... replacement is an operation in which a damaged hip joint is removed and replaced with an artificial joint. ... are many medical conditions that can damage the hip joint. (Watch the video to learn about what goes ...
... cemented and uncemented prostheses are comparable. However, more long-term data are available in the United States for hip replacements with cemented prostheses, because doctors have been using them ... period. Because it takes a long time for the natural bone to grow and ...
... surgery to replace all or part of your hip joint with an artificial joint called a prosthesis. This ... You're in the Hospital You had a hip joint replacement surgery to replace all or part of ...
Fenelon, Christopher; Galbraith, John G.; Dalton, David M.; Masterson, Eric
A 69-year-old female with a history of bilateral total hip replacements presented with rigors, fever and sudden onset left groin pain. A pelvic X-ray showed well-fixed implants. Blood results revealed a leucocytosis (white cell count 22.3 × 109 l–1) and elevated C-reactive protein (211 mg/l). Ultrasound-guided aspiration of her left hip grew Streptococcus gordonii. No source infection could be identified apart from a new chronic sinus infection in a left upper incisor. Following a discussion with the patient a 6-week course of intravenous ceftriaxone was started and was successful in normalizing her inflammatory markers. She was placed on long-term suppressive amoxicillin following this. Her suppressive antibiotic therapy was complicated by the development of a clostridium difficile infection and her antibiotics were changed to doxycycline. At 1-year follow-up, she was asymptomatic with no further episodes of groin pain or fever. PMID:28096320
... ankle pump exercises, and early mobilization. Leg-length Inequality Sometimes after a hip replacement, one leg may ... Surgeons (AAOS). To learn more about your orthopaedic health, please visit orthoinfo.org. Page ( 12 ) AAOS does ...
... Replacement PDF Version Size: 123 KB Audio Version Time: 10:01 Size: 9.4 MB November 2014 What Is a Hip Replacement? Fast Facts: An Easy-to-Read Series of Publications for the Public Hip replacement surgery ...
Mahmoud, Samer S.S.; Sukeik, Mohamed; Alazzawi, Sulaiman; Shaath, Mohammed; Sabri, Omar
Background: The increasing load placed by joint replacement surgery on health care systems makes infection, even with the lowest rates, a serious concern that needs to be thoroughly studied and addressed using all possible measures. Methods: A comprehensive review of the current literature on salvage procedures for recurrent PJIs using PubMed, EMBASE and CINAHL has been conducted. Results: Prolonged suppressive antibiotic therapy (PSAT), resection arthroplasty and arthrodesis were the most common procedures performed. Suppressive antibiotic therapy is based on the use of well tolerated long term antibiotics in controlling sensitive organisms. Resection arthroplasty which should be reserved as a last resort provided more predictable outcomes in the hip whereas arthrodesis was associated with better outcomes in the knee. Various methods for arthrodesis including internal and external fixation have been described. Conclusion: Despite good union and infection control rates, all methods were associated with complications occasionally requiring further surgical interventions. PMID:28144373
Volpin, Andrea; Sukeik, Mohamed; Alazzawi, Sulaiman; Haddad, Fares Sami
Background: Periprosthetic Joint Infection Remains a Dreaded Complication After Hip and Knee Replacement Surgery. Treatment Options for Acute Postoperative and Acute Hematogenous Infections Include Arthroscopic or Open Debridement With Retention or Exchange of the Prostheses. This Review Article Aims to Summarize the Evidence for Management of Acute Postoperative And Acute Hematogenous Infections. Methods: A Systematic Literature Search Was Performed Using a Computer-based Search Engine Covering Medline (OvidSP), PubMed Database (U.S. National Library of Medicine, National Institutes of Health), Embase, Web of Science, Cochrane and Google Scholar for Relevant Articles. Results: Common Themes Around Treatment of Acute Postoperative and Acute Hematogenous Infections Discussed in this Review Include the Timing of Intervention, Description of the Optimal Procedure and How we Perform it at our Institution, the Role of Arthroscopic Debridement, Most Commonly Isolated Micro-organisms and Prognostic Factors for Infection Control. Conclusion: Success in Treating Acute Postoperative and Acute Hematogenous Infections Depends on Early Diagnosis and Aggressive Surgical Debridement Combined With Effective Antibiotic Therapy. PMID:28144377
Kliushin, Nikolai M; Ababkov, Yuri V; Ermakov, Artem M; Malkova, Tatiana A
Background: Resection arthroplasty or hip arthrodesis after total hip replacement (THR) can be used to salvage the limb in case with deep infection and severe bone loss. The Ilizarov fixator provides stability, axial correction, weight-bearing and good fusion rates. Materials and Methods: We retrospectively assessed the outcomes of 37 patients with severe periprosthetic infection after THR treated between 1999 and 2011. The treatment included implant removal, debridement and a modified Girdestone arthroplasty (29 cases) or hip arthrodesis (seven cases) using the Ilizarov fixator. The Ilizarov fixation continued from 45 to 50 days in the modified arthroplasty group and 90 days in the arthrodesis group. One case was treated using the conventional resection arthroplasty bilaterally. Results: Eighteen months after treatment, infection control was seen in 97.3% cases. Six hips were fused as one patient died in this group. Limb length discrepancy (LLD) averaged 5.5 cm. The Harris hip score ranged from 35 to 92 points. Hip joint motion ranged from 10° to 30° in the modified arthroplasty group. All subjects could walk independently or using support aids. No subluxation or LLD progression was observed. Conclusion: The modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov apparatus results in sufficient ability for ambulation and good infection control in cases of failed THR associated with severe infection. PMID:26955173
Zilkens, K W; Casser, H R; Ohnsorge, J
When treating a septic hip-joint prosthesis with bone loss of the proximal femur secondary to osteomyelitis, we implanted a specially designed prosthesis to act as a local antibiotic and spacer between the acetabulum and femur until the infection abated. Arthroplasty could then be carried out with no trouble and there was no recurrence of infection.
Buyls, Inge R A E; Rietveld, A B M Boni; Ourila, Tiia; Emerton, Mark E; Bird, H A
A case report of a professional contemporary dancer who successfully returned to the stage after bilateral total hip replacements (THR) for osteoarthritis is presented, together with her own commentary and a retrospective cohort study of total hip replacements in dancers. In the presented cohort, there were no post-operative dislocations or infections, the original pain had been relieved, rehabilitation was objectively normal and all resumed their dance (teaching) activities. Nevertheless, they were disappointed about the prolonged rehabilitation. Due to their high demands as professional dancers, post-operative expectations were too optimistic in view of the usual quick and favourable results of THR in the older and less physically active, general population. In all dancers with unilateral osteoarthritis, the left hip was involved, which may reflect the tendency to use the left leg as standing leg and be suggestive that strenuous physical activity may lead to osteoarthritis. Better rehabilitation guidelines are needed for dancer patients undergoing THR, especially drawing their attention to realistic post-operative expectations.
... 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 ...
... A socket, which is usually made of strong metal. A liner, which fits inside the socket. It ... are now trying other materials, like ceramic or metal. The liner allows the hip to move smoothly. ...
Maksimov, I B; Paniushin, K A; Brizhan', L K; Buriachenko, B P; Varfolomeev, D I; Mimanchev, O V
Hip joint diseases and injuries are common for orthopedic pathology among military personnel. Hip replacement is one of the most frequent operations. Authors evaluated hip replacement in 136 servicemen treated at the center of traumatology and orthopedics of Burdenko General Military Clinical Hospital of the Ministry of Defense of Russia in 2010-2013. On the basis of the conducted analysis the main disease groups were revealed, peculiarities of pathology among this category of patients. Authors proposed surgical doctrine for the treatment of this contingent. Effective surgical treatment, in particular, hip replacement surgery, conducted with the use of the proposed principles, as a rule, fully functionally cured patients and contributes to return them in the system that contributes to the strengthening of defensibility of the country.
Moretti, B; Larocca, A M V; Napoli, C; Martinelli, D; Paolillo, L; Cassano, M; Notarnicola, A; Moretti, L; Pesce, V
Various reliable body heat-regulating systems have been designed and developed with the aim of maintaining an adequate body temperature in the course of major surgery. This is crucial to avoid the onset of potentially severe complications that are especially serious in elderly and debilitated subjects. Among these systems, the Bair Hugger blanket has demonstrated excellent efficacy. However, some reports in the literature have suggested that the use of such devices can increase the risk of nosocomial infections, particularly surgical wound infections. The aim of this study was to assess the risk of contamination of the surgical site correlated to the use of the Bair Hugger blanket during hip replacement surgery. To this end, the level of bacterial contamination of the air in the operating theatre was quantified with and without the use of the Bair Hugger, during the course of 30 total non-cemented hip implants performed in patients with osteoarthritis. Sampling was done both in the empty theatre and during surgical procedures, in different zones around the operating table and on the patient's body surface. Statistical analysis of the results demonstrated that the Bair Hugger system does not pose a real risk for nosocomial infections, whereas it does offer the advantage of preventing the potentially very severe consequences of hypothermia during major orthopaedic surgery. In addition, monitoring patients over the six months following the operation allowed us to exclude a later manifestation of a nosocomial infection.
Cuéllar, Ricardo; Aguinaga, Iñaki; Corcuera, Irene; Ponte, Juan; Usabiaga, Jaime
Hip arthroscopy may be useful in the diagnosis and treatment of apparently well-implanted but unstable total hip replacement prostheses. We present 2 cases of arthroscopically assisted capsular tightening in unstable total hip replacements. Both cases had significant capsular laxity. Case 2 had impingement of the lower part of the acetabulum with the lesser trochanter that caused hip dislocation. Early revision surgery can be avoided with the use of this technique in selected cases of unstable total hip replacements.
... Hip Replacement (Arabic) العربية Bilingual PDF Health Information Translations Bosnian (Bosanski) Total Hip Replacement Potpuna zamjena kuka - Bosanski (Bosnian) Bilingual PDF Health Information Translations Chinese - Simplified (简体中文) Total Hip Replacement 全髋关节置换 - 简体中文 ( ...
... bone is reshaped and capped with a metal prosthesis. The hip socket is fitted with a metal ... but higher levels may be problematic. The socket prosthesis for a traditional hip replacement is usually lined ...
Cheung, Y M; Gupte, C M; Beverly, M J
We report the imaging features of a 52-year-old man presenting with a groin mass and gross lower limb oedema secondary to venous occlusion by massive cystic enlargement of the iliopsoas bursa 4 years after uncemented primary total hip replacement. Ultrasonography of the groin mass demonstrated a large cystic lesion extending into the pelvis. CT showed displacement of the external iliac vessels with venous compression. Bursography showed the bursa's margins and no communication with the hip joint. Diagnostic aspiration excluded infection, but fluid recollection occurred subsequently. Complete resolution of symptoms, including limb swelling, followed surgical excision with no recurrence at the 5-year follow-up. We believe iliopsoas bursitis occurred as a tissue response to polyethylene wear within the prosthetic hip and occurred even in the absence of loosening or a direct communication between bursa and joint.
Zilkens, K W; Forst, R; Casser, H R
In total hip arthroplasty the most serious complication besides aseptic loosening is infection. The results observed in 42 cases of infected hip arthroplasties are presented. In contrast to early superficial infection, deep infection following total hip replacement is difficult to treat. Depending on the general condition of the patient, a well-defined, adequate treatment is required. In patients at vital risk the provocation of a permanent fistula can be recommended as an alternative method in preference to revision arthroplasty.
Infection of a total hip replacement (THR) is considered a devastating complication, necessitating its complete removal and thorough debridement of the site. It is undoubted that one stage exchange, if successful, would provide the best benefit both for the patient and the society. Still the fear of re-infection dominates the surgeons decisions and in the majority of cases directs them to multiple stage protocols. However, there is no scientifically based argument for that practice. Successful eradication of infection with two stage procedures is reported to average 80% to 98%. On the other hand a literature review of Jackson and Schmalzried (CORR 2000) summarizing the results of 1,299 infected hip replacements treated with direct exchange (almost exclusively using antibiotic loaded cement), reports of 1,077 (83%) having been successful. The comparable results suggest, that the major factor for a successful outcome with traditional approaches may be found in the quality of surgical debridement and dead space management. Failures in all protocols seem to be caused by small fragments of bacterial colonies remaining after debridement, whereas neither systemic antibiotics nor antibiotic loaded bone cement (PMMA) have been able to improve the situation significantly. Reasons for failure may be found in the limited sensitivity of traditional bacterial culturing and reduced antibiotic susceptibility of involved pathogens, especially considering biofilm formation. Whenever a new prosthesis is implanted into a previously infected site the surgeon must be aware of increased risk of failure, both in single or two stage revisions. Eventual removal therefore should be easy with low risk of additional damage to the bony substance. On the other hand it should also have potential of a good long term result in case of success. Cemented revisions generally show inferior long term results compared to uncemented techniques; the addition of antibiotics to cement reduces its
Schrama, J. C.; Lutro, O.; Langvatn, H.; Hallan, G.; Espehaug, B.; Sjursen, H.; Engesaeter, L. B.; Fevang, B.-T.
High rates of Staphylococcus aureus are reported in prosthetic joint infection (PJI) in rheumatoid arthritis (RA). RA patients are considered to have a high risk of infection with bacteria of potentially oral or dental origin. One thousand four hundred forty-three revisions for infection were reported to the Norwegian Arthroplasty Register (NAR) from 1987 to 2007. For this study 269 infection episodes in 255 OA patients served as control group. In the NAR we identified 49 infection episodes in 37 RA patients from 1987 to 2009. The RA patients were, on average, 10 years younger than the OA patients and there were more females (70% versus 54%). We found no differences in the bacterial findings in RA and OA. A tendency towards a higher frequency of Staphylococcus aureus (18% versus 11%) causing PJI was found in the RA patients compared to OA. There were no bacteria of potential odontogenic origin found in the RA patients, while we found 4% in OA. The bacteria identified in revisions for infection in THRs in patients with RA did not significantly differ from those in OA. Bacteria of oral or dental origin were not found in infected hip joint replacements in RA. PMID:24977078
Merx, H; Dreinhofer, K; Schrader, P; Sturmer, T; Puhl, W; Gunther, K; Brenner, H
Objectives: To summarise epidemiological data on the frequency of hip replacements in the countries of the developed world, especially in countries of the Organisation for Economic Cooperation and Development (OECD), and to investigate whether missing consensus criteria for the indication for total hip replacement (THR) result in different replacement rates. Methods: Country-specific hip replacement rates were collected using the available literature, different data sources of national authorities, and estimates of leading hip replacement manufacturers. Results: According to administrative and literature data sources the reported crude primary THR rate varied between 50 and 130 procedures/100 000 inhabitants in OECD countries in the 1990s. The crude overall hip implantation rate, summarising THR, partial hip replacement, and hip revision procedures, was reported to range from 60 to 200 procedures/100 000 inhabitants in the late 1990s. Moreover, large national differences were seen in the relationship between total and partial hip replacement procedures. Conclusion: The reported differences in hip replacement rates in OECD countries are substantial. They may be due to various causes, including different coding systems, country-specific differences in the healthcare system, in total expenditure on health per capita, in the population age structure, and in different indication criteria for THR. PMID:12594106
Zheng, Henry; Barnett, Adrian G; Merollini, Katharina; Sutton, Alex; Cooper, Nicola; Berendt, Tony; Wilson, Jennie; Graves, Nicholas
Objective To synthesise the available evidence and estimate the comparative efficacy of control strategies to prevent total hip replacement (THR)-related surgical site infections (SSIs) using a mixed treatment comparison. Design Systematic review and mixed treatment comparison. Setting Hospital and other healthcare settings. Participants Patients undergoing THR. Primary and secondary outcome measures The number of THR-related SSIs occurring following the surgical operation. Results 12 studies involving 123 788 THRs and 9 infection control strategies were identified. The strategy of ‘systemic antibiotics+antibiotic-impregnated cement+conventional ventilation’ significantly reduced the risk of THR-related SSI compared with the referent strategy (no systemic antibiotics+plain cement+conventional ventilation), OR 0.13 (95% credible interval (CrI) 0.03–0.35), and had the highest probability (47–64%) and highest median rank of being the most effective strategy. There was some evidence to suggest that ‘systemic antibiotics+antibiotic-impregnated cement+laminar airflow’ could potentially increase infection risk compared with ‘systemic antibiotics+antibiotic-impregnated cement+conventional ventilation’, 1.96 (95% CrI 0.52–5.37). There was no high-quality evidence that antibiotic-impregnated cement without systemic antibiotic prophylaxis was effective in reducing infection compared with plain cement with systemic antibiotics, 1.28 (95% CrI 0.38–3.38). Conclusions We found no convincing evidence in favour of the use of laminar airflow over conventional ventilation for prevention of THR-related SSIs, yet laminar airflow is costly and widely used. Antibiotic-impregnated cement without systemic antibiotics may not be effective in reducing THR-related SSIs. The combination with the highest confidence for reducing SSIs was ‘systemic antibiotics+antibiotic-impregnated cement+conventional ventilation’. Our evidence synthesis underscores the need to review
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
... hip socket. The socket is usually made of metal. A liner that fits inside the socket. It ... usually plastic, but some surgeons use ceramic and metal. The liner allows the hip to move smoothly. ...
... PA: Elsevier Mosby; 2012:chap 7. Read More Hip joint replacement Hip pain Knee joint replacement Knee pain ... joint replacement - discharge Taking care of your new hip joint Review Date 3/5/2015 Updated by: C. ...
... PA: Elsevier Mosby; 2012:chap 7. Read More Hip joint replacement Hip pain Knee joint replacement Knee pain ... joint replacement - discharge Taking care of your new hip joint Review Date 3/5/2015 Updated by: C. ...
Hartofilakidis, G; Babis, G C; Georgiades, G; Kourlaba, G
We studied the effect of trochanteric osteotomy in 192 total hip replacements in 140 patients with congenital hip disease. There was bony union in 158 hips (82%), fibrous union in 29 (15%) and nonunion in five (3%). The rate of union had a statistically significant relationship with the position of reattachment of the trochanter, which depended greatly on the pre-operative diagnosis. The pre-operative Trendelenburg gait substantially improved in all three disease types (dysplasia, low and high dislocation) and all four categories of reattachment position. A persistent Trendelenburg gait post-operatively was noticed mostly in patients with defective union (fibrous or nonunion). Acetabular and femoral loosening had a statistically significant relationship with defective union and the position of reattachment of the trochanter. These results suggest that the complications of trochanteric osteotomy in total hip replacement for patients with congenital hip disease are less important than the benefits of this surgical approach.
Total hip replacement represents the most significant advance in orthopaedic surgery in the 20th century. Periprosthetic osteolysis remains the most significant long‐term complication with total hip replacement. It has been reported with all materials and prosthetic devices in use or that have been used to date. This paper reviews the current thinking on the aetiology, pathogenesis, management and future treatment options for osteolysis. PMID:17488859
Ibrahim, M S; Raja, S; Khan, M A; Haddad, F S
We report the five year outcomes of a two-stage approach for infected total hip replacement. This is a single-surgeon experience at a tertiary centre where the more straightforward cases are treated using single-stage exchange. This study highlights the vital role of the multidisciplinary team in managing these cases. A total of 125 patients (51 male, 74 female) with a mean age of 68 years (42 to 78) were reviewed prospectively. Functional status was assessed using the Harris hip score (HHS). The mean HHS improved from 38 (6 to 78.5) pre-operatively to 81.2 (33 to 98) post-operatively. Staphylococcus species were isolated in 85 patients (68%). The rate of control of infection was 96% at five years. In all, 19 patients died during the period of the study. This represented a one year mortality of 0.8% and an overall mortality of 15.2% at five years. No patients were lost to follow-up. We report excellent control of infection in a series of complex patients and infections using a two-stage revision protocol supported by a multidisciplinary approach. The reason for the high rate of mortality in these patients is not known.
Coomber, Ross; Porteous, Matthew; Hubble, Matthew J W; Parker, Martyn J
When treating a hip fracture with a total hip replacement (THR) the surgical technique may differ in a number of aspects in comparison to elective arthroplasty. The hip fracture patient is more likely to have poor bone stock secondary to osteoporosis, be older, have a greater number of co-morbidities, and have had limited peri-operative work-up. These factors lead to a higher risk of complications, morbidity and perioperative mortality. Consideration should be made to performing the THR in a laminar flow theatre, by a surgeon experienced in total hip arthroplasty, using an anterolateral approach, cementing the implant in place, using a large head size and with repair of the joint capsule. Combined Ortho-geriatric care is recommended with similar post-operative rehabilitation to elective THR patients but with less expectation of short length of stay and consideration for fracture prevention measures.
Boreham, J. F.; Postal, R. B.; Luntz, R. A.
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.
Graves, Nicholas; Wloch, Catherine; Wilson, Jennie; Barnett, Adrian; Sutton, Alex; Cooper, Nicola; Merollini, Katharina; McCreanor, Victoria; Cheng, Qinglu; Burn, Edward; Lamagni, Theresa; Charlett, Andre
123,788 total hip replacements (THRs) and nine infection control strategies, were identified. The quality of the evidence was judged against four categories developed by the National Institute for Health and Care Excellence Methods for Development of NICE Public Health Guidance ( http://publications.nice.org.uk/methods-for-the-development-of-nice-public-health-guidance-third-edition-pmg4 ), accessed March 2012. All evidence was found to fit the two highest categories of 1 and 2. Nine competing infection control interventions [treatments (Ts) 1-9] were used in a cohort simulation model of 77,321 patients who had a primary THR in 2012. Predictions were made for cases of deep infection and total costs, and QALY outcomes. Compared with a baseline of T1 (no systemic antibiotics, plain cement and conventional ventilation) all other treatment strategies reduced risk. T6 was the most effective (systemic antibiotics, antibiotic-impregnated cement and conventional ventilation) and prevented a further 1481 cases of deep infection, and led to the largest annual cost savings and the greatest gains to QALYs. The additional uses of laminar airflow and body exhaust suits indicate higher costs and worse health outcomes. CONCLUSIONS T6 is an optimal strategy for reducing the risk of SSI following THA. The other strategies that are commonly used among NHS hospitals lead to higher cost and worse QALY outcomes. Policy-makers, therefore, have an opportunity to save resources and improve health outcomes. The effects of laminar air flow and body exhaust suits might be further studied if policy-makers are to consider disinvesting in these technologies. LIMITATIONS A wide range of evidence sources was synthesised and there is large uncertainty in the conclusions. FUNDING The National Institute for Health Research Health Technology Assessment programme and the Queensland Health Quality Improvement and Enhancement Programme (grant number 2008001769). PMID:27468732
Grammatopoulos, G; Pandit, H G; da Assunção, R; Taylor, A; McLardy-Smith, P; De Smet, K A; Murray, D W; Gill, H S
The orientation of the acetabular component is influenced not only by the orientation at which the surgeon implants the component, but also the orientation of the pelvis at the time of implantation. Hence, the orientation of the pelvis at set-up and its movement during the operation, are important. During 67 hip replacements, using a validated photogrammetric technique, we measured how three surgeons orientated the patient's pelvis, how much the pelvis moved during surgery, and what effect these had on the final orientation of the acetabular component. Pelvic orientation at set-up, varied widely (mean (± 2, standard deviation (sd))): tilt 8° (2sd ± 32), obliquity -4° (2sd ± 12), rotation -8° (2sd ± 14). Significant differences in pelvic positioning were detected between surgeons (p < 0.001). The mean angular movement of the pelvis between set-up and component implantation was 9° (sd 6). Factors influencing pelvic movement included surgeon, approach (posterior > lateral), procedure (hip resurfacing > total hip replacement) and type of support (p < 0.001). Although, on average, surgeons achieved their desired acetabular component orientation, there was considerable variability (2sd ± 16) in component orientation. We conclude that inconsistency in positioning the patient at set-up and movement of the pelvis during the operation account for much of the variation in acetabular component orientation. Improved methods of positioning and holding the pelvis are required.
... and Drug Administration) Information for Patients Who Have Metal-on-Metal Hip Implants (Food and Drug Administration) Images Hip ... Article: Investigation of Taper Failure in a Contemporary Metal-on-Metal Hip Arthroplasty... Article: Effects of the ...
Doshi, H. K.; Selvaraj, Dahshaini; Chan, William; Naidu, G.; Ramason, R.
Introduction: Although there is evidence of improved functional outcomes with our “integrated care pathway” for geriatric hip fractures, we do not know if there is a significant difference in functional recovery of activities of daily living and attainment of independence in self-care between patients who underwent fixation and those treated with arthroplasty. Objective: To determine whether such a difference exists in surgically fixed hip fractures. Materials and Methods: Patients with hip fracture treated surgically were divided into group A (internal fixation, n = 213) and group B (arthroplasty, n = 199). Demographic data, Charlson comorbidity index (CCI) score, time to surgery, and length of stay were recorded. Inpatient complications and mortality rates were also documented. Modified Barthel Index (MBI) scores were recorded for the following intervals: prefall, discharge, 6-month, and at 1-year follow-up. Results: The mean age (A: 80 years and B: 81years), CCI (A: 5.41 and B: 5.43), and length of stay (A: 13.6 days and B: 15.2 days) were not significantly different. However, there was a significant difference (P < .05) in time to surgery (A: 102.2 hours and B: 86.6 hours). Complication rates were about 6% in both groups (A = 6.57%: urinary infections = 13, wound infections = 1 and B = 6.03%: urinary infections = 10, wound infections = 1, pressure ulcer = 1). The preinjury MBI scores were significantly different (P < .05; A: 91.65 and B: 88.19), however, there was no significant difference in scores measured at discharge (A: 60.79 and B: 59.39), 6 months (A: 77.65 and B: 77.47) and 1 year (A: 80.71 and B: 83.03). Patients who underwent surgery for hip fracture had overall recovered 90.9% of their preinjury function (overall MBI at 1 year: 81.83). Conclusion: The MBI scores reflect the extent of attainment of independence in self-care, and actual functional recovery is gauged from the percentage of recovery of preinjury function at 1 year postsurgery. We
Jamshid, T.; Schneider, R.; Freiberger, R.H.
Ninety-four cases of clinically failed, cemented, total hip prostheses requiring surgery were reviewed to determine the accuracy of preoperative plain radiography, culture of aspirated fluid, arthrography, and bone scanning. When radiopaque cement had been used to embed the prosthesis, plain radiography was highly accurate in detecting a loose femoral component, less so in detecting a loose acetabular component. Culture of aspirated fluid was accurate in diagnosing infection. A positive arthrogram identified loosening with good accuracy; however, a negative arthrogram did not reliably exclude loosening. /sup 99/mTc bone scans frequently differentiated loosening from loosening with infection. The suggested sequence of diagnostic tests is plain radiography followed by bone scanning. If the bone scan shows diffuse augmented uptake, culture of aspirated fluid followed by arthrography is indicated.
Tehranzadeh, J.; Schneider, R.; Freiberger, R.H.
Ninety-four cases of clinically failed, cemented, total hip prostheses requiring surgery were reviewed to determine the accuracy of preoperative plain radiography, culture of aspirated fluid, arthrography, and bone scanning. When radiopaque cement had been used to embed the prosthesis, plain radiography was highly accurate in detecting a loose femoral component, less so in detecting a loose acetabular component. Culture of aspirated fluid was accurate in diagnosing infection. A positive arthrogram identified loosening with good accuracy; however, a negative arthrogram did not reliably exclude loosening. /sup 99/mTc bone scans frequently differentiated loosening from loosening with infection. The suggested sequence of diagnostic tests is plain radiography followed by bone scanning. If the bone scan shows diffuse augmented uptake, culture of aspirated fluid followed by arthrography is indicated.
Selvaratnam, Veenesh; Shetty, Vishwanath; Sahni, Vishal
The purpose of this study was to assess whether subsidence occurs in collarless Corail hip replacement (CCHR) and to ascertain the extent and timing of subsidence if present. Retrospective case notes analysis was performed. Sixty eight patients who had CCHR were identified from our database. Male to female ratio was 32:36. Their mean age was 74.2 years (range 37-95 years). Indications for surgery were osteoarthritis in 64 (94%) patients, rheumatoid arthritis in two (3%) patients and avascular necrosis in two (3%) patients. Subsidence was measured at 6 weeks, 6 months and 1 year post-op compared to initial post-op x-rays. At 6 weeks x-ray 21 patients did not have any subsidence, 18 patients had 1 millimeter (mm) subsidence, 10 patients had 2mms subsidence, 4 patients had 3mms subsidence, 5 patients had 4mms subsidence, 1 patient had 5mms subsidence, 4 patients had 6 mms subsidence and 1 patient each had subsidence of 7mms, 9mms, 11mms, 13mms and 26 mms respectively. When compared with 6 months x-rays only 2 patients had a further subsidence of 2mms while another patient had 3mms subsidence. No further subsidence occurred at 1 year follow up x-rays. One patient had revision surgery due to symptomatic subsidence (29mms) at 6 months follow up. Subsidence does occur in the first 6 weeks in collarless Corail hip replacement, and to a lesser extent until 6 months postoperatively, but does not progress further. PMID:26069515
Selvaratnam, Veenesh; Shetty, Vishwanath; Sahni, Vishal
The purpose of this study was to assess whether subsidence occurs in collarless Corail hip replacement (CCHR) and to ascertain the extent and timing of subsidence if present. Retrospective case notes analysis was performed. Sixty eight patients who had CCHR were identified from our database. Male to female ratio was 32:36. Their mean age was 74.2 years (range 37-95 years). Indications for surgery were osteoarthritis in 64 (94%) patients, rheumatoid arthritis in two (3%) patients and avascular necrosis in two (3%) patients. Subsidence was measured at 6 weeks, 6 months and 1 year post-op compared to initial post-op x-rays. At 6 weeks x-ray 21 patients did not have any subsidence, 18 patients had 1 millimeter (mm) subsidence, 10 patients had 2mms subsidence, 4 patients had 3mms subsidence, 5 patients had 4mms subsidence, 1 patient had 5mms subsidence, 4 patients had 6 mms subsidence and 1 patient each had subsidence of 7mms, 9mms, 11mms, 13mms and 26 mms respectively. When compared with 6 months x-rays only 2 patients had a further subsidence of 2mms while another patient had 3mms subsidence. No further subsidence occurred at 1 year follow up x-rays. One patient had revision surgery due to symptomatic subsidence (29mms) at 6 months follow up. Subsidence does occur in the first 6 weeks in collarless Corail hip replacement, and to a lesser extent until 6 months postoperatively, but does not progress further.
Luthra, Jatinder Singh; Al Riyami, Amur; Allami, Mohamad Kasim
Objective: The purpose of the study was to evaluate results of dual mobility total replacement in a high risk population who take hip into hyperflexed position while sitting and praying on the floor. Method: The study included 65 (35 primary total replacement and 30 complex total hip replacement) cases of total hip replacement using avantage privilege dual mobility cup system from biomet. A cemented acetabular component and on femoral side a bimetric stem, either cemented or uncemented used depending on the canal type. Ten cases were examined fluoroscopically in follow up. Result: There was dislocation in one patient undergoing complex hip replacement. Fluoroscopy study showed no impingement between the neck of prosthesis and acetabular shell at extremes of all movements. Conclusion: The prevalence of dislocation is low in our high risk population and we consider it preferred concept for patients undergoing complex total hip replacement. PMID:27924742
Derar, H; Shahinpoor, M
Hip replacement surgery has gone through tremendous evolution since the first procedure in 1840. In the past five decades the advances that have been made in technology, advanced and smart materials innovations, surgical techniques, robotic surgery and methods of fixations and sterilization, facilitated hip implants that undergo multiple design revolutions seeking the least problematic implants and a longer survivorship. Hip surgery has become a solution for many in need of hip joint remedy and replacement across the globe. Nevertheless, there are still long-term problems that are essential to search and resolve to find the optimum implant. This paper reviews several recent patents on hip replacement surgery. The patents present various designs of prostheses, different materials as well as methods of fixation. Each of the patents presents a new design as a solution to different issues ranging from the longevity of the hip prostheses to discomfort and inconvenience experienced by patients in the long-term. PMID:25893020
Derar, H; Shahinpoor, M
Hip replacement surgery has gone through tremendous evolution since the first procedure in 1840. In the past five decades the advances that have been made in technology, advanced and smart materials innovations, surgical techniques, robotic surgery and methods of fixations and sterilization, facilitated hip implants that undergo multiple design revolutions seeking the least problematic implants and a longer survivorship. Hip surgery has become a solution for many in need of hip joint remedy and replacement across the globe. Nevertheless, there are still long-term problems that are essential to search and resolve to find the optimum implant. This paper reviews several recent patents on hip replacement surgery. The patents present various designs of prostheses, different materials as well as methods of fixation. Each of the patents presents a new design as a solution to different issues ranging from the longevity of the hip prostheses to discomfort and inconvenience experienced by patients in the long-term.
Gebel, Philipp; Oszwald, Markus; Ishaque, Bernd; Ahmed, Gaffar; Blessing, Recha; Thorey, Fritz; Ottersbach, Andreas
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
GRANO, GIOVANNI F.; PAVLIDOU, MARIA; TODESCO, ALBERTO; PALERMO, AUGUSTO; MOLFETTA, LUIGI
Purpose the purpose of the present paper is to present the short-term results of a “detachment-free” (DF) anterolateral approach for primary total hip replacement (THR) performed in a large series of patients. Methods two hundred patients submitted to primary THR were retrospectively reviewed for the present study. In all cases, the surgery was performed using a minimally invasive DF anterolateral approach, which entails no disconnection of tendons and no muscle damage. The study population consisted of 96 men (48%) and 104 women (52%), with an average age of 69.4 years (range 38–75). Clinical and radiographic follow-up was performed after 12 months. Results the clinical results, evaluated using the Harris Hip Score, were excellent in 95% of the cases and good in 5%; no cases had fair or poor results. X-rays taken at 3, 6 and 12 months after surgery did not show heterotopic ossification, mobilization of the prosthetic components, or hip dislocation. No infections, deep vein thrombosis, or failure of the gluteal muscles were reported. Conclusions the DF anterolateral approach for THR proved safe and provided effective results at short-term follow-up. Level of evidence Level IV, therapeutic case series. PMID:27900306
Ward, William G; Carter, Christina J; Barone, Marisa; Jinnah, Riyaz
Multiple factors regarding surgical procedures and patient selection affect hospital staffing needs as well as hospital revenues. In order to better understand the potential impact on hospitals that hip arthroplasty device selection (standard total hip arthroplasty vs. resurfacing) creates, a review of all primary hip arthroplasties performed at one institution was designed to identify factors that impacted hospital staffing needs and revenue generation. All primary hip arthroplasties undertaken over three fiscal years (2008 to 2010) were reviewed, utilizing only hospital business office data and medical records data that had been previously extracted prior for billing purposes. Analysis confirmed differing demographics for two hip arthroplasty populations, with the resurfacing patients (compared to the conventional total hip arthroplasty population) consisting of younger patients (mean age, 50 vs. 61 years), who were more often male (75% vs. 45%), were more likely to have osteoarthritis as their primary diagnosis (83 vs. 67%) and were more often covered by managed care or commercial insurance (83 vs. 34%). They also had shorter hospital stays (mean length of stay, 2.3 vs. 4.1 days) and consequently provided a more favorable financial revenue stream to the hospital on a per patient basis. Several trends appeared during the study periods. There was a steady increase in all procedures in all groups except for the resurfacings, which decreased 26% in males and 53% in females between 2009 and 2010. Differences were observed in the demographics of patients presenting for resurfacing, compared to those presenting for conventional total hip arthroplasty. In addition to the revenue stream considerations, institutions undertaking a resurfacing program must commit the resources and planning in order to rehabilitate these patients more expeditiously than is usually required with conventional hip arthroplasty patients.
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Total hip replacement (THR) and total knee replacement (TKR) surgery are carried out for the relief of hip or knee pain, usually caused by osteoarthritis. This is the first of two articles on THR and TKR. It will outline the different types of replacement used in lower limb joint replacement surgery. Preparation of patients for surgery requires attention to physical, psychological and social factors and these are explored in detail. The organization of services along the patient pathway to ensure comprehensive preparation is considered and the nursing role highlighted. The second article, to be published in the next issue, will discuss recovery and rehabilitation from THR and TKR surgery.
... the hip In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics . 12th ed. Philadelphia, PA: Elsevier Mosby; ... the knee. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics . 12th ed. Philadelphia, PA: Elsevier Mosby; ...
... the hip In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics . 12th ed. Philadelphia, PA: Elsevier Mosby; ... the knee. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics . 12th ed. Philadelphia, PA: Elsevier Mosby; ...
Schwartsmann, Carlos Roberto; Boschin, Leonardo Carbonera; Gonçalves, Ramiro Zilles; Yépez, Anthony Kerbes; de Freitas Spinelli, Leandro
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
Tsao, Audrey; Pesut, Tracy; Peacock, Charity; Tucci, Michelle; Buckhalter, Ruth Ann
Between 4/5/99 and 5/20/2002, our university performed 31 total hip arthroplasties in 27 young patients utilizing a conservative hip prosthesis developed at the Mayo Clinic. Eleven patients underwent Bipolar replacement, while the remaining twenty required an acetabular component. The patients ranged in age from 25 to 50 (mean of 39.9). The mean follow up was 12.4 months (range 4.5-27). Twenty-eight hips were treated for AVN secondary to RA, HIV, ETOH abuse, and SLE; while two underwent THA for OA secondary to trauma, and one for JRA. Three patients were lost to follow up at less than 6 months and were excluded from the study. The patients were followed for a minimum of 6 months utilizing the Harris hip score, the Charnley hip score, and radiographic evaluation including subsidence, radiolucency, and calcar resorption. Four patients (13%) had subsidence ranging from 1 to 3 mm at the most recent visit. One patients (3.2%) had radiographic evidence of radiolucency measuring 2 mm. Nine patients (29%) developed 1-3 mm of calcar resorption. No hips required revision. Thirty patients had improvement in their Harris hip score and Charnley hip score. The one patient who decreased his score had developed AVN secondary to ETOH abuse. Three hips had an intra-operative complication of lateral cortex penetration and required circlage wiring. Comparisons were made utilizing Multiple Logistic Regression to determine if preoperative BMI, Dorr score, and gender had an impact on the postoperative hip scores or degree of osteolysis, subsidence, and calcar resorption. Although the Harris hip score and Charnley hip scores significantly improved postoperatively, the preoperative BMI, Dorr score, and gender did not correlate with patient outcome. Our patients improved clinically in pain level, function and ROM. Further follow up will reveal if this component truly preserves bone stock for ease of future revision.
Lee, Hee Dong; Prashant, Kumar
Total hip joint replacement offers dramatic improvement in the quality of life but periprosthetic joint infection (PJI) is the most devastating complication of this procedure. The infection threatens the function of the joint, the preservation of the limb, and occasionally even the life of the patient due to long term hospitalization and high cost. For the surgeon it is a disastrous burden, which requires repeated, complicated procedures to eradicate infection and to provide a mobile joint without pain. Yet in the absence of a true gold standard, the diagnosis of PJI can be elusive. Synovial fluid aspiration, diagnostic imaging, traditional culture, peripheral serum inflammatory markers, and intraoperative frozen sections each have their limitations but continue to be the mainstay for diagnosis of PJI. Treatment options mainly include thorough irrigation and debridement with prosthesis retention, or a two-stage prosthesis exchange with intervening placement of an antibiotic-loaded spacer. Success in treating PJI depends on extensive surgical debridement and adequate and effective antibiotic therapy. Treatment in two stages using a spacer is recommended for most chronic PJI. Debridement, antibiotics and implant retention is the obvious choice for treatment of acute PJI, with good success rates in selected patients. This article presents an overview of recent management concepts for PJI of the hip emphasizing diagnosis and the clinical approach, and also share own experience at our institution. PMID:27536605
Czyżewska, Anna; Walesiak, Katarzyna; Krawczak, Karolina; Cabaj, Dominika; Górecki, Andrzej
Introduction The World Health Organization (WHO) claimed osteoarthritis as a civilization-related disease. The effectiveness of preoperative physiotherapy among patients suffering hip osteoarthritis (OA) at the end of their conservative treatment is rarely described in the literature. The aim of this study was to assess the quality of life and musculoskeletal health status of patients who received preoperative physiotherapy before total hip replacement (THR) surgery within a year prior to admission for a scheduled THR and those who did not. Material and methods Forty-five patients, admitted to the Department of Orthopaedics and Traumatology of Locomotor System for elective total hip replacement surgery, were recruited for this study. The assessment consisted of a detailed interview using various questionnaires: the Harris Hip Score (HHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the 36-Item Short Form Health Survey (SF-36), and the Hip disability and Osteoarthritis Outcome Score (HOOS), as well as physical examination. Patients were assigned to groups based on their attendance of preoperative physiotherapy within a year prior to surgery. Results Among patients who received preoperative physiotherapy a significant improvement was found for pain, daily functioning, vitality, psychological health, social life, and (active and passive) internal rotation (p < 0.05). Conclusions Patients are not routinely referred to physiotherapy within a year before total hip replacement surgery. This study confirmed that pre-operative physiotherapy may have a positive influence on selected musculoskeletal system status indicators and quality of life in hip osteoarthritis patients awaiting surgery. PMID:25395951
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
Liao, Yifeng; Hoffman, Emily; Wimmer, Markus; Fischer, Alfons; Jacobs, Joshua; Marks, Laurence
After the rapid growth in the use of CoCrMo metal-on-metal hip replacements since the second generation was introduced circa 1990, metal-on-metal hip replacements have experienced a sharp decline in the last two years due to biocompatibility issues related to wear and corrosion products. Despite some excellent clinical results, the release of wear and corrosion debris and the adverse response of local tissues have been of great concern. There are many unknowns regarding how CoCrMo metal bearings interact with the human body. This perspective article is intended to outline some recent progresses in understanding wear and corrosion of metal-on-metal hip replacement both in-vivo and in-vitro. The materials, mechanical deformation, corrosion, wear-assisted corrosion, and wear products will be discussed. Possible adverse health effects caused by wear products will be briefly addressed, as well as some of the many open questions such as the detailed chemistry of corrosion, tribochemical reactions and the formation of graphitic layers. Nowadays we design almost routinely for high performance materials and lubricants for automobiles; humans are at least as important. It is worth remembering that a hip implant is often the difference between walking and leading a relatively normal life, and a wheelchair. PMID:23196425
Scholes, S C; Unsworth, A
Total hip surgery is an effective way of alleviating the pain and discomfort caused by diseased or damaged joints. However, in the majority of cases, these joints have a finite life. The main reason for failure is osteolysis (bone resorption). It is well documented that an important cause of osteolysis, and therefore the subsequent loosening and failure of conventional metal- or ceramic-on-ultra-high molecular weight polyethylene joints, is the body's immunological response to the polyethylene wear particles. To avoid this, interest has been renewed in metal-on-metal joints. The intention of this paper is to review the studies that have taken place within different laboratories to determine the tribological performance of new-generation metal-on-metal total hip replacements. These types of joint offer a potential solution to enhance the longevity of prosthetic hip systems; however, problems may arise owing to the effects of metal ion release, which are, as yet, not fully understood.
Łyp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; Włostowska, Ewa; Stanisławska, Iwona; Szypuła, Jan; Tomaszewski, Wiesław
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
Malagelada, Francesc; Coll Rivas, Moisès; Jiménez Obach, Albert; Auleda, Jaume; Guirao, Lluis; Pleguezuelos, Eulogio
In this article, we present a case report of a 62-year-old patient who previously underwent an above-the-knee amputation for vascular disease and we performed a total hip replacement on him because of hip osteoarthritis. As the only postoperative complication, the patient developed a methicillin-resistant Staphylococcus aureus surgical site infection, which was successfully treated. The surgical technique and the postoperative rehabilitation program are described in detail in an attempt to detect and face the challenges that patients with major lower limb amputations may present. The literature is reviewed and all known cases of hip replacements in amputees are presented.
Langton, D J; Jameson, S S; Joyce, T J; Gandhi, J N; Sidaginamale, R; Mereddy, P; Lord, J; Nargol, A V F
There is widespread concern regarding the incidence of adverse soft-tissue reactions after metal-on-metal (MoM) hip replacement. Recent National Joint Registry data have shown clear differences in the rates of failure of different designs of hip resurfacing. Our aim was to update the failure rates related to metal debris for the Articular Surface Replacement (ASR). A total of 505 of these were implanted. Kaplan-Meier analysis showed a failure rate of 25% at six years for the ASR resurfacing and of 48.8% for the ASR total hip replacement (THR). Of 257 patients with a minimum follow-up of two years, 67 (26.1%) had a serum cobalt concentration which was greater than 7 μg/l. Co-ordinate measuring machine analysis of revised components showed that all patients suffering adverse tissue reactions in the resurfacing group had abnormal wear of the bearing surfaces. Six THR patients had relatively low rates of articular wear, but were found to have considerable damage at the trunion-taper interface. Our results suggest that wear at the modular junction is an important factor in the development of adverse tissue reactions after implantation of a large-diameter MoM THR.
Mirza, Saqeb B; Dunlop, Douglas G; Panesar, Sukhmeet S; Naqvi, Syed G; Gangoo, Shafat; Salih, Saif
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
Amstutz, H C; Grigoris, P; Dorey, F J
Surface replacement is a bone-conserving alternative to total hip arthroplasty and is a significant development in the evolution of hip arthroplasty. Surface replacement with polyethylene bearings was largely abandoned, primarily because of component aseptic loosening caused by tissue reaction to high-volumetric polyethylene wear. For patients with osteonecrosis and collapse of the femoral head but with preservation of some acetabular articular cartilage, precision fit, hemisurface replacement of the femoral head only has emerged as the treatment of choice. The survivorship of our series of patients, performed in the 1981-84 era (average age, 32 years), has been 85% at 5 years, 67% at 10 years, and 42% at 16 years. In the absence of polyethylene, there has been no loosening. Revisions were for cartilage wear. The procedure is now much improved with instrumentation for non-trochanteric osteotomy approaches and off-the-shelf components in 1-mm increments. For arthritic hips, a new era of surface replacement has emerged. With metal-on-metal bearings, the volumetric wear has been reduced 20-100 times from those with polyethylene, and there is no penalty for the large ball size. The devices are now conservative on the acetabular as well as femoral side. Hybrid or all-cementless fixation is superior to earlier all-cemented devices. In those patients, the results with up to 4 years have been complication-free, with an absence of pain and a return to high functional levels, including participation in sports. Forty patients have received a Conserve Plus with interference fitting of the acetabular component with sintered beads to obtain fixation. Although the follow-up is short, surface replacement with the large ball size is extremely stable, and dislocation is rare.
Alho, A; Jaer, O; Slungaard, U; Holme, I
Two-hundred and fifty-two patients waiting for a total hip replacement for degenerative hip disease were randomized to two groups of nonsteroidal anti-inflammatory medication using piroxicam, 20 mg per day, and naproxen, 750 mg per day, after exclusion for severe dyspepsia or peptic ulcer, asthma, idiosyncracy, dissent, age below 50 years, Harris hip score above 50, or significant contralateral disease. A significant improvement in the pain and daily activity parameters was obtained in both groups. The effect was better in the piroxicam group one month after the commencement of the treatment, and equal in the groups later during the observation period of 2-5 months. We conclude that continuous medication is beneficial in patients with severe osteoarthritis scheduled for operation. However, the side effects of the medication have to be carefully considered and followed up.
Background Osteopetrosis is a rare, inherited, bone disorder, characterized by osteosclerosis, obliteration of the medullary cavity and calcified cartilage. The autosomal dominant form is compatible with a normal life span, although fractures often result from minimal trauma, due to the pathologic nature of bone. Osteomyelitis is common in patients with osteopetrosis because of a reduced resistance to infection, attributed to the lack of marrow vascularity and impairment of white cell function. Only one case of osteomyelitis of the proximal third of the femur has been previously reported, treated with several repeated debridements and finally with femoral head resection. Here we present for the first time a case of a staged implant of a cementless total hip prosthesis for the treatment of a septic hip in femoral neck nonunion in osteopetrosis. Case presentation A 36-years-old woman, affected by autosomal dominant osteopetrosis was referred to our department because of a septic hip arthritis associated with femoral neck septic non-union, with draining fistulas. The infection occurred early after a plate osteosynthesis for a closed perthrocanteric fracture of the femur and persisted in spite of osteosynthesis removal, surgical debridement and external fixation. In our hospital the patient underwent accurate debridement, femoral head and greater trochanter resection, preparation of the diaphyseal intramedullary canal and implant of an antibiotic-loaded cement spacer. The spacer was exchanged after one month, due to infection recurrence and four months later, a cementless total hip arthroplasty was implanted, with no clinical and laboratory signs of infection recurrence at two years follow-up. Conclusions In case of hip septic arthritis and proximal femur septic non-union, femoral head resection may not be the only option available and staged total hip arthroplasty can be considered. PMID:22472060
Hotchen, Andrew J.; Vonberg, Frederick W.; Ironside, Emily C.; Ross-Thriepland, Stephen; Avery, Naomi; Pearce, Oliver J. N.
Objectives: This study sought to assess the value of differing pre-operative measures in prediction of post-operative non-surgical site infection (NSSI) and length of hospital stay following hip fracture surgery. Methods: All patients admitted during a one year period with a hip fracture to our department were included in the study (n=207). Primary outcome measures were ten independent risk factors correlated to the development of non-surgical site infection following surgery for hip fracture. Secondary outcome measures were duration of hospital stay and inpatient mortality. Results: The patients who had severe cognitive impairment had a 71.0% risk of developing non-surgical site infection. Patients who had multiple medical co-morbidities also had increased risk of developing non-surgical site infection at 59.1%. Patients who developed NSSI on average stayed in hospital 13.1 days longer than patients who did not (31.6 vs. 18.5, p < .001). Conclusions: This study demonstrates the importance of reducing post-operative infection in hip fracture patients in view of reducing morbidity, mortality and cost. These patients can be stratified by risk factors and interventions can be employed in view of reducing inpatient post-operative infection rates in this cohort. PMID:28138499
Liao, Y.; Pourzal, R.; Wimmer, M. A.; Jacobs, J. J.; Fischer, A.; Marks, L. D.
Arthritis is a leading cause of disability, and when nonoperative methods have failed, a prosthetic implant is a cost-effective and clinically successful treatment. Metal-on-metal replacements are an attractive implant technology, a lower-wear alternative to metal-on-polyethylene devices. Relatively little is known about how sliding occurs in these implants, except that proteins play a critical role and that there is a tribological layer on the metal surface. We report evidence for graphitic material in the tribological layer in metal-on-metal hip replacements retrieved from patients. As graphite is a solid lubricant, its presence helps to explain why these components exhibit low wear and suggests methods of improving their performance; simultaneously, this raises the issue of the physiological effects of graphitic wear debris.
Introduction The National Institute for Health and Care Excellence (NICE) currently recommends the use of total hip replacement (THR) for displaced intracapsular hip fractures in patients who meet certain mobility, cognitive and health criteria. Methods A multicentre prospective audit was conducted within a defined geographic region to assess current practice and variation in provision of THR for displaced intracapsular hip fractures. Results A total of 879 patients with hip fractures, admitted to 8 acute trauma units, were included in this study. Of 462 patients with displaced intracapsular hip fractures, 169 fulfilled the NICE criteria for THR. THR was performed for only 49 of (29%) the eligible patients. There was significant variation in THR provision between the eight units (0% to 50% THR usage, p<0.001). There were statistically significant differences in age, ASA (American Society of Anesthesiologists) grade, abbreviated mental test score and walking ability prior to the injury between patients who underwent fixation, THR or hemiarthroplasty (all p≤0.05). There was a significantly increased chance of not undergoing THR if a patient was older than 77 years (median age for the THR eligible cohort; relative risk [RR]: 7.9, 95% confidence interval [CI]: 2.8–22.0, p<0.001). There was also a trend for this with patients who were ASA grade 3 compared with ASA grade 1 or 2 (RR: 2.7, 95% CI: 1.0–7.3, p=0.06). The surgeons gave multifactorial reasons for not performing THR in eligible patients. Conclusions There is significant variation in the provision of THR for eligible hip fracture patients, which is influenced by both patient demographics and the unit to which a patient is admitted. PMID:26741658
Joy, PJ; Bennet, SJ
INTRODUCTION A significant proportion of all red cell transfusions are given to patients undergoing elective orthopaedic surgery. Concern over transfusion safety and cost, coupled with evidence showing that restrictive transfusion policies benefit patients, prompted us to audit our blood prescribing practice at Gloucestershire Hospitals NHS Foundation Trust in order to assess the appropriateness of every transfusion episode following elective primary total hip replacement. METHODS All patients undergoing a primary total hip replacement in our department over a six-month period were included in the study. Data were collected retrospectively using case note examination and transfusion service data. Standards were dictated by the British Orthopaedic Association guidelines on blood conservation in elective orthopaedic surgery. RESULTS Twenty-seven per cent of patients (39/143) were transfused. Forty-six per cent of these (18/39) were transfused inappropriately and twenty-three per cent (9/39) appropriately. Thirteen per cent (5/39) had a valid indication for transfusion but were over-transfused and in eighteen per cent (7/39) the quality of documentation did not allow an assessment to be made. Fifty-two per cent of patients who had surgical drains (29/56) were transfused. Reaudit following staff education and amendments to the local transfusion policy did not demonstrate a reduction in transfusion rates. CONCLUSIONS This audit showed that significant potential exists for reducing transfusion rates based on optimising prescribing practice alone. It also demonstrated that changing local practice based on audit data can be challenging. PMID:22507728
Scaglione, Michelangelo; Fabbri, Luca; Celli, Fabio; Casella, Francesco; Guido, Giulio
Summary Osteonecrosis of the femoral head is a destructive disease that usually affects young adults with high functional demands and can have devastating effects on hip joint. The treatment depends on extent and location of the necrosis lesion and on patient’s factors, that suggest disease progression, collapse probability and also implants survival. Non-idiopathic osteonecrosis patients had the worst outcome. There is not a gold standard treatment and frequently it is necessary a multidisciplinary approach. Preservation procedures of the femoral head are the first choice and can be attempted in younger patients without head collapse. Replacement procedure remains the main treatment after failure of preserving procedures and in the late-stage ONFH, involving collapse of the femoral head and degenerative changes to the acetabulum. Resurfacing procedure still has good results but the patient selection is a critical factor. Total hip arthroplasties had historically poor results in patients with osteonecrosis. More recently, reports have shown excellent results, but implant longevity and following revisions are still outstanding problems. PMID:27134633
Redmond, A; Stewart, T; Stone, M
Introduction Total hip replacement (THR) is successful and performed commonly. Component placement is a determinant of outcome. Influence of surgeon handedness on component placement has not been considered previously. This study was a radiographic assessment of component positioning with respect to handedness. Early data from 160 patients are reported. Methods Overall, 160 primary THRs for osteoarthritis were included. Equal numbers of left and right THRs were performed by four surgeons, two right-handed and two left-handed. Postoperative radiography was assessed for THR component position by measurement of leg length inequality, acetabular inclination and centre of rotation. Surgeons’ handedness was assessed using the Edinburgh inventory. Results For leg length inequality, no significant interaction was seen between hip side and surgeon handedness. Acetabular inclination angles showed a statistically significant difference, however, depending on hand dominance, with higher inclination angles recorded when operating on the dominant side. There was a trend towards greater medialisation of the centre of rotation on the non-dominant side although this did not reach statistical significance. Conclusions Surgeon handedness appears to influence acetabular component position during THR but it is one factor of many that interact to achieve a successful outcome. PMID:25198975
Lüdemann, C M; Schütze, N; Rudert, M
The diagnosis of periprosthetic infection requires a clear definition itself and structured procedure concerning anamnesis, clinical examination, laboratory findings, puncture and imaging diagnostics. The clinical presentation may vary considerable due to the time of their occurrence as early, delayed, or late infection. Recognition of risk factors and knowledge of differential diagnoses facilitate and confirm the diagnosis. The synovial fluid is assessed with regard to leukocyte count, protein content, and glucose. Intraoperative tissue specimen sampling has to be performed correctly; the histopathological and microbiological studies must be assessed using specific criteria. The examination and classification of periprosthetic membranes make discrimination of the causal pathological mechanism possible, especially distinction between septic and aseptic loosening. In this manner statements with regard to etiology and prosthesis durability are possible. Different causative microorganisms appear postoperatively at specific times. Pathogens that grow as biofilms are of great significance, as they may compound diagnosis and therapy. Early infections are often caused by virulent microorganisms (S. aureus) with acute onset. Delayed (low grade) infections are usually caused by less virulent microorganisms, such as S. epidermidis or coagulase-negative staphylococci. Many diagnostic imaging methods have been used in the assessment of periprosthetic infection: plain radiographs, arthrography, ultrasonography, computed tomography, and magnetic resonance imaging. Nuclear medicine with bone scintigraphy or positron-emission tomography enhance diagnostic capabilities. Cultures of samples obtained by sonication of prostheses are more sensitive than conventional periprosthetic tissue culture. Multiplex PCR of sonication fluid is a promising test for diagnosis of periprosthetic joint infection. The promising diagnostic accuracy for interleukin-6 and procalcitonin has yet not been
Infections of the hip joint are usually of bacterial etiology. Only rarely, an infectious arthritis is caused in this localization by viruses or fungi. Native joint infections of the hip are less common than infections after implantation of prosthetic devices. Difficulties in prosthetic joint infections are, (I) a higher age of patients, and, thus an associated presence of other medical risk factors, (II) often long courses of treatment regimes depending on the bacterium and its antibiotic resistance, (III) an increased mortality, and (IV) a high economic burden for removal and reimplantation of an infected prosthetic device. The pathogenic mechanisms responsible for articular infections are well studied only for some bacteria, e.g. Staphylococcus aureus, while others are only partially understood. Important known bacterial properties and microbiological characteristics of infection are the bacterial adhesion on the native joint or prosthetic material, the bacterial biofilm formation, the development of small colony variants (SCV) as sessile bacterial types and the increasing resistance to antibiotics. PMID:19834588
Gillam, Marianne H; Pratt, Nicole L; Inacio, Maria C S; Roughead, Elizabeth E; Shakib, Sepehr; Nicholls, Stephen J; Graves, Stephen E
Background and purpose — It is unclear whether metal particles and ions produced by mechanical wear and corrosion of hip prostheses with metal-on-metal (MoM) bearings have systemic adverse effects on health. We compared the risk of heart failure in patients with conventional MoM total hip arthroplasty (THA) and in those with metal-on-polyethylene (MoP) THA. Patients and methods — We conducted a retrospective cohort study using data from the Australian Government Department of Veterans’ Affairs health claims database on patients who received conventional THA for osteoarthritis between 2004 and 2012. The MoM THAs were classified into groups: Articular Surface Replacement (ASR) XL Acetabular System, other large-head (LH) (> 32 mm) MoM, and small-head (SH) (≤ 32 mm) MoM. The primary outcome was hospitalization for heart failure after THA. Results — 4,019 patients with no history of heart failure were included (56% women). Men with an ASR XL THA had a higher rate of hospitalization for heart failure than men with MoP THA (hazard ratio (HR) = 3.2, 95% CI: 1.6–6.5). No statistically significant difference in the rate of heart failure was found with the other LH MoM or SH MoM compared to MoP in men. There was no statistically significant difference in heart failure rate between exposure groups in women. Interpretation — An association between ASR XL and hospitalization for heart failure was found in men. While causality between ASR XL and heart failure could not be established in this study, it highlights an urgent need for further studies to investigate the possibility of systemic effects associated with MoM THA. PMID:27759468
Popov, I; Onuh, S O
Research into fabrication of hip joint replacements combines knowledge from distinct domains, such as engineering, materials and medical fields. Recent computer assisted technologies have played an important role in the medical field. Unlike the modelling of most of the human bones, the creation of an accurate 3D model of a pelvic bone has been a challenging task. The main source of difficulties in this case has proven to be the complexity of the structure of the pelvis, having basically a free-form shape with a hole in the middle constituting some over-shadowed areas (undercuts), various cavities, areas with high form curvature, variable wall thickness with some very thin sections and inside layers with different mechanical properties. In this research work, a pelvic bone is generated using reverse engineering, rapid prototyping and rapid tooling techniques. The geometric data obtained from reverse engineering through laser scanning are used and manipulated to create accurate 3D CAD representations of these devices. These CAD models can be used for various virtual tests and simulations, as well as for reproduction through rapid manufacturing processes and then used as prototypes in tooling, physical tests and planning of surgical operations.
