Primary stability is achieved by the press fit technique, where an oversized component is inserted into an undersized reamed cavity. The major geometric design of an acetabular shell is hemispherical type. On the other one, there are the hemielliptical type acetabular shells for enhanced peripheral contact. In the case of developmental dysplasia of the hip (DDH), the aseptic loosening may be induced by instability due to decreased in the contact area between the acetabular shell and host bone. The aim of this study was to assess the effect of reaming size on the primary stability of two different outer geometry shells in DDH models. The authors evaluated hemispherical (Continuum Acetabular Shell, Zimmer Biomet G.K.) and hemielliptical (Trabecular Metal Modular Acetabular Shell, Zimmer Biomet G.K.) acetabular shells. Both shells had a 50 mm outer diameter and same tantalum 3D highly porous surface. An acetabular bone model was prepared using a solid rigid polyurethane foam block with 20 pcf density (Sawbones, Pacific Research Laboratories Inc.) as a synthetic bone substrate. Press fit conditions were every 1 mm from 4 mm under reaming to 2 mm over reaming. To simulate the acetabular dysplasia the synthetic bone substrate was cut diagonally at 40°. Where, the acetabular inclination and cup-CE angle were assumed to 40° and 10°, respectively. Acetabular components were installed with 5 kN by a uniaxial universal testing machine (Autograph AGS-X, Shimadzu Corporation). Primary stability was evaluated by lever-out test. The lever-out test was performed in 4 mm undersized to 2 mm oversized reaming conditions. Lever out moment was calculated from the multiplication of the maximum load and the moment arm for primary stability of the shell. The sample size was 6 for each shell type.Introduction
Materials and methods
We used a polymerase chain reaction (PCR) lateral flow assay1) to rapidly diagnose joint infection. We evaluated the usefulness of multiplex-PCR (PCR lateral flow assay: PCR-LF) using detailed clinical data. A total of 35 synovial fluid samples were collected from 26 patients in whom bacterial infection was suspected, including 22 from knee joints, 11 from hip joints, and 2 from other joints. After purifying the DNA from the samples, multiplex PCR targeting two MRSA-associated genes (Aim
Method
The preparation of antibiotic-containing polymethyl methacrylate (PMMA), as spacers generates a high polymerization heat, which may affect their antibiotic activity; it is desirable to use bone cement with a low polymerization heat. Calcium phosphate cement (CPC) does not generate heat on polymerization, and comparative elution testings are reported that vancomycin (VCM)-containing CPC (VCM-CPC) exceeded the antibiotic elution volume and period of PMMA (VCM-PMMA). Although CPC alone is a weak of mechanical property spacer, the double-layered, PMMA-covered CPC spacer has been created and clinically used in our hospital. In this study, we prepared the double-layered spacers: CPC covered with PMMA and we evaluated its elution concentration, antimicrobial activity and antibacterial capability. We prepared spherical, double-layered, PMMA-coated (CPC+PMMA; 24 g CPC coated with 16 g PMMA and 2 g VCM) and PMMA alone (40 g PMMA with 2 g VCM) spacers (5 each). In order to facilitate VCM elution from the central CPC, we drilled multiple holes into the CPC from the spacer surface. Each spacer was immersed in phosphate buffer (1.5 mL/g of the spacer), and the solvent was changed daily. VCM concentrations were measured on days 1, 3, 7, 14, 28, 56, and 84. Antimicrobial activity against MRSA and MSSA was evaluated by the broth microdilution method. After measuring all the concentration, the spacers were compressed at 5 mm/min and the maximum compressive load up to destruction was measured.Aim
Method
On the basis of a proposal by Noble, the marrow cavity form can be classified into three categories: normal, champagne-fluted and stovepipe. In the present study, three typical finite element femoral models were created using CT data based on Noble's three categories. The purpose was to identify the relationship of stress distribution of the surrounding areas between femoral bone marrow cavity form and hip stems. The results shed light on whether the distribution of the high-stress area reflects the stem design concept. In order to improve the results of THA, researchers need to consider the instability of a stem design based on the stress distributioin and give feedback on future stem selection. As analyzing object, we selected SL-PLUS and BiCONTACT stems. To develop finite element models, two parts (cortical bone and stem) were constructed using four-node tetrahedral elements. The model consisted of about 60,000 elements. The material characteristics were defined by the combination of mass density, elastic coefficient, and Poisson's ratio. Concerning the analysis system, HP Z800 Workstation was used as hardware and LS-DYNA Ver. 971 as software. The distal end of the femur was constrained in all directions. On the basis of ISO 7206 Part 4,8 that specifies a method of endurance testing for joint prostheses, the stem was tilted 10°, and a 1500 N resultant force in the area around the hip joint was applied to the head at an angle of 25° with the long axis. Automatic contact with a consideration of slip was used.Introduction
Methods
Proximal humeral fracture occurs most frequently in elderly and usually unite within 12 weeks. Malunion is more common than nonunion. And even if nonunion occurs, we usually treat it by the blade plate. Norris et al. reported hemiarthroplasty is indicated for severe degenerative changes of the articular surface, osteonecrosis of the humeral head, or osteopenia severe enough to jeopardize fixation in order patients. Therefore, it is not common that hemiarthroplasty is used for primary treatment of the proximal humeral pseudoarthrosis. We report a case of proximal humerus pseudoarthrosis which was treated by hemiarthroplasty. A patients is 75 years old male. He was injured by falling from ladder. He was diagnosed proximal humeral fracture Neer type2. After he was followed conservatively for one year, he was referred to our hospital. In X-ray film and CT, the humeral head was scraped by the humeral shaft that was tucked inward to humeral head.(Figure 1) In MRI, rotator cuff muscles were left. The fatty infiltration was stage 1 in the Gourtallier classification. (Figure 2)And osteoarthritis of shoulder was not so severe. Therefore, we decided to do hemiarthroplasty. We used the SMR implant (Lima Corporate, Milano, Italy). Surgical reconstruction was done using a deltpectral approach. Lesser tuberosity was cut from greater tuberosity with subscaplaris muscle. We used the cementless stem. Each fragments and stem was fixed using FiberWire (Arthrex, Florida USA), after autograft which scraped from the reseceted humeral head was stuffed. After the operation, the shoulder was fixed by brace for 4weeks. The passive ROM exercise was started from 21 days later. The Active ROM exercise was started at 28 days later. Three months later, the pseudoarthrosis united successfully. (Figure 3) The active flexion was improved from 20 degrees to 110 degrees. The active abduction was from 20 degrees to 90 degrees. USLA score was improved from 10 to 26.Introduction
Case
According to proposal of Noble, the femoral bone marrow cavity form of patients who underwent Total Hip Arthroplasty (THA) can be classified under 3 categories; those are Stovepipe, Normal and Champagne-fluted. We developed typical sodium chloride femoral model was created by 3D prototyping technique. The purpose was to identify the relationship of pressure zone of the surrounding areas between femoral bone marrow cavity form and hip stem. As opponent clarified stem design concept Zweymüller type model was used. According to CT data with the patients who underwent THA, the sodium chloride femoral model was custom-made and selected as the representative model based on Noble's 3 categories. Eight models of each category were used to performed mechanical test.Introduction
Materials and Method
On the basis of a proposal by Noble, the marrow cavity form can be classified into three categories: stovepipe, normal, and champagne-fluted. In the present study, three typical finite element femoral models were created using CT data based on Noble's three categories. The purpose was to identify the relationship of stress distribution of the surrounding areas between femoral bone marrow cavity form and hip stem. The results shed light on whether the distribution of the high-stress area reflects the stem design concept. In order to improve the results of THA, researchers need to consider the instability of a stem design based on the pressure zone and give feedback on future stem selection. To develop finite element models, two parts (cortical bone and stem) were constructed using four-node tetrahedral elements. The model consisted of about 40,000 elements. The material characteristics were defined by the combination of mass density, elastic coefficient, and Poisson's ratio. Concerning the analysis system, HP Z800 Workstation(HP, Japan) was used as hardware and LS-DYNA Ver. 971 (Livermore Software Technology Corporation, USA) as software. The distal end of the femur was constrained in all directions. On the basis of ISO 7206 Part 4,8 that specifies a method of endurance testing for joint prostheses, the stem was tilted 10°, and a 500 N resultant force in the area around the hip joint was applied to the head at an angle of 25° with the long axis. Automatic contact with a consideration of slip was used. Von Mises stress during a 1.0 s period after loading was analyzed, and stress distribution in the stem and its maximum value were calculated.Introduction
Methods
Fracture during total hip arthroplasty occurs partly because the acquisition of fixation at the time of stem implantation depends on the operator's experience and sensation due to the absence of definite criteria. Therefore, an objective evaluation method to determine whether the stem has been appropriately implanted is necessary. We clarified the relationship between the hammering sound frequency during stem implantation and internal stress in a femoral model, and evaluated the possible usefulness of hammering sound frequency analysis for preventing intraoperative fracture. Three types of cementless stem were used. Orthopedists performed stem insertion using a procedure similar to that employed in routine operation. Stress was estimated by finite element analysis using the hammering force calculated from the loading sensor as a loading condition, and frequency analysis of hammering sound data obtained using a microphone was performed (Fig. 1). Finite element analysis showed a decrease in the hammering sound frequency with an increase in the estimated maximum stress (Fig. 2, 3). When a decrease in frequency was observed, adequate hammering had already been performed to achieve press-fit stability. Therefore, there is a possibility that the continuation of hammering induces intraoperative fractures that become a problem. Based on the relationship between stress and frequency, the evaluation of changes in frequency may be useful for preventing the development of intraoperative fractures. When a decrease in frequency is observed, the hammering force should be reduced thereafter. Hammering sound frequency analysis may allow the prediction of bone fractures that can be visually confirmed, and may be a useful objective evaluation method for the prevention of intraoperative bone fracture.
The purpose of this study is to prove whether Japanese patients undergoing primary total hip arthroplasty (THA) for the hip dysplasia were able to return to sport after surgery. A questionnaire survey was completed by 77 patients in 9 males and 68 females between 1 and 3 years after surgery. Mean age at surgery was 66.1 (range, 49 to 87). In the 3 years before surgery 40 (51.9%) patients were participating in sport. By 1 to 3 years after surgery 43 (55.8%) patients were participating in sport. A total of 33 (82.5%) had returned to their sporting activities by 1 to 3 years after surgery in groups who played sports before surgery and 7 (17.5%) were unable to do with the most common reason being “cannot move as much as I wanted”. On the other hand, a total of 10 (27%) had started playing sports after surgery. The sports activities after surgery were the most common being walking, radio calisthenics, and swimming as low-impact sports. A total of 27 (73%) did not play sports before or after surgery with the most common reason being “fear of damage to the hip joint”. In conclusion, when Japanese patients who have undergone THA for hip dysplasia choose to participate in sports, orthopedic surgeons should provide information with which to evaluate the risk of sports activity and recommend appropriate sports activity.
