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Sample records for cemented acetabular replacements

  1. Severe osteolysis of the pelvic in association with acetabular replacement without cement.

    PubMed

    Maloney, W J; Peters, P; Engh, C A; Chandler, H

    1993-11-01

    We reviewed the cases of fourteen patients (fifteen lesions) who had osteolysis following the replacement of the acetabulum without cement. Nine women and five men, seventeen to sixty-seven years old, were involved in the study. One woman had bilateral pelvic osteolysis. Eight of the fifteen index acetabular reconstructions were done with a titanium-alloy implant and seven, with a chromium-cobalt-alloy implant. Eleven of the fifteen acetabular components had holes in the metal shell that may have acted as a conduit through which wear debris could gain access to the implant-bone interface, but only two of the acetabular components had been fixed with screws. In these two acetabular components, all available screw holes were not filled. The polyethylene liner was eight millimeters thick or less in twelve of the fifteen acetabular components; all of the liners were ten millimeters thick or less. The diameter of the head of eleven of the fifteen femoral components was thirty-two millimeters. Fourteen of the fifteen femoral components were placed without cement, and all but one was radiographically stable. The duration from the index operation to the appearance of pelvic osteolysis ranged from fifty-three to eighty-four months (mean, sixty-five months). At the time of the diagnosis, the patients were functioning well clinically, and all but three had a Harris hip score of 90 points or better, despite extensive destruction of bone in some instances. Since these patients were functioning well, the pelvic osteolysis was diagnosed radiographically at a regular follow-up examination. Only one patient had evidence of migration of the acetabular component on serial radiographs.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Fatigue failure in the cement mantle of a simplified acetabular replacement model

    PubMed Central

    Zant, Nikolaus P.; Wong, Charles K.Y.; Tong, Jie

    2007-01-01

    Although the role of fatigue failure in aseptic loosening of cemented total hip replacements has been extensively studied in femoral components, studies of fatigue failure in cement mantle of acetabular replacements have yet to be reported, despite that the long-term failure rate in the latter is about three times that of femoral components. Part of the reason may be that a complex pelvic bone structure does not land itself readily for a 2D representation as that of a femur. In this work, a simple multilayer model has been developed to reproduce the stress distributions in the cement mantle of an acetabular replacement from a plane strain finite element pelvic bone model. The experimental multilayer model was subjected to cyclic loading up to peak hip contact force during normal walking. Radial fatigue cracks were observed in the vicinity of the maximum tangential and compressive stresses, as predicted by the FE models. Typical fatigue striations were also observed on the fracture surfaces post cyclic testing. The results were examined in the context of retrieval studies, 3D FE analysis and in vitro experimental results using full-sized hemi-pelvic bone models. PMID:19330048

  3. In vitro fatigue failure of cemented acetabular replacements: a hip simulator study.

    PubMed

    Zant, N P; Heaton-Adegbile, P; Hussell, J G; Tong, J

    2008-04-01

    Although hip simulators for in vitro wear testing of prosthetic materials used in total hip arthroplasty (THA) have been available for a number of years, similar equipment has yet to appear for endurance testing of fixation in cemented THA, despite considerable evidence of late aseptic loosening as one of the most significant failure mechanisms in this type of replacements. An in vitro study of fatigue behavior in cemented acetabular replacements has been carried out, utilizing a newly developed hip simulator. The machine was designed to simulate the direction and the magnitude of the hip contact force under typical physiological loading conditions, including normal walking and stair climbing, as reported by Bergmann et al. (2001, Hip 98, Freie Universitaet, Berlin). A 3D finite element analysis has been carried out to validate the function of the hip simulator and to evaluate the effects of boundary conditions and geometry of the specimen on the stress distribution in the cement mantle. Bovine pelvic bones were implanted with a Charnley cup, using standard manual cementing techniques. Experiments were carried out under normal walking and descending stairs loading conditions with selected load levels from a body weight of 75-125 kg. Periodically, the samples were removed from the test rigs to allow CT scanning for the purpose of monitoring damage development in the cement fixation. The hip simulator was found to be satisfactory in reproducing the hip contact force during normal walking and stair climbing, as reported by Bergmann et al. Finite element analysis shows that the stress distributions in the cement mantle and at the bone-cement interface are largely unaffected by the geometry and the boundary conditions of the model. Three samples were tested up to 17 x 10(6) cycles and sectioned post-testing for microscopic studies. Debonding at the bone-cement interface of various degrees in the posterior-superior quadrant was revealed in these samples, and the location

  4. Cementing constrained acetabular liners in revision hip replacement: clinical and laboratory observations.

    PubMed

    Mountney, John; Garbuz, Donald S; Greidanus, Nelson V; Masri, Bassam A; Duncan, Clive P

    2004-01-01

    During revision hip arthroplasty, removal of a well-fixed, ingrown metal acetabular component may not be possible. Therefore, a new polyethylene liner can be cemented into the existing shell via the cement locking mechanism. This technique is well recognized, and the cement locking mechanism has proved to be sufficiently strong and durable for clinical use. A constrained polyethylene liner is designed to reduce the risk of hip dislocation by capturing the femoral head. However, there are increased shear forces created at the liner interface as the dislocation is resisted. If a constrained liner is cemented into an ingrown acetabular component, then there is the theoretical risk that these increased shear forces will damage the cement locking mechanism, thus leading to failure of the construct. There are a few clinical series in which a constrained liner has been used with the cement locking mechanism. Overall, the failure rate of the cement locking mechanism is no greater if a constrained liner instead of a standard liner is used. The cement locking mechanism can be strengthened by roughening the backside of a smooth polyethylene liner to improve the cement-polyethylene interface, or by using an all-polyethylene acetabular component that is designed to be used with cement. Whether a smooth metal shell needs to be roughened as well is a matter of debate.

  5. Total hip replacements done without cement after acetabular fractures: a 4- to 8-year follow-up study.

    PubMed

    Huo, M H; Solberg, B D; Zatorski, L E; Keggi, K J

    1999-10-01

    Twenty-one patients (21 hips) underwent cementless total hip replacement surgeries for previous acetabular fractures. The mean age at the time of hip replacement was 52 years (range, 23-78 years). The mean follow-up was 65 months (range, 48-104 months). One hip required revision of the stem secondary to a periprosthetic femur fracture from a fall at 3 months after surgery. Good to excellent clinical rating was achieved and maintained in 19 hips. Radiographic evaluation demonstrated stable cup and stem fixation in 17 and 15 hips. Only 1 patient with radiographic loosening of the components was sufficiently symptomatic. The results in this series appeared slightly better than those reported previously in hip replacements done with cement at comparable medium-term follow-up. The mechanical failure rates remained high in this patient population: 19% for the cups and 29% for the stems.

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

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hip joint (hemi-hip) acetabular metal cemented... (hemi-hip) acetabular metal cemented prosthesis. (a) Identification. A hip joint (hemi-hip) acetabular metal cemented prosthesis is a device intended to be implanted to replace a portion of the hip...

  7. The Exeter method-acetabular impaction grafting with cemented reimplantation.

    PubMed

    Petheram, T G; Howell, J R

    2014-04-01

    Restoration of acetabular anatomy and biomechanics at revision hip surgery by replacing deficient acetabular bone through impaction of allograft and/or autograft bone chips. Aseptic loosening of the socket due to osteolysis, bone loss from infection, iatrogenic bone loss due to implant removal, and in the primary setting protrusio acetabuli, dysplasia and previous acetabular fracture. Large segmental peripheral acetabular defects which cannot be contained, the presence of untreated infection, unstable acetabular fractures, previous radiotherapy to the affected hip area. Sound exposure of the acetabulum with delineation of the bony defect. Creation of a host environment suitable for bone graft and containment of segmental defects using rim mesh or porous augments. Impaction grafting using layered allograft or autograft bone chips of 0.8-1 cm(3), packed using hemispherical impactors, followed by cementing of a polyethylene acetabular component with pressurisation. Partial weight bearing 6 weeks, modified depending on level of containment and intra-operative findings. A successful and reproducible technique with survival up to 87 % at 20 years for aseptic loosening in the revision setting.

  8. Cementation of a polyethylene liner into a metal acetabular shell: a biomechanical study.

    PubMed

    Hofmann, Aaron A; Prince, Edward J; Drake, F Thurston; Hunt, Kenneth J

    2009-08-01

    Cementation of a liner into a well-fixed acetabular shell is common in revision hip arthroplasty. We compare the biomechanical strengths of cemented liners with standard locked liners. Fifty polyethylene liners were inserted into acetabular shells using the standard locking mechanism or 1 of 2 cement types then loaded to failure by torsion or lever-out testing. Lever-out testing showed that all cemented liners failed at similar loads to standard locked liners. With torsion testing, cemented liners failed at significantly higher loads than standard locked liners; roughening the liner increased load to failure. Cementation of an acetabular liner into a metal shell is safe and strong and a good alternative to metal shell replacement. Saw roughening of the polyethylene liner strengthens the poly-cement interface.

  9. Cemented total hip arthroplasty following acetabular fracture.

    PubMed

    Scott, C E H; MacDonald, D; Moran, M; White, T O; Patton, J T; Keating, J F

    2017-10-01

    To evaluate the outcomes of cemented total hip arthroplasty (THA) following a fracture of the acetabulum, with evaluation of risk factors and comparison with a patient group with no history of fracture. Between 1992 and 2016, 49 patients (33 male) with mean age of 57 years (25 to 87) underwent cemented THA at a mean of 6.5 years (0.1 to 25) following acetabular fracture. A total of 38 had undergone surgical fixation and 11 had been treated non-operatively; 13 patients died at a mean of 10.2 years after THA (0.6 to 19). Patients were assessed pre-operatively, at one year and at final follow-up (mean 9.1 years, 0.5 to 23) using the Oxford Hip Score (OHS). Implant survivorship was assessed. An age and gender-matched cohort of THAs performed for non-traumatic osteoarthritis (OA) or avascular necrosis (AVN) (n = 98) were used to compare complications and patient-reported outcome measures (PROMs). The mean time from fracture to THA was significantly shorter for patients with AVN (2.2 years) or protrusio (2.2 years) than those with post-traumatic OA (9.4 years) or infection (8.0 years) (p = 0.03). Nine contained and four uncontained defects were managed with autograft (n = 11), bulk allograft (n = 1), or trabecular metal augment (n = 1). Initial fracture management (open reduction and internal fixation or non-operative), timing of THA (>/< one year), and age (>/< 55 years) had no significant effect on OHS or ten-year survival. Six THAs were revised at mean of 12 years (5 to 23) with ten-year all-cause survival of 92% (95% confidence interval 80.8 to 100). THA complication rates (all complications, heterotopic ossification, leg length discrepancy > 10 mm) were significantly higher following acetabular fracture compared with atraumatic OA/AVN and OHSs were inferior: one-year OHS (35.7 versus 40.2, p = 0.026); and final follow-up OHS (33.6 versus 40.9, p = 0.008). Cemented THA is a reasonable option for the sequelae of acetabular fracture. Higher complication rates and

  10. Intrapelvic protrusion of the acetabular component following total hip replacement.

    PubMed

    Salvati, E A; Bullough, P; Wilson, P D

    1975-09-01

    Protrusion of the acetabular component into the true pelvis following total hip replacement has occurred in 5 patients, 4 with severe rheumatoid arthritis and 1 with a destructive type of degenerative hip disease. Preoperatively all hips had severe protrusio acetabuli, a markedly thin acetabular medial wall and advanced osteoporosis. Four had a McKee-Farrar prosthesis, a metal-to-metal device with high frictional torque, particularly when the contact is equatorial, and no damping capacity against marginal impingement in the extreme range of motion. In order to reduce the incidence of intrapelvic protrusion, extreme care should be given to preserve the medial bone stock of the acetabulum, more so when it is already damaged or defective. If anchoring holes are used they should be restricted to the superior ilium, pubis and ischium and should not perforate the medial wall. Once loosening is present, reoperation is indicated to avoid progressive bone reabsorption by the abrasive motion of the loosened prosthesis, that might lead to irreparable bone loss. To reduce the stress transmitted to an already weakened acetabulum, select a total prosthetic device with low friction; fix it with acrylic cement in order to distribute the stress over a large surface; carefully orient both components to avoid marginal impingement; be certain to preserve the medial wall as much as possible and if it is already defective reinforce it by bone grafting and/or wire mesh.

  11. 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].

  12. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 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)...

  13. 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)...

  14. 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)...

  15. 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)...

  16. Clinical and radiological outcome of the cemented Contemporary acetabular component in patients < 50 years of age.

    PubMed

    Schmitz, M W J L; Timmer, C; Rijnen, W H C; Gardeniers, J W M; Schreurs, B W

    2013-12-01

    Despite the worldwide usage of the cemented Contemporary acetabular component (Stryker), no published data are available regarding its use in patients aged < 50 years. We undertook a mid- to long-term follow-up study, including all consecutive patients aged < 50 years who underwent a primary total hip replacement using the Contemporary acetabular component with the Exeter cemented stem between January 1999 and January 2006. There were 152 hips in 126 patients, 61 men and 65 women, mean age at surgery 37.6 years (16 to 49 yrs). One patient was lost to follow-up. Mean clinical follow-up of all implants was 7.6 years (0.9 to 12.0). All clinical questionnaire scores, including Harris hip score, Oxford hip score and several visual analogue scales, were found to have improved. The eight year survivorship of all acetabular components for the endpoints revision for any reason or revision for aseptic loosening was 94.4% (95% confidence interval (CI) 89.2 to 97.2) and 96.4% (95% CI 91.6 to 98.5), respectively. Radiological follow-up was complete for 146 implants. The eight year survival for the endpoint radiological loosening was 93.1% (95% CI 86.2 to 96.6). Three surviving implants were considered radiologically loose but were asymptomatic. The presence of acetabular osteolysis (n = 17, 11.8%) and radiolucent lines (n = 20, 13.9%) in the 144 surviving cups indicates a need for continued observation in the second decade of follow-up in order to observe their influence on long-term survival. The clinical and radiological data resulting in a ten-year survival rate > 90% in young patients support the use of the Contemporary acetabular component in this specific patient group.

  17. Cementation of an acetabular liner into a well-fixed acetabular shell during revision total hip arthroplasty.

    PubMed

    Springer, Bryan D; Hanssen, Arlen D; Lewallen, David G

    2003-10-01

    Cementing a polyethylene liner into a well-fixed acetabular shell during revision hip arthroplasty may be appropriate in select patients. The purpose of this study was to review our early results with this technique. Sixteen patients with >2-year follow-up or who had any complications at <2 years from surgery were identified. Indications for this technique included: failure of the previous locking mechanism, significant polyethylene wear, malposition of the well-fixed metal shell, and previous removal of the liner with a retained acetabular shell. One acetabular shell has been revised at 13 months for multiple dislocations. Hip scores improved an average of 24.2 points. Radiographs revealed no polyethylene dissociation or acetabular loosening. Complications occurred in 7 patients. Initial results appear successful at providing secure fixation, while preventing the bone loss that might occur with removal of a well-fixed component.

  18. Long Term Results of Liner Polyethylene Cementation Technique in Revision for Peri-acetabular Osteolysis.

    PubMed

    Rivkin, Gurion; Kandel, Leonid; Qutteineh, Bilal; Liebergall, Meir; Mattan, Yoav

    2015-06-01

    Patients with peri-acetabular osteolysis around a well fixed cementless acetabular component may be treated with liner exchange. When the locking mechanism is unreliable or unavailable, cementing the liner into the fixed acetabular component is a feasible option. The purpose of this study was to evaluate the clinical and radiographic long term results of this technique. Forty hip revisions with liner cementation in 37 patients were performed. The minimum follow up was 10 years. Modified Harris Hip Score and recent x rays were reviewed. Four hips were re-revised. Two patients were diagnosed with exacerbation of osteolysis but refused revision. Dislocation rate was relatively high (16%). Liner cementation technique in revision hip surgery is useful in patients with a well fixed metal backed acetabular component.

  19. Fix and replace; an emerging paradigm for treating acetabular fractures

    PubMed Central

    Murphy, Colin G.; Carrothers, Andrew D.

    2016-01-01

    Summary Although technically challenging even for the experienced surgeon, simultaneous open reduction and internal fixation (ORIF) of acetabular fracture and total hip replacement (THR) have some potential advantages over the more traditional treatment options in specific patient subgroups; theoretically allowing immediate weight bearing and faster rehabilitation, reducing the cost of inpatient stay, and reducing the risks of early and late local complications associated with standard treatment for this type of injury. We review the evolution of the indications and techniques, outline the surgical challenges, and discuss implant options and outcomes for this treatment paradigm. PMID:28228787

  20. 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.

  1. A technique to remove a stable all-polyethylene cemented acetabular liner in revision hip arthroplasty: A case report

    PubMed Central

    Judas, Fernando M.; Lucas, Francisco M.; Fonseca, Ruben L.

    2015-01-01

    Introduction The removal of a well-fixed acetabular component in a total hip arthroplasty can cause bone fractures, excessive bleeding, as well as extended bone loss. The reimplantation of a new acetabular component may be compromised. Presentation of case We report a technique using 2 cork-screws for removal a stable cemented acetabular component for the treatment of a recurrent dislocation of a cemented total hip arthroplasty, due to acetabular malposition. Discussion A diversity of approaches and tools has been used for extraction of the acetabular prosthesis. Using 2 cork-screws it is possible to create fissures and fractures into the cement mantle, and greater manual control is obtained facilitating the manipulation of the acetabular component in different directions. The cup-cemented bond can be disrupted, the host bone is preserved and the risks of complications are minimized. Conclusion This technique is simple, available in any environment, reproducible, non-costly, non-timing consuming and safe. PMID:25725330

  2. The effect of geometry and abduction angle on the stresses in cemented UHMWPE acetabular cups – finite element simulations and experimental tests

    PubMed Central

    Korhonen, Rami K; Koistinen, Arto; Konttinen, Yrjö T; Santavirta, Seppo S; Lappalainen, Reijo

    2005-01-01

    Background Contact pressure of UHMWPE acetabular cup has been shown to correlate with wear in total hip replacement (THR). The aim of the present study was to test the hypotheses that the cup geometry, abduction angle, thickness and clearance can modify the stresses in cemented polyethylene cups. Methods Acetabular cups with different geometries (Link®: IP and Lubinus eccentric) were tested cyclically in a simulator at 45° and 60° abduction angles. Finite element (FE) meshes were generated and two additional designs were reconstructed to test the effects of the cup clearance and thickness. Contact pressures at cup-head and cup-cement interfaces were calculated as a function of loading force at 45°, 60° and 80° abduction angles. Results At the cup-head interface, IP experienced lower contact pressures than the Lubinus eccentric at low loading forces. However, at higher loading forces, much higher contact pressures were produced on the surface of IP cup. An increase in the abduction angle increased contact pressure in the IP model, but this did not occur to any major extent with the Lubinus eccentric model. At the cup-cement interface, IP experienced lower contact pressures. Increased clearance between cup and head increased contact pressure both at cup-head and cup-cement interfaces, whereas a decreased thickness of polyethylene layer increased contact pressure only at the cup-cement interface. FE results were consistent with experimental tests and acetabular cup deformations. Conclusion FE analyses showed that geometrical design, thickness and abduction angle of the acetabular cup, as well as the clearance between the cup and head do change significantly the mechanical stresses experienced by a cemented UHMWPE acetabular cup. These factors should be taken into account in future development of THR prostheses. FE technique is a useful tool with which to address these issues. PMID:15904521

  3. The Exeter Contemporary flanged cemented acetabular component in primary total hip arthroplasty.

    PubMed

    Maggs, J L; Smeatham, A; Whitehouse, S L; Charity, J; Timperley, A J; Gie, G A

    2016-03-01

    We report on the outcome of the Exeter Contemporary flanged cemented all-polyethylene acetabular component with a mean follow-up of 12 years (10 to 13.9). This study reviewed 203 hips in 194 patients. 129 hips in 122 patients are still in situ; 66 hips in 64 patients were in patients who died before ten years, and eight hips (eight patients) were revised. Clinical outcome scores were available for 108 hips (104 patients) and radiographs for 103 hips (100 patients). A retrospective review was undertaken of a consecutive series of 203 routine primary cemented total hip arthroplasties (THA) in 194 patients. There were no acetabular component revisions for aseptic loosening. Acetabular revision was undertaken in eight hips. In four hips revision was necessitated by periprosthetic femoral fractures, in two hips by recurrent dislocation, in one hip for infection and in one hip for unexplained ongoing pain. Oxford and Harris hip scores demonstrated significant clinical improvement (all p < 0.001). Radiolucent lines were present in 37 (36%) of the 103 acetabular components available for radiological evaluation. In 27 of these, the line was confined to zone 1. No component had migrated. Kaplan-Meier survivorship, with revision for aseptic loosening as the endpoint, was 100% at 12.5 years and for all causes was 97.8% (95% confidence interval 95.6 to 100) when 40 components remained at risk. The Exeter Contemporary flanged cemented acetabular component demonstrates excellent survivorship at 12.5 years. The Exeter Contemporary flanged cemented acetabular component has excellent clinical outcomes and survivorship when used with the Exeter stem in total hip arthroplasty. ©2016 The British Editorial Society of Bone & Joint Surgery.

  4. Revisions of Extensive Acetabular Defects with Impaction Grafting and a Cement Cup

    PubMed Central

    van Egmond, Nienke; De Kam, Daniel C. J.; Gardeniers, Jean W. M.

    2010-01-01

    Background Loosening of acetabular components often leads to bony defects. Management of extensive acetabular bone loss in hip revision arthroplasty can be a tremendous challenge. Questions/purposes We asked whether a reconstruction with impacted bone grafts will provide a durable and pain-free function in extensive acetabular defects. We specifically determined the (1) survival rates with the end point of revision for any reason, aseptic revision, and radiographic loosening; (2) visual analog scale (VAS) pain score, Harris hip score (HHS), and the Oxford Hip Questionnaire score (OHQS); (3) number of repeat revisions; (4) complications; and (5) radiographic loosening, wear, and radiolucencies. Patients and Methods We retrospectively followed 25 patients (27 hips) with extensive acetabular defects. No patient was lost to followup. Two patients died during followup. Minimum followup was 3 years (mean, 8.8 years; range, 3–14.1 years). Results Three patients (three hips) underwent repeat revision surgery and another two patients (two hips) had radiographically loose hips. The 10-year survival rate was 88% (95% confidence interval, 74.2%–100%) with the end point acetabular revision for any reason and 95% (95% confidence interval, 86.0%–100%) with the end point acetabular revision for aseptic loosening. The mean HHSs were 55 points before surgery and 72 points postoperatively. Conclusions Acetabular reconstruction with impaction bone grafting and a cemented cup is a reliable technique with a 10-year survival rate of 88% in patients with extensive acetabular deficiencies. Level of Evidence Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence. PMID:20931308

  5. Local bisphosphonate reduces migration and formation of radiolucent lines adjacent to cemented acetabular components.

    PubMed

    Schilcher, J; Palm, L; Ivarsson, I; Aspenberg, P

    2017-03-01

    Post-operative migration of cemented acetabular components as measured by radiostereometric analysis (RSA) has a strong predictive power for late, aseptic loosening. Also, radiolucent lines predict late loosening. Migration has been reduced by systemic bisphosphonate treatment in randomised trials of hip and knee arthroplasty. Used as a local treatment, a higher local dose of bisphosphonate can be achieved without systemic exposure. We wished to see if this principle could be applied usefully in total hip arthroplasty (THA). In this randomised placebo-controlled, double-blinded trial with 60 participants, we compressed gauze soaked in bisphosphonate solution (ibandronate) or saline against the acetabular bone bed immediately before cementing the acetabular component. RSA, classification of radiolucent lines, the Harris Hip Score (HHS) and the Western Ontario McMasters Universities Osteoarthritis Index (WOMAC) were carried out at three-, six-, 12-, and 24-month follow-up. Migration of the cemented acetabular component relative to the pelvis was reduced by movement almost half in the ibandronate group, when measured as maximum total point or as movement of the femoral head (p = 0.001 and 0.004, respectively). Radiolucent lines after one year were classified as absent, partial or complete, and correlated with treatment (rho 0.37; p = 0.004). Only three of 30 patients in the ibandronate group had complete lines, compared with 13 of 28 in the placebo group (p = 0.002). There were no significant effects on HHS or WOMAC score. Considering the power of RSA to predict loosening of cemented acetabular components, and the likelihood that radiolucent lines indicate risk of loosening, these data suggest that local treatment with a bisphosphonate can reduce the risk of late aseptic loosening. Cite this article: Bone Joint J 2017;99-B:317-24. ©2017 The British Editorial Society of Bone & Joint Surgery.

  6. Management of neglected acetabular fractures.

    PubMed

    Veerappa, L A; Tripathy, S K; Sen, R K

    2015-08-01

    Management of neglected acetabular fractures is a difficult task. Osteosynthesis in such cases may not be an ideal solution because of the femoral head damage due to pressure by the fractured acetabular edge, avascular necrosis, difficulty in mobilizing the fragments due to callus formation, difficulty in indirect reduction of the fracture fragments and macerated acetabular fragments all contributing to inadequate fracture reduction. Majority of such fractures are now treated with total hip replacement. While treating such fractures with THR, problems associated with neglected acetabular fractures such as fracture non-union, hip dislocation, protrusio, cavitary bone defect or peripheral bone defect must be considered. 3D computed tomography scan provides a clear view about the acetabular and periacetabular bony anatomy. Impaction grafting and antiprotrusio cage or ring with a cemented acetabular cup can address most of the hip protrusio and cavitary bone defects. Segmental bone defect needs cortical strut-bone graft fixation and subsequent implantation of a cemented or uncemented acetabular cup implantation. Fracture non-union needs approximate reduction and fixation with plates followed by bone grafting and implantation of an acetabular cup. Despite these efforts, the outcome of THR in neglected acetabular fracture is considerable worse than after conventional hip replacement.

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  11. 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...

  12. Peri-acetabular bone mineral density in total hip replacement

    PubMed Central

    Gauthier, L.; Dinh, L.; Beaulé, P. E.

    2013-01-01

    Objectives To quantify and compare peri-acetabular bone mineral density (BMD) between a monoblock acetabular component using a metal-on-metal (MoM) bearing and a modular titanium shell with a polyethylene (PE) insert. The secondary outcome was to measure patient-reported clinical function. Methods A total of 50 patients (25 per group) were randomised to MoM or metal-on-polyethlene (MoP). There were 27 women (11 MoM) and 23 men (14 MoM) with a mean age of 61.6 years (47.7 to 73.2). Measurements of peri-prosthetic acetabular and contralateral hip (covariate) BMD were performed at baseline and at one and two years’ follow-up. The Western Ontario and McMaster Universities osteoarthritis index (WOMAC), University of California, Los Angeles (UCLA) activity score, Harris hip score, and RAND-36 were also completed at these intervals. Results At two years, only zone 1 showed a loss in BMD (-2.5%) in MoM group compared with a gain in the MoP group (+2.2%). Zone 2 showed loss in both groups (-2.2% for MoM; -3.9% for MoP) and zones 3 and 4 a gain in both groups (+0.1% for MoM; +3.3% for MoP). No other between-group differences were detected. When adjusting for BMD of the contralateral hip, no differences in BMD were observed. The only significant differences in functional scores at two years were higher UCLA activity (7.3 (sd 1.2) vs 6.1 (sd 1.5); p = 0.01) and RAND-36 physical function (82.1 (sd 13.0) vs 64.5 (sd 26.4); p = 0.02) for MoM bearings versus MoP. One revision was performed in the MoM group, for aseptic acetabular loosening at 11 months. Conclusions When controlling for systemic BMD, there were no significant differences between MoM and MoP groups in peri-acetabular BMD. However, increasing reports of adverse tissue reactions with large head MoM THR have restricted the use of the monoblock acetabular component to resurfacing only. PMID:23913361

  13. Early failure of a polyethylene acetabular liner cemented into a metal cup.

    PubMed

    Wilson, David A J; Corkum, Joseph P; Teeter, Matthew G; Holdsworth, David W; Dunbar, Michael J

    2012-05-01

    In 2002, a patient underwent revision total hip arthroplasty for polyethylene wear. The acetabular cup was well fixed, and it was decided to cement a new polyethylene liner into the existing cup. In 2006, the patient presented with inability to weight bear and easy subluxation of the hip. Revision surgery was performed, and all components were examined postoperatively. Investigation with microcomputed tomography revealed that the liner had plastically deformed at the superior pole resulting in the hip instability. The reasons for this are suspected to be related to the abducted nature of the original cup and an uneven cement mantle. This report suggests that cementation of polyethylene liners into metal cups has limitations and is not appropriate in all circumstances. Copyright © 2012 Elsevier Inc. All rights reserved.

  14. The use of a "rim cutter" device and a flanged cup for improving the mantle of the acetabular component of a cemented Exeter total hip arthroplasty.

    PubMed

    Fernández-Valencia, Jenaro Ángel; Gallart, Xavier; Bori, Guillem; Rodríguez-Roiz, Juan Miguel; Combalia, Andreu

    2016-12-01

    A retrospective study was performed to evaluate the cement mantle in two groups of patients treated with the acetabular components of cemented Exeter total hip arthroplasties (THAs). Two groups of 20 patients were compared: Group 1 received non-flanged acetabular cemented cups (Contemporary, Stryker) and Group 2 received flanged acetabular cemented cups (X3 Rim Fit, Stryker). Cups in Group 2 were implanted after using a rim cutter device. Group 2 showed better penetration of cement in zone 1 (10.76 mm compared with 2.93 mm; p = 0.008) and a thicker cement mantle in zone 1 (3.57 mm compared with 2.89 mm; p = 0.04). More cups in Group 2 had a cement mantle thickness less than 3 mm (30 % in Group 1 compared with 70 % in Group 2; p = 0.0039). No other radiological differences were observed. These results favor the use of a rim cutter device and flanged cup to improve the cement mantle for the acetabular components of cemented Exeter THAs. However, the improvements were less than expected. In view of the results of previous studies, further research is therefore needed to assess the value of this approach in improving the acetabular cement mantle.

  15. Corrosion on the acetabular liner taper from retrieved modular metal-on-metal total hip replacements.

    PubMed

    Gascoyne, Trevor C; Dyrkacz, Richard M; Turgeon, Thomas R; Burnell, Colin D; Wyss, Urs P; Brandt, Jan-M

    2014-10-01

    Eight retrieved metal-on-metal total hip replacements displayed corrosion damage along the cobalt-chromium alloy liner taper junction with the Ti alloy acetabular shell. Scanning electron microscopy indicated the primary mechanism of corrosion to be grain boundary and associated crevice corrosion, which was likely accelerated through mechanical micromotion and galvanic corrosion resulting from dissimilar alloys. Coordinate measurements revealed up to 4.3mm(3) of the cobalt-chromium alloy taper surface was removed due to corrosion, which is comparable to previous reports of corrosion damage on head-neck tapers. The acetabular liner-shell taper appears to be an additional source of metal corrosion products in modular total hip replacements. Patients with these prostheses should be closely monitored for signs of adverse reaction towards corrosion by-products.

  16. 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).

  17. Revision of the acetabular component without cement after a previous acetabular reconstruction with use of a bulk femoral head graft in patients who had congenital dislocation or dysplasia. A follow-up note.

    PubMed

    Bal, B S; Maurer, T; Harris, W H

    1999-12-01

    Revision of an acetabular component that has failed after a total hip arthroplasty in which a bulk femoral head autogenous graft or allograft was used as a structural graft for acetabular reconstruction is an uncommon but complex and challenging procedure. We previously reported the results for seventy hips at an average of 16.5 years after a total hip arthroplasty in which an acetabular reconstruction had been performed with a femoral head graft. In the present study, we evaluated a subset of nine hips from that series that had a subsequent revision of the acetabular component without cement. The purpose of the current study was to assess the usefulness of the bone graft in this revision. The nine patients (nine hips) were followed clinically and radiographically for an average of seventy-six months (range, sixty-one to 114 months) after the index revision. In six hips the autogenous femoral head graft previously had been bolted to the lateral side of the ilium, and in one hip the femoral head allograft had been affixed in this manner. In the two remaining hips, the allograft had been placed within the acetabulum. The hips were classified according to the extent of acetabular bone loss, with use of criteria described previously. Three hips had stage-I bone loss; four, stage-II; and two, stage-IIB. A porous-coated hemispherical acetabular component was inserted without cement and fixed with screws in each hip. At least 70 percent of the porous coating was in contact with viable bone. At the time of the latest follow-up after the index revision, all nine acetabular components were functioning well without loosening or osteolysis and none had been revised. The average Harris hip score was 77 points (range, 61 to 98 points) compared with 49 points (range, 27 to 96 points) preoperatively. One hip had had revision of the femoral stem, and another had had exchange of the acetabular liner because of recurrent dislocations. There was no additional resorption of the

  18. 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.

  19. Outcomes of polyethylene liner cementation into a fixed metal acetabular shell with minimum follow-up of 7 years.

    PubMed

    Park, Myung-Sik; Yoon, Sun-Jung; Lee, Ju Rang

    2015-01-01

    Cementation of a polyethylene liner into the well-fixed shell is a convenient option for revision total hip arthroplasty. We retrospectively reviewed 45 patients who had liner cementation to investigate the risk factors which gave rise to major complications and reoperation. Patients were observed for a minimum of 7 years (range 7.8-14 years). Relevant risk factors (age, BMI, surgical approach, previous cup size and position, types of coated surface) were assessed with Cox regression analysis. The mean Harris Hip Score was improved from 62.5 (range 57-68) preoperatively to 87.1 (range 70-97). A total of 7 hips (15.5%) had acetabular component loosening that was treated with reoperation. Prevalence of acetabular component loosening was statistically significantly higher in hydroxyapatite-coated group (5 of 13) than in the Ti-coated group (2 of 32, p = 0.015). All recurrent dislocations occurred in patients treated with a posterior approach. Diameter of the previous metal shell of below 54 mm showed a lower 10-year survival rate than those greater than 54 mm in diameter. PE liner cementation in stable metal cup is a useful alternative option for carefully selected patients. Pre-existing HA-coated cups as well as small sized cups were indicative of poor outcomes.

  20. 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.

  1. Combination acetabular radiofrequency ablation and cementoplasty using a navigational radiofrequency ablation device and ultrahigh viscosity cement: technical note.

    PubMed

    Wallace, Adam N; Huang, Ambrose J; Vaswani, Devin; Chang, Randy O; Jennings, Jack W

    2016-03-01

    Percutaneous radiofrequency ablation and cementoplasty is an alternative palliative therapy for painful metastases involving axial load-bearing bones. This technical report describes the use of a navigational radiofrequency probe to ablate acetabular metastases from an anterior approach followed by instillation of ultrahigh viscosity cement under CT-fluoroscopic guidance. The tumor ablation databases of two institutions were retrospectively reviewed to identify patients who underwent combination acetabular radiofrequency ablation and cementoplasty using the STAR Tumor Ablation and StabiliT Vertebral Augmentation Systems (DFINE; San Jose, CA). Pre-procedure acetabular tumor volume was measured on cross-sectional imaging. Pre- and post-procedure pain scores were measured using the Numeric Rating Scale (10-point scale) and compared. Partial pain improvement was categorically defined as ≥ 2-point pain score reduction. Patients were evaluated for evidence of immediate complications. Electronic medical records were reviewed for evidence of delayed complications. During the study period, 12 patients with acetabular metastases were treated. The median tumor volume was 54.3 mL (range, 28.3-109.8 mL). Pre- and post-procedure pain scores were obtained from 92% (11/12) of the cohort. The median pre-procedure pain score was 8 (range, 3-10). Post-procedure pain scores were obtained 7 days (82%; 9/11), 11 days (9.1%; 1/11) or 21 days (9.1%; 1/11) after treatment. The median post-treatment pain score was 3 (range, 1-8), a statistically significant difference compared with pre-treatment (P = 0.002). Categorically, 73% (8/11) of patients reported partial pain relief after treatment. No immediate symptomatic complications occurred. Three patients (25%; 3/12) were discharged to hospice within 1 week of treatment. No delayed complications occurred in the remaining 75% (9/12) of patients during median clinical follow-up of 62 days (range, 14-178 days). Palliative percutaneous

  2. Fix and replace: An emerging paradigm for treating acetabular fractures in older patients

    PubMed Central

    Tissingh, Elizabeth K; Johnson, Abigail; Queally, Joseph M; Carrothers, Andrew D

    2017-01-01

    Acetabular fractures in older patients are challenging to manage. The “fix and replace” construct may present a new paradigm for the management of these injuries. We present the current challenge of acetabular fractures in older patients. We present this in the context of the current literature. This invited editorial presents early results from our centre and the ongoing challenges are discussed. PMID:28361014

  3. Petroleum Sludge as gypsum replacement in cement plants: Its Impact on Cement Strength

    NASA Astrophysics Data System (ADS)

    Benlamoudi, Ali; Kadir, Aeslina Abdul; Khodja, Mohamed

    2017-08-01

    Due to high cost of cement manufacturing and the huge amount of resources exhaustion, companies are trying to incorporate alternative raw materials or by-products into cement production so as to produce alternative sustainable cement. Petroleum sludge is a dangerous waste that poses serious imparts on soil and groundwater. Given that this sludge contains a high percentage of anhydrite (CaSO4), which is the main component of gypsum (CaSO4.2H2O), it may play the same gypsum role in strength development. In this research, a total replacement of gypsum (100%) has been substituted by petroleum sludge in cement production and has led to an increase of 28.8% in UCS values after 28 curing days. Nevertheless, the burning of this waste has emitted a considerable amount of carbon monoxide (CO) gas that needs to be carefully considered prior to use petroleum sludge within cement plants.

  4. Porous tantalum uncemented acetabular shells in revision total hip replacement: two to four year clinical and radiographic results.

    PubMed

    Kim, W Y; Greidanus, N V; Duncan, C P; Masri, B A; Garbuz, D S

    2008-01-01

    In cementless revision total hip arthroplasty (THA), achieving initial implant stability and maximising host bone contact is key to the success of reconstruction. Porous tantalum acetabular shells may represent an improvement from conventional porous coated uncemented cups in revision acetabular reconstruction associated with severe acetabular bone defects. We reviewed the results of 46 acetabular revisions with Paprosky 2 and 3 acetabular bone defects done with a hemispheric, tantalum acetabular shell and multiple supplementary screws. At a mean follow-up of 40 (24-51) months, one acetabular shell had been revised in a patient with a Paprosky 3B defect. Cementless acetabular revision with the tantalum acetabular shell demonstrated excellent early clinical and radiographic results and warrants further evaluation in revision acetabular reconstruction associated with severe acetabular bone defects.

  5. Medium-term results of cementation of a highly cross-linked polyethylene liner into a well-fixed acetabular shell in revision hip arthroplasty.

    PubMed

    Lim, Seung-Jae; Lee, Keun-Ho; Park, Shin-Hyung; Park, Youn-Soo

    2014-03-01

    The present study was undertaken to document outcomes of cementation of a highly cross-linked polyethylene (PE) liner into a well-fixed acetabular metal shell in 36 hips. All operations were performed by a single surgeon using only one type of liner. Patients were followed for a mean of 6.1 years (range, 3-8 years). Mean Harris hip score improved from 58 points preoperatively to 91 points postoperatively. There were no cases of PE liner dislodgement or progressive osteolysis. 1 hip (2.8%) required revision surgery for acetabular cup loosening with greater trochanteric fracture. Complications included 1 peroneal nerve palsy and 1 dislocation. The results of this study and previous reports demonstrated that cementation of highly cross-linked PE liner into well-fixed metal shell could provide good midterm durability.

  6. Acetabular Cup Revision.

    PubMed

    Kim, Young-Ho

    2017-09-01

    The use of acetabular cup revision arthroplasty is on the rise as demands for total hip arthroplasty, improved life expectancies, and the need for individual activity increase. For an acetabular cup revision to be successful, the cup should gain stable fixation within the remaining supportive bone of the acetabulum. Since the patient's remaining supportive acetabular bone stock plays an important role in the success of revision, accurate classification of the degree of acetabular bone defect is necessary. The Paprosky classification system is most commonly used when determining the location and degree of acetabular bone loss. Common treatment options include: acetabular liner exchange, high hip center, oblong cup, trabecular metal cup with augment, bipolar cup, bulk structural graft, cemented cup, uncemented cup including jumbo cup, acetabular reinforcement device (cage), trabecular metal cup cage. The optimal treatment option is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable fixation upon supportive host bone. To achieve successful acetabular cup revision, accurate evaluation of bone defect preoperatively and intraoperatively, proper choice of method of acetabular revision according to the evaluation of acetabular bone deficiency, proper technique to get primary stability of implant such as precise grafting technique, and stable fixation of implant are mandatory.

  7. Properties of Cement Mortar Containing Rubber Ash as Sand Replacement

    NASA Astrophysics Data System (ADS)

    Syamir Senin, Mohamad; Shahidan, Shahiron; Syazani Leman, Alif; Izzati Raihan Ramzi Hannan, Nurul

    2016-11-01

    Discarded scrap tyres have become one of the major environmental problems nowadays. There has been increasing public worry about the mining of natural resources in recent years. In order to minimize the consumption of natural resources, rubber ash has been postulated as a potential material for partial replacement of sand in concrete materials especially for applications which are subjected to impact and vibration such as road and bridge construction. Thus, it contributes to the development of the construction industry in a sustainable way. This paper mainly emphasizes on the use of rubber ash from waste tyres in cement mortar. 100mm cubic specimens were produced by adding rubber ash volume ratios of 0%, 3%, 5% and 7% as sand replacement in M30 quality cement mortar. A compressive stress test and a density test were conducted at the end of 7, 14, and 28 days. The result shows that 5% is the optimum value for sand replacement in the cement mortar. Therefore, rubber ash is acceptable to be used as sand replacement.

  8. Utilization of Palm Oil Clinker as Cement Replacement Material.

    PubMed

    Kanadasan, Jegathish; Abdul Razak, Hashim

    2015-12-16

    The utilization of waste materials from the palm oil industry provides immense benefit to various sectors of the construction industry. Palm oil clinker is a by-product from the processing stages of palm oil goods. Channelling this waste material into the building industry helps to promote sustainability besides overcoming waste disposal problems. Environmental pollution due to inappropriate waste management system can also be drastically reduced. In this study, cement was substituted with palm oil clinker powder as a binder material in self-compacting mortar. The fresh, hardened and microstructure properties were evaluated throughout this study. In addition, sustainability component analysis was also carried out to assess the environmental impact of introducing palm oil clinker powder as a replacement material for cement. It can be inferred that approximately 3.3% of cement production can be saved by substituting palm oil clinker powder with cement. Reducing the utilization of cement through a high substitution level of this waste material will also help to reduce carbon emissions by 52%. A cleaner environment free from pollutants can be created to ensure healthier living. Certain industries may benefit through the inclusion of this waste material as the cost and energy consumption of the product can be minimized.

  9. Utilization of Palm Oil Clinker as Cement Replacement Material

    PubMed Central

    Kanadasan, Jegathish; Abdul Razak, Hashim

    2015-01-01

    The utilization of waste materials from the palm oil industry provides immense benefit to various sectors of the construction industry. Palm oil clinker is a by-product from the processing stages of palm oil goods. Channelling this waste material into the building industry helps to promote sustainability besides overcoming waste disposal problems. Environmental pollution due to inappropriate waste management system can also be drastically reduced. In this study, cement was substituted with palm oil clinker powder as a binder material in self-compacting mortar. The fresh, hardened and microstructure properties were evaluated throughout this study. In addition, sustainability component analysis was also carried out to assess the environmental impact of introducing palm oil clinker powder as a replacement material for cement. It can be inferred that approximately 3.3% of cement production can be saved by substituting palm oil clinker powder with cement. Reducing the utilization of cement through a high substitution level of this waste material will also help to reduce carbon emissions by 52%. A cleaner environment free from pollutants can be created to ensure healthier living. Certain industries may benefit through the inclusion of this waste material as the cost and energy consumption of the product can be minimized. PMID:28793748

  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.

  11. The use of a constrained cementless acetabular component for instability in total hip replacement.

    PubMed

    Rady, Ahmad Emad; Asal, Mohammed Kamal; Bassiony, Ayman Abdelaziz

    2010-01-01

    Recurrent dislocation after total hip arthroplasty is a disabling complication that can be difficult to treat. We evaluated the early clinical and radiographic outcome associated with the use of a constrained acetabular component for instability in total hip arthroplasty. Fifteen patients underwent either primary or revision total hip arthroplasty with a cementless constrained acetabular component for different indications. The mean patient age at surgery was 57.4 years and the mean clinical and radiological follow-up period was 26.4 months. Clinical assessment was performed by the Harris hip score and at the latest follow up patients reported outcome using the Oxford hip score questionnaire. All radiographs were evaluated for evidence of loosening. Only one patient experienced redislocation with the constrained prosthesis. The average Harris hip score increased from a preoperative mean of 22 (range, 16 - 36) to a postoperative mean of 85 (range, 66-94). Preoperatively, the mean Oxford Hip Score was 48.6, which decreased to 20.5 at the final examination. All but one of the 15 hips had a well-fixed, stable cup. Femoral component stability with bone ingrowth was achieved in 10 cases. A constrained acetabular component is an effective option for the treatment of hip instability in primary and revision arthroplasty in those at high risk of dislocation. The potential for aseptic loosening requires evaluation by long term studies.

  12. Fly ash as replacement for cement in extruded fiber-reinforced cement composites

    SciTech Connect

    Peled, A.; Akkaya, Y.; Shah, S.P.

    1999-11-01

    The objective of this work was to develop extrudable compositions of fiber-reinforced cement composites that contain high content of fly ash. For that purpose specimens containing different ratio of fly ash as replacement for cement were extruded, with different fiber types: acrylic, PVA, glass and cellulose. Composites produced with the conventional cast process were also examined for comparison. It was found that fly ash improves the flexural strength and ductility of the extruded composite compared to composites without fly ash, for all fiber types. In the cast composites fly ash improved the composite ductility but reduced the flexural strength of the composite. Differences in matrix properties and fiber-matrix interface between the cast and extrusion composites can explain the differences in the flexural performances.

  13. 40 CFR 63.1220 - What are the replacement standards for hazardous waste burning cement kilns?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... hazardous waste burning cement kilns? 63.1220 Section 63.1220 Protection of Environment ENVIRONMENTAL... Waste Combustors Replacement Emissions Standards and Operating Limits for Incinerators, Cement Kilns... burning cement kilns? (a) Emission and hazardous waste feed limits for existing sources. You must...

  14. 40 CFR 63.1220 - What are the replacement standards for hazardous waste burning cement kilns?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... hazardous waste burning cement kilns? 63.1220 Section 63.1220 Protection of Environment ENVIRONMENTAL... Hazardous Waste Combustors Replacement Emissions Standards and Operating Limits for Incinerators, Cement... burning cement kilns? (a) Emission and hazardous waste feed limits for existing sources. You must not...

  15. 40 CFR 63.1220 - What are the replacement standards for hazardous waste burning cement kilns?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... hazardous waste burning cement kilns? 63.1220 Section 63.1220 Protection of Environment ENVIRONMENTAL... Waste Combustors Replacement Emissions Standards and Operating Limits for Incinerators, Cement Kilns... burning cement kilns? (a) Emission and hazardous waste feed limits for existing sources. You must not...

  16. 40 CFR 63.1220 - What are the replacement standards for hazardous waste burning cement kilns?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... hazardous waste burning cement kilns? 63.1220 Section 63.1220 Protection of Environment ENVIRONMENTAL... Waste Combustors Replacement Emissions Standards and Operating Limits for Incinerators, Cement Kilns... burning cement kilns? (a) Emission and hazardous waste feed limits for existing sources. You must not...

  17. 40 CFR 63.1220 - What are the replacement standards for hazardous waste burning cement kilns?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... hazardous waste burning cement kilns? 63.1220 Section 63.1220 Protection of Environment ENVIRONMENTAL... Hazardous Waste Combustors Replacement Emissions Standards and Operating Limits for Incinerators, Cement... burning cement kilns? (a) Emission and hazardous waste feed limits for existing sources. You must not...

  18. To Compare Time-Weighted Graphs to Evaluate the Inclination of the Acetabular Component of Patients Who Had Total Hip Replacement Surgery

    PubMed Central

    Tomak, Leman; Tomak, Yılmaz

    2015-01-01

    Time-weighted graphs are used to detect small shifts in statistical process control. The aim of this study is to evaluate the inclination of the acetabular component with CUmulative SUM (CUSUM) chart, Moving Average (MA) chart, and Exponentially Weighted Moving Average (EWMA) chart. The data were obtained directly from thirty patients who had undergone total hip replacement surgery at Ondokuz Mayis University, Faculty of Medicine. The inclination of the acetabular component of these people, after total hip replacement, was evaluated. CUSUM chart, Moving Average chart, and Exponentially Weighted Moving Average were used to evaluate the quality control process of acetabular component inclination. MINITAB Statistical Software 15.0 was used to generate these control charts. The assessment done with time-weighted charts revealed that the acetabular inclination angles were settled within control limits and the process was under control. It was determined that the change within the control limits had a random pattern. As a result of this study it has been obtained that time-weighted quality control charts which are used mostly in the field of industry can also be used in the field of medicine. It has provided us with a faster visual decision. PMID:26413501

  19. 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

  20. 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.

  1. 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

  2. Acetabular distraction: an alternative approach to pelvic discontinuity in failed total hip replacement.

    PubMed

    Brown, N M; Hellman, M; Haughom, B H; Shah, R P; Sporer, S M; Paprosky, W G

    2014-11-01

    A pelvic discontinuity occurs when the superior and inferior parts of the hemi-pelvis are no longer connected, which is difficult to manage when associated with a failed total hip replacement. Chronic pelvic discontinuity is found in 0.9% to 2.1% of hip revision cases with risk factors including severe pelvic bone loss, female gender, prior pelvic radiation and rheumatoid arthritis. Common treatment options include: pelvic plating with allograft, cage reconstruction, custom triflange implants, and porous tantalum implants with modular augments. The optimal technique is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable healing between the two segments. A method of treating pelvic discontinuity using porous tantalum components with a distraction technique that achieves both initial stability and subsequent long-term biological fixation is described.

  3. 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.

  4. The medium term outcome of the Omnifit constrained acetabular cup.

    PubMed

    Bigsby, Ewan; Whitehouse, Michael R; Bannister, Gordon C; Blom, Ashley W

    2012-01-01

    Recurrent dislocation requiring revision surgery occurs in approximately 4% of primary total hip arthroplasties (THAs). To reduce this risk, or to treat those patients who recurrently dislocate, a constrained acetabular component may be used, however there are concerns over the success of such components due to increased mechanical stresses. The purpose of this study was to analyse the survivorship and radiological results for the Omnifit constrained acetabular component, providing a longer patient reported outcome follow-up than previous studies. 117 patients (median age 82 years) underwent a THA with an Omnifit constrained acetabular component. Of these, 45 were primary replacements and 72 were revisions. Survivorship analysis was performed and patients were assessed both radiologically and functionally. At follow-up, 53 patients (45.3%) had died at a median time of 33 months from operation. The median overall follow-up was 7.0 (5.5-8.2) years. Survivors (median age 83 years) reported a median Oxford Hip Score (OHS) of 16.6 (0-48), 87.8% were satisfied with their surgery. 45 (91.8%) of the acetabular components were stable radiologically, 48 (96%) of the femoral components were stable (5 uncemented, 43 cemented) and two possibly unstable. Four of the 117 patients underwent further surgery. Only one required revision of the prosthesis and this was for a periprosthetic fracture. In the medium term the Omnifit constrained acetabular component prevents dislocation and does not cause excessive loosening of either the acetabular or femoral components in our patient population. Our results support the use of the Omnifit constrained acetabular component in elderly patients at risk of dislocation with low functional demand.

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

    PubMed Central

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

    2016-01-01

    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

  6. 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.

  7. 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.

  8. Highly Cross-linked Polyethylene Liner Dissociation from a Cement-less Modular Acetabular Shell: Two Case Reports

    PubMed Central

    Kawano, Shunsuke; Sonohata, Motoki; Kitajima, Masaru; Mawatari, Masaaki

    2016-01-01

    Liner dissociation of polyethylene from a cementless acetabular socket following total hip arthroplasty (THA) is a rare complication. Cross-linked polyethylene liner dissociation from AMS-HA shell (KYOCERA Med, Osaka, Japan) occurred in 2 out of the 4153 (0.04%) cases approximately 10 years after undergoing surgery at our institute. First case was an 80-year-old female who underwent right THA along with subtrochanteric femoral shortening osteotomy due to complete dislocation hip, and second case was a 72-year-old male, who underwent right THA due to coxarthrosis. A 26 mm femoral head and CPE liner were used in both cases and the inclination degree of the acetabular socket was within 50°.There was no implant loosening in both cases. There was partial damage in the elevated rim on the alternative side and scratches on the back side in the both extracted CPE liner. It was surmised that liner dissociation was caused due to a problem in the liner fixing format of the push in type of the present model. PMID:28217197

  9. Cemented Müller straight stem total hip replacement: 18 year survival, clinical and radiological outcomes

    PubMed Central

    Nikolaou, Vasileios S; Korres, Demetrios; Lallos, Stergios; Mavrogenis, Andreas; Lazarettos, Ioannis; Sourlas, Ioannis; Efstathopoulos, Nicolas

    2013-01-01

    AIM: To present the 18 year survival and the clinical and radiological outcomes of the Müller straight stem, cemented, total hip arthroplasty (THA). METHODS: Between 1989 and 2007, 176 primary total hip arthroplasties in 164 consecutive patients were performed in our institution by the senior author. All patients received a Müller cemented straight stem and a cemented polyethylene liner. The mean age of the patients was 62 years (45-78). The diagnosis was primary osteoarthritis in 151 hips, dysplasia of the hip in 12 and subcapital fracture of the femur in 13. Following discharge, serial follow-up consisted of clinical evaluation based on the Harris Hip Score and radiological assessment. The survival of the prosthesis using revision for any reason as an end-point was calculated by Kaplan-Meier analysis. RESULTS: Twenty-four (15%) patients died during the follow-up study, 6 (4%) patients were lost, while the remaining 134 patients (141 hips) were followed-up for a mean of 10 years (3-18 years). HSS score at the latest follow-up revealed that 84 hips (59.5%) had excellent results, 30 (22.2%) good, 11 (7.8%) fair and 9 (6.3%) poor. There were 3 acetabular revisions due to aseptic loosening. Six (4.2%) stems were diagnosed as having radiographic definitive loosening; however, only 1 was revised. 30% of the surviving stems showed no radiological changes of radiolucency, while 70% showed some changes. Survival of the prosthesis for any reason was 96% at 10 years and 81% at 18 years. CONCLUSION: The 18 year survival of the Müller straight stem, cemented THA is comparable to those of other successful cemented systems. PMID:24147267

  10. 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.

  11. [Analysis of migration of screwed acetabular components following revision arthroplasty of the hip joint. Results of single-image roentgen analysis].

    PubMed

    Dihlmann, S W; Ochsner, P E; Pfister, A; Mayrhofer, P

    1994-01-01

    Out of 57 revised acetabular components, which were regularly checked, 47 had been replaced by a cemented Müller's acetabular reinforcement ring resp. a cementless Müller's Sl-shell with flange. Both types of cups are anchored in the acetabular roof with cancellous bone screws (tab. 1). 42 cases with radiograph series permitted a detailed analysis with the EBRA-method, a computer aided method for the evaluation of acetabular spatial migration based on standard radiographs of the pelvis. The clinical results were very satisfying (tab. 6). The screwed acetabular components migrated little, although, some essential displacements of the center of rotation (in relation to the anatomical position) had to be accepted. As was recognizable with today's inaccurate methods of measuring the center of the head, the displacement too far towards cranial influenced the migration tendency less than an excessive lateralisation. Especially satisfying is the fact, that no increased migration was observed after reconstruction bone grafting of severe acetabular defects, provided that at least a partly direct contact between the acetabular component and the original bone stock was obtained. For the first time EBRA shall be introduced here as a method which shows the migration and the spatial inclination of the acetabular cup in a vector chart.

  12. The use of glass powder as a partial Portland cement replacement

    NASA Astrophysics Data System (ADS)

    Pokorný, Jaroslav; Pavlíková, Milena; Tydlitát, Vratislav; Scheinherrová, Lenka; Rovnaníková, Pavla; Pavlík, Zbyšek

    2017-07-01

    Finely grinded waste glass powder can become material having suitable properties from the point of view of particle size and pozzolanic activity. Glass powder incorporation into cement paste and cement-based composites can bring improvement in porous structure resulting in increased mechanical strength and durability characteristics. On this account, two types of recycled glass powder are investigated in the presented paper as a possible partial Portland cement substitutes in cement blends. For raw glass powders, basic physical parameters and chemical composition are measured. The studied glass powders are applied as 5, 10 and 20 mass% of Portland cement replacement in cement paste mix composition, whereas water/binder ratio of 0.3 is used for all studied pastes. Fresh paste mixtures are characterized using initial and final setting time measurement. For hardened pastes cured 28 days in water, bulk density, matrix density, total open porosity and mechanical properties represented by flexural and compressive strength are accessed. Portlandite consumption by the pozzolanic reaction is monitored with TGA. The obtained results show effectiveness of a borosilicate glass powder that acts as a pozzolanic active admixture. This resulted in improvement of mechanical characteristics for cement substitution up to 10 mass%.

  13. The economics of using prophylactic antibiotic-loaded bone cement in total knee replacement.

    PubMed

    Gutowski, C J; Zmistowski, B M; Clyde, C T; Parvizi, J

    2014-01-01

    The rate of peri-prosthetic infection following total joint replacement continues to rise, and attempts to curb this trend have included the use of antibiotic-loaded bone cement at the time of primary surgery. We have investigated the clinical- and cost-effectiveness of the use of antibiotic-loaded cement for primary total knee replacement (TKR) by comparing the rate of infection in 3048 TKRs performed without loaded cement over a three-year period versus the incidence of infection after 4830 TKRs performed with tobramycin-loaded cement over a later period of time of a similar duration. In order to adjust for confounding factors, the rate of infection in 3347 and 4702 uncemented total hip replacements (THR) performed during the same time periods, respectively, was also examined. There were no significant differences in the characteristics of the patients in the different cohorts. The absolute rate of infection increased when antibiotic-loaded cement was used in TKR. However, this rate of increase was less than the rate of increase in infection following uncemented THR during the same period. If the rise in the rate of infection observed in THR were extrapolated to the TKR cohort, 18 additional cases of infection would have been expected to occur in the cohort receiving antibiotic-loaded cement, compared with the number observed. Depending on the type of antibiotic-loaded cement that is used, its cost in all primary TKRs ranges between USD $2112.72 and USD $112 606.67 per case of infection that is prevented.

  14. A case control study of cemented acetabular total hip arthroplasty components in patients less than 50 with 5-year minimum follow-up.

    PubMed

    Yeoman, Thomas F M; Smy, William; Gaston, Paul

    2017-03-31

    This study investigates the outcomes of cemented sockets in young patients (<50 years) requiring a total hip replacement (THR) compared to older patients (>50 years) having the same procedure, under the same surgeon between June 2005 and May 2009. Prosthesis survivorship rates, patient outcomes and radiological findings were compared between a consecutive series of 56 young patients (mean 42, range 25-49) and 56 older patients (mean 69, range 53-81) that underwent a primary THR using a cemented Stryker® Exeter™ Contemporary™ flanged cup. The minimum follow-up was 5 years. No significant difference was observed between the groups' Oxford Hip Scores (p = 0.078) or satisfaction scores (p = 0.67). Worst case scenario analysis for revision, failure or lost to follow-up showed 94.6% survival in the <50 year olds and 92.9% survival in the >50 year olds at 5 years. This study demonstrates no significant difference in patient outcomes, survivorship or radiographic findings at a minimum of 5 years between patients <50 years old and those >50 years old undergoing THR with a cemented socket. We believe the current trend towards uncemented cups may be driven by marketing rather than by evidence of improved outcomes. Cemented sockets provide very good outcomes for patients of all ages.

  15. Radiostereometric analysis study of tantalum compared with titanium acetabular cups and highly cross-linked compared with conventional liners in young patients undergoing total hip replacement.

    PubMed

    Ayers, David C; Greene, Meridith; Snyder, Benjamin; Aubin, Michelle; Drew, Jacob; Bragdon, Charles

    2015-04-15

    Radiostereometric analysis provides highly precise measurements of component micromotion relative to the bone that is otherwise undetectable by routine radiographs. This study compared, at a minimum of five years following surgery, the micromotion of tantalum and titanium acetabular cups and femoral head penetration in highly cross-linked polyethylene liners and conventional (ultra-high molecular weight polyethylene) liners in active patients who had undergone total hip replacement. This institutional review board-approved prospective, randomized, blinded study involved forty-six patients. Patients were randomized into one of four cohorts according to both acetabular cup and polyethylene liner. Patients received either a cementless cup with a titanium mesh surface or a tantalum trabecular surface and either a highly cross-linked polyethylene liner or an ultra-high molecular weight polyethylene liner. Radiostereometric analysis examinations and Short Form-36 Physical Component Summary, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), University of California Los Angeles (UCLA) activity, and Harris hip scores were obtained preoperatively, postoperatively, at six months, and annually thereafter. All patients had significant improvement (p < 0.05) in Short Form-36 Physical Component Summary, WOMAC, UCLA activity, and Harris hip scores postoperatively. On radiostereometric analysis examination, highly cross-linked polyethylene liners showed significantly less median femoral head penetration at five years (p < 0.05). Steady-state wear rates from one year to five years were 0.04 mm per year for ultra-high molecular weight polyethylene liners and 0.004 mm per year for highly cross-linked polyethylene liners. At the five-year follow-up, the median migration (and standard error) was 0.05 ± 0.20 mm proximally for titanium cups and 0.21 ± 0.05 mm for tantalum cups. In this young population who had undergone total hip replacement, radiostereometric

  16. Radiostereometric Analysis Study of Tantalum Compared with Titanium Acetabular Cups and Highly Cross-Linked Compared with Conventional Liners in Young Patients Undergoing Total Hip Replacement

    PubMed Central

    Ayers, David C.; Greene, Meridith; Snyder, Benjamin; Aubin, Michelle; Drew, Jacob; Bragdon, Charles

    2015-01-01

    Background: Radiostereometric analysis provides highly precise measurements of component micromotion relative to the bone that is otherwise undetectable by routine radiographs. This study compared, at a minimum of five years following surgery, the micromotion of tantalum and titanium acetabular cups and femoral head penetration in highly cross-linked polyethylene liners and conventional (ultra-high molecular weight polyethylene) liners in active patients who had undergone total hip replacement. Methods: This institutional review board-approved prospective, randomized, blinded study involved forty-six patients. Patients were randomized into one of four cohorts according to both acetabular cup and polyethylene liner. Patients received either a cementless cup with a titanium mesh surface or a tantalum trabecular surface and either a highly cross-linked polyethylene liner or an ultra-high molecular weight polyethylene liner. Radiostereometric analysis examinations and Short Form-36 Physical Component Summary, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), University of California Los Angeles (UCLA) activity, and Harris hip scores were obtained preoperatively, postoperatively, at six months, and annually thereafter. Results: All patients had significant improvement (p < 0.05) in Short Form-36 Physical Component Summary, WOMAC, UCLA activity, and Harris hip scores postoperatively. On radiostereometric analysis examination, highly cross-linked polyethylene liners showed significantly less median femoral head penetration at five years (p < 0.05). Steady-state wear rates from one year to five years were 0.04 mm per year for ultra-high molecular weight polyethylene liners and 0.004 mm per year for highly cross-linked polyethylene liners. At the five-year follow-up, the median migration (and standard error) was 0.05 ± 0.20 mm proximally for titanium cups and 0.21 ± 0.05 mm for tantalum cups. Conclusions: In this young population who had undergone

  17. Dual mobility total hip replacement in a high risk population

    PubMed Central

    Luthra, Jatinder Singh; Al Riyami, Amur; Allami, Mohamad Kasim

    2016-01-01

    Objective: The purpose of the study was to evaluate results of dual mobility total replacement in a high risk population who take hip into hyperflexed position while sitting and praying on the floor. Method: The study included 65 (35 primary total replacement and 30 complex total hip replacement) cases of total hip replacement using avantage privilege dual mobility cup system from biomet. A cemented acetabular component and on femoral side a bimetric stem, either cemented or uncemented used depending on the canal type. Ten cases were examined fluoroscopically in follow up. Result: There was dislocation in one patient undergoing complex hip replacement. Fluoroscopy study showed no impingement between the neck of prosthesis and acetabular shell at extremes of all movements. Conclusion: The prevalence of dislocation is low in our high risk population and we consider it preferred concept for patients undergoing complex total hip replacement. PMID:27924742

  18. Modelling the fibrous tissue layer in cemented hip replacements: experimental and finite element methods.

    PubMed

    Waide, V; Cristofolini, L; Stolk, J; Verdonschot, N; Boogaard, G J; Toni, A

    2004-01-01

    The long-term fixation of cemented femoral components may be jeopardised by the presence of a fibrous tissue layer at the bone-cement interface. This study used both experimental and finite element (FE) methods to investigate the load transfer characteristics of two types of cemented hip replacements (Lubinus SPII and Müller-Curved) with a fibrous tissue layer. The experimental part investigated six stems of each type, where these were implanted in composite femurs with a specially selected silicone elastomer modelling the soft interfacial layer. Two fibrous tissue conditions were examined: a layer covering the full cement mantle, representing a revision condition; and a layer covering the proximal portion of the cement mantle, representing a non-revised implant with partial debonding and fibrous tissue formation. The FE method was used to model the full fibrous tissue layer condition, for both implants. The layer was modelled as a homogeneous, linearly isotropic material. A cross-comparison was performed of the experimental and FE findings. Agreement between experimental and FE models was verified to be within 15%. Varying the stiffness parameter of the FE soft tissue layer had little influence on the cortical bone strains, though had considerable effect on the cement strains. Stress shielding occurred for both stems under both fibrous tissue conditions, with the greatest reduction around the calcar. However, the cortical bone strains were generally larger than those for the equivalent well-fixed stems. The fibrous tissue layer was not found to increase the general strain pattern of the cement mantle, though localised regions of high stress were detected.

  19. Distal femoral physeal growth arrest secondary to a cemented proximal femoral endoprosthetic replacement.

    PubMed

    Gaston, C L; Tillman, R M; Grimer, R J

    2011-05-01

    We report a case of spontaneous physeal growth arrest of the distal femur in a nine-year-old child with Ewing's sarcoma of the proximal femur treated with chemotherapy and endoprosthetic replacement. Owing to the extent of disuse osteoporosis at the time of surgery, the entire intramedullary canal up to the distal femoral physis was filled with cement. Three years later, the femur remained at its pre-operative length of 19 cm. Pre-operative calculations of further growth failed to account for the growth arrest, and the initial expandable growing prosthesis inserted has been revised to a longer one in order to address the leg-length discrepancy. To our knowledge, this is the only reported case of distal femoral physeal growth arrest following cemented endoprosthetic replacement of the proximal femur.

  20. Effects on cement after partial replacement with burned joss paper ash.

    PubMed

    Lin, D F; Huang, L S; Luo, H L; Weng, R S

    2012-12-01

    In the last ten years, as international environmental protection consciousness has increased, the study and applications of green building, green construction materials and energy savings as well as reduction of carbon dioxide have become urgent issues for governments. In Taiwan, joss papers are burned in more than 11,731 registered shrines or temples in traditional Chinese deity or ancestor worship ceremonies during special holidays or occasions. Instead of placing this large amount of burned joss paper ash (BJPA) in landfills, this study proposes recycling BJPA by replacing some cement with calcined BJPA (CBJPA) in mortar specimens. After BJPA samples were calcined at a high kiln temperature, mortar samples were created using CBJPA to replace cement at seven different levels: 0%, 5%, 10%, 15%, 20%, 25% and 30%. Tests like setting time and compressive strength were performed for macro-analyses; scanning electron microscopy-energy dispersive spectroscopy, X-ray diffraction and thermal gravimetric analysis/differential thermal analysis were carried out for the microstructure and chemical composition analyses. The test results showed that the compressive strengths of specimens with different levels of CBJPA replacement were apparently less than those of the control group (0% CBJPA) at all curing times. The compressive strength and setting time both decreased as the fraction of CBJPA in the mortar increased. Furthermore, because the hydration product did not cement and the mortar specimen structure was loose, the expected strength improvement from the pozzolanic reaction provided by the CBJPA was not clearly observed.

  1. Three- to five-year results with the cementless Harris-Galante acetabular component used in hybrid total hip arthroplasty.

    PubMed

    Kienapfel, H; Pitzer, W; Griss, P

    1992-01-01

    In this paper we present our 3- to 5-year results after hybrid total hip replacement using the cementless porous coated Harris-Galante acetabular component and the cemented Griss femoral component in 39 patients with 40 implantations. Postoperatively, mild to moderate pain was experienced by 16.1% of patients, mostly following hard activity. A slight to moderate limp occurred in 24.2%. All patients were able to walk more than 1000 m. Full-time use of support was required by 2.8%. The postoperative range of motion was increased in 93.9%. Radiographically, none of the acetabular or femoral components had to be classified as unstable. Only one acetabular component displayed complete (i.e., along all interface zones) radiolucency and was therefore classified as possibly unstable.

  2. Cement replacement by sugar cane bagasse ash: CO2 emissions reduction and potential for carbon credits.

    PubMed

    Fairbairn, Eduardo M R; Americano, Branca B; Cordeiro, Guilherme C; Paula, Thiago P; Toledo Filho, Romildo D; Silvoso, Marcos M

    2010-09-01

    This paper presents a study of cement replacement by sugar cane bagasse ash (SCBA) in industrial scale aiming to reduce the CO(2) emissions into the atmosphere. SCBA is a by-product of the sugar/ethanol agro-industry abundantly available in some regions of the world and has cementitious properties indicating that it can be used together with cement. Recent comprehensive research developed at the Federal University of Rio de Janeiro/Brazil has demonstrated that SCBA maintains, or even improves, the mechanical and durability properties of cement-based materials such as mortars and concretes. Brazil is the world's largest sugar cane producer and being a developing country can claim carbon credits. A simulation was carried out to estimate the potential of CO(2) emission reductions and the viability to issue certified emission reduction (CER) credits. The simulation was developed within the framework of the methodology established by the United Nations Framework Convention on Climate Change (UNFCCC) for the Clean Development Mechanism (CDM). The State of São Paulo (Brazil) was chosen for this case study because it concentrates about 60% of the national sugar cane and ash production together with an important concentration of cement factories. Since one of the key variables to estimate the CO(2) emissions is the average distance between sugar cane/ethanol factories and the cement plants, a genetic algorithm was developed to solve this optimization problem. The results indicated that SCBA blended cement reduces CO(2) emissions, which qualifies this product for CDM projects. 2010 Elsevier Ltd. All rights reserved.

  3. 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.

  4. 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.

  5. Study on concrete with partial replacement of cement by rice husk ash

    NASA Astrophysics Data System (ADS)

    Kaarthik Krishna, N.; Sandeep, S.; Mini, K. M.

    2016-09-01

    Increase in the demand of conventional construction materials and the need for providing a sustainable growth in the construction field has prompted the designers and developers to opt for ‘alternative materials’ feasible for use in construction. For this objective, the use of industrial waste products and agricultural byproducts are very constructive. These industrial wastes and agricultural by products such as Fly Ash, Rice Husk Ash, Silica Fume, and Slag can be replaced instead of cement because of their pozzolanic behavior, which otherwise requires large tract of lands for dumping. In the present investigation, Rice Husk Ash has been used as an admixture to cement in concrete and its properties has been studied. An attempt was also done to examine the strength and workability parameters of concrete. For normal concrete, mix design is done based on Indian Standard (IS) method and taking this as reference, mix design has been made for replacement of Rice Husk Ash. Four different replacement levels namely 5%, 10%, 15% and 20% are selected and studied with respect to the replacement method.

  6. Effects of cement creep on stem subsidence and stresses in the cement mantle of a total hip replacement.

    PubMed

    Lu, Z; McKellop, H

    1997-02-01

    In cemented total hip prostheses, the role of creep of the acrylic cement (polymethyl methacrylate, [PMMA]) in increasing or decreasing the chance of failure of the cement mantle is a subject of ongoing controversy. In the present study we used a three-dimensional finite-element model of a cemented stem to assess the influence of cement creep on subsidence of the stem, and on the stress and strain in the cement under cyclic load, both in the short and long term. The cement layer was assigned the shear and bulk creep moduli of Zimmer regular PMMA cement, which were obtained experimentally. The stem-cement interface was modeled either as (1) completely bonded, (2) completely debonded with friction, or (3) completely debonded and frictionless. Under the cyclic load some cement creep occurred with all three bonding conditions, allowing additional subsidence of the stem and a decrease in the stress components within the cement. During the unloaded period the full recovery of the preload conditions could be reached with the completely bonded and with the frictionless interfaces. With the frictional interface there was residual cement creep, residual stresses within the cement, and residual subsidence of the stem during the unloaded period; however, the reduction of the stress was at most 13% and the subsidence was about 0.46 mm. The much larger subsidence of debonded stems that is often observed clinically might be attributed to the factors which were not included in the present model, such as circumferential bone remodeling.

  7. Total hip replacement: A meta-analysis to evaluate survival of cemented, cementless and hybrid implants

    PubMed Central

    Phedy, Phedy; Ismail, H Dilogo; Hoo, Charles; Djaja, Yoshi P

    2017-01-01

    AIM To determine whether cemented, cementless, or hybrid implant was superior to the other in terms of survival rate. METHODS Systematic searches across MEDLINE, CINAHL, and Cochrane that compared cemented, cementless and hybrid total hip replacement (THR) were performed. Two independent reviewers evaluated the risk ratios of revision due to any cause, aseptic loosening, infection, and dislocation rate of each implants with a pre-determined form. The risk ratios were pooled separately for clinical trials, cohorts and registers before pooled altogether using fixed-effect model. Meta-regressions were performed to identify the source of heterogeneity. Funnel plots were analyzed. RESULTS Twenty-seven studies comprising 5 clinical trials, 9 cohorts, and 13 registers fulfilled the research criteria and analyzed. Compared to cementless THR, cemented THR have pooled RR of 0.47 (95%CI: 0.45-0.48), 0.9 (0.84-0.95), 1.29 (1.06-1.57) and 0.69 (0.6-0.79) for revision due to any reason, revision due to aseptic loosening, revision due to infection, and dislocation respectively. Compared to hybrid THR, the pooled RRs of cemented THR were 0.82 (0.76-0.89), 2.65 (1.14-6.17), 0.98 (0.7-1.38), and 0.67 (0.57-0.79) respectively. Compared to hybrid THR, cementless THR had RRs of 0.7 (0.65-0.75), 0.85 (0.49-1.5), 1.47 (0.93-2.34) and 1.13 (0.98-1.3). CONCLUSION Despite the limitations in this study, there was some tendency that cemented fixation was still superior than other types of fixation in terms of implant survival. PMID:28251071

  8. Cementless acetabular fixation in patients 50 years and younger at 10 to 18 years of follow-up.

    PubMed

    Teusink, Matthew J; Callaghan, John J; Warth, Lucian C; Goetz, Devon D; Pedersen, Douglas R; Johnston, Richard C

    2012-08-01

    The purpose of the study was to evaluate the 10- to 18-year follow-up of cementless acetabular fixation in patients 50 years and younger. We retrospectively reviewed a consecutive group of 118 patients (144 hips) in whom primary total hip arthroplasty had been performed by 2 surgeons using a cementless acetabular component. Two (1.4%) cementless acetabular components were revised because of aseptic loosening. Twenty-four hips (16.7%) were revised for any mechanical failure of the acetabular component mostly related to acetabular liner wear and osteolysis. The average linear wear rate was 0.19 mm per year, which was higher than our previous reports with cemented acetabular fixation. The fiber mesh ingrowth surface of the cementless acetabular component in this study was superior to cemented acetabular components in terms of fixation. However, the high rates of wear and osteolysis have led to poor overall acetabular component construct survivorship.

  9. Acetabular blood flow during total hip arthroplasty

    PubMed Central

    ElMaraghy, Amr W.; Schemitsch, Emil H.; Waddell, James P.

    2000-01-01

    Objective To determine the immediate effect of reaming and insertion of the acetabular component with and without cement on periacetabular blood flow during primary total hip arthroplasty (THA). Design A clinical experimental study. Setting A tertiary referral and teaching hospital in Toronto. Patients Sixteen patients (9 men, 7 women) ranging in age from 30 to 78 years and suffering from arthritis. Intervention Elective primary THA with a cemented (8 patients) and noncemented (8 patients) acetabular component. All procedures were done by a single surgeon who used a posterior approach. Main outcome measure Acetabular bone blood-flow measurements made with a laser Doppler flowmeter before reaming, after reaming and after insertion of the acetabular prosthesis. Results Acetabular blood flow after prosthesis insertion was decreased by 52% in the noncemented group (p < 0.001) and 59% in the cemented group (p < 0.001) compared with baseline (prereaming) values. Conclusion The significance of these changes in periacetabular bone blood flow during THA may relate to the extent of bony ingrowth, periprosthetic remodelling and ultimately the incidence of implant failure because of aseptic loosening. PMID:10851413

  10. Early postoperative acetabular discontinuity after total hip arthroplasty.

    PubMed

    Desai, Gaurav; Ries, Michael D

    2011-12-01

    Periprosthetic acetabular fracture is a rare complication after total hip arthroplasty (THA). However, we have treated 2 patients with acute postoperative acetabular discontinuity that occurred 2 and 3 weeks after primary THA. Both fractures were in elderly osteoporotic female patients with minimal trauma and may have developed from unrecognized intraoperative fractures. Pelvic stability was restored with acetabular revision using medial morselized bone grafting and a cemented reconstruction cage. This report demonstrates that early postoperative periprosthetic acetabular discontinuity after THA is a risk in elderly patients with severe osteoporosis and that salvage of acetabular fixation can be achieved with cemented cage reconstruction and medial morselized bone grafting. Copyright © 2011 Elsevier Inc. All rights reserved.

  11. Compressive strength of concrete by partial replacement of cement with metakaolin

    NASA Astrophysics Data System (ADS)

    Ganesh, Y. S. V.; Durgaiyya, P.; Shivanarayana, Ch.; Prasad, D. S. V.

    2017-07-01

    Metakaolin or calcined kaolin, other type of pozzolan, produced by calcination has the capability to replace silica fume as an alternative material. Supplementary cementitious materials have been widely used all over the world in concrete due to their economic and environmental benefits; hence, they have drawn much attention in recent years. Mineral admixtures such as fly ash, rice husk ash, silica fume etc. are more commonly used SCMs. They help in obtaining both higher performance and economy. Metakaolin is also one of such non - conventional material, which can be utilized beneficially in the construction industry. This paper presents the results of an experimental investigations carried out to find the suitability of metakaolin in production of concrete. In the present work, the results of a study carried out to investigate the effects of Metakaolin on compressive strength of concrete are presented. The referral concrete M30 was made using 43 grade OPC and the other mixes were prepared by replacing part of OPC with Metakaolin. The replacement levels were 5%, 10%, 15% and 20%(by weight) for Metakaolin. The various results, which indicate the effect of replacement of cement by metakalion on concrete, are presented in this paper to draw useful conclusions.

  12. Pulmonary cement embolism in a child following total elbow replacement for primitive neuroectodermal tumour (PNET) of the humerus.

    PubMed

    Ramanathan, Subramaniam; Vora, Tushar; Gulia, Ashish; Mahajan, Abhishek; Desai, Subhash

    2017-05-01

    Pulmonary bone cement embolism (PCE) is an uncommon event occurring after implantation of polymethylmethacrylate (PMMA) in orthopaedic surgeries involving adult patients, more so in the elderly. Its incidence in the paediatric population is extremely rare. We herein describe a case of PCE in a 15-year-old girl, 9 days after she underwent total elbow replacement with PMMA placement for a primitive neuroectodermal tumour (PNET) of the distal humerus. This report describes the occurrence of a common post-operative complication of bone cement embolism in an uncommon scenario of total elbow replacement for a bone tumour in a child, which masqueraded initially as acute pneumonitis.

  13. The dog as a preclinical model to evaluate interface morphology and micro-motion in cemented total knee replacement.

    PubMed

    Mann, K A; Miller, M A; Khorasani, M; Townsend, K L; Allen, M J

    2012-01-01

    This study investigated cemented fixation of the tibial component from a canine total knee replacement preclinical model. The objective was to determine the local morphology at the material interfaces (implant, cement, bone) and the local relative micro- motion due to functional loading following in vivo service. Five skeletally mature research dogs underwent unilateral total knee replacement using a cemented implant system with a polyethylene (PE) monobloc tibial component. Use of the implanted limb was assessed by pressure-sensitive walkway analysis. At 60 weeks post-surgery, the animals were euthanatized and the tibia sectioned en bloc in the sagittal plane to create medial and lateral specimens. High resolution imaging was used to quantify the morphology under the tray and along the keel. Specimens were loaded to 50% body weight and micro- motions at the PE-cement and cement-bone interfaces were quantified. There was significantly (p = 0.002) more cement-bone apposition and interdigitation along the central keel compared to the regions under the tray. Cavitary defects were associated with the perimeters of the implant (60 ± 25%). Interdigitation fraction was negatively correlated with cavitary defect fraction, cement crack fraction, and total micro-motion. Achieving good interdigitation of cement into subchondral bone beneath the tibial tray is associated with improved interface morphology and reduced micro-motion; features that could result in a reduced incidence of aseptic loosening. Multiple drill holes distributed over the cut tibial surface and adequate pressurization of the cement into the subchondral bone should improve fixation and reduce interface micromotion and cavitary defects.

  14. 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. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Ten-year survival of cemented total knee replacement in patients aged less than 55 years.

    PubMed

    Keenan, A C M; Wood, A M; Arthur, C A; Jenkins, P J; Brenkel, I J; Walmsley, P J

    2012-07-01

    We report the ten-year survival of a cemented total knee replacement (TKR) in patients aged < 55 years at the time of surgery, and compare the functional outcome with that of patients aged > 55 years. The data were collected prospectively and analysed using Kaplan-Meier survival statistics, with revision for any reason, or death, as the endpoint. A total of 203 patients aged < 55 years were identified. Four had moved out of the area and were excluded, leaving a total of 221 TKRs in 199 patients for analysis (101 men and 98 women, mean age 50.6 years (28 to 55)); 171 patients had osteoarthritis and 28 had inflammatory arthritis. Four patients required revision and four died. The ten-year survival using revision as the endpoint was 98.2% (95% confidence interval 94.6 to 99.4). Based on the Oxford knee scores at five and ten years, the rate of dissatisfaction was 18% and 21%, respectively. This was no worse in the patients aged < 55 years than in patients aged > 55 years. These results demonstrate that the cemented PFC Sigma knee has an excellent survival rate in patients aged < 55 ten years post-operatively, with clinical outcomes similar to those of an older group. We conclude that TKR should not be withheld from patients on the basis of age.

  16. The importance of acetabular component position in total hip arthroplasty.

    PubMed

    Daines, Brian K; Dennis, Douglas A

    2012-11-01

    Correct acetabular cup position is critical to successful total hip replacement. Unfortunately, malposition of acetabular cups is common and leads to increased rates of dislocation, wear, and ion toxicity. Despite the popularity of Lewinnek's safe zone, the exact target of acetabular abduction and version remains elusive. Differences in functional pelvic position, surgical approach, and femoral anteversion affect the optimal cup position for individual patients. Surgeons need to be aware of pelvic position changes from the supine to lateral decubitus position.

  17. Comparison of flanged and unflanged acetabular cup design

    PubMed Central

    2010-01-01

    Background and purpose Adequate depth of cement penetration and cement mantle thickness is important for the durability of cemented cups. A flanged cup, as opposed to unflanged, has been suggested to give a more uniform cement mantle and superior cement pressurization, thus improving the depth of cement penetration. This hypothesis was tested experimentally. Materials and methods The same cup design with and without flange (both without cement spacers) was investigated regarding intraacetabular pressure, cement mantle thickness, and depth of cement penetration. With machine control, the cups were inserted into open-pore ceramic acetabular models (10 flanged, 10 unflanged) and into paired cadaver acetabuli (10 flanged, 10 unflanged) with prior pressurization of the cement. Results No differences in intraacetabular pressures during cup insertion were found, but unflanged cups tended to migrate more towards the acetabular pole. Flanged cups resulted in thicker cement mantles because of less bottoming out, whereas no differences in cement penetration into the bone were observed. Interpretation Flanged cups do not generate higher cementation pressure or better cement penetration than unflanged cups. A possible advantage of the flange, however, may be to protect the cup from bottoming out, and there is possibly better closure of the periphery around the cup, sealing off the cement-bone interface. PMID:20860522

  18. Relationship between Wiberg's lateral center edge angle, Lequesne's acetabular index, and medial acetabular bone stock.

    PubMed

    Werner, Clément M L; Copeland, Carol E; Ruckstuhl, Thomas; Stromberg, Jeff; Turen, Clifford H; Bouaicha, Samy

    2011-11-01

    Knowledge of acetabular anatomy is crucial for cup positioning in total hip replacement. Medial wall thickness of the acetabulum is known to correlate with the degree of developmental dysplasia of the hip (DDH). No data exist about the relationship of routinely used radiographic parameters such as Wiberg's lateral center edge angle (LCE-angle) or Lequesne's acetabular index (AI) with thickness of the medial acetabular wall in the general population. The aim of our study was to clarify the relationship between LCE, AI, and thickness of the medial acetabular wall. Measurements on plain radiographs (LCE and AI) and axial CT scans (quadrilateral plate acetabular distance QPAD) of 1,201 individuals (2,402 hips) were obtained using a PACS imaging program and statistical analyses were performed. The mean thickness of the medial acetabulum bone stock (QPAD) was 1.08 mm (95% CI: 1.05-1.10) with a range of 0.1 to 8.8 mm. For pathological values of either the LCE (<20°) or the AI (>12°) the medial acetabular wall showed to be thicker than in radiological normal hips. The overall correlation between coxometric indices and medial acetabular was weak for LCE (r =-0.21. 95% CI [-0.25, -0.17]) and moderate for AI (r = 0.37, [0.33, 0.41]). We did not find a linear relationship between Wiberg's lateral center edge angle, Lequesne's acetabular index and medial acetabular bone stock in radiological normal hips but medial acetabular wall thickness increases with dysplastic indices.

  19. The use of a bioresorbable nano-crystalline hydroxyapatite paste in acetabular bone impaction grafting.

    PubMed

    Chris Arts, J J; Verdonschot, Nico; Schreurs, Berend W; Buma, Pieter

    2006-03-01

    Calcium phosphates such as TCP-HA granules are considered promising bone graft substitutes. In the future, they may completely replace allograft bone for impaction grafting procedures. Mechanically, acetabular reconstructions with TCP-HA granules show high stability, however this is partly caused by excessive cement penetration, which is unfavourable from a biological perspective. It has been hypothesised that mixtures of morselised cancellous bone grafts (MCB) and/or TCP-HA granules with a nano-crystalline hydroxyapatite paste (Ostim) may reduce cement penetration while maintaining adequate implant stability and biocompatibility of the graft mixture. To investigate this hypothesis, destructive lever-out tests and in vivo animal test were performed with various combinations of materials. Mechanically, the addition of 10% Ostim to mixtures of MCB and/or TCP-HA granules reduced cement penetration and resulted in a mechanical stability comparable to pure allograft (the current gold standard). Biologically, the application of Ostim with MCB or TCP-HA granules did not hamper the biocompatibility of the materials. Ostim was mostly osseous-integrated with MCB or TCP-HA granules after 8 weeks. Also, non-osseous-integrated Ostim remnants were observed. In tartrate resistant acid phosphatase stained sections, these few non-osseous integrated Ostim remnants were actively being resorbed by osteoclasts. In conclusion, Ostim HA-paste could be a valuable addition when TCP-HA ceramic granules are being used for acetabular bone impaction grafting procedures.

  20. Treatment algorithm of acetabular periprosthetic fractures.

    PubMed

    Simon, Paul; von Roth, Philipp; Perka, Carsten

    2015-10-01

    Periprosthetic fractures of the acetabulum represent a rare incident in primary and revision total hip arthroplasty. The management of these fractures can be challenging. At present, there are no reliable guidelines for the treatment of periprosthetic acetabular fractures. Periprosthetic acetabular fractures can occur intra-operatively, in particular during insertion of non-cemented cups or in the context of revision surgery. Post-operative causes for periprosthetic acetabular fractures are traumatic events or, more commonly, pelvic discontinuity due to severe bone loss related to osteolysis. Despite their aetiology, the main objective of surgery is to achieve a stable acetabular component and fracture. While stable fractures and implants could be treated non-operatively, unstable fractures require surgery to achieve component stability and allow appropriate biological fixation of the revision cup. Assessment of the stability plays a crucial role before determining the treatment strategy. There is a large variety of surgical techniques available for the management of these fractures. This review article outlines the epidemiology, aetiology and current classification systems, and provides a distinct diagnostic and therapeutic algorithm for the treatment of periprosthetic acetabular fractures.

  1. Studies on Punching Shear Resistance of Two Way Slab Specimens with Partial Replacement of Cement by GGBS with Different Edge Conditions

    NASA Astrophysics Data System (ADS)

    Nemani, Ravi Dakshina Murthy; Rao, M. V. S.; Grandhe, Veera Venkata Satya Naranyana

    2016-09-01

    The present work is an effort to quantify the punching shear load resistance effect on two way simply supported slab specimens with replacement of cement by Ground Granulated Blast Furnace Slag (GGBS) with different edge conditions at various replacement levels and evaluate its efficiency. GGBS replacement has emerged as a major alternative to conventional concrete and has rapidly drawn the concrete industry attention due to its cement savings, cost savings, environmental and socio-economic benefits. The two way slab specimens were subjected to punching shear load by in house fabricated apparatus. The slab specimens were cast using M30 grade concrete with HYSD bars. The cement was partially replaced with GGBS at different percentages i.e., 0 to 30 % at regular intervals of 10 %. The test results indicate that the two way slab specimens with partial replacement of cement by GGBS exhibit high resistance against punching shear when compared with conventional concretes slab specimens.

  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. 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.

  4. Functional interface micromechanics of 11 en-bloc retrieved cemented femoral hip replacements

    PubMed Central

    Miller, Mark A; Verdonschot, Nico; Izant, Timothy H; Race, Amos

    2010-01-01

    Background and purpose Despite the longstanding use of micromotion as a measure of implant stability, direct measurement of the micromechanics of implant/bone interfaces from en bloc human retrievals has not been performed. The purpose of this study was to determine the stem-cement and cement-bone micromechanics of functionally loaded, en-bloc retrieved, cemented femoral hip components. Methods 11 fresh frozen proximal femurs with cemented implants were retrieved at autopsy. Specimens were sectioned transversely into 10-mm slabs and fixed to a loading device where functional torsional loads were applied to the stem. A digital image correlation technique was used to document micromotions at stem-cement and cement-bone interfaces during loading. Results There was a wide range of responses with stem-cement micromotions ranging from 0.0006 mm to 0.83 mm (mean 0.17 mm, SD 0.29) and cement-bone micromotions ranging from 0.0022 mm to 0.73 mm (mean 0.092 mm, SD 0.22). There was a strong (linear-log) inverse correlation between apposition fraction and micromotion at the stem-cement interface (r2 = 0.71, p < 0.001). There was a strong inverse log-log correlation between apposition fraction at the cement-bone interface and micromotion (r2 = 0.85, p < 0.001). Components that were radiographically well-fixed had a relatively narrow range of micromotions at the stem-cement (0.0006–0.057 mm) and cement-bone (0.0022–0.029 mm) interfaces. Interpretatation Minimizing gaps at the stem-cement interface and encouraging bony apposition at the cement-bone interface would be clinically desirable. The cement-bone interface does not act as a bonded interface in actual use, even in radiographically well-fixed components. Rather, the interface is quite compliant, with sliding and opening motions between the cement and bone surfaces. PMID:20367421

  5. Chloride Diffusion and Acid Resistance of Concrete Containing Zeolite and Tuff as Partial Replacements of Cement and Sand

    PubMed Central

    Mohseni, Ehsan; Tang, Waiching; Cui, Hongzhi

    2017-01-01

    In this paper, the properties of concrete containing zeolite and tuff as partial replacements of cement and sand were studied. The compressive strength, water absorption, chloride ion diffusion and resistance to acid environments of concretes made with zeolite at proportions of 10% and 15% of binder and tuff at ratios of 5%, 10% and 15% of fine aggregate were investigated. The results showed that the compressive strength of samples with zeolite and tuff increased considerably. In general, the concrete strength increased with increasing tuff content, and the strength was further improved when cement was replaced by zeolite. According to the water absorption results, specimens with zeolite showed the lowest water absorption values. With the incorporation of tuff and zeolite, the chloride resistance of specimens was enhanced significantly. In terms of the water absorption and chloride diffusion results, the most favorable replacement of cement and sand was 10% zeolite and 15% tuff, respectively. However, the resistance to acid attack reduced due to the absorbing characteristic and calcareous nature of the tuff. PMID:28772737

  6. Experimental Evaluation of Cement Replacement Fillers on the Performance of Slurry Seal

    NASA Astrophysics Data System (ADS)

    Fakhri, Mansour; Alrezaei, Hossein Ali; Naji Almasi, Soroush

    2016-10-01

    Reducing the level of roads service is a process that starts from the first day of the operation of road and the slope of deterioration curve of road sustainability becomes faster with the passage of time. After building the road, adopting an economic approach in order to maintain the road is very important. Slurry seal as one type of protective asphalts that works by sealing inactive cracks of the road and increasing skid resistance is the most effective types of restoration with environmentally friendly behaviour. Fillers are responsible for adjusting set time in slurry seal. Cement is the most common filler used in slurry seal. Cements having suitable properties as a filler, has a very energy demanding manufacturing process and a notable amount of energy is used for manufacturing cement in the country annually. On the other hand, manufacturing process and application of cement have increased levels of pollutant gases, followed by significant environmental pollution. So in this study other options as a filler such as hydrated lime, stone powder and the slag from iron melting furnace were compared with two common types of cement (Portland and type-v cement) in the mixtures of slurry seal by wet abrasion and cohesion tests. Results indicated that, in both tests, lime and slag fillers had behaviours close to the cement filler.

  7. Backside nonconformity and locking restraints affect liner/shell load transfer mechanisms and relative motion in modular acetabular components for total hip replacement.

    PubMed

    Kurtz, S M; Ochoa, J A; White, C V; Srivastav, S; Cournoyer, J

    1998-05-01

    Nonconformity between the polyethylene liner and the metal shell may exist in modular acetabular components by design, due to manufacturing tolerances, or from locking mechanisms that attach the polyethylene liner to the metal shell. Relative motion at the liner/shell interface has been associated with backside wear, which may contribute to osteolysis which has been clinically observed near screw holes. The purpose of this study was to investigate the effect of nonconformity and locking restraints on the liner/shell relative motion and load transfer mechanisms in a commercially available, metal-backed acetabular component with a polar fenestration. The finite element method was used to explore the hypothesis that backside nonconformity and locking restraints play important roles in long-term surface damage mechanisms that are unique to modular components, such as backside wear and liner extrusion through screw holes. The three-body quasi-static contact problem was solved using a commercially available explicit finite element code, which modeled contact between the femoral head, polyethylene liner, and the metal shell. Four sets of liner boundary conditions were investigated: no restraints, rim restraints, equatorial restraints, and both rim and equatorial restraints. The finite element model with a conforming shell predicted between 8.5 and 12.8 microm of incremental extrusion of the polyethylene through the polar fenestration, consistent with in vitro experiments of the same design under identical loading conditions. Furthermore, idealized rim and/or equatorial liner restraints were found to share up to 71% of the load across the liner/shell interface. Consequently, the results of this study demonstrate that backside nonconformity and locking restraints substantially influence backside relative motion as well as load transfer at the liner/shell interface.

  8. Radiolucent lines below the tibial component of a total knee replacement (TKR) – a comparison between single-and two-stage cementation techniques

    PubMed Central

    Debnath, Ujjwal Kanti; Graham, Niall McKenzie

    2007-01-01

    Early non-progressive horizontal radiolucent lines (RLLs) (<2 mm) under the tibial component following cemented total knee replacement (TKR) are considered to result from poor cement injection into cancellous bone. These RLLs may facilitate the entry of joint fluid and wear debris into the interface, which may proceed to ballooning osteolysis. There is currently no consensus on the preferred cementing technique (single- versus two-stage cementation) in TKR. We have prospectively analysed postoperative radiographs in 50 consecutive TKRs to compare the RLLs following single- (25 TKRs) and two-stage (25 TKRs) cementation techniques. Of the TKR radiographs studied, 26 (52%) had RLLs; nine (36%) of these were single-stage TKRs, and 17 (68%) were two-stage TKRs. This study demonstrates that single-stage cementing may be superior to the two-stage technique in terms of avoiding RLLs in immediate postoperative TKRs. PMID:17364179

  9. Stair climbing is more detrimental to the cement in hip replacement than walking.

    PubMed

    Stolk, Jan; Verdonschot, Nico; Huiskes, Rik

    2002-12-01

    Stair climbing may be detrimental to cemented total hip arthroplasties, because it subjects the reconstruction to high torsional loads. The current study investigated how stair climbing contributes to damage accumulation in the cement around a femoral stem compared with walking, taking into account the different frequencies of these activities during patient functioning. In finite element analyses, the damage accumulation process in the cement mantle around a Lubinus SPII stem was simulated for three different loading histories: (1) isolated walking, representative for patients who climb no stairs; (2) isolated stair climbing; (3) alternating walking and stair climbing in a ratio of nine to one cycles, representative for patients who climb many stairs. Relative to isolated walking, isolated stair climbing increased the amount of cement damage by a factor of 6. Inclusion of 10% stair climbing cycles in the loading history increased the amount of damage by 47% relative to isolated walking. Stair climbing produced damage along the entire stem, whereas isolated walking produced damage proximomedially and around the tip only. This study confirmed that stair climbing is more risky for failure of cemented femoral stems than walking. A few stair climbing cycles during daily patient functioning increases the amount of cement damage dramatically.

  10. 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

  11. 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

  12. Management of acetabular fractures in the geriatric patient

    PubMed Central

    Hanschen, Marc; Pesch, Sebastian; Huber-Wagner, Stefan; Biberthaler, Peter

    2017-01-01

    Introduction: Open reduction and internal fixation (ORIF) is standard care for most acetabular fractures. With increasing numbers of acetabular fractures in the elderly, the risk of revision surgery and conversion to total hip replacement (THR) is increasing. Alarmingly, about 20–25% of acetabular fractures in the elderly following ORIF needed revision and conversion to delayed THR. Methods: Recently, prognostic factors have been identified, which correlate with an increased risk of worse outcomes following ORIF of acetabular fractures in the elderly patient. Patient risk factors include, for example, age, comorbidities, and degree of osteoporosis. Injury risk factors mainly include the fracture pattern. Results: The concept of primary THR following acetabular fractures is an alternative to ORIF, especially in the elderly patient. Satisfactory outcomes have been reported in different studies for primary THR following acetabular fractures in the elderly. The surgeon should be aware of strict selection criteria in order to achieve these satisfactory outcomes. Therefore, an individualized treatment plan has to be defined for elderly patients following acetabular fractures. Discussion: Here, the advantages and disadvantages of ORIF versus THR following acetabular fractures in the elderly are discussed. PMID:28534471

  13. 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.

  14. 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

  15. 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

  16. 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. Copyright 2000 John Wiley & Sons, Inc.

  17. More complications with uncemented than cemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly

    PubMed Central

    Chammout, Ghazi; Muren, Olle; Laurencikas, Evaldas; Bodén, Henrik; Kelly-Pettersson, Paula; Sjöö, Helene; Stark, André; Sköldenberg, Olof

    2017-01-01

    Background and purpose Total hip replacement (THR) is the preferred method for the active and lucid elderly patient with a displaced femoral neck fracture (FNF). Controversy still exists regarding the use of cemented or uncemented stems in these patients. We compared the effectiveness and safety between a modern cemented, and a modern uncemented hydroxyapatite-coated femoral stem in patients 65–79 years of age who were treated with THR for displaced FNF. Patients and methods In a single-center, single-blinded randomized controlled trial, we included 69 patients, mean age 75 (65–79) and with a displaced FNF (Garden III–IV). 35 patients were randomized to a cemented THR and 34 to a reverse-hybrid THR with an uncemented stem. Primary endpoints were: prevalence of all hip-related complications and health-related quality of life, evaluated with EuroQol-5D (EQ-5D) index up to 2 years after surgery. Secondary outcomes included: overall mortality, general medical complications, and hip function. The patients were followed up at 3, 12, and 24 months. Results According to the calculation of sample size, 140 patients would be required for the primary endpoints, but the study was stopped when only half of the sample size was included (n = 69). An interim analysis at that time showed that the total number of early hip-related complications was substantially higher in the uncemented group, 9 (among them, 3 dislocations and 4 periprosthetic fractures) as compared to 1 in the cemented group. The mortality and functional outcome scores were similar in the 2 groups. Interpretation We do not recommend uncemented femoral stems for the treatment of elderly patients with displaced FNFs. PMID:27967333

  18. 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.

  19. Postoperative Development of Bone Mineral Density and Muscle Strength in the Lower Limb After Cemented and Uncemented Total Hip Replacement

    PubMed Central

    Lindner, Tobias; Krüger, Christine; Kasch, Cornelius; Finze, Susanne; Steens, Wolfram; Mittelmeier, Wolfram; Skripitz, Ralf

    2014-01-01

    Background : Numerous studies have shown reduction of periprosthetic bone mineral density (BMD) after hip replacement. The effect on the whole limb, however, is still unexplored. This study’s objective was to analyse the postoperative development of BMD and muscle strength of the limb after total hip replacement (THR) and to determine links between these parameters. Methods : 55 patients, who underwent THR, were included. Depending on therapeutic indication, either an uncemented stem (Group A, n=30) or a cemented stem (Group B, n=25) has been implanted. In the limbs, the measurement of BMD using DEXA and the maximum isometric muscle strength, detected by a leg press, were undertaken preoperatively and after 3, 6 and 12 months. Results : A total of 12 patients (Group A: n = 6, Group B: n = 6) were excluded due to reasons which were not relevant to the study. So, the results refer to the data of 43 patients. In Group A (uncemented, n = 24), a significant decrease of BMD on the operated extremity was seen after 3, 6 and 12 months compared with preoperative values. Isometric muscle strength on the affected extremity increased significantly after 6 and 12 months. In Group B (cemented, n = 19), with a lower baseline compared to group A, an increase in BMD of the affected limb was seen postoperatively. This rise was significant after 12 months. With regard to the isometric muscle strength, a significant increase could be observed in this group after 6 and 12 months. Conclusion : Analogous to postoperative reduction of periprosthetic bone density, a decrease of the entire limb BMD on the operated leg occurred after implantation of uncemented hip stems. In contrast, an increase in BMD was recorded for cemented stems. Regardless of the type of anchoring, a substantial increase in muscular strength could be observed postoperatively in both groups. PMID:25246993

  20. Acetabular revision using a press-fit dual mobility cup.

    PubMed

    Massin, P; Besnier, L

    2010-02-01

    Dual mobility cups are especially indicated in total hip replacement revision, the risk of recurrent instability being greater than in primary surgery. In revision, however, primary cup fixation is uncertain without routine anchoring screws. The stability of dual mobility cups impacted without cement, supplementary screw(s) or anchoring pegs fixation is satisfactory in total hip arthroplasty acetabular component revision, and prevents instability accidents. Twenty three patients were operated on by the same surgeon between January 1999 and December 2006 and prospectively followed up to a mean 4 1/2 years (range,2-10 yrs). A Collégia cup (Wright Medical France, Créteil, France) was impacted in 23 total hip arthroplasty acetabular component revisions, including 17 cases of SOFCOT grade-1 bone-stock loss and six of grade 2. There were six clinically poor results on the Merle D'Aubigné scale. One case of early migration occurred, in a multioperated acetabulum. There was one isolated dislocation and one recurrent dislocation associated with loose greater trochanter nonunion, but tolerated as it was infrequent. This option simplifies revision surgery and limits the risk of dislocation if the abductor muscles unit is continuous. It is indicated when local bone-site compromise encompass a wall-contained cavitary defect at most. A medial wall defect, if moderate, does not in our view preclude using a primary cup, impacted with a certain degree of protrusion. Longer-term follow-up will be needed to confirm these medium-term findings. Level IV. Prospective non comparative therapeutic study. Elsevier Masson SAS. All rights reserved.

  1. Strong and tough magnesium wire reinforced phosphate cement composites for load-bearing bone replacement.

    PubMed

    Krüger, Reinhard; Seitz, Jan-Marten; Ewald, Andrea; Bach, Friedrich-Wilhelm; Groll, Jürgen

    2013-04-01

    Calcium phosphate cements are brittle biomaterials of low bending strength. One promising approach to improve their mechanical properties is reinforcement with fibers. State of the art degradable reinforced composites contain fibers made of polymers, resorbable glass or whiskers of calcium minerals. We introduce a new class of composite that is reinforced with degradable magnesium alloy wires. Bending strength and ductility of the composites increased with aspect ratio and volume content of the reinforcements up to a maximal bending strength of 139±41MPa. Hybrid reinforcement with metal and polymer fibers (PLA) further improved the qualitative fracture behavior and gave indication of enhanced strength and ductility. Immersion tests of composites in SBF for seven weeks showed high corrosion stability of ZEK100 wires and slow degradation of the magnesium calcium phosphate cement by struvite dissolution. Finally, in vitro tests with the osteoblast-like cell line MG63 demonstrate cytocompatibility of the composite materials.

  2. Periprosthetic acetabular fractures.

    PubMed

    Benazzo, Francesco; Formagnana, Mario; Bargagliotti, Marco; Perticarini, Loris

    2015-10-01

    The aim of this article is to propose a diagnostic and therapeutic algorithm for the acetabular periprosthetic fractures. This article explores the current literature on the epidemiology, causes and classification of periprosthetic acetabular fractures. Integrating data with the experience of the authors, it offers a guide to diagnosis and possible therapeutic strategies. Intra-operative fractures can occur during rasping, reaming or implant impaction, and they must be treated immediately if the component(s) is (are) unstable. Post-operative fractures can be due to major trauma (acute fractures) or minor forces in bone osteolysis; it is possible to plan reconstruction and fixation according to fracture characteristics. Treatment choice depends upon fracture site and implant stability. Periprosthetic acetabular fractures are uncommon complications that can occur intra-operatively or post-operatively, and a reconstructive surgeon must be able to manage the procedure. Accurate planning and reconstruction implant are necessary to achieve good cup stability.

  3. Pulmonary function during and after total hip replacement. Findings in patients who have insertion of a femoral component with and without cement.

    PubMed

    Ries, M D; Lynch, F; Rauscher, L A; Richman, J; Mick, C; Gomez, M

    1993-04-01

    Eleven patients who had a femoral component inserted with cement and twenty-three who had a femoral component inserted without cement were studied prospectively for changes in the pulmonary shunt associated with total hip replacement. The levels of oxygen in the arterial blood and the platelet counts were measured preoperatively and each morning for three days after the arthroplasty. Levels of oxygen in the arterial blood were determined intraoperatively, once before and once after the femoral component was inserted. Intraoperative shunt values increased 28 per cent when a femoral component was inserted with cement (p < 0.05), but they did not change when cement was not used. The average postoperative shunt values were higher than the average preoperative shunt values for both groups of patients, but only the values on the second postoperative day after a procedure with cement were significantly higher (p < 0.05). The ability of the patient to tolerate an increase in pulmonary shunt should be assessed when the femoral component is to be cemented during total hip replacement.

  4. 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

    2015-06-02

    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.

  5. Trabecular metal acetabular revision system (cup-cage construct) to address the massive acetabular defects in revision arthroplasty

    PubMed Central

    Malhotra, Rajesh; Kancherla, Ramprasad; Kumar, Vijay; Soral, Aditya

    2012-01-01

    The increasing number of total hip replacements in the younger clique has added to the demand for revision procedures. Revision situations are often encountered with infection, loss of bone stock and bone defects. There are various methods of reconstruction of acetabular defects. The management options of type 3B Paprosky acetabular defects are limited with allograft and conventional cages. Trabecular metal technology has evolved to address these bone defects. Trabecular metal acetabular revision system (TMARS) cup-cage construct is a new technique to address massive acetabular defects. We describe a case of failed hip reconstruction done for a Giant cell tumour of proximal femur managed by a two stage procedure, initial debridement and second stage reconstruction of acetabulum with TMARS cup-cage construct and femur with allograft prosthesis composite. PMID:22912527

  6. Cementless acetabular revision arthroplasty

    PubMed Central

    Jain, Rina; Schemitsch, Emil H.; Waddell, James P.

    2000-01-01

    Objective To evaluate the effects of clinical factors on outcome after acetabular revision with a cementless beaded cup. Design Retrospective case series. Setting Tertiary care referral centre. Patients Forty-one patients who underwent acetabular revision with a cementless cup were followed up for a mean of 3.4 years. Interventions Acetabular revision with a beaded cementless cup in all patients. A morcellized allograft was used in 10 patients. Outcome measures A modified Harris hip score (range of motion measurement omitted), the SF-36 health survey, and the Western Ontario McMaster (WOMAC) osteoarthritis index. Multivariate analysis was used to evaluate the effects of age, gender, morcellized allografting, time to revision from the previous operation, acetabular screw fixation and concurrent femoral revision on outcome. Results Gender accounted for a significant portion of the variation seen in the SF-36 physical component scores (r = 0.36, p = 0.02), with women tending to have worse results. Increasing age was associated with lower WOMAC index function scores (r = 0.36, p = 0.03), whereas concurrent femoral revision tended to have a positive effect on WOMAC index function (r = 0.39, p = 0.01). None of the potential clinical predictors had any significant effect on the SF-36 mental component scores, or WOMAC index pain and stiffness scores. Conclusions In cementless acetabular revision arthroplasty, physical function, as measured by generic and limb-specific scales, may be affected by gender, age and the presence of a concurrent femoral revision. Time to revision from the previous operation, morcellized allografting and screw fixation of the acetabulum did not affect outcomes. This information may provide some prognostic value for patients’ expectations. PMID:10948687

  7. 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. Copyright © 2010 Elsevier B.V. All rights reserved.

  8. The cemented twin-peg Oxford partial knee replacement survivorship: a cohort study.

    PubMed

    White, Stephen H; Roberts, Sharon; Kuiper, Jan Herman

    2015-09-01

    A new twin-peg version of the Oxford knee was introduced in 2003. However, until now there has been no information about its survivorship. The aim of this study was to determine the survivorship, and the patients' perception of outcome over time. A cohort of all patients treated from 2003 until 2009 using the twin-peg Oxford partial knee was contacted. The main indication for treatment was anteromedial osteoarthritis (AMOA). The Oxford Knee Score (OKS), American Knee Society Functional (AKS-F) score and satisfaction rate were obtained, and the time-to-failure was used to perform a survival analysis. There were 249 patients treated, with 288 medial cemented implants. Of these, 248 patients with 287 implants could be contacted and implant survival or failure was verified. Their mean age was 67years (range: 34-94). The mean follow-up time was 5.1years (maximum: 9.2). The nine years cumulative implant survival rate for all cases using revision for any reason to define failure was 98% (95% CI, 84 to 100). There were no cases of femoral loosening. The mean OKS was 22 pre-operatively, 41 at two years, and 41 at final review, at which point 96% of patients were very or fairly pleased with the result. The survivorship of the twin-peg knee was better than that of the single peg knee at our centre, and appeared no worse than the results of the single peg knee at the originating centre. It can offer secure femoral fixation, sustained clinical benefit and patient satisfaction. Level IV case-series. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. Determination of interfacial fracture toughness of bone–cement interface using sandwich Brazilian disks

    PubMed Central

    Tong, J.; Wong, K.Y.; Lupton, C.

    2007-01-01

    The long-term stability of cemented total hip replacements critically depends on the lasting integrity of the bond between bone and bone cement. Conventionally, the bonding strength of bone–cement is obtained by mechanical tests that tend to produce a large variability between specimens and test methods. In this work, interfacial fracture toughness of synthetic bone–cement interface has been studied using sandwiched Brazilian disk specimens. Experiments were carried out using polyurethane foams as substrates and a common bone cement as an interlayer. Selected loading angles from 0° to 25° were used to achieve full loading conditions from mode I to mode II. Finite element analyses were carried out to obtain the solutions for strain energy release rates at given phase angles associated with the experimental models. The effects of crack length on the measured interfacial fracture toughness were examined. Microscopic studies were also carried out to obtain the morphology of the fractured interfaces at selected loading angles. The implication of the results on the assessment of fixation in acetabular replacements is discussed in the light of preliminary work on bovine cancellous bone–cement interface. PMID:19330043

  10. Stresses in cement mantles of hip replacements: effect of femoral implant sizes, body mass index and bone quality.

    PubMed

    Lamvohee, J-M S; Mootanah, R; Ingle, P; Cheah, K; Dowell, J K

    2009-10-01

    The effects of femoral prosthetic heads of diameters 22 and 28 mm were investigated on the stability of reconstructed hemi-pelves with cement mantles of thicknesses 1-4 mm and different bone qualities. Materialise medical imaging package and I-Deas finite element (FE) software were used to create accurate geometry of a hemi-pelvis from CT-scan images. Our FE results show an increase in cement mantle stresses associated with the larger femoral head. When a 22 mm femoral head is used on acetabulae of diameters 56 mm and above, the probability of survivorship can be increased by creating a cement mantle of at least 1 mm thick. However, when a 28 mm femoral head is used, a cement mantle thickness of at least 4 mm is needed. Poor bone quality resulted in an average 45% increase in the tensile stresses of the cement mantles, indicating resulting poor survivorship rate.

  11. Current attitudes to total hip replacement in the younger patient: results of a national survey.

    PubMed

    Tennent, T D; Goddard, N J

    2000-01-01

    A postal questionnaire was sent to all practicing consultant orthopaedic surgeons in the UK seeking information regarding their usual total hip replacement practice, the age at which they would define a patient as falling into the 'young hip group' and whether this might modify their practice. In particular, in the 'younger' age group, we were interested in the frequency of usage of uncemented implants, the choice of implant and the bearing surfaces. Of 1242 surgeons surveyed, we had a response from 935 who currently undertake total hip arthroplasty. Their responses confirm that approximately 60,645 total hip replacements are performed annually in the UK of which 9,376 are performed in the younger age group (mean age 57.5 years). As with our previous survey, the most popular prosthesis in the 'older' age group overall was the Charnley (51%) followed by the Exeter (15%). These implants also proved to be the most popular in the 'younger' age group (40% Charnley, 18% Exeter), with 75% of surgeons choosing a cemented stem, and 65% also opting to cement the socket. 23% of surgeons used hydroxy-apatite coated implants on both the femoral and acetabular sides of the joint. Stainless steel remained the most popular choice of femoral head bearing surface (42%) followed by chrome-cobalt (33%) and ceramic (25%). On the acetabular side, high density polyethylene predominated--accounting for 95%, with only 3% using chrome cobalt and 2% ceramic. There would appear to be a remarkably conservative attitude among British surgeons, the majority of whom prefer to stick with tried and tested cemented femoral implants when dealing with the younger patient. There are a small number of uncemented acetabulae and the hybrid configuration. Hydroxy-apatite coatings seem to be the most popular choice for the non-cemented prostheses. Ceramic femoral heads are used more frequently than the ceramic acetabular bearing, and equally metal/metal bearings remain infrequently used.

  12. Symposium on Surface Replacement Arthroplasty of the Hip. Biomechanics: mutifactorial design choices--an essential compromise?

    PubMed

    Clarke, I C

    1982-10-01

    The main flaws to be overcome in realizing the potential success of the double-cup arthroplasty procedure are failures due to femoral cup loosening, acetabular cup loosening, and femoral-neck fractures. The clinical uncertainties include the selection of a suitable patient with adequate bone stock and the technical difficulties associated with (I) reaming the acetabulum adequately, (2) reaming down onto the neck without violating it, and (3) anchoring the components securely by interdigitation of acrylic cement. The higher frictional torques of the double-cup arthroplasty designs are not a clinical loosening issue--the resulting acetabular cement-bone shear stresses are very low. Computer models of both the femoral and acetabular components predict significant stress shielding of the cancellous bone under metal femoral shells. At the rim of the femoral cup, the stresses are increased by a factor of 3 owing to the stress concentration effect and can rise to a factor of 10 if cystic or osteoporotic changes are present. This finding if confirmed in the three-dimensional models may explain some of the femoral neck fractures. The thin polyethylene acetabular cups may also cause a stress concentration effect on the underlying cement and bone. This may explain the higher incidence of radiographic loosening around the acetabulum in double-cup arthroplasty designs compared with total hip replacements. Metal-backed sockets may reduce cancellous bone stresses and appear advantageous. There is no clinical evidence of unusual wear or wear-related problems. However, new material formulations are now either in use or being planned for the double-cup arthroplasty designs. As yet, there have been no published data on hip simulator wear for the efficacy of any of the current or proposed changes. Biologic fixation appears to be the theme for the 1980s. However, the combination of technology, design instrumentation, and patient selection will be critical in achieving success with this

  13. A novel method to assess primary stability of press-fit acetabular cups.

    PubMed

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

    2014-11-01

    Initial stability is an essential prerequisite to achieve osseointegration of press-fit acetabular cups in total hip replacements. Most in vitro methods that assess cup stability do not reproduce physiological loading conditions and use simplified acetabular models with a spherical cavity. The aim of this study was to investigate the effect of bone density and acetabular geometry on cup stability using a novel method for measuring acetabular cup micromotion. A press-fit cup was inserted into Sawbones(®) foam blocks having different densities to simulate normal and osteoporotic bone variations and different acetabular geometries. The stability of the cup was assessed in two ways: (a) measurement of micromotion of the cup in 6 degrees of freedom under physiological loading and (b) uniaxial push-out tests. The results indicate that changes in bone substrate density and acetabular geometry affect the stability of press-fit acetabular cups. They also suggest that cups implanted into weaker, for example, osteoporotic, bone are subjected to higher levels of micromotion and are therefore more prone to loosening. The decrease in stability of the cup in the physiological model suggests that using simplified spherical cavities to model the acetabulum over-estimates the initial stability of press-fit cups. This novel testing method should provide the basis for a more representative protocol for future pre-clinical evaluation of new acetabular cup designs.

