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Sample records for primary cementless total

  1. Intraoperative Proximal Femoral Fracture in Primary Cementless Total Hip Arthroplasty.

    PubMed

    Ponzio, Danielle Y; Shahi, Alisina; Park, Andrew G; Purtill, James J

    2015-08-01

    Intraoperative proximal femoral fracture is a complication of primary cementless total hip arthroplasty (THA) at rates of 2.95-27.8%. A retrospective review of 2423 consecutive primary cementless THA cases identified 102 hips (96 patients) with fracture. Multivariate analysis compared fracture incidences between implants, Accolade (Stryker Orthopaedics) and Tri-Lock (DePuy Orthopaedics, Inc.), and evaluated potential risk factors using a randomized control group of 1150 cases without fracture. The fracture incidence was 4.4% (102/2423), 3.7% (36/1019) using Accolade and 4.9% using Tri-Lock (66/1404) (P=0.18). Female gender (OR=1.96; 95% CI 1.19-3.23; P=0.008) and smaller stem size (OR=1.64; 95% CI 1.04-2.63; P=0.03) predicted increased odds of fracture. No revisions of the femoral component were required in the fracture cohort.

  2. Bilaterally Primary Cementless Total Hip Arthroplasty for Severe Hip Ankylosis with Ankylosing Spondylitis.

    PubMed

    Feng, Dong-Xu; Zhang, Kun; Zhang, Yu-Min; Nian, Yue-Wen; Zhang, Jun; Kang, Xiao-Min; Wu, Shu-Fang; Zhu, Yang-Jun

    2016-08-01

    Total hip arthroplasty is a reliable therapeutic intervention in patients with ankylosing spondylitis, in whom the aims of surgery are to reduce pain, restore hip function and improve quality of life. The current study is a retrospective analysis of the clinical and radiographic findings in a consecutive series of patients with hip ankylosis associated with severe ankylosing spondylitis who underwent bilateral primary total hip arthroplasty using non-cemented components. From June 2008 to May 2012, total hip arthroplasty was performed on 34 hips in 17 patients with bilateral ankylosis caused by ankylosing spondylitis. The study patients included 13 men and 4 women with a mean age of 24.2 years. The mean duration of disease was 8.3 years and the average duration of hip involvement was 7.6 years. All patients had severe hip pain and dysfunction with bilateral bony ankylosis and no range of motion preoperatively and all underwent bilateral cementless total hip arthroplasty performed by a single surgeon. Joint pain, range of motion (ROM), and Harris hip scores were assessed to evaluate the postoperative results. At a mean follow-up of 31.7 months, all patients had experienced significant clinical improvement in function, ROM, posture and ambulation. At the final follow-up, the mean postoperative flexion ROM was 134.4° compared with 0° preoperatively. Similar improvements were seen in hip abduction, adduction, internal rotation and external rotation. Postoperatively, 23 hips were completely pain-free, six had only occasional discomfort, three mild to moderate pain and two severe pain. The average Harris Hip Score improved from 23.7 preoperatively to 65.8 postoperatively. No stems had loosened at the final follow-up in any patient, nor had any revision surgery been required. Bilateral severe hip ankylosis in patients with ankylosing spondylitis can be treated with cementless bilateral synchronous total hip arthroplasty, which can greatly improve hip joint function and

  3. [Cementless total hip arthroplasty: a review].

    PubMed

    Diehl, Peter; Haenle, Maximilian; Bergschmidt, Philipp; Gollwitzer, Hans; Schauwecker, Johannes; Bader, Rainer; Mittelmeier, Wolfram

    2010-10-01

    The purpose of total hip replacement (THR) is the restoration of a painless functioning hip joint with the main focus on the biomechanical properties. Advances in surgical techniques and biomaterial properties currently allow predictable surgical results in most patients. Despite the overwhelming success of this surgical procedure, the debate continues surrounding the optimal choice of implants and fixation. Femoral and acetabular implants with varying geometries and fixation methods are currently available. Problems inherent with acrylic bone cement, however, have encouraged surgeons to use alternative surfaces to allow biologic fixation. Optimal primary and secondary fixation of cementless hip stems is a precondition for long-term stability. Important criteria to achieve primary stability are good rotational and axial stability by press-fit fixation. The objective of the cementless secondary fixation is the biological integration of the implant by bony ingrowth. Nevertheless, current investigations show excellent results of cementless fixation even in older patients with reduced osseous quality. The main advantages of cementless fixation include biological integration, reduced duration of surgery, no tissue damage by cement polymerization and reduction of intraoperative embolisms. In comparison to cemented THR both, cementless sockets and stems provide good long-term results.

  4. Cementless total knee arthroplasty

    PubMed Central

    Risitano, Salvatore; Sabatini, Luigi; Giachino, Matteo; Agati, Gabriele; Massè, Alessandro

    2016-01-01

    Interest for uncemented total knee arthroplasty (TKA) has greatly increased in recent years. This technique, less used than cemented knee replacement in the last decades, sees a revival thanks an advance in prosthetic design, instrumentation and operative technique. The related literature in some cases shows conflicting data on survival and on the revision’s rate, but in most cases a success rate comparable to cemented TKA is reported. The optimal fixation in TKA is a subject of debate with the majority of surgeons favouring cemented fixation. PMID:27162779

  5. [Second-generation metal bearings in cementless primary total hip arthroplasty: rationale, French homologation and preliminary results].

    PubMed

    Delaunay, C

    2000-12-01

    Long-term outcome of Charnley low-friction arthroplasty in young active patients is impaired worldwide due to wear of the polyethylene (PE) component and osteolysis. In the late eighties, reports of possible low wear with some former metal on metal total hip arthroplasties led to the reintroduction of metallic bearings. The aims of this work were to examine the rationale for using metal on metal bearings in primary total hip arthroplasty (THA) and report preliminary results obtained with cementless Metasul -Alloclassic hips. From January 1994 to March 1997, 64 cementless primary Alloclassic-THA (grit-blasted titanium SL stems and CSF treaded cups) with 28 mm Metasul bearings were performed. Mean age at surgery was 60 years (range, 36-73). Diagnoses were usual, mainly primary osteoarthrosis in 70 p. 100 of the hips. Two bearing surfaces were exchanged for late dislocation at 2.6 and 2.9 years. Thus, 62 hips in 58 active patients (4 bilateral) were reviewed after a minimum 2-year follow-up (mean 3.2 years, range 24-66 months). Clinical results according to the Merle d'Aubigne and Charnley rating system were graded excellent or good in all 62 hips. Radiologically, calcar, atrophy and spot welds were noted in 93 p. 100 and 82 p. 100 of hips respectively. Proximal reactive and lucent lines and mild proximal stress shielding were observed in 8 p. 100 and 4.8 p. 100 of hips respectively. No osteolysis granuloma has thus far been observed in the vicinity of any component. Cobalt blood level remained normal, except in 6 cases due to occupational exposure (n=1), possible impingement (n=1) or an unknown cause (n=4). All elevated cobalt levels (range 7 to 25 microg/l) were nevertheless far below the toxic limit. Dislocation may be due either to the posterolateral surgical approach and/or early impingement with the first Metasul bearing design (head sleeve). Metasul acetabular component fixation is not restricted to only cementless metal-backing, unlike alumina-ceramic cups

  6. Comparison of cementless and hybrid cemented total knee arthroplasty.

    PubMed

    Lass, Richard; Kubista, Bernd; Holinka, Johannes; Pfeiffer, Martin; Schuller, Spiro; Stenicka, Sandra; Windhager, Reinhard; Giurea, Alexander

    2013-04-01

    Cementless total knee arthroplasty (TKA) implants were designed to provide long-term fixation without the risk of cement-associated complications. The purpose of this study was to evaluate the outcome of titanium-coated cementless implants compared with hybrid TKA implants with a cemented tibial and a cementless femoral component. The authors performed a case-control, single-center study of 120 TKAs performed between 2003 and 2007, including 60 cementless and 60 hybrid cemented TKAs. The authors prospectively analyzed the radiographic and clinical data and the survivorship of the implants at a minimum follow-up of 5 years. Ninety patients who underwent TKA completed the 5-year assessment. Knee Society Scores increased significantly in both groups (P<.001). In both groups, 2 patients underwent revision due to aseptic tibial component loosening, resulting in a 96% implant survival rate. Radiographs showed significantly less radiolucent lines around the tibial baseplate in the cementless group (n=12) than in the hybrid cemented group (n=26) (P=.009).At 6-year mean follow-up, no significant difference existed between the cementless and hybrid cemented tibial components in TKA in terms of clinical and functional results and postoperative complications. The significantly smaller number of radiolucent lines in the cementless group is an indicator of primary stability with the benefit of long-term fixation durability of TKA.

  7. Two-Stage Cementless Revision Total Hip Arthroplasty for Infected Primary Hip Arthroplasties.

    PubMed

    Camurcu, Yalkin; Sofu, Hakan; Buyuk, Abdul Fettah; Gursu, Sarper; Kaygusuz, Mehmet Akif; Sahin, Vedat

    2015-09-01

    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. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Intraoperative Femur Fracture Risk During Primary Direct Anterior Approach Cementless Total Hip Arthroplasty With and Without a Fracture Table.

    PubMed

    Cohen, Eric M; Vaughn, Joshua J; Ritterman, Scott A; Eisenson, Daniel L; Rubin, Lee E

    2017-09-01

    There is no study to date comparing intraoperative femur fractures (IFFs) in the direct anterior approach (DAA) with and without a fracture table. We hypothesize that there is no significant difference in the IFF with and without a fracture table when performed by experienced DAA hip surgeons. This study is a 1-year retrospective review of patients who underwent DAA total hip arthroplasty by 2 surgeons: one surgeon uses a flat table and manually elevates the femur with a large bone hook, while the other surgeon uses a fracture table and a mechanical femoral elevator. Exclusion criteria included cemented femoral implants, femoral neck fractures, and lack of 6-month follow-up. We identified 487 patients for analysis (220 male and 267 female, average age 66.55 years). There were 12 total IFFs (2.46%): 8 female and 4 male patients. The average age of IFF patients was 70.67 years and in nonfracture patients was 66.00 years. There was no difference in gender (P = .2981) or age (P = .2099) between IFF and nonfracture patients. In the fracture table group, there were 6 IFFs (2.22%) in 271 patients; in the nonfracture table group, there were 6 IFFs (2.76%) in 216 patients. There was no statistical difference in IFF between the 2 groups (P = .6973). We observed just 2 patients (0.4%) in this series where the IFFs changed management requiring a revision femoral stem. There was no statistical difference in IFF with or without the use of fracture table. Both DAA surgical technique variations are felt to be equivalent regarding the risk for IFF during DAA cementless total hip arthroplasty. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. The influence of contact ratio and its location on the primary stability of cementless total hip arthroplasty: A finite element analysis.

    PubMed

    Reimeringer, M; Nuño, N

    2016-05-03

    Cementless hip stems are fixed to the surrounding bone by means of press-fit. To ensure a good press-fit, current surgical technique specifies an under-reaming of the bone cavity using successively larger broaches. Nevertheless, this surgical technique is inaccurate. Several studies show that the contact ratio (percentage of stem interface in contact with bone) achieved after surgery can vary between 20% and 95%. Therefore, this study aimed to investigate the influence of the contact ratio and its location on the primary stability of a cementless total hip arthroplasty using finite element analysis. A straight tapered femoral stem implanted in a composite bone was subjected to stair climbing. Micromotion of 7600 nodes at the stem-bone interface was computed for different configurations of contact ratios between 2% and 98%) along the hip stem. Considering the 15 configurations evaluated, the average micromotion ranges between 27μm and 54μm. The percentage of the porous interface of the stem having micromotion below 40μm that allows bone ingrowth range between 25-57%. The present numerical study shows that full contact (100%) between stem and bone is not necessary to obtain a good primary stability. The stem primary stability is influenced by both the contact ratio and its location. Several configurations with contact ratio lower than 100% and involving either the proximal or the cortical contact provide better primary stability than the full contact configuration. However, with contact ratio lower than 40%, the stem should be in contact with cortical bone to ensure a good primary stability.

  10. Primary cementless total hip arthroplasty with an alumina ceramic-on-ceramic bearing: results after a minimum of twenty years of follow-up.

    PubMed

    Petsatodis, George E; Papadopoulos, Pericles P; Papavasiliou, Kyriakos A; Hatzokos, Ippokratis G; Agathangelidis, Filon G; Christodoulou, Anastasios G

    2010-03-01

    The biological problems related to wear debris after total hip arthroplasty have stimulated renewed interest in alternatives to metal-on-polyethylene bearing surfaces. We retrospectively evaluated the clinical and radiographic results of 100 patients who had undergone a total of 109 primary total hip arthroplasties with a cementless alumina ceramic-on-ceramic prosthesis between January 1985 and December 1989. The mean age of the patients at the time of the index arthroplasty was forty-six years. Clinical evaluation was performed with use of the Charnley modification of the Merle d'Aubigné-Postel scale. Seventy-eight patients who had had a total of eighty-five arthroplasties were available for follow-up evaluation at an average of 20.8 years. The patients' average age at the time of the latest follow-up was 66.8 years. Six hips (six acetabular cups and one femoral stem) in six patients underwent revision. Aseptic loosening of the cup combined with focal osteolysis was the cause of all six revisions. In one patient, the stem was also revised because of aseptic loosening. At the time of final follow-up, the result was excellent (according to the Merle d'Aubigné-Postel scale) in 68% of the hips, good in 19%, fair in 9%, and poor in 4%. The mean Merle d'Aubigné-Postel score improved from 7.9 points preoperatively to 16.9 points postoperatively (p < 0.001). The cumulative rate of survival of the prostheses was 84.4% at 20.8 years. The results of these cementless ceramic-on-ceramic total hip arthroplasties continued to be satisfactory at a minimum of twenty years postoperatively. The improved design of contemporary prostheses and the new generation of ceramic-on-ceramic bearing surfaces may lead to even better long-term results.

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

    PubMed

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

    2009-03-01

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

  12. [Revision total hip arthroplasty using a cementless prosthesis].

    PubMed

    Jiang, Qing; Xu, Zhi-hong; Chen, Dong-yang; Shi, Dong-quan; Qin, Jiang-hui; Dai, Jin; Weng, Wen-jie; Yuan, Tao

    2012-05-01

    To assess the operative technique and results with the usage of cementless prosthesis in hip revision. Retrospective study was done on revision of total hip arthroplasty with cementless prosthesis in 72 patients (41 males and 31 females) with an average age of 65.7 years (28-82 years) from January 2004 to December 2009. The reason for revision was 2 infection, 54 aseptic loosening, 4 periprosthetic fractures, 5 fracture of femoral stems and 7 cases of acetabular abrasion after hemi-arthroplasty. The operation time, bleeding loss, complications of infection, dislocation, periprosthetic fractures and loosening were evaluated. The Harris score were used for hip function evaluation. The average operation time was (146±47) minutes (70-280 minutes) and bleeding loss during the operation was (970±540) ml (200-2500 ml). Bacterium cultivation during operation demonstrated infection in 2 patients. Bone windows at the lateral femoral were opened in 4 patients and extend trochanteric osteotomy was done in 7 patients. Fracture of the proximal femur occurred in 8 cases. Twenty-nine patients were treated with bone graft including 18 autografts and 11 allografts. Sixty-seven patients were followed up for an average time of 66 months (20-92 months). Additional revisions were performed in 3 cases including 2 dislocations and 1 infection. There were no death, no damage of major blood vessels and nerves. The bone graft healed during 3-5 months. The survival rates of the femoral prosthesis and the acetabulum prostheses were 95.5% and 98.4%. The mean Harris score was 86±8 (55-95 points). Osteolysis were seen in 13 hips but migration was seen in only 1 patient. The cementless prosthesis is useful in revision total hip arthroplasty and the perfect clinical results are related to the reliable primary fixation.

  13. Cementless revisions of failed aseptic cemented and cementless total hip arthroplasties. 284 cases.

    PubMed

    Lord, G; Marotte, J H; Guillamon, J L; Blanchard, J P

    1988-10-01

    Over the past 13 years, 284 revisions of aseptic total hip arthroplasty failures have been performed with cementless implants. There were 213 cases involving cemented implant failures and 71 involving cementless ones. Considered as salvage procedures, these revisions provided a satisfactory result in about 70% of the reviewed patients after five years. A biologic fixation by bony ingrowth can be expected under certain conditions from decorticated living bone, a tight mechanical fitting, and a retentive corrugated surface of the implant. A prosthetic reimplantation, safely done without cement, appears more economical for the bone stock and prevents the long-term complications related with cement. Bone grafts are often required but cannot ensure the incoming osteogenic fixation of the implant. Long-term results and complications mandate harmless extractability of the revisional implant, a forged stem, an easy exchange of the plastic liner (in a two-part acetabular component), and an updated low-friction system (high-density polyethylene wear being a potential long-term problem).

  14. Cementless revision for infection following total hip arthroplasty.

    PubMed

    Mitchell, Philip A; Masri, Bassam A; Garbuz, Donald S; Greidanus, Nelson V; Duncan, Clive P

    2003-01-01

    Eradication of chronic infection complicating total hip arthroplasty requires removal of all infected, devitalized and foreign tissue, including the arthroplasty components. Reimplantation into a sterile bed is the goal of treatment in most patients and successful reimplantation yields better functional results than excision arthroplasty. Reimplantation may be performed at the same stage as débridement as part of a single-stage procedure, using cemented components with antibiotic-loaded cement. Alternatively, a two-stage procedure may be performed so that the débridement and reimplantation are separated by a period of antibiotic delivery, both locally and systemically. The results of these treatment regimens and the rationale for cementless reconstruction at the second stage of a two-stage treatment protocol are important considerations in the treatment of periprosthetic infection.

  15. Second-generation cementless total hip arthroplasty. Eight to eleven-year results.

    PubMed

    Archibeck, M J; Berger, R A; Jacobs, J J; Quigley, L R; Gitelis, S; Rosenberg, A G; Galante, J O

    2001-11-01

    Second-generation cementless femoral components were designed to provide more reliable ingrowth and to limit distal osteolysis by incorporating circumferential proximal ingrowth surfaces. We examined the eight to eleven-year results of total hip arthroplasty with a cementless, anatomically designed femoral component and a cementless hemispheric acetabular component. Ninety-two consecutive primary total hip arthroplasties with implantation of a femoral component with a circumferential proximal porous coating (Anatomic Hip) and a cementless hemispheric porous-coated acetabular component (Harris-Galante II) were performed in eighty-five patients. These patients were prospectively followed clinically and radiographically. Six patients (seven hips) died and five patients (seven hips) were lost to follow-up, leaving seventy-four patients (seventy-eight hips) who had been followed for a mean of ten years (range, eight to eleven years). The mean age at the time of the arthroplasty was fifty-two years. The mean preoperative Harris hip score of 51 points improved to 94 points at the time of final follow-up; 86% of the hips had a good or excellent result. Thigh pain was reported as mild to severe after seven hip arthroplasties. No femoral component was revised for any reason, and none were loose radiographically at the time of the last follow-up. Two hips underwent acetabular revision (one because of dislocation and one because of loosening). Kaplan-Meier survivorship analysis was performed with revision or loosening of any component as the end point. The ten-year survival rate was 96.4% +/- 2.1% for the total hip prosthesis, 100% for the femoral component, and 96.4% +/- 2.1% for the acetabular component. Radiolucencies adjacent to the nonporous portion of the femoral component were seen in sixty-eight (93%) of the -seventy-three hips with complete radiographic follow-up. Femoral osteolysis proximal to the lesser trochanter was noted in four hips (5%). No osteolysis was

  16. Migration pattern of cementless press fit cups in the presence of stabilizing screws in total hip arthroplasty

    PubMed Central

    2011-01-01

    The aim of this study was to evaluate the initial acetabular implant stability and late acetabular implant migration in press fit cups combined with screw fixation of the acetabular component in order to answer the question whether screws are necessary for the fixation of the acetabular component in cementless primary total hip arthroplasty. One hundred and seven hips were available for follow-up after primary THA using a cementless, porous-coated acetabular component. A total of 631 standardized radiographs were analyzed digitally by the "single-film-x-ray-analysis" method (EBRA). One hundred 'and one (94.4%) acetabular components did not show significant migration of more than 1 mm. Six (5.6%) implants showed migration of more than 1 mm. Statistical analysis did not reveal preoperative patterns that would identify predictors for future migration. Our findings suggest that the use of screw fixation for cementless porous- coated acetabular components for primary THA does not prevent cup migration. PMID:21486725

  17. Total Knee Arthroplasty Using Cementless Porous Tantalum Monoblock Tibial Component: A Minimum 10-Year Follow-Up.

    PubMed

    De Martino, Ivan; D'Apolito, Rocco; Sculco, Peter K; Poultsides, Lazaros A; Gasparini, Giorgio

    2016-10-01

    Cementless fixation in total knee arthroplasty (TKA) was introduced to improve the longevity of implants but has yet to be widely adopted because of reports of higher failure rates in some series. The cementless tantalum monoblock tibial component, in contrast, has shown successful short-term results, but long-term survivorship with this design is still lacking. The purpose of this study was to investigate the minimum 10-year clinical and radiographic results of the cementless tantalum monoblock tibial component in primary TKA. From March 2002 to March 2005, 33 patients (33 knees) underwent primary TKA with a cementless tantalum monoblock tibial component. All patients were followed clinically and radiographically for a minimum of 10 years (mean 11.5 years, range 10-13 years). No patients were lost to follow-up. The underlying diagnosis that led to the primary TKA was primary osteoarthritis in 31 knees and post-traumatic osteoarthritis in 2 knees. None of the components was revised. At a minimum 10-year follow-up, the survivorship with reoperation for any reason as end point was 96.9%. With tibial component revision for aseptic loosening or osteolysis as the end point survivorship was 100%. There was no radiographic evidence of tibial component loosening, subsidence, osteolysis, or migration at the time of the latest follow-up. The mean Knee Society knee scores improved from 56 points preoperatively to 93 points at the last clinical visit. The porous tantalum tibial monoblock component demonstrated excellent clinical and radiographic outcomes with no component revisions for aseptic loosening at a minimum follow-up of 10 years. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Cementless total hip arthroplasty in patients with ankylosing spondylitis

    PubMed Central

    Xu, Jun; Zeng, Min; Xie, Jie; Wen, Ting; Hu, Yihe

    2017-01-01

    Abstract Controversies on the surgical protocols and efficacies of total hip arthroplasty (THA) in ankylosing spondylitis (AS) still exist. The aim of this study was to retrospectively analyze the perioperative managements and their outcomes related to performing THA on patients with AS. Data of 54 AS patients who underwent 81 THAs between 2008 and 2014 were retrospectively analyzed. Clinical and imaging data were collected preoperatively, postoperatively, and during the follow-up period for surgical efficacy. Using posterolateral approach, cementless prostheses were selected in all cases. Mean follow-up period was 3.6 years (range, 2–8 years). Inclinations and anteversions of acetabular cups were 36.3°±4.5° (range, 30°–50°) and 12.3°±4.9° (range, 0°–25°) respectively. Mean visual analog scale (VAS) score decreased from 6.7 ± 2.1 (range, 4–10) preoperatively to 1.5 ± 1.0 (range, 0–4) at final follow-up, and mean Harris hip score (HHS) improved from 31.2 ± 11.6 (range, 15–45) to 86.1 ± 4.3 (range, 80–95) (P < 0.05). Postoperative range of motion (ROM) in flexion was improved from 6.7°±13.5° (range, 0°–50°) preoperatively to 82.5°±6.4° (range, 70°–100°) at final follow-up, and ROM in extension was improved from 1.8°±5.7°(range, 0°–15°) to 15.4°±2.6° (range, 10°–20°) (P < 0.05). Heterotopic ossification (HO) was documented in 9 hips (11.1%). Signs of stable fibrous ingrowth and bone ingrowth were detected in 52 and 29 hips, respectively. Sciatic never injury was occurred in 3 cases, and treated conservatively. There were no signs of periprosthetic fractures, dislocation, or prosthesis loosening. Surgical efficacies of THA for AS patients with severe hip involvement are satisfactory. PMID:28121928

  19. A second-generation cementless total hip arthroplasty mean 9-year results.

    PubMed

    Surdam, Jonathan W; Archibeck, Michael J; Schultz, Steven C; Junick, Daniel W; White, Richard E

    2007-02-01

    Two hundred fifty-eight primary total hip arthroplasties in 231 patients were implanted using a circumferentially, proximally porous-coated, collared femoral component and a cementless, hemispherical, porous-coated acetabular component and followed up for a mean of 9 years (5-14 years). Four femoral components were revised (2 stems for infection and 2 stems for aseptic loosening). One additional femoral component was radiographically loose at last follow-up. Nine hips underwent acetabular revision (4 for instability, 2 for infection, 2 for loosening, and 1 for osteolysis). Ten-year survivorship with revision or loosening of any component as the end point was 92%; with femoral component aseptic loosening as end point, survivorship was 98%; with acetabular aseptic loosening as the end point, survivorship was 99%. Osteolysis was identified in 26 hips (13%).

  20. Robot-assisted primary cementless total hip arthroplasty with a short femoral stem: a prospective randomized short-term outcome study.

    PubMed

    Lim, Seung-Jae; Ko, Kyung-Rae; Park, Chan-Woo; Moon, Young-Wan; Park, Youn-Soo

    2015-01-01

    Recently, two topical issues in total hip arthroplasty (THA) have been robot-assisted surgery and use of a short stem. The purpose of this study was to evaluate the effects of robotic milling on the accuracy of short femoral stem positioning and on the short-term clinical outcome in THA using a prospective, randomized design. We randomized 54 patients into two groups, either robotic milling group or manual rasping group. The patients were assessed clinically and radiographically at 8 weeks, 5 months, 12 months, and 24 months. Robotic milling group had a significantly longer operation time, requiring on average 8.9 min for registration and 11.2 min for milling. On the other hand, robotic milling group showed superior results in terms of stem alignment and leg length equality. Two intraoperative femoral fractures occurred only in manual rasping group. Harris hip scores and WOMAC scores at 24 months postoperatively were similar in both groups. No complications including stem loosening, infection, nerve palsy, or dislocation were encountered in either group during the follow-up period. The present study suggested that robot-assisted short stem THA could increase the accuracy of stem alignment, improve leg length equality, and help reduce the risk of intraoperative femoral fracture as compared with manual rasping. However, the clinical outcome scores did not differ between the two groups at the time of short-term follow-up. Long-term follow-up is needed to determine whether there will be a long-term clinical relevance of robot-assisted implantation of short femoral stems in THA.

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

    PubMed

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

    2010-01-01

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

  2. A multicenter approach evaluating the impact of vitamin e-blended polyethylene in cementless total hip replacement.

    PubMed

    Jäger, Marcus; van Wasen, Andrea; Warwas, Sebastian; Landgraeber, Stefan; Haversath, Marcel; Group, Vitas

    2014-04-22

    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

  3. A Multicenter Approach Evaluating the Impact of Vitamin E-Blended Polyethylene in Cementless Total Hip Replacement

    PubMed Central

    Jäger, Marcus; van Wasen, Andrea; Warwas, Sebastian; Landgraeber, Stefan; Haversath, Marcel; Group, VITAS

    2014-01-01

    Since polyethylene is one of the most frequently used biomaterials as a liner in total hip arthroplasty, strong efforts have been made to improve design and material properties over the last 50 years. Antioxidants seems to be a promising alternative to further increase durability and reduce polyethylene wear in long term. As of yet, only in vitro results are available. While they are promising, there is yet no clinical evidence that the new material shows these advantages in vivo. To answer the question if vitamin-E enhanced ultra-high molecular weight polyethylene (UHMWPE) is able to improve long-term survivorship of cementless total hip arthroplasty we initiated a randomized long-term multicenter trial. Designed as a superiority study, the oxidation index assessed in retrieval analyses of explanted liners was chosen as primary parameter. Radiographic results (wear rate, osteolysis, radiolucency) and functional outcome (Harris Hip Scores, University of California-Los Angeles, Hip Disability and Osteoarthritis Outcome Score, Visual Analogue Scale) will serve as secondary parameters. Patients with the indication for a cementless total hip arthroplasty will be asked to participate in the study and will be randomized to either receive a standard hip replacement with a highly cross-linked UHMWPE-X liner or a highly cross-linked vitamin-E supplemented UHMWPE-XE liner. The follow-up will be 15 years, with evaluation after 5, 10 and 15 years. The controlled randomized study has been designed to determine if Vitamin-E supplemented highly cross-linked polyethylene liners are superior to standard XLPE liners in cementless total hip arthroplasty. While several studies have been started to evaluate the influence of vitamin-E, most of them evaluate wear rates and functional results. The approach used for this multicenter study, to analyze the oxidation status of retrieved implants, should make it possible to directly evaluate the ageing process and development of the implant

  4. Cementless two-stage exchange arthroplasty for infection after total hip arthroplasty.

    PubMed

    Masri, Bassam A; Panagiotopoulos, Kostas P; Greidanus, Nelson V; Garbuz, Donald S; Duncan, Clive P

    2007-01-01

    We retrospectively reviewed all patients at one center with an infected total hip arthroplasty treated with 2-stage revision using cementless components for the second stage and the PROSTALAC articulated spacer at the first stage. Twenty-nine patients were reviewed and followed for at least 2 years postoperatively. An isolated Staphylococcus species was cultured in 76% (22/29) of patients. Three (10.3%) of 29 patients had recurrent infection at the site of the prosthesis. One of the 3 patients ultimately underwent a Girdlestone arthroplasty. Another patient was managed with irrigation and debridement, whereas the final patient was treated with intravenous antibiotics alone. Treatment of infection at the site of a hip arthroplasty with 2-stage revision using cementless components and an articulated spacer yields recurrence rates similar to revisions where at least one of the components at the second stage is fixed with antibiotic-loaded cement.

  5. Bone scans after total knee arthroplasty in asymptomatic patients. Cemented versus cementless

    SciTech Connect

    Hofmann, A.A.; Wyatt, R.W.; Daniels, A.U.; Armstrong, L.; Alazraki, N.; Taylor, A. Jr. )

    1990-02-01

    The natural history of bone scans after total knee arthroplasty (TKA) was studied in 26 patients with 28 cemented TKAs and 29 patients with 31 cementless TKAs. The bone scans were examined at specified postoperative intervals. Radionuclide activity of the femoral, tibial, and patellar regions was measured. Six patients who developed pain postoperatively were excluded. Bone scans immediately postoperative and at three months demonstrated increased uptake, which gradually decreased to baseline levels at ten to 12 months. Radioisotope uptake was comparable in the cemented and cementless groups, but was highly variable in individual patients and in each of the follow-up periods. A single postoperative bone scan cannot differentiate component loosening from early bone remodeling. Sequential bone scans, as a supplement to the clinical examination and conventional radiography, may prove useful in the diagnosis of TKA failure.

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

    PubMed Central

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

    2017-01-01

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

  7. Sports and physical activity after cementless total hip arthroplasty with a minimum follow-up of 10 years.

    PubMed

    Innmann, M M; Weiss, S; Andreas, F; Merle, C; Streit, M R

    2016-05-01

    The present retrospective cohort study was conducted to compare sporting activity levels before and a minimum of 10 years after primary cementless total hip arthroplasty (THA). A consecutive series of 86 patients with a mean age at surgery of 52 years (range, 21-60 years) was evaluated 11 years after surgery (range, 10-12 years). Pre- and post-operative sporting activities were assessed at routine follow-up using the University of California, Los Angeles activity score and the Schulthess Clinic sports and activity questionnaire. Post-operative health-related quality of life was measured using the Short-Form 36 (SF-36) questionnaire and compared with age-matched reference populations from the SF-36 database. Eleven years after THA, 89% of preoperatively active patients had returned to sport. Comparing sports activity preoperatively (before the onset of symptoms) and 11 years after THA, no significant difference was found for the mean number of disciplines or session length. A significant decline in high-impact activities was observed, while participation in low-impact activities significantly increased. Health-related quality of life compared well against a healthy age-matched reference population and was significantly higher than in a reference group of patients with osteoarthritis. The majority of patients were able to maintain their physical activity level in the long term after primary cementless THA, compared with the activity level before the onset of restricting osteoarthritis symptoms. However, a change in disciplines toward low-impact activities was observed.

  8. No difference between cemented and cementless total knee arthroplasty in young patients: a review of the evidence.

    PubMed

    Franceschetti, Edoardo; Torre, Guglielmo; Palumbo, Alessio; Papalia, Rocco; Karlsson, Jón; Ayeni, Olufemi R; Samuelsson, Kristian; Franceschi, Francesco

    2017-06-01

    The present piece of work provides improved knowledge about the evidence related to TKA in patients 60 years of age or younger, with special focus on fixation methods. Main concern of the review is to analyse the difference of survival rate and complications of cemented and cementless implants. An electronic search was carried out between October and December 2015, through CINAHL, PubMed and the Cochrane Central Registry of Controlled Trials web databases. Articles in English, Italian, French and Spanish were considered for inclusion. Only peer-reviewed studies with adult patients aged 60 years or less, with diagnosis of osteoarthritis in more than 90% of the subjects, were considered for inclusion. All studies had to report outcomes after TKA with either cemented or cementless fixation technique. No significant differences in terms of clinical, functional and radiological outcomes were found between cemented and cementless implants. Good clinical and functional results were obtained in terms of the Knee Society score and Western Ontario and McMaster Universities Osteoarthritis Index for both techniques. Radiographic results showed that radiolucent lines of <2 mm in width were detected at radiographs, without difference between cemented or cementless implants. Well-conducted trials on cemented versus cementless TKA were carried out in few papers. A survival rate of over 90% was reported in the majority of the studies at a mean follow-up of 8.6 years (range 5-18 years). Similar results were observed in terms of functional outcome and survival rates for both cemented and cementless TKAs. High survival rates were reported for both operative techniques and cemented TKA did not offer additional benefit. Assuming that cementless prosthesis allows a stable fixation and reduces the time of operation, the authors recommend the cementless fixation as a primary choice in the investigated patient population. However, evidence is low, and further research is needed. IV.

  9. Cementless Total Hip Arthroplasty Involving Trochanteric Osteotomy without Subtrochanteric Shortening for High Hip Dislocation

    PubMed Central

    Lee, Soong Joon; Kim, Hee Joong

    2017-01-01

    Background Total hip arthroplasty with subtrochanteric shortening osteotomy is widely performed for high hip dislocation. However, suboptimal leg length discrepancy correction and nonunion of the osteotomy site remain concerns. Although total hip arthroplasty using trochanteric osteotomy without subtrochanteric osteotomy was introduced, cemented implants have been more commonly used than contemporary cementless implants in this procedure. We evaluated the long-term results of cementless total hip arthroplasty with trochanteric osteotomy without subtrochanteric osteotomy for high hip dislocation. Methods From 1990 to 2002, 27 cementless total hip arthroplasties using trochanteric osteotomy without subtrochanteric osteotomy were performed in 26 patients with Crowe III or IV high hip dislocation and a mean age of 36.4 ± 12.9 years. Seven ceramic-on-ceramic, 8 ceramic-on-polyethylene, 10 metal-on-polyethylene, and 2 metal-on-metal bearings were inserted. Mean follow-up was 15.1 ± 3.7 years. We retrospectively reviewed medical records and radiographic data and evaluated the clinical and radiological results including the Harris hip score, implant survival, correction of leg length discrepancy, and occurrence of complications. Results The mean Harris hip score and leg length discrepancy improved significantly from 73.3 to 94.9 points and from 4.3 cm to 1.0 cm, respectively. With revision for loosening set as the end point, implant survival rates at 10 and 15 years postoperatively were 96.0% and 90.9% for stems and 74.1% and 52.3% for cups. In 8 of 10 hips with the metal-on-polyethylene bearing and 4 of 8 hips with the ceramic-on-polyethylene bearing, revision surgery was performed for aseptic loosening. However, no revision was performed in hips with the ceramic-on-ceramic bearing or the metal-on-metal bearing. Implant survival was significantly different by the type of bearing surface. Two permanent neurologic complications occurred in patients with a limb lengthening

  10. Navigated Cementless Total Knee Arthroplasty - Medium-Term Clinical and Radiological Results§

    PubMed Central

    Schüttrumpf, Jan P; Balcarek, Peter; Sehmisch, Stephan; Frosch, Stephan; Wachowski, Martin M; Stürmer, Klaus M; Walde, Hans-Joachim; Walde, Tim A

    2012-01-01

    Purpose: The objective of this prospective study was to evaluate the medium-term clinical and radiological results after navigated cementless implantation, without patella resurfacing, of a total knee endoprosthesis with tibial and femoral press-fit components, with a focus on survival rate and clinical outcome. The innovation is the non-cemented fixation together with the use of a navigation system. Scope and Methods: Sixty patients with gonarthrosis were included consecutively in this study. In all cases, the cementless Columbus total knee endoprosthesis with a coating out of pure titanium was implanted, using a navigation system. The Knee Society Score showed a statistically significant increase from 75 (± 21.26) before surgery to 180 (± 16.15) after a mean follow-up of 5.6 (± 0.25) years. The last radiological examination revealed no osteolysis. No radiolucent lines were seen at any time in the area of the femoral prosthetic components. In the tibial area, radiolucent lines were seen in 24.4 % of the cases, mostly in the distal uncoated part of the stem. During follow-up, no prosthesis had to be replaced because of aseptic loosening while in 2 cases revision surgery was necessary due to septic loosening and in 1 case due to unexplainable pain. Results and Conclusions: Navigated cementless implantation of the Columbus total knee endoprosthesis yielded good clinical and radiological results in the medium term. The excellent radiological osteointegration of the prosthetic components, coated with a microporous pure titanium layer and implanted with a press-fit technique, should be emphasized. PMID:22550552

  11. Celecoxib does not affect osteointegration of cementless total hip stems.

    PubMed

    Lionberger, David R; Noble, Philip C

    2005-10-01

    Celecoxib's effect on prosthetic osteointegration in patients undergoing total hip arthroplasty was studied. In a prospective, placebo-controlled, double-blind study of 49 patients, 24 were randomized to celecoxib (200 mg/d) and 25 to placebo over 6 weeks. Bone markers, N-teleopeptide, and bone-specific alkaline phosphatase were obtained postoperatively, and at 6 and 12 weeks. No radiographic prosthetic subsidence occurred. There were no significant differences from baseline in periprosthetic bone mineral density between the celecoxib and placebo groups at 3 and 6 months. There were no significant differences in baseline BSAlkP values between the 2 groups. At 6 and 12 weeks, average BSAlkP values increased. Urinary NTx concentrations followed a skewed distribution. Normalized NTx concentrations were statistically significantly greater in the celecoxib group than the placebo group at 6 weeks but not at 12 weeks.

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

    PubMed

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

    2012-01-01

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

  13. Total hip arthroplasty using a cylindrical cementless stem in patients with a small physique.

    PubMed

    Nakamura, Yoshihide; Mitsui, Hiromasa; Kikuchi, Akira; Toh, Satoshi; Katano, Hiroshi

    2011-01-01

    We performed total hip arthroplasty using an anatomic medullary locking cementless stem for small-physique patients from 1988 to 1995. We conducted a retrospective study of 50 joints in 44 cases, including 40 developmentally dysplastic hips followed for 12 to 20 years (average, 15.1 years). Average height and body weight were 152 cm and 56 kg (5.0 ft and 124 lb), respectively, with an average body mass index of 24.2. Twelve joints (24%) were revised for acetabular-sided failures. Forty-eight stems (96%) showed bone ingrowth fixation, and there were no unstable stems. The simple cylindrical shape of the distal portion of the AML stem was less affected by deformity of the proximal femur of developmental dysplasia of the hip in patients with a small physique, and both clinically and radiologically good results were confirmed at long-term follow-up.

  14. Increased risk of revision of cementless stemmed total hip arthroplasty with metal-on-metal bearings

    PubMed Central

    Pedersen, Alma B; Mäkelä, Keijo; Eskelinen, Antti; Havelin, Leif Ivar; Furnes, Ove; Kärrholm, Johan; Garellick, Göran; Overgaard, Søren

    2015-01-01

    Background and purpose Data from the national joint registries in Australia and England and Wales have revealed inferior medium-term survivorship for metal-on-metal (MoM) total hip arthroplasty (THA) than for metal-on-polyethylene (MoP) THA. Based on data from the Nordic Arthroplasty Register Association (NARA), we compared the revision risk of cementless stemmed THA with MoM and MoP bearings and we also compared MoM THA to each other. Patients and methods We identified 32,678 patients who were operated from 2002 through 2010 with cementless stemmed THA with either MoM bearings (11,567 patients, 35%) or MoP bearings (21,111 patients, 65%). The patients were followed until revision, death, emigration, or the end of the study period (December 31, 2011), and median follow-up was 3.6 (interquartile range (IQR): 2.4–4.8) years for MoM bearings and 3.4 (IQR: 2.0–5.8) years for MoP bearings. Multivariable regression in the presence of competing risk of death was used to assess the relative risk (RR) of revision for any reason (with 95% confidence interval (CI)). Results The cumulative incidence of revision at 8 years of follow-up was 7.0% (CI: 6.0–8.1) for MoM bearings and 5.1% (CI: 4.7–5.6) for MoP bearings. At 6 years of follow-up, the RR of revision for any reason was 1.5 (CI: 1.3–1.7) for MoM bearings compared to MoP bearings. The RR of revision for any reason was higher for the ASR (adjusted RR = 6.4, CI: 5.0–8.1), the Conserve Plus (adjusted RR = 1.7, CI: 1.1–2.5) and “other” acetabular components (adjusted RR = 2.4, CI: 1.5–3.9) than for MoP THA at 6 years of follow-up. Interpretation At medium-term follow-up, the survivorship for cementless stemmed MoM THA was inferior to that for MoP THA, and metal-related problems may cause higher revision rates for MoM bearings with longer follow-up. PMID:25715878

  15. Low BMD affects initial stability and delays stem osseointegration in cementless total hip arthroplasty in women

    PubMed Central

    2012-01-01

    Background and purpose Immediate implant stability is a key factor for success in cementless total hip arthroplasty (THA). Low bone mineral density (BMD) and age-related geometric changes of the proximal femur may jeopardize initial stability and osseointegration. We compared migration of hydroxyapatite-coated femoral stems in women with or without low systemic BMD. Patients and methods 61 female patients with hip osteoarthritis were treated with cementless THA with anatomically designed hydroxyapatite-coated femoral stems and ceramic-ceramic bearing surfaces (ABG-II). Of the 39 eligible patients between the ages of 41 and 78 years, 12 had normal systemic BMD and 27 had osteopenia or osteoporosis. According to the Dorr classification, 21 had type A bone and 18 had type B. Translational and rotational migration of the stems was evaluated with radiostereometric analysis (RSA) up to 2 years after surgery. Results Patients with low systemic BMD showed higher subsidence of the femoral stem during the first 3 months after surgery than did those with normal BMD (difference = 0.6, 95% CI: 0.1–1.1; p = 0.03). Low systemic BMD (odds ratio (OR) = 0.1, CI: 0.006–1.0; p = 0.02), low local hip BMD (OR = 0.3, CI: 0.1–0.7; p = 0.005) and ageing (OR = 1.1, CI: 1.0–1.2; p = 0.02) were risk factors for delayed translational stability. Ageing and low canal flare index were risk factors for delayed rotational stabilization (OR = 3, CI: 1.1–9; p = 0.04 and OR = 1.1, CI: 1.0–1.2; p = 0.02, respectively). Harris hip score and WOMAC score were similar in patients with normal systemic BMD and low systemic BMD. Interpretation Low BMD, changes in intraosseous dimensions of the proximal femur, and ageing adversely affected initial stability and delayed osseointegration of cementless stems in women. PMID:22489886

  16. Does osteoporosis reduce the primary tilting stability of cementless acetabular cups?

    PubMed

    von Schulze Pellengahr, Christoph; von Engelhardt, Lars V; Wegener, Bernd; Müller, Peter E; Fottner, Andreas; Weber, Patrick; Ackermann, Ole; Lahner, Matthias; Teske, Wolfram

    2015-04-21

    Cementless hip cups need sufficient primary tilting stability to achieve osseointegration. The aim of the study was to assess differences of the primary implant stability in osteoporotic bone and in bone with normal bone density. To assess the influence of different cup designs, two types of threaded and two types of press-fit cups were tested. The maximum tilting moment for two different cementless threaded cups and two different cementless press-fit cups was determined in macerated human hip acetabuli with reduced (n=20) and normal bone density (n=20), determined using Q-CT. The tilting moments for each cup were determined five times in the group with reduced bone density and five times in the group with normal bone density, and the respective average values were calculated. The mean maximum extrusion force of the threaded cup Zintra was 5670.5 N (max. tilting moment 141.8 Nm) in bone with normal density and.5748.3 N (max. tilting moment 143.7 Nm) in osteoporotic bone. For the Hofer Imhof (HI) threaded cup it was 7681.5 N (192.0 Nm) in bone with normal density and 6828.9 N (max. tilting moment 170.7 Nm) in the group with osteoporotic bone. The mean maximum extrusion force of the macro-textured press-fit cup Metallsockel CL was 3824.6 N (max. tilting moment 95.6 Nm) in bone with normal and 2246.2 N (max. tilting moment 56.2 Nm) in osteoporotic bone. For the Monoblock it was 1303.8 N (max. tilting moment 32.6 Nm) in normal and 1317 N (max. tilting moment 32.9 Nm) in osteoporotic bone. There was no significance. A reduction of the maximum tilting moment in osteoporotic bone of the ESKA press-fit cup Metallsockel CL was noticed. Results on macerated bone specimens showed no statistically significant reduction of the maximum tilting moment in specimens with osteoporotic bone density compared to normal bone, neither for threaded nor for the press-fit cups. With the limitation that the results were obtained using macerated bone, we could not detect any restrictions for

  17. Mesh morphing for finite element analysis of implant positioning in cementless total hip replacements.

    PubMed

    Bah, Mamadou T; Nair, Prasanth B; Browne, Martin

    2009-12-01

    Finite element (FE) analysis of the effect of implant positioning on the performance of cementless total hip replacements (THRs) requires the generation of multiple meshes to account for positioning variability. This process can be labour intensive and time consuming as CAD operations are needed each time a specific orientation is to be analysed. In the present work, a mesh morphing technique is developed to automate the model generation process. The volume mesh of a baseline femur with the implant in a nominal position is deformed as the prosthesis location is varied. A virtual deformation field, obtained by solving a linear elasticity problem with appropriate boundary conditions, is applied. The effectiveness of the technique is evaluated using two metrics: the percentages of morphed elements exceeding an aspect ratio of 20 and an angle of 165 degrees between the adjacent edges of each tetrahedron. Results show that for 100 different implant positions, the first and second metrics never exceed 3% and 3.5%, respectively. To further validate the proposed technique, FE contact analyses are conducted using three selected morphed models to predict the strain distribution in the bone and the implant micromotion under joint and muscle loading. The entire bone strain distribution is well captured and both percentages of bone volume with strain exceeding 0.7% and bone average strains are accurately computed. The results generated from the morphed mesh models correlate well with those for models generated from scratch, increasing confidence in the methodology. This morphing technique forms an accurate and efficient basis for FE based implant orientation and stability analysis of cementless hip replacements.

  18. Preclinical trial of a novel surface architecture for improved primary fixation of cementless orthopaedic implants.

    PubMed

    Harrison, Noel; Field, John R; Quondamatteo, Fabio; Curtin, William; McHugh, Peter E; Mc Donnell, Pat

    2014-09-01

    A new surface architecture for cementless orthopaedic implants (OsteoAnchor), which incorporates a multitude of tiny anchor features for enhancing primary fixation, was tested in an ovine hemi-arthroplasty pilot study. Test animals were implanted with a hip stem component incorporating the OsteoAnchor surface architecture produced using additive layer manufacturing and control animals were implanted with stems containing a standard plasma sprayed titanium coating. Intra-operative surgeon feedback indicated that superior primary fixation was achieved for the OsteoAnchor stems and rapid return to normal gait and load bearing was observed post-operation. Following a 16-week recovery time, histological evaluation of the excised femurs revealed in-growth of healthy bone into the porous structure of the OsteoAnchor stems. Bone in-growth was not achieved for the plasma sprayed stems. These results indicate the potential for the OsteoAnchor surface architecture to enhance both the initial stability and long term lifetime of cementless orthopaedic implants. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Metallosis with pseudotumour formation: Long-term complication following cementless total hip replacement in a dog

    PubMed Central

    Volstad, Nicola J.; Schaefer, Susan L.; Snyder, Laura A.; Meinen, Jeffrey B.; Sample, Susannah J.

    2017-01-01

    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

  20. Intra-articular injection of tranexamic acid via a drain plus drain-clamping to reduce blood loss in cementless total knee arthroplasty

    PubMed Central

    2012-01-01

    Background Patients undergoing cementless total knee arthroplasty (TKA) sometimes suffer large blood loss. In a retrospective study, we explored whether postoperative intra-articular retrograde injection of tranexamic acid (TA) and leaving a drain clamp in place for 1 h reduced blood loss. Patients and methods Patients (n = 140) treated with unilateral primary cementless TKA (posterior cruciate ligament retained) were divided into two groups: those who had an intra-articular injection of TA (1000 mg) and drain clamping for 1 h postoperatively (study group, n = 70) and those who were not given TA and did not undergo clamping of their drains (control group, n = 70). Postoperative total blood loss, volume of drainage, hemoglobin level, transfusion amounts and rates, D-dimer level at postoperative day (POD) 7, and complications were recorded. Results Total blood loss, total drainage, mean transfusion volume, and transfusion rates were lower in the study group than in controls (P < 0.001). Hemoglobin levels on PODs 1 and 14 were similar in the groups, but on POD 7 the hemoglobin level was higher in the study group than in controls (P < 0.001). D-dimer level on POD 7 was lower in the study group than in controls (P < 0.05). There were no complications in either group. Conclusions Immediately postoperative intra-articular retrograde injection of TA and 1 h of drain-clamping effectively reduced blood loss and blood transfusion after cementless TKA. We believe that this method is simple, easy, and suitable for these patients. PMID:23020868

  1. Cementless Gustilo-Kyle and BIAS total hip arthroplasty: 2- to 5-year results.

    PubMed

    Kienapfel, H; Martell, J; Rosenberg, A; Galante, J

    1991-01-01

    We conducted extensive radiographic and clinical examination of 58 cementless total hip arthroplasties. Forty BIAS femoral stems had heads made of Co-base F 75 alloy and 18 Gustilo-Kyle femoral stems had Ti6A14V alloy heads. The cross-sectional geometry and location of the porous coating pads of the two stem types was identical, the BIAS component being slightly shorter. At the last follow-up, 27.8% of the Gustilo-Kyle femoral components and 2.5% of the BIAS femoral components were unstable. None of the acetabular components in the BIAS group as against 38.9% of the acetabular components in the Gustilo-Kyle group demonstrated wear of more than 1 mm. All unstable components which did not suffer intraoperative fracture had also acetabular wear of more than 1 mm. The only case with endosteal erosion was seen in a patient with an unstable implant displaying the most extensive wear. Nonparametric statistical analysis showed that the patients with Ti6A14V/polyethylene bearing surfaces had a statistically significantly higher extent of wear and a statistically significant higher incidence of femoral component loosening than patients with CrCoMo/polyethylene bearing surfaces.

  2. Alumina Delta-on-Alumina Delta Bearing in Cementless Total Hip Arthroplasty in Patients Aged <50 Years.

    PubMed

    Kim, Young-Hoo; Park, Jang-Won; Kim, Jun-Shik

    2016-10-01

    There are limited studies to evaluate long-term clinical and radiographic outcomes of alumina delta ceramic-on-ceramic bearings in cementless total hip arthroplasty (THA). The purpose of this study was to evaluate the clinical and radiographic results, prevalence of osteolysis, squeaking, and fracture of ceramic material associated with the use of the alumina delta ceramic-on-alumina delta ceramic bearing in cementless THA in patients aged <50 years. We reviewed the cases of 277 patients (334 hips) who underwent a cementless THA using alumina delta ceramic-on-alumina delta ceramic when they were 50 years or younger at the time of surgery. Demographic data; Harris Hip Score; Western Ontario McMaster Universities Osteoarthritis Index; and University of California, Los Angeles activity score were recorded. Radiographic and computerized tomographic evaluations were used to evaluate implant fixation and osteolysis. Squeaking sound and ceramic fracture were documented. The mean follow-up was 13.1 years (range, 10-14). The mean postoperative Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index score, University of California, Los Angeles activity score were 93 points, 15 points, and 8.6 points, respectively. Two patients had thigh pain (grade 7 points). All acetabular components and all but 2 femoral components were well fixed. Thirty-three hips (10%) exhibited clicking sound, and 2 hips (0.6%) exhibited squeaking sound. No hip had osteolysis or ceramic head or liner fracture. Our minimum 10-year follow-up results with the use of alumina delta ceramic-on-alumina delta ceramic bearings in patients aged <50 years suggest that cementless THA provides a high rate of survivorship without evidence of osteolysis or fracture of ceramic material. Copyright © 2016. Published by Elsevier Inc.

  3. Comparison of the risk of revision in cementless total hip arthroplasty with ceramic-on-ceramic and metal-on-polyethylene bearings

    PubMed Central

    Varnum, Claus; Pedersen, Alma B; Kjærsgaard-Andersen, Per; Overgaard, Søren

    2015-01-01

    Background and purpose Ceramic-on-ceramic (CoC) bearings were introduced in total hip arthroplasty (THA) to reduce problems related to polyethylene wear. We compared the 9-year revision risk for cementless CoC THA and for cementless metal-on-polyethylene (MoP) THA. Patients and methods In this prospective, population-based study from the Danish Hip Arthroplasty Registry, we identified all the primary cementless THAs that had been performed from 2002 through 2009 (n = 25,656). Of these, 1,773 THAs with CoC bearings and 9,323 THAs with MoP bearings were included in the study. To estimate the relative risk (RR) of revision, we used regression with the pseudo-value approach and treated death as a competing risk. Results 444 revisions were identified: 4.0% for CoC THA (71 of 1,773) and 4.0% for MoP THA (373 of 9,323). No statistically significant difference in the risk of revision for any reason was found for CoC and MoP bearings after 9 years of follow-up (adjusted RR = 1.3, 95% CI: 0.72–2.4). Revision rates due to component failure were 0.5% (n = 8) for CoC bearings and 0.1% (n = 6) for MoP bearings (p < 0.001). 6 patients with CoC bearings (0.34%) underwent revision due to ceramic fracture. Interpretation When compared to the “standard” MoP bearings, CoC THA had a 33% higher (though not statistically significantly higher) risk of revision for any reason at 9 years. PMID:25637339

  4. The dimensional accuracy of preparation of femoral cavity in cementless total hip arthroplasty*

    PubMed Central

    Wu, Li-dong; Hahne, HJ; Hassenpflug, J

    2004-01-01

    Objective: To observe the accuracy of femoral preparation and the position of the cementless prosthesis in femoral cavity, and to compare the results between the computer-assisted surgical group (CASPAR) and the conventional group. Methods: Ten femoral components were implanted either manually or by CASPAR in cadaver femurs. The specimens were cut to 3 mm thick slices. Microradiograms of every slice were sent to a computer for analysis with special software (IDL). The gaps and the medullary cavities between component and bone, the direct bone contact area of the implant surface, the gap width and the percentage of gap and bone contact area were measured in every slice. Results: In the proximal implant coated with HA of the CASPAR group, the average percentage of bone contact reached 93.2% (ranging from 87.6% to 99.7%); the average gap percentage was 2.9% (ranging from 0.3% to 7.8%); the maximum gap width was 0.81 mm and the average gap width was only 0.20 mm. While in the conventional group, the average percentage of bone contact reached 60.1% (ranging from 49.2% to 70.4%); the average gap percentage was 32.8% (ranging from 25.1% to 39.9%); the maximum gap width was 2.97 mm and the average gap width was 0.77 mm. The average gap around the implant in the CASPAR group was only 9% of that in the manual group; the maximum and average gap widths were only about 26% of those in the manual group. On the other hand, the CASPAR group showed 33% higher bone contact than the manual group. Conclusion: With the use of robotics-assisted system, significant progress can be achieved for femoral preparation in total hip arthroplasty. PMID:15362200

  5. Cementless total hip arthroplasty with ceramic-on-ceramic bearing in patients younger than 45 years with femoral-head osteonecrosis.

    PubMed

    Kim, Young-Hoo; Choi, Yoowang; Kim, Jun-Shik

    2010-12-01

    Despite improvements in the quality of alumina ceramics, osteolysis has been reported anecdotally after total hip arthroplasty (THA) with use of a contemporary alumina-on-alumina ceramic bearing. The purpose of this study was to evaluate the clinical and radiographic outcomes of THA using alumina-on-alumina ceramic bearing and to determine osteolysis using radiographs and computed tomographic (CT) scans in young patients. Consecutive primary cementless THA using alumina-on-alumina ceramic bearing were performed in 64 patients (93 hips) who were younger than 45 years of age with femoral-head osteonecrosis. There were 55 men (84 hips) and nine women (nine hips). Average age was 38.2 (range 24-45) years. Average follow-up was 11.1 (range 10-13) years. Preoperative Harris Hip Score was 52.9 (range 22-58) points, which improved to 96 (range 85-100) points at the final follow-up examination. Two of 93 hips (2%) had clicking or squeaking sound. No hip had revision or aseptic loosening. Radiographs and CT scans demonstrated that no acetabular or femoral osteolysis was detected in any hip at the latest follow-up. Contemporary cementless acetabular and femoral components with alumina-on-alumina ceramic bearing couples function well with no osteolysis at a ten year minimum and average of 11.1-year follow-up in this series of young patients with femoral-head osteonecrosis.

  6. Long-Term Results of Third-Generation Ceramic-on-Ceramic Bearing Cementless Total Hip Arthroplasty in Young Patients.

    PubMed

    Kim, Young-Hoo; Park, Jang-Won; Kim, Jun-Shik

    2016-11-01

    The results of third-generation of alumina-on-alumina ceramic bearing in a large number of patient cohorts are limited. The purpose of this study was to determine clinical and radiologic outcome, prevalence of osteolysis detected with radiographs and computerized tomographic scan, and survivorship of a cementless total hip arthroplasty using a third-generation of alumina-on-alumina ceramic bearing in a large number of active patients aged younger than 65 years. We reviewed the cases of 871 patients (1131 hips) who underwent a cementless total hip arthroplasty when they were aged 65 years or younger at the time of surgery. The most common diagnoses were osteonecrosis (53%) and osteoarthritis (20%). Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index, and University of California, Los Angeles activity scores were recorded. Radiographic and computerized tomographic evaluations were used to evaluate implant fixation and osteolysis. The mean follow-up interval was 18.8 years (range, 15-20 years). At the time of final follow-up, the mean Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index score, and University of California, Los Angeles activity score were 90 points, 15 points, and 8 points, respectively. All the femoral stem and acetabular components were well-fixed at the time of final follow-up. No hip had aseptic loosening or osteolysis or fracture of ceramic material at the time of the final follow-up. The current results with the use of the third-generation of alumina-on-alumina ceramic bearings in young patients suggest that cementless acetabular and femoral components provide outstanding long-term fixation and provide a high rate of survivorship without evidence of osteolysis. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Cementless total hip arthroplasty in patients with ankylosing spondylitis: A retrospective observational study.

    PubMed

    Xu, Jun; Zeng, Min; Xie, Jie; Wen, Ting; Hu, Yihe

    2017-01-01

    Controversies on the surgical protocols and efficacies of total hip arthroplasty (THA) in ankylosing spondylitis (AS) still exist. The aim of this study was to retrospectively analyze the perioperative managements and their outcomes related to performing THA on patients with AS.Data of 54 AS patients who underwent 81 THAs between 2008 and 2014 were retrospectively analyzed. Clinical and imaging data were collected preoperatively, postoperatively, and during the follow-up period for surgical efficacy.Using posterolateral approach, cementless prostheses were selected in all cases. Mean follow-up period was 3.6 years (range, 2-8 years). Inclinations and anteversions of acetabular cups were 36.3°±4.5° (range, 30°-50°) and 12.3°±4.9° (range, 0°-25°) respectively. Mean visual analog scale (VAS) score decreased from 6.7 ± 2.1 (range, 4-10) preoperatively to 1.5 ± 1.0 (range, 0-4) at final follow-up, and mean Harris hip score (HHS) improved from 31.2 ± 11.6 (range, 15-45) to 86.1 ± 4.3 (range, 80-95) (P < 0.05). Postoperative range of motion (ROM) in flexion was improved from 6.7°±13.5° (range, 0°-50°) preoperatively to 82.5°±6.4° (range, 70°-100°) at final follow-up, and ROM in extension was improved from 1.8°±5.7°(range, 0°-15°) to 15.4°±2.6° (range, 10°-20°) (P < 0.05). Heterotopic ossification (HO) was documented in 9 hips (11.1%). Signs of stable fibrous ingrowth and bone ingrowth were detected in 52 and 29 hips, respectively. Sciatic never injury was occurred in 3 cases, and treated conservatively. There were no signs of periprosthetic fractures, dislocation, or prosthesis loosening.Surgical efficacies of THA for AS patients with severe hip involvement are satisfactory.

  8. Long-term results using the straight tapered femoral cementless hip stem in total hip arthroplasty: a minimum of twenty-year follow-up.

    PubMed

    Ateschrang, Atesch; Weise, Kuno; Weller, Siegfried; Stöckle, Ulrich; de Zwart, Peter; Ochs, Björn Gunnar

    2014-08-01

    We report the first long-term results of a prospective cohort study after total hip arthroplasty using the cementless Bicontact hip stem. Between 1987 and 1990, 250 total hip arthroplasties in 236 patients were performed using the cementless Bicontact hip stem. The average follow-up was 22.8 years (20.4-24.8) and average age at index surgery was 58.1 years. Eighty-one patients died and 9 were lost to follow-up. We noted 11 stem revisions revealing an overall Kaplan Meier survival rate of 95.0% (CI 95%: 91.1-97.2%). The average Harris Hip Score revealed 81 points (range 24-93). The Bicontact hip stem demonstrated high survival rates despite high ages and osteopenic changes, which are equivalent to other long-term reports of cementless stem fixation.

  9. Midterm Outcome of Cementless Total Hip Arthroplasty in Crowe IV-Hartofilakidis Type III Developmental Dysplasia of the Hip.

    PubMed

    Mu, Wenbo; Yang, Desheng; Xu, Boyong; Mamtimin, Askar; Guo, Wentao; Cao, Li

    2016-03-01

    Developmental dysplasia of the hip (DDH) is widespread in developing countries, and treating Crowe IV-Hartofilakidis Type III DDH in adults requires the use of a highly demanding technique. We sought to determine the outcome of cementless total hip arthroplasty using Zweymüller components to treat Crowe IV-Hartofilakidis Type III DDH. Fifty-eight patients (71 hips) with a mean age of 35.8 years at time of index operation were included in our study. The average duration of follow-up was 70.5 months. The acetabular component was placed in the true acetabulum in all cases, and subtrochanteric shortening osteotomy was performed in 61 hips. With any component revision for any reason as the end point, Kaplan-Meier survivorship analysis at 98 months revealed a cumulative survival rate for implanted components of 91.40%. The mean Harris Hip Score improved from 35.6 preoperatively to 82.9 postoperatively. There were 20 cases of intraoperative fracture, 1 case of complete nerve palsy, and 7 cases of transient nerve palsy. Revision surgery was performed in 7 patients because of cup loosening in 1, severe polyethylene wear in 4, cup breakage in 1, and dislocation in 1. Midterm results for cementless total hip arthroplasty in patients with Crowe IV-Hartofilakidis Type III DDH was satisfactory; however, intraoperative fracture and polyethylene wear were major complications. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Biomechanical evaluation of adjunctive cerclage wire fixation for the prevention of periprosthetic femur fractures using cementless press-fit total hip replacement.

    PubMed

    Christopher, Scott A; Kim, Stanley E; Roe, Simon; Pozzi, Antonio

    2016-08-01

    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.

  11. Use of an Electron Beam Melting Manufactured Titanium Collared Cementless Femoral Stem to Resist Subsidence After Canine Total Hip Replacement.

    PubMed

    Liska, William D; Doyle, Nancy D

    2015-10-01

    To evaluate the effect of a collared electron beam melting (EBM)-manufactured titanium cementless femoral stem on implant subsidence after total hip replacement (THR). Prospective study Dogs (n = 26); 33 THR. Records were maintained on the first 110 consecutive THR using an EBM collared femoral stem. Radiographs on the first 33 THR that had 6-months follow-up were evaluated for implant subsidence. These results were compared to 27 dogs with subsidence after THR with a Co Cr collarless stem. Dogs that had EBM collared stem THR had a mean body weight of 35.4 kg, body condition score (BCS) of 6.21, and mean canal flare index (CFI) of 1.56. EBM stem sizes used (number implanted) were #7 (13), #8 (10), #9 (8), and #10 (2). Subsidence of collared stems did not occur if the collar was in contact with cortical bone during surgery. Subsidence of 1-3 mm occurred closing a gap between the collar and bone if contact was not made during surgery, but subsidence stopped once contact was made. No major complications directly related to the EBM collared stem were encountered. A collar on a cementless femoral stem in contact with cortical bone resists subsidence. © Copyright 2015 by The American College of Veterinary Surgeons.

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

    PubMed

    Kienapfel, H; Pitzer, W; Griss, P

    1992-01-01

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

  13. Implant Design in Cementless Hip Arthroplasty

    PubMed Central

    Kim, Jung Taek

    2016-01-01

    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

  14. A new cementless total hip arthroplasty with bioactive titanium porous-coating by alkaline and heat treatment: average 4.8-year results.

    PubMed

    Kawanabe, Keiichi; Ise, Kentaro; Goto, Koji; Akiyama, Haruhiko; Nakamura, Takashi; Kaneuji, Ayumi; Sugimori, Tanzo; Matsumoto, Tadami

    2009-07-01

    A method has been developed for creating a bioactive coating on titanium by alkaline and heat treatment, and shown that it forms a thin layer of hydroxyapatite (HA) on the surface of implants when soaked in simulated body fluid. A series of 70 cementless primary total hip arthroplasties using this coating technique on a porous titanium surface was performed, and followed up the patients for a mean period of 4.8 years. There were no instances of loosening or revision, or formation of a reactive line on the porous coating. Although radiography just after operation showed a gap between the host bone and the socket in over 70% of cases, all the gaps disappeared within a year, indicating the good osteoconduction provided by the coating. Alkaline-heat treatment of titanium to provide a thin HA coating has several advantages over plasma-spraying, including no degeneration or absorption of the HA coating, simplicity of the manufacturing process, and cost effectiveness. In addition, this method allows homogeneous deposition of bone-like apatite within a porous implant. Although this was a relatively short-term study, treatment that creates a bioactive surface on titanium and titanium alloy implants has considerable promise for clinical application.

  15. A prospective comparative study of cementless total hip arthroplasty and hip resurfacing in patients under the age of 55 years: a ten-year follow-up.

    PubMed

    Haddad, F S; Konan, S; Tahmassebi, J

    2015-05-01

    The aim of this study was to evaluate the ten-year clinical and functional outcome of hip resurfacing and to compare it with that of cementless hip arthroplasty in patients under the age of 55 years. Between 1999 and 2002, 80 patients were enrolled into the study: 24 were randomised (11 to hip resurfacing, 13 to total hip arthroplasty), 18 refused hip resurfacing and chose cementless total hip arthroplasty with a 32 mm bearing, and 38 insisted on resurfacing. The mean follow-up for all patients was 12.1 years (10 to 14). Patients were assessed clinically and radiologically at one year, five years and ten years. Outcome measures included EuroQol EQ5D, Oxford, Harris hip, University of California Los Angeles and University College Hospital functional scores. No differences were seen between the two groups in the Oxford or Harris hip scores or in the quality of life scores. Despite a similar aspiration to activity pre-operatively, a higher proportion of patients with a hip resurfacing were running and involved in sport and heavy manual labour after ten years. We found significantly higher function scores in patients who had undergone hip resurfacing than in those with a cementless hip arthroplasty at ten years. This suggests a functional advantage for hip resurfacing. There were no other attendant problems. ©2015 The British Editorial Society of Bone & Joint Surgery.

  16. Results of Total Elbow Arthroplasty with Cementless Implantation of an Alumina Ceramic Elbow Prosthesis for Patients with Rheumatoid Arthritis.

    PubMed

    Nishida, Keiichiro; Hashizume, Kenzo; Ozawa, Masatsugu; Takeshita, Ayumu; Kaneda, Daisuke; Nakahara, Ryuichi; Nasu, Yoshihisa; Shimamura, Yasunori; Inoue, Hajime; Ozaki, Toshifumi

    2017-02-01

    We investigated the long-term clinical results of total elbow arthroplasty (TEA) by cementless fixation of alumina ceramic unlinked elbow prostheses (J-alumina ceramic elbows: JACE) for the reconstruction of elbow joints with rheumatoid arthritis (RA). Seventeen elbows in 17 patients (aged 44-72 years, average 54.8) replaced by JACE TEA without bone cement were investigated. The average follow-up period was 10.7 (range, 1.0-19.3) years. Clinical conditions of each elbow before and after surgery were assessed according to the Mayo Elbow Performance Index (MEPI). Radiographic loosening was defined as a progressive radiolucent line of more than 1 mm that was completely circumferential around the intramedullary stem. The average MEPI significantly improved from 46.8 points preoperatively to 66.8 points at final follow-up (p=0.0226). However, aseptic loosening was noted in 10 of 17 elbows (58.8%) and revision surgery was required in 7 (41.2%). Most loosening was observed on the humeral side. With radiographic loosening and revision surgery defined as the end points, the likelihoods of prosthesis survival were 41.2% and 51.8%, respectively, up to 15 years by Kaplan-Meier analysis. The clinical results of JACE implantation without bone cement were disappointing, with high revision and loosening rates of the humeral component.

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

    PubMed

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

    2010-05-12

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

  18. Bilateral fatigue fracture of the femoral components in a cruciate-retaining cementless total knee prosthesis.

    PubMed

    Saito, Shu; Tokuhashi, Yasuaki; Ishii, Takao; Mori, Sei; Hosaka, Kunihiro; Ryu, Keinosuke; Suzuki, Gen

    2011-10-05

    This article reports a case of bilateral fatigue fracture of the femoral components in a cruciate-retaining uncemented total knee arthroplasty (TKA). A 75-year-old woman (height, 158 cm; weight, 72 kg; body mass index, 29.2) had undergone one-stage bilateral TKA for osteoarthritis 11 years previously at the author's institution. Surgery was performed using an uncemented Flexible Nichidai Knee. Equal tension of the collateral ligaments and normal mechanical axis were achieved during the primary procedure. The patient was an ardent lover of the game of badminton and had higher activity levels with daily playing. At 8 years postoperatively, she started complaining of mild pain in both knees. The pain gradually increased, and at 11 years postoperatively, she had difficulty walking. Anteroposterior radiographs showed narrowing of the medial joint space, indicating wear of the polyethylene insert. Lateral radiographs showed signs of broken implants in both knees. There were no signs of gross implant loosening or osteolysis. One-stage revision surgery was performed, and the knees were converted to cemented posterior-stabilized TKAs. At revision, the bilateral femoral components were found to be fractured at the junction between the trochlear flange and the medial condyle, anteriorly to the medial peg. The polyethylene insert showed mild wear at the medial middle portion. In the majority of case reports, stress fractures of the femoral component have predominantly affected the medial condyle, following uncemented implantation of fixed-bearing knees. In this case, failure of bone ingrowth in uncemented components, higher body mass index, and a higher athletic activity led to fatigue fracture of the femoral components.

  19. Prospective study of a cementless, mobile-bearing, third generation total ankle prosthesis.

    PubMed

    Schenk, Katja; Lieske, Sebastian; John, Michael; Franke, Konrad; Mouly, Stéphane; Lizee, Emmanuel; Neumann, Wolfram

    2011-08-01

    The SALTO total ankle prosthesis is a noncemented mobile bearing anatomic design characterized by dual Ti-HA coating. This study reviews our results with this prosthesis. Between 2001 and 2007, 413 consecutive SALTO prostheses were implanted in our institution in 215 women and 198 men, aged 57.1 +/- 11.9 years. At the last visit, 401 implants (47% in the left ankle) were available with a mean followup of 29 (range, 1 to 84) months. Based on the results of the 218 patients with at least 2 years of postoperative followup, the 5-year estimated survivorship, with the primary end-point being implant removal, was 86.6% and ranged from 85.1% in patients with post-traumatic osteoarthritis to 95.6% in those with rheumatoid arthritis. The AOFAS score increased from 50.9 +/- 16.8 points preoperatively to 82.2 +/- 14 points at followup (mean difference, 31.1 +/- 1.4, 95% confidence interval (C.I.) for the difference, 28.3 to 33.8, p < 0.001). Visual analog scale for pain decreased from 7.4 +/- 1.1 preoperatively to 2.0 +/- 2.0 postoperatively (mean difference, -5.4 +/- 0.7, 95% C.I. for the difference, -5.6 to -5.2, p < 0.001). Flexion/extension ROM increased from 25.2 +/- 14.1 degrees to 33.1 +/- 13.6 degrees at the last followup visit (mean difference, 7.9 +/- 0.5 degrees, 95% C.I. for the difference, 4.3 to 7.2, p < 0.001), while pronation/supination ROM increased from 23.8 +/- 13.7 degrees to 25.4 +/- 14.5 degrees (mean difference, 1.6 +/- 0.7 degrees, 95% C.I. for the difference, 0.9 to 2.2, p = 0.005). The SALTO prosthesis provided good clinical and functional results and we believe helps validate the concept of anatomic replacement.

  20. Hydroxyapatite in total hip arthroplasty. Our experience with a plasma spray porous titanium alloy/hydroxyapatite double-coated cementless stem

    PubMed Central

    Castellini, Iacopo; Andreani, Lorenzo; Parchi, Paolo Domenico; Bonicoli, Enrico; Piolanti, Nicola; Risoli, Francesca; Lisanti, Michele

    2016-01-01

    Summary Purpose Total hip arthroplasty could fail due to many factors and one of the most common is the aseptic loosening. In order to achieve an effective osseointegration and reduce risk of lossening, the use of cemented implant, contact porous bearing surface and organic coating were developed. Aim of this study was to evaluate clinical and radiological mid-term outcomes of a porous titanium alloy/hydroxyapatite double coating manufactured cementless femoral stem applied with “plasma spray” technique and to demonstrate the possibility to use this stem in different types of femoral canals. Methods Between January 2008 and December 2012, 240 consecutive primary total hip arthroplasties (THAs) were performed using a porous titanium alloy/hydroxyapatite double coating manufactured cementless femoral stem. 182 patients were examined: 136 were females (74.7%) and 46 males (25.2%); average age was 72 years old (ranging from 26 to 92 years old). For each patient, Harris Hip Scores (HHS) and Womac Scores were collected. All X-ray images were analyzed in order to demonstrate stem survival rate and subsidence. Results Harris Hip Score was good or excellent in 85% of the cases (average 90%) and mean WOMAC score was 97.5 (ranging from 73.4 to 100). No cases of early/late infection or periprosthetic fracture were noticed, with an excellent implant survival rate (100%) in a mean period of 40 months (ranging from 24 and 84 months). 5 cases presented acute implant dislocation, 2 due to wrong cup positioning in a dysplastic acetabulum and 3 after ground level fall. Dorr classification of femoral geometry was uses and the results were: 51 type A bone, 53 type B bone and 78 type C bone. Stem subsidence over 2 mm was considered as a risk factor of future implant loosening and was evidenced in 3 female patients with type C of Dorr classification. No radiolucencies signs around the proximally coated portion of stem or proximal reabsorption were visible during the radiographic

  1. Cementless metaphyseal fitting anatomic total hip arthroplasty with a ceramic-on-ceramic bearing in patients thirty years of age or younger.

    PubMed

    Kim, Young-Hoo; Park, Jang-Won; Kim, Jun-Shik

    2012-09-05

    The number of midterm or long-term studies on the current generation of cementless total hip replacements with alumina-on-alumina ceramic bearings in patients younger than thirty years of age is limited. The purpose of this study was to evaluate the midterm results of the cementless metaphyseal fitting anatomic total hip prosthesis in patients younger than thirty years of age, with a particular emphasis on the prevalence of thigh pain, resorption of bone due to stress-shielding of the proximal part of the femur, aseptic loosening, and osteolysis. We reviewed the cases of ninety-six patients (127 hips) who had a cementless total hip arthroplasty when they were thirty years or younger at the time of surgery. All surgical procedures were performed by a single surgeon. The most common diagnoses were osteonecrosis (54.3%) and developmental dysplasia of the hip (20.5%). Demographic data, the Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and University of California, Los Angeles (UCLA) activity scores were recorded. Radiographic evaluation was used to evaluate implant fixation and osteolysis. The minimum follow-up interval was ten years (mean, 14.6 years; range, ten to sixteen years). The mean preoperative Harris hip score, WOMAC score, and UCLA activity score were 41 points, 66 points, and 3 points, respectively. At the time of final follow-up, the mean Harris hip score, WOMAC score, and UCLA activity score were 95 points, 16 points, and 8 points, respectively. No patient had thigh pain after one year postoperatively. All of the femoral stems and all but one of the acetabular components were well-fixed at the time of final follow-up. No hip exhibited squeaking, ceramic fracture, loosening, or osteolysis at the time of the final follow-up. These results in patients thirty years of age or younger suggest that the cementless metaphyseal fitting anatomic total hip prosthesis provides outstanding midterm fixation and substantial

  2. Cemented and cementless fixation: results and techniques.

    PubMed

    Silverton, Craig D

    2006-01-01

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

  3. Cementless total hip arthroplasty using Biolox®delta ceramic-on-ceramic bearing in patients with osteonecrosis of the femoral head.

    PubMed

    Lim, Seung-Jae; Kim, Sang-Min; Kim, Dong-Wook; Moon, Young-Wan; Park, Youn-Soo

    2016-01-01

    The purpose of this study was to evaluate the results of cementless total hip arthroplasty (THA) using a 32 mm or larger Biolox®delta ceramic-on-ceramic (CoC) bearing in patients with osteonecrosis of the femoral head after a minimum of 5 years of follow-up. We retrospectively analysed 44 patients (53 hips) who underwent cementless THA using Biolox®delta CoC bearing. There were 33 men (40 hips) and 11 women (13 hips) with the mean age of 49 years. A 36 mm head was used in 42 (79%) of 53 hips and a 32 mm head was used in 11 hips with smaller acetabular shells. The mean duration of follow-up was 5.3 years (range 5-6 years). The mean Harris Hip Score improved from 50 points preoperatively to 97 points at final follow-up (p<0.001). All acetabular and femoral components showed radiographic evidence of osseointegration. No osteolysis was observed. No patients sustained ceramic fracture. An audible hip noise was identified in 2 (4%) of the 53 hips (1 squeaking and 1 clicking). Survivorship with revision for any reason at a minimum of 5 years was 100% in the best-case scenario and 95 % in the worst-case scenario. The minimum 5-year results of cementless THA using a 32 mm or larger Biolox®delta CoC bearing in patients with osteonecrosis of the femoral head were encouraging with excellent survivorship. However, it was also found that the risk of noise development remains even for the new alumina matrix composite ceramic.

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

    PubMed

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

    2012-08-01

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

  5. [Cementless total hip arthroplasty after acute femoral neck fracture in active patients. Prospective matched study with a minimum follow-up of 5 years].

    PubMed

    Lizaur-Utrilla, A; Sanz-Reig, J; Miralles-Muñoz, F A

    2014-01-01

    To evaluate outcomes of cementless total hip replacement after acute femoral neck fracture in active patients. A prospective matched study was conducted to compare the results between 76 patients with fractures and 76 patients with osteoarthritis. The Harris score, short-WOMAC and SF-12 were used for the clinical assessment. The mean follow-up was 7.3 years (range 5-11). There were no significant differences in medical or surgical complications between the 2 groups. Functional outcomes were similar, but more walking aids were used in fracture group. There were 6 revisions among the fractures group (one dislocation, 2 deep infections, 3 aseptic loosening), and 2 aseptic loosening among controls. There was no significant difference in arthroplasty survival at 10 years (88.7 vs. 96.1%, P=.15). The mortality rates at 2 and 10 years were similar. Cementless total hip replacement for treatment of acute femoral neck fracture showed similar results to those of elective surgery for osteoarthritis in these selected patients. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  6. Ibandronate and cementless total hip arthroplasty: densitometric measurement of periprosthetic bone mass and new therapeutic approach to the prevention of aseptic loosening

    PubMed Central

    Muratore, Maurizio; Quarta, Eugenio; Quarta, Laura; Calcagnile, Fabio; Grimaldi, Antonella; Orgiani, M. Antonio; Marsilio, Antonio; Rollo, Giuseppe

    2012-01-01

    Summary Studies of the mechanisms of periprosthetic bone loss have led to the development of pharmacologic strategies intended to enhance bone mass recovery after surgery and consequently prevent aseptic loosening and prolong the implant survival. Bisphosphonates, potent anti-resorptive drugs widely used in the treatment of osteoporosis and other disorders of bone metabolism, were shown to be particularly effective in reducing periprosthetic bone resorption in the first year after hip and knee arthroplasty, both cemented and cementless. Based on these results, we investigated the inhibitory effects of ibandronate on periprosthetic bone loss in a 2-year study of postmenopausal women that underwent cementless total hip arthroplasty. In the first 6 months both groups (A, treated with ibandronate 3 mg i.v. within five days after surgery and then with oral ibandronate 150 mg/month, plus calcium and vitamin D supplementation; and B, treated with calcium and vitamin D supplementation only) experienced bone loss, though to a lesser extent in group A. After 12 months, group A showed a remarkable BMD recovery, that was statistically significant versus baseline values (about +1, 74% of global BMD) and most evident in region R1 (+3, 81%) and R2 (+4, 12%); in group B, on the contrary, BMD values were unchanged compared with those at 6 months post-surgery. Quality of life scores also showed a greater improvement in group A, both at 6 and 12 months after surgery, likely because of the pain-reducing effects of ibandronate treatment. PMID:22783337

  7. Unicondylar knee arthroplasty: a cementless perspective

    PubMed Central

    Forsythe, Michael E.; Englund, Roy E.; Leighton, Ross K.

    2000-01-01

    Objective To compare the results of cementless unicondylar knee arthroplasty (UKA) with those already reported in a similar study on cemented UKA. Design A case-series cross-sectional study. Setting The Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax. Patients Fifty-one patients who underwent a total of 57 UKAs between May 1989 and May 1997. Inclusion criteria were osteoarthritis involving the predominantly the medial compartment of the knee, relative sparing of the other compartments, less than 15° of varus, minimal knee instability, and attendance at the postoperative clinical visit. Intervention Cementless UKA. Main outcome measures Clinical parameters that included pain, range of motion and the Knee Society Clinical Knee Score. Roentgenographic parameters that included α, β, γ and σ angles and the presence of periprosthetic radiolucency or loose beads. Results Age, weight, gender and follow-up interval did not significantly affect the clinical results in terms of pain, range of motion or knee score. Knees with more than 1 mm of radiolucency had significantly lower knee scores than those with no radiolucency. Knees that radiologically had loose beads also had significantly lower knee scores. The clinical outcomes of cementless UKA were comparable to those already reported on cemented UKA. Cementless femurs had less radiolucency than the cemented femurs, whereas cementless tibias had more radiolucency than their cemented counterparts. Conclusions Cementless UKA seems to be as efficacious as cemented UKA. However, there is some concern about the amount of radiolucency in the cementless tibial components. A randomized clinical trial comparing both cementless and cemented tibial components with a cementless femur (hybrid knee) is needed to further assess this controversial issue in UKA. PMID:11129829

  8. Primary cementless hip arthroplasty as a potential risk factor for non-union after long-stem revision arthroplasty in periprosthetic femoral fractures.

    PubMed

    Boesmueller, Sandra; Michel, Marc; Hofbauer, Marcus; Platzer, Patrick

    2015-04-01

    In case of stem loosening in periprosthetic femoral fractures (PPFF), revision arthroplasty should be performed. The first hypothesis of this study was that advanced patient age and female gender shows higher non-union rates. The second hypothesis was that primary cementless arthroplasty is associated with a higher non-union rate compared to cemented primary hip arthroplasty. All PPFF occurring between January 2000 and June 2010 treated by revision arthroplasty were included. Multiple regression analysis was performed to identify independent variables leading to fracture non-union. Eighty one patients (78 % female) met the inclusion criteria. In 20/81 patients (24.7 %) no adequate fracture healing could be determined on radiographs 12 months after revision surgery. Although age and female gender showed a positive correlation with bony non-union after PPFF as expected, the p-values were not statistically significant. Multiple regression analysis revealed primary cementless prosthesis (p = 0.001) to be the only independent variable associated with non-union. Non-cemented primary prosthesis might be a negative predicting factor for the development of non-union after long-stem revision arthroplasty in PPFF. We therefore recommend the thorough debridement of pannus tissue thus inducing bone healing before the implantation of revision prostheses.

  9. [Cementless Plasmacup-Bicontact total hip arthroplasty. Results of a minimum of ten-year follow-up].

    PubMed

    Špička, J; Radová, L; Gallo, J

    2012-01-01

    The aim of the study was to analyse the long-term clinical and radiographic results of total hip arthroplasty (THA) with the Bicontact-Plasmacup prosthesis, In this retrospective observational study, 34 consecutive patients undergoing Bicontact-Plasmacup THA between August 1998 and July 2000 were evaluated. The group included 15 women and 19 men with an average age of 56 years (30 to 67 years). The mean ± SD of follow-up was 132 ± 9 months (122 to 149 months). Patients' satisfaction with the treatment outcome and selected clinical and radiographic features were evaluated. The data were analysed using the concordance test, Spearman's correlation coefficient and chi-square test. At the final follow-up, 94% of the interviewed patients reported satisfaction with the surgery outcome. The mean Harris score was 93 (67 to 98) points, with excellent or very good results in 91% of the patients. Compared with the post-operative radiographs, the mean ± SD value for vertical migration of the acetabular cup was 2.43 ± 3.21 mm (0 to 12 mm) and that for horizontal migration was 0.35 ± 1.0 mm (0 to 4.3 mm). The mean stem subsidence was by 3.87 mm (range, 0.36 to 21.11 mm; SD 4.03). At the final follow-up, all implants showed radiographic stability and absence of radiolucent lines. Early acetabular osteolysis was detected in two patients (5.9 %). In 19 patients (56%) a change in bone architecture, similar to alterations due to weight-bearing adaptation, was seen around the cup following surgery. The stress shielding effect of the femoral component was recorded in 79%, bypass phenomenon in 41 % and pedestal formation under the apex of the stem in 18% of the patients. The mean rate of polyethylene wear measured by the Dorr and Wan method was 0.106 mm per year (range, 0.00 to 0.267 mm) or it was 0.078 mm per year (0.00 to 0.19 mm) when assessed by a modification of the method described by Kang et al. The clinical and radiographic findings presented here are in accordance with the

  10. Congenital hip dysplasia treated by total hip arthroplasty using cementless tapered stem in patients younger than 50 years old: results after 12-years follow-up.

    PubMed

    Faldini, Cesare; Miscione, Maria Teresa; Chehrassan, Mohammadreza; Acri, Francesco; Pungetti, Camilla; d'Amato, Michele; Luciani, Deianira; Giannini, Sandro

    2011-12-01

    Congenital hip dysplasia may lead to severe acetabular and femoral abnormalities that can make total hip arthroplasty a challenging procedure. We assessed a series of patients affected by developmental hip dysplasia treated with total hip arthroplasty using cementless tapered stem and here we report the outcomes at long-term follow-up. Twenty-eight patients (24 women and 4 men) aged between 44 and 50 years (mean 47 years) were observed. Clinical evaluation was rated with the Harris Hip Score. Radiographic evaluation consisted in standard anteroposterior and axial view radiographs of the hip. According to Crowe's classification, 16 hips presented dysplasia grade 1, 14 grade 2, and 4 grade 3. All patients were treated with total hip arthroplasty using a cementless tapered stem (Wagner Cone Prosthesis). Six patients were operated bilaterally, with a totally of 34 hips operated. After surgery, the patients were clinically and radiographically checked at 3, 6, and 12 months and yearly thereafter until an average follow-up of 12 years (range 10-14 years). Average Harris Hip Score was 56 ± 9 (range 45-69) preoperatively, 90 ± 9 (range 81-100) 12 months after surgery, and 91 ± 8 (range 83-100) at last follow-up. Radiographic evaluation demonstrated excellent osteointegration of the implants. Signs of bone resorption were present in 6 hips, nevertheless no evidence of loosening was observed and none of the implants has been revised. Even in dysplasic femur, the tapered stem allowed adequate stability and orientation of the implant. We consider tapered stem a suitable option for total hip arthroplasty in developmental hip dysplasia, also in case of young patients, thanks to the favourable long-term results.

  11. Cementless hydroxyapatite coated hip prostheses.

    PubMed

    Herrera, Antonio; Mateo, Jesús; Gil-Albarova, Jorge; Lobo-Escolar, Antonio; Ibarz, Elena; Gabarre, Sergio; Más, Yolanda; Gracia, Luis

    2015-01-01

    More than twenty years ago, hydroxyapatite (HA), calcium phosphate ceramics, was introduced as a coating for cementless hip prostheses. The choice of this ceramic is due to its composition being similar to organic apatite bone crystals. This ceramic is biocompatible, bioactive, and osteoconductive. These qualities facilitate the primary stability and osseointegration of implants. Our surgical experience includes the implantation of more than 4,000 cementless hydroxyapatite coated hip prostheses since 1990. The models implanted are coated with HA in the acetabulum and in the metaphyseal area of the stem. The results corresponding to survival and stability of implants were very satisfactory in the long-term. From our experience, HA-coated hip implants are a reliable alternative which can achieve long term survival, provided that certain requirements are met: good design selection, sound choice of bearing surfaces based on patient life expectancy, meticulous surgical technique, and indications based on adequate bone quality.

  12. Cementless Hydroxyapatite Coated Hip Prostheses

    PubMed Central

    Herrera, Antonio; Mateo, Jesús; Gil-Albarova, Jorge; Lobo-Escolar, Antonio; Ibarz, Elena; Gabarre, Sergio; Más, Yolanda

    2015-01-01

    More than twenty years ago, hydroxyapatite (HA), calcium phosphate ceramics, was introduced as a coating for cementless hip prostheses. The choice of this ceramic is due to its composition being similar to organic apatite bone crystals. This ceramic is biocompatible, bioactive, and osteoconductive. These qualities facilitate the primary stability and osseointegration of implants. Our surgical experience includes the implantation of more than 4,000 cementless hydroxyapatite coated hip prostheses since 1990. The models implanted are coated with HA in the acetabulum and in the metaphyseal area of the stem. The results corresponding to survival and stability of implants were very satisfactory in the long-term. From our experience, HA-coated hip implants are a reliable alternative which can achieve long term survival, provided that certain requirements are met: good design selection, sound choice of bearing surfaces based on patient life expectancy, meticulous surgical technique, and indications based on adequate bone quality. PMID:25802848

  13. Computational Evaluation of the Effects of Bone Ingrowth on Bone Resorptive Remodeling after a Cementless Total Hip Arthroplasty

    NASA Astrophysics Data System (ADS)

    Jung, Duk-Young; Kang, Yu-Bong; Tsutsumi, Sadami; Nakai, Ryusuke; Ikeuchi, Ken; Sekel, Ron

    In this study, we simulated a wide cortex separation from a cementless hip prosthesis using the bone resorption remodeling method that is based on the generation of high compressive stress around the distal cortical bone. Thereafter, we estimated the effect on late migration quantities of the hip prosthesis produced by the interface state arising from bone ingrowth. This was accomplished using cortical bone remodeling over a long period of time. Two-dimensional natural hip and implanted hip FEM models were constructed with each of the following interface statements between the bone and prosthesis: (1) non-fixation, (2) proximal 1/3, (3) proximal 2/3 and (4) full-fixation. The fixation interfaces in the fully and partially porous coated regions were rigidly fixed by bony ingrowth. The non-fixation model was constructed as a critical situation, with the fibrous or bony tissue not integrated at all into the implant surface. The daily load history was generated using the three loading cases of a one-legged stance as well as abduction and adduction motions. With the natural hip and one-legged stance, the peak compressive principal stresses were found to be under the criteria value for causing bone resorption, while no implant movement occurred. The migration magnitude of the stem of the proximal 1/3 fixation model with adduction motion was much higher, reaching 6%, 11%and 21%greater than those of the non-fixation, proximal 2/3 fixation and all-fixation models, respectively. The full-fixation model showed the lowest compressive principal stress and implant movement. Thus, we concluded that the late loosening and subsequent movement of the stem in the long term could be estimated with the cortical bone remodeling method based on a high compressive stress at the bone-implant interface. The change caused at the bone-prosthesis interface by bony or fibrous tissue ingrowth constituted the major factor in determining the extent of cortical bone resorption occurring with

  14. An integrated CAD/CAM/robotic milling method for custom cementless femoral prostheses.

    PubMed

    Wen-ming, Xi; Ai-min, Wang; Qi, Wu; Chang-hua, Liu; Jian-fei, Zhu; Fang-fang, Xia

    2015-09-01

    Aseptic loosening is the primary cause of cementless femoral prosthesis failure and is related to the primary stability of the cementless femoral prosthesis in the femoral cavity. The primary stability affects both the osseointegration and the long-term stability of cementless femoral prostheses. A custom cementless femoral prosthesis can improve the fit and fill of the prosthesis in the femoral cavity and decrease the micromotion of the proximal prosthesis such that the primary stability of the custom prosthesis can be improved, and osseointegration of the proximal prosthesis is achieved. These results will help to achieve long-term stability in total hip arthroplasty (THA). In this paper, we introduce an integrated CAD/CAM/robotic method of milling custom cementless femoral prostheses. The 3D reconstruction model uses femoral CT images and 3D design software to design a CAD model of the custom prosthesis. After the transformation matrices between two units of the robotic system are calibrated, consistency between the CAM software and the robotic system can be achieved, and errors in the robotic milling can be limited. According to the CAD model of the custom prosthesis, the positions of the robotic tool points are produced by the CAM software of the CNC machine. The normal vector of the three adjacent robotic tool point positions determines the pose of the robotic tool point. In conclusion, the fit rate of custom pig femur stems in the femoral cavities was 90.84%. After custom femoral prostheses were inserted into the femoral cavities, the maximum gaps between the prostheses and the cavities measured less than 1 mm at the diaphysis and 1.3 mm at the metaphysis. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

  15. Mid-term results of cementless total hip replacement using a ceramic-on-ceramic bearing with and without computer navigation.

    PubMed

    Sugano, N; Nishii, T; Miki, H; Yoshikawa, H; Sato, Y; Tamura, S

    2007-04-01

    We have developed a CT-based navigation system using infrared light-emitting diode markers and an optical camera. We used this system to perform cementless total hip replacement using a ceramic-on-ceramic bearing couple in 53 patients (60 hips) between 1998 and 2001. We reviewed 52 patients (59 hips) at a mean of six years (5 to 8) postoperatively. The mid-term results of total hip replacement using navigation were compared with those of 91 patients (111 hips) who underwent this procedure using the same implants, during the same period, without navigation. There were no significant differences in age, gender, diagnosis, height, weight, body mass index, or pre-operative clinical score between the two groups. The operation time was significantly longer where navigation was used, but there was no significant difference in blood loss or navigation-related complications. With navigation, the acetabular components were placed within the safe zone defined by Lewinnek, while without, 31 of the 111 components were placed outside this zone. There was no significant difference in the Merle d'Aubigne and Postel hip score at the final follow-up. However, hips treated without navigation had a higher rate of dislocation. Revision was performed in two cases undertaken without navigation, one for aseptic acetabular loosening and one for fracture of a ceramic liner, both of which showed evidence of neck impingement on the liner. A further five cases undertaken without navigation showed erosion of the posterior aspect of the neck of the femoral component on the lateral radiographs. These seven impingement-related mechanical problems correlated with malorientation of the acetabular component. There were no such mechanical problems in the navigated group. We conclude that CT-based navigation increased the precision of orientation of the acetabular component and control of limb length in total hip replacement, without navigation-related complications. It also reduced the rate of

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

    PubMed Central

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

    2006-01-01

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

  17. Short-stem prostheses in primary total hip arthroplasty

    PubMed Central

    Huo, Shao-Chuan; Wang, Fan; Dong, Lu-Jue; Wei, Wei; Zeng, Jing-Qi; Huang, Hong-Xing; Han, Qing-Min; Duan, Rui-Qi

    2016-01-01

    Abstract Background: Short-stem (SS) prostheses require less resection of the femoral neck, produce a more physiological load pattern in the proximal femur, reduce stress shielding, and aid bone conservation and are, therefore, beneficial for young patients. Conventional cementless implants in total hip arthroplasty (THA) have shown excellent clinical results; however, it is unclear whether SS prostheses can obtain the same clinical and radiological outcomes. We conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate whether SS prostheses are superior to conventional implants after primary THA. Methods: We reviewed the literature published up to June 2016 from PubMed, Web of Science, and the Cochrane Library to find relevant RCTs comparing SSs and conventional stems in primary THA. Quality assessment was performed by 2 independent reviewers. The RevMan 5.3 software program of the Cochrane Collaboration was used to analyze the data. Random- or fixed-effect models were used to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs) for each comparison. Results: Six RCTs involving 552 patients with 572 hips were identified. Strong evidence indicated that SS prostheses were more effective for reducing thigh pain than conventional implants (I 2 = 46%, P = 0.002; risk ratio [RR], 95% CI 0.15, 0.04–0.49). However, there were no significant differences between the 2 groups in Harris Hip Scores (I 2 = 0%, P = 0.84; SMD, 95% CI 0.02, −0.15–0.18), Western Ontario and McMaster Universities Osteoarthritis Index Scores (I 2 = 0%, P = 0.35; SMD, 95% CI 0.09, −0.10–0.27), femoral offset of stem (I 2 = 0%, P = 0.57; SMD, 95% CI 0.06, −0.16–0.29), and leg-length discrepancy (I 2 = 79%, P = 0.88; SMD, 95% CI 0.04, −0.44–0.51). Conclusion: SS prostheses achieve the same clinical and radiological outcomes as conventional implants, and were superior in terms of reducing thigh pain. But whether the postoperative thigh pain

  18. Cementless surface replacement hemiarthroplasty for primary glenohumeral osteoarthritis: results of over 5-year follow-up in patients with or without rotator cuff deficiency

    PubMed Central

    Al-Hadithy, Nawfal; Furness, Nicholas; Patel, Ronak; Jonas, Sam; Jobbagy, Attila; Lowdon, Ian

    2015-01-01

    Background Cementless surface replacement hemiarthroplasty (CSRHA) is an established treatment for glenohumeral osteoarthritis; however, studies evaluating its role in arthritis with rotator cuff deficiency are limited. This study reviews the outcomes of CSRHA for glenohumeral osteoarthritis with and without rotator cuff tears. Methods 41 CSRHA (Mark III Copeland prosthesis) were performed for glenohumeral osteoarthritis with intact rotator cuffs (n = 21) and cuff-deficient shoulders (n = 20). Patients were assessed using Oxford and Constant questionnaires, patient satisfaction, range of motion measurements and by radiography. Results Mean age and follow-up were 75 years and 5.1 years, respectively. Functional gains were significantly higher in patients with intact rotator cuffs compared to cuff-deficient shoulders, with Oxford Shoulder Score improving from 18 to 37.5 and 15 to 27 and forward flexion improved from 60° to 126° and 44° to 77° in each group, respectively. Two patients with deficient cuffs had deficient subscapularis tendons; one of which was dislocated anteriorly. Conclusions CSRHA provides significant improvements in pain and function in patients with glenohumeral osteoarthritis. In patients with deficient cuffs, functional gains are limited, and should be considered in low-demand patients where pain is the primary problem. Caution should be taken in patients with a deficient subscapularis as a result of the risk of dislocation. PMID:27582984

  19. Primary total hip arthroplasty using 3rd generation ceramic-on-ceramic articulation.

    PubMed

    Seo, Beom H; Ryu, Dong J; Kang, Joon S; Moon, Kyoung H

    2016-09-29

    Ceramic-on-ceramic (CoC) is currently a popular bearing combination in young patients in primary total hip arthroplasty (THA). The purpose of this study was to evaluate clinical and radiographic results and complications of cementless THA with 3rd generation CoC articulation. From April 2001 to January 2008, 310 primary THAs were performed in 300 patients using 3rd generation CoC articulation. The mean follow-up period was 8.9 years and the mean age at index surgery was 54.6 years. Patient clinical outcome was evaluated with the Harris Hip Score. Radiographic evaluations was performed to analyse osteolysis, implant fixation and loosening. Mean Harris Hip Score at last follow-up was 95.4 (76-100). Radiographic analysis demonstrated no evidence of stem or cup loosening and there were no cases of osteolysis. Ceramic wear was not detectable on the plain radiograph. Complications requiring revision occurred in 12 cases; 2 ceramic head fractures, 4 dislocations, 2 deep infections and 4 cases of periprosthetic fracture. The cohort had an overall revision rate of 3.9%. Clinical outcomes using cementless THA with 3rd generation CoC articulation were satisfactory. Although the mechanical properties of ceramic materials have improved, there are still problems such as ceramic fracture and squeaking. More clinical study and investigation for alternative bearing are necessary to reduce complications. 4th generation CoC or ceramic on cross linked polyethylene may address some of these issues.

  20. Cementless acetabular revision arthroplasty

    PubMed Central

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

    2000-01-01

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

  1. Ceramic bearings with bilayer coating in cementless total hip arthroplasty. A safe solution. A retrospective study of one hundred and twenty six cases with more than ten years' follow-up.

    PubMed

    Ferreira, André; Aslanian, Thierry; Dalin, Thibaud; Picaud, Jean

    2017-05-01

    Using a ceramic-ceramic bearings, cementless total hip arthroplasty (THA) has provided good clinical results. To ensure longevity a good quality fixation of the implants is mandatory. Different surface treatments had been used, with inconsistent results. We hypothesized that a "bilayer coating" applied to both THA components using validated technology will provide a long-lasting and reliable bone fixation. We studied the survival and bone integration of a continuous, single-surgeon, retrospective series of 126 THA cases (116 patients) with an average follow-up of 12.2 years (minimum 10 years). The THA consisted of cementless implants with a bilayer coating of titanium and hydroxyapatite and used a ceramic-ceramic bearing. With surgical revision for any cause (except infection) as the end point, THA survival was 95.1 % at 13 years. Stem (98.8 %) and cup (98.6 %) survival was similar at 13 years. Bone integration was confirmed in 100 % of implants (Engh-Massin score of 17.42 and ARA score of 5.94). There were no instances of loosening. Revisions were performed because of instability (1.6 %), prosthetic impingement or material-related issues. A bilayer titanium and hydroxyapatite coating provides strong, fast, reliable osseo integration, without deterioration at the interface or release of damaging particles. The good clinical outcomes expected of ceramic bearings were achieved, as were equally reliable stem and cup fixation.

  2. Distributed analysis of hip implants using six national and regional registries: comparing metal-on-metal with metal-on-highly cross-linked polyethylene bearings in cementless total hip arthroplasty in young patients.

    PubMed

    Furnes, Ove; Paxton, Elizabeth; Cafri, Guy; Graves, Stephen; Bordini, Barbara; Comfort, Thomas; Rivas, Moises Coll; Banerjee, Samprit; Sedrakyan, Art

    2014-12-17

    The regulation of medical devices has attracted controversy recently because of problems related to metal-on-metal hip implants. There is growing evidence that metal-on-metal implants fail early and cause local and systemic complications. However, the failure associated with metal-on-metal head size is not consistently documented and needs to be communicated to patients and surgeons. The purpose of this study is to compare implant survival of metal on metal with that of metal on highly cross-linked polyethylene. Using a distributed health data network, primary total hip arthroplasties were identified from six national and regional total joint arthroplasty registries (2001 to 2010). Inclusion criteria were patient age of forty-five to sixty-four years, cementless total hip arthroplasties, primary osteoarthritis diagnosis, and exclusion of the well-known outlier implant ASR (articular surface replacement). The primary outcome was revision for any reason. A meta-analysis of survival probabilities was performed with use of a fixed-effects model. Metal-on-metal implants with a large head size of >36 mm were compared with metal-on-highly cross-linked polyethylene implants. Metal-on-metal implants with a large head size of >36 mm were used in 5172 hips and metal-on-highly cross-linked polyethylene implants were used in 14,372 hips. Metal-on-metal total hip replacements with a large head size of >36 mm had an increased risk of revision compared with metal-on-highly cross-linked polyethylene total hip replacements with more than two years of follow-up, with no difference during the first two years after implantation. The results of the hazard ratios (and 95% confidence intervals) from the multivariable model at various durations of follow-up were 0.95 (0.74 to 1.23) at zero to two years (p = 0.698), 1.42 (1.16 to 1.75) at more than two years to four years (p = 0.001), 1.78 (1.45 to 2.19) at more than four years to six years (p < 0.001), and 2.15 (1.63 to 2.83) at more than

  3. Distributed Analysis of Hip Implants Using Six National and Regional Registries: Comparing Metal-on-Metal with Metal-on-Highly Cross-Linked Polyethylene Bearings in Cementless Total Hip Arthroplasty in Young Patients

    PubMed Central

    Furnes, Ove; Paxton, Elizabeth; Cafri, Guy; Graves, Stephen; Bordini, Barbara; Comfort, Thomas; Rivas, Moises Coll; Banerjee, Samprit; Sedrakyan, Art

    2014-01-01

    Background: The regulation of medical devices has attracted controversy recently because of problems related to metal-on-metal hip implants. There is growing evidence that metal-on-metal implants fail early and cause local and systemic complications. However, the failure associated with metal-on-metal head size is not consistently documented and needs to be communicated to patients and surgeons. The purpose of this study is to compare implant survival of metal on metal with that of metal on highly cross-linked polyethylene. Methods: Using a distributed health data network, primary total hip arthroplasties were identified from six national and regional total joint arthroplasty registries (2001 to 2010). Inclusion criteria were patient age of forty-five to sixty-four years, cementless total hip arthroplasties, primary osteoarthritis diagnosis, and exclusion of the well-known outlier implant ASR (articular surface replacement). The primary outcome was revision for any reason. A meta-analysis of survival probabilities was performed with use of a fixed-effects model. Metal-on-metal implants with a large head size of >36 mm were compared with metal-on-highly cross-linked polyethylene implants. Results: Metal-on-metal implants with a large head size of >36 mm were used in 5172 hips and metal-on-highly cross-linked polyethylene implants were used in 14,372 hips. Metal-on-metal total hip replacements with a large head size of >36 mm had an increased risk of revision compared with metal-on-highly cross-linked polyethylene total hip replacements with more than two years of follow-up, with no difference during the first two years after implantation. The results of the hazard ratios (and 95% confidence intervals) from the multivariable model at various durations of follow-up were 0.95 (0.74 to 1.23) at zero to two years (p = 0.698), 1.42 (1.16 to 1.75) at more than two years to four years (p = 0.001), 1.78 (1.45 to 2.19) at more than four years to six years (p < 0.001), and 2

  4. Complex primary total hip arthroplasty.

    PubMed

    Boisgard, S; Descamps, S; Bouillet, B

    2013-02-01

    Although total hip arthroplasty is now a classic procedure that is well controlled by orthopedic surgeons, some cases remain complex. Difficulties may be due to co-morbidities: obesity, skin problems, muscular problems, a history of neurological disease or associated morphological bone deformities. Obese patients must be informed of their specific risks and a surgical approach must be used that obtains maximum exposure. Healing of incisions is not a particular problem, but adhesions must be assessed. Neurological diseases may require tenotomy and the use of implants that limit instability. Specific techniques or implants are necessary to respect hip biomechanics (offset, neck-shaft angle) in case of a large lever arm or coxa vara. In case of arthrodesis, before THA can be performed, the risk of infection must be specifically evaluated if the etiology is infection, and the strength of the gluteal muscles must be determined. Congenital hip dysplasia presents three problems: the position and coverage of the cup, placement of a specific or custom made femoral stem, with an osteotomy if necessary, and finally lowering the femoral head into the cup by freeing the soft tissues or a shortening osteotomy. Acetabular dysplasia should not be underestimated in the presence of significant bone defect (BD), and reconstruction with a bone graft can be proposed. Sequelae from acetabular fractures presents a problem of associated BD. Internal fixation hardware is rarely an obstacle but the surgical approach should take this into account. Treatment of acetabular protrusio should restore a normal center of rotation, and prevent recurrent progressive protrusion. The use of bone grafts and reinforcement rings are indispensible. Femoral deformities may be congenital or secondary to trauma or osteotomy. They must be evaluated to restore hip biomechanics that are as close to normal as possible. Fixation of implants should restore anteversion, length and the lever arm. Most problems that

  5. Promising short-term clinical results of the cementless Oxford phase III medial unicondylar knee prosthesis.

    PubMed

    van Dorp, Karin B; Breugem, Stefan Jm; Bruijn, Daniël J; Driessen, Marcel Jm

    2016-04-18

    To investigate the short-term clinical results of the Oxford phase III cementless medial unicondylar knee prosthesis (UKP) compared to the cemented medial UKP. We conducted a cross-sectional study in a tertairy orthopedic centre between the period of May 2010 and September 2012. We included 99 medial UKP in 97 patients and of these UKP, 53 were cemented and 46 were cementless. Clinical outcome was measured using a questionnaire, containing a visual analogue scale (VAS) for pain, Oxford Knee score, Kujala score and SF-12 score. Knee function was tested using the American Knee Society score. Complications, reoperations and revisions were recorded. Statistical significance was defined as a P value < 0.05. In a mean follow-up time of 19.5 mo, three cemented medial UKP were revised to a total knee prosthesis. Reasons for revision were malrotation of the tibial component, aseptic loosening of the tibial component and progression of osteoarthritis in the lateral- and patellofemoral compartment. In five patients a successful reoperation was performed, because of impingement or (sub)luxation of the polyethylene bearing. Patients with a reoperation were significant younger than patients in the primary group (56.7 vs 64.0, P = 0.01) and were more likely to be male (85.7% vs 38.8%, P = 0.015). Overall the cementless medial UKP seems to perform better, but the differences in clinical outcome are not significant; a VAS pain score of 7.4 vs 11.7 (P = 0.22), an Oxford Knee score of 43.3 vs 41.7 (P = 0.27) and a Kujala score of 79.6 vs 78.0 (P = 0.63). The American Knee Society scores were slightly better in the cementless group with 94.5 vs 90.2 (P = 0.055) for the objective score and 91.2 vs 87.8 (P = 0.25) for the subjective score. The cementless Oxford phase III medial UKP shows good short-term clinical results, when used in a specialist clinic by an experienced surgeon.

  6. The effect of abductor muscle and anterior-posterior hip contact load simulation on the in-vitro primary stability of a cementless hip stem

    PubMed Central

    2010-01-01

    Background In-vitro mechanical tests are commonly performed to assess pre-clinically the effect of implant design on the stability of hip endoprostheses. There is no standard protocol for these tests, and the forces applied vary between studies. This study examines the effect of the abductor force with and without application of the anterior-posterior hip contact force in the in-vitro assessment of cementless hip implant stability. Methods Cementless stems (VerSys Fiber Metal) were implanted in twelve composite femurs which were divided into two groups: group 1 (N = 6) was loaded with the hip contact force only, whereas group 2 (N = 6) was additionally subjected to an abductor force. Both groups were subjected to the same cranial-caudal hip contact force component, 2.3 times body weight (BW) and each specimen was subjected to three levels of anterior-posterior hip contact load: 0, -0.1 to 0.3 BW (walking), and -0.1 to 0.6 BW (stair climbing). The implant migration and micromotion relative to the femur was measured using a custom-built system comprised of 6 LVDT sensors. Results Substantially higher implant motion was observed when the anterior-posterior force was 0.6BW compared to the lower anterior-posterior load levels, particularly distally and in retroversion. The abductor load had little effect on implant motion when simulating walking, but resulted in significantly less motion than the hip contact force alone when simulating stair climbing. Conclusions The anterior-posterior component of the hip contact load has a significant effect on the axial motion of the stem relative to the bone. Inclusion of the abductor force had a stabilizing effect on the implant motion when simulating stair climbing. PMID:20576151

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

    PubMed

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

    2009-01-01

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

  8. Results of single stage exchange arthroplasty with retention of well fixed cement-less femoral component in management of infected total hip arthroplasty

    PubMed Central

    Rahman, Wael A; Kazi, Hussain A; Gollish, Jeffery D

    2017-01-01

    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

  9. Fracture Blisters After Primary Total Knee Arthroplasty.

    PubMed

    Halawi, Mohamad J

    2015-08-01

    Fracture blisters are tense vesicles that arise on markedly swollen skin overlying traumatized soft tissue. While this relatively uncommon complication has been well described in the trauma literature, this article reports for the first time a case of fracture blisters after primary total knee arthroplasty. The fracture blisters developed within 36 hours of surgery and were associated with profound swelling and erythema. There was no evidence of vascular injury, compartment syndrome, iatrogenic fracture, or deep venous thrombosis. The patient was treated with leg elevation, loosely applied nonadhesive dressings, and a short course of oral antibiotics after skin desquamation. Blood-filled blisters required longer time to reepithelialization than fluid-filled blisters. Knee stiffness developed because of pain and fear of participation with physical therapy, but the patient was able to resume intensive rehabilitation after resolution of the blisters. Patient factors, surgical factors, and review of the literature are discussed.

  10. Cementless modular hip arthroplasty as a salvage operation for failed internal fixation of trochanteric fractures in elderly patients.

    PubMed

    Laffosse, Jean-Michel; Molinier, François; Tricoire, Jean-Louis; Bonnevialle, Nicolas; Chiron, Philippe; Puget, Jean

    2007-12-01

    Failure of internal fixation of trochanteric fractures requires repeat surgery in order to avoid the risks of complications affecting bedridden patients. This study was conducted to assess the results of hemi- or total hip arthroplasty with a cementless modular femoral stem, as a salvage operation following early mechanical failure of internal fixation. Twenty nine patients with a mean age of 81.1 years (70-91) were included in the study. Fractures extending into the diaphysis and pathological fractures were excluded, as well as patients who presented late complications. A cementless modular stem designed for metaphyso-diaphyseal anchorage was used in all cases. Twenty-two patients underwent hemiarthroplasty and seven total hip arthroplasty. Four patients died within one year and two were lost to follow-up. The remaining 23 patients were followed for a mean of 20 months (range: 6-89). At the time of last follow-up, 20 were ambulatory with (11 cases) or without support (9 cases) and three were bedridden. There were no intra- or postoperative femoral fractures. Two patients presented an early dislocation after bipolar hemiarthroplasty. One was successfully treated by closed reduction; the other underwent revision with a dual mobility acetabular component because of recurrent dislocation. All the patients reported significant pain relief and functional improvement. Subsidence of the stem greater than 5 mm was noted in three cases, without clinical consequences. The cementless modular femoral stem used in this study appeared as a reliable implant. Primary arthroplasty with such an implant could be considered in selected cases such as markedly unstable fractures and in osteoporotic elderly patients.

  11. Initial mechanical stability of cementless highly-porous titanium tibial components

    SciTech Connect

    Stone, Timothy Brandon; Amer, Luke D; Warren, Christopher P; Cornwell, Phillip; Meneghini, R Michael

    2008-01-01

    Cementless fixation in total knee replacement has seen limited use since reports of early failure surfaced in the late 80s and early 90s. However the emergence of improved biomaterials, particularly porous titanium and tantalum, has led to a renewed interest in developing a cementless tibial component to enhance long-term survivorship of the implants. Cement is commonly employed to minimize micromotion in new implants but represents a weak interface between the implant and bone. The elimination of cement and application of these new biomaterials, which theoretically provide improved stability and ultimate osseointegration, would likely result in greater knee replacement success. Additionally, the removal of cement from the procedure would help minimize surgical durations and get rid of the time needed for curing, thereby the chance of infection. The purpose of this biomechanical study was twofold. The first goal was to assess whether vibration analysis techniques can be used to evaluate and characterize initial mechanical stability of cementless implants more accurately than the traditional method of micromotion determination, which employs linear variable differential transducers (LVDTs). Second, an evaluative study was performed to determine the comparative mechanical stability of five designs of cementless tibial components under mechanical loading designed to simulate in vivo forces. The test groups will include a cemented Triathlon Keeled baseplate control group, three different 2-peg cementless baseplates with smooth, mid, and high roughnesses and a 4-peg cement/ess baseplate with mid-roughness.

  12. Mid-term outcome of a modular, cementless, proximally hydroxyapatite-coated, anatomic femoral stem.

    PubMed

    Cossetto, David J; Goudar, Anil

    2012-12-01

    To report the mid-term outcome of a modular, cementless, proximally hydroxyapatitecoated, anatomic femoral stem in total hip arthroplasty (THA). 160 consecutive patients aged 42 to 92 (mean, 70) years underwent 185 cementless THAs for primary osteoarthritis or femoral neck fractures. All procedures were performed by a single surgeon using the same modular, cementless, proximally hydroxyapatite-coated, anatomic femoral stem, regardless of age and bone quality. Clinical evaluation (pain, range of movement, and ability to walk) was based on the Merle d'Aubigne and Postel scores. Radiological assessment was based on criteria by Engh et al. in the 7 Gruen zones with regard to the presence of radiolucent lines, osteolysis, cancellous condensation, cortical hypertrophy or atrophy, reactive lines, and pedestal formation. Failure of the stem was defined as revision or impending revision because of aseptic loosening or pain. Of the 160 patients, 21 died and none were lost to follow-up. In 3 of the 21 patients, the femoral stems were revised for periprosthetic fractures after a fall at 6 weeks, 10 months, and 3.8 years. 138 patients (162 THAs) completed a mean follow-up of 7.8 (range, 5.5-10.4) years. Their overall mean Merle d'Aubigne and Postel scores increased from 7.09 preoperatively to 16.36 postoperatively. The mean Engh score was 24.9 out of 27, with the mean score for femoral stem fixation 10 out of 10 and 14.9 out of 17 for femoral stem stability. No reactive lines at the bone-stem interfaces and no subsidence or osteolysis were evident in any of the radiographs. There were 5 periprosthetic femoral fractures, 2 deep infections, 3 dislocations, and 2 aseptic loosening (one each for the femoral stem and acetabular socket). Survivorship of the femoral stem at 10 years was 99% when revision secondary to only aseptic loosening of the stem was the endpoint. It was 96% when failures due to all causes (infection, periprosthetic fracture, and aseptic loosening) were the

  13. Computationally efficient prediction of bone-implant interface micromotion of a cementless tibial tray during gait.

    PubMed

    Fitzpatrick, Clare K; Hemelaar, Pleun; Taylor, Mark

    2014-05-07

    Cementless tibial fixation in total knee replacement (TKR) has potential for improved fixation and ease of revision. Achieving primary stability in cementless TKR is critical to the performance of the components. Excessive micromotion may prevent osseointegration at the bone-implant interface. Computational finite element (FE) studies have been used to predict micromotion at the interface, but analysis of an entire activity cycle is computational expensive, prohibiting large numbers of analyses. Surrogate modeling methods can be used to train a numerical model to predict the response of an FE model. These models are computationally efficient and are suitable for high-volume or iterative analyses requiring probabilistic, statistical or optimization methods. The objective of this work was to train a surrogate model capable of predicting micromotion over the entire bone-implant interface. A proximal tibial bone with mapped material properties was virtually implanted with a tibial tray. A FE model, with six-degree-of-freedom loads sampled from telemetric patients during walking, was used to generate training data for the surrogate model. The linear response surrogate model was evaluated for six full gait cycles; the average and peak micromotion across the interface, and the percentage of bone-implant interface surface area experiencing micromotions less than 50 and greater than 150µm were calculated both as a function of the activity cycle and as the composite peak micromotion throughout the cycle. Differences in root-mean-square (RMS) micromotion between FE and surrogate models were less than 14µm. FE analysis time for a complete gait cycle was 15h, compared to 30s for the surrogate model. Surrogate models have significant potential to rapidly predict micromotion over the entire bone-implant interface, allowing greater range in loading conditions to be explored than is possible through conventional methods. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Long-term follow-up results of a second-generation cementless femoral prosthesis with a collar and straight distal fixation channels.

    PubMed

    Han, Chang Wook; Yang, Ick Hwan; Lee, Hye Yeon; Han, Chang Dong

    2012-01-01

    We evaluated the results of more than 10 years of follow-up of total hip arthroplasty using a second-generation cementless femoral prosthesis with a collar and straight distal fixation channels. One hundred five patients (129 hips) who underwent surgery between 1991 and 1996 for primary total hip arthroplasty using cementless straight distal fluted femoral stems were followed for more than 10 years. Ninety-four hips in 80 patients were available for clinical and radiologic analysis. The mean age at the time of surgery was 47 years, and the mean duration of follow-up was 14.3 years. The mean Harris hip scores had improved from 58 points to 88 points at the time of the 10-year follow-up. Activity-related thigh pain was reported in nine hips (10%). At the last follow-up, 93 stems (99%) were biologically stable and one stem (1%) was revised because of loosening. No hip had distal diaphyseal osteolysis. Proximal femoral stress-shielding was reported in 86 hips (91%). We found no significant relationship between collar-calcar contact and thigh pain, stem fixation status, or stress-shielding. The cumulative survival of the femoral stem was 99% (95% confidence interval, 98-100%) after 10 years. The long-term results of total hip arthroplasty using a second-generation cementless femoral prosthesis with a collar and straight distal fixation channels were satisfactory; however, the high rate of proximal stress-shielding and the minimal effect of the collar indicate the need for some changes in the stem design.

  15. Application of Total Quality Management System in Thai Primary Schools

    ERIC Educational Resources Information Center

    Prueangphitchayathon, Setthiya; Tesaputa, Kowat; Somprach, Kanokorn

    2015-01-01

    The present study seeks to develop a total quality management (TQM) system that can be applied to primary schools. The approach focuses on customer orientation, total involvement of all constituencies and continuous improvement. TQM principles were studied and synthesized according to case studies of the best practices in 3 primary schools (small,…

  16. Application of Total Quality Management System in Thai Primary Schools

    ERIC Educational Resources Information Center

    Prueangphitchayathon, Setthiya; Tesaputa, Kowat; Somprach, Kanokorn

    2015-01-01

    The present study seeks to develop a total quality management (TQM) system that can be applied to primary schools. The approach focuses on customer orientation, total involvement of all constituencies and continuous improvement. TQM principles were studied and synthesized according to case studies of the best practices in 3 primary schools (small,…

  17. The Harris-Galante cementless acetabular component: results in 190 cases with at least 3 years follow-up.

    PubMed

    Claus, B; Van Innis, B; De Witte, E; Van Overschelde, J; Magotteaux, B; Fatemi, F; Vandepaer, F

    1993-01-01

    The results of 190 primary total hip arthroplasties with a Harris-Galante cementless acetabular cup were reviewed. All patients had a minimum follow-up of 3 years (range, 3 to 5.5 years, mean 46 months). Clinical and radiographical analysis was performed. Inguinal pain was recorded in five cases. We noted a fracture of a screw in four cases without further implications. There was no evidence of acetabular loosening. There was no migration of the acetabular cup. No acetabular component showed measurable wear of the polyethylene liner. Non-progressive radiolucent lines were recorded in 14% of the patients: among these patients, radiolucent lines were noted in zone 1 in 46%, in zone 2 in 4% and in zone 3 in 86%. Two socket revisions became necessary. One patient suffered a deep-seated infection. Another revision was necessary because of recurrent dislocation.

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

    PubMed Central

    Pulido, Luis; Rachala, Sridhar R.

    2011-01-01

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

  19. [2- to 5-year follow-up of cementless implantable knee joint prosthesis of the Miller-Galante type].

    PubMed

    Kienapfel, H; Griss, P; Orth, J; Roloff, K; Malzer, U

    1991-06-01

    Based on a prospective study protocol, the two- to five-year results of the Miller-Galante cementless total knee arthroplasty are presented. Sixty-four implants were placed in 59 patients: 60 implantations were cementless and 4 cemented. Clinically, the scores for pain, range of motion, walking and stair climbing improved significantly. Radiographically, the uncemented components displayed no signs of definite or possible loosening, whereas one of the cemented components was found to be definitely loose. On histological evaluation of the retrieved implants, all components had bone ingrowth.

  20. In vitro osteogenic capacity of bone marrow MSCs from postmenopausal women reflect the osseointegration of their cementless hip stems.

    PubMed

    Alm, Jessica J; Moritz, Niko; Aro, Hannu T

    2016-12-01

    Age-related dysfunction of mesenchymal stromal cells (MSCs) is suggested as a main cause of altered bone repair with aging. We recently showed that in postmenopausal women undergoing cementless total hip arthroplasty (THA) aging, low bone mineral density (BMD) and age-related geometric changes of the proximal femur are risk factors for increased early migration and delayed osseointegration of the femoral stems. Extending these analyses, we have here explored how the in vitro osteogenic capacity of bone marrow MSCs from these patients reflects implant osseointegration, representing the patient's in vivo bone healing capacity. A total of 19 postmenopausal women with primary hip osteoarthritis (mean age 65 years, range 50-78) and well-defined bone quality underwent successful preoperative in vitro analysis of osteogenic capacity of iliac crest bone marrow MSCs as well as two-year radiostereometric (RSA) follow-up of femoral stem migration after cementless THA. In patients with MSCs of low osteogenic capacity, the magnitude of cumulative stem subsidence after the settling period of three months was greater (p = 0.028) and the time point for translational osseointegration was significantly delayed (p = 0.030) compared to patients with MSCs of high osteogenic capacity. This study suggests that patients with MSCs of low in vitro osteogenic capacity may display increased stem subsidence after the settling period of 3 months and thereby delayed osseointegration. Our study presents a novel approach for studying the biological progress of hip implant osseointegration and to verify the impact of decreased MSCs function, especially in patients with age-related dysfunction of MSCs and bone healing capacity.

  1. Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis.

    PubMed

    Chin, Garwin; Wright, David J; Snir, Nimrod; Schwarzkopf, Ran

    2016-02-01

    Increasing hip fracture incidence in the United States is leading to higher occurrences of conversion total hip arthroplasty (THA) for failed surgical treatment of the hip. In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Medicaid services currently bundles conversion and primary THA under the same diagnosis-related group. We examined the cost of treatment of conversion THA compared with primary THA. Our hypothesis is that conversion THA will have higher cost and resource use than primary THA. Fifty-one consecutive conversion THA patients (Current Procedure Terminology code 27132) and 105 matched primary THA patients (Current Procedure Terminology code 27130) were included in this study. The natural log-transformed costs for conversion and primary THA were compared using regression analysis. Age, gender, body mass index, American Society of Anesthesiologist, Charlson comorbidity score, and smoker status were controlled in the analysis. Conversion THA subgroups formed based on etiology were compared using analysis of variance analysis. Conversion and primary THAs were determined to be significantly different (P<.05) and greater in the following costs: hospital operating direct cost (29.2% greater), hospital operating total cost (28.8% greater), direct hospital cost (24.7% greater), and total hospital cost (26.4% greater). Based on greater hospital operating direct cost, hospital operating total cost, direct hospital cost, and total hospital cost, conversion THA has significantly greater cost and resource use than primary THA. In order to prevent disincentives for treating these complex surgical patients, reclassification of conversion THA is needed, as they do not fit together with primary THA. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Greater trochanter osteotomy with cementless THA for Crowe type IV DDH.

    PubMed

    Lei, Pengfei; Hu, Yihe; Cai, PengDe; Xie, Jie; Yang, XuCheng; Wang, Long

    2013-05-01

    This study explored the surgical method and short-term clinical effect of a greater trochanter osteotomy along with cementless artificial total hip arthroplasty in the treatment of Crowe type IV developmental dysplasia of the hip. The authors conducted a retrospective analysis of 18 patients (22 hips) with Crowe type IV dysplasia who were seen between June 2008 and August 2010. After undergoing cementless artificial total hip arthroplasty using a posterolateral approach, a greater trochanter osteotomy was used to adjust the tension of the gluteal muscle, and an acetabular cup was placed. Average preoperative length shortening of the affected limb was 4.5 cm (range, 3.4-6 cm), and average postoperative length increase was 4.0 cm (range, 3.2-4.8 cm). Average postoperative Harris Hip Score was 87 (range, 79-91), which was higher than the average preoperative score of 38 (range, 32-51). Intraoperatively, 3 hips (3 patients) sustained a proximal femur fracture. Due to the stability of the femoral prosthesis, either no treatment or wire fixation only was given; by 2 months postoperatively, radiographs indicated that all fractures had healed. One patient had symptoms of sciatic nerve paralysis that resolved 3 months postoperatively. Performing a greater trochanter osteotomy after cementless artificial total hip arthroplasty is effective for the treatment of Crowe type IV dysplasia and can rebuild the complex biology and biomechanics of hip dysplasia without increasing the complication risk. Copyright 2013, SLACK Incorporated.

  3. Contemporary total hip arthroplasty with and without cement in patients with osteonecrosis of the femoral head.

    PubMed

    Kim, Young-Hoo; Oh, S-H; Kim, J-S; Koo, K-H

    2003-04-01

    The rate of failure of primary total hip arthroplasty in patients with osteonecrosis of the femoral head is higher than that in patients with osteoarthritis. The purpose of this prospective study was to document the clinical and radiographic results of arthroplasty with so-called third-generation cementing and the results of second-generation cementless total hip arthroplasty in ninety-eight consecutive patients with osteonecrosis of the femoral head. Fifty patients who had had simultaneous bilateral total hip arthroplasty with a cemented stem in one hip and a cementless stem in the other and forty-eight patients who had had a unilateral total hip arthroplasty with a cementless stem were included in the study. A cementless acetabular component was used in all hips. The presumed cause of the osteonecrosis was ethanol abuse in fifty-seven patients, unknown in twenty-seven, fracture of the femoral neck in nine, and steroid use in five. There were eighty men and eighteen women. The mean age at the time of the arthroplasty was 47.3 years (range, twenty-six to fifty-eight years). Clinical and radiographic evaluations were performed preoperatively; at six weeks; at three, six, and twelve months; and yearly thereafter. The average duration of follow-up was 9.3 years. The average Harris hip scores in the group treated with unilateral arthroplasty (97 points) and the group treated with bilateral arthroplasty (94 points) were similar at the time of final follow-up. They were also similar between the group treated with cement (mean, 96 points) and that treated without cement (95 points). No component had aseptic loosening in either group. In one hip, a cemented femoral stem (2%) and a cementless cup were revised because of infection. Two cementless stems (2%) were revised because of fracture of the proximal part of the femur with loosening of the stem. Annual wear of the polyethylene liner averaged 0.22 mm in the group treated with cement (a zirconia head) and 0.14 mm in the

  4. Design process of cementless femoral stem using a nonlinear three dimensional finite element analysis

    PubMed Central

    2014-01-01

    Background Minimal available information concerning hip morphology is the motivation for several researchers to study the difference between Asian and Western populations. Current use of a universal hip stem of variable size is not the best option for all femur types. This present study proposed a new design process of the cementless femoral stem using a three dimensional model which provided more information and accurate analysis compared to conventional methods. Methods This complete design cycle began with morphological analysis, followed by femoral stem design, fit and fill analysis, and nonlinear finite element analysis (FEA). Various femur parameters for periosteal and endosteal canal diameters are measured from the osteotomy level to 150 mm below to determine the isthmus position. Results The results showed better total fit (53.7%) and fill (76.7%) canal, with more load distributed proximally to prevent stress shielding at calcar region. The stem demonstrated lower displacement and micromotion (less than 40 μm) promoting osseointegration between the stem–bone and providing primary fixation stability. Conclusion This new design process could be used as a preclinical assessment tool and will shorten the design cycle by identifying the major steps which must be taken while designing the femoral stem. PMID:24484753

  5. Total Quality Management Practices in Turkish Primary Schools

    ERIC Educational Resources Information Center

    Toremen, Fatih; Karakus, Mehmet; Yasan, Tezcan

    2009-01-01

    Purpose: The purpose of this paper is to determine the extent of total quality management (TQM) practices in primary schools based on teachers' perceptions, and how their perceptions are related to different variables. Design/methodology/approach: In this study, a survey based descriptive scanning model was used. This study was carried out in…

  6. Total Quality Management Practices in Turkish Primary Schools

    ERIC Educational Resources Information Center

    Toremen, Fatih; Karakus, Mehmet; Yasan, Tezcan

    2009-01-01

    Purpose: The purpose of this paper is to determine the extent of total quality management (TQM) practices in primary schools based on teachers' perceptions, and how their perceptions are related to different variables. Design/methodology/approach: In this study, a survey based descriptive scanning model was used. This study was carried out in…

  7. Comparative Fixation and Subsidence Profiles of Cementless Unicompartmental Knee Arthroplasty Implants.

    PubMed

    Yildirim, Gokce; Gopalakrishnan, Ananthkrishnan; Davignon, Robert A; Parker, John W; Chawla, Harshvardhan; Pearle, Andrew D

    2016-09-01

    Aseptic loosening is the primary cause of failure for both cemented and cementless unicondylar knee replacements (UKRs). Micromotion and subsidence of tibial baseplate are two causes of failure, due to poor fixation and misalignment, respectively. Stair ascent activity profiles from Bergmann et al and Li et al were used. Biphasic Sawbones models were prepared according to the surgical techniques of traditional and novel cementless UKRs. Implants were tested for 10,000 cycles representing post-operative bone interdigitation period, and micromotion was observed using speckle pattern measurements, which demonstrated sufficient resolution. Additionally, the test method proposed by Liddle et al was used to measure subsidence with pressure sensors under increasingly lateralized loading. Mean displacement due to micromotion for mediolateral and anteroposterior plane was consistently greater for traditional cementless UKR. Mean displacement for axial micromotion was significantly higher for traditional UKR at the anterior aspect of the implant; however, values were lower for the medial periphery of the implant. Subsidence was significantly lower for the novel design with increasingly lateralized loading, and indentation was not observed on the test substrate, when compared to the traditional design. Our findings demonstrate that the novel cementless design is capable of fixation and elimination of subsidence in laboratory test settings. Both designs limit micromotion to below the established loosening micromotion value of 150 μm. The L-shaped keel design resists both micromotion and subsidence and may prevent failure modes that can lead to aseptic loosening for UKRs. These findings are highly relevant for clinical application. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Comparative Study of Bipolar Hemiarthroplasty for Femur Neck Fractures Treated with Cemented versus Cementless Stem

    PubMed Central

    Choi, Jung-Yun; Kim, Joo-Hyung

    2016-01-01

    Purpose To compare and analyze clinical and radiologic outcomes of cemented versus cementless bipolar hemiarthroplasty for treatment of femur neck fractures. Materials and Methods A total of 180 patients aged 65 years and over older who underwent bipolar hemiarthroplasty for treatment of displaced femur neck fractures (Garden stage III, IV) from March 2009 to February 2014 were included in this study. Among the 180 patients, 115 were treated with cemented stems and 65 patients with cementless stems. Clinical outcomes assessed were: i) postoperative ambulatory status, ii) inguinal and thigh pain, and iii) complications. The radiologic outcome was femoral stem subsidence measured using postoperative simple X-ray. Results The cemented group had significantly lower occurrence of complications (postoperative infection, P=0.04) compared to the cementless group. There was no significant difference in postoperative ambulatory status, inguinal and thigh pain, and femoral stem subsidence. Conclusion For patients undergoing bipolar hemiarthroplasty, other than complications, there was no statistically significant difference in clinical or radiologic outcomes in our study. Selective use of cemented stem in bipolar hemiarthroplasty may be a desirable treatment method for patients with poor bone quality and higher risk of infections. PMID:28097110

  9. Mid-Term Outcomes and Complications with Cementless Distal Locking Hip Revision Stem with Hydroxyapatite Coating for Proximal Bone Defects and Fractures.

    PubMed

    Carrera, Lluis; Haddad, Sleiman; Minguell, Joan; Amat, Carles; Corona, Pablo S

    2015-06-01

    We revised the first 100 revision total hip arthroplasties using a cementless distal locking revision stem conducted in our referral centre. Average follow-up was 9.2 years (range: 5.5-12 years). Harris Hip Score improved from 42.5 to 81.6, and none had thigh pain at last follow-up. No significant stress shielding, osteolysis, or radiologic loosening was found. All patients showed radiological evidence of secondary implant osseointegration. Overall survival was 97% with three patients being revised: two stem ruptures and one subsidence. We could trace these complications to technical errors. These findings suggest that a diaphyseal fixation of the revision stem with distal locking can provide the needed primary axial and rotational stability of the prosthesis. This would allow further bony ingrowth, enhanced by the hydroxyapatite coating.

  10. Uncemented primary press-fit total hip arthroplasty: a 3 to 6 years of experience.

    PubMed

    Vidyadhara, S; Rao, S K

    2007-04-01

    To analyse the 3 to 6 years' clinicoradiological outcome of 45 uncemented total hip arthroplasties performed in 37 patients using cementless Spotorno stem and St Nabor cup. The main indications for surgery were avascular necrosis of the femoral head and rheumatoid arthritis. Younger patients with good bone quality and a trumpet-shaped femur were eligible. A single surgeon performed all the operations using a posterolateral approach. Patients were reviewed at 6 weeks, 3 months, 6 months, and yearly thereafter. The clinical status was recorded using the Harris Hip Score. All radiographs were analysed by 2 independent blinded observers on 2 separate occasions. The mean follow-up period was 49 months and the mean Harris Hip Score at the latest follow-up was 94. Osseointegration in the form of trabeculae running from the endosteum to the prosthesis surface along with tropism of the calcar was evident in 73% of the hips. None of the remaining hips showed any continuous radio-opaque lines suggestive of a lack of bone ongrowth. Patients with endosteal condensation had better Harris Hip Scores. Intra-operative stability of the implants could fairly predict outcome. Initial clinicoradiological results of uncemented total hip arthroplasty are promising in younger patients with good bone quality and a trumpet-shaped femur.

  11. Thrombin-Based Hemostatic Agent in Primary Total Knee Arthroplasty.

    PubMed

    Fu, Xin; Tian, Peng; Xu, Gui-Jun; Sun, Xiao-Lei; Ma, Xin-Long

    2017-02-01

    The present meta-analysis pooled the results from randomized controlled trials (RCTs) to identify and assess the efficacy and safety of thrombin-based hemostatic agent in primary total knee arthroplasty (TKA). Potential academic articles were identified from the Cochrane Library, Medline (1966-2015.5), PubMed (1966-2015.5), Embase (1980-2015.5), and ScienceDirect (1966-2015.5). Relevant journals and the recommendations of expert panels were also searched by using Google search engine. RCTs assessing the efficacy and safety of thrombin-based hemostatic agent in primary TKA were included. Pooling of data was analyzed by RevMan 5.1 (The Cochrane Collaboration, Oxford, UK). A total of four RCTs met the inclusion criteria. The meta-analysis revealed significant differences in postoperative hemoglobin decline (p < 0.00001), total blood loss (p < 0.00001), drainage volume (p = 0.01), and allogenic blood transfusion (p = 0.01) between the treatment group and the control group. No significant differences were found regarding incidence of infection (p = 0.45) and deep vein thrombosis (DVT; p = 0.80) between the groups. Meta-analysis indicated that the application of thrombin-based hemostatic agent before wound closure decreased postoperative hemoglobin decline, drainage volume, total blood loss, and transfusion rate and did not increase the risk of infection, DVT, or other complications. Therefore, the reviewers believe that thrombin-based hemostatic agent is effective and safe in primary TKA. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. The difficult primary total knee arthroplasty: a review.

    PubMed

    Baldini, A; Castellani, L; Traverso, F; Balatri, A; Balato, G; Franceschini, V

    2015-10-01

    Primary total knee arthroplasty (TKA) is a reliable procedure with reproducible long-term results. Nevertheless, there are conditions related to the type of patient or local conditions of the knee that can make it a difficult procedure. The most common scenarios that make it difficult are discussed in this review. These include patients with many previous operations and incisions, and those with severe coronal deformities, genu recurvatum, a stiff knee, extra-articular deformities and those who have previously undergone osteotomy around the knee and those with chronic dislocation of the patella. Each condition is analysed according to the characteristics of the patient, the pre-operative planning and the reported outcomes. When approaching the difficult primary TKA surgeons should use a systematic approach, which begins with the review of the existing literature for each specific clinical situation.

  13. Primary total hip replacement versus hip resurfacing - hospital considerations.

    PubMed

    Ward, William G; Carter, Christina J; Barone, Marisa; Jinnah, Riyaz

    2011-01-01

    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.

  14. Utility of modular implants in primary total hip arthroplasty.

    PubMed

    Berry, Daniel J

    2014-04-01

    Most surgeons believe that some level of modularity has a valuable role to play in primary total hip arthroplasty. However, all modular junctions carry some risk and recent problems with taper tribocorrosion have elevated concerns. These problems suggest that more rigorous preclinical testing should be undertaken before new types of modularity are widely used. Efforts to further optimize these junctions where they are needed, avoidance of gratuitous use of modular junctions where they provide only modest benefits, and a judicious approach to adopting new modularity are reasonable approaches to current concerns. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. The appropriateness of blood transfusion following primary total hip replacement

    PubMed Central

    Joy, PJ; Bennet, SJ

    2012-01-01

    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

  16. Cost Analysis of Ceramic Heads in Primary Total Hip Arthroplasty.

    PubMed

    Carnes, Keith J; Odum, Susan M; Troyer, Jennifer L; Fehring, Thomas K

    2016-11-02

    The advent of adverse local tissue reactions seen in metal-on-metal bearings, and the recent recognition of trunnionosis, have led many surgeons to recommend ceramic-on-polyethylene articulations for primary total hip arthroplasty. However, to our knowledge, there has been little research that has considered whether the increased cost of ceramic provides enough benefit over cobalt-chromium to justify its use. The primary purpose of this study was to compare the cost-effectiveness of ceramic-on-polyethylene implants and metal-on-polyethylene implants in patients undergoing total hip arthroplasty. Markov decision modeling was used to determine the ceramic-on-polyethylene implant revision rate necessary to be cost-effective compared with the revision rate of metal-on-polyethylene implants across a range of patient ages and implant costs. A different set of Markov models was used to estimate the national cost burden of choosing ceramic-on-polyethylene implants over metal-on-polyethylene implants for primary total hip arthroplasties. The Premier Research Database was used to identify 20,398 patients who in 2012 were ≥45 years of age and underwent a total hip arthroplasty with either a ceramic-on-polyethylene implant or a metal-on-polyethylene implant. The cost-effectiveness of ceramic heads is highly dependent on the cost differential between ceramic and metal femoral heads and the age of the patient. At a cost differential of $325, ceramic-on-polyethylene bearings are cost-effective for patients <85 years of age. At a cost differential of $600, it is cost-effective to utilize ceramic-on-polyethylene bearings in patients <65 years of age, and, at a differential of $1,003, ceramic-on-polyethylene bearings are not cost-effective at any age. The ability to recoup the initial increased expenditure of ceramic heads through a diminished lifetime revision cost is dependent on the price premium for ceramic and the age of the patient. A wholesale switch to ceramic bearings

  17. Comparison of Clinical Efficacy Between Modular Cementless Stem Prostheses and Coated Cementless Long-Stem Prostheses on Bone Defect in Hip Revision Arthroplasty

    PubMed Central

    Li, Huibin; Chen, Fang; Wang, Zhe; Chen, Qian

    2016-01-01

    Background The aim of this study was to investigate and compare the clinical efficacy of modular cementless stem and coated cementless long-stem prostheses in hip revision arthroplasty. Material/Methods Sixty-five patients with complete hip revision surgery data during January 2005 to March 2015 were selected from the People’s Hospital of Linyi City and randomly divided into a S-ROM group (implanted with cementless modular stem prostheses, n=32) and a SLR-PLUS group (implanted with cementless coated long-stem prostheses, n=33). Harris score was used to evaluate the hip function of the patients in order to measure the clinical efficacy of the prostheses in total hip arthroplasty. Anteroposterior pelvic radiographs and lateral pelvic radiographs were taken and each patient’s hip arthroplasty condition was recorded. Kaplan-Meier method was applied to compare the cumulative 5-year non-revision rate between the 2 prostheses and log-rank method was used to inspect the statistical data. Results The Harris scores of both the S-ROM group and the SLR-PLUS group were significantly higher at 12 months after the operation than those before the operation (both P<0.05). The Harris scores of the patients with type I/II bone defects in the S-ROM group were not significantly different from those of the same types in the SLR-PLUS group at all time points (all P>0.05), while the Harris scores of the patients with type IIIA/IIIB in the S-ROM group were both significantly higher than those of the same types in the SLR-PLUS group at 3 months, 6 months, and 12 months after the operation (all P<0.05). No significant difference was found in the cumulative 5-year non-revision rate between the type I/II patients in the S-ROM group (92.31%) and the patients of the same types in the SLR-PLUS group (85.71%) (P>0.05). However, the cumulative 5-year non-revision rate of the type IIIA/IIIB patients in the S-ROM group (89.47%) was significantly different from the patients of the same types in

  18. Gross trunnion failure after primary total hip arthroplasty.

    PubMed

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

    2015-04-01

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

  19. Perioperative Periprosthetic Fractures Associated With Primary Total Hip Arthroplasty.

    PubMed

    Park, Kwan J; Menendez, Mariano E; Barnes, C Lowry

    2017-03-01

    Periprosthetic fracture (PPF) is a rare but devastating complication of primary total hip arthroplasty (THA). While PPF is associated with increased morbidity and mortality, early revision rate, and poor patient outcome, there is a paucity of data on patient and hospital-dependent risk factors. Using a large administrative database, we investigated epidemiology and the risk factors associated with perioperative PPF after primary THA. We performed a retrospective review of the National Inpatient Sample records from 2006 to 2011 and identified 1062 PPFs of 1,187,969 patients using International Classification of Diseases, Ninth Revision code for PPF (996.44). We then analyzed sociodemographic characteristics, comorbidities, and hospital characteristics of our study population. The overall incidence of PPF in National Inpatient Sample database was 0.089% (8.9 per 10,000 THAs). Patient-dependent risk factors were: female (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.67-2.22), low household income (OR 1.4, 95% CI 1.18-1.65), Medicaid (OR 1.89, 95% CI 1.39-2.57), and uninsured (OR 2.74, 95% CI 1.63-4.61). Patients with malnutrition and hemiparesis/hemiplegia were associated 10-fold and 6-fold risk of PPF. Nonteaching hospitals (OR 1.15, 95% CI 1.01-1.32), hospitals in northeast (OR 1.29, 95% CI 1.04-1.59), and rural hospitals (OR 1.27, 95% CI 1.06-1.53) had higher incidence of PPF. Our study demonstrates that the incidence of PPF was low in our study population, and greater awareness is needed when performing primary THAs in patients with risk factors identified in our study to prevent PPF. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Digital templating in primary total hip and knee arthroplasty.

    PubMed

    Levine, Brett; Fabi, David; Deirmengian, Carl

    2010-11-02

    The use of digital radiography is becoming more prevalent in orthopedics. This transition impacts the ability to preoperatively plan for implants in total hip arthroplasty (THA) and total knee arthroplasty (TKA). This article reports on the clinical success of digital templating using the Advanced Case Plan (Stryker Imaging, Flower Mound, Texas) system in primary THA and TKA. Digital radiographs of 269 consecutive patients undergoing primary THA (93 cases) or TKA (176 cases) were templated using the Advanced Case Plan digital software package. A 25.4-mm metallic sphere was used as a calibrating marker. Anteroposterior hip and lateral knee radiographs were digitally templated preoperatively and compared to the actual size of the implants at the time of surgery. The accuracy of calibrating images using the metallic sphere was validated by measuring the diameter of femoral heads on 25 postoperative hip radiographs. Digital templating was accurate in predicting the correct implant size in 58.5% of THAs and 66% of TKAs. In 93% of THAs and 98.5% of TKAs, preoperative templating was within 1 size of the final implant. There were no cases in which the predicted implant size varied from the final components by >2 sizes. Calibrating the image using the metallic sphere marker was found to be highly accurate, predicting the correct femoral head size within 1.5 mm in all 25 cases (7 hemiarthroplasties and 18 THAs). Digital templating is an effective means for predicting the size of THA and TKA components, thus remaining a viable option as we transition into the modern era of digital radiography. Future studies will evaluate interobserver reliability and the impact of level of training on templating accuracy. Copyright 2010, SLACK Incorporated.

  1. Intravenous versus topical tranexamic acid in primary total hip replacement

    PubMed Central

    Zhang, Pei; Liang, Yuan; Chen, Pengtao; Fang, Yongchao; He, Jinshan; Wang, Jingcheng

    2016-01-01

    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

  2. Cementless surface replacement arthroplasty (Copeland CSRA) for osteoarthritis of the shoulder.

    PubMed

    Levy, Ofer; Copeland, Stephen A

    2004-01-01

    Clinical experience with the Copeland cementless surface replacement arthroplasty (CSRA) of the shoulder now spans 17 years. Between 1986 and 1997, 79 CSRAs (42 total shoulder replacements and 37 hemiarthroplasties) were performed for primary osteoarthritis of the shoulder. Total shoulder replacement was done in 12 men and 30 women with a mean age of 71.5 years (range, 50-87 years). Hemiarthroplasty was used in 9 men and 28 women; 5 patients had bilateral hemiarthroplasty. The mean age was 73.4 years (range, 53-88 years). Thirty-nine total shoulder arthroplasties and thirty hemiarthroplasties with a follow-up of more than 2 years were available for review. The mean follow-up was 7.6 years (range, 48 months to 13 years) for total shoulder replacement and 4.4 years (range, 24 months to 6.5 years) for hemiarthroplasty. The Constant scores improved from an age-adjusted Constant score of 33.8% (20.0 points) to 94% (61.9 points) for total shoulder replacement and from an age-adjusted Constant score 40.0% (25.3 points) to 91% (58.1 points) for hemiarthroplasty. Active elevation improved by a mean of 59.9 degrees to a mean of 128 degrees for total shoulder replacement and to a mean of 124 degrees for hemiarthroplasty. Of the patients, 89.9% considered the shoulder to be much better or better as a result of the operation. Radiographically, one humeral implant and three glenoid implants had evidence of loosening. Four revisions were performed in the total shoulder replacement group. No revision surgery was needed in the hemiarthroplasty group. The results of this series are at least comparable to those reported for stemmed prostheses with a comparable length of follow-up. The results of total shoulder replacement and hemiarthroplasty in osteoarthritis of the shoulder seem to be comparable. With use of the CSRA prosthesis, several severe complications mainly concerning the humeral shaft and periprosthetic fractures can be avoided. Should the need for revision surgery or

  3. Constrained total hip megaprosthesis for primary periacetabular tumors.

    PubMed

    Ueda, Takafumi; Kakunaga, Shigeki; Takenaka, Satoshi; Araki, Nobuhito; Yoshikawa, Hideki

    2013-03-01

    Limb-salvage reconstruction for periacetabular malignant tumors is one of the most challenging problems in orthopaedic oncology. Reconstructive options include resection arthroplasty, endoprosthesis, allograft, recycled autobone graft, arthrodesis, and pseudarthrosis. However, no standard procedure exists because of rarity and clinical variability of the disease. We previously developed a megaprosthetic system with a constrained total hip mechanism (C-THA). We evaluated (1) survival of patients and C-THA; (2) postoperative function; and (3) complications. We retrospectively reviewed 25 patients with primary periacetabular tumors treated using C-THA between 1985 and 2009. There were 18 male and seven female patients with a median age of 44 years (range, 16-72 years). They included 11 chondrosarcomas, eight osteosarcomas, two giant cell tumors of bone (one locally aggressive benign, one malignant), and others in four. Surgical margin was wide in 18 patients, marginal in five, and intralesional in two. The minimum postoperative followup for survivors was 32 months (median, 163 months; range, 32-285 months). The 10-year overall survival rate of all patients was 47%. C-THA implants survived in 19 of 25 patients at last followup. Twenty-one patients acquired ambulatory activity. There were seven local recurrences, resulting in hemipelvectomy in one patient. Postoperative complications included deep infection in eight of the 25 patients, dislocation in four, and aseptic loosening in two, necessitating five revision surgeries and three implant removals. Our observations suggest C-THA using an acetabular reconstruction cup is a useful reconstructive option after resection of periacetabular malignant tumors despite frequent postoperative complications. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

  4. [Reflections on a small series of cementless total hip prostheses].

    PubMed

    Troussel, S; Van Innis, F; Thys, R

    1990-01-01

    We report on our series of 48 patients with uncemented hip prostheses, with an average follow-up of 3 years. The clinical results, according to the Merle d'Aubigné's classification, are comparable to those obtained with cemented prostheses except for transitory pain, very often localized to the lateral aspect of the thigh, which seems to be correlated with the bone adaptation to the implant. Radiological findings are valuable in the assessment of long-term results with uncemented prostheses. During the operation, it is of utmost importance that the surgeon obtain a very tight fit of the prosthesis into the bone, which must be confirmed on postoperative X-ray. Under such conditions, the radiological appearance remains the same, showing a condensation line outlining the cup and absence of radiolucent lines along the stem. On the other hand, cortical thickening, bony condensation around the tip of the stem and sclerotic lines are the radiological evidence of bone adaptation to the prosthesis. They are not indicative of a less good result. Finally, radiolucent lines wider than 1 millimeter, extending along the stem, or a progressive sinking of the femoral component are the radiological signs of implant instability. In these rare cases, the prognosis may be compromised.

  5. Intra-operative evaluation of cementless hip implant stability: a prototype device based on vibration analysis.

    PubMed

    Lannocca, Maurizio; Varini, Elena; Cappello, Angelo; Cristofolini, Luca; Bialoblocka, Ewa

    2007-10-01

    Cementless implants are mechanically stabilized during surgery by a press-fitting procedure. Good initial stability is crucial to avoid stem loosening and bone cracking, therefore, the surgeon must achieve optimal press-fitting. A possible approach to solve this problem and assist the surgeon in achieving the optimal compromise, involves the use of vibration analysis. The present study aimed to design and test a prototype device able to evaluate the primary mechanical stability of a cementless prosthesis, based on vibration analysis. In particular, the goal was to discriminate between stable and quasi-stable implants; thus the stem-bone system was assumed to be linear in both cases. For that reason, it was decided to study the frequency responses of the system, instead of the harmonic distortion. The prototype developed consists of a piezoelectric exciter connected to the stem and an accelerometer attached to the femur. Preliminary tests were performed on four composite femurs implanted with a conventional stem. The results showed that the input signal was repeatable and the output could be recorded accurately. The most sensitive parameter to stability was the shift in resonance frequency of the stem-bone system, which was highly correlated with residual micromotion on all four specimens.

  6. INNOPLANT Total Hip Replacement System.

    PubMed

    Harper, Tisha A M

    2017-07-01

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

  7. A genetic algorithm based multi-objective shape optimization scheme for cementless femoral implant.

    PubMed

    Chanda, Souptick; Gupta, Sanjay; Kumar Pratihar, Dilip

    2015-03-01

    The shape and geometry of femoral implant influence implant-induced periprosthetic bone resorption and implant-bone interface stresses, which are potential causes of aseptic loosening in cementless total hip arthroplasty (THA). Development of a shape optimization scheme is necessary to achieve a trade-off between these two conflicting objectives. The objective of this study was to develop a novel multi-objective custom-based shape optimization scheme for cementless femoral implant by integrating finite element (FE) analysis and a multi-objective genetic algorithm (GA). The FE model of a proximal femur was based on a subject-specific CT-scan dataset. Eighteen parameters describing the nature of four key sections of the implant were identified as design variables. Two objective functions, one based on implant-bone interface failure criterion, and the other based on resorbed proximal bone mass fraction (BMF), were formulated. The results predicted by the two objective functions were found to be contradictory; a reduction in the proximal bone resorption was accompanied by a greater chance of interface failure. The resorbed proximal BMF was found to be between 23% and 27% for the trade-off geometries as compared to ∼39% for a generic implant. Moreover, the overall chances of interface failure have been minimized for the optimal designs, compared to the generic implant. The adaptive bone remodeling was also found to be minimal for the optimally designed implants and, further with remodeling, the chances of interface debonding increased only marginally.

  8. Subsequent Total Joint Arthroplasty After Primary Total Knee or Hip Arthroplasty: A 40-Year Population-Based Study.

    PubMed

    Sanders, Thomas L; Maradit Kremers, Hilal; Schleck, Cathy D; Larson, Dirk R; Berry, Daniel J

    2017-03-01

    Despite the large increase in total hip arthroplasties and total knee arthroplasties, the incidence and prevalence of additional contralateral or ipsilateral joint arthroplasty are poorly understood. The purpose of this study was to determine the rate of additional joint arthroplasty after a primary total hip arthroplasty or total knee arthroplasty. This historical cohort study identified population-based cohorts of patients who underwent primary total hip arthroplasty (n = 1,933) or total knee arthroplasty (n = 2,139) between 1969 and 2008. Patients underwent passive follow-up through their medical records beginning with the primary total hip arthroplasty or total knee arthroplasty. We assessed the likelihood of undergoing a subsequent total joint arthroplasty, including simultaneous and staged bilateral procedures. Age, sex, and calendar year were evaluated as potential predictors of subsequent arthroplasty. During a mean follow-up of 12 years after an initial total hip arthroplasty, we observed 422 contralateral total hip arthroplasties (29% at 20 years), 76 contralateral total knee arthroplasties (6% at 10 years), and 32 ipsilateral total knee arthroplasties (2% at 20 years). Younger age was a significant predictor of contralateral total hip arthroplasty (p < 0.0001), but not a predictor of the subsequent risk of total knee arthroplasty. During a mean follow-up of 11 years after an initial total knee arthroplasty, we observed 809 contralateral total knee arthroplasties (45% at 20 years), 31 contralateral total hip arthroplasties (3% at 20 years), and 29 ipsilateral total hip arthroplasties (2% at 20 years). Older age was a significant predictor of ipsilateral or contralateral total hip arthroplasty (p < 0.001). Patients undergoing total hip arthroplasty or total knee arthroplasty can be informed of a 30% to 45% chance of a surgical procedure in a contralateral cognate joint and about a 5% chance of a surgical procedure in noncognate joints within 20 years of

  9. Medial pivot knee in primary total knee arthroplasty.

    PubMed

    Atzori, Francesco; Salama, Wael; Sabatini, Luigi; Mousa, Shazly; Khalefa, Abdelrahman

    2016-01-01

    Total knee arthroplasty (TKA) with a medial pivot design was developed in order to mimic normal knee kinematics; the highly congruent medial compartment implant should improve clinical results and decrease contact stresses. Clinical and radiographic mid-term outcomes are satisfactory, but we need other studies to evaluate long-term results and indications for unusual cases.

  10. Basic Science Considerations in Primary Total Hip Replacement Arthroplasty

    PubMed Central

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

    2010-01-01

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

  11. [Management of Flexion Contracture in Primary Total Knee Arthroplasty].

    PubMed

    Hube, R; Mayr, H O; Pfitzner, T; von Roth, P

    2015-06-01

    Flexion contracture is a common deformity of the arthritic knee. The present publication describes causes, clinical relevance and surgical technique in the presence of flexion contractures in total knee arthroplasty. Flexion contracture can be attributed to different causes. Basically it is a mismatch between flexion and extension gaps. Moderate and severe deformities have to be corrected by additional surgical interventions. In most cases soft tissue techniques with release of contracted structures, the removal of osteophytes and additional distal femoral bone resection are necessary. The goal of these interventions is to achieve full extension of the knee. During rehabilitation attention has to be paid to maintain it with intensive physical therapy. A remaining flexion contracture is associated with inferior functional outcome and persistent pain.

  12. [Pain following primary total knee replacement: causes, diagnosis and treatment].

    PubMed

    van Geene, Arnoud R; Saris, Daniël B F; Custers, Roel J H

    2015-01-01

    Total knee prosthesis (TKP) placement is a successful treatment for patients with disabling osteoarthritis of the knee. Despite good results, there is a large group of patients who are not satisfied following the procedure. Men, young patients and patients with chronic pain are more often satisfied after TKP placement, as are patients with a higher social status, better mental-health status and lower preoperative pain scores. The diagnostic workup for patients suffering pain after TKP placement is labour intensive, and should be carried out in a systematic manner. Treatment of pain varies per individual, ranging from medication and physiotherapy to revision surgery. There is limited data on how many patients do actually experience pain reduction following treatment.

  13. Anterior knee pain following primary total knee arthroplasty

    PubMed Central

    Shervin, David; Pratt, Katelyn; Healey, Travis; Nguyen, Samantha; Mihalko, William M; El-Othmani, Mouhanad M; Saleh, Khaled J

    2015-01-01

    Despite improvements in technique and technology for total knee arthroplasty (TKA), anterior knee pain impacts patient outcomes and satisfaction. Addressing the prosthetic and surgical technique related causes of pain after TKA, specifically as it relates to anterior knee pain, can aid surgeons in addressing these issues with their patients. Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/flange combination; asymmetric patellar resurfacing, improper transverse plane component rotation resulting in patellar subluxation/tilt. Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator. As the number of TKA procedures continues to increase, it is increasingly critical to develop improved, evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications. PMID:26601061

  14. Wound dressings for primary and revision total joint arthroplasty

    PubMed Central

    Chowdhry, Madhav

    2015-01-01

    Background Preventing post-surgical complications after total joint arthroplasty (TJA) is of great importance, and application of an appropriate wound dressing is necessary. Since no dressing encompasses all the parameters required for ideal wound healing, a comparison of the available dressing types can assist the surgeon to choose the best dressing after TJA. Methods Studies evaluating postoperative wound dressings after TJA were reviewed in order to assess the outcomes, complications and costs associated with dressing types. Results Traditional cotton dressings have a high ability to absorb exudate. However, they dry out sooner and there is a risk of pain and additional trauma during dressing changes. Although vapor permeable dressings allow transmission of moisture, but they have low absorptive capacity and require frequent changes even with moderately exudating wounds. On the other hand, hydrofiber and hydrocolloid dressings have high absorptive capacity and permeability, and can cope with exudate production. They are changed less often and have low blistering rates, which may reduce surgical site infection (SSI). Although the unit cost associated with advanced dressings is much higher than the traditional dressings, the decreased rate of periprosthetic joint infection (PJI) and the cost associated with treating PJI more than compensate for it. Conclusions Choice of dressing type after TJA should depend upon permeability, absorptive capacity, documented rate of SSI and cost effectiveness with its use, apart from a surgeon’s past clinical experience and familiarity. PMID:26605314

  15. Femoral head diameter considerations for primary total hip arthroplasty.

    PubMed

    Girard, J

    2015-02-01

    The configuration of total hip arthroplasty (THA) implants has constantly evolved since they were first introduced. One of the key components of THA design is the diameter of the prosthetic femoral head. It has been well established that the risk of dislocation is lower as the head diameter increases. But head diameter impacts other variables beyond joint stability: wear, cam-type impingement, range of motion, restoration of biomechanics, proprioception and groin pain. The introduction of highly cross-linked polyethylene and hard-on-hard bearings has allowed surgeons to implant large-diameter heads that almost completely eliminate the risk of dislocation. But as a result, cup liners have become thinner. With femoral head diameters up to 36 mm, the improvement in joint range of motion, delay in cam-type impingement and reduction in dislocation risk have been clearly demonstrated. Conversely, large-diameter heads do not provide any additional improvements. If an "ecologically sound" approach to hip replacement is embraced (e.g. keeping the native femoral head diameter), hip resurfacing with a metal-on-metal bearing must be carried out. The reliability of large-diameter femoral heads in the longer term is questionable. Large-diameter ceramic-on-ceramic bearings may be plagued by the same problems as metal-on-metal bearings: groin pain, squeaking, increased stiffness, irregular lubrication, acetabular loosening and notable friction at the Morse taper. These possibilities require us to be extra careful when using femoral heads with a diameter greater than 36 mm. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  16. Use of PROMIS for Patients Undergoing Primary Total Shoulder Arthroplasty

    PubMed Central

    Dowdle, S. Blake; Glass, Natalie; Anthony, Chris A.; Hettrich, Carolyn M.

    2017-01-01

    Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) consists of question banks for health domains through computer adaptive testing (CAT). Hypothesis: For patients with glenohumeral arthritis, (1) there would be high correlation between traditional patient-reported outcome (PRO) measures and the PROMIS upper extremity item bank (PROMIS UE) and PROMIS physical function CAT (PROMIS PF CAT), and (2) PROMIS PF CAT would not demonstrate ceiling effects. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Sixty-one patients with glenohumeral osteoarthritis were included. Each patient completed the American Shoulder and Elbow Surgeons (ASES) assessment form, Marx Shoulder Activity Scale, Short Form–36 physical function scale (SF-36 PF), EuroQol 5 Dimensions (EQ-5D) questionnaire, Western Ontario Osteoarthritis Shoulder (WOOS) index, PROMIS PF CAT, and the PROMIS UE. Correlation was defined as high (>0.7), moderate (0.4-0.6), or weak (0.2-0.3). Significant floor and ceiling effects were present if more than 15% of individuals scored the lowest or highest possible total score on any PRO. Results: The PROMIS PF demonstrated excellent correlation with the SF-36 PF (r = 0.81, P < .0001) and good correlation with the ASES (r = 0.62, P < .0001), EQ-5D (r = 0.64, P < .001), and WOOS index (r = 0.51, P < .01). The PROMIS PF demonstrated low correlation with the Marx scale (r = 0.29, P = .02). The PROMIS UE demonstrated good correlation with the ASES (r = 0.55, P < .0001), SF-36 (r = 0.53, P < .01), EQ-5D (r = 0.48, P < .01), and WOOS (r = 0.34, P <.01), and poor correlation with the Marx scale (r = 0.06, P = .62). There were no ceiling or floor effects observed. The mean number of items administered by the PROMIS PRO was 4. Conclusion: These data suggest that for a patient population with operative shoulder osteoarthritis, PROMIS UE and PROMIS PF CAT may be valid alternative PROs. Additionally, PROMIS PF CAT offers a decreased

  17. Use of PROMIS for Patients Undergoing Primary Total Shoulder Arthroplasty.

    PubMed

    Dowdle, S Blake; Glass, Natalie; Anthony, Chris A; Hettrich, Carolyn M

    2017-09-01

    The Patient-Reported Outcomes Measurement Information System (PROMIS) consists of question banks for health domains through computer adaptive testing (CAT). For patients with glenohumeral arthritis, (1) there would be high correlation between traditional patient-reported outcome (PRO) measures and the PROMIS upper extremity item bank (PROMIS UE) and PROMIS physical function CAT (PROMIS PF CAT), and (2) PROMIS PF CAT would not demonstrate ceiling effects. Cohort study (diagnosis); Level of evidence, 3. Sixty-one patients with glenohumeral osteoarthritis were included. Each patient completed the American Shoulder and Elbow Surgeons (ASES) assessment form, Marx Shoulder Activity Scale, Short Form-36 physical function scale (SF-36 PF), EuroQol 5 Dimensions (EQ-5D) questionnaire, Western Ontario Osteoarthritis Shoulder (WOOS) index, PROMIS PF CAT, and the PROMIS UE. Correlation was defined as high (>0.7), moderate (0.4-0.6), or weak (0.2-0.3). Significant floor and ceiling effects were present if more than 15% of individuals scored the lowest or highest possible total score on any PRO. The PROMIS PF demonstrated excellent correlation with the SF-36 PF (r = 0.81, P < .0001) and good correlation with the ASES (r = 0.62, P < .0001), EQ-5D (r = 0.64, P < .001), and WOOS index (r = 0.51, P < .01). The PROMIS PF demonstrated low correlation with the Marx scale (r = 0.29, P = .02). The PROMIS UE demonstrated good correlation with the ASES (r = 0.55, P < .0001), SF-36 (r = 0.53, P < .01), EQ-5D (r = 0.48, P < .01), and WOOS (r = 0.34, P <.01), and poor correlation with the Marx scale (r = 0.06, P = .62). There were no ceiling or floor effects observed. The mean number of items administered by the PROMIS PRO was 4. These data suggest that for a patient population with operative shoulder osteoarthritis, PROMIS UE and PROMIS PF CAT may be valid alternative PROs. Additionally, PROMIS PF CAT offers a decreased question burden with no ceiling effects.

  18. Change in preoperative expectations in patients undergoing staged bilateral primary total knee or total hip arthroplasty.

    PubMed

    Poultsides, Lazaros A; Ghomrawi, Hassan M K; Lyman, Stephen; Aharonoff, Gina B; Mancuso, Carol A; Sculco, Thomas P

    2012-10-01

    The objective of this study was to compare preoperative expectation scores between stages in patients with bilateral total knee arthroplasty (TKA) and total hip arthroplasty (THA) using intraclass correlation coefficients (ICCs). For patients with TKA (57), ICC was 0.449, indicating fair agreement between stages; expectations did not change for 31% of patients, whereas 40% had higher and 29% had lower expectations. For patients with THA (55), ICC was 0.663, indicating moderate agreement; expectations did not change for 42% of patients, whereas 38% had higher and 20% had lower expectations. In multivariable analyses controlling for first expectation score, second expectation score was associated with better Western Ontario McMaster Universities Osteoarthritis Index stiffness score for TKA and with worse Western Ontario McMaster Universities Osteoarthritis Index function score for patients with THA. For most patients, expectations changed between staged bilateral TKA and THA, but the direction of change was not uniform.

  19. Clinical results of Hi-tech Knee II total knee arthroplasty in patients with rheumatoid athritis: 5- to 12-year follow-up

    PubMed Central

    2012-01-01

    Background Total knee arthroplasty (TKA) is a common form of treatment to relieve pain and improve function in cases of rheumatoid arthritis (RA). Good clinical outcomes have been reported with a variety of TKA prostheses. The cementless Hi-Tech Knee II cruciate-retaining (CR)-type prosthesis, which has 6 fins at the anterior of the femoral component, posterior cruciate ligament (PCL) retention, flat-on-flat surface component geometry, all-polyethylene patella, strong initial fixation by the center screw of the tibial base plate, 10 layers of titanium alloy fiber mesh, and direct compression molded ultra high molecular weight polyethylene (UHMWPE), is appropriate for TKA in the Japanese knee. The present study was performed to evaluate the clinical results of primary TKA in RA using the cementless Hi-Tech Knee II CR-type prosthesis. Materials and methods We performed 32 consecutive primary TKAs using cementless Hi-Tech Knee II CR-type prosthesis in 31 RA patients. The average follow-up period was 8 years 3 months. Clinical evaluations were performed according to the American Knee Society (KS) system, knee score, function score, radiographic evaluation, and complications. Results The mean postoperative maximum flexion angle was 115.6°, and the KS knee score and function score improved to 88 and 70 after surgery, respectively. Complications, such as infection, occurred in 1 patient and revision surgery was performed. There were no cases of loosening in this cohort, and prosthesis survival rate was 96.9% at 12 years postoperatively. Conclusion These results suggest that TKA using the cementless Hi-Tech Knee II CR-type prosthesis is a very effective form of treatment in RA patients at 5 to 12 years postoperatively. Further long-term follow-up studies are required to determine the ultimate utility of this type of prosthesis. PMID:22356935

  20. Cementless Tapered Wedge Femoral Stems Decrease Subsidence in Obese Patients Compared to Traditional Fit-and-Fill Stems.

    PubMed

    Grant, Tanner W; Lovro, Luke R; Licini, David J; Warth, Lucian C; Ziemba-Davis, Mary; Meneghini, Robert M

    2017-03-01

    Femoral component stability and resistance to subsidence is critical for osseointegration and clinical success in cementless total hip arthroplasty. The purpose of this study was to radiographically evaluate the anatomic fit and subsidence of 2 different proximally tapered, porous-coated modern cementless femoral component designs. A retrospective cohort study of 126 consecutive cementless total hip arthroplasties was performed. Traditional fit-and-fill stems were implanted in the first 61 hips with the remaining 65 receiving morphometric tapered wedge stems. Preoperative bone morphology was radiographically assessed by the canal flare index. Canal fill in the coronal plane, subsidence, and the sagittal alignment of stems was measured digitally on immediate and 1-month postoperative radiographs. Demographics and canal flare indices were similar between groups. The percentage of femoral canal fill was greater in the tapered wedge compared to the fit-and-fill stem (P = .001). There was significantly less subsidence in the tapered wedge design (0.3 mm) compared to the fit-and-fill design (1.1 mm) (P = .001). Subsidence significantly increased as body mass index (BMI) increased in the fit-and-fill stems, a finding not observed in the tapered wedge design (P = .013). An anatomically designed morphometric tapered wedge femoral stem demonstrated greater axial stability and decreased subsidence with increasing BMI than a traditional fit-and-fill stem. The resistance to subsidence, irrespective of BMI, is likely due to the inherent axial stability of a tapered wedge design and may be the optimal stem design for obese patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. The prevention of periprosthetic fractures of the femur during and after total hip arthroplasty.

    PubMed

    Mitchell, Philip A; Greidanus, Nelson V; Masri, Bassam A; Garbuz, Donald S; Duncan, Clive P

    2003-01-01

    The increasing prevalence of periprosthetic fractures of the femur associated with total hip arthroplasty (THA) is caused by several factors, including the increasing use of cementless prostheses in both primary and revision procedure, the rise in THAs in younger patients, who are more at risk of high-energy trauma, and the increasing longevity of elderly patients after THA. With approximately 200,000 THAs performed annually in North America, fracture prevention is extremely important for the individual patient and has a significant impact on the health care system.

  2. A gentamicin-releasing coating for cementless hip prostheses-Longitudinal evaluation of efficacy using in vitro bio-optical imaging and its wide-spectrum antibacterial efficacy.

    PubMed

    Neut, Daniëlle; Dijkstra, René J B; Thompson, Jonathan I; van der Mei, Henny C; Busscher, Henk J

    2012-12-01

    Cementless prostheses are increasingly popular in total hip arthroplasties. Therewith, common prophylactic measures to reduce the risk of postoperative infection like the use of antibiotic-loaded bone cements, will no longer be available. Alternative prophylactic measures may include the use of antibiotic-releasing coatings. Previously, we developed a gentamicin-releasing coating for cementless titanium hip prostheses and derived an appropriate dosing of this coating by adjusting the amount of gentamicin in the coating to match the antibacterial efficacy of clinically employed gentamicin-loaded bone cement. In this manuscript, we investigated two important issues regarding the prophylactic use of this 1 mg cm(-2) bioactive gentamicin-releasing coating in cementless total hip arthroplasty: (1) its ability to prevent bacterial growth in a geometrically relevant set-up and (2) its antibacterial spectrum. A geometrically relevant set-up was developed in which miniature titanium stems were surrounded by agar, contaminated with bioluminescent Staphylococcus aureus. Novel, bio-optical imaging was performed allowing noninvasive, longitudinal monitoring of staphylococcal growth around miniature stems with and without the gentamicin-releasing coating. Furthermore, the antibacterial efficacy of the gentamicin-releasing coating was determined against a wide variety of clinical isolates, including bioluminescent Staphylococcus aureus strains, using traditional zone of inhibition measurements. The gentamicin-releasing coating demonstrated a wide-spectrum of antibacterial efficacy and successfully prevented growth of bioluminescent staphylococci around a miniature stem mounted in bacterially contaminated agar for at least 60 h. This implies that the gentamicin-releasing coating has potential to contribute to the improvement of infection prophylaxis in cementless total hip arthroplasty.

  3. Acoustic pattern evaluation during cementless hip arthroplasty surgery may be a new method for predicting complications

    PubMed Central

    Morohashi, Itaru; Iwase, Hideaki; Kanda, Akio; Sato, Taichi; Homma, Yasuhiro; Mogami, Atsuhiko; Obayashi, Osamu; Kaneko, Kazuo

    2017-01-01

    Background: Although surgeons must perform implantation of the cementless stem during total hip arthroplasty (THA) without complications, assessment is left to the surgeon’s intuitive judgement, which could contain inter/intra-observer bias variety. We therefore asked (1) whether the sound created during the stem implantation could be evaluated objectively and (2) whether those sounds are correlate to the complication specific to the cementless stems. Our hypothesis is that the sounds produced during stem insertion could be quantified and related to the complications. Patients and method: In 71 THAs, we quantified the sound produced during stem insertion and investigated the relationship between these sounds and the occurrence of intraoperative fracture and subsidence. Results: The sound data were divided into two patterns: Patterns A and B. The difference between the peak value (dB) at the most common frequency (near 7 kHz) and the second most common frequency (near 4 kHz) of strikes during the final phase of implantation in Patterns A and B showed a significant difference. Adverse events on intraoperative fracture and subsidence were significantly less common in patients with Pattern A than in those with Pattern B (six of 42 hips with Pattern A and 13 of 29 hips with Pattern B, p = 0.004). Pattern A in predicting a clinical course without those adverse events was 69.2% and the specificity was 68.4%. Positive and negative predictive values were 85.7% and 44.8%, respectively. Conclusion: The sound generated during stem insertion was quantified. Those sound patterns were associated with complications. PMID:28186872

  4. Ten-year results after cementless THA with a sandwich-type alumina ceramic bearing.

    PubMed

    Park, Youn-Soo; Park, Se-Jun; Lim, Seung-Jae

    2010-11-02

    We analyzed the long-term results of a single-surgeon series of 102 cementless total hip arthroplasties (THAs) performed using a sandwich-type alumina ceramic bearing. The prostheses involved a porous-coated acetabular socket, a polyethylene-alumina composite liner, a 28-mm alumina head, and a grit-blasted titanium-alloy stem. Mean patient age at the time of THA was 39 years (range, 18-66 years), and 76% of the patients were younger than 50 years. All procedures were performed with use of the same surgical technique and the same implant at a single center. Mean follow-up was 115 months (range, 84-133 months). When failure was defined as revision of either the acetabular or the femoral component for any reason, Kaplan-Meier survival probability at 10 years was 95.3% (95% confidence interval, 89.5%-100%). Mean Harris Hip Score improved from 47 points (range, 16-70 points) preoperatively to 95 points (range, 85-100 points) at final follow-up. No radiographically detectable osteolysis around the acetabular or femoral component was observed in any hip. No patient reported squeaking in the operated hip. During the follow-up period, 3 hips (3%) required revision surgery; 2 underwent acetabular revision because of a ceramic liner fracture and 1 underwent revision for early loosening of the acetabular cup. Ten-year results of cementless THA with a sandwich-type alumina ceramic bearing were encouraging, and no great increase in ceramic failure rate was observed, which contrasts with the findings of previously reported short-term follow-up studies. Copyright 2010, SLACK Incorporated.

  5. Five-year experience of cementless Oxford unicompartmental knee replacement.

    PubMed

    Pandit, H G; Campi, S; Hamilton, T W; Dada, O D; Pollalis, S; Jenkins, C; Dodd, C A F; Murray, D W

    2017-03-01

    Cementless unicompartmental knee replacement (UKR) was introduced to address some of the problems that can occur following cemented UKR. The aim of this study was to report the 5-year experience of the first 512 medial cementless Oxford UKR implanted by two surgeons for the recommended indications. The first consecutive 512 cementless Phase 3 Oxford UKRs implanted by two surgeons for the recommended indications between June 2004 and October 2013 were prospectively identified and followed up independently. All the procedures were carried out through a minimally invasive approach without eversion or dislocation of the patella. Patients were assessed clinically pre-operatively and at 1, 2, 5, 7 and 10 years after surgery with functional outcome scores and radiographs. There were eight reoperations of which six were revisions giving a 5-year survival of 98 % (95 % CI 94-100 %). At a mean follow-up of 3.4 years (1.0-10.2), the mean OKS was 43 (SD 7), AKSS (objective) was 81 (SD 13), and AKSS (functional) was 86 (SD 17). The first 120 cases had a minimum follow-up of 5 years (mean 5.9; range 5-10.2). In these patients, the mean OKS was 41 (SD 8), AKSS (objective) was 81 (SD 14), and AKSS (functional) was 82 (SD 18). There were no femoral radiolucencies and no complete tibial radiolucencies. 11 % of tibial components had partial radiolucent lines; the remaining 89 % had no radiolucencies. The clinical results are as good as or better than those previously reported for cemented fixation. The radiographic results are better with secure bony attachment to the implants in every case. IV.

  6. Effect of femoral canal shape on mechanical stress distribution and adaptive bone remodelling around a cementless tapered-wedge stem.

    PubMed

    Oba, M; Inaba, Y; Kobayashi, N; Ike, H; Tezuka, T; Saito, T

    2016-09-01

    In total hip arthroplasty (THA), the cementless, tapered-wedge stem design contributes to achieving initial stability and providing optimal load transfer in the proximal femur. However, loading conditions on the femur following THA are also influenced by femoral structure. Therefore, we determined the effects of tapered-wedge stems on the load distribution of the femur using subject-specific finite element models of femurs with various canal shapes. We studied 20 femurs, including seven champagne flute-type femurs, five stovepipe-type femurs, and eight intermediate-type femurs, in patients who had undergone cementless THA using the Accolade TMZF stem at our institution. Subject-specific finite element (FE) models of pre- and post-operative femurs with stems were constructed and used to perform FE analyses (FEAs) to simulate single-leg stance. FEA predictions were compared with changes in bone mineral density (BMD) measured for each patient during the first post-operative year. Stovepipe models implanted with large-size stems had significantly lower equivalent stress on the proximal-medial area of the femur compared with champagne-flute and intermediate models, with a significant loss of BMD in the corresponding area at one year post-operatively. The stovepipe femurs required a large-size stem to obtain an optimal fit of the stem. The FEA result and post-operative BMD change of the femur suggest that the combination of a large-size Accolade TMZF stem and stovepipe femur may be associated with proximal stress shielding.Cite this article: M. Oba, Y. Inaba, N. Kobayashi, H. Ike, T. Tezuka, T. Saito. Effect of femoral canal shape on mechanical stress distribution and adaptive bone remodelling around a cementless tapered-wedge stem. Bone Joint Res 2016;5:362-369. DOI: 10.1302/2046-3758.59.2000525. © 2016 Yutaka et al.

  7. Effect of femoral canal shape on mechanical stress distribution and adaptive bone remodelling around a cementless tapered-wedge stem

    PubMed Central

    Oba, M.; Kobayashi, N.; Ike, H.; Tezuka, T.; Saito, T.

    2016-01-01

    Objectives In total hip arthroplasty (THA), the cementless, tapered-wedge stem design contributes to achieving initial stability and providing optimal load transfer in the proximal femur. However, loading conditions on the femur following THA are also influenced by femoral structure. Therefore, we determined the effects of tapered-wedge stems on the load distribution of the femur using subject-specific finite element models of femurs with various canal shapes. Patients and Methods We studied 20 femurs, including seven champagne flute-type femurs, five stovepipe-type femurs, and eight intermediate-type femurs, in patients who had undergone cementless THA using the Accolade TMZF stem at our institution. Subject–specific finite element (FE) models of pre- and post-operative femurs with stems were constructed and used to perform FE analyses (FEAs) to simulate single-leg stance. FEA predictions were compared with changes in bone mineral density (BMD) measured for each patient during the first post-operative year. Results Stovepipe models implanted with large-size stems had significantly lower equivalent stress on the proximal-medial area of the femur compared with champagne-flute and intermediate models, with a significant loss of BMD in the corresponding area at one year post-operatively. Conclusions The stovepipe femurs required a large-size stem to obtain an optimal fit of the stem. The FEA result and post-operative BMD change of the femur suggest that the combination of a large-size Accolade TMZF stem and stovepipe femur may be associated with proximal stress shielding. Cite this article: M. Oba, Y. Inaba, N. Kobayashi, H. Ike, T. Tezuka, T. Saito. Effect of femoral canal shape on mechanical stress distribution and adaptive bone remodelling around a cementless tapered-wedge stem. Bone Joint Res 2016;5:362–369. DOI: 10.1302/2046-3758.59.2000525. PMID:27601435

  8. Comparative Risk of Transfusion and Incremental Total Hospitalization Cost for Primary Unilateral, Bilateral, and Revision Total Knee Arthroplasty Procedures.

    PubMed

    Nichols, Christine I; Vose, Joshua G

    2016-03-01

    This study evaluated the comparative risk of autologous and allogenic blood transfusion, inhospital complications, and incremental total hospitalization costs for primary unilateral, simultaneous bilateral, and revision total knee arthroplasty (TKA) procedures. Using the Premier Perspective database, we identified adults who underwent primary unilateral, simultaneous bilateral, or revision TKA procedures. Logistic regression, controlling for patient and hospital characteristics, was used to determine the risk of autologous or allogeneic blood transfusion. Controlling for the same factors, generalized linear models predicted incremental total hospitalization cost associated with transfusion. Between January 2008 and June 2014, 513,558 primary unilateral, 33,977 bilateral, and 32,494 revision TKA patients met selection criteria. The overall percentage receiving a transfusion was 14.1% for unilateral, 36.3% for bilateral, and 20.0% for revision procedures. Logistic regression showed patients aged >65 years, female gender, Northeastern location, large hospitals, and higher Charlson score to be significantly associated with higher transfusion risk. Although overall risk of transfusion decreased over the study period, patients with Charlson score ≥3 were at 2.27 (primary unilateral), 1.88 (bilateral), and 2.44 (revision) greater odds of transfusion compared with healthy controls (Charlson score = 0). Generalized linear models showed an incremental total hospitalization cost among those receiving a transfusion of $2477, $4235, and $8594, respectively, compared with those without transfusion. Transfusion risk remains a significant burden in select patient populations and procedures. The incremental cost of receiving a transfusion is significant, including not only direct costs but also staff time and increased hospital resource use. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Primary repair of infracardiac total anomalous pulmonary venous connection using a modified sutureless technique.

    PubMed

    Buitrago, Efren; Panos, Anthony L; Ricci, Marco

    2008-07-01

    Primary repair of infracardiac total anomalous pulmonary venous connection is associated with a significant risk of recurrent pulmonary venous obstruction. Herein we describe a technique of primary repair in which a modified sutureless anastomosis is constructed by suturing the left atrium to the posterior mediastinal pleura that surrounds the pulmonary venous confluence.

  10. Late Disassembly of Femoral Head and Neck of A Modular Primary Total Hip Arthroplasty

    PubMed Central

    Ahmed, Parvej; Kumar, Dinesh

    2015-01-01

    Introduction: Modular total hip arthroplasty system are now widely used, as these components increase the flexibility during primary and revision total hip arthoplasty. But this modularity itself associated with some risk of intraoperative and postoperative complications. Case Report: We report a case of late disassembly of a primary total arthroplasty in a 42 years old patient five years after the replacement surgery where the femoral head remained in the acetabular socket. Conclusion: Femoral head should be solidly impacted onto the stem and confirm that it has been assembled correctly before reduction. PMID:27299010

  11. Antibacterial efficacy of a new gentamicin-coating for cementless prostheses compared to gentamicin-loaded bone cement.

    PubMed

    Neut, Daniëlle; Dijkstra, René J B; Thompson, Jonathan I; van der Mei, Henny C; Busscher, Henk J

    2011-11-01

    Cementless prostheses are increasingly popular but require alternative prophylactic measures than the use of antibiotic-loaded bone cements. Here, we determine the 24-h growth inhibition of gentamicin-releasing coatings from grit-blasted and porous-coated titanium alloys, and compare their antibacterial efficacies and gentamicin release-profiles to those of a commercially available gentamicin-loaded bone cement. Antibacterial efficacy increased with increasing doses of gentamicin in the coating and loading with 1.0 and 0.1 mg gentamicin/cm(2) on both grit-blasted and porous-coated samples yielded comparable efficacy to gentamicin-loaded bone cement. The coating had a higher burst release than bone cement, and also inhibited growth of gentamicin-resistant strains. Antibacterial efficacy of the gentamicin coatings disappeared after 4 days, while gentamicin-loaded bone cement exhibited efficacy over at least 7 days. Shut-down after 4 days of gentamicin-release from coatings is advantageous over the low-dosage tail-release from bone cements, as it minimizing risk of inducing antibiotic-resistant strains. Both gentamicin-loaded cement discs and gentamicin-coated titanium coupons were able to kill gentamicin-sensitive and -resistant bacteria in a simulated prothesis-related interfacial gap. In conclusion, the gentamicin coating provided similar antibacterial properties to those seen by gentamicin-loaded bone cement, implying protection of a prosthesis from being colonized by peri-operatively introduced bacteria in cementless total joint arthroplasty.

  12. Removal of well-fixed, cementless, acetabular components in revision hip arthroplasty.

    PubMed

    Mitchell, P A; Masri, B A; Garbuz, D S; Greidanus, N V; Wilson, D; Duncan, C P

    2003-09-01

    Removal of well-fixed, cementless, acetabular components during revision arthroplasty remains a challenging problem. Further damage to host bone may limit options for reconstruction and compromise the long-term result of the revision operation. We report the results of 31 hips with well-fixed, cementless sockets which were removed using a new cup extraction system. In all hips the socket was removed without difficulty and with minimal further bone loss.

  13. Primary versus secondary distal femoral arthroplasty for treatment of total knee arthroplasty periprosthetic femur fractures.

    PubMed

    Chen, Antonia F; Choi, Lisa E; Colman, Matthew W; Goodman, Mark A; Crossett, Lawrence S; Tarkin, Ivan S; McGough, Richard L

    2013-10-01

    Current methods of fixing periprosthetic fractures after total knee arthroplasty (TKA) are variable, and include open reduction and internal fixation (ORIF) via plating, retrograde nailing, or revision using standard revision TKA components or a distal femoral arthroplasty (DFA). The purpose of this study is to compare patients who failed plating techniques requiring subsequent revision to DFA to patients who underwent primary DFA. Of the 13 patients (9.2%) who failed primary ORIF, causes included nonunion (53.8%), infection (30.8%), loosening (7.7%), and refracture (7.7%). There were significantly more surgical procedures for ORIF revision to DFA compared to primary DFA. Complications for patients who underwent primary reconstruction with DFAs included extensor mechanism disruption (8.3%), infection (5.6%), and dislocation (2.8%). Primary reconstruction via ORIF is beneficial for preserving bone stock, but primary DFA may be preferred in osteopenic patients, or those at high risk for nonunion.

  14. Revision of minimal resection resurfacing unicondylar knee arthroplasty to total knee arthroplasty: results compared with primary total knee arthroplasty.

    PubMed

    O'Donnell, Turlough M P; Abouazza, Omar; Neil, Michael J

    2013-01-01

    We compared a cohort of patients undergoing revision of a minimal resection resurfacing unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) with a cohort of patients undergoing primary TKA. Both cohorts were matched in terms of age, sex, and body mass index. We collected data on preoperative and postoperative range of motion, International Knee Society scores, and radiologic data. We also collected data on the modes of failure of the primary UKA. There were 55 patients in each cohort. The average time the UKA was in place was 48.3 months. The average follow-up period from the time of revision was 39.2 months. The most common reason for revision was subsidence of the tibial base plate (58%). Forty percent of patients required particulate bone grafting for contained defects. Two patients required metal augments, and 1 required stems. There was no significant difference between the 2 groups in terms of range of motion, functional outcome, or radiologic outcomes. Revision of these types of implants to TKA is associated with similar results to primary TKA and is superior to revision of other forms of UKA.

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

    PubMed Central

    Kumar, Sandeep

    2016-01-01

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

  16. Immediate Cementless Hemiarthroplasty for Severe Destructive Glenohumeral Tuberculous Arthritis

    PubMed Central

    Kosiyatrakul, Arkaphat

    2013-01-01

    The glenohumeral joint tuberculosis (TB) is rare as compared with other joints. Plaster immobilization, arthrodesis, and resection arthroplasty have been proposed as the additional treatments with anti-TB medications in severe destructive arthritis. To our knowledge, however, the surgical treatment with shoulder arthroplasty has never been reported. We present two cases of active TB with unsalvageable glenohumeral joint. The cementless hemishoulder arthroplasties were performed immediately following the radical debridement. Anti-TB medications were given for 12 months after the surgery. Postoperatively, the patients were satisfied with the rapid symptomatic relief and significant functional recovery. With the follow-up period of 5 years, the operative results were still satisfactory and the reactivation of the infection was not detected. PMID:24167752

  17. Quality of life outcomes in revision vs primary total hip arthroplasty: a prospective cohort study.

    PubMed

    Patil, Sanjeev; Garbuz, Donald S; Greidanus, Nelson V; Masri, Bassam A; Duncan, Clive P

    2008-06-01

    This study included 143 patients who had revision total hip arthroplasty (THA) and 144 patients who had primary THA. The primary outcome variable in this study was the Western Ontario and McMaster Universities Osteoarthritis Index scores. Univariate and multivariate regression models were used to assess the relationship between surgical procedure and postoperative health related quality of life outcomes. The mean follow-up period was 1.7 years (range, 1-3 years). The mean preoperative function of patients with primary THA was significantly worse than that in the revision group (delta = -6.2; P = .013). Postoperative functional outcome was significantly better in patients with primary THA (delta = 6.5, P = .016) than in patients who had revision THA. The magnitude of improvement in quality of life is greater for the patient with primary THA in comparison to the patient with revision THA.

  18. Quality of life outcomes in revision versus primary total knee arthroplasty.

    PubMed

    Greidanus, Nelson V; Peterson, Richard C; Masri, Bassam A; Garbuz, Donald S

    2011-06-01

    The purpose of this study was to evaluate and compare the quality of life and satisfaction outcomes of patients undergoing primary and revision total knee arthroplasty (TKA). Sixty revision and 199 primary TKA patients were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford-12 Knee Score, Short Form-12, and patient-reported satisfaction. Baseline preoperative scores demonstrate that revision TKA patients have inferior quality of life across all measures (WOMAC, Oxford-12, and Short Form-12) in comparison with primary TKA patients (P < .05). At follow-up revision, TKA patients continue to have inferior outcomes (P < .05) in comparison with primary TKA patients. When adjusting for confounding factors in regression analyses, revisions are inferior to primary TKA by 8.6 (95% confidence interval, 2.7-14.6) normalized WOMAC units. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. Preparation of the femoral bone cavity in cementless stems: broaching versus compaction

    PubMed Central

    Hjorth, Mette H; Stilling, Maiken; Søballe, Kjeld; Nielsen, Poul Torben; Christensen, Poul H; Kold, Søren

    2016-01-01

    Background and purpose — Short-term experimental studies have confirmed that there is superior fixation of cementless implants inserted with compaction compared to broaching of the cancellous bone. Patients and methods — 1-stage, bilateral primary THA was performed in 28 patients between May 2001 and September 2007. The patients were randomized to femoral bone preparation with broaching on 1 side and compaction on the other side. 8 patients declined to attend the postoperative follow-up, leaving 20 patients (13 male) with a mean age of 58 (36–70) years for evaluation. The patients were followed with radiostereometric analysis (RSA) at baseline, at 6 and 12 weeks, and at 1, 2, and 5 years, and measurements of periprosthetic bone mineral density (BMD) at baseline and at 1, 2, and 5 years. The subjective part of the Harris hip score (HHS) and details of complications throughout the observation period were obtained at a mean interval of 6.3 (3.0–9.5) years after surgery. Results — Femoral stems in the compaction group had a higher degree of medio-lateral migration (0.21 mm, 95% CI: 0.03–0.40) than femoral stems in the broaching group at 5 years (p = 0.02). No other significant differences in translations or rotations were found between the 2 surgical techniques at 2 years (p > 0.4) and 5 years (p > 0.7) postoperatively. There were no individual stems with continuous migration. Periprosthetic BMD in the 7 Gruen zones was similar at 2 years and at 5 years. Intraoperative femoral fractures occurred in 2 of 20 compacted hips, but there were none in the 20 broached hips. The HHS and dislocations were similar in the 2 groups at 6.3 (3.0–9.5) years after surgery. Interpretation — Bone compaction as a surgical technique with the Bi-Metric stem did not show the superior outcomes expected compared to conventional broaching. Furthermore, 2 periprosthetic fractures occurred using the compaction technique, so we cannot recommend compaction for insertion of the

  20. The impact of subsidence on straight and curved modular cementless revision stems in hip revision surgery.

    PubMed

    Fraile Suari, A; Gil González, S; Pérez Prieto, D; León García, A; Mestre Cortadellas, C; Tey Pons, M; Marqués López, F

    Subsidence is one of the potential complications in femoral stem revision total hip arthroplasty surgery, and can affect stability and osseointegration. A retrospective study was conducted on the outcomes at one year and 5 years (specifically subsidence and clinical relevance) of 40 consecutive femoral total hip arthroplasty revisions, comparing two modular cementless revision stems, Straight vs. Curved, with 20 patients in each group. No mechanical failure was observed, and there was an improvement in functional outcomes. Mean radiological subsidence was 9.9±4.9mm (straight=10.75mm vs. curved=9.03mm), with no statistically significant difference between groups (p=0,076). Fourteen patients (35%) had ≥10mm of subsidence, up to a maximum of 22mm. The subsidence found in this study is similar to published series, with no short-term clinical manifestations, or an increased number of complications or stem loosening in either the Straight or Curved group. No differences in subsidence were observed at one year and 5 years after surgery between the 2 types of stems. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Short-term wear of Japanese highly cross-linked polyethylene in cementless THA.

    PubMed

    Miyanishi, Keita; Hara, Toshihiko; Kaminomachi, Shigekazu; Maekawa, Masayuki; Iwamoto, Mikio; Torisu, Takehiko

    2008-09-01

    Production of polyethylene wear from acetabular liners is thought, in part, to mediate the periprosthetic osteolysis. This study examined the in vivo wear performance of Japanese highly cross-linked polyethylene (Aeonian) in cementless total hip arthroplasty. Ninety-five hips received a highly cross-linked polyethylene liner, while 20 hips were implanted with conventional polyethylene. Two-dimensional linear wear was measured on radiographs and volumetric wear was then calculated. Both linear and volumetric wear rates were examined for the 1-year postoperative period as well as for the time frame beginning after 1 year ending with the final follow-up. The amount of linear wear was significantly lower in the cross-linked group at 3 and 5 years postoperatively (P < 0.01 and < 0.001, respectively). Linear and volumetric wear rates after 1 year postoperatively for hips with the cross-linked polyethylene were significantly reduced by 57 and 59%, respectively, when compared to rates for those who received conventional polyethylene (P < 0.01). A multiple logistic regression analysis revealed that cross-linking was a significant factor influencing linear wear rate after 1 year postoperatively with an odds ratio, exp(ss) = 10.033 (P < 0.001). These results suggest that the highly cross-linked polyethylene reduces penetration of the femoral head and may be an optimal bearing surface for patients receiving total hip arthroplasty.

  2. Mortality following primary total knee replacement in public hospitals in Hong Kong.

    PubMed

    Lee, Q J; Mak, W P; Wong, Y C

    2016-06-01

    More than 2000 total knee replacements are performed each year in Hong Kong and more than 10 000 patients are on the waiting list. How safe is total knee replacement, however? The aims of the study were to review the mortality of primary total knee replacement in public hospitals in Hong Kong and to identify risk factors for mortality in a high-volume hospital. All primary total knee replacements performed in Hospital Authority hospitals and Yan Chai Hospital from October 2011 to September 2014 were reviewed. Case-control analysis was performed for risk factors of total all-cause mortality in total knee replacement at Yan Chai Hospital. There were 6588 patients in Hospital Authority hospitals and 1184 in Yan Chai Hospital (1095 unilateral and 89 bilateral total knee replacement). The mean follow-up time of patients in Yan Chai Hospital was 12.8 months. The mortality at 30 days, 90 days and 1 year was 0%, 0.08%, 0.34% for Yan Chai Hospital; and 0.1%, 0.2%, 0.7% for Hospital Authority hospitals, respectively. For Yan Chai Hospital, the mean operation-to-death interval was 21 months (range, 1-35 months). The mean age at death was 78 years and main causes were malignancy (50%) and pneumonia (21%). Predictors of mortality included age at surgery, American Society of Anesthesiologists class 3, and preoperative range of motion. Hospital surgery volume, preoperative co-morbidities, and postoperative deep vein thrombosis were not significant factors. Mortality after primary total knee replacement was low in public hospitals in Hong Kong. Patients of older age or poorer general well-being in terms of poor range of motion or American Society of Anesthesiologists class 3 should be in optimal health before surgery and counselled about the higher mortality rate. A citywide joint replacement registry may help monitor and analyse postoperative total knee replacement mortality specific to our locality.

  3. Cooled-turbine aerodynamic performance prediction from reduced primary to coolant total-temperature-ratio results

    NASA Technical Reports Server (NTRS)

    Goldman, L. J.

    1976-01-01

    The prediction of the cooled aerodynamic performance, for both stators and turbines, at actual primary to coolant inlet total temperature ratios from the results obtained at a reduced total temperature ratio is described. Theoretical and available experimental results were compared for convection film and transpiration cooled stator vanes and for a film cooled, single stage core turbine. For these tests the total temperature ratio varied from near 1.0 to about 2.7. The agreement between the theoretical and the experimental results was, in general, reasonable.

  4. Acidic and total primary sulfates: development of emission factors for major stationary combustion sources

    SciTech Connect

    Goklany, I.M.; Hoffnagle, G.F.; Brackbill, E.A.

    1984-01-01

    ''Best estimates'' of emission factors for major sources of acidic and total primary sulfates are developed for use in the compilation of emission inventories for the eastern U.S. These may, in turn, be used for modeling of acidic or sulfate deposition. The factors are based upon a critical evaluation of the generic measurement methods used to quantify total and acidic primary sulfate emissions, and an exhaustive review and critique of individual papers and studies available in the open literature which present measurement data on primary sulfate emissions. It develops a qualitative rating scheme which specifies the level of confidence that should be attached to the emission factor determinations. The paper concludes that much of the existing data on primary sulfates from stationary combustion sources are, probably, significantly biased upward and, therefore, inappropriate for the derivation of emission factors. Therefore, existing estimates of primary sulfate emissions for these source categories are, probably, substanitally inflated. It also concludes that, for most source categories, very little confidence can be attached to the best estimates because of the paucity of data obtained from measurement techniques which are likely to be free of systematic bias. 68 references.

  5. Comprehensive Operative Note Templates for Primary and Revision Total Hip and Knee Arthroplasty

    PubMed Central

    Electricwala, Ali J.; Amanatullah, Derek F.; Narkbunnam, Rapeepat I.; Huddleston, James I.; Maloney, William J.; Goodman, Stuart B.

    2016-01-01

    Background: Adequate preoperative planning is the first and most crucial step in the successful completion of a revision total joint arthroplasty. The purpose of this study was to evaluate the availability, adequacy and accuracy of operative notes of primary surgeries in patients requiring subsequent revision and to construct comprehensive templates of minimum necessary information required in the operative notes to further simplify re-operations, if they should become necessary. Methods: The operative notes of 144 patients (80 revision THA’s and 64 revision TKA’s) who underwent revision total joint arthroplasty at Stanford Hospital and Clinics in the year 2013 were reviewed. We assessed the availability of operative notes and implant stickers prior to revision total joint arthroplasty. The availability of implant details within the operative notes was assessed against the available surgical stickers for adequacy and accuracy. Statistical comparisons were made using the Fischer-exact test and a P-value of less than 0.05 was considered statistically significant. Results: The primary operative note was available in 68 of 144 revisions (47%), 39 of 80 revision THAs (49%) and 29 of 66 revision TKAs (44%, p = 0.619). Primary implant stickers were available in 46 of 144 revisions (32%), 26 of 80 revision THAs (32%) and 20 of 66 revision TKAs (30%, p = 0.859). Utilizing the operative notes and implant stickers combined identified accurate primary implant details in only 40 of the 80 revision THAs (50%) and 34 of all 66 revision TKAs (52%, p = 0.870). Conclusion: Operative notes are often unavailable or fail to provide the necessary information required which makes planning and execution of revision hip and knee athroplasty difficult. This emphasizes the need for enhancing the quality of operative notes and records of patient information. Based on this information, we provide comprehensive operative note templates for primary and revision total hip and knee

  6. Economic impact of tranexamic acid in healthy patients undergoing primary total hip and knee arthroplasty.

    PubMed

    Gillette, Blake P; Maradit Kremers, Hilal; Duncan, Christopher M; Smith, Hugh M; Trousdale, Robert T; Pagnano, Mark W; Sierra, Rafael J

    2013-09-01

    Tranexamic acid (TA) has been shown to reduce perioperative blood loss and blood transfusion. While concern remains about the cost of antifibrinolytic medication, we hypothesized that routine use of tranexamic acid would result in lower direct hospital total cost by decreasing costs associated with blood transfusion, laboratory testing, and room & board. Patients with an American Society of Anesthesiologists (ASA) class II or less undergoing primary total hip or knee arthroplasty at a single institution during 2007-2008 were retrospectively reviewed. The estimated mean direct hospital total cost, operating room, blood/lab, room & board, and pharmacy costs were compared between patients who did and did not receive TA. The study population included 1018 patients, and 580 patients received TA. The mean direct total cost of hospitalization with and without TA was $15,099 and $15,978 (P<.0002) respectively, a difference of $879. The only increased cost associated with TA was the pharmacy cost which was $921 versus $781 (P<.0001). The routine use of tranexamic acid TA was associated with lower mean direct hospital total costs after primary total hip and knee arthroplasty as the increase in pharmacy costs was more than offset by cost savings in other categories.

  7. Quantifying Blood Loss and Transfusion Risk After Primary vs Conversion Total Hip Arthroplasty.

    PubMed

    Newman, Jared M; Webb, Matthew R; Klika, Alison K; Murray, Trevor G; Barsoum, Wael K; Higuera, Carlos A

    2017-06-01

    Primary total hip arthroplasty (THA) and conversion THA may result in substantial blood loss, sometimes necessitating transfusion. Despite the complexities of the latter, both are grouped in the same category for quality assessment and reimbursement. This study's purpose was to compare both blood loss and transfusion risk in primary and conversion THA and identify their associated predictors. A total of 1616 patients who underwent primary and conversion THA at a single hospital from 2009-2013 were reviewed (primary THA = 1575; conversion THA = 41). Demographics, comorbidities, and perioperative data were collected from electronic records. Blood loss was calculated using a validated method. Transfusion triggers were based on standardized criteria. Separate multivariable regression models for blood loss and transfusion were performed. Conversion THA patients were younger (P = .002), had lower age-adjusted Charlson scores (P = .006), longer surgeries (P < .001), higher blood loss (P < .001), and more transfusions (P < .001). Primary and conversion THA groups were different in terms of surgical approach (P < .001), anesthesia type (P = .002), and venous thromboembolism prophylaxis (P = .01). Compared to primary THA, conversion THA had an average 478.9 mL higher blood loss (P = .003) and increased adjusted odds ratio of 3.2 (P = .019) for transfusion. Conversion THA leads to higher blood loss and transfusion compared with primary THA. These differences were quantified in the present study and showed consistent results between the 2 metrics. The differences between these procedures should be addressed during quality assurance because conversion THA is associated with higher resource utilization, which is important in the allocation of resources and tiered reimbursement strategies. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Cementless versus cemented Oxford unicompartmental knee arthroplasty: early results of a non-designer user group.

    PubMed

    Kerens, B; Schotanus, M G M; Boonen, B; Boog, P; Emans, P J; Lacroix, H; Kort, N P

    2017-03-01

    Although fewer tibial radiolucent lines are observed in cementless Oxford unicompartmental knee arthroplasty (UKA) compared with cemented Oxford UKA, an independent comparative study on this topic is lacking. In this multicentre retrospective study, a cohort of 60 consecutive cases of cementless Oxford UKA is compared with a cohort of 60 consecutive cases of cemented Oxford UKA. Radiolucent lines, survival, perioperative data and clinical results were compared. No complete tibial radiolucent lines were observed in either group. Seventeen per cent of partial tibial radiolucent lines were observed in the cementless group versus 21 % in the cemented group (n.s.). The percentage of tibial radiolucent zones was 4 versus 9 %, respectively (p = 0.036). Survival rates were 90 % at 34 months for the cementless group and 84 % at 54 months for the cemented group (n.s.). Mean operation time was 10 min shorter in the cementless group (p < 0.001), and clinical results were not significantly different. Although no significant differences in radiolucent lines were found between both groups, they appear to be more common in the cemented group. This confirms previous results from reports by prosthesis designers. The presence of radiolucent lines after cemented Oxford UKA does not correlate with clinical outcome or survival. III.

  9. Blood Sparing Efficacy of Oral Tranexamic Acid in Primary Total Knee Arthroplasty: A Randomized Controlled Trial

    PubMed Central

    Lee, Qunn Jid; Ching, Wai Yee; Wong, Yiu Chung

    2017-01-01

    Purpose Tranexamic acid (TXA) is effective in reducing blood loss in primary total knee replacement. Almost all studies used an intravenous form or a topical form. The aim of this study was to assess the blood sparing efficacy and the safety of oral TXA. Materials and Methods All patients with primary total knee replacement performed in our institute from January 2015 to October 2015 were eligible. Oral TXA group was given 1 g oral TXA 2 hours before induction of anesthesia and 6 hours and 12 hours postoperatively. The control group was not given TXA. Results There were 94 cases in the oral TXA group and 95 cases in the control group. There was no difference in the baseline characteristics. The oral TXA group had a significantly lower hemoglobin drop (1.7 g/dL vs. 2.5 g/dL), lower drain output (154 mL vs. 203 mL), lower hidden blood loss (244 mL vs. 423 mL) and lower total blood loss (398 mL vs. 626 mL). There was no difference in transfusion rate (1.1% vs. 3.2%) and thromboembolic complication. There was no infection or mortality in both groups. Conclusions Oral TXA is effective in reducing blood loss in primary total knee replacement. It is a safe alternative to the intravenous or topical form. PMID:28231650

  10. A finite element analysis of the vibration behaviour of a cementless hip system.

    PubMed

    Pérez, M A; Seral-García, B

    2013-01-01

    An early diagnosis of aseptic loosening of a total hip replacement (THR) by plain radiography, scintigraphy or arthography has been shown to be less reliable than using a vibration technique. However, it has been suggested that it may be possible to distinguish between a secure and a loose prosthesis using a vibration technique. In fact, vibration analysis methods have been successfully used to assess dental implant stability, to monitor fracture healing and to measure bone mechanical properties. Several studies have combined the vibration technique with the finite element (FE) method in order to better understand the events involved in the experimental technique. In the present study, the main goal is to simulate the change in the resonance frequency during the osseointegration process of a cementless THR (Zweymüller). The FE method was used and a numerical modal analysis was conducted to obtain the natural frequencies and mode shapes under vibration. The effects were studied of different bone and stem material properties, and different contact conditions at the bone-implant interface. The results were in agreement with previous experimental and computational observations, and differences among the different cases studied were detected. As the osseointegration process at the bone-implant interface evolved, the resonance frequency values of the femur-prosthesis system also increased. In summary, vibration analysis combined with the FE method was able to detect different boundary conditions at the bone-implant interface in cases of both osseointegration and loosening.

  11. Fabrication of low-cost, cementless femoral stem 316L stainless steel using investment casting technique.

    PubMed

    Baharuddin, Mohd Yusof; Salleh, Sh-Hussain; Suhasril, Andril Arafat; Zulkifly, Ahmad Hafiz; Lee, Muhammad Hisyam; Omar, Mohd Afian; Abd Kader, Ab Saman; Mohd Noor, Alias; A Harris, Arief Ruhullah; Abdul Majid, Norazman

    2014-07-01

    Total hip arthroplasty is a flourishing orthopedic surgery, generating billions of dollars of revenue. The cost associated with the fabrication of implants has been increasing year by year, and this phenomenon has burdened the patient with extra charges. Consequently, this study will focus on designing an accurate implant via implementing the reverse engineering of three-dimensional morphological study based on a particular population. By using finite element analysis, this study will assist to predict the outcome and could become a useful tool for preclinical testing of newly designed implants. A prototype is then fabricated using 316L stainless steel by applying investment casting techniques that reduce manufacturing cost without jeopardizing implant quality. The finite element analysis showed that the maximum von Mises stress was 66.88 MPa proximally with a safety factor of 2.39 against endosteal fracture, and micromotion was 4.73 μm, which promotes osseointegration. This method offers a fabrication process of cementless femoral stems with lower cost, subsequently helping patients, particularly those from nondeveloped countries.

  12. [Custom cementless stem for osteoarthritis following developmental hip dysplasia].

    PubMed

    Flecher, X; Argenson, J N; Parratte, S; Ryembault, E; Aubaniac, J M

    2006-06-01

    Arthroplasty in developmental dysplasia of the hip joint raises technical problems related to the anatomy and age of the young patient. The purpose of this work was to report results obtained with a custom-designed cementless stem. This study included 257 hips reviewed at mean 82 months (range 43-162 months). Mean patient age was 55 years (17-78), mean weight 67 kg (42-118), and mean height 164 cm (147-190). A standard imaging protocol was performed for all patients: AP pelvis in reclining position, AP and lateral views of healthy and pathological hip, AP view of entire lower limb in standing position, computed tomography of lower limb. La position of the greater trochanter and the lengthening necessary was determined from the preoperative films. Stem integration and migration as well as osteolysis were studied postoperatively. Femoral anteversion and the anteroposterior diameter of the paleoacetabulum were measured on the superposed computed tomographic images. Surgery was performed via a Watson-Jones approach to insert a noncemented cup hooked in the obturator foramen and implanted in the paleoacetabulum. The femur endomedullary cavity was prepared with a ream having the form of the definitive stem and the prosthetic neck was custom fit to match the desired lever arm and anteversion. The series included 174 cases of dysplasia and 83 dislocations, 39% stage 1, 30% stage 2, 14% stage 3 and 17% stage 4. Mean lengthening was 39 mm. The mean helitorsion was 28 +/- 16 degrees and the mean anteroposterior diameter of the acetabulum was 51 mm. On average, the alpha correction in the prosthetic neck was -13.4 degrees (-71 degrees to +37 degrees). The Postel-Merle-d'Aubigné score improved from 10.4 points preoperatively to 16.7 points at last follow-up. Postoperative x-rays showed signs of osteointegration in 88% of cases, osteolysis in 5% and one case of stem impaction. Ten hips (3.9%) required revision for replacement (7 for an aseptic problem and 3 for sepsis

  13. Patient expectation is the most important predictor of discharge destination after primary total joint arthroplasty.

    PubMed

    Halawi, Mohamad J; Vovos, Tyler J; Green, Cindy L; Wellman, Samuel S; Attarian, David E; Bolognesi, Michael P

    2015-04-01

    The purpose of this study was to identify preoperative predictors of discharge destination after total joint arthroplasty. A retrospective study of three hundred and seventy-two consecutive patients who underwent primary total hip and knee arthroplasty was performed. The mean length of stay was 2.9 days and 29.0% of patients were discharged to extended care facilities. Age, caregiver support at home, and patient expectation of discharge destination were the only significant multivariable predictors regardless of the type of surgery (total knee versus total hip arthroplasty). Among those variables, patient expectation was the most important predictor (P < 0.001; OR 169.53). The study was adequately powered to analyze the variables in the multivariable logistic regression model, which had a high concordance index of 0.969.

  14. Acidic and total primary sulfates: development of emission factors for major stationary combustion sources

    SciTech Connect

    Goklamy, I.M.

    1984-02-01

    This paper develops 'best estimates' of emission factors for major sources of acidic and total primary sulphates for use in the compilation of emission inventories for the eastern US, which may, in turn, be used for modelling acidic or sulphate deposition. The authors conclude that much of the existing data on primary sulphates from stationary combustion sources are probably significantly biased upward and, therefore, inappropriate for the derivation of emission factors. Existing estimates of primary sulphate emissions for these source categories are probably substantially inflated. It also concludes that for most source categories, very little confidence can be attached to the best estimates because of the paucity of data obtained from measurement techniques which are likely to be free of systematic bias.

  15. Lower Urinary Tract Infection and Periprosthetic Joint Infection after Elective Primary Total Hip Arthroplasty

    PubMed Central

    Park, Chan Ho; Lee, Young-Kyun

    2017-01-01

    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

  16. The impact of blood management on length of stay after primary total knee arthroplasty.

    PubMed

    Monsef, Jad B; Della Valle, Alejandro G; Mayman, David J; Marx, Robert G; Ranawat, Amar S; Boettner, Friedrich

    2014-01-01

    The current study investigates the impact of patient factors, surgical factors, and blood management on postoperative length of stay (LOS) in 516 patients who underwent primary total knee arthroplasty. Age, gender, type of anticoagulation, but not body mass index (BMI) were found to be highly significant predictors of an increased LOS. Allogeneic transfusion and the number of allogeneic units significantly increased LOS, whereas donation and/or transfusion of autologous blood did not. Hemoglobin levels preoperatively until 48 hours postoperatively were negatively correlated with LOS. After adjusting for confounding factors through Poisson regression, age (p = 0.001) and allogeneic blood transfusion (p = 0.002) were the most significant determinants of LOS. Avoiding allogeneic blood plays an essential role in reducing the overall length of stay after primary total knee arthroplasty.

  17. Citrobacter koseri as a cause of early periprosthetic infection after primary total hip arthroplasty.

    PubMed

    Kaufman, Adam M; Watters, Tyler Steven; Henderson, Robert A; Wellman, Samuel S; Bolognesi, Michael P

    2011-09-01

    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.

  18. The identification and quantification of instability in a primary total knee replacement prior to revision.

    PubMed

    Hamilton, D F; Burnett, R; Patton, J T; Howie, C R; Simpson, A H R W

    2014-10-01

    Instability is the reason for revision of a primary total knee replacement (TKR) in 20% of patients. To date, the diagnosis of instability has been based on the patient's symptoms and a subjective clinical assessment. We assessed whether a measured standardised forced leg extension could be used to quantify instability. A total of 25 patients (11 male/14 female, mean age 70 years; 49 to 85) who were to undergo a revision TKR for instability of a primary implant were assessed with a Nottingham rig pre-operatively and then at six and 26 weeks post-operatively. Output was quantified (in revolutions per minute (rpm)) by accelerating a stationary flywheel. A control group of 183 patients (71 male/112 female, mean age 69 years) who had undergone primary TKR were evaluated for comparison. Pre-operatively, all 25 patients with instability exhibited a distinctive pattern of reduction in 'mid-push' speed. The mean reduction was 55 rpm (sd 33.2). Post-operatively, no patient exhibited this pattern and the reduction in 'mid-push' speed was 0 rpm. The change between pre- and post-operative assessment was significant (p < 0.001). No patients in the control group exhibited this pattern at any of the intervals assessed. The between-groups difference was also significant (p < 0.001). This suggests that a quantitative diagnostic test to assess the unstable primary TKR could be developed. ©2014 The British Editorial Society of Bone & Joint Surgery.

  19. [Use of tranexamic acid in primary total knee replacement: effects on perioperative blood loss].

    PubMed

    Volquind, Daniel; Zardo, Remi Antônio; Winkler, Bruno Costamilan; Londero, Bruno Bertagnolli; Zanelatto, Natália; Leichtweis, Gisele Perondi

    2016-01-01

    The use of tranexamic acid in primary total knee replacement surgeries has been the subject of constant study. The strategies to reduce bleeding are aimed at reducing the need for blood transfusion due to the risks involved. In this study we evaluated the use of tranexamic acid in reducing bleeding, need for blood transfusion, and prevalence of postoperative deep vein thrombosis (DVT) in primary total knee replacement. 62 patients undergoing primary total knee replacement were enrolled in the study, from June 2012 to May 2013, and randomized to receive a single dose of 2.5g of intravenous tranexamic acid (Group TA) or saline (Group GP), 5minutes before opening the pneumatic tourniquet, respectively. Hemoglobin, hematocrit, and blood loss were recorded 24hours after surgery. DVT was investigated during patient's hospitalization and 15 and 30 days after surgery in review visits. There was no demographic difference between groups. Group TA had 13.89% decreased hematocrit (p=0.925) compared to placebo. Group TA had a decrease of 12.28% (p=0.898) in hemoglobin compared to Group GP. Group TA had a mean decrease of 187.35mL in blood loss (25.32%) compared to group GP (p=0.027). The number of blood transfusions was higher in Group GP (p=0.078). Thromboembolic events were not seen in this study. Tranexamic acid reduced postoperative bleeding without promoting thromboembolic events. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  20. Is routine splintage following primary total knee replacement necessary? A prospective randomised trial.

    PubMed

    Horton, T C; Jackson, R; Mohan, N; Hambidge, J E

    2002-09-01

    It was hypothesised that routine splintage following primary total knee replacement has no affect on flexion deformity and offers no benefit over simple wool and crepe. Fifty-five patients undergoing primary total knee replacement were entered into a prospective study. The patients were randomly assigned to two groups: The first group was rehabilitated without a splint and the second received an adjustable semi-rigid extension splint (Richards splint) for the first 48 h after surgery. Range of motion measurements were recorded pre-operatively and at 2 days, 1 week and 3 months post-operation by a research nurse blinded to the allocation. No statistically significant difference in flexion deformity was found at any stage (P>0.5). No difference was found in general or wound complications, or requirement for blood transfusion, and the post-operative stay was equal in the two groups. We conclude that routine use of a semi-rigid splint following primary total knee replacement has no advantage over simple wound dressings.

  1. Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study

    PubMed Central

    2011-01-01

    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

  2. Results after Cementless Medial Oxford Unicompartmental Knee Replacement - Incidence of Radiolucent Lines

    PubMed Central

    Panzram, Benjamin; Bertlich, Ines; Reiner, Tobias; Walker, Tilman; Hagmann, Sébastien; Weber, Marc-André; Gotterbarm, Tobias

    2017-01-01

    Purpose Tibial radiolucent lines (RL) are commonly seen in cemented unicompartmental knee replacement (UKR). In the postoperative course, they can be misinterpreted as signs of loosening, thus leading to unnecessary revision. Since 2004, a cementless OUKR is available. First studies and registry data have shown equally good clinical results of cementless OUKR compared to the cemented version and a significantly reduced incidence of RL in cementless implants. Methods This single-centre retrospective cohort study includes the first 30 UKR (27 patients) implanted between 2007 and 2009 with a mean follow-up of 5 years. Clinical outcome was evaluated using the OKS, AKS, range of movement (ROM) and level of pain (VAS). Standard radiologic evaluation was performed at three months, one and five years after surgery. The results five years after implantation were compared to a group of 27 cemented Oxford UKR (OUKR) in a matched-pair-analysis. Results Tibial RL were seen in 10 implants three months after operation, which significantly decreased to five after one year and to three after five years (p = 0.02). RL did not have a significant influence on revision (p = 1.0) or clinical outcome after five years. RL were always partial, never progressive and strictly limited to the tibia. There was no significant difference in the incidence of tibial RL five years after implantation between cemented and cementless implants (cemented: 4, cementless: 3, p = 1.0). Conclusions After cementless implantation RL were limited to the tibia, partial and never progressive. During short term follow-up the incidence of RL decreased significantly. RL seem to have no influence on clinical outcome and revision. PMID:28103308

  3. A short tapered stem reduces intraoperative complications in primary total hip arthroplasty.

    PubMed

    Molli, Ryan G; Lombardi, Adolph V; Berend, Keith R; Adams, Joanne B; Sneller, Michael A

    2012-02-01

    While short-stem design is not a new concept, interest has surged with increasing utilization of less invasive techniques. Short stems are easier to insert through small incisions. Reliable long-term results including functional improvement, pain relief, and implant survival have been reported with standard tapered stems, but will a short taper perform as well? We compared short, flat-wedge, tapered, broach-only femoral stems to standard-length, double-tapered, ream and broach femoral stems in terms of intraoperative complications, short-term survivorship, and pain and function scores. We retrospectively reviewed the records of 606 patients who had 658 THAs using a less invasive direct lateral approach from January 2006 to March 2008. Three hundred sixty patients (389 hips) had standard-length stems and 246 (269 hips) had short stems. Age averaged 63 years, and body mass index averaged 30.7 kg/m(2). We recorded complications and pain and function scores and computed short-term survival. Minimum followup was 0.8 months (mean, 29.2 months; range, 0.8-62.2 months). We observed a higher rate of intraoperative complications with the standard-length stems (3.1%; three trochanteric avulsions, nine femoral fractures) compared with the shorter stems (0.4%; one femoral fracture) and managed all complications with application of one or more cerclage cables. There were no differences in implant survival, Harris hip score, and Lower Extremity Activity Scale score between groups. Fewer intraoperative complications occurred with the short stems, attesting to the easier insertion of these devices. While longer followup is required, our early results suggest shortened stems can be used with low complication rates and do not compromise the survival and functional outcome of cementless THA. Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

  4. Small phytoplankton contribution to the standing stocks and the total primary production in the Amundsen Sea

    NASA Astrophysics Data System (ADS)

    Lee, Sang H.; Kim, Bo Kyung; Lim, Yu Jeong; Joo, HuiTae; Kang, Jae Joong; Lee, Dabin; Park, Jisoo; Ha, Sun-Yong; Lee, Sang Hoon

    2017-08-01

    Small phytoplankton are anticipated to be more important in a recently warming and freshening ocean condition. However, little information on the contribution of small phytoplankton to overall phytoplankton production is currently available in the Amundsen Sea. To determine the contributions of small phytoplankton to total biomass and primary production, carbon and nitrogen uptake rates of total and small phytoplankton were obtained from 12 productivity stations in the Amundsen Sea. The daily carbon uptake rates of total phytoplankton averaged in this study were 0.42 g C m-2 d-1 (SD = ± 0.30 g C m-2 d-1) and 0.84 g C m-2 d-1 (SD = ± 0.18 g C m-2 d-1) for non-polynya and polynya regions, respectively, whereas the daily total nitrogen (nitrate and ammonium) uptake rates were 0.12 g N m-2 d-1 (SD = ± 0.09 g N m-2 d-1) and 0.21 g N m-2 d-1 (SD = ± 0.11 g N m-2 d-1), respectively, for non-polynya and polynya regions, all of which were within the ranges reported previously. Small phytoplankton contributed 26.9 and 27.7 % to the total carbon and nitrogen uptake rates of phytoplankton in this study, respectively, which were relatively higher than the chlorophyll a contribution (19.4 %) of small phytoplankton. For a comparison of different regions, the contributions for chlorophyll a concentration and primary production of small phytoplankton averaged from all the non-polynya stations were 42.4 and 50.8 %, which were significantly higher than those (7.9 and 14.9 %, respectively) in the polynya region. A strong negative correlation (r2 = 0. 790, p<0. 05) was found between the contributions of small phytoplankton and the total daily primary production of phytoplankton in this study. This finding implies that daily primary production decreases as small phytoplankton contribution increases, which is mainly due to the lower carbon uptake rate of small phytoplankton than large phytoplankton.

  5. Case Report: Cementless Stem Stabilization after Intraoperative Fracture: A Radiostereometric Analysis

    PubMed Central

    Mercer, Graham; Nilsson, Kjell G.; Callary, Stuart A.

    2009-01-01

    We present the case of a patient with intraoperative femoral fracture during THA, which was repaired using cerclage fixation and insertion of an hydroxyapatite-coated cementless stem. The patient was evaluated postoperatively using radiostereometry during a 2-year course, and despite a large amount of subsidence and rotation, stabilization occurred and was maintained by 6 months. By evaluating the pattern of stem migration after intraoperative fracture, this case shows, even in the presence of instability, a successful clinical outcome can be achieved using an hydroxyapatite-coated cementless stem. PMID:19760467

  6. Case report: Cementless stem stabilization after intraoperative fracture: a radiostereometric analysis.

    PubMed

    Campbell, David; Mercer, Graham; Nilsson, Kjell G; Callary, Stuart A

    2010-03-01

    We present the case of a patient with intraoperative femoral fracture during THA, which was repaired using cerclage fixation and insertion of an hydroxyapatite-coated cementless stem. The patient was evaluated postoperatively using radiostereometry during a 2-year course, and despite a large amount of subsidence and rotation, stabilization occurred and was maintained by 6 months. By evaluating the pattern of stem migration after intraoperative fracture, this case shows, even in the presence of instability, a successful clinical outcome can be achieved using an hydroxyapatite-coated cementless stem.

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

    PubMed Central

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

    2014-01-01

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

  8. Prospective Assessment of Sleep Quality Before and After Primary Total Joint Replacement.

    PubMed

    Manning, Blaine T; Kearns, Sean M; Bohl, Daniel D; Edmiston, Tori; Sporer, Scott M; Levine, Brett R

    2017-07-01

    Sleep disruption is a common, yet rarely addressed, complaint among patients who have undergone total joint arthroplasty (TJA). This study assessed sleep quality before and after primary TJA. A total of 105 patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) prospectively completed questionnaires during the preoperative, early postoperative, and late postoperative periods. The survey included the Epworth Sleepiness Scale, current sleeping habits, and patient perspectives of sleep quality and duration. In the early postoperative period (4.7±2.0 weeks), patients reported significant increases in sleep disturbance as denoted by increased length of time to fall asleep (P=.006) and mean nightly awakenings (P=.002) compared with the preoperative baseline. At late postoperative follow-up (40.8±19.5 weeks), patients' sleep quality subsequently improved above the preoperative baseline. Approximately 40% of patients tried a new sleeping method postoperatively, the most common being new pillow placement. No significant differences in pre- or postoperative sleeping trends were noted between THA and TKA patients. These findings suggest transient sleep disturbance is common in the early postoperative period, with subsequent improvement by 10-month follow-up after a primary TJA. Given the growing importance of patient satisfaction in health care systems, orthopedic surgeons must manage patients' expectations while working with them to optimize sleep quality after TJA. A multimodal approach with preoperative counseling, early postoperative sleep modifications, and possibly preemptive use of medications may improve transient sleep disturbance among TJA patients. [Orthopedics. 2017; 40(4):e636-e640.]. Copyright 2017, SLACK Incorporated.

  9. Predicting length of stay from an electronic patient record system: a primary total knee replacement example.

    PubMed

    Carter, Evelene M; Potts, Henry W W

    2014-04-04

    To investigate whether factors can be identified that significantly affect hospital length of stay from those available in an electronic patient record system, using primary total knee replacements as an example. To investigate whether a model can be produced to predict the length of stay based on these factors to help resource planning and patient expectations on their length of stay. Data were extracted from the electronic patient record system for discharges from primary total knee operations from January 2007 to December 2011 (n=2,130) at one UK hospital and analysed for their effect on length of stay using Mann-Whitney and Kruskal-Wallis tests for discrete data and Spearman's correlation coefficient for continuous data. Models for predicting length of stay for primary total knee replacements were tested using the Poisson regression and the negative binomial modelling techniques. Factors found to have a significant effect on length of stay were age, gender, consultant, discharge destination, deprivation and ethnicity. Applying a negative binomial model to these variables was successful. The model predicted the length of stay of those patients who stayed 4-6 days (~50% of admissions) with 75% accuracy within 2 days (model data). Overall, the model predicted the total days stayed over 5 years to be only 88 days more than actual, a 6.9% uplift (test data). Valuable information can be found about length of stay from the analysis of variables easily extracted from an electronic patient record system. Models can be successfully created to help improve resource planning and from which a simple decision support system can be produced to help patient expectation on their length of stay.

  10. Revision of medial Oxford unicompartmental knee replacement to a total knee replacement: similar to a primary?

    PubMed

    Wynn Jones, Henry; Chan, Warwick; Harrison, Timothy; Smith, Toby O; Masonda, Patrick; Walton, Neil P

    2012-08-01

    Unicompartmental knee replacement (UKR) is an option for the treatment of isolated medial compartment osteoarthritis. A commonly perceived potential advantage is that revision of a UKR is straightforward. The purpose of this study was to determine the early outcomes and the level of complexity of revisions of Oxford UKRs performed at our hospital. A retrospective review of a prospective database of all phase III Oxford UKRs was undertaken. This identified 89 Oxford UKRs which were revised at our institution between 2002 and 2008. The median time from the primary procedure to revision was 19 months (interquartile range 2-73 months). Nine were revised to another UKR. Eighty were revised to a total knee replacement (TKR). Fifty-three were revised with primary TKR components. Twenty-seven were revised using stems and/or augments. The median overall tibial component thickness (including augments) was 15 mm. Forty-five knees had an overall tibial component thickness greater than 15 mm. A primary Oxford UKR bearing thickness of greater than 6mm was associated with an increased likelihood of requiring revision components. On the basis of this review, tibial bone defects were commonly encountered when revising UKRs. Reconstruction with either an augment and a stem, or thick polyethylene component was often required. We recommend that the potential complexity of revision for UKR failure should be borne in mind when considering a primary Oxford UKR. Copyright © 2011 Elsevier B.V. All rights reserved.

  11. Effectiveness of an Acetabular Positioning Device in Primary Total Hip Arthroplasty

    PubMed Central

    Hendrix, Stephen L.; Mologne, Timothy S.; Peterson, Drew A.; Holley, Keith A.

    2005-01-01

    To evaluate the efficacy of a commercially available acetabular positioning device, we performed a prospective evaluation of 40 consecutive patients undergoing primary total hip arthroplasty. All surgery was performed by the same surgeon, in the same operating room, and on the same operating table. The acetabular positioning device was designed to place the component in 45° of abduction. At 6 weeks, all radiographs were evaluated by 3 investigators not involved with the surgery. Each radiograph was evaluated by each reviewer on 3 separate occasions, blinded to the findings of the other reviewer to assess interobserver and intraobserver variability. The mean cup abduction angle was 42.1°, with a range from 23° to 57° (SD 8.3°). Intraobserver and interobserver variability were 0.2 and 0.3°, respectively. The findings of this study demonstrate a wide variability in acetabular cup placement in primary total hip arthroplasty. We believe this is due to movement of the pelvis, which may occur during preparation, draping, and retracting during surgery. We feel surgeons should not rely solely on positioning devices when implanting the acetabular component in total hip arthroplasty. Identification of bone landmarks and determination of superolateral implant coverage noted on preoperative templating is advocated to improve the precision of component position. PMID:18751812

  12. Creatine Kinase (CK)-MB-to-Total-CK Ratio: a Laboratory Indicator for Primary Cancer Screening.

    PubMed

    Chang, Chih-Chun; Liou, Ching-Biau; Su, Ming-Jang; Lee, Yi-Chen; Liang, Chai-Ting; Ho, Jung-Li; Tsai, Huang-Wen; Yen, Tzung-Hai; Chu, Fang-Yeh

    2015-01-01

    For the determination of creatine kinase (CK)-MB, the immunoinhibition method is utilized most commonly. However, the estimated CK-MB activity may be influenced by the presence of CK isoenzymes in some conditions like cancer. Thus, a CK-MB-to-total-CK ratio more than 1.0 could be found in such a situation. The study aimed to explore the relationship of cancer to high CK-MB-to-total-CK ratio. From January 2011 to December 2014, laboratory data on all CK-MB and total CK test requests were extracted at Far Eastern Memorial Hospital (88,415 requests). Patients with a CK-MB-to-total-CK ratio more than 1.0 were registered in this study. Clinical data including tumor location, tumor TNM stage and metastatic status were also collected. A total of 846 patients were identified with a CK-MB-to-total-CK ratio more than 1.0. Of these, 339 (40.1%) were diagnosed with malignancies. The mean CK-MB-to-total-CK ratio was significantly higher in malignancy than in non-malignancy (1.35±0.28 vs 1.25±0.23, p<0.001) groups. The most frequent malignancy with a CK-MB-to-total-CK ratio more than 1.0 was colorectal cancer (1.42±0.28, 16.5%, n=56), followed by lung cancer (1.38±0.24, 15.9%, n=54) and hepatocellular carcinoma (14.5%, n=49). Higher CK-MB-to-total-CK ratios in hematological malignancies (1.44±0.41)were also noted. Additionally, the CK-MB-to-total-CK ratio was markedly higher in advanced stage malignancy than in early stage (1.37±0.26 vs. 1.29±0.31, p=0.014) and significantly higher in liver metastasis than in non-liver metastasis (1.48±0.30 vs. 1.30±0.21, p<0.001). The CK-MB-to-total-CK ratio is an easily available indicator and could be clinically utilized as a primary screening tool for cancer. Higher ratio of CK-MB-to-total-CK was specifically associated with certain malignancies, like colorectal cancer, lung cancer and hepatocellular carcinoma, as well as some cancer-associated status factors such as advanced stage and liver metastasis.

  13. Use of tranexamic acid in primary total knee replacement: effects on perioperative blood loss.

    PubMed

    Volquind, Daniel; Zardo, Remi Antônio; Winkler, Bruno Costamilan; Londero, Bruno Bertagnolli; Zanelatto, Natália; Leichtweis, Gisele Perondi

    2016-01-01

    The use of tranexamic acid in primary total knee replacement surgeries has been the subject of constant study. The strategies to reduce bleeding are aimed at reducing the need for blood transfusion due to the risks involved. In this study we evaluated the use of tranexamic acid in reducing bleeding, need for blood transfusion, and prevalence of postoperative deep vein thrombosis in primary total knee replacement. 62 patients undergoing primary total knee replacement were enrolled in the study, from June 2012 to May 2013, and randomized to receive a single dose of 2.5g of intravenous tranexamic acid (Group TA) or saline (Group GP), 5min before opening the pneumatic tourniquet, respectively. Hemoglobin, hematocrit, and blood loss were recorded 24h after surgery. Deep vein thrombosis was investigated during patient's hospitalization and 15 and 30 days after surgery in review visits. There was no demographic difference between groups. Group TA had 13.89% decreased hematocrit (p=0.925) compared to placebo. Group TA had a decrease of 12.28% (p=0.898) in hemoglobin compared to Group GP. Group TA had a mean decrease of 187.35mL in blood loss (25.32%) compared to group GP (p=0.027). The number of blood transfusions was higher in Group GP (p=0.078). Thromboembolic events were not seen in this study. Tranexamic acid reduced postoperative bleeding without promoting thromboembolic events. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

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

    PubMed Central

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

    2016-01-01

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

  15. Sequential therapy of primary cardiac lymphoma with cardiectomy, total artificial heart support, and cardiac transplantation.

    PubMed

    Ried, Michael; Rupprecht, Leopold; Hirt, Stephan; Zausig, York; Grube, Matthias; Resch, Markus; Hilker, Michael; Hofstädter, Ferdinand; Schmid, Christof

    2010-06-01

    Primary cardiac T-cell lymphoma is an extremely rare entity, with only 3 patients having been reported so far in the literature. We describe the case of a young patient with acute heart failure involving the whole myocardium. The patient successfully underwent emergency cardiectomy, custom-made total artificial heart implantation and heart transplantation, combined with chemotherapy. The problems we encountered with this rare disease are discussed and compared with those of previous studies. Copyright 2010 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  16. The all-polyethylene tibial component in primary total knee arthroplasty.

    PubMed

    Gioe, Terence J; Maheshwari, Aditya V

    2010-02-01

    Outcomes of total knee arthroplasties performed with modern all-polyethylene tibial components have been found to be comparable with or better than those of arthroplasties done with metal-backed modular components in numerous mid-to-long-term follow-up studies, radiostereometric analyses, and the few prospective randomized trials available. Advantages of an all-polyethylene tibial component over a metal-backed modular component include lower cost, avoidance of locking-mechanism issues and backside wear, and increased polyethylene thickness after identical bone resections. Disadvantages of an all-polyethylene tibial component compared with a metal-backed modular component include a lack of modularity, limiting intraoperative options; no option for liner removal in the setting of acute irrigation and débridement; and no option for late liner exchange. Primary total knee arthroplasty with a modern all-polyethylene design can be done in many patients, with substantial cost savings across the health-care system.

  17. An updated h-index measures both the primary and total scientific output of a researcher

    PubMed Central

    Bucur, Octavian; Almasan, Alex; Zubarev, Roman; Friedman, Mark; Nicolson, Garth L.; Sumazin, Pavel; Leabu, Mircea; Nikolajczyk, Barbara S.; Avram, Dorina; Kunej, Tanja; Calin, George A.; Godwin, Andrew K.; Adami, Hans-Olov; Zaphiropoulos, Peter G.; Richardson, Des R.; Schmitt-Ulms, Gerold; Westerblad, Håkan; Keniry, Megan; Grau, Georges E. R.; Carbonetto, Salvatore; Stan, Radu V.; Popa-Wagner, Aurel; Takhar, Kasumov; Baron, Beverly W.; Galardy, Paul J.; Yang, Feng; Data, Dipak; Fadare, Oluwole; Yeo, KT Jerry; Gabreanu, Georgiana R.; Andrei, Stefan; Soare, Georgiana R.; Nelson, Mark A.; Liehn, Elisa A.

    2015-01-01

    The growing interest in scientometry stems from ethical concerns related to the proper evaluation of scientific contributions of an author working in a hard science. In the absence of a consensus, institutions may use arbitrary methods for evaluating scientists for employment and promotion. There are several indices in use that attempt to establish the most appropriate and suggestive position of any scientist in the field he/she works in. A scientist’s Hirsch-index (h-index) quantifies their total effective published output, but h-index summarizes the total value of their published work without regard to their contribution to each publication. Consequently, articles where the author was a primary contributor carry the same weight as articles where the author played a minor role. Thus, we propose an updated h-index named Hirsch(p,t)-index that informs about both total scientific output and output where the author played a primary role. Our measure, h(p,t) = h(p),h(t), is composed of the h-index h(t) and the h-index calculated for articles where the author was a key contributor; i.e. first/shared first or senior or corresponding author. Thus, a h(p,t) = 5,10 would mean that the author has 5 articles as first, shared first, senior or corresponding author with at least 5 citations each, and 10 total articles with at least 10 citations each. This index can be applied in biomedical disciplines and in all areas where the first and last position on an article are the most important. Although other indexes, such as r- and w-indexes, were proposed for measuring the authors output based on the position of researchers within the published articles, our simpler strategy uses the already established algorithms for h-index calculation and may be more practical to implement. PMID:26504901

  18. An updated h-index measures both the primary and total scientific output of a researcher.

    PubMed

    Bucur, Octavian; Almasan, Alex; Zubarev, Roman; Friedman, Mark; Nicolson, Garth L; Sumazin, Pavel; Leabu, Mircea; Nikolajczyk, Barbara S; Avram, Dorina; Kunej, Tanja; Calin, George A; Godwin, Andrew K; Adami, Hans-Olov; Zaphiropoulos, Peter G; Richardson, Des R; Schmitt-Ulms, Gerold; Westerblad, Håkan; Keniry, Megan; Grau, Georges E R; Carbonetto, Salvatore; Stan, Radu V; Popa-Wagner, Aurel; Takhar, Kasumov; Baron, Beverly W; Galardy, Paul J; Yang, Feng; Data, Dipak; Fadare, Oluwole; Yeo, Kt Jerry; Gabreanu, Georgiana R; Andrei, Stefan; Soare, Georgiana R; Nelson, Mark A; Liehn, Elisa A

    2015-01-01

    The growing interest in scientometry stems from ethical concerns related to the proper evaluation of scientific contributions of an author working in a hard science. In the absence of a consensus, institutions may use arbitrary methods for evaluating scientists for employment and promotion. There are several indices in use that attempt to establish the most appropriate and suggestive position of any scientist in the field he/she works in. A scientist's Hirsch-index (h-index) quantifies their total effective published output, but h-index summarizes the total value of their published work without regard to their contribution to each publication. Consequently, articles where the author was a primary contributor carry the same weight as articles where the author played a minor role. Thus, we propose an updated h-index named Hirsch(p,t)-index that informs about both total scientific output and output where the author played a primary role. Our measure, h(p,t) = h(p),h(t), is composed of the h-index h(t) and the h-index calculated for articles where the author was a key contributor; i.e. first/shared first or senior or corresponding author. Thus, a h(p,t) = 5,10 would mean that the author has 5 articles as first, shared first, senior or corresponding author with at least 5 citations each, and 10 total articles with at least 10 citations each. This index can be applied in biomedical disciplines and in all areas where the first and last position on an article are the most important. Although other indexes, such as r- and w-indexes, were proposed for measuring the authors output based on the position of researchers within the published articles, our simpler strategy uses the already established algorithms for h-index calculation and may be more practical to implement.

  19. Poly(2-methacryloyloxyethyl phosphorylcholine)-grafted highly cross-linked polyethylene liner in primary total hip replacement: one-year results of a prospective cohort study.

    PubMed

    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

    2013-06-01

    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.

  20. Metallosis Presenting as Knee Pain 26 years after Primary Total Knee Arthroplasty.

    PubMed

    Sharareh, Behnam; Phan, Duy L; Goreal, Wamda; Schwarzkopf, Ran

    2015-01-01

    Metallosis occurs when periprosthetic soft tissues, synovium, and/or bone is infiltrated by metallic debris secondary to metal-on-metal wear. This debris can cause a chronic inflammatory reaction leading to joint instability, pain, and swelling, and may cause osteolysis, implant looseningand ultimately implant failure. An 81 year old female, with a history of primary left total knee arthroplasty, presented with a 6 month history of left knee pain, swelling, and limited range of motion following a fall. Radiographs and joint aspiration were performed, with results that showed no evidence of periprosthetic trauma or infection but were suspicious for chronic metallosis. The patient underwent revision total knee replacement of the left knee which revealed extensive necrotic black metal debris throughout the joint space. Histopathology confirmed the diagnosis of a foreign body reaction consistent with metallosis. This case is a rare example of chronic metallosis presenting 26 years following total knee replacement. Treatment with revision total knee replacement is the consensus management choice to avoid further destruction of the bone and joint capsule that can occur with metal-induced inflammation.

  1. Primary tracheoesophageal puncture and cricopharyngeal myotomy in stapler-assisted total laryngectomy.

    PubMed

    Beswick, D M; Damrose, E J

    2016-07-01

    To evaluate the utility of the hybrid tracheoesophageal puncture procedure in stapler-assisted laryngectomy. Patients who underwent total laryngectomy at a single institution from 2009 to 2015 were reviewed. The interventions assessed were surgical creation of a tracheoesophageal puncture and placement of a voice prosthesis. The outcomes measured included voicing ability and valve failure. Thirty-nine patients underwent total laryngectomy or pharyngolaryngectomy. Of these, nine underwent stapler-assisted laryngectomy; seven of the nine patients underwent concurrent stapler-assisted laryngectomy, cricopharyngeal myotomy and a hybrid tracheoesophageal puncture procedure. These seven patients were the focus of this review. Successful voicing and oral alimentation was achieved in all patients. Mean time to phonation was 30 days (range, 7-77 days) and mean time to first valve change was 90 days (range, 35-117 days). Primary tracheoesophageal puncture with concurrent voice prosthesis placement and cricopharyngeal myotomy is easily performed with stapler-assisted laryngectomy. The hybrid tracheoesophageal puncture procedure is a simple method that enables a single operator to achieve primary tracheoesophageal puncture and valve placement; in addition, it facilitates concurrent cricopharyngeal myotomy.

  2. Is there a need for routine follow-up after primary total hip arthroplasty?

    PubMed

    Hacking, Craig; Weinrauch, Patrick; Whitehouse, Sarah L; Crawford, Ross W; Donnelly, William J

    2010-10-01

    The objective of routine outpatient assessment of well-functioning patients after primary total hip arthroplasty (THA) is to detect asymptomatic failure of prostheses to guide recommendations for early intervention. We have observed that the revision of THAs in asymptomatic patients is highly uncommon. We therefore question the need for routine follow-up of patients after THA. A prospective analysis of an orthopaedic database identified 158 patients who received 177 revision THAs over a four-year period. A retrospective chart review was conducted. Patient demographics, primary and revision surgery parameters and follow-up information were recorded and cross-referenced with Australian Orthopaedic Association National Joint Replacement Registry data. One hundred ten THAs in 104 patients (average age 70.4 (SD 9.8 years)). There were 70 (63.6%) in total, 13 (11.8%) femoral and 27 (24.5%) acetabular revisions. The indications for revision were aseptic loosening (70%), dislocation (8.2%), peri-prosthetic fracture (7.3%), osteolysis (6.4%) and infection (4.5%). Only four (3.6%) were asymptomatic revisions. A mean of 5.3 (SD 5.2 and 1.9 (SD 5.3)) follow-up appointments were required before revision in patients with and without symptoms, respectively. The average time from the primary to revision surgery was 11.8 (SD 7.23) years. We conclude that patients with prostheses with excellent long-term clinical results as validated by joint registries, routine follow-up of asymptomatic THA should be questioned and requires further investigation. Based on the work of this study, the current practice of routine follow-up of asymptomatic THA may be excessively costly and unnecessary, and a less resource-intensive review method may be more appropriate. © 2010 The Authors. ANZ Journal of Surgery © 2010 Royal Australasian College of Surgeons.

  3. GENDER AND SURGICAL OUTCOMES AND MORTALITY AFTER PRIMARY TOTAL KNEE ARTHROPLASTY: A RISK-ADJUSTED ANALYSIS

    PubMed Central

    Singh, Jasvinder A.; Kwoh, C. Kent; Richardson, Diane; Chen, Wei; Ibrahim, Said A.

    2013-01-01

    Objective Total knee arthroplasty (TKA) is a widely utilized and an effective treatment option for end-stage knee OA. Knee OA is more prevalent among women compared to men, but there are limited data on gender differences in surgical outcomes after total knee arthroplasty. Methods Our sample consisted of all primary TKA’s performed in the State of Pennsylvania during the fiscal year 2002. We used ICD-9 codes to identify major complications and surgical revision. We used mixed effects logistic regression models to examine the associations between gender and all-cause mortality, readmissions, and major surgical complications. We used proportional hazards model to assess the risk of surgical revision after index arthroplasty. We adjusted for race, age, hospital teaching status, hospital procedure volume, insurance status and risk of mortality. Results In 17,994 primary TKA’s, there were 46 deaths at 30-days and 220 at one-year. Compared to women, men had higher adjusted odds of one-year mortality (Odds Ratio (OR)=1.48; 95% CI=1.13–1.94) after primary TKA. The overall odds of most major 30-day complications did not differ by gender, except surgical wound infections, which were higher in men compared to women (OR= 1.31; 95% CI=1.08–1.60); 30-day readmission was higher in men (OR=1.25; 95% CI=1.10–1.43). Men had significantly higher rates of index knee arthroplasty revision at 5-years (hazard ratio= 1.20; 95% CI=1.05–1.36) compared to women. Conclusion Higher rates of mortality, hospital readmissions, revision surgery and wound infections in men undergoing elective TKA, compared to women, indicates gender disparity in these outcomes. PMID:23335560

  4. Preoperative physiotherapy and short-term functional outcomes of primary total knee arthroplasty

    PubMed Central

    Ismail, Mohd Shukry Mat Eil @; Sharifudin, Mohd Ariff; Shokri, Amran Ahmed; Rahman, Shaifuzain Ab

    2016-01-01

    INTRODUCTION Physiotherapy is an important part of rehabilitation following arthroplasty, but the impact of preoperative physiotherapy on functional outcomes is still being studied. This randomised controlled trial evaluated the effect of preoperative physiotherapy on the short-term functional outcomes of primary total knee arthroplasty (TKA). METHODS 50 patients with primary knee osteoarthritis who underwent unilateral primary TKA were randomised into two groups: the physiotherapy group (n = 24), whose patients performed physical exercises for six weeks immediately prior to surgery, and the nonphysiotherapy group (n = 26). All patients went through a similar physiotherapy regime in the postoperative rehabilitation period. Functional outcome assessment using the algofunctional Knee Injury and Osteoarthritis Outcome Score (KOOS) scale and range of motion (ROM) evaluation was performed preoperatively, and postoperatively at six weeks and three months. RESULTS Both groups showed a significant difference in all algofunctional KOOS subscales (p < 0.001). The mean score difference at six weeks and three months was not significant in the sports and recreational activities subscale for both groups (p > 0.05). Significant differences were observed in the time-versus-treatment analysis between groups for the symptoms (p = 0.003) and activities of daily living (p = 0.025) subscales. No significant difference in ROM was found when comparing preoperative measurements and those at three months following surgery, as well as in time-versus-treatment analysis (p = 0.928). CONCLUSION Six-week preoperative physiotherapy showed no significant impact on short-term functional outcomes (KOOS subscales) and ROM of the knee following primary TKA. PMID:26996450

  5. Preoperative physiotherapy and short-term functional outcomes of primary total knee arthroplasty.

    PubMed

    Mat Eil Ismail, Mohd Shukry; Sharifudin, Mohd Ariff; Shokri, Amran Ahmed; Ab Rahman, Shaifuzain

    2016-03-01

    Physiotherapy is an important part of rehabilitation following arthroplasty, but the impact of preoperative physiotherapy on functional outcomes is still being studied. This randomised controlled trial evaluated the effect of preoperative physiotherapy on the short-term functional outcomes of primary total knee arthroplasty (TKA). 50 patients with primary knee osteoarthritis who underwent unilateral primary TKA were randomised into two groups: the physiotherapy group (n = 24), whose patients performed physical exercises for six weeks immediately prior to surgery, and the nonphysiotherapy group (n = 26). All patients went through a similar physiotherapy regime in the postoperative rehabilitation period. Functional outcome assessment using the algofunctional Knee Injury and Osteoarthritis Outcome Score (KOOS) scale and range of motion (ROM) evaluation was performed preoperatively, and postoperatively at six weeks and three months. Both groups showed a significant difference in all algofunctional KOOS subscales (p < 0.001). The mean score difference at six weeks and three months was not significant in the sports and recreational activities subscale for both groups (p > 0.05). Significant differences were observed in the time-versus-treatment analysis between groups for the symptoms (p = 0.003) and activities of daily living (p = 0.025) subscales. No significant difference in ROM was found when comparing preoperative measurements and those at three months following surgery, as well as in time-versus-treatment analysis (p = 0.928). Six-week preoperative physiotherapy showed no significant impact on short-term functional outcomes (KOOS subscales) and ROM of the knee following primary TKA. Copyright: © Singapore Medical Association.

  6. Outcomes of reverse total shoulder arthroplasty as primary versus revision procedure for proximal humerus fractures.

    PubMed

    Dezfuli, Bobby; King, Joseph J; Farmer, Kevin W; Struk, Aimee M; Wright, Thomas W

    2016-07-01

    Reverse total shoulder arthroplasty (RTSA) has been shown to be an effective treatment for proximal humerus fracture (PHF). This study evaluates outcomes of all patients with PHF treated with RTSA as a primary procedure for acute PHF, a delayed primary procedure for symptomatic PHF malunion or nonunion, a revision procedure for failed PHF hemiarthroplasty (HA), or a revision procedure for failed open reduction and internal fixation (ORIF). Patients who underwent RTSA for PHF were evaluated for active range of motion and Shoulder Pain and Disability Index (SPADI), Simple Shoulder Test-12, American Shoulder and Elbow Surgeons (ASES), University of California-Los Angeles (UCLA) shoulder rating scale, Constant, and 12-Item Short Form Health Survey scores. Scaption and external rotation (ER) strength were also assessed. RTSA was performed in 49 patients with PHF; 13 patients underwent RTSA for acute PHF, 13 for malunion or nonunion, 12 for failed PHF HA, and 11 for failed PHF ORIF. ER range of motion, SPADI, ASES, UCLA, and Constant scores achieved significance. The acute fracture group significantly outperformed the failed HA group in SPADI, ASES, and UCLA scores. The malunion/nonunion group significantly outperformed the failed HA group in ASES and UCLA scores. The acute fracture and malunion/nonunion groups each had significantly greater ER than the failed HA group. RTSA is an effective treatment option for PHF as both a primary and a revision procedure. Primary RTSA outperformed RTSA done as a revision procedure. RTSA for acute PHF is comparable to RTSA for malunions and nonunions. Our outcomes of revision RTSA for failed HA and ORIF are more promising than previously published. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  7. Ecosystem model intercomparison of under-ice and total primary production in the Arctic Ocean

    NASA Astrophysics Data System (ADS)

    Jin, Meibing; Popova, Ekaterina E.; Zhang, Jinlun; Ji, Rubao; Pendleton, Daniel; Varpe, Øystein; Yool, Andrew; Lee, Younjoo J.

    2016-01-01

    Previous observational studies have found increasing primary production (PP) in response to declining sea ice cover in the Arctic Ocean. In this study, under-ice PP was assessed based on three coupled ice-ocean-ecosystem models participating in the Forum for Arctic Modeling and Observational Synthesis (FAMOS) project. All models showed good agreement with under-ice measurements of surface chlorophyll-a concentration and vertically integrated PP rates during the main under-ice production period, from mid-May to September. Further, modeled 30-year (1980-2009) mean values and spatial patterns of sea ice concentration compared well with remote sensing data. Under-ice PP was higher in the Arctic shelf seas than in the Arctic Basin, but ratios of under-ice PP over total PP were spatially correlated with annual mean sea ice concentration, with higher ratios in higher ice concentration regions. Decreases in sea ice from 1980 to 2009 were correlated significantly with increases in total PP and decreases in the under-ice PP/total PP ratio for most of the Arctic, but nonsignificantly related to under-ice PP, especially in marginal ice zones. Total PP within the Arctic Circle increased at an annual rate of between 3.2 and 8.0 Tg C/yr from 1980 to 2009. This increase in total PP was due mainly to a PP increase in open water, including increases in both open water area and PP rate per unit area, and therefore much stronger than the changes in under-ice PP. All models suggested that, on a pan-Arctic scale, the fraction of under-ice PP declined with declining sea ice cover over the last three decades.

  8. Differences in short-term complications between spinal and general anesthesia for primary total knee arthroplasty.

    PubMed

    Pugely, Andrew J; Martin, Christopher T; Gao, Yubo; Mendoza-Lattes, Sergio; Callaghan, John J

    2013-02-06

    Spinal anesthesia has been associated with lower postoperative rates of deep-vein thrombosis, a shorter operative time, and less blood loss when compared with general anesthesia. The purpose of the present study was to identify differences in thirty-day perioperative morbidity and mortality between anesthesia choices among patients undergoing total knee arthroplasty. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was searched to identify patients who underwent primary total knee arthroplasty between 2005 and 2010. Complications that occurred within thirty days after the procedure in patients who had been managed with either general or spinal anesthesia were identified. Patient characteristics, thirty-day complication rates, and mortality were compared. Multivariate logistic regression identified predictors of thirty-day morbidity, and stratified propensity scores were used to adjust for selection bias. The database search identified 14,052 cases of primary total knee arthroplasty; 6030 (42.9%) were performed with the patient under spinal anesthesia and 8022 (57.1%) were performed with the patient under general anesthesia. The spinal anesthesia group had a lower unadjusted frequency of superficial wound infections (0.68% versus 0.92%; p = 0.0003), blood transfusions (5.02% versus 6.07%; p = 0.0086), and overall complications (10.72% versus 12.34%; p = 0.0032). The length of surgery (ninety-six versus 100 minutes; p < 0.0001) and the length of hospital stay (3.45 versus 3.77 days; p < 0.0001) were shorter in the spinal anesthesia group. After adjustment for potential confounders, the overall likelihood of complications was significantly higher in association with general anesthesia (odds ratio, 1.129; 95% confidence interval, 1.004 to 1.269). Patients with the highest number of preoperative comorbidities, as defined by propensity score-matched quintiles, demonstrated a significant difference between the groups with

  9. Periprosthetic bone turnover after primary total hip arthroplasty measured by single-photon emission computed tomography.

    PubMed

    Venesmaa, P; Vanninen, E; Miettinen, H; Kröger, H

    2012-01-01

    Alterations in periprosthetic bone are common sequlae of prosthetic implants.This prospective 3-year study was performed to follow regional periprosthetic bone turnover after uncomplicated total hip arthroplasty (THA) using single-photon emission computed tomography (SPECT). Eighteen patients (nine men, nine women: mean age 61 years, range from 50 to 73 years) with primary hip osteoarthritis underwent either uncemented or cemented THA. The SPECT measurements were taken 6, 12, and 36 months after THA. Bone mineral density (BMD) measurements were performed on the patients during follow-up. The mean SPECT uptake ratios decreased significantly in the regions of interest (ROIs) during follow-up compared to baseline value, in the trochanter major (p = 0.006), the trochanter minor (p = 0.009) and the total area (p = 0.018). Despite these decreases the uptake ratios in the medial cortex (p = 0.014), tip (p = 0.002) and total area (p = 0.016) remained significantly higher in the operated side than in the contralateral side (non-operated) 3 years after THA. Changes in bone turnover in the vicinity of the implant did not correlate with changes in periprosthetic BMD. Local periprosthetic bone turnover decreased slowly after THA and did not recover to the level typical of non-operated hips. This led us to suggest that bone turnover around the femoral implants remains increased more than 3 years after THA even if there are no signs of failure of the prosthesis.

  10. Preoperative Acute Inflammatory Markers as Predictors for Postoperative Complications in Primary Total Knee Arthroplasty

    PubMed Central

    Godoy, Gustavo; Sumarriva, Gonzalo; Ochsner, J. Lockwood; Chimento, George; Schmucker, Dana; Dasa, Vinod; Meyer, Mark

    2016-01-01

    Background: C-reactive protein (CRP) has been suggested as an independent risk factor for cardiovascular pathology in the nonsurgical setting. While postoperative CRP and erythrocyte sedimentation rate (ESR) have an established role in aiding the diagnosis of periprosthetic joint infections, some authors suggest a link between preoperative CRP and postoperative complications in patients undergoing total joint arthroplasty. Methods: We conducted a retrospective cohort study of 351 patients who underwent unilateral primary total knee arthroplasty by a single surgeon during a 28-month period (January 2013 through April 2015). Patient medical records were reviewed for the following complications occurring within 90 days postoperatively: myocardial infarction, arrhythmia, pulmonary embolism, wound infection, acute renal failure, and reoperation. Results: We found no statistically significant link between postoperative complications and preoperative CRP levels (P=0.5005) or ESR levels (P=0.1610). Conclusion: The results of this study do not support the routine inclusion of CRP and ESR analysis as part of the preoperative evaluation for elective total knee arthroplasty. PMID:27999506

  11. Modified Frailty Index Is an Effective Risk Assessment Tool in Primary Total Knee Arthroplasty.

    PubMed

    Runner, Robert P; Bellamy, Jaime L; Vu, CatPhuong Cathy L; Erens, Greg A; Schenker, Mara L; Guild, George N

    2017-09-01

    "Frailty" is a marker of physiological decline of multiple organ systems, and the frailty index identifies patients who are more susceptible to postoperative complications. The purpose of this study is to validate the modified frailty index (MFI) as a predictor of postoperative complications, reoperations, and readmissions in patients who underwent primary total knee arthroplasty (TKA). The American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2014 was queried by the Current Procedural Terminology code for primary TKA (27447). A previously described MFI was used to summate 11 variables in 5 organ systems. Bivariate analysis was performed for postoperative complications. A multiple logistic regression model was used to determine the relationship between MFI, American Society of Anesthesiologists score, and 30-day reoperation, controlling for age, gender, and body mass index. A total of 90,260 patients underwent primary TKA during the study period. As MFI score increased, 30-day mortality significantly increased (P < .001). In addition, significantly higher rates of postoperative complications (all P < .001) were observed with increasing MFI: infection, wound, cardiac, pulmonary, and renal complications; and any occurrence. More frail patients also had increasing odds of adverse hospital discharge disposition, reoperation, and readmission (all P < .001). Length of hospital stay increased from 3.10 to 5.16 days (P < .001), while length of intensive care unit stay increased from 3.47 to 5.07 days (P < .001) between MFI score 0 and ≥0.36. MFI predicts 30-day reoperation with an adjusted odds ratio of 3.32 (95% confidence interval, 1.36-8.11; P < .001). Comparatively, MFI was a stronger predictor of reoperation compared with American Society of Anesthesiologists score and age with adjustment for gender and body mass index. Utilization of the MFI is a valid method in predicting postoperative complications, reoperations, and

  12. A large scale finite element study of a cementless osseointegrated tibial tray.

    PubMed

    Galloway, Francis; Kahnt, Max; Ramm, Heiko; Worsley, Peter; Zachow, Stefan; Nair, Prasanth; Taylor, Mark

    2013-07-26

    The aim of this study was to investigate the performance of a cementless osseointegrated tibial tray (P.F.C. ® Sigma®, Depuy® Inc, USA) in a general population using finite element (FE) analysis. Computational testing of total knee replacements (TKRs) typically only use a model of a single patient and assume the results can be extrapolated to the general population. In this study, two statistical models (SMs) were used; one of the shape and elastic modulus of the tibia, and one of the tibiofemoral joint loads over a gait cycle, to generate a population of FE models. A method was developed to automatically size, position and implant the tibial tray in each tibia, and 328 models were successfully implanted and analysed. The peak strain in the bone of the resected surface was examined and the percentage surface area of bone above yield strain (PSAY) was used to determine the risk of failure of a model. Using an arbitrary threshold of 10% PSAY, the models were divided into two groups ('higher risk' and 'lower risk') in order to explore factors that may influence potential failure. In this study, 17% of models were in the 'higher risk' group and it was found that these models had a lower elastic modulus (mean 275.7MPa), a higher weight (mean 85.3kg), and larger peak loads, of which the axial force was the most significant. This study showed the mean peak strain of the resected surface and PSAY were not significantly different between implant sizes. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Pulpotomy of primary molars with coronal or total pulpitis using formocresol technique.

    PubMed

    Mejàre, I

    1979-06-01

    The aim of this study was to evaluate whether formocresol can be used successfully in teeth with carious exposure and a vital pulp with clinical symptoms of chronic pulpitis. Further, the study concerned the influence on the success rate of the vehicle for formocresol. Pulpotomies were performed on 81 primary molars. Radiographic and other clinical symptoms were used to divide the material into a coronal chronic and a total chronic pulpitis group. Chosen by lot, zinc oxide-eugenol or Pharmatec (a plaster-like non-eugenol cement) was used as the vehicle for formocresol. After an observation period of 2.5 years the success rate for the whole material was 55%. No statistically significant difference in the rate of success could be demonstrated either between the two diagnostic groups or between the two vehicle groups.

  14. Revision total knee arthroplasty for failure of primary treatment of periprosthetic knee fractures.

    PubMed

    Abbas, Ammar M I; Morgan-Jones, Rhidian L

    2014-10-01

    Periprosthetic knee fractures and their complications are expected to increase as the numbers of knee arthroplasties continue to rise. We report our experience with revision knee arthroplasty for failure of primary fracture treatment. Five periprosthetic knee non-unions and 1 mal-union in 6 patients, with ages ranging from 65 to 83years (average 74.6years) were treated with revision total knee arthroplasty, and were followed up for 3 to 10years (average 4.5years). Union occurred in 8 to 18weeks (average 12.5weeks). All patients were ambulatory at the latest follow-up, with a range of motion averaging 84.2° (P = 0.03), and an Oxford Knee Score averaging 35 (P = 0.03). We conclude that union complications of periprosthetic knee fractures can be satisfactorily addressed with revision arthroplasty.

  15. Cancellous impaction bone grafting of acetabular defects in complex primary and revision total hip arthroplasty.

    PubMed

    Patil, Nilesh; Hwang, Katherine; Goodman, Stuart B

    2012-03-07

    The reconstruction of major acetabular bone defects during revision, conversion, and primary total hip arthroplasties (THAs) is challenging. We reviewed a consecutive series of 168 THAs (108 revisions, 8 conversions, and 52 primary THAs) performed by 1 surgeon (S.B.G.) between 1997 and 2008 using impaction bone grafting for acetabular reconstruction. Autograft, cancellous allograft croutons, and demineralized bone matrix were used to fill bone defects as needed. The acetabular bone deficiency was classified according to the American Academy of Orthopaedic Surgeons: type I, segmental deficiency with significant rim defect; type II, cavitary defects medially or posteriorly; type III, combined cavitary and segmental deficiency; type IV, pelvic discontinuity; and type V, arthrodesis. According to this method, 56 hips had type I, 31 hips had type II, 48 hips had type III, and 27 hips had type IV deficiencies. Of the 168 patients, 19 subsequently died of causes unrelated to the THA, and 11 were lost to follow-up. All patients had at least 2 years of follow-up. Average Harris Hip Score improved from 45.5±17.9 preoperatively to 81.1±16.5 postoperatively (P<.05) for revision THAs, from 40.0±11.3 preoperatively to 85.0±12.8 postoperatively (P<.05) for conversion THAs, and from 42.3±14.9 preoperatively to 85.0±12.0 postoperatively (P<.05) for primary THAs. All impaction grafted bone (allograft, autograft, or a combination) incorporated radiographically, thus restoring bone stock. Complications included 1 early infection, which was managed successfully with debridement and liner exchange, and 2 late infections that were managed successfully with staged revision. Two revisions required subsequent re-revision for late loosening. Two hip dislocations occurred, 1 of which required surgical treatment to place a constrained liner. Copyright 2012, SLACK Incorporated.

  16. Hospital, Patient, and Clinical Factors Influence 30- and 90-Day Readmission After Primary Total Hip Arthroplasty.

    PubMed

    Kurtz, Steven M; Lau, Edmund C; Ong, Kevin L; Adler, Edward M; Kolisek, Frank R; Manley, Michael T

    2016-10-01

    The purpose of this study was to analyze the hospital, clinical, and patient factors associated with inpatient readmission after total hip arthroplasty (THA) in the Medicare population and to understand the primary reasons for readmission. The Medicare 100% national hospital claims database was used to identify 442,333 older patients (65+) with a primary THA in 3730 hospitals between 2010 and 2013. A multilevel logistic regression analysis with a clustered data structure was used to investigate the risk of all-cause 30- and 90-day readmission, incorporating hospital, clinical, and patient factors. At 30 days, 5.8% (median) of the patients were readmitted, whereas at 90 days, 10.5% (median) were readmitted. Geographic census region, hospital procedure volume, and nonprofit ownership were the only significant hospital factors among those we studied. Overall, clinical factors explained more of the variation in readmission rates than general hospital factors. Use of a perioperative transfusion was associated with 14% greater risk, patients discharged to home had 28% lower risk, and surgeon volume and length of stay were also significant risk factors. The top 5 most frequently reported primary reasons for 30-day readmission in THA were procedure related: dislocation (5.9%), deep infection (5.1%), wound infection (4.8%), periprosthetic fracture (4.4%), or hematoma (3.4%). These findings support further optimization of the delivery of care-both intraoperative and postoperative-to reduce the broad variation in hospital readmissions. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  17. Does patella resurfacing really matter? Pain and function in 972 patients after primary total knee arthroplasty

    PubMed Central

    Espehaug, Birgitte; Havelin, Leif Ivar; Vollset, Stein Emil; Furnes, Ove

    2010-01-01

    Background and purpose Resurfacing of the patella during primary total knee arthroplasty (TKA) is often recommended based on higher revision rates in non-resurfaced knees. As many of these revisions are insertions of a patella component due to pain, and since only patients with a non-resurfaced patella have the option of secondary resurfacing, we do not really know whether these patients have more pain and poorer function. The main purpose of the present paper was therefore to assess pain and function at least 2 years after surgery for unrevised primary non-resurfaced and resurfaced TKA, and secondary among prosthesis brands. Methods Information needed to calculate subscales from the knee injury and osteoarthritis outcome score (KOOS) was collected in a questionnaire given to 972 osteoarthritis patients with intact primary TKAs that had been reported to the Norwegian Arthroplasty Register. Pain and satisfaction on visual analog scales and improvement in EQ-5D index score ΔEQ-5D) were also used as outcomes. Outcomes were measured on a scale from 0 to 100 units (worst to best). To estimate differences in mean scores, we used multiple linear regression with adjustment for possible confounders. Results We did not observe any differences between resurfacing and non-resurfacing in any outcome, with estimated differences of ≤ 1.4 units and p-values of > 0.4. There was, however, a tendency of better results for the NexGen implant as compared to the reference brand AGC for symptoms (difference = 4.9, p = 0.05), pain (VAS) (difference = 8.3, p = 0.004), and satisfaction (VAS) (difference = 7.9, p = 0.02). However, none of these differences reached the stated level of minimal perceptible clinical difference. Interpretation Resurfacing of the patella has no clinical effect on pain and function after TKA. Differences between the brands investigated were small and they were assumed to be of minor importance. PMID:20158405

  18. Tibiofemoral Instability After Primary Total Knee Arthroplasty: Posterior-Stabilized Implants for Obese Patients.

    PubMed

    Can, Ata; Erdogan, Fahri; Erdogan, Ayse Ovul

    2017-06-15

    Tibiofemoral instability is a common complication after total knee arthroplasty (TKA), accounting for up to 22% of all revision procedures. Instability is the second most common cause of revision in the first 5 years after primary TKA. In this study, 13 knees with tibiofemoral instability after TKA were identified among 693 consecutive primary TKA procedures. Patient demographics, body mass index, clinical symptoms, previous deformity, previous knee surgery, complications, interval between index TKA and first tibiofemoral instability, causes of instability, and interval between index TKA and revision TKA were retrospectively reviewed. Clinical outcomes were assessed with the Lysholm Knee Scoring Scale. All patients were women, and mean body mass index was 37.7 kg/m(2) (range, 27.2-52.6 kg/m(2)). Mean interval between index TKA and first tibiofemoral instability was 23.4 months (range, 9-45 months), and mean interval between index TKA and revision TKA was 25.6 months (range, 14-48 months). All patients had posterior cruciate ligament-retaining implants. Of the 13 knees, 11 had flexion instability and 2 had global instability. In all patients, instability was caused by incompetence of the posterior cruciate ligament; additionally, 1 patient had undersized and malpositioned implants. In 4 knees, the polyethylene insert was broken as well. All patients underwent revision TKA. Lysholm Knee Scoring Scale score had improved from a mean of 35.8 (range, 30-46) to a mean of 68.3 (range, 66-76). All patients included in this study were female and obese. The main cause of instability was secondary posterior cruciate ligament rupture and incompetence. The use of posterior-stabilized implants for primary TKA may prevent secondary instability in obese patients. [Orthopedics. 201x; xx(x):xx-xx.]. Copyright 2017, SLACK Incorporated.

  19. [Single intravenous tranexamic acid dose to reduce blood loss in primary total knee replacement].

    PubMed

    Sanz-Reig, J; Parra Ruiz, B; Ferrández Martínez, J; Martínez López, J F

    2016-01-01

    To evaluate the effectiveness and safety of a single intravenous dose of tranexamic acid in order to reduce blood loss in total knee replacement. Prospective observational study of the administration of tranexamic acid in patients undergoing primary total knee arthroplasty from November 2013 to February 2015, in which an autologous blood recovery system was used. The study included 98 patients, distributed into two groups of 49 patients according to whether or not they received intravenous tranexamic acid. The primary endpoint was the number of patients requiring autologous transfusion from the recovery system autologous blood recovery system. No drop-outs were recorded during follow-up. There were no significant differences between groups as regards the preoperative and hospital variables. The mean preoperative haemoglobin and haematocrit at 24 and 48 hours postoperatively were similar in both groups. The average volume of bleeding in the autologous blood recovery system and estimated average blood loss was lower in patients who had been administered tranexamic acid, with significant differences. No patients in the group that was administered tranexamic acid required blood autotransfusion. The transfusion rate was zero in the two groups. No adverse events related to the administration of tranexamic acid were recorded. Intravenous administration of tranexamic acid, according to the described protocol, has presented a non-autotransfusion or allo-transfusion rate of 100%, with no increased incidence of thrombotic events. Thus, its use in this group of patients is recommended. The indication should be individualized, its use justified in the patient medical records, and informed consent is mandatory. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

  20. Modified Frailty Index Is an Effective Risk Assessment Tool in Primary Total Hip Arthroplasty.

    PubMed

    Bellamy, Jaime L; Runner, Robert P; Vu, CatPhuong Cathy L; Schenker, Mara L; Bradbury, Thomas L; Roberson, James R

    2017-10-01

    Frailty is described as decreased physiological reserve and typically increasing with age. Hospitals are being penalized for reoperations and readmissions, which can affect reimbursement. The purpose of this study was to determine if the modified frailty index (MFI) could be used as a risk assessment tool for preoperative counseling and to make an objective decision on whether to perform total hip arthroplasty (THA) on a frail patient. The American College of Surgeons National Surgical Quality Improvement Program database was queried by Current Procedural Terminology code for primary THA (27130) from 2005 to 2014. MFI was calculated using 11 variables extracted from the medical record. Bivariate analysis was performed for outcomes and complications, and the multiple logistic regression model was used to compare MFI with other predictors of readmission, any complication, and reoperation. A total of 51,582 patients underwent primary THA during the study period. MFI was a significant and stronger predictor than the American Society of Anesthesiologists class and age for readmission (odds ratio [OR], 14.72; 95% confidence interval [CI], 6.95-31.18; P < .001), any complication (OR, 3.63; 95% CI, 1.64-8.05; P = .002), and reoperation (OR, 8.78; 95% CI, 3.67-20.98; P < .001). As MFI increased, adverse discharge, any complication, readmission, reoperation, and mortality significantly increased (P < .001). Rates of systemic complications and length of stay significantly increased with increasing MFI. MFI is a simple and effective risk assessment tool to preoperatively counsel and make an objective decision on whether to perform THA on a frail patient. Published by Elsevier Inc.

  1. Effect of training level on accuracy of digital templating in primary total hip and knee arthroplasty.

    PubMed

    Hsu, Andrew R; Kim, Jeffrey D; Bhatia, Sanjeev; Levine, Brett R

    2012-02-17

    The use of digital radiography and templating software continues to become more prevalent in orthopedics as the number of total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures increases every year. The purpose of this study was to evaluate the effect of training level on the accuracy of digital templating for primary THA and TKA. Digital radiographs of 97 patients undergoing primary THA (49 cases) and TKA (48 cases) were retrospectively templated using OrthoView digital planning software (OrthoView LLC, Jacksonville, Florida). Anteroposterior hip and lateral knee radiographs were digitally templated and compared with the actual size of the implants used intraoperatively. An implant sales representative, physician assistant, medical student (J.D.K.), resident (A.R.H.), and fellowship-trained arthroplasty surgeon (B.R.L.) templated all cases independently after a standardized orientation and were blinded to the actual component sizes used for surgery. The medical student, resident, and arthroplasty surgeon retemplated the same 97 cases 1 month later to determine intraobserver reliability. Digital templating was accurate in predicting the correct implant size in 33% of THAs and 54% of TKAs. In 73% of THAs and 92% of TKAs, digital templating was within 1 size of the actual implant used, and in 88% of THAs and 99% of TKAs, templating was within 2 sizes of the final components. In no cases did the templated implant size vary by >3 sizes from the final components. Interobserver reliability for templating THAs and TKAs showed good reliability as measured by intraclass correlation coefficient (ICC) (ICC(THA)=.70; ICC(TKA)=.86). Intraobserver reliability for templating THAs had excellent reliability for the resident and arthroplasty surgeon, with a kappa coefficient (κ) of 0.92, and good reliability for the medical student (κ=0.78). Intraobserver reliability for templating TKAs showed excellent reliability among all examiners (κ=0.90).

  2. Preoperative planning of primary total hip arthroplasty using conventional radiographs☆☆☆

    PubMed Central

    Miashiro, Edson Hidenori; Fujiki, Edson Noboru; Yamaguchi, Eduardo Nagashigue; Chikude, Takeshi; Rodrigues, Luiz Henrique Silveira; Fontes, Gustavo Martins; Rosa, Fausto Boccatto

    2014-01-01

    Objective the objective of this study was to present an analog method for preoperative planning of primary total hip arthroplasty procedures based on measuring the components by overlaying the transparencies of the prosthesis on the preoperative radiographs and checking the accuracy, both for predicting the size of the acetabular and femoral components used and for restoring the offset and correcting the dysmetria. Methods between March 2005 and July 2009, 56 primary total hip arthroplasty procedures performed on 56 patients at the Mario Covas State Hospital in Santo André were analyzed. The measurements on the femoral and acetabular components obtained through planning were compared with those that were used in the surgery. The offsets measured through the preoperative planning were compared with those measured on the postoperative radiographs. Dysmetria was evaluated before and after the operation. Results accuracy of 78.6% (p < 0.001) in predicting the size of the acetabular component and 82.2% (p < 0.001) in predicting the femoral nail was observed. The offsets measured through preoperative planning were statistically similar to the offsets measured on the postoperative radiographs. After the operation, we observed absolute equalization in 48.2% of the cases. In 87.5%, the dysmetria was less than or equal to 1 cm and in 69.6%, it was less than or equal to 0.5 cm. Conclusions the accuracy was 78.6% and 82.2%, respectively, for the acetabular and femoral components. The offsets that were planned preoperatively were statistically similar to those measured on postoperative radiographs. We found absolute equalization in 48.2% of the cases. PMID:26229790

  3. Initial experience with a newly developed cementless hip endoprosthesis.

    PubMed

    Hach, V; Delfs, G

    2009-01-01

    The HELICA-Endoprosthesis is a newly developed cementless hip prosthesis for dogs. It was implanted in 39 dogs that had severe hip osteoarthritis and a history of hip pain, as well as in one dog that had chronic hip luxation. One dog had a bilateral arthroplasty. The body weight of the patients ranged between 22 and 54 kg and their ages between nine months and 10 years. Both the femoral stem and acetabular component of the prosthesis were screwed into position following bony preparation. Additional fixation was not necessary as the components remain fixed in position until osteointegration is complete. There are currently five sizes of prosthesis available, and the various components such as the stem, cup and head are readily interchangeable. Although it appeared that good osseous anchorage of the prostheses in the bone on the surgery table had been obtained, three patients experienced both stem and cup loosening (one week, three weeks and six months after surgery). In one animal, stem loosening was observed six weeks after surgery, and another dog experienced a cup loosening two weeks postoperatively. Most of the complications were due to technical errors that occurred during the learning phase. Surgical revisions were successful in three out of five animals. In two animals we had to perform a femoral head and neck excision. Two other animals experienced radiographic bone resorption underneath the segmented collar of the femoral prosthesis but did not show any significant clinical signs of lameness. Another dog that showed signs of ischial neuropraxy after surgery, recovered completely within six weeks after surgery. All of the dogs were capable of weight bearing on the operated leg one day after surgery. The main advantage of the HELICA-Endoprosthesis is the relatively easy surgical technique and short surgery time. The initial clinical results in these 40 cases have been very encouraging. The aim of this study was to assess the early clinical results in these 39

  4. Improvement in quality of lifesix months after primary total hip arthroplasty in a Pakistani population.

    PubMed

    Zubairi, Akbar Jaleel; Bin Mahmood, Syed Usman; Ali, Moiz; Noordin, Shahryar

    2016-10-01

    This prospective, cohort study was carried out to assess the improvement in quality of life of patients undergoing elective primary total hip arthroplasty (THA). It was conducted at the orthopaedic department of the Aga Khan University Hospital, Karachi, from June 2014 to May 2015, and comprised patients who had undergone THA. A total of 89 patients having a mean age of 41.5±12.0 years with a baseline core outcomes measure index (COMI)-hip score of > 3.5 were included. A decrease in COMI-hip score by >3 points six months post-operatively was considered improvement in quality of life. Patient satisfaction with restriction to squatting was assessed separately. The mean reduction in COMI-hip was 4.9±1.3 with 83(93%) patients experiencing significant improvement in quality of life. Age >50 years and American Society of Anaesthesiologists (ASA) level >III was significantly associated with no improvement in quality of life. Most patients were satisfied with their disability to squat irrespective of COMI-hip score. THA was found to be associated with significant improvement in quality of life and COMI-hip score was applicable in our population despite its inability to assess disability with restriction in squatting.

  5. Technical feasibility of laparoscopic extended surgery beyond total mesorectal excision for primary or recurrent rectal cancer.

    PubMed

    Akiyoshi, Takashi

    2016-01-14

    Relatively little is known about the oncologic safety of laparoscopic surgery for advanced rectal cancer. Recently, large randomized clinical trials showed that laparoscopic surgery was not inferior to open surgery, as evidenced by survival and local control rates. However, patients with T4 tumors were excluded from these trials. Technological advances in the instrumentation and techniques used by laparoscopic surgery have increased the use of laparoscopic surgery for advanced rectal cancer. High-definition, illuminated, and magnified images obtained by laparoscopy may enable more precise laparoscopic surgery than open techniques, even during extended surgery for T4 or locally recurrent rectal cancer. To date, the quality of evidence regarding the usefulness of laparoscopy for extended surgery beyond total mesorectal excision has been low because most studies have been uncontrolled series, with small sample sizes, and long-term data are lacking. Nevertheless, laparoscopic extended surgery for rectal cancer, when performed by specialized laparoscopic colorectal surgeons, has been reported safe in selected patients, with significant advantages, including a clear visual field and less blood loss. This review summarizes current knowledge on laparoscopic extended surgery beyond total mesorectal excision for primary or locally recurrent rectal cancer.

  6. Variation in the cost of care for primary total knee arthroplasties.

    PubMed

    Haas, Derek A; Kaplan, Robert S

    2017-03-01

    The study examined the cost variation across 29 high-volume US hospitals and their affiliated orthopaedic surgeons for delivering a primary total knee arthroplasty without major complicating conditions. The hospitals had similar patient demographics, and more than 80% of them had statistically-similar Medicare risk-adjusted readmission and complication rates. Hospital and physician personnel costs were calculated using time-driven activity-based costing. Consumable supply costs, such as the prosthetic implant, were calculated using purchase prices, and postacute care costs were measured using either internal costs or external claims as reported by each hospital. Despite having similar patient demographics and readmission and complication rates, the average cost of care for total knee arthroplasty across the hospitals varied by a factor of about 2 to 1. Even after adjusting for differences in internal labor cost rates, the hospital at the 90th percentile of cost spent about twice as much as the one at the 10th percentile of cost. The large variation in costs among sites suggests major and multiple opportunities to transfer knowledge about process and productivity improvements that lower costs while simultaneously maintaining or improving outcomes.

  7. [Comparation of the antero-lateral and posterior approaches in primary total hip arthroplasty].

    PubMed

    Macedo, C A; Galia, C R; Rosito, R; Valin, M R; Kruel, A V; Muller, L; Rodríguez, F A

    1999-01-01

    Comparison between the antero-lateral and posterior approaches in primary total hip arthroplasty. In this retrospective study, 184 patients were enrolled, 95 submitted to the anterolateral (Watson jones) and 89 to the posterior approach (Moore) from June 1993 to June 1997. The outcomes assessed were perioperative data (operative time, hospital stay, time from surgery until hospital discharge, surgical bleeding and the need for blood transfusion), as well as late complications (deep venous thrombosis DVP, pulmonary embolism, periopheral nerve injury, prothesis instability and others). Both groups did not differ in terms of preoperative parameters. Those submitted to the posterior approach had shorter operative times (p < 0.001), as well as reduced bleeding (p < 0.05) and need for blood transfusion (p < 0.001) during surgery. The outcomes, such as late complications, had similar reduced frequency in both groups. The posterior approach has been successfully applied in our service and proves to be an excellent alternative surgical access to the total hip arthroplasty.

  8. Cementless femoral components should be made from cobalt chrome.

    PubMed

    Sotereanos, N G; Engh, C A; Glassman, A H; Macalino, G E; Engh, C A

    1995-04-01

    Before 1982, the authors performed 177 primary total hip arthroplasties using a single-sized, extensively porous-coated cobalt-chrome femoral prosthesis. The current status of 122 of these arthroplasties is known. Two femoral prostheses have been revised for late symptomatic loosening, 2 for stem fracture, and 1 for infection. From 1982 to 1984, 227 primary arthroplasties were performed using the same stem in multiple sizes. Of these cases, 171 are available for followup. One stem (0.6%) has been revised for symptomatic loosening. Large osteolytic femoral lesions (average size, 8.1 cm2) developed in 3 patients, associated with an unusually large amount of polyethylene wear of their acetabular components. These patients have been treated by exchange of the polyethylene liner within the porous-coated acetabular component and allografting of the osteolytic lesions. The femoral components were not exchanged because osteolysis had not eroded the integrity of the supporting bone-implant interface to a point where loosening occurred. Before 1987, 193 patients with loose femoral components were treated with revision total hip arthroplasty, also using an extensively porous-coated cobalt-chrome femoral stem of similar design. Ten (5.7%) patients have required rerevision of the femoral prosthesis. Six of these 10 rerevisions were performed because of symptomatic loosening. Ninety-three percent of the patients in the primary series had relief of their preoperative pain and have improved functional ability; 94.2% are satisfied with their results. In the revision series, 89.1% of the patients are free of pain and function better than preoperatively, and 89.6% are fully satisfied with their results.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Ten-Year Outcome of Serum Metal Ion Levels After Primary Total Hip Arthroplasty

    PubMed Central

    Levine, Brett R.; Hsu, Andrew R.; Skipor, Anastasia K.; Hallab, Nadim J.; Paprosky, Wayne G.; Galante, Jorge O.; Jacobs, Joshua J.

    2013-01-01

    Abstract: We previously reported on the metal ion concentrations of cobalt, chromium, and titanium that were found in the serum of patients three years after they had undergone primary total hip arthroplasty as compared with the concentrations found in the serum of control patients who did not have an implant. This study is a concise update on the serum metal levels found in a cohort of these patients ten years after the time of hip implantation. Of the original seventy-five subjects, metal ion levels were available for forty patients (53%). Ten patients (hybrid group) had received a hybrid total hip replacement that consisted of a modular cobalt-alloy femoral stem with a cobalt-alloy femoral head that had been inserted with cement and a titanium acetabular socket that had been inserted without cement. Nine patients (cobalt-chromium [CoCr] group) had received an implant with an extensively porous-coated modular cobalt-alloy femoral stem and femoral head along with a titanium acetabular socket; the femoral and acetabular components had each been inserted without cement. Eight patients (titanium group) had undergone insertion of a proximally porous-coated modular titanium-alloy femoral stem with a cobalt-alloy femoral head and a titanium acetabular socket; the femoral and acetabular components had each been inserted without cement. Thirteen patients (control group) from the original control group of patients who had not received an implant served as control subjects. Serum metal levels were measured with use of high-resolution sector field inductively coupled plasma mass spectrometry. The hybrid total hip arthroplasty group had mean cobalt levels that were 3.2 times higher at 120 months than they were at baseline, and the cobalt levels in that group were significantly higher than those in the titanium total hip arthroplasty group at thirty-six, sixty, eighty-four, ninety-six, and 120 months (p < 0.01). The hybrid group had mean chromium levels that were 3.9 times

  10. Biological indicators of exposure to total and respirable aluminium dust fractions in a primary aluminium smelter.

    PubMed Central

    Röllin, H B; Theodorou, P; Cantrell, A C

    1996-01-01

    OBJECTIVES: The study attempts to define biological indicators of aluminium uptake and excretion in workers exposed to airborne aluminium compounds in a primary aluminium smelter. Also, this study defines the total and respirable aluminium dust fractions in two different potrooms, and correlates their concentrations with biological indicators in this group of workers. METHODS: Air was sampled at defined work sites. Non-destructive and conventional techniques were used to find total and respirable aluminium content of the dust. Blood and urine was collected from 84 volunteers employed at various work stations throughout the smelter and from two different cohorts of controls matched for sex, age, and socioeconomic status. Aluminium in serum samples and urine specimens was measured by flameless atomic absorption with a PE 4100 ZL spectrometer. RESULTS: The correlation of aluminium concentrations in serum and urine samples with the degree of exposure was assessed for three arbitrary exposure categories; low (0.036 mg Al/m3), medium (0.35 mg Al/m3) and high (1.47 mg Al/m3) as found in different areas of the smelter. At medium and high exposure, the ratio of respirable to total aluminium in the dust samples varied significantly. At high exposure, serum aluminium, although significantly raised, was still within the normal range of an unexposed population. The workers with low exposure excreted aluminium in urine at levels significantly higher than the controls, but still within the normal range of the population. However, potroom workers with medium and high exposure had significantly higher urinary aluminium than the normal range. CONCLUSIONS: It is concluded that only urinary aluminium constitutes a practical index of occupational exposure at or above 0.35 mg Al/m3, and that the respirable fraction of the dust may play a major role in the biological response to exposure to aluminium in a smelter environment. PMID:8758038

  11. The Evolution of Implant Design Decreases the Incidence of Lateral Release in Primary Total Knee Arthroplasty.

    PubMed

    Webb, Jonathan E; Yang, Heidi Y; Collins, Jamie E; Losina, Elena; Thornhill, Thomas S; Katz, Jeffrey N

    2017-05-01

    Appropriate balancing of the patellofemoral joint (PFJ) using a lateral release can help to prevent patellar instability in total knee arthroplasty (TKA). Contemporary total knee implant designs are characterized by enhanced trochlear geometry more similar to native knee anatomy to minimize instability and reduce utilization of a lateral release. We retrospectively reviewed consecutive TKA cases from a single senior surgeon's practice with 3 successive total knee designs: the Press-Fit Condylar (PFC), the Sigma, and the ATTUNE (DePuy, Warsaw, IN). We evaluated the use of lateral release with each implant type to determine if design changes have improved patellar stability, reducing the need for lateral release. We used multivariate analysis to determine the association between implant type and lateral release, adjusting for age, sex, preoperative alignment, and bearing type. We evaluated 1991 records of primary TKAs performed from 1980-2015. As compared with the ATTUNE, the adjusted odds of lateral release were greater for patients receiving PFC implants (Odds ratio [OR] 6.35, 95% confidence interval [CI] 3.85,10.49) and Sigma implants (OR 2.02, 95% CI 1.26, 3.23). In addition, fixed bearing implants were associated with greater adjusted odds of lateral release (OR 1.80, 95% CI 1.24, 2.62). We found that older knee implants were associated with higher use of lateral release, with successive designs the need for lateral release to balance the PFJ decreased. Continued design improvements to match the native knee anatomy may further improve the stability of the PFJ in future designs. Copyright © 2016. Published by Elsevier Inc.

