Although cemented fixation provides excellent results in primary total hip replacement (THR), particularly in patients older than 75 years, uncemented implants are most commonly used nowadays. We compare the rate of complications, clinical and radiological results of three different designs over 75-years-old patients. 433 hips implanted in patients over 75 years old were identified from our Local Joint Registry. Group A consisted of 139 tapered cemented hips, group B of 140 tapered grit-blasted uncemented hips and group C of 154 tapered porous-coated uncemented hips. A 28 mm femoral head size on polyethylene was used in all cases. The mean age was greater in group A and the physical activity level according to Devane was lower in this group (p<0.001 for both variables). Primary osteoarthritis was the most frequent diagnoses in all groups. The radiological acetabular shape was similar according to Dorr, however, an osteopenic-cylindrical femur was most frequently observed in group A (p<0.001). The pre- and post-operative clinical results were evaluated according to the Merle-D'Aubigne and Postel scale. Radiological cup position was assessed, including hip rotation centre distance according to Ranawat and cup anteversion according to Widmer. We also evaluated the lever arm and height of the greater trochanter distances and the stem position. Kaplan-Meier analysis was done for revision for any cause and loosening. The hip rotation centre distance was greater and the height of the greater trochanter was lower in group B (p=0.003, p<0.001, respectively). The lever arm distance was lower in group C (p<0.001). A varus stem position was more frequently observed in group B (p<0.001). There were no intra- or post-operative fractures in group A, although there were five intra-operative fractures in the other groups plus two post-operative fractures in group B and four in group C. The rate of dislocation was similar among groups and was the most frequent cause for revision surgery (8 hips for the whole series). The mean post-operative clinical score improved in all groups. The overall survival rate for revision for any cause at 120 months was 88.4% (95% CI 78.8–98), being 97.8% (95% CI 95.2–100) for group A, 81.8% (95% CI 64.8–98.8) for group B and 95.3% (95% CI 91.1–99.6) for group C (log Rank: 0.416). Five hips were revised for loosening. The overall survival rate for loosening at 120 months was 91.9% (95% CI 81.7–100), being 99.2%(95% CI 97.6–100) for group A, 85.5 (95% CI 69.9 −100) for group B and 100% for group C (Log Rank 0.093).Materials and Methods
Results
Composite screws of uncalcined and unsintered hydroxyapatite (HA) particles and poly-l-lactide (PLLA) were developed as completely absorbable bone fixation devices. So far the durability of HA-PLLA composite screws is unclear when used for the fixation of acetabular bone graft in total hip arthroplasty under full-weight conditions. We have used this type of screw for the fixation of acetabular bone graft in cemented or reverse-hybrid total hip arthroplasty since 2003. Hence, we conducted a follow-up study to assess the safety and efficacy of these screws when used for cemented socket fixation. During 2003–2009, HA-PLLA composite screws were used for fixation of acetabular bone graft in cemented or reverse-hybrid primary THA in 106 patients (114 cases). All the THAs were performed through direct lateral approaches, and postoperative gait exercise with full weight bearing usually started two days after surgery. One patient died of an unrelated disease and seven patients were lost to follow-up within 5 years. Finally, 98 patients (106 cases) were followed up for over 5 years and were reviewed retrospectively (follow-up rate, 93%). Radiographic loosening of the acetabular component was assessed according to the criteria of Hodgkinson et al., and the radiolucent line around the socket was evaluated in all zones, as described by DeLee and Charnley.Background
Methods
Loosening is generally the most common reason for revision TKA. In the AOA NJR, the rate of revision varies depending on
Dorr bone type is both a qualitative and quantitative classification. Qualitatively on x-rays the cortical thickness determines the ABC type. The cortical thickness is best judged on a lateral x-ray and the focus is on the posterior cortex. In Type A bone it is a thick convex structure (posterior fin of bone) that can force the tip of the tapered implant anteriorly – which then displaces the femoral head posteriorly into relative retroversion. Fractures in DAA hips have had increased fractures in Type A bone because of the metaphyseal-diaphyseal mismatch (metaphysis is bigger than diaphysis in relation to stem size). Quantitatively, Type B bone has osteoclastic erosion of the posterior fin which proceeds from proximal to distal and is characterised by flattening of the fin, and erosive cysts in it from osteoclasts. A tapered stem works well in this bone type, and the bone cells respond positively. Type C bone has loss of the entire posterior fin (stove pipe bone), and the osteoblast function at a low level with dominance of osteoclasts. Type C is also progressive and is worse when both the lateral and AP views show a stove pipe shape. If just the lateral x-ray has thin cortices, and the AP has a tapered thickness of the cortex a non-cemented stem will work, but there is a higher risk for fracture because of weak bone. At surgery Type C bone has “mushy” cancellous bone compared to the hard structure of type A. Tapered stems have high risk for loosening because the diaphysis is bigger than the metaphysis (opposite of Type A). Fully coated rod type stems fix well, but have a high incidence of stress shielding.
Loosening is generally the most common reason for revision TKA. In the AOA NJR, the rate of revision varies depending on
Total knee arthroplasty (TKA) is reliable, durable, and reproducible in relieving pain and improving function in patients with arthritis of the knee joint.
Background. Endoprosthetic reconstruction is an established method of treatment for primary bone tumours in children. Traditionally these were implanted with cemented intramedullary fixation. Hydroxyapatite collars at the shoulder of the implant are now standard on all extremity endoprostheses, but older cases were implanted without collars. Uncemented intramedullary fixation with hydroxyapatite collars has also been used in an attempt to reduce the incidence of problems such as aseptic loosening. Currently there are various indications that dictate which method is used. Aims. To establish long term survivorship of cemented versus uncemented endoprosthesis in paediatric patients with primary bone tumours. Methods. This was a retrospective study of 441 endoprostheses implanted in 367 consecutive patients aged 18 years or less, between 1973 and 2005. This included the use of case notes, hospital databases and a radiological review. Information obtained included patient demographics, indications for surgery, anatomical distribution and type of implants, complications and survivorship. Results. Mean age was 13.9 (range 3 - 38). 210 patients were male, 157 were female. There were 364 primaries and 77 revision implants. 161 extendable and 280 definitive prostheses. 282 patients had osteosarcoma, 54 had Ewing's sarcoma and 28 had other diagnoses. Commonest sites included 197 distal femoral replacements, 85 proximal tibial implants and 57 were in the upper limb. Kaplan-Meier survival analysis was used to compare anatomical sites and method of fixation. Upper limb implants had the best long term survival. Failure rates for distal femoral replacements were compared for cemented fixation (21.7% due to aseptic loosening) with cement plus hydroxyapatite collars (3.1%) and uncemented implants with hydroxyapatite collars (6.2%). Conclusions. In the distal femur cemented fixation with hydroxyapatite collars gave the best survivorship in definitive primary prostheses. Uncemented fixation with hydroxyapatite collars gave the best survivorship in extendable prostheses.
Introduction. Total knee arthroplasty has become an established operation.
The elements of my routine pre-operative planning include skin and scar assessment, the limb length (physical exam and radiographic assessments), the socket type, the stem type, and radiographic templating. Blood management is rarely an issue for primary total hips today and I generally do not recommend pre-operative autologous donation. I currently use a low molecular weight heparin for venous thromboembolic prophylaxis for most all patients. All of my patients have pre-operative medical clearance from a hospital intensivist. A press-fit modular cementless socket is my “workhorse”, although I occasionally use supplemental fixation with spikes (low bone density) or screws (shallow or otherwise deficient hemisphere).
The elements of my routine pre-op. planning include skin and scar assessment, the limb length (physical exam and radiographic assessments), the socket type, the stem type, and radiographic templating. Blood management is rarely an issue for primary total hips today and I generally do not recommend pre-operative autologous donation. I currently use a low molecular weight heparin for venous thromboembolic prophylaxis for most all patients. All of my patients have pre-operative medical clearance from a hospital intensivist. A press-fit modular cementless socket is my “workhorse,” although I occasionally use supplemental fixation with spikes (low bone density) or screws (shallow or otherwise deficient hemisphere).
Bactericidal levels of antibiotics are difficult
to achieve in infected total joint arthroplasty when intravenous antibiotics
or antibiotic-loaded cement spacers are used, but intra-articular
(IA) delivery of antibiotics has been effective in several studies.
This paper describes a protocol for IA delivery of antibiotics in
infected knee arthroplasty, and summarises the results of a pharmacokinetic
study and two clinical follow-up studies of especially difficult
groups: methicillin-resistant Cite this article: