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Sample records for alloy femoral stem

  1. Cemented femoral stems in patients with DDH.

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    Garcia-Cimbrelo, E

    2007-01-01

    Total hip arthroplasty is the procedure of choice for most adult patients with symptomatic arthrosis secondary to developmental dysplasia (DDH), but it requires complex reconstructive techniques, is usually performed in young patients, and has an increased risk of complications. THA is indicated in presence of severe pain and when osteotomy is contraindicated. The complexity of surgery is related to the degree of dysplasia. Anatomic abnormalities in the acetabulum and femur are the cause of the complexity and complications of this procedure. Acetabular bone deficiency requires reconstructive techniques before implanting the cup at the anatomic acetabular location, such as bone autograft augmentation, implanting the cup at higher level of the hip center and cup medialization. Femoral shortening and special cemented or uncemented stems are currently used to avoid intraoperative complications. While a cemented stem needs metaphyseal femoral shortening, subtrochanteric shortening requires a cementless stem. Because of these patients' age, alternative bearing surfaces, such as alumina-on-alumina couples are recommended when possible. Although the long-term results of total hip arthroplasty in DDH are inferior to those in a general population, the results show a high level of pain relief and functional improvement.

  2. Femoral revision with a primary cementless stem.

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    Gastaud, O; Cambas, P M; Tabutin, J

    2016-04-01

    The use of a primary cementless component is a tempting option for revision total hip arthrosplasty (reTHA), however, the results of this type of revision have not been clearly determined. The goal of this retrospective study was to determine: if revision with a primary anatomical cementless femoral stem gives adequate bone fixation; the rate of secondary subsidence or recurrent loosening; the survival rate with this device. Revision with a primary anatomical cementless femoral stem results in a low rate of subsidence and recurrent loosening. This retrospective series of 43 reTHA performed between 1994 and 2012 included 43 patients, mean age 66 years old (37-90) with a minimum follow-up of 24months. There were grade 1 (n=24) or 2A (n=19) bone defects according to the Paprosky classification. The causes of revision were: aseptic loosening in 27, septic loosening in 6, malposition of the implant in 7 and periprosthetic fractures in 3. Clinical (Postel Merle d'Aubigné [PMA] and Harris scores), and radiological (subsidence) assessment was performed, as well as survival analysis (with a 95% confidence interval). All components were changed through posterolateral approach without femorotomy. In four cases de-escalation (use of a primary component for secondary revision of a prior revision component) was performed. There were no perioperative fractures or perforations. After a mean 47months (24-134), the mean PMA score increased from 10 (5-15) to 16 (11-18), and the Harris score from 58 (20-80) to 85 (66-96). Radiological assessment did not show any extensive radiolucencies or secondary subsidence. Only 3 components were placed in a varus position, with no clinical consequences. One patient had subsequent revision for recurrent dislocations. Estimated survival at 80months by Kaplan-Meier analysis was 85% (CI 95%: 64-100%). There are very few studies in the literature (7 series) on this topic, which shows the reluctance of surgeons to use this technique. Placement of a

  3. Prospective, randomized comparison of cobalt-chrome and titanium trilock femoral stems.

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    Healy, William L; Tilzey, John F; Iorio, Richard; Specht, Lawrence M; Sharma, Sanjeev

    2009-09-01

    The purpose of this article was to demonstrate the efficacy of a cementless, flat, tapered wedge femoral stem and compare cobalt-chrome and titanium femoral stems with this design. Three hundred ninety femoral stems observed for a mean of 4.7 years (2.0-8.9 years) were prospectively evaluated with clinical and radiographic follow-up. Hips were stratified by Dorr classification, bone stock (femoral index), size of implant used, and material of femoral implant. Survivorship of the femoral stem at 8.9 years was 99.8% with no significant difference between cohorts. Thigh pain (4.9%) was more common with cobalt-chrome femoral stems (6.5%) than titanium femoral stems (3.1%). The flat, tapered wedge femoral stem design provides excellent femoral reconstruction in total hip arthroplasty. On the basis of this study, we use titanium femoral stems.

  4. Trunnion Failure of the Recalled Low Friction Ion Treatment Cobalt Chromium Alloy Femoral Head.

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    Urish, Kenneth L; Hamlin, Brian R; Plakseychuk, Anton Y; Levison, Timothy J; Higgs, Genymphas B; Kurtz, Steven M; DiGioia, Anthony M

    2017-09-01

    Gross trunnion failure (GTF) is a rare complication in total hip arthroplasty (THA) reported across a range of manufacturers. Specific lots of the Stryker low friction ion treatment (LFIT) anatomic cobalt chromium alloy (CoCr) V40 femoral head were recalled in August 2016. In part, the recall was based out of concerns for disassociation of the femoral head from the stem and GTF. We report on 28 patients (30 implants) with either GTF (n = 18) or head-neck taper corrosion (n = 12) of the LFIT CoCr femoral head and the Accolade titanium-molybdenum-zirconium-iron alloy femoral stems. All these cases were associated with adverse local tissue reactions requiring revision of the THA. In our series, a conservative estimate of the incidence of failure was 4.7% (n = 636 total implanted) at 8.0 ± 1.4 years from the index procedure. Failures were associated with a high-offset 127° femoral stem neck angle and increased neck lengths; 43.3% (13 of 30) of the observed failures included implant sizes outside the voluntary recall (27.8% [5 of 18] of the GTF and 75.0% [8 of 12] of the taper corrosion cases). Serum cobalt and chromium levels were elevated (cobalt: 8.4 ± 7.0 μg/mL; chromium: 3.4 ± 3.3 μ/L; cobalt/chromium ratio: 3.7). The metal artifact reduction sequence magnetic resonance imaging demonstrated large cystic fluid collections typical with adverse local tissue reactions. During revision, a pseudotumor was observed in all cases. Pathology suggested a chronic inflammatory response. Impending GTF could be diagnosed based on aspiration of black synovial fluid and an oblique femoral head as compared with the neck taper on radiographs. In our series of the recalled LFIT CoCr femoral head, the risk of impending GTF or head-neck taper corrosion should be considered as a potential diagnosis in a painful LFIT femoral head and Accolade titanium-molybdenum-zirconium-iron alloy THA with unknown etiology. Almost half of the failures we observed included sizes outside of the

  5. Fatigue fracture of a cemented Omnifit CoCr femoral stem: implant and failure analysis

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    Noah Bonnheim, MS

    2017-12-01

    Full Text Available A cemented, cast CoCr alloy, Omnifit Plus femoral stem was retrieved following mid-stem fracture after 24 years in vivo. The patient was an active 55-year-old male with a high body mass index (31.3 and no traumatic incidents before stem fracture. Fractographic and fatigue-based failure analyses were performed to illuminate the etiology of fracture and retrospectively predict the device lifetime. The fracture surfaces show evidence of a coarse grain microstructure, intergranular fracture, and regions of porosity. The failure analysis suggests that stems with similar metallurgical characteristics, biomechanical environments, and in vivo durations may be abutting their functioning lifetimes, raising the possibility of an increased revision burden. Keywords: Fatigue fracture, Total hip arthroplasty, Stem fracture

  6. Umbrella-shaped, memory alloy femoral head support device for treatment of avascular osteonecrosis of the femoral head.

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    Yu, Xiaowei; Jiang, Wenxiong; Pan, Qi; Wu, Tianyi; Zhang, Yan; Zhou, Zubin; Du, Dongpeng

    2013-07-01

    Avascular necrosis (AVN) of the femoral head is a common orthopaedic disease that is difficult to treat. The purpose of this study was to explore the preliminary efficacy of a self-designed umbrella-shaped memory alloy femoral head support device in the treatment of adult patients with avascular osteonecrosis of the femoral head. The minimally-invasive approach involved curettage of the necrotic tissue of the femoral head, and a self-designed umbrella-shaped, memory alloy femoral head support device was implanted into the collapsed necrotic area to support the collapsed femoral head. Autologous iliac bone and artificial bone were implanted into the support device for the treatment of adult patients with avascular osteonecrosis of the femoral head. The clinical device was used in ten patients and 18 hip joints. The support device failed in one hip joint, which subsequently underwent joint replacement surgery, and the remaining 17 implanted devices were followed up for four to 19 months. The 17 postoperative hip joints were evaluated using the percent-efficacy evaluation method for avascular osteonecrosis of the femoral head in adult patients, and the efficacy rate was 82.35 %. The umbrella-shaped femoral head support device can be used in Ficat stage I, stage II, and stage III adult patients with avascular osteonecrosis of the femoral head.

  7. Revision total hip arthroplasty with a modular cementless femoral stem.

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    Pelt, Christoper E; Madsen, Wes; Erickson, Jill A; Gililland, Jeremy M; Anderson, Mike B; Peters, Christopher L

    2014-09-01

    We retrospectively reviewed 123 patients who underwent cementless THA with modular femoral stem designs for revision THA or conversion of failed ORIF and found 75 patients available for analysis. The Harris Hip Score (HHS) improved from 52 ± 14 to 86 ± 11 (P revised in eight patients (11%). The mean time to re-revision was 1.1years (0.13-2.54). Reasons for re-revision included infection (n = 5, 7%), aseptic loosening (n = 2, 3%) and significant pain (n = 1, 1%). There were no failures of the modular junctions. PC stems had an increased rate of intraoperative fractures (PC 28% vs. STS 9%, P = 0.04). Modular cementless femoral stems provide acceptable mid-term results in revision THA. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Extended porous femoral stems in hip revisions.

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    Pablo Bruno

    2016-08-01

    Full Text Available Introduction: The porous coated cylindrical  stem are one of the most popular option in the set of hip revison surgery. The poupose of this study is present the clinical and radiographic results of a group of patients treated with this stem. Material and Methods: Between 1997 and 2010, we retrospectively evaluated 150 stem in 148 patients. The indication for revisión was aseptic loosening in 88 cases (58.6%, septic loosening in 41 cases (27.3%, periprosthetic fracture in 14 cases (9.3%, failed hip ostesynthesis in 4 cases (2.6% and stem fracture in 3 cases (2%. We followed the patient on average for 7.7 years. Results: We achived bone-ingrowth fixation in 135 patients (90 %,,  fibrous tissue fixation in 12 (8% and unstable fixation in 3 (2 %. The mean Harris hip score improved to 92 points at last follow-up. Three stem were revised (2%. One patient had revisión becouse of stem loosening. The other two becouse of deep infection required a 2 staged revision.  Three patient (2% had dislocation and was treated succesfully with closed reduction. Conclusion:  The porous coated cylindrical stem is a predictable technique with excellent survival rates  in  the set of  revisión hip surgery.

  9. Femoral cortical thickness influences the pattern of proximal femoral periprosthetic fractures with a cemented stem.

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    Stevens, Jarrad; Clement, Nicholas; Nasserallah, Michael; Millar, Michael; Joseph, Sam

    2018-02-08

    Periprosthetic fractures of the proximal femur place a significant burden on the patients who endure them, as well as the medical health system that supports them. The purpose of this study was to determine whether femoral cortical thickness, as an absolute measurement, is a predictor of periprosthetic fracture pattern. A cohort of 102 patients who had sustained a periprosthetic hip fracture were retrospectively identified. This included 58 males and 44 females with a mean age of 79.8 years. The femoral periprosthetic fracture pattern was classified based on the Vancouver classification system. Stem fixation was recorded and femoral cortical thickness measured. Patients were grouped into cemented and cementless stems. The relationship between cortical thickness and periprosthetic fracture pattern was assessed using the primary stem fixation method. Receiver operating characteristic (ROC) curve analysis was used to identify a threshold in the cortical thickness that predicted fracture pattern. Multinomial logistic regression analysis was used to adjust for confounding variables to assess the independent influence of cortical thickness on the risk of sustaining a Vancouver type A, B or C. There were 65 (63.7%) patients in the cemented group and 37 (36.3%) in the cementless group. The pattern of periprosthetic fractures around cemented stems was significantly (p pattern. In contrast, no association between femoral cortical thickness and fracture pattern assessment was demonstrated in the cementless group (p = 0.82 Chi square). Comparing the rate of type A fracture patterns between the groups illustrated a significantly decreased risk in the cemented group with a cortical thickness of > 7 mm (odds ratio 0.03, p  6.3 mm. In contrast, the ROC curve analysis did not find cortical thickness to be a predictor of fracture pattern in the cementless group. When adjusting for confounding variables, multinomial logistic regression demonstrated a cortical thickness of 6

  10. Failure of Emperion modular femoral stem with implant analysis

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    Benjamin M. Stronach, MD, MS

    2016-03-01

    Full Text Available Modularity in total hip arthroplasty provides multiple benefits to the surgeon in restoring the appropriate alignment and position to a previously damaged hip joint. The vast majority of modern implants incorporate modularity into their design with some implants having multiple modular interfaces. There is the potential for failure at modular junctions because of fretting and crevice corrosion in combination with mechanical loading. This case report details the failure of an Emperion (Smith and Nephew, Memphis, TN femoral stem in a 67-year-old male patient 6 years after total hip replacement. Analysis of the implant revealed mechanically assisted crevice corrosion that likely accelerated fatigue crack initiation in the hip stem. The benefits of modularity come with the potential drawback of a combination of fretting and crevice corrosion at the modular junction, which may accelerate fatigue, crack initiation and ultimately reduce the hip longevity.

  11. Comparison of anatomic vs. straight femoral stem design in total hip replacement - femoral canal fill in vivo.

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    de Boer, Friso A; Sariali, Elhadi

    2017-05-12

    The femoral canal fill between an anatomic and a straight prosthesis design in cementless total hip arthroplasty (THA) was compared. We hypothesised that the anatomic SPS stem has higher proximal fill and lesser distal fill than the straight stem. The femoral canal fill was measured on 3 months routine postoperative x-rays at 5 levels of the stem in 50 consecutive patients, aged 35-83 years, who underwent 56 THA procedures by a single surgeon in this hospital. 22 patients received a straight design Ceramconcept Global stem, 34 patients received an anatomic design Symbios SPS stem. Both anteroposterior (AP) and lateral x-rays were combined to suggest a 3-D measurement. On the AP x-rays, the canal fill was significantly higher using the anatomic design stem at the proximal measurement levels, and was significantly higher at the distal levels using the straight stem. With the AP and lateral x-rays combined, the canal fill at the proximal levels was also significantly higher in the anatomic groups, nonsignificantly lower at the central level and significantly lower at the distal levels. In THA surgery, achieving high fill at the metaphysis of the femur and less fill at the diaphysis has been suggested to result in satisfactory outcome and high stability of the prosthesis. This study demonstrated that, compared to straight stem design, an anatomically designed stem has a significantly higher metaphyseal femoral canal fill.

  12. Short-Stem Hip Arthroplasty as a Solution for limited Proximal Femoral Bone Stock

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    Ai E Gamboa

    2015-08-01

    Full Text Available We describe an uncommon scenario where the femoral diaphysis was subjugated by previous long stemmed revision knee replacements limiting options for primary hip arthroplasty. A  short stemmed pressfit femoral componet was implanted bilaterally. At 11 years the implants remain stable with improved clinical function. This case emphasizes the importance of preoperative templating and  the utility of considering the use of unconventional stems in the management of unusual situations.

  13. Femoral component revision with use of impaction bone-grafting and a cemented polished stem.

    NARCIS (Netherlands)

    Schreurs, B.W.; Arts, J.J.C.; Verdonschot, N.J.J.; Buma, P.; Slooff, T.J.J.H.; Gardeniers, J.W.M.

