To assess the diagnostic value of C-reactive protein (CRP), leucocyte count (LC), and erythrocyte sedimentation rate (ESR) in late fracture-related infection (FRI). PubMed, Embase, and Cochrane databases were searched focusing on the diagnostic value of CRP, LC, and ESR in late FRI. Sensitivity and specificity combinations were extracted for each marker. Average estimates were obtained using bivariate mixed effects models.Aims
Materials and Methods
The aim of this study was to investigate the incidence of knee arthroplasty and arthroscopy following patellar fractures, and to compare this with an age- and gender-matched group without a prior patellar fracture. A national matched cohort study based on the Danish National Patient Register including all citizens of Denmark (approximately 5.3 million) was undertaken. A total of 6096 patients who sustained a patellar fracture in Denmark between 1 January 1996 and 31 December 2000 were included. The median age of these patients was 50.6 years (interquartile range (IQR) 28.5 to 68.9); 49.1% were women. Patients were followed-up until 31 December 2015, with regard to treatment with knee arthroplasty and/or knee arthroscopy.Aims
Patients and Methods
The management of acetabular defects at the time of revision hip arthroplasty surgery is a challenge. This study presents the results of a long-term follow-up study of the use of irradiated allograft bone in acetabular reconstruction. Between 1990 and 2000, 123 hips in 110 patients underwent acetabular reconstruction for aseptic loosening, using impaction bone grafting with frozen, irradiated, and morsellized femoral heads and a cemented acetabular component. A total of 55 men and 55 women with a mean age of 64.3 years (26 to 97) at the time of revision surgery are included in this study.Aims
Patients and Methods
Aims
Patients and Methods
Mechanical wear and corrosion at the head-stem junction of total hip arthroplasties (THAs) (trunnionosis) have been implicated in their early revision, most commonly in metal-on-metal (MOM) hips. We can isolate the role of the head-stem junction as the predominant source of metal release by investigating non-MOM hips; this can help to identify clinically significant volumes of material loss and corrosion from these surfaces. In this study we examined a series of 94 retrieved metal-on-polyethylene (MOP) hips for evidence of corrosion and material loss at the taper junction using a well published visual grading method and an established roundness-measuring machine protocol. Hips were retrieved from 74 male and 20 female patients with a median age of 57 years (30 to 76) and a median time to revision of 215 months (2 to 324). The reasons for revision were loosening of both the acetabular component and the stem (n = 29), loosening of the acetabular component (n = 58) and infection (n = 7). No adverse tissue reactions were reported by the revision surgeons.Objectives
Methods
Periprosthetic joint infection (PJI) is a serious complication
of total hip arthroplasty (THA). Different bearing surface materials
have different surface properties and it has been suggested that
the choice of bearing surface may influence the risk of PJI after
THA. The objective of this meta-analysis was to compare the rate
of PJI between metal-on-polyethylene (MoP), ceramic-on-polyethylene
(CoP), and ceramic-on-ceramic (CoC) bearings. Electronic databases (Medline, Embase, Cochrane library, Web
of Science, and Cumulative Index of Nursing and Allied Health Literature)
were searched for comparative randomized and observational studies
that reported the incidence of PJI for different bearing surfaces.
Two investigators independently reviewed studies for eligibility, evaluated
risk of bias, and performed data extraction. Meta-analysis was performed
using the Mantel–Haenzel method and random-effects model in accordance
with methods of the Cochrane group.Aims
Patients and Methods
This study presents the long-term survivorship, risk factors for prosthesis survival, and an assessment of the long-term effects of changes in surgical technique in a large series of patients treated by metal-on-metal (MoM) hip resurfacing arthroplasty (HRA). Between November 1996 and January 2012, 1074 patients (1321 hips) underwent HRA using the Conserve Plus Hip Resurfacing System. There were 787 men (73%) and 287 women (27%) with a mean age of 51 years (14 to 83). The underlying pathology was osteoarthritis (OA) in 1003 (75.9%), developmental dysplasia of the hip (DDH) in 136 (10.3%), avascular necrosis in 98 (7.4%), and other conditions, including inflammatory arthritis, in 84 (6.4%).Aims
Patients and Methods
The aim of this study was to examine the results of the acetabular
distraction technique in achieving implantation of a stable construct,
obtaining biological fixation, and producing healing of chronic
pelvic discontinuity at revision total hip arthroplasty. We identified 32 patients treated between 2006 and 2013 who underwent
acetabular revision for a chronic pelvic discontinuity using acetabular
distraction, and who were radiographically evaluated at a mean of
62 months (25 to 160). Of these patients, 28 (87.5%) were female.
The mean age at the time of revision was 67 years (44 to 86). The patients
represented a continuous series drawn from two institutions that
adhered to an identical operative technique.Aims
Patients and Methods
The aim of this study was to determine whether there is a difference
in the rate of wear between acetabular components positioned within
and outside the ‘safe zones’ of anteversion and inclination angle. We reviewed 100 hips in 94 patients who had undergone primary
total hip arthroplasty (THA) at least ten years previously. Patients
all had the same type of acetabular component with a bearing couple
which consisted of a 28 mm cobalt-chromium head on a highly crosslinked
polyethylene (HXLPE) liner. A supine radiostereometric analysis
(RSA) examination was carried out which acquired anteroposterior
(AP) and lateral paired images. Acetabular component anteversion
and inclination angles were measured as well as total femoral head
penetration, which was divided by the length of implantation to
determine the rate of polyethylene wear.Aims
Patients and Methods
Early evidence has emerged suggesting that ceramic-on-ceramic
articulations induce a different tissue reaction to ceramic-on-polyethylene
and metal-on-metal bearings. Therefore, the aim of this study was
to investigate the tissue reaction and cellular response to ceramic
total hip arthroplasty (THA) materials We investigated tissue collected at revision surgery from nine
ceramic-on-ceramic articulations. we compared our findings with
tissue obtained from five metal-on-metal THA revisions, four ceramic-on-polyethylene
THAs, and four primary osteoarthritis synovial membranes. The latter
were analyzed to assess the amount of tissue fibrosis that might
have been present at the time of implantation to enable evaluation,
in relation to implantation time, of any subsequent response in
the tissues.Aims
Patients and Methods
We sought to determine whether cobalt-chromium alloy (CoCr) femoral
stem tapers (trunnions) wear more than titanium (Ti) alloy stem
tapers (trunnions) when used in a large diameter (LD) metal-on-metal
(MoM) hip arthroplasty system. We performed explant analysis using validated methodology to
determine the volumetric material loss at the taper surfaces of
explanted LD CoCr MoM hip arthroplasties used with either a Ti alloy
(n = 28) or CoCr femoral stem (n = 21). Only 12/14 taper constructs
with a rough male taper surface and a nominal included angle close
to 5.666° were included. Multiple regression modelling was undertaken
using taper angle, taper roughness, bearing diameter (horizontal
lever arm) as independent variables. Material loss was mapped using
a coordinate measuring machine, profilometry and scanning electron
microscopy.Aims
Patients and Methods
The sacrum is frequently invaded by a pelvic tumour. The aim
of this study was to review our experience of treating this group
of patients and to identify the feasibility of a new surgical classification
in the management of these tumours. We reviewed 141 patients who, between 2005 and 2014, had undergone
surgical excision of a pelvic tumour with invasion of the sacrum. In a new classification, pelvisacral (Ps) I, II, and III resections
refer to a sagittal osteotomy through the ipsilateral wing of the
sacrum, through the sacral midline, or lateral to the contralateral
sacral foramina, respectively. A Ps a resection describes a pelvic
osteotomy through the ilium and a Ps b resection describes a concurrent
resection of the acetabulum with osteotomies performed through the
pubis and ischium or the pubic symphysis. Within each type, surgical
approaches were standardized to guide resection of the tumour.Aims
Patients and Methods
Advances in polyethylene (PE) in total hip arthroplasty
have led to interest and increased use of highly crosslinked PE
(HXLPE) in total knee arthroplasty (TKA). Biomechanical data suggest
improved wear characteristics for HXLPE inserts over conventional
PE in TKA. Short-term results from registry data and few clinical
trials are promising. Our aim is to present a review of the history
of HXLPEs, the use of HXLPE inserts in TKA, concerns regarding potential mechanical
complications, and a thorough review of the available biomechanical
and clinical data. Cite this article:
There is increasing global awareness of adverse
reactions to metal debris and elevated serum metal ion concentrations
following the use of second generation metal-on-metal total hip
arthroplasties. The high incidence of these complications can be
largely attributed to corrosion at the head-neck interface. Severe
corrosion of the taper is identified most commonly in association
with larger diameter femoral heads. However, there is emerging evidence
of varying levels of corrosion observed in retrieved components
with smaller diameter femoral heads. This same mechanism of galvanic
and mechanically-assisted crevice corrosion has been observed in
metal-on-polyethylene and ceramic components, suggesting an inherent
biomechanical problem with current designs of the head-neck interface. We provide a review of the fundamental questions and answers
clinicians and researchers must understand regarding corrosion of
the taper, and its relevance to current orthopaedic practice. Cite this article:
The high revision rates of the DePuy Articular Surface Replacement (ASR) and the DePuy ASR XL (the total hip arthroplasty (THA) version) have led to questions over the viability of metal-on-metal (MoM) hip joints. Some designs of MoM hip joint do, however, have reasonable mid-term performance when implanted in appropriate patients. Investigations into the reasons for implant failure are important to offer help with the choice of implants and direction for future implant designs. One way to assess the performance of explanted hip prostheses is to measure the wear (in terms of material loss) on the joint surfaces. In this study, a coordinate measuring machine (CMM) was used to measure the wear on five failed cementless Biomet Magnum/ReCap/ Taperloc large head MoM THAs, along with one Biomet ReCap resurfacing joint. Surface roughness measurements were also taken. The reason for revision of these implants was pain and/or adverse reaction to metal debris (ARMD) and/or elevated blood metal ion levels.Objectives
Methods
This study aimed to examine the effects of SRT1720, a potent SIRT1 activator, on osteoarthritis (OA) progression using an experimental OA model. Osteoarthritis was surgically induced by destabilization of the medial meniscus in eight-week-old C57BL/6 male mice. SRT1720 was administered intraperitoneally twice a week after surgery. Osteoarthritis progression was evaluated histologically using the Osteoarthritis Research Society International (OARSI) score at four, eight, 12 and 16 weeks. The expression of SIRT1, matrix metalloproteinase 13 (MMP-13), a disintegrin and metalloproteinase with thrombospondin motifs-5 (ADAMTS-5), cleaved caspase-3, PARP p85, and acetylated nuclear factor (NF)-κB p65 in cartilage was examined by immunohistochemistry. Synovitis was also evaluated histologically. Primary mouse epiphyseal chondrocytes were treated with SRT1720 in the presence or absence of interleukin 1 beta (IL-1β), and gene expression changes were examined by real-time polymerase chain reaction (PCR).Objectives
Methods
Enhanced micromotions between the implant and surrounding bone can impair osseointegration, resulting in fibrous encapsulation and aseptic loosening of the implant. Since the effect of micromotions on human bone cells is sparsely investigated, an Micromotions ranging from 25 µm to 100 µm were applied as sine or triangle signal with 1 Hz frequency to human osteoblasts seeded on collagen scaffolds. Micromotions were applied for six hours per day over three days. During the micromotions, a static pressure of 527 Pa was exerted on the cells by Ti6Al4V cylinders. Osteoblasts loaded with Ti6Al4V cylinders and unloaded osteoblasts without micromotions served as controls. Subsequently, cell viability, expression of the osteogenic markers collagen type I, alkaline phosphatase, and osteocalcin, as well as gene expression of osteoprotegerin, receptor activator of NF-κB ligand, matrix metalloproteinase-1, and tissue inhibitor of metalloproteinase-1, were investigated.Objectives
Methods
Our aim in this study was to describe a continuing review of
11 total hip arthroplasties using 22.225 mm Alumina ceramic femoral
heads on a Charnley flanged femoral component, articulating against
a silane crosslinked polyethylene. Nine patients (11 THAs) were reviewed at a mean of 27.5 years
(26 to 28) post-operatively. Outcome was assessed using the d’Aubigne
and Postel, and Charnley scores and penetration was recorded on
radiographs. In addition, the oxidation of a 29-year-old shelf-aged
acetabular component was analysed.Aims
Patients and Methods
Tribocorrosion at the head–neck taper interface
– so-called ‘taperosis’ – may be a source of metal ions and particulate
debris in metal-on-polyethylene total hip arthroplasty (THA). We examined the effect of femoral head length on fretting and
corrosion in retrieved head–neck tapers Head length was observed to affect fretting (p = 0.03), with
28 mm + 8 mm femoral heads showing greater total fretting scores
than all other head lengths. The central zone of the femoral head
bore taper was subject to increased fretting damage (p = 0.01),
regardless of head length or stem offset. High-offset femoral stems
were associated with greater total fretting of the bore taper (p
= 0.04). Increased fretting damage is seen with longer head lengths and
high-offset femoral stems, and occurs within a central concentric
zone of the femoral head bore taper. Further investigation is required
to determine the effect of increased head size, and variations in
head–neck taper design. Cite this article:
Tissue responses to debris formed by abrasion of polymethylmethacrylate
(PMMA) spacers at two-stage revision arthroplasty for prosthetic
joint infection are not well described. We hypothesised that PMMA
debris induces immunomodulation in periprosthetic tissues. Samples of tissue were taken during 35 two-stage revision arthroplasties
(nine total hip and 26 total knee arthroplasties) in patients whose
mean age was 67 years (44 to 85). Fourier transform infrared microscopy
was used to confirm the presence of PMMA particles. Histomorphometry
was performed using Sudan Red and Haematoxylin-Eosin staining.
CD-68, CD-20, CD-11(c), CD-3 and IL-17 antibodies were used to immunophenotype
the inflammatory cells. All slides were scored semi-quantitatively
using the modified Willert scoring system.Aims
Patients and Methods