  12. Iliopsoas Impingement After Primary Total Hip Arthroplasty: Operative and Nonoperative Treatment Outcomes.

    PubMed

    Chalmers, Brian P; Sculco, Peter K; Sierra, Rafael J; Trousdale, Robert T; Berry, Daniel J

    2017-04-05

    A potential cause of persistent groin pain after total hip arthroplasty is impingement of the iliopsoas tendon. Treatment options include conservative management, tenotomy, and acetabular revision, but the literature, to our knowledge, has been limited to small case series on each technique. We present a series of patients with iliopsoas impingement after total hip arthroplasty and evaluate efficacy and risk factors for success or failure of each treatment strategy. Forty-nine patients treated at one institution for a diagnosis of iliopsoas impingement after primary total hip arthroplasty with hemispherical acetabular component and polyethylene bearing were retrospectively reviewed. Twenty-one patients underwent acetabular revision, 8 patients underwent tenotomy, and 20 patients had nonoperative management. The mean follow-up was 4 years. Anterior acetabular component prominence was measured on true lateral hip radiographs. At the most recent follow-up, 10 patients (50%) in the nonoperative group had groin pain resolution compared with 22 patients (76%) in the operative group (p = 0.06). In patients with <8 mm of component prominence, tenotomy provided resolution of groin pain in 5 (100%) of 5 patients and a mean Harris hip score of 89 points. In patients with ≥8 mm of prominence, acetabular revision led to groin pain resolution in 12 (92%) of 13 patients compared with 1 (33%) of 3 patients treated with tenotomy (p = 0.07). Nonoperative management of iliopsoas impingement led to groin pain resolution in 50% of patients. In patients with minimal acetabular component prominence, iliopsoas release provided a high rate of success. Acetabular revision was more predictable for groin pain resolution in patients with ≥8 mm of anterior component prominence. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  13. Wound dressing following primary total hip arthroplasty: a prospective randomised controlled trial.

    PubMed

    Siddiqui, M; Bidaye, A; Baird, E; Abu-Rajab, R; Stark, A; Jones, B; Ingram, R; Anthony, I

    2016-01-01

    This study compared three methods of surgical wound dressing in patients undergoing primary total hip arthroplasty to determine their effect on wound leakage. Total hip arthroplasties were randomised to 3 groups: 2-octyl cyanoacrylate (Dermabond-Ethicon Inc, G) with Opsite (Smith & Nephew; O) [G+O], 2-octyl cyanoacrylate with Tegaderm (3M; T) [G+T], and Opsite without 2-octyl cyanoacrylate [O]. Postoperative wound leakage was assessed and graded daily until discharge, the frequency of the dressing changes was also recorded. Patients were clinically reviewed at three months to assess cosmesis of their surgical scar and wound complications. In all 211 total hip arthoplasties were included. A greater proportion of patients' dressings remained dry on day 1 postoperatively in the two groups using 2-octyl cyanoacrylate (G+O and G+T) compared to the no glue group (O; p=0.0001). The G+T group had a significantly lower proportion of patients with increased leakage of wounds on days 2 and 3 postoperatively compared with both G+O and O groups (p=0.0043). The overall rate of dressing change for G+O was 8%, G+T 5%, and O 13%. Overall wound cosmesis was similar in all groups (p=0.690). The reduction in frequency of dressing changes coupled with low levels of wound leakage observed using the combination of the glue and nonabsorbent dressings (O+T), makes this combination of wound closing products ideal for facilitating enhanced recovery and early discharge programmes in elective hip arthroplasty.

  14. Primary total hip arthroplasty in Catalonia: What is the clinical evidence that supports our prosthesis?

    PubMed

    Chaverri-Fierro, D; Lobo-Escolar, L; Espallargues, M; Martínez-Cruz, O; Domingo, L; Pons-Cabrafiga, M

    The implementation of National Prostheses Registries allows us to obtain a large amount of data and make conclusions in order to improve the use of them. Sweden was the first country to implement a National Prostheses Registry in 1979. Catalonia has been doing this since 2005. The aim of our study is to analyse the evidence that supports primary total hip replacement in Catalonia in the last 9 years, based on the Arthroplasty Registry of Catalonia (RACat). A review of the literature was carried out of the prosthesis (acetabular cups/stems) reported in the RACat between the period 2005 to 2013 in the following databases: ODEP (Orthopaedic Data Evaluation Panel), TRIP database, PubMed, and Google Scholar. Those prostheses implanted in less than 10 units (182 acetabular components corresponding to 49 models/228 stems corresponding to 63 models) were excluded. A total of 18,634 (99%) implanted acetabular cups were analysed out of a total number of 18,816, corresponding to 74 different models. In 18 models (2527 acetabular cups) no clinical evidence to support its use was found. An analysis was performed on 19,367 (98.84%) out of a total number of 19,595 implanted stems, corresponding to 75 different models. In 16 models (1845 stems) no clinical evidence was found to support their use. Variable evidence was found in the 56 models of acetabular cups (16,107) and 59 models of stems (17,522), most of it corresponding to level iv clinical evidence. There was a significant number implanted prostheses evaluated (13.56% acetabular cups/9.5% stems) for which no clinical evidence was found. The elevated number of models is highlighted (49 types for acetabular cups/63 types for stems) with less than 10 units implanted, which corresponds to only 1% of the total implants. The use of arthroplasty registers is shown to be an extremely helpful tool that allows analyses and conclusions to be made for the follow-up and post-marketing surveillance period. Copyright © 2016 SECOT

  15. Younger age increases the risk of early prosthesis failure following primary total knee replacement for osteoarthritis

    PubMed Central

    2010-01-01

    Background and purpose Total knee replacements (TKRs) are being increasingly performed in patients aged ≤ 65 years who often have high physical demands. We investigated the relation between age of the patient and prosthesis survival following primary TKR using nationwide data collected from the Finnish Arthroplasty Register. Materials From Jan 1, 1997 through Dec 31, 2003, 32,019 TKRs for primary or secondary osteoarthritis were reported to the Finnish Arthroplasty Register. The TKRs were followed until the end of 2004. During the follow-up, 909 TKRs were revised, 205 (23%) due to infection and 704 for other reasons. Results Crude overall implant survival improved with increasing age between the ages of 40 and 80. The 5-year survival rates were 92% and 95% in patients aged ≤ 55 and 56–65 years, respectively, compared to 97% in patients who were > 65 years of age (p < 0.001). The difference was mainly attributable to reasons other than infections. Sex, diagnosis, type of TKR (condylar, constrained, or hinge), use of patellar component, and fixation method were also associated with higher revision rates. However, the differences in prosthesis survival between the age groups ≤ 55, 56–65, and > 65 years remained after adjustment for these factors (p < 0.001). Interpretation Young age impairs the prognosis of TKR and is associated with increased revision rates for non-infectious reasons. Diagnosis, sex, type of TKR, use of patellar component, and fixation method partly explain the differences, but the effects of physical activity, patient demands, and obesity on implant survival in younger patients warrant further research. PMID:20809740

  16. Total pelvic exenteration for the treatment of advanced primary or recurrent pelvic neoplasia.

    PubMed

    Carballo, Laura; Enríquez-Navascués, José M; Saralegui, Yolanda; Placer, Carlos; Timoteo, Ander; Borda, Nerea; Carrillo, Alberto; Sainz-Lete, Aitor

    2015-03-01

    Complete resection with clear margins in locally advanced pelvic visceral tumors, primary or recurrent, occasionally requires total pelvic exenteration (TPE). We reviewed the results of EFA in 34 consecutive patients operated on between June 2006 and December 2013. Median age was 62 (40-82) years; 24 (70%) were male. The tumor origin most frequent was advanced primary rectal tumor (APRT), with 19 cases (55.9%) and most common type of exenteration was supraelevator (61.8%). R₀ resection was achieved in 24 (70.6%) patients and in 16 (85%) of the APRT. Fifteen (79%) patients had pT₄ APRT, and 4 (20%) pN +. Reconstruction of the bowel and bladder was performed with two stomas in 17 cases (50%), colorectal anastomosis and Bricker in 11 (32.3%) and wet double barreled colostomy in 6 (17.6%). There was no postoperative mortality; 23 (67,5%) patients had complications, and 5 (14.6%) required a postoperative reoperation to solve them. Median follow-up was 23 (13-45) months. Overall survival (OS) and disease free survival (DFS) at 2 years were 67% and 58% respectively, and the median OS and DFS was 59 months (95% CI 26-110) and 39 months (95% CI 14-64), respectively. The DFS of R₀ was significantly better (p=0.003) than R₁. TPE is a potentially curative procedure for advanced pelvic visceral malignancies with similar morbi-mortality than other extended excisional surgery. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Primary ileus after total hip arthroplasty: rare complication or sentinel event?

    PubMed

    Vannelli, Alberto; Laveneziana, Domenico; Rampa, Mario; Battaglia, Luigi; Leo, Ermanno

    2011-09-01

    The incidence of hip dislocation after primary total hip arthroplasty (THA) has been reported to range from 1 to 25% in THA revision. Here, we explore the hypothesis that there is a correlation between postoperative ileus (POI) and THA dislocation, with POI after THA possibly representing a sentinel event. We retrospectively identified a cohort of 529 consecutive patients who underwent hip arthroplasty from 2008 to 2010. Of them, 251 were male and 278 were female, and a mean average for age of 71.5 (range 65-76). In particular, 19 THA patients showed signs of gastrointestinal complications, and therapeutic consultation was performed with the onset of the first intestinal symptom. Of these 19 patients, 3 THA patients developed POI within 1 week after surgical treatment. A conservative treatment was practised and it seemed to improve the condition: canalization returned and all patients were discharged from the hospital. Unfortunately, two of these patients were readmitted after 2 weeks due to THA dislocation and they underwent THA revision and were discharged from the hospital 7 days later. Follow-up revealed no further problems at 6 months. Our clinical experience with these post-THA primary ileus patients raises the possibility that intra-abdominal symptoms represent a sentinel event in THA dislocation. THA dislocation using neuronal pathway of immunomodulation may modulate POI. Since the risk of THA dislocation is the greatest in the first 3 months after hip arthroplasty, the surgeon should be familiar with the relationship between THA and various pelvic and visceral complications to ensure that POI remains only a rare complication.

  18. [Biomechanical aspects of load-bearing capacity after total endoprosthesis replacement of the hip joint. An evaluation of current knowledge and review of the literature].

    PubMed

    Wirtz, D C; Heller, K D; Niethard, F U

    1998-01-01

    Purpose of the study was to summarize the current scientific knowledge of the interaction between rehabilitative procedures and the periprosthetic bone remodeling processes in the early postoperative phase of total hip arthroplasties. In a comprehensive review of the international literature we analysed the interdependence between osseointegration, primary implant stability, relative micromotion of implant versus bone, and joint loading forces during mobilisation or physiotherapy. Accordingly, guidelines for the rehabilitation of cemented as well as cementless hip arthroplasties were established in order to eliminate factors disturbing prosthetic integration and hence provide for the best long-term stability of the implanted prosthesis possible. Osseointegration of cementless implants is impossible if relative micromotions exceed > 150 microns. Furthermore, torsional stresses (i.e. alternate climbing of stairs, rising from seated position without arm support) will destabilize uncemented femoral shaft implants. Cemented prostheses may be loaded with full body weight. Uncemented implants should be loaded only partially for at least 6 weeks. Loadings of the hip joint with more than twice the body-weight (i.e. walking without crutches, physical exercise against high resistances or long levers) are to be avoided for 3 months. The transition from the three-points walking to the two-points walking technique depends particularly on the conditions of the muscles stabilizing the hip joint. The rehabilitation of patients after total hip arthroplasty has to be brought into line with the changed biomechanical situation, the particulars of the implants and the individual requirements of the patients.

  19. Use of closed suction drain after primary total knee arthroplasty – an overrated practice

    PubMed Central

    Sharma, Gaurav M.; Palekar, Gauresh; Tanna, Dilip D.

    2016-01-01

    Purpose: The age-old practice of closed suction drain following orthopedic procedures has been challenged since past few decades. Our aim was to assess the effectiveness of closed suction drain after total knee arthroplasty. Materials and methods: One hundred twenty patients (135 knees) with primary Total Knee Arthroplasty were divided into a study group (no drain) and a control group (drain used). Inclusion criteria were grade 3 and grade 4 osteoarthritis of the knee. Revision cases and rheumatoid arthritis were excluded. Parameters assessed were pain, pre and post-op Hb, dressing change, early infection, ecchymosis and duration of stay. Results were calculated using Western Ontario and McMaster Universities Osteoarthritis Index and Oxford Knee scoring systems at two weeks, six months and one year. Results: Mean age was 72.03 ± 6.68 in study group and 71.38 ± 7.02 in control group. Pre and post op Hb was 12.1678 ± 1.3220 (study group), 12.1803 ± 1.2717 (control group) and 9.8373 ± 1.5703 (study group), 9.7918 ± 1.4163 (control group). There was one case of early infection in both groups which was controlled by oral antibiotics. Change of dressing and ecchymosis were more in the study group. Duration of hospital stay was more in the control group p < 0.0006 (statistically significant). Conclusion: There is no added advantage of closed suction drain over no drain usage and this practice can safely be brought to a halt. PMID:27855775

  20. Greater patient confidence yields greater functional outcomes after primary total shoulder arthroplasty.

    PubMed

    Styron, Joseph F; Higuera, Carlos A; Strnad, Greg; Iannotti, Joseph P

    2015-08-01

    Patient satisfaction is increasingly being tied to reimbursement rates, and patient satisfaction is often associated with improving functionality and decreasing disability postoperatively. This study sought to determine if a total shoulder arthroplasty patient's preoperative confidence in his or her ability to attain the level of activity desired would influence postoperative functional scores. Patients undergoing a primary total shoulder arthroplasty at a single institution were asked to complete a preoperative questionnaire with multiple items including baseline symptom severity measures and their confidence in reaching their level of desired functionality postoperatively (scored 0-10). Patients then completed an identical postoperative questionnaire at their follow-up visits. Associations between the patient's confidence in attaining treatment goals and functional outcomes was established by multiple linear regression models that were adjusted for gender, age, body mass index, baseline 12-Item Short Form Health Survey mental component scores, college education, smoking status, baseline functional scores, and length of follow-up. Patients had a high level of confidence that their outcome would match their expectations, with an average score of 7.8 (range, 0-10; 28.4% reported a full 10/10 confidence). For every 1-point increase in confidence, patients experienced an average increase in their function score of 2.7 points (P = .039) and improvement in their pain score of 2.0 (P = .033) according to the Penn Shoulder Score. There was no significant association with the patient's 12-Item Short Form Health Survey score postoperatively. Patients with greater preoperative confidence actually have significantly better postoperative functional outcomes than their less confident peers even with adjustment for other known risk factors. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  1. Wear Analysis of Second-generation Highly Cross-Linked Polyethylene in Primary Total Hip Arthroplasty.

    PubMed

    Samujh, Christopher; Bhimani, Samrath; Smith, Langan; Malkani, Arthur L

    2016-11-01

    A major limiting factor in the longevity of total hip replacement is the wear rate of the hip bearing. As manufacturing technology has improved during the past several decades, much attention has been focused on developing newer generations of polyethylene that have lower rates of wear while minimizing free radical formation and subsequent osteolysis. The turning point for the manufacture of polyethylene was moving from gamma irradiation in air to irradiation in a low oxygen environment, which reduced free radical formation while increasing the wear resistance. New polyethylene manufacturing methods, including multiple cycles of irradiation and annealing, have resulted in greater wear resistance. Wear analysis studies are essential to determine if these new liners actually show a benefit from prior generations of polyethylene and, more importantly, if they are safe to use. This study involved a single center retrospective review of 60 patients with a mean follow-up of 5.5 years who underwent primary total hip arthroplasty with a second-generation highly cross-linked polyethylene manufactured by 3 cycles of sequential irradiation and annealing. Linear and volumetric wear rates were determined from digitized radiographs using contemporary wear analysis software. The mean linear wear rate for the entire group was 0.025 millimeters per year (mm/y). This value represents a linear wear rate 2.7 times less than that of a first-generation highly cross-linked polyethylene and 4.2 times less than that of a conventional polyethylene. At an average of 5 years, compared with a first-generation highly cross-linked polyethylene, a second-generation highly cross-linked polyethylene appears to show significant improvement regarding wear. [Orthopedics. 2016; 39(6):e1178-e1182.].

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

    PubMed

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

    2016-03-01

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

  3. Effect of tranexamic acid administration on bleeding in primary total hip arthroplasty.

    PubMed

    Fernández-Cortiñas, A B; Quintáns-Vázquez, J M; Gómez-Suárez, F; Murillo, O Simón; Sánchez-López, B R; Pena-Gracía, J M

    2017-07-06

    To study the efficacy of tranexamic acid to decrease perioperative bleeding in patients who have undergone a total hip arthroplasty operation and to evaluate drug safety. Observational, prospective, controlled and randomized study on the efficacy of tranexamic acid as a method to reduce bleeding in primary hip replacement surgery. We included 134 patients operated during 2014 in our centre, who were divided into 2 groups according to whether or not they had received tranexamic acid. The main study variables were haemoglobin and haematocrit levels, the amount of blood collected from the post-operative drain in the first 12, 24 and 48hours and transfusion requirements. Post-operative haemoglobin and haematocrit levels were statistically higher (P<.001) in the group with treatment. During the first 48hours bleeding values from the group that did not receive TAX were higher compared to patients treated with tranexamic acid. Statistically significant differences (P=.001) were found as to the need for transfusion according to group, more transfusions were performed in the cohort that had not received tranexamic acid: 25.37% compared to 4.48% for the group with tranexamic acid. No adverse events related to administration of tranexamic acid were recorded. Administration of tranexamic acid has proved to be an effective and safe method to reduce peri-operative bleeding in patients who underwent total hip arthroplasty and avoids allogenic blood transfusion. Therefore, tranexamic acid treatment could entail a financial saving for the healthcare system and expose the patient to less risk. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Long-term Outcome of Unconstrained Primary Total Hip Arthroplasty in Ipsilateral Residual Poliomyelitis.

    PubMed

    Buttaro, Martín A; Slullitel, Pablo A; García Mansilla, Agustín M; Carlucci, Sofía; Comba, Fernando M; Zanotti, Gerardo; Piccaluga, Francisco

    2017-03-01

    Incapacitating articular sequelae in the hip joint have been described for patients with late effects of poliomyelitis. In these patients, total hip arthroplasty (THA) has been associated with a substantial rate of dislocation. This study was conducted to evaluate the long-term clinical and radiologic outcomes of unconstrained THA in this specific group of patients. The study included 6 patients with ipsilateral polio who underwent primary THA between 1985 and 2006. Patients with polio who underwent THA on the nonparalytic limb were excluded. Mean follow-up was 119.5 months (minimum, 84 months). Clinical outcomes were evaluated with the modified Harris Hip Score (mHHS) and the visual analog scale (VAS) pain score. Radiographs were examined to identify the cause of complications and determine the need for revision surgery. All patients showed significantly better functional results when preoperative and postoperative mHHS (67.58 vs 87.33, respectively; P=.002) and VAS pain score (7.66 vs 2, respectively; P=.0003) were compared. Although 2 cases of instability were diagnosed, only 1 patient needed acetabular revision as a result of component malpositioning. None of the patients had component loosening, osteolysis, or infection. Unconstrained THA in the affected limb of patients with poliomyelitis showed favorable long-term clinical results, with improved function and pain relief. Nevertheless, instability may be a more frequent complication in this group of patients compared with the general population. [Orthopedics. 2017; 40(2):e255-e261.]. Copyright 2016, SLACK Incorporated.

  5. Primary Total Knee Arthroplasty for Simple Distal Femoral Fractures in Elderly Patients with Knee Osteoarthritis

    PubMed Central

    Choi, Nam-Yong; Sohn, Jong-Min; Cho, Sung-Gil; Kim, Seung-Chan

    2013-01-01

    Purpose Primary total knee arthroplasty (TKA) can be an alternative method for treating distal femoral fractures in elderly patients with knee osteoarthritis. The purpose of this study was to evaluate the clinical and radiographic results in patients with knee osteoarthritis who underwent TKA with the Medial Pivot prosthesis for distal femoral fractures. Materials and Methods Eight displaced distal femoral fractures in 8 patients were treated with TKA using the Medial Pivot prosthesis and internal fixation. The radiographic and clinical evaluations were performed using simple radiographs and Hospital for Special Surgery (HSS) knee scores during a mean follow-up period of 49 months. Results All fractures united and the mean time to radiographic union was 15 weeks. The mean range of motion of the knee joint was 114.3° and the mean HSS knee score was 85.1 at the final follow-up. Conclusions Based on the radiographic and clinical results, TKA with internal fixation can be considered as an option for the treatment of simple distal femoral fractures in elderly patients who have advanced osteoarthritis of the knee with appropriate bone stock. PMID:24032103

  6. Prospective monitoring improves outcomes of primary total hip replacement: a cohort study

    PubMed Central

    Streubel, Philipp N; Pachón, Marcela; Kerguelén, Carlos A; Navas, José; Portocarrero, Julio; Pesantez, Rodrigo F; Zayed, Gamal; Carrillo, Germán; Llinás, Adolfo M

    2009-01-01

    Background Over the past decade several studies have questioned current standards of patient safety in health care delivery. In response, our institution started a clinical pathway for total hip replacement in 1996. Prospective monitoring with regular feedback sessions to the individuals involved in patient care did however not start until 2003. The present study evaluates the effect of prospective monitoring on outcomes of total hip replacement. Methods Clinical records of patients undergoing primary elective total hip replacement between 1997 and 2004 were reviewed. Data on adverse events as well as adherence to protocols for venous thromboembolism prophylaxis were extracted retrospectively for the period 1997 to 2001 and prospectively from 2003 to 2004. Results were compared and analyzed in order to establish possible improvement in outcomes. Data was analyzed with Chi-square or Fisher's Exact test for categorical variables and Student's t-test for continuous variables. Alpha was set as less than 5% and analysis was performed with Stata 9.0 for Macintosh. Results Two-hundred and eighty-three patients were included from 1997 to 2001, and 62 from 2003 to 2004. Mean age, male to female ratio and initial diagnosis were similar in both groups. At least one adverse event occurred in 45% of patients in 1997–2001 and in 21% in 2003–2004 (p < 0.001). In-hospital hip dislocations occurred in 6% and 0% (p = 0.05), oliguria in 19% and 5% (p = 0.007), SSI and VTE in 3% and 0% (p = 0.37), adverse drug reactions in 11% and 13% (p = 0.66) and non-adherence to VTE prophylaxis protocols in 15% and 2% of cases respectively (p = 0.002). Conclusion Overall rate of adverse events as well as in-hospital hip dislocations, oliguria and non-adherence to VTE prophylaxis protocols were significantly reduced during the second period. We conclude that clinical pathways alone are insufficient to improve patient safety and require prospective monitoring and continuous feedback to health

  7. Can a Total Knee Arthroplasty Perioperative Surgical Home Close the Gap Between Primary and Revision TKA Outcomes?

    PubMed

    Iwuchukwu, Chijioke; Wright, David; Sofine, Anna; Schwarzkopf, Ran

    Given the steady increase in the number of primary and revision total knee arthroplasties (TKAs) performed in the United States, we wanted to determine if an evidence-based TKA perioperative surgical home could close the perioperative morbidity gap between primary and revision TKAs. We conducted a prospective cross-sectional cohort study comparing outcomes of patients who had primary TKA (n = 235) with outcomes of patients who had revision TKA (n = 50). We measured several perioperative outcomes: length of stay, discharge disposition, 30-day readmission rate, and 30-day reoperation rate. Mean length of stay was 2.55 days for primary TKA and 2.92 days for revision TKA (P = .061). Eighty (34%) of the 235 primary TKA patients and 21 (41%) of the 51 revision TKA patients were discharged to a subacute nursing facility (P = .123). One primary TKA patient (0.4%) and 2 revision TKA patients (4%) were readmitted within 30 days after surgery (P = .081). None of the primary TKAs and 2 (4%) of the revision TKAs underwent reoperation (P = .993). There was no difference in perioperative outcomes between the primary and revision TKA groups in our Total Joint Replacement Perioperative Surgical Home (TJR-PSH) cohort. Advances in multidisciplinary co-management of TKA patients are highlighted in the TJR-PSH. The similarity in primary and revision TKA outcomes has significant implications regarding costs and potential increased patient satisfaction.

  8. Cementless Oxford medial unicompartimental knee replacement: an independent series with a 5-year-follow-up.

    PubMed

    Panzram, Benjamin; Bertlich, Ines; Reiner, Tobias; Walker, Tilman; Hagmann, Sébastien; Gotterbarm, Tobias

    2017-07-01

    Cemented unicompartmental knee replacement (UKR) has proven excellent long-term survival rates and functional scores in Price et al. (Clin Orthop Relat Res 435:171-180, 2005), Price and Svard (Clin Orthop Relat Res 469(1):174-179, 2011) and Murray et al. (Bone Joint Surg Br 80(6):983-989, 1998). The main causes for revision, aseptic loosening and pain of unknown origin might be addressed by cementless UKR in Liddle et al. (Bone Joint J 95-B(2):181-187, 2013), Pandit et al. (J Bone Joint Surg Am 95(15):1365-1372, 2013), National Joint Registry for England, Wales and Northern Ireland: 10th Annual Report 2013 ( http://www.njrcentre.org.uk/njrcentre/Portals/0/Documents/England/Reports/10th_annual_report/NJR%2010th%20Annual%20Report%202013%20B.pdf , 2013), Swedish Knee Arthroplasty Register: Annual Report 2013 ( http://www.myknee.se/pdf/SKAR2013_Eng.pdf , 2013). This single-centre retrospective cohort study reports the 5-year follow-up results of our first 30 consecutively implanted cementless Oxford UKR (OUKR). Clinical outcome was measured using the OKS, AKSS, range of movement and level of pain (visual analogue scale). The results were compared to cemented OUKR in a matched-pair analysis. Implant survival was 89.7%. One revision each was performed due to tibial fracture, progression of osteoarthritis (OA) and inlay dislocation. The 5-year survival rate of the cementless group was 89.7% and of the cemented group 94.1%. Both groups showed excellent postoperative clinical scores. Cementless fixation shows good survival rates and clinical outcome compared to cemented fixation.

  9. Prospective five-year subsidence analysis of a cementless fully hydroxyapatite-coated femoral hip arthroplasty component.

    PubMed

    Clauss, Martin; Van Der Straeten, Catherine; Goossens, Marc

    2014-01-01

    Early subsidence >1.5 mm is considered to be a predictive factor for later aseptic loosening of the femoral component following total hip arthroplasty (THA). The aim of this study was to assess five-year subsidence rates of the cementless hydroxyapatite-coated twinSys stem (Mathys Ltd., Bettlach, Switzerland).This prospective single-surgeon series examined consecutive patients receiving a twinSys stem at Maria Middelares Hospital, Belgium. Patients aged >85 years or unable to come to follow-up were excluded. Subsidence was assessed using Ein Bild Roentgen Analyse--Femoral Component Analysis (EBRA-FCA). Additional clinical and radiographic assessments were performed. Follow-ups were prospectively scheduled at two, five, 12, 24, and 60 months.In total, 218 THA (211 patients) were included. At five years, mean subsidence was 0.66 mm (95% CI: 0.43-0.90). Of the 211 patients, 95.2% had an excellent or good Harris Hip Score. There were few radiological changes. Kaplan-Meier analysis indicated five-year stem survival to be 98.4% (95% CI: 97.6-100%).Subsidence levels of the twinSys femoral stem throughout the five years of follow-up were substantially lower than the 1.5 mm level predictive of aseptic loosening. This was reflected in the high five-year survival rate.

  10. Five-year clinical and radiological outcomes in 257 consecutive cementless Oxford medial unicompartmental knee arthroplasties.

    PubMed

    Blaney, J; Harty, H; Doran, E; O'Brien, S; Hill, J; Dobie, I; Beverland, D

    2017-05-01

    Our aim was to examine the clinical and radiographic outcomes in 257 consecutive Oxford unicompartmental knee arthroplasties (OUKAs) (238 patients), five years post-operatively. A retrospective evaluation was undertaken of patients treated between April 2008 and October 2010 in a regional centre by two non-designing surgeons with no previous experience of UKAs. The Oxford Knee Scores (OKSs) were recorded and fluoroscopically aligned radiographs were assessed post-operatively at one and five years. The median age of the 238 patients was 65.0 years (interquartile range (IQR) 59.0 to 73.0), the median body mas index was 30.0 (IQR 27.5 to 33.0) and 51.7% were male. There were no intra-operative complications. There was a significant improvement in the median OKS at six weeks (34, IQR 31.0 to 37.0), one year (38, IQR 29.0 to 43.0) and five years (37, IQR 27.0 to 42.0) when compared with the pre-operative scores (16, IQR 13.0 to 19.0) (all p = < 0.01). No patient had progressive radiolucent lines or loosening. A total of 16 patients had died by five years. The cumulative survival at five years was 98.8% and the mean survival time was 5.8 years (95% confidence interval 5.6 to 5.9). A total of seven OUKAs (2.7%) were revised; three within five years and four thereafter, between 5.1 and 5.7 years post-operatively. Five (1.9%) had re-operations within five years. The proportion of patients requiring revision at five years is lower than that generally reported for UKA. These findings add support for the use of the cementless OUKA outside the design centre. Longer follow-up is required. Cite this article: Bone Joint J 2017;99-B:623-31. ©2017 The British Editorial Society of Bone & Joint Surgery.

  11. Bone ingrowth and wear debris in well-fixed cementless porous-coated tibial components removed from patients.

    PubMed

    Sumner, D R; Kienapfel, H; Jacobs, J J; Urban, R M; Turner, T M; Galante, J O

    1995-04-01

    Bone ingrowth and the distribution of wear debris within the porous coating of 13 primary cementless porous-coated tibial components removed for reasons unrelated to fixation or infection were quantitatively described. The average length of implantation was 15.3 months (range, 3-30 months). The implants were all of the same design, made for Ti6A14V with a commercially pure titanium fiber-metal porous coating, which covered the undersurface of the tray and the four fixation pegs. In all but one component, supplemental screw fixation was used. The average extent of bone ingrowth within the tray was 27.1 +/- 16.1%, and the average volume fraction was 9.5 +/- 7.5%. There was significantly more bone ingrowth within the fixation pegs than within the tray and also more bone ingrowth in the anterior half of the tray than posteriorly. There was no correlation between the amount of bone ingrowth and the length of implantation, age, or sex of the patient; however, the depth and orientation of the resection plane were found to correlate with the topographic distribution of bone ingrowth. Particulate debris appeared to gain access to the interface via soft tissue pathways both at the periphery and through the holes for adjuvant screw fixation.

  12. Risk factors for surgical-site infection following primary total knee arthroplasty.

    PubMed

    Minnema, Brian; Vearncombe, Mary; Augustin, Anne; Gollish, Jeffrey; Simor, Andrew E

    2004-06-01

    To identify risk factors associated with the development of surgical-site infection (SSI) following total knee arthroplasty (TKA). A case-control study. A 1,100-bed, university-affiliated, tertiary-care teaching hospital. Case-patients with SSI occurring up to 1 year following primary TKA performed between January 1999 and December 2001 were identified prospectively by infection control practitioners using National Nosocomial Infections Surveillance (NNIS) System methods. Three control-patients were selected for each case-patient, matched by date of surgery. Stepwise logistic regression analysis was used to determine the relation of potential risk factors to the development of infection. Twenty-two patients with infections (6 superficial and 16 deep) were identified. Infection rates per year were 0.95%, 1.07%, and 1.19% in 1999, 2000, and 2001, respectively. Logistic regression analysis identified two variables independently associated with the development of infection: the use of closed suction drainage (odds ratio [OR], 7.0; 95% confidence interval [CI95], 2.1-25.0; P = .0015) and increased international normalized ratio (INR) (OR, 2.4; CI95, 1.1-5.7; P = .035). Factors not statistically associated with the development of infection included age, NNIS System risk index score, presence of various comorbidities, surgeon, duration of procedure or tourniquet time, type of bone cement or prosthesis used, or receipt of blood product transfusions. The use of closed suction drainage and a high postoperative INR were associated with the development of SSI following TKA. Avoiding the use of surgical drains and careful monitoring of anticoagulant prophylaxis in patients undergoing TKA should reduce the risk of infection.

  13. Hospital economics of primary total knee arthroplasty at a teaching hospital.

    PubMed

    Healy, William L; Rana, Adam J; Iorio, Richard

    2011-01-01

    The hospital cost of total knee arthroplasty (TKA) in the United States is a major growing expense for the Centers for Medicare & Medicaid Services (CMS). Many hospitals are unable to deliver TKA with profitable or breakeven economics under the current Diagnosis-Related Group (DRG) hospital reimbursement system. The purposes of the current study were to (1) determine revenue, expenses, and profitability (loss) for TKA for all patients and for different payors; (2) define changes in utilization and unit costs associated with this operation; and (3) describe TKA cost control strategies to provide insight for hospitals to improve their economic results for TKA. From 1991 to 2009, Lahey Clinic converted a $2172 loss per case on primary TKA in 1991 to a $2986 profit per case in 2008. The improved economics was associated with decreasing revenue in inflation-adjusted dollars and implementation of hospital cost control programs that reduced hospital expenses for TKA. Reduction of hospital length of stay and reduction of knee implant costs were the major drivers of hospital expense reduction. During the last 25 years, our economic experience with TKA is concerning. Hospital revenues have lagged behind inflation, hospital expenses have been reduced, and our institution is earning a profit. However, the margin for TKA is decreasing and Managed Medicare patients do not generate a profit. The erosion of hospital revenue for TKA will become a critical issue if it leads to economic losses for hospitals or reduced access to TKA. Level III, Economic and Decision Analyses. See Guidelines for Authors for a complete description of levels of evidence.

  14. Rotator cuff tears after total shoulder arthroplasty in primary osteoarthritis: A systematic review

    PubMed Central

    Levy, David M.; Abrams, Geoffrey D.; Harris, Joshua D.; Bach, Bernard R.; Nicholson, Gregory P.; Romeo, Anthony A.

    2016-01-01

    Rotator cuff tears have been reported to be uncommon following total shoulder arthroplasty (TSA). Postoperative rotator cuff tears can lead to pain, proximal humeral migration, and glenoid component loosening. The purpose of this paper was to evaluate the incidence of post-TSA rotator cuff tears or dysfunction in osteoarthritic patients. A systematic review of multiple databases was performed using preferred reporting items for systematic reviews and meta-analyses guidelines. Levels I-IV evidence clinical studies of patients with primary osteoarthritis with a minimum 2-year follow-up were included. Fifteen studies with 1259 patients (1338 shoulders) were selected. Student's t-tests were used with a significant alpha value of 0.05. All patients demonstrated significant improvements in motion and validated clinical outcome scores (P < 0.001). Radiographic humeral head migration was the most commonly reported data point for extrapolation of rotator cuff integrity. After 6.6 ± 3.1 years, 29.9 ± 20.7% of shoulders demonstrated superior humeral head migration and 17.9 ± 14.3% migrated a distance more than 25% of the head. This was associated with an 11.3 ± 7.9% incidence of postoperative superior cuff tears. The incidence of radiographic anterior humeral head migration was 11.9 ± 15.9%, corresponding to a 3.0 ± 13.6% rate of subscapularis tears. We found an overall 1.2 ± 4.5% rate of reoperation for cuff injury. Nearly all studies reported indirect markers of rotator cuff dysfunction, such as radiographic humeral head migration and clinical exam findings. This systematic review suggests that rotator cuff dysfunction following TSA may be more common than previously reported. IV, systematic review of Levels I-IV studies. PMID:27186060

  15. Is Selectively Not Resurfacing the Patella an Acceptable Practice in Primary Total Knee Arthroplasty?

    PubMed

    Maradit-Kremers, Hilal; Haque, Omar J; Kremers, Walter K; Berry, Daniel J; Lewallen, David G; Trousdale, Robert T; Sierra, Rafael J

    2017-04-01

    To resurface or not to resurface the patella remains a controversy in total knee arthroplasty (TKA). The purpose of this study was to assess the long-term outcomes associated with selectively not resurfacing the patella. This was a historical cohort study of 15,497 patients with 21,371 primary TKA procedures performed at a single institution between 1985 and 2010. The cohort included 402 (2%) knees with unresurfaced patellae and 20,969 knees with all-polyethylene patellae designs. Reasons for not resurfacing the patella were documented. Multivariable Cox regression analyses were used to estimate the risk of complications and revisions among procedures with unresurfaced patellae. According to the surgeon, reasons for not resurfacing were normal cartilage (226, 56%), young patient (30, 8%), thin patella (53, 13%), and surgeons' choice (93, 23%). In age, sex, and calendar year-adjusted analyses, the risk of complications (hazard ratio [HR]: 1.25, 95% confidence interval [CI]: 1.06, 1.46) and all-cause revisions (HR: 1.39, 95% CI: 1.02, 1.89) were significantly higher after TKA with unresurfaced patellae. However, after adjusting for femoral component types and operative diagnoses, these associations were no longer significant. The only group with significantly worse outcomes were those with a thin patellae with increased risk of complications (HR: 2.66, 95% CI: 1.70, 4.17) and revisions (HR: 5.94, 95% CI: 2.35, 15.02). Yet, the excess risk in the thin patellae group was mainly due to infections, and not related to unresurfaced patellae. Selectively not resurfacing the patella seemed to provide similar results compared with routine resurfacing. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Analysis of differences in bone removal during femoral box osteotomy for primary total knee arthroplasty

    PubMed Central

    GRACEFFA, ANGELO; INDELLI, PIER FRANCESCO; BASNETT, KAITLYN; MARCUCCI, MASSIMILIANO

    2014-01-01

    Purpose this study was conducted to compare the quantity of intercondylar bone removed during femoral box osteotomy for implantation of three contemporary posterior stabilized (PS) total knee arthroplasty designs: Sigma PS (DePuy), Vanguard (Biomet) and Persona (Zimmer). Methods we compared the maximum volumetric bone resection required for the housing of the PS mechanism of these three designs. Bone removal by each PS box cutting jig was three-dimensionally measured. The differences between the three designs were analyzed by the Kruskal-Wallis test. The Mann-Whitney U-test was used for pairwise comparisons. The level of significance was set at p<0.05. Results for small-size implants, the average box osteotomy volume of Persona was significantly smaller than the Vanguard and Sigma PS volumes (p=0.003). The mean difference between Vanguard and Sigma PS (p=0.01) was also significant. For medium size implants, the mean difference between Persona and Sigma PS (p=0.008) and the mean difference between Vanguard and Sigma PS (p=0.01) were statistically significant. For large size implants, the mean difference between Vanguard and Sigma PS (p=0.01) and the mean difference between Sigma PS and Persona (p=0.008) were statistically significant. Conclusions irrespective of implant size, the Persona cutting jig always resected significantly less bone than did Vanguard and Sigma PS. Clinical Relevance although this study does not establish any clinical relevance of removing more or less bone at primary TKA, its results suggest that if a PS design is indicated, it is preferable to select a model which resects less distal femoral bone. PMID:25606547

  17. Acetabular cup position and risk of dislocation in primary total hip arthroplasty

    PubMed Central

    Seagrave, Kurt G; Troelsen, Anders; Malchau, Henrik; Husted, Henrik; Gromov, Kirill

    2017-01-01

    Background and purpose — Hip dislocation is one of the most common complications following total hip arthroplasty (THA). Several factors that affect dislocation have been identified, including acetabular cup positioning. Optimal values for cup inclination and anteversion are debatable. We performed a systematic review to describe the different methods for measuring cup placement, target zones for cup positioning, and the association between cup positioning and dislocation following primary THA. Methods — A systematic search of literature in the PubMed database was performed (January and February 2016) to identify articles that compared acetabular cup positioning and the risk of dislocation. Surgical approach and methods for measurement of cup angles were also considered. Results— 28 articles were determined to be relevant to our research question. Some articles demonstrated that cup positioning influenced postoperative dislocation whereas others did not. The majority of articles could not identify a statistically significant difference between dislocating and non-dislocating THA with regard to mean angles of cup anteversion and inclination. Most of the articles that assessed cup placement within the Lewinnek safe zone did not show a statistically significant reduction in dislocation rate. Alternative target ranges have been proposed by several authors. Interpretation— The Lewinnek safe zone could not be justified. It is difficult to draw broad conclusions regarding a definitive target zone for cup positioning in THA, due to variability between studies and the likely multifactorial nature of THA dislocation. Future studies comparing cup positioning and dislocation rate should investigate surgical approach separately. Standardized tools for measurement of cup positioning should be implemented to allow comparison between studies. PMID:27879150

  18. 75 FR 53267 - National Primary Drinking Water Regulations: Revisions to the Total Coliform Rule; Extension of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-31

    ... AGENCY 40 CFR Parts 141 and 142 RIN 2040-AD94 National Primary Drinking Water Regulations: Revisions to... 30 days the public comment period for a proposed National Primary Drinking Water Regulation, the.... ADDRESSES: Comments may be submitted by mail to: Water Docket, Environmental Protection Agency, Mail...

  19. Uncemented porous tantalum acetabular components: early follow-up and failures in 613 primary total hip arthroplasties.

    PubMed

    Noiseux, Nicolas O; Long, William J; Mabry, Tad M; Hanssen, Arlen D; Lewallen, David G

    2014-03-01

    Uncemented tantalum acetabular components were introduced in 1997. The purpose was to determine the 2- to 10-year results with this implant material in primary total hip arthroplasty. Our registry identified all primary total hip cases with porous tantalum cups implanted from 1997 to 2004. Clinical outcomes and radiographs were studied. 613 cases were identified. Seventeen percent of patients were lost to follow-up. Twenty-five reoperations were performed (4.4%). Acetabular cup removal occurred in 6 cases (1.2%). No cups were revised for aseptic loosening. Incomplete radiolucent lines were found on 9.3% of initial postoperative radiographs. At 2 years, 67% had resolved. Zero new radiolucent lines were detected. Two- to 10-year results of porous tantalum acetabular components for primary total hip arthroplasty demonstrate high rates of initial stability and apparent ingrowth. © 2014.

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2013-01-01

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

  2. A comparison of a conventional versus a short, anatomical metaphyseal-fitting cementless femoral stem in the treatment of patients with a fracture of the femoral neck.

    PubMed

    Kim, Y-H; Oh, J-H

    2012-06-01

    We compared the clinical and radiological outcomes of two cementless femoral stems in the treatment of patients with a Garden III or IV fracture of the femoral neck. A total of 70 patients (70 hips) in each group were enrolled into a prospective randomised study. One group received a short anatomical cementless stem and the other received a conventional cementless stem. Their mean age was 74.9 years (50 to 94) and 76.0 years (55 to 96), respectively (p = 0.328). The mean follow-up was 4.1 years (2 to 5) and 4.8 years (2 to 6), respectively. Perfusion lung scans and high resolution chest CTs were performed to detect pulmonary microemboli. At final follow-up there were no statistically significant differences between the short anatomical and the conventional stems with regard to the mean Harris hip score (85.7 (66 to 100) versus 86.5 (55 to 100); p = 0.791), the mean Western Ontario and McMaster Universities Osteoarthritis Index (17 (6 to 34) versus 16 (5 to 35); p = 0.13) or the mean University of California, Los Angeles activity score (5 (3 to 6) versus 4 (3 to 6); p = 0.032). No patient with a short stem had thigh pain, but 11 patients (16%) with a conventional stem had thigh pain. No patients with a short stem had symptomatic pulmonary microemboli, but 11 patients with a conventional stem had pulmonary microemboli (symptomatic in three patients and asymptomatic in eight patients). One hip (1.4%) in the short stem group and eight (11.4%) in the conventional group had an intra-operative undisplaced fracture of the calcar. No component was revised for aseptic loosening in either group. One acetabular component in the short stem group and two acetabular components in the conventional stem group were revised for recurrent dislocation. Our study demonstrated that despite the poor bone quality in these elderly patients with a fracture of the femoral neck, osseo-integration was obtained in all hips in both groups. However, the incidence of thigh pain, pulmonary

  3. Development and verification of a cementless novel tapered wedge stem for total hip arthroplasty.

    PubMed

    Faizan, Ahmad; Wuestemann, Thies; Nevelos, Jim; Bastian, Adam C; Collopy, Dermot

    2015-02-01

    Most current tapered wedge hip stems were designed based upon the original Mueller straight stem design introduced in 1977. These stems were designed to have a single medial curvature and grew laterally to accommodate different sizes. In this preclinical study, the design and verification of a tapered wedge stem using computed tomography scans of 556 patients are presented. The computer simulation demonstrated that the novel stem, designed for proximal engagement, allowed for reduced distal fixation, particularly in the 40-60 year male population. Moreover, the physical micromotion testing and finite element analysis demonstrated that the novel stem allowed for reduced micromotion. In summary, preclinical data suggest that the computed tomography based stem design described here may offer enhanced implant fit and reduced micromotion.

  4. Calculation of total and ionization cross sections for electron scattering by primary benzene compounds

    NASA Astrophysics Data System (ADS)

    Singh, Suvam; Naghma, Rahla; Kaur, Jaspreet; Antony, Bobby

    2016-07-01

    The total and ionization cross sections for electron scattering by benzene, halobenzenes, toluene, aniline, and phenol are reported over a wide energy domain. The multi-scattering centre spherical complex optical potential method has been employed to find the total elastic and inelastic cross sections. The total ionization cross section is estimated from total inelastic cross section using the complex scattering potential-ionization contribution method. In the present article, the first theoretical calculations for electron impact total and ionization cross section have been performed for most of the targets having numerous practical applications. A reasonable agreement is obtained compared to existing experimental observations for all the targets reported here, especially for the total cross section.

  5. Lessons Learned from Selective Soft-Tissue Release for Gap Balancing in Primary Total Knee Arthroplasty: An Analysis of 1216 Consecutive Total Knee Arthroplasties

    PubMed Central

    Peters, Christopher L.; Jimenez, Chris; Erickson, Jill; Anderson, Mike B.; Pelt, Christopher E.

    2013-01-01

    Background: Soft-tissue releases are commonly necessary to achieve symmetrical flexion and extension gaps in primary total knee arthroplasty performed with a measured resection technique. We reviewed the frequency of required releases according to preoperative alignment and the clinical and radiographic results; associations with failure, reoperations, and complications are presented. Methods: We reviewed 1216 knees that underwent primary total knee arthroplasty from 2004 to 2009; 774 (64%) were in female patients and 442 (36%), in male patients. In the coronal plane, 855 knees had preoperative varus deformity, 123 were neutral, and 238 had valgus deformity. The mean age at the time of the index procedure was 62.7 years (range, twenty-three to ninety-four years), and the mean body mass index was 32.7 kg/m2 (range, 17.4 to 87.9 kg/m2). Clinical outcomes included the Knee Society Score (KSS), implant failure, reoperation, and complications. Radiographs were analyzed for component alignment. Results: The only difference in the total KSS was found at the time of final follow-up between valgus knees with zero releases (total KSS = 178) and those with one or two releases (KSS = 160, p = 0.026). Overall, 407 knees (33.5%) required zero releases, 686 (56.4%) required oneor two releases, and 123 (10.1%) required three or more releases. Among varus knees, 37% required zero releases, 55% required one or two releases, and 7.5% required three or more releases. Among neutral knees, 39% required zero releases, 55% required one or two releases, and 5.7% required three or more releases. Only 17% of valgus knees required zero releases whereas 61% required one or two releases and 21.8% required three or more releases. Valgus knees required more releases than neutral or varus knees did (p < 0.001). Conclusions: Selective soft-tissue release for gap balancing in primary total knee arthroplasty is an effective technique that produced excellent clinical and radiographic results

  6. Free disease long-term survival in primary thoracic spine leiomyosarcoma after total en bloc spondylectomy: A case report.

    PubMed

    Ramirez-Villaescusa, José; Canosa-Fernández, Adriana; Martin-Benlloch, Antonio; Ruiz-Picazo, David; López-Torres Hidalgo, Jesús

    2017-09-01

    To describe an unusual primary vertebral leiomyosarcoma in thoracic spine. An isolated lesion of the T11 vertebra in a 62-year-old woman with no neurologic deficit is reported. Imaging findings indicated a nonspecific high-grade malignant lesion. TC-guided biopsy failed thus open incisional biopsy was needed. A diagnosis of low-intermediate mesenchymal sarcoma was made. A total en bloc spondylectomy of T11 was performed with three-column reconstruction. The histology and immunostaining showed the appearance of leiomyosarcoma. After diagnosis, post-operative radiation therapy was performed. Metastatic lesion was ruled out by CT scans of the chest, abdomen and pelvis, in addition to total body radionuclide scanning and 18-F-FDG-PET. After five years of follow-up, no signs of local recurrence, metastasis or distant lesions suggesting a primary lesion were observed. Vertebral primary leiomyosarcoma is exceedingly rare. Primary vertebral leiomyosarcoma diagnosis must be performed when the metastatic origin is excluded. For the treatment of primary tumors, total en bloc spondylectomy (TES) is the technique of choice to achieve marginal or wide tumor resection, decrease the risk of local recurrence and remote lesions and increase survival. A well-planned pre-operative study and a wide surgical excision can result in local tumor control and long-term survival. This case presents the longest disease-free survival period of a primary leiomyosarcoma in spinal location after total en bloc spondylectomy. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  7. Comparison of Biocompatibility of Cemented vs. Cementless Hip Joint Endoprostheses Based on Postoperative Evaluation of Proinflammatory Cytokine Levels

    PubMed Central

    Szypuła, Jan; Cabak, Anna; Kiljański, Marek; Boguszewski, Dariusz; Tomaszewski, Wiesław

    2016-01-01

    Background The yearly increase in the number of procedures involving implantation of hip joint endoprostheses forces prosthetics manufacturers to search for biologically neutral implants. The goal of this study was to assess the concentration of Interleukin-6 (IL-6) and its correlation with C-reactive protein (CRP), depending on the type of hip joint endoprosthesis (cemented or cementless endoprosthesis) in order to determine implant biotolerance during the early postoperative period. Material/Methods The sample comprised 200 patients [mean age=64 (31–81) years] with coxarthrosis. All patients underwent hip joint arthroplasty using a cemented or cementless endoprosthesis. Blood samples were collected 3 times: before the procedure, on the first day after the procedure, and after 6 weeks. IL-6 and CRP levels were assayed using immunoenzymatic methods. The results were subjected to statistical analysis using the Shapiro-Wilk test. Results On the 1st day after the procedure, CRP and IL-6 concentration increased rapidly after implantation of both cemented and cementless endoprostheses. At 6 weeks postoperatively, the CRP value remained at a similar level in patients after cemented arthroplasty and was almost 2-fold lower in patients who underwent cementless arthroplasty. The IL-6 value returned to the baseline level in patients after cementless arthroplasty and showed an ongoing increasing tendency in patients after cemented arthroplasty. Conclusions 1. The measurement of C-reactive protein and Interleukin-6 is a high-sensitivity test, assessing implant biotolerance. 2. The implantation of a cemented endoprosthesis induces a higher increase in the level of proinflammatory cytokines as compared with a cementless endoprosthesis. 3. For a complete assessment of both early and later body responses to implantation and the related surgical procedure, further studies using available approaches and tools are recommended. PMID:27935873

  8. One Stage Bilateral Total Hip Arthroplasty in Siblings with Larsen Syndrome

    PubMed Central

    Merle, Christian; Waldstein, Wenzel; Lipman, Joseph D; Kasparek, Maximilian F; Boettner, Friedrich

    2016-01-01

    Background: Larsen syndrome is a rare genetic disorder caused by congenital weakness of the connective tissues. It can present with a variety of musculoskeletal and cardiovascular abnormalities. The current report describes two siblings with Larsen Syndrome who presented with severe bilateral hip arthritis and underwent one stage bilateral total hip arthroplasty (THA). The aim was to report on the clinical features of Larsen Syndrome and their implications for total hip replacement surgery. Methods: Two siblings, a 32 year-old female and a 30 year-old male, presented with severe bilateral hip arthritis and a history of Larsen Syndrome. Both patients underwent a detailed, multidisciplinary preoperative medical work up and radiological imaging including computer tomography. All four hips were operated using a cementless primary press-fit cup (Pinnacle, DePuy, Warsaw, IN) and a cementless modular stem system (S-ROM, DePuy, Warsaw, IN) utilizing a posterior approach. Prophylactic cerclages wires were placed proximal to the lesser trochanter before stem preparation and bone grafting of bone cysts in the greater trochanter was performed in all four hips. Results: After 2 years both patients reported significant improvements of function, pain and quality of life. The Oxford hip score improved from preoperative 21 (range 12-24) points up to 39 (range 38-41) points at 2-year follow up. Radiographic follow-up showed good graft incorporation and no signs of implant loosening. Conclusion: The current case report suggests that one stage bilateral THA is a feasible treatment option for young adults with Larsen syndrome and secondary arthritis of the hip. PMID:28144369

  9. Does a standard outpatient physiotherapy regime improve the range of knee motion after primary total knee arthroplasty?

    PubMed

    Mockford, Brian James; Thompson, Neville W; Humphreys, Patricia; Beverland, David E

    2008-12-01

    The aim of this study was to investigate whether a standard course of outpatient physiotherapy improves the range of knee motion after primary total knee arthroplasty. One hundred and fifty patients were randomly assigned into one of 2 groups. One group received outpatient physiotherapy for 6 weeks (group A). Another received no outpatient physiotherapy (group B). Range of knee motion was measured preoperatively and at 1-year review. Validated knee scores and an SF-12 health questionnaire were also recorded. Although patients in group A achieved a greater range of knee motion than those in group B, this was not statistically significant. No difference either was noted in any of the outcome measures used. In conclusion, outpatient physiotherapy does not improve the range of knee motion after primary total knee arthroplasty.

  10. The influence of uncemented femoral stem length and design on its primary stability: a finite element analysis.

    PubMed

    Reimeringer, M; Nuño, N; Desmarais-Trépanier, C; Lavigne, M; Vendittoli, P A

    2013-01-01

    One of the crucial factors for short- and long-term clinical success of total hip arthroplasty cementless implants is primary stability. Indeed, motion at the bone-implant interface above 40 μm leads to partial bone ingrowth, while motion exceeding 150 μm completely inhibits bone ingrowth. The aim of this study was to investigate the effect of two cementless femoral stem designs with different lengths on the primary stability. A finite element model of a composite Sawbones(®) fourth generation, implanted with five lengths of the straight prosthesis design and four lengths of the curved prosthesis design, was loaded with hip joint and abductor forces representing two physiological activities: fast walking and stair climbing. We found that reducing the straight stem length from 146 to 54 mm increased the average micromotion from 17 to 52 μm during fast walking, while the peak value increased from 42 to 104 μm. With the curved stem, reducing length from 105 to 54 mm increased the average micromotion from 10 to 29 μm, while the peak value increased from 37 to 101 μm. Similar findings are obtained for stair climbing for both stems. Although the present study showed that femoral stem length as well as stem design directly influences its primary stability, for the two femoral stems tested, length could be reduced substantially without compromising the primary stability. With the aim of minimising surgical invasiveness, newer femoral stem design and currently well performing stems might be used with a reduced length without compromising primary stability and hence, long-term survivorship.

  11. Small phytoplankton contribution to the total primary production in the highly productive Ulleung Basin in the East/Japan Sea

    NASA Astrophysics Data System (ADS)

    Joo, HuiTae; Son, SeungHyun; Park, Jung-Woo; Kang, Jae Joong; Jeong, Jin-Yong; Kwon, Jae-Il; Kang, Chang-Keun; Lee, Sang Heon

    2017-09-01

    The Ulleung Basin in the southwestern East/Japan Sea (hereafter East Sea) is known as a biologically productive ;hot spot; but climate-associated changes in the physicochemical oceanographic conditions and some biological changes have been reported. In this study, our main objective was to determine the contribution of small phytoplankton to the total primary production, which is valuable information for detecting marine ecosystem changes in the Ulleung Basin. The small phytoplankton productivity contributions determined by Moderate-Resolution Imaging Spectroradiometer (MODIS)-derived monthly productivities using a phytoplankton community-based productivity algorithm was significantly consistent with the field-measured productivity contributions of small phytoplankton in this study. The daily primary productivity of small phytoplankton ranged from 42.7 to 418.7 mg C m-2 d-1 with an average of 172.9 mg C m-2 d-1 (S.D. = ±61.4 mg C m-2 d-1, n = 120), and the annual contribution of small phytoplankton ranged from 19.6% to 28.4% with an average of 23.6% (S.D. = ±8.1%) in the Ulleung Basin from 2003 to 2012. Overall, large phytoplankton were a major contributor to the total primary production in the Ulleung Basin (76.4 ± 8.2%) from 2003 to 2012, which indicates that the Ulleung Basin is a highly productive region. A significantly negative relationship (p < 0.05) was found between the small phytoplankton primary productivity contribution and the annual primary production in this study. This finding revealed that the recent decreasing annual primary production in the Ulleung Basin could be a consequence of the increasing contribution of small phytoplankton. The response of phytoplankton to ongoing climate change depending on different-size phytoplankton compositions should be a subject for further investigation in the Ulleung Basin as a biologically highly productive region in the East Sea.

  12. Routine use of antibiotic laden bone cement for primary total knee arthroplasty: impact on infecting microbial patterns and resistance profiles.

    PubMed

    Hansen, Erik N; Adeli, Bahar; Kenyon, Robert; Parvizi, Javad

    2014-06-01

    Antibiotic-laden bone cement (ALBC) is used in primary arthroplasties throughout Europe. In North America, ALBC is only FDA approved for revision arthroplasty after periprosthetic joint infection (PJI). No article has evaluated whether infecting microbial profile and resistance has changed with the introduction of ALBC. We hypothesized that prophylactic use of ALBC in primary total knee arthroplasty (TKA) has not had a significant impact on infecting pathogens, and antibiotic resistance profiles. A retrospective cohort analysis was conducted of all PJI patients undergoing primary TKA and total hip arthroplasty (THA) between January 2000 and January 2009. No significant change in the patterns of infecting PJI pathogens, and no notable increase in percentage resistance was found among organisms grown from patients with PJI that had received prophylactic antibiotic-loaded cement in their primary joint arthroplasty. Early findings suggest that routine prophylactic use of ALBC has not led to changes in infecting pathogen profile, nor has led to the emergence of antimicrobial resistance at our institution.

  13. Analysis of Preventive Interventions for Malaria: Exploring Partial and Complete Protection and Total and Primary Intervention Effects

    PubMed Central

    Cairns, Matthew; Cheung, Yin Bun; Xu, Ying; Asante, Kwaku Poku; Owusu-Agyei, Seth; Diallo, Diadier; Konate, Amadou T.; Dicko, Alassane; Chandramohan, Daniel; Greenwood, Brian; Milligan, Paul

    2015-01-01

    Event dependence, the phenomenon in which future risk depends on past disease history, is not commonly accounted for in the statistical models used by malaria researchers. However, recently developed methods for the analysis of repeated events allow this to be done, while also accounting for heterogeneity in risk and nonsusceptible subgroups. Accounting for event dependence allows separation of the primary effect of an intervention from its total effect, which is composed of its primary effect on risk of disease and its secondary effect mediated by event dependence. To illustrate these methods and show the insights they can provide, we have reanalyzed 2 trials of seasonal malaria chemoprevention (SMC) in Boussé, Burkina Faso, and Kati, Mali, in 2008–2009, as well as a trial of intermittent preventive treatment of malaria in infants in Navrongo, Ghana, in 2000–2004. SMC completely protects a large fraction of recipients, while intermittent preventive treatment in infants provides modest partial protection, consistent with the rationale of these 2 different chemopreventive approaches. SMC has a primary effect that is substantially greater than the total effect previously estimated by trials, with the lower total effect mediated by negative event dependence. These methods contribute to an understanding of the mechanisms of protection from these interventions and could improve understanding of other tools to control malaria, including vaccines. PMID:26022663

  14. Morbidity and mortality following preoperative radiation therapy and total pelvic exenteration for primary rectal adenocarcinoma.

    PubMed

    Luna-Perez, P; Rodriguez, D F; Flores, D; Delgado, S; Labastida, S

    1995-01-01

    Pelvic exenteration, the standard treatment for patients with locally advanced rectal adenocarcinoma infiltrating neighbouring pelvic visceras, carried a significant morbidity and mortality rate. The aim of this study was to determine the morbidity and mortality rates in a group of patients who were treated with preoperative radiation therapy and total pelvic exenteration. Between January 1980 and January 1995, we treated 18 patients. Pretreatment staging was determined by clinical examination and computed tomography (CT) scan of the abdomen and pelvis. Each patient received preoperative radiation therapy of 45 Gy in 20 fractions delivered to the whole pelvis; approximately 6 weeks later total pelvic exenteration was performed. There were 17 males and 1 female, with a median age of 59 years. All patients underwent and completed the scheduled radiation therapy treatment. The main complaints related to radiotherapy were transient skin erythema in five patients and diarrhoea in four. Blood loss (estimated by the surgeon) ranged from 1000 ml to 4200 ml, with a mean loss of 2020 ml. Eight patients (44%) developed major complications: anastomatic leak from the uretero-intestinal suture line (n = 1); perineal wound infection (n = 2); abnormal wall infection (n = 1); haemorrhage from the right internal iliac vein (n = 1) and pneumonia (n = 1). Three patients required surgical reintervention for immediate postoperative haemorrhage from the sacral venous plexus (n = 1), small bowel obstruction (n = 1), and intra-abdominal and pelvic abscess (n = 1). There were two postoperative deaths (11%). The mean and median follow-up was 41 and 32 months, respectively. Two patients (12%) developed local recurrence at 5 and 8 months, and six developed distant recurrences (37%). The overall 5-year survival rate was 61%. Our treatment approach was associated with high morbidity and mortality rates, but was similar to previously published series based on total pelvic exenteration without

  15. Total hip replacement as primary treatment of unstable intertrochanteric fractures in elderly patients.

    PubMed

    Sidhu, Amarjit Singh; Singh, Ajay Pal; Singh, Arun Pal; Singh, Sukhraj

    2010-08-01

    Fifty-three patients with A2.2 and A2.3 intertrochanteric fracture according to the Muller classification were treated with total hip replacement between April 2000 and February 2004. The average age of the patients was 77 years. Average follow-up period was 3.7 years. We studied postoperative complications, mortality rate, functional outcome using the Harris hip score, time to return to normal activities, and radiographic evidence of healing. Two patients died on the third and fifth postoperative days. Seven more patients died within one year. The Harris hip score at one month was 66 +/- 7 (mean +/- standard deviation); at three months 72 +/- 6; at one year 74 +/- 5; at three years 76 +/- 6 and in the 27 patients who completed five year follow-up it was 76 +/- 8. Mobilisation and weight-bearing was started immediately in the postoperative period. Average time taken to return to normal daily activities was 28 days (range 24-33). No loosening or infection of the implants was observed. Total hip arthroplasty is a valid treatment option for mobile and mentally healthy elderly patients with intertrochanteric fractures. This procedure offers quick recovery with little risk of mechanical failure, avoids the risks associated with internal fixation and enables the patient to maintain a good level of function immediately after surgery.

  16. Comparison of robotic-assisted and conventional manual implantation of a primary total knee arthroplasty.

    PubMed

    Park, Sang Eun; Lee, Chun Taek

    2007-10-01

    This study was aimed to compare robotic-assisted implantation of a total knee arthroplasty with conventional manual implantation. We controlled, randomized, and reviewed 72 patients for total knee arthroplasty assigned to undergo either conventional manual implantation (excluding navigation-assisted implantation cases) of a Zimmer LPS prosthesis (Zimmer, Warsaw, Ind) (30 patients: group 1) or robotic-assisted implantation of such a prosthesis (32 patients: group 2). The femoral flexion angle (gamma angle) and tibial angle (delta angle) in the lateral x-ray of group 1 were 4.19 +/- 3.28 degrees and 89.7 +/- 1.7 degrees, and those of group 2 were 0.17 +/- 0.65 degrees and 85.5 +/- 0.92 degrees. The major complications were from improper small skin incision during a constraint attempt of minimally invasive surgery and during bulk fixation frame pins insertion. Robotic-assisted technology had definite advantages in terms of preoperative planning, accuracy of the intraoperative procedure, and postoperative follow-up, especially in the femoral flexion angle (gamma angle) and tibial flexion angle (delta angle) in the lateral x-ray, and in the femoral flexion angle (alpha angle) in the anteroposterior x-ray. But a disadvantage was the high complication rate in early stage.

  17. Retaining well-fixed cementless stem in the treatment of infected hip arthroplasty

    PubMed Central

    2013-01-01

    Background and purpose Two-stage reconstruction, reimplantation after removal of an infected prosthesis, has been considered to be the gold standard for treatment of infected hip arthroplasty. However, during the removal of a well-fixed femoral stem, the proximal femur can be damaged and a sequestrum can be formed, which might lead to chronic osteomyelitis and difficulty in reimplantation. We wanted to determine whether infection after hip arthroplasty can be treated without removal of a well-fixed stem. Methods We treated 19 patients who had an infection after hip replacement, but a well-fixed cementless stem, with 2-stage reconstruction. At the first stage, we removed the acetabular cup, the liner and the head, but not the stem. We then implanted a cup of cement spacer. After control of infection, we reimplanted the acetabular component and head. Results 2 patients did not undergo second-stage reconstruction because they were satisfied with the pain relief and the activity that they had with the cement-spacer implantation. The remaining 17 patients underwent the second-stage of the reconstruction using cementless arthroplasty. At a mean follow-up time of 4 (2–8) years, 15 of the patients had no recurrence of infection, with satisfactory clinical and radiographic outcome. Interpretation This second-stage reconstruction after retention of the stem could be an alternative treatment option for periprosthetic infection with a well-fixed stem. PMID:23621807

  18. Suppression of Hepatic Cyp1a2 by Total Ginsenosides in Lipopolysaccharide-Treated Mice and Primary Mouse Hepatocytes.

    PubMed

    Sun, Haiyan; Yan, Yijing; Xu, Chenshu; Wan, Hongxia; Liu, Dong

    2016-03-23

    The roots of Panax ginseng (ginseng) have been extensively used in traditional Chinese medicine. However, herb-drug interactions between ginseng and other co-administered drugs are not fully understood concerning the effect of ginseng on drug metabolism and clearance. The current study aimed to elucidate the effect of total ginsenosides, a typical ginseng extract, on the regulation of Cyp1a2, a key enzyme to regulate drug metabolism under the normal and inflammatory conditions in mice. Female C57BL/6J mice treated with vehicle and lipopolysaccharide (LPS) were intragastrically administered ginseng extract for 7 days before hepatic P450 expression was analyzed. Primary mouse hepatocytes were also employed to further explore the effects of total ginsenosides on Cyp1a2 expression. The results showed that total ginsenosides in P. ginseng extract exhibited a concentration-dependent suppression on Cyp1a2 mRNA and protein level in both mice and primary mouse hepatocytes. Notably, the inhibitory effects of total ginsenosides on Cyp1a2 mRNA and protein expression were further enhanced following LPS treatment. Therefore, future research is warranted to investigate the role of ginsenosides in the regulation of hepatic CYP450s. Moreover, consumption of ginseng as food or supplement should be monitored for patients on combinational therapy, especially those with inflammatory diseases.

  19. Revision hip arthroplasty in patients with a previous total hip replacement for osteonecrosis of the femoral head.

    PubMed

    Park, Youn-Soo; Moon, Young-Wan; Lee, Keun-Ho; Lim, Seung-Jae

    2014-12-01

    Patients with osteonecrosis of the femoral head are typically relatively young and active and often require high rates of revision after primary total hip arthroplasty. However, outcomes of revision hip arthroplasty in this patient population have rarely been reported in the literature. The authors conducted a retrospective review of 72 patients (75 hips) who underwent revision hip arthroplasty with a primary diagnosis of osteonecrosis of the femoral head. Mean age at index revision was 53.3 years (range, 34-76). Components of acetabular revision included a cementless porous-coated cup in 58 hips and an acetabular cage in 3 hips. Components of femoral revision included a fully grit-blasted tapered stem in 30 hips and a proximally porous-coated modular stem in 9 hips. Mean duration of follow-up was 7 years (range, 3-17). Mean Harris Hip Score improved from 49 points preoperatively to 90 points postoperatively. At final follow-up, 11 hips (14.7%) required reoperation because of aseptic loosening (6 hips), infection (2 hips), recurrent dislocation (1 hip), periprosthetic fracture (1 hip), and ceramic fracture (1 hip). Kaplan-Meier survivor-ship with an endpoint of re-revision for any reason was 81% and for mechanical failure was 87.5% for the cup and 100% for the stem at 10 years. Unlike the previous report, the authors' study showed a lower failure rate of the femoral stem after revision hip arthroplasty using modern cementless femoral components in patients with osteonecrosis of the femoral head. Aseptic cup loosening or osteolysis is the most common mechanism of failure at medium-term follow-up. Copyright 2014, SLACK Incorporated.

  20. Primary total elbow replacement in a patient with old unreduced complex posterior elbow dislocation.

    PubMed

    Kanakaraddi, Sandeep

    2013-01-01

    A 65-year-old female presented with history of a fall on an outstretched hand 2 months back and with complaints of pain, limitation of movement of right elbow, and inability to carry out her daily routine activities. On examination, there was swelling and tenderness at the elbow, three point relation was altered, had fixed flexion deformity of 50° with range of motion from 50° to 60°. Radiographs showed neglected old unreduced posterior elbow dislocation, fractures of radial head, and coronoid process. Patient was treated with total elbow replacement using 3rd generation sloppy hinged elbow prosthesis. At 3 weeks, range of motion was from 30° to 120°. At 6 weeks follow-up, patient was able to do her routine activities independently with ROM of 20° to 140° and minimum pain.

  1. The natural history of a newly developed flexion contracture following primary total knee arthroplasty.

    PubMed

    Anania, Andres; Abdel, Matthew P; Lee, Yuo-yu; Lyman, Stephen; González Della Valle, Alejandro

    2013-10-01

    We investigated the incidence, natural history, and functional consequences of a newly developed flexion contracture after total knee arthroplasty (TKA). Forty patients with full knee extension preoperatively who developed a postoperative flexion contracture were match-paired 1:2 with 80 patients who had full extension. The incidence of a newly developed flexion contracture, ROM, and Knee Society scores (KSS) at six weeks, four months, and one year were analysed. The incidence of a new flexion contracture at six weeks was 14%, but diminished to 5% and 0.3% at four months and one year, respectively. One year after surgery, there was no difference in the KSS (p = 0.5). This study showed that the majority of patients who developed a new flexion contracture after TKA have full knee extension one year postoperatively. Moreover, knee extension and KSS at one year are equivalent to those patients who did not developed a flexion contracture.

  2. Blood conservation with tranexamic acid in total hip arthroplasty: a randomized, double-blind study in 40 primary operations.

    PubMed

    Benoni, G; Fredin, H; Knebel, R; Nilsson, P

    2001-10-01

    We performed a randomized, double-blind study on the effect of tranexamic acid on blood loss and blood transfusions in 40 primary total hip arthroplasties. Tranexamic acid, 10 mg/kg body weight, or placebo, was given intravenously just before the operation. Blood loss during the operation and postoperatively into the drains was recorded, as also were blood hemoglobin concentrations. Ultrasound examination 1 week postoperatively was done to estimate the blood loss due to remaining hematomas. Total (operation + drain) blood loss was 0.76 (95 CI 0.63-0.89) L in the tranexamic acid group as compared to 1.0 (CI 0.81-1.2) L in the placebo group (p = 0.03). The number of blood transfusions during the day of operation was 2 vs. 10 (p = 0.07) and the total number during the hospital stay was 5 vs. 13 (p = 0.2). 1 patient in each group had a pulmonary embolism.

  3. Relationship between Tibial Baseplate Design and Rotational Alignment Landmarks in Primary Total Knee Arthroplasty

    PubMed Central

    Indelli, Pier Francesco; Graceffa, Angelo; Baldini, Andrea; Payne, Brielle; Pipino, Gennaro; Marcucci, Massimiliano

    2015-01-01

    This study evaluated the influence of modern tibial baseplate designs when using the anterior tibial cortex as a primary rotational landmark for the tibial baseplate in TKA. Eighty patients undergoing TKA were randomized in two groups. Group 1 included 25 females and 15 males receiving a posterior-stabilized (PS) symmetric tibial baseplate while Group 2 included 24 females and 16 males receiving a PS anatomical tibial component. Identical surgical technique, including the use of the surgical transepicondylar femoral axis (sTEA) and the anterior tibial cortex (“Curve-on-Curve”) as rotational alignment landmarks, was used. All patients underwent CT evaluation performed with the knee in full extension. Three observers independently measured the rotational alignment of the tibial component in relation to the sTEA. The rotational alignment of the symmetric baseplate showed an average external rotation of 1.3° (minimum 5°, maximum −1°): 91% of the knees showed 0 ± 3° with respect to the surgical sTEA, being internally rotated in 20%. The rotational alignment of the anatomical baseplate showed an average external rotation of 4.1° (minimum 0.4°, maximum 8.9°): only 47.5% of the knees showed 0 ± 3°, being externally rotated in 100%. The difference between the two groups was statistically significant. This study confirms the reliability of the “Curve-on-Curve” technique as an adequate rotational alignment anatomical landmark in TKA: the use of an asymmetric tibial baseplate might lead to external rotation of the tibial component when this technique is intraoperatively chosen. PMID:26491564

  4. Prognostic impact of chronic total occlusion in a nonculprit artery in patients with acute myocardial infarction undergoing primary angioplasty.

    PubMed

    Ariza-Solé, Albert; Teruel, Luis; di Marco, Andrea; Lorente, Victòria; Sánchez-Salado, José C; Sánchez-Elvira, Guillermo; Romaguera, Rafael; Gómez-Lara, Josep; Gómez-Hospital, Joan A; Cequier, Angel

    2014-05-01

    The prognostic value of chronic total occlusion in nonculprit coronary arteries in patients with myocardial infarction undergoing primary angioplasty remains controversial. Several publications have described different methodologies and conflicting findings. In addition, causes of death were not reported. Our aim is to analyze the prognostic impact of chronic total occlusion in nonculprit coronary arteries and the role of left ventricular ejection fraction in this analysis. Prospective inclusion of consecutive patients with ST-segment elevation myocardial infarction who underwent primary angioplasty. We recorded baseline characteristics, in-hospital clinical course, and mortality and its causes during follow-up. We assessed the impact of chronic total occlusion on mortality using Cox regression analysis. Chronic total occlusion in nonculprit arteries was present in 125 of 1176 patients (10.6%); in 79 of these 125 patients, chronic total occlusion was present in the proximal segments. The mean follow-up was 339 days; 64 (5.8%) patients died during the first 6 months. Patients with chronic total occlusions had more comorbidities, poorer ventricular function, and higher mortality (hazard ratio=2.79; 95% confidence interval, 1.71-4.56). Chronic total occlusion was also associated with noncardiac death (hazard ratio=3.83; 95% confidence interval, 2.10-7.01). Chronic total occlusion in proximal segments was associated with both cardiac (hazard ratio=3.22; 95% confidence interval, 1.42-7.30) and noncardiac deaths (hazard ratio=3.43; 95% confidence interval, 1.67-7.06). The multivariate analysis performed without including left ventricular ejection fraction showed a significant association between chronic total occlusion and mortality. However, when left ventricular ejection fraction was included in the analysis, this association was nonsignificant (hazard ratio=1.76; 95% confidence interval, 0.85-3.65; P=.166). Chronic total occlusion in this clinical setting identified

  5. Can an Arthroplasty Registry Help Decrease Transfusions in Primary Total Joint Replacement? A Quality Initiative.

    PubMed

    Markel, David C; Allen, Mark W; Zappa, Nicole M

    2016-01-01

    Standardized care plans are effective at controlling cost and quality. Registries provide insights into quality and outcomes for use of implants, but most registries do not combine implant and care quality data. In 2012, several Michigan area hospitals and a major insurance provider formed a voluntary statewide total joint database/registry, the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), to collect procedural, hospital, discharge, and readmission data. Noting substantial variation in transfusion practices after total joint arthroplasty (TJA) in our institutions, we used these prospectively collected data to examine whether awareness and education of the American Association of Blood Banks' (AABB) transfusion guidelines would result in decreased transfusions. (1) Can an established arthroplasty registry help implement a quality initiative (QI) designed to decrease the proportion of transfused postoperative patients undergoing TJA? (2) Do data-driven transfusion protocols decrease length of stay without increasing ischemic complications (myocardial infarctions and cerebrovascular accidents)? (3) Are decreased transfusion proportions associated with decreased readmissions, nonischemic morbidity (including deep vein thrombosis and deep prosthetic infection), and mortality in postoperative patients who had undergone TJA? After reviewing data from the recently established MARCQI registry, the orthopaedic department noticed many discrepancies and practice variances regarding blood transfusions among their providers. In October 2013, a QI was implemented to raise awareness of the discrepancies and education about the AABB guidelines was presented at the monthly orthopaedic service line meeting. A total of 1872 TJA cases were reviewed; 50 were excluded for incomplete data and two for intraoperative transfusions for the period before education (May 2012 to June 2013, n = 1240) and after education (November 2013 to April 2014, n = 580). Data

  6. What is the role of mental health in primary total knee arthroplasty?

    PubMed

    Lavernia, Carlos J; Villa, Jesus M; Iacobelli, David A

    2015-01-01

    Psychological distress has been associated with inferior scores for pain after total knee arthroplasty (TKA). However, its relationships with scores and arthrofibrosis after TKA remain unclear. The objectives of this study were (1) to assess patient-reported outcomes (PROs), including Knee Society (KS) scores, of those patients who developed arthrofibrosis and underwent manipulation and compare them with a control group; and (2) in patients with arthrofibrosis who underwent manipulation, to determine PROs and KS scores of those with psychological distress and those without it. During a 17-year period (August 1992 to October 2009), a total of 1952 TKAs were performed and included in our prospectively collected joint registry database; 1248 procedures had a postoperative followup of at least 2 years (mean, 5 years; range, 2-16 years). Among them, 57 knees (53 patients) developed arthrofibrosis and underwent manipulation under anesthesia after the index procedure. This group was compared with a matched group (by age, sex, race, and ethnicity) of 63 knees (58 patients) without arthrofibrosis. Demographics, preoperative and postoperative Quality of Well-Being scale (QWB-7), SF-36, WOMAC, and The KS knee and function scores were prospectively collected and retrospectively analyzed. Patients with <52 points on the SF-36 Mental Component Summary subscale were considered in psychological distress for all comparisons. Active knee flexion and KS range of motion (ROM) were used as objective motion measures. Minimum followup was 2 years (mean, 5 years; range, 2-16 years). Patients who developed arthrofibrosis had worse KS function scores before TKA than did patients in the nonarthrofibrosis control group (mean 27, SD 20.5 versus 37, SD 19.3; p=0.006). Patients with arthrofibrosis and psychological distress, before TKA and when compared with patients with arthrofibrosis but without distress, had worse QWB-7 (0.490 versus 0.547; p<0.001) and worse WOMAC stiffness (4.92, versus 3

  7. A Practiced Basis for Predicting the Total Signal of Primary Climate Variables. Scientific Session U06

    NASA Astrophysics Data System (ADS)

    Suhler, G.

    2009-12-01

    From within Talmudic law came the counsel that for something to be real it must have real effects arising from its interactions. Then it may follow that a certain level of understanding of that which is real can be demonstrated by what is explained well in breadth and depth. An even stronger degree of understanding may be to fairly predict that which is real and to know through its future effects what turns out to be real. Indeed these two, explanatory power and predictive power, have been the first two measures of a science from the time of Galileo and Bacon and even prior. The third measure of a science has been the ability to prescribe a course of action and interaction that leads to desired results. We focus mainly on the first two. From such presentations as at American Association of State Climatologists beginning in 1998, AGU2002Fall Session H-061, and as organizer and presenters for AAAS2006 Symposium #127 (El Nino Predictability), the presenters have made known and placed into the public record predictions of monthly temperature and precipitation that are site-specific as well as regional. This session will take such examples of ‘total signal’ prediction over time frames up to now 12 years and counting and examine in terms of empirical observation and theoretical basis. That theoretical basis derives from Navier-Stokes primitive equations and can be shown to generate, among others, what have been called binary subharmonics that hold ‘period doubling’ as a special yet oft-obtained case for an interactive climate system at numerous time scales. The upshot is that from annual forcings Earth’s climate tends to repeat itself at or near up-time scale periods of 2,4,8, 16, 32, 64, 128, 256.…years. The interactive nature leads to modulation at all levels. Specifics of these forced system interactions will be examined from their theoretical basis through examples ranging from site-specific precipitation through Nino3 SST prediction to global

  8. The first 6 weeks of recovery after primary total hip arthroplasty with fast track

    PubMed Central

    Klapwijk, Lisette C M; Mathijssen, Nina M C; Van Egmond, Jeroen C; Verbeek, Bianca M; Vehmeijer, Stephan B W

    2017-01-01

    Background and purpose Fast-track protocols have been introduced worldwide to improve the recovery after total hip arthroplasty (THA). These protocols have reduced the length of hospital stay (LOS), and THA in an outpatient setting is also feasible. However, less is known regarding the first weeks after THA with fast track. We examined patients’ experiences of the first 6 weeks after hospital discharge following inpatient and outpatient THA with fast track. Patients and methods In a prospective cohort study, 100 consecutive patients who underwent THA surgery in a fast-track setting between February 2015 and October 2015 received a diary for 6 weeks. This diary contained various internationally validated questionnaires including HOOS-PS, OHS, EQ-5D, SF-12, and ICOAP. In addition, there were general questions regarding pain, the wound, physiotherapy, and thrombosis prophylaxis injections. Results 94 patients completed the diary, 42 of whom were operated in an outpatient setting. Pain and use of pain medication had gradually decreased during the 6 weeks. Function and quality of life gradually improved. After 6 weeks, 91% of all patients reported better functioning and less pain than preoperatively. Interpretation Fast track improves early functional outcome, and the PROMs reported during the first 6 weeks in this study showed continued improvement. They can be used as a baseline for future studies. The PROMs reported could also serve as a guide for staff and patients alike to modify expectations and therefore possibly improve patient satisfaction. PMID:28079428

  9. Immediate recovery room radiographs after primary total knee arthroplasty—why do we keep doing them?

    PubMed Central

    Kosashvili, Yona; Alvi, Mansour; Safir, Oleg; Gross, Alan; Backstein, David

    2009-01-01

    Recovery room radiographs (RRR) are routinely performed after total knee arthroplasty (TKA). This study investigates the utility of these radiographs. Twenty four arthroplasty surgeons were surveyed to rank the value of RRRs. Since RRRs were primarily valued for educational purposes, we examined the ability of 49 orthopaedic trainees to determine the coronal alignment of TKA performed in cadaveric specimens based on these radiographs in neutral, 10° internal and external rotations. Surgeons rated the quality of the RRRs to be significantly lower than the radiographs taken in the radiology suite (5.5 ± 2.5 versus 8.9 ± 0.9, p < 0.0001). Of an estimated 65,910 TKAs performed by these surgeons, only eight cases (0.01%) required same day revision based on the RRR. Neutral alignment was significantly more accurately (p < 0.0001) interpreted than valgus or varus (69.4% versus 42.9% and 16.3%, respectively). Surprisingly, internal rotation of the limb significantly improved interpretation of both varus (from 16.3% to 40.8%, p = 0.014) and valgus (from 42.9% to 63.3%, p = 0.048). Increased level of orthopaedic training did not significantly affect the accuracy of interpretation (p = 0.46). Interpretation of RRRs for coronal malalignment is inaccurate and has a limited educational value. PMID:19826813

  10. The first 6 weeks of recovery after primary total hip arthroplasty with fast track.

    PubMed

    Klapwijk, Lisette C M; Mathijssen, Nina M C; Van Egmond, Jeroen C; Verbeek, Bianca M; Vehmeijer, Stephan B W

    2017-04-01

    Background and purpose - Fast-track protocols have been introduced worldwide to improve the recovery after total hip arthroplasty (THA). These protocols have reduced the length of hospital stay (LOS), and THA in an outpatient setting is also feasible. However, less is known regarding the first weeks after THA with fast track. We examined patients' experiences of the first 6 weeks after hospital discharge following inpatient and outpatient THA with fast track. Patients and methods - In a prospective cohort study, 100 consecutive patients who underwent THA surgery in a fast-track setting between February 2015 and October 2015 received a diary for 6 weeks. This diary contained various internationally validated questionnaires including HOOS-PS, OHS, EQ-5D, SF-12, and ICOAP. In addition, there were general questions regarding pain, the wound, physiotherapy, and thrombosis prophylaxis injections. Results - 94 patients completed the diary, 42 of whom were operated in an outpatient setting. Pain and use of pain medication had gradually decreased during the 6 weeks. Function and quality of life gradually improved. After 6 weeks, 91% of all patients reported better functioning and less pain than preoperatively. Interpretation - Fast track improves early functional outcome, and the PROMs reported during the first 6 weeks in this study showed continued improvement. They can be used as a baseline for future studies. The PROMs reported could also serve as a guide for staff and patients alike to modify expectations and therefore possibly improve patient satisfaction.

  11. Micromotion at the tibial plateau in primary and revision total knee arthroplasty: fixed versus rotating platform designs

    PubMed Central

    Rogge, R. D.; Malinzak, R. A.; Reyes, E. M.; Cook, P. L.; Farley, K. A.; Ritter, M. A.

    2016-01-01

    Objectives Initial stability of tibial trays is crucial for long-term success of total knee arthroplasty (TKA) in both primary and revision settings. Rotating platform (RP) designs reduce torque transfer at the tibiofemoral interface. We asked if this reduced torque transfer in RP designs resulted in subsequently reduced micromotion at the cemented fixation interface between the prosthesis component and the adjacent bone. Methods Composite tibias were implanted with fixed and RP primary and revision tibial trays and biomechanically tested under up to 2.5 kN of axial compression and 10° of external femoral component rotation. Relative micromotion between the implanted tibial tray and the neighbouring bone was quantified using high-precision digital image correlation techniques. Results Rotational malalignment between femoral and tibial components generated 40% less overall tibial tray micromotion in RP designs than in standard fixed bearing tibial trays. RP trays reduced micromotion by up to 172 µm in axial compression and 84 µm in rotational malalignment models. Conclusions Reduced torque transfer at the tibiofemoral interface in RP tibial trays reduces relative component micromotion and may aid long-term stability in cases of revision TKA or poor bone quality. Cite this article: Mr S. R. Small. Micromotion at the tibial plateau in primary and revision total knee arthroplasty: fixed versus rotating platform designs. Bone Joint Res 2016;5:122–129. DOI: 10.1302/2046-3758.54.2000481. PMID:27095658

  12. Is closed suction drainage effective in early recovery of hip joint function? Comparative evaluation in one-stage bilateral total hip arthroplasty.

    PubMed

    Koyano, Gaku; Jinno, Tetsuya; Koga, Daisuke; Hoshino, Chisato; Muneta, Takeshi; Okawa, Atsushi

    2015-01-01

    One-stage primary bilateral cementless total hip arthroplasty with unilateral closed suction drainage (CSD) was prospectively performed for 51 patients (102 hips), and local effects of CSD were quantitatively evaluated. Postoperatively, pain scores evaluated by visual analog scale and periwound temperatures measured by thermography were lower in the CSD side than the non-CSD side. CT measurements also showed that postoperative cross-sectional area of the thigh was smaller in the CSD side. Active straight leg raising and weight bearing were more accelerated in the CSD side., showing earlier recovery of hip joint function. CSD for hip arthroplasty has an advantage in reducing postoperative local inflammation and be recommended from the viewpoint of postoperative pain relief and early recovery of hip joint function.

  13. Computer Assisted Surgery and Current Trends in Orthopaedics Research and Total Joint Replacements

    NASA Astrophysics Data System (ADS)

    Amirouche, Farid

    2008-06-01

    Musculoskeletal research has brought about revolutionary changes in our ability to perform high precision surgery in joint replacement procedures. Recent advances in computer assisted surgery as well better materials have lead to reduced wear and greatly enhanced the quality of life of patients. The new surgical techniques to reduce the size of the incision and damage to underlying structures have been the primary advance toward this goal. These new techniques are known as MIS or Minimally Invasive Surgery. Total hip and knee Arthoplasties are at all time high reaching 1.2 million surgeries per year in the USA. Primary joint failures are usually due to osteoarthristis, rheumatoid arthritis, osteocronis and other inflammatory arthritis conditions. The methods for THR and TKA are critical to initial stability and longevity of the prostheses. This research aims at understanding the fundamental mechanics of the joint Arthoplasty and providing an insight into current challenges in patient specific fitting, fixing, and stability. Both experimental and analytical work will be presented. We will examine Cementless total hip arthroplasty success in the last 10 years and how computer assisted navigation is playing in the follow up studies. Cementless total hip arthroplasty attains permanent fixation by the ingrowth of bone into a porous coated surface. Loosening of an ingrown total hip arthroplasty occurs as a result of osteolysis of the periprosthetic bone and degradation of the bone prosthetic interface. The osteolytic process occurs as a result of polyethylene wear particles produced by the metal polyethylene articulation of the prosthesis. The total hip arthroplasty is a congruent joint and the submicron wear particles produced are phagocytized by macrophages initiating an inflammatory cascade. This cascade produces cytokines ultimately implicated in osteolysis. Resulting bone loss both on the acetabular and femoral sides eventually leads to component instability. As

  14. A modified S-ROM stem in primary total hip arthroplasty for developmental dysplasia of the hip.

    PubMed

    Tamegai, Hideaki; Otani, Takuya; Fujii, Hideki; Kawaguchi, Yasuhiko; Hayama, Tetsuo; Marumo, Keishi

    2013-12-01

    This study examined the clinical outcome of 220 hips in 196 Asian patients who underwent primary total hip arthroplasty (THA) for treatment of developmental dysplasia of the hip (DDH) using a modified S-ROM modular (S-ROM-A) stem designed for Asians, after 2-5 years (mean, 3.3 years) of follow-up. The stem was placed so that the anteversion angle of the neck was decreased against the sleeve in 56% of the hips and increased in 18% of the hips. Bone ingrown fixation was achieved in 99.5% of the hips on X-ray at final follow-up. There were 2 (0.9%) dislocations postoperatively. In primary THA for treatment of DDH accompanied by femoral rotational deformity, the freely-rotatable modular stem provided favorable short-term outcomes by affording both morphological and functional advantages.

  15. Primary total hip arthroplasty versus internal fixation in displaced fracture of femoral neck in sexa- and septuagenarians.

    PubMed

    Wani, Iftikhar H; Sharma, Sidhartha; Latoo, Irfan; Salaria, A Q; Farooq, Munir; Jan, Masrat

    2014-09-01

    The optimal treatment of femoral neck fracture in the elderly patient is still under debate. In patients aged 60-80 years, the decision between internal fixation and arthroplasty remains controversial. The primary aim of the present study is to evaluate the functional outcome of patients aged 60-80 years with femoral neck fracture treated with total hip arthroplasty or closed reduction and internal fixation. The secondary aim is to evaluate the incidence of nonunion and avascular necrosis in femoral neck fracture in different age groups. We studied 100 patients affected by displaced fracture of the femoral neck from May 2007 through June 2010. There were 60 men and 40 women with mean age of 66 years. Fifty patients were treated with closed reduction and internal fixation with cannulated screws (group A), and the other 50 patients with total hip arthroplasty (group B). Mean surgical time, blood loss, duration of hospital stay, Harris hip score, complications, and need for reoperation were recorded. Harris hip score was significantly higher in group B at 3-, 6-, 12-, and 18-month follow-up evaluation. The overall complication rate was 28 % in group A and 32 % in group B, which was not statistically significant. A statistically significant difference was found regarding patients who required reoperation in group A (20 %) compared with group B (no one). The average Harris hip score in the internal fixation group was 90.6 and in the total hip arthroplasty group was 93.7, which was statistically significant (p < 0.05). Our study showed an increased risk for intracapsular hip fracture developing nonunion with older age. Primary total hip arthroplasty compared with internal fixation appears to be a reasonably safe method of treating displaced fracture of femoral neck in elderly patients. We also concluded that outcome regarding hip function is generally better after total hip arthroplasty compared with internal fixation. Level II-Prospective cohort study.

  16. [Investigate progress of intraoperative periprosthetic fracture of total hip arthroplasty].

    PubMed

    Cong, Yu; Zhao, Jian-ning

    2011-02-01

    One of the complications of total hip arthroplasty is intraoperative periprosthetic fracture. Periprosthetic fracture is divided into acetabular fracture and femoral fracture. Risk factors for intraoperative periprosthetic fracture include use of minimally invasive techniques, press-fit cementless stems, revision operations and osteoporosis. It has been recognized that treatment of intraoperative periprosthetic fractures should be based on the classification of the Vancouver system for intraoperative fractures.

  17. Unsuspected Malignancies in Routine Femoral Head Histopathologic Examination During Primary Total Hip Arthroplasty: Cost-Effectiveness Analysis.

    PubMed

    Liow, Ming Han Lincoln; Agrawal, Kshitijkumar; Anderson, David W; Freiberg, Andrew A; Rubash, Harry E; Kwon, Young-Min

    2017-03-01

    Routine femoral head histopathology during primary total hip arthroplasty (THA) has been recently reported as a potentially useful screening tool for bone- and bone marrow-associated malignancies. However, cost-effectiveness of routine histopathology during THA remains unclear due to low prevalence of significant medical findings which alter patient management. The aim of this study was to evaluate the cost-effectiveness of routine histopathology in diagnosing unsuspected malignancy in patients undergoing primary THA. From 1993 to 2011, we retrospectively analyzed routine histopathologic findings of 3200 femoral head specimens from 2725 patients that underwent primary THA. Preoperative and postoperative diagnoses were classified into concordant (clinical diagnosis concurred with pathologic diagnosis), discrepant (differing diagnosis with no resultant impact on patient management), and discordant (differing diagnosis with subsequent change in patient management). Cost-effectiveness analysis was performed using the incremental cost-utility ratio. A total of 3055 of 3200 pathologic samples were concordant with the preoperative diagnosis (95.4%), 140 of 3200 were discrepant (4.4%), and 5 of 3200 were discordant (0.2%). Routine histopathology revealed 1 unsuspected malignancy out of 640 (5 of 3200) femoral heads. The total cost of histopathologic screening was $614,664.80. The average cost to identify a discrepant case was $4390.46, and the cost to identify a discordant case was $122,932.96. The incremental cost-utility ratio was $49,569.74 per quality-adjusted life year (QALY) gained. Our study indicates routine femoral head histopathology may be cost-effective in diagnosing unsuspected malignancy at $49,569.74/QALY gained (less than World Health Organization recommended threshold $159,000/QALY gained), providing useful clinical information for surgeons considering the value of routine femoral head histopathology in patients undergoing THA. Copyright © 2016 Elsevier

  18. Fast-track recovery technique applied to primary total hip and knee replacement surgery. Analysis of costs and complications.

    PubMed

    Wilches, C; Sulbarán, J D; Fernández, J E; Gisbert, J M; Bausili, J M; Pelfort, X

    To determine the cost reduction and complication rates of using an enhanced recovery pathway (Fast-track) when compared to traditional recovery in primary total hip replacement (THR) and total knee replacement (TKR), as well as to determine if there were significant differences in complication rates. Retrospective review of 100 primary total arthroplasties using the Fast-track recovery system and another 100 using conventional recovery. Gender, Charlston comorbidity index, ASA score, length of stay and early complications were measured, as well in-hospital complications and those in the first six months, re-admissions and transfusion rates. The total and daily cost of stay was determined and the cost reduction was calculated based on the reduction in the length of stay found between the groups. Both groups where comparable as regards age, gender, ASA score, and Charlston index. The mean reduction in length of stay was 4.5 days for TKR and 2.1 days for THR. The calculated cost reduction was 1266 euros for TKR and 583 euros for THR. There were no statistically significant differences between groups regarding in-hospital complications, transfusion requirements, re-admissions and complication rates in the first six months. There are few publications in the literature reviewed that analyse the cost implications of using fast-track recovery protocols in arthroplasty. Several published series comparing recovery protocols found no significant differences in complication rates either. The use of a fast-track recovery protocol resulted in a significant cost reduction of 1266 euros for the TKR group and 583 for the THR group, without affecting complication rates. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Circumferential electrocautery of the patella in primary total knee replacement without patellar replacement: a meta-analysis and systematic review

    NASA Astrophysics Data System (ADS)

    Fan, Lihong; Ge, Zhaogang; Zhang, Chen; Li, Jia; Yu, Zefeng; Dang, Xiaoqian; Wang, Kunzheng

    2015-03-01

    The purpose of this meta-analysis and systematic review was to identify and assess whether circumferential electrocautery is useful for improving outcomes after primary total knee replacement(TKR). We searched MEDLINE, EMBASE, PubMed, SpringerLink, Web of Knowledge, OVID CINAHL, OVID EBM and Google Scholar and included articles published through January 2014. A total of 6 articles met the inclusion criteria. Of the 776 cases included in the analysis, 388 cases involved patellar denervation, and 388 cases were designated as the control group. The meta-analysis revealed no significant difference in the incidence of anterior knee pain (AKP, p = 0.18) or in the visual analogue scale score (VAS, p = 0.23) between the two groups. In addition, AKSS Function Score indicated no significant difference between the two groups (p = 0.28). However, the OKS (p = 0.02), patellar score (p = 0.01), AKSS-Knee Score (p = 0.004), range of motion (ROM, p < 0.0001) and WOMAC Score (p = 0.0003) indicated that circumpatellarelectrocautery improved clinical outcomes compared with non-electrocautery. The results indicate that circumferential electrocautery of the patella does not significantly improve AKP compared with non-electrocautery techniques but that circumferential electrocautery significantly improves patients' knee function after surgery. Therefore, we believe that circumferential electrocautery is beneficial to the outcome of primary TKR surgery without patellar replacement.

  20. Circumferential electrocautery of the patella in primary total knee replacement without patellar replacement: a meta-analysis and systematic review.

    PubMed

    Fan, Lihong; Ge, Zhaogang; Zhang, Chen; Li, Jia; Yu, Zefeng; Dang, Xiaoqian; Wang, Kunzheng

    2015-03-24

    The purpose of this meta-analysis and systematic review was to identify and assess whether circumferential electrocautery is useful for improving outcomes after primary total knee replacement(TKR). We searched MEDLINE, EMBASE, PubMed, SpringerLink, Web of Knowledge, OVID CINAHL, OVID EBM and Google Scholar and included articles published through January 2014. A total of 6 articles met the inclusion criteria. Of the 776 cases included in the analysis, 388 cases involved patellar denervation, and 388 cases were designated as the control group. The meta-analysis revealed no significant difference in the incidence of anterior knee pain (AKP, p = 0.18) or in the visual analogue scale score (VAS, p = 0.23) between the two groups. In addition, AKSS Function Score indicated no significant difference between the two groups (p = 0.28). However, the OKS (p = 0.02), patellar score (p = 0.01), AKSS-Knee Score (p = 0.004), range of motion (ROM, p < 0.0001) and WOMAC Score (p = 0.0003) indicated that circumpatellarelectrocautery improved clinical outcomes compared with non-electrocautery. The results indicate that circumferential electrocautery of the patella does not significantly improve AKP compared with non-electrocautery techniques but that circumferential electrocautery significantly improves patients' knee function after surgery. Therefore, we believe that circumferential electrocautery is beneficial to the outcome of primary TKR surgery without patellar replacement.

  1. Circumferential electrocautery of the patella in primary total knee replacement without patellar replacement: a meta-analysis and systematic review

    PubMed Central

    Fan, Lihong; Ge, Zhaogang; Zhang, Chen; Li, Jia; Yu, Zefeng; Dang, Xiaoqian; Wang, Kunzheng

    2015-01-01

    The purpose of this meta-analysis and systematic review was to identify and assess whether circumferential electrocautery is useful for improving outcomes after primary total knee replacement(TKR). We searched MEDLINE, EMBASE, PubMed, SpringerLink, Web of Knowledge, OVID CINAHL, OVID EBM and Google Scholar and included articles published through January 2014. A total of 6 articles met the inclusion criteria. Of the 776 cases included in the analysis, 388 cases involved patellar denervation, and 388 cases were designated as the control group. The meta-analysis revealed no significant difference in the incidence of anterior knee pain (AKP, p = 0.18) or in the visual analogue scale score (VAS, p = 0.23) between the two groups. In addition, AKSS Function Score indicated no significant difference between the two groups (p = 0.28). However, the OKS (p = 0.02), patellar score (p = 0.01), AKSS-Knee Score (p = 0.004), range of motion (ROM, p < 0.0001) and WOMAC Score (p = 0.0003) indicated that circumpatellarelectrocautery improved clinical outcomes compared with non-electrocautery. The results indicate that circumferential electrocautery of the patella does not significantly improve AKP compared with non-electrocautery techniques but that circumferential electrocautery significantly improves patients' knee function after surgery. Therefore, we believe that circumferential electrocautery is beneficial to the outcome of primary TKR surgery without patellar replacement. PMID:25801456

  2. [Quality of Outcome after Primary Total Hip Replacement at a Maximum Care Hospital in Relation to Preoperative Influencing Factors].

    PubMed

    Osmanski-Zenk, K; Steinig, N S; Glass, Ä; Mittelmeier, W; Bader, R

    2015-12-01

    As the need for joint replacements will continue to rise, the outcome of primary total hip replacement (THR) must be improved and stabilised at a high level. In this study, we investigated whether pre-operative risk factors, such as gender, age and body weight at the time of the surgery or a restricted physical status (ASA-Status > 2 or Kellgren and Lawrence grade > 2) have a negative influence on the post-operative results or on patient satisfaction. Retrospective data collection and a prospective interview were performed with 486 patients who underwent primary total hip replacement between January 2007 and December 2010 in our hospital. The patients' satisfaction and quality of life were surveyed with the WOMAC-Score, SF-36 and EuroQol-5. Differences between more than two independent spot tests were tested with the non-parametric Kruskal-Wallis test. Differences between two independent spot tests were tested with the non-parametric Mann-Whitney U test. The frequencies were reported and odds ratios calculated. The confidence interval was set at 95 %. The level of significance was p < 0.05. The average WOMAC-Score was 77.1 and the total score of the SF-36 was 66.9 points. The patients declared an average EuroQol Index of 0.81. Our data show that the patients' gender did not influence the duration of surgery or the scores. However, female patients tended to exhibit more postoperative complications. However, increased patient age at the time of surgery was associated with an increased OR for duration of surgery, length of stay and risk of complications. Patients who had a normal body weight at time of the surgery showed better peri- and post-operative results. We showed that the preoperative estimated Kellgren and Lawrence grade had a significant influence on the duration of surgery. The ASA classification influenced the duration of surgery as well the length of stay and the rate of complications. The quality of results after primary THR depends on

  3. Revision in Cemented and Cementless Infected Hip Arthroplasty

    PubMed Central

    Cherubino, Paolo; Puricelli, Marco; D’Angelo, Fabio

    2013-01-01

    Infection is a frequent cause of failure after joint replacement surgery. The infection rate after total hip arthroplasty (THA) has been reduced to 1-2% in the last years. However, it still represents a challenging problem for the orthopedic surgeon. Difficulty of therapeutic approach, and poor functional outcomes together with length of treatment and overall cost are the main burden of this issue. Even the diagnosis of an infected hip could be challenging although it is the first step of an accurate treatment. At the end, many cases require removing the implants. Afterwards, the treatment strategy varies according to authors with three different procedures: no re-implantation, immediate placement of new implants or a two-stage surgery re-implantation. Based on the most recently systematic review there is no suggestion that one- or two-stage revision methods have different re-infection outcomes. The two-stage implant-exchange protocol remains the gold standard. It is considered as the most efficacious clinical approach for the treatment of periprosthetic infection, especially in patients with sinus tracts, swelling, extended abscess formation in depth and infection of Methicillin Resistant Staphylococcus Aureus (MRSA), and other multidrug-resistant bacteria as reported in recent consensus documents. PMID:23898351

  4. Long-term outcome of a metal-on-polyethylene cementless hip resurfacing.

    PubMed

    Tan, Timothy L; Ebramzadeh, Edward; Campbell, Patricia A; Al-Hamad, Mariam; Amstutz, Harlan C

    2014-04-01

    Due to the well-documented problems surrounding metal-on-metal bearings, the use of hip resurfacing has declined. Since the potential benefits of hip resurfacing remain desirable, it may be beneficial to investigate the long-term outcome of hip resurfacings using metal-on-polyethylene in the 1980's. We report the long-term survivorship and modes of failure of a cementless metal-on-polyethylene resurfacing (n = 178) with different porous ingrowth surfaces. While acetabular loosening was absent, a high incidence of femoral failures (femoral loosening = 18.1%, osteolytic neck fracture = 21%) occurred despite using the same ingrowth surface for both components. Ongoing developments using the lessons learned from these previous generation components and utilizing modern low wear materials, e.g., cross-linked polyethylene, may lead to improved implants for future hip resurfacings. © 2014 Elsevier Inc. All rights reserved.

  5. Radiographic wear measurements in a cementless metal-backed modular cobalt-chromium acetabular component.

    PubMed

    Barrack, R L; Lavernia, C; Szuszczewicz, E S; Sawhney, J

    2001-10-01

    Linear polyethylene wear was measured radiographically and correlated with direct measurements of wear from 21 of 24 liners retrieved at revision. An optical comparator was used to assess linear wear using the shadowgraph technique. Postoperative and prerevision radiographs were reviewed to measure the amount of linear wear radiographically. Seven radiographic methods described in the literature were used: 5 were manual techniques, and 2 techniques used a computer-assisted digitizer. Linear regression analysis showed that there was a statistically significant correlation between the radiographic measurements compared with the direct measurement for 4 of the 5 manual techniques but only 1 of the 2 computerized techniques. Based on these results, radiographic wear measurements of cementless, modular components should be considered qualitative rather than quantitative. There is a significant difference in the measurements obtained among various published techniques. The addition of computer digitization to enhance manual methodology does not improve accuracy.

  6. Which patient characteristics influence length of hospital stay after primary total hip arthroplasty in a 'fast-track' setting?

    PubMed

    den Hartog, Y M; Mathijssen, N M C; Hannink, G; Vehmeijer, S B W

    2015-01-01

    After implementation of a 'fast-track' rehabilitation protocol in our hospital, mean length of hospital stay for primary total hip arthroplasty decreased from 4.6 to 2.9 nights for unselected patients. However, despite this reduction there was still a wide range across the patients' hospital duration. The purpose of this study was to identify which specific patient characteristics influence length of stay after successful implementation of a 'fast-track' rehabilitation protocol. A total of 477 patients (317 female and 160 male, mean age 71.0 years; 39.3 to 92.6, mean BMI 27.0 kg/m(2);18.8 to 45.2) who underwent primary total hip arthroplasty between 1 February 2011 and 31 January 2013, were included in this retrospective cohort study. A length of stay greater than the median was considered as an increased duration. Logistic regression analyses were performed to identify potential factors associated with increased durations. Median length of stay was two nights (interquartile range 1), and the mean length of stay 2.9 nights (1 to 75). In all, 266 patients had a length of stay ≤ two nights. Age (odds ratio (OR) 2.46; 95% confidence intervals (CI) 1.72 to 3.51; p < 0.001), living situation (alone vs living together with cohabitants, OR 2.09; 95% CI 1.33 to 3.30; p = 0.002) and approach (anterior approach vs lateral, OR 0.29; 95% CI 0.19 to 0.46; p < 0.001) (posterolateral approach vs lateral, OR 0.24; 95% CI 0.10 to 0.55; p < 0.001) were factors that were significantly associated with increased length of stay in the multivariable logistic regression model.

  7. Cemented all-polyethylene and metal-backed polyethylene tibial components used for primary total knee arthroplasty: a systematic review of the literature and meta-analysis of randomized controlled trials involving 1798 primary total knee implants.

    PubMed

    Voigt, Jeffrey; Mosier, Michael

    2011-10-05

    The cost of the implant as part of a total knee arthroplasty accounts for a substantial portion of the costs for the overall procedure: all-polyethylene tibial components cost considerably less than cemented metal-backed tibial components. We performed a systematic review of the literature to determine whether the clinical results of lower-cost all-polyethylene tibial components were comparable with the results of a more expensive metal-backed tibial component. We searched The Cochrane Library, MEDLINE, EMBASE, EBSCO CINAHL, the bibliographies of identified articles, orthopaedic meeting abstracts, health technology assessment web sites, and important orthopaedic journals. This search was performed for the years 1990 to the present. No language restriction was applied. We restricted our search to Level-I studies involving participants who received either an all-polyethylene or a metal-backed tibial implant. The primary outcome measures were durability, function, and adverse events. Two reviewers independently screened the papers for inclusion, assessed trial quality, and extracted data. Effects estimates were pooled with use of fixed and random-effects models of risk ratios, calculated with 95% confidence intervals. Heterogeneity was assessed with the I2 statistic. Forest plots were also generated. Data on 1798 primary total knee implants from twelve studies were analyzed. In all studies, the median or mean age of the participants was greater than sixty-seven years, with a majority of the patients being female. There was no difference between patients managed with an all-polyethylene tibial component and those managed with a metal-backed tibial component in terms of adverse events. There was no significant difference between the two groups in terms of the durability of the implants at two, ten, and fifteen years postoperatively, regardless of the year or how durability was defined (revision or radiographic failure). Finally, with use of a variety of validated

  8. Incidence and natural history of deep-vein thrombosis after total hip arthroplasty. A prospective and randomised clinical study.

    PubMed

    Kim, Young-Hoo; Oh, S H; Kim, J S

    2003-07-01

    There are many reports concerning the aetiology and prophylaxis of deep-vein thrombosis (DVT) but little is known about its natural history. The purpose of our study was to identify the incidence and site of DVT, the risk factors for pulmonary embolism and the natural history of DVT after total hip replacement (THR) in patients who do not receive any form of prophylactic or therapeutic treatment for DVT. Two hundred patients who had a primary THR were included: 100 had one-staged bilateral THR and 100 had unilateral THR and 150 implants were cemented and 150 cementless. Coagulation assays, a full blood count, blood typing and serum chemical profile tests were performed for all patients on three separate occasions. Bilateral simultaneous or unilateral venograms were performed on the sixth or seventh postoperative day and perfusion lung scans preoperatively and on the seventh or eighth postoperative day. Further venograms were performed in all patients who had thrombi six months later. In the patients with bilateral THR, 52 (26%) venograms were positive for thrombi, while in the patients with unilateral THR 20 (20%) were positive (p = 0.89). In the patients with a cemented THR, 31 venograms (20.7%) were positive for thrombi, while in those with a cementless THR 41 (27.3%) were positive (p = 0.654). Further venograms in all 72 patients who had thrombi at six months after operation showed that they resolved completely and spontaneously regardless of their site and size. No patients had symptoms of pulmonary emboli and none were seen on the perfusion lung scans. Two patients died from unrelated causes. Although the prevailing opinion is that patients with proximal venous thrombosis should be treated with anticoagulants, our study has shown that all thrombi regardless of their site and size resolve spontaneously without associated pulmonary embolism.

  9. Are patients with preoperative air travel at higher risk for venous thromboembolism following primary total hip and knee arthroplasty?

    PubMed

    Citak, Mustafa; Klatte, Till Orla; Suero, Eduardo M; Lenhart, Johannes; Gehrke, Thorsten; Kendoff, Daniel

    2015-01-01

    The advent of international medical travel has resulted in many patients travelling abroad to seek medical attention at foreign institutions. However, it is not known whether long-haul flights further increase the risk of VTE in patients who are to receive a joint replacement. We performed this retrospective cohort study to analyze if patients with preoperative air travel with a flight time more than four hours are at higher risk for VTE development following total knee or total hip athroplasty (THA) compared to patients without preoperative travel. Between January 2007 and December 2012, 245 patients were treated with either a primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) with preoperative air travel with a flight time more than 4 hours at our institution. One-hundred fifty five patients (n= 87 THA and n= 68 TKA) out of 245 patients met the inclusion and exclusion criteria and were included in this study. A total of 187 patients (n= 92 THA and n= 95 TKA) without bus, air or car travel longer than 30 minutes met the inclusion and exclusion criteria and were included in this study as controls. Patients with preoperative air travel were not at higher risk for VTE development compared to patients without preoperative air travel following TKA (HR = 0.95; 95%CI = 0.14-6.52). Gender (HR = 0.41; 95%CI = 0.05-3.56) and age (HR = 3.77; 95%CI = 0.63-22.37) did not influence the VTE development in TKA patients. Our study results show that preoperative air travel do not further increase the risk of VTE after TKA and THA.

  10. Improved design of cementless hip stems using two-dimensional functionally graded materials.

    PubMed

    Hedia, H S; Shabara, M A N; El-Midany, T T; Fouda, N

    2006-10-01

    Increasingly, it is acknowledged that bone resorption around cementless hip implants may cause future problems. The solution is frequently sought in reducing implant stiffness. However, this confronts the designer with a true design conflict: how to reduce the stiffness without excessively loading the proximal bone/prosthesis interface? The aim of this work is to improve the design of cementless hip stem material, using two-dimensional (2D) functionally graded material (FGM) concept in order to solve the above problems. Two models were used in this analysis, using three materials with different elastic moduli, E(1), E(2), and E(3). In model I, the elastic moduli E(1) and E(2) gradually change along the upper stem surface, while E(3) is maintained constant along all the lower surface of the stem. However, in model II, the elastic moduli E(1) and E(2) gradually change along the lower stem surface, while E(3) is maintained constant all along the upper stem surface. It is found that the recommended model is model I, which has three distinct materials of hydroxyapatite, Bioglass, and collagen. The recommended design of 2D FGM is expected to reduce the stress shielding by 91% and 12%, respectively, compared with titanium stem and model II of FGM. It is found that this new design reduces the maximum interface shear stress at the lateral and medial sides of the femur by about 50%, compared with titanium stem. Furthermore, the maximum interface shear stress is reduced by about 17% and 11% at the lateral and medial sides of the femur, respectively, compared with that of model II of FGM.

  11. A biodegradable gentamicin-hydroxyapatite-coating for infection prophylaxis in cementless hip prostheses.

    PubMed

    Neut, D; Dijkstra, R J; Thompson, J I; Kavanagh, C; van der Mei, H C; Busscher, H J

    2015-01-02

    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.

  12. [Intra-Articular Application of Tranexamic Acid Significantly Reduces Blood Loss and Transfusion Requirement in Primary Total Knee Arthroplasty].

    PubMed

    Lošťák, J; Gallo, J; Špička, J; Langová, K

    2016-01-01

    PURPOSE OF THE STUDY The aim of this prospective study was to investigate the effect of topical application of tranexamic acid (TXA, Exacyl) on the amount of post-operative blood loss, and blood transfusion requirement in patients undergoing primary total knee arthroplasty (TKA). Attention was paid to early complications potentially associated with TXA administration, such as haematoma, wound exudate, or knee swelling. In addition, the economic benefit of TXA treatment was also taken into account. MATERIAL AND METHODS The study included 238 patients (85 men and 153 women) who underwent primary total knee arthroplasty (TKA) at our department between January 2013 and November 2015. A group of 119 patients (41 men and 78 women) received intraarticular TXA injections according to the treatment protocol (TXA group). A control group matched in basic characteristics to the TXA group also consisted of 119 patients. The average age in the TXA group was 69.8 years, and the most frequent indication for TKA surgery was primary knee osteoarthritis (81.5%). In each patient, post-operative volume of blood lost from drains and total blood loss including hidden blood loss were recorded, as well as post-operative haemoglobin and haematocrit levels. On discharge of each patient from hospital, the size and site of a haematoma; wound exudate, if present after post-operative day 4; joint swelling; range of motion and early revision surgery, if performed, were evaluated. Requirements of analgesic drugs after surgery were also recorded. RESULTS In the TXA group, blood losses from drains were significantly lower than in the control group (456.7 ± 270.8 vs 640.5 ±448.2; p = 0.004). The median value for blood losses from drains was lower by 22% and the average value for total blood loss, including hidden losses, was also lower than in the control group (762.4 ± 345.2 ml vs 995.5 ± 457.3 ml). The difference in the total amount of blood loss between the two groups was significant (p = 0

  13. [Minimally invasive total hip arthroplasty via direct anterior approach].

    PubMed

    Rachbauer, Franz; Krismer, Martin

    2008-09-01

    Minimally invasive total hip arthroplasty via direct anterior approach aims at reducing soft-tissue damage, diminishing blood loss and postoperative pain, shortening stay in hospital, accelerating rehabilitation, and keeping scars small. The technique is suitable for primary and secondary osteoarthritis as well as fractures of the femoral neck. Complex distortions of the proximal femur should be exempted. Complex malalignment of the proximal femur. The femoral neck is exposed in the interval between tensor fasciae latae, glutei medius and minimus muscles laterally, and sartorius and rectus femoris muscles medially. After osteotomy of the neck and extraction of the head the acetabulum is reamed to prepare for cup prosthesis. Following peritrochanteric capsulotomy the externally rotated, adducted and elevated femor is broached. Cemented and cementless implants may be used. The patients are allowed to walk full weight bearing beginning on the 1st postoperative day. As soon as they are able to safely master the transfers and stairs, they are discharged. The method is a safe procedure that allows correct placement of acetabular and femoral components. It may be performed in a reasonable time, the blood loss is little. The procedure preserves the muscles and leads to small, cosmetically pleasing scars. Patients usually do not suffer from pronounced pain, rehabilitation is accelerated. They therefore agree in an short postoperative stay in hospital.

  14. Ceramic-on-ceramic bearing surface and risk of revision due to dislocation after primary total hip replacement.

    PubMed

    Sexton, S A; Walter, W L; Jackson, M P; De Steiger, R; Stanford, T

    2009-11-01

    Dislocation is a common reason for revision following total hip replacement. This study investigated the relationship between the bearing surface and the risk of revision due to dislocation. It was based on 110 239 primary total hip replacements with a diagnosis of osteoarthritis collected by the Australian Orthopaedic Association National Joint Replacement Registry between September 1999 and December 2007. A total of 862 (0.78%) were revised because of dislocation. Ceramic-on-ceramic bearing surfaces had a lower risk of requiring revision due to dislocation than did metal-on-polyethylene and ceramic-on-polyethylene surfaces, with a follow-up of up to seven years. However, ceramic-on-ceramic implants were more likely to have larger prosthetic heads and to have been implanted in younger patients. The size of the head of the femoral component and age are known to be independent predictors of dislocation. Therefore, the outcomes were stratified by the size of the head and age. There is a significantly higher rate of revision for dislocation in ceramic-on-ceramic bearing surfaces than in metal-on-polyethylene implants when smaller sizes (< or = 28 mm) of the head were used in younger patients (< 65 years) (hazard ratio = 1.53, p = 0.041) and also with larger (> 28 mm) and in older patients (> or = 65 years) (hazard ratio = 1.73, p = 0.016).

  15. Higher Rate of Revision in PFC Sigma Primary Total Knee Arthroplasty With Mismatch of Femoro-Tibial Component Sizes.

    PubMed

    Young, Simon W; Clarke, Henry D; Graves, Stephen E; Liu, Yen-Liang; de Steiger, Richard N

    2015-05-01

    Total knee arthroplasty (TKA) systems permit a degree of femoro-tibial component size mismatch. The effect of mismatched components on revision rates has not been evaluated in a large study. We reviewed 21,906 fixed-bearing PFC Sigma primary TKAs using the Australian Orthopaedic Association National Joint Replacement Registry, dividing patients into three groups: no femoro-tibial size mismatch, tibial component size > femoral component size, and femoral component > tibial component. Revision rates were higher when the femoral size was greater than the tibia, compared to both equal size (HR = 1.20 (1.00, 1.45), P = 0.047) and to tibial size greater than femoral (HR = 1.60 (1.08, 2.37), P = 0.019). Potential mechanisms to explain these findings include edge loading of polyethylene and increased tibial component stresses.

  16. Does Co-Existing Lumbar Spinal Canal Stenosis Impair Functional Outcomes and Activity Levels after Primary Total Hip Arthroplasty?

    PubMed

    Jauregui, Julio J; Banerjee, Samik; Issa, Kimona; Cherian, Jeffrey J; Mont, Michael A

    2015-09-01

    Degenerative lumbar spinal stenosis (LSS) is a cause for substantial morbidity in the elderly population: many often undergo total hip arthroplasty for associated hip arthritis. With a matched cohort we investigated the effect of co-existing LSS on aseptic survivorship, functional outcomes, activity levels, overall subjective physical and mental health status, and satisfaction rates in patients undergoing primary THA. The aseptic-implant survivorship was similar in LSS and non-stenosis cohort. Although both cohorts significantly improved, the LSS cohort achieved lower improvements in HHS, UCLA, SF-36 physical, and satisfaction rates than the matched non-stenotic cohort. Surgeons should consider cautioning patients with LSS that although they can expect relief of their arthritic symptoms following THA, they may continue to expect limitations in function, physical-status, activity-levels, and satisfaction rates. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Does tranexamic acid reduce blood transfusion cost for primary total hip arthroplasty? A case-control study.

    PubMed

    Harris, Ryan N; Moskal, Joseph T; Capps, Susan G

    2015-02-01

    Peri-operative tranexamic acid (TXA) significantly reduces the need for allogeneic blood transfusion in total hip arthroplasty (THA) and thus hospital costs are reduced. Before employing TXA in primary THA at our institution, facility costs were $286.90/THA for blood transfusion and required 0.45 man-hours/THA (transfusion rate 19.87%). After incorporating TXA, the cost for intravenous application was $123.38/THA for blood transfusion and TXA medication and 0.07 man-hours/THA (transfusion rate 4.39%) and the cost for topical application was $132.41/THA for blood transfusion and TXA and 0.14 man-hours/THA (transfusion rate 12.86%). TXA has the potential to reduce the facility cost per THA and the man-hours/THA from blood transfusions.

  18. Role of Sociodemographic, Co-morbid and Intraoperative Factors in Length of Stay Following Primary Total Hip Arthroplasty.

    PubMed

    Inneh, Ifeoma A; Iorio, Richard; Slover, James D; Bosco, Joseph A

    2015-12-01

    We aimed to examine and quantify the combined association of patient sociodemographic, preoperative comorbidities and intraoperative factors with extended and prolonged length of stay (LOS) following primary total hip arthroplasty. Longer LOS was associated with Age (≥65 years), BMI ≥30 kg/m(2), ASA score >2, minority race/ethnicity, low SES, general anesthesia, comorbidities of the Circulatory, Genitourinary and Respiratory systems, and operating time. Collectively, being of low SES, advanced age (≥65 years) and minority race/ethnicity was most significantly associated with prolonged LOS (>7 days). The combined associations of lower SES, female gender, advanced age, non-Caucasian race/ethnicity and certain comorbidities presented a synergistically elevated risk for longer LOS and may warrant the need to consider sociodemographic status when allocating resources to hospitals serving such patients.

  19. Early Patient Outcomes After Primary Total Knee Arthroplasty with Quadriceps-Sparing Subvastus and Medial Parapatellar Techniques

    PubMed Central

    Tomek, Ivan M.; Kantor, Stephen R.; Cori, LuAnne A.; Scoville, Jennifer M.; Grove, Margaret R.; Morgan, Tamara S.; Swarup, Ishaan; Moschetti, Wayne E.; Spratt, Kevin F.

    2014-01-01

    Background: Techniques that reduce injury to the knee extensor mechanism may cause less pain and allow faster recovery of knee function after primary total knee arthroplasty. A quadriceps-sparing (QS) subvastus technique of total knee arthroplasty was compared with medial parapatellar arthrotomy (MPPA) to determine which surgical technique led to better patient-reported function and less postoperative pain and opioid utilization. Methods: In this prospective, double-blind study, 129 patients undergoing total knee arthroplasty were randomized to the QS or the MPPA group after skin incision. All surgical procedures utilized minimally invasive surgery principles and standardized anesthesia, implants, analgesia, and rehabilitation. The Knee Society Score (KSS) was obtained at baseline and one and three months after surgery. Weekly telephone interviews were used to collect patient-reported outcomes including ambulatory device use, the UCLA (University of California Los Angeles) activity score, performance of daily living activities, and opioid utilization. Results: No differences between groups were seen in opioid utilization, either during the acute hospitalization or in the eight weeks after surgery. The QS group reported significantly less pain at rest on postoperative day one and with activity on day three (p = 0.04 for each). Compared with baseline, both groups showed significant improvements in the KSS at one month (MPPA, p = 0.0278; QS, p = 0.0021) and three months (p < 0.0001 for each) as well as week-to-week gains in walking independence through five weeks after surgery. Independence from ambulatory devices outside the home lagged behind independence indoors by about two weeks in both groups. Conclusions: When primary total knee arthroplasty was performed with contemporary minimally invasive surgery principles and standardized implants, anesthesia, and postoperative pathways, the QS technique yielded no significant early functional advantages or differences in

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

    PubMed

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

    2017-04-01

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

  1. The Direct Anterior Approach for Complex Primary Total Hip Arthroplasty: The Extensile Acetabular Approach on a Regular Operating Room Table.

    PubMed

    Molenaers, Ben; Driesen, Ronald; Molenaers, Guy; Corten, Kristoff

    2017-05-01

    The direct anterior approach on a regular operating room table has been reported with low dislocation rates. This might be beneficial for complex primary total hip arthroplasty (THA) such as in patients with cerebral palsy or following femoral or pelvic osteotomies. Extending the approach is often required to overcome problems such as acetabular deformities or severe contractures. We retrospectively evaluated the results and complications of 29 patients with 37 complex primary THA in which an extensile approach was used. The extensile approach is described. Functional scores were collected in case the patient was ambulatory independently (n = 17). The average age was 35 years (range 15-85) with a mean follow-up of 39 months (range 12-60). There were 3 (8%) intra-operative and 4 (11%) early post-operative complications (<3 months), of which 3 (8%) were anterior dislocations. Late complications (>3 months) consisted of a fibrous ingrown stem, a socket loosening following a pelvic fracture, and a late hematogenous infection (8%). Seventy-one percent of the complications occurred in the first 18 cases (49%) indicating a learning curve. The mean post-operative Harris Hip Score was 79 (range 56-97). Complex THA can be safely conducted through the extensile anterior approach on a regular operating room table with the use of conventional implants, even in cases with a high risk of dislocation. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Management of tibial bone defects with metal augmentation in primary total knee replacement: a minimum five-year review.

    PubMed

    Lee, J K; Choi, C H

    2011-11-01

    Bone defects are occasionally encountered during primary total knee replacement (TKR) and cause difficulty in establishing a stable well-aligned bone-implant interface. Between March 1999 and November 2005, 59 knees in 43 patients underwent primary TKR with a metal block augmentation for tibial bone deficiency. In all, six patients (eight knees) died less than four years post-operatively, and four patients (five knees) were lost to follow-up leaving 46 knees in 33 patients available for review at a mean of 78.6 months (62 to 129). The clinical results obtained, including range of movement, American Knee Society and Oxford knee scores, and the Western Ontario and McMaster Universities osteoarthritis index, were good to excellent, with no failures. Radiolucent lines at the block-cement-bone interface were noted in five knees (11%) during the first post-operative year, but these did not progress. Modular rectangular metal augmentation for tibial bone deficiency is a useful option. No deterioration of the block-prosthesis or block-cement-bone interface was seen at minimum of five years follow-up.

  3. An enhanced recovery programme for primary total knee arthroplasty in the United Kingdom--follow up at one year.

    PubMed

    McDonald, D A; Siegmeth, R; Deakin, A H; Kinninmonth, A W G; Scott, N B

    2012-10-01

    The concepts of Enhanced Recovery Programmes (ERP) are to reduce peri-operative morbidity whilst accelerating patient's rehabilitation resulting in a shortened hospital stay following primary joint arthroplasty. These programmes should include all patients undergoing surgery and should not be selective. We report a consecutive series of 1081 primary total knee arthroplasties undergoing an enhanced recovery programme with a one year follow up period. A comparative cohort of 735 patients from immediately prior to the enhanced recovery programme implementation was also reviewed. The median day of discharge home was reduced from post-operative day six to day four (p<0.001) for the ERP group. Post-operative urinary catheterisation (35% vs. 6.9%) and blood transfusion (3.7% vs. 0.6%) rates were significantly reduced (p<0.001). Within the ERP group median pain scores (0 = no pain, 10 = maximal pain) on mobilisation were three throughout hospital stay with 95% of patients ambulating within 24h. No statistical difference was found in post-operative thrombolytic events (p=0.35 and 0.5), infection (p=0.86), mortality rates (p=0.8) and Oxford Knee Scores (p=0.99) at follow up. This multidisciplinary approach provided satisfactory post-operative analgesia allowing early safe ambulation and expedited discharge to home with no detriment to continuing rehabilitation, infection or complication rates at one year. Copyright © 2011 Elsevier B.V. All rights reserved.

  4. Post-Discharge Care Duration, Charges, and Outcomes Among Medicare Patients After Primary Total Hip and Knee Arthroplasty.

    PubMed

    Ponnusamy, Karthikeyan E; Naseer, Zan; El Dafrawy, Mostafa H; Okafor, Louis; Alexander, Clayton; Sterling, Robert S; Khanuja, Harpal S; Skolasky, Richard L

    2017-06-07

    In April 2016, the U.S. Centers for Medicare & Medicaid Services initiated mandatory 90-day bundled payments for total hip and knee arthroplasty for much of the country. Our goal was to determine duration of care, 90-day charges, and readmission rates by discharge disposition and U.S. region after hip or knee arthroplasty. Using the 2008 Medicare Provider Analysis and Review database 100% sample, we identified patients who had undergone elective primary total hip or knee arthroplasty. We collected data on patient age, sex, comorbidities, U.S. Census region, discharge disposition, duration of care, 90-day charges, and readmission. Multivariate regression was used to assess factors associated with readmission (logistic) and charges (linear). Significance was set at p < 0.01. Patients undergoing 138,842 total hip arthroplasties were discharged to home (18%), home health care (34%), extended-care facilities (35%), and inpatient rehabilitation (13%); patients undergoing 329,233 total knee arthroplasties were discharged to home (21%), home health care (38%), extended-care facilities (31%), and inpatient rehabilitation (10%). Patients in the Northeast were more likely to be discharged to extended-care facilities or inpatient rehabilitation than patients in other regions. Patients in the West had the highest 90-day charges. Approximately 70% of patients were discharged home from extended-care facilities, whereas after inpatient rehabilitation, >50% of patients received home health care. Among those discharged to home, 90-day readmission rates were highest in the South (9.6%) for patients undergoing total hip arthroplasty and in the Midwest (8.7%) and the South (8.5%) for patients undergoing total knee arthroplasty. Having ≥4 comorbidities, followed by discharge to inpatient rehabilitation or an extended-care facility, had the strongest associations with readmission, whereas the region of the West and the discharge disposition to inpatient rehabilitation had the strongest

  5. Correlation between the coverage percentage of prosthesis and postoperative hidden blood loss in primary total knee arthroplasty.

    PubMed

    Gao, Fuqiang; Guo, Wanshou; Sun, Wei; Li, Zirong; Wang, Weiguo; Wang, Bailiang; Cheng, Liming; Kush, Nepali

    2014-01-01

    The aim of this study was to determine the relationship between prosthesis coverage and postoperative hidden blood loss (HBL) in primary total knee arthroplasty (TKA). A total of 120 patients who had undergone unilateral TKA from August 2012 to May 2013 were retrospectively studied. The Gross formula was used to calculate the amount of HBL. Routine standard anteroposterior (AP) and lateral X-ray films of the knee joint were taken postoperatively and used to measure the percentages of coronal femoral and of coronal and sagittal tibial prosthetic coverage. Then Pearson's correlation analysis was performed to assess the correlations between the percentages of prosthetic coverage for each AP and lateral position and HBL on the first and third postoperative days. The volumes of HBL on the first and third postoperative days after TKA were (786.5 ± 191.6) ml and (1 256.6 ± 205.1) ml, respectively, and lateral X-ray film measurements of percentages of coronal femoral, tibial coronal, and sagittal prosthetic coverage were (87.9 ± 2.5)%, (88.5 ± 2.2)%, and (89.1 ± 2.3)%, respectively. Pearson's correlation analysis showed statistically significant correlations between percentages of total knee prosthetic coverage for each AP and lateral position and volumes of HBL on the first and third postoperative days (P < 0.05). HBL after TKA correlates with degree of prosthetic coverage. To some extent, the size of the surfaces exposed by osteotomy determines the amount of HBL. Choice of the appropriate prosthesis can significantly reduce postoperative HBL. Designing individualized prostheses would be a worthwhile development in joint replacement surgery.

  6. Few geographic and socioeconomic variations exist in primary total shoulder arthroplasty: a multi-level study of Australian registry data.

    PubMed

    Brennan-Olsen, Sharon L; Page, Richard S; Lane, Stephen E; Lorimer, Michelle; Buchbinder, Rachelle; Osborne, Richard H; Pasco, Julie A; Wluka, Anita E; Sanders, Kerrie M; Ebeling, Peter R; Graves, Stephen E

    2016-07-16

    Associations between socioeconomic position (SEP) and the uptake of primary total shoulder arthroplasty (TSA) is not well understood in the Australian population, thus potentially limiting equitable allocation of healthcare resources. We used the Australian Orthopaedic Association National Joint Replacement Registry (AOA NJRR) to examine whether geographic or socioeconomic variations exist in TSA performed for a diagnosis of osteoarthritis 2007-11 for all Australians aged ≥40 years. Primary anatomical and reverse TSA data were extracted from the AOA NJRR which captures >99 % of all TSA nationally. Residential addresses were cross-referenced to Australian Bureau of Statistics 2011 Census data to identify SEP measured at the area-level (categorised into deciles), and geographic location defined as Australian State/Territory of residence. We used a Poisson distribution for the number of TSA over the study period, and modelled the effects of age, SEP and geographic location using multilevel modelling. During 2007-11, we observed 6,123 TSA (62.2 % female). For both sexes, TSA showed a proportional increase with advancing age. TSA did not vary by SEP or geographic location, with the exception of greater TSA among men in New South Wales. Using a national registry approach we provide the first reliable picture of TSA at a national level. The uptake of TSA was equitable across SEP; however, there was some variation between the States/Territories. With an aging population, it is imperative that monitoring of major surgical procedures continues, and be focused toward determining whether TSA uptake correlates with need across different social and area-based groups.

  7. Kerboull-type plate in a direct anterior approach for severe bone defects at primary total hip arthroplasty: technical note

    PubMed Central

    Matsumoto, Mikio; Baba, Tomonori; Ochi, Hironori; Ozaki, Yu; Watari, Taiji; Homma, Yasuhiro; Kaneko, Kazuo

    2017-01-01

    Introduction: For cases with extensive acetabular bone defects, we perform surgery combining the Kerboull-type (KT) plate and bone graft through direct anterior approach (DAA) in primary total hip arthroplasty (THA) requiring acetabular reconstruction as minimally invasive surgery. This paper provides the details of the surgical procedure. Methods: The basic structure of the Kerboull-type plate is a cruciform plate. Since the hook of the Kerboull-type plate has to be applied to the tear drop, a space for it was exposed. The tear drop is located in the anterior lower region in surgery through DAA in supine position. It was also confirmed by fluoroscopy as needed. The bone grafting was performed using an auto- or allogeneic femoral head for bone defects in the weight-bearing region of the hip joint. Results: Of 563 patients who underwent primary THA between 2012 and 2014, THA using the KT plate through DAA was performed in 21 patients (3.7%). The mean duration of postoperative follow-up was 31.8 months. The mean operative time was 188.4 min, and the mean blood loss was 770 g. The patients became able to walk independently after 2.4 days on average (1–4 days). On clinical evaluation, the modified Harris Hip Score was 45.6 ± 12.4 before surgery, and it was significantly improved to 85.3 ± 8.97 on the final follow-up. Discussion: DAA is a true intermuscular approach capable of conserving soft tissue. Since it is applied in a supine position, fluoroscopy can be readily used, and it was very useful to accurately place the plate. PMID:28287388

  8. Hydroxyapatite (HA) coating appears to be of benefit for implant durability of tibial components in primary total knee arthroplasty

    PubMed Central

    2011-01-01

    Background It is unclear whether there is a clinical benefit to adding hydroxyapatite (HA) coatings to total knee implants, especially with the tibial component, where failure of the implant more often occurs. A systematic review of the literature was undertaken to identify all prospective randomized trials for determining whether the overall clinical results (as a function of durability, function, and adverse events) favored HA-coated tibial components. Methods A comprehensive literature search was performed for the years 1990 to September 16, 2010. We restricted our search to randomized controlled trials involving participants receiving either an HA-coated tibia or other forms of tibial fixation. The primary outcome measures evaluated were durability, function, and acute adverse events. Results Data from 926 evaluable primary total knee implants in 14 studies were analyzed. Using an RSA definition for durability, HA-coated tibial components (porous or press-fit) without screw fixation were less likely to be unstable at 2 years than porous and cemented metal-backed tibial components (RR = 0.58, 95% CI: 0.34–0.98; p = 0.04, I2 = 39%, M-H random effects model). There was no significant difference in durability, as measured from revision and evaluated at 2 and 8–10 years, between groups. Also, functional status using different validated measures showed no significant difference at 2 and 5 years, no matter what measure was used. Lastly, there was no significant difference in adverse events. Limitations included small numbers of evaluable patients (≤ 50) in 7 of the 14 trials identified, and a lack of “hard” evidence of durability with need for replacement (i.e. frank failure, pain, or loss of functionality). Interpretation In patients > 65 years of age, an HA-coated tibial implant may provide better durability than other forms of tibial fixation. Larger trials should be undertaken comparing the long-term durability, function, and adverse events of HA

  9. Hydroxyapatite (HA) coating appears to be of benefit for implant durability of tibial components in primary total knee arthroplasty.

    PubMed

    Voigt, Jeffrey D; Mosier, Michael

    2011-08-01

    It is unclear whether there is a clinical benefit to adding hydroxyapatite (HA) coatings to total knee implants, especially with the tibial component, where failure of the implant more often occurs. A systematic review of the literature was undertaken to identify all prospective randomized trials for determining whether the overall clinical results (as a function of durability, function, and adverse events) favored HA-coated tibial components. A comprehensive literature search was performed for the years 1990 to September 16, 2010. We restricted our search to randomized controlled trials involving participants receiving either an HA-coated tibia or other forms of tibial fixation. The primary outcome measures evaluated were durability, function, and acute adverse events. Data from 926 evaluable primary total knee implants in 14 studies were analyzed. Using an RSA definition for durability, HA-coated tibial components (porous or press-fit) without screw fixation were less likely to be unstable at 2 years than porous and cemented metal-backed tibial components (RR = 0.58, 95% CI: 0.34-0.98; p = 0.04, I(2) = 39%, M-H random effects model). There was no significant difference in durability, as measured from revision and evaluated at 2 and 8-10 years, between groups. Also, functional status using different validated measures showed no significant difference at 2 and 5 years, no matter what measure was used. Lastly, there was no significant difference in adverse events. Limitations included small numbers of evaluable patients (≤ 50) in 7 of the 14 trials identified, and a lack of "hard" evidence of durability with need for replacement (i.e. frank failure, pain, or loss of functionality). In patients > 65 years of age, an HA-coated tibial implant may provide better durability than other forms of tibial fixation. Larger trials should be undertaken comparing the long-term durability, function, and adverse events of HA-coated implants with those of other porous

  10. Early outcomes of twin-peg mobile-bearing unicompartmental knee arthroplasty compared with primary total knee arthroplasty

    PubMed Central

    Lum, Z. C.; Lombardi, A. V.; Hurst, J. M.; Morris, M. J.; Adams, J. B.; Berend, K. R.

    2016-01-01

    Aims Since redesign of the Oxford phase III mobile-bearing unicompartmental knee arthroplasty (UKA) femoral component to a twin-peg design, there has not been a direct comparison to total knee arthroplasty (TKA). Thus, we explored differences between the two cohorts. Patients and Methods A total of 168 patients (201 knees) underwent medial UKA with the Oxford Partial Knee Twin-Peg. These patients were compared with a randomly selected group of 177 patients (189 knees) with primary Vanguard TKA. Patient demographics, Knee Society (KS) scores and range of movement (ROM) were compared between the two cohorts. Additionally, revision, re-operation and manipulation under anaesthesia rates were analysed. Results The mean follow-up for UKA and TKA groups was 5.4 and 5.5 years, respectively. Six TKA (3.2%) versus three UKAs (1.5%) were revised which was not significant (p = 0.269). Manipulation was more frequent after TKA (16; 8.5%) versus none in the UKA group (p < 0.001). UKA patients had higher post-operative KS function scores versus TKA patients (78 versus 66, p < 0.001) with a trend toward greater improvement, but there was no difference in ROM and KS clinical improvement (p = 0.382 and 0.420, respectively). Conclusion We found fewer manipulations, and higher functional outcomes for patients treated with medial mobile-bearing UKA compared with TKA. TKA had twice the revision rate as UKA although this did not reach statistical significance with the numbers available. Cite this article: Bone Joint J 2016;98-B(10 Suppl B):28–33. PMID:27694513

  11. Description and primary results of Total Solar Irradiance Monitor, a solar-pointing instrument on an Earth observing satellite

    NASA Astrophysics Data System (ADS)

    Wang, Hongrui; Fang, Wei; Li, Huiduan

    2015-04-01

    Solar driving mechanism for Earth climate has been a controversial problem for centuries. Long-time data of solar activity is required by the investigations of the solar driving mechanism, such as Total Solar Irradiance (TSI) record. Three Total Solar Irradiance Monitors (TSIM) have been developed by Changchun Institute of Optics, Fine Mechanics and Physics for China Meteorological Administration to maintain continuities of TSI data series which lasted for nearly 4 decades.The newest TSIM has recorded TSI daily with accurate solar pointing on the FY-3C meteorological satellite since Oct 2013. TSIM/FY-3C has a pointing system for automatic solar tracking, onboard the satellite designed mainly for Earth observing. Most payloads of FY-3C are developed for observation of land, ocean and atmosphere. Consequently, the FY-3C satellite is a nadir-pointing spacecraft with its z axis to be pointed at the center of the Earth. Previous TSIMs onboard the FY-3A and FY-3B satellites had no pointing system, solar observations were only performed when the sun swept through field-of-view of the instruments. And TSI measurements are influenced inevitably by the solar pointing errors. Corrections of the solar pointing errors were complex. The problem is now removed by TSIM/FY-3C.TSIM/FY-3C follows the sun accurately by itself using its pointing system based on scheme of visual servo control. The pointing system is consisted of a radiometer package, two motors for solar tracking, a sun sensor and etc. TSIM/FY-3C has made daily observations of TSI for more than one year, with nearly zero solar pointing errors. Short time-scale variations in TSI detected by TSIM/FY-3C are nearly the same with VIRGO/SOHO and TIM/SORCE.Instrument details, primary results of solar pointing control, solar observations and etc will be given in the presentation.

  12. Does Use of a Variable Distal Femur Resection Angle Improve Radiographic Alignment in Primary Total Knee Arthroplasty?

    PubMed

    Nam, Denis; Vajapey, Sravya; Haynes, Jacob A; Barrack, Robert L; Nunley, Ryan M

    2016-09-01

    The distal femur resection in total knee arthroplasty (TKA) is commonly made using a fixed angle relative to an intramedullary rod. This study's purpose was to assess if a variable distal femur resection angle technique improves femoral component alignment in TKA. This was a review of primary TKAs performed by 2 surgeons. One surgeon used a fixed resection angle of 5° for varus and 3° for valgus knees ("fixed" cohort). The second used hip-knee-ankle (HKA) radiographs to measure the angle between the femoral anatomic axis and a line perpendicular to the femoral mechanical axis, which was used as the resection angle for each patient ("variable" cohort). Femoral component and HKA alignment were measured from standing HKA radiographs by 2, independent, blinded observers. Two hundred ninety patients were needed for power to detect a 15% difference in femoral component "outliers" (target of 0° ± 2°; significance = P < .05). Three hundred twenty consecutive patients were included with no differences in age, body mass index, or preoperative deformity (P = .3-.8). A 5° resection angle was used in 46.3% of the variable and 80.0% of the fixed cohort patients. A total of 80.2% of femoral components in the variable and 63.1% in the fixed cohort were within 0° ± 2° (P = .002; 84.6% of variable and 56.3% of fixed for valgus knees, P < .001). The mean HKA alignment was improved in the variable cohort (-1.4° ± 3.3° vs -2.6° ± 3.3°, P = .001). Use of a variable distal femur resection angle improves femoral component alignment after TKA. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Predictors of Same-Day Discharge in Primary Total Joint Arthroplasty Patients and Risk Factors for Post-Discharge Complications.

    PubMed

    Sher, Alex; Keswani, Aakash; Yao, Dong-Han; Anderson, Michael; Koenig, Karl; Moucha, Calin S

    2017-09-01

    Same-day (<24 h) discharge total joint arthroplasty (TJA) may be a safe and effective option for certain patients with end-stage osteoarthritis. Given the growing pressure to improve quality and lower TJA episode costs, surgeons must identify which TJA patients can be appropriately discharged home quickly and safely. This study identifies characteristics associated with same-day discharge post-TJA as well as assesses risk factors for complications in this select patient population. Bivariate and multivariate analyses were performed using perioperative variables from the 2011 to 2014 National Surgical Quality Improvement Program database. In total, 7474 primary TJAs among 120,847 TJA patients were discharged within 24 h post-surgery. These patients were more likely to be younger (<50 years), male sex, American Society of Anesthesiologists class 1 or 2, and less likely to be obese or taking steroids (P < .05 for all). They were also less likely to have co-morbidities. Rates of severe adverse event (SAE) or unplanned readmission post-discharge were 1.3% and 1.9%, respectively. Multivariate analysis identified age >80 (odds ratio [OR] 4.16, P = .001), smoking (OR 1.61, P = .03), bleeding-causing disorders (OR 2.56, P = .01), American Society of Anesthesiologists class 3 or 4 (OR 1.42, P < .05), and SAE pre-discharge (OR 13.13, P < .0001) as independent predictors for adverse events or readmission in this population. Patient characteristics, co-morbidities, and SAEs pre-discharge can be used to assess potential for discharge within 24 h. The results of our analysis may be used to develop risk stratification tools for identification of patients that are truly appropriate for same-day discharge TJA. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Alumina-on-alumina total hip arthroplasty. A five-year minimum follow-up study.

    PubMed

    Yoo, Jeong Joon; Kim, Young-Min; Yoon, Kang Sup; Koo, Kyung-Hoi; Song, Won Seok; Kim, Hee Joong

    2005-03-01

    Ceramic-on-ceramic couplings are attractive alternative bearing surfaces that have been reported to eliminate or reduce problems related to polyethylene wear debris. Disappointing experiences with alumina ceramic bearings in the past have led to many improvements in the manufacture and design of ceramic implants. The purpose of the present study was to report the results of contemporary alumina-on-alumina total hip arthroplasties with regard to wear, osteolysis, and fracture of the ceramic after a minimum duration of follow-up of five years. We evaluated the results of a consecutive series of 100 primary alumina-on-alumina total hip arthroplasties that had been performed with use of a metal-backed socket and a cementless stem in eighty-four patients. All of the patients were sixty-five years of age or younger (mean age, forty-one years), and a single surgeon performed all of the procedures. After a minimum duration of follow-up of sixty months, one patient (one hip) had died and four patients (six hips) had been lost to follow-up, leaving a total of seventy-nine patients (ninety-three hips) available for study. All of these patients were evaluated clinically and radiographically with special attention to wear, periprosthetic osteolysis, and ceramic failure. The mean Harris hip score was 97 points at the time of the latest follow-up evaluation. All prostheses demonstrated radiographic evidence of bone ingrowth. No implant was loose radiographically, and no implant was revised. Ceramic wear was not detectable in the thirty-seven hips in which the femoral head could be differentiated from the cup on radiographs. Periprosthetic osteolysis was not observed in any hip. A fracture of the alumina femoral head and a peripheral chip fracture of the alumina insert occurred in one hip following a motor-vehicle accident. The results of contemporary alumina-on-alumina total hip arthroplasty with a metal-backed socket and a cementless stem were encouraging after a minimum

  15. Advanced age, obesity and continuous femoral nerve blockade are independent risk factors for inpatient falls after primary total knee arthroplasty.

    PubMed

    Wasserstein, David; Farlinger, Christopher; Brull, Richard; Mahomed, Nizar; Gandhi, Rajiv

    2013-08-01

    We asked whether femoral nerve blockade (FNB) was an independent risk factor for inpatient post-operative falls after total knee arthroplasty (TKA). Data on 2197 primary TKAs were collected from our institution between 2003 and 2010. Patient demographics, type and duration of blocks were considered predictors of falls in a logistic regression model. Among 60 (2.7%) falls, the odds ratio was 1.04 (1.0-1.07; p=0.008) for each 1 year of increased age above the mean (66 years), 2.4 (1.3-4.5; p=0.005) for BMI >30 kg/m(2) and 4.4 (1.04-18.2; p=0.04) for continuous FNB. Single-shot FNB did not increase risk. No fall resulted in operative morbidity. The use of continuous FNB should be cautioned, especially in patients with other risk factors such as obesity and advanced age. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Long-term changes in the total ozone mapping spectrometer relative to world primary standard Dobson spectrometer 83

    SciTech Connect

    McPeters, R.D. ); Komhyr, W.D. )

    1991-02-20

    The authors have examined the stability of the calibration of the Nimbus 7 solar backscatter ultraviolet (SBUV) and total ozone mapping spectrometer (TOMS) instruments by comparing their ozone measurements with those made by a single, very stable Dobson instrument: the world primary standard Dobson spectrometer number 83. Measurements of ozone made with instrument 83 at Mauna Loa observatory in eight summers between 1979 and 1989 were compared with coincident TOMS ozone measurements. The comparison shows that relative to instrument 83, ozone measured by TOMS (and SBUV) was stable between 1979 and approximately 1983, had decreased by 3% by 1986, and had decreased by almost 7% by 1989. A similar time dependence is seen when data from an ensemble of 39 Dobson stations throughout the world is compared with TOMS over the period 1979-1987. The most likely reason for the relative drift is that the diffuser plate used by both SBUV and TOMS to measure solar flux has suffered an uncorrected wavelength dependent degradation, with most of the degradation occurring after 1983. The recently released version 6 TOMS data, corrected using the internal pair justification technique, show almost no drift relative to Dobson instrument 83. The authors conclude from these comparisons that accurate measurements of long-term global ozone change will require a coherent system incorporating both ground based and satellite based ozone measurements.

  17. Inactivation and injury of total coliform bacteria after primary disinfection of drinking water by TiO2 photocatalysis.

    PubMed

    Rizzo, Luigi

    2009-06-15

    In this study the potential application of TiO(2) photocatalysis as primary disinfection system of drinking water was investigated in terms of coliform bacteria inactivation and injury. As model water the effluent of biological denitrification unit for nitrate removal from groundwater, which is characterized by high organic matter and bacteria release, was used. The injury of photocatalysis on coliform bacteria was characterized by means of selective (mEndo) and less selective (mT7) culture media. Different catalyst loadings as well as photolysis and adsorption effects were investigated. Photocatalysis was effective in coliform bacteria inactivation (91-99% after 60 min irradiation time, depending on both catalyst loading and initial density of coliform bacteria detected by mEndo), although no total removal was observed after 60 min irradiation time. The contribution of adsorption mechanism was significant (60-98% after 60 min, depending on catalyst loading) compared to previous investigations probably due to the nature of source water rich in particulate organic matter and biofilm. Photocatalysis process did not result in any irreversible injury (98.8% being the higher injury) under investigated conditions, thus a bacteria regrowth may take place under optimum environment conditions if any final disinfection process (e.g., chlorine or chlorine dioxide) is not used.

  18. Titanium niobium nitride knee implants are not inferior to chrome cobalt components for primary total knee arthroplasty.

    PubMed

    Thienpont, Emmanuel

    2015-12-01

    Metal allergy in total knee arthroplasty (TKA) is still a controversial topic. Oxinium, ceramic or titanium niobium nitride (TiNbN) coated implants are available for some knee systems. The hypothesis of this study was that the use of TiNbN-coated components would not lead to inferior results compared to conventional implants and that none of the allergic patients receiving TiNbN-coated implants would require revision for metal allergy. This study was a retrospective, 2 to 1 matched pairs study with 40 titanium niobium nitride-coated TKA compared with 80 conventional cobalt chrome implants. No demographic differences between these groups were observed. The mean follow-up for this study was 2 years. No differences in clinical, radiological, or patient-reported outcome measurements were observed between the two groups. No patients have been revised at this short- to medium-term outcome evaluation. Metal allergy leading to contact or systemic dermatitis is especially linked to chrome and cobalt allergy. Nickel allergy because of knee implants rarely gives cutaneous symptoms, but could potentially lead to peri-prosthetic osteolysis and loosening. The use of titanium niobium nitride implants in case of a positive history of metal allergy could avoid this devastating complication. The use of titanium niobium nitride-coated implants for primary knee osteoarthritis shows similar clinical and radiological outcomes as conventional TKA without revision for loosening at short- to medium-term follow-up. Level of evidence Level IV study.

  19. Pre-operative psychological distress does not adversely affect functional or mental health gain after primary total hip arthroplasty.

    PubMed

    Hossain, Munier; Parfitt, Daniel J; Beard, David J; Darrah, Clare; Nolan, John; Murray, David W; Andrew, John G

    2011-01-01

    Preoperative psychological distress has been reported to predict poor outcome and patient dissatisfaction after total hip arthroplasty (THA). The purpose of this study was to investigate if pre-operative psychological distress was associated with adverse functional outcome after primary THR. We analysed the database of a prospective multi-centre study undertaken between January 1999 and January 2002. We recorded the Oxford Hip Score (OHS) and SF36 score preoperatively and up to five years after surgery for 1055 patients. We dichotomised the patients into the mentally distressed (Mental Health Scale score - MHS =56) and the not mentally distressed (MHS >56) groups based on their pre-operative MHS of the SF36. 762 (72.22%). Patients (595 not distressed and 167 distressed) were followed up at 5 years. Both pre and post-operative OHS and SF-36 scores were significantly worse in the distressed group (both p<0.001). However, both groups experienced statistically significant improvement in OHS and MHS, which was maximal at 1 year after surgery and was maintained over the follow up (p=0.00). There was a substantial improvement in mental distress in patients who reported mental distress prior to surgery. The results suggest that pre-operative psychological distress did not adversely compromise functional outcome gain after THA. Despite having worse absolute values both pre and post operatively, patients with mental distress did not have any less functional gain from THA as measured by improvement in OHS.

  20. A randomized trial of hydroxyapatite coated prostheses in total hip arthroplasty.

    PubMed

    Yee, A J; Kreder, H K; Bookman, I; Davey, J R

    1999-09-01

    In a prospective randomized trial, 62 consecutive primary cementless total hip arthroplasties in 55 patients were performed by one surgeon using either hydroxyapatite coated (35 hips) or nonhydroxyapatite coated femoral prostheses (27 hips). The dual tapered femoral stem had a Ti-6AI-4V plasma sprayed circumferential proximal porous coat applied to the proximal 1/3 of the stem. The middle 1/3 had a roughened blasted textured surface, and the distal 1/3 had a smooth surface. The hydroxyapatite coated femoral stems had an additional hydroxyapatite coating applied to the proximal porous coat with use of an air plasma process. The patients in the two groups were not significantly different regarding age (48.2 +/- 9.0 years hydroxyapatite group, 50.4 +/- 8.7 years control group), gender, Charnley class, or length of followup (4.4 +/- 0.7 years hydroxyapatite group, 4.9 +/- 1.0 years control group). Forty-nine patients (54 hips) were available for clinical followup, and 45 patients (50 hips) had radiographic followup. A minimum 3-year followup was recorded. To date, there have been no femoral prostheses failures. No femoral implant has migrated or subsided. Radiographically, the hydroxyapatite coated stems showed trends toward increased distal stem related cortical hypertrophy, increased cancellous condensation and less endosteal cavitation. Two nonhydroxyapatite coated stems had distal endosteal cavitation, whereas no hydroxyapatite coated stems did. There were two cases of acetabular osteolysis (revision in one) and two cases of acetabular cup migration (nonrevised), all occurring in the control group. The overall revision rate was 4%. There was no difference in Harris hip scores at 6 months (80.6 +/- 13.0 points hydroxyapatite group, 83.8 +/- 12.4 points control group) or at last followup (85.6 +/- 15.4 points hydroxyapatite group, 89.7 +/- 13.4 control group). The Harris hip pain scores also were not significantly different at 6 months or at last followup. Multiple

  1. Meuli total wrist arthroplasty.

    PubMed

    Meuli, H C

    1984-01-01

    The wrist endoprosthesis developed and used since 1971 by the author is comparable to other designs of total joint implants. The completely unconstrained design has proved effective. It has sufficient stability, provided that the proper muscle balance is achieved at the end of the procedure. Careful, exact centering of the prosthesis is a vital prerequisite for good function, along with the use of adequate bone stock for securing implantation and survival of the cement-bone interface. The eccentric placement of the anchoring prongs of the distal component has made centering of the prosthesis easier but has not obviated the need for careful, individual contouring and implantation of each prosthesis. Indications for a total wrist prosthesis must take into account pain, disability, and the local findings. Patients who engage in heavy, manual work and those who must rely on walking aids, such as a cane or crutch, should not be considered as suitable candidates for total wrist implantations. Salvage is always possible either by revision of the arthroplasty or arthrodesis. Cementless implantation of the components may have certain advantages. The prototypes that have been designed are still under investigation.

  2. Acceleration of Intended Pozzolanic Reaction under Initial Thermal Treatment for Developing Cementless Fly Ash Based Mortar

    PubMed Central

    Kwon, Yang-Hee; Kang, Sung-Hoon; Hong, Sung-Gul; Moon, Juhyuk

    2017-01-01

    Without using strong alkaline solution or ordinary Portland cement, a new structural binder consisting of fly ash and hydrated lime was hardened through an intensified pozzolanic reaction. The main experimental variables are the addition of silica fume and initial thermal treatment (60 °C for 3 days). A series of experiments consisting of mechanical testing (compressive and flexural strength, modulus of elasticity), X-ray diffraction, and measurements of the heat of hydration, pore structure, and shrinkage were conducted. These tests show that this new fly ash-based mortar has a compressive strength of 15 MPa at 91 days without any silica fume addition or initial thermal treatment. The strength increased to over 50 MPa based on the acceleration of the intensified pozzolanic reaction from the silica fume addition and initial thermal treatment. This is explained by a significant synergistic effect induced by the silica fume. It intensifies the pozzolanic reaction under thermal treatment and provides a space filling effect. This improved material performance can open a new pathway to utilize the industrial by-product of fly ash in cementless construction materials. PMID:28772585

  3. Primary ceramic-on-ceramic total hip arthroplasty using a 32-mm ceramic head with a titanium-alloy sleeve.

    PubMed

    Lim, Seung-Jae; Jang, Seung-Pil; Kim, Dong-Wook; Moon, Young-Wan; Park, Youn-Soo

    2015-12-01

    Modern ceramic-on-ceramic bearings have become attractive alternatives to conventional polyethylene in total hip arthroplasty (THA) as a result of their low wear and minimal particle production. However, 28-mm heads in ceramic-on-ceramic bearing couples have been associated with ceramic fracture. To address these issues, 32-mm and larger ceramic heads with a titanium-alloy sleeve have been introduced, although limited data are available on their durability and clinical outcomes. We determined (1) the survivorship of the primary ceramic-on-ceramic THA using a 32-mm ceramic head with a titanium-alloy sleeve at a minimum followup of 5 years; (2) Harris hip scores; (3) the incidence of ceramic fracture and noisy hip; and (4) the proportion of hips showing radiographic evidence of osteolysis. From November 2005 to August 2009, we performed 301 ceramic-on-ceramic THAs using a 32-mm ceramic head with a titanium-alloy sleeve in 270 patients. Of these, 12 patients (12 hips [4%]) died from problems unrelated to surgery and 13 patients (15 hips [5%]) were lost during followup before a minimum of 5 years had been reached, leaving 245 patients who had 274 THAs with a minimum followup of 5 years (mean, 6.5 years; range, 5-9 years) in this retrospective analysis. During the study period, 30% (301 of 997 hips) were performed with this articulation based on the operating surgeon's discretion. The mean patient age at the time of surgery was 55 years (range, 16-82 years). All operations were performed at a single center. All of the ceramic implants were hot isostatic-pressed, laser-marked, proof-tested third-generation alumina. We determined the implant survival, Harris hip scores, incidence of ceramic fracture or noisy hips (based on a questionnaire), and presence of osteolysis. The survival rate of ceramic-on-ceramic bearings in primary THA using a 32-mm ceramic head with a titanium-alloy sleeve was 98% (95% confidence interval, 96%-100%) at 9 years. The Harris hip score improved

  4. Patterns of bone tracer uptake on SPECT-CT in symptomatic and asymptomatic patients with primary total hip arthroplasty.

    PubMed

    Schweizer, Thierry; Schiapparelli, Filippo-Franco; Rotigliano, Niccolo; Rasch, Helmut; Amsler, Felix; Hirschmann, Michael T

    2017-09-19

    The primary purpose of this study was to compare bone tracer uptake (BTU) on SPECT/CT in symptomatic and asymptomatic total hip arthroplasty (THA) and identify a possible relationship between BTU patterns and patient's symptoms. The secondary purpose was to investigate if the fixation methods (cemented versus uncemented) lead to different BTU patterns. A total of 58 THAs, 31 symptomatic (group S) and 27 asymptomatic (group AS), were prospectively collected and retrospectively analyzed. All symptomatic patients underwent standardized detailed history, clinical examination, radiographs and 99mTc-HDP SPECT/CT. BTU in SPECT/CT was quantified in three dimensions and anatomically localized in a scheme of quadrants and levels using a customized previously validated software. T tests were used on both quadrants and levels inside and between groups. A Pearson correlation was performed for BTU within the quadrants. An area under receiver operating characteristic curves was drawn in order to find a BTU value that could differentiate the two groups. Within the groups, patients with cemented and uncemented stems were compared for influences on BTU intensity. The causes of pain were identified in 61% of the patients. The most common problem was aseptic loosening (n = 12). In group AS, levels 1, 2 and 5 had similar BTUs. BTUs in these levels were significantly higher than in level 3, 4 and 6. In group S, no significant differences were seen in terms of BTU in level 1-5. However, BTU here was significantly higher than at level 6 (p < 0.001). In both groups, level 1, the superior, had a significantly higher BTU than level 2 (group AS p < 0.01, group S p < 0.05). Comparing the BTU of the two groups among levels, significant differences were found for level 4, level 5 and the entire stem areas (p < 0.05). The ROC curve calculated on the whole stem allowed identification of a BTU ratio of 3.1 that separated the 92.6% patients of group AS with BTU < 3.1 from the 54.8% of

  5. Dislocation of a primary total hip arthroplasty is more common in patients with a lumbar spinal fusion.

    PubMed

    Buckland, A J; Puvanesarajah, V; Vigdorchik, J; Schwarzkopf, R; Jain, A; Klineberg, E O; Hart, R A; Callaghan, J J; Hassanzadeh, H

    2017-05-01

    Lumbar fusion is known to reduce the variation in pelvic tilt between standing and sitting. A flexible lumbo-pelvic unit increases the stability of total hip arthroplasty (THA) when seated by increasing anterior clearance and acetabular anteversion, thereby preventing impingement of the prosthesis. Lumbar fusion may eliminate this protective pelvic movement. The effect of lumbar fusion on the stability of total hip arthroplasty has not previously been investigated. The Medicare database was searched for patients who had undergone THA and spinal fusion between 2005 and 2012. PearlDiver software was used to query the database by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedural code for primary THA and lumbar spinal fusion. Patients who had undergone both lumbar fusion and THA were then divided into three groups: 1 to 2 levels, 3 to 7 levels and 8+ levels of fusion. The rate of dislocation in each group was established using ICD-9-CM codes. Patients who underwent THA without spinal fusion were used as a control group. Statistical significant difference between groups was tested using the chi-squared test, and significance set at p < 0.05. At one-year follow-up, 14 747 patients were found to have had a THA after lumbar spinal fusion (12 079 1 to 2 levels, 2594 3 to 7 levels, 74 8+ levels). The control group consisted of 839 004 patients. The dislocation rate in the control group was 1.55%. A higher rate of dislocation was found in patients with a spinal fusion of 1 to 2 levels (2.96%, p < 0.0001) and 3 to 7 levels (4.12%, p < 0.0001). Patients with 3 to 7 levels of fusion had a higher rate of dislocation than patients with 1 to 2 levels of fusion (odds ratio (OR) = 1.60, p < 0.0001). When groups were matched for age and gender to the unfused cohort, patients with 1 to 2 levels of fusion had an OR of 1.93 (95% confidence interval (CI) 1.42 to 2.32, p < 0.001), and those with 3 to 7 levels of fusion an OR of 2.77 (CI

  6. Excellent long-term results of the Müller acetabular reinforcement ring in primary total hip arthroplasty

    PubMed Central

    Sirka, Aurimas; Clauss, Martin; Tarasevicius, Sarunas; Wingstrand, Hans; Stucinskas, Justinas; Robertsson, Otto; Emil Ochsner, Peter; Ilchmann, Thomas

    2016-01-01

    Background and purpose — The original Müller acetabular reinforcement ring (ARR) shows favorable medium-term results for acetabular reconstruction in total hip arthroplasty, where it is used when the acetabular bone stock is deficient. However, there are no data regarding long-term survival of the device. We therefore investigated long-term survival and analyzed radiological modes of failure. Patients and methods — Between 1984 and 2002, 321 consecutive primary arthroplasties using an ARR were performed in 291 patients. The mean follow-up time was 11 (0–25) years, and 24 hips were lost to follow-up. For survival analysis, we investigated 321 hips and the end of the follow-up was the date of revision, date of death, or the last patient contact date with implant still in situ. Radiological assessment was performed for 160 hips with a minimum of 10 years of follow-up and with radiographs of sufficient quality. It included evaluation of osteolysis, migration, and loosening. Results — 12 ARR THAs were revised: 1 isolated ARR revision for aseptic loosening, 4 revisions of the ARR and the stem for aseptic loosening, 6 for infection, and 1 for recurrent dislocation. The cumulative revision rate for all components, for any reason, at 20 years was 15% (95% CI: 10–22), while for the ARR only it was 7% (95% CI: 4–12) for any reason and 3.4% (95% CI: 1–9) for aseptic loosening. 21 (13%) of 160 ARR THAs examined had radiological changes: 7 had osteolysis but were not loose, and 14 were radiologically loose but were not painful and not revised. Interpretation — Our data suggest that the long-term survival of the ARR is excellent. PMID:26471881

  7. Weight loss and total lipid profile changes in overweight women consuming beef or chicken as the primary protein source.

    PubMed

    Melanson, Kathleen; Gootman, Jason; Myrdal, Amy; Kline, Gregory; Rippe, James M

    2003-05-01

    Conflicting recommendations are prevalent regarding the appropriateness of red meat versus white meat consumption for individuals aiming to reduce body weight and cardiovascular disease risk. We examined changes in body weight and lipid profiles in a 12-wk, randomized, controlled trial, in which overweight women followed a hypocaloric diet with lean beef or chicken as the primary protein source, while participating in a fitness walking program. Sedentary non-smoking females (n = 61), age 43.4 +/- 7.8 years, with body mass indexes of 32.1 +/- 3.4 kg/m(2) (means +/- standard deviation), followed calculated-deficit diets (-500 kcal daily) and were randomly assigned to the beef-consumption or chicken-consumption dietary group, while following a fitness walking program. Body weight, body composition (by hydrodensitometry), and blood lipid profiles were measured at baseline and 12 wk. Weight loss was significant within (P < 0.05) but similar between (P > 0.05) the beef-consumption (5.6 +/- 0.6 kg, mean +/- standard error) and the chicken-consumption (6.0 +/- 0.5 kg) groups. Both groups showed significant reductions in body fat percentage (P < 0.05) and total (P < 0.05) and low-density lipoprotein (P < 0.05) cholesterol, with no significant differences between groups. High-density lipoprotein cholesterol did not change significantly in either group. These findings demonstrated that weight loss and improved lipid profile can be accomplished through diet and exercise, whether the dietary protein source is lean beef or chicken.

  8. Cost-utility analysis comparing radioactive iodine, anti-thyroid drugs and total thyroidectomy for primary treatment of Graves' disease.

    PubMed

    Donovan, Peter J; McLeod, Donald S A; Little, Richard; Gordon, Louisa

    2016-12-01

    Little data is in existence about the most cost-effective primary treatment for Graves' disease. We performed a cost-utility analysis comparing radioactive iodine (RAI), anti-thyroid drugs (ATD) and total thyroidectomy (TT) as first-line therapy for Graves' disease in England and Australia. We used a Markov model to compare lifetime costs and benefits (quality-adjusted life-years (QALYs)). The model included efficacy, rates of relapse and major complications associated with each treatment, and alternative second-line therapies. Model parameters were obtained from published literature. One-way sensitivity analyses were conducted. Costs were presented in 2015£ or Australian Dollars (AUD). RAI was the least expensive therapy in both England (£5425; QALYs 34.73) and Australia (AUD5601; 30.97 QALYs). In base case results, in both countries, ATD was a cost-effective alternative to RAI (£16 866; 35.17 QALYs; incremental cost-effectiveness ratio (ICER) £26 279 per QALY gained England; AUD8924; 31.37 QALYs; ICER AUD9687 per QALY gained Australia), while RAI dominated TT (£7115; QALYs 33.93 England; AUD15 668; 30.25 QALYs Australia). In sensitivity analysis, base case results were stable to changes in most cost, transition probabilities and health-relative quality-of-life (HRQoL) weights; however, in England, the results were sensitive to changes in the HRQoL weights of hypothyroidism and euthyroidism on ATD. In this analysis, RAI is the least expensive choice for first-line treatment strategy for Graves' disease. In England and Australia, ATD is likely to be a cost-effective alternative, while TT is unlikely to be cost-effective. Further research into HRQoL in Graves' disease could improve the quality of future studies. © 2016 European Society of Endocrinology.

  9. Determinants of patient satisfaction and their willingness to return after primary total hip replacement: a cross-sectional study.

    PubMed

    Schaal, Tom; Schoenfelder, Tonio; Klewer, Joerg; Kugler, Joachim

    2016-08-08

    Surveys of patient satisfaction and their willingness to return can be used for the optimization of processes, improving their quality, and increasing the satisfaction and loyalty in customers. This study looked at the factors significantly associated with patient satisfaction after primary total hip replacement (THR), and which affect the patients' willingness to return to the same hospital for future treatment, even when unrelated to their THR. Data for the study was collected by written survey from 810 patients of 43 hospitals following their THR. Satisfaction and willingness to return were measured using a validated, multidimensional questionnaire, primarily based on six-point scales, which were then evaluated together with routine hospital data, according to bivariate and multivariate analyses. The bivariate analysis showed a strong correlation between satisfaction or willingness to return and the health condition before hospitalization as well as the perceived length of stay. In contrast, the patient's gender and the number of inpatient cases in a hospital with THR had no influence. The binary logistic regression analyses identified three predictors associated with overall satisfaction and seven predictors associated with willingness to return. The strongest factor for both dependent variables was the perceived length of stay, and the weakest factor for satisfaction was the treatment outcome. Overall, with all of the medical and service-related issues considered, high levels of satisfaction were reached. Despite the high satisfaction scores, probable causes for declining the willingness to return were identified. The results provide incentives for hospitals and medical professionals to attain a high satisfaction levels in their THR patients.

  10. Impact of Preemptive Analgesia on inflammatory responses and Rehabilitation after Primary Total Knee Arthroplasty: A Controlled Clinical Study

    PubMed Central

    Jianda, Xu; Yuxing, Qu; Yi, Gao; Hong, Zhao; Libo, Peng; Jianning, Zhao

    2016-01-01

    The aim of this study was to investigate the effects of preemptive analgesia on the inflammatory response and rehabilitation in TKA. 75 patients with unilateral primary knee osteoarthritis were conducted in this prospective study. All patients were randomly divided into two groups (MMA with/without preemptive analgesia group). The following parameters were used to evaluate analgesic efficacy: knee flexion, pain at rest and walking, functional walking capacity (2 MWT and 6 MWT), WOMAC score, and hs-CRP level. Patients in MMA with preemptive analgesia group had lower hs-CRP level and less pain at rest and walking during the first week postoperatively (P < 0.05). The 2 MWT was significantly better in MMA with preemptive analgesia group (17.13 ± 3.82 VS 14.19 ± 3.56, P = 0.001). The 6 MWT scores and WOMAC scores increased significantly within Groups (P = 0.020, 0.000), but no difference between groups postoperatively (P > 0.05). Less cumulative consumption of morphine was found in MMA with preemptive analgesia group at 48 h (P = 0.017, 0.023), but no difference at total requirement (P = 0.113). Preemptive analgesia added to a multimodal analgesic regime improved analgesia, reduced inflammatory reaction and accelerated functional recovery at the first week postoperatively, but not improved long-term function. PMID:27578313

  11. Comparison of postdischarge physiotherapy versus usual care following primary total knee arthroplasty for osteoarthritis: an exploratory pilot randomized clinical trial.

    PubMed

    Minns Lowe, Catherine J; Barker, Karen L; Holder, Roger; Sackley, Catherine M

    2012-07-01

    To evaluate a pilot trial of a postdischarge physiotherapy intervention to improve patient function versus usual physiotherapy in patients undergoing total knee arthroplasty aiming to assess: recruitment rate, feasibility and acceptability of the intervention and control, suitability of outcomes, retention and adverse events and to inform sample size calculation for a definitive trial. Exploratory pilot randomized controlled trial using independent assessment. Mixed urban and rural, UK. Patients undergoing primary, elective unilateral knee arthroplasty for osteoarthritis. Two additional home physiotherapy visits of functional weight-bearing exercises, functional task-specific training versus treatment as usual. Oxford Knee Score at 12 months. completion rates, adverse events, Knee Injury and Osteoarthritis Outcome Score, leg extensor power, timed 10-m walk, timed sit-to-stand, resource use diaries. Assessments completed at baseline (pre-operatively), 3, 6 and 12 months. Of 181 eligible participants 107 (59.1%) were randomized over 13 months, one participant withdrew, no adverse events. Intervention group n = 56 (mean age 67.8), control group n = 51 (mean age 70.8). The difference in mean change of Oxford Knee Scores between groups (intervention--control) at 12 months was 0.2 (95% confidence interval (CI) -3.8, 4.2), P = 0.94. Patient diaries revealed non-trial additional physiotherapy requires improved measurement. Successful recruitment and retention rates were achieved. The intervention appeared feasible and acceptable but may be suboptimal in intensity given recent research. A sample size of 1271 participants would be required for a fully powered randomized controlled trial using the main outcome. However new outcomes, potentially of greater validity and responsiveness, require consideration.

  12. Prosthetic Dislocation and Revision After Primary Total Hip Arthroplasty in Lumbar Fusion Patients: A Propensity Score Matched-Pair Analysis.

    PubMed

    Perfetti, Dean C; Schwarzkopf, Ran; Buckland, Aaron J; Paulino, Carl B; Vigdorchik, Jonathan M

    2017-05-01

    Lumbar-pelvic fusion reduces the variation in pelvic tilt in functional situations by reducing lumbar spine flexibility, which is thought to be important in maintaining stability of a total hip arthroplasty (THA). We compared dislocation and revision rates for patients with lumbar fusion and subsequent THA to a matched comparison cohort with hip and spine degenerative changes undergoing only THA. We identified patients in New York State who underwent primary elective lumbar fusion for degenerative disc disease pathology and subsequent THA between January 2005 and December 2012. A propensity score match was performed to compare 934 patients with prior lumbar fusion to 934 patients with only THA according to age, gender, race, Deyo comorbidity score, year of surgery, and surgeon volume. Revision and dislocation rates were assessed at 3, 6, and 12 months post-THA. At 12 months, patients with prior lumbar fusion had significantly increased rates of THA dislocation (control: 0.4%; fusion: 3.0%; P < .001) and revision (control: 0.9%; fusion: 3.9%; P < .001). At 12 months, fusion patients were 7.19 times more likely to dislocate their THA (P < .001) and 4.64 times more likely to undergo revision (P < .001). Patients undergoing lumbar fusion and subsequent THA have significantly higher risks of dislocation and revision of their hip arthroplasty than a matched cohort of patients with similar hip and spine pathology but only undergoing THA. During preoperative consultation for patients with prior lumbar fusion, orthopedic surgeons must educate the patient and family about the increased risk of dislocation and revision. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Is reverse total shoulder arthroplasty a feasible treatment option for failed shoulder arthroplasty? A retrospective study of 44 cases with special regards to stemless and stemmed primary implants.

    PubMed

    Holschen, M; Franetzki, B; Witt, K-A; Liem, D; Steinbeck, J

    2017-08-01

    Is reverse total shoulder arthroplasty a feasible treatment option for failed shoulder arthroplasty? A retrospective study of 44 cases with special regards to stemless and stemmed primary implants. Due to humeral or glenoid bone-loss and rotator cuff insufficiency reverse total shoulder arthroplasty often means the only remaining treatment option in revision shoulder arthroplasty. This study investigates the clinical outcome of patients treated with a reverse total shoulder in revision cases with special regard to stemless and stemmed primary implants. From 2010 to 2012 60 failed shoulder arthroplasties were converted to reverse total shoulder arthroplasty. Forty-four patients were available for follow-up after a mean of 24 months. Patients were assessed with X-rays, Constant- and ASES Score and a questionnaire about their subjective satisfaction. The total number of observed complications was seven (16%). Ninety-eight percent of the patients were satisfied with their clinical result. Patients achieved a mean normalized constant score of 70.2% and a mean ASES Score of 65.3. Patients with stemless primary implants achieved a higher normalized constant score than patients with stemmed primary implants (82 vs. 61.8%; p = 0009). Reverse total shoulder arthroplasty provides satisfactory clinical results and a high patient satisfaction in revision shoulder arthroplasty. The complication rate needs to be considered and discussed with the patient prior to surgery. Presence or absence of a stem of revised shoulder arthroplasties interferes with the outcome. LEVEL OF EVIDENCE IV: (Retrospective study).

  14. [Total hip prosthesis for chronic juvenile arthritis. A review of a series of 34 prosthesis].

    PubMed

    Journeau, P; Mabesoone, F; Touzet, P; Prieur, A M; Rigault, P

    1996-01-01

    The purpose of this study was to analyse the results of total hip arthroplasty for chronic juvenile arthritis in order to evaluate risks, problems and benefits of this procedure. Between 1984 and 1992, 34 total hip prostheses were implanted for chronic juvenile arthritis in 20 patients. Most prosthesis were Zweymuller cementless prosthesis. Mean follow up was 5 years. Results were good. In 85 per cent of cases, patients had a normal activity recovery. Pain relief was very good since in 80 per cent cases patients had a total indolence. Beyond these good clinical results at this mean follow-up, the main interest of this study is to characterize two different periods in the surgical technique. The first period when cemented prosthesis was employed and the second one when cementless femoral implants with screwed acetabular component were used. Cementless prostheses appear to be a satisfying solution in this disease, preserving bones and showing very good radiological and functional results. Furthermore, the very low complication rate despite general discomfort may prompt us to use total hip arthroplasty for the treatment of chronic juvenile arthritis.

  15. A comparison of outcomes in morbidly obese, obese and non-obese patients undergoing primary total knee and total hip arthroplasty.

    PubMed

    Deakin, Angela H; Iyayi-Igbinovia, Aghimien; Love, Gavin J

    2017-01-27

    Obesity is a growing public health issue with the prevalence of morbid obesity, (Body Mass Index (BMI) ≥ 40 kg/m(2)) increasing. There is some evidence these patients have more peri- and post-operative complications and poorer outcomes when undergoing arthroplasty procedures. This audit aimed to determine and compare the outcomes of non-obese, obese and morbidly obese patients undergoing arthroplasty at our institution. This was a retrospective audit of patients from our institution who had undergone total knee (TKA) or total hip arthroplasty (THA) in 2009. Data collected were: age, gender, BMI, length of stay (LOS), Oxford knee or hip score (OKS/OHS), satisfaction and complications up to two years post operation. Patients were divided into three groups: BMI < 30, BMI 30-40 and BMI > 40. Outcomes for each BMI group were compared. 1014 TKA and 906 THA operations were included. When compared to obese and non-obese patients, morbidly obese patients undergoing TKA had a mean LOS one day longer, a mean OKS four points lower and higher rates of postoperative problems, 37% vs. 21%. For THA patients there was no difference in LOS, OHS score was two points lower for each increasing BMI category and postoperative problems increase from 25% for non-obese to 31% for obese and 38% for morbidly obese patients. These results will be useful in informing obese patients of their potential outcomes following TKA or THA. These patients can then make a more informed choice before proceeding with arthroplasty. Copyright © 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  16. Totally laparoscopic associating liver tourniquet and portal vein occlusion for staged hepatectomy combined with simultaneous left hemicolectomy for bilateral liver metastases of the primary colon cancer

    PubMed Central

    Xu, Hong-wei; Li, Hong-yu; Liu, Fei; Wei, Yong-gang; Li, Bo

    2017-01-01

    Abstract Background: Resection of the liver is often limited to the insufficient future liver remnant (FLR). To address this problem, the modification surgical technique “associating liver tourniquet and portal vein occlusion for staged hepatectomy” (ALTPS) was developed and led to quick hypertrophy in a short interval. In some colorectal cancer patients with multiple and bilobar metastases, the resection of the primary is often protracted immensely to the unpredictable postoperative complications for whom is to be treated with a liver-first approach. To overcome this problem, a simultaneous resection of the primary tumor and totally laparoscopic ALTPS for bilateral liver metastases of the primary colon cancer were performed. Case summary: A 63-year-old female patient with left colon cancer and synchronous bilateral colorectal liver metastases underwent a totally laparoscopic ALTPS and simultaneous left hemicolectomy because of the small FLR. The operative times were 460 minutes for the first stage and 240 minutes for the second stage without the need for blood transfusions. The recoveries after the first and the second operations were uneventful, and the patient was discharged on postoperative day 11 of the second stage operation. Conclusion: Our case shows the totally laparoscopic ALTPS and simultaneous left hemicolectomy at step 1 for bilobar liver metastases of the primary colon cancer with no severe postoperative complications. If a resection of the primary tumor does not compromise the split procedure, the combination of pure laparoscopic ALTPS and primary resection is feasible and safe. PMID:28296776

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

    PubMed

    Blumenfeld, Thomas J

    2010-04-01

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

  18. National Comparative Audit of Blood Use in Elective Primary Unilateral Total Hip Replacement Surgery in the UK

    PubMed Central

    Boralessa, H; Goldhill, DR; Tucker, K; Mortimer, AJ; Grant-Casey, J

    2009-01-01

    INTRODUCTION Blood is a scarce and expensive product. Although it may be life-saving, in recent years there has been an increased emphasis on the potential hazards of transfusion as well as evidence supporting the use of lower transfusion thresholds. Orthopaedic surgery accounts for some 10% of transfused red blood cells and evidence suggests that there is considerable variation in transfusion practice. PATIENTS AND METHODS NHS Blood and Transplant, in collaboration with the Royal College of Physicians, undertook a national audit on transfusion practice. Each hospital was asked to provide information relating to 40 consecutive patients undergoing elective, primary unilateral total hip replacement surgery. The results were compared to indicators and standards. RESULTS Information was analysed relating to 7465 operations performed in 223 hospitals. Almost all hospitals had a system for referring abnormal pre-operative blood results to a doctor and 73% performed a group-and-save rather than a cross-match before surgery. Of hospitals, 47% had a transfusion policy. In 73%, the policy recommended a transfusion threshold at a haemoglobin concentration of 8 g/dl or less. There was a wide variation in transfusion rate among hospitals. Of patients, 15% had a haemoglobin concentration less than 12 g/dl recorded in the 28 days before surgery and 57% of these patients were transfused compared to 20% with higher pre-operative values. Of those who were transfused, 7% were given a single unit and 67% two units. Of patients transfused two or more units during days 1–14 after surgery, 65% had a post transfusion haemoglobin concentration of 10 g/dl or more. CONCLUSIONS Pre-operative anaemia, lack of availability of transfusion protocols and use of different thresholds for transfusion may have contributed to the wide variation in transfusion rate. Effective measures to identify and correct pre-operative anaemia may decrease the need for transfusion. A consistent, evidence

  19. Robot-assisted total hip arthroplasty.

    PubMed

    Banerjee, Samik; Cherian, Jeffery J; Elmallah, Randa K; Pierce, Todd P; Jauregui, Julio J; Mont, Michael A

    2016-01-01

    Precise and accurate biomechanical reconstruction during total hip arthroplasty (THA) is essential for durable long-term survivorship. Accurate fit of cementless hip implants is also crucial to reduce micromotion between the bone-implant interfaces to allow for stable osseointegration. Robotic technology aims to minimize potential human errors and improve implant alignment and fit, and address persisting concerns with modern-day cementless THA. Although robotic THA dates back to the early 1990s, concerns with increased operating times, costs, and complications led to its withdrawal. However, semi-active systems have renewed interest in robot-assisted joint arthroplasty. We reviewed the current technology, its potential benefits, and the reported clinical and radiographic outcomes. Early evidence suggests that robotic use may lead to more accurate reconstruction of radiographic parameters, such as implant positioning, fit, center-of-rotation, and leg-length discrepancy. Further research is needed to determine if these will translate into better outcomes and improved implant longevity to justify increased costs.

  20. Radiologic bone adaptations on a cementless short-stem shoulder prosthesis.

    PubMed

    Schnetzke, Marc; Coda, Sebastian; Raiss, Patric; Walch, Gilles; Loew, Markus

    2016-04-01

    This study evaluated the timing and location of radiologic bone adaptations related to shoulder arthroplasty using a single type of cementless short-stem shoulder prosthesis. Uncemented short-stem shoulder arthroplasties were evaluated in 52 patients at a mean age of 71.6 years (range, 58.1-86.6) with a minimum clinical and radiologic follow-up of 2 years (mean, 32 months; range, 23-52 months). All radiographs were analyzed for inclination of the stem, filling ratio of metaphysis and diaphysis, bone remodeling around the stem, radiolucent lines around the glenoid, and subsidence of the humeral stem. Finally, the radiographic and clinical findings were compared between patients with low and high bone adaptations. At final follow-up, no loosening, subsidence, or osteolysis was seen. High bone adaptations were present in 27 patients (51.9%). Cortical thinning and osteopenia in the medial cortex (82.7%) and spot welds in the lateral cortex (78.6%) were the most frequently occurring bone adaptations. Patients with high bone adaptations had significantly higher metaphyseal (0.60 ± 0.05 vs. 0.56 ± 0.06; P = .024) and diaphyseal filling ratio (0.66 ± 0.04 vs. 0.61 ± 0.06; P = .019) at 2-year follow-up than patients with low bone adaptations. Clinical outcome was not influenced by the radiographic changes. The clinical and radiologic results of the short-stem shoulder arthroplasty are comparable to those with the third and fourth generations of standard stem arthroplasty. Higher filling ratios in the metaphysis and the diaphysis were significantly associated with the occurrence of high bone adaptations. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  1. Total Endovascular Treatment of Acute Non-A-non-B Dissection Complicated by Visceral Malperfusion without Primary Entry Tear Coverage.

    PubMed

    Soler, Raphael J; Bartoli, Michel A; Simonet, Gaetan; Amabile, Philippe; Sarlon-Bartoli, Gabrielle; Magnan, Pierre-Edouard

    2017-07-21

    Management of visceral ischemia due to non-A, non-B dissection is extremely challenging due to the position of the primary entry tear at the level of the brachiocephalic vessels. We report on a patient who was admitted for a complicated non-A, non-B-type dissection with visceral and leg ischemia. A covered stent graft was implanted below the primary entry tear to redirect the flow in the true lumen, associated with stents implantation in the visceral arteries, to treat the dissection's static component. The patient did well, without need for bowel resection visceral or late stent restenosis. Stent-graft implantation below the primary entry tear in cases of visceral ischemia due to non-A, non-B dissection seems feasible. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. An analytical approach to study the intraoperative fractures of femoral shaft during total hip arthroplasty.

    PubMed

    Malekmotiei, Leila; Farahmand, Farzam; Shodja, Hossein M; Samadi-Dooki, Aref

    2013-04-01

    An analytical approach which is popular in micromechanical studies has been extended to the solution for the interference fit problem of the femoral stem in cementless total hip arthroplasty (THA). The multiple inhomogeneity problem of THA in transverse plane, including an elliptical stem, a cortical wall, and a cancellous layer interface, was formulated using the equivalent inclusion method (EIM) to obtain the induced interference elastic fields. Results indicated a maximum interference fit of about 210 μm before bone fracture, predicted based on the Drucker-Prager criterion for a partially reamed section. The cancellous layer had a significant effect on reducing the hoop stresses in the cortical wall; the maximum press fit increased to as high as 480 μm for a 2 mm thick cancellous. The increase of the thickness and the mechanical quality, i.e., stiffness and strength, of the cortical wall also increased the maximum interference fit before fracture significantly. No considerable effect was found for the implant material on the maximum allowable interference fit. It was concluded that while larger interference fits could be adapted for younger patients, care must be taken when dealing with the elderly and those suffering from osteoporosis. A conservative reaming procedure is beneficial for such patients; however, in order to ensure sufficient primary stability without risking bone fracture, a preoperative analysis might be necessary.

  3. Accuracy and Reliability of Preoperative On-screen Templating Using Digital Radiographs for Total Hip Arthroplasty

    PubMed Central

    Shin, Jong Ki; Son, Seung Min; Kim, Tae Woo; Shin, Won Chul; Lee, Jung Sub

    2016-01-01

    Purpose Preoperative on-screen templating is a method of using acetate templates on digital images. The aim of the present study was to evaluate the accuracy, intra- and interobserver reliabilities of preoperative on-screen templating using digital radiographs for total hip arthroplasty (THA). Materials and Methods Two hundred patients with hip disease who were treated with primary cementless THA were retrospectively evaluated. The accuracy of on-screen templating was assessed by comparing the predicted prosthesis sizes with the actual sizes used operatively. The inter- and intraobserver reliabilities of the templating results were also evaluated. Results The prosthesis prediction accuracy within ±one size was 96.6% for the cup size and 97.8% for the stem size. The inter- and intraobserver reliabilities for the implant size were substantial (kappa>0.70). The intra- and interobserver reliabilities for the leg length discrepancy and femoral offset difference using the intraclass correlation coefficient ranged from 0.89 to 0.97. Conclusion Preoperative on-screen templating using digital radiographs showed substantial accuracy and reliability for implant prediction. It is an effective method for predicting the size of implant, correcting the leg length discrepancy and restoring the femoral offset. PMID:28097109

  4. Outcomes Study of the TM Reverse Shoulder System Used in Primary or Revision Reverse Total Shoulder Arthroplasty

    ClinicalTrials.gov

    2017-01-10

    Osteoarthritis; Rheumatoid Arthritis; Post-traumatic Arthritis; Ununited Humeral Head Fracture; Irreducible 3-and 4-part Proximal Humeral Fractures; Avascular Necrosis; Gross Rotator Cuff Deficiency; Failed Total Shoulder Arthroplasty (Both Glenoid and Humeral Components Require Revision

  5. Have cementless and resurfacing components improved the medium-term results of hip replacement for patients under 60 years of age?

    PubMed Central

    Mason, James; Baker, Paul; Gregg, Paul J; Porter, Martyn; Deehan, David J; Reed, Mike R

    2015-01-01

    Background and purpose The optimal hip replacement for young patients remains unknown. We compared patient-reported outcome measures (PROMs), revision risk, and implant costs over a range of hip replacements. Methods We included hip replacements for osteoarthritis in patients under 60 years of age performed between 2003 and 2010 using the commonest brand of cemented, cementless, hybrid, or resurfacing prosthesis (11,622 women and 13,087 men). The reference implant comprised a cemented stem with a conventional polyethylene cemented cup and a standard-sized head (28- or 32-mm). Differences in implant survival were assessed using competing-risks models, adjusted for known prognostic influences. Analysis of covariance was used to assess improvement in PROMs (Oxford hip score (OHS) and EQ5D index) in 2014 linked procedures. Results In males, PROMs and implant survival were similar across all types of implants. In females, revision was statistically significantly higher in hard-bearing and/or small-stem cementless implants (hazard ratio (HR) = 4) and resurfacings (small head sizes (< 48 mm): HR = 6; large head sizes (≥ 48 mm): HR = 5) when compared to the reference cemented implant. In component combinations with equivalent survival, women reported significantly greater improvements in OHS with hybrid implants (22, p = 0.006) and cementless implants (21, p = 0.03) (reference, 18), but similar EQ5D index. For men and women, National Health Service (NHS) costs were lowest with the reference implant and highest with a hard-bearing cementless replacement. Interpretation In young women, hybrids offer a balance of good early functional improvement and low revision risk. Fully cementless and resurfacing components are more costly and do not provide any additional benefit for younger patients. PMID:25285617

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

    PubMed

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

    2014-01-01

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

  7. Efficacy of a modified coagulation factor substitution for total hip arthroplasty in patients with end-stage haemophilic arthropathy.

    PubMed

    Zhai, Jiliang; Weng, Xisheng; Lin, Jin; Qian, Wenwei; Guo, Shigong

    2017-01-01

    Total hip arthroplasty (THA) is an effective treatment for end-stage haemophilic arthropathy, and substitution therapy plays a key role in the success of THA. The aim of this study was to evaluate the efficacy of a modified coagulation factor substitution regime in THA. Nineteen haemophiliac patients (20 hips) who received primary cementless THA were enrolled. Based on World Federation of Haemophilia (WFH) guideline, a modified coagulation factor substitution regime was adopted. Blood loss, implant survival rates and complications were reviewed, retrospectively. The mean age at surgery was 29.7 years (15-49 years) and the mean follow-up period was 91 months (43-151 months). Mean total blood loss, external blood loss and hidden blood loss were 3543 (1494-7576), 1435 (600-3440), and 2110 ml (534-4402), respectively. Mean intraoperative blood loss and postoperative drainage were 715 (300-2000) and 713 ml (200-2950), respectively. Mean red blood cell transfusion used was 5 U (0-14). All prostheses were found to have bony ingrowth. One patient had hematoma formation in the thigh and one with a lower limb deep vein thrombosis, postoperatively. Other complications included one skin ulcer, one femur splitting fracture, and one transient neuropraxia. Intraoperative blood loss and wound drainage, in our study, were similar to that in haemophiliac patients and nonhaemophilic patients in literature. This supports the efficacy of the modified coagulation factor substitution strategy in our study.

  8. Evaluation of total purchasing pilots in England and Scotland and implications for primary care groups in England: personal interviews and analysis of routine data

    PubMed Central

    Goodwin, Nicholas; Mays, Nicholas; McLeod, Hugh; Malbon, Gill; Raftery, James

    1998-01-01

    Objectives: To evaluate the reported achievements of the 52 first wave total purchasing pilot schemes in 1996-7 and the factors associated with these; and to consider the implications of these findings for the development of the proposed primary care groups. Design: Face to face interviews with lead general practitioners, project managers, and health authority representatives responsible for each pilot; and analysis of hospital episode statistics. Setting: England and Scotland for evaluation of pilots; England only for consideration of implications for primary care groups. Main outcome measures: The ability of total purchasers to achieve their own objectives and their ability specifically to achieve objectives in the service areas beyond fundholding included in total purchasing. Results: The level of achievement between pilots varied widely. Achievement was more likely to be reported in primary than in secondary care. Reported achievements in reducing length of stay and emergency admissions were corroborated by analysis of hospital episode statistics. Single practice and small multipractice pilots were more likely than large multipractice projects to report achieving their objectives. Achievements were also associated with higher direct management costs per head and the ability to undertake independent contracting. Large multipractice pilots required considerable organisational development before progress could be made. Conclusion: The ability to create effective commissioning organisations the size of the proposed primary care groups should not be underestimated. To be effective commissioners, these care groups will need to invest heavily in their organisational development and in the short term are likely to need an additional development budget rather than the reduction in spending on NHS management that is planned by the government. Key messages The level of reported achievement between the total purchasing pilots in 1996-7 varied widely; achievement was more

  9. Modular calcar replacement prosthesis with strengthened taper junction in total hip arthroplasty.

    PubMed

    Lombardi, Adolph V; Berend, Keith R; Mallory, Thomas H; Adams, Joanne B

    2007-01-01

    Whereas femoral component modularity allows the surgeon to address a variety of femoral defects in complex total hip arthroplasty (THA), breakage of modular stems is a known complication that typically occurs at the taper junction. In response, a proprietary process of taper roller-hardening that increases taper strength by a factor of 3.5 was introduced in 1999. The authors reviewed a consecutive series of patients by a single surgeon who underwent cementless revision or difficult primary THA with a taper roller-hardened modular calcar replacement prosthesis, and have the potential for a minimum of two-year follow up. In 116 patients, 123 hips were involved. Two surgeries were primary, 101 were revision/conversion, 18 were for reimplantation after treatment of infection, and two were intramedullary total femur constructs, one of which was a reimplantation after sepsis. The patients' ages at surgery averaged 71 years, and BMIs averaged 28.12 kg/m2. Nine of the patients, all with single hip involvement, were lost to contact. Twenty-one patients, three of whom had bilateral hip involvement, expired during the follow-up period with implant outcome known. Follow up in the patients who survived averaged 44 (range: 18-78) months. Six femoral components have been revised: two (1.6%) due to recurrent sepsis, three (2.4%) due to sepsis, one (0.8%) from periprosthetic fracture, and none from septic loosening or component breakage. Survivorship with aseptic loosening as the end-point was 100%. In this series, roller-hardening appears to improve the durability of the tapered junction. No roller-hardened modular calcar devices have failed due to component breakage. However, their use is not recommended in the totally deficient proximal femur, as fatigue breaks of distally fixed monoblock extensively coated stems have been reported. Caution is advised when potting or anchoring any stem in the femoral diaphysis without reconstituting proximal bone stock and support.

  10. Management of a full-thickness burn to the foot following sciatic nerve palsy secondary to primary total hip replacement

    PubMed Central

    Jabir, Shehab; Frew, Quentin; El-Muttardi, Naguib; Dziewulski, Peter

    2013-01-01

    Sciatic nerve palsy following total hip replacement is a rare but serious complication. The neurological sequelae that follow range from pure sensory loss to combined motor and sensory loss involving most of the lower limb. The loss of nociceptive feedback predisposes patients to accidental damage to the lower limb. We present the case of a lady with sciatic nerve palsy who sustained full-thickness burn injuries to her foot via a hot water bottle. The dilemma between debridement and grafting following a recent history of surgical trauma (ie, total hip replacement) versus secondary healing via dressings and regular review is discussed. Although grafting is the standard treatment in such burns, we recommend secondary healing over grafting provided the burns are not extensive. This enables potential recovery of sensation and reduces operative trauma to the limb which may retard resolution of the neuropraxia. PMID:23595171

  11. In Vivo Performance of Moderately Crosslinked, Thermally Treated Polyethylene in a Prospective Randomized Controlled Primary Total Knee Arthroplasty Trial.

    PubMed

    Kindsfater, Kirk A; Pomeroy, Donald; Clark, Charles R; Gruen, Thomas A; Murphy, Jeff; Himden, Sam

    2015-08-01

    Cross-linked bearings have been developed for use in total knee arthroplasty that exhibit improved wear properties, but at the expense of a decrease in mechanical strength of the cross-linked material. Adoption has been slow due to fears of mechanical failure secondary to this alteration in mechanical properties. This prospective, randomized study compared mid-term survivorship, clinical and radiographic results of a conventional polyethylene (GVF) to a cross-linked polyethylene (XLK) in total knee prostheses of the same design. At minimum 5-year follow-up there was no difference in survivorship, clinical performance or radiographic findings between the groups. There were no revisions for polyethylene wear, osteolysis or tibial insert dissociation. Most importantly, there were no revisions for mechanical failure or fracture of the polyethylene bearing in either group.

  12. 10-year follow-up wear analysis of first-generation highly crosslinked polyethylene in primary total hip arthroplasty.

    PubMed

    Snir, Nimrod; Kaye, Ian D; Klifto, Christopher S; Hamula, Mathew J; Wolfson, Theodore S; Schwarzkopf, Ran; Jaffe, Fredrick F

    2014-03-01

    Our goal was to report a 10-year follow up of linear penetration rates for HCLPE, and to determine whether a difference exists between penetrations measured on pelvis or hip anterior-posterior radiographs. We reviewed 48 total hip arthroplasties where a first-generation HCLPE liner was used. Femoral head penetration was measured on both AP pelvis and hip radiographs. Total wear and wear rate at 10 years were 1.26 mm and 0.122 mm/y, respectively. The rate decreased significantly after the first 2-3 years, plateauing at a wear rate of 0.05 mm/y for the last 5 years. The AP hip total wear and wear rate were 1.38 mm and 0.133 mm/y respectively, while rates were 1.13 mm and 0.109 mm/y respectively for the pelvis radiographs (P<.05). We found a significant difference in measurements of linear penetration when comparing AP pelvis vs. hip radiographs with lower rates recorded using an AP pelvis. © 2014.

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

    PubMed

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

    2003-10-01

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

  14. Pain control after primary total knee replacement. A prospective randomised controlled trial of local infiltration versus single shot femoral nerve block.

    PubMed

    Ashraf, Anam; Raut, Videsh V; Canty, Stephen J; McLauchlan, George J

    2013-10-01

    We report a prospective blinded randomised trial of local infiltration versus femoral nerve block in patients undergoing primary total knee replacement (TKR), in accordance with the CONSORT statement 2010. Fifty patients in a teaching hospital were consented for the study. The study arms were intraoperative local anaesthesia (150ml 0.2% ropivacaine/1ml 1:1000 adrenaline/30mg ketolorac) and femoral nerve block (30ml 0.2% ropivacaine) with a primary outcome of pain score at 4h post operatively. Secondary outcomes were pain at 2h, pain scores before and after physiotherapy on day one, total opiate administered, time to physiotherapy goals and length of stay. Randomisation was by sealed envelope. The assessor was blinded and the patients partially blinded to the intervention. Ten patients were excluded, eight before randomisation. The trial is complete. Forty patients were analysed for the primary outcome measure. The local infiltration group had significantly lower pain scores at 4h post-operatively; mean [SD] score 2.1 [2.6] versus 6.8 [3.2], p<0.00001 and on post-operative day one prior to physiotherapy; mean score 2.4 [2.3] versus 4.4 [2.3], p<0.05. Total opiate use was also significantly lower in the local infiltration group; mean total 115 [50.3]mg versus 176.5 [103.5]mg, p<0.01. There was no difference in any other outcome. There were no harms as a result of either intervention. Intraoperative local infiltration gives superior pain relief compared to single shot femoral nerve block over the first 24h following primary TKR and minimises post-operative opiate use. Copyright © 2013 Elsevier B.V. All rights reserved.

  15. No clear benefit or drawback to the use of closed drainage after primary total knee arthroplasty: a systematic review and meta-analysis.

    PubMed

    Si, Hai-Bo; Yang, Ti-Min; Zeng, Yi; Shen, Bin

    2016-04-26

    Closed drainage after primary total knee arthroplasty (TKA) has been used routinely for many decades, but controversies have arisen in recent years. The purposes of this study were to compare the clinical outcomes of closed drainage with nondrainage after primary TKA; and to assess the benefit and drawback of closed drainage. Electronic databases (PubMed/Medline, CENTRAL, Embase and Web of Science) were systematically searched for randomised controlled trials (RCTs) that investigated the efficacy and risks of closed drainage after primary TKA. Two investigators independently reviewed studies for eligibility, assessed the risk of bias and extracted the data. A meta-analysis was then performed using Review Manager Software. Twelve RCTs totalling 889 TKAs were identified. No significant differences in infection rate or blood loss were found between the closed drainage and nondrainage TKAs, and there was also no significant difference in haematoma formation, deep venous thrombosis, postoperative VAS score or range of motion between the two groups. There appears to be no clear benefit or drawback to the use of closed drainage after primary TKA. Improving the use of closed drainage might provide better outcomes.

  16. Real-time job monitoring and performance control of primary cementing operations as a way to total quality management

    SciTech Connect

    Spoerker, H.F.

    1995-12-01

    A high-accuracy wellsite mud-logging system was developed and implemented to compare standpipe pressures and annular flow rates during primary cementing operations with real-time predictions from a hydraulic simulation model. This paper investigates the development of possible cementing job execution problems, such as low (laminar) flow rates in the annulus at critical job stages, resulting in unsatisfactory mud displacement and ultimately inadequate zonal isolation. Ways to eliminate or at least control free-fall-induced problems through hydraulic simulation at the rigsite and comparison with real-time job parameters, such as pump rates, standpipe pressures, and annular return rates, are presented with detailed descriptions of tested flowmeter equipment and logging experience gained during field testing. Several case studies are presented that compare predictions from job simulation with recorded data (flow-in/-out and standpipe pressure) highlighting special trends, such as fracturing formations, caused by excessive equivalent circulating densities (ECD`s) during free-fall conditions.

  17. Computerized tomography based “patient specific blocks” improve postoperative mechanical alignment in primary total knee arthroplasty

    PubMed Central

    Vaishya, Raju; Vijay, Vipul; Birla, Vikas P; Agarwal, Amit K

    2016-01-01

    AIM: To compare the postoperative mechanical alignment achieved after total knee arthroplasty (TKA) using computer tomography (CT) based patient specific blocks (PSB) to conventional instruments (CI). METHODS: Total 80 knees were included in the study, with 40 knees in both the groups operated using PSB and CI. All the knees were performed by a single surgeon using the same cruciate sacrificing implants. In our study we used CT based PSB to compare with CI. Postoperative mechanical femoro-tibial angle (MFT angle) was measured on long leg x-rays using picture archiving and communication system (PACS). We compared mechanical alignment achieved using PSB and CI in TKA using statistical analysis. RESULTS: The PSB group (group 1) included 17 females and seven males while in CI group (group 2) there were 15 females and eight males. The mean age of patients in group 1 was 60.5 years and in group 2 it was 60.2 years. The mean postoperative MFT angle measured on long-leg radiographs in group 1 was 178.23° (SD = 2.67°, range: 171.9° to 182.5°) while in group 2, the mean MFT angle was 175.73° (SD = 3.62°, range: 166.0° to 179.8°). There was significant improvement in postoperative mechanical alignment (P value = 0.001), in PSB group compared to CI. Number of outliers were also found to be less in group operated with PSB (7 Knee) compared to those operated with CI (17 Knee). CONCLUSION: PSB improve mechanical alignment after total knee arthroplasty, compared to CI. This may lead to lower rates of revision in the PSB based TKA as compared to the conventional instrumentation. PMID:27458553

  18. Does hydroxyapatite coating have no advantage over porous coating in primary total hip arthroplasty? A meta-analysis.

    PubMed

    Chen, Yun-Lin; Lin, Tiao; Liu, An; Shi, Ming-Min; Hu, Bin; Shi, Zhong-Li; Yan, Shi-Gui

    2015-01-28

    There are some arguments between the use of hydroxyapatite and porous coating. Some studies have shown that there is no difference between these two coatings in total hip arthroplasty (THA), while several other studies have shown that hydroxyapatite has advantages over the porous one. We have collected the studies in Pubmed, MEDLINE, EMBASE, and the Cochrane library from the earliest possible years to present, with the search strategy of "(HA OR hydroxyapatite) AND ((total hip arthroplasty) OR (total hip replacement)) AND (RCT* OR randomiz* OR control* OR compar* OR trial*)". The randomized controlled trials and comparative observation trials that evaluated the clinical and radiographic effects between hydroxyapatite coating and porous coating were included. Our main outcome measurements were Harris hip score (HHS) and survival, while the secondary outcome measurements were osteolysis, radiolucent lines, and polyethylene wear. Twelve RCTs and 9 comparative observation trials were included. Hydroxyapatite coating could improve the HHS (p < 0.01), reduce the incidence of thigh pain (p = 0.01), and reduce the incidence of femoral osteolysis (p = 0.01), but hydroxyapatite coating had no advantages on survival (p = 0.32), polyethylene wear (p = 0.08), and radiolucent lines (p = 0.78). Hydroxyapatite coating has shown to have an advantage over porous coating. The HHS and survival was duration-dependent-if given the sufficient duration of follow-up, hydroxyapatite coating would be better than porous coating for the survival. The properties of hydroxyapatite and the implant design had influence on thigh pain incidence, femoral osteolysis, and polyethylene wear. Thickness of 50 to 80 μm and purity larger than 90% increased the thigh pain incidence. Anatomic design had less polyethylene wear.

  19. Primary Total Laparoscopic Sigmoid Vaginoplasty in Transgender Women with Penoscrotal Hypoplasia: A Prospective Cohort Study of Surgical Outcomes and Follow-Up of 42 Patients.

    PubMed

    Bouman, Mark-Bram; van der Sluis, Wouter B; Buncamper, Marlon E; Özer, Müjde; Mullender, Margriet G; Meijerink, Wilhelmus J H J

    2016-10-01

    In young transgender women previously treated with puberty-suppressing hormones, penoscrotal hypoplasia can make penoscrotal inversion vaginoplasty unfeasible. The aim of this study was to prospectively assess surgical outcomes and follow-up of total laparoscopic sigmoid vaginoplasty as primary reconstruction in a cohort of transgender women with penoscrotal hypoplasia. Baseline demographics, surgical characteristics, and intraoperative and postoperative complications of all performed total laparoscopic sigmoid vaginoplasty procedures were prospectively recorded. From November of 2007 to July of 2015, 42 transgender women underwent total laparoscopic sigmoid vaginoplasty as primary vaginal reconstruction. The mean age at the time of surgery was 21.1 ± 4.7 years. Mean follow-up time was 3.2 ± 2.1 years. The mean operative duration was 210 ± 44 minutes. There were no conversions to laparotomy. One rectal perforation was recognized during surgery and immediately oversewn without long-term consequences. The mean length of hospitalization was 5.7 ± 1.1 days. One patient died as a result of an extended-spectrum beta-lactamase-positive necrotizing fasciitis leading to septic shock, with multiorgan failure. Direct postoperative complications that needed laparoscopic reoperation occurred in three cases (7.1 percent). In seven cases (17.1 percent), long-term complications needed a secondary correction. After 1 year, all patients had a functional neovagina with a mean depth of 16.3 ± 1.5 cm. Total laparoscopic sigmoid vaginoplasty seems to have a similar complication rate as other types of elective laparoscopic colorectal surgery. Primary total laparoscopic sigmoid vaginoplasty is a feasible gender-confirming surgical technique with good functional outcomes for transgender women with penoscrotal hypoplasia. Therapeutic, IV.

  20. Tranexamic acid reduces blood loss and transfusion requirements in primary simultaneous bilateral total knee arthroplasty: a meta-analysis of randomized controlled trials.

    PubMed

    Wu, Yuangang; Yang, Timin; Zeng, Yi; Si, Haibo; Cao, Fei; Shen, Bin

    2017-10-01

    : The aim of this meta-analysis is to assess the effectiveness and safety of intravenous application tranexamic acid (TXA) in primary simultaneous bilateral total knee arthroplasty (TKA). We searched electronic databases including PubMed, Embase, the Web of Science, the Cochrane Library and the Google Scholar, for published studies involving the intravenous application TXA in primary simultaneous bilateral TKA. All randomized controlled trials were included. The focus of the meta-analysis was on the outcomes of total blood loss, drainage volume, transfusion requirements and deep venous thrombosis (DVT) and/or pulmonary embolism. The relevant data were analyzed using RevMan 5.2. Six high randomized controlled trials were included, with a total sample size of 394 patients. The intravenous application of TXA significantly reduced total blood loss [95% confidence interval (CI), -519.52 to -126.40; P = 0.001], drainage volume (95% CI, -551.76 to -138.57; P = 0.001) and transfusion requirements (risk ratio, 0.38; 95% CI, 0.21-0.68; P = 0.001) compared with the control group. In addition, there were no significant differences in the rate of DVT (P = 1.00) and/or pulmonary embolism between the two groups. Based on the current evidence, this meta-analysis showed that intravenous application of TXA is effective and a well tolerated treatment to reduce total blood loss, drainage volume and transfusion requirements without increasing the risk of DVT and/or pulmonary embolism in primary simultaneous bilateral TKA.

  1. Total Energy Expenditure in Obese Kuwaiti Primary School Children Assessed by the Doubly-Labeled Water Technique

    PubMed Central

    Davidsson, Lena; Al-Ghanim, Jameela; Al-Ati, Tareq; Al-Hamad, Nawal; Al-Mutairi, Anwar; Al-Olayan, Lulwa; Preston, Thomas

    2016-01-01

    The aim of this pilot study was to assess body composition and total energy expenditure (TEE) in 35 obese 7–9 years old Kuwaiti children (18 girls and 17 boys). Total body water (TBW) and TEE were assessed by doubly-labeled water technique. TBW was derived from the intercept of the elimination rate of deuterium and TEE from the difference in elimination rates of 18O and deuterium. TBW was used to estimate fat-free mass (FFM), using hydration factors for different ages and gender. Fat mass (FM) was calculated as the difference between body weight and FFM. Body weight was not statistically different but TBW was significantly higher (p = 0.018) in boys (44.9% ± 3.3%) than girls (42.4% ± 3.0%), while girls had significantly higher estimated FM (45.2 ± 3.9 weight % versus 41.6% ± 4.3%; p = 0.014). TEE was significantly higher in boys (2395 ± 349 kcal/day) compared with girls (1978 ± 169 kcal/day); p = 0.001. Estimated physical activity level (PAL) was significantly higher in boys; 1.61 ± 0.167 versus 1.51 ± 0.870; p = 0.034. Our results provide the first dataset of TEE in 7–9 years old obese Kuwaiti children and highlight important gender differences to be considered during the development of school based interventions targeted to combat childhood obesity. PMID:27754397

  2. Mid- to long-term outcomes of a medial-pivot system for primary total knee replacement

    PubMed Central

    Fitch, D. A.; Sedacki, K.; Yang, Y.

    2014-01-01

    Objectives This systematic review and meta-analysis was conducted to determine the mid- to long-term clinical outcomes for a medial-pivot total knee replacement (TKR) system. The objectives were to synthesise available survivorship, Knee Society Scores (KSS), and reasons for revision for this system. Methods A systematic search was conducted of two online databases to identify sources of survivorship, KSS, and reasons for revision. Survivorship results were compared with values in the National Joint Registry of England, Wales, and Northern Ireland (NJR). Results A total of eight studies that included data for 1146 TKRs performed in six countries satisfied the inclusion/exclusion criteria. Pooled component survivorship estimates were 99.2% (95% CI, 97.7 to 99.7) and 97.6% (95% CI, 95.8 to 98.6) at five and eight years, respectively. Survivorship was similar or better when compared with rates reported for all cemented TKRs combined in the NJR and was significantly better than some insert types at mid-term intervals. The weighted mean post-operative KSS was 87.9 (73.2 to 94.2), in the excellent range. Similar cumulative revision rates and KSS were reported at centres in the United States, Europe, and Asia. Conclusions The subject system was associated with survivorship and KSS similar or better than that reported for other TKR systems. Cite this article: Bone Joint Res 2014;3:297–304 PMID:25325997

  3. Delivery of antibiotics from cementless titanium-alloy cubes may be a novel way to control postoperative infections.

    PubMed

    Bezuidenhout, Martin B; van Staden, Anton D; Oosthuizen, Gert A; Dimitrov, Dimitar M; Dicks, Leon M T

    2015-01-01

    Bacterial colonisation and biofilm formation onto orthopaedic devices are difficult to eradicate. In most cases infection is treated by surgical removal of the implant and cleaning of the infected area, followed by extensive treatment with broad-spectrum antibiotics. Such treatment causes great discomfort, is expensive, and is not always successful. In this study we report on the release of vancomycin through polyethersulfone membranes from channels in cementless titanium-alloy cubes. The cubes were constructed with LaserCUSING from Ti6Al4V ELI powder. Vancomycin was released by non-Fickian anomalous (constraint) diffusion. Approximately 50% of the vancomycin was released within the first 17 h. However, sustained delivery of vancomycin for 100 h was possible by reinjecting the channels. Refillable implants may be a novel way to control postoperative infections.

  4. Delivery of Antibiotics from Cementless Titanium-Alloy Cubes May Be a Novel Way to Control Postoperative Infections

    PubMed Central

    Bezuidenhout, Martin B.; van Staden, Anton D.; Oosthuizen, Gert A.; Dimitrov, Dimitar M.; Dicks, Leon M. T.

    2015-01-01

    Bacterial colonisation and biofilm formation onto orthopaedic devices are difficult to eradicate. In most cases infection is treated by surgical removal of the implant and cleaning of the infected area, followed by extensive treatment with broad-spectrum antibiotics. Such treatment causes great discomfort, is expensive, and is not always successful. In this study we report on the release of vancomycin through polyethersulfone membranes from channels in cementless titanium-alloy cubes. The cubes were constructed with LaserCUSING from Ti6Al4V ELI powder. Vancomycin was released by non-Fickian anomalous (constraint) diffusion. Approximately 50% of the vancomycin was released within the first 17 h. However, sustained delivery of vancomycin for 100 h was possible by reinjecting the channels. Refillable implants may be a novel way to control postoperative infections. PMID:25861649

  5. Effect of a collar on subsidence and local micromotion of cementless femoral stems: in vitro comparative study based on micro-computerised tomography.

    PubMed

    Malfroy Camine, Valérie; Rüdiger, Hannes A; Pioletti, Dominique P; Terrier, Alexandre

    2017-06-07

    The aim of this study is to quantitatively compare the difference in primary stability between collarless and collared versions of the same femoral stem. Specifically, we tested differences in subsidence and micromotion. Collarless and collared versions of the same cementless femoral stem were implanted in two groups of six fresh-frozen cadaveric femurs. Each implanted femur was then subsequently tested for axial compressive and torsional loadings. A micro-CT based technique was applied to quantify implant subsidence and compute the map of local micromotion around the femoral stems. Micromotion of collarless and collared stems was compared in each Gruen zone. Subsidence was higher but not significantly (p = 0.352) with collarless (41.0 ± 29.9 μm) than with collared stems (37.0 ± 44.6 μm). In compression, micromotion was lower (p = 0.257) with collarless (19.5 ± 5 μm) than with collared stems (43.3 ± 33.1 μm). In torsion, micromotion was also lower (p = 0.476) with collarless (96.9 ± 59.8 μm) than collared stems (118.7 ± 45.0 μm). Micromotion was only significantly lower (p = 0.001) in Gruen zone 1 and for compression with collarless (7.0 ± 0.6 μm) than with collared stems (22.6 ± 25.5 μm). Primary stability was achieved for both stem designs, with a mean micromotion below the osseointegration threshold. Under loading conditions similar to those observed in normal daily activity and with good press-fit, the collar had no influence on subsidence or micromotion. Further studies are required to test the potential advantage of collar with higher loads, undersized stems, or osteoporotic femurs.

  6. The Cost-Effectiveness of Dual Mobility Implants for Primary Total Hip Arthroplasty: A Computer-Based Cost-Utility Model.

    PubMed

    Barlow, Brian T; McLawhorn, Alexander S; Westrich, Geoffrey H

    2017-05-03

    Dislocation remains a clinically important problem following primary total hip arthroplasty, and it is a common reason for revision total hip arthroplasty. Dual mobility (DM) implants decrease the risk of dislocation but can be more expensive than conventional implants and have idiosyncratic failure mechanisms. The purpose of this study was to investigate the cost-effectiveness of DM implants compared with conventional bearings for primary total hip arthroplasty. Markov model analysis was conducted from the societal perspective with use of direct and indirect costs. Costs, expressed in 2013 U.S. dollars, were derived from the literature, the National Inpatient Sample, and the Centers for Medicare & Medicaid Services. Effectiveness was expressed in quality-adjusted life years (QALYs). The model was populated with health state utilities and state transition probabilities derived from previously published literature. The analysis was performed for a patient's lifetime, and costs and effectiveness were discounted at 3% annually. The principal outcome was the incremental cost-effectiveness ratio (ICER), with a willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses were performed to explore relevant uncertainty. In the base case, DM total hip arthroplasty showed absolute dominance over conventional total hip arthroplasty, with lower accrued costs ($39,008 versus $40,031 U.S. dollars) and higher accrued utility (13.18 versus 13.13 QALYs) indicating cost-savings. DM total hip arthroplasty ceased being cost-saving when its implant costs exceeded those of conventional total hip arthroplasty by $1,023, and the cost-effectiveness threshold for DM implants was $5,287 greater than that for conventional implants. DM was not cost-effective when the annualized incremental probability of revision from any unforeseen failure mechanism or mechanisms exceeded 0.29%. The probability of intraprosthetic dislocation exerted the most influence on model results. This model

  7. Primary Total Knee Arthroplasty in Super-obese Patients: Dramatically Higher Postoperative Complication Rates Even Compared to Revision Surgery.

    PubMed

    Werner, Brian C; Evans, Cody L; Carothers, Joshua T; Browne, James A

    2015-05-01

    This study utilized a national database to evaluate 90 day postoperative complication rates after total knee arthroplasty (TKA) in super obese (BMI > 50 kg/m(2)) patients (n = 7666) compared to non-obese patients (n = 1,212,793), obese patients (n = 291,914), morbidly obese patients (n = 169,308) and revision TKA patients (n = 28,812). Super obese patients had significantly higher rates of local and systemic complications compared to all other BMI groups as well as those undergoing revision TKA with higher rates of venous thromboembolism (VTE), infection, and medical complications. Super obesity is associated with dramatically increased rates of postoperative complications after TKA compared to non-obese, obese, and morbidly obese patients as well as those undergoing revision TKA.

  8. Short-interval two-stage approach to primary total knee arthroplasty for acutely septic osteoarthritic knees.

    PubMed

    Hochreiter, Bettina; Strahm, Carol; Behrend, Henrik

    2016-10-01

    Treatment strategies for advanced knee osteoarthritis with coexistent joint infection are not well established. While in periprosthetic joint infection the two-stage approach has been studied extensively, only few case reports on two-stage total knee arthroplasty (TKA) for knee osteoarthritis with coexistent joint infection have been published. The purpose of this paper was to report on our method of implementing a two-stage TKA with intervening antibiotic-loaded articulating cement spacers and a short interval between first- and second-stage procedures to treat two patients with Staphylococcus aureus-infected end-stage knee osteoarthritis. Consistent infection eradication was found at a 1-year follow-up with postoperative range of motion and knee scores comparing favourably with those of other case series. Level of evidence V.

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

    PubMed

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

    2017-09-15

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

  10. Tranexamic Acid Administration in Primary Total Hip Arthroplasty: A Randomized Controlled Trial of Intravenous Combined with Topical Versus Single-Dose Intravenous Administration.

    PubMed

    Yi, Zeng; Bin, Shen; Jing, Yang; Zongke, Zhou; Pengde, Kang; Fuxing, Pei

    2016-06-15

    The use of tranexamic acid (TXA) in primary total hip arthroplasty is well documented. However, considering the potential side effects, including deep vein thrombosis and pulmonary embolism, the ideal method of providing TXA to patients undergoing total hip arthroplasty remains controversial. The objective of this trial was to assess the efficacy and safety of intravenous (IV) administration combined with topical administration of TXA regarding postoperative blood loss and transfusion rates in patients treated with primary unilateral total hip arthroplasty. In this prospective, randomized controlled trial, 150 patients were divided into three groups: the combined group (IV administration of 15 mg/kg of TXA combined with topical administration of 1 g/100 mL of TXA), the single IV group (IV administration of 15 mg/kg of TXA), and the placebo group. The primary outcomes included blood-loss variables (total, intraoperative, and drainage blood loss; changes in hemoglobin, hematocrit, and platelet concentration; and amount of IV transfusion fluid) and transfusion values (frequency of transfusion and number of transfused blood units). The secondary outcomes included the length of the hospital stay, range of hip motion, Harris hip score, and prevalences of deep vein thrombosis and pulmonary embolism. The total blood loss in the combined group (mean and standard deviation, 835.49 ± 343.50 mL) was significantly reduced (p < 0.05) in comparison with that in the single IV group (1002.62 ± 366.85 mL) and placebo group (1221.11 ± 386.25 mL). The combined group also had fewer transfusions in comparison with the single IV and placebo groups (1, 8, and 19, respectively; p < 0.05). There was no difference among the 3 groups with regard to the rates of deep vein thrombosis or pulmonary embolism. Intravenous combined with topical administration of TXA in patients undergoing a primary unilateral total hip arthroplasty significantly reduced postoperative bleeding and the transfusion

  11. Cementless RM Pressfit Cup: a clinical and radiological study of 91 cases with at least four years follow-up.

    PubMed

    Lafon, L; Moubarak, H; Druon, J; Rosset, P

    2014-06-01

    Cementless metal-back acetabular cups have good long-term results, but some problems have appeared due to the shell's stiffness, modularity and required bearing surfaces. The RM Pressfit Cup is a single-piece polyethylene cementless acetabular cup that is covered by a thin layer of titanium. This allows for bone integration without limitations related to the stiffness of a metal-back shell. There is very little published information about this new, innovative implant design. The purpose of this study was to evaluate the clinical and radiological results from a continuous series of 91 cups (85 patients) with a follow-up of at least 4 years. No patients were lost to follow-up. The Harris Hip Score (HHS) was used to assess the clinical outcome. To assess the radiological outcomes, digital X-rays were used to evaluate the cup position and integration; wear was measured using Livermore's technique. The clinical results were excellent: the mean HHS was 94 and 82% of cases had good or excellent scores. Three of the cups had to be revised because of dislocation brought on by incorrect positioning. X-rays revealed that three implants had shifted during the first 6 weeks, but had stabilized afterwards. Bone integration on X-rays was satisfactory in all cases with no signs of osteolysis. The configuration of the bone trabeculae showed that loads between the implant and peri-acetabular cancellous bone were evenly distributed. The wear of the polyethylene cup-ceramic head bearing was 0.07 mm/year. The results of this series are consistent with recent published studies with the RM Pressfit Cup. IV. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  12. Incidence of revision after primary implantation of the Salto ® mobile version and Salto Talaris ™ total ankle prostheses: a systematic review.

    PubMed

    Roukis, Thomas S; Elliott, Andrew D

    2015-01-01

    The incidence of revision of total ankle replacement prostheses remains unclear. We undertook a systematic review to identify the material relating to the incidence of revision after implantation of the Salto(®) mobile version and Salto Talaris™ total ankle prostheses. Studies were eligible for inclusion only if they had involved primary total ankle replacement with these prostheses and had included the incidence of revision. Eight studies involving 1,209 Salto(®) mobile version prostheses, with a weighted mean follow-up period of 55.2 months, and 5 studies involving 212 Salto Talaris™ total ankle prostheses, with a weighted mean follow-up period of 34.9 months, were included. Forty-eight patients with Salto(®) mobile version prostheses (4%) underwent revision, of whom 24 (70.5%) underwent ankle arthrodesis, 9 (26.5%) metallic component replacement, and 1 (3%) below-the-knee amputation. Five (2.4%) Salto Talaris™ total ankle prostheses underwent revision (3 metallic component replacement and 2 ankle arthrodeses). Restricting the data to the inventor, design team, or disclosed consultants, the incidence of revision was 5.2% for the Salto(®) mobile version and 2.6% for the Salto Talaris™ total ankle prostheses. In contrast, data that excluded these individuals had an incidence of revision of 2.8% for the Salto(®) mobile version and 2.0% for the Salto Talaris™ total ankle prostheses. We could not identify any obvious difference in the etiology responsible for the incidence of revision between these mobile- and fixed-bearing prostheses. The incidence of revision for the Salto(®) mobile version and Salto Talaris™ total ankle prostheses was lower than those reported through systematic review for the Agility™ and Scandinavian Total Ankle Replacement™ systems without obvious selection (inventor) or publication (conflict of interest) bias.

  13. Comparison of robotic-assisted and manual implantation of a primary total hip replacement. A prospective study.

    PubMed

    Honl, Matthias; Dierk, Oliver; Gauck, Christian; Carrero, Volker; Lampe, Frank; Dries, Sebastian; Quante, Markus; Schwieger, Karsten; Hille, Ekkehard; Morlock, Michael M

    2003-08-01

    Robotic-assisted total hip replacement has become a common method of implantation, especially in Europe. It frequently has been postulated that robotic reaming would result in an improved clinical outcome due to the better fit of the prosthesis, but that has never been demonstrated in a prospective study, to our knowledge. The purpose of this study was to compare robotic-assisted implantation of a total hip replacement with conventional manual implantation. One hundred and fifty-four patients scheduled for total hip replacement were randomly assigned to undergo either conventional manual implantation of an S-ROM prosthesis (eighty patients) or robotic-assisted implantation of such a prosthesis (seventy-four patients). The five-axis ROBODOC was used for the robotic-assisted procedures. Preoperatively as well as at three, six, twelve, and twenty-four months after surgery, the scores according to the Harris and Merle d'Aubigné systems and the Mayo clinical score were determined. Radiographs made at these intervals were analyzed for evidence of loosening, prosthetic alignment, and heterotopic ossification. Thirteen (18%) of the seventy-four attempted robotic implantations had to be converted to manual implantations as a result of failure of the system. The duration of the robotic procedures was longer than that of the manual procedures (mean and standard deviation,107.1 +/- 29.1 compared with 82.4 +/- 23.4 minutes, p < 0.001). Limb-length equality (mean discrepancy, 0.18 +/- 0.30 compared with 0.96 +/- 0.93 cm, p < 0.001) and varus-valgus orientation of the stem (mean angle between the femur and the shaft of the prosthesis, 0.34 degrees +/- 0.67 degrees compared with 0.84 degrees +/- 1.23 degrees, p < 0.001) were better after the robotic procedures. At six months, slightly more heterotopic ossification was seen in the group treated with robotic implantation. The group treated with robotic implantation had a better Mayo clinical score at six and twelve months and a

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

    PubMed

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

    2008-01-01

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

  15. Wireless Microcurrent-Generating Antimicrobial Wound Dressing in Primary Total Knee Arthroplasty: A Single-Center Experience.

    PubMed

    Chow, James

    2016-06-27

    The spread of multidrug-resistant bacteria and financial burden of periprosthetic joint infection (PJI) further the need for treatments to address pathogenic contamination and expedite healing. This retrospective study was a chart review of a series of 92 patients who underwent 100 total knee arthroplasties performed by the same surgeon and treated with a novel microcurrent-generating antimicrobial dressing (MCD). Mean hospital length of stay was 2.3±0.9 days, while the mean length of treatment with MCD was 8.3±1.2 days. No major complications, PJI or major infectious complications were reported, with two readmissions (2%) within 30 days of surgery. Knee Society Score function showed statistically significant improvements post-operatively, with a mean six-month score of 75.0±20.3 and mean change from baseline of 36.3±21.1 (P<0.0001). These results support previous findings that use of the MCD may result in improved outcomes as an element in post-operative wound management.

  16. Wireless Microcurrent-Generating Antimicrobial Wound Dressing in Primary Total Knee Arthroplasty: A Single-Center Experience

    PubMed Central

    Chow, James

    2016-01-01

    The spread of multidrug-resistant bacteria and financial burden of periprosthetic joint infection (PJI) further the need for treatments to address pathogenic contamination and expedite healing. This retrospective study was a chart review of a series of 92 patients who underwent 100 total knee arthroplasties performed by the same surgeon and treated with a novel microcurrent-generating antimicrobial dressing (MCD). Mean hospital length of stay was 2.3±0.9 days, while the mean length of treatment with MCD was 8.3±1.2 days. No major complications, PJI or major infectious complications were reported, with two readmissions (2%) within 30 days of surgery. Knee Society Score function showed statistically significant improvements post-operatively, with a mean six-month score of 75.0±20.3 and mean change from baseline of 36.3±21.1 (P<0.0001). These results support previous findings that use of the MCD may result in improved outcomes as an element in post-operative wound management. PMID:27433298

  17. Topical vs Intravenous Tranexamic Acid in Primary Total Hip Arthroplasty: A Double-Blind, Randomized Controlled Trial.

    PubMed

    North, Wayne T; Mehran, Nima; Davis, Jason J; Silverton, Craig D; Weir, Robb M; Laker, Michael W

    2016-05-01

    Tranexamic acid (TXA) reduces perioperative blood loss in total hip arthroplasty (THA). In our randomized control trial, 139 patients were enrolled and received 2 g of either topical or intravenous (IV) TXA. Preoperative and postoperative protocols were standardized. Calculated blood and Hgb loss were lower in the IV group (1195.0 ± 485.9 mL, 1442.7 ± 562.7 mL; P = .006), (160.3 [g] ± 63.8, 188.4 [g] ± 68.5; P = .014). There was a trend toward significance in transfusion reduction (11% [IV] vs 18% [topical]; P = .3). Both groups effectively reduced the transfusion rate. There was significant financial incentive for the use of TXA in THA with a savings of $314 per patient. IV and topical TXA are effective tools to reduce blood loss and transfusion costs in THA, and we recommend the IV form for ease of use. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Distribution and quantitation of skin iron in primary haemochromatosis: correlation with total body iron stores in patients undergoing phlebotomy.

    PubMed

    Pinheiro, Teresa; Silva, Raquel; Fleming, Rita; Gonçalves, Afonso; Barreiros, Maria A; Silva, João N; Morlière, Patrice; Santus, René; Filipe, Paulo

    2014-01-01

    Measurement of the concentration of iron in the skin, if correlated with total body iron stores, may enable better informed decisions on when to initiate, change or stop therapy in hereditary heamochromatosis. Naïve haemochromatosis patients with iron overload and with C282Y and/or H63D HFE mutations were evaluated at the following time-points: disease diagnosis, end of the therapy programme, and 6 months after the end of therapy. The distribution and concentration of iron in the skin were assessed by quantitative nuclear microscopy methods, in parallel with serum and plasma iron concentration. Iron content in the liver was determined by nuclear magnetic resonance. Iron accumulated in the epidermis; its concentration increased from outer to inner layers, being maximal in the basal layer (7.33 ± 0.98 µmol/g). At all 3 time-points, most of the iron was associated with the extracellular space. During the phlebotomy programme the iron content of the skin and the liver decreased by a factor of 2. These data suggest that measurements of iron concentration in the epidermis, which is a readily accessible tissue, reflect iron overload in the liver.

  19. Comparative cost-effectiveness of focal and total salvage 125I brachytherapy for recurrent prostate cancer after primary radiotherapy

    PubMed Central

    Piena, Marjanne A.; Steuten, Lotte M.G.; van der Voort van Zyp, Jochem R.N.; Moerland, Marinus A.; van Vulpen, Marco

    2016-01-01

    Purpose Focal salvage (FS) iodine 125 (125I) brachytherapy could be an effective treatment for locally radiorecurrent prostate cancer (PCa). Toxicity is often reduced compared to total salvage (TS) while cancer control can be maintained, which could increase cost-effectiveness. The current study estimates the incremental cost per quality-adjusted life year (QALY) of FS compared to TS. Material and methods A decision analytic Markov model was developed, which compares costs and QALYs associated with FS and TS. A 3-year time horizon was adopted with six month cycles, with a hospital perspective on costs. Probabilities for genitourinary (GU) and gastrointestinal (GI) toxicity and their impact on health-related quality of life (SF-36) were derived from clinical studies in the University Medical Center Utrecht (UMCU). Probabilistic sensitivity analysis, using 10,000 Monte Carlo simulations, was performed to quantify the joint decision uncertainty up to the recommended maximum willingness-to-pay threshold of €80,000/QALY. Results Focal salvage dominates TS as it results in less severe toxicity and lower treatment costs. Decision uncertainty is small, with a 97-100% probability for FS to be cost-effective compared to TS (€0-€80,000/QALY). Half of the difference in costs between FS and TS was explained by higher treatment costs of TS, the other half by higher incidence of severe toxicity. One-way sensitivity analyses show that model outcomes are most sensitive to utilities and probabilities for severe toxicity. Conclusions Focal salvage 125I brachytherapy dominates TS, as it has lower treatment costs and leads to less toxicity in our center. Larger comparative studies with longer follow-up are necessary to assess the exact influence on (biochemical disease free) survival and toxicity. PMID:28115953

  20. Sediment-adsorbed total mercury flux through Yolo Bypass, the primary floodway and wetland in the Sacramento Valley, California.

    PubMed

    Springborn, Michael; Singer, Michael Bliss; Dunne, Thomas

    2011-12-15

    The fate and transport of mercury are of critical concern in lowland floodplains and wetlands worldwide, especially those with a history of upstream mining that increases the mobility of both dissolved and sediment-bound Hg in watersheds. A mass budget of total mercury (THg) quantifies sources and storage for particular areas - knowledge that is required for understanding of management options in lowland floodplains. In order to assess contaminant risk in the largest flood-control bypass, prime wetland, and restoration target in the Sacramento River basin, we estimated empirical relationships between THg, suspended sediment concentration (SSC), and streamflow (Q) for each of the major inputs and outputs using data from various publicly available sources. These relationships were improved by incorporating statistical representations of the dynamics of seasonal and intra-flood exhaustion (hysteresis) of sediment and mercury. Using continuous records of Q to estimate SSC suspended sediment flux and SSC to estimate THg flux, we computed the net transfer of sediment-adsorbed mercury through the Yolo Bypass over a decade, 1993-2003. Flood control weirs spilling Sacramento River floodwaters into the bypass deliver ~75% of the water and ~50% of the river's suspended sediment load, while one Coast Range tributary of the bypass, Cache Creek, contributes twice the THg load of the mainstem Sacramento. Although estimated sediment flux entering Yolo Bypass is balanced by efflux to the Sacramento/San Francisco Bay-Delta, there is much evidence of deposition and remobilization of sediment in Yolo Bypass during flooding. These factors point to the importance of the bypass as sedimentary reservoir and as an evolving substrate for biogeochemical processing of heavy metals. The estimates of mercury flux suggest net deposition of ~500 kg in the 24,000 ha floodway over a decade, dominated by two large floods, representing a storage reservoir for this important contaminant. Copyright

  1. Comparative clinical study of the prophylaxis of heterotopic ossifications after total hip arthroplasty using etoricoxib or diclofenac.

    PubMed

    Winkler, Sebastian; Springorum, Hans-Robert; Vaitl, Tobias; Handel, Martin; Barta, Sabine; Kehl, Victoria; Craiovan, Benjamin; Grifka, Joachim

    2016-04-01

    This study investigated whether etoricoxib (COX-II blocker) has a superior efficacy of preventing heterotopic ossification (HO) after total hip arthroplasty (THA) compared to diclofenac (non-selective NSAID). One hundred patients were included (50 in each group) in this single centre, prospective, double-blinded, randomized, controlled trial. Etoricoxib (90 mg) was administered once and diclofenac (75 mg) twice per day for a perioperative period of nine days. The incidence of HO was evaluated on radiographs of the pelvis six months after surgery. Eighty nine of 100 (89 %) patients could be analysed. The overall HO incidence was 37.8 %. There was no significant difference between both study groups. Twelve patients (27.3 %) of the DIC group and 13 patients (28.9 %) of the ETO group showed Brooker grade I ossifications. Five patients (11.4 %) of the DIC and four patients of the ETO (8.9 %) group showed grade II HO formations. No class III or IV HO formations occured in both groups. Ad hoc analysis detected a negative correlation between HO incidence and limited abduction and internal rotation of the hip. Etoricoxib and diclofenac are equally effective for oral HO prophylaxis after primary cementless THA when given for nine peri-operative days to ensure a full recovery and high patient satisfaction.

  2. Minimum Lateral Bone Coverage Required for Securing Fixation of Cementless Acetabular Components in Hip Dysplasia

    PubMed Central

    Nakashima, Yasuharu; Nakamura, Tetsuro; Ito, Yoshihiro; Hara, Toshihiko

    2017-01-01

    Objectives. To determine the minimum lateral bone coverage required for securing stable fixation of the porous-coated acetabular components (cups) in hip dysplasia. Methods. In total, 215 primary total hip arthroplasties in 199 patients were reviewed. The average follow-up period was 49 months (range: 24–77 months). The lateral bone coverage of the cups was assessed by determining the cup center-edge (cup-CE) angle and the bone coverage index (BCI) from anteroposterior pelvic radiographs. Further, cup fixation was determined using the modified DeLee and Charnley classification system. Results. All cups were judged to show stable fixation by bone ingrowth. The cup-CE angle was less than 0° in 7 hips (3.3%) and the minimum cup-CE angle was −9.2° (BCI: 48.8%). Thin radiolucent lines were observed in 5 hips (2.3%), which were not associated with decreased lateral bone coverage. Loosening, osteolysis, dislocation, or revision was not observed in any of the cases during the follow-up period. Conclusion. A cup-CE angle greater than −10° (BCI > 50%) was acceptable for stable bony fixation of the cup. Considering possible errors in manual implantation, we recommend that the cup position be planned such that the cup-CE angle is greater than 0° (BCI > 60%). PMID:28299327

  3. Risk of Revision Following Total Hip Arthroplasty: Metal-on-Conventional Polyethylene Compared with Metal-on-Highly Cross-Linked Polyethylene Bearing Surfaces

    PubMed Central

    Paxton, Elizabeth; Cafri, Guy; Havelin, Leif; Stea, Susanna; Pallisó, Francesc; Graves, Stephen; Hoeffel, Daniel; Sedrakyan, Art

    2014-01-01

    The results of randomized controlled trials and systematic reviews have suggested reduced radiographic wear in highly cross-linked polyethylene compared with conventional polyethylene in primary total hip arthroplasty. However, longer-term clinical results have not been thoroughly examined, to our knowledge. The purpose of this study was to compare the risk of revision for metal-on-conventional and metal-on-highly cross-linked total hip arthroplasty bearing surfaces with use of a distributed data network of six national and regional registries (Kaiser Permanente, HealthEast, the Emilia-Romagna region in Italy, the Catalan region in Spain, Norway, and Australia). Inclusion criteria were osteoarthritis as the primary diagnosis, cementless implant fixation, and a patient age of forty-five to sixty-four years. These criteria resulted in a sample of 16,571 primary total hip arthroplasties. Multivariate meta-analysis was performed with use of linear mixed models, with survival probability as the unit of analysis. The results of a fixed-effects model suggested that there was insufficient evidence of a difference in risk of revision between bearing surfaces (hazard ratio, 1.20 [95% confidence interval, 0.80 to 1.79]; p = 0.384). Highly cross-linked polyethylene does not appear to have a reduced risk of revision in this subgroup of total hip arthroplasty patients. Arthroplasties involving highly cross-linked polyethylene do not appear to have an increased risk of revision in this subgroup of total hip arthroplasty patients. PMID:25520415

  4. Primary Total Hip Arthroplasty Using Third Generation Ceramic-Ceramic Articulation: Results after a Minimum of Three-years of Follow-up.

    PubMed

    Lee, Dong Woo; Hwang, Sung Kwan

    2014-06-01

    This study assessed the short term clinicoradiological results of primary total hip arthroplasty using third generation ceramic-ceramic articulation Accolade TMZF femoral stems. Two hundred and seventy two patients (294 hips) with primary total hip arthroplasty using third generation ceramic-ceramic articulation Accolade TMZF femoral stems who had been followed-up for a minimum of 3 years were included. Clinicoradiological results were analyzed and postoperative complications were observed. At final follow-up, mean Harris hip score was increased from 52 to 94 points. On radiogical evaluation, the average acetabular inclination was 42 degrees and the average acetabular anteversion was 15 degrees. Neither osteolysis nor loosening were observed around the acetabulum or proximal femur. Among 294 acetabular cups, 293 cups (99.66%) achieved stable fixation. Regarding the 294 femoral stems, 286 (97.28%) had bony fixation, 7 (2.38%) had fibrous fixation, and none were found to have unstable stem fixation. Proximal bone resorption was observed in 17 hips (5.78%; only Grade 1) and radiolucent lines were observed in 88 hips (29.93%), however, all were around the distal smooth portion of the stems. Postoperative complications included dislocation in 6 hips (2.04%), heterotopic ossification in 3 hips (1.02%), ceramic fractures in 4 hips (1.36%), superficial infection in 1 hip (0.34%), and squeaking in 8 hips (2.72%). The short term clinicoradiological results of primary total hip arthroplasty using third generation ceramic-ceramic articulation and Accolade TMZF femoral stems together with Secur-Fit acetabular cups were satisfactory. However, problems such as ceramic fractures and squeaking after arthroplasty were observed. Additional studies are necessary in order to develop methods that may reduce or eliminate these complications.

  5. Long-Term Primary Patency Rate After Nitinol Self-Expandable Stents Implantation in Long, Totally Occluded Femoropopliteal (TASC II C & D) Lesions.

    PubMed

    Elmahdy, Mahmoud Farouk; Buonamici, Piergiovanni; Trapani, Maurizio; Valenti, Renato; Migliorini, Angela; Parodi, Guido; Antoniucci, David

    2017-06-01

    Endovascular therapy for long femoropopliteal lesions using percutaneous transluminal balloon angioplasty or first-generation of peripheral stents has been associated with unacceptable one-year restenosis rates. However, with recent advances in equipment and techniques, a better primary patency rate is expected. This study was conducted to detect the long-term primary patency rate of nitinol self-expandable stents implanted in long, totally occluded femoropopliteal lesions TransAtlantic Inter-Society Census (TASC II type C & D), and determine the predictors of reocclusion or restenosis in the stented segments. The demographics, clinical, anatomical, and procedural data of 213 patients with 240 de novo totally occluded femoropopliteal (TASC II type C & D) lesions treated with nitinol self-expandable stents were retrospectively analysed. Of these limbs, 159 (66.2%) presented with intermittent claudication, while 81 (33.8%) presented with critical limb ischaemia. The mean-time of follow-up was 36±22.6 months, (range: 6.3-106.2 months). Outcomes evaluated were, primary patency rate and predictors of reocclusion or restenosis in the stented segments. The mean age of the patients was 70.9±9.3 years, with male gender 66.2%. Mean pre-procedural ABI was 0.45±0.53. One-hundred-and-seventy-five (73%) lesions were TASC II type C, while 65 (27%) were type D lesions. The mean length of the lesions was 17.9±11.3mm. Procedure related complications occurred in 10 (4.1%) limbs. There was no periprocedural mortality. Reocclusion and restenosis were detected during follow-up in 45 and 30 limbs respectively, and all were re-treated by endovascular approach. None of the patients required major amputation. Primary patency rates were 81.4±1.1%, 77.7±1.9% and 74.4±2.8% at 12, 24, and 36 months respectively. Male gender, severe calcification, and TASC II D lesion were independent predictors for reocclusion, while predictors of restenosis were DM, smoking and TASC II D lesions

  6. Results of a Second-generation Constrained Condylar Prosthesis in Complex Primary and Revision Total Knee Arthroplasty: A Mean 5.5-Year Follow-up

    PubMed Central

    Ye, Chen-Yi; Xue, De-Ting; Jiang, Shuai; He, Rong-Xin

    2016-01-01

    Background: The application of second-generation constrained condylar knee (CCK) prostheses has not been widely studied. This retrospective study was carried out to evaluate the clinical and radiographic outcomes of a second-generation CCK prosthesis for complex primary or revision total knee arthroplasty (TKA). Methods: In total, 51 consecutive TKAs (47 patients) were performed between June 2003 and June 2013 using second-generation modular CCK prostheses. The follow-up was conducted at 3rd day, 1st, 6th, and 12th months postoperatively and later annually. Anteroposterior (AP), lateral, skyline, and long-standing AP radiographs of the affected knees were taken. The Hospital for Special Surgery (HSS) Knee Score, the Knee Society Knee Score (KSKS), the Knee Society Function Score (KSFS), and range of motion (ROM) were also recorded. Heteroscedastic two-tailed Student's t-tests were used to compare the HSS score and the Knee Society score between primary and revision TKAs. A value of P < 0.05 was considered statistically significant. Results: Four knees (two patients) were lost to follow-up, and 47 knees (31 primary TKAs and 16 revision TKAs) had a mean follow-up time of 5.5 years. The mean HSS score improved from 51.1 ± 15.0 preoperatively to 85.3 ± 8.4 points at the final follow-up (P < 0.05). Similar results were observed in terms of the KSKS and KSFS, which improved from 26.0 ± 13.0 to 80.0 ± 12.2 and from 40.0 ± 15.0 to 85.0 ± 9.3 points, respectively (P < 0.05). No significant difference in the HSS, KSKS, KSFS, or ROM was found between primary and revision TKAs (P > 0.05). Two complications were observed in the revision TKA group (one intraoperative distal femur fracture and one recurrence of infection) while one complication (infection) was observed in the primary TKA group. No prosthesis loosening, joint dislocation, patella problems, tibial fracture, or nerve injury were observed. Radiolucent lines were observed in 4% of the knees without progressive

  7. Primary metastatic Ewing's family tumors: results of the Italian Sarcoma Group and Scandinavian Sarcoma Group ISG/SSG IV Study including myeloablative chemotherapy and total-lung irradiation.

    PubMed

    Luksch, R; Tienghi, A; Hall, K Sundby; Fagioli, F; Picci, P; Barbieri, E; Gandola, L; Eriksson, M; Ruggieri, P; Daolio, P; Lindholm, P; Prete, A; Bisogno, G; Tamburini, A; Grignani, G; Abate, M E; Podda, M; Smeland, S; Ferrari, S

    2012-11-01

    The Italian Sarcoma Group and the Scandinavian Sarcoma Group designed a joint study to improve the prognosis for patients with Ewing's family tumors and synchronous metastatic disease limited to the lungs, or the pleura, or a single bone. The study was opened in 1999 and closed to the enrollment in 2008. The program consisted of intensive five-drug combination chemotherapy, surgery and/or radiotherapy as local treatment, and consolidation treatment with high-dose busulfan/melphalan plus autologous stem cell rescue and total-lung irradiation. During the study period, 102 consecutive patients were enrolled. The median follow-up was 62 months (range 24-124). The 5-year event-free survival probability was 0.43 [standard deviation (SD) = 0.05] and the 5-year overall survival probability was 0.52 (SD = 0.052). Unfavorable prognostic factors emerging on multivariate analysis were a poor histological/radiological response at the site of the primary tumor [relative risk (RR) = 3.4], and incomplete radiological remission of lung metastases after primary chemotherapy (RR = 2.6). One toxic death and one secondary leukemia were recorded. This intensive approach is feasible and long-term survival is achievable in ∼50% of patients. New treatment approaches are warranted for patients responding poorly to primary chemotherapy.

  8. Predictors of Fecal Incontinence and Related Quality of Life After a Total Mesorectal Excision With Primary Anastomosis for Patients With Rectal Cancer

    PubMed Central

    Kornmann, Verena N. N.; Boerma, Djamila; de Roos, Marnix A. J.; van Westreenen, Henderik L.

    2015-01-01

    Purpose After total mesorectal excision (TME) with primary anastomosis for patients with rectal cancer, the quality of life (QoL) may be decreased due to fecal incontinence. This study aimed to identify predictors of fecal incontinence and related QoL. Methods Patients who underwent TME with primary anastomosis for rectal cancer between December 2008 and June 2012 completed the fecal incontinence quality of life scale (FIQoL) and Wexner incontinence score. Factors associated with these scores were identified using a linear regression analysis. Results A total of 80 patients were included. Multivariate analysis identified a diverting ileostomy (n = 58) as an independent predictor of an unfavorable outcome on the FIQoL subscale coping/behavior (P = 0.041). Ileostomy closure within and after 3 months resulted in median Wexner scores of 5.0 (interquartile range [IQR], 2.5-8.0) and 10.5 (IQR, 6.0-13.8), respectively (P < 0.001). The median FIQoL score was 15.0 (IQR, 13.1-16.0) for stoma closure within 3 months versus 12.0 (IQR, 10.5-13.9) for closure after 3 months (P = 0.001). Conclusion A diverting ileostomy is a predictor for an impaired FIQoL after a TME for rectal cancer. Stoma reversal within 3 months showed better outcomes than reversal after 3 months. Patients with a diverting ileostomy should be informed about the impaired QoL, even after stoma closure. PMID:25745623

  9. Doctor Referral of Overweight People to a Low-Energy Treatment (DROPLET) in primary care using total diet replacement products: a protocol for a randomised controlled trial.

    PubMed

    Jebb, Susan A; Astbury, Nerys M; Tearne, Sarah; Nickless, Alecia; Aveyard, Paul

    2017-08-04

    The global prevalence of obesity has risen significantly in recent decades. There is a pressing need to identify effective interventions to treat established obesity that can be delivered at scale. The aim of the Doctor Referral of Overweight People to a Low-Energy Treatment (DROPLET) study is to determine the clinical effectiveness, feasibility and acceptability of referral to a low-energy total diet replacement programme compared with usual weight management interventions in primary care. The DROPLET trial is a randomised controlled trial comparing a low-energy total diet replacement programme with usual weight management interventions delivered in primary care. Eligible patients will be recruited through primary care registers and randomised to receive a behavioural support programme delivered by their practice nurse or a referral to a commercial provider offering an initial 810 kcal/d low-energy total diet replacement programme for 8 weeks, followed by gradual food reintroduction, along with weekly behavioural support for 24 weeks. The primary outcome is weight change at 12 months. The secondary outcomes are weight change at 3 and 6 months, the proportion of participants achieving 5% and 10% weight loss at 12 months, and change in fat mass, haemoglobin A1c, low-density lipoprotein cholesterol and systolic and diastolic blood pressure at 12 months. Data will be analysed on the basis of intention to treat. Qualitative interviews on a subsample of patients and healthcare providers will assess their experiences of the weight loss programmes and identify factors affecting acceptability and adherence. This study has been reviewed and approved by the National Health ServiceHealth Research Authority (HRA)Research Ethics Committee (Ref: SC/15/0337). The trial findings will be disseminated to academic and health professionals through presentations at meetings and peer-reviewed journals and to the public through the media. If the intervention is effective, the results

  10. A Comparative Evaluation of the Efficacy of Etching by the Total Etch and Self-etch Dentin Bonding Systems in the Primary Teeth: An in vitro Study

    PubMed Central

    Chaugule, Vishwas; Katge, Farhin; Poojari, Manohar; Pujari, Prashant; Pammi, Thejokrishna

    2015-01-01

    ABSTRACT Objective: Early childhood caries is now affecting the children in dangerous proportions. There is a wide spread loss of the tooth material irrespective of the type of the carious lesion. Restoration of such lesions with a strong permanent bond between the dental tissues and the restorative dental materials would be a highly desirable requisite. Ultramorphological characterizations show that the interfacial morphology and the chemical characterization of the bonding systems appear to be strongly associated with each other and, therefore, observing and understanding the interfacial phenomenon and its quality would be of great importance in the selection of a dental adhesive for its use in pediatric restorative dentistry. Study design: Human primary molars, which were indicated for extraction, for an array of reasons like caries, normal exfoliation, pathological root resorption, over-retained and serial extraction, were collected for the study purpose. Total number of teeth was then equally distributed into two subgroups, each namely A1 (Prime and Bond NT) and A2 (Xeno III). Results: The type of etching pattern that was observed in group A1 (Prime and Bond NT) of Silverstone’s type II compared to the Silverstone’s type III observed in group A2 (Xeno III). Conclusion: Results of this study indicate that the use of an etchant separately followed by the application of the bonding system–Prime and Bond NT–would provide a better quality of adhesion thus improving the quality and longevity of the restoration done within the limits of enamel in primary dentition. How to cite this article: Mithiborwala SH, Chaugule V, Katge F, Poojari M, Pujari P, Pammi T. A Comparative Evaluation of the Efficacy of Etching by the Total Etch and Self-etch Dentin Bonding Systems in the Primary Teeth: An in vitro Study. Int J Clin Pediatr Dent 2015;8(1):30-36. PMID:26124578

  11. Comparison of Enoxaparin and Rivaroxaban in Balance of Anti-Fibrinolysis and Anticoagulation Following Primary Total Knee Replacement: A Pilot Study

    PubMed Central

    Xie, Jinwei; Ma, Jun; Huang, Qiang; Yue, Chen; Pei, Fuxing

    2017-01-01

    Background This study aimed to assess whether the efficacy of tranexamic acid (TXA) would be altered when rivaroxaban or enoxaparin was used for thromboprophylaxis in primary total knee replacement (TKR). It was hypothesized that the hemostatic effect of TXA would be better with the use of enoxaparin. Material/Methods A randomized clinical trial was conducted on 194 patients undergoing primary TKR for osteoarthritis. An intravenous dose of 15 mg/kg (TXA) and 1 g topical TXA were used. Patients randomly received enoxaparin or rivaroxaban prophylaxis when the drainage was less than 30 ml/h 6–8 h postoperatively. The primary endpoint was hidden blood loss (HBL). Indexes of total blood loss drainage, hemoglobin drop, transfusion, range of motion (ROM), HSS score, VAS pain score, knee swelling, length of hospital stay (LOHS), incidence of venous thromboembolism, major/minor bleeding, and wound complications were also compared between the groups. Results More than 80% of patients initiated anticoagulation within 6 h postoperatively. No statistically significance difference was detected in terms of HBL (679.0±205.6 vs. 770.5±206.1, p=.062) or other bleeding index, ROM, or LOHS. The motion VAS pain score and knee swelling (16.7% vs. 6.1%, p=.021) were significantly lower, and HSS score at discharge was higher in the enoxaparin group. The rivaroxaban group had less asymptomatic deep venous (4.1% vs. 0%, p=.121) and muscular venous thrombosis (2.1% vs. 9.2%, p=.033); more ecchymosis (13.5% vs. 10.2%, p=.472), and wound complications (13.5% vs. 6.1%, p=.082). No episodes of transfusion, pulmonary embolism, or major bleeding occurred in either group. Conclusions More attention should be paid to the increased risk of wound complications and knee swelling associated with rivaroxaban, although the hidden blood loss was similar in both groups. PMID:28174415

  12. Continued Inpatient Care After Primary Total Knee Arthroplasty Increases 30-Day Post-Discharge Complications: A Propensity Score-Adjusted Analysis.

    PubMed

    McLawhorn, Alexander S; Fu, Michael C; Schairer, William W; Sculco, Peter K; MacLean, Catherine H; Padgett, Douglas E

    2017-09-01

    Discharge destination, either home or skilled care facility, after total knee arthroplasty (TKA) may be associated with significant variation in postacute care outcomes. The purpose of this study was to characterize the 30-day postdischarge outcomes after primary TKA relative to discharge destination. All primary unilateral TKAs performed for osteoarthritis from 2011-2014 were identified in the National Surgical Quality Improvement Program database. Propensity scores based on predischarge characteristics were used to adjust for selection bias in discharge destination. Propensity-adjusted multivariable logistic regressions were used to examine associations between discharge destination and postdischarge complications. Among 101,256 primary TKAs identified, 70,628 were discharged home and 30,628 to skilled care facilities. Patients discharged to facilities were more frequently were female, older, higher body mass index class, higher Charlson comorbidity index and American Society of Anesthesiologists scores, had predischarge complications, received general anesthesia, and classified as nonindependent preoperatively. Propensity adjustment accounted for this selection bias. Patients discharged to skilled care facilities after TKA had higher odds of any major complication (odds ratio = 1.25; 95% confidence interval, 1.13-1.37) and readmission (odds ratio = 1.81; 95% confidence interval, 1.50-2.18). Skilled care was associated with increased odds for respiratory, septic, thromboembolic, and urinary complications. Associations with death, cardiac, and wound complications were not significant. After controlling for predischarge characteristics, discharge to skilled care facilities vs home after primary TKA is associated with higher odds of numerous complications and unplanned readmission. These results support coordination of care pathways to facilitate home discharge after hospitalization for TKA whenever possible. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Thirty-day postoperative complications following primary total knee arthroplasty: A retrospective study of incidence and risk factors at a single center in China.

    PubMed

    Feng, Bin; Lin, Jin; Jin, Jin; Qian, Wen-Wei; Wang, Wei; Weng, Xi-Sheng

    2017-08-16

    Total knee arthroplasty (TKA) may be associated with serious complications that adversely affect outcomes and increase the likelihood of disability. However, few studies with sufficient sample size have reported postoperative complications following TKA among Chinese patients. This study aimed to evaluate complications of TKA within 30 postoperative days and to identify the related risk factors. A retrospective complication-based analysis of TKA using the arthroplasty registry between 2008 and 2013 was performed by summarizing complications of TKA within 30 postoperative days. Multivariate logistic regression was used to identify the predicting factors for complications 30 days after operation. A total of 1542 patients underwent 2254 primary TKA between January 2008 and December 2013. A total of 137 complications occurred within 30 days after operation with an incidence rate of 6.1%. The incidence rate of major systemic complications within postoperative 30 days was 2.3%, with cardiovascular and respiratory complications as the most common complications. The incidence rates of deep venous thrombosis (DVT) and local complications were 2.4% and 1.0%, respectively. The 30-day postoperative mortality rate was 0.1% (3/2254). Multivariate logistic regression analyses identified body mass index (BMI) of ≥30.0 kg/m2 (odds ratio [OR]: 1.47) and age ≥80 years (OR: 1.87) as significant risk factors for postoperative systemic complications. A BMI of ≥30.0 kg/m2 was a significant risk factor for DVT (OR: 2.86) and other complications (OR: 2.11). The comorbidity of diabetes was a risk factor for postoperative mortality (OR: 19.20). This study highlighted complications with cardiac and respiratory origins as the most common complications within 30 postoperative days following primary TKA. The BMI of ≥30.0 kg/m2 and age ≥80 years were significant risk factors for 30-day postoperative complications.

  14. Primary Total Hip Arthroplasty With Fourth-Generation Ceramic-on-Ceramic: Analysis of Complications in 939 Consecutive Cases Followed for 2-10 Years.

    PubMed

    Buttaro, Martin A; Zanotti, Gerardo; Comba, Fernando M; Piccaluga, Francisco

    2017-02-01

    Delta ceramics may be the bearing of choice for younger and active patients due to its improved toughness and wear characteristics, provided there is no risk of fracture. However, ceramic fracture is the most serious complication related to this type of bearing. Although millions of Delta ceramics have been implanted worldwide, short to midterm results have been scarcely reported in the literature. The purpose of this study was to report the complication rate at short to midterm follow-up associated with the bearing surface used in a series of primary total hip arthroplasties with Delta ceramic-on-ceramic bearings performed in a single institution. A total of 939 cases (880 patients) undergoing primary total hip arthroplasty with fourth-generation Delta ceramic-on-ceramic bearings were retrospectively reviewed. They were followed for an average of 5.3 years (2-10 years). One hip experienced a liner fracture, 2 cups presented early loosening due to friction between the acetabular screw and the backside of the liner, one femoral ball head had a fracture; one case of squeaking was reported, which is impending revision. Considering revision or impending revision in relationship with the bearing surface as the end point, the mean survival rate was 99.3% (confidence interval 95%, 98.3%-99.7%) at 2-10 years. This study showed a low rate of ceramic fracture compared with others; however, it was much higher than the complication rate presented by the manufacturers. The complications observed were directly related to technical errors that surgeons should avoid when using this type of surface. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Impact of Chronic Total Occlusion in a Noninfarct-related Artery on Clinical Outcomes in Patients With Acute ST-elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

    PubMed Central

    Zhang, Hui-Ping; Zhao, Ying; Li, Hui; Tang, Guo-Dong; Ai, Hu; Zheng, Nai-Xin; Liu, Jing-Hua; Sun, Fu-Cheng

    2016-01-01

    Abstract In the setting of primary percutaneous coronary intervention (PCI), encountering with chronic total occlusion (CTO) in a noninfarct-related artery (IRA) is not a rare situation. Limited information on the impact of CTO on clinical outcomes in acute ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI has raised more concerns. The aim of the present study was to evaluate the effect of concurrent CTO in a non-IRA on the clinical outcomes in patients with STEMI undergoing primary PCI. In the present prospective study, 555 consecutive patients with STEMI who underwent early primary PCI from January 2010 to December 2013 were included. The patients were divided into 2 groups: no CTO and CTO. Data on 12 months follow-up was obtained from 449 patients. The primary endpoint was the composite of hospitalization from angina, reinfarction, heart failure, or re-revascularization, and cardiac death at 12 months follow-up. Of the 555 patients, 75 (13.5%) had CTO in a non-IRA. Compared with patients in no CTO group, more patients in CTO group had hypertension (62.7% vs 46.5%, P = 0.009), diabetes (49.3% vs 35.0%, P = 0.024), and 3-vessel disease (52.0% vs 32.3%, P = 0.001). Patients with CTO had a lower left ventricular ejection fraction (LVEF) (40.1% ± 16.8% vs 54.3% ± 12.1%, P = 0.038), more presented with cardiogenic shock on admission (13.3% vs 4.8%, P = 0.008), compared with patients without CTO. Complete revascularization (CR) was less achieved in CTO group than in no CTO group (33.3% vs 49.1%, P = 0.013). The 12-month cardiac mortality rate was 14.5% versus 6.2% (P = 0.039), the incidence of 12-month primary endpoint was 38.7% versus 21.2% (P = 0.003) for CTO and no CTO group, respectively. Multivariate analysis revealed that after correction for baseline differences, CTO in a non-IRA (hazard ratio 4.183, 95% confidence interval 1.940–6.019, P = 0.001), cardiogenic shock on admission (hazard

  16. The impact of food and nutrient-based standards on primary school children's lunch and total dietary intake: a natural experimental evaluation of government policy in England.

    PubMed

    Spence, Suzanne; Delve, Jennifer; Stamp, Elaine; Matthews, John N S; White, Martin; Adamson, Ashley J

    2013-01-01

    In 2005, the nutritional content of children's school lunches in England was widely criticised, leading to a major policy change in 2006. Food and nutrient-based standards were reintroduced requiring primary schools to comply by September 2008. We aimed to determine the effect of the policy on the nutritional content at lunchtime and in children's total diet. We undertook a natural experimental evaluation, analysing data from cross-sectional surveys in 12 primary schools in North East England, pre and post policy. Dietary data were collected on four consecutive days from children aged 4-7 years (n = 385 in 2003-4; n = 632 in 2008-9). We used linear mixed effect models to analyse the effects of gender, year, and lunch type on children's mean total daily intake. Both pre- and post-implementation, children who ate a school lunch consumed less sodium (mean change -128 mg, 95% CI: -183 to -73 mg) in their total diet than children eating home-packed lunches. Post-implementation, children eating school lunches consumed a lower % energy from fat (-1.8%, -2.8 to -0.9) and saturated fat (-1.0%; -1.6 to -0.5) than children eating packed lunches. Children eating school lunches post implementation consumed significantly more carbohydrate (16.4 g, 5.3 to 27.6), protein (3.6 g, 1.1 to 6.0), non-starch polysaccharides (1.5 g, 0.5 to 1.9), vitamin C (0.7 mg, 0.6 to 0.8), and folate (12.3 µg, 9.7 to 20.4) in their total diet than children eating packed lunches. Implementation of school food policy standards was associated with significant improvements in the nutritional content of school lunches; this was reflected in children's total diet. School food- and nutrient-based standards can play an important role in promoting dietary health and may contribute to tackling childhood obesity. Similar policy measures should be considered for other environments influencing children's diet.

  17. WHO/ISH total risk approach for primary prevention of cardiovascular disease shows greater decrease in costs for women but not the elderly in Jamaica.

    PubMed

    Abdulkadri, Abdullahi O; Tulloch-Reid, Marshall K; Francis, Damian K; Gordon-Strachan, Georgiana M; Younger-Coleman, Novie O; Rocke, Kern D; McFarlane, Shelly R; Cunningham-Myrie, Colette A; Ferguson, Trevor S; Wilks, Rainford J; Anderson, Simon G

    2015-09-01

    To investigate cost savings from and implications of replacing the single risk with a total cardiovascular risk approach in primary prevention of cardiovascular disease (CVD). A cost analysis using data from the 2007-08 Jamaica Health and Lifestyle Survey of 1,432 persons aged 40 years and older with 10-year risk estimated from region-specific World Health Organization/International Society for Hypertension (WHO/ISH) CVD risk charts. The WHO/ISH and local treatment guidelines were used to cost lifestyle changes, medications, and provider visits. Use of the total cardiovascular risk approach was less costly regardless of age. Women showed greater cost disparity. However, if 10-year CVD risk was estimated without measured cholesterol, both approaches resulted in similar costs in men ≥60 years. The annual per capita cost of lifestyle recommendations, critical in the absence of pharmacotherapy, was estimated at US $869.05 for diet and US $80 for physical activity. This represents about a third of the annual income of a minimum wage earner. At the national level, implementation of the WHO/ISH total risk approach could reduce health care costs by US $5 million annually. Cost savings that mainly resulted from reduced care for women may lead to gender disparity in CVD outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Laparoscopic Totally Extraperitoneal Groin Hernia Repair Using a Self-Gripping Mesh: Clinical Results of 235 Primary and Recurrent Groin Hernias.

    PubMed

    Ozmen, John; Choi, Vincent; Hepburn, Kirsten; Hawkins, Will; Loi, Ken

    2015-11-01

    Compared with open surgery, laparoscopic groin hernia repair has been shown to significantly reduce postoperative pain. However, chronic pain remains a problem with the laparoscopic approach, affecting approximately 10% of patients. The purpose of this study was to evaluate clinical outcomes following the use of Parietex ProGrip™ (Covidien, Dublin, Ireland) self-gripping mesh during laparoscopic totally extraperitoneal groin hernia repair. Data were collected prospectively from 145 male and 15 female patients with 235 inguinal hernias. All patients underwent repair by the laparoscopic totally extraperitoneal approach using Parietex ProGrip mesh. During follow-up ranging from 5 to 24 months, complications, pain score, patient satisfaction, and recurrence were analyzed. All patients were discharged on the day of surgery or the next morning. There were no immediate complications or returns to the operating room. Delayed postoperative complications included minor bruising to the genital region (3 cases), hematoma/seroma (1 case), and wound infection (1 case). The mean follow-up was 15 months, at which time there were no reports of hernia recurrence and 99% of patients were satisfied with their hernia repair. One patient (0.63%) reported severe pain (numeric rating scale score of >7), and 4 patients (2.5%) reported intermittent mild pain on exertion. The results of this study suggest that the use of a self-gripping mesh during the laparoscopic totally extraperitoneal approach is a promising and effective technique for repairing both primary and recurrent inguinal hernias.

  19. Study of bone remodeling of two models of femoral cementless stems by means of DEXA and finite elements

    PubMed Central

    2010-01-01

    Background A hip replacement with a cemented or cementless femoral stem produces an effect on the bone called adaptive remodelling, attributable to mechanical and biological factors. All of the cementless prostheses designs try to achieve an optimal load transfer in order to avoid stress-shielding, which produces an osteopenia. Long-term densitometric studies taken after implanting ABG-I and ABG-II stems confirm that the changes made to the design and alloy of the ABG-II stem help produce less proximal atrophy of the femur. The simulation with FE allowed us to study the biomechanical behaviour of two stems. The aim of this study was, if possible, to correlate the biological and mechanical findings. Methods Both models with prostheses ABG-I and II have been simulated in five different moments of time which coincide with the DEXA measurements: postoperative, 6 months, 1, 3 and 5 years, in addition to the healthy femur as the initial reference. For the complete comparative analysis of both stems, all of the possible combinations of bone mass (group I and group II of pacients in two controlled studies for ABG-I and II stems, respectively), prosthetic geometry (ABG-I and ABG-II) and stem material (Wrought Titanium or TMZF) were simulated. Results and Discussion In both groups of bone mass an increase of stress in the area of the cancellous bone is produced, which coincides with the end of the HA coating, as a consequence of the bottleneck effect which is produced in the transmission of loads, and corresponds to Gruen zones 2 and 6, where no osteopenia can be seen in contrast to zones 1 and 7. Conclusions In this study it is shown that the ABG-II stem is more effective than the ABG-I given that it generates higher tensional values on the bone, due to which proximal bone atrophy diminishes. This biomechanical behaviour with an improved transmission of loads confirmed by means of FE simulation corresponds to the biological findings obtained with Dual-Energy X

  20. Interaction of chronic total occlusion and chronic kidney disease in patients undergoing primary percutaneous coronary intervention for acute ST-elevation myocardial infarction.

    PubMed

    Bataille, Yoann; Plourde, Guillaume; Machaalany, Jimmy; Abdelaal, Eltigani; Déry, Jean-Pierre; Larose, Eric; Déry, Ugo; Noël, Bernard; Barbeau, Gérald; Roy, Louis; Costerousse, Olivier; Bertrand, Olivier F

    2013-07-15

    Chronic total occlusion (CTO) in a non-infarct-related artery and chronic kidney failure (CKD) are associated with worse outcomes after primary percutaneous coronary intervention (PCI). The aim of this study was to investigate the interaction of CTO and CKD in patients who underwent primary PCI for acute ST-segment elevation myocardial infarction (STEMI). Patients with STEMIs with or without CKD, defined as an estimated glomerular filtration rate <60 ml/min/1.73 m(2), were categorized into those with single-vessel disease and those with multivessel disease with or without CTO. The primary outcomes were the incidence of 30-day and 1-year mortality. Among 1,873 consecutive patients with STEMIs included between 2006 and 2011, 336 (18%) had CKD. The prevalence of CTO in a non-infarct-related artery was 13% in patients with CKD compared with 7% in those without CKD (p = 0.0003). There was a significant interaction between CKD and CTO on 30-day mortality (p = 0.018) and 1-year mortality (p = 0.013). Independent predictors of late mortality in patients with CKD were previous myocardial infarction (hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.01 to 2.79), age >75 years (HR 1.86, 95% CI 1.19 to 2.95), a left ventricular ejection fraction after primary PCI <40% (HR 2.20, 95% CI 1.36 to 3.63), left main culprit artery (HR 4.46, 95% CI 1.64 to 10.25), and shock (HR 7.44, 95% CI 4.56 to 12.31), but multivessel disease with CTO was not a predictor. In contrast, multivessel disease with CTO was an independent predictor of mortality in patients without CKD (HR 3.30, 95% CI 1.70 to 6.17). In conclusion, in patients with STEMIs who underwent primary PCI, with preexisting CKD, the prevalence of CTO in a non-infarct-related artery was twice as great. In these patients, the clinical impact of CTO seems to be overshadowed by the presence of CKD. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Correlations between serum adipocytokine concentrations, disease stage, radiological status and total body fat content in the patients with primary knee osteoarthritis.

    PubMed

    Richter, Magdalena; Trzeciak, Tomasz; Rybka, Jakub Dalibor; Suchorska, Wiktoria; Augustyniak, Ewelina; Lach, Michał; Kaczmarek, Małgorzata; Kaczmarczyk, Jacek

    2017-05-01

    The study was designed to investigate whether serum concentrations of leptin, resistin and adiponectin in obese and normal-weight patients with primary knee osteoarthritis (OA) correlate with clinical and radiological stages of the disease and percentage of total body fat. Seventy-three patients with knee OA, divided into obese and normal-weight groups, were clinically evaluated according to the Knee Society Score (KSS), and radiologically assessed using Kellgren and Lawrence scale. The percentage of total body fat and some anthropometric data were also given. Serum leptin, resistin and adiponectin concentrations were measured by Elisa and were correlated with the clinical, radiological and anthropometric parameters. Leptin concentrations were significantly higher (p = 0.001) in the obese patients and positively correlated (R = 0.63) with radiologically assessed OA grade, but only in the normal-weight group. Resistin and adiponectin concentrations were identical in obese and normal-weight patients and negatively correlated (R = -0.41) with the clinical status of obese patients. In both groups, percentage of total body fat positively correlated (R = 0.29 and R = 0.53 for obese and normal-weight respectively) with radiologically assessed OA grade. However, no correlations were found with clinical status of the patients. It was found that in the obese patients with knee OA, increased percentage of total body fat and elevated serum leptin concentration might favour the advancement of clinical but not radiologically assessed changes in the joint structures, while in normal-weight patients it correlates only with radiologically assessed changes but does not affect to an appreciable extent the clinical status of the patients.

  2. Predictors of Facility Discharge, Range of Motion, and Patient-Reported Physical Function Improvement Following Primary Total Knee Arthroplasty: A Prospective CohortAnalysis

    PubMed Central

    M.Rissman, Cody; Keeney, Benjamin J.; Ercolano, Ellyn M.; Koenig, Karl M.

    2015-01-01

    Patients are discharged to home or inpatient settings following primary unilateral total knee arthroplasty (TKA). We identified predictors of inpatient discharge and 3-month postoperative range of motion (ROM) and patient-reported physical function improvement (VR12 PCS) between these discharge settings. We studied prospectively collected cohortdata for 738 TKAs between April 2011 and April 2013. Significant adjusted predictors of inpatient discharge included older age, female gender, surgeon, comorbidity, lower PCS, and BMI >40. Only lower preoperative ROM predicted postoperative ROM. Inpatient discharge and higher preoperative PCS predicted lower PCS improvement. Home-based rehabilitation was associated with greater 3-month PCS improvement and showed no difference with 3-month ROM. TKA inpatient discharge should be based on patient care requirements rather than perceived benefit of improved ROM and physical function. PMID:26483260

  3. An Assessment of Gender-Specific Risk of Implant Revision After Primary Total Hip Arthroplasty: A Systematic Review and Meta-analysis.

    PubMed

    Towle, Kevin M; Monnot, Andrew D

    2016-12-01

    Total hip arthroplasty (THA) has been a successful reconstructive procedure to mitigate pain associated with diseases of the hip joint. However, some THA procedures require revision due to mechanical or biological failure. The purpose of this study was to synthesize and examine the evidence on the relative risk of revision in men and women after primary THA procedures. We conducted a systematic literature review of cohort studies reporting THA revision risk estimate by gender. Study quality scoring and a random effects meta-analysis were performed to estimate the meta-relative risk (meta-RR) and corresponding 95% confidence interval (95% CI) of revision, comparing men to women. Males had a statistically significant increased risk of revision after primary THA (meta-RR = 1.33 [95% CI: 1.13-1.57]), when compared to females. When stratified by cause of revision, males had a statistically significant increased risk of revision due to any cause (meta-RR = 1.16 [95% CI: 1.01-1.33]), aseptic loosening (meta-RR = 1.54 [95% CI: 1.05-2.25]), and infection (meta-RR = 1.55 [95% CI: 1.11-2.15]). For primary THA operations performed during the 2000s, males in Europe had a statistically significant increased risk of revision (meta-RR 1.42 [95% CI: 1.25-1.61]) while males in the United States had a statistically significant decreased risk of revision (meta-RR 0.80 [95% CI: 0.72-0.89]). These results provide evidence for an increased risk of revision after THA among males, which may be impacted by geographic location and time period of operation. Findings suggest that a better understanding of the underlying drivers of gender-specific risks would help reduce postsurgery complications. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Total Lignans of Schisandra chinensis Ameliorates Aβ1-42-Induced Neurodegeneration with Cognitive Impairment in Mice and Primary Mouse Neuronal Cells.

    PubMed

    Zhao, Xu; Liu, Chunmei; Xu, Mengjie; Li, Xiaolong; Bi, Kaishun; Jia, Ying

    2016-01-01

    Lignan compounds extracted from Schisandra chinensis (Turcz.) Baill. have been reported to possess various biological activities, and have potential in the treatment of Alzheimer's disease. This study was designed to investigate the effects of total lignans of Schisandra chinensis (TLS) on cognitive function and neurodegeneration in the model of AD induced by Aβ1-42 in vivo and in vitro. It was found that intragastric infusion with TLS (50 and 200 mg/kg) to Aβ1-42-induced mice significantly increased the number of avoidances in the shuttle-box test and swimming time in the target quadrant in the Morris water maze test. TLS at dose of 200 mg/kg significantly restored the activities of total antioxidant capacity (T-AOC), as well as the level of malondialdehyde (MDA) both in the hippocampus and cerebral cortex in mice. Results of histopathological examination indicated that TLS noticeably ameliorated the neurodegeneration in the hippocampus in mice. On the other hand, TLS (100 μM) could protect the Aβ1-42-induced primary mouse neuronal cells by blocking the decrease of mitochondrial membrane potential (MMP), change the expressions of Bcl-2 (important regulator in the mitochondria apoptosis pathway). Moreover, TLS also decreased the activity of β-secretase 1 (BACE1), crucial protease contributes to the hydrolysis of amyloid precursor protein (APP), and inhibited the expression of JKN/p38, which involved in the MAPKs signaling pathways in both mice and primary mouse neuronal cells. In summary, TLS might protect against cognitive deficits and neurodegeneration by releasing the damage of oxidative stress, inhibiting the expression of BACE1 and the MAPKs inflammatory signaling pathways.

  5. The efficacy of multimodal high-volume wound infiltration in primary total knee replacement in facilitating immediate post-operative pain relief and attainment of early rehabilitation milestones.

    PubMed

    Banerjee, Purnajyoti

    2014-05-01

    Inadequate pain relief after lower limb joint replacement surgery has been a well-recognised limiting factor affecting post-operative mobilisation and length of hospital stay. Multimodal local wound infiltration with local anaesthetics, adrenaline and non-steroidal anti-inflammatory agents can lower the opiate intake, reduce the length of stay and enhance early mobilisation in knee replacement patients. A retrospective review of 64 patients undergoing primary total knee replacement was undertaken. Thirty-two patients (cases) had their wounds infiltrated with ropivacaine, adrenaline and ketorolac by the operating surgeon, intraoperatively. Subsequently, a 19G wound catheter placed into the knee joint. They received two further top-up doses of the same combination at 10 and 20 h post-operatively. This group was compared with a control group of 32 patients who did not receive any local infiltration. Both groups were comparable in terms of BMI and age. Post-operative opiate drug consumption in first 48 h after surgery, length of hospital stays and time taken to mobilise after surgery were recorded. There was significant reduction in opiate consumption in the treatment group with an average consumption of 49.35 mg of morphine compared to 71.48 mg in the control group (p = 0.004). The median length of hospital stay was significantly reduced from 5 days in the control group to 4 days in the treatment group (p = 0.03). The patients in the treatment group mobilised around 19 h earlier (p = 0.001). No major post-operative complications were encountered in either group. Wound infiltration is an effective and safe technique that promotes early rehabilitation and discharge of patients following primary total knee replacement.

  6. Total Lignans of Schisandra chinensis Ameliorates Aβ1-42-Induced Neurodegeneration with Cognitive Impairment in Mice and Primary Mouse Neuronal Cells

    PubMed Central

    Zhao, Xu; Liu, Chunmei; Xu, Mengjie; Li, Xiaolong; Bi, Kaishun; Jia, Ying

    2016-01-01

    Lignan compounds extracted from Schisandra chinensis (Turcz.) Baill. have been reported to possess various biological activities, and have potential in the treatment of Alzheimer’s disease. This study was designed to investigate the effects of total lignans of Schisandra chinensis (TLS) on cognitive function and neurodegeneration in the model of AD induced by Aβ1–42 in vivo and in vitro. It was found that intragastric infusion with TLS (50 and 200 mg/kg) to Aβ1–42-induced mice significantly increased the number of avoidances in the shuttle-box test and swimming time in the target quadrant in the Morris water maze test. TLS at dose of 200 mg/kg significantly restored the activities of total antioxidant capacity (T-AOC), as well as the level of malondialdehyde (MDA) both in the hippocampus and cerebral cortex in mice. Results of histopathological examination indicated that TLS noticeably ameliorated the neurodegeneration in the hippocampus in mice. On the other hand, TLS (100 μM) could protect the Aβ1–42-induced primary mouse neuronal cells by blocking the decrease of mitochondrial membrane potential (MMP), change the expressions of Bcl-2 (important regulator in the mitochondria apoptosis pathway). Moreover, TLS also decreased the activity of β-secretase 1 (BACE1), crucial protease contributes to the hydrolysis of amyloid precursor protein (APP), and inhibited the expression of JKN/p38, which involved in the MAPKs signaling pathways in both mice and primary mouse neuronal cells. In summary, TLS might protect against cognitive deficits and neurodegeneration by releasing the damage of oxidative stress, inhibiting the expression of BACE1 and the MAPKs inflammatory signaling pathways. PMID:27035824

  7. Effect of local anaesthetic wound infiltration on acute pain and bleeding after primary total hip arthroplasty: the EDIPO randomised controlled study.

    PubMed

    Villatte, Guillaume; Engels, Emilien; Erivan, Roger; Mulliez, Aurélien; Caumon, Nicolas; Boisgard, Stéphane; Descamps, Stéphane

    2016-11-01

    Total hip arthroplasty (THA) is considered a painful procedure with significant blood loss. The aim of the this study was to determine whether local infiltration analgaesia (LIA) (with long-acting local anaesthetics and epinephrine) during THA could reduce acute postoperative pain, improve early recovery and reduce per- and postoperative bleeding. One hundred and fifty patients scheduled for primary THA were randomised into two groups. The treatment group received LIA (ropivacaine with epinephrine), whereas the control group had no infiltration. Pain intensity was measured with a visual analogue scale (VAS) for the duration of hospital stay and analgaesic consumption. Length of hospital stay, time to get out of bed alone and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index at 3, 6 and 12 months were recorded to evaluate recovery. Per- and postoperative bleeding were evaluated using direct and indirect criteria (operative blood loss, haemoglobin, estimation of uncompensated blood loss and red blood cell transfusion). Patients with LIA had significantly less pain during the first 24 h (p = 0.04). No significant differences were found in terms of analgaesic consumption (p = 0.57), early and delayed recovery or bleeding between groups. Operative wound infiltration of LIA reduced acute pain after primary THA but did not improve recovery or influence per- and postoperative bleeding.

  8. Secondary rotator cuff dysfunction following total shoulder arthroplasty for primary glenohumeral osteoarthritis: results of a multicenter study with more than five years of follow-up.

    PubMed

    Young, Allan A; Walch, Gilles; Pape, Guido; Gohlke, Frank; Favard, Luc

    2012-04-18

    Secondary rotator cuff dysfunction is a recognized complication following shoulder arthroplasty. We hypothesized that the rate of secondary rotator cuff dysfunction would increase with follow-up and result in less satisfactory clinical and radiographic outcomes. Our aim was to investigate the rate of secondary rotator cuff dysfunction following shoulder arthroplasty for primary osteoarthritis and identify factors associated with the dysfunction. Between 1991 and 2003, in ten European centers, 704 total shoulder arthroplasties were performed for primary glenohumeral osteoarthritis. Complete radiographic and clinical follow-up of more than five years was available for 518 shoulders. The diagnosis of secondary rotator cuff dysfunction was made when moderate or severe superior subluxation of the prosthetic humeral head was present on radiographs. Multivariate logistic regression identified factors associated with the development of rotator cuff dysfunction. Kaplan-Meier survivorship analysis was performed, with the end point being secondary rotator cuff failure. Clinical outcome was assessed with use of the Constant score, a subjective assessment of the shoulder, and an evaluation of shoulder motion. At an average of 103.6 months (range, sixty to 219 months) after shoulder arthroplasty, the rate of secondary rotator cuff dysfunction was 16.8%. Survivorship free of secondary cuff dysfunction was 100% at five years, 84% at ten years, and 45% at fifteen years. Duration of follow-up (p < 0.0001), implantation of the glenoid implant with superior tilt (p < 0.001), and fatty infiltration of the infraspinatus muscle (p < 0.05) were risk factors for the development of secondary cuff dysfunction. Patients with secondary rotator cuff dysfunction had significantly worse clinical outcomes (Constant score, subjective assessment, and range of motion; p < 0.0001) and radiographic results (radiolucent line score, radiographic loosening, glenoid component migration; p < 0.0001). In

  9. Optimization of custom cementless stem using finite element analysis and elastic modulus distribution for reducing stress-shielding effect.

    PubMed

    Saravana Kumar, Gurunathan; George, Subin Philip

    2017-02-01

    This work proposes a methodology involving stiffness optimization for subject-specific cementless hip implant design based on finite element analysis for reducing stress-shielding effect. To assess the change in the stress-strain state of the femur and the resulting stress-shielding effect due to insertion of the implant, a finite element analysis of the resected femur with implant assembly is carried out for a clinically relevant loading condition. Selecting the von Mises stress as the criterion for discriminating regions for elastic modulus difference, a stiffness minimization method was employed by varying the elastic modulus distribution in custom implant stem. The stiffness minimization problem is formulated as material distribution problem without explicitly penalizing partial volume elements. This formulation enables designs that could be fabricated using additive manufacturing to make porous implant with varying levels of porosity. Stress-shielding effect, measured as difference between the von Mises stress in the intact and implanted femur, decreased as the elastic modulus distribution is optimized.

  10. Comparison of synovial fluid, urine, and serum ion levels in metal-on-metal total hip arthroplasty at a minimum follow-up of 18 years.

    PubMed

    Lass, Richard; Grübl, Alexander; Kolb, Alexander; Stelzeneder, David; Pilger, Alexander; Kubista, Bernd; Giurea, Alexander; Windhager, Reinhard

    2014-09-01

    Diagnosis of adverse reactions to metal debris in metal-on-metal hip arthroplasty is a multifactorial process. Systemic ion levels are just one factor in the evaluation and should not be relied upon solely to determine the need for revision surgery. Furthermore, the correlation between cobalt or chromium serum, urine, or synovial fluid levels and adverse local tissue reactions is still incompletely understood. The hypothesis was that elevated serum and urine metal-ion concentrations are associated with elevated local metal-ion concentrations in primary total hip arthroplasties (THA) and with failure of metal-on-metal articulations in the long-term. In our present study, we evaluated these concentrations in 105 cementless THA with metal-on-metal articulating surfaces with small head diameter at a minimum of 18 years postoperatively. Spearman correlation showed a high correlation between the joint fluid aspirate concentration of cobalt and chromium with the serum cobalt (r = 0.81) and chromium level (r = 0.77) in patients with the THA as the only source of metal-ions. In these patients serum metal-ion analysis is a valuable method for screening. In patients with more than one source of metal or renal insufficiency additional investigations, like joint aspirations are an important tool for evaluation of wear and adverse tissue reactions in metal-on-metal THA.

  11. Evaluation of current practices in surgical antimicrobial prophylaxis in primary total hip prosthesis--a multicentre survey in private and public French hospitals.

    PubMed

    Quenon, J-L; Eveillard, M; Vivien, A; Bourderont, D; Lepape, A; Lathelize, M; Jestin, C

    2004-03-01

    Deep wound infection is a rare but dreaded postoperative complication after total hip prosthesis (THP) procedures but its incidence can be reduced by systemic antimicrobial prophylaxis. The objective of the present study was to evaluate whether antimicrobial prophylaxis for elective primary THP in patients without any history of hip infection, in orthopaedic wards, participating on a voluntary basis, in French public hospitals and private institutions, complies with published guidelines. Three types of data were collected from anaesthetic and surgical records (November 2000-January 2001) in participating hospitals: (1) administrative data on the hospitals and orthopaedic wards, (2) data on patients, (3) data on compliance of practices with five critical criteria derived from published French guidelines. These criteria concerned administration of prophylaxis, choice of antimicrobial agent, dose of first injection, timing of administration and total length of prophylaxis. Thirty institutions sent data files on 1257 THPs to the coordination centre. Compliance exceeded 80% for all criteria except one (interval between first and second injection). Cumulative compliance with the five criteria was 66.9%. Major compliance failures were an inappropriate interval between the first injection and incision, and total antimicrobial prophylaxis exceeding 48 h. Cumulative compliance was 87.9% in teaching hospitals, 61.8% in general hospitals and 67.7% in private institutions (P<1 x 10(-6)). It was slightly higher when the annual number of interventions was > or =100 (69.4 versus 62.3%; P<0.02). Although the protocol for antimicrobial prophylaxis in THP was clear and easy, one-third of practices did not conform with all five standards. Knowledge of the results by the participating institutions should encourage them to set up working groups to draft care protocols for THP and other surgical interventions, in order to improve practice and perhaps reduce costs.

  12. Correlation of the Caprini Score and Venous Thromboembolism Incidence Following Primary Total Joint Arthroplasty-Results of a Single-Institution Protocol.

    PubMed

    Bateman, Dexter K; Dow, Robert W; Brzezinski, Andrzej; Bar-Eli, Howard Y; Kayiaros, Stephen T

    2017-07-05

    Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis, is a serious complication after total joint arthroplasty (TJA). Risk assessment models are increasingly used to provide patient-specific risk stratification. A recently implemented protocol mandates calculation of a Caprini Score for all surgical patients at our institution. We investigated the accuracy of the Caprini Score in predicting VTE events following TJA. A retrospective review of patients undergoing primary total hip (THA) and total knee arthroplasty (TKA) over a 1-year time period was performed. The 90-day postoperative incidence of emergency department evaluations, hospital readmissions, medical complications, need for revision surgery, and symptomatic VTE was recorded. "Preoperative" Caprini Scores routinely recorded per protocol and calculated during review ("Calculated") were compared and assessed for relationship with VTE events. A "VTEstimator" Score was calculated for each patient. Three hundred seventy-six arthroplasties (151 TKA and 225 THA) meeting inclusion criteria were identified. Ten patients (2.5%) had symptomatic VTE postoperatively, with 3 pulmonary embolism (0.8%) and 7 deep vein thrombosis (1.8%). Eight VTE (5.3%) occurred following TKA and 2 (0.9%) occurred following THA. For each surgical characteristic evaluated, no significant difference was observed between mean Preoperative or Calculated Caprini Scores for patients with and without VTE (P > .05). Additionally, the distribution of VTEstimator Scores for patients with and without VTE was not significantly different (P = .93). The Caprini risk assessment model does not appear to provide clinically useful risk stratification for TJA patients. Alternative risk stratification protocols may provide assistance in balancing safety and efficacy of thromboprophylaxis. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Analysis of the Causes of Elevated C-Reactive Protein Level in the Early Postoperative Period After Primary Total Knee Arthroplasty.

    PubMed

    Kim, Tae Won; Kim, Dong Hwan; Oh, Won Seuk; Sim, Jae Ang; Lee, Yong Seuk; Lee, Beom Koo

    2016-09-01

    Measurement of C-reactive protein (CRP) levels as a screening test for acute periprosthetic joint infection has high sensitivity and low specificity. We performed the present study to analyze the causes of elevated CRP levels in the early postoperative period after primary total knee arthroplasty (TKA). This study is intended to help the postoperative care of patients through understanding the factors associated with postoperative elevation of CRP. The records for 627 patients who underwent primary TKA between January 2005