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Sample records for charnley total hip

  1. [50 years of total hip prosthesis--a tribute to Prof. Sir John Charnley].

    PubMed

    Mikić, Zelimir Dj; Lesić, Aleksandar R

    2013-01-01

    November 2012 marked the 50th anniversary of the first implantation of a successful and long-lived hip endoprosthesis, which was performed by Prof Sir John Charnley in the "Centre for Hip Surgery" at a small country place in the north-west England. John Charnley (1911-1982) finished medical school at the Victoria University of Manchester in 1935, and than started training in orthopaedics at the Manchester Royal Infirmary, and completed it after the Second World War, in which he served as a volunteer. After that he continued working in the same hospital, and, apart from that he worked as a lecturer at the University of Manchester, and from 1949 as a visiting surgeon in the Wrightington Hospital. In 1958 Charnley decided to put his efforts into the development of hip replacement research and surgery, and initiated the foundation of the "Centre for Hip Surgery" with Biomechanical laboratory in the Wrightington Hospital in 1960, where the intesive basic and clinical research started, and becuase of that Charnley in 1962 left Manchester and moved with a full time practice at the Wrightington Hospital. That period of research time was not easy, there were many "trial and tribulations", but, owing to the tenacity and inventive mind of Charnley, in 1962 a new prosthesis consisting of a cemented metal stem with a 22 mm head articulating with a cemented polyethilene acetabular component, and with a low frictional torque was designed. The first such prosthesis, which later produced excellent long-term results, was implanted on November 22nd, 1962, and today, when we look back over a distance of fifty years, we can conclude that that day could be considered as a beginning of a modem aloarthroplastic surgery, and certainly as one of the greatest orthopaedic advance in the whole of the 20th century; and all that was initiated and promoted by Prof. Sir John Charnley.

  2. Tribological measurements on a Charnley-type artificial hip joint

    NASA Technical Reports Server (NTRS)

    Jones, W. R., Jr.

    1983-01-01

    A total hip simulator was used to determine the friction and wear properties of Charnley-type (316L stainless steel balls and sterile ultrahigh molecular weight polyethylene cups) hip prostheses. Three different sets of specimens were tested to 395,000, 101,500 and 233,000 walking cycles, respectively. All tests were run unlubricated, at ambient conditions (22 to 26 C, 30 to 50 percent relative humidity), at 30 walking cycles per minute, under a dynamic load simulating walking. Polyethylene cup wear rates ranged from 1.4 to 39 ten billions cu m which corresponds to dimensional losses of 4.0 to 11 microns per year. Although these wear rates are lower than those obtained from other hip simulators and from in vivo X-ray measurements, they are comparable when taking run-in and plastic deformation into account. Maximum tangential friction forces ranged from 93 to 129 N under variable load (267 to 3090 N range) and from 93 to 143 N under a static load of 3090 N. A portion of one test 250,000 walking cycles) run under dry air ( 1 percent relative humidity) yielded a wear rate almost 6 times greater than that obtained under wet air ( 70 percent relative humidity) conditions.

  3. Validation of a digital image processing software package for the in vivo measurement of wear in cemented Charnley total hip arthroplasties.

    PubMed

    Kennard, Emma; Wilcox, Ruth K; Hall, Richard M

    2006-05-01

    Computer-generated images were used to assess image processing software employed in the radiographic evaluation of penetration in total hip replacement. The images were corrupted using Laplacian noise and smoothed to simulate different modulation transfer functions in a range associated with hospital digital radiographic systems. With no corruption, the penetration depth measurements were both precise and accurate. However, as the noise increased so did the inaccuracy and imprecision to levels that may make changes in the penetration observed clinically difficult to discern between follow-up assessments. Simulated rotation of the wire marker produced significant bias in the measured penetration depth. The use of these simulated radiographs allows the evaluation of the software used to process the digital images alone rather than the whole measurement system.

  4. Fracture After Total Hip Replacement

    MedlinePlus

    ... er Total Hip Replacement cont. • Dislocation • Limb length inequality • Poor fracture healing • Repeat fracture • Lack of in- ... Surgeons (AAOS). To learn more about your orthopaedic health, please visit orthoinfo.org. Page ( 5 ) AAOS does ...

  5. [Treatment of femoral neck fractures using a total hip prosthesis].

    PubMed

    Ansorge, D; Hack, U

    1983-01-01

    From October 1. 1977 to December 1. 1982 106 patients suffering from fractures of the femoral neck (n = 75) or necroses of the femoral head and nonunions of the neck fracture respectively (n = 33) underwent total hip replacement by TEP (type Müller-Charnley). The results obtained were much better in comparison to other methods of treatment: less complications, shortening of in-hospital stay (average 21.1 days) and satisfactory till good late results in 82.8%. The mortality rate came up to 13.9% (fractures: 20.0%, necrosis of the head and nonunion: 0.0%). Concerning complications we observed wound infections 0.9%, dislocations 1.9%, twice fractures of the thigh bone, twice loosening of the shaft of the prosthesis and once its fracture. The authors emphasize that in spite of the good results obtained for the time being total hip replacement for fractures of the femoral neck should be reserved to special wards.

  6. The unstable total hip replacement

    PubMed Central

    D'Angelo, F; Murena, L; Zatti, G; Cherubino, P

    2008-01-01

    Background: Dislocation is one of the most common complications of total hip arthroplasty with a reported dislocation rate of 3.2%. Despite increased experience with hip replacement, the overall rate has not yet changed. The aim of this paper is to review the most recent literature published on this topic and indexed in Medline, in order to clarify the main risk factors, and to standardize a treatment protocol of such an important complication of prosthetic surgery. Materials and Methods: Medline database was searched using key words: “hip dislocation”, “hip instability” from 1980-2007. Studies were eligible for review and included if they met the following criteria: (1) publication in English, (2) clinical trials (3) review papers. Results: The risk of first-time dislocation as a function of time after the surgery is not well understood. Most, but not all, series have demonstrated that the risk of dislocation is highest during the first few months after hip arthroplasty; however, first-time late dislocation can also occur many years after the procedure. Several risk factors were described, including the surgical approach, the diameter of the head, impingement, component malposition, insufficient abductor musculature. In addition, there are also many treatment options, such as long-term bracing after closed reduction, component reorientation, capsulorraphy, trochanteric advancement, increasing offset, exchange of the modular head and the polyethylene liner, insertion of constrained liner. Conclusion: Preventing hip dislocation is obviously the best strategy. Surgeons must take into account patient and surgical risk factors. For patients at high risk for dislocation the surgeon should accurately restore leg length and femoral offset; the use of larger femoral heads, posterior transosseous repair of the capsulotendinous envelope if posterior approach is chosen or the use of a lateral approach should be considered. Proper patient education and postoperative

  7. Osteonecrosis: avoiding total hip arthroplasty.

    PubMed

    Hungerford, David S

    2002-06-01

    Osteonecrosis of the femoral head afflicts approximately 20,000 new patients per year, at an average age of 38. Of the patients seen in our institution, 25% are <25 years old. Without treatment, most of these patients can be expected to need a total hip arthroplasty. Joint-preserving procedures have a significant failure rate, and some have significant morbidity. It is desirable to avoid or delay total hip arthroplasty because most patients with osteonecrosis outlive the current state-of-the-art prostheses. Four issues need to be weighed to arrive at a reasonable algorithm for the preservative treatment of osteonecrosis: i) patient risk factors, ii) morbidity of the proposed procedure, iii) size of the lesion, and iv) stage of the lesion. All of the issues must be considered to make sense out of a complex clinical situation.

  8. An automated method for assessing routine radiographs of patients with total hip replacements.

    PubMed

    Redhead, A L; Kotcheff, A C; Taylor, C J; Porter, M L; Hukins, D W

    1997-01-01

    This paper describes a new, fully automated method of locating objects on radiographs of patients with total joint replacements (TJRs). A statistical computer model, known as an active shape model, was trained to identify the position of the femur, pelvis, stem and cup marker wire on radiographs of patients with Charnley total hip prostheses. Once trained, the model was able to locate these objects through a process of automatic image searching, despite their appearance depending on the orientation and anatomy of the patient. Experiments were carried out to test the accuracy with which the model was able to fit to previously unseen data and with which reference points could be calculated from the model points. The model was able to locate the femur and stem with a mean error of approximately 0.8 mm and a 95 per cent confidence limit of 1.7 mm. Once the model had successfully located these objects, the midpoint of the stem head could be calculated with a mean error of approximately 0.2 mm. Although the model has been trained on Charnley total hip replacements, the method is generic and so can be applied to radiographs of patients with any TJR. This paper shows that computer models can form the basis of a quick, automatic method of taking measurements from standard clinical radiographs.

  9. A historical and economic perspective on Sir John Charnley, Chas F. Thackray Limited, and the early arthoplasty industry.

    PubMed

    Gomez, Pablo F; Morcuende, Jose A

    2005-01-01

    In the 1960s, Sir John Charnley pioneered modern total hip arthroplasty (THA) and spent the next two decades refining all aspects of the procedure, working with the commercial firm of Chas F. Thackray Limited, now a subsidiary of DePuy Orthopaedics, a Johnson and Johnson Company. We review here that relationship, in light of the complex relationships today that exist among industry, researchers, surgeons, and the public.

  10. A Historical and Economic Perspective on Sir John Charnley, Chas F. Thackray Limited, and the Early Arthroplasty Industry

    PubMed Central

    Gomez, Pablo F; Morcuende, Jose A

    2005-01-01

    In the 1960s, Sir John Charnley pioneered modern total hip arthroplasty (THA) and spent the next two decades refining all aspects of the procedure, working with the commercial firm of Chas F. Thackray Limited, now a subsidiary of DePuy Orthopaedics, a Johnson and Johnson Company. We review here that relationship, in light of the complex relationships today that exist among industry, researchers, surgeons, and the public. PMID:16089068

  11. Total hip replacement in young adults with hip dysplasia

    PubMed Central

    2011-01-01

    Background and purpose Dysplasia of the hip increases the risk of secondary degenerative change and subsequent total hip replacement. Here we report on age at diagnosis of dysplasia, previous treatment, and quality of life for patients born after 1967 and registered with a total hip replacement due to dysplasia in the Norwegian Arthroplasty Register. We also used the medical records to validate the diagnosis reported by the orthopedic surgeon to the register. Methods Subjects born after January 1, 1967 and registered with a primary total hip replacement in the Norwegian Arthroplasty Register during the period 1987–2007 (n = 713) were included in the study. Data on hip symptoms and quality of life (EQ-5D) were collected through questionnaires. Elaborating information was retrieved from the medical records. Results 540 of 713 patients (76%) (corresponding to 634 hips) returned the questionnaires and consented for additional information to be retrieved from their medical records. Hip dysplasia accounted for 163 of 634 hip replacements (26%), 134 of which were in females (82%). Median age at time of diagnosis was 7.8 (0–39) years: 4.4 years for females and 22 years for males. After reviewing accessible medical records, the diagnosis of hip dysplasia was confirmed in 132 of 150 hips (88%). Interpretation One quarter of hip replacements performed in patients aged 40 or younger were due to an underlying hip dysplasia, which, in most cases, was diagnosed during late childhood. The dysplasia diagnosis reported to the register was correct for 88% of the hips. PMID:21434808

  12. Comparison of measures to assess outcomes in total hip replacement surgery.

    PubMed Central

    Dawson, J; Fitzpatrick, R; Murray, D; Carr, A

    1996-01-01

    OBJECTIVES--To compare the performance of a disease specific and a general health questionnaire in assessing changes resulting from total hip replacement. DESIGN--Two stage prospective study of patients undergoing total hip replacement surgery involving an assessment at a clinic before and six months after surgery. 60(32%) patients were followed up by post. SETTING--Outpatient departments at a specialist orthopaedic hospital and peripheral clinics within Oxfordshire. PATIENTS--188 patients admitted for unilateral total hip replacement between February and mid-August 1994. MAIN MEASURES--Patients' self assessed scores with the 12 item Oxford hip score and SF-36 general health questionnaire together with surgeons' assessment with Charnley hip score obtained before and again at six months after surgery. RESULTS--186 patients were followed up six months after total hip replacement; a subsample (n=60) by post. Of the 60 postal patients, 59(98.3%) fully completed the Oxford hip score compared with 44(73.3%) who fully completed the SF-36. For the followup sample as a whole, post operative changes in scores produced a large effect size of 2.75 on the Oxford hip score, compared with -1.89 physical function (SF-36), -2.13 pain (SF-36). With the exception of physical function and role (physical), postoperative SF-36 scores were shown to be similar to or better than those found by two population surveys on patients of comparable age. The responsiveness of a disease specific questionnaire, the Oxford hip score, and relevant sections of a general questionnaire, SF-36, were found to be similar as assessed by three different criteria. CONCLUSIONS--A disease specific questionnaire, the Oxford hip score, and a general state of health questionnaire, SF-36, performed similarly in assessing outcomes of total hip replacement except that the disease specific questionnaire resulted in a higher completion rate and greater responsiveness in some sections. On the other hand the general

  13. NEW BEARING SURFACES IN TOTAL HIP REPLACEMENT

    PubMed Central

    Schwartsmann, Carlos Roberto; Boschin, Leonardo Carbonera; Gonçalves, Ramiro Zilles; Yépez, Anthony Kerbes; de Freitas Spinelli, Leandro

    2015-01-01

    Total hip arthroplasty is being increasingly indicated for younger and more active patients, in addition to a naturally growing demand for the procedure because of increasing life expectancy among patients. The high costs of this surgery and the controversies regarding implant performance have made this topic the subject of constant research, seeking new materials with better resistance to wear and better biocompatibility. The present article provides a review of new surfaces in total hip arthroplasty. PMID:27042614

  14. Is the use of antidepressants associated with patient-reported outcomes following total hip replacement surgery?

    PubMed

    Greene, Meridith E; Rolfson, Ola; Gordon, Max; Annerbrink, Kristina; Malchau, Henrik; Garellick, Göran

    2016-10-01

    Background and purpose - Patients with anxiety and/or depression tend to report less pain reduction and less satisfaction with surgical treatment. We hypothesized that the use of antidepressants would be correlated to patient-reported outcomes (PROs) 1 year after total hip replacement (THR), where increased dosage or discontinuation would be associated with worse outcomes. Patients and methods - THR cases with pre- and postoperative patient-reported outcome measures (PROMs) were selected from the Swedish Hip Arthroplasty Register (n = 9,092; women: n = 5,106). The PROMs were EQ-5D, visual analog scale (VAS) for pain, Charnley class, and VAS for satisfaction after surgery. These cases were merged with a national database of prescription purchases to determine the prevalence of antidepressant purchases. Regression analyses were performed where PROs were dependent variables and sex, age, Charnley class, preoperative pain, preoperative health-related quality of life (HRQoL), patient-reported anxiety/depression, and antidepressant use were independent variables. Results - Antidepressants were used by 10% of the cases (n = 943). Patients using antidepressants had poorer HRQoL and higher levels of pain before and after surgery and they experienced less satisfaction. Preoperative antidepressant use was independently associated with PROs 1 year after THR regardless of patient-reported anxiety/depression. Interpretation - Antidepressant usage before surgery was associated with reduced PROs after THR. Cases at risk of poorer outcomes may be identified through review of the patient's medical record. Clinicians are encouraged to screen for antidepressant use preoperatively, because their use may be associated with PROs after THR. PMID:27482877

  15. Hip Squeaking after Ceramic-on-ceramic Total Hip Arthroplasty

    PubMed Central

    Wu, Guo-Liang; Zhu, Wei; Zhao, Yan; Ma, Qi; Weng, Xi-Sheng

    2016-01-01

    Objective: The present study aimed to review the characteristics and influencing factors of squeaking after ceramic-on-ceramic (CoC) total hip arthroplasty (THA) and to analyze the possible mechanisms of the audible noise. Data Sources: The data analyzed in this review were based on articles from PubMed and Web of Science. Study Selection: The articles selected for review were original articles and reviews found based on the following search terms: “total hip arthroplasty”, “ceramic-on-ceramic”, “hip squeaking”, and “hip noise.” Results: The mechanism of the squeaking remains unknown. The possible explanations included stripe wear, edge loading, a third body, fracture of the ceramic liner, and resonance of the prosthesis components. Squeaking occurrence is influenced by patient, surgical, and implant factors. Conclusions: Most studies indicated that squeaking after CoC THA was the consequence of increasing wear or impingement, caused by prosthesis design, patient characteristics, or surgical factors. However, as conflicts exist among different articles, the major reasons for the squeaking remain to be identified. PMID:27453238

  16. The use of primary total hip arthroplasty in university hospitals of the European Union.

    PubMed

    Scheerlinck, Thierry; Druyts, Pieter; Casteleyn, Pierre-Paul

    2004-06-01

    Current practice in primary total hip replacement was investigated by postal survey in 125 university hospitals of the European Union (EU). Most hospitals (78.4%) use a hip register and implant cemented as well as uncemented stems (72.0%) and cups (68.8%). In Scandinavian & Anglo-Saxon countries, 42.9% of the departments implant cemented stems in all their patients, and 16.7% implant cemented cups in all their patients. In these countries, modern cementing techniques are commonly used and therapeutic choices are strongly influenced by hip registers. In Southern Europe, cemented cups have been abandoned in 31.1% and modern cementing techniques are less common. Benelux & Germanic countries have a practice in between. Three cemented (Exeter, Charnley, Lubinus) and three uncemented stems (Zweymüller, ABG, Bi-contact) represent 41.9% and 25.3% of stem types in use. Most departments (70.4%) have adopted alternative bearings. Ceramic-ceramic and metal-metal are both used in almost half of the hospitals. Metal-polyethylene has been abandoned in 15.2%. These trends are taught to new generations of surgeons in the EU and could become common practice in a near future. PMID:15287402

  17. Total hip replacement for arthritis following tuberculosis of hip

    PubMed Central

    Kumar, Vijay; Garg, Bhavuk; Malhotra, Rajesh

    2015-01-01

    AIM: To present the results of total hip arthroplasty (THA) for post tubercular arthritis of the hip joint. METHODS: Sixty-five patients (45 male, 20 female) with previously treated tuberculosis of the hip joint underwent cementless THA for post tubercular arthritis. The average age at the time of THA was 48 years (range 29 to 65 years). Erythrocyte sedimentation rate, C reactive protein, chest X-ray and contrast enhanced magnetic resonance imaging were done preoperatively to confirm resolution of the disease and to rule out any residual disease. Intra-operative samples were taken for microbiological examination, polymerase chain reaction (PCR) and histological examination. Patients were started on anti-tubercular drugs one week before the operation and continued for 6 mo post operatively. The patients were followed up clinically using the Harris hip score as well as radiologically for any loosening of the implants, osteolysis and any recurrence of tuberculosis. Any complications especially the recurrence of the infection was also recorded. RESULTS: The mean interval from completion of antitubercular therapy for tuberculosis to surgery was 4.2 years (range, 2-6 years). Preoperatively, 17 patients had ankylosis whereas 48 patients had functional but painful range of motion. The mean surgical time was 97 min (range, 65-125) whereas the mean blood loss was 600 mL (range, 400-900 mL). The average follow up was 8.3 years (range 6-11 years). The average Harris Hip score improved from 27 preoperatively to 91 at the final follow up. Seventeen patients had acetabular protrusion which was managed with impaction grafting and cementless acetabular cup. The bone graft had consolidated in all these 17 patients at the follow up. Two patients developed discharging sinuses at 9 and 11 mo postoperatively respectively. The discharge tested positive for tuberculosis on the PCR. Both these patients were put on antitubercular therapy for another year. Both of them recovered and had no

  18. Total hip arthroplasty in Malaysia--the Universiti Kebangsaan Malaysia and Hospital Kuala Lumpur experience.

    PubMed

    Tay, B H; Masbah, O; Razak, M; Ruslan, G N

    2000-09-01

    The results of 109 primary total hip arthroplasties in 92 patients performed in Hospital Kuala Lumpur from January 1987 to December 1996 were reviewed after a mean follow-up of 30.8 months. There were 22 males and 70 females with the average age of 49.9 years (range 19 to 94 years). Chinese females comprised the largest group of patients (52.2%). Avascular necrosis was the most common diagnosis (33.1%) followed by hip dysplasia and primary osteoarthritis (17.4%). The procedure was performed more on the right hip (64.2%) compared to the left (35.8%). All patients received prophylactic antibiotics but none were given deep vein thrombosis prophylaxis. The Charnley prosthesis was most commonly used and the majority of the arthroplasties were cemented (60.5%). About 80% of the THA were performed via the lateral approach. The functional hip score improved from an average of 8.9 to 15.0 with 66.3% of the patients categorized as good and excellent results. There were 16 patients (17.4%) with poor outcome. The most common complications encountered were dislocation (10.1%), aseptic loosening (9.2%) and periprosthetic fracture (5.5%). Other complications were deep infection (1.8%), deep vein thrombosis (0.9%), trochanteric osteotomy complications (1.8%), superficial infection (7.3%), urinary tract infection (5.5%), pressure sore (3.7%) and respiratory complication (1.8%). Fifteen hips (13.8%) required revision. The causes for revision were aseptic loosening, dislocation and infection. Technical anomalies were recognized as one of the factors contributing to poor results. Five-year survival rate was 87.3%. Better results can be expected with increasing experience and technical skulls.

  19. Total hip arthroplasty after rotational acetabular osteotomy.

    PubMed

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

    2015-03-01

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

  20. Total Hip Joint Replacement Biotelemetry System

    NASA Technical Reports Server (NTRS)

    Boreham, J. F.; Postal, R. B.; Luntz, R. A.

    1981-01-01

    The development of a biotelemetry system that is hermetically sealed within a total hip replacement implant is reported. The telemetry system transmits six channels of stress data to reconstruct the major forces acting on the neck of the prosthesis and uses an induction power coupling technique to eliminate the need for internal batteries. The activities associated with the telemetry microminiaturization, data recovery console, hardware fabrications, power induction systems, electrical and mechanical testing and hermetic sealing test results are discussed.

  1. Renal function after elective total hip replacement.

    PubMed

    Perregaard, Helene; Damholt, Mette B; Solgaard, Søren; Petersen, Morten B

    2016-06-01

    Background and purpose - Acute kidney injury (AKI) is associated with increased short-term and long-term mortality in intensive care populations and in several surgical specialties, but there are very few data concerning orthopedic populations. We have studied the incidence of AKI and the prevalence of chronic kidney disease (CKD) in an elective population of orthopedic patients undergoing primary total hip replacement, hypothesizing that chronic kidney disease predisposes to AKI. Patients and methods - This was a single-center, population-based, retrospective, registry-based cohort study involving all primary elective total hip replacements performed from January 2003 through December 2012. Patient demographics and creatinine values were registered. We evaluated the presence of CKD and AKI according to the international guidelines for kidney disease (KDIGO Acute Kidney Injury Workgroup 2013 ). Results - 3,416 patients were included (2,064 females (60%)). AKI (according to KDIGO criteria) was seen in 75 patients (2.2%, 95% CI: 1.7-2.7) in the course of primary total hip replacement. Of these, 26 had pre-existing CKD of class 3-5. Pre-existing CKD of class 3-5, indicating moderately to severely reduced kidney function, was seen in 374 individuals (11%). Interpretation - Development of acute kidney injury appears to be a substantial problem compared to other complications related to elective total hip arthroplasty, i.e. luxation and infection. Patients with pre-existing chronic kidney disease may be especially vulnerable. The clinical impact of acute kidney injury in an elective orthopedic population remains to be elucidated. PMID:26937782

  2. The Anterior Approach for Total Hip Replacement.

    PubMed

    Hochfelder, Jason P; Davidovitch, Roy I

    2016-03-01

    The anterior approach for total hip replacements has recently gained popularity. Some authors report faster recoveries and decreased dislocation rated with no increased risk of complications. However others claim no difference in outcomes when compared to other approaches yet an increase in complication rates. This paper provides a brief history of the approach, discusses various indications and contraindications, preoperative considerations, surgical techniques, and postoperative protocols. PMID:26977549

  3. Total hip arthroplasty revision in elderly patients.

    PubMed

    Gasbarra, Elena; Perrone, Fabio Luigi; Celi, Monica; Rao, Cecilia; Feola, Maurizio; Cuozzo, Nicola; Tarantino, Umberto

    2013-10-01

    In the last years, the number of total hip arthroplasty is increased both in young patients and elderly with a poor bone quality due to extension of surgical indications. According to this trend, also revision surgery showed a growth of its number, especially in elderly patients, because of implant loosening, failed osseointegration of prosthetic components, errors in biomechanical restoration and infections. The aim of this study is to analyze life quality improvement through evaluation of articular functionality and postoperative pain, and to examine osseointegration of implant components with periprosthetic bone. During total hip arthroplasty revision, the orthopedic surgeon often has to face complex cases, especially in elderly patients with a preexisting status of poor bone quality and sarcopenia. In these cases, a correct planning and a surgical procedure well-executed are able to ensure a good outcome that led to pain relief and functional recovery. Furthermore anti-osteoporotic therapy surely represents a useful resource both in primary total hip arthroplasty and in revisions, mainly for elderly patients with a poor bone quality. PMID:24046034

  4. Acetabular Reconstruction in Total Hip Arthroplasty.

    PubMed

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

    2016-03-01

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

  5. Mortality after total hip replacement surgery

    PubMed Central

    Berstock, J. R.; Beswick, A. D.; Lenguerrand, E.; Whitehouse, M. R.; Blom, A. W.

    2014-01-01

    Total hip replacement causes a short-term increase in the risk of mortality. It is important to quantify this and to identify modifiable risk factors so that the risk of post-operative mortality can be minimised. We performed a systematic review and critical evaluation of the current literature on the topic. We identified 32 studies published over the last 10 years which provide either 30-day or 90-day mortality data. We estimate the pooled incidence of mortality during the first 30 and 90 days following hip replacement to be 0.30% (95% CI 0.22 to 0.38) and 0.65% (95% CI 0.50 to 0.81), respectively. We found strong evidence of a temporal trend towards reducing mortality rates despite increasingly co-morbid patients. The risk factors for early mortality most commonly identified are increasing age, male gender and co-morbid conditions, particularly cardiovascular disease. Cardiovascular complications appear to have overtaken fatal pulmonary emboli as the leading cause of death after hip replacement. Cite this article: Bone Joint Res 2014;3:175–82. PMID:24894596

  6. BLEEDING OF FEMORAL HEAD DURING TOTAL HIP ARTHROPLASTY FOR OSTEOARTHROSIS

    PubMed Central

    Schwartsmann, Carlos Roberto; Spinelli, Leandro de Freitas; Sotomayor, Marco Yánez; Yépez, Anthony Kerbes; Boschin, Leonardo Carbonera; Silva, Marcelo Faria

    2015-01-01

    ABSTRACT Objective: To evaluate the bleeding of the femoral head on hip osteoarthritis in patients who underwent total hip arthroplasty. Methods: One hundred and three hips affected by primary hip osteoarthritis were evaluated. After surgical dislocation, the femoral head was divided into four quadrants, and micro perforations were made in order to observe and assess the presence of bleeding, as early type (EB), late type (LB) or without bleeding (WB). Results: We observed early bleeding (EB) in the upper quadrant in 16 hips (15.5%), late bleeding in 14 hips (13.6%) and no bleeding (WB) in 73 hips (70.9%). The anterior quadrant showed EB in 24 hips (23.3%), LB in 7 hips (6.8%) and WB in 72 hips (69.9%). The lower quadrant presented EB in 40 hips (38.8%), LB 14 hips (13.6%) and WB in 49 hips (47.6%). The posterior quadrant showed EB in 39 hips (37.9%), LB 19 hips (18.4%) and WB in 45 hips (43.7%). Comparing BMI and gender, we found no association between these parameters (p> 0.05). Conclusions: The inferior and posterior quadrant had the highest bleeding levels, following the path of the medial circumflex artery. Level of Evidence III, Therapeutic Study. PMID:26981036

  7. Minimally invasive total hip arthroplasty: in opposition.

    PubMed

    Hungerford, David S

    2004-06-01

    At the Knee Society Winter Meeting in 2003, Seth Greenwald and I debated about whether there should be new standards (ie, regulations) applied to the release of information to the public on "new developments." I argued for the public's "right to know" prior to the publication of peer-reviewed literature. He argued for regulatory constraint or "proving by peer-reviewed publication" before alerting the public. It is not a contradiction for me to currently argue against the public advertising of minimally invasive (MIS) total hip arthroplasty as not yet being in the best interest of the public. It is hard to remember a concept that has so captured both the public's and the surgical community's fancy as MIS. Patients are "demanding" MIS without knowing why. Surgeons are offering it as the next best, greatest thing without having developed the skill and experience to avoid the surgery's risks. If you put "minimally invasive hip replacement" into the Google search engine (http://www.google.com), you get 5,170 matches. If you put the same words in PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi), referencing the National Library of Medicine database, you get SEVENTEEN; none is really a peer-reviewed article. Most are 1 page papers in orthopedics from medical education meetings. On the other hand, there are over 6,000 peer-reviewed articles on total hip arthroplasty. Dr. Thomas Sculco, my couterpart in this debate, wrote an insightful editorial in the American Journal of Orthopedic Surgery in which he stated: "Although these procedures have generated incredible interest and enthusiasm, I am concerned that they may be performed to the detriment of our patients." I couldn't agree with him more. Smaller is not necessarily better and, when it is worse, it will be the "smaller" that is held accountable.

  8. Dual mobility cups in total hip arthroplasty

    PubMed Central

    De Martino, Ivan; Triantafyllopoulos, Georgios Konstantinos; Sculco, Peter Keyes; Sculco, Thomas Peter

    2014-01-01

    Total hip arthroplasty (THA) is considered one of the most successful surgical procedures in orthopaedics. With the increase in the number of THAs performed in the world in the next decades, reducing or preventing medical and mechanical complications such as post-operative THA instability will be of paramount importance, particularly in an emerging health care environment based on quality control and patient outcome. Dual mobility acetabular component (also known as unconstrained tripolar implant) was introduced in France at the end of the 1970s as an alternative to standard sockets, to reduce the risk of THA dislocation in patients undergoing primary THA in France. Dual mobility cups have recently gained wider attention in the United States as an alternative option in the prevention and treatment of instability in both primary and revision THA and offer the benefit of increased stability without compromising clinical outcomes and implant longevity. In this article, we review the use of dual mobility cup in total hip arthroplasty in terms of its history, biomechanics, outcomes and complications based on more than 20 years of medical literature. PMID:25035820

  9. [Clinical evaluation tools of total hip arthroplasties].

    PubMed

    Hamadouche, M

    2006-10-01

    Total hip arthroplasty is one of the most efficient hip surgery procedures enabling improved function in the vast majority of operated patients. The major long-term complication is aseptic loosening due to an inflammatory response to particle wear debris coming from the bearings. Polyethylene is the key culprit. Currently two solutions are proposed: eliminating polyethylene from the prosthetic articulation or reducing material wear. This leads to the need for reliable tools for evaluating short-term results, predictive of long-term outcome. When the innovation concerns reduction of polyethylene wear, short-term wear should be measured with software methods or radiostereometry. If the innovation concerns improvement of polyethyleneless implants, then short-term migration should be measured with EBRA or radiostereometry. In addition, the long-term retrospective evaluation of large series of patients remains of major interest provided that it is performed with survival analysis. These different methods are detailed in this study, indicating the pros and cons for each solution. PMID:17088755

  10. Total hip replacement for developmental dysplasia of hip and postoperative nursing.

    PubMed

    Zong, S J; Wang, F; Hu, S L

    2016-01-01

    This study was designed to determine the clinical effect of total hip replacement for the treatment of developmental dysplasia of the hip (DDH) and analyze the postoperative nursing. Sixty patients (78 hips) aged 18-75 years (average 58.6±2.31 years) who received total hip replacement for treatment of DDH at the Zhengzhou People’s Hospital, Henan, China, from April 2013 to June 2016 were selected as research subjects. Twenty-four patients were male (30 hips) and 36 were female (48 hips). Of the 60 patients, according to Crowe typing, 24 were type I (30 hips), 26 were type II (34 hips), 6 were type III (8 hips) and 4 were type IV (6 hips). According to the Harris hip score system, the score of all hips was 39.46±3.56 points average (18-56 points) before treatment and resulted as 89.60±4.25 points (79-98 points) at the last follow-up, showing a statistically significant difference (P < 0.05). Complications such as wound infection, dislocation, fracture of femoral shaft, femoral nerve and injury of sciatic nerve were not found after treatment. A total of 48 cases (58 hips) obtained excellent curative results (93.33% recovery), 8 cases (14 hips) good (92.31% recovery), and 4 cases (6 hips) medium. Total hip replacement proved to be effective in treating DDH and secondary osteoarthritis. Moreover, soft tissue release and an optimum degree recovery of anatomic form and physiological function of the diseased hip is an important basis for reconstructing the acetabulum and stabilizing acetabulum prosthesis. PMID:27049089

  11. Reproduction of Hip Offset and Leg Length in Navigated Total Hip Arthroplasty: How Accurate Are We?

    PubMed

    Ellapparadja, Pregash; Mahajan, Vivek; Deakin, Angela H; Deep, Kamal

    2015-06-01

    This study assesses how accurately we can restore hip offset and leg length in navigated total hip arthroplasty (THA). 152 consecutive patients with navigated THA formed the study group. The contra-lateral hip formed control for measuring hip offset and leg length. All radiological measurements were made using Orthoview digital software. In the normal hip offset group, the mean is 75.73 (SD- 8.61). In the reconstructed hip offset group, the mean is 75.35 (SD - 7.48). 95.39% had hip offset within 6 mm of opposite side while 96.04% had leg length restored within 6 mm of contra-lateral side. Equivalence test revealed that the two groups of hip offsets were essentially the same. We conclude that computer navigation can successfully reproduce hip offset and leg length accurately.

  12. Unstable total hip arthroplasty: detailed overview.

    PubMed

    Berry, D J

    2001-01-01

    Hip dislocation is one of the most common complications of THA. Good preoperative planning, good postoperative patient education, accurate intraoperative component positioning, rigorous intraoperative testing of hip stability, and good repair of soft tissues during closure all help prevent dislocation. Early postoperative dislocations and first or second dislocations usually are treated with closed reduction and a hip guide brace or hip spica cast, but when dislocation becomes recurrent, surgical treatment usually is needed. When possible, surgical treatment is based on identifying and treating a specific problem leading to the dislocation, such as implant malposition, inadequate soft-tissue tension, or impingement. In selected circumstances, constrained implants or bipolar or tripolar implants provide powerful tools to restore hip stability.

  13. Process optimized minimally invasive total hip replacement

    PubMed Central

    Gebel, Philipp; Oszwald, Markus; Ishaque, Bernd; Ahmed, Gaffar; Blessing, Recha; Thorey, Fritz; Ottersbach, Andreas

    2012-01-01

    The purpose of this study was to analyse a new concept of using the the minimally invasive direct anterior approach (DAA) in total hip replacement (THR) in combination with the leg positioner (Rotex- Table) and a modified retractor system (Condor). We evaluated retrospectively the first 100 primary THR operated with the new concept between 2009 and 2010, regarding operation data, radiological and clinical outcome (HOOS). All surgeries were perfomed in a standardized operation technique including navigation. The average age of the patients was 68 years (37 to 92 years), with a mean BMI of 26.5 (17 to 43). The mean time of surgery was 80 min. (55 to 130 min). The blood loss showed an average of 511.5 mL (200 to 1000 mL). No intra-operative complications occurred. The postoperative complication rate was 6%. The HOOS increased from 43 points pre-operatively to 90 (max 100 points) 3 months after surgery. The radiological analysis showed an average cup inclination of 43° and a leg length discrepancy in a range of +/− 5 mm in 99%. The presented technique led to excellent clinic results, showed low complication rates and allowed correct implant positions although manpower was saved. PMID:22577504

  14. Muscular strength after total hip arthroplasty

    PubMed Central

    Winther, Siri B; Husby, Vigdis S; Foss, Olav A; Wik, Tina S; Svenningsen, Svein; Engdal, Monika; Haugan, Kristin; Husby, Otto S

    2016-01-01

    Background and purpose Minimizing the decrease in muscular strength after total hip arthroplasty (THA) might allow patients to recover faster. We evaluated muscular strength in patients who were operated on using 3 surgical approaches. Patients and methods In a prospective cohort study, 60 patients scheduled for primary THA were allocated to the direct lateral, posterior, or anterior approach. Leg press and abduction strength were evaluated 2 weeks or less preoperatively, 2 and 8 days postoperatively, and at 6-week and 3-month follow-up. Results Differences in maximal strength change were greatest after 2 and 8 days. The posterior and anterior approaches produced less decrease in muscular strength than the direct lateral approach. 6 weeks postoperatively, the posterior approach produced greater increase in muscular strength than the direct lateral approach, and resulted in a greater increase in abduction strength than the anterior approach. At 3-month follow-up, no statistically significant differences between the groups were found. The operated legs were 18% weaker in leg press and 15% weaker in abduction than the unoperated legs, and the results were similar between groups. Interpretation The posterior and anterior approaches appeared to have the least negative effect on abduction and leg press muscular strength in the first postoperative week; the posterior approach had the least negative effect, even up to 6 weeks postoperatively. THA patients have reduced muscle strength in the operated leg (compared to the unoperated leg) 3 months after surgery. PMID:26141371

  15. Process optimized minimally invasive total hip replacement.

    PubMed

    Gebel, Philipp; Oszwald, Markus; Ishaque, Bernd; Ahmed, Gaffar; Blessing, Recha; Thorey, Fritz; Ottersbach, Andreas

    2012-01-01

    The purpose of this study was to analyse a new concept of using the the minimally invasive direct anterior approach (DAA) in total hip replacement (THR) in combination with the leg positioner (Rotex- Table) and a modified retractor system (Condor). We evaluated retrospectively the first 100 primary THR operated with the new concept between 2009 and 2010, regarding operation data, radiological and clinical outcome (HOOS). All surgeries were perfomed in a standardized operation technique including navigation. The average age of the patients was 68 years (37 to 92 years), with a mean BMI of 26.5 (17 to 43). The mean time of surgery was 80 min. (55 to 130 min). The blood loss showed an average of 511.5 mL (200 to 1000 mL). No intra-operative complications occurred. The postoperative complication rate was 6%. The HOOS increased from 43 points pre-operatively to 90 (max 100 points) 3 months after surgery. The radiological analysis showed an average cup inclination of 43° and a leg length discrepancy in a range of +/- 5 mm in 99%. The presented technique led to excellent clinic results, showed low complication rates and allowed correct implant positions although manpower was saved. PMID:22577504

  16. CLINICAL OUTCOME AFTER INFECTED TOTAL KNEE AND TOTAL HIP ARTHROPLASTY

    PubMed Central

    Mittag, Falk; Leichtle, Carmen Ina; Schlumberger, Michael; Leichtle, Ulf Gunther; Wünschel, Markus

    2016-01-01

    ABSTRACT Objective: Infection after total hip (THA) and knee arthroplasty (TKA) is a serious complication which typically leads to a long lasting and intensive surgical and medicamentous treatment. The aim of this study was to identify factors that influence outcome after revision surgery caused by prosthetic infection. Methods: We retrospectively analyzed 64 patients who had revision surgery between 1989 and 2009 due to periprosthetic infection. We examined a total of 69 joints (TKA: 36%, THA: 64%), follow-up 5.1 years (0.5-21 years) after the initial surgical intervention. The mean patient age at time of surgery was 67 years old (43-79 years old). Clinical data and scores including the Western Ontario and McMaster Universities (WOMAC)-Index, the Harris Hip Score (HHS) and the Hospital for Special Surgery Score (HSS) were surveyed. Results: There was no difference in clinical scores regarding treatment between a single and a multiple stage treatment regime. Infections with multiple microorganisms and Enterococcus spp. lead to a significantly higher number of interventions. Using a modified Tsukayama system we classified 24% as type I, 34% type II and 42% type III- infections, with no differences in clinical outcome. Overweight patients had a significantly lower HHS and WOMAC-score. Immunosuppression leads to a worse WOMAC and HSS-Score. An increased number of procedures was associated to a limping gait. Conclusion: Thorough surgical technique leads to good clinical results independent of infection-type and treatment philosophy. Level of Evidence III, Case Control Study. PMID:26997914

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

    PubMed

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

    2015-10-01

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

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

    PubMed

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

    2015-10-01

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

  19. Total hip arthroplasty and bone fragility.

    PubMed

    Cherubino, Paolo; Ratti, Chiara; Fagetti, Alessandro; Binda, Tommaso

    2011-04-01

    The number of elderly people is steadily increasing: in the United States it will increase from 12.9% to 20% in 2030 with respect to the total population. Italy, with UK, Denmark and Sweden are the countries with the largest number of octogenarians (about 4% of the population) and it is estimated that this rate will increase by 300% over the next 50 years. The number of people affected by osteoarthritis will increase significantly and therefore the number of total hip arthroplasties will progressively increase. The success of an implant depends firstly by a flawless surgical technique, a correct and stable implant fixation and an optimal preoperative planning that should consider the bone quality of the patient, in order to choose a proper implant design. Different approaches could be followed to achieve adequate fixation: northern Europe surgeons prefer the cemented implant, instead American orthopedics generally use systems that allow a direct biological osteointegration. Elderly patients often present with multiple local and general problems that could affect significantly the normal course of a prosthetic surgery procedure and its results: they have bone tissue changes that lead to increased bone fragility and, consequently, difficulties to obtain primary stability. Osteoporotic bone is characterized by reduction of bone mass, decrease of cancellous bone trabeculae and by increased porosity of cortical bone. The bone fragility implies a greater risk of iatrogenic intraoperative fractures. Furthermore, difficulties linked to bone stock deficiencies become even more significant in revision surgery, where cortical bone thinning is associated with enlargement of the isthmus thus making more difficult to obtain distal fixation of prosthetic stems. At the moment, the role played by the drugs used for the treatment of osteoporosis during implant osteointegration is still not clearly understood and is still under investigation.

  20. Activation of Complement Following Total Hip Replacement.

    PubMed

    Thordardottir, S; Vikingsdottir, T; Bjarnadottir, H; Jonsson, H; Gudbjornsson, B

    2016-03-01

    The aim of this study was to investigate whether complement activation, via the classical and alternative pathways, occurs following a cemented total hip replacement (THR) surgery due to osteoarthritis. Blood samples were collected systematically from 12 patients - six male and six women, with a median age of 75 (range: 59-90 years) - preoperatively, 6 h post-operatively and on the first, second and third post-operative day. Total function of classical (CH50) and alternative pathways (AH50) was evaluated, along with the determination of serum concentrations of the complement proteins C3, C4, C3d, the soluble terminal complement complex (sTCC) sC5b-9, as well as C-reactive protein (CRP) and albumin. Measurements of CRP and albumin levels elucidated a marked inflammatory response following the operation. The CH50, AH50 and C3 and C4 levels were significantly lower 6 h after the surgery compared with the preoperative levels, but elevated above the preoperative levels during the following 3 days. The complement activation product C3d levels increased continually during the whole observation period, from 13.5 AU/ml (range: 8-19 AU/ml) preoperative to 20 AU/ml (range: 12-34 AU/ml) on the third post-operative day. Furthermore, we observed an increase in the sC5b-9 levels between the preoperative and the third post-operative day. These results demonstrate a significant activation of the complement system following cemented THR. Further studies are needed to elucidate the time frame and the pathogenic role of this observed complement activation.

  1. Catastrophic failure of ceramic-on-ceramic total hip arthroplasty presenting as squeaking hip

    PubMed Central

    Malem, David; Nagy, Mathias Thomas; Ghosh, Sabyasachi; Shah, Bhavik

    2013-01-01

    A 68-year-old woman with osteoarthritis had a ceramic-on-ceramic left total hip arthroplasty, including ceramic femoral head and acetabular liner. At 5 years after surgery, the patient developed onset of a very loud squeaking noise, which could be heard 25 m from her, associated with limited hip movement. Findings at revision surgery included a broken ceramic femoral head component, complete wear of the ceramic acetabular component, and black wear debris. Squeaking hip after ceramic-on-ceramic total hip arthroplasty may be associated with catastrophic failure of the arthroplasty components. PMID:23429031

  2. Patient injuries in primary total hip replacement.

    PubMed

    Helkamaa, Teemu; Hirvensalo, Eero; Huhtala, Heini; Remes, Ville

    2016-06-01

    Background and purpose - Although the results of primary total hip replacements (THRs) are generally excellent, sometimes serious complications arise. Some of these severe complications are considered to be patient injuries. We analyzed primary THR-related patient injuries in a nationwide setting. Patients and methods - We evaluated all the primary THR-related patient injury claims in Finland between 2008 and 2010. We used the original medical records and 2 nationwide registries, the Care Register for Social Welfare and Health Care and the Patient Injury Claim Register. Results - We identified 563 claims, 44% of which were compensated (n = 250). Of these 250 compensated claims, 79% were considered to be avoidable (treatment injuries) and 21% were severe unexpected infections (with a preoperative infection risk of less than 2%). The most common type of technical error was cup malposition (31%). High-volume hospitals (with an annual primary THR volume ≥ 400) had a lower patient injury rate. In lower-volume hospitals (with an annual primary THR volume of < 400), the relative risks (RRs) of patient injury for any reason, due to technical errors, or because of cup malposition were 2-fold (95% CI: 1.6-3.1), 4-fold (95% CI: 2.3-6.2), and 9-fold (95% CI: 3-28), respectively, compared to high-volume hospitals. Interpretation - Our study provides the first comprehensive nationwide data on THR-related patient injury types. Hospital volume was associated with the quality and quantity of errors detected. An annual hospital volume of ≥ 400 primary THRs was established as a protective factor against patient injuries. PMID:26808350

  3. Future Bearing Surfaces in Total Hip Arthroplasty

    PubMed Central

    2014-01-01

    One of the most important issues in the modern total hip arthroplasty (THA) is the bearing surface. Extensive research on bearing surfaces is being conducted to seek an ideal bearing surface for THA. The ideal bearing surface for THA should have superior wear characteristics and should be durable, bio-inert, cost-effective, and easy to implant. However, bearing surfaces that are currently being implemented do not completely fulfill these requirements, especially for young individuals for whom implant longevity is paramount. Even though various new bearing surfaces have been investigated, research is still ongoing, and only short-term results have been reported from clinical trials. Future bearing surfaces can be developed in the following ways: (1) change in design, (2) further improvement of polyethylene, (3) surface modification of the metal, (4) improvement in the ceramic, and (5) use of alternative, new materials. One way to reduce wear and impingement in THA is to make changes in its design by using a large femoral head, a monobloc metal shell with preassembled ceramic liner, dual mobility cups, a combination of different bearing surfaces, etc. Polyethylene has improved over time with the development of highly crosslinked polyethylene. Further improvements can be made by reinforcing it with vitamin E or multiwalled carbon nanotubes and by performing a surface modification with a biomembrane. Surface modifications with titanium nitride or titanium niobium nitride are implemented to try to improve the metal bearings. The advance to the fourth generation ceramics has shown relatively promising results, even in young patients. Nevertheless, further improvement is required to reduce fragility and squeaking. Alternative materials like diamond coatings on surfaces, carbon based composite materials, oxidized zirconium, silicon nitride, and sapphire are being sought. However, long-term studies are necessary to confirm the efficacy of these surfaces after enhancements

  4. Patient injuries in primary total hip replacement

    PubMed Central

    Helkamaa, Teemu; Hirvensalo, Eero; Huhtala, Heini; Remes, Ville

    2016-01-01

    Background and purpose Although the results of primary total hip replacements (THRs) are generally excellent, sometimes serious complications arise. Some of these severe complications are considered to be patient injuries. We analyzed primary THR-related patient injuries in a nationwide setting. Patients and methods We evaluated all the primary THR-related patient injury claims in Finland between 2008 and 2010. We used the original medical records and 2 nationwide registries, the Care Register for Social Welfare and Health Care and the Patient Injury Claim Register. Results We identified 563 claims, 44% of which were compensated (n = 250). Of these 250 compensated claims, 79% were considered to be avoidable (treatment injuries) and 21% were severe unexpected infections (with a preoperative infection risk of less than 2%). The most common type of technical error was cup malposition (31%). High-volume hospitals (with an annual primary THR volume ≥ 400) had a lower patient injury rate. In lower-volume hospitals (with an annual primary THR volume of < 400), the relative risks (RRs) of patient injury for any reason, due to technical errors, or because of cup malposition were 2-fold (95% CI: 1.6–3.1), 4-fold (95% CI: 2.3–6.2), and 9-fold (95% CI: 3–28), respectively, compared to high-volume hospitals. Interpretation Our study provides the first comprehensive nationwide data on THR-related patient injury types. Hospital volume was associated with the quality and quantity of errors detected. An annual hospital volume of ≥ 400 primary THRs was established as a protective factor against patient injuries. PMID:26808350

  5. Future bearing surfaces in total hip arthroplasty.

    PubMed

    Chang, Jun-Dong

    2014-03-01

    One of the most important issues in the modern total hip arthroplasty (THA) is the bearing surface. Extensive research on bearing surfaces is being conducted to seek an ideal bearing surface for THA. The ideal bearing surface for THA should have superior wear characteristics and should be durable, bio-inert, cost-effective, and easy to implant. However, bearing surfaces that are currently being implemented do not completely fulfill these requirements, especially for young individuals for whom implant longevity is paramount. Even though various new bearing surfaces have been investigated, research is still ongoing, and only short-term results have been reported from clinical trials. Future bearing surfaces can be developed in the following ways: (1) change in design, (2) further improvement of polyethylene, (3) surface modification of the metal, (4) improvement in the ceramic, and (5) use of alternative, new materials. One way to reduce wear and impingement in THA is to make changes in its design by using a large femoral head, a monobloc metal shell with preassembled ceramic liner, dual mobility cups, a combination of different bearing surfaces, etc. Polyethylene has improved over time with the development of highly crosslinked polyethylene. Further improvements can be made by reinforcing it with vitamin E or multiwalled carbon nanotubes and by performing a surface modification with a biomembrane. Surface modifications with titanium nitride or titanium niobium nitride are implemented to try to improve the metal bearings. The advance to the fourth generation ceramics has shown relatively promising results, even in young patients. Nevertheless, further improvement is required to reduce fragility and squeaking. Alternative materials like diamond coatings on surfaces, carbon based composite materials, oxidized zirconium, silicon nitride, and sapphire are being sought. However, long-term studies are necessary to confirm the efficacy of these surfaces after enhancements

  6. Retrieval analysis of 240 metal-on-metal hip components, comparing modular total hip replacement with hip resurfacing.

    PubMed

    Matthies, A; Underwood, R; Cann, P; Ilo, K; Nawaz, Z; Skinner, J; Hart, A J

    2011-03-01

    This study compared component wear rates and pre-revision blood metal ions levels in two groups of failed metal-on-metal hip arthroplasties: hip resurfacing and modular total hip replacement (THR). There was no significant difference in the median rate of linear wear between the groups for both acetabular (p = 0.4633) and femoral (p = 0.0872) components. There was also no significant difference in the median linear wear rates when failed hip resurfacing and modular THR hips of the same type (ASR and Birmingham hip resurfacing (BHR)) were compared. Unlike other studies of well-functioning hips, there was no significant difference in pre-revision blood metal ion levels between hip resurfacing and modular THR. Edge loading was common in both groups, but more common in the resurfacing group (67%) than in the modular group (57%). However, this was not significant (p = 0.3479). We attribute this difference to retention of the neck in resurfacing of the hip, leading to impingement-type edge loading. This was supported by visual evidence of impingement on the femur. These findings show that failed metal-on-metal hip resurfacing and modular THRs have similar component wear rates and are both associated with raised pre-revision blood levels of metal ions. PMID:21357950

  7. Contralateral Total Hip Arthroplasty After Hindquarter Amputation

    PubMed Central

    Sommerville, Scott M. M.; Patton, James T.; Luscombe, Jonathan C.; Grimer, Robert J.

    2006-01-01

    We describe the management and outcome of a 62-year old lady who developed severe osteoarthritis of the hip, nine years after a hindquarter amputation for radiation-induced sarcoma of the contralateral pelvis. The difficulties of stabilising the pelvis intraoperatively and the problems of postoperative rehabilitation are outlined. The operation successfully relieved her pain and restored limited mobility. PMID:17496994

  8. Reconstruction of the Acetabulum in Developmental Dysplasia of the Hip in total hip replacement.

    PubMed

    Sakellariou, Vasileios I; Christodoulou, Michael; Sasalos, Gregory; Babis, George C

    2014-09-01

    Developmental dysplasia of the hip (DDH) or congenital hip dysplasia (CDH) is the most prevalent developmental childhood hip disorder. It includes a wide spectrum of hip abnormalities ranging from dysplasia to subluxation and complete dislocation of the hip joint. The natural history of neglected DDH in adults is highly variable. The mean age of onset of symptoms is 34.5 years for dysplastic DDH, 32.5 years for low dislocation, 31.2 years for high dislocation with a false acetabulum, and 46.4 years for high dislocation without a false acetabulum. Thorough understanding of the bony and soft tissue deformities induced by dysplasia is crucial for the success of total hip arthroplasty. It is important to evaluate the existing acetabular deformity three-dimensionally, and customize the correction in accordance with the quantity and location of ace tabular deficiencies. Acetabular reconstruction in patients with DDH is challenging. Interpretation of published data is difficult and should be done with caution because most series include patients with different types of hip disease. In general, the complication rate associated with THA is higher in patients with hip dysplasia than it is in patients with osteoarthritis. Overall, clinical and functional outcomes following THA in patients hip dysplasia (DDH) differ from those treated for primary hip osteoarthritis, possibly due to the lower age and level of activity. Although function scores decline with age, the scores for pain and range of motion presented with a statistically significant improvement in the long-term. PMID:25386570

  9. [Hemispheric hydroxyapatite coated cups in total hip arthroplasty].

    PubMed

    Blacha, J; Bednarek, A; Gagała, J

    1998-01-01

    The paper presents principles of implantation as well as clinical and radiological results of hemispheric hydroxyapatite coated cups use in total hip replacement. Eighty-seven patients (60 females, 27 males) aged from 16 to 72 years (mean 49 years) underwent 96 total hip replacements with the use of 51 ABG and 45 OCTOFIT hemispheric cups. Clinical results were satisfactory with an average Harris Hip Score of 89 to 91 at final follow-up. We have found total ingrowth and osteointegration of nearly all cups. In one case of acetabular reconstruction with bone grafts cup migration has been observed and revision was necessary.

  10. Sir John Charnley (1911-1982): inspiration to future generations of orthopaedic surgeons.

    PubMed

    Donald, S M

    2007-05-01

    For young doctors embarking on a career in medicine, the decision on which path to take is often influenced by their experiences as an undergraduate student and, in particular, by those doctors and teachers who have stimulated and encouraged them. Likewise, inspiration can be derived from studying the life and work of eminent practitioners of the past. A final year elective module provided me with the opportunity to undertake a detailed critique of an aspect of the history of medicine of my choosing, which enabled me to investigate the history of hip replacement. This opened my eyes to the prodigious contribution of Sir John Charnley in the field of orthopaedics. His commitment to the practice and advancement of medical science is indeed an inspiration. This account of John Charnley's work is a testimony to the lifetime achievements of one man, whose hard work and dedication have brought enormous benefit to generations of patients the world over.

  11. Alternative bearings in total hip arthroplasty in the young patient.

    PubMed

    Kamath, Atul F; Prieto, Hernan; Lewallen, David G

    2013-10-01

    Total hip arthroplasty is an effective treatment option for advanced hip arthritis in elderly patients. Studies in young patients have traditionally shown less durable results. With current implants, surgical technique, and cementless fixation methods, the durability of total hip arthroplasty may now be related to the wear performance of the bearing surfaces. To improve implant longevity, there are several bearing surface choices currently available for this demanding group of patients. Alternatives must be evaluated in terms of the risks and benefits associated with each articulation, and all new technologies must be carefully monitored over the long term. PMID:24095062

  12. Are Hip Precautions Necessary Post Total Hip Arthroplasty? A Systematic Review

    PubMed Central

    Barnsley, Leslie; Page, Richard

    2015-01-01

    Purpose: Total hip arthroplasty (THA) is a common and effective treatment of hip osteoarthritis. Activity restrictions known as hip precautions are widely practiced in rehabilitation post THA, aiming to foster healing and prevent hip dislocation. The focused clinical question was: Does the application of hip precautions in patients post THA versus unrestricted activities significantly decrease the risk of prosthetic dislocation? Methods: A comprehensive literature search was conducted for randomized controlled trials or cohort studies with a comparative group and minimum 6 months follow-up, with dislocation as an end point. Retrieved titles were assessed independently by 2 reviewers for inclusion and underwent standardized data extraction. Results: Title search produced 80 potentially relevant articles. Five articles were retrieved for data extraction of which 2 met a prior eligibility criteria. No eligible studies were found that concerned posterior approaches to hip arthroplasty, so the results of this review concern only anterolateral approaches. Neither included study showed any benefit of hip precautions in preventing dislocation. Conclusion: The rate of dislocation after anterolateral THA is low and is not improved by hip precautions. Hip precautions are associated with a slower return to activities, significant expense, and decreased patient satisfaction. Existing studies risk being compromised by a type II error, but a definitive study may be prohibitively large and expensive. PMID:26328242

  13. Socket and cup surface replacement of the hip.

    PubMed

    Nishio, A; Eguchi, M; Kaibara, N

    1978-01-01

    To improve the surgical results of severe osteoarthritis of the hip, surface replacement of the hip using a double cup without cement was employed on 75 hips during the period from 1972 to 1977. The results of the procedures have been analyzed on 67 hips followed for more than 6 months. The most dramatic improvement following the procedure has been pain relief, observed in 58 of 67 hips (86%). Three reoperations were necessary. Failures were treated satisfactorily either by total hip replacement, or by arthrodesis and/or by placing a new cup on the head respectively. There was no operative death, pulmonary embolism, thrombophlebitis, nor deep infection. We do not think this procedure replaces more definitive surgery such as the Charnley-type total hip replacement, but it is a good adjunctive procedure particularly in patients younger than 60 years of age.

  14. Recurrent Catastrophic Ceramic Femoral Head Failure in Total Hip Arthroplasty

    PubMed Central

    Tai, S. M. M.; Parker, L.; de Roeck, N. J.; Skinner, J. A.

    2014-01-01

    Fracture of a modern ceramic head component in total hip replacement is an uncommon but catastrophic complication. Hence, the occurrence of a second ceramic head fracture in the same hip replacement of an individual represents a perishingly rare event. We present the case as a means of highlighting potential risk factors for ceramic head fracture and suggest possible management strategies in such cases. PMID:24991441

  15. Preventing Leg Length Discrepancy and Instability After Total Hip Arthroplasty.

    PubMed

    Sculco, Peter K; Austin, Matthew S; Lavernia, Carlos J; Rosenberg, Aaron G; Sierra, Rafael J

    2016-01-01

    Restoration of equal leg lengths and dynamic hip stability are essential elements of a successful total hip arthroplasty. A careful clinical examination, a preoperative plan, and appropriate intraoperative techniques are necessary to achieve these goals. Preoperative identification of patients at risk for residual leg length discrepancy allows surgeons to adjust the surgical approach and/or the type of implant and provide better preoperative patient education. The use of larger femoral heads, high-offset stem options, and enhanced soft-tissue repairs have improved impingement-free range of motion as well as dynamic hip stability and have contributed to an overall reduction in dislocation. Methods for accurate leg length restoration and component positioning include anatomic landmarks, intraoperative radiographs, intraoperative calipers, stability testing, and computer-assisted surgery. If recurrent instability occurs after total hip arthroplasty, the underlying cause for dislocation should be identified and treated; this may include the use of semiconstrained dual-mobility or fully constrained liners, depending on abductor function. Surgeons should be aware of the clinical and surgical techniques for achieving leg length equalization and dynamic hip stability in total hip arthroplasty. PMID:27049193

  16. Prevalence of osteoporosis in patients awaiting total hip arthroplasty

    PubMed Central

    Domingues, Vitor Rodrigues; de Campos, Gustavo Constantino; Plapler, Pérola Grimberg; de Rezende, Márcia Uchôa

    2015-01-01

    Objective: To evaluate the prevalence of osteoporosis in patients awaiting total hip arthroplasty. Method: Twenty-nine patients diagnosed with hip osteoarthritis awaiting primary total arthroplasty of the hip answered WOMAC questionnaire, VAS and questions about habits, osteoporosis and related diseases. Bone mineral densitometry of the lumbar spine and hips and laboratory tests (complete blood count and examination of calcium metabolism) were performed. Weight and height were measured to calculate body mass index (BMI). The evaluated quantitative characteristics were compared between patients with and without osteoporosis using the Mann-Whitney tests. Results: Thirteen men and 16 women with a mean age of 61.5 years old, WOMAC 51.4; EVA 6.4 and BMI 27.6 were evaluated. The prevalence of osteoporosis was 20.7%, and 37.9% had osteopenia. Patients with osteoporosis were older than patients without osteoporosis (p=0.006). The mean bone mineral density of the femoral neck without hip osteoarthritis was lower than the affected side (p=0.007). Thirty-five percent of patients did not know what osteoporosis is. Of these, 30% had osteopenia or osteoporosis. Conclusion: osteoarthritis and osteoporosis may coexist and the population waiting for total hip arthroplasty should be considered at risk for the presence of osteoporosis. Level of Evidence III, Observational Study. PMID:26327793

  17. Composite technology for total hip arthroplasty.

    PubMed

    Skinner, H B

    1988-10-01

    Composite materials, which can be very strong while having a low modulus of elasticity, are being studied because such materials have potential to be made into isoelastic hip prostheses. Composites intended for medical applications incorporate carbon or polyamide as a fiber component, while polysulfone, polyetheretherketone, or polyethylene is used as a matrix component. Mechanical properties (especially the modulus of elasticity) are emphasized because of the desire to match those properties of the proximal femur. Many of the variables that affect the mechanical properties of these materials are explained. The application of stress to different fiber orientations demonstrates the mechanical properties of the composite, and this is proved mathematically. It is shown that in composites with fibers oriented in the same direction, the modulus of elasticity in the direction of the fibers generally approaches that of the fibers as the amount of matrix decreases. Perpendicular to the fibers, the modulus of elasticity of the composite is only slightly greater than that of the matrix material. For isotropic chopped-fiber composites, the modulus of elasticity approaches that of the matrix as the fiber content decreases; at high-fiber content, the modulus is significantly less than that of oriented long-fiber composites. In general, the modulus of elasticity and fiber content have a linear relationship. Composites have fatigue properties that vary with direction and approach ultimate strength in tension but are lower in compression. The fatigue properties of proposed composites are discussed. Abrasion as a cause of stress concentration sites and wear particles is considered.

  18. Is tantalum protective against infection in revision total hip arthroplasty?

    PubMed

    Tokarski, A T; Novack, T A; Parvizi, J

    2015-01-01

    We hypothesised that the use of tantalum (Ta) acetabular components in revision total hip arthroplasty (THA) was protective against subsequent failure due to infection. We identified 966 patients (421 men, 545 women and 990 hips) who had undergone revision THA between 2000 and 2013. The mean follow up was 40.2 months (3 months to 13.1 years). The mean age of the men and women was 62.3 years (31 to 90) and 65.1 years (25 to 92), respectively. Titanium (Ti) acetabular components were used in 536 hips while Ta components were used in 454 hips. In total, 73 (7.3%) hips experienced subsequent acetabular failure. The incidence of failure was lower in the Ta group at 4.4% (20/454) compared with 9.9% (53/536) in the Ti group (p < 0.001, odds ratio 2.38; 95% CI 1.37 to 4.27). Among the 144 hips (64 Ta, 80 Ti) for which revision had been performed because of infection, failure due to a subsequent infection was lower in the Ta group at 3.1% (2/64) compared with 17.5% (14/80) for the Ti group (p = 0.006). Thus, the use of Ta acetabular components during revision THA was associated with a lower incidence of failure from all causes and Ta components were associated with a lower incidence of subsequent infection when used in patients with periprosthetic joint infection.

  19. Composite technology for total hip arthroplasty.

    PubMed

    Skinner, H B

    1988-10-01

    Composite materials, which can be very strong while having a low modulus of elasticity, are being studied because such materials have potential to be made into isoelastic hip prostheses. Composites intended for medical applications incorporate carbon or polyamide as a fiber component, while polysulfone, polyetheretherketone, or polyethylene is used as a matrix component. Mechanical properties (especially the modulus of elasticity) are emphasized because of the desire to match those properties of the proximal femur. Many of the variables that affect the mechanical properties of these materials are explained. The application of stress to different fiber orientations demonstrates the mechanical properties of the composite, and this is proved mathematically. It is shown that in composites with fibers oriented in the same direction, the modulus of elasticity in the direction of the fibers generally approaches that of the fibers as the amount of matrix decreases. Perpendicular to the fibers, the modulus of elasticity of the composite is only slightly greater than that of the matrix material. For isotropic chopped-fiber composites, the modulus of elasticity approaches that of the matrix as the fiber content decreases; at high-fiber content, the modulus is significantly less than that of oriented long-fiber composites. In general, the modulus of elasticity and fiber content have a linear relationship. Composites have fatigue properties that vary with direction and approach ultimate strength in tension but are lower in compression. The fatigue properties of proposed composites are discussed. Abrasion as a cause of stress concentration sites and wear particles is considered. PMID:3416528

  20. Combined Anterior and Posterior Approach in Total Hip Arthroplasty for Crowe IV Dysplasia or Ankylosed Hips.

    PubMed

    Lee, Young-Kyun; Kim, Ki-Choul; Ha, Yong-chan; Koo, Kyung-Hoi

    2015-05-01

    We evaluated 70 patients (71 hips) who underwent complex total hip arthroplasty (THA) through the combined anterior and posterior approach. Sixty-five patients (32 dislocated hips and 34 ankylosed hips) were followed-up at a minimum of 3 years (median, 6 years; range, 3-10 years). Seven patients (10.6%), who had transient paresthesia on the anterior thigh, recovered within 3 months. All patients had a good clinical outcome in terms of range of motion, pain and recovery of walking. At the latest follow-up, all prostheses had bone-ingrown stability without any detectable wear or osteolysis. The combined approach allows an excellent exposure of the acetabulum for accurate cup alignment, leg lengthening and mobilization of joint in complex THA without trochanteric osteotomy, excessive abductor release and femoral shortening osteotomy. PMID:25682205

  1. The utility of bladder catheterization in total hip arthroplasty.

    PubMed

    Iorio, Richard; Whang, William; Healy, William L; Patch, Douglas A; Najibi, Soheil; Appleby, David

    2005-03-01

    The use of a urinary bladder catheter in patients having a total hip arthroplasty is controversial. Universal insertion of an indwelling catheter before a total hip arthroplasty, and insertion of a catheter postoperatively as necessary, are accepted variations of care. From 1993 to 1999, 719 patients having primary, unilateral total hip arthroplasties were randomized by surgeons into two groups: a group of patients who had universal preoperative insertion of an indwelling bladder catheter (340 patients) and an observation group who had catheterization as needed (379 patients). Catheterization was required for 295 of these 379 patients (77.8%). Patients were followed up using a total hip arthroplasty database, which recorded all complications. Six patients (1.8%) in the universal catheter insertion group had a urinary tract infection develop. Nine patients (2.4%) in the catheter as necessary group had a urinary tract infection develop. There was no significant difference in incidence of urinary tract infections between the two groups. Female gender and increasing age were associated with a higher incidence of urinary tract infection in both groups. The average length of stay in the hospital for the universal catheter group was 4.8 days, and the average length of stay for the catheter as necessary group was 4.5 days. There was no significant difference in length of stay in the hospital between the two groups. The universal catheter group had an average 590 dollars higher hospital cost for their total hip arthroplasties, which was significant. Routine preoperative bladder catheterization may not be warranted in patients having total hip arthroplasties. Postoperative catheterization as necessary may be more cost effective. PMID:15738815

  2. Perioperative Pain Management in Total Hip Arthroplasty: Korean Hip Society Guidelines

    PubMed Central

    Kim, Yeesuk; Cho, Hong-Man; Park, Kyung-Soon; Yoon, Pil Whan; Nho, Jae-Hwi; Kim, Sang-Min; Lee, Kyung-Jae; Moon, Kyong-Ho

    2016-01-01

    Effective perioperative pain management techniques and accelerated rehabilitation programs can improve health-related quality of life and functional status of patients after total hip arthroplasty. Traditionally, postoperative analgesia following arthroplasty was provided by intravenous patient-controlled analgesia or epidural analgesia. Recently, peripheral nerve blockade has emerged alternative analgesic approach. Multimodal analgesia strategy combines analgesics with different mechanisms of action to improve pain management. Intraoperative periarticular injection of multimodal drugs is one of the most important procedures in perioperative pain control for total hip arthroplasty. The goal of this review article is to provide a concise overview of the principles of multimodal pain management regimens as a practical guide for the perioperative pain management for total hip arthroplasty. PMID:27536639

  3. Perioperative Pain Management in Total Hip Arthroplasty: Korean Hip Society Guidelines.

    PubMed

    Min, Byung-Woo; Kim, Yeesuk; Cho, Hong-Man; Park, Kyung-Soon; Yoon, Pil Whan; Nho, Jae-Hwi; Kim, Sang-Min; Lee, Kyung-Jae; Moon, Kyong-Ho

    2016-03-01

    Effective perioperative pain management techniques and accelerated rehabilitation programs can improve health-related quality of life and functional status of patients after total hip arthroplasty. Traditionally, postoperative analgesia following arthroplasty was provided by intravenous patient-controlled analgesia or epidural analgesia. Recently, peripheral nerve blockade has emerged alternative analgesic approach. Multimodal analgesia strategy combines analgesics with different mechanisms of action to improve pain management. Intraoperative periarticular injection of multimodal drugs is one of the most important procedures in perioperative pain control for total hip arthroplasty. The goal of this review article is to provide a concise overview of the principles of multimodal pain management regimens as a practical guide for the perioperative pain management for total hip arthroplasty. PMID:27536639

  4. Learning curve for the anterior approach total hip arthroplasty.

    PubMed

    Goytia, Robin N; Jones, Lynne C; Hungerford, Marc W

    2012-01-01

    The anterior approach to total hip arthroplasty has the advantages of using intermuscular and internervous planes, but it is technically demanding. We evaluated the learning curve for this approach with regard to operative parameters and immediate outcomes. From November 2005 through May 2007, 73 patients underwent 81 consecutive primary anterior-approach total hip arthroplasties. We grouped the hips into three consecutive groups of 20 and one of 21, and surgical and fluoroscopy times, estimated blood loss, intraoperative and postoperative complications, patient comorbidities, component position, and leg-length discrepancy were compared (statistical significance, p < 0.05). Comparing Groups 1 and 4, there were only two significant differences: operative time, 124 to 98 minutes, respectively, and estimated blood loss, 596 to 347 mL, respectively. Proficiency improved after Group 2 (40 cases) and was more marked after Group 3 (60 cases), with no major complications. Surgeons considering this approach should expect a substantial learning period.

  5. Wear testing of total hip replacements under severe conditions.

    PubMed

    Zietz, Carmen; Fabry, Christian; Reinders, Joern; Dammer, Rebecca; Kretzer, Jan Philippe; Bader, Rainer; Sonntag, Robert

    2015-07-01

    Controlled wear testing of total hip replacements in hip joint simulators is a well-established and powerful method, giving an extensive prediction of the long-term clinical performance. To understand the wear behavior of a bearing and its limits under in vivo conditions, testing scenarios should be designed as physiologically as possible. Currently, the ISO standard protocol 14242 is the most common preclinical testing procedure for total hip replacements, based on a simplified gait cycle for normal walking conditions. However, in recent years, wear patterns have increasingly been observed on retrievals that cannot be replicated by the current standard. The purpose of this study is to review the severe testing conditions that enable the generation of clinically relevant wear rates and phenomena. These conditions include changes in loading and activity, third-body wear, surface topography, edge wear and the role of aging of the bearing materials. PMID:26048088

  6. A Water Rehabilitation Program in Patients with Hip Osteoarthritis Before and After Total Hip Replacement.

    PubMed

    Łyp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; Włostowska, Ewa; Stanisławska, Iwona; Szypuła, Jan; Tomaszewski, Wiesław

    2016-01-01

    BACKGROUND Pain associated with coxarthrosis, typically occurring in middle-aged and elderly patients, very commonly causes considerable limitation of motor fitness and dependence on pharmacotherapy. This article provides an assessment of a rehabilitation program with tailored water exercises in patients with osteoarthritis before and after total hip replacement. MATERIAL AND METHODS A total of 192 patients (the mean age 61.03±10.89) suffering from hip osteoarthritis (OA) were evaluated before and after total hip replacement (THR). The clinical study covered measurements of hip active ranges of motion (HAROM) and the forces generated by pelvis stabilizer muscles. Pain intensity was assessed according to analogue-visual scale of pain (VAS) and according to the Modified Laitinen Questionnaire. The patients were divided into 6 groups (4 treatment and 2 control). We compared 2 rehabilitation programs using kinesitherapy and low-frequency magnetic field. One of them also had specially designed exercises in the water. Statistical analysis was carried out at the significance level α=0.05. This was a cross-sectional study. RESULTS A positive effect of water exercises on a number of parameters was found in patients with OA both before and after total hip replacement surgery. We noted a significant reduction of pain (p<0.001), increased ranges of motion and muscle strength, and reduced use of medicines (NASAIDs) (p<0.001). A correlation was found between the degree of degenerative deforming lesions and the effects of the treatment process (p<0.01). CONCLUSIONS 1. The rehabilitation program including water exercises most significantly reduced pain in patients with OA before and after total hip replacement surgery. 2. Inclusion of water exercises in a rehabilitation program can reduce the use of medicines in patient with OA and after THR. PMID:27455419

  7. A Water Rehabilitation Program in Patients with Hip Osteoarthritis Before and After Total Hip Replacement

    PubMed Central

    Łyp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; Włostowska, Ewa; Stanisławska, Iwona; Szypuła, Jan; Tomaszewski, Wiesław

    2016-01-01

    Background Pain associated with coxarthrosis, typically occurring in middle-aged and elderly patients, very commonly causes considerable limitation of motor fitness and dependence on pharmacotherapy. This article provides an assessment of a rehabilitation program with tailored water exercises in patients with osteoarthritis before and after total hip replacement. Material/Methods A total of 192 patients (the mean age 61.03±10.89) suffering from hip osteoarthritis (OA) were evaluated before and after total hip replacement (THR). The clinical study covered measurements of hip active ranges of motion (HAROM) and the forces generated by pelvis stabilizer muscles. Pain intensity was assessed according to analogue-visual scale of pain (VAS) and according to the Modified Laitinen Questionnaire. The patients were divided into 6 groups (4 treatment and 2 control). We compared 2 rehabilitation programs using kinesitherapy and low-frequency magnetic field. One of them also had specially designed exercises in the water. Statistical analysis was carried out at the significance level α=0.05. This was a cross-sectional study. Results A positive effect of water exercises on a number of parameters was found in patients with OA both before and after total hip replacement surgery. We noted a significant reduction of pain (p<0.001), increased ranges of motion and muscle strength, and reduced use of medicines (NASAIDs) (p<0.001). A correlation was found between the degree of degenerative deforming lesions and the effects of the treatment process (p<0.01). Conclusions 1. The rehabilitation program including water exercises most significantly reduced pain in patients with OA before and after total hip replacement surgery. 2. Inclusion of water exercises in a rehabilitation program can reduce the use of medicines in patient with OA and after THR. PMID:27455419

  8. A Water Rehabilitation Program in Patients with Hip Osteoarthritis Before and After Total Hip Replacement.

    PubMed

    Łyp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; Włostowska, Ewa; Stanisławska, Iwona; Szypuła, Jan; Tomaszewski, Wiesław

    2016-07-25

    BACKGROUND Pain associated with coxarthrosis, typically occurring in middle-aged and elderly patients, very commonly causes considerable limitation of motor fitness and dependence on pharmacotherapy. This article provides an assessment of a rehabilitation program with tailored water exercises in patients with osteoarthritis before and after total hip replacement. MATERIAL AND METHODS A total of 192 patients (the mean age 61.03±10.89) suffering from hip osteoarthritis (OA) were evaluated before and after total hip replacement (THR). The clinical study covered measurements of hip active ranges of motion (HAROM) and the forces generated by pelvis stabilizer muscles. Pain intensity was assessed according to analogue-visual scale of pain (VAS) and according to the Modified Laitinen Questionnaire. The patients were divided into 6 groups (4 treatment and 2 control). We compared 2 rehabilitation programs using kinesitherapy and low-frequency magnetic field. One of them also had specially designed exercises in the water. Statistical analysis was carried out at the significance level α=0.05. This was a cross-sectional study. RESULTS A positive effect of water exercises on a number of parameters was found in patients with OA both before and after total hip replacement surgery. We noted a significant reduction of pain (p<0.001), increased ranges of motion and muscle strength, and reduced use of medicines (NASAIDs) (p<0.001). A correlation was found between the degree of degenerative deforming lesions and the effects of the treatment process (p<0.01). CONCLUSIONS 1. The rehabilitation program including water exercises most significantly reduced pain in patients with OA before and after total hip replacement surgery. 2. Inclusion of water exercises in a rehabilitation program can reduce the use of medicines in patient with OA and after THR.

  9. Assessment of polyethylene wear in total hip replacement.

    PubMed

    Devane, P A; Horne, J G

    1999-12-01

    The three-dimensional technique is a method for the measurement of polyethylene wear in patients with total hip joint replacement. Application of image processing technology allows automation of point selection from digital images of radiographs scanned into the computer. Validation of image processing modifications reveals a three-fold increase in accuracy and a 40-fold increase in reproducibility compared with manual input of points from a digitizer during bench testing. A review of three-dimensional technique application to clinical patients gives information on the factors that influence polyethylene wear. Increasing age, activity level, femoral head size, decreasing polyethylene thickness, and insertion of total hip prostheses without cement all increase polyethylene wear. Restoration of femoral offset during total hip replacement seems to decreases polyethylene wear. No apparent difference in polyethylene wear rate could be found between two groups of patients, one group had a stainless steel-polyethylene articulation and the other had a ceramic-polyethylene articulation. Measurement of the serial polyethylene wear of individual patients reveals a high rate of femoral head penetration during the first 2 years after total hip replacement using metal-backed acetabular components inserted without cement. Interpretation of this femoral head penetration as true polyethylene wear may be erroneous, however, because creep of the polyethylene and acetabular liner movement within its metal shell cannot be measured. PMID:10611861

  10. Internal iliac artery pseudoaneurysm in primary total hip arthroplasty

    PubMed Central

    Agarwala, Sanjay; Mohrir, Ganesh; Moonot, Pradeep

    2016-01-01

    Vascular injury is one of the rare complications of primary total hip arthroplasty (THA). We report an unusual case of lobulated pseudoaneurysm arising from one of the branches of the left internal iliac artery during acetabulum preparation in THA, which was successfully treated with coil embolization and multidisciplinary care. After 6 years follow up, patient did not have any symptoms related to the hip replacement. We recommend that surgeons should be extremely cautious while drilling medial wall of the acetabulum for depth assessment. Aggressive multidisciplinary approach, including possible support from an interventional radiologist is required for the treatment of such vascular injuries. PMID:27053814

  11. [Total hip arthroplasty with a less invasive anterolateral approach].

    PubMed

    Bopp, F

    2014-04-01

    Soft tissue injury in total hip replacements has recently developed into a main topic of orthopaedic surgery. The M. glutaeus medius is at risk to be injured in Watson-Jones' approach to the hip. A special technique in positioning of the leg offers the possibility to save the integrity of the muscles. While profiling the femur shaft the leg is held underneath the opposite leg in outer rotation, hyperextention and forced adduction. The advantage in comparison to other less invasive techniques is the common supine position of the patient on the table. The different technical steps are easy to achieve.

  12. Bilateral total hip replacement in arthrogryposis multiplex congenita.

    PubMed

    Dalton, David Michael; Magill, Paul; Mulhall, Kevin James

    2015-01-01

    The authors present a case of bilateral total hip replacements (THRs) in a 56-year-old patient with arthrogryposis multiplex congenita (AMC). The considerations for the perioperative period and the outcome are discussed. Preoperative planning included an anaesthetic review and availability of fiberoptic intubation due to poor mouth opening. Perioperatively, contractures can make positioning and exposure difficult but in this case a standard posterior approach was taken. Particular attention was given to soft tissue balancing given the theoretical risk of dislocation. There were no perioperative complications. Postoperatively there has been improvement in pain and hip scores but the patient has failed to return to work. Objective improvements in range of motion (ROM) have not been made. This experience suggests THR is a safe and effective treatment for osteoarthritic hip pain in patients with AMC but patients should be informed that ROM is unlikely to improve. PMID:26607193

  13. Alumina-on-Polyethylene Bearing Surfaces in Total Hip Arthroplasty

    PubMed Central

    Jung, Yup Lee; Kim, Shin-Yoon

    2010-01-01

    The long-term durability of polyethylene lining total hip arthroplasty (THA) mainly depends on periprosthetic osteolysis due to wear particles, especially in young active patients. In hip simulator study, reports revealed significant wear reduction of the alumina ceramic-on-polyethylene articulation of THA compared with metal-on-polyethylene bearing surfaces. However, medium to long-term clinical studies of THA using the alumina ceramic-on-polyethylene are few and the reported wear rate of this articulation is variable. We reviewed the advantages and disadvantages of ceramicon- polyethylene articulation in THA, hip simulator study and retrieval study for polyethylene wear, in vivo clinical results of THA using alumina ceramic-on-polyethylene bearing surfaces in the literature, and new trial alumina ceramic-onhighly cross linked polyethylene bearing surfaces. PMID:20224739

  14. Fracture of the Modular Neck in Total Hip Arthroplasty

    PubMed Central

    Hernandez, A.; Gargallo-Margarit, A.; Barro, V.; Gallardo-Calero, I.; Sallent, A.

    2015-01-01

    Modularity of the components in total hip arthroplasty has had an increase in popularity in the last decades. We present the case of a 53-year-old man with a history of avascular necrosis of the femoral head due to a hypophyseal adenoma. A total hip modular arthroplasty was implanted. Three and a half years after the surgery the patient attended the emergency room due to acute left hip pain with no prior traumatism. Radiological examination confirmed a fracture of the modular neck. A revision surgery was performed finding an important pseudotumoral well-organized periprosthetic tissue reaction. Through an extended trochanteric osteotomy the femoral component was removed, and a straight-stem revision prosthesis implanted. There are several potential advantages when using modularity in total hip arthroplasty that surgeons may benefit from, but complications have arisen and must be addressed. Various circumstances such as large femoral head with a long varus neck, corrosion, patient's BMI, and activity level may participate in creating the necessary environment for fatigue failure of the implant. PMID:26266069

  15. [Rehabilitation after total knee arthroplasty of hip and knee].

    PubMed

    Jansen, E; Brienza, S; Gierasimowicz-Fontana, A; Matos, C; Reynders-Frederix-Dobre, C; HateM, S M

    2015-09-01

    Numbers of total hip and knee arthroplasties are increasing on a regular basis. Clinical pathways tend to shorten the duration of hospitalization in acute care after surgery. Therefore, the preoperative preparation of the patient and his abilities for postoperative rehabilitation should be carefully addressed. Before the surgical intervention, it is recommended that the patient receives an educational program and a physical preparation. After the surgical intervention, the patient can benefit from a home-based rehabilitation program supervised by a physiotherapist, if there were no preoperative reasons for prolonging the hospital stay and if the surgery took place without complications. Some patients may benefit from postsurgical rehabilitation in a specialized locomotor rehabilitation long-stay care unit. The indications for inpatient multidisciplinary rehabilitation are : two simultaneous arthroplasties, revision of a previous hip or knee arthroplasty, postsurgical complications, advanced age, comorbidities influencing the rehabilitation process, social difficulties, necessity for adaptation of the environment, insufficient or unadapted out-patient (para)medical care. The goals of the rehabilitation treatment depend on the patient's characteristics and environment, on the properties of the prosthesis and on the postsurgical complications. The functional prognosis of a total joint arthroplasty of the knee or hip is excellent, provided that there are no post-surgical complications and that the patient benefits from adequate rehabilitation therapy. The present paper describes the different phases of rehabilitation treatment and the general and specific complications of total hip and knee arthroplasties that may influence the rehabilitation outcome.

  16. [Rehabilitation after total knee arthroplasty of hip and knee].

    PubMed

    Jansen, E; Brienza, S; Gierasimowicz-Fontana, A; Matos, C; Reynders-Frederix-Dobre, C; HateM, S M

    2015-09-01

    Numbers of total hip and knee arthroplasties are increasing on a regular basis. Clinical pathways tend to shorten the duration of hospitalization in acute care after surgery. Therefore, the preoperative preparation of the patient and his abilities for postoperative rehabilitation should be carefully addressed. Before the surgical intervention, it is recommended that the patient receives an educational program and a physical preparation. After the surgical intervention, the patient can benefit from a home-based rehabilitation program supervised by a physiotherapist, if there were no preoperative reasons for prolonging the hospital stay and if the surgery took place without complications. Some patients may benefit from postsurgical rehabilitation in a specialized locomotor rehabilitation long-stay care unit. The indications for inpatient multidisciplinary rehabilitation are : two simultaneous arthroplasties, revision of a previous hip or knee arthroplasty, postsurgical complications, advanced age, comorbidities influencing the rehabilitation process, social difficulties, necessity for adaptation of the environment, insufficient or unadapted out-patient (para)medical care. The goals of the rehabilitation treatment depend on the patient's characteristics and environment, on the properties of the prosthesis and on the postsurgical complications. The functional prognosis of a total joint arthroplasty of the knee or hip is excellent, provided that there are no post-surgical complications and that the patient benefits from adequate rehabilitation therapy. The present paper describes the different phases of rehabilitation treatment and the general and specific complications of total hip and knee arthroplasties that may influence the rehabilitation outcome. PMID:26591319

  17. Cementless total hip arthroplasty in developmental dysplasia of the hip with end stage osteoarthritis: 2-7 years' clinical results.

    PubMed

    Yildirim, Tugrul; Guclu, Berk; Karaguven, Dogac; Kaya, Alper; Akan, Burak; Cetin, Ilker

    2015-01-01

    Between 2006 and 2011, 102 hips of 78 patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip (DDH) underwent cementless total hip arthroplasty (THA). According to the Crowe's classification, 22 hips (21%) were type 1, 19 hips (18%) were type 2, 22 hips (21%) were type 3 and 39 hips (38%) were type 4 respectively. Functional and clinical analyses were performed by Harris Hip Scores (HHS). There were 73 (71%) excellent or good results according to HHS. The postoperative HHS was significantly lower in patients who underwent femoral shortening (p<0.01). We observed 25 (24.5%) complications in total, 15 (14.7%) of which required revision surgery. The authors concluded that THA for DDH is a safe and a reliable procedure with good clinical outcomes. PMID:25907395

  18. A Useful Anatomical Reference Guide for Stem Anteversion during Total Hip Arthroplasty in the Dysplastic Hip.

    PubMed

    Tsukeoka, Tadashi; Tsuneizumi, Yoshikazu; Lee, Tae Hyun

    2015-08-01

    Computed tomography scans of 50 dysplastic hips were obtained and reconstructed using preoperative planning software for total hip arthroplasty. The anteversion of the stem implanted parallel to the line connecting the trochanteric fossa and the middle of the medial cortex of the femoral neck (T line) was measured. The cutting heights of 5mm and 10mm above the lesser trochanter were simulated. The mean difference of the anteversion of the stem using the T line and the native femoral anteversion was 2.7° (95% CI: 1.0°-4.5°) and 3.5° (95% CI: 1.5°-5.5°) at cutting heights of 5mm and 10mm respectively. An anteversion using a T line is compatible with native femoral anteversion even in developmental dysplasia of the hip. PMID:25873282

  19. The Influence of Hip Rotation on Femoral Offset Following Short Stem Total Hip Arthroplasty.

    PubMed

    Boese, Christoph K; Bredow, Jan; Ettinger, Max; Eysel, Peer; Thorey, Fritz; Lechler, Philipp; Budde, Stefan

    2016-01-01

    Short stem total hip arthroplasty (THA) is thought to be an advantageous surgical option for young patients. Femoral offset has been identified as an important factor for clinical outcome of THA. However, little is known on functional implications of femoral offset after short stem THA. Importantly, hip rotation influences the projected femoral offset and may lead to significant underestimation. Therefore, a novel method to identify and account for hip rotation was applied to a prospectively enrolled series of 37 patients (48 radiographs) undergoing short stem THA. Repeated measurements were performed and intraobserver and interobserver reliability was assessed and femoral offset was corrected for rotation. Based on this study, rotation-correction of femoral offset is of highest relevance for the correct interpretation in future studies.

  20. Cementless Revision Total Hip Arthroplasty with Ceramic Articulation

    PubMed Central

    Yang, Jong-Hyuck; Yang, Seong-Jo; Kang, Joon-Soon

    2015-01-01

    Purpose The results of ceramic-on-ceramic (CoC) bearing surfaces in primary total hip arthroplasty (THA) were well known. However, it was not known in revision THA. The purpose of this study is to report the results of revision THA with ceramic articulation. Materials and Methods A total of 112 revision THAs were evaluated. The mean age at the time of surgery was 51.6 years (27.7 to 84.2 years). The mean duration of the follow-up periods was 6.3 years (2.3 to 11.4 years). Results The Harris hip scores improved from an average of 56.2 at the index surgery to an average of 93.3 at the last follow-up (P<0.001). None of hips showed osteolysis or ceramic head fracture. One hip showed aseptic loosening in the acetabular component with squeaking that caused a re-revision. There were nine cases of dislocation. The survivorship at 5 years was 94.5% (95% confidence interval, 87.9% to 97.6%) with revision for any reason as the endpoint and 100% with femoral revision. Conclusion The ceramic articulation is one of good bearing options for revision THA in patients with a long life expectancy. PMID:27536630

  1. Increased Long-Term Cardiovascular Risk After Total Hip Arthroplasty

    PubMed Central

    Gordon, Max; Rysinska, Agata; Garland, Anne; Rolfson, Ola; Aspberg, Sara; Eisler, Thomas; Garellick, Göran; Stark, André; Hailer, Nils P.; Sköldenberg, Olof

    2016-01-01

    Abstract Total hip arthroplasty is a common and important treatment for osteoarthritis patients. Long-term cardiovascular effects elicited by osteoarthritis or the implant itself remain unknown. The purpose of the present study was to determine if there is an increased risk of late cardiovascular mortality and morbidity after total hip arthroplasty surgery. A nationwide matched cohort study with data on 91,527 osteoarthritis patients operated on, obtained from the Swedish Hip Arthroplasty Register. A control cohort (n = 270,688) from the general Swedish population was matched 1:3 to each case by sex, age, and residence. Mean follow-up time was 10 years (range, 7–21). The exposure was presence of a hip replacement for more than 5 years. The primary outcome was cardiovascular mortality after 5 years. Secondary outcomes were total mortality and re-admissions due to cardiovascular events. During the first 5 to 9 years, the arthroplasty cohort had a lower cardiovascular mortality risk compared with the control cohort. However, the risk in the arthroplasty cohort increased over time and was higher than in controls after 8.8 years (95% confidence interval [CI] 7.0–10.5). Between 9 and 13 years postoperatively, the hazard ratio was 1.11 (95% CI 1.05–1.17). Arthroplasty patients were also more frequently admitted to hospital for cardiovascular reasons compared with controls, with a rate ratio of 1.08 (95% CI 1.06–1.11). Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation when compared with controls. PMID:26871792

  2. Measuring functional outcome after total hip replacement with subject-specific hip joint loading.

    PubMed

    Weber, Tim; Dendorfer, Sebastian; Dullien, Silvia; Grifka, Joachim; Verkerke, Gijsbertus Jacob; Renkawitz, Tobias

    2012-12-01

    Total hip replacement is an often-performed orthopedic surgical procedure; the amount of procedures undertaken will increase since our life expectancy is growing. In order to optimize function, hip biomechanics should be restored to as near normal as possible. The goal of this pilot study was to determine whether or not it is feasible to compute the vectorial hip reaction force pathways on the head of the prosthesis and the force angles relative to the cup of the prosthesis that occur during gait in total hip replacement patients, serving as an objective measurement of the functional outcome following hip replacement. A three-dimensional gait analysis, measuring ground reaction forces and kinematics, was performed. The data retrieved from the gait analysis was used as the input for the musculoskeletal model to compute vectorial joint reaction forces for data processing. To evaluate the position and orientation of the joint reaction forces, the force path, as well as the force angles for the operated and non-operated joint, has been calculated during the stance phase of the specific leg. The force path for subject 2 on the non-operated side is only located in the posterior-lateral quarter, as is the force path for subject 1. In contrast to this subject, the force path for subject 2 at the operated hip joint can be found only within the anterior quarter of the head of the implant, where it is nearly equally distributed in the medio-lateral half of the prosthesis head. The force-inclination angles on the cup of subject 1, with respect to the plane of the socket face, indicates that the force vector is mainly positioned in the same quadrant when compared with subject 2 (in a cup-fixed coordinate system). The force-anteversion angle behaves similarly to the force-inclination angle, even when the effects are not as pronounced. The proposed methods in this article are aiming to define two functional outcomes of total hip replacement that are related to wear and rim

  3. Conventional Versus Cross-Linked Polyethylene for Total Hip Arthroplasty.

    PubMed

    Surace, Michele F; Monestier, Luca; Vulcano, Ettore; Harwin, Steven F; Cherubino, Paolo

    2015-09-01

    The clinical and radiographic outcomes of 88 patients who underwent primary total hip arthroplasty with either conventional polyethylene or cross-linked polyethylene (XLPE) from the same manufacturer were compared. There were no significant differences between the 2 subpopulations regarding average age, gender, side affected, or prosthetic stem and cup size. The average follow-up was 104 months (range, 55 to 131 months). To the authors' knowledge, this is the longest follow-up for this particular insert. Clinical and radiographic evaluations were performed at 1, 3, 6, and 12 months and then annually. Results showed that XLPE has a significantly greater wear reduction than that of standard polyethylene in primary total hip arthroplasty. At the longest available follow-up for these specific inserts, XLPE proved to be effective in reducing wear. PMID:26375527

  4. [Modern tribology in total hip arthroplasty: pros and cons].

    PubMed

    Gómez-García, F

    2014-01-01

    The wear products and adverse reactions that occur on bearing surfaces represent one of the greatest challenges in prosthetic replacements, as the latter experience increasing demands due to the large number of young and older adult patients that have a long life expectancy and remarkable activity. The purpose of this review is to analyze the pros and cons of the new advances in the bearing components of the articular surfaces of current total hip arthroplasties. We also discuss the strategies used historically, their problems, results and the surgeon's role in prescribing the tribologic couple that best fits each patient's needs. We conclude with practical recommendations for the prescription and management of the latest articular couples for total hip arthroplasty. PMID:26021098

  5. Modular hybrid total hip arthroplasty. Experimental study in dogs

    PubMed Central

    2011-01-01

    Background This prospective experimental study evaluated the surgical procedure and results of modular hybrid total hip arthroplasty in dogs. Methods Ten skeletally mature healthy mongrel dogs with weights varying between 19 and 27 kg were used. Cemented modular femoral stems and uncemented porous-coated acetabular cups were employed. Clinical and radiographic evaluations were performed before surgery and at 30, 60, 90, 120, 180 and 360 days post-operation. Results Excellent weight bearing was noticed in the operated limb in seven dogs. Dislocation followed by loosening of the prosthesis was noticed in two dogs, which were therefore properly treated with a femoral head osteotomy. Femoral fracture occurred in one dog, which was promptly treated with full implant removal and femoral osteosynthesis. Conclusions The canine modular hybrid total hip arthroplasty provided excellent functionality of the operated limb. PMID:21736758

  6. Transesophageal echocardiography in the anesthetic management of total hip arthroplasty.

    PubMed

    Johnson, C; Lewis, K D; Steen, S N; Mok, M S; Wu, C C

    2001-09-01

    Total hip arthroplasty is a common procedure in the elderly and thromboembolism continues to be a cause of mortality and morbidity associated with this procedure. When properly diagnosed and treated the mortality rate from pulmonary embolism can be reduced significantly. Transesophageal echocardiograpic (TEE) detection of central pulmonary artery thromboemboli in patients with severe pulmonary embolism has been reported to have a sensitivity of 96.7% and a specificity of 88%. However TEE is not universally available due to its cost and expertise that is required. Taking into consideration its cost/effectiveness we suggest that in patients undergoing the cement type of total hip arthroplasty who are cardiopulmonary compromised, debilitated or elderly the use of TEE is indicated.

  7. The local effects of metal corrosion in total hip arthroplasty.

    PubMed

    Cooper, H John

    2014-01-01

    Corrosion has long been recognized to occur in total hip arthroplasty, but the local effects of this process have only recently become better understood. This article provides an overview of corrosion at modular junctions, and discusses the various etiologic factors for corrosion and the biologic response to metal debris released from this junction. Algorithms are provided for diagnosis and treatment, in accordance with the best available data.

  8. Vibroacoustography for the assessment of total hip arthroplasty

    PubMed Central

    Kamimura, Hermes A. S.; Wang, Liao; Carneiro, Antonio A. O.; Kinnick, Randall R.; An, Kai-Nan; Fatemi, Mostafa

    2013-01-01

    OBJECTIVES: This paper proposes imaging with 3-dimensional vibroacoustography for postoperatively assessing the uncovered cup area after total hip arthroplasty as a quantitative criterion to evaluate implant fixation. METHODS: A phantom with a bone-like structure covered by a tissue-mimicking material was used to simulate a total hip arthroplasty case. Vibroacoustography images of the uncovered cup region were generated using a two-element confocal ultrasound transducer and a hydrophone inside a water tank. Topological correction based on the geometry of the implant was performed to generate a 3-dimensional representation of the vibroacoustography image and to accurately evaluate the surface. The 3-dimensional area obtained by the vibroacoustography approach was compared to the area evaluated by a 3-dimensional motion capture system. RESULTS: The vibroacoustography technique provided high-resolution, high-contrast, and speckle-free images with less sensitivity to the beam incidence. Using a 3-dimensional-topology correction of the image, we accurately estimated the uncovered area of the implant with a relative error of 8.1% in comparison with the motion capture system measurements. CONCLUSION: Measurement of the cup coverage after total hip arthroplasty has not been well established; however, the covered surface area of the acetabular component is one of the most important prognostic factors. The preliminary results of this study show that vibroacoustography is a 3-dimensional approach that can be used to postoperatively evaluate total hip arthroplasty. The favorable results also provide an impetus for exploring vibroacoustography in other bone or implant surface imaging applications. PMID:23778334

  9. Clinical Biomechanics of Wear in Total Hip Arthroplasty

    PubMed Central

    Callaghan, John J; Pedersen, Douglas R; Johnston, Richard C; Brown, Thomas D

    2003-01-01

    Complementary clinical and laboratory studies were performed to identify variables associated with polyethylene wear following total hip replacement, and to elucidate the mechanisms responsible for accelerated wear in the total hip arthroplasty construct. Observational cohort studies were performed using a prospective clinical database of more than 4000 consecutive primary total hip arthroplasties performed by a single surgeon, to identify wear-related variables. These variables included head size, acetabular/femoral component impingement, and third body debris. Novel digital edge detection techniques were developed and employed to accurately measure wear, and to determine the relationships of head size and third body debris to acceleration of wear. A novel slidingdistance-coupled finite element model was formulated and employed to examine the mechanisms responsible for wear. The long-term cohort studies demonstrated smaller head sizes to be associated with less wear. Third body debris generated from cable fretting was associated with an increase in wear, osteolysis, and acetabular loosening, especially with larger head sizes. The sliding-distance-coupled finite element model replicated the wear rates occurring in vitro and in vivo, demonstrating the importance of sliding distance on polyethylene wear following total hip arthroplasty. It also demonstrated substantial increases in wear associated with femoral head scratching from third body debris. Further extension of the finite element formulation demonstrated the potential for acetabular component rim damage from impingement wear, and the enhanced potential for third body ingress to the bearing surface with larger head sizes. Edge detection wear measurement techniques demonstrated that early wear rates were predictive of long-term wear rates. These complementary clinical and laboratory investigations have provided insight into 1) the significance of sliding distance and physiologic loci of motion as contributing

  10. Metal-on-Metal Total Hip Resurfacing Arthroplasty

    PubMed Central

    2006-01-01

    Executive Summary Objective The objective of this review was to assess the safety and effectiveness of metal on metal (MOM) hip resurfacing arthroplasty for young patients compared with that of total hip replacement (THR) in the same population. Clinical Need Total hip replacement has proved to be very effective for late middle-aged and elderly patients with severe degenerative diseases of the hips. As indications for THR began to include younger patients and those with a more active life style, the longevity of the implant became a concern. Evidence suggests that these patients experience relatively higher rates of early implant failure and the need for revision. The Swedish hip registry, for example, has demonstrated a survival rate in excess of 80% at 20 years for those aged over 65 years, whereas this figure was 33% by 16 years in those aged under 55 years. Hip resurfacing arthroplasty is a bone-conserving alternative to THR that restores normal joint biomechanics and load transfer. The technique has been used around the world for more than 10 years, specifically in the United Kingdom and other European countries. The Technology Metal-on-metal hip resurfacing arthroplasty is an alternative procedure to conventional THR in younger patients. Hip resurfacing arthroplasty is less invasive than THR and addresses the problem of preserving femoral bone stock at the initial operation. This means that future hip revisions are possible with THR if the initial MOM arthroplasty becomes less effective with time in these younger patients. The procedure involves the removal and replacement of the surface of the femoral head with a hollow metal hemisphere, which fits into a metal acetabular cup. Hip resurfacing arthroplasty is a technically more demanding procedure than is conventional THR. In hip resurfacing, the femoral head is retained, which makes it much more difficult to access the acetabular cup. However, hip resurfacing arthroplasty has several advantages over a

  11. Saving Implants BMP-2 Application in Revision Total Hip Surgery

    PubMed Central

    Jäger, M.; Emami, R.; Thorey, F.; Krauspe, R.

    2006-01-01

    Objective: Besides others, there are two major problems in total hip replacement surgery which result in implant failure. First there is aseptic loosening due to a lack of implant biocompatibility or micromovements and second periimplant wear debris induced osteolysis which limits the survival rate of an implant. Regarding to recent data there are only limited therapeutic strategies to heal these bony defects without arthroplasty revision surgery. Since the investigation and characterization of adult mesenchymal stem cells (MSCs) from bone marrow, a cell and tissue engineering based therapy might be a promising solution to heal endoprosthesis associated bony defects. Moreover the application of growth factors in bone reconstructive surgery is another treatment concept to promote local bone regeneration. Patient and Methods: We report about a 73-year old patient with a painful weight bearing and a large, wear debris induced pelvic osteolysis after total hip arthroplasty. To prevent from salvage surgical procedures and preserve bone, a healing attempted was performed by filling the critical bony defect zone with a BMP-2/MSC composit. Results: Clinical and radiological follow-ups showed a progressive bony healing of the critical size defect area without any complications. Fifteen months after application the patient is still pain free, has no limitations in daily life or sport activities. Conclusion: The case embarks on a strategy of non-embryonic stem cell and growth factor application to heal bony defects at patients with total hip endoprosthesis. PMID:23674982

  12. 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

  13. Preparation of the proximal femur in cementless total hip revision.

    PubMed

    Mallory, T H

    1988-10-01

    With an increased incidence of revision for the failed cemented total hip arthroplasty, techniques of revision surgery need meticulous attention to detail. Although the causes of the failed cemented total hip arthroplasty are many, they tend to follow characteristic patterns. The proximal femur can be exposed through an extensive muscle split incision, which offers a complete circumferential view of the femur. The cement removal is enhanced by controlled perforation using high-speed drills. Classification of bony deficits of the proximal femur can be divided into Type I, including intact cortex and medullary content; Type II, in which there is intact cortex but deficient medullary content; and Type III, in which deficits of both the cortex and medullary canal are present. Prosthetic selection is based on residual bone stock. In general, cementless fixation is advocated, with distal fixation using long-stem devices. Augmentation of bone deficits requires the use of segmental prosthetic replacement or fresh-frozen allografts. One hundred sixty patients were followed for two to six years. Satisfactory results have occurred in over 90% of the patients; better results are anticipated in patients with minimal bone deficits. Aseptic loosening requiring rerevision has occurred in 5% of the patient population. Understanding the dynamics of failure and the residual bone deficits allows one to manage the failed cemented total hip arthroplasty with greater efficiency and predictability. PMID:3416541

  14. Impingement and Dislocation in Total HIP Arthroplasty: Mechanisms and Consequences

    PubMed Central

    Brown, Thomas D; Elkins, Jacob M; Pedersen, Douglas R; Callaghan, John J

    2014-01-01

    In contemporary total hip arthroplasty, instability has been a complication in approximately 2% to 5% of primary surgeries and 5% to 10% of revisions. Due to the reduction in the incidence of wear-induced osteolysis that has been achieved over the last decade, instability now stands as the single most common reason for revision surgery. Moreover, even without frank dislocation, impingement and subluxation are implicated in a set of new concerns arising with advanced bearings, associated with the relatively unforgiving nature of many of those designs. Against that backdrop, the biomechanical factors responsible for impingement, subluxation, and dislocation remain under-investigated relative to their burden of morbidity. This manuscript outlines a 15-year program of laboratory and clinical research undertaken to improve the scientific basis for understanding total hip impingement and dislocation. The broad theme has been to systematically evaluate the role of surgical factors, implant design factors, and patient factors in predisposing total hip constructs to impinge, sublux, and/or dislocate. Because this class of adverse biomechanical events had not lent itself well to study with existing approaches, it was necessary to develop (and validate) a series of new research methodologies, relying heavily on advanced finite element formulations. Specific areas of focus have included identifying the biomechanical challenges posed by dislocation-prone patient activities, quantifying design parameter effects and component surgical positioning effects for conventional metal-on-polyethylene implant constructs, and the impingement/dislocation behavior of non-conventional constructs, quantifying the stabilizing role of the hip capsule (and of surgical repairs of capsule defects), and systematically studying impingement and edge loading of hard-on-hard bearings, fracture of ceramic liners, confounding effects of patient obesity, and subluxation-mediated worsening of third body

  15. Minimally invasive total hip replacement: the posterolateral approach.

    PubMed

    Bottner, Friedrich; Delgado, Samuel; Sculco, Thomas P

    2006-05-01

    Our experience with the posterolateral mini-incision technique over the last 8 years has shown that total hip arthroplasty can be performed safely and effectively in properly selected patients through a much smaller incision than the one traditionally used. The main advantage of the posterolateral approach compared with other mini-incisions is its simplicity, with shortened operating time as a result. While the surgical time for a posterior approach is an average of 37 to 70 minutes throughout the literature, the 2-incision approach prolongs the surgery by a factor of 2 or 3. Compared with the anterior or 2-incision approach, the posterolateral and anterolateral approaches also have a much lower incidence of perioperative complications, with the rate being similar to rates seen with a standard incision. For the 2-incision technique and the anterior mini-incision approach, perioperative periprosthetic fracture rates of up to 8.7% and 8.4%, respectively, have been described. Surgeons who traditionally used an anterolateral standard approach might prefer an anterolateral mini-incision. The anterolateral mini-incision total hip arthroplasty has demonstrated excellent results; in the past it was suggested that the anterolateral approach has a higher incidence of heterotopic bone formation and impaired early abductor function, but more recent studies show no difference in abductor strength and limping between the anterolateral and posterior approaches. On the other hand, the posterior approach has been associated with an increased risk of postoperative dislocations. We did not encounter an increased incidence of postoperative dislocation at our institution. This might be related to the routine repair of the external rotators and the capsule in all patients. In summary, both the anterolateral and the posterior mini-incision approaches are reasonable alternatives, and surgeons should choose the approach that they feel most comfortable with. Statements in the press and by

  16. Polyethylene Oxidation in Total Hip Arthroplasty: Evolution and New Advances

    PubMed Central

    Gómez-Barrena, Enrique; Medel, Francisco; Puértolas, José Antonio

    2009-01-01

    Ultra-high molecular weight polyethylene (UHMWPE) remains the gold standard acetabular bearing material for hip arthroplasty. Its successful performance has shown consistent results and survivorship in total hip replacement (THR) above 85% after 15 years, with different patients, surgeons, or designs. As THR results have been challenged by wear, oxidation, and liner fracture, relevant research on the material properties in the past decade has led to the development and clinical introduction of highly crosslinked polyethylenes (HXLPE). More stress on the bearing (more active, overweighted, younger patients), and more variability in the implantation technique in different small and large Hospitals may further compromise the clinical performance for many patients. The long-term in vivo performance of these materials remains to be proven. Clinical and retrieval studies after more than 5 years of in vivo use with HXLPE in THR are reviewed and consistently show a substantial decrease in wear rate. Moreover, a second generation of improved polyethylenes is backed by in vitro data and awaits more clinical experience to confirm the experimental improvements. Also, new antioxidant, free radical scavengers, candidates and the reinforcement of polyethylene through composites are currently under basic research. Oxidation of polyethylene is today significantly reduced by present formulations, and this forgiving, affordable, and wellknown material is still reliable to meet today’s higher requirements in total hip replacement. PMID:20111694

  17. Total hip arthroplasty: areview of advances, advantages and limitations

    PubMed Central

    Liu, Xin-Wei; Zi, Ying; Xiang, Liang-Bi; Wang, Yu

    2015-01-01

    The therapeutic outcomes of Osteoarthritis (OA) has been unsatisfactory and often surgeries such as total hip arthroplasty (THA) is required. THA is an effective treatment for patients with end-stage arthritic hip conditions. Cemented THA has been the treatment of choice for elderly patients with OA. An improvement in Timed “Up and Go” (TUG) before surgery might contribute to a decrease in the occurrence of DVT after THA, though post-thrombotic syndrome (PTS), a chronic condition in the lower extremity does not appear to be a major complication after DVT in patients undergoing THA. For OA, four domains to be evaluated: pain, physical function, joint imaging, and patient global assessment. Thus, THA can be cost saving or, at least cost- effective in improving quality-adjusted life expectancy. The purpose of this review is to discuss the recent advances as well as advantages and limitations of THA. PMID:25784971

  18. Inequalities in use of total hip arthroplasty for hip fracture: population based study

    PubMed Central

    Metcalfe, David; Griffin, Xavier L; Costa, Matthew L

    2016-01-01

    Objectives To determine whether the use of total hip arthroplasty (THA) among individuals with a displaced intracapsular fracture of the femoral neck is based on national guidelines or if there are systematic inequalities. Design Observational cohort study using the National Hip Fracture Database (NHFD). Setting All hospitals that treat adults with hip fractures in England, Wales, and Northern Ireland. Participants Patients within the national database (all aged ≥60) who received operative treatment for a non-pathological displaced intracapsular hip fracture from 1 July 2011 to 31 April 2015. Main outcome measures Provision of THA to patients considered eligible under criteria published by the National Institute for Health and Care Excellence (NICE). Results 114 119 patients with hip fracture were included, 11 683 (10.2%) of whom underwent THA. Of those who satisfied the NICE criteria, 32% (6780)received a THA. Of patients who underwent THA, 42% (4903) did not satisfy the NICE criteria. A recursive partitioning algorithm found that the NICE eligibility criteria did not optimally explain which patients underwent THA. A model with superior explanatory power drew distinctions that are not supported by NICE, which were an age cut off at 76 and a different ambulation cut off. Among patients who satisfied the NICE eligibility, the use of THA was less likely with higher age (odds ratio 0.88, 95% confidence interval 0.87 to 0.88), worsening abbreviated mental test scores (0.49 (0.41 to 0.58) for normal cognition v borderline cognitive impairment)), worsening American Society of Anesthesiologists score (0.74, 0.66 to 0.84), male sex (0.85, 0.77 to 0.93), worsening ambulatory status (0.32, 0.28 to 0.35 for walking with a stick v independent ambulation), and fifths of worsening socioeconomic area deprivation (0.76 (0.66 to 0.88) for least v most deprived fifth). Patients receiving treatment during the working week were more likely to receive THA than at the

  19. Management of the recalcitrant total-hip arthroplasty wound.

    PubMed

    Meland, N B; Arnold, P G; Weiss, H C

    1991-10-01

    The infection rate for total-hip arthroplasty is around 1 percent. This small group is usually managed by complete removal of the prosthesis and the cement and closure over suction catheters to "collapse" the wound and eventually achieve a girdlestone arthroplasty. Occasionally, there are patients who have a persistent draining wound after this treatment and repeated efforts at wound closure. We present 27 patients who had recalcitrant, noncollapsible wounds of the hip that were present for many months to years. Twenty-eight cases of infected total-hip arthroplasties that did not respond to removal of the prosthesis and cement and closure were seen by the authors between January of 1977 and December of 1988. One patient had bilateral involvement. Average age was 64 years (range 33 to 79 years). There was an average of 4.2 previous surgical attempts at closure (range 1 to 21). Staphylococcus aureus was the most common organism, but the infections were virtually all multiple. Thirty-three muscles were utilized in 27 patients. The rectus femoris was used in 23 cases, the vastus lateralis in 8, tensor fasciae latae in 1, and combined latissimus dorsi-serratus anterior free-tissue transfers were carried out in 2. Multiple combinations of transpositions and free flaps were utilized. Follow-up ranged from 1 to 10 years, with an average of 6.4 years. Eighteen patients were ambulatory with minor degrees of pain, five ambulated with a cane, seven ambulated with a walker, six ambulated with crutches, and four ambulated unassisted, all of whom had reimplantation of their hip arthroplasty at least 12 months following the muscle flap procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. [A new hip milling machine for preparation of the hip acetabulum for total hip prothesis (author's transl)].

    PubMed

    Weigand, H

    1976-08-19

    The problemes of the exact preparation of the hip acetabulum for implantation of total hip prothesis have caused the development of several milling machines. Two sorts of construction predominate. Their disadvantages, especially the fact, that there is now mechanism, while is able to carry of the milled tissue, gave rise to construct a new milling machine. In cooperation with engineers of the branch mechanical engineering a new model was developed. The characteristic features are described and explained by pictures. The milling basket will be fastened on the ground plate by a quick fastener. In this way we get a hemisphere cavity, which is able to absorb all the milled tissue without any residue. A grasp will be connected with the drive shaft and guarantee an exact and rightangeled direction. The clinical tests have shown, that the new milling machine with the grasp especially is qualified for use in the osteoporotic senil bone too.

  1. Patients' perception of leg length discrepancy post total hip arthroplasty.

    PubMed

    Sykes, Alice; Hill, Janet; Orr, John; Humphreys, Patricia; Rooney, Aidan; Morrow, Esther; Beverland, David

    2015-01-01

    Perception of a leg length discrepancy post total hip arthroplasty (THA) is one of the most common sources of patient dissatisfaction and can have a direct influence on the considered success of the operation.This research examined postoperative perception of imposed limb discrepancies in a group of THA patients compared to a group of participants with no previous hip surgery. Two subgroups of THA patients were involved: those who did not perceive a difference in limb length following THA and those that did.Discrepancies were imposed in 2.5 mm increments. For discrepancies ≥5 mm, a significant number of participants were aware of a difference (74%). There was no significant difference in perception of imposed discrepancies between THA patients and participants with no previous hip surgery. THA patients who perceived a difference in their limb lengths postoperatively had significantly worse pain and oxford scores when compared to THA patients who perceived their limb lengths to be equal. Knowing the boundaries between LLDs that go undetected and those that patients are aware of could guide surgeons when evaluating the balance between correct soft tissue tension and the resulting unequal leg length. From these findings, discrepancies >5 mm are likely to be perceived. Whether this perception would lead directly to a negative outcome score and patient dissatisfaction is more complex to project and likely to be patient specific. Intraoperative methods to aid the controlled positioning of implanted components could help maintain and restore leg length to within an acceptable amount that patients cannot perceive.

  2. The First 50 Years of Total Hip Arthroplasty: Lessons Learned

    PubMed Central

    2008-01-01

    Fifty years have passed since the first total hip arthroplasty of the modern era was performed. At this, the vantage point, it is reasonable to review these five decades, inquiring behind the single dominating observation that, in its current form, this operation is one of the most successful of all surgical procedures for the management of end-stage human disease. What are the generic lessons that can be derived from the experience? Succinctly, five major observations appear valuable. They are “skunk works,” “Pasteur’s motto,” “the totally unexpected,” “research solutions,” and “the role of alternatives.” “Skunk works,” an industrial management term, might be characterized as an innovative endeavor that is offline and off-budget resulting from the relentless pursuit of a vivid dream by creative zealots who eschew defeat. Pasteur’s motto dealt with serendipity, which was crucial to total hip arthroplasty progress. The totally unexpected is represented by an entirely new manmade disease, “periprosthetic osteolysis.” The research solutions are represented by the complex, sophisticated contemporary research that has unraveled periprosthetic osteolysis and suggested modes of correction. Finally, the application of “alternatives” has characterized major progress. Importantly, these, or similar generic observations, may provide insights into important progress in the future. PMID:18982399

  3. Meralgia paresthetica of the contralateral leg after total hip arthroplasty.

    PubMed

    Weier, Chris A; Jones, Lynne C; Hungerford, Marc W

    2010-04-01

    In the United States, total hip arthroplasty (THA) is typically performed with the patient in the lateral decubitus position. Positioning of the morbidly obese patient can be technically challenging and may require special positioning equipment. Although the increased incidence of complications after THA in obese patients has been well documented, neurologic complications in the contralateral limb are rare. This article describes a case of a patient with impairment of the lateral femoral cutaneous nerve in the contralateral leg after THA.A 55-year-old woman with a body mass index of 34.24 kg/m(2) underwent THA in the right lateral decubitus position. Because of her body habitus, a bean-bag positioner was used. Total hip arthroplasty was performed using a direct lateral approach. Intraoperative surgical time was 2.5 hours, and total anesthesia time was 3.5 hours. A few days postoperatively, the patient began to experience "burning and shooting" pain in the contralateral hip, but she did not report this pain until 6 weeks postoperatively. She was treated initially with a single lidocaine injection. When this was ineffective, she was treated with topiramate (100 mg daily) and vitamin B6 (100 mg orally twice daily). The symptoms lessened markedly at 5 months and resolved completely at 9 months postoperatively.Meralgia paresthetica is an uncommon, but known, complication of THA. To our knowledge, it has been reported only in the operative limb. This report reinforces the need for careful positioning to avoid pressure over the anterior superior iliac spine intraoperatively.

  4. Acute periprosthetic fractures of the acetabulum after total hip arthroplasty.

    PubMed

    Potty, Anish G; Corona, Jacqueline; Manning, Blaine T; Le, Amanda; Saleh, Khaled J

    2014-01-01

    Although periprosthetic fractures of the acetabulum are relatively uncommon after total hip arthroplasty, a variety of patient-, surgeon-, and implant-related risk factors can contribute to the occurrence of this serious complication. These risk factors, combined with the increased use of cementless acetabular cups, will likely result in an increased prevalence of these fractures in the future. By better understanding the risk factors, classification schemes, and treatment options for periprosthetic fractures of the acetabulum, orthopaedic surgeons can achieve better outcomes for their patients.

  5. Tribological characteristics of a composite total-surface hip replacement

    NASA Technical Reports Server (NTRS)

    Jones, W. R., Jr.; Roberts, J. C.; Ling, F. F.

    1982-01-01

    Continuous fiber, woven E glass composite femoral shells having the same elastic properties as bone were fabricated. The shells were then encrusted with filled epoxy wear resistant coatings and run dry against ultrahigh molecular weight polyethylene acetabular cups in 42,000 and 250,000 cycle wear tests on a total hip simulator. The tribological characteristics of these continuous fiber particulate composite femoral shells articulating with ultrahigh molecular weight polyethylene acetabular cups were comparable to those of a vitallium ball articulating with an ultrahigh molecular weight polyethylene acetabular cup.

  6. Effects of Cobalt and Chromium Levels Following Modular Hip Stem Total Hip Arthroplasty.

    PubMed

    Koziara, Christopher R; Lombardo, Daniel J; Petersen-Fitts, Graysen R; Jildeh, Toufic R; Morawa, Lawrence

    2016-09-01

    Due to the increased number of revision total hip arthroplasties (THAs) to correct pain secondary to fretting from modular hip stems, this study was conducted in an effort to correlate objective findings of serum cobalt (Co) levels, serum chromium (Cr) levels, and/or reactive tissue seen on metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) with a patient's need for revision THA. The study group comprised 66 patients, 18 of whom received MARS MRI. Serum Co levels, serum Cr levels, and standard numeric rating scale for pain were documented for all patients. Statistical analysis was then performed to determine whether there was a correlation between the aforementioned variables and the need for revision THA. Serum Cr levels were higher in patients with positive reactive tissue findings on MARS MRI, although this only approached significance (P=.083). Serum Co levels were higher in those undergoing revision THA, but this also only approached significance (P=.076). Pain scores were significantly different between those undergoing revision and those not (P<.001). It is the opinion of the authors that there is no objective finding in this study that can be used to identify patients who require revision THA secondary to fretting of a modular hip stem prosthesis. Only a patient's stated pain level can assist a surgeon in the decision-making process regarding the need for revision THA secondary to fretting. [Orthopedics.2016; 39(5):288-292.]. PMID:27337670

  7. Spontaneous modular femoral head dissociation complicating total hip arthroplasty.

    PubMed

    Talmo, Carl T; Sharp, Kinzie G; Malinowska, Magdalena; Bono, James V; Ward, Daniel M; LaReau, Justin

    2014-06-01

    Modular femoral heads have been used successfully for many years in total hip arthroplasty. Few complications have been reported for the modular Morse taper connection between the femoral head and trunnion of the stem in metal-on-polyethylene bearings. Although there has always been some concern over the potential for fretting, corrosion, and generation of particulate debris at the modular junction, this was not considered a significant clinical problem. More recently, concern has increased because fretting and corrosive debris have resulted in rare cases of pain, adverse local tissue reaction, pseudotumor, and osteolysis. Larger femoral heads, which have gained popularity in total hip arthroplasty, are suspected to increase the potential for local and systemic complications of fretting, corrosion, and generation of metal ions because of greater torque at the modular junction. A less common complication is dissociation of the modular femoral heads. Morse taper dissociation has been reported in the literature, mainly in association with a traumatic event, such as closed reduction of a dislocation or fatigue fracture of the femoral neck of a prosthesis. This report describes 3 cases of spontaneous dissociation of the modular prosthetic femoral head from the trunnion of the same tapered titanium stem because of fretting and wear of the Morse taper in a metal-on-polyethylene bearing. Continued clinical and scientific research on Morse taper junctions is warranted to identify and prioritize implant and surgical factors that lead to this and other types of trunnion failure to minimize complications associated with Morse taper junctions as hip implants and surgical techniques continue to evolve.

  8. Early surveillance of ceramic-on-metal total hip arthroplasty.

    PubMed

    Hill, J C; Diamond, O J; O'Brien, S; Boldt, J G; Stevenson, M; Beverland, D E

    2015-03-01

    Ceramic-on-metal (CoM) is a relatively new bearing combination for total hip arthroplasty (THA) with few reported outcomes. A total of 287 CoM THAs were carried out in 271 patients (mean age 55.6 years (20 to 77), 150 THAs in female patients, 137 in male) under the care of a single surgeon between October 2007 and October 2009. With the issues surrounding metal-on-metal bearings the decision was taken to review these patients between March and November 2011, at a mean follow-up of 34 months (23 to 45) and to record pain, outcome scores, radiological analysis and blood ion levels. The mean Oxford Hip Score was 19.2 (12 to 53), 254 patients with 268 hips (95%) had mild/very mild/no pain, the mean angle of inclination of the acetabular component was 44.8(o) (28(o) to 63(o)), 82 stems (29%) had evidence of radiolucent lines of > 1 mm in at least one Gruen zone and the median levels of cobalt and chromium ions in the blood were 0.83 μg/L (0.24 μg/L to 27.56 μg/L) and 0.78 μg/L (0.21 μg/L to 8.84 μg/L), respectively. The five-year survival rate is 96.9% (95% confidence interval 94.7% to 99%). Due to the presence of radiolucent lines and the higher than expected levels of metal ions in the blood, we would not recommend the use of CoM THA without further long-term follow-up. We plan to monitor all these patients regularly. PMID:25737511

  9. Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty.

    PubMed

    Berger, Richard A; Jacobs, Joshua J; Meneghini, R Michael; Della Valle, Craig; Paprosky, Wayne; Rosenberg, Aaron G

    2004-12-01

    To assess the potential recovery rate of a minimally invasive total hip replacement technique with minimal soft tissue disruption, an accelerated rehabilitation protocol was implemented with weightbearing as tolerated on the day of surgery. One hundred consecutive patients were enrolled in this prospective study. Ninety-seven patients (97%) met all the inpatient physical therapy goals required for discharge to home on the day of surgery; 100% of patients achieved these goals within 23 hours of surgery. Outpatient therapy was initiated in 9% of patients immediately, 62% of patients by 1 week, and all patients by 2 weeks. The mean time to discontinued use of crutches, discontinued use of narcotic pain medications, and resumed driving was 6 days postoperatively. The mean time to return to work was 8 days, discontinued use of any assistive device was 9 days, and resumption of all activities of daily living was 10 days. The mean time to walk (1/2) mile was 16 days. Furthermore, there were no readmissions, no dislocations, and no reoperations. Therefore, a rapid rehabilitation protocol is safe and fulfills the potential benefits of a rapid recovery with minimally invasive total hip arthroplasty. PMID:15577494

  10. Pseudotumor Caused by Titanium Particles From a Total Hip Prosthesis.

    PubMed

    Sakamoto, Masaaki; Watanabe, Hitoshi; Higashi, Hidetaka; Kubosawa, Hitoshi

    2016-01-01

    A 77-year-old woman underwent metal-on-polyethylene total hip arthroplasty for osteoarthritis of the right hip at another institution. During surgery, the greater trochanter was broken and internal fixation was performed with a trochanteric cable grip reattachment. Although postoperative recovery was uneventful, approximately 6 years later, the patient had severe right hip pain with apparent swelling, and she was referred to the authors' institution. Plain radiographs showed evidence of severe osteolysis in the proximal femur and cable breakage; however, preoperative aspiration culture findings were negative for bacterial growth. Magnetic resonance imaging showed a well-circumscribed mass, presumed to be a pseudotumor. Serum cobalt and chromium levels were within normal limits, and the serum titanium level was high. During surgery, the mass was excised and removal of the cable system revealed a sharp deficit in the bare femoral stem. Gross surgical findings showed no obvious evidence of infection and no corrosion at the head-neck junction; therefore, all components were retained besides the cable system, which resulted in clinical recovery. All of the cultures from specimens were negative for bacterial growth, and histologic findings were compatible with a pseudotumor, such as histiocytes containing metal particles, abundant plasma cells, and CD8-positive cells. Quantitative analysis by inductively coupled plasma atomic emission spectrometry showed that the main source of metal debris in the pseudotumor was the femoral stem, which was made of titanium alloy, not the broken cable, which was made of cobalt-chromium alloy. The findings suggest that titanium particles can form symptomatic solid pseudotumors.

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

    PubMed

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

    1991-01-01

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

  12. Severity of Diabetes Mellitus and Total Hip or Knee Replacement

    PubMed Central

    Nielen, Johannes T.H.; Emans, Pieter J.; Dagnelie, Pieter C.; Boonen, Annelies; Lalmohamed, Arief; de Boer, Anthonius; van den Bemt, Bart J.F.; de Vries, Frank

    2016-01-01

    Abstract It is generally thought that people with diabetes mellitus (DM) are more likely to suffer from osteoarthritis (OA) due to an increased body mass index (BMI), resulting in mechanical destruction of cartilage. However, previous studies have suggested a coexisting metabolic causality. To evaluate the risk of hip or knee replacement, as a proxy for severe OA, in patients with DM. We additionally evaluated the risk of total joint replacement (TJR) with various proxies for increased DM severity. A population-based case–control study was performed, using the Clinical Practice Research Datalink (CPRD). Cases (n = 94,609) were defined as patients >18 years who had undergone TJR between 2000 and 2012. Controls were matched by age, gender, and general practice. Conditional logistic regression was used to estimate the risk of total knee (TKR) and total hip replacement (THR) surgery associated with use of antidiabetic drugs (ADs). We additionally stratified current AD users by proxies for DM severity. Current AD use was significantly associated with a lower risk of TKR (OR = 0.86 (95% CI = 0.78–0.94)) and THR (OR = 0.90 (95% CI = 0.82–0.99)) compared to patients not using ADs. Moreover, risk of TKR and THR was decreased with increasing HbA1c. This study does not support the theory that DM patients are more likely to suffer from severe OA as compared to patients without diabetes. Moreover, risk of severe OA necessitating TJR decreases with increasing DM severity. This is possibly due to dissimilarities in methodology, a decrease in eligibility for surgery, or variability of OA phenotypes. PMID:27196498

  13. Evaluation and management of the infected total hip and knee.

    PubMed

    Moyad, Thomas F; Thornhill, Thomas; Estok, Daniel

    2008-06-01

    Infection should be in the differentia for any painful total hip or knee. A thorough history and physical, complete set of radiographs and appropriate labs including C-reactive protein and erythrocyte sedimentation rate are essential in the initial evaluation. Ancillary tests such as aspiration and nuclear imaging may be helpful in unclear cases or when labs are concerning for infection. It is essential that all antibiotics are discontinued several weeks prior to gram stain and culture, if possible, to reduce the number of false negative test results. Classifying infection into acute versus late infection aids in the treatment plan. For acute infections presenting within 2 to 4 weeks of symptom onset, irrigation and debridement with polyethylene liner exchange and retention of components may be possible. When attempting component retention, thorough debridement and rapid treatment of the infection prior to the accumulation of any biofilm is paramount for a successful outcome. Other important prognostic factors to consider include the virulence of the microorganism as well as the immune status of the host. Despite expeditious management, irrigation and debridement of acute total hip and knee infections frequently leads to recurrent infection. Thus, patients should be counseled accordingly. Further management may be needed following an initial attempt at component retention. These options include resection arthroplasty with or without re-implantation, long term antibiotic suppressive therapy, arthrodesis and even above the knee amputation in rare circumstances. For chronic infections, a successful outcome depends on several factors including the baseline health status of the patient, implant removal with a thorough debridement followed by culture specific antibiotic treatment. Furthermore, methods of monitoring for persistent infection include following laboratory values such as the C-reactive protein, erythrocyte sedimentation rate, and cultures from joint

  14. Two Different Total Hip Arthroplasties for Hartofilakidis Type C1 Developmental Dysplasia of Hip in Adults

    PubMed Central

    Chu, Ya-Ming; Zhou, Yi-Xin; Han, Na; Yang, De-Jin

    2016-01-01

    Background: Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) is more complex than the normal hip, with large replacement risks and many complications. Although nonosteotomy THA is convenient to perform, femoral osteotomy shortening can avoid blood vessel and nerve traction injuries. This study aimed to compare osteotomy THA with nonosteotomy to determine reasonable options for operative management of DDH. Methods: Data on 48 DDH patients who underwent THA were analyzed retrospectively. The patients were divided into two groups: Group A 29 cases (nonosteotomy), and group B 19 cases (osteotomy). Harris and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, limb length discrepancy (LLD), radiological data on the hip, and claudication were evaluated. Data were analyzed by using paired-sample Student's t-test, independent-sample Student's t-test, and Pearson's Chi-square test; the test level was α =0.05. Results: Postoperative Harris (90.7 ± 5.1) and WOMAC scores (88.0 ± 10.6) were significantly improved compared with preoperative Harris (44.8 ± 5.7) and WOMAC scores (42.0 ± 5.3) in group A (P < 0.05). Postoperative Harris (90.4 ± 2.8) and WOMAC scores (88.2 ± 5.9) were significantly improved compared with preoperative Harris (44.4 ± 4.2) and WOMAC scores (43.2 ± 4.3) in group B (P < 0.05). One case of dislocation occurred in group A; after closed reduction, dislocation did not recur. In group A, 2 patients developed cutaneous branch injury of the femoral nerve, which spontaneously recovered without treatment. Postoperative LLD >2 cm was seen in one case in group A and five cases in group B. Postoperative claudication showed no significant difference between the two groups (P > 0.05). No patients developed infection; postoperative X-rays showed that the location of the prosthesis was satisfactory, and the surrounding bone was not dissolved. Conclusions: THA is effective and safe for DDH. For unilateral high

  15. The long-term results of Charnley low-friction arthroplasty in young patients who have congenital dislocation, degenerative osteoarthrosis, or rheumatoid arthritis.

    PubMed

    Sochart, D H; Porter, M L

    1997-11-01

    We present the long-term results of 226 Charnley low-friction arthroplasties that were performed with use of cement in 161 patients between 1966 and 1978. Forty-four patients (sixty hips) had congenital dislocation of the hip, fifty-four patients (sixty-six hips) had degenerative osteoarthrosis, and sixty-three patients (100 hips) had rheumatoid arthritis. There were 114 female patients and forty-seven male patients. The average age of the patients at the time of the operation was 31.7 years (range, seventeen to thirty-nine years). Sixty-five patients (40 per cent) had a bilateral hip replacement. Thirty-eight patients (24 per cent; fifty-five hips), twenty-seven of whom had juvenile-onset chronic rheumatoid arthritis, died during the follow-up period. The average duration of follow-up for the entire series until the time of death, revision of both components, or the latest evaluation was 236 months (19.7 years; range, twenty-four to 361 months). Survivorship analysis was performed with the Kaplan-Meier method. At twenty-five years, the survival of the femoral component (with 95 per cent confidence intervals) was 89 per cent (80 to 98 per cent) in the patients who had congenital dislocation of the hip, 85 per cent (77 to 93 per cent) in the patients who had rheumatoid arthritis, and 74 per cent (61 to 87 per cent) in the patients who had degenerative osteoarthrosis. The rate of survival of the acetabular component was lower: at twenty-five years, it was 58 per cent (42 to 74 per cent) in the patients who had congenital dislocation, 79 per cent (70 to 88 per cent) in the patients who had rheumatoid arthritis, and 59 per cent (41 to 77 per cent) in the patients who had degenerative osteoarthrosis. The forty-four patients (sixty hips) who had congenital dislocation had the highest rates of aseptic loosening (twenty-two hips; 37 per cent), migration (seventeen hips; 28 per cent), and revision (twenty-two hips; 37 per cent) of the acetabular component. The fifty

  16. Modular noncemented total hip arthroplasty for congenital dislocation of the hip. Case report and design rationale.

    PubMed

    Gorski, J M

    1988-03-01

    The highest rate of failure and the greatest technical difficulty in total hip arthroplasty occurs with congenital dislocation of the hip (CDH). Predisposing factors are failure to secure special femoral components to fit an extremely narrow and straight medullary cavity with space for only a very thin mantle of cement. The acetabulum is usually atrophic, and bone grafts are commonly required to support a small-diameter cup. The young age of the average patient and high levels of activity contribute to cement failure. A new modular cementless prosthesis provides excellent immediate skeletal fixation and pain relief in CDH patients. Five modular components are screwed or press-fit into bone. The modular approach facilitates implantation, reduces inventory, and is adaptable to unforeseen problems. These advantages are ordinarily absent with standard or custom cemented components. Modular components may also permit easier revision. The prosthesis is made of titanium alloy for its superalloy strength, elastic modulus, and bioinertness. By omitting the cement mantle, press-fit is obtained with the largest possible implant. The large size minimizes stem breakage in these young, small bones. Excellent short-term results suggest that modular cementless implants are indicated in some patients with CDH.

  17. Modular noncemented total hip arthroplasty for congenital dislocation of the hip. Case report and design rationale.

    PubMed

    Gorski, J M

    1988-03-01

    The highest rate of failure and the greatest technical difficulty in total hip arthroplasty occurs with congenital dislocation of the hip (CDH). Predisposing factors are failure to secure special femoral components to fit an extremely narrow and straight medullary cavity with space for only a very thin mantle of cement. The acetabulum is usually atrophic, and bone grafts are commonly required to support a small-diameter cup. The young age of the average patient and high levels of activity contribute to cement failure. A new modular cementless prosthesis provides excellent immediate skeletal fixation and pain relief in CDH patients. Five modular components are screwed or press-fit into bone. The modular approach facilitates implantation, reduces inventory, and is adaptable to unforeseen problems. These advantages are ordinarily absent with standard or custom cemented components. Modular components may also permit easier revision. The prosthesis is made of titanium alloy for its superalloy strength, elastic modulus, and bioinertness. By omitting the cement mantle, press-fit is obtained with the largest possible implant. The large size minimizes stem breakage in these young, small bones. Excellent short-term results suggest that modular cementless implants are indicated in some patients with CDH. PMID:3342552

  18. Pathogenesis of bone loss after total hip arthroplasty.

    PubMed

    Rubash, H E; Sinha, R K; Shanbhag, A S; Kim, S Y

    1998-04-01

    Bone loss with or without evidence of aseptic loosening is a long term complication after total hip arthroplasty (THA). It occurs with all materials and in all prosthetic systems in use or that have been used to date. Bone loss after THA can be a serious problem in revision surgery because bone deficiencies may limit reconstructive options, increase the difficulty of surgery, and necessitate autogenous or allogenic bone grafting. There are three factors adversely affecting maintenance of bone mass after THA: (1) bone loss secondary to particulate debris; (2) adaptive bone remodeling and stress shielding secondary to size, material properties, and surface characteristics of contemporary prostheses; and (3) bone loss as a consequence of natural aging. This chapter reviews the mechanisms of the primary causes of bone loss after THA.

  19. 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.

  20. Catastrophic failure of ceramic-polyethylene bearing total hip arthroplasty.

    PubMed

    Needham, Justin; Burns, Travis; Gerlinger, Tad

    2008-06-01

    Complications of ceramic-polyethylene bearing total hip arthroplasty (THA) include osteolysis, loosening, dislocation, and component failure. Catastrophic acetabular component failure involves severe damage to both the polyethylene liner and metal shell. This case study presents the first reported complete wear-through of the acetabular portion of a ceramic-polyethylene arthroplasty presenting as a dislocation and a review of the literature. In this study, a patient's alumina ceramic femoral head penetrated the polyethylene liner and titanium shell and presented as a dislocated THA. The contributing factors for this catastrophic failure include young patient age, high activity level, thin polyethylene liner, backside wear, component positioning, polyethylene sterilization with gamma irradiation in air, and lack of appropriate follow-up. Revision THA was performed without complications. PMID:18514888

  1. Profunda Femoris Pseudoaneurysm following Total Hip Arthroplasty Revision

    PubMed Central

    Harper, Katharine; Iorio, Justin; Balasubramanian, Easwaran

    2015-01-01

    Vascular injuries following total hip arthroplasty (THA) are very rare, with pseudoaneurysm being a small subset. We report a case of profunda femoris artery (PFA) pseudoaneurysm in a 61-year-old male following a posterior approach revision left THA. Presentation involved continued blood transfusion requirements several weeks postoperatively. Diagnosis of the pseduoaneurysm was made by contrast CT of the lower extremity, with confirmation via IR angiography. Successful embolization was achieved with selective coiling and Gelfoam. Presenting complaints of such complications are often vague and therefore lead to delayed diagnosis. Causes of such complications are not completely understood, particularly with PFA injuries in THA. Possible mechanisms are discussed in this paper. Vascular complications following THA can be difficult to diagnose. High suspicion in the setting of continued postoperative pain or bleeding may allow prompt diagnosis and avoidance of serious limb-threatening complications. PMID:26347839

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

    PubMed Central

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

    2012-01-01

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

  3. Gross trunnion failure after primary total hip arthroplasty.

    PubMed

    Banerjee, Samik; Cherian, Jeffrey J; Bono, James V; Kurtz, Steven M; Geesink, Rudolph; Meneghini, R Michael; Delanois, Ronald E; Mont, Michael A

    2015-04-01

    Unfavorable outcomes from trunnion fretting and corrosion damage have been reported in the literature, gross failures of tapers in primary total hip arthroplasties have been less frequently reported. We report on 5 patients, who presented with gross trunnion failures of modular metal-on-polyethylene or ceramic-on-polyethylene bearings from 5 implant manufacturers, all necessitating revision surgery. None of these patients had an antecedent history of trauma, and the majority presented with pain or instability. No common factor was identified that may be predictive of these type of failures. Since there were 5 different stem designs, this suggests that it may be a rare generic phenomenon occurring with multiple designs. Currently, further investigations are necessary, including retrieval analysis, to identify risk factors that may predispose to such failures.

  4. Complications in primary total hip arthroplasty: avoidance and management: wear.

    PubMed

    Ries, Michael D

    2003-01-01

    Many factors, including polyethylene processing, sterilization method, counterface material, femoral head size, femoral offset, acetabular component position, implant design, and patient activity level, affect the rate of wear in total hip arthroplasty. For patients with life expectancy that exceeds the longevity of the conventional implant materials, an alternative bearing surface (highly cross-linked polyethylene, metal-on-metal, or ceramic-on-ceramic) may be considered. Although laboratory wear tests with these materials are very favorable, clinical outcomes have not been clearly established. When osteolysis does develop in response to particulate debris, the location and progression of the lesions may be quite variable. Asymptomatic stable lesions can be followed clinically and radiographically while symptomatic or enlarging lesions or those that may compromise the integrity of the periprosthetic bone stock require surgery. If acetabular component revision is necessary and an adequate rim of host bone is maintained to support a revision acetabular component, defects can be filled with particulate bone graft. Large segmental defects generally require structural allografts. If the acetabular shell is well fixed in good position and the osteolytic defects are accessible, treatment with curettage and bone grafting of the lesions with liner revision is appropriate to avoid use of a structural allograft. Proximal femoral defects around a well-fixed stem can be managed in a similar manner with curettage and bone grafting. Distal lesions associated with risk of periprosthetic femur fracture or implant loosening require stem revision. Osteoclastic resportion of bone in response to particulate debris can be impaired with use of some drugs such as alendronate. However, the safety and efficacy of alendronate in the clinical management of osteolysis associated with total hip arthroplasty has not been established. PMID:12690853

  5. Total hip replacement in osteoarthritis: the role of bone metabolism and its complications.

    PubMed

    Bottai, Vanna; Dell'Osso, Giacomo; Celli, Fabio; Bugelli, Giulia; Cazzella, Niki; Cei, Elena; Guido, Giulio; Giannotti, Stefano

    2015-01-01

    Osteoarthritis is one of the most common joint disorder. For treatment of hip symptomatic osteoarthritis, when conservative medical therapy has failed, total hip arthroplasty (THA) is a successful orthopaedic procedures that reduces pain and improves function and quality of life. Incidence of osteoarthritis is constantly increasing with raising life expectancy. This aging process also has led to an increasing number of patients with osteoporosis who need hip replacement for osteoarthritis. Osteoporosis have 3 major potential complications in total hip arthroplasty: perioperative fracture, an increased risk of periprosthetic fracture, and late aseptic loosening. The purpose of the present study was to examine the effects of osteoporosis on total hip replacement procedure outcome and highlight the importance of adequate study of calcium-phosphorus metabolism in patient candidate for hip surgery, and the need to start a suitable therapy to recover the bone mass before surgery. Bone quality of the hip joint has become an important risk factor limiting the durability of THA. PMID:26811704

  6. Uncemented total hip arthroplasty in osteoarthritis of hip secondary to low and high dislocated hips: A mid-term follow-up study

    PubMed Central

    Munigangaiah, Sudarshan; O’Dwyer, Sinead; Masterson, Eric

    2016-01-01

    Background: Performing successful total hip replacement (THR) in dysplastic, subluxed, and dislocated hip is a challenging task. Here, we assessed midterm clinical and radiological outcomes of uncemented total hip arthroplasty in osteoarthritis (OA) of hip secondary to Hartofilakidis low and high-dislocated hips with a mean follow-up of 8.8 years. Materials and Methods: A retrospective study of prospectively collected data was designed involving all consecutive patients who underwent uncemented THR for OA of hip secondary to developmental dysplasia of the hip and Grade II or Grade III Hartofilakidis classification. Results: Thirty-two patients underwent 45 THR, with 23 Grade II (low dislocation) and 22 Grade III (high-dislocation) of Hartofilakidis classification. Thirteen patients had bilateral hip replacements, 19 patients had unilateral THR. There was highly statistically significant difference between preoperative and postoperative HHS and SF-36v2™ at each follow-up. Survivorship of original implant was 98.88% at a mean follow-up of 8.8 years. The mean improvement in leg length in this series was 3.6 cm (1.8-4.5, 95% confidence interval). No sciatic nerve or femoral nerve palsies were observed. Conclusions: Uncemented THR provides better function and quality of life. However, longer follow-up studies are needed to assess survivorship of uncemented THR in Hartofilakidis low and high-dislocations. PMID:27433063

  7. Physiotherapy Rehabilitation After Total Knee or Hip Replacement

    PubMed Central

    2005-01-01

    Executive Summary Objective The objective of this health technology policy analysis was to determine, where, how, and when physiotherapy services are best delivered to optimize functional outcomes for patients after they undergo primary (first-time) total hip replacement or total knee replacement, and to determine the Ontario-specific economic impact of the best delivery strategy. The objectives of the systematic review were as follows: To determine the effectiveness of inpatient physiotherapy after discharge from an acute care hospital compared with outpatient physiotherapy delivered in either a clinic-based or home-based setting for primary total joint replacement patients To determine the effectiveness of outpatient physiotherapy delivered by a physiotherapist in either a clinic-based or home-based setting in addition to a home exercise program compared with a home exercise program alone for primary total joint replacement patients To determine the effectiveness of preoperative exercise for people who are scheduled to receive primary total knee or hip replacement surgery Clinical Need Total hip replacements and total knee replacements are among the most commonly performed surgical procedures in Ontario. Physiotherapy rehabilitation after first-time total hip or knee replacement surgery is accepted as the standard and essential treatment. The aim is to maximize a person’s functionality and independence and minimize complications such as hip dislocation (for hip replacements), wound infection, deep vein thrombosis, and pulmonary embolism. The Therapy The physiotherapy rehabilitation routine has 4 components: therapeutic exercise, transfer training, gait training, and instruction in the activities of daily living. Physiotherapy rehabilitation for people who have had total joint replacement surgery varies in where, how, and when it is delivered. In Ontario, after discharge from an acute care hospital, people who have had a primary total knee or hip replacement may

  8. Head size and dislocation rate in primary total hip arthroplasty

    PubMed Central

    Singh, Somesh P; Bhalodiya, Haresh P

    2013-01-01

    Background: Dislocation after total hip arthroplasty (THA) has a multifactorial etiology with variables such as surgical approach, component orientation and position, type of cup, stem and head size. Review of the literature regarding the relationship of head size and dislocation rate in THA is suggestive that large femoral head size is associated with lower dislocation rate after THA. However, limited data is available as a proof of this hypothesis. The purpose of this study was to determine that the use of large head size would lead to a decreased incidence of dislocations following THA. Materials and Methods: 317 primary THAs were performed using the posterolateral approach with posterior soft-tissue repair between January 2006 and December 2009. Cases were divided into two groups (A and B). Femoral head diameter size 36 mm was used in 163 THA in group A and 28 mm in 154 THA in group B. Average period of followup being 2 years (6 month to 4 years). Patients were routinely followed at definite intervals and were specifically assessed for dislocation. Results: One or more dislocations occurred in 11 out of 317 hips with the overall rate of dislocation being 3.47%. Dislocation rate was 0.6% in 36 mm head size and 6.49% with 28 mm head size (P value is 0.0107). Keeping the stem design variable as a constant, the difference in the rate of dislocation between the two groups was again found to be statistically significant for both un-cemented and cemented stem. Conclusion: Dislocation rate decreased significantly as the size of the head increased in primary THA. However, longer followup is necessary as rate of dislocation or in vivo highly cross linked poly failure or fracture may increase in future affecting the rate of dislocations in primary THA. PMID:24133302

  9. Robotic-Arm Assisted Surgery in Total Hip Arthroplasty.

    PubMed

    Elmallah, Randa K; Cherian, Jeffrey J; Jauregui, Julio J; Padden, David A; Harwin, Steven F; Mont, Michael A

    2015-05-01

    Complications following total hip arthroplasty (THA), such as dislocation, component loosening and wear, continue to be common indications for revision surgery. Multiple studies have attributed some of these problems to poor acetabular cup alignment and placement outside of the purported radiographic safe zone. In addition, it has been shown that conventional manually performed acetabular cup placement may not lead to optimal alignment, regardless of surgical experience. Additionally, incorrect leg length and offset can lead to dissatisfaction and instability. Therefore, robotic-arm assisted surgery has been introduced to improve accuracy of cup placement and leg length, and to offset with the aim of reducing the risk of hip instability and improving satisfaction after primary THA. Our aim was to prospectively review the use of robotic-arm assisted surgery in 224 patients and to assess whether the pre-operatively determined radiographic targets were achieved post-operatively and the proportion of acetabular cups outside of the safe zone. Pre-determined anteversion and inclination were 15 and 40 degrees, respectively. Our results have shown that the use of robotic-arm assisted surgery resulted in a post-operative mean inclination of 40 degrees (range, 34 to 51 degrees) and a mean anteversion of 16 degrees (range, 9 to 25 degrees). Ninety-nine percent of the patients remained within the pre-designated safe zone. Evidence has shown that robotic-arm assisted surgery may have improved accuracy in cup placement when compared to conventional surgery and possibly to computer-assisted surgery. When compared to the literature on robotic-arm assisted surgery, our results were comparable. We believe that this surgical technique may aid in reducing post-operative THA complications, such as aseptic loosening and dislocations, but further prospective studies are needed to evaluate clinical outcomes and long-term results. PMID:26055021

  10. Analysis of Femoral Components of Cemented Total Hip Arthroplasty

    NASA Astrophysics Data System (ADS)

    Singh, Shantanu; Harsha, A. P.