Muth, John; Poggie, Matthew; Kulesha, Gene; Michael Meneghini, R.
Hip and knee replacement can dramatically improve a patient's quality of life through pain relief and restored function. Fixation of hip and knee replacement implants to bone is critical to the success of the procedure. A variety of roughened surfaces and three-dimensional porous surfaces have been used to enhance biological fixation on orthopedic implants. Recently, highly porous metals have emerged as versatile biomaterials that may enhance fixation to bone and are suitable to a number of applications in hip and knee replacement surgery. This article provides an overview of several processes used to create these implant surfaces.
Zhang, Pei; Liang, Yuan; Chen, Pengtao; Fang, Yongchao; He, Jinshan; Wang, Jingcheng
Abstract Background: As the prevalence of total hip arthroplasty (THA) is increasing, it is usually associated with considerable blood loss. Tranexamic acid (TXA) has been reported to reduce perioperative blood loss in hip joint arthroplasty. But the best route of TXA administration continues to be controversial. So, we conducted a meta-analysis that integrated all data from the 7 included trials to compare the effectiveness and safety of topical and intravenous TXA administration in primary THA. The endpoints assessed in this meta-analysis include the comparisons of total blood loss, postoperative hemoglobin decline, transfusion rates, the incidence rate of deep vein thrombosis (DVT), pulmonary embolisms (PE), and wound infection. Methods: Literature searches of PubMed, EMBASE, the Cochrane Library, the Chinese Biomedical Literature database, the CNKI database, and Wan Fang Data were performed up to August 30, 2016. Randomized controlled trials (RCTs) were included in our meta-analysis if they compared the efficiency and safety of intravenous versus topical administration of TXA in patients who underwent primary THA. The endpoints included the comparisons of total blood loss, postoperative hemoglobin decline, transfusion rates, the incidence rate of DVT, PE, and wound infection. A meta-analysis was performed following the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. The pooling of data was carried out by using RevMan 5.3, Denmark. Results: Seven RCTs involving 964 patients met the inclusion criteria. Our meta-analysis indicated that there were no significant differences in the 2 groups in terms of total blood loss ([mean difference (MD) = −14.74, 95% confidence interval (CI): −89.21 to 59.74, P = 0.7], transfusion rates [RD = −0.02, 95% CI: −0.05 to 0.02, P = 0.39]; no significant differences were found regarding the incidence of adverse effects such as deep venous thrombosis [DVT] [RD = 0.00, 95% CI: −0
Huang, Ziqiang; Zhou, Yonggang; Chai, Wei; Ji, Weiping; Cui, Guopeng; Ma, Miaoqun; Zhu, Yin
[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).
Huang, Ziqiang; Zhou, Yonggang; Chai, Wei; Ji, Weiping; Cui, Guopeng; Ma, Miaoqun; Zhu, Yin
[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
... pain involves any pain in or around the hip joint. You may not feel pain from your hip ... 2012:chap 48. Read More Hip fracture surgery Hip joint replacement Patient Instructions Hip fracture - discharge Hip or ...
... the hip. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics . 12th ed. Philadelphia, PA: Elsevier Mosby; ... the knee. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics . 12th ed. Philadelphia, PA: Elsevier Mosby; ...
Awasthi, Bhanu; Kumar, Krishna; Kohli, Navneet; Katoch, Punit
Introduction Management of displaced fracture neck femur in the elderly population is frequently done by Hemiarthroplasty or Total Hip Replacement (THR). It avoids high rates of nonunion and avascular necrosis which usually occur after internal fixation of neck femur fractures in this age group. Aim The present study aimed to evaluate patient function and complications following hemiarthroplasty and total hip replacement in elderly population with displaced femoral neck fractures. Materials and Methods Patients above 60 years of age with displaced fracture neck femur were studied over the period of four years. All the clinical parameters and co-morbid conditions were noted at the time of presentation. The patients associated with co-morbid conditions and underlying pathology were excluded from study. Garden’s classification was used for classification of neck femur fractures. After due informed consent patients of displaced fracture neck femur were randomized by simple randomization and allocated for hemiarthroplasty or THR. Antibiotics were given preoperatively at the time of induction and postoperatively for 5-7 days. Surgery was carried out by Modified Gibson approach. Any complications during pre and postoperative period were noted. Follow-up of patients was done 1 month, 3 months, 6 months and 1 year interval with the help of Harris hip score. Results Total 80 patients were enrolled in the study group, with 40 patients in each group. The mean age of patients was 73 years in hemiarthroplasty group and 78 years in THR group. Female to male ratio was 55:45. Mean operative time was 35 minutes in hemiarthroplasty group and 45 minutes in THR. Average intraoperative blood loss was 200cc and 300cc in hemiarthroplasty and THR respectively. The mean hospital stay was 14 days in both the groups. Superficial wound infection was noted in hemiarthroplasty group while in THR group deep wound infection (n=1) and prolonged ICU stay (n=1) were noted. The mean Harris hip score
Kumar, Narinder; Arora, Gen N.C.; Datta, Barun
Total hip arthroplasty has evolved from the first total hip arthroplasty in 1938, through the revolutionization of hip arthroplasty by principles of low friction arthroplasty introduced by Sir John Charnley in 1960s to the present state of the art implants and techniques. The main concern regarding failure of total hip arthroplasty has been the biological response to particulate polyethylene debris generated by conventional metal on polyethylene bearing surfaces leading to osteolysis and aseptic loosening of the prosthesis. Therefore, recent research has been focussing on alternative bearing surfaces to reduce the particulate debris generated. These bearing surfaces include ceramic-polyethylene, metal–metal as well as ceramic–ceramic articulations and have demonstrated lesser friction rates as well as significantly lower wear rates as compared to widely used metal on polyethylene surfaces. Clinical experience until now has shown that metal on metal articulations have significant safety concerns whereas metal-on-highly crosslinked polyethylene, ceramic on ceramic and ceramic on highly crosslinked polyethylene articulations have shown encouraging results to hold promise for wider use in younger and more active patients. This review article discusses positives and drawbacks of various bearing surfaces in current clinical use in total hip arthroplasty as well as briefly explores the newer technologies on the horizon which may even further decrease wear and improve total hip arthroplasty survivorship. PMID:25382913
Sakellariou, Vasileios I.; Christodoulou, Michael; Sasalos, Gregory; Babis, George C.
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
Santavirta, Seppo; Böhler, Max; Harris, William H; Konttinen, Yrjö T; Lappalainen, Reijo; Muratoglu, Orhun; Rieker, Claude; Salzer, Martin
An improvement in tribology of bearing surfaces is an effective means of increasing the longevity of total hip replacement (THR). Currently, 3 approaches are available to achieve this aim: first, use of highly cross-linked UHMWPE; second, aluminum oxide ceramic bearings, and third, metal-on-metal bearings. Cross-linking reduces the wear resistance of UHMWPE markedly without impairment of other significant properties of the material. Simulator studies and some clinical long-term (10-22 years) follow-up surveys suggest an almost immeasurable wear of the highly cross-linked UHMWPE-based acetabular components during an expected clinical life span. Bioinert alumina ceramic (aluminum oxide) was introduced 3 decades ago for THR-bearing surfaces to improve performance and longevity. Alumina ceramic is entirely biostable and bioinert and has good mechanical properties. For correctly positioned alumina-on-alumina bearings, the annual linear wear rate has been reported to be 3.9 microm. Alumina heads have been successfully used in combination with polyethylene sockets, but as regards wear, the best results have been obtained with alumina-on-alumina bearings. In ceramic THR bearings, precise manufacture and contact surface geometry, including optimal clearance, are most important. For the currently available products, the component fracture risk is almost nonexistent (less than 1 per 1000). Metal-on-metal bearings were used in the early stage of THR surgery, although not all old designs were successful. More recent analyses of the early series have shown the advantages of metal-on-metal to be better and have led to a renaissance of this articulation. Initially, stainless steel was used because it was easy to manufacture and polish. Current metal-on-metal bearings are based on cobalt-chromium-molybdenum alloys with varying carbon contents. Such bearings are self-polishing. Linear wear rates remain at the level of a few microm a year. An improvement in technology has increased
Camurcu, Yalkin; Sofu, Hakan; Buyuk, Abdul Fettah; Gursu, Sarper; Kaygusuz, Mehmet Akif; Sahin, Vedat
The main purpose of the present study was to analyze the clinical features, the most common infective agents, and the results of two-stage total hip revision using a teicoplanin-impregnated spacer. Between January 2005 and July 2011, 41 patients were included. At the clinical status analysis, physical examination was performed, Harris hip score was noted, isolated microorganisms were recorded, and the radiographic evaluation was performed. The mean Harris hip score was improved from 38.9 ± 9.6 points to 81.8 ± 5.8 points (P<0.05). Infection was eradicated in 39 hips. Radiographic evidence of stability was noted in 37 acetabular revision components, and all femoral stems. Two-stage revision of the infected primary hip arthroplasty is a time-consuming but a reliable procedure with high rates of success.
Gheorghiu, Daniel; Peter, Viju; Lynch, Martin
The teflon hip arthroplasty design was used by Sir John Charnley in the early 60's but was taken off the market due to high complication rates. A case is reported of an intrapelvic granuloma after total hip arthroplasty following the use of a teflon socket. This appears to be the last surviving patient treated by Sir John Charnley using a Teflon hip socket design.
Howard, Jason J
Due to problems with wear particle generation and subsequent loosening using conventional metal-on-polyethylene total hip replacements, there has been a shift toward alternative bearing systems, including metal-on-metal (MoM), for younger, more active patients with degenerative joint disease. Based on positive results from early short-term clinical studies, MoM hip replacements were readily adopted by orthopedic surgeons with thousands being implanted worldwide over the past decade. Unacceptably high revision rates reported by two national joint registries called into question the rigorousness of the regulatory approval process for these implants, particularly with respect to premarket data requirements to prove safety, effectiveness, and the appropriateness of the regulatory pathway chosen. The purpose of this review was to investigate the balance between facilitating the introduction of new medical technologies and the need to ensure safety and effectiveness through comprehensive regulatory assessment. The case of MoM hip replacement devices was used to frame the investigation and subsequent discussions. The regulatory approval processes and post-market surveillance requirements associated with three common MoM hip replacements (two resurfacings: the Birmingham and articular surface replacement and the articular surface replacement XL total hip replacement) were investigated. With respect to modern MoM hip replacement devices, the balance between facilitating the introduction of these new medical technologies and the need to ensure safety and effectiveness through comprehensive regulatory assessment was not achieved. The lessons learned from these experiences have application beyond joint replacements to the introduction of new medical technologies in general, particularly for those who have a significant potential for harm. In this regard, a series of recommendations have been developed to contribute to the evolution of the medical device regulatory process
Winiarski, Sławomir; Aleksandrowicz, Krzysztof; Jarząb, Sławomir; Pozowski, Andrzej; Rutkowska-Kucharska, Alicja
Total hip arthroplasty (THA) is one of the most effective methods of treatment of severe hip osteoarthritis (HOA). In many cases pathological gait patterns persist despite properly conducted surgery and disturb the normal wear of the artificial joint surfaces. The aim of the study was to conduct functional and biomechanical assessment of gait in a patient after bilateral THA due to severe degenerative changes in the hip. The assessment focused on the gait parameters which significantly deviate from a normal gait pattern at various stages of treatment. Physiotherapeutic assessment of the patient included measurements of the range of motion in lower limb joints, the Timed Up and Go test, and pain assessment. Biomechanical assessment involved measurements of spatiotemporal gait parameters and the dynamic range of motion using BTS Smart-E motion analysis system. Although clinical examinations after both the first and second procedure suggested recovery of the patient's physical function, biomechanical assessment of her gait after the second procedure indicated the presence of deviations from a normal gait pattern. Secondary to a limited range of internal/external hip rotation, extension, and abduction, corresponding indices were still in the pathological range.
Pistollato, Michele; Charlesworth, Anita; Devlin, Nancy; Propper, Carol; Sussex, Jon
Objectives To assess the association between market concentration of hospitals (as a proxy for competition) and patient-reported health gains after elective primary hip replacement surgery. Methods Patient Reported Outcome Measures data linked to NHS Hospital Episode Statistics in England in 2011/12 were used to analyse the association between market concentration of hospitals measured by the Herfindahl-Hirschman Index (HHI) and health gains for 337 hospitals. Results The association between market concentration and patient gain in health status measured by the change in Oxford Hip Score (OHS) after primary hip replacement surgery was not statistically significant at the 5% level both for the average patient and for those with more than average severity of hip disease (OHS worse than average). For 12,583 (49.1%) patients with an OHS before hip replacement surgery better than the mean, a one standard deviation increase in the HHI, equivalent to a reduction of about one hospital in the local market, was associated with a 0.104 decrease in patients’ self-reported improvement in OHS after surgery, but this was not statistically significant at the 5% level. Conclusions Hospital market concentration (as a proxy for competition) appears to have no significant influence (at the 5% level) on the outcome of elective primary hip replacement. The generalizability of this finding needs to be investigated. PMID:25213207
Liao, Kuang-Ming; Lu, Hsueh-Yi
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
Liao, Kuang-Ming; Lu, Hsueh-Yi
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.
Gil Gonzalez, Sergi; Marqués López, Fernando; Rigol Ramon, Pau; Mestre Cortadellas, Carlos; Cáceres Palou, Enric; León García, Alfonso
Two-stage revision hip arthroplasty for infection using an antibiotic-loaded cement spacer has been used frequently with good results. However, spacer instability is also frequent. Proximal cementation of the spacer could avoid spacer dislocation. We retrospectively assessed 35 patients in whom a 2-stage revision hip arthroplasty for infection was carried out using an antibiotic-loaded cement spacer with gentamicin (Spacer-G) in which the spacer was proximally cemented in 16 patients. The mean follow-up was 32 months. We assessed spacer stability and infection elimination. There were 8 spacer dislocations (22.9%), 5 in hips without proximal cementation and 2 in hips with proximal cementation (p>0.05). There was no fracture in any hip. Reinfection occurred in 5 hips (14.3%), in 3 with the same microorganism, while 2 had a different microorganism. Our results indicate that the proximal cementation of the spacer prevents its dislocation. Infection was eliminated in 86% of the hips.
Hua, Xijin; Wang, Ling; Al-Hajjar, Mazen; Jin, Zhongmin; Wilcox, Ruth K; Fisher, John
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.
Lee, P T H; Lakstein, D L; Lozano, B; Safir, O; Backstein, J; Gross, A E
Revision total hip replacement (THR) for young patients is challenging because of technical complexity and the potential need for subsequent further revisions. We have assessed the survivorship, functional outcome and complications of this procedure in patients aged < 50 years through a large longitudinal series with consistent treatment algorithms. Of 132 consecutive patients (181 hips) who underwent revision THR, 102 patients (151 hips) with a mean age of 43 years (22 to 50) were reviewed at a mean follow-up of 11 years (2 to 26) post-operatively. We attempted to restore bone stock with allograft where indicated. Using further revision for any reason as an end point, the survival of the acetabular component was 71% (sd 4) and 54% (sd 7) at ten- and 20 years. The survival of the femoral component was 80% (sd 4) and 62% (sd 6) at ten- and 20 years. Complications included 11 dislocations (6.1%), ten periprosthetic fractures (5.5%), two deep infections (1.1%), four sciatic nerve palsies (2.2%; three resolved without intervention, one improved after exploration and freeing from adhesions) and one vascular injury (0.6%). The mean modified Harris Hip Score was 41 (10 to 82) pre-operatively, 77 (39 to 93) one year post-operatively and 77 (38 to 93) at the latest review. This overall perspective on the mid- to long-term results is valuable when advising young patients on the prospects of revision surgery at the time of primary replacement.
Singh, Jas; Politis, Angelos; Loucks, Lynda; Hedden, David R.; Bohm, Eric R.
Background National joint replacement registries outside North America have been effective in reducing revision risk. However, there is little information on the role of smaller regional registries similar to those found in Canada or the United States. We sought to understand trends in total hip (THA) and knee (TKA) arthroplasty revision patterns after implementation of a regional registry. Methods We reviewed our regional joint replacement registry containing all 30 252 cases of primary and revision THA and TKA performed between Jan. 1, 2005, and Dec. 31, 2013. Each revision case was stratified into early (< 2 yr), mid (2–10 yr) or late (> 10 yr), and we determined the primary reason for revision. Results The early revision rate for TKA dropped from 3.0% in 2005 to 1.3% in 2011 (R2 = 0.84, p = 0.003). Similarly, the early revision rate for THA dropped from 4.2% to 2.1% (R2 = 0.78, p = 0.008). Despite primary TKA and THA volumes increasing by 35.5% and 39.5%, respectively, there was no concomitant rise in revision volumes. The leading reasons for TKA revision were infection, instability, aseptic loosening and stiffness. The leading reasons for THA revision were infection, instability, aseptic loosening and periprosthetic fracture. There were no discernible trends over time in reasons for early, mid-term or late revision for either TKA or THA. Conclusion After implementation of a regional joint replacement registry we observed a significant reduction in early revision rates. Further work investigating the mechanism by which registry reporting reduces early revision risk is warranted. PMID:27438053
Ozdemir, Ozlem; Tosun, Bet Uuml L
This study systematically reviews the research, focused on the effects of home exercise programmes implemented during home visits after hip replacement on patients. PubMed (MEDLINE), Wiley Online Library, EBSCOhost, Science Direct databases (between 2004 and June 2015) were searched with the keywords "hip replacement, home exercise programme and home visit". Eleven original articles were retrieved. Different parameters were used in the trials to assess the physical functions, mobility and quality of life of patients. In six trials, the intervention group achieved significantly better improvements statistically in all parameters after home exercise programmes. In three trials, the intervention group achieved better but not significant outcomes. Early recovery in daily living activities with home exercise programme was reported only in one trial. Reviewed studies suggest that home exercise programmes, implemented during home visits after hip replacement, improve patients' physical functions and life quality.
Brockett, Claire L; John, Gemma; Williams, Sophie; Jin, Zhongmin; Isaac, Graham H; Fisher, John
Total hip replacement has been a successful surgical intervention for over 50 years, with the majority of bearings using a polyethylene cup. Long-term failure due to osteolysis and loosening has been widely documented and alternative bearings have been sought. A novel carbon fiber-reinforced poly-ether ether ketone (CFR-PEEK) cup was investigated through experimental friction and wear studies. Friction studies demonstrated the bearings operated in a boundary lubrication condition, with friction factors higher than those for other hip replacement bearings. The wear study was conducted with 36 mm diameter bearings tested against Biolox Delta heads for a period of 10 million cycles. The mean volumetric wear rate was 0.3 mm(3)/Mc, indicating the ceramic-on-CFR-PEEK bearing to be a very low wearing option for total hip replacement.
Papanicolas, Irene; McGuire, Alistair
Following devolution in 1999 England and Scotland's National Health Services diverged, resulting in major differences in hospital payment. England introduced a case payment mechanism from 2003/4, while Scotland continued to pay through global budgets. We investigate the impact this change had on activity for Hip Replacement. We examine the financial reimbursement attached to uncemented Hip Replacement in England, which has been more generous than for its cemented counterpart, although clinical guidance from the National Institute for Clinical Excellence recommends the later. In Scotland this financial differential does not exist. We use a difference-in-difference estimator, using Scotland as a control, to test whether the change in reimbursement across the two countries had an influence on treatment. Our results indicate that financial incentives are directly linked to the faster uptake of the more expensive, uncemented Hip Replacement in England, which ran against the clinical guidance.
Volstad, Nicola J.; Schaefer, Susan L.; Snyder, Laura A.; Meinen, Jeffrey B.; Sample, Susannah J.
Summary Case description A 10-year-old female Belgian Teruven dog was presented to our clinic for total hip revision following a diagnosis of implant (cup) failure with metallosis and abdominal pseudotumour formation. The patient had a cementless metal-on-polyethylene total hip replacement performed nine years prior to presentation. Clinical findings The clinical findings, including pseudotumour formation locally and at sites distant from the implant and pain associated with the joint replacement, were similar to those described in human patients with this condition. Histopathological, surgical, and radiographic findings additionally supported the diagnosis of metallosis and pseudotumour formation. Treatment and outcome Distant site pseudo tumours were surgically removed and the total hip replacement was explanted due to poor bone quality. The patient recovered uneventfully and has since resumed normal activity. Conclusion In veterinary patients with metal-on-polyethylene total hip implants, cup failure leading to metallosis and pseudotumour formation should be considered as a potential cause of ipsilateral hindlimb lameness, intra-pelvic abdominal tumours, or a combination of both. These clinical findings may occur years after total hip replacement surgery. PMID:27189390
Viceconti, M; Lattanzi, R; Antonietti, B; Paderni, S; Olmi, R; Sudanese, A; Toni, A
The present study is aimed to compare accuracy and the repeatability in planning total hip replacements with the conventional templates on radiographs to that attainable on the same clinical cases when using CT-based planning software. The sizes of the cementless components planned with new computer aided preoperative planning system called Hip-Op and with standard templates were compared to those effectively implanted. The study group intentionally included only difficult clinical cases. The most common aetiology was congenital dysplasia of hip (65.6%). The Hip-Op planning system allowed the surgeons to obtain a preoperative planning more accurate than with templates, especially for the socket. Assuming correct a size planned one calliper above or below that implanted the accuracy increased from 83% for the stem and 69% for the socket when using templates to 86% for the stem and 93% for the socket when using the Hip-Op system. The repeatability of the Hip-Op system was found comparable to that of the template procedure, which is much more familiar to the surgeons. Furthermore, the repeatability of the preoperative planning with the Hip-Op system was consistent between surgeons, independently from their major or minor experience. The study clearly shows the advantages of a three-dimensional computer-based preoperative planning over the traditional template planning, especially when deformed anatomies are involved. The surgical planning performed with the Hip-Op system is accurate and repeatable, especially for the socket and for less experienced surgeons.
Van Den Eeden, Yannick N T; De Turck, Bruno J G; Van Den Eeden, Frank M C
Background and purpose — The length of stay after total hip arthroplasty has been reduced to 2–4 days after implementing fast-track surgery. We investigated whether a new time-based patient-centered primary direct anterior approach (DAA) total hip arthroplasty (THA) treatment protocol in a specialized clinic, with a planned length of stay of about 24 hours, could be achieved in all patients or only in a selected group of patients. Patients and methods — We analyzed prospectively collected data in a cohort of 378 consecutive patients who underwent a primary direct anterior THA as a patient-centered time-based procedure between March 1, 2012 and December 31, 2015. Patients with complicated medical comorbidity and those over the age of 85 were excluded from the study. The average length of stay was recorded and all complications, re-admissions, and reoperations were registered and analyzed. The primary outcome measures were length of stay and complication rate, at discharge and 90 days postoperatively. Results — The average length of stay for all patients was 26 hours. All patients were discharged from the clinic on the day after the operation and were able to continue their recovery at home or in a rehabilitation facility. The overall complication rate within 3 months of surgery was 6%. The 3-month re-admission rate and the 3-month reoperation rate were both 2%. Interpretation — Performing a time-based, patient-centered fast-track program for DAA total hip arthroplasty can result in a standardized length of stay of about 24 hours and a high level of patient satisfaction with few complications, re-admissions, and reoperations. PMID:27658640
Van Den Eeden, Yannick N T; De Turck, Bruno J G; Van Den Eeden, Frank M C
Background and purpose - The length of stay after total hip arthroplasty has been reduced to 2-4 days after implementing fast-track surgery. We investigated whether a new time-based patient-centered primary direct anterior approach (DAA) total hip arthroplasty (THA) treatment protocol in a specialized clinic, with a planned length of stay of about 24 hours, could be achieved in all patients or only in a selected group of patients. Patients and methods - We analyzed prospectively collected data in a cohort of 378 consecutive patients who underwent a primary direct anterior THA as a patient-centered time-based procedure between March 1, 2012 and December 31, 2015. Patients with complicated medical comorbidity and those over the age of 85 were excluded from the study. The average length of stay was recorded and all complications, re-admissions, and reoperations were registered and analyzed. The primary outcome measures were length of stay and complication rate, at discharge and 90 days postoperatively. Results - The average length of stay for all patients was 26 hours. All patients were discharged from the clinic on the day after the operation and were able to continue their recovery at home or in a rehabilitation facility. The overall complication rate within 3 months of surgery was 6%. The 3-month re-admission rate and the 3-month reoperation rate were both 2%. Interpretation - Performing a time-based, patient-centered fast-track program for DAA total hip arthroplasty can result in a standardized length of stay of about 24 hours and a high level of patient satisfaction with few complications, re-admissions, and reoperations.
Jones, W. R., Jr.; Roberts, J. C.; Ling, F. F.
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.
Rastogi, Amita; Mohr, Beth A; Williams, Jeffery O; Soobader, Mah-Jabeen; de Brantes, Francois
The Prometheus Payment Model offers a potential solution to the failings of the current fee-for-service system and various forms of capitation. At the core of the Prometheus model are evidence-informed case rates (ECRs), which include a bundle of typical services that are informed by evidence and/or expert opinion as well as empirical data analysis, payment based on the severity of patients, and allowances for potentially avoidable complications (PACs) and other provider-specific variations in payer costs. We outline the methods and findings of the hip and knee arthroplasty ECRs with an emphasis on PACs. Of the 2076 commercially insured patients undergoing hip arthroplasty in our study, PAC costs totaled $7.8 million (14% of total costs; n = 699 index PAC stays). Similarly, PAC costs were $12.7 million (14% of total costs; n = 897 index PAC stays) for 3403 patients undergoing knee arthroplasty. By holding the providers clinically and financially responsible for PACs, and by segmenting and quantifying the type of PACs generated during and after the procedure, the Prometheus model creates an opportunity for providers to focus on the reduction of PACs, including readmissions, making the data actionable and turn the waste related to PAC costs into potential savings.
Tokarski, A T; Novack, T A; Parvizi, J
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.
Brown, Thomas D.; Callaghan, John J.
The occurrence of total hip impingement, whether or not accompanied by frank dislocation, holds substantial untoward clinical consequences, especially as less-forgiving advanced bearing implant designs come into ever more widespread use. Biomechanical aspects of impingement and dislocation have historically received relatively little scientific attention, although that situation is now rapidly changing. The present article reviews contemporary laboratory and clinical research on the impingement/dislocation phenomena, focusing particularly on how implant design variables, surgical implantation factors and patient activity each act individually and in concert to pose impingement and dislocation challenges. In recent years, several powerful new research methodologies have emerged that have greatly expanded the scope for clinical translation of systematic laboratory study. Transferring the findings from such research into yet better implant designs, and even better surgical procedures, offers encouragement that the clinical impact of this troublesome complication can be further reduced. PMID:19956356
Oonishi, H; Wakitani, S; Murata, N; Saito, M; Imoto, K; Kim, S; Matsuura, M
As part of a search for better articulation in total hip prostheses, the decrease in the thickness of the socket in different total hip prostheses was measured in vivo. The wear rates of (1) RCH 1000 (molecular weight, 10(6)) socket gamma-irradiated with 100 Mrad articulating with a crude COP (stainless steel containing 20% cobalt and 0.01% phosphorous) metal femoral head; (2) RCH 1000 socket nonirradiated articulating with a crude COP femoral head; (3) RCH 1000 socket irradiated with 100 Mrad articulating with an alumina femoral head; (4) ultra high molecular weight polyethylene (molecular weight, 5-6 x 10(6)) socket articulating with an alumina femoral head; and (5) ultrahigh molecular weight polyethylene socket articulating with a stainless steel femoral head (T-28) were 0.06, 0.30, 0.06, 0.1 and 0.25 mm/year, respectively, in the authors' clinical cases. Alumina femoral heads were effective in decreasing wear of the polyethylene socket. However, the wear rates of gamma-irradiated sockets articulating with alumina and with metal femoral heads wear very low and were not different from each other. Regarding the relationship between wear rate and the thickness of the ultra high molecular weight polyethylene socket articulating with a 28 mm alumina femoral head, on radiographs, average wear rates of socket thicknesses of 7, 8, 9, 10 and 11 mm were 0.14, 0.15, 0.12, 0.06, and 0.08 mm/year, respectively. On measuring retrieved prostheses, average wear rates of 7, 8, 9 and 11 mm thickness sockets were 0.2, 0.19, 0.14, and 0.1 mm/year, respectively. The wear of sockets has been proven to be minimal in alumina femoral heads articulating with ultrahigh molecular weight polyethylene sockets thicker than 10 mm.
Nguyen, Manny; Sukeik, Mohamed; Zahar, Akos; Nizam, Ikram; Haddad, Fares Sami
Background: Periprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery. In an aging population of the developed world, the increasing numbers of hip and knee replacements will inevitably lead to increasing incidence of PJI, carrying with (it) significant patient morbidity and cost to the health care system. Two-stage exchange arthroplasty is currently the gold standard but it is associated with multiple operations, prolonged hospitalization and impaired functionality. One-stage exchange arthroplasty is similar to the two-stage procedure but the interval between removal of the prosthesis and reimplantation of a new one is only a few minutes. It has the theoretical benefits of a single anesthetic, shorter hospitalization, less cost and improved function. Methods: We reviewed the current literature regarding the outcomes of one-stage exchange arthroplasties focusing on re-infection rates and functional outcomes. Results: Current themes around the one-stage exchange procedure include the indications for the procedure, definition of re-infection, surgical techniques used to provide fixation and differences in approach for hip and knee replacements. Conclusion: The current literature on one-stage exchange procedure is promising, with comparable results to two-stage revisions for hips and knees in selected patients. However, there is a great need for a large multi-centred randomized control trial, focusing on re-infection rates and functional scores postoperatively, to provide concrete guidelines in managing this complex condition. PMID:28144374
Sylvester, J.E.; Greenberg, P.; Selch, M.T.; Thomas, B.J.; Amstutz, H.
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.
Rittmeister, M; König, D P; Eysel, P; Kerschbaumer, F
The manuscript features the different minimally invasive approaches to the hip for joint replacement. These include medial, anterior, anterolateral, and posterior approaches. The concept of minimally invasive hip arthroplasty makes sense if it is an integral part of a larger concept to lower postoperative morbidity. Besides minimal soft tissue trauma, this concept involves preoperative patient education, preemptive analgesia, and postoperative physiotherapy. It is our belief that minimal incision techniques for the hip are not suited for all patients and all surgeons. The different minimally invasive approaches to the knee joint for implantation of a knee arthroplasty are described and discussed. There have been no studies published yet that fulfill EBM criteria. The data so far show that minimally invasive approaches and implantation techniques for total knee replacements lead to quicker rehabilitation of patients.
King, Garry; Hunt, Linda P; Wilkinson, J Mark; Blom, Ashley W
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
Buttaro, M; González Della Valle, A; Piccaluga, F
A 65-year-old man with a left uncemented total hip arthroplasty performed 11 years previously was admitted with a history of progressive low back pain, left hip pain, and sepsis that had begun 6 months earlier. On physical examination, a gross, fluctuant mass was palpated in the left thigh. A computed tomography (CT) scan revealed a 6.5 x 3 cm left retrofascial psoas abscess communicating with the hip joint. The patient underwent irrigation and débridement of the hip with removal of the components. The psoas abscess was drained through the iliopsoas bursa. A residual psoas abscess was drained percutaneously under CT guidance. Cultures isolated Escherichia coli, and the patient responded to 6 months of ciprofloxacin therapy. After 1 year, the patient had no evidence of infection. Pathways of infection spread, diagnosis, and treatment of a patient with this rare association are discussed with a review of the literature.
Peltola, Mikko; Malmivaara, Antti; Paavola, Mika; Seitsalo, Seppo
Background and purpose — The effects of launch or closure of an entire arthroplasty unit on the first or last patients treated in these units have not been studied. Using a 3-year follow-up, we investigated whether patients who were treated at the launch or closure stage of an arthroplasty unit of a hospital would have a higher risk of reoperation than patients treated in-between at the same units. Patients and methods — From the Finnish Arthroplasty Register, we identified all the units that had performed total joint arthroplasty and the units that were launched or closed in Finland between 1998 and 2011. The risks of reoperation within 3 years for the 41,748 total hip and knee replacements performed due to osteoarthritis in these units were modeled with Cox proportional-hazards regression, separately for hip and knee and for the launch and the closure stage. Results — The unadjusted and adjusted hazard ratios (HRs) for total hip and knee replacements performed in the initial stage of activity of the units that were launched were similar to the reoperation risks in patients who were operated in these units after the early stage of activity. The unadjusted and risk-adjusted HRs for early reoperation after total hip replacement (THR) were increased at the closure stage (adjusted HR = 1.8, 95% CI: 1.2–2.8). The reoperation risk at the closure stage after total knee replacement (TKR) was not increased. Interpretation — The results indicate that closure of units performing total hip replacements poses an increased risk of reoperation. Closures need to be managed carefully to prevent the quality from deteriorating when performing the final arthroplasties. PMID:26541178
Moreschini, O; Braidotti, P
The authors describe breakage of the 32 mm alumina AL2 O3 ceramic head in 3 cases of total hip replacement using two different models of prosthesis (Charnley-Müller and Mittelmeier). All three patients were of average height, weight, and activity (Brown et al., 1985; Callaghan et al., 1988), and the breakage had been caused by an accidental fall. The same mechanism of injury, in people the same age as our subjects, can cause femoral neck fractures. Reoperation was necessary in order to replace the component. The implants all appeared to be positioned correctly, and the patients had reported no symptoms. Before the trauma that caused breakage, there had been no other injuries worth noting. All patients were satisfied with their hip replacements.
Pelayo-de Tomás, J M; Novoa-Parra, C; Gómez-Barbero, P
Symptomatic cobalt toxicity from a failed total hip replacement is a rare, but devastating complication. Potential clinical findings include cardiomyopathy, hypothyroidism, skin rash, visual and hearing impairment, polycythaemia, weakness, fatigue, cognitive impairment, and neuropathy. The case is presented of a 74year-old man in whom, after a ceramic-ceramic replacement and two episodes of prosthetic dislocation, it was decided to replace it with a polyethylene-metal total hip arthroplasty (THA). At 6months after the revision he developed symptoms of cobalt toxicity, confirmed by analytical determination (serum cobalt level=651.2μg/L). After removal of the prosthesis, the levels of chromium and cobalt in blood and urine returned to normal, with the patient currently being asymptomatic. It is recommended to use a new ceramic on ceramic bearing at revision, in order to minimise the risk of wear-related cobalt toxicity following breakage of ceramic components.
Li, Jia; Zheng, Wei; Zhao, Jinzhu; Liu, Denghui; Xu, Weidong
Background: Patients with Parkinson's disease and poliomyelitis can have a femoral neck fracture; yet, the optimal methods of treatment for these hips remains controversial. Many constrained or semi-constrained prostheses, using constrained liners (CLs) with a locking mechanism to capture the femoral head, were used to treat femoral neck fractures in patients with neurological disorders. We retrospectively studied a group of patients with Parkinson's disease and poliomyelitis who sustained femoral neck fractures and were treated by total hip arthroplasty using an L-MoM prosthesis. Materials and Methods: We retrospectively reviewed 12 hips in 12 patients who underwent large-diameter metal-on-metal (L-MoM) total hip replacement between May 2007 and October 2009. Eight of the 12 patients (8 hips; 66.7%) had Parkinson's disease and 4 patients (4 hips; 33.3%) were affected with poliomyelitis. Results: The followup time was 5.2 years (range 3.6-6.0 years). At the latest followup, all the patients showed satisfactory clinical and radiographic results, with pain relief. No complications, such as dislocation or aseptic loosening occurred. Conclusion: We believe the use of L-MoM can diminish the rate of instability or dislocation, after operation. The L-MoM is an option for patients with Parkinson's disease and poliomyelitis with femoral neck fracture. PMID:25404774
Cech, O; Beznoska, S; Krbec, M
The authors present cementless endoprothesis of the hip joint from the new series of hybrid endoprothesis of the hip joint being developed. The endoprothesis has a conic shaft allowing - with a precise reaming of the medullary canal by means of pneumatic reamer - good primary stability which provides the prerequisites for the remodellation of the bone bed. Endoprothesis is produced from the titanium alloy Ti-5 AI-2,5 Fe. The replacement is indicated for biologically young patients with a solid skeleton. Key words: hybrid endoprothesis, titanium alloy Ti-5 AI-2,5 Fe, cementless endoprothesis.
An English setter (case 1) and a Tibetan mastiff (case 2) presented with intermittent weight-bearing lameness on the right hind limb when trotting. The dogs had a history of femoral head and neck ostectomy (FHNO). Orthopedic examination revealed pain and crepitus on the right hip joint. The dogs underwent total hip replacement (THR). At the 2-year (case 1) and 1-year (case 2) follow-up, both dogs had resumed normal activity without lameness. The muscle mass and range of motion were significantly improved in the affected hind limb. In conclusion, FHNO with poor functional outcomes can be successfully ameliorated with THR. PMID:25269715
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
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
Tsertsvadze, Alexander; Grove, Amy; Freeman, Karoline; Court, Rachel; Johnson, Samantha; Connock, Martin; Clarke, Aileen; Sutcliffe, Paul
Background Evolvements in the design, fixation methods, size, and bearing surface of implants for total hip replacement (THR) have led to a variety of options for healthcare professionals to consider. The need to determine the most optimal combinations of THR implant is warranted. This systematic review evaluated the clinical effectiveness of different types of THR used for the treatment of end stage arthritis of the hip. Methods A comprehensive literature search was undertaken in major health databases. Randomised controlled trials (RCTs) and systematic reviews published from 2008 onwards comparing different types of primary THR in patients with end stage arthritis of the hip were included. Results Fourteen RCTs and five systematic reviews were included. Patients experienced significant post-THR improvements in Harris Hip scores, but this did not differ between impact types. There was a reduced risk of implant dislocation after receiving a larger femoral head size (36 mm vs. 28 mm; RR = 0.17, 95% CI: 0.04, 0.78) or cemented cup (vs. cementless cup; pooled odds ratio: 0.34, 95% CI: 0.13, 0.89). Recipients of cross-linked vs. conventional polyethylene cup liners experienced reduced femoral head penetration and revision. There was no impact of femoral stem fixation and cup shell design on implant survival rates. Evidence on mortality and complications (aseptic loosening, femoral fracture) was inconclusive. Conclusions The majority of evidence was inconclusive due to poor reporting, missing data, or uncertainty in treatment estimates. The findings warrant cautious interpretation given the risk of bias (blinding, attrition), methodological limitations (small sample size, low event counts, short follow-up), and poor reporting. Long-term pragmatic RCTs are needed to allow for more definitive conclusions. Authors are encouraged to specify the minimal clinically important difference and power calculation for their primary outcome(s) as well CONSORT, PRISMA and STROBE
Jämsen, Esa; Nevalainen, Pasi I; Eskelinen, Antti; Kalliovalkama, Jarkko; Moilanen, Teemu
Background and purpose Background and purpose — Perioperative hyperglycemia has been associated with adverse outcomes in several fields of surgery. In this observational study, we identified factors associated with an increased risk of hyperglycemia following hip and knee replacement. Patients and methods Patients and methods — We prospectively monitored changes in glucose following primary hip and knee replacements in 191 patients with osteoarthritis. Possible associations of patient characteristics and operation-related factors with hyperglycemia (defined as glucose > 7.8 mmol/L in 2 consecutive measurements) and severe hyperglycemia (glucose > 10 mmol/L) were analyzed using binary logistic regression with adjustment for age, sex, operated joint, and anesthesiological risk score. Results Results — 76 patients (40%) developed hyperglycemia, and 48 of them (25% of the whole cohort) had severe hyperglycemia. Glycemic responses were similar following hip replacement and knee replacement. Previously diagnosed diabetes was associated with an increased risk of hyperglycemia and severe hyperglycemia, compared to patients with normal glucose metabolism, whereas newly diagnosed diabetes and milder glucose metabolism disorders had no effect. In patients without previously diagnosed diabetes, increased values of preoperative glycosylated hemoglobin (HbA1c) and fasting glucose on the day of operation were associated with hyperglycemia. Higher anesthesiological risk score—but none of the operation-related factors analyzed—was associated with an increased risk of hyperglycemia. Interpretation Interpretation — Perioperative hyperglycemia is common in primary hip and knee replacements. Previously diagnosed diabetes is the strongest risk factor for hyperglycemia. In patients with no history of diabetes, preoperative HbA1c and fasting glucose on the day of operation can be used to stratify the risk of hyperglycemia. PMID:25409255
Früh, H J; Willmann, G
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.
Phedy, Phedy; Ismail, H Dilogo; Hoo, Charles; Djaja, Yoshi P
AIM To determine whether cemented, cementless, or hybrid implant was superior to the other in terms of survival rate. METHODS Systematic searches across MEDLINE, CINAHL, and Cochrane that compared cemented, cementless and hybrid total hip replacement (THR) were performed. Two independent reviewers evaluated the risk ratios of revision due to any cause, aseptic loosening, infection, and dislocation rate of each implants with a pre-determined form. The risk ratios were pooled separately for clinical trials, cohorts and registers before pooled altogether using fixed-effect model. Meta-regressions were performed to identify the source of heterogeneity. Funnel plots were analyzed. RESULTS Twenty-seven studies comprising 5 clinical trials, 9 cohorts, and 13 registers fulfilled the research criteria and analyzed. Compared to cementless THR, cemented THR have pooled RR of 0.47 (95%CI: 0.45-0.48), 0.9 (0.84-0.95), 1.29 (1.06-1.57) and 0.69 (0.6-0.79) for revision due to any reason, revision due to aseptic loosening, revision due to infection, and dislocation respectively. Compared to hybrid THR, the pooled RRs of cemented THR were 0.82 (0.76-0.89), 2.65 (1.14-6.17), 0.98 (0.7-1.38), and 0.67 (0.57-0.79) respectively. Compared to hybrid THR, cementless THR had RRs of 0.7 (0.65-0.75), 0.85 (0.49-1.5), 1.47 (0.93-2.34) and 1.13 (0.98-1.3). CONCLUSION Despite the limitations in this study, there was some tendency that cemented fixation was still superior than other types of fixation in terms of implant survival. PMID:28251071
Meinardi, Joris E; Valstar, Edward R; Van Der Voort, Paul; Kaptein, Bart L; Fiocco, Marta; Nelissen, Rob G H H
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
Gascoyne, Trevor C; Dyrkacz, Richard M; Turgeon, Thomas R; Burnell, Colin D; Wyss, Urs P; Brandt, Jan-M
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.
Hua, Xijin; Li, Junyan; Wang, Ling; Jin, Zhongmin; Wilcox, Ruth; Fisher, John
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.
Pidoux, O.; Argenson, J.-N.; Jacomo, V.; Drancourt, M.
Dietzia maris, an environmental actinomycete, has been implicated only once in human disease. We herein report the first D. maris isolate from a bone biopsy specimen in a patient hospitalized for a total hip prosthesis replacement. Cell wall fatty acid analysis and 16S ribosomal DNA gene sequencing were utilized to achieve its definite identification. This case report illustrates the usefulness of such methods for the accurate identification of actinomycetes. PMID:11427581
Vesterby, Martin Svoldgaard; Pedersen, Preben Ulrich; Laursen, Malene; Mikkelsen, Søren; Larsen, Jens; Søballe, Kjeld; Jørgensen, Lene Bastrup
Background and purpose - Telemedicine could allow patients to be discharged more quickly after surgery and contribute to improve fast-track procedures without compromising quality, patient safety, functionality, anxiety, or other patient-perceived parameters. We investigated whether using telemedicine support (TMS) would permit hospital discharge after 1 day without loss of self-assessed quality of life, loss of functionality, increased anxiety, increased rates of re-admission, or increased rates of complications after hip replacement. Patients and methods - We performed a randomized controlled trial involving 72 Danish patients in 1 region who were referred for elective fast-track total hip replacement between August 2009 and March 2011 (654 were screened for eligibility). Half of the patients received a telemedicine solution connected to their TV. The patients were followed until 1 year after surgery. Results - Length of stay was reduced from 2.1 days (95% CI: 2.0-2.3) to 1.1 day (CI: 0.9-1.4; p < 0.001) with the TMS intervention. Health-related quality of life increased in both groups, but there were no statistically significant differences between groups. There were also no statistically significant differences between groups regarding timed up-and-go test and Oxford hip score at 3-month follow-up. At 12-month follow-up, the rates of complications and re-admissions were similar between the groups, but the number of postoperative hospital contacts was lower in the TMS group. Interpretation - Length of postoperative stay was shortened in patients with the TMS solution, without compromising patient-perceived or clinical parameters in patients undergoing elective fast-track surgery. These results indicate that telemedicine can be of value in fast-track treatment of patients undergoing total hip replacement.
Su, Shaojie; Zhou, Yixin; Wang, Zhihua; Chen, Hong
The average age of population increases worldwide, so does the number of total hip replacement surgeries. Total hip replacement, however, often involves a risk of dislocation and prosthetic impingement. To minimize the risk after surgery, we propose an instrumented hip prosthesis that estimates the relative pose between prostheses intraoperatively and ensures the placement of prostheses within a safe zone. We create a model of the hip prosthesis as a ball and socket joint, which has four degrees of freedom (DOFs), including 3-DOF rotation and 1-DOF translation. We mount a camera and an inertial measurement unit (IMU) inside the hollow ball, or "femoral head prosthesis," while printing customized patterns on the internal surface of the socket, or "acetabular cup." Since the sensors were rigidly fixed to the femoral head prosthesis, measuring its motions poses a sensor ego-motion estimation problem. By matching feature points in images of the reference patterns, we propose a monocular vision based method with a relative error of less than 7% in the 3-DOF rotation and 8% in the 1-DOF translation. Further, to reduce system power consumption, we apply the IMU with its data fused by an extended Kalman filter to replace the camera in the 3-DOF rotation estimation, which yields a less than 4.8% relative error and a 21.6% decrease in power consumption. Experimental results show that the best approach to prosthesis pose estimation is a combination of monocular vision-based translation estimation and IMU-based rotation estimation, and we have verified the feasibility and validity of this system in prosthesis pose estimation.
Vesterby, Martin Svoldgaard; Pedersen, Preben Ulrich; Laursen, Malene; Mikkelsen, Søren; Larsen, Jens; Søballe, Kjeld; Jørgensen, Lene Bastrup
Background and purpose — Telemedicine could allow patients to be discharged more quickly after surgery and contribute to improve fast-track procedures without compromising quality, patient safety, functionality, anxiety, or other patient-perceived parameters. We investigated whether using telemedicine support (TMS) would permit hospital discharge after 1 day without loss of self-assessed quality of life, loss of functionality, increased anxiety, increased rates of re-admission, or increased rates of complications after hip replacement. Patients and methods — We performed a randomized controlled trial involving 72 Danish patients in 1 region who were referred for elective fast-track total hip replacement between August 2009 and March 2011 (654 were screened for eligibility). Half of the patients received a telemedicine solution connected to their TV. The patients were followed until 1 year after surgery. Results — Length of stay was reduced from 2.1 days (95% CI: 2.0–2.3) to 1.1 day (CI: 0.9–1.4; p < 0.001) with the TMS intervention. Health-related quality of life increased in both groups, but there were no statistically significant differences between groups. There were also no statistically significant differences between groups regarding timed up-and-go test and Oxford hip score at 3-month follow-up. At 12-month follow-up, the rates of complications and re-admissions were similar between the groups, but the number of postoperative hospital contacts was lower in the TMS group. Interpretation — Length of postoperative stay was shortened in patients with the TMS solution, without compromising patient-perceived or clinical parameters in patients undergoing elective fast-track surgery. These results indicate that telemedicine can be of value in fast-track treatment of patients undergoing total hip replacement. PMID:28097941
Oshima, Yasushi; Fetto, Joseph F
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.
Tsukanaka, Masako; Halvorsen, Vera; Nordsletten, Lars; EngesæTer, Ingvild Ø; EngesæTer, Lars B; Marie Fenstad, Anne; Röhrl, Stephan M
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
Budenberg, Sarah; Redmond, Anthony; White, Derek; Grainger, Andrew; O'Connor, Philip; Stone, Martin H; Stewart, Todd D
In the past, there has been little research into leg length inequality (LLI) and its effect on hip arthroplasty bearing longevity. This investigation aimed to determine the effects of post-operative LLI on hip motions during gait and to postulate the subsequent influence on the wear of the artificial hip joint replacement. Motion data from a clinical gait analysis were processed with an in-house computational model to plot graphs showing the movement of loci of 20 points on the femoral head during one gait cycle for two cohorts: 19 LLI patients and 38 normal healthy patients. Loci paths were quantified by calculating the aspect ratio (AR) of the path shape. It was found that on average, LLI patients had a reduction in flexion/extension and abduction/adduction. Furthermore, the AR of LLI patients was found to be 8% smaller than the normal group. The shorter, more multidirectional, motion paths in LLI patients would suggest the potential for greater wear in a polyethylene bearing compared to an asymptomatic, non-LLI patient. The results have potential implications towards preclinical wear testing of joint replacements.
Whitcomb, Winthrop F.; Lagu, Tara; Krushell, Robert J.; Lehman, Andrew P.; Greenbaum, Jordan; McGirr, Joan; Pekow, Penelope S.; Calcasola, Stephanie; Benjamin, Evan; Mayforth, Janice; Lindenauer, Peter K.
Background Bundled payments, also known as episode-based payments, are intended to contain health care costs and promote quality. In 2011 a bundled payment pilot program for total hip replacement was implemented by an integrated health care delivery system in conjunction with a commercial health plan subsidiary. In July 2015 the Centers for Medicare & Medicaid Services (CMS) proposed the Comprehensive Care for Joint Replacement Model to test bundled payment for hip and knee replacement. Methods Stakeholders were identified and a structure for program development and implementation was created. An Oversight Committee provided governance over a Clinical Model Subgroup and a Financial Model Subgroup. Results The pilot program included (1) a clinical model of care encompassing the period from the preoperative evaluation through the third postoperative visit, (2) a pricing model, (3) a program to share savings, and (4) a patient engagement and expectation strategy. Compared to 32 historical controls— patients treated before bundle implementation—45 post-bundle-implementation patients with total hip replacement had a similar length of hospital stay (3.0 versus 3.4 days, p = .24), higher rates of discharge to home or home with services than to a rehabilitation facility (87% versus 63%), similar adjusted median total payments ($22,272 versus $22,567, p = .43), and lower median posthospital payments ($704 versus $1,121, p = .002), and were more likely to receive guideline-consistent care (99% versus 95%, p = .05). Discussion The bundled payment pilot program was associated with similar total costs, decreased posthospital costs, fewer discharges to rehabilitation facilities, and improved quality. Successful implementation of the program hinged on buy-in from stakeholders and close collaboration between stakeholders and the clinical and financial teams. PMID:26289235
Cordero-Ampuero, José; Esteban, Jaime; García-Cimbrelo, Eduardo
Infected arthroplasties reportedly have a lower eradication rate when caused by highly resistant and/or polymicrobial isolates and in these patients most authors recommend intravenous antibiotics. We asked whether two-stage revision with interim oral antibiotics could eradicate these infections. We prospectively followed 36 patients (mean age, 71.8 years) with late hip arthroplasty infections. Combinations of oral antibiotics were prescribed according to cultures, biofilm, and intracellular effectiveness. The minimum followup was 1 year (mean, 4.4 years; range, 1-12 years). We presumed eradication in the absence of clinical, serologic, and radiographic signs of infection. Infection was eradicated in all 13 patients with highly resistant bacteria who completed a two-stage protocol (10 with methicillin-resistant Staphylococci) and in eight of 11 patients treated with only the first stage (and six of nine with methicillin-resistant Staphylococci). Infection was eradicated in six of six patients with polymicrobial isolates (of sensitive and/or resistant bacteria) who completed a two-stage protocol and in five of seven with polymicrobial isolates treated with only the first surgery. The Harris hip score averaged 88.1 (range, 70-98) in patients who underwent reimplantation and 56.8 (range, 32-76) in patients who underwent resection arthroplasty. Long cycles of combined oral antibiotics plus a two-stage surgical exchange appear a promising alternative for infections by highly resistant bacteria, methicillin-resistant Staphylococci, and polymicrobial infections.
Brown, N M; Hellman, M; Haughom, B H; Shah, R P; Sporer, S M; Paprosky, W G
A pelvic discontinuity occurs when the superior and inferior parts of the hemi-pelvis are no longer connected, which is difficult to manage when associated with a failed total hip replacement. Chronic pelvic discontinuity is found in 0.9% to 2.1% of hip revision cases with risk factors including severe pelvic bone loss, female gender, prior pelvic radiation and rheumatoid arthritis. Common treatment options include: pelvic plating with allograft, cage reconstruction, custom triflange implants, and porous tantalum implants with modular augments. The optimal technique is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable healing between the two segments. A method of treating pelvic discontinuity using porous tantalum components with a distraction technique that achieves both initial stability and subsequent long-term biological fixation is described.
Tennent, T D; Goddard, N J
A postal questionnaire was sent to all practicing consultant orthopaedic surgeons in the UK seeking information regarding their usual total hip replacement practice, the age at which they would define a patient as falling into the 'young hip group' and whether this might modify their practice. In particular, in the 'younger' age group, we were interested in the frequency of usage of uncemented implants, the choice of implant and the bearing surfaces. Of 1242 surgeons surveyed, we had a response from 935 who currently undertake total hip arthroplasty. Their responses confirm that approximately 60,645 total hip replacements are performed annually in the UK of which 9,376 are performed in the younger age group (mean age 57.5 years). As with our previous survey, the most popular prosthesis in the 'older' age group overall was the Charnley (51%) followed by the Exeter (15%). These implants also proved to be the most popular in the 'younger' age group (40% Charnley, 18% Exeter), with 75% of surgeons choosing a cemented stem, and 65% also opting to cement the socket. 23% of surgeons used hydroxy-apatite coated implants on both the femoral and acetabular sides of the joint. Stainless steel remained the most popular choice of femoral head bearing surface (42%) followed by chrome-cobalt (33%) and ceramic (25%). On the acetabular side, high density polyethylene predominated--accounting for 95%, with only 3% using chrome cobalt and 2% ceramic. There would appear to be a remarkably conservative attitude among British surgeons, the majority of whom prefer to stick with tried and tested cemented femoral implants when dealing with the younger patient. There are a small number of uncemented acetabulae and the hybrid configuration. Hydroxy-apatite coatings seem to be the most popular choice for the non-cemented prostheses. Ceramic femoral heads are used more frequently than the ceramic acetabular bearing, and equally metal/metal bearings remain infrequently used.
Cip, Johannes; Bach, Christian; Widemschek, Mark; Luegmair, Matthias; Martin, Arno
The articular surface replacement (ASR) total hip arthroplasty (THA) showed accelerated failure rates due to adverse-reaction to metal debris (ARMD). Literature correlating preoperative with intraoperative revision findings respectively post-revision outcome results are rare. 30 of 99 available ASR THA were revised due to ARMD. Mean post-revision follow-up term was 2.3 years. In part, preoperative data did not correlate with intraoperative revision findings. ARMD was even found in asymptomatic patients with non-elevated ion levels. Postoperative pain and metal ions decreased significantly (P ≤ 0.016). Cobalt decreased faster than chrome. Patients with intraoperative pseudotumors, osteolysis or bilateral THA did not have higher pre- or postoperative ion values (P ≥ 0.053). Females showed higher postoperative chrome levels (P=0.031). One major post-revision complication (femoral nerve palsy) and one re-revision (late onset infection) occurred.
Madanat, Rami; Hussey, Daniel K; Donahue, Gabrielle S; Potter, Hollis G; Wallace, Robert; Bragdon, Charles R; Muratoglu, Orhun K; Malchau, Henrik
The purpose of this study was to evaluate whether patients with bilateral metal-on-metal (MoM) hip replacements have symmetric adverse local tissue reactions (ALTRs) at follow-up. An MRI of both hips was performed at a mean time of six years after surgery in 43 patients. The prevalence and severity of ALTRs were found to be similar in simultaneous hips but differences were observed in sequential hips. The order and timing of sequential hip arthroplasties did not affect the severity of ALTRs. Thus, in addition to metal ion exposure from an earlier MoM implant other factors may also play a role in the progression of ALTRs. Bilateral implants should be given special consideration in risk stratification algorithms for management of patients with MoM hip arthroplasty.
Wylde, Vikki; Sayers, Adrian; Lenguerrand, Erik; Gooberman-Hill, Rachael; Pyke, Mark; Beswick, Andrew D.; Dieppe, Paul; Blom, Ashley W.
Abstract Chronic pain after joint replacement is common, affecting approximately 10% of patients after total hip replacement (THR) and 20% of patients after total knee replacement (TKR). Heightened generalized sensitivity to nociceptive input could be a risk factor for the development of this pain. The primary aim of this study was to investigate whether preoperative widespread pain sensitivity was associated with chronic pain after joint replacement. Data were analyzed from 254 patients receiving THR and 239 patients receiving TKR. Pain was assessed preoperatively and at 12 months after surgery using the Western Ontario and McMaster Universities Osteoarthritis Pain Scale. Preoperative widespread pain sensitivity was assessed through measurement of pressure pain thresholds (PPTs) at the forearm using an algometer. Statistical analysis was conducted using linear regression and linear mixed models, and adjustments were made for confounding variables. In both the THR and TKR cohort, lower PPTs (heightened widespread pain sensitivity) were significantly associated with higher preoperative pain severity. Lower PPTs were also significantly associated with higher pain severity at 12 months after surgery in the THR cohort. However, PPTs were not associated with the change in pain severity from preoperative to 12 months postoperative in either the TKR or THR cohort. These findings suggest that although preoperative widespread pressure pain sensitivity is associated with pain severity before and after joint replacement, it is not a predictor of the amount of pain relief that patients gain from joint replacement surgery, independent of preoperative pain severity. PMID:25599300
Finšgar, Matjaž; Uzunalić, Amra Perva; Stergar, Janja; Gradišnik, Lidija; Maver, Uroš
Corrosion resistance, biocompatibility, improved osteointegration, as well the prevention of inflammation and pain are the most desired characteristics of hip replacement implants. In this study we introduce a novel multi-layered coating on AISI 316LVM stainless steel that shows promise with regard to all mentioned characteristics. The coating is prepared from alternating layers of the biocompatible polysaccharide chitosan and the non-steroid anti-inflammatory drug (NSAID), diclofenac. Electrochemical methods were employed to characterize the corrosion behavior of coated and uncoated samples in physiological solution. It is shown that these coatings improve corrosion resistance. It was also found that these coatings release the incorporated drug in controlled, multi-mechanism manner. Adding additional layers on top of the as-prepared samples, has potential for further tailoring of the release profile and increasing the drug dose. Biocompatibility was proven on human-derived osteoblasts in several experiments. Only viable cells were found on the sample surface after incubation of the samples with the same cell line. This novel coating could prove important for prolongation of the application potential of steel-based hip replacements, which are these days often replaced by more expensive ceramic or other metal alloys. PMID:27215333
Finšgar, Matjaž; Uzunalić, Amra Perva; Stergar, Janja; Gradišnik, Lidija; Maver, Uroš
Corrosion resistance, biocompatibility, improved osteointegration, as well the prevention of inflammation and pain are the most desired characteristics of hip replacement implants. In this study we introduce a novel multi-layered coating on AISI 316LVM stainless steel that shows promise with regard to all mentioned characteristics. The coating is prepared from alternating layers of the biocompatible polysaccharide chitosan and the non-steroid anti-inflammatory drug (NSAID), diclofenac. Electrochemical methods were employed to characterize the corrosion behavior of coated and uncoated samples in physiological solution. It is shown that these coatings improve corrosion resistance. It was also found that these coatings release the incorporated drug in controlled, multi-mechanism manner. Adding additional layers on top of the as-prepared samples, has potential for further tailoring of the release profile and increasing the drug dose. Biocompatibility was proven on human-derived osteoblasts in several experiments. Only viable cells were found on the sample surface after incubation of the samples with the same cell line. This novel coating could prove important for prolongation of the application potential of steel-based hip replacements, which are these days often replaced by more expensive ceramic or other metal alloys.
Ma, He; Lai, Bingjie; Dong, Shanshan; Li, Xinyu; Cui, Yunfeng; Sun, Qianchuang; Liu, Wenhua; Jiang, Wei; Xu, Feng; Lv, Hui; Han, Hongyu; Pan, Zhenxiang
Abstract Background: This prospective, randomized, and controlled study was performed to determine the benefits of prewarmed infusion in elderly patients who underwent bilateral hip replacement. Methods: Between September 2015 and April 2016, elderly patients who underwent bilateral hips replacement that met the inclusion and exclusion criteria were included in this study. After inclusion, patients were randomized into one of the study groups: in the control group, patients received an infusion of fluid kept at room temperature (22–23°C); in the warming infusion group, patients received an infusion of fluid warmed using an infusion fluid heating apparatus (35°C). Postoperative outcomes, including recovery time, length of hospital stay, visual analogue scale (VAS) score, and postoperative complications rate of patients from both groups, were compared. Results: A total of 64 patients were included in our study (71.2 ± 7.6 years, 53.1% males), with 32 patients in the control group and 32 patients in warming infusion group. No significant difference was found in terms of demographic data and intraoperative blood transfusion rate between 2 groups (P > 0.05). Patients receiving a prewarmed infusion had a significantly shorter time to spontaneous breath, eye opening, consciousness recovery, and extubation than the control group (P < 0.05). In addition, significant differences were found in Steward score and VAS score between 2 groups (P < 0.05). Moreover, warming infusion group also showed an obviously decreased incidence of shivering and postoperative cognitive dysfunction (P < 0.05). Conclusion: A prewarmed infusion could reduce the incidence of perioperative hypothermia and improve outcomes in the elderly during bilateral hip replacement. PMID:28353593
Johnson, Emma C; Horwood, Jeremy; Gooberman-Hill, Rachael
Interpretations of time underlie patients' experiences of illness and the way in which the National Health Service (NHS) is organised. In the NHS, achieving short waiting times for treatment is seen as important, and this is particularly evident in relation to chronic conditions where the time waiting in care from onset of symptoms to successful management can last months and years. One example of a chronic condition with high prevalence is osteoarthritis, estimated to affect 10% of people aged over 55 years in the UK. Osteoarthritis of the hip is particularly common, and treatments include exercise and medication. If these options do not provide enough relief from pain and functional difficulties, then joint replacement may be considered. With over 70,000 such operations conducted every year in England and Wales, processes relating to waiting times impact on many patients. This article explores how 24 patients with osteoarthritis experience time during the lead up to hip replacement surgery. We draw on data collected during longitudinal in-depth interviews with patients a median of 9.5 days before surgery and at two to four weeks post-operatively. Transcripts of audio-recorded interviews were imported into Atlas.ti(®) and inductive thematic analysis undertaken. Increasing pain and deterioration in function altered the experience of time during the journey towards hip replacement. Patients made essential changes to how they filled their days. They experienced lost and wasted time and faced disruption to the temporal order of their lives. A surgical date marked in the calendar became their focus. However, this date was not static, moving because of changing perceptions of duration and real-time alterations by the healthcare system. Findings highlight that patients' experience of time is complex and multi-dimensional and does not reflect the linear, monochronic conceptualisation of time embedded in the healthcare system.
Chen, Jie; Rizzo, John A; Parasuraman, Shreekant; Gunnarsson, Candace
Using a nationally-representative inpatient care dataset (the HCUP National Inpatient Sample from 2002 to 2007) we examined racial disparities in receiving total hip replacement (THR) and total knee replacement (TKR) surgeries. Multivariable logistic regression models revealed that racial minorities were significantly less likely to receive THR or TKR than Whites, controlling for patients' hospital admission source and hospital characteristics. Employing Blinder-Oaxaca decomposition techniques, we found that observed difference in population characteristics explained 55%-67% and 78% of the racial disparities in THR and TKR, respectively. Differences in patients' hospital admission source emerged as the major individual factor associated with these disparities, explaining 57%-77% of racial disparities in THR and 26%-50% of racial disparities in TKR. This study suggests that substantive racial and ethnic disparities exist in utilization of THR and TKR surgery. Observed population characteristics accounted for most of these differences, with hospital admission source being the key factor.
Jeong, Yeo Won
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
Konttinen, Y.; Li, T.; Michelsson, O.; Xu, J.; Sorsa, T.; Santavirta, S.; Imai, S.; Virtanen, I.
OBJECTIVE—To assess if the bonding interlayer between the implant and bone in aseptic loosening of total hip replacement (THR) is qualitatively deteriorated by excessive accumulation of anti-adhesive glycoprotein, tenascin-C. METHODS—Alkaline phosphatase-anti-alkaline phosphatase (APAAP) method was used for immunohistochemical staining of tenascin-C in interface tissue and control synovial tissue. RESULTS—Tenascin-C was found to be a major component of the extracellular matrix at a hitherto unrecognised site, namely the synovial membrane-like interface tissue between implant and bone in aseptic loosening of THR. The overall tenascin-C staining (median score 4.0) was greatly increased in aseptic loosening compared with synovial membrane (median score 2.0; p<0.001) and fibrous capsule (median score 2.0; p<0.001) from primary THR operations. Topological analysis disclosed that tenascin-C was also found at the critical implant-interface and interface-bone surfaces. CONCLUSION—Local tenascin-C expression is increased as a result of a chronic foreign body type reaction associated with excessive cytokine production and tissue injury mediated by microtrauma and neutral endoproteinases. This qualitative and topological deterioration of the bonding interlayer by an increase of anti-adhesive tenascin-C expression may inadvertantly contribute to loosening. Keywords: tenascin; aseptic loosening; total hip replacement PMID:9893574
McKellop, H; Shen, F W; Lu, B; Campbell, P; Salovey, R
Osteolysis induced by ultra high molecular weight polyethylene wear debris is one of the primary factors limiting the lifespan of total hip replacements. Crosslinking polyethylene is known to improve its wear resistance in certain industrial applications, and crosslinked polyethylene acetabular cups have shown improved wear resistance in two clinical studies. In the present study, crosslinked polyethylene cups were produced by two methods. Chemically crosslinked cups were produced by mixing a peroxide with ultra high molecular weight polyethylene powder and then molding the cups directly to shape. Radiation-crosslinked cups were produced by exposing conventional extruded ultra high molecular weight polyethylene bar stock to gamma radiation at various doses from 3.3 to 100 Mrad (1 Mrad = 10 kGy), remelting the bars to extinguish residual free radicals (i.e., to minimize long-term oxidation), and then machining the cups by conventional techniques. In hip-joint simulator tests lasting as long as 5 million cycles, both types of cross-linked cups exhibited dramatically improved resistance to wear. Artificial aging of the cups by heating for 30 days in air at 80 degrees C induced oxidation of the chemically crosslinked cups. However, a chemically crosslinked cup that was aged 2.7 years at room temperature had very little oxidation. Thus, whether substantial oxidation of chemically crosslinked polyethylene would occur at body temperature remains unclear. The radiation-crosslinked remelted cups exhibited excellent resistance to oxidation. Because crosslinking can reduce the ultimate tensile strength, fatigue strength, and elongation to failure of ultra high molecular weight polyethylene, the optimal crosslinking dose provides a balance between these physical properties and the wear resistance of the implant and might substantially reduce the incidence of wear-induced osteolysis with total hip replacements.
Affatato, S; Spinelli, M; Zavalloni, M; Mazzega-Fabbro, C; Viceconti, M
Interest in the rheology and effects of interacting surfaces is as ancient as man. This subject can be represented by a recently coined word: tribology. This term is derived from the Greek word "tribos" and means the "science of rubbing". Friction, lubrication, and wear mechanism in the common English language means the precise field of interest of tribology. Wear of total hip prosthesis is a significant clinical problem that involves, nowadays, a too high a number of patients. In order to acquire further knowledge on the tribological phenomena that involve hip prosthesis wear tests are conducted on employed materials to extend lifetime of orthopaedic implants. The most basic type of test device is the material wear machine, however, a more advanced one may more accurately reproduce some of the in vivo conditions. Typically, these apparatus are called simulators, and, while there is no absolute definition of a joint simulator, its description as a mechanical rig used to test a joint replacement, under conditions approximating those occurring in the human body, is acceptable. Simulator tests, moreover, can be used to conduct accelerated protocols that replicate/simulate particularly extreme conditions, thus establishing the limits of performance for the material. Simulators vary in their level of sophistication and the international literature reveals many interpretations of the design of machines used for joint replacement testing. This paper aims to review the current state of the art of the hip joint simulators worldwide. This is specified through a schematic overview by describing, in particular, constructive solutions adopted to reproduce in vivo conditions. An exhaustive commentary on the evolution and actually existing simulation standards is proposed by the authors. The need of a shared protocol among research laboratories all over the world could lead to a consensus conference.
Sundararajan, Sabapathy; Teferi, Abraham
Introduction: Granulicatella adiacens is a Gram-positive bacteria and a normal component of oral flora. It is also found in dental plaques, endodontic abscesses and can rarely cause more serious infections. Case presentation: We describe a prosthetic hip joint infection in an 81-year-old fit and healthy man due to Granulicatella adiacens who underwent a prolonged dental intervention two days earlier without antibiotic prophylaxis. The infection was successfully treated with surgical intervention and a combination of antibiotics. The patient eventually succumbed to severe community-acquired pneumonia two months later. Conclusion: Current guidelines recommend avoidance of antibiotic prophylaxis prior to dental treatment in patients who have no co-morbidities and no prior operation on the index prosthetic joint. This case report indicates that infections of prosthetic joints may be associated with dental procedures even in fit and healthy patients without the recognized risk factors. PMID:28348763
Hung, D-Z; Tien, N; Lin, C-L; Lee, Y-R; Wang, C C N; Chen, J-J; Lim, Y-P
The correlation between hip replacement (Hip-Repl) and chronic osteomyelitis (COM) has not been studied in Asian populations. Thus, we assessed Hip-Repl-related risk of developing COM via a population-based, nationwide, retrospective cohort study. The Hip-Repl cohort was obtained from Taiwan's Longitudinal Health Insurance Database 2000, and included patients who underwent Hip-Repl between 2000 and 2010; the control cohort was also selected from this database. Patients with a history of COM were excluded in both cohorts. We used univariate and multivariate Cox proportional hazards regression models to calculate the adjusted hazard ratios (aHRs) by age, sex, and comorbidities for developing COM. A total of 5349 patients who received a Hip-Repl and 10,372 matched controls were enrolled. In the Hip-Repl group, the risk for COM was 4.18-fold [95 % confidence interval (CI) = 2.24-7.80] higher than that in the control group after adjustment. For patients aged ≤65 years, the risk was 10.0-fold higher (95 % CI = 2.89-34.6). Furthermore, the risk was higher in the Hip-Repl cohort than in the non-Hip-Repl cohort, for both patients without comorbidity (aHR = 16.5, 95 % CI = 2.07-132.3) and those with comorbidity (aHR = 3.49, 95 % CI = 1.78-6.83). The impact of Hip-Repl on the risk for COM was greater among patients not using immunosuppressive drugs, and occurred during the first postoperative year. Patients who received Hip-Repl have an increased risk of developing COM. This risk was higher among males and patients aged 65 years or younger, and during the first postoperative year.
Svege, Ida; Nordsletten, Lars; Fernandes, Linda; Risberg, May Arna
Background Exercise treatment is recommended for all patients with hip osteoarthritis (OA), but its effect on the long-term need for total hip replacement (THR) is unknown. Methods We conducted a long-term follow-up of a randomised trial investigating the efficacy of exercise therapy and patient education versus patient education only on the 6-year cumulative survival of the native hip to THR in 109 patients with symptomatic and radiographic hip OA. Results regarding the primary outcome measure of the trial, self-reported pain at 16 months follow-up, have been reported previously. Results There were no group differences at baseline. The response rate at follow-up was 94%. 22 patients in the group receiving both exercise therapy and patient education and 31 patients in the group receiving patient education only underwent THR during the follow-up period, giving a 6-year cumulative survival of the native hip of 41% and 25%, respectively (p=0.034). The HR for survival of the native hip was 0.56 (CI 0.32 to 0.96) for the exercise therapy group compared with the control group. Median time to THR was 5.4 and 3.5 years, respectively. The exercise therapy group had better self-reported hip function prior to THR or end of study, but no significant differences were found for pain and stiffness. Conclusions Our findings in this explanatory study suggest that exercise therapy in addition to patient education can reduce the need for THR by 44% in patients with hip OA. ClinicalTrials.gov number NCT00319423 (original project protocol) and NCT01338532 (additional protocol for long-term follow-up). PMID:24255546
Perez Alamino, Rodolfo; Casellini, Carolina; Baňos, Andrea; Schneeberger, Emilce Edith; Gagliardi, Susana Alicia; Maldonado Cocco, José Antonio; Citera, Gustavo
Periprosthetic osteolysis (PO) is a frequent complication in patients with joint implants. There are no data regarding the prevalence of PO in patients with rheumatoid arthritis (RA), juvenile chronic arthritis (JCA), ankylosing spondylitis (AS), and osteoarthritis (OA). Objectives To evaluate the prevalence of PO in patients with RA, JCA, AS, and OA, who have undergone total hip replacement (THR), and to identify factors associated with its development. Methods The study included patients diagnosed with RA (ACR 1987), AS (modified New York criteria), JCA (European 1977 criteria), and osteoarthritis (OA) (ACR 1990 criteria) with unilateral or bilateral THR. Demographic, clinical, and therapeutic data were collected. Panoramic pelvic plain radiographs were performed, to determine the presence of PO at acetabular and femoral levels. Images were read by two independent observers. Results One hundred twenty-two hip prostheses were analyzed (74 cemented, 30 cementless, and 18 hybrids). The average time from prosthesis implantation to pelvic radiograph was comparable among groups. PO was observed in 72 hips (59%). In 55% of cases, PO was detected on the femoral component, with a lower prevalence in RA (53%) vs AS (64.7%) and JCA (76.5%). Acetabular PO was more frequent in JCA patients (58.8%), compared with RA (11.6%) and OA (28.5%) patients (P = 0.0001 and P = 0.06, respectively). There was no significant association between the presence of PO and clinical, functional, or therapeutic features. Conclusion The prevalence of PO was 59%, being more frequent at the femoral level. Larger studies must be carried out to determine the clinical significance of radiologic PO. PMID:27790012
Vaishya, Raju; Agarwal, Amit Kumar; Vijay, Vipul
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.
Miles, Brad; Kolos, Elizabeth; Walter, William L; Appleyard, Richard; Li, Qing; Chen, Youngang; Ruys, Andrew J
Intra-operative peri-prosthetic femoral fractures are a significant concern in total hip arthroplasty and can occur at any time during surgery, with the highest incidence during implant insertion. This study combines subject-specific finite element analysis modeling with an optical tracking system to characterize the resultant strain in the bone and results of impaction during total hip replacement surgery. The use of ABG II femoral stem (Stryker Orthopaedics, Mahwah, NJ, USA) in the model yielded the following results. Hammer velocity was measured experimentally using a three-dimensional optical tracking system and these data were input into the finite element analysis model so that intra-operative loading scenario could be simulated. A quasi-static explicit simulation and a dynamic loading step using two implant-bone interface friction (0.1 and 0.4 friction coefficients) states were simulated. The maximum swing velocity of a mallet was experimentally measured at 1.5 m/s and occurred just before impaction of the hammer with implant introducer. Two friction states resulted in different results with the lower friction coefficient generating higher strains in the anterior regions of the model and higher displacement of the implant with respect to the femur when compared to the high friction state.
García-Rey, E; García-Cimbrelo, E; Cruz-Pardos, A
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.
Lee, J. M.; Salvati, E. A.; Betts, F.; DiCarlo, E. F.; Doty, S. B.; Bullough, P. G.
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.
Kim, Chul-Ho; Choi, Young Hyun; Jeong, Mi Yeon; Chang, Jae Suk
In 1960s, toxic heart failure due to cobalt poisoning was firstly reported from Canadian industrial worker. Following development of bearing materials in hip arthroplasties, using cobalt-chrome alloy in bearing surface, there were rarely reported of systemic affect toxic cobaltism include toxic heart failure due to articulation wear in Western countries. It could be happened more easily by third body wear from ceramic particle especially revision total hip replacement (THR) surgery using cobalt-chrome alloy following ceramic articulation breakage which index surgery performed by ceramic on ceramic bearing. In Korea, due to many surgeons prefer ceramic on ceramic bearing in THR compared to Western countries, it might be more important issue within a time. However in our knowledge, there was no previous report about cobalt poisoning heart failure in Korea. It is still very rare and hard to diagnose cobalt intoxication heart failure after THR, so we report a case of fatal heart failure caused by cobalt intoxication after revision THR in 53-year old man who successfully underwent re-revision THR. PMID:28097117
Kim, Chul-Ho; Choi, Young Hyun; Jeong, Mi Yeon; Chang, Jae Suk; Yoon, Pil Whan
In 1960s, toxic heart failure due to cobalt poisoning was firstly reported from Canadian industrial worker. Following development of bearing materials in hip arthroplasties, using cobalt-chrome alloy in bearing surface, there were rarely reported of systemic affect toxic cobaltism include toxic heart failure due to articulation wear in Western countries. It could be happened more easily by third body wear from ceramic particle especially revision total hip replacement (THR) surgery using cobalt-chrome alloy following ceramic articulation breakage which index surgery performed by ceramic on ceramic bearing. In Korea, due to many surgeons prefer ceramic on ceramic bearing in THR compared to Western countries, it might be more important issue within a time. However in our knowledge, there was no previous report about cobalt poisoning heart failure in Korea. It is still very rare and hard to diagnose cobalt intoxication heart failure after THR, so we report a case of fatal heart failure caused by cobalt intoxication after revision THR in 53-year old man who successfully underwent re-revision THR.
Parchi, Paolo Domenico; Ferrari, Vincenzo; Piolanti, Nicola; Andreani, Lorenzo; Condino, Sara; Evangelisti, Gisberto; Lisanti, Michele
Each year approximately 1 million total hip replacements (THR) are performed worldwide. A percentage of failure due to surgical approach and imprecise implant placement still exists. These result in several serious complications. We propose an approach to plan, to simulate, and to assist prosthesis implantation for difficult cases of THR based on 3-D virtual models, generated by segmenting patients' CT images, 3-D solid models, obtained by rapid prototyping (RP), and virtual procedure simulation. We carried out 8 THR with the aid of 3-D reconstruction and RP. After each procedure a questionnaire was submitted to the surgeon to assess the perceived added value of the technology. In all cases, the surgeon evaluated the 3-D model as useful in order to perform the planning. The clinical results showed a mean increase in the Harris Hip Score of about 42.5 points. The mean time of prototyping was 7.3 hours, (min 3.5 hours, max 9.3 hours). The mean surgery time was 65 minutes (min 50 minutes, max 88 minutes). Our study suggests that meticulous preoperative planning is necessary in front of a great aberration of the joint and in absence of normal anatomical landmarks, CT scan is mandatory, and 3-D reconstruction with solid model is useful.
Shi, Hon-Yi; Khan, Mahmud; Culbertson, Richard; Chang, Je-Ken; Wang, Jun-Wen; Chiu, Herng-Chia
This study applied the generalised estimating equations (GEE) in a large-scale prospective cohort study of predictors of health-related quality of life (HRQoL) in a Taiwan population. The study population included all patients who had undergone primary total hip replacement (THR) performed between March 1998 and December 2002 by either of two orthopaedic surgeons in two hospitals. The SF-36 was used in pre- and postoperative assessments of 335 patients. Young age, male gender, minimal comorbidity, use of epidural anaesthesia, lack of readmission within the previous 30 days, and higher preoperative functional status were positively associated with HRQoL (P < 0.05). Patients should be advised that their postoperative HRQoL may depend not only on their postoperative health care but also on their preoperative functional status. These analytical results should be applicable to other Taiwan hospitals and to other countries with similar social and cultural practices.
Zhe Cao; Shaojie Su; Hong Chen; Hao Tang; Yixin Zhou; Zhihua Wang
In Total Hip Replacement (THR), inaccurate measurement of Anterior Pelvic Plane (APP), which is usually used as a reference plane, will lead to malposition of the acetabular prosthesis. As a result, the risk of impingement, dislocation and wear will increase and the safe range of motion will be limited. In order to acquire the accurate pose of APP, a measurement system is designed in this paper, which includes two parts: one is used to estimate the initial pose of APP and the other is used to trail dynamic motion of APP. Both parts are composed of an Inertial Measurement Unit (IMU) and magnetometer sensors. An Extended Kalman Filter (EKF) is adopted to fuse the data from IMU and the magnetometer sensors to estimate the orientation of the pelvis. The test results show that the error angle between calculated axis and true axis of the pelvis in geodetic coordinate frame is less than 1.2 degree, which meets the requirement of the surgery.
Oskanian, T L; Solopova, I A; Grishin, A A; Sidorov, V D
Patients after total endoprosthesis replacement of hip joint underwent method of functional electrostimulation (FES) with the purpose to recovery correct walking stereotype, to increase leisured muscle strength, to prevent secondary coxarthrosis development via stimulation or relaxation of muscles, and for analgesia of joints and pain zones at walking. Results of treatment of 143 patients received rehabilitation course of FES (15 procedures of 30 minutes) were compared with results of treatment of 54 patients received traditional methods. It is shown that FES is effective method of rehabilitation because it makes possible to improve muscle strength significantly, to eliminate or reduce motor deficit, to decrease pain syndrome, to form correct walking stereotype, and to perform early prophylaxis of secondary coxarthrosis on contralateral side. The main advantage of proposed method of nonmedicamental influence is better clinic-biomechanical result without use of drugs.
Cip, Johannes; von Strempel, Archibald; Bach, Christian; Luegmair, Matthias; Benesch, Thomas; Martin, Arno
Taper junctions of large diameter metal-on-metal femoral heads and femoral stems were described as metal ion generator due to accelerated wear and corrosion. However, literature about the Articular Surface Replacement (ASR) total hip arthroplasty (THA) invariably deals with stems manufactured by DePuy Orthopedics (Warsaw, IN, USA). Nothing is known whether different stems with common 12/14 mm tapers affect failure rate or ion release. 99 ASR THA (88 patients) implanted with CoxaFit or ARGE Geradschaft stems (K-Implant, Hannover, Germany) were retrospectively analyzed. After a mean follow-up of 3.5 years revision rate was 24.5%, mostly due to adverse reaction to metal debris (ARMD). CT scan revealed component loosening in 10.3% and pseudotumoral lesions in 12.6%. Elevated ion concentrations (>7 μg/l) were found in 38.6%.
Nassiri, Mujtaba; Bruce-Brand, Robert A; O'Neill, Francis; Chenouri, Shojaeddin; Curtin, Paul T
This study aimed to determine the quality of information available on the internet regarding Total Hip Replacement (THR). The unique websites identified were categorised by type and assessed using the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark criteria, and a novel (THR)-specific content score. The presence of the Health On the Net (HON) code, a reported quality assurance marker, was noted. Commercial websites predominate. Governmental & Non-Profit Organizations websites attained the highest DISCERN score. Sites that bore the HONcode seal obtained significantly higher DISCERN and THR content scores than those without the certification. Physicians should recommend the HONcode seal to their patients as a reliable indicator of website quality or, better yet, refer patients to sites they have personally reviewed.
Stigmar, Kjerstin; Dahlberg, Leif E; Zhou, Caddie; Jacobson Lidgren, Helena; Petersson, Ingemar F; Englund, Martin
Background and purpose Little is know about patterns of sick leave in connection with total hip and knee joint replacement (THR and TKR) in patients with osteoarthritis (OA). Patients and methods Using registers from southern Sweden, we identified hip and knee OA patients aged 40–59 years who had a THR or TKR in the period 2004–2012. Patients who died or started on disability pension were excluded. We included 1,307 patients with THR (46% women) and 996 patients with TKR (56% women). For the period 1 year before until 2 years after the surgery, we linked individual-level data on sick leave from the Swedish Social Insurance Agency. We created a matched reference cohort from the general population by age, birth year, and area of residence (THR: n = 4,604; TKR: n = 3,425). The mean number of days on sick leave and the proportion (%) on sick leave 12 and 24 months before and after surgery were calculated. Results The month after surgery, about 90% of patients in both cohorts were on sick leave. At the two-year follow-up, sick leave was lower for both cohorts than 1 year before surgery, except for men with THR, but about 9% of the THR patients and 12–17% of the TKR patients were still sick-listed. In the matched reference cohorts, sick leave was constant at around 4–7% during the entire study period. Interpretation A long period of sick leave is common after total joint replacement, especially after TKR. There is a need for better knowledge on how workplace adjustments and rehabilitation can facilitate the return to work and can postpone surgery. PMID:27996342
Lainiala, Olli; Elo, Petra; Reito, Aleksi; Pajamäki, Jorma; Puolakka, Timo; Eskelinen, Antti
Background and purpose Ultrasound is used for imaging of pseudotumors associated with metal-on-metal (MoM) hips. Ultrasound has been compared with magnetic resonance imaging, but to date there have been no studies comparing ultrasound findings and revision findings. Methods We evaluated the sensitivity and specificity of preoperative ultrasound for detecting pseudotumors in 82 patients with MoM hip replacement (82 hips). Ultrasound examinations were performed by 1 of 3 musculoskeletal radiologists, and pseudotumors seen by ultrasound were retrospectively classified as fluid-filled, mixed-type, or solid. Findings at revision surgery were retrieved from surgical notes and graded according to the same system as used for ultrasound findings. Results Ultrasound had a sensitivity of 83% (95% CI: 63–93) and a specificity of 92% (CI: 82–96) for detecting trochanteric region pseudotumors, and a sensitivity of 79% (CI: 62–89) and a specificity of 94% (CI: 83–98) for detecting iliopsoas-region pseudotumors. Type misclassification of pseudotumors found at revision occurred in 8 of 23 hips in the trochanteric region and in 19 of 33 hips in the iliopsoas region. Interpretation Despite the discrepancy in type classification between ultrasound and revision findings, the presence of pseudotumors was predicted well with ultrasound in our cohort of failed MoM hip replacements. PMID:25582840
Gunaratne, G D Rajitha; Khan, Riaz J K; Tan, Cynthia; Golledge, Clayton
Introduction: Psoas abscess is a recognized but under-diagnosed complication of prosthetic hip joint infections. Case report: We report a case of a 68-year-old man with right and left hip arthroplasties performed 22 and 14 years ago, respectively, who presented with non-specific symptoms and was subsequently diagnosed with left psoas abscess on CT scan. Drainage of the psoas abscess was complicated by the formation of a discharging sinus connected to the left hip. He then developed an infected right thigh haematoma, which also formed a discharging sinus connecting to the right hip post-drainage. He was treated with bilateral two-stage revision total hip arthroplasties and multiple courses of prolonged antibacterial therapy. Both abscesses and hip joints cultured the same species of multi-sensitive Staphylococcus aureus. The causal link between the psoas abscess and the prosthetic hip infections is discussed, as well as the investigation and management. Conclusion: We recommend routine exploration of the iliopsoas bursa when revision of an infected total hip arthroplasty is performed to rule out intrapelvic spread of the infection . There should be high index of suspicion of prosthetic hip infection in patients presenting with Psoas abscess and vice versa. A CT scan might be warranted to rule out concomitant infection in both these patients. PMID:28116254
Guerado, Enrique; Cano, Juan Ramon; Cruz, Encarnacion; Benitez-Parejo, Nicolás; Perea-Milla, Emilio
The association between mental disorders (MDs) and iatrogenic complications after hip fracture surgery has been poorly studied. Among iatrogenic complications, nosocomial infections (NIs) are a major factor in hip fracture surgery. The aim of this paper was to determine whether patients with a MD and a hip fracture develop more NIs after hip surgery than patients with no MD. We studied 912 patients who underwent surgery for a hip fracture (223 patients with a MD who underwent surgery for a hip fracture and 689 control patients without a MD who also underwent surgery for a hip fracture) and followed them after surgery. Univariable and multivariable analyses were performed using simple and multiple logistic regression analysis (confidence interval, crude and adjusted odds ratios, and P value). We found that MDs, gender, and comorbidities were not associated with a higher risk of developing a NI after surgery for a hip fracture. Only age increases the risk of a NI. PMID:20628560
McMinn, D; Treacy, R; Lin, K; Pynsent, P
The historical failure of surface replacement has been due to the production of wear debris with subsequent bone resorption, loosening, and failure. To avoid these problems, a surface replacement using a metal on metal bearing allowing thin components and femoral design and instrumentation to avoid varus alignment has been designed. Two hundred thirty-five joints have been resurfaced with this prosthesis in almost 5 years. There have been no femoral neck fractures and no dislocations. There have been 4 designs differing in the method of fixation. In the press fit group, 6 of 70 hips had to be revised for aseptic loosening. In the cemented group, debonding of the cup occurred in 3 of 43 cases. Six patients had hydroxyapatite coated components and have had excellent clinical outcomes. The current design uses a peripherally expanded hydroxyapatite coated cup and a cemented metal head; 116 of this design have been implanted during a 19-month period with excellent outcome. Despite short followup the authors are hopeful that the combination of a polar metal on metal bearing with appropriate fixation will yield a method of preserving bone stock in the younger patient requiring arthroplasty.
Clarke, I C; Phillips, W; McKellop, H; Coster, I R; Hedley, A; Amstutz, H C
The objective of this study was to investigate the design and fixation advantages of Sialon ceramic surface replacements implanted without acrylic bone cement. The biocompatibility and friction and wear properties of Sialon ceramic were compared with more conventional prosthetic materials such as stainless steel and alumina. A functional load-bearing canine hip surface replacement model was established to test Sialon femoral cups designed for fixation by bone ingrowth. The results of the polyethylene wear tests on highly polished ceramic and stainless steel counterfaces were essentially similar. These laboratory data indicated that the in-vivo polyethylene wear performance on metal or ceramic prosthetic surfaces could be expected to be indistinguishable, i.e. the ceramic/polyethylene combination would not offer any improved wear resistance in-vivo. It was found possible to get bone ingrowth into the macrokeying areas of the ceramic femoral cups but not into the microporous surfaces due to the presence of a fibrous membrane lining their internal surfaces. The biocompatability specimens also appeared to be invested with a fibrous membrane. Further studies are under way to determine the relationship between reaming procedures, micro motion at the interfaces and Sialon biocompatibility.
Kane, Sheryl R; Ashby, Paul D; Pruitt, Lisa A
A crosslinked hydrogel coating similar to poly(ethylene glycol) (PEG) was covalently bonded to the surface of ultrahigh molecular weight polyethylene (UHMWPE) to improve the lubricity and wear resistance of the UHWMPE for use in total joint replacements. The chemistry, hydrophilicity, and protein adsorption resistance of the coatings were determined, and the wear behavior of the PEG-like coating was examined by two methods: pin-on-disk tribometry to evaluate macroscale behavior, and atomic force microscopy (AFM) to simulate asperity wear. As expected, the coating was found to be highly PEG-like, with approximately 83% ether content by x-ray photoelectron spectroscopy and more hydrophilic and resistant to protein adsorption than uncoated UHMWPE. Pin-on-disk testing showed that the PEG-like coating could survive 3 MPa of contact pressure, comparable to that experienced by total hip replacements. AFM nanoscratching experiments uncovered three damage mechanisms for the coatings: adhesion/microfracture, pure adhesion, and delamination. The latter two mechanisms appear to correlate well with wear patterns induced by pin-on-disk testing and evaluated by attenuated total reflection Fourier transform infrared spectroscopy mapping. Understanding the mechanisms by which the PEG-like coatings wear is critical for improving the behavior of subsequent generations of wear-resistant hydrogel coatings.
Ollivier, M; Frey, S; Parratte, S; Flecher, X; Argenson, J N
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.
Nečas, David; Vrbka, Martin; Urban, Filip; Křupka, Ivan; Hartl, Martin
The aim of the present paper is to provide a novel experimental approach enabling to assess the thickness of lubricant film within hip prostheses in meaning of the contribution of particular proteins. Thin film colorimetric interferometry was combined with fluorescent microscopy finding that a combination of optical methods can help to better understand the interfacial lubrication processes in hip replacements. The contact of metal femoral head against a glass disc was investigated under various operating conditions. As a test lubricant, the saline solution containing the albumin and γ-globulin in a concentration 2:1 was employed. Two different mean speeds were applied, 5.7 and 22mm/s, respectively. The measurements were carried out under pure rolling, partial negative and partial positive sliding conditions showing that kinematic conditions substantially affects the formation of protein film. Under pure rolling conditions, an increasing tendency of lubricant film independently on rolling speed was detected, while the total thickness of lubricant film can be attributed mainly to albumin. When the ball was faster than the disc (negative sliding), a very thin lubricant film was observed for lower speed with no significant effect of particular proteins. The increase in sliding speed led to the increase of film thickness mainly caused due to the presence of γ-globulin. On the contrary, when the disc was faster than the ball (positive sliding), the film formation was very complex and time dependent while both of the studied proteins have shown any qualitative change during the test, however the effect of albumin seems to be much more important. Since a very good agreement of the results was obtained, it can be concluded that the approach consisting of two optical methods can provide the fundamental information about the lubricant film formation in meaning of particular proteins while the simultaneous presence of other constituents in model synovial fluid.
Clarke, I C
The main flaws to be overcome in realizing the potential success of the double-cup arthroplasty procedure are failures due to femoral cup loosening, acetabular cup loosening, and femoral-neck fractures. The clinical uncertainties include the selection of a suitable patient with adequate bone stock and the technical difficulties associated with (I) reaming the acetabulum adequately, (2) reaming down onto the neck without violating it, and (3) anchoring the components securely by interdigitation of acrylic cement. The higher frictional torques of the double-cup arthroplasty designs are not a clinical loosening issue--the resulting acetabular cement-bone shear stresses are very low. Computer models of both the femoral and acetabular components predict significant stress shielding of the cancellous bone under metal femoral shells. At the rim of the femoral cup, the stresses are increased by a factor of 3 owing to the stress concentration effect and can rise to a factor of 10 if cystic or osteoporotic changes are present. This finding if confirmed in the three-dimensional models may explain some of the femoral neck fractures. The thin polyethylene acetabular cups may also cause a stress concentration effect on the underlying cement and bone. This may explain the higher incidence of radiographic loosening around the acetabulum in double-cup arthroplasty designs compared with total hip replacements. Metal-backed sockets may reduce cancellous bone stresses and appear advantageous. There is no clinical evidence of unusual wear or wear-related problems. However, new material formulations are now either in use or being planned for the double-cup arthroplasty designs. As yet, there have been no published data on hip simulator wear for the efficacy of any of the current or proposed changes. Biologic fixation appears to be the theme for the 1980s. However, the combination of technology, design instrumentation, and patient selection will be critical in achieving success with this
Affatato, Saverio; Spinelli, Michele; Zavalloni, Mara; Traina, Francesco; Carmignato, Simone; Toni, Aldo
Ceramic-on-ceramic and metal-on-metal bearing surfaces are often employed for total hip replacement because of their resistance to wear. However, they have some limits: brittleness is a major concern for ceramic, and ion release is a drawback for metal. To reduce the effect of these limitations, a hybrid coupling of ceramic-on-metal has been proposed. The theoretical advantage of this new coupling might lead orthopedic surgeons to use it indiscriminately. We asked whether the wear rate of this innovative solution was comparable with that of ceramic-on-ceramic, which is considered to be the gold standard for wear resistance. In a hip simulator study, we tested the wear pattern of a hybrid ceramic-on-metal coupling supplied by the same distributor; in particular, three different configurations were tested for 5 million cycles: 36-mm ceramic-on-ceramic, 32-mm and 36-mm ceramic-on-metal. These combinations were gravimetrically and geometrically evaluated. After 5 million cycles, the volumetric loss for the metal acetabular cups (Phi 36-mm) was 20-fold greater than that of the ceramic cups of the same size (Phi 36-mm); a volumetric loss of 4.35 mm(3) and 0.26 mm(3) was observed, respectively, for ceramic-on-metal and ceramic-on-ceramic combinations. Significant statistical differences were observed between all 36-mm different combinations (P < 0.0001). The increased diameter of the 36-mm ceramic-on-metal configuration resulted in a lower volumetric loss compared with that of the 32-mm ceramic-on-metal configuration. Our findings showed an increase in wear for the proposed hybrid specimens with respect to that of the ceramic-on-ceramic ones. This confirms that even in the case of ceramic-on-metal bearings, mixing and matching could not prove effective wear behavior, not even comparable with that of the ceramic-on-ceramic gold standard.
Colwell, Clifford; Mouret, Patrick
Patients undergoing major lower-extremity orthopedic surgery such as total hip replacement (THR) and total knee replacement (TKR) are at an increased risk of venous thromboembolism (VTE). Routine prophylaxis is necessary to reduce the risk of deep vein thrombosis (DVT), which may progress to potentially fatal pulmonary embolism and secondary complications such as postthrombotic syndrome, recurrent DVT, and chronic pulmonary hypertension. Prophylaxis in patients undergoing TKR, THR, and hip fracture surgery is now standard practice and generally involves anticoagulant treatment with either low-molecular-weight heparin (LMWH) or warfarin for a period of 7 to 10 days, with extended prophylaxis in those with ongoing risk factors such as obesity, cancer, or previous VTE. Data from clinical practice suggest that there is a general trend toward longer postsurgical prophylaxis and shorter hospital stays, making practicality of treatment an important consideration. LMWH is effective for the prophylaxis of VTE, but the parenteral route of administration is not convenient for use in the outpatient setting. Warfarin, on the other hand, can be administered orally but requires the infrastructure for careful patient monitoring and dose adjustments because of its unpredictable dose-response relationship. The development of new anticoagulants has been pursued with the aim of improving efficacy, predictability, consistency of response, safety, and convenience. A recently approved anticoagulant, fondaparinux, has been proven to provide superior efficacy for the prevention of VTE compared with LMWH, but this agent requires parenteral administration and does not overcome the convenience issue. Ximelagatran is the oral form of the direct thrombin inhibitor melagatran, which is available for subcutaneous administration. Ximelagatran has a consistent anticoagulant response allowing fixed oral dosing without the need for coagulation monitoring. The efficacy and safety profile of melagatran
Objective To determine whether there was a difference in balance, proprioception, and skeletal muscle mass among patients who undergo hip fracture surgery relative to and elective total hip replacement (THR). Methods Thirty-one THR patients were enrolled. The patients were categorized into two groups: fracture group (n=15) and non-fracture group (n=16). Berg Balance Scale (BBS) was used to balance the proprioception of the hip joint while a joint position sense (JPS) test was used to evaluate it. Skeletal muscle mass was measured by bioelectrical impedance analysis and expressed as a skeletal muscle mass index (SMI). Quality of life (QOL) was also assessed using a 36-item short form health survey (SF-36). All tests were assessed at 3 months after the surgery. An independent t-test was used to compare the fracture group and non-fracture group. Spearman correlation was used to identify the correlation of each variable. Results In an independent t-test, the BBS score of patients undergoing elective surgery was higher than the BBS score of patients undergoing hip fracture surgery. There was a significant correlation between the BBS and JPS score after a THR. SMI also correlated with the score of BBS. Conclusion It seems that THR patients undergoing surgery for a hip fracture might have more trouble balancing than elective THR patients. Therefore THR patients undergoing hip fracture surgery might need more care during rehabilitation. PMID:28119837
Aubin, G. G.; Bémer, P.; Guillouzouic, A.; Crémet, L.; Touchais, S.; Fraquet, N.; Boutoille, D.; Reynaud, A.; Lepelletier, D.; Corvec, S.
We describe the first case of hip prosthetic infection due to Lactococcus garvieae. The patient, a 71-year-old woman fishmonger, developed a hip infection 7 years after total hip arthroplasty. The origin of infection was possibly due to the manipulation or intake of seafood or fish contaminated with Lactococcus garvieae. PMID:21367987
Aubin, G G; Bémer, P; Guillouzouic, A; Crémet, L; Touchais, S; Fraquet, N; Boutoille, D; Reynaud, A; Lepelletier, D; Corvec, S
We describe the first case of hip prosthetic infection due to Lactococcus garvieae. The patient, a 71-year-old woman fishmonger, developed a hip infection 7 years after total hip arthroplasty. The origin of infection was possibly due to the manipulation or intake of seafood or fish contaminated with Lactococcus garvieae.
Bourke, Michael; Crossley, Kay; Russell, Trevor
Background Total hip replacement (THR) is the gold standard treatment for severe hip osteoarthritis. Effectiveness of physical rehabilitation for THR patients following discharge from hospital is supported by evidence; however, barriers such as geographical location and transport can limit access to appropriate health care. One solution to this issue is using an alternative model of care using telerehabilitation technology to deliver rehabilitation programs directly into patients’ homes. A telerehabilitation model may also have potential health care cost savings for health care providers. Objective This study aims to determine if a telerehabilitation model of care delivered remotely is as effective as face-to-face rehabilitation in the THR population and cost effective for health care providers and patients. Methods A total of 70 people undergoing THR will be recruited to participate in a randomized, single-blind, controlled noninferiority clinical trial. The trial will compare a technology-based THR rehabilitation program to in-person care. On discharge from hospital, participants randomized to the in-person group will receive usual care, defined as a paper home exercise program (HEP) targeting strengthening exercises for quadriceps, hip abductors, extensors, and flexors; they will be advised to perform their HEP 3 times per day. At 2, 4, and 6 weeks postoperatively, they will receive a 30-minute in-person physiotherapy session with a focus on gait retraining and reviewing and progressing their HEP. The telerehabilitation protocol will involve a program similar in content to the in-person rehabilitation program, except delivery will be directly into the homes of the participants via telerehabilitation technology on an iPad. Outcomes will be evaluated preoperatively, day of discharge from in-patient physiotherapy, 6 weeks and 6 months postoperatively. The primary outcome will be the quality of life subscale of the hip disability and osteoarthritis outcome score
MacWilliam, C H; Yood, M U; Verner, J J; McCarthy, B D; Ward, R E
OBJECTIVE: To identify factors associated with poor outcome after total hip replacement (THR) surgery. DATA SOURCES: This article is the first to present results from the American Medical Group Association (AMGA) THR consortium. STUDY DESIGN: The outcomes evaluated were pain and physical function. Eight patient risk factors were evaluated. These included the age, sex, race, marital status, and education of the patient; whether the patient had polyarticular disease or other comorbid conditions; and the patient's preoperative pain and physical function score. DATA COLLECTION: Data were collected from patients using AMGA-approved, self-administered questionnaires preoperatively and at six weeks, three months, six months, one year, and two years postoperatively. PRINCIPAL FINDINGS: Of the patient risk factors studied, race, education, number of comorbid conditions, and preoperative Health Status Questionnaire (HSQ) score were found to be associated with poor outcome. These risk factors were found to have an effect on both pain and physical function at six months postoperatively. Patients with higher preoperative scores were found to have higher postoperative scores, but substantially fewer of these patients received any benefit from their surgery. For each 10-point increase in preoperative score, patients could expect at least a 6-point decrease in postoperative improvement. CONCLUSIONS: Our study indicates that preoperative status is an important predictor of outcome for THR. PMID:8943994
Antón, David; Nelson, Mark; Russell, Trevor; Goñi, Alfredo; Illarramendi, Arantza
The evolving telecommunications industry combined with medical information technology has been proposed as a solution to reduce health care cost and provide remote medical services. This paper aims to validate and show the feasibility and user acceptance of using a telerehabilitation system called Kinect Rehabilitation System (KiReS) in a real scenario, with patients attending repeated rehabilitation sessions after they had a Total Hip Replacement (THR). We present the main features of KiReS, how it was set up in the considered scenario and the experimental results obtained in relation to two different perspectives: patients' subjective perceptions (gathered through questionnaires) and the accuracy of the performed exercises (by analysing the data captured using KiReS). We made a full deployment of KiReS, defining step by step all the elements of a therapy: postures, movements, exercises and the therapy itself. Seven patients participated in this trial in a total of 19 sessions, and the system recorded 3865 exercise executions. The group showed general support for telerehabilitation and the possibilities that systems such as KiReS bring to physiotherapy treatment.
Muñoz, M; Naveira, E; Seara, J; Palmer, J H; Cuenca, J; García-Erce, J A
An important percentage of patients undergoing total hip replacement (THR) receive allogeneic blood transfusion (ABT) to avoid the risks of acute anaemia. However, concerns about the risks of ABT have led to the search for alternatives, such as stimulation of erythropoiesis. We prospectively investigated the effect of postoperative administration of 300 mg of intravenous iron sucrose on ABT requirements in THR patients (group 2; n = 24). A previous series of 22 THR patients served as the control group (group 1). All patients were operated on by the same surgeon, using the same implant, and a set of clinical data was gathered. No adverse reactions to iron administration were observed. The group-given iron showed a trend to a lower transfusion rate (46 vs. 73%; P = 0.067) and lower transfusion index (0.96 vs. 1.68 units/patient; P = 0.038). Moreover, amongst the non-transfused patients, admission haemoglobin levels were lower in those coming from the iron group than those from the control group (12.7 +/- 0.9 vs. 14.0 +/- 1.2 g dL(-1), respectively; P = 0.017). Postoperative parenteral iron administration could be a safe and effective way to reduce ABT requirements in the THR patients. A large, randomized controlled trial to confirm these results is warranted.
Olofsson, Johanna; Grehk, T. Mikael; Berlind, Torun; Persson, Cecilia; Jacobson, Staffan; Engqvist, Håkan
Many of the failures of total joint replacements are related to tribology, i.e., wear of the cup, head and liner. Accumulation of wear particles at the implants can be linked to osteolysis which leads to bone loss and in the end aseptic implant loosening. Therefore it is highly desirable to reduce the generation of wear particles from the implant surfaces. Silicon nitride (Si3N4) has shown to be biocompatible and have a low wear rate when sliding against itself and is therefore a good candidate as a hip joint material. Furthermore, wear particles of Si3N4 are predicted to slowly dissolve in polar liquids and they therefore have the potential to be resorbed in vivo, potentially reducing the risk for aseptic loosening. In this study, it was shown that α-Si3N4-powder dissolves in PBS. Adsorption of blood plasma indicated a good acceptance of Si3N4 in the body with relatively low immune response. Si3N4 sliding against Si3N4 showed low wear rates both in bovine serum and PBS compared with the other tested wear couples. Tribofilms were built up on the Si3N4 surfaces both in PBS and in bovine serum, controlling the friction and wear characteristics. PMID:23507807
Alshuhri, Abdullah A; Holsgrove, Timothy P; Miles, Anthony W; Cunningham, James L
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).
Wylde, Vikki; Maclean, Angus; Blom, Ashley W
Although total hip replacement (THR) is considered a very successful surgical intervention, a proportion of patients experience persistent pain or disability, and/or dissatisfaction with the outcome of surgery. Our aim was to determine whether post-operative radiographic variables were predictive of patient-reported pain, function and satisfaction after primary THR. At 1-3 years after surgery patients completed the WOMAC Pain scale, WOMAC Function scale and a validated measure of satisfaction with the outcome of surgery. Post-operative radiographs taken prior to discharge were graded for the restoration of offset, restoration of leg length, anteroposterior (AP) alignment of the femoral stem and AP acetabular inclination. Binary logistic regression was used to identify whether radiographic variables were significant predictors of patient-reported outcome scores. Radiographic and patient-reported outcomes data were available for 452 THR patients. No radiographic predictors were found to be significant predictors of patient reported pain, function or satisfaction at 1-3 years after THR. This highlights that patients with continuing problems after THR may benefit from a thorough multidisciplinary assessment to diagnose the underlying cause of the problems.
Byers, P D; Roper, B A; Glennie, B
Using clinical, radiological, and morbid anatomical data about patients with arthritis of the hip and their femoral heads resected during total hip replacement, an attempt has been made first, to classify patients and femoral heads by a cluster analysis technique, and secondly and more realistically, to use existing clinical and radiological classification as a basis for seeking discriminating features in the data from the femoral head. Both types of analysis failed to give results, and led to a conclusion that arthritis of the hip is a spectrum of disease. This may not pose problems to the clinician, but it does to the investigator studying the pathogenesis of osteoarthrosis. This problem is briefly discussed. PMID:1190850
Høgdall, Dan; Hvolris, Jørgen Jesper; Christensen, Lise
Awareness of the role of bacterial biofilm in the pathogenesis of low-grade or chronic infections diagnosed in hip arthroplasty has been on the rise in recent years. The importance of bacterial biofilm for the development of prosthesis failure is probably underestimated, and terms like aseptic loosening, sterile pus and aseptic necrosis are up for revision. The diagnosis of biofilm has been, and still is, difficult, but new molecular biological techniques, alone or in combination with older established ones, have further helped us to uncover lesions, where biofilm is part of the pathology. This article based on a literature search and own observations is primarily focused on newer methods that help us identify the pathology behind infection-based prosthesis failure. We suggest that the fluorescence in situ hybridization technique on carefully selected biopsy material is used in the future to identify live as well as dead bacteria within their environment. The method is quick and sensitive and provides a reliable result with optimal detection rate.
Klatte, Till O; O’Loughlin, Padraigh F; Citak, Mustafa; Rueger, Johannes M; Gehrke, Thorsten; Kendoff, Daniel
Background and purpose Mechanically failed internal fixation following hip fracture is often treated by salvage arthroplasty. If deep wound infection is present, a 2-stage procedure is often used. We have used a 1-stage procedure in infected cases, and we now report the outcome. Patients and methods We reviewed 16 cases of deep wound infection after mechanically failed hip fracture fixation, treated between 1994 and 2010. In all patients, a joint prosthesis was implanted in a 1-stage procedure. Results After an average follow-up period of 12 (2–18) years, no reinfection was detected. In 4 cases, a hip dislocation occurred and 3 of these needed further surgery. Interpretation A 1-stage procedure for arthroplasty of an infected, mechanically failed hip fracture fixation is feasible and carries a low risk of infection. PMID:23799345
Background Total knee (TKR) and hip (THR) replacement (arthroplasty) are effective surgical procedures that relieve pain, improve patients' quality of life and increase functional capacity. Studies on variations in medical practice usually place the indications for performing these procedures to be highly variable, because surgeons appear to follow different criteria when recommending surgery in patients with different severity levels. We therefore proposed a study to evaluate inter-hospital variability in arthroplasty indication. Methods The pre-surgical condition of 1603 patients included was compared by their personal characteristics, clinical situation and self-perceived health status. Patients were asked to complete two health-related quality of life questionnaires: the generic SF-12 (Short Form) and the specific WOMAC (Western Ontario and Mcmaster Universities) scale. The type of patient undergoing primary arthroplasty was similar in the 15 different hospitals evaluated. The variability in baseline WOMAC score between hospitals in THR and TKR indication was described by range, mean and standard deviation (SD), mean and standard deviation weighted by the number of procedures at each hospital, high/low ratio or extremal quotient (EQ5-95), variation coefficient (CV5-95) and weighted variation coefficient (WCV5-95) for 5-95 percentile range. The variability in subjective and objective signs was evaluated using median, range and WCV5-95. The appropriateness of the procedures performed was calculated using a specific threshold proposed by Quintana et al for assessing pain and functional capacity. Results The variability expressed as WCV5-95 was very low, between 0.05 and 0.11 for all three dimensions on WOMAC scale for both types of procedure in all participating hospitals. The variability in the physical and mental SF-12 components was very low for both types of procedure (0.08 and 0.07 for hip and 0.03 and 0.07 for knee surgery patients). However, a moderate
Dickinson, Alexander S
Periprosthetic bone remodeling is frequently observed after total hip replacement. Reduced bone density increases the implant and bone fracture risk, and a gross loss of bone density challenges fixation in subsequent revision surgery. Computational approaches allow bone remodeling to be predicted in agreement with the general clinical observations of proximal resorption and distal hypertrophy. However, these models do not reproduce other clinically observed bone density trends, including faster stabilizing mid-stem density losses, and loss-recovery trends around the distal stem. These may resemble trends in postoperative joint loading and activity, during recovery and rehabilitation, but the established remodeling prediction approach is often used with identical pre- and postoperative load and activity assumptions. Therefore, this study aimed to evaluate the influence of pre- to postoperative changes in activity and loading upon the predicted progression of remodeling. A strain-adaptive finite element model of a femur implanted with a cemented Charnley stem was generated, to predict 60 months of periprosthetic remodeling. A control set of model input data assumed identical pre- and postoperative loading and activity, and was compared to the results obtained from another set of inputs with three varying activity and load profiles. These represented activity changes during rehabilitation for weak, intermediate and strong recoveries, and pre- to postoperative joint force changes due to hip center translation and the use of walking aids. Predicted temporal bone density change trends were analyzed, and absolute bone density changes and the time to homeostasis were inspected, alongside virtual X-rays. The predicted periprosthetic bone density changes obtained using modified loading inputs demonstrated closer agreement with clinical measurements than the control. The modified inputs also predicted the clinically observed temporal density change trends, but still under
Jäger, Marcus; van Wasen, Andrea; Warwas, Sebastian; Landgraeber, Stefan; Haversath, Marcel; Group, VITAS
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
Jäger, Marcus; van Wasen, Andrea; Warwas, Sebastian; Landgraeber, Stefan; Haversath, Marcel; Group, Vitas
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
Rady, Ahmad Emad; Asal, Mohammed Kamal; Bassiony, Ayman Abdelaziz
Recurrent dislocation after total hip arthroplasty is a disabling complication that can be difficult to treat. We evaluated the early clinical and radiographic outcome associated with the use of a constrained acetabular component for instability in total hip arthroplasty. Fifteen patients underwent either primary or revision total hip arthroplasty with a cementless constrained acetabular component for different indications. The mean patient age at surgery was 57.4 years and the mean clinical and radiological follow-up period was 26.4 months. Clinical assessment was performed by the Harris hip score and at the latest follow up patients reported outcome using the Oxford hip score questionnaire. All radiographs were evaluated for evidence of loosening. Only one patient experienced redislocation with the constrained prosthesis. The average Harris hip score increased from a preoperative mean of 22 (range, 16 - 36) to a postoperative mean of 85 (range, 66-94). Preoperatively, the mean Oxford Hip Score was 48.6, which decreased to 20.5 at the final examination. All but one of the 15 hips had a well-fixed, stable cup. Femoral component stability with bone ingrowth was achieved in 10 cases. A constrained acetabular component is an effective option for the treatment of hip instability in primary and revision arthroplasty in those at high risk of dislocation. The potential for aseptic loosening requires evaluation by long term studies.
Hischebeth, G T R; Wimmer, M D; Molitor, E; Seifert, H; Gravius, S; Bekeredjian-Ding, I
Acinetobacter baumannii is an emerging nosocomial pathogen primarily in countries with a high prevalence of multidrug resistance. Here we report the detection of a bla OXA23 carbapenemase-producing A. baumannii strain in a German patient with prosthetic hip joint infection following several hip joint surgeries but no history of foreign travel.
Schwarzkopf, Ran; Russell, Tara A; Shea, Megan; Slover, James D
Orthopaedic patients with poor nutritional status are at an increased risk of postoperative complications, such as infection and wound healing. Nasal colonization with Staphylococcus aureus, especially with methicillin-resistant Staphylococcus aureus, has been shown to be a risk factor for surgical-site infections. We examined the incidence of nutritional depletion in our arthroplasty population and its correlation with Staphylococcus aureus colonization. We conducted a retrospective review of prospectively collected data of our arthroplasty patient population. Patients with known Staphylococcus aureus colonization or surgical-site infection were compared with a random cohort of patients. Patient demographics, preoperative nasal culture, and two nutritional screening scores were collected. Six hundred and fifty-two patients underwent arthroplasty and completed preoperative nasal cultures and nutritional assessment. A high percentage (27%) of our patients demonstrated some level of nutritional depletion prior to joint replacement. Overall nutritional scores were not significantly associated with surgery-type, preoperative nasal culture, or surgical- site infection in our patient population.
Karva, A R; Board, T N; Porter, M L
We present a 25-year-old patient with juvenile rheumatoid arthritis and ankylosis of both hips and both knees treated by staged bilateral hip and knee arthroplasty. She was followed up for 18 months. We discuss the pre-operative planning, surgical details and post-operative rehabilitation.
Otto, K; Matis, U
Changes in cardiopulmonary function and platelet count were determined in 22 dogs of various breeds that underwent total hip replacement with cemented femoral prostheses. In 11 dogs (group I) polymethylmethacrylate (PMMA) was inserted without venting the reamed and lavaged femoral canal. In a second group of 11 dogs (group II) a urethral catheter (ID: approximately 2.7 mm) was placed into the medullary cavity before the insertion of PMMA. The application of PMMA resulted in a decrease in end-tidal carbon dioxide tension (PETCO2) until 5 minutes after insertion of bone cement. Increases in arterial to end-tidal pCO2 gradient [P(a-ET)CO2] and physiological dead space (VD/VT) were recorded between 2 minutes before and 5 minutes after insertion of PMMA in 12 dogs. A significant decrease in platelet count occurred in both groups of dogs. Decreases in arterial pO2 (PaO2), arterial/alveolar oxygen tension ratio (PaO2/PAO2), and percent O2 saturation of hemoglobin in arterial blood (SaO2) were not statistically significant. No significant differences could be detected between data obtained from both groups of dogs. An increase in femoral intramedullary pressure caused by the insertion of PMMA and subsequent pulmonary microembolism by medullary contents has been considered the most likely cause for changes in pulmonary function. The lack of statistically significant differences in cardiopulmonary variables and platelet count between the two groups of dogs could have been related to inefficient pressure reduction by the method used.
Kapoor, Alok; Chuang, Warren; Radhakrishnan, Nila; Smith, Kenneth J; Berlowitz, Dan; Segal, Jodi B; Katz, Jeffrey N; Losina, Elena
Total hip and knee replacements (THR and TKR) are high-risk settings for venous thromboembolism (VTE). This review summarizes the cost effectiveness of VTE prophylaxis regimens for THR and TKR. We searched MEDLINE (January 1997 to October 2009), EMBASE (January 1997 to June 2009) and the UK NHS Economic Evaluation Database (1997 to October 2009). We analysed recent cost-effectiveness studies examining five categories of comparisons: (i) anticoagulants (warfarin, low-molecular-weight heparin [LMWH] or fondaparinux) versus acetylsalicylic acid (aspirin); (ii) LMWH versus warfarin; (iii) fondaparinux versus LMWH; (iv) comparisons with new oral anticoagulants; and (v) extended-duration (> or =3 weeks) versus short-duration (<3 weeks) prophylaxis. We abstracted information on cost and effectiveness for each prophylaxis regimen in order to calculate an incremental cost-effectiveness ratio. Because of variations in effectiveness units reported and horizon length analysed, we calculated two cost-effectiveness ratios, one for the number of symptomatic VTE events avoided at 90 days and the other for QALYs at the 1-year mark or beyond. Our search identified 33 studies with 67 comparisons. After standardization, comparisons between LMWH and warfarin were inconclusive, whereas fondaparinux dominated LMWH in nearly every comparison. The latter results were derived from radiographic VTE rates. Extended-duration prophylaxis after THR was generally cost effective. Small numbers prohibit conclusions about aspirin, new oral anticoagulants or extended-duration prophylaxis after TKR. Fondaparinux after both THR and TKR and extended-duration LMWH after THR appear to be cost-effective prophylaxis regimens. Small numbers for other comparisons and absence of trials reporting symptomatic endpoints prohibit comprehensive conclusions.
Liebs, T R; Nasser, L; Herzberg, W; Rüther, W; Hassenpflug, J
Several factors have been implicated in unsatisfactory results after total hip replacement (THR). We examined whether femoral offset, as measured on digitised post-operative radiographs, was associated with pain after THR. The routine post-operative radiographs of 362 patients (230 women and 132 men, mean age 70.0 years (35.2 to 90.5)) who received primary unilateral THRs of varying designs were measured after calibration. The femoral offset was calculated using the known dimensions of the implants to control for femoral rotation. Femoral offset was categorised into three groups: normal offset (within 5 mm of the height-adjusted femoral offset), low offset and high offset. We determined the associations to the absolute final score and the improvement in the mean Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain subscale scores at three, six, 12 and 24 months, adjusting for confounding variables. The amount of femoral offset was associated with the mean WOMAC pain subscale score at all points of follow-up, with the low-offset group reporting less WOMAC pain than the normal or high-offset groups (six months: 7.01 (sd 11.69) vs 12.26 (sd 15.10) vs 13.10 (sd 16.20), p = 0.006; 12 months: 6.55 (sd 11.09) vs 9.73 (sd 13.76) vs 13.46 (sd 18.39), p = 0.010; 24 months: 5.84 (sd 10.23) vs 9.60 (sd 14.43) vs 13.12 (sd 17.43), p = 0.004). When adjusting for confounding variables, including age and gender, the greatest improvement was seen in the low-offset group, with the normal-offset group demonstrating more improvement than the high-offset group.
Naylor, C D; Williams, J I
OBJECTIVES--To develop, from simple clinical factors, criteria to identify appropriate patients for referral to a surgeon for consideration for arthroplasty, and to rank them in the queue once surgery is agreed. DESIGN--Delphi process, with a panel including orthopaedic surgeons, rheumatologists, general practitioners, epidemiologists, and physiotherapists, who rated 120 case scenarios for appropriateness and 42 for waiting list priority. Scenarios incorporated combinations of relevant clinical factors. It was assumed that queues should be organised not simply by chronology but by clinical and social impact of delayed surgery. The panel focused on information obtained from clinical histories, to ensure the utility of the guidelines in practice. Relevant high quality research evidence was limited. SETTING--Ontario, Canada. MAIN MEASURES--Appropriateness ratings on a 7-point scale, and urgency rankings on a 4-point scale keyed to specific waiting times. RESULTS--Despite incomplete evidence panellists agreed on ratings in 92.5% of appropriateness and 73.8% of urgency scenarios versus 15% and 18% agreement expected by chance, respectively. Statistically validated algorithms in decision tree form, which should permit rapid estimation of urgency or appropriateness in practice, were compiled by recursive partitioning. Rating patterns and algorithms were also used to make brief written guidelines on how clinical factors affect appropriateness and urgency of surgery. A summary score was provided for each case scenario; scenarios could then be matched to chart audit results, with scoring for quality management. CONCLUSIONS--These algorithms and criteria can be used by managers or practitioners to assess appropriateness of referral for hip or knee replacement and relative rankings of patients in the queue for surgery. PMID:10157268
Waide, V; Cristofolini, L; Stolk, J; Verdonschot, N; Boogaard, G J; Toni, A
The long-term fixation of cemented femoral components may be jeopardised by the presence of a fibrous tissue layer at the bone-cement interface. This study used both experimental and finite element (FE) methods to investigate the load transfer characteristics of two types of cemented hip replacements (Lubinus SPII and Müller-Curved) with a fibrous tissue layer. The experimental part investigated six stems of each type, where these were implanted in composite femurs with a specially selected silicone elastomer modelling the soft interfacial layer. Two fibrous tissue conditions were examined: a layer covering the full cement mantle, representing a revision condition; and a layer covering the proximal portion of the cement mantle, representing a non-revised implant with partial debonding and fibrous tissue formation. The FE method was used to model the full fibrous tissue layer condition, for both implants. The layer was modelled as a homogeneous, linearly isotropic material. A cross-comparison was performed of the experimental and FE findings. Agreement between experimental and FE models was verified to be within 15%. Varying the stiffness parameter of the FE soft tissue layer had little influence on the cortical bone strains, though had considerable effect on the cement strains. Stress shielding occurred for both stems under both fibrous tissue conditions, with the greatest reduction around the calcar. However, the cortical bone strains were generally larger than those for the equivalent well-fixed stems. The fibrous tissue layer was not found to increase the general strain pattern of the cement mantle, though localised regions of high stress were detected.
GRACEFFA, ANGELO; INDELLI, PIER FRANCESCO; LATELLA, LEONARDO; POLI, PAOLO; FULCO, ALEXANDER; MARCUCCI, MASSIMILIANO
Purpose historically, the original CLS Spotorno Stem has demonstrated excellent survival. The design of this stem was recently modified, resulting in the introduction of a shorter, modular version (CLS Brevius). The purpose of the current study was to evaluate the functional, radiological and survivorship outcomes of the cementless CLS Brevius Stem in a multi-surgeon, single center, consecutive series study at two years post-surgery. Methods the Authors performed 170 total hip arthroplasties in 155 patients using the shorter, triple-taper stem design (CLS Brevius). The patients’ diagnoses were primary hip osteoarthritis (OA) in 74.4%, secondary hip OA in 22.6%, and post-traumatic hip OA in 3%. All operations were performed through a mini-posterior approach, with the patient in the lateral decubitus position. The mean follow-up was 32 months (24–44 months). Outcome was assessed using the Harris Hip Score (HHS). Results the mean HHS improved from 32 preoperatively to 92 points at final follow-up, while the stem survival rate was 99.4%. Overall, the results were excellent in148 hips (87%), good in 14 hips (8.2%), fair in six hips (3.6%), and poor in two hips (1.2%). Intraoperative complications included a calcar fissure in three hips (1.7%). Correct femoral offset was reproduced in 97% while the planned center of hip rotation was achieved in 98%. Only one hip underwent early stem revision; this was due to major subsidence. Conclusions the modified CLS stem design showed excellent short-term results with a low rate of early postoperative complications. One of the main findings of this study was the high correlation between the planned femoral offset and center of hip rotation and the final radiographic measurements. This high reproducibility, which indicates the ability of the system to restore normal hip anatomy, is indeed due to the extensive modularity that characterizes this stem system. Long-term follow-up studies are necessary to fully compare the outcomes of
Background and purpose Joint replacement with metal-on-metal (MOM) bearings have gained popularity in the last decades in young and active patients. However, the possible effects of MOM wear debris and its corrosion products are still the subject of debate. Alongside the potential disadvantages such as toxicity, the influences of metal particles and metal ions on infection risk are unclear. Methods We reviewed the available literature on the influence of degradation products of MOM bearings in total hip arthroplasties on infection risk. Results Wear products were found to influence the risk of infection by hampering the immune system, by inhibiting or accelerating bacterial growth, and by a possible antibiotic resistance and heavy metal co-selection mechanism. Interpretation Whether or not the combined effects of MOM wear products make MOM bearings less or more prone to infection requires investigation in the near future. PMID:20860450
Khoo, B. C. C.; Brown, J. K.; Prince, R. L.
Objectives In recent years quantitative computed tomography (QCT) has allowed precise non-invasive, three dimensional, in vivo measurement of hip structure in large numbers of individuals. The effects of ageing on proximal femur structure are reported and implications for the prevention of hip prosthesis loosening and hip fracture considered. Design, Setting and Participants An observational cross-sectional study of proximal femur QCT in 719 unselected female European descent aged 20 to 89 years recruited from US and Australian populations. Main Outcomes Measures QCT scans were obtained using software that separates cortical and cancellous bone by a thresholding technique. Voxel based mineral volume and mass was computed for the integral (external), cancellous and cortical compartments of 1 mm wide sections through the femoral neck (FN), trochanter (TR) and intertrochanter (IT) regions. Results Over the adult life span total integral volumes at the FN, TR and IT sites expand linearly by between 18 and 37% at the same time as bone mass decreased by 22 to 25% resulting in massive reductions in true volumetric BMD (vBMD) of 40 to 50%. Cancellous volume expansion was larger at 65 to 79% at the three sites. Between the ages of 65 and 75 the average increase in cancellous volume at the IT site was 3.74 cm3 (12.1%). Voxel determined FN cortical volume decreased linearly by 43%, as did cortical bone mass so that vBMD did not change substantially. TR and IT cortical volumes decreased 54 and 28% respectively, small reductions in TR and IT cortical vBMD also occurred. Conclusions Large endosteal expansion in the area in which hip replacement stem placement occurs may contribute to loosening. Regarding the propensity to hip fracture, periosteal expansion contributes to increased resistance to bending but cortical thinning contributes to loss of bone to resistance to bending forces. Understanding individual hip structure may contribute to individualisation of risk and
Wraighte, P J; Howard, P W
Femoral impaction bone allografting has been developed as a means of restoring bone stock in revision total hip replacement. We report the results of 75 consecutive patients (75 hips) with a mean age of 68 years (35 to 87) who underwent impaction grafting using the Exeter collarless, polished, tapered femoral stem between 1992 and 1998. The mean follow-up period was 10.5 years (6.3 to 14.1). The median pre-operative bone defect score was 3 (interquartile range (IQR) 2 to 3) using the Endo-Klinik classification. The median subsidence at one year post-operatively was 2 mm (IQR 1 to 3). At the final review the median Harris hip score was 80.6 (IQR 67.6 to 88.9) and the median subsidence 2 mm (IQR 1 to 4). Incorporation of the allograft into trabecular bone and secondary remodelling were noted radiologically at the final follow-up in 87% (393 of 452 zones) and 40% (181 of 452 zones), respectively. Subsidence of the Exeter stem correlated with the pre-operative Endo-Klinik bone loss score (p = 0.037). The degree of subsidence at one year had a strong association with long-term subsidence (p < 0.001). There was a significant correlation between previous revision surgery and a poor Harris Hip score (p = 0.028), and those who had undergone previous revision surgery for infection had a higher risk of complications (p = 0.048). Survivorship at 10.5 years with any further femoral operation as the end-point was 92% (95% confidence interval 82 to 97).
Gandhi, Rajiv; Zywiel, Michael G; Mahomed, Nizar N; Perruccio, Anthony V
The majority of patients with hip or knee osteoarthritis (OA) report one or more symptomatic joints apart from the one targeted for surgical care. Therefore, the purpose of the present study was to investigate the association between the burden of multiple symptomatic joints and self-reported depression in patients awaiting joint replacement for OA. Four hundred and seventy-five patients at a single centre were evaluated. Patients self-reported joints that were painful and/or symptomatic most days of the previous month on a homunculus, with nearly one-third of the sample reporting 6 or more painful joints. The prevalence of depression was 12.2% (58/475). When adjusted for age, sex, education level, hip or knee OA, body mass index, chronic condition count, and joint-specific WOMAC scores, each additional symptomatic joint was associated with a 19% increased odds (odds ratio: 1.19 (95% CI: 1.08, 1.31, P < 0.01)) of self-reported depression. Individuals reporting 6 or more painful joints had 2.5-fold or greater odds of depression when compared to those patients whose symptoms were limited to the surgical joint. A focus on the surgical joint alone is likely to miss a potentially important determinant of postsurgical patient-reported outcomes in patients undergoing hip or knee replacement.
Gallay, Steve; Waddell, James P.; Cardella, Piera; Morton, Jane
Objective To determine the efficacy of a short course of low-molecular-weight heparin (enoxaparin) in the prevention of deep venous thrombosis and pulmonary embolism after elective total hip replacement. Design A prospective cohort study. Follow-up was a minimum of 3 months. Setting An acute-care hospital with a large-volume practice of elective total joint replacement. Patients A prospective group of 150 patients who required primary total hip arthroplasty and a historic control group of 150 patients. All patients were treated with compression stockings, indomethacin and early mobilization. The treatment group received low-molecular-weight heparin, 30 mg every 12 hours for 5 days postoperatively; the control group received no specific anticoagulant therapy. Interventions Total hip replacement. Doppler venography on postoperative day 5 and 2 to 5 days later if required. Main outcome measures Presence or absence of deep venous thrombosis. Wound hemorrhage, transfusion rate, number of units of blood transfused and changes in the hemoglobin level. Results The incidence of proximal deep venous thrombosis (popliteal vein to common iliac vein) was 0% in the treatment group versus 4% in the control group. There was no difference in bleeding or number of transfusions required. There was, however, a significant (p = 0.005) drop in hemoglobin level in the treatment group. Conclusions A short course of low-molecular-weight heparin provides effective protection against proximal deep venous thrombosis without significantly increasing the risk to the patient. The treatment is compatible with early patient discharge and the pharmacologic prevention of heterotopic ossification after total joint replacement. PMID:9126125
Tsang, S-T J; Gaston, P
Total hip replacement (THR) has been shown to be a cost-effective procedure. However, it is not risk-free. Certain conditions, such as diabetes mellitus, are thought to increase the risk of complications. In this study we have evaluated the prevalence of diabetes mellitus in patients undergoing THR and the associated risk of adverse operative outcomes. A meta-analysis and systematic review were conducted according to the guidelines of the meta-analysis of observational studies in epidemiology. Inclusion criteria were observational studies reporting the prevalence of diabetes in the study population, accompanied by reports of at least one of the following outcomes: venous thromboembolic events; acute coronary events; infections of the urinary tract, lower respiratory tract or surgical site; or requirement for revision arthroplasty. Altman and Bland's methods were used to calculate differences in relative risks. The prevalence of diabetes mellitus was found to be 5.0% among patients undergoing THR, and was associated with an increased risk of established surgical site infection (odds ratio (OR) 2.04 (95% confidence interval (CI) 1.52 to 2.76)), urinary infection (OR 1.43 (95% CI 1.33 to 1.55)) and lower respiratory tract infections (OR 1.95 (95% CI 1.61 to 2.26)). Diabetes mellitus is a relatively common comorbidity encountered in THR. Diabetic patients have a higher rate of developing both surgical site and non-surgical site infections following THR.
García-Alvarez, F; Al-Ghanem, R; García-Alvarez, I; López-Baisson, A; Bernal, M
Specific conditions associated with surgery may predispose elderly people to septic complications after hip fracture surgery. This study investigated the risk factors predisposing infection in aged patients with subcapital hip fracture. We performed a prospective study of 290 patients with displaced subcapital hip fracture, operated by means of Thompson hip hemi-arthroplasty (83.5% fractures in women). The mean age was 85.42+/-6.06 years (ranging from 69 to 104). Follow-up was realized until death or at least for 2 years. The chi(2) test, analysis of variance, Kruskal-Wallis test, correlation analysis and the Spearman test were applied. Odds ratios (OR) were calculated. During the hospital stay, there were diagnosed 94 urinary tract infections, 25 pneumonias, 50 superficial wound infections, 11 deep wound infections. Transfusions were made in 120 patients (in average: 2.54+/-1.45 units of red cell concentrate/transfused patient). Transfusion appeared to be correlated with superficial wound infection (OR=1.96), urinary infection (OR=1.76) and pneumonia (OR=2.85). Higher number of days waiting for surgery were related significantly with pneumonia (9.8+/-7.44 days vs. 6.39+/-3.75), or urinary tract infection (7.76+/-4.39 days vs. 6.17+/-4.14). We concluded that the transfusion and longer waiting time for surgery have been associated with the septic complications in elderly patients treated surgically for hip fracture.
Nikolaou, Vasileios S; Korres, Demetrios; Lallos, Stergios; Mavrogenis, Andreas; Lazarettos, Ioannis; Sourlas, Ioannis; Efstathopoulos, Nicolas
AIM: To present the 18 year survival and the clinical and radiological outcomes of the Müller straight stem, cemented, total hip arthroplasty (THA). METHODS: Between 1989 and 2007, 176 primary total hip arthroplasties in 164 consecutive patients were performed in our institution by the senior author. All patients received a Müller cemented straight stem and a cemented polyethylene liner. The mean age of the patients was 62 years (45-78). The diagnosis was primary osteoarthritis in 151 hips, dysplasia of the hip in 12 and subcapital fracture of the femur in 13. Following discharge, serial follow-up consisted of clinical evaluation based on the Harris Hip Score and radiological assessment. The survival of the prosthesis using revision for any reason as an end-point was calculated by Kaplan-Meier analysis. RESULTS: Twenty-four (15%) patients died during the follow-up study, 6 (4%) patients were lost, while the remaining 134 patients (141 hips) were followed-up for a mean of 10 years (3-18 years). HSS score at the latest follow-up revealed that 84 hips (59.5%) had excellent results, 30 (22.2%) good, 11 (7.8%) fair and 9 (6.3%) poor. There were 3 acetabular revisions due to aseptic loosening. Six (4.2%) stems were diagnosed as having radiographic definitive loosening; however, only 1 was revised. 30% of the surviving stems showed no radiological changes of radiolucency, while 70% showed some changes. Survival of the prosthesis for any reason was 96% at 10 years and 81% at 18 years. CONCLUSION: The 18 year survival of the Müller straight stem, cemented THA is comparable to those of other successful cemented systems. PMID:24147267
Rijavec, B; Košak, R; Daniel, M; Kralj-Iglič, V; Dolinar, D
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.
Yu, Bin; He, Miao; Cai, Guang-Yu; Zou, Tian-Xiao; Zhang, Na
Abstract Background: Continuous femoral nerve block and fascia iliaca compartment block are 2 traditional anesthesia methods in orthopedic surgeries, but it is controversial which method is better. The objective of this study was to compare the practicality, efficacy, and complications of the 2 modalities in hip replacement surgery in the elderly and to assess the utility of a novel cannula-over-needle set. Methods: In this prospective, randomized controlled clinical investigation, 60 elderly patients undergoing hip replacement were randomly assigned to receive either continuous femoral nerve block or continuous fascia iliaca compartment block. After ultrasound-guided nerve block, all patients received general anesthesia for surgery and postoperative analgesia through an indwelling cannula. Single-factor analysis of variance was used to compare the outcome variables between the 2 groups. Results: There was a significant difference between the 2 groups in the mean visual analog scale scores (at rest) at 6 hours after surgery: 1.0 ± 1.3 in the femoral nerve block group vs 0.5 ± 0.8 in the fascia iliaca compartment block group (P < 0.05). The femoral nerve block group had better postoperative analgesia on the medial aspect of the thigh, whereas the fascia iliaca compartment block group had better analgesia on the lateral aspect of the thigh. There were no other significant differences between the groups. Conclusions: Both ultrasound-guided continuous femoral nerve block and fascia iliaca compartment block with the novel cannula-over-needle provide effective anesthesia and postoperative analgesia for elderly hip replacement patients. PMID:27759633
Leyvraz, P F; Bachmann, F; Hoek, J; Büller, H R; Postel, M; Samama, M; Vandenbroek, M D
OBJECTIVE--To evaluate the efficacy and safety of two subcutaneous prophylactic regimens for postoperative deep vein thrombosis after total hip replacement. DESIGN--Prospective open randomised multicentre trial. SETTING--28 European departments of orthopaedic surgery. INTERVENTION--All patients had bilateral phlebography 10 days after surgery. 31 patients receiving low molecular weight heparin and 29 receiving unfractionated heparin were excluded from the efficacy analysis for various reasons. PATIENTS--349 patients undergoing total hip replacement between September 1988 and May 1989. 174 patients received subcutaneously a low molecular weight heparin (Fraxiparine) with anti-factor Xa activity of 41 IU/kg/day for three days, then 62 IU/kg/day from day 4 to day 10. 175 patients received subcutaneous unfractionated heparin at intervals of eight hours; doses were adjusted to maintain the activated thromboplastin time at two to five seconds above control values. MAIN OUTCOME MEASURE--Total incidence of deep vein thrombosis and incidence of proximal deep vein thrombosis on bilateral phlebography. RESULTS--The total incidence of deep vein thrombosis was 16% in patients receiving unfractionated heparin and 12.6% in patients receiving low molecular weight heparin (p = 0.45), and the incidence of thrombosis of the proximal veins was 13.1% and 2.9% respectively (p less than 0.001). Four patients receiving unfractionated heparin and one receiving low molecular weight heparin developed pulmonary embolism. The incidence of bleeding complications was low and comparable in the two groups. CONCLUSION--Low molecular weight heparin is at least as effective as unfractionated heparin in preventing deep vein thrombosis and is more effective at preventing thrombosis of the proximal veins in patients undergoing hip replacement. Low molecular weight heparin is not more likely to cause bleeding complications and is simpler to give than unfractionated heparin. PMID:1655136
Roth, Virginia R; Mitchell, Robyn; Vachon, Julie; Alexandre, Stéphanie; Amaratunga, Kanchana; Smith, Stephanie; Vearncombe, Mary; Davis, Ian; Mertz, Dominik; Henderson, Elizabeth; John, Michael; Johnston, Lynn; Lemieux, Camille; Pelude, Linda; Gravel, Denise
BACKGROUND Hip and knee arthroplasty infections are associated with considerable healthcare costs. The merits of reducing the postoperative surveillance period from 1 year to 90 days have been debated. OBJECTIVES To report the first pan-Canadian hip and knee periprosthetic joint infection (PJI) rates and to describe the implications of a shorter (90-day) postoperative surveillance period. METHODS Prospective surveillance for infection following hip and knee arthroplasty was conducted by hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) using standard surveillance definitions. RESULTS Overall hip and knee PJI rates were 1.64 and 1.52 per 100 procedures, respectively. Deep incisional and organ-space hip and knee PJI rates were 0.96 and 0.71, respectively. In total, 93% of hip PJIs and 92% of knee PJIs were identified within 90 days, with a median time to detection of 21 days. However, 11%-16% of deep incisional and organ-space infections were not detected within 90 days. This rate was reduced to 3%-4% at 180 days post procedure. Anaerobic and polymicrobial infections had the shortest median time from procedure to detection (17 and 18 days, respectively) compared with infections due to other microorganisms, including Staphylococcus aureus. CONCLUSIONS PJI rates were similar to those reported elsewhere, although differences in national surveillance systems limit direct comparisons. Our results suggest that a postoperative surveillance period of 90 days will detect the majority of PJIs; however, up to 16% of deep incisional and organ-space infections may be missed. Extending the surveillance period to 180 days could allow for a better estimate of disease burden. Infect Control Hosp Epidemiol 2017;38:147-153.
Munir, Selin; Walter, William L; Walsh, William Robert
Modular hip implants allows for the adjustment of leg length, offset, and the ability to remove the head for acetabular exposure during primary and revision surgery. The design of the Morse taper facilitates the intimate contact of the conical trunnion of the femoral stem (male component), with the conical bore of the femoral head (female component). Orthopaedic trunnion tapers are not standardized and vary in length, taper angle, and base dimension. Variations in the design and surface characteristics of the trunnion, will directly reflect on the interface at the taper junction and can influence the likelihood of subsequent wear, corrosion and longevity of the implant. The effect of surface topography of trunnions on commercially available hip stems has not yet been considered as a possible contributing factor in the corrosion observed at taper junctions. In this study we analyzed the surface topography and surface roughness of randomly selected commercially available femoral hip stem trunnions to obtain a greater insight into their surface characteristics.
The elderly population is growing. Geriatric patients undergo a large proportion of surgical procedures and have increased complications, morbidity, and mortality, which may be associated with increased intensive care unit time, length of stay, hospital readmission, and cost. Identification of optimal anesthetic care for these patients, leading to decreased complications and contributing to best possible outcomes, will have great value. This article reviews the anesthetic considerations for intraoperative care of geriatric patients and focus on 3 procedures (hip fractures, emergency abdominal surgery, and transcatheter aortic valve replacement). An approach to evaluation and management of the elderly surgical patient is described.
Cruz, Encarnacion; Cano, Juan Ramon; Benitez-Parejo, Nicolás; Rivas-Ruiz, Francisco; Perea-Milla, Emilio; Guerado, Enrique
Surgery for the treatment of hip fractures is considered the gold standard even among nonagerians with a heavy comorbidity burden. Therefore, a study of an association between surgical complications and some variables in elderly individuals appears to be very important. We designed a transverse study in which we determined patient age at the time of development of a nosocomial infection (NI) in patients who underwent surgery to treat a hip fracture. Univariate and multivariate analyses were performed by simple and multiple logistic regression. We found that age was a determinant in NI after surgical treatment for hip fracture. The older the patient was, the higher the risk of development of an NI after surgical treatment for hip fracture (operative hypothesis). However, the risk of infection changed depending on the treatment. No association with other variables was found.
Ceretti, Marco; Falez, Francesco
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.
Villalba, J; Solernou, X
Many postoperative complications have been described after a total hip arthroplasty, with early and acute, as well as late, complications being reported. Two cases of compartment syndrome of the buttock are described following a hybrid total hip arthroplasty (cemented stem and press-fit and screwed acetabulum) performed on 2 patients of 60 and 68 years old, both diagnosed and treated 24-48 hours after the surgery. Both cases had a primary prosthesis with no previous significant pathological findings. This condition is still rare, and few cases have been described at the medical literature.
Weisenstein, D B; Popescu, I-A
This article presents the case of a patient with an acute late infection of the hip prosthesis. At first, complaints in the hip region were in the foreground. Shortly after the revision operation the patient noticed a barking noise during micturition, as sign of a pneumaturia. The following diagnostics showed a perforated sigmoid diverticulitis with a sigmoid-urinary bladder-fistula.
Ultra-high-molecular weight polyethylene (PE) cups bearing against metal or ceramic balls are the most commonly used combinations of materials for human hip joint replacements. The wear properties of these materials are typically evaluated in the laboratory using hip joint wear simulators, while lubricated with bovine serum. A previous test evaluating the PE cups against cobalt-chrome (CoCr), zirconia (Zr) and alumina balls demonstrated the sensitivity of serum proteins to elevated temperature; especially for Zr/PE, which showed the highest protein precipitation and bulk lubricant temperature but the lowest cup wear. In the present investigation, a temperature control system was used on a hip simulator to systematically evaluate the relationship between temperature and denaturation of the serum proteins which, in turn, affects the friction and wear properties of the prosthetic materials being tested. In order to control protein precipitation, the interface was temperature reduced by circulating coolant at 4°C through the center of the CoCr or Zr balls during a wear test. With cooling, protein assay of the serum showed 66% and 50% reductions in protein precipitation with the CoCr and Zr balls, respectively. The wear rate of the PE cups against the CoCr balls decreased by an average of 44%, whereas two of the three PE cups running against Zr balls exhibited slight increases in their wear rates, and the third showed a two fold increase. Under scanning electron microscopy, there were marked differences in the worn surfaces of the cups for the various conditions, and differences in the morphology of the PE wear debris recovered from the serum. For example, granular particles predominated without cooling, whereas fibrous particles predominated with cooling. Since particles generated in vivo (i.e., retrieved from periprosthetic tissues) typically show approximately equal proportions of granules and fibrils, the use of an intermediate coolant temperature might provide
Park, Chan Ho; Lee, Young-Kyun
Purpose Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is a grave complication. Urinary tract infection (UTI) as a source for PJI is controversial. Our purposes were, (1) to evaluate the incidence of PJI after elective primary THA and (2) to determine whether UTI was associated with a risk of PJI after elective primary THA. Materials and Methods We retrospectively reviewed the medical records of 527 patients who underwent elective primary THA by using universal aseptic technique from May 2003 to October 2007. UTI group (13 patients) was defined as patients who underwent THA in status of having an UTI, and the remaining patients were defined as control group (514 patients). We compared the incidence of PJI in both groups. Results During the study period, the incidence of PJI was 0%, regardless of existence (or presence) of UTI. Conclusion There was no significant association between UTI and PJI, when cautiously performed THA. PMID:28316960
Ebreo, D; Bell, P J; Arshad, H; Donell, S T; Toms, A; Nolan, J F
Metal artefact reduction (MAR) MRI is now widely considered to be the standard for imaging metal-on-metal (MoM) hip implants. The Medicines and Healthcare Products Regulatory Agency (MHRA) has recommended cross-sectional imaging for all patients with symptomatic MoM bearings. This paper describes the natural history of MoM disease in a 28 mm MoM total hip replacement (THR) using MAR MRI. Inclusion criteria were patients with MoM THRs who had not been revised and had at least two serial MAR MRI scans. All examinations were reported by an experienced observer and classified as A (normal), B (infection) or C1-C3 (mild, moderate, severe MoM-related abnormalities). Between 2002 and 2011 a total of 239 MRIs were performed on 80 patients (two to four scans per THR); 63 initial MRIs (61%) were normal. On subsequent MRIs, six initially normal scans (9.5%) showed progression to a disease state; 15 (15%) of 103 THRs with sequential scans demonstrated worsening disease on subsequent imaging. Most patients with a MoM THR who do not undergo early revision have normal MRI scans. Late progression (from normal to abnormal, or from mild to more severe MoM disease) is not common and takes place over several years.
Chammout, Ghazi; Muren, Olle; Laurencikas, Evaldas; Bodén, Henrik; Kelly-Pettersson, Paula; Sjöö, Helene; Stark, André; Sköldenberg, Olof
Background and purpose Total hip replacement (THR) is the preferred method for the active and lucid elderly patient with a displaced femoral neck fracture (FNF). Controversy still exists regarding the use of cemented or uncemented stems in these patients. We compared the effectiveness and safety between a modern cemented, and a modern uncemented hydroxyapatite-coated femoral stem in patients 65–79 years of age who were treated with THR for displaced FNF. Patients and methods In a single-center, single-blinded randomized controlled trial, we included 69 patients, mean age 75 (65–79) and with a displaced FNF (Garden III–IV). 35 patients were randomized to a cemented THR and 34 to a reverse-hybrid THR with an uncemented stem. Primary endpoints were: prevalence of all hip-related complications and health-related quality of life, evaluated with EuroQol-5D (EQ-5D) index up to 2 years after surgery. Secondary outcomes included: overall mortality, general medical complications, and hip function. The patients were followed up at 3, 12, and 24 months. Results According to the calculation of sample size, 140 patients would be required for the primary endpoints, but the study was stopped when only half of the sample size was included (n = 69). An interim analysis at that time showed that the total number of early hip-related complications was substantially higher in the uncemented group, 9 (among them, 3 dislocations and 4 periprosthetic fractures) as compared to 1 in the cemented group. The mortality and functional outcome scores were similar in the 2 groups. Interpretation We do not recommend uncemented femoral stems for the treatment of elderly patients with displaced FNFs. PMID:27967333
Jalovaara, P; Puranen, J
Air bacterial and particle counts were obtained in a conventionally ventilated operating theatre, during 8 operations for total hip replacement performed using synthetic non-woven fabrics as drapes for the patients and gowns for the staff (trousers and stockings were of conventional cotton material), ('non-woven' group), and in 8 corresponding operations using conventional cotton fabrics ('cotton' group). No significant difference between the groups with regard to air bacterial counts was observed. The use of cotton fabrics was associated with substantially higher particle counts, probably due to particles from the cotton textiles themselves. No significant correlation was observed between the bacterial and particle counts, indicating that these came from different sources and that the particles were mainly of sterile origin. Thus, the benefit of the synthetic, non-woven fabrics in hip replacement surgery, when these fabrics are used to cover theatre staff only partially in the form of gowns, seems questionable with regard to the reduction of air bacterial counts. On the other hand, the surgical textiles of non-woven material improve the purity of the operating theatre since unlike cotton fabrics they do not produce and disperse particles in the air.
Lindner, Tobias; Krüger, Christine; Kasch, Cornelius; Finze, Susanne; Steens, Wolfram; Mittelmeier, Wolfram; Skripitz, Ralf
Background : Numerous studies have shown reduction of periprosthetic bone mineral density (BMD) after hip replacement. The effect on the whole limb, however, is still unexplored. This study’s objective was to analyse the postoperative development of BMD and muscle strength of the limb after total hip replacement (THR) and to determine links between these parameters. Methods : 55 patients, who underwent THR, were included. Depending on therapeutic indication, either an uncemented stem (Group A, n=30) or a cemented stem (Group B, n=25) has been implanted. In the limbs, the measurement of BMD using DEXA and the maximum isometric muscle strength, detected by a leg press, were undertaken preoperatively and after 3, 6 and 12 months. Results : A total of 12 patients (Group A: n = 6, Group B: n = 6) were excluded due to reasons which were not relevant to the study. So, the results refer to the data of 43 patients. In Group A (uncemented, n = 24), a significant decrease of BMD on the operated extremity was seen after 3, 6 and 12 months compared with preoperative values. Isometric muscle strength on the affected extremity increased significantly after 6 and 12 months. In Group B (cemented, n = 19), with a lower baseline compared to group A, an increase in BMD of the affected limb was seen postoperatively. This rise was significant after 12 months. With regard to the isometric muscle strength, a significant increase could be observed in this group after 6 and 12 months. Conclusion : Analogous to postoperative reduction of periprosthetic bone density, a decrease of the entire limb BMD on the operated leg occurred after implantation of uncemented hip stems. In contrast, an increase in BMD was recorded for cemented stems. Regardless of the type of anchoring, a substantial increase in muscular strength could be observed postoperatively in both groups. PMID:25246993
Ceretti, Marco; Falez, Francesco
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
Although total hip prosthetic replacement is a common surgical procedure, it is not without social and professional consequences. In a certain number of cases, return to occupational activities is not possible. In others, it is difficult. Long-term work break repercussions can be major as they often go together with financial difficulties. The medical counsultant and the occupational doctor will have an important role to play at the time of the return to occupational activities or to determine the conditions of workplace adaptation or a vocational training program.Functional recovery after insertion of total hip prosthesis observes precise rules of articular mobilization, weight bearing and muscular strengthening.In the young patient, before 50 years old, objectives will be more accurate and progress not only will concern recovery of daily living, walking and do-it-yourself activities but also return to sports, play and occupational activities. Not only will reactivation be physical, muscular and articular but also behavioral and psychological.Disease and its consequences, surgery in particular, cause a psychological and a physical aggression which modifies the patient's self-concept. • Vulnerability and plastic wrong (limping, modifications of gesture and sports performanee as well as modifications of the living conditions). The patient unconsciously translates this physical affection into: * loneliness (taking away or exclusion from the usual surroundings of those who are in good health) * "blues" * lack of dynamism * uselessness, feeling of being incompetent "in those conditions, what's the use of fighting?" ٜ At the same time - loss of social status: "Colleagues get up to go to work, children go to school, all the others are productive, I'm good at nothing." - impression of uselessness, dependence; reinforcement of turning in on the self. •The undertaking by a surgeon and his team (anaesthetist, nurse, physiotherapist) which implies constraints, orders
Roberts, J. C.; Ling, F. F.; Jones, W. R., Jr.
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.
Schwartsmann, Carlos Roberto; Spinelli, Leandro de Freitas; Boschin, Leonardo Carbonera; Yépez, Anthony Kerbes; Crestani, Marcus Vinicius; Silva, Marcelo Faria
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 1(st), 1970 to July 31(th), 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.
Pasek, Jarosław; Koczy, Bodgan; Stołtny, Tomasz; Pajak, Jan; Pyda, Michał; Pasek, Tomasz; Kloza, Zygmunt; Sieroń, Aleksander
In last years on the whole world violently grows up the number of patients at which occurrence productive degenerative changes of osteoarticular system. Actually these diseases more and more concern the young persons, active professionally. This consequences of these changes lead to limiting the functional functions of pond, pain as well as they worsen the quality of life. Pain in degenerative joint disease of various aetiology can be combated with the new surgical techniques offered by contemporary orthopaedics. Hip alloplasty is the only effective treatment method facilitating the restoration of physical fitness, correct mobility and the eradication of chronic pain. After operating introduces the different methods of improving finally. This work presents physiotherapeutic procedures, commenced on admission to the orthopaedic ward, involved in hip joint alloplasty with the J&J Proxima stem. The disseminating of introduced model of improving as well as the initiation him to program of the treatment confirms the legitimacy of choice, and it influences on improvement of the state of health also and the patients' functional efficiency with degenerative disease of hip joint.
Schwartsmann1, Carlos Roberto; Spinelli, Leandro de Freitas; Boschin, Leonardo Carbonera; Yépez, Anthony Kerbes; Crestani, Marcus Vinicius; Silva, Marcelo Faria
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
Born, Philipp; Ilchmann, Thomas; Zimmerli, Werner; Zwicky, Lukas; Graber, Peter; Ochsner, Peter E; Clauss, Martin
Background and purpose — The use of uncemented revision stems is an established option in 2-stage procedures in patients with periprosthetic joint infection (PJI) after total hip arthroplasty (THA). However, in 1-stage procedures, they are still rarely used. There are still no detailed data on radiological outcome after uncemented 1-stage revisions. We assessed (1) the clinical outcome, including reoperation due to persistent infection and any other reoperation, and (2) the radiological outcome after 1- and 2-stage revision, using an uncemented stem. Patients and methods — Between January 1993 and December 2012, an uncemented revision stem was used in 81 THAs revised for PJI. Patients were treated with 1- or 2-stage procedures according to a well-defined algorithm (1-stage: n = 28; 2-stage: n = 53). All hips had a clinical and radiological follow-up. Outcome parameters were eradication of infection, re-revision of the stem, and radiological changes. Survival was calculated using Kaplan-Meier analysis. Radiographs were analyzed for bone restoration and signs of loosening. The mean clinical follow-up time was 7 (2–15) years. Results — The 7-year infection-free survival was 96% (95% CI: 92–100), 100% for 1-stage revision and 94% for 2-stage revision (95% CI: 87–100) (p = 0.2). The 7-year survival for aseptic loosening of the stem was 97% (95% CI: 93–100), 97% for 1-stage revision (95% CI: 90–100) and 97% for 2-stage revision (95% CI: 92–100) (p = 0.3). No further infection or aseptic loosening occurred later than 7 years postoperatively. The radiographic results were similar for 1- and 2-stage procedures. Interpretation — Surgical management of PJI with stratification to 1- or 2-stage exchange according to a well-defined algorithm combined with antibiotic treatment allows the safe use of uncemented revision stems. Eradication of infection can be achieved in most cases, and medium- and long-term results appear to be comparable to those for revisions
Born, Philipp; Ilchmann, Thomas; Zimmerli, Werner; Zwicky, Lukas; Graber, Peter; Ochsner, Peter E; Clauss, Martin
Background and purpose - The use of uncemented revision stems is an established option in 2-stage procedures in patients with periprosthetic joint infection (PJI) after total hip arthroplasty (THA). However, in 1-stage procedures, they are still rarely used. There are still no detailed data on radiological outcome after uncemented 1-stage revisions. We assessed (1) the clinical outcome, including reoperation due to persistent infection and any other reoperation, and (2) the radiological outcome after 1- and 2-stage revision, using an uncemented stem. Patients and methods - Between January 1993 and December 2012, an uncemented revision stem was used in 81 THAs revised for PJI. Patients were treated with 1- or 2-stage procedures according to a well-defined algorithm (1-stage: n = 28; 2-stage: n = 53). All hips had a clinical and radiological follow-up. Outcome parameters were eradication of infection, re-revision of the stem, and radiological changes. Survival was calculated using Kaplan-Meier analysis. Radiographs were analyzed for bone restoration and signs of loosening. The mean clinical follow-up time was 7 (2-15) years. Results - The 7-year infection-free survival was 96% (95% CI: 92-100), 100% for 1-stage revision and 94% for 2-stage revision (95% CI: 87-100) (p = 0.2). The 7-year survival for aseptic loosening of the stem was 97% (95% CI: 93-100), 97% for 1-stage revision (95% CI: 90-100) and 97% for 2-stage revision (95% CI: 92-100) (p = 0.3). No further infection or aseptic loosening occurred later than 7 years postoperatively. The radiographic results were similar for 1- and 2-stage procedures. Interpretation - Surgical management of PJI with stratification to 1- or 2-stage exchange according to a well-defined algorithm combined with antibiotic treatment allows the safe use of uncemented revision stems. Eradication of infection can be achieved in most cases, and medium- and long-term results appear to be comparable to those for revisions for aseptic
Leng, Joanna; Al-Hajjar, Mazen; Wilcox, Ruth; Jones, Alison; Barton, David; Fisher, John
Variation in the surgical positioning of total hip replacement can result in edge loading of the femoral head on the rim of the acetabular cup. Previous work has reported the effect of edge loading on the wear of hip replacement bearings with a fixed level of dynamic biomechanical hip separation. Variations in both rotational and translational surgical positioning of the hip joint replacement combine to influence both the biomechanics and the tribology including the severity of edge loading, the amount of dynamic separation, the force acting on the rim of the cup and the resultant wear and torque acting on the cup. In this study, a virtual model of a hip joint simulator has been developed to predict the effect of variations in some surgical positioning (inclination and medial-lateral offset) on the level of dynamic separation and the contact force of the head acting on the rim as a measure of severity of edge loading. The level of dynamic separation and force acting on the rim increased with increased translational mismatch between the centres of the femoral head and the acetabular cup from 0 to 4 mm and with increased cup inclination angle from 45° to 65°. The virtual model closely replicated the dynamics of the experimental hip simulator previously reported, which showed similar dynamic biomechanical trends, with the highest level of separation being found with a mismatch of 4 mm between the centres of the femoral head and acetabular cup and 65° cup inclination angle.
Bragdon, Charles R; Estok, Daniel M; Malchau, Henrik; Kärrholm, Johan; Yuan, Xunhua; Bourne, Robert; Veldhoven, Jean; Harris, William H
Radiostereometric analysis (RSA) has been used extensively to evaluate the magnitude and direction of penetration of the femoral head into the acetabular component of a total hip replacement as a result of polyethylene wear and creep. The accuracy and precision of an RSA study depends on several factors, including the radiographic technique, the analytical software, and the positioning of the tantalum markers. This study had three sequential purposes. First, an in vitro phantom model was used to quantify the accuracy and precision of digital images versus conventional radiography in RSA measurements of penetration of the femoral head into the acetabular shell in a total hip replacement. The Umeå RSA software package was used for analysis of both the conventional films, which were digitized at a resolution of 300 DPI, and digital radiographs, which were converted from a DICOM format at a resolution of 218 DPI. Digital radiography was found to be superior. Next, two methods of RSA analysis currently in use for determining femoral head penetration into polyethylene of total joint replacements were compared. Using the phantom model, we compared the Umeå RSA system (Biomedical Innovations AB) to the RSA-CMS (RSA Clinical Measurement Solution) and in both cases used the digital radiographs. The Umeå RSA system was found to be superior. Finally, two methods of marking the position of the acetabular component with tantalum beads were compared: one in which beads were inserted into previously described towers protruding from the back of the acetabular shell and another in which beads were placed into the peripheral flange of the polyethylene liner using the Umeå RSA analysis system of the digital radiographs. The results using the two marker configurations were similar.
Balck, F; Kirschner, S; Jeszenszky, C; Lippmann, M; Günther, K-P
Background: Total hip arthroplasty is one of the most successful operations in medicine. The clinical result after surgery and compliance during rehabilitation are influenced by the patient's expectations. There is a lack of a validated German instrument to record these expectations in a standardised manner. Patients: 193 patients from the Dresden Hip Register with osteoarthritis of the hip were surveyed with respect to their expectations before the operation. The study sample consists of 108 women and 85 men. The average age of the patients was 59.7 years, with a standard deviation of 12.2 years. Methods: The Hospital for Special Patient Expectations Survey was translated into German and culturally adapted. In addition, the RKI demographic core data set, the HADS-D, LOT-R and the SCL-(K-)9 were collected to validate the instrument. In the statistical analysis, four main factors could be distinguished. These were "everyday activities", "pain relief and improvement in function", "medication and social participation" and "gait improvement". Results: Patients were predominantly married. 20 % of the women were widowed. 20 % had received higher education. Almost half of the patients were retired, 30 % were employed, 15.1 % self-employed and 7.3 % were unemployed. For most of the items, patients expected major improvements up to normalisation of their health. There were many different answers to several items, such as the question on occupation. For sporting and sexual activities no high expectations were given. The average expectation of the whole sample shows major differences to individual expectations. Men showed higher expectations for medication, social participation and gait improvement than did women. There were lower expectations for everyday activities, medication and social participation and gait improvement for older patients. Summary: The German version of the HSS patients expectation survey was validated. The instrument is useful in the
Background Recent case–control studies have shown an association between type 3 finger length pattern (longer ring finger than index finger) and knee osteoarthritis. This large cross-sectional study tests the hypothesis that the type 3 pattern is associated with total joint replacements due to osteoarthritis in a large population based study. Methods Finger length ratios were assessed visually on 5170 hand photographs (2975 females, 2195 males, mean age 76). In this population-based multidisciplinary study of aging in Reykjavik, Iceland, the prevalence of osteoarthritis associated total knee replacements was 223(4.3%) and total hip replacements 316(6.1%). We then performed a binary logistic regression analysis for total knee replacements and total hip replacements, including finger length patterns, osteoarthritis at other sites and other variables with possible association to osteoarthritis such as age, BMI and bone mineral density of the spine. Results The prevalence of the type 3 pattern was 50% (43% in females, 58% in males). The regression analysis revealed an odds ratio for total knee replacements of 1.65 (1.24-2.2) p = 0.0007, in the type 3 finger pattern group, similar in both genders. This association was independent of the associations we have previously reported between total knee replacements and BMI and the presence of hand osteoarthritis. No association was seen between finger length patterns and total hip replacements. Conclusion Finger length patterns read from digital photographs in this large study confirm previous radiographic observations with significant associations between the type 3 pattern and total knee replacements but not total hip replacements in both genders in this elderly group. PMID:23530906
Pérez-Núñez, Josefina; Baeza-Montañez, Lourdes
Factor V (FV) is a pivotal coagulation factor present in plasma and platelets. It plays an essential role in secondary haemostasis acting as a cofactor in the prothrombinase complex, catalysing the conversion of prothrombin to thrombin. There is little evidence on the management of mayor orthopaedic surgery in paediatric or adolescents subjects with this coagulopathy and almost no information about thromboprophylaxis in these situations. We report a case of a hip replacement in a 14-year-old girl with moderate FV deficiency (0.07 IU mL−1). As haemostatic replacement, inactivated fresh frozen plasma (FFP) was transfused at doses of 600 mL (15 mL kg−1, 45 kg weight) 2 hours before surgery and then sequential FFP infusions of 250 mL (7 mL kg−1) every 12 hours for 7 days. Plasma factor VIII, von Willebrand factor antigen, and von Willebrand ristocetin cofactor were monitored to avoid supranormal levels. Since the patient was sexually mature (Marshall and Tanner stage 5) with the hormone replacement therapy, she was immobilized and the surgery was considered as a high thrombotic risk. Thus, low molecular weight heparin was administered at doses of intermediate risk (Enoxaparin 20 mg daily, by weight) after finishing the daily infusion of plasma: 24 hours and during the 7 days after intervention. No tranexamic acid was used. No haemorrhagic or thrombotic adverse event was described. PMID:27872768
Fieten, Lorenz; Dupraz, Ingrid; Reising, Kilian; Helwig, Peter; Heger, Stefan; Blömer, Wilhelm; Radermacher, Klaus
In total hip replacement, patient placement in the lateral position is preferred by many surgeons. However, it complicates registration of the so-called pelvic coordinate system that is the standard reference for surgeons to measure cup orientation. This coordinate system comprises the anterior pelvic plane and the mid-sagittal plane, and it is conventionally registered on the basis of bony anatomical landmarks including the left and the right anterior superior iliac spine (ASIS). Ultrasound has been suggested for transcutaneous palpation of the bone surface. The difficulty in registration of the pelvic coordinate system with the patient in the lateral position arises because the contralateral ASIS cannot be reached easily by a mechanical pointer and is not accessible by means of an ultrasound probe. Up to now, methods to compensate for these missing data have not been used in clinical routine. This paper describes a new ultrasound-based method that requires neither image segmentation nor statistical shape models and uses symmetry to approximate the position of the contralateral ASIS. A detailed analysis based on computed tomography data of 60 hips following a cadaver study is presented to show the ability of our method to reliably reconstruct the pelvic coordinate system. The median angles between ground truth planes and the "reconstructed" planes were <2°. By choosing a standard cup orientation w.r.t. the "reconstructed" planes, the median abduction and version angle errors were <2°, too.
Cash, David J W; Khanduja, Vikas
The optimum choice of bearing surfaces in total hip arthroplasty, particularly in the younger and more active patient, remains controversial. Despite several studies demonstrating good long-term results for the metal-on-polyethylene articulation, there has been a recent vogue towards the utilisation of hard-on-hard bearings for younger patients due, in part, to concerns regarding polyethylene induced osteolysis. However, well-documented complications concerning metal-on-metal bearings and the risk of fracture in ceramic-on-ceramic bearings have raised concerns regarding the principle of the hard-on-hard bearing in the active patient. With recent technological advancements in the manufacture of both polyethylene and alumina ceramics, the in vitro properties of each material with regards to strength and toughness have been significantly improved. In addition, ceramic femoral heads have consistently been shown to produce less in vivo polyethylene wear than similar sized metal heads. This paper aims to critically review the biomechanical, in vivo and clinical studies related to the use of the ceramic on polyethylene bearing, and highlights its potential use as the preferred bearing for a young adult hip replacement.
Periasamy, Kumar; Meek, Dominic; Crossman, Paul
Introduction Posterior dislocation of the elbow is usually associated with trauma to the joint with a reported incidence of 3%to 6%. Chronic instability is usually symptomatic following the initial injury. Case presentation We report a case of posterior dislocation of the elbow occurring in a patient while using her arm to lift herself using a monkey pole on the second day following a total hip replacement. The dislocation was reduced under sedation in the ward. There were no signs or symptoms suggesting any joint hypermobility syndrome in the patient. Follow up 4 months following the injury revealed a complete recovery in the range of motion and a pain free elbow. There were no signs and symptoms of any instability. Conclusion This is the first time such a case is reported in the literature. It certainly demonstrates that even in the absence of instability a patient can be predisposed to low energy dislocation of the elbow. PMID:18254950
Wittmann, P H; Wittmann, F W; Ring, P A
A retrospective study of the morbidity and mortality from deep vein thrombosis (DVT) and pulmonary embolus (PE) in 490 consecutive patients undergoing uncemented total hip replacement was carried out in a district general hospital. Special diagnostic tests for DVT and PE were not available. Patients were followed up for one year. There were three deaths in hospital and eight further deaths during the first year, all unrelated to DVT and PE. The clinical incidence of venous thromboembolism was 2.04%. While clinical diagnosis of venous thromboembolic disease probably underestimates its incidence, the figures for mortality are accurate. With every patient accounted for one year after operation, there were no deaths attributable to PE in this series. PMID:1941855
Cook, Richard B; Bolland, Benjamin J R F; Wharton, Julian A; Tilley, Simon; Latham, Jeremy M; Wood, Robert J K
We present an in-depth failure analysis of two large diameter bearing metal-on-polymer (MoP) modular total hip replacements, which have required revision surgery due to pseudotumour formation. The failure analysis showed a discrete pattern of material loss from the distal end of the head taper/stem trunnion interface. We postulate that the use of a proximal contacting taper design had provided insufficient mechanical locking between the head and the stem, enabling the head to toggle on the trunnion. In addition, the difference in angle between the taper and the trunnion formed a crevice between the two components. Through a combination of crevice environment, mechanically assisted corrosion, mechanical wear and erosion; debris and metal-ions have been released resulting in the adverse local tissue reactions (ALTR).
Costa, Christopher R; Johnson, Aaron J; Naziri, Qais; Maralunda, German A; Delanois, Ronald E; Mont, Michael A
The diagnosis of periprosthetic hip infections is often challenging. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level blood laboratory tests are commonly used to aid in the diagnosis. We studied the sensitivity, specificity, and false-negative rates of ESR and CRP level in a prospective group of patients who underwent revision total hip arthroplasty between 2000 and 2008. Seventy-seven patients with periprosthetic hip infections and ESR and CRP data were identified. Chi-square analysis was performed to determine the significance of false-negatives, compared with sex, body mass index, primary diagnosis, infection type, and immunity status. ESR had 89% sensitivity and 69% specificity. CRP level had 93% sensitivity and 40% specificity. The false-negative rate was 10.8% for ESR and 7% for CRP level. The false-negative rate for ESR and CRP level combined (with either result positive) was 3%. All false-negatives in the combined group were immunocompromised. Chi-square analysis did not find a significant correlation between false-negatives and any other variables. ESR and CRP level are useful in the diagnosis of periprosthetic hip infections. Ordering these tests concurrently reduces the chance of false-negative results.
Troelsen, Andres; Møller, Jens K; Bolvig, Lars; Prynø, Thomas; Pedersen, Lisbeth N; Søballe, Kjeld
Invasive infection with animal-associated bacteria, Erysipelotrix rhusiopathiae, is unusual and has, to our knowledge, never been described as the cause of infected total hip arthroplasty. We describe how an infected total hip arthroplasty caused by these bacteria is eradicated using standard surgical and antibiotic treatment. Before 2-stage revision surgery, the patient had persistent groin pain, elevated C-reactive protein, radiographic periprosthetic osteolysis, excessive intra-articular fluid, and periprosthetic activity accumulation on the white cell scan. The patient was treated with benzylpenicillin after confirmed sensitivity of E rhusiopathiae diagnosed by culture of five tissue samples and polymerase chain reaction of the prosthetic sonicate sample. Sixteen weeks after the last stage of revision surgery, there were no signs of reoccurring infection.
Min, Kyung-Keun; Min, Byung-Woo; Choi, Jung-Hoon
Periprosthetic joint infection (PJI) of the hip can be difficult to treat and can lead to a number of problems including: i) severe functional decline of the hip joint and ii) increasing financial burden for patients due to long treatment periods and the need for repeated surgical interventions. Because there is risk of inadequate control of infection or relapse of a preexisting infection following the treatment of PJI through surgery, it is important to closely observe clinical symptoms such as systemic fever. Kikuchi-Fujimoto disease is usually a self-limiting disease characterized by fever and cervical lymphadenopathy. We report one case of Kikuchi-Fujimoto disease, with literatures review, that was mistaken for an infection relapse after surgical treatment of the PJI due to sustained fever postoperatively. PMID:28097116
Vaz, Sofia; Ferreira, Teresa C; Salgado, Lucília; Paycha, Frédéric
In recent years, with the higher median life expectancy, the number of hip and knee replacements has increased. Clinical examination and morphological studies are essential to evaluate patients with a painful arthroplasty. Nuclear medicine examinations also play an important role, their main usefulness being the exclusion of prosthesis complications. Nevertheless, conventional examinations, namely bone scan and white blood cell scintigraphy, can also identify complications, such as loosening and infection. This study describes the normal and pathologic patterns of a bone scan and exemplifies ten common situations that can cause pain in patients with hip or knee arthroplasty, other than loosening and infection, which can be disclosed on a bone scintigraphy. The ten situations that should be considered and looked for when analysing a bone scan are: referred pain, patellofemoral pain syndrome, fractures, fissures, abscess/haematoma, bone insert behaviour, heterotopic ossification, greater trochanter pseudarthrosis, osteoarthritis extension in a knee with an unicompartmental prosthesis, and systemic disease with bone involvement.
Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis
Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis; Perthes Disease
Bennett, D; Humphreys, L; O'Brien, S; Kelly, C; Orr, J F; Beverland, D E
Wear particle accumulation is one of the main contributors to osteolysis and implant failure in hip replacements. Altered kinematics produce significant differences in wear rates of hip replacements in simulator studies due to varying degrees of multidirectional motion. Gait analysis data from 153 hip-replacement patients 10-years post-operation were used to model two- and three-dimensional wear paths for each patient. Wear paths were quantified in two dimensions using aspect ratios and in three dimensions using the surface areas of the wear paths, with wear-path surface area correlating poorly with aspect ratio. The average aspect ratio of the patients wear paths was 3.97 (standard deviation=1.38), ranging from 2.13 to 10.86. Sixty percent of patients displayed aspect ratios between 2.50 and 3.99. However, 13% of patients displayed wear paths with aspect ratios >5.5, which indicates reduced multidirectional motion. The majority of total hip replacement (THR) patients display gait kinematics which produce multidirectional wear paths, but a significant minority display more linear paths.
Judge, A; Arden, N K; Price, A; Glyn-Jones, S; Beard, D; Carr, A J; Dawson, J; Fitzpatrick, R; Field, R E
We obtained pre-operative and six-month post-operative Oxford hip (OHS) and knee scores (OKS) for 1523 patients who underwent total hip replacement and 1784 patients who underwent total knee replacement. They all also completed a six-month satisfaction question. Scatter plots showed no relationship between pre-operative Oxford scores and six-month satisfaction scores. Spearman's rank correlation coefficients were -0.04 (95% confidence interval (CI) -0.09 to 0.01) between OHS and satisfaction and 0.04 (95% CI -0.01 to 0.08) between OKS and satisfaction. A receiver operating characteristic (ROC) curve analysis was used to identify a cut-off point for the pre-operative OHS/OKS that identifies whether or not a patient is satisfied with surgery. We obtained an area under the ROC curve of 0.51 (95% CI 0.45 to 0.56) for hip replacement and 0.56 (95% CI 0.51 to 0.60) for knee replacement, indicating that pre-operative Oxford scores have no predictive accuracy in distinguishing satisfied from dissatisfied patients. In the NHS widespread attempts are being made to use patient-reported outcome measures (PROMs) data for the purpose of prioritising patients for surgery. Oxford hip and knee scores have no predictive accuracy in relation to post-operative patient satisfaction. This evidence does not support their current use in prioritising access to care.
Putzer, David; Mayr, Eckart; Haid, Christian; Hozack, Wiliam; Nogler, Michael
In minimally invasive hip arthroplasty double offset broach handles are used, to facilitate the preparation of the femoral canal. The aim of this study was to quantify the differences in force and impulse transmission between two double offset broach handles and a single offset broach handle. Two double offset broach handles (A European version, B American version) were compared to a single offset broach handle. A surgical hammer was used to give a variable impact to the head of the broach handle. Thirty measurements for each of five falling heights were recorded for each broach handle. The force measured by a load cell connected to the broaches was used to obtain the maximum force peak and to calculate the impaction impulse. Normal data distribution was assumed and analysis of variances was performed. Results have demonstrated that the highest values of the force peak and force impulse were found in the single offset broach handle. Broach handle A had higher impulse values and lower maximum force values compared to broach handle B. The lateral lever arm has a measurable effect on the force transmission. In double offset broach handles less energy is transmitted to the tip. Surgeons have to be aware of the differences between the broach handles when using them intraoperatively.
Yoon, Jiyeol; Kim, Sungmin; Lee, Soo Chan; Lim, Hongsub
Erythropoietin combined with parenteral iron sucrose therapy is an alternative to blood transfusion in anemic patients. It was shown to be effective in surgical patients in several previous studies when used in conjunction with other methods. However, there are no guidelines about safety limits in dosage amounts or intervals. In this study, we report a case of significant postoperative hemorrhage managed with high dose parenteral iron sucrose, low dose erythropoietin, vitamin B(12), vitamin C, and folic acid. An 80-year-old female patient presented for severe anemia after a total hip arthroplasty and refused an allogenic blood transfusion as treatment. The preoperative hemoglobin of 12.2 g/dL decreased to 5.3 g/dL postoperatively. She received the aforementioned combination of iron sucrose, erythropoietin, and vitamins. A total of 1,500 mg of intravenous iron sucrose was given postoperatively for 6 consecutive days. Erythropoietin was also administered at 2,000 IU every other day for a total of 12,000 IU. The patient was discharged in good condition on the twelfth postoperative day with a hemoglobin of 8.5 g/dL. Her hemoglobin was at 11.2 g/dL on the twentieth postoperative day.
Re, Vincent Lo; Volk, Jessica; Newcomb, Craig W.; Yang, Yu-Xiao; Freeman, Cristin P.; Hennessy, Sean; Kostman, Jay R.; Tebas, Pablo; Leonard, Mary B.; Localio, A. Russell
Hepatitis C virus (HCV) infection has been associated with reduced bone mineral density, but its association with fracture rates is unknown, particularly in the setting of human immunodeficiency virus (HIV) coinfection. Our objectives were to determine whether persons with HCV infection alone are at increased risk for hip fracture compared to uninfected individuals and to examine if the risk of hip fracture is higher among HCV/HIV-coinfected persons compared to those with HCV alone, those with HIV alone, and those uninfected with either virus. We conducted a cohort study in 36,950 HCV/HIV-coinfected, 276,901HCV-monoinfected, 95,827 HIV-monoinfected, and 3,110,904 HCV/HIV-uninfected persons within the U.S. Medicaid populations of California, Florida, New York, Ohio, and Pennsylvania (1999–2005). Incidence rates of hip fracture were lowest among uninfected persons (1.29 events/1000 person-years), increased with the presence of either HIV infection (1.95 events/1000 person-years) or HCV infection (2.69 events/1000 person-years), and were highest among HCV/HIV-coinfected individuals (3.06 events/1000 person-years). HCV/HIV coinfection was associated with an increased relative hazard (adjusted hazard ratio [95% confidence interval]) of hip fracture compared to HCV-monoinfected (1.38 [1.25–1.53]), HIV-monoinfected (females: 1.76 [1.44–2.16]; males: 1.36 [1.20–1.55]), and uninfected persons (females: 2.65 [2.21–3.17]; males: 2.20 [1.97–2.47]). HCV monoinfection was associated with an increased risk of hip fracture compared to uninfected individuals, and the relative increase was highest in the youngest age groups (females, 18–39 years: 3.56 [2.93–4.32]; males, 18–39 years: 2.40 [2.02–2.84]). Conclusion Among Medicaid enrollees, HCV/HIV coinfection was associated with increased rates of hip fracture compared to HCV-monoinfected, HIV-monoinfected, and HCV/HIV-uninfected persons. HCV-monoinfected patients had an increased risk of hip fracture compared to
Kostensalo, Inari; Junnila, Mika; Mokka, Jari; Virolainen, Petri; Vahlberg, Tero; Mäkelä, Keijo T
The aim of this retrospective study was to evaluate short- to mid-term results of three different metal-on-metal hip devices from the same manufacturer. A total of 329 hip operations were performed in a single academic unit between 2004 and 2010 using either Birmingham hip resurfacing or Synergy--Birmingham and Synergy--R3 total hip arthroplasty. The overall survival rate at the end of the follow-up time for Birmingham hip resurfacing was 88%, for Synergy--Birmingham total hip arthroplasty 95%, and for Synergy--R3 total hip arthroplasty 81% (p = 0.036). Five revision operations were performed due to adverse reaction to metal debris. Head sizes > 50 mm had lower revision rates compared to smaller ones. Synergy--R3 had a poor survival already at short-term. The mid-term survival of Birmingham hip resurfacing arthroplasty was inferior compared to previous studies.
Grübl, A; Weissinger, M; Brodner, W; Gleiss, A; Giurea, A; Gruber, M; Pöll, G; Meisinger, V; Gottsauner-Wolf, F; Kotz, R
In a randomised study, 28 patients with a mean age of 62.2 years (32 to 81) with osteoarthritis or avascular necrosis of the hip received either a ceramic-on-ceramic or a metal-on-metal total hip replacement. Apart from the liners the acetabular and femoral components were made of Ti-Al-Nb alloy. The serum aluminium and cobalt levels were measured before, and at one year after surgery. The 15 patients in the ceramic-on-ceramic group had a median pre-operative aluminium level of 1.3 microg/l (0.25 to 8.4) and a cobalt level below the detection limit. At one year the aluminium level was 1.1 microg/l (0.25 to 2.3) and the cobalt level was 0.4 microg/l (0.15 to 0.7). The 13 patients in the metal-on-metal group had a median pre-operative aluminium level of 1.9 microg/l (0.25 to 4.4) and a cobalt level below the detection limit. At one year the median aluminium level was 0.9 microg/l (0.25 to 3.9) whereas the cobalt level was 1.4 microg/l (0.5 to 10.5). This increase in the cobalt level at one year was significant (p < 0.001). Our findings indicate that ceramic-on-ceramic bearings do not cause elevated levels of serum aluminium in the first post-operative year.
Kaufman, Adam M; Watters, Tyler Steven; Henderson, Robert A; Wellman, Samuel S; Bolognesi, Michael P
Periprosthetic joint infection in the acute setting is usually caused by gram-positive species and remains a major problem facing total joint surgeons. We report a case of a 53-year-old male who presented with drainage 3 weeks after primary total hip arthroplasty. Citrobacter koseri was cultured from an infected hematoma in his deep tissues. Surgical treatment included irrigation and debridement with femoral head and liner exchange. He received a 6-week course of ertapenem and is currently asymptomatic. We present C. koseri as a rare cause of acute periprosthetic infection and offer an effective treatment protocol.
Miller, Mark A; Verdonschot, Nico; Izant, Timothy H; Race, Amos
Background and purpose Despite the longstanding use of micromotion as a measure of implant stability, direct measurement of the micromechanics of implant/bone interfaces from en bloc human retrievals has not been performed. The purpose of this study was to determine the stem-cement and cement-bone micromechanics of functionally loaded, en-bloc retrieved, cemented femoral hip components. Methods 11 fresh frozen proximal femurs with cemented implants were retrieved at autopsy. Specimens were sectioned transversely into 10-mm slabs and fixed to a loading device where functional torsional loads were applied to the stem. A digital image correlation technique was used to document micromotions at stem-cement and cement-bone interfaces during loading. Results There was a wide range of responses with stem-cement micromotions ranging from 0.0006 mm to 0.83 mm (mean 0.17 mm, SD 0.29) and cement-bone micromotions ranging from 0.0022 mm to 0.73 mm (mean 0.092 mm, SD 0.22). There was a strong (linear-log) inverse correlation between apposition fraction and micromotion at the stem-cement interface (r2 = 0.71, p < 0.001). There was a strong inverse log-log correlation between apposition fraction at the cement-bone interface and micromotion (r2 = 0.85, p < 0.001). Components that were radiographically well-fixed had a relatively narrow range of micromotions at the stem-cement (0.0006–0.057 mm) and cement-bone (0.0022–0.029 mm) interfaces. Interpretatation Minimizing gaps at the stem-cement interface and encouraging bony apposition at the cement-bone interface would be clinically desirable. The cement-bone interface does not act as a bonded interface in actual use, even in radiographically well-fixed components. Rather, the interface is quite compliant, with sliding and opening motions between the cement and bone surfaces. PMID:20367421
Loeschner, Katrin; Harrington, Chris F; Kearney, Jacque-Lucca; Langton, David J; Larsen, Erik H
Hip replacements are used to improve the quality of life of people with orthopaedic conditions, but the use of metal-on-metal (MoM) arthroplasty has led to poor outcomes for some patients. These problems are related to the generation of micro- to nanosized metal wear particles containing Cr, Co or other elements, but the current analytical methods used to investigate the processes involved do not provide sufficient information to understand the size or composition of the wear particles generated in vivo. In this qualitative feasibility study, asymmetric flow field-flow fractionation (AF(4)) coupled with inductively coupled plasma mass spectrometry (ICP-MS) was used to investigate metal protein binding and the size and composition of wear metal particles present in serum and hip aspirates from MoM hip replacement patients. A well-established HPLC anion exchange chromatography (AEC) separation system coupled to ICP-MS was used to confirm the metal-protein associations in the serum samples. Off-line single particle ICP-MS (spICP-MS) analysis was used to confirm the approximate size distribution indicated by AF(4) of the wear particles in hip aspirates. In the serum samples, AF(4) -ICP-MS suggested that Cr was associated with transferrin (Tf) and Co with albumin (Alb) and an unidentified species; AEC-ICP-MS confirmed these associations and also indicated an association of Cr with Alb. In the hip aspirate sample, AF(4)-ICP-MS suggested that Cr was associated with Alb and Tf and that Co was associated with Alb and two unidentified compounds; AEC analysis confirmed the Cr results and the association of Co with Alb and a second compound. Enzymatic digestion of the hip aspirate sample, followed by separation using AF(4) with detection by UV absorption (280 nm), multi-angle light scattering and ICP-MS, suggested that the sizes of the Cr-, Co- and Mo-containing wear particles in a hip aspirate sample were in the range 40-150 nm. Off-line spICP-MS was used to confirm these
Merkel, K.D.; Brown, M.L.; Fitzgerald, R.H.; Dewanjee, M.K.
Differentiating low-grade sepsis from aseptic loosening of an orthopedic prosthesis is difficult. This study was designed to compare the ability of Tc-99m-HMDP, Ga-67, and In-111 leukocytes (WC) to differentiate low-grade sepsis from aseptic THA component loosening in a canine model. A canine THA was implanted in 14 dogs. Six dogs were given infected femoral components by injecting 10/sup 5/ colony-forming units of Staphylococcus aureus into the femoral canal 6y0 to 90 seconds prior to cementing. Four dogs had an aseptic loose femoral component, and four dogs had an aseptic tight femoral component (control). At six months all dogs were evaluated with X-ray, lab scintigraphy, and tissue quantitation of each tracer. Diagnosis was confirmed by histology and quantitative microbiology. White blood cell counts and differentials were normal in all dogs, and in only one out of six infected dogs was the sedimentation rate abnormal. X-rays were interpreted as possible infection in five dogs and probable infection in only one dog. In-111 WBC scans were more accurate than sequential Tc-Ga scans (sensitivity 94% vs 61%, specificity 86% vs 71% accuracy 90% vs 67%). Quantitative counting of gamma camera data and tissue samples demonstrated significantly (P < .01) higher accumulation of In-111 WBC about the infected than the loose or control component. No significant difference was demonstrated between the loose and septic components with TC-HMDP or Ga. These results correlate well and confirm our clinical data that In-111 WBC scanning is accurate and useful in the workup of the painful orthopedic prosthesis.
Jameson, Simon S.; Mason, James; Baker, Paul N.; Gregg, Paul J.; Deehan, David J.; Reed, Mike R.
Background Hip replacement is one of the most commonly performed surgical procedures worldwide; hundreds of implant configurations provide options for femoral head size, joint surface material and fixation method with dramatically varying costs. Robust comparative evidence to inform the choice of implant is needed. This retrospective cohort study uses linked national databases from England and Wales to determine the optimal type of replacement for patients over 60 years undergoing hip replacement for osteoarthritis. Methods and Findings Implants included were the commonest brand from each of the four types of replacement (cemented, cementless, hybrid and resurfacing); the reference prosthesis was the cemented hip procedure. Patient reported outcome scores (PROMs), costs and risk of repeat (revision) surgery were examined. Multivariable analyses included analysis of covariance to assess improvement in PROMs (Oxford hip score, OHS, and EQ5D index) (9159 linked episodes) and competing risks modelling of implant survival (79,775 procedures). Cost of implants and ancillary equipment were obtained from National Health Service procurement data. Results EQ5D score improvements (at 6 months) were similar for all hip replacement types. In females, revision risk was significantly higher in cementless hip prostheses (hazard ratio, HR = 2.22, p<0.001), when compared to the reference hip. Although improvement in OHS was statistically higher (22.1 versus 20.5, p<0.001) for cementless implants, this small difference is unlikely to be clinically important. In males, revision risk was significantly higher in cementless (HR = 1.95, p = 0.003) and resurfacing implants, HR = 3.46, p<0.001), with no differences in OHS. Material costs were lowest with the reference implant (cemented, range £1103 to £1524) and highest with cementless implants (£1928 to £4285). Limitations include the design of the study, which is intrinsically vulnerable to omitted variables, a paucity of long
Karachalios, Theofilos; Koutalos, Antonios; Komnos, George
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.
Triantafyllopoulos, Georgios K; Soranoglou, Vasileios; Memtsoudis, Stavros G; Poultsides, Lazaros A
Periprosthetic joint infections (PJI) of the hip and the knee are grossly classified as early post-operative, acute hematogenous and late chronic infections. Whereas two-stage exchange arthroplasty is the standard of care in North America for treating chronic infections, irrigation and debridement (I and D) with retention of implants has been used in an attempt to treat the other two types of PJIs. The rationale of this approach is that a PJI may be eradicated without the need of explanting the prostheses, as long as it has not transitioned into a chronic state. With the present paper, we review current evidence regarding the role of I and D with implant retention for treating PJIs of the hip and the knee. While a very wide range of success rates is reported in different studies, a short period of time between initiation of symptoms and intervention seems to play a prominent role with regards to a successful outcome. Moreover, pathogens of higher virulence and resistance to antibiotics are associated with a poorer result. Specific comorbidities have been also correlated with a less favorable outcome. Finally, one should proceed with serial I and Ds only under the condition that a predefined, aggressive protocol is applied. In conclusion, when treating a PJI of the hip or the knee, all the above factors should be considered in order to decide whether the patient is likely to benefit from this approach. PMID:27672567
Austin, Paul N
The majority of the evidence indicates preventing inadvertent perioperative hypothermia reduces the incidence of many perioperative complications. Among the results of inadvertent perioperative hypothermia are increased bleeding, myocardial events, impaired wound healing, and diminished renal function. Most researchers agree there is an increased incidence of surgical site infections in patients who experience inadvertent perioperative hypothermia. Forced-air warming is effective in preventing inadvertent perioperative hypothermia. Paradoxically, forced-air warmers have been implicated in causing surgical site infections in patients undergoing total knee or hip arthroplasty. The results of investigations suggest these devices harbor pathogens and cause unwanted airflow disturbances. However, no significant increases in bacterial counts were found when forced-air warmers were used according to the manufacturer's directions. The results of one study suggested the incidence of surgical site infections in patients undergoing total joint arthroplasty was increased when using a forced-air warmer. However these researchers did not control for other factors affecting the incidence of surgical site infections in these patients. Current evidence does not support forced-air warmers causing surgical site infections in patients undergoing total knee or hip arthroplasty. Clinicians must use and maintain these devices as per the manufacturer's directions. They may consider using alternative warming methods. Well-conducted studies are needed to help determine the role of forced-air warmers in causing infections in these patients.
Cheung, Graham; Carmont, Michael R; Bing, Andrew J F; Kuiper, Jan-Herman; Alcock, Robert J; Graham, Niall M
We performed a prospective, randomised controlled trial to assess the differences in the use of a conventional suction drain, an Autologous Blood Transfusion (ABT) drain and no drain, in 168 patients. There was no significant difference between the drainage from ABT drains ( mean : 345 ml) and the suction drain (314 ml). Forty percent of patients receiving a suction drain had a haemoglobin level less than 10 g/dL at 24 hours, compared to 35% with no drain and 28% with an ABT drain. Patients that had no drains had wounds that were dry significantly sooner, mean 3.0 days compared to a mean of 3.9 days with an ABT drain and a mean of 4 days with a suction drain. Patients that did not have a drain inserted stayed in hospital a significantly shorter period of time, compared with drains. We feel the benefits of quicker drying wounds, shorter hospital stays and the economic savings justify the conclusion that no drain is required after hip replacement.
Cho, Seung Mok; Park, Jin-Woo; Han, Hyung-Seop; Seok, Hyun-Kwang; Moon, Myoung-Woon; Kim, Yu Chan
In this study, we developed Ti-TiN composite coatings with fine lamellar structures for use as an enhanced wear-resistant layer between the bearing components of the polymer-lined acetabular cup and the metal femoral head of total hip joint replacements (THRs). A plasma spraying deposition method was used to apply the composite coatings, and the thickness of TiN layer in the composite could be controlled by varying the flow rate of N(2) atmospheric gas. The surface properties, such as roughness and hardness, were analyzed, and the friction coefficient (μ) and wear rate (k) were measured using a bovine serum wear test. A biocompatibility test was performed to evaluate the toxicity of the composite coatings. Our experimental results reveal that the friction and wear resistance of composite coatings is superior to that of the metallic implant materials, and they have a higher level of fracture toughness as compared with other ceramic coatings because of a good balance between the hardness of the TiN and the toughness of the Ti. Furthermore, these coatings possessed excellent biocompatibility. The experimental results also demonstrate that the improved wear properties can be attributed to a certain level of unavoidable porosity that is due to the rapid solidification of liquid droplets during the plasma spraying process. The pores in the coating surface play an important role as a lubricant (bovine serum) reservoir, reducing the actual contact area and friction losses.
Nganbe, Michel; Louati, Hakim; Khan, Usman; Speirs, Andrew; Beaulé, Paul E
We investigated a commercial Co-Cr-alloy head--Ti6Al4V alloy neck and Ti6Al4V stem modular total hip replacement. We assessed the distraction forces after in vitro cycling in bovine serum, fatigue durability, fretting corrosion damage, and load bearing capacity of new implants using fatigue-corrosion, pull-off, scanning electron microscopy, fatigue and compression investigations. In addition, we studied corrosion, fretting damage, and distraction forces on retrievals. For both retrievals and in vitro test samples, the neck-stem interface required the higher distraction force as compared with the head-neck interface. One of 12 retrievals showed strong fretting corrosion at the neck-stem interface which resulted in a high disassembly force of about 16 kN. For in vitro test samples, the neck-stem pull-off force initially increased during cycling and showed a maximum value of 5.704 kN at ∼100,000 cycles, which is equivalent to gait cycles performed in approximately 36 days. Overall, assembly force, initial component settling, and interface corrosion primarily determine the force required to distract the modular components. One million cycles fatigue failure of the neck can be expected at a maximum compression load of -6.5 kN. No component failure was observed during quasistatic compression; rather the neck deformed plastically and the ultimate compression load-bearing capacity was -13 kN.
Stöckli, Cornel; Theiler, Robert; Sidelnikov, Eduard; Balsiger, Maria; Ferrari, Stephen M; Buchzig, Beatus; Uehlinger, Kurt; Riniker, Christoph; Bischoff-Ferrari, Heike A
We developed a user-friendly Internet-based tool for patients undergoing total hip replacement (THR) due to osteoarthritis to predict their pain and function after surgery. In the first step, the key questions were identified by statistical modelling in a data set of 375 patients undergoing THR. Based on multiple regression, we identified the two most predictive WOMAC questions for pain and the three most predictive WOMAC questions for functional outcome, while controlling for comorbidity, body mass index, age, gender and specific comorbidities relevant to the outcome. In the second step, a pilot study was performed to validate the resulting tool against the full WOMAC questionnaire among 108 patients undergoing THR. The mean difference between observed (WOMAC) and model-predicted value was -1.1 points (95% confidence interval, CI -3.8, 1.5) for pain and -2.5 points (95% CI -5.3, 0.3) for function. The model-predicted value was within 20% of the observed value in 48% of cases for pain and in 57% of cases for function. The tool demonstrated moderate validity, but performed weakly for patients with extreme levels of pain and extreme functional limitations at 3 months post surgery. This may have been partly due to early complications after surgery. However, the outcome-prediction tool may be useful in helping patients to become better informed about the realistic outcome of their THR.
Stöckli, Cornel; Theiler, Robert; Sidelnikov, Eduard; Balsiger, Maria; Ferrari, Stephen M; Buchzig, Beatus; Uehlinger, Kurt; Riniker, Christoph
Summary We developed a user-friendly Internet-based tool for patients undergoing total hip replacement (THR) due to osteoarthritis to predict their pain and function after surgery. In the first step, the key questions were identified by statistical modelling in a data set of 375 patients undergoing THR. Based on multiple regression, we identified the two most predictive WOMAC questions for pain and the three most predictive WOMAC questions for functional outcome, while controlling for comorbidity, body mass index, age, gender and specific comorbidities relevant to the outcome. In the second step, a pilot study was performed to validate the resulting tool against the full WOMAC questionnaire among 108 patients undergoing THR. The mean difference between observed (WOMAC) and model-predicted value was −1.1 points (95% confidence interval, CI −3.8, 1.5) for pain and −2.5 points (95% CI −5.3, 0.3) for function. The model-predicted value was within 20% of the observed value in 48% of cases for pain and in 57% of cases for function. The tool demonstrated moderate validity, but performed weakly for patients with extreme levels of pain and extreme functional limitations at 3 months post surgery. This may have been partly due to early complications after surgery. However, the outcome-prediction tool may be useful in helping patients to become better informed about the realistic outcome of their THR. PMID:24585892
Colman, Matthew; Choi, Lisa; Chen, Antonia; Crossett, Lawrence; Tarkin, Ivan; McGough, Richard
To examine the mortality and implant survivorship of proximal femoral replacement (PFR), revision total hip arthroplasty (REV) and open reduction internal fixation (ORIF) in the treatment of acute periprosthetic fractures of the proximal femur, we retrospectively reviewed 97 consecutive acute periprosthetic proximal femoral fractures from 2000–2010. Three groups were defined: PFR (n=21), REV (n=19), and ORIF (n=57). Outcome measures were all-cause mortality, implant failure, and reoperation. Competing Risks survival analysis of overall mortality during the mean 35-month follow-up showed no statistical difference between the three groups (p=0.65; 12 and 60 month mortality for PFR: 37%, 45%; REV: 16%, 46%; ORIF: 14%, 100%). Implant survival was worse for the PFR group (p=0.03, 12 and 60-month implant failure rate for PFR: 5%, 39%; REV: 7%, 7%; ORIF 2%, 2%). We conclude that PFR as compared with REV or ORIF may have worse medium-term implant survival, primarily due to instability and dislocation. PMID:23856062
Colman, Matthew; Choi, Lisa; Chen, Antonia; Crossett, Lawrence; Tarkin, Ivan; McGough, Richard
To examine the mortality and implant survivorship of proximal femoral replacement (PFR), revision total hip arthroplasty (REV) and open reduction internal fixation (ORIF) in the treatment of acute periprosthetic fractures of the proximal femur, we retrospectively reviewed 97 consecutive acute periprosthetic proximal femoral fractures from 2000 to 2010. Three groups were defined: PFR (n=21), REV (n=19), and ORIF (n=57). Outcome measures were all-cause mortality, implant failure, and reoperation. Competing Risks survival analysis of overall mortality during the mean 35-month follow-up showed no statistical difference between the three groups (P=0.65; 12 and 60 month mortality for PFR: 37%, 45%; REV: 16%, 46%; ORIF: 14%, 100%). Implant survival was worse for the PFR group (P=0.03, 12 and 60-month implant failure rate for PFR: 5%, 39%; REV: 7%, 7%; ORIF 2%, 2%). We conclude that PFR as compared with REV or ORIF may have worse medium-term implant survival, primarily due to instability and dislocation.
Reito, Aleksi; Elo, Petra; Nieminen, Jyrki; Puolakka, Timo; Eskelinen, Antti
Background and purpose There are no international guidelines to define adverse reaction to metal debris (ARMD). Muscle fatty atrophy has been reported to be common in patients with failing metal-on-metal (MoM) hip replacements. We assessed whether gluteal muscle fatty atrophy is associated with elevated blood metal ion levels and pseudotumors. Patients and methods 263 consecutive patients with unilateral ASR XL total hip replacement using a posterior approach and with an unoperated contralateral hip were included in the study. All patients had undergone a standard screening program at our institution, including MRI and blood metal ion measurement. Muscle fatty atrophy was graded as being absent, mild, moderate, or severe in each of the gluteal muscles. Results The prevalance of moderate-to-severe gluteal muscle atrophy was low (12% for gluteus minimus, 10% for gluteus medius, and 2% for gluteus maximus). Muscle atrophy was neither associated with elevated blood metal ion levels (> 5 ppb) nor with the presence of a clear (solid- or mixed-type) pseudotumor seen in MRI. A combination of moderate-to-severe atrophy in MRI, elevated blood metal ion levels, and MRI-confirmed mixed or solid pseudotumor was rare. Multivariable regression revealed that “preoperative diagnosis other than osteoarthrosis” was the strongest predictor of the presence of fatty atrophy. Interpretation Gluteal muscle atrophy may be a clinically significant finding with influence on hip muscle strength in patients with MoM hip replacement. However, our results suggest that gluteal muscle atrophy seen in MRI is not associated with either the presence or severity of ARMD, at least not in patients who have been operated on using the posterior approach. PMID:26427902
Takatori, Yoshio; Moro, Toru; Kamogawa, Morihide; Oda, Hiromi; Morimoto, Shuhei; Umeyama, Takashige; Minami, Manabu; Sugimoto, Hideharu; Nakamura, Shigeru; Karita, Tatsuro; Kim, Juntaku; Koyama, Yurie; Ito, Hideya; Kawaguchi, Hiroshi; Nakamura, Kozo
To control particle-induced osteolysis in total hip replacement (THR), we developed a new technique to graft poly(2-methacryloyloxyethyl phosphorylcholine) onto the surface of polyethylene liners. A prospective cohort study was conducted to investigate the clinical safety of this novel bearing surface. Between April 2007 and September 2008, we recruited a prospective consecutive series of 80 patients in five participating hospitals. These patients received a cementless THR; a 26-mm-diameter cobalt-chromium-molybdenum alloy ball and a poly(2-methacryloyloxyethyl phosphorylcholine)-grafted cross-linked polyethylene liner were used for the bearing couplings. These individuals were followed a year postoperatively. An evaluation of clinical performance was conducted through an assessment of hip joint function based on the evaluation chart authorized by the Japanese Orthopaedic Association. No patients were lost to follow-up. No adverse events were found to be correlated with the implanted liners. The average hip joint function score improved from 43.2 preoperatively to 91.7 postoperatively at 1 year. There was no implant migration nor periprosthetic osteolysis detected on radiographic analysis. On the basis of our results, we conclude that poly(2-methacryloyloxyethyl phosphorylcholine)-grafted cross-linked polyethylene liners are a safe implant option for hip replacement surgery for short-term clinical use.
Siopack, J S; Jergesen, H E
Total hip arthroplasty, or surgical replacement of the hip joint with an artificial prosthesis, is a reconstructive procedure that has improved the management of those diseases of the hip joint that have responded poorly to conventional medical therapy. In this review we briefly summarize the evolution of total hip arthroplasty, the design and development of prosthetic hip components, and the current clinical indications for this procedure. The possible complications of total hip arthroplasty, its clinical performance over time, and future directions in hip replacement surgery are also discussed. Images PMID:7725707
Donaldson, Finn E; Nyman, Edward; Coburn, James C
Manufacturers and investigators of Total Hip Replacement (THR) bearings require tools to predict the contact mechanics resulting from diverse design and loading parameters. This study provides contact mechanics solutions for metal-on-metal (MoM) bearings that encompass the current design space and could aid pre-clinical design optimization and evaluation. Stochastic finite element (FE) simulation was used to calculate the head-on-cup contact mechanics for five thousand combinations of design and loading parameters. FE results were used to train a Random Forest (RF) surrogate model to rapidly predict the contact patch dimensions, contact area, pressures and plastic deformations for arbitrary designs and loading. In addition to widely observed polar and edge contact, FE results included ring-polar, asymmetric-polar, and transitional categories which have previously received limited attention. Combinations of design and load parameters associated with each contact category were identified. Polar contact pressures were predicted in the range of 0-200 MPa with no permanent deformation. Edge loading (with subluxation) was associated with pressures greater than 500 MPa and induced permanent deformation in 83% of cases. Transitional-edge contact (with little subluxation) was associated with intermediate pressures and permanent deformation in most cases, indicating that, even with ideal anatomical alignment, bearings may face extreme wear challenges. Surrogate models were able to accurately predict contact mechanics 18,000 times faster than FE analyses. The developed surrogate models enable rapid prediction of MoM bearing contact mechanics across the most comprehensive range of loading and designs to date, and may be useful to those performing bearing design optimization or evaluation.
Schnell-Inderst, Petra; Iglesias, Cynthia P; Arvandi, Marjan; Ciani, Oriana; Matteucci Gothe, Raffaella; Peters, Jaime; Blom, Ashley W; Taylor, Rod S; Siebert, Uwe
Evaluation of clinical effectiveness of medical devices differs in some aspects from the evaluation of pharmaceuticals. One of the main challenges identified is lack of robust evidence and a will to make use of experimental and observational studies (OSs) in quantitative evidence synthesis accounting for internal and external biases. Using a case study of total hip replacement to compare the risk of revision of cemented and uncemented implant fixation modalities, we pooled treatment effect estimates from OS and RCTs, and simplified existing methods for bias-adjusted evidence synthesis to enhance practical application. We performed an elicitation exercise using methodological and clinical experts to determine the strength of beliefs about the magnitude of internal and external bias affecting estimates of treatment effect. We incorporated the bias-adjusted treatment effects into a generalized evidence synthesis, calculating both frequentist and Bayesian statistical models. We estimated relative risks as summary effect estimates with 95% confidence/credibility intervals to capture uncertainty. When we compared alternative approaches to synthesizing evidence, we found that the pooled effect size strongly depended on the inclusion of observational data as well as on the use bias-adjusted estimates. We demonstrated the feasibility of using observational studies in meta-analyses to complement RCTs and incorporate evidence from a wider spectrum of clinically relevant studies and healthcare settings. To ensure internal validity, OS data require sufficient correction for confounding and selection bias, either through study design and primary analysis, or by applying post-hoc bias adjustments to the results. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.
Background Inpatient satisfaction with care is a standard indicator of the quality of care delivered during hospitalization. Total hip and knee replacement (THR/TKR) for osteoarthritis (OA) are among the most successful orthopaedic interventions having a positive impact on health-related quality of life (HRQoL). The aim was to evaluate the effect of satisfaction shortly after hospital discharge on 1-month, 6-month and 1-year Medical Outcomes Study 36-item Short Form (SF-36) scores for OA patients after THR and TKR, controlling for patient characteristics, clinical presentation and preoperative SF-36 scores. Methods A multicenter prospective cohort study recruited 231 patients with OA scheduled to receive THR or TKR. Satisfaction was assessed by the Patients Judgment of Hospital Quality (PJHQ) questionnaire and HRQoL by the SF-36 questionnaire. Linear models for repeated measures assessed the relation between satisfaction (scores were dichotomized) and postoperative SF-36 scores. Results Of 231 participants, 189 were followed up 12 months after discharge (mean age 69 SD = 8; 42.6% male). The mean length of hospital stay was 13.5 (SD = 4) days. After adjustment for preoperative SF-36 scores, sociodemographic and clinical patient characteristics, satisfied patients (PJHQ score > 70) had higher SF-36 scores 1 year after surgery than did less-satisfied patients. Admission, medical care, and nursing and daily care scores mainly predicted bodily pain, mental health, social functioning, vitality and general health scores of the SF-36. Conclusion Besides being a quality-of-care indicator, immediate postoperative patient satisfaction with care may bring a new insight into clinical practice, as a predictor of self-perceived health status after surgery. PMID:19958520
Walschot, Lucas H B; Aquarius, René; Verdonschot, Nico; Buma, Pieter
Background and purpose — The bone impaction grafting technique restores bone defects in total hip replacement. Porous titanium particles (TiPs) are deformable, like bone particles, and offer better primary stability. We addressed the following questions in this animal study: are impacted TiPs osteoconductive under loaded conditions; do released micro-particles accelerate wear; and are systemic titanium blood levels elevated after implantation of TiPs? Animals and methods — An AAOS type-III defect was created in the right acetabulum of 10 goats weighing 63 (SD 6) kg, and reconstructed with calcium phosphate-coated TiPs and a cemented polyethylene cup. A stem with a cobalt chrome head was cemented in the femur. The goats were killed after 15 weeks. Blood samples were taken pre- and postoperatively. Results — The TiP-graft layer measured 5.6 (SD 0.8) mm with a mean bone ingrowth distance of 2.8 (SD 0.8) mm. Cement penetrated 0.9 (0.3–1.9) mm into the TiPs. 1 reconstruction showed minimal cement penetration (0.3 mm) and failed at the cement-TiP interface. There were no signs of accelerated wear, metallic particle debris, or osteolysis. Median systemic titanium concentrations increased on a log-linear scale from 0.5 (0.3–1.1) parts per billion (ppb) to 0.9 (0.5–2.8) ppb (p = 0.01). Interpretation — Adequate cement pressurization is advocated for impaction grafting with TiPs. After implantation, calcium phosphate-coated TiPs were osteoconductive under loaded conditions and caused an increase in systemic titanium concentrations. However, absolute levels remained low. There were no signs of accelerated wear. A clinical pilot study should be performed to prove that application in humans is safe in the long term. PMID:25238431
McGovern, P D; Albrecht, M; Belani, K G; Nachtsheim, C; Partington, P F; Carluke, I; Reed, M R
We investigated the capacity of patient warming devices to disrupt the ultra-clean airflow system. We compared the effects of two patient warming technologies, forced-air and conductive fabric, on operating theatre ventilation during simulated hip replacement and lumbar spinal procedures using a mannequin as a patient. Infection data were reviewed to determine whether joint infection rates were associated with the type of patient warming device that was used. Neutral-buoyancy detergent bubbles were released adjacent to the mannequin's head and at floor level to assess the movement of non-sterile air into the clean airflow over the surgical site. During simulated hip replacement, bubble counts over the surgical site were greater for forced-air than for conductive fabric warming when the anaesthesia/surgery drape was laid down (p = 0.010) and at half-height (p < 0.001). For lumbar surgery, forced-air warming generated convection currents that mobilised floor air into the surgical site area. Conductive fabric warming had no such effect. A significant increase in deep joint infection, as demonstrated by an elevated infection odds ratio (3.8, p = 0.024), was identified during a period when forced-air warming was used compared to a period when conductive fabric warming was used. Air-free warming is, therefore, recommended over forced-air warming for orthopaedic procedures.
Söylemez, Mehmet Salih; Özkan, Korhan; Kılıç, Bülent; Erinç, Samet
Intermittent negative pressure wound therapy with instillation (NPWTi) is starting to be used successfully to treat early periprosthetic infections of endoprostheses. However, few articles have reported the outcome of treatment with intermittent NPWTi for late persistent periprosthetic infections of the hip. In this study, we report two cases who underwent several rounds of radical wound debridement for the treatment of a late persistent periprosthetic infection of the hip. Intermittent NPWTi was used in both cases. Patients were treated successfully and there was no recurrence after 3 and 1 years of follow-up, respectively. PMID:26929628
Ellenrieder, Martin; Haenle, Maximilian; Lenz, Robert; Bader, Rainer; Mittelmeier, Wolfram
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
Ellenrieder, Martin; Haenle, Maximilian; Lenz, Robert; Bader, Rainer; Mittelmeier, Wolfram
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.
The, B.; Diercks, R.L.; Stewart, R.E.; Ooijen, P.M.A. van; Horn, J.R. van
The introduction of digital radiological facilities leads to the necessity of digital preoperative planning, which is an essential part of joint replacement surgery. To avoid errors in the preparation and execution of hip surgery, reliable correction of the magnification of the projected hip is a prerequisite. So far, no validated method exists to accomplish this. We present validated geometrical models of the x-ray projection of spheres, relevant for the calibration procedure to correct for the radiographic magnification. With help of these models a new calibration protocol was developed. The validity and precision of this procedure was determined in clinical practice. Magnification factors could be predicted with a maximal margin of error of 1.5%. The new calibration protocol is valid and reliable. The clinical tests revealed that correction of magnification has a 95% margin of error of -3% to +3%. Future research might clarify if a strict calibration protocol, as presented in this study, results in more accurate preoperative planning of hip joint replacements.
Foucher, Kharma C; Hurwitz, Debra E; Wimmer, Markus A
The purpose of this study was to evaluate whether preoperative gait adaptations persist one year after THR in the same set of subjects. The hypothesis tested was that hip dynamic range of motion and peak external moments during walking return to normal after THR. Hip kinematics and kinetics were measured for 28 subjects before and one year after THR and compared to those of 25 subjects with radiographically normal hips. All THR subjects improved clinically after surgery with Harris hip scores improving from 33-85 (average 53) to 61-100 (average 95) (sign test p<0.001). Preoperatively dynamic hip range of motion (ROM), and all peak external moments were reduced compared to normal (Mann-Whitney p< or =0.040). Improvement was seen in the ROM and all but the frontal plane, and external rotation peak moments (Friedman p< or =0.023). The preoperative and postoperative values of the ROM, and peak flexion, abduction and external rotation moments were all significantly correlated (Spearman p<0.020) indicating a possible learned effect from before THR surgery. Postoperative THR subjects continued to have a significantly lower than normal ROM, and peak adduction and peak internal rotation moments (Mann-Whitney p< or =0.003). Despite good to excellent clinical functional outcome, gait in THR patients does not return to normal by one year after surgery. Aggressive muscle strengthening is currently not emphasized after THR surgery. Some THR patients may benefit from more intensive rehabilitation before and after surgery.
Kini, Sunil Gurpur; Gabr, Ayman; Das, Rishi; Sukeik, Mohamed; Haddad, Fares Sami
Background: Periprosthetic joint infection (PJI) continues to be one of the leading causes of failure following hip and knee surgery. The diagnostic workflow of PJI includes detailed clinical examination, serum markers, imaging and aspiration/biopsy of the affected joint. The goals of treatment are eradication of the infection, alleviation of pain, and restoration of joint function. Surgical management of PJI consists of debridement, antibiotics and implant retention (DAIR) and single or two-stage revision procedures. Two-stage revision remains the gold standard for treatment of PJIs. We aim to discuss the two stage procedure in this article and report the outcomes. Methods: The first stage of the two stages consists of removal of all components and associated cement with aggressive debridement and placement of an antibiotic-loaded cement spacer. Patients are then treated with variable periods of parenteral antibiotics, followed by an antibiotic free period to help ensure the infection has been eradicated. If the clinical evaluation and serum inflammatory markers suggest infection control, then the second stage can be undertaken and this involves removal of the cement spacer, repeat debridement, and placement of a new prosthesis. Results: Common themes around the two-stage revision procedure include timing of the second stage, antibiotics used in the interim period, length of the interim period before consideration of reimplantation and close liaising with microbiologists. Conclusion: Successful eradication of infection and good functional outcome using the two stage procedure is dependent on a multidisciplinary approach and having a standard reproducible startegy. PMID:28144371
Janssen, Daniël M C; Geurts, Jan A P; Jütten, Liesbeth M C; Walenkamp, Geert H I M
Background and purpose - A 2-stage revision is the most common treatment for late deep prosthesis-related infections and in all cases of septic loosening. However, there is no consensus about the optimal interval between the 2 stages. Patients and methods - We retrospectively studied 120 deep infections of total hip (n = 95) and knee (n = 25) prostheses that had occurred over a period of 25 years. The mean follow-up time was 5 (2-20) years. All infections had been treated with extraction, 1 or more debridements with systemic antibiotics, and implantation of gentamicin-PMMA beads. There had been different time intervals between extraction and reimplantation: median 14 (11-47) days for short-term treatment with uninterrupted hospital stay, and 7 (3-22) months for long-term treatment with temporary discharge. We analyzed the outcome regarding resolution of the infection and clinical results. Results - 88% (105/120) of the infections healed, with no difference in healing rate between short- and long-term treatment. 82 prostheses were reimplanted. In the most recent decade, we treated patients more often with a long-term treatment but reduced the length of time between the extraction and the reimplantation. More reimplantations were performed in long-term treatments than in short-term treatments, despite more having difficult-to-treat infections with worse soft-tissue condition. Interpretation - Patient, wound, and infection considerations resulted in an individualized treatment with different intervals between stages. The 2-stage revision treatment in combination with local gentamicin-PMMA beads gave good results even with difficult prosthesis infections and gentamicin-resistant bacteria.
Takahira, Naonobu; Moriya, Mitsutoshi; Yamamoto, Takeaki; Minegishi, Yojiro; Sakai, Rina; Itoman, Moritoshi; Takaso, Masashi
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
Takada, Ryohei; Jinno, Tetsuya; Koga, Daisuke; Hirao, Masanobu; Muneta, Takeshi; Okawa, Atsushi
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.
Eklund, K; Jonsson, K; Lindblom, G; Lundin, B; Sanfridsson, J; Sloth, M; Sivberg, B
The aim of this study was to evaluate the inter- and intra-observer variability and to find differences in diagnostic safety between digital and analog technique in diagnostic zones around hip prostheses. In 80 patients who had had a total hip replacement (THR) for more than 2 years, a conventional image and a digital image were taken. Gruen's model of seven distinct regions of interest was used for evaluations. Five experienced radiologists observed the seven regions and noted in a protocol the following distances: stem-cement; cement-bone; and stem-bone. All images were printed on hard copies and were read twice. Weighted kappa, kappa(w), analyses were used. The two most frequently loosening regions, stem-cement region 1 and cement-bone region 7, were closely analyzed. In region 1 the five observers had an agreement of 86.75-97.92% between analog and digital images in stem-cement, which is a varied kappa(w) 0.29-0.71. For cement-bone region 7 an agreement of 87.21-90.45% was found, which is a varied kappa(w) of 0.48-0.58. All the kappa values differ significantly from nil. The result shows that digital technique is as good as analog radiographs for diagnosing possible loosening of hip prostheses.
Pulkkinen, Maria; Junttila, Kristiina; Lindwall, Lillemor
The aim of the study was to describe how patients undergoing either a hip or a knee replacement surgery under spinal anaesthesia experienced to be a part of the perioperative dialogue as an ideal model of caring. A qualitative approach was chosen as a method. Nineteen patients undergoing either a hip or a knee replacement surgery under spinal anaesthesia participated. These patients and their nurse anaesthetists had three perioperative dialogues in the pre-, intra- and postoperative phase of care. Data were collected by means of conversational interviews by four voluntary nurse anaesthetists who wrote the dialogues from each perioperative phase. The text from the collected data was analysed by qualitative, latent content analysis. The findings of the analysis show three identified themes: Suffering while waiting for surgery (preoperative dialogue), Continuity creates togetherness (intraoperative dialogue) and Uniqueness - the patient has been seen (postoperative dialogue). The findings show evidence that the perioperative dialogue is an ideal model of caring and serves the patients' desires of individual and dignified care. The patients have a deep appreciation when there is time to develop a caring encounter with his or her own nurse. When a caring encounter has been established, the patient is involved in his or her own care. This model of caring offers the perioperative nurses a new way of caring and arouses reflections about their main task caring for the suffering patient. The continuity created by the perioperative dialogue probably has an influence on both patient satisfaction and patient safety.
He, R.; Giri, Shankar; Kumar, P.; Hu, Y.; Suggs, J.; Yang, C.
Purpose: Target localization of prostate for Intensity Modulated Radiation Therapy (IMRT) in patients with bilateral hip replacements is difficult due to artifacts in Computed Tomography (CT) images generated from the prostheses high Z materials. In this study, Magnetic Resonance (MR) images fused with CT images are tested as a solution. Methods: CT images of 2.5 mm slice thickness were acquired on a GE Lightspeed scanner with a flat-topped couch for a prostate cancer patient with bilateral hip replacements. T2 weighted images of 5 mm separation were acquired on a MR Scanner. After the MR-CT registration on a radiotherapy treatment planning system (Eclipse, Varian), the target volumes were defined by the radiation oncologists on MR images and then transferred to CT images for planning and dose calculation. The CT Hounsfield Units (HU) was reassigned to zero (as water) for artifacts. The Varian flat panel treatment couch was modeled for dose calculation accuracy with heterogeneity correction. A Volume Matrix Arc Therapy (VMAT) and a seven-field IMRT plans were generated, each avoiding any beam transversing the prostheses; the two plans were compared. The superior VMAT plan was used for treating the patient. In-vivo dosimetry was performed using MOSFET (Best Canada) placed in a surgical tube inserted into the patient rectum during therapy. The measured dose was compared with planned dose for MOSFET location. Results: The registration of MR-CT images and the agreement of target volumes were confirmed by three physicians. VMAT plan was deemed superior to IMRT based on dose to critical nearby structures and overall conformality of target dosing. In-vivo measured dose compared with calculated dose was -4.5% which was likely due to attenuation of the surgical tube surrounding MOSFET. Conclusion: When artifacts are present on planning CT due to bilateral hip prostheses, MR-CT image fusion is a feasible solution for target delineation.
... problems. Osteoarthritis can cause pain and limited motion. Osteoporosis of the hip causes weak bones that break easily. Both of these are common in older people. Treatment for hip disorders may include rest, medicines, physical therapy, or surgery, including hip replacement.
Rozemeijer, Wouter; Jiya, Timothy U; Rijnsburger, Martine; Heddema, Edou; Savelkoul, Paul; Ang, Wim
We describe a case of a total hip arthroplasty infection caused by Abiotrophia defectiva, identified by 16S rRNA gene sequencing. Removal of the prosthesis followed by antibiotic treatment resulted in a good clinical outcome. 16S rRNA gene sequencing can be a useful tool in diagnosing infection with this fastidious microorganism that can easily be misidentified using phenotypic identification methods.
Brüggemann, Holger; Scholz, Christian F. P.; Leimbach, Andreas; Söderquist, Bo
Propionibacterium acnes is well-established as a possible etiologic agent of prosthetic joint infections (PJIs). Other Propionibacterium spp. have occasionally been described as a cause of PJIs, but this has not previously been the case for P. avidum despite its capacity to form biofilm. We describe two patients with prosthetic hip joint infections caused by P. avidum. Both patients were primarily operated with an anteriorly curved skin incision close to the skin crease of the groin, and both were obese. Initial treatment was performed according to the DAIR procedure (debridement, antibiotics, and implant retention). In case 1, the outcome was successful, but in case 2, a loosening of the cup was present 18 months post debridement. The P. avidum isolate from case 1 and two isolates from case 2 (obtained 18 months apart) were selected for whole genome sequencing. The genome of P. avidum obtained from case 1 was approximately 60 kb larger than the genomes of the two isolates of case 2. These latter isolates were clonal with the exception of SNPs in the genome. All three strains possessed the gene cluster encoding exopolysaccharide synthesis. P. avidum has a pathogenic potential and the ability to cause clinically relevant infections, including abscess formation, in the presence of foreign bodies such as prosthetic joint components. Skin incision in close proximity to the groin or deep skin crease, such as the anteriorly curved skin incision approach, might pose a risk of PJIs by P. avidum, especially in obese patients. PMID:27355425
Wang, Ling; Yang, Wenjian; Peng, Xifeng; Li, Dichen; Dong, Shuangpeng; Zhang, Shu; Zhu, Jinyu; Jin, Zhongmin
The contact mechanics of artificial metal-on-polyethylene hip joints are believed to affect the lubrication, wear and friction of the articulating surfaces and may lead to the joint loosening. Finite element analysis has been widely used for contact mechanics studies and good agreements have been achieved with current experimental data; however, most studies were carried out with idealist spherical geometries of the hip prostheses rather than the realistic worn surfaces, either for simplification reason or lacking of worn surface profile. In this study, the worn surfaces of the samples from various stages of hip simulator testing (0 to 5 million cycles) were reconstructed as solid models and were applied in the contact mechanics study. The simulator testing results suggested that the center of the head has various departure value from that of the cup and the value of the departure varies with progressively increased wear. This finding was adopted into the finite element study for better evaluation accuracy. Results indicated that the realistic model provided different evaluation from that of the ideal spherical model. Moreover, with the progressively increased wear, large increase of the contact pressure (from 12 to 31 MPa) was predicted on the articulating surface, and the predicted maximum von Mises stress was increased from 7.47 to 13.26 MPa, indicating the marked effect of the worn surface profiles on the contact mechanics of the joint. This study seeks to emphasize the importance of realistic worn surface profile of the acetabular cup especially following large wear volume.
Masaoka, Toshinori; Pezzotti, Giuseppe; Shishido, Takaaki; Tateiwa, Toshiyuki; Kubo, Kosuke
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
Takahashi, Yasuhito; Masaoka, Toshinori; Pezzotti, Giuseppe; Shishido, Takaaki; Tateiwa, Toshiyuki; Kubo, Kosuke; Yamamoto, Kengo
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.
Ayers, David C.; Greene, Meridith; Snyder, Benjamin; Aubin, Michelle; Drew, Jacob; Bragdon, Charles
Background: Radiostereometric analysis provides highly precise measurements of component micromotion relative to the bone that is otherwise undetectable by routine radiographs. This study compared, at a minimum of five years following surgery, the micromotion of tantalum and titanium acetabular cups and femoral head penetration in highly cross-linked polyethylene liners and conventional (ultra-high molecular weight polyethylene) liners in active patients who had undergone total hip replacement. Methods: This institutional review board-approved prospective, randomized, blinded study involved forty-six patients. Patients were randomized into one of four cohorts according to both acetabular cup and polyethylene liner. Patients received either a cementless cup with a titanium mesh surface or a tantalum trabecular surface and either a highly cross-linked polyethylene liner or an ultra-high molecular weight polyethylene liner. Radiostereometric analysis examinations and Short Form-36 Physical Component Summary, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), University of California Los Angeles (UCLA) activity, and Harris hip scores were obtained preoperatively, postoperatively, at six months, and annually thereafter. Results: All patients had significant improvement (p < 0.05) in Short Form-36 Physical Component Summary, WOMAC, UCLA activity, and Harris hip scores postoperatively. On radiostereometric analysis examination, highly cross-linked polyethylene liners showed significantly less median femoral head penetration at five years (p < 0.05). Steady-state wear rates from one year to five years were 0.04 mm per year for ultra-high molecular weight polyethylene liners and 0.004 mm per year for highly cross-linked polyethylene liners. At the five-year follow-up, the median migration (and standard error) was 0.05 ± 0.20 mm proximally for titanium cups and 0.21 ± 0.05 mm for tantalum cups. Conclusions: In this young population who had undergone
Barbon, Bruno; Militello, Carmelo; De Rossi, Aldo; Martella, Bruno; Ballotta, Enzo
The authors propose a technique using the autologous great saphenous vein to replace an infected prosthetic limb graft at the groin. The whole great saphenous vein is incised longitudinally and divided into 2 approximately equal segments, which are sewn side to side. The longitudinal edges of the resulting great saphenous vein are then joined and anastomosed side to side to form a conduit, whose caliber is twice the original vein's diameter. The authors have used this technique to replace 1 limb of a prosthetic aortofemoral bypass infected at the groin. After 5 years, the new venous conduit is patent, with no recurrent infection, dilation, or aneurysmal degeneration. If validated by further experiences, this might be an attractive alternative to restoring flow through clean tissue planes using extra-anatomic bypass or the femoral vein in the infected fields.
Williams, S; Butterfield, M; Stewart, T; Ingham, E; Stone, M; Fisher, J
Wear of polyethylene and the resulting wear debris-induced osteolysis remains a major cause of long-term failure in artificial hip joints. There is interest in understanding engineering and clinical conditions that influence wear rates. Fluoroscopic studies have shown separation of the head and the cup during the swing phase of walking due to joint laxity. In ceramic-on-ceramic hips, joint laxity and microseparation, which leads to contact of the head on the superior rim of the cup, has led to localized damage and increased wear in vivo and in vitro. The aim of this study was to investigate the influence of joint laxity and microseparation on the wear of ceramic on polyethylene artificial hip joints in an in vitro simulator. Microseparation during the swing phase of the walking cycle produced contact of the ceramic head on the rim of the polyethylene acetabular cup that deformed the softer polyethylene cup. No damage to the alumina ceramic femoral head was found. Under standard simulator conditions the volume change of the moderately crosslinked polyethylene cups was 25.6 +/- 5.3 mm3/million cycles and this reduced to 5.6 +/- 4.2 mm3/million cycles under microseparation conditions. Testing under microseparation conditions caused the rim of the polyethylene cup to deform locally, possibly due to creep, and the volume change of the polyethylene cup when the head relocated was substantially reduced, possibly due to improved lubrication. Joint laxity may be caused by poor soft tissue tension or migration and subsidence of components. In ceramic-on-polyethylene acetabular cups wear was decreased with a small degree of joint laxity, while in contrast in hard-on-hard alumina bearings, microseparation accelerated wear. These findings may have significant implications for the choice of fixation systems to be used for different types of bearing couples.
Gao, Leiming; Wang, Fengcai; Yang, Peiran; Jin, Zhongmin
An elastohydrodynamic lubrication (EHL) simulation of a metal-on-metal (MOM) total hip implant was presented, considering both steady state and transient physiological loading and motion gait cycle in all three directions. The governing equations were solved numerically by the multi-grid method and fast Fourier transform in spherical coordinates, and full numerical solutions were presented included the pressure and film thickness distribution. Despite small variations in the magnitude of 3D resultant load, the horizontal anterior-posterior (AP) and medial-lateral (ML) load components were found to translate the contact area substantially in the corresponding direction and consequently to result in significant squeeze-film actions. For a cup positioned anatomically at 45 degrees , the variation of the resultant load was shown unlikely to cause the edge contact. The contact area was found within the cup dimensions of 70-130 degrees and 90-150 degrees in the AP and ML direction respectively even under the largest translations. Under walking conditions, the horizontal load components had a significant impact on the lubrication film due to the squeeze-film effect. The time-dependent film thickness was increased by the horizontal translation and decreased during the reverse of this translation caused by the multi-direction of the AP load during walking. The minimum film thickness of 12-20 nm was found at 0.4s and around the location at (95, 125) degrees. During the whole walking cycle both the average and centre film thickness were found obviously increased to a range of 40-65 nm, compared with the range of 25-55 nm under one load (vertical) and one motion (flexion-extension) condition, which suggested the lubrication in the current MOM hip implant was improved under 3D physiological loading and motion. This study suggested the lubrication performance especially the film thickness distribution should vary greatly under different operating conditions and the time and
Judge, Andy; Batra, Rajbir N; Thomas, Geraint; Beard, David; Javaid, M Kassim; Murray, David; Dieppe, Paul A; Dreinhoefer, Karsten; Peter-Guenther, Klaus; Field, Richard; Cooper, Cyrus; Arden, Nigel K
Objectives To describe whether body mass index (BMI) is a clinically meaningful predictor of patient reported outcomes following primary total hip replacement (THR) surgery Design Combined data from prospective cohort studies. We obtained information from four cohorts of patients receiving primary THR for osteoarthritis: Exeter Primary Outcomes Study (n=1431); EUROHIP (n=1327); Elective Orthopaedic Centre (n=2832); and St. Helier (n=787). The exposure of interest was pre-operative BMI. Confounding variables included: age, sex, SF-36 mental health, comorbidities, fixed flexion, analgesic use, college education, OA in other joints, expectation of less pain, radiographic K&L grade, ASA grade, years of hip pain. The primary outcome was the Oxford Hip Score (OHS). Regression models describe the association of BMI on outcome adjusting for all confounders. Results For a 5-unit increase in BMI, the attained 12-month OHS decreases by 0.78 points 95%CI (0.27 to 1.28), p-value 0.001. Compared to people of normal BMI (20 to 25), those in the obese class II (BMI 35 to 40) would have a 12-month OHS that is 2.34 points lower. Although statistically significant this effect is small and not clinically meaningful in contrast to the substantial change in OHS seen across all BMI groupings. In obese class II patients achieved a 22.2 point change in OHS following surgery. Conclusions Patients achieved substantial change in OHS after THR across all BMI categories, which greatly outweighs the small difference in attained post-operative score. The findings suggest BMI should not present a barrier to access THR in terms of PROMs. PMID:24418679
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hip joint (hemi-hip) acetabular metal cemented... (hemi-hip) acetabular metal cemented prosthesis. (a) Identification. A hip joint (hemi-hip) acetabular metal cemented prosthesis is a device intended to be implanted to replace a portion of the hip...
Liu, Feng; Williams, Sophie; Jin, Zhongmin; Fisher, John
Head contact on the rim of the cup causes stress concentration and consequently increased wear. The head contact on the rim of the cup may in addition cause an offset load and torque on the cup. The head-rim contact resulting from microseparation or subluxation has been investigated. An analytical model has been developed to calculate the offset loading and resultant torque on the cup as a function of the translational displacement of the head under simplified loading condition of the hip joint at heel strike during a walking cycle. The magnitude of the torque on the cup was found to increase with the increasing translational displacement, larger diameter heads, eccentric cups, and the coefficient of friction of the contact. The effects of cup inclination, cup rim radius, and cup coverage angle on the magnitude of the torque were found to be relatively small with a maximum variation in the torque magnitude being lower than 20%. This study has shown an increased torque due to the head loading on the rim of the cup, and this may contribute to the incidence of cup loosening. Particularly, metal-on-metal hip joints with larger head diameters may produce the highest offset loading torque.
Gallo, Jiri; Vaculova, Jana; Goodman, Stuart B.; Konttinen, Yrjö T.; Thyssen, Jacob P.
Aseptic loosening and osteolysis are the most frequent late complications of total hip arthroplasty (THA) leading to revision of the prosthesis. This review aims to demonstrate how histopathological studies contribute to our understanding of the mechanisms of aseptic loosening/osteolysis development. Only studies analysing periprosthetic tissues retrieved from failed implants in humans were included. Data from 101 studies (5532 patients with failure of THA implants) published in English or German between 1974 and 2013 were included. “Control” samples were reported in 45 of the 101 studies. The most frequently examined tissues were the bone-implant interface membrane and pseudosynovial tissues. Histopathological studies contribute importantly to determination of key cell populations underlying the biological mechanisms of aseptic loosening and osteolysis. The studies demonstrated the key molecules of the host response at the protein level (chemokines, cytokines, nitric oxide metabolites, metalloproteinases). However, these studies also have important limitations. Tissues harvested at revision surgery reflect specifically end-stage failure and may not adequately reveal the evolution of pathophysiological events that lead to prosthetic loosening and osteolysis. One possible solution is to examine tissues harvested from stable total hip arthroplasties that have been revised at various time periods due to dislocation or periprosthetic fracture in multicenter studies. PMID:24525037
Zivkovic, I; Gonzalez, M; Amirouche, F
This paper explores the effect of under-reaming on micromotion at the cup/bone interface of a press-fit acetabular cup. A cadaver experiment was performed on 11 acetabuli implanted with a cementless acetabular cup. The loading profile simulated hip impingement at the extremes of motion and subluxation relocation of the hip joint. Micromotion of each cup was measured in a custom made jig with linear variable differential transducers. A CAT scan and DEXA scan of the acetabulum and femoral head respectively were used to construct a three-dimensional patient specific finite element model of the hemi-pelvis. The model predicted cup micromotion under loading conditions and stresses in the acetabulum as a result of cup insertion. Micromotion was then calculated as a function of variable bone density and variable degree of underreaming. Simulated cup insertion with under-reaming of 2 mm or more approached or exceeded the yield strength of bone in acetabula with reduced bone mass density.
Figueiredo-Pina, C G; Yan, Y; Neville, A; Fisher, J
Hip simulator studies have been carried out extensively to understand and test artificial hip implants in vitro as an efficient alternative to obtaining long-term results in vivo. Recent studies have shown that a ceramic-on-metal material combination lowers the wear by up to 100 times in comparison with a typical metal-on-metal design. The reason for this reduction remains unclear and for this reason this study has undertaken simple tribometer tests to understand the fundamental material loss mechanisms in two material combinations: metal-on-metal and ceramic-on-ceramic. A simple-configuration reciprocating pin-on-plate wear study was performed under open-circuit potential (OCP) and with applied cathodic protection (CP) in a serum solution using two tribological couples: firstly, cobalt-chromium (Co-Cr) pins against Co-Cr plates; secondly, Co-Cr pins against alumina (Al2O3) plates. The pin and plate surfaces prior to and after testing were examined by profilometry and scanning electron microscopy. The results showed a marked reduction in wear when CP was applied, indicating that total material degradation under the OCP condition was attributed to corrosion processes. The substitution of the Co-Cr pin with an Al2O3 plate also resulted in a dramatic reduction in wear, probably due to the reduction in the corrosion-wear interactions between the tribological pair.
Sigurdsson, Eyjolfur; Siggeirsdottir, Kristin; Jonsson, Halldor; Gudnason, Vilmundur; Matthiasson, Thorolfur; Jonsson, Brynjolfur Y
Total hip replacement (THR) is a common and costly procedure. The number of THR is expected to increase over the coming years. Two pathways of postoperative treatment were compared in a randomized study. Fifty patients from two hospitals were randomized into a study group (SG) of 27 patients receiving preoperative and postoperative education programs, as well as home visits from an outpatient team. A control group (CG) of 23 patients received "conventional" rehabilitation augmented by a stay at a rehabilitation center if needed. All costs for the two groups both in hospitals and after discharge were collected and analyzed. On average total costs for the SG were $8,550 and $11,952 for the CG, a 28% cost reduction. Total inpatient costs were $5,225 for the SG and $6,515 for the CG. In a regression analysis the group difference is statistically significant. Adjusting for changes in the Oxford Hip Score gives effective costs (C/E). The ratio of the SGs C/E to the CGs is 0.60. That is a cost-effectiveness gain of 40%. A shorter hospital stay augmented with better preoperative education and home treatment appears to be more effective and costs less than the traditional in hospital pathway of treatment.
Neut, D; Dijkstra, R J; Thompson, J I; Kavanagh, C; van der Mei, H C; Busscher, H J
A degradable, poly (lactic-co-glycolic acid) (PLGA), gentamicin-loaded prophylactic coating for hydroxyapatite (HA)-coated cementless hip prostheses is developed with similar antibacterial efficacy as offered by gentamicin-loaded cements for fixing traditional, cemented prostheses in bone. We describe the development pathway, from in vitro investigation of antibiotic release and antibacterial properties of this PLGA-gentamicin-HA-coating in different in vitro models to an evaluation of its efficacy in preventing implant-related infection in rabbits. Bone in-growth in the absence and presence of the coating was investigated in a canine model. The PLGA-gentamicin-HA-coating showed high-burst release, with antibacterial efficacy in agar-assays completely disappearing after 4 days, minimising risk of inducing antibiotic resistance. Gentamicin-sensitive and gentamicin-resistant staphylococci were killed by the antibiotic-loaded coating, in a simulated prosthesis-related interfacial gap. PLGA-gentamicin-HA-coatings prevented growth of bioluminescent staphylococci around a miniature-stem mounted in bacterially contaminated agar, as observed using bio-optical imaging. PLGA-gentamicin-HA-coated pins inserted in bacterially contaminated medullary canals in rabbits caused a statistically significant reduction in infection rates compared to HA-coated pins without gentamicin. Bone ingrowth to PLGA-gentamicin-HA-coated pins, in condylar defects of Beagle dogs was not impaired by the presence of the degradable, gentamicin-loaded coating. In conclusion, the PLGA-gentamicin-HA-coating constitutes an effective strategy for infection prophylaxis in cementless prostheses.
Karpenko, A A; Ignatenko, P V; Beliaev, A M
Aortic prosthesis replacements including extra-anatomical bypass procedures, in situ revascularisations with the neoaortoiliac system, antibiotic bounded prostheses or allogeneic grafts have high graft reinfection rates. We described a case of a 68-year-old man with Samson group V Staphylococcus aureus infection of his aortobifemoral graft. He underwent an explantation of the infected graft, wound debridement and a hybrid in situ allogeneic aortoiliofemoral replacement. During surgery one of the limbs of the cryopreserved human aortic allogeneic graft was anastomosed with the endarterectomised left common iliac artery, which later was angioplastied and stented. The closed system Jackson-Pratt drains were used to prevent perigraft fluid collection. The groin wound was treated with the vacuum-assisted closure dressing. On review in 6 months he remained symptom free. We conclude that a hybrid management of infected aortic prosthesis may reduce graft reinfection. PMID:23897382
Petre, Benjamin M; Roxbury, Christopher R; McCallum, Jeremy R; Defontes, Kenneth W; Belkoff, Stephen M; Mears, Simon C
Our goal was to determine whether there were age-related differences in pain, opiate use, and opiate side effects after total hip or knee arthroplasty in patients 60 years old or older. We hypothesized that there would be no significant differences between age groups in (1) mean pain score, (2) opiate use after adjusting for pain, or (3) opiate side effects after adjusting for opiate use and pain score. We retrospectively reviewed the electronic and paper charts of all patients undergoing total joint replacements at our institution over 3 years who met the following criteria: (1) 60 years old or older, (2) primary single total knee or total hip replacement, and (3) no preoperative dementia. Preoperative, intraoperative, and postoperative course data were collected using a customized data entry process and database. We divided the patients into 2 age groups, those 60 to 79 years old and those 80 years old or older. Using a marginal model with the panel variable of postoperative day, we investigated the associations between age group and pain, age group and pain adjusting for opiate use, and age group and complications (respiratory depression, naloxone usage as a measure of respiratory arrest, delirium, constipation, and urinary retention) adjusting for opiate use (Xtgee, Stata10, Stata Corp. LP, College Station, Texas). Significance was set at P < .05. We found no significant difference in pain scores between groups, but the older group had significantly fewer opiates prescribed yet significantly more side effects, including delirium (odds ratio 4.2), than did the younger group, even after adjusting for opiate dose and pain score.
Nganbe, Michel; Khan, Usman; Louati, Hakim; Speirs, Andrew; Beaulé, Paul E
Modularity in total hip replacement offers advantages with regard to biomechanical adjustments and leg lengths. Recently, modular femoral necks were introduced as an added advantage to head modularity permitting further adjustments in femoral version as well as offset and ease of revision. Currently, most necks are made of Ti6Al4V for which cases of in vivo fractures and inseparable neck-stem junctions have been reported. Therefore, we investigated CoCrMo head-Ti6Al4V stem hip replacements with necks made of CoCrMo as an alternative to Ti6Al4V. We compared the two materials with respect to (1) compressive load bearing capacity; (2) fatigue durability; and (3) component distraction. We performed in vitro fatigue-pull-off, microscopy, fatigue durability and compression investigations. The CoCrMo neck showed a load bearing capacity of 18 kN, 38% higher than 13 kN for the Ti6Al4V neck. A fatigue load of 11.2 kN for 1 million cycle failure was achieved with CoCrMo translating into nearly 1000 times longer fatigue life compared to Ti6Al4V necks. The neck-stem distraction force showed large statistical variation and was similar for both neck materials. Overall, the results suggest a superiority of CoCrMo over Ti6Al4V as neck material with regard to mechanical behavior. However, the corrosion behavior was not appropriately assessed and necessitates additional investigations.
Terleira-Fernández, Ana Isabel; Suárez-Gea, M Luisa; Vargas-Castrillón, Emilio
Objective To analyse clinical outcomes with new oral anticoagulants for prophylaxis against venous thromboembolism after total hip or knee replacement. Design Systematic review, meta-analysis, and indirect treatment comparisons. Data sources Medline and CENTRAL (up to April 2011), clinical trials registers, conference proceedings, and websites of regulatory agencies. Study selection Randomised controlled trials of rivaroxaban, dabigatran, or apixaban compared with enoxaparin for prophylaxis against venous thromboembolism after total hip or knee replacement. Two investigators independently extracted data. Relative risks of symptomatic venous thromboembolism, clinically relevant bleeding, deaths, and a net clinical endpoint (composite of symptomatic venous thromboembolism, major bleeding, and death) were estimated using a random effect meta-analysis. RevMan and ITC software were used for direct and indirect comparisons, respectively. Results 16 trials in 38 747 patients were included. Compared with enoxaparin, the risk of symptomatic venous thromboembolism was lower with rivaroxaban (relative risk 0.48, 95% confidence interval 0.31 to 0.75) and similar with dabigatran (0.71, 0.23 to 2.12) and apixaban (0.82, 0.41 to 1.64). Compared with enoxaparin, the relative risk of clinically relevant bleeding was higher with rivaroxaban (1.25, 1.05 to 1.49), similar with dabigatran (1.12, 0.94 to 1.35), and lower with apixaban (0.82, 0.69 to 0.98). The treatments did not differ on the net clinical endpoint in direct or indirect comparisons. Conclusions A higher efficacy of new anticoagulants was generally associated with a higher bleeding tendency. The new anticoagulants did not differ significantly for efficacy and safety. PMID:22700784
Porsch, M; Schmidt, J; Brimmers, P; Menne, A; Merkle, W
During primary hip arthroplasty an increase in intramedullary pressure (IMP) of up to 1000 mm Hg can be observed. As a result of this increased intrafemoral pressure, intramedullary constituents can pass into the venous circulation creating a risk of fat embolism syndrome (FES). In the present experimental study on 9 femora obtained from human corpses, we investigated the question as to whether various methods of cement removal during total hip revision arthroplasty are also associated with increased intramedullary pressure and a risk of FES. The IMP was recorded with a standardized experimental set-up during removal of cement from the proximal and distal regions, including removal of the cement "tip" and the intramedullary plug. The methods employed for this purpose included the osteotome and mallet, a compressed air powered chisel, and a modified intracorporal lithotripter. All the methods induced fluctuations in the IMP the highest values being recorded for the conventional method using the osteotome and mallet (45 mm Hg) and the lowest values for the intracorporeal lithotripter (7.5 mm Hg). Working on the distal cement caused higher fluctuations in comparison with the proximal region. The study failed to reveal any increase in mean IMP, and all measured values were in the low pressure range (considerably below 150 mm Hg). While there seems to be no apparent risk of an FES developing during removal of cement, careless manipulation of the distal cement plug may result in higher intrafemoral pressures--above 150 mm Hg--thus increasing the risk of a fat embolism syndrome.
Malik, M. H. A.; Gambhir, A. K.; Bale, L.; Pradhan, N.; Porter, M. L.
BACKGROUND: In 1999, a statement of best practice in primary total hip replacement was approved by the Council of the British Orthopaedic Association (BOA) and by the British Hip Society (BHS) to provide a basis for regional and national auditable standards. We have compared practice in the North West Region of England to this document to ascertain adherence to this guide to best practice. METHODS: A total of 86 surgeons from 26 hospitals were included in a questionnaire study. RESULTS: A mean of 93.3% of operations were performed in the surgeon's usual theatre. All of these theatres had vertical laminar air flow systems. Of respondents, 42.2% routinely used exhaust suits, 68.1% routinely used impermeable disposable gowns, and 26.1% used impermeable re-usable gowns. The Charnley femoral and acetabular prostheses were the most commonly used prostheses. All surgeons used some form of anti-thromboembolic prophylaxis: 66.2% use a combination of both mechanical and chemical means. All surgeons used antibiotic prophylaxis. The most popular choice of antibiotic was a cephalosporin--70.7% used a 3-dose regimen over 24 h, 2.6% of surgeons continued antibiotic prophylaxis for 48 h after surgery, and 93.7% of surgeons routinely use antibiotic-loaded cement. All surgeons routinely cleaned, irrigated and dried the acetabulum and femur before cement insertion. Only one surgeon did not use any form of femoral canal occlusion. 69.4% used an intramedullary bone block. Retrograde filling of the femoral shaft by means of a cement gun was practised by 65.1%. CONCLUSIONS: This study has demonstrated considerable variation of practice in total hip arthroplasty across the North West Region and significant divergence from the statement of best practice approved by the BOA and BHS. The introduction of a properly funded national hip register will surely help to clarify the effect of such diverse practice on patient outcome. We would recommend that all trusts locally audit their practices
Khalfaoui, Mahdi Y; Veravalli, Karunakar; Evans, D Alun
Objective The aims of the current study were to determine whether pre-operative urinary tract infections in patients presenting acutely with neck of femur fractures resulted in a delay to surgery and whether such patients were at increased risk of developing post-operative surgical site infections. Design A retrospective review of all patients presenting with a neck of femur fracture, at a single centre over a one-year period. The hospital hip fracture database was used as the main source of data. Setting UK University Teaching Hospital Participants All patients (n = 460) presenting across a single year study period with a confirmed hip fracture. Outcome measures The presence of pre-operative urinary tract infection, the timing of surgical intervention, the occurrence of post-operative surgical site infection and the pathogens identified. Results A total of 367 patients were operated upon within 24 hours of admission. Urinary infections were the least common cause of delay. A total of 99 patients (21.5%) had pre-operative urinary tract infection. Post-operatively, a total of 57 (12.4%) patients developed a surgical site infection. Among the latter, 31 (54.4%) did not have a pre-operative urinary infection, 23 (40.4%) patients had a pre-operative urinary tract infection, 2 had chronic leg ulcers and one patient had a pre-operative chest infection. Statistically, there was a strong relationship between pre-operative urinary tract infection and the development of post-operative surgical site infection (p-value: 0.0005). Conclusion The results of our study indicate that pre-operative urinary tract infection has a high prevalence amongst those presenting with neck of femur fractures, and this is a risk factor for the later development of post-operative surgical site infection. PMID:28321316
Pommepuy, Thomas; Lons, Adrien; Benad, Kevin; Beltrand, Eric; Senneville, Eric; Migaud, Henri
Recommendations for the management of chronic and bilateral total hip arthroplasty (THA) infection are lacking. However, this type of infection involves medical problems concerning the management of the antibiotic therapy. We report two cases of such infections operated as one-stage revision. For each case, both hips were infected with the same bacteria (Staphylococcus caprae for one patient and methicillin-sensitive Staphylococcus aureus for the other). The probabilistic antibiotic treatment started during the first side (after harvesting intraoperative samples) did not prevent the culture of the bacteriologic harvested during the intervention of the second side. Cultures were positive for the same bacteria for both sides in the two cases presented herein. After results of intraoperative cultures, patients received culture-guided antibiotic therapy for three months and were considered cured at the end of a two-year follow-up. Our results suggest one-stage bilateral change of infected THA is a viable option and that early intraoperative antibiotic, started during the first-side exchange, does not jeopardize microbiological documentation of the second side. This work brings indirect arguments, in favor of the use of prophylactic antibiotics during revision of infected THA. PMID:26904335
Evaluation of variables influencing success and complication rates in canine total hip replacement: results from the British Veterinary Orthopaedic Association Canine Hip Registry (collation of data: 2010-2012).
Henderson, Elisabeth R; Wills, Andrew; Torrington, Andrew M; Moores, Andy P; Thomson, David; Arthurs, Gareth; Brown, Gordon; Denny, Hamish R; Scott, Harry W; MacQueen, Ian; Dunne, James; Onyett, Jeremy; Walker, John D; Prior, John; Owen, Martin R; Burton, Neil; Whitelock, Richard; Girling, Sarah; Morrison, Shane; Gilbert, Simon; Langley-Hobbs, Sorrel J; Gemmill, Toby J; Störk, Christoph K; Bright, Steve; Comerford, Eithne; Pettitt, Rob; Macdonald, Nick; Innes, John F
The objective of this study was to assess the variables associated with complications of total hip replacement (THR) and report owner-assessed outcomes. Entries into the British Veterinary Orthopaedic Association-Canine Hip Registry (BVOA-CHR) between September 2011 and December 2012 were reviewed separately and in conjunction with previous data (January 2010-August 2011). An outcomes assessment questionnaire was used to collect data from owners. Incidences of surgeon-reported and owner-reported complications were 8.2 per cent and 4.3 per cent, respectively. THR using the BioMedtrix BFX cup/stem prosthesis had a greater incidence of complications compared with THR using the BioMedtrix CFX cup/stem prosthesis (P=0.002); complications were 4.48 times more likely when using the BioMedtrix BFX cup/stem prosthesis versus the BioMedtrix CFX cup/stem prosthesis. THR using the BioMedtrix BFX cup/stem prosthesis had a higher incidence of complications compared with THR using a hybrid prosthesis (BioMedtrix BFX cup/CFX stem, BioMedtrix CFX cup/BFX stem) (P=0.046); complications were 2.85 times more likely when using the BioMedtrix BFX cup/stem prosthesis versus a hybrid prosthesis. In 95 per cent of cases, owner satisfaction with the outcome of THR was 'very good' or 'good'. Complication rates from the BVOA-CHR are similar to previous studies. The data suggest that prosthesis type is associated with complication rate, with BioMedtrix BFX (circa 2012) having a high short-term complication rate.
Lu, Z; McKellop, H
In cemented total hip prostheses, the role of creep of the acrylic cement (polymethyl methacrylate, [PMMA]) in increasing or decreasing the chance of failure of the cement mantle is a subject of ongoing controversy. In the present study we used a three-dimensional finite-element model of a cemented stem to assess the influence of cement creep on subsidence of the stem, and on the stress and strain in the cement under cyclic load, both in the short and long term. The cement layer was assigned the shear and bulk creep moduli of Zimmer regular PMMA cement, which were obtained experimentally. The stem-cement interface was modeled either as (1) completely bonded, (2) completely debonded with friction, or (3) completely debonded and frictionless. Under the cyclic load some cement creep occurred with all three bonding conditions, allowing additional subsidence of the stem and a decrease in the stress components within the cement. During the unloaded period the full recovery of the preload conditions could be reached with the completely bonded and with the frictionless interfaces. With the frictional interface there was residual cement creep, residual stresses within the cement, and residual subsidence of the stem during the unloaded period; however, the reduction of the stress was at most 13% and the subsidence was about 0.46 mm. The much larger subsidence of debonded stems that is often observed clinically might be attributed to the factors which were not included in the present model, such as circumferential bone remodeling.
Miyazato, Akiko; Ohkusu, Kiyohumi; Ishii, Shunsuke; Sasaoka, Taishi; Ikeda, Masahiro; Niinami, Hiroshi; Ezaki, Takayuki; Mitsutake, Kotaro
Aerococcus urinae is a endocarditis rare causative organism with low virulene. We report an A. urinae endocarditis case treated by aortic valve replacement. An 80-year-old woman hospitalized for urinary tract infection and hydronephrosis due to three-week renal calculi. Blood culture on admission isolated Streptococcus acidominimus. During the course, she was transferred to our care for surgical intervention after developing congestive heart failure due to severe aortic regurgitation. Echocardiographic findings indicated infective endocarditis. She underwent aortic valve replacement, and gram staining of the resected valve tissue showed gram-positive cocci, although valve culture was negative. PCR amplification and DNA sequencing using the valve material matched an A. urinae sequence. The woman recovered and was discharged six weeks after antibiotic treatment.
Roba, Marcella; Naka, Marco; Gautier, Emanuel; Spencer, Nicholas D; Crockett, Rowena
The selectivity of synovial fluid protein adsorption onto ultra-high molecular weight polyethylene (UHMWPE) and alumina (Al(2)O(3)), and in particular the ability of glycoproteins to adsorb in the presence of all the other synovial fluid proteins, was investigated by means of fluorescence microscopy and gel electrophoresis (SDS-PAGE). The non-specific nature of protein adsorption from synovial fluid indicated that the lubrication of artificial hip-joint materials may not be attributable to a single protein as has been frequently suggested. The friction behavior of polyethylene (PE) sliding against Al(2)O(3) in solutions of bovine serum albumin (BSA), alpha-1-acid glycoprotein (AGP) and alpha-1-antitrypsin (A1AT) was investigated by means of colloidal probe atomic force microscopy. BSA was shown to be a poorer boundary lubricant than the phosphate buffered saline used as a control. This was attributed to denaturation of the BSA upon adsorption, which provided a high-shear-strength layer at the interface, impairing the lubrication. Interestingly, both the glycoproteins AGP and A1AT, despite their low concentrations, improved lubrication. The lubricating properties of AGP and A1AT were attributed to adsorption via the hydrophobic backbone, allowing the hydrophilic carbohydrate moieties to be exposed to the aqueous solution, thus providing a low-shear-strength fluid film that lubricated the system. The amount of glycoprotein adsorbed on hydrophobic surfaces was determined by means of optical waveguide lightmode spectroscopy (OWLS), allowing conclusions to be drawn about the conformation of the glycan residues following adsorption.
Imam, Mohamed A; Barke, Samuel; Stafford, Giles H; Parkin, David; Field, Richard E
Patient reported outcome measures (PROMs) are used to gauge clinical performance. The PROMs outcome programme at our centre achieves a preoperative data capture rate of 99%. This falls to 90.6%, 89%, 83% and 79% at the six-week, six-month, one-year and two-year time points, respectively. The study aims were to determine factors associated with patients who did not respond to outcome questionnaires following total hip replacement (THR), and the potential implications this may have when assessing patients following THRs. During the first year of the PROMs programme, 1,322 patients underwent unilateral primary THR at our institution. Of these, 1,311 completed preoperative questionnaires. Thirty-eight patients (2.9%) died within two years of surgery and have been excluded. For the remaining 1,273 patients, we identified those who did not return postoperative questionnaires at each of our review time points. Younger age, lower baseline EQ5D and Oxford Hip scores (OHS) were significantly associated with non-response (p<0.001). Patients with lower satisfaction scores, OHS and EQ5D scores, were less likely to respond to subsequent questionnaires. A significant association between non-response and deprivation (p<0.001) was demonstrated. Our findings suggest that the more satisfied patients are over-represented and our reported outcome results are better than they would have been if all patients had responded. This phenomenon may apply to studies where those categorised as "lost to follow-up" represent a subset of patients who have disengaged due to poor outcome or satisfaction.
Beziz, Dan; Colas, Sandrine; Collin, Cédric; Dray-Spira, Rosemary; Zureik, Mahmoud
Background Total hip replacement (THR) is successful in treating hip arthritis. Prosthetic survivorship may depend on the medications taken by the patient; particularly, the role of benzodiazepines and related drugs (Z-drugs) with THR revision has been poorly investigated. Our objective was to compare THR short-term survivorship according to level of exposure to benzodiazepine and Z-drugs. Design, Setting and Participants All French patients aged 40 years or older, having undergone primary THR from January 1, 2009, through December 31, 2012, for arthritis according to French national health insurance databases were included in the cohort. Outcome of interest was THR revision, including any surgical procedure in which the implant or any component was changed or removed. Follow-up started the day the primary THR was performed. Observations were right-censored on December 31, 2014, if neither revision nor death had yet occurred. Exposure of interest was the cumulative defined daily doses per day (cDDD/day) of benzodiazepines and Z-drugs dispensed within 6 months before or after inclusion. We defined four exposure groups; cDDD/d = 0: unexposed; <0.08: low exposure;] 0.08–0.38]: medium exposure; >0.38: high exposure. THR survivorship was assessed according to level of exposure to benzodiazepines and Z-drugs in univariate and multivariate Cox models adjusted for patient, THR and implanting center characteristics. Results The study cohort comprised 246,940 individuals: mean age at baseline, 69.9 years; women, 57.9%; unexposed: 51.7%; low exposure: 16.7%; medium exposure: 15.9%; and high exposure: 15.7%. During the median 45-month follow-up, 9043 individuals underwent prosthetic revision. Adjusted hazard ratios in low, medium and high exposed groups were 1.18 (95%CI, 1.12–1.26; P<0.001), 1.32 (95%CI, 1.24–1.40; P<0.001) and 1.37 (95%CI, 1.29–1.45; P<0.001), respectively, compared to unexposed. Conclusion and Relevance Exposure to benzodiazepines and Z-drugs is
Klatte, Till Orla; Kendoff, Daniel; Sabihi, Reza; Kamath, Atul F; Rueger, Johannes M; Gehrke, Thorsten
During the one-stage exchange procedure for periprosthetic joint infection (PJI) after total hip arthroplasty (THA), acetabular defects challenge reconstructive options. Porous tantalum augments are an established tool for addressing acetabular destruction in aseptic cases, but their utility in septic exchange is unknown. This retrospective case-control study presents the initial results of tantalum augmentation during one-stage exchange for PJI. Primary endpoints were rates of re-infection and short-term complications associated with this technique. Study patients had no higher risk of re-infection with equivalent durability at early follow-up with a re-infection rate in both groups of 4%. In conclusion, tantalum augments are a viable option for addressing acetabular defects in one-stage exchange for septic THA. Further study is necessary to assess long-term durability when compared to traditional techniques for acetabular reconstruction.
Purushotham, VJ; Ranganath, BT
Introduction: Girdlestone hip arthroplasty, though described as a salvage procedure for infected hip joints, can also be considered for failed Hemiarthroplasty procedures. The functional results of such Girdlestone hip may not be satisfactory. They may require total hip replacement to improve the quality of life, which are technically challenging. Here we are reporting such a case ina 60 year old male patient, with review of literature. Case Report: A 60 year old male patient underwent cemented bipolar hemiarthroplasty for fracture neck of femur which failed, owing to improper implantation. Subsequently he underwent Girdlestone arthroplasty which resulted in persistent painful hip. He presented to us in this situation, where we successfully converted the Girdlestone arthroplasty to a Total Hip arthroplasty. Conclusion: Improper implantation in Hemiarthroplasty fails subsequently. In such cases Girdlestone arthroplasty may be an option to consider, though it may not give requisite relief to patient in some cases. In such situations total hip arthroplasty procedure, though technically challenging will give stable painless hip to the patient. PMID:27299043
Duquin, T R; Jacobson, J A; Schleck, C D; Larson, D R; Sanchez-Sotelo, J; Morrey, B F
Treatment of an infected total elbow replacement (TER) is often successful in eradicating or suppressing the infection. However, the extensor mechanism may be compromised by both the infection and the surgery. The goal of this study was to assess triceps function in patients treated for deep infection complicating a TER. Between 1976 and 2007 a total of 217 TERs in 207 patients were treated for infection of a TER at our institution. Superficial infections and those that underwent resection arthroplasty were excluded, leaving 93 TERs. Triceps function was assessed by examination and a questionnaire. Outcome was measured using the Mayo Elbow Performance Score (MEPS). Triceps weakness was identified in 51 TERs (49 patients, 55%). At a mean follow-up of five years (0.8 to 34), the extensor mechanism was intact in 13 patients, with the remaining 38 having bone or soft-tissue loss. The mean MEPS was 70 points (5 to 100), with a mean functional score of 18 (0 to 25) of a possible 25 points. Infection following TER can often be eradicated; however, triceps weakness occurs in more than half of the patients and may represent a major functional problem.
Background The evolutionary success of Wolbachia bacteria, infections of which are widespread in invertebrates, is largely attributed to an ability to manipulate host reproduction without imposing substantial fitness costs. Here, we describe a stage-structured model with deterministic immature lifestages and a stochastic adult female lifestage. Simulations were conducted to better understand Wolbachia invasions into uninfected host populations. The model includes conventional Wolbachia parameters (the level of cytoplasmic incompatibility, maternal inheritance, the relative fecundity of infected females, and the initial Wolbachia infection frequency) and a new parameter termed relative larval viability (RLV), which is the survival of infected larvae relative to uninfected larvae. Results The results predict the RLV parameter to be the most important determinant for Wolbachia invasion and establishment. Specifically, the fitness of infected immature hosts must be close to equal to that of uninfected hosts before population replacement can occur. Furthermore, minute decreases in RLV inhibit the invasion of Wolbachia despite high levels of cytoplasmic incompatibility, maternal inheritance, and low adult fitness costs. Conclusions The model described here takes a novel approach to understanding the spread of Wolbachia through a population with explicit dynamics. By combining a stochastic female adult lifestage and deterministic immature/adult male lifestages, the model predicts that even those Wolbachia infections that cause minor decreases in immature survival are unlikely to invade and spread within the host population. The results are discussed in relation to recent theoretical and empirical studies of natural population replacement events and proposed applied research, which would use Wolbachia as a tool to manipulate insect populations. PMID:21975225
Verhamme, Peter; Gunn, Sophie; Sonesson, Elisabeth; Peerlinck, Kathelijne; Vanassche, Thomas; Vandenbriele, Christophe; Ageno, Walter; Glazer, Steven; Prins, Martin; Buller, Harry; Tangelder, Marco
TB-402 is a long-acting monoclonal antibody that partially inhibits factor VIII. A single administration of TB-402 was effective and well-tolerated for the prevention of venous thromboembolism (VTE) after total knee replacement. In this study, the efficacy and safety of a single administration of TB-402 for the extended prophylaxis of VTE after total hip replacement (THR) was investigated. This was a phase II, randomised, active-controlled, double-blind study that included patients undergoing elective THR surgery. Patients were randomised to TB-402 25 mg or TB-402 50 mg, administered as a single intravenous administration 2-4 hours postoperatively, or to rivaroxaban 10 mg once daily for 35 days. The primary efficacy outcome was total VTE defined as symptomatic VTE and asymptomatic deep-vein thrombosis (DVT) detected by bilateral venography at day 35. The principal safety outcome was the incidence of major bleeding and clinically relevant non-major bleeding until day 35. Total VTE was similar in all groups: 5.3% (95%CI 2.9-9.6), 5.2% (95%CI 2.8-9.3) and 4.7% (95%CI 2.5-8.7) for TB-402 25 mg, TB-402 50 mg and rivaroxaban, respectively. All were asymptomatic DVTs. Major or clinically relevant non-major bleedings were observed in 5.8% (95%CI 3.3-9.9), 7.2% (95%CI 4.4-11.6) and 1.4% (95%CI 0.5-4.2) for TB-402 25 mg, TB-402 50 mg and rivaroxaban, respectively. In conclusion, TB-402, administered as a single postoperative dose, had a similar efficacy compared to rivaroxaban for the prevention of VTE after THR. The incidence of major and clinically relevant non-major bleeding was higher in the TB-402 groups than in the rivaroxaban group.
Baernholdt, Marianne; Merwin, Elizabeth I.
Purpose To describe trends in the length of stay (LOS), costs, mortality, and discharge destination among a national sample of total hip replacement (THR) patients between 1997 and 2012. Design Longitudinal retrospective design. Methods Descriptive analysis of the Healthcare Utilization Project (HCUP) National Inpatient Sample data. Findings A total of 3,516,636 procedures were performed over the study period. Most THR patients were women, and the proportion aged 44–65 years increased. LOS decreased from 5 to 3 days. Charges more than doubled, from $22,184 to $53,901. Deaths decreased from 43 to 12 deaths per 10,000 patients. THR patients discharged to an institutional setting declined, while those discharged to the community increased. Conclusion We found an increase in THR patients, who were younger, women, had private insurance, and among those discharged to community-based settings. Clinical Relevance Findings have implications for patient profiles, workplace environments, quality improvement, and educational preparation of nurses in acute and post-acute settings. PMID:25820992
Kotirum, Surachai; Chongmelaxme, Bunchai; Chaiyakunapruk, Nathorn
To analyze the cost-utility of oral dabigatran etexilate, enoxaparin sodium injection, and no intervention for venous thromboembolism (VTE) prophylaxis after total hip or knee replacement (THR/TKR) surgery among Thai patients. A cost-utility analysis using a decision tree model was conducted using societal and healthcare payers' perspectives to simulate relevant costs and health outcomes covering a 3-month time horizon. Costs were adjusted to year 2014. The willingness-to-pay threshold of THB 160,000 (USD 4926) was used. One-way sensitivity and probabilistic sensitivity analyses using a Monte Carlo simulation were performed. Compared with no VTE prophylaxis, dabigatran and enoxaparin after THR and TKR surgery incurred higher costs and increased quality adjusted life years (QALYs). However, their incremental cost-effectiveness ratios were high above the willingness to pay. Compared with enoxaparin, dabigatran for THR/TKR lowered VTE complications but increased bleeding cases; dabigatran was cost-saving by reducing the costs [by THB 3809.96 (USD 117.30) for THR] and producing more QALYs gained (by 0.00013 for THR). Dabigatran (vs. enoxaparin) had a 98 % likelihood of being cost effective. Dabigatran is cost-saving compared to enoxaparin for VTE prophylaxis after THR or TKR under the Thai context. However, both medications are not cost-effective compared to no thromboprophylaxis.
Gul, Rizwan M
The wear of the ultra-high molecular weight polyethylene (UHMWPE) acetabular components and wear debris induced osteolysis are the major causes of failure in total hip replacements. Crosslinking has been shown to improve the wear resistance of UHMWPE by producing a network structure, resisting the plastic deformation of the surface layer. In this study organic peroxides were used to crosslink two different types of UHMWPE resins, using hot isostatic pressing as the processing method. The effects of peroxide content on the different properties were investigated, along with the effect of the crosslink density on the wear behavior. An increase in peroxide content decreases the melting point and the degree of crystallinity, which results in a decrease in the yield strength. The ultimate tensile strength remains essentially unchanged. The molecular weight between crosslinks decreases with an increase in the peroxide content and reaches a saturation limit at around 0.3-0.5 weight percent peroxide, its value at the saturation limit is a function of the virgin resin used for processing. The wear rate decreases linearly with the increase in crosslink density.
Kerr, Elizabeth; Middleton, Annie; Churchill, Duncan; Walker-Bone, Karen
Objectives This was a cross-sectional case-control study amongst a cohort of HIV-infected adults aiming to explore the prevalence of and risk factors for elective hip surgery (total hip arthroplasty and resurfacing). Methods Cases were identified from the outpatient database of HIV-infected adults attending one tertiary hospital service. For each case, 5 controls matched by age, gender and ethnicity were identified. From the case notes, information about demographic factors, HIV factors and risk factors for hip surgery due to osteoarthritis or avascular necrosis (body mass index, lipids, alcohol, comorbidities and treatment with oral glucocorticoids) were extracted. Results Amongst the cohort of 1900 HIV-infected outpatients, 13 cases (12 male) who had undergone hip surgery (0.7%) were identified, median age 47 years.11/13 (85%) were Caucasian and 7/13 were in stage 3 of HIV. Significantly more of the control subjects (46% vs. 16%, p=0.04) were in the asymptomatic stage of infection. Ever use of oral glucocorticoids was highly significantly associated with elective hip surgery (92% vs. 11%, P<0.001). Conclusions Amongst this young cohort, the prevalence of elective hip surgery was 0.7% with median age at surgery (47 years) considerably younger than that amongst the general population. Ever exposure to systemic glucocorticoids was highly significantly associated with elective hip surgery, suggesting that the principal mechanism underlying the need for surgery was avascular necrosis. There may be an increased need for elective hip surgery associated with HIV. PMID:24025108
Glassou, Eva N; Hansen, Torben B; Pedersen, Alma B
Background Pneumonia and urinary tract infections (UTIs) increase morbidity and mortality. There is little epidemiological evidence from large population-based studies on risk factors for these infections and subsequent mortality in total hip arthroplasty (THA) patients. Aim To examine the risk factors of postoperative pneumonia and UTI after THA and their impact on survival. Patients and methods We used the Danish Hip Arthroplasty Register to identify THAs due to osteoarthritis registered from 2000 to 2013. We collected data about comorbidities, mortality and infections in relation to primary hospitalization and potential predictive variables from administrative databases. Regression models were used to estimate associations between potential risk factors and infection, and subsequently, between infection and mortality. Results In total 84,812 THAs were included. The cumulative incidence of pneumonia and UTI within 7 days of the primary procedure were 0.21 (95% confidence interval [CI]: 0.18–0.25) and 0.29 (95% CI: 0.26–0.33), respectively. Patient-related risk factors for infection were being 80 years or older, gender and a comorbidity burden at time of surgery. The hazard ratio (HR) of dying within 90 days of the primary THA was 10.67 (95% CI: 5.79–19.57) compared to patients without pneumonia. For patients with UTIs, the HR was 1.64 (95% CI: 0.41–6.59) compared to those without a UTI. Conclusion Pneumonia was associated with an increased short-term risk of dying, despite adjustment for coexisting comorbidity and other potential confounders. Age, gender and comorbidity were the most important risk factors for pneumonia and UTIs. Individual initiatives to reduce the risk of pneumonia in select patient groups may be essential to the effort to optimize outcomes after a THA. PMID:28176979
Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis
Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis.
Osteoarthritis; Post-Traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis
Osteoarthritis; Post-traumatic Arthritis; Collagen Disorder; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis
Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis
Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis.
Buller, Leonard T; Sabry, Fady Youssef; Easton, Robert W; Klika, Alison K; Barsoum, Wael K
Although the criterion standard for the treatment of prosthetic joint infections (PJIs) is 2-stage revision with interim placement of an antibiotic-loaded spacer, irrigation and debridement with polyethylene exchange offer advantages such as fewer surgeries, reduced potential for intraoperative complications, and lower direct costs. The purpose of this study was to develop a tool to preoperatively predict the probability of successful infection eradication following irrigation and debridement with polyethylene exchange for hip or knee PJIs. A total of 10,411 surgical cases were retrospectively reviewed, and data were collected from 309 charts. Overall, 149 (48.2%) cases failed to eradicate the infection following irrigation and debridement with polyethylene exchange. Univariate analysis identified multiple variables independently associated with reinfection including duration of symptoms, preoperative inflammatory markers, and infecting organism. Logistic regression was used to generate a model (bootstrap-corrected concordance index of 0.645) to predict successful eradication of the infection, which was the basis for a nomogram. Using commonly obtained preoperative variables, the nomogram can be used to predict the probability of infection-free survival at 1, 2, 3, 4, and 5 years. Preoperative knowledge of the probability that a treatment strategy will eradicate a patient's PJI may improve risk assessment.
Prevalence of Failure due to Adverse Reaction to Metal Debris in Modern, Medium and Large Diameter Metal-on-Metal Hip Replacements – The Effect of Novel Screening Methods: Systematic Review and Metaregression Analysis
Reito, Aleksi; Lainiala, Olli; Elo, Petra; Eskelinen, Antti
Metal-on-metal (MoM) hip replacements were used for almost a decade before adverse reactions to metal debris (ARMD) were found to be a true clinical problem. Currently, there is a paucity of evidence regarding the usefulness of systematic screening for ARMD. We implemented a systematic review and meta-analysis to establish the prevalence of revision confirmed ARMD stratified by the use of different screening protocols in patients with MoM hip replacements. Five levels of screening were identified: no screening (level 0), targeted blood metal ion measurement and/or cross-sectional imaging (level 1), metal ion measurement without imaging (level 2), metal ion measurement with targeted imaging (level 3) and comprehensive screening (both metal ions and imaging for all; level 4). 122 studies meeting our eligibility criteria were included in analysis. These studies included 144 study arms: 100 study arms with hip resurfacings, 33 study arms with large-diameter MoM total hip replacements (THR), and 11 study arms with medium-diameter MoM THRs. For hip resurfacing, the lowest prevalence of ARMD was seen with level 0 screening (pooled prevalence 0.13%) and the highest with level 4 screening (pooled prevalace 9.49%). Pooled prevalence of ARMD with level 0 screening was 0.29% and with level 4 screening 21.3% in the large-diameter MoM THR group. In metaregression analysis of hip resurfacings, level 4 screening was superior with regard to prevalence of ARMD when compared with other levels. In the large diameter THR group level 4 screening was superior to screening 0,2 and 3. These outcomes were irrespective of follow-up time or study publication year. With hip resurfacings, routine cross-sectional imaging regardless of clinical findings is advisable. It is clear, however, that targeted metal ion measurement and/or imaging is not sufficient in the screening for ARMD in any implant concepts. However, economic aspects should be weighed when choosing the preferred screening level
Maradit Kremers, Hilal; Lewallen, Laura W; Mabry, Tad M; Berry, Daniel J; Berbari, Elie F; Osmon, Douglas R
Diabetes mellitus is an established risk factor for infections but evidence is conflicting to what extent perioperative hyperglycemia, glycemic control and treatment around the time of surgery modify the risk of prosthetic joint infections (PJIs). In a cohort of 20,171 total hip and knee arthroplasty procedures, we observed a significantly higher risk of PJIs among patients with a diagnosis of diabetes mellitus (hazard ratio [HR] 1.55, 95% CI 1.11, 2.16), patients using diabetes medications (HR 1.56, 95% CI 1.08, 2.25) and patients with perioperative hyperglycemia (HR 1.59, 95% CI 1.07, 2.35), but the effects were attenuated after adjusting for body mass index, type of surgery, ASA score and operative time. Although data were limited, there was no association between hemoglobin A1c values and PJIs.
Punt, Ilona M.; Austen, Shennah; Cleutjens, Jack P.M.; Kurtz, Steven M.; ten Broeke, René H.M.; van Rhijn, Lodewijk W.; Willems, Paul C.; van Ooij, André
Study design Comparative study. Objective To compare periprosthetic tissue reactions observed after total disc replacement (TDR), total hip arthroplasty (THA) and total knee arthroplasty (TKA) revision surgery. Summary of background data Prosthetic wear debris leading to particle disease, followed by osteolysis, is often observed after THA and TKA. Although the presence of polyethylene (PE) particles and periprosthetic inflammation after TDR has been proven recently, osteolysis is rarely observed. The clinical relevance of PE wear debris in the spine remains poorly understood. Methods Number, size and shape of PE particles, as well as quantity and type of inflammatory cells in periprosthetic tissue retrieved during Charité TDR (n=22), THA (n=10) and TKA (n=4) revision surgery were compared. Tissue samples were stained with hematoxylin/eosin and examined by using light microscopy with bright field and polarized light. Results After THA, large numbers of PE particles <6 µm were observed, which were mainly phagocytosed by macrophages. The TKA group had a broad size range with many larger PE particles and more giant cells. In TDR, the size range was similar to that observed in TKA. However, the smallest particles were the most prevalent with 75% of the particles being <6 µm, as seen in revision THA. In TDR, both macrophages and giant cells were present with a higher number of macrophages. Conclusions Both small and large PE particles are present after TDR revision surgery compatible with both THA and TKA wear patterns. The similarities between periprosthetic tissue reactions in the different groups may give more insight in the clinical relevance of PE particles and inflammatory cells in the lumbar spine. The current findings may help to improve TDR design as applied from technologies previously developed in THA and TKA with the goal of a longer survival of TDR. PMID:21336235
Lainiala, O; Eskelinen, A; Elo, P; Puolakka, T; Korhonen, J; Moilanen, T
We conducted a retrospective study to assess the prevalence of adverse reactions to metal debris (ARMD) in patients operated on at our institution with metal-on-metal (MoM) total hip replacements with 36 mm heads using a Pinnacle acetabular shell. A total of 326 patients (150 males, 175 hips; 176 females, 203 hips) with a mean age of 62.7 years (28 to 85) and mean follow-up of 7.5 years (0.1 to 10.8) participating in our in-depth modern MoM follow-up programme were included in the study, which involved recording whole blood cobalt and chromium ion measurements, Oxford hip scores (OHS) and plain radiographs of the hip and targeted cross-sectional imaging. Elevated blood metal ion levels (> 5 parts per billion) were seen in 32 (16.1%) of the 199 patients who underwent unilateral replacement. At 23 months after the start of our modern MoM follow-up programme, 29 new cases of ARMD had been revealed. Hence, the nine-year survival of this cohort declined from 96% (95% CI 95 to 98) with the old surveillance routine to 86% (95% CI 82 to 90) following the new protocol. Although ARMD may not be as common in 36 mm MoM THRs as in those with larger heads, these results support the Medicines and Healthcare Products Regulatory Agency guidelines on regular reviews and further investigations, and emphasise the need for specific a follow-up programme for patients with MoM THRs.
Corten, K; Struelens, B; Evans, B; Graham, E; Bourne, R B; MacDonald, S J
A soft-tissue defect over an infected total knee replacement (TKR) presents a difficult technical problem that can be treated with a gastrocnemius flap, which is rotated over the defect during the first-stage of a revision procedure. This facilitates wound healing and the safe introduction of a prosthesis at the second stage. We describe the outcome at a mean follow-up of 4.5 years (1 to 10) in 24 patients with an infected TKR who underwent this procedure. A total of 22 (92%) eventually obtained a satisfactory result. The mean Knee Society score improved from 53 pre-operatively to 103 at the latest follow-up (p < 0.001). The mean Western Ontario and McMaster Universities osteoarthritis index and Short-Form 12 score also improved significantly (p < 0.001). This form of treatment can be used reliably and safely to treat many of these complex cases where control of infection, retention of the components and acceptable functional recovery are the primary goals.
Said, Salah A.M.; Nijhuis, Rogier; Derks, Anita; Droste, Herman
Patient: Male, 70 Final Diagnosis: Pacemaker leads endocarditis Symptoms: Bacterial lead endocarditis • congestive heart failure • fever • pacemaker dysfunction Medication: — Clinical Procedure: Pacemaker box replacement due to end-of-service Specialty: Cardiology Objective: Unusual clinical course Background: Cardiac resynchronization therapy (CRT) has been demonstrated to reduce morbidity and mortality in patients with advanced, drug-refractory heart failure. Procedure-related mortality is less than 1% in larger studies. Approximately10% of CRT patients have to undergo surgical revision because of infections, dislocations, or unacceptable electrical behavior manifested as high threshold, unstable sensing, or unwanted phrenic nerve stimulation. Case Report: A 70-year-old man with symptomatic congestive heart failure underwent implantation of a biventricular pacemaker on the left anterior chest wall in 2003 and pulse generator exchange in August 2009. The patient responded well to CRT. At follow-up, the pacing system functioned normally. In September 2009, in the context of a predialysis program, an abdominal computed tomography (CT) scan was performed in another hospital for assessment and evaluation of chronic kidney disease. This procedure was complicated with peripheral thrombophlebitis that was managed appropriately with complete recovery. Eight months later (May 2010), the patient was admitted to our hospital with fever, anemia, and elevated infection parameters. During admission, blood cultures grew Staphylococcus epidermidis. The chest X-ray, lung perfusion scintigraphy, and CT scan depicted pulmonary embolism and infarction. The right ventricular lead threshold was found to be increased to 7 volts with unsuccessful capture. Echocardiography demonstrated vegetations on leads. The entire pacing system was explanted, but the patient expired few days later following percutaneous removal due to multiorgan failure. Conclusions: In heart failure
Rahman, Wael A; Kazi, Hussain A; Gollish, Jeffery D
AIM To investigate success of one stage exchange with retention of fixed acetabular cup. METHODS Fifteen patients treated by single stage acetabular component exchange with retention of well-fixed femoral component in infected total hip arthroplasty (THA) were retrospectively reviewed. Inclusion criteria were patients with painful chronic infected total hip. The patient had radiologically well fixed femoral components, absence of major soft tissue or bone defect compromising, and infecting organism was not poly or virulent micro-organism. The organisms were identified preoperatively in 14 patients (93.3%), coagulase negative Staphylococcus was the infecting organism in 8 patients (53.3%). RESULTS Mean age of the patients at surgery was 58.93 (± 10.67) years. Mean follow-up was 102.8 mo (36-217 mo, SD 56.4). Fourteen patients had no recurrence of the infection; one hip (6.7%) was revised for management of infection. Statistical analysis using Kaplan Meier curve showed 93.3% survival rate. One failure in our series; the infection recurred after 14 mo, the patient was treated successfully with surgical intervention by irrigation, and debridement and liner exchange. Two complications: The first patient had recurrent hip dislocation 12 years following the definitive procedure, which was managed by revision THA with abductor reconstruction and constrained acetabular liner; the second complication was aseptic loosening of the acetabular component 2 years following the definitive procedure. CONCLUSION Successful in management of infected THA when following criteria are met; well-fixed stem, no draining sinuses, non-immune compromised patients, and infection with sensitive organisms. PMID:28361019
Stipetic, Laurence H.; Hamilton, Graham; Dalby, Matthew J.; Davies, Robert L.; Meek, R. M. Dominic; Ramage, Gordon; Smith, David G. E.
We report here the genome sequence of a clinical isolate of Staphylococcus aureus from an orthopedic infection. Phenotypically diverse Staphylococcus aureus strains are associated with orthopedic infections and subsequent implant failure, and some are highly resistant to antibiotics. This genome sequence will support further analyses of strains causing orthopedic infections. PMID:25931597
Bich Hang, Bui Thi; Phuong, Nguyen Thanh; Kestemont, Patrick
The present study was performed to determine the efficacy of lipopolysaccharide (LPS) and levamisole on immune response and disease resistance in striped catfish and to compare their respective efficiency with the one of an antibiotic treatment after infection of fish by the bacteria Edwardsiella ictaluri. Fish were divided into 3 groups and each group was injected with LPS (3 mg/kg fish), levamisole (5 mg/kg fish) or phosphate buffer saline as control. At day 21st post immunostimulant injection, fish were bled for assaying immunological variables and then challenged with E. ictaluri. Three days after bacterial infection, an antibiotic treatment was applied into fish subgroups and mortality was compared daily between antibiotic treated and untreated fish until 2 weeks post-challenge. LPS and levamisole significantly enhanced non-specific immune responses such as respiratory burst, lysozyme and complement activity in fish compared with control (p < 0.05). Respiratory burst and complement activity significantly increased in levamisole groups when compared with LPS groups while lysozyme activity did not differ significantly between immunostimulant treatments. Total immunoglobulins significantly increased in levamisole treatment compared with control. After challenge test, accumulated mortality was reduced significantly in both non-antibiotic and antibiotic subgroups of LPS and levamisole compared with control. Moreover, no differences of mortality were observed between fish treated with levamisole or LPS without antibiotics and control fish treated with antibiotics. These results support the possible replacement of antibiotics in striped catfish farming by immunostimulants such as levamisole and LPS.
... clues about the underlying cause. Problems within the hip joint itself tend to result in pain on the ... tendons and other soft tissues that surround your hip joint. Hip pain can sometimes be caused by diseases ...
John, Santhosh G.; William, Preethi; Murugapandian, Sangeetha; Thajudeen, Bijin
Infective endocarditis is a potentially life threatening condition. It is associated with high mortality and morbidity resulting mostly due to cardiorespiratory failure. Extracorporeal membrane oxygenation is a modality of treatment used to support hypoxic respiratory failure especially in patients who are already on mechanical ventilation. Continuous renal replacement therapy is added mainly for maintaining fluid and electrolyte balance. Here we report a case series of patients diagnosed with infective endocarditis who were treated with combined extracorporeal membrane oxygenation and continuous renal replacement therapy. Three patients in the age group 20-60 years were admitted with clinical features suggestive of infective endocarditis. During the course of hospital stay they developed cardiorespiratory failure requiring mechanical ventilation and extracorporeal membrane oxygenation support for refractory hypoxia. It was complicated by heart failure, renal failure and fluid overload which required initiation of continuous renal replacement therapy. All the three patients succumbed in spite of the aggressive treatment. In addition to the role played by each complication, delayed start of continuous renal replacement therapy might have also contributed to the high mortality. Early initiation of continuous renal replacement therapy for management of fluid overload needs to be considered in the management of these critically ill patients. PMID:25568769
Gupta, Arjun; Osmon, Douglas R.; Hanssen, Arlen D.; Lightner, Deborah J.; Wilson, Walter R.; Steckelberg, James M.; Baddour, Larry M.; Harmsen, William S.; Mandrekar, Jay N.; Berbari, Elie F.
Background. The purpose of this study was to determine the risk of prosthetic joint infection (PJI) as a complication of routine genitourinary (GU) procedures in patients with total hip arthroplasty (THA) or total knee arthroplasty (TKA) and to study the impact of antibiotic prophylaxis administered prior to these procedures. Methods. We conducted a prospective, single-center, case-control study between December 1, 2001 and May 31, 2006. Case patients were hospitalized with total hip or knee PJI. Control subjects underwent a THA or TKA and were hospitalized during the same period on the same orthopedic floor without a PJI. Data regarding demographic features and potential risk factors were collected. The outcome measure was the odds ratio (OR) of PJI after GU procedures performed within 2 years of admission. Results. A total of 339 case patients and 339 control subjects were enrolled in the study. Of these, 52 cases (15%) and 55 controls (16%) had undergone a GU procedure in the preceding 2 years. There was no increased risk of PJI for patients undergoing a GU procedure with or without antibiotic prophylaxis (adjusted OR [aOR] = 1.0, 95% confidence interval [CI] = 0.2–4.5, P = .95 and aOR = 1.0, 95% CI = 0.6–1.7, P = .99, respectively). Results were similar in a subset of patients with a joint age less than 6 months, less than 1 year, or greater than 1 year. Conclusions. Genitourinary procedures were not risk factors for subsequent PJI. The use of antibiotic prophylaxis before GU procedures did not decrease the risk of subsequent PJI in our study. PMID:26258154
Fernández-Valencia, Jenaro; Gallart, Xavier; Bori, Guillem; Ramiro, Sebastián Garcia; Combalía, Andrés; Riba, Josep
The prognosis associated with the DePuy ASR hip cup is poor and varies according to the series. This implant was withdrawn from use in 2010 and all patients needed to be assessed. We present the results of the assessment of our patients treated with this device, according to the Spanish Society of Hip Surgery (SECCA) algorithm published in 2011. This retrospective study evaluates 83 consecutive ASR cups, followed up at a mean of 2.9 years. Serum levels of chromium and cobalt, as well as the acetabular abduction angle, were determined in order to assess their possible correlation with failure, defined as the need for revision surgery. The mean Harris Hip Score was 83.2 (range 42-97). Eight arthroplasties (13.3%) required revision due to persistent pain and/or elevated serum levels of chromium/cobalt. All the cups had a correct abduction angle, and there was no correlation between elevated serum levels of metal ions and implant failure. Since two previous ASR implants were exchanged previously to the recall, the revision rate for ASR cups in our centre is 18.2% at 2.9 years.
Langton, David John; Sidaginamale, Raghavendra Prasad; Avery, Peter; Waller, Sue; Tank, Ghanshyabhai; Lord, James; Joyce, Thomas; Cooke, Nick; Logishetty, Raj; Nargol, Antoni Viraf Francis
Objectives To determine risk factors for revision in patients implanted with a commonly used metal on metal (MoM) hip replacement. Design Retrospective cohort study in combination with a prospective national retrieval study (Northern Retrieval Registry (NRR)). Setting Combined orthopaedic unit in combination with the NRR. Participants All patients implanted with a DePuy Pinnacle MoM hip prostheses by the 2 senior authors were invited to attend for a review which included clinical examination, blood metal ion measurements, radiographs and targeted imaging. Explanted components underwent wear analysis using validated methodology and these results were compared with those obtained from the NRR. Results 489 MoM Pinnacle hips were implanted into 434 patients (243 females and 191 males). Of these, 352 patients attended the MoM recall clinics. 64 patients had died during the study period. For the purposes of survival analysis, non-attendees were assumed to have well-functioning prostheses. The mean follow-up of the cohort as a whole was 89 months. 71 hips were revised. Prosthetic survival for the whole cohort was 83.6% (79.9–87.3) at 9 years. The majority of explanted devices exhibited signs of taper junction failure. Risk factors for revision were bilateral MoM prostheses, smaller Pinnacle liners, and implantation in 2006 and later years. A significant number of devices were found to be manufactured out of their specifications. This was confirmed with analysis of the wider data set from the NRR. Conclusions This device was found to have an unacceptably high revision rate. Bilateral prostheses, those implanted into female patients and devices implanted in later years were found to be at greater risk. A significant number of explanted components were found to be manufactured with bearing diameters outside of the manufacturer's stated tolerances. Our findings highlight the clinical importance of hitherto unrecognised variations in device production. PMID:27130159
Warren, Martin J. Fabian, Sebastian; Tisi, Paul
A 75-year-old woman with an external iliac artery pseudoaneurysm, thought to have resulted from a chronic loosening and infection of a total hip replacement, was successfully treated by placement of a covered endoluminal stent.
Saracho, Ramón; Martín Escobar, Eduardo; Comas Farnés, Jordi; Arcos, Emma; Mazuecos Blanca, Auxiliadora; Gentil Govantes, Miguel Ángel; Castro de la Nuez, Pablo; Zurriaga, Óscar; Ferrer Alamar, Manuel; Bouzas Caamaño, Encarnación; García Falcón, Teresa; Portolés Pérez, José; Herrero Calvo, José A; Chamorro Jambrina, Carlos; Moina Eguren, Íñigo; Rodrigo de Tomás, María Teresa; Abad Díez, José María; Sánchez Miret, José I; Alvarez Lipe, Rafael; Díaz Tejeiro, Rafael; Moreno Alía, Inmaculada; Torres Guinea, Marta; Huarte Loza, Enma; Artamendi Larrañaga, Marta; Fernández Renedo, Carlos; González Fernández, Raquel; Sánchez Álvarez, Emilio; Alonso de la Torre, Ramón
Patients on renal replacement therapy (RRT) infected with the human immunodeficiency virus (HIV) are a special group with growing interest. In order to study the epidemiological data of HIV+ patients on RRT in Spain, we collected individual information from 2004-2011 (period of use of highly active antiretroviral therapy [HAART] in the Autonomous Communities of Andalusia, Aragon, Asturias, Catalonia, Valencia, Castilla la Mancha, Castilla León, Galicia, Madrid, La Rioja and the Basque Country, comprising 85% of the Spanish population. A total of 271 incident and 209 prevalent patients were analysed. They were compared with the remaining patients on RRT during the same period. The annual incidence was 0.8 patients per one million inhabitants, with a significant increase during the follow-up period. The proportion of prevalent HIV+ patients was 5.1 per 1,000 patients on RRT (95% confidence interval [CI] 4.4-5.8. Although glomerular diseases constituted the majority of cases (42%), diabetic nephropathy was the cause in 14% of patients. The nation-wide totals for these percentages were 13 and 25%, respectively. Compared to the total of patients in treatment, the risk of death was significantly higher in the HIV+ group: hazard ratio (HR) adjusted for age, sex and diabetes was 2.26 (95% CI 1.74 - 2.91). Hepatitis C coinfection increased the risk of death in the HIV+ group (HR 1.77; 95% CI 1.10 - 2.85). The probability of kidney transplantation in HIV+ was only 17% after 7 years, comparing with total RTT patients (HR 0.15; 95% CI: 0.10-0.24). Despite the use of HAART, the incidence of HIV+ patients on dialysis has increased; their mortality still exceeds non-HIV patients, and they have a very low rate of transplantation. It is necessary to further our knowledge of this disease in order to improve results.
Background Outcome data on two-stage revision surgery for deep infection after septic hip arthritis are limited and inconsistent. This study presents the medium-term results of a new, standardized two-stage arthroplasty with preformed hip spacers and cementless implants in a consecutive series of adult patients with septic arthritis of the hip treated according to a same protocol. Methods Nineteen patients (20 hips) were enrolled in this prospective, non-randomized cohort study between 2000 and 2008. The first stage comprised femoral head resection, debridement, and insertion of a preformed, commercially available, antibiotic-loaded cement hip spacer. After eradication of infection, a cementless total hip arthroplasty was implanted in the second stage. Patients were assessed for infection recurrence, pain (visual analog scale [VAS]) and hip joint function (Harris Hip score). Results The mean time between first diagnosis of infection and revision surgery was 5.8 ± 9.0 months; the average duration of follow up was 56.6 (range, 24 - 104) months; all 20 hips were successfully converted to prosthesis an average 22 ± 5.1 weeks after spacer implantation. Reinfection after total hip joint replacement occurred in 1 patient. The mean VAS pain score improved from 48 (range, 35 - 84) pre-operatively to 18 (range, 0 - 38) prior to spacer removal and to 8 (range, 0 - 15) at the last follow-up assessment after prosthesis implantation. The average Harris Hip score improved from 27.5 before surgery to 61.8 between the two stages to 92.3 at the final follow-up assessment. Conclusions Satisfactory outcomes can be obtained with two-stage revision hip arthroplasty using preformed spacers and cementless implants for prosthetic hip joint infections of various etiologies. PMID:21575241
Logroscino, G; Del Tedesco, F; Cambise, C; Coraci, D; Donati, F; Santilli, V; Padua, L
Mononeuropathy after surgery may occur and hereditary neuropathy with liability to pressure palsies is a possible pathological condition related to paresis after hip surgery. We present a case of 66-year-old man presenting severe weakness at inferior limb muscles after hip prosthesis revision. Clinic and electrophysiology showed severe right fibular nerve damage and ultrasound found a marked enlargement of the same nerve, associated with focal enlargements in other nerves. A diagnosis of hereditary neuropathy with liability to pressure palsies was suspected and confirmed by genetic test. The patient gradually recovered returning to a normal daily active life. Ultrasound was crucial for diagnosis. The suspicion and diagnosis of latent neuropathy, which can occur after surgical intervention, may lead to a better understand of the risks of the surgery, specific for the patient, and avoid the wrong attribution to surgical malpractice.
Despite advancements and improvements in methods for preventing infection, periprosthetic joint infection (PJI) is a significant complication following total joint arthroplasty (TJA). Prevention is the most important strategy to deal with this disabling complication, and prevention should begin with identifying patient-related risk factors. Medical risk factors, such as morbid obesity, malnutrition, hyperglycemia, uncontrolled diabetes mellitus, rheumatoid arthritis (RA), preoperative anemia, cardiovascular disorders, chronic renal failure, smoking, alcohol abuse and depression, should be evaluated and optimized prior to surgery. Treating patients to get laboratory values under a specified threshold or cessation of certain modifiable risk factors can decrease the risk of PJI. Although significant advances have been made in past decades to identify these risk factors, there remains some uncertainty regarding the risk factors predisposing TJA patients to PJI. Through a review of the current literature, this paper aims to comprehensively evaluate and provide a better understanding of known medical risk factors for PJI after TJA. PMID:26539450
Meunier, P J
For a 50-year old Caucasian woman today, the risk of a hip fracture over her remaining life-time is about 17%. Tomorrow the situation will clearly be worse because the continuous increase in life expectancy will cause a three-fold increase in worldwide fracture incidence over the next 60 years. Through diagnostic bone mass measurements at the hip and assessment of biochemical parameters, a great deal has been learned in recent years about reduction of hip fracture risk. Preventive strategies are based on prevention of falls, use of hip protectors, and prevention of bone fragility. The latter includes the optimization of peak bone mass during childhood, postmenopausal estrogen replacement therapy, and also late prevention consisting in reversing senile secondary hyperparathyroidism, which plays an important role in the decrease of skeletal strength. This secondary hyperparathyroidism, which results from both vitamin D insufficiency and low calcium intake, is preventable with vitamin D3 and calcium supplements. They have recently been shown capable of providing effective prevention of hip fractures in elderly women living in nursing homes, with a reduction of about 25% in the number of hip fractures noted in a 3-year controlled study in 3,270 women (intention-to-treat analysis). In conclusion, it is never too early to reduce the risk of osteoporosis and never too late to prevent hip fractures.
... AL. Total hip replacement. In: Frontera, WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and ... TE. Total knee replacement. In: Frontera, WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and ...
Lee, A H; Chin, A E; Ramanujam, T; Thadhani, R I; Callegari, P E; Freundlich, B
We describe a patient with a Neisseria gonorrhoeae monoarthritis of the hip. Treatment with intravenous ceftriaxone, oral doxycycline, and repeated fluoroscopic needle aspirations resulted in a complete recovery of function without residual deficit. Gonococcal monoarthritis of the hip is rare. Gonococcal hip infections appear to respond well to antibiotics and drainage by arthrocentesis. This differs from hip infections caused by other bacteria where joint damage is common and where the recommended initial treatment is open surgical drainage.
... make older people more likely to trip and fall — one of the most common causes of hip ... Taking steps to maintain bone density and avoid falls can help prevent hip fracture. Signs and symptoms ...
... Index A-Z Hip Ultrasound Hip ultrasound uses sound waves to produce pictures of muscles, tendons, ligaments, ... pictures of the inside of the body using sound waves. Ultrasound imaging, also called ultrasound scanning or ...
Chang, Jun-Dong; Kim, In-Sung; Lee, Sang-Soo
Purpose The treatment of infected revision total hip arthroplasty (THA) is very challenging due to retained revision prosthesis, poor bone stock and soft tissue condition derived from previous revision surgeries, and comorbidities. The purpose of this study was to investigate the effectiveness and short-term outcomes of aggressive debridement and use of antibiotic-loaded cement beads with retention of the prosthesis for acute delayed or late infection of revision THAs. Materials and Methods Ten consecutive patients with symptoms or signs of less than one-week evolution and well-fixed prostheses, were treated with this procedure and a postoperative course of organism-specific antibiotics for a minimum of 6 weeks. All hips presented with acute delayed or late infection of revision THAs. Patients with a mean age of 68.1 years (range, 59-78 years) underwent an average of 1.9 previous revision THAs (1-4) before the index surgery. The minimal follow-up was 2 years with a mean of 46.2 months (range, 24-64 months). Results There were 8 cures (80.0%) and 2 failures with no mortality during the study period. The 2 failures involved the same and resistant bacteria implicated in the primary infection (methicillin-resistant Staphylococcus aureus and Prevotella oralis, respectively). The mean Harris hip score was 65.2 (range, 26-83) and the mean visual analogue scale was 2.6 (range, 1-4) at final follow-up. Conclusion With a favorable success rate and no mortality, our procedure may be considered a safe and effective alternative for the treatment of acute delayed or late infection of revision THAs with well-fixed prostheses. PMID:28316961
Patel, Ripal; Alijanipour, Pouya; Parvizi, Javad
Periprosthetic joint infection (PJI) is a complication of total joint arthroplasty that is challenging to diagnose. Currently, there is no “gold standard” for definite diagnosis of PJI. A multi-criteria definition has been described for PJI based on microbiology cultures, serum markers, such as erythrocyte sedimentation rate and C-reactive protein (CRP), synovial fluid biomarkers, such as leukocyte esterase and histopathology assessment of the periprosthetic tissue. The conventional serum markers are generally nonspecific and can be elevated in inflammatory conditions. Therefore, they cannot be relied on for definite diagnosis of PJI. Hence, with the use of proteomics, synovial fluid biomarkers such as α-defensin, IL-6, and CRP have been proposed as more accurate biomarkers for PJI. Current methods to culture micro-organisms have several limitations, and can be false-negative and false-positive in a considerable number of cases. In an attempt to improve culture sensitivity, diagnostic methods to target biofilms have recently been studied. The understanding of the concept of biofilms has also allowed for the development of novel techniques for PJI diagnosis, such as visualizing biofilms with fluorescent in-situ hybridization and detection of bacteria via DNA microarray. Lastly, the use of amplification-based molecular techniques has provided methods to identify specific species of bacteria that cause culture-negative PJI. While diagnosing PJI is difficult, these advances could be valuable tools for clinicians. PMID:28144375
Myerson, Merle; Armstrong, Ehrin J; Poltavskiy, Eduard; Fefer, Jose; Bang, Heejung
Surgical intervention for severe tricuspid regurgitation secondary to remote infective endocarditis has been infrequent, especially in patients also infected with the human immunodeficiency virus (HIV). We describe the case of a 62-year-old HIV-positive man, with a 24-year history of endocarditis caused by intravenous heroin use, who presented with severe tricuspid regurgitation. The patient was initially asymptomatic, was taking antiretroviral medications, and had a satisfactory CD4 count and an undetectable viral load, so we decided to manage the regurgitation conservatively. Two years later, he presented with biventricular heart failure and dyspnea. After surgical tricuspid valve replacement, his condition improved substantially. This case illustrates that HIV-infected patients with complex medical conditions can successfully undergo cardiac surgery.
Armstrong, Ehrin J.; Poltavskiy, Eduard; Fefer, Jose; Bang, Heejung
Surgical intervention for severe tricuspid regurgitation secondary to remote infective endocarditis has been infrequent, especially in patients also infected with the human immunodeficiency virus (HIV). We describe the case of a 62-year-old HIV-positive man, with a 24-year history of endocarditis caused by intravenous heroin use, who presented with severe tricuspid regurgitation. The patient was initially asymptomatic, was taking antiretroviral medications, and had a satisfactory CD4 count and an undetectable viral load, so we decided to manage the regurgitation conservatively. Two years later, he presented with biventricular heart failure and dyspnea. After surgical tricuspid valve replacement, his condition improved substantially. This case illustrates that HIV-infected patients with complex medical conditions can successfully undergo cardiac surgery. PMID:28100971
Sharma, Sonam; Sharma, Sansar Chand
Primary total hip replacement has become a routine procedure these days. With improvement in surgical techniques and implant designs, the survival rate of prosthesis has increased significantly but unfortunately, prosthetic infections though uncommon continue to be a threatening complication. We present a detailed review of the literature along with a case report of infected total hip prosthesis in a 36-year-old female who had been operated 6 years back. The causative organism was found to be Actinomyces israelii which was related to an infected intrauterine device used for contraception that had been forgotten after being implanted 8 years earlier. PMID:27182152
Beswick, Andrew D.; Peters, Tim J.; Gooberman-Hill, Rachael; Whitehouse, Michael R.; Blom, Ashley W.
Background Hip and knee arthroplasty are common interventions for the treatment of joint conditions, most notably osteoarthritis. Although many patients benefit from surgery, approximately 1% of patients develop infection afterwards known as deep prosthetic joint infection (PJI), which often requires further major surgery. Objective To assess support needs of patients undergoing treatment for PJI following hip or knee arthroplasty and to identify and evaluate what interventions are routinely offered to support such patients. Design Systematic review Data sources MEDLINE, EMBASE, Web of Science, PsycINFO, Cinahl, Social Science Citation Index, The Cochrane Library, and reference lists of relevant studies from January 01, 1980 to October 05, 2016. Selection criteria Observational (prospective or retrospective cohort, nested case-control or case-control) studies, qualitative studies, or clinical trials conducted in patients treated for PJI and/or other major adverse occurrences following hip or knee arthroplasty. Review methods Data were extracted by two independent investigators and consensus was reached with involvement of a third. Given the heterogeneous nature of study designs, methods, and limited number of studies, a narrative synthesis is presented. Results Of 4,213 potentially relevant citations, we identified one case-control, one prospective cohort and two qualitative studies for inclusion in the synthesis. Patients report that PJI and treatment had a profoundly negative impact affecting physical, emotional, social and economic aspects of their lives. No study evaluated support interventions. Conclusion The findings demonstrate that patients undergoing treatment for PJI have extensive physical, psychological, social and economic support needs. The interpretation of study results is limited by variation in study design, outcome measures and the small number of relevant eligible studies. However, our review highlights a lack of evidence about support
Christopher, Scott A; Kim, Stanley E; Roe, Simon; Pozzi, Antonio
Periprosthetic femoral fractures are a common complication associated with cementless press-fit total hip arthroplasty. The use of prophylactic cerclage wire fixation has been advocated to reduce this complication. The objective of this study was to evaluate whether a double loop cerclage wire, used as adjunctive fixation, increased the peak torsional load to failure in femora implanted with press-fit cementless stems. Peak torsional load to failure was compared between femora without adjunctive fixation and femora receiving a 1 mm double loop cerclage wire placed proximally to the lesser trochanter. Femora treated with adjunctive cerclage wire fixation failed at 20% greater peak torque (P = 0.0001). In conclusion, a double loop cerclage wire may aid in the prevention of periprosthetic fractures associated with press-fit cementless femoral stems.
Langston, Joseph R; DeHaan, Alexander M; Huff, Thomas W
Hip arthroplasty in young patients requires thoughtful preoperative planning. Patients with proximal femoral bone loss complicate this planning and may require a staged procedure to optimize implant insertion. We report on a case of a 26-year-old woman with secondary hip arthritis from developmental dysplasia of the hip and a large pertrochanteric bone cyst that was treated with staged total hip arthroplasty. The cyst was decompressed and filled with an osteoconductive and osteoinductive bone graft substitute called EquivaBone. One year later, the patient underwent a successful primary total hip arthroplasty. Fifteen-month follow-up after her hip replacement revealed resolution of postoperative pain and significant functional improvement.
Juneja, Subhash C.; Viswanathan, Sowmya; Ganguly, Milan; Veillette, Christian
The procedure for aspiration of bone marrow from the femur of patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA) may vary from an OR (operating room) to OR based on the surgeon's skill and may lead to varied extent of clotting of the marrow and this, in turn, presents difficulty in the isolation of mesenchymal stem cells (MSCs) from such clotted bone marrow. We present a simple detailed protocol for aspirating bone marrow from such patients, isolation, and characterization of MSCs from the aspirated bone marrow specimens and show that the bone marrow presented no clotting or exhibited minimal clotting. This represents an economical source and convenient source of MSCs from bone marrow for use in regenerative medicine. Also, we presented the detailed protocol and showed that the MSCs derived from such bone marrow specimens exhibited MSCs characteristics and generated micromass cartilages, the recipe for regenerative medicine for osteoarthritis. The protocols we presented can be used as standard operating procedures (SOPs) by researchers and clinicians. PMID:27057356
Konski, A.; Weiss, C.; Rosier, R.; Poulter, C.; Pelligrini, V.; Anthony, P.; Evarts, C.M.; Richardson, M.; Henzler, M.; Rubin, P. )
Radiation has been shown to be effective in the prevention of heterotopic bone. The exact etiology of heterotopic bone is unknown. Total hip prosthetic devices that do not depend upon bone cement for fixation have become increasingly popular. The mechanism by which the bone forms around the prosthesis is similar to the process by which fractures heal which has been shown to be sensitive to irradiation. Using a rabbit model we have undertaken a study to investigate the effect of irradiation on the bony ingrowth on porous coated implants. Forty-five rabbits had porous coated implants surgically placed in the tibiae bilaterally. Each rabbit had one tibia randomly irradiated with 1,000 cGy in 5 fractions starting on the first post-operative day. Animals were sacrificed weekly starting 2 weeks post-operatively and the tibae were sent for pullout studies. The amount of force necessary to pullout the treated tibae was statistically less than the amount of force necessary to remove the untreated tibae at 2 weeks. From 3 weeks on there was no difference in the force necessary to remove the prosthesis from the untreated or treated tibae. Histologically, the untreated tibae showed bone formation while the treated tibae did not. Because of these results, it is suggested that the treatment of patients at risk for development of heterotopic bone be modified to only include the area between the femur and pelvis avoiding treatment of the prosthetic device.
Lepetsos, Panagiotis; Anastasopoulos, Panagiotis P.; Galanakos, Spyridon P.
Total hip replacement (THR) is the treatment of choice for the patient suffering from end-stage hip osteoarthritis. In the presence of deformities due to congenital hip disease (CHD), THR is, in most of the cases, a difficult task, since the technique of performing such an operation is demanding and the results could vary. We present our experience and preferred strategies focusing on challenges and surgical techniques associated with reconstructing the dysplastic hip. PMID:28090526
de Amorim Cabrita, Henrique Antônio Berwanger; de Castro Trindade, Christiano Augusto; de Campos Gurgel, Henrique Melo; Leal, Rafael Demura; de Souza Marques, Ricardo da Fonseca
Hip arthroscopy is a safe method for treating a variety of pathological conditions that were unknown until a decade ago. Femoroacetabular impingement is the commonest of these pathological conditions and the one with the best results when treated early on. The instruments and surgical technique for hip arthroscopy continue to evolve. New indications for hip arthroscopy has been studied as the ligamentum teres injuries, capsular repair in instabilities, dissection of the sciatic nerve and repair of gluteal muscles tears (injuries to the hip rotator cuff), although still with debatable reproducibility. The complication rate is low, and ever-better results with fewer complications should be expected with the progression of the learning curve.
Yoon, Pil Whan; Jang, Woo Young; Yoo, Jeong Joon; Yoon, Kang Sup; Kim, Hee Joong
Although the incidence of malignant tumors in patients undergoing total hip arthroplasties (THAs) is known to be lower than the general population, there exist several reports on the development of malignant tumors at the site of THAs. We report another case of malignant fibrous histiocytoma at the site of a THA, which was developed in an older patient who presented a cystic mass around the total hip prosthesis using a ceramic-on-ceramic bearing system, even without evidence of osteolysis or loosening of implants. This is the second case associated with an aluminum oxide prosthesis in English literature.
Al-Hajjar, Mazen; Fisher, John; Williams, Sophie; Tipper, Joanne L; Jennings, Louise M
Metal-on-metal (MoM) bearings have shown low-wear rates under standard hip simulator conditions; however, retrieval studies have shown large variations in wear rates and mechanisms. High-wear in vivo has caused catastrophic complications and has been associated with steep cup-inclination angle (rotational malpositioning). However, increasing the cup-inclination angle in vitro has not replicated the increases in wear to the same extent as those observed in retrievals. Clinically relevant wear rates, patterns, and particles were observed in vitro for ceramic-on-ceramic bearings when microseparation (translational malpositioning) conditions were introduced into the gait cycle. In the present study, 28 and 36-mm MoM bearings were investigated under adverse conditions. Increasing the cup angle from 45° to 65° resulted in a significant increase in the wear rate of the 28 mm bearings. However, for the 36 mm bearings, head-rim contact did not occur under the steep cup-angle condition, and the wear rate did not increase. The introduction of microseparation to the gait cycle significantly increased the wear rate of the MoM bearings. Cup angle and head size did not influence the wear rate under microseparation conditions. This study indicated that high-in vivo wear rates were associated with edge loading due to rotational malpositioning such as high-cup-inclination angle and translational malpositioning that could occur due to several surgical factors. Translational malpositioning had a more dominant effect on the wear rate. Preclinical simulation testing should be undertaken with translational and rotational malpositioning conditions as well as standard walking cycle conditions defined by the ISO standard.
Warwick, D; Harrison, J; Glew, D; Mitchelmore, A; Peters, T J; Donovan, J
We conducted a prospective, randomized trial to compare the safety and effectiveness of the A-V Impulse System foot pump with that of low-molecular-weight heparin for reducing the prevalence of deep-vein thrombosis after total hip replacement. Of 290 patients who were to have a primary total hip replacement, 143 were randomized to receive enoxaparin (forty milligrams daily) for seven days after the operation and 147, to use the foot pump for seven days. The primary outcome measure was the prevalence of deep-vein thrombosis, as determined by venography on the sixth, seventh, or eighth postoperative day. Secondary outcome measures included transfusion requirements, intraoperative blood loss, postoperative drainage, blood-loss index, appearance of the site of the wound according to a subjective visual-analog scale, and swelling of the thigh. The patients' compliance with the regimen for use of the foot pump was monitored with an internal timing device, and their acceptance of the device was assessed with a questionnaire. Symptoms consistent with pulmonary embolism were investigated with ventilation-perfusion scanning. The patients were contacted later for detection of symptoms of venous thromboembolism that may have occurred during the first three months after discharge from the hospital. Venography was performed on 274 patients: 136 who used the foot pump and 138 who received enoxaparin. Deep-vein thrombosis was detected in twenty-four (18 per cent) of the patients who used the foot pump compared with eighteen patients (13 per cent) who received enoxaparin (95 per cent confidence interval for the difference in proportions, -3.9 to +13.0 per cent). Thrombosis in the calf was found in seven patients (5 per cent) in the former group compared with six patients (4 per cent) in the latter (95 per cent confidence interval for the difference, -4.2 to +5.8 per cent), and proximal thrombosis was observed in seventeen patients (13 per cent) in the former group compared with
Troelsen, Anders; Søballe, Kjeld
Introduction Limited information is available regarding the treatment strategy and prognosis of non-selected patients treated for chronic periprosthetic hip joint infection. Such information is important as no head-to-head studies on treatment strategies are available. The purpose of this study is to report on the treatment strategy and prognosis of a non-selected, consecutive patient population Methods We identified 130 patients in the National Patient Registry, consecutively treated for a chronic periprosthetic hip joint infection between 2003–2008 at 11 departments of orthopaedic surgery. We extracted information regarding patient demographics, treatment and outcome. 82 patients were re-implanted in a two-stage revision (national standard), the remaining 48 were not re-implanted in a two-stage revision. We were able to collect up-to-date information on all patients to date of death or medical chart review with a minimum of 5 years follow-up by the nationwide electronic patient record system Results After primary revision surgery, 53 patients (41%) had a spacer in situ, 64 (50%) had a resection arthroplasty and 13 (9%) did not have the infected implant removed. 63% were re-implanted in a two-stage revision. Re-implantation was performed after an interim period of 14 weeks (IQR 10–18). Patients re-implanted were younger (p-value 0.0006), had a lower CCS score (p-value 0.005), a lower ASA score (p-value 0.0001) and a 68% lower mortality risk in the follow-up period (p-value <0.00001). After adjusting for selected confounders, the mortality risk was no longer significantly different. The 5-year re-infection rate after re-implantation was 14.6% (95%CI 8.0–23.1). Re-infections occurred mainly within 3 years of follow-up. The overall 1-year survival rate was 92% (95%CI 86–96) and the overall 5-year survival rate was 68% (95%CI 59–75). The 5-year survival rate after a two-stage revision was 82% (95%CI 71–89) and in those not re-implanted 45% (95%CI 30–58
Di Lorenzo, Luigi; Jennifer, Yanow; Pappagallo, Marco
The degenerative processes underlying osteoarthritis of the hip produce both anatomical and biomechanical changes in and around the involved joint. A good understanding of hip anatomy and the forces crossing the hip joint is essential to understand both hip pathology and current treatment techniques. Total hip arthroplasty (THA) has become a mainstay of treatment for advanced osteoarthritis of the hip. Several factors contribute to post-operative hip pain in THA patients. Iliopsoas impingement on the prosthetic cup after total hip replacement is one of the causes of pain following hip surgery, often due to an anterior overlap of the implant with respect to the acetabulum. The anatomic shape of the anterior acetabular ridge, which may be straight or curved, influences this overlap. In this paper we present a case illustrating a psoas impingement-like syndrome in a patient with severe hip osteoarthritis who has not undergone hip replacement surgery. We discuss the compensatory strategies employed by the patient to reduce pain and prevent falls, and show CT scan images depicting the underlying anatomic pathology.
Lawrence, H; Deehan, D; Holland, J; Kirby, J; Tyson-Capper, A
Abnormal wear of cobalt-containing metal-on-metal joints is associated with inflammatory pseudotumours. Cobalt ions activate human toll-like receptor 4 (TLR4), which normally responds to bacterial lipopolysaccharide (LPS) in sepsis. Activation of TLR4 by LPS increases the expression of chemokines IL-8 and CXCL10, which recruit leukocytes and activated T-cells, respectively. This study was designed to determine whether cobalt induces a similar inflammatory response to LPS by promoting the expression of IL-8 and CXCL10. A human monocytic cell line, derived from acute monocytic leukaemia, was treated with cobalt ions and expression of IL-8 and CXCL10 measured at mRNA and protein levels. Cobalt-treated macrophages showed a 60-fold increase in IL-8 mRNA, and an eightfold increase in production of the mature chemokine (both p < 0.001); expression of the CXCL10 gene and protein was also significantly increased by cobalt (both p < 0.001). Experiments were also performed in the presence of CLI-095, a TLR4-specific antagonist which abrogated the cobalt-mediated increase in IL-8 and CXCL10 expression. These findings suggest that cobalt ions induce inflammation similar to that observed during sepsis by the simultaneous activation of two TLR4-mediated signalling pathways. These pathways result in increased production of IL-8 and CXCL10, and may be implicated in pseudotumour formation following metal-on-metal replacement.
Johnson D, Weiss WM. Basic arthroscopic principles. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic ... 11. Sanchez VMI, Meza AO. Hip arthroscopy. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic ...
Kim, Jung Taek
When performing cementless hip arthroplasty, it is critical to achieve firm primary mechanical stability followed by biological fixation. In order to achieve this, it is essential to fully understand characteristics of implant design. In this review, the authors review fixation principles for a variety of implants used for cementless hip replacement and considerations for making an optimal selection. PMID:27536647
Macheras, George A; Koutsostathis, Stefanos D; Lepetsos, Panagiotis; Anastasopoulos, Panagiotis P; Galanakos, Spyridon; Papadakis, Stamatios A
Total hip replacement is the treatment of choice for the patient suffering from end-stage hip osteoarthritis. Excellent long-term results have been published. In the presence of deformities due to congenital hip dislocation, total hip replacement is, in most of the cases, a difficult task, since the technique of performing such an operation is demanding and the results could vary. This paper presents our experience and preferred strategies focusing on challenges and surgical techniques associated with reconstructing the dysplastic hip.
Wagner, H; Wagner, M
50 years ago, prosthetic replacement of the hip joint ushered in a new epoch in orthopaedics. Total hip replacement made it possible to remove a severely diseased, painful hip and restore normal function and a normal quality of life to the afflicted patient. The early results of total hip replacement are almost all spectacular and hip replacement has become the most successful type of orthopaedic surgery. These good results using an approach that was technically relatively simple resulted in a temptation to implant prosthetic hip joints with ever increasing frequency in ever younger patients. This led to the emergence of new problems, which were not so clearly recognised at the outset: it emerged that the stability of prosthetic hip joints was of limited duration. This had the following consequence: If a total hip prosthesis is implanted in an elderly person whose remaining life-expectancy is shorter than the longevity of the prosthesis, hip replacement is a life-long solution. We can therefore say that, for a patient who has only 10 to 15 years left to live, their hip problem is solved by total hip replacement. For young people, who still have a long life expectancy in front of them, it is different. They will experience failure of the artificial joint and require further surgery. The commonest and most important type of failure in total hip prostheses is aseptic loosening, which is associated with resorption of bone at the site of the prosthesis. The cause of this phenomenon has only gradually been recognised in the course of the years. Initially, the unanimous opinion was that the methacrylate cement, used to fix the components of the prosthesis in the bone, was the definitive cause of aseptic loosening because fissures and fractures of the cement were almost always found during surgical revision of loosened joints. There was talk of "cement disease" and great efforts were made to improve the quality of the cement and the cementing technique. Moreover, even
We reviewed the results of 25 consecutive patients who underwent revision of a hip resurfacing prosthesis to a total hip replacement. Revisions were performed for recurrent pain and effusion, infection and proximal femoral fractures. Both components were revised in 20 cases. There were 12 male and 13 female patients with average time to revision of 34.4 and 26.4 months respectively. The mean follow up period was 12.7 months (3 to 31). All patients reported relief of pain and excellent satisfaction scores. Two patients experienced stiffness up to three months post operatively. Pre operative Oxford, Harris and WOMAC hip scores were 39.1, 36.4 and 52.2 respectively. Mean post operative scores at last follow up were 17.4, 89.8 and 6.1 respectively (p < 0.001 for each score). These results show that conversion of hip resurfacing to total hip arthroplasty has high satisfaction rates. These results compare favourably with those for revision total hip arthroplasty. PMID:21114835
Ilizaliturri Sánchez, Víctor M; Mangino Pariente, Gerardo; Camacho Galindo, Javier
Total hip replacement is one of the most successful procedures in orthopaedic surgery. There are two different technologies for implant fixation in total hip replacement: cemented and cementless, both can be combined, which is called Hybrid arthroplasty. Long term implant stability results in long term function. The most important factor that limits longevity of well-fixed implants is the wear of the articular surfaces. Wear of the polyethylene from the acetabulum generates particles that access the implant bone or the implant-cement-bone interface. This produces an inflammatory reaction, osteolysis and implant loosening. Polyethylene of higher resistance to wear and prosthetic articulations without polyethylene (hard on hard bearings), have been introduced to improve wear particle generation. Minimally invasive surgical techniques minimize surgical trauma to sort tissue around the hip joint, facilitating a better and more rapid recovery.
Aliabadi, P.; Tumeh, S.S.; Weissman, B.N.; McNeil, B.J. )
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.
Getzlaf, Matthew A.; Lewallen, Eric A.; Kremers, Hilal M.; Jones, Dakota L.; Bonin, Carolina A.; Dudakovic, Amel; Thaler, Roman; Cohen, Robert C.; Lewallen, David G.; van Wijnen, Andre J.
Like any foreign object, orthopaedic implants are susceptible to infection when introduced into the human body. Without additional preventative measures, the absolute number of annual prosthetic joint infections will continue to rise, and may exceed the capacity of health care systems in the near future. Bacteria are difficult to eradicate from synovial joints due to their exceptionally diverse taxonomy, complex mechanistic attachment capabilities, and tendency to evolve antibiotic resistance. When a primary orthopaedic implant fails from prosthetic joint infection, surgeons are generally challenged by limited options for intervention. In this review, we highlight the etiology and taxonomic groupings of bacteria known to cause prosthetic joint infections, and examine their key mechanisms of attachment. We propose that antimicrobial strategies should focus on the most harmful bacteria taxa within the context of occurrence, taxonomic diversity, adhesion mechanisms, and implant design. Patient-specific identification of organisms that cause prosthetic joint infections will permit assessment of their biological vulnerabilities. The latter can be targeted using a range of antimicrobial techniques that exploit different colonization mechanisms including implant surface attachment, biofilm formation, and/or hematogenous recruitment. We anticipate that customized strategies for each patient, joint, and prosthetic component will be most effective at reducing prosthetic joint infections, including those caused by antibiotic-resistant and polymicrobial bacteria. PMID:26449208
Getzlaf, Matthew A; Lewallen, Eric A; Kremers, Hilal M; Jones, Dakota L; Bonin, Carolina A; Dudakovic, Amel; Thaler, Roman; Cohen, Robert C; Lewallen, David G; van Wijnen, Andre J
Like any foreign object, orthopaedic implants are susceptible to infection when introduced into the human body. Without additional preventative measures, the absolute number of annual prosthetic joint infections will continue to rise, and may exceed the capacity of health care systems in the near future. Bacteria are difficult to eradicate from synovial joints due to their exceptionally diverse taxonomy, complex mechanistic attachment capabilities, and tendency to evolve antibiotic resistance. When a primary orthopaedic implant fails from prosthetic joint infection, surgeons are generally challenged by limited options for intervention. In this review, we highlight the etiology and taxonomic groupings of bacteria known to cause prosthetic joint infections, and examine their key mechanisms of attachment. We propose that antimicrobial strategies should focus on the most harmful bacteria taxa within the context of occurrence, taxonomic diversity, adhesion mechanisms, and implant design. Patient-specific identification of organisms that cause prosthetic joint infections will permit assessment of their biological vulnerabilities. The latter can be targeted using a range of antimicrobial techniques that exploit different colonization mechanisms including implant surface attachment, biofilm formation, and/or hematogenous recruitment. We anticipate that customized strategies for each patient, joint, and prosthetic component will be most effective at reducing prosthetic joint infections, including those caused by antibiotic-resistant and polymicrobial bacteria.
Kirr, R; Wiberg, J; Hertlein, H
Since September 2005 our patients with acute endoprosthetic infection are treated, next to the normal wound debridement, with a full automatic vacuum drain system (V.A.C. instill system). This therapy unit entail a three step program. Based on the well known vacuum therapy, the new system contains an additional fluid drain and affecting period with an antibiotic or antiseptic instillation therapy. In the last half year we were able to treat five patients with endoprosthetic infection by using this therapy unit. In our opinion, we have a successfull method of treating patients with acute, infected big joints after endoprosthetic implantation. The therapy unit of V.A.C. instill is quickly available and easy to learn. Next to much better comfort for the patients the most advantage is to leave the prosthetic inside during the infection management with the new therapy unit. Further results in treating acute joint infections after endoprosthetic implantation must been shown, if this new method is to be the new standard in daily clinical routine.
Horstmann, W G; Swierstra, M J; Ohanis, D; Castelein, R M; Kollen, B J; Verheyen, C C P M
Autologous retransfusion and no-drainage are both blood-saving measures in total hip replacement (THR). A new combined intra- and post-operative autotransfusion filter system has been developed especially for primary THR, and we conducted a randomised controlled blinded study comparing this with no-drainage. A total of 204 THR patients were randomised to autologous blood transfusion (ABT) (n = 102) or no-drainage (n = 102). In the ABT group, a mean of 488 ml (sd 252) of blood was retransfused. The mean lowest post-operative haemoglobin level during the hospital stay was higher in the autotransfusion group (10.6 g/dl (7.8 to 13.9) vs 10.2 g/dl (7.5 to 13.3); p = 0.01). The mean haemoglobin levels for the ABT and no-drainage groups were not significantly different on the first day (11.3 g/dl (7.8 to 13.9) vs 11.0 g/dl (8.1 to 13.4); p = 0.07), the second day (11.1 g/dl (8.2 to 13.8) vs 10.8 g/dl (7.5 to 13.3); p = 0.09) or the third day (10.8 g/dl (8.0 to 13.0) vs 10.6 g/dl (7.5 to 14.1); p = 0.15). The mean total peri-operative net blood loss was 1464 ml (sd 505) in the ABT group and 1654 ml (sd 553) in the no-drainage group (p = 0.01). Homologous blood transfusions were needed in four patients (3.9%) in the ABT group and nine (8.8%) in the no-drainage group (p = 0.15). No statistically significant difference in adverse events was found between the groups. The use of a new intra- and post-operative autologous blood transfusion filter system results in less total blood loss and a smaller maximum decrease in haemoglobin levels than no-drainage following primary THR.
Posada, Olga M.; Gilmour, Denise; Tate, Rothwelle J.; Grant, M. Helen
Cobalt-chromium (CoCr) particles in the nanometre size range and their concomitant release of Co and Cr ions into the patients' circulation are produced by wear at the articulating surfaces of metal-on-metal (MoM) implants. This process is associated with inflammation, bone loss and implant loosening and led to the withdrawal from the market of the DePuy ASR™ MoM hip replacements in 2010. Ions released from CoCr particles derived from a resurfacing implant in vitro and their subsequent cellular up-take were measured by ICP-MS. Moreover, the ability of such metal debris and Co ions to induce both apoptosis was evaluated with both FACS and immunoblotting. qRT-PCR was used to assess the effects on the expression of lymphotoxin alpha (LTA), BCL2-associated athanogene (BAG1), nitric oxide synthase 2 inducible (NOS2), FBJ murine osteosarcoma viral oncogene homolog (FOS), growth arrest and DNA-damage-inducible alpha (GADD45A). ICP-MS showed that the wear debris released significant (p < 0.05) amounts of Co and Cr ions into the culture medium, and significant (p < 0.05) cellular uptake of both ions. There was also an increase (p < 0.05) in apoptosis after a 48 h exposure to wear debris. Analysis of qRT-PCR results found significant up-regulation (p < 0.05) particularly of NOS2 and BAG1 in Co pre-treated cells which were subsequently exposed to Co ions + debris. Metal debris was more effective as an inducer of apoptosis and gene expression when cells had been pre-treated with Co ions. This suggests that if a patient receives sequential bilateral CoCr implants, the second implant may be more likely to produce adverse effects than the first one. - Highlights: • Effects of CoCr nanoparticles and Co ions on U937 cells were investigated. • Ions released from wear debris play an important role in cellular response, • Toxicity of Co ions could be related to NO metabolic processes and apoptosis. • CoCr particles were a more effective inducer of apoptosis after cell
Papathakis, P. C.; Rollins, N. C.
OBJECTIVE: Little is known about the nutritional adequacy and feasibility of breastmilk replacement options recommended by WHO/UNAIDS/UNICEF. The study aim was to explore suitability of the 2001 feeding recommendations for infants of HIV-infected mothers for a rural region in KwaZulu Natal, South Africa specifically with respect to adequacy of micronutrients and essential fatty acids, cost, and preparation times of replacement milks. METHODS: Nutritional adequacy, cost, and preparation time of home-prepared replacement milks containing powdered full cream milk (PM) and fresh full cream milk (FM) and different micronutrient supplements (2 g UNICEF micronutrient sachet, government supplement routinely available in district public health clinics, and best available liquid paediatric supplement found in local pharmacies) were compared. Costs of locally available ingredients for replacement milk were used to calculate monthly costs for infants aged one, three, and six months. Total monthly costs of ingredients of commercial and home-prepared replacement milks were compared with each other and the average monthly income of domestic or shop workers. Time needed to prepare one feed of replacement milk was simulated. FINDINGS: When mixed with water, sugar, and each micronutrient supplement, PM and FM provided <50% of estimated required amounts for vitamins E and C, folic acid, iodine, and selenium and <75% for zinc and pantothenic acid. PM and FM made with UNICEF micronutrient sachets provided 30% adequate intake for niacin. FM prepared with any micronutrient supplement provided no more than 32% vitamin D. All PMs provided more than adequate amounts of vitamin D. Compared with the commercial formula, PM and FM provided 8-60% of vitamins A, E, and C, folic acid, manganese, zinc, and iodine. Preparations of PM and FM provided 11% minimum recommended linoleic acid and 67% minimum recommended alpha-linolenic acid per 450 ml mixture. It took 21-25 minutes to optimally prepare
Mohamad, Siti Azleen; Mohd Haspani, Mohd Safari; Idris, Badrisyah
Objectives This study, conducted in 2012, was performed to determine the incidence of graft infection after cranioplasty procedures and factors affecting the graft infection rate at Hospital Kuala Lumpur (HKL). Methodology This was an observational cross-sectional case study of patients who have undergone cranioplasty at HKL over a period of one year (2012). One hundred seventy-two patients were included in the study. A total of 105 (61.8%) cases were autologous bone flap replacements, and 67 (38.2%) were acrylic cranioplasty. Result A total of five infected grafts were identified among the 172 cases included in the study, resulting in an overall infection rate of 2.9%. Of this infected group, three (4.5%) were cases of cranioplasty and two (1.9%) were cases of autologous bone flap replacement. There was high proportion of male patients undergoing cranioplasty (118 [or 68.6%]) and only 54 (or 31.4%) female patients. The primary pathology in the majority of patients (126 [or 73.2%]) was due to trauma; only 46 cases (or 26.8%) did not result from trauma. Of the patients, 123 (or 71.5%) had undergone a single cranial procedure prior to their cranioplasty, and 43 (or 28.5%) had undergone multiple cranial procedures. Most of the patients (114 [or 66.3%]) underwent cranioplasty 90 days after undergoing decompressive craniectomy while 58 (or 33.7%) underwent cranioplasty less than 90 days after decompressive craniectomy. PMID:27904429
Desai, C.; Hirani, H.; Chawla, A.
Hip joint is one of the largest weight-bearing structures in the human body. In the event of a failure of the natural hip joint, it is replaced with an artificial hip joint, known as hip joint prosthesis. The design of hip joint prosthesis must be such so as to resist fatigue failure of hip joint stem as well as bone cement, and minimize wear caused by sliding present between its head and socket. In the present paper an attempt is made to consider both fatigue and wear effects simultaneously in estimating functional-life of the hip joint prosthesis. The finite element modeling of hip joint prosthesis using HyperMesh™ (version 9) has been reported. The static analysis (load due to the dead weight of the body) and dynamic analysis (load due to walking cycle) have been described. Fatigue life is estimated by using the S-N curve of individual materials. To account for progressive wear of hip joint prosthesis, Archard's wear law, modifications in socket geometry and dynamic analysis have been used in a sequential manner. Using such sequential programming reduction in peak stress has been observed with increase in wear. Finally life is estimated on the basis of socket wear.
Sawaia, Rogério Naim; Galvão, Antonio Felipe Martensen; Oliveira, Fernando Machado; Secunho, Guilherme Rondinelli; Filho, Geraldo Vilela
Objective: The aim of this study was to present a minimally invasive anterolateral access route and to ascertain whether this enables total hip replacement without compromising the quality of the implant positioning, while maintaining the integrity of the gluteus muscles. Method: A retrospective study was conducted on 260 patients (186 females and 74 males) with an average age of 62 years. There were 18 bilateral cases, totaling 278 hips. All the patients had osteoarthritis and had undergone non-cemented total hip arthroplasty (metal-metal or metal-polyethylene) between October 2004 and December 2007. A minimally invasive anterolateral access route was used, measuring 7 to 10 cm in length, according to body weight and the size of the femoral head. The patients were assessed clinically regarding age, sex and presence of the Trendelenburg sign, and radiologically regarding acetabular and femoral positioning. Results: The acetabular inclination was between 30° and 40° in 78 patients, between 41° and 50° in 189 patients, and 51° or over in 11 patients. On anteroposterior radiographs to study femoral positioning, the positioning was central in 209 cases, 41 presented valgus deviation and 28 presented varus deviation. On lateral views, 173 were central, 67 anterior and 38 posterior. The mean duration of the procedure was 63 minutes. Regarding complications, there were five cases of infection, three of deep vein thrombosis, two of hip dislocation, 80 of lengthening of the lower limbs and five of shortening of the operated limb. The Trendelenburg sign was present in four cases, of which one showed superior gluteal nerve injury. Conclusion: The minimally invasive anterolateral access route made it possible to perform total hip arthroplasty without compromising the positioning of the implants, thereby maintaining the integrity of the gluteus muscles. PMID:27027008
Chen W-S; Wan Y-L
The iliacus muscle is closely associated with the psoas muscle, femoral nerve, hip joint, pelvic and intraabdominal structures; thus, its disorders may present as lower abdominal pain, hip pain, or femoral neuropathy. Iliacus pyomyositis, a primary bacterial infection of the skeletal muscle not secondary to a contiguous skin, bone, or soft-tissue infection, presenting as hip pain, femoral neuropathy, and sympathetic effusion of the hip joint in an 8-year-old boy mimicked septic arthritis of the hip joint. Computed tomography was helpful in delineating the accurate location of the lesion. Surgical drainage and appropriate antibiotic therapy led to complete resolution and full functional recovery.
Mulvaney, Sean W
Viscosupplementation of the hip for symptomatic osteoarthritis appears to be safe and effective in more than 25 yr of use in Europe. More than 11 studies suggest that viscosupplementation in the hip is as effective as viscosupplementation in the knee. It appears to be a safe and reasonable alternative to nonsteroidal antiinflammatory drugs or intra-articular steroids for the treatment of osteoarthritis pain. Viscosupplementation in the hip may delay the need for hip replacement surgery. Viscosupplementation in the hip appears to work better in patients with fewer radiographic changes of osteoarthritis. Placement of viscosupplement in the hip under real-time ultrasound or fluoroscopic guidance is safe and well tolerated. Hip joint communication with the iliopsoas bursa may be a factor in studies of the effectiveness of viscosupplementation in the hip.
Clarke, M.G.; Thomas, H.G. Chester, J.F.
A 48-year-old woman with severe juvenile-onset rheumatoid arthritis presented with a bleeding cutaneous sinus distal to her right total hip replacement scar. Methicillin resistant Staphylococcus aureus (MRSA) was isolated on culture. She had previously undergone bilateral total hip and knee replacements at aged 23 and six years later had the right knee prosthesis removed for infection, with subsequent osteomyelitis of the femoral shaft and right total hip prosthesis disruption. Peripheral arteriography was performed in view of persistent bleeding from the sinus, which revealed a 6 cm false aneurysm filling from and compressing the right external iliac artery (EIA). A PTFE-covered, balloon expandable JOSTENT was deployed in the right EIA, successfully excluding the false aneurysm and preventing further bleeding from the sinus. No graft infection was reported at 12 months. This case illustrates the potential use of endovascular stent-grafting in the treatment of an infected pseudoaneurysm.
Steinbach, L.S.; Schneider, R.; Goldman, A.B.; Kazam, E.; Ranawat, C.S.; Ghelman, B.
Bursae or abscess cavities communicating with the hip joint were demonstrated by hip arthrography or by computed tomography (CT) in 40 cases. The bursae or abscess cavities were associated with underlying abnormalities in the hip, including painful hip prostheses, infection, and inflammatory or degenerative arthritis. Symptoms may be produced directly as a result of infection or indirectly as a result of inflammation or pressure on adjacent structures. Hip arthrography can confirm a diagnosis of bursae and abscess cavities communicating with the hip joint in patients with hip pain or soft-tissue masses around the groin. Differentiation of enlarged bursae from other abnormalities is important to avoid unnecessary or incorrect surgery.
Safdar, Atif; Shaaban, Hamid; Tibayan, Restituto; Miller, Richard; Boairdo, Richard; Guron, Gunwant
Background: Platelet rich plasma (PRP) is a blood derivative concentrate of platelets, fibrin and growth factors obtained through withdrawal and centrifugation of autologous blood and use for its inherent hemostatic and adhesive properties to promote wound healing. Hip arthroplasty is often associated with significant perioperative complications including blood loss necessitating blood transfusions, which can lead to multiple adverse reactions, infection transmission, and longer hospital stay. Materials and Methods: We conducted this retrospective comparative study to determine whether the use of PRP can reduce the bleeding complications in hip replacement surgeries and therefore decrease analgesic requirements and shorten the hospital stay. Results: Sixty patients had consecutive hip replacement surgeries. The study group (n=23) received PRP applications while the control group (n=37) were operated without PRP applications. Postoperative drop of hemoglobin, number of red blood cell (RBC) transfusions, analgesic requirements, and duration of hospital stay were recorded. There was no significant difference in the drop of hemoglobin preoperatively and postoperatively comparing study and control groups (P=0.75). There was no difference in transfusion requirements between the two groups (P=0.16) but there was trend toward less transfusion in the PRP-treated group. There were also no statistical differences in analgesic use (P=0.83) and lengths of hospitalization (P=0.68) between the two groups. Conclusion: We concluded that there is no clinical efficacy in using PRP in hip replacement surgeries. We recommend a larger prospective study be conducted to determine its clinical utility as an optimization strategy to improve outcome after hip arthroplasty PMID:25810634
Gomez, Eric; Cazanave, Charles; Cunningham, Scott A.; Greenwood-Quaintance, Kerryl E.; Steckelberg, James M.; Uhl, James R.; Hanssen, Arlen D.; Karau, Melissa J.; Schmidt, Suzannah M.; Osmon, Douglas R.; Berbari, Elie F.; Mandrekar, Jayawant
Periprosthetic tissue and/or synovial fluid PCR has been previously studied for prosthetic joint infection (PJI) diagnosis; however, few studies have assessed the utility of PCR on biofilms dislodged from the surface of explanted arthroplasties using vortexing and sonication (i.e., sonicate fluid PCR). We compared sonicate fluid 16S rRNA gene real-time PCR and sequencing to culture of synovial fluid, tissue, and sonicate fluid for the microbiologic diagnosis of PJI. PCR sequences generating mixed chromatograms were decatenated using RipSeq Mixed. We studied sonicate fluids from 135 and 231 subjects with PJI and aseptic failure, respectively. Synovial fluid, tissue, and sonicate fluid culture and sonicate fluid PCR had similar sensitivities (64.7, 70.4, 72.6, and 70.4%, respectively; P > 0.05) and specificities (96.9, 98.7, 98.3, and 97.8%, respectively; P > 0.05). Combining sonicate fluid culture and PCR, the sensitivity was higher (78.5%, P < 0.05) than those of individual tests, with similar specificity (97.0%). Thirteen subjects had positive sonicate fluid culture but negative PCR, and 11 had negative sonicate fluid culture but positive PCR (among which 7 had prior use of antimicrobials). Broad-range PCR and culture of sonicate fluid have equivalent performance for PJI diagnosis. PMID:22895042
Qasim, Sultan Naseer; Swann, Andrew; Ashford, Robert
Prosthetic joint infection (PJI) is a devastating complication in total knee arthroplasty (TKA) and third most common cause of revision of TKA with significant morbidity and surgical challenges. Treatment options include non-operative measures with long term antibiotic suppression, debridement and implant retention (DAIR), one- or two-stage revision arthroplasty, arthrodesis and amputation. Implant retention without infection is ideal and DAIR has been reported to have variable success rates depending on patient factors, duration of infection, infecting micro-organisms, choice of procedure, single or multiple debridement procedures, arthroscopic or open, antibiotic choice and duration of antibiotic use. We present a thorough literature review of DAIR for infected TKA. The important factors contributing to failure are presence of sinus, immunocompromised patient, delay between onset of infection and debridement procedure, Staphylococcal infection in particular Meticillin Resistant Staphylococcal aureus, multiple debridement procedures, retention of exchangeable components and short antibiotic duration. In conclusion DAIR can be successful procedure to eradicate infection in TKA in selective patients with factors contributing to failure taken into account. PMID:28074774
Fink, B; Makowiak, C; Fuerst, M; Berger, I; Schäfer, P; Frommelt, L
We analysed the serum C-reactive protein level, synovial fluid obtained by joint aspiration and five synovial biopsies from 145 knee replacements prior to revision to assess the value of these parameters in diagnosing late peri-prosthetic infection. Five further synovial biopsies were used for histological analysis. Samples were also obtained during the revision and incubated and analysed in an identical manner for 14 days. A total of 40 total knee replacements were found to be infected (prevalence 27.6%). The aspiration technique had a sensitivity of 72.5% (95% confidence interval (CI) 58.7 to 86.3), a specificity of 95.2% (95% CI 91.2 to 99.2), a positive predictive value of 85.3% (95% CI 73.4 to 100), a negative predictive value of 90.1% (95% CI 84.5 to 95.7) and an accuracy of 89%. The biopsy technique had a sensitivity of 100%, a specificity of 98.1% (95% CI 95.5 to 100), a positive predictive value of 95.2% (95% CI 88.8 to 100), a negative predictive value of 100% and an accuracy of 98.6%. C-reactive protein with a cut-off-point of 13.5 mg/l had a sensitivity of 72.5% (95% CI 58.7 to 86.3), a specificity of 80.9% (95% CI 73.4 to 88.4), a positive predictive value of 59.2% (95% CI 45.4 to 73.0), a negative predictive value of 88.5% (95% 81.0 to 96.0 CI) and an accuracy of 78.1%. We found that biopsy was superior to joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements.
Keller, Sara C.; Cosgrove, Sara E.; Higgins, Yvonne; Piggott, Damani A.; Osgood, Greg; Auwaerter, Paul G.
Background. The use of suppressive antibiotics in treatment of orthopedic hardware infections (OHIs), including spinal hardware infections, prosthetic joint infections, and infections of internal fixation devices, is controversial. Methods. Over a 4-year period at 2 academic medical centers, patients with OHI who were treated with debridement and retention of hardware components, with single-stage exchange, or without surgery were studied to determine whether use of oral antibiotics for at least 6 months after diagnosis impacts successful treatment of the infection at 1 year after diagnosis. Results. Of 89 patients in the study, 42 (47.2%) were free of clinical infection 1 year after initial diagnosis. Suppressive antibiotics used for at least 6 months after diagnosis was not associated with being free of clinical infection (adjusted odds ratio [aOR], 5.29; 95% confidence interval [CI], .74–37.80), but being on suppressive antibiotics at least 3 months after diagnosis was associated with being free of clinical infection (OR, 3.50; 95% CI, 1.30–9.43). Causative organisms impacted the likelihood of success; patients with methicillin-resistant Staphylococcus aureus as well as with Gram-negative rods were both less likely to have achieved clinical success at 1 year after surgery (aOR = 0.018, 95% CI = .0017–.19 and aOR = 0.20, 95% CI = .039–.99, respectively). Conclusions. Oral suppressive antibiotic therapy in treatment of OHI with retention of hardware for 3 months, but not 6 months, postdiagnosis increases the likelihood of treatment success. The organisms implicated in the infection directly impact the likelihood of treatment success. PMID:27747252
Wünschel, Markus; Leichtle, Ulf G; Leichtle, Carmen I; Walter, Christian; Mittag, Falk; Arlt, Eva; Suckel, Andreas
Although mid- to long-term results after total ankle replacement have improved because of available second- and third-generation devices, failure of total ankle replacement is still more common compared with total hip replacement and total knee replacement. The portfolio of available total ankle replacement revision component options is small. Furthermore, the bone stock of the tibiotalar region is scarce making it difficult and in some situations impossible to perform revision total ankle replacement. In these cases tibiotalar and tibiotalocalcaneal fusions are valuable options. This article describes which surgical procedures should be performed depending on the initial situation and gives detailed advice on surgical technique, postoperative care, and clinical results.
Agten, C A; Sutter, R; Pfirrmann, C W A
Metal-induced artifacts impair image quality of computed tomography (CT) and magnetic resonance imaging (MRI) in patients with hip prostheses. Due to new developments in metal artifact reduction both methods can now be used for evaluation of a painful hip prosthesis. Iterative reconstruction algorithms and dual-energy scans are among the newer CT techniques for artifact reduction, while slice-encoding for metal artifact correction (SEMAC) and multi-acquisition variable-resonance image combination (MAVRIC) have introduced substantial improvements for MRI. Loosening of the hip prosthesis, osteolysis from small wear particles and pseudotumors in metal-on-metal prostheses are specific pathologies in patients with total hip arthroplasty. Other causes of painful hip prostheses are infections, fractures, tendinopathies, tendon ruptures, muscle and nerve alterations and heterotopic ossifications.
Arazi, T; Shiboleth, Y M; Gal-On, A
Systematic deletion and peptide tagging of the amino-terminal domain (NT, ~43 amino acids) of an attenuated zucchini yellow mosaic potyvirus (ZYMV-AGII) coat protein (CP) were used to elucidate its role in viral systemic infection. Deletion mutants truncated by 8, 13, and 33 amino acid residues from the CP-NT 5' end were systemically infectious and produced symptoms similar to those of the AGII virus. Tagging these deletion mutants with either human c-Myc (Myc) or hexahistidine peptides maintained viral infectivity. Similarly, addition of these peptides to the intact AGII CP-NT did not affect viral life cycle. To determine which parts, if any, of the CP-NT are essential for viral systemic infection, a series of Myc-tagged mutants with 8 to 43 amino acids removed from the CP-NT were constructed. All Myc-tagged CP-NT deletion mutants, including those from which virtually all the viral CP-NT had been eliminated, were able to encapsidate and cause systemic infection. Furthermore, chimeric viruses with deletions of up to 33 amino acids from CP-NT produced symptoms indistinguishable from those caused by the parental AGII virus. In contrast to CP-NT Myc fusion, addition of the foot-and-mouth disease virus (FMDV) immunogenic epitope to AGII CP-NT did not permit systemic infection. However, fusion of the Myc peptide to the N terminus of the FMDV peptide restored the capability of the virus to spread systemically. We have demonstrated that all CP-NT fused peptides were exposed on the virion surface, masking natural CP immunogenic determinants. Our findings demonstrate that CP-NT is not essential for ZYMV spread and that it can be replaced by an appropriate foreign peptide while maintaining systemic infectivity.
Miranda, I; Angulo, M; Amaya, J V
In the last 15 years only few cases of Pasteurella multocida (P. multocida) total knee arthroplasty infection have been published, mostly related to cat or dog bites or scratches. We report a case of P. multocida total knee arthroplasty infection in a 64-year- old patient, 10 days after being scratched and bitten by his cat. The patient was successfully treated with debridement and tibial interspacer exchange and antibiotic treatment for 6 weeks. Antimicrobial prophylaxis should be considered in cat or dog bites or scratches victims with prosthetic joints.
Swanson, Megan A; Huo, Michael H
Altered biomechanics secondary to hip ankylosis often result in degeneration of the lumbar spine, ipsilateral knee, and contralateral hip and knee. Symptoms in these joints may be reduced with conversion total hip arthroplasty (THA) of the ankylosed hip. THA in the ankylosed hip is a technically challenging procedure, and the overall clinical outcome is generally less satisfactory than routine THA performed for osteoarthritis and other etiologies. Functional integrity of the hip abductor muscles is the most important predictor of walking ability following conversion THA. Many patients experience persistent limp, and it can take up to 2 years to fully assess final functional outcome. Risk factors cited for increased risk of failed THA include prior surgical ankylosis and age <50 years at the time of conversion THA.
... is surgery to replace the damaged bone and cartilage in the ankle joint. Artificial joint parts (prosthetics) ... Your surgeon will remove the damaged bone and cartilage. Your surgeon will replace the damaged part of: ...
Standifird, Tyler W; Saxton, Arnold M; Coe, Dawn P; Cates, Harold E; Reinbolt, Jeffrey A; Zhang, Songning
This study compared biomechanics during stair ascent in replaced and non-replaced limbs of total knee arthroplasty (TKA) patients with control limbs of healthy participants. Thirteen TKA patients and fifteen controls performed stair ascent. Replaced and non-replaced knees of TKA patients were less flexed at contact compared to controls. The loading response peak knee extension moment was greater in control and non-replaced knees compared with replaced. The push-off peak knee abduction moment was elevated in replaced limbs compared to controls. Loading and push-off peak hip abduction moments were greater in replaced limbs compared to controls. The push-off peak hip abduction moment was greater in non-replaced limbs compared to controls. Future rehabilitation protocols should consider the replaced knee and also the non-replaced knee and surrounding joints.
LeBoff, Meryl S.; Cobb, Haley; Gao, Lisa Y.; Hawkes, William; Yu-Yahiro, Janet; Kolatkar, Nikheel S.; Magaziner, Jay
Objective Celiac disease is associated with decreased bone density, however, the risk of fractures in celiac disease patients is unclear. We compared the prevalence of celiac disease between a group of women with hip fractures and a group of women undergoing elective joint replacement surgery and the association between celiac disease and vitamin D levels. Methods Two hundred eight community dwelling and postmenopausal women were recruited from Boston, MA (n=81) and Baltimore, MD (n=127). We measured tissue transglutaminase IgA by ELISA to diagnose celiac disease and 25-hydroxyvitamin D (25(OH)D) levels by radioimmunoassay in both women with hip fractures (n=157) and the control group (n=51), all of whom were from Boston. Subjects were excluded if they took any medications or had medical conditions that might affect bone. Results Median serum 25(OH)D levels were significantly lower (p< 0.0001) in the hip fracture cohorts compared to the elective joint replacement cohort (14.1 ng/ml vs. 21.3 ng/ml, respectively). There were no differences in the percentage of subjects with a positive tissue transglutaminase in the women with hip fractures versus the control group (1.91% vs. 1.61%, respectively). Conclusion Vitamin D levels are markedly reduced in women with hip fractures, however hip fracture patients did not show a higher percentage of positive tissue transglutaminase levels compared with controls. These data suggest that routine testing for celiac disease among hip fracture patients may not prove useful, although larger prospective studies among hip fracture subjects are needed. PMID:23732553
de Villiers, Danielle; Shelton, Julia C
Simulation of wear in total hip replacements has been recognised as an important factor in determining the likelihood of clinical success. However, accurate measurement of wear can be problematic with factors such as number and morphology of wear particles produced as well as ion release proving more important in the biological response to hip replacements than wear volume or wear rate alone. In this study, hard-on-hard (CoCr alloy, AgCrN coating) and hard-on-soft (CoCr alloy and CrN coating on vitamin E blended highly cross-linked polyethylene) bearing combinations were tested in an orbital hip simulator under standard and some adverse conditions. Gravimetric wear rates were determined for all bearings, with cobalt and where applicable, silver release determined throughout testing. Isolation of wear particles from the lubricating fluid was used to determine the influence of different bearing combinations and wear conditions on particle morphology. It was found that cobalt and silver could be measured in the lubricating fluid even when volumetric wear was not detectable. In hard-on-hard bearings, Pearson's correlation of 0.98 was established between metal release into the lubricating fluid and wear volume. In hard-on-soft bearings, coating the head did not influence the polyethylene wear rates measured under standard conditions but did influence the cobalt release; the diameter influenced both polyethylene wear and cobalt release, and the introduction of adverse testing generated smaller polyethylene particles. While hip simulators can be useful to assess the wear performance of a new material or design, measurement of other outcomes may yield greater insight into the clinical behaviour of the bearings in vivo.
Di Puccio, Francesca; Mattei, Lorenza
Hip arthroplasty can be considered one of the major successes of orthopedic surgery, with more than 350000 replacements performed every year in the United States with a constantly increasing rate. The main limitations to the lifespan of these devices are due to tribological aspects, in particular the wear of mating surfaces, which implies a loss of matter and modification of surface geometry. However, wear is a complex phenomenon, also involving lubrication and friction. The present paper deals with the tribological performance of hip implants and is organized in to three main sections. Firstly, the basic elements of tribology are presented, from contact mechanics of ball-in-socket joints to ultra high molecular weight polyethylene wear laws. Some fundamental equations are also reported, with the aim of providing the reader with some simple tools for tribological investigations. In the second section, the focus moves to artificial hip joints, defining materials and geometrical properties and discussing their friction, lubrication and wear characteristics. In particular, the features of different couplings, from metal-on-plastic to metal-on-metal and ceramic-on-ceramic, are discussed as well as the role of the head radius and clearance. How friction, lubrication and wear are interconnected and most of all how they are specific for each loading and kinematic condition is highlighted. Thus, the significant differences in patients and their lifestyles account for the high dispersion of clinical data. Furthermore, such consideration has raised a new discussion on the most suitable in vitro tests for hip implants as simplified gait cycles can be too far from effective implant working conditions. In the third section, the trends of hip implants in the years from 2003 to 2012 provided by the National Joint Registry of England, Wales and Northern Ireland are summarized and commented on in a discussion. PMID:25621213
... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery; Osteoarthritis-hip ... You may receive general anesthesia before this surgery. This means ... spinal anesthesia. With this kind of anesthesia, medicine is ...
... Devices Products and Medical Procedures Implants and Prosthetics Metal-on-Metal Hip Implants Hip Implants Share Tweet Linkedin Pin ... devices available with different bearing surfaces. These are: Metal-on-Polyethylene: The ball is made of metal ...
... this page: //medlineplus.gov/ency/article/007633.htm Hip joint injection To use the sharing features on this ... injection is a shot of medicine into the hip joint. The medicine helps relieve pain and inflammation. It ...
Romness, D W; Morrey, B F
Sixteen total knee arthroplasties performed between 1977 and 1985 in 13 patients with prior ipsilateral hip arthrodesis or ankylosis were studied to determine the preferred sequence and long-term follow-up of procedures in this clinical setting. Twelve of 16 underwent fusion takedown and total hip arthroplasty prior to knee replacement. The average age at total knee arthroplasty was 52.7 years and the average time from hip fusion to total knee arthroplasty was 36.3 years. Mean follow-up after total knee arthroplasty was 5.5 years (range, 2.3 to 10 years). The Hospital for Special Surgery knee score increased from a mean of 31.8 preoperatively to 72.2 after surgery. In patients who had conversion of the hip fusion prior to knee replacement, knee scores were 28 before and 72.5 after both procedures. Patients who retained their hip fusion had mean scores of 43.5 and 72.1, respectively. None of the knees has been removed and 14 of 16 had no pain at last follow-up. One had mild pain and one had moderate pain attributed to pes anserine bursitis. Although the numbers are small, this experience reveals that takedown of the fusion with total hip arthroplasty is an effective technique before performing the knee replacement. Though successful in some instances, the experience is too small to show that if hip fusion is in good position, knee replacement without fusion takedown is acceptable.
Ward, M. B.; Brown, A. P.; Cox, A.; Curry, A.; Denton, J.
Metal on metal hip joint prostheses are now commonly implanted in patients with hip problems. Although hip replacements largely go ahead problem free, some complications can arise such as infection immediately after surgery and aseptic necrosis caused by vascular complications due to surgery. A recent observation that has been made at Manchester is that some Cobalt Chromium (CoCr) implants are causing chronic pain, with the source being as yet unidentified. This form of replacement failure is independent of surgeon or hospital and so some underlying body/implant interface process is thought to be the problem. When the synovial fluid from a failed joint is examined particles of metal (wear debris) can be found. Transmission Electron Microscopy (TEM) has been used to look at fixed and sectioned samples of the synovial fluid and this has identified fine (< 100 nm) metal and metal oxide particles within the fluid. TEM EDX and Electron Energy Loss Spectroscopy (EELS) have been employed to examine the composition of the particles, showing them to be chromium rich. This gives rise to concern that the failure mechanism may be associated with the debris.
Karachalios, T; Hartofilakidis, G
This paper reviews the current knowledge relating to the management of adult patients with congenital hip disease. Orthopaedic surgeons who treat these patients with a total hip replacement should be familiar with the arguments concerning its terminology, be able to recognise the different anatomical abnormalities and to undertake thorough pre-operative planning in order to replace the hip using an appropriate surgical technique and the correct implants and be able to anticipate the clinical outcome and the complications.
Stubbs, Allston Julius; Atilla, Halis Atil
Summary Background Despite the rapid advancement of imaging and arthroscopic techniques about the hip joint, missed diagnoses are still common. As a deep joint and compared to the shoulder and knee joints, localization of hip symptoms is difficult. Hip pathology is not easily isolated and is often related to intra and extra-articular abnormalities. In light of these diagnostic challenges, we recommend an algorithmic approach to effectively diagnoses and treat hip pain. Methods In this review, hip pain is evaluated from diagnosis to treatment in a clear decision model. First we discuss emergency hip situations followed by the differentiation of intra and extra-articular causes of the hip pain. We differentiate the intra-articular hip as arthritic and non-arthritic and extra-articular pain as surrounding or remote tissue generated. Further, extra-articular hip pain is evaluated according to pain location. Finally we summarize the surgical treatment approach with an algorithmic diagram. Conclusion Diagnosis of hip pathology is difficult because the etiologies of pain may be various. An algorithmic approach to hip restoration from diagnosis to rehabilitation is crucial to successfully identify and manage hip pathologies. Level of evidence: V. PMID:28066734
... the outside rim of the socket of your hip joint. In addition to cushioning the hip joint, the labrum acts like a rubber seal or gasket to help hold the ball at the top of your thighbone securely within your hip socket. Athletes who participate in such sports as ...
Alarcon, E. I.; Vulesevic, B.; Argawal, A.; Ross, A.; Bejjani, P.; Podrebarac, J.; Ravichandran, R.; Phopase, J.; Suuronen, E. J.; Griffith, M.
Despite the broad anti-microbial and anti-inflammatory properties of silver nanoparticles (AgNPs), their use in bioengineered corneal replacements or bandage contact lenses has been hindered due to their intense yellow coloration. In this communication, we report the development of a new strategy to pre-stabilize and incorporate AgNPs with different colours into collagen matrices for fabrication of corneal implants and lenses, and assessed their in vitro and in vivo activity.Despite the broad anti-microbial and anti-inflammatory properties of silver nanoparticles (AgNPs), their use in bioengineered corneal replacements or bandage contact lenses has been hindered due to their intense yellow coloration. In this communication, we report the development of a new strategy to pre-stabilize and incorporate AgNPs with different colours into collagen matrices for fabrication of corneal implants and lenses, and assessed their in vitro and in vivo activity. Electronic supplementary information (ESI) available: Collagen hydrogel, moulded as a cornea, prepared containing collagen protected AgNPs and representative images for collagen hydrogels, moulded as corneas, containing Blue AgNPs either unprotected or protected with LL37-SH; representative TEM images for Green-1 AgNPs prepared in this work; changes on surface plasmon band after synthesis for Green-2 AgNPs without LL37-SH; representative picture of the powder obtained for Green-1 AgNPs capped with LL37-SH after 72 h lyophilization, see main text; representative TEM images for Blue and Green-1 AgNPs prepared in this work; absorption spectra for the supernatants for collagen hydrogels containing Blue AgNPs; absorbance at 600 nm of PAO1 cultures prepared in 25% LB media incubated for 14 h at 37 °C in the presence of different concentrations of AgNPs, Green-1 or Blue, or silver nitrate; HECC cell density (cells per cm2) measured on gels with and without silver nitrate after 1 day of cell incubation; total silver concentration
Munigangaiah, Sudarshan; O’Dwyer, Sinead; Masterson, Eric
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
Kamath, Atul F
For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosis at an early age due to poor coverage of the femoral head and abnormal loading of the joint articulation. In patients with symptomatic dysplasia and closed triradiate cartilage (generally over age 10), including adolescents and young adults (generally up to around age 40), the Bernese periacetabular osteotomy (PAO) is a durable technique for addressing underlying structural deformity. The PAO involves a modified Smith-Petersen approach. Advantages of the Bernese osteotomy include preservation of the weight-bearing posterior column of the hemi-pelvis, preservation of the acetabular blood supply, maintenance of the hip abductor musculature, and the ability to effect powerful deformity correction about an ideal center of rotation. There is an increasing body of evidence that preservation of the native hip can be improved through pelvic osteotomy. In contrast to hip osteotomy and joint preservation, the role of total hip arthroplasty in young, active patients with correctable hip deformity remains controversial. Moreover, the durability of hip replacement in young patients is inherently limited. Pelvic osteotomy should be considered the preferred method to address correctable structural deformity of the hip in the young, active patient with developmental dysplasia. The Bernese PAO is technically demanding, yet offers reproducible results with good long-term survivorship in carefully selected patients with preserved cartilage and the ability to meet the demands of rehabilitation.
Seitz, S; Rüther, W
Rheumatoid arthritis is often accompanied by massive destruction of the smaller and larger joints even with early therapy using antirheumatic drugs. In these cases total joint arthroplasty is the only surgical option, especially for the knee and hip joint. Knowledge of the specific disease-related postoperative characteristics is a prerequisite for the successful treatment of patients with rheumatoid arthritis. As dislocation of the arthroplastic joint does not occur more often in rheumatoid arthritis, the risk of periprosthetic infection is increased due to the use of biologicals. Therefore, a perioperative optimization is obligatory. In order to facilitate independence in daily living physiotherapy in combination with aids such as arthritis crutches, gripping pliers or raised toilet seat need to be started as soon as possible after surgical treatment. To achieve this goal it is recommended to refer patients with inflammatory arthritis to inpatient rehabilitation facilities. With respect to the specific postoperative treatment after joint replacement the long-term results are comparable with those from patients with primary osteoarthritis.
Weissman, B.N. )
Several methods of total hip joint replacement are currently used. Radiographic appearances after cemented, bone ingrowth, press-fit, and bipolar hip prostheses are reviewed. The roles of nuclear medicine and arthrographic procedures for identifying complications are discussed. Total knee prostheses and, in particular, complications related to the patellar component are described.115 references.
Casey, J L; Coley, A M; Parisi, K; Foley, M
There is an expanding area of small molecule discovery, especially in the area of peptide mimetics. Peptide sequences can be used to substitute for the entire native antigen for use in diagnostic assays. Our approach is to select peptides that mimic epitopes of the natural immune response to Epstein-Barr virus (EBV) that may be recognised by antibodies typically produced after infection with EBV. We screened a random peptide library on sera from rabbits immunised with a crude preparation of EBV and serum antibodies from a patient with a high titer of EBV antibodies. We selected four peptides (Eb1-4) with the highest relative binding affinity with immune rabbit sera and a single peptide with high affinity to human serum antibodies. The peptides were coupled to the carrier molecule BSA and the recognition of the peptides by IgM antibodies in clinical samples after infection with EBV was measured. The sensitivities were Eb1 94%, Eb2, 3, 4 88%, H1 81% and all had 100% specificity. This study illustrates that the phage display approach to select epitope mimics can be applied to polyclonal antibodies and peptides that represent several diagnostically important epitopes can be selected simultaneously. This panel of EBV peptides representing a wide coverage of immunodominant epitopes could replace crude antigen preparations currently used for capture in commercial diagnostic tests for EBV.
Casey, J.L.; Coley, A.M.; Parisi, K.; Foley, M.
There is an expanding area of small molecule discovery, especially in the area of peptide mimetics. Peptide sequences can be used to substitute for the entire native antigen for use in diagnostic assays. Our approach is to select peptides that mimic epitopes of the natural immune response to Epstein–Barr virus (EBV) that may be recognised by antibodies typically produced after infection with EBV. We screened a random peptide library on sera from rabbits immunised with a crude preparation of EBV and serum antibodies from a patient with a high titer of EBV antibodies. We selected four peptides (Eb1–4) with the highest relative binding affinity with immune rabbit sera and a single peptide with high affinity to human serum antibodies. The peptides were coupled to the carrier molecule BSA and the recognition of the peptides by IgM antibodies in clinical samples after infection with EBV was measured. The sensitivities were Eb1 94%, Eb2, 3, 4 88%, H1 81% and all had 100% specificity. This study illustrates that the phage display approach to select epitope mimics can be applied to polyclonal antibodies and peptides that represent several diagnostically important epitopes can be selected simultaneously. This panel of EBV peptides representing a wide coverage of immunodominant epitopes could replace crude antigen preparations currently used for capture in commercial diagnostic tests for EBV. PMID:19073711
Umer, Masood; Rashid, Haroon; Umer, Hafiz Muhammad; Raza, Hasnain
Hip joint instability can be secondary to congenital hip pathologies like developmental dysplasia (DDH) or acquired such as sequel of infective or neoplastic process. An unstable hip is usually associated with loss of bone from the proximal femur, proximal migration of the femur, lower-extremity length discrepancy, abnormal gait, and pain. In this case series of 37 patients coming to our institution between May 2005 and December 2011, we report our results in treatment of unstable hip joint by hip reconstruction osteotomy using the Ilizarov method and apparatus. This includes an acute valgus and extension osteotomy of the proximal femur combined with gradual varus and distraction (if required) for realignment and lengthening at a second, more distal, femoral osteotomy. 18 males and 19 females participated in the study. There were 17 patients with DDH, 12 with sequelae of septic arthritis, 2 with tuberculous arthritis, 4 with posttraumatic arthritis, and 2 with focal proximal femoral deficiency. Outcomes were evaluated by using Harris Hip Scoring system. At the mean follow-up of 37 months, Harris Hip Score had significantly improved in all patients. To conclude, illizarov hip reconstruction can successfully improve Trendelenburg's gait. It supports the pelvis and simultaneously restores knee alignment and corrects lower-extremity length discrepancy (LLD).
Sambri, A; Cadossi, M; Mazzotti, A; Faldini, C; Giannini, S
Osteoarthritis secondary to developmental dysplasia of the hip is a surgical challenge because of the modified anatomy of the acetabulum which is deficient in its shape with poor bone quality, torsional deformities of the femur and the altered morphology of femoral head. Particularly in Crowe type III and IV, additional surgical challenges are present, such as limb-length discrepancy and adductor muscle contractures. This is a bilateral hip dysplasia case where bilateral hip replacement was indicated, on the left side with a resurfacing one and on the other side a two stage procedure using a iliofemoral external fixator to restore equal leg length with a lower risk of complications. This case report shows both the negative clinical outcome of the left and the excellent one of the right hip where the dysplasia was much more severe. Patient selection and implant positioning are crucial in determining long-term results.
Fink, B; Casser, H R; Zilkens, K W; Rüther, W
A 45-year-old woman who suffered from juvenile tuberculous coxitis at the age of 4 is presented. Her hip joint replacement lasted for 18 years and then needed replacing. Intraoperatively removed caseous soft tissue and an opalescent secretion histologically resembled a tuberculous focus, and bacteriological culture grew a Mycobacterium tuberculosis strain. Four months after the replacement, the patient suffered from a tuberculosis-induced septic loosening of the newly replaced hip joint endoprosthesis. The tuberculosis relapse was probably due to aseptic loosening of the first hip joint endoprosthesis.
... the opening at the end of the shoulder blade, called the socket. This type of joint allows ... head. The socket part (glenoid) of your shoulder blade will be replaced with a smooth plastic shell ( ...
Therapeutic drug monitoring of continuous-infusion acylovir for disseminated herpes simplex virus infection in a neonate receiving concurrent extracorporeal life support and continuous renal replacement therapy.
Cies, Jeffrey J; Moore, Wayne S; Miller, Kyle; Small, Christine; Carella, Dominick; Conley, Susan; Parker, Jason; Shea, Paul; Chopra, Arun
Disseminated herpes simplex virus (HSV) infection in neonates represents a devastating entity that yields high mortality. Acyclovir is the primary antiviral agent used to treat life-threatening HSV infections in neonates; however, even though the agent has reduced morbidity overall from these infections, mortality with disseminated disease remains high. Currently, to our knowledge, no data exist regarding therapeutic drug monitoring of acyclovir in the setting of extracorporeal life support (ECLS) or continuous renal replacement therapy (CRRT) coupled with ECLS. We describe the case of a 14-day-old female with disseminated HSV-1 infection that progressed to fulminant hepatic and renal failure, necessitating the use of ECLS for hemodynamic support and CRRT as a treatment modality for hepatic and renal failure. The standard dosage of acyclovir 20 mg/kg/dose intravenously every 8 hours had been initiated, but after conversion to ECLS and CRRT, the patient's dosage was increased to 30 mg/kg/dose every 8 hours. After a repeat viral load remained unchanged from the initial viral load at 1 × 10(8) copies/ml, the patient was transitioned from intermittent dosing to a continuous infusion of acyclovir added to the dialysate solution for CRRT at a concentration of 5.5 mg/L. To provide an optimal outcome, dosing was designed to maintain acyclovir plasma concentrations of at least 3 mg/L in order to maintain an acyclovir concentration of at least 1 mg/L in the cerebrospinal fluid. The patient's acyclovir serum concentrations measured at 24 and 72 hours after starting continuous-infusion acyclovir via the dialysate were 8.8 and 5.3 mg/L, respectively, allowing for a continuous serum concentration above 3 mg/L. Unfortunately, before a repeat viral load could be obtained to assess the efficacy of the continuous infusion acyclovir, the patient experienced an intracerebral hemorrhage as a complication related to ECLS after which technological support was withdrawn
Hernigou, Philippe; Quiennec, Steffen; Guissou, Isaac
In 1939, Frederick R. Thompson of New York and Austin T. Moore of South Carolina separately developed replacements for the entire ball of the hip. These were used to treat hip fractures and also certain arthritis cases. This type of hemiarthroplasty addressed the problem of the arthritic femoral head only. The diseased acetabulum (hip socket) was not replaced. This prosthesis consisted of a metal stem that was placed into the marrow cavity of the femur, connected in one piece with a metal ball fitted into the hip socket. Bohlman and Austin T. Moore (1939) collaborated for the fabrication and implantation of a custom made 12-inch-long vitallium (metal alloy invented by Venable) femoral head prosthesis for a patient with a recurrent giant cell tumour. This prosthesis functioned well and later on influenced the development of long stem femoral head prostheses.
Erceg, Marinko; Becić, Kristijan
The use of closed-suction drainage systems after total hip and knee replacement is a common practice. It is believed that drainage reduces the haematomas and infection. The usual time to remove drains is 48 hours. Usefulness of the long time drainage of the haematomas and possible harmfulness of infection is still a subject of discussion. In this article, using our own operative material, we want to show the justification of the 48 hour duration of closed-suction drainage. The investigation was done on the patients with hip replacement (45 patients) and knee replacement (11 patients). The amount of blood in the drainage systems in the first 24 hours after the surgery and after 24 hours till the removal of drainage was observed. The results show that the amount of blood lost in the drainage system in the first 24 hours was on average 95.29%, and only 4.71% in the next 24 hours. This article supports the opinion that postoperative drainage has to be removed after 24 hours, i.e. the 48 hours-drainage seems not to be justified.
... training for health care providers. Learn More Hip Fractures Among Older Adults Recommend on Facebook Tweet Share ... older. What You Can Do to Prevent Hip Fractures You can prevent hip fractures by taking steps ...
... inflammation and swelling of the tissues around the hip joint. Usually only one hip is affected. This condition ... to reduce the swelling and inflammation around the hip joint.Your child's doctor will probably ask you to ...
Bittersohl, Bernd; Zaps, Daniela; Bomar, James D.; Hosalkar, Harish S.
Reconstructive and salvage procedures have continued to evolve in orthopedic surgery with changing functional demands of the population as well as advances in implants and surgical techniques. What used to be popular or traditional care at some point may eventually become a thing of the past, and this is true as far as many orthopedic surgical procedures are concerned. Understanding the etiology, pathogenesis, and managing and postponing the destructive pathway of osteoarthritis (OA) has been the goal of orthopedists since the specialty began in the early part of 18th century. Options of treating the severe sequelae of an arthritic joint have varied in different treatment eras. Management options have changed from a spectrum of non-treatment and slow suffering to muscle and soft-tissue releases, interposition arthroplasty and eventual extreme options like joint fusion or arthrodesis. The concept and advent of joint replacement surgery started a new era in the management of OA and was a dream come true in many ways. Mobility and stability are achieved together during the arthroplasty (joint replacement) that allowes the patient to maintain a good level of function. Arthroplasty certainly has its pros and cons as we have discovered in the past six decades. Pushing the envelope to younger population has its limitation in terms of longevity of the prosthesis, early loosening, need for repeated revisions that at some point may not be technically possible and risk of infection and disastrous consequences like PE and death associated with the gravity of the procedure. As infrequent as it is in today's clinical practice, arthrodesis of the hip joint has a role and remains a solid option for a well selected case. The purpose of this review is to discuss the current indications in the pediatric population and outline surgical techniques for hip arthrodesis while pointing out limitations and shortcomings. PMID:22053254
Clarke, Kester Diederik
The intent of this report is to document a procedure used at LANL for HIP bonding aluminum cladding to U-10Mo fuel foils using a formed HIP can for the Domestic Reactor Conversion program in the NNSA Office of Material, Management and Minimization, and provide some details that may not have been published elsewhere. The HIP process is based on the procedures that have been used to develop the formed HIP can process, including the baseline process developed at Idaho National Laboratory (INL). The HIP bonding cladding process development is summarized in the listed references. Further iterations with Babcock & Wilcox (B&W) to refine the process to meet production and facility requirements is expected.
Gutowski, C J; Zmistowski, B M; Clyde, C T; Parvizi, J
The rate of peri-prosthetic infection following total joint replacement continues to rise, and attempts to curb this trend have included the use of antibiotic-loaded bone cement at the time of primary surgery. We have investigated the clinical- and cost-effectiveness of the use of antibiotic-loaded cement for primary total knee replacement (TKR) by comparing the rate of infection in 3048 TKRs performed without loaded cement over a three-year period versus the incidence of infection after 4830 TKRs performed with tobramycin-loaded cement over a later period of time of a similar duration. In order to adjust for confounding factors, the rate of infection in 3347 and 4702 uncemented total hip replacements (THR) performed during the same time periods, respectively, was also examined. There were no significant differences in the characteristics of the patients in the different cohorts. The absolute rate of infection increased when antibiotic-loaded cement was used in TKR. However, this rate of increase was less than the rate of increase in infection following uncemented THR during the same period. If the rise in the rate of infection observed in THR were extrapolated to the TKR cohort, 18 additional cases of infection would have been expected to occur in the cohort receiving antibiotic-loaded cement, compared with the number observed. Depending on the type of antibiotic-loaded cement that is used, its cost in all primary TKRs ranges between USD $2112.72 and USD $112 606.67 per case of infection that is prevented.
Daniel, J; Ziaee, H; Kamali, A; Pradhan, C; Band, T; McMinn, D J W
Second-generation metal-on-metal bearings were introduced as a response to the considerable incidence of wear-induced failures associated with conventional replacements, especially in young patients. We present the results at ten years of a consecutive series of patients treated using a metal-on-metal hip resurfacing. A distinct feature of the bearings used in our series was that they had been subjected to double-heat treatments during the post-casting phase of their manufacture. In the past these bearings had not been subjected to thermal treatments, making this a unique metal-on-metal bearing which had not been used before in clinical practice. We report the outcome of 184 consecutive hips (160 patients) treated using a hybrid-fixed metal-on-metal hip resurfacing during 1996. Patients were invited for a clinicoradiological follow-up at a minimum of ten years. The Oxford hip score and anteroposterior and lateral radiographs were obtained. The mean age at operation was 54 years (21 to 75). A series of 107 consecutive hips (99 patients) who received the same prosthesis, but subjected to a single thermal treatment after being cast, between March 1994 and December 1995, were used as a control group for comparison. In the 1994 to 1995 group seven patients (seven hips) died from unrelated causes and there were four revisions (4%) for osteolysis and aseptic loosening. In the 1996 group nine patients died at a mean of 6.9 years after operation because of unrelated causes. There were 30 revisions (16%) at a mean of 7.3 years (1.2 to 10.9), one for infection at 1.2 years and 29 for osteolysis and aseptic loosening. Furthermore, in the latter group there were radiological signs of failure in 27 (24%) of the 111 surviving hips. The magnitude of the problem of osteolysis and aseptic loosening in the 1996 cohort did not become obvious until five years after the operation. Our results indicate that double-heat treatments of metal-on-metal bearings can lead to an increased
Maurer-Ertl, Werner; Friesenbichler, Joerg; Holzer, Lukas A; Leitner, Lukas; Ogris, Kathrin; Maier, Michael; Leithner, Andreas
At the beginning of the 21st century, use of large-diameter, metal-on-metal devices was a popular procedure for hip replacement in young and physically active patients; however, within a few years, the number of revisions increased, resulting in a worldwide recall for the articular surface replacement (ASR) system. Complication rates for the ASR devices implanted at the authors' department are reported, with revision rates of 32% and 30% in the ASR XL Head and ASR Resurfacing groups, respectively. Reasons for revision surgery were serum metal ion elevation, luxation or subluxation, aseptic loosening, soft tissue compromise (adverse reactions to metal debris [ARMD]), and infection. The calculated implant survival for the ASR XL Head system and the ASR Resurfacing device (DePuy Orthopaedics Inc, Warsaw, Indiana) in the current series was 79% and 90%, respectively, at 60 months. Symptomatic patients with metal-on-metal devices, with or without elevated metal ion concentrations, should undergo cross sectional imaging to exclude ARMD. In cases of increased metal ion concentrations, local pain, or ARMD, revision surgery has to be evaluated. In the future, closer monitoring of new implants is needed to prevent high failure rates, as seen with the ASR design. Furthermore, the withdrawal of the device highlights the importance of national implant registries. [Orthopedics. 201x; xx(x):xx-xx.].
Silva, Paulo; de Oliveira, Leandro Alves; Coelho, Danilo Lopes; do Amaral, Rogério Andrade; Rebello, Percival Rosa; de Moraes, Frederico Barra
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.
Ratzlaff, C.; Van Wyngaarden, C.; Duryea, J.
Objective To establish the performance of a location-specific computer-assisted quantitative measure of hip JSW, by measuring responsiveness at fixed locations in those with hip OA and pain and those without. Secondary purposes included investigating the most responsive location, comparison to mJSW and evaluating reading time. Methods Design: nested case-control Data: drawn from the Osteoarthritis Initiative (OAI), a longitudinal cohort study of knee OA. All OAI participants had standardized standing AP pelvis radiographs at baseline and 48 months. Case definition (1): subjects with a total hip replacement (THR) after the 48 month visit with adequate baseline and 48 month radiographs (n=27) were selected and matched (1:1) on sex and age to subjects without a THR and no hip pain. Case definition (2): subjects with a THR at any point after baseline (n=79) were selected and the contralateral (CL) hip was designated the case hip, and subjects were matched (1:1) as above. Pain: the CL hip group were examined for the presence/absence of pain Measurements of superior hip JSW were made at three fixed locations relative to a landmark-based line, facilitated by software that delineated the femoral head and found the acetabular margin at the three points. The standardized response mean (SRM) was used to examine sensitivity to change from baseline to 48 months. Paired t-tests were used to compare cases and controls. Results Significant differences were observed between cases and controls and those with and without pain. The location-specific measure outperformed mJSW in all analyses, with SRM ranging from 0.53 (contralateral hip) to 1.06 (THR hip). The superior-medial location was the most responsive. Conclusion A new computer-assisted location-specific method of hip JSW is feasible and may provide a superior method to mJSW for radiographic OA progression. The superior-medial location was the most responsive. PMID:25278059
Hui-Hui Wu; Dong Wang; An-Bang Ma; Dong-Yun Gu
The cartilage surface geometry of natural human hip joint is commonly regarded as sphere. It has been widely applied in computational simulation and hip joint prosthesis design. Some new geometry models have been developed and the sphere assumption has been questioned recently. The objective of this study was to analyze joint geometry effects on cartilage contact stress distribution and investigate contact patterns during a whole gait cycle. Hip surface was reconstructed from CT data of a healthy volunteer. Three finite element (FE) models of hip joint were developed from different cartilage geometries: natural geometry, sphere and rotational ellipsoid. Loads at ten instants of gait cycle were applied to these models based on published in-vivo data. FE predictions of peak contact pressure during gait of natural hip were compared with sphere and rotational ellipsoid replaced hip joint. Contact occurs mainly in upper anterior region of both acetabulum and femur distributing along sagittal plane of human body. It moves towards inferolateral aspect as the resultant joint reaction force changes during walking for natural hip. Peak pressures at the instant with maximum contact force were 7.48 MPa, 14.97 MPa and 13.12 MPa for models with natural hip surface, sphere replaced and rotational ellipsoid replaced surface respectively. During the whole gait cycle, contact pressure of natural hip ranked lowest in most of the instants, followed by rotational ellipsoid replaced and sphere replaced hip. The results indicate that rotational ellipsoid is more consistent with natural hip cartilage geometry than sphere during normal walking. This means rotational ellipsoid prosthesis could give a better description of physiological structure compared with standard sphere prosthesis. Therefore, rotational ellipsoid would be a better choice for prosthesis design.
... hip area, and images are recorded on a computer. The black-and-white images show the internal ... the images can be seen clearly on the computer screen. A technician (sonographer) trained in ultrasound imaging ...
Harris, E Clare; Coggon, David
Epidemiological evidence points strongly to a hazard of hip osteoarthritis from heavy manual work. Harmful exposures may be reduced by the elimination or redesign of processes and the use of mechanical aids. Reducing obesity might help to protect workers whose need to perform heavy lifting cannot be eliminated. Particularly high relative risks have been reported in farmers, and hip osteoarthritis is a prescribed occupational disease in the UK for long-term employees in agriculture. Even where it is not attributable to employment, hip osteoarthritis impacts importantly on the capacity to work. Factors that may influence work participation include the severity of disease, the physical demands of the job, age and the size of the employer. Published research does not provide a strong guide to the timing of return to work following hip arthroplasty for osteoarthritis, and it is unclear whether patients should avoid heavy manual tasks in their future employment.
Age- and gender-specific numbers of patients with hip fracture increase with age and peaked at the age 80-84; however, age- and gender-specific incidences increase exponentially with age. According to the recent nation-wide survey, the most common cause of hip fractures was a simple fall, 68.8% sustained fractures in-doors, and the incidences were higher in the winter than the summer period. More than 90% of patients with hip fracture were treated surgically and about 3/4 of patients with femoral neck fractures were treated with hemi-arthroplasty. Hip fractures for Asian people including Japanese are lower than those for Caucasians living in Northern Europe and North America; however, recent reports from the Asian area indicated an increase in the incidence with time.
Harris, E Clare; Coggon, David
Epidemiological evidence points strongly to a hazard of hip osteoarthritis from heavy manual work. Harmful exposures may be reduced by elimination or redesign of processes and use of mechanical aids. Reducing obesity might help to protect workers whose need to perform heavy lifting cannot be eliminated. Particularly high relative risks have been reported in farmers, and hip osteoarthritis is a prescribed occupational disease in the UK for long-term employees in agriculture. Even where it is not attributable to employment, hip osteoarthritis impacts importantly on capacity to work. Factors that may influence work participation include the severity of disease, the physical demands of the job, age, and the size of the employer. Published research does not provide a strong guide to the timing of return to work following hip arthroplasty for osteoarthritis, and it is unclear whether patients should avoid heavy manual tasks in their future employment. PMID:26612242
Yang, Lang; Peel, Nicola; Clowes, Jackie A; McCloskey, Eugene V; Eastell, Richard
Several DXA-based structural engineering models (SEMs) of the proximal femur have been developed to estimate stress caused by sideway falls. Their usefulness in discriminating hip fracture has not yet been established and we therefore evaluated these models. The hip DXA scans of 51 postmenopausal women with hip fracture (30 femoral neck, 17 trochanteric, and 4 unspecified) and 153 age-, height-, and weight-matched controls were reanalyzed using a special version of Hologic’s software that produced a pixel-by-pixel BMD map. For each map, a curved-beam, a curved composite-beam, and a finite element model were generated to calculate stress within the bone when falling sideways. An index of fracture risk (IFR) was defined over the femoral neck, trochanter, and total hip as the stress divided by the yield stress at each pixel and averaged over the regions of interest. Hip structure analysis (HSA) was also performed using Hologic APEX analysis software. Hip BMD and almost all parameters derived from HSA and SEM were discriminators of hip fracture on their own because their ORs were significantly >1. Because of the high correlation of total hip BMD to HSA and SEM-derived parameters, only the bone width discriminated hip fracture independently from total hip BMD. Judged by the area under the receiver operating characteristics curve, the trochanteric IFR derived from the finite element model was significant better than total hip BMD alone and similar to the total hip BMD plus bone width in discriminating all hip fracture and femoral neck fracture. No index was better than total hip BMD for discriminating trochanteric fractures. In conclusion, the finite element model has the potential to replace hip BMD in discriminating hip fractures. PMID:18767924
Polesello, Giancarlo Cavalli; Keiske Ono, Nelson; Bellan, Davi Gabriel; Honda, Emerson Kiyoshi; Guimarães, Rodrigo Pereira; Junior, Walter Riccioli; Do Val Sella, Guilherme
To confirm the therapeutic importance of hip arthroplasty in athletes whose pain precludes sportive function of the hip joint, being able to minimize it to the extent of helping on the return of sports practice at satisfactory levels. Methods: 49 athlete patients (51 hips) submitted to hip arthroscopy complaining of pain and inability to practice sports were assessed. Follow-up time ranged from 12 to 74 months (mean: 39.0 months). Preoperatively, pain site, severity according to Facial Expression Scale (FES) and the degree of disability using the modified Harris Hip Score (HHS) were assessed. Different diagnoses were provided, which led to the indication of arthroscopy, such as femoralacetabular impact, acetabular lip injury not secondary to femoral-acetabular impact, etc. Postoperatively, the patients were assessed by using the same methods as used at baseline and by the subjective analysis of return to sports activities. Results: Based on pre-and postoperative HHS and FES, the statistical analysis showed significance between values. We found some improvement in all cases and return to sports activities at a satisfactory level in most of the cases. Conclusion: As a result of our study, we confirm that arthroscopy in athletes with local hip injuries is an effective technique, able to promote the return to sports practice in most of the cases, without pain, and with an effective joint function, provided well indicated. PMID:26998449
Nestorova, Rodina; Vlad, Violeta; Petranova, Tzvetanka; Porta, Francesco; Radunovic, Goran; Micu, Mihaela C; Iagnocco, Annamaria
A complete physical examination of the hip is often difficult due to its size and deep position. During the last two decades, ultrasonography (US) of the hip has been widely accepted as a useful diagnostic tool in patients with hip pain and /or limited range of motion. It is commonly used in both adults and children. This technique allows evaluation of different anatomical structures and their pathological changes, such as joint recess (joint effusion, synovial hypertrophy), changes within the bursae (bursitis), tendons and muscles (tendinopathy, ruptures, calcifications), as well as changes in the bony profile of the joint surfaces, ischial tuberosity, and greater trochanter (erosions, osteophytes, calcific deposits). US is very useful for guided procedures in hip joint and periarticular soft tissues under direct visualization. The needle aspiration of synovial fluid and steroid injections are commonly-applied activities in daily rheumatology practice. The relatively limited acoustic windows available to the US beam are the principal limitations to hip US. Therefore, conducting a detailed examination of some important structures together with the interpretation of Doppler signal (sometimes undetectable) is not easy, requiring good knowledge of the modality. The aim of this review is to analyze the current literature about US of the hip and to describe the most frequently-observed normal and pathological findings.
Hartofilakidis, George; Lampropoulou-Adamidou, Kalliopi
Orthopaedic surgeons specialising in adult hip reconstruction surgery often face the problem of osteoarthritis secondary to congenital hip disease (CHD). To achieve better communication among physicians, better treatment planning and evaluation of the results of various treatment options, an agreed terminology is needed to describe the entire pathology. Furthermore, a generally accepted classification of the deformities is necessary. Herein, the authors propose the use of the term “congenital hip disease” and its classification as dysplasia, low dislocation and high dislocation. Knowledge of the CHD natural history facilitates comprehension of the potential development and progression of the disease, which differs among the aforementioned types. This can lead to better understanding of the anatomical abnormalities found in the different CHD types and thus facilitate preoperative planning and choice of the most appropriate management for adult patients. The basic principles for improved results of total hip replacement in patients with CHD, especially those with low and high dislocation, are: Wide exposure, restoration of the normal centre of rotation and the use of special techniques and implants for the reconstruction of the acetabulum and femur. Application of these principles during total hip replacement in young female patients born with severe deformities of the hip joint has led to radical improvement of their quality of life. PMID:28032030
Kamath, Atul F
For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosis at an early age due to poor coverage of the femoral head and abnormal loading of the joint articulation. In patients with symptomatic dysplasia and closed triradiate cartilage (generally over age 10), including adolescents and young adults (generally up to around age 40), the Bernese periacetabular osteotomy (PAO) is a durable technique for addressing underlying structural deformity. The PAO involves a modified Smith-Petersen approach. Advantages of the Bernese osteotomy include preservation of the weight-bearing posterior column of the hemi-pelvis, preservation of the acetabular blood supply, maintenance of the hip abductor musculature, and the ability to effect powerful deformity correction about an ideal center of rotation. There is an increasing body of evidence that preservation of the native hip can be improved through pelvic osteotomy. In contrast to hip osteotomy and joint preservation, the role of total hip arthroplasty in young, active patients with correctable hip deformity remains controversial. Moreover, the durability of hip replacement in young patients is inherently limited. Pelvic osteotomy should be considered the preferred method to address correctable structural deformity of the hip in the young, active patient with developmental dysplasia. The Bernese PAO is technically demanding, yet offers reproducible results with good long-term survivorship in carefully selected patients with preserved cartilage and the ability to meet the demands of rehabilitation. PMID:27190755
Ilizaliturri Sánchez, Víctor M; Camacho Galindo, Javier
Arthroscopic surgery of the hip is a routine procedure in an increasing number of institutions around the world. Indications for this procedure increase as more experience is developed. Thanks to hip arthroscopy some intraarticular lesions like labral or ligamentum teres tears and cartilage lesions have been recognized. All of these have the potential to develop hip osteoarthritis. Open techniques for the treatment of femoroacetabular impingement have been transformed to arthroscopic techniques. Femoroacetabular impingement has the potential to cause hip osteoarthritis. The role of hip arthroscopy in the treatment of formally established hip osteoarthritis is limited and has better results in young patients with early degenerative changes.
Williams, P L; Corbett, M
Two patients who developed widespread severe avascular necrosis of bone while on steroid replacement therapy are described. One, a diabetic, underwent yttrium-90 pituitary ablation for retinopathy and developed avascular necrosis within 18 months of starting prednisolone. The other, who had Addison's disease, developed avascular necrosis within 14 months of starting cortisol replacement therapy. Both cases came to bilateral total hip replacement. Images PMID:6859959
Yeo, Ingwon; Cha, Hoon-Suk; Yoon, Young Cheol; Park, Youn-Soo; Lim, Seung-Jae
Abstract Introduction: Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is an increasingly recognized entity. The hip joint is known as a less frequently affected site in SAPHO syndrome, and there has been limited reports about hip joint diseases caused by SAPHO syndrome, and as such adequate treatment for this disease spectrum is still not fully elucidated. Case: We describe the case of a 52-year-old man admitted for SAPHO syndrome who went on to be diagnosed with advanced secondary hip arthritis associated with disabling right hip pain. The diagnosis of SAPHO syndrome was delayed; the patient was given a clinical diagnosis of osteomyelitis and treated with prolonged courses of antibiotics and open surgical debridement at previous tertiary health facility. The patient underwent 2-stage joint replacement surgery in our hospital. At 1 year after the surgery, he is well, with minimal right hip pain and the prosthesis is functioning well. Conclusion: This case shows the safety and effectiveness of the 2-stage joint replacement in treating destructive hip disease caused by SAPHO syndrome mimicking infectious arthritis. PMID:27399138
Asada, K; Yoshida, K; Shimazu, A; Yunoki, H; Ishida, N
The concept of the bipolar type prosthesis is that the articular motion is observed primarily between the HDP bearing insert and the inner head, thereby avoiding the greater frictional shear force between the prosthetic head and acetabulum found with the traditional one piece endoprosthesis. A newly developed ceramic bipolar hip prosthesis utilizes an outer head composed of bio-inert fine alumina ceramic rather than a metal head. The mechanical strength of this prototype bipolar hip prosthesis was tested with static load and impact force, and the dynamic fatigue strength was also tested with repeated loads. Results were judged to show that the device has strength adequate for clinical use. The hip prostheses has been clinically applied in replacement of the femoral head of a neck fracture, femoral head necrosis and osteoarthritic hip. Finally, using a mathematical model, the so-called self-centering effect due to center offset between outer and inner heads is discussed.
Mühlbacher, E; Lick-Schiffer, W; Lojpur, M; Baumgartner, F; Spieß, T; Tschauner, C
The so-called "congenital" luxation of the hip joint is endemic in Central Europe and occurs in about 1% of all newborn infants. By the means of ultrasonographic diagnosis according to the Graf method an early detection instantly after birth has become a good clinical routine in the German-speaking countries. Sonography-based conservative treatment has become the gold standard. The cast in squatting ("human") position is a standard procedure in order to retain the originally decentred or unstable hip joints in the reduced position: 100° flexion and 50° abduction are necessary to fix the hip joint in the reduced position without the risk of avascular necrosis. After the fixation in a squatting-cast, a period of functional bracing in flexed position enhances bony maturation. This two-phase functional conservative treatment can avoid later osteotomies or even early total hip replacement.
Stryła, Wanda; Pogorzała, Adam M; Rogala, Piotr; Nowakowski, Andrzej
Authors present a set of exercises for patients after total hip replacement (THR) treated due to idiopathic hip joint osteoarthritis. Outcome of surgical treatment depends largely on physical therapy conducted after the procedure. Physical therapy following total hip arthroplasty involves restoration of proper physical function. Exercises increase the strength of hip girdle muscles and stabilize the involved hip joint. Total postoperative rehabilitation improves the gait esthetics. Restoring patient's full independence in everyday and professional life after total hip arthroplasty is the best test for properly conducted rehabilitation. A rehabilitation algorithm following hip arthroplasty was established based on the data acquired from literature and authors' own studies. Methods of rehabilitation following total arthroplasty was unified with regard to the type of endoprosthesis (cemented and non-cemented). Rehabilitation after revision and cancer arthroplasties were not taken into consideration. Exercises were divided into those performed in supine and standing positions as well as resistance training (using an elastic TheraBand® tape). At a later stage of rehabilitation, marching and walking as well as cycloergometer training were included. Patient's position during the day and in the sleep for two months following THR was taken into account, including some types of exercises that are contraindicated and pose a threat of endoprosthesis luxation.
Anagnostakos, Konstantinos; Jung, Jochen; Schmid, Nora Verena; Schmitt, Eduard; Kelm, Jens
Over the past two decades antibiotic-impregnated hip spacers have become a popular procedure in the treatment of hip joint infections. Besides infection persistence and/or reinfection, major complications after hip spacer implantation include spacer fracture, -dislocation, and bone fracture. Moreover, in cases with extensive loss of femoral and/or acetabular bone alternative reconstructive techniques should be used for a stable spacer fixation and prevention of fractures or dislocations. The present article reviews the different types of spacer fractures and dislocations and offers some suggestions about reconstructive techniques for management of extensive loss of femoral and/or acetabular bone at the site of hip spacer implantation. PMID:19834593
Föger-Samwald, Ursula; Vekszler, György; Hörz-Schuch, Edith; Salem, Sylvia; Wipperich, Markus; Ritschl, Peter; Mousavi, Mehdi; Pietschmann, Peter
A common manifestation of age-related bone loss and resultant osteoporosis are fractures of the hip. Age-related osteoporosis is thought to be determined by a number of intrinsic factors including genetics, hormonal changes, changes in levels of oxidative stress, or an inflammatory status associated with the aging process. The aim of this study was to investigate gene expression and bone architecture in bone samples derived from elderly osteoporotic women with hip fractures (OP) in comparison to bone samples from age matched women with osteoarthritis of the hip (OA). Femoral heads and adjacent neck tissue were collected from 10 women with low-trauma hip fractures (mean age 83±6) and consecutive surgical hip replacement. Ten bone samples from patients undergoing hip replacement due to osteoarthritis (mean age 80±5) served as controls. One half of each bone sample was subjected to gene expression analysis. The second half of each bone sample was analyzed by microcomputed tomography. From each half, samples from four different regions, the central and subcortical region of the femoral head and neck, were analyzed. We could show a significantly decreased expression of the osteoblast related genes RUNX2, Osterix, Sclerostin, WNT10B, and Osteocalcin, a significantly increased ratio of RANKL to Osteoprotegerin, and a significantly increased expression of the enzymes superoxide dismutase 2 (SOD2) and glutathione peroxidase GPX3, and of the inflammatory cytokine IL6 in bone samples from hip fracture patients compared to controls. Major microstructural changes in OP bone were seen in the neck and were characterized by a significant decrease of bone volume, trabecular number, and connectivity density and a significant increase of trabecular separation. In conclusion, our data give evidence for a decreased expression of osteoblast related genes and increased expression of osteoclast related genes. Furthermore, increased expression of SOD2 and GPX3 suggest increased
Kannus, P; Parkkari, J; Sievänen, H; Heinonen, A; Vuori, I; Järvinen, M
There were an estimated 1.66 million hip fractures world-wide in 1990. According to the epidemiologic projections, this worldwide annual number will rise to 6.26 million by the year 2050. This rise will be in great part due to the huge increase in the elderly population of the world. However, the age-specific incidence rates of hip fractures have also increased during the recent decades and in many countries this rise has not leveled off. In the districts where this increase has either showed or leveled off, the change seems to especially concern women's cervical fractures. In men, the increase has continued unabated almost everywhere. Reasons for the age-specific increase are not known: increase in the age-adjusted incidence of falls of the elderly individuals with accompanying deterioration in the age-adjusted bone quality (strength, mineral density) may partially explain the phenomenon. The growth of the elderly population will be more marked in Asia, Latin America, the Middle East, and Africa than in Europe and North America, and it is in the former regions that the greatest increments in hip fracture are projected so that these regions will account for over 70% of the 6.26 million hip fractures in the year 2050. The incidence rates of hip fractures vary considerably from population to population and race to race but increase exponentially with age in every group. Highest incidences have been described in the whites of Northern Europe (Scandinavia) and North America. In Finland, for example, the 1991 incidence of hip fractures was 1.1% for women and 0.7% for men over 70 years of age. Among elderly nursing home residents, the figures can be as high as 6.2% and 4.9%. The lifetime risk of a hip fracture is 16%-18% in white women and 5%-6% in white men. At the age of 80 years, every fifth woman and at the age of 90 years almost every second woman has suffered a hip fracture. Since populations are aging worldwide, the mean age of the hip fracture patients are
Khurana, Ashish; Parker, Salim; Goel, Vivek; Alderman, Phillip M
Cyanoacrylate glues have been used in various surgical specialties for primary wound closure or as a supplement to other methods. We assessed the overall results and safety of this technique following primary hip arthroplasty. Ninety-three patients undergoing primary total hip replacement were studied. The surgical wound had been closed with subcuticular vicryl followed by the application of topical dermabond adhesive, without any additional dressings. The mean follow-up was 7.2 months. One patient suffered wound dehiscence on the third post operative day. Two patients had serous oozing from the wound for the initial 3-4 days. This technique provides an immediate water tight seal in a sterile operative environment and provides a barrier to micro organisms. It has good tensile strength, aesthetic value and patient satisfaction.
Nakano, Naoki; Khanduja, Vikas
Summary Background Recent developments in hip arthroscopic techniques and technology have made it possible in many cases to avoid open surgical dislocation for treating a variety of pathology in the hip. Although early reports suggest favourable results’ using hip arthroscopy and it has been shown to be a relatively safe procedure, complications do exist and can sometimes lead to significant morbidity. Methods This is a review article. The aim of this manuscript is to present the most frequent and/or serious complications that could occur at or following hip arthroscopy and some guidelines to avoid these complications. Conclusion Most complications of hip arthroscopy are minor or transient but serious complications can occur as well. A lot of complication e.g. acetabular labral puncture go unreported. Appropriate education and training, precise and meticulous surgical technique with correct instrumentation, the right indication in the right patient and adherence to advice from mentors and experienced colleagues are all essential factors for a successful outcome. Level of evidence: V. PMID:28066747
Weber, Alexander E.; Bedi, Asheesh; Tibor, Lisa M.; Zaltz, Ira; Larson, Christopher M.
Context: Dance, gymnastics, figure skating, and competitive cheerleading require a high degree of hip range of motion. Athletes who participate in these sports use their hips in a mechanically complex manner. Evidence Acquisition: A search of the entire PubMed database (through December 2013) and additional searches of the reference lists of pertinent articles. Study Design: Systematic review. Level of Evidence: Level 3. Results: Whether innate or acquired, dancers and gymnasts have some hypermobility that allows their hips to be placed in potentially impinging or unstable positions required for their given activity. Such extremes of motion can result in both intra-articular and extra-articular impingement as well as compensatory osseous and muscular pathology. In addition, dancers and gymnasts are susceptible to impingement-induced instability. Dancers with innate generalized hyperlaxity are at increased risk of injury because of their activities and may require longer recovery times to return to play. Both nonoperative and operative treatments (arthroscopic and open) have an important role in returning flexibility athletes to their preoperative levels of sport and dance. Conclusion: Because of the extreme hip motion required and the compensatory soft tissue laxity in dancers and gymnasts, these athletes may develop instability, impingement, or combinations of both. This frequently occurs in the setting of subtle pathoanatomy or in patients with normal bony anatomy. With appropriate surgical indications and the correct operative technique, the treating surgeon can anticipate high levels of return to play for the gymnast and dancer with hip pain. PMID:26137181
... distinction, according to James Robinson, a professor of health economics at the University of California, Berkeley. That's because ... James Robinson, Ph.D., M.P.H., professor, health economics, and director, Berkeley Center for Health Technology, and ...
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