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Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 52 - 52
1 Mar 2006
Matewski D Kruczynski J Szymkowiak E
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Search for optimal shape of hip implant have gone on from 70th’s. Different shapes of hip cups and methods of their implantation, which were created within those years, indicate, that long term results of cementless arthroplasty are still not satisfactory. The clinical and radiological results of cementless hip arthroplasty, which were performed with two types of shape cups (threaded spherical and threaded conical), were analyzed after at least 7 years follow up. Analysis was based on results 106 of cementless hip arthroplasties among 141, which were done during 1993 – 1996. The study concerned 58 threaded spherical cups (group A) and 48 conical (group B). Application of cups was randomized with respect to both sex and etiology of hip dysfunction and their implantation conditioned to possession of this type of implant on this moment. The mean age of 63 women and 35 men ( in 8 both side) in the moment of implantation were 48,9 years ( 10,6)and ranged from 28 to 76 years. Mean time of follow up was 8,2 years( 1,4) and ranged from 7 to 10 years. Pre- and postoperative clinical evaluation of hip function was carried out by means of Harris Hip Scale. Radiological evaluation was based on measurements of angle of inclination, horizontal and vertical migration of cup and radiolucent lines in DeLee-Charnley zones. Those measurements of last x-ray examination were compared with those, which were done immediately after arthroplasty. There were 80% of excellent and good results and 17% poor results in clinical evaluation of group A. In radiological evaluation of this group mean horizontal migration was 1mm, and vertical was 2,5mm. Clinical and radiological symptoms of cup loosening were confirmed in 10 hips. The revision procedures were performed in 9 hips. In group B excellent and good clinical results were in 98% and poor results only in 2 % of treated hips. Radiological evaluation also showed less migration of cups. Mean horizontal migration was 0,3mm, and vertical was 0,7mm. Clinical and radiological symptoms of loosening were in 1 hip, which were treated by revision procedure. Conclusion of our study is statement, that application of cementless threaded conical cup in hip arthroplasty give better clinical and radiological midterm results, than apllication of cementless threaded spherical cups


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_14 | Pages 5 - 5
23 Jul 2024
Mohammed F Jones S Mansoor Z Mehta S Rathore S Azam A
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Paget's disease of bone (PDB) is characterised by increased bone resorption and development of an erratic bone structure that is highly fragile and susceptible to fracture. In addition, altered joint biomechanics lead to arthritis, more often in the hip and pelvis, resulting in disability and a Total hip Arthroplasty (THA) may be required. THA in PDB is associated with more complications compared to normal population. There is no consensus on the type of arthroplasty that performs better in people with PDB. To our knowledge, there is no meta-analysis in literature on this rare problem.

We undertook a systematic review and meta-analysis to compare the effectiveness of cemented versus cementless THA in patients with PDB. PRISMA guidelines were followed. Search strings were generated based on Boolean operators for identification of the reference articles.

31 studies were included overall. Revision rate was lower in the cementless group compared to the cemented group (chi square=4.36, p=0.04), aseptic loosening was lesser in the cementless group compared to the cemented group (chi square=4.13, p=0.04). The type of the arthroplasty did not affect the infection rate (chi square=2.51, p=0.11), pre and post op Harris Hip Score showed statistically significant difference, but there was no difference between types of arthroplasty

We conclude that THA with uncemented components is better and provided lower revision and aseptic loosening when compared to cemented groups in patients with PDB.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 94 - 94
1 Mar 2010
Binazzi R Bondi A De Zerbi M Manca A
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Little is published about the use of cementless conical stems in primary hip arthroplasty for congenital hip disease. A conical stem was designed in the 80’s by Prof. Wagner. The stem is made of a rough blasted titanium alloy with a cone angle of 5° and 8 sharp longitudinal “ribs” that cut into the inner cortex, designed to achieve rotational stability: The ribs depth of penetration ranges between 0.1 and 0.5 mm and is also very important to achieve osteo-integration. The CCD angle is 135°. The stem is straight and can be implanted in any degree of version thus being very useful for dysplastic arthritis with significant femoral neck anteversion.

Between 1993 and 1998 the senior author (RB) implanted 92 conical stems in 88 consecutive patients with dysplastic arthritis. The acetabular component was cementless and titanium with tridimensional porosity. The articulating surface was a second generation Metal-on-Metal.with a femoral head of 28 mm. According to the Hartofilakidis classification 63 patients had type A, 18 type B and 11 type C.

The average follow-up was 11.2 years (range 10.1–14.8)

Using the Harris Hip Scoring system we had 82 (89%) satisfactory results, with excellent correction of pre-op pain (42/44 Harris) and no case of anterior thigh pain; 88% of patients had no or slight limp at follow-up. No patient required revision of the stem, but one cup required revision for loosening (Type C class). We had one dislocation (1%) that was treated conservatively

Radiographically, all stems were osteo-integrated, 17% showed some resorption in femoral zone 1 and 7. In the same zones we observed 4 cases of real osteolysis without loosening. No radiolucent line was observed in other femoral zones. In the acetabular side we had 13 cases (14%) of radiolucency, but in only 1 case (1%) was it progressive.

A straight conical titanium femoral stem gave very satisfactory clinico-radiographical results in dysplastic arthritis at a mean of 11.2 years of follow-up.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_I | Pages 62 - 62
1 Jan 2003
Saksena J Singh S Muirhead-Allwood SK
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Introduction: Patients with developmental dysplasia of the hip with secondary osteoarthritis are often found to have severe anatomical deformities of the hip. Total hip replacement in such patients is a complex undertaking associated with complication and failure rates. Subtrochanteric derotational osteotomy with customized uncemented total hip arthroplasty has been described to combat the problems of severe femoral anteversion. We present the medium term follow up of 12 patients where such a procedure was undertaken.

Materials and Methods: 11 female and 3 male patients with an average age of 49 (range, 32–79 years) were reviewed by an independent observer. The mean follow up was 50 months (range, 24–93 months). Patients were classified on AP radiographs according to Crowe and Hartofilakidis. All have femoral neck anteversions of greater than 45° on CT scans. The patients were followed up radiographically and clinically using the WOMAC, Oxford and Harris hip scores.

Results: 1 patient died due to unrelated causes. The average Harris hip score improved from 44 (range, 38–57) preoperatively to 88 (range, 67–94). The average WOMAC score improved from 83 (range, 45–112) pre-operatively to 36 (range, 25–72). The average Oxford score improved from 44 (range, 38–57) preoperatively to 19 (range, 14–34). Radiologically, the prosthesis appears to have osseointegrated with union of the osteotomy site in all cases and there is no evidence of implant migration or osteolysis.

Conclusion: Custom total hip arthroplasty with subtrochanteric osteotomy provides a method whereby the hip centre can be restored to its normal level, proximal bone stock is preserved and a more normal proximal femoral morphology is created. We have undertaken this procedure routinely in patients with excessive femoral anter-version and report excellent medium term clinical and radiographic results.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 143 - 143
1 Mar 2010
Munakata Y Kan N Nagase K Kusaba A Kondo S Kato Y Kuroki Y
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A special surgical technique and consideration is necessary in the total hip arthroplasty for dysplastic osteoarthritis after Kalamchi and MacEwen Type III or IV deformity (so called “Perthes-like-deformity”). There have been few reports concerning the total hip arthroplasty for “Perthes-like-deformity”. We evaluated the clinical and radiological outcome of 52 uncemented hip arthroplasties for the lesion.

We have performed 106 hips of uncemented total hip arthroplasty for dysplastic osteoarthritis after Kalamchi and MacEwen Type III or IV deformity. Among them, 52 hips of 47 patients (11 males and 41 females) were evaluated with minimum of three years follow-up. The average age at the surgery was 52 (28 to 65). The average follow-up period was 4.8 (3 to 8.1) years. Against the developmental dysplasia or dislocation, 29 hips of 26 patients had been treated by casting or surgery in infancy. Thirteen hips of 11 patients had no previous treatment before the arthroplasty. Spongiosa metal cup (GHE: ESKA implants, Lübeck, Germany) was used for 33 hips of 28 patients and Zweymüller type cup (Allo-classic cup: Zimmer Inc., Warsaw, IN, Bicon cup: Smith & Nephew Orthopedics AG, Rotkreuz, Switzerland) for 19 hips of 19 patients. Spongiosa Metal stem (GHE: ESKA implants) was used for 23 hips of 19 patients and Zweymüller type stem (Alloclassic stem: Zimmer Inc., SL stem: Smith & Nephew Orthopedics AG) for 29 hips of 28 patients. The average operative time was 108 (53 to 233) minutes. The average blood loss during the surgery was 731(150 to 1749) milliliters. The adductor tendon release was added in 28 hips of 26 patients against the severe contracture. The patients were evaluated clinically (pre-surgical history, hip score, leg length discrepancy, Trendelenburg sign, and gait function) and radiologically (ATD before the surgery, alignment, and stability of implants). Average ATD before the surgery was −2.2 (−28 to 17) millimeters. The average leg length discrepancy was 1.9 (0 to 7) centimeters before the surgery and was improved to 0.1 (0 to 1) centimeters after the surgery. The average hip score was 54 (23 to 80) before the surgery and was improved to 90 (69 to 100) after the surgery. At the final follow-up, Trendelenburg sign was positive in 14 hips of 14 patients (26.9%) and the limping was not obvious in 38 hips of 33 patients (73.1%). All implants were stable at the final follow-up.

“Perthes-like-deformity” often has the severe deformity. It has a shortening or an absence of the neck and an excessive antetorsion of the femur. When it has the coxa magna, the acetabulum is shallow, has the narrow anteroposterior diameter, and has the thin wall like the osteophyte. It is frequently accompanied by shortening of leg and contracture, as the lesion arises from the development disorders. Thus, the total hip arthroplasty, especially uncemented one, is complicated. However, the satisfactory result can be obtained by careful consideration and surgical procedure such as a provision against the bleeding and the soft tissue release.


The Bone & Joint Journal
Vol. 103-B, Issue 3 | Pages 522 - 529
1 Mar 2021
Nichol T Callaghan J Townsend R Stockley I Hatton PV Le Maitre C Smith TJ Akid R

Aims. The aim of this study was to develop a single-layer hybrid organic-inorganic sol-gel coating that is capable of a controlled antibiotic release for cementless hydroxyapatite (HA)-coated titanium orthopaedic prostheses. Methods. Coatings containing gentamicin at a concentration of 1.25% weight/volume (wt/vol), similar to that found in commercially available antibiotic-loaded bone cement, were prepared and tested in the laboratory for: kinetics of antibiotic release; activity against planktonic and biofilm bacterial cultures; biocompatibility with cultured mammalian cells; and physical bonding to the material (n = 3 in all tests). The sol-gel coatings and controls were then tested in vivo in a small animal healing model (four materials tested; n = 6 per material), and applied to the surface of commercially pure HA-coated titanium rods. Results. The coating released gentamicin at > 10 × minimum inhibitory concentration (MIC) for sensitive staphylococcal strains within one hour thereby potentially giving effective prophylaxis for arthroplasty surgery, and showed > 99% elution of the antibiotic within the coating after 48 hours. There was total eradication of both planktonic bacteria and established bacterial biofilms of a panel of clinically relevant staphylococci. Mesenchymal stem cells adhered to the coated surfaces and differentiated towards osteoblasts, depositing calcium and expressing the bone marker protein, osteopontin. In the in vivo small animal bone healing model, the antibiotic sol-gel coated titanium (Ti)/HA rod led to osseointegration equivalent to that of the conventional HA-coated surface. Conclusion. In this study we report a new sol-gel technology that can release gentamicin from a bioceramic-coated cementless arthroplasty material. In vitro, local gentamicin levels are in excess of what can be achieved by antibiotic-loaded bone cement. In vivo, bone healing in an animal model is not impaired. This, thus, represents a biomaterial modification that may have the potential to protect at-risk patients from implant-related deep infection. Cite this article: Bone Joint J 2021;103-B(3):522–529


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_3 | Pages 69 - 69
1 Feb 2017
Kim J Cho H
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Purpose. We evaluated the clinical and radiographic outcomes of cementless bipolar hemiarthroplasty using rectangular cross-section stem for femoral neck fracture in elderly patients more than 80 years of age with osteoporosis. Material and Methods. 76(cemented 46, cementless 30) bipolar hemiarthroplasties for femur neck fracture were performed in elderly patients more than 80 years old. The mean follow-up period was 4.3 years (2 to 7 years). The Harris hip score at last follow-up and pre-postoperative daily living activity scale according to Kitamura methods were analyzed clinically. The radiological results were assessed using stability of femoral stem and other complications were evaluated. Results: At last follow-up, there were no significant differences of Harris hip score and daily living activity between two groups. Stem loosening and instability were not observed in cementless arthroplasty. There were 18 cases of osseous fixation in radiologic study. There were 1 case of dislocation and 1 case of superficial infection in cemented arthroplasty and 1 case of deep infection in cementless arthroplasty. Conclusion. Cementless bipolar hemiarthroplasty using rectangular cross-section stem for elderly patients with a femoral neck fracture showed satisfactory short-term clinical and radiological results compared to using cement stem


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_16 | Pages 36 - 36
1 Dec 2015
Lepetsos P Stylianakis A Leonidou A Argyris D Anastasopoulos P Lelekis M Tsiridis E Macheras G
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In spite of its incidence decreasing to 1% nowadays, prosthesis-related infections remain a research, diagnostic, therapeutic and cost-related problem. Early diagnosis, selection of an appropriate surgical strategy, accurate identification of the responsible microorganisms and construction of an appropriate antibiotic regimen are essential elements of any management strategy. Our study aim was firstly to compare the diagnostic accuracy of conventional periprosthetic tissue culture and culture of fluid derived from vortexing and bath sonication of the explanted hardware and secondly to investigate the role of possible metabolic factors affecting the sensitivity of the sonication method. We investigated 70 patients undergoing revision hip or knee arthroplasty because of loosening of the prostheses, at our institution, between October 2011 and November 2013. Patients’ medical history and demographic characteristics were recorded. We compared the culture of samples obtained by sonication of explanted hip and knee prostheses with conventional culture of periprosthetic tissue for the microbiological diagnosis of prosthetic-joint infection. Infectious Diseases Society of America (IDSA) Guidelines were used for the definition of prosthetic-joint infection. Thirty-two patients had septic loosening and 38 aseptic loosening (48 hip prostheses and 22 knee prostheses). The sensitivity of sonication fluid culture was 81.25% and the sensitivity of conventional tissue cultures was 56.25% (p-value = 0.043). The sensitivity of the sonication method was statistically higher in obese, diabetic patients, with age above 60, in uncemented arthroplasties and in arthroplasties because of primary osteoarthritis (p-values < 0.05). The sonication method represents a reliable test for the diagnosis of prosthetic – joint infections with a greater sensitivity than the conventional periprosthetic tissue cultures, especially in obese, diabetic patients, with age above 60, in uncemented arthroplasties and in arthroplasties because of primary osteoarthritis


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XL | Pages 56 - 56
1 Sep 2012
Geesink R
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Cementless arthroplasty has progressed substantially in the recent decades from pressfit implantation to porous-coated and later HA-coated implant fixation as its ultimate current state-of-the-art incarnation. As a consequence ever younger and older patients have received the benefits of hip and other arthroplasty although attention to age-related factors is key to success. Key factors for success, from the implant perspective, are adequate primary stability of the device in the bone supported by design and surface structure variables that together with optimal implant biocompatibility result in durable osseo-integration of the device. The high activity levels of younger patients but similarly the generally inferior muscular condition of elderly patients require special attention for the stability of the hip joint with avoidance of impingement. Also bone quality may be a topic for consideration to avoid problems. Excellent survival rates past twenty years are documented in both literature and registries with quantitative studies confirming the excellent implant stability and bone quality. With an optimal consideration for patient related factors as well as anatomic reconstruction of the arthroplasty, modern cementless arthroplasty provides every patient an outlook on both excellent long term functionality and survival


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_10 | Pages 35 - 35
1 May 2016
Shin T Kang K Park S Kwon S Lim Y Lim D
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Introduction. Cementless arthroplasty has been widely used for younger patients with osteoarthritis and other joint pathology. Cementless arthroplasty will be required to porous surface which is to similar to the trabecular bone for bone ingrowth. Titanium Plasma Spray (TPS) has been worldwide used for the porous coating method on arthroplasty. However, TPS coating is limited that would not to establish optimal porosity for bone ingrowth due to arbitary position of melted powder by plasma gas on substrate. Therefore, it is reported coating detached from its substrate (i.e. arthroplasty) is induced implant loosening. Thus, a novel Laser-aided Direct Metal Tooling (DMT) based on Additive Manufacturing (AM) was developed to overcome these limitations. In this study, we were done to assess stereological analysis, static tensile, shear, abrasion test, and physical analysis for evaluation of the efficacy of DMT which was newly-developed coating technology. Then, mechanical characteristics of DMT coating were compared to commercial TPS coating's. Materials and Methods. First, porosity of the DMT coating was evaluated using Microphotography and Scanning Electron Microscopy (SEM), as described in Figure 1. Static tensile and shear test for assessment of mechanical characteristic in relation to the DMT and TPS coating specimens were conducted on the basis of ASTM F1147 and F1044 using universal testing machine (Endolab®, Servohydraulic Test Frame, DE). Maximum tensile strength and maximum shear strength were evaluated for each specimen (n=5). Abrasion test was performed based on ASTM F1978 using Taber® Rotary Platform Abraser Model 5135 (TABER®Industries, USA). Abrasion losses for each specimen (n=6) were measured at 2, 5, 10, and 100 cycles, respectively. Results. Porosity of the DMT coating was found to be 64 ± 11%. Maximum tensile strength (mean ± SD) of the DMT coating (48.6 ± 4.3 MPa) was lower than TPS's (51.5 ± 11.6 MPa) about 5.6%, but detached position of one of the TPS specimens was observed at coating layer not in adhesive layer. Maximum shear strength of the DMT coating (46.3 ± 1.9 MPa) was 10.2% higher, compared to TPS's (42.0 ± 0.6 MPa). Abrasion losses of the DMT (2 cycles, 1.0 ± 0.5 mg; 5 cycles, 2.5 ± 0.9 mg; 10 cycles, 4.2 ± 0.7 mg; 100 cycles, 20 ± 1.4 mg) were significantly higher (71.9% – 77.8% higher) than that of TPS's (2 cycles, 4.5 ± 1.4 mg; 5 cycles, 9.8 ± 2.8 mg; 10 cycles, 17.0 ± 3.4 mg; 100 cycles, 71.1 ± 4.2 mg), as shown in Figure 2. Roughness of the DMT coating was Ra 62.5 ± 2 μm, Rz 316.1 ± 8.1 μm which were 33.5%, 40.6% (Ra, Rz sequence) higher than that of TPS coating (Ra 46.8 ± 8.9 μm, Rz 224.9 ± 28.8 μm), as shown in Figure 3. Conclusions. Our results suggested that a novel DMT coating technology was feasible to apply coating method on the surface of the arthroplasty in terms of outstanding mechanical characteristics which were compared to commercial TPS coating


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_III | Pages 363 - 363
1 Oct 2006
Marsh R Emeagi C Goodship A Amrich M Blunn G
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Introduction: The use of uncemented arthroplasty in joint replacement surgery requires osseointegration of the prosthesis to maximise function and longevity. It has been demonstrated that osteoblast-like cells will preferentially proliferate, differentiate and produce mineralised matrix in pits and grooves on non-biological surfaces, of similar dimensions to those of Howslip’s lacunae produced by osteoclasts in vitro. The hypotheses of this study were that a photochemically etched titanium alloy surface would 1) induce proliferation and differentiation in osteoblast-like cells; 2) induce osteoblastic differentiation of human mesenchymal stem cells and 3) induce greater bone to implant contact in a caprine model. Methods: Three microgrooved titanium alloy surfaces (fine, medium & coarse) were created by photochemical etching, with dimensions of 200 to 515 microns. Human Mesenchymal stem cells (MSC) and Human Osteosarcoma (HOS) cells (TE-85) were seeded onto these surfaces and cultured in standard media; in the case of MSC, with and without the addition of osteogenic supplements. At intervals of time each surface and cell type were assessed for proliferation by Alamar blue assay and osteoblastic differentiation by Alkaline Phosphatase expression. A polished titanium surface was used as a control. A plate of each surface dimension was placed into a femoral condyle of ten adult male goats. The animals were euthanased at 6 and 12 weeks post-implantation. The specimens were histologically processed and examined under light and backscattered electron microscopy to establish the percentage of bone to implant contact and the presence of new bone within the grooves. Results: In vitro, all cells showed an increase in proliferation with time, the greatest occurring on the coarse surface. Alkaline phosphatase expression showed a rise with time on all surfaces, the greatest being on the coarse surface seeded with HOS cells (p< 0.05). MSC could not be induced to differentiate to an osteogenic lineage by these surface textures alone. On addition of osteogenic supplements their results followed the trends of HOS cells. In vivo, histomorphometric analysis showed significantly greater bone implant contact on the coarse surface at both 6 and 12 weeks (p< 0.05). In a number of cases there were signs of osteogenesis occurring deep within the pits and grooves. Discussion: This study confirms that a photochemically etched surface topography mimicking that created by osteoclasts will increase the proliferation and differentiation of osteoblastic cells in vitro. The rate of differentiation of these cells increased significantly in relation to the size of the grooves. When implanted in vivo these same surfaces were shown to support osseointegration. This surface has the potential to improve the function of uncemented arthroplasties in the future


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_10 | Pages 33 - 33
1 Jun 2018
Callaghan J
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Successful nonarthroplasty solutions for the treatment of osteonecrosis of the femoral head continued to be sought. However, no definitive nonarthroplasty solutions have to date been found. Hence, even in the best of hands a large number of patients with osteonecrosis end up with debilitating end-stage osteoarthritis. In the inception of total hip arthroplasty (THA), the results of treatment of femoral head osteonecrosis by THA were inferior to total hip replacement performed for osteoarthritis. Reasons for this included the young age of many osteonecrosis patients, the high numbers of comorbidities in this population (SLE, sickle cell anemia, alcoholism), and the poor bone quality at the time of surgery. Arthroplasty considerations included bipolar replacement, hemiresurfacing, resurfacing (non metal-on-metal and later metal-on-metal), cemented total hip arthroplasty and cementless total hip arthroplasty. Previous to the use of cementless arthroplasty, all of these procedures had a relatively high 5 to 10 year failure rate of 10–50%. Even our own 10-year results using contemporary cementing techniques demonstrated 10% failure compared to 1–2% failure in our nonosteonecrosis patients. For this reason, it made sense to continue exploring nonarthroplasty solutions for osteonecrosis of the hip. The introduction of cementless fixation for total hip arthroplasty changed the entire thinking about hip osteonecrosis treatment for many of us. Although initially we were concerned about whether bone would grow into the prosthesis in the environment of relatively poor bone, the early results demonstrated that it can and does. Most recently, with the use of crosslinked polyethylene, the cementless construct gives many of us hope that with cementless fixation, the treatment of many patients including the young (especially if followed closely to exchange bearing surfaces if necessary) will last a lifetime with THA being the only and definitive procedure. Our most recent 10-year results demonstrated a femoral stem revision rate of 1.5% will all other stems (other than the stem revised) bone ingrown. Acetabular fixation was also 100% and although 6% required liner exchange, our own and others' results with crosslinked polyethylene would suggest that this problem should be markedly reduced


Aim. To assess the survivorship of a tapered fluted Titanium monoblock stem in conjunction with subtrochanteric shortening for patients with High Dislocation performed at 2 centres. Methods. This was a retrospective study of 84 hips in 52 patients between two centres. All patients had a high dislocation. Thirty five patients had bilateral dysplasia. All patients had total hip arthroplasty with a subtrochanteric shortening osteotomy. The acetabular component was placed at the level of the anatomic hip centre. The femoral component was the “Wagner Cone prosthesis” which is a monoblock Titnium Alloy stem, tapered and fluted. The acetabular component varied. All patients had a follow up examination with a Harris Hip Score and a plain radiograph. The radiographs were assessed for osteotomy complications, change in stem position, evidence of loosening, heterotopic ossification & stress shielding if any. Notes were reviewed for complications. Results. The mean age at operation was 55 yrs (range 20–83). The mean follow up was 9 years (range3–20). Eight patients were lost to follow up (16%). All the rest of the femoral components survived that were available for follow up −84% (worst case scenario). Six patients (7.8%) had an early complication that needed a reoperation. The Mean Harris Hip Score (HHS) improved from 42 points to 88 points. Conclusion. The success rate of patients undergoing Cementless Arthroplasty using the Wagner cone stem in conjunction with a subtrochanteric shortening osteotomy is very high. The complication rate is however larger than in the normal population


Bone & Joint Research
Vol. 12, Issue 5 | Pages 331 - 338
16 May 2023
Szymski D Walter N Krull P Melsheimer O Grimberg A Alt V Steinbrueck A Rupp M

Aims

The aim of this investigation was to compare risk of infection in both cemented and uncemented hemiarthroplasty (HA) as well as in total hip arthroplasty (THA) following femoral neck fracture.

Methods

Data collection was performed using the German Arthroplasty Registry (EPRD). In HA and THA following femoral neck fracture, fixation method was divided into cemented and uncemented prostheses and paired according to age, sex, BMI, and the Elixhauser Comorbidity Index using Mahalanobis distance matching.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 452 - 452
1 Dec 2013
Lee Y Nho J Lee K Ha Y Koo K
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Background:. 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. Materials and 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. Discussion:. This second-stage reconstruction after retention of the stem could be an alternative treatment option for periprosthetic infection with a well-fixed stem


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_2 | Pages 1 - 1
1 Jan 2016
Giardina F Guerra G Stea S Bordini B Sudanese A Toni A
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After a few years from its introduction, the limits of the THA became evident, mainly due to high rates of mobilization for polyethylene wear and to the release of metal ions from MOM and MOP couplings. Ceramic bearings were thus introduced in surgery to obtain lower levels of friction and wear. These issues have now been well recognized by several studies, which show that ceramic-on-ceramic joint has the lowest wear rate among various articulations and that ceramic particles induce less macrophage reaction and decrease cytokine secretion, allowing to have little periprosthetic osteolysis. After the first results in the late 70′s and early 80′s, the mechanical reliability was improved due to the manufacturers' efforts to reduce the ceramic fragility evolving average grain microstructure and lowering the degree of impurity. Betterment and standardization of production have led to 3. rd. generation alumina, Biolox Forte in 1994, that achieved a lower incidence of fracture. The purpose of our study has been to assess long-term follow-up results of alumina-on-alumina 3. rd. generation ceramic total hip cementless arthroplasty performed at our institution from January 1995 to December 2000. We prospectively followed more than 200 patients operated of THA for primary or secondary hip osteoarthritis analyzing clinical and radiographs features. In this period, the total hip replacement were performed by a single surgeon, who is the senior author (A.T.) in our Institution. All patients were clinically examined to confirm the diagnosis and all of them were checked with a standard plain radiographs in two projections and, when necessary, the radiographic examination was completed by CT scans. The same prosthesis was used in all patients, a 3. rd. generation alumina COC articulation, composed of a hemispherical titanium alloy cup and a 28-mm alumina ceramic femoral head. The modular ceramic head was fixed to a 12/14 taper cone. Proximally plasma-spray hydroxyapatite coated Ti alloy stems completes the implant features. Modular necks were used in retro or anteversion and varus or valgus offset, allowing changes in neck-shaft angle and giving a perfect intraoperative stability. Clinical assessment was performed using the Merle-D'Aubigne and Postel hip score. Each patient was assessed before surgery, after 30 days, afterwards at 4 months and annually after surgery. The mode of femoral component fixation was radiographically classified as bone ingrowth fixation, stable fibrous fixation or unstable fixation, according to the criteria Engh-Bobyn. Osteolysis was evaluated on the femoral side at each Gruen zone. Osteolysis on the acetabular side was evaluated by DeLee and Chanley zone. Our study has concluded that cementless modular hip arthroplasty with 3. rd. generation ceramic-on-ceramic bearing, with a 13 to 18 years follow-up, shows an excellent survivorship, in particular for the very low volume release of microparticles during friction, which consequently reduction of cytokine release, thus diminishing the risk of periprosthetic osteolysis and loosening of implant components


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_II | Pages 322 - 322
1 May 2010
Jämsen E Pajamaki J Moilainen T
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Antibiotic-impregnated cement is frequently used for fixation of total knee prostheses as a measure to prevent postoperative infection. In recent years, more cementless knee prostheses have been implanted especially for younger patients. In 1997 to June 2004, 35044 primary total knee arthroplasties for primary or secondary osteoarthritis were performed in Finland and registered in nationwide arthroplasty register. The patients aged 70 years (range 21–96) on average, and 71.7% were women. During the median follow-up of 39 months (range 0–104), 978 (2.8%) knees were revised. There were 188 (0.58%), 21 (1.09%) and 10 (1.18%) reoperations due to infection after cemented, hybrid and cementless arthroplasties, respectively (p=0.003). In hybrid arthroplasties with cemented tibial component, the septic reoperation rate did not significantly differ from cemented arthroplasties. Instead, the higher number of infections after hybrid arthroplasty was related to use of cementless tibial components (5.3% vs. 0.9%, p< 0.008). In Cox regression model adjusted for age, gender and diagnosis, the hazard ratio for septic reoperation after knee replacement with cementless tibial component was 2.4 (95% CI 1.4–4.1) compared to the cemented alternative. The fixation method did not affect the rate of septic reoperations occurring after the first postoperative year. Cementless fixation of tibial component in primary total knee arthroplasty may associate with an increased risk of early septic reoperation. Until this finding is confirmed in other materials, cementless fixation in primary knee arthroplasty should be used cautiously in patients with increased risk for infection


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 302 - 302
1 May 2009
García S Soriano A Bori G Font L Gallart X Fuster D Tomás X Suso S Mensa J
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Exchange of infected implant using antibiotic-impregnated cement is the treatment of choice in prosthetic joint infection (PJI). We presented our experience using one or two-stage exchange with uncemented implants. From January 2000 to June 2006 patients with a PJI that were treated with one or two-stage exchange with uncemented implants, were prospectively followed up. The treatment protocol consisted of radical excision of devitalized tissue and of maintaining a high serum antibiotic concentration during surgery followed by systemic antibiotic administration according to the microbiology results. Only patients with ≥6 months of follow-up were included. Good evolution was considered when symptoms and signs of infection disappeared and the C-Reactive Protein was normal. Forty-two patients were included in the study, of whom 25 were male. The mean age was 70 years. The most common symptom was pain (100%) and radiological signs of prosthesis loosening were present in 36 cases (85.7%). Histology was positive in 32 patients (76.2%). Coagulase-negative staphylococci was the most common microorganism (23 cases) followed by S. aureus (5 cases). One-stage exchange was performed in 18 patients, and the long stem component was always uncemented. In one case an acute infection after the arthroplasty obligated to perform an open debridément without implant removal. After a mean follow-up of 31 months (range: 6–84) all patients had a good evolution. In 24 cases a 2-stage exchange with a joint spacer with gentamycin (Spacer-G) was performed. In all cases the definitive arthroplasty was performed using an uncemented long stem. Good evolution was documented in all but one case with persistent infection due to S. aureus after a mean follow-up of 19 months (range: 12–48). Our results suggest that uncemented arthroplasty following a protocol based on radical debridément and systemic antibiotic therapy during and after surgery is a useful approach in PJI


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 231 - 231
1 May 2009
Aslim N Schemitsch E Tokunaga K Waddell J
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The purpose of this study was to evaluate the effect of previous femoral osteotomy on the outcome of total hip replacement performed for degenerative arthritis secondary to developmental dysplasia of the hip. Eighty three primary total hip arthroplasties were performed in sixty-nine patients with osteoarthritis secondary to developmental hip dysplasia (DDH) with a minimum three year follow up. Twenty six hips had undergone previous femoral osteotomy (eleven hips, femoral osteotomy alone (FO); fifteen hips, combined femoral and pelvic osteotomy and fifty-seven hips, no previous surgery. The non operative patients with DDH served as an age and sex matched control group (control). Cementless arthroplasty was performed in seventy-eight hips. The mean duration from femoral osteotomy to primary THA was 22.9 years. The mean follow up was 7.6 years (FO) and 7.2 years (control). The overall revision rate was 15.4 % (FO) and 21.1 % in the Control group (p> 0.05). Twenty-one hips had one or more complications during or after surgery. The FO group had a higher femoral fracture rate (23.1%) compared to controls (10.5%) (p< 0.05). At latest mean follow-up (7.4 yrs (range, two to sixteen)), the mean Harris hip score was eighty-five (FO) and eighty-five (control group) (p> 0.05). The function and pain scores in the femoral osteotomy group were similar to the controls (p> 0.05). The requirement for bone grafting was similar and operative time significantly greater (FO) compared to controls. The frequency of radiolucent lines around the femoral component in the FO group (36%) was significantly higher than the control group (12.2%) (p< 0.05). Survival analysis was performed with the Kaplan-Meier method. At ten years, the survival of the acetabular component was 84.6%/73.6% and for the femoral component 92.2%/96% in the FO/control group. Patients with a prior femoral osteotomy have no significant difference in functional outcome, overall complication rate or revision rate compared to controls. However, there is a significant increase in femoral fracture and operative time. Previous femoral osteotomy does not compromise the functional outcome of subsequent total hip arthroplasty


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_I | Pages 145 - 146
1 Mar 2008
Pan J Schemitsch E Aslam N Waddell J
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Purpose: The purpose of this study was to evaluate total hip arthroplasty in the treatment of post-traumatic arthritis following acetabular fracture and to compare the long-term outcome of THA after previous open reduction and internal fixation or conservative treatment of the acetabular fracture. Methods: Thirty-four patients (thirty-six hips) underwent total hip arthroplasty for arthritis resulting from an acetabular fracture. The mean age at the time of hip arthroplasty was 49 years. The mean follow-up was eight years and nine months (range, 4–17 years). The mean interval from fracture to arthroplasty was 7.5 years (range, 5 months-29 years). Twenty-three hips had been previously treated by open reduction and internal fixation and 12 hips had a conservatively treated fracture. An uncemented arthroplasty was performed in 31 hips, cemented arthroplasty in 2 patients and a hybrid replacement in 2 patients. Results: Only 16 patients achieved and maintained a good to excellent result over the course of the follow-up. The mean Harris hip score improved from 44.5 points preoperatively to 72.76 points for operatively treated fractures (23 patients). The mean Harris hip score improved from 44.2 points preoperatively to 78.7 points for conservatively treated fractures (12 patients) (p> 0.05). Ten out of 35 hips required revision; 9 were revised because of aseptic loosening and one for infection with a total revision rate of 29%. Femoral bone quality was significant in predicting revision. No femoral radiographic loosening was found at latest follow-up. On the acetabular side, the rate of radiographic loosening was higher. There was no significant difference in bone grafting, heterotopic bone formation, revision rate, operative time and blood loss between the two groups (ORIF vs conservative treatment of acetabular fracture) (p> 0.05). Conclusions: Outcome following total hip arthroplasty in the treatment of post-traumatic arthritis following acetabular fracture is less favourable than following primary osteoarthritis. Those patients initially treated conservatively had similar long term results compared to those treated primarily by open reduction and internal fixation. At long term follow-up, the main problem identified was osteolysis and acetabular wear