    2005-01-01

    BACKGROUND: The purpose of this study was to evaluate the clinical and radiographic outcomes of revision of the femoral component of a hip arthroplasty with use of an impaction bone-grafting technique and a cemented polished stem. METHODS: Thirty-three consecutive femoral reconstructions that were

  14. Risk Factors for Subsidence of a Modular Tapered Femoral Stem Used for Revision Total Hip Arthroplasty.

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    Tangsataporn, Suksan; Safir, Oleg A; Vincent, Alexander D; Abdelbary, Hesham; Gross, Allan E; Kuzyk, Paul R T

    2015-06-01

    The purpose of this study was to determine the incidence, and the clinical and radiographic risk factors for significant subsidence of a cementless, modular tapered revision femoral stem. Femoral stem subsidence of at least 10 mm or subsidence requiring revision was considered significant subsidence. Ninety-seven patients (99 hips) were included with minimum radiographic follow-up of one year (mean 34 months; range, 12-91 months). The mean stem subsidence was 4.5 mm (range, 0-44 mm). Fourteen out of 99 (14.1%) stems had significant subsidence and 6 (6.1%) stems required revision due to subsidence. Patient weight greater than 80 kg (P=0.04) and femoral stem press-fit distance of less than 2 cm (Psubsidence. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Recobrimento da liga Ti-6Al-4V com hidroxiapatita pelo método sol-gel e sua aplicação a hastes femorais não-cimentadas Coating of Ti-6Al-4V alloy with hydroxyapatite by using sol-gel method and its application to non-cemented femoral stem

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    E. P. Avés

    2008-12-01

    Full Text Available O recobrimento de ligas metálicas com cerâmicas bioativas visa acelerar a formação óssea ao redor do implante, contribuindo para a sua estabilização. Neste trabalho estudou-se a fase cerâmica de hidroxiapatita depositada pelo processo sol-gel em chapas da liga metálica Ti-6Al-4V. A camada de recobrimento foi caracterizada por microscopia eletrônica de varredura, por difração de raios X e sua adesão ao substrato foi avaliada pelo teste de cisalhamento O teste de citocompatibilidade mostrou que o processo de recobrimento por sol-gel não promoveu morte celular significativamente maior que o controle (p > 0,05. Além disso, hastes femorais removidas de pacientes (explantes foram adequadamente recobertas utilizando-se o processo sol-gel.The coating of metallic alloys with bioactive ceramics aims to accelerate bone formation around the implant, contributing to its fixation. In this paper, the deposition of hydroxyapatite ceramic on Ti-6Al-4V alloy sheets by the sol-gel method was studied. The coating layer was characterized by scanning electron microscopy, X-ray diffraction and its adhesion to substrate was evaluated by shear testing. The citocompatibility test shows that the sol-gel coating did not provoke the cell death significantly higher than the control (p > 0.05. Moreover, femoral stems removed from patient (explants were adequately coated using the sol-gel process.

  16. Coupling failure between stem and femoral component in a constrained revision total knee arthroplasty.

    LENUS (Irish Health Repository)

    Butt, Ahsan Javed

    2013-02-01

    Knee revision using constrained implants is associated with greater stresses on the implant and interface surfaces. The present report describes a case of failure of the screw coupling between the stem and the femoral component. The cause of the failure is surmised with outline of the treatment in this case with extensive femoral bone loss. Revision implant stability was augmented with the use of a cemented femoral stem, screw fixation and the metaphyseal sleeve of an S-ROM modular hip system (DePuy international Ltd).

  17. Coupling failure between stem and femoral component in a constrained revision total knee arthroplasty

    International Nuclear Information System (INIS)

    Butt, A.J.; Shaikh, A.H.; Cameron, H.U.

    2013-01-01

    Knee revision using constrained implants is associated with greater stresses on the implant and interface surfaces. The present report describes a case of failure of the screw coupling between the stem and the femoral component. The cause of the failure is surmised with outline of the treatment in this case with extensive femoral bone loss. Revision implant stability was augmented with the use of a cemented femoral stem, screw fixation and the metaphyseal sleeve of an S-ROM modular hip system (DePuy international Ltd). (author)

  18. Stem cell treatment for avascular necrosis of the femoral head: current perspectives

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    Houdek MT

    2014-04-01

    Full Text Available Matthew T Houdek,1 Cody C Wyles,2 John R Martin,1 Rafael J Sierra11Department of Orthopedic Surgery, 2School of Medicine, Mayo Clinic, Rochester, MN, USAAbstract: Avascular necrosis (AVN of the femoral head is a progressive disease that predominantly affects younger patients. Although the exact pathophysiology of AVN has yet to be elucidated, the disease is characterized by a vascular insult to the blood supply of the femoral head, which can lead to collapse of the femoral head and subsequent degenerative changes. If AVN is diagnosed in the early stages of the disease, it may be possible to attempt surgical procedures which preserve the hip joint, including decompression of the femoral head augmented with concentrated bone marrow. The use of autologous stem cells has shown promise in halting the progression of AVN of the femoral head, and subsequently preventing young patients from undergoing total hip arthroplasty. The purpose of this study was to review the current use of stem cells for the treatment of AVN of the femoral head.Keywords: avascular necrosis, femoral head, osteonecrosis, stem cells, concentrated bone marrow

  19. Differences in subsidence rate between alternative designs of a commonly used uncemented femoral stem.

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    Al-Najjim, Munnan; Khattak, Usman; Sim, Juluis; Chambers, Iain

    2016-12-01

    Measurement of early subsidence of uncemented femoral stems can be used to evaluate the likelihood of long term stem component loosening and therefore clinical failure. Our aim was to evaluate the factors associated with subsidence in collared and uncollared versions of the Corail femoral stem. 121 hips in 113 consecutive patients were studied, operated on by two surgeons in our hospital differing in their choice of Corail stem. This gave two groups of patients with 66 hips having collared stems and 55 hips having uncollared. We recorded patients' age, sex, ASA grade and BMI. Radiographs post-operatively at day 1, 6 weeks and 1 year were evaluated measuring subsidence, angulation, signs of stability and fixation, and canal fill ratio at the metaphysis and diaphysisafter correcting for magnification errors by calibration using femoral head size. Clinically significant subsidence (>3 mm) occurred in 7.6% of collared and 10.9% of uncollared stems, all within 6-8 weeks, but did not reach statistical significance (p = 0.345). Revision for symptomatic loosening was required in 1 patient in each group (1.5% collared versus 1.8% uncollared). Early subsidence of Corail femoral stem should alert surgeons to closer patient follow-up as the rate of early revision is 18% in stems with >3 mm of subsidence. However, the presence of a collar does not seem to be protective.

  20. Using a scale-bridging technique to determine the effect of elastic properties on stress distribution around the femoral stem of an artificial hip joint with a simplified geometry

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    Jeong, C. U.; Lee, S.-C.; Rhee, H. N.; Park, K. S.; Choi, S.-H.

    2014-07-01

    A scale-bridging technique was used to investigate the effect of the elastic properties of β-Ti alloys on the stress distribution around the femoral stem of an artificial hip joint with a simplified geometry when under an external loading. The anisotropic elastic constants of single-crystalline β-Ti alloys (TN1: Ti-18.75 at% Nb, TN2: Ti-37.5 at% Nb, and TN3: Ti-43.75 at% Nb) were calculated using an ab-initio technique that was based on density functional theory calculation. The single-crystalline elastic constants calculated via the ab-initio technique were used to calculate the elastic constants of polycrystal β-Ti alloys using an elastic selfconsistent scheme. Finite element analysis based on the elastic constants of polycrystalline β-Ti alloys for a femoral stem was conducted to calculate the above-mentioned stress distribution. The model system consisting of a TN1 alloy exhibited a relatively high level of von Mises stress on the surface of cancellous and cortical bones compared to model systems consisting of TN2, TN3 alloys and commercial biomaterials (Ti-6Al-4V alloy and 316STS). The thickness of the cancellous bone between the femoral stem and the cortical bone affected the stress concentration on the surface of the cortical bone.

