This paper describes the methodology, validation and reliability
of a new computer-assisted method which uses models of the patient’s
bones and the components to measure their migration and polyethylene
wear from radiographs after total hip arthroplasty (THA). Models of the patient’s acetabular and femoral component obtained
from the manufacturer and models of the patient’s pelvis and femur
built from a single computed tomography (CT) scan, are used by a
computer program to measure the migration of the components and
the penetration of the femoral head from anteroposterior and lateral radiographs
taken at follow-up visits. The program simulates the radiographic
setup and matches the position and orientation of the models to
outlines of the pelvis, the acetabular and femoral component, and
femur on radiographs. Changes in position and orientation reflect
the migration of the components and the penetration of the femoral
head. Validation was performed using radiographs of phantoms simulating
known migration and penetration, and the clinical feasibility of
measuring migration was assessed in two patients.Aims
Materials and Methods
Introduction. In Europe a femoral neck retaining stem (Metha, Aesculap Inc, Tuttlingen, Germany) has been reported with excellent midterm survivorship. We report on a US series and compare it to a review of reports in Europe over the past decade to determine if US experience matches that in Europe. Methods. A review of published studies was performed on PubMed with search terms:
Total hip arthroplasty (THA) is one of the most successful surgical procedures. The objectives of this study were to define whether there is a correlation between socioeconomic status (SES) and surgical complications after elective primary unilateral THA, and investigate whether access to elective THA differs within SES groups. We conducted a retrospective, population-based cohort study involving 202 hospitals in Ontario, Canada, over a 17-year period. Patients were divided into income quintiles based on postal codes as a proxy for personal economic status. Multivariable logistic regression models were then used to primarily assess the relationship between SES and surgical complications within one year of index THA.Aims
Methods
The histopathology of periprosthetic tissues has been important to understanding the relationship between wear debris and arthroplasty outcome. In a landmark 1977paper, Willert and Semlitsch (1) used a semiquantitative rating to show that tissue reactions largely reflected the extent of particulate debris. Notably, small amounts of debris, including metal, could be eliminated without “overstraining the tissues” but excess debris led to deleterious changes. Currently, a plethora of terms is used to describe tissues from metal-on-metal (M-M) hips and corroded modular connections. We reviewed the evaluation and reporting of local tissue reactions over time, and asked if a dose response has been found between metal and tissue features, and how the use of more standardized terms and quantitative methodologies could reduce the current confusion in terminology. Methods. The PubMed database was searchedbetween 2000 and 2015 for papers using “metal sensitivity /allergy /hypersensitivity, Adverse Local Tissue Reaction (ALTR): osteolysis, metallosis, lymphocytic infiltration, Aseptic Lymphocytic Vasculitis-Associated Lesions (ALVAL), Adverse Reaction to Metal Debris (ARMD) or pseudotumor/ pseudotumour” as well as metal-on-metal / metal-metal AND
Artificial joints have been increasingly used in the treatment of physically disabled people who suffer from joint diseases such as osteoarthritis and rheumatoid arthritis. Ultra high molecular weight polyethylene (UHMWPE) is commonly used in hard-on-polymer joints as an impact-absorbing material for artificial hip joints because of its very low friction coefficient, high wear resistance, impact strength, and biocompatibility. However, particles generated by excessive wear and fatigue can cause osteolysis, which may lead to loosening. This has led to recent interest in metal-on-metal joints, which can provide better wear properties than hard-on-polymer joints, leading to reduced osteolysis. However, during gait, metal-on-metal joints are exposed to greater impacts than hard-on-polymer joints. These impacts can cause severe pain in patients who have undergone
Our center has performed
Introduction: Arthroplasty plays a growing role in our society today. Due to scientific and medical progress there are an increasing number of viable candidates and the improvement of quality of life thereafter speaks for itself. Even though the operations are largely successful, complications after joint replacement surgery occur frequently. Approximately 10% of lower limb arthroplasties need surgical revision, of which 70% are due to loosening. The purpose of this study was to assess the feasibility of 18-fluorodeoxyglucose positron emission tomography (18FFDG–PET) in detecting septic and aseptic endoprosthetic loosening of hip and knee endoprostheses. Materials and Methods: Thirty-three patients (age range: 45–90y) with lower limb arthroplasty complaints (74 prostheses) were studied preoperatively with 18F-FDG-PET. All patients underwent surgery at a later stage with microbiological culturing to differentiate aseptic and septic loosening and to confirm the final diagnosis. Prostheses were tested intraoperatively for stability and microbiology. Results: The sensitivity/specificity of 18F-FDG-PET towards implant loosening in the hip was 80%/87%, in the knee 56%/82%. The sensitivity/specificity for infectious loosening in
Introduction: Arthroplasty plays a growing role in our society today. Due to scientific and medical progress there are an increasing number of viable candidates and the improvement of quality of life thereafter speaks for itself. Even though the operations are largely successful, complications after joint replacement surgery occur frequently. Approximately 10% of lower limb arthroplasties need surgical revision, of which 70% are due to loosening. The purpose of this study was to assess the feasibility of 18-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) in detecting septic and aseptic endoprosthetic loosening of hip and knee endoprostheses. Materials and Methods: Thirty-three patients (age range: 45 – 90y) with lower limb arthroplasty complaints (74 prostheses) were studied preoperatively with 18F-FDG-PET. All patients underwent surgery at a later stage with microbiological culturing to differentiate aseptic and septic loosening and to confirm the final diagnosis. Prostheses were tested intraoperatively for stability and microbiology. Results: The sensitivity/specificity of 18F-FDG-PET towards implant loosening in the hip was 80%/87%, in the knee 56%/82%. The sensitivity/specificity for infectious loosening in
Computer aided joint replacement surgery is being used increasingly. It is more commonly used at present in the knee replacement surgery as compared to
Introduction: Osteonecrosis of the femoral head occurs in young patients. The preservation of the hip joint is vitally important because
Metal-on-metal bearing surfaces have been reintroduced for use in total hip replacement, despite concerns regarding the potential risks posed by metallic by-products. We have compared periprosthetic tissues from metal-on-metal and metal-on-polyethylene hip replacements at revision surgery with control tissues at primary arthroplasty. Tissues were obtained from 9 control, 25 contemporary metal-on-metal, 9 CoCr-on-polyethylene and 10 titanium-on-polyethylene
Pain relief in hip arthroplasty plays an important role in the intra/post operative stages in order to achieve an almost pain free post operative recovery period to mobilise the patient as early and safely as possible and avoid undesirable post surgical complications. A consecutive series of 99 total hip arthroplasties in 93 patients performed by a single surgeon between December 1996 and January 2006 were assessed for signs of clinical or radiological loosening. Intra-operative local anaesthetic mixture (Ropivacaine-Ketorolac (30mg) -Adrenaline or RKA mixture) was infiltrated into the joint capsule and surrounding tissue around the acetabular component, and into the different muscle layers in the thigh around the femoral component. A total of 150–200 mls of this mixture was injected and a further 50 mls (with 30mg ketorolac) injected through a catheter left in-situ before discharge 12 to 24 hours later. Radiographic analysis was carried out using the Hodgkinson criteria to predict acetabular component loosening and the Gruen method to determine femoral component loosening. Of the 99 hybrid hips, 57 were right and 42 were left hip arthroplasties and 6 patients had bilateral consecutive hips done. 5 were performed for revision of fractured necks of femur in Birmingham hip resurfacings and one total hip arthroplasty revised to a hybrid and the remaining 92 were primary hybrid
Vascular injuries during total hip arthroplasty
(THA) are rare but when they occur, have serious consequences. These have
traditionally been managed with open exploration and repair, but
more recently there has been a trend towards percutaneous endovascular
management. We performed a systematic review of the literature to assess
if this change in trend has led to an improvement in the overall
reported rates of morbidity and mortality during the last 22 years
in comparison with the reviews of the literature published previously. We found a total of 61 articles describing 138 vascular injuries
in 124 patients. Injuries because of a laceration were the most
prevalent (n = 51, 44%) and the most common presenting feature,
when recorded, was bleeding (n = 41, 53.3%). Delay in diagnosis
was associated with the type of vascular lesion (p <
0.001) and
the clinical presentation (p = 0.002). Open exploration and repair was the most common form of management,
however percutaneous endovascular intervention was used in one third
of the injuries and more constantly during the last 13 years. The main overall reported complications included death (n = 9,
7.3%), amputation (n = 2, 1.6%), and persistent ischaemia (n = 9,
7.3%). When compared with previous reviews there was a similar rate
of mortality but lower rates of amputation and permanent disability,
especially in patients managed by endovascular strategies. Cite this article:
To investigate psychosocial and biomedical outcomes following
total hip replacement (THR) and to identify predictors of recovery
from THR. Patients with osteoarthritis (OA) on the waiting list for primary
THR in North West England were assessed pre-operatively and at six
and 12 months post-operatively to investigate psychosocial and biomedical
outcomes. Psychosocial outcomes were anxiety and depression, social
support and health-related quality of life (HRQoL). Biomedical outcomes
were pain, physical function and stiffness. The primary outcome
was the Short-Form 36 (SF-36) Health Survey Total Physical Function.
Potential predictors of outcome were age, sex, body mass index,
previous joint replacement, involvement in the decision for THR,
any comorbidities, any complications, type of medication, and pre-operative
ENRICHD Social Support Instrument score, Hospital Anxiety and Depression
scores and Western Ontario and McMaster Universities osteoarthritis index
score.Objectives
Methods
Between 1986 and 1991 we implanted 331 consecutive Furlong hydroxyapatite-coated femoral components of a total hip replacement in 291 patients. A cemented acetabular prosthesis was used in 217 hips and a hydroxyapatite-coated component in 114. We describe the long-term clinical and radiological survival of the femoral component at a mean follow-up of 17.5 years (15 to 21). Only two patients (0.68%) were lost to follow-up. With revision of the femoral component for any reason as the endpoint, the survival at a mean of 17 years was 97.4% (95% confidence interval 94.1 to 99.5), and with revision for aseptic loosening as the endpoint it was 100%. The survival at a maximum of 21 years with revision of the femoral component for any reason as the endpoint was 97.4% (95% confidence interval 81.0 or 99.5). These results compare favourably with the best long-term results of cemented or uncemented femoral components used in total hip replacement.