    2015-10-01

    There have been continuous on-going revisions in design of prosthesis in Total Hip Arthroplasty (THA) to improve the endurance of hip replacement. In the present work, Finite Element Analysis was performed on cemented THA with CoCrMo trapezoidal, CoCrMo circular, Ti6Al4V trapezoidal and Ti6Al4V circular stem. It was observed that cross section and material of femoral stem proved to be critical parameters for stress distribution in femoral components, distribution of interfacial stress and micro movements. In the first part of analysis, designs were investigated for micro movements and stress developed, for different stem materials. Later part of the analysis focused on investigations with respect to different stem cross sections. Femoral stem made of Titanium alloy (Ti6Al4V) resulted in larger debonding of stem at cement-stem interface and increased stress within the cement mantle in contrast to chromium alloy (CoCrMo) stem. Thus, CoCrMo proved to be a better choice for cemented THA. Comparison between CoCrMo femoral stem of trapezium and circular cross section showed that trapezoidal stem experiences lesser sliding and debonding at interfaces than circular cross section stem. Also, trapezium cross section generated lower peak stress in femoral stem and cortical femur. In present study, femur head with diameter of 36 mm was considered for the analysis in order to avoid dislocation of the stem. Also, metallic femur head was coupled with cross linked polyethylene liner as it experiences negligible wear compared to conventional polyethylene liner and unlike metallic liner it is non carcinogenic.

  11. [What are the recommendations for sport activity following total hip or total knee arthroplasty?].

    PubMed

    Tsur, Azmon; Volpin, Gershon

    2013-11-01

    Total hip and knee arthroplasty are surgical procedures usually performed in older adults aged 65-70 years and more, who suffer from arthritic joint degeneration, in order to relieve pain and improve functioning. In the past decade there have been more and more documentations of younger people, 50-60 years old and even less, who expect to participate in physical activity following these procedures. The trend today is to recommend activities which exert mild pressure on the implants such as swimming, cycling, golf, bowling, walking and cycling. It is not recommended to participate in sports activities that place greater pressure on the implants such as soccer, football, volleyball, handball, basketball, hockey and jogging. Such high-stress activities may cause early loosening of implants, as described in the article by Keren et al. in this issue: "Sport activity after hip and knee arthroplasty". PMID:24416821

  12. [What are the recommendations for sport activity following total hip or total knee arthroplasty?].

    PubMed

    Tsur, Azmon; Volpin, Gershon

    2013-11-01

    Total hip and knee arthroplasty are surgical procedures usually performed in older adults aged 65-70 years and more, who suffer from arthritic joint degeneration, in order to relieve pain and improve functioning. In the past decade there have been more and more documentations of younger people, 50-60 years old and even less, who expect to participate in physical activity following these procedures. The trend today is to recommend activities which exert mild pressure on the implants such as swimming, cycling, golf, bowling, walking and cycling. It is not recommended to participate in sports activities that place greater pressure on the implants such as soccer, football, volleyball, handball, basketball, hockey and jogging. Such high-stress activities may cause early loosening of implants, as described in the article by Keren et al. in this issue: "Sport activity after hip and knee arthroplasty".

  13. Durability of highly cross-linked polyethylene in total hip and total knee arthroplasty.

    PubMed

    Dion, Neil T; Bragdon, Charles; Muratoglu, Orhun; Freiberg, Andrew A

    2015-07-01

    This article reviews the history of the development of highly cross-linked polyethylene and provides an in-depth review of the clinical results regarding the durability of highly cross-linked polyethylene (HXLPE) used in total hip arthroplasty (THA) and total knee arthroplasty (TKA). The use of polyethylene as a bearing surface has contributed to the success of THA and TKA; however, polyethylene wear and osteolysis can lead to failure. Ongoing clinical and retrieval studies are required to analyze outcomes at longer-term follow-up.

  14. Durability of highly cross-linked polyethylene in total hip and total knee arthroplasty.

    PubMed

    Dion, Neil T; Bragdon, Charles; Muratoglu, Orhun; Freiberg, Andrew A

    2015-07-01

    This article reviews the history of the development of highly cross-linked polyethylene and provides an in-depth review of the clinical results regarding the durability of highly cross-linked polyethylene (HXLPE) used in total hip arthroplasty (THA) and total knee arthroplasty (TKA). The use of polyethylene as a bearing surface has contributed to the success of THA and TKA; however, polyethylene wear and osteolysis can lead to failure. Ongoing clinical and retrieval studies are required to analyze outcomes at longer-term follow-up. PMID:26043046

  15. Hospitalization for total hip replacement among inpatients aged 45 and over: United States, 2000-2010.

    PubMed

    Wolford, Monica L; Palso, Kathleen; Bercovitz, Anita

    2015-02-01

     Total hip replacement, in which both the head of the femur and its socket are replaced, is done to restore movement to hips damaged by osteoarthritis, late-stage degenerative bone and cartilage disease, or other injuries and disease (1). The number of total hip replacements is expected to increase over the next few decades (2). National Hospital Discharge Survey (NHDS) data show trends and estimates of the number and rate of total hip replacements and average length of stay among inpatients aged 45 and over. PMID:25714040

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

    PubMed

    Mallory, T H

    1992-10-01

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

  17. Probabilistic analysis of an uncemented total hip replacement.

    PubMed

    Dopico-González, Carolina; New, Andrew M; Browne, Martin

    2009-05-01

    This paper describes the application of probabilistic design methods to the analysis of the behaviour of an uncemented total hip replacement femoral component implanted in a proximal femur. Probabilistic methods allow variations in factors which control the behaviour of the implanted femur (the input parameters) to be taken into account in determining the performance of the construct. Monte Carlo sampling techniques were applied and the performance indicator was the maximum strain in the bone. The random input parameters were the joint load, the angle of the applied load and the material properties of the bone and the implant. Two Monte Carlo based simulations were applied, direct sampling and latin hypercube sampling. The results showed that the convergence of the mean value of the maximum strain improved gradually as a function of the number of simulations and it stabilised around a value of 0.008 after 6200 simulations. A similar trend was observed for the cumulative distribution function of the output. The strain output was most sensitive to the bone stiffness, followed very closely by the magnitude of the applied load. The application of latin hypercube sampling with 1000 simulations gave similar results to direct sampling with 10,000 simulations in a much reduced time. The results suggested that the number of simulations and the selection of parameters and models are important for the reliability of both the probability values and the sensitivity analyses. PMID:19217340

  18. Pharmacological thromboprophylaxis and total hip or knee replacement.

    PubMed

    Frostick, Simon

    Pharmacological and mechanical thromboprophylaxis reduces the risk of venous thromboembolism (VTE) in patients undergoing total knee/hip replacement (TKR/THR). Nurses play a key role in VTE prevention through clinical care, before and after discharge from hospital, and patient education. Conventional pharmacological agents for VTE prophylaxis include low molecular weight heparins (LMWHs) and fondaparinux. However, parenteral administration, increased bleeding risk, and patient/physician non-adherence to treatment and guidelines, are important limitations. Three non-vitamin K antagonist oral anticoagulants--dabigatran etexilate, rivaroxaban and apixaban--are available in the UK for VTE prevention following THR/TKR. In common with LMWHs and fondaparinux, these offer rapid onset of action and fixed doses without the need for routine coagulation monitoring. An agent for emergency reversal of dabigatran is in development, while there is no antidote for fondaparinux and LMWHs can be partially neutralised by protamine. Oral administration may result in better adherence to treatment and guidelines, reducing the nurse burden after discharge, and enhancing cost-effectiveness. PMID:26768045

  19. Calibration Markers for Digital Templating in Total Hip Arthroplasty

    PubMed Central

    Boese, Christoph Kolja; Lechler, Philipp; Rose, Leonard; Dargel, Jens; Oppermann, Johannes; Eysel, Peer; Geiges, Hansjörg; Bredow, Jan

    2015-01-01

    Digital templating with external calibration markers is the standard method for planning total hip arthroplasty. We determined the geometrical basis of the magnification effect, compared magnification with external and internal calibration markers, and examined the influence on magnification of the position of the calibration markers, patient weight, and body mass index (BMI). A formula was derived to calculate magnification with internal and external calibration markers, informed by 100 digital radiographs of the pelvis. Intraclass correlations between the measured and calculated values and the strength of relationships between magnification, position and distance of calibration markers and height, weight, and BMI were sought. There was a weak correlation between magnification of internal and external calibration markers (r = 0.297–0.361; p < 0.01). Intraclass correlations were 0.882–1.000 (p = 0.000) for all parameters. There were also weak correlations between magnification of internal and external calibration markers and weight and BMI (r = 0.420, p = 0.000; r = 0.428, p = 0.000, respectively). The correlation between external and internal calibration markers was poor, indicating the need for more accurate calibration methods. While weight and BMI weakly correlated with the magnification of markers, future studies should examine this phenomenon in more detail. PMID:26168410

  20. Calibration Markers for Digital Templating in Total Hip Arthroplasty.

    PubMed

    Boese, Christoph Kolja; Lechler, Philipp; Rose, Leonard; Dargel, Jens; Oppermann, Johannes; Eysel, Peer; Geiges, Hansjörg; Bredow, Jan

    2015-01-01

    Digital templating with external calibration markers is the standard method for planning total hip arthroplasty. We determined the geometrical basis of the magnification effect, compared magnification with external and internal calibration markers, and examined the influence on magnification of the position of the calibration markers, patient weight, and body mass index (BMI). A formula was derived to calculate magnification with internal and external calibration markers, informed by 100 digital radiographs of the pelvis. Intraclass correlations between the measured and calculated values and the strength of relationships between magnification, position and distance of calibration markers and height, weight, and BMI were sought. There was a weak correlation between magnification of internal and external calibration markers (r = 0.297-0.361; p < 0.01). Intraclass correlations were 0.882-1.000 (p = 0.000) for all parameters. There were also weak correlations between magnification of internal and external calibration markers and weight and BMI (r = 0.420, p = 0.000; r = 0.428, p = 0.000, respectively). The correlation between external and internal calibration markers was poor, indicating the need for more accurate calibration methods. While weight and BMI weakly correlated with the magnification of markers, future studies should examine this phenomenon in more detail.

  1. Iliopsoas Irritation as Presentation of Head-Neck Corrosion After Total Hip Arthroplasty: A Case Series.

    PubMed

    Matsen Ko, Laura; Coleman, Jacob J; Stas, Venessa; Duwelius, Paul J

    2015-10-01

    Corrosion of modular components at the femoral neck remains a complication of total hip arthroplasty (THA). The authors have found the iliopsoas sign (pain on resisted flexion of the hip) to be suggestive of femoral component corrosion. These cases represented 8 of 120 revision hip arthroplasties (7%) performed at the authors' institution. After the revisions, all iliopsoas tendonitis symptoms resolved. Based on the authors' experience and the recent literature, they recommend that the iliopsoas sign or presentation of a sterile iliopsoas abscess in a previously well-functioning THA be concern for corrosion of the femoral component of the total hip.

  2. Total hip arthroplasty in paralytic dislocation from poliomyelitis.

    PubMed

    Laguna, Rafael; Barrientos, Jesús

    2008-02-01

    This article presents a case of a patient with degenerative hip disease in paralytic dislocation by poliomyelitis. Poliomyelitis is an acute infection disease caused by a group of neurotrophic viruses, which has a special affinity by the anterior horns cells of the spinal cord and for certain motor nuclei of the brain stem. Paralysis is a flaccid type and characteristically paralysis is asymmetrical. It is said that the joints of the affected limb by poliomyelitis are protected from the development of osteoarthritis. Hip dislocation in poliomyelitis is an acquired deformity caused by flaccid paralysis and the resulting muscular imbalance. In young children, when the gluteus maximus and medius muscles are paralyzed and the hip flexors and adductors are of normal strength, eventual luxation of the hip is almost inevitable. Hip osteoarthritis in a limb with poliomyelitis is an unusual entity because these limbs do not support excessive loads. In patients who present with the residual effects of poliomyelitis including degenerative disease and hip dysplastic, surgery is one of the most difficult challenges faced by reconstructive surgeons. In such cases, surgeons should attempt to optimize the component position and choice, surgical approach, and soft tissue tensioning because stability of the prosthesis can be problematic. PMID:19292189

  3. 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.

  4. A clinical comparative study of anatomic parameters before and after total hip replacement on congenital dysplasia.

    PubMed

    Huang, Ziqiang; Zhou, Yonggang; Chai, Wei; Ji, Weiping; Cui, Guopeng; Ma, Miaoqun; Zhu, Yin

    2016-07-01

    [Purpose] To study preoperative and postoperative hip circumference data of various types of congenital dysplasia of the hip treated with total hip replacement, including the femoral offset, femoral neck length, height, and hip abductor arm parameters. [Subjects and Methods] This study included seventy-eight cases of congenital dysplasia of the hip (I-III type). Furthermore, four parameters were measured, including the preoperative and postoperative femoral offset. Statistical data analysis was performed using the SPSS 13.0 software. [Results] The femoral offset was 33.3 ± 8.4 mm (preoperative) and 39.1 ± 7.1 mm (postoperative). The femoral head height was 59.5 ± 8.7 mm (preoperative) and 68.8 ± 11.0 mm (postoperative). The femoral neck length was 50.8 ± 10.8 mm (preoperative) and 61.5 ± 10.4 mm (postoperative). The hip abductor arm was 54.3 ± 9.6 mm (preoperative) 64.7 ± 10.1 mm (postoperative). The preoperative and postoperative parameters showed statistical differences. Furthermore, no significant differences were evidenced when comparing the postoperative hip parameters with the normal data parameters. [Conclusion] Total hip replacement on congenital dysplasia of the hip could lead to the rebuilt of an almost normal physiological anatomy for each hip case (type I-III). PMID:27512242

  5. A clinical comparative study of anatomic parameters before and after total hip replacement on congenital dysplasia

    PubMed Central

    Huang, Ziqiang; Zhou, Yonggang; Chai, Wei; Ji, Weiping; Cui, Guopeng; Ma, Miaoqun; Zhu, Yin

    2016-01-01

    [Purpose] To study preoperative and postoperative hip circumference data of various types of congenital dysplasia of the hip treated with total hip replacement, including the femoral offset, femoral neck length, height, and hip abductor arm parameters. [Subjects and Methods] This study included seventy-eight cases of congenital dysplasia of the hip (I–III type). Furthermore, four parameters were measured, including the preoperative and postoperative femoral offset. Statistical data analysis was performed using the SPSS 13.0 software. [Results] The femoral offset was 33.3 ± 8.4 mm (preoperative) and 39.1 ± 7.1 mm (postoperative). The femoral head height was 59.5 ± 8.7 mm (preoperative) and 68.8 ± 11.0 mm (postoperative). The femoral neck length was 50.8 ± 10.8 mm (preoperative) and 61.5 ± 10.4 mm (postoperative). The hip abductor arm was 54.3 ± 9.6 mm (preoperative) 64.7 ± 10.1 mm (postoperative). The preoperative and postoperative parameters showed statistical differences. Furthermore, no significant differences were evidenced when comparing the postoperative hip parameters with the normal data parameters. [Conclusion] Total hip replacement on congenital dysplasia of the hip could lead to the rebuilt of an almost normal physiological anatomy for each hip case (type I–III). PMID:27512242

  6. Mid-term clinical results of total hip arthroplasty using a Wagner standard cup for dysplastic hip

    PubMed Central

    Maezawa, Katsuhiko; Nozawa, Masahiko; Yuasa, Takahito; Aritomi, Kentaro; Ogawa, Seiki; Maruyama, Yuichiro; Kaneko, Kazuo

    2014-01-01

    Background The outcome of cementless total hip arthroplasty depends on many factors. We must not forget fundamental things those are design of outer surface of the component, that leads bone ingrowth into the prosthesis, better initial stability, and better insertional techniques. The purpose of this study was to review our experience with metal-on-metal total hip arthroplasty with a Wagner standard cup for patients who had acetabular dysplasia. Patients and methods Fifty-four patients with 55 hips underwent primary metal-on-metal total hip arthroplasty (Metasul prosthesis) with a Wagner standard cup (44–48 mm in outer diameter) and were followed for a minimum of 10 years. All patients received the same type of cementless femoral component (Natural hip stem) and femoral head (28 mm in diameter). Results Seventeen of the 55 Wagner standard cups (30.9%) showed aseptic loosening over a mean period of 3.6 years after surgery, and there were no bone anchors on the outer surface of the 16 retrieved cups. Conclusion From our experience, the small Wagner standard cup does not achieve sufficient osteointegration and we do not recommend the use of this cup, especially for patients with acetabular dysplasia and/or those with a small stature. PMID:25561751

  7. Transfusion-Transmitted Babesiosis During Total Hip Arthroplasty.

    PubMed

    Carnevale, Joseph; Feller, Ross; Shalvoy, Robert M

    2015-09-01

    Babesiosis is a potentially life-threatening zoonotic disease that is endemic to the northeastern United States and increasing in prevalence worldwide. Transmitted by the same Ixodes tick responsible for Lyme disease, the intraerythrocytic parasite Babesia causes a wide range of clinical presentations--from asymptomatic carriage to a fulminant course with rapid deterioration. Symptoms typically present 1 to 6 weeks after inoculation, with the gradual onset of fatigue, malaise, weakness, and intermittent or sustained fever as high as 40.9°C. Severe cases are associated with parasitemia greater than 4%, alkaline phosphatase greater than 125 U/L, and white blood cell counts greater than 5×10(9)/L. Definitive diagnosis is made by microscopic examination of thin blood smears, polymerase chain reaction, and indirect immunofluorescent antibody testing. The increasing frequency of babesiosis paired with a lack of blood-donor screening assays poses a serious threat to the safety of the US blood supply. Although babesiosis is responsible for 3.6% of transfusion-related deaths, the Food and Drug Administration has yet to approve mandatory screening for the parasite in donated blood. Historically, transfusion-transmitted babesiosis has been thought to be isolated to the immunocompromised patient population. However, a recent case of transfusion-transmitted babesiosis in an immunocompetent patient following total hip arthroplasty is the first reported in the literature and may represent a growing risk to a far greater segment of the population than previously thought. This article summarizes the current state of transfusion-transmitted babesiosis and the detrimental impact of this infection on blood transfusion safety. PMID:26375547

  8. A frictional study of total hip joint replacements

    NASA Astrophysics Data System (ADS)

    Scholes, S. C.; Unsworth, A.; Goldsmith, A. A. J.

    2000-12-01

    Polymeric wear debris produced by articulation of the femoral head against the ultra-high-molecular-weight polyethylene socket of a total hip replacement has been implicated as the main cause of osteolysis and subsequent failure of these implants. Potential solutions to this problem are to employ hard bearing surface combinations such as metal-on-metal or ceramic-on-ceramic prostheses. The aim of this study was to investigate the difference in lubrication modes and friction of a range of material combinations using synthetic and biological fluids as the lubricants. The experimental results were compared with theoretical predictions of film thicknesses and lubrication modes. A strong correlation was observed between experiment and theory when employing carboxy methyl cellulose (CMC) fluids as the lubricant. Under these conditions the ceramic-on-ceramic joints showed full fluid film lubrication while the metal-on-metal, metal-on-plastic, diamond-like carbon-coated stainless steel (DLC)-on-plastic and ceramic-on-plastic prostheses operated under a mixed lubrication regime. With bovine serum as the lubricant in the all ceramic joints, however, the full fluid film lubrication was inhibited due to adsorbed proteins. In the metal-on-metal joints this adsorbed protein layer acted to reduce the friction while in the ceramic coupling the friction was increased. The use of bovine serum as the lubricant also significantly increased the friction in both the metal-on-plastic and ceramic-on-plastic joints. The friction produced by the DLC-on-plastic joints depended on the quality of the coating. Those joints with a less consistent coating and therefore a higher surface roughness gave significantly higher friction than the smoother, more consistently coated heads.

  9. Single-dose radiation therapy for prevention of heterotopic ossification after total hip arthroplasty

    SciTech Connect

    Healy, W.L.; Lo, T.C.; Covall, D.J.; Pfeifer, B.A.; Wasilewski, S.A. )

    1990-12-01

    Single-dose radiation therapy was prospectively evaluated for its efficacy in prevention of heterotopic ossification in patients at high risk after total hip arthroplasty. Thirty-one patients (34 hips) were treated between 1981 and 1988. Risk factors for inclusion in the protocol included prior evidence of heterotopic ossification, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis. Patients with hypertrophic osteoarthritis or traumatic arthritis with osteophytes were not included. Operations on 34 hips included 19 primary total and 11 revision total hip arthroplasties and 4 excisions of heterotopic ossification. All patients received radiotherapy to the hip after operation with a single dose of 700 centigray. Radiotherapy is recommended on the first postoperative day. After this single-dose radiation treatment, no patient had clinically significant heterotopic ossification. Recurrent disease developed in two hips (6%), as seen on radiography (grades 2 and 3). This series documents a 100% clinical success rate and a 94% radiographic success rate in preventing heterotopic ossification in patients at high risk after total hip arthroplasty. Single-dose radiotherapy is as effective as other radiation protocols in preventing heterotopic ossification after total hip arthroplasty. It is less expensive and easier to administer than multidose radiotherapy.

  10. Reverse-total shoulder arthroplasty cost-effectiveness: A quality-adjusted life years comparison with total hip arthroplasty

    PubMed Central

    Bachman, Daniel; Nyland, John; Krupp, Ryan

    2016-01-01

    AIM: To compare reverse-total shoulder arthroplasty (RSA) cost-effectiveness with total hip arthroplasty cost-effectiveness. METHODS: This study used a stochastic model and decision-making algorithm to compare the cost-effectiveness of RSA and total hip arthroplasty. Fifteen patients underwent pre-operative, and 3, 6, and 12 mo post-operative clinical examinations and Short Form-36 Health Survey completion. Short form-36 Health Survey subscale scores were converted to EuroQual Group Five Dimension Health Outcome scores and compared with historical data from age-matched patients who had undergone total hip arthroplasty. Quality-adjusted life year (QALY) improvements based on life expectancies were calculated. RESULTS: The cost/QALY was $3900 for total hip arthroplasty and $11100 for RSA. After adjusting the model to only include shoulder-specific physical function subscale items, the RSA QALY improved to 2.8 years, and its cost/QALY decreased to $8100. CONCLUSION: Based on industry accepted standards, cost/QALY estimates supported both RSA and total hip arthroplasty cost-effectiveness. Although total hip arthroplasty remains the quality of life improvement “gold standard” among arthroplasty procedures, cost/QALY estimates identified in this study support the growing use of RSA to improve patient quality of life. PMID:26925384

  11. Treatment of primary hip osteoarthritis for the primary care physician and the indications for total hip arthroplasty.

    PubMed

    Levine, Mathew E; Nace, James; Kapadia, Bhaveen H; Issa, Kimona; Banerjee, Samik; Cherian, Jeffery J; Mont, Michael A

    2013-01-01

    Osteoarthritis is a degenerative condition that commonly affects knees and hips with an annual incidence of 88 in 100,000 people in the United States. The purpose of this study was to review the clinical presentation of osteoarthritis of the hip as well as the available management options. We reviewed the recent literature in regard to epidemiology, presentation, and treatment options available to patients. Nonoperative treatments include weight loss and low-impact, aerobic exercises. Along with weight loss and exercise, nonsteroidal anti-inflammatory drugs (NSAIDS), narcotics, and intra-articular steroid injections have been used to improve patient's symptoms. Surgical intervention is a viable option; however, indications such as severe pain that is refractory to nonsurgical management, osteophytes, or joint space narrowing on radiographic films, or impairment of function should be present. The most common surgical option, total hip arthroplasty, has been shown to improve a patient's physical and psychological well-being. However, inherent risks are present with surgery and these should be addressed with the patient so a sound decision can be made. Osteoarthritis of the hip can be bothersome to patients, but physicians can begin management with lifestyle changes or pharmaceuticals. In the event nonoperative measures fail to markedly improve quality of life, total hip arthroplasty remains a viable option.

  12. Mortality rates at 10 years after metal-on-metal hip resurfacing compared with total hip replacement in England: retrospective cohort analysis of hospital episode statistics

    PubMed Central

    Kendal, Adrian R; Prieto-Alhambra, Daniel; Arden, Nigel K; Judge, Andrew

    2013-01-01

    Objectives To compare 10 year mortality rates among patients undergoing metal-on-metal hip resurfacing and total hip replacement in England. Design Retrospective cohort study. Setting English hospital episode statistics database linked to mortality records from the Office for National Statistics. Population All adults who underwent primary elective hip replacement for osteoarthritis from April 1999 to March 2012. The exposure of interest was prosthesis type: cemented total hip replacement, uncemented total hip replacement, and metal-on-metal hip resurfacing. Confounding variables included age, sex, Charlson comorbidity index, rurality, area deprivation, surgical volume, and year of operation. Main outcome measures All cause mortality. Propensity score matching was used to minimise confounding by indication. Kaplan-Meier plots estimated the probability of survival up to 10 years after surgery. Multilevel Cox regression modelling, stratified on matched sets, described the association between prosthesis type and time to death, accounting for variation across hospital trusts. Results 7437 patients undergoing metal-on-metal hip resurfacing were matched to 22 311 undergoing cemented total hip replacement; 8101 patients undergoing metal-on-metal hip resurfacing were matched to 24 303 undergoing uncemented total hip replacement. 10 year rates of cumulative mortality were 271 (3.6%) for metal-on-metal hip resurfacing versus 1363 (6.1%) for cemented total hip replacement, and 239 (3.0%) for metal-on-metal hip resurfacing versus 999 (4.1%) for uncemented total hip replacement. Patients undergoing metal-on-metal hip resurfacing had an increased survival probability (hazard ratio 0.51 (95% confidence interval 0.45 to 0.59) for cemented hip replacement; 0.55 (0.47 to 0.65) for uncemented hip replacement). There was no evidence for an interaction with age or sex. Conclusions Patients with hip osteoarthritis undergoing metal-on-metal hip resurfacing have reduced mortality in

  13. Delayed Femoral Nerve Palsy Associated with Iliopsoas Hematoma after Primary Total Hip Arthroplasty

    PubMed Central

    Kumar, Sandeep

    2016-01-01

    Femoral nerve neuropathy after total hip arthroplasty is rare but catastrophic complication. Pain and quadriceps muscle weakness caused by this complication can significantly affect the functional outcome. Here we present a case report, describing delayed onset femoral nerve palsy associated with iliopsoas hematoma following pseudoaneurysm of a branch of profunda femoris artery after 3 months of primary total hip arthroplasty in an 80-year-old female patient with single kidney. Hip arthroplasty was done for painful primary osteoarthritis of left hip. Diagnosis of femoral nerve palsy was made by clinical examination and computed tomography imaging of pelvis. Patient was managed by surgical evacuation of hematoma and physiotherapy. The patient's clinical symptoms were improved after surgical evacuation of hematoma. This is the first case report of its kind in English literature regarding delayed onset femoral nerve palsy after primary total hip arthroplasty due to pseudoaneurysm of a branch of profunda femoris artery without any obvious precipitating factor. PMID:27752378

  14. Actis Total Hip System 2 Year Follow-up

    ClinicalTrials.gov

    2016-08-09

    Osteoarthritis; Traumatic Arthritis; Rheumatoid Arthritis; Congenital Hip Dysplasia; Avascular Necrosis of the Femoral Head; Acute Traumatic Fracture of the Femoral Head or Neck; Certain Cases of Ankylosis; Non-union of Femoral Neck Fractures; Certain High Sub-Capital and Femoral Neck Fractures in the Elderly

  15. Total hip arthroplasty to treat congenital musculoskeletal abnormalities in the juvenile Down Syndrome hip: review of literature with case.

    PubMed

    Taylor, Drew W; MacDonald, Matthew P; Kosashvili, Yona; Gross, Allan E

    2012-05-01

    Down Syndrome can result in musculoskeletal abnormalities of the hip at an early age. Avascular necrosis of the femoral head can occur as a result of slipped capital femoral epiphysis causing the patient a great deal of pain, limiting the ability to ambulate. Despite the benefits that this patient group can receive from the surgery, surgeons may be apprehensive to operate. It is our experience that these patients benefit greatly from arthroplasty without complication. In this report, we present a total hip replacement to treat avascular necrosis in an adolescent and address the concerns that surgeons may have in treating this patient population.

  16. The effect of cup inclination and wear on the contact mechanics and cement fixation for ultra high molecular weight polyethylene total hip replacements.

    PubMed

    Hua, Xijin; Wroblewski, B Michael; Jin, Zhongmin; Wang, Ling

    2012-04-01

    The present study aimed to investigate individual and combined influences of the cup inclination and wear on the contact mechanics and fixation of a Charnley hip replacement using finite element method. The effects of cup inclination and penetration on the contact mechanics of articulating bearings as well as the stress within the cement and at the bone-cement interface were examined. The maximum contact pressure and the von Mises stress on the cup were reduced by ~30% and ~20% respectively when even a small penetration occurred. However, no large differences were found between different cup penetration depths with regards to either the contact pressure or the von Mises stress. The von Mises stress at the bone-cement interface was predicted almost unaltered with an increased cup inclination angle to 55° for a cup penetration to 4mm. These predictions suggest that the contact mechanics and the cement stress are insensitive to the cup inclination and wear under these normal conditions investigated, therefore explaining the robustness of the Charnley hip implant. An increase in the cup inclination angle to 65°, coupled with a maximum penetration of 4mm, resulted in a large increase in the maximum von Mises stress at the bone-cement interface.

  17. Obesity and long term functional outcomes following elective total hip replacement

    PubMed Central

    2012-01-01

    Introduction Obesity rates continue to rise and more total hip arthroplasty procedures are being performed in progressively younger, obese patients. Hence, maintenance of long term physical function will become very important for quality of life, functional independence and hip prosthesis survival. Presently, there are no reviews of the long term efficacy of total hip arthroplasty on physical function. This review: 1) synopsized available data regarding obesity effects on long term functional outcomes after total hip arthroplasty, and 2) suggested future directions for research. Methods A literature search was conducted from 1965 to January of 2011 for studies that evaluated long term functional outcomes at one year or longer after THA in obese (body mass index values ≥30 kg/m2) and non-obese patients (body mass index <30 kg/m2). Results Five retrospective studies and 18 prospective studies were identified as those that assessed physical function before surgery out to ≥ one year after total hip arthroplasty. Study sample sizes ranged from 108–18,968 and followed patients from one to twenty years. Total hip arthroplasty confers significant pain reduction and improvement in quality of life irrespective of body mass index. Functional improvement occurred after total hip arthroplasty among all studies, but obese patients generally did not attain the same level of physical function by the follow-up time point. Discussion Uncontrolled obesity after total hip arthroplasty is related to worsening of comorbidities and excessive health care costs over the long term. Aggressive and sustainable rehabilitation strategies that include physical exercise, psychosocial components and behavior modification may be highly useful in maximizing and maintaining weight loss after total hip arthroplasty. PMID:22533938

  18. Risk factors for poor hip flexion after total hip arthroplasty for the treatment of ankylosing spondylitis a multivariate analysis.

    PubMed

    Zhang, Liang; Yang, Dejin; Yin, Xinghua; Zhou, Yixin

    2014-09-01

    The purpose of this study is to investigate the clinical and radiographic results of total hip arthroplasty (THA) for the treatment of ankylosing spondylitis (AS) and to evaluate the effects of patient, prosthesis design, and surgical technique-related risk factors on postoperative functional results. We retrospectively reviewed the clinical and radiographic results of THA performed in 167 hips for 100 patients with AS. The average follow-up period was 54.8 months (range, 32-129 months). The hip passive-flexion arc averaged only 0 ° (0-40.0 °) before surgery, compared with 100.0 ° (85.0-110.0 °) at the most recent follow-up examination (P < 0.001). Multivariate regression demonstrated that significant variables for postoperative hip flexion were degree of preoperative flexion contracture, preoperative level of C-reactive protein, use of a 32-mm femoral head, and postoperative heterotopic ossification. In patients with AS with severe pain, limited motion and posture, as well as deformity, the overall outcomes after THA were found to be favorable with an encouraging midterm prosthetic survivorship, a low complication rate and a high level of patients' satisfaction. It seemed these patients were particularly predisposed to relative poor range of motion of the involved hips after THA which was closely related to patients' satisfaction. The surgeons should pay careful attention to all possible risk factors perioperatively and develop a comprehensive treatment regimen.

  19. Total Hip Arthroplasty for the Paralytic and Non-paralytic Side in Patient with Residual Poliomyelitis

    PubMed Central

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

    2016-01-01

    Background: Total hip arthroplasty (THA) for poliomyelitis is a problematic procedure due to difficulty in positioning the cup of the prosthesis in the true acetabulum and the risk of dislocation after THA due to the low muscle tone. Methods: We herein present a case of bilateral hip pain with a history of poliomyelitis. Radiograph showed bilateral hip osteoarthritis caused by hip dysplasia due to residual poliomyelitis in right hip joint or developing dysplasia of the hip joint in left hip joint. THA was performed to bilateral hip joints. Results: Six years after bilateral THA, bilateral hip pain significantly improved. Additionally, the muscle strength on the paralyzed right side partially improved. However, the muscle strength on the non-paralyzed left side did not significantly improve. No complications related to the surgery were observed. Conclusion: Promising early results were obtained for THA in our patient with residual poliomyelitis. However, surgeons should pay attention to the potential development of complications concerning THA that may arise due to the residual poliomyelitis. PMID:27347238

  20. Perioperative Pulmonary Circulatory Changes During Bilateral Total Hip Arthroplasty Under Regional Anesthesia

    PubMed Central

    Memtsoudis, Stavros G.; Salvati, Eduardo A.; Go, George; Ma, Yan; Sharrock, Nigel E.

    2010-01-01

    Background and Objectives The transient and rarely clinically relevant effect of bone and cement embolization during unilateral joint arthroplasty is a known phenomenon. However, available studies do not address events surrounding bilateral total hip arthroplasties, during which embolic load is presumably doubled. To elucidate events surrounding this increasingly utilized procedure and assess the effect on the pulmonary hemodynamics in the intra- and postoperative period, we studied 24 subjects undergoing cemented bilateral total hip arthroplasty during the same anesthetic session. Materials Twenty four patients without previous pulmonary history undergoing cemented bilateral total hip arthroplasty under controlled epidural hypotension were enrolled. Pulmonary artery catheters were inserted and hemodynamic variables were recorded at baseline, 5 minutes after the implantation of each hip joint, 1 hour and 1 day postoperatively. Mixed venous blood gases and complete blood counts were analyzed at every time point. Results An increase in pulmonary vascular resistance was observed after the second but not the first hip implantation when compared to values at incision. Pulmonary vascular resistance remained elevated 1 hour postoperatively. Pulmonary artery pressures were significantly elevated on post operative day 1 compared to baseline values. The white blood cell count increased in response to the second hip implantation but not the first compared to incision. Conclusion The embolization of material during bilateral total hip arthroplasty is associated with prolonged increases in pulmonary artery pressures and vascular resistance, particularly after the second side. The performance of bilateral procedures should be cautiously considered in patients with diseases suggesting decreased right ventricular reserve. PMID:20814281

  1. Small diameter acetabulum and femoral head in total hip arthroplasty for developmental dysplasia of the hip, with no femoral osteotomy.

    PubMed

    Verettas, Dionysios-Alexandros; Chloropoulou, Pelagia; Xarchas, Konstantinos; Drosos, Georgios; Ververidis, Athanasios; Kazakos, Konstantinos

    2015-01-01

    We present the results of 66 total hip arthroplasties in 62 patients of mean age 46 years (24-74 years), with developmental dysplasia of the hip. In all cases the centre of rotation of the new hip was positioned at the site of the true acetabulum. In all patients cementless press fit acetabular components of small diameter (42-44 mm) were used, articulating exclusively with a 22.25 mm modular metal femoral head, without the use of bone grafts or shortening osteotomies of the femur. Despite the use of small diameter femoral heads the rate of dislocation was 3%. After an average follow-up period of 9 years (4-18 years), no revisions were required for infection, loosening or wear or implant migration. Osteolytic lesions were seen in the periacetabular region in 3 patients who were symptom free. A total of 2 revisions were required for instability and 2 patients had the wires of their trochanteric osteotomy removed because of bursitis. Leg length inequality was improved in 55% of the patients and one postoperative transient sciatic nerve lesion settled within 4 months. We believe that in patients with painful dysplastic hips, the use of small diameter implants with the centre of rotation at the true acetabulum, can give very satisfactory results, without any supplementary procedures. PMID:25907394

  2. Small diameter acetabulum and femoral head in total hip arthroplasty for developmental dysplasia of the hip, with no femoral osteotomy.

    PubMed

    Verettas, Dionysios-Alexandros; Chloropoulou, Pelagia; Xarchas, Konstantinos; Drosos, Georgios; Ververidis, Athanasios; Kazakos, Konstantinos

    2015-01-01

    We present the results of 66 total hip arthroplasties in 62 patients of mean age 46 years (24-74 years), with developmental dysplasia of the hip. In all cases the centre of rotation of the new hip was positioned at the site of the true acetabulum. In all patients cementless press fit acetabular components of small diameter (42-44 mm) were used, articulating exclusively with a 22.25 mm modular metal femoral head, without the use of bone grafts or shortening osteotomies of the femur. Despite the use of small diameter femoral heads the rate of dislocation was 3%. After an average follow-up period of 9 years (4-18 years), no revisions were required for infection, loosening or wear or implant migration. Osteolytic lesions were seen in the periacetabular region in 3 patients who were symptom free. A total of 2 revisions were required for instability and 2 patients had the wires of their trochanteric osteotomy removed because of bursitis. Leg length inequality was improved in 55% of the patients and one postoperative transient sciatic nerve lesion settled within 4 months. We believe that in patients with painful dysplastic hips, the use of small diameter implants with the centre of rotation at the true acetabulum, can give very satisfactory results, without any supplementary procedures.

  3. Two-Stage Progressive Femoral Lowering Followed by Cementless Total Hip Arthroplasty for Treating Crowe IV-Hartofilakidis Type 3 Developmental Dysplasia of the Hip.

    PubMed

    Binazzi, Roberto

    2015-05-01

    High developmental dysplasia of the hip is commonly treated with total hip arthroplasty and shortening osteotomy. We present a two stage technique, consisting of progressive femoral lowering followed by total hip arthroplasty. The clinico-radiographic results of eleven patients (twelve hips) who were operated on with the two-stage technique were evaluated at a mean follow-up of 11 ± 5 years. At the final follow-up, ten patients (eleven hips) had a mean Harris hip score of 85 ± 5 points with no implant loosening. One patient (one hip) was revised at 5 years due to infection. No neurovascular complications were observed in any patients. With this technique, we could place the cup in the anatomical position and obtain complete limb symmetry with excellent clinical results at long-term. PMID:25599863

  4. Total hip replacement in osteoarthritis: the role of bone metabolism and its complications

    PubMed Central

    Bottai, Vanna; Dell'Osso, Giacomo; Celli, Fabio; Bugelli, Giulia; Cazzella, Niki; Cei, Elena; Guido, Giulio; Giannotti, Stefano

    2015-01-01

    Summary Osteoarthritis is one of the most common joint disorder. For treatment of hip symptomatic osteoarthritis, when conservative medical therapy has failed, total hip arthroplasty (THA) is a successful orthopaedic procedures that reduces pain and improves function and quality of life. Incidence of osteoarthritis is constantly increasing with raising life expectancy. This aging process also has led to an increasing number of patients with osteoporosis who need hip replacement for osteoarthritis. Osteoporosis have 3 major potential complications in total hip arthroplasty: perioperative fracture, an increased risk of periprosthetic fracture, and late aseptic loosening. The purpose of the present study was to examine the effects of osteoporosis on total hip replacement procedure outcome and highlight the importance of adequate study of calcium-phosphorus metabolism in patient candidate for hip surgery, and the need to start a suitable therapy to recover the bone mass before surgery. Bone quality of the hip joint has become an important risk factor limiting the durability of THA. PMID:26811704

  5. Changes in bone mineral density around the femoral stem after total hip replacement: a preliminary report.

    PubMed

    Szpunar, Jacek; Gaździk, Tadeusz Szymon

    2006-02-28

    Background. Degenerative changes in the hip, accompanied by clinically significant pain, decrease the range of motion in physical examination and give characteristic changes in X-ray images. Total hip replacement is most often indicated. The most important factor affecting the usable life of implants is the adaptive rebuilding of osseous tissue in this region. A typical radiological examination showing the hip prosthesis and surrounding osseous tissue gives only late, qualitative indications of possible loosening of the prosthesis. Examination of bone mineral density (DEXA) gives quantitative data on changes occurring in the immediate region of the hip prosthesis, enabling early assessment of prothesis endurance. The aim of our study was to compare proportional changes in the BMD of the proximal femur after cemented and cementless total hip replacement. Material and methods. Densitometry of osseous tissue was done with a LUNAR device, using the Orthopedic computer program, in two groups of female patients after total hip replacement. BMD changes were analyzed occurring around the femoral stem 3 months after surgery using autoanalysis in the 7 Gruen zones. Examinations were done across different types of hip prosthesis. Results. In both groups our preliminary data point to a proportional decrease in BMD in all the analyzed zones. The greatest decreases occurred in zones 1 and 7, the least in zone 4. Conclusions. DEXA allows for quantitative monitoring of changes in osseous tissue in the region around the prosthesis. PMID:17603460

  6. 18 years of results with cemented primary hip prostheses in the Norwegian Arthroplasty Register

    PubMed Central

    Furnes, Ove; Engesæter, Lars B; Havelin, Leif I

    2009-01-01

    Background and purpose Few studies have compared the long-term survival of cemented primary total hip arthroplasties (THAs), and several prostheses have been used without adequate knowledge of their endurance. We studied long-term outcome based on data in the Norwegian Arthroplasty Register. Patients and methods The 10 most used prosthesis brands in 62,305 primary Palacos or Simplex cemented THAs reported to the Register from 1987 through 2007 were included. Survival analyses with revision as endpoint (for any cause or for aseptic loosening) were performed using Kaplan-Meier and multiple Cox regression with time-dependent covariates. Revision rate ratios (RRs) were estimated for the follow-up intervals: 0–5, 6–10, and > 10 years. Results 5 prosthesis brands (cup/stem combinations) (Charnley, Exeter, Titan, Spectron/ITH, Link IP/Lubinus SP; n = 24,728) were investigated with 0–20 year follow-up (inserted 1987–1997). After 18 years, 11% (95% CI: 10.6–12.1) were revised for any cause and 8.4% (7.7–9.1) for aseptic loosening. Beyond 10 years of follow-up, the Charnley cup had a lower revision rate due to aseptic loosening than Exeter (RR = 1.8) and Spectron (RR = 2.4) cups. For stems, beyond 10 years we did not find statistically significant differences comparing Charnley with Titan, ITH, and SP stems, but the Exeter stem had better results (RR = 0.5). 10 prosthesis brands (9 cups in combination with 6 stems; n = 37,577) were investigated with 0–10 years of follow-up (inserted from 1998 through 2007). The Charnley cup had a lower revision rate due to aseptic loosening than all cups except the IP. Beyond 5 years follow-up, the Reflection All-Poly cup had a 14 times higher revision rate. For stems, beyond 5 years the Spectron-EF (RR = 6.1) and Titan (RR = 5.5) stems had higher revision rates due to aseptic loosening than Charnley. The analyses also showed a marked improvement in Charnley results between the periods 1987–1997 and 1998–2007

  7. Total Hip Arthroplasty Using a Polished Tapered Cemented Stem in Hereditary Multiple Exostosis.

    PubMed

    Kanda, Akio; Kaneko, Kazuo; Obayashi, Osamu; Mogami, Atsuhiko

    2016-01-01

    A 61-year-old Japanese man underwent right total hip arthroplasty for hereditary multiple exostosis. At first presentation, he had suffered from coxalgia for a long time. On radiographic images, there was a gigantic femoral head, increased shaft angle, and large diameter of the femoral neck. He had also developed coxarthrosis and severe pain of the hip joint. The transformation of the proximal femur bone causes difficulty in setting a cementless total hip prosthesis. Therefore, total hip arthroplasty using a cemented polished tapered stem was performed via a direct lateral approach. Using a cemented polished tapered stem allowed us to deal with the femoral bone transformation and bone substance defectiveness due to exostosis and also minimized the invasiveness of the operation. PMID:27127668

  8. An intramedullary cement spacer in total hip arthroplasty .

    PubMed

    Deshmukh, R G; Thevarajan, K; Kok, C S; Sivapathasundaram, N; George, S V

    1998-02-01

    Revision arthroplasty of the hip is often complicated by infection, bone loss, and perioperative fracture of the femur. A simple, inexpensive spacer that keeps tissue planes intact and prevents soft tissue contracture during the interoperative period of a 2-stage revision is described. This can provide intramedullary support to a fractured or weak femur and enable local antibiotic delivery, as well as permit limited mobilization of the patient. It can be easily fabricated during surgery using universally available materials and can be tailored for specific requirements. Such a spacer was used in 5 cases. The experience is presented, and the technique and pitfalls are discussed. PMID:9526214

  9. Sports activities 5 years after total knee or hip arthroplasty: the Ulm Osteoarthritis Study

    PubMed Central

    Huch, K; Muller, K; Sturmer, T; Brenner, H; Puhl, W; Gunther, K

    2005-01-01

    Objective: To analyse sports activities of patients with hip or knee osteoarthritis (OA) over lifetime, preoperatively, and 5 years after arthroplasty. Methods: In a longitudinal four centre study, 809 consecutive patients with advanced OA of the hip (420) or the knee (389) joint under the age of 76 years who required total joint replacement were recruited. A completed questionnaire about sports activities at 5 year follow up was received from 636 (79%) of the 809 patients. Results: Although most patients with hip (97%) and knee (94%) OA had performed sports activities during their life, only 36% (hip patients) and 42% (knee patients) had maintained sports activities at the time of surgery. Five years postoperatively, the proportion of patients performing sports activities increased to 52% among patients with hip OA, but further declined to 34% among those with knee OA. Accordingly, the proportion of patients with hip OA performing sports activities for more than 2 hours a week increased from 8 to 14%, whereas this proportion decreased from 12 to 5% among patients with knee OA. Pain in the replaced joint was reported by 9% of patients with hip and by >16% with knee OA. Conclusion: Differences in pain 5 years after joint replacement may explain some of the difference of sports activities between patients with hip and knee OA. Reasons for reduction of sports activities may include the increasing age of the patients, their worries about an "artificial joint", and the advice of their surgeon to be cautious. PMID:15843453

  10. Perfusion MRI in hips with metal-on-metal and metal-on-polyethylene total hip arthroplasty

    PubMed Central

    Anwander, H.; Cron, G. O.; Rakhra, K.

    2016-01-01

    Objectives Hips with metal-on-metal total hip arthroplasty (MoM THA) have a high rate of adverse local tissue reactions (ALTR), often associated with hypersensitivity reactions. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) measures tissue perfusion with the parameter Ktrans (volume transfer constant of contrast agent). Our purpose was 1) to evaluate the feasibility of DCE-MRI in patients with THA and 2) to compare DCE-MRI in patients with MoM bearings with metal-on-polyethylene (MoP) bearings, hypothesising that the perfusion index Ktrans in hips with MoM THA is higher than in hips with MoP THA. Methods In this pilot study, 16 patients with primary THA were recruited (eight MoM, eight MoP). DCE-MRI of the hip was performed at 1.5 Tesla (T). For each patient, Ktrans was computed voxel-by-voxel in all tissue lateral to the bladder. The mean Ktrans for all voxels was then calculated. These values were compared with respect to implant type and gender, and further correlated with clinical parameters. Results There was no significant difference between the two bearing types with both genders combined. However, dividing patients by THA bearing and gender, women with MoM bearings had the highest Ktrans values, exceeding those of women with MoP bearings (0.067 min−1 versus 0.053 min−1; p-value < 0.05) and men with MoM bearings (0.067 min−1 versus 0.034 min−1; p-value < 0.001). Considering only the men, patients with MoM bearings had lower Ktrans than those with MoP bearings (0.034 min−1 versus 0.046 min−1; p < 0.05). Conclusion DCE-MRI is feasible to perform in tissues surrounding THA. Females with MoM THA show high Ktrans values in DCE-MRI, suggesting altered tissue perfusion kinematics which may reflect relatively greater inflammation. Cite this article: Dr P. E. Beaule. Perfusion MRI in hips with metal-on-metal and metal-on-polyethylene total hip arthroplasty: A pilot stud. Bone Joint Res 2016;5:73–79. DOI: 10

  11. Assessment of asymmetric leg loading before and after total hip arthroplasty using instrumented shoes

    PubMed Central

    2014-01-01

    Background Total hip arthroplasty is a successful surgical treatment in patients with osteoarthritis of the hip. Different questionnaires are used by the clinicians to assess functional capacity and the patient's pain, despite these questionnaires are known to be subjective. Furthermore, many studies agree that kinematic and kinetic parameters are crucial to evaluate and to provide useful information about the patient’s evolution for clinicians and rehabilitation specialists. However, these quantities can currently only be obtained in a fully equipped gait laboratory. Instrumented shoes can quantify gait velocity, kinetic, kinematic and symmetry parameters. The aim of this study was to investigate whether the instrumented shoes is a sufficiently sensitive instrument to show differences in mobility performance before and after total hip arthroplasty. Methods In this study, patients undergoing total hip arthroplasty were measured before and 6–8 months after total hip arthroplasty. Both measurement sessions include 2 functional mobility tasks while the subject was wearing instrumented shoes. Before each measurement the Harris Hip Score and the Traditional Western Ontario and McMaster Universities osteoarthritis index were administered as well. Results The stance time and the average vertical ground reaction force measured with the instrumented shoes during walking, and their symmetry index, showed significant differences before and after total hip arthroplasty. However, the data obtained with the sit to stand test did not reveal this improvement after surgery. Conclusions Our results show that inter-limb asymmetry during a walking activity can be evaluated with the instrumented shoes before and after total hip arthroplasty in an outpatient clinical setting. PMID:24581227

  12. Rapid recovery protocol for peri-operative care of total hip and total knee arthroplasty patients.

    PubMed

    Berend, Keith R; Lombardi, Adolph V; Mallory, Thomas H

    2004-01-01

    Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are among the most successful procedures performed in terms of quality-of-life years gained. The long-term goals of arthroplasty, to relieve pain, increase function, provide stability, and obtain durability, are accomplished in the vast majority of cases. The short-term goals, however, have become the target of aggressive peri-operative programs that aim to speed recovery, reduce morbidity and complications, and create a program of efficiency while maintaining the highest level of patient care. The concept of rapid recovery is built upon the burgeoning interest in less-invasive and small-incision surgeries for (THA and TKA). However, the incision size does not appear to be the most critical aspect of the program. This article outlines the specific elements of the rapid-recovery program for lower-extremity arthroplasty patients, including pre-operative patient education, peri-operative nutrition, vitamin and herbal medication supplementation, preemptive analgesia, and post-operative rehabilitation. A holistic peri-operative, rapid-recovery program has lead to a significantly decreased hospital length of stay and significantly lower hospital readmission rates in patients who undergo primary THAs and TKAs. Combining these results with minimally invasive techniques and instrumentation should make recovery even faster.

  13. Bilateral Total Hip Arthroplasty in a Rare Case of Multicentric Reticulohistiocytosis

    PubMed Central

    Sen, Ramesh Kumar; Das, Ashim; Sharma, Aman

    2015-01-01

    Multicentric reticulohistiocytosis (MRH) is a rare systemic disease, which commonly manifests as muco-cutaneous papulonodules and inflammatory erosive polyarthropathy. In this research, we report the clinical manifestations and management of a rare case of MRH with destructive arthropathy of bilateral hip joints and arthritis mutilans presenting with characteristic deformities. Disabling hip arthropathy that occurs secondary to MRH can be successfully managed with bilateral total hip arthroplasty (THA). Osteopenia and acetabular bone defects must be anticipated during THA. This case is reported due to its rare occurrence and because little literature has been published regarding THA in such patients. PMID:26640636

  14. Lower-limb joint mechanics after total hip arthroplasty during sitting and standing tasks.

    PubMed

    Lamontagne, Mario; Beaulieu, Mélanie L; Varin, Daniel; Beaulé, Paul E

    2012-10-01

    While the effect of total hip arthroplasty on the operated limb mechanics is well documented, little is known on its effect on the contralateral limb. The purpose of this study was to measure the joint mechanics of both lower limbs during the tasks of sit-to-stand and stand-to-sit. Twenty total hip arthroplasty patients and 20 control participants performed three trials of each task from which 3D lower-limb joint kinematics and kinetics were obtained. Total hip arthroplasty patients exhibited lower operated-hip joint flexion, extension moments, and power, occurring most frequently near seat-on and seat-off. Despite these reduced kinetic variables in the operated hip, the joints of the non-operated limb generated similar joint kinetics as the matched control participants. These results indicated the patients who underwent total hip arthroplasty could adopt a strategy that allowed them to reduce moments and power generated at the operated lower-limb joints without overcompensating with the non-operated leg. Although such a strategy may be desirable given that higher loads can increase friction and accelerate wear of the prosthesis, reduced loading may be an indication of inadequate muscle strength that needs to be addressed.

  15. Review of quality of x-rays for templating for total hip arthroplasty.

    PubMed

    Khan, Faiz; Ahmad, Tayyab; Condon, Finbarr; Lenehan, Brian

    2015-03-01

    Digital templating of x-rays for total hip arthroplasty is used routinely for pre-operative planning. This is to assure that appropriately sized implants are selected to replicate patient's hip biomechanics. Multiple studies have shown that templating does not always correspond to the final implants used. The aim of this study was to assess the suitability of the x-rays taken pre-operatively for templating for total hip arthroplasty. We undertook a review of a series of pre-operative templating pelvis x-rays in 100 consecutive patients undergoing total hip arthroplasty. These x-rays were compared against set criteria to determine their suitability for use for templating. We determined that six x-rays met the criteria whereas ninety four x-rays did not meet the criteria for suitable x-rays. Twenty patients had repeat x-rays. The reasons for unsuitability were inadequate opposite femur (66%), absence or incomplete template (54%), inadequate femur length (47%), external rotation (39%), absence of opposite hip (4%). The twenty repeated x-rays were also reviewed for the same parameters and two (10%) satisfied the established criteria. It is imperative that x-rays for templating for total hip arthroplasty are done to a strict standard to obtain an x-ray that is appropriate for templating and there is minimal exposure of the patient to irradiation.

  16. Use of postoperative irradiation for the prevention of heterotopic bone formation after total hip replacement

    SciTech Connect

    Sylvester, J.E.; Greenberg, P.; Selch, M.T.; Thomas, B.J.; Amstutz, H.

    1988-03-01

    Formation of heterotopic bone (HTB) following total hip replacement may partially or completely ankylose the joint space, causing pain and/or limiting the range of motion. Patients at high risk for formation of HTB postoperatively include those with previous HTB formation, heterotopic osteoarthritis, and active rheumatoid spondylitis. Patients in these high risk groups have a 63-69% incidence of post-operative HTB formation, usually seen radiographically by 2 months post-operation. From 1980-1986 twenty-nine hips in 28 consecutively treated patients were irradiated post-operatively at the UCLA Center for the Health Sciences. The indication for irradiation was documented HTB formation previously in 26 of the 27 hips presented below. From 1980-1982 patients received 20 Gray (Gy) in 2 Gy fractions; from 1982-1986 the dose was reduced to 10 Gy in 2 Gy fractions. Twenty-seven hips in 26 patients completed therapy and were available for evaluation, with a minimum of 2 month follow-up, and a median follow-up of 12 months. Three of 27 hips developed significant HTB (Brooker grade III or IV) post-operatively, whereas 5 of 27 hips developed minor, nonsymptomatic HTB (Brooker grade I). When irradiation was begun by postoperative day 4, 0 of 17 hips formed significant HTB. If irradiation began after post-operative day 4, 3 of 10 hips formed significant HTB (Brooker grade III or IV). These 3 hips received doses of 10 Gy in one hip and 20 Gy in the other 2 hips. There were no differences in the incidence or severity of side effects in the 10 Gy vs. the 20 Gy treatment groups. Eighteen hips received 10 Gy, 8 hips 20 Gy and, 1 hip 12 Gy. In conclusion, 10 Gy in 5 fractions appears as effective as 20 Gy in 10 fractions at preventing post-operative formation of HTB. For optimal results, treatment should begin as early as possible prior to post-operative day 4.

  17. A New Case of Fracture of a Modular Femoral Neck Device After a Total Hip Arthroplasty

    PubMed Central

    Trieb, Klemens; Stadler, Nicola

    2015-01-01

    This report addresses a new case of a modular femoral neck fracture after total hip arthroplasty. A now seventy-three-year- old overweight female underwent total hip replacement of the right hip because of osteoarthritis in the year 2002. Then, years later, the head and the polyethylene were changed due to wear. In October 2014, the patient was transferred from the trauma department of her hometown to our department after she had slipped and fallen directly on her right hip. The x-rays done at the trauma department have shown no periprosthetic fracture but a fracture of the modular neck. Therefore, the patient was transferred to our department in order to undergo a revision arthroplasty with change of the stem and head after splitting the femur. PMID:26157528

  18. Changes in bone mineral density of the acetabulum and proximal femur after total hip resurfacing arthroplasty.

    PubMed

    Huang, Qiang; Shen, Bin; Yang, Jing; Zhou, Zong-ke; Kang, Peng-de; Pei, Fu-xing

    2013-12-01

    Our aim was to investigate the changes in bone mineral density (BMD) of acetabulum and proximal femur after total hip resurfacing arthroplasty. A comparative study was carried out on 51 hips in 48 patients. Group A consisted of 25 patients (26 hips) who had undergone total hip resurfacing and group B consisted of 23 patients (25 hips) who had had large-diameter metal-on-metal total hip arthroplasty (THA). BMDs around the acetabulum and proximal femur were measured using dual-energy x-ray absorptiometry (DEXA) at 2 weeks, 6 months, 1 year and annually thereafter during the 3 years after surgery. At final follow-up, the acetabular net mean BMD decreased by 11% in group A and 10% in group B with no differences between two groups (P = .35). For the femoral side, in Gruen zone 1, the mean BMD increased by 4% in group A, whereas it decreased by 11% in group B (P = .029). In Gruen zone 7, the mean BMD increased by 8% at the final follow-up in group A, whereas it decreased by 13% in group B (P = .02). In both groups the mean BMD increased by 3% in Gruen zones 3, 4, 5, and 6. Stress-related bone loss of the acetabulum was comparable for MOM THA and resurfacing devices, but proximal femoral bone density increased in the resurfacing group and decreased in the THA group.

  19. Center of Mass Compensation during Gait in Hip Arthroplasty Patients: Comparison between Large Diameter Head Total Hip Arthroplasty and Hip Resurfacing.

    PubMed

    Bouffard, Vicky; Nantel, Julie; Therrien, Marc; Vendittoli, Pascal-André; Lavigne, Martin; Prince, François

    2011-01-01

    Objective. To compare center of mass (COM) compensation in the frontal and sagittal plane during gait in patients with large diameter head total hip arthroplasty (LDH-THA) and hip resurfacing (HR). Design. Observational study. Setting. Outpatient biomechanical laboratory. Participants. Two groups of 12 patients with LDH-THA and HR recruited from a larger randomized study and 11 healthy controls. Interventions. Not applicable. Main Outcome Measures. To compare the distance between the hip prosthetic joint center (HPJC) and the COM. The ratio (R(HPJC-COM)) and the variability (CV(HPJC-COM)) were compared between groups. Hip flexor, abductor, and adductor muscle strength was also correlated between groups while radiographic measurements were correlated with the outcome measures. Results. In the frontal plane, HR shows less variability than healthy controls at push-off and toe-off and R(HPJC-COM) is correlated with the muscle strength ratios (FR(ABD)) at heel contact, maximal weight acceptance, and mid stance. In the sagittal plane, LDH-THA has a higher R(HPJC-COM) than healthy controls at push-off, and CV(HPJC-COM) is significantly correlated with FR(FLEX). Conclusions. One year after surgery, both groups of patients, LDH-THA and HR, demonstrate minor compensations at some specific instant of the gait cycle, in both frontal and sagittal planes. However, their locomotion pattern is similar to the healthy controls. PMID:22110976

  20. Theoretical and practical aspects in total uncemented hip arthroplasty by using short femoral stem prosthesis

    PubMed Central

    Moga, M; Pogarasteanu, ME; Barbilian, A

    2015-01-01

    Hip arthrosis, primary or secondary, is an osteoarthritic degenerative process that affects the hip joint. Primary hip arthrosis has an unknown etiology, and secondary hip arthrosis has well defined causes; of these causes, some are known to lead to arthrosis of the hip in the young age patient. The surgical treatment aims either to preserve the patient’s hip joint, or to replace the joint. The most commonly used procedure at this time is the total hip arthroplasty. The femoral component may have a short or a long stem. The short femoral stem prosthesis is usually impacted by using a unique technique and unique instruments, according to the manufacturer’s specifications. There are several models of short stem femoral prosthesis, but no matter which one is chosen, the surgical indication, the surgical technique and a well-conducted recovery program are important. The choosing of each arthroplastic implant must be made with care, taking into consideration the patient’s benefit, his expectations, and also the surgeon’s experience. PMID:26103643

  1. Cementless Total Hip Arthroplasty in Hip Dysplasia with an Extensively Porous-Coated Cylindrical Stem Modified for Asians: A 12-Year Follow-Up Study.

    PubMed

    Kato, Tsutomu; Otani, Takuya; Sugiyama, Hajime; Hayama, Tetsuo; Katsumata, Souichi; Marumo, Keishi

    2015-06-01

    Long-term outcomes of primary cementless total hip arthroplasty were examined for 198 hips of Asian patients with developmental dysplasia of the hip. AML stems were modified for patients' relatively small physique. Stable fixation was achieved despite various proximal femoral deformities. At follow up (mean 12.1 years), radiographs demonstrated fixation in all hips, with 100% stem survivorship. Radiographic changes revealed that the severity of stress-shielding was mild in 55% of hips, moderate in 26%, and severe in 19%. Longer follow up is needed to determine whether these changes will develop into clinical manifestations. A distal fixation stem can be a useful reconstruction option when application of a proximal fixation stem in primary total hip arthroplasty is difficult for various reasons. PMID:25677937

  2. Anterior Longitudinal Osteotomy of the Greater Trochanter in Total Hip Arthroplasty.

    PubMed

    Surace, Michele F; Regazzola, Gianmarco M V; Vulcano, Ettore; Monestier, Luca; Cherubino, Paolo

    2015-08-01

    The extra-articular impingement of the greater trochanter against the ileum is an underrated cause of early dislocation in total hip arthroplasty. In this preliminary study, the authors assess the effectiveness of an anterior longitudinal osteotomy of the greater trochanter for preventing dislocation. A total of 115 patients underwent a total hip arthroplasty through a posterolateral approach. All patients underwent clinical and radiological follow-up at 1, 3, and 6 months. No dislocation was reported. All patients demonstrated fast recovery of range of motion and walking. No trochanter fractures were observed. The osteotomy of the greater trochanter is an effective surgical technique that decreases anterior impingement and consequently lowers the dislocation rate in primary total hip arthroplasty. [Orthopedics. 2015; 38(8):490-493.]. PMID:26313167

  3. Experimental validation of finite element modelling of a modular metal-on-polyethylene total hip replacement.

    PubMed

    Hua, Xijin; Wang, Ling; Al-Hajjar, Mazen; Jin, Zhongmin; Wilcox, Ruth K; Fisher, John

    2014-07-01

    Finite element models are becoming increasingly useful tools to conduct parametric analysis, design optimisation and pre-clinical testing for hip joint replacements. However, the verification of the finite element model is critically important. The purposes of this study were to develop a three-dimensional anatomic finite element model for a modular metal-on-polyethylene total hip replacement for predicting its contact mechanics and to conduct experimental validation for a simple finite element model which was simplified from the anatomic finite element model. An anatomic modular metal-on-polyethylene total hip replacement model (anatomic model) was first developed and then simplified with reasonable accuracy to a simple modular total hip replacement model (simplified model) for validation. The contact areas on the articulating surface of three polyethylene liners of modular metal-on-polyethylene total hip replacement bearings with different clearances were measured experimentally in the Leeds ProSim hip joint simulator under a series of loading conditions and different cup inclination angles. The contact areas predicted from the simplified model were then compared with that measured experimentally under the same conditions. The results showed that the simplification made for the anatomic model did not change the predictions of contact mechanics of the modular metal-on-polyethylene total hip replacement substantially (less than 12% for contact stresses and contact areas). Good agreements of contact areas between the finite element predictions from the simplified model and experimental measurements were obtained, with maximum difference of 14% across all conditions considered. This indicated that the simplification and assumptions made in the anatomic model were reasonable and the finite element predictions from the simplified model were valid.

  4. New concept in durability improvement of hip total joint endoprostheses.

    PubMed

    Capitanu, Lucian; Florescu, Virgil; Badita, Liliana-Laura

    2014-01-01

    Starting from the well-known fact that the rolling movement always has a lower friction compared to sliding friction, the authors have conceived and realized a pivoting movement joint on a "layer of balls" with "compensation space", placed between the acetabular cup and the femoral head. This technical solution allows free self-directed migration of the balls, depending on the resistance opposed, with successive occupation of the "compensation space". As a concept, the proposed technical solution excludes the existence of a cage for maintaining the relative positions of the spheres. It can be observed that the smallest values of the force and of the friction coefficient are obtained for the prostheses with balls and self-directed movement (approximately 5 times smaller than the values obtained for a classical prosthesis). For all the couples tested, the friction force grows with the growth of the normal load and of the oscillation speed. Changing the contact mechanism for the artificial hip joint from one sliding contact between two large surfaces, to a multitude of rolling contacts, could lead to some problems regarding functionality and durability of the active prosthesis elements. The key to an accurate evaluation of damaging mechanisms acting on THP with self directed rolling balls is a clear and complete picture of the load transfer mechanism.

  5. New concept in durability improvement of hip total joint endoprostheses.

    PubMed

    Capitanu, Lucian; Florescu, Virgil; Badita, Liliana-Laura

    2014-01-01

    Starting from the well-known fact that the rolling movement always has a lower friction compared to sliding friction, the authors have conceived and realized a pivoting movement joint on a "layer of balls" with "compensation space", placed between the acetabular cup and the femoral head. This technical solution allows free self-directed migration of the balls, depending on the resistance opposed, with successive occupation of the "compensation space". As a concept, the proposed technical solution excludes the existence of a cage for maintaining the relative positions of the spheres. It can be observed that the smallest values of the force and of the friction coefficient are obtained for the prostheses with balls and self-directed movement (approximately 5 times smaller than the values obtained for a classical prosthesis). For all the couples tested, the friction force grows with the growth of the normal load and of the oscillation speed. Changing the contact mechanism for the artificial hip joint from one sliding contact between two large surfaces, to a multitude of rolling contacts, could lead to some problems regarding functionality and durability of the active prosthesis elements. The key to an accurate evaluation of damaging mechanisms acting on THP with self directed rolling balls is a clear and complete picture of the load transfer mechanism. PMID:24707822

  6. Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes

    PubMed Central

    Petis, Stephen; Howard, James L.; Lanting, Brent L.; Vasarhelyi, Edward M.

    2015-01-01

    Total hip arthroplasty (THA) has revolutionized the treatment of hip arthritis. A number of surgical approaches to the hip joint exist, each with unique advantages and disadvantages. The most commonly used approaches include the direct anterior, direct lateral and posterior approaches. A number of technical intricacies allow safe and efficient femoral and acetabular reconstruction when using each approach. Hip dislocation, abductor insufficiency, fracture and nerve injury are complications of THA, although their relative risk varies by approach. Numerous clinical trials have sought to elicit differences in patient-reported outcomes, complication rates and return to function among the surgical approaches. This review outlines some of the technical pearls of performing a THA through either a direct anterior, direct lateral or posterior approach. A literature review outlines the impact of surgical approach on clinical outcomes and clinically relevant complication rates. PMID:25799249

  7. [Mecring threaded cup in total arthroplasty of the hip with acetabular protrusion].

    PubMed

    Bednarek, A; Blacha, J; Gagała, J

    1998-01-01

    Results of total arthroplasty of the hip with acetabular protrusion with the use of Mecring cup in 21 patients (25 hips) aged 25-75 years (mean 62) are reported. Morsalised impacted autografts were used to fill acetabular defect in all cases. There were 14 rheumatoid arthritis patients, 4 cases of osteoarthritis and 3 cases of Otto-Chrobak disease. Mean follow-up was 2.5 years (range 6 months-5 years). All autografts were incorporated after 6-9 months. Only one loosening and migration of the cup occurred. One patient died because of pulmonary embolism. Harris Hip Score increased from 37 points (22-49) preoperatively to 81 points (65-89) at the latest follow-up. Incorporation of autografts reinforced acetabular bottom and prevented recurrence of protrusion. Bone remodeling indicates restoring normal biomechanics of the hip.

  8. Clinical results of cementless total hip arthroplasty with shortening osteotomy for high dislocation with developmental dysplasia.