  1. Varus will have varus; a radiological study to assess and predict varus stem placement in uncemented femoral stems.

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    Murphy, Colin G; Bonnin, Michel P; Desbiolles, Antoine H; Carrillon, Yannick; Aїt Si Selmi, Tarik

    2016-11-10

    Varus inclination of the uncemented stem is not necessarily a technical error. The proximal femoral anatomy of hips with a coxa vara deformity frequently predisposes varus inclination. We reviewed a series of 200 patients undergoing primary uncemented THA with the Corail® hip system. Preoperative data were based on patient demographics, diagnosis, and radiographic information (preoperative templating-CT measurements), and compared postoperative alignment for each stem and type of stem used. Proximal femoral traits which can alert surgeons, when templating preoperatively, to potential varus alignment were noted. All stems were inserted either in neutral or varus alignments. Low neck shaft angle is strongly predictive of increased varus stem alignment (p<0.001). Stems inserted with higher varus alignment were associated with the preoperative morphological traits associated with coxa vara hip deformities - increased femoral offset (p<0.001), greater trochanteric overhang (p<0.001), greater trochanteric height (p<0.046), and a lower canal flare index (p<0.046). Varus stem alignment is neither unexpected nor necessarily a technical failure when using this particular uncemented stem system. Coxa vara deformities, due to a combination of morphological traits, are more likely to be inserted with higher varus alignment than hips with normal or higher neck shaft angles. Surgeons need to be aware of this when carrying out preoperative templating and intraoperative assessment, in order to prevent over-compensation for offset, length or stability.

  2. Satisfactory Results of the Exeter Revision Femoral Stem Used for Primary Total Hip Arthroplasty.

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    Desy, Nicholas M; Johnson, Joshua D; Sierra, Rafael J

    2017-02-01

    The Exeter cemented femoral stem has demonstrated excellent clinical and radiographic outcomes as well as long-term survivorship free from aseptic loosening. A shorter revision stem (125 mm) with a 44 offset became available for the purpose of cement-in-cement revision situations. In certain cases, this shorter revision stem may be used for various primary total hip arthroplasties (THAs) where the standard length stem would require distally reaming the femoral canal. We sought to report on the early to midterm results of this specific stem when used for primary THA regarding (1) clinical and radiographic outcomes, (2) complications, and (3) survivorship. Twenty-nine patients (33 hips) underwent a hybrid THA using the smaller revision Exeter cemented femoral stem. Twenty-five patients (28 hips) had at least 2 years of follow-up and were assessed for clinical and radiographic outcomes. All 33 hips were included in the analysis of complications and survivorship. The Kaplan-Meier survivorship was performed using revision for all causes and for aseptic loosening as the end points. The average clinical follow-up was 4 years (range, 2-7). Harris Hip Scores improved from a mean preoperative value of 56 (range, 23-96) to 90 (range, 51-100) at the latest follow-up. All patients demonstrated superior cement mantles with no signs of loosening. One patient suffered a B2 periprosthetic fracture and 1 patient experienced 2 episodes of instability. The 5-year Kaplan-Meier survivorship was 96.7% for all causes of revision and was 100% using aseptic loosening as the end point. The shorter Exeter revision cemented femoral stem has favorable early to midterm clinical and radiographic outcomes when used for primary THA with a low complication rate and is a viable option in patients with narrow femoral canals where uncemented stem fixation is not desired. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Tapered modular fluted titanium stems for femoral fixation in revision total knee arthroplasty.

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    Stambough, Jeffrey B; Mason, J Bohannon; Riesgo, Aldo M; Fehring, Thomas K

    2018-03-01

    Consensus regarding femoral stem fixation options in revision total knee arthroplasty remains controversial. Tapered, modular, fluted titanium (TMFT) stems have an excellent track record in total hip arthroplasty for their ability to provide axial and rotational stability in situations of compromised host bone. We present 3 successfully treated cases in which the Food & Drug Administration granted permission to use custom TMFT stems in situations of failed femoral fixation in multiple revised knees. These stems hold promise to achieve stable fixation in revision total knee arthroplasty where host metadiaphyseal bone is deficient. Implant manufactures should consider dedicating future resources to create adapters that can link existing successful TMFT stems currently used in hip arthroplasty to revision total knee components when host bone is severely compromised.

  4. Femoral revision with primary cementless stems: a systematic review of the literature.

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    Cavagnaro, Luca; Formica, Matteo; Basso, Marco; Zanirato, Andrea; Divano, Stefano; Felli, Lamberto

    2018-04-01

    The use of primary cementless stems in femoral revision has gained popularity, but no clear consensus about the correct indication is still present. The aim of our systematic review is to: (1) summarize the available literature focused on the use of cementless primary stem in revision total hip arthroplasty (THA); (2) evaluate whether the use of cementless primary stems could represent a feasible option in hip revision; (3) define the proper indication of this surgical approach. A systematic literature review was performed about the use of cementless primary stems in revision THA. The PRISMA 2009 checklist was considered to edit our review. A total of nine articles were included. The current evidence is primarily Level IV. A total of 439 patients (454 hips) underwent THA revision with primary cementless stem. Partial cementless porous coated stems were used in 246 hips (54.2%). The majority of patients were affected by type I or II Paprosky femoral defects. The mean stem-related survival rate is 95.6% ± 3.8 with a mean follow-up of 4.7 years ± 1.3. Poor standardization of methodological analysis was observed. Current literature shows lacking evidence about primary cementless stems in revision THA. Despite these limitations, we can affirm that primary cementless stems in femoral revision surgery represent a viable option in selected patients. The proper indication is a patient with femoral Paprosky defect types I or II, with low number of previous surgeries and a previous cementless stem.

  5. Survivorship and Complications of Revision Total Hip Arthroplasty with a Mid-Modular Femoral Stem.

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    Riesgo, Aldo M; Hochfelder, Jason P; Adler, Edward M; Slover, James D; Specht, Lawrence M; Iorio, Richard

    2015-12-01

    We retrospectively reviewed 161 revision THAs with diaphyseal fitting, mid-modular femoral components performed by ten surgeons at two academic medical centers. The average follow-up was 6.1 years. At final follow-up, 4 patients required re-revision for failure of the femoral component; 3 (2%) for aseptic loosening and 1 for mechanical failure of stem in setting of periprosthetic fracture. There were a total of 24 (14.9%) revisions for any reason, with the most common reason being septic failure (10 of 24). To our knowledge, this is the largest reported series of mid-term survivorship and complications of revision THA with mid-modular femoral components. Our results show that these stems have a low rate of aseptic loosening, subsidence, and mechanical failure. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. High failure rate of soft-interface stem coating for fixation of femoral endoprostheses

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    Maathuis, PGM; Visser, JD

    Twenty-five total hip arthroplasties were performed in 25 patients using a femoral stem with a soft-interface coating of Proplast (Vitek, Houston, TX). Follow-up periods for 24 of the hips ranged from 82 to 104 months (median, 96 months). Fourteen (58%) of the hips were judged to be failures, and

  7. Early Subsidence Predicts Failure of a Cemented Femoral Stem With Minor Design Changes.

    Science.gov (United States)

    Johanson, Per-Erik; Antonsson, Martin; Shareghi, Bita; Kärrholm, Johan

    2016-10-01

    Radiostereometry (RSA) measurements of early micromotion can predict later failure in hip and knee prostheses. In hip implants, RSA has been particularly helpful in the evaluation of composite-beam stem designs. The Spectron EF Primary stem (Smith & Nephew, London, UK) has shown inferior performance compared with its predecessors in both clinical studies and registry reports. Early RSA studies have shown somewhat greater subsidence for the Spectron EF Primary stem compared with the earlier Spectron EF, but still within boundaries considered to be safe. Our primary research question was whether stem subsidence and rotation for this stem design measured with RSA at 2 years can predict later stem failure. A secondary question was whether high femoral stem offset and small stem sizes, both features specific to the Spectron EF Primary stem compared with its predecessors, are associated with stem failure rate. Two hundred forty-seven hips (209 patients with median age 63 years [range, 29-80 years], 65% female, and 77% primary osteoarthritis) with a valid RSA examination at 2 years were selected from four different RSA studies (totaling 279 hips in 236 patients) in our department. The studies were primarily aimed at evaluating cup fixation, bone cement, and polyethylene types. All study patients received a cemented Spectron EF Primary stem. The selected hips had complete followup until stem failure, death, or the end of the followup period. Stem failure was defined as revision of a loose femoral stem or radiological failure with significant osteolysis in Gruen zones 2 to 6. Cox regression analyses were performed to evaluate if stem subsidence and rotation after 2 years, adjusted for age, sex, stem size, standard/high stem offset, and conventional/highly crosslinked polyethylene, could predict later clinical aseptic failure of the stem. We identified 32 stem failures (27 revisions, five radiological failures) at 14 years median followup (range, 3-18 years). Ten-year stem

  8. Modular Neck vs Nonmodular Femoral Stems in Total Hip Arthroplasty-Clinical Outcome, Metal Ion Levels, and Radiologic Findings

    DEFF Research Database (Denmark)

    Mikkelsen, Rasmus T; Fløjstrup, Marianne; Lund, Christian

    2017-01-01

    BACKGROUND: Modular neck femoral stem (MNFS) for total hip arthroplasty (THA) was introduced to optimize the outcome, but created concerns about pain, elevated blood metal ion levels, and adverse reaction to metal debris such as pseudotumors (PTs), related to corrosion between femoral neck and st...

