Background

There are numerous concerns associated with femoral stems that feature a modular neck design, including the potential for corrosion, modular neck fracture, and adverse local tissue reactions. These stems have a higher-than-anticipated rate of failure in registry results, but large single-center cohort studies are lacking.

Purpose

The purpose of this study is to evaluate the midterm results of cementless revision total hip arthroplasty (THA) using Wagner Cone Prosthesis.

Introduction:

There is no consensus whether a traditional post and cam-style posterior stabilized (PS) total knee device is superior to a deep-dish, more congruent cruciate-substituting (CS) device. This study compared the clinical and radiographic outcomes of two such devices. The primary hypothesis was that the clinical outcomes would be equivalent and the secondary hypothesis was that there would be measurable differences in the tourniquet time and intraoperative blood loss.

Aim

In the last years, many short hip stem variants were developed, almost always sharing the principle of metaphyseal and proximal diaphyseal anchorage. In this study, we analyzed the midterm results after implanting short cementless hip stem of ESKA.

Background and Objective

Total hip arthroplasty (THA) has been applied to treat pain and disability in patients with post-traumatic arthritis after acetabular fracture for many years. However, the midterm and long-term results of THA for this unique population are still controversial. According to previous studies, we found that uncemented acetabular reconstructions were usually performed in patients who were most likely to have the best results and an abnormal acetabular structure was usually the reason for THA failure. In this study, we evaluated the midterm results of using uncement acetabular components to treat posttraumatic arthritis after acetabular fracture. In addition, we investigated the effects of different acetabular fracture treatments and fracture patterns on THA.

OBJECTIVES

In elderly patients the temporary loss of function of the upper extremity due to immobilization for treatment of unstable proximal humeral fractures is a very disabling condition. Stable fixation of such fractures allowing immediate functional aftercare may contribute to early social reintegration in this group of patients. Aim of this study is to present the surgical technique of humeral blade plate fixation and the clinical and radiographic results after fixation of unstable surgical neck fractures with this implant followed by immediate functional treatment in patients older than 60 years.

Aims: The purpose of the study was to assess the mid-term knee functional results after Medial Patellofemoral Ligament (MPFL) reconstruction with single semitendinosus autograft in patients with patellofemoral instability.

Methods and Results: Knee function was assessed in 45 patients (46 knees) who underwent MPFL reconstruction with semitendinosus autograft. The tibial insertion of the semitendinosus was preserved whereas the free end, after stripping of the tendon from the musculo-tendinus junction was rerouted through the most distal part of the medial intermuscular septum proximally to the adductor tubercle, to the superomedial border of the patella, where it was fixed. Clinical and radiological evidence of patellar instability and MPFL rupture or deficiency was documented prior to surgery. Knee function was assessed preoperatively and postoperatively with the use of Kujala, Tegner, Lysholm and International Knee Documentation Committee (IKDC) scores. There were 34 male and 11 female patients with an average age of 32.5 years, ranging from 17 to 60 years. The minimum follow up was 2 years with an average of 33.5 months (range 24–54 months). Fourteen patients (30%) presented a degree of patellofemoral dysplasia. All knee functional scores significantly improved postoperatively. Kujala score improved from 57.7 to 77.1, Tegner score improved from 3.06 to 5.26, IKDC score improved from 51.2 to 75.44 and Lysholm score improved from 58.7 to 79.3. One of the patients required revision of the MPFL reconstruction due to traumatic redislocation of the patella.

Conclusions: At a midterm follow-up, reconstruction of the MPFL with rerouting of the semitendinosus tendon is an effective method with improved function in all patients. Maximum improvement was achieved within the first six postoperative months. Heterogeneity of our population may have affected some of our results.

The aim of this study is the presentation of the midterm results of the radial head replacement with pyrocarbon head prosthesis (MoPyc).

Thirty two patients (20 males and 12 females) with a mean age of 54 y.o. (32–68 y.o.) were subjected to replacement of the radial head with a pyrocarbon head prosthesis. Twenty of them had a comminuted radial head fracture(15 Mason IV type and 5 Mason III), two had a malunion and ten had a complex elbow injury (ligamentous rupture and comminuted radial head fracture with/without coronoid process fracture). In 22 patients the fracture was on the dominant side. The mean follow up time was 27 months (21 – 46 months).

The post-operative results were:

The mean range of motion in flexion-extension was 130° (105° to 150°), while in pronation and supination was 74° (60°–80°).

Pain was evaluated with a visual analogue scale. Finally there was also a radiographic evaluation of the patients (that yielded six cases of loosening or osteolysis without any clinical manifestation)

Replacement of the radial head with the specific prosthesis leads to very satisfactory results when performed under specific indications.

Introduction: Femoroacetabular impingement (FAI) has been recently recognized as the main cause of hip pain in sportsmen. We analyse if clinical and functional results of surgical treatment are influenced by preoperative degenerative hip changes.

Materials and Methods: A series of 117 consecutive Ribas mini open procedures (mini open femoroacetabular osteoplasty with labral refixation) were performed in 115 sportsmen with confirmed clinical, radiographic, and MR-arthrography diagnosis of FAI, and were evaluated with a minimum follow up of 4 years (range: 4 – 6,5). According to Tönnis Grade for preoperative radiological degenerative hip stage, the hips were divided into 3 groups: group A/Tönnis 0: 32 hips; group B/Tönnis 1: 61 hips; group C/Tönnis 2: 24 hips. A Combined Clinical Score (CCS), which includes Impingement test, Merle D’Aubigné and WOMAC scores, was used to evaluate the patients before surgery and at 6 weeks, 3 months, 6 months and every year after operation. Satisfactory and unsatisfactory results were obtained and collected. SPSS 10.0 software (SPSS INC, Chicago, Ill) was used for statistical analysis and comparisons were performed by means of chi-squared and Wilcoxon tests; p< 0,05 was considered to be significant.

Results: With CCS method, satisfactory results were obtained in group A (Tönnis 0) in 93,4% of the cases at 12 months, in 96,5% at 24 months, and in 97,8% at the latest follow up of 48 months; in group B (Tönnis 1) satisfactory results were observed in 91,3% of the cases at 12 months, in 91,2% at 24 months, and in 93,6% at 48 months; in group C (Tönnis 2) satisfactory results were obtained in 58,3% of the cases at 12 months, in 55,3% at 24 months, and in 50,1% at 48 months. Differences between groups A and C, as like between groups B and C, were significant (p< 0,001), but not between groups A and B (p> 0,05).

Conclusions: Midterm results of the Ribas mini open procedure for the treatment of femoroacetabular impingement are encouraging, expecially in hips not exceeding Tönnis Grade 1 osteoarthrosis, as results depend directly on degenerative state. If symptomatic patients are treated in early stages, excellent expectancies can be obtained with this procedure already at midterm. In addition, instruction of general physicians and specialists in the diagnosis of FAI is of paramount importance.

Introduction: This minimally invasive (MI) anterior approach has been developed to improve patients’ rehabilitation and long-term function. It is aligned along the interneural plane of Smith-Peterson, with complete preservation of the musculotendinous structures. The femoral neck oeteotomy is performed without dislocation of the joint or resection of the joint capsule. As there is also no additional traction applied to the soft tissues it is one of the most tissue sparing techniques available for THA. The outcome was recorded prospectively and is compared with retrospective data of a conventional lateral approach. No other variables other than the surgical technique were changed for the protocol.

Methods: 55 patients underwent traditional THR (lateral approach) surgery in 2003 and 216 consecutive, non selected patients having an anterior minimal invasive procedure during 2004/05 were followed up for an independent review.

Results: The two groups of patients were comparable in terms of age and BMI. Blood loss dropped by 42%. Hospital stay was reduced by 2.1 days (+/−0.6.) Cup inclination was 45.56 (+/−3.4) in the traditional group and 44.8 (+/−3.7) in the MicroHip group. The dislocation rate was lower in the MicroHip group, being 1/216 compared with 3/55 in the traditional group. Harris Hip score for the MicroHip group was 91.35 at 3 months and 94.43 at 1 year. Average time for return to work was reduced from 8.2 to 2.7 weeks

Discussion: The results show that a truly minimal invasive approach improves the outcome of THR without additional risks. By the use of a treadmill incorporating a dynamic force plate there is even strong evidence that perception and therefore long term results can be improved.

We performed a prospective, randomised, blinded clinical trial comparing metal versus polyethylene bearing surfaces in patients receiving a THA.

Forty-one patients were randomised to receive a metal (twenty-three) or a polyethylene (eighteen) insert with identical femoral and acetabular components. The metal bearing was a 28mm low carbon on high carbon couple. Patients were evaluated pre-operatively, at three, six, twelve months and annually thereafter, including an evaluation of erythrocyte and urine cobalt, chromium, and titanium, outcome measures (WOMAC, SF-12, Harris Hip Score) and radiographs.

No patients were lost to follow-up. At an average 7.2 (range 6.1 – 7.8) years follow-up there were no differences in any outcome measures or radiographic findings. Patients receiving metal liners had significantly elevated metal ion measurements. At most recent follow-up, compared to the polyethylene control group, patients receiving a metal on metal bearing had erythrocyte cobalt levels were eleven times elevated (median 1.4 μg/L (metal) vs 0.12 μg/L (poly), p< .001). Urine cobalt levels were thirty-nine times elevated (median 11.4 μg/L/day (metal) vs 0.29 μg/day (poly), p< .001) and urine chromium levels were twenty-eight times elevated (median 4.75 μg/day (metal) vs 0.17 μg/day (poly), p< .001). Additionally the metal ion levels reached an early steady state level and did not decrease over time. (Erythrocyte Co (μg/L): 1.29 (6 mos), 1.20 (1 yr), 1.0 (2 yr), 1.10 (3 yr), 1.35 (4 yr), 1.40 (5 yr)).

Both cobalt and chromium ion measurements were significantly elevated in the blood and urine of the patients randomised to receive the metal on metal THA at all time intervals. Contrary to previous reports, in 34% of patients with a metal liner, metal ion (erythrocyte cobalt) elevation was still increasing at latest follow-up, and in the overall metal on metal patient cohort, metal ion median levels were not decreasing over time. As in polyethylene wear data, metal ion results are not necessarily generalizable, but are bearing design specific.

Aims : This prospective study investigated outcomes from TKA using the ligament balancing technique to implant a PCL-retaining knee prosthesis (balanSys^™ knee system). In addition we wanted to know if we can achieve stability in these knees and if there is a difference between mobile and fixed bearing prosthesis designs?

Methods: Between March 2001 and Mai 2005 143 patients (17 bilateral; n=160) with osteoarthritis received the balanSys^™ knee system with either a fixed or mobile polyethylene bearing. Objective assessments of the implant used Knee Society score (KSS) with the knee and functional score. Anterior-posterior translation was measured with the Rolimeter (Aircast) in 25° (Lachman) (mean of 3) and 90° of knee flexion (mean of 3), intraoperatively under anaesthesia and at follow up time. Subjective assessments used Visual Analogue Scale (VAS) data for pain, and patient satisfaction.

Results: The study population at follow up time (mean 4 years) contained 112 patients (31 males; 81 females) with 126 knee implants out of 160. Of these 126, 93 had fixed and 33 mobile bearings. Mean age at surgery was 70.6 years. The Rolimeter measurements for ap-translation showed an increase of stability from 8.3 preop to 4.6 mm at FU in 25° of flexion and 6.3 to 4.9 in 90° of flexion. The increase of stability for mobile bearings (7.8 to 5.8/6.1 to 6.0) is smaller than for fixed bearings (8.4 to 5.8/6.9 to 4.5). The t-test shows a clear cut significance Pr > [t] = 0.0038, the difference of the paired difference amounts to 1.4 mm. The t-test shows significant differences for both angles (25°/90°) Pr > [t] < 0.001. Mobile bearings have a higher laxity in ap direction compared to fixed bearings. ROM was similar for both genders (mean 118°). According to VAS, mean scores for pain and satisfaction were 1.5 (best 0) and 8.5 (best 10), respectively. The KSS (mean score 168; SD 31.1) was similar for both, fixed and mobile bearings. In 25° of flexion the subgroup of ‘tight’ knees (1–3.5 mm ap translation) and in 90° the subgroup of ‘loose’ knees (< 5.5 mm) performed best, with highest knee scores.

Conclusions: The TKA’s performed with a PCL-retaining prosthesis and a soft tissue oriented, ligament balancing, surgical technique were associated with good outcome (KSS mean score 168), a good range of motion (118°), good stability and with no significant differences between mobile bearing or fixed bearing implants at follow up (4 years). In addition patients reported little pain (1.5) and were very satisfied (8.5) with the outcome. Interesting was the fact that in 25° of flexion the subgroup of tight knees (1–3.5mm) and in 90° the subgroup of loose knees (< 5.5 mm) performed best, with highest knee scores.

Approximately 40 to 50% of the civilized population may expect feet disorders, and in 90% localized in the forefoot. Hallux valgus (H.V.) deformity is not a single malformation, but a complex problem affecting the first ray of foot, frequently accompanied by deformities and symptoms of the lesser toes. Proximal osteotomy and soft tissue release of I metatarso-phalangeal joint (MTP) provides adequate correction of intermetatarsal angle and joint alignment.

Material and methods. 65 patients (59 women and 6 men) with 83 hallux valgus deformities treated by surgical corrections with cuneiform proximal osteotomy of the first metatarsal bone and soft tissue plasty of I MTP joint were evaluated. The average age of the patients was 52,8 years (±12,4) and the mean follow-up was 4,2 years (±1,0). Mann criteria were used to assess the radiological stage of the disease. Treatment results were assessed by means of two numerical scales: Mielke scale and AOFAS scale. On the basis of the sum of points obtained for each criteria, the treatment result was qualified as: excellent, good, fair or poor. In the radiological assessment the alteration of the valgus angle (HVA) and the intermetatarsal angle (IMA) of the hallux were evaluated.

Results. Exacerbation of hallux valgus deformity in radiological examination was moderate or severe in accordance to the Mann criteria. 21 feet accompanied by deformities of lesser toes had additionally surgical procedure for the treatment of them. According to Mielkie scale the mean score was 6,5pts. (±1,9), and the treatment result of 95% of patients was evaluated as excellent or good. The mean score in AOFAS scale was 91,2pts (±11,2) with percentage of 80,6% excellent and good results. Higher percentage of fair and poor results in AOFAS scale was due to restricted motion of first MTP joint in 8 patients, out of whom due to persistent pain ailments in 6. In case of 4 feet, cosmetic improvement was unsatisfactory, and 4 patients had problems with wearing commercial shoes. Average correction value of the hallux valgus angle was 21° (33,5° to 12,5°). Foot intermetatarsal angle correction was 9° (16,2° to 7,2°).

Conclusions. Proximal osteotomy of the first metatarsal bone with soft tissue release of I metatarso-phalangeal joint allows for good correction of the hallux valgus deformity with good functional results.

The purpose of this study was to review the midterm results of HAC coated bipolar hemiarthroplasty in patients with displaced intracapsular fracture neck of femur in elderly patients.

There were 264 patients with 274 fractures from November, 2001, to June, 2004. The operations were performed by employing a similar technique and anterolateral approach. Postoperative treatment was same. The mobility was assessed by ambulation. Pain was evaluated using a visual analogue scale and clinical evaluations were performed using the Harris Hip Scoring System.

The mean age of 142 survived patients reviewed in the study was 77.5 years (range 61-89 years) at the time of operation and mean follow-up was 25 months (range 18-48 months). Hundred and twenty six patients had no or mild occasional pain but no restriction of activity. Ninety of the ninety eight able to walk independently or with one stick before fracture were doing the same. The surviving implants were radiographically stable and demonstrated evidence of osseointegration and no acetabular wear. Harris hip score averaged 84 points. Fourteen patients (10%) scored 90-100, 80 patients (56%) scored 80-89, 42 patients (30%) scored 70-79, and 6 patients (4%) scored less than 70.

We conclude that patients who score grade 1-3 of American Society of Anaesthesiologist and are mobile preoperatively outside their own home either independently or with one stick are better treated with HAC coated bipolar hemiarthroplasty with extra benefit of easy and quick conversion to total hip replacement if required in future.

Abstract: Between 1997 to 200, 230 patients underwent primary cemented total hip replacement using the ULTIMA Cobalt alloy, collarless femoral stem and UHMW Polyethylene Cup.184 Patients were available for review with an average follow up of 48 months. The average age at operation was 69 years. The majority of the patients were female (58%). Most of the surgeries were performed by a Consultant Surgeon(91%). Cementing technique was satisfactory in majority with a cement mantle of Grade B noted in 81% of the patients. The position of the femoral stem was noted to be in neutral position in the majority of the patients (76%) with varus and valgus positions in 21 % and 3 % respectively. There was radiological evidence of loosening in 39% of the patients at the follow up out of which a quarter of patients were symptomatic clinically. Subsidence of the femoral stem was noted in 30% of the patients out of which majority 71% had evidence of loosening. About 8 patients had undergone revision or waiting revision surgery. Revision surgeries were performed between 3 to 7 years following the primary surgery with a peak in the 5^th year

Background: In 80% of patients with rheumatoid arthritis the metacarpophalangeal (MP) joints are involved with increasing destruction and loss of function. Silicone arhtroplasties of the MP joints produce a limited range of motion, increasing osteolysis and fractures of the implants. The cementless, unconstrained design of the ElogenicsTM prosthesis is a new concept for treating the MP joints of rheumatoid patients.

Methods: In a prospective study 72 ElogenicsTM prosthesis were implanted, 62 in patients with rheumatoid arthritis, osteoarthritis (n=4), polyarthritis (n=5) and 1 after revision of a silicone implant. The patients were reexamined after an average follow up of 21 months (12–51 months) clinically and radiologically.

Results: The average active range of motion for extension to flexion increased from 0/18/65° before surgery to 0/14/71° after surgery. The remaining ulnar drift was 12° (preoperative 18°!). Pain in the visual analogue scale improved from 2.3 to 1.7 postoperatively. Eight palmar luxations of the implants were recognized. They were revised and are stable during the follow-up. No infection occurred. Two prostheses were changed because of loosening. The X-rays showed osteointegration in the metacarpal components. Radiolucent zones were found in progress at the basis on the palangeal components.

Conclusion: The short- and midterm results after implantation of the cementless, unconstrained ElogenicsTM prosthesis show an improved hand function and pain relief. The design of the implant may solve the accepted postoperative problem of instability of the MP joints.

In 85 % of the patients with rheumatoid arthritis the MCP-joints are involved with incressing deterioration an loss of function. The standard replacement of the MCP-joints using the Swanson-Silastic Spacers shows pain reduction and a realigment of the fingers, but the functional capacity is not improved.

The HM-MCP-arthroplasty offers a concept for better function an restoration of the rheumatoid hands and osteoarthritis.

In a prospective multicenter study 63 HM-MCP arthroplasties have been implanted. We used the redesigned model (PE-metacarpal head and Ti-ODH phalangeal base) with titanium stems. The follow up-time is 18 months (6 – 40 months). All patients are controlled with clinical and radiographic evaluation.

The active ROM of the MCP-joints demonstrated on average flex./ext. 65/10/0 (preop. 70/15/0). The grip strength at FU demonstrated 80 % of the untreated contralateral control hand. Pain has been improved using the verbal pain scale at 1.6 (preop. 2.1).

Radiographically all metacarpal and phalangeal stems show an osteointegration of the implants. Radio-lucent lines of < 1 mm have been detected at the phalangeal base without a sign of loosing.

Complications: 1 palmar luxation with a successful closed reposition, 1 ulnar subluxation of the fifth finger, 1 unsuccessful revised palmar luxation.

The results of the uncemented, unconstrained HM-MCP-arthroplasty show an improvement of the hand function and pain reduction. This endoprosthesis gives a new chance to treat the rheumatoid hand at an earlier stage of destruction before severe contracture of the soft tissues.

This is a retrospective assessment of the performance of a consecutive series of the titanium uncemented Gemini femoral component. The Gemini uncemented stem (De Puy) is a modular titanium femoral stem with a cobalt chrome head. It has proximal porous coating allowing stable fixation by bony in-growth and a smooth distal stem allowing mechanical fixation.

Using a direct lateral approach, 152 consecutive patients underwent a total hip replacement using the Gemini uncemented femoral component and an unce-mented cup. Patients were regularly assessed clinically (Harris hip score) and radiologically (Engh’s criteria for fixation of the prosthesis). Kaplan Meier survivorship analysis was used to assess survival.

16 patients were lost to follow-up and 30 were dead with the THR in situ, leaving 106 hips for final analysis, at a mean follow-up of 106 months. The mean age of the group was 60 years (range 25–83) and OA was the commonest diagnosis. The mean Harris hip score improved from 34 to 92(range 83–100). 7 stems have been revised, four of which for aseptic loosening and a further two are radiologically loose. Mean time to revision was 41 months (range 14–76). By Engh’s criteria, 90% of the hips had stable bony fixation; only 4% of the patients complained of thigh pain at final follow-up. Kaplan Meier survivorship analysis with aseptic loosening as endpoint indicated a survival of 93% at 8 years.

A mid-term result with the Gemini uncemented stems at a mean follow-up of approximately 9 years was excellent. This is in sharp contrast to the cemented stem of similar design, even though the uncemented version was used in younger and more active group of patients. Titanium alloy is biocompatible allowing for excellent bony in growth, making it an ideal alloy in the manufacture of uncemented stems. Having a modulus of elasticity close to that of bone explains the low incidence of thigh pain.