implanted femur, less decreases were found in Sr-HA group than PMMA group at proximal and mid-levels, and significant differences were shown for bone area and hardness at proximal level. The results suggested that the use of Sr-HA cement might alleviate femoral bone remodeling after hip replacement. PMID:19728042

  1. Palacos compared to Palamed bone cement in total hip replacement: a randomized controlled trial.

    PubMed

    Meinardi, Joris E; Valstar, Edward R; Van Der Voort, Paul; Kaptein, Bart L; Fiocco, Marta; Nelissen, Rob G H H

    2016-10-01

    Background and purpose - Stability and survival of cemented total hip prostheses is dependent on a multitude of factors, including the type of cement that is used. Bone cements vary in viscosity, from low to medium and high. There have been few clinical RSA studies comparing the performance of low- and high-viscosity bone cements. We compared the migration behavior of the Stanmore hip stem cemented using novel low-viscosity Palamed bone cement with that of the same stem cemented with conventional high-viscosity Palacos bone cement. Patients and methods - We performed a randomized controlled study involving 39 patients (40 hips) undergoing primary total hip replacement for primary or secondary osteoarthritis. 22 patients (22 hips) were randomized to Palacos and 17 patients (18 hips) were randomized to Palamed. Migration was determined by RSA. Results - None of these 40 hips had been revised at the 10-year follow-up mark. To our knowledge, the patients who died before they reached the 10-year endpoint still had the implant in situ. No statistically significant or clinically significant differences were found between the 2 groups for mean translations, rotations, and maximum total-point motion (MTPM). Interpretation - We found similar migration of the Stanmore stem in the high-viscosity Palacos cement group and the low-viscosity Palamed cement group. We therefore expect that the risk of aseptic loosening with the new Palamed cement would be comparable to that with the conventional Palacos cement. The choice of which type of bone cement to use is therefore up to the surgeon's preference. PMID:27329869

  2. Use of waste brick as a partial replacement of cement in mortar

    SciTech Connect

    Naceri, Abdelghani Hamina, Makhloufi Chikouche

    2009-08-15

    The aim of this study is to investigate the use of waste brick as a partial replacement for cement in the production of cement mortar. Clinker was replaced by waste brick in different proportions (0%, 5%, 10%, 15% and 20%) by weight for cement. The physico-chemical properties of cement at anhydrous state and the hydrated state, thus the mechanical strengths (flexural and compressive strengths after 7, 28 and 90 days) for the mortar were studied. The microstructure of the mortar was investigated using scanning electron microscopy (SEM), the mineralogical composition (mineral phases) of the artificial pozzolan was investigated by the X-ray diffraction (XRD) and the particle size distributions was obtained from laser granulometry (LG) of cements powders used in this study. The results obtained show that the addition of artificial pozzolan improves the grinding time and setting times of the cement, thus the mechanical characteristics of mortar. A substitution of cement by 10% of waste brick increased mechanical strengths of mortar. The results of the investigation confirmed the potential use of this waste material to produce pozzolanic cement.

  3. Use of waste brick as a partial replacement of cement in mortar.

    PubMed

    Naceri, Abdelghani; Hamina, Makhloufi Chikouche

    2009-08-01

    The aim of this study is to investigate the use of waste brick as a partial replacement for cement in the production of cement mortar. Clinker was replaced by waste brick in different proportions (0%, 5%, 10%, 15% and 20%) by weight for cement. The physico-chemical properties of cement at anhydrous state and the hydrated state, thus the mechanical strengths (flexural and compressive strengths after 7, 28 and 90 days) for the mortar were studied. The microstructure of the mortar was investigated using scanning electron microscopy (SEM), the mineralogical composition (mineral phases) of the artificial pozzolan was investigated by the X-ray diffraction (XRD) and the particle size distributions was obtained from laser granulometry (LG) of cements powders used in this study. The results obtained show that the addition of artificial pozzolan improves the grinding time and setting times of the cement, thus the mechanical characteristics of mortar. A substitution of cement by 10% of waste brick increased mechanical strengths of mortar. The results of the investigation confirmed the potential use of this waste material to produce pozzolanic cement. PMID:19383569

  4. Polyethylene wear in uncemented acetabular components.

    PubMed

    Hernandez, J R; Keating, E M; Faris, P M; Meding, J B; Ritter, M A

    1994-03-01

    We measured polyethylene wear in 231 porous-coated uncemented acetabular cups. We divided the hips into two groups according to the fixation of the femoral component, by cementing (n = 97) or press-fit (n = 134). Follow-up was from three to five years. The patients in two sub-groups were matched for weight, diagnosis, sex, age and length of follow-up. The linear wear rate of cups articulated with uncemented femoral components (0.22 mm/year) was significantly higher than the wear rate (0.15 mm/year) of cups articulated within cemented femoral components (p < 0.05). These results can be compared with previously reported wear rates of 0.08 mm/year for cemented all-polyethylene cups and 0.11 mm/year for cemented metal-backed cups. The higher wear rates of uncemented arthroplasties could jeopardize the long-term results of this type of hip replacement. PMID:8113288

  5. Comparison of cementing techniques of the tibial component in total knee replacement

    PubMed Central

    Li, Ming Guo; Wood, David; Nivbrant, Bo

    2008-01-01

    A few studies have shown that cementing the stem enhances fixation of the tibial baseplate in total knee replacement (TKR). Even the horizontal technique has been shown to provide good fixation. We used radiostereometry to study migration of the tibial component in 30 knees operated with Profix TKR. The knees were randomised for either complete (both under the baseplate and around the stem) or horizontal (only under the baseplate) cementing of the tibial component. At two years the tibial baseplate rotated externally a median of 0.18° in the uncemented stem group and internally a median of 0.23° in the cemented stem group. The tibial baseplate subsided 0.14 mm in the cemented stem group, and no translation was seen in the uncemented stem group. The differences in migration were small and probably without clinical significance. The findings do not favour either of the cementing techniques in TKR. PMID:18704414

  6. Comparison of cementing techniques of the tibial component in total knee replacement.

    PubMed

    Saari, Tuuli; Li, Ming Guo; Wood, David; Nivbrant, Bo

    2009-10-01

    A few studies have shown that cementing the stem enhances fixation of the tibial baseplate in total knee replacement (TKR). Even the horizontal technique has been shown to provide good fixation. We used radiostereometry to study migration of the tibial component in 30 knees operated with Profix TKR. The knees were randomised for either complete (both under the baseplate and around the stem) or horizontal (only under the baseplate) cementing of the tibial component. At two years the tibial baseplate rotated externally a median of 0.18 degrees in the uncemented stem group and internally a median of 0.23 degrees in the cemented stem group. The tibial baseplate subsided 0.14 mm in the cemented stem group, and no translation was seen in the uncemented stem group. The differences in migration were small and probably without clinical significance. The findings do not favour either of the cementing techniques in TKR. PMID:18704414

  7. Optimization of fly ash as sand replacement materials (SRM) in cement composites containing coconut fiber

    NASA Astrophysics Data System (ADS)

    Nadzri, N. I. M.; Jamaludin, S. B.; Mazlee, M. N.; Jamal, Z. A. Z.

    2016-07-01

    The need of utilizing industrial and agricultural wastes is very important to maintain sustainability. These wastes are often incorporated with cement composites to improve performances in term of physical and mechanical properties. This study presents the results of the investigation of the response of cement composites containing coconut fiber as reinforcement and fly ash use as substitution of sand at different hardening days. Hardening periods of time (7, 14 and 28 days) were selected to study the properties of cement composites. Optimization result showed that 20 wt. % of fly ash (FA) is a suitable material for sand replacement (SRM). Meanwhile 14 days of hardening period gave highest compressive strength (70.12 MPa) from the cement composite containing 9 wt. % of coconut fiber and fly ash. This strength was comparable with the cement without coconut fiber (74.19 MPa) after 28 days of curing.

  8. Options for acetabular fixation surfaces.

    PubMed

    Klika, Alison K; Murray, Trevor G; Darwiche, Hussein; Barsoum, Wael K

    2007-01-01

    Aseptic loosening is the most common cause for revision total hip arthroplasty (THA). Due to poor long-term results with cemented acetabular components, cementless implants that rely on biologic fixation became popular in the United States for both primary and revision procedures in the early 1980s. Cementless acetabular components used in THA have been reported to have superior radiographic performance compared with cemented fixation, although the optimal method of acetabular fixation remains controversial. Cementless acetabular components require initial implant stability to allow for bone ingrowth and remodeling into the acetabular shell, providing long-term durability of the prosthesis. Many improved implant materials are available to facilitate bone growth and remodeling, including the 3 most common surface treatments; fibermesh, sintered beads, and plasma spray coatings. Recently added to these are porous metal surfaces, which have increased porosity and optimal pore sizes when compared with titanium fibermesh. The most studied of these materials is the titanium fibermesh fixation surface, which has demonstrated a mechanical failure rate of 1% at 10 to 15 years. This technology utilizes the diffusion bonding process to attach fiber metal pads to a titanium substrate using heat and pressure. The sintered bead fixation surface offers a porous coating of various sizes of spherical beads, achieved by the sintering process, and has been shown to provide long-term fixation. While there are less long-term published data regarding the titanium plasma spray surface, its early results have provided evidence of its durability, even in the face of significant osteolysis. The most recently added alternative fixation surface is porous tantalum metal, which offers potentially greater bone ingrowth and bone graft incorporation due to its high porosity (80%) and low modulus of elasticity (3 MPa). Porous tantalum implants have shown early favorable clinical results and have

  9. Impaction grafted bone chip size effect on initial stability in an acetabular model: Mechanical evaluation

    PubMed Central

    Holton, Colin; Bobak, Peter; Wilcox, Ruth; Jin, Zhongmin

    2013-01-01

    Introduction Acetabular bone defect reconstruction is an increasing problem for surgeons with patients undergoing complex primary or revision total hip replacement surgery. Impaction bone grafting is one technique that has favourable long-term clinical outcome results for patients who undergo this reconstruction method for acetabular bone defects. Creating initial mechanical stability of the impaction bone graft in this technique is known to be the key factor in achieving a favourable implant survival rate. Different sizes of bone chips were used in this technique to investigate if the size of bone chips used affected initial mechanical stability of a reconstructed acetabulum. Methodology Twenty acetabular models were created in total. Five control models were created with a cemented cup in a normal acetabulum. Then five models in three different groups of bone chip size were constructed. The three groups had an acetabular protrusion defect reconstructed using either; 2–4 mm3, 10 mm3 or 20 mm3 bone chip size for impaction grafting reconstruction. The models underwent compression loading up to 9500 N and displacement within the acetabular model was measured indicating the initial mechanical stability. Results This study reveals that, although not statistically significant, the largest (20 mm3) bone chip size grafted models have an inferior maximum stiffness compared to the medium (10 mm3) bone chip size. Interpretations Our study suggests that 10 mm3 size of bone chips provide better initial mechanical stability compared to smaller or larger bone chips. We dismissed the previously held opinion that the biggest practically possible graft is best for acetabular bone graft impaction. PMID:24396238

  10. Use of waste gypsum to replace natural gypsum as set retarders in portland cement

    SciTech Connect

    Chandara, Chea; Azizli, Khairun Azizi Mohd; Ahmad, Zainal Arifin Sakai, Etsuo

    2009-05-15

    The present study is focused on clarifying the influence of waste gypsum (WG) in replacing natural gypsum (NG) in the production of ordinary Portland cement (OPC). WG taken from slip casting moulds in a ceramic factory was formed from the hydration of plaster of paris. Clinker and 3-5 wt% of WG was ground in a laboratory ball mill to produce cement waste gypsum (CMWG). The same procedure was repeated with NG to substitute WG to prepare cement natural gypsum (CMNG). The properties of NG and WG were investigated via X-ray Diffraction (XRD), X-ray fluorescence (XRF) and differential scanning calorimetry (DSC)/thermogravimetric (TG) to evaluate the properties of CMNG and CMWG. The mechanical properties of cement were tested in terms of setting time, flexural and compressive strength. The XRD result of NG revealed the presence of dihydrate while WG contained dihydrate and hemihydrate. The content of dihydrate and hemihydrates were obtained via DSC/TG, and the results showed that WG and NG contained 12.45% and 1.61% of hemihydrate, respectively. Furthermore, CMWG was found to set faster than CMNG, an average of 15.29% and 13.67% faster for the initial and final setting times, respectively. This was due to the presence of hemihydrate in WG. However, the values obtained for flexural and compressive strength were relatively the same for CMNG and CMWG. Therefore, this result provides evidence that WG can be used as an alternative material to NG in the production of OPC.

  11. Dislodgement of a cemented exeter femoral stem during closed manipulative reduction of a dislocated total hip replacement

    PubMed Central

    Rajeev, Aysha; Mohamed, Abdalla; Shaikh, Mazharuddin; Banaszkiewicz, Paul

    2016-01-01

    Introduction The incidence of cemented femoral stem migration and dislodgement even though has been described is extremely unusual. There is a high chance of polished femoral stem displacement happening while trying to reduce a dislocated total hip replacement by closed measures. Presentation of the case A 73 year old lady who had an Exeter cemented total hip replacement about two weeks back was admitted from Accident and Emergency with a dislocation. During the closed manipulative reduction under general anaesthesia it was noted that the femoral stem has dislodged from the canal. She underwent revision of the total hip replacement with good outcome. Discussion Femoral stem dislodgement occurs in total hip replacement if polished stem or inadequate cementing of the collar is carried out. Conclusion Gentle manipulative reduction under general anaesthesia of dislocated total hip replacement should be carried out if the polished femoral stem is used. PMID:27060643

  12. Recycling municipal incinerator fly- and scrubber-ash into fused slag for the substantial replacement of cement in cement-mortars.

    PubMed

    Lee, Tzen-Chin; Rao, Ming-Kang

    2009-06-01

    Fly- and scrubber-ash (weight ratio of approximately 1:3) from municipal solid waste incinerators (MSWI) are a major land-fill disposal problem due to their leaching of heavy metals. We uniformly mixed both types of ash with optimal amounts of waste glass frit, which was then melted into a glassy slag. The glassy slag was then pulverized to a particle size smaller than 38microm for use as a cement substitute (20-40% of total cement) and blended with sand and cement to produce slag-blended cement-mortar (SCM) specimens. The toxicity characteristics of the leaching procedure tests on the pulverized slag samples revealed that the amount of leached heavy metals was far below regulatory thresholds. The compressive strength of the 28-day cured SCM specimens was comparable to that of ordinary Portland cement mortars, while the compressive strength of specimens cured for 60 or 90 days were 3-11% greater. The observed enhanced strength is achieved by Pozzolanic reaction. Preliminary evaluation shows that the combination of MSWI fly- and scrubber-ash with waste glass yields a cost effective and environmentally friendly cement replacement in cement-mortars. PMID:19216067

  13. Use of waste gypsum to replace natural gypsum as set retarders in portland cement.

    PubMed

    Chandara, Chea; Azizli, Khairun Azizi Mohd; Ahmad, Zainal Arifin; Sakai, Etsuo

    2009-05-01

    The present study is focused on clarifying the influence of waste gypsum (WG) in replacing natural gypsum (NG) in the production of ordinary Portland cement (OPC). WG taken from slip casting moulds in a ceramic factory was formed from the hydration of plaster of paris. Clinker and 3-5wt% of WG was ground in a laboratory ball mill to produce cement waste gypsum (CMWG). The same procedure was repeated with NG to substitute WG to prepare cement natural gypsum (CMNG). The properties of NG and WG were investigated via X-ray Diffraction (XRD), X-ray fluorescence (XRF) and differential scanning calorimetry (DSC)/thermogravimetric (TG) to evaluate the properties of CMNG and CMWG. The mechanical properties of cement were tested in terms of setting time, flexural and compressive strength. The XRD result of NG revealed the presence of dihydrate while WG contained dihydrate and hemihydrate. The content of dihydrate and hemihydrates were obtained via DSC/TG, and the results showed that WG and NG contained 12.45% and 1.61% of hemihydrate, respectively. Furthermore, CMWG was found to set faster than CMNG, an average of 15.29% and 13.67% faster for the initial and final setting times, respectively. This was due to the presence of hemihydrate in WG. However, the values obtained for flexural and compressive strength were relatively the same for CMNG and CMWG. Therefore, this result provides evidence that WG can be used as an alternative material to NG in the production of OPC. PMID:19131236

  14. Canine intersegmental hip joint forces and moments before and after cemented total hip replacement.

    PubMed

    Dogan, S; Manley, P A; Vanderby, R; Kohles, S S; Hartman, L M; McBeath, A A

    1991-01-01

    Intersegmental forces and moments (i.e. resultant free body forces and moments computed at the joint centers) were studied in canine hindlimbs before and after cemented total hip replacement (THR). Five large, adult, mixed-breed dogs were selected. Their gait was recorded (while leash-walked) before surgery using high-speed cinematography and a force plate. Cemented total hip replacement was unilaterally performed on each dog. Gait was again recorded at one and four months after surgery. Segmental properties (mass, center of mass, and mass moment of inertia) of the hindlimbs were experimentally determined, and an inverse dynamics approach was used to compute intersegmental forces and moments in the sagittal plane. Significant reductions in intersegmental joint forces and moments were observed in the operated hindlimb one month after surgery, although kinematic gait parameters were unaltered. Decreases of 77.0% for vertical forces, 61.9% for craniocaudal forces, and 66.2% for extension moments were determined. Four months after surgery, the joint forces and moments had returned to their preoperative values. This experiment demonstrates that the dynamics of normal walking can be restored in a canine model by four months after THR. It also shows that kinetic (rather than kinematic) parameters are more descriptive of antalgic gait in the canine. PMID:1856240

  15. The acetabular component: an elliptical monoblock alternative.

    PubMed

    Sculco, Thomas P

    2002-06-01

    The major failure mode of cemented or noncemented acetabular fixation is osteolysis produced by biologic reaction to polyethylene and metallic debris. A monoblock acetabular noncemented component offers advantages in reducing the failure mechanism of acetabular cups. First, there is no extra-articular back surface polyethylene wear. Second, locking rings that may generate metallic debris are eliminated. Third, screw-holes, which decrease the surface area for ingrowth, are not needed, and pelvic entrance points for wear debris are eliminated. Fourth, an elliptical configuration allows better coaptation of the shell to the dome of the acetabulum. I have implanted >2,400 elliptical monoblock acetabular cups with a short-term follow-up of 6.5 years, with >4 years of follow-up in 840 hips. There have been no mechanical failures requiring revision. Four patients have been revised for recurrent hip instability, and one has been revised for infection. The need to convert to an acetabular component with screw fixation because of poor press-fit is <1%. PMID:12068420

  16. Impacted morsellized bone grafting and cemented primary total hip arthroplasty for acetabular protrusion in patients with rheumatoid arthritis: an 8- to 18-year follow-up study of 36 hips.

    PubMed

    Rosenberg, W W; Schreurs, B W; de Waal Malefijt, M C; Veth, R P; Slooff, T J

    2000-04-01

    Between 1979 and 1989, we performed 36 primary total hip replacements in 31 rheumatoid arthritis patients with protrusio acetabuli. The deficient acetabulum was reconstructed with autologous morsellized bone grafts from the femoral head. 3 patients were lost to follow-up. 12 patients (13 hips) died within 8 years postoperatively, none had a revision. 16 patients (20 hips) were reviewed at an average follow-up of 12 (8-18) years. In 2 hips, a revision was performed for aseptic loosening of the acetabular component, 65 and 8 years after primary surgery, which means a 90% (95% CI: 77%-100%) survival rate at 12 years (Kaplan Meier analysis). This technique is a good option in cases with protrusio acetabuli due to rheumatoid arthritis. PMID:10852319

  17. New methodology for assessing the environmental burden of cement mortars with partial replacement of coal bottom ash and fly ash.

    PubMed

    Menéndez, E; Álvaro, A M; Hernández, M T; Parra, J L

    2014-01-15

    This paper assess the mechanical an environmental behaviour of cement mortars manufactured with addition of fly ash (FA) and bottom ash (BA), as partial cement replacement (10%, 25% and 35%). The environmental behaviour was studied by leaching tests, which were performed under several temperature (23 °C and 60 °C) and pH (5 and 10) conditions, and ages (1, 2, 4 and 7 days). Then, the accumulated amount of the different constituents leached was analysed. In order to obtain an environmental burden (EB) value of each cement mixture, a new methodology was developed. The EB value obtained is related to the amount leached and the hazardous level of each constituent. Finally, the integral study of compressive strength and EB values of cement mixtures allowed their classification. The results showed that mortars manufactured with ordinary Portland cement (OPC) and with coal BA had similar or even better environmental and mechanical behaviour than mortars with FA. Therefore, the partial replacement of cement by BA might be as suitable or even better as the replacement by FA. PMID:24412590

  18. The behavior of the micro-mechanical cement-bone interface affects the cement failure in total hip replacement

    PubMed Central

    Waanders, Daan; Janssen, Dennis; Mann, Kenneth A.; Verdonschot, Nico

    2010-01-01

    In the current study, the effects of different ways to implement the complex micro-mechanical behavior of the cement-bone interface on the fatigue failure of the cement mantle was investigated. In an FEA-model of a cemented hip reconstruction the cement-bone interface was modeled and numerically implemented in four different ways: (I) as infinitely stiff, (II) as infinitely strong with a constant stiffness, (III) a mixed-mode failure response with failure in tension and shear, and (IV) realistic mixed mode behavior obtained from micro FEA-models. Case II, III and IV were analyzed using data from a stiff and a compliant micro-FEA model and their effects on cement failure were analyzed. The data used for Case IV was derived from experimental specimens that were tested previously. Although the total number of cement cracks was low for all cases, the compliant Case II resulted in twice as many cracks as Case I. All cases caused similar stress distributions at the interface. In all cases, the interface did not display interfacial softening; all stayed the elastic zone. Fatigue failure of the cement mantle resulted in a more favorable stress distribution at the cement-bone interface in terms of less tension and lower shear tractions. We conclude that immediate cement-bone interface failure is not likely to occur, but its local compliancy does affect the formation of cement cracks. This means that at a macro-level the cement-bone interface should be modeled as a compliant layer. However, implementation of interfacial post-yield softening does seem to be necessary. PMID:21036358

  19. Bone density and anisotropy affect periprosthetic cement and bone stresses after anatomical glenoid replacement: A micro finite element analysis.

    PubMed

    Chevalier, Yan; Santos, Inês; Müller, Peter E; Pietschmann, Matthias F

    2016-06-14

    Glenoid loosening is still a main complication for shoulder arthroplasty. We hypothesize that cement and bone stresses potentially leading to fixation failure are related not only to glenohumeral conformity, fixation design or eccentric loading, but also to bone volume fraction, cortical thickness and degree of anisotropy in the glenoid. In this study, periprosthetic bone and cement stresses were computed with micro finite element models of the replaced glenoid depicting realistic bone microstructure. These models were used to quantify potential effects of bone microstructural parameters under loading conditions simulating different levels of glenohumeral conformity and eccentric loading simulating glenohumeral instability. Results show that peak cement stresses were achieved near the cement-bone interface in all loading schemes. Higher stresses within trabecular bone tissue and cement mantle were obtained within specimens of lower bone volume fraction and in regions of low anisotropy, increasing with decreasing glenohumeral conformity and reaching their maxima below the keeled design when the load is shifted superiorly. Our analyses confirm the combined influences of eccentric load shifts with reduced bone volume fraction and anisotropy on increasing periprosthetic stresses. They finally suggest that improving fixation of glenoid replacements must reduce internal cement and bone tissue stresses, in particular in glenoids of low bone density and heterogeneity. PMID:27087675

  20. Pelvic and acetabular fractures

    SciTech Connect

    Mears, D.C.; Rubash, H.E.

    1986-01-01

    This treatise focuses primarily on the clinical aspects of diagnosis and treatments of pelvic and acetabular fractures. However, considerable attention is also paid to the radiographic diagnosis of trauma and postoperative effects. The book begins with a succinct review of pelvic and acetabular anatomy and pelvic biomechanics. It continues with a radiographic classification of pelvic injury, which will represent the major source of the book's interest for radiologists. The remainder of the book is concerned with clinical management of pelvic and acetabular trauma, including preoperative planning, surgical approaches, techniques of reduction, internal fixation, eternal fixation, post-operative care, and late problems. Even throughout this later portion of the book there are extensive illustrations, including plain radiographs, computed tomographic (CT) scans, reconstructed three-dimensional CT scans, and schematic diagrams of diverse pelvic and acetabular fractures and the elementary surgical techniques for their repair.

  1. Mechanical effects of stem cement interface characteristics in total hip replacement.

    PubMed

    Verdonschot, N; Huiskes, R

    1996-08-01

    Stem cement debonding is 1 of the most common forms of fixation failure and is thought to be a prelude to gross loosening of a total hip reconstruction. However, the immediate consequences of debonding remains a matter of controversy. The dynamic effects of stem cement debonding in total hip reconstruction were analyzed using 3-dimensional finite element techniques. Stem cement interface conditions were assumed as completely bonded or unbonded, with or without friction. The dynamic effects were accounted for, as presented by the stance and swing phases of the gait cycle. It was found that both cyclic micromotions at the stem cement interface and stresses in the cement mantle were effectively reduced by friction. The friction cases produced failure probabilities of the cement mantle that were relatively close to the one generated by the bonded stem. The probability of mechanical failure of the cement bone interface decreased after debonding and decreased more with reduced stem cement friction. These results show that, although a firm and lasting bond between stem and cement may be desirable for preventing cement failure, the mechanical effects of a debonded stem are less detrimental than were assumed earlier. For straight tapered stem shapes subjected to the loading conditions described, a polished stem may be desirable for the cement bone interface mechanics. PMID:8769468

  2. Size of metallic and polyethylene debris particles in failed cemented total hip replacements

    NASA Technical Reports Server (NTRS)

    Lee, J. M.; Salvati, E. A.; Betts, F.; DiCarlo, E. F.; Doty, S. B.; Bullough, P. G.

    1992-01-01

    Reports of differing failure rates of total hip prostheses made of various metals prompted us to measure the size of metallic and polyethylene particulate debris around failed cemented arthroplasties. We used an isolation method, in which metallic debris was extracted from the tissues, and a non-isolation method of routine preparation for light and electron microscopy. Specimens were taken from 30 cases in which the femoral component was of titanium alloy (10), cobalt-chrome alloy (10), or stainless steel (10). The mean size of metallic particles with the isolation method was 0.8 to 1.0 microns by 1.5 to 1.8 microns. The non-isolation method gave a significantly smaller mean size of 0.3 to 0.4 microns by 0.6 to 0.7 microns. For each technique the particle sizes of the three metals were similar. The mean size of polyethylene particles was 2 to 4 microns by 8 to 13 microns. They were larger in tissue retrieved from failed titanium-alloy implants than from cobalt-chrome and stainless-steel implants. Our results suggest that factors other than the size of the metal particles, such as the constituents of the alloy, and the amount and speed of generation of debris, may be more important in the failure of hip replacements.

  3. A tribological study of UHMWPE acetabular cups and polyurethane compliant layer acetabular cups.

    PubMed

    Smith, S L; Ash, H E; Unsworth, A

    2000-01-01

    , was found with cement fixation (0.30 mm penetration with cement fixation, 0.44 mm with polyethylene holder mounting, and 0.52 mm with metal shell mounting). A 4. 25-million-cycle wear test was then conducted on a further five ABG flared form, polyurethane acetabular cups with cement fixation. Five ABG standard form, UHMWPE acetabular cups were also wear-tested to 5. 0-million cycles. The mean and standard error of the wear rate for the polyurethane cups were 14.1 +/- 4.3 mg/10(6) (12.0 +/- 3.6 mm(3)/10(6)), cycles compared with 44.8 +/- 3.4 mg/10(6) (48.2 +/- 3. 7 mm(3)/10(6)), cycles for the UHMWPE cups. This study showed that the novel polyurethane-compliant layer acetabular cup with cement fixation was tribologically superior to the ABG standard form UHMWPE design currently being used clinically. PMID:11074431

  4. Validation of a computer-assisted method for measurement of radiographic wear in total hip arthroplasty using all polyethylene cemented acetabular components.

    PubMed

    Langlois, Jean; Zaoui, Amine; Scemama, Caroline; Martell, John; Bragdon, Charles; Hamadouche, Moussa

    2015-03-01

    Although cemented all polyethylene (PE) cups have been routinely used in total hip arthroplasty for decades, no computer-assisted method for measurement of radiographic wear has ever been specifically validated for these implants. Using a validated hip phantom model, AP plain hip radiographs were obtained consecutively for eight simulated wear positions. A version of Martell's Hip Analysis Suite software dedicated to all polyethylene sockets was used by three different examiners of varied experience. Bias (mean, standard deviation and 95% confidence interval limit), repeatability (standard deviation and 95% limit) and reproducibility (standard deviation and 95% limit) for two-dimensional wear measurements were assessed, as recommended by the current ASTM guidelines. Using this protocol, the dedicated software showed an overall mean bias of 0.089 ± 0.060 mm (mean ± SD), and 0.118 mm for 95% CI limit. Repeatability (intra examiner) standard deviation and 95% limit were respectively 0.106 mm and 0.292 mm. Reproducibility (inter examiner) standard deviation and 95% limit were respectively 0.112 mm and 0.308 mm. Martell Hip Analysis for all PE cemented cups is a reliable and low-cost instrument in the assessment of wear, despite being less precise than its original version dedicated to cementless components. PMID:25564735

  5. Hemispheric titanium porous coated acetabular component without screw fixation.

    PubMed

    Dorr, L D; Wan, Z; Cohen, J

    1998-06-01

    One hundred fifteen hips in 108 patients with primary total hip arthroplasty using the anatomic porous replacement hemispheric acetabular component implanted without adjunctive screw fixation had a mean postoperative followup time of 6 years (range, 5-7.4 years). Clinical evaluation was performed using the Harris hip score and patient self assessment using a modified Short Form-36 questionnaire. Radiographs were measured for radiolucent lines, polyethylene wear, osteolysis, migration, and fractures. No acetabular metal shell had been revised for loosening or was radiographically loose with or without migration (more than 3 mm) at final followup. Reoperation was done in nine (8%) hips because of polyethylene insert wear or disassembly. No fracture of the acetabular bone occurred at the time of surgery or was observed on radiograph. Fixation of the metal shell was stable, with progressive radiolucent lines observed at final followup in 2% of the hips. Osteolysis was recorded in one patient with two acetabular components. The fixation of noncemented hemispheric porous coated acetabular components is more related to the technique of acetabular bone preparation and press fit implantation than to whether additional screws or peg fixation are used. Fixation of this acetabular component without screws at an average of 6 years after surgery is reproducible and predictable in primary hip arthroplasty. The design of modular polyethylene inserts has been improved and should reduce the wear rate of reoperations of the polyethylene insert. PMID:9646758

  6. Femoral and obturator nerves palsy caused by pelvic cement extrusion after hip arthroplasty.

    PubMed

    Zwolak, Pawel; Eysel, Peer; William-Patrick Michael, Joern

    2011-03-17

    Cement extrusion into the pelvis with subsequent palsy of the obturator and femoral nerves is a rare entity after hip replacement surgery. Cemented fixation of the acetabular cup has been considered as a safe and reliable standard procedure with very good long term results. We present a case of fifty year old female patient after hip arthroplasty procedure which suffered an obturator and femoral nerve palsy caused by extrusion of bone cement into the pelvis. Postoperative X-rays and CT-scan of the pelvis demonstrated a huge mass consisted of bone cement in close proximity of femoral and obturator nerves. The surgery charts reported shallow and weak bony substance in postero-superior aspect of the acetabulum. This weak bony acetabular substance may have caused extrusion of bone cement during press-fitting of the polyethylene cup into the acetabulum, and the following damage of the both nerves produced by polymerization of bone cement. The bone cement fragment has been surgically removed 3 weeks after arthroplasty. The female patient underwent intensive postoperative physical therapy and electro stimulation which resulted in full recovery of the patient to daily routine and almost normal electromyography results. PMID:21808718

  7. Computer-based gait analysis of dogs: evaluation of kinetic and kinematic parameters after cemented and cementless total hip replacement.

    PubMed

    Drüen, S; Böddeker, J; Meyer-Lindenberg, A; Fehr, M; Nolte, I; Wefstaedt, P

    2012-01-01

    To date it is unclear whether cementless total hip replacement (THR) in dogs is of clinical advantage in comparison to cemented THR with regard to lameness improvement. Thus the aim of this study was to compare objectively the development of the gait pattern after cemented and cementless THR in dogs. For this purpose, 18 adult dogs with hip dysplasia underwent computer-based gait analysis on an instrumented treadmill prior to unilateral THR and then again ten days, four weeks and four months after surgery. Analysed kinetic parameters were symmetry indices (SI) of vertical ground reaction forces (GRF), which included peak vertical forces (PFz), mean vertical forces (MFz), vertical impulse (IFz), and vertical ground reaction forces of the arthroplasty limbs only. Analysed kinematic parameters were range-of-motion and the flexion and extension angles of hip, stifle and hock joints. The symmetry indice for PVF, MFz and IFz decreased to a value less than six in both THR groups four months after surgery, which is defined as not lame. Improvement in lameness of the arthroplasty limbs during the examination period of four months was not significantly different between the cemented and cementless groups. The results suggest that within a short-term observation period of four months after surgery, neither cementless nor cemented THR have a greater advantage with regard to lameness improvement. Additional studies with larger pools of subjects and longer time periods for follow-up examinations are necessary to verify these findings. PMID:22828804

  8. Difference in the acetabular cup orientation in standing and supine radiographs.

    PubMed

    Khan, Munir; Beckingsale, Tom; Marsh, Martin; Holland, Jim

    2016-09-01

    Acetabular orientation changes with that of the pelvis during lying and standing. This study was designed to measure these changes. We assessed 17 BHR replacements using EBRA software. The mean acetabular anteversion was more (p = 0.02) on erect than supine radiographs. Linear regression analysis showed that anteversion and inclination increased in some while decreased in others, and Bland and Altman analysis showed wide limits of agreement. The changes in acetabular orientation are thus subject to significant variations between the patients. We suggest studying the factors affecting acetabular orientation in standing to help reduce joint reaction forces and improve outcomes. PMID:27408490

  9. Activity and loading influence the predicted bone remodeling around cemented hip replacements.

    PubMed

    Dickinson, Alexander S

    2014-04-01

    Periprosthetic bone remodeling is frequently observed after total hip replacement. Reduced bone density increases the implant and bone fracture risk, and a gross loss of bone density challenges fixation in subsequent revision surgery. Computational approaches allow bone remodeling to be predicted in agreement with the general clinical observations of proximal resorption and distal hypertrophy. However, these models do not reproduce other clinically observed bone density trends, including faster stabilizing mid-stem density losses, and loss-recovery trends around the distal stem. These may resemble trends in postoperative joint loading and activity, during recovery and rehabilitation, but the established remodeling prediction approach is often used with identical pre- and postoperative load and activity assumptions. Therefore, this study aimed to evaluate the influence of pre- to postoperative changes in activity and loading upon the predicted progression of remodeling. A strain-adaptive finite element model of a femur implanted with a cemented Charnley stem was generated, to predict 60 months of periprosthetic remodeling. A control set of model input data assumed identical pre- and postoperative loading and activity, and was compared to the results obtained from another set of inputs with three varying activity and load profiles. These represented activity changes during rehabilitation for weak, intermediate and strong recoveries, and pre- to postoperative joint force changes due to hip center translation and the use of walking aids. Predicted temporal bone density change trends were analyzed, and absolute bone density changes and the time to homeostasis were inspected, alongside virtual X-rays. The predicted periprosthetic bone density changes obtained using modified loading inputs demonstrated closer agreement with clinical measurements than the control. The modified inputs also predicted the clinically observed temporal density change trends, but still under

  10. Outcome of total knee replacement following explantation and cemented spacer therapy

    PubMed Central

    Ghanem, Mohamed; Zajonz, Dirk; Bollmann, Juliane; Geissler, Vanessa; Prietzel, Torsten; Moche, Michael; Roth, Andreas; Heyde, Christoph-E.; Josten, Christoph

    2016-01-01

    Background: Infection after total knee replacement (TKR) is one of the serious complications which must be pursued with a very effective therapeutic concept. In most cases this means revision arthroplasty, in which one-setting and two-setting procedures are distinguished. Healing of infection is the conditio sine qua non for re-implantation. This retrospective work presents an assessment of the success rate after a two-setting revision arthroplasty of the knee following periprosthetic infection. It further considers drawing conclusions concerning the optimal timing of re-implantation. Patients and methods: A total of 34 patients have been enclosed in this study from September 2005 to December 2013. 35 re-implantations were carried out following explantation of total knee and implantation of cemented spacer. The patient’s group comprised of 53% (18) males and 47% (16) females. The average age at re-implantation time was 72.2 years (ranging from 54 to 85 years). We particularly evaluated the microbial spectrum, the interval between explantation and re-implantation, the number of surgeries that were necessary prior to re-implantation as well as the postoperative course. Results: We reported 31.4% (11) reinfections following re-implantation surgeries. The number of the reinfections declined with increasing time interval between explantation and re-implantation. Patients who developed reinfections were operated on (re-implantation) after an average of 4.47 months. Those patients with uncomplicated course were operated on (re-implantation) after an average of 6.79 months. Nevertheless, we noticed no essential differences in outcome with regard to the number of surgeries carried out prior to re-implantation. Mobile spacers proved better outcome than temporary arthrodesis with intramedullary fixation. Conclusion: No uniform strategy of treatment exists after peri-prosthetic infections. In particular, no optimal timing can be stated concerning re-implantation. Our data

  11. A valuable technique for femoral stem revision in total hip replacement: The in-cement revision - A case series and technical note.

    PubMed

    McDougall, C J; Yu, J; Calligeros, K; Crawford, R; Howie, C R

    2016-12-01

    Revision of a cemented femoral stem can be a challenging procedure. We present a series of cases utilising the "In-cement" revision, whereby the same size stem is introduced into the original cement mantle, without additional cementing. It requires a stable cement mantle in the correct version. We describe the technique and present a review of 23 revision total hip replacements performed over a 5 year period. At average follow-up of 67 months (12-128 months), the overall survivorship was 91.3% with no patient requiring re-revision for stem loosening or mechanical failure. Two patients required re-revision for infection and one of those patients is now deceased. No further operations were required in 21 patients. The "In-cement" revision can be a valuable technique for the revision arthroplasty surgeon. Early results suggest this is a safe and effective technique in the appropriate patient. PMID:27408507

  12. Effect of copolymer latexes on physicomechanical properties of mortar containing high volume fly ash as a replacement material of cement.

    PubMed

    Negim, El-Sayed; Kozhamzharova, Latipa; Gulzhakhan, Yeligbayeva; Khatib, Jamal; Bekbayeva, Lyazzat; Williams, Craig

    2014-01-01

    This paper investigates the physicomechanical properties of mortar containing high volume of fly ash (FA) as partial replacement of cement in presence of copolymer latexes. Portland cement (PC) was partially replaced with 0, 10, 20, 30 50, and 60% FA. Copolymer latexes were used based on 2-hydroxyethyl acrylate (2-HEA) and 2-hydroxymethylacrylate (2-HEMA). Testing included workability, setting time, absorption, chemically combined water content, compressive strength, and scanning electron microscopy (SEM). The addition of FA to mortar as replacement of PC affected the physicomechanical properties of mortar. As the content of FA in the concrete increased, the setting times (initial and final) were elongated. The results obtained at 28 days of curing indicate that the maximum properties of mortar occur at around 30% FA. Beyond 30% FA the properties of mortar reduce and at 60% FA the properties of mortar are lower than those of the reference mortar without FA. However, the addition of polymer latexes into mortar containing FA improved most of the physicomechanical properties of mortar at all curing times. Compressive strength, combined water, and workability of mortar containing FA premixed with latexes are higher than those of mortar containing FA without latexes. PMID:25254256

  13. Effect of Copolymer Latexes on Physicomechanical Properties of Mortar Containing High Volume Fly Ash as a Replacement Material of Cement

    PubMed Central

    Kozhamzharova, Latipa; Gulzhakhan, Yeligbayeva; Bekbayeva, Lyazzat; Williams, Craig

    2014-01-01

    This paper investigates the physicomechanical properties of mortar containing high volume of fly ash (FA) as partial replacement of cement in presence of copolymer latexes. Portland cement (PC) was partially replaced with 0, 10, 20, 30 50, and 60% FA. Copolymer latexes were used based on 2-hydroxyethyl acrylate (2-HEA) and 2-hydroxymethylacrylate (2-HEMA). Testing included workability, setting time, absorption, chemically combined water content, compressive strength, and scanning electron microscopy (SEM). The addition of FA to mortar as replacement of PC affected the physicomechanical properties of mortar. As the content of FA in the concrete increased, the setting times (initial and final) were elongated. The results obtained at 28 days of curing indicate that the maximum properties of mortar occur at around 30% FA. Beyond 30% FA the properties of mortar reduce and at 60% FA the properties of mortar are lower than those of the reference mortar without FA. However, the addition of polymer latexes into mortar containing FA improved most of the physicomechanical properties of mortar at all curing times. Compressive strength, combined water, and workability of mortar containing FA premixed with latexes are higher than those of mortar containing FA without latexes. PMID:25254256

  14. Cemented total hip prosthesis: Radiographic and scintigraphic evaluation

    SciTech Connect

    Aliabadi, P.; Tumeh, S.S.; Weissman, B.N.; McNeil, B.J. )

    1989-10-01

    Conventional radiographs, technetium-99m bone scans, and gallium-67 scans were reviewed in 44 patients who had undergone cemented total hip joint replacement and were imaged because of suspicion of prosthesis loosening or infection. A complete radiolucent line of 2 mm or wider along the bone-cement interface or metal-cement lucency on conventional radiographs was used as the criterion for prosthetic loosening with or without infection and proved to be 54% sensitive and 96% specific. Scintigraphic criteria for prosthetic loosening were increased focal uptake of the radiopharmaceutical for the femoral component and increased focal or diffuse uptake for the acetabular component. For bone scintigraphy, sensitivity was 73% and specificity was 96%. Combining the results of conventional radiographs and bone scans increased sensitivity to 84% and decreased specificity to 92% for the diagnosis of loosening, infection, or both. The study also showed that Ga-67 scintigraphy has a low sensitivity for the detection of infection.

  15. In vitro measurement of strain in the bone cement surrounding the femoral component of total hip replacements during simulated gait and stair-climbing.

    PubMed

    O'Connor, D O; Burke, D W; Jasty, M; Sedlacek, R C; Harris, W H

    1996-09-01

    The strains in the cement mantle surrounding the cemented femoral component of a total hip replacement were measured in vitro, using strain gauges embedded within the cement mantle adjacent to the femoral component in femurs from cadavers under physiologic loads simulating both single-limb stance and stair-climbing. Cement strains in the most proximal portion of the cement mantle were measured with and without full contact of the collar of the femoral stem on the cortex of the medial portion of the femoral neck during both loading conditions. To our knowledge, these are the first studies to contrast by direct measurement the strain profile in the cement mantle of a cemented femoral component under simulated stair-climbing with that occurring under simulated single-limb stance. They extend the findings from finite element analyses and from clinical specimens retrieved at autopsy in identifying those regions of the cement mantle most likely to fail. At two specific foci, the magnitude of the strain in the cement mantle approaches values that could lead to early fatigue failure of the cement. The two regions in which the strains were highest (greater than 1,000 microstrain) were the most proximal portions of the cement mantle and near the tip of the femoral component. Although these two regions are recognized areas of high strain and also common sites of cement debonding and cement mantle failure, the strain-gauge studies showed that the magnitude of cement strains in the proximal portion of the cement mantle were highest during stair-climbing; in contrast, high strains at the tip region occurred in both gait and stair-climbing. Contact between the collar and the medial portion of the femoral neck reduced the strain in the proximal portion of the cement mantle not only in single-limb stance but in stair-climbing as well. The level of strain recorded in these studies for a simulated person weighing 115 pounds (52 kg) could lead to cement fracture during extended in

  16. Bone cement

    PubMed Central

    Vaishya, Raju; Chauhan, Mayank; Vaish, Abhishek

    2013-01-01

    The knowledge about the bone cement is of paramount importance to all Orthopaedic surgeons. Although the bone cement had been the gold standard in the field of joint replacement surgery, its use has somewhat decreased because of the advent of press-fit implants which encourages bone in growth. The shortcomings, side effects and toxicity of the bone cement are being addressed recently. More research is needed and continues in the field of nanoparticle additives, enhanced bone–cement interface etc. PMID:26403875

  17. Calcium looping spent sorbent as a limestone replacement in the manufacture of portland and calcium sulfoaluminate cements.

    PubMed

    Telesca, Antonio; Marroccoli, Milena; Tomasulo, Michele; Valenti, Gian Lorenzo; Dieter, Heiko; Montagnaro, Fabio

    2015-06-01

    The calcium looping (CaL) spent sorbent (i) can be a suitable limestone replacement in the production of both ordinary Portland cement (OPC) and calcium sulfoaluminate (CSA) cement, and (ii) promotes environmental benefits in terms of reduced CO2 emission, increased energy saving and larger utilization of industrial byproducts. A sample of CaL spent sorbent, purged from a 200 kWth pilot facility, was tested as a raw material for the synthesis of two series of OPC and CSA clinkers, obtained from mixes heated in a laboratory electric oven within temperature ranges 1350°-1500 °C and 1200°-1350 °C, respectively. As OPC clinker-generating mixtures, six clay-containing binary blends were investigated, three with limestone (reference mixes) and three with the CaL spent sorbent. All of them showed similar burnability indexes. Moreover, three CSA clinker-generating blends (termed RM, MA and MB) were explored. They included, in the order: (I) limestone, bauxite and gypsum (reference mix); (II) CaL spent sorbent, bauxite and gypsum; (III) CaL spent sorbent plus anodization mud and a mixture of fluidized bed combustion (FBC) fly and bottom ashes. The maximum conversion toward 4CaO·3Al2O3·SO3, the chief CSA clinker component, was the largest for MB and almost the same for RM and MA. PMID:25915150

  18. Osteonecrosis with the use of polymethylmethacrylate cement for hip replacement: thermal-induced damage evidenced in vivo by decreased osteocyte viability.

    PubMed

    Whitehouse, M R; Atwal, N S; Pabbruwe, M; Blom, A W; Bannister, G C

    2014-01-01

    Thermal damage to host bone is a possible source of compromise of fixation in patients undergoing cemented total hip replacement (THR). Data on the subject to date are derived from mathematical modelling powered by animal studies. The aim of this study was to assess the effect of cement thickness on osteocyte viability in a population of patients undergoing cemented THR. An in vivo model was designed and validated by means of a finite element analysis. During standard hip joint replacement in 14 patients, the femoral necks were exposed before final resection to the heat of a curing cement mantle equivalent to 2.5 (Group 1) or 5 mm (Group 2) in vivo in the cemented acetabulum. Matched controls were collected for each patient. Osteocyte counts and viability were assessed by means of haematoxylin and eosin (H&E) stain and lactate dehydrogenase (LDH) assay. Ex vivo experiments were performed to determine the extent of thermal insult. H&E staining proved unreliable for assessing thermal insult in the short term. The LDH assay was reliable and demonstrated a significant reduction in osteocyte viability to a depth of 2.19 mm in group 1 and 9.19 mm in group 2. There was a significant difference between the groups at all depths. The ex vivo experiments revealed thermoclines indicating that host bone in the population undergoing cemented THR is more sensitive to the thermal insult delivered by curing polymethylmethacrylate cement than previously believed. This thermal insult may weaken the fixation between bone and cement and contribute towards aseptic loosening, the commonest cause of failure of THRs. PMID:24464728

  19. 21 CFR 888.3330 - Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... uncemented acetabular component, prosthesis. 888.3330 Section 888.3330 Food and Drugs FOOD AND DRUG..., prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis is a two-part device intended to be implanted to replace a hip joint. The...

  20. 21 CFR 888.3330 - Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... uncemented acetabular component, prosthesis. 888.3330 Section 888.3330 Food and Drugs FOOD AND DRUG..., prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis is a two-part device intended to be implanted to replace a hip joint. The...

  1. Porous surface replacement of the hip with chamfered-cylinder component.

    PubMed

    Amstutz, H; Kilgus, D; Kabo, M; Dorey, F

    1988-01-01

    One hundred porous surface replacements (PSR) were performed in 92 patients (63 men and 29 women) with a mean age of 53 (range 17-76). Follow-up times range from 1 to 4 years, with 48 patients having a follow-up of at least 2 years. Preoperative diagnoses were osteoarthritis (OA) 63, osteonecrosis (ON) 13, dysplasia 9, rheumatoid-ankylosing spondylitis 6, and other 9. Seventeen hips had metal-backed acrylic-fixed THARIES acetabular sockets, nine hips had a porous cobalt chrome hemispheric beaded acetabular component with adjuvant fixation screws and externally protruding screw hubs, and 74 hips had a porous chamfered cylinder-design acetabulum. Pain relief had been immediate and more complete than with acrylic-fixed or biologic-ingrowth stem-type replacement with comparable walking and function improvements. There have been no major systemic complications, sepsis, or loosening. There have been two transient peroneal nerve palsies and three trochanteric fibrous unions. There have been three reoperations, one for subluxation, one for "metalosis" due to mesh pad loosening, and one femoral neck fracture. Examination of one removed femoral surface component which has been histologically sectioned revealed excellent (90%) bone in-growth. Circumferential progressive radiolucencies developed at the bone-cement interface by 1 year in all of the 17 acrylic-fixed acetabular components. Reaming or seating defects were noted in 25% of the ingrowth components on postoperative radiographs. Radiographic analysis of immediate postoperative films of the chamfered cylinder design acetabular components frequently demonstrated bone-component interface radiolucencies which represented component seating defects. These initial interface radiolucencies became progressively more narrow over the first six months postoperatively suggesting "healing" of the reamed bone-component interface with trabecular bone around the chamfered cylinder acetabular components. Partial healing of initial

  2. Partial replacement of fossil fuel in a cement plant: risk assessment for the population living in the neighborhood.

    PubMed

    Rovira, Joaquim; Mari, Montse; Nadal, Martí; Schuhmacher, Marta; Domingo, José L

    2010-10-15

    In cement plants, the substitution of traditional fossil fuels not only allows a reduction of CO(2), but it also means to check-out residual materials, such as sewage sludge or municipal solid wastes (MSW), which should otherwise be disposed somehow/somewhere. In recent months, a cement plant placed in Alcanar (Catalonia, Spain) has been conducting tests to replace fossil fuel by refuse-derived fuel (RDF) from MSW. In July 2009, an operational test was progressively initiated by reaching a maximum of partial substitution of 20% of the required energy. In order to study the influence of the new process, environmental monitoring surveys were performed before and after the RDF implementation. Metals and polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) were analyzed in soil, herbage, and air samples collected around the facility. In soils, significant decreases of PCDD/F levels, as well as in some metal concentrations were found, while no significant increases in the concentrations of these pollutants were observed. In turn, PM(10) levels remained constant, with a value of 16μgm(-3). In both surveys, the carcinogenic and non-carcinogenic risks derived from exposure to metals and PCDD/Fs for the population living in the vicinity of the facility were within the ranges considered as acceptable according to national and international standards. This means that RDF may be a successful choice in front of classical fossil fuels, being in accordance with the new EU environmental policies, which entail the reduction of CO(2) emissions and the energetic valorization of MSW. However, further long-term environmental studies are necessary to corroborate the harmlessness of RDF, in terms of human health risks. PMID:20709362

  3. Cross table lateral radiography for measurement of acetabular cup version

    PubMed Central

    Gunderson, Ragnhild Beate

    2016-01-01

    Background Appropriate orientation of the acetabular cup is an important factor for long-term results of total hip arthroplasty. For measurement of cup version cross-table lateral radiography is frequently used, but the reliability has been questioned. We compared cross table lateral radiography with computed tomography in patients that had undergone primary total hip arthroplasty. Methods The study was prospectively done in 117 patients (117 hips). At 3 months after total hip replacement the acetabular version was measured by cross table lateral radiography and compared to measurements by computed tomography. Results By cross table lateral radiography acetabular anteversion was on mean 13.9° with a standard deviation of 10.1° as compared to 17.8°±12.6° by computed tomography. Mean difference was −3.8 with a distribution of measurements of ±13 degrees for 95% of the cases. Conclusions Our study shows that cross table radiography provides acceptable information for clinical use, but has limited use for precise analysis of acetabular cup version. PMID:27275482

  4. Acute polyethylene fracture in an uncemented acetabular cup

    PubMed Central

    Gross, Allan E.; Dust, William N.

    1997-01-01

    The smaller acetabular components used in total hip replacement may have a polyethylene liner that is too thin, resulting in higher polyethylene stress and an increased potential for wear. The authors present a case that highlights the problem of acute polyethylene fracture. To compensate for the thinness of the polyethylene, the authors recommend the use of a smaller head size to allow polyethylene thickness of at least 8 mm. PMID:9267302

  5. A technique to remove a well-fixed titanium-coated rm acetabular cup in revision hip arthroplasty

    PubMed Central

    2011-01-01

    A major concern during revision hip arthroplasty is acetabular bone loss and bleeding during the extraction of well-fixed cementless acetabular cup, because no interface exists between the host bone and the cup. Forceful removal of such component using curved gouges and osteotomes often leads to extended bone loss and compromises reimplantation of a new socket. In the following case report, we removed a well-fixed polyethylene titanium-coated RM acetabular cup with 20 years of follow-up, by significant wear of the polyethylene layer. The isoelastic femoral stem was also removed by mechanical failure. We report a technique for removal of the cementless acetabular cup using powered acetabular reamers. The RM cup was sequentially reamed and when the polyethylene layer was thin enough, the remaining cup was removed easily by hand tools. The acetabular bone stock is preserved and the risks of bone fractures and bleeding are minimized. To our knowledge, these principles were applied only in cemented cups. We have used this technique in 10 cases with excellent results and no complications were noted. This is a simple, reproducible, non-costly, non-timing consuming, safe and successful technique to remove well-fixed titanium-coated RM acetabular cups. PMID:21689456

  6. Dislocation of a dual mobility total hip replacement following fracture of the polyethylene liner.

    PubMed

    Vedrine, Bertrand; Guillaumot, Pierre; Chancrin, Jean-Luc

    2016-05-18

    An eight-year-old male English Setter was referred for management of a dislocation of a cemented dual mobility canine total hip prosthesis that occurred four months after the initial surgery. Revision surgery showed that the dislocation was associated with fracture of the ultra-high molecular weight polyethylene liner. The dislocation was successfully reduced after replacing the liner. A dual mobility acetabular component is composed of a mobile polyethylene liner inside a metallic cemented cup. Chronic wear of the components of a canine dual mobility total hip replacement has not been described previously. The use of this type of implant is fairly recent and limited long term follow-up of the implanted cases may be the explanation. Acute rupture of a polyethylene liner has never been described in humans, the only case of rupture of a polyethylene liner occurred 10 years after implantation. The case presented here of rupture of the polyethylene liner of a dual mobility total hip replacement is a hitherto unreported failure mode in this model of acetabular cup in the dog. PMID:26991949

  7. Acetabular Reconstruction in Total Hip Arthroplasty

    PubMed Central

    Santhanam, Siva Swaminathan; Choi, Jung Woo

    2016-01-01

    The difficulties encountered in dealing with the bone deficient acetabulum are amongst the greatest challenges in hip surgery. Acetabular reconstruction in revision total hip arthroplasty can successfully be achieved with hemispherical components featuring a porous or roughened ingrowth surface and options for placement of multiple screws for minor acetabular defect. Acetabular component selection is mostly based on the amount of bone loss present. In the presence of combined cavitary and segmental defects without superior acetabular coverage, reconstructions with a structural acetabular allograft protected by a cage or a custom-made triflange cage have been one of preferred surgical options. The use of a cage or ring over structural allograft bone for massive uncontained defects in acetabular revision can restore host bone stock and facilitate subsequent rerevision surgery to a certain extent. But high complication rates have been reported including aseptic loosening, infection, dislocation and metal failure. On the other hand, recent literature is reporting satisfactory outcomes with the use of modular augments combined with a hemispherical shell for major acetabular defect. Highly porous metals have been introduced for clinical use in arthroplasty surgery over the last decade. Their higher porosity and surface friction are ideal for acetabular revision, optimizing biological fixation. The use of trabecular metal cups in acetabular revision has yielded excellent clinical results. This article summarizes author's experience regarding revision acetabular reconstruction options following failed hip surgery including arthroplasty. PMID:27536638

  8. Acetabular Reconstruction in Total Hip Arthroplasty.

    PubMed

    Shon, Won Yong; Santhanam, Siva Swaminathan; Choi, Jung Woo

    2016-03-01

    The difficulties encountered in dealing with the bone deficient acetabulum are amongst the greatest challenges in hip surgery. Acetabular reconstruction in revision total hip arthroplasty can successfully be achieved with hemispherical components featuring a porous or roughened ingrowth surface and options for placement of multiple screws for minor acetabular defect. Acetabular component selection is mostly based on the amount of bone loss present. In the presence of combined cavitary and segmental defects without superior acetabular coverage, reconstructions with a structural acetabular allograft protected by a cage or a custom-made triflange cage have been one of preferred surgical options. The use of a cage or ring over structural allograft bone for massive uncontained defects in acetabular revision can restore host bone stock and facilitate subsequent rerevision surgery to a certain extent. But high complication rates have been reported including aseptic loosening, infection, dislocation and metal failure. On the other hand, recent literature is reporting satisfactory outcomes with the use of modular augments combined with a hemispherical shell for major acetabular defect. Highly porous metals have been introduced for clinical use in arthroplasty surgery over the last decade. Their higher porosity and surface friction are ideal for acetabular revision, optimizing biological fixation. The use of trabecular metal cups in acetabular revision has yielded excellent clinical results. This article summarizes author's experience regarding revision acetabular reconstruction options following failed hip surgery including arthroplasty. PMID:27536638

  9. Porous-coated acetabular components with screw fixation. Five to ten-year results.

    PubMed

    Latimer, H A; Lachiewicz, P F

    1996-07-01

    The results of 136 consecutive primary total hip arthroplasties performed by one surgeon with the Harris-Galante-I porous-coated acetabular component were reviewed at a mean of seven years (range, five to ten years). In all hips, the outer diameter of the acetabular component was the same as the diameter of the final reamer used in the preparation of the acetabulum. However, this reamer was used only briefly at the rim of the acetabulum, and therefore the components had so-called press-fit stability. A mean of four screws (range, three to six screws) were used for additional fixation of the component. The clinical evaluation was performed with use of the Harris hip score. Standardized anteroposterior radiographs of the pelvis were assessed for migration of the component, radiolucent and radiodense lines, linear wear of the polyethylene, and osteolysis. No acetabular component had been revised for loosening and none were radiographically loose at the time of the most recent follow-up evaluation. There were no complications related to the use of the screws, and no screw had bent or broken. A non-progressive radiolucent line was seen in one acetabular zone in thirty-four hips (25 per cent) and in two acetabular zones in six hips (4 per cent). No hip had a radiolucent line in all three acetabular zones. The mean rate of linear wear of the polyethylene was 0.1 millimeter per year. There was no dissociation of the acetabular liner from the metal shell. Two hips (1 per cent) had asymptomatic osteolysis in the ischium and adjacent to the rim of the acetabular component; this was treated with grafting at the site of the lesion and exchange of the femoral head and the worn polyethylene liner. Five femoral components inserted without cement and one inserted with cement were revised because of loosening. The data suggest that, at a mean of seven years, fixation of this porous-coated component was uniformly excellent. The low prevalence of radiolucent lines and the absence of

  10. Biological and mechanical properties of an experimental glass-ionomer cement modified by partial replacement of CaO with MgO or ZnO.

    PubMed

    Kim, Dong-Ae; Abo-Mosallam, Hany; Lee, Hye-Young; Lee, Jung-Hwan; Kim, Hae-Won; Lee, Hae-Hyoung

    2015-01-01

    Some weaknesses of conventional glass ionomer cement (GIC) as dental materials, for instance the lack of bioactive potential and poor mechanical properties, remain unsolved.Objective The purpose of this study was to investigate the effects of the partial replacement of CaO with MgO or ZnO on the mechanical and biological properties of the experimental glass ionomer cements.Material and Methods Calcium fluoro-alumino-silicate glass was prepared for an experimental glass ionomer cement by melt quenching technique. The glass composition was modified by partial replacement (10 mol%) of CaO with MgO or ZnO. Net setting time, compressive and flexural properties, and in vitrorat dental pulp stem cells (rDPSCs) viability were examined for the prepared GICs and compared to a commercial GIC.Results The experimental GICs set more slowly than the commercial product, but their extended setting times are still within the maximum limit (8 min) specified in ISO 9917-1. Compressive strength of the experimental GIC was not increased by the partial substitution of CaO with either MgO or ZnO, but was comparable to the commercial control. For flexural properties, although there was no significance between the base and the modified glass, all prepared GICs marked a statistically higher flexural strength (p<0.05) and comparable modulus to control. The modified cements showed increased cell viability for rDPSCs.Conclusions The experimental GICs modified with MgO or ZnO can be considered bioactive dental materials. PMID:26398508

  11. Biological and mechanical properties of an experimental glass-ionomer cement modified by partial replacement of CaO with MgO or ZnO

    PubMed Central

    Dong-Ae, KIM; Hany, ABO-MOSALLAM; Hye-Young, LEE; Jung-Hwan, LEE; Hae-Won, KIM; Hae-Hyoung, LEE

    2015-01-01

    Some weaknesses of conventional glass ionomer cement (GIC) as dental materials, for instance the lack of bioactive potential and poor mechanical properties, remain unsolved. Objective The purpose of this study was to investigate the effects of the partial replacement of CaO with MgO or ZnO on the mechanical and biological properties of the experimental glass ionomer cements. Material and Methods Calcium fluoro-alumino-silicate glass was prepared for an experimental glass ionomer cement by melt quenching technique. The glass composition was modified by partial replacement (10 mol%) of CaO with MgO or ZnO. Net setting time, compressive and flexural properties, and in vitro rat dental pulp stem cells (rDPSCs) viability were examined for the prepared GICs and compared to a commercial GIC. Results The experimental GICs set more slowly than the commercial product, but their extended setting times are still within the maximum limit (8 min) specified in ISO 9917-1. Compressive strength of the experimental GIC was not increased by the partial substitution of CaO with either MgO or ZnO, but was comparable to the commercial control. For flexural properties, although there was no significance between the base and the modified glass, all prepared GICs marked a statistically higher flexural strength (p<0.05) and comparable modulus to control. The modified cements showed increased cell viability for rDPSCs. Conclusions The experimental GICs modified with MgO or ZnO can be considered bioactive dental materials. PMID:26398508

  12. [Aseptic, simultaneous and bilateral mobilisation due to an acetabular shell fracture in a 43 year-old patient].

    PubMed

    Ceretti, M; Fanelli, M; Pappalardo, S

    2014-01-01

    The acetabular shell mobilization is the main long-term complication in total hip replacement. Metal-back fracture has also to be considered among the possible causes of shell mobilization. A case is presented of bilateral acetabular shell mobilization due to the trabecular covering de-soldering from the metal-back in a 43 year-old patient, 13-14 years after the first surgery. PMID:24360788

  13. Placement of the acetabular component.

    PubMed

    Beverland, D E; O'Neill, C K J; Rutherford, M; Molloy, D; Hill, J C

    2016-01-01

    Ideal placement of the acetabular component remains elusive both in terms of defining and achieving a target. Our aim is to help restore original anatomy by using the transverse acetabular ligament (TAL) to control the height, depth and version of the component. In the normal hip the TAL and labrum extend beyond the equator of the femoral head and therefore, if the definitive acetabular component is positioned such that it is cradled by and just deep to the plane of the TAL and labrum and is no more than 4mm larger than the original femoral head, the centre of the hip should be restored. If the face of the component is positioned parallel to the TAL and psoas groove the patient specific version should be restored. We still use the TAL for controlling version in the dysplastic hip because we believe that the TAL and labrum compensate for any underlying bony abnormality. The TAL should not be used as an aid to inclination. Worldwide, > 75% of surgeons operate with the patient in the lateral decubitus position and we have shown that errors in post-operative radiographic inclination (RI) of > 50° are generally caused by errors in patient positioning. Consequently, great care needs to be taken when positioning the patient. We also recommend 35° of apparent operative inclination (AOI) during surgery, as opposed to the traditional 45°. PMID:26733639

  14. Ten-year follow-up of the non-porous Allofit cementless acetabular component.

    PubMed

    Zenz, P; Stiehl, J B; Knechtel, H; Titzer-Hochmaier, G; Schwagerl, W

    2009-11-01

    Cementless acetabular fixation has demonstrated superior long-term durability in total hip replacement, but most series have studied implants with porous metal surfaces. We retrospectively evaluated the results of 100 consecutive patients undergoing total hip replacement where a non-porous Allofit component was used for primary press-fit fixation. This implant is titanium alloy, grit-blasted, with a macrostructure of forged teeth and has a biradial shape. A total of 81 patients (82 hips) were evaluated at final follow-up at a mean of 10.1 years (8.9 to 11.9). The Harris Hip Score improved from a mean 53 points (23 to 73) pre-operatively to a mean of 96 points (78 to 100) at final review. The osseointegration of all acetabular components was radiologically evaluated with no evidence of loosening. The survival rate with revision of the component as the endpoint was 97.5% (95% confidence interval 94 to 100) after 11.9 years. Radiolucency was found in one DeLee-Charnley zone in four acetabular components. None of the implants required revision for aseptic loosening. Two patients were treated for infection, one requiring a two-stage revision of the implant. One femoral stem was revised for osteolysis due to the production of metal wear debris, but the acetabular shell did not require revision. This study demonstrates that a non-porous titanium acetabular component with adjunct surface fixation offers an alternative to standard porous-coated implants. PMID:19880887

  15. Revision stapes surgery for lysis of the long process of the incus: comparing hydroxyapatite bone cement versus malleovestibulopexy and total ossicular replacement prosthesis.

    PubMed

    Pitiot, Vincent; Hermann, Ruben; Tringali, Stéphane; Dubreuil, Christian; Truy, Eric

    2016-09-01

    The objective of the study was to report audiological results in revision stapes surgery, comparing hydroxyapatite (HAP) bone cement, malleovestibular (MV) prosthesis, and total ossicular replacement prosthesis (TORP). The study is a retrospective case review conducted in a tertiary referral center. Patients treated for revision stapes surgery from 2010 to 2014, where a lysis of the long process of the incus (LPI) was observed with the use of HAP bone cement, MV prosthesis, or a TORP were included in the study. The main outcomes measured were pre- and postoperative bone conduction (BC) and air conduction (AC) pure-tone averages (PTA) (0.5, 1, 2, 3 kHz), including high frequencies BC (HFBC) (1, 2, 3, 4 kHz) and air-bone gap (ABG). 107 revision stapes surgery were performed in 96 ears. Main cause of failure was LPI lysis in 38 cases (39.6 %). 31 patients were analyzed: HAP bone cement was used in 11 patients (Group I), MV prosthesis in ten patients (Group II), and TORP in ten patients (Group III). The mean post-operative ABG was 10.7 dB (±7.4) (p = 0.003), 10.7 dB (±8.8) (p = 0.001), and 16.9 dB (±9.8) (p = 0.001), respectively. There were no significant differences between groups. In Group I, the mean change in HFBC revealed an improvement of 5.6 dB (±7.9) (p = 0.03), while in Group III there was a significant deterioration of the thresholds of 5.8 dB (±7.6) (p = 0.04). There were no cases of post-operative anacusis. In revision stapes surgery when LPI is eroded, we recommend to perform a cement ossiculoplasty for stabilizing a standard Teflon piston when LPI is still usable, the LPI lengthening with cement being not recommended. When LPI is too eroded, we prefer performing a malleovestibulopexy, and reserve TORP for cases with a bad anatomical presentation. PMID:26690574

  16. Increased risk of revision of acetabular cups coated with hydroxyapatite

    PubMed Central

    Lazarinis, Stergios; Kärrholm, Johan

    2010-01-01

    Background Hydroxyapatite (HA) is the main inorganic component of bone, and HA coating is widely used on acetabular cups in hip arthroplasty. It has been suggested that this surface finish improves cup survival. Methods All patients registered in the Swedish Hip Arthroplasty Register between 1992 and 2007 with an uncemented acetabular implant that was available either with or without HA coating were identified. 8,043 total hip arthroplasties (THAs) with the most common cup types (Harris-Galante, Romanus, and Trilogy) were investigated. A Cox regression model including type of coating, age, sex, primary diagnosis, cup type, and type of stem fixation was used to calculate adjusted risk ratios (RRs) for the risk of revision. Results HA coating was a risk factor for cup revision due to aseptic loosening (adjusted RR 1.7; 95% CI: 1.3–2). Age at primary arthroplasty of < 50 years, a diagnosis of pediatric hip disease, the use of a cemented stem, and the Romanus and Harris-Galante cup types were also associated with statistically significantly increased risk of cup revision due to aseptic loosening. Interpretation Our findings question the routine use of HA-coated cups in primary total hip arthroplasty. With some designs, this practice may even increase the risk of loosening—resulting in revision surgery. PMID:19968603

  17. Fly and bottom ashes from biomass combustion as cement replacing components in mortars production: rheological behaviour of the pastes and materials compression strength.

    PubMed

    Maschio, Stefano; Tonello, Gabriele; Piani, Luciano; Furlani, Erika

    2011-10-01

    In the present research mortar pastes obtained by replacing a commercial cement with the equivalent mass of 5, 10, 20 and 30 wt.% of fly ash or bottom ash from fir chips combustion, were prepared and rheologically characterized. It was observed that the presence of ash modifies their rheological behaviour with respect to the reference blend due to the presence, in the ashes, of KCl and K2SO4 which cause precipitation of gypsum and portlandite during the first hydration stages of the pastes. Hydrated materials containing 5 wt.% of ash display compression strength and absorption at 28 d of same magnitude as the reference composition; conversely, progressive increase of ash cause a continuous decline of materials performances. Conversely, samples tested after 180 d display a marked decline of compression strength, as a consequence of potassium elution and consequent alkali-silica reaction against materials under curing. PMID:21762950

  18. Quantification of clearance and creep in acetabular wear measurements

    PubMed Central

    Gregory, Thomas; Vandenbussche, Eric

    2016-01-01

    Background This study aimed to measure femoral head penetration before occurrence of real wear, and to quantify the portions attributable respectively to clearance and plastic deformations in various acetabular designs. Methods We analyzed CT scans from 15 patients at ‘day five’ after total hip arthroplasty (THA). All patients received Exafit® femoral stems and 28 mm heads: 5 patients had cemented Durasul® all-PE cups, 5 patients had un-cemented Allofit® metal-backed cups, and 5 patients had un-cemented Stafit® dual-mobility cups. We also analyzed CT scans of samples of the three head-cup combinations to compare in vivo and in vitro measurements. Results The mean femoral head penetration measured on ‘day five’ was lower for all-PE cups (0.196 mm) than for metal-backed cups (0.551 mm) and dual-mobility cups (0.634 mm). Conclusions The present study indicates that isolated measurements of femoral head penetration include 0.15–0.46 mm of radial clearance and 0.05–0.27 mm of creep, and confirms that the majority of so-called bedding-in observed in the first post-operative months is not entirely due to wear. PMID:27162781

  19. Importance of maintaining the basic stress pathway above the acetabular dome during acetabular reconstruction.

    PubMed

    Nie, Yong; Pei, Fuxing; Shen, Bin; Kang, Pengde; Li, Zongming

    2016-07-01

    The basic stress pathway above the acetabular dome is important for the maintenance of implant stability in press-fit acetabular reconstruction of total hip arthroplasty. However, information on the basic stress pathway and its impact factors remains unclear. The objective of this study was to investigate the effects of the orientations and positions of the acetabular component on the basic stress pathway. The basic stress pathway above the acetabular dome was defined as two parts: 3D basic trabecular bone stress distribution and quantified basic cortical bone stress level, using two subject-specific finite element normal hip models. The effects were then analysed by generating 32 reconstructed acetabular cases with different cup abduction and anteversion angles within a range of 35-50° and 10-25°, respectively, and 12 cases with different hip centre heights within a range of 0-15 mm above the acetabular dome. The 3D trabecular stress distribution decreased remarkably in all cases, while the 80% of the basic cortical bone stress level was maintained in cases when the acetabular component was positioned at 10° or 15° anteversion and 40° or 45° abduction angles. The basic stress pathway above the acetabular dome was disturbed when the superior displacement of the hip centre exceeded 5 mm above the anatomical hip centre. Positioning the acetabular component correctly contributes to maintain the stress balance between the acetabular cup and the bone during acetabular reconstruction, thus helping restore the normal hip biomechanics and preserve the stability of the implants. PMID:26469561

  20. [Cemented total knee replacement: comparative study between the use or not of tourniquet on the inmediate results].

    PubMed

    Gutiérrez-García, J A; Sierra-Pérez, M; García-Velazco, R A; Salas-Mora, C A; Cisneros-González, V M

    2016-01-01

    Comparison of immediate postoperative results of patients undergoing cemented total knee arthroplasty with and without ischemia. Observational, cross-sectional, retrospective, analytical, single-center study that included 180 patients who underwent total knee arthroplasty from 2011 to 2014: 120 without ischemia, 60 with ischemia. Mean age was 70 years with SD ± 7. Criteria to assess the immediate postoperative results include intraoperative bleeding, hemoglobin differential and pain. Exclusion criteria comprised patients being treated at a pain clinic, those on anticoagulants, with a history of bleeding disorders, psychiatric conditions, kidney failure or those intolerant to NSAIDs. In total knee arthroplasty without ischemia there is better pain control (p = 0.026). The hemoglobin differential and intraoperative bleeding were less with ischemia (p = 0.008). 32.8% of patients required blood transfusion, but no statistically significant relationship was established with the use or non-use of ischemia (p = 0.301). The most commonly reported pain was within a VAS of 0-3; 62.2% of cases reported mild pain. Mean hemoglobin differential was 3.7 with SD ± 1.3 with a range from 0 to 7.4. Patients in whom no ischemia was used during the surgical procedure experienced less pain. There was less bleeding and hemoglobin differential with the use of ischemia. However, this did not result in a statistically significant difference in the need for blood transfusion. The use of ischemia with caution and according to the surgeons preference is recommended. PMID:27627771

  1. Long-term Radiographic Assessment of Cemented Polyethylene Acetabular Cups

    PubMed Central

    Isaac, Graham; Porter, Neil; Fisher, John; Older, John

    2008-01-01

    In vitro studies demonstrating excessive wear in polyethylene cups sterilized using gamma irradiation and stored in air led to the abandonment of this sterilization technique. We evaluated the clinical wear performance of a metal femoral component on a polyethylene cup in a hip prosthesis from a selected subset of implants in a group of patients followed for at least 20 years and assessed the time dependency of variation in penetration rates. We measured penetration in 33 polyethylene cups in 25 patients who had a Charnley low-friction arthroplasty between 1982 and 1984. All patients had Charnley Ogee® cups implanted for more than 20 years and sterilized using the gamma irradiation in air technique. If degradation occurred over time in vivo, it was not reflected by an increased penetration rate with increasing time in vivo; even after 20 years of implantation, the degree of wear remained low. This suggests gamma irradiation affects wear on ultra-high-molecular-weight polyethylene by reducing wear secondary to the crosslinking, by increasing wear as shown through in vitro studies of heavily oxidized samples, or by oxidation resulting from prolonged shelf life. The effect of progressive oxidation in vivo does not appear to affect wear in vivo. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18196419

  2. Reducing cement's CO2 footprint

    USGS Publications Warehouse

    van Oss, Hendrik G.

    2011-01-01

    The manufacturing process for Portland cement causes high levels of greenhouse gas emissions. However, environmental impacts can be reduced by using more energy-efficient kilns and replacing fossil energy with alternative fuels. Although carbon capture and new cements with less CO2 emission are still in the experimental phase, all these innovations can help develop a cleaner cement industry.

  3. Osteopathic diagnosis of an acetabular injury.

    PubMed

    Morthland, Tim; Cote, Nicholas S; Humphrey, Jon; Fulk, Doug

    2010-05-01

    Physical findings demarking pathologic somatovisceral reflex activity and fascial strain patterns may lead the osteopathic physician to diagnoses that are masked within the initial presentation of a patient. The authors present a case report that demonstrates the use of osteopathic principles in the diagnosis of a chronic acetabular fracture and acetabular labral tear in a 19-year-old man. The injuries resulted from a posterior hip dislocation sustained during a basketball game more than 1 year before presentation. Osteopathic manipulative treatment and diagnostic techniques also relieved the patient's persistent thoracic pain, nausea, and vomiting. Subsequent orthopedic repair had the potential to avert or delay degenerative hip disease in the patient. PMID:20538751

  4. Coralline hydroxyapatite in complex acetabular reconstruction.

    PubMed

    Wasielewski, Ray C; Sheridan, Kate C; Lubbers, Melissa A

    2008-04-01

    This retrospective study examined whether a coralline hydroxyapatite bone graft substitute adequately repaired bone defects during complex acetabular reconstructions. Seventeen patients who underwent acetabular revision using Pro Osteon 500 were assessed to determine whether any cups required re-revision, whether bone had incorporated into the coralline hydroxyapatite grafts, and whether the coralline hydroxyapatite grafts resorbed with time. At latest follow-up, no cups required re-revision, but 1 had failed. Radiographic evidence of bone incorporation was observed in every coralline hydroxyapatite graft. Graft resorption was not observed. PMID:19292282

  5. Surgical dislocation of the hip for the fixation of acetabular fractures.

    PubMed

    Tannast, M; Krüger, A; Mack, P W; Powell, J N; Hosalkar, H S; Siebenrock, K A

    2010-06-01

    Surgical dislocation of the hip in the treatment of acetabular fractures allows the femoral head to be safely displaced from the acetabulum. This permits full intra-articular acetabular and femoral inspection for the evaluation and potential treatment of cartilage lesions of the labrum and femoral head, reduction of the fracture under direct vision and avoidance of intra-articular penetration with hardware. We report 60 patients with selected types of acetabular fracture who were treated using this approach. Six were lost to follow-up and the remaining 54 were available for clinical and radiological review at a mean follow-up of 4.4 years (2 to 9). Substantial damage to the intra-articular cartilage was found in the anteromedial portion of the femoral head and the posterosuperior aspect of the acetabulum. Labral lesions were predominantly seen in the posterior acetabular area. Anatomical reduction was achieved in 50 hips (93%) which was considerably higher than that seen in previous reports. There were no cases of avascular necrosis. Four patients subsequently required total hip replacement. Good or excellent results were achieved in 44 hips (81.5%). The cumulative eight-year survivorship was 89.0% (95% confidence interval 84.5 to 94.1). Significant predictors of poor outcome were involvement of the acetabular dome and lesions of the femoral cartilage greater than grade 2. The functional mid-term results were better than those of previous reports. Surgical dislocation of the hip allows accurate reduction and a predictable mid-term outcome in the management of these difficult injuries without the risk of the development of avascular necrosis. PMID:20513883

  6. Survival rates and causes of revision in cemented primary total knee replacement: a report from the Norwegian Arthroplasty Register 1994-2009.

    PubMed

    Gøthesen, O; Espehaug, B; Havelin, L; Petursson, G; Lygre, S; Ellison, P; Hallan, G; Furnes, O

    2013-05-01

    We evaluated the rates of survival and cause of revision of seven different brands of cemented primary total knee replacement (TKR) in the Norwegian Arthroplasty Register during the years 1994 to 2009. Revision for any cause, including resurfacing of the patella, was the primary endpoint. Specific causes of revision were secondary outcomes. Three posterior cruciate-retaining (PCR) fixed modular-bearing TKRs, two fixed non-modular bearing PCR TKRs and two mobile-bearing posterior cruciate-sacrificing TKRs were investigated in a total of 17 782 primary TKRs. The median follow-up for the implants ranged from 1.8 to 6.9 years. Kaplan-Meier 10-year survival ranged from 89.5% to 95.3%. Cox's relative risk (RR) was calculated relative to the fixed modular-bearing Profix knee (the most frequently used TKR in Norway), and ranged from 1.1 to 2.6. The risk of revision for aseptic tibial loosening was higher in the mobile-bearing LCS Classic (RR 6.8 (95% confidence interval (CI) 3.8 to 12.1)), the LCS Complete (RR 7.7 (95% CI 4.1 to 14.4)), the fixed modular-bearing Duracon (RR 4.5 (95% CI 1.8 to 11.1)) and the fixed non-modular bearing AGC Universal TKR (RR 2.5 (95% CI 1.3 to 5.1)), compared with the Profix. These implants (except AGC Universal) also had an increased risk of revision for femoral loosening (RR 2.3 (95% CI 1.1 to 4.8), RR 3.7 (95% CI 1.6 to 8.9), and RR 3.4 (95% CI 1.1 to 11.0), respectively). These results suggest that aseptic loosening is related to design in TKR. PMID:23632673

  7. The relationship between operative and radiographic acetabular component orientation: which factors influence resultant cup orientation?

    PubMed

    Grammatopoulos, G; Pandit, H G; da Assunção, R; McLardy-Smith, P; De Smet, K A; Gill, H S; Murray, D W

    2014-10-01

    There is great variability in acetabular component orientation following hip replacement. The aims of this study were to compare the component orientation at impaction with the orientation measured on post-operative radiographs and identify factors that influence the difference between the two. A total of 67 hip replacements (52 total hip replacements and 15 hip resurfacings) were prospectively studied. Intra-operatively, the orientation of the acetabular component after impaction relative to the operating table was measured using a validated stereo-photogrammetry protocol. Post-operatively, the radiographic orientation was measured; the mean inclination/anteversion was 43° (sd 6°)/ 19° (sd 7°). A simulated radiographic orientation was calculated based on how the orientation would have appeared had an on-table radiograph been taken intra-operatively. The mean difference between radiographic and intra-operative inclination/anteversion was 5° (sd 5°)/ -8° (sd 8°). The mean difference between simulated radiographic and intra-operative inclination/anteversion, which quantifies the effect of the different way acetabular orientation is measured, was 3°/-6° (sd 2°). The mean difference between radiographic and simulated radiographic orientation inclination/anteversion, which is a manifestation of the change in pelvic position between component impaction and radiograph, was 1°/-2° (sd 7°). This study demonstrated that in order to achieve a specific radiographic orientation target, surgeons should implant the acetabular component 5° less inclined and 8° more anteverted than their target. Great variability (2 sd about ± 15°) in the post-operative radiographic cup orientation was seen. The two equally contributing causes for this are variability in the orientation at which the cup is implanted, and the change in pelvic position between impaction and post-operative radiograph. PMID:25274911

  8. The use of fibre-based demineralised bone matrix in major acetabular reconstruction: surgical technique and preliminary results

    PubMed Central

    Karoubi, Mathieu; Dumaine, Valérie; Courpied, Jean Pierre

    2010-01-01

    Acetabular osteolysis associated with socket loosening is one of the main long-term complications of total hip arthroplasty. In case of major bone loss, where <50% host bone coverage can be obtained with a porous-coated cementless cup, it is generally agreed that a metal ring or cage in association with a cemented component and allograft bone should be used. In order to promote allograft bone consolidation and incorporation, we have associated demineralised bone matrix (DBM, Grafton® A Flex) to the construct ion. Here we describe the technical details of major acetabular reconstruction using the Kerboull acetabular reinforcement device with allograft bone and DBM. This device has a hook that must be placed under the teardrop of the acetabulum and a plate for iliac fixation. The main advantages of this device are help in restoring the normal centre of hip rotation, guiding the reconstruction and partially unloading the graft. The Kerboull acetabular reinforcement device has provided a 92% survival rate free of loosening at 13-year follow-up in a consecutive series of 60 type III and IV deficiencies. Our preliminary results using DBM indicate faster allograft consolidation and remodelling. PMID:21057788

  9. Cementless hemispheric acetabular component in total hip replacement.

    PubMed

    Weber, D; Schaper, L A; Pomeroy, D L; Badenhausen, W E; Curry, J I; Smith, M W; Suthers, K E

    2000-01-01

    A series of 198 total hip arthroplasties was performed using a porous-coated, hemispheric press-fit cup. One hundred and twenty-seven cups were available for clinical and radiological examination at mean follow-up of 10.6 years. The mean age at the index procedure was 61.2 years. The mean Harris hip score at final follow-up was 89.8. Three cups were revised for aseptic loosening and two liners were changed for eccentric wear and pelvic osteolysis. Nine additional patients showed mild or suspected osteolysis. Two cups were rated "fibrous" stable. There was no correlation between additional screw fixation of the press-fit cup and osteolysis or revision. PMID:10990381

  10. Basic Science Considerations in Primary Total Hip Replacement Arthroplasty

    PubMed Central

    Mirza, Saqeb B; Dunlop, Douglas G; Panesar, Sukhmeet S; Naqvi, Syed G; Gangoo, Shafat; Salih, Saif

    2010-01-01

    Total Hip Replacement is one of the most common operations performed in the developed world today. An increasingly ageing population means that the numbers of people undergoing this operation is set to rise. There are a numerous number of prosthesis on the market and it is often difficult to choose between them. It is therefore necessary to have a good understanding of the basic scientific principles in Total Hip Replacement and the evidence base underpinning them. This paper reviews the relevant anatomical and biomechanical principles in THA. It goes on to elaborate on the structural properties of materials used in modern implants and looks at the evidence base for different types of fixation including cemented and uncemented components. Modern bearing surfaces are discussed in addition to the scientific basis of various surface engineering modifications in THA prostheses. The basic science considerations in component alignment and abductor tension are also discussed. A brief discussion on modular and custom designs of THR is also included. This article reviews basic science concepts and the rationale underpinning the use of the femoral and acetabular component in total hip replacement. PMID:20582240

  11. Fixation method does not affect restoration of rotation center in hip replacements: A single-site retrospective study

    PubMed Central

    2012-01-01

    Background Aseptic loosening is one of the greatest problems in hip replacement surgery. The rotation center of the hip is believed to influence the longevity of fixation. The aim of this study was to compare the influence of cemented and cementless cup fixation techniques on the position of the center of rotation because cemented cup fixation requires the removal of more bone for solid fixation than the cementless technique. Methods We retrospectively compared pre- and post-operative positions of the hip rotation center in 25 and 68 patients who underwent artificial hip replacements in our department in 2007 using cemented or cementless cup fixation, respectively, with digital radiographic image analysis. Results The mean horizontal and vertical distances between the rotation center and the acetabular teardrop were compared in radiographic images taken pre- and post-operatively. The mean horizontal difference was −2.63 mm (range: -11.00 mm to 10.46 mm, standard deviation 4.23 mm) for patients who underwent cementless fixation, and −2.84 mm (range: -10.87 to 5.30 mm, standard deviation 4.59 mm) for patients who underwent cemented fixation. The mean vertical difference was 0.60 mm (range: -20.15 mm to 10.00 mm, standard deviation 3.93 mm) and 0.41 mm (range: -9.26 mm to 6.54 mm, standard deviation 3.58 mm) for the cementless and cemented fixation groups, respectively. The two fixation techniques had no significant difference on the position of the hip rotation center in the 93 patients in this study. Conclusions The hip rotation center was similarly restored using either the cemented or cementless fixation techniques in this patient cohort, indicating that the fixation technique itself does not interfere with the position of the center of rotation. To completely answer this question further studies with more patients are needed. PMID:22686355

  12. Meralgia Paresthetica and Femoral Acetabular Impingement: A Possible Association

    PubMed Central

    Ahmed, Aiesha

    2010-01-01

    Meralgia paresthetica consists of pain and dysesthesia in the anterolateral thigh. Etiology is divided into spontaneous and iatrogenic causes. To my knowledge this has never been attributed to femoral acetabular impingement. This case highlights the presence of lateral femoral cutaneous neuropathy in the setting of femoral acetabular impingement syndrome thus raising the possibility of an association. Keywords Femoral acetabular impingement; Lateral femoral cutaneous nerve; Dysesthesia; Nerve conduction studies PMID:22043261

  13. [What's new in total hip replacement?].

    PubMed

    Kowalczewski, Jacek B; Milecki, Marcin; Marczak, Dariusz

    2005-01-01

    The authors present special types of stems and acetabulum components. Analyzing the available the authors try to assess which parameters of the prosthesis influence long-term outcomes. "Wear and tear" of the implants was also analysed. Cemented and cementless acetabular components where also analysed. Capoplasties neck-sparing procedures and MIS techniques were also taken into consideration with special attention given to the dangers related to these new techniques. PMID:16875180

  14. Finite element analysis of the impingement on the acetabular liner rim due to wear of the acetabular liner surface

    NASA Astrophysics Data System (ADS)

    Saputra, Eko; Anwar, Iwan Budiwan; Ismail, Rifky; Jamari, J.; van der Heide, Emile

    2016-04-01

    This workstudies the impingement on the rim of acetabular liner due to wear on the surface of acetabular liner using finite element simulation. A three dimensional contact model between a femoral head and an acetabular liner was developed. There are three steps in this simulation, i.e. creating the virtualwear on the surface of acetabular liner, applying the load at the femoral head, and rotating the femoral head from neutral position till the impingement occurrence. The virtualwear is created based on the data of wear depth which was obtained from literature. Results showed that the wear on the acetabular liner surface wouldaffected the impingement occurrence, in which the impingement angle becomes narrow. In addition, the failure possibility of the acetabular liner rimwould become higher.

  15. Hydroxyapatite coating of an acetabular prosthesis. Effect on stability.

    PubMed

    Moilanen, T; Stocks, G W; Freeman, M A; Scott, G; Goodier, W D; Evans, S J

    1996-03-01

    We report the radiological and clinical outcome of a press-fit (SLF) acetabular component at two to three years in two groups of patients having primary total hip replacement. In 69 the implant was coated with hydroxyapatite (HA) and in 40 it was uncoated. The stability of the cup was assessed by measurement of proximal migration and change in the angle of inclination. The clinical results in the two groups did not differ significantly, and the mean proximal linear wear was similar in both. Fewer radiolucent lines (RLLs) were seen on the radiographs of cups coated with HA. The mean proximal migration was studied by calculating regression lines for each patient using migration measurements: for the SLF+HA group the mean slope was 0.06 mm/year and for the SLF-HA group 0.20 mm/year (p = 0.22). The change in the angle of inclination during follow-up was also consistently smaller in HA-coated cups. Using regression methods the SLF+HA group had a mean slope of 0.08 degrees/year and the SLF-HA group 0.44 degrees/year and the SLF-HA group 0.44 degrees/year (p = 0.023). Partial HA coating appeared to have no effect on the clinical outcome or on the rate of wear of polyethylene, but there was a trend towards a reduced rate of proximal migration, and a significant reduction in rotational migration and the number of radiolucent lines. This suggests that HA coating enhances the stability of this acetabular component. PMID:8666624

  16. Failure analysis of retrieved PE-UHMW acetabular liners.

    PubMed

    Laska, Anna; Archodoulaki, Vasiliki-Maria; Duscher, Bernadette

    2016-08-01

    Ultra-high molecular weight polyethylene (PE-UHMW) acetabular liners have a limited lifespan in a patient's body. There are many factors affecting the performance of the implant and furthermore the properties of the polymeric material are changing after implantation. In this work material changes according to structure and morphology and their implication on mechanical properties are in focus. The physical and mechanical properties of ten crosslinked (xL) PE-UHMW and nine conventional (conv) gamma-sterilized PE-UHMW hip components, used as sliding surface in total hip joint replacement, with different in-vivo times are compared. The evaluation of the retrieved acetabular liners is performed in view of crosslinking and conventional gamma-sterilization but also in terms of the influence of gender concerning alteration in properties. The oxidative degradation in the PE-UHMW is investigated by means of Fourier Transformed Infrared Spectroscopy (FTIR). The characterization of the morphology is carried out via differential scanning calorimetry (DSC). A depth profile of the micro-hardness and elastic modulus is taken over the cross-section of the components in order to find the influence of chemical constitution and morphology on the micro-mechanical properties. It could be shown that crosslinking and oxidative degradation influence the degree of crystallinity of the polymer. Oxidation occurs for both types of the material due to in-vivo time. Higher degree of crystallinity can be correlated to higher hardness and indentation modulus. No unequivocal superiority of crosslinked over conventional liners can be observed. The influence of sex concerning alteration of the evaluated properties matters but need to be further investigated. PMID:26849029

  17. Optimal acetabular orientation for hip resurfacing.

    PubMed

    Grammatopoulos, G; Pandit, H; Glyn-Jones, S; McLardy-Smith, P; Gundle, R; Whitwell, D; Gill, H S; Murray, D W

    2010-08-01

    Pseudotumours are a rare complication of hip resurfacing. They are thought to be a response to metal debris which may be caused by edge loading due to poor orientation of the acetabular component. Our aim was to determine the optimal acetabular orientation to minimise the risk of pseudotumour formation. We matched 31 hip resurfacings revised for pseudotumour formation with 58 controls who had a satisfactory outcome from this procedure. The radiographic inclination and anteversion angles of the acetabular component were measured on anteroposterior radiographs of the pelvis using Einzel-Bild-Roentgen-Analyse software. The mean inclination angle (47 degrees, 10 degrees to 81 degrees) and anteversion angle (14 degrees, 4 degrees to 34 degrees) of the pseudotumour cases were the same (p = 0.8, p = 0.2) as the controls, 46 degrees (29 degrees to 60 degrees) and 16 degrees (4 degrees to 30 degrees) respectively, but the variation was greater. Assuming an accuracy of implantation of +/- 10 degrees about a target position, the optimal radiographic position was found to be approximately 45 degrees of inclination and 20 degrees of anteversion. The incidence of pseudotumours inside the zone was four times lower (p = 0.007) than outside the zone. In order to minimise the risk of pseudotumour formation we recommend that surgeons implant the acetabular component at an inclination of 45 degrees (+/- 10) and anteversion of 20 degrees (+/- 10) on post-operative radiographs. Because of differences between the radiographic and the operative angles, this may be best achieved by aiming for an inclination of 40 degrees and an anteversion of 25 degrees. PMID:20675749

  18. Micro-observations of different types of nano-Al₂O₃on the hydration of cement paste with sludge ash replacement.

    PubMed

    Luo, Huan-Lin; Lin, Deng-Fong; Shieh, Show-Ing; You, Yan-Fei

    2015-01-01

    In recent years, sewer systems and wastewater treatment plants have become important in developing countries. Consequently, the amount of sewage sludge produced by these countries has been gradually increasing, and determining how to properly recycle this sludge is becoming an important topic for researchers. In this study, to expand the recyclability of sewage sludge ash (SSA) in engineering applications, two types of nano-aluminium oxides (Al₂O₃), MC2A and MC2R, were added to SSA/cement paste and mortar specimens. The MC2R type (γ phase) had a smaller particle size and larger specific surface area than the MC2A type (α phase). The results indicate that the addition of nano-Al₂O₃to SSA/cement paste can effectively improve the hydration products of the paste. Moreover, the amount of hydration products increased as the amount of nano-Al₂O₃added to the SSA/cement paste increased. The test results indicate that MC2A nano-Al₂O₃can more uniformly distribute in the paste body and improve the hydration of cement than MC2R nano-Al₂O₃. Thus, more calcium-silicate-hydrate (C-S-H) gel and calcium aluminate hydrate (C-A-H) salts were produced, and the strength of the specimens was improved. This study suggests that MC2A nano-Al₂O₃is preferable to MC2R nano- Al₂O₃for SSA/cement specimen applications. PMID:26510613

  19. Action Of Cement Hardening On Artificial Hip Joint Components

    NASA Astrophysics Data System (ADS)

    Roder, U.; Niess, N.; Plitz, W.

    1981-05-01

    Artificial acetabular cups loose their original shape and undergo deformations during implantation, caused by the polymerization shrinkage of the bone cement. In laboratory experiments, two acetabula of different material - both common in clinical use - were studied by holographic real-time interferometry during cement hardening. This method picks up characteristic features in the transient behaviour of the form changes. It is shown, that temperature, porosity and shrinkage of the cement has a large influence on the form of a polyethylene acetabulum, whereas there is only little effect on an acetabulum, made of alumina ceramic.

  20. Navigated Acetabular Cup Fixation for Acetabular Deformity or Revision Total Hip Arthroplasty

    PubMed Central

    Yoon, Jung-Ro; Yu, Jung Jin; Seo, Hyo-Sung

    2014-01-01

    Purpose To evaluate the usefulness of navigated acetabular cup fixation for total hip arthroplasty in patients with acetabular deformity or revision total hip arthroplasty. Materials and Methods This study enrolled 28 patients with at least 12 months' follow-up. The safe zone of the acetabular cup was defined as 40°±10°in inclination and 15°±10°in anteversion. The authors used the navigation and radiographic data to determine whether the acetabular cup was located within the safe zone or not. To evaluate the clinical outcomes, preoperative and last follow-up Harris hip scores were checked, and the occurrence of complications was evaluated. Results According to the navigation data, the mean inclination and anteversion were 38.5°±4.7°(range, 32°-50°) and 16.6°±4.0°(range, 8°-23°), respectively. According to the radiographic data the mean inclination and anteversion were 40.5°±4.6°(range, 32°-50°) and 19.4°±4.2°(range, 8°-25°), respectively. In both cases, all values were within the safe zone. Harris hip score was improved in all patients from preoperative 52.3±14.4 points (range, 29-87 points) to 88.0±9.0 points (range, 65-99 points) at the last follow-up. There was no dislocation or loosening of both cases. Conclusion Navigated acetabular cup fixation is a useful technique for total hip arthroplasty in patients with acetabular deformity or revision total hip arthroplasty because it prevents the malposition and related complications.

  1. Bilateral Femoral Nutrient Foraminal Cement Penetration during Total Hip Arthroplasty

    PubMed Central

    Coomber, Ross; Bhumbra, Rej S; Marston, Robert

    2012-01-01

    Introduction: Cement pressurisation is important for the insertion of both the acetabular and femoral components during Total Hip Arthroplasty (THA). Secondary to pressurization the rare phenomenon of unilateral cement incursion into the nutrient foramen has previously been reported. No bilateral case has been reported to date. This has implications both for misdiagnosis of periprosthetic fractures and for medico-legal consequences due to a presumed adverse intra-operative event. Case Report: We present a case report of a 59 year old, caucasian female who underwent staged bilateral cemented Stanmore THA. The post-operative radiographs demonstrate evidence of bilateral nutrient foramen penetration intra-operatively by standard viscosity cement. The patient suffered no adverse consequences. Conclusions: In summary, cement extravasation into the nutrient foramen is an important differential to be considered in presence of posterior-medial cement in the diaphysis of femur following THA. This requires no further intervention and has no effect on the outcome.

  2. Hip replacement: landmark surgery in modern medical history.

    PubMed

    Mellon, Stephen J; Liddle, Alexander D; Pandit, Hemant

    2013-07-01

    Total hip replacement (THR) is most often performed to treat end-stage symptomatic osteoarthritis. Patients typically present with increasing pain, restricted mobility and stiffness. In this procedure, the femoral head and part of the femoral neck are excised. The acetabulum is enlarged and an acetabular cup is inserted. The femoral head is replaced by a femoral component, the stem of which is inserted into the medullary canal of the femur. The components can be either cemented in place or press-fit (cementless). The THR concept was popularised by Sir John Charnley in the 1960s and although, over half a century of development has resulted in incremental improvements, the procedure is not dramatically different from the one he described. However, over the last two decades there have been significant changes in the types of bearing surfaces used. Metal on polyethylene continues to be the workhorse for the majority of cases. In the young and active, bearing surfaces with low wear rate are increasingly used. Since the early 1960s, THR has played an important role in alleviating pain and restoring mobility to millions of people. The cost-effectiveness of THR in treating advanced osteoarthritis makes it one of the most successful of all surgical interventions. PMID:23693138

  3. The Morscher Press Fit acetabular component: a nine- to 13-year review.

    PubMed

    Gwynne-Jones, D P; Garneti, N; Wainwright, C; Matheson, J A; King, R

    2009-07-01

    We reviewed the results at nine to 13 years of 125 total hip replacements in 113 patients using the monoblock uncemented Morscher press-fit acetabular component. The mean age at the time of operation was 56.9 years (36 to 74). The mean clinical follow-up was 11 years (9.7 to 13.5) and the mean radiological follow-up was 9.4 years (7.7 to 13.1). Three hips were revised, one immediately for instability, one for excessive wear and one for deep infection. No revisions were required for aseptic loosening. A total of eight hips (7.0%) had osteolytic lesions greater than 1 cm, in four around the acetabular component (3.5%). One required bone grafting behind a well-fixed implant. The mean wear rate was 0.11 mm/year (0.06 to 0.78) and was significantly higher in components with a steeper abduction angle. Kaplan-Meier survival curves at 13 years showed survival of 96.8% (95% confidence interval 90.2 to 99.0) for revision for any cause and of 95.7% (95% confidence interval 88.6 to 98.4) for any acetabular re-operation. PMID:19567847

  4. Unusual Cause of Hip Pain: Intrusion of the Acetabular Labrum

    PubMed Central

    Jang, Se-Ang; Byun, Young-Soo; Jeong, Dae-Geun; Han, In-Ho; Kim, Min-Guek

    2015-01-01

    Femoroacetabular impingement and dysplatic hip joint is well known cause of osteoarthritis. In these diseases, labral tear and subsequent cartilage damage is thought to be main pathophysiology of development of osteoarthritis. If there are no known bony abnormalities, we called it as idiopathic osteoarthritis. Normal appearance of acetabular labrum is a continuous, usually triangular structure that attaches to the bony rim of the acetabulum and is completed at the inferior portion by the transverse acetabular ligament over the acetabular notch. A few authors reported intra-articular labrum and its relation to the development of osteoarthritis. But they didn't comment the primary bony abnormality especially acetabulum. We'd like to report x-ray, computed tomogram, magnetic resonance arthrogram and arthroscopic findings of a case had double contour sign of acetabular dome combined with intrusion of acetabular labrum.

  5. The jumbo acetabular component for acetabular revision: Curtain Calls and Caveats.

    PubMed

    Lachiewicz, P F; Watters, T S

    2016-01-01

    The 'jumbo' acetabular component is now commonly used in acetabular revision surgery where there is extensive bone loss. It offers high surface contact, permits weight bearing over a large area of the pelvis, the need for bone grafting is reduced and it is usually possible to restore centre of rotation of the hip. Disadvantages of its use include a technique in which bone structure may not be restored, a risk of excessive posterior bone loss during reaming, an obligation to employ screw fixation, limited bone ingrowth with late failure and high hip centre, leading to increased risk of dislocation. Contraindications include unaddressed pelvic dissociation, inability to implant the component with a rim fit, and an inability to achieve screw fixation. Use in acetabulae with < 50% bone stock has also been questioned. Published results have been encouraging in the first decade, with late failures predominantly because of polyethylene wear and aseptic loosening. Dislocation is the most common complication of jumbo acetabular revisions, with an incidence of approximately 10%, and often mandates revision. Based on published results, a hemispherical component with an enhanced porous coating, highly cross-linked polyethylene, and a large femoral head appears to represent the optimum tribology for jumbo acetabular revisions. PMID:26733644

  6. Bipolar hip arthroplasty as salvage treatment for loosening of the acetabular cup with significant bone defects

    PubMed Central

    Ghanem, Mohamed; Glase, Almuth; Zajonz, Dirk; Roth, Andreas; Heyde, Christoph-E.; Josten, Christoph; von Salis-Soglio, Georg

    2016-01-01

    Introduction: Revision arthroplasty of the hip is becoming increasingly important in recent years. Early primary arthroplasty and longer life expectancy of the patients increases the number of revision surgery. Revision surgery of hip arthroplasty is major surgery for the patients, especially the elderly, with significant risks concerning the general condition of the patient. The aim of this work is to evaluate the outcome of bipolar hip arthroplasty as a salvage procedure for treatment of loosening of the acetabular cup with significant acetabular bone defects after total hip replacement (THR) in multi-morbid patients. Patients and methods: During the period from January 1st 2007 to December 31st 2011 19 revision hip surgeries were performed in 19 patients, in which the loosened acetabular cup was replaced by a bipolar head. The examined patient group consisted exclusively of female patients with an average of 75 years. The predominant diagnosis was “aseptic loosening” (84.2%). All patients in our study were multi-morbid. We decided to resort to bipolar hip arthroplasty due to the compromised general condition of patients and the major acetabular bone defects, which were confirmed intraoperatively. The postoperative follow-up ranged from 0.5 to 67 months (average 19.1 months). Results: Evaluation of the modified Harris Hip Score showed an overall improvement of the function of the hip joint after surgery of approximately 45%. Surgery was less time consuming and thus adequate for patients with significantly poor general health condition. We noticed different complications in a significant amount of patients (68.4%). The most common complication encountered was the proximal migration of the bipolar head. The rate of revision following the use of bipolar hip arthroplasty in revision surgery of the hip in our patients was high (21%). Despite the high number of complications reported in our study, we have noticed significant improvement of hip joint function as

  7. The National Register of Joint Replacements of the Czech Republic.

    PubMed

    Vavřík, P; Landor, I; Popelka, S; Fialka, R; Hach, J

    2014-01-01

    The National Register of Joint Replacements of the Czech Republic was established as part of the National Health Information System in 2002. The register's administrator is the Institute of Health Information and Statistics of the Czech Republic, the Czech Society for Orthopaedics and Traumatology acts as its guarantor of scientific quality. The register is financed from governmental sources. It was launched into full operation in 2003 and it currently focuses on hip joint replacements. Register of knee and shoulder joint replacements is in the process of preparation. The register provides aggregate epidemiological data and other statistics, including the Revision Rate (RR) and curves of cumulative survival probability (Kaplan-Meier) for the main monitored groups of patients and implants used. In years 2003-2012 there were 101,734 primary implantations and 13,459 revision surgeries registered. In terms of gender distribution there is a predominance of females amounting to 59.4% in primary implantations and to 63.49% in revision surgeries. The age structure covers the entire range of adult population; however, more than 50% of the replacements are being implanted between 60-74 years of age. Most frequent indications for primary implantation are primary coxarthrosis (69.85%), post-fracture conditions (13.41%) and post-dysplasia arthritis (8.73%). The most frequent indications for revision surgery are aseptic loosening of acetabular component (38.15%), aseptic loosening of femoral component (22.01%) and recurrent dislocation (6.5%). 45,450 (44.68%) of primary implantations were cemented, 36,477 (35.86%) uncemented, 16,559 (16.28%) hybrid with cemented femur and 656 (0.64%) hybrid with cemented acetabulum. There were also records of 2,592 cervicocapital prostheses (2.55%). Most commonly used is the classic anterolateral approach 75.86% in primary implantations and 50.06% in revision surgeries. Mini-invasive approaches in primary implantations did not exceed 3.2% of all

  8. [Analysis of the Basic Stress Pathway Above Acetabular Dome].

    PubMed

    Nie, Yong; Ma, Jun; Haung, Qiang; Hu, Qinsheng; Shi, Xiaojun; Pei, Fuxing

    2015-08-01

    The basic stress pathway above the acetabular dome is important for the maintenance of implant stability in acetabular reconstruction of total hip arthroplasty (THA). The purpose of this study was to describe the basic stress pathway to provide evidence for clinical acetabular reconstruction guidance of THA. A subject-specific finite element (FE) model was developed from CT data to generate 3 normal hip models and a convergence study was conducted to determine the number of pelvic trabecular bone material properties using 5 material assignment plans. In addition, in the range of 0 to 20 mm above the acetabular dome, the models were sectioned and the stress pathway was defined as two parts, i.e., 3D, trabecular bone stress distribution and quantified cortical bone stress level. The results showed that using 100 materials to define the material property of pelvic trabecular bone could assure both the accuracy and efficiency of the FE model. Under the same body weight condition, the 3D trabecular bone stress distributions above the acetabular dome were consistent, and especially the quantified cortical bone stress levels were all above 20 MPa and showed no statistically significant difference (P>0.05). Therefore, defining the basic stress pathway above the acetabular dome under certain body weight condition contributes to design accurate preoperative plan for acetabular reconstruction, thus helping restore the normal hip biomechanics and preserve the stability of the implants. PMID:26710451

  9. Revision hip replacement for recurrent Hydatid disease of the pelvis: a case report and review of the literature.

    PubMed

    Neelapala, Venkata S S; Chandrasekar, Coonoor R; Grimer, Robert J

    2010-01-01

    A case of a large recurrent hydatid cyst involving the right ilium and right hip treated with excision of the cyst, Total hip replacement and revision of the acetabular component with a Tripolar articulation for cyst recurrence and acetabular component loosening is presented along with a review of the relevant literature. To our knowledge there is no reported case of Total Hip replacement and revision for hydatid disease involving the bony pelvis. PMID:20222941

  10. Bridging Suture Repair for Acetabular Chondral Carpet Delamination

    PubMed Central

    Kaya, Mitsunori; Hirose, Toshiaki; Yamashita, Toshihiko

    2015-01-01

    Acetabular chondral carpet delamination is a frequent finding at hip arthroscopy. The cartilage is macroscopically normal but deboned from the subchondral bone, without a disruption at the chondrolabral junction. Arthroscopic anatomic repair of delaminated cartilage is challenging. We propose that a combination of microfracture and use of stitches to press the delaminated cartilage against the subchondral bone using a suture limb offers an effective method to provide an environment for cartilage repair. This article describes the technique of bridging suture repair for carpet delamination in detail; the technique enables the surgeon to stabilize the delaminated acetabular cartilage. Intra-articular soft anchors and an acetabular rim knotless anchor footprint provide a stable repair for delaminated cartilage. This technique is especially helpful in cases with acetabular cartilage carpet delamination. PMID:26759774

  11. Total hip arthroplasty after rotational acetabular osteotomy.

    PubMed

    Ito, Hideya; Takatori, Yoshio; Moro, Toru; Oshima, Hirofumi; Oka, Hiroyuki; Tanaka, Sakae

    2015-03-01

    In this study, we aimed to determine whether the outcomes of total hip arthroplasty (THA) after rotational acetabular osteotomy (RAO) are equal to those of primary THA, and to elucidate the characteristics of THA after RAO. The clinical and radiographic findings of THA after RAO (44 hips), with minimum 24 months of follow-up, were compared with a matched control group of 58 hips without prior RAO. We found that the outcomes in terms of functional scores and complication rates did not differ between THA after RAO and THA without previous pelvic osteotomy, indicating that the results of THA after RAO are equivalent to those of primary THA. Although THA after RAO requires technical considerations, similar clinical outcomes to primary THA can be expected. PMID:25456635

  12. Modern cementing techniques. An experimental study of vacuum insertion of bone cement.

    PubMed

    Draenert, K

    1989-01-01

    The results of these experiments show that an increase in the intramedullary pressure (IMP) can lead to embolization of bone marrow contents via the venous drainage system along the linea aspera. A vacuum applied distally to the medullary canal is very effective for filling the diaphyseal tube with cement. The cancellous bone honeycombs of the proximal metaphysis, however, can only be filled if the bone sponge is tunneled at the level of the femoral calcar; a proximal vacuum then yields filling of the cancellous bone framework with bone cement. In order to fill the weight-bearing spongious framework of the pelvic bone with cement, the acetabular cavity should be sealed with a rubber ring and vacuum applied proximo-laterally to the ilium, thereby giving an extremely high suction pressure. PMID:2690560

  13. Wear of highly crosslinked polyethylene acetabular components

    PubMed Central

    Callary, Stuart A; Solomon, Lucian B; Holubowycz, Oksana T; Campbell, David G; Munn, Zachary; Howie, Donald W

    2015-01-01

    Background and purpose Wear rates of highly crosslinked polyethylene (XLPE) acetabular components have varied considerably between different published studies. This variation is in part due to the different techniques used to measure wear and to the errors inherent in measuring the relatively low amounts of wear in XLPE bearings. We undertook a scoping review of studies that have examined the in vivo wear of XLPE acetabular components using the most sensitive method available, radiostereometric analysis (RSA). Methods A systematic search of the PubMed, Scopus, and Cochrane databases was performed to identify published studies in which RSA was used to measure wear of XLPE components in primary total hip arthroplasty (THA). Results 18 publications examined 12 primary THA cohorts, comprising only 260 THAs at 2–10 years of follow-up. The mean or median proximal wear rate reported ranged from 0.00 to 0.06 mm/year. However, differences in the manner in which wear was determined made it difficult to compare some studies. Furthermore, differences in RSA methodology between studies, such as the use of supine or standing radiographs and the use of beaded or unbeaded reference segments, may limit future meta-analyses examining the effect of patient and implant variables on wear rates. Interpretation This scoping review confirmed the low wear rates of XLPE in THA, as measured by RSA. We make recommendations to enhance the standardization of reporting of RSA wear results, which will facilitate early identification of poorly performing implants and enable a better understanding of the effects of surgical and patient factors on wear. PMID:25301435

  14. Preliminary Biomechanical Study of Different Acetabular Reinforcement Devices for Acetabular Reconstruction

    PubMed Central

    Tai, Ching-Lung; Lee, Po-Yi; Hsieh, Pang-Hsing

    2015-01-01

    Background Acetabular reinforcement devices (ARDs) are frequently used as load-sharing devices to allow allograft incorporation in revision hip arthroplasty with massive acetabular bone loss. The key to a successful reconstruction is robust fixation of the device to the host acetabulum. Interlocking fixation is expected to improve the initial stability of the postoperative construct. However, all commercially available ARDs are designed with non-locking fixation. This study investigates the efficacy of standard ARDs modified with locking screw mechanisms for improving stability in acetabular reconstruction. Methods Three types of ARDs were examined to evaluate the postoperative compression and angular stability: i) standard commercial ARDs, ii) standard ARDs modified with monoaxial and iii) standard ARDs modified with polyaxial locking screw mechanisms. All ARDs were implanted into osteomized synthetic pelvis with pelvic discontinuity. Axial compression and torsion tests were then performed using a servohydraulic material testing machine that measured load (angle) versus displacement (torque). Initial stability was compared among the groups. Results Equipping ARDs with interlocking mechanisms effectively improved the initial stability at the device/bone interface compared to standard non-locked ARDs. In both compression and torsion experiments, the monoaxial interlocking construct demonstrated the highest construct stiffness (672.6 ± 84.1 N/mm in compression and 13.3 ± 1.0 N·m/degree in torsion), whereas the non-locked construct had the lowest construct stiffness (381.4 ± 117.2 N/mm in compression and 6.9 ± 2.1 N·m/degree in torsion) (P < 0.05). Conclusions Our study demonstrates the potential benefit of adding a locking mechanism to an ARD. Polyaxial ARDs provide the surgeon with more flexibility in placing the screws at the cost of reduced mechanical performance. This in vitro study provides a preliminary evaluation of biomechanical performance for ARDs

  15. Arthroscopic Reduction and Transportal Screw Fixation of Acetabular Posterior Wall Fracture: Technical Note.

    PubMed

    Park, Jin Young; Chung, Woo Chull; Kim, Che Keun; Huh, Soon Ho; Kim, Se Jin; Jung, Bo Hyun

    2016-06-01

    Acetabular fractures can be treated with variable method. In this study, acetabular posterior wall fracture was treated with arthroscopic reduction and fixation using cannulated screw. The patient recovered immediately and had a satisfactory outcome. In some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal. So, we report our case with technical note. PMID:27536654

  16. Arthroscopic Reduction and Transportal Screw Fixation of Acetabular Posterior Wall Fracture: Technical Note

    PubMed Central

    Park, Jin young; Kim, Che Keun; Huh, Soon Ho; Kim, Se Jin; Jung, Bo Hyun

    2016-01-01

    Acetabular fractures can be treated with variable method. In this study, acetabular posterior wall fracture was treated with arthroscopic reduction and fixation using cannulated screw. The patient recovered immediately and had a satisfactory outcome. In some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal. So, we report our case with technical note. PMID:27536654

  17. Total Hip Arthroplasty Using Modular Trabecular Metal Acetabular Components for Failed Treatment of Acetabular Fractures: A Mid-term Follow-up Study

    PubMed Central

    Huang, De-Yong; Zhang, Liang; Zhou, Yi-Xin; Zhang, Chun-Yu; Xu, Hui; Huang, Yong

    2016-01-01

    Background: Porous-coated cups have been widely used in acetabular reconstruction after failed treatment of acetabular fractures, and good results have been reported with the use of these cups; however, the durability and functionality of modular trabecular metal (TM) acetabular components in acetabular reconstruction after failed treatment of acetabular fractures remain unclear. This study aimed to examine the radiographic and clinical outcomes associated with the use of modular TM acetabular components for failed treatment of acetabular fractures to assess the durability and functionality of these components in acetabular reconstruction after failed treatment of acetabular fractures. Methods: A total of 41 patients (41 hips) underwent total hip arthroplasty (THA) using modular TM acetabular components for failed treatment of acetabular fractures at our hospital between January 2007 and December 2012. Among these patients, two were lost to follow-up. Therefore, 39 patients (39 hips) were finally included in this study. The Harris hip score before and after the surgery, satisfaction level of the patients, and radiographic results were assessed. Results: The mean Harris hip score increased from 34 (range, 8–52) before surgery to 91 (range, 22–100) at the latest follow-up examination (P < 0.001). The results were excellent for 28 hips, good for six, fair for three, and poor for two. Among the 39 patients, 25 (64%) and 10 (26%) were very satisfied and somewhat satisfied, respectively. All cups were found to be fully incorporated, and no evidence of cup migration or periacetabular osteolysis was noted. Conclusions: Despite the technically demanding nature of the procedure, THA using modular TM acetabular components showed good durability and functionality and may be an effective reconstruction option for failed treatment of acetabular fractures. PMID:27064033

  18. Open-configuration MRI study of femoro-acetabular impingement.

    PubMed

    Yamamura, Mitsuyoshi; Miki, Hidenobu; Nakamura, Nobuo; Murai, Masakazu; Yoshikawa, Hideki; Sugano, Nobuhiko

    2007-12-01

    Femoro-acetabular impingement has been proposed as a causative factor of primary hip osteoarthritis. However, primary osteoarthritis of the hip is infrequent in Japan and other Asian countries, even though the hips of Asians frequently sustain impingement, since the Asian lifestyle commonly requires a larger range of hip motion than the Western lifestyle. Therefore, using open-configuration MRI, we investigated whether impingement actually occurs during some traditional Japanese hip positions. The hips of 5 healthy Japanese females were examined in 5 sitting postures: 1) sitting straight; 2) bowing while sitting straight; 3) sitting cross-legged; 4) W-sitting; and 5) squatting. The impingement point was detected by multiple plane reconstructed (MPR) views along with the acetabular rim depicted circumferentially. Impingement was considered to have occurred when, on MRI, the anterior femoral head-neck junction approached the acetabular rim and the femoral head was seen to float from the bottom of the acetabulum with the acetabular rim acting as a fulcrum. Impingement was observed in all volunteers in the W-sitting position, and in 2 of 5 volunteers during squatting. These findings show that impingement occurs frequently during daily Japanese activities. Thus, depending on race, femoro-acetabular impingement might not always cause primary osteoarthritis of the hip. (c) 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:1582-1588, 2007. PMID:17600811

  19. Accuracy of the modified Hardinge approach in acetabular positioning

    PubMed Central

    Goyal, Prateek; Lau, Adrian; McCalden, Richard; Teeter, Matthew G.; Howard, James L.; Lanting, Brent A.

    2016-01-01

    Background The surgical approach chosen for total hip arthroplasty (THA) may affect the positioning of the acetabular component. The purpose of this study was to examine the accuracy in orienting the acetabular component using the modified Hardinge approach. Methods We used our institutional arthroplasty database to identify patients with primary, press-fit, hemispherical acetabular components of a metal-on-polyethylene THA performed between 2003 and 2011. Patients with radiographs obtained 1–3 years after the index procedure were included for measurement of anteversion and inclination angles. Acceptable values of anteversion and abduction angles were defined as 15° ± 10° and 40° ± 10°, respectively. Results We identified 1241 patients from the database, and the modified Hardinge approach was used in 1010 of the patients included in our analysis. The acetabular component was anteverted in the acceptable zone in 54.1% of patients. The abduction angle was within the defined range in 79.2% of patients. Combined anteversion and abduction angles within the defined zone were present in 43.6% of patients. Conclusion Consistent with studies examining accuracy from other approaches, our study reveals that the modified Hardinge approach was only moderately accurate in positioning the acetabular component in the acceptable zone. PMID:27240130

  20. Cement disease.

    PubMed

    Jones, L C; Hungerford, D S

    1987-12-01

    Does "cement disease" exist? The bony environment surrounding a loosened cemented prosthesis is an abnormal pathologic condition which, if left unattended, will progress to a total failure of the joint including an inhibition of function and immobilizing pain. That biomaterial properties of the cement used for fixation also contribute to the pathologic state separates this disease from other modes of loosening. This leads inevitably to the conclusion that "cement disease" does exist. Methyl methacrylate has revolutionized the treatment of severe joint dysfunction. There can be no doubt that improving surgical technique, cement handling, and the cement itself will continue to improve the results and reduce the incidence of failure due to loosening. Cement is undoubtedly satisfactory for elderly patients with low activity levels and relatively short life expectancies. However, because of the inherent biologic and biomechanical properties of methyl methacrylate, it is unlikely that it can be rendered satisfactory in the long run for the young, the active, or the overweight patient, for whom alternatives are currently being sought. In such cases, the elimination of "cement disease" can only occur with the elimination of cement. Alternatives include the search for other grouting materials and the development of prostheses with satisfactory surfaces for either press-fit or biologic ingrowth. PMID:3315375

  1. Early polyethylene wear and osteolysis with ABG acetabular cups (7- to 12-year follow-up)

    PubMed Central

    Livesley, Peter

    2005-01-01

    We reviewed 81 consecutive ABG I primary total hip replacements implanted in 72 patients between January 1993 and December 1998. The mean follow-up was 8.2 (range 7–12) years. There was significant polyethylene wear and osteolysis associated with the acetabular cup .The cumulative survival of the cup with revision being the end point at 8.2 years was 95.1% (95% CI: 92–97.6%). However, the cumulative survival of the cup with revision and aseptic loosening together was 72% (95% CI: 61–78%) and survival of the acetabular liner for wear was 62% (95% CI: 48–74%). Stem survival with revision being the end point was 100%. In spite of significant radiological failures of the cups, most patients remained asymptomatic. Though results of the ABG stems in this series were good, we advocate a regular follow-up of all these hips in view of the poor outcome of the cups. PMID:16283307

  2. Computer-Assisted Rotational Acetabular Osteotomy for Patients with Acetabular Dysplasia

    PubMed Central

    Kobayashi, Naomi; Ike, Hiroyuki; Kubota, So; Saito, Tomoyuki

    2016-01-01

    Rotational acetabular osteotomy (RAO) is a well-established surgical procedure for patients with acetabular dysplasia, and excellent long-term results have been reported. However, RAO is technically demanding and precise execution of this procedure requires experience with this surgery. The usefulness of computer navigation in RAO includes its ability to perform three-dimensional (3D) preoperative planning, enable safe osteotomy even with a poor visual field, reduce exposure to radiation from intraoperative fluoroscopy, and display the tip position of the chisel in real time, which is educationally useful as it allows staff other than the operator to follow the progress of the surgery. In our results comparing 23 hips that underwent RAO with navigation and 23 hips operated on without navigation, no significant difference in radiological assessment was observed. However, no perioperative complications were observed in the navigation group whereas one case of transient femoral nerve palsy was observed in non-navigation group. A more accurate and safer RAO can be performed using 3D preoperative planning and intraoperative assistance with a computed tomography-based navigation system. PMID:26929806

  3. The submuscular sliding plate technique for acetabular posterior wall fractures extending to the acetabular roof.

    PubMed

    Kim, J J; Kim, J W; Oh, H K

    2014-12-01

    There is extension of the Kocher-Langenbeck approach using trochanteric osteotomy for posterior wall fracture extending to acetabular roof, but it exposes to complications such as nonunion, breakage, and heterotopic ossification. The current study introduces a submuscular sliding plate technique. We retrospectively analyzed 13 patients treated with this technique. It is based on conventional method for posterior wall fracture. After reduction of roof fragment with direct visualization, a pre-contoured plate was passed through a submuscular tunnel under the gluteus medius and minimus. A small split incision was performed on the muscles, and screws were inserted with a triple trocar complex safely under fluoroscopic imaging. All patients had fracture union without complications. X-rays results showed anatomical reduction in 10 cases and imperfect reduction in 3 cases. Our results were satisfactory, particularly without heterotopic ossifications despite no prophylactic regimen of NSAID was applied and no neurological complications, so we believe that this technique is a good option for posterior wall fractures extending to the acetabular roof. PMID:25453921

  4. The role of the cemented all-polyethylene tibial component in total knee replacement: a 30-year patient follow-up and review of the literature.

    PubMed

    Blumenfeld, Thomas J; Scott, Richard D

    2010-12-01

    Use of an all-polyethylene tibial component in primary total knee arthroplasty remains an attractive option considering the reported durability of the construct, the lowered cost compared to modular metal-backed tibia, and the elimination of backside wear. The two major intra-operative disadvantages include the inability to alter the tibial component thickness after permanent implant placement and the inability to use varus-valgus constrained designs. The long-term disadvantage is the inability to perform a modular insert exchange should this be required. We report the 30-year outcome of a single patient using the duopatellar total knee replacement system. Based on a critical review of the literature we would recommend use in patients 80 years of age or older, consideration in patients 75 to 79 years, and possibly in younger yet less active patients. These three groups would be the least likely to require a modular tibial liner exchange in their lifetime. PMID:20060725

  5. Revision of hemiarthroplasty to total hip arthroplasty using the cement-in-cement technique.

    PubMed

    Mounsey, E J; Williams, D H; Howell, J R; Hubble, M J

    2015-12-01

    Revision of a cemented hemiarthroplasty of the hip may be a hazardous procedure with high rates of intra-operative complications. Removing well-fixed cement is time consuming and risks damaging already weak bone or perforating the femoral shaft. The cement-in-cement method avoids removal of intact cement and has shown good results when used for revision total hip arthroplasty (THA). The use of this technique for the revision of a hemiarthroplasty to THA has not been previously reported. A total of 28 consecutive hemiarthroplasties (in 28 patients) were revised to a THA using an Exeter stem and the cement-in-cement technique. There were four men and 24 women; their mean age was 80 years (35 to 93). Clinical and radiographic data, as well as operative notes, were collected prospectively and no patient was lost to follow-up. Four patients died within two years of surgery. The mean follow up of the remainder was 70 months (25 to 124). Intra-operatively there was one proximal perforation, one crack of the femoral calcar and one acetabular fracture. No femoral components have required subsequent revision for aseptic loosening or are radiologically loose. Four patients with late complications (14%) have since undergone surgery (two for a peri-prosthetic fracture, and one each for deep infection and recurrent dislocation) resulting in an overall major rate of complication of 35.7%. The cement-in-cement technique provides reliable femoral fixation in this elderly population and may reduce operating time and rates of complication. PMID:26637675

  6. Observations on the initial stability of acetabular components in total hip arthroplasty. An experimental study.

    PubMed

    Pitto, R P; Sterzl, M; Hohmann, D

    1996-01-01

    It was the purpose of the study to investigate the initial stability, with or without screws, of 3 acetabular components with press-fit anchoring, by measuring bone-prosthesis micromovements during the application of physiological loading on the hip simulated in the laboratory. The prostheses, already used clinically, were characterized by different shapes and coatings. For the purposes of the study a total of 30 acetabula were used in 10 human pelves in polyurethane and 5 human pelves preserved at -20 degrees. The pelves were assembled on a hydraulic bench test with a steel jig that could be oriented, and they were cemented with polymethylmethacrylate. Three electromagnetic transducers with sensitivity of up to 1 micron (+ 500 microns) were used to measure the micromovements between the prosthesis and the acetabular rim in its three anatomical quadrants. Bone-prosthesis micromovements were recorded during 5 consecutive load tests, from 0 to 2.39 kN (244 kg). Experimental studies have shown that bone-prosthesis micromovement that exceeds 150 microns obstructs bone integration. The most significant micromovement was observed for all of the prostheses, without accessory screws, in the iliac quadrant, but only the hemispherical one with a semi-smooth surface in zirconium oxide surpassed the threshold of 150 microns. Prostheses with a porous surface demonstrated good stability (102 +/- 33 microns and 94 +/- 36 microns, respectively). None of the prostheses demonstrated micromovement exceeding 90 microns in the area corresponding to the pubis and the ischium. The use of 2 accessory screws sensitively increased the stability of all of the prostheses on the ilium, reducing the average micromovement by 40 microns. Reduction of micromovement was less on the pubis and on the ischium. PMID:8968114

  7. Acetabular Labral Tears in Patients with Sports Injury

    PubMed Central

    Kang, Chan; Cha, Soo-Min

    2009-01-01

    Background We wanted to investigate acetabular labral tears and their correlation with femoroacetabular impingement in patients with sports injury. Methods Among 111 patients who were diagnosed with the acetabular labral tears after arthroscopic treatment from January 2004 to December 2007, we selected 41 patients with sports injury. There were 12 cases of Taekwondo injury, 5 of golf injury, 4 of soccer injury, 3 of gymnastics injury, 2 of Hapkido injury, 2 of aerobics injury, 2 of rock-climbing injury, 2 of fitness training injury and 9 of other sports injuries. We checked the subtypes of acetabular labral tears and the accompanying femoroacetabular impingement. For the cases with accompanying femoroacetabular impingement, we investigated the subtypes according to the types of sports, gender and age. At last follow-up, we checked the Harris Hip Score (HHS), the Hip Outcome Score (HOS) sports scale and the percentage of patients who returned to their sports activity. Results The average age of symptomatic onset was 26 years (range, 12 to 65 years). The ratio of males to females was 29 : 12. An average duration of the hip pain was 17 months (range, 1 to 60 months). The degenerative type of acetabular labral tears was the most prevalent with 32 cases (78%), and there were 9 cases (22%) of the partial tear type. Thirty cases (73%) were accompanied by femoroacetabular impingement. The average age of the 23 cases (56%) of the cam-type was 23 years (range, 12 to 48 years), and it was more likely to occur in men (87%) and for people practicing martial arts such as Taekwondo or Hapkido. An average age of the 5 cases (12%) of the pincer-type was 26 (range, 16 to 43 years), it usually occurred in women (60%) and for non-martial arts such as golf and gymnastics. There were 2 cases of the mixed type (cam + pincer-type). At 27 months follow-up, the HHS was 61 to 92 points, the HOS sports scale increased 43 to 75%, and the rate of returning to sports was 71%. Conclusions In

  8. Effect of acetabular reinforcement ring with hook for acetabular dysplasia clarified by three-dimensional finite element analysis.

    PubMed

    Zhao, Xin; Chosa, Etsuo; Yamako, Go; Watanabe, Shinji; Deng, Gang; Totoribe, Koji

    2013-12-01

    The objective of this study was to biomechanically determine the effect of the severity of acetabular dysplasia, number and positions of screws and type of bone graft material used on the initial fixation strength of the acetabular reinforcement ring with hook (Ganz ring) using the finite element method. Relative micromotion increased as the severity of acetabular dysplasia increased and tended to decrease as the number of screws increased, but varied according to screw placement position. Increased strength of the bone graft material led to decreased relative micromotion. Biomechanically, the Ganz ring can be placed securely using 3 screws in patients with Crowe 1 dysplasia. However, in patients with Crowe 2 or higher dysplasia, it is necessary to spread at least 4 screws across an area of good host bone. PMID:23993349

  9. Natural cement as the precursor of Portland cement: Methodology for its identification

    SciTech Connect

    Varas, M.J. . E-mail: mjvaras@geo.ucm.es; Alvarez de Buergo, M.; Fort, R.

    2005-11-15

    When cements appeared in the 19th century, they took the place of traditional binding materials (lime, gypsum, and hydraulic lime) which had been used until that time. Early cements can be divided into two groups, natural and artificial (Portland) cements. Natural cements were introduced first, but their widespread usage was short-lived as they were quickly replaced by artificial cements (Portland), still the most important and predominant today. The main differences between natural and artificial cements arise during the manufacturing process. The final properties of the cements are greatly influenced by differences in the raw materials and burning temperatures employed. The aim of this paper is to assess the efficiency of traditional analytical techniques (petrographic microscopy, X-ray diffraction (XRD), scanning electron microscopy (SEM), and Fourier transform infrared spectroscopy (FTIR)) used to differentiate natural and artificial cements.

  10. European experience with cementless total hip replacements.

    PubMed

    Morscher, E W

    1983-01-01

    The differences between prostheses fixed with and without cement consist mainly of the design and the nature of the surface of the implant. The shapes of the sockets to be implanted without cement show a wide variety--cylinder, square, conus, ellipsoid with and without threads. The hemispherical shape, which was chosen for the acetabular component of the isoelastic hip joint, does not disturb the natural form and function of the hip joint since the outer surface is closely adapted to the original subchondral bone layer. Undesired stress concentrations therefore are eliminated. The fixation of the noncemented cup is secured by threads, pegs, screws, etc. and by ingrowth of bony tissue in the grooves of the surfaces. Except for some special forms, most of the stems are based on the self-locking principle. All prosthesis models show preparations that increase the surface area (ribs, wings, corrugations, or rims). PMID:6368478

  11. Ten-year results of a press-fit, porous-coated acetabular component.

    PubMed

    Grobler, G P; Learmonth, I D; Bernstein, B P; Dower, B J

    2005-06-01

    We retrospectively reviewed, ten years after surgery, 100 consecutive total hip replacements in which the Duraloc 300 cup had been used. Post-operative radiographs were analysed for placement of the cup and interface gaps and follow-up radiographs for lucent lines, osteolysis, wear and migration. All the components were found to be stable with no evidence of loosening. The mean rate of wear was 0.12 mm/year. Three hips developed acetabular osteolysis at the level of the apex hole. Two have successfully undergone bone grafting without removal of the implants and one patient is awaiting surgery. The Duraloc 300 cup has a survival of 100% at ten years with no aseptic loosening and a low incidence of pelvic osteolysis. PMID:15911659

  12. Traumatic Periprosthetic Acetabular Fracture Treated with One-Stage Exchange and Bone Reconstruction Using a Synthetic Bone Graft Substitute

    PubMed Central

    2016-01-01

    A case of a traumatic periprosthetic acetabular fracture in an elderly patient, which was treated by one-stage hip exchange with implantation of an antiprotrusio cage and reconstruction of the acetabular bone loss with an injectable calcium sulphate/hydroxyapatite bone graft substitute, is reported. The paste-like bone graft substitute was injected through the holes of the antiprotrusio cage. After a setting time of 15 minutes, a low-profile cup was cemented onto the cage using polymethylmethacrylate and a new stem was inserted. The patient was encouraged to ambulate three days postoperatively weight-bearing as tolerated. At the one-year follow-up visit the patient was ambulatory and full weight-bearing without any walking aids. The follow-up radiographs demonstrated stable position and articulation of the revision hip arthroplasty with no signs of loosening of the antiprotrusio cage. However, the most interesting finding was that the bone graft substitute had remodelled to a great extent into bone. This calcium sulphate/hydroxyapatite composite shows high osteoconductive potential and can be used to regenerate bone stock in revision arthroplasty. PMID:27446621

  13. Traumatic Periprosthetic Acetabular Fracture Treated with One-Stage Exchange and Bone Reconstruction Using a Synthetic Bone Graft Substitute.

    PubMed

    Svacina, Jan

    2016-01-01

    A case of a traumatic periprosthetic acetabular fracture in an elderly patient, which was treated by one-stage hip exchange with implantation of an antiprotrusio cage and reconstruction of the acetabular bone loss with an injectable calcium sulphate/hydroxyapatite bone graft substitute, is reported. The paste-like bone graft substitute was injected through the holes of the antiprotrusio cage. After a setting time of 15 minutes, a low-profile cup was cemented onto the cage using polymethylmethacrylate and a new stem was inserted. The patient was encouraged to ambulate three days postoperatively weight-bearing as tolerated. At the one-year follow-up visit the patient was ambulatory and full weight-bearing without any walking aids. The follow-up radiographs demonstrated stable position and articulation of the revision hip arthroplasty with no signs of loosening of the antiprotrusio cage. However, the most interesting finding was that the bone graft substitute had remodelled to a great extent into bone. This calcium sulphate/hydroxyapatite composite shows high osteoconductive potential and can be used to regenerate bone stock in revision arthroplasty. PMID:27446621

  14. Dissociation of a polyethylene liner from an acetabular cup.

    PubMed

    Cameron, H U

    1993-10-01

    A polyethylene linear dissociated from a metal acetabular shell that could not be removed at the time of hip revision because the hexagonal hole in its screw head had become rounded off. A high-speed metal cutting burr was used to remove the screw and allow cup revision. PMID:8265224

  15. Tritanium acetabular wedge augments: short-term results

    PubMed Central

    Restrepo, Camilo; Heller, Snir

    2016-01-01

    Background Reconstruction of acetabular defects in total hip arthroplasty (THA) presents a great challenge to orthopaedic surgeons. Previous studies have reported on the use and outcomes of trabecular metal acetabular augments for the reconstruction of acetabular defects. However, no study has been conducted evaluating the short-term results of tritanium acetabular wedge augments for the reconstruction of acetabular defects in THA. Methods A retrospective study was conducted using a prospective database at a single institution including primary and revision THA patients from January 2013 to December 2014. Patients were included if they received a tritanium acetabular wedge augment system and had a minimum of 2-year follow-up (average 2.2 years ±0.3, range, 2–2.6 years). Demographic data and outcomes data [Harris Hip Score—HHS and Short Form (SF)-36] was collected. Radiographic data was also collected on THA revision cases (Paprosky classification), developmental dysplasia of the hip (DDH) cases (Crowe classification), and radiographic follow-up using DeLee and Charnley’s classification system. Results There were 4 revision THA patients, 3 DDH patients, and 1 patient with posttraumatic arthritis. At the latest radiographic follow-up, there were no lucent lines in DeLee and Charnley Zones I, II or III. During the follow-up period, there was no open revision surgery. The SF-36 physical score significantly improved from preoperative measurement (29.6±2.2) to postoperative measurement (52.2±8.7, P=0.003), and the SF-36 mental score also significantly improved from preoperative assessment (34.5±4.5) to postoperative assessment (52.2±7.5, P=0.003). Total HHS scores also significantly improved postoperatively (P=0.02), with significant improvements in both the pain score (P=0.01) and function score (P=0.02). Conclusions Tritanium acetabular wedge augments in this short follow-up case series exhibit high clinical outcome scores, no radiographic lucency, and no

  16. Porous Tantalum Buttress Augments for Severe Acetabular Posterior Column Deficiency.

    PubMed

    Meneghini, R Michael; Hull, Jason R; Russo, Glenn S; Lieberman, Jay R; Jiranek, William A

    2015-11-01

    In revision total hip arthroplasty (THA), consensus is lacking regarding the optimal method for reconstruction of the most severe acetabular defects. Porous tantalum (TM) buttress augments were designed for the most severe postero-superior defects. The purpose of this study was to report the results of a consecutive series of acetabular reconstructions utilizing TM buttress augments. Eight complex acetabular reconstructions utilizing a TM buttress augment were performed at two centers. All were Paprosky 3A or Paprosky 3B bone loss classification, with severe superior and posterior column deficiency where wedge augments were insufficient for mechanical support. The acetabular cup sizes ranged from 64-78, and a buttress shim was used in 7 of 8 cases. Clinical and radiographic follow-up averaged 16.5 months (range, 10-28) and no cases were lost to follow-up. There were no cases of clinical or radiographic loosening, and no case had required reoperation or revision. All patients except one were ambulating with either no assist device or a single cane at final follow-up. There was one complication of an iliac wing fracture noted incidentally on postoperative x-rays in the lone patient in whom a buttress shim was not used. At short-term follow-up, TM acetabular buttress augments appear to effectively substitute for the use of structural allografts or cages, which would otherwise be used in this challenging setting. The potential for biologic fixation is promising for the durability of these reconstructions; however, longer-term follow-up is required for full evaluation. PMID:26680404

  17. An occult acetabular fracture preceding a femoral neck fracture.

    PubMed

    Lasanianos, Nikolaos; Kanakaris, Nikolaos; Giannoudis, Peter V

    2009-08-01

    This article describes the case of a 69-year-old patient with an occult acetabular fracture complicated by an ipsilateral femoral neck fracture occurring within 2 months. The acetabular fracture remained undiagnosed at examination due to insufficient clinical and radiographic data interpretation. The patient was assured of early mobilization that led to a fall and subsequent hip fracture. We focus on the potential reasons for the nondiagnosis of the acetabular fracture. Acetabular fractures in the elderly may occur after low-energy injuries. The lack of history of violent injury may lead to an incorrect diagnosis. Plain anteroposterior (AP) pelvis radiographs alone may prove an insufficient tool, especially in the hands of inexperienced personnel. As is characteristic, a retrospective review of the AP pelvis radiograph obtained after the first fall in our case revealed the undisplaced fracture of the anterior column that was missed initially. Combined fractures of the hip and the acetabulum are rarely described in the literature and are usually addressed by total hip arthroplasty (THA) alone. Similar fracture patterns that develop in 2 stages (2 injuries), as the 1 presented herein, are even more rare. The uniqueness of this combined fracture required a unique surgical treatment. The senior surgeon (P.V.G.) addressed the acetabular fracture separately to graft the anterior column fracture and facilitate union, as it was already 8 weeks old and the second fall had generated a further gap between the fragments. Stable fixation was felt appropriate prior to the THA. Thus, a double surgical approach was used. Six weeks postoperatively, the patient was able to perform full weight-bearing mobilization without an antalgic gait pattern. At 6-month follow-up, radiographs showed the metalwork to be in place with no displacement, and the fracture had progressed to union. PMID:19708620

  18. Protrusio After Medial Acetabular Wall Breach in Total Hip Arthroplasty

    PubMed Central

    Martin, Christopher T.; Heiner, Anneliese D.; Baer, Thomas E.; Pugely, Andrew J.; Noiseux, Nicolas O.

    2015-01-01

    Background Medial protrusio is a recognized complication of total hip arthroplasty, but it is not known if a medial wall breach during cup implantation increases the risk. We thus investigated the effect of up to a 2 cm defect in the medial acetabular wall in a cadaveric model. Separately, we investigated the ability of acetabular screws to rescue the construct. Methods Nine human fresh-frozen hemipelves were reamed medially to create the defect, implanted with acetabular cups, and then loaded to failure. The nine contralateral hemipelves were reamed in a standard fashion and served as controls. Separately, nine hemipelves with a medial defect were augmented with two acetabular screws each, then loaded to failure, with the contralateral side as a control. Load-to-failure, stiffness, and energy were recorded. Findings The presence of a medial wall defect decreased the load-to-failure by a mean of 26% (5710 v. 4221 N, p=0.024). The addition of two acetabular screws did not rescue the construct (mean 27% decrease, 4082 v. 2985 N, p=0.024). The majority of specimens failed in a supra-physiologic range of force. Bone density correlated with failure loads (R2 range of 0.54-0.78), and osteoporotic specimens were more likely to fail at a physiologic range, consistent with forces experienced during minor stumbles or falls. Interpretation Osteoporotic patients with a medial wall defect after hip arthroplasty may be susceptible to fracture during activities of daily living. Protected weight bearing with an assistive device may be reasonable in order to minimize fall risk until cup ingrowth is achieved. PMID:26361450

  19. Validation of neck axis distance as a radiographic measure for acetabular anteversion

    PubMed Central

    Nitschke, Ashley; Petersen, Brian; Lambert, Jeffery R.; Glueck, Deborah H.; Jesse, Mary Kristen; Strickland, Colin; Mei-Dan, Omer

    2016-01-01

    Excessive acetabular anteversion is an important treatment consideration in hip preservation surgery. There is currently no reliable quantitative method for determining acetabular anteversion utilizing radiographs alone. The three main purposes of this study were to: (i) define and validate the neck axis distance (NAD) as a new visual and reproducible semi-quantitative radiographic parameter used to measure acetabular anteversion; (ii) determine the degree of correlation between NAD and computed tomography (CT)-measured acetabular anteversion; (iii) establish a sensitive and specific threshold value for NAD to identify excessive acetabular anteversion. This retrospective cohort study included all patients presenting to a single institution over a 14-month period who had undergone a dedicated musculoskeletal CT pelvis along with a standardized anteroposterior (AP) pelvis radiograph. Trained observers measured the NAD on the AP pelvis radiograph and equatorial acetabular anteversion on CT for all hips. Mixed model analysis was used to find prediction equations, and ROC analysis was used to evaluate the diagnostic accuracy of NAD. NAD is a valid semi-quantitative predictor of acetabular anteversion and strongly correlates with CT-measured equatorial acetabular anteversion (P  <  0.0001). A NAD measurement of greater than 14 mm predicts excessive acetabular anteversion with 76% sensitivity and 78% specificity. NAD is an accurate radiographic predictor of acetabular anteversion, which may be readily used as an effective screening tool during the evaluation of patients with hip pain. PMID:27026824

  20. Lateral acetabular labral length is inversely related to acetabular coverage as measured by lateral center edge angle of Wiberg

    PubMed Central

    Petersen, Brian D.; Wolf, Bryan; Lambert, Jeffrey R.; Clayton, Carolyn W.; Glueck, Deborah H.; Jesse, Mary Kristen; Mei-Dan, Omer

    2016-01-01

    Patients with developmental dysplasia of the hip often have compensatory labral hypertrophy, which presumably lends stability to an unstable joint. Conversely, patients with acetabular overcoverage may have small or ossified labra. The purpose of this study is to explore the interaction of labral length with the degree of acetabular hip coverage. A retrospective cohort of patients with hip pain presenting to a hip preservation center, who had undergone hip magnetic resonance imaging and AP pelvis radiographs were studied. General linear multivariate models were used to assess the association between three measures of labral length (lateral, anterior and anterior inferior locations along the acetabular rim) and the X-ray derived lateral center edge angle (LCEA) of Wiberg. Of the three acetabular labral locations measured, only the lateral labrum was associated with LCEA Wiberg (P = 0.0008). Lateral labral length increases as LCEA of Wiberg decreases. The anterior and anterior inferior labral locations did not show a predictable increase in labral length as LCEA Wiberg decreased. PMID:27583157

  1. Initial Results of an Acetabular Center Axis Registration Technique in Navigated Hip Arthroplasty with Deformed Acetabular Rims

    PubMed Central

    Wada, Hiroshi; Mishima, Hajime; Yoshizawa, Tomohiro; Sugaya, Hisashi; Nishino, Tomofumi; Yamazaki, Masashi

    2016-01-01

    Background In cementless total hip arthroplasty, imageless computer-assisted navigation is usually used to register the anterior pelvic plane (APP). The accuracy of this method is influenced by the subcutaneous tissues overlying the registration landmarks. On the other hand, the acetabular center axis (ACA) is determined from the acetabular rim. Precise registration of the ACA is possible because of direct palpation using a pointer. Imageless navigation using the ACA usually targets patients with normal acetabular morphology. The aim of this study was to investigate the accuracy of imageless navigation using the ACA instead of the APP in patients with normal or deformed acetabular rims. Methods The intraoperative cup position was compared with that obtained from the postoperative computed tomography (CT) images in 18 cases. Results The inclination angle derived from the navigation system was 3.4 ± 5.3 degrees smaller and the anteversion angle was 1.4 ± 3.1 degrees larger than those derived from the CT images. Conclusion The inclination cup angle of the navigation system was significantly inferior to the true value, particularly in cases with large anterior osteophytes. PMID:27073586

  2. Lateral acetabular labral length is inversely related to acetabular coverage as measured by lateral center edge angle of Wiberg.

    PubMed

    Petersen, Brian D; Wolf, Bryan; Lambert, Jeffrey R; Clayton, Carolyn W; Glueck, Deborah H; Jesse, Mary Kristen; Mei-Dan, Omer

    2016-08-01

    Patients with developmental dysplasia of the hip often have compensatory labral hypertrophy, which presumably lends stability to an unstable joint. Conversely, patients with acetabular overcoverage may have small or ossified labra. The purpose of this study is to explore the interaction of labral length with the degree of acetabular hip coverage. A retrospective cohort of patients with hip pain presenting to a hip preservation center, who had undergone hip magnetic resonance imaging and AP pelvis radiographs were studied. General linear multivariate models were used to assess the association between three measures of labral length (lateral, anterior and anterior inferior locations along the acetabular rim) and the X-ray derived lateral center edge angle (LCEA) of Wiberg. Of the three acetabular labral locations measured, only the lateral labrum was associated with LCEA Wiberg (P = 0.0008). Lateral labral length increases as LCEA of Wiberg decreases. The anterior and anterior inferior labral locations did not show a predictable increase in labral length as LCEA Wiberg decreased. PMID:27583157

  3. Implication of acetabular width on the anteroposterior pelvic radiograph of patients with developmental dysplasia of the hip.

    PubMed

    Nie, Yong; Pei, Fuxing; Shen, Bin; Kang, Pengde; Li, Zongming

    2015-03-01

    Radiographic parameters that can help acetabular reconstruction during total hip arthroplasty (THA) for patients with developmental dysplasia of the hip (DDH) are few. The radiographs of 138 dysplastic hips that had undergone cementless THA were evaluated regarding the acetabular width above the acetabular component and the coverage of the component by native bone. The acetabular reconstruction process was simulated using 3D models from CT data, and the acetabular component coverage was calculated in 3D space based on the measurement and algorithm we proposed. Significant positive correlation between the acetabular width and the acetabular component coverage was found. Our study introduced a useful parameter, which can mark the superior reference position of the acetabular component for acetabular reconstruction in DDH patients. PMID:25311162

  4. Properties of Cement Mortar Produced from Mixed Waste Materials with Pozzolanic Characteristics.

    PubMed

    Yen, Chi-Liang; Tseng, Dyi-Hwa; Wu, Yue-Ze

    2012-07-01

    Waste materials with pozzolanic characteristics, such as sewage sludge ash (SSA), coal combustion fly ash (FA), and granulated blast furnace slag (GBS), were reused as partial cement replacements for making cement mortar in this study. Experimental results revealed that with dual replacement of cement by SSA and GBS and triple replacement by SSA, FA, and GBS at 50% of total cement replacement, the compressive strength (Sc) of the blended cement mortars at 56 days was 93.7% and 92.9% of the control cement mortar, respectively. GBS had the highest strength activity index value and could produce large amounts of CaO to enhance the pozzolanic activity of SSA/FA and form calcium silicate hydrate gels to fill the capillary pores of the cement mortar. Consequently, the Sc development of cement mortar with GBS replacement was better than that without GBS, and the total pore volume of blended cement mortars with GBS/SSA replacement was less than that with FA/SSA replacement. In the cement mortar with modified SSA and GBS at 70% of total cement replacement, the Sc at 56 days was 92.4% of the control mortar. Modifying the content of calcium in SSA also increased its pozzolanic reaction. CaCl(2) accelerated the pozzolanic activity of SSA better than lime did. Moreover, blending cement mortars with GBS/SSA replacement could generate more monosulfoaluminate to fill capillary pores. PMID:22783062

  5. Properties of Cement Mortar Produced from Mixed Waste Materials with Pozzolanic Characteristics

    PubMed Central

    Yen, Chi-Liang; Tseng, Dyi-Hwa; Wu, Yue-Ze

    2012-01-01

    Abstract Waste materials with pozzolanic characteristics, such as sewage sludge ash (SSA), coal combustion fly ash (FA), and granulated blast furnace slag (GBS), were reused as partial cement replacements for making cement mortar in this study. Experimental results revealed that with dual replacement of cement by SSA and GBS and triple replacement by SSA, FA, and GBS at 50% of total cement replacement, the compressive strength (Sc) of the blended cement mortars at 56 days was 93.7% and 92.9% of the control cement mortar, respectively. GBS had the highest strength activity index value and could produce large amounts of CaO to enhance the pozzolanic activity of SSA/FA and form calcium silicate hydrate gels to fill the capillary pores of the cement mortar. Consequently, the Sc development of cement mortar with GBS replacement was better than that without GBS, and the total pore volume of blended cement mortars with GBS/SSA replacement was less than that with FA/SSA replacement. In the cement mortar with modified SSA and GBS at 70% of total cement replacement, the Sc at 56 days was 92.4% of the control mortar. Modifying the content of calcium in SSA also increased its pozzolanic reaction. CaCl2 accelerated the pozzolanic activity of SSA better than lime did. Moreover, blending cement mortars with GBS/SSA replacement could generate more monosulfoaluminate to fill capillary pores. PMID:22783062

  6. Debonding of porous coating of a threaded acetabular component: retrieval analysis.

    PubMed

    Łapaj, Łukasz; Markuszewski, Jacek; Rybak, Tomasz; Wierusz-Kozłowska, Małgorzata

    2013-01-01

    This report presents a case of debonding of plasma sprayed porous titanium coating from a threaded acetabular component which caused aseptic loosening of the implant. Weight bearing after delamination caused abrasive damage of the acetabular shell, and particles of the coating embedded in the acetabular liner. Microscopic examination of periprosthetic tissues showed presence of metal particles and macrophage infiltration. Despite microscopic examination of the retrieved component the cause of debonding remains unclear. PMID:23127634

  7. Acetabular component deformation with press-fit fixation.

    PubMed

    Squire, Matthew; Griffin, William L; Mason, J Bohannon; Peindl, Richard D; Odum, Susan

    2006-09-01

    Acetabular component deformation secondary to forces encountered during insertion is a potential consequence of the press-fit technique. This study characterized the stiffness of Pinnacle 100 cups (DePuy, Warsaw, Ind) via mechanical testing and used this information with intraoperative measurements of cup deformation to calculate the in vivo forces acting on cups inserted during hip arthroplasty in 21 patients. We found that 90.5% of cups had measurable compression deformity, averaging 0.16 +/- 0.16 mm. The corresponding forces acting on these cups averaged 414 +/- 421 N. For hard-on-hard bearing surfaces, such in vivo deformation of acetabular shells may result in negative clinical consequences such as equatorial loading with increased wear and potential seizing of components, chipping of ceramic inserts, or locking mechanism damage. PMID:16950065

  8. Profile Measurement of Worn Acetabular Cup by Holographic Contouring

    NASA Astrophysics Data System (ADS)

    Kakunai, Satoshi; Sakamoto, Tohoru; Sakurai, Daisuke; Aota, Yuuki; Shelton, Julia

    Wear in a polyethylene acetabular cup is dependent on the history of the cup, namely on the sterilization treatment, initial mounting situation, the patient's lifestyle and length of time in vivo. Understanding wear patterns is essential in order to prevent inflammation and prosthesis failure. This study describes the profile measurement of a worn acetabular cup by holographic contouring, which can provide non-contact measurement over the entire visual field. Experiments were performed to verify the method, and measurements of cups worn in vivo were carried out. Cup profile was investigated using holograms obtained in three directions and changes in cup profile were evaluated using fringe patterns in which the interval range was adjusted from tens of microns to several millimeters.

  9. Acetabular Paralabral Cyst: An Unusual Cause of Femoral Vein Compression

    PubMed Central

    Kullar, Raj S.; Kapron, Ashley L.; Ihnat, Daniel; Aoki, Stephen K.; Maak, Travis G.

    2015-01-01

    Acetabular labral tears are a known cause of hip pain in the young, active patient. Labral tears can be due to trauma, femoroacetabular impingement, capsular laxity, dysplasia, and degenerative pathology. Paralabral cysts are relatively common in association with labral tears of the hip, with cysts seen on magnetic resonance imaging studies in as many as 50% to 70% of patients with labral tears. In some cases the cysts can become sizeable and cause neurovascular compression. Nonoperative interventions for the management of paralabral cysts in the shoulder and knee have shown high recurrence rates. In the shoulder and knee, arthroscopic debridement of paralabral cysts has shown good results with lower recurrence rates and resolution of neurovascular function. In the hip there is limited literature regarding surgical management of paralabral cysts. We present a surgical technique for arthroscopic decompression of acetabular paralabral cysts combined with labral repair. PMID:25973371

  10. Nonunion of acetabular fractures: evaluation with interactive multiplanar CT

    SciTech Connect

    Kuhlman, J.E.; Fishman, E.K.; Ney, D.R.; Brooker, A.F. Jr.; Magid, D.

    1989-01-01

    Nonunions involving fractures of the acetabulum are reportedly rare, with few citings and little discussion in the literature. It is possible that acetabular nonunions go undetected because imaging of the acetabulum is difficult by conventional radiography. We report two cases of fracture nonunion involving the weight-bearing surface of the acetabulum diagnosed with the aid of computed tomography (CT) and a newly developed interactive 2D/3D orthotool that uniquely processes and reformats routine CT data. The interactive 2D/3D orthotool is a sophisticated computer program that allows dynamic viewing of standard multiplanar reconstructions in the axial, coronal, and sagittal planes as well as multiple oblique projections. The 2D/3D orthotool provides on screen correlation of two-dimensional multiplanar images with three-dimensional reconstructions of the pelvis. The authors found this capability ideally suited for studying fractures with off-axis orientation such as those through the acetabular dome, greatly facilitating the diagnosis of nonunion.

  11. Stress fracture in acetabular roof due to motocross: case report.

    PubMed

    de Paiva Luciano, Alexandre; Filho, Nelson Franco

    2016-01-01

    One of the first steps to be taken in order to reduce sports injuries such as stress fractures is to have in-depth knowledge of the nature and extent of these pathological conditions. We present a case report of a stress fracture of the acetabular roof caused through motocross. This type of case is considered rare in the literature. The description of the clinical case is as follows. The patient was a 27-year-old male who started to have medical follow-up because of uncharacteristic pain in his left hip, which was concentrated mainly in the inguinal region of the left hip during motocross practice. After clinical investigation and complementary tests, he was diagnosed with a stress fracture of the acetabular roof. PMID:27274494

  12. Arthroscopic repair of acetabular chondral delamination with fibrin adhesive.

    PubMed

    Tzaveas, Alexandros P; Villar, Richard N

    2010-01-01

    Acetabular chondral delamination is a frequent finding at hip arthroscopy. The cartilage is macroscopically normal but disrupted from the subchondral bone. Excision of chondral flaps is the usual procedure for this type of lesion. However, we report 19 consecutive patients in whom the delaminated chondral flap was re-attached to the underlying subchondral bone with fibrin adhesive. We used the modified Harris hip score for assessment of pain and function. Improvement in pain and function was found to be statistically significant six months and one year after surgery. No local or general complications were noted. Three patients underwent further surgery for unrelated reasons. In each, the area of fibrin repair appeared intact and secure. Our results suggest that fibrin is a safe agent to use for acetabular chondral delamination. PMID:20235074

  13. An extended posterior approach to the hip and pelvis for complex acetabular reconstruction that preserves the gluteal muscles and their neurovascular supply.

    PubMed

    Solomon, L B; Hofstaetter, J G; Bolt, M J; Howie, D W

    2014-01-01

    We investigated the detailed anatomy of the gluteus maximus, gluteus medius and gluteus minimus and their neurovascular supply in 22 hips in 11 embalmed adult Caucasian human cadavers. This led to the development of a surgical technique for an extended posterior approach to the hip and pelvis that exposes the supra-acetabular ilium and preserves the glutei during revision hip surgery. Proximal to distal mobilisation of the gluteus medius from the posterior gluteal line permits exposure and mobilisation of the superior gluteal neurovascular bundle between the sciatic notch and the entrance to the gluteus medius, enabling a wider exposure of the supra-acetabular ilium. This technique was subsequently used in nine patients undergoing revision total hip replacement involving the reconstruction of nine Paprosky 3B acetabular defects, five of which had pelvic discontinuity. Intra-operative electromyography showed that the innervation of the gluteal muscles was not affected by surgery. Clinical follow-up demonstrated good hip abduction function in all patients. These results were compared with those of a matched cohort treated through a Kocher-Langenbeck approach. Our modified approach maximises the exposure of the ilium above the sciatic notch while protecting the gluteal muscles and their neurovascular bundle. PMID:24395310

  14. The influence of cement mantle thickness and stem geometry on fatigue damage in two different cemented hip femoral prostheses.

    PubMed

    Ramos, A; Simões, J A

    2009-11-13

    Experimental models can be used for pre-clinical testing of cemented and other type of hip replacements. Total hip replacement (THR) failure scenarios include, among others, cement damage accumulation and the assessment of accurate stress and strain magnitudes at the cement mantle interfaces (stem-cement and cement-bone) can be used to predict mechanical failure. The aseptic loosening scenario in cemented hip replacements is currently not fully understood, and methods of evaluating medical devices must be developed to improve clinical performance. Different results and conclusions concerning the cement micro-cracking mechanism have been reported. The aim of this study was to verify the in vitro behavior of two cemented femoral stems with respect to fatigue crack formation. Fatigue crack damage was assessed at the medial, lateral, anterior and posterior sides of the Lubinus SPII and Charnley stems. All stems were loaded and tested in stair climbing fatigue loading during one million cycles at 2 Hz. After the experiments each implanted synthetic femur was sectioned and analyzed. We observed more damage (cracks per area) for the Lubinus SPII stem, mainly on the proximal part of the cement mantle. The micro-cracking formation initiated in the stem-cement interface and grew towards the direction of cortical bone of the femur. Overall, the cement-bone interface seems to be crucial for the success of the hip replacement. The Charnley stem provoked more damage on the cement-bone interface. A failure index (maximum length of crack/maximum thickness of cement) considered was higher for the cement-stem interface of the Lubinus SPII stem. For a cement mantle thickness higher than 5 mm, cracking initiated at the cement-bone interface and depended on the opening canal process (reaming procedure and instrumentation). The analysis also showed that fatigue-induced damage on the cement mantle, increasing proximally, and depended on the axial position of the stem. The cement

  15. Successful Long-Term Fixation and Progression of Osteolysis Associated with First-Generation Cementless Acetabular Components Retrieved Post Mortem

    PubMed Central

    Urban, Robert M.; Hall, Deborah J.; Della Valle, Craig; Wimmer, Markus A.; Jacobs, Joshua J.; Galante, Jorge O.

    2012-01-01

    Background: Primary cementless acetabular reconstruction has shown durable long-term fixation. Late failures secondary to aseptic loosening are rare but may occur in patients with previously well-fixed components. In the present study, the histopathological characteristics of postmortem specimens were correlated with wear damage and radiographic data in an attempt to better understand the long-term events in the periacetabular tissue around well-functioning devices. Methods: Seventeen primary cementless Harris-Galante I acetabular components with adjacent tissues were harvested after a mean of eleven years (range, four to twenty-five years) from patients whose implants were well functioning at the time of death. Undecalcified and paraffin sections were used to quantify the extent of bone and soft tissues within the porous coating and at the interface between the coating and the surrounding bone. Wear particles were identified with use of polarized light microscopy and energy-dispersive x-ray analysis. Bearing-surface volumetric wear and backside wear damage of the polyethylene liner were assessed. Results: All of the components were fixed by bone ingrowth (mean extent, 33% ± 21%). Particle-induced granulomas were present in the porous coating and along the interface and progressed through screw holes, ballooning into the retroacetabular bone in the longer-term specimens. Particles of femoral and acetabular origin were identified in the granulomas. Bearing-surface volumetric wear (mean, 41.6 mm3/year) increased with duration and correlated with increasing extent of granuloma in the porous coating and the increasing size of pelvic granulomas. Radiolucencies on radiographs correlated with the extent of bone and fibrous tissue ingrowth. Of the six pelvic granulomas that were identified histologically, only one was apparent on routine radiographs. Conclusions: Acetabular fixation by bone ingrowth can be successful into the third decade after implantation. Osteolysis

  16. Press-fit versus threaded acetabular cups in total hip arthroplasty: Functional and radiological results after five years.

    PubMed

    Ellenrieder, Martin; Bader, Rainer; Bergschmidt, Philipp; Mittelmeier, Wolfram

    2016-03-01

    Prospectively the outcome after total hip replacement with a new threaded acetabular cup design was compared to an established press-fit cup. After 1, 2 and 5 years, the 36-item Short Form Health Survey, Western Ontario and McMaster University Osteoarthritis Index and Harris Hip Score revealed no significant differences between the two groups (each group: n=42 patients), except for a higher Harris Hip Score in the threaded cup group after five years (p=0.02). After five years, one threaded cup had a mild radiolucent line without further signs of loosening. All other cups of both groups (98.6%) showed a full osseous integration. The cup inclination angle ranged from 41-58° (threaded cups) to 39-77° (press-fit cups). The new threaded cup provides equivalent clinical outcomes and osseous integration but more precise implant positioning compared to the press-fit design. No complications typically ascribed to threaded cups (acetabular fractures, bone resorption, nerve impairment) occurred. PMID:26984655

  17. The effect of dynamic hip motion on the micromotion of press-fit acetabular cups in six degrees of freedom.

    PubMed

    Crosnier, Emilie A; Keogh, Patrick S; Miles, Anthony W

    2016-08-01

    The hip joint is subjected to cyclic loading and motion during activities of daily living and this can induce micromotions at the bone-implant interface of cementless total hip replacements. Initial stability has been identified as a crucial factor to achieve osseointegration and long-term survival. Whilst fixation of femoral stems achieves good clinical results, the fixation of acetabular components remains a challenge. In vitro methods assessing cup stability keep the hip joint in a fixed position, overlooking the effect of hip motion. The effect of hip motion on cup micromotion using a hip motion simulator replicating hip flexion-extension and a six degrees of freedom measurement system was investigated. The results show an increase in cup micromotion under dynamic hip motion compared to Static Flexion. This highlights the need to incorporate hip motion and measure all degrees of freedom when assessing cup micromotion. In addition, comparison of two press-fit acetabular cups with different surface coatings suggested similar stability between the two cups. This new method provides a basis for a more representative protocol for future pre-clinical evaluation of different cup designs. PMID:27210567

  18. Lunar cement

    NASA Technical Reports Server (NTRS)

    Agosto, William N.

    1992-01-01

    With the exception of water, the major oxide constituents of terrestrial cements are present at all nine lunar sites from which samples have been returned. However, with the exception of relatively rare cristobalite, the lunar oxides are not present as individual phases but are combined in silicates and in mixed oxides. Lime (CaO) is most abundant on the Moon in the plagioclase (CaAl2Si2O8) of highland anorthosites. It may be possible to enrich the lime content of anorthite to levels like those of Portland cement by pyrolyzing it with lunar-derived phosphate. The phosphate consumed in such a reaction can be regenerated by reacting the phosphorus product with lunar augite pyroxenes at elevated temperatures. Other possible sources of lunar phosphate and other oxides are discussed.

  19. Intermediate clinical follow-up of a dual-radius acetabular component.

    PubMed

    Van Flandern, G J; Bierbaum, B E; Newberg, A H; Gomes, S L; Mattingly, D A; Karpos, P A

    1998-10-01

    In this study, 92 primary total hip arthroplasties were performed in 83 patients using a porous-coated, dual-radius, cementless, acetabular component. All hips underwent line-to-line dome reaming with press-fit implantation that was judged to have complete bone contact. This acetabular shell provides a 1-mm oversized peripheral rim, which adds excellent initial stability while allowing complete bone contact in all hips. No fractures occurred. In 83% of hips, adjunctive screw fixation was not necessary. At a minimum of 4 years, follow-up, there were no revisions, no acetabular migration, one case of acetabular erosion consistent with osteolysis, and the average Harris Hip Score was 95. The design features of this new acetabular component have provided excellent fixation with complete initial bone contact, resulting in satisfactory intermediate clinical and radiographic results. The design provides excellent peripheral stability and complete bone contact. PMID:9802669

  20. Improving acetabular cup orientation in total hip arthroplasty by using smartphone technology.

    PubMed

    Peters, Frank M; Greeff, Richard; Goldstein, Neal; Frey, Chris T

    2012-08-01

    Acetabular cup placement in total hip arthroplasty is often difficult to assess, especially in the lateral position and using the posterior approach. Conventional techniques and computer-assisted surgery are the 2 most popular methods for proper placement of the acetabular cup in Lewinnek's safe zone of orientation (anteversion 15° ± 10° and lateral inclination 40° ± 10°). We developed a system that uses the accelerometer and camera function of the iPhone. A level indicator application and protractor application were downloaded to the iPhone and used to improve acetabular cup placement. This system has proven to be accurate and quick. Our series of 50 prospective cases showed good results with all our acetabular cups being placed within a narrow range in the safe zone and with less than 5% difference between the preoperative, intraoperative, and postoperative acetabular inclinations. PMID:22245126

  1. Arthroscopic Technique for Chondrolabral Capsular Preservation During Labral Repair and Acetabular Osteoplasty

    PubMed Central

    Nwachukwu, Benedict U.; McCormick, Frank; Martin, Scott D.

    2013-01-01

    Traditional techniques for acetabular osteoplasty in femoral acetabular impingement have required surgical detachment of the labrum at the chondrolabral junction. Such approaches compromise labral blood flow and contribute to a limited ability for healing at the chondrolabral junction. In this technical note and accompanying video, we present a technique for preservation of the chondrolabral junction during labral repair and acetabular osteoplasty. We elevate the chondrolabral complex subperiosteally off the acetabular rim, and the acetabular shelf is then contoured under fluoroscopic guidance. The labrum is then repaired and reconstituted to a new anatomic footprint. We find this technique to be advantageous because it preserves the blood flow to the labrum, thereby maximizing healing potential. Outcome studies are warranted to further elucidate the functional and outcome benefits of this surgical technique. PMID:24265986

  2. Sacroiliac joint dysfunction as a reason for the development of acetabular retroversion: a new theory.

    PubMed

    Cibulka, Michael T

    2014-05-01

    Acetabular retroversion has been recently implicated as an important factor in the development of femoral acetabular impingement and hip osteoarthritis. The proper function of the hip joint requires that the anatomic features of the acetabulum and femoral head complement one another. In acetabular retroversion, the alignment of the acetabulum is altered where it opens in a posterolaterally instead of anterior direction. Changes in acetabular orientation can occur with alterations in pelvic tilt (anterior/posterior), and pelvic rotation (left/right). An overlooked problem that alters pelvic tilt and rotation, often seen by physical therapists, is sacroiliac joint dysfunction. A unique feature that develops in patients with sacroiliac joint dysfunction (SIJD) is asymmetry between the left and right innominate bones that can alter pelvic tilt and rotation. This article puts forth a theory suggesting that acetabular retroversion may be produced by sacroiliac joint dysfunction. PMID:24350878

  3. Ankle replacement

    MedlinePlus

    Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle surgery ... Ankle replacement surgery is most often done while you are under general anesthesia. This means you will ...

  4. Ankle replacement

    MedlinePlus

    ... to the cut bony surfaces. A special glue/bone cement may be used to hold them in place. A piece of plastic is then inserted between the two metal parts. Screws maybe placed to stabilize your ankle. The surgeon ...

  5. Sculpting with Cement.

    ERIC Educational Resources Information Center

    Olson, Lynn

    1983-01-01

    Cement offers many creative possibilities for school art programs. Instructions are given for sculpting with fiber-cement and sand-cement, as well as for finishing processes and the addition of color. Safety is stressed. (IS)

  6. The importance of a thick cement mantle depends on stem geometry and stem-cement interfacial bonding.

    PubMed

    Caruana, J; Janssen, D; Verdonschot, N; Blunn, G W

    2009-04-01

    The thickness of the cement mantle around the femoral component of total hip replacements is a contributing factor to aseptic loosening and revision. Nevertheless, various designs of stems and surgical tooling lead to cement mantles of different thicknesses. Opinion is divided on whether a thick mantle enhances implant longevity. This study investigates the effect of cement mantle thickness on accumulated damage in the cement, and how this is influenced by the presence or absence of a proximal collar and on whether the stem-cement interface remains bonded. Three-dimensional finite element simulations incorporating creep and non-linear damage accumulation were performed to investigate cracking in the cement mantles around Stanmore Hips under physiologically informed stair-climbing and gait loads. Cement mantle thickness, stem-cement interfacial bonding, and collar design were varied to assess the interactive effects of these parameters. In all cases, damage levels were three to six times higher when the stem-cement interface remained bonded. Cement mantle thickness had little effect on cement damage accumulation around debonded collared stems but was critical in both bonded and collarless cases, where a thicker mantle reduced cement cracking. Damage around a smooth debonded stem with a collar is thus much less sensitive to cement thickness than around bonded or collarless stems. PMID:19405437

  7. Is labral hypotrophy correlated with increased acetabular depth?

    PubMed

    Toft, Felix; Anliker, Elmar; Beck, Martin

    2015-07-01

    Labral hypertrophy is a distinct feature in hip dysplasia. Occasionally, very small, hypotrophic labra are observed. However, there is no literature concerning this pathology. We investigated if the size of the labrum correlated with any radiologic parameters reflecting the amount of acetabular coverage. It was hypothezised that there is a negative correlation between labrum size and acetabular coverage. Labra were categorized into three groups depending on the relation between length of the articular sided surface and height of bony attachment. Labra with a height:length ratio of 2 were classified as hypotrophic, with a height:length ratio of 1 as normal and with a ratio of 0.5 as hypertrophic. Labral cross-sectional areas (CSA) were measured on radial magnetic resonance imaging-arthrography slices using the measuring tool of the PACS system of 20 hips with hypotrophic labra (group 1), 20 hips with normal labral appearance (group 2) and 10 hips with hypertrophic labra (group 3). These values were then analyzed against following parameters: neck-shaft-angle (NSA), lateral center-edge angle (LCE), acetabular index (AI), femoral extrusion index (FEI) and acetabular retroversion index (ARI). Analyses of variance were used to determine differences in mean values between the three groups. Mean labral CSA differed significantly between all groups (group 1: 12.1 ± 2.9 mm(2); group 2: 25.2 ± 6.2 mm(2); group 3: 41.1 ± 12.3 mm(2); P < 0.001). NSA, LCE, AI and FEI all showed a significant difference between group 3 and 1 or 2. The ARI showed no difference between groups. Stepwise linear regression analyses showed a significant correlation between LCE angle and labral CSA with a corrected R (2)-value of 0.301. Labral CSA correlates with the LCE. No statistically significant difference between groups 1 and 2 concerning the LCE, AI or FEI could be identified. Nevertheless, group 1 had the highest mean coverage of all groups, hips with hypertrophic

  8. Is labral hypotrophy correlated with increased acetabular depth?

    PubMed Central

    Toft, Felix; Anliker, Elmar; Beck, Martin

    2015-01-01

    Labral hypertrophy is a distinct feature in hip dysplasia. Occasionally, very small, hypotrophic labra are observed. However, there is no literature concerning this pathology. We investigated if the size of the labrum correlated with any radiologic parameters reflecting the amount of acetabular coverage. It was hypothezised that there is a negative correlation between labrum size and acetabular coverage. Labra were categorized into three groups depending on the relation between length of the articular sided surface and height of bony attachment. Labra with a height:length ratio of 2 were classified as hypotrophic, with a height:length ratio of 1 as normal and with a ratio of 0.5 as hypertrophic. Labral cross-sectional areas (CSA) were measured on radial magnetic resonance imaging-arthrography slices using the measuring tool of the PACS system of 20 hips with hypotrophic labra (group 1), 20 hips with normal labral appearance (group 2) and 10 hips with hypertrophic labra (group 3). These values were then analyzed against following parameters: neck-shaft-angle (NSA), lateral center-edge angle (LCE), acetabular index (AI), femoral extrusion index (FEI) and acetabular retroversion index (ARI). Analyses of variance were used to determine differences in mean values between the three groups. Mean labral CSA differed significantly between all groups (group 1: 12.1 ± 2.9 mm2; group 2: 25.2 ± 6.2 mm2; group 3: 41.1 ± 12.3 mm2; P < 0.001). NSA, LCE, AI and FEI all showed a significant difference between group 3 and 1 or 2. The ARI showed no difference between groups. Stepwise linear regression analyses showed a significant correlation between LCE angle and labral CSA with a corrected R2-value of 0.301. Labral CSA correlates with the LCE. No statistically significant difference between groups 1 and 2 concerning the LCE, AI or FEI could be identified. Nevertheless, group 1 had the highest mean coverage of all groups, hips with hypertrophic labra

  9. Acetabular fractures: what radiologists should know and how 3D CT can aid classification.

    PubMed

    Scheinfeld, Meir H; Dym, Akiva A; Spektor, Michael; Avery, Laura L; Dym, R Joshua; Amanatullah, Derek F

    2015-01-01

    Correct recognition, description, and classification of acetabular fractures is essential for efficient patient triage and treatment. Acetabular fractures may result from high-energy trauma or low-energy trauma in the elderly. The most widely used acetabular fracture classification system among radiologists and orthopedic surgeons is the system of Judet and Letournel, which includes five elementary (or elemental) and five associated fractures. The elementary fractures are anterior wall, posterior wall, anterior column, posterior column, and transverse. The associated fractures are all combinations or partial combinations of the elementary fractures and include transverse with posterior wall, T-shaped, associated both column, anterior column or wall with posterior hemitransverse, and posterior column with posterior wall. The most unique fracture is the associated both column fracture, which completely dissociates the acetabular articular surface from the sciatic buttress. Accurate categorization of acetabular fractures is challenging because of the complex three-dimensional (3D) anatomy of the pelvis, the rarity of certain acetabular fracture variants, and confusing nomenclature. Comparing a 3D image of the fractured acetabulum with a standard diagram containing the 10 Judet and Letournel categories of acetabular fracture and using a flowchart algorithm are effective ways of arriving at the correct fracture classification. Online supplemental material is available for this article. PMID:25763739

  10. Decreased Lumbar Lordosis and Deficient Acetabular Coverage Are Risk Factors for Subchondral Insufficiency Fracture.

    PubMed

    Jo, Woo Lam; Lee, Woo Suk; Chae, Dong Sik; Yang, Ick Hwan; Lee, Kyoung Min; Koo, Kyung Hoi

    2016-10-01

    Subchondral insufficiency fracture (SIF) of the femoral head occurs in the elderly and recipients of organ transplantation. Osteoporosis and deficient lateral coverage of the acetabulum are known risk factors for SIF. There has been no study about relation between spinopelvic alignment and anterior acetabular coverage with SIF. We therefore asked whether a decrease of lumbar lordosis and a deficiency in the anterior acetabular coverage are risk factors. We investigated 37 patients with SIF. There were 33 women and 4 men, and their mean age was 71.5 years (59-85 years). These 37 patients were matched with 37 controls for gender, age, height, weight, body mass index and bone mineral density. We compared the lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, acetabular index, acetabular roof angle, acetabular head index, anterior center-edge angle and lateral center-edge angle. Lumbar lordosis, pelvic tilt, sacral slope, lateral center edge angle, anterior center edge angle, acetabular index and acetabular head index were significantly different between SIF group and control group. Lumbar lordosis (OR = 1.11), lateral center edge angle (OR = 1.30) and anterior center edge angle (OR = 1.27) had significant associations in multivariate analysis. Decreased lumbar lordosis and deficient anterior coverage of the acetabulum are risk factors for SIF as well as decreased lateral coverage of the acetabulum. PMID:27550496

  11. Role of the Acetabular Labrum in Load Support Across the Hip Joint

    PubMed Central

    Henak, Corinne R.; Ellis, Benjamin J.; Harris, Michael D.; Anderson, Andrew E.; Peters, Christopher L.; Weiss, Jeffrey A.

    2011-01-01

    The relatively high incidence of labral tears among patients presenting with hip pain suggests that the acetabular labrum is often subjected to injurious loading in vivo. However, it is unclear whether the labrum participates in load transfer across the joint during activities of daily living. This study examined the role of the acetabular labrum in load transfer for hips with normal acetabular geometry and acetabular dysplasia using subject-specific finite element analysis. Models were generated from volumetric CT data and analyzed with and without the labrum during activities of daily living. The labrum in the dysplastic model supported 4-11% of the total load transferred across the joint, while the labrum in the normal model supported only 1-2% of the total load. Despite the increased load transferred to the acetabular cartilage in simulations without the labrum, there were minimal differences in cartilage contact stresses. This was because the load supported by the cartilage correlated to the cartilage contact area. A higher percentage of load was transferred to the labrum in the dysplastic model because the femoral head achieved equilibrium near the lateral edge of the acetabulum. The results of this study suggest that the labrum plays a larger role in load transfer and joint stability in hips with acetabular dysplasia than in hips with normal acetabular geometry. PMID:21757198

  12. Massive acetabular bone loss: Limits of trabecular metal cages

    PubMed Central

    Villanueva-Martínez, Manuel; Ríos-Luna, Antonio; Diaz-Mauriño, Juán

    2011-01-01

    Massive acetabular bone loss (more than 50% of the acetabular area) can result in insufficient native bone for stable fixation and long-term bone ingrowth of conventional porous cups. The development of trabecular metal cages with osteoconductive properties may allow a more biological and versatile approach that will help restore bone loss, thus reducing the frequency of implant failure in the short-to-medium term. We report a case of massive bone loss affecting the dome of the acetabulum and the ilium, which was treated with a trabecular metal cage and particulate allograft. Although the trabecular metal components had no intrinsic stability, they did enhance osseointegration and incorporation of a non-impacted particulate graft, thus preventing failure of the reconstruction. The minimum 50% contact area between the native bone and the cup required for osseointegration with the use of porous cups may not hold for new trabecular metal cups, thus reducing the need for antiprotrusio cages. The osteoconductive properties of trabecular metal enhanced allograft incorportation and iliac bone rebuilding without the need to fill the defect with multiple wedges nor protect the reconstruction with an antiprotrusio cage. PMID:21221229

  13. Transosseous Acetabular Labral Repair as an Alternative to Anchors

    PubMed Central

    Pérez-Carro, Luis; Cabello, Andres Gonzalez; Rakha, Mohamed Ibrahim; Patnaik, Sarthak; Centeno, Elias; Miranda, Victor; Fernández, Ana Alfonso

    2015-01-01

    Labral tears are the most common pathology in patients undergoing hip arthroscopy and the most common cause of mechanical hip symptoms. Labral repair techniques have been described in the literature using suture anchors placed as close as possible to the acetabular rim without penetrating the articular surface. Optimal surgical technique for labral repair is very important, and an inappropriate entry point and guide angulation may lead to intra-articular penetration of the anchor, chondral damage, anchor loosening, or inadequate fixation. A shallow dysplastic hip, the drilling trajectory, the narrow width of the acetabular rim, or some specific anatomic variations may generate difficulty during anchor placement. Suture anchors themselves have been associated with several significant complications, including rim fracture, osteolysis, enlargement of drill holes, and infection. The treatment of labral lesions with transosseous suture is an alternative to anchor use, eliminating the need for anchors and avoiding anchor-associated complications. This technique offers versatility to surgeons and is more cost-effective for patients and health services. We aim to describe the indications and technique for transosseous labral repair without anchors. PMID:26697295

  14. Subchondral Insufficiency Fracture of the Femoral Head Caused by Excessive Lateralization of the Acetabular Rim

    PubMed Central

    Kimura, Tetsuya; Goto, Tomohiro; Hamada, Daisuke; Tsutsui, Takahiko; Wada, Keizo; Fukuta, Shoji; Nagamachi, Akihiro; Sairyo, Koichi

    2016-01-01

    We present a case of a 53-year-old woman with subchondral insufficiency fracture (SIF) of the femoral head without history of severe osteoporosis or overexertion. Plain radiographs showed acetabular overcoverage with excessive lateralization of the acetabular rim. A diagnosis of SIF was made by typical MRI findings of SIF. The lesion occurred at the antipodes of the extended rim. Increased mechanical stress over the femoral head due to impingement against the excess bone was suspected as a cause of SIF. The distinct femoral head deformity is consistent with this hypothesis. This is the first report of SIF associated with acetabular overcoverage. PMID:27293935

  15. Explicit finite element modelling of the impaction of metal press-fit acetabular components.

    PubMed

    Hothi, H S; Busfield, J J C; Shelton, J C

    2011-03-01

    Metal press-fit cups and shells are widely used in hip resurfacing and total hip replacement procedures. These acetabular components are inserted into a reamed acetabula cavity by either impacting their inner polar surface (shells) or outer rim (cups). Two-dimensional explicit dynamics axisymmetric finite element models were developed to simulate these impaction methods. Greater impact velocities were needed to insert the components when the interference fit was increased; a minimum velocity of 2 m/s was required to fully seat a component with a 2 mm interference between the bone and outer diameter. Changing the component material from cobalt-chromium to titanium alloy resulted in a reduction in the number of impacts on the pole to seat it from 14 to nine. Of greatest significance, it was found that locking a rigid cap to the cup or shell rim resulted in up to nine fewer impactions being necessary to seat it than impacting directly on the polar surface or using a cap free from the rim of the component, as is the case with many commercial resurfacing cup impaction devices currently used. This is important to impactor design and could make insertion easier and also reduce acetabula bone damage. PMID:21485331

  16. ULTRA-LIGHTWEIGHT CEMENT

    SciTech Connect

    Fred Sabins

    2002-07-30

    The objective of this project is to develop an improved ultra-lightweight cement using ultra-lightweight hollow glass spheres (ULHS). This report includes results from laboratory testing of ULHS systems along with other lightweight cement systems, including foamed and sodium silicate slurries. During this project quarter, a comparison study of the three cement systems examined the effect that cement drillout has on the three cement systems. Testing to determine the effect of pressure cycling on the shear bond properties of the cement systems was also conducted. This report discusses testing that was performed to analyze the alkali-silica reactivity of ULHS in cement slurries.

  17. Hip Replacement

    MedlinePlus

    ... replacement is an operation in which a damaged hip joint is removed and replaced with an artificial joint. ... are many medical conditions that can damage the hip joint. (Watch the video to learn about what goes ...

  18. Hip Replacement

    MedlinePlus

    ... surgeon removes damaged cartilage and bone from your hip joint and replaces them with new, man-made parts. A hip replacement can Relieve pain Help your hip joint work better Improve walking and other movements The ...

  19. Traumatic medial displacement of Rotalok uncemented acetabular component. A case report.

    PubMed

    Charnley, G J; Ridge, J; Ribbans, W J

    1994-04-01

    The failure of uncemented acetabular components has been described in association with component wear, disassembly, and proximal migration. The authors report a case of medial displacement following minor trauma some 18 months after surgery. The component involved differs in design from both press-fit, porous-coated or screw-in, fully threaded acetabular cups. The authors suggest that additional screws should be inserted to enhance long-term stability. PMID:8014654

  20. Rapid resolution of femoral head osteonecrosis after rotational acetabular osteotomy.

    PubMed

    Nozawa, Masahiko; Matsuda, Keiji; Maezawa, Katsuhiko; Kim, Sungon; Maeda, Kouichi; Ikegami, Takashi; Kubota, Reiko; Hayashi, Kentaro; Nagayama, Masataka; Kaneko, Haruka

    2008-12-01

    The natural history of osteonecrosis of the femoral head is generally thought to be one of progressive deterioration if no intervention is undertaken. However, it is unknown whether surgical intervention is beneficial for patients with a small region of osteonecrosis. We observed rapid improvement of MRI findings after rotational acetabular osteotomy (RAO) was performed in a young patient with osteonecrosis of the femoral head. The band-like low signal area on T2-weighted images almost resolved by six months after surgery. He returned to work as an electrician by six months after surgery. Early surgical intervention such as RAO that alters the mechanical force acting on the necrotic region of the femoral head may accelerate the recovery of osteonecrosis and the improvement of symptoms. PMID:19384490

  1. Retained Sponge: A Rare Complication in Acetabular Osteosinthesis

    PubMed Central

    Chana-Rodríguez, Francisco; Mañanes, Rubén Pérez; Rojo-Manaute, José; Moran-Blanco, Luz María; Vaquero-Martín, Javier

    2015-01-01

    Retained sponges after a surgical treatment of polytrauma may cause a broad spectrum of clinical symptoms and present a difficult diagnostic problem. We report a case of retained surgical sponge in a 35-year-old man transferred from another hospital, that sustained a open acetabular fracture. The fracture was reduced through a limited ilio-inguinal approach. After 4 days, he presented massive wound dehiscence of the surgical approach. An abdominal CT scan showed, lying adjacent to the outer aspect of the left iliac crest, a mass of 10 cm, identified as probable foreign body. The possibility of this rare complication should be in the differential diagnosis of any postoperative patient who presents with pain, infection, or palpable mass. PMID:26312116

  2. Hip Arthroscopy in the Presence of Acetabular Dysplasia

    PubMed Central

    Jayasekera, Narlaka; Aprato, Alessandro; Villar, Richard N

    2015-01-01

    Purpose : Hip arthroscopy is a well established therapeutic intervention for an increasing number of painful hip conditions. Developmental dysplasia of the hip (DDH) is commonly associated with intra-articular hip pathology. However, some surgeons perceive patients with hip dysplasia as poor candidates for hip arthroscopy. Our aim was to describe early outcomes of arthroscopic treatment for patients with DDH, who also had femoroacetabular impingement (FAI) treated when necessary, and to compare these outcomes against a control group of patients without DDH. Methods : Prospective case-control study of 68 consecutive hip arthroscopy patients assessed with a modified Harris Hip Score (mHHS) preoperatively and at six weeks, six months, and one year after surgery. Presence of DDH was determined using a standard anteroposterior (AP) pelvic radiograph to measure the centre-edge angle (CEA) of Wiberg, with a CEA < 20º used as threshold for diagnosis of DDH. Results : 12 patients (eight female and four male) with acetabular dysplasia and mean CEA of 15.4º (9º to 19º). The control, nondysplastic group comprised 54 patients (23 females and 31 males) with a mean CEA of 33.1º (22º to 45º). All patients in the dysplastic group had a labral tear and 11 (91.7%) had associated femoral cam impingement lesion addressed at arthroscopy. Our study demonstrates a significant (p=0.02) improvement in outcome in the dysplastic group at one year using the mHHS. Conclusion : Hip arthroscopy in the presence of DDH is effective in relieving pain for at least one year after surgery although does not address underlying acetabular abnormality. PMID:26069512

  3. A histological study of retrieved Cambridge acetabular components.

    PubMed

    Brooks, Roger A; Field, Richard E; Jones, Eric; Sood, Asheesh; Rushton, Neil

    2010-01-01

    A new uncemented acetabular component, the Cambridge cup, has been designed to mimic the anatomy and physiology of subchondral bone in order to minimise stress shielding and enhance long-term component stability. Cambridge cups were implanted in a cohort of 50 women who presented with displaced sub-capital fracture of the femoral neck. The cups were manufactured with an hydroxyapatite (HA) coating. Twenty six cups were implanted after removal of the HA. Twelve Cambridge cups were retrieved post-mortem between two and 84 months after implantation. Histological and histomorphometric testing was undertaken to analyse the residual HA coating thickness, bone apposition to the implant surface and particulate wear debris in the surrounding tissues. The HA-coated implants showed significantly greater bone apposition to the implant surface with significantly less fibrous tissue formation than the uncoated implants. Where HA resorption occurred, bone and bone marrow was seen adjacent to the implant. Excessive wear of the ultra high molecular weight polyethylene liner was not seen. The HA-coated components demonstrated good initial bone implant bonding and the flexible carbon polymer appeared to maintain stability following HA resorption. The uncoated implants showed little or no bony apposition but had a fibrous membrane apposed to the implant surface. This may be explained by a combination of micro-motion at the bone implant interface and having a component surface finish that was poorly suited to osseous attachment. Hydroxyapatite coated acetabular components can provide reliable osseous attachment. Subsequent HA resorption need not compromise medium-term osseous fixation to an appropriate implant surface. PMID:20235075

  4. About Calcium Phosphate Cements (CPC)

    NASA Astrophysics Data System (ADS)

    Piñera, Silvia; Piña, Cristina

    2006-09-01

    Calcium phosphate cements (CPC) are used in orthopaedic surgery as bone substitution and fixation of metallic implants, showing advantages with respect to other materials like polymeric cements or ceramic blocks also used for bone repair. For example, they are easy to shape and fill bone defects, react at low temperature and their setting product is hydroxyapatite, mineral from it's composed the inorganic part of the bone, resulting a bioabsorbable material that can be replaced by new bone. Nevertheless there are still some complications like their low absorption rate, inyectability, setting times and their low strength that limits their use to only non load bearing applications. In this work we present a brief resume of some investigations that has been proposed to solve some of these problems, like the addition of phosphates solutions or seeds to increase the reaction rate, or fibers and hard particles to produce a composite material.

  5. Quantitative Computerized Assessment of the Degree of Acetabular Bone Deficiency: Total radial Acetabular Bone Loss (TrABL).

    PubMed

    Gelaude, Frederik; Clijmans, Tim; Delport, Hendrik

    2011-01-01

    A novel quantitative, computerized, and, therefore, highly objective method is presented to assess the degree of total radical acetabular bone loss. The method, which is abbreviated to "TrABL", makes use of advanced 3D CT-based image processing and effective 3D anatomical reconstruction methodology. The output data consist of a ratio and a graph, which can both be used for direct comparison between specimens. A first dataset of twelve highly deficient hemipelves, mainly Paprosky types IIIB, is used as illustration. Although generalization of the findings will require further investigation on a larger population, it can be assumed that the presented method has the potential to facilitate the preoperative use of existing classifications and related decision schemes for treatment selection in complex revision cases. PMID:22013539

  6. Stress shielding in bone of a bone-cement interface.

    PubMed

    Zhang, Qing-Hang; Cossey, Andrew; Tong, Jie

    2016-04-01

    Cementation is one of the main fixation methods used in joint replacement surgeries such as Total Knee Replacement (TKR). This work was prompted by a recent retrieval study, which shows losses up to 75% of the bone stock at the bone-cement interface ten years post TKR. It aims to examine the effects of cementation on the stress shielding of the interfacing bone, when the influence of an implant is removed. A micromechanics finite element study of a generic bone-cement interface is presented here, where bone elements in the partially and the fully interdigitated regions were evaluated under selected load cases. The results revealed significant stress shielding effect in the bone of all bone-cement interface regions, particularly in fully interdigitated region. This finding may be useful in the studies of implant fixation and other related orthopedic treatment strategies. PMID:26904919

  7. Utilization of waste glass in ECO-cement: Strength properties and microstructural observations

    SciTech Connect

    Sobolev, Konstantin Tuerker, Pelin; Soboleva, Svetlana; Iscioglu, Gunsel

    2007-07-01

    Waste glass creates a serious environmental problem, mainly because of the inconsistency of the waste glass streams. The use of waste glass as a finely ground mineral additive (FGMA) in cement is a promising direction for recycling. Based on the method of mechano-chemical activation, a new group of ECO-cements was developed. In ECO-cement, relatively large amounts (up to 70%) of portland cement clinker can be replaced with waste glass. This report examines the effect of waste glass on the microstructure and strength of ECO-cement based materials. Scanning electron microscopy (SEM) investigations were used to observe the changes in the cement hydrates and interface between the cement matrix and waste glass particles. According to the research results, the developed ECO-cement with 50% of waste glass possessed compressive strength properties at a level similar to normal portland cement.

  8. ULTRA-LIGHTWEIGHT CEMENT

    SciTech Connect

    Fred Sabins

    2003-10-31

    The objective of this project is to develop an improved ultra- lightweight cement using ultra-lightweight hollow glass spheres (ULHS). This report discusses testing that was performed for analyzing the alkali-silica reactivity of ULHS in cement slurries.

  9. The contemporary cement cycle of the United States

    USGS Publications Warehouse

    Kapur, A.; Van Oss, H. G.; Keoleian, G.; Kesler, S.E.; Kendall, A.

    2009-01-01

    A country-level stock and flow model for cement, an important construction material, was developed based on a material flow analysis framework. Using this model, the contemporary cement cycle of the United States was constructed by analyzing production, import, and export data for different stages of the cement cycle. The United States currently supplies approximately 80% of its cement consumption through domestic production and the rest is imported. The average annual net addition of in-use new cement stock over the period 2000-2004 was approximately 83 million metric tons and amounts to 2.3 tons per capita of concrete. Nonfuel carbon dioxide emissions (42 million metric tons per year) from the calcination phase of cement manufacture account for 62% of the total 68 million tons per year of cement production residues. The end-of-life cement discards are estimated to be 33 million metric tons per year, of which between 30% and 80% is recycled. A significant portion of the infrastructure in the United States is reaching the end of its useful life and will need to be replaced or rehabilitated; this could require far more cement than might be expected from economic forecasts of demand for cement. ?? 2009 Springer Japan.

  10. Radiopacity in bone cements using an organo-bismuth compound.

    PubMed

    Deb, S; Abdulghani, S; Behiri, J C

    2002-08-01

    In a joint replacement surgery it is vital for bone cement to be radiologically detectable. Consequently, heavy metal salts of barium and zirconia are incorporated as a contrast medium for this purpose. The addition of such particulate additives, however, can be detrimental to some of the physical, mechanical and biological properties. The present study reports the feasibility of using an organo-bismuth compound, namely. triphenyl bismuth (TPB) as a radiopaque agent for orthopaedic bone cements. TPB was incorporated in the bone cement matrix by two methods, (i) blending: TPB was added to the polymer phase of the bone cement and (ii) dissolution: by dissolving TPB in the monomer phase methylmethacrylate. The results showed that the inclusion of TPB at concentrations of 15% and 25% by weight of the polymer, in the bone cement matrix did not affect the polymerisation exotherm temperature and setting time. Furthermore, the addition of TPB via the dissolution method provided a statistically significant increase in the strain to failure in comparison to commercial acrylic cements containing barium sulphate, thus reducing the brittleness of the cement. The detrimental effects on the mechanical properties post conditioning in water, was also much less pronounced in the homogeneous TPB cements in comparison to barium sulphate containing cements. These observations can be attributed to the formation of a homogeneous and continuous matrix of the resultant bone cement with a much lower porosity. PMID:12099281

  11. Surgical exposure and cement removal in revision total hip arthroplasty.

    PubMed

    Mallory, T H

    1992-10-01

    The surgical approach in revision total hip arthroplasty (THA) must conform to the preoperative goals of revision surgery. Factors to be considered include adequate visualization, assessment of remaining bone stock, presence or absence of cement, status of the trochanter, leg length discrepancies, and previous surgical approaches. To maintain neurovascular structures, blood supply to the involved bone, postoperative abductor function, stability, and gait normalcy, an anterolateral approach is best used. Three anterolateral approaches are used to address various aspects of revision THA. Approach 1 allows for exposure of the acetabulum and proximal femur. The associated abductor muscle split allows for excellent proximal exposure. Approach 2 is performed when acetabular reconstruction is neither complex nor involved, and when extended access to the femur is necessary. The lateral-distal incision is determined by the need for adequate femur exposure for implant removal, cement removal, and any bone grafting procedures to reconstitute osseous structures. Approach 3 is further developed proximally to expose necessary anatomic regions of the acetabulum while preserving the underlying neurovascular structures. Using special instrumentation and controlled femoral perforations, cement mantles are quickly removed, minimizing damage to the bone and preserving the osseous structures. For all three approaches, abductor muscle separation repair and/or reattachment is performed with a heavy, no. 5, nonabsorbable suture. Postoperative patient management depends on the degree of dissection and extent of reconstruction. PMID:10147935

  12. Shoulder replacement

    MedlinePlus

    ... the opening at the end of the shoulder blade, called the socket. This type of joint allows ... head. The socket part (glenoid) of your shoulder blade will be replaced with a smooth plastic shell ( ...

  13. Knee Replacement

    MedlinePlus

    ... doctor may recommend it if you have knee pain and medicine and other treatments are not helping you anymore. When you have a total knee replacement, the surgeon removes damaged cartilage and bone ...

  14. ULTRA-LIGHTWEIGHT CEMENT

    SciTech Connect

    Fred Sabins

    2001-04-15

    The objective of this project is to develop an improved ultra-lightweight cement using ultralight hollow glass spheres (ULHS). Work reported herein addresses Task 1: Assess Ultra-Lightweight Cementing Problems and Task 3: Test Ultra-Lightweight Cements. Results reported this quarter include a review and summary of Halliburton Energy Services (HES) and BJ Services historical performance data for lightweight cement applications. These data are analyzed and compared to ULHS cement and foamed cement performances. Similar data is expected from Schlumberger, and an analysis of this data will be completed in the following phases of the project. Quality control testing of materials used to formulate ULHS cements in the laboratory was completed to establish baseline material performance standards. A testing protocol was developed employing standard procedures as well as procedures tailored to evaluate ULHS and foamed cement. This protocol is presented and discussed. Results of further testing of ULHS cements are presented along with an analysis to establish cement performance design criteria to be used during the remainder of the project. Finally, a list of relevant literature on lightweight cement performance is compiled for review during the next quarter.

  15. Research synthesis of recommended acetabular cup orientations for total hip arthroplasty.

    PubMed

    Harrison, Claire L; Thomson, Avril I; Cutts, Steven; Rowe, Philip J; Riches, Philip E

    2014-02-01

    Total hip arthroplasty (THA) is regarded as one of the most successful surgical procedures of modern times yet continues to be associated with a small but significant complication rate. Many early failures may be associated with poor component positioning with, in particular, acetabular component orientation dependent on the subjective judgement of the surgeon. In this paper, we compare the manufacturers' instructions on acetabular cup orientation with the literature-based recommended safety zones and surgical technique, by transforming them onto a single, clinically-relevant framework in which the different reference systems, safety guidelines and current instrumentation surgical techniques can be evaluated. The observed limited consensus between results reflects ongoing uncertainty regarding the optimum acetabular component positioning. As malpositioning of the acetabular cup increases the risk of revision surgery, any ambiguity over the correct position can have a causal effect. Our analysis highlights the need for a surgical reference system which can be used to describe the position of the acetabular cup intra-operatively. PMID:23958234

  16. Management of an Open Acetabular Fracture in a Skeletally Immature Patient

    PubMed Central

    Clutter, Sarah Y; Morgan, Steven J; Erickson, Mark; Smith, Wade R; Stahel, Philip F

    2007-01-01

    Background: Open acetabular fractures in children are rare, but potentially devastating injuries. Secondary to the low incidence, there is an apparent lack of reports on appropriate management strategies for open pediatric acetabular fractures in the literature. Methods: Description of a case study. Results: A 3 years and ten months-old girl was ejected as a passenger from an all terrain vehicle. She sustained a displaced, grade IIIA open left anterior column acetabular fracture. The injury was treated by extending the open wound to a formal first window of the ilioinguinal approach. After surgical debridement, the anterior column was reduced anatomically and fixed by two lag screws which avoided the tri-radiate cartilage. A vaginal laceration was debrided and repaired. The patient was treated in a spica cast without weight bearing on the left lower extremity for 8 weeks. No perioperative complications occurred. The acetabular fracture healed in an anatomic position within 8 weeks. To avoid premature closure of the tri-radiate cartilage, the patient underwent a physeal bar resection at one year after injury. At two-year follow up, she was walking and running without pain and had a free range of motion of her left hip. Conclusions: Operative management should represent the therapy of choice for open, displaced pediatric acetabular fractures. After fracture healing, a scheduled physeal bar resection may be required for injuries which involve the tri-radiate cartilage. PMID:19461903

  17. Radiological evaluation of acetabular erosion after antibiotic-impregnated polymethylmethacrylate spacer (Spacer-G).

    PubMed

    García-Oltra, Ester; Bori, Guillem; Tomas, Xavier; Gallart, Xavier; Garcia, Sebastian; Soriano, Alex

    2013-06-01

    Different types of hip spacers have been described (hand-made, custom-molded or prefabricated) for treatment of a chronic hip infection. A potential disadvantage of monoblock prefabricated spacer is that it may cause acetabular bone loss. This study assesses the radiological acetabular erosion using an antibiotic-impregnated pre-fabricated polymethylmethacrylate Spacer-G. We retrospectively reviewed the radiographs of thirty five patients who were managed with Spacer-G to treat chronic hip infection. No acetabular erosion were observed in thirty two patients with a mean time from the first to second stage and from the first to the last radiograph of 5.09 and 3.77 months respectively. In three patients the time between the radiographs was more than one year and the second stage was not performed; two developed a protrusion acetabuli whereas the other one a destruction of the acetabular roof. Using a Spacer-G in chronic hip infection treatment for less than one year is not associated with radiological acetabular erosion if the patient is maintained at partial weight bearing. PMID:23142448

  18. Morphometric assessment of the canine hip joint using the acetabular angle of retrotorsion.

    PubMed

    Doskarova, B; Kyllar, M; Paral, V

    2010-01-01

    Morphometric assessment of the canine hip joint using acetabular angle of retrotorsion was used in this study. The aim of our study was to compare the acetabular angle of retrotorsion (AAR) with values of the Norberg angle (NA) and the hip score (HS) in the Leonberger dog breed and to determine the cut-off point of AAR that distinguish between normal and dysplastic hip status on the basis of Fédération Cynologique Internationale (FCI) hip evaluation. Retrospective analysis of NA and AAR was measured from standard ventrodorsal pelvic radiographs with extended femurs in 387 Leonberger dogs (141 males and 246 females) from 18 to 63 months of age, which were then divided into five age-groups. Through analysis of these radiographs, it was determined that the cut-off point for NA was 105°, AAR was 15°, and the acetabular angle of retrotorsion was positively correlated with Norberg angle and negatively correlated with hip score. The results of our study indicate that the acetabular angle of retrotorsion may represent a reliable morphometric assessment tool in evaluating acetabular cup conformation, and values of AAR may help to assess the FCI grade of canine hip dysplasia. PMID:20740259

  19. Acetabular rim and surface segmentation for hip surgery planning and dysplasia evaluation

    NASA Astrophysics Data System (ADS)

    Tan, Sovira; Yao, Jianhua; Yao, Lawrence; Summers, Ronald M.; Ward, Michael M.

    2008-03-01

    Knowledge of the acetabular rim and surface can be invaluable for hip surgery planning and dysplasia evaluation. The acetabular rim can also be used as a landmark for registration purposes. At the present time acetabular features are mostly extracted manually at great cost of time and human labor. Using a recent level set algorithm that can evolve on the surface of a 3D object represented by a triangular mesh we automatically extracted rims and surfaces of acetabulae. The level set is guided by curvature features on the mesh. It can segment portions of a surface that are bounded by a line of extremal curvature (ridgeline or crestline). The rim of the acetabulum is such an extremal curvature line. Our material consists of eight hemi-pelvis surfaces. The algorithm is initiated by putting a small circle (level set seed) at the center of the acetabular surface. Because this surface distinctively has the form of a cup we were able to use the Shape Index feature to automatically extract an approximate center. The circle then expands and deforms so as to take the shape of the acetabular rim. The results were visually inspected. Only minor errors were detected. The algorithm also proved to be robust. Seed placement was satisfactory for the eight hemi-pelvis surfaces without changing any parameters. For the level set evolution we were able to use a single set of parameters for seven out of eight surfaces.

  20. Magnesia-Based Cements: A Journey of 150 Years, and Cements for the Future?

    PubMed

    Walling, Sam A; Provis, John L

    2016-04-13

    This review examines the detailed chemical insights that have been generated through 150 years of work worldwide on magnesium-based inorganic cements, with a focus on both scientific and patent literature. Magnesium carbonate, phosphate, silicate-hydrate, and oxysalt (both chloride and sulfate) cements are all assessed. Many such cements are ideally suited to specialist applications in precast construction, road repair, and other fields including nuclear waste immobilization. The majority of MgO-based cements are more costly to produce than Portland cement because of the relatively high cost of reactive sources of MgO and do not have a sufficiently high internal pH to passivate mild steel reinforcing bars. This precludes MgO-based cements from providing a large-scale replacement for Portland cement in the production of steel-reinforced concretes for civil engineering applications, despite the potential for CO2 emissions reductions offered by some such systems. Nonetheless, in uses that do not require steel reinforcement, and in locations where the MgO can be sourced at a competitive price, a detailed understanding of these systems enables their specification, design, and selection as advanced engineering materials with a strongly defined chemical basis. PMID:27002788

  1. ULTRA-LIGHTWEIGHT CEMENT

    SciTech Connect

    Fred Sabins

    2001-07-18

    The objective of this project is to develop an improved ultra-lightweight cement using ultra-lightweight hollow glass spheres (ULHS). Work reported herein addresses Task 1: Assess Ultra-Lightweight Cementing Issues, Task 2: Review Russian Ultra-Lightweight Cement Literature, Task 3: Test Ultra-Lightweight Cements, and Task 8: Develop Field ULHS Cement Blending and Mixing Techniques. Results reported this quarter include: preliminary findings from a literature review focusing on problems associated with ultra-lightweight cements; summary of pertinent information from Russian ultra-lightweight cement literature review; laboratory tests comparing ULHS slurries to foamed slurries and sodium silicate slurries for two different applications; and initial laboratory studies with ULHS in preparation for a field job.

  2. ULTRA-LIGHTWEIGHT CEMENT

    SciTech Connect

    Fred Sabins

    2002-04-29

    The objective of this project is to develop an improved ultra-lightweight cement using ultra-lightweight hollow glass spheres (ULHS). This report includes results from laboratory testing of ULHS systems along with other lightweight cement systems, including foamed and sodium silicate slurries. During this project quarter, comparison studies of the three cement systems examined several properties: tensile strength, Young's modulus, and shear bond. Testing to determine the effect of temperature cycling on the shear bond properties of the cement systems was also conducted. In addition, the stress-strain behavior of the cement types was studied. This report discusses a software program that is being developed to help design ULHS cements and foamed cements.

  3. ULTRA-LIGHTWEIGHT CEMENT

    SciTech Connect

    Fred Sabins

    2002-10-31

    The objective of this project is to develop an improved ultra-lightweight cement using ultra-lightweight hollow glass spheres (ULHS). This report includes results from laboratory testing of ULHS systems along with other lightweight cement systems, including foamed and sodium silicate slurries. During this project quarter, a comparison study of the three cement systems examined the effect that cement drillout has on the three cement systems. Testing to determine the effect of pressure cycling on the shear bond properties of the cement systems was also conducted. This report discusses testing that will be performed for analyzing the alkali-silica reactivity of ULHS in cement slurries, as well as the results of Field Tests 1 and 2.

  4. Acetabular cup liner and prosthetic head exchange to increase the head diameter for management of recurrent luxation of a prosthetic hip in two dogs.

    PubMed

    Roe, S C; Sidebotham, C; Marcellin-Little, D J

    2015-01-01

    Component malalignment and impingement are possible causes of recurrent luxation following total hip replacement in the dog. In the two cases presented in this report, luxation that was probably due to impingement was managed by exchanging the standard 17 mm prosthetic head for a 24 mm prosthetic head. This required removal of the original acetabular cup liner and placement of a new polyethylene liner that would accept the 24 mm head into the stable acetabular shell. In the first case, a 50 kg Malamute dog, recurrent luxation was initially managed by component alignment revision, iliofemoral suture, triple pelvic osteotomy and a novel lasso technique, without long-term success. After exchanging the head and cup liner, luxation did not recur over a 12-month period. In the second case, a 65 kg Newfoundland dog, impingement was suspected after a second luxation event. Luxation did not recur during the nine months after exchange of the head and cup liner. The larger prosthetic head used in these two cases increased the impingement-free range-of-motion of the joint and increased the translation distance required for luxation (jump distance). PMID:25448927

  5. The effect of acetabular cup size on the short-term stability of revision hip arthroplasty: a finite element investigation.

    PubMed

    Phillips, A T M; Pankaj; Usmani, A S; Howie, C R

    2004-01-01

    The study uses idealized two-dimensional finite element models to examine the behaviour of the acetabular construct following revision hip arthroplasty, carried out using the Slooff-Ling impaction grafting technique. The behaviour of bone graft was considered in detail, with non-linear elasticity and non-associated plasticity being adopted. Load was applied to the acetabular construct through a femoral head using smooth sliding surfaces. In particular, four models were subjected to two idealized cyclic load cases to investigate the effect of acetabular cup size on the short-term stability of the acetabular construct. The study suggests that benefits may be gained by using the largest practical size of acetabular cup. PMID:15376726

  6. Midterm survivorship of a press-fit, plasma-sprayed, tri-spike acetabular component.

    PubMed

    Klaassen, Mark A; Martínez-Villalobos, Mario; Pietrzak, William S; Mangino, Gerardo P; Guzman, Delfino Carranza

    2009-04-01

    Press-fit acetabular cups without screw holes can limit migration of particulate wear debris and reduce risk of acetabular osteolysis and device loosening. The Tri-Spike cup (Biomet, Inc, Warsaw, Ind) includes a titanium alloy plasma spray porous surface and does not require screw fixation. We retrospectively examined the incidence of cup loosening and acetabular osteolysis after implantation of 45 cups (44 patients) with mean follow-up of 7.3 years (range, 4-9 years). Only one patient (one cup) had evidence of less than 1 mm of retroacetabular radiolucency at 3 years (nonprogressive), which was found to remain firmly fixed during revision of the aseptically loosened femoral component. No cups were removed or revised at latest follow-up. Projected Kaplan-Meier survivorship at 9 years was 100% for cup loosening/revision and 97.8% for radiolucency. PMID:18534453

  7. Biomechanical Analysis of the Fixation System for T-Shaped Acetabular Fracture

    PubMed Central

    Fan, Yanping; Lei, Jianyin; Zhu, Feng; Li, Zhiqiang; Chen, Weiyi; Liu, Ximing

    2015-01-01

    This study aims to evaluate the biomechanical mechanism of fixation systems in the most frequent T-shaped acetabular fracture using finite element method. The treatment of acetabular fractures was based on extensive clinical experience. Three commonly accepted rigid fixation methods (double column reconstruction plates (P × 2), anterior column plate combined with posterior column screws (P + PS), and anterior column plate combined with quadrilateral area screws (P + QS)) were chosen for evaluation. On the basis of the finite element model, the biomechanics of these fixation systems were assessed through effective stiffness levels, stress distributions, force transfers, and displacements along the fracture lines. All three fixation systems can be used to obtain effective functional outcomes. The third fixation system (P + QS) was the optimal method for T-shaped acetabular fracture. This fixation system may reduce many of the risks and limitations associated with other fixation systems. PMID:26495030

  8. Effect of Metakaolin on Strength and Efflorescence Quantity of Cement-Based Composites

    PubMed Central

    Weng, Tsai-Lung; Lin, Wei-Ting; Cheng, An

    2013-01-01

    This study investigated the basic mechanical and microscopic properties of cement produced with metakaolin and quantified the production of residual white efflorescence. Cement mortar was produced at various replacement ratios of metakaolin (0, 5, 10, 15, 20, and 25% by weight of cement) and exposed to various environments. Compressive strength and efflorescence quantify (using Matrix Laboratory image analysis and the curettage method), scanning electron microscopy, and X-ray diffraction analysis were reported in this study. Specimens with metakaolin as a replacement for Portland cement present higher compressive strength and greater resistance to efflorescence; however, the addition of more than 20% metakaolin has a detrimental effect on strength and efflorescence. This may be explained by the microstructure and hydration products. The quantity of efflorescence determined using MATLAB image analysis is close to the result obtained using the curettage method. The results demonstrate the best effectiveness of replacing Portland cement with metakaolin at a 15% replacement ratio by weight. PMID:23737719

  9. Patient-specific acetabular shape modelling: comparison among sphere, ellipsoid and conchoid parameterisations.

    PubMed

    Cerveri, Pietro; Manzotti, Alfonso; Baroni, Guido

    2014-04-01

    The shape of the human acetabular cup was commonly represented as a hemisphere, but different geometries and patient-specific shapes have been recently proposed in the literature. Our aim was to test the limits of the sphericity assumption by comparing three different parameterisations, namely the sphere, the ellipsoid and the rotational conchoid. Models of hip surfaces, reconstructed from CT scans taken from Caucasian race cadavers and patients, were automatically processed to extract the acetabular surface. Two separate analyses were carried out on the overall acetabular shape, including both the acetabular fossa and the lunate surface (case A) and acetabular cup represented by the lunate surface only (case B). Nonlinear gradient-based and evolutionary computation approaches were implemented for the fitting process. Minor differences from the three idealised geometries were detected (median values of the fitting errors < 1 mm). Nonetheless, the sphere fitting was found to be statistically different from both the ellipsoid (p < 2.50e - 10) and the conchoid (p < 1.07e - 09), whereas no statistical difference was detected between the ellipsoid and the conchoid for case A. Significance of the difference between ellipsoid and sphere (p < 4.55e - 12) and between conchoid and sphere (p < 1.93e - 11) was found for case B as well. Interestingly, for case B statistical difference was detected between the ellipsoid and the conchoid. In conclusion, we synthesise that the morphology of the overall acetabular cup can be parameterised both with an ellipsoid shape and with a conchoid shape as well with superior quality than the simple sphere. Differently, if one considers just the lunate surface, better fitting results are expected when using the ellipsoid. PMID:22789071

  10. [Acetabular fractures in the elderly. Outcome of open reduction and internal fixation].

    PubMed

    Tosounidis, G; Culemann, U; Bauer, M; Holstein, J H; Garcia, P; Kurowski, R; Pizanis, A; Aghayev, E; Pohlemann, T

    2011-08-01

    The aim of this study was to analyze the clinical outcome and incidence of hip arthritis in elderly patients with acetabular fractures. Because of poor bone quality in the elderly, even a low-energy trauma may lead to an acetabular fracture. An anatomical reconstruction of the acetabulum is necessary to achieve sufficient stability also for a potential hip arthroplasty. So far, there is very limited information on the outcome of acetabular fractures in the elderly. During a period of 6 years (2001-2006), 48 patients older than 60 years were admitted to our department with an acetabular fracture. Thirty-nine patients were treated operatively and nine patients non-operatively. Twenty-nine operatively treated patients were followed up. Nineteen of them were assessed using EQ-5D, SF-12 and Merle d'Aubigné questionnaires in addition to their clinical examination. Ten other surgical patients were only examined using the questionnaires. Of the 29 patients that were followed up, 5 underwent total hip arthroplasty due to secondary post-traumatic hip arthritis after open reduction and internal fixation (ORIF). The range of motion of the operated hip was comparable to that of the non-operated contralateral side. However, the internal rotation was found to be slightly decreased at the operated side when compared to the non-operated contralateral side. Merle d'Aubigné score and physical and mental SF-12 score components as well as quality of life were better in patients treated with ORIF compared to those patients that were treated by secondary hip arthroplasty. Regarding the different treatment strategies (ORIF vs primary hip arthroplasty vs non-operative treatment) of acetabular fractures in the elderly, data from the literature are conflicting. Our results indicate that ORIF represents a good treatment option for acetabular fractures in the elderly. In patients that did not develop secondary hip arthritis, a good clinical outcome and quality of life was documented. PMID

  11. Methods and Guidelines for Venous Thromboembolism Prevention in Polytrauma Patients with Pelvic and Acetabular Fractures

    PubMed Central

    Chana-Rodríguez, Francisco; Mañanes, Rubén Pérez; Rojo-Manaute, José; Haro, José Antonio Calvo; Vaquero-Martín, Javier

    2015-01-01

    Sequential compression devices and chemical prophylaxis are the standard venous thromboembolism (VTE) prevention for trauma patients with acetabular and pelvic fractures. Current chemical pharmacological contemplates the use of heparins or fondaparinux. Other anticoagulants include coumarins and aspirin, however these oral agents can be challenging to administer and may need monitoring. When contraindications to anticoagulation in high-risk patients are present, prophylactic inferior vena cava filters can be an option to prevent pulmonary emboli. Unfortunately strong evidence about the most effective method, and the timing of their commencement, in patients with pelvic and acetabular fractures remains controversial. PMID:26312115

  12. Acetabular labral tears: focused review of anatomy, diagnosis, and current management.

    PubMed

    Huang, Ronald; Diaz, Claudio; Parvizi, Javad

    2012-05-01

    Acetabular labral tears have become an increasingly common diagnosis with the advancement of imaging techniques and hip arthroscopy. Therefore, understanding the anatomic significance, healing potential, and associated pathologies of labral tears is helpful. Furthermore, recognizing the clinical picture and understanding appropriate imaging techniques, such as magnetic resonance arthrography, are essential to making a correct diagnosis. This article reviews the relevant anatomy, diagnosis, and management of acetabular labral tears for physicians of all specialties who may be involved in the care of patients with labral tears. Short-term results of labral repair have been promising, but further studies are needed to clarify appropriate indications and long-term results of treatment. PMID:22759609

  13. Abyssal seep site cementation

    SciTech Connect

    Neumann, A.C.; Paull, C.K.; Commeau, R.; Commeau, J.

    1988-01-01

    The deepest submarine cements known so far occur along the 3,300-m deep base of the Florida escarpment and are associated with methane-bearing brine seeps, which emanate there. These deep Holocene carbonates, which occur as surficial and buried crusts, burrow fillings, and friable horizons, were sampled via ALVIN. The carbonates form irregular halos extending up to 20 m from seeps colonized by chemosynthetic fauna. Mussels, gastropods, and clams, the carbonate components of the community, produce a shell hash that is locally cemented by coarsely crystalline low-Mg calcite. Halos of palisade calcite are reminiscent of ancient examples of marine cements. Also present are carbonate hemipelagics cemented by micrite into crusts and burrow fillings. The degree of cementation varies from pervasive to light. Slabs of cemented crust up to 30 cm thick contrast with typical shallow crusts and exhibit irregular tops and smooth bottoms indicating different chemical gradients and pathways.

  14. ULTRA-LIGHTWEIGHT CEMENT

    SciTech Connect

    Fred Sabins

    2003-01-31

    The objective of this project is to develop an improved ultra-lightweight cement using ultra-lightweight hollow glass spheres (ULHS). This report discusses testing that was performed for analyzing the alkali-silica reactivity of ULHS in cement slurries. DOE joined the Materials Management Service (MMS)-sponsored joint industry project ''Long-Term Integrity of Deepwater Cement under Stress/Compaction Conditions.'' Results of the project contained in two progress reports are also presented in this report.

  15. Pain Palliation by Percutaneous Acetabular Osteoplasty for Metastatic Hepatocellular Carcinoma

    SciTech Connect

    Hokotate, Hirofumi; Baba, Yasutaka; Churei, Hisahiko; Nakajo, Masayuki; Ohkubo, Kouichi; Hamada, Kenji

    2001-09-15

    A 68-year-old man with hepatocellular carcinoma and known skeletal metastasis developed right hip pain and gait disturbance due to an osteolytic metastasis in the right acetabulum. This was treated initially with chemoembolization and radiation therapy. When these procedures proved unsuccessful percutaneous injection of acrylic bone cement into the acetabulum was undertaken. Immediately after this procedure, he obtained sufficient pain relief and improved walking ability, which continued for 3 months until he died of hepatic insufficiency.

  16. Biomechanical Study of Acetabular Tridimensional Memoryalloy Fixation System

    NASA Astrophysics Data System (ADS)

    Liu, Xin-Wei; Xu, Shuo-Gui; Zhang, Yun-Tong; Zhang, Chun-Cai

    2011-07-01

    We developed the acetabular tridimensional memoryalloy fixation system (ATMFS), which is made of NiTi shape memory alloy, according to the specific mechanical properties of biological memory material, NiTi shape memory alloy and measured distribution of contact area and pressure between the acetabulum and the femoral head of cadaveric pelvis. Seven formalin-preserved cadaveric pelves were used for this investigation. Pressure-sensitive film was used to measure contact area and pressure within the anterior, superior, and posterior regions of the acetabulum. The pelves were loaded under the following four conditions: (1) intact; (2) following a creation posterior wall fracture defect; (3) following reduction and standard internal fixation with reconstruction plate; and (4) following reduction and internal fixation with a new shape memory alloy device named ATMFS. A posterior wall fracture was created along an arc of 40° to 90° about the acetabulur rim. Creation of a posterior wall defect resulted in increased load in the superior acetabulum (1485 N) as compared to the intact condition (748 N, P = 0.009). Following reduction and internal fixation, the load distributed to the superior acetabulum (1545 N) was not statistically different from the defect condition. Following the fixation with ATMFS, the load seen at the superior region of the actabulum (964 N) was familiar with fixation with reconstruction plate and was not different from intact state ( P = 0.45). These data indicate that the use of ATMFS as a fracture internal fixation device resulted a partial restoration of joint loading parameters toward the intact state. ATMFS fixation may result in a clinical benefit.

  17. Cements from nanocrystalline hydroxyapatite.

    PubMed

    Barralet, J E; Lilley, K J; Grover, L M; Farrar, D F; Ansell, C; Gbureck, U

    2004-04-01

    Calcium phosphate cements are used as bone substitute materials because they may be moulded to fill a void or defect in bone and are osteoconductive. Although apatite cements are stronger than brushite cements, they are potentially less resorbable in vivo. Brushite cements are three-component systems whereby phosphate ions and water react with a soluble calcium phosphate to form brushite (CaHPO4 x 2H2O). Previously reported brushite cement formulations set following the mixture of a calcium phosphate, such as beta-tricalcium phosphate (beta-TCP), with an acidic component such as H3PO4 or monocalcium phosphate monohydrate (MCPM). Due to its low solubility, hydroxyapatite (HA) is yet to be reported as a reactive component in calcium phosphate cement systems. Here we report a new cement system setting to form a matrix consisting predominantly of brushite following the mixture of phosphoric acid with nanocrystalline HA. As a result of the relative ease with which ionic substitutions may be made in apatite this route may offer a novel way to control cement composition or setting characteristics. Since kinetic solubility is dependent on particle size and precipitation temperature is known to affect precipitated HA crystal size, the phase composition and mechanical properties of cements made from HA precipitated at temperatures between 4 and 60 degrees C were investigated. PMID:15332608

  18. Shoulder replacement - discharge

    MedlinePlus

    Total shoulder arthroplasty - discharge; Endoprosthetic shoulder replacement - discharge; Partial shoulder replacement - discharge; Partial shoulder arthroplasty - discharge; Replacement - shoulder - discharge; ...

  19. Reuse of fresh water sludge in cement making.

    PubMed

    Pan, R; Huang, C; Lin, S

    2004-01-01

    With the increasing demand for high quality water, a large quantity of chemical agent must be added in the water purification process, which in turn generates enormous amount of fresh water sludge. Of all the options for sludge disposal, sludge reuse has been considered most economical and environmentally sound. This study evaluated the possibility of incorporating fresh water sludge in the making of Portland cement through the sintering process. The goal was to search for the optimal condition to maximize the replacement of clay with the fresh water sludge. Characteristics of fresh water sludge were collected and analyzed. The analysis showed that water source and water treatment process dominate th characteristics, particularly the chemical composition of the fresh water sludge. The fresh water sludge was mixed with the cement clay in various percentages, from 0% to 100%, as raw material for cement-making. The effects of its addition on the sintering condition and the quality of cement were evaluated. The analysis of the clinkers showed that the addition of the fresh water sludge did not change the phase form and the f-CaO content of the cement. The compressive strength of the masonry increased with the increasing addition of fresh water sludge. All cement products made from various replacement ratios met the Chinese National Standard of first degree Portland cement. PMID:15581011

  20. Uncemented acetabular components with femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip: a concise follow-up report at a mean of twenty years.

    PubMed

    Abdel, Matthew P; Stryker, Louis S; Trousdale, Robert T; Berry, Daniel J; Cabanela, Miguel E

    2014-11-19

    We previously reported the five to twelve-year results of total hip arthroplasty with an uncemented acetabular component and an autogenous femoral head graft in forty-four consecutive hips with developmental dysplasia. The goal of the present study was to report the implant survival rate, status of bone grafts, and clinical outcomes in thirty-five of these hips (in twenty-nine patients) followed for a mean of 21.3 years. Functional, radiographic, and survivorship results were examined. Radiographic analysis revealed an average cup inclination angle of 43° and a mean arc of cup coverage by the graft of 30°. The twenty-year survivorship free from acetabular revision was 66% (twelve acetabular revisions; eight since our previous report). Of the twelve revisions, nine were for liner wear and/or osteolysis, one was for a liner fracture, one was for aseptic loosening, and one was for instability. All bone grafts healed to the pelvis. The graft facilitated revision cup placement as no additional structural grafts or metal augments were required. We concluded that an uncemented porous-coated socket used in conjunction with a bulk femoral head autograft provides good long-term fixation and restores bone stock. PMID:25410505

  1. Accuracy and Precision of Three-Dimensional Low Dose CT Compared to Standard RSA in Acetabular Cups: An Experimental Study.

    PubMed

    Brodén, Cyrus; Olivecrona, Henrik; Maguire, Gerald Q; Noz, Marilyn E; Zeleznik, Michael P; Sköldenberg, Olof

    2016-01-01

    Background and Purpose. The gold standard for detection of implant wear and migration is currently radiostereometry (RSA). The purpose of this study is to compare a three-dimensional computed tomography technique (3D CT) to standard RSA as an alternative technique for measuring migration of acetabular cups in total hip arthroplasty. Materials and Methods. With tantalum beads, we marked one cemented and one uncemented cup and mounted these on a similarly marked pelvic model. A comparison was made between 3D CT and standard RSA for measuring migration. Twelve repeated stereoradiographs and CT scans with double examinations in each position and gradual migration of the implants were made. Precision and accuracy of the 3D CT were calculated. Results. The accuracy of the 3D CT ranged between 0.07 and 0.32 mm for translations and 0.21 and 0.82° for rotation. The precision ranged between 0.01 and 0.09 mm for translations and 0.06 and 0.29° for rotations, respectively. For standard RSA, the precision ranged between 0.04 and 0.09 mm for translations and 0.08 and 0.32° for rotations, respectively. There was no significant difference in precision between 3D CT and standard RSA. The effective radiation dose of the 3D CT method, comparable to RSA, was estimated to be 0.33 mSv. Interpretation. Low dose 3D CT is a comparable method to standard RSA in an experimental setting. PMID:27478832

  2. Accuracy and Precision of Three-Dimensional Low Dose CT Compared to Standard RSA in Acetabular Cups: An Experimental Study

    PubMed Central

    Olivecrona, Henrik; Maguire, Gerald Q.; Noz, Marilyn E.; Zeleznik, Michael P.

    2016-01-01

    Background and Purpose. The gold standard for detection of implant wear and migration is currently radiostereometry (RSA). The purpose of this study is to compare a three-dimensional computed tomography technique (3D CT) to standard RSA as an alternative technique for measuring migration of acetabular cups in total hip arthroplasty. Materials and Methods. With tantalum beads, we marked one cemented and one uncemented cup and mounted these on a similarly marked pelvic model. A comparison was made between 3D CT and standard RSA for measuring migration. Twelve repeated stereoradiographs and CT scans with double examinations in each position and gradual migration of the implants were made. Precision and accuracy of the 3D CT were calculated. Results. The accuracy of the 3D CT ranged between 0.07 and 0.32 mm for translations and 0.21 and 0.82° for rotation. The precision ranged between 0.01 and 0.09 mm for translations and 0.06 and 0.29° for rotations, respectively. For standard RSA, the precision ranged between 0.04 and 0.09 mm for translations and 0.08 and 0.32° for rotations, respectively. There was no significant difference in precision between 3D CT and standard RSA. The effective radiation dose of the 3D CT method, comparable to RSA, was estimated to be 0.33 mSv. Interpretation. Low dose 3D CT is a comparable method to standard RSA in an experimental setting. PMID:27478832

  3. Catastrophic Failure of the Acetabular Polyethylene Liner in Ceramic-on-Polyethylene Total Hip Arthroplasty

    PubMed Central

    Manzano, Givenchy; Levin, Rayna A. C.; Mayor, Michael B.; Schwarzkopf, Ran

    2014-01-01

    Introduction: Catastrophic polyethylene failure is a rare complication of ceramic-on-polyethylene total hip arthroplasty due to the favorable tribological characteristics of ceramic. Failure of the polyethylene liner can be disastrous, increasing periprosthetic osteolysis, metallosis, and risk of dislocation. Complications associated with ceramic-on-polyethylene articulations have been studied extensively, however, only few reports have described its catastrophic wear. We report such a case of complete wear of the acetabular liner in a ceramic-on-polyethylene prosthesis in a 57-year adult male. Case Report: A 57-year adult male with a history of bilateral total hip arthroplasty presented to our institution with bilateral hip pain worst on the right. Range of motion was limited by pain on the right hip at the extremes of motion. Radiographs revealed severe osteolysis, heterotopic ossification, complete wear of the acetabular liner, bony impingement of the femoral greater trochanter on the acetabular rim and superior migration of the femoral head. All findings were confirmed intraoperatively. Revision of the acetabular components was performed, which successfully alleviated the patient’s symptoms. Conclusion: Failure of the ceramic-on-polyethylene liner in our patient is due to the use of a non-cross linked polyethylene liner, a highly active lifestyle, and poor follow up. Arthroplasty surgeons should be aware of this complication especially in highly active patients with a conventional polyethylene liner and chronic hip pain. PMID:27298960

  4. Effect of acetabular orientation on stress distribution of highly cross-linked polyethylene liners.

    PubMed

    Lam, Luthan; Drew, Timothy; Boscainos, Petros

    2013-11-01

    Several case reports have documented the fracture of highly cross-linked polyethylene (HCLPE) liners used in total hip arthroplasty (THA). Although uncommon, fractured liners result in considerable morbidity for patients and require revision surgery. One postulated mechanism that leads to this type of implant failure is malorientation of the acetabular component. The purpose of this study was to investigate the effect of acetabular orientation on the stress distribution of HCLPE liners used in THA by means of finite element analysis. Three-dimensional models of a commonly used HCLPE liner were created corresponding to 12 different acetabular component orientations (inclination ranging from 20° to 70° and version ranging from 20° of retroversion to 40° of anteversion). A static stress analysis of the finite element models was performed under conditions simulating peak gait loads. The results of the analysis revealed that excessive inclination and extremes of version were associated with an increase in peak stress magnitudes. The locations of peak stress also were found to lie within the rim notch and locking ring groove regions, which were consistent with the fracture locations reported in published case reports. Therefore, the acetabular component should be oriented carefully during implantation to reduce the risk of rim loading and subsequent liner fracture. In addition, an alternative liner design may further help reduce stress risers and risk of fracture. PMID:24200436

  5. Relationship between developmental dislocation of the hip in infant and acetabular dysplasia at skeletal maturity.

    PubMed

    Okano, Kunihiko; Yamaguchi, Kazumasa; Ninomiya, Yoshikazu; Matsubayashi, Shohei; Aoyagi, Kiyoshi; Osaki, Makoto; Enomoto, Hiroshi; Takahashi, Katsuro

    2015-01-01

    Previous reports demonstrated 8-60% patients treated for developmental dislocation of hip (DDH) in infancy have residual acetabular dysplasia (AD) at skeletal maturity. AD patients reportedly exhibit abnormal morphology of the pelvis, high rates of comorbid spinal congenital anomalies and high bone mineral density. These physical findings suggest that AD patients have genetic background. We examined the percentage of AD patients with hip pain at skeletal maturity having a history of DDH in infancy and the correlation between the severity of AD at skeletal maturity and history of DDH treatment to investigate the relationship between AD and DDH.A total of 245 patients were radiographically examined for any history of DDH treatment in infancy. The study included 226 women and 19 men with a mean age at examination of 40.7 years (range 17-59 years).Eighty-eight patients (36%) had a history of DDH treatment (DDH group) and the remaining 157 patients (64%) had no history of DDH treatment (non-DDH group). The average age was lower and acetabular angle was larger in the DDH group. There was a significant increasing trend of the percentage of DDH patients associated with the severity of AD classified with CE, acetabular angle, and acetabular roof angle.Our data suggest that there are several AD patients without a history of DDH in Japan, and AD in patients without a history of DDH has different characteristics from AD in patients with a history of DDH. PMID:25569642

  6. The effect of incisional negative pressure therapy on wound complications after acetabular fracture surgery.

    PubMed

    Reddix, Robert N; Leng, Xiaoyan Iris'; Woodall, James; Jackson, Benjamin; Dedmond, Barnaby; Webb, Lawrence X

    2010-01-01

    The purpose of the study was to determine if the use of incisional negative pressure therapy affected the rate of wound complications after acetabular fracture surgery. Between August 1996 to April 2005, 301 patients were found to have had an operatively treated acetabular fracture. There were 235 patients who had placement of incisional vacuum-assisted closure (VAC) who had three (1.27%) deep wound infections and one (0.426%) wound dehiscence. There were 66 consecutive patients who were available in the 5 years preceding the usage of the incisional VAC who had four (6.06%) deep wound infections and two (3.03%) wound dehiscences. This is less than the published infection rate of 4% for patients undergoing operative treatment of acetabular fractures and less than the authors' rate of 6.15% in the time period before the use of the incisional negative pressure wound therapy (p=.0414). The use of incisional negative pressure wound therapy significantly decreases perioperative wound complications after acetabular fracture surgery. PMID:20727304

  7. The role of cages in the management of severe acetabular bone defects at revision arthroplasty.

    PubMed

    Mäkinen, T J; Fichman, S G; Watts, E; Kuzyk, P R T; Safir, O A; Gross, A E

    2016-01-01

    An uncemented hemispherical acetabular component is the mainstay of acetabular revision and gives excellent long-term results. Occasionally, the degree of acetabular bone loss means that a hemispherical component will be unstable when sited in the correct anatomical location or there is minimal bleeding host bone left for biological fixation. On these occasions an alternative method of reconstruction has to be used. A major column structural allograft has been shown to restore the deficient bone stock to some degree, but it needs to be off-loaded with a reconstruction cage to prevent collapse of the graft. The use of porous metal augments is a promising method of overcoming some of the problems associated with structural allograft. If the defect is large, the augment needs to be protected by a cage to allow ingrowth to occur. Cup-cage reconstruction is an effective method of treating chronic pelvic discontinuity and large contained or uncontained bone defects. This paper presents the indications, surgical techniques and outcomes of various methods which use acetabular reconstruction cages for revision total hip arthroplasty. PMID:26733646

  8. Unsatisfactory results with the cementless Omnifit acetabular component due to polyethylene and severe osteolysis.

    PubMed

    Nieuwenhuis, Jeroen J; Malefijt, Jan de Waal; Hendriks, Jan C M; Gosens, Taco; Bonnet, Michel

    2005-06-01

    A high incidence of acetabular osteolysis (43%), associated with osteolytic lesions in the proximal femur (22.6%) and leading to a high revision rate, was experienced with the Omnifit total hip prosthesis. We reviewed the clinical and radiological results with 429 Omnifit total hips in 356 patients after a mean follow-up of 60 months. Time to revision and wear of the polyethylene liner with different acetabular shell types were specifically analysed. Pelvic osteolysis first became manifest in the acetabular bone opposite to the holes in the metal shell. Osteolysis occurred predominantly adjacent to the central hole in the metal shell of threaded cups; widespread and larger defects were found in press fit cups with peripheral screw holes. Kaplan Meier survival analysis demonstrated a higher probability for retaining the threaded cup at 6 years (96%; 95%-confidence interval: 93-99%) compared to the survival of the press fit cup (66%; 95%-CI: 56-77%). The results suggest a negative relationship between backside wear, the larger number of holes in the cup, the extent of osteolysis and survival rate of the press fit cups. Based on these findings and supported by similar reports about osteolysis related to the same cup design, it was hypothesised that backside wear due to the insufficient locking mechanism of the Omnifit acetabular cup was the major cause of the unsatisfactory results in our patients. For this reason we discontinued using this type of uncemented socket. PMID:16035702

  9. Percutaneous screw placement in acetabular posterior column surgery: gender differences in implant positioning.

    PubMed

    Dienstknecht, Thomas; Müller, Michael; Sellei, Richard; Nerlich, Michael; Pfeifer, Christian; Krutsch, Werner; Fuechtmeier, Bernd; Berner, Arne

    2014-04-01

    Percutaneous reduction and periarticular screw implantation techniques have been successfully introduced in acetabular surgery. Image guided navigation techniques might be beneficial in increasing accuracy. However, a thorough understanding of standard values is needed to oversee pitfalls. This cadaver study was designed to identify reliable angulation values for screw implantation in the posterior acetabular column and to provide knowledge of the bony thickness for the periarticular corridor. Gender differences were specifically addressed. 27 embalmed cadaveric hemipelvic specimens (13 male, 14 female) were used. After soft-tissue removal posterior column acetabular screw placement was conducted by one experienced orthopaedic trauma surgeon under visibility. Radiographic verification of ideal screw placement was followed by radiographic assessment in three standard views and angulation values were assessed. Through bony dissection the maximal periarticular canal width was assessed. Various angulation values with regard to anatomical landmarks could be determined in the anteroposterior radiograph, as well as in the iliac oblique and the obturator oblique view. Gender differences were significant for all reference points with the pubic rami involved. The minimal canal width was 1.1cm in female and 1.6 cm in male specimen. The findings provide standard values for safe passages in percutaneous posterior column acetabular surgery. Gender differences have to be taken in consideration when planning the drill corridor. By adherence to standard values, screw placement can be performed safely. PMID:24182644

  10. ULTRA-LIGHTWEIGHT CEMENT

    SciTech Connect

    Fred Sabins

    2004-01-30

    The objective of this project is to develop an improved ultra-lightweight cement using ultra-lightweight hollow glass spheres (ULHS). This report discusses testing that was performed for analyzing the alkali-silica reactivity of ULHS in cement slurries.