  9. Femoral component revision with use of impaction bone-grafting and a cemented polished stem. Surgical technique.

    NARCIS (Netherlands)

    Schreurs, B.W.; Arts, J.J.C.; Verdonschot, N.J.J.; Buma, P.; Slooff, T.J.J.H.; Gardeniers, J.W.M.

    2006-01-01

    BACKGROUND: The purpose of this study was to evaluate the clinical and radiographic outcomes of revision of the femoral component of a hip arthroplasty with use of an impaction bone-grafting technique and a cemented polished stem. METHODS: Thirty-three consecutive femoral reconstructions that were

  10. The use of femoral stems with exchangeable necks in primary total hip arthroplasty increases the rate of revision.

    Science.gov (United States)

    Graves, S E; de Steiger, R; Davidson, D; Donnelly, W; Rainbird, S; Lorimer, M F; Cashman, K S; Vial, R J

    2017-06-01

    Femoral stems with exchangeable (modular) necks were introduced to offer surgeons an increased choice when determining the version, offset and length of the femoral neck during total hip arthroplasty (THA). It was hoped that this would improve outcomes and reduce complications, particularly dislocation. In 2010, the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) first reported an increased rate of revision after primary THA using femoral stems with an exchangeable neck. The aim of this study was to provide a more comprehensive up-to-date analysis of primary THA using femoral stems with exchangeable and fixed necks. The data included all primary THA procedures performed for osteoarthritis (OA), reported to the AOANJRR between 01 September 1999 and 31 December 2014. There were 9289 femoral stems with an exchangeable neck and 253 165 femoral stems with a fixed neck. The characteristics of the patients and prostheses including the bearing surface and stem/neck metal combinations were examined using Cox proportional hazard ratios (HRs) and Kaplan-Meier estimates of survivorship. It was found that prostheses with an exchangeable neck had a higher rate of revision and this was evident regardless of the bearing surface or the size of the femoral head. Exchangeable neck prostheses with a titanium stem and a cobalt-chromium neck had a significantly higher rate of revision compared with titanium stem/titanium neck combinations (HR 1.83, 95% confidence interval 1.49 to 2.23, p Revisions were higher for these combinations compared with femoral stems with a fixed neck. There appears to be little evidence to support the continued use of prostheses with an exchangeable neck in primary THA undertaken for OA. Cite this article: Bone Joint J 2017;99-B:766-73. ©2017 The British Editorial Society of Bone & Joint Surgery.

  11. Effect of morselized bones on binding of the canine hydroxyapatite-coated femoral stem.

    Science.gov (United States)

    Song, Ke-guan; Ma, De-heng; Hou, Jian-wen; Wang, Huan; Yan, Jing-long; Yu, Zhan-ge; Liang, Zhi-zhong

    2010-05-05

    Non-cement femoral stems are recognized in clinical use, but there are still some problems. The aim of this research was to make non-cement femoral stems to be press-fit with the medullary cavity. Twenty-four healthy adult mongrel dogs were randomly divided into experimental and control groups. In the right hip joint, an artificial femoral bone replacement surgery was conducted. For the experimental group, the replacement surgery of hydroxyapatite (HA)-coated femoral stems was done, while autogeneous morselized bone was implanted into the medullary cavity. For the control group, morselized bone was not implanted. At postoperative 1, 3, 6 months, a test for interfacial shear characteristics was conducted in the MTS810 Tester. The comparison between the two groups' bone-prostheses in shear strength for their interface from shearing destruction was made. A histological observation to check prosthesis-bone interface contact ratios and bone growth was carried out. For the experimental group, shear strength was 0.317 MPa in 1 month, 1.447 MPa in 3 months, and 1.621 MPa in 6 months. For the control group, shear strength was 0.195 MPa in 1 month, 1.023 MPa in 3 months, and 1.483 MPa in 6 months. The difference was statistically significant. Stereomicroscope-based observation showed that the number of trabecular bones in the experimental group was larger than that of the control group, and bone growth of the former group was better than that of the latter group. Inverted microscopic observation showed that the binding degree between the prosthesis and trabecular bone of the experimental group was higher than that of the control group. Comparatively, the experimental group's trabecular bone had more stromal cells. The morselized bones can effectively improve the biological bonding strength and bone-contact ratios in the short term for the HA-coated femoral stem and accelerate the bonding process. The use of morselized autogenous bones played a good role in bone in-growth of

  12. Mechanical Failure of Revision Knee Prosthesis at both Femoral and Tibial Modular Metaphyseal Stem Junctions

    OpenAIRE

    Woodgate, Ian G; Rooney, John; Mulford, Johnathan S; Gillies, R Mark

    2016-01-01

    Introduction: This is a report of a mechanical failure of an S-ROM revision total knee prosthesis. The prosthesis was used as a revision implant following deep peri-prosthetic infection in a morbidly obese male. The prosthesis failed on both the femoral and tibial sides at the modular metaphyseal stem junctions and required a further revision using the same type of implant after infection was excluded. Case Presentation: A 57 year old male had previously undergone a left total knee arthroplas...

  13. The tridimensional geometry of the proximal femur should determine the design of cementless femoral stem in total hip arthroplasty.

    Science.gov (United States)

    Wegrzyn, Julien; Roux, Jean-Paul; Loriau, Charlotte; Bonin, Nicolas; Pibarot, Vincent

    2018-02-22

    Using a cementless femoral stem in total hip arthroplasty (THA), optimal filling of the proximal femoral metaphyseal volume (PFMV) and restoration of the extramedullary proximal femoral (PF) parameters (i.e., femoral offset (FO), neck length (FNL), and head height (FHH)) constitute key goals for optimal hip biomechanics, functional outcome, and THA survivorship. However, almost 30% of mismatch between the PF anatomy and implant geometry of the most widely implanted non-modular cementless femoral stem has been demonstrated in a computed tomography scan (CT scan) study. Therefore, this anatomic study aimed to evaluate the relationship between the intra- and extramedullary PF parameters using tridimensional CT scan reconstructions. One hundred fifty-one CT scans of adult healthy hips were obtained from 151 male Caucasian patients (mean age = 66 ± 11 years) undergoing lower limb CT scan arteriography. Tridimensional PF reconstructions and parameter measurements were performed using a corrected PF coronal plane-defined by the femoral neck and diaphyseal canal longitudinal axes-to avoid influence of PF helitorsion and femoral neck version on extramedullary PF parameters. Independently of the femoral neck-shaft angle, the PFMV was significantly and positively correlated with the FO, FNL, and FHH (r = 0.407 to 0.420; p tridimensional PF geometry measurement in the corrected coronal plane of the femoral neck can be useful to determine and optimize the design of a non-modular cementless femoral stem. Particularly, continuous homothetic size progression of the intra- and extramedullary PF parameters should be achieved to assure stem fixation and restore anatomic hip biomechanics.