  14. Evolution and future of surface replacement of the hip.

    PubMed

    Amstutz, H C; Grigoris, P; Dorey, F J

    1998-01-01

    Surface replacement is a bone-conserving alternative to total hip arthroplasty and is a significant development in the evolution of hip arthroplasty. Surface replacement with polyethylene bearings was largely abandoned, primarily because of component aseptic loosening caused by tissue reaction to high-volumetric polyethylene wear. For patients with osteonecrosis and collapse of the femoral head but with preservation of some acetabular articular cartilage, precision fit, hemisurface replacement of the femoral head only has emerged as the treatment of choice. The survivorship of our series of patients, performed in the 1981-84 era (average age, 32 years), has been 85% at 5 years, 67% at 10 years, and 42% at 16 years. In the absence of polyethylene, there has been no loosening. Revisions were for cartilage wear. The procedure is now much improved with instrumentation for non-trochanteric osteotomy approaches and off-the-shelf components in 1-mm increments. For arthritic hips, a new era of surface replacement has emerged. With metal-on-metal bearings, the volumetric wear has been reduced 20-100 times from those with polyethylene, and there is no penalty for the large ball size. The devices are now conservative on the acetabular as well as femoral side. Hybrid or all-cementless fixation is superior to earlier all-cemented devices. In those patients, the results with up to 4 years have been complication-free, with an absence of pain and a return to high functional levels, including participation in sports. Forty patients have received a Conserve Plus with interference fitting of the acetabular component with sintered beads to obtain fixation. Although the follow-up is short, surface replacement with the large ball size is extremely stable, and dislocation is rare.

  15. Autopsy studies of the bone-cement interface in well-fixed cemented total hip arthroplasties.

    PubMed

    Schmalzried, T P; Maloney, W J; Jasty, M; Kwong, L M; Harris, W H

    1993-04-01

    Although knowledge of the clinical status of the implant is important, only instrumented mechanical testing of retrieved specimens provides quantitative assessment of implant fixation. This measurement allows placement of the implant along a continuum of loosening and is the foundation for the interpretation of subsequent findings. Analysis of implants that have been proven to be well fixed by instrumented testing reveals significant differences in the initial events in the loosening of femoral and acetabular components. Although radiolucencies were observed around all of these well-fixed femoral and acetabular components, the histology (and therefore the etiology) of the radiolucency is different and variable on the two sides of the articulation. The majority of femoral radiolucencies appear to be due to age and stress-related remodeling while particulate-induced bone resorption plays an important role in acetabular radiolucencies. A finding common to both sides of the articulation in these stable components, however, was intimate contact of bone with cement without any interposed soft tissue even after 17.5 years of service. Primary incompatibility and/or failure of the cement was not identified as a factor in initiating either femoral or acetabular component loosening. These studies document the long-term compatibility of bone with cement in bulk form. Improvements in cemented femoral component fixation should focus on stem design and cementing technique. Long-term acetabular component fixation can be improved by reduction or elimination of polyethylene wear and optimization of the bone-implant interface.

  16. 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

  17. 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.

  18. Total arthroplasty in displaced dysplastic hips with acetabular reconstruction and femoral shortening - technical note.

    PubMed

    Silva, Paulo; de Oliveira, Leandro Alves; Coelho, Danilo Lopes; do Amaral, Rogério Andrade; Rebello, Percival Rosa; de Moraes, Frederico Barra

    2014-01-01

    To describe a new procedure of total hip replacement in patient with severe developmental dysplasia of the left hip, using technique of acetabular reconstruction with autogenous bone grafts and subtrochanteric shortening femoral osteotomy. Total hip replacement done in January of 2003. The Eftekhar's classification was used and included type D, neglected dislocations. Bone graft incorporated in acetabular shelf and femoral osteotomy. Our contribution is the use of an Allis plate to better fix acetabular grafts, avoiding loosening, and cerclage around bone graft in femoral osteotomy site, which diminish pseudoarthrosis risk. This technique shows efficiency, allowing immediately resolution for this case with pain and range of motion of hip improvement. It also allows the acetabular dysplasia reconstruction, equalization of the limb length (without elevated risk of neurovascular lesion) and repairs the normal hip biomechanics due to the correction of the hip's center of rotation.

  19. [Intrafemoral pressure measurement in different cement removal procedures during hip prosthesis replacement operations--experimental study with cadaver femora].

    PubMed

    Porsch, M; Schmidt, J; Brimmers, P; Menne, A; Merkle, W

    1998-03-01

    During primary hip arthroplasty an increase in intramedullary pressure (IMP) of up to 1000 mm Hg can be observed. As a result of this increased intrafemoral pressure, intramedullary constituents can pass into the venous circulation creating a risk of fat embolism syndrome (FES). In the present experimental study on 9 femora obtained from human corpses, we investigated the question as to whether various methods of cement removal during total hip revision arthroplasty are also associated with increased intramedullary pressure and a risk of FES. The IMP was recorded with a standardized experimental set-up during removal of cement from the proximal and distal regions, including removal of the cement "tip" and the intramedullary plug. The methods employed for this purpose included the osteotome and mallet, a compressed air powered chisel, and a modified intracorporal lithotripter. All the methods induced fluctuations in the IMP the highest values being recorded for the conventional method using the osteotome and mallet (45 mm Hg) and the lowest values for the intracorporeal lithotripter (7.5 mm Hg). Working on the distal cement caused higher fluctuations in comparison with the proximal region. The study failed to reveal any increase in mean IMP, and all measured values were in the low pressure range (considerably below 150 mm Hg). While there seems to be no apparent risk of an FES developing during removal of cement, careless manipulation of the distal cement plug may result in higher intrafemoral pressures--above 150 mm Hg--thus increasing the risk of a fat embolism syndrome.

  20. [Biological acetabular defect reconstruction in revision hip arthroplasty using impaction bone grafting and an acetabular reconstruction ring].

    PubMed

    Friedrich, M J; Gravius, S; Schmolders, J; Wimmer, M D; Wirtz, D C

    2014-04-01

    Management of acetabular bone defects Paprosky types IIa and IIb in revision hip arthroplasty by rebuilding the bone stock using impaction bone grafting, primary stable reconstruction with an acetabular reconstruction ring, and restoring the hip center of rotation to its anatomical position. Acetabular segmental or combined structural defects in the superior acetabular dome with superior/lateral hip center migration with intact anterior and posterior columns (Paprosky types IIa, IIb). Acute or chronic infections, severe acetabular bone defects preventing adequate anchorage of the prosthesis-particularly destruction of the posterior column. Modified transgluteal, lateral approach to the hip joint. Removal of the loose acetabular component. Complete circumferential exposure of the acetabular rim, while maintaining mechanical stability of the remaining bone. Preparation of the homologous spongiosa chips and reconstruction of the acetabular defect in impaction grafting technique. Implantation of the acetabular reconstruction ring and primary stable fixation with cancellous screws in the acetabular dome. Cemented fixation of a polyethylene inlay. Mobilization on 2 underarm crutches from postoperative day 1. Partial weight bearing with 20 kg for 6 weeks postoperatively. If plain radiographs show unchanged seating of the prosthesis after 6 weeks, loading can be increased by 10 kg/week until full weight bearing is achieved; thrombosis prophylaxis is continued throughout. Limitation of hip flexion to 90° during the first 6 weeks, and no adduction and forced external rotation to avoid dislocation. Avoidance of sports involving jumping and axial impact loading for 12 months. Radiologic checkups after 3, 6, and 12 months and, thereafter, every 2 years. Analysis between 2008 and 2011 involved 22 consecutive patients with a total of 23 prostheses; the mean follow-up was 38 ± 11 months. Compared to the preoperative evaluation, follow-up yielded a significant

  1. Cementless acetabular revision: past, present, and future

    PubMed Central

    Pulido, Luis; Rachala, Sridhar R.

    2011-01-01

    Background Acetabular revision is probably the most difficult aspect of hip reconstructive surgery. Although the majority of acetabular revisions can be performed using an uncemented hemispherical acetabular device with ancillary fixation, patients with severe acetabular deficiencies and poor bone quality require more complex alternatives for revision. The limitations of traditional cementless acetabular implants has promoted the development of improved methods of fixation and revision techniques. 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, optimising biological fixation. The use of trabecular metal cups in acetabular revision has yielded excellent clinical results. Purpose This review focuses on the use of cementless implants for acetabular revision. The use of trabecular metal cups, augments, jumbo cups, oblong cups, cages, and structural grafting are also discussed. PMID:21234562

  2. A biocompatible and bioactive replacement for dentine: is this a reality? The properties and uses of a novel calcium-based cement.

    PubMed

    Bachoo, I K; Seymour, D; Brunton, P

    2013-01-01

    As part of the continuing evolution towards conservative dentistry there has been a drive to push further and investigate the possibility of inducing the repair and regeneration of lost dental hard tissue. Until recently, the prospect of repair and regeneration had been confined to laboratory studies and hypothesised scientific models. In 2009, a new product was launched claiming to be a revolutionary material capable of offering a bioactive and biocompatible replacement for dentine. The calcium-based cement is reported to preserve pulp vitality, promote pulp healing and provide a natural substitute for dentine through bioactive stimulation of the dentino-pulpal complex. Its clinical indications are extensive, described as a restorative material suitable for use wherever dentine replacement is required. In this article the physical, mechanical, chemical and biological properties of this novel material are presented, together with the results of experimental laboratory-based investigations and on-going clinical in vivo investigations.

  3. Cavitary acetabular defects treated with morselized cancellous bone graft and cementless cups

    PubMed Central

    Pereira, G. C.T.; Kubiak, E. N.; Levine, B.; Chen, F. S.

    2006-01-01

    The use of impacted morselized cancellous bone grafts in conjunction with cementless hemispherical acetabular cups for treatment of AAOS type II acetabular cavitary deficiencies was evaluated in a retrospective study of 23 primary and 24 revision total hip arthroplasties, at a mean follow-up of 7.9 and 8.1 years, respectively. All primary hips received autografts, while all revision hips received allografts. Modified Harris Hip Scores for primary and revision hip replacements increased from a pre-operative mean of 37 and 47 to a postoperative mean of 90 and 86, respectively. All 23 autografts and 23 out of 24 cancellous allografts were radiographically incorporated without evidence of resorption. There were no instances of infection, component migration, or cases requiring subsequent acetabular revision. We conclude that impacted morselized cancellous bone-graft augmentation of cementless cups is a viable surgical option for AAOS type II cavitary acetabular defects. PMID:16988799

  4. 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.

  5. Early failure mechanisms of constrained tripolar acetabular sockets used in revision total hip arthroplasty.

    PubMed

    Cooke, Christopher C; Hozack, William; Lavernia, Carlos; Sharkey, Peter; Shastri, Shani; Rothman, Richard H

    2003-10-01

    Fifty-eight patients received an Osteonics constrained acetabular implant for recurrent instability (46), girdlestone reimplant (8), correction of leg lengthening (3), and periprosthetic fracture (1). The constrained liner was inserted into a cementless shell (49), cemented into a pre-existing cementless shell (6), cemented into a cage (2), and cemented directly into the acetabular bone (1). Eight patients (13.8%) required reoperation for failure of the constrained implant. Type I failure (bone-prosthesis interface) occurred in 3 cases. Two cementless shells became loose, and in 1 patient, the constrained liner was cemented into an acetabular cage, which then failed by pivoting laterally about the superior fixation screws. Type II failure (liner locking mechanism) occurred in 2 cases. Type III failure (femoral head locking mechanism) occurred in 3 patients. Seven of the 8 failures occurred in patients with recurrent instability. Constrained liners are an effective method for treatment during revision total hip arthroplasty but should be used in select cases only.

  6. 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.

  7. Acetabular revision in THA using tantalum augments combined with impaction bone grafting.

    PubMed

    Gehrke, Thorsten; Bangert, Yannic; Schwantes, Bernd; Gebauer, Matthias; Kendoff, Daniel

    2013-01-01

    Acetabular revision with associated bone loss in uncontained defects can be difficult. We report preliminary results utilising a novel technique, combining tantalum-augments with allograft bone and cemented cups. Forty-six patients undergoing cup revision with a tantalum augment and allografting were clinically (HHS) and radiographically reviewed at an average of 46 months postoperatively. There were 28 type-2B and 18 type-3A Paprosky defects. Postoperative images were assessed for osteointegration, bone-remodelling and recreation of the native hip centre. The average patient age at time of acetabular revision was 65 years, with 18 male and 28 female patients. The HHS improved on average from 44 to 82 points. Correction of the high hip centre was possible in all patients with average medialisation of 10 mm and lowering of the hip centre by 14 mm. Four patients (four hips) sustained a hip dislocation postoperatively and one required revision. Two acetabular revisions were necessary after implantation, because of early cup loosening and failure of the construct. In one of these, the tantalum augment was found to be well fixed. Of the remaining hips, at latest radiographic follow-up, 44 tantalum implants were radiographically stable and osteointegrated. Non-progressive radiolucent lines were present around the acetabular component in two other hips. The combination of tantalum-augmentation with impaction allografting is a promising technique to manage severe uncontained acetabular defects.

  8. Average 12-year outcome of a chrome-cobalt, beaded, bony ingrowth acetabular component.

    PubMed

    Smith, S E; Estok, D M; Harris, W H

    1998-01-01

    Seventy-two hips (67 patients) were reconstructed with the Acetabular Reconstruction Component (ARC, Howmedica, Rutherford, NJ), a chrome-cobalt component with sintered ingrowth beads and peripheral flanges for screw fixation. All the materials used in the ARC (metal, porous layer, and polyethylene) are identical to those used in the Porous Coated Anatomic (PCA) acetabular component (Howmedica), but the design is different. To determine the importance of design features alone, clinical results obtained with the 2 different designs made of identical materials were compared. The average follow-up period for patients with the ARC was 12 years (range, 10-13.3 years). Seven patients (7 hips) with the ARC died prior to the minimum 10-year follow-up period, none having undergone revision procedures. Overall, 3 acetabular components (4%) in 3 patients were revised, at an average of 8.5 years (range, 7.6-9.3 years) from the index operation. The reasons for revision were aseptic loosening, third-body polyethylene wear observed during a revision for femoral lysis, and acetabular component malposition and recurrent dislocation. The total incidence of acetabular aseptic loosening was 4% (3 of 72 hips). Pelvic osteolysis occurred in 3 cases (4%). In contrast, the incidence of acetabular revision of the PCA acetabular component at follow-up periods of 2-10 years is reported to be as high as 11% (range, 3-11%). Rates of aseptic loosening are as high as 30% (range, 3-30%) at substantially shorter follow-up periods, and the incidence of pelvic osteolysis associated with the PCA component is also as high as 30% (range, 5-30%). These differences may reflect differences in design between the 2 acetabular components, as the materials used were identical. In this, the longest reported average follow-up study of a successful cementless acetabular component, the aseptic loosening rate of 4% contrasts with the 42% rate at similar follow-up duration for cemented acetabular components placed

  9. Total arthroplasty in displaced dysplastic hips with acetabular reconstruction and femoral shortening – technical note☆☆☆

    PubMed Central

    Silva, Paulo; de Oliveira, Leandro Alves; Coelho, Danilo Lopes; do Amaral, Rogério Andrade; Rebello, Percival Rosa; de Moraes, Frederico Barra

    2014-01-01

    To describe a new procedure of total hip replacement in patient with severe developmental dysplasia of the left hip, using technique of acetabular reconstruction with autogenous bone grafts and subtrochanteric shortening femoral osteotomy. Total hip replacement done in January of 2003. The Eftekhar's classification was used and included type D, neglected dislocations. Bone graft incorporated in acetabular shelf and femoral osteotomy. Our contribution is the use of an Allis plate to better fix acetabular grafts, avoiding loosening, and cerclage around bone graft in femoral osteotomy site, which diminish pseudoarthrosis risk. This technique shows efficiency, allowing immediately resolution for this case with pain and range of motion of hip improvement. It also allows the acetabular dysplasia reconstruction, equalization of the limb length (without elevated risk of neurovascular lesion) and repairs the normal hip biomechanics due to the correction of the hip's center of rotation. PMID:26229775

  10. [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.

  11. Treatment of periprosthetic acetabular fractures after previous hemi- or total hip arthroplasty: Introduction of a new implant.

    PubMed

    Resch, H; Krappinger, D; Moroder, P; Blauth, M; Becker, J

    2016-04-01

    Treatment of displaced periprosthetic acetabular fractures in elderly patients. The goal is to stabilize an acetabular fracture independent of the fracture pattern, by inserting the custom-made roof-reinforcement plate and starting early postoperative full weight-bearing mobilization. Acetabular fracture with or without previous hemi- or total hip arthroplasty. Non-displaced acetabular fractures. Watson-Jones approach to provide accessibility to the anterior and supraacetabular part of the iliac bone. Angle-stable positioning of the roof-reinforcement plate without any fracture reduction. Cementing a polyethylene cup into the metal plate and restoring prosthetic femoral components. Full weight-bearing mobilization within the first 10 days after surgery. In cases of two column fractures, partial weight-bearing is recommended. Of 7 patients with periprosthetic acetabular fracture, 5 were available for follow-up at 3, 6, 6, 15, and 24 months postoperatively. No complications were recognized and all fractures showed bony consolidation. Early postoperative mobilization was started within the first 10 days. All patients except one reached their preinjury mobility level. This individual and novel implant is custom made for displaced acetabular and periprosthetic fractures in patients with osteopenic bone. It provides a hopeful benefit due to early full weight-bearing mobilization within the first 10 days after surgery. In case of largely destroyed supraacetabular bone or two-column fractures according to Letournel additional synthesis via an anterior approach might be necessary. In these cases partial weight bearing is recommended.

  12. [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.

  13. 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.

  14. Improving the accuracy of acetabular cup implantation using a bulls-eye spirit level.

    PubMed

    Macdonald, Duncan; Gupta, Sanjay; Ohly, Nicholas E; Patil, Sanjeev; Meek, R; Mohammed, Aslam

    2011-01-01

    Acetabular introducers have a built-in inclination of 45 degrees to the handle shaft. With patients in the lateral position, surgeons aim to align the introducer shaft vertical to the floor to implant the acetabulum at 45 degrees. We aimed to determine if a bulls-eye spirit level attached to an introducer improved the accuracy of implantation. A small circular bulls-eye spirit level was attached to the handle of an acetabular introducer. A saw bone hemipelvis was fixed to a horizontal, flat surface. A cement substitute was placed in the acetabulum and subjects were asked to implant a polyethylene cup, aiming to obtain an angle of inclination of 45 degrees. Two attempts were made with the spirit level masked and two with it unmasked. The distance of the air bubble from the spirit level's center was recorded by a single assessor. The angle of inclination of the acetabular component was then calculated. Subjects included both orthopedic consultants and trainees. Twenty-five subjects completed the study. Accuracy of acetabular implantation when using the unmasked spirit level improved significantly in all grades of surgeon. With the spirit level masked, 12 out of 50 attempts were accurate at 45 degrees inclination; 11 out of 50 attempts were "open," with greater than 45 degrees of inclination, and 27 were "closed," with less than 45 degrees. With the spirit level visible, all subjects achieved an inclination angle of exactly 45 degrees. A simple device attached to the handle of an acetabular introducer can significantly improve the accuracy of implantation of a cemented cup into a saw bone pelvis in the lateral position.

  15. [Periprosthetic acetabular fractures in geriatric patients].

    PubMed

    Herath, S C; Rollmann, M F R; Histing, T; Holstein, J H; Pohlemann, T

    2017-02-01

    Periprosthetic acetabular fractures in geriatric patients are rare injuries; however, the incidence is increasing because of the current demographic developments. For diagnosis of periprosthetic acetabular fractures, conventional X‑ray images are regularly complemented by computed tomography (CT). For exclusion of loosening of the prosthesis more advanced techniques, such as single photon emission CT (SPECT/CT) are applied. In addition to classification of periprosthetic acetabular fractures by the traditional system of Letournel there are several other classification systems, which take into account the etiology of the fracture and the stability of the prosthesis. While, under certain circumstances conservative treatment of periprosthetic acetabular fractures is possible, operative treatment often requires extensive surgical procedures to restore the stability of the acetabulum as a support for the cup of the prosthesis. Besides the traditional techniques of acetabular osteosynthesis, special revision systems, augmentations and allografts are used for the reconstruction of periprosthetic acetabular fractures. To determine a therapeutic regimen patient-specific preconditions as well as fracture pattern and type of prosthesis need to be taken into account. In the literature there are several algorithms, which are aimed at supporting the attending physician in making the correct decision for the treatment of periprosthetic acetabular fractures. In cases of periprosthetic acetabular fractures even experienced surgeons are faced with great challenges. Thus, treatment should be carried out in specialized centers.

  16. Femoral nerve lesion in total hip replacement: an experimental study.

    PubMed

    Heller, K D; Prescher, A; Birnbaum, K; Forst, R

    1998-01-01

    A total of 20 hip joints of 10 non-fixed corpses were examined within 48 h of death to measure the pressure below the inguinal ligament simulating the surgical conditions during total hip arthroplasty. The purpose of this study was to assess the influence of various leg positions and insertion techniques of retractors during the surgical procedure for total hip replacement in order to detect supposed causes for indirect pressure injuries of the femoral nerve. The obtained results verified no increase of pressure in the inguinal canal which could explain an indirect injury of the femoral nerve. If the retractor is inserted correctly at the anterior acetabular rim, the pressure in the lacuna musculorum can even be reduced, and furthermore, the femoral nerve is protected by the iliopsoas muscle. Femoral nerve lesions which have been published so far can only be explained by an incorrect use of instruments or implants (e.g., screws, cement, acetabular cup) or an extreme postoperative leg length discrepancy.

  17. Quantification of clearance and creep in acetabular wear measurements.

    PubMed

    Saffarini, Mo; Gregory, Thomas; Vandenbussche, Eric

    2016-04-01

    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. 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. 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). 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.

  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. Geometric analysis and clinical outcome of two cemented stems for primary total hip replacement with and without modular necks.

    PubMed

    Haversath, Marcel; Wendelborn, Christine; Jäger, Marcus; Schmidt, Boris; Kowalczyk, Wojciech; Landgraeber, Stefan

    2017-09-15

    Restoration of the physiological biomechanical principles of the hip is crucial in total hip replacement. The aim of this study was to compare an arthroplasty system with different offset options (a: Exeter(®)) with a dual-modular stem (b: Profemur Xm(®)). A local and an inertial coordinate system were used to assist the description of the components' assembly in the prosthesis. A resection line of the femoral head in standard position was added to the arthroplasties and geometric parameters were measured. The outcomes of 93 patients were clinically evaluated (a: n = 50, b: n = 43). Preoperative planning was compared to postoperative radiographs (femoral offset, leg-length), and clinical scores (HHS, WOMAC, total range of motion) were assessed preoperatively, and then 1 and 2 years after surgery. The Exeter(®) offers an offset range from 32.1 to 56.9 mm and the Profemur Xm(®) a range from 29.3 to 55.3 mm. The leg-length variability of the Profemur Xm(®) has a range of 25.9 mm, the Exeter(®) a range of 13.7 mm. The Profemur Xm(®) offers more possible combinations of offset and leg-length reconstruction. The neck-stem angles of the Exeter(®) range from 125.2° to 126.3°, of the Profemur Xm(®) from 127.2° to 142.6°. There was no statistically significant difference in clinical outcome and radiological parameters. We conclude that both stems offer a wide range of options for anatomical reconstruction of the hip resulting in similarly good clinical results. The Profemur Xm(®) stem has advantages for the reconstruction of hips that deviate from standard anatomy but has the drawback of additional corrosive wear at the stem/neck interface.

  20. Interfacial fracture toughness of synthetic bone-cement interface

    PubMed Central

    Tong, J

    2008-01-01

    Conventionally, the bonding strength of bone-cement interface is obtained by mechanical strength testing which tends to produce large variability between specimens and test methods. In this work, interfacial fracture toughness of synthetic bone-cement interface has been determined using sandwiched Brazilian disk specimens. Experiments were carried out under selected loading angles from 0 to 25 degrees to achieve full loading conditions from mode I to mode II. Solutions for complex stress intensity factors as well as strain energy release rates were obtained for a sandwich disk with a finite interlayer using the finite element method. Phase angles were obtained at a fixed distance to the crack tip. The fracture loads were obtained from the load displacement curves and the values of interfacial fracture toughness were calculated from the fracture loads and the finite element J-integral solutions. The implication of this information on the assessment of fixation in acetabular replacements was discussed in the light of in-vitro fatigue testing of implanted acetabula. PMID:19325935

  1. Interfacial fracture toughness of synthetic bone-cement interface.

    PubMed

    Tong, J

    2006-06-15

    Conventionally, the bonding strength of bone-cement interface is obtained by mechanical strength testing which tends to produce large variability between specimens and test methods. In this work, interfacial fracture toughness of synthetic bone-cement interface has been determined using sandwiched Brazilian disk specimens. Experiments were carried out under selected loading angles from 0 to 25 degrees to achieve full loading conditions from mode I to mode II. Solutions for complex stress intensity factors as well as strain energy release rates were obtained for a sandwich disk with a finite interlayer using the finite element method. Phase angles were obtained at a fixed distance to the crack tip. The fracture loads were obtained from the load displacement curves and the values of interfacial fracture toughness were calculated from the fracture loads and the finite element J-integral solutions. The implication of this information on the assessment of fixation in acetabular replacements was discussed in the light of in-vitro fatigue testing of implanted acetabula.

  2. Acetabular spacers in 2-stage hip revision: is it worth it? A single-centre retrospective study.

    PubMed

    Burastero, Giorgio; Basso, Marco; Carrega, Giuliana; Cavagnaro, Luca; Chiarlone, Francesco; Salomone, Carlo; Papa, Gabriele; Felli, Lamberto

    2017-03-31

    The aim of this work is to evaluate an acetabular antibiotic loaded bone cement spacer in 2-stage revision surgery as a potential approach able to reduce complications during the inter-stage period (i.e. dislocation, acetabular wear), as well as simplify 2-stage hip revision surgery and improve hip biomechanics. We performed a retrospective comparative study and evaluated clinical, radiological and surgical data of 71 patients affected by periprosthetic hip infection who were treated with 2-stage exchange. 31 patients were treated using an acetabular spacer in addition to the femoral (group A) while 40 underwent a standard revision surgery (femoral spacer only, group B). Mean time of surgery for the first stage was 148 ± 59 minutes and 142 ± 45 minutes for group A and B respectively; we noted a statistically significant reduction (26 min, p = 0.015) in the same parameter for the second stage (83 ± 35 minutes for group A and 109 ± 36 minutes for group B). We observed the following interstage complications: 5 femoral spacer dislocations (1 for group A and 4 for group B); 1 spacer fracture (group B), 1 spacer fracture (group A), 2 periprosthetic fractures (group B) and 2 patients with acetabular spacer instability (group B). Additionally, we observed a significant improvement in leg length restoration for group A (p = 0.03). Our data show that the acetabular spacer technique is able to reduce the interstage complication rate and allow improved hip biomechanics restoration.

  3. Optimization of acetabular component orientation using DOE

    NASA Astrophysics Data System (ADS)

    Krepelka, Mircea; Toth-Taşcǎu, Mirela

    2012-09-01

    Stress shielding is increasingly recognized as an important cause of acetabular component failure. Several studies have been focused on improving the acetabular component placement to reduce the risk of dislocation, impingement and range of motion but little is known of its influence on implant-bone interface pressures. This study employs experimental design, 3D reconstruction and FE simulation to identify the most significant factors for acetabular component behavior and predict the best configuration of acetabular spatial orientation angles within the constraints of the Lewinnek's safe zone in order to minimize peak contact pressures. Data analysis by response surface method revealed that the magnitude of periacetabular pressures was significantly reduced by the anteversion angle at its lowest value as well as the abduction angle located at the central point value, which corresponded to a 40° abduction and 5° anteversion of cup orientation.

  4. 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

    2016-01-01

    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.

  5. Safe surgical technique for associated acetabular fractures

    PubMed Central

    2013-01-01

    Associated acetabular fractures are challenging injuries to manage. The complex surgical approaches and the technical difficulty in achieving anatomical reduction imply that the learning curve to achieve high-quality care of patients with such challenging injuries is extremely steep. This first article in the Journal’s “Safe Surgical Technique” section presents the standard surgical care, in conjunction with intraoperative tips and tricks, for the safe management of all subgroups of associated acetabular fractures. PMID:23414782

  6. Revision Total Hip Arthroplasty Using the Cement-in-Cement Technique.

    PubMed

    Amanatullah, Derek F; Pallante, Graham D; Floccari, Lorena V; Vasileiadis, George I; Trousdale, Robert T

    2017-03-01

    The cement-in-cement technique is useful in the setting of revision total hip arthroplasty (THA), especially to gain acetabular exposure, change a damaged or loose femoral component, or change the version, offset, or length of a fixed femoral component. The goal of this retrospective study was to assess the clinical and radiographic characteristics of revision THA using the cement-in- cement technique. Between 1971 and 2013, a total of 63 revision THAs used an Omnifit (Osteonics, Mahwah, New Jersey) or Exeter (Howmedica, Mahwah, New Jersey) stem and the cement-in-cement technique at the senior author's institution. Aseptic loosening (74%) was the predominant preoperative diagnosis followed by periprosthetic fracture (14%), instability (8%), and implant fracture (6%). Mean clinical follow-up was 5.5±3.8 years. The Harris Hip Score had a statistically significant increase of 18.5 points (P<.001) after revision THA using the cement-in-cement technique. There were 13 returns to the operating room, resulting in an overall failure rate of 21%. Eleven (18%) cases required revision THA, but only 1 (2%) revision THA was for aseptic removal of the femoral component. All other femoral implants had no evidence of component migration, cement mantel fracture, or circumferential lucent lines at final follow-up. The patients who underwent cement-in-cement revision THA at the senior author's institution had good restoration of function but a high complication rate. [Orthopedics. 2017; 40(2):e348-e351.]. Copyright 2016, SLACK Incorporated.

  7. 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

  8. Cam Deformity and Acetabular Dysplasia as Risk Factors for Hip Osteoarthritis.

    PubMed

    Saberi Hosnijeh, Fatemeh; Zuiderwijk, Maria E; Versteeg, Mathijs; Smeele, Hieronymus T W; Hofman, Albert; Uitterlinden, André G; Agricola, Rintje; Oei, Edwin H G; Waarsing, Jan H; Bierma-Zeinstra, Sita M; van Meurs, Joyce B J

    2017-01-01

    Cam deformity and acetabular dysplasia have been recognized as relevant risk factors for hip osteoarthritis (OA) in a few prospective studies with limited sample sizes. To date, however, no evidence is available from prospective studies regarding whether the magnitude of these associations differs according to sex, body mass index (BMI), and age. Participants in the Rotterdam Study cohort including men and women ages 55 years or older without OA at baseline (n = 4,438) and a mean follow-up of 9.2 years were included in the study. Incident radiographic OA was defined as a Kellgren/Lawrence grade of ≥2 or a total hip replacement at follow-up. Alpha and center-edge angles were measured to determine the presence of cam deformity and acetabular dysplasia/pincer deformity, respectively. Odds ratios (ORs) were calculated to assess the associations between both deformities and the development of OA. Subjects with cam deformity (OR 2.11, 95% confidence interval [95% CI] 1.55-2.87) and those with acetabular dysplasia (OR 2.19, 95% CI 1.50-3.21) had a 2-fold increased risk of developing OA compared with subjects without deformity, while pincer deformity did not increase the risk of OA. Stratification analyses showed that the associations of cam deformity and acetabular dysplasia with OA were driven by younger individuals, whereas BMI did not influence the associations. Female sex appears to modify the risk of hip OA related to acetabular dysplasia. Individuals with cam deformity and those with acetabular dysplasia are predisposed to OA; these associations were independent of other well-known risk factors. Interestingly, both deformities predisposed to OA only in relatively young individuals. Therefore, early identification of these conditions is important. © 2016, American College of Rheumatology.

  9. Outcome of porous tantalum acetabular components for Paprosky type 3 and 4 acetabular defects.

    PubMed

    Batuyong, Eldridge D; Brock, Hugh S; Thiruvengadam, Nikhil; Maloney, William J; Goodman, Stuart B; Huddleston, James I

    2014-06-01

    Porous tantalum acetabular implants provide a potential solution for dealing with significant acetabular bone loss. This study reviews 24 acetabular revisions using tantalum implants for Paprosky type 3 and 4 defects. The mean Harris Hip Score improved from 35 ± 19 (range, 4-71) to 88 ± 14 (range, 41-100), p < 0.0001. Postoperative radiographs showed radiolucent lines in 14 hips with a mean width of 1.3 ± 1.0 mm (range, 0.27-4.37 mm). No gaps enlarged and 71% of them disappeared at a mean of 13 ± 10 months (range, 3-29 months). At a mean follow-up of 37 ± 14 months (range, 24-66 months), 22 reconstructions showed radiograpic evidence of osseointegration (92%). The two failures were secondary to septic loosening. When dealing with severe acetabular bone loss, porous tantalum acetabular components show promising short-term results. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Isolated acetabular revision with femoral stem retention after bipolar hip arthroplasty.

    PubMed

    Kaku, Nobuhiro; Tabata, Tomonori; Tagomori, Hiroaki; Tsumura, Hiroshi

    2017-03-01

    In bipolar hemiarthroplasty, migration of the outer cup component into the acetabular cup, with evidence of severe osteolysis in the acetabulum, commonly occurs without loosening of the femoral component. The merits of retaining the stable femoral component in these cases have been debated. Our study aimed to determine whether revision of the acetabular component in isolation could be successfully performed. The data of 54 patients (61 hips), 44 women, and 10 men, aged 67.7 (range 47-86) years at the time of the index revision, were analyzed. The average time from primary operation to revision surgery was 14.9 (range 1.0-27.0) years, with an average follow-up time after revision of 5.2 (range, 1.0-18.7) years. Indications for acetabular revision included migration of the outer cup component (N = 55), disassembly of the bipolar cup (N = 4), and recurrent dislocation (N = 2). Fixation of the femoral stem was cementless in 49 hips and cemented in 12. Bone grafting for osteolysis of the proximal femur around the stem was performed in six hips. An acetabular reinforcement ring with a cemented cup was used in 31 hips, with cementless cup fixation in 29 hips, and cemented cup in one case. On average, the Harris hip score improved from 57.0 ± 21.6 to 87.4 ± 6.40 points after revision. Two cases of femoral periprosthetic fracture were treated with osteosynthesis 3 year post-revision. There was no evidence of loosening of the femoral stem or subsidence, with a non-progressive radiolucent line <2 mm identified in one case. There was no incidence of dislocation or deep infection, and all components were judged to be stable at the final follow-up. Isolated acetabular revision can be reliably performed in cases of failed bipolar hemiarthroplasty with a well-fixed femoral component.

  11. Replacing a Missing Tooth

    MedlinePlus

    ... vessels in the tooth pulps are rather large. Drilling down these teeth for crowns may expose the ... porcelain replacement tooth is held in place by metal extensions cemented to the backs of the adjacent ...

  12. Natural acetabular orientation in arthritic hips.

    PubMed

    Goudie, S T; Deakin, A H; Deep, K

    2015-01-01

    Acetabular component orientation in total hip arthroplasty (THA) influences results. Intra-operatively, the natural arthritic acetabulum is often used as a reference to position the acetabular component. Detailed information regarding its orientation is therefore essential. The aim of this study was to identify the acetabular inclination and anteversion in arthritic hips. Acetabular inclination and anteversion in 65 symptomatic arthritic hips requiring THA were measured using a computer navigation system. All patients were Caucasian with primary osteoarthritis (29 men, 36 women). The mean age was 68 years (SD 8). Mean inclination was 50.5° (SD 7.8) in men and 52.1° (SD 6.7) in women. Mean anteversion was 8.3° (SD 8.7) in men and 14.4° (SD 11.6) in women. The difference between men and women in terms of anteversion was significant (p = 0.022). In 75% of hips, the natural orientation was outside the safe zone described by Lewinnek et al (anteversion 15° ± 10°; inclination 40° ± 10°). When using the natural acetabular orientation to guide component placement, it is important to be aware of the differences between men and women, and that in up to 75% of hips natural orientation may be out of what many consider to be a safe zone. Cite this article: Bone Joint Res 2015;4:6-10. ©2015 The British Editorial Society of Bone & Joint Surgery.

  13. 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

  14. Three Patterns of Acetabular Deficiency Are Common in Young Adult Patients With Acetabular Dysplasia.

    PubMed

    Nepple, Jeffrey J; Wells, Joel; Ross, James R; Bedi, Asheesh; Schoenecker, Perry L; Clohisy, John C

    2017-04-01

    Detailed recognition of the three-dimensional (3-D) deformity in acetabular dysplasia is important to help guide correction at the time of reorientation during periacetabular osteotomy (PAO). Common plain radiographic parameters of acetabular dysplasia are limited in their ability to characterize acetabular deficiency precisely. The 3-D characterization of such deficiencies with low-dose CT may allow for more precise characterization. The purposes of this study were (1) to determine the variability in 3-D acetabular deficiency in acetabular dysplasia; (2) to define subtypes of acetabular dysplasia based on 3-D morphology; (3) to determine the correlation of plain radiographic parameters with 3-D morphology; and (4) to determine the association of acetabular dysplasia subtype with patient clinical characteristics including sex, range of motion, and femoral version. Using our hip preservation database, we identified 153 hips (148 patients) that underwent PAO from October 2013 to July 2015. Among those, we noted 103 hips in 100 patients with acetabular dysplasia (lateral center-edge angle < 20°) and who had a Tönnis grade of 0 or 1. Eighty-six patients (86%) underwent preoperative low-dose pelvic CT scans at our institution as part of the preoperative planning for PAO. It is currently our standard to obtain preoperative low-dose pelvic CT scans (0.75-1.25 mSv, equivalent to three to five AP pelvis radiographs) on all patients before undergoing PAO unless a prior CT scan was performed at an outside institution. Hips with a history of a neuromuscular disorder, prior trauma, prior surgery, radiographic evidence of joint degeneration, ischemic necrosis, or Perthes-like deformities were excluded. Fifty hips in 50 patients met inclusion criteria and had CT scans available for review. These low-dose CT scans of 50 patients with symptomatic acetabular dysplasia undergoing evaluation for surgical planning of PAO were then retrospectively studied. CT scans were analyzed

  15. 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.

  16. Fatigue fracture of a forged cobalt-chromium-molybdenum femoral component inserted with cement. A report of ten cases.

    PubMed

    Woolson, S T; Milbauer, J P; Bobyn, J D; Yue, S; Maloney, W J

    1997-12-01

    Ten patients who had had a total hip replacement with a forged cobalt-chromium-molybdenum femoral prosthesis (Precoat or Precoat Plus) inserted with cement were seen with a fatigue fracture of the stem an average of fifty months (range, nineteen to seventy-four months) postoperatively. The average age of the patients was sixty-one years (range, forty-three to seventy-three years), and the average weight was ninety-six kilograms (range, seventy to 130 kilograms). Eight patients had had a primary total hip replacement, and two had had a revision; all of the acetabular components had been inserted without cement. Radiographs that had been made before the fracture were available for four of the eight hips that had had a primary replacement; all four had radiographic evidence of debonding of the cement mantle from the proximal end of the stem. This probably caused exaggerated cantilever bending stresses on the proximal aspect of the stem as the distal end of the stem was well fixed. The radiographs of both hips that had had a revision demonstrated a non-union of the greater trochanter, which had resulted in separation at the cement-bone interface at the proximal portion of the femur before the fracture. Scanning electron micrographs of five of the ten fractured prostheses demonstrated a fatigue fracture that began near the anterolateral corner of the prosthesis, through characters that had been etched on the implant with a laser. Metallurgical analysis indicated subsurface voids or inclusions, or both, immediately under the region that had been etched. This finding is consistent with thermal changes to the microstructure of the alloy that probably caused a focal reduction in the material strength. A high proportion (seven) of the ten stems had a poor cement mantle. Also, of the seven small stems that were used, six had been implanted in patients who weighed more than eighty kilograms, so there was relative undersizing of the prostheses. Early debonding of the proximal

  17. Management of periprosthetic acetabular fractures in elderly patients--a minimally invasive approach.

    PubMed

    Zettl, Ralph; Eschbach, Daphne; Ruchholtz, Steffen

    2015-09-01

    Periprosthetic acetabular fractures are rare and in the current literature largely underreported. The management is reported to be difficult. Treatment varies from non-operative to open reduction and internal fixation up to revision of the acetabular components. A prospective consecutive case series in acetabular fractures was performed in a level 1 trauma centre. All patients with pre-existing total hip replacement were followed up for one year. Perioperative data, complications, radiological results, functional outcome and quality of life were measured. Eight (15%) of 53 patients who were included in the study underwent total hip arthroplasty before and had stable implants at time of fracture. Mean age of the patients was 83 years. All of them were female. Mean operative time was 85 minutes. There were no soft tissue complications like infection or nerve damage in the post-operative course. No revision was needed. Two patients died in between the follow up. The Harris hip score was a mean of 77, with quality of life comparable to persons in the same age. Minimally invasive reconstruction of the anterior column is a viable method to conserve stable acetabular components in this type of fracture. Short operation time and limited incisions are the most conclusive advantages.

  18. Metal-backed acetabular components with conventional polyethylene: a review of 9113 primary components with a follow-up of 20 years.

    PubMed

    Hallan, G; Dybvik, E; Furnes, O; Havelin, L I

    2010-02-01

    The Norwegian Arthroplasty Register has shown that several designs of uncemented femoral stems give good or excellent survivorship. The overall findings for uncemented total hip replacement however, have been disappointing because of poor results with the use of metal-backed acetabular components. In this study, we exclusively investigated the medium-to long-term performance of primary uncemented metal-backed acetabular components. A total of 9113 primary uncemented acetabular components were implanted in 7937 patients between 1987 and 2007. These were included in a prospective, population-based observational study. All the implants were modular and metal-backed with ultra-high-molecular-weight polyethylene liners. The femoral heads were made of stainless steel, cobalt-chrome (CoCr) alloy or alumina ceramic. In all, seven different designs of acetabular component were evaluated by the Kaplan-Meier survivorship method and Cox regression analysis. Most acetabular components performed well up to seven years. When the endpoint was revision of the acetabular component because of aseptic loosening, the survival ranged between 87% and 100% at ten years. However, when the endpoint was revision for any reason, the survival estimates were 81% to 92% for the same implants at ten years. Aseptic loosening, wear, osteolysis and dislocation were the main reasons for the relatively poor overall performance of the acetabular components. Prostheses with alumina heads performed slightly better than those with stainless steel or CoCr alloy in subgroups. Whereas most acetabular components performed well at seven years, the survivorship declined with longer follow-up. Fixation was generally good. None of the metal-backed uncemented acetabular components with ultra-high-molecular-weight polyethylene liners in our study had satisfactory long-term results because of high rates of wear, osteolysis, aseptic loosening and dislocation.

  19. Clinical and Radiological Results over the Medium Term of Isolated Acetabular Revision

    PubMed Central

    Andreani, Lorenzo; Bonicoli, Enrico; Niccolai, Francesco; Lisanti, Michele

    2014-01-01

    Acetabular cup loosening is associated with pain, reduced function, and instability of the implant. If such event happens while the femoral implant is in a satisfactory position and is well fixed to the bone, isolated acetabular revision surgery is indicated. The aim of this single-center retrospective study was to evaluate the clinical and radiological results over the medium term (12-month follow-up mean 36, max 60) of isolated acetabular revisions surgery using a porous hemispheric revision shell matched with a cemented all-poly cup and large diameter femoral head (>32). 33 patients were enrolled. We collect any relevant data from the clinical board. Routine clinical and radiographic examinations were performed preoperatively; the postoperative follow-up was made at 1, 3, and 6 months and yearly thereafter. At the last available follow-up, we report satisfactory improvement of functional scores in all the patients; 2 patients (6.1%) showed thigh pain and only 4 hips (12.11%) presented mild groin pain; all the femoral components are well fixed and there were no potential or pending rerevisions. With bias due to the follow-up and to the retrospective design of the study, we report clinical, functional, and radiological satisfactory results. PMID:25610894

  20. Acetabular pneumatocyst containing air-fluid level.

    PubMed

    Narváez, J A; Narváez, J; Rodríguez-Mijarro, M; Quintero, J C

    1999-01-01

    The presence of intraosseous gas most commonly occurs in osteomyelitis, vacuum phenomenon, and postsurgery or posttraumatic states. Several cases of subchondral gas-filled lesions, called pneumatocysts, have also been described in the sacroiliac joint and clavicle, none of them with intralesional air-fluid level. These pneumatocysts are innocuous lesions of uncertain origin. We describe one case of acetabular pneumatocyst containing air-fluid level in a 62-year-old man with long-standing ankylosing spondylitis involving hip joint. To our knowledge, this is the first reported case of a pneumatocyst in an acetabular location containing air-fluid level.

  1. The acetabular point: a morphological and ontogenetic study

    PubMed Central

    RISSECH, C.; SAÑUDO, J. R.; MALGOSA, A.

    2001-01-01

    The acetabular point was analysed by studying human pelvic bones from 326 individuals ranging from newborns to age 97 y. The bones were categorised into 3 groups according to the degree of fusion for the 3 elements of the pelvis: nonfused (59), semifused (5) and fused (262). The acetabular point in immature pelvic bones is clearly represented by the point of the fusion lines for each bony element at the level of the acetabular fossa. In adult pelvic bones the acetabular fossa has an irregular clover-leaf shape, the superior lobe being smaller than the anterior and posterior lobes. Cross-sectional analysis of acetabular morphology suggested that the acetabular point in adult pelvic bones is always represented by the indentation between the superior and the anterior lobes of the acetabular fossa. PMID:11465866

  2. Fixation strength at the interface between Kerboull-type plate and bone cement.

    PubMed

    Kaku, Nobuhiro; Hara, Katsutoshi; Tabata, Tomonori; Tsumura, Hiroshi

    2014-12-01

    To evaluate the fixation strength at the interface between the Kerboull-type plate and bone cement in 6 experimental conditions. Experimental materials comprised a simulated acetabular block, a simulated Kerboulltype plate, a pressuriser cover, a pressuriser arm, and bone cement. The simulated Kerboull-type plate was placed on the simulated acetabular block, with the pressuriser cover. Bone cement was added and the pressuriser arm was inserted. After 6 days of curing, pulling tests were performed to measure the fixation strength at the interface between the plate and the bone cement. Six experimental conditions were evaluated. In condition 1, a 1-mm plate was used with no gap between the plate and the acetabular block. In condition 2, a 2.5-mm plate was used with no gap. In condition 3, a 2.5-mm plate was used with a 2-mm gap. In condition 4, the plate was not used. In condition 5, condition 2 was tested with the model rotated 45º. In condition 6, condition 3 was tested with the model rotated 45º. The maximum fixation strengths in conditions 1, 2, 3, 5, and 6 were 44.4 N, 59.1 N, 122.5 N, 86.9 N, and 185.2 N, respectively. The most important factor affecting the maximum fixation strength was bone cement at the interface between the plate and the acetabular block, followed by 45º rotation during testing, and then thickness of the plate. To enhance fixation of the Kerboull-type plate with cemented acetabular cup, penetration of cement into the outer side of the Kerboull-type plate should be minimised.

  3. Surgical treatment of acetabular fractures in the elderly: a systematic review of the results

    PubMed Central

    Capone, Antomio; Peri, Marcella; Mastio, Michele

    2017-01-01

    We performed a systematic review of the literature involving a number of databases to identify studies that included outcomes of surgical treatment of acetabular fractures in patients aged > 55 years. An initial search identified 1564 studies. After exclusion by two independent reviewers, 15 studies met the inclusion criteria. All studies were case series and the mean Coleman Methodology score for methodological quality assessment was 43.7 (standard deviation 12.3). There were 354 patients with acetabular fractures. Pooled analysis revealed a mean age of 71.6 years (55 to 96) and a mean follow-up of 43 months (20 to 188). Complex fractures were reported in 70.1% of patients. Seven studies presented the results of open reduction and internal fixation (ORIF); in eight other studies a total hip arthroplasty (THA), alone or combined with different internal fixation techniques, was the chosen treatment. In the ORIF sub-group, conversion to THA was performed at a mean of 25.5 months with anatomical reduction in 11.6% and imperfect and poor reduction in 22.3%. In the THA sub-group, an acetabular ring or cage with a cemented acetabular component was used in four studies (52 patients) and a cementless acetabular component was implanted in five studies (78 patients). Six patients (4.9%) underwent revision at a mean of 39 months after the index procedure. The analysis of intra-operative and post-operative parameters showed a statistical difference between the two sub-groups with regards to the mean operating time (236 mins ORIF vs 178 mins THA), the mean blood loss (707 mL ORIF vs 974 mL THA) and the mean mortality rate at one year (22.6% ORIF vs 8.8% THA). Based on the current data available, acute THA (alone or in combination with internal fixation) may have a role in the treatment of older patients with complex acetabular fractures. Despite the wide heterogenecity of fracture types and patient co-morbidities, THA procedures were associated with lower rates of mortality and

  4. [Acetabular reconstruction in revision arthroplasty. Retrospective study of 76 cases. Hospital Español de México].

    PubMed

    Trueba Davalillo, Cesáreo; Gil Orbazo, Félix; Reyes Marco, Fernando; Minueza Mejía, Tomás; Navarrete Alvarez, José Mario

    2007-01-01

    To review our experience with the various acetabular reconstruction techniques used during revision arthroplasty based on the defect in each patient. We undertook a retrospective, descriptive, observational study of patients who underwent acetabular reconstruction during revision ar. throplasty, from January 1997 to January 2005. We documented the type of acetabular defect, the type of cup and graft used, the complications, and the pre- and postoperative assessment with the Harris scale. Data were analyzed with the SPSS software and the Wilcoxon test (p < 0.05). Seventy-six patients underwent surgery. Mean time elapsed between the primary replacement and the revision was 5 years. The acetabular defects found were: 16 type I, 22 type II, 30 type IIIA, and 8 type IIIB. The mean Harris score was 44 preoperatively and 76 postoperatively. The most frequently used technique involved the use of an autograft, a structural allograft with a porous threaded cup or a reinforcement ring. The most common complications included dislocation 5%, infection 3%, graft loss and cup loosening 21%, and loss of the hip center of rotation 15% (p < 0.05). Acetabular reconstruction is technically challenging and involves high failure and complication rates, thus providing little improvement in patient activity. It is important to restore the hip center of rotation to improve function. The reconstruction techniques we used are the most common ones and are described in the literature.

  5. Periprosthetic acetabular fracture associated with extensive osteolysis.

    PubMed

    Chatoo, M; Parfitt, J; Pearse, M F

    1998-10-01

    Periprosthetic fracture of the acetabulum is an uncommon complication of total hip arthroplasty. The management is reported to be difficult, and complications such as nonunion and implant loosening are common. We described herein a case of nontraumatic periprosthetic acetabular fracture associated with significant osteolysis, which was successfully managed by addressing the fracture and osteolysis independently.

  6. The effect of stem material and surface treatment on the torsional stability at the metal-cement interface of upper limb joint replacement systems.

    PubMed

    Hosein, Yara K; King, Graham J W; Dunning, Cynthia E

    2014-08-01

    Stem surface treatment and material are two design factors that may affect the onset of implant loosening. For upper limb applications, no known in vitro studies have addressed the role of these two factors on cemented implant stability. Therefore, the purpose of this study was to compare the torsional stability of cemented titanium and cobalt chrome stems with varying surface treatments in vitro. Thirty implant stems of circular cross-section (Ø = 8mm) were machined from cobalt chrome (n = 15) and titanium (n = 15). For each type, stems were subdivided into three groups for application of clinically relevant surface treatments: smooth, sintered beads, or plasma spray. Stems were potted in bone cement, allowed 24 h to cure, and placed in a materials testing machine. Stems were tested under cyclic torsion (1-30 Nm), using a staircase loading protocol. Failure was defined as either the first rapid increase in stem rotation without resistance, or attaining a maximum torque of 30 Nm. Implant stems with non-smooth surfaces offered greater resistance to torsion (p < 0.05), with the plasma spray treatment outlasting the beaded and smooth stems (p < 0.05). Titanium offered superior interface strength (p < 0.05) but reduced resistance to motion (p < 0.05) when compared to cobalt chrome. Therefore, these design features should be considered during upper limb implant design.

  7. Porous tantalum uncemented acetabular components in revision total hip arthroplasty: a minimum ten-year clinical, radiological and quality of life outcome study.

    PubMed

    Konan, S; Duncan, C P; Masri, B A; Garbuz, D S

    2016-06-01

    Reconstruction of the acetabulum after failed total hip arthroplasty (THA) can be a surgical challenge in the presence of severe bone loss. We report the long-term survival of a porous tantalum revision acetabular component, its radiological appearance and quality of life outcomes. We reviewed the results of 46 patients who had undergone revision of a failed acetabular component with a Paprosky II or III bone defect and reconstruction with a hemispherical, tantalum acetabular component, supplementary screws and a cemented polyethylene liner. After a minimum follow-up of ten years (ten to 12), the survivorship of the porous tantalum acetabular component was 96%, with further revision of the acetabular component as the end point. The ten-year survivorship, with hip revision for any reason as the end point, was 92%. We noted excellent pain relief (mean Western Ontario and McMaster Universities Arthritis Index (WOMAC) score pain 92.6, (40 to 100)) and good functional outcomes (mean WOMAC function 90.3 (30.9 to 100), mean University of California Los Angeles activity scale 5 (2 to 10)) and generic quality of life measures (mean Short Form-12 (SF-12) physical component 48.3 (18.1 to 56.8), mean SF-12 mental component 56.7 (32.9 to 70.3)). Patient satisfaction with pain relief, function and return to recreational activities were excellent. Uncemented acetabular reconstruction using a tantalum acetabular component gives excellent clinical and quality of life outcomes at a minimum follow-up of ten years. Cite this article: Bone Joint J 2016;98-B:767-71. ©2016 The British Editorial Society of Bone & Joint Surgery.

  8. Wear of a sequentially annealed polyethylene acetabular liner

    PubMed Central

    Gascoyne, Trevor C; Petrak, Martin J; Turgeon, Thomas R; Bohm, Eric R

    2014-01-01

    Background and purpose We previously reported on a randomized controlled trial (RCT) that examined the effect of adding tobramycin to bone cement after femoral stem migration. The present study examined femoral head penetration into both conventional and highly crosslinked polyethylene acetabular liners in the same group of RCT patients, with a minimum of 5 years of postoperative follow-up. Patients and methods Linear penetration of the femoral head into an X3 (Stryker) crosslinked polyethylene (XLPE) liner was measured in 18 patients (19 hips) using radiostereometric analysis (RSA). Femoral head penetration was also measured in 6 patients (6 hips) with a conventional polyethylene liner (CPE), which served as a control group. Results The median proximal femoral head penetration in the XLPE group after 5.5 years was 0.025 mm with a steady-state penetration rate of 0.001 mm/year between year 1 and year 5. The CPE liner showed a median proximal head penetration of 0.274 mm after 7.2 years, at a rate of 0.037 mm/year. Interpretation The Trident X3 sequentially annealed XLPE liner shows excellent in vivo wear resistance compared to non-crosslinked CPE liners at medium-term implantation. The rate of linear head penetration in the XLPE liners after > 5 years of follow-up was 0.001 mm/year, which is in close agreement with the results of previous studies. PMID:25140986

  9. Acetabular augmentation induced by extracorporeal shock waves in rabbits.

    PubMed

    Saisu, Takashi; Kamegaya, Makoto; Wada, Yuichi; Takahashi, Kenji; Mitsuhashi, Shigeru; Moriya, Hideshige; Maier, Markus

    2005-05-01

    We conducted this animal study to demonstrate whether exposing the acetabulum in immature rabbits to extracorporeal shock waves induces bone formation in the acetabulum. Five thousand shock waves of 100 MPa each were directed, from outside, at the acetabular roof of eight immature rabbits. At each of two time points (4 and 8 weeks) after treatment, the pelvises of four rabbits were removed and evaluated morphologically. Woven bone formation was observed on the lateral margin of the acetabular roof at 4 weeks after treatment, and the breadth of the acetabular roof in the coronal plane was significantly increased. Eight weeks after treatment, the woven bone disappeared; the breadth of the acetabular roof, however, was significantly increased. These findings demonstrated that extracorporeal shock waves induced acetabular augmentation in rabbits. We conclude that extracorporeal shock waves, perhaps, could be applied clinically for the treatment of acetabular dysplasia.

  10. Bone temperature during cementation with a heatsink: a bovine model pilot study.

    PubMed

    Spurrier, Edward; Payton, Olivia; Latimer, Mark

    2014-08-07

    Bone cement is an effective means of supporting implants, but reaches high temperatures while undergoing polymerisation. Bone has been shown to be sensitive to thermal injury with osteonecrosis reported after one minute at 47°C. Necrosis during cementing may lead to loosening of the prosthesis. Some surgeons fill the joint cavity with cool irrigation fluid to provide a heatsink during cementing, but this has not been supported by research. This paper assesses a simple technique to investigate the efficacy of this method. We used a model acetabulum in a bovine humerus to allow measurement of bone temperatures in cementing. Models were prepared with a 50 mm diameter acetabulum and three temperature probe holes; two as close as possible to the acetabular margin at half the depth of the acetabulum and at the full depth of the acetabulum, and one 10 mm from the acetabular rim. Four warmed models were cemented with Palacos RG using a standard mixing system and a 10 mm polyethylene disc to represent an acetabular component. Two of the acetabular models were filled with room temperature water to provide a heatsink. An electronic probe measured temperature at 5 second intervals from the moment of cementing.In the models with no heatsink, peak temperature was 40.3°C. The mean temperature rise was 10.9°C. In the models with a heatsink, there was an average fall in the bone temperature during cementing of 4.4°C. These results suggest that using a heatsink while cementing prostheses may reduce the peak bone temperature. This study demonstrates a simple, repeatable technique which may be useful for larger trials.

  11. Meralgia paresthetica and femoral acetabular impingement: a possible association.

    PubMed

    Ahmed, Aiesha

    2010-12-11

    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. Femoral acetabular impingement; Lateral femoral cutaneous nerve; Dysesthesia; Nerve conduction studies.

  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. Syndrome of symptomatic adult acetabular dysplasia (SAAD syndrome)

    PubMed Central

    Birrell, F; Silman, A; Croft, P; Cooper, C; Hosie, G; Macfarlane, G

    2003-01-01

    Design: Cross sectional analysis of a prospective cohort. Setting: 35 general practices across the UK. Subjects: 195 patients (63 male, 132 female) aged 40 years and over presenting with a new episode of hip pain Results: The prevalence of acetabular dysplasia in this study of new presenters with hip pain was high (32%). There was no significant relationship between acetabular dysplasia and radiographic OA overall. Conclusions: The high prevalence of acetabular dysplasia across all grades of OA severity suggests that dysplasia itself may be an important cause of hip pain ("symptomatic adult acetabular dysplasia"). PMID:12634238

  14. Outcome and complications of constrained acetabular components.

    PubMed

    Yang, Cao; Goodman, Stuart B

    2009-02-01

    Constrained acetabular liners were developed for the surgical treatment of recurrent instability by holding the femoral head captive within the socket. This article summarizes the data describing constrained component designs, indications, outcome, and complications. Different designs accept head sizes of varying diameter and have differing amounts of rim elevation and offset, allowing slight variations in the range of movement allowed. Complications of constrained acetabular components can be divided into three categories. The first category is directly related to the constraining mechanism such as dislocation, head dissociation from the stem, liner dissociation from the acetabular device, and impingement with or without locking ring breakage. The second category is related to increased constraint such as aseptic component loosening and osteolysis and periprosthetic fracture. The third category includes those cases not associated with increased constraint such as infection, deep vein thrombosis, and periprosthetic fracture. This device is effective at achieving hip stability, but the complications related to the constraining mechanism and increased constraint are of concern. These devices should be used as a salvage measure for the treatment of severe instability.

  15. 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. PMID:27536573

  16. Finite element modelling for assessing effect of acetabular component orientation on the basic stress path above acetabular dome.

    PubMed

    Nie, Yong; Pei, Fu-xing; Li, Zong-ming

    2015-02-01

    To investigate the effect of acetabular component orientation on the basic stress path above the acetabular dome in the recommended safe zone. A subject-specific normal hip finite element model was generated and a convergence study carried out to determine the number of material properties for trabecular bone using a normal hip model. Four abduction angles (35°, 40°, 45° and 50°) and four anteversion angles (10°, 15°, 20° and 25°) from the recommended safe zone of acetabular cup orientation were chosen to simulate acetabular reconstruction. The distribution and level of periacetabular stress was assessed using a normal hip model as a control and 16 reconstructed acetabula in simulated single-legged stances. The error of the average stress between plans four and five (50 and 100 materials for trabecular bone respectively) was 4.8%, which is less than the previously defined 5% error. The effect of acetabular component orientation on stress distribution in trabecular bone was not pronounced. When the acetabular component was at 15° anteversion and the abduction angle was 40° or 45°, the stress level on posterolateral cortical bone above the acetabular dome was as stable as that in the normal hip model. Acetabular component orientation affects the basic stress path above the acetabular dome. Thus, orientation should be considered when attempting to restore normal biomechanics in the main load-bearing area. © 2015 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  17. Successful cementless cup reimplantation using cortical bone graft augmentation after an acetabular fracture and cup displacement.

    PubMed

    Torres, Bryan T; Chambers, Jonathan N; Budsberg, Steven C

    2009-01-01

    To report repair of a periprosthetic acetabular fracture with concurrent component displacement after cementless total hip arthroplasty (THA). Clinical case report. Dog (n=1) with an acetabular fracture after THA. Acetabular repair was performed on a highly comminuted periprosthetic acetabular fracture after cementless THA. A bulk, structural corticocancellous autograft from the ipsilateral ilial wing was used for repair and reconstruction of the dorsal acetabular wall before reimplantation of a cementless acetabular component. Repair of a periprosthetic acetabular fracture with a bulk structural autograft was successful in reconstruction of the dorsal acetabular wall and in reestablishing a stable, functional cementless THA acetabular prosthesis. Structural corticocancellous autografts from the ilium can be successfully used in repair of periprosthetic acetabular fractures after THA. Structural corticocancellous grafting from the ilium can be considered as a treatment option for repair of periprosthetic acetabular fractures after THA.

  18. Characteristics of Bone Tissue and Composite Materials on the Basis of Natural Hydroxyapatite and Endodontic Cement for Replacement of the Tissue

    NASA Astrophysics Data System (ADS)

    Filipenkov, V. V.; Rupeks, L. E.; Vitins, V. M.; Knets, I. V.; Kasyanov, V. A.

    2017-07-01

    New biocomposites and the cattle bone tissue were investigated. The composites were made from an endodontic cement (EC) and natural hydroxyapatite (NHAp.) The results of experiments performed by the method of infrared spectroscopy showed that protein was removed from the heat-treated specimens of bone tissue practically completely. The structure of bone tissue before and after deproteinization and the structure of the composite materials based on NHAp and EC (with different percentage) were investigated by the method of optical microscopy. The characteristics of mechanical properties (the initial elastic modulus, breaking tensile and compressive stresses, and breaking strain) and the density and porosity of these materials were determined. The new composite materials were implanted in the live tissue of rat. Biocompatibility between the live tissue and the new biocomposites was estimated.

  19. Cemented rotating-platform total knee replacement: a concise follow-up, at a minimum of twenty years, of a previous report.

    PubMed

    Callaghan, John J; Wells, Christopher W; Liu, Steve S; Goetz, Devon D; Johnston, Richard C

    2010-07-07

    We previously evaluated 119 consecutive total knee arthroplasties performed by a single surgeon in eighty-six patients with use of the cemented LCS (low contact stress) mobile-bearing, rotating-platform system and an all-polyethylene patellar component. The average age of the patients at the time of surgery was seventy years. The patients were contacted as part of their routine follow-up and were asked to participate in this study. The purpose of the present study was to report the updated results at a minimum follow-up of twenty years. Twenty patients (twenty-six knees) were living, and one was lost to follow-up. Three knees required a reoperation (two for periprosthetic fractures and one for infection). No component was revised as a part of the reoperations. No knee required revision since the fifteen-year follow-up evaluation. Osteolysis was present in six knees compared with only three knees at the time of the fifteen-year follow-up. One knee had radiographic signs of femoral component loosening, which was associated with osteolysis. It occurred after the fifteen-year follow-up study. The average range of motion was from 1 degrees of extension to 105 degrees of flexion. The average clinical and functional Knee Society scores were 43 and 49 points, respectively, at the preoperative evaluation and 89 and 67 points at the time of the final follow-up. We concluded that the cemented LCS rotating-platform knee performed well, with durable clinical and radiographic results at a minimum follow-up of twenty years. However, the prevalence of osteolysis continues to increase with a longer duration of follow-up in these patients.

  20. Outcomes of Charnley total hip arthroplasty using improved cementing with so-called second- and third-generation techniques.

    PubMed

    Hirose, Shiro; Otsuka, Hiromi; Morishima, Takkan; Sato, Keiji

    2012-03-01

    Techniques of cemented total hip arthroplasty have developed over time. We present the outcomes of Charnley total hip arthroplasty performed using improved second- and third-generation cementing techniques. We reviewed the radiologic results of 91 Charnley total hip arthroplasties performed using second- and third-generation cementing techniques. Second-generation techniques involved making multiple anchor holes, a double-cementing method on the acetabular side and an intramedullary plug, and retrograde filling with a cement gun on the femoral side in 57 hips. Third-generation techniques involved additional vacuum mixing and cement pressurization in 34 hips. Joint survival rates at 20 years when using second-generation techniques were 89% for the socket and 94% for the stem with aseptic loosening as the end point; the survival rates at 10 years when using third-generation techniques were 97 and 100%, respectively. According to our radiographic evaluation system for the clear zone at 5 years, there was less clear zone in the acetabular side with the third-generation techniques than with second-generation techniques. In the femoral side, there was very little development of the clear zone, but the difference between generations was not significant. Second- and third-generation cementing techniques showed excellent survivorship. The clear zone scores at 5 years indicated that third-generation techniques were effective, especially in the acetabular side, and may produce better long-term results than second-generation techniques.

  1. The use of ceramic-on-ceramic bearings in isolated revision of the acetabular component.

    PubMed

    Jack, C M; Molloy, D O; Walter, W L; Zicat, B A; Walter, W K

    2013-03-01

    The practice of removing a well-fixed cementless femoral component is associated with high morbidity. Ceramic bearing couples are low wearing and their use minimises the risk of subsequent further revision due to the production of wear debris. A total of 165 revision hip replacements were performed, in which a polyethylene-lined acetabular component was revised to a new acetabular component with a ceramic liner, while retaining the well-fixed femoral component. A titanium sleeve was placed over the used femoral trunnion, to which a ceramic head was added. There were 100 alumina and 65 Delta bearing couples inserted. The mean Harris hip score improved significantly from 71.3 (9.0 to 100.0) pre-operatively to 91.0 (41.0 to 100.0) at a mean follow up of 4.8 years (2.1 to 12.5) (p < 0.001). No patients reported squeaking of the hip. There were two fractures of the ceramic head, both in alumina bearings. No liners were seen to fracture. No fractures were observed in components made of Delta ceramic. At 8.3 years post-operatively the survival with any cause of failure as the endpoint was 96.6% (95% confidence interval (CI) 85.7 to 99.3) for the acetabular component and 94.0% (95% CI 82.1 to 98.4) for the femoral component. The technique of revising the acetabular component in the presence of a well-fixed femoral component with a ceramic head placed on a titanium sleeve over the used trunnion is a useful adjunct in revision hip practice. The use of Delta ceramic is recommended.

  2. Controversies in Treatment of Acetabular Fracture

    PubMed Central

    Grubor, Predrag; Krupic, Ferid; Biscevic, Mirza; Grubor, Milan

    2015-01-01

    Introduction: Acetabular fractures treatment represents a great controversy, challenge and dilemma for an orthopedic surgeon. Aim: The aim of the paper was to present the results of treatment of 96 acetabular fractures in the Clinic of Traumatology Banja Luka, in the period from 2003 to 2013, as well as to raise awareness regarding the controversy in the methods of choice in treating acetabulum fractures. Material and methods: The series consists of 96 patients, 82 males and 14 females, average age 40.5 years. Traffic trauma was the cause of fractures in 79 patients (85%), and in 17 patients (15%) fractures occurred due to falls from height. Polytrauma was present in 31 patients (32%). According to the classification of Judet and Letournel, representation of acetabular fractures was as follows: posterior wall in 32 patients, posterior column in 28, anterior wall in 4, anterior column in 2, transverse fractures in 8, posterior wall and posterior column in 10, anterior and posterior wall in 6, both- column in 4 and transversal fracture and posterior wall in 2 patients. 14 patients were treated with traction, that is, 6 patients with femoral traction and 8 patients with both lateral and femoral traction. 82 patients (86.4%) were surgically treated. Kocher-Langenbeck approach was applied in the treatment of 78 patients. In two patients from the Kocher-Langenbeck’s approach, the Ollier’s approach had to be applied as well. Two acetabular were primarily treated with Ollier’s approach. Extended Smith- Peterson’s approach was applied 4 times, and Emile Letournel’s (ilioinguinal) approach 14 times. Results: Functional outcome (after follow-up of 18 months), according to the Harris hip score of surgical treatment in 82 patients, was as follows: good 46 (56%), satisfactory 32 (39%) and poor 4 (5%). Results of acetabulum fractures treated with traction were: good 8 (57%), satisfactory 4 (28%) and poor 2 (15%). According to the Brook’s classification of heterotopic

  3. 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.

  4. Use of Incineration Solid Waste Bottom Ash as Cement Mixture in Cement Production

    NASA Astrophysics Data System (ADS)

    Jun, N. H.; Abdullah, M. M. A. B.; Jin, T. S.; Kadir, A. A.; Tugui, C. A.; Sandu, A. V.

    2017-06-01

    Incineration solid waste bottom ash was use to examine the suitability as a substitution in cement production. This study enveloped an innovative technology option for designing new equivalent cement that contains incineration solid waste bottom ash. The compressive strength of the samples was determined at 7, 14, 28 and 90 days. The result was compared to control cement with cement mixture containing incineration waste bottom ash where the result proved that bottom ash cement mixture able achieve its equivalent performance compared to control cement which meeting the requirement of the standards according to EN 196-1. The pozzolanic activity index of bottom ash cement mixture reached 0.92 at 28 days and 0.95 at 90 and this values can be concluded as a pozzolanic material with positive pozzolanic activity. Calcium hydroxide in Portland cement decreasing with the increasing replacement of bottom ash where the reaction occur between Ca(OH)2 and active SiO2.

  5. Pelvic position and movement during hip replacement.

    PubMed

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

    2014-07-01

    The orientation of the acetabular component is influenced not only by the orientation at which the surgeon implants the component, but also the orientation of the pelvis at the time of implantation. Hence, the orientation of the pelvis at set-up and its movement during the operation, are important. During 67 hip replacements, using a validated photogrammetric technique, we measured how three surgeons orientated the patient's pelvis, how much the pelvis moved during surgery, and what effect these had on the final orientation of the acetabular component. Pelvic orientation at set-up, varied widely (mean (± 2, standard deviation (sd))): tilt 8° (2sd ± 32), obliquity -4° (2sd ± 12), rotation -8° (2sd ± 14). Significant differences in pelvic positioning were detected between surgeons (p < 0.001). The mean angular movement of the pelvis between set-up and component implantation was 9° (sd 6). Factors influencing pelvic movement included surgeon, approach (posterior > lateral), procedure (hip resurfacing > total hip replacement) and type of support (p < 0.001). Although, on average, surgeons achieved their desired acetabular component orientation, there was considerable variability (2sd ± 16) in component orientation. We conclude that inconsistency in positioning the patient at set-up and movement of the pelvis during the operation account for much of the variation in acetabular component orientation. Improved methods of positioning and holding the pelvis are required.

  6. [Polyethylene liner replacement: behavior and morbidity in 68 cases].

    PubMed

    Bidar, R; Girard, J; May, O; Pinoit, Y; Laffargue, P; Migaud, H

    2007-09-01

    Isolated acetabular polyethylene exchange is advocated as an advantage of metal-backed cups, since the acetabular bone stock can be spared and operative time is shorter. The purpose of this study was to determine whether this is true. A consecutive serie of 68 THA revisions involving replacement of the polyethylene liner was analyzed retrospectively (liner replacement alone for 37 hips and liner replacement plus femoral component revision for 31). The posterolateral approach was used for the revision in all cases. This series was compared with a control series of revisions involving the acetabular component with revision of the femoral component in patients matched for age, sex, and BMI. Operative time and hospital stay were significantly shorter when the revision involved the polyethylene liner alone. In 19 hips, a limited zone of osteolysis was observed around the liner before replacement. At last follow-up, new zones of osteolysis were noted in two hips and aggravation in five, one of which required revision because of acetabular loosening. Episodes of dislocation were observed in nine hips (2 anterior and 7 posterior) of which three underwent revision because of recurrence. These dislocations occurred after liner replacement (n=4) or combined liner and femoral component replacement (n=5). Dislocations were more frequent after multiple hip operations and when the cup inclination was less than 40 degrees . Ten revisions were required for: an unclipped liner (n=2), recurrent dislocation (n=3), acetabular loosening (n=1), infection which was cured after a one-stage procedure (n=1). At seven years, survival was comparable between liner replacement alone (82+/-10%), combined liner replacement and femoral component revision (84+/-11%), and femoral component and acetabular component revision (82+/-11%). Changing the cup liner can limit morbidity compared with a more complex revision, but liner replacement alone is insufficient in the event of acetabular osteolysis. It

  7. The effect of bone porosity on the shear strength of the bone–cement interface

    PubMed Central

    Bannister, Gordon

    2008-01-01

    This study investigated the relationship of bone porosity and bone–cement interface shear strength. One hundred forty-six samples were taken from the distal metaphysis of 20 bovine femora. After cementation, the shear strength of the bone–cement interface was tested. According to the porosity, the samples were divided into four groups. Group I (porosity <80%) had a median interface shear strength of 4.03 MPa, group II (80% ≤porosity <85%) 7.06 MPa, group III (85% ≤porosity <90%) 9.44 MPa, and group IV (porosity ≥90%) 14.85 MPa. The differences between the four groups were statistically significant. Greater porosity yielded a stronger bone–cement interface shear strength under the identical cementation technique. The optimum porosity of cancellous bone is more than 90% which can be found by reaming or drilling to deeper bone in cemented acetabular fixation. PMID:18437380

  8. Cemented femoral stems in patients with DDH.

    PubMed

    Garcia-Cimbrelo, E

    2007-01-01

    Total hip arthroplasty is the procedure of choice for most adult patients with symptomatic arthrosis secondary to developmental dysplasia (DDH), but it requires complex reconstructive techniques, is usually performed in young patients, and has an increased risk of complications. THA is indicated in presence of severe pain and when osteotomy is contraindicated. The complexity of surgery is related to the degree of dysplasia. Anatomic abnormalities in the acetabulum and femur are the cause of the complexity and complications of this procedure. Acetabular bone deficiency requires reconstructive techniques before implanting the cup at the anatomic acetabular location, such as bone autograft augmentation, implanting the cup at higher level of the hip center and cup medialization. Femoral shortening and special cemented or uncemented stems are currently used to avoid intraoperative complications. While a cemented stem needs metaphyseal femoral shortening, subtrochanteric shortening requires a cementless stem. Because of these patients' age, alternative bearing surfaces, such as alumina-on-alumina couples are recommended when possible. Although the long-term results of total hip arthroplasty in DDH are inferior to those in a general population, the results show a high level of pain relief and functional improvement.

  9. Cementless total hip replacement: past, present, and future.

    PubMed

    Yamada, Harumoto; Yoshihara, Yasuo; Henmi, Osamu; Morita, Mitsuhiro; Shiromoto, Yuichiro; Kawano, Tomoki; Kanaji, Arihiko; Ando, Kennichi; Nakagawa, Masato; Kosaki, Naoto; Fukaya, Eiichi

    2009-03-01

    Cementless total hip replacement (THR) is rapidly being accepted as the surgery for arthritic diseases of the hip joint. The bone-ingrowth rate in porous-type cementless implants was about 90% over 10 years after surgery, showing that biological fixation of cementless THR was well maintained on both the stem and cup sides. As for the stress shielding of the femur operated using a distal fixation-type stem, severe bone resorption was observed. The severe bone resorption group showed continuous progression for more than 10 years after surgery. Stem loosening directly caused by stress shielding has been considered less likely; however, close attention should be paid to bone resorption-associated disorders including femoral fracture. Cementless cups have several specific problems. It is difficult to decide whether a cup should be placed in the physiological position for the case of acetabular dysplasia by bone grafting or at a relatively higher position without bone grafting. The bone-ingrowth rate was lower in the group with en bloc bone grafting, and the reactive line was frequently noted in the bone-grafted region. Although no data indicated that en bloc bone grafting directly led to poor outcomes, such as loosening, cup placement at a higher site without bone grafting is now selected by most operators. The polyethylene liner in a cementless cup is thinned due to the metal cup thickness; however, it has been suggested that the apparent relation between the cup size and the wear rate was absent as long as a cementless cup is used. Comparative study indicated cementless THR was inferior with regard to the yearly polyethylene wear rate and incidence of osteolysis on both the stem and cup sides. Meta-analysis study on the survival rate between cement and cementless THR reported that cemented THR was slightly superior. It should be considered that specific problems for cementless THR, especially with regard to polyethylene wear, do occur.

  10. Tantalum in type IV and V Paprosky periprosthetic acetabular fractures surgery in Paprosky type IV and V periprosthetic acetabular fractures surgery.

    PubMed

    Falzarano, G; Piscopo, A; Rollo, G; Medici, A; Grubor, P; Bisaccia, M; Pipola, V; Cioffi, R; Nobile, F; Meccariello, L

    2017-09-30

    Periprosthetic acetabular fractures represent a growing and serious complication of total hip arthroplasty (THA). The purpose of the study is to report our experience in the use of tantalum for the treatment of Paprosky type IV and V periprosthetic acetabular fractures. We analyzed 24 patients with type IV and V periprosthetic acetabular fractures. Patients were treated with a revision surgery using tantalum components, in some cases in association with posterior plating. Outcomes were evaluated using VAS, Harris hip score and considering the average time of integration of the acetabulum and the number of complications. The endpoint evaluation was established at 24 months. Results show that the average time of integration of the neoacetabulum in tantalum was 12.3 months (range 6-18 months). The average VAS pain is 8.7/10 cm at time 0 and gradually returns to basic pre-injury values in the following months. The average value of HHS at time 0 is 13.5 points. This value tends to increase progressively until reaching a mean score of 89.3 points at 24 months, higher than the average pre-trauma value of 84.3 points. Periprosthetic fractures of the acetabulum with bone loss are a rare but potentially disastrous complication of total hip prostheses. Their management and therapeutic choice will test the ability of the orthopedic surgeon. It is important to determine the type of fracture and characteristics in order to pursue an adequate therapeutic strategy. The modern biomaterials, such as porous tantalum, offer a greater potential in replacing bone loss, promoting bone regrowth and obtaining a stable implant.

  11. Treatment of acetabular fractures in older patients-introduction of a new implant for primary total hip arthroplasty.

    PubMed

    Resch, H; Krappinger, D; Moroder, P; Auffarth, A; Blauth, M; Becker, J

    2017-04-01

    Fractures of the acetabulum in younger patients are commonly treated by open reduction and internal fixation. For elderly patients, stable primary total hip arthroplasty with the advantage of immediate postoperative mobilization might be the adequate treatment. For this purpose, a sufficiently stable fixation of the acetabular component is required. Between August 2009 and 2014, 30 cases were reported in which all patients underwent total hip arthroplasty additionally to a customized implant designed as an antiprotrusion cage. Inclusion criteria were an acetabular fracture with or without a previous hemiarthroplasty, age above 65 years, and pre-injury mobility dependent on a walking frame at the most. The median age was 79.9 years (65-92), and of 30 fractures, 25 were primary acetabular fractures (83%), four periprosthetic acetabular fractures (14%), and one non-union after a failed ORIF (3%). The average time from injury to surgery was 9.4 days (3-23) and 295 days for the non-union case. Mean time of surgery was 154.4 min (range 100 to 303). In 21 cases (70%), mobilization with full weight bearing was possible within the first 10 days. Six patients died before the follow-up examination 3 and 6 months after surgery, while 24 patients underwent radiologic examination showing consolidated fractures in bi-plane radiographs. In 9 patients, additional CT scan was performed which confirmed the radiographical results. 13 had regained their pre-injury level of mobility including the non-union case. Only one patient did not regain independent mobility. Four complications were recognized with necessary surgical revision (one prosthetic head dislocation, one pelvic cement leakage, one femoral shaft fracture, and one infected hematoma). The presented cage provides the possibility of early mobilization with full weight bearing which represents a valuable addition to the treatment spectrum in this challenging patient group.

  12. [Modular reconstruction in acetabular revision with antiprotrusio cages and metal augments : the cage-and-augment system].

    PubMed

    Günther, K-P; Wegner, T; Kirschner, S; Hartmann, A

    2014-04-01

    Restore primary center of rotation and reconstruct extensive bone defects in hip revision surgery with a modular off-label implant combined with antiprotrusion cage and metal augment, thus, achieving improved hip function. Large segmental acetabular defects with nonsupportive columns (Paprosky type 3a and 3b) in cup loosening or Girdlestone situation. In case of pelvic discontinuity posterior column-plating is possible. Persisting hip infection and severe systemic disorders impairing achievement of secondary stability through bony integration of metal augment. Posterolateral (if dorsal column plating) or other approach. Remove loose implant and granulation tissue with sufficient exposure of bleeding bone. Size acetabular defect with trial components of augment and appropriate antiprotrusio cage. Fixation of selected metal augment with screws. Fill additional acetabular defects with morsellized bone graft. Open a slot into the ischium to fix the distal flange of the cage. If necessary, bend both flanges according to patient's anatomy. Enter the ischium with distal flange and gradual impaction of the antiprotrusio ring. Final stabilization of the ring with several screws aiming at the posterior column or the acetabular dome. Inject cement between ring and augment to stabilize the construction and avoid metal wear. Final cement fixation of a polyethylene liner or a dual-mobility cup into the antiprotrusio ring. In pelvic discontinuity with major instability osteosynthesis of the dorsal column can be performed prior to cementation. Prophylaxis of periprosthetic infection, DVT and heterotopic ossification. Physical therapy with partial weight bearing (20 kp) for 6 weeks; in discontinuity initial wheel chair mobilization. Since 2008, 72 off-label implantations of a combined antiprotrusio cage and a Trabecular Metal™ Augment were performed. A total of 44 patients (46 operations) were investigated at 38.8 (36-51) months postoperatively. In all, 36 patients had a

  13. Squeeze cementing

    SciTech Connect

    Ewert, D.P.; Kundert, D.P.; Dahl, J.A.; Dalrymple, E.D.; Gerke, R.R.

    1992-06-16

    This patent describes a method for terminating the flow of fluid from a portion of a subterranean formation into a wellbore. It comprises: placing within the wellbore adjacent the portion a volume of a slurry of hydraulic cement, permitting the volume to penetrate into the portion; and maintaining the slurry in the portion for a time sufficient to enable the slurry to form a rigid mass of cement in the portion.

  14. 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. Copyright © 2009 Elsevier B.V. All rights reserved.

  15. 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

  16. Prevalence of periprosthetic osteolysis after total hip replacement in patients with rheumatic diseases

    PubMed Central

    Perez Alamino, Rodolfo; Casellini, Carolina; Baňos, Andrea; Schneeberger, Emilce Edith; Gagliardi, Susana Alicia; Maldonado Cocco, José Antonio; Citera, Gustavo

    2012-01-01

    Periprosthetic osteolysis (PO) is a frequent complication in patients with joint implants. There are no data regarding the prevalence of PO in patients with rheumatoid arthritis (RA), juvenile chronic arthritis (JCA), ankylosing spondylitis (AS), and osteoarthritis (OA). Objectives To evaluate the prevalence of PO in patients with RA, JCA, AS, and OA, who have undergone total hip replacement (THR), and to identify factors associated with its development. Methods The study included patients diagnosed with RA (ACR 1987), AS (modified New York criteria), JCA (European 1977 criteria), and osteoarthritis (OA) (ACR 1990 criteria) with unilateral or bilateral THR. Demographic, clinical, and therapeutic data were collected. Panoramic pelvic plain radiographs were performed, to determine the presence of PO at acetabular and femoral levels. Images were read by two independent observers. Results One hundred twenty-two hip prostheses were analyzed (74 cemented, 30 cementless, and 18 hybrids). The average time from prosthesis implantation to pelvic radiograph was comparable among groups. PO was observed in 72 hips (59%). In 55% of cases, PO was detected on the femoral component, with a lower prevalence in RA (53%) vs AS (64.7%) and JCA (76.5%). Acetabular PO was more frequent in JCA patients (58.8%), compared with RA (11.6%) and OA (28.5%) patients (P = 0.0001 and P = 0.06, respectively). There was no significant association between the presence of PO and clinical, functional, or therapeutic features. Conclusion The prevalence of PO was 59%, being more frequent at the femoral level. Larger studies must be carried out to determine the clinical significance of radiologic PO. PMID:27790012

  17. Femoral impaction bone allografting with an Exeter cemented collarless, polished, tapered stem in revision hip replacement: a mean follow-up of 10.5 years.

    PubMed

    Wraighte, P J; Howard, P W

    2008-08-01

    Femoral impaction bone allografting has been developed as a means of restoring bone stock in revision total hip replacement. We report the results of 75 consecutive patients (75 hips) with a mean age of 68 years (35 to 87) who underwent impaction grafting using the Exeter collarless, polished, tapered femoral stem between 1992 and 1998. The mean follow-up period was 10.5 years (6.3 to 14.1). The median pre-operative bone defect score was 3 (interquartile range (IQR) 2 to 3) using the Endo-Klinik classification. The median subsidence at one year post-operatively was 2 mm (IQR 1 to 3). At the final review the median Harris hip score was 80.6 (IQR 67.6 to 88.9) and the median subsidence 2 mm (IQR 1 to 4). Incorporation of the allograft into trabecular bone and secondary remodelling were noted radiologically at the final follow-up in 87% (393 of 452 zones) and 40% (181 of 452 zones), respectively. Subsidence of the Exeter stem correlated with the pre-operative Endo-Klinik bone loss score (p = 0.037). The degree of subsidence at one year had a strong association with long-term subsidence (p < 0.001). There was a significant correlation between previous revision surgery and a poor Harris Hip score (p = 0.028), and those who had undergone previous revision surgery for infection had a higher risk of complications (p = 0.048). Survivorship at 10.5 years with any further femoral operation as the end-point was 92% (95% confidence interval 82 to 97).

  18. Canted seating of the Stryker Modular Dual Mobility liner within a Trident hemispherical acetabular shell.

    PubMed

    Eskildsen, Scott M; Olsson, Erik C; Del Gaizo, Daniel J

    2016-03-01

    A 75-year-old woman who suffered a left femoral neck fracture underwent a left total hip arthroplasty using a Stryker Trident (Kalamazoo, MI) hemispherical acetabular shell and Modular Dual Mobility (MDM) metal liner. Post-operative radiographs demonstrated canted seating of the liner. The patient was taken immediately back to the operating room where the acetabular liner appeared well seated superiorly but was in a canted position inferiorly. Removal and replacement was performed and post-operative radiographs demonstrated complete seating. Subsequent follow up at 6 months demonstrated good clinical function with no adverse radiographic findings. Canted seating is a potential complication of the MDM metal liner. Providers should be aware of potential incomplete seating inferiorly despite the superior portion of the liner being well seated.

  19. Femoral cement within cement technique in carefully selected aseptic revision arthroplasties.

    PubMed

    Marcos, Lucas; Buttaro, Martin; Comba, Fernando; Piccaluga, Francisco

    2009-06-01

    The aim of this study was to evaluate the clinical and radiological results in a group of patients who underwent aseptic revision hip arthroplasty using the cement within cement (CWC) technique. Between 1999 and 2005, 37 aseptic revision hip operations were performed. There were 30 women and five men, with an average age of 68 years. The reasons for revision were femoral stem fracture, cup failure, acetabular protrusion after hemi-arthroplasty and recurrent dislocation. At an average follow-up of 46 months, none of the patients required further femoral revision. The average post-operative Merle D'Aubigne score was 16.6 points (p<0.05). No evidence of radiological stem failure was observed and no femoral component was considered to be at risk for loosening. In this series of patients, the CWC technique provided consistent with high functional outcomes. This valid and effective alternative should be considered in carefully selected aseptic cases.

  20. The long-term in vivo behavior of polymethyl methacrylate bone cement in total hip arthroplasty

    PubMed Central

    2011-01-01

    Background and purpose The long-term success of cemented total hip arthroplasty (THA) has been well established. Improved outcomes, both radiographically and clinically, have resulted mainly from advances in stem design and improvements in operating techniques. However, there is concern about the durability of bone cement in vivo. We evaluated the physical and chemical properties of CMW1 bone cements retrieved from patients undergoing revision THA. Methods CMW1 cements were retrieved from 14 patients who underwent acetabular revision because of aseptic loosening. The time in vivo before revision was 7–30 years. The bending properties of the retrieved bone cement were assessed using the three-point bending method. The molecular weight and chemical structure were analyzed by gel permeation chromatography and Fourier-transform infrared spectroscopy. The porosity of the bone cements was evaluated by 3-D microcomputer tomography. Results The bending strength decreased with increasing time in vivo and depended on the density of the bone cement, which we assume to be determined by the porosity. There was no correlation between molecular weight and time in vivo. The infrared spectra were similar in the retrieved cements and in the control CMW1 cements. Interpretation Our results indicate that polymer chain scission and significant hydrolysis do not occur in CMW1 cement after implantation in vivo, even in the long term. CMW1 cement was stable through long-term implantation and functional loading. PMID:22103279

  1. Acetabular Fractures in the Elderly: Treatment Recommendations

    PubMed Central

    Pagenkopf, Eric; Grose, Andrew; Partal, George

    2006-01-01

    Acetabular fractures in the elderly population are marked by a high degree of variability in terms of patient and fracture characteristics. Successful outcomes depend on application of highly individualized management principles by experienced teams. Reviewed are indications and outcomes associated with various management options, including closed treatment, open reduction internal fixation, and acute or staged total hip arthroplasty. Proper initial management choices are critical, as early failures and subsequent salvage surgery can be accompanied by significant morbidity. Clinical results after ORIF closely follow the quality of articular reduction and the ability to maintain a congruent reduction of the hip joint. Fracture characteristics predictive of anatomic articular reduction should be treated with ORIF. Fracture characteristics predictive of early post-traumatic arthritis should be treated with simultaneous ORIF and THA. Presented is one referral institution’s treatment algorithm and management approach. PMID:18751831

  2. 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

  3. A novel electromagnetic navigation tool for acetabular surgery.

    PubMed

    Lehmann, Wolfgang; Rueger, Johannes M; Nuechtern, Jakob; Grossterlinden, Lars; Kammal, Michael; Hoffmann, Michael

    2015-10-01

    Acetabular fracture surgery is demanding and screw placement along narrow bony corridors remains challenging. It necessitates x-ray radiation for fluoroscopically assisted screw insertion. The purpose of this cadaver study was to evaluate the feasibility, accuracy and operation time of a novel electromagnetic navigation system for screw insertion along predefined acetabular corridors. A controlled laboratory study with a total of 24 electromagnetically navigated screw insertions was performed on 8 cadaveric acetabula. 3 peri-acetabular bony corridors (QSS, Quadrilateral Surface Screw; IAS, Infra-Acetabular Screw; PCS, Posterior Column Screw) were defined and screws were placed in a defined order without fluoroscopy. Operation time was documented. Postoperative CT scans were performed to analyse accuracy of screw placement. Mean cadaver age was 70.4 ± 11.7. Successful screw placement was accomplished in 22 out of 24 (91.7%) cases. The overall mean time for all 3 acetabular screws was 576.6 ± 75.9s. All 3 complications occurred during the placement of the IAS due to an impassable narrow bony corridor. QSS mean length was 50 ± 5mm, IAS mean length was 85 ± 10mm and PCS mean length was 120 ± 5mm. In this cadaver study the novel electromagnetic navigation system was feasible to allow accurate screw placement without fluoroscopy in defined narrow peri-acetabular bony corridors. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Cement Burns

    PubMed Central

    Alam, Munir; Moynagh, M.; Lawlor, C.

    2007-01-01

    Objective: Cement burns account for relatively few admissions to a burn unit; however, these burns deserve separate consideration because of special features of diagnosis and management. Cement burns, even though potentially disabling, have rarely been reported in literature. Methods: A retrospective review was performed of all patients admitted with cement burns injuries to the national burns unit at the St James's Hospital in Dublin, Ireland, over a 10-year period for the years 1996–2005. Results: A total of 46 patients with cement burns were admitted. The majority of patients were aged 16–74 years (mean age = 32 years). Eighty-seven percent of injuries occurred in an industrial and 13% in a domestic setting. The upper and lower extremities were involved in all the patients, and the mean total body surface area affected was 6.5%. The mean length of hospital stay was 21 days with a range of 1–40 days. Thirty-eight (82%) were surgically managed involving debridement and split-thickness skin graft (SSG) and four (9%) were conservatively managed. A further four did not have data available. Conclusion: Widespread inexperience in dealing with this group of cement burns patients and delays in referral to burns unit highlights the potential for greater levels of general awareness and knowledge in both prevention and treatment of these burns. As well, early debridement and split-thickness skin grafting at diagnosis constitutes the best means of reducing the high socioeconomic costs and allows for early return to work. PMID:18091981

  5. Life cycle benefits of calcium silicate replacements

    SciTech Connect

    Cabrera, J.G.; Woolley, G.R.

    1996-12-31

    The most universal of all binders, produced in huge quantities worldwide, is Portland cement. Following introduction in 1824 by Joseph Aspin, it has quite properly enjoyed popular appeal with craftsmen, architects and engineers for its bonding properties. The manufacture of cement relies largely on primary minerals for feedstock and depends heavily on carboniferous fuels for production. Naturally occurring minerals have similar properties as a binder and have been used in their own right or as partial replacements for cement. Likewise, secondary products recovered from modern manufacturing or energy production processes also have the potential to replace in part a proportion of cement. Life cycle analysis of cement production supports the proposition that large quantities of fossil fuel and primary minerals are being unnecessarily used in situations where alternative replacements are available and frequently placed to waste. This paper considers the implications of cement production on a sustainable environment. It argues that, contrary to some opinions, partial replacement of cement with secondary wastes which have potential cementitious properties can enhance and improve structures which otherwise would include only Portland cement as the binder. Acceptance of this argument would leave massive quantities of primary minerals untouched and reduce the amount of fossil fuels demanded of cement production on the present scale.

  6. The influence of acetabular cup material on pelvis cortex surface strains, measured using digital image correlation.

    PubMed

    Dickinson, A S; Taylor, A C; Browne, M

    2012-02-23

    Acetabular cup loosening is a late failure mode of total hip replacements, and peri-prosthetic bone deterioration may promote earlier failure. Preservation of supporting bone quality is a goal for implant design and materials selection, to avoid stress shielding and bone resorption. Advanced polymer composite materials have closer stiffness to bone than metals, ceramics or polymers, and have been hypothesised to promote less adverse bone adaptation. Computer simulations have supported this hypothesis, and the present study aimed to verify this experimentally. A composite hemi-pelvis was implanted with Cobalt Chromium (CoCr), polyethylene (UHMWPE) and MOTIS(®)carbon-fibre-reinforced polyether etherketone (CFR-PEEK) acetabular cups. In each case, load was applied to the implanted pelvis and Digital Image Correlation (DIC) was used for surface strain measurement. The test was repeated for an intact hemi-pelvis. Trends in implanted vs. intact bone principal strains were inspected to assess the average principal strain magnitude change, allowing comparison of the potential bone responses to implantation with the three cups. The CFR-PEEK cup was observed to produce the closest bone strain to the intact hip in the main load path, the superior peri-acetabular cortex (+12% on average, R(2)=0.84), in comparison to CoCr (+40%, R(2)=0.91) and UHWMPE cups (-26%, R(2)=0.94). Clinical observations have indicated that increased periacetabular cortex loading may result in reduced polar cancellous bone loading, leading to longer term losses in periprosthetic bone mineral density. This study provides experimental evidence to verify previous computational studies, indicating that cups produced using materials with stiffness closer to cortical bone recreate physiological cortical bone strains more closely and could, therefore, potentially promote less adverse bone adaptation than stiffer press-fitted implants in current use.

  7. Calcium Orthophosphate Cements and Concretes

    PubMed Central

    Dorozhkin, Sergey V.

    2009-01-01

    In early 1980s, researchers discovered self-setting calcium orthophosphate cements, which are a bioactive and biodegradable grafting material in the form of a powder and a liquid. Both phases form after mixing a viscous paste that after being implanted, sets and hardens within the body as either a non-stoichiometric calcium deficient hydroxyapatite (CDHA) or brushite, sometimes blended with unreacted particles and other phases. As both CDHA and brushite are remarkably biocompartible and bioresorbable (therefore, in vivo they can be replaced with newly forming bone), calcium orthophosphate cements represent a good correction technique for non-weight-bearing bone fractures or defects and appear to be very promising materials for bone grafting applications. Besides, these cements possess an excellent osteoconductivity, molding capabilities and easy manipulation. Furthermore, reinforced cement formulations are available, which in a certain sense might be described as calcium orthophosphate concretes. The concepts established by calcium orthophosphate cement pioneers in the early 1980s were used as a platform to initiate a new generation of bone substitute materials for commercialization. Since then, advances have been made in the composition, performance and manufacturing; several beneficial formulations have already been introduced as a result. Many other compositions are in experimental stages. In this review, an insight into calcium orthophosphate cements and concretes, as excellent biomaterials suitable for both dental and bone grafting application, has been provided.

  8. Anaphylactic shock during cement implantation of a total hip arthroplasty in a patient with underlying mastocytosis: case report of a rare intraoperative complication.

    PubMed

    Ten Hagen, Anita; Doldersum, Pieter; van Raaij, Tom

    2016-01-01

    Cemented total hip arthroplasty (THA) is a safe and common procedure. In rare cases life threatening bone cement implantation syndrome (BCIS) may occur, which is commonly caused by pulmonary embolism (PE). We describe the rare case of a 70-year old patient who underwent an elective total hip replacement. Before surgery he was diagnosed with underlying systemic indolent mastocytosis, a rare pathological disorder that may result in anaphylaxis after massive systemic mast cell activation. Triggers may be IgE-mediated, direct mast cell activation, or unclear. Some patients may be at risk for severe non IgE-mediated reactions, such as those experienced with nonsteroidal anti-inflammatory drugs, or with perioperative muscle relaxants. During cementing of the acetabular component, our patient developed acute hypotension (blood pressure dropped from 90/50 to 60/40 mmHg, and saturation dropped from 95 to 80 %). The differential diagnosis of acute PE was excluded (no signs of breathing abnormalities during physical examination, normal arterial blood sample, and no electrocardiography or cardiac ultrasound abnormalities). The patient was diagnosed with acute anaphylactic shock, which was successfully managed by 100 % oxygen administration, rapid fluid induction, and vasoconstrictive drug therapy. He recovered hemodynamically within 15 min, did not lose consciousness, and did not develop angioedema or an urticarial rash. Forty-five minutes after onset of the symptoms, the surgical procedure was completed after inserting a press fitted uncemented femoral stem component. The patient was transported to the Intensive Care Unit (ICU) for optimal monitoring. Our patient had an uneventful recovery. Within six hours after surgery he started to ambulate following our standard fast-track rehabilitation regime. Post-operative day one he was discharged to the specialized Orthopedic Department, and after five hospital days discharged to his home. Twelve months after THA surgery our

  9. Porosity reduction in bone cement at the cement-stem interface.

    PubMed

    Bishop, N E; Ferguson, S; Tepic, S

    1996-05-01

    The fatigue failure of bone cement, leading to loosening of the stem, is likely to be one mode of failure of cemented total hip replacements. There is strong evidence that cracks in the cement are initiated at voids which act as stress risers, particularly at the cement-stem interface. The preferential formation of voids at this site results from shrinkage during polymerisation and the initiation of this process at the warmer cement-bone interface, which causes bone cement to shrink away from the stem. A reversal of the direction of polymerisation would shrink the cement on to the stem and reduce or eliminate the formation of voids at this interface. We have investigated this by implanting hip prostheses, at room temperature or preheated to 44 degrees C, into human cadaver femora kept at 37 degrees C. Two types of bone cement were either hand-mixed or vacuum-mixed before implantation. We found that the area of porosity at the cement-stem interface was dramatically reduced by preheating the stem and that the preheating temperature of 44 degrees C determined by computer analysis of transient heat transfer was the minimum required to induce initial polymerisation at the cement-stem interface. Temperature measurements taken during these experiments in vitro showed that preheating of the stem caused a negligible increase in the temperature of the bone. Reduction of porosity at the cement-stem interface could significantly increase the life of hip arthroplasties.

  10. 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

  11. Comparative study of comminuted posterior acetabular wall fracture treated with the Acetabular Tridimensional Memory Fixation System.

    PubMed

    Zhang, Yuntong; Zhao, Xue; Tang, Yang; Zhang, Chuncai; Xu, Shuogui; Xie, Yang

    2014-04-01

    Posterior wall fractures are one of the most common acetabular fractures. However, only 30% of these fractures involve a single large fragment, and comminuted acetabular posterior wall fractures pose a particular surgical challenge. The purpose of this study was to compare outcomes between patients who received fixation for comminuted posterior wall fracture using the Acetabular Tridimensional Memory Fixation System (ATMFS) and patients who underwent fixation with conventional screws and buttress plates (Plates group). Between April 2003 and May 2007, 196 consecutive patients who sustained a comminuted posterior wall fracture of acetabulum were treated with ATMFS or conventional screws and buttress plates. Operative time, fluoroscopy time, blood loss, and any intra-operative complications were recorded. Plain AP and lateral radiographs were obtained at all visits (Matta's criteria). Modified Merle d' Aubigne-Postel score, and Mos SF-36 score were compared between groups. Fifty patients were included in the analysis with 26 in the ATMFS group and 24 in the Plates group. The mean follow-up time was 57.5 months, ranging from 31 to 69 months. All patients had fully healed fractures at the final follow-up. There was no difference in clinical outcomes or radiological evaluations between groups. Patients with comminuted posterior wall fractures of the acetabulum treated with the ATMFS or conventional screws and buttress plate techniques achieve a good surgical result. Both techniques are safe, reliable, and practical. Use of the ATMFS technique may reduce blood loss and improve rigid support to marginal bone impaction. The use ATMFS may need additional support when fractures involve the superior roof. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Radiological evaluation of painful total hip replacement

    SciTech Connect

    Jamshid, T.; Schneider, R.; Freiberger, R.H.

    1981-11-01

    Ninety-four cases of clinically failed, cemented, total hip prostheses requiring surgery were reviewed to determine the accuracy of preoperative plain radiography, culture of aspirated fluid, arthrography, and bone scanning. When radiopaque cement had been used to embed the prosthesis, plain radiography was highly accurate in detecting a loose femoral component, less so in detecting a loose acetabular component. Culture of aspirated fluid was accurate in diagnosing infection. A positive arthrogram identified loosening with good accuracy; however, a negative arthrogram did not reliably exclude loosening. /sup 99/mTc bone scans frequently differentiated loosening from loosening with infection. The suggested sequence of diagnostic tests is plain radiography followed by bone scanning. If the bone scan shows diffuse augmented uptake, culture of aspirated fluid followed by arthrography is indicated.

  13. Radiological evaluation of painful total hip replacement

    SciTech Connect

    Tehranzadeh, J.; Schneider, R.; Freiberger, R.H.

    1981-01-01

    Ninety-four cases of clinically failed, cemented, total hip prostheses requiring surgery were reviewed to determine the accuracy of preoperative plain radiography, culture of aspirated fluid, arthrography, and bone scanning. When radiopaque cement had been used to embed the prosthesis, plain radiography was highly accurate in detecting a loose femoral component, less so in detecting a loose acetabular component. Culture of aspirated fluid was accurate in diagnosing infection. A positive arthrogram identified loosening with good accuracy; however, a negative arthrogram did not reliably exclude loosening. /sup 99/mTc bone scans frequently differentiated loosening from loosening with infection. The suggested sequence of diagnostic tests is plain radiography followed by bone scanning. If the bone scan shows diffuse augmented uptake, culture of aspirated fluid followed by arthrography is indicated.

  14. Outcomes at least 10 years after cemented PF® (Zimmer) total hip arthroplasty: 83 cases.

    PubMed

    Aubault, M; Druon, J; Le Nail, L; Rosset, P

    2013-06-01

    Cementless total hip arthroplasty (TKA) is gaining ground over cemented TKA. The objective of this study was to assess survival rates of a cemented THA implant (PF(®), Zimmer), after at least 10 years and to assess changes in acetabular bone structure. Eighty-three ceramic-on-polyethylene THA prostheses were implanted between 1998 and 2001. Clinical outcomes were assessed using the Harris hip score and Postel Merle d'Aubigné score. For each hip, radiographs were examined for acetabular radiolucent lines, geodes, and granulomas; in addition, changes in bone structure and trabeculae were assessed comparatively to the other hip and classified from no change to severe osteolysis. Changes in trabeculae served to assess the loads applied to the bone. Polyethylene wear was assessed using the Livermore method. A single patient was lost to follow-up. At last follow-up, 16 patients had died and six were contacted and had not required revision surgery; the remaining 52 patients (59 THAs) were re-evaluated and none had evidence of loosening. The Harris hip score at last evaluation was 91.6 compared to 60.5 preoperatively. No hips had evidence of acetabular osteolysis. For two hips, the radiographs showed complete acetabular radiolucent lines less than 2mm in width, with no mobilisation. Trabecular distribution was homogeneous with no stress shielding. Mean annual rate of wear was 0.08mm. No instances of femoral component loosening were recorded; granulomas involving no more than five Gruën zones were seen in three cases. This study confirms the reliability of cemented THA, with a 12-year survival rate of 98.3%, in keeping with earlier data. Thus, our results establish that cemented ceramic-on-polyethylene prostheses remain valid options for THA. IV. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  15. Long-Term Outcome of Acetabular Reconstruction Using a Kerboull-Type Acetabular Reinforcement Device with Hydroxyapetite Granule and Structural Autograft for AAOS type II and III Acetabular Defects.

    PubMed

    Kim, Youngwoo; Tanaka, Chiaki; Kanoe, Hiroshi

    2015-10-01

    We evaluated the clinical results of the reconstruction of acetabular bone deficiency using hydroxyapatite (HA) granules and structural autografts supported by a Kerboull-type acetabular reinforcement device at a minimum of 10 years follow-up. Between 1993 and 2003, 40 consecutive THA revisions were performed in 37 patients with a mean age of 66.4 years. The mean follow-up period was 12.8 years. Radiologically, 5 hips failed, of which 2 were revised. The survival rate of the acetabular component at 10 years was 100% in type II defects and 94.9% in the type III defects, using acetabular revision for loosening as the end point. Acetabular reconstruction with HA granules, structural autografts and a Kerboull-type acetabular reinforcement device provided satisfactory clinical and radiological results at 12.8 years postoperatively.

  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. A Novel Approach for Treatment of Acetabular Fractures

    PubMed Central

    Xue, Zichao; Qin, Hui; Ding, Haoliang; An, Zhiquan

    2016-01-01

    Background There is no single approach that provides adequate exposure for treatment of all types of acetabular fractures. We describe our experience with an easier, relatively less invasive pubic symphysis approach (PSA) for the treatment of acetabular fractures. Material/Methods Between March 2011 and March 2012, fifteen patients with acetabular fracture underwent surgery using the PSA technique. Fracture reduction and treatment outcomes were assessed by clinical and radiological examination. Operation time, intraoperative blood loss and postoperative complications were documented. Results Mean operative time was 222±78 minutes. Average blood loss was 993±361 mL. Anatomical reduction was achieved in all patients. Minimum follow-up period was 31 months. Postoperative hypoesthesia in the area of innervation of the lateral femoral cutaneous nerve was reported in one patient, with spontaneous recovery at one month after surgery. No complications were reported during the follow-up period. At the most recent follow up, clinical outcomes were graded as “excellent” in six patients, “good” in eight patients and “fair” in one patient based on the modified Merle d’Aubigné-Postel score. Conclusions PSA appears to be a timesaving and safe approach for treatment of acetabular fractures that affords good visual access and allows for excellent fracture reduction. Our preliminary results revealed a much lower incidence of complications than traditional approaches, suggesting PSA is an alternative for treatment of acetabular fractures. PMID:27734825

  18. Hemispheric cups do not reproduce acetabular rim morphology.

    PubMed

    Vandenbussche, Eric; Saffarini, Mohammed; Delogé, Nicolas; Moctezuma, José-Luis; Nogler, Michael

    2007-06-01

    Iliopsoas impingement is a recurrent complication following THA, caused by muscle friction against a protrusive prosthetic cup.This study was designed to quantify the dimensional variations in acetabular rim profiles, with particular regard to the iliopubic valley, in order to suggest means to prevent iliopsoas impingement. 34 cadaver pelvises were analyzed using a hip navigation system. The morphometric data were processed to plot profiles of all acetabular rims with particular regard to the shape and depth of the psoas valley. The acetabular rim is an asymmetric succession of 3 peaks and 3 troughs. The psoas valley is a salient feature in most pelvises and there is only a weak correlation between its depth (mean 3.8 mm, SD 2.0) and acetabular diameter, anteversion, or inclination. It would be difficult to obviate the anterior overlap of the acetabulum using a hemispheric cup, a fortiori in certain morphotypes, without compromising range of motion or risk of dislocation. The solution for prevention of iliopsoas impingement would be to adapt cup design to acetabular anatomy, which may require different implants for the right and left sides, and hence a doubled inventory.

  19. Acetabular bone loss in revision total hip arthroplasty: principles and techniques.

    PubMed

    Noordin, Shahryar; Masri, Bassam A; Duncan, Clive P; Garbuz, Donald S

    2010-01-01

    Bone stock deficiency presents the major challenge in acetabular reconstruction during revision hip arthroplasty. The preoperative assessment of acetabular bone stock before revision surgery is critical because the amount and location of pelvic osteolysis can determine the type and success of revision surgery. Traditionally, plain radiographs with AP and lateral views have been used for this purpose; however, Judet views can provide additional information about the integrity of the anterior and posterior columns. CT and MRI scans are indicated in selected patients. A variety of surgical options are available for treating Paprosky type 3 defects. Jumbo cups, the high hip center technique, impaction grafting, bilobed implants, antiprotrusio cages, and structural allografts, in addition to other types of implants, are part of the armamentarium available for revision hip arthroplasty. Segmental bone loss involving more than 50% of the acetabulum is one of the biggest challenges in revision hip replacement. The short-term clinical and radiographic results of treating these large defects with modular, highly porous metal components appear promising. However, potential problems with these components include their unknown long-term durability, potential for debris generation at the shell-augment interface, potential for fatigue failure, and the inability to restore bone stock if future revisions are needed.

  20. Volumetric computerized tomography as a measurement of periprosthetic acetabular osteolysis and its correlation with wear

    PubMed Central

    Looney, R John; Boyd, Allen; Totterman, Saara; Seo, Gwy-Suk; Tamez-Pena, Jose; Campbell, Debbie; Novotny, Leonore; Olcott, Christopher; Martell, John; Hayes, F Ann; O'Keefe, Regis J; Schwarz, Edward M

    2002-01-01

    Osteolysis, which is considered to be a major source of morbidity following total hip joint replacement, has been notoriously difficult to measure accurately, particularly in the acetabular area. In order to study periacetabular osteolysis, specialized software for computerized tomography (CT) scan image analysis has been developed. This software (3D-CT) eliminates metal artifacts, allows three-dimensional segmentation of the CT image, and reconstructs the segmented image to provide an accurate representation and measurement of volume for osteolytic lesions. In the present study, 20 patients underwent periacetabular osteolytic volume determination using 3D-CT, functional assessment (using the Harris Hip Scale, the Western Ontario and McMaster University Osteoarthritis Index, and the short form 36 questionnaire), and two-dimensional analysis of volumetic polyethylene wear using digitalized plain films. Periacetabular osteolysis correlated directly with the polyethylene wear rate (relative risk [RR] = 0.494, P = 0.027). If one patient with an acetabular revision, one patient with recurrent dislocation, and one patient with a Biomet prosthesis are excluded, then the correlation between wear and osteolysis is improved (RR = 0.685, P = 0.002). In summary, the current study demonstrates both the feasibility of CT imaging of periacetabular osteolysis and the correlation between polyethylene wear and osteolytic volume, providing a potential outcome measure for clinical trials that are designed to examine interventions in this complex disease process. PMID:11879538

  1. 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

  2. Effects of screw eccentricity on the initial stability of the acetabular cup in artificial foam bone of different qualities.

    PubMed

    Hsu, Jui-Ting; Lin, Dan-Jae

    2010-01-01

    Acetabular cup loosening is one of the major failure models of total hip replacement (THR), which is mostly due to insufficient initial stability of the cup. Previous studies have demonstrated that cup stability is affected by the quality of the host bone and the surgical skill when inserting screws. The purpose of this study was to determine the effects on the initial stability of the acetabular cup of eccentric screws in bone of different qualities. In this study, hemispherical cups were fixed into bone specimens constructed from artificial foam with three elastic moduli using one to three screws. The effects of two types of screw eccentricity (offset and angular) on the stability of the acetabular cup were also evaluated. The experimental results indicate that in the presence of ideal screwing, the cup was stable in bone specimens constructed from foam with the highest elastic modulus. In addition, increasing the number of ideal screws enhanced the cup stability, especially in bone specimens constructed from soft foam. Moreover, the cup stability was most affected by offset eccentric screw(s) in the hard-foam bone specimens and by angular eccentric screw(s) in the soft-foam bone specimens. The reported results indicate that the presence of screw eccentricity affects the initial stability of the acetabular cup. Surgeons should keep this in mind when performing screw insertions in THR. However, care is necessary when translating these results to the intraoperative situation due to the experiments being conducted under laboratory conditions, and hence, future studies should attempt to replicate the results reported here in vivo.

  3. Cemented versus uncemented fixation of the femoral component of the NexGen CR total knee replacement in patients younger than 60 years: a prospective randomised controlled RSA study.

    PubMed

    Gao, Feng; Henricson, Anders; Nilsson, Kjell G

    2009-06-01

    The optimal mode of femoral fixation in total knee arthroplasty (TKA) remains controversial, especially for the young patient. In a prospective randomised study we compared the magnitude and pattern of the fixation of cemented versus uncemented femoral components during 2 years in patients younger than 60 years. Forty-one knees in 41 patients were randomised to receive a NexGen (Zimmer, Warsaw, USA) cruciate-retaining TKA with either a cemented or an uncemented non HA-coated femoral component. The patients were examined by radiostereometric analysis (RSA), as well as clinical and radiological evaluation. The magnitude and pattern of migration as measured by RSA did not differ significantly between the cemented and uncemented fixation during the 2-year follow-up, nor were there any differences between the groups in clinical parameters. These findings suggest that an uncemented and non HA-coated femoral component may behave equally as well as a cemented one in the long-term.

  4. 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.

  5. A computer simulation of rotational acetabular osteotomy for dysplastic hip joint: does the optimal transposition of the acetabular fragment exist?

