The purpose of this study is to evaluate the midterm results of cementless revision total hip arthroplasty (THA) using Wagner Cone Prosthesis. Between 1996 and 2007, 36 hips in 36 consecutive patients underwent femoral revision THA using Wagner Cone Prosthesis. Among them 28 hips were followed for more than 5 years. The mean age at revision surgery was 57 years and a mean follow-up was 7.6 years. The Paprosky classification system was used for preoperative bone loss evaluation. Clinical results were evaluated using Harris hip scores. For evaluation of the femoral component, radiolucent lines at bone-implant interfaces were evaluated and femoral component vertical subsidence was measured. Heterotopic bone formation and complications were also evaluated.Purpose
Material and Methods
The purpose of this study was to evaluate the results of two stage reconstruction for infected arthroplasty of hip joint and to know the risk factor for failures. From May 2004 to September 2011, 104 consecutive patients (105 hips) who underwent two stage reconstruction for the infected arthroplasty of hip joint were retrospectively evaluated. There were 60 hips with primary THA infection (Acute infection 22, Delayed infection 38), 4 hips with revision THA infection (Acute infection 1, Delayed infection 3), 20 hips with primary hemiarthroplasty infection (Acute infection 14, Delayed infection 6) and 24 hips with acute pyogenic coxitis. We evaluated the number of surgeries before two-stage reconstruction and also analysed the cultured pathogens. Mean follow duration after 2nd stage revision THA was 1.80 ± 1.76 years and average age at the time of 1st stage surgery (Debridement and PROSTALAC insertion) was 62.8 ± 14.3 years.Purpose:
Patients and Methods:
This study was performed to evaluate the minimum 5-year clinical and radiological results of liner cementation into a stable acetabular shell using a metal-inlay, polyethylene liner during revision total hip arthroplasty (THA). Sixty-six hips (63 patients) that underwent revision THA using a metal-inlay polyethylene liner cementation were included. The causes of revision were; polyethylene wear in 37 cases, femoral stem loosening in 20 cases, ceramic head fracture in 4 cases, and recurrent dislocation in 5 cases. Clinical results were graded at final follow-up using Harris hip scores, and radiographs were evaluated to determine acetabular component inclination, the stabilities of acetabular and femoral components, correction of hip centers, and the progression of osteolysis.Introduction
Methods
The purpose of this study is to know the peri-operative morbidity, clinical and radiographical outcomes of conversion THA from failed transtrochanter rotational osteotomy (TRO). From 2003 January to 2009 January, there were 18 hips(18 patients) who underwent conversion THA from TRO for osteonecrosis of the femoral head (ONFH) (Group I). The mean duration from TRO to conversion THA was 2.6 years. We made a matched control group of 18 primary THA for ONFH (Group II) and we evaluated perioperative morbidity and complications in each group. For the clinical evaluation, we checked Harris hip score (HHS) and WOMAC score. For the radiographical evaluation, we evaluated implant position, stability and osteolysis.Purpose
Patients and methods
Hip arthroplasty is a good treatment option for displaced femoral neck fracture in elderly patients. However, neuromuscular disease such as cerebral infarction or hemorrhage can be a concerning problem for THA since dislocation after operation can frequently occur. The purpose of this prospective study was to evaluate the functional results of modified minimally invasive (MI) two-incision total hip arthroplasty (THA) with the use of large-diameter (>38mm) metal-on-metal articulation in patients with muscle weakness. 19 consecutive patients (19 hips) with displaced femoral neck fracture with muscle weakness were enrolled. There were 11 patients with cerebral infarction, 4 patients with cerebral hemorrhage and 4 patients with Parkinson's disease. In the lateral position, an anterolateral approach between the gluteus medius and tensor fascia lata and a posterior approach between the piriformis and gluteus medius were used. Surgical morbidity, functional recovery, radiological implantation properties, range of motion (ROM) and complications were assessed.Purpose
Patients and Methods
The purpose of this study was to evaluate the functional and radiographical mid-term follow-up results of a second generation metal-on-metal cementless total hip arthroplasty for the treatment of osteonecrosis of the femoral head in patients younger than 50 years. Twenty eight patients (35 hips) who underwent total hip arthroplasty with second generation metal-on-metal bearings for osteonecrosis of the femoral head at a minimum 5-year follow-up were included in this study. There were 5 women (6 hips) and 23 men (29 hips) who had a mean age of 40 years (range, 23 to 49 years) and a mean follow-up of 7 years. We used a Fitmore (Zimmer) cup and a 28mm Metasul femoral head in all cases. A CLS (Protek AG/Zimmer) femoral stem was used in 30 hips and a Cone prosthesis¯ (Protek AG) was used in 5 hips. Functional results were measured by Harris hip (HHS) and WOMAC scores. Radiographic evaluations were used to assess loosening and osteolysis according to Gruen and Delee and Charnley criteria.Introduction
Methods
The purpose of this study was to evaluate the functional and radiographical results in patients who underwent a modified minimally invasive two-incision total hip arthroplasty using large-diameter ceramic-on-ceramic articulations for osteonecrosis of the femoral head. One hundred and one patients (135 hips) who underwent unilateral minimally invasive two-incision total hip arthroplasties using large diameter ceramic-on-ceramic bearings for osteonecrosis of the femoral head with a minimum 12-months follow-up were included in this study. There were 22 women and 79 men who had a mean age of 46 years (range, 22 to 82 years). The mean follow-up was 25 months (range, 12 to 36 months). All surgeries were done by a single hip surgeon. The authors modified the original minimally invasive two-incision total hip arthroplasty technique and used large-diameter (32mm, 36mm) ceramic-on-ceramic articulations. In the lateral position, an anterolateral approach between the gluteus medius and tensor fascia lata muscles and a posterior approach between the piriformis and gluteus medius muscles was used. Functional results were measured by Harris hip (HHS) and WOMAC scores. Radiographic evaluation was assessed for positioning of the components and complications were assessed.Introduction
Methods
The purpose of this study was to evaluate the functional and radiographical results in patients who underwent a modified minimally invasive two-incision total hip arthroplasty using large-diameter metal-on-metal articulations for osteonecrosis of the femoral head. From December 2007 to July 2008, 45 hips (33 patients) underwent total hip arthroplasty for the treatment of osteonecrosis of the femoral head. There was 1 woman (2 hips) and 32 men (43 hips) who had a mean age of 39 years (range, 22 to 64 years). The minimum follow-up was 12 months (range, 12 to 19 months). The authors modified the original minimally invasive two-incision total hip arthroplasty technique and used large-diameter metal-on-metal articulations. In the lateral position, an anterolateral approach was used between the gluteus medius and tensor fascia lata muscles and for the posterior approach the muscle plane was between the piriformis and gluteus medius muscles. The acetabular components, Durom¯ (Zimmer) in 20 hips and Magnum¯ (Biomet) was used in 25 hips. M/L taper¯ (Zimmer) femoral stems were used in all cases. The size of the femoral heads were 38 mm (1 hip), 40 mm (3 hips), 42 mm (13 hips), 44 mm (18 hips), 46 mm (5 hips), 48 mm (4 hips) and 50 mm (1 hip). Postures such as excessive flexion or adduction which cause dislocation were not restricted, post-operatively. Functional results were measured by Harris hip scores (HHS), WOMAC scores, and range of motion. Radiographic evaluation was assessed for positions of components and post-operative complications were noted.Introduction
Methods
Bone morphogenetic proteins (BMPs) are members of the TGF-beta superfamily of growth factors and are known to regulate proliferation and expression of the differentiated phenotype of chondrocytes, osteoblasts, and osteoclasts. To investigate the osteoblastic differentiation gene expressions that contribute to BMP-7 dependent ostogenesis, we performed gene expression profiling of BMP-7-treated mouse bone marrow stromal cells. D1 cells (mouse bone marrow stromal cells) were cultured in osteogenic differentiation medium (ODM) for 3 days, and then treated with BMP-7 for 24 hr. Total RNA was extracted using Trizol, purified using RNeasy columns. Total RNA was amplified and purified using the Ambion Illumina RNA amplification kit to yield biotinylated cRNA. The data analysis up- and down-regulation developmental processes (anterior/posterior patterning, ectoderm development, embryogenesis, gametogenesis, mesoderm development, other development process, and segment specification) genes expression fold.Introduction
Methods
The purpose of this study was to evaluate the functional and radiographical results in patients younger than 30 years who underwent cementless third generation ceramic-on-ceramic total hip arthroplasty for osteonecrosis of the femoral head. Forty one patients (55 hips) who underwent total hip arthroplasty with third generation ceramic-on-ceramic bearings for osteonecrosis of the femoral head with a minimum 4-year follow-up were included in this study. There were 26 men and 15 women who had a mean age of 26 years (range, 16 to 29 years). The average duration of follow-up was 6 years (range, 4 to 7 years). All surgeries were done by a single hip surgeon and third generation ceramic-on-ceramic articulations were used. Securefit (Stryker) acetabular components were used in 46 hips and Duraloc (Depuy) in 9 hips. Accolade (Stryker) femoral stems were used in 33 hips, cone prosthesis (Zimmer) in 18 hips and CLS (Zimmer) in 4 hips. Functional results were measured by Harris hip (HHS) and WOMAC scores. Radiographic evaluation was assessed for loosening and osteolysis according to Gruen and Delee and Charnley criteria.Introduction
Methods
The amount of anteroposterior laxity required for a good range of movement and knee function in a cruciate-retaining total knee replacement (TKR) continues to be debated. We undertook a retrospective study to evaluate the effects of anteroposterior laxity on the range of movement and knee function in 55 patients following the e-motion cruciate-retaining TKR with a minimum follow-up of two years. The knees were divided into stable (anteroposterior translation, ≤ 10 mm, 38 patients) and unstable (anteroposterior translation, >
10 mm, 17) groups based on the anteroposterior laxity, measured using stress radiographs. We compared the Hospital for Special Surgery (HSS) scores, the Western Ontario MacMasters University Osteoarthritis (WOMAC) index, weight-bearing flexion, non-weight-bearing flexion and the reduction of flexion under weight-bearing There were no differences between the stable and unstable groups with regard to the mean HHS and WOMAC total scores, as well as weight-bearing and non-weight-bearing flexion (p = 0.277, p = 0.082, p = 0.095 and p = 0.646, respectively). However, the stable group had a better WOMAC function score and less delta flexion than the unstable group (p = 0.011 and p = 0.005, respectively). Our results suggest that stable knees with laxity ≤ 10 mm have a good functional outcome and less reduction of flexion under weight-bearing conditions than unstable knees with laxity >
10 mm following an e-motion cruciate-retaining TKR.
Intraoperative measurement of tightening torque In vivo data of the maximal torque which was applied by an experienced surgeon was measured using a torquemeter. Total 11 cases of periprosthetic femoral fractures from 11 patients were participated with their agreement. A two-side Dall-Miles cable tightener (Stryker Co., USA) was used. To measure the torque of Dall-Miles tightener applied by a surgeon, a torquemeter (Torque driver 80FTD2-N-S, TOHNICHI, JAPAN) was connected to the Dall-Miles tightener through a square groove. The groove was machined with 1cm × 1cm × 1cm in dimension on the proximal end of the rotational shaft of the Dall-Miles tightener. Laboratory measurement of torque and tension To reveal the relationship between the torque of Dall-Miles cable tensioner and the tension of the cable, mechanical tests were done. A two-side Dall-Miles cable tightener were mounted to INSTRON (INSTRON, Norwood, MA, USA) using a customized fixation jig. One cable of 2 mm in diameter was connected to the upper head of INSTRON, and another to the lower headA preload was slowly applied to the cables up to 10 N so that the initially loose interaction among a tightener, two cables, and two loading heads of INSTRON became tight. Once the preloading finished, tightening torque and cable tension were simultaneously measured. The tightening torque was increased in increment of 1 N-m; accordingly, at each torque the tension hung to Dall-Miles cable was measured by reading loadcell data of INSTRON.
Numerical expression of torque-tension relationship Based on the data of tightening torque and cable tension measured from mechanical tests, the relationship between the torque (T) and tension (P) of Dall-Midles cable fixation system was numerically expressed. Total range of measured tightening torques and cable tensions was linearized. The linear expression was “T=106.8 × P”. Based on this numerical relationship, the amount of cable tension applied to the cable was calculated as 606.6±58 N.
The treatment of osteochondritis dissecans after Legg-Calvé-Perthes’disease hasnot been clearly determined. It may be either by simple observation or surgical removal of the osteochondral fragment. We studied the evolution of the lesion in 13 children and reviewed 92 hips reported in the literature. In our patients ten showed a tendency towards spontaneous healing, one required drilling + grafting to obtain fusion, and in two there was separation into the joint. These loose bodies were in the acetabular fossa and caused no symptoms. On reviewing the literature, we found only four cases of hips with loose bodies from osteochondritis dissecans. These were lying in the inferomedial capsule and were also asymptomatic. Treatment of osteochondritis dissecans after Legg-Calvé-Perthes’ disease should therefore be conservative unless the fragment interferes with the mechanics of the hip.