  14. Study of bone remodeling of two models of femoral cementless stems by means of DEXA and finite elements

    Directory of Open Access Journals (Sweden)

    López-Prats Fernando

    2010-05-01

    Full Text Available Abstract Background A hip replacement with a cemented or cementless femoral stem produces an effect on the bone called adaptive remodelling, attributable to mechanical and biological factors. All of the cementless prostheses designs try to achieve an optimal load transfer in order to avoid stress-shielding, which produces an osteopenia. Long-term densitometric studies taken after implanting ABG-I and ABG-II stems confirm that the changes made to the design and alloy of the ABG-II stem help produce less proximal atrophy of the femur. The simulation with FE allowed us to study the biomechanical behaviour of two stems. The aim of this study was, if possible, to correlate the biological and mechanical findings. Methods Both models with prostheses ABG-I and II have been simulated in five different moments of time which coincide with the DEXA measurements: postoperative, 6 months, 1, 3 and 5 years, in addition to the healthy femur as the initial reference. For the complete comparative analysis of both stems, all of the possible combinations of bone mass (group I and group II of pacients in two controlled studies for ABG-I and II stems, respectively, prosthetic geometry (ABG-I and ABG-II and stem material (Wrought Titanium or TMZF were simulated. Results and Discussion In both groups of bone mass an increase of stress in the area of the cancellous bone is produced, which coincides with the end of the HA coating, as a consequence of the bottleneck effect which is produced in the transmission of loads, and corresponds to Gruen zones 2 and 6, where no osteopenia can be seen in contrast to zones 1 and 7. Conclusions In this study it is shown that the ABG-II stem is more effective than the ABG-I given that it generates higher tensional values on the bone, due to which proximal bone atrophy diminishes. This biomechanical behaviour with an improved transmission of loads confirmed by means of FE simulation corresponds to the biological findings obtained with

  15. Mechanical Failure of Revision Knee Prosthesis at both Femoral and Tibial Modular Metaphyseal Stem Junctions.

    Science.gov (United States)

    Woodgate, Ian G; Rooney, John; Mulford, Johnathan S; Gillies, R Mark

    2016-01-01

    This is a report of a mechanical failure of an S-ROM revision total knee prosthesis. The prosthesis was used as a revision implant following deep peri-prosthetic infection in a morbidly obese male. The prosthesis failed on both the femoral and tibial sides at the modular metaphyseal stem junctions and required a further revision using the same type of implant after infection was excluded. A 57 year old male had previously undergone a left total knee arthroplasty in 1999 for osteoarthritis. He acquired a late deep peri-prosthetic infection with a multi-resistant Staphylococcus epidermidis. The organism was sensitive to vancomycin and rifampicin. A two stage revision was undertaken after clinical signs of infection had resolved and blood parameters had normalized. Intra-operative gram stain was negative for micro-organisms and frozen section of deep tissue was less than five polymorphs per high power field. A cemented S-ROM prosthesis was implanted using a coronal tibial osteotomy and a lateral release for exposure. After three years of the second stage of revision, the patient again presented to the orthopaedic department after reportedly falling on a wet floor six weeks ago. Radiographically, there was a broken tibial wire, osteolysis and pedestal formation around both the femoral and distal tibial stem extensions. The prosthesis was bent at the proximal tibial sleeve and stem junction. The prosthesis was considered loose with mechanical failure. At implant removal, it was noted that the femoral and tibial components at the modular metaphyseal sleeve-stem junction were fractured. Surgeons should be cautious in the use of these implants in morbidly obese patients where the stresses generated maybe above the yield stress of the material and the frictional forces that may overcome the modular taper junction's locking mechanism.

  16. Adaptive Bone Remodeling of the Femoral Bone After Tumor Resection Arthroplasty With an Uncemented Proximally Hydroxyapatite-Coated Stem

    DEFF Research Database (Denmark)

    Andersen, Mikkel R.; Petersen, Michael M.

    2016-01-01

    Loss of bone stock and stress shielding is a significant challenge in limb salvage surgery. This study investigates the adaptive bone remodeling of the femoral bone after implantation of a tumor prosthesis with an uncemented press fit stem. We performed a prospective 1 yr follow-up of 6 patients...... of 8%-9% during the first postoperative year was seen along the femoral stem, but in the bone containing the hydroxyapatite-coated part of the stem, the decrease in BMD was 14%, thus indicating that stress shielding of this part of the bone may play a role for the adaptive bone remodeling....

  17. Short-Term Metal Ion Trends Following Removal of Recalled Modular Neck Femoral Stems.

    Science.gov (United States)

    Barlow, Brian T; Assini, Joseph; Boles, John; Lee, Yuo-Yu; Westrich, Geoffrey H

    2015-07-01

    Elevated serum metal ions have been well documented with the Rejuvenate modular neck femoral stem (Stryker, Mahwah, NJ); however, the rate at which ion levels decline following revision is less clear. This study included fifty-nine consecutive revisions of Rejuvenate stems for symptomatic ALTR. Blood tests prior to revision and postoperatively at 6weeks, 3months, 6months, and 1year measured serum cobalt and chromium concentrations, ESR, and CRP. At six weeks following revision of a unilateral Rejuvenate, cobalt and chromium levels dropped from preoperative levels by 67% and 42%, respectively. At three months, cobalt levels declined to 19% of preoperative values, but chromium levels remained stable. With this information, surgeons can set realistic expectations for serum metal ion levels following Rejuvenate stem revision. Published by Elsevier Inc.

  18. Resistance to subsidence of an uncemented femoral stem after cerclage wiring of a fissure.

    Science.gov (United States)

    McCulloch, Ryan S; Roe, Simon C; Marcellin-Little, Denis J; Mente, Peter L

    2012-01-01

    To compare: (1) the force required to initiate subsidence, and (2) the relative subsidence, of femoral stems implanted into intact femora, and then into the same femora in which an induced fissure had been stabilized by cerclage. In vitro, mechanical study. Femora (n=9) from 9 dogs. Femora were prepared for implantation of an uncemented stem. Stems were implanted with continuous and impact loading. After axial loading until a fissure occurred, the stems were extracted, and the fissure stabilized with double-loop cerclage. Stems were reimplanted, and reloaded to failure. Mean±SD load to initiate subsidence in intact femora was 1706±584 N compared with 2379±657 N for cerclaged bones (P=.002). Mean relative subsidence of intact femora was 3.99±2.09 mm compared with 1.79±2.99 mm for cerclaged bones (P=.091). The load to initiate subsidence is increased in femora that have fissured, then have been stabilized with double-loop cerclage, when compared with intact femora. The relative subsidence is not different between intact and stabilized specimens. © Copyright 2011 by The American College of Veterinary Surgeons.

  19. Failure mechanisms in CoCrMo modular femoral stems for revision total hip arthroplasty.

    Science.gov (United States)

    Wang, Qiong; Parry, Michael; Masri, Bassam A; Duncan, Clive; Wang, Rizhi

    2017-08-01

    In this retrieval study, we reported the failure mechanisms of the CoCrMo-based hip implants. Systematic analyses on the clinically failed modular femoral stems from Revitan™ revision prostheses revealed a multistep fracture process. Multiple microcracks were first developed under the combined action of pitting corrosion and dynamic tensile stress on the lateral side of the CoCrMo connection taper. These microcracks then served as the initiation sites of further corrosion fatigue cracking leading to the final catastrophic failure. This crack initiation process has not been previously reported on retrieved CoCrMo components and our findings provide valuable information on the clinical performance of such implants, as well as the material selection and structural designs of future modular stems. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1525-1535, 2017. © 2016 Wiley Periodicals, Inc.

  20. Use of an Electron Beam Melting Manufactured Titanium Collared Cementless Femoral Stem to Resist Subsidence After Canine Total Hip Replacement.

    Science.gov (United States)

    Liska, William D; Doyle, Nancy D

    2015-10-01

    To evaluate the effect of a collared electron beam melting (EBM)-manufactured titanium cementless femoral stem on implant subsidence after total hip replacement (THR). Prospective study Dogs (n = 26); 33 THR. Records were maintained on the first 110 consecutive THR using an EBM collared femoral stem. Radiographs on the first 33 THR that had 6-months follow-up were evaluated for implant subsidence. These results were compared to 27 dogs with subsidence after THR with a Co Cr collarless stem. Dogs that had EBM collared stem THR had a mean body weight of 35.4 kg, body condition score (BCS) of 6.21, and mean canal flare index (CFI) of 1.56. EBM stem sizes used (number implanted) were #7 (13), #8 (10), #9 (8), and #10 (2). Subsidence of collared stems did not occur if the collar was in contact with cortical bone during surgery. Subsidence of 1-3 mm occurred closing a gap between the collar and bone if contact was not made during surgery, but subsidence stopped once contact was made. No major complications directly related to the EBM collared stem were encountered. A collar on a cementless femoral stem in contact with cortical bone resists subsidence. © Copyright 2015 by The American College of Veterinary Surgeons.

  1. Progressive femoral cortical and cancellous bone density loss after uncemented tapered-design stem fixation

    Science.gov (United States)

    Nowak, Tobias E; Haeberle, Lothar; Mueller, Lars P; Kress, Alexander; Voelk, Michael; Pfander, David; Forst, Raimund; Schmidt, Rainer

    2010-01-01

    Background Aseptic implant loosening and periprosthetic bone loss are major problems after total hip arthroplasty (THA). We present an in vivo method of computed tomography (CT) assisted osteodensitometry after THA that differentiates between cortical and cancellous bone density (BD) and area around the femoral component. Method Cortical and cancellous periprosthetic femoral BD (mg CaHA/mL), area (mm2) and contact area between the prothesis and cortical bone were determined prospectively in 31 patients 10 days, 1 year, and 6 years after uncemented THA (mean age at implantation: 55 years) using CT-osteodensitometry. Results 6 years postoperatively, cancellous BD had decreased by as much as 41% and cortical BD by up to 27% at the metaphyseal portion of the femur; this decrease was progressive between the 1-year and 6-year examinations. Mild cortical hypertrophy was observed along the entire length of the diaphysis. No statistically significant changes in cortical BD were observed along the diaphysis of the stem. Interpretation Periprosthetic CT-assisted osteodensitometry has the technical ability to discriminate between cortical and cancellous bone structures with respect to strain-adapted remodeling. Continuous loss of cortical and cancellous BD at the femoral metaphysis, a homeostatic cortical strain configuration, and mild cortical hypertrophy along the diaphysis suggest a diaphyseal fixation of the implanted stem. CT-assisted osteodensitometry has the potential to become an effective instrument for quality control in THA by means of in vivo determination of periprosthetic BD, which may be a causal factor in implant loosening after THA. PMID:20180716

  2. The potential application of a Cobalt Chrome Molybdenum femoral stem with functionally graded orthotropic structures manufactured using Laser Melting technologies.

    Science.gov (United States)

    Hazlehurst, K B; Wang, C J; Stanford, M

    2013-12-01

    The cementless fixation of porous coated femoral stems is a common technique employed for Total Hip Arthroplasty (THA). With the rate of revision surgery appearing to rise and younger more active patients requiring primary surgery it can be thought that alternative methods for increasing implant longevity need to be considered. The stress shielding of periprosthetic bone still remains a contributing factor to implant loosening, caused through a mismatch in stiffness between the implant and the bone. However, the ability to achieve stiffness matching characteristics is being realised through the use of Additive Layer Manufacturing (ALM) technologies and Functionally Graded Materials (FGM). This paper proposes an alternative design methodology for a monoblock Cobalt Chrome Molybdenum (CoCrMo) femoral stem. It hypothesises that a femoral stem suitable for cementless fixation can be manufactured using Laser Melting (LM) technology offering orthotropic functionally graded porous structures with similar mechanical properties to human bone. The structure and mechanical properties of the natural femur have been used as a basis for the design criteria which hypothesises that through a combination of numerical analysis and physical testing, an optimal design can be proposed to provide a lightweight, customised femoral stem that can reduce the risk of implant loosening through stress shielding whilst maintaining bone-implant interface stability. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Stable Fixation of a Cementless, Proximally Coated, Double Wedged, Double Tapered Femoral Stem in Total Hip Arthroplasty

    DEFF Research Database (Denmark)

    Nebergall, Audrey K; Rolfson, Ola; Rubash, Harry E

    2016-01-01

    BACKGROUND: The objective of this 5-year prospective study of 51 hips was to assess migration of a cementless tapered femoral stem using radiostereometric analysis (RSA), plain radiographs (radiolucencies), and patient-reported outcome measures (PROMs). METHODS: Forty-seven patients (51 hips......, and 5 years after surgery. RESULTS: The median (interquartile range) subsidence was 0.03 mm (-0.23 to 0.06) at 5 years, with no significant differences over time. Four outlier stems had >1.5 mm of subsidence by 1 year. No stem showed radiolucencies in more than 3 zones during the 5 years. All PROMs...

  4. Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Jørgensen, Christoffer C; Solgaard, Søren

    2017-01-01

    .4 per 10 years, CI: 1.2-1.6) were associated with increased risk of periprosthetic femoral fracture when analyzed using multivariable regression analysis. Interpretation - Uncemented femoral components were associated with an increased risk of early periprosthetic femoral fractures, especially...

  5. [Medium-term results of the Mayo™ short-stem hip prosthesis after avascular necrosis of the femoral head].

    Science.gov (United States)

    Zeh, A; Weise, A; Vasarhelyi, A; Bach, A G; Wohlrab, D

    2011-04-01

    Short-stemmed prostheses are increasingly regarded as implants of first choice in coxarthrosis, especially in young patients. Despite promising short-term results, long-term follow-up studies are still lacking. Short-stemmed femoral implants are characterised by a metaphyseal osseointegration and strain distribution. Therefore a reduced stress shielding of the proximal femur is hypothesized and in some studies already proven. There is histological evidence that osteonecrosis (ON) of the femoral head may involve not only the intracapital region but also the femoral neck and metaphyseal area. This could lead to a higher rate of aseptic loosening of short-stemmed implants. The aim of this retrospective study was to analyze the midterm results of the Mayo™ short-stem prosthesis after ON with particular attention on osseointegration. From 2002-2004, in 21 patients (2 females, 19 males; mean age 45 years; mean BMI = 27) with secondary coxarthrosis after ON implantation of 26 Mayo™ Conservative Hips was performed. Postoperatively, all patients were mobilised with full weight-bearing. Using the specially developed Wristing® software, longitudinal stem migration and varus-valgus femoral stem alignment were examined digitally in anteroposterior X-rays taken immediately after surgery and in standing AP radiographs after 8.2 months and on average after 7.9 years (16 patients). The incidence of periprosthetic radiolucent lines was captured in the anteroposterior X-rays and assigned to the Gruen zones and a DEXA scan was performed. The X-rays of a matched control group with implantation of a Mayo™ short-stem prosthesis in primary coxarthrosis were analyzed by the same method. In all patients the Harris hip score (HHS) was obtained pre- and postoperatively. There was no significant migration or valgus tilt of the Mayo™ prosthesis in the study and control groups during postoperative follow-up (paired t-test, p = 0.13 and 0.69, respectively). In six of 26 Mayo™-Stems 12

  6. Analysis of Femoral Components of Cemented Total Hip Arthroplasty

    Science.gov (United States)

    Singh, Shantanu; Harsha, A. P.

    2016-10-01

    There have been continuous on-going revisions in design of prosthesis in Total Hip Arthroplasty (THA) to improve the endurance of hip replacement. In the present work, Finite Element Analysis was performed on cemented THA with CoCrMo trapezoidal, CoCrMo circular, Ti6Al4V trapezoidal and Ti6Al4V circular stem. It was observed that cross section and material of femoral stem proved to be critical parameters for stress distribution in femoral components, distribution of interfacial stress and micro movements. In the first part of analysis, designs were investigated for micro movements and stress developed, for different stem materials. Later part of the analysis focused on investigations with respect to different stem cross sections. Femoral stem made of Titanium alloy (Ti6Al4V) resulted in larger debonding of stem at cement-stem interface and increased stress within the cement mantle in contrast to chromium alloy (CoCrMo) stem. Thus, CoCrMo proved to be a better choice for cemented THA. Comparison between CoCrMo femoral stem of trapezium and circular cross section showed that trapezoidal stem experiences lesser sliding and debonding at interfaces than circular cross section stem. Also, trapezium cross section generated lower peak stress in femoral stem and cortical femur. In present study, femur head with diameter of 36 mm was considered for the analysis in order to avoid dislocation of the stem. Also, metallic femur head was coupled with cross linked polyethylene liner as it experiences negligible wear compared to conventional polyethylene liner and unlike metallic liner it is non carcinogenic.