    PubMed

    Tsumura, Hiroshi; Kaku, Nobuhiro; Ikeda, Shinichi; Torisu, Takehiko

    2005-01-01

    For young patients who have early signs of coxarthrosis resulting from acetabular dysplasia, periacetabular osteotomies for correcting abnormal stress distribution can be useful for preventing the progression of the disease. However, it is difficult to confirm the optimal transposition of the osteotomized acetabular fragment. To deal with this problem, we devised a computer program to support preoperative planning. Hip images obtained by computed tomography were loaded into our program, and a three-dimensional voxel model was created. Then, osteotomy was simulated and the pressure distribution was analyzed with a rigid-body spring analysis (computational nonlinear mechanical analysis). The three-dimensional pressure distributions in seven dysplastic hips were evaluated before and after virtual rotational acetabular osteotomy. A peak pressure was calculated for every 5 degrees of rotation of the acetabular fragment. The peak pressure decreased gradually and increased again afterward, indicating the optimal transposition of the acetabular fragment. The postoperative peak pressure decreased to about 40% in the most improved case. This program allows the hip joint mechanics to be evaluated easily so that the advantages and disadvantages of various surgical methods can be examined biomechanically prior to surgery.

  6. Cryogenics with cement microscopy redefines cement behavior

    SciTech Connect

    Mehta, S.; Jones, R. ); Caveny, B. )

    1994-10-03

    Cement microscopy (CM), cryogenics, environmental scanning microscopy (ESM), scanning electron microscopy (SEM), and other technologies are leading investigators to change their views on cement gelation, hydration, and retardation. Cement samples frozen in a nitrogen slush and viewed with an SEM present a more accurate picture of the setting process. Observations made through this technique have revolutionized ARCO Exploration and Production Technology's and Halliburton Energy Services' oil field cement procurement and slurry design. Findings from this joint study are expected to lead to: optimized waiting on cement (WOC) times; reduced planning and design time; optimized slurry retarder additions; optimized gel times to fit given situations; especially applicable to squeeze operations; improved cement selection (from vendors) for peak performance; and improved cement manufacture. The paper discusses the measuring methods and the findings on the following: cement voids, cement gelation, and retardation mechanisms. It also briefly discusses the impact these discoveries have on operations.

  7. Tension band stabilisation of acetabular physeal fractures in four kittens.

    PubMed

    Langley-Hobbs, S J; Sissener, T R; Shales, C J

    2007-06-01

    The surgical repair of acetabular physeal fractures in four kittens using a screw and tension band technique is reported. This was an appropriate method for restoring articular congruency and improving pelvic alignment. All cases had an excellent outcome and full limb use following fracture repair. In kittens younger than 12 weeks, there is a possibility of premature fusion of the acetabular bone resulting in development of a deformed, shallow acetabulum and hip subluxation. However, surgery is still justified when there is pelvic canal narrowing to decrease the risk of future defecatory problems. Early implant removal in such young kittens may decrease the severity of deformity caused by premature physeal closure. In kittens of 16 weeks or older, the prognosis is good for normal acetabular development and implant removal is not necessary.

  8. Development of site-specific locking plates for acetabular fractures.

    PubMed

    Xu, Meng; Zhang, Li-Hai; Zhang, Ying-Ze; He, Chun-Qing; Zhang, Li-Cheng; Wang, Yan; Tang, Pei-Fu

    2013-05-01

    Site-specific locking plates have gained popularity for the treatment of fractures. However, the clinical use of a site-specific locking plate for acetabular fractures remains untested due to production limits. To design a universal site-specific locking plate for acetabular fractures, the 3-dimensional (3D) photographic records of 171 pelvises were retrospectively studied to generate a universal posterior innominate bone surface. Using 3D photographical processing software, the 3D coordinate system was reset according to bony landmarks and was scaled based on the acetabular diameter to allow a direct comparison between surfaces. The measured surface was separated into measurement units. At each measurement unit, the authors calculated the average z-axis values in all samples and obtained the 3D coordinate values of the point cloud that could be reconstructed into the universal surface. A plate was subsequently designed in 3D photographical processing software, and the orientation and distribution of locking screws was included. To manufacture a plate, the data were entered into Unigraphics NX version 6.0 software (Siemens PLM Software, Co, Ltd, Plano, Texas) and a CNC digital milling machine (FANUC Co, Ltd, Yamanashi, Japan). The resulting locking plate fit excellently with the reduced bone surface intraoperatively. Plate contouring was avoided intraoperatively. Universal 3.5-mm locking screws locked successfully into the plate, and their orientations were consistent with the design. No screw yielded to acetabular penetration. This method of designing a site-specific acetabular locking plate is practical, and the plates are suitable for clinical use. These site-specific locking plates may be an option for the treatment of acetabular fractures, particularly in elderly patients.

  9. Rationales for the Bernese approaches in acetabular surgery.

    PubMed

    Keel, M J B; Ecker, T M; Siebenrock, K-A; Bastian, J D

    2012-10-01

    To present two new approaches to acetabular surgery that were established in Berne, and which aim at enhanced visualization and anatomical reconstruction of acetabular fractures. The trochanteric flip osteotomy allows for surgical hip dislocation, and was introduced as a posterior approach for acetabular fracture management involving the posterior column and wall. For acetabular fractures predominantly involving the anterior column and the quadrilateral plate, the Pararectus approach is described. Full exposure of the hip joint, as provided by the trochanteric flip osteotomy, facilitates anatomical reduction of acetabular or femoral head fractures and safe positioning of the anterior column screw in transverse or T-shaped fractures. Additionally, the approach enables osteochondral transplantation as a salvage procedure for severe chondral femoral head damage and osteoplasty of an associated inadequate offset at the femoral head-neck junction. The Pararectus approach allows anatomical restoration with minimal access morbidity, and combines advantages of the ilioinguinal and modified Stoppa approaches. Utilization of the trochanteric flip osteotomy eases visualization of the superior aspect of the acetabulum, and enables the evaluation and treatment of chondral lesions of the femoral head or acetabulum and labral tears. Displaced fractures of the anterior column with a medialized quadrilateral plate can be addressed successfully through the Pararectus approach, in which surgical access is associated with minimal morbidity. However, long-term results following the two presented Bernese approaches are needed to confirm that in the treatment of complex acetabular fractures the rate of poor results in almost one-third of all cases (as currently yielded using traditional approaches) might be reduced by the utilization of the presented novel approaches.

  10. 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)

  11. 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)

  12. Arthroscopic Technique for Acetabular Labral Reconstruction Using Iliotibial Band Autograft.

    PubMed

    Chahla, Jorge; Soares, Eduardo; Bhatia, Sanjeev; Mitchell, Justin J; Philippon, Marc J

    2016-06-01

    The dynamic function of the acetabular labrum makes it an important structure for both hip stability and motion. Because of this, injuries to the labrum can cause significant dysfunction, leading to altered hip kinematics. Labral repair is the gold standard for symptomatic labral tears to keep as much labral tissue as possible; however, in cases where the labrum has been injured to such a degree that it is either deficient or repair is not possible, arthroscopic labral reconstruction is preferred. This article describes our preferred approach for reconstruction of the acetabular labrum using iliotibial band autograft.

  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.

  14. 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

  15. Analysis of version in the acetabular cup.

    PubMed

    Seradge, H; Nagle, K R; Miller, R J

    1982-06-01

    To determine the amount of anteversion or retroversion of the acetabular component of the implanted total hip prosthesis, two anteroposterior radiographs of the hip are obtained, with the contralateral hip flexed to compensate for the possible existing flexion contracture. The X-ray beam is centered on the implanted total hip in one radiograph, and moved away from it toward the contralateral hip in the second radiograph. If the cup is anteverted, the opening will seem wider in the second radiograph. To calculate the angle, the location of the center of the X-ray beam on the X-ray plate must be know. The center of the X-ray beam can be marked on the radiograph by putting a metalic cross on the patient, over the centering cross of the X-ray light source. If the distance of the signature of the X-ray's center beam is less than 8 mm for the center of the cup on the X-ray film, the cup version can be calculated from the arcsin of the shortest to the largest diameter of the cup. If the central ray's signature is farther away, correction is necessary for this calculation. Also, the variable parameters, e.g., cup size, and magnification rate, should be considered in the calculations. The anteroposterior radiographs of the implanted total hip, obtained with the central beam being marked on the X-ray plate, not only are useful for evaluation of the implant but also can be used to calculate the version angle with an accuracy of +/-2 degrees. The necessary calculation is tabulated for cups with an outside diameter of 44-56 mm.

  16. Comparative survival analysis of porous tantalum and porous titanium acetabular components in total hip arthroplasty.

    PubMed

    Vutescu, Emil S; Hsiue, Peter; Paprosky, Wayne; Nandi, Sumon

    2017-02-04

    Porous tantalum acetabular components (PoTa) are well-studied, but less is known about widely used porous titanium (PoTi) acetabular components. We performed a comparative survival analysis between PoTi and PoTa acetabular components. Primary or revision THA performed using PoTi (n = 2,976) or PoTa (n = 184) acetabular components with minimum 2-year follow-up (PoTi n = 1,539; PoTa n = 157) were analysed. Univariate and multivariate logistic regression were performed to test the effect of porous metal acetabular component type on revision surgery for aseptic cup loosening. Multivariate model was adjusted for acetabular defect severity according to the Paprosky Classification. Only PoTi components used in revision THA failed. Survival of the PoTi acetabular component was 98.6% when used in revision THA at mean 48.3-month follow-up. After adjusting for severity of acetabular defect, there was no difference in survival between PoTi and PoTa acetabular components when used in primary or revision THA. After adjusting for acetabular defect severity, both PoTa and PoTi acetabular components had excellent survival at mean 44.4-month (range 4.3-91.5 months) follow-up when used in primary and revision THA.

  17. Cemented and cementless fixation: results and techniques.

    PubMed

    Silverton, Craig D

    2006-01-01

    There are multiple reports of successful cemented and cementless total knee arthroplasty in the current literature. Although technically more demanding to implant, selected cementless designs, with nearly 20 years of follow-up, demonstrate near-equal success compared with cemented implants, the gold standard. Far more important than the decision to use a cemented or cementless implant is the use of precise technique, adequate balancing of the soft tissues, and proper overall alignment. Failure to achieve these basic principles can lead to early failure in any total knee replacement system.

  18. [Acetabular defect reconstruction in revision surgery of the hip. Autologous, homologous or metal?].

    PubMed

    Gravius, S; Pagenstert, G; Weber, O; Kraska, N; Röhrig, H; Wirtz, D C

    2009-08-01

    The treatment of periprosthetic bone defects of the acetabulum is a therapeutic challenge in hip revision surgery. The aims are the biological reconstruction of osseous acetabular defects and the restoration of a load-bearing acetabular bone stock as well as restoring the physiological joint biomechanics and achieving primary and load-stable fixation of the revision graft in the vital pelvic bone. The biological reconstruction of the acetabular bone stock should include what is referred to as "down-grading" of the acetabular defect situation in case a repeat revision procedure becomes necessary.Nowadays, a large variety of grafts and reconstruction procedures are available for the reconstruction of acetabular defects. The choice of suitable materials (osseous or metallic) for the restoration of a load-bearing acetabular bone stock is currently the subject of controversial discussion.This article reviews the various options for the reconstruction of acetabular bone defects taking into consideration the current findings in the scientific literature.

  19. Acetabular screw head-induced ceramic acetabular liner fracture in cementless ceramic-on-ceramic total hip arthroplasty.

    PubMed

    Lee, Su Chan; Jung, Kwang Am; Nam, Chang Hyun; Kim, Tea Ho; Ahn, Nong Kyoum; Hwang, Seung Hyun

    2010-05-12

    Ceramic liner fractures are rare after ceramic-on-ceramic THA. This article describes a case of an early ceramic liner fracture caused by impingement with a tilted acetabular screw head 2 months after cementless ceramic-on-ceramic THA. A 59-year-old man underwent primary THA for avascular necrosis of his right femoral head. The implant used was an Osteonics Secur-Fit HA ceramic-on-ceramic bearing system. The metal shell was fixed with 1 cancellous bone screw. During the index procedure, the acetabular screw seemed tilted in the metal shell hole, but the liner was fully seated in the metal shell without difficulty. However, 2 months later he re-presented due to pain and crepitation in the right hip. Radiographs showed that the ceramic acetabular insert had fractured. At revision, ceramic insert had fractured into large and numerous comminuted fragments, and the acetabular screw head was slightly tilted and protruded over the inner surface of the metal shell, which had worn eccentrically. The ceramic inner head and metal shell were visibly intact. Because the metal shell-bone fixation was firm, a new identical design ceramic liner and head were fitted, and no adverse event has occurred since. This case suggests that a complete check of the inside of the shell should be made when using an acetabular screw and ceramic liner. In particular, the screw head must not be tilted or left proud of the inside surface of the shell. Correct acetabular screw direction and seating are essential to avoid detrimental clinical consequences. Copyright 2010, SLACK Incorporated.

  20. Cementing multilateral wells with latex cement

    SciTech Connect

    1997-08-01

    A multilateral well is a well with one or more branches or lateral sections extending from its main wellbore. The laterals can be openhole or cased hole. When laterals are cased hole, the cement integrity for casing support and zonal isolation is very important. When cementing the lateral sections of multilateral wells, it is important to use a cement with high strength and durability to support the liner throughout the life of the well and to support the lateral section. The cement column is subjected to various stresses when the cemented inner stub is cut. High tensile strength, flexural strength, and crack resistance are required. These properties are necessary to make a clean cut through the cement sheath that does not induce cracks in the cement column. Latex cement is commonly used for its gas-migration-control property.

  1. Expansive Cements

    DTIC Science & Technology

    1970-10-01

    sulfate (C), and free lime (C) as well as other known portland cement compounds. 9. Etiite (C6AS3H3 2 ) is the phase formed during the hydration of...hydroxide (CH), required for chemical combination originates by hydration of alite (C3 S), belite (C2 S), and hydration of free lime in both the... shrinkage was also observed when the specimens were moist cured to full exparn-on for a pericd of 33 days. The data regarding the effect of aggregate size on

  2. [Vascular injuries in joint replacement surgery].

    PubMed

    Novotný, K; Pádr, R; Landor, I; Sosna, A

    2011-01-01

    Iatrogenic injuries to blood vessels in joint replacement surgery are rare events that occur as few per thousand. However, their sequelae are serious. The patient may either bleed to death, because vascular injury is not obvious and therefore difficult to diagnose, or lose the limb due to ischaemia. The highest risk of vascular injury is associated with repeat surgery and loosening of the acetabular component. We distinguish sharp and blunt force injuries. The former are caused by implants, sharp instruments, bone fragments or bone cement debris. The latter arise from stretching over a part of implanted material. Bleeding can be inapparent or apparent. Inapparent bleeding is difficult to diagnose and is recognized from the dynamics of blood losses. Haemodynamic instability or, in a worse case, even hypovolaemic shock may be the only signs of bleeding. Occlusion of an artery is manifested by limb ischaemia. The seriousness and progression of ischaemia depends on the rate of arterial occlusion, potential pathways for collateral circulation and the degree of atherosclerotic vascular disease. The patient with conduction anaesthesia does not feel pain and therefore the diagnosis must primarily be based on arterial pulsation in the limb and its skin colour. A pseudoaneurysm can develop due to a partially weakened vascular wall and its rupture is a life-threatening complication. Its presence is recognized as a pulsating mass in the groin. An arterio- venous fistula which arises from traumatic communication between the two vessels may lead to cardiac failure. The diagnosis is based on examination by sonography and digital subtraction angiography. The results of CT angiography and MR angiography are difficult to evaluate because of the presence of metal implants. In apparent bleeding it is sometimes difficult to locate the source. It is recommended to perform digital compression and gain access to the vessels from the extraperitoneal approach. When an expanding haematoma or

  3. Revision hip arthroplasty using impacted cancellous bone and cement: a long-term follow-up study.

    PubMed

    Arumugam, Gowthaman; Nanjayan, Shashi Kumar; Quah, Conal; Wraighte, Philip; Howard, Peter

    2015-12-01

    Acetabular bone deficiency is one of the many challenging problems encountered in revision hip arthroplasty. A variety of surgical options and techniques are available including impaction bone grafting. We present our long-term experience of 68 consecutive cups in 64 patients, using impacted cancellous bone grafting with bone cement. With a mean follow-up of 10.5 year (IQR 7.5-12.9) after revision surgery, three implants had undergone further revision. Three patients had subsequent femoral peri-prosthetic fractures, and none of these three required further acetabular revision. Survival of the acetabular components was 95.5 % for all causes and 100 % for aseptic loosening as the end point, with a further four patients showing radiographic, but asymptomatic loosening. A significant correlation was found between previous revision and re-revision (early failure) (p = 0.01) as well as progression of lytic lesion and re-revision (p = 0.01). The median Harris hip score at final follow-up was 79.5 (IQR 67.9-80.4). The use of impacted morcellised allograft bone with a cemented cup is an effective technique to achieve longevity and restoration of bone stock in acetabular revision arthroplasty. Our series has shown good clinical and radiological outcome with survivorship of the prosthesis exceeding 95 % at 10 years.

  4. Abduction bracing for residual acetabular dysplasia in infantile DDH.

    PubMed

    Gans, Itai; Flynn, John M; Sankar, Wudbhav N

    2013-01-01

    Abduction bracing is often used to treat residual acetabular dysplasia in infants whose acetabular indices (AI) exceed 30 degrees after 6 months of age. However, little data exist to support this practice. The purpose of this study was to determine the efficacy of part-time abduction bracing in treating residual acetabular dysplasia by comparing a cohort of braced infants with a cohort of unbraced infants. We performed a retrospective review of a consecutive series of patients with developmental dysplasia of the hip (DDH) treated at our institution over 4 years. Children with stable, treated DDH but residual acetabular dysplasia at 6 months of age were identified; those with available anteroposterior pelvic radiographs at 6 months and 1 year of age were included. Patients who required open surgical reduction and those with syndromic or neuromuscular diagnoses were excluded. On the basis of practice variations at our institution, some orthopaedists start bracing when the 6-month radiograph demonstrates an AI≥30 degrees, whereas others do not; we compared these 2 cohorts. Braced patients were instructed to wear an abduction orthosis during nights and naps until follow-up at 1 year of age. The AI at 6 months and 1 year of age for both cohorts were then measured by a single observer and the differences compared. Seventy-six hips in 52 patients were identified with residual dysplasia on the 6-month radiograph. Thirty-nine hips (27 patients) were unbraced, 31 hips (21 patients) were braced, and 6 hips (4 patients) were excluded for cross-over. Over a 6-month period, the braced cohort had significantly better improvement in the AI of 5.3 degrees (95% confidence interval, 4.3 to 6.3 degrees) compared to the unbraced cohort which had an improvement in the AI of only 1.1 degrees (95% confidence interval 0.6 to 1.6 degrees) (P<0.001). In this comparative analysis of infants with residual acetabular dysplasia treated with abduction bracing or observation, part-time bracing

  5. 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.

  6. Labral morphologic characteristics in patients with symptomatic acetabular dysplasia.

    PubMed

    Sankar, Wudbhav N; Beaulé, Paul E; Clohisy, John C; Kim, Young-jo; Millis, Michael B; Peters, Christopher L; Podeszwa, David A; Schoenecker, Perry L; Sierra, Rafael J; Sink, Ernest L; Sucato, Daniel J; Zaltz, Ira

    2015-09-01

    The morphologic characteristics of the labrum in patients with symptomatic acetabular dysplasia have been described to some extent in smaller retrospective series, but the need remains to further define these disease characteristics and their importance as a diagnostic feature of hip instability. To (1) characterize the morphologic characteristics of the labrum in patients with symptomatic acetabular dysplasia and (2) test the relationships between specific labral variants, severity of dysplasia, and duration of symptoms. Cross-sectional study; Level of evidence, 3. Thirteen surgeons from 10 centers enrolled patients undergoing periacetabular osteotomy (PAO) for symptomatic acetabular dysplasia from 2008 to 2014. Patient demographics, presenting characteristics, preoperative radiographic data, operative data, and intraoperative findings were prospectively collected and retrospectively reviewed. A total of 942 patients (972 hips) met the initial inclusion criteria, with a mean age of 25.2 years (range, 9-51 years; 84% female, 16% male). In addition to having PAO, 52.6% of hips had an anterior arthrotomy and 19.8% had a hip arthroscopy either to perform an osteochondroplasty of the femoral head-neck junction or to address labral pathologic changes. Of these 553 hips in which the labrum was visualized, labral morphologic status was graded as hypertrophic in 50%, normal in 45%, hypoplastic in 4%, and ossified in less than 1%. Decreased lateral center-edge angle and anterior center-edge angle and increased acetabular inclination were associated with labral hypertrophy, but chronicity of symptoms was not. Of the 553 hips, 64% had tears of the labrum, with the majority being degenerative-type tears. Labral pathologic changes are common in patients with symptomatic acetabular dysplasia. Labral hypertrophy, however, is not a universal finding, particularly in hips with mild dysplasia, and therefore should not be considered a reliable diagnostic criterion for instability.

  7. Polyethylene liner cementation technique in asymptomatic versus symptomatic osteolysis.

    PubMed

    Kandel, Leonid; Rivkin, Gurion; Friedman, Adi; Segal, David; Liebergall, Meir; Mattan, Yoav

    2009-08-01

    Osteolysis around a cementless acetabular component can lead to severe bone loss. This study examined whether osteolysis should be treated while still asymptomatic. Thirty-seven liner cementation revisions were performed in 34 patients. Mean patient age was 61 years, and mean time elapsed after index surgery was 85 months (range, 36-168 months). Patients were evaluated by Harris Hip Score (HHS), and mean follow-up was 5 years (range, 43-82 months). Average HHS was 87 with a pain component of 39. In asymptomatic patients, both the HHS and the pain score were significantly higher: 95 and 43, respectively (P<.01). One patient with extensive bone loss had a fracture of the acetabulum and underwent revision at another institution. Revision of the polyethylene liner and cementation of a new one is a useful technique in patients with a stable acetabular shell. This is especially true for asymptomatic patients with osteolysis and thus should be performed early; however, high dislocation rate is still a concern.

  8. 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

  9. 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

  10. 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.

  11. [Acetabular morphological analysis in patients with high dislocated DDH using three-dimensional surface reconstruction technique].

    PubMed

    Zengy, Yi; Min, Li; Lai, Ou-jie; Shen, Bin; Yang, Jing; Zhou, Zong-ke; Kang, Peng-de; Pei, Fu-xing

    2015-03-01

    To simulate acetabular morphology and perform acetabular quantitative analysis in high dislocated developmental dysplasia of the hip (DDH) patients using three-dimensional (3D) surface reconstruction technique, in order to understand the acetabular anatomic features and develop operative strategies for acetabular reconstruction. 3D pelvic images were reconstructed by Mimics software from CT data of 13 patients (13 hips) with high developmental DDH and 13 normal persons (26 hips). True acetabular superior-inferior diameter, anterior-posterior diameter, acetabular depth, medial wall thickness, abduction angle and anteversion angle were measured and compared between the two groups of participants. Irregular acetabular shape was found in high dislocated group, showing a triangle with wide upper and narrow lower. The acetabular quantitative analysis revealed (38.29 +/- 2.71) mm superior-inferior diameter, (21.74 +/- 5.33) mm anterior-posterior diameter, (15.50 +/- 2.93) mm acetabular depth, (6.80 +/- 2.97) mm medial wall thickness, (49.29 +/- 7.40) degrees abduction angle and (23.82 +/- 11.21) degrees anteversion angle in high dislocated patients. The superior-inferior diameter, anterior-posterior diameter and acetabular depth of high dislocated patients were significantly smaller than those of the normal contirols (P<0.05). However, the medial wall thickness, abduction angle and anteversion angle of high dislocated patients were significantly bigger than those of the normal controls (P<0.05). 3D reconstruction technique can restore true acetabular morphology and perform quantitative analysis. Compared with normal controls, high dislocated DDH patients have acetabular features: irregular shape, lower opening, higher medial wall and bigger abduction and anteversion angles. Joint arthroplasty surgery in high dislocated DDH patients needs to look at these acetabular features.

  12. Cement design based on cement mechanical response

    SciTech Connect

    Thiercelin, M.J.; Dargaud, B.; Baret, J.F.; Rodriquez, W.J.

    1998-12-01

    The disappearance of cement bond log response as a result of variations of downhole conditions has been observed in numerous wells. This observation has led to concern about the loss of proper zonal isolation. Stresses induced in the cement, through deformation of the cemented casing resulting from the variation of downhole conditions, are the cause of this damage. The authors present an analysis of the mechanical response of set cement in a cased wellbore to quantify this damage and determine the key controlling parameters. The results show that the thermo-elastic properties of the casing, cement, and formation play a significant role. The type of failure, either cement debonding or cement cracking, is a function of the nature of the downhole condition variations. This analysis allows one to propose appropriate cement mechanical properties to avoid cement failure and debonding. The authors show that the use of high compressive strength cement is not always the best solution and, in some cases, flexible cements are preferred.

  13. Acetabular Wall Indices Help to Distinguish Acetabular Coverage in Asymptomatic Adults With Varying Morphologies.

    PubMed

    Anderson, Lucas A; Anderson, Mike B; Erickson, Jill A; Chrastil, Jesse; Peters, Christopher L

    2017-04-01

    The anterior wall index (AWI) and posterior wall index (PWI) have been proposed to quantify anterior and posterior acetabular coverage using AP pelvic radiographs. However, these indices have only been reported in symptomatic patients with apparent pathomorphologies (dysplasia, overcoverage, and retroversion) undergoing osteochondroplasty or reorientation osteotomy. (1) What are the ranges for AWI and PWI from measurements obtained on AP pelvic radiographs of asymptomatic senior athletes with well-functioning hips? (2) Is there a difference between the AWI and PWI in asymptomatic athletes with acetabular morphology consistent with acetabular dysplasia, overcoverage, and retroversion when compared with asymptomatic hips that do not meet the radiographic definitions for those morphologies (controls)? Five hundred five athletes (998 asymptomatic native hips) were independently evaluated by two readers on AP pelvic radiographs for AWI and the PWI after excluding hips with prior surgery, inadequate radiographs, or poor function (modified Harris hip score < 80). Hips with a lateral center-edge angle (LCEA) ≥ 20° and ≤ 38° and without acetabular retroversion, based on a positive crossover sign, were used as controls. Hips were categorized as developmental dysplasia of the hip (DDH; undercoverage) if the LCEA was < 20°. Finally, overcoverage was defined as an LCEA > 38°. The mean age of the athletes was 67 years (range, 50-91 years) and 55% were men. Linear generalized estimating equation regression was used to compare each individual diagnosis (DDH, retroversion, overcoverage) with the controls for both AWI and PWI adjusting for age and sex. The mean AWI in the study population was 0.36 (range, -0.02 to 0.91). The mean PWI was 1.13 (range, 0.12-1.74). The mean AWI and PWI in controls (n = 740) was 0.35 (range, -0.02 to 0.91) and 1.13 (range, 0.64-1.70), respectively. There were 25 (3%) with DDH in whom the mean AWI was 0.26 (range, 0.05-0.5) and the

  14. 21 CFR 888.3480 - Knee joint femorotibial metallic constrained cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... cemented prosthesis. 888.3480 Section 888.3480 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Knee joint femorotibial metallic constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metallic constrained cemented prosthesis is a device intended to be implanted to replace part of a...

  15. 21 CFR 888.3480 - Knee joint femorotibial metallic constrained cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... cemented prosthesis. 888.3480 Section 888.3480 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Knee joint femorotibial metallic constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metallic constrained cemented prosthesis is a device intended to be implanted to replace part of a...

  16. 21 CFR 888.3100 - Ankle joint metal/composite semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... cemented prosthesis. 888.3100 Section 888.3100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Ankle joint metal/composite semi-constrained cemented prosthesis. (a) Identification. An ankle joint metal/composite semi-constrained cemented prosthesis is a device intended to be implanted to replace an...

  17. 21 CFR 888.3480 - Knee joint femorotibial metallic constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... cemented prosthesis. 888.3480 Section 888.3480 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Knee joint femorotibial metallic constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metallic constrained cemented prosthesis is a device intended to be implanted to replace part of a...

  18. 21 CFR 888.3480 - Knee joint femorotibial metallic constrained cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... cemented prosthesis. 888.3480 Section 888.3480 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Knee joint femorotibial metallic constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metallic constrained cemented prosthesis is a device intended to be implanted to replace part of a...

  19. 21 CFR 888.3100 - Ankle joint metal/composite semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... cemented prosthesis. 888.3100 Section 888.3100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Ankle joint metal/composite semi-constrained cemented prosthesis. (a) Identification. An ankle joint metal/composite semi-constrained cemented prosthesis is a device intended to be implanted to replace an...

  20. 21 CFR 888.3100 - Ankle joint metal/composite semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... cemented prosthesis. 888.3100 Section 888.3100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Ankle joint metal/composite semi-constrained cemented prosthesis. (a) Identification. An ankle joint metal/composite semi-constrained cemented prosthesis is a device intended to be implanted to replace an...

  1. [Association between allergy to benzoyl peroxide, vitiligo and implantation of a cemented total knee joint prosthesis: Is there a connection?].

    PubMed

    Gothner, M; Ozokyay, L; Godau, P; Kälicke, T; Muhr, G; Schildhauer, T A; Dudda, M

    2011-09-01

    Allergies against bone cement or bone cement components have been well-described. We report on a 63-year-old patient who presented with progressive vitiligo all over the body after implantation of a cemented total knee replacement. A dermatological examination was performed and an allergy to benzoyl peroxide was found. A low-grade infection was diagnosed 5 months after implantation of the total knee replacement and the prosthesis was replaced with a cement spacer. After treating the infection of the knee replacement non-cemented arthrodesis of the knee was performed. In cases of new, unknown skin efflorescence, urticaria and periprosthetic loosening of cemented joint replacement, the differential diagnosis should include not only infections but also possible allergies against bone-cement and components such as benzoyl peroxide or metal components.

  2. [Themistocles Gluck. 100 years artificial joint replacement].

    PubMed

    Wessinghage, D

    1991-01-01

    One hundred years ago Themistocles Gluck reported for the first time about artificial joint replacements and the fixation by cement in a most important publication. Extirpation even of internal organs and differentiated possibilities of their replacement were standing in the center of the scientific work of this genius but first of all controversial discussed German doctor.

  3. Constrained Acetabular Components Used in Revision Total Hip Arthroplasty: A Registry Analysis.

    PubMed

    Lewis, Peter L; Graves, Stephen E; de Steiger, Richard N; Cuthbert, Alana R

    2017-10-01

    Constrained acetabular components have a mechanism to lock in the femoral head. They have been developed to control postoperative dislocation, particularly in revision total hip arthroplasty (THA). Although these components may reduce dislocation, there are durability concerns: with reports of locking mechanism failures and loosening. We wanted to determine the outcome of constrained components in controlling dislocation, and if these components had a higher rate of second revision when compared with standard nonconstrained components. Revision THA procedures from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) with a recorded primary procedure and initial diagnosis of osteoarthritis were used to compare constrained and standard nonconstrained components. Kaplan-Meier estimates of survivorship were calculated, and hazard ratios using Cox proportional hazard models were used to compare groups. There were 9509 THA first-revision procedures and 700 constrained components. Constrained components had a significantly higher revision rate after 3 months when large-head metal-on-metal components were included (hazard ratio = 1.37; P = .005). When large-head metal-on-metal components were excluded, there was no difference in the rate of second revision between the 2 groups. When the analysis was limited to first revision for dislocation, constrained components had a higher second revision rate for further dislocation after 9 months. Constrained acetabular components had similar second-revision rates when compared with standard nonconstrained components, both for all first-revision reasons and when used to treat dislocation. Although possibly used for the more difficult unstable hips, constrained components had a higher rate of second revision for further dislocation. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Acetabular component navigation in lateral decubitus based on EOS imaging: A preliminary study of 13 cases.

    PubMed

    Billaud, A; Verdier, N; de Bartolo, R; Lavoinne, N; Chauveaux, D; Fabre, T

    2015-05-01

    Acetabular component navigation classically requires palpation of the bone landmarks defining the anterior pelvic plane (APP) (anterior superior iliac spine [ASIS] and pubis), the recording of which is not very reliable when performed in lateral decubitus. The objectives of the current experimental study were: (1) to assess the clinical feasibility of NAVEOS navigation (based on EOS imaging) in lateral decubitus; and (2) to compare precision versus classical APP-based navigation (NAVAPP). Iliac plane navigation using EOS is as reliable as APP navigation. A continuous prospective series of 13 total hip replacements were implanted in lateral decubitus under APP-guided navigation (NAVAPP). Planning used preoperative EOS measurement. The ASIS, pubis and ipsilateral posterior superior iliac spine (PSIS) were located and exported to the navigator. Intra-operatively, NAVEOS landmarks (acetabular center, ASIS and PSIS on the operated side) were palpated. Postoperatively, cup inclination and anteversion with respect to the APP were measured on EOS imaging (SterEOS3D software). The SterEOS3D measurements were compared to those of the performed NAVAPP and simulated NAVEOS navigations. Three patients were excluded for technical reasons. In the remaining 10, inclination on NAVAPP and SterEOS3D differed by a median 4° (range, 0-12°), and on NAVEOS versus SteEOS3D by 5° (range, 2-10°); anteversion on NAVAPP and SterEOS3D differed by a median 4.5° (range, 0-12°), and on NAVEOS versus SteEOS3D by 4° (range, 0-14°). Precision was comparable between NAVEOS and classical navigation. NAVEOS simplifies cup navigation in lateral decubitus on initial acquisition. These results require validation on a larger sample. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  5. Acetabular shell deformation as a function of shell stiffness and bone strength.

    PubMed

    Dold, Philipp; Pandorf, Thomas; Flohr, Markus; Preuss, Roman; Bone, Martin C; Joyce, Tom J; Holland, James; Deehan, David

    2016-04-01

    Press-fit acetabular shells used for hip replacement rely upon an interference fit with the bone to provide initial stability. This process may result in deformation of the shell. This study aimed to model shell deformation as a process of shell stiffness and bone strength. A cohort of 32 shells with two different wall thicknesses (3 and 4 mm) and 10 different shell sizes (44- to 62-mm outer diameter) were implanted into eight cadavers. Shell deformation was then measured in the cadavers using a previously validated ATOS Triple Scan III optical system. The shell-bone interface was then considered as a spring system according to Hooke's law and from this the force exerted on the shell by the bone was calculated using a combined stiffness consisting of the measured shell stiffness and a calculated bone stiffness. The median radial stiffness for the 3-mm wall thickness was 4192 N/mm (range, 2920-6257 N/mm), while for the 4-mm wall thickness the median was 9633 N/mm (range, 6875-14,341 N/mm). The median deformation was 48 µm (range, 3-187 µm), while the median force was 256 N (range, 26-916 N). No statistically significant correlation was found between shell stiffness and deformation. Deformation was also found to be not fully symmetric (centres 180° apart), with a median angle discrepancy of 11.5° between the two maximum positive points of deformation. Further work is still required to understand how the bone influences acetabular shell deformation. © IMechE 2016.

  6. Vacuum-mixing cement does not decrease overall porosity in cemented femoral stems: AN IN VITRO LABORATORY INVESTIGATION

    PubMed Central

    Messick, K. J.; Miller, M. A.; Damron, L. A.; Race, A.; Clarke, M. T.; Mann, K. A.

    2008-01-01

    The role of vacuum mixing on the reduction of porosity and on the clinical performance of cemented total hip replacements remains uncertain. We have used paired femoral constructs prepared with either hand-mixed or vacuum-mixed cement in a cadaver model which simulated intra-operative conditions during cementing of the femoral component. After the cement had cured, the distribution of its porosity was determined, as was the strength of the cement-stem and cement-bone interfaces. The overall fraction of the pore area was similar for both hand-mixed and vacuum-mixed cement (hand 6%; vacuum 5.7%; paired t-test, p = 0.187). The linear pore fractions at the interfaces were also similar for the two techniques. The pore number-density was much higher for the hand-mixed cement (paired t-test, p = 0.0013). The strength of the cement-stem interface was greater with the hand-mixed cement (paired t-test, p = 0.0005), while the strength of the cement-bone interface was not affected by the conditions of mixing (paired t-test, p = 0.275). The reduction in porosity with vacuum mixing did not affect the porosity of the mantle, but the distribution of the porosity can be affected by the technique of mixing used. PMID:17785755

  7. Cement mixing with vibrator

    SciTech Connect

    Allen, T.E.

    1991-07-09

    This patent describes a method of cementing a casing string in a bore hole of a well. It comprises introducing water and dry cement material into a mixing vessel; mixing the water and dry cement material in the mixing vessel to form a cement slurry, the slurry including lumps of the dry cement material, the mixing including steps of: agitating the slurry; and while agitating the slurry, transmitting vibrational energy into the slurry and thereby aiding disintegration and subsequent wetting of the lumps of the dry cement material in the slurry; and pumping the slurry into an annulus between the casing string and the bore hole.

  8. INNOPLANT Total Hip Replacement System.

    PubMed

    Harper, Tisha A M

    2017-07-01

    Total hip replacement is a salvage procedure that is done to alleviate discomfort secondary to osteoarthritis in the hip, which is most often a result of hip dysplasia. Commercially available total hip replacement implants for small animal patients are classified as cemented or cementless. The INNOPLANT Total Hip Replacement system includes modular, screw-in cementless components that were developed to improve implant stability by maintaining as much normal anatomic structure, and by extension biomechanics of the coxofemoral joint, as possible. As a newer system, there are few data and no long-term studies available in the veterinary literature. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. 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.

  10. 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.

  11. Late sciatic nerve axonotmesis following acetabular reconstruction plate.

    PubMed

    Moreta, J; Foruria, X; Labayru, F

    2016-01-01

    Sciatic nerve injuries associated with acetabular fractures can be post-traumatic, perioperative or postoperative. Late postoperative injury is very uncommon and can be due to heterotopic ossifications, muscular scarring, or implant migration. A case is presented of a patient with a previous transverse acetabular fracture treated with a reconstruction plate for the posterior column. After 17 years, she presented with progressive pain and motor deficit in the sciatic territory. Radiological and neurophysiological assessments were performed and the patient underwent surgical decompression of the sciatic nerve. A transection of the nerve was observed that was due to extended compression of one of the screws. At 4 years postoperatively, her pain had substantially diminished and the paresthesias in her leg had resolved. However, her motor symptoms did not improve. This case report could be relevant due to this uncommon delayed sciatic nerve injury due to prolonged hardware impingement.

  12. Multiobjective optimization of an electrostimulative acetabular revision system.

    PubMed

    Potratz, Carsten; Kluess, Daniel; Ewald, Hartmut; van Rienen, Ursula

    2010-02-01

    In this paper, we present a new approach for the enhancement of the bone proliferation rate by electrostimulation in the acetabular region. Based on the complex tissue structure in this area, the electric field distributions were computed by numerical means using a model based on high-resolution computed tomography scans of the acetabular area. This results in a complex, nonlinear, and discrete optimization problem. Therefore, an adapted algorithm was developed to reduce the computational effort in the order of several magnitudes. We divided the procedure into two stages: data extraction and a subsequent optimization process. The used optimization algorithm utilizes an evolutionary concept and a multidimensional definition of optimality for different, partly contradictive objective functions. Finally, we present first optimization results for different stimulation situations.

  13. Para-acetabular periarthritis calcarea: its radiographic manifestations.

    PubMed

    Kawashima, A; Murayama, S; Ohuchida, T; Russell, W J

    1988-01-01

    On retrospective reviews of radiographs, periarthritis calcarea was distinguished from os acetabula by interval radiographic progression and regression. Among 59 men and 51 women, there were 137 instances of para-acetabular calcifications and ossifications, which were morphologically classified as 58 discrete, 58 amorphous, and 21 segmented types. Correlations with other radiographic abnormalities, symptoms, signs, and laboratory abnormalities were sought, but not established. Out of 93 serially imaged opacities, 90 changed, including 37 of the 40 instances (92.5%) of the discrete type and 53 instances (100%) of the amorphous and segmented types--due to periarthritis calcarea. At least 43 of 90 densities were newly developed. Mean age at first detection was 47.7 years. Three of the discrete densities were unchanged and represented os acetabula. Thus, recognition of para-acetabular periarthritis calcarea is not only of academic importance; it can facilitate proper treatment as well.

  14. Acetabular augmentation for the treatment of unstable total hip arthroplasties.

    PubMed Central

    Nicholl, J. E.; Koka, S. R.; Bintcliffe, I. W.; Addison, A. K.

    1999-01-01

    Twenty-eight unstable total hip arthroplasties were treated with an acetabular augmentation wedge. Of the hips, 23 have had no further dislocations at a mean follow-up of 26 months. Five patients continued to dislocate and have needed further surgery. To our knowledge this is the largest reported series of acetabular augmentation with as good results as those of the most successful reported series of this technique, and a success rate comparable to other methods of treating recurrent dislocation. Careful patient selection, and using a thin augmentation wedge to avoid impingement, are important to the success of a technique which is a useful option in the management of recurrent dislocation. Images Figure 1 PMID:10364973

  15. Strontium-containing hydroxyapatite bioactive bone cement in revision hip arthroplasty.

    PubMed

    Ni, G X; Chiu, K Y; Lu, W W; Wang, Y; Zhang, Y G; Hao, L B; Li, Z Y; Lam, W M; Lu, S B; Luk, K D K

    2006-08-01

    Clinical outcome of cemented implants to revision total hip replacement (THR) is not as satisfactory as primary THR, due to the loss of bone stock and normal trabecular pattern. This study evaluated a bioactive bone cement, strontium-containing hydroxyapatite (Sr-HA) bone cement, in a goat revision hip hemi-arthroplasty model, and compared outcomes with polymethylmethacrylate (PMMA) bone cement. Nine months after operation, significantly higher bonding strength was found in the Sr-HA group (3.36+/-1.84 MPa) than in the PMMA bone cement group (1.23+/-0.73 MPa). After detached from the femoral component, the surface of PMMA bone cement mantle was shown relatively smooth, whereas the surface of the Sr-HA bioactive bone cement mantle was uneven, by SEM observation. EDX analysis detected little calcium and no phosphorus on the surface of PMMA bone cement mantle, while high content of calcium (14.03%) and phosphorus (10.37%) was found on the surface of the Sr-HA bone cement mantle. Even higher content of calcium (17.37%) and phosphorus (10.84%) were detected in the concave area. Intimate contact between Sr-HA bioactive bone cement and bone was demonstrated by histological and SEM observation. New bone bonded to the surface of Sr-HA cement and grew along its surface. However, fibrous tissue was observed between PMMA bone cement and bone. The results showed good bioactivity of Sr-HA bioactive bone cement in this revision hip replacement model using goats. This in vivo study also suggested that Sr-HA bioactive bone cement was superior to PMMA bone cement in terms of bone-bonding strength. Use of bioactive bone cement may be a possible solution overcoming problems associated with the use of PMMA bone cement in revision hip replacement.

  16. 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.

  17. Use of porous tantalum components in Paprosky two and three acetabular revision. A minimum five-year follow-up of fifty one hips.

    PubMed

    Flecher, Xavier; Appy, Benjamin; Parratte, Sébastien; Ollivier, Matthieu; Argenson, Jean-Noel

    2017-05-01

    Recent studies have reported short-term favourable results of tantalum-made components in acetabular revisions with bone loss. However, there is a lack of information regarding the mid to long-term results of such components. The objective of this study was to analyse the outcome and survivorship of acetabular revision hip arthroplasty using tantalum components for loosening associated with bone loss at a minimum of five-year follow-up. We retrospectively reviewed 51 consecutive patients (51 hips) who had an acetabular revision using porous tantalum components at a minimum follow-up of five years. The mean age was 64 years (range, 31-87). There were 27 males and 24 females, 47 right hips and four left hips. Twenty-five (49 %) included a femoral revision. According to Paprosky's classification 18 hips were classified type 2A, 11 type 2B, ten type 2C, seven type 3A and five type 3B. No bone grafting was performed. Sixteen hips (31.3 %) required the use of additional tantalum-made augments stabilized by screws and cement at the cup-augment interface. At a mean followup of 6.8 years (range, 5.1-10 years), the Harris hip score improved from 44 pre- operatively (range, 23-72) to 84 post-operatively (range, 33-98). The mean post-operative hip centre position in relation to the teardrop was 29 mm (range, 20-43 mm) horizontally and 21 mm (range, 8-36 mm) vertically. The mean acetabular inclination was 42° (range, 17-60°). Six hips (11.7 %) required a re-operation without component revision (two for chronic instability, one ossification removal, one haematoma, one deep infection and one periprosthetic femoral fracture). One patient required a cup re-revision for septic loosening. No aseptic loosening occurred. At last followup the radiological analysis showed one evolutive osteolysis and one screw breakage. The global survivorship was 92.3 % at 64 months. If only aseptic loosening was defined as the end-point the survivorship was 100 % at 64 months. When

  18. Complications of acetabular fracture surgery in morbidly obese patients.

    PubMed

    Porter, Scott E; Russell, George V; Dews, Robert C; Qin, Zhen; Woodall, James; Graves, Matthew L

    2008-10-01

    To compare the early complications with operative treatment of acetabular fractures in morbidly obese (body mass index >or=40) patients when compared with all other patients. Retrospective review. University medical center. Four hundred thirty-five consecutive patients with acetabular fractures operatively treated by a single surgeon. Forty-one of these patients were morbidly obese (group 1) and were compared with the remaining patients (group 2). Group 2, therefore, included patients who were clinically overweight and obese. Operative repair of acetabular fracture. Outcome variables included patient positioning time, total operative time, estimated intraoperative blood loss, length of hospital stay, perioperative complications, and late complications. The average total operative time was 293 minutes for group 1 and 250 minutes (P = 0.008) for group 2. The hospital stay for group 1 averaged 26 days versus 15 days in group 2 (P < 0.01). There were 19 (46%) wound complications in group 1 compared with 49 (12%) in group 2 (P < 0.0001). Overall, there were complications in 26 of the 41 patients (63%) in group 1 and in 96 of the 394 patients (24%) in group 2. Group 1's relative risk of having a complication was 2.6 (95% confidence interval = 2.4-2.8) when compared with group 2. Our morbidly obese population had a statistically higher complication rate, longer operative times, and greater estimated intraoperative blood loss. The majority of complications were related primarily to wound healing problems and successfully controlled with aggressive approach to surgical debridement.

  19. Fate of the unrevised cemented stem following cup only revision: 227 hips at an average of 6 years follow-up.

    PubMed

    McGonagle, L; Siney, P D; Raut, V V

    2015-11-01

    After primary total hip replacement, aseptic loosening of the acetabular cup is more common than loosening of the femoral stem. Removal of a well-fixed stem adds to operative time, blood loss, risk of bone loss and fracture. There is limited evidence that isolated cup revision can be a safe option in revision hip arthroplasty. We question the following regarding the unrevised cemented stem after isolated cup revision: 1) Does the unrevised stem require revision after isolated cup revision? 2) When is the stem subsequently revised? 3) Why is the stem subsequently revised? 4) Do unrevised stems exhibit radiographic loosening? We hypothesise that after isolated cup revision most unrevised stems do not need subsequent revision, and that most do not exhibit evidence of radiographic loosening. A retrospective analysis of all patients who underwent revision of the acetabular component only during revision hip arthroplasty between March 1970 and July 2013 was carried out. We assessed survival of the unrevised stem, reasons for subsequent revision, plus radiographic analysis for stem loosening. Two hundred and twenty-seven hips were included [215 patients with an average age at the time of primary surgery was 47 (13-70) years]. The Charnley stem was used in 161 cases; C-stem 65, Howse 1. Average time between primary surgery and cup revision was 15.9 (1.6-33.4) years. Average follow-up for all stems post-isolated cup revision was 6.1 (0.1-30.7) years. Twenty-eight stems (12.3%) were subsequently revised 5.1 (0.1-12.6) years after the isolated cup revision. Reasons for subsequent revision were: aseptic loosening (10); infection (8); dislocation (6); unreconstructable joint post-loose cup removal (2); fracture (2). Radiographic review was possible on 140 cases. Five femoral stems were revised and 2 others showed evidence of possible radiological loosening but were not revised. To our knowledge this is the largest series showing that isolated cup revision in the place of a well

  20. Antibiotic-Loaded Cement in Orthopedic Surgery: A Review

    PubMed Central

    Bistolfi, Alessandro; Massazza, Giuseppe; Verné, Enrica; Massè, Alessandro; Deledda, Davide; Ferraris, Sara; Miola, Marta; Galetto, Fabrizio; Crova, Maurizio

    2011-01-01

    Infections in orthopaedic surgery are a serious issue. Antibiotic-loaded bone cement was developed for the treatment of infected joint arthroplasties and for prophylaxes in total joint replacement in selected cases. Despite the widespread use of the antibiotic-loaded bone cement in orthopedics, many issues are still unclear or controversial: bacterial adhesion and antibiotic resistance, modification of mechanical properties which follows the addition of the antibiotic, factors influencing the release of the antibiotic from the cement and the role of the surface, the method for mixing the cement and the antibiotic, the choice and the effectiveness of the antibiotic, the combination of two or more antibiotics, and the toxicity. This review discusses all these topics, focusing on properties, merits, and defects of the antibiotic loaded cement. The final objective is to provide the orthopaedic surgeons clear and concise information for the correct choice of cement in their clinical practice. PMID:24977058

  1. Asphalt cement poisoning

    MedlinePlus

    ... petroleum material that hardens when it cools. Asphalt cement poisoning occurs when someone swallows asphalt. If hot ... found in: Road paving materials Roofing materials Tile cements Asphalt may also be used for other purposes.

  2. 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.

  3. Increased Mortality in Elderly Patients with Sarcopenia and Acetabular Fractures.

    PubMed

    Deren, Matthew E; Babu, Jacob; Cohen, Eric M; Machan, Jason; Born, Christopher T; Hayda, Roman

    2017-02-01

    Sarcopenia is a condition of clinically relevant loss of muscle mass and function. Acetabular fractures in elderly patients are common and difficult to treat. This study aimed to determine if sarcopenia is common in elderly patients with acetabular fractures and correlates with lower-energy mechanisms of injury, higher rates of complications, and higher mortality than patients with normal muscle mass. The Rhode Island Hospital Trauma Database was queried for patients who were ≥60 years of age from 2005 to 2014 using the International Classification of Diseases, Ninth Revision, code for closed acetabular fracture, 808.0. Charts were retrospectively reviewed for demographic data, operative intervention, mechanism of injury, mortality, comorbidities, and other factors. Computed tomography (CT) was used to determine the muscle cross-sectional area and to calculate the skeletal muscle index. The database revealed 192 patients coded for acetabular fracture; of these, 181 were correctly diagnosed. Ninety-nine patients had recorded body mass index (BMI) and adequate CT scans to measure the skeletal muscle index. Forty-two patients (42.4%) had sarcopenia, and 57 patients (57.6%) did not have sarcopenia. There were no significant differences in demographic characteristics between the groups with the exception of BMI and sex. BMI was higher in patients who did not have sarcopenia (31.7 kg/m) than it was in patients with sarcopenia (23.6 kg/m) (p < 0.001). Male sex was significantly greater (p = 0.0104) in patients with sarcopenia at 76.2% (32 of 42 patients) than in patients without sarcopenia at 50.9% (29 of 57 patients). Fractures in patients without sarcopenia were associated with a higher-energy mechanism of injury in 78.9% of cases compared with 52.4% of cases of patients with sarcopenia (p = 0.005). Sarcopenia was significantly associated (p = 0.0419) with increased 1-year mortality (28.6%) compared with the absence of sarcopenia (12.3%). This association was even

  4. 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.

  5. A biomechanical study of periacetabular defects and cement filling.

    PubMed

    Li, Zuoping; Butala, Neha B; Etheridge, Brandon S; Siegel, Herrick J; Lemons, Jack E; Eberhardt, Alan W

    2007-04-01

    Periacetabular bone metastases cause severe pain and functional disability in cancer patients. Percutaneous acetabuloplasty (PCA) is a minimally invasive, image-guided procedure whereby cement is injected into lesion sites. Pain relief and functional restoration have been observed clinically; however, neither the biomechanical consequences of the lesions nor the effectiveness of the PCA technique are well understood. The objective of this study was to investigate how periacetabular lesion size, cortex involvement, and cement modulus affect pelvic bone stresses and strains under single-legged stance loading. Experiments were performed on a male cadaver pelvis under conditions of intact, periacetabular defect, and cement-filling with surface strains recorded at three strain gage locations. The experimental data were then employed to validate three-dimensional finite element models of the same pelvis, developed using computed tomography data. The models demonstrated that increases in cortical stresses were highest along the posterior column of the acetabulum, adjacent to the defect. Cortical stresses were more profoundly affected in the presence of transcortical defects, as compared to those involving only trabecular bone. Cement filling with a modulus of 2.2 GPa was shown to restore cortical stresses to near intact values, while a decrease in cement modulus due to inclusion of BaSO(4) reduced the restorative effect. Peak acetabular contact pressures increased less than 15% for all simulated defect conditions; however, the contact stresses were reduced to levels below intact in the presence of either cement filling. These results suggest that periacetabular defects may increase the vulnerability of the pelvis to fracture depending on size and cortical involvement and that PCA filling may lower the risk of periacetabular fractures.

  6. Nondestructive evaluation of bone cement and bone cement/metal interface failure.

    PubMed

    Browne, M; Jeffers, J R T; Saffari, N

    2010-02-01

    To quantify the failure mechanisms related to the loosening of cemented hip joint replacements, novel techniques, capable of monitoring, nondestructively, the initiation and progression of failure during in vitro fatigue tests, were employed. Fatigue testing of model cement and cement-stem test pieces was monitored using acoustic emission (AE) sensors. Once damage was detected, an ultrasonic imaging system was used to obtain an image of the damage site and to measure the stiffness of the affected region. This method of examination provided a detailed insight into the internal crack propagation and delamination patterns. Initial work was conducted on bulk cement specimens subjected to bending and tension. The second stage of the work examined a model stem-cement interface under tensile opening loading conditions. A novel ultrasonic technique was used to measure the bond quality at the cement-metal interface. Progressive delamination was identified over time, and the AE technique was able to identify critical areas of delamination before they could be identified conclusively by ultrasonic imaging. The work has demonstrated the potential of the AE technique as a tool for the preclinical assessment of total hip replacements.

  7. Copy number loss in the region of the ASPN gene in patients with acetabular dysplasia: ASPN CNV in acetabular dysplasia.

    PubMed

    Sekimoto, T; Ishii, M; Emi, M; Kurogi, S; Funamoto, T; Yonezawa, Y; Tajima, T; Sakamoto, T; Hamada, H; Chosa, E

    2017-07-01

    We have previously investigated an association between the genome copy number variation (CNV) and acetabular dysplasia (AD). Hip osteoarthritis is associated with a genetic polymorphism in the aspartic acid repeat in the N-terminal region of the asporin (ASPN) gene; therefore, the present study aimed to investigate whether the CNV of ASPN is involved in the pathogenesis of AD. Acetabular coverage of all subjects was evaluated using radiological findings (Sharp angle, centre-edge (CE) angle, acetabular roof obliquity (ARO) angle, and minimum joint space width). Genomic DNA was extracted from peripheral blood leukocytes. Agilent's region-targeted high-density oligonucleotide tiling microarray was used to analyse 64 female AD patients and 32 female control subjects. All statistical analyses were performed using EZR software (Fisher's exact probability test, Pearson's correlation test, and Student's t-test). CNV analysis of the ASPN gene revealed a copy number loss in significantly more AD patients (9/64) than control subjects (0/32; p = 0.0212). This loss occurred within a 60 kb region on 9q22.31, which harbours the gene for ASPN. The mean radiological parameters of these AD patients were significantly worse than those of the other subjects (Sharp angle, p = 0.0056; CE angle, p = 0.0076; ARO angle, p = 0.0065), and all nine patients required operative therapy such as total hip arthroplasty or pelvic osteotomy. Moreover, six of these nine patients had a history of operative or conservative therapy for developmental dysplasia of the hip. Copy number loss within the region harbouring the ASPN gene on 9q22.31 is associated with severe AD. A copy number loss in the ASPN gene region may play a role in the aetiology of severe AD.Cite this article: T. Sekimoto, M. Ishii, M. Emi, S. Kurogi, T. Funamoto, Y. Yonezawa, T. Tajima, T. Sakamoto, H. Hamada, E. Chosa. Copy number loss in the region of the ASPN gene in patients with acetabular dysplasia: ASPN CNV in acetabular

  8. Shape-based acetabular cartilage segmentation: application to CT and MRI datasets.

    PubMed

    Tabrizi, Pooneh R; Zoroofi, Reza A; Yokota, Futoshi; Nishii, Takashi; Sato, Yoshinobu

    2016-07-01

    A new method for acetabular cartilage segmentation in both computed tomography (CT) arthrography and magnetic resonance imaging (MRI) datasets with leg tension is developed and tested. The new segmentation method is based on the combination of shape and intensity information. Shape information is acquired according to the predictable nonlinear relationship between the U-shaped acetabulum region and acetabular cartilage. Intensity information is obtained from the acetabular cartilage region automatically to complete the segmentation procedures. This method is evaluated using 54 CT arthrography datasets with two different radiation doses and 20 MRI datasets. Additionally, the performance of this method in identifying acetabular cartilage is compared with four other acetabular cartilage segmentation methods. This method performed better than the comparison methods. Indeed, this method maintained good accuracy level for 74 datasets independent of the cartilage modality and with minimum user interaction in the bone segmentation procedures. In addition, this method was efficient in noisy conditions and in detection of the damaged cartilages with zero thickness, which confirmed its potential clinical usefulness. Our new method proposes acetabular cartilage segmentation in three different datasets based on the combination of the shape and intensity information. This method executes well in situations where there are clear boundaries between the acetabular and femoral cartilages. However, the acetabular cartilage and pelvic bone information should be obtained from one dataset such as CT arthrography or MRI datasets with leg traction.

  9. [Use of the anatomical cemented femoral stem SAS I: mid-term results].

    PubMed

    Mikláš, M; Pink, M; Valoušek, T

    2015-01-01

    is an implant made to fit the proximal femur anatomy. Its highly polished surface allows for optimal fitting with the supporting bone and for even distribution of weight bearing. This results in a low rate of THA failure. In accordance with the relevant literature, the acetabular components is considered to be the weakest element in total hip replacement in terms of aseptic loosening and implant failure. At present, the SAS I stem has no Morse Eurocone taper and this is the chief obstacle hindering its more frequent use in endoprosthetics. CONCLUSIONS The results of our study are in agreement with those of other successfully implanted polished cemented femoral components. Key words: anatomical cemented femoral component, surface adjustment of the femoral stem, complications.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. [Protrusio acetabuli. An update on the primary and secondary acetabular protrusion].

    PubMed

    Kindynis, P; Garcia, J

    1990-01-01

    Acetabular protrusion refers to intrapelvic displacement of the medial wall of the acetabulum and is defined as inward movement of the acetabular line so that the distance between this line and the laterally located ilioischial line is 3 mm or more in adult men and 6 mm or more in adult women. As discussed in this article, acetabular protrusion may be found in many bone disorders such as degenerative joint disease, Paget's disease, rheumatoid arthritis, ankylosing spondylitis, osteomalacia, Marfan's disease and as an effect of irradiation. Protrusio acetabuli appearing in absence of any recognizable cause is termed primary acetabular protrusion or Otto pelvis. Primary acetabular protrusion usually affects both hips in young to middle aged women with a history of diminished abduction, rotation and hip pain since puberty. Radiographically one notes a bilateral axial migration of the femoral head without joint space loss and with moderate degenerative changes.

  15. 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.

  16. 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.

  17. 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.

  18. A novel liposomal drug delivery system for PMMA bone cements

    PubMed Central

    Birchall, James C.; Evans, Samuel L.; Denyer, Stephen P.

    2015-01-01

    Abstract The population in developed countries is ageing and the number of people experiencing joint‐related conditions, such as osteoarthritis, is expected to increase. Joint replacements are currently the most effective treatment for severe joint conditions and although many of these procedures are successful, infection developing after the procedure is still an issue, requiring complex and expensive revisions. Whilst incorporating a powdered antibiotic within the bone cement can reduce infection rates, the powder frequently agglomerates, resulting in poor antibiotic release characteristics and compromised mechanical performance of the cement. To overcome these issues, a novel delivery system consisting of antibiotic‐loaded nano‐sized liposomes was developed for inclusion into polymethyl methacrylate (PMMA) bone cement. This system was tested in a commercial cement (Palacos R) and consistently delivered a higher percentage (22%) of the incorporated antibiotic when compared to the powdered antibiotic cement (9%), meaning less antibiotic needs to be incorporated than with conventional cement. The novel system resulted in a controlled and gradual release of antibiotic over a longer, 30‐day period and enhanced the toughness, bending strength and Vickers hardness of the cement, without altering its polymerization or molecular structure. This new material has the potential to significantly reduce infections in cemented joint replacements leading to enhanced patient quality of life and reduced healthcare costs. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1510–1524, 2016. PMID:26256271

  19. Ankle replacement

    MedlinePlus

    ... is surgery to replace the damaged bone and cartilage in the ankle joint. Artificial joint parts (prosthetics) ... Your surgeon will remove the damaged bone and cartilage. Your surgeon will replace the damaged part of: ...

  20. 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 ...

  1. Three-dimensional acetabular orientation measurement in a reliable coordinate system among one hundred Chinese

    PubMed Central

    Zhang, Henghui; Wang, Yiping; Ai, Songtao; Chen, Xiaojun; Wang, Liao; Dai, Kerong

    2017-01-01

    Determining three-dimensional (3D) acetabular orientation is important for several orthopaedic scenarios, but the complex geometries of both pelvis and acetabulum make measurements of orientation unreliable. Acetabular orientation may also differ between the sexes or racial groups. We aimed to (1) establish and evaluate a novel method for measuring 3D acetabular orientation, (2) apply this new method to a large population of Chinese subjects, and (3) report relevant characteristics of native acetabular orientation in this population. We obtained computed tomography scans taken for non-orthopaedic indications in 100 Chinese subjects (50 male, 50 female). A novel algorithm tailored to segmentation of the hip joint was used to construct 3D pelvic models from these scans. We developed a surface-based method to establish a reliable 3D pelvic coordinate system and software to semi-automatically measure 3D acetabular orientation. Differences in various acetabular orientations were compared within and between subjects, between male and female subjects, and between our subjects and subjects previously reported by another group. The reported method was reliable (intraclass correlation coefficient >0.999). Acetabular orientations were symmetrical within subjects, but ranged widely between subjects. The sexes differed significantly in acetabular anteversion (average difference, 3.0°; p < 0.001) and inclination (1.5°; p < 0.03). Acetabular anteversion and inclination were substantially smaller among our Chinese subjects than previously reported for American subjects. Thus, our method was reliable and sensitive, and we detected sex differences in 3D acetabular orientation. Awareness of differences between the sexes and races is the first step towards better reconstruction of the hip joint for all individuals and could also be applied to other orthopaedic scenarios. PMID:28207829

  2. Penetration of a metallic femoral head through the acetabular shell.

    PubMed

    Sherman, Robert A; Damron, Timothy A

    2009-10-01

    Extensive wear of a metal-on-polyethylene total hip arthroplasty may rarely result in erosion of the metal-backed acetabular shell and penetration of the femoral head. We report on the case of an 85-year-old man who presented to the emergency department with an apparent dislocated total hip. He subsequently was discovered to have a periprosthetic fracture after an attempt at closed reduction of what was only discovered intraoperatively to be an irreducible transacetabular component central dislocation. Recognition of this rare complication may change clinical outcome.

  3. The dynamic volume changes of polymerising polymethyl methacrylate bone cement.

    PubMed

    Muller, Scott D; Green, Sarah M; McCaskie, Andrew W

    2002-12-01

    The Swedish hip register found an increased risk of early revision of vacuum-mixed cemented total hip replacements. The influence of cement mixing technique on the dynamic volume change in polymerising PMMA is not well understood and may be relevant to this observation. Applying Archimedes' principle, we have investigated the dynamic volume changes in polymerising cement and determined the influence of mixing technique. All specimens showed an overall volume reduction: hand-mixed 3.4% and vacuum-mixed 6.0%. Regression analysis of sectional porosity and volume reduction showed a highly significant relationship. Hand-mixed porous cement showed a transient volume increase before solidification. However, vacuum-mixed cement showed a progressive volume reduction throughout polymerisation. Transient expansion of porous cement occurs at the critical time of micro-interlock formation, possibly improving fixation. Conversely, progressive volume reduction of vacuum-mixed cement throughout the formation of interlock may damage fixation. Stable fixation of vacuum-mixed cement may depend on additional techniques to offset the altered volumetric behaviour of vacuum-mixed cement.

  4. 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

  5. Good diagnostic performance of early migration as a predictor of late aseptic loosening of acetabular cups: results from ten years of follow-up with Roentgen stereophotogrammetric analysis (RSA).

    PubMed

    Nieuwenhuijse, Marc J; Valstar, Edward R; Kaptein, Bart L; Nelissen, Rob G H H

    2012-05-16

    Excessive early migration of femoral stems following total hip arthroplasty and tibial components following total knee arthroplasty is associated with their long-term survival and allows reliable early evaluation of implant performance. However, a similar relationship involving acetabular components following hip arthroplasty has not been evaluated. This prospective, long-term study with clinical and Roentgen stereophotogrammetric analysis (RSA) follow-up establishes the existence of this relationship and its associated diagnostic performance. Thirty-nine consecutive patients (forty-one hips) who underwent total hip arthroplasty with a cemented Exeter stem and a cemented Exeter all-polyethylene cup had prospective clinical and RSA follow-up. Patients were evaluated postoperatively at six weeks, at three, six, and twelve months, and annually thereafter. Conventional anteroposterior and lateral radiographs were made at six weeks and at two, five, and ten years postoperatively as well as when indicated. The mean duration of follow-up (and standard deviation) was 9.4 ± 3.2 years. No patients were lost to follow-up; fifteen patients died during the follow-up period. Eleven acetabular components were observed to be loose on conventional radiographs after a mean of seventy-six months (range, twelve to 140 months). During the first two postoperative years, the failed acetabular components showed markedly greater and more rapid cranial translation and sagittal rotation. Both cranial translation (hazard ratio = 19.9 [95% confidence interval, 4.94 to 80.0], p < 0.001) and sagittal rotation (hazard ratio = 11.1 [95% confidence interval, 2.83 to 43.9], p = 0.001) were strong risk factors for late aseptic loosening. Eight of the eleven failed components showed a distinctive pattern of excessive cranial translation combined with excessive sagittal rotation. The associated diagnostic performance of two-year cranial translation and/or sagittal rotation for predicting late aseptic

  6. Hydration Characteristics of Metakaolin Admixtured Cement using DTA, XRD and SEM Techniques

    NASA Astrophysics Data System (ADS)

    Govindarajan, D.; Gopalakrishnan, R.

    2008-04-01

    The paper aims to investigate hydration and pozzolanic reaction in Portland cement paste with different replacement percentages (0%, 10%, 20% and 30%) of metakaolin. The compressive strength of the metakaolin admixtured cement was measured at 1 day, 1 week and 4 weeks. The compressive strength developments of the metakaolin admixtured cement are compared with Portland cement. It is found that metakaolin contributes significantly to strength development as an accelerating admixture for Portland cement. The pozzolanic reactions and the reaction products were determined by DTA, XRD and SEM.

  7. [Application of three-dimensional printing personalized acetabular wing-plate in treatment of complex acetabular fractures via lateral-rectus approach].

    PubMed

    Mai, J G; Gu, C; Lin, X Z; Li, T; Huang, W Q; Wang, H; Tan, X Y; Lin, H; Wang, Y M; Yang, Y Q; Jin, D D; Fan, S C

    2017-03-01

    Objective: To investigate reduction and fixation of complex acetabular fractures using three-dimensional (3D) printing technique and personalized acetabular wing-plate via lateral-rectus approach. Methods: From March to July 2016, 8 patients with complex acetabular fractures were surgically managed through 3D printing personalized acetabular wing-plate via lateral-rectus approach at Department of Orthopedics, the Third Affiliated Hospital of Southern Medical University. There were 4 male patients and 4 female patients, with an average age of 57 years (ranging from 31 to 76 years). According to Letournel-Judet classification, there were 2 anterior+ posterior hemitransverse fractures and 6 both-column fractures, without posterior wall fracture or contralateral pelvic fracture. The CT data files of acetabular fracture were imported into the computer and 3D printing technique was used to print the fractures models after reduction by digital orthopedic technique. The acetabular wing-plate was designed and printed with titanium. All fractures were treated via the lateral-rectus approach in a horizontal position after general anesthesia. The anterior column and the quadrilateral surface fractures were fixed by 3D printing personalized acetabular wing-plate, and the posterior column fractures were reduction and fixed by antegrade lag screws under direct vision. Results: All the 8 cases underwent the operation successfully. Postoperative X-ray and CT examination showed excellent or good reduction of anterior and posterior column, without any operation complications. Only 1 case with 75 years old was found screw loosening in the pubic bone with osteoporosis after 1 month's follow-up, who didn't accept any treatment because the patient didn't feel discomfort. According to the Matta radiological evaluation, the reduction of the acetabular fracture was rated as excellent in 3 cases, good in 4 cases and fair in 1 case. All patients were followed up for 3 to 6 months and all

  8. Improvement of casing cementation of deep and ultradeep wells. Part 2: Oilfield cements and cement additives

    NASA Astrophysics Data System (ADS)

    Arens, K. H.; Akstinat, M.

    1982-07-01

    Oilfield cements and cement additives were investigated in order to improve the casing cementation of deep and ultradeep wells. Characterization and evaluation of the main oil field cements commercially available were studied. The testing was carried out according to American Petroleum Institute API standards and nonstandardized test methods (dynamic modulus of elasticity, expansion/shrinkage), especially the rheology, thickening time and the influence of pressure, temperature and water-cement ratio, were considered. The main emphasis in the field of cement additives was on the evaluation of cement retarders for high temperatures, accelerators, and additives for cement expansion. Furthermore oil field cements were tested, and their properties are described.

  9. 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.

  10. Acetabular revision with freeze-dried irradiated and chemically treated allograft: a minimum 5-year follow-up of 17 cases

    PubMed Central

    Caton, Jacques

    2007-01-01

    We reviewed the results of 17 consecutive revision total hip arthroplasties performed with the use of freeze-dried irradiated bone allograft in 15 patients. These allografts were used in conjunction with five Kerboull rings, two steel meshes and ten cemented isolated cups. All the patients have had a follow-up of at least 5 years. The patients were evaluated clinically and radiographically. No revisions were necessary and X-rays confirmed partial or total ingrowth of the allografts. In acetabular revision surgery, hip reconstruction can be successfully treated by freeze-dried irradiated and chemically treated allografts. Additional studies with longer term follow-up are necessary to confirm this outcome. PMID:17828537

  11. Cementation of indirect restorations: an overview of resin cements.

    PubMed

    Stamatacos, Catherine; Simon, James F

    2013-01-01

    The process of ensuring proper retention, marginal seal, and durability of indirect restorations depends heavily on effective cementation. Careful consideration must be made when selecting an adhesive cement for a given application. This article provides information on resin cements that can guide clinicians in determining which type of cement is best suited to their clinical needs regarding cementation of indirect restorations. Emphasis is placed on successful cementation of all-ceramic restorations.

  12. Gelatin powders accelerate the resorption of calcium phosphate cement and improve healing in the alveolar ridge.

    PubMed

    Matsumoto, Goichi; Sugita, Yoshihiko; Kubo, Katsutoshi; Yoshida, Waka; Ikada, Yoshito; Sobajima, Satoshi; Neo, Masashi; Maeda, Hatsuhiko; Kinoshita, Yukihiko

    2014-05-01

    The aim of this study was to show the effectiveness of combining calcium phosphate cement and gelatin powders to promote bone regeneration in the canine mandible. We mixed gelatin powders with calcium phosphate cement to create a macroporous composite. In four beagle dogs, two saddle-type bone defects were created on each side of the mandible, and calcium phosphate cement alone or calcium phosphate cement containing composite gelatin powders was implanted in each of the defects. After a healing period of six months, mandibles were removed for µCT and histological analyses. The µCT and histological analyses showed that at experimental sites at which calcium phosphate cement alone had been placed new bone had formed only around the periphery of the residual calcium phosphate cement and that there had been little or no ingrowth into the calcium phosphate cement. On the other hand, at experimental sites at which calcium phosphate cement containing composite gelatin powders had been placed, we observed regenerated new bone in the interior of the residual calcium phosphate cement as well as around its periphery. The amount of resorption of calcium phosphate cement and bone regeneration depended on the mixing ratio of gelatin powders to calcium phosphate cement. New bone replacement was significantly better in the sites treated with calcium phosphate cement containing composite gelatin powders than in those treated with calcium phosphate cement alone.

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

    PubMed Central

    2016-01-01

    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

  14. Prevalence of post-traumatic osteoarthritis in morbidly obese patients after acetabular fracture fixation.

    PubMed

    Lawyer, Tracye J; Jankowski, Jaclyn; Russell, George V; Stronach, Benjamin M

    2014-01-01

    Morbid obesity and osteoarthritis are conditions that place a significant burden on the US healthcare system. Acetabular fracture is a known cause of post-traumatic osteoarthritis (PTOA) and morbid obesity contributes to the development of osteoarthritis. This study aimed to determine the prevalence of PTOA in morbidly obese patients who underwent acetabular fracture fixation. A retrospective review of morbidly obese patients who underwent acetabular fracture repair was performed. Patient information included demographics, body mass index, patient age, and length of hospital stay. The prevalence of PTOA was determined by radiographic review with a minimum follow-up of 4 years. There were 299 acetabular fracture fixations performed from 2007 to 2012 at our institution and 39 of these were in morbidly obese patients. One patient was excluded due to preoperative osteoarthritis of the hip. Of the 38 patients, 26 (68%) went on to develop PTOA after acetabular fracture fixation. This is significantly higher than previously reported rates of PTOA after acetabular fracture fixation. There was a higher rate of PTOA in morbidly obese males compared with females (P=0.008). Morbid obesity appears to pose a significantly increased risk for the development of PTOA after fixation of acetabular fractures.

  15. 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.

  16. 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.

  17. Automated measurement of anterior and posterior acetabular sector angles

    NASA Astrophysics Data System (ADS)

    Ibragimov, Bulat; Likar, Boštjan; Pernuš, Franjo; Vrtovec, Tomaž

    2012-03-01

    In this paper, we propose a segmentation algorithm by which anatomical landmarks on the pelvis are extracted from computed tomography (CT) images. The landmarks are used to automatically define the anterior (AASA) and posterior acetabular sector angles (PASA) describing the degree of hip misalignment. The center of each femoral head is obtained by searching for the point at which most intensity gradient vectors defined at edge points intersect. The radius of each femoral head is computed by finding the sphere, positioned at the center of the femoral head, for which the normalized sum of gradient vector magnitudes on the sphere surface is maximal. The anterior and posterior corners of each acetabulum are searched for on a curve representing the acetabulum and defined by dynamic programming. The femoral head centers and anterior and posterior corners are used to calculate the AASA and PASA. The algorithm was applied to CT images of 120 normal subjects and the results were compared to ground truth values obtained by manual segmentation. The mean absolute difference (+/- standard deviation) between the obtained and ground truth values was 1.3 +/- 0.3 mm for the femoral head centers and 2.1 +/- 1.3 degrees for the acetabular angles.

  18. Atypical periprosthetic acetabular fracture in long-term alendronate therapy

    PubMed Central

    Marongiu, Giuseppe; Capone, Antonio

    2016-01-01

    Summary Bisphosphonates have been commonly used in the treatment of osteoporosis, demonstrating its efficacy in fracture risk reduction. However, even if are generally safe and well tolerated, concerns have emerged about atypical fractures related to its prolonged use. Although atypical femoral fracture are more common, case reports demonstrated that even other skeletal areas can be involved by unusual pattern of fracture. We report a atypical acetabular periprosthetic fracture in a 83-year-old female patient after prolonged alendronate treatment for osteoporosis and isolated acetabular revision surgery. The patient underwent to clinical, bioumoral and radiological evaluation and all the history cases were fully reported. We believe this periprosthetic fracture, according to the available data, may have similar underlying pathology to atypical femoral fractures. Awareness of symptoms, in addition to a regular radiographic survey may facilitate early diagnosis and possible prevention of spontaneous periprosthetic fractures, in patients receiving bisphosphonate therapy beyond 5 years. The treatment of this atypical periprosthetic fracture should include both surgical than pharmacological therapy to obtained bone healing. PMID:28228784

  19. Atypical periprosthetic acetabular fracture in long-term alendronate therapy.

    PubMed

    Marongiu, Giuseppe; Capone, Antonio

    2016-01-01

    Bisphosphonates have been commonly used in the treatment of osteoporosis, demonstrating its efficacy in fracture risk reduction. However, even if are generally safe and well tolerated, concerns have emerged about atypical fractures related to its prolonged use. Although atypical femoral fracture are more common, case reports demonstrated that even other skeletal areas can be involved by unusual pattern of fracture. We report a atypical acetabular periprosthetic fracture in a 83-year-old female patient after prolonged alendronate treatment for osteoporosis and isolated acetabular revision surgery. The patient underwent to clinical, bioumoral and radiological evaluation and all the history cases were fully reported. We believe this periprosthetic fracture, according to the available data, may have similar underlying pathology to atypical femoral fractures. Awareness of symptoms, in addition to a regular radiographic survey may facilitate early diagnosis and possible prevention of spontaneous periprosthetic fractures, in patients receiving bisphosphonate therapy beyond 5 years. The treatment of this atypical periprosthetic fracture should include both surgical than pharmacological therapy to obtained bone healing.

  20. 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.

  1. [Acetabular Osteolysis in Total Hip Replacement - When to Retain the Cup?].

    PubMed

    Lutz, B; Faschingbauer, M; Bieger, R; Reichel, H; Kappe, T

    2016-08-01

    Periacetabular osteolysis is a frequent long-term complication of cementless total hip arthroplasty. The decision whether to retain or to revise a cup in the presence of osteolysis remains a challenge. The options are regular clinical and radiological check-ups, isolated liner exchange with and without bone grafting, and complete cup revision. Thorough preoperative diagnostics, including a medical history, examination and imaging, are mandatory for correct decision making. In most patients, computed tomography is useful to assess periacetabular osteolysis. If the cup is well-fixed and positioned in an asymptomatic patient without progressive osteolysis and no implant defect or higher grade polyethylene wear and no signs of infection, continuous clinical and radiological monitoring is preferred. If imaging reveals cup loosening, malposition, osteolysis localised in a weight-bearing area, imminent or present periprosthetic fractures, rapid progressive osteolysis, implant defects or massive inlay wear, surgical treatment may be preferred. Cup revision is usually performed in such patients. If the cup is well-positioned and well-fixed in the X-ray, the procedure has to be discussed with the patient individually. Apart from patient-specific risk factors, the risk of further progression has to be assessed. Isolated liner exchange can be performed if the patient is asymptomatic and the cup proves to be stable intraoperatively. It is still unclear whether filling osteolyses through screw holes or osseous windows is of long-term benefit. Georg Thieme Verlag KG Stuttgart · New York.

  2. Preparation of special cements from red mud

    SciTech Connect

    Singh, M.; Upadhayay, S.N.; Prasad, P.M.

    1996-12-31

    Red mud from HINDALCO (Hindustan Aluminium Corporation) Industries Limited, Renukoot, India, contains significant quantities of alumina, iron oxide and silica. Presence of the said constituents makes it a suitable ingredient for the preparation of special cements. Preparation of three varieties of cements was investigated, namely: (a) aluminoferrite (C{sub 4}AF)-belite ({beta}-C{sub 2}S) using lime + red mud + fly ash; (b) aluminoferrite-ferrite (C{sub 2}F)-aluminates (C{sub 3}A and C{sub 12}A{sub 7}) utilizing lime + red mud + bauxite; and (c) sulfoaluminate (C{sub 4}A{sub 3}{bar S})-aluminoferrite-ferrite using lime + red mud + bauxite + gypsum. The effects of composition (proportions of lime, red mud, fly ash, bauxite and gypsum), firing temperature and duration on the properties of cements produced were studied in detail. Cements made from lime + red mud + bauxite or lime + red mud + bauxite + gypsum exhibit strengths comparable or superior to ordinary Portland cement (OPC). On the other hand, those prepared using lime + red mud + fly ash did not have sufficient strength. Moreover, it was not possible to replace bauxite by fly ash (as a source of alumina) in any significant quantity.

  3. Relationship between proximal femoral and acetabular alignment in normal hip joints using 3-dimensional computed tomography.

    PubMed

    Buller, Leonard T; Rosneck, James; Monaco, Feno M; Butler, Robert; Smith, Travis; Barsoum, Wael K

    2012-02-01

    The bony architecture of the hip depends upon functional adaptation to mechanical usage via the dynamic interaction between the acetabulum and femoral head. Acetabular retroversion is thought to be a contributing factor of pincer-type femoroacetabular impingement. Studies of pathological hip joints suggest proximal femoral anatomy compensates for acetabular retroversion. HYPOTHESIS/ PURPOSE: The purpose of this study was to determine if a predictable relationship exists between proximal femoral and acetabular angles, age, and gender in normal hip joints. We hypothesized that, through functional adaptation to mechanical loading, a complementary developmental relationship exists between the acetabulum and proximal femur. Descriptive laboratory study. The femoral neck version, femoral neck shaft angle, acetabular version, acetabular inclination, and center edge angle were measured in 230 normal hip joints in 115 adults using 3-dimensional reconstruction software. Correlations between the angles, age, and gender were examined using the methods of stepwise regression and backward elimination. Regarding side-to-side comparison and variability, there was no statistically significant difference between the left and right sides in the average value of each angle measurement. The correlations specifically between angles, age, and gender were similar on the left and right sides for all pairs except femoral version and acetabular inclination. Regarding significant findings of the study, a positive correlation (P < .05) was found between femoral version and acetabular version (0.38° to 1°). A positive correlation was found between femoral neck shaft angle and acetabular version (0.21° to 1°). A negative correlation was found between femoral neck shaft angle and age (-0.17° to 1°). A positive correlation was found between acetabular version and female gender (2.6° to 1°). A positive correlation was found between center edge angle and female gender (2.8° to 1°). A

  4. 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.

  5. Reduction of soil pollution by usingwaste of the limestone in the cement industry

    NASA Astrophysics Data System (ADS)

    Muñoz, M. Cecilia Soto; Robles Castillo, Marcelo; Blanco Fernandez, David; Diaz Gonzalez, Marcos; Naranjo Lamilla, Pedro; Moore Undurraga, Fernando; Pardo Fabregat, Francisco; Vidal, Manuel Miguel Jordan; Bech, Jaume; Roca, Nuria

    2016-04-01

    In the cement manufacturing process (wet) a residue is generated in the flotation process. This builds up causing contamination of soil, groundwater and agricultural land unusable type. In this study to reduce soil and water pollution 10% of the dose of cement was replaced by waste of origin limestone. Concretes were produced with 3 doses of cement and mechanical strengths of each type of concrete to 7, 28 and 90 days were determined. the results indicate that the characteristics of calcareous residue can replace up to 10% of the dose of cement without significant decreases in strength occurs. It is noted that use of the residue reduces the initial resistance, so that the dose of cement should not be less than 200 kg of cement per m3. The results allow recommends the use of limestone waste since it has been observed decrease in soil and water contamination without prejudice construction material Keywords: Soil contamination; Limestone residue; Adding concrete

  6. Mechanical and physical properties of cement blended with sewage sludge ash.

    PubMed

    Garcés, P; Pérez Carrión, M; García-Alcocel, E; Payá, J; Monzó, J; Borrachero, M V

    2008-12-01

    The aim of this paper is to evaluate the compatibility of sewage sludge ash (SSA) with various types of commercially available cements (CEM I and CEM II types, cements with several proportions of clinker). The behaviour of mortars fabricated with various percentages (10-30% by weight) of the cement replaced by SSA has been analyzed in terms of workability, mechanical strength, porosity and shrinkage/expansion. SSA exhibits moderate pozzolanic activity; the highest compressive strengths were obtained with 10% of the cement replaced by SSA. The CEM II/B-M (V-LL) 42.5R cement is considered ideal for preparing mortars containing SSA. Shrinkage data demonstrate that sulphates present in SSA are not reactive towards cement.

  7. 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.

  8. Computational modelling of bone cement polymerization: temperature and residual stresses.

    PubMed

    Pérez, M A; Nuño, N; Madrala, A; García-Aznar, J M; Doblaré, M

    2009-09-01

    The two major concerns associated with the use of bone cement are the generation of residual stresses and possible thermal necrosis of surrounding bone. An accurate modelling of these two factors could be a helpful tool to improve cemented hip designs. Therefore, a computational methodology based on previous published works is presented in this paper combining a kinetic and an energy balance equation. New assumptions are that both the elasticity modulus and the thermal expansion coefficient depend on the bone cement polymerization fraction. This model allows to estimate the thermal distribution in the cement which is later used to predict the stress-locking effect, and to also estimate the cement residual stresses. In order to validate the model, computational results are compared with experiments performed on an idealized cemented femoral implant. It will be shown that the use of the standard finite element approach cannot predict the exact temporal evolution of the temperature nor the residual stresses, underestimating and overestimating their value, respectively. However, this standard approach can estimate the peak and long-term values of temperature and residual stresses within acceptable limits of measured values. Therefore, this approach is adequate to evaluate residual stresses for the mechanical design of cemented implants. In conclusion, new numerical techniques should be proposed in order to achieve accurate simulations of the problem involved in cemented hip replacements.

  9. Recycling of ladle slag in cement composites: Environmental impacts.

    PubMed

    Serjun, Vesna Zalar; Mladenovič, Ana; Mirtič, Breda; Meden, Anton; Ščančar, Janez; Milačič, Radmila

    2015-09-01

    In the present work compact and ground cement composites in which 30% of cement by mass was replaced by ladle slag were investigated for their chemical and physico-mechanical properties. To evaluate long-term environmental impacts, leachability test based on diffusion, which combined both, diffusion and dissolution of contaminants, was performed in water and saline water. Total element concentrations and Cr(VI) were determined in leachates over a time period of 180days. At the end of the experiment, the mineralogical composition and the physico-mechanical stability of cement composites was also assessed. The results revealed that Cr(III) and Cr(VI) were immobilized by the hydration products formed in the cement composites with the addition of ladle slag. Cr(VI) content originating from the cement was also appreciably reduced by Fe(II) from minerals present in the added ladle slag, which thus had significant positive environmental effects. Among metals, only Mo and Ba were leached in elevated concentrations, but solely in ground cement composites with the addition of ladle slag. Lower V concentrations were observed in leachates of ground than compact composite. It was demonstrated that the presence of ladle slag in cement composites can even contribute to improved mortar resistance. The investigated ladle slag can be successfully implemented in cement composites as supplementary cementitious material. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. ULTRA-LIGHTWEIGHT CEMENT

    SciTech Connect

    Fred Sabins

    2002-01-23

    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: foamed and sodium silicate slurries. Comparison studies of the three cement systems examined several properties: tensile strength, Young's modulus, water permeability, and shear bond. Testing was also done to determine the effect that temperature cycling has on the shear bond properties of the cement systems. In addition, analysis was carried out to examine alkali silica reactivity of slurries containing ULHS. Data is also presented from a study investigating the effects of mixing and pump circulation on breakage of ULHS. Information is also presented about the field application of ULHS in cementing a 7-in. intermediate casing in south Texas.

  11. Fixed-angle screws vs standard screws in acetabular prosthesis fixation: a cadaveric biomechanical study.

    PubMed

    Hugate, Ronald R; Dickey, Ian D; Chen, Qingshan; Wood, Christina M; Sim, Franklin H; Rock, Michael G

    2009-08-01

    Secure fixation of acetabular components in total hip arthroplasty can be challenging. The purpose of this study was to perform biomechanical analysis of cup fixation strength using fixed-angle vs standard screw fixation. Multihole, porous-backed acetabular prostheses were implanted in both acetabuli of 8 cadaveric pelves using standard press-fit techniques. Fixed-angle screws were used on the left side, and standard cancellous screws were used in the right. The use of fixed-angle screws enhanced acetabular fixation substantially under subfailure cyclic loading conditions and load-to-failure. The triradiate screw configuration increases the bending moment required to fail the specimens as well. Fixed-angle screws may be useful for achieving rigid fixation of acetabular prostheses in challenging clinical scenarios.

  12. A simplified method to determine acetabular cup anteversion from plain radiographs.

    PubMed

    Widmer, Karl-Heinz

    2004-04-01

    Plain radiographs are the most important diagnostic means for determining the indication and following up on total hip arthroplasty. The acetabular cup position can be easily determined by applying trigonometric functions. This report presents an even simpler method. The short axis of the projected ellipse is measured and related to the total cross-section of the projected cup along the short axis. This relationship correlates with acetabular cup anteversion angles and represents an inverse sinus function. A close linear correlation is seen within the most common interval from 10 degrees to 30 degrees. Anteversion is between 23 degrees to 24 degrees when the ellipse bisects the total acetabular cross-section. This means that simply measuring the length of the short ellipse axis and the total length of the projected cross-section along the short axis provides the radiographic acetabular anteversion. Nonorthogonal projected radiographs should be corrected first.

  13. Chromium stabilization chemistry of paint removal wastes in Portland cement and blast furnace slag

    SciTech Connect

    Boy, J.H.; Race, T.D.; Reinbold, K.A.

    1995-12-31

    The use of cement based systems for solidification and stabilization of hazardous wastes has been proposed. The stabilization of Cr contaminated paint removal wastes in ordinary Portland cement and in a Portland cement and blast furnace slag matrix was investigated. A loading by volume of 75% waste and 25% cement (or cement + slag) was used. The expression of pore solution was utilized to determine the chemical environment encountered by the waste species in the cement matrix. The highly alkaline conditions of ordinary Portland cement determined the stability of the metal species, with Cr being highly soluble. The replacement of 25% of the Portland cement by blast furnace slag was found to decrease the [OH-] of the pore solution resulting in a decrease of the Cr concentration. For cement wastes forms hydrated for 28 days, the Cr concentration decreased in the expressed pore solution. During the TCLP tests the cement waste form and extraction solution were found to react, changing the chemistry of the extraction solution. The expression of pore solution was found to give a direct measure of the chemistry of the waste species in the cement matrix. This avoids the reaction of the TCLP extraction solution with the cement matrix which changes the solubility of the hazardous metals. 15 refs., 4 figs., 6 tabs.

  14. The impact of surgeon handedness in total hip replacement

    PubMed Central

    Redmond, A; Stewart, T; Stone, M

    2014-01-01

    Introduction Total hip replacement (THR) is successful and performed commonly. Component placement is a determinant of outcome. Influence of surgeon handedness on component placement has not been considered previously. This study was a radiographic assessment of component positioning with respect to handedness. Early data from 160 patients are reported. Methods Overall, 160 primary THRs for osteoarthritis were included. Equal numbers of left and right THRs were performed by four surgeons, two right-handed and two left-handed. Postoperative radiography was assessed for THR component position by measurement of leg length inequality, acetabular inclination and centre of rotation. Surgeons’ handedness was assessed using the Edinburgh inventory. Results For leg length inequality, no significant interaction was seen between hip side and surgeon handedness. Acetabular inclination angles showed a statistically significant difference, however, depending on hand dominance, with higher inclination angles recorded when operating on the dominant side. There was a trend towards greater medialisation of the centre of rotation on the non-dominant side although this did not reach statistical significance. Conclusions Surgeon handedness appears to influence acetabular component position during THR but it is one factor of many that interact to achieve a successful outcome. PMID:25198975

  15. Alternative Fuel for Portland Cement Processing

    SciTech Connect

    Schindler, Anton K; Duke, Steve R; Burch, Thomas E; Davis, Edward W; Zee, Ralph H; Bransby, David I; Hopkins, Carla; Thompson, Rutherford L; Duan, Jingran; Venkatasubramanian, Vignesh; Stephen, Giles

    2012-06-30

    at a full-scale cement plant with alternative fuels to examine their compatibility with the cement production process. Construction and demolition waste, woodchips, and soybean seeds were used as alternative fuels at a full-scale cement production facility. These fuels were co-fired with coal and waste plastics. The alternative fuels used in this trial accounted for 5 to 16 % of the total energy consumed during these burns. The overall performance of the portland cement produced during the various trial burns performed for practical purposes very similar to the cement produced during the control burn. The cement plant was successful in implementing alternative fuels to produce a consistent, high-quality product that increased cement performance while reducing the environmental footprint of the plant. The utilization of construction and demolition waste, woodchips and soybean seeds proved to be viable replacements for traditional fuels. The future use of these fuels depends on local availability, associated costs, and compatibility with a facility's production process.

  16. 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

  17. Navigated percutaneous screw fixation of a periprosthetic acetabular fracture.

    PubMed

    Gras, Florian; Marintschev, Ivan; Klos, Kajetan; Fujak, Albert; Mückley, Thomas; Hofmann, Gunther O

    2010-10-01

    Periprosthetic fractures are severe complications of total hip arthroplasty with increasing incidence. Most fractures are localized around the femoral component of prosthesis, whereas periacetabular fractures are rare and their management is difficult. In most cases, an operative procedure with revision and exchange of the acetabular cup is necessary. The approaches are demanding and an increased risk of complications is reported. We present the case of a female patient with a cementless total hip arthroplasty due to severe arthritis, suffering of an infratectal transverse periprosthetic fracture. After an initial conservative treatment attempt, we performed a minimally invasive screw fixation using navigated 2-dimensional fluoroscopic guidance. In this report, the literature for treatment recommendations is reviewed and the chosen navigation technique discussed. Copyright © 2010. Published by Elsevier Inc.

  18. 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 ( ...

  19. Acetabular cartilage defects cause altered hip and knee joint coordination variability during gait

    PubMed Central

    Samaan, Michael A.; Teng, Hsiang-Ling; Kumar, Deepak; Lee, Sonia; Link, Thomas; Majumdar, Sharmila; Souza, Richard B.

    2015-01-01

    Background Patients with acetabular cartilage defects reported increased pain and disability compared to those without acetabular cartilage defects. The specific effects of acetabular cartilage defects on lower extremity coordination patterns are unclear. The purpose of this study was to determine hip and knee joint coordination variability during gait in those with and without acetabular cartilage defects. Methods A combined approach, consisting of a semi-quantitative MRI-based quantification method and vector coding, was used to assess hip and knee joint coordination variability during gait in those with and without acetabular cartilage lesions. Findings The coordination variability of the hip flexion-extension/knee rotation, hip abduction-adduction/knee rotation and hip rotation/knee rotation joint couplings were reduced in the acetabular lesion group compared to the control group during loading response of the gait cycle. The lesion group demonstrated increased variability in the hip flexion-extension/knee rotation and hip abduction-adduction/knee rotation joint couplings, compared to the control group, during the terminal stance/pre-swing phase of gait. Interpretation Reduced variability during loading response in the lesion group may suggest reduced movement strategies and a possible compensation mechanism for lower extremity instability during this phase of the gait cycle. During terminal stance/pre-swing, a larger variability in the lesion group may suggest increased movement strategies and represent a compensation or pain avoidance mechanism caused by the load applied to the hip joint. PMID:26298706

  20. Value of 3-D CT in classifying acetabular fractures during orthopedic residency training.

    PubMed

    Garrett, Jeffrey; Halvorson, Jason; Carroll, Eben; Webb, Lawrence X

    2012-05-01

    The complex anatomy of the pelvis and acetabulum have historically made classification and interpretation of acetabular fractures difficult for orthopedic trainees. The addition of 3-dimensional (3-D) computed tomography (CT) scan has gained popularity in preoperative planning, identification, and education of acetabular fractures given their complexity. Therefore, the authors examined the value of 3-D CT compared with conventional radiography in classifying acetabular fractures at different levels of orthopedic training. Their hypothesis was that 3-D CT would improve correct identification of acetabular fractures compared with conventional radiography.The classic Letournel fracture pattern classification system was presented in quiz format to 57 orthopedic residents and 20 fellowship-trained orthopedic traumatologists. A case consisted of (1) plain radiographs and 2-dimensional axial CT scans or (2) 3-D CT scans. All levels of training showed significant improvement in classifying acetabular fractures with 3-D vs 2-D CT, with the greatest benefit from 3-D CT found in junior residents (postgraduate years 1-3).Three-dimensional CT scans can be an effective educational tool for understanding the complex spatial anatomy of the pelvis, learning acetabular fracture patterns, and correctly applying a widely accepted fracture classification system.

  1. Acetabular cartilage defects cause altered hip and knee joint coordination variability during gait.

    PubMed

    Samaan, Michael A; Teng, Hsiang-Ling; Kumar, Deepak; Lee, Sonia; Link, Thomas M; Majumdar, Sharmila; Souza, Richard B

    2015-12-01

    Patients with acetabular cartilage defects reported increased pain and disability compared to those without acetabular cartilage defects. The specific effects of acetabular cartilage defects on lower extremity coordination patterns are unclear. The purpose of this study was to determine hip and knee joint coordination variability during gait in those with and without acetabular cartilage defects. A combined approach, consisting of a semi-quantitative MRI-based quantification method and vector coding, was used to assess hip and knee joint coordination variability during gait in those with and without acetabular cartilage lesions. The coordination variability of the hip flexion-extension/knee rotation, hip abduction-adduction/knee rotation, and hip rotation/knee rotation joint couplings were reduced in the acetabular lesion group compared to the control group during loading response of the gait cycle. The lesion group demonstrated increased variability in the hip flexion-extension/knee rotation and hip abduction-adduction/knee rotation joint couplings, compared to the control group, during the terminal stance/pre-swing phase of gait. Reduced variability during loading response in the lesion group may suggest reduced movement strategies and a possible compensation mechanism for lower extremity instability during this phase of the gait cycle. During terminal stance/pre-swing, a larger variability in the lesion group may suggest increased movement strategies and represent a compensation or pain avoidance mechanism caused by the load applied to the hip joint. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. A comparative study of the posterolateral and anterolateral approaches for isolated acetabular revision.

    PubMed

    Park, Youn-Soo; Moon, Young-Wan; Lim, Byung-Ho; Shon, Min-Soo; Lim, Seung-Jae

    2011-07-01

    Although isolated revision of the acetabular component has become an increasingly common option for revision hip surgery, opinions differ regarding the ideal surgical approach for reducing postoperative instability. The purpose of this study was to compare the clinical and radiographic results of isolated acetabular revision performed using a posterolateral and an anterolateral approach. The authors retrospectively compared the clinical and radiographic results of isolated acetabular revision performed in 33 hips using a posterolateral approach with those performed in 36 hips using an anterolateral approach. All procedures were performed by a single surgeon and all patients received the same postoperative protocol. Mean duration of follow-up was 4.6 years (range 2-13.2). Mean postoperative Harris hip scores were similar in the posterolateral and anterolateral groups (86.5 and 87.2 points, respectively). In the entire series of 69 hips, 6 (9%) underwent re-revision of the acetabular component because of aseptic cup loosening in 4, recurrent dislocation in 1, and deep infection in 1. No significant difference was found between the two groups with respect to complication or re-revision rates, but the dislocation rate in the anterolateral approach group was significantly lower than that in the posterolateral group (0 vs. 12%, p = 0.047). Isolated acetabular revision performed using an anterolateral approach seems to be the more viable option in selected patients, and in particular, it has a significantly lower postoperative dislocation rate than posterolateral acetabular revision.

  3. Total hip arthroplasty with cement and use of a collared matte-finish femoral component: nineteen to twenty-year follow-up.

    PubMed

    Callaghan, John J; Liu, Steve S; Firestone, Daniel E; Yehyawi, Tameem M; Goetz, Devon D; Sullivan, Jason; Vittetoe, David A; O'Rourke, Michael R; Johnston, Richard C

    2008-02-01

    In the mid- to late 1970s, on the basis of laboratory and finite element data, many surgeons in the United States began using collared matte-finish femoral components and metal-backed acetabular components in their total hip arthroplasties. The purpose of this study was to evaluate the long-term results of the use of one such construct in arthroplasties performed by a single surgeon in a consecutive nonselected patient cohort. Between January 1984 and December 1985, 273 patients underwent a total of 304 consecutive nonselected total hip arthroplasties with cement and use of the Iowa femoral component (which is collared, has a proximal cobra shape, and has a matte finish) and a metal-backed TiBac acetabular component performed by a single surgeon. At nineteen to twenty years postoperatively, only two patients (two hips) were lost to follow-up. For clinical evaluation, we attempted to interview all living patients and the families of the patients who had died to verify the status of the hip prosthesis or any revisions. Radiographic evaluation consisted of analysis for loosening and osteolysis as well as wear of the acetabular component. At the time of the nineteen to twenty-year follow-up, the rate of revision of the arthroplasty for any reason was 10.5% (thirty-two hips) for all patients and 25% (twenty-three hips) for living patients. The rate of revision due to aseptic femoral loosening was 2.6% (eight hips). There was radiographic evidence of loosening of the femoral component in fifteen hips (4.9%), including those that were revised, and femoral osteolysis was seen distal to the trochanters in twenty-two hips (7.2%). The rate of revision due to aseptic loosening of the acetabular component was 7.9% (twenty-four hips), and there was radiographic evidence of acetabular loosening in forty-two hips (13.8%), including those that were revised. This study demonstrates the durability of a cemented matte-finish collared femoral component at twenty years postoperatively

  4. Biomechanical comparison of different acetabular plate systems and constructs--the role of an infra-acetabular screw placement and use of locking plates.

    PubMed

    Marintschev, Ivan; Gras, Florian; Schwarz, Christoph E; Pohlemann, Tim; Hofmann, Gunther O; Culemann, Ulf

    2012-04-01

    The aim of this study was the direct comparison of the static fixation strength of two common plate systems: MPS (Matta Pelvic System) and LPPS (Low Profile Plate System). Furthermore the role of a modified screw placement with addressing the infra-acetabular corridor and the use of locking screws were evaluated. Custom made anterior column fractures in artificial SYNBONE pelves were fixed with different acetabular plates (group I: MPS, group II: LPPS none locking and group III: LPPS locking). Each pelvis was tested twice, with the additionally placed infra-acetabular lag screw [+] first, followed by a repeated measurement without the infra-acetabular screw [-]. Six pelves per group were tested under static loading with six cycles up to 800N, each. The fracture displacement was measured in the weight bearing dome using an ultrasound based Zebris-3D-Motion Analyzer. The MPS-plate had a less fixation strength compared to the LPPS-plate (mean±SD of maximum fracture displacement [mm] in group I vs. group II=0.63±0.02 vs. 0.37±0.02, p<0.05). The locking feature did not increase the fracture fixation strength (mean±SD of maximum fracture displacement [mm] in group II vs. group III: 0.37±0.02 vs. 0.37±0.03; ns). The infra-acetabular screw significantly reduces the maximum fracture displacement in all groups, independent of the plate systems ([Delta%] in group I=50; group II=63 and group III=40; p<0.05 each). The LPPS-plate performed superior fixation strength for anterior column fractures compared to the MPS-plate. The locking plate modality did not reduce the maximum fracture displacement, whereas the additional infra-acetabular screw placement actually doubles the fracture fixation strength independent of the used plate system. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Timing of syntaxial cement

    SciTech Connect

    Perkins, R.D.

    1985-02-01

    Echinodermal fragments are commonly overgrown in ancient limestones, with large single crystals growing in optical continuity over their skeletal hosts (i.e., syntaxial overgrowths). Such syntaxial cements are usually considered to have precipitated from meteoric pore waters associated with a later stage of subaerial exposure. Although several examples have been reported from ancient carbonates where petrographic relationships may indicate an early submarine formation of syntaxial cement, no occurrences have been noted in Holocene submarine-cemented rocks. Syntaxial cements of submarine origin have been found in Bermuda beachrock where isopachous high-magnesian calcite cements merge with large optically continuous crystals growing on echinodermal debris. Examination of other Holocene sediments cemented by magnesian calcite indicates that echinodermal fragments are not always overgrown syntaxially, but may be rimmed by microcrystalline calcite. The reason for this difference is not clear, although it may be a function of the spacing of nucleation sites and rates of crystal growth. A review of syntaxial cements from several localities in ancient carbonate sequences reveals that many are best interpreted as having formed in the submarine setting, whereas it is more clear that others formed from meteoric precipitation. These occurrences suggest that care should be exercised in inferring meteoric diagenesis from syntaxial overgrowths and that the possibility of submarine formation should be considered.

  6. ULTRA-LIGHTWEIGHT CEMENT

    SciTech Connect

    Fred Sabins

    2003-07-31

    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. Laboratory testing during the eleventh quarter focused on evaluation of the alkali-silica reaction of eight different cement compositions, four of which contain ULHS. This report provides a progress summary of ASR testing. The original laboratory procedure for measuring set cement expansion resulted in unacceptable erosion of the test specimens. In subsequent tests, a different expansion procedure was implemented and an alternate curing method for cements formulated with TXI Lightweight cement was employed to prevent sample failure caused by thermal shock. The results obtained with the modified procedure showed improvement over data obtained with the original procedure, but data for some compositions were still questionable. Additional modification of test procedures for compositions containing TXI Lightweight cement were implemented and testing is ongoing.

  7. 21 CFR 888.3100 - Ankle joint metal/composite semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ankle joint metal/composite semi-constrained... Ankle joint metal/composite semi-constrained cemented prosthesis. (a) Identification. An ankle joint metal/composite semi-constrained cemented prosthesis is a device intended to be implanted to replace an...

  8. 21 CFR 888.3650 - Shoulder joint metal/polymer non-constrained cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Shoulder joint metal/polymer non-constrained... Shoulder joint metal/polymer non-constrained cemented prosthesis. (a) Identification. A shoulder joint metal/polymer non-constrained cemented prosthesis is a device intended to be implanted to replace...

  9. 21 CFR 888.3800 - Wrist joint metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint metal/polymer semi-constrained... Wrist joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. A wrist joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace a wrist...

  10. 21 CFR 888.3510 - Knee joint femorotibial metal/polymer constrained cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Knee joint femorotibial metal/polymer constrained... Knee joint femorotibial metal/polymer constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer constrained cemented prosthesis is a device intended to be implanted to replace...

  11. 21 CFR 888.3650 - Shoulder joint metal/polymer non-constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Shoulder joint metal/polymer non-constrained... Shoulder joint metal/polymer non-constrained cemented prosthesis. (a) Identification. A shoulder joint metal/polymer non-constrained cemented prosthesis is a device intended to be implanted to replace...

  12. 21 CFR 888.3160 - Elbow joint metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Elbow joint metal/polymer semi-constrained... Elbow joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An elbow joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an...

  13. 21 CFR 888.3800 - Wrist joint metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Wrist joint metal/polymer semi-constrained... Wrist joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. A wrist joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace a wrist...

  14. 21 CFR 888.3110 - Ankle joint metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ankle joint metal/polymer semi-constrained... Ankle joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an...

  15. 21 CFR 888.3510 - Knee joint femorotibial metal/polymer constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint femorotibial metal/polymer constrained... Knee joint femorotibial metal/polymer constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer constrained cemented prosthesis is a device intended to be implanted to replace...

  16. 21 CFR 888.3660 - Shoulder joint metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Shoulder joint metal/polymer semi-constrained... Shoulder joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. A shoulder joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace...

  17. 21 CFR 888.3660 - Shoulder joint metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Shoulder joint metal/polymer semi-constrained... Shoulder joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. A shoulder joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace...

  18. Influence of increasing amount of recycled concrete powder on mechanical properties of cement paste

    NASA Astrophysics Data System (ADS)

    Topič, Jaroslav; Prošek, Zdeněk; Plachý, Tomáš

    2017-09-01

    This paper deals with using fine recycled concrete powder in cement composites as micro-filler and partial cement replacement. Binder properties of recycled concrete powder are given by exposed non-hydrated cement grains, which can hydrate again and in small amount replace cement or improve some mechanical properties. Concrete powder used in the experiments was obtained from old railway sleepers. Infrastructure offer more sources of old concrete and they can be recycled directly on building site and used again. Experimental part of this paper focuses on influence of increasing amount of concrete powder on mechanical properties of cement paste. Bulk density, shrinkage, dynamic Young’s modulus, compression and flexural strength are observed during research. This will help to determine limiting amount of concrete powder when decrease of mechanical properties outweighs the benefits of cement replacement. The shrinkage, dynamic Young’s modulus and flexural strength of samples with 20 to 30 wt. % of concrete powder are comparable with reference cement paste or even better. Negative effect of concrete powder mainly influenced the compression strength. Only a 10 % cement replacement reduced compression strength by about 25 % and further decrease was almost linear.

  19. 21 CFR 888.3100 - Ankle joint metal/composite semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Ankle joint metal/composite semi-constrained... Ankle joint metal/composite semi-constrained cemented prosthesis. (a) Identification. An ankle joint metal/composite semi-constrained cemented prosthesis is a device intended to be implanted to replace...

  20. 21 CFR 888.3510 - Knee joint femorotibial metal/polymer constrained cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint femorotibial metal/polymer constrained... Knee joint femorotibial metal/polymer constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer constrained cemented prosthesis is a device intended to be implanted to replace part...

  1. 21 CFR 888.3110 - Ankle joint metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Ankle joint metal/polymer semi-constrained... Ankle joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an ankle...

  2. 21 CFR 888.3110 - Ankle joint metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Ankle joint metal/polymer semi-constrained... Ankle joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an ankle...

  3. 21 CFR 888.3110 - Ankle joint metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Ankle joint metal/polymer semi-constrained... Ankle joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an ankle...

  4. 21 CFR 888.3160 - Elbow joint metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Elbow joint metal/polymer semi-constrained... Elbow joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An elbow joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an elbow...

  5. 21 CFR 888.3510 - Knee joint femorotibial metal/polymer constrained cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint femorotibial metal/polymer constrained... Knee joint femorotibial metal/polymer constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer constrained cemented prosthesis is a device intended to be implanted to replace part...

  6. 21 CFR 888.3160 - Elbow joint metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Elbow joint metal/polymer semi-constrained... Elbow joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An elbow joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an elbow...

  7. 21 CFR 888.3510 - Knee joint femorotibial metal/polymer constrained cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint femorotibial metal/polymer constrained... Knee joint femorotibial metal/polymer constrained cemented prosthesis. (a) Identification. A knee joint femorotibial metal/polymer constrained cemented prosthesis is a device intended to be implanted to replace part...

  8. 21 CFR 888.3160 - Elbow joint metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Elbow joint metal/polymer semi-constrained... Elbow joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An elbow joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an elbow...

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

    PubMed Central

    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

  10. Cement and concrete

    NASA Technical Reports Server (NTRS)

    Corley, Gene; Haskin, Larry A.

    1992-01-01

    To produce lunar cement, high-temperature processing will be required. It may be possible to make calcium-rich silicate and aluminate for cement by solar heating of lunar pyroxene and feldspar, or chemical treatment may be required to enrich the calcium and aluminum in lunar soil. The effects of magnesium and ferrous iron present in the starting materials and products would need to be evaluated. So would the problems of grinding to produce cement, mixing, forming in vacuo and low gravity, and minimizing water loss.

  11. Stage cementing apparatus

    SciTech Connect

    Blamford, D.M.; Easter, J.H.

    1988-06-21

    A stage cementing apparatus for selectively passing cement from the interior passage of a casing to the annulus between the exterior of the casing and borehole, the casing having an upper portion and a lower portion, is described comprising: a barrel secured to the upper portion of the casing; a mandrel secured to the lower portion of the casing, and a stage cementing tool having a generally cylindrical configuration adapted for attachment to the lower end of the barrel about a portion of the mandrel.

  12. Removing a well-fixed nonmodular large-bearing cementless acetabular component: a simple modification of an existing removal device.

    PubMed

    Blumenfeld, Thomas J

    2010-04-01

    Removing well-fixed cementless acetabular components while minimizing bone loss has been facilitated by the use of a removal device featuring sharp curved gouges, specific to the outside diameter of the existing acetabular shell, mated to a femoral head designed to sit inside the acetabular liner. Nonmodular acetabular components with inner bearing diameters greater than 36 mm are to date not accommodated by femoral head sizes in this system. A simple modification, placement of a bipolar head matching the inner diameter of the fixed shell, allows use of this removal device for nonmodular shells. (c) 2010 Elsevier Inc. All rights reserved.

  13. [A comparative study on short-term effectiveness between cemented and uncemented total hip arthroplasty for osteonecrosis of femoral head after renal transplantation].

    PubMed

    Yu, Liankui; Qi, Chao; Yu, Tengbo; Meng, Qingyang; Zhao, Xia; Liu, Kai; Cai, Yan

    2013-12-01

    To compare the short-term effectiveness between primary cemented and uncemented total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH) after renal transplantation. The clinical data were retrospectively analyzed from 18 patients (21 hips) with ONFH after renal transplantation undergoing cemented THA in 11 cases (13 hips) (cemented group) and uncemented THA in 7 cases (8 hips) (uncemented group) between February 2005 and February 2012. There was no significant difference in gender, age, disease duration, ONFH stage, preoperative Harris score, and bone density between 2 groups (P > 0.05). Postoperative complications were observed in 2 groups; the hip function was assessed based on Harris scores; X-ray film was used to observe the prosthetic situation. All the wounds healed by first intention. The patients were followed up 6-77 months (mean, 46 months) in the cemented group, and 4-71 months (mean, 42 months) in the uncemented group. Femoral prosthesis infection occurred in 1 case (1 hip) respectively in each group; hip dislocation, femoral prosthesis loosening, and acetabular prosthesis loosening occurred in 1 case (1 hip) of the cemented group, respectively. At last follow-up, the incidences of postoperative complications and revision rate of the cemented group were 30.7% (4/13) and 23.1% (3/13) respectively, which were significantly higher than those of the uncemented group [12.5% (1/8) and 0 (0/8)] (P=0.047, P=0.040). Harris score was significantly increased to 94.1 +/- 3.7 in the uncemented group and 90.0 +/- 4.2 in the cemented group, showing significant differences compared with the preoperative scores in 2 groups (P < 0.05), but there was no significant difference between 2 groups (t = -1.815, P = 0.062). Postoperative X-ray films showed that the initial position of the prosthesis was satisfactory. At last follow-up, the bone fixation, fibrous stability, and loosening of the femoral prosthesis and loosening of acetabular prosthesis occurred

  14. Osteointegration and Resorption of Intravertebral and Extravertebral Calcium Phosphate Cement.

    PubMed

    Klein, Roman; Tetzlaff, Ralf; Weiss, Christel; Schäfer, Meike-Kristina; Tanner, Michael; Wiedenhöfer, Bernd; Grafe, Ingo; Meeder, Peter-Jürgen; Noeldge, Gerd; Nawroth, Peter P; Kasperk, Christian

    2017-04-01

    Eleven patients with painful osteoporotic vertebral fractures who underwent kyphoplasty using calcium phosphate (CaP) cement were followed up for 1 week, 1, 2, and 3 years in a monocentric, nonrandomized, noncontrolled retrospective trial. This study investigates long-term radiomorphologic features of intraosseous CaP cement implants and of extraosseous CaP cement leakages for up to 3 years after implantation by kyphoplasty. Kyphoplasty is frequently used for the treatment of painful osteoporotic fractures. Of the materials available, CaP is frequently used as a filling material. Resorption of this material is frequently observed, although clinical outcome is comparable with other cements. Kyphoplasty utilizing CaP cement was performed in 11 patients with painful osteoporotic vertebral fractures. All patients received a pharmacological antiosteoporosis treatment consisting of calcium, vitamin D, and a standard dose of oral bisphosphonates. Radiomorphologic measurements, pain, and mobility were assessed. Intraosseous and extraosseous CaP cement volumes decreased significantly over 3 years. However, vertebral stability as determined by a constant vertebral body height and the sagittal index was not impaired. Pain improved significantly 2 years after implantation and the mobility scores 1 year after kyphoplasty at least until the third year. Intravertebral CaP cement implants are resorbed slowly over time without jeopardizing stability and clinical outcomes most likely because of a slowly progressing osseous replacement. Extraosseous CaP cement material because of leakages during the kyphoplasty procedure is almost completely resorbed as early as 2 years after the leakage occurred. Therefore, CaP cement is an important alternative to PMMA-based cement materials utilized for kyphoplasty of osteoporotic vertebral fractures.

  15. Bone cement product and failure in total knee arthroplasty

    PubMed Central

    Birkeland, Øystein; Espehaug, Birgitte; Havelin, Leif I; Furnes, Ove

    2017-01-01

    Background and purpose — The bone cement market for total knee arthroplasty (TKA) in Norway has been dominated by a few products and distributors. Palacos with gentamicin had a market share exceeding 90% before 2005, but it was then withdrawn from the market and replaced by new slightly altered products. We have compared the survival of TKAs fixated with Palacos with gentamicin with the survival of TKAs fixated with the bone cements that took over the market. Patients and methods — Using data from the Norwegian Arthroplasty Register for the period 1997–2013, we included 26,147 primary TKAs in the study. The inclusion criteria were TKAs fixated with the 5 most used bone cements and the 5 most common total knee prostheses for that time period. 6-year Kaplan-Meier survival probabilities were established for each cement product. The Cox proportional hazards regression model was used to assess the association between bone cement product and revision risk. Separate analyses were performed with revision for any reason and revision due to deep infection within 1 year postoperatively as endpoints. Adjustments were made for age, sex, diagnosis, and prosthesis brand. Results — Survival was similar for the prostheses in the follow-up period, between the 5 bone cements included: Palacos with gentamicin, Refobacin Palacos R, Refobacin Bone Cement R (Refobacin BCR), Optipac Refobacin Bone Cement R (Optipac Refobacin BCR), and Palacos R + G. Interpretation — According to our findings, the use of the new bone cements led to a survival rate that was as good as with the old bone cement (Palacos with gentamicin). PMID:27841713

  16. Porous Surface Modified Bioactive Bone Cement for Enhanced Bone Bonding

    PubMed Central

    Huang, Li; Dong, Jingjing; Guo, Dagang; Mao, Mengmeng; Kong, Liang; Li, Yang; Wu, Zixiang; Lei, Wei

    2012-01-01

    Our findings suggested a new bioactive bone cement for prosthetic fixation in total joint replacement. PMID:22905143

  17. Global warming impact on the cement and aggregates industries

    SciTech Connect

    Davidovits, J. . Geopolymer Inst.)

    1994-06-01

    CO[sub 2] related energy taxes are focusing essentially on fuel consumption, not on actual CO[sub 2] emission measured at the chimneys. Ordinary Portland cement, used in the aggregates and industries, results from the calcination of limestone and silica. The production of 1 ton of cement directly generates 0.55 tons of chemical-CO[sub 2] and requires the combustion of carbon-fuel to yield an additional 0.40 tons of CO[sub 2]. The 1987 1 billion metric tons world production of cement accounted for 1 billion metric tons of CO[sub 2], i.e., 5% of the 1987 world CO[sub 2] emission. A world-wide freeze of CO[sub 2] emission at the 1990 level as recommended by international institutions, is incompatible with the extremely high cement development needs of less industrialized countries. Present cement production growth ranges from 5% to 16% and suggests that in 25 years from now, world cement CO[sub 2] emissions could equal 3,500 million tons. Eco-taxes when applied would have a spectacular impact on traditional Portland cement based aggregates industries. Taxation based only on fuel consumption would lead to a cement price increase of 20%, whereas taxation based on actual CO[sub 2] emission would multiply cement price by 1.5 to 2. A 25--30% minor reduction of CO[sub 2] emissions may be achieved through the blending of Portland cement with replacement materials such as coal-fly ash and iron blast furnace slag.

  18. Does Orientation of the Femoral Head Affect Acetabular Development? An Experimental Study in Lamb.

    PubMed

    Moraleda, Luis; Bravo, Christian; Forriol, Francisco; Albiñana, Javier

    2017-03-21

    Derotational osteotomy of the proximal femur has proved to be effective in the treatment of residual acetabular dysplasia. However, the reason why this osteotomy is effective remains debatable. The purpose of this study is to investigate if an alteration of femoral head orientation affects acetabular growth. A proximal femoral osteotomy was performed in 21 lambs aged 3 months: 5 varus osteotomies (110 degrees), 4 valgus osteotomies (150 degrees), and 12 derotation osteotomies. Results were compared with a control group (5 animals). Osteotomy was fixed with a screw-plate device. Version was controlled intraoperatively with K-wires. Animals were killed 3 months after surgical procedure. A morphometric study of both proximal femur and acetabulum was performed, including deepness, volume and diameters of the acetabulum, neck-shaft angle and femoral version. The average neck-shaft angle for the normal, anteversion, and retroversion groups was 129 degrees, whereas it was 110 degrees for the varus group and 149 degrees for the valgus group. The average femoral version for the normal, valgus, and varus groups was 21 degrees of anteversion, whereas it was 38 degrees of anteversion for the so-called anteversion group and 17 degrees of retroversion for the retroversion group. Nor the neck-shaft angle, nor the femoral version correlated with the acetabular anteroposterior diameter (P=0.698, 0.6, respectively), the acetabular inferosuperior diameter (P=0.083, 0.451, respectively) or the acetabular deepness (P=0.14, 0.371, respectively). The neck-shaft angle correlated significantly with acetabular volume (P=0.023), so that the lower the neck-shaft angle, the higher the acetabular volume (r=-0.453). The femoral version did not correlated with acetabular volume (P=0.381). Decreasing the neck-shaft angle provokes an increase in acetabular volume, whereas changes in femoral version do not affect the acetabular growth. Extra-articular osteotomies that alter femoral orientation

  19. The role of retraction in direct nerve injury in total hip replacement: an anatomical study.

    PubMed

    McConaghie, F A; Payne, A P; Kinninmonth, A W G

    2014-06-01

    Acetabular retractors have been implicated in damage to the femoral and obturator nerves during total hip replacement. The aim of this study was to determine the anatomical relationship between retractor placement and these nerves. A posterior approach to the hip was carried out in six fresh cadaveric half pelves. Large Hohmann acetabular retractors were placed anteriorly, over the acetabular lip, and inferiorly, and their relationship to the femoral and obturator nerves was examined. If contact with bone was not maintained during retractor placement, the tip of the anterior retractor had the potential to compress the femoral nerve by passing superficial to the iliopsoas. If pressure was removed from the anterior retractor, the tip pivoted on the anterior acetabular lip, and passed superficial to the iliopsoas, overlying and compressing the femoral nerve, when pressure was reapplied. The inferior retractor pierced the obturator membrane in all specimens medial to the obturator nerve, with subsequent retraction causing the tip to move laterally, making contact with the nerve. Iliopsoas can only offer protection to the femoral nerve if the retractor passes deep to the muscle bulk. The anterior retractor should be reinserted if pressure is removed intra-operatively. Vigorous movement of the inferior retractor should be avoided. Cite this article: Bone Joint Res 2014;3:212-6. ©2014 The British Editorial Society of Bone & Joint Surgery.

  20. The use of buttress plates in the management of acetabular fractures with quadrilateral plate involvement: is it still a valid option?

    PubMed

    Tosounidis, Theodoros H; Gudipati, Suribabu; Panteli, Michalis; Kanakaris, Nikolaos K; Giannoudis, Peter V

    2015-11-01

    The primary aim of this study was to report on the mid-term outcomes after quadrilateral plate reconstruction of acetabular fractures using a buttress/spring plate through an ilioinguinal approach. Between 2003 and 2011, 30 adult patients (25 males) with mean age 54 years (range 17-80) who underwent surgical fixation for an acetabular fracture and had minimum follow up of 24 months (mean 46.2, range 24-78.6) were retrospectively reviewed. Standard demographics, admission and hospitalization data (concomitant injuries, number of operative procedures, time to operating theatre, early and late complications) were correlated to the clinical (Harris Hip Score) and radiological (Matta Reduction Score and Matta Arthritis Score) outcome. Three patients underwent a Total Hip Replacement. Functional score was excellent in 17 (56.6 %), good in 4 (13.3 %), fair in 6 (20 %) and poor in 3 (10 %) cases. Surgery-related complications included two patients with temporary lateral femoral cutaneous palsy and three with heterotopic ossification. The quality of the postoperative reduction was associated to Harris Hip Score (p = 0.015) and postoperative arthritis (p = 0.010). Strong association was evident between age and both post-operative reduction (p = 0.010) and arthritis (p = 0.014). The presence of quadrilateral plate comminution and gull-sign were associated to poor post-operative reduction (p = 0.016) and low Harris Hip Score (p = 0.049) respectively. Quadrilateral plate reconstruction with a buttress plate though the ilioinguinal approach remains a valid method of fixation in acetabular surgery. Additional studies are needed to compare the efficiency of this method to new surgical approaches and fixation implants.

  1. Esophageal replacement.

    PubMed

    Kunisaki, Shaun M; Coran, Arnold G

    2017-04-01

    This article focuses on esophageal replacement as a surgical option for pediatric patients with end-stage esophageal disease. While it is obvious that the patient׳s own esophagus is the best esophagus, persisting with attempts to retain a native esophagus with no function and at all costs are futile and usually detrimental to the overall well-being of the child. In such cases, the esophagus should be abandoned, and the appropriate esophageal replacement is chosen for definitive reconstruction. We review the various types of conduits used for esophageal replacement and discuss the unique advantages and disadvantages that are relevant for clinical decision-making. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Environmentally compatible spray cement

    SciTech Connect

    Loeschnig, P.

    1995-12-31

    Within the framework of a European research project, Heidelberger Zement developed a quickly setting and hardening binder for shotcrete, called Chronolith S, which avoids the application of setting accelerators. Density and strength of the shotcrete produced with this spray cement correspond to those of an unaccelerated shotcrete. An increased hazard for the heading team and for the environment, which may occur when applying setting accelerators, can be excluded here. Owing to the special setting properties of a spray cement, the process engineering for its manufacturing is of great importance. The treatment of a spray cement as a dry concrete with kiln-dried aggregates is possible without any problems. The use of a naturally damp pre-batched mixture is possible with Chronolith S but requires special process engineering; spray cement and damp aggregate are mixed with one another immediately before entering the spraying machinery.

  3. Thermodynamics and cement science

    SciTech Connect

    Damidot, D.; Lothenbach, B.; Herfort, D.; Glasser, F.P.

    2011-07-15

    Thermodynamics applied to cement science has proved to be very valuable. One of the most striking findings has been the extent to which the hydrate phases, with one conspicuous exception, achieve equilibrium. The important exception is the persistence of amorphous C-S-H which is metastable with respect to crystalline calcium silicate hydrates. Nevertheless C-S-H can be included in the scope of calculations. As a consequence, from comparison of calculation and experiment, it appears that kinetics is not necessarily an insuperable barrier to engineering the phase composition of a hydrated Portland cement. Also the sensitivity of the mineralogy of the AFm and AFt phase compositions to the presence of calcite and to temperature has been reported. This knowledge gives a powerful incentive to develop links between the mineralogy and engineering properties of hydrated cement paste and, of course, anticipates improvements in its performance leading to decreasing the environmental impacts of cement production.

  4. Durability of pulp fiber-cement composites

    NASA Astrophysics Data System (ADS)

    Mohr, Benjamin J.

    Wood pulp fibers are a unique reinforcing material as they are non-hazardous, renewable, and readily available at relatively low cost compared to other commercially available fibers. Today, pulp fiber-cement composites can be found in products such as extruded non-pressure pipes and non-structural building materials, mainly thin-sheet products. Although natural fibers have been used historically to reinforce various building materials, little scientific effort has been devoted to the examination of natural fibers to reinforce engineering materials until recently. The need for this type of fundamental research has been emphasized by widespread awareness of moisture-related failures of some engineered materials; these failures have led to the filing of national- and state-level class action lawsuits against several manufacturers. Thus, if pulp fiber-cement composites are to be used for exterior structural applications, the effects of cyclical wet/dry (rain/heat) exposure on performance must be known. Pulp fiber-cement composites have been tested in flexure to examine the progression of strength and toughness degradation. Based on scanning electron microscopy (SEM), environmental scanning electron microscopy (ESEM), energy dispersive spectroscopy (EDS), a three-part model describing the mechanisms of progressive degradation has been proposed: (1) initial fiber-cement/fiber interlayer debonding, (2) reprecipitation of crystalline and amorphous ettringite within the void space at the former fiber-cement interface, and (3) fiber embrittlement due to reprecipitation of calcium hydroxide filling the spaces within the fiber cell wall structure. Finally, as a means to mitigate kraft pulp fiber-cement composite degradation, the effects of partial portland cement replacement with various supplementary cementitious materials (SCMs) has been investigated for their effect on mitigating kraft pulp fiber-cement composite mechanical property degradation (i.e., strength and toughness

  5. Formulation of geopolymer cement using mixture of slag and class f fly ash for oil well cementing

    NASA Astrophysics Data System (ADS)

    Kanesan, Dinesh; Ridha, Syahrir; Rao, Prasath

    2017-05-01

    The increase in greenhouse gas emissions has been a factor for the increase in global temperature. Geopolymer cement has been intensively studied to replace conventional ordinary Portland cement, however the focus is limited to civil purposes under atmospheric conditions. This research focuses on the formulation of geopolymer cement to be used in oil well cementing application by taking account the effect of sodium hydroxide (NaoH) molarity, ratio of alkali binder and fly ash, amount of dispersant for oilwell operation under temperature ranging of 80°C and 90C° and pressure of 1000 and 3000psi. The formulated composition is tested for fluid loss where the standard has been from 60 to 80 ml. The cement slurry is cured in a 50mm x 50mm x 50mm mold for period of 24 hours. Four manipulating variables were set in formulating the cement slurry namely, the ratio between fly ash and slag to alkali binder, ratio of sodium hydroxide (NaoH) to sodium silicate, molarity of NaoH and amount of dispersant added. After running a set of 16 experiment, sample (12) was found to possess the best rheological properties and fluid loss according to API RP10B. It was found that as the curing temperature and pressure increase, the compressive strength of the formulated geopolymer cement also increased.

  6. Failure of dual radius hydroxyapatite-coated acetabular cups

    PubMed Central

    D'Angelo, Fabio; Molina, Mauro; Riva, Giacomo; Zatti, Giovanni; Cherubino, Paolo

    2008-01-01

    Introduction Many kind of hydroxyapatite-coated cups were used, with favorable results in short term studies; it was supposed that its use could improve osteointegration of the cup, enhancing thus stability and survivorship. The purpose of this study is to analyze the long term behavior of the hemispheric HA coated, Dual Radius Osteonics cup and to discuss the way of failure through the exam of the revised components and of both periacetabular and osteolysis tissue. Materials and Methods Between 1994 and 1997, at the Department of Orthopedic Sciences of the Insubria University, using the posterolateral approach, were implanted 276 Dual Radius Osteonics® in 256 patients, with mean age of 63 years. Results At a mean follow-up of 10 years (range 8–12 years), 183 cups in 165 patients, were available for clinical and radiographical evaluation. 22 Cups among the 183 were revised (11%). The cause of revision was aseptic loosening in 17 cases, septic loosening in one case, periprosthetic fracture in another case, osteolysis and polyethylene wear in two cases and, finally, recurrent dislocations in the last one. In the remaining patients, mean HHS increased from a preoperative value of 50,15 to a postoperative value of 92,69. The mean polyethylene wear was 1,25 mm (min. 0,08, max. 3,9 mm), with a mean annual wear of 0,17 mm. The mean acetabular migration on the two axis was 1,6 mm and 1,8 mm. Peri-acetabular osteolysis were recorded in 89% of the implants (163 cases). The cumulative survivorship (revision as endpoint) at the time was 88,9%. Conclusion Our study confirms the bad behavior of this type of cup probably related to the design, to the method of HA fixation. The observations carried out on the revised cup confirm these hypotheses but did not clarify if the third body wear could be a further problem. Another interesting aspect is the high incidence of osteolysis, which are often asymptomatic becoming a problem for the surgeon as the patient refuses the

  7. Failure of dual radius hydroxyapatite-coated acetabular cups.

    PubMed

    D'Angelo, Fabio; Molina, Mauro; Riva, Giacomo; Zatti, Giovanni; Cherubino, Paolo

    2008-08-07

    Many kind of hydroxyapatite-coated cups were used, with favorable results in short term studies; it was supposed that its use could improve osteointegration of the cup, enhancing thus stability and survivorship. The purpose of this study is to analyze the long term behavior of the hemispheric HA coated, Dual Radius Osteonics cup and to discuss the way of failure through the exam of the revised components and of both periacetabular and osteolysis tissue. Between 1994 and 1997, at the Department of Orthopedic Sciences of the Insubria University, using the posterolateral approach, were implanted 276 Dual Radius Osteonics in 256 patients, with mean age of 63 years. At a mean follow-up of 10 years (range 8-12 years), 183 cups in 165 patients, were available for clinical and radiographical evaluation. 22 Cups among the 183 were revised (11%). The cause of revision was aseptic loosening in 17 cases, septic loosening in one case, periprosthetic fracture in another case, osteolysis and polyethylene wear in two cases and, finally, recurrent dislocations in the last one. In the remaining patients, mean HHS increased from a preoperative value of 50.15 to a postoperative value of 92.69. The mean polyethylene wear was 1.25 mm (min. 0.08, max 3.9 mm), with a mean annual wear of 0.17 mm. The mean acetabular migration on the two axis was 1.6 mm and 1.8 mm. Peri-acetabular osteolysis were recorded in 89% of the implants (163 cases). The cumulative survivorship (revision as endpoint) at the time was 88,9%. Our study confirms the bad behavior of this type of cup probably related to the design, to the method of HA fixation. The observations carried out on the revised cup confirm these hypotheses but did not clarify if the third body wear could be a further problem. Another interesting aspect is the high incidence of osteolysis, which are often asymptomatic becoming a problem for the surgeon as the patient refuses the possibility of a revision.

  8. [Design of ABC damage variable and positioning system for acetabular fractures and 1122 cases multi-center statistic analysis].

    PubMed

    Zhang, Chun-cai; Xu, Shuo-gui; Yu, Bao-qing; Ji, Fang; Fu, Qing-ge; Liu, Xin-wei; Zhang, Yun-tong; Niu, Yun-fei; Wang, Pan-feng; Su, Jia-can; Cao, Lie-hu; Xu, Yong-qing; Ruan, Mo; Chen, Zhuang-hong; Huang, Ji-feng; Cai, Xian-hua; Shen, Hui-liang; Liu, Li-min; Wang, Ji-fang; Wang, Yan; Tang, Pei-fu; Liang, Yu-tian; Wang, Jia-rang; Wang, Yu-ri; Wang, Zhen-hao; Liu, Wen-di; Li, Wen-rui; Li, Wen-hu; Wang, Xu-quan; Zhou, Dong-sheng; Zhang, Peng; Wang, Ren; Wang, Gang; Chen, Yu-yue; Cong, Yong-jian

    2011-02-01

    To design ABC damage variable and positioning system for acetabular fracture and explore the feasibility and clinical practical value of the system through the multi-center analysis of 1122 acetabular fractures. According to acetabular three-column conception, and pelvic ring lesions damage direction caused by acetabular fracture domino effect and injury degree of proximal femur joint, it defined class A as any column acetabular fracture; class B as any two-column acetabular fracture; class C as front, dome and posterior mixture acetabular fracture. Lower case English letters a, m, p represented front, dome, posterior fracture, respectively. Acetabular damage variables: 1 was simple displaced fractures; 2 was comminuted fractures; 3 was compression fractures. Pelvic ring lesions damage variables: alpha was sacroiliac joints or sacroiliac fracture horizontal separation deflection; beta was sacroiliac joints or sacroiliac fracture vertical separation deflection; gamma was pubic symphysis separation/superior and inferior ramus of pubis fracture deflection; alpha beta gamma delta was compound floating damage. Proximal humerus joint damage variables: I was femoral head fracture; II was femoral neck fracture; II was intertrochanteric fractures of femur; IV was I to III compound fracture. The ABC damage variable positioning system for acetabular fracture was made up by the above-mentioned variables. The statistics from March 1997 to February 2010 showed 1122 cases acetabular fractures with 18 cases of double side acetabular fracture and 1140 cases of acetabular fractures. The pelvics anterior-posterior view, ilium and obturator oblique view, and 2/3D-CT materials were analyzed and researched. Each damage variables distribution situation in 1140 cases of acetabular fracture involved A in 237 cases (20.8%), B in 605 cases (53.1%), C in 298 cases (26.1%);front column fracture in 808 cases(70.9%), dome fracture in 507 cases (44.5%), posterior fracture in 1026 cases (90

  9. Femoral Version, Neck-Shaft Angle, and Acetabular Anteversion in Chinese Han Population

    PubMed Central

    Jiang, Nan; Peng, Lin; Al-Qwbani, Mohammed; Xie, Guo-Ping; Yang, Qin-Meng; Chai, Yu; Zhang, Qing; Yu, Bin

    2015-01-01

    Abstract Anatomic data regarding femoral version, neck-shaft angle, and acetabular anteversion are still limited in Chinese Han adult population. The aim of this study was to investigate the effects of age, sex, and body laterality on the 3 important anatomic indicators in Chinese Han healthy adults. Measurements were performed independently by 3 experienced observers using the picture archiving and communication system (PACS) in healthy adults who had received imaging tests of the femur and acetabulum between January 2009 and October 2014. Relevant data were measured and analyzed. A total of 466 adults (353 males and 113 females) were included. The mean femoral version, neck-shaft angle, and acetabular anteversion for all were 10.62, 133.02, and18.79, respectively. Age-based analysis showed that adults younger than 60 years had a significantly higher neck-shaft angle (P < 0.001) but a significantly lower acetabular anteversion (P < 0.001) than those older than 60 years. Sex-based analysis revealed that females had significantly higher values of femoral version (P < 0.001) and acetabular anteversion (P < 0.001) than males. Laterality-based analysis found the left side had a significantly lower acetabular anteversion (P < 0.001) than the right side. Outcomes of multiple linear regression analysis indicated that femoral version may be associated with sex (P < 0.001) but not age (P = 0.076) or laterality (P = 0.430), neck-shaft angle may be associated with age (P < 0.001) but not sex (P = 0.378) or laterality (P = 0.233), and acetabular anteversion may be associated with age (P < 0.001) and sex (P < 0.001) but not laterality (P = 0.060). In this representative Chinese cohort, neck-shaft angle may decrease, whereas acetabular anteversion may increase with age, females may have higher values of femoral version and acetabular anteversion than males, and the right body side may have a higher value of acetabular

  10. Predictors of poor outcome after both column acetabular fractures: a 30-year retrospective cohort study

    PubMed Central

    2013-01-01

    Background and Purpose Acetabular fractures are often combined with associated injuries to the hip joint. Some of these associated injuries seem to be responsible for poor long-term results and these injuries seem to affect the outcome independent of the quality of the acetabular reduction. The aim of our study was to analyze the outcome of both column acetabular fractures and the influence of osseous cofactors such as initial fracture displacement, hip dislocation, femoral head lesions and injuries of the acetabular joint surface. Methods A retrospective cohort study in patients with both column acetabular fractures treated over a 30 year period was performed. Patients with a follow-up of more than two years were invited for a clinical and radiological examination. Displacement was analyzed on initial and postoperative radiographs. Contusion and impaction of the femoral head was grouped. Injuries of the acetabular joint surface consisting of impaction, contusion and comminution were recorded. The Merle d’Aubigné Score was documented and radiographs were analysed for arthritis (Helfet classification), femoral head avascular necrosis (Ficat/Arlet classification) and heterotopic ossifications (Brooker classification). Results 115 patients were included in the follow up examination. Anatomic reduction (malreduction ≤ 1mm) was associated with a significantly better clinical outcome than nonanatomical reduction (p = 0.001). Initial displacement of more than 10mm (p = 0.031) and initial intraarticular fragments (p = 0.041) were associated with worse outcome. Other associated injuries, such as the presence of a femoral head dislocation, femoral head injuries and injuries to the acetabular joint surface showed no significant difference in outcome individually, but in fractures with more than two associated local injuries the risk for joint degeneration was significant higher (p < 0.001) than in cases with less than two of them. In the subgroup of

  11. Does radiographic coxa profunda indicate increased acetabular coverage or depth in hip dysplasia?

    PubMed

    Fujii, Masanori; Nakamura, Tetsuro; Hara, Toshihiko; Nakashima, Yasuharu; Iwamoto, Yukihide

    2015-06-01

    Although radiographic coxa profunda has been considered an indicator of acetabular overcoverage, recent studies suggest that radiographic coxa profunda is a nonspecific finding seen even in hip dysplasia. The morphologic features of coxa profunda in hip dysplasia and the frequency with which the two overlap are not well defined. We determined (1) the prevalence of radiographic coxa profunda in patients with hip dysplasia; (2) the morphologic differences of the acetabulum and pelvis between patients with hip dysplasia and control subjects; and (3) the morphologic differences between hip dysplasia with and without coxa profunda. We retrospectively reviewed the pelvic radiographs and CT scans of 70 patients (70 hips) with hip dysplasia. Forty normal hips were used as controls. Normal hips were defined as those with a lateral center-edge angle between 25° and 40°. Coxa profunda was defined as present when the acetabular fossa was observed to touch or was medial to the ilioischial line on an AP pelvic radiograph. CT measurements included acetabular version, acetabular coverage, acetabular depth, and rotational alignment of the innominate bone. The prevalence of coxa profunda was 44% (31 of 70 hips) in dysplastic hips and 73% (29 of 40 hips) in the control hips (odds ratio, 3.32; 95% CI, 1.43-7.68). Dysplastic hips had a more anteverted and globally shallow acetabulum with inwardly rotated innominate bone compared with the control hips (p < 0.001). Dysplastic hips with coxa profunda had a more anteverted acetabulum (p < 0.001) and inwardly rotated innominate bone (p < 0.002) compared with those without coxa profunda, whereas the acetabular coverage and depth did not differ between the two groups, with the numbers available. Radiographic coxa profunda was not a sign of increased acetabular coverage and depth in patients with hip dysplasia, but rather indicates classic acetabular dysplasia, defined by an anteverted acetabulum with anterolateral acetabular

  12. Glass ionomer restorative cement systems: an update.

    PubMed

    Berg, Joel H; Croll, Theodore P

    2015-01-01

    Glass ionomer cements have been used in pediatric restorative dentistry for more than two decades. Their usefulness in clinical dentistry is preferential to other materials because of fluoride release from the glass component, biocompatibility, chemical adhesion to dentin and enamel, coefficient of thermal expansion similar to that of tooth structure, and versatility. The purpose of this paper was to review the uses of glass ionomer materials in pediatric dentistry, specifically as pit and fissure sealants, dentin and enamel replacement repair materials, and luting cements, and for use in glass ionomer/resin-based composite stratification tooth restoration (the sandwich technique). This article can also be used as a guide to research and clinical references regarding specific aspects of the glass ionomer systems and how they are used for young patients.

  13. Utilization of ground waste seashells in cement mortars for masonry and plastering.

    PubMed

    Lertwattanaruk, Pusit; Makul, Natt; Siripattarapravat, Chalothorn

    2012-11-30

    In this research, four types of waste seashells, including short-necked clam, green mussel, oyster, and cockle, were investigated experimentally to develop a cement product for masonry and plastering. The parameters studied included water demand, setting time, compressive strength, drying shrinkage and thermal conductivity of the mortars. These properties were compared with those of a control mortar that was made of a conventional Portland cement. The main parameter of this study was the proportion of ground seashells used as cement replacement (5%, 10%, 15%, or 20% by weight). Incorporation of ground seashells resulted in reduced water demand and extended setting times of the mortars, which are advantages for rendering and plastering in hot climates. All mortars containing ground seashells yielded adequate strength, less shrinkage with drying and lower thermal conductivity compared to the conventional cement. The results indicate that ground seashells can be applied as a cement replacement in mortar mixes and may improve the workability of rendering and plastering mortar.

  14. Reuse of grits waste for the production of soil--cement bricks.

    PubMed

    Siqueira, F B; Holanda, J N F

    2013-12-15

    This investigation focuses on the reuse of grits waste as a raw material for replacing Portland cement by up to 30 wt.% in soil-cement bricks. The grits waste was obtained from a cellulose factory located in south-eastern Brazil. We initially characterized the waste sample with respect to its chemical composition, X-ray diffraction, fineness index, morphology, pozzolanic activity, and pollution potential. Soil-cement bricks were then prepared using the waste material and were tested to determine their technological properties (e.g., water absorption, apparent density, volumetric shrinkage, and compressive strength). Microstructural evolution was accompanied by confocal microscopy. It was found that the grits waste is mainly composed of calcite (CaCO3) particles. Our results indicate that grits waste can be used economically, safely, and sustainably at weight percentages of up to 20% to partially replace Portland cement in soil-cement bricks. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Pelvic Incidence: A Predictive Factor for Three-Dimensional Acetabular Orientation—A Preliminary Study

    PubMed Central

    Bollini, Gérard; Legaye, Jean; Tardieu, Christine; Prat-Pradal, Dominique; Chabrol, Brigitte; Jouve, Jean-Luc; Duval-Beaupère, Ginette; Pélissier, Jacques

    2014-01-01

    Acetabular cup orientation (inclination and anteversion) is a fundamental topic in orthopaedics and depends on pelvis tilt (positional parameter) emphasising the notion of a safe range of pelvis tilt. The hypothesis was that pelvic incidence (morphologic parameter) could yield a more accurate and reliable assessment than pelvis tilt. The aim was to find out a predictive equation of acetabular 3D orientation parameters which were determined by pelvic incidence to include in the model. The second aim was to consider the asymmetry between the right and left acetabulae. Twelve pelvic anatomic specimens were measured with an electromagnetic Fastrak system (Polhemus Society) providing 3D position of anatomical landmarks to allow measurement of acetabular and pelvic parameters. Acetabulum and pelvis data were correlated by a Spearman matrix. A robust linear regression analysis provided prediction of acetabulum axes. The orientation of each acetabulum could be predicted by the incidence. The incidence is correlated with the morphology of acetabula. The asymmetry of the acetabular roof was correlated with pelvic incidence. This study allowed analysis of relationships of acetabular orientation and pelvic incidence. Pelvic incidence (morphologic parameter) could determine the safe range of pelvis tilt (positional parameter) for an individual and not a group. PMID:25006461

  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. Thromboprophylaxis for acetabular injuries in the UK What prophylaxis is used?

    PubMed

    Geoghegan, J M; Hassan, K; Calthorpe, D

    2006-09-01

    Due to chronic underfunding and the absence of a comprehensive and coordinated national approach to the management of acetabular trauma throughout the UK, patients can incur prolonged recumbancy. We have performed a postal questionnaire to establish the current clinical practice in the specialist pelvic and acetabular units throughout the UK, with respect to time to surgery from injury, thromboprophylaxis, and surveillance. We have identified 21 units, and 37 surgeons in the NHS who deal with acetabular trauma. The mean time to surgery from injury in the UK is 8.5 days (range 2-19 days). Mechanical thromboprophylaxis was used in 67% (14) of the units. No unit routinely uses prophylactic IVC filters. Chemical thromboprophylaxis is routinely used in 100% (21) of the units. Ninety-five percent (20) used prophylactic doses of LDH or LMWH. Clinical surveillance alone for thromboembolism is employed in 90% (19) of the units. Only 2 (10%) units routinely perform radiological surveillance with ultrasound Doppler, pre-operatively. Currently there is no published directory of dedicated pelvic and acetabular surgeons in the UK. There is no general consensus on the approach to thromboprophylaxis and surveillance in acetabular trauma in the UK. There is no consensus approach to thromboprophylaxis and surveillance in the literature.

  18. Acetabular revisions using a cementless oblong cup: five to ten year results

    PubMed Central

    Capone, A.; Carulli, C.; Villano, M.; Gusso, M. I.

    2007-01-01

    The purpose of this paper was to evaluate the results of acetabular revisions with the use of an oblong revision cup that is designed with its longitudinal diameter elongated relative to its transverse diameter. Between 1996 and 2001, 62 hips in 60 patients underwent an acetabular revision with the insertion of a LOR acetabular component. Seven hips were lost to follow-up or the patients died; the remaining 55 hips (53 patients) remained in follow-up for an average of 7.2 years (range: 5.0–10.1 years). One socket was revised for aseptic loosening, and another was operated on for a late polyethylene liner dissociation. The average Harris hip score (HHS) improved from 34 to 79. Results were rated as excellent in 16 hips, good in 28, fair in six and poor in three. Radiographic analysis demonstrated an improvement in the average vertical displacement of the hip centre: 49 hips had a well-fixed, bone-ingrown cup and four had a stable fibrous union. For large superolateral acetabular bone deficiencies, this implant facilitated a complex reconstruction without the need for bulk structural acetabular bone grafts, provided good clinical results and showed satisfactory stability at the midterm follow-up. PMID:17221262

  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. Proximal femoral replacement for the treatment of periprosthetic fractures.

    PubMed

    Klein, Gregg R; Parvizi, Javad; Rapuri, Venkat; Wolf, Christopher F; Hozack, William J; Sharkey, Peter F; Purtill, James J

    2005-08-01

    A periprosthetic fracture around the femoral component is a rare but potentially problematic complication after total hip arthroplasty. Reconstruction can be challenging, especially when severe bone stock deficiency is encountered. Proximal femoral replacement is one method of treating the severely deficient proximal part of the femur. The present report describes the outcomes of revision total hip arthroplasty with use of a proximal femoral replacement in a cohort of patients who had a Vancouver type-B3 periprosthetic fracture. With use of a computerized institutional database, all patients in whom a Vancouver type-B3 fracture (characterized by severe proximal bone deficiency and a loose femoral stem) had been treated with a proximal femoral replacement were identified. A modular femoral replacement with proximal porous coating had been used in all cases. The twenty-one patients who were identified had had a mean age of 78.3 years (range, fifty-two to ninety years) at the time of the index operation. The clinical and radiographic records of these patients were reviewed. At the time of the latest follow-up (mean, 3.2 years), all but one of the patients were able to walk and had minimal to no pain. Complications included persistent wound drainage that was treated with incision and drainage (two hips), dislocation (two hips), refracture of the femur distal to the stem (one hip), and acetabular cage failure (one hip). Despite a relatively high complication rate, we believe that proximal femoral replacement is a viable option for the treatment of periprosthetic fractures in older patients with severe bone deficiency. If a proximal femoral replacement is used, the stability of the hip must be tested diligently intraoperatively and a constrained acetabular liner should be utilized if instability is encountered. In order to enhance the bone stock, the proximal part of the femur, however poor in quality, should be retained for reapproximation onto the implant.

  1. ULTRA-LIGHTWEIGHT CEMENT

    SciTech Connect

    Fred Sabins

    2001-10-23

    The objective of this project is to develop an improved ultra-lightweight cement using ultra-lightweight hollow glass spheres (ULHS). Work reported herein addresses tasks performed in the fourth quarter as well as the other three quarters of the past year. The subjects that were covered in previous reports and that are also discussed in this report include: Analysis of field laboratory data of active cement applications from three oil-well service companies; 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; and Comparison of compressive strengths of ULHS systems using ultrasonic and crush methods Results reported from the fourth quarter include laboratory testing of ULHS systems along with other lightweight cement systems--foamed and sodium silicate slurries. These comparison studies were completed for two different densities (10.0 and 11.5 lb/gal) and three different field application scenarios. Additional testing included the mechanical properties of ULHS systems and other lightweight systems. Studies were also performed to examine the effect that circulation by centrifugal pump during mixing has on breakage of ULHS.

  2. ULTRA-LIGHTWEIGHT CEMENT

    SciTech Connect

    Fred Sabins

    2003-06-16

    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. Laboratory testing during the tenth quarter focused on evaluation of the alkali-silica reaction of eight different cement compositions, four of which contain ULHS. The original laboratory procedure for measuring set cement expansion resulted in test specimen erosion that was unacceptable. A different expansion procedure is being evaluated. This report provides a progress summary of ASR testing. The testing program initiated in November produced questionable initial results so the procedure was modified slightly and the testing was reinitiated. The results obtained with the modified procedure showed improvement over data obtained with the original procedure, but questionable data were obtained from several of the compositions. Additional modification of test procedures for compositions containing TXI Lightweight cement are being implemented and testing is ongoing.

  3. Primary total hip replacement: a comparison of a nationally agreed guide to best practice and current surgical technique as determined by the North West Regional Arthroplasty Register.

    PubMed Central

    Malik, M. H. A.; Gambhir, A. K.; Bale, L.; Pradhan, N.; Porter, M. L.

    2004-01-01

    BACKGROUND: In 1999, a statement of best practice in primary total hip replacement was approved by the Council of the British Orthopaedic Association (BOA) and by the British Hip Society (BHS) to provide a basis for regional and national auditable standards. We have compared practice in the North West Region of England to this document to ascertain adherence to this guide to best practice. METHODS: A total of 86 surgeons from 26 hospitals were included in a questionnaire study. RESULTS: A mean of 93.3% of operations were performed in the surgeon's usual theatre. All of these theatres had vertical laminar air flow systems. Of respondents, 42.2% routinely used exhaust suits, 68.1% routinely used impermeable disposable gowns, and 26.1% used impermeable re-usable gowns. The Charnley femoral and acetabular prostheses were the most commonly used prostheses. All surgeons used some form of anti-thromboembolic prophylaxis: 66.2% use a combination of both mechanical and chemical means. All surgeons used antibiotic prophylaxis. The most popular choice of antibiotic was a cephalosporin--70.7% used a 3-dose regimen over 24 h, 2.6% of surgeons continued antibiotic prophylaxis for 48 h after surgery, and 93.7% of surgeons routinely use antibiotic-loaded cement. All surgeons routinely cleaned, irrigated and dried the acetabulum and femur before cement insertion. Only one surgeon did not use any form of femoral canal occlusion. 69.4% used an intramedullary bone block. Retrograde filling of the femoral shaft by means of a cement gun was practised by 65.1%. CONCLUSIONS: This study has demonstrated considerable variation of practice in total hip arthroplasty across the North West Region and significant divergence from the statement of best practice approved by the BOA and BHS. The introduction of a properly funded national hip register will surely help to clarify the effect of such diverse practice on patient outcome. We would recommend that all trusts locally audit their practices

  4. 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.

  5. A new predictive indicator by arthrography for future acetabular growth following conservative treatment of developmental dysplasia of the hip.

    PubMed

    Satsuma, Shinichi; Kobayashi, Daisuke; Kinugasa, Maki; Takeoka, Yoshiki; Kuroda, Ryosuke; Kurosaka, Masahiro

    2016-05-01

    The aim of this study was to find a new predictive indicator for acetabular growth of developmental dysplasia of the hip. Seventy-three hips that were diagnosed with developmental dysplasia of the hip and treated by conservative reduction were included in our study. In 30 hips with center-edge angle ≤ 10° at age 4, the center-edge of the acetabular limbus angle (CEALA) in the arthrogram was measured. On the basis of the results, CEALA was significantly smaller in the secondary acetabular dysplasia group than in the normal group at maturity. In conclusion, CEALA is a more reliable and accurate predictive indicator for acetabular development than center-edge angle or acetabular index.

  6. Radiographic preoperative templating of extra-offset cemented THA implants: how reliable is it and how does it affect survival?

    PubMed

    Bachour, F; Marchetti, E; Bocquet, D; Vasseur, L; Migaud, H; Girard, J

    2010-11-01

    Securing femoral offset should in theory improve hip stability and abductor muscles moment arms. As problems arise mainly in case of originally increased offset (>40 mm), a range of extra-offset stems is available; the exact impact in terms of fixation, however, is not known. Extra-offset stems should more reliably reestablish original femoral offsets exceeding 40 mm than standard femoral components, limiting instability risk without possible adverse effect on fixation. To compare the ability of five commonly available femoral stem designs to restitute offset exceeding 40 mm, and to assess function and cement fixation at a minimum 6 years' follow-up in a stem conceived to reproduce such offset. A continuous series of 74 total hip replacements (THR) in hips with increased (>40 mm) femoral offset was studied. All underwent preoperative X-ray templating on Imagika™ software to assess offset reproduction by five models of stem: four standard, and one Lubinus SP2™ extra-offset stem. A retrospective clinical and X-ray study was conducted with a minimum 6 years' follow-up on the Lubinus SP2™ 117° stems used to try to reproduce offset in the 74 THRs. Apart from the increased (>40 mm) offset, the cervicodiaphyseal angle was consistently <135°, <130° in 60 femurs (81%) and <125° in 45 (60%). Planning showed the four standard stems to induce (>5mm femoral offset reduction in 50-83% of cases, versus only 25% with the Lubinus SP2™ 117°). All 74 hips received Lubinus SP2™ 117° stems: at a mean 78 months FU (range, 70-94 mo), their mean Postel-Merle d'Aubigné score was 17±1.8 (range, 13-18). Five of the 74 THRs underwent surgical revision: three cases of loosening, in which the stem was replaced, and two of instability, without change of stem. Loosening was not related to offset reproduction quality; two of the three cases were due to initial cementing defect, and the third occurred in a femur with previous history of two osteotomies. There were four cases of

  7. Small-particle-size cement

    SciTech Connect

    Ewert, D.P.; Almond, S.W.; Blerhaus, W.M. II )

    1991-05-01

    Successful remedial cementing has historically been difficult in wells with large-interval, multizone, gravel-packed completions. The reason is the inability of conventional oilfield cements to penetrate gravel packs adequately. Small-particle-size cement (SPSC) was developed to penetrate gravel packs and to provide the zonal isolation required. This paper details the laboratory work, job design, and field implementation of this new cement.

  8. Hinge total knee replacement revisited

    PubMed Central

    Cameron, Hugh U.; Hu, Cungen; Vyamont, Didier

    1997-01-01

    Objective To determine if aseptic loosening is a major problem in hinge total knee replacement. Design A cohort study. Setting A university-affiliated institute, specializing in elective orthopedic surgery. Patients Fifty-eight patients, mainly those requiring revision, in whom the conditions were such that it was felt only a totally constrained implant was appropriate. In 7 patients the implant was press-fitted; in the remainder it was cemented. Five patients required fusion or revision, and 8 died less than 2 years after implantation, leaving 45 for review. Follow-up was 2 to 13 years. Intervention Total knee replacement with a Guepar II prosthesis. Main outcome measures Radiolucency determined by the Cameron system and clinical scoring using the Hospital for Special Surgery system. Results Of the cemented components, 91% of femoral stems were type IA (no lucency), 9% were type IB (partial lucency), with no type II or III lucency. Tibial lucency was 87% type IA and 13% type IB, with no type II or III lucency. Of the noncemented components, 58% of femoral components were type IA and 42% type IB. Tibial lucency was 71% type IA and 29% type IB. Lucency was mainly present in zones 1 and 2 adjacent to the knee. Clinical rating was 18% excellent, 20% good, 20% fair and 42% poor. Postoperative complications included infection (13%), aseptic loosening (7%), quadriceps lag (16%) and extensor mechanism problems (16%). Conclusions Aseptic loosening is an uncommon problem in hinge total knee replacement. The complication rate in cases of sufficient severity as to require a hinge replacement remains high. Current indications for a hinge prosthesis are anteroposterior instability with a very large flexion gap, complete absence of the collateral ligaments and complete absence of a functioning extensor mechanism. PMID:9267296

  9. Shape variability of the adult human acetabulum and acetabular fossa related to sex and age by geometric morphometrics. Implications for adult age estimation.

    PubMed

    San-Millán, Marta; Rissech, Carme; Turbón, Daniel

    2017-03-01

    This study aims to explore shape variability of the acetabulum during the human adult life span, in relation to sex and age. The human acetabular shape was analysed in 682 os coxae from three different documented skeletal collections from the Iberian Peninsula. Two landmarks and thirty-two sliding semi-landmarks were used for the geometric morphometric procedures and a clock-wise standard was used for orientation. The 180° meridian (6:00) line was positioned over the midpoint of the acetabular notch and 36 reference points in 10° increments along the rim were marked. Data showed that size, sex and age significantly influence acetabular shape variation. Sex differences were significant in individuals younger than 65 years old and were characterised by males exhibiting relatively extended acetabular rim profiles from 10:00 to 1:00, narrower acetabular notches, and reduced acetabular fossae. In addition, three main age-related changes occurred to the acetabular shape in both sexes: outer acetabular profile modification, with extension from 10:00 to 1:00 and reduction from 7:00 to 9:00, acetabular notch narrowing, and acetabular fossa reduction. The age-related changes that were observed are shared by both sexes and seem to be related to bone production associated with age. Specifically, age appears to affect the entire border of the lunate surface: the acetabular rim, both acetabular horns, and the outer edge of the acetabular fossa. Furthermore, shape data confirmed the clover-leaf shape of the acetabular fossa in both males and females. These results improve our understanding of acetabular shape, and assist in refining age-estimation methods and enhancing hip surgery and rehabilitation.

  10. Effects of acetabular rim trimming on hip joint contact pressures: how much is too much?

    PubMed

    Bhatia, Sanjeev; Lee, Simon; Shewman, Elizabeth; Mather, Richard C; Salata, Michael J; Bush-Joseph, Charles A; Nho, Shane J

    2015-09-01

    In patients with femoroacetabular impingement (FAI), acetabular rim trimming removes the offending area of the acetabular deformity in patients with pincer-type and mixed-type FAI to improve hip joint kinematics. Although the rationale for arthroscopic acetabular rim trimming in patients with FAI is well established, the amount of rim resection has not been quantified, and the threshold at which excessive rim resection results in abnormal hip contact pressures has not been described. To investigate the changes in contact areas, contact pressures, and peak forces within the hip joint with sequential acetabular rim trimming. Controlled laboratory study. Six fresh-frozen, nondysplastic, human cadaveric hemipelvises were analyzed utilizing thin-film piezoresistive load sensors to measure the contact area, contact pressure, and peak force after anterosuperior acetabular rim trimming at depths of 0 mm (intact), 2 mm, 4 mm, 6 mm, and 8 mm. Each specimen was examined at 20° of extension and 60° of flexion. Analysis was performed on 2 regions of interest: the acetabular rim and the acetabular base (deep part of the acetabulum). After each experimental condition, the acetabulum was normalized with respect to the intact state to account for specimen variability. Statistical analysis was conducted through 1-way analysis of variance with post hoc Games-Howell tests. At the acetabular base, there were significant increases in the contact area after 4-mm resection (60°: 169.12% ± 30.64%; P = .0138), contact pressure after 6-mm resection (60°: 292.76% ± 79.07%; P = .009), and peak force after 6-mm resection (60°: 166.00% ± 34.40%; P = .027). At the acetabular rim, there were significant decreases in the contact area after 6-mm resection (60°: 66.32% ± 18.80%; P = .0354) (20°: 65.47% ± 15.87%; P = .0127), contact pressure after 6-mm resection (60°: 50.77% ± 11.49%; P < .001) (20°: 58.01% ± 23.10%; P = .0335), and peak force after 6-mm resection (60°: 60.67% ± 9

  11. Oxidation and other property changes of retrieved sequentially annealed UHMWPE acetabular and tibial bearings.

    PubMed

    Reinitz, Steven D; Currier, Barbara H; Van Citters, Douglas W; Levine, Rayna A; Collier, John P

    2015-04-01

    This investigation analyzed retrieved sequentially crosslinked and annealed (SXL) ultra-high molecular weight polyethylene bearings to determine whether the material is chemically stable in vivo. A series of retrieved tibial and acetabular components were analyzed for changes in ketone oxidation, crosslink density, and free radical concentration. Oxidation was observed to increase with in vivo duration, and the rate of oxidation in tibial inserts was significantly greater than in acetabular liners. SXL acetabular bearings oxidized at a rate comparable to gamma-sterilized liners, while SXL tibial inserts oxidized at a significantly faster rate than their gamma-sterilized counterparts. A significant decrease in crosslink density with increased mean ketone oxidation index was observed, suggesting that in vivo oxidation may be causing material degradation. Furthermore, a subsurface whitened damage region was also found in a subset of the bearings, indicating the possibility of a clinically relevant decrease in mechanical properties of these components.

  12. The influence of sagittal spinal deformity on anteversion of the acetabular component in total hip arthroplasty.

    PubMed

    Phan, D; Bederman, S S; Schwarzkopf, R

    2015-08-01

    The interaction between the lumbosacral spine and the pelvis is dynamically related to positional change, and may be complicated by co-existing pathology. This review summarises the current literature examining the effect of sagittal spinal deformity on pelvic and acetabular orientation during total hip arthroplasty (THA) and provides recommendations to aid in placement of the acetabular component for patients with co-existing spinal pathology or long spinal fusions. Pre-operatively, patients can be divided into four categories based on the flexibility and sagittal balance of the spine. Using this information as a guide, placement of the acetabular component can be optimal based on the type and significance of co-existing spinal deformity. ©2015 The British Editorial Society of Bone & Joint Surgery.

  13. 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

  14. Use of porous tantalum for acetabular reconstruction in revision hip arthroplasty.

    PubMed

    Issack, Paul S

    2013-11-06

    ➤ Over the past decade, porous tantalum has emerged as a powerful tool for reconstruction of the failed acetabular component.➤ The increased porosity, high coefficient of friction, and favorable elastic modulus of porous tantalum compared with traditional titanium mesh or cobalt chromium acetabular components allow for greater bone ingrowth potential, implant stability, and host bone preservation, respectively, in porous tantalum shells.➤ Several studies have confirmed the excellent early and midterm results of porous tantalum reconstruction for revision hip arthroplasty.➤ Depending on the degree of bone loss, excellent results have been achieved with modular or revision porous tantalum shells, tantalum shells with tantalum augments, and cup-cage constructs.➤ These implants and techniques are greatly changing the approach to acetabular revision surgery and are providing constructs with greater stability and more physiologic biomechanical properties than those achieved through the use of traditional reconstructive methods.

  15. Central acetabular fracture with dislocation treated by minimally invasive plate osteosynthesis.

    PubMed

    2015-06-01

    Central acetabular fractures with dislocation are usually the result of high-energy trauma, resulting in joint incongruity, and are frequently associated with other injuries. Open reduction and internal fixation has been the standard treatment for acetabular fractures, but it is associated with extensive surgical trauma, and complications such as haematoma formation, iatrogenic nerve injury, and heterotopic ossification. We present the case of a 63-year-old female who sustained a central acetabular fracture of the hip with dislocation as a result of an automobile collision. Closed reduction of the dislocation was performed, and the fracture was managed by minimally invasive plate osteosynthesis using a specially prepared plate. At 01 year postoperatively, radiographs showed the fracture to have been well-healed with good congruity of the joint. However, heterotopic ossification of the joint was noted. The technique allowed reduction of the fracture with minimal surgical trauma.

  16. Contemporary total hip arthroplasty with and without cement in patients with osteonecrosis of the femoral head.

    PubMed

    Kim, Young-Hoo; Oh, S-H; Kim, J-S; Koo, K-H

    2003-04-01

    The rate of failure of primary total hip arthroplasty in patients with osteonecrosis of the femoral head is higher than that in patients with osteoarthritis. The purpose of this prospective study was to document the clinical and radiographic results of arthroplasty with so-called third-generation cementing and the results of second-generation cementless total hip arthroplasty in ninety-eight consecutive patients with osteonecrosis of the femoral head. Fifty patients who had had simultaneous bilateral total hip arthroplasty with a cemented stem in one hip and a cementless stem in the other and forty-eight patients who had had a unilateral total hip arthroplasty with a cementless stem were included in the study. A cementless acetabular component was used in all hips. The presumed cause of the osteonecrosis was ethanol abuse in fifty-seven patients, unknown in twenty-seven, fracture of the femoral neck in nine, and steroid use in five. There were eighty men and eighteen women. The mean age at the time of the arthroplasty was 47.3 years (range, twenty-six to fifty-eight years). Clinical and radiographic evaluations were performed preoperatively; at six weeks; at three, six, and twelve months; and yearly thereafter. The average duration of follow-up was 9.3 years. The average Harris hip scores in the group treated with unilateral arthroplasty (97 points) and the group treated with bilateral arthroplasty (94 points) were similar at the time of final follow-up. They were also similar between the group treated with cement (mean, 96 points) and that treated without cement (95 points). No component had aseptic loosening in either group. In one hip, a cemented femoral stem (2%) and a cementless cup were revised because of infection. Two cementless stems (2%) were revised because of fracture of the proximal part of the femur with loosening of the stem. Annual wear of the polyethylene liner averaged 0.22 mm in the group treated with cement (a zirconia head) and 0.14 mm in the

  17. High temperature lightweight foamed cements

    DOEpatents

    Sugama, Toshifumi.

    1989-10-03

    Cement slurries are disclosed which are suitable for use in geothermal wells since they can withstand high temperatures and high pressures. The formulation consists of cement, silica flour, water, a retarder, a foaming agent, a foam stabilizer, and a reinforcing agent. A process for producing these cements is also disclosed. 3 figs.

  18. Cement Mason's Curriculum. Instructional Units.

    ERIC Educational Resources Information Center

    Hendirx, Laborn J.; Patton, Bob

    To assist cement mason instructors in providing comprehensive instruction to their students, this curriculum guide treats both the skills and information necessary for cement masons in commercial and industrial construction. Ten sections are included, as follow: related information, covering orientation, safety, the history of cement, and applying…

  19. High temperature lightweight foamed cements

    DOEpatents

    Sugama, Toshifumi

    1989-01-01

    Cement slurries are disclosed which are suitable for use in geothermal wells since they can withstand high temperatures and high pressures. The formulation consists of cement, silica flour, water, a retarder, a foaming agent, a foam stabilizer, and a reinforcing agent. A process for producing these cements is also disclosed.

  20. Cement Mason's Curriculum. Instructional Units.

    ERIC Educational Resources Information Center

    Hendirx, Laborn J.; Patton, Bob

    To assist cement mason instructors in providing comprehensive instruction to their students, this curriculum guide treats both the skills and information necessary for cement masons in commercial and industrial construction. Ten sections are included, as follow: related information, covering orientation, safety, the history of cement, and applying…

  1. [Proximal and total femur replacement].

    PubMed

    Pennekamp, P H; Wirtz, D C; Dürr, H R

    2012-07-01

    Reconstruction of segmental bone defects of the proximal femur following wide tumor resection or revision arthroplasty. Aggressive benign or primary malignant bone tumors of the proximal femur; destructive metastases; massive segmental bone defects of the proximal femur; periprosthetic fractures. Local infection; very short life expectancy (< 3 months); massive deficiency of acetabular bone stock. Anterolateral approach. Exposure and detachment of the iliopsoas and gluteus medius muscle from the proximal femur with a sufficient safety margin to the bone; distal transsection of the vastus lateralis/intermedius and rectus femoris muscle according to the extraosseous tumor extension; distal femur osteotomy al least 3 cm beyond the farthest point of tumor extension; in case of total femur replacement, additional lateral arthrotomy of the knee with resection of the ligaments and menisci; reaming of the medullary canal after securing the shaft with a Verbrugge clamp; trial assembly and reduction followed by the definitive implantation of the prosthesis with adjustment of the femoral neck anteversion in 5° increments; soft tissue reconstruction and fixation to an attachment tube covering the prosthesis; in case of total femur replacement, the preparation of the tibia is followed by the coupling of the tibial and femoral components. Infection prophylaxis, 20 kg partial weight bearing, continuous passive motion. A total of 20  patients with proximal femur replacement and 2 patients with total femur replacement implanted between June 2007 and December 2011 were retrospectively reviewed. Three patients had primary malignant bone tumors, while 19 patients underwent resection for metastatic disease. The mean age at surgery was 62.0 ± 18.1 years (18-82 years). Fifteen patients with a mean follow-up of 20.3 ± 17.2 months (4-51 months) were studied. Among the 22 cases, periprosthetic infection occurred in 3 patients (13.6%), dislocation in 2 patients (9

  2. Evaluation of a new methodology to simulate damage and wear of polyethylene hip replacements subjected to edge loading in hip simulator testing.

    PubMed

    Partridge, Susan; Tipper, Joanne L; Al-Hajjar, Mazen; Isaac, Graham H; Fisher, John; Williams, Sophie

    2017-06-29

    Wear and fatigue of polyethylene acetabular cups have been reported to play a role in the failure of total hip replacements. Hip simulator testing under a wide range of clinically relevant loading conditions is important. Edge loading of hip replacements can occur following impingement under extreme activities and can also occur during normal gait, where there is an offset deficiency and/or joint laxity. This study evaluated a hip simulator method that assessed wear and damage in polyethylene acetabular liners that were subjected to edge loading. The liners tested to evaluate the method were a currently manufactured crosslinked polyethylene acetabular liner and an aged conventional polyethylene acetabular liner. The acetabular liners were tested for 5 million standard walking cycles and following this 5 million walking cycles with edge loading. Edge loading conditions represented a separation of the centers of rotation of the femoral head and the acetabular liner during the swing phase, leading to loading of the liner rim on heel strike. Rim damage and cracking was observed in the aged conventional polyethylene liner. Steady-state wear rates assessed gravimetrically were lower under edge loading compared to standard loading. This study supports previous clinical findings that edge loading may cause rim cracking in liners, where component positioning is suboptimal or where material degradation is present. The simulation method developed has the potential to be used in the future to test the effect of aging and different levels of severity of edge loading on a range of cross-linked polyethylene materials. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2017. © 2017 Wiley Periodicals, Inc.

  3. Acetabular Fractures in the Elderly: Midterm Outcomes of Column Stabilisation and Primary Arthroplasty

    PubMed Central

    Ortega-Briones, A.; Smith, S.

    2017-01-01

    Background. Interest in arthroplasty techniques for periarticular or intra-articular fractures in the elderly/osteoporotic patient continues to rise, including for geriatric acetabular fractures. In line with this, many acetabular fracture surgeons are now undertaking acute total hip arthroplasty in elderly/osteoporotic patients. Little is known however of the outcomes of this procedure, beyond the first year after surgery. Questions/Purposes. We determined the clinical outcomes of a series of elderly osteoporotic patients (mean age at surgery 77.4 years) treated for acetabular fractures with column fixation and simultaneous total hip arthroplasty, at a mean of 49 months after surgery. Methods. 24 patients (25 hips) were reviewed at a mean of 49 months after surgery. The surgical technique employed has previously been described. Radiographs were obtained, and clinical outcomes were assessed using Harris Hip Scores and the Merle d'Aubigné score. Results. 14 hips were available for assessment (9 deceased, 2 lost to follow-up). No patient suffered any complications beyond the perioperative period, no acetabular components were loose clinically or on latest radiographs, and the mean Harris Hip Score was 92. All but one patient scored good or excellent on the Merle d'Aubigné score. Conclusions. Column fixation and simultaneous total hip arthroplasty are a viable option for complex geriatric acetabular fractures, with encouraging midterm results. We conclude that THR is a viable long-term solution in this situation provided that the acetabular columns are stabilised prior to implantation, but more research is needed to aid in overall management decision making. PMID:28194414

  4. Protection of the Proximal Articular Cartilage During Percutaneous Thermal Ablation of Acetabular Metastasis Using Temperature Monitoring.

    PubMed

    Bauones, Salem; Garnon, Julien; Chari, Basavaraj; Cazzato, Roberto L; Tsoumakidou, Georgia; Caudrelier, Jean; Koch, Guillaume; Gangi, Afshin

    2017-07-24

    To review our initial experience in acetabular cartilage protection from thermal injury with temperature monitoring during percutaneous image-guided tumor thermal ablation. Between June 2015 and December 2016, three consecutive oncologic patients (mean age 58 years; range 48-67 years) with acetabular bone metastasis underwent percutaneous image-guided thermal ablation procedures along with hip joint cartilage thermal monitoring. Due to the close proximity of the metastatic lesion to the acetabular articular cartilage, a thermosensor device was placed under CT and fluoroscopic guidance near the acetabular roof and next to the ablation zone in order to monitor the local temperature around the articular cartilage. Stand-alone thermal ablation (n = 1) and combined thermal ablation with cementoplasty (n = 2) were performed to optimize local palliation or disease control. Clinical and radiological outcomes at follow-up were assessed. Three acetabular metastatic lesions were treated with thermal ablation, and temperature monitoring of the acetabular articular cartilage was conducted during the ablation procedure. Mean size of lesions was 1.6 cm (range 1.5-2 cm). Technical success was achieved in all cases (100%) without any immediate complications. No hip cartilage damage occurred clinically and radiologically. Good palliation and local disease control were achieved in two cases, and in the other case, there was local recurrence and distant progression of hip metastatic disease after 7 months of follow-up. Temperature monitoring of the articular cartilage during percutaneous image-guided thermal ablation appears technically feasible with good short-term efficacy in a complex patient subset. Further studies are warranted to confirm these promising initial results.

  5. Does Increased Coefficient of Friction of Highly Porous Metal Increase Initial Stability at the Acetabular Interface?

    PubMed

    Goldman, Ashton H; Armstrong, Lucas C; Owen, John R; Wayne, Jennifer S; Jiranek, William A

    2016-03-01

    Highly porous metal acetabular components illustrate a decreased rate of aseptic loosening in short-term follow-up compared with previous registry data. This study compared the effect of component surface roughness at the bone-implant interface and the quality of the bone on initial pressfit stability. The null hypothesis is that a standard porous coated acetabular cup would show no difference in initial stability as compared with a highly porous acetabular cup when subjected to a bending moment. Second, would bone mineral density (BMD) be a significant variable under these test conditions. In a cadaveric model, acetabular cup micromotion was measured during a 1-time cantilever bending moment applied to 2 generations of pressfit acetabular components. BMD data were also obtained from the femoral necks available for associated specimen. The mean bending moment at 150 μm was not found to be significantly different for Gription (24.6 ± 14.0 N m) cups vs Porocoat (25 ± 10.2 N m; P > .84). The peak bending moment tolerated by Gription cups (33.9 ± 20.3 N m) was not found to be significantly different from Porocoat (33.5 ± 12.2 N m; P > .92). No correlation between BMD and bending moment at 150 μm of displacement could be identified. The coefficient of friction provided by highly porous metal acetabular shells used in this study did not provide better resistance to migration under bending load when compared with a standard porous coated component. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Cementing a wellbore using cementing material encapsulated in a shell

    DOEpatents

    Aines, Roger D.; Bourcier, William L.; Duoss, Eric B.; Floyd, III, William C.; Spadaccini, Christopher M.; Vericella, John J.; Cowan, Kenneth Michael

    2017-03-14

    A system for cementing a wellbore penetrating an earth formation into which a pipe extends. A cement material is positioned in the space between the wellbore and the pipe by circulated capsules containing the cement material through the pipe into the space between the wellbore and the pipe. The capsules contain the cementing material encapsulated in a shell. The capsules are added to a fluid and the fluid with capsules is circulated through the pipe into the space between the wellbore and the pipe. The shell is breached once the capsules contain the cementing material are in position in the space between the wellbore and the pipe.

  7. Cementing a wellbore using cementing material encapsulated in a shell

    DOEpatents

    Aines, Roger D.; Bourcier, William L.; Duoss, Eric B.; Spadaccini, Christopher M.; Cowan, Kenneth Michael

    2016-08-16

    A system for cementing a wellbore penetrating an earth formation into which a pipe extends. A cement material is positioned in the space between the wellbore and the pipe by circulated capsules containing the cement material through the pipe into the space between the wellbore and the pipe. The capsules contain the cementing material encapsulated in a shell. The capsules are added to a fluid and the fluid with capsules is circulated through the pipe into the space between the wellbore and the pipe. The shell is breached once the capsules contain the cementing material are in position in the space between the wellbore and the pipe.

  8. Calcium sulfate cement in contained traumatic metaphyseal bone defects.

    PubMed

    Drosos, Georgios I; Ververidis, Athanasios; Babourda, Eleni C; Kakagia, Despoina; Verettas, Dionisios-Alexandros

    2012-12-01

    The aim of this study was to evaluate prospective patients with periarticular fractures where a meta physeal bone defect was grafted with high compressive calcium sulfate cement. The calcium sulfate cement MIIG X3, (Wright Medical Technology, Inc, Arlington, TN) was used in 45 patients with periarticular fractures--distal radial, tibial plateau, humeral head, and calcaneal fractures--to fill the metaphyseal defect. All fractures were treated either with open or closed reduction, fracture fixation, and the cement was applied openly or closed. Radiographs were evaluated for fracture reduction, joint line gap, and step, as well as for rate of graft replacement by bone. All fractures united without an additional procedure. There were no wound infections or other complications attributed to the graft. At three-month follow-up, a complete graft replacement by bone was observed in all fractures. Joint line step was not developed in any patient, but a joint line gap of 3 mm was observed postoperatively in one patient with a tibial plateau fracture. Loss of reduction occurred in one patient with an extra-articular distal radial fracture treated with closed reduction and k-wire fixation. Cement that escaped into the joint or the surrounding soft tissues was not visible at the six-week follow-up. In conclusion, the results of this study confirm the safety and the efficacy of this cement when it is used as graft with the appropriate fixation method in traumatic metaphyseal bone defects.

  9. Acetabular roof stress fracture: a rare cause of hip pain in children

    PubMed Central

    Jlalia, Zied; Bellil, Mehdi; Ghachem, Maher Ben

    2016-01-01

    Stress fracture of acetabular roof is an unusual cause of hip pain. It is considered as an underdiagnosed entity. People who are more susceptible to experience this fracture are athletes, soldiers and dancers. We present the case of an 11 year old girl with a roof acetabular stress fracture for which the diagnosis and follow-ups were possible by the means of MRI. The treatment was keeping the child at a complete rest. Failure to abide with this treatment can cause the stress fracture to evaluate into a complete fracture. PMID:28154643

  10. A growing problem: acetabular fractures in the elderly and the combined hip procedure.

    PubMed

    Buller, Leonard T; Lawrie, Charles M; Vilella, Fernando E

    2015-04-01

    Acetabular fractures in the elderly are most frequently the result of low-energy trauma and present unique management challenges to orthopedic surgeons. Evaluation and treatment should be performed in a multidisciplinary fashion with early involvement of internal medicine subspecialists and geriatricians. Distinct fracture patterns and pre-existing osteoarthritis and osteoporosis necessitate careful preoperative planning. The role of total hip arthroplasty should also be considered when surgical treatment is indicated. The outcomes of acetabular fractures in the elderly have improved, but complications remain higher and results less satisfactory than in younger individuals. The lack of randomized controlled trials has limited the ability to establish an evidence-based treatment algorithm.

  11. Effect of acetabular labrum tears on hip stability and labral strain in a joint compression model.

    PubMed

    Smith, Matthew V; Panchal, Hemang B; Ruberte Thiele, Ramon A; Sekiya, Jon K

    2011-07-01

    Acetabular labrum tears are now commonly diagnosed in young and active patients. Because the role of the acetabular labrum is incompletely understood, it is critical to determine how these tears affect native hip biomechanics. Radial and circumferential labral tears significantly decrease hip stability and significantly alter strain patterns in the anterior and anterior-superior acetabular labrum. Controlled laboratory study. Twenty-two human cadaveric hips without evidence of degeneration or dysplasia were assigned to a circumferential tear (n = 11) and a radial tear (n = 11) group. The hips were tested in a neutral position with an average compressive force of 25 N. In the circumferential tear group, the labral states were intact; 1-, 2-, and 3-cm circumferential tears; a 3-cm partial labrectomy; and a full labrectomy. In the radial tear group, the labral states were intact; a radial tear; a 1-, 2-, and 3-cm partial labrectomy; and a full labrectomy. The effect of labral injury on the stability ratio (peak dislocation force/compressive loads) and labral strain in the anterior and anterior-superior labrum was analyzed using repeated-measures analysis of variance. There was no significant difference in stability ratio after circumferential tears 3 cm or less in size compared with the intact labral state. Strain in the anterior and anterior-superior labrum was either unchanged or increased after circumferential labral tear. There was no significant difference in stability ratio after a radial tear or a 1-cm partial labrectomy compared with the intact labral state. A 2-cm partial labrectomy significantly decreased the stability ratio. Anterior and anterior-superior labral strain significantly decreased after a radial tear. Under the influence of joint compression in a neutral hip position, the acetabular labrum continues to resist femoral head dislocation despite detachment from the acetabular rim. A radial tear in the acetabular labrum decreases adjacent labral

  12. Direct hip joint distraction during acetabular fracture surgery using the AO universal manipulator.

    PubMed

    Calafi, L Afshin; Routt, M L Chip

    2010-02-01

    Certain acetabular fractures may necessitate distraction of the hip joint for removal of intra-articular debris and assessment of reduction. Distraction can be accomplished by manual traction, using a traction table or an AO universal manipulator (UM). The UM is a relatively simple and an inexpensive device that can provide focal distraction in a controlled manner without the risks associated with the use of a traction table. We describe a technique using the UM for hip joint distraction during acetabular fracture surgery through a Kocher-Langenbeck surgical exposure.

  13. Stabilization of an acetabular fracture with cables for acute total hip arthroplasty.

    PubMed

    Mears, D C; Shirahama, M

    1998-01-01

    A critical stage of total hip arthroplasty for an acute acetabular fracture where extensive comminution, impaction, and osteopenia thwart the application of conventional open or closed methods, especially in the elderly, is stable fixation of the acetabulum. The use of 2-mm braided cables permits effective immobilization of the fracture for use in conjunction with a hybrid arthroplasty. The method is consistent with the use of a conventional arthroplastic incision and is suitable for other applications including the fixation of periprosthetic fractures, bulk allografts, and conventional acetabular fractures.

  14. Are custom triflange acetabular components effective for reconstruction of catastrophic bone loss?

    PubMed

    Berasi, Carl C; Berend, Keith R; Adams, Joanne B; Ruh, Erin L; Lombardi, Adolph V

    2015-02-01

    Although the introduction of ultraporous metals in the forms of acetabular components and augments has increased the orthopaedic surgeon's ability to reconstruct severely compromised acetabuli, there remain some that cannot be managed readily using cups, augments, or cages. In such situations, allograft-prosthetic composites or custom acetabular components may be called for. However, few studies have reported on the results of these components. The purposes of this study were to determine the (1) frequency of repeat revision, (2) complications and radiographic findings, and (3) Harris hip scores in patients who underwent complex acetabular revision surgery with custom acetabular components. Between August 2003 and February 2012, 26 patients (28 hips) have undergone acetabular reconstruction with custom triflange components. During this time, the general indications for using these implants included (1) failed prior salvage reconstruction with cage or porous metal construct augments, (2) large contained defects with possible discontinuity, (3) known pelvic discontinuity, and (4) complex multiply surgically treated hips with insufficient bone stock to reconstruct using other means. This approach was used in a cohort of patients with Paprosky Type 3B acetabular defects, which represented 3% (30 of 955) of the acetabular revisions we performed during the study period. Minimum followup was 2 years (mean, 57 months; range, 28-108 months). Seven patients (eight hips) died during the study period, and three (11%) of these patients (four hips; 14%) were lost to followup before 2 years, leaving 23 patients (24 hips) with minimum 2-year followup. Sixteen patients were women. The mean age of the patients was 67 years (range, 47-85 years) and mean BMI was 28 kg/m2 (range, 23-39 kg/m2). Revisions and complications were identified by chart review; hip scores were registered in our institution's longitudinal database. Pre- and postoperative radiographs were analyzed by the patient

  15. In vivo performance of a reduced-modulus bone cement

    NASA Astrophysics Data System (ADS)

    Forehand, Brett Ramsey

    Total joint replacement has become one of the most common procedures in the area of orthopedics and is often the solution in patients with diseased or injured hip joints. Component loosening is a significant problem and is primarily caused by bone resorption at the bone-cement interface in cemented implants. It is our hypothesis that localized shear stresses are responsible for the resorption. It was previously shown analytically that local stresses at the interface could be reduced by using a cement of lower modulus. A new reduced modulus cement, polybutyl methylmethacrylate (PBMMA), was developed to test the hypothesis. PBMMA was formulated to exist as polybutyl methacrylate filler in a polymethyl methacrylate matrix. The success of PBMMA cement is based largely on the fact that the polybutyl component of the cement will be in the rubbery state at body temperature. In vitro characterization of the cement was undertaken previously and demonstrated a modulus of approximately one-eighth that of conventional bone cement, polymethyl methacrylate (PMMA) and increased fracture toughness. The purpose of this experiment was to perform an in vivo comparison of the two cements. A sheep model was selected. Total hip arthroplasty was performed on 50 ewes using either PBMMA or PMMA. Radiographs were taken at 6 month intervals. At one year, the contralateral femur of each sheep was implanted so that each animal served as its own control, and the animals were sacrificed. The stiffness of the bone-cement interface of the femoral component within the femur was assessed by applying a torque to the femoral component and demonstrated a significant difference in loosening between the cements when the specimens were tested in external rotation (p < 0.007). Evaluation of the mechanical data also suggests that the PBMMA sheep had a greater amount of loosening for each subject, 59% versus 4% for standard PMMA. A radiographic analysis demonstrated more signs of loosening in the PMMA series

  16. Properties of cement based composites modified using diatomaceous earth

    NASA Astrophysics Data System (ADS)

    Pokorný, Jaroslav; Pavlíková, Milena; Záleská, Martina; Pavlík, Zbyšek

    2017-07-01

    Diatomite belongs among natural materials rich on amorphous silica (a-SiO2). When finely milled, it can potentially substitute part of cement binder and positively support formation of more dense composite structure. In this connection, two types of diatomaceous earth applied as a partial substitution of 5, 10, 15, and 20 mass% of Portland cement in the composition of cement paste were studied. In the tested mixtures with cement blends, the amount of batch water remained same, with water/binder ratio 0.5. For fresh paste mixtures, initial and final setting times were measured. First, hardened pastes cured 28 days in water were characterized by their physical properties such as bulk density, matrix density and open porosity. Then, their mechanical and thermophysical parameters were assessed. Obtained results gave clear evidence of setting time shortening for pastes with diatomite what brought negative effect with respect to the impaired workability of fresh mixtures. On the other hand, there was observed strength improvement for mixtures containing diatomite with higher amount of SiO2. Here, the increase in mechanical resistivity was distinct up to 15 mass% of cement replacement. Higher cement substitution by diatomite resulted in an increase in porosity and thus improvement of thermal insulation properties.

  17. The efficacy of a “double-D-shaped” wire marker for radiographic measurement of acetabular cup orientation and wear

    PubMed Central

    Derbyshire, Brian; Raut, Videshnandan V.

    2013-01-01

    Historically, wire markers were attached to cemented all-plastic acetabular cups to demarcate the periphery and to measure socket wear. The wire shape was either a semi-circle passing over the pole of the cup, or a circle around the cup equator. More recently, “double-D” shaped markers were introduced with a part-circular aspect passing over the pole and a semi-circular aspect parallel to the equatorial plane. This configuration enabled cup retroversion to be distinguished from anteversion. In this study, the accuracy of radiographic measurement of cup orientation and wear was assessed for cups with “double-D” and circular markers. Each cup was attached to a measurement jig which could vary the anteversion/retroversion and internal/external rotation of the cup. A metal femoral head was fixed within the socket and radiographic images were created for all combinations of cup orientation settings. The images were measured using software with automatic edge detection, and cup orientation and zero-wear accuracies were determined for each setting. The median error for cup version measurements was similar for both types of wire marker (0.2° double-D marker, −0.24° circular marker), but measurements of the circular marker were more repeatable. The median inclination errors were 2.05° (double-D marker) and 0.23° (circular marker). The median overall “zero wear” errors were 0.19 mm (double-D marker) and 0.03 mm (circular marker). Measurements of the circular wire marker were much more repeatable. PMID:23813165

  18. Treatment of acetabular chondral lesions with microfracture technique

    PubMed Central

    Mella, Claudio; Nuñez, Alvaro; Villalón, Ignacio

    2017-01-01

    Introduction: Acetabular cartilage lesions are frequently found during hip arthroscopy. In the hip joint they mostly occur secondary to a mechanical overload resulting from a pre-existing deformity as hip dysplasia or femoroacetabular impingement (FAI). Lesions identified during arthroscopy can vary greatly from the earliest stages to the most advanced (full-thickness lesions). These lesions occur in the acetabulum in the early stages of joint damage. Microfractures are indicated in full-thickness chondral defects. Ideally, these lesions must be focal and contained. Methods: The procedure begins debriding all the unstable chondral tissue of the lesion. The edges should have a net cut towards stable and healthy cartilage. It is recommended to make as many perforations as possible using arthroscopic awls. They should be ideally 4 mm deep and must have a vertical orientation to the surface. The suggested distance between perforations is of 3–4 mm. Once the treatment of the chondral lesion with the microfractures is complete, the labrum must be repaired. The repair of the labrum transforms in most of the cases the defect in a contained lesion containing better the clot in the lesion after the microfractures have been performed. It is also important to correct the bone deformity that has caused this lesion, which mostly corresponds to a “cam” deformity. Conclusion: Clinical studies confirm good short- and medium-term results in full-thickness chondral lesions treated with microfractures in the absence of osteoarthritis. However, it is difficult to determine if these results are only due to the microfractures, as this treatment is always complemented with several other factors and surgical procedures, such as labrum repair, correction of underlying bone deformity or change in postoperative activity of operated patients. PMID:28612705

  19. Acetabular anteversion is associated with gluteal tendinopathy at MRI.

    PubMed

    Moulton, Kyle M; Aly, Abdel-Rahman; Rajasekaran, Sathish; Shepel, Michael; Obaid, Haron

    2015-01-01

    Gluteal tendinopathy and greater trochanteric pain syndrome (GTPS) remain incompletely understood despite their pervasiveness in clinical practice. To date, no study has analyzed the morphometric characteristics of the hip on magnetic resonance imaging (MRI) that may predispose to gluteal tendinopathy. This study aimed to evaluate whether acetabular anteversion (AA), femoral neck anteversion (FNA), and femoral neck-shaft angle (FNSA) are associated with MRI features of gluteal tendinopathy. A total of 203 MRI examinations of the hip met our inclusion and exclusion criteria. A single blinded investigator measured AA, FNA, and FNSA according to validated MRI techniques. Two blinded subspecialty-trained musculoskeletal radiologists then independently evaluated the presence of gluteal tendinosis, trochanteric bursitis, and subgluteal bursitis. Statistical analysis was performed using a one-way analysis of variance (ANOVA; post-hoc Tukey's range test). At MRI, 57 patients had gluteal tendinosis with or without bursitis, 26 had isolated trochanteric bursitis, and 11 had isolated subgluteal bursitis. AA was significantly (p = 0.01) increased in patients with MRI evidence of gluteal tendinosis with or without bursitis [mean: 18.4°, 95 % confidence interval (CI): 17.2°-19.6°] compared with normal controls (mean: 15.7°, 95 % CI: 14.7°-16.8°). Similarly, AA was significantly (p = 0.04) increased in patients with isolated trochanteric bursitis (mean: 18.8°, 95 % CI: 16.2°-21.6°). No association was found between FNA or FNSA and the presence of gluteal tendinopathy. Interobserver agreement for the presence and categorization of gluteal tendinopathy was very good (kappa = 0.859, 95 % CI: 0.815-0.903). Our MRI study suggests that there is an association between increased AA and gluteal tendinopathy, which supports a growing body of evidence implicating abnormal biomechanics in the development of this condition.

  20. Single implant tooth replacement.

    PubMed

    Briley, T F

    1998-01-01

    It has been shown that direct bone anchorage of dental implants will provide long-term predictability for single tooth implants and multi-unit implants. The function of implant-supported restoration is now routinely achieved. The real challenge facing the restorative dentist and laboratory technician is to achieve optimal aesthetics. The learning objective of this article is to review the prosthodontic procedures essential to maximizing natural aesthetics in implant supported restorations. It will provide a review of master impression techniques, prepable titanium abutments and designing the cement on restoration. Particular emphasis is directed to the soft tissue model from which a series of sequenced techniques can be followed to achieve optimal aesthetics. Analysis of the implant alignment with regard to the neighboring teeth will result in having to make a choice of which prepable abutment will maximize the aesthetic result. The following case outlines how to replace a single missing tooth using an externally hexed implant system and a prefabricated titanium abutment on a 26-year-old male patient.

  1. Comparison of acetabular anterior coverage after Salter osteotomy and Pemberton acetabuloplasty: a long-term followup.

    PubMed

    Wang, Cheng-Wei; Wu, Kuan-Wen; Wang, Ting-Ming; Huang, Shier-Chieg; Kuo, Ken N

    2014-03-01

    The Salter osteotomy and Pemberton acetabuloplasty are common procedures for a deficient acetabulum in patients with developmental dysplasia of the hip. However, the degree of increasing retroversion and anterior acetabular coverage of these two procedures remains unanswered. The purpose of this study is to show the change in anterior coverage and relevant parameters in measuring pain and function among patients who have undergone either a Salter osteotomy or Pemberton acetabuloplasty. Forty-two patients who underwent either a Salter or Pemberton procedure at one institution between January 1981 and December 2000 and were available for followup at least 10 years later (mean, 18 years; range, 12-28 years) were evaluated retrospectively. This represented 12% of the Salter and Pemberton procedures performed in patients between 12 and 36 months old at our institution during the study period. We measured vertical-center-anterior margin angle, anterior acetabular head index, and weightbearing zone acetabular index, and we made comparisons using the radiographic parameter ratio (the division of each radiographic measurement of the operative side by that of the nonoperated side). All patients completed SF-36 and Harris hip score questionnaires at followup. In the Salter group, there were no differences in vertical-center-anterior margin angle, anterior acetabular head index, or weightbearing zone acetabular index. In the Pemberton group, there was no difference in vertical-center-anterior margin angle or anterior acetabular head index, but the weightbearing zone acetabular index decreased, suggesting increased anterior acetabular coverage (surgically treated side, 6 [95% CI, 4.84, 7.16]; nonoperated side, 12 [95% CI, 10.07, 13.39]; p < 0.001). Compared with that in the Salter group, the weightbearing zone acetabular index ratio was smaller in the Pemberton group, which means more acquired anterior coverage after a Pemberton acetabuloplasty (Salter procedure, 0.94 [95

  2. Evaluation of the wear performance of a polycarbonate-urethane acetabular component in a hip joint simulator and comparison with UHMWPE and cross-linked UHMWPE.

    PubMed

    St John, Kenneth; Gupta, Minakshi

    2012-07-01

    Acetabular hip joint components manufactured from gamma-sterilized ultra high molecular weight polyethylene (UHMWPE), gamma cross-linked UHMWPE, or polycarbonate-urethane (PCU) polymers were evaluated in a hip joint simulator, using cobalt alloy femoral components, for at least 5 million cycles. The volume of material losses due to wear was calculated for each type of sample, based upon mass loss measurements, every 500,000 cycles. The loss of material for the conventional UHMWPE was much higher than for the cross-linked UHMWPE, showing about a 70% reduction in wear due to cross-linking. The material loss for the PCU samples appears to have been at least 24% lower than for the cross-linked UHMWPE. Based upon these results, the PCU material seems to have potential for use as an alternative bearing material to UHMWPE for total hip replacement surgeries.

  3. Cement composition and sulfate attack

    SciTech Connect

    Shanahan, Natalya; Zayed, Abla . E-mail: zayed@eng.usf.edu

    2007-04-15

    Four cements were used to address the effect of tricalcium silicate content of cement on external sulfate attack in sodium sulfate solution. The selected cements had similar fineness and Bogue-calculated tricalcium aluminate content but variable tricalcium silicates. Durability was assessed using linear expansion and compressive strength. Phases associated with deterioration were examined using scanning electron microscopy and X-ray diffraction. Mineralogical phase content of the as-received cements was studied by X-ray diffraction using two methods: internal standard and Rietveld analysis. The results indicate that phase content of cements determined by X-ray mineralogical analysis correlates better with the mortar performance in sulfate environment than Bogue content. Additionally, it was found that in cements containing triclacium aluminate only in the cubic form, the observed deterioration is affected by tricalcium silicate content. Morphological similarities between hydration products of high tricalcium aluminate and high tricalcium silicate cements exposed to sodium sulfate environment were also observed.

  4. Long-Term Outcomes of Liner Cementation into a Stable Retained Shell: A Concise Follow-up of a Previous Report.

    PubMed

    Tan, Timothy L; Le Duff, Michel J; Ebramzadeh, Edward; Bhaurla, Sandeep K; Amstutz, Harlan C

    2015-06-03

    Liner cementation into a preexisting stable socket may reduce the morbidity of revision hip arthroplasty and preserve acetabular bone. However, the long-term outcomes of this technique remain unknown. The purpose of this report was to analyze the long-term results of a previously reported cohort of patients. Cementation of thirty-two liners (seventeen polyethylene and fifteen metal liners) into preexisting sockets was performed during revision hip arthroplasty, and the patients were followed for a minimum of two years. A retrospective chart review was performed to investigate the complications and survivorship. The mean duration of follow-up was 12.7 years (range, 2.1 to 19.1 years), with ten hips requiring rerevision at a mean of 6.4 years (range, 1.0 to 15.5 years). Nine patients experienced posterior dislocations, and two hips required rerevision for instability. Liner dissociation from the shell occurred in two patients. Survivorship analysis, with rerevision as the end point, demonstrated ten and fifteen-year survivorship of 77.3% and 68.8%, respectively. Dissociation of the cemented liner from the acetabular shell was an infrequent cause of failure despite long-term follow-up. Given the high rate of dislocations in this study, careful patient selection and surgical technique should be considered. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  5. Quantitative measures of damage to subchondral bone are associated with functional outcome following treatment of displaced acetabular fractures.

    PubMed

    Lubovsky, Omri; Kreder, Michael; Wright, David A; Kiss, Alex; Gallant, Aimee; Kreder, Hans J; Whyne, Cari M

    2013-12-01

    Current analysis of displaced acetabular fractures is limited in its ability to predict functional outcome. This study aimed to (1) quantify initial acetabular damage following acetabular fracture through measurement of subchondral bone density and fracture lines, and (2) evaluate associations between acetabular damage and functional outcomes following fracture. Subchondral bone intensity maps were created for 24 patients with unilateral acetabular fractures. Measures of crack length and density differences between corresponding regions in the fractured acetabuli, normalized by the unfractured side, were generated from preoperative CT images. Damage measures were compared to quality of life survey data collected for each patient at least 2 years post-injury (Musculoskeletal Functional Assessment [MFA] and Short Form-36 [SF-36], with specific focus on parameters that best describe patients' physical health). CT image quantification of initial damage to acetabular subchondral bone was associated with functional outcome post-injury. In general, damage as quantified through differences in density in the superior dome region (zones 8 and 12) and the central anterior region of the acetabulum (zone 3) were found to be the strongest significant predictors of functional outcome (adjusted R(2) = 0.3-0.45, p < 0.05). Damage to the superior dome was predictive of worse functional outcome whereas damage to the central anterior region indicated a better functional outcome. Once automated, this approach may form a basis to score acetabular fractures toward improving clinical prognoses. © 2013 Orthopaedic Research Society.

  6. New cement formulation helps solve deep cementing problems

    SciTech Connect

    Brothers, L.E.; DeBlanc, F.X.

    1989-06-01

    Invert-emulsion muds are used in most deep, hot wells. The internal aqueous phase of these muds frequently contains high concentrations of salts. It is desirable to complete these wells with a cement slurry containing salt concentrations up to and including saturation to minimize compatibility problems between cement slurry and mud. Above their effective temperature range, however, saturated salt cements - though still considered desirable for their other properties - pose design difficulties regarding thickening time, fluid loss, and rheology. High salt concentrations tend to decrease the effectiveness of most common cement additives - e.g., retarders, fluid-loss additives, and dispersants. At high temperatures, concentrations of these additives can become unacceptably large, while the additives themselves are not as effective under these conditions. Development of and field experience with a new cementing formulation for deep, high-temperature, saturated-salt applications have helped resolve the cement design problems encountered in south Texas and southern and offshore Louisiana. A single synthetic-polymer additive provides cement retardation, fluid-loss control, and dispersant properties with normal design considerations as opposed to the lengthy design requirements of other cement systems. A particular benefit derived from use of the new cement system involves cementing of long liners. Such liners frequently require squeeze cementing at the liner top because the cement is designed for conditions at the bottom of the liner and is thus frequently over-retarded for the cooler temperatures encountered at the top of the liner. This over-retardation tendency is alleviated greatly by use of the new saturated-salt cement additive.

  7. Trochanteric osteotomy in total hip replacement for congenital hip disease.

    PubMed

    Hartofilakidis, G; Babis, G C; Georgiades, G; Kourlaba, G

    2011-05-01

    We studied the effect of trochanteric osteotomy in 192 total hip replacements in 140 patients with congenital hip disease. There was bony union in 158 hips (82%), fibrous union in 29 (15%) and nonunion in five (3%). The rate of union had a statistically significant relationship with the position of reattachment of the trochanter, which depended greatly on the pre-operative diagnosis. The pre-operative Trendelenburg gait substantially improved in all three disease types (dysplasia, low and high dislocation) and all four categories of reattachment position. A persistent Trendelenburg gait post-operatively was noticed mostly in patients with defective union (fibrous or nonunion). Acetabular and femoral loosening had a statistically significant relationship with defective union and the position of reattachment of the trochanter. These results suggest that the complications of trochanteric osteotomy in total hip replacement for patients with congenital hip disease are less important than the benefits of this surgical approach.

  8. Relationship Between Developmental Dislocation of the Hip in Infant and Acetabular Dysplasia at Skeletal Maturity

    PubMed Central

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

    2015-01-01

    Abstract 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

  9. 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.

  10. External Rotator Sparing with Posterior Acetabular Fracture Surgery: Does It Change Outcome?

    PubMed Central

    Ceylan, Halil; Inanir, Murat; Sarlak, Ahmet Y.

    2014-01-01

    This study analyses the results of the treatment with external rotator sparing approach in acetabular fractures to determine whether muscle sparing has a positive impact on functional outcome. 20 patients with a mean age of 45.9 years (range: 26–64) that had been treated for displaced acetabular fractures were included in this series. Short Musculoskeletal Function Assessment (SMFA) questionnaire and hip muscle strength measurement were done at the 24-month of follow-up period. The radiographic results at the final followup were excellent in 9 hips (45%), good in 6 hips (30%), fair in 4 hips (20%), and poor in one hip (5%) according to the criteria developed by Matta. The average SMFA score for all of the patients was 18.3 (range: 0–55.4). The mean dysfunctional and bother indexes were 17.2 and 20.6, respectively. The overall muscle strength deficit was 11.8%. The greatest loss of strength was in internal rotation. In patients with better postoperative reduction quality of acetabular fracture, peak torque, and maximum work of hip flexion, extension and also internal rotation maximum work deficit were significantly lower (P < 0.05). Accurate initial reduction and longer postoperative muscle strengthening exercise programs seem critical to decrease postoperative hip muscle weakness after acetabular fractures. PMID:25110590

  11. Double-crush syndrome after acetabular fractures. A sign of poor prognosis.

    PubMed

    Giannoudis, P V; Da Costa, A A; Raman, R; Mohamed, A K; Smith, R M

    2005-03-01

    Injury to the sciatic nerve is one of the more serious complications of acetabular fracture and traumatic dislocation of the hip, both in the short and long term. We have reviewed prospectively patients, treated in our unit, for acetabular fractures who had concomitant injury to the sciatic nerve, with the aim of predicting the functional outcome after these injuries. Of 136 patients who underwent stabilisation of acetabular fractures, there were 27 (19.9%) with neurological injury. At initial presentation, 13 patients had a complete foot-drop, ten had weakness of the foot and four had burning pain and altered sensation over the dorsum of the foot. Serial electromyography (EMG) studies were performed and the degree of functional recovery was monitored using the grading system of the Medical Research Council. In nine patients with a foot-drop, there was evidence of a proximal acetabular (sciatic) and a distal knee (neck of fibula) nerve lesion, the double-crush syndrome. At the final follow-up, clinical examination and EMG studies showed full recovery in five of the ten patients with initial muscle weakness, and complete resolution in all four patients with sensory symptoms (burning pain and hyperaesthesia). There was improvement of functional capacity (motor and sensory) in two patients who presented initially with complete foot-drop. In the remaining 11 with foot-drop at presentation, including all nine with the double-crush lesion, there was no improvement in function at a mean follow-up of 4.3 years.

  12. Management of High-Energy Acetabular Fractures in the Elderly Individuals

    PubMed Central

    Hill, Brian W.; Switzer, Julie A.; Cole, Peter A.

    2012-01-01

    Acetabular fractures in the elderly individuals are increasing in prevalence. Although there is evidence in the literature that acetabular fractures in elderly patients sustained as a result of low-energy mechanisms can be well treated by nonoperative management, open reduction and internal fixation, or even acute arthroplasty, almost no literature exists that may appropriately guide the treatment of elderly acetabular fractures that occur as a result of high-energy mechanisms. In spite of this lack of evidence, specific principles for providing the best care in adult trauma patients may reasonably be adopted. These principles include aggressive resuscitation and medical optimization; surgical care that focuses on a patient’s survival but does not sacrifice skeletal stability; and early mobilization. Best practices that guide the care of hip fracture patients, such as a team approach to care, the use of protocols to guide treatment, and the timing of surgery to occur as soon as is safely possible also should be employed to guide care in patients who have sustained acetabular fractures. Opportunity exists to better study these higher energy fractures and to, thereby, affect outcomes in patients who have sustained them. PMID:23569703

  13. Effectiveness of an Acetabular Positioning Device in Primary Total Hip Arthroplasty

    PubMed Central

    Hendrix, Stephen L.; Mologne, Timothy S.; Peterson, Drew A.; Holley, Keith A.

    2005-01-01

    To evaluate the efficacy of a commercially available acetabular positioning device, we performed a prospective evaluation of 40 consecutive patients undergoing primary total hip arthroplasty. All surgery was performed by the same surgeon, in the same operating room, and on the same operating table. The acetabular positioning device was designed to place the component in 45° of abduction. At 6 weeks, all radiographs were evaluated by 3 investigators not involved with the surgery. Each radiograph was evaluated by each reviewer on 3 separate occasions, blinded to the findings of the other reviewer to assess interobserver and intraobserver variability. The mean cup abduction angle was 42.1°, with a range from 23° to 57° (SD 8.3°). Intraobserver and interobserver variability were 0.2 and 0.3°, respectively. The findings of this study demonstrate a wide variability in acetabular cup placement in primary total hip arthroplasty. We believe this is due to movement of the pelvis, which may occur during preparation, draping, and retracting during surgery. We feel surgeons should not rely solely on positioning devices when implanting the acetabular component in total hip arthroplasty. Identification of bone landmarks and determination of superolateral implant coverage noted on preoperative templating is advocated to improve the precision of component position. PMID:18751812

  14. A Monoblock Porous Tantalum Acetabular Cup Has No Osteolysis on CT at 10 Years

    PubMed Central

    Ghate, Raju; Salaz, Noel; Ghodasra, Jason; Stulberg, S. David

    2010-01-01

    Background Aseptic osteolysis has been the single most important factor limiting the longevity of a THA. A great deal of attention has been focused on the development of implants and materials that minimize the development of osteolysis. The monoblock porous tantalum acetabular cup was designed to minimize osteolysis, but whether it does so is unclear. Questions/purposes We evaluated the incidence of osteolytic lesions after THA using a monoblock porous tantalum acetabular component. Methods We retrospectively reviewed 51 patients who had a THA using a monoblock porous tantalum acetabular cup. At a minimum of 9.6 years postoperatively (average, 10.3 years; SD, 0.2 years; range, 9.6–10.8 years), a helical CT scan of the pelvis using a metal suppression protocol was obtained. This scan was evaluated for the presence of osteolysis. Results We found no evidence of osteolysis on CT scan at an average of 10.3 years. Conclusions Osteolysis appears not to be a major problem at 10 years with this monoblock porous tantalum acetabular component, but longer term followup will be required to determine whether these findings persist. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. PMID:20809172

  15. A new method for the measurement of anteversion of the acetabular cup after total hip arthroplasty.

    PubMed

    Aydogan, Mehmet; Burç, Halil; Saka, Gursel

    2014-08-01

    Many methods of determining the anteversion of the acetabular cup have been described in the literature. The advantages and disadvantages of each of these methods are discussed in this paper. We present a new method of measuring the acetabular anteversion at the anteroposterior hip. The formula designed by the authors was anteversion angle (α) = arc sin |PK|/√ |AK| × |BK|. The formula was tested using the AutoCAD software, and an experimental study was conducted to evaluate the accuracy. Three groups were created, and 16 X-ray images were taken and coded. Ten orthopaedic surgeons measured the acetabular anteversion from these X-rays using our formula. The results in Group 1 were closer to the actual value; in contrast, the results in Group 2 differed from the actual values. The results in Group 3 were as close to the actual anteversion values as were those in Group 1. Developments in technology often bring an increase in complications. Despite newly developed surgical methods and technology, the position of the acetabular cup is still used to determine the results of a total hip arthroplasty. Our method is simple, cost-effective and achieves almost 100 % accuracy.

  16. Autologous Membrane Induced Chondrogenesis (AMIC) for the treatment of acetabular chondral defect

    PubMed Central

    Fontana, Andrea

    2016-01-01

    Summary Background Acetabular chondral defect are very frequently associated to FAI. Treatment options are still questionable. Methods Between 2008 and 2014, 201 patients over 583 have been arthroscopically treated with the AMIC procedure for grade III and/or IV acetabular chondral lesions. Patients age was between 18 and 50 years; acetabular chondral lesion size was between 2 and 4 cm2; radiological Tönnis degree of osteoarthritis was ≤ 2. Results The mean follow up of the entire group of 201 patients was 5 years (from 8 to 2). Significant improvement, as measured by the mHHS, was observed at 6 months in comparison to preoperative levels (80.3 ± 8.3) (p<0.001). Continuous improvement with respect to each previous evaluation time point was seen, reaching the highest improvement level at the three year follow-up (85.5 ± 7.2). The mean mHHS improvement recorded at the five year follow-up compared with preoperative scores was 39.1 ± 5.9. Conclusions AMIC is a valid procedure to repair medium-sized chondral defects on the acetabular side of the hip found during treatment of FAI and lead to long-term favourable outcomes. Level of evidence IV. PMID:28066742

  17. New method for measuring acetabular component positioning with EOS imaging: feasibility study on dry bone.

    PubMed

    Journé, Alexandre; Sadaka, Jérome; Bélicourt, Claire; Sautet, Alain

    2012-11-01

    Malposition of the acetabular cup is the most common cause of total hip arthroplasty (THA) dislocation. The position of a total hip implant is usually analysed on computed tomography (CT) scan. We aim to prove it is possible to measure, with good accuracy, the position of an acetabular cup using the low-dose irradiation (EOS) imaging. We implanted an acetabular cup in a pelvic dry bone and measured cup anteversion and inclination with scanography. We performed 14 series of EOS acquisitions with different inclination, rotation and pelvic tilt, which were analysed by five observers. Two observers repeated angle measurements. We then calculated measurement inter- and intrareproducibility and accuracy. Using a confidence interval (CI) of 95 %, inter- and intra-observer reproducibility were ±1.6, and ±1.4°, respectively, for cup inclination; accuracy in comparison with CT was ±2.6°. Using a 95 % CI, inter- and intra-observer reproducibility for cup anteversion were ±2.5° and ±2.3°, respectively. Measurement accuracy compared with CT was ±3.9°. EOS imaging system is superior to standard radiography in terms of measuring acetabular anteversion and inclination.

  18. Mineral resource of the month: hydraulic cement

    USGS Publications Warehouse

    van Oss, Hendrik G.

    2012-01-01

    Hydraulic cements are the binders in concrete and most mortars and stuccos. Concrete, particularly the reinforced variety, is the most versatile of all construction materials, and most of the hydraulic cement produced worldwide is portland cement or similar cements that have portland cement as a basis, such as blended cements and masonry cements. Cement typically makes up less than 15 percent of the concrete mix; most of the rest is aggregates. Not counting the weight of reinforcing media, 1 ton of cement will typically yield about 8 tons of concrete.

  19. Chemical vs. Physical Acceleration of Cement Hydration

    PubMed Central

    Bentz, Dale P.; Zunino, Franco; Lootens, Didier

    2016-01-01

    Cold weather concreting often requires the use of chemical accelerators to speed up the hydration reactions of the cement, so that setting and early-age strength development will occur in a timely manner. While calcium chloride (dihydrate – CaCl2·2H2O) is the most commonly used chemical accelerator, recent research using fine limestone powders has indicated their high proficiency for physically accelerating early-age hydration and reducing setting times. This paper presents a comparative study of the efficiency of these two approaches in accelerating hydration (as assessed via isothermal calorimetry), reducing setting times (Vicat needle), and increasing early-age mortar cube strength (1 d and 7 d). Both the CaCl2 and the fine limestone powder are used to replace a portion of the finest sand in the mortar mixtures, while keeping both the water-to-cement ratio and volume fractions of water and cement constant. Studies are conducted at 73.4 °F (23°C) and 50 °F (10 °C), so that activation energies can be estimated for the hydration and setting processes. Because the mechanisms of acceleration of the CaCl2 and limestone powder are different, a hybrid mixture with 1 % CaCl2 and 20 % limestone powder (by mass of cement) is also investigated. Both technologies are found to be viable options for reducing setting times and increasing early-age strengths, and it is hoped that concrete producers and contractors will consider the addition of fine limestone powder to their toolbox of techniques for assuring performance in cold weather and other concreting conditions where acceleration may be needed. PMID:28077884

  20. Cement from magnesium substituted hydroxyapatite.

    PubMed

    Lilley, K J; Gbureck, U; Knowles, J C; Farrar, D F; Barralet, J E

    2005-05-01

    Brushite cement may be used as a bone graft material and is more soluble than apatite in physiological conditions. Consequently it is considerably more resorbable in vivo than apatite forming cements. Brushite cement formation has previously been reported by our group following the mixture of nanocrystalline hydroxyapatite and phosphoric acid. In this study, brushite cement was formed from the reaction of nanocrystalline magnesium-substituted hydroxyapatite with phosphoric acid in an attempt to produce a magnesium substituted brushite cement. The presence of magnesium was shown to have a strong effect on cement composition and strength. Additionally the presence of magnesium in brushite cement was found to reduce the extent of brushite hydrolysis resulting in the formation of HA. By incorporating magnesium ions in the apatite reactant structure the concentration of magnesium ions in the liquid phase of the cement was controlled by the dissolution rate of the apatite. This approach may be used to supply other ions to cement systems during setting as a means to manipulate the clinical performance and characteristics of brushite cements.

  1. Development of the Use of Alternative Cements for the Treatment of Intermediate Level Waste

    SciTech Connect

    Hayes, M.; Godfrey, I.H.

    2007-07-01

    This paper describes initial development studies undertaken to investigate the potential use of alternative, non ordinary Portland cement (OPC) based encapsulation matrices to treat historic legacy wastes within the UK's Intermediate Level Waste (ILW) inventory. Currently these wastes are encapsulated in composite OPC cement systems based on high replacement with blast furnace slag of pulverised fuel ash. However, the high alkalinity of these cements can lead to high corrosion rates with reactive metals found in some wastes releasing hydrogen and forming expansive corrosion products. This paper therefore details preliminary results from studies on two commercial products, calcium sulfo-aluminate (CSA) and magnesium phosphate (MP) cement which react with a different hydration chemistry, and which may allow wastes containing these metals to be encapsulated with lower reactivity. The results indicate that grouts can be formulated from both cements over a range of water contents and reactant ratios that have significantly improved fluidity in comparison to typical OPC cements. All designed mixes set in 24 hours with zero bleed and the pH values in the plastic state were in the range 10-11 for CSA and 5-7 for MP cements. In addition, a marked reduction in aluminium corrosion rate has been observed in both types of cements compared to a composite OPC system. These results therefore provide encouragement that both cement types can provide a possible alternative to OPC in the immobilisation of reactive wastes, however further investigation is needed. (authors)

  2. Mechanical, material, and antimicrobial properties of acrylic bone cement impregnated with silver nanoparticles.

    PubMed

    Slane, Josh; Vivanco, Juan; Rose, Warren; Ploeg, Heidi-Lynn; Squire, Matthew

    2015-03-01

    Prosthetic joint infection is one of the most serious complications that can lead to failure of a total joint replacement. Recently, the rise of multidrug resistant bacteria has substantially reduced the efficacy of antibiotics that are typically incorporated into acrylic bone cement. Silver nanoparticles (AgNPs) are an attractive alternative to traditional antibiotics resulting from their broad-spectrum antimicrobial activity and low bacterial resistance. The purpose of this study, therefore, was to incorporate metallic silver nanoparticles into acrylic bone cement and quantify the effects on the cement's mechanical, material and antimicrobial properties. AgNPs at three loading ratios (0.25, 0.5, and 1.0% wt/wt) were incorporated into a commercial bone cement using a probe sonication technique. The resulting cements demonstrated mechanical and material properties that were not substantially different from the standard cement. Testing against Staphylococcus aureus and Staphylococcus epidermidis using Kirby-Bauer and time-kill assays demonstrated no antimicrobial activity against planktonic bacteria. In contrast, cements modified with AgNPs significantly reduced biofilm formation on the surface of the cement. These results indicate that AgNP-loaded cement is of high potential for use in primary arthroplasty where prevention of bacterial surface colonization is vital. Copyright © 2014 Elsevier B.V. All rights reserved.

  3. Does Salter innominate osteotomy predispose the patient to acetabular retroversion in adulthood?

    PubMed

    Kobayashi, Daisuke; Satsuma, Shinichi; Kinugasa, Maki; Kuroda, Ryosuke; Kurosaka, Masahiro

    2015-05-01

    Salter innominate osteotomy has been identified as an effective additional surgery for the dysplastic hip. However, because in this procedure, the distal segment of the pelvis is displaced laterally and anteriorly, it may predispose the patient to acetabular retroversion. The degree to which this may be the case, however, remains incompletely characterized. We asked, in a group of pediatric patients with acetabular dysplasia who underwent Salter osteotomy, whether the operated hip developed (1) acetabular retroversion compared with contralateral unaffected hips; (2) radiographic evidence of osteoarthritis; or (3) worse functional scores. (4) In addition, we asked whether femoral head deformity resulting from aseptic necrosis was a risk factor for acetabular retroversion. Between 1971 and 2001, we performed 213 Salter innominate osteotomies for unilateral pediatric dysplasia, of which 99 hips (47%) in 99 patients were available for review at a mean of 16 years after surgery (range, 12-25 years). Average patient age at surgery was 4 years (range, 2-9 years) and the average age at the most recent followup was 21 years (range, 18-29 years). Acetabular retroversion was diagnosed based on the presence of a positive crossover sign and prominence of the ischial spine sign at the final visit. The center-edge angle, acetabular angle of Sharp, and acetabular index were measured at preoperative and final visits. Contralateral unaffected hips were used as controls, and statistical comparison was made in each patient. Clinical findings, including Harris hip score (HHS) and the anterior impingement sign, were recorded at the final visit. Patients were no more likely to have a positive crossover sign in the surgically treated hips (20 of 99 hips [20%]) than in the contralateral control hips (17 of 99 hips [17%]; p = 0584). In addition, the percentage of positive prominence of the ischial spine sign was not different between treated hips (22 of 99 hips [22%]) and contralateral hips

  4. Total Hip Arthroplasty After Acetabular Fracture Is Associated With Lower Survivorship and More Complications.

    PubMed

    Morison, Zachary; Moojen, Dirk Jan F; Nauth, Aaron; Hall, Jeremy; McKee, Michael D; Waddell, James P; Schemitsch, Emil H

    2016-02-01

    Despite modern fracture management techniques allowing for near anatomic reduction of acetabular fractures, there continues to be a risk of posttraumatic arthritis and need for total hip arthroplasty (THA). Few well-controlled studies have compared THA after acetabular fractures with THAs performed for other indications in terms of survivorship or complications, and none, to our knowledge, present 10-year survivorship data in this setting. (1) How does the 10-year survival of THA compare between those patients who underwent THA after an acetabular fracture and those who underwent THA for primary arthritis or avascular necrosis (AVN)? (2) Is there an increased risk of serious complications like infection, dislocation, and aseptic loosening as well as heterotopic ossification associated with a THA performed after a previous acetabular fracture? This retrospective case-control study compared findings of patients who underwent THA after acetabular fracture versus a matched cohort of patients who had received a primary THA for primary osteoarthritis or AVN. Between 1987 and 2011, we performed 95 THAs after acetabular fracture; of those, 74 (78%) met inclusion criteria and had documented followup beyond 2 years in our institutional registry. We selected 74 matched patients based on an algorithm that matched patients based on preoperative diagnosis, date of operation, age, gender, and type of prosthesis. During this time, we performed approximately 8000 THAs that were potentially available for matching based on complete followup beyond 2 years. We compared cases and control subjects using the Kaplan-Meier survivorship estimator as well as a comparison of the proportions in each group that developed major complications (including infection, dislocation, loosening, and heterotopic ossification) based a retrospective chart review. The 10-year survivorship after THA was lower in patients with a previous acetabular fracture than in the matched cohort (70%, 95% confidence

  5. How Often Does Femoroacetabular Impingement Occur After an Innominate Osteotomy for Acetabular Dysplasia?

    PubMed

    Castañeda, Pablo; Vidal-Ruiz, Carlos; Méndez, Alfonso; Salazar, Diego Pérez; Torres, Armando

    2016-05-01

    Femoroacetabular impingement is increasingly recognized as a cause of hip pain but its incidence after an innominate osteotomy for the correction of acetabular dysplasia has not been determined. This information would be essential for the orthopaedic surgeon because it has the potential to produce a poor outcome in the long term when trying to balance acetabular instability and overcorrection. The purposes of our study were (1) to determine the frequency with which clinically relevant femoroacetabular impingement (FAI) occurs after an innominate osteotomy for the treatment of acetabular dysplasia; (2) to determine risk factors for the development of FAI; and (3) to compare postoperative radiographic and clinical outcomes in patients having undergone an innominate osteotomy for the correction of acetabular dysplasia both with and without FAI. This was a retrospective review of 154 hips (132 patients) that had undergone an innominate osteotomy for acetabular dysplasia and were evaluated at a minimum followup of 10 years (mean = 12 years). Mean age at the time of surgery was 3 years, 114 hips had a concomitant open reduction, and 54 hips also had femoral shortening. One hundred eight hips had a Salter osteotomy and 46 had a Pemberton osteotomy. Radiographs were analyzed to determine the lateral center-edge angle (CE angle) and the presence of a crossover sign. The diagnosis of FAI was established when the CE angle was greater than 40°, there was a positive crossover sign, and the patient had groin pain when flexing the hip less than 90°. Comparisons between nonparametric variables were performed with a Mann-Whitney's U test. Categorical variables were compared with a chi-square test. Change in acetabular index (correction) was dichotomized considering 20° of correction as the cutoff point. Association is presented as odds ratio (95% confidence interval), and logistic regression was performed. According to our criteria, 18 of 154 hips had FAI (12%). Of the 18

  6. Foamed well cementing compositions and methods

    SciTech Connect

    Bour, D.L.; Childs, J.D.

    1992-07-28

    This patent describes a method of cementing a well penetrating a salt containing subterranean formation. It comprises: forming a foamed cement composition; placing the foamed cement composition in contact with the salt containing formation; and permitting the foamed cement composition to set in contact with the salt containing formation to form a hardened mass of cement.

  7. Peri-implant stress correlates with bone and cement morphology: micro-FE modeling of implanted cadaveric glenoids

    PubMed Central

    Wee, Hwabok; Armstrong, April D.; Flint, Wesley W.; Kunselman, Allen R.; Lewis, Gregory S.

    2015-01-01

    Aseptic loosening of cemented joint replacements is a complex biological and mechanical process, and remains a clinical concern especially in patients with poor bone quality. Utilizing high resolution finite element analysis of a series of implanted cadaver glenoids, the objective of this study was to quantify relationships between construct morphology and resulting mechanical stresses in cement and trabeculae. Eight glenoid cadavers were implanted with a cemented central peg implant. Specimens were imaged by micro-CT, and subject-specific finite element models were developed. Bone volume fraction, glenoid width, implant-cortex distance, cement volume, cement-cortex contact, and cement-bone interface area were measured. Axial loading was applied to the implant of each model and stress distributions were characterized. Correlation analysis was completed across all specimens for pairs of morphological and mechanical variables. The amount of trabecular bone with high stress was strongly negatively correlated with both cement volume and contact between the cement and cortex (r = −0.85 and −0.84, p < 0.05). Bone with high stress was also correlated with both glenoid width and implant-cortex distance. Contact between the cement and underlying cortex may dramatically reduce trabecular bone stresses surrounding the cement, and this contact depends on bone shape, cement amount, and implant positioning. PMID:25929691

  8. Are pelvic anatomical structures in danger during arthroscopic acetabular labral repair? Definition of safe bone depth.

    PubMed

    Gereli, Arel; Kocaoglu, Baris; Ulku, Kerem Tekin; Veli Ismailoglu, Abdul; Silay, Sena; Karahan, Mustafa

    2017-01-01

    The purpose of this study was to evaluate safe depth for suture anchor insertion during acetabular labral repair and to determine the neighbouring structures at risk during drilling and anchor insertion. Ten human cadaveric hips (six males and four females) were obtained. Acetabular labral surface was prepared and marked for right hips as 12, 1 and 3 o'clock positions, for left hips 12, 11 and 9 o'clock positions. Those were defined as anterior, anterior-superior and superior zones, respectively. These labral positions were drilled at defined zones. After measurements, depth of the bone at 10° and 20° drill angles on zones was compared statistically. Acetabular bone widths at investigated labral insertion points did not statistically differ. A total of 14 injuries in 60 penetrations occurred (23.3 %) with free drill penetrations, and no injuries occurred with stopped drill penetrations. The bone depth was gradually decreasing from 10° to 20° drill angles and from anterior to superior inserting zones without significant importance. The risk of perforation to the pelvic cavity started with 20 mm drill depth, and the mean depth for all insertions was calculated as 31.7 mm (SD 2.6). It is anatomically possible that some pelvic structures sustain iatrogenic injury during acetabular drilling for anchor placement. Being aware of mean pelvic vault is important in which drilling after excessive pincer rim trimming could easily decrease the depth of acetabular bone without a standard. Careful drilling by using stopped drill bit is crucial to prevent iatrogenic injury.

  9. The use of blood cell salvage in acetabular fracture internal fixation surgery.

    PubMed

    Bigsby, Ewan; Acharya, Mehool R; Ward, Anthony J; Chesser, Timothy Js

    2013-10-01

    To determine if the routine use of intraoperative blood cell salvage in acetabular fracture internal fixation reduces the need for allogenic blood transfusion, is cost effective, and whether it is influenced by the acetabular fracture pattern. A retrospective study. Tertiary pelvic and acetabular reconstructive center. Patients undergoing internal fixation for acetabular fractures. Eighty consecutive patients were reviewed, comprising 26 elementary fracture (EF) and 54 associated fracture (AF) types. The mean volume of autologous blood transfused was 484 mL. The mean volume of 561 mL of autologous blood transfused in patients with AF types was significantly greater than the mean volume of 325 mL transfused in the EF group (P = 0.007). Additional allogenic blood transfusion was required in 5 (19%) patients with EFs and 15 (28%) patients with AFs (P = 0.418). The mean cost of the blood cell salvage and additional blood products in our study was $223 (£135) for all fracture types ($174/£105 for EF and $246/£149 for AF).When treating AF types, the mean cost of using blood cell salvage was $246 (£149) as compared with the mean predicted cost of not using blood cell salvage and transfusing the equivalent of 1.7 units of allogenic blood instead, which was $463 (£281). These distributions are significantly different (P = 0.01). The use of blood cell salvage for internal fixation surgery for acetabular fracture is cost effective, particularly when treating AF types, and its routine use is advocated to limit the need for allogenic blood transfusion.

  10. The use of a constrained acetabular component to treat instability after total hip arthroplasty.

    PubMed

    Shrader, M Wade; Parvizi, Javad; Lewallen, David G

    2003-11-01

    Recurrent dislocation after total hip arthroplasty is a disabling complication that can be difficult to treat and may not be amenable to nonoperative management. The purpose of the present study was to evaluate the clinical and radiographic outcome associated with the use of a constrained acetabular component as a salvage treatment for instability after hip arthroplasty. We retrospectively reviewed the clinical and radiographic outcome of 110 arthroplasties, in 109 patients, that had been performed with use of a single design of constrained acetabular component. In seventy-nine hips the constrained component was implanted for the treatment of recurrent instability, and in thirty-one hips it was implanted because of absent or grossly deficient soft-tissue attachments that were believed to be associated with a high risk for subsequent instability. The constrained acetabular device eliminated or prevented hip instability in all patients except two, who continued to have sensations of subluxation. The mean Harris hip score improved significantly, from 62.7 points preoperatively to 76.4 points at the time of the latest follow-up (p < 0.0001). There were no instances of dislocation or disassembly of the hip components. Radiographic analysis revealed radiolucent lines around the cup in fifteen hips (14%). There was a total of nine revisions: six for deep infection, two for acetabular component loosening, and one for a periprosthetic fracture of the femur. A constrained acetabular component reliably restores and maintains hip stability in patients with recalcitrant recurrent instability and can dependably prevent dislocation in those who are at high risk because of absent or deficient soft tissues about the hip. However, because of the early appearance of radiolucent lines around some components and concerns about long-term fixation, the use of these devices should be reserved for situations in which other methods are inadequate or have already failed.

  11. Cementless revisions of failed aseptic cemented and cementless total hip arthroplasties. 284 cases.

    PubMed

    Lord, G; Marotte, J H; Guillamon, J L; Blanchard, J P

    1988-10-01

    Over the past 13 years, 284 revisions of aseptic total hip arthroplasty failures have been performed with cementless implants. There were 213 cases involving cemented implant failures and 71 involving cementless ones. Considered as salvage procedures, these revisions provided a satisfactory result in about 70% of the reviewed patients after five years. A biologic fixation by bony ingrowth can be expected under certain conditions from decorticated living bone, a tight mechanical fitting, and a retentive corrugated surface of the implant. A prosthetic reimplantation, safely done without cement, appears more economical for the bone stock and prevents the long-term complications related with cement. Bone grafts are often required but cannot ensure the incoming osteogenic fixation of the implant. Long-term results and complications mandate harmless extractability of the revisional implant, a forged stem, an easy exchange of the plastic liner (in a two-part acetabular component), and an updated low-friction system (high-density polyethylene wear being a potential long-term problem).

  12. Early hydration of portland cement with crystalline mineral additions

    SciTech Connect

    Rahhal, V. . E-mail: vrahhal@fio.unicen.edu.ar; Talero, R.

    2005-07-01

    This research presents the effects of finely divided crystalline mineral additions (quartz and limestone), commonly known as filler,