    PubMed

    Desteli, Engin Eren; Imren, Yunus; Tan, Erkan; Erdoğan, Murat; Özcan, Hüseyin

    2015-03-01

    Total hip arthroplasty for severe developmental dysplasia of the hip is a technically challenging procedure. Subtrochanteric femoral osteotomy enables reducing the femoral head and restoring abductor muscle strength without compromising proximal femoral bone stock in advanced dysplasia.We aimed to retrospectively evaluate Crowe type III or IV developmental dysplasia of the hip who underwent reconstruction with cementless total hip arthroplasty combined with a transverse subtrochanteric femoral osteotomy. Sixty hips of 52 patients (11 male, 49 female) with Crowe type III (n: 37) or IV (n: 23) developmental dysplasia of the hip were included. The average age was 51.4 years. Surgery was performed in lateral decubitis position with posterolateral approach. Subtrochanteric transverse femoral osteotomy were used with cementless components. 40 of the femoral components were Secur-Fit type, and 20 of them were secur-fit plus max type. Ceramic-ceramic coupling was used in 24 cases and metal-polyethylene coupling was used in 36 cases. Merle D'Aubigne and Harris Hip score were used to rate the clinical outcome at the final follow up. All femoral shortening osteotomies were united at a mean of 5.7 months. Mean Merle D'Aubigne pain score was increased from 3.1 to 5.4, and mean Harris Hip score improved from 39 to 92.8, postoperatively (p<0.01). There was no significant difference in time to union between different types of stems. 4 femoral stems had asymptomatic radiolucent lines. There was no significant difference in time to union between different types of stems. PMID:26280851

  9. A novel classification to guide total hip arthroplasty for adult acetabular dysplasia

    PubMed Central

    ZHU, CHEN; CHENG, MENG-QI; CHENG, TAO; MA, RUI-XIANG; KONG, RONG; GUO, YONG-YUAN; QIN, HUI; SHI, SI FENG; ZHANG, XIAN-LONG

    2013-01-01

    In the field of hip arthroplasties, the secondary fixation of the implants depends directly on the quality of the primary stability. A good acetabular fit and metaphyseal filling between the prostheses and implants improve the initial stabilization, and optimize the transmission of forces to the bone. A precise knowledge of the three-dimensional acetabular or femoral shape is essential to the selection of adapted implants. A total of 63 patients diagnosed with developmental dysplasia were analyzed by three-dimensional computed tomography (3DCT), and the preoperative radiographic and 3DCT images were used to assess the acetabular/femoral deformities and variations of the hips. All joints were classified as Crowe type I, and bilateral measurements were taken for 10 patients. The acetabular abnormalities were classified according to the type of deficiency and the section angles of the acetabulum, with 26 hips (36%) classified as an anterior deficiency, 13 hips (18%) as a posterior deficiency and 34 hips (46%) as a lateral deficiency. The femoral side deformities were divided into three types according to the anteversion angle of the femur. A gradual increase in anteversion angle led to secondary rotational anomalies, and a narrowing of the canal at the isthmus. A total of 35 hips (48%) were classified as an F1 type deficiency, femur anteversion angle (FAVA) <30°; 32 hips (44%) as F2-type, 30°≤ FAVA ≤40°, with mild abnormalities of the femoral canal rotation and the diameter of the isthmus; and 6 hips (8%) as F3 type, FAVA >40°, with significant abnormalities of the femoral canal rotation and the diameter of the isthmus. This novel classification for adult acetabular dysplasia may provide a useful guide for surgery, and enable an improved selection of a suitable prosthesis. PMID:23935749

  10. Polyethylene wear with an entirely HA-coated total hip replacement: 79 hips followed for 5 years.

    PubMed

    Røkkum, M; Reigstad, A

    1998-06-01

    We measured the eccentricity of the femoral head in the metal backing annually during 5 years in 79 consecutive total hip replacements (73 patients). The mean age of the patients was 57 (32-73) years and the female/male ratio 63/22. The prostheses were entirely coated with hydroxyapatite. Modular 32 mm stainless steel heads and hemispherical, self-tapping screw cups with polyethylene liners were used. We found accelerating eccentricity throughout the observation period. The mean eccentricity at 5 years was 0.71 mm (95% CI 0.53-0.90), resulting in a mean eccentricity rate of 0.14 mm (0.11-0.18) per year. The 5-year eccentricity was 0.5 mm or less in 45 hips and more than 1.5 mm in 13 hips, 2 in the latter group apparently having worn through the polyethylene liner. The true wear may be twice as great. The use of 32 mm stainless steel heads and thin polyethylene inlays may have aggravated the wear problems. These HA-coated prostheses must all be checked regularly, so that cases with excessive polyethylene wear can be reoperated on before wear-through of the liner. PMID:9703398

  11. Total hip arthroplasty (S-ROM stem) and subtrochanteric osteotomy for Crowe type IV developmental dysplasia of the hip

    PubMed Central

    Li, Liangtao; Yu, Mingyang; Yang, Chen; Gu, Guishan

    2016-01-01

    Background: Developmental dysplasia of the hip (DDH) in adults with severe pain and disability is best treated by total hip arthroplasty (THA). The purpose of this study was to retrospectively evaluate the outcomes of subtrochanteric shortening osteotomy combined with THA using S-ROM stem for those severe patients with a special focus on the effect of two shapes in the subtrochanteric osteotomy ends: Oblique and transverse. Materials and Methods: Twenty one cases with mean age of 43.6 years who met inclusion criteria and were operated between February 2007 and February 2012 were included in the study. Those cases had been divided into two groups (oblique vs. transverse) and all records between the two groups were analyzed. Results: The Harris hip score significantly improved from 30.6 (range 18–59) preoperatively to 91.2 (range 87–98) postoperatively by the latest followup. Complications including one deep venous thrombosis, one intraoperative fracture of femur and two dislocations occurred while they were addressed properly afterward. The oblique group showed significant advantages in operative time, union time and additional fixation in comparison with the transverse group. Conclusions: In the primary THA for the treatment of irreducible DDH, subtrochanteric oblique osteotomy combined with the freely-rotatable S-ROM stem provided favorable short term outcomes by affording both morphological and functional advantages. PMID:27053810

  12. A prospective evaluation of 2 different pain management protocols for total hip arthroplasty.

    PubMed

    Post, Zachary D; Restrepo, Camilo; Kahl, Lauren K; van de Leur, Tim; Purtill, James J; Hozack, William J

    2010-04-01

    Pain management after total hip arthroplasty has improved dramatically in the past decade. However, most protocols use opioid medications for pain control. In the current study, 100 patients were prospectively selected to receive a traditional narcotic-based patient-controlled analgesia protocol or a nonnarcotic oral protocol for pain management after primary total hip arthroplasty. Therapy programs were similar for both groups. Postoperatively, patients were followed daily for opioid use, medication adverse effects, pain control, and overall satisfaction. The nonnarcotic oral group showed lower mean pain scores during the first 24 hours after surgery. The satisfaction rate was high in both groups. Both protocols provided adequate pain control after total hip arthroplasty; the nonnarcotic pain management protocol resulted in significantly decreased opioid consumption and fewer adverse effects.

  13. Association between trochanteric bursitis, osteoarthrosis and total hip arthroplasty☆☆☆

    PubMed Central

    Schwartsmann, Carlos Roberto; Loss, Felipe; de Freitas Spinelli, Leandro; Furian, Roque; Silva, Marcelo Faria; Zanatta, Júlia Mazzuchello; Boschin, Leonardo Carbonera; Gonçalves, Ramiro Zilles; Yépez, Anthony Kerbes

    2014-01-01

    Objective this was an epidemiological study on trochanteric bursitis at the time of performing total hip arthroplasty. Methods sixty-two sequential patients who underwent total hip arthroplasty due to osteoarthrosis, without any previous history of trochanteric bursitis, were evaluated. The bursas were collected and evaluated histologically. Results there were 35 female patients (56.5%) and 27 male patients (43.5%), with a mean age of 65 years (±11). Trochanteric bursitis was conformed histologically in nine patients (14.5%), of whom six were female (66.7%) and three were male (33.3%). Conclusions 14.5% of the bursas analyzed presented inflammation at the time that the primary total hip arthroplasty due to osteoarthrosis was performed, and the majority of the cases of bursitis were detected in female patients. PMID:26229811

  14. Early results of metal on metal articulation total hip arthroplasty in young patients.

    PubMed

    Mohamad, J A; Kwan, M K; Merican, A M; Abbas, A A; Kamari, Z H; Hisa, M K; Ismail, Z; Idrus, R M

    2004-12-01

    We report our early experience of 20 cases of metal on metal articulation total hip arthroplasty in 19 young patients. Avascular necrosis of the femoral head (63%) was the commonest diagnosis for patients undergoing this procedure, followed by osteoarthritis (21%). In general, most of the patients were young and physically active with an average age of 43.1 years (range, 25 to 58 years). The average follow-up period was 18 months (range, 7 to 46 months). The mean total Harris Hip Score preoperatively and at final follow-up was 31 points and 89 points respectively. The mean total Pain Score improved from an average of 11.5 to 41.1 points at final follow-up. Sixteen (84%) of the patients had a good to excellent hip score. There was one dislocation, which stabilized after reduction and conservative management. One case of early infection underwent a two-staged revision.

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

    PubMed

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

    2016-10-01

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

  16. 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

  17. Functional evaluation of total hip arthroplasty with five- to ten-year follow-up evaluation.

    PubMed

    Perrin, T; Dorr, L D; Perry, J; Gronley, J; Hull, D B

    1985-05-01

    Forty-seven patients with unilateral hip disease had a preoperative and postoperative gait analysis of total hip arthroplasty with a follow-up period of five to ten years. The object was to correlate the levels of function with mechanical loosening. Unilateral total hip arthroplasty in uncomplicated patients restored function to 80% of normal over a two- to four-year period. Patients followed longer than five years appeared to have an accelerated decline in function unassociated with pain. No Class C patient, regardless of age or gait velocity, developed loosening or required revision of the hip prosthesis. Survivorship studies revealed an 85%-90% incidence of loosening by the seventh postoperative year in Class A patients 55 years or younger and those walking preoperatively at more than 50% of normal gait velocity. In these same two groups of patients, the probability of revision for mechanical failure by ten years is 58% for age and 66% for fast walkers. The majority of patients in this study had a technical rating not acceptable by present standards so that these results represent most likely the worst prognosis for longevity of total hip arthroplasty. In high-risk patients, protected ambulation with crutches for six months postoperation may improve their prognosis.

  18. Mid-term Results of Revision Total Hip Arthroplasty Using Modular Cementless Femoral Stems

    PubMed Central

    Jang, Hyung-Gyu; Min, Byung-Woo; Ye, Hee-Uk; Lim, Kyung-Hwan

    2015-01-01

    Purpose The purpose of this study was to evaluate the clinical and radiological results of revision total hip arthroplasty using modular distal fixation stems for proximal femoral deficiency. Materials and Methods Forty-five patients (47 hips) were analyzed more than 24 months after revision total hip arthroplasty that used modular distal fixation stems and was performed between 2006 and 2012. There were proximal femoral defects in all cases. Preoperative femoral defect classification revealed Paprosky type II in 31 cases, type IIIA in 7, and type IIIB in 9. The mean duration of follow-up was 53.4 (25-100) months. We evaluated the Harris hip score (HHS), walking ability according to Koval as clinical parameters, stem stability, and stem position change as radiographic parameters. Kaplan-Meier survival analysis was performed. Results The average HHS improved form 39.5 points to 91.3 points and walking ability also improved in most cases; all patients had stable fixation of the femoral stem. Postoperative complications included 5 cases of infection and 2 cases of dislocation. The survival rate with the end point of re-revision surgery due to infection or dislocation was 86% after 8-year follow-up. Conclusion Cementless revision total hip arthroplasty using modular femoral stems is useful because the stems can be stably fixed on the diaphyseal portion of the femur, which has relatively good bone quality at mid-term follow-up. PMID:27536616

  19. Total Hip Arthroplasty around the Inception of the Interface Bioactive Bone Cement Technique

    PubMed Central

    Oonishi, Hiroyuki; Kawahara, Ikuo

    2016-01-01

    Background To augment cement-bone fixation, Dr. Hironobu Oonishi attempted additional physicochemical bonding through interposition of osteoconductive crystal hydroxyapatite (HA) granules at the cement-bone interface in 1982. He first used the interface bioactive bone cement (IBBC) technique in 12 selected patients (12 hips) in 1982 (first stage) and followed them for 2 years. In 1985, the technique was applied in 25 total hip arthroplasty (THA) patients (second stage) and the effects were investigated by comparing the side with the IBBC technique and the other side without the IBBC technique. He has employed this technique in all THA patients since 1987 (third stage). Methods In the IBBC technique, HA granules (2 to 3 g) were smeared on the bone surface just before the acetabular and femoral components were cemented. In the first stage, 12 hips were operated using the IBBC technique in 1982. In the second stage, THA was performed without the IBBC technique on one side and with the IBBC technique on the other side within 1 year in 25 patients. In the third stage, THA was performed with the IBBC technique in 285 hips in 1987. Results In the first stage patients, implant loosening was not detected at 30 years after operation. In the second stage patients, revision was required in 7 hips without the IBBC technique due to cup loosening (5 hips) and stem loosening (2 hips), whereas no hip was revised after THA with the IBBC technique at 26 years after operation. In the third stage patients, the incidence of radiolucent lines and osteolysis was very few at 25 years after operation. Conclusions The long-term follow-up of THA performed around the inception of the IBBC technique has revealed low incidences of radiolucent lines, osteolysis, and revision surgery. PMID:27583104

  20. Hip fracture evaluation with alternatives of total hip arthroplasty versus hemiarthroplasty (HEALTH): protocol for a multicentre randomised trial

    PubMed Central

    Bhandari, Mohit; Devereaux, P J; Einhorn, Thomas A; Thabane, Lehana; Schemitsch, Emil H; Koval, Kenneth J; Frihagen, Frede; Poolman, Rudolf W; Tetsworth, Kevin; Guerra-Farfán, Ernesto; Madden, Kim; Sprague, Sheila; Guyatt, Gordon

    2015-01-01

    Introduction Hip fractures are a leading cause of mortality and disability worldwide, and the number of hip fractures is expected to rise to over 6 million per year by 2050. The optimal approach for the surgical management of displaced femoral neck fractures remains unknown. Current evidence suggests the use of arthroplasty; however, there is lack of evidence regarding whether patients with displaced femoral neck fractures experience better outcomes with total hip arthroplasty (THA) or hemiarthroplasty (HA). The HEALTH trial compares outcomes following THA versus HA in patients 50 years of age or older with displaced femoral neck fractures. Methods and analysis HEALTH is a multicentre, randomised controlled trial where 1434 patients, 50 years of age or older, with displaced femoral neck fractures from international sites are randomised to receive either THA or HA. Exclusion criteria include associated major injuries of the lower extremity, hip infection(s) and a history of frank dementia. The primary outcome is unplanned secondary procedures and the secondary outcomes include functional outcomes, patient quality of life, mortality and hip-related complications—both within 2 years of the initial surgery. We are using minimisation to ensure balance between intervention groups for the following factors: age, prefracture living, prefracture functional status, American Society for Anesthesiologists (ASA) Class and centre number. Data analysts and the HEALTH Steering Committee are blinded to the surgical allocation throughout the trial. Outcome analysis will be performed using a χ2 test (or Fisher's exact test) and Cox proportional hazards modelling estimate. All results will be presented with 95% CIs. Ethics and dissemination The HEALTH trial has received local and McMaster University Research Ethics Board (REB) approval (REB#: 06-151). Results Outcomes from the primary manuscript will be disseminated through publications in academic journals and presentations

  1. Primary and revision total hip replacement without cement and with associated femoral osteotomy.

    PubMed

    Holtgrewe, J L; Hungerford, D S

    1989-12-01

    Nine porous-coated total hip prostheses were implanted without cement in nine patients who had a major proximal femoral deformity. Six patients had revision and three, primary total hip replacement. In all nine patients, as well placed corrective osteotomy was needed to successfully perform the arthroplasty. The average time until union of the proximal femoral osteotomy was fifteen weeks for the patients who had a primary arthroplasty and twenty-seven weeks for the patients who had a revision arthroplasty. The average Harris hip-rating score was 94 points for the patients who had a primary arthroplasty and 84 points (range, 60 to 93 points) for those who had a revision arthroplasty. The length of follow-up averaged forty-seven months.

  2. Optimal sterilization method for the zirconia/alumina composites used for total hip replacements.

    PubMed

    Nam, Kwang Woo; Yoo, Jeong Joon; Koo, Kyung-Hoi; Yoon, Kang Sup; Kim, Hee Joong

    2009-08-01

    Zirconia/alumina composite ceramics have been recently developed for total hip arthroplasty because of their excellent mechanical properties and tribologic characteristics. All such materials used clinically must be easily sterilized, but no report has been issued concerning methods for sterilizing zirconia/alumina composite hip prostheses. Here, we show that 50 kGy of gamma irradiation effectively sterilizes both the surfaces and interiors of these materials. In addition, it was found that the commonly used ethylene oxide and 25-kGy gamma irradiation sterilization methods inadequately sterilize deep inside the femoral head. Moreover, no changes in the chemical or mechanical properties of the composites were noted after exposure to 50-kGy gamma irradiation. We suggest that 50-kGy gamma irradiation is an optimal sterilization method for zirconia/alumina composite total hip replacements. PMID:19441113

  3. Tribological investigations of the wear couple alumina-CFRP for total hip replacement.

    PubMed

    Früh, H J; Willmann, G

    1998-07-01

    Wear debris is the main reason for aseptic loosening in total hip. Most troublesome is the wear of polyethylene cups. Ceramic femoral heads were introduced about 20 years ago. The combination ceramic-on-polyethylene reduces the wear rate and the loosening rate. But cups of polyethylene are still the weakest link in a hip prosthesis. Carbon fibre reinforced plastic (CFRP) was proposed as an alternative for polyethylene. Various test were performed to study the combination metal-on-CFRP, zirconia-on-CFRP, and alumina-on-CFRP. The simulator tests showed that the wear rate of alumina-on-CFRP is in the order of 1-3 microm per year. Based on investigation of retrieved implants the wear rate is 6.3 microm per year. Based on these results the combination alumina femoral heads (Biolox-forte) and CFRP cups (Caproman) could be approved for total hip replacement.

  4. Two-incision minimally invasive total hip arthroplasty--results and complications.

    PubMed

    Van Oldenrijk, Jakob; Hoogervorst, Paul; Schaap, Gerard R; van Dijk, C Niek; Schafroth, Matthias U

    2011-01-01

    The purpose of this study was to determine the complication rate and functional result after two-incision minimally invasive total hip arthroplasty in a retrospective consecutive case series of the first 45 patients treated by a single surgeon. The mean follow up period was 2.1 years. There were 4 early major complications (2 peri-operative fractures and 2 re-interventions) and 28 early minor complications (1 superficial infection and 27 patients with a loss of sensation of the lateral aspect of the thigh). One stem loosening required revision within two years. The mean modified Harris Hip Score at final follow-up was 91.5. Our experience shows a relatively high complication risk after two-incision minimally invasive total hip arthroplasty, and we have since abandoned this technique.

  5. 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

  6. Current attitudes to cementing techniques in British hip surgery.

    PubMed

    Hashemi-Nejad, A; Birch, N C; Goddard, N J

    1994-11-01

    Aseptic loosening is the major problem in hip joint replacement. Improved cementing techniques have been shown to improve the long-term survival of implants significantly. To assess the use of modern cementing techniques in British surgeons, a detailed questionnaire was sent to all Fellows of The British Orthopaedic Association (BOA) regarding cement preparation, bone preparation, cementing technique and prostheses used in total hip arthroplasty. Excluding retired fellows, surgeons who use no cement, and those who had filled in forms inadequately, 668 responded, who between them performed 43,680 hip arthroplasties per year. In this survey, 21 different types of hip prostheses were implanted by the surgeons; 48% of hips implanted were Charnley type. Of the surgeons, 46% used Palacos with gentamicin as their cement for both the femur and acetabulum. For the femur, 44% of surgeons remove all cancellous bone, 40% use pulse lavage, 59% use a brush to clear debris, 94% dry the femur, 97% plug the femur, 76% use a cement gun and 70% pressurise the cement. For the acetabulum, 88% of surgeons retain the subchondral bone, 40% use pulse lavage, 100% dry the acetabulum, 22% use hypotensive anaesthesia and 58% pressurise the cement. Overall only 25% of surgeons (26% of hips implanted) use 'modern' cementing techniques. This has implications for the number of arthroplasties that may require early revision.

  7. Lifestyle and health-related quality of life in Asian patients with total hip arthroplasties.

    PubMed

    Fujita, Kimie; Xia, Zhenlan; Liu, Xueqin; Mawatari, Masaaki; Makimoto, Kiyoko

    2014-09-01

    Total hip arthroplasty reduces pain and restores physical function in patients with hip joint problems. This study examined lifestyle and health-related quality of life before and after total hip arthroplasty in Japanese and Chinese patients. Two hospitals in China recruited 120 patients and 120 Japanese patients matched by age and operative status were drawn from a prospective cohort database. Oxford Hip Score, EuroQol, and characteristics of Asian lifestyle and attitudes toward the operation were assessed. There were no differences between patients from the two countries in quality-of-life-scale scores: postoperative patients had significantly better quality-of-life scores than preoperative patients in both countries. In China, patients who reported that living at home was inconvenient had significantly worse Oxford Hip Scores than those who did not. Mean scores for anxiety items concerning possible dislocation and durability of the implant were significantly higher in Japanese than in Chinese subjects. Our findings suggest that providing information about housing conditions and lifestyles would result in improved quality of life and reduced anxiety in patients with implanted joints.

  8. Lifestyle and health-related quality of life in Asian patients with total hip arthroplasties.

    PubMed

    Fujita, Kimie; Xia, Zhenlan; Liu, Xueqin; Mawatari, Masaaki; Makimoto, Kiyoko

    2014-09-01

    Total hip arthroplasty reduces pain and restores physical function in patients with hip joint problems. This study examined lifestyle and health-related quality of life before and after total hip arthroplasty in Japanese and Chinese patients. Two hospitals in China recruited 120 patients and 120 Japanese patients matched by age and operative status were drawn from a prospective cohort database. Oxford Hip Score, EuroQol, and characteristics of Asian lifestyle and attitudes toward the operation were assessed. There were no differences between patients from the two countries in quality-of-life-scale scores: postoperative patients had significantly better quality-of-life scores than preoperative patients in both countries. In China, patients who reported that living at home was inconvenient had significantly worse Oxford Hip Scores than those who did not. Mean scores for anxiety items concerning possible dislocation and durability of the implant were significantly higher in Japanese than in Chinese subjects. Our findings suggest that providing information about housing conditions and lifestyles would result in improved quality of life and reduced anxiety in patients with implanted joints. PMID:24845456

  9. Long-Term Outcome after Rehabilitation of Bilateral Total Hip Arthroplasty in Renal Transplant Recipient – A Case Report

    PubMed Central

    Dimitrova, Erieta Nikolikj; Adamov, Aleksandar; Koevska, Valentina; Mitrevska, Biljana; Gacevikj, Ivan; Agushi, Arsim

    2016-01-01

    INTRODUCTION: Total hip replacement is generally proposed for renal transplant patients with avascular osteonecrosis of the femoral head. PURPOSE: The purpose of the study is to report the long-term outcome after rehabilitation of bilateral total hip arthroplasty in a patient with renal transplantation suffering from avascular osteonecrosis of the both femoral heads. MATERIAL AND METHOD: The patient S.D, 49 years old at follow-up. Few months after renal transplantation, the patient had got avascular osteonecrosis of both femoral head. One year after transplantation the total hip arthroplasty for both hip joints were performed. Three years later repeat total hip arthroplasty surgery for left hip was performed. After any surgery intervention the patient was referred for inpatient rehabilitation. For clinical assessment the clinical findings and Harris Hip Score have been used. The rehabilitation program consisted of exercises, occupational therapy, and patient education. RESULTS: After any rehabilitation treatment the patient had improvement of clinical findings. At follow-up assessment outcome for both hip function was good - Harris Hip Score was 81 points. CONCLUSION: Rehabilitation is integral part of multidisciplinary treatment of renal transplant recipient after total hip arthroplasty. Regular exercise training of these patients is very important for improving of their long-term outcome. PMID:27275350

  10. Venous thromboembolism prophylaxis after total hip or knee arthroplasty: a survey of Canadian orthopedic surgeons

    PubMed Central

    Gross, Michael; Anderson, David R.; Nagpal, Seema; O’Brien, Bernie

    1999-01-01

    Objective To determine the pharmacologic and physical modalities used by orthopedic surgeons in Canada to prevent venous thromboembolism (deep venous thrombosis and pulmonary embolism) after total hip or knee arthroplasty. Design Mail survey sent to all members of the Canadian Orthopaedic Association. Setting A nation-wide study. Methods A total of 828 questionnaires, designed to identify the type and frequency of prophylaxis against venous thromboembolism that were used after hip and knee arthroplasty were mailed to orthopedic surgeons. Outcome measures Demographic data and the frequency and type of thromboprophylaxis. Results Of the 828 surveys mailed 445 (54%) were returned, and 397 were included in this analysis. Of the respondents, 97% used prophylaxis routinely for patients who undergo total hip or knee arthroplasty. Three of the 397 (0.8%) did not use any method of prophylaxis. Warfarin was the most common agent used (46%), followed by low-molecular-weight heparin (LMWH) (36%). Combination therapy with both mechanical and pharmacologic methods were used in 39% of patients. Objective screening tests were not frequently performed before discharge. Extended prophylaxis beyond the duration of hospitalization was used by 36% of physicians. Conclusion Prophylaxis for venous thromboembolism with warfarin or LMWH has become standard care after total hip or knee arthroplasty in Canada. PMID:10593248

  11. Acute compartment syndrome of the thigh 10 days following an elective primary total hip replacement.

    PubMed

    Elsorafy, Kareem R; Jm Stone, Andrew; Nicol, Stephen G

    2013-06-28

    Acute compartment syndrome (ACS) of the thigh is an uncommon condition usually treated surgically by emergency dermofasciotomy. We report a rare case of acute delayed compartment syndrome of the anterior compartment of the thigh following an uncemented Total Hip Replacement (THR). Surgical decompression was performed and patient had full recovery.

  12. Preoperative planning and postoperative evaluation of total hip arthroplasty that takes combined anteversion.

    PubMed

    Imai, Hiroshi; Miyawaki, Joji; Kamada, Tomomi; Takeba, Jun; Mashima, Naohiko; Miura, Hiromasa

    2016-07-01

    The purpose of this study was to investigate whether postoperative combined anteversion (CA) can be kept within the safe zone while using cementless total hip arthroplasty (THA) using the operative technique which prepares the socket first for developmental dysplasia of the hip (DDH), by estimating the anteversion of the metaphyseal fit stem using preoperative three-dimensional (3D) computerized planning and by adjusting the anteversion of the socket using a navigation system that considers CA. Our subjects were 65 patients (65 hips) that had undergone cementless THA for DDH that could be observed for 1 year or more. Clinical assessments were made using the Japanese Orthopaedic Association's (JOA) hip score. For a radiological evaluation, we investigated 3D-planned stem versions, postoperative stem versions, preoperative and postoperative CA, and the relationship between CA and dislocation tendencies with temporary intraoperative reductions. JOA hip scores improved from 52.3 ± 11.4 points to 88.9 ± 8.6 points. CT evaluations revealed that 3D-planned stem versions were strongly correlated with postoperative stem versions (r = 0.80; p < 0.01). Preoperative CA was 50.5° ± 7.2°, and postoperative CA was 41.3° ± 8.6°. Postoperative CA was kept within the safe zone in 61 hips. No intraoperative dislocation tendencies were observed in any hips. By estimating the anteversion of the cementless metaphyseal fit stem using 3D planning preoperatively and adjusting the angle of anteversion of the socket using a navigation system that considers CA intraoperatively, postoperative CA can very frequently be kept within the safe zone, even with cementless THA using the operative technique which prepares the socket first for DDH. PMID:27154291

  13. Abductor Reconstruction with Gluteus Maximus Transfer in Primary Abductor Deficiency during Total Hip Arthroplasty

    PubMed Central

    Jang, Se Ang; Byun, Young Soo; Gu, Tae Hoe

    2016-01-01

    Abductor deficiency in native hip joint may cause severe limping and pain. It is more serious situation in case of arthroplasty due to instability and recurrent dislocation. Well-known causes of abductor deficiency are repeated surgery, chronic trochanteric bursitis, superior gluteal nerve injury, failure of repair of abductor tendon insertion to the greater trochanter. Author had experienced primary abductor deficiency during total hip replacement and treated successfully with the transfer of gluteus maximus. We'd like to introduce the operation technique with the review of literature. PMID:27777922

  14. Minimal-invasive posterior approach for total hip arthroplasty versus standard lateral approach.

    PubMed

    Schleicher, Iris; Haas, Holger; Adams, Tim S; Szalay, Gabor; Klein, Heiko; Kordelle, Jens

    2011-08-01

    In this prospective study we compared clinical and radiological results and rehabilitation progress of 64 patients who underwent total hip arthroplasty using the standard lateral approach with 64 patients operated with a minimal-invasive (MIS) posterior approach. The outcome of our study did not show any significant differences with regard to patient's safety such as complication rate and radiological assessment of the cup position. There was no difference in the duration of surgery, blood loss, hospital stay and postoperative leg length discrepancy. Rehabilitation milestones were achieved earlier by MIS patients and three and six months postoperatively, the Harris Hip Score of the MIS group was significantly higher.

  15. The friction of explanted hip prostheses.

    PubMed

    Hall, R M; Unsworth, A; Wroblewski, B M; Siney, P; Powell, N J

    1997-01-01

    Charnley prostheses, retrieved at revision surgery, were studied to assess the effects of friction on the total hip replacement procedure. Frictional resistance was measured using the Durham hip function simulator under both dry and lubricated conditions. The friction factor values (f) for the explanted prostheses were found to have a non-Gaussian distribution with medians of 0.13 [inter-quartile range (IQR) 0.10-0.16] and 0.06 (IQR 0.005-0.08) for dry and lubricated (n = 0.01 Pa s) regimes, respectively. New Charnley prostheses had values of f equal to 0.11 +/- 0.025 and 0.04 +/- 0.01 under the same conditions, and showed no large deviation from a Gaussian distribution. There was found to be a statistically significant difference in the medians of the friction factors for new and retrieved prostheses in the lubricated regime. Ingression of cement into the worn region of the cup was found to increase the friction factor significantly under dry conditions. There was no evidence of an increase in the friction factor or torque for those joints that had a loose socket with respect to those that were fixed at revision. A decrease in the frictional torque against number of cycles undergone by the joint in vivo may indicate that a fatigue-type process may have a role in the loosening of the socket. However, this relationship was found not to be significant for friction measured under lubricated conditions and it seems unlikely that the frictional torque generated in this type of prosthesis will contribute significantly to the long-term loosening of the socket.

  16. [Total knee and hip prosthesis: variables associated with costs].

    PubMed

    Herrera-Espiñeira, Carmen; Escobar, Antonio; Navarro-Espigares, José Luis; Castillo, Juan de Dios Lunadel; García-Pérez, Lidia; Godoy-Montijano, Amparo

    2013-01-01

    antecedentes: la alta prevalencia de artrosis en los países occidentales, el elevado costo de las intervenciones de artroplastia de cadera y rodilla y las amplias variaciones en la práctica médica generan gran interés por comparar los costos asociados antes y después de la cirugía. Objetivo: conocer el costo de las intervenciones de reemplazo total de cadera y rodilla durante la estancia hospitalaria y al año de seguimiento posterior al alta. material y métodos: estudio multicéntrico y prospectivo efectuado en 15 hospitales de tres comunidades autónomas. La relación entre las variables independientes con el costo de la estancia y costo post-alta, se analizó con modelos multinivel y para agrupar los casos se utilizó la variable "hospital." Las variables independientes fueron: edad, sexo, índice de masa corporal, calidad de vida prequirúrgica (cuestionarios ED-5D, SF-12 y Womac), intervención (cadera-rodilla), índice Charlson, complicaciones, número de camas y dependencia económico-institucional del hospital, comunidad autó-noma y presencia de cuidador. Resultados: el costo promedio por paciente, sin incluir el costo de la prótesis, fue de 4,734 Euros ± 2,136 y el costo del seguimiento post alta de 554 Euros ± 509. Si se incluye el costo de la prótesis, al final del año el costo total asciende a 7,645 Euros ± 2,248. Conclusiones: existe un margen considerable en la reducción de los costos de estancia; más de 44% de la variabilidad observada no está determinada por las condiciones clínicas de los pacientes sino por el comportamiento de los centros hospitalarios.

  17. Venous thromboembolic disease management patterns in total hip arthroplasty and total knee arthroplasty patients: a survey of the AAHKS membership.

    PubMed

    Mesko, J W; Brand, R A; Iorio, R; Gradisar, I; Heekin, R; Leighton, R; Thornberry, R

    2001-09-01

    The American Association of Hip and Knee Surgeons (AAHKS) distributed a survey to its members exploring practice patterns implemented to prevent venous thromboembolic disease (VTED) in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Of 720 (33%) members, 236 responded. Prophylaxis was prescribed for 100% of patients during the course of hospitalization for THA and TKA. Warfarin was the commonest pharmacologic treatment used for THA (66%) and TKA (59%) patients. Low-molecular-weight heparin was used in 16% of THA patients and 18% of TKA patients. The most commonly employed mechanical modality was pneumatic devices in THA (51%) and TKA (50%). Universal acceptance of the need for prophylaxis administration for patients undergoing THA and TKA is shown. The method and duration remain highly variable; although the survey illustrates such variation, it suggests there is no one best method of prophylaxis.

  18. Does bearing size influence metal ion levels in large-head metal-on-metal total hip arthroplasty? A comparison of three total hip systems

    PubMed Central

    2014-01-01

    Background The purpose of the study was twofold: first, to determine whether there is a statistically significant difference in the metal ion levels among three different large-head metal-on-metal (MOM) total hip systems. The second objective was to assess whether position of the implanted prostheses, patient demographics or factors such as activity levels influence overall blood metal ion levels and whether there is a difference in the functional outcomes between the systems. Methods In a cross-sectional cohort study, three different metal-on-metal total hip systems were assessed: two monoblock heads, the Durom socket (Zimmer, Warsaw, IN, USA) and the Birmingham socket (Smith and Nephew, Memphis, TN, USA), and one modular metal-on-metal total hip system (Pinnacle, Depuy Orthopedics, Warsaw, IN, USA). Fifty-four patients were recruited, with a mean age of 59.7 years and a mean follow-up time of 41 months (12 to 60). Patients were evaluated clinically, radiologically and biochemically. Statistical analysis was performed on all collected data to assess any differences between the three groups in terms of overall blood metal ion levels and also to identify whether there was any other factor within the group demographics and outcomes that could influence the mean levels of Co and Cr. Results Although the functional outcome scores were similar in all three groups, the blood metal ion levels in the larger monoblock large heads (Durom, Birmingham sockets) were significantly raised compared with those of the Pinnacle group. In addition, the metal ion levels were not found to have a statistically significant relationship to the anteversion or abduction angles as measured on the radiographs. Conclusions When considering a MOM THR, the use of a monoblock large-head system leads to higher elevations in whole blood metal ions and offers no advantage over a smaller head modular system. PMID:24472283

  19. Risk Factors of Heterotopic Ossification Following Total Hip Arthroplasty in Patients With Ankylosing Spondylitis.

    PubMed

    Thilak, Jai; Panakkal, Jiss Joseph; Kim, Tae-Young; Goodman, Susan M; Lee, Sang-Soo; Salvati, Eduardo A

    2015-12-01

    This study was to identify the risk factors of heterotopic ossification (HO) after total hip arthroplasty (THA) in ankylosing spondylitis. We analyzed 47 hips (24 patients) with ankylosing spondylitis that underwent primary THA. The incidence of HO was 14.9%. The risk factors were divided into modifiable and nonmodifiable factors. Female gender (P=0.008), preoperative ankylosed hip (P<0.001), occurrence of HO in previous surgery (P=0.036) were nonmodifiable risk factors which increased the prevalence of HO. Of the various modifiable risk factors, elevated preoperative ESR (P=0.007), elevated preoperative CRP (P=0.004) and prolonged duration of surgery (P=0.014) were associated with increased occurrence of HO. Perioperative medical intervention to reduce inflammation (ESR and CRP) may help to decrease HO.

  20. Minimum 10-Year Wear Analysis of Highly Cross-Linked Polyethylene in Cementless Total Hip Arthroplasty.

    PubMed

    So, Kazutaka; Goto, Koji; Kuroda, Yutaka; Matsuda, Shuichi

    2015-12-01

    Fifty-four patients (64 hips) underwent cementless total hip arthroplasty between 2000 and 2003 with a 22-mm zirconia ceramic bearing on highly cross-linked polyethylene, and were evaluated with a mean 11.9-year postoperative follow-up (range, 10-14 years). Linear wear was measured on the anteroposterior radiograph of the hip. No evidence of osteolysis and loosening was found on the final radiograph in any of the cases, and the steady-state linear wear rate was 0.017±0.018 mm/year. No significant correlation was found between the linear wear rate and age, body weight, cup inclination angle, or polyethylene thickness. Highly cross-linked polyethylene showed excellent wear resistance for >10 years when used in combination with 22-mm zirconia heads.

  1. [Clinical and radiological assessment of proximally coated stems in growth in total hip replacement].

    PubMed

    Blacha, J; Bednarek, A; Gagała, J

    1998-01-01

    Clinical and radiological results of total hip replacement with proximally coated stems are discussed. Material included 90 hips (50 ABG stems, 40 Level III stems) in 83 patients (59 females, 24 males), mean age 48 years (range 17-22) and mean follow-up of 27 months (range 1-5 years). No stems were revised, the average Harris Hip Score at last follow-up ranged from 89 to 91 points. Stress transfer around the proximal part of the stem resulted in endosteal osteogenesis in the 2nd and 6th Gruen zones and changed trabecular orientation. There was no evidence of bone resorption due to stress shielding. Peri- and endosteal bone reaction in the 3rd and 5th Gruen zones need longer follow-up.

  2. Contemporary Ceramic Total Hip Arthroplasty in Patients with Cerebral Palsy: Does It Work?

    PubMed Central

    Yoon, Byung-Ho; Ha, Yong-Chan; Koo, Kyung-Hoi

    2015-01-01

    Background Adult patients with cerebral palsy (CP), who have advanced degenerative arthritis of the hip, have been treated with resection arthroplasty and arthrodesis. Although total hip arthroplasty (THA) has also been used as one of the alternative options, there are few studies on contemporary bearings used in THA. Therefore, we evaluated the results of the contemporary ceramic-on-ceramic THA in adult patients with CP. Methods From January 2005 to December 2007, five adult CP patients (5 hips) underwent THA using contemporary ceramic-on-ceramic bearings. All patients were able to stand or ambulate with intermittent use of assistive devices at home. We retrospectively reviewed the series to determine the results of THA in terms of pain relief, improved function, and durability of prosthesis. Results There were 3 men and 2 women with a mean age of 35.9 years. All patients had pain relief without decline in mobility postoperatively. One hip was dislocated, which was treated successfully with closed reduction and an abduction brace for 2 months. There was no ceramic fracture, loosening, or osteolysis during the mean follow-up of 6.8 years (range, 5.8 to 8.3 years). Conclusions Cementless THA using contemporary ceramic-on-ceramic bearings is a useful option for the treatment of advanced degenerative arthritis of the hip in ambulatory adults with CP. PMID:25729517

  3. Long-term results of the threaded Weill cup in primary total hip arthroplasty

    PubMed Central

    Clarius, Michael; Jung, Alexander W.; Raiss, Patric; Streit, Marcus R.; Merle, Christian

    2009-01-01

    Uncemented, threaded acetabular components with smooth surface treatment were widely used in continental Europe in the 1970s and 1980s for primary total hip arthroplasty (THA). Previously published studies showed high failure rates in the mid-term. In a consecutive series of 116 patients, 127 threaded cups with smooth surface treatment (Weill cup; Zimmer, Winterthur, Switzerland) were implanted in combination with one type of uncemented stem. Patients were followed up clinically and radiographically. Mean time of follow-up was 17 years (range 15–20). At the time of follow-up, the acetabular component had been revised or was awaiting revision in 30 hips (24%). Two hips were revised for infection and 23 for aseptic loosening. Four polyethylene liners were exchanged because of excessive wear. One hip was awaiting revision. The survival rate for all acetabular revisions including one hip awaiting revision was 75% (95%CI: 65–85%) at 17 years. These results support the view that smooth, threaded acetabular components do not provide satisfactory long-term fixation and should be abandoned. It is important to closely monitor patients with these components as the failure rate remains high in the long-term. PMID:19629480

  4. Application and evaluation of biomechanical models and scores for the planning of total hip arthroplasty.

    PubMed

    Eschweiler, Jörg; Fieten, Lorenz; Dell'Anna, Jasmin; Kabir, Koroush; Gravius, Sascha; Tingart, Markus; Radermacher, Klaus

    2012-12-01

    Intimate knowledge of the biomechanics of a given individual hip joint provides a potential advantage during the planning of total hip arthroplasty, and would thus have a positive influence over the outcome of such an intervention. In current clinical practise, the surgical planning is based solely on the status of the individual hip and its radiographic appearance. However, additional information could be gathered from the radiography to be used as input data for biomechanical models aimed at calculating the resultant force FR within the hip joint. An investigation of the biomechanical models by Pauwels, Debrunner and Iglič was performed, where the magnitude of FR calculated by the models showed a favourable comparison to the in-vivo data from instrumented prostheses by Bergmann. The Blumentritt model returned abnormally high results. The computational results showed large variations for FR orientation, which tends to depend more on the model used than on patient-specific parameters. Furthermore, a discrepancy was found between the data gathered from instrumented prostheses and the Standing Human Model within the 'AnyBody Modeling System™' software by AnyBody Tech. Additionally, the variations in inter-rater and intra-rater errors made while localizing radiographic landmarks were analysed with respect to their influence on Babisch-Layher-Blumentritt (BLB)-scoring using the Blumentritt hip model.

  5. Formation of a pseudotumor in total hip arthroplasty using a tribological metal-polyethylene pair.

    PubMed

    Fagotti, Lorenzo; Vicente, José Ricardo Negreiros; Miyahara, Helder Souza; de Oliveira, Pedro Vitoriano; Bernabé, Antônio Carlos; Croci, Alberto Tesconi

    2015-01-01

    The aim here was to report a case of a young adult patient who evolved with tumor formation in the left thigh, 14 years after revision surgery on hip arthroplasty. Davies in 2005 made the first description of this disease in patients undergoing metal-on-metal hip arthroplasty. Over the last decade, however, pseudotumors around metal-on-polyethylene surfaces have become more prevalent. Our patient presented with increased volume of the left thigh 8 years after hip arthroplasty revision surgery. Two years before the arising of the tumor in the thigh, a nodule in the inguinal region was investigated to rule out a malignant neoplastic process, but the results were inconclusive. The main preoperative complaints were pain, functional limitation and marked reduction in the range of motion of the left hip. Plain radiographs showed loosening of acetabular and femoral, and a large mass between the muscle planes was revealed through magnetic resonance imaging of the left thigh. The surgical procedure consisted of resection of the lesion and removal of the components through lateral approach. In respect of total hip arthroplasty, pseudotumors are benign neoplasms in which the bearing surface consists of metal-on-metal, but they can also occur in different tribological pairs, as presented in this case.

  6. Gait and stair function in total and resurfacing hip arthroplasty: a pilot study.

    PubMed

    Shrader, M Wade; Bhowmik-Stoker, Manoshi; Jacofsky, Marc C; Jacofsky, David J

    2009-06-01

    Standard total hip arthroplasty (THA) is the established surgical treatment for patients older than 65 years with progressive osteoarthritis but survivorship curves wane in patients younger than 50. Resurfacing hip arthroplasty (RHA) is an alternative for younger, active patients reportedly providing superior range of motion. Quantitative investigation of functional recovery following arthroplasty may elucidate limitations that aid in device selection. Although limited long-term kinematic data are available, the early rate of recovery and gait compensations are not well described. This information may aid in refining rehabilitation protocols based on limitations specific to the implant. We presumed hip motion and forces for subjects receiving RHA are more similar to age-matched controls during physically demanding tasks, such as stair negotiation, at early time points than those for THA. In a pilot study, we quantified walking and stair negotiation preoperatively and 3 months postoperatively for seven patients with RHA (mean age, 49 years), seven patients with standard THA (mean age, 52 years), and seven age-matched control subjects (mean age, 56 years). Although both treatment groups demonstrated trends toward functional recovery, the RHA group had greater improvements in hip extension and abduction moment indicating typical loading of the hip. Further investigation is needed to determine if differences persist long term or are clinically meaningful. PMID:19305961

  7. Effect of cup inclination on predicted contact stress-induced volumetric wear in total hip replacement.

    PubMed

    Rijavec, B; Košak, R; Daniel, M; Kralj-Iglič, V; Dolinar, D

    2015-01-01

    In order to increase the lifetime of the total hip endoprosthesis, it is necessary to understand mechanisms leading to its failure. In this work, we address volumetric wear of the artificial cup, in particular the effect of its inclination with respect to the vertical. Volumetric wear was calculated by using mathematical models for resultant hip force, contact stress and penetration of the prosthesis head into the cup. Relevance of the dependence of volumetric wear on inclination of the cup (its abduction angle ϑA) was assessed by the results of 95 hips with implanted endoprosthesis. Geometrical parameters obtained from standard antero-posterior radiographs were taken as input data. Volumetric wear decreases with increasing cup abduction angle ϑA. The correlation within the population of 95 hips was statistically significant (P = 0.006). Large cup abduction angle minimises predicted volumetric wear but may increase the risk for dislocation of the artificial head from the cup in the one-legged stance. Cup abduction angle and direction of the resultant hip force may compensate each other to achieve optimal position of the cup with respect to wear and dislocation in the one-legged stance for a particular patient.

  8. Wake-up test in total hip arthroplasty with high-riding developmental dysplasia.

    PubMed

    Chen, Kun-Hui; Wang, Hsin-Yi; Sung, Chun-Sung; Wu, Po-Kuei; Chen, Cheng-Fong; Liu, Chien-Lin; Chen, Wei-Ming

    2014-07-01

    Total hip arthroplasty (THA) for patients with Crowe type IV developmental dysplasia of the hip is technically challenging. This group of patients has a higher incidence of nerve injury during THA. Although neurophysiologic intraoperative monitoring has been developed to provide nerve monitoring, it is not always available. The wake-up test has been used for intraoperative spinal cord monitoring during major spinal surgery, but no study has reported the use of the wake-up test for neurologic monitoring during THA in patients with severe developmental dysplasia of the hip. The authors retrospectively reviewed 22 THA procedures in 20 patients with Crowe type IV developmental dysplasia of the hip who underwent the wakeup test during THA. In the current study, 1 patient could not dorsiflex her foot during the wake-up test. Therefore, the authors immediately reduced the length of limb lengthening by 1 cm. Postoperative drop foot and numbness occurred but resolved completely 2 months later. None of the patients who showed no deficits in motion of the feet during the intraoperative wake-up test had signs of postoperative nerve injury. In the current study, there was no false-positive or false-negative finding. The authors concluded that the wake-up test, which is simple, safe, and reliable, is a useful technique and a possible alternative to neurophysiologic intraoperative monitoring in checking nerve function during THA in patients with severe developmental dysplasia of the hip. PMID:24992057

  9. Impingement and stability of total hip arthroplasty versus femoral head resurfacing using a cadaveric robotics model.

    PubMed

    Colbrunn, R W; Bottros, J J; Butler, R S; Klika, A K; Bonner, T F; Greeson, C; van den Bogert, A J; Barsoum, W K

    2013-07-01

    We identified and compared the impingent-free range of motion (ROM) and subluxation potential for native hip, femoral head resurfacing (FHR), and total hip arthroplasty (THA). These constructs were also compared both with and without soft tissue to elucidate the role of the soft tissue. Five fresh-frozen bilateral hip specimens were mounted to a six-degree of freedom robotic manipulator. Under load-control parameters, in vivo mechanics were recreated to evaluate impingement free ROM, and the subluxation potential in two "at risk" positions for native hip, FHR, and THA. Impingement-free ROM of the skeletonized THA was greater than FHR for the anterior subluxation position. For skeletonized posterior subluxations, stability for THA and FHR constructs were similar, while a different pattern was observed for specimens with soft tissues intact. FHR constructs were more stable than THA constructs for both anterior and posterior subluxations. When the femoral neck is intact the joint has an earlier impingement profile placing the hip at risk for subluxation. However, FHR design was shown to be more stable than THA only when soft tissues were intact. PMID:23494830

  10. Periprosthetic fractures of the femur after total hip arthroplasty: etiology and outcome.

    PubMed

    Blacha, Jan; Gagała, Jacek

    2004-10-30

    Background. This article reports on our experience in the management of periprosthetic fractures of the femur. Materials and methods. We studied 44 patients (39 women and 5 men) with periprosthetic fractures of the femur after total hip replacement (THR). The average age of the patients at the time of surgery was 68 (range 33-82). Femoral fractures had occurred 1-20 years after THR in 27 hips. Revision hip arthroplasty was associated with periprosthetic fracture in 14 hips. Three patients had primary THR complicated by intraoperative femoral periprosthetic fracture. The outcome measures were bone union, delayed union or any revision intervention. Results. Bone union was achieved in 42 cases (95%). Thirty-five patients were satisfied with the surgical results, seven were moderately satisfied. Two patients had non-union of the femoral shaft, necessitating another intervention. The mean Harris Hip Score after bone union was 84 points (range 58-97). Deviation of the femoral axis was observed in 4 cases, due to subsiding of polished cemented stems. There were no deep infections. Conclusions. Internal stabilization with plate and cables is the best option in the treatment of fractured femur around a stable stem. Ineffective stabilization due to the use of a plate that was not long enough resulted in union with angulation. Long polished stems tended to subside within the cement mantle.

  11. Formation of a pseudotumor in total hip arthroplasty using a tribological metal–polyethylene pair☆

    PubMed Central

    Fagotti, Lorenzo; Vicente, José Ricardo Negreiros; Miyahara, Helder Souza; de Oliveira, Pedro Vitoriano; Bernabé, Antônio Carlos; Croci, Alberto Tesconi

    2015-01-01

    The aim here was to report a case of a young adult patient who evolved with tumor formation in the left thigh, 14 years after revision surgery on hip arthroplasty. Davies in 2005 made the first description of this disease in patients undergoing metal-on-metal hip arthroplasty. Over the last decade, however, pseudotumors around metal-on-polyethylene surfaces have become more prevalent. Our patient presented with increased volume of the left thigh 8 years after hip arthroplasty revision surgery. Two years before the arising of the tumor in the thigh, a nodule in the inguinal region was investigated to rule out a malignant neoplastic process, but the results were inconclusive. The main preoperative complaints were pain, functional limitation and marked reduction in the range of motion of the left hip. Plain radiographs showed loosening of acetabular and femoral, and a large mass between the muscle planes was revealed through magnetic resonance imaging of the left thigh. The surgical procedure consisted of resection of the lesion and removal of the components through lateral approach. In respect of total hip arthroplasty, pseudotumors are benign neoplasms in which the bearing surface consists of metal-on-metal, but they can also occur in different tribological pairs, as presented in this case. PMID:27218090

  12. Technique to treat iliopsoas irritation after total hip replacement: Thickening of articular hip capsule through an abridged direct anterior approach.

    PubMed

    Benad, K; Delay, C; Putman, S; Girard, J; Pasquier, G; Migaud, H

    2015-12-01

    Iliopsoas irritation due to acetabular cup component impingement following total hip arthroplasty (THA) is usually treated by infiltration or by distal iliopsoas tenotomy in case of recurrence; however, this can result in an active flexion deficit of the thigh. To prevent this complication, we developed an original technique that we performed between 2012 and 2014 in patients with recurrent impingement following extraarticular corticosteroid injections. This included 5 patients (mean age: 64 [53-75] years old) in whom we performed an ambulatory bursectomy by the Hueter approach and placed a polyglactin 910 (Vicryl™) mesh plate on the entire anterior hip capsule. After a mean follow-up of 12months (9-29months), anterior pain had decreased in all patients with improvement and an increase in the Oxford-12 (mean: 15 points [10-19]), Merle d'Aubigné (mean: 2.5 points [1-5]) and Harris (mean: 18 points [10-29]) scores. No flexion deficits were observed. An infected postoperative hematoma had to be drained but was cured at follow-up. This simple procedure provides satisfactory results and preserves THA function. It does not jeopardize future procedures and is an alternative option in case of unsuccessful conservative treatment. PMID:26548515

  13. [Total hip replacement as a result of coxalgia: about 10 cases].

    PubMed

    Chagou, Aniss; Benbouha, Abdelatif; Rhanim, Abdelkarim; Lahlou, Abdou; Berrada, Mohammed Saleh; El Yaacoubi, Moradh

    2016-01-01

    Coxalgia causes osteocartilaginous destructions of the hip joint; these lesions are responsible for severe pain leading to functional discomfort and limitations in everyday life. Their surgical treatment is still not well established. The aim of our study was to demonstrate the interest of total hip arthroplasty associated with anti-tuberculous chemotherapy to improve patients' quality of life. We report a retrospective study of 10 cases of total hip replacement following coxalgia at the Department of Orthopaedics and Trauma of Rabat University Hospital from 2002 to 2011. The average age of our patients was 38 years. The discovery of coxalgia was made under different circumstances according to the patients. The surgical approach we used was exclusively posterolateral (Moore). All prostheses were cemented. Four patients required acetabulum reconstruction. Intraoperative biopsy was positive in a patient, negative in the remaining nine. All patients underwent anti-tuberculous treatment. No recurrence was noted after a minimum follow-up of 3 years. Results according to Merle d'Aubigné score were considered good. In case of advanced bone destruction with badly tolerated functional impact in mature subject, total hip arthroplasty always associated with effective anti-tuberculous chemotherapy is the treatment of choice for sequelae of coxalgia. PMID:27642444

  14. Influence of cementless cup surface on stability and bone fixation 2 years after total hip arthroplasty.

    PubMed

    Urbański, Wiktor; Krawczyk, Artur; Dragan, Szymon Ł; Kulej, Mirosław; Dragan, Szymon F

    2012-01-01

    Loss of fixation between bone and implant surface is one of the main treatment problems in total hip arthroplasty. It might lead to implant instability, bone loss and treatment failure resulting in revision surgery. Surface modification is a method for improving bone response to implant and increasing implant osseointegration. However, the currently applied modifications such as hydroxyapatite coatings do not meet expectation and do not provide good clinical result. The object of the study was to evaluate the influence of acetabular cup surface modification on fixation and bone remodelling in total hip arthroplasty. Clinical and radiological outcomes were evaluated in patients two years after cementless total hip replacement. Two groups were compared: patients with acetabular component with uncoated titanium surface and patients with hydroxyapatite-coated acetabular surface. Hips X-rays were analysed for early signs of losing stability of acetabular cups. Two years after surgery the analysis of X-rays did not reveal any statistical differences in stability, migration of acetabular components of endoprosthesis between both groups. No differences were also observed in bone remodelling around implants. Particularly high percentage of cups, i.e. 17.64%, were classified into the group with high risk of early implant loosening, i.e., the group with HA coatings. Hydroxyapatite coatings on titanium cementless acetabular cups implanted by press-fit technique have no influence on their stability, bone-implant fixation and the remodelling of bone surrounding an implant two years after surgery.

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

    PubMed Central

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

    2016-01-01

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

  16. Treatment of postoperative sciatic nerve palsy after total hip arthroplasty for postoperative acetabular fracture: A case report.

    PubMed

    Kanda, Akio; Kaneko, Kazuo; Obayashi, Osamu; Mogami, Atsuhiko; Morohashi, Itaru

    2016-11-01

    Acetabular fracture is usually treated with osteosynthesis. However, in the case of an intra-articular fracture, osteosynthesis can result in arthropathy of the hip joint and poor long-term results, hence, total hip arthroplasty is required. However, in total hip arthroplasty for postoperative acetabular fracture, sciatic nerve palsy tends to develop more commonly than after primary total hip arthroplasty. This is a case report of a 57-year-old Japanese male who had internal skeletal fixation for a left acetabular fracture that had occurred 2 years earlier. One year later, he developed coxarthrosis and severe pain of the hip joint and total hip arthroplasty was performed. After the second surgery, he experienced pain along the distribution of the sciatic nerve and weakness of the muscles innervated by the peroneal nerve, indicating sciatic nerve palsy. We performed a third operation, and divided adhesions around the sciatic nerve. Postoperatively, the anterior hip joint pain and the buttocks pain when the hip was flexed were improved. Abduction of the fifth toe was also improved. However, the footdrop and sensory disturbance were not improved. A year after the third operation, sensory disturbance was slightly improved but the footdrop was not improved. We believe the sciatic nerve palsy developed when we dislocated the hip joint as the sciatic nerve was excessively extended as the hip joint flexed and internally rotated. Sciatic nerve adhesion can occur easily in total hip replacement for postoperative acetabular fracture; hence, adhesiotomy should be conducted before performing hip dislocation to prevent injury caused by nerve tension. The patient agreed that the details of this case could be submitted for publication. The work has been reported in line with the CARE criteria and cite. PMID:27672438

  17. Results of Wagner SL revision stem with impaction bone grafting in revision total hip arthroplasty

    PubMed Central

    Singh, Somesh P; Bhalodiya, Haresh P

    2013-01-01

    Background: As the number of total hip arthroplasties (THAs) performed increases, so do the number of required revisions. Impaction bone grafting with Wagner SL Revision stem is a good option for managing bone deficiencies arising from aseptic osteolysis. We studied the results of cementless diaphyseal fixation in femoral revision after total hip arthroplasty and whether there was spontaneous regeneration of bone stock in the proximal femur after the use of Wagner SL Revision stem (Zimmer, Warsaw, IN, USA) with impaction bone grafting. Materials and Methods: We performed 53 hip revisions using impaction bone grafting and Wagner SL Revision stems in 48 patients; (5 cases were bilateral) for variety of indications ranging from aseptic osteolysis to preiprosthetic fractures. The average age was 59 years (range 44-68 years). There were 42 male and 6 female patients. Four patients died after surgery for reasons unrelated to surgery. 44 patients were available for complete analysis. Results: The mean Harris Hip Score was 42 before surgery and improved to 86 by the final followup evaluation at a mean point of 5.5 years. Of the 44 patients, 87% (n=39) had excellent results and 10% (n=5) had good results. The stem survival rate was 98% (n=43). Conclusion: Short term results for revision THA with impaction bone grafting and Wagner SL revision stems are encouraging. However, it is necessary to obtain long term results through periodic followup evaluation, as rate of complications may increase in future. PMID:23960279

  18. Return to flight status following total hip replacement: a case report.

    PubMed

    Tormes, Felix R; Webster, David E

    2002-07-01

    In the recent past, total hip replacement (THR) surgery in naval aviation personnel has been considered for selected individuals. There is a trend in the armed services to return individuals to flight status after total hip arthroplasty. Some individuals have successfully returned to ejection seat aircraft. A case report of an aviator who returned to tactical flying in the F/A-18 community is presented. This naval aviator has functioned successfully on a shipboard environment and accumulated in excess of 900 flight hours without functional compromise after successful hip arthroplasty, reporting no difficulty with aviation-related ergonomic issues, such as ingress/egress, sitting in a confined cockpit, or tolerating G forces. Two other individuals have also returned to flight status, but have not accumulated a significant number of flight hours to warrant evaluation. Irrespective of the apparent early success in returning to flight status, significant concerns remain. This preliminary assessment of individuals returned to flight status after THR appears to justify return to flight status, including ejection seat aircraft. However, there is a potential for hip fracture or dislocation in the event of ejection or PLF which poses significant risks for aircrews requesting return to flight status after THR. Additionally, personnel in this relatively young population should be advised of the likelihood of accelerated wear imposed by strenuous activity. PMID:12137111

  19. Direct anterior total hip arthroplasty: Literature review of variations in surgical technique

    PubMed Central

    Connolly, Keith P; Kamath, Atul F

    2016-01-01

    The direct anterior approach to the hip has been suggested to have several advantages compared to previously popular approaches through its use of an intra-muscular and intra-nervous interval between the tensor fasciae latae and sartorius muscles. Recent increased interest in tissue-sparing and minimally-invasive arthroplasty has given rise to a sharp increase in the utilization of direct anterior total hip arthroplasty. A number of variations of the procedure have been described and several authors have published their experiences and feedback to successfully accomplishing this procedure. Additionally, improved understanding of relevant soft tissue constraints and anatomic variants has provided improved margin of safety for patients. The procedure may be performed using specially-designed instruments and a fracture table, however many authors have also described equally efficacious performance using a regular table and standard arthroplasty tools. The capacity to utilize fluoroscopy intra-operatively for component positioning is a valuable asset to the approach and can be of particular benefit for surgeons gaining familiarity. Proper management of patient and limb positioning are vital to reducing risk of intra-operative complications. An understanding of its limitations and challenges are also critical to safe employment. This review summarizes the key features of the direct anterior approach for total hip arthroplasty as an aid to improving the understanding of this important and effective method for modern hip replacement surgeons. PMID:26807354

  20. Increased Long-Term Cardiovascular Risk After Total Hip Arthroplasty: A Nationwide Cohort Study.

    PubMed

    Gordon, Max; Rysinska, Agata; Garland, Anne; Rolfson, Ola; Aspberg, Sara; Eisler, Thomas; Garellick, Göran; Stark, André; Hailer, Nils P; Sköldenberg, Olof

    2016-02-01

    Total hip arthroplasty is a common and important treatment for osteoarthritis patients. Long-term cardiovascular effects elicited by osteoarthritis or the implant itself remain unknown. The purpose of the present study was to determine if there is an increased risk of late cardiovascular mortality and morbidity after total hip arthroplasty surgery.A nationwide matched cohort study with data on 91,527 osteoarthritis patients operated on, obtained from the Swedish Hip Arthroplasty Register. A control cohort (n = 270,688) from the general Swedish population was matched 1:3 to each case by sex, age, and residence. Mean follow-up time was 10 years (range, 7-21).The exposure was presence of a hip replacement for more than 5 years. The primary outcome was cardiovascular mortality after 5 years. Secondary outcomes were total mortality and re-admissions due to cardiovascular events.During the first 5 to 9 years, the arthroplasty cohort had a lower cardiovascular mortality risk compared with the control cohort. However, the risk in the arthroplasty cohort increased over time and was higher than in controls after 8.8 years (95% confidence interval [CI] 7.0-10.5). Between 9 and 13 years postoperatively, the hazard ratio was 1.11 (95% CI 1.05-1.17). Arthroplasty patients were also more frequently admitted to hospital for cardiovascular reasons compared with controls, with a rate ratio of 1.08 (95% CI 1.06-1.11).Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation when compared with controls. PMID:26871792

  1. The influence of optimism on functionality after total hip replacement surgery.

    PubMed

    Balck, Friedrich; Lippmann, Maike; Jeszenszky, Csilla; Günther, Klaus-Peter; Kirschner, Stephan

    2016-08-01

    Among other factors, optimism has been shown to significantly influence the course of some diseases (cancer, HIV, coronary heart disease). This study investigated whether optimism of a patient before a total hip replacement can predict the functionality of the lower limbs 3 and 6 months after surgery. A total of 325 patients took part in the study (age: 58.7 years; w: 55%). The functionality was measured with the Western Ontario and McMaster Universities arthrosis index, and optimism with the Life Orientation Test. To analyse the influences of age, gender and optimism, general linear models were calculated. In optimistic patients, functionality improved significantly over time. The study showed a clear influence of dispositional optimism on the recovery after total hip replacement in the first 3 months after surgery.

  2. Ten to twelve-year results with the Zweymüller cementless total hip prosthesis.

    PubMed

    Vervest, Ton M J S; Anderson, Patricia G; Van Hout, Freek; Wapstra, Frits-Hein; Louwerse, Robert T; Koetsier, Juriaan W A

    2005-04-01

    Between January 1987 and December 1990, 221 Zweymüller cementless total hip arthroplasties were performed in 211 patients with idiopathic osteoarthritis. A total of 136 patients (142 prostheses) were evaluated at a mean follow-up of 134 months (SD 9.5). The study group consisted of 78 Hochgezogen and 64 Stepless stem prostheses, all with a threaded titanium cup and ceramic head. No clinical and radiological differences were found between the 2 stem prostheses. Seven cups had been revised because of aseptic loosening; 17 cups showed radiolucent lines, osteolysis, or migration. Mean linear polyethylene wear of 105 (74%) cups was 0.46 mm (SD 0.27), with an annual wear of 0.04 mm (SD 0.02). Wear did not correlate with pain, cup migration, radiolucent lines, or osteolysis. Cumulative survival was 96%. Zweymüller cementless total hip arthroplasty showed good midterm results. PMID:15809956

  3. Survival analysis of cementless grit-blasted titanium total hip arthroplasties.

    PubMed

    Delaunay, C; Kapandji, A I

    2001-04-01

    Although about 200000 cementless Zweymüller-Alloclassic total hip arthroplasties (THAs) were carried out worldwide in the last decade, the survival analysis of these prostheses was not available in the 2000 report of the Swedish national hip arthroplasty registry. We report a prospective survivorship analysis of 200 consecutive grit-blasted cementless Alloclassic primary THAs carried out since 1988. Using surgical, clinical and radiological endpoints for the stem and the threaded cup the ten-year survivorship was 91.5% for reoperation for any cause, 96.4% for hip pain (Merle d'Aubigné score < 5 points, clinical failure), 99.4% for definite aseptic loosening (radiological failure) and 99.3% for revision for aseptic loosening. Using the Swedish registry criteria of primary osteoarthritis and revision for aseptic loosening as the endpoint, the survival rate of 99.1% at ten years for the subgroup of 157 Alloclassic THAs in osteoarthritis compares favourably with that of the best modern cemented hip replacements reported in the Swedish arthroplasty registry. PMID:11341429

  4. Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old

    PubMed Central

    Tsukanaka, Masako; Halvorsen, Vera; Nordsletten, Lars; EngesæTer, Ingvild Ø; EngesæTer, Lars B; Marie Fenstad, Anne; Röhrl, Stephan M

    2016-01-01

    Background and purpose Total hip replacement (THR) is not recommended for children and very young teenagers because early and repetitive revisions are likely. We investigated the clinical and radiographic outcomes of THR performed in children and teenage patients. Patients and methods We included 111 patients (132 hips) who underwent THR before 20 years of age. They were identified in the Norwegian Arthroplasty Register, together with information on the primary diagnosis, types of implants, and any revisions that required implant change. Radiographs and Harris hip score (HHS) were also evaluated. Results The mean age at primary THR was 17 (11–19) years and the mean follow-up time was 14 (3–26) years. The 10-year survival rate after primary THR (with the endpoint being any revision) was 70%. 39 patients had at least 1 revision and 16 patients had 2 or more revisions. In the latest radiographs, osteolysis and atrophy were observed in 19% and 27% of the acetabulae and 21% and 62% of the femurs, respectively. The mean HHS at the final follow-up was 83 (15–100). Interpretation The clinical score after THR in these young patients was acceptable, but many revisions had been performed. However, young patients with developmental dysplasia of the hip had lower implant survival. Moreover, the bone stock in these patients was poor, which could complicate future revisions. PMID:27435903

  5. Tribological characterisation of UHMWPE used in dual mobility total hip prosthesis

    NASA Astrophysics Data System (ADS)

    Essefi, I.; Hakkouna, H.; Ouenzerfi, G.; Mollon, G.; Hamza, S.; Renault, E.; Berthier, Y.; Trunfio-Sfarghiu, A.-M.

    2016-08-01

    Total hip arthroplasty represents an effective solution for bone and joint diseases. Nevertheless, the hip prosthesis has a limited lifetime, in the average around fifteen years. Their improvement, especially their dual mobility is the objective of this study. Therefore, our strategy is focused on improving the material by comparing three types of polyethylene to determine the best one from a friction mechanism and wear rate minimization standpoint. A dual mobility hip prosthesis, containing a two-sided steel and cobalt chrome cup, was tested with a TORNIER hip joint simulator in calf serum. The rubbed surfaces were characterized using scanning electron microscopy (SEM), contact angle measurements, atomic force microscopy (AFM) and confocal fluorescence microscopy. All these multiscale characterization techniques (from nanoscale to millimeter and micro- scale) showed that the velocity accommodation mechanism is different from one type of polyethylene to another. The wear in the case of standard polyethylene was noticeable and the particles were large and scattered between the surface of polyethylene, the surface of the cup and in the calf serum. For the crosslinked polyethylene, the particles coming from the wear, were not as large, but they were spread the same way as the first case. Even though it shares the same accommodation principle on the detachment of the material with the crosslinked polyethylene the wear particles for the crosslinked vitaminized polyethylene were large and they were only found on the surface of the polyethylene.

  6. Mechanical failure of metal-polyethylene sandwich liner in metal-on-metal total hip replacement.

    PubMed

    Oshima, Yasushi; Fetto, Joseph F

    2015-01-01

    Metal-on-metal had been proposed as an optimal articulation in THRs, however, many monoblock prostheses have been recalled in the USA because of significant high rates of early failure. Metal-on-metal prostheses had been implanted in our institution, and this is a case history of a single patient, in whom metal-on-metal THRs with different femoral sizes of heads were implanted. A 57-year-old female patient underwent bilateral total hip replacements with metal-on-metal prostheses using metal-polyethylene "sandwich" liners 9 years ago on the right side and 7 years ago on the left side respectively. The only difference in both sides was the femoral head diameter of 28 mm in right and 34 mm in left. Seven years after the left surgery, the acetabular liner was dissociated, however, metallosis was not detected. Although the larger femoral head was thought to increase hip joint stability, it dictated a reduction in polyethylene thickness in this prosthesis design, and it was 4 mm in the left hip. Recently, metal-on-metal articulations are thought not to be optimal for hip joint bearing surface, however, this clinical failure was due to the polyethylene thickness and quality.

  7. Total Hip Arthroplasty for Implant Rupture after Surgery for Atypical Subtrochanteric Femoral Fracture

    PubMed Central

    Ozaki, Yu; Ochi, Hironori; Watari, Taiji; Matsumoto, Mikio; Kaneko, Kazuo

    2016-01-01

    Treatment methods for delayed union and nonunion of atypical femoral fracture are still controversial. Moreover, no treatment method has been established for implant rupture caused by delayed union and nonunion. We encountered a 74-year-old female in whom nonunion-induced implant rupture occurred after treatment of atypical subtrochanteric femoral fracture with internal fixation using a long femoral nail. It was unlikely that sufficient fixation could be obtained by repeating osteosynthesis alone. Moreover, the patient was elderly and early weight-bearing activity was essential for early recovery of ADL. Based on these reasons, we selected one-stage surgery with total hip arthroplasty and osteosynthesis with inverted condylar locking plate as salvage procedures. Bone union was achieved at 6 months after surgery. This case illustrated that osteosynthesis-combined one-staged total hip arthroplasty could be considered as one of the options for nonunion-induced implant rupture of atypical femoral subtrochanteric fracture.

  8. 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.

  9. Age Related Macular Degeneration and Total Hip Replacement Due to Osteoarthritis or Fracture: Melbourne Collaborative Cohort Study.

    PubMed

    Chong, Elaine W; Wang, Yuanyuan; Robman, Liubov D; Aung, Khin Zaw; Makeyeva, Galina A; Giles, Graham G; Graves, Stephen; Cicuttini, Flavia M; Guymer, Robyn H

    2015-01-01

    Osteoarthritis is the leading cause of total hip replacement, accounting for more than 80% of all total hip replacements. Emerging evidence suggests that osteoarthritis has a chronic inflammatory component to its pathogenesis similar to age-related macular degeneration. We evaluated the association between age-related macular degeneration and total hip replacement as proxy for severe osteoarthritis or fractured neck of femur in the Melbourne Collaborative Cohort Study. 20,744 participants had complete data on both age-related macular degeneration assessed from colour fundus photographs taken during 2003-2007 and total hip replacement. Total hip replacements due to hip osteoarthritis and fractured neck of femur during 2001-2011 were identified by linking the cohort records to the Australian Orthopedic Association National Joint Replacement Registry. Logistic regression was used to examine the association between age-related macular degeneration and risk of total hip replacement due to osteoarthritis and fracture separately, adjusted for confounders. There were 791 cases of total hip replacement for osteoarthritis and 102 cases of total hip replacement due to fractured neck of femur. After adjustment for age, sex, body mass index, smoking, and grouped country of birth, intermediate age-related macular degeneration was directly associated with total hip replacement for osteoarthritis (odds ratio 1.22, 95% CI 1.00-1.49). Late age-related macular degeneration was directly associated with total hip replacement due to fractured neck of femur (odds ratio 5.21, 95% CI2.25-12.02). The association between intermediate age-related macular degeneration and an increased 10-year incidence of total hip replacement due to osteoarthritis suggests the possibility of similar inflammatory processes underlying both chronic diseases. The association of late age-related macular degeneration with an increased 10-year incidence of total hip replacement due to fractured neck of femur may be

  10. Age Related Macular Degeneration and Total Hip Replacement Due to Osteoarthritis or Fracture: Melbourne Collaborative Cohort Study.

    PubMed

    Chong, Elaine W; Wang, Yuanyuan; Robman, Liubov D; Aung, Khin Zaw; Makeyeva, Galina A; Giles, Graham G; Graves, Stephen; Cicuttini, Flavia M; Guymer, Robyn H

    2015-01-01

    Osteoarthritis is the leading cause of total hip replacement, accounting for more than 80% of all total hip replacements. Emerging evidence suggests that osteoarthritis has a chronic inflammatory component to its pathogenesis similar to age-related macular degeneration. We evaluated the association between age-related macular degeneration and total hip replacement as proxy for severe osteoarthritis or fractured neck of femur in the Melbourne Collaborative Cohort Study. 20,744 participants had complete data on both age-related macular degeneration assessed from colour fundus photographs taken during 2003-2007 and total hip replacement. Total hip replacements due to hip osteoarthritis and fractured neck of femur during 2001-2011 were identified by linking the cohort records to the Australian Orthopedic Association National Joint Replacement Registry. Logistic regression was used to examine the association between age-related macular degeneration and risk of total hip replacement due to osteoarthritis and fracture separately, adjusted for confounders. There were 791 cases of total hip replacement for osteoarthritis and 102 cases of total hip replacement due to fractured neck of femur. After adjustment for age, sex, body mass index, smoking, and grouped country of birth, intermediate age-related macular degeneration was directly associated with total hip replacement for osteoarthritis (odds ratio 1.22, 95% CI 1.00-1.49). Late age-related macular degeneration was directly associated with total hip replacement due to fractured neck of femur (odds ratio 5.21, 95% CI2.25-12.02). The association between intermediate age-related macular degeneration and an increased 10-year incidence of total hip replacement due to osteoarthritis suggests the possibility of similar inflammatory processes underlying both chronic diseases. The association of late age-related macular degeneration with an increased 10-year incidence of total hip replacement due to fractured neck of femur may be

  11. Age Related Macular Degeneration and Total Hip Replacement Due to Osteoarthritis or Fracture: Melbourne Collaborative Cohort Study

    PubMed Central

    Chong, Elaine W.; Wang, Yuanyuan; Robman, Liubov D.; Aung, Khin Zaw; Makeyeva, Galina A.; Giles, Graham G.; Graves, Stephen; Cicuttini, Flavia M.; Guymer, Robyn H.

    2015-01-01

    Osteoarthritis is the leading cause of total hip replacement, accounting for more than 80% of all total hip replacements. Emerging evidence suggests that osteoarthritis has a chronic inflammatory component to its pathogenesis similar to age-related macular degeneration. We evaluated the association between age-related macular degeneration and total hip replacement as proxy for severe osteoarthritis or fractured neck of femur in the Melbourne Collaborative Cohort Study. 20,744 participants had complete data on both age-related macular degeneration assessed from colour fundus photographs taken during 2003–2007 and total hip replacement. Total hip replacements due to hip osteoarthritis and fractured neck of femur during 2001–2011 were identified by linking the cohort records to the Australian Orthopedic Association National Joint Replacement Registry. Logistic regression was used to examine the association between age-related macular degeneration and risk of total hip replacement due to osteoarthritis and fracture separately, adjusted for confounders. There were 791 cases of total hip replacement for osteoarthritis and 102 cases of total hip replacement due to fractured neck of femur. After adjustment for age, sex, body mass index, smoking, and grouped country of birth, intermediate age-related macular degeneration was directly associated with total hip replacement for osteoarthritis (odds ratio 1.22, 95% CI 1.00–1.49). Late age-related macular degeneration was directly associated with total hip replacement due to fractured neck of femur (odds ratio 5.21, 95% CI2.25–12.02). The association between intermediate age-related macular degeneration and an increased 10-year incidence of total hip replacement due to osteoarthritis suggests the possibility of similar inflammatory processes underlying both chronic diseases. The association of late age-related macular degeneration with an increased 10-year incidence of total hip replacement due to fractured neck of femur

  12. Minimum Ten-Year Follow-Up of Cemented Total Hip Replacement in Patients with Osteonecrosis of the Femoral Head

    PubMed Central

    Fyda, Thomas M; Callaghan, John J; Olejniczak, Jason; Johnston, Richard C

    2002-01-01

    Between November 1970 and September 1984 the senior author performed fifty-three consecutive total hip arthroplasties with cement in forty-one patients with the diagnosis of osteonecrosis of the femoral head. Five hips in three patients with failed renal transplants requiring chronic hemodialysis were excluded. At the time of final review, a minimum of ten years after the procedure, twenty-one patients (twenty-eight hips) were living, fifteen patients (eighteen hips) had died, and two patients (two hips) were lost to followup. A minimum ten-year follow-up radiograph was obtained on twenty-two (79%) of the hips in surviving patients. During the follow-up period 17.4% of hips (eight hips) required revision: 3.0% (six hips) for aseptic loosening, 2.2% (one hip) for sepsis, and 2.2% (one hip) for recurrent dislocation. All eight revisions occurred in patients living at time of final review, giving a revision prevalence of 22.9% (17.1% for aseptic loosening, 2.9% for sepsis, and 2.9% for recurrent dislocation) in patients surviving ten years. The prevalence of revision of the femoral component for aseptic loosening was 6.5% (three hips) for all hips and 9.1% (three hips) in patients surviving at least ten years. The prevalence of femoral aseptic loosening, defined as those components revised for aseptic loosening and those that demonstrated definite or probable radiographic loosening, was 13.0% (six hips) for all hips and 28.6% (six hips) for hips with at least ten-year radiographic follow-up. The prevalence of revision of the acetabular component for aseptic loosening was 13.0% (six hips) for all hips and 18.2% (six hips) in patients surviving at least ten years. The prevalence of acetabular aseptic loosening was 15.2% (seven hips) for all hips and 29.2% (seven hips) for hips with at least ten-year radiographic follow-up. In patients with osteonecrosis of the femoral head survivorship was significantly inferior to that in the senior author's overall patient population

  13. Fabrication and wear test of a continuous fiber/particulate composite total surface hip replacement

    NASA Technical Reports Server (NTRS)

    Roberts, J. C.; Ling, F. F.; Jones, W. R., Jr.

    1981-01-01

    Continuous fiber woven E-glass composite femoral shells having the ame elastic properties as bone were fabricated. The shells were then encrusted with filled epoxy wear resistant coatings and run dry against ultrahigh molecular weight polyethylene acetabular cups in 42,000 and 250,000 cycle were tests on a total hip simulator. The tribological characteristics of these shells atriculating with the acetabular cups are comparable to a vitallium bal articulating with an ultrahigh molecular weight polyethylene cup.

  14. Management strategies for infected total hip arthroplasty. A critical appreciation of problems and techniques.

    PubMed

    Karachalios, Theofilos; Koutalos, Antonios; Komnos, George

    2014-01-01

    Infection is a devastating complication of total hip arthroplasty (THA). Risk factors have been recognised and prevention is possible. The nature of the disease is heterogeneous and for satisfactory management one has to weigh factors related to pathogen, host, local soft tissue, bone stock, surgeon experience and financial resources. Available data in the current literature is of poor quality and there is a lack of data comparing different techniques. Referral of patients to dedicated departments with the appropriate facilities may be more appropriate.

  15. Pre-surgical sensorimotor training for patients undergoing total hip replacement: a randomised controlled trial.

    PubMed

    Bitterli, R; Sieben, J M; Hartmann, M; de Bruin, E D

    2011-09-01

    The aim of this study was to investigate whether pre-operative, sensorimotor training results in improved physical function, quality of life, sensorimotor function and reduced disability in total hip replacement patients. 80 subjects awaiting total hip replacement at a Swiss hospital were recruited for this randomised controlled trial. The intervention group participated in a pre-operative home exercise sensorimotor training programme; the control group received no therapy. Primary outcome measure was physical function, secondary outcome measures were quality of life, disability and sensorimotor function. Outcomes were measured using generic and disease-specific questionnaires as well as objectively assessed balance ability. Measurements were taken one day before surgery and 10 days, 4 and 12 months after surgery. The intervention showed improved quality of life and sensorimotor function before surgery. These effects were lost following surgery. The intervention group experienced more disability at 4 months than the control group. At one year follow-up group-membership influenced quality of life scores depending on the measurement-time-point. It can be concluded that no useful effect was identified for a pre-operative sensory-motor training-programme. The psychological aspects following total hip replacement need to be considered in order to facilitate coping-strategies, reduce unrealistic expectations and increase satisfaction. PMID:21630176

  16. Comparison of Direct Anterior and Lateral Approaches in Total Hip Arthroplasty

    PubMed Central

    Yue, Chen; Kang, Pengde; Pei, Fuxing

    2015-01-01

    Abstract The direct anterior approach (DAA) to total hip arthroplasty has been promoted as a minimally invasive alternative to the lateral approach, which we sought to verify by systematically reviewing and meta-analyzing the literature comparing clinical, radiographic, and surgical outcomes. Two reviewers independently searched PubMed, OVID, and Web of Science databases for randomized controlled trials (RCTs) and cohort studies comparing the DAA and lateral approach for total hip arthroplasty. Quality of RCTs was assessed using the Jadad scoring system, quality of cohort studies, using the Minors system. Data were extracted and meta-analyzed or qualitatively synthesized for primary outcomes (function, complications, and hospitalization time) and several secondary outcomes. Data were extracted from 12 trials involving 4901 arthroplasty procedures. Meta-analysis showed that DAA was associated with significantly shorter hospitalization than the lateral approach, as well as greater functional rehabilitation and lower perceived pain during the early postoperative period. On the other hand, DAA was associated with longer surgery time. The 2 approaches were associated with similar rates of perioperative surgical complications and transfusions, as well as similar radiographic analysis results. Although DAA may provide shorter hospitalization and faster recovery during the early postoperative period, the available evidence is still insufficient to conclude whether the DAA or lateral approach is superior for total hip arthroplasty. More high-quality studies and subsequent meta-analyses are needed. PMID:26683920

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

    PubMed

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

    2016-05-18

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

  18. Adherence to guidelines regarding total hip replacement for fractured neck of femur.

    PubMed

    Fishlock, A; Scarsbrook, C; Marsh, R

    2016-07-01

    Introduction In 2011 the National Institute for Health and Care Excellence (NICE) published guidelines suggesting that clinicians offer total hip replacement (THR) to patients with displaced intracapsular hip fractures who could walk independently outside with no aids or one stick, who are not cognitively impaired and are ASA (American Society of Anesthesiologists) grade ≤2. They also stated that best practice is operating within 36 hours of presentation. This audit aimed to determine whether Scarborough Hospital was following these guidelines and compared the results with the national average. Methods Two years of data (January 2012 - December 2013) were collected retrospectively from Scarborough Hospital's hip fracture database on all patients presenting with an intracapsular hip fracture. Data were analysed to determine whether patients who had a THR fulfilled NICE criteria. Furthermore, patients with hemiarthroplasties who were eligible for THRs were identified. Finally, the time to surgery was calculated to examine whether patients receiving THRs waited longer than patients receiving hemiarthroplasties. Results In 2012, 48.6% of all eligible patients received a THR while in 2013 the figure was 55.9%. These percentages are much higher than the national average. However, 36 (53.7%) of the 67 patients who received a THR did not fulfil all the NICE criteria, mainly owing to high ASA grade. The mean time from presentation to theatre for THR was 8 hours and 37 minutes longer for THR patients than for hemiarthroplasty in 2012. This difference was reduced to 2 hours and 12 minutes in 2013. Conclusions Small general hospitals can meet and even exceed the standards regarding treatment strategies for hip factures. However, there is still room for improvement. Departmental training may be useful in achieving this aim. The anaesthetic team should be involved at the earliest opportunity, to help optimise patients preoperatively and determine whether patients listed for

  19. Botulinum toxin type A in the treatment of painful adductor muscle contracture after total hip arthroplasty.

    PubMed

    Santamato, Andrea; Ranieri, Maurizio; Panza, Francesco; Solfrizzi, Vincenzo; Frisardi, Vincenza; Lapenna, Luisa Maria; Moretti, Biagio; Fiore, Pietro

    2009-10-01

    Painful adductor muscle contracture is an important cause of failure during rehabilitation following total hip arthroplasty (THA). Adductor muscle contracture may be caused by postoperative muscle retractions, adhesive capsulitis, postoperative leg-length inequalities caused by implant failure, or preexisting hip pathologies. A 34-year-old woman experienced a persistent painful contracture into the left adductor magnus muscle after THA. She had no leg-length inequalities and, according to the Medical Research Council scale (grades 0-5), muscle strength of the quadriceps was 5/5 for the right side and 3/5 for the left. The degree of functionality according to the Harris hip score (HHS) was 16/100 in the left hip. The pain level, measured with the visual analog scale (VAS), was 7/10. The patient was unable to fully adhere to the rehabilitation program and walked with a limp during the stance phase of gait. After 7 days of treatment with injections of botulinum toxin type A into the left adductor magnus muscle (dose, 150 UM) and subsequent rehabilitation, a great reduction of painful contracture was observed (VAS score, 2/10). The procedure was well tolerated and no adverse effects were noted. After 20 days, hip articular range of motion and gait had improved (HHS score, 75/100). The clinical effects of botulinum toxin type A were present at 2-month follow-up. This treatment may be a viable alternative for the management of painful adductor muscle contracture after THA, without significant side effects. PMID:19824593

  20. Lateral femoral cutaneous nerve impairment after direct anterior approach for total hip arthroplasty.

    PubMed

    Bhargava, Tarun; Goytia, Robin N; Jones, Lynne C; Hungerford, Marc W

    2010-07-13

    The anterior supine approach for total hip arthroplasty (THA) offers the advantage of operating through a true intravascular and intranervous plane, but it places the lateral femoral cutaneous nerve at risk. The purpose of this study was to identify the incidence of and impairment relating to injury of the lateral femoral cutaneous nerve. We performed a retrospective chart review of 81 hips undergoing anterior supine THA from November 2005 through May 2007 to determine operative time, estimated blood loss, fluoroscopic time, type of anesthesia used, intraoperative complications, and postoperative systemic and wound complications. Postoperative radiographs were evaluated for leg-length discrepancy, acetabular inclination and anteversion, and femoral stem position. Patients were reassessed at 6 weeks, 3 months, 6 months, 1 year, and 2 years. At each visit, patients were questioned about numbness or paresthesias in the distribution of the lateral femoral cutaneous nerve; if present, the patient outlined the area with a marking pen. This area was photographed, and data were collected. No hip had frank numbness; 12 hips (14.8%) had paresthesias. For those 12, symptoms resolved in 4 by 6 months, in 6 by 1 year, and in 10 (83.3%) by 2 years; 2 remained unresolved. No significant difference was found between patients with and without paresthesias or between patients with resolved or unresolved paresthesias. Impaired sensation did not appear to affect functional outcome or Harris Hip Score. Incision position, dissection plane, retractor placement, tension and soft tissue handling, and surgeon experience may affect incidence of injury to the lateral femoral cutaneous nerve.

  1. [Treatment of chronic hip dislocation in adults by recentered total prosthesis. Apropos of 43 cases].

    PubMed

    Gau, M; Simonnet, J H; Rocca, A; Aubaniac, J M

    1988-01-01

    Forty-three total hip prostheses were inserted in 33 adults suffering from a chronic high dislocation of the hip. Ten patients had a bilateral arthroplasty. The authors decided to keep in this series only hips presenting with a very considerable upward displacement of the femoral head of type IV in Crowe, Maini and Ranawat's classification. All the hips were treated in the same way with pre-operative planning using template tracings to anticipate problems of length and choice of implant. The acetabular cup was placed in the old acetabulum with downward displacement of the femur. The results were studied in 39 prostheses with a mean follow-up of five-and-a-half years (two years to nine-and-a-half years). The mean age of the patients was 48 and-a-half years (28 to 76 years). A satisfactory result was obtained in 79.5 per cent of cases. The mean downward displacement of the femur was 4.8 cm. Complications included one death from pulmonary embolus, two phlebitides, two fractures of the femoral shaft and four dislocations. There were nos cases of sepsis or neurological complications. The authors advise the use of custom-made implants, consider the tactical problems relative to the opposite hip. It is concluded that the value of the method often lies in the transformation of the life of these young patients by a "functional miracle", but the operative indications need to be considered carefully, since the procedures are sometimes extensive, often difficult and always require technical skill.

  2. REVISION TOTAL HIP ARTHROPLASTY USING A MODULAR CEMENTLESS DISTAL FIXATION PROSTHESIS: THE ZMR® HIP SYSTEM. CLINICAL AND RADIOGRAPHIC ANALYSIS OF 30 CASES

    PubMed Central

    Canella, Richard Prazeres; de Alencar, Paulo Gilberto Cimbalista; Ganev, Gerson Gandhi; de Vincenzi, Luiz Fernando

    2015-01-01

    Objective: To evaluate the clinical and radiographic results from 30 cases of revision of total hip arthroplasty using a modular cementless distal fixation prosthesis: the ZMR® Hip System. Method: Between July 2005 and December 2008, 30 operations were performed, on 14 men and 14 women. Two male patients had bilateral surgery. The mean age was 59.2 years (29-81 years), with a mean follow-up of 24 months. The Paprosky classification was used for periprosthetic bone loss, and the Harris Hip Score (HHS) was used to evaluate clinical results. On radiographs, distal migration of the femoral stem was defined in accordance with Sporer. Proximal bone remodeling was classified using the Callaghan criteria. Results: The mean preoperative HHS was 39, and there was a significant increase to 93 points in the final evaluation, which indicated excellent clinical results. No femoral stem migration greater than 5 mm (Sporer) was observed on radiographs, thus suggesting that all the femoral prostheses presented osseointegration and remained stable from the time of the surgery until the final evaluation. The proximal femoral remodeling was either type B or type C in 29 hips, according to Callaghan. Seven patients had complications, but without interfering with osseointegration of the femoral components. Conclusion: Our results from revision of total hip arthroplasty using the ZMR® Hip System were extremely encouraging, and all the components became osseointegrated and remained fixed at the time of the final evaluation. PMID:27022553

  3. Three-dimensional modeling of in vitro hip kinematics under micro-separation regime for ceramic on ceramic total hip prosthesis: an analysis of vibration and noise.

    PubMed

    Sariali, Elhadi; Stewart, Todd; Jin, Zongmin; Fisher, John

    2010-01-19

    Micro-separation corresponds to a medial-lateral hip laxity after total hip replacement (THR). This laxity has been shown to generate higher wear rates and a specific pattern of stripe wear caused by edge loading of the head on the rim of the cup. Recently some authors have implicated edge loading as a source of noise generation and in particular squeaking. The goal of this study was to model hip kinematics under the micro-separation regime in a computational simulation of total hip prosthesis including joint laxity and to analyze the vibration frequencies and the potential for noise generation. A three-dimensional computer model of the Leeds II hip simulator was developed using ADAMS((R)) software, simulating a controlled micro-separation during the swing phase of the walking cycle and replicating the experimental conditions previously reported. There was an excellent correlation between the theoretical values and the experimental values of the medial-lateral separation during the walking cycle. Vibratory frequencies were in the audible zone but were lower in magnitude than those reported clinically in relation to squeaking. Micro-separation and rim loading may explain the generation of some sounds from noisy hips after THR. However, the computational model, and the experimental model of micro-separation were unable to replicate the higher frequency squeaking reported clinically. In contrast, other experimental studies involving normal kinematics in combination with third-body particles have replicated clinically relevant frequencies and noises.

  4. Cost of Radiotherapy Versus NSAID Administration for Prevention of Heterotopic Ossification After Total Hip Arthroplasty

    SciTech Connect

    Strauss, Jonathan B. Chen, Sea S.; Shah, Anand P.; Coon, Alan B.; Dickler, Adam

    2008-08-01

    Purpose: Heterotopic ossification (HO), or abnormal bone formation, is a common sequela of total hip arthroplasty. This abnormal bone can impair joint function and must be surgically removed to restore mobility. HO can be prevented by postoperative nonsteroidal anti-inflammatory drug (NSAID) use or radiotherapy (RT). NSAIDs are associated with multiple toxicities, including gastrointestinal bleeding. Although RT has been shown to be more efficacious than NSAIDs at preventing HO, its cost-effectiveness has been questioned. Methods and Materials: We performed an analysis of the cost of postoperative RT to the hip compared with NSAID administration, taking into account the costs of surgery for HO formation, treatment-induced morbidity, and productivity loss from missed work. The costs of RT, surgical revision, and treatment of gastrointestinal bleeding were estimated using the 2007 Medicare Fee Schedule and inpatient diagnosis-related group codes. The cost of lost wages was estimated using the 2006 median salary data from the U.S. Census Bureau. Results: The cost of administering RT was estimated at $899 vs. $20 for NSAID use. After accounting for the additional costs associated with revision total hip arthroplasty and gastrointestinal bleeding, the corresponding estimated costs were $1,208 vs. $930. Conclusion: If the costs associated with treatment failure and treatment-induced morbidity are considered, the cost of NSAIDs approaches that of RT. Other NSAID morbidities and quality-of-life differences that are difficult to quantify add to the cost of NSAIDs. These considerations have led us to recommend RT as the preferred modality for use in prophylaxis against HO after total hip arthroplasty, even when the cost is considered.

  5. Total hip arthroplasty using a posterior minimally invasive approach – results after six years☆

    PubMed Central

    Vicente, José Ricardo Negreiros; Miyahara, Helder Souza; Luzo, Carlos Malheiros; Gurgel, Henrique Melo; Croci, Alberto Tesconi

    2014-01-01

    Objective To evaluate the medium-term clinical–functional results (minimum follow-up of six years) from total uncemented hip arthroplasty performed by means of a posterior minimally invasive access, in comparison with the traditional right lateral access. Methods In a comparative prospective study, 224 adult patients underwent elective total hip arthroplasty due to a diagnosis of primary or secondary osteoarthrosis. A group of 103 patients with posterior minimally invasive access was compared with a group of 121 patients with the traditional right lateral access. The mean length of follow-up among the patients of this sample was 7.2 years. We evaluated the clinical–functional and radiographic results and occurrences of loosening, along with any complications that occurred, with a minimum follow-up of six years. Results The clinical–functional analyses before the surgical procedure and six years afterwards were similar in the two groups (p = 0.88 and p = 0.55). One patient in the minimally invasive group underwent revision of the acetabular component and two patients in the control group underwent the same procedure (p = 0.46). The Trendelenburg clinical test, which showed weakness of the hip abductor musculature, was present in five patients operated using the traditional lateral route and absent in all those who underwent the minimally invasive procedure (p = 0.06). There was no difference regarding the radiographic parameters obtained, either in acetabular or in femoral positioning (p = 0.32 and p = 0.58). Conclusions The medium-term clinical and radiographic results and the complication rates were similar between the patients who underwent total hip arthroplasty by means of the posterior minimally invasive access and those with the traditional lateral access. PMID:26229883

  6. New Joints, Same Old Weight: Weight Changes After Total Hip and Knee Arthroplasty.

    PubMed

    Hurwit, Daniel J; Trehan, Samir K; Cross, Michael B

    2016-07-01

    Obesity is a well-known risk factor for postoperative complications following total joint arthroplasty. However, because the operation is often successful, orthopedic surgeons continue to operate on obese individuals, and many surgeons do so under the assumption that patients will lose weight after they are able to walk and exercise without pain. In this article, we review a recent study by Ast et al., who performed a retrospective review, using a single-center institutional registry, to determine (1) whether patients do actually lose weight after total hip and/or total knee arthroplasty, (2) whether there are predictors of postoperative weight change, and (3) whether postoperative weight changes affect patient-reported clinical outcomes. The principle conclusion was that most patients maintained their body mass index (BMI) after total hip and total knee arthroplasty (73 and 69%, respectively). However, patients undergoing total knee arthroplasty, patients who had a higher preoperative BMI, and female patients were more likely to lose weight postoperatively. When examined in the context of the current literature, this study provides valuable information for the preoperative counseling of total joint arthroplasty candidates, especially in the setting of obesity. PMID:27385952

  7. Botulinum toxin type A injections for the management of muscle tightness following total hip arthroplasty: a case series

    PubMed Central

    Bhave, Anil; Zywiel, Michael G; Ulrich, Slif D; McGrath, Mike S; Seyler, Thorsten M; Marker, David R; Delanois, Ronald E; Mont, Michael A

    2009-01-01

    Background Development of hip adductor, tensor fascia lata, and rectus femoris muscle contractures following total hip arthroplasties are quite common, with some patients failing to improve despite treatment with a variety of non-operative modalities. The purpose of the present study was to describe the use of and patient outcomes of botulinum toxin injections as an adjunctive treatment for muscle tightness following total hip arthroplasty. Methods Ten patients (14 hips) who had hip adductor, abductor, and/or flexor muscle contractures following total arthroplasty and had been refractory to physical therapeutic efforts were treated with injection of botulinum toxin A. Eight limbs received injections into the adductor muscle, 8 limbs received injections into the tensor fascia lata muscle, and 2 limbs received injection into the rectus femoris muscle, followed by intensive physical therapy for 6 weeks. Results At a mean final follow-up of 20 months, all 14 hips had increased range in the affected arc of motion, with a mean improvement of 23 degrees (range, 10 to 45 degrees). Additionally all hips had an improvement in hip scores, with a significant increase in mean score from 74 points (range, 57 to 91 points) prior to injection to a mean of 96 points (range, 93 to 98) at final follow-up. There were no serious treatment-related adverse events. Conclusion Botulinum toxin A injections combined with intensive physical therapy may be considered as a potential treatment modality, especially in difficult cases of muscle tightness that are refractory to standard therapy. PMID:19709429

  8. Taper Failure After Large-Diameter Metal-on-Metal Total Hip Arthroplasty.

    PubMed

    Goldstein, Zachary H; Estrera, Kenneth; Levine, Brett R

    2016-09-01

    The use of metal-on-metal bearing surfaces for total hip arthroplasty increased dramatically in the past decade for a variety of reasons, including the advantage of using larger-diameter femoral heads to reduce instability. However, recent research suggesting negative outcomes and high failure rates associated with some of these implants has decreased their use. Further, the use of larger-diameter femoral heads on relatively small femoral neck tapers has caused concern about localized corrosion at this junction, particularly with varus femoral alignment and longer femoral neck and head lengths. Although the advent of modular components offers the surgeon greater intraoperative flexibility, this modularity may prove to be a weak link when coupled with large-diameter femoral heads. This report describes a patient with a history of bilateral metal-on-metal total hip arthroplasty complicated by failure of the right hip as a result of fretting and mechanically assisted crevice corrosion. Notching of the femoral neck and head dissociation occurred 10 years after the primary procedure. The authors describe the patient's presenting symptoms, the possible etiology of the catastrophic failure, and the method of treatment and provide a brief review of metal-on-metal implants that may shed some light on the complications in this case. [Orthopedics.2016; 39(5):e984-e987.]. PMID:27248338

  9. Initial Stability of Subtrochanteric Oblique Osteotomy in Uncemented Total Hip Arthroplasty: A Preliminary Finite Element Study

    PubMed Central

    Li, Liangtao; Yu, Mingyang; Ma, Renshi; Zhu, Dong; Gu, Guishan

    2015-01-01

    Background Subtrochanteric oblique osteotomy (SOO) has been widely used to reconstruct highly dislocated hips in uncemented total hip arthroplasty. The occurrence of complications can be attributed to the instability of the osteotomy region. The aim of this study was to evaluate the initial stability of SOO in uncemented total hip arthroplasty. Material/Methods A 3-dimensional finite element femur-stem model was created, and a virtual SOO was performed at 4 oblique angles: 30°, 45°, 60°, and 90°. The von Mises stress distribution in the femur-stem complex and the displacement under different oblique angles were evaluated in the SOO models, in comparison with that of the intact model. Results The study demonstrated that the distal fragment of the femur bore more stresses than the proximal fragment, and the maximum stress was concentrated in the femoral neck and the cortical bone, which contacted with the distal end of the stem. SOO increased the stress of both the femur and the stem, and fractures may occur in the stress concentration sites. Additionally, comparing the displacement at different oblique angles, the lateral region was larger than that of the medial region on the subtrochanteric osteotomy plane. The minimum micromotion on the osteotomy plane was obtained when the oblique angle was 45°. Conclusions The fit and fill of the distal fragment of the femur and the stem is essential for the stability of the subtrochanteric osteotomy region. The optimal oblique angle for SOO appears to be 45°. PMID:26153071

  10. Correlation between patient age at total hip replacement surgery and lifeexpectancy

    PubMed Central

    Schwartsmann1, Carlos Roberto; Spinelli, Leandro de Freitas; Boschin, Leonardo Carbonera; Yépez, Anthony Kerbes; Crestani, Marcus Vinicius; Silva, Marcelo Faria

    2015-01-01

    ABSTRACT Total hip arthroplasty (THA) is one of the most cost-effective hip surgeries among orthopedic procedures. We conducted an extensive literature review with 5,394 papers regarding survival rates after THA. We searched PubMed, Embase and the Cochrane library from January 1st, 1970 to July 31th, 2014 looking for all citations about total hip arthroplasty with a long term follow-up (longer than 10 years). The criteria were rigorous: no loss of follow-up, and follow-up more than 10 years. The authors should have known the complete history of patients (whether the patient is alive or dead). Considering the criteria, we found only 15 papers. To evaluate the relationship between follow-up and survival, a linear regression analysis was applied. Considering the papers analysed, and applying the search criteria, we obtained a mean age for the patients above 57.5 years. The chance of survival at 15 years was 57.6%, at 20 years it was 34.6% and at 25 years it is only 11.6%. The relationship between follow-up and survival was significantly linear (p <0.001). Only 11.6% of patients undergoing THA will be still alive 25 years after the surgical procedure. Level of Evidence I, Prognostic Study. PMID:27057147

  11. Influence of Pelvic Tilt on Polyethylene Wear after Total Hip Arthroplasty.

    PubMed

    Tezuka, Taro; Inaba, Yutaka; Kobayashi, Naomi; Ike, Hiroyuki; Kubota, So; Kawamura, Masaki; Saito, Tomoyuki

    2015-01-01

    We aimed to evaluate the effects of pelvic tilt on polyethylene wear after total hip arthroplasty (THA). A total of 105 joints treated with primary THA were included; conventional polyethylene (CPE) liners were used in 43 hips and highly cross-linked polyethylene (HXLPE) liners were used in the remaining 62 hips. The pelvis was tilted 6° posteriorly in the standing position as compared to the supine position, which resulted in significant increases of 1.7° and 2.8° in cup inclination in the CPE and HXLPE groups, respectively. Moreover, the change in pelvic tilt resulted in significant increases of 3.6° and 4.9° in cup anteversion in the CPE and HXLPE groups, respectively. For the CPE group, multiple regression analysis showed a significant association between the angle of pelvic tilt (PTA) and cup inclination and the polyethylene wear ratio. The adjusted R (2) of the regression model was larger for measures obtained in the standing position as compared to the supine position. For the HXLPE group, there was no significant relationship between radiographic parameters and polyethylene wear. Close observation of polyethylene wear is recommended for patients with severe posterior pelvic tilt who have undergone THA with conventional polyethylene.

  12. Serum Metal Ions with a Titanium Modular Neck Total Hip Replacement System.

    PubMed

    Gofton, Wade; Beaule, Paul E

    2015-10-01

    The goal of this study is to evaluate serum levels of chromium (Cr), cobalt (Co), and titanium (Ti) within the first two years following total hip arthroplasty using a Ti modular neck system. Twenty-five patients were randomized to a metal-on-metal (MoM) bearing with an all CoCr shell, and the remaining 25 received a metal-on-polyethylene (MoP) with a Ti shell. Serum levels demonstrated increases for Cr, Co, and Ti at 1 year (P < .001). MoM had similar Ti levels to MoP hips at 1 year (P=0.11) but lower at 2 years (P=0.03). Results suggest that the passive corrosion (i.e., chemical, pitting, and crevice corrosion) of exposed non-articular metal surfaces may be a greater source of ions than the neck-stem or head-neck interfaces.

  13. Trochanteric bursitis after total hip arthroplasty: incidence and evaluation of response to treatment.

    PubMed

    Farmer, Kevin W; Jones, Lynne C; Brownson, Kirstyn E; Khanuja, Harpal S; Hungerford, Marc W

    2010-02-01

    We examined the efficacy of corticosteroid injection as treatment for postarthroplasty trochanteric bursitis and the risk factors for failure of nonoperative treatment. There were 32 (4.6%) cases of postsurgical trochanteric bursitis in 689 primary total hip arthroplasties. Of the 25 hips with follow-up, 11 (45%) required multiple injections. Symptoms resolved in 20 (80%) but persisted in 5. We found no statistically significant differences between patients who did and did not develop trochanteric bursitis, or between those who did and did not respond to treatment. There was a trend toward younger age and greater limb-length discrepancy in nonresponders. In conclusion, (1) corticosteroid injection(s) for postoperative trochanteric bursitis is effective; and (2) nonoperative management may be more likely to fail in young patients and those with leg-length discrepancy.

  14. The fate of osteophytes in the superolateral region of the acetabulum after total hip arthroplasty.

    PubMed

    Mao, Yuanqing; Yu, Degang; Xu, Chen; Liu, Fengxiang; Li, Huiwu; Zhu, Zhenan

    2014-12-01

    Acetabular osteophytes are common during total hip arthroplasty (THA). However, the fate and role of superolateral osteophytes of the acetabulum after THA remain unclear. The present study reviewed a series of radiographic changes in the osteophytes on the superolateral region of the acetabulum in 35 hips. The mean follow-up period was 42.2months. The results revealed that the osteophytes that were not in contact with the superolateral edge of acetabular cup were gradually absorbed after THA. In contrast, the osteophytes that were in contact with the superolateral edge of the acetabular cup underwent remodeling, formed regular trabecula, were stress bearing, and eventually integrated with the acetabular cup and the original acetabular bone, and should play a role in stabilizing the acetabular cup.

  15. Current Concepts of Using Large Femoral Heads in Total Hip Arthroplasty

    PubMed Central

    Choi, Won Kee; Kim, Jae Jung

    2016-01-01

    Instability and dislocation after total hip arthroplasty are the most common causes of revisions and major complications for failure of inserted prostheses, leading to a reduction in quality of life. Because the use of artificial femoral head sizes smaller than patient's own size is the important cause for dislocation, the use of large femoral head have increased. Femoral head sizes greater than 32 mm offer multiple advantages in physical function and activity levels of patients by improving hip stability, decreasing dislocation rate and increasing range of motion. However, various concerns are encountered including wear debris generation at the trunnion-bore interface and increases in frictional torque and stress over the component-bone interface when using larger head sizes. So, the use of femoral head sizes less than 40 mm is recommended. PMID:27777915

  16. One stage bilateral total hip arthroplasty, is it safe? A meta-analysis.

    PubMed

    Haverkamp, Daniël; van den Bekerom, Michel P J; Harmse, Ivo; Schafroth, Matthias U

    2010-01-01

    Controversy has prevailed for many years relating to the safety of one-stage and two-stage total hip arthroplasty (THA) for bilateral disease. We performed a meta-analysis of 1460 studies of which 5 prospective studies met our inclusion criteria. A total of 579 patients had two-stage procedures and 334 had one-stage surgery. The studies showed a low heterogeneity (I2 =0%) allowing pooling of data. No differences were found in the incidence of major complications (odds ratio 0.72 95%CI: 0.45-1.15). One-stage bilateral THA may therefore be a safe procedure.

  17. A novel blood-saving plan for less-invasive primary total hip replacement.

    PubMed

    Hourlier, Hervé; Fennema, Peter; Liné, Bernhard

    2008-12-01

    We conducted a quality improvement program to examine the effect of a blood-saving plan during primary total hip replacement (THR) performed using a nonvascular less invasive approach (LI-THR) and compared the results with historical control subjects. Erythropoietin and tranexamic acid (TA) were administered for selected patients. Analysis of 221 (study group) and 186 (historic group) LI-THRs showed reductions in total blood loss by 20% in a group of 133 patients compared to a control group of 82 patients who did not receive TA. This novel blood plan for LI-THR changed practice, improved quality of care, and allowed all patients to remain blood transfusion free.

  18. The type of surgical approach influences the risk of revision in total hip arthroplasty

    PubMed Central

    2012-01-01

    Background and purpose The most common surgical approaches in total hip arthroplasty in Sweden are the posterior and the anterolateral transgluteal approach. Currently, however, there is insufficient evidence to prefer one over the other regarding risk of subsequent surgery. Patients and methods We searched the Swedish Hip Arthroplasty Register between the years 1992 and 2009 to compare the posterior and anterolateral transgluteal approach regarding risk of revision in the 3 most common all-cemented hip prosthesis designs in Sweden. 90,662 total hip replacements met the inclusion criteria. We used Cox regression analysis for estimation of prosthesis survival and relative risk of revision due to dislocation, infection, or aseptic loosening. Results Our results show that for the Lubinus SPII prosthesis and the Spectron EF Primary prosthesis, the anterolateral transgluteal approach gave an increased risk of revision due to aseptic loosening (relative risk (RR) = 1.3, 95% CI: 1.0–1.6 and RR = 1.6, CI: 1.0–2.5) but a reduced risk of revision due to dislocation (RR = 0.7, CI: 0.5–0.8 and RR = 0.3, CI: 0.1–0.4). For the Exeter Polished prosthesis, the surgical approach did not affect the outcome for dislocation or aseptic loosening. The surgical approach had no influence on the risk of revision due to infection in any of these designs. Interpretation This observational study shows that the surgical approach affected the risk of revision due to aseptic loosening and dislocation for 2 of the most commonly used cemented implants in Sweden. Further studies are needed to determine whether these results are generalizable to other implants and to uncemented fixation. PMID:23116440

  19. Loosening of the femoral component of total hip replacement after plugging the femoral canal.

    PubMed

    Harris, W H; McCarthy, J C; O'Neill, D A

    1982-01-01

    A roentgen follow-up study was done of 171 total hip replacements at an average of 3.3 years (range 2 to 5 years) after insertion to assess the loosening rate in older adult patients (average age 60 years) in whom the medullary canal was plugged. The cement (Simplex P) was introduced using a cement gun. The femoral components used were CAD and HD-2 in design, made of chrome cobalt alloy. Evaluation was made according to three categories of loosening: definite (requiring evidence of migration of the component or the cement), probable (requiring a continuous radiolucent zone around the cement mantle in one or more radiographic views), or possible (requiring a radiolucent zone that occupied 50% or more of the cement-bone interface in one or more views but was not continuous). One hip was revised for a loose femoral component. Another patient has asymptomatic subsidence of the femoral component. Thus the total incidence of definitely loose femoral components was 1.1%. No hip was classified as probably loose. Seven hips (4%) were rated as possibly loose. Compared to four other reported series of similar groups of patients followed for like duration, this incidence of definitely loose components is statistically significantly less than in nonplugged canals. The other differences among the series compared, such as stem design, type of cement introduction, modulus of elasticity of the metal used, presence or absence of a collar, and dates during which the surgery was done, are also discussed. Plugging the femoral canal; introducing the cement with a cement gun; using a femoral stem that largely fills the medullary canal, has a collar, and has a rounded rectangular cross section with no medial stress risers made of a superalloy with a modulus of elasticity of about 200 GPa--all these factors were associated with a low (1.1%) incidence of femoral component loosening at 3 years. PMID:7166501

  20. Identifying the procedural gap and improved methods for maintaining accuracy during total hip arthroplasty.

    PubMed

    Gross, Allan; Muir, Jeffrey M

    2016-09-01

    Osteoarthritis is a ubiquitous condition, affecting 26 million Americans each year, with up to 17% of adults over age 75 suffering from one variation of arthritis. The hip is one of the most commonly affected joints and while there are conservative options for treatment, as symptoms progress, many patients eventually turn to surgery to manage their pain and dysfunction. Early surgical options such as osteotomy or arthroscopy are reserved for younger, more active patients with less severe disease and symptoms. Total hip arthroplasty offers a viable solution for patients with severe degenerative changes; however, post-surgical discrepancies in leg length, offset and component malposition are common and cause significant complications. Such discrepancies are associated with consequences such as low back pain, neurological deficits, instability and overall patient dissatisfaction. Current methods for managing leg length and offset during hip arthroplasty are either inaccurate and susceptible to error or are cumbersome, expensive and lengthen surgical time. There is currently no viable option that provides accurate, real-time data to surgeons regarding leg length, offset and cup position in a cost-effective manner. As such, we hypothesize that a procedural gap exists in hip arthroplasty, a gap into which fall a large majority of arthroplasty patients who are at increased risk of complications following surgery. These complications and associated treatments place significant stress on the healthcare system. The costs associated with addressing leg length and offset discrepancies can be minor, requiring only heel lifts and short-term rehabilitation, but can also be substantial, with revision hip arthroplasty costs of up to $54,000 per procedure. The need for a cost-effective, simple to use and unobtrusive technology to address this procedural gap in hip arthroplasty and improve patient outcomes is of increasing importance. Given the aging of the population, the projected

  1. Excellent Survivorship With the Use of Proximally Coated Tapered Cementless Stems for Total Hip Arthroplasty in Octogenarians

    PubMed Central

    Stroh, D. Alex; Johnson, Aaron J.; Mont, Michael A.

    2011-01-01

    The use of total hip arthroplasty (THA) continues to grow partially because of the increasing life expectancy of the American population. Whether to use cemented or cementless femoral fixation options in older patients is often debated. The purpose of the present study was to compare the clinical and radiographic outcomes after cementless THA in patients ≥80 years to younger patients. Clinical and radiographic data were gathered on 33 patients (35 hips) all 80 years or older who had undergone proximally coated cementless total hip arthroplasties. Outcomes were compared with a matching group for age, body mass index, and diagnosis, who had undergone the same procedure by the same surgeon at a similar time. Harris hip scores were evaluated pre- and postoperatively, and radiographs were reviewed for evaluation of fixation and stability. At a mean follow-up of 4 years, 97% of the hips (34 of 35) remained unrevised and the mean Harris hip score had improved by 39 points to 83 points (range, 26-100 points). On radiographic evaluation, 91% were found to have full bony ingrowth, with 1 hip having osteolysis of the proximal femur. Mortality was 23% at 86 months. Except for mortality, the outcomes and complication rates were similar to the younger group except that the matching group had higher final postoperative Harris hip scores. Proximally coated tapered cementless THA is a safe and efficacious method for providing good clinical outcomes with low revision rates in patients 80 years of age or older. PMID:23569678

  2. In Vitro Bioactivity Study of RGD-Coated Titanium Alloy Prothesis for Revision Total Hip Arthroplasty

    PubMed Central

    Man, Zhentao; Sha, Dan; Sun, Shui; Li, Tao; Li, Bin; Yang, Guang; Wu, Changshun; Jiang, Peng

    2016-01-01

    Total hip arthroplasty (THA) is a common procedure for the treatment of end-stage hip joint disease, and the demand for revision THA will double by 2026. Ti6Al4V (Titanium, 6% Aluminum, and 4% Vanadium) is a kind of alloy commonly used to make hip prothesis. To promote the osseointegration between the prothesis and host bone is very important for the revision THA. The peptide Arg-Gly-Asp (RGD) could increase cell attachment and has been used in the vascular tissue engineering. In this study, we combined the RGD with Ti6Al4V alloy using the covalent cross-linking method to fabricate the functional Ti6Al4V alloy (FTA). The distribution of RGD oligopeptide on the FTA was even and homogeneous. The FTA scaffolds could promote mouse osteoblasts adhesion and spreading. Furthermore, the result of RT-qPCR indicated that the FTA scaffolds were more beneficial to osteogenesis, which may be due to the improvement of osteoblast adhesion by the RGD oligopeptide coated on FTA. Overall, the FTA scaffolds developed herein pave the road for designing and building more efficient prothesis for osseointegration between the host bone and prothesis in revision THA. PMID:27493968

  3. Total hip arthroplasty with ceramic-on-ceramic bearing failure from third-body wear.

    PubMed

    Bonnaig, Nicolas S; Freiberg, Richard A; Freiberg, Andrew A

    2011-01-01

    This article describes a new mechanism of failure of a ceramic-on-ceramic total hip arthroplasty (THA) due to fretting corrosion and failure of the Morse taper. A 46-year-old man with hip osteonecrosis underwent THA in 2006. A ceramic-on-ceramic, un-cemented THA with a titanium femoral component and metal-on-ceramic Morse taper was implanted. Two years postoperatively, he presented with swelling in his groin and a painless medial thigh mass. The thigh mass was diagnosed as an abscess. Incision and drainage was performed and resulted in a sinus tract that continuously drained copious amounts of seropurulent fluid. Two months later, the patient underwent irrigation, debridement, and explantation of his hip. Frozen sections showed no signs of infection. There was dramatic visible wear of the Morse taper and pieces of metal embedded in the ceramic. Permanent sections showed chronic inflammation and foreign body reaction. He subsequently underwent an uneventful re-implantation with a metal-on-highly-cross-linked-polyethylene THA. In this case, failure of the morse taper led to metal debris, which reacted with the ceramic and caused dramatic third-body wear. The thigh mass, which appeared to be an infection, proved to be a massive foreign body granuloma. Malfunction of the morse taper as reported in this case represents a possible failure mechanism of a ceramic-on-ceramic THA.

  4. Contact mechanics of modular metal-on-polyethylene total hip replacement under adverse edge loading conditions

    PubMed Central

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

    2014-01-01

    Edge loading can negatively impact the biomechanics and long-term performance of hip replacements. Although edge loading has been widely investigated for hard-on-hard articulations, limited work has been conducted for hard-on-soft combinations. The aim of the present study was to investigate edge loading and its effect on the contact mechanics of a modular metal-on-polyethylene (MoP) total hip replacement (THR). A three-dimensional finite element model was developed based on a modular MoP bearing. Different cup inclination angles and head lateral microseparation were modelled and their effect on the contact mechanics of the modular MoP hip replacement were examined. The results showed that lateral microseparation caused loading of the head on the rim of the cup, which produced substantial increases in the maximum von Mises stress in the polyethylene liner and the maximum contact pressure on both the articulating surface and backside surface of the liner. Plastic deformation of the liner was observed under both standard conditions and microseparation conditions, however, the maximum equivalent plastic strain in the liner under microseparation conditions of 2000 µm was predicted to be approximately six times that under standard conditions. The study has indicated that correct positioning the components to avoid edge loading is likely to be important clinically even for hard-on-soft bearings for THR. PMID:25218504

  5. In Vitro Bioactivity Study of RGD-Coated Titanium Alloy Prothesis for Revision Total Hip Arthroplasty.

    PubMed

    Man, Zhentao; Sha, Dan; Sun, Shui; Li, Tao; Li, Bin; Yang, Guang; Zhang, Laibo; Wu, Changshun; Jiang, Peng; Han, Xiaojuan; Li, Wei

    2016-01-01

    Total hip arthroplasty (THA) is a common procedure for the treatment of end-stage hip joint disease, and the demand for revision THA will double by 2026. Ti6Al4V (Titanium, 6% Aluminum, and 4% Vanadium) is a kind of alloy commonly used to make hip prothesis. To promote the osseointegration between the prothesis and host bone is very important for the revision THA. The peptide Arg-Gly-Asp (RGD) could increase cell attachment and has been used in the vascular tissue engineering. In this study, we combined the RGD with Ti6Al4V alloy using the covalent cross-linking method to fabricate the functional Ti6Al4V alloy (FTA). The distribution of RGD oligopeptide on the FTA was even and homogeneous. The FTA scaffolds could promote mouse osteoblasts adhesion and spreading. Furthermore, the result of RT-qPCR indicated that the FTA scaffolds were more beneficial to osteogenesis, which may be due to the improvement of osteoblast adhesion by the RGD oligopeptide coated on FTA. Overall, the FTA scaffolds developed herein pave the road for designing and building more efficient prothesis for osseointegration between the host bone and prothesis in revision THA. PMID:27493968

  6. Contact mechanics of modular metal-on-polyethylene total hip replacement under adverse edge loading conditions.

    PubMed

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

    2014-10-17

    Edge loading can negatively impact the biomechanics and long-term performance of hip replacements. Although edge loading has been widely investigated for hard-on-hard articulations, limited work has been conducted for hard-on-soft combinations. The aim of the present study was to investigate edge loading and its effect on the contact mechanics of a modular metal-on-polyethylene (MoP) total hip replacement (THR). A three-dimensional finite element model was developed based on a modular MoP bearing. Different cup inclination angles and head lateral microseparation were modelled and their effect on the contact mechanics of the modular MoP hip replacement were examined. The results showed that lateral microseparation caused loading of the head on the rim of the cup, which produced substantial increases in the maximum von Mises stress in the polyethylene liner and the maximum contact pressure on both the articulating surface and backside surface of the liner. Plastic deformation of the liner was observed under both standard conditions and microseparation conditions, however, the maximum equivalent plastic strain in the liner under microseparation conditions of 2000 µm was predicted to be approximately six times that under standard conditions. The study has indicated that correct positioning the components to avoid edge loading is likely to be important clinically even for hard-on-soft bearings for THR.

  7. Long-term Outcome of Polished Stems in Total Hip Arthroplasty

    PubMed Central

    Park, Jin-Young; Han, Hong-Joon; Baik, Seok-Jong

    2015-01-01

    Purpose The purpose of this study was to evaluate the clinical outcomes and radiologic findings of primary total hip arthroplasty (THA) using cemented polished femoral stems. Materials and Methods We retrospectively reviewed 91 hips (91 patients) that had undergone primary THA with cemented polished femoral stems who were followed for at least 10 years. The mean age at surgery was 57 years (47-75 years). Mean follow up period was 12.8 years (10.1-14.0 years). Harris Hip Score (HHS) was used for clinical evaluation. Radiologic evaluation was focused on cementing technique including subsidence within the cement mantle, radiolucent lines at the cement-bone or cement-stem interface, cortical hypertrophy, and calcar resorption. Results The average HHS was 55.2 points before the surgery that improved to an average of 93.2 points at the final follow-up. According to Barrack classification, there were 50, 32, and 9 cases in A, B, and C grades, respectively. Subsidence of femoral stem was less than 2 mm except in one patient. There were no progressing radiolucent line or loosening of the femoral stem. Conclusion In this study, THA using cemented polished femoral stems was found to have favorable outcomes in long term follow-up. PMID:27536608

  8. Treatment of Arthritis Associated With Legg-Calve-Perthes Disease With Modular Total Hip Arthroplasty.

    PubMed

    Seufert, Christopher R; McGrory, Brian J

    2015-10-01

    Legg-Calve-Perthes (LCP) disease can result in morphological deformities and associated adult hip arthritis. Thirty-five consecutive total hip arthroplasties (THA) were performed in 28 patients with a history of LCP using a non-cemented modular femoral component. There was one revision for late hematogenous infection and no evidence of prosthesis failure. Harris hip scores, on average, improved from 49.8 (26-73) to 93.9 (82-100) (P<0.05) after a minimum of 2 years follow-up (average, 8.2 years, range 2-14 years). Clinically, patients demonstrated diminished or no limping (94%, 33/35) and improved leg length equality post-operatively (100%, 35/35). This style of stem accommodated metaphyseal/diaphyseal size mismatch in 80% (28/35), allowed for abnormal anteversion in 71% (25/35), and resulted in radiographic improvements in trochanteric height (P<0.05), body weight lever arm (P<0.05), and leg length (P<0.05). PMID:25979188

  9. Accuracy and repeatability of cementless total hip replacement surgery in patients with deformed anatomies.

    PubMed

    Lattanzi, Riccardo; Grazi, Erika; Testi, Debora; Viceconti, Marco; Cappello, Angelo; Toni, Aldo

    2003-03-01

    The present study is aimed to assess the repeatability of orthopaedic surgeons in planning total hip replacement surgery, and the Planned-vs.-Achieved accuracy obtainable with a conventional unassisted surgical procedure. A CT-based surgical planning system called Hip-Op was used for pre-operative planning the pose of the cementless components. The study group included only patients affected by severe deformities of the hip joint. In the repeatability study three surgeons were asked to repetitively plan the same three cases in a blind way. There was agreement among surgeons and also consistency for each surgeon in planning the implant position, while the most expert surgeon was more repeatable in planning the implant orientation. For all patients of the study group, the Planned-vs.-Achieved accuracy was computed as the difference between the spatial position of both prosthetic components derived from the post-operative CT scans and that achieved by the surgeon in the pre-operative planning. The average differences for the stem were lower than 5 mm for the position, and lower than 5 degrees for the orientation. For the socket the average differences increased to 8 mm and 10 degrees. The study shows the need for a more informative planning environment and for intra-operative supports, especially when deformed anatomies are involved.

  10. The effect of stem fit on bone hypertrophy and pain relief in cementless total hip arthroplasty.

    PubMed

    Whiteside, L A

    1989-10-01

    This study was designed to clinically evaluate the effects of a tight distal fit and collar seating in hips with a cylindrical distal stem, collar, and proximal porous coating. A clinical assessment of pain and a roentgenographic assessment of patterns of proximal femoral hypertrophy were made in 105 patients. Intraoperative evaluations of the distal stem fit were performed so that a tight distal fit was ensured in 67 patients. Thirty-eight patients who did not have intraoperative sizing were determined roentgenographically to have a loose distal fit. Pain was significantly more likely to occur in those patients with a loose distal fit (20 of 38) than in those with a tight distal fit (two of 67). Collar seating was associated with hypertrophy under the seated portion of the collar in all cases, and failure to seat the collar was associated with recession and rounding of the upper femoral cortical edge. Distal hypertrophy occurred in 24 of the 67 hips with a tight distal fit, and a tight distal fit did not prevent proximal hypertrophy. It was concluded that a tight distal fit is associated with more complete pain relief in cementless total hip arthroplasty and that a tight distal fit of a cylindrical stem does not prevent proximal load bearing. PMID:2791383

  11. Early follow-up after primary total knee and total hip arthroplasty with rapid recovery : Focus groups.

    PubMed

    van Egmond, Jeroen C; Verburg, Hennie; Vehmeijer, Stephan B W; Mathijssen, Nina M C

    2015-09-01

    Rapid recovery protocols reduce the length of hospital stay after Total Knee Arthroplasty (TKA) and Total Hip Arthroplasty (THA). However, little is known about the early postoperative phase. The purpose of this study was to examine which problems patients encountered during the first six weeks after primary TKA or THA surgery with rapid recovery. We invited twenty patients for a focus group meeting which discussed various subjects regarding the first six weeks after hospital discharge. The focus group meetings were analysed qualitatively. Patients were mostly satisfied by the short length of hospital stay. Patients who lived alone needs more care and would like to stay longer in the hospital. After THA surgery all patients complained of inability to sleep. More patients experienced pain after TKA surgery compared to THA surgery. All patients had various experiences regarding physical therapy therefore an evidence based rehabilitation protocol might be needed.

  12. Long-term radiographic follow-up of total hip replacements.

    PubMed

    Collis, D K

    1982-01-01

    This report relates the long-term clinical result with the serial radiologic findings of 350 consecutive total hip replacements done by the author. Thirteen femoral components and one acetabular component have been revised, and 12 of the 14 components had shown radiologic changes in the surrounding cement prior to the need for revision. Available roentgenograms at 6 weeks, 1 year, 5 years, and 8 to 10 years after surgery made radiologic assessment possible in 129 hips. Heterotopic bone formation, calcar resorption and distal cortical hypertrophy all appeared to be primarily radiologic findings with little effect on clinical results. A variety of changes seen in the cement or bone-cement interface were noted on the femoral component side of 13.6% of the hips. None of these patients had any symptoms or functional limitations. These radiologic femoral cement mantle changes showed a high correlation with apparently inadequate initial cementing techniques and were usually already seen on the 1- and 5-year postoperative roentgenogram. Only one acetabular cup was identified as radiologically loose and one as migrated. Radiolucent lines at the bone-cement interface on the acetabular side showed vascillating increases and decreases on the serial roentgenograms. Since the lucent lines on the acetabular component side improved as often as they increased in size, these lucencies did not seem to be of similar predictive value as those on the femoral side. Of the hips followed 8 to 10 years only 2 circumferential and 10 lucencies greater than 2 mm could be found. I could not correlate these with inadequate cup position or inadequate cement mantle on the initial radiograph. The 29 patients in this series who were under 50 years of age did not have a revision rate or radiologic change different from the group as a whole.

  13. The Geometry of the Bone Structure Associated with Total Hip Arthroplasty

    PubMed Central

    Yang, Zhang; Jian, Wang; Zhi-han, Li; Jun, Xiao; Liang, Zhao; Ge, Yan; Zhan-jun, Shi

    2014-01-01

    Close adaptation of the prosthesis to the bone is the key to achieving optimal stability and fixation for total hip arthroplasty (THA). However, there have been no adequate studies of bone morphology, especially in different races. The aim of this study was to analyze the geometry of the acetabulum and proximal femur of people from South China, based on three-dimensional reconstruction, and to detect differences between different population subsets. CT scans were performed on 80 healthy volunteers (160 hips) from South China, comprising 40 males (80 hips) and 40 females (80 hips). The images were imported into Mimics 10.01 to perform 3D reconstruction. THA-associated anatomical parameters were measured and compared with other published data. In comparison with published data, it seemed that people from South China have smaller acetabular abduction angle, larger acetabular supro-inferior diameter, larger neck-shaft angle, smaller offset, thinner femoral shaft and more proximal isthmus, which needed to be further confirmed. There were significant differences between the genders in most parameters. As significant differences in canal flare index (CFI) and distal canal flare index (DCFI) were found between genders, it was concluded the most significant differences lay in the isthmus of the femur. Among the femora, according to Noble’s classification we identified more normal types and fewer stovepipe and champagne-flute types than expected from the literature, indicating that uncemented prostheses would be suitable for most people from South China. Our findings reveal that simply choosing the smallest of a series of prostheses would not necessarily provide a good fit, due to the different trends from the proximal to the distal part of the femur. Significant variation exists in THA-associated anatomy between genders and population subsets. It is therefore imperative that each patient receives individual consideration rather than assuming all patients have the same

  14. Alumina-on-alumina Total Hip Arthroplasty in Young Patients: Diagnosis is More Important than Age

    PubMed Central

    Garcia-Rey, Eduardo; Cruz-Pardos, Ana

    2009-01-01

    Abstract Total hip arthroplasty (THA) in young patients has a high loosening rate, due in part to acetabular deformities that may compromise bone fixation and polyethylene wear. We therefore asked whether wear or osteolysis and loosening differ in patients under 40 years of age with alumina-on-alumina THA compared to those who are older. We prospectively followed 56 patients (63 hips) younger than 40 years (Group 1) and 247 patients (274 hips) older than 40 (Group 2) who had an alumina-on-alumina THA. The minimum followup was 4 years (mean, 5.6 years; range, 4–9 years). The two groups differed in various features: there were no patients with primary osteoarthritis in Group 1 and they had worse preoperative function and range of mobility, while weight, activity level, and implant size were greater in Group 2. The survival rate for cup loosening at 80 months postsurgery was 90.8% (95% confidence interval, 82.9–98.6%) for Group 1 and 96.5% (95% confidence interval, 94.2–98.7%) for Group 2. Cup loosening was less frequent with primary osteoarthritis than with severe developmental dysplasia of the hip. Although an alumina-on-alumina THA provided similar midterm survival and radiographic loosening in both age groups, the preoperative diagnosis seems more important than age for outcome. Continued followup will be required to determine if the alumina-on-alumina bearings in young patients result less risk of osteolysis and loosening. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:19495898

  15. The geometry of the bone structure associated with total hip arthroplasty.

    PubMed

    Yang, Zhang; Jian, Wang; Li, Zhi-han; Jun, Xiao; Liang, Zhao; Ge, Yan; Shi, Zhan-jun

    2014-01-01

    Close adaptation of the prosthesis to the bone is the key to achieving optimal stability and fixation for total hip arthroplasty (THA). However, there have been no adequate studies of bone morphology, especially in different races. The aim of this study was to analyze the geometry of the acetabulum and proximal femur of people from South China, based on three-dimensional reconstruction, and to detect differences between different population subsets. CT scans were performed on 80 healthy volunteers (160 hips) from South China, comprising 40 males (80 hips) and 40 females (80 hips). The images were imported into Mimics 10.01 to perform 3D reconstruction. THA-associated anatomical parameters were measured and compared with other published data. In comparison with published data, it seemed that people from South China have smaller acetabular abduction angle, larger acetabular supro-inferior diameter, larger neck-shaft angle, smaller offset, thinner femoral shaft and more proximal isthmus, which needed to be further confirmed. There were significant differences between the genders in most parameters. As significant differences in canal flare index (CFI) and distal canal flare index (DCFI) were found between genders, it was concluded the most significant differences lay in the isthmus of the femur. Among the femora, according to Noble's classification we identified more normal types and fewer stovepipe and champagne-flute types than expected from the literature, indicating that uncemented prostheses would be suitable for most people from South China. Our findings reveal that simply choosing the smallest of a series of prostheses would not necessarily provide a good fit, due to the different trends from the proximal to the distal part of the femur. Significant variation exists in THA-associated anatomy between genders and population subsets. It is therefore imperative that each patient receives individual consideration rather than assuming all patients have the same

  16. Use of the G-guide for Measuring Stem Antetorsion During Total Hip Arthroplasty.

    PubMed

    Fujihara, Yuki; Fukunishi, Shigeo; Fukui, Tomokazu; Nishio, Shoji; Okahisa, Shohei; Takeda, Yu; Kurosaka, Kenji; Yoshiya, Shinichi

    2016-01-01

    Implant positioning is one of the critical factors influencing postoperative outcomes in total hip arthroplasty (THA). Several studies have reported that the postoperative antetorsion (AT) measurement for the femoral stem inserted without navigation showed wide variability. The current authors developed a simple instrument, the Gravity-guide (G-guide), for intraoperative assessment of stem AT and adjustment. They evaluated the effectiveness of the G-guide with postoperative computed tomography (CT) examination. Ninety patients (96 hips) who underwent primary THA using the G-guide for stem adjustment were evaluated. The G-guide consists of 2 parts: one attached to the lower leg and the other attached to the handle of the rasp. The G-guide was used to evaluate the AT at the time of inserting the final rasp. In addition, the AT value in the G-guide evaluation system required correction by the angle obtained in the preoperative epicondylar view. Intraoperative stem AT was defined as the sum of the intraoperative G-guide value and the correction angle. Postoperative AT was evaluated by CT examination. The discrepancy between the intra- and postoperative measurements was 4.6°±4.1°. Acceptable accuracy with discrepancy of less than 5° and 10° was achieved in 66 (69%) hips and 85 (89%) hips, respectively. The use of the G-guide could effectively reduce the variability of stem anteversion compared with manual adjustment. This study proved the effectiveness of the newly developed G-guide system in intraoperative stem AT adjustment.

  17. Total hip arthroplasty for acute acetabular fractures: a review of the literature.

    PubMed

    Jauregui, Julio J; Clayton, Adrian; Kapadia, Bhaveen H; Cherian, Jeffrey J; Issa, Kimona; Mont, Michael A

    2015-05-01

    There have been many advances in the treatment of acetabular fractures; however, the role of total hip arthroplasty (THA) as part of acute fracture management is not well-defined. The indications to acutely manage an acetabular fracture with THA include patients who were older than 65 years of age, who had extensive intra-articular comminution, impaction of the acetabular dome, a displaced-impacted femoral neck fracture, presented with severe osteopenia or osteoporosis, or preexisting osteoarthritis. Implant survivorship and clinical outcomes were favorable with low complications when managing an acetabular fracture with THA. THA may be an effective option for treating acetabular fractures in appropriately selected patients.

  18. Titanium-copper-nitride coated spacers for two-stage revision of infected total hip endoprostheses

    PubMed Central

    Ellenrieder, Martin; Haenle, Maximilian; Lenz, Robert; Bader, Rainer; Mittelmeier, Wolfram

    2011-01-01

    Within the first two years after total hip arthroplasty implant-associated infection has become the second most common reason for a revision surgery. Two-stage implant exchange is frequently conducted using temporary spacers made of antibiotic-loaded cement in order to prevent a bacterial colonization on the spacer. Avoiding several disadvantages of cement spacers, a conventional hemi-endoprosthesis was equipped with a copper-containing implant coating for inhibition of bacterial biofilms. In the present paper details of this novel treatment concept are presented including a case report. PMID:22242097

  19. Metal release and corrosion effects of modular neck total hip arthroplasty

    PubMed Central

    Jakubowitz, Eike; Krachler, Michael; Thomsen, Marc; Heisel, Christian

    2009-01-01

    Modular neck implants are an attractive treatment tool in total hip replacement. Concerns remain about the mechanical stability and metal ion release caused by the modular connection. Five different implant designs were investigated in an experimental set-up. In vivo conditions were simulated and the long-term titanium release was measured. Finally, the modular connections were inspected for corrosion processes and signs of fretting. No mechanical failure or excessive corrosion could be identified for the implants tested. The titanium releases measured were extremely low compared to in vivo and in vitro studies and were not in a critical range. PMID:19219434

  20. In vitro experiments with an injection technique for cup fixation in total hip arthroplasty.

    PubMed

    Somville, J M; Moldenaers, P F; Mulier, J C; Mewis, J J

    1987-01-01

    A new technique has been developed to position the cup rigidly into the acetabulum during total hip joint replacement. After positioning the flanged cup on the acetabulum by means of screws, a low-viscosity cement is injected through a hole in the rim of the cup. A comparison with the standard cementing technique was made on the basis of in vitro experiments. For this purpose a mold was constructed to produce castings simulating the human acetabulum. The distribution of the cement, the pressure developed in the acetabulum, and the penetration of the cement are compared for the two cementing techniques. PMID:3606358

  1. Clinical outcome of Zweymüller total hip arthroplasty for patients with high congenital hip dislocation.

    PubMed

    Chen, Dongyang; Xu, Zhihong; Shi, Dongquan; Qiu, Xusheng; Dai, Jin; Yuan, Tao; Weng, Wenjie; Jiang, Qing

    2011-01-01

    Treatment of high congenital dislocation of the hip (CDH) remains controversial. We report the outcome of hip arthroplasty using a cementless threaded cup and a cementless straight stem in patients with high congenital hip dislocation. Between January 2001 and August 2004, 17 patients with high congenital hip dislocation were treated. During surgery, at least 25% of the cup was anchored in bone. By monitoring somatosensory-evoked potentials (SEPs) of the common peroneal nerve we were able to reduce the femoral head into position in the true acetabulum by releasing soft tissues. A bulk autogenous femoral head bone graft was implanted in 5 patients to achieve at least 75% bony coverage of the acertabular component. Follow-up ranged from 48 months to 91 months with an average of 69.7 months. The mean Harris hip score increased from 43 points preoperatively to 89 points at the time of final follow-up (P<0.001). Radiographic analysis showed bony union of the bone graft in all cases. PMID:21279967

  2. Alumina-on-alumina total hip replacement for femoral neck fracture in healthy patients

    PubMed Central

    2011-01-01

    Background Total hip replacement is considered the best option for treatment of displaced intracapsular fractures of the femoral neck (FFN). The size of the femoral head is an important factor that influences the outcome of a total hip arthroplasty (THA): implants with a 28 mm femoral head are more prone to dislocate than implants with a 32 mm head. Obviously, a large head coupled to a polyethylene inlay can lead to more wear, osteolysis and failure of the implant. Ceramic induces less friction and minimal wear even with larger heads. Methods A total of 35 THAs were performed for displaced intracapsular FFN, using a 32 mm alumina-alumina coupling. Results At a mean follow-up of 80 months, 33 have been clinically and radiologically reviewed. None of the implants needed revision for any reason, none of the cups were considered to have failed, no dislocations nor breakage of the ceramic components were recorded. One anatomic cementless stem was radiologically loose. Conclusions On the basis of our experience, we suggest that ceramic-on-ceramic coupling offers minimal friction and wear even with large heads. PMID:21284879

  3. Total Hip Arthroplasty Using Metal Head on a Highly Cross-linked Polyethylene Liner

    PubMed Central

    Kim, Min-Yook; Park, Ji-Hoon; Lee, Jung-Ho

    2015-01-01

    Purpose This retrospective study was performed to evaluate the clinical results and measure polyethylene liner wear in total hip arthroplasty (THA) with highly cross-linked polyethylene. Materials and Methods Except for patients who had died or were unable to have follow-up at least 2 years, 60 of 78 hips that underwent THA were included this study. The mean age was 64.5 years (range, 25-81 years) and the mean body mass index (BMI) was 23.0 kg/m2 (18.1-32.3 kg/m2). Diagnosis at the time of the operation was osteonecrois of the femoral head in 28 hips, primary osteoarthritis in 14, hip fracture in 13, and other diseases in 5. The mean follow-up period was 3.8 years (2.1-7.1 years). Harris hip score (HHS) was reviewed before THA and at the last follow-up. On the anteroposterior pelvic radiographs, acetabular cup inclination and ante-version were also measured. The annual linear wear rate was measured using Livermore's method on the radiographs. Results The mean HHS was 60.1 (28-94) before operation and 90.4 (47-100) at the last follow-up. In the immediate post-operation, the average inclination and anteversion angles of the acetabular cups were 46.3° (standard deviation, ±6.7°) and, 21.4°(±10.1°) respectively. The mean of the annual linear polyethylene wear was 0.079 mm/year (0.001-0.291 mm/year). Age, gender and BMI were not statistically related to linear polyethylene wear but the period of follow-up and the acetabular cup's inclination showed significant negative and positive correlation respectively. Conclusion The wear rate of a highly cross-linked polyethylene was shown to correlate negatively with duration of follow-up. However, our study was based on a short-term follow-up, so a long-term follow-up study is necessary in the future. PMID:27536629

  4. Postoperative changes in in vivo measured friction in total hip joint prosthesis during walking.

    PubMed

    Damm, Philipp; Bender, Alwina; Bergmann, Georg

    2015-01-01

    Loosening of the artificial cup and inlay is the most common reasons for total hip replacement failures. Polyethylene wear and aseptic loosening are frequent reasons. Furthermore, over the past few decades, the population of patients receiving total hip replacements has become younger and more active. Hence, a higher level of activity may include an increased risk of implant loosening as a result of friction-induced wear. In this study, an instrumented hip implant was used to measure the contact forces and friction moments in vivo during walking. Subsequently, the three-dimensional coefficient of friction in vivo was calculated over the whole gait cycle. Measurements were collected from ten subjects at several time points between three and twelve months postoperative. No significant change in the average resultant contact force was observed between three and twelve months postoperative. In contrast, a significant decrease of up to 47% was observed in the friction moment. The coefficient of friction also decreased over postoperative time on average. These changes may be caused by 'running-in' effects of the gliding components or by the improved lubricating properties of the synovia. Because the walking velocity and contact forces were found to be nearly constant during the observed period, the decrease in friction moment suggests an increase in fluid viscosity. The peak values of the contact force individually varied by 32%-44%. The friction moment individually differed much more, by 110%-129% at three and up to 451% at twelve months postoperative. The maximum coefficient of friction showed the highest individual variability, about 100% at three and up to 914% at twelve months after surgery. These individual variations in the friction parameters were most likely due to different 'running-in' effects that were influenced by the individual activity levels and synovia properties. PMID:25806805

  5. Changes of center of rotation and femoral offset in total hip arthroplasty

    PubMed Central

    Bjarnason, Jon A.

    2015-01-01

    Background It is a challenge to reconstruct the center of rotation (COR) and femoroacetabular offset anatomically in total hip arthroplasty (THA). We addressed the controversy how we manage to preserve the COR and femoroacetabular offset with an uncemented total hip prosthesis implanted with free hand technique. Methods We analyzed a prospective series of 73 patients who underwent primary THA. The series was composed of 40 females and 33 males, mean age 64 years (range, 35–90 years). The reasons for THA were primary osteoarthritis (n=63) and developmental dysplasia of the hip (n=10). Pre- and postoperative X-rays were done in a standardized format for anterior-posterior (AP) radiographs of the pelvis, and digitalized measurements were done using SectraTM. We compared preoperative measurements with the final outcome to determine changes in COR and femoral offset. Results We found that 40 patients had their COR and 34 patients had their femoral offset preserved within preoperative 5.0 mm limits. Twenty-three patients had both their values of COR and femoral offset preserved within 5.0 mm limits. While a significant correlation was found between changes of femoral and global offset (r=0.786, P<0.001), there were no correlation between changes of acetabular and femoral offset (r=−0.027, P=0.822). Conclusions Using an uncemented THA and free hand technique, there is a fair reproducibility of anatomy. The variations were mostly minor, but our results indicate a potential for better restoring the location of COR and femoral offset when planning and implanting an uncemented THA. PMID:26807410

  6. Postoperative changes in in vivo measured friction in total hip joint prosthesis during walking.

    PubMed

    Damm, Philipp; Bender, Alwina; Bergmann, Georg

    2015-01-01

    Loosening of the artificial cup and inlay is the most common reasons for total hip replacement failures. Polyethylene wear and aseptic loosening are frequent reasons. Furthermore, over the past few decades, the population of patients receiving total hip replacements has become younger and more active. Hence, a higher level of activity may include an increased risk of implant loosening as a result of friction-induced wear. In this study, an instrumented hip implant was used to measure the contact forces and friction moments in vivo during walking. Subsequently, the three-dimensional coefficient of friction in vivo was calculated over the whole gait cycle. Measurements were collected from ten subjects at several time points between three and twelve months postoperative. No significant change in the average resultant contact force was observed between three and twelve months postoperative. In contrast, a significant decrease of up to 47% was observed in the friction moment. The coefficient of friction also decreased over postoperative time on average. These changes may be caused by 'running-in' effects of the gliding components or by the improved lubricating properties of the synovia. Because the walking velocity and contact forces were found to be nearly constant during the observed period, the decrease in friction moment suggests an increase in fluid viscosity. The peak values of the contact force individually varied by 32%-44%. The friction moment individually differed much more, by 110%-129% at three and up to 451% at twelve months postoperative. The maximum coefficient of friction showed the highest individual variability, about 100% at three and up to 914% at twelve months after surgery. These individual variations in the friction parameters were most likely due to different 'running-in' effects that were influenced by the individual activity levels and synovia properties.

  7. Risk factors for revision due to infection after primary total hip arthroplasty

    PubMed Central

    2010-01-01

    Background and purpose There has been a limited amount of research on risk factors for revision due to infection following total hip arthroplasty (THA), probably due to low absolute numbers of revisions. We therefore studied patient- and surgery-related risk factors for revision due to infection after primary THA in a population-based setting. Materials and methods Using the Danish Hip Arthroplasty Registry, we identified 80,756 primary THAs performed in Denmark between Jan 1, 1995 and Dec 31, 2008. We used Cox regression analysis to compute crude and adjusted relative risk (RR) of revision due to infection. Revision was defined as extraction or exchange of any component due to infection. The median follow-up time was 5 (0–14) years. Results 597 primary THAs (0.7%) were revised due to infection. Males, patients with any co-morbidity, patients operated due to non-traumatic avascular femoral head necrosis, and patients with long duration of surgery had an increased RR of revision due to infection within the total follow-up time. A tendency of increased RR of revision was found for patients who had received cemented THA without antibiotic and hybrid THA relative to patients with cementless implants. Hip diagnosis and fixation technique were not associated with risk of revision due to infection within 1 year of surgery (short-term risk). Interpretation We identified several categories of THA patients who had a higher risk of revision due to infection. Further research is required to explain the mechanism underlying this increased risk. More attention should be paid by clinicians to infection prevention strategies in patients with THA, particularly those with increased risk. PMID:20860453

  8. Good short-term outcome of primary total hip arthroplasty with cementless bioactive glass ceramic bottom-coated implants

    PubMed Central

    2012-01-01

    Background and purpose Cementless total hip arthroplasty is currently favored by many orthopedic surgeons. The design of the porous surface is critically important for long-term fixation. We examined the clinical and radiographic outcome of the cementless titanium hip implant with a bottom coating of apatite-wollastonite containing bioactive glass ceramic. Methods We retrospectively reviewed 109 hips (92 patients) that had undergone primary cementless total hip arthroplasty with bioactive glass ceramic bottom-coated implants. The mean follow-up period was 7 (3–9) years. Hip joint function was evaluated with the Merle d’Aubigné and Postel hip score, and radiographic changes were determined from anteroposterior radiographs. Results The mean hip score improved from 9.7 preoperatively to 17 at the final follow-up. The overall survival rate was 100% at 9 years, when radiographic loosening or revision for any reason was used as the endpoint. 3 stems in 2 patients subsided more than 3 mm vertically within 1 year after implantation. Radiographs of the interface of the stem and femur were all classified as bone ingrowth fixation. Conclusions The short-term results of this study show good outcome for cementless implants with a bottom coating of apatite-wollastonite containing bioactive glass ceramic. PMID:23043270

  9. Alcohol Misuse is an Independent Risk Factor for Poorer Postoperative Outcomes Following Primary Total Hip and Total Knee Arthroplasty.

    PubMed

    Best, Matthew J; Buller, Leonard T; Gosthe, Raul G; Klika, Alison K; Barsoum, Wael K

    2015-08-01

    The influence of alcohol misuse on outcomes following primary total hip (THA) or knee (TKA) arthroplasty is poorly understood. Using the National Hospital Discharge Survey, a cohort representative of 8,372,232 patients (without cirrhosis) who underwent THA or TKA between 1990 and 2007 was identified and divided into two groups: (1) those who misused alcohol (n=50,861) and (2) those who did not (n=8,321,371). Differences in discharge status, comorbidities and perioperative complications were analyzed. Compared to patients with no diagnosis of alcohol misuse, alcohol misusers were nine times more likely to leave against medical advice and had longer hospital stays (P<0.001). Alcohol misuse was independently associated with higher odds of in hospital complications (OR: 1.334, range: 1.307-1.361), surgery related complications (OR: 1.293, range: 1.218-1.373) and general medical complications (OR: 1.300, range: 1.273-1.327). PMID:25769745

  10. Variations in ESR and CRP in total knee arthroplasty and total hip arthroplasty in Iranian patients from 2009 to 2011

    PubMed Central

    Nazem, Khalilolah; Motififard, Mehdi; Yousefian, Mehdi

    2016-01-01

    Background: Implantation of joint prosthesis, either in the knee or in the hip, may cause some problems such as an infection, so that a timely treatment is essential. In this respect, discovering a marker detecting the incidence of an infection is one of the requirements of arthroplasty. The present study was conducted to determine variations of two markers in arthroplasty and infection incidence in Iranian patients. Materials and Methods: This prospective study was carried out in Isfahan’s educational treatment centers from 2009 to 2011 on patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) surgical operations. The erythrocyte sedimentation rate (ESR) was measured by Sed rate device (Lena) and C-reactive protein (CRP) by autoanalyzer device (Erba) with the unit of ng/dL. The patients underwent ESR and CRP tests the day before operation, the day of operation, and 1, 2, 5, and 15 days and 1, 3, 6, and 12 months after operation. Results: Mean ESR increased during the first 5 days then decreased gradually lasting for 3 months. After 1 year it increased to a level higher than before the operation. The variations in ESR values were 19.1 ± 12.9 before the operation and 21.14 ± 10.8 after 1 year with significant difference (P < 0.001). The level of CRP had an upward trend from the first day after operation and reached its maximum on the second day, then had a downward trend up to 1 month after the operation; however, it did not reach its preoperative level during 1 year. Conclusion: ESR and CRP and their variations can be suitable factors to detect probable infections in patients undergoing TKA and THA operations.

  11. Variations in ESR and CRP in total knee arthroplasty and total hip arthroplasty in Iranian patients from 2009 to 2011

    PubMed Central

    Nazem, Khalilolah; Motififard, Mehdi; Yousefian, Mehdi

    2016-01-01

    Background: Implantation of joint prosthesis, either in the knee or in the hip, may cause some problems such as an infection, so that a timely treatment is essential. In this respect, discovering a marker detecting the incidence of an infection is one of the requirements of arthroplasty. The present study was conducted to determine variations of two markers in arthroplasty and infection incidence in Iranian patients. Materials and Methods: This prospective study was carried out in Isfahan’s educational treatment centers from 2009 to 2011 on patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) surgical operations. The erythrocyte sedimentation rate (ESR) was measured by Sed rate device (Lena) and C-reactive protein (CRP) by autoanalyzer device (Erba) with the unit of ng/dL. The patients underwent ESR and CRP tests the day before operation, the day of operation, and 1, 2, 5, and 15 days and 1, 3, 6, and 12 months after operation. Results: Mean ESR increased during the first 5 days then decreased gradually lasting for 3 months. After 1 year it increased to a level higher than before the operation. The variations in ESR values were 19.1 ± 12.9 before the operation and 21.14 ± 10.8 after 1 year with significant difference (P < 0.001). The level of CRP had an upward trend from the first day after operation and reached its maximum on the second day, then had a downward trend up to 1 month after the operation; however, it did not reach its preoperative level during 1 year. Conclusion: ESR and CRP and their variations can be suitable factors to detect probable infections in patients undergoing TKA and THA operations. PMID:27656617

  12. Cementless total hip replacement without femoral osteotomy in patients with severe developmental dysplasia of the hip: minimum 15-year clinical and radiological results.

    PubMed

    Imbuldeniya, A M; Walter, W L; Zicat, B A; Walter, W K

    2014-11-01

    We describe the clinical and radiological results of cementless primary total hip replacement (THR) in 25 patients (18 women and seven men; 30 THRs) with severe developmental dysplasia of the hip (DDH). Their mean age at surgery was 47 years (23 to 89). In all, 21 hips had Crowe type III dysplasia and nine had Crowe type IV. Cementless acetabular components with standard polyethylene liners were introduced as close to the level of the true acetabulum as possible. The modular cementless S-ROM femoral component was used with a low resection of the femoral neck. A total of 21 patients (25 THRs) were available for review at a mean follow-up of 18.7 years (15.8 to 21.8). The mean modified Harris hip score improved from 46 points pre-operatively to 90 at final follow up (p < 0.001). A total of 15 patients (17 THRs; 57%) underwent revision of the acetabular component at a mean of 14.6 years (7 to 20.8), all for osteolysis. Two patients (two THRs) had symptomatic loosening. No patient underwent femoral revision. Survival with revision of either component for any indication was 81% at 15 years (95% CI 60.1 to 92.3), with 21 patients at risk. This technique may reduce the need for femoral osteotomy in severe DDH, while providing a good long-term functional result. PMID:25371455

  13. Qualifying CT for wrist arthroplasty: extending techniques for total hip arthroplasty to total wrist arthroplasty

    NASA Astrophysics Data System (ADS)

    Alcala, Yvonne; Olivecrona, Henrik; Olivecrona, Lotta; Noz, Marilyn E.; Maguire, Gerald Q., Jr.; Zeleznik, Michael P.; Sollerman, Christer

    2005-04-01

    The purpose of this study was to extend previous work to detect migration of total wrist arthroplasty non-invasively, and with greater accuracy. Two human cadaverous arms, each with a cemented total wrist implant, were used in this study. In one of the arms, 1 mm tantalum balls were implanted, six in the carpal bones and five in the radius. Five CT scans of each arm were acquired, changing the position of the arm each time to mimic different positions patients might take on repeated examinations. Registration of CT volume data sets was performed using an extensively validated, 3D semi-automatic volume fusion tool in which co-homologous point pairs (landmarks) are chosen on each volume to be registered. Three sets of ten cases each were obtained by placing landmarks on 1) bone only (using only arm one), 2) tantalum implants only, and 3) bone and tantalum implants (both using only arm two). The accuracy of the match was assessed visually in 2D and 3D, and numerically by calculating the distance difference between the actual position of the transformed landmarks and their ideal position (i.e., the reference landmark positions). All cases were matched visually within one width of cortical bone and numerically within one half CT voxel (0.32 mm, p = 0.05). This method matched only the bone/arm and not the prosthetic component per se, thus making it possible to detect prosthetic movement and wear. This method was clinically used for one patient with pain. Loosening of the carpal prosthetic component was accurately detected and this was confirmed at surgery.

  14. [Comparison of total hip arthroplasty via a posterior mini-incision versus a classic anterolateral approach].

    PubMed

    Rittmeister, M; Peters, A

    2006-07-01

    Surgical approaches to the hip for total hip arthroplasty (THA) are termed minimally invasive when allowing for a skin incision length of 10 cm or less. The aim of this study was to explore if a minimally invasive posterior approach compared to a classic anterolateral approach negatively influenced surgical time, blood loss, implant position, or perioperative complications. Two groups of THA patients mainly differing with respect to the surgical approach were compared. Results of 76 consecutive THA via a posterior mini-incision approach were recorded prospectively and those of 76 controls operated via a classic anterolateral approach were recorded retrospectively. THA was performed by the same surgeon in every case. Surgical time or intraoperative blood loss were not different among the groups. Total 24-h blood loss was significantly less in patients undergoing THA via minimally invasive posterior approaches. Median cup inclination was 45 degrees in both groups. Cup anteversion was 15 degrees (classic anterolateral) and 12 degrees (minimally invasive posterior), respectively. Stem position was regarded as neutral in 80% of THA through classic anterolateral and in 76 % through minimally invasive dorsal incisions. Complications occurred in 8% (classic anterolateral) and 9% (minimally invasive posterior) of THA patients. Surgical time, blood loss, risk of malpositioned implants, or complications were not increased for THA patients operated through minimally invasive posterior incisions compared to those operated via classic anterolateral approaches.

  15. Development of Computer-Tailored Education Program for Patients with Total Hip Replacement

    PubMed Central

    Jeong, Yeo Won

    2014-01-01

    Objectives The purpose of this study was to develop a Web-based computer-tailored education program to promote self-care for patients with total hip replacement. Methods The program was developed in five phases. Results Phase 1: Program content was developed, including the educational needs of patients with total hip replacement, based on a review of previous research and literature. Phase 2: A computer-tailored algorithm written as a series of 'if-then' statements was developed to offer the appropriate type of intervention based on an individual's personal health characteristics. Phase 3: A professional Web programmer produced then the program for use on the Web. Phase 4: An expert evaluation was performed focusing on two aspects, Web contents and website design. SPSS ver. 16.0 was used for the analysis, and grade point averages were used to compare each evaluation item. Phase 5: Based on comments from the experts' evaluation, modifications and revisions were made, and the program was completed. Conclusions The developed program presented tailored messages using animations, video and flash considering the individual health status and characteristics of the primary target generation. In addition, the expert evaluation confirmed the validity of the program's content and design. PMID:25405061

  16. Microscale wear behavior and crosslinking of PEG-like coatings for total hip replacements.

    PubMed

    Kane, Sheryl R; Ashby, Paul D; Pruitt, Lisa A

    2010-04-01

    The predominant cause of late-state failure of total hip replacements is wear-mediated osteolysis caused by wear particles that originate from the ultrahigh molecular weight polyethylene (UHMWPE) acetabular cup surface. One strategy for reducing wear particle formation from UHMWPE is to modify the surface with a hydrophilic coating to increase lubrication from synovial fluid. This study focuses on the wear behavior of hydrophilic coatings similar to poly(ethylene glycol) (PEG). The coatings were produced by plasma-polymerizing tetraglyme on UHMWPE in a chamber heated to 40 degrees C or 50 degrees C. Both temperatures yielded coatings with PEG-like chemistry and increased hydrophilicity relative to uncoated UHMWPE; however, the 40 degrees C coatings were significantly more resistant to damage induced by atomic force microscopy nanoscratching. The 40 degrees C coatings exhibited only one damage mode (delamination) and often showed no signs of damage after repeated scratching. In contrast, the 50 degrees C coatings exhibited three damage modes (roughening, thinning, and delamination), and always showed visible signs of damage after no more than two scratches. The greater wear resistance of the 40 degrees C coatings could not be explained by coating chemistry or hydrophilicity, but it corresponded to an approximately 26-32% greater degree of crosslinking relative to the 50 degrees C surfaces, suggesting that crosslinking should be a significant design consideration for hydrophilic coatings used for total hip replacements and other wear-dependent applications.

  17. Relationship between cup position and obturator externus muscle in total hip arthroplasty

    PubMed Central

    2010-01-01

    Background It is often challenging to find the causes for postoperative pain syndromes after total hip replacement, since they can be very allotropic. One possible cause is the muscular impingement syndrome. The most commonly known impingement syndrome is the psoas impingement. Another recently described impingement syndrome is the obturator externus muscle impingement. The aim of this study is to analyze pathological conditions of the Obturator externus and to show possible causes. Methods 40 patients who had undergone a total hip replacement were subjected to clinical and MRI examinations 12 months after the surgery. The Harris Hip Score (HHS) was used to analyze pain and function. Additionally, a satisfaction score and a pain score (VAS) were determined. The MRI allowed for the assessment of the spatial relation between the obturator externus muscle and the acetabulum. Also measured were the acetabular inclination angle as well as the volume and cross-sectional area of the obturator externus muscle. Results The patients were assigned to 3 groups in accordance with their MRI results. Group 1 patients (n = 18) showed no contact between the obturator externus and the acetabulum. Group 2 (n = 13) showed contact, and group 3 (n = 9) an additional clear displacement of the muscle in its course. It was not possible to establish a connection between the imaging findings, the HHS, the VAS, and patient satisfaction. What was striking, however, was a significant difference between the median inclination angle in group 1 (40° ± 5.4°) and group 3 (49° ± 4.7°) (p < 0.05), and the corresponding image-morphological pathology. The average inclination angle in group 2 was 43.3° ± 3.8° Conclusion Contact between the obturator externus muscle and the caudal acetabula border occurs frequently, but is only rarely accompanied by a painful muscular impingement. The position of the acetabula must be seen as one of the main risk factors for contact between the acetabula border

  18. OPTIMAL IMPROVEMENT IN FUNCTION AFTER TOTAL HIP AND KNEE REPLACEMENT: HOW DEEP DO YOU KNOW YOUR PATIENT’S MIND?

    PubMed

    De Caro, M F; Vicenti, G; Abate, A; Picca, G; Leoncini, V; Lomuscio, M; Casalino, A; Solarino, G; Moretti, B

    2015-01-01

    Osteoarthritis (OA) of the hip and knee causes pain and loss of joint mobility, leading to limitations in physical function. When conservative treatment fails total hip and knee replacement is a cost-effective surgical option. Patients have high expectations regarding functional outcome after these procedures. If such expectations are not met, they may still be dissatisfied with the outcome of a technically successful procedure. Recently, numerous studies reported that psychological factors can influence the outcome of total knee replacement (tkr) and total hip artrhoplasty with total hip replacement (thr). We conducted a prospective study on a consecutive sample of 280 patients affected by hip or knee OA who underwent total joint replacement. At patients’ admission, Harris Hip Score (HHS) and Knee Society Score (KSS) were used to assess pain and function. Furthermore, SF-36, Mini-Mental Status Examination (MMSE), Symptom Checklist-90-R (SCL-90-R), Coping Orientation to Problems Experienced (BRIEF-COPE) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) were administered. Patients had clinical and radio graphical follow up at 1, 3 and 6 months post-operatively. The HHS and KSS values before surgery showed a linear correlation with both SCL-90-R and MMSE. None of the investigated variables influenced post-operative HHS and KSS scores; however, the improvement of functional scores resulted conditioned by SCL-90-R values, VAS score, schooling and MMSE. Psychological factors and mental status in primary total hip and knee replacement can affect outcome and patient satisfaction. Strategies focused on identification and facing of these conditions must be considered to improve outcome of total replacement. PMID:26652495

  19. Simulated studies of wear and friction in total hip prosthesis components with various ball sizes and surface finishes

    NASA Technical Reports Server (NTRS)

    Swikert, M. A.; Johnson, R. L.

    1976-01-01

    Experiments were conducted on a newly designed total hip joint simulator. The apparatus closely simulates the complex motions and loads of the human hip in normal walking. The wear and friction of presently used appliance configurations and materials were determined. A surface treatment of the metal femoral ball specimens was applied to influence wear. The results of the investigation indicate that wear can be reduced by mechanical treatment of metal femoral ball surfaces. A metallographic examination and surface roughness measurements were made.

  20. Mixing of components from different manufacturers in total hip arthroplasty: prevalence and comparative outcomes

    PubMed Central

    Tucker, Keith; Pickford, Martin; Newell, Claire; Howard, Peter; Hunt, Linda P; Blom, Ashley W

    2015-01-01

    Background and purpose — There have recently been highly publicized examples of suboptimal outcomes with some newer implant designs used for total hip replacement. This has led to calls for tighter regulation. However, surgeons do not always adhere to the regulations already in place and often use implants from different manufacturers together to replace a hip, which is against the recommendations of the Medicines and Healthcare Products Regulatory Agency (MHRA) and the directions of the manufacturers. Patients and methods — We used data from the National Joint Registry of England and Wales (NJR) to investigate this practice. Results — Mixing of components was common, and we identified over 90,000 cases recorded between 2003 and 2013. In the majority of these cases (48,156), stems and heads from one manufacturer were mixed with polyethylene cemented cups from another manufacturer. When using a cemented stem and a polyethylene cup, mixing of stems from one manufacturer with cups from another was associated with a lower revision rate. At 8 years, the cumulative percentage of revisions was 1.9% (95% CI: 1.7–2.1) in the mixed group as compared to 2.4% (2.3–2.5) in the matched group (p = 0.001). Mixing of heads from one manufacturer with stems from another was associated with a higher revision rate (p < 0.001). In hip replacements with ceramic-on-ceramic or metal-on-metal bearings, mixing of stems, heads, and cups from different manufacturers was associated with similar revision rates (p > 0.05). Interpretation — Mixing of components from different manufacturers is a common practice, despite the fact that it goes against regulatory guidance. However, it is not associated with increased revision rates unless heads and stems from different manufacturers are used together. PMID:26201845

  1. No effect of risedronate on femoral periprosthetic bone loss following total hip arthroplasty

    PubMed Central

    Muren, Olle; Akbarian, Ehsan; Salemyr, Mats; Bodén, Henrik; Eisler, Thomas; Stark, André

    2015-01-01

    Background and purpose We have previously shown that during the first 2 years after total hip arthroplasty (THA), periprosthetic bone resorption can be prevented by 6 months of risedronate therapy. This follow-up study investigated this effect at 4 years. Patients and methods A single-center, double-blind, randomized placebo-controlled trial was carried out from 2006 to 2010 in 73 patients with osteoarthritis of the hip who were scheduled to undergo THA. The patients were randomly assigned to receive either 35 mg risedronate or placebo orally, once a week, for 6 months postoperatively. The primary outcome was the percentage change in bone mineral density (BMD) in Gruen zones 1 and 7 in the proximal part of the femur at follow-up. Secondary outcomes included migration of the femoral stem and clinical outcome scores. Results 61 of the 73 patients participated in this 4-year (3.9- to 4.1-year) follow-up study. BMD was similar in the risedronate group (n = 30) and the placebo group (n = 31). The mean difference was −1.8% in zone 1 and 0.5% in zone 7. Migration of the femoral stem, the clinical outcome, and the frequency of adverse events were similar in the 2 groups. Interpretation Although risedronate prevents periprosthetic bone loss postoperatively, a decrease in periprosthetic BMD accelerates when therapy is discontinued, and no effect is seen at 4 years. We do not recommend the use of risedronate following THA for osteoarthritis of the hip. PMID:25885280

  2. Wear of polyethylene cups in total hip arthroplasty: a parametric mathematical model.

    PubMed

    Pietrabissa, R; Raimondi, M; Di Martino, E

    1998-04-01

    This paper presents a parametric mathematical model of the head-cup wear coupling in total hip arthroplasty (THA). The model evaluates the dependence of acetabular volumetric wear upon the characteristic parameters of patient and hip prosthesis. Archard's law is assumed to calculate the wear coupling behaviour. The wear factor is taken from pin-on-disc wear tests as a function of materials and finishing of the articular joint. The forces acting on the hip joint are taken from experimental data found in the literature whilst the load distribution is calculated under the hypotheses of perfectly rigid ideal wear coupling. The sliding distance is obtained by combining the three elementary displacements -- due to rotations around the three axes -- at the generic bearing surface location. The simulations show that the polymeric wear volume per step cycle decreases ranging from fast walking speeds to low running speeds, it increases linearly with patient body weight and with femoral head diameter, it decreases slightly for positive variations of the socket inclination angle and it increases exponentially with femoral head roughness. The volumetric wear rate per year calculated for a standard reference patient is 5.8 mm3. The relevant iso-wear maps show a marginal pattern with the maximum located near the cup superior borderline. At the instant of peak load, the iso-stress maps show a paracentral pattern with the maximum superior to the cup polar point, and the iso-sliding distance maps show a marginal pattern with two maxima located near the cup's superior and inferior borderlines. PMID:9690490

  3. 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.

  4. Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty

    PubMed Central

    Miettinen, Simo S A; Mäkinen, Tatu J; Kostensalo, Inari; Mäkelä, Keijo; Huhtala, Heini; Kettunen, Jukka S; Remes, Ville

    2016-01-01

    Background and purpose — Intraoperative periprosthetic femoral fracture is a known complication of cementless total hip arthroplasty (THA). We determined the incidence of—and risk factors for—intraoperative calcar fracture, and assessed its influence on the risk of revision. Patients and methods — This retrospective analysis included 3,207 cementless THAs (in 2,913 patients). 118 intraoperative calcar fractures were observed in these hips (3.7%). A control group of 118 patients/hips without calcar fractures was randomly selected. The mean follow-up was 4.2 (1.8–8.0) years. Demographic data, surgical data, type of implant, and proximal femur morphology were evaluated to determine risk factors for intraoperative calcar fracture. Results — The revision rates in the calcar fracture group and the control group were 10% (95% CI: 5.9–17) and 3.4% (CI: 1.3–8.4), respectively. The revision rate directly related to intraoperative calcar fracture was 7.6%. The Hardinge approach and lower age were risk factors for calcar fracture. In the fracture group, 55 of 118 patients (47%) had at least one risk factor, while only 23 of118 patients in the control group (20%) had a risk factor (p = 0.001). Radiological analysis showed that in the calcar fracture group, there were more deviated femoral anatomies and proximal femur bone cortices were thinner. Interpretation — Intraoperative calcar fracture increased the risk of revision. The Hardinge approach and lower age were risk factors for intraoperative calcar fracture. To avoid intraoperative fractures, special attention should be paid when cementless stems are used with deviant-shaped proximal femurs and with thin cortices. PMID:26541230

  5. A National Analysis of Complications Following Total Hip Replacement in Patients With Chronic Obstructive Pulmonary Disease

    PubMed Central

    Liao, Kuang-Ming; Lu, Hsueh-Yi

    2016-01-01

    Abstract Patients with chronic obstructive pulmonary disease (COPD) have a high risk of osteoporosis and fractures. The incidence rate of hip fracture has steadily increased over time and is a major common event in patients with osteoporosis and COPD. Total hip replacement (THR) is commonly performed in patients with hip fracture. Our aim was to compare the complications of THR between patients with and without COPD. Longitudinally linked data from the National Health Insurance Research Database, which consists of registration, claims, and reimbursement records, for a cohort of 1,000,000 randomly selected enrollees traced retrospectively from 1996 to 2000 in Taiwan. Patients who had undergone THR surgery between January 1, 2004, and December 31, 2008, were identified and divided into COPD and non-COPD cohorts. Outcomes and complications, including 90-day mortality, 1-year mortality, 1-year wound infection, 30-day readmission for hospitalization, 30-day pneumonia, 30-day acute respiratory failure, 30-day cerebrovascular accident, and length of stay during hospitalization, were measured after THR. The COPD group had a significantly higher ratio of complications, including 30-day readmission (14.0% vs 8.4%), 30-day pneumonia (10.4% vs 4.4%), 30-day acute respiratory failure (1.5% vs 0.5%), 1-year mortality (6.9% vs 2.7%), and length of stay in the hospital (10.6% vs 0.8%) than the non-COPD group. In addition to airway diseases, patients in the COPD group had higher mortality than those in non-COPD group after THR. Surgeons should give more attention to airway evaluation and selection of patients with COPD for THR. PMID:27015210

  6. Performance-based versus self-reported outcomes using the HOOS following total hip arthroplasty

    PubMed Central

    Dayton, Michael R.; Judd, Dana L.; Hogan, Craig A.; Stevens-Lapsley, Jennifer E.

    2016-01-01

    Objective The purpose of this study was to explore the relationship between patients’ self-reported and performance-based function after total hip arthroplasty (THA). Design Twenty-three patients (age 61.4 ± 8.3 years) undergoing primary THA for hip osteoarthritis participated. Self-reported function and recovery was measured using The Hip Dysfunction and Osteoarthritis Outcome Score (HOOS) ADL and Pain subscales. Performance-based functional measures included Timed Up and Go Test (TUG), Stair Climbing Test (SCT), and the 6 Minute Walk Test (6MW). Outcome measures were assessed pre- and post-operatively at one and six months. Results One month after THA, performance-based function declined compared to baseline as follows: TUG: −22.1 ± 25.4%; SCT: −58.5 ± 63.6%; and 6MWT: −22.6 ± 31.7%. In contrast, self-reported function on the HOOS ADL significantly improved one month after THA compared to baseline: 40.8 ± 33.3%. One to six months after THA, there were significant improvements in TUG, SCT and 6MWT which paralleled improvements on the HOOS subscales, although changes were not significantly correlated. Conclusion The disparity between changes in HOOS scores and functional performance post-operatively suggests that patients may overestimate their functional capacity early after THA, likely in response to pain improvements over the same time period. Therefore, outcomes assessment after THA should include both self-report and performance-based functional measures. PMID:26259051

  7. The Efficacy of Bipolar Sealer on Blood Loss in Primary Total Hip Arthroplasty

    PubMed Central

    Min, Ji-Kang; Zhang, Qiang-Hua; Li, Hai-Dong; Li, Heng; Guo, Pan

    2016-01-01

    Abstract The blood loss during total hip arthroplasty is difficult to manage and there is no consensus about the effect of bipolar sealer used during operation. Thus, a systematic review of randomized controlled trials (RCTs) was performed to evaluate the efficacy and safety of blood loss using bipolar sealer after total hip arthroplasty (THA). Relevant literature of comparisons of bipolar sealer after THA for blood loss were searched for in Embase, PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and Google scholar from their inception to October, 2015. High-quality RCTs were selected to evaluate the need for transfusion, blood loss, and other complications. The software RevMan 5.30 was used for the meta-analysis. Six studies reporting on 6 RCTs comprising 751 patients were included. Compared with standard electrocautery, bipolar sealer was associated with lower rates of need for transfusion (relative risk [RR] = 0.60; 95% confidence interval [CI] 0.39–0.94), estimated blood loss (mean differences [MD] = −127.39; 95% CI −233.32 to −21.46; P = 0.02), and lower total blood loss (MD = −226.57; 95% CI −350.80–102.34; P = 0.0004). There is no significant difference between the hemoglobin drop, blood loss in drainage, intraoperative blood loss, Harris score, and rates of infection. The present meta-analysis indicated that bipolar sealer can decrease the need for transfusion and total blood loss; however, there is no benefit of bipolar sealer from the recovery. It is still need for samples to determine the balance between the economic cost and transfusion. PMID:27175643

  8. Midterm results of 36 mm metal-on-metal total hip arthroplasty

    PubMed Central

    Akrawi, Hawar; Hossain, Fahad S; Niculescu, Stefan; Hashim, Zaid; Ng, Arron Biing; Shetty, Ajit

    2016-01-01

    Background: Despite the many perceived benefits of metal-on-metal (MoM) articulation in total hip arthroplasty (THA), there have been growing concerns about metallosis and adverse reaction to metal debris (ARMD). Analysis of size 36 mm MoM articulation THAs is presented. These patients were evaluated for patient characteristics, relationship between blood metal ions levels and the inclination as well as the version of acetabular component, cumulative survival probability at final followup and functional outcome at final followup. Materials and Methods: 288, size 36 mm MoM THAs implanted in 269 patients at our institution from 2004 to 2010 were included in this retrospective study. These patients were assessed clinically for hip symptoms, perioperative complications and causes of revision arthroplasty were analysed. Biochemically, blood cobalt and chromium metal ions level were recorded and measurements of acetabular inclination and version were examined. Radiological evaluation utilizing Metal Artefact Reduction Sequence (MARS) MRI was undertaken and implant cumulative survivorship was evaluated. Results: The mean followup was 5 years (range 2–7 years), mean age was 73 years and the mean Oxford hip score was 36.9 (range 5–48). Revision arthroplasty was executed in 20 (7.4%) patients, of which 15 patients underwent single-stage revision THA. The causes of revision arthroplasty were: ARMD changes in 6 (2.2%) patients, infection in 5 (1.9%) patients and aseptic loosening in 5 (1.9%) patients. Three (1.1%) patients had their hips revised for instability, 1 (0.3%) for raised blood metal ions levels. The implant cumulative survival rate, with revision for any reason, was 68.9% at 7 years. Conclusions: Although medium-sized MoM THA with a 36 mm head has a marginally better survivorship at midterm followup, compared to larger size head MoM articulating THA, our findings nonetheless are still worryingly poor in comparison to what has been quoted in the literature

  9. Delayed Presentation of Sciatic Nerve Injury after Total Hip Arthroplasty: Neurosurgical Considerations, Diagnosis, and Management

    PubMed Central

    Xu, Linda W.; Veeravagu, Anand; Azad, Tej D.; Harraher, Ciara; Ratliff, John K.

    2016-01-01

    Background  Total hip arthroplasty (THA) is an established treatment for end-stage arthritis, congenital deformity, and trauma with good long-term clinical and functional outcomes. Delayed sciatic nerve injury is a rare complication after THA that requires prompt diagnosis and management. Methods  We present a case of sciatic nerve motor and sensory deficit in a 52-year-old patient 2 years after index left THA. Electromyography (EMG) results and imaging with radiographs and CT of the affected hip demonstrated an aberrant acetabular cup screw in the posterior-inferior quadrant adjacent to the sciatic nerve. Case Description  The patient underwent surgical exploration that revealed injury to the peroneal division of the sciatic nerve due to direct injury from screw impingement. A literature review identified 11 patients with late-onset neuropathy after THA. Ten patients underwent surgical exploration and pain often resolved after surgery with 56% of patients recovering sensory function and 25% experiencing full recovery of motor function. Conclusions  Delayed neuropathy of the sciatic nerve is a rare complication after THA that is most often due to hardware irritation, component failure, or wear-related pseudotumor formation. Operative intervention is often pursued to explore and directly visualize the nerve with limited results in the literature showing modest relief of pain and sensory symptoms and poor restoration of motor function. PMID:27602309

  10. An Unusual Cause of Fever in a Patient with Total Hip Replacement.

    PubMed

    Vaishya, Raju; Agarwal, Amit Kumar; Vijay, Vipul

    2016-01-01

    Pyrexia of unknown origin (PUO) in a patient with acquired immunodeficiency syndrome (AIDS) is a challenging clinical problem despite recent advances in the diagnostic modalities. The diagnosis of the cause of fever is especially difficult in the postoperative period as the focus remains on the operative site. We present an unusual cause of PUO in a patient with advanced HIV disease during an immediate postoperative period following total hip arthroplasty (THA) for osteoarthritis (OA) of the left hip. The fever started on the eighth postoperative day, and after an extensive workup to rule out infection it was found that the patient was allergic to sulfa drugs. The fever subsided after discontinuation of trimethoprim/sulfamethoxazole. Fever in an immunocompromised patient should not be attributed only to infection. A high index of suspicion along with careful history making is required to diagnose drug fever. An early diagnosis of drug fever can reduce hospital stay and the costs of investigations and treatment. PMID:27014530

  11. Dislocation of a total hip arthroplasty: acute management in the ED.

    PubMed

    Fillingham, Yale A; Erickson, Brandon J; Cvetanovich, Gregory L; Della Valle, Craig J

    2014-12-01

    Dislocation is one of the most common complications of total hip arthroplasty (THA). Because of the growing number of patients undergoing THA annually and the immense number of patients who have previously undergone the procedure, familiarity with the diagnosis and treatment of this complication is critical. Although the most common direction of dislocation is posterior, anterior dislocations do occur, and correctly identifying the direction of dislocation is important before attempted closed reduction as both the reduction maneuvers used and the postoperative instructions afterward are distinct for an anterior as opposed to a posterior dislocation. We present the current case of an anterior hip dislocation that was unable to be closed reduced as the direction of dislocation was presumed to be posterior. Although a shoot through lateral is recommended in all cases to confirm the direction of dislocation, we highlight how the physician can differentiate the direction of dislocation based on the position of the foot and location of the lesser trochanter on the anteroposterior radiograph. PMID:24877720

  12. An appraisal of rehabilitation regimes used for improving functional outcome after total hip replacement surgery

    PubMed Central

    2012-01-01

    This study aimed to systematically review the literature with regards to studies of rehabilitation programmes that have tried to improve function after total hip replacement (THR) surgery. 15 randomised controlled trials were identified of which 11 were centre-based, 2 were home based and 2 were trials comparing home and centre based interventions. The use of a progressive resistance training (PRT) programme led to significant improvement in muscle strength and function if the intervention was carried out early (< 1 month following surgery) in a centre (6/11 centre-based studies used PRT), or late (> 1 month following surgery) in a home based setting (2/2 home based studies used PRT). In direct comparison, there was no difference in functional measures between home and centre based programmes (2 studies), with PRT not included in the regimes prescribed. A limitation of the majority of these intervention studies was the short period of follow up. Centre based program delivery is expensive as high costs are associated with supervision, facility provision, and transport of patients. Early interventions are important to counteract the deficit in muscle strength in the affected limb, as well as persistent atrophy that exists around the affected hip at 2 years post-operatively. Studies of early home-based regimes featuring PRT with long term follow up are needed to address the problems currently associated with rehabilitation following THR. PMID:22313723

  13. Poor short term outcome with a metal-on-metal total hip arthroplasty.

    PubMed

    Levy, Yadin D; Ezzet, Kace A

    2013-08-01

    Metal-on-metal (MoM) bearings for total hip arthroplasty (THA) have come under scrutiny with reports of high failure rates. Clinical outcome studies with several commercially available MoM THA bearings remain unreported. We evaluated 78 consecutive MoM THAs from a single manufacturer in 68 patients. Sixty-six received cobalt-chrome (CoCr) monoblock and 12 received modular titanium acetabular cups with internal CoCr liners. Femoral components were titanium with modular necks. At average 2.1 years postoperatively, 12 THAs (15.4%) demonstrated aseptic failure (10 revisions, 2 revision recommended). All revised hips demonstrated capsular necrosis with positive histology reaction for aseptic lymphocytic vasculitis-associated lesions/adverse local tissue reactions. Prosthetic instability following revision surgery was relatively common. Female gender was a strong risk factor for failure, though smaller cups were not. Both monoblock and modular components fared poorly. Corrosion was frequently observed around the proximal and distal end of the modular femoral necks. PMID:23538122

  14. An Unusual Cause of Fever in a Patient with Total Hip Replacement

    PubMed Central

    Vaishya, Raju; Vijay, Vipul

    2016-01-01

    Pyrexia of unknown origin (PUO) in a patient with acquired immunodeficiency syndrome (AIDS) is a challenging clinical problem despite recent advances in the diagnostic modalities. The diagnosis of the cause of fever is especially difficult in the postoperative period as the focus remains on the operative site. We present an unusual cause of PUO in a patient with advanced HIV disease during an immediate postoperative period following total hip arthroplasty (THA) for osteoarthritis (OA) of the left hip. The fever started on the eighth postoperative day, and after an extensive workup to rule out infection it was found that the patient was allergic to sulfa drugs. The fever subsided after discontinuation of trimethoprim/sulfamethoxazole. Fever in an immunocompromised patient should not be attributed only to infection. A high index of suspicion along with careful history making is required to diagnose drug fever. An early diagnosis of drug fever can reduce hospital stay and the costs of investigations and treatment. PMID:27014530

  15. Patient characteristics that affect the outcome of total hip arthroplasty: a review

    PubMed Central

    Young, Nancy L.; Cheah, David; Waddell, James P.; Wright, James G.

    1998-01-01

    Objective To review the literature regarding patient factors pertinent to the outcome of total hip arthroplasty (THA). Data sources MEDLINE from 1966 onward (key words “hip prosthesis” and “treatment outcome”) and literature previously known to the authors and cited in papers from all sources. Study selection All identified studies were included provided the methodology permitted assessment of the effect of patient factors and a clear outcome was defined (either prosthesis survival or specific functional outcomes). Data extraction The patient factors, methods and outcomes described in each paper were summarized on a data extraction form. Data synthesis All data were reviewed by one author. This process was repeated by a second author, and the findings were reviewed by the remaining 2 authors to verify the findings. The best functional outcomes and prosthesis survival rates were reported among patients who were between 45 and 75 years of age, weighed less than 70 kg, had strong social support, had a higher educational level, had better preoperative functional status and had no comorbid disease. Conclusion Important research remains to be done to examine the magnitude and interaction of patient factors on the outcome of THA. PMID:9627543

  16. Decision making regarding spinal osteotomy and total hip replacement for ankylosing spondylitis: experience with 28 patients.

    PubMed

    Zheng, G Q; Zhang, Y G; Chen, J Y; Wang, Y

    2014-03-01

    Few studies have examined the order in which a spinal osteotomy and total hip replacement (THR) are to be performed for patients with ankylosing spondylitis. We have retrospectively reviewed 28 consecutive patients with ankylosing spondylitis who underwent both a spinal osteotomy and a THR from September 2004 to November 2012. In the cohort 22 patients had a spinal osteotomy before a THR (group 1), and six patients had a THR before a spinal osteotomy (group 2). The mean duration of follow-up was 3.5 years (2 to 9). The spinal sagittal Cobb angle of the vertebral osteotomy segment was corrected from a pre-operative kyphosis angle of 32.4 (SD 15.5°) to a post-operative lordosis 29.6 (SD 11.2°) (p < 0.001). Significant improvements in pain, function and range of movement were observed following THR. In group 2, two of six patients had an early anterior dislocation. The spinal osteotomy was performed two weeks after the THR. At follow-up, no hip has required revision in either group. Although this non-comparative study only involved a small number of patients, given our experience, we believe a spinal osteotomy should be performed prior to a THR, unless the deformity is so severe that the procedure cannot be performed.

  17. 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.

  18. New polyethylenes in total hip replacement: A ten- to 12-year follow-up study.

    PubMed

    García-Rey, E; García-Cimbrelo, E; Cruz-Pardos, A

    2013-03-01

    Between 1999 and 2001, 90 patients underwent total hip replacement using the same uncemented acetabular and femoral components with a 28 mm metallic femoral head but with prospective randomisation of the acetabular liner to either Durasul highly cross-linked polyethylene or nitrogen-sterilised Sulene polyethylene. We assessed 83 patients at a minimum follow-up of ten years. Linear penetration of the femoral head was estimated at six weeks, six and 12 months and annually thereafter, using the Dorr method, given the non-spherical shape of the acetabular component. There was no loosening of any component; only one hip in the Sulene group showed proximal femoral osteolysis. The mean penetration of the femoral head at six weeks was 0.08 mm (0.02 to 0.15) for the Durasul group and 0.16 mm (0.05 to 0.28) for the Sulene group (p = 0.001). The mean yearly linear penetration was 64.8% lower for the Durasul group at 0.05 mm/year (sd 0.035) for the Sulene group and 0.02 mm/year (sd 0.016) for the Durasul (p < 0.001). Mean linear femoral head penetration at ten years was 61% less in the Durasul than Sulene group. Highly cross-linked polyethylene gives excellent results at ten years.

  19. Delayed Presentation of Sciatic Nerve Injury after Total Hip Arthroplasty: Neurosurgical Considerations, Diagnosis, and Management

    PubMed Central

    Xu, Linda W.; Veeravagu, Anand; Azad, Tej D.; Harraher, Ciara; Ratliff, John K.

    2016-01-01

    Background  Total hip arthroplasty (THA) is an established treatment for end-stage arthritis, congenital deformity, and trauma with good long-term clinical and functional outcomes. Delayed sciatic nerve injury is a rare complication after THA that requires prompt diagnosis and management. Methods  We present a case of sciatic nerve motor and sensory deficit in a 52-year-old patient 2 years after index left THA. Electromyography (EMG) results and imaging with radiographs and CT of the affected hip demonstrated an aberrant acetabular cup screw in the posterior-inferior quadrant adjacent to the sciatic nerve. Case Description  The patient underwent surgical exploration that revealed injury to the peroneal division of the sciatic nerve due to direct injury from screw impingement. A literature review identified 11 patients with late-onset neuropathy after THA. Ten patients underwent surgical exploration and pain often resolved after surgery with 56% of patients recovering sensory function and 25% experiencing full recovery of motor function. Conclusions  Delayed neuropathy of the sciatic nerve is a rare complication after THA that is most often due to hardware irritation, component failure, or wear-related pseudotumor formation. Operative intervention is often pursued to explore and directly visualize the nerve with limited results in the literature showing modest relief of pain and sensory symptoms and poor restoration of motor function.

  20. Friction of total hip replacements with different bearings and loading conditions.

    PubMed

    Brockett, Claire; Williams, Sophie; Jin, Zhongmin; Isaac, Graham; Fisher, John

    2007-05-01

    Metal-on-ultra-high molecular weight polyethylene (UHMWPE) total hip replacements have been the most popular and clinically successful implants to date. However, it is well documented that the wear debris from these prostheses contributes to osteolysis and ultimate failure of the prosthesis, hence alternative materials have been sought. A range of 28 mm diameter bearings were investigated using a hip friction simulator, including conventional material combinations such as metal-on-UHWMPE, ceramic-on-ceramic (CoC), and metal-on-metal (MoM), as well as novel ceramic-on-metal (CoM) pairings. Studies were performed under different swing-phase load and lubricant conditions. The friction factors were lowest in the ceramic bearings, with the CoC bearing having the lowest friction factor in all conditions. CoM bearings also had low friction factors compared with MoM, and the trends were similar to CoC bearings for all test conditions. Increasing swing phase load was shown to cause an increase in friction factor in all tests. Increased serum concentration resulted in increased friction factor in all material combinations, except MoM, where increased serum concentration produced a significant reduction in friction factor.

  1. The effect of femoral offset modification on gait after total hip arthroplasty

    PubMed Central

    2014-01-01

    Background and purpose A decrease of 15% in femoral offset (FO) has been reported to generate a weakness of the abductor muscle, but this has not been directly linked to an alteration of gait. Our hypothesis was that this 15% decrease in FO may also generate a clinically detectable alteration in the gait. Patients and methods We performed a prospective comparative study on 28 patients who underwent total hip arthroplasty (THA) for unilateral primary osteoarthritis. The 3D hip anatomy was analyzed preoperatively and postoperatively. 3 groups were defined according to the alteration in FO following surgery: a minimum decrease of 15% (9 patients), restored (14), and a minimum increase of 15% (5). A gait analysis was performed at 1-year follow-up using an ambulatory device. Each limb was compared to the contralateral healthy limb. Results In contrast to the “restored” group and the “increased” group, in the “decreased” group there was a statistically significant asymmetry between sides, with reduced range of motion and a lower maximal swing speed on the operated side. Interpretation A decrease in FO of 15% or more after THA leads to an alteration in the gait. We recommend 3-D preoperative planning because the FO may be underestimated by up to 20% on radiographs and it may therefore not be restored, with clinical consequences. PMID:24564749

  2. Is Drain Tip Culture Prognostic of Surgical Site Infection? Results of 1380 Drain Tip Cultures in Total Hip Arthroplasty.

    PubMed

    Takada, Ryohei; Jinno, Tetsuya; Koga, Daisuke; Hirao, Masanobu; Muneta, Takeshi; Okawa, Atsushi

    2015-08-01

    The purpose of this study was to evaluate a prognostic value of drain tip culture for surgical site infection (SSI) after total hip arthroplasty. A total of 1380 closed suction drain tips cultured after removal in primary total hip arthroplasty were included in this study. Drains were removed in 12-72 hours after surgery. Drain tip cultures were positive in 11 cases (0.8%). SSI was found in 4 cases (0.3%), where the drain tip cultures were all negative. The sensitivity of drain tip culture for infection after surgery was 0%, and the specificity was 99.7%. We concluded that, drain tip culture cannot be prognostic for SSI after total hip arthroplasty. Routine use of drain tip culture is not supported.

  3. The Current State of Screening and Decolonization for the Prevention of Staphylococcus aureus Surgical Site Infection After Total Hip and Knee Arthroplasty.

    PubMed

    Weiser, Mitchell C; Moucha, Calin S

    2015-09-01

    The most common pathogens in surgical site infections after total hip and knee arthroplasty are methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA), and coagulase-negative staphylococci. Patients colonized with MSSA or MRSA have an increased risk for a staphylococcal infection at the site of a total hip or knee arthroplasty. Most colonized individuals who develop a staphylococcal infection at the site of a total hip or total knee arthroplasty have molecularly identical S. aureus isolates in their nares and wounds. Screening and nasal decolonization of S. aureus can potentially reduce the rates of staphylococcal surgical site infection after total hip and total knee arthroplasty.

  4. Prevalence of deep vein thrombosis and pulmonary embolism treated with mechanical compression device after total hip arthroplasty.

    PubMed

    Kim, Young-Hoo; Kulkarni, Sourabh S; Park, Jang-Won; Kim, Bom Sahn

    2015-04-01

    Several reports have suggested that there is a strikingly low prevalence of deep vein thrombosis (DVT) and pulmonary embolism (PE) after total hip arthroplasty (THA) in Asian patients. We determined the prevalence of DVT and PE after the use of a mechanical compression device only without pharmacological thromboprophylaxis in 459 patients (516 hips). The overall prevalence of DVT was 4.8% (27 of 561 hips). Nine of 27 hips had proximal thrombi. Three patients (0.7%) had asymptomatic PE. In our patients, combinations of absent thrombophilic polymorphisms with low clinical prothrombotic risk factors led to a low prevalence of DVT and virtually no symptomatic PE. Therefore, mechanical compression device only suffices to prevent DVT and PE in Asian patients.

  5. A Multicenter Approach Evaluating the Impact of Vitamin E-Blended Polyethylene in Cementless Total Hip Replacement

    PubMed Central

    Jäger, Marcus; van Wasen, Andrea; Warwas, Sebastian; Landgraeber, Stefan; Haversath, Marcel; Group, VITAS

    2014-01-01

    Since polyethylene is one of the most frequently used biomaterials as a liner in total hip arthroplasty, strong efforts have been made to improve design and material properties over the last 50 years. Antioxidants seems to be a promising alternative to further increase durability and reduce polyethylene wear in long term. As of yet, only in vitro results are available. While they are promising, there is yet no clinical evidence that the new material shows these advantages in vivo. To answer the question if vitamin-E enhanced ultra-high molecular weight polyethylene (UHMWPE) is able to improve long-term survivorship of cementless total hip arthroplasty we initiated a randomized long-term multicenter trial. Designed as a superiority study, the oxidation index assessed in retrieval analyses of explanted liners was chosen as primary parameter. Radiographic results (wear rate, osteolysis, radiolucency) and functional outcome (Harris Hip Scores, University of California-Los Angeles, Hip Disability and Osteoarthritis Outcome Score, Visual Analogue Scale) will serve as secondary parameters. Patients with the indication for a cementless total hip arthroplasty will be asked to participate in the study and will be randomized to either receive a standard hip replacement with a highly cross-linked UHMWPE-X liner or a highly cross-linked vitamin-E supplemented UHMWPE-XE liner. The follow-up will be 15 years, with evaluation after 5, 10 and 15 years. The controlled randomized study has been designed to determine if Vitamin-E supplemented highly cross-linked polyethylene liners are superior to standard XLPE liners in cementless total hip arthroplasty. While several studies have been started to evaluate the influence of vitamin-E, most of them evaluate wear rates and functional results. The approach used for this multicenter study, to analyze the oxidation status of retrieved implants, should make it possible to directly evaluate the ageing process and development of the implant

  6. In-Hospital Cost Analysis of Total Hip Arthroplasty: Does Surgical Approach Matter?

    PubMed

    Petis, Stephen M; Howard, James L; Lanting, Brent A; Marsh, Jacquelyn D; Vasarhelyi, Edward M

    2016-01-01

    The purposes of this study were to determine the impact of surgical approach on costs of total hip arthroplasty (THA) from a hospital perspective and to provide an updated cost estimation of THA. A prospective, microcosting analysis was performed on 118 patients undergoing a THA through an anterior, lateral, or posterior approach. We determined that overall costs (intraoperative costs and hospital stay) were significantly less for the anterior ($7300.22; 95% confidence interval [CI], 7064.49-7535.95) vs lateral ($7853.10; 95% CI, 7577.29-8128.91; P = .031) and anterior vs posterior approach ($8287.46; 95% CI, 7906.42-8668.51; P < .001). A reduction in hospital length of stay when THA was performed through an anterior approach contributed significantly to an overall reduction in costs from a hospital perspective.

  7. Biomechanical Study on Distal Filling Effects in Cementless Total Hip Replacement

    NASA Astrophysics Data System (ADS)

    Chae, Soo-Won; Lee, Jun-Hyoung; Choi, Hyung-Yun

    In cementless total hip replacement, initial stability of the femoral component is important in the long term fixation of the femoral stem. Initial stability is closely related to the relative displacement between the prosthesis and the cancellous bone of the proximal femur. After implantation of the prosthesis, the surrounding bone is partially shielded from load carrying and starts to resorb. Stress shielding causes the loss of the proximal bone. The stress distribution of femur must be assessed to predict stress shielding. The initial stability and the stress shielding were investigated for two loading conditions approximating a single leg stance and stair climbing. Two types of stems involving a distal filling and a distal short stem were studied by the finite element method to investigate the biomechanical distal filling effects. The distal short stem produced less stress shielding at the proximal bone than the distal filling stem, while both types of stems seemed to satisfy the initial stability requirement.

  8. Morse-type tapers: factors that may influence taper strength during total hip arthroplasty.

    PubMed

    Pennock, Andrew T; Schmidt, Andrew H; Bourgeault, Craig A

    2002-09-01

    We studied the effect of varying impaction force, repeated impactions, and fluid contamination on the disassembly strength of Morse-type tapers in 4 commercially available, modular femoral total hip components. The effect of varying techniques of taper assembly on the distraction force was studied. Our results show a reproducible and linear relationship between the taper impaction force and the disassembly force. The force necessary to separate the taper for a given impaction force varied, however, among manufacturers. Repeated impactions added little strength, and we found that when multiple impactions of varying force are used, the strength is roughly equivalent to the expected strength from the single strongest blow. Fluid contamination at the taper interface had unpredictable effects on taper strength.

  9. Vascular complications following total hip arthroplasty: a case study and a review of the literature.

    PubMed

    Barbier, Olivier; Pierret, Charles; Bazile, Fabrice; De Kerangal, Xavier; Duverger, Vincent; Versier, Gilbert

    2012-11-01

    Vascular complications after total hip arthroplasty (THA) are rare but represent a real risk. The diversity of clinical presentations can make diagnosis difficult. They could manifest as an immediate and acute hemorrhage or subsequent ischemia. We report the case of a patient who presented a thrombosis of the femoral artery associated with a sciatic palsy after THA for a coxa profunda. The diagnosis was actually made 3 years after surgery because of atypical symptoms. The mechanism involved was either a crash of the artery by a retractor on the anterior wall of the acetabulum, or a stretching of the artery. A review of the literature of vascular complications occurring after THA recalls the multiplicity of clinical presentations and the diagnostic difficulties. They could manifest as an immediate and acute hemorrhage or deferred ischemia, as in our case. Knowledge of these complications should help prevent them, and the diagnosis should be considered in atypical sequences after THA.

  10. A Novel Formulation for Scratch-Based Wear Modeling in Total Hip Arthroplasty

    PubMed Central

    Kruger, Karen M.; Tikekar, Nishant M.; Heiner, Anneliese D.; Baer, Thomas E.; Lannutti, John J.; Callaghan, John J.; Brown, Thomas D.

    2013-01-01

    Damage to the femoral head in total hip arthroplasty often takes the form of discrete scratches, which can lead to dramatic wear acceleration of the polyethylene (PE) liner. Here, a novel formulation is reported for finite element analysis of wear acceleration due to scratch damage. A diffused-light photography technique was used to globally locate areas of damage, providing guidance for usage of high-magnification optical profilometry to determine individual scratch morphology. This multiscale image combination allowed comprehensive input of scratch-based damage patterns to a finite element (FE) Archard wear model, to determine the wear acceleration associated with specific retrieval femoral heads. The wear algorithm imposed correspondingly elevated wear factors on areas of PE incrementally overpassed by individual scratches. Physical validation was provided by agreement with experimental data for custom-ruled scratch patterns. Illustrative wear acceleration results are presented for four retrieval femoral heads. PMID:23305334

  11. Serum Metal Ion Levels Following Total Hip Arthroplasty With Modular Dual Mobility Components.

    PubMed

    Matsen Ko, Laura J; Pollag, Kimberley E; Yoo, Joanne Y; Sharkey, Peter F

    2016-01-01

    Dual mobility acetabular components can reduce the incidence of total hip arthroplasty (THA) instability. Modular dual mobility (MDM) components facilitate acetabular component implantation. However, corrosion can occur at modular junctions. Serum cobalt and chromium levels and Oxford scores were obtained at minimum two year follow-up for 100 consecutive patients who had THA with MDM components. Average Oxford score was 43 (range 13-48). Average serum cobalt and chromium values were 0.7 mcg/L (range, 0.0 to 7.0) and 0.6 mcg/L (range, 0.1 to 2.7), respectively. MARS MRI was performed for four patients with pain and elevated serum cobalt levels. Two of these studies were consistent with adverse local tissue reaction. We recommend use of MDM implants in only patients at high risk for dislocation following THA.

  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. PMID:22245126

  13. A novel formulation for scratch-based wear modelling in total hip arthroplasty.

    PubMed

    Kruger, Karen M; Tikekar, Nishant M; Heiner, Anneliese D; Baer, Thomas E; Lannutti, John J; Callaghan, John J; Brown, Thomas D

    2014-01-01

    Damage to the femoral head in total hip arthroplasty often takes the form of discrete scratches, which can lead to dramatic wear acceleration of the polyethylene (PE) liner. Here, a novel formulation is reported for finite element (FE) analysis of wear acceleration due to scratch damage. A diffused-light photography technique was used to globally locate areas of damage, providing guidance for usage of high-magnification optical profilometry to determine individual scratch morphology. This multiscale image combination allowed comprehensive input of scratch-based damage patterns to an FE Archard wear model, to determine the wear acceleration associated with specific retrieval femoral heads. The wear algorithm imposed correspondingly elevated wear factors on areas of PE incrementally overpassed by individual scratches. Physical validation was provided by agreement with experimental data for custom-ruled scratch patterns. Illustrative wear acceleration results are presented for four retrieval femoral heads.

  14. Three-dimensional printing for preoperative planning of total hip arthroplasty revision: case report.

    PubMed

    Zerr, Joseph; Chatzinoff, Yonatan; Chopra, Rajiv; Estrera, Kenneth; Chhabra, Avneesh

    2016-10-01

    Three dimensional (3D) printing can be used to create material models to aid preoperative planning of complex orthopedic procedures as exemplified by this case of total hip arthroplasty failure due to infection with resulting severe acetabular bone stock deficiency. The 3D model allowed for trialing of the acetabular component to determine cup size, position, and screw placement. Most importantly, the model confirmed that there was not a pelvic discontinuity and the revision shell would be sufficient for the reconstruction. Previously, the cost and complexity of utilization of 3D printers were prohibitive. Recent improvements in commercially available 3D printers have made rapid prototype model creation a realistic option, which can facilitate difficult surgery. PMID:27480617

  15. Outcomes Following Primary Total Hip or Knee Arthroplasty in Substance Misusers.

    PubMed

    Best, Matthew J; Buller, Leonard T; Klika, Alison K; Barsoum, Wael K

    2015-07-01

    The influence of drug misuse on outcomes following primary total hip (THA) or knee (TKA) arthroplasty is poorly understood. The National Hospital Discharge Survey was used to identify patients who underwent primary THA or TKA between 1990 and 2007. Patients were divided into two groups: 1) those with a diagnosis of drug misuse (cannabis, opioids, cocaine, amphetamines, sedatives, inhalants or mixed combinations) (n=13,163) and 2) those with no diagnosis of misuse (n=8,366,327). Patients with a diagnosis of drug misuse had longer hospital stays (P<0.001), nearly eight times the odds of leaving against medical advice (P<0.001) and five times the mortality rate (P<0.001). Drug misuse was associated with higher odds (P<0.001) of complications including postoperative infection, anemia, convulsions, osteomyelitis, and blood transfusion. PMID:25765129

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

    NASA Astrophysics Data System (ADS)

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

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

  17. Design parameters dependences on contact stress distribution in gait and jogging phases after total hip arthroplasty.

    PubMed

    Rixrath, E; Wendling-Mansuy, S; Flecher, X; Chabrand, P; Argenson, J N

    2008-01-01

    We have developed a mathematical model to calculate the contact stress distribution in total hip arthroplasty (THA) prosthesis between the articulating surfaces. The model uses the clearance between bearing surfaces as well as the inclination and thickness of the Ultra High Molecular Weight Poly-Ethylene (UHMWPE) cup to achieve this. We have used this mathematical model to contrast the maximal force during normal gait and during jogging. This is based on the assumption that the contact stress is proportional to the radial deformation of the cup. The results show that the magnitude of the maximal contact stress remains constant for inclination values in the range of [0-35 degrees ] and increase significantly with the cup clearance and liner thickness for inclination values in the range of [35-65 degrees ]. A major use for this model would be the calculation of spatial contact stress distribution during normal gait or jogging for different couples of bearing surfaces. PMID:18234204

  18. Preventing Venous Thromboembolism with Use of Intermittent Pneumatic Compression after Total Hip Arthroplasty in Korean Patients

    PubMed Central

    2016-01-01

    Intermittent Pneumatic Compression (IPC) device has been used to prevent venous thromboembolism (VTE). This study investigated the effectiveness of IPC device. We evaluated incidences of deep vein thrombosis (DVT) and pulmonary embolism (PE) in total hip arthroplasty (THA) patients after use of IPC device, and compared with historical incidences from our institution. We applied IPC device in 741 patients who underwent 870 elective primary THAs from January 2010 to December 2013, DVT was detected in 3 patients (0.3%) by sonography, and one (0.1%) of them was symptomatic. Symptomatic PE occurred in 1 patient (0.1%) and there were no cases of fatal PE. The incidence of symptomatic DVT was significantly lower than the historical control (P = 0.042). The IPC is a safe and effective prophylaxis of VTE after primary THA in Korea. PMID:27478345

  19. Patient, Surgery, and Hospital Related Risk Factors for Surgical Site Infections following Total Hip Arthroplasty

    PubMed Central

    Triantafyllopoulos, Georgios; Memtsoudis, Stavros; Poultsides, Lazaros A.

    2015-01-01

    Surgical site infections (SSI) following total hip arthroplasty (THA) have a significantly adverse impact on patient outcomes and pose a great challenge to the treating surgeon. Therefore, timely recognition of those patients at risk for this complication is very important, as it allows for adopting measures to reduce this risk. This review discusses literature reported risk factors for SSI after THA. These can be classified into patient-related factors (age, gender, obesity, comorbidities, history of infection, primary diagnosis, and socioeconomic profile), surgery-related factors (allogeneic blood transfusion, DVT prophylaxis and coagulopathy, duration of surgery, antibiotic prophylaxis, bearing surface and fixation, bilateral procedures, NNIS index score, and anesthesia type), and hospital-related factors (duration of hospitalization, institution and surgeon volume, and admission from a healthcare facility). All these factors are discussed with respect to potential measures that can be taken to reduce their effect and consequently the overall risk for infection. PMID:26075298

  20. Three-dimensional printing for preoperative planning of total hip arthroplasty revision: case report.

    PubMed

    Zerr, Joseph; Chatzinoff, Yonatan; Chopra, Rajiv; Estrera, Kenneth; Chhabra, Avneesh

    2016-10-01

    Three dimensional (3D) printing can be used to create material models to aid preoperative planning of complex orthopedic procedures as exemplified by this case of total hip arthroplasty failure due to infection with resulting severe acetabular bone stock deficiency. The 3D model allowed for trialing of the acetabular component to determine cup size, position, and screw placement. Most importantly, the model confirmed that there was not a pelvic discontinuity and the revision shell would be sufficient for the reconstruction. Previously, the cost and complexity of utilization of 3D printers were prohibitive. Recent improvements in commercially available 3D printers have made rapid prototype model creation a realistic option, which can facilitate difficult surgery.

  1. Uncemented porous tantalum acetabular components: early follow-up and failures in 613 primary total hip arthroplasties.

    PubMed

    Noiseux, Nicolas O; Long, William J; Mabry, Tad M; Hanssen, Arlen D; Lewallen, David G

    2014-03-01

    Uncemented tantalum acetabular components were introduced in 1997. The purpose was to determine the 2- to 10-year results with this implant material in primary total hip arthroplasty. Our registry identified all primary total hip cases with porous tantalum cups implanted from 1997 to 2004. Clinical outcomes and radiographs were studied. 613 cases were identified. Seventeen percent of patients were lost to follow-up. Twenty-five reoperations were performed (4.4%). Acetabular cup removal occurred in 6 cases (1.2%). No cups were revised for aseptic loosening. Incomplete radiolucent lines were found on 9.3% of initial postoperative radiographs. At 2 years, 67% had resolved. Zero new radiolucent lines were detected. Two- to 10-year results of porous tantalum acetabular components for primary total hip arthroplasty demonstrate high rates of initial stability and apparent ingrowth.

  2. Surrogate markers of long-term outcome in primary total hip arthroplasty

    PubMed Central

    Malak, T. T.; Broomfield, J. A. J.; Palmer, A. J. R.; Hopewell, S.; Carr, A.; Brown, C.; Prieto-Alhambra, D.

    2016-01-01

    Objectives High failure rates of metal-on-metal hip arthroplasty implants have highlighted the need for more careful introduction and monitoring of new implants and for the evaluation of the safety of medical devices. The National Joint Registry and other regulatory services are unable to detect failing implants at an early enough stage. We aimed to identify validated surrogate markers of long-term outcome in patients undergoing primary total hip arthroplasty (THA). Methods We conducted a systematic review of studies evaluating surrogate markers for predicting long-term outcome in primary THA. Long-term outcome was defined as revision rate of an implant at ten years according to National Institute of Health and Care Excellence guidelines. We conducted a search of Medline and Embase (OVID) databases. Separate search strategies were devised for the Cochrane database and Google Scholar. Each search was performed to include articles from the date of their inception to June 8, 2015. Results Our search strategy identified 1082 studies of which 115 studies were included for full article review. Following review, 17 articles were found that investigated surrogate markers of long-term outcome. These included one systematic review, one randomised control trial (RCT), one case control study and 13 case series. Validated surrogate markers included Radiostereometric Analysis (RSA) and Einzel-Bild-Röntgen-Analyse (EBRA), each measuring implant migration and wear. We identified five RSA studies (one systematic review and four case series) and four EBRA studies (one RCT and three case series). Patient Reported Outcome Measures (PROMs) at six months have been investigated but have not been validated against long-term outcomes. Conclusions This systematic review identified two validated surrogate markers of long-term primary THA outcome: RSA and EBRA, each measuring implant migration and wear. We recommend the consideration of RSA in the pre-market testing of new implants. EBRA can

  3. Clinical and Wear Analyses of 9 Large Metal-on-Metal Total Hip Prostheses

    PubMed Central

    Mathijssen, N. M. C.; Witt, F.; Morlock, M. M.; Vehmeijer, S. B. W.

    2016-01-01

    Background Metal-on-Metal (MoM) total hip arthroplasties (THA) are associated with pseudotumor formation and high revision rates. This prospective study analysed the clinical and wear analyses of 9 large Metal-on-Metal (MoM) total hip arthroplasties (THA) to understand the underlying mechanisms of failure. The MoM bearings were revised for multiple reasons; the main reason was pseudotumor formation. Materials and Methods From 2006 till 2010 the Reinier de Graaf Hospital implanted 160 large head M2a-Magnum™ (Biomet Inc. Warsaw, Indiana, USA) THAs in 150 patients. The first year, 9 bearings were revised and analysed at the Biomechanics Section, Hamburg University of Technology, Germany. We performed clinical (Harris Hip Score, radiographic analysis, blood cobalt and chromium) and wear analysis (implant, tissue and fluid) of the 9 bearings. Since this study did not fall under the scope of the Medical Research Involving Human Subjects Act in The Netherlands, no ethical approval was necessary. In this prospective study all patient details were anonymized by the corresponding author, all other authors were blinded during the research and wear analyses. Patients with bilateral MoM implants were excluded. Results The 9 bearings had a median (IQR) survival of 41.0 (25) months in situ. From these bearings, three showed no noticeable wear. The median (IQR) head wear volume was 3.2 (3.6) mm3 and maximum wear depth 0.02 (0.02) mm. For the cup the median (IQR) wear volume was 0.23 (0.3) mm3 with a maximum wear depth of 0.03 (0.05) mm. Conclusion An early identification of parameters related to failure of the MoM THA, such as pain, decreased range of motion, radiographic changes and high levels of blood cobalt and chromium is of great importance for patient’s quality of life. Especially now patients and surgeons face the long term effects of all these bearings still in situ. This study reports the clinical and wear analyses of 9 MoM THA. In the majority of this group the

  4. Cancer risk estimates from radiation therapy for heterotopic ossification prophylaxis after total hip arthroplasty

    SciTech Connect

    Mazonakis, Michalis; Berris, Theoharris; Damilakis, John; Lyraraki, Efrossyni

    2013-10-15

    Purpose: Heterotopic ossification (HO) is a frequent complication following total hip arthroplasty. This study was conducted to calculate the radiation dose to organs-at-risk and estimate the probability of cancer induction from radiotherapy for HO prophylaxis.Methods: Hip irradiation for HO with a 6 MV photon beam was simulated with the aid of a Monte Carlo model. A realistic humanoid phantom representing an average adult patient was implemented in Monte Carlo environment for dosimetric calculations. The average out-of-field radiation dose to stomach, liver, lung, prostate, bladder, thyroid, breast, uterus, and ovary was calculated. The organ-equivalent-dose to colon, that was partly included within the treatment field, was also determined. Organ dose calculations were carried out using three different field sizes. The dependence of organ doses upon the block insertion into primary beam for shielding colon and prosthesis was investigated. The lifetime attributable risk for cancer development was estimated using organ, age, and gender-specific risk coefficients.Results: For a typical target dose of 7 Gy, organ doses varied from 1.0 to 741.1 mGy by the field dimensions and organ location relative to the field edge. Blocked field irradiations resulted in a dose range of 1.4–146.3 mGy. The most probable detriment from open field treatment of male patients was colon cancer with a high risk of 564.3 × 10{sup −5} to 837.4 × 10{sup −5} depending upon the organ dose magnitude and the patient's age. The corresponding colon cancer risk for female patients was (372.2–541.0) × 10{sup −5}. The probability of bladder cancer development was more than 113.7 × 10{sup −5} and 110.3 × 10{sup −5} for males and females, respectively. The cancer risk range to other individual organs was reduced to (0.003–68.5) × 10{sup −5}.Conclusions: The risk for cancer induction from radiation therapy for HO prophylaxis after total hip arthroplasty varies considerably by the

  5. Total Hip Arthroplasty Dislocations Are More Complex Than They Appear: A Case Report of Intraprosthetic Dislocation of an Anatomic Dual-Mobility Implant After Closed Reduction

    PubMed Central

    Waddell, Bradford S.; De Martino, Ivan; Sculco, Thomas; Sculco, Peter

    2016-01-01

    Background: Total hip arthroplasty is a successful operation for the treatment of hip pain. One of the common complications of hip arthroplasty is dislocation. While reduction of standard prosthetic dislocations is highly successful, new prostheses add the potential for new complications. Case Report: We present the case of a patient who experienced intraprosthetic dislocation of an anatomic dual-mobility total hip prosthesis after a closed hip reduction and include the prereduction and postreduction radiographic findings. Conclusion: Emergency department physicians should be aware of intraprosthetic dislocation. This complication can be easily missed because the metal/ceramic femoral head appears to be reduced in the acetabulum. PMID:27303232

  6. Clinical outcome following primary total hip or knee replacement in nonagenarians.

    PubMed

    Skinner, D; Tadros, B J; Bray, E; Elsherbiny, M; Stafford, G

    2016-04-01

    Introduction The Elective Orthopaedic Centre in Epsom has an established patient reported outcome measures programme, into which all patients are enrolled. Postoperative complications, Oxford hip/knee scores (OHS/OKS) and EQ-5D™ (EuroQol, Rotterdam, Netherlands) scores are collected up to the second postoperative year. Our population is ageing and the number of joint replacements being performed on the very elderly is rising. The aim of this study was to investigate the outcome of joint replacements in a nonagenarian population. Methods Our dataset was reviewed retrospectively for a cohort of nonagenarians undergoing either a primary total hip replacement (THR) or total knee replacement (TKR) between April 2008 and October 2011. Postoperative complications, mortality rates and functional outcomes were compared with those of a time matched 70-79-year-old cohort. Results Nonagenarians requiring a THR presented with a lower preoperative OHS (p=0.020) but made a greater improvement in the first postoperative year than the younger cohort (p=0.040). The preoperative OKS was lower for nonagenarians than for the control group (p=0.022). At one and two years after TKR, however, there was no significant difference between the age groups. The nonagenarians had a greater risk of requiring a blood transfusion following both THR (p=0.027; 95% confidence interval [CI]: 1.11-5.75) and TKR (p=0.037; 95% CI: 1.08-16.65) while the latter cohort also required a longer stay than their younger counterparts (p=0.001). Mortality rates were higher in the nonagenarian group but these were in keeping with the life expectancy projections identified by the Office for National Statistics. Conclusions Over a two-year period, the functional outcome and satisfaction rates achieved by nonagenarians following a THR or TKR are comparable with 70-79-year-olds. PMID:26924477

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

    PubMed

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

    2015-12-01

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

  8. Pre-operative function, motivation and duration of symptoms predict sporting participation after total hip replacement.

    PubMed

    Ollivier, M; Frey, S; Parratte, S; Flecher, X; Argenson, J N

    2014-08-01

    There is little in the literature on the level of participation in sports which patients undertake after total hip replacement (THR). Our aims in this study were to determine first, the level of sporting activity, second, the predictive factors for returning to sporting activity, and third, the correlation between participation in sports and satisfaction after THR. We retrospectively identified 815 patients who had undergone THR between 1995 and 2005. All were asked to complete a self-administered questionnaire regarding their sporting activity. A total of 571 patients (71%) met the inclusion criteria and completed the evaluation. At a mean follow-up of 9.8 years (sd 2.9), 366 patients (64%) returned to sporting activity as defined by a University of California at Los Angeles (UCLA) score of > 5. The main reasons that patients had for refraining from sports were fear of dislocation (65; 31.6%), avoiding wear (52; 25.4%), and the recommendation of the surgeon (34; 16.6%). There was a significant relationship between higher post-operative participation in sport in those patients with a higher pre-operative Harris hip score (HHS) (p = 0.0074), motivation to participate in sporting activities (p = 0.00022) and a shorter duration of symptoms (p = 0.0034). Finally, there was a correlation between age (p = 0.00013), UCLA score (p = 0.012) and pre-operative HHS (p = 0.00091) and satisfaction. In conclusion, we found that most patients participate in sporting activity after THR, regardless of the advice of their surgeon, and that there is a correlation between the level of participation and pre-operative function, motivation, duration of symptoms and post-operative satisfaction.

  9. Can Optimism, Pessimism, Hope, Treatment Credibility and Treatment Expectancy Be Distinguished in Patients Undergoing Total Hip and Total Knee Arthroplasty?

    PubMed Central

    Haanstra, Tsjitske M.; Tilbury, Claire; Kamper, Steven J.; Tordoir, Rutger L.; Vliet Vlieland, Thea P. M.; Nelissen, Rob G. H. H.; Cuijpers, Pim; de Vet, Henrica C. W.; Dekker, Joost; Knol, Dirk L.; Ostelo, Raymond W.

    2015-01-01

    Objectives The constructs optimism, pessimism, hope, treatment credibility and treatment expectancy are associated with outcomes of medical treatment. While these constructs are grounded in different theoretical models, they nonetheless show some conceptual overlap. The purpose of this study was to examine whether currently available measurement instruments for these constructs capture the conceptual differences between these constructs within a treatment setting. Methods Patients undergoing Total Hip and Total Knee Arthroplasty (THA and TKA) (Total N = 361; 182 THA; 179 TKA), completed the Life Orientation Test-Revised for optimism and pessimism, the Hope Scale, the Credibility Expectancy Questionnaire for treatment credibility and treatment expectancy. Confirmatory factor analysis was used to examine whether the instruments measure distinct constructs. Four theory-driven models with one, two, four and five latent factors were evaluated using multiple fit indices and Δχ2 tests, followed by some posthoc models. Results The results of the theory driven confirmatory factor analysis showed that a five factor model in which all constructs loaded on separate factors yielded the most optimal and satisfactory fit. Posthoc, a bifactor model in which (besides the 5 separate factors) a general factor is hypothesized accounting for the commonality of the items showed a significantly better fit than the five factor model. All specific factors, except for the hope factor, showed to explain a substantial amount of variance beyond the general factor. Conclusion Based on our primary analyses we conclude that optimism, pessimism, hope, treatment credibility and treatment expectancy are distinguishable in THA and TKA patients. Postdoc, we determined that all constructs, except hope, showed substantial specific variance, while also sharing some general variance. PMID:26214176

  10. Three-Dimensional Analysis of the Contact Pattern between the Cortical Bone and Femoral Prosthesis after Cementless Total Hip Arthroplasty

    PubMed Central

    Mishima, Hajime; Sugaya, Hisashi; Nishino, Tomofumi; Yamazaki, Masashi

    2016-01-01

    The cementless stem Excia (B. Braun, Melsungen, Germany) implant has a rectangular cross-sectional shape with back-and-forth flanges and a plasma-sprayed, dicalcium phosphate dihydrate coating from the middle to proximal portion to increase initial fixation and early bone formation. Here, the conformity of the Excia stem to the femoral canal morphology was three-dimensionally assessed using computed tomography. Forty-three patients (45 hips) were examined after primary total hip arthroplasty with a mean follow-up of 27 ± 3 months (range: 24–36 months). Spot welds occurred at zone 2 in 16 hips and at zone 6 in 24 hips, with 83% (20/24 hips) of those occurring within 3 months after surgery. First- (n = 12 hips), second- (n = 32), and third- (n = 1) degree stress shielding were observed. The stem was typically in contact with the cortical bone in the anterolateral mid-portion (100%) and posteromedial distal portions (85%). Stress shielding did not progress, even in cases where the stems were in contact with the distal portions. The anterior flange was in contact with the bone in all cases. The stability of the mid-lateral portion with the dicalcium phosphate dihydrate coating and the anterior flange may have inhibited the progression of stress shielding beyond the second degree. PMID:26881087

  11. Deep venous thrombosis after total hip or knee arthroplasty in a "low-risk" Chinese population.

    PubMed

    Ko, P S; Chan, W F; Siu, T H; Khoo, J; Wu, W C; Lam, J J

    2003-02-01

    Scarcely any information has been published on deep vein thrombosis (DVT) in Chinese patients after total hip arthroplasty (THA) or total knee arthroplasty (TKA). However, generally, no prophylaxis is given to patients who do not have conventional high-risk factors because they are believed to be at "low risk." We performed a prospective study on 80 such "low risk" patients undergoing THA or TKA (58 TKA and 22 THA) without prophylaxis and performed duplex ultrasonography on both lower limbs 6 to 8 days after surgery. A total of 22 patients (27.5%) showed ultrasonographic evidence of DVT. Eighteen (31%) TKAs and 4 (18.1%) THAs were complicated by DVT. Three patients showed bilateral involvement, all of whom underwent TKA. Two patients had symptomatic pulmonary embolism. The sensitivity and positive predictive value of the clinical examination was 27.2% and 31.6%, respectively. This study showed that patients who are labeled "low risk" for DVT actually had a significant risk and suggests that the current practice of providing prophylaxis to only patients deemed at "high risk" should be revised.

  12. Topical versus systemic tranexamic acid after total knee and hip arthroplasty

    PubMed Central

    Chen, Yongcai; Chen, Zhuo; Cui, Shuo; Li, Zhiyang; Yuan, Zhengjiang

    2016-01-01

    Abstract Background: Tranexamic acid (TXA) is an antifibrinolytic drug widely used to reduce blood loss during joint replacements, including total knee arthroplasty (TKA) and total hip arthroplasty (THA). However, there is no final consensus regarding the composition of an optimal administration of TXA regime between topical and systemic (intravenous). The purpose of our study was to compare the efficacy of topical and intravenous (IV) regimen of TXA during TKA and THA. Methods: Five relevant electronic online databases, PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science and Chinese Biomedical Database were systematically searched in November 2015. Randomized controlled trials (RCTs) that compared topical with intravenous TXA in patients with TKA or THA were included. The search terms included “topical,” “intravenous,” “tranexamic acid,” “knee arthroplasty” and “hip arthroplasty.” Two reviewers independently extracted data and assessed the risk of bias and study quality. Data were analyzed with Review Manager 5.3 software. Grades of Recommendation Assessment, Development and Evaluation (GRADE) were used to assess the quality of evidence. Results: Sixteen RCTs with 1250 patients undergoing TKA and 4 RCTs involving 550 patients undergoing THA were included. There were no significant differences in total blood loss (mean difference [MD]TKA = −28.72 mL, 95% confidence interval [CI] −195.97 to 138.54 mL, P = 0.74; MDTHA = 14.03 mL, 95% CI −35.53 to 63.59 mL; P = 0.78), total drain out (MDTKA = −3.09 mL, 95% CI −39.05 to 32.88 mL; P = 0.87; MDTHA −31.00 mL, 95% CI −66.56 to 4.66 mL; P = 0.09), and transfusion rates (ORTKA = 0.90, 95% CI 0.58–1.40, P = 0.64; ORTHA = 1.19, 95% CI 0.67–2.09; P = 0.63) between topical and intravenous (IV) TXA. Conclusions: The current evidence suggested that topical TXA was equally effective and safe compared with intravenous TXA in reducing blood loss

  13. A ported, proximally-cemented femoral stem for total hip arthroplasty. Development and clinical application.

    PubMed

    Edidin, A A; Merritt, P O; Hack, B H; Manley, M T

    1998-09-01

    We describe the development and early clinical application of a ported, proximally-cemented titanium stem for cemented total hip arthroplasty. PMMA bone cement is delivered to the proximal femur under pressure after the stem has been positioned within the femoral canal. A mid-stem cement occluder contains the cement to the proximal stem only. A tapered body is incorporated in the design of the stem to reduce the structural stiffness and hence the degree of stress shielding within the reconstructed joint. We performed preclinical studies to measure the reduction in porosity and the pressurisation achieved. The porosity, as measured by the void percentage within the cured cement mantle, was reduced by more than 50% and there was an almost threefold increase in the mean pressure. Mechanical testing of the stem, using a three-point bend test, showed that the addition of cement injection ports on the anterior and posterior sides of the body of the proximal stem did not reduce its strength. Finite-element analysis indicated that, compared with a fully-cemented conventional stem, there was no change in the stresses within the cement mantle. In a series of 40 proximally-cemented stems followed for up to six years (mean 51 months) the mean Harris hip score was 91, and 85% of patients had good or excellent results. There was excellent pain relief, an increased level of activity and good patient satisfaction. One mechanical failure of the stem required revision at three years after implantation. The early results indicate that the clinical performance was equal to that achieved with other modern cemented stems. Radiological evaluation showed excellent results with no evidence of stress shielding. Further follow-up will determine if long-term stress shielding is reduced and if revision is made easier by the absence of a distal cement mantle.

  14. [Cementless total hip arthroplasty--results of 8-year follow-up study].

    PubMed

    Wall, Andrzej; Dragan, Szymon

    2006-01-01

    The subjects of the clinical examinations were 382 patients who from 1994 to 1999 were treated with the method of total cementless arthroplasty. The observation time ranged from 3 to 8 years. In the examined group the secondary cause of degenerative changes was identified in 210 (55%) patients. In the remaining 172 cases (45%) the primary cause of degenerative changes in the hip was diagnosed. Four types of cementless endoprostheses, varied in their construction, structure of their surfaces and material they were made of, were used to carry out the postoperative treatment of the degenerative changes in the hip: Antega, Zweymüller SL PLUS (Endoprosthetic) or Alloclasic type of stem, GSS-CL and PM-Plasmapore. The findings of the clinical investigation made it possible to determine the probability of surviving of an endoprosthesis up to the 8th year after an operation depending on a type of implanted stem, which according to Kaplan-Meier's method, amounted to 0.9603. The results of Harris scale evaluation of the function of the operated joints demonstrated the existence of the relationship between the function and the course of bone osteointegration and growth process. The detailed analysis of the X-ray examinations, and especially of the roentgenometric ones, taking into account stability of the endoprosthesis stem enabled to distinguish two stages of the clinical and roentgenological changes: the early stage (up to 6 months after an operation) characterised by settling and micromotions of the stem and the late stage (starting 6-9 months after an operation) with slowly gradual increasing of the function and holding back of stem settling. PMID:17017478

  15. Friction in total hip joint prosthesis measured in vivo during walking.

    PubMed

    Damm, Philipp; Dymke, Joern; Ackermann, Robert; Bender, Alwina; Graichen, Friedmar; Halder, Andreas; Beier, Alexander; Bergmann, Georg

    2013-01-01

    Friction-induced moments and subsequent cup loosening can be the reason for total hip joint replacement failure. The aim of this study was to measure the in vivo contact forces and friction moments during walking. Instrumented hip implants with Al2O3 ceramic head and an XPE inlay were used. In vivo measurements were taken 3 months post operatively in 8 subjects. The coefficient of friction was calculated in 3D throughout the whole gait cycle, and average values of the friction-induced power dissipation in the joint were determined. On average, peak contact forces of 248% of the bodyweight and peak friction moments of 0.26% bodyweight times meter were determined. However, contact forces and friction moments varied greatly between individuals. The friction moment increased during the extension phase of the joint. The average coefficient of friction also increased during this period, from 0.04 (0.03 to 0.06) at contralateral toe off to 0.06 (0.04 to 0.08) at contralateral heel strike. During the flexion phase, the coefficient of friction increased further to 0.14 (0.09 to 0.23) at toe off. The average friction-induced power throughout the whole gait cycle was 2.3 W (1.4 W to 3.8 W). Although more parameters than only the synovia determine the friction, the wide ranges of friction coefficients and power dissipation indicate that the lubricating properties of synovia are individually very different. However, such differences may also exist in natural joints and may influence the progression of arthrosis. Furthermore, subjects with very high power dissipation may be at risk of thermally induced implant loosening. The large increase of the friction coefficient during each step could be caused by the synovia being squeezed out under load.

  16. The Short-term Clinical Outcome of Total Hip Arthroplasty Using Short Metaphyseal Loading Femoral Stem

    PubMed Central

    Choi, Yoo Wang

    2016-01-01

    Purpose The purpose of this study was to retrospectively evaluate the short-term clinical and radiological outcomes of total hip arthroplasty (THA) with short metaphyseal loading femoral stem. Materials and Methods We retrospectively reviewed the records of 56 cases in 47 patients who had undergone THA with short metaphyseal loading femoral stem from April 2010 to December 2011. There were 20 males and 27 females. The mean age was 54 years (range, 26-77 years). The average follow up period was 4.6 years. Clinical results were evaluated by Harris hip scores (HHS) before the operation and at the last follow-up. Radiographic analysis was done by evaluating osteolysis, loosening, stress shielding, and alignement. Results The mean HHS significantly improved from 45 (range, 15-58) preoperatively to 98 (range, 85-100) at the last follow-up. In radiographic analyses, there was no evidence of osteolysis or loosening around the stems and the acetabuluar components. All cases showed rounding off of the calcar, grade 1 bone resorption of the proximal femur. With regard to implant alignment, 51 femoral component (91.1%) were in neutral position, and 5 (8.9%) were in varus position. There was 1 intraoperative fracture treated by cerclage wiring and no case was revised during follow-up period. Conclusion Although longer follow-up is needed to confirm the durability of the short metaphyseal loading femoral stem, this short stem might provide stable fixation without diaphyseal fixation and demonstrated good clinical result at mean 4.6 year short term follow-up. PMID:27536649

  17. A Novel Approach for Dynamic Testing of Total Hip Dislocation under Physiological Conditions.

    PubMed

    Herrmann, Sven; Kluess, Daniel; Kaehler, Michael; Grawe, Robert; Rachholz, Roman; Souffrant, Robert; Zierath, János; Bader, Rainer; Woernle, Christoph

    2015-01-01

    Constant high rates of dislocation-related complications of total hip replacements (THRs) show that contributing factors like implant position and design, soft tissue condition and dynamics of physiological motions have not yet been fully understood. As in vivo measurements of excessive motions are not possible due to ethical objections, a comprehensive approach is proposed which is capable of testing THR stability under dynamic, reproducible and physiological conditions. The approach is based on a hardware-in-the-loop (HiL) simulation where a robotic physical setup interacts with a computational musculoskeletal model based on inverse dynamics. A major objective of this work was the validation of the HiL test system against in vivo data derived from patients with instrumented THRs. Moreover, the impact of certain test conditions, such as joint lubrication, implant position, load level in terms of body mass and removal of muscle structures, was evaluated within several HiL simulations. The outcomes for a normal sitting down and standing up maneuver revealed good agreement in trend and magnitude compared with in vivo measured hip joint forces. For a deep maneuver with femoral adduction, lubrication was shown to cause less friction torques than under dry conditions. Similarly, it could be demonstrated that less cup anteversion and inclination lead to earlier impingement in flexion motion including pelvic tilt for selected combinations of cup and stem positions. Reducing body mass did not influence impingement-free range of motion and dislocation behavior; however, higher resisting torques were observed under higher loads. Muscle removal emulating a posterior surgical approach indicated alterations in THR loading and the instability process in contrast to a reference case with intact musculature. Based on the presented data, it can be concluded that the HiL test system is able to reproduce comparable joint dynamics as present in THR patients. PMID:26717236

  18. A Novel Approach for Dynamic Testing of Total Hip Dislocation under Physiological Conditions

    PubMed Central

    Herrmann, Sven; Kluess, Daniel; Kaehler, Michael; Grawe, Robert; Rachholz, Roman; Souffrant, Robert; Zierath, János; Bader, Rainer; Woernle, Christoph

    2015-01-01

    Constant high rates of dislocation-related complications of total hip replacements (THRs) show that contributing factors like implant position and design, soft tissue condition and dynamics of physiological motions have not yet been fully understood. As in vivo measurements of excessive motions are not possible due to ethical objections, a comprehensive approach is proposed which is capable of testing THR stability under dynamic, reproducible and physiological conditions. The approach is based on a hardware-in-the-loop (HiL) simulation where a robotic physical setup interacts with a computational musculoskeletal model based on inverse dynamics. A major objective of this work was the validation of the HiL test system against in vivo data derived from patients with instrumented THRs. Moreover, the impact of certain test conditions, such as joint lubrication, implant position, load level in terms of body mass and removal of muscle structures, was evaluated within several HiL simulations. The outcomes for a normal sitting down and standing up maneuver revealed good agreement in trend and magnitude compared with in vivo measured hip joint forces. For a deep maneuver with femoral adduction, lubrication was shown to cause less friction torques than under dry conditions. Similarly, it could be demonstrated that less cup anteversion and inclination lead to earlier impingement in flexion motion including pelvic tilt for selected combinations of cup and stem positions. Reducing body mass did not influence impingement-free range of motion and dislocation behavior; however, higher resisting torques were observed under higher loads. Muscle removal emulating a posterior surgical approach indicated alterations in THR loading and the instability process in contrast to a reference case with intact musculature. Based on the presented data, it can be concluded that the HiL test system is able to reproduce comparable joint dynamics as present in THR patients. PMID:26717236

  19. Hard-on-Hard Total Hip Impingement Causes Extreme Contact Stress Concentrations

    PubMed Central

    Elkins, Jacob M.; O’Brien, Megan K.; Stroud, Nicholas J.; Pedersen, Douglas R.; Callaghan, John J.

    2010-01-01

    Background Impingement events, in addition to their role immediately proximate to frank dislocation, hold the potential to damage new-generation hard-on-hard bearings as a result of the relatively unforgiving nature of the materials and designs. Because of the higher stiffness and tighter design tolerances of metal-on-metal and ceramic implants, surgical positioning plausibly has become even more important. Questions/purposes We asked (1) whether, and under what cup orientation conditions, hard-on-hard impingements might challenge implant material failure strength; and (2) whether particle generation propensity at impingement and egress sites would show similar dependence on cup orientation. Methods Realistic computational simulations were enabled by multistage finite element analyses, addressing both global construct motion and loading, and focal stress concentrations at neck impingement and rim egress sites. The global model, validated by a cadaveric simulation in a servohydraulic hip simulator, included both hardware components and advanced anisotropic capsule characterization. Parametric computational runs explored the effect of cup orientation for both ceramic-on-ceramic and metal-on-metal bearing couples for two distinct motion sequences associated with dislocation. Results Stress concentrations from impingement increased nearly linearly with increased cup tilt and with cup anteversion. In some situations, peak values of stress approached or exceeded 1 GPa, levels challenging the yield strength of cobalt-chromium implants, and potentially the fracture strength of ceramics. The tendency for impingement events to generate debris, indexed in terms of a new scraping severity metric, showed orientation dependences similar to that for bulk material failure. Conclusions Damage propensity arising from impingement events in hard total hip bearings is highly orientation-dependent. PMID:20953853

  20. Total hip arthroplasty in a 6-month-old acetabulum fracture-dislocation of the hip: an 8-year follow-up.

    PubMed

    Khan, Kashif Mahmood; Bhatti, Anisuddin; Rasheed, Khurram

    2013-06-01

    Old unreduced acetabulum fracture-dislocation is common in developing countries due to various factors. Different options including arthrodesis, Girdlestone arthroplasty and total hip replacement (THR) are used for its treatment. THR with reconstruction of the acetabulum is recommended, but not much work has been reported so far in our country. Till date, arthrodesis in youngsters and resection arthroplasty in the elders has been the treatment of choice.THR, however, is being done by a few, but the experience has not been published. We are reporting a case of a middle-aged woman, who had a 6-month-old acetabulum dislocation of the hip with fracture of the posterior wall of the acetabulum. It was treated by THR and acetabulum reconstruction and had good functional result 8 years after the surgery.

  1. The Results of Long-term Follow-up of Total Hip Arthroplasty Using Hydroxyapatite-coated Cups

    PubMed Central

    Han, Chang-Dong; Shin, Keun-Young; Lee, Hyun-Hee; Park, Kwan-Kyu; Yang, Ick-Hwan

    2015-01-01

    Purpose The aim of this study was to report the long-term outcome and the failure mechanism of cementless total hip arthroplasty (THA) using hydroxyapatite (HA)-coated acetabular cup. Materials and Methods From January 1992 to May 1994, a total of 123 consecutive cementless primary THAs were performed using a HA-coated acetabular cup with metal-on-polyethylene articulation. We retrospectively evaluated 66 hips available for follow-up at a mean 18.3 years (range, 10.4-23.6 years). The survival analysis was performed by the Kaplan-Meier method. We defined end point as any failure that required a reoperation of acetabular component. Results Thirty-nine of 66 hips (59.1%) were defined as a failure for progressive acetabular osteolysis or aseptic loosening of the cup. Acetabular osteolysis was observed in 47 hips (71.2%) and 33 hips (50.0%) were revised because of cup loosening. The Kaplan-Meier method showed the survival rate of the acetabular cup to be 46.3% at 15 years and 34.8% at 20 years for any failure that required a reoperation of acetabular component. Conclusion The long-term survival rate of THA using HA-coated acetabular cup was unsatisfactory, and it was attributed to vulnerable property of HA coating and progressive osteolysis. PMID:27536628

  2. Excellent results with cementless total hip arthroplasty and alumina-on-alumina pairing: minimum ten-year follow-up

    PubMed Central

    Kress, Alexander M.; Schmidt, Rainer; Holzwarth, Ulrich; Forst, Raimund

    2010-01-01

    Ceramic-on-ceramic coupling is thought to be a durable alternative to metal- or alumina-on-polyethylene pairing. No evidence exists suggesting superior clinical and radiological results for hydroxyapatite-coated stems versus uncoated stems. The aim of this study is to report the performance of an alumina-on-alumina bearing cementless total hip arthroplasty and to compare stems with a tapered design with and without hydroxyapatite coating. We prospectively analysed the results of cementless tapered femoral stems (40 hydroxyapatite-coated versus 22 uncoated stems), a metal-backed fibre mesh hydroxyapatite-coated socket and alumina-on-alumina pairing. Of 75 hips studied, 62 were available for follow-up (mean of 10.5 years after surgery). The average Harris hip score was 90. Only one hydroxyapatite-coated stem was revised for aseptic loosening. One instance of non-progressive osteolysis was detected around a screw of a cup. All other components showed radiographic signs of stable ingrowth. Hydroxyapatite coating of the stem had no significant impact on the clinical or radiological results. Total hip arthroplasty with the presented implant and pairing provides a durable standard for all patients requiring hip joint replacement against which all newer generations of cementless implants should be judged. PMID:21079952

  3. Large-diameter total hip arthroplasty modular heads require greater assembly forces for initial stability

    PubMed Central

    MacLeod, A. R.; Sullivan, N. P. T.; Whitehouse, M. R.

    2016-01-01

    to play a role in the high failure rates of large diameter MoM hips. Cite this article: A. R. MacLeod, N. P. T. Sullivan, M. R. Whitehouse, H. S. Gill. Large-diameter total hip arthroplasty modular heads require greater assembly forces for initial stability. Bone Joint Res 2016;5:338–346. DOI: 10.1302/2046-3758.58.BJR-2016-0044.R1. PMID:27496914

  4. Ceramic-on-Ceramic Total Hip Arthroplasty in a Twelve-Year-Old Patient: Case Report with a 27-Year Follow-Up.

    PubMed

    Save, Ameya V; Varthi, Arya; Talusan, Paul G; Gala, Raj; Nelson, Stephen; Keggi, Kristaps J

    2016-01-01

    Total hip arthroplasty in the juvenile patient with a severely diseasedjoint can provide long-term pain relief and improvement in function. We present a patient with juvenile rheumatoid arthritis who underwent a Mittelmeier ceramic-on-ceramic total hip arthroplasty at age 12 in 1986. The implant provided the patient with a functioning hip for 24 years, but subsequently required revision due to femoral component loosening. This case report represents the longest reported clinical follow-up of noncemented, ceramic-on-ceramic total hip arthroplasty in a juvenile patient and depicts an excellent outcome at 27 years. Our case is also unique in that the Mittelmeier ceramic acetabulum was left in place during revision surgery. In this report, we also describe the senior author's choice of the Mittelmeier hip prosthesis within its historical context and provide a brief review of the literature as it relates to total hip arthroplasty in the juvenile patient. PMID:27509640

  5. The concentric all-polyethylene Exeter acetabular component in primary total hip replacement.

    PubMed

    Veitch, S W; Whitehouse, S L; Howell, J R; Hubble, M J W; Gie, G A; Timperley, A J

    2010-10-01

    We report the outcome of the flangeless, cemented all-polyethylene Exeter acetabular component at a mean of 14.6 years (10 to 17) after operation. Of the 263 hips in 243 patients, 122 prostheses are still in situ; 112 patients (119 hips) have died, 18 hips have been revised, and three patients (four hips) were lost to follow-up. Radiographs at the final review were available for 110 of the 122 surviving hips. There were acetabular radiolucent lines in 54 hips (49%). Two acetabular components had migrated but neither patient required revision. The Kaplan-Meier survivorship at 15 years with 61 hips at risk with revision for any cause as the endpoint was 89.9% (95% confidence interval (CI) 84.6 to 95.2) and for aseptic loosening of the acetabular component or lysis 91.7% (95% CI 86.6 to 96.8). In 210 hips with a diagnosis of primary osteoarthritis, survivorship with revision for any cause as the endpoint was 93.2% (95% CI 88.1 to 98.3), and for aseptic loosening of the acetabular component 95.0% (95% CI 90.3 to 99.7). The cemented all-polyethylene Exeter acetabular component has an excellent long-term survivorship.

  6. Serum C-Reactive Protein and Procalcitonin Kinetics in Patients Undergoing Elective Total Hip Arthroplasty

    PubMed Central

    Battistelli, Sandra; Fortina, Mattia; Carta, Serafino; Guerranti, Roberto; Nobile, Francesco; Ferrata, Paolo

    2014-01-01

    Background. The sensitivity and the specificity of different methods to detect periprosthetic infection have been questioned. The current study aimed to investigate the kinetics of C-reactive protein (CRP) and procalcitonin (PCT) in patients undergoing uncomplicated elective total hip arthroplasty (THA), to provide a better interpretation of their levels in noninfectious inflammatory reaction. Methods. A total of 51 patients were included. Serum CRP and PCT concentrations were obtained before surgery, on the 1st, 3rd, and 7th postoperative days and after discharge on the 14th and 30th days and at 2 years. Results. Both markers were confirmed to increase after surgery. The serum CRP showed a marked increase on the 3rd postoperative day while the peak of serum PCT was earlier, even if much lower, on the first day. Then, they declined slowly approaching the baseline values by the second postoperative week. PCT mean values never exceed concentrations typically related to bacterial infections. Conclusions. CRP is very sensitive to inflammation. It could be the routine screening test in the follow-up of THA orthopaedic patients, but it should be complemented by PCT when there is the clinical suspicion of periprosthetic infection. PMID:24877114

  7. Learning curve analysis of the Collum Femoris Preserving total hip surgical technique.

    PubMed

    Van Oldenrijk, Jakob; Schafroth, Matthias U; Rijk, Elisa; Runne, Wouter C; Verheyen, Cees C P M; van Egmond, Cees; Bhandari, Mohit; Poolman, Rudolf W

    2013-01-01

    The aim of this study was to determine whether femoral neck preserving total hip arthroplasty would become less difficult and more efficient during the first 20 cases and to identify potential pitfalls during the introduction of this procedure. The difficulty and efficiency of the initial 20 procedures performed by four surgeons was prospectively determined by analysing a total of 68 video recordings using time-action analysis. This method measures the duration and efficiency of individual actions needed for a surgeon to achieve his or her goal. Afterwards, we reviewed all actions with a long duration and discussed possible causes of delay with the surgeons to identify possible pitfalls. We found a decrease of difficulty and an increase of efficiency during the first 20 cases and a more consistent execution after the initial five cases. Estimating the correct osteotomy level and stem curvature was often difficult, which resulted in a variable stem position. Radiologic analysis demonstrated a tendency for varus position and increased leg length throughout the series, even after the surgeons demonstrated technical proficiency.

  8. Role of negative pressure wound therapy in total hip and knee arthroplasty

    PubMed Central

    Siqueira, Marcelo BP; Ramanathan, Deepak; Klika, Alison K; Higuera, Carlos A; Barsoum, Wael K

    2016-01-01

    Negative-pressure wound therapy (NPWT) has been a successful modality of wound management which is in widespread use in several surgical fields. The main mechanisms of action thought to play a role in enhancing wound healing and preventing surgical site infection are macrodeformation and microdeformation of the wound bed, fluid removal, and stabilization of the wound environment. Due to the devastating consequences of infection in the setting of joint arthroplasty, there has been some interest in the use of NPWT following total hip arthroplasty and total knee arthroplasty. However, there is still a scarcity of data reporting on the use of NPWT within this field and most studies are limited by small sample sizes, high variability of clinical settings and end-points. There is little evidence to support the use of NPWT as an adjunctive treatment for surgical wound drainage, and for this reason surgical intervention should not be delayed when indicated. The prophylactic use of NPWT after arthroplasty in patients that are at high risk for postoperative wound drainage appears to have the strongest clinical evidence. Several clinical trials including single-use NPWT devices for this purpose are currently in progress and this may soon be incorporated in clinical guidelines as a mean to prevent periprosthetic joint infections. PMID:26807353

  9. Determinants of satisfaction 1 year after total hip arthroplasty: the role of expectations fulfilment

    PubMed Central

    2014-01-01

    Background Between 7% and 15% of patients are dissatisfied after total hip arthroplasty (THA). To assess predictors and postoperative determinants of satisfaction and expectation fulfilment one year after (THA). Methods Before THA surgery, 132 patients from three tertiary care centres and their surgeons were interviewed to assess their expectations using the Hospital for Special Surgery Total Hip Replacement Expectations Survey (THR survey). One year after surgery, patients (n = 123) were contacted by phone to complete a questionnaire on expectation fulfilment (THR survey), satisfaction, functional outcome (Womac), and health-related quality of life (SF 12). Univariate and multivariate analyses were performed. Results Preoperative predictors of satisfaction were a good mental wellbeing (adjusted OR 1.09 [1.02; 1.16], p = 0.01) and optimistic surgeons expectations (1.07 [1.01; 1.14], p = 0.02). The main postoperative determinant of satisfaction was the fulfilment of patient’s expectations (1.08 [1.04; 1.12], p < 0.001). Expectation fulfilment could be predicted before surgery by young age (regression coefficient −0.55 [−0.88; -0.21], p = 0.002), good physical function (−0.96 [−1.82; -0.10], p = 0.03) and good mental wellbeing (0.56 [0.14; 0.99], p = 0.01). Postoperative determinants of expectation fulfilment were functional outcome (−2.10 [−2.79; -1.42], p <0.001) and pain relief (−14.83 [−22.38; -7.29], p < 0.001). Conclusion To improve patient satisfaction after THA, patients’ expectations and their fulfilment need to be carefully addressed. Patients with low mental wellbeing or physical function should be identified and specifically informed on expected surgical outcome. Surgeons’ expectations are predictive of satisfaction and information should aim to lower discrepancy between surgeons’ and patients’ expectations. PMID:24564856

  10. The effects of acute normovolaemic haemodilution on peri-operative coagulation in total hip arthroplasty.

    PubMed

    Shin, H J; Na, H S; Do, S H

    2015-03-01

    Total hip arthroplasty results in substantial blood loss in the peri-operative period. We evaluated the effects of acute normovolaemic haemodilution on blood coagulation and platelet function in 11 patients undergoing total hip arthroplasty. We performed acute normovolaemic haemodilution and haematological tests, rotational thromboelastometry (ROTEM(®) ) and whole-blood impedance aggregometry. Blood samples were obtained at three time points: (i) before the initiation of acute normovolaemic haemodilution; (ii) 20 min after completion of acute normovolaemic haemodilution; and (iii) 20 min after retransfusion. After acute normovolaemic haemodilution, ROTEM parameters demonstrated hypocoagulability. Clot formation time of INTEM was increased by 31.6% (p = 0.016), whereas the α-angle and maximum clot formation of INTEM decreased by 8.1% (p = 0.032) and 3.0% (p = 0.013) respectively, compared with baseline values. Clotting time and clot formation time of EXTEM were increased by 40.8% (p = 0.042) and 31.3% (p = 0.016), respectively, whereas the α-angle and maximum clot formation of EXTEM were decreased by 11.9% (p = 0.020) and 9.5% (p = 0.013), respectively. The maximum clot formation of FIBTEM decreased by 35.1% compared with the baseline value (p = 0.007). Following retransfusion, ROTEM values returned to baseline; clot formation time decreased and the α-angle and maximum clot formation increased. There were no significant changes in platelet aggregation during the study. At 20 min after the end of acute normovolaemic haemodilution, the international normalised ratio of prothrombin time was increased compared with the baseline value (p = 0.003). We conclude that acute normovolaemic haemodilution resulted in a hypocoagulable state compared with baseline values and that coagulation parameters returned to normal after retransfusion.

  11. Transverse Subtrochanteric Shortening Osteotomy During Cementless Total Hip Arthroplasty in Crowe Type-III or IV Developmental Dysplasia.

    PubMed

    Sofu, Hakan; Kockara, Nizamettin; Gursu, Sarper; Issin, Ahmet; Oner, Ali; Sahin, Vedat

    2015-06-01

    The purpose of this study was to review the outcomes of transverse subtrochanteric shortening osteotomy during cementless total hip arthroplasty in Crowe Type-III or IV developmental dysplasia. Seventy-three osteotomies were included in our study. Mean follow-up was 61 months. Harris hip score, leg length discrepancy, neurological status, union status of the osteotomy, and femoral component stability were the criteria for evaluation. All complications were noted. The mean Harris hip score improved from 38.6 points to 83.7 points. The mean leg length discrepancy decreased from 56.5 mm to 10.7 at the latest follow-up. The mean union time was 5.2 months. We observed 4 non-unions. Transverse subtrochanteric shortening osteotomy is an effective and reliable method in restoration of a more normal limb. PMID:25707993

  12. First series of Exeter small stem primary total hip arthroplasty minimum 5 years of follow-up.

    PubMed

    Tai, Cheh Chin; Nam, Hui Yin; Abbas, Azlina Amir; Merican, Azhar M; Choon, Siew Kit

    2009-12-01

    We carried out a prospective study of 47 Exeter (Stryker Inc, Warsaw, Ind) small stem total hip arthroplasty in 42 patients with an average age of 58 years and a mean follow-up of 8.5 years. The Oxford hip score improved from a preoperative mean of 47 to 17 at last follow-up. More than 87% patients had excellent or good Harris hip scores, and 90% were able to walk with little or no pain. Stem subsidence within the cement mantle was observed in 26% of cases, and none showed evidence of aseptic loosening or implant failure. Two stems were removed due to infection. The survival rate of this implant was 95.7% at 10 years. This first series of Exeter small stem showed excellent medium-term results, comparable to its larger counterparts. PMID:19682839

  13. Total Hip Arthroplasty Using the S-ROM-A Prosthesis for Anatomically Difficult Asian Patients

    PubMed Central

    Hozumi, Akira; Kobayashi, Kyousuke; Tsuru, Nobuhisa; Miyamoto, Chikara; Maeda, Jyunichiro; Chiba, Ko; Goto, Hisataka; Osaki, Makoto

    2015-01-01

    Background. The S-ROM-A prosthesis has been designed for the Asian proximal femur with a small deformed shape and narrow canal. In this study, the clinical and radiological results using the S-ROM-A prosthesis for Japanese patients with severe deformity due to dysplasia and excessive posterior pelvic tilt were examined. Methods. 94 hips were followed up for a mean of 55 months, with a mean age at surgery of 61 years. The primary diagnoses were 94 coxarthritis cases, including 51 dysplasia and 37 primary OA, 1 avascular necrosis, 2 traumatic arthritis, and 3 Perthes disease. Thirty-one hips had been treated with osteotomy of the hip joints. Preoperative intramedullary canal shapes were stovepipe in 23 hips, normal in 51 hips, and champagne-flute in 5 hips. The maximum pelvic inclination angle was 56°. Results. The mean JOA score improved from 46 points preoperatively to 80 points at final follow-up. On radiological evaluation of the fixation of the implants according to the Engh classification, 92 (97%) hips were classified as “bone ingrown fixation.” Conclusion. In primary THA, using the S-ROM-A prosthesis for Asian patients with proximal femoral deformity, even after osteotomy and with posterior pelvic tilt, provided good short- to midterm results. PMID:26582575

  14. Pre-operative ambulatory measurement of asymmetric lower limb loading during walking in total hip arthroplasty patients

    PubMed Central

    2013-01-01

    Background Total hip arthroplasty is a successful surgical procedure to treat hip osteoarthritis. Clinicians use different questionnaires to assess the patient’s pain and functional capacity. Furthermore, they assess the quality of gait in a very global way. This clinical evaluation usually shows significant improvement after total hip arthroplasty, however, does not provide objective, quantifiable information about the movement patterns underlying the functional capacity, which can currently only be obtained in a gait laboratory. Instrumented force shoes can quantify gait velocity, ground reaction forces and the gait pattern easily in an outpatient setting. The main goal of this study was to investigate how mobility characteristics during walking, relate to gait velocity and questionnaire outcomes of patients with hip osteoarthritis in an outpatient setting. Methods 22 patients with primary osteoarthritis of the hip selected for a total hip arthroplasty participated in this study. For each patient the Harris Hip Score, the Traditional Western Ontario and the McMaster Universities osteoarthritis index were administered. Subsequently, the patients were instructed to walk through the corridor while wearing instrumented shoes. The gait velocity estimated with the instrumented force shoes was validated measuring the time required to walk a distance of 10 m using a stopwatch and a measuring tape as a reference system. A regression analysis between spatial, temporal, ground reaction force parameters, including asymmetry, and the gait velocity and the questionnaires outcomes was performed. Results The velocity estimated with the instrumented shoes did not differ significantly from the velocity measured independently. Although gait parameters correlated significantly with velocity, symmetry index parameters were not correlated with velocity. These symmetry index parameters show significant inter-limb asymmetry during walking. No correlation was found between any of the

  15. RSA wear measurements with or without markers in total hip arthroplasty.

    PubMed

    Börlin, Niclas; Röhrl, Stephan M; Bragdon, Charles R

    2006-01-01

    Novel algorithms for radiostereometric (RSA) measurements of the femoral head and metal-backed, hemi-spherical cups of a total hip replacement are presented and evaluated on phantom images and clinical double examinations of 20 patients. The materials were analysed with classical RSA and three novel algorithms: (1) a dual-projection head algorithm using the outline of the femoral head together with markers in the cup; (2) a marker-less algorithm based on measurements of the outline of the femoral head, the cup shell and opening circle of the cup; and (3) a combination of both methods. The novel algorithms improve current, marker-based, RSA measurements, as well as allows studies without marked cups. This opens the possibility of performing wear measurements on larger group of patients, in clinical follow-ups, even retrospective studies. The novel algorithms may help to save patient data in current RSA studies lost due to insufficiently marked cups. Finally, the novel algorithms simplify the RSA procedure and allow new studies without markers, saving time, money, and reducing safety concerns. Other potential uses include migration measurements of re-surfacing heads and measuring spherical sections as implant landmarks instead of markers.

  16. Heterotopic ossification after total hip replacement and the HLA system in the Sicilian population.

    PubMed

    Sessa, G; Costarella, L; Mollica, R; Pavone, V

    2002-06-01

    Heterotopic ossification (HO) is a frequent complication following total hip arthroplasty (THA). At present, the etiology HO is unknown, however, genetic predisposition may be a cause of HO in individuals in whom no risk factors can be detected. The goal of this study was to investigate the HLA system, searching for any correlation with the presence of HO after THA. Thirty-five patients of Sicilian origin were operated on between January 1997 and January 1999 for cementless THA under regional anesthesia. The entire series was divided into three groups and all underwent histocompatibility typing. Group I was made up of 10 patients who presented with HO Brooker grades 1 and 2 after THA; group 2 comprised 7 patients affected by grades 3 and 4 HO after THA; and group 3 was made up of 18 subjects who presented with one or more preoperative risk factors for developing peri-prosthetic HO before undergoing THA. No positivity for HLA-B27 antigen was observed, but there was as an increase in HLA-B18 (with respect to that in the Sicilian population) in patients with HO following THA. The main conclusion from the study is that there is a strong correlation between the presence of the antigens HLA-A2 and HLA-B18 in patients with HO grades 3 and 4. PMID:24604489

  17. Measurement of pelvic osteolytic lesions in follow-up studies after total hip arthroplasty

    NASA Astrophysics Data System (ADS)

    Castaneda, Benjamin; Tamez-Pena, Jose G.; Totterman, Saara; O'Keefe, Regis; Looney, R. John

    2006-03-01

    Previous studies have demonstrated the plausibility of using volumetric computerized tomography to provide an accurate representation and measurement of volume for pelvic osteolytic lesions following total hip joint replacement. These studies have been performed manually (or computed-assisted) by expert radiologists with the disadvantage of poor reproducibility of the experiment. The purpose of this work is to minimize the effect of user interaction in these experiments by introducing Laplacian level set methods in the volume segmentation process and using temporal articulated registration in order to follow the evolution of a lesion over time. Laplacian level set methods reduce the inter and intra-observer variability by attaching the segmented contour to edges defined in the image while keeping smoothness. The registration process allows the information of the lesion from the first visit to be used in the segmentation process of the current visit. This work compares the automated results on 7 volunteers versus the volume measured manually. Results have shown that the proposed technique is able to track osteolytic lesions and detect changes in volume over time. Intra-reader and inter-observer variabilities were reduced.

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

    PubMed

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

    2015-08-01

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

  19. Increased incidence of femoral fractures in small femurs and women undergoing uncemented total hip arthroplasty - why?

    PubMed

    Bonnin, M P; Neto, C C; Aitsiselmi, T; Murphy, C G; Bossard, N; Roche, S

    2015-06-01

    The aim of this study was to investigate the relationship between the geometry of the proximal femur and the incidence of intra-operative fracture during uncemented total hip arthroplasty (THA). We studied the pre-operative CT scans of 100 patients undergoing THA with an uncemented femoral component. We measured the anteroposterior and mediolateral dimensions at the level of division of the femoral neck to calculate the aspect ratio of the femur. Wide variations in the shape of the femur were observed, from round, to very narrow elliptic. The femurs of women were narrower than those of men (p < 0.0001) and small femurs were also narrower than large ones. Patients with an intra-operative fracture of the calcar had smaller and narrower femurs than those without a fracture (p < 0.05) and the implanted Corail stems were smaller in those with a fracture (mean size 9 vs 12, p < 0.0001). The variability of the shape of the femoral neck at the level of division contributes to the understanding of the causation of intra-operative fractures in uncemented THA. PMID:26033052

  20. Survival outcomes of cemented compared to uncemented stems in primary total hip replacement

    PubMed Central

    Wyatt, Michael; Hooper, Gary; Frampton, Christopher; Rothwell, Alastair

    2014-01-01

    Total hip replacement (THR) is a successful and reliable operation for both relieving pain and improving function in patients who are disabled with end stage arthritis. The ageing population is predicted to significantly increase the requirement for THR in patients who have a higher functional demand than those of the past. Uncemented THR was introduced to improve the long term results and in particular the results in younger, higher functioning patients. There has been controversy about the value of uncemented compared to cemented THR although there has been a world-wide trend towards uncemented fixation. Uncemented acetabular fixation has gained wide acceptance, as seen in the increasing number of hybrid THR in joint registries, but there remains debate about the best mode of femoral fixation. In this article we review the history and current world-wide registry data, with an in-depth analysis of the New Zealand Joint Registry, to determine the results of uncemented femoral fixation in an attempt to provide an evidence-based answer as to the value of this form of fixation. PMID:25405087

  1. A complication during femoral broaching in total hip arthroplasty: a case report.

    PubMed

    Waldstein, Wenzel; Boettner, Friedrich

    2013-01-01

    Press-fit component fixation is one of the primary goals in uncemented total hip arthroplasty. When aiming at proximal load transfer, the stem size has to be selected with regard to the shape of the proximal femoral canal. This can be challenging in patients with 'champagne flute' femurs with a relatively narrow diaphysis, especially when a long stem femoral component is used. The present case report describes a complication during femoral broaching for a primary uncemented femoral component. Because of the narrow diaphysis, the distal portion of the broach got caught in the narrow canal and it became impossible to remove the broach with conventional techniques. Via a second distal incision, the femur was split from the distal tip of the broach to approximately 5 cm distal of the femoral neck cut along the posterior aspects of the femur. This loosened the broach enough to allow for an uncomplicated removal. The longitudinal split was secured with cables before a similar size primary implant was press fitted into the femoral canal. PMID:23961301

  2. Lower Limb Loading during Gait in Patients Long Period after Total Hip Arthroplasty Revision

    PubMed Central

    Kubonova, Eliska; Janura, Miroslav; Duskova, Sarka

    2016-01-01

    The aim of the study was to assess lower limb loading during walking after unilateral total hip arthroplasty (THA) revision. Twenty-three THA revision subjects (12 men, 11 women) were divided into three groups according to time since surgery as 1 to 6 years, 6 to 11 years, and over 11 years. Two force plates were used to measure the ground reaction force during the stance phase. On the operated limb, compared to nonoperated limb, we found lower first vertical peak in the group of 1 to 6 years after revision and lower propulsion peak in the group of 6 to 11 years since revision. In the group of 11 years since THA revision, no significant difference was found. With advancing years after surgery, the stance phase duration got reduced and propulsion peak increased in the operated limb; minimal vertical force decreased and the time of minimal vertical force increased in the nonoperated limb. The study findings suggest the tendency to a more gradual and safer weight acceptance on the operated limb during the first years after THA revision, followed by limitation of foot propulsion. Despite this fact, lower limb loading can be considered as symmetrical across the whole measured period. PMID:27579321

  3. Multi-technique characterization of retrieved bone cement from revised total hip arthroplasties.

    PubMed

    Eliades, T; Papadopulos, J S; Eliades, G; Silikas, N; Watts, D C

    2003-11-01

    The purpose of this study was to assess the chemical composition, structure and degree of double bond conversion of retrieved bone cement from 29 total hip replacement revision arthroplasties, employing a multi-technique approach. Scanning electron microscopy revealed a porous cement surface, which replicated the characteristics of bone or femoral stem surface irregularities. Fourier transform infrared spectroscopy indicated that the retrieved bone cement samples were covered by a well-organized proteinaceous film rich in amides and alcohols, probably because of the adsorption of species from body tissues and fluids. X-ray fluorescence spectrometry showed the presence of potassium, sodium, calcium and phosphorus, implying the development of a mineralization process of the adsorbed biofilm. X-ray microtomography demonstrated a dense porous network in the bulk material comprised of macropores with a mean diameter >1 mm. FTIR analysis of the degree of double bond conversion of retrieved samples was in the order of 70%, similar to that of samples prepared in vitro in air, but 30% lower relative to their counterparts mixed in vitro and set in water. The effect of the adsorption of species onto bone cement surface on the reactivity of the material with the surrounding tissues and materials, is currently unknown. The results of this investigation reveal that the in vivo aging pattern of bone cements may involve alterations, which cannot be simulated under current in vitro protocols, emphasizing the necessity for adopting in vivo approaches including retrieval studies in assessing bone cement properties.

  4. Bone Mineral Density and Fracture Risk Assessment to Optimize Prosthesis Selection in Total Hip Replacement

    PubMed Central

    Pétursson, Þröstur; Edmunds, Kyle Joseph; Gíslason, Magnús Kjartan; Magnússon, Benedikt; Magnúsdóttir, Gígja; Halldórsson, Grétar; Jónsson, Halldór; Gargiulo, Paolo

    2015-01-01

    The variability in patient outcome and propensity for surgical complications in total hip replacement (THR) necessitates the development of a comprehensive, quantitative methodology for prescribing the optimal type of prosthetic stem: cemented or cementless. The objective of the research presented herein was to describe a novel approach to this problem as a first step towards creating a patient-specific, presurgical application for determining the optimal prosthesis procedure. Finite element analysis (FEA) and bone mineral density (BMD) calculations were performed with ten voluntary primary THR patients to estimate the status of their operative femurs before surgery. A compilation model of the press-fitting procedure was generated to define a fracture risk index (FRI) from incurred forces on the periprosthetic femoral head. Comparing these values to patient age, sex, and gender elicited a high degree of variability between patients grouped by implant procedure, reinforcing the notion that age and gender alone are poor indicators for prescribing prosthesis type. Additionally, correlating FRI and BMD measurements indicated that at least two of the ten patients may have received nonideal implants. This investigation highlights the utility of our model as a foundation for presurgical software applications to assist orthopedic surgeons with selecting THR prostheses. PMID:26417376

  5. Total hip replacement with a zirconium oxide ceramic femoral head: a randomised roentgen stereophotogrammetric study.

    PubMed

    von Schewelov, T; Sanzén, L; Onsten, I; Carlsson, A; Besjakov, J

    2005-12-01

    We investigated the wear characteristics and clinical performance of four different total hip joint articulations in 114 patients. Wear and migration was measured by roentgenstereophotogrammetric analysis at five years or at the last follow-up. The mean annual wear was 0.11 mm for a stainless steel/Enduron articulation, 0.34 mm for stainless steel/Hylamer cup, 0.17 mm for zirconium oxide ceramic/Enduron and 0.40 mm for zirconium oxide ceramic/Hylamer. The difference between the groups was significant (p < 0.008) except for stainless steel/Hylamer vs zirconium oxide ceramic/Hylamer (p = 0.26). At present, 12 patients have undergone a revision procedure, four at five years and eight thereafter. No patient who received a stainless steel/Enduron articulation at their primary replacement required revision. Conflicting results have been reported about the performance of the zirconium oxide ceramic femoral head, but our findings suggest that it should not be used with a polymethylmethacrylate acetabular component. Hylamer has already been withdrawn from the market.

  6. Stem length and canal filling in uncemented custom-made total hip arthroplasty.

    PubMed

    Sakai, T; Sugano, N; Nishii, T; Haraguchi, K; Ochi, T; Ohzono, K

    1999-01-01

    We reviewed 60 custom-made femoral components of two different lengths : 125 mm (group A) and 100 mm (group B), in order to investigate the relationship between stem length and canal filling in uncemented custom-made total hip arthroplasty. There were no statistical differences between the two groups in age, gender, height, body weight, canal flare index, or bowing angle of the femur. Postoperatively there was no statistical difference between the two groups in the proximal canal filling, but significant difference in the distal canal filling (75.5% vs 85.8% on the anteroposterior view and 76.0% vs 82.5% in the lateral view, P<0.001). The distal canal filling inversely correlated with the ratio of the proximal portion and the distal portion of the stem curvature on the lateral view (lateral curve ratio of the stem, P=0.002). We conclude that superior filling at both the proximal and the distal levels can be obtained by using 100-mm custom made components with a small lateral curve ratio. PMID:10591939

  7. Bone remodeling adjacent to total hip replacements: A naturally occurring material design problem

    NASA Astrophysics Data System (ADS)

    Harrigan, Timothy P.; Hamilton, James J.

    1993-10-01

    The reaction of bone to orthopedic implants is an example of a self-adjusting material which changes from a ‘normal state’ to an altered state, based on the mechanical features of the implant and the loads applied to it. The changes in bone around cemented and uncemented femoral total hip components are well documented, and many numerical characterizations of the material reaction to stress have attempted to mimic the natural remodeling process. In this study we review the development of a simple material remodeling rule which yields a stable structure which is optimal and which allows a unique solution. We then use this algorithm to assess the effect of prosthesis stiffness and the presence of a compliant layer on bone remodeling around these implants. An axisymmetric model for axial loading is used to model changes in bone density through the thickness of the cancellous bone around the implants. With cortical remodeling left out of the simulation, the simulations showed density distributions that agreed in general with the results in the literature, and showed a marked difference in response if a compliant layer was added to the prosthesis.

  8. [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. PMID:27249047

  9. Bone Mineral Density and Fracture Risk Assessment to Optimize Prosthesis Selection in Total Hip Replacement.

    PubMed

    Pétursson, Þröstur; Edmunds, Kyle Joseph; Gíslason, Magnús Kjartan; Magnússon, Benedikt; Magnúsdóttir, Gígja; Halldórsson, Grétar; Jónsson, Halldór; Gargiulo, Paolo

    2015-01-01

    The variability in patient outcome and propensity for surgical complications in total hip replacement (THR) necessitates the development of a comprehensive, quantitative methodology for prescribing the optimal type of prosthetic stem: cemented or cementless. The objective of the research presented herein was to describe a novel approach to this problem as a first step towards creating a patient-specific, presurgical application for determining the optimal prosthesis procedure. Finite element analysis (FEA) and bone mineral density (BMD) calculations were performed with ten voluntary primary THR patients to estimate the status of their operative femurs before surgery. A compilation model of the press-fitting procedure was generated to define a fracture risk index (FRI) from incurred forces on the periprosthetic femoral head. Comparing these values to patient age, sex, and gender elicited a high degree of variability between patients grouped by implant procedure, reinforcing the notion that age and gender alone are poor indicators for prescribing prosthesis type. Additionally, correlating FRI and BMD measurements indicated that at least two of the ten patients may have received nonideal implants. This investigation highlights the utility of our model as a foundation for presurgical software applications to assist orthopedic surgeons with selecting THR prostheses. PMID:26417376

  10. The modern, hybrid total hip arthroplasty for primary osteoarthritis at the Hospital for Special Surgery.

    PubMed

    González Della Valle, A; Sharrock, N; Barlow, M; Caceres, L; Go, G; Salvati, E A

    2016-01-01

    We describe our technique and rationale using hybrid fixation for primary total hip arthroplasty (THA) at the Hospital for Special Surgery. Modern uncemented acetabular components have few screw holes, or no holes, polished inner surfaces, improved locking mechanisms, and maximised thickness and shell-liner conformity. Uncemented sockets can be combined with highly cross-linked polyethylene liners, which have demonstrated very low wear and osteolysis rates after ten to 15 years of implantation. The results of cement fixation with a smooth or polished surface finished stem have been excellent, virtually eliminating complications seen with cementless fixation like peri-operative femoral fractures and thigh pain. Although mid-term results of modern cementless stems are encouraging, the long-term data do not show reduced revision rates for cementless stems compared with cemented smooth stems. In this paper we review the conduct of a hybrid THA, with emphasis on pre-operative planning, surgical technique, hypotensive epidural anaesthesia, and intra-operative physiology. PMID:26733642

  11. Two-Stage Revision Total Hip Arthroplasty for Periprosthetic Infections Using Antibiotic-Impregnated Cement Spacers of Various Types and Materials

    PubMed Central

    Takahira, Naonobu; Moriya, Mitsutoshi; Yamamoto, Takeaki; Minegishi, Yojiro; Sakai, Rina; Itoman, Moritoshi; Takaso, Masashi

    2013-01-01

    Antibiotic-impregnated hip cement spacers of various types and materials have been used in the treatment of periprosthetic hip infections. We developed a handmade spacer by using polymethylmethacrylate (PMMA) and/or α-tricalcium phosphate (α-TCP). In this study, we retrospectively reviewed the surgical outcomes in 36 consecutive patients treated with 2-stage revision total hip arthroplasty by using our antibiotic-impregnated hip cement spacers. We aimed to analyze the infection control and reinfection rates after revision surgery. Moreover, we analyzed the possible predictors of postoperative reinfection. After exclusion of 1 patient who died immediately after the first-stage surgery, infection was controlled in 33 of the 36 hips (success rate, 91.7%). Two of these 33 hips underwent resection arthroplasty. Of the 36 hips that had been treated with the antibiotic-cement spacer, 31 hips (86.1%) were eligible for the second-stage prosthesis re-implantation. The 31 protocol hip joints of patients followed up for >6 months (mean, 48.6 months). Ten of these 31 hips (32.3%) became reinfected. No possible predictor examined differed significantly between the reinfection-positive and reinfection-negative groups. However, spacers consisting of PMMA cement alone were associated with the highest risk of reinfection. Therefore, α-TCP-containing antibiotic-impregnated hip cement spacers might decrease the reinfection rate in patients undergoing re-implantation. PMID:24381509

  12. Prevalence and risk factors for periprosthetic fracture in older recipients of total hip replacement: a cohort study

    PubMed Central

    2014-01-01

    Background The growing utilization of total joint replacement will increase the frequency of its complications, including periprosthetic fracture. The prevalence and risk factors of periprosthetic fracture require further study, particularly over the course of long-term follow-up. The objective of this study was to estimate the prevalence and risk factors for periprosthetic fractures occurring in recipients of total hip replacement. Methods We identified Medicare beneficiaries who had elective primary total hip replacement (THR) for non-fracture diagnoses between July 1995 and June 1996. We followed them using Medicare Part A claims data through 2008. We used ICD-9 codes to identify periprosthetic femoral fractures occurring from 2006–2008. We used the incidence density method to calculate the annual incidence of these fractures and Cox proportional hazards models to identify risk factors for periprosthetic fracture. We also calculated the risk of hospitalization over the subsequent year. Results Of 58,521 Medicare beneficiaries who had elective primary THR between July 1995 and June 1996, 32,463 (55%) survived until January 2006. Of these, 215 (0.7%) developed a periprosthetic femoral fracture between 2006 and 2008. The annual incidence of periprosthetic fracture among these individuals was 26 per 10,000 person-years. In the Cox model, a greater risk of periprosthetic fracture was associated with having had a total knee replacement (HR 1.82, 95% CI 1.30, 2.55) or a revision total hip replacement (HR1.40, 95% CI 0.95, 2.07) between the primary THR and 2006. Compared to those without fractures, THR recipients who sustained periprosthetic femoral fracture had three-fold higher risk of hospitalization in the subsequent year (89% vs. 27%, p < 0.0001). Conclusion A decade after primary THR, periprosthetic fractures occur annually in 26 per 10,000 persons and are especially frequent in those with prior total knee or revision total hip replacements. PMID:24885707

  13. Postoperative opioid use as an early indication of total hip arthroplasty failure

    PubMed Central

    Inacio, Maria C S; Pratt, Nicole L; Graves, Stephen E; Roughead, Elizabeth E; Craig Cheetham, T; Paxton, Elizabeth W

    2016-01-01

    Background and purpose — A criticism of total hip arthroplasty (THA) survivorship analysis is that revisions are a late and rare outcome. We investigated whether prolonged opioid use is a possible indicator of early THA failure. Patients and methods — We conducted a cohort study of THAs registered in a total joint replacement registry from January 2008 to December 2011. 12,859 patients were evaluated. The median age was 67 years and 58% were women. Opioid use in the year after surgery was the exposure of interest, and the cumulative daily amounts of oral morphine equivalents (OMEs) were calculated. Post-THA OMEs per 90 day periods were categorized into quartiles. The endpoints were 1- and 5-year revisions. Results — After the first 90 days, 27% continued to use opioids. The revision rate was 0.9% within a year and 1.7% within 5 years. Use of medium-low (100–219 mg), medium-high (220–533 mg), and high (≥ 534 mg) amounts of OMEs in days 91–180 after surgery was associated with a 6 times (95% confidence interval (CI): 3–15), 5 times (CI: 2–13), and 11 times (CI: 2.9–44) higher adjusted risk of 1 year revision, respectively. The use of medium-low and medium-high amounts of OMEs in days 181–270 after surgery was associated with a 17 times (CI: 6–44) and 14 times (95% CI: 4–46) higher adjusted risk of 1-year revision. There was a similar higher risk of 5-year revision. Interpretation — Persistent postoperative use of opioids was associated with revision THA surgery in this cohort, and it may be an early indicator of potential surgical failures. PMID:27168377

  14. Comparison of efficacy and safety of topical versus intravenous tranexamic acid in total hip arthroplasty

    PubMed Central

    Li, Jian; Zhang, Zhijie; Chen, Jie

    2016-01-01

    Abstract Background: The study aimed to compare the effectiveness and safety of topical versus intravenous (IV) tranexamic acid (TXA) for reducing blood loss in primary total hip arthroplasty (THA). Methods: This systematic review and meta-analysis were performed according to the preferred reporting items for systematic reviews and meta-analyses statement criteria. PubMed, Embase, the Cochrane Library, Web of Science, Chinese Biomedicine Literature (CBM), Wanfang Database, China National Knowledge Infrastructure (CNKI), and Google Scholar were searched for randomized controlled trials (RCTs) and non-RCTs that compare topical versus IV-TXA administration for reducing blood loss during TKA from their inception to February, 2016. Meta-analysis was performed by Stata 12.0 software. Results: Seven studies comprising 2056 patients were included in this meta-analysis. No significant difference is found between topical TXA groups and IV-TXA groups regarding transfusion requirements (RR = 1.37, 95% confidence interval [CI]: 0.96–1.97, P = 0.083), total blood loss (MD 17.09, 95% CI: −33.74–67.91, P = 0.510), and hemoglobin decline (MD 0.32, 95%CI: −0.04–0.69, P = 0.122). Meanwhile, there is no significant difference in terms of the occurrence of deep venous thrombosis (RR = 1.09, 95% CI: 0.40–3.90, P = 0.869). Conclusion: Topical TXA has a similar efficacy to IV-TXA in reducing both blood loss and transfusion rate without sacrificing safety in primary THA. PMID:27603364

  15. The Epidemiology and National Trends of Bearing Surface Usage in Primary Total Hip Arthroplasty in Korea

    PubMed Central

    Yoon, Pil Whan; Kim, Yunjung; Yoo, Seungmi; Lee, Sahnghoon; Kim, Hee Joong

    2016-01-01

    Background We analyzed the data for primary total hip arthroplasty (THA) in the Korean nationwide database to assess (1) the epidemiology and national trends of bearing surface usage in THAs and (2) the prevalence of each type of bearing surface according to age, gender, hospital type, primary payer, and hospital procedure volume. Methods A total of 30,881 THAs were analyzed using the Korean Health Insurance Review and Assessment Service database for 2007 through 2011. Bearing surfaces were sub-grouped according to device code for national health insurance claims and consisted of ceramic-on-ceramic (CoC), metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), and metal-on-metal (MoM). The prevalence of each type of bearing surface was calculated and stratified by age, gender, hospital type, primary payer, and procedure volume of each hospital. Results CoC was the most frequently used bearing surface (76.7%), followed by MoP (11.9%), CoP (7.3%), and MoM (4.1%). The proportion of THAs using a CoC bearing surface increased steadily from 71.6% in 2007 to 81.4% in 2011, whereas the proportions using CoP, MoP, and MoM bearing surfaces decreased. The order of prevalence was identical to that in the general population regardless of age, gender, hospital type, primary payer, and hospital procedure volume. Conclusions The trends and epidemiology of bearing surface usage in THAs in Korea are different from those in other countries, and the CoC bearing surface is the most prevalent articulation. In future, the results of a large-scale study using nationwide data of THAs involving a CoC bearing surface will be reported in Korea. PMID:26929796

  16. [Pelvic lymphadenitis after total hip arthroplasty : Mimicking of lymph node metastases in a patient with prostate cancer].

    PubMed

    Sevinc, S; Westhoff, C C; Schrader, A J; Olbert, P J; Hofmann, R; Hegele, A

    2010-08-01

    This report describes the case of a 65-year-old patient who underwent radical prostatectomy in our department. Intraoperatively we detected suspicious lymph nodes on the left side. The histopathological examination revealed histiocytosis and foreign body giant cells but no sign of tumor. The enlarged lymph nodes were ascribed to an ipsilateral total hip arthroplasty performed 14 years previously because of progressive coxarthrosis. Lymphadenitis after total hip arthroplasty is frequently observed. Histopathologically and with the use of polarized light microscopy, histiocytosis and wear particles such as titanium, polyethylene, and polyethylene-methylacrylate may be detected. When operating on patients with arthroplasty of a lower limb, particularly those with a total endoprosthesis, the surgeon should bear in mind that changes in lymph node consistency and size do not necessarily indicate tumor involvement or metastases.

  17. Semi-automated CT-based analysis of regional bone-density in contra lateral total hip replacement

    NASA Astrophysics Data System (ADS)

    Barbu-McInnis, Monica; Tamez-Pena, Jose; Crilly, Therese; Looney, John R.; O'Keefe, R.; Campbell, Debbie; Totterman, Saara M.

    2004-04-01

    Methods for quantifying hip prosthesis induced changes in the adjacent bone are of great interest to orthopedics. In this work, we present a semi-automated technique for measuring the differences in bone density between the prosthetic and contra lateral hips within a CT volumetric data set. In order to reliably compare the bone-density measurements between the prosthetic and the contra laterals hips, a standardized zoning was developed. Using a spherical model of the outer surface of the prosthetic cup, the superior volume of the acetabular region was subdivided into four distance zones: 0-1mm, 1-6mm, 6-11mm, and 11-16mm, respectively. Furthermore, these regions were divided into four positional zones: medial, lateral, anterior, and posterior. At the same time, the positional zones were divided into four angular regions 15, 30, 45, and 60 degrees from the apex of the acetabular cup. The bone density is computed as the average density in Hounsfield unit (HU) measured from the CT scan using all the voxels within each of the 64 zones. Preliminary analysis has been completed on 3 subjects with total hip replacement. The zonal densities on the prosthetic hip and the contra lateral hip were computed and compared. Contrary to initial expectations, a paired t-test showed no statistical significance between the prosthetic and contra lateral bone-densities at any of the four distance zones. Further analysis with a larger sample subject is needed to detect differences in bone-density between the hips in the stress/weight bearing areas in the 15 to 30 degree regions. A method for reliably and consistently measuring the bone-density within standardized zones has been developed and applied on prosthetic and contra lateral hips. The average bone-density for each of the zones takes into account the entire volumetric data set within that region, which is a considerable improvement over the subjective, user driven region of interest estimate selected within one slice practiced in

  18. A Stereophotogrammetric System For The Detection Of Prosthesis Loosening In Total Hip Arthroplasty

    NASA Astrophysics Data System (ADS)

    Baumrind, Sheldon; Genant, Harry K.; Hunter, John; Miller, David; Moffitt, Francis; Murray, William R.; Ross, Steven E.

    1980-07-01

    Loosening of the prosthetic device occurs in about 5% of cases following placement of total hip prostheses (THP). Early detection of loosening is much desired but is difficult to achieve using conventional methods. Due to errors of projection, it is quite possible to fail to detect mobility of even as much as 5 mm on single x-ray films. We are attempting to develop a simplified photogrammetric system suitable for general hospital use which could detect loosening of 0.8 mm at the 95 % level of confidence without use of complex stereoplotting equipment. Metal reference markers are placed in the shaft of the femur and in the acetabular region of the pelvis at the time of surgery. The distances between these reference markers and certain unambiguous points on the prostheses are computed analytically using an X-Y acoustical digitizer (accuracy ± 0.1 mm) and software developed previously for craniofacial measurement. Separate stereopairs of the joint region are taken under weight-bearing and nonweight-bearing conditions. Differences in the measured distances between the bo-ne markers and the prosthetic components on the two stereopairs are taken as indicators of prosthesis loosening. Measurements on a phantom using ten different x-ray stereopairs taken from as many different perspectives have established that true linear distances between reference points and prostheses can be measured at the desired reliability with the present low precision system. Preliminary in vivo measurements indicate that the main unresolved problem is the movement of the subject between the two exposures of each single stereopair. Two possible solutions to this problem are discussed.

  19. Bone creep and short and long term subsidence after cemented stem total hip arthroplasty (THA).

    PubMed

    Norman, T L; Shultz, T; Noble, G; Gruen, T A; Blaha, J D

    2013-03-15

    Stem-cement and cement-bone interfacial failures as well as cement fractures have been noted in cemented total hip arthroplasty (THA) as the cause of aseptic loosening. Attempts to reduce the risk of femoral component loosening include improving the stem-cement interface by various coatings, using a textured or porous coated stem surfaces or by using a tapered stem having a highly-polished surface. The latter approach, often referred to as "force-closed" femoral stem design, would theoretically result in stem stabilization subsequent to debonding and 'taper-lock'. Previous work using three-dimensional finite element analysis has shown a state of stress at the stem-cement interface indicative of 'taper-lock' for the debonded stem and indicated that stem-cement interface friction and bone cement creep played a significant role in the magnitudes of stresses and subsidence of the stem. However, the previous analysis did not include the viscoelastic properties of bone, which has been hypothesized to permit additional expansion of the bone canal and allow additional stem subsidence (Lu and McKellop, 1997). The goal of this study was to investigate the effect of bone viscoelastic behavior on stem subsidence using a 3D finite element analysis. It was hypothesized that the viscoelastic behavior of bone in the hoop direction would allow expansion of the bone reducing the constraint on bone over time and permit additional stem subsidence, which may account for the discrepancies between predicted and clinical subsidence measurements. Analyses were conducted using physiological loads, 'average peak loads' and 'high peak loads' for 'normal patient' and 'active patient' (Bergmann et al., 2010) from which short and long term subsidence was predicted. Results indicated that bone creep does contribute to higher stem subsidence initially and after 10 years of simulated loading. However, it was concluded that the "constraint" upon the cement mantle is not mitigated enough to result in

  20. Bone-on-Bone versus Hardware Impingement in Total Hips: A Biomechanical Study

    PubMed Central

    Elkins, Jacob M.; Pedersen, Douglas R.; Callaghan, John J.; Brown, Thomas D.

    2012-01-01

    Dislocation remains a serious concern for total hip arthroplasty (THA). Impingement, typically between the implant femoral neck and the acetabular cup, remains the most common dislocation impetus. Wear reductions from recent bearing technology advancements have encouraged introduction of substantially increased femoral head diameters. However, there is some evidence that range of motion with larger head sizes is limited by bone-on-bone, rather than hardware, impingement. While all impingement events are of course undesirable, currently little is known biomechanically if these two impingement modes differ in terms of generation of potentially deleterious stress concentrations or with regard to dislocation resistance. Finite element (FE) analysis was therefore used to parametrically investigate the role of head diameter on the local biomechanics of bone-on-bone versus component-on-component impingement events. Of several dislocation-prone patient motion challenges considered, only squatting consistently resulted in bone-on-bone (as opposed to hardware) impingement. Implant stress concentrations arising from hardware impingement during squatting were greater than those from bony impingement, for all head sizes considered. Additionally, dislocation resistance was substantially greater for instances of bony impingement versus hardware-only impingement. These findings suggest that hardware impingement may still be a/the the predominant mode of impingement even with the use of larger femoral heads, for sub-optimally positioned cups. Additionally, the data indicate that, should impingement occur, impingements between the implant neck and cup are (1) more likely to dislocate, and (2) have a greater propensity for causing damage to the implant compared to impingement events involving bony members. PMID:23576916

  1. Haptically guided robotic technology in total hip arthroplasty: a cadaveric investigation.

    PubMed

    Nawabi, Danyal H; Conditt, Michael A; Ranawat, Amar S; Dunbar, Nicholas J; Jones, Jennifer; Banks, Scott; Padgett, Douglas E

    2013-03-01

    The longevity of total hip arthroplasty (THA) continues to improve with advancements in design and bearing materials. However, the incidence of dislocation and impingement-related failures continue to rise, with the inability of the surgeon to achieve optimal component orientation cited as a cause. Computer-assistance has been shown to increase the accuracy of component orientation and robotic-assistance has been developed to translate this advantage into precise surgical execution. We sought to validate a haptically-guided robotic arm system in performing THA with the aim of comparing the accuracy of robotic-assisted acetabular cup placement to manual placement. We implanted 12 acetabular components in 6 cadaveric pelvises comparing robotic-assistance on one side with manual implantation on the other. We measured planned and actual center of rotation (COR), cup position, leg-length equalization and offset for each THA using computed tomography and the robotic platform. The root-mean-square (RMS) error for the robotic-assisted system was within 3 degrees for cup placement and within 1 mm for leg-length equalization and offset when compared to computed tomography. The robotic-assisted system was significantly more accurate than manual implantation in reproducing the COR and cup orientation, as determined by a preoperative plan. The RMS error for manual implantation compared to robotic-assistance was 5 times higher for cup inclination and 3.4 times higher for cup anteversion (p < 0.01). Robotic-assistance is more accurate than manual implantation in achieving optimal cup orientation. It has the ability to eliminate human error from THA and should be considered in light of THA failures due to component malposition.

  2. In vivo and ex vivo measurement of polyethylene wear in total hip arthroplasty

    PubMed Central

    Hansen, Viktor J; Noz, Marilyn E; Maguire, Gerald Q; Zeleznik, Michael P; Olivecrona, Henrik; Bragdon, Charles R; Weidenhielm, Lars; Malchau, Henrik

    2014-01-01

    Background Determination of the amount of wear in a polyethylene liner following total hip arthroplasty (THA) is important for both the clinical care of individual patients and the development of new types of liners. Patients and methods We measured in vivo wear of the polyethylene liner using computed tomography (CT) (obtained in the course of regular clinical care) and compared it to coordinate-measuring machine (CMM) readings. Also, changes in liner thickness of the same retrieved polyethylene liner were measured using a micrometer, and were compared to CT and CMM measurements. The distance between the centers of the acetabular cup and femoral head component was measured in 3D CT, using a semi-automatic analysis method. CMM readings were performed on each acetabular liner and data were analyzed using 3D computer-aided design software. Micrometer readings compared the thickest and thinnest regions of the liner. We analyzed 10 THA CTs and retrievals that met minimal requirements for CT slice thickness and explanted cup condition. Results For the 10 cups, the mean difference between the CT readings and the CMM readings was -0.09 (–0.38 to 0.20) mm. This difference was not statistically significant (p = 0.6). Between CT and micrometer, the mean difference was 0.11 (–0.33 to 0.55) mm. This difference was not statistically significant (p = 0.6). Interpretation Our results show that CT imaging is ready to be used as a tool in clinical wear measurement of polyethylene liners used in THA. PMID:24758322

  3. A visual-aided wireless monitoring system design for total hip replacement surgery.

    PubMed

    Chen, Hong; Gao, Jiyang; Su, Shaojie; Zhang, Xu; Wang, Zhihua

    2015-04-01

    To improve the positioning accuracy of implants in Total Hip Replacement (THR) surgeries, a visual-aided wireless monitoring system for THR surgery is proposed in this paper. This system aims to measure and display the contact distribution and relative pose between femoral head and acetabulum prosthesis during the surgery to help surgeons obtain accurate position of implants. The system consists of two parts: the Sensors Array Measuring System (SAMS) and the display part. The SAMS is composed of a sensors array (including contact sensors and an image sensor), signal conditioning circuits, a low power microcontroller (MCU), and a low-power transceiver. The SAMS is designed to estimate the relative pose of femoral head component to acetabular component. The display part processes the data from sensors and demonstrates the contact distribution and the pose of the prothesis during the surgery in 3-D graphics. The two parts of the system communicate with each other on an RF link at the band of 400 MHz. The signal conditioning circuits have been designed and fabricated in 0.18 μm CMOS process. Testing results show that the resolution of the signal conditioning circuits is 60.1 μ Vpp (1.35 g) with ±100 mVpp input. The chip can operate under 1.2-to-3.6 V supply voltage for single battery applications with 116-160 μ A current consumption. The system has been verified by the simulation with rotation quaternion and translation vector. The experimental results show that the contact distribution and relative pose of the two components could be measured and demonstrated in real time. The relative error of rotation is less than 8% and the actual relative error of translation is less than 10%.

  4. Predictors of physical functioning after total hip arthroplasty: a systematic review

    PubMed Central

    Buirs, L D; Van Beers, L W A H; Scholtes, V A B; Pastoors, T; Sprague, S; Poolman, R W

    2016-01-01

    Objective The objective of this systematic review of the literature was to identify the predictors of functional outcome after total hip arthroplasty (THA). Method A systematic literature search in Web of Science, CINAHL, EMBASE and PubMed was conducted on 23 June 2015. The articles were selected based on their quality, relevance and measurement of the predictive factor. The level of evidence of all studies was determined using the GRADE rating scheme. Results The initial search resulted in 1092 citations. After application of the inclusion and exclusion criteria, 33 articles met our eligibility criteria and were graded. Included studies were classified as level of evidence low (11), moderate (17) or high (5). Of the included studies, 18 evaluated body mass index (BMI), 17 evaluated preoperative physical functions, 15 evaluated age, 15 evaluated gender and 13 evaluated comorbidity. There was strong evidence suggesting an association between BMI, age, comorbidity, preoperative physical functions and mental health with functional outcome after THA. There was weak evidence suggesting an association between quadriceps strength and education with functional outcome after THA. The evidence was inconsistent for associations with gender and socioeconomic status and functional outcome following THA. We found limited evidence suggesting that alcohol consumption, vitamin D insufficiency and allergies were predictors of functional outcome following THA. Conclusions We have identified multiple predictors of functional outcome after THA, which will enable general practitioners and orthopaedic surgeons to better predict the improvement in physical functioning for their patients with THA. They can use this information to provide patient-specific advice regarding the referral for THA and the expected outcomes after THA. Further research with consistent measurement tools, outcomes and duration of follow-up across studies is needed to confirm the influence of these factors. PMID

  5. A visual-aided wireless monitoring system design for total hip replacement surgery.

    PubMed

    Chen, Hong; Gao, Jiyang; Su, Shaojie; Zhang, Xu; Wang, Zhihua

    2015-04-01

    To improve the positioning accuracy of implants in Total Hip Replacement (THR) surgeries, a visual-aided wireless monitoring system for THR surgery is proposed in this paper. This system aims to measure and display the contact distribution and relative pose between femoral head and acetabulum prosthesis during the surgery to help surgeons obtain accurate position of implants. The system consists of two parts: the Sensors Array Measuring System (SAMS) and the display part. The SAMS is composed of a sensors array (including contact sensors and an image sensor), signal conditioning circuits, a low power microcontroller (MCU), and a low-power transceiver. The SAMS is designed to estimate the relative pose of femoral head component to acetabular component. The display part processes the data from sensors and demonstrates the contact distribution and the pose of the prothesis during the surgery in 3-D graphics. The two parts of the system communicate with each other on an RF link at the band of 400 MHz. The signal conditioning circuits have been designed and fabricated in 0.18 μm CMOS process. Testing results show that the resolution of the signal conditioning circuits is 60.1 μ Vpp (1.35 g) with ±100 mVpp input. The chip can operate under 1.2-to-3.6 V supply voltage for single battery applications with 116-160 μ A current consumption. The system has been verified by the simulation with rotation quaternion and translation vector. The experimental results show that the contact distribution and relative pose of the two components could be measured and demonstrated in real time. The relative error of rotation is less than 8% and the actual relative error of translation is less than 10%. PMID:25879970

  6. Late Anterior Dislocation Due to Posterior Pelvic Tilt in Total Hip Arthroplasty

    PubMed Central

    Kobayashi, Hiroki; Nakashima, Yasuharu; Yamamoto, Takuaki; Motomura, Goro; Kanazawa, Masayuki; Takagishi, Kenji; Iwamoto, Yukihide

    2016-01-01

    Background: Excessive pelvic tilt may be one of the factors leading to instability in total hip arthroplasty (THA), even when the acetabular cup is placed properly. To our knowledge, only a few studies have described late anterior dislocation due to posterior pelvic tilt. We present 3 cases with late anterior dislocations possibly due to posterior pelvic tilt. Cases Presentations: Case-1: An 84-years-old woman fell and presented with an anterior dislocation 12-years after THA. Her pelvis had tilted to approximately 30° posteriorly in a supine position. After conservative treatment, she presented with 10 recurrent anterior dislocations. She had thoracolumbar kyphosis due to multiple compression fractures. Revision with anterior placement of an elevated liner and a 32-mm head corrected the dislocation, and no further dislocations occurred. Case-2: A 78-years-old woman fell and presented with an anterior dislocation 4-years after THA. Her posterior pelvic tilt had increased 23° due to a lumbar compression fracture. Revision by decreasing the cup anteversion was performed, but recurrent posterior dislocations occurred. Owing to her worsened general condition, further treatment was abandoned. Case-3: A 79-years-old woman twisted her body and presented an anterior dislocation 3-years after THA. After manual reduction and conservative treatment, the dislocation recurred. Her posterior pelvic tilt had increased 16°. Conclusion: Although minor trauma triggered the anterior instability in these patients, the underlying pathomechanism existed in the progressive pelvic posterior tilt due to thoracolumbar kyphosis. As longer life expectancy as well as implant survivorship is predicted, attention must be paid to the change of pelvic tilt in elderly patients. PMID:27398108

  7. Incidence, risk factors and the healthcare cost of falls postdischarge after elective total hip and total knee replacement surgery: protocol for a prospective observational cohort study

    PubMed Central

    Hill, Anne-Marie; Ross-Adjie, Gail; McPhail, Steven M; Monterosso, Leanne; Bulsara, Max; Etherton-Beer, Christopher; Powell, Sarah-Jayne; Hardisty, Gerard

    2016-01-01

    Introduction The number of major joint replacement procedures continues to increase in Australia. The primary aim of this study is to determine the incidence of falls in the first 12 months after discharge from hospital in a cohort of older patients who undergo elective total hip or total knee replacement. Methods and analyses A prospective longitudinal observational cohort study starting in July 2015, enrolling patients aged ≥60 years who are admitted for elective major joint replacement (n=267 total hip replacement, n=267 total knee replacement) and are to be discharged to the community. Participants are followed up for 12 months after hospital discharge. The primary outcome measure is the rate of falls per thousand patient-days. Falls data will be collected by 2 methods: issuing a falls diary to each participant and telephoning participants monthly after discharge. Secondary outcomes include the rate of injurious falls and health-related quality of life. Patient-rated outcomes will be measured using the Oxford Hip or Oxford Knee score. Generalised linear mixed modelling will be used to examine the falls outcomes in the 12 months after discharge and to examine patient and clinical characteristics predictive of falls. An economic evaluation will be conducted to describe the nature of healthcare costs in the first 12 months after elective joint replacement and estimate costs directly attributable to fall events. Ethics and dissemination The results will be disseminated through local site networks and will inform future services to support older people undergoing hip or knee joint replacement and also through peer-reviewed publications and medical conferences. This study has been approved by The University of Notre Dame Australia and local hospital human research ethics committees. Trial registration number ACTRN12615000653561; Pre-results. PMID:27412102

  8. Long-term results of the threaded Mecron cup in primary total hip arthroplasty

    PubMed Central

    Clarius, Michael; Jung, Alexander W.; Streit, Marcus R.; Merle, Christian; Raiss, Patric

    2009-01-01

    In the 1970s, high failure rates of cemented acetabular components, especially in young patients, in the middle- and long-term prompted a search for alternatives. The Mecring was one of the most popular first generation uncemented, threaded cups widely used in the 1980s for arthroplasty of the hip. First generation threaded cups commonly had smooth surface treatment and showed unacceptably high failure rates in the mid-term. In a consecutive series of 209 patients, 221 threaded uncemented acetabular cups with smooth surface treatment (Mecring) had been implanted in combination with one type of uncemented stem. Patients were followed up clinically and radiographically. The mean time of follow-up was 17 (range 15–20) years. In 91 (41%) hips the acetabular component had been revised or was awaiting revision: two hips for infection and 84 (38%) for aseptic loosening. Five hips were awaiting revision. The survival rate for all revisions including hips awaiting revision was 49% (95% CI: 41–57%) at 17 years. These results support the view that smooth, threaded acetabular components do not provide satisfactory long-term fixation and should be abandoned. Patients with these components must be closely monitored as the failure rate remains high in the long-term. PMID:19629481

  9. Clinical evaluation following the use of mineralized collagen graft for bone defects in revision total hip arthroplasty

    PubMed Central

    Huang, Cheng; Qin, Liwu; Yan, Wei; Weng, Xisheng; Huang, Xiangjie

    2015-01-01

    Revision total hip arthroplasty (THA) with massive bone loss has been a real challenge for orthopaedic surgeons. Here we describe an approach using mineralized collagen (MC) graft to reconstruct acetabulum and femur with massive bone defects. We identified 89 patients suffering acetabular or femoral bone defects after primary THA, who required revision THA for this study. During the surgery, MC was applied to reconstruct both the acetabular and femoral defects. Harris hip score was used to evaluate hip function while radiographs were taken to estimate bone formation in the defect regions. The average follow-up period was 33.6 ± 2.4 months. None of the components needed re-revised. Mean Harris hip scores were 42.5 ± 3.5 before operation, 75.2 ± 4.0 at 10th month and 95.0 ± 3.6 at the final follow-up. There were no instances of deep infection, severe venous thrombosis or nerve palsy. The present study demonstrated that MC graft can serve as a promising option for revision THA with massive bone deficiency. Meanwhile, extended follow-up is needed to further prove its long-term performance. PMID:26816647

  10. A new technique of subtrochanteric shortening in total hip arthroplasty: surgical technique and results of 9 cases.

    PubMed

    Bruce, W J; Rizkallah, S M; Kwon, Y M; Goldberg, J A; Walsh, W R

    2000-08-01

    Total hip arthroplasty for severe chronic proximal femoral migration, most commonly seen in congenital dislocation of the hip, has been associated with high rates of complications. A new technique of femoral subtrochanteric shortening osteotomy with the prosthesis in situ is described. This technique minimizes the potential complications, allows for correction of severe femoral neck anteversion, and gives excellent rotational stability, while preserving the proximal femur for better press-fit cementless fixation. In this series, there were 9 cases: 6 women and 2 men with a mean age of 53 years (range, 26-77 years). The average follow-up period was 56 months (range, 6-86 months). The mean preoperative Harris Hip Score was 31 (range, 20-35), and the mean postoperative score was 81 (range, 60-98). At follow-up, all patients reported significant pain relief and functional improvement. All osteotomies appeared to be healed on radiographs by 12 weeks. There were 3 complications. The first complication was a recurrent dislocation resulting from muscle incompetence, which was revised using a constrained liner and a 32-mm head with no further dislocations. The second complication was a breach of the femoral shaft, which was treated operatively using a longer stem. The third complication was a proximal femoral shaft split, which was treated by leaving the cerclage wire in situ. This technique should be considered in cases of congenital dislocation of the hip and when femoral shortening is needed. PMID:10960001

  11. Directed air flow to reduce airborne particulate and bacterial contamination in the surgical field during total hip arthroplasty.

    PubMed

    Stocks, Gregory W; O'Connor, Daniel P; Self, Sean D; Marcek, Geoff A; Thompson, Brandon L

    2011-08-01

    This study evaluated the use of a system that delivers a small field of local, directed air from a high-efficiency particulate air (HEPA) filter to reduce airborne particulate and airborne bacteria in the surgical field during total hip arthroplasty. Thirty-six patients were randomized into 3 groups: with directed air flow, with the directed air flow system present but turned off, and control. Airborne particulate and bacteria were collected from within 5 cm of the surgical wound. All particulate and bacterial counts at the surgical site were significantly lower in the directed air flow group (P < .001). The directed air flow system was effective in reducing airborne particulate and colony-forming units in the surgical field during total hip arthroplasty. PMID:20851565

  12. Risk stratification algorithm for management of patients with dual modular taper total hip arthroplasty: consensus statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons and the Hip Society.

    PubMed

    Kwon, Young-Min; Fehring, Thomas K; Lombardi, Adolph V; Barnes, C Lowry; Cabanela, Miguel E; Jacobs, Joshua J

    2014-11-01

    Although 'dual taper' modular stems with interchangeable modular necks have the potential to optimize hip biomechanical parameters, there is increasing concern regarding the occurrence of adverse local tissue reactions from mechanically assisted crevice corrosion at the neck-stem taper junction. A systematic treatment approach (risk stratification algorithm) based on the currently available data is recommended to optimize patient management. While specialized tests such as metal ion analysis and MARS MRI are useful modalities in evaluating for adverse tissue reactions, over-reliance on any single investigative tool in the clinical decision-making process should be avoided. There should be a low threshold to perform a systematic evaluation of patients with dual taper stem total hip arthroplasty as early recognition and diagnosis will facilitate the initiation of appropriate treatment. PMID:25189673

  13. No association between serum metal ions and implant fixation in large-head metal-on-metal total hip arthroplasty

    PubMed Central

    Søballe, Kjeld; Jakobsen, Stig Storgaard; Lorenzen, Nina Dyrberg; Mechlenburg, Inger; Stilling, Maiken

    2014-01-01

    Background The mechanism of failure of metal-on-metal (MoM) total hip arthroplasty (THA) has been related to a high rate of metal wear debris, which is partly generated from the head-trunnion interface. However, it is not known whether implant fixation is affected by metal wear debris. Patients and methods 49 cases of MoM THA in 41 patients (10 women) with a mean age of 52 (28–68) years were followed with stereoradiographs after surgery and at 1, 2, and 5 years to analyze implant migration by radiostereometric analysis (RSA). Patients also participated in a 5- to 7-year follow-up with measurement of serum metal ions, questionnaires (Oxford hip score (OHS) and Harris hip score (HHS)), and measurement of cup and stem positions and systemic bone mineral density. Results At 1–2 years, mean total translation (TT) was 0.04 mm (95% CI: –0.07 to 0.14; p = 0.5) for the stems; at 2–5 years, mean TT was 0.13 mm (95% CI: –0.25 to –0.01; p = 0.03), but within the precision limit of the method. For the cups, there was no statistically significant TT or total rotation (TR) at 1–2 and 2–5 years. At 2–5 years, we found 4 cups and 5 stems with TT migrations exceeding the precision limit of the method. There was an association between cup migration and total OHS < 40 (4 patients, 4 hips; p = 0.04), but there were no statistically significant associations between cup or stem migration and T-scores < –1 (n = 10), cup and stem positions, or elevated serum metal ion levels (> 7µg/L (4 patients, 6 hips)). Interpretation Most cups and stems were well-fixed at 1–5 years. However, at 2–5 years, 4 cups and 5 stems had TT migrations above the precision limits, but these patients had serum metal ion levels similar to those of patients without measurable migrations, and they were pain-free. Patients with serum metal ion levels > 7 µg/L had migrations similar to those in patients with serum metal ion levels < 7 µg/L. Metal wear debris does not appear to influence the

  14. Cement augmentation of the acetabulum for revision total hip arthroplasty for infection.

    PubMed

    Rogers, Benedict A; Kuchinad, R; Garbedian, S; Backstein, D; Gross, A E; Safir, O A

    2015-02-01

    Antibiotic-loaded cement spacers in first-stage revision hip arthroplasty for infection are associated with a high dislocation and fracture rate. This technical note describes a novel surgical technique, utilizing screws and cement, improving acetabular coverage and reducing the risk of mechanical failure. Fifteen infected hip prostheses underwent removal, cement acetabular augmentation and insertion of a femoral cement spacer. Eleven hips had successful infection eradication and subsequently underwent a second stage revision procedure a mean duration of 15 weeks (9-48) after the first stage. No dislocations or fractures of the cement spacers were observed. This technique affords the potential to reduce the duration of time cement spacers remaining in situ, provides enhanced mechanical stability and improved antibiotic elution through cement-on-cement articulation.

  15. Good outcome of total hip replacement in patients with cerebral palsy

    PubMed Central

    King, Garry; Hunt, Linda P; Wilkinson, J Mark; Blom, Ashley W

    2016-01-01

    Background and purpose — People with cerebral palsy (CP) often have painful deformed hips, but they are seldom treated with hip replacement as the surgery is considered to be high risk. However, few data are available on the outcome of hip replacement in these patients. Patients and methods — We linked Hospital Episode Statistics (HES) records to the National Joint Registry for England and Wales to identify 389 patients with CP who had undergone hip replacement. Their treatment and outcomes were compared with those of 425,813 patients who did not have CP. Kaplan-Meier estimates were calculated to describe implant survivorship and the curves were compared using log-rank tests, with further stratification for age and implant type. Reasons for revision were quantified as patient-time incidence rates (PTIRs). Nationally collected patient-reported outcomes (PROMS) before and 6 months after operation were compared if available. Cumulative mortality (Kaplan-Meier) was estimated at 90 days and at 1, 3, and 5 years. Results — The cumulative probability of revision at 5 years post-surgery was 6.4% (95% CI: 3.8–11) in the CP cohort as opposed to 2.9% (CI 2.9–3%) in the non-CP cohort (p < 0.001). Patient-reported outcomes showed that CP patients had worse pain and function preoperatively, but had equivalent postoperative improvement. The median improvement in Oxford hip score at 6 months was 23 (IQR: 14–28) in CP and it was 21 (14–28) in non-CP patients. 91% of CP patients reported good or excellent satisfaction with their outcome. The cumulative probability of mortality for CP up to 7 years was similar to that in the controls after stratification for age and sex. Interpretation — Hip replacement for cerebral palsy appears to be safe and effective, although implant revision rates are higher than those in patients without cerebral palsy. PMID:26863583

  16. Do we need hip-ankle radiographs to assess the coronal alignment and implant position after total knee replacement?

    PubMed Central

    Dargel, Jens; Oppermann, Johannes; Eysel, Peer; Penning, Lenhard

    2016-01-01

    Aims and Objectives: Restoration of the coronal alignment of the knee is known to be one of the major criteria of a successful total knee arthroplasty (TKA). It therefore appears to be mandatory to routinely assess the postoperative limb alignment using hip-ankle radiographs and to identify implants that may be at risk of premature failure. However, there is no clear consensus whether weight-bearing hip-ankle radiographs or rather standardized a-p knee-radiographs should be used to assess implant position and coronal alignment after TKA. It is the aim of the present study to investigate if implant position and the mechanical alignment after TKA can reproducibly be assessed using standardized a-p knee-radiographs or rather if weight-bearing hip-ankle radiographs are needed. Materials and Methods: This study was performed on 100 postoperative weight-bearing hip-ankle radiographs after conventional primary TKA. The true mechanical and anatomical femorotibial angle as well as coronal implant position (MPTA, LDFA) was assessed using the MediCAD software, which served as a control. The hip-ankle radiographs were then digitally cropped to 80%, 60% and 40% of the leg-length. In each cropped radiograph, tibial coronal implant position was assessed by referencing against the visible mid-shaft, whereas femoral implant position was referenced against the visible mid-shaft (anatomical axis) or against a surrogate mechanical axis, which was drawn perpendicular to the distal tangent of the femoral component. Each measurement was performed by three independent observers. The difference between the alignment parameters in the hip-ankle radiographs were statistically compared with the cropped radiographs and the inter-observer correlation coefficient (ICC) was calculated for each parameter. Results: The ICC for inter-observer agreement of measurement of the mechanical femorotibial angle was significantly higher in hip-ankle radiographs (.95) when compared with a radiograph cropped

  17. Hydroxyapatite coating does not improve uncemented stem survival after total hip arthroplasty!

    PubMed Central

    Hailer, Nils P; Lazarinis, Stergios; Mäkelä, Keijo T; Eskelinen, Antti; Fenstad, Anne M; Hallan, Geir; Havelin, Leif; Overgaard, Søren; Pedersen, Alma B; Mehnert, Frank; Kärrholm, Johan

    2015-01-01

    Background and purpose It is still being debated whether HA coating of uncemented stems used in total hip arthroplasty (THA) improves implant survival. We therefore investigated different uncemented stem brands, with and without HA coating, regarding early and long-term survival. Patients and methods We identified 152,410 THA procedures using uncemented stems that were performed between 1995 and 2011 and registered in the Nordic Arthroplasty Register Association (NARA) database. We excluded 19,446 procedures that used stem brands less than 500 times in each country, procedures performed due to diagnoses other than osteoarthritis or pediatric hip disease, and procedures with missing information on the type of coating. 22 stem brands remained (which were used in 116,069 procedures) for analysis of revision of any component. 79,192 procedures from Denmark, Norway, and Sweden were analyzed for the endpoint stem revision. Unadjusted survival rates were calculated according to Kaplan-Meier, and Cox proportional hazards models were fitted in order to calculate hazard ratios (HRs) for the risk of revision with 95% confidence intervals (CIs). Results Unadjusted 10-year survival with the endpoint revision of any component for any reason was 92.1% (CI: 91.8–92.4). Unadjusted 10-year survival with the endpoint stem revision due to aseptic loosening varied between the stem brands investigated and ranged from 96.7% (CI: 94.4–99.0) to 99.9% (CI: 99.6–100). Of the stem brands with the best survival, stems with and without HA coating were found. The presence of HA coating was not associated with statistically significant effects on the adjusted risk of stem revision due to aseptic loosening, with an HR of 0.8 (CI: 0.5–1.3; p = 0.4). The adjusted risk of revision due to infection was similar in the groups of THAs using HA-coated and non-HA-coated stems, with an HR of 0.9 (CI: 0.8–1.1; p = 0.6) for the presence of HA coating. The commonly used Bimetric stem (n = 25,329) was

  18. Modular titanium alloy neck failure in total hip replacement: analysis of a relapse case.

    PubMed

    Ceretti, Marco; Falez, Francesco

    2016-01-01

    Modular neck hip prosthesis born in the 1990 with the aim of allowing the surgeon to modify CCD angle, offset and femoral anteversion intra-operatively restoring patient's original biomechanics. In order to achieve the best biomechanics of the reconstructed hip, preoperative planning is essential. In the last few years modularity has been questioned and an argument made for the return to mono block stems due to events of breakage or disconnection of modular components. Fretting or crevice corrosion may lead to failure of such modular device due to the contamination inside the modular coupling or to high loads. We present a case of repetitive modular femoral neck prosthesis fracture. PMID:27163109

  19. Nonsteroidal Anti-inflammatory Drugs as Prophylaxis for Heterotopic Ossification after Total Hip Arthroplasty

    PubMed Central

    Kan, Shun-Li; Yang, Bo; Ning, Guang-Zhi; Chen, Ling-Xiao; Li, Yu-Lin; Gao, Shi-Jie; Chen, Xing-Yu; Sun, Jing-Cheng; Feng, Shi-Qing

    2015-01-01

    Abstract Heterotopic ossification (HO) is a frequent complication after total hip arthroplasty (THA). Nonsteroidal anti-inflammatory drugs (NSAIDs) have been used as routine prophylaxis for HO after THA. However, the efficacy of NSAIDs on HO, particularly selective NSAIDs versus nonselective NSAIDs, is uncertain. We searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, and clinicaltrials.gov to identify randomized controlled trials with respect to HO after THA. Two reviewers extracted the data and estimated the risk of bias. For the ordered data, we followed the Bayesian framework to calculate the odds ratio (OR) with a 95% credible interval (CrI). For the dichotomous data, the OR and 95% confidence interval (CI) were calculated using Stata version 12.0. The subgroup analyses and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach were used. A total of 1856 articles were identified, and 21 studies (5995 patients) were included. In the NSAIDs versus placebo analysis, NSAIDs could decrease the incidence of HO, according to the Brooker scale (OR = 2.786, 95% CrI 1.879–3.993) and Delee scale (OR = 9.987, 95% CrI 5.592–16.17). In the selective NSAIDs versus nonselective NSAIDs analysis, there was no significant difference (OR = 0.7989, 95% CrI 0.5506–1.125) in the prevention of HO. NSAIDs could increase discontinuation caused by gastrointestinal side effects (DGSE) (OR = 1.28, 95% CI 1.00–1.63, P = 0.046) more than a placebo. Selective NSAIDs could decrease DGSE (OR = 0.48, 95% CI 0.24–0.97, P = 0.042) compared with the nonselective NSAIDs. There was no significant difference with respect to discontinuation caused by nongastrointestinal side effects (DNGSE) in NSAIDs versus a placebo (OR = 1.16, 95% CI 0.88–1.53, P = 0.297) and in selective NSAIDs versus nonselective NSAIDs (OR = 0.83, 95% CI 0.50–1.37, P = 0.462). NSAIDs might reduce the incidence of HO

  20. Structural allograft and cemented long-stem prosthesis for complex revision hip arthroplasty: use of a trochanteric claw plate improves final hip function

    PubMed Central

    Lemoine, Camille Thevenin; Kerboull, Marcel; Courpied, Jean Pierre

    2007-01-01

    Extensive bone loss raises formidable challenges in total hip revision. The aim of this study was to evaluate the results of reconstruction using a cemented long-stem and massive structural allograft implanted in a filleted proximal femur, with and without the use of a trochanteric claw plate. Between 1988 and 2001, 44 revisions were performed in 42 patients. After a transtrochanteric approach, the femur was cut longitudinally. A long, cemented Charnley-type prosthesis was used, and flaps of the residual femur were folded around the allograft. The greater trochanter was reinserted with wires in all revisions, and with both wires and a claw plate in 20 revisions. Mean follow-up was 7.15 years (range: 3–16); seven patients, died and four were lost to follow-up. The follow-up exceeded five years in 34 patients. The major complication was nonunion of the greater trochanter, which occurred in 25 cases. Six dislocations, one recurrence of infection, two mechanical loosening, and two fractures below the stem were also recorded. The use of a trochanteric claw plate significantly improved final hip stability, even in patients with nonunion. Femoral reconstruction with a massive structural allograft is reliable and long-lived, and serious complications and long-term resorption are uncommon. The use of a trochanteric claw plate significantly improves final hip stability. Level of evidence: Therapeutic study, level III (retrospective comparative study). PMID:18008098

  1. Association between perioperative blood transfusion and early postoperative cognitive dysfunction in aged patients following total hip replacement surgery

    PubMed Central

    Zhu, Si-Hai; Ji, Mu-Huo; Gao, Da-Peng; Yang, Jian-Jun

    2014-01-01

    Introduction Accumulating evidence suggests that enhanced inflammatory responses contribute to the pathogenesis of postoperative cognitive dysfunction (POCD). Blood transfusion can trigger an enhancement of acute inflammatory responses. Therefore, we hypothesized that perioperative blood transfusion is associated with a higher risk of POCD in aged patients following total hip replacement surgery. Material and methods Patients older than 65 years undergoing elective total hip replacement surgery were enrolled from October 2011 to December 2012. Neurocognitive tests were evaluated at baseline and at 7 d after surgery by a Mini-Mental State Test. Multivariate logistic regression analysis was used to determine risk factors associated with POCD. Results Fifty-six patients (27.3%) developed POCD 7 d postoperatively. Patients who developed POCD were older, had a lower education level and preoperative hemoglobin concentration, had more blood loss, and had a lower body weight (p < 0.05). Patients with POCD were more likely to receive red blood cells (RBCs) transfusion (51.8% versus 31.5%; p < 0.05). A multivariable logistic regression model identified older age, lower education level, and perioperative blood transfusion of more than 3 units as independent risk factors for POCD 7 d postoperatively. Conclusion Our data suggested that perioperative blood transfusion of more than 3 units of RBCs is an independent risk factor for POCD in aged patients following total hip replacement surgery. PMID:24345210

  2. Does hydroxyapatite coating have no advantage over porous coating in primary total hip arthroplasty? A meta-analysis.

    PubMed

    Chen, Yun-Lin; Lin, Tiao; Liu, An; Shi, Ming-Min; Hu, Bin; Shi, Zhong-Li; Yan, Shi-Gui

    2015-01-28

    There are some arguments between the use of hydroxyapatite and porous coating. Some studies have shown that there is no difference between these two coatings in total hip arthroplasty (THA), while several other studies have shown that hydroxyapatite has advantages over the porous one. We have collected the studies in Pubmed, MEDLINE, EMBASE, and the Cochrane library from the earliest possible years to present, with the search strategy of "(HA OR hydroxyapatite) AND ((total hip arthroplasty) OR (total hip replacement)) AND (RCT* OR randomiz* OR control* OR compar* OR trial*)". The randomized controlled trials and comparative observation trials that evaluated the clinical and radiographic effects between hydroxyapatite coating and porous coating were included. Our main outcome measurements were Harris hip score (HHS) and survival, while the secondary outcome measurements were osteolysis, radiolucent lines, and polyethylene wear. Twelve RCTs and 9 comparative observation trials were included. Hydroxyapatite coating could improve the HHS (p < 0.01), reduce the incidence of thigh pain (p = 0.01), and reduce the incidence of femoral osteolysis (p = 0.01), but hydroxyapatite coating had no advantages on survival (p = 0.32), polyethylene wear (p = 0.08), and radiolucent lines (p = 0.78). Hydroxyapatite coating has shown to have an advantage over porous coating. The HHS and survival was duration-dependent-if given the sufficient duration of follow-up, hydroxyapatite coating would be better than porous coating for the survival. The properties of hydroxyapatite and the implant design had influence on thigh pain incidence, femoral osteolysis, and polyethylene wear. Thickness of 50 to 80 μm and purity larger than 90% increased the thigh pain incidence. Anatomic design had less polyethylene wear.

  3. Cathepsin G and alpha 1-antichymotrypsin in the local host reaction to loosening of total hip prostheses.

    PubMed

    Takagi, M; Konttinen, Y T; Santavirta, S; Kangaspunta, P; Suda, A; Rokkanen, P

    1995-01-01

    The tissue localization and content of the proteolytic enzyme cathepsin G and its inhibitor alpha 1-antichymotrypsin were studied in the local host reaction to loosening of total hip-replacement prostheses in eleven patients and were compared with those in samples of non-inflammatory tissue from the synovial capsule obtained during arthroscopies of the knee. Immunostaining demonstrated cellular localization of cathepsin G in 71 per cent of monocyte or macrophage-like cells and in 46 per cent of fibroblast-like cells in the samples of interface tissue between the bone and the loose acetabular component obtained at the time of the total hip replacements, and in 59 and 42 per cent, respectively, in the samples of pseudocapsular tissue obtained at the same time, whereas the synovial lining cells in the samples of non-inflammatory tissue from the synovial capsule revealed only a slight immunoreactivity to cathepsin G. Cathepsin-G activity was also measured with synthetic succinyl-alanine-alanine-proline-phenylalanine-paranitroanilide as a substrate, the degradation of which was monitored spectrophotometrically. In accordance with results from immunohistochemical studies, cathepsin-G activity was found in the samples of interface tissue (31.6 international units per liter) and the samples of pseudocapsular tissue (15.5 international units per liter) obtained during the total hip replacements, whereas the level of cathepsin-G was low in the samples of non-inflammatory synovial capsular tissue (2.5 international units per liter). Cathepsin-G activity in the samples of pseudosynovial fluid obtained at the time of the total hip replacements was low (2.4 international units per liter), although immunoblot analysis showed marked immunoreactive cathepsin G in the samples of pseudosynovial fluid. This low activity of cathepsin G might be explained by the presence of alpha 1-antichymotrypsin, which was detected by laser nephlometric immunoassay and immunoblot analysis. These

  4. Increased risk of revision of cementless stemmed total hip arthroplasty with metal-on-metal bearings

    PubMed Central

    Pedersen, Alma B; Mäkelä, Keijo; Eskelinen, Antti; Havelin, Leif Ivar; Furnes, Ove; Kärrholm, Johan; Garellick, Göran; Overgaard, Søren

    2015-01-01

    Background and purpose Data from the national joint registries in Australia and England and Wales have revealed inferior medium-term survivorship for metal-on-metal (MoM) total hip arthroplasty (THA) than for metal-on-polyethylene (MoP) THA. Based on data from the Nordic Arthroplasty Register Association (NARA), we compared the revision risk of cementless stemmed THA with MoM and MoP bearings and we also compared MoM THA to each other. Patients and methods We identified 32,678 patients who were operated from 2002 through 2010 with cementless stemmed THA with either MoM bearings (11,567 patients, 35%) or MoP bearings (21,111 patients, 65%). The patients were followed until revision, death, emigration, or the end of the study period (December 31, 2011), and median follow-up was 3.6 (interquartile range (IQR): 2.4–4.8) years for MoM bearings and 3.4 (IQR: 2.0–5.8) years for MoP bearings. Multivariable regression in the presence of competing risk of death was used to assess the relative risk (RR) of revision for any reason (with 95% confidence interval (CI)). Results The cumulative incidence of revision at 8 years of follow-up was 7.0% (CI: 6.0–8.1) for MoM bearings and 5.1% (CI: 4.7–5.6) for MoP bearings. At 6 years of follow-up, the RR of revision for any reason was 1.5 (CI: 1.3–1.7) for MoM bearings compared to MoP bearings. The RR of revision for any reason was higher for the ASR (adjusted RR = 6.4, CI: 5.0–8.1), the Conserve Plus (adjusted RR = 1.7, CI: 1.1–2.5) and “other” acetabular components (adjusted RR = 2.4, CI: 1.5–3.9) than for MoP THA at 6 years of follow-up. Interpretation At medium-term follow-up, the survivorship for cementless stemmed MoM THA was inferior to that for MoP THA, and metal-related problems may cause higher revision rates for MoM bearings with longer follow-up. PMID:25715878

  5. Low in vitro third-body wear on total hip prostheses induced by calcium sulphate used for local antibiotic therapy.

    PubMed

    Heuberger, R; Wahl, P; Krieg, J; Gautier, E

    2014-01-01

    In case of implant associated infection, implant preservation is associated with high failure rates. Therefore, a removal or exchange of the implant is most often mandatory for treatment success. Alternatively, under certain conditions, local antibiotic delivery can be applied - preserving the implant, using for example calcium sulphate as a resorbable carrier. In this work, third-body wear on total hip prostheses caused by calcium sulphate particles was tested in a hip simulator. Inlays made of ultra-high-molecular-weight polyethylene (UHMWPE) and cross-linked polyethylene (XLPE) against 28 mm CoCrMo heads and 36 mm alumina pairings were tested in triplicate, both with and without calcium sulphate particles in the test liquid. Neither the alumina articulations nor the CoCrMo heads were affected by the calcium sulphate particles since calcium sulphate is a relatively soft material. The polyethylene inlays showed 39-89 % higher wear during exposure compared to references, but wear returned to normal when no more particles were added. Thus, calcium sulphate might be used as antibiotic carrier even in the presence of total hip prostheses without fearing excessive third-body wear. PMID:25340804

  6. Tribo-biological deposits on the articulating surfaces of metal-on-polyethylene total hip implants retrieved from patients

    NASA Astrophysics Data System (ADS)

    Cui, Zhiwei; Tian, Yi-Xing; Yue, Wen; Yang, Lei; Li, Qunyang

    2016-06-01

    Artificial total hip arthroplasty (THA) is one of the most effective orthopaedic surgeries that has been used for decades. However, wear of the articulating surfaces is one of the key failure causes limiting the lifetime of total hip implant. In this paper, Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM) were employed to explore the composition and formation mechanism of the tribo-layer on the articulating surfaces of metal-on-polyethylene (MoPE) implants retrieved from patients. Results showed that, in contrast to conventional understanding, the attached tribo-layer contained not only denatured proteins but also a fraction of polymer particles. The formation of the tribo-layer was believed to relate to lubrication regime, which was supposed to be largely affected by the nature of the ultra-high-molecule-weight-polyethylene (UHMWPE). Wear and formation of tribo-layer could be minimized in elasto-hydrodynamic lubrication (EHL) regime when the UHMWPE was less stiff and have a morphology containing micro-pits; whereas the wear was more severe and tribo-layer formed in boundary lubrication. Our results and analyses suggest that enhancing interface lubrication may be more effective on reducing wear than increasing the hardness of material. This finding may shed light on the design strategy of artificial hip joints.

  7. Tribo-biological deposits on the articulating surfaces of metal-on-polyethylene total hip implants retrieved from patients

    PubMed Central

    Cui, Zhiwei; Tian, Yi-Xing; Yue, Wen; Yang, Lei; Li, Qunyang

    2016-01-01

    Artificial total hip arthroplasty (THA) is one of the most effective orthopaedic surgeries that has been used for decades. However, wear of the articulating surfaces is one of the key failure causes limiting the lifetime of total hip implant. In this paper, Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM) were employed to explore the composition and formation mechanism of the tribo-layer on the articulating surfaces of metal-on-polyethylene (MoPE) implants retrieved from patients. Results showed that, in contrast to conventional understanding, the attached tribo-layer contained not only denatured proteins but also a fraction of polymer particles. The formation of the tribo-layer was believed to relate to lubrication regime, which was supposed to be largely affected by the nature of the ultra-high-molecule-weight-polyethylene (UHMWPE). Wear and formation of tribo-layer could be minimized in elasto-hydrodynamic lubrication (EHL) regime when the UHMWPE was less stiff and have a morphology containing micro-pits; whereas the wear was more severe and tribo-layer formed in boundary lubrication. Our results and analyses suggest that enhancing interface lubrication may be more effective on reducing wear than increasing the hardness of material. This finding may shed light on the design strategy of artificial hip joints. PMID:27345704

  8. Tribo-biological deposits on the articulating surfaces of metal-on-polyethylene total hip implants retrieved from patients.

    PubMed

    Cui, Zhiwei; Tian, Yi-Xing; Yue, Wen; Yang, Lei; Li, Qunyang

    2016-01-01

    Artificial total hip arthroplasty (THA) is one of the most effective orthopaedic surgeries that has been used for decades. However, wear of the articulating surfaces is one of the key failure causes limiting the lifetime of total hip implant. In this paper, Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM) were employed to explore the composition and formation mechanism of the tribo-layer on the articulating surfaces of metal-on-polyethylene (MoPE) implants retrieved from patients. Results showed that, in contrast to conventional understanding, the attached tribo-layer contained not only denatured proteins but also a fraction of polymer particles. The formation of the tribo-layer was believed to relate to lubrication regime, which was supposed to be largely affected by the nature of the ultra-high-molecule-weight-polyethylene (UHMWPE). Wear and formation of tribo-layer could be minimized in elasto-hydrodynamic lubrication (EHL) regime when the UHMWPE was less stiff and have a morphology containing micro-pits; whereas the wear was more severe and tribo-layer formed in boundary lubrication. Our results and analyses suggest that enhancing interface lubrication may be more effective on reducing wear than increasing the hardness of material. This finding may shed light on the design strategy of artificial hip joints. PMID:27345704

  9. Tribo-biological deposits on the articulating surfaces of metal-on-polyethylene total hip implants retrieved from patients.

    PubMed

    Cui, Zhiwei; Tian, Yi-Xing; Yue, Wen; Yang, Lei; Li, Qunyang

    2016-06-27

    Artificial total hip arthroplasty (THA) is one of the most effective orthopaedic surgeries that has been used for decades. However, wear of the articulating surfaces is one of the key failure causes limiting the lifetime of total hip implant. In this paper, Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM) were employed to explore the composition and formation mechanism of the tribo-layer on the articulating surfaces of metal-on-polyethylene (MoPE) implants retrieved from patients. Results showed that, in contrast to conventional understanding, the attached tribo-layer contained not only denatured proteins but also a fraction of polymer particles. The formation of the tribo-layer was believed to relate to lubrication regime, which was supposed to be largely affected by the nature of the ultra-high-molecule-weight-polyethylene (UHMWPE). Wear and formation of tribo-layer could be minimized in elasto-hydrodynamic lubrication (EHL) regime when the UHMWPE was less stiff and have a morphology containing micro-pits; whereas the wear was more severe and tribo-layer formed in boundary lubrication. Our results and analyses suggest that enhancing interface lubrication may be more effective on reducing wear than increasing the hardness of material. This finding may shed light on the design strategy of artificial hip joints.

  10. Postural and Chronological Change in Pelvic Tilt Five Years After Total Hip Arthroplasty in Patients With Developmental Dysplasia of the Hip: A Three-Dimensional Analysis.

    PubMed

    Suzuki, Haruka; Inaba, Yutaka; Kobayashi, Naomi; Ishida, Takashi; Ike, Hiroyuki; Saito, Tomoyuki

    2016-01-01

    The pelvis generally tilts to the posterior with movement from the supine to standing position, and with time after total hip arthroplasty (THA). This study aimed to investigate changes in pelvic tilt from the preoperative supine position to the standing position at 5 years after THA (pelvic change, PC). We measured pelvic tilt using a 2D-3D matching technique in 77 unilaterally affected patients who underwent primary THA. PC in 8% of all patients was ≤-20°, and the greatest PC was -25°. In these patients, posterior pelvic tilt continued up to 5 years after THA. These patients were older, and their lumbo-lordotic angle was small. For such cases, cup orientation should be planned to account for continuous posterior change in pelvic tilt after THA.

  11. A painful soft tissue mass secondary to impingement of a metal on polyethylene bearing total hip arthroplasty.

    PubMed

    William, Griffiths-Jones; Daniel, Williams

    2014-05-20

    A 60-year-old woman underwent a metal on polyethylene total hip replacement. The patient experienced pain and sustained multiple dislocations over the following 2 years and was referred for consideration of revision surgery. At the time of revision surgery it was found that there was a significant amount of polyethylene wear likely to have arisen as a result of the neutral cup placement and subsequent anterior impingement. A large cystic mass was excised and on histology was found to contain tissue with a lymphocytic infiltrate with a large amount of intracellular birefringent debris, consistent with polyethylene. The appearance of such masses is well reported as pseudotumours in metal-on-metal hip replacements but as yet their aetiology is unknown. We believe that the formation of the mass in this case could represent a model by which these pseudotumours occur.

  12. Oxinium modular femoral heads do not reduce polyethylene wear in cemented total hip arthroplasty at five years: a randomised trial of 120 hips using radiostereometric analysis.

    PubMed

    Jonsson, B A; Kadar, T; Havelin, L I; Haugan, K; Espehaug, B; Indrekvam, K; Furnes, O; Hallan, G

    2015-11-01

    We report the five-year outcome of a randomised controlled trial which used radiostereometric analysis (RSA) to assess the influence of surface oxidised zirconium (OxZr, Oxinium) on polyethylene wear in vivo. A total of 120 patients, 85 women and 35 men with a mean age of 70 years (59 to 80) who were scheduled for primary cemented total hip arthroplasty were randomly allocated to four study groups. Patients were blinded to their group assignment and received either a conventional polyethylene (CPE) or a highly cross-linked (HXL) acetabular component of identical design. On the femoral side patients received a 28 mm head made of either cobalt-chromium (CoCr) or OxZr. The proximal head penetration (wear) was measured with repeated RSA examinations over five years. Clinical outcome was measured using the Harris hip score. There was no difference in polyethylene wear between the two head materials when used with either of the two types of acetabular component (p = 0.3 to 0.6). When comparing the two types of polyethylene there was a significant difference in favour of HXLPE, regardless of the head material used (p < 0.001). In conclusion, we found no advantage of OxZr over CoCr in terms of polyethylene wear after five years of follow-up. Our findings do not support laboratory results which have shown a reduced rate of wear with OxZr. They do however add to the evidence on the better resistance to wear of HXLPE over CPE.

  13. Oxinium modular femoral heads do not reduce polyethylene wear in cemented total hip arthroplasty at five years: a randomised trial of 120 hips using radiostereometric analysis.

    PubMed

    Jonsson, B A; Kadar, T; Havelin, L I; Haugan, K; Espehaug, B; Indrekvam, K; Furnes, O; Hallan, G

    2015-11-01

    We report the five-year outcome of a randomised controlled trial which used radiostereometric analysis (RSA) to assess the influence of surface oxidised zirconium (OxZr, Oxinium) on polyethylene wear in vivo. A total of 120 patients, 85 women and 35 men with a mean age of 70 years (59 to 80) who were scheduled for primary cemented total hip arthroplasty were randomly allocated to four study groups. Patients were blinded to their group assignment and received either a conventional polyethylene (CPE) or a highly cross-linked (HXL) acetabular component of identical design. On the femoral side patients received a 28 mm head made of either cobalt-chromium (CoCr) or OxZr. The proximal head penetration (wear) was measured with repeated RSA examinations over five years. Clinical outcome was measured using the Harris hip score. There was no difference in polyethylene wear between the two head materials when used with either of the two types of acetabular component (p = 0.3 to 0.6). When comparing the two types of polyethylene there was a significant difference in favour of HXLPE, regardless of the head material used (p < 0.001). In conclusion, we found no advantage of OxZr over CoCr in terms of polyethylene wear after five years of follow-up. Our findings do not support laboratory results which have shown a reduced rate of wear with OxZr. They do however add to the evidence on the better resistance to wear of HXLPE over CPE. PMID:26530646

  14. Intraoperative measurement of rotational stability of femoral components of total hip arthroplasty.

    PubMed

    Harris, W H; Mulroy, R D; Maloney, W J; Burke, D W; Chandler, H P; Zalenski, E B

    1991-05-01

    High out-of-plane forces acting on the hip joint can produce important rotational micromotion of the femoral component. This micromotion at the prosthesis interface may be detrimental to the stability of the implant. In cementless femoral implants this could prevent bone ingrowth, and in the cemented component this could cause generation of particulate debris, lysis, and loosening. The introduction of the torque wrench micrometer for assessment of intraoperative femoral component stability can quantify the initial stability of primary cementless femoral components and critically evaluate the stability (at either the initial or revision arthroplasty) of both cemented and cementless femoral components. It allows the surgeon to produce a known torque in the direction and magnitude of the out-of-plane forces that load the hip in vivo. PMID:2019039

  15. Modular titanium alloy neck failure in total hip replacement: analysis of a relapse case

    PubMed Central

    Ceretti, Marco; Falez, Francesco

    2016-01-01

    Modular neck hip prosthesis born in the 1990 with the aim of allowing the surgeon to modify CCD angle, offset and femoral anteversion intra-operatively restoring patient’s original biomechanics. In order to achieve the best biomechanics of the reconstructed hip, preoperative planning is essential. In the last few years modularity has been questioned and an argument made for the return to mono block stems due to events of breakage or disconnection of modular components. Fretting or crevice corrosion may lead to failure of such modular device due to the contamination inside the modular coupling or to high loads. We present a case of repetitive modular femoral neck prosthesis fracture. PMID:27163109

  16. Displaced femoral neck fractures in the elderly: hemiarthroplasty versus total hip arthroplasty.

    PubMed

    Macaulay, William; Pagnotto, Michael R; Iorio, Richard; Mont, Michael A; Saleh, Khaled J

    2006-05-01

    The incidence of femoral neck fracture among the elderly in the United States is expected to increase dramatically because of the anticipated explosion in the population aged 65 years and older, increased life expectancy, and the rising incidence of osteoporosis. The resulting public health implications may be significant, with annual hospital admissions resulting from hip fracture projected to increase to 700,000 by 2050, and with annual spending on hip fracture care expected to exceed 15 billion dollars within a few years. The decision to perform internal fixation, unipolar hemiarthroplasty, bipolar hemiarthroplasty, or THA must be based on patient mental status, living arrangement, level of independence and activity, and bone and joint quality.

  17. Anesthesia Strategies and Perioperative Optimization for Patients with Ankylosing Spondylitis Undergoing Total Hip Replacement Surgery.

    PubMed

    2016-06-10

    Objective To identify the characteristics of anesthesia and perioperative management for ankylosing spondylitis (AS) patients undergoing total hip arthroplasty (THA). Methods Totally 63 patients scheduled for single THA in PUMC Hospital from January 1st 2013 to June 1st 2015 were included in this retrospective analysis,among whom 21 patients were diagnosed of AS. The perioperative clinical data included:demographic data,American Society of Anesthesiologists (ASA) classification,medical history,airway assessment,preoperative laboratory examinations,electrocardiogram,pulmonary function tests,intubation information,operation time,intraoperative intake and output volume,postoperative hospital stay,and postoperative complications. Results Significantly fewer AS patients undergoing THA were evaluated as ASA classification I than non-AS patients (9.5% vs. 33.3%,P=0.041). AS patients had significantly higher level of preoperative high-sensitivity C-reactive protein [(17.0±14.8)mg/L vs.(4.3±7.1)mg/L,P<0.001],platelets [(275.0±71.3)×10(9)/L vs. (237.7±68.0)×10(9)/L,P=0.048] and neutrophils [(4.7±1.7)×10(9)/L vs. (3.9±1.4)×10(9)/L,P=0.044] and higher incidence of pulmonary function abnormality (42.9% vs.16.7%,P=0.024).More AS patients were induced with scoline (14.3% vs.0,P=0.012). More AS patients underwent THA with Mallampati classification 3 (28.6% vs.7.1%,P=0.022),reduced neck extension(47.6% vs.2.4%,P<0.001),Cormack-Lehane classification2(56.3% vs.15.4%,P=0.002)and 3 (18.8% vs.0,P=0.005),while much fewer AS patients had Cormack-Lehane classification1 (25.0% vs.84.6%,P<0.001).A variety of difficult airway tools were used in intubation (AS group:Macintosh laryngoscope:14%,Macintosh laryngoscope with stylet:38%,visualization laryngoscope:24%,visualization stylet:10% and fiber bronchoscope:14%;non-AS group:57%,24%,12%,5% and 2%,respectively). The use of intraoperative autologous blood transfusion (33.3% vs.11.9%,P

  18. Candida glabrata: an unusual fungal infection following a total hip replacement

    PubMed Central

    Hall, Rebecca Louise; Frost, Rebecca Meghan; Vasukutty, Nijil Lal; Minhas, Hasnat

    2012-01-01

    A 60-year-old woman, after a femoral neck fracture and joint replacement, underwent a Girdlestone's procedure and received aggressive antimicrobial therapy in order to completely eradicate the fungal infection Candida glabrata. In the majority of such cases, a revised hip arthroplasty would be considered following debridement. However, due to the recurrence of this infection and a key associated risk factor, radical removal with concurrent drug therapy was the only option. PMID:23008369

  19. Candida glabrata: an unusual fungal infection following a total hip replacement.

    PubMed

    Hall, Rebecca Louise; Frost, Rebecca Meghan; Vasukutty, Nijil Lal; Minhas, Hasnat

    2012-09-24

    A 60-year-old woman, after a femoral neck fracture and joint replacement, underwent a Girdlestone's procedure and received aggressive antimicrobial therapy in order to completely eradicate the fungal infection Candida glabrata. In the majority of such cases, a revised hip arthroplasty would be considered following debridement. However, due to the recurrence of this infection and a key associated risk factor, radical removal with concurrent drug therapy was the only option.

  20. Polyethylene wear after total hip arthroplasty: the effect of a modular femoral head with an extended flange-reinforced neck.

    PubMed

    Urquhart, A G; D'Lima, D D; Venn-Watson, E; Colwell, C W; Walker, R H

    1998-11-01

    The use of modular components in total hip arthroplasty has been thought to contribute to accelerated polyethylene wear. Specifically, a modular femoral head with a flange extension and a longer neck may cause increased wear. The purpose of the current study was to evaluate the effect of a flange extension on polyethylene wear. Ninety-one patients who had had a total of 100 primary total hip arthroplasties were evaluated after an intermediate duration of follow-up. All of the acetabular components consisted of a hemispherical titanium-alloy fiber-mesh porous-coated shell with a nonelevated modular polyethylene liner; they were inserted without cement and with use of supplemental screws through the dome after so-called line-to-line reaming. All of the femoral components consisted of a modular head with a diameter of twenty-eight millimeters and either a long neck (with a flange extension) or a short or medium neck (without a flange extension). The study group comprised sixty-two patients (sixty-six hips) who had had radiographic evaluation that was adequate to allow the valid measurement of polyethylene wear. Thirty-two hips were in men, and thirty-four were in women. The mean age of the patients was fifty-six years, the mean weight was seventy-three kilograms, and the mean duration of follow-up was 6.1 years (range, four to eight years). The rate of polyethylene wear in the eleven hips in which the femoral component had a flange extension was significantly greater than that in the fifty-five in which the femoral component did not have a flange extension (mean, 0.17 compared with 0.11 millimeter per year; p = 0.009). Multivariate analysis showed that the presence of a flange extension was associated with increased polyethylene wear to a greater degree (F = 2.86) than were all other variables that were measured, including a younger age (F = 1.72), a more vertical angle of the acetabular component (F = 0.49), a heavier weight (F = 0.14), male gender (F = 0.11), and a

  1. Surface and Subsurface Analyses of Metal-on-Polyethylene Total Hip Replacement Retrievals.

    PubMed

    Vuong, Vicky; Pettersson, Maria; Persson, Cecilia; Larsson, Sune; Grandfield, Kathryn; Engqvist, Håkan

    2016-05-01

    Metal-on-polyethylene (MoP) articulations are one of the most reliable implanted hip prostheses. Unfortunately, long-term failure remains an obstacle to the service life. There is a lack of higher resolution research investigating the metallic surface component of MoP hip implants. This study investigates the surface and subsurface features of metallic cobalt chromium molybdenum alloy (CoCrMo) femoral head components from failed MoP retrievals. Unused prostheses were used for comparison to differentiate between wear-induced defects and imperfections incurred during implant manufacturing. The predominant scratch morphology observed on the non-implanted references was shallow and linear, whereas the scratches on the retrievals consisted of largely nonlinear, irregular scratches of varying depth (up to 150 nm in retrievals and up to 60 nm in reference samples). Characteristic hard phases were observed on the surface and subsurface material of the cast samples. Across all samples, a 100-400 nm thick nanocrystalline layer was visible in the immediate subsurface microstructure. Although observation of the nanocrystalline layer has been reported in metal-on-metal articulations, its presence in MoP retrievals and unimplanted prostheses has not been extensively examined. The results suggest that manufacturing-induced surface and subsurface microstructural features are present in MoP hip prostheses prior to implantation and naturally, these imperfections may influence the in vivo wear processes after implantation. PMID:26399989

  2. Surface and Subsurface Analyses of Metal-on-Polyethylene Total Hip Replacement Retrievals.

    PubMed

    Vuong, Vicky; Pettersson, Maria; Persson, Cecilia; Larsson, Sune; Grandfield, Kathryn; Engqvist, Håkan

    2016-05-01

    Metal-on-polyethylene (MoP) articulations are one of the most reliable implanted hip prostheses. Unfortunately, long-term failure remains an obstacle to the service life. There is a lack of higher resolution research investigating the metallic surface component of MoP hip implants. This study investigates the surface and subsurface features of metallic cobalt chromium molybdenum alloy (CoCrMo) femoral head components from failed MoP retrievals. Unused prostheses were used for comparison to differentiate between wear-induced defects and imperfections incurred during implant manufacturing. The predominant scratch morphology observed on the non-implanted references was shallow and linear, whereas the scratches on the retrievals consisted of largely nonlinear, irregular scratches of varying depth (up to 150 nm in retrievals and up to 60 nm in reference samples). Characteristic hard phases were observed on the surface and subsurface material of the cast samples. Across all samples, a 100-400 nm thick nanocrystalline layer was visible in the immediate subsurface microstructure. Although observation of the nanocrystalline layer has been reported in metal-on-metal articulations, its presence in MoP retrievals and unimplanted prostheses has not been extensively examined. The results suggest that manufacturing-induced surface and subsurface microstructural features are present in MoP hip prostheses prior to implantation and naturally, these imperfections may influence the in vivo wear processes after implantation.

  3. A Randomised Multi-centre Study to Compare the Long-term Performance of the Future Hip to 3 Other Implants in Primary Total Hip Replacement

    ClinicalTrials.gov

    2016-10-06

    Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis; Perthes Disease

  4. A Multi-centre Study to Assess the Long-term Performance of the Summit™ Hip in Primary Total Hip Replacement

    ClinicalTrials.gov

    2016-08-03

    Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis

  5. Highly Cross-Linked Polyethylene in Total Hip and Knee Replacement: Spatial Distribution of Molecular Orientation and Shape Recovery Behavior

    PubMed Central

    Masaoka, Toshinori; Pezzotti, Giuseppe; Shishido, Takaaki; Tateiwa, Toshiyuki; Kubo, Kosuke

    2014-01-01

    The present study investigated effects of processing procedures on morphology of highly cross-linked and re-melted UHMWPE (XLPE) in total hip and knee arthroplasty (THA, TKA). The shape recovery behavior was also monitored via uniaxial compression test at room temperature after non-destructive characterizations of the in-depth microstructure by confocal/polarized Raman spectroscopy. The goal of this study was to relate the manufacturing-induced morphology to the in vivo micromechanical performance, and ultimately to explore an optimal structure in each alternative joint bearing. It was clearly confirmed that the investigated XLPE hip and knee implants, which were produced from different orthopaedic grade resins (GUR 1050 and GUR 1020), consisted of two structural regions in the as-received states: the near-surface transitional anisotropic layer (≈100 μm thickness) and the bulk isotropic structural region. These XLPEs exhibited a different crystalline anisotropy and molecular texture within the near-surface layers. In addition, the knee insert showed a slightly higher efficiency of shape recovery against the applied strain over the hip liner owing to a markedly higher percentage of the bulk amorphous phase with intermolecular cross-linking. The quantitative data presented in this study might contribute to construct manufacturing strategies for further rationalized structures as alternative bearings in THA and TKA. PMID:25243183

  6. Extracorporeal Irradiation and Reimplantation with Total Hip Arthroplasty for Periacetabular Pelvic Resections: A Review of 9 Cases

    PubMed Central

    Chan, Lester Wai Mon; Imanishi, Jungo; Ngan, Samuel Y.; Chander, Sarat; Chu, Julie; Thorson, Renae; Pang, Grant; Choong, Peter

    2016-01-01

    We report the early results of nine patients with periacetabular malignancies treated with Enneking and Dunham type 2 resection and reconstruction using extracorporeally irradiated (ECI) tumour bone combined with total hip arthroplasty (THA). Diagnosis was chondrosarcoma in six patients, osteosarcoma in two patients, and metastatic renal cell carcinoma in one patient. All patients underwent surgical resection and the resected specimen was irradiated with 50 Gy in a single fraction before being prepared for reimplantation as a composite autograft. The mean follow-up was 21 months (range, 3–59). All patients were alive at latest follow-up. No local recurrence was observed. One patient serially developed three pulmonary metastases, all of which were resected. One experienced hip dislocation due to incorrect seating of an acetabular liner. This was successfully treated with revision of the liner with no further episodes of instability. There were no cases of deep infection or loss of graft. The average Musculoskeletal Tumor Society (MSTS) score was 75% (range, 57–87%). Type 2 pelvic reconstruction with ECI and THA has shown excellent early oncological and functional results in our series. Preservation of the gluteus maximus and hip abductors is important for joint stability and prevention of infection. PMID:27199613

  7. Extracorporeal Irradiation and Reimplantation with Total Hip Arthroplasty for Periacetabular Pelvic Resections: A Review of 9 Cases.

    PubMed

    Chan, Lester Wai Mon; Imanishi, Jungo; Ngan, Samuel Y; Chander, Sarat; Chu, Julie; Thorson, Renae; Pang, Grant; Choong, Peter

    2016-01-01

    We report the early results of nine patients with periacetabular malignancies treated with Enneking and Dunham type 2 resection and reconstruction using extracorporeally irradiated (ECI) tumour bone combined with total hip arthroplasty (THA). Diagnosis was chondrosarcoma in six patients, osteosarcoma in two patients, and metastatic renal cell carcinoma in one patient. All patients underwent surgical resection and the resected specimen was irradiated with 50 Gy in a single fraction before being prepared for reimplantation as a composite autograft. The mean follow-up was 21 months (range, 3-59). All patients were alive at latest follow-up. No local recurrence was observed. One patient serially developed three pulmonary metastases, all of which were resected. One experienced hip dislocation due to incorrect seating of an acetabular liner. This was successfully treated with revision of the liner with no further episodes of instability. There were no cases of deep infection or loss of graft. The average Musculoskeletal Tumor Society (MSTS) score was 75% (range, 57-87%). Type 2 pelvic reconstruction with ECI and THA has shown excellent early oncological and functional results in our series. Preservation of the gluteus maximus and hip abductors is important for joint stability and prevention of infection. PMID:27199613

  8. In-vivo 6 degrees-of-freedom kinematics of metal-on-polyethylene total hip arthroplasty during gait.

    PubMed

    Tsai, Tsung-Yuan; Li, Jing-Sheng; Wang, Shaobai; Scarborough, Donna; Kwon, Young-Min

    2014-05-01

    Knowledge of accurate in-vivo 6 degree-of-freedom (6-DOF) kinematics of total hip arthroplasty (THA) during daily activities is critical for improvement of longevity of the components. Previous studies assessed in-vivo THA kinematics using skin marker-based motion analysis. However, skin markers are prone to move with respect to the underlying bones. A non-invasive dual fluoroscopic imaging system (DFIS) based tracking technique has been used to avoid skin artifacts and provide accurate 6-DOF kinematic measurement. This study aimed to quantify in-vivo 6-DOF THA kinematics during gait using DFIS. Twenty eight well-functioning THAs were evaluated during treadmill gait under DFIS surveillance. The maximum translations of the femoral head were 0.46±0.10mm and 0.45±0.10mm during the stance and swing phases (p=0.57), respectively. The range of hip flexion was from 8.7° to 47.6°, adduction from 3.0° to 12.5° and external rotation from 19.2° to 29.7°. The THA was flexed, externally rotated and adducted throughout the gait. The magnitudes of the femoral head translations were found to be within the manufacture tolerance of the components, suggesting that in-vivo hip "pistoning" during gait cycle may be minimal in well-functioning THAs. The 6-DOF kinematics could be used as the baseline knowledge for further improvement of wear-testing of hip implant, implants manufacturing and implant positioning during surgery.

  9. Excellent long-term results of the Müller acetabular reinforcement ring in primary total hip arthroplasty

    PubMed Central

    Sirka, Aurimas; Clauss, Martin; Tarasevicius, Sarunas; Wingstrand, Hans; Stucinskas, Justinas; Robertsson, Otto; Emil Ochsner, Peter; Ilchmann, Thomas

    2016-01-01

    Background and purpose — The original Müller acetabular reinforcement ring (ARR) shows favorable medium-term results for acetabular reconstruction in total hip arthroplasty, where it is used when the acetabular bone stock is deficient. However, there are no data regarding long-term survival of the device. We therefore investigated long-term survival and analyzed radiological modes of failure. Patients and methods — Between 1984 and 2002, 321 consecutive primary arthroplasties using an ARR were performed in 291 patients. The mean follow-up time was 11 (0–25) years, and 24 hips were lost to follow-up. For survival analysis, we investigated 321 hips and the end of the follow-up was the date of revision, date of death, or the last patient contact date with implant still in situ. Radiological assessment was performed for 160 hips with a minimum of 10 years of follow-up and with radiographs of sufficient quality. It included evaluation of osteolysis, migration, and loosening. Results — 12 ARR THAs were revised: 1 isolated ARR revision for aseptic loosening, 4 revisions of the ARR and the stem for aseptic loosening, 6 for infection, and 1 for recurrent dislocation. The cumulative revision rate for all components, for any reason, at 20 years was 15% (95% CI: 10–22), while for the ARR only it was 7% (95% CI: 4–12) for any reason and 3.4% (95% CI: 1–9) for aseptic loosening. 21 (13%) of 160 ARR THAs examined had radiological changes: 7 had osteolysis but were not loose, and 14 were radiologically loose but were not painful and not revised. Interpretation — Our data suggest that the long-term survival of the ARR is excellent. PMID:26471881

  10. Result of Modular Necks in Primary Total Hip Arthroplasty with a Average Follow-up of Four Years

    PubMed Central

    Yi, Jemin; Nam, Young Jun; Kim, Keun Woo

    2016-01-01

    Purpose This study aimed to investigate the outcomes of modular neck-utilization in primary total hip arthroplasty (THA). Materials and Methods Thirty patients (34 hips) who had modular stem THA between April 2011 and January 2013 were evaluated. There were 19 men and 11 women with a mean age of 61.2 years at the time of surgery. There were 20 cases of osteonecrosis of femoral head, 7 cases of osteoarthritis, 6 cases of femur neck fracture, and 1 case of rheumatoid arthritis. No patients presented with anatomical deformity of hip. Patients were operated on using a modified Watson-Jones anterolateral approach. All patients underwent clinical and radiological follow-up at 6 weeks, 3, 6, and 12 months, and every year postoperatively. The mean duration of follow-up was 48.2 months (range, 39 to 59 months). Results The average Harris hip score improved from 63.7 to 88.1 at the final follow-up. Radiographically, mean acetabular cup inclination was 45.3°(range, 36°-61°) and anteversion was 21.7°(range, 11°-29°). All were neutral-positioned stems except 5 which were varus-positioned stems. In only 3 cases (8.8%), varus or valgus necks were required. A case of linear femoral fracture occurred intraoperatively and 1 case of dislocation occurred at postoperative 2 weeks. No complications at modular junction were occurred. Conclusion Our study shows that the use of modular necks had favorable clinical and radiographic results. This suggests that the use of modular neck in primary THA without anatomical deformity is safe at a follow-up of 39 months. PMID:27777916

  11. In-vivo 6 degrees-of-freedom kinematics of metal-on-polyethylene total hip arthroplasty during gait.

    PubMed

    Tsai, Tsung-Yuan; Li, Jing-Sheng; Wang, Shaobai; Scarborough, Donna; Kwon, Young-Min

    2014-05-01

    Knowledge of accurate in-vivo 6 degree-of-freedom (6-DOF) kinematics of total hip arthroplasty (THA) during daily activities is critical for improvement of longevity of the components. Previous studies assessed in-vivo THA kinematics using skin marker-based motion analysis. However, skin markers are prone to move with respect to the underlying bones. A non-invasive dual fluoroscopic imaging system (DFIS) based tracking technique has been used to avoid skin artifacts and provide accurate 6-DOF kinematic measurement. This study aimed to quantify in-vivo 6-DOF THA kinematics during gait using DFIS. Twenty eight well-functioning THAs were evaluated during treadmill gait under DFIS surveillance. The maximum translations of the femoral head were 0.46±0.10mm and 0.45±0.10mm during the stance and swing phases (p=0.57), respectively. The range of hip flexion was from 8.7° to 47.6°, adduction from 3.0° to 12.5° and external rotation from 19.2° to 29.7°. The THA was flexed, externally rotated and adducted throughout the gait. The magnitudes of the femoral head translations were found to be within the manufacture tolerance of the components, suggesting that in-vivo hip "pistoning" during gait cycle may be minimal in well-functioning THAs. The 6-DOF kinematics could be used as the baseline knowledge for further improvement of wear-testing of hip implant, implants manufacturing and implant positioning during surgery. PMID:24704170

  12. Patient-Controlled Epidural Analgesia or Multimodal Pain Regimen with Periarticular Injection After Total Hip Arthroplasty

    PubMed Central

    Jules-Elysee, Kethy M.; Goon, Amanda K.; Westrich, Geoffrey H.; Padgett, Douglas E.; Mayman, David J.; Ranawat, Amar S.; Ranawat, Chitranjan S.; Lin, Yi; Kahn, Richard L.; Bhagat, Devan D.; Goytizolo, Enrique A.; Ma, Yan; Reid, Shane C.; Curren, Jodie; YaDeau, Jacques T.

    2015-01-01

    Background: The optimal postoperative analgesia after primary total hip arthroplasty remains in question. This randomized, double-blind, placebo-controlled study compared the use of patient-controlled epidural analgesia (PCEA) with use of a multimodal pain regimen including periarticular injection (PAI). We hypothesized that PAI would lead to earlier readiness for discharge, decreased opioid consumption, and lower pain scores. Methods: Forty-one patients received PAI, and forty-three patients received PCEA. Preoperatively, both groups were administered dexamethasone (6 mg, orally). The PAI group received a clonidine patch and sustained-release oxycodone (10 mg), while the PCEA group had placebo. Both groups received combined spinal-epidural anesthesia and used an epidural pain pump postoperatively; the PAI group had normal saline solution, while the PCEA group had bupivacaine and hydromorphone. The primary outcome, readiness for discharge, required the discontinuation of the epidural, a pain score of <4 (numeric rating scale) without parenteral narcotics, normal eating, minimal nausea, urination without a catheter, a dry surgical wound, no acute medical problems, and the ability to independently transfer and walk 12.2 m (40 ft). Results: The mean time to readiness for discharge (and standard deviation) was 2.4 ± 0.7 days (PAI) compared with 2.3 ± 0.8 days (PCEA) (p = 0.86). The mean length of stay was 3.0 ± 0.8 days (PAI) compared with 3.1 ± 0.7 days (PCEA) (p = 0.46). A significant mean difference in pain score of 0.74 with ambulation (p = 0.01; 95% confidence interval [CI], 0.18 to 1.31) and 0.80 during physical therapy (p = 0.03; 95% CI, 0.09 to 1.51) favored the PCEA group. The mean opioid consumption (oral morphine equivalents in milligrams) was significantly higher in the PAI group on postoperative day 0 (43 ± 21 compared with 28 ± 23; p = 0.002) and postoperative days 0 through 2 (136 ± 59 compared with 90 ± 79; p = 0.004). Opioid-Related Symptom

  13. Long-term outcome of 73 Zweymüller total hip prostheses with a screw cup in patients under 50 years of age.

    PubMed

    Busch, Vincentius J J F; Pouw, Martin H; Laumen, Armand M R P; van Susante, Job L C; Vervest, Antonius M J S

    2012-01-01

    Total hip arthroplasty in young patients is associated with high failure rates and the best option for this demanding group of patients remains controversial. We report the long-term results of 73 consecutive Zweymüller total hip arthroplasties with a titanium threaded cup and a polyethylene insert in 67 patients aged under 50 years at the time of surgery (mean 43 years, range 23-49). Independent assessment was performed clinically and radiographically, and Kaplan-Meier analysis was used to determine survival for different end-points. Three hips were revised for septic loosening, three cups for aseptic loosening and one hip because of a periprosthetic fracture. Three patients (3 hips) died and seven patients (8 hips) were lost to radiographic follow-up without any reoperation. The mean follow-up was 17.5 (15-21) years and the mean HHS was 90 (52-100). Survival with an end-point of revision for any reason was 89% (95% C.I. 85-93) and of revision for aseptic loosening was 94% (C.I. 95-99) at 17 years. Zweymüller total hip arthroplasty with a titanium threaded cup and a polyethylene insert showed good long-term results, even in this group of young patients. PMID:22740279

  14. Long-term outcome of 73 Zweymüller total hip prostheses with a screw cup in patients under 50 years of age.

    PubMed

    Busch, Vincentius J J F; Pouw, Martin H; Laumen, Armand M R P; van Susante, Job L C; Vervest, Antonius M J S

    2012-01-01

    Total hip arthroplasty in young patients is associated with high failure rates and the best option for this demanding group of patients remains controversial. We report the long-term results of 73 consecutive Zweymüller total hip arthroplasties with a titanium threaded cup and a polyethylene insert in 67 patients aged under 50 years at the time of surgery (mean 43 years, range 23-49). Independent assessment was performed clinically and radiographically, and Kaplan-Meier analysis was used to determine survival for different end-points. Three hips were revised for septic loosening, three cups for aseptic loosening and one hip because of a periprosthetic fracture. Three patients (3 hips) died and seven patients (8 hips) were lost to radiographic follow-up without any reoperation. The mean follow-up was 17.5 (15-21) years and the mean HHS was 90 (52-100). Survival with an end-point of revision for any reason was 89% (95% C.I. 85-93) and of revision for aseptic loosening was 94% (C.I. 95-99) at 17 years. Zweymüller total hip arthroplasty with a titanium threaded cup and a polyethylene insert showed good long-term results, even in this group of young patients.

  15. Role of hyaluronic acid and phospholipid in the lubrication of a cobalt-chromium head for total hip arthroplasty.

    PubMed

    Park, Jong-Bong; Duong, Cong-Truyen; Chang, Ho-Geun; Sharma, Ashish R; Thompson, Mark S; Park, Sungchan; Kwak, Byung-Chan; Kim, Tae-Young; Lee, Sang-Soo; Park, Seonghun

    2014-09-01

    The tribological performance of total hip arthroplasty has an important influence on its success rate. This study examined the concentration-dependent role of hyaluronic acid (HA) and phospholipid (dipalmitoylphosphatidylcholine, DPPC) in the boundary lubricating ability of retrieved cobalt-chromium femoral heads. The microscale frictional coefficients (μ) were measured by atomic force microscopy using a rectangular silicon cantilever integrated with sharp silicon tips. In the case of HA lubricant, the frictional coefficients decreased significantly at concentrations of 2.0 (0.16 ± 0.03) and 3.5 mg/ml (0.11 ± 0.01) while increased at 5.0 mg/ml (0.15 ± 0.01), compared to that with phosphate buffer saline (0.25 ± 0.03). The concentration-dependent lubrication behavior of DPPC was most effective when DPPC was in the physiological concentration range, showing μ = 0.16 ± 0.01 in polypropylene glycol, and 0.05 ± 0.01, 0.02 ± 0.01, and 0.03 ± 0.01 at a DPPC concentration of 0.05, 0.2, and 3.0 mg/ml, respectively. Results obtained show significant differences between the DPPC concentration groups. Conclusively, the microscale frictional response of the retrieved CoCr femoral head has a significant dependence on the concentrations of HA and DPPC. Moreover, observed optimal concentration of HA and DPPC for effective lubrication is similar to that observed in normal human synovial fluid. Therefore, a retrieval of the synovia may be considered during total hip replacement surgeries in an effort for reduction of friction between head and liner of total hip replacement implants.

  16. Aprotinin and classic wound drainage are unnecessary in total hip replacement a prospective randomized trial

    PubMed Central

    2011-01-01

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