  7. Stem cell- and growth factor-based regenerative therapies for avascular necrosis of the femoral head

    Science.gov (United States)

    2012-01-01

    Avascular necrosis (AVN) of the femoral head is a debilitating disease of multifactorial genesis, predominately affects young patients, and often leads to the development of secondary osteoarthritis. The evolving field of regenerative medicine offers promising treatment strategies using cells, biomaterial scaffolds, and bioactive factors, which might improve clinical outcome. Early stages of AVN with preserved structural integrity of the subchondral plate are accessible to retrograde surgical procedures, such as core decompression to reduce the intraosseous pressure and to induce bone remodeling. The additive application of concentrated bone marrow aspirates, ex vivo expanded mesenchymal stem cells, and osteogenic or angiogenic growth factors (or both) holds great potential to improve bone regeneration. In contrast, advanced stages of AVN with collapsed subchondral bone require an osteochondral reconstruction to preserve the physiological joint function. Analogously to strategies for osteochondral reconstruction in the knee, anterograde surgical techniques, such as osteochondral transplantation (mosaicplasty), matrix-based autologous chondrocyte implantation, or the use of acellular scaffolds alone, might preserve joint function and reduce the need for hip replacement. This review summarizes recent experimental accomplishments and initial clinical findings in the field of regenerative medicine which apply cells, growth factors, and matrices to address the clinical problem of AVN. PMID:22356811

  8. The impact of proximal femoral morphology on failure strength with a mid-head resection short-stem hip arthroplasty.

    Science.gov (United States)

    Olsen, Michael; Al Saied, Mohamed; Morison, Zachary; Sellan, Michael; Waddell, James P; Schemitsch, Emil H

    2014-12-01

    Mid-head resection short-stem hip arthroplasty is a conservative alternative to conventional total hip replacement and addresses proximal fixation challenges in patients not suitable for hip resurfacing. It is unclear whether proximal femoral morphology impacts the ultimate failure load of mid-head resection implanted femurs, thus the aim of this study was to investigate the effect of native neck-shaft angle (NSA) and coronal implant alignment on proximal femoral strength. In total, 36 synthetic femurs with two different proximal femoral morphologies were utilized in this study. Of them, 18 femurs with a varus NSA of 120° and 18 femurs with a valgus NSA of 135° were each implanted with a mid-head resection prosthesis. Femurs within the two different femoral morphology groups were divided into three equal coronal implant alignment groups: 10° valgus, 10° varus or neutral alignment. Prepared femurs were tested for stiffness and to failure in axial compression. There was no significant difference in stiffness nor failure load between femurs implanted with valgus-, varus- or neutrally aligned implants in femurs with a NSA of 120° (p = 0.396, p = 0.111, respectively). Femurs implanted in valgus orientation were significantly stiffer and failed at significantly higher loads than those implanted in varus alignment in femurs with a NSA of 135° (p = 0.001, p = 0.007, respectively). A mid-head resection short-stem hip arthroplasty seems less sensitive to clinically relevant variations of coronal implant alignment and may be more forgiving upon implantation in some femoral morphologies, however, a relative valgus component alignment is recommended. © IMechE 2014.

  9. Autologous adipose tissue-derived stem cells induce persistent bone-like tissue in osteonecrotic femoral heads.

    Science.gov (United States)

    Pak, Jaewoo

    2012-01-01

    Osteonecrosis, also known as avascular necrosis, of the femoral head is a debilitating disorder that commonly affects 30- to 50-year-old individuals. Currently, definitive treatment is limited to total hip replacement. However, recent studies have demonstrated bone regeneration in the femoral head after the infusion of bone marrow-derived mesenchymal stem cells. In addition, local injection of adipose tissue-derived stem cells has been shown to regenerate medullary bone-like tissue 3 months after treatment. However, there have been no long-term follow-up studies on humans treated with adipose tissue-derived stem cells for osteonecrosis. To determine if treatment with adipose tissue-derived stem cells and platelet-rich plasma leads to the regeneration of medullary bone-like tissue and long-term reduction of hip pain in patients with femoral head osteonecrosis. This report of two clinical cases was in compliance with the Declaration of Helsinki. Also, the Korean Food and Drug Administration has allowed the use of adipose tissue-derived stem cells (ADSCs) in medical treatments since 2009. To obtain ADSCs, lipoaspirates were obtained from lower abdominal subcutaneous adipose tissue. The stromal vascular fraction was separated from the lipoaspirates by centrifugation after treatment with collagenase. The stem-cell-containing stromal vascular fraction was mixed with calcium chloride-activated platelet rich plasma and hyaluronic acid, and this mixture was then injected into the diseased hip. The affected hip was reinjected with calcium chloride-activated platelet rich plasma weekly for 4 weeks. Patients were subjected to pre- and post-treatment magnetic resonance imaging (MRI) scans. Two patients (34- and 39-year-old men) with femoral head osteonecrosis and severe hip pain were treated with adipose-derived stem cells. The MRI scans of the affected hip in both patients showed segmental areas of low signal intensity (T1 axial views) in the subchondral bones with a "double

  10. REVISION TOTAL HIP ARTHROPLASTY IN PATIENTS WITH ASEPTIC LOOSENING OF FEMORAL STEM (REVIEW

    Directory of Open Access Journals (Sweden)

    A. V. Sementkovsky

    2011-01-01

    Full Text Available The paper presents literature data with regard to the classification of femoral bone loss defects. It also describes the contemporary techniques of revision total hip arthroplasty in patients with aseptic loosening of the femoral component and provides the evaluation of the treatment outcomes of the described approaches.

  11. External fixation of femoral defects in athymic rats: Applications for human stem cell implantation and bone regeneration

    Directory of Open Access Journals (Sweden)

    Terasa Foo

    2013-01-01

    Full Text Available An appropriate animal model is critical for the research of stem/progenitor cell therapy and tissue engineering for bone regeneration in vivo. This study reports the design of an external fixator and its application to critical-sized femoral defects in athymic rats. The external fixator consists of clamps and screws that are readily available from hardware stores as well as Kirschner wires. A total of 35 rats underwent application of the external fixator with creation of a 6-mm bone defect in one femur of each animal. This model had been used in several separate studies, including implantation of collagen gel, umbilical cord blood mesenchymal stem cells, endothelial progenitor cells, or bone morphogenetic protein-2. One rat developed fracture at the proximal pin site and two rats developed deep tissue infection. Pin loosening was found in nine rats, but it only led to the failure of external fixation in two animals. In 8 to 10 weeks, various degrees of bone growth in the femoral defects were observed in different study groups, from full repair of the bone defect with bone morphogenetic protein-2 implantation to fibrous nonunion with collagen gel implantation. The external fixator used in these studies provided sufficient mechanical stability to the bone defects and had a comparable complication rate in athymic rats as in immunocompetent rats. The external fixator does not interfere with the natural environment of a bone defect. This model is particularly valuable for investigation of osteogenesis of human stem/progenitor cells in vivo.

  12. Cementless Stem for Femoral Neck Fractures in a Patient's 10th Decade of Life: High Rate of Periprosthetic Fractures.

    Science.gov (United States)

    Kabelitz, Method; Fritz, Yannick; Grueninger, Patrick; Meier, Christoph; Fries, Patrick; Dietrich, Michael

    2018-01-01

    Subsidence of cementless femoral stems in hemiarthroplasty (HA) and increased fracture rates are ongoing concerns of orthopedic surgeons when treating fractures in very old patients. Additionally, bone cement implantation syndrome may result in perioperative cardiac or pulmonary complications, especially in older patients, leading to morbidity and mortality. This study was performed to analyze possible subsidence and intraoperative fractures in a cohort of very old patients treated with cementless stems. We retrospectively analyzed a consecutive cohort of patients aged ≥90 years with femoral neck fractures treated by uncