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
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.
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.
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.
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
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
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
Introduction.
Introduction: The use of
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
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
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.
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
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
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
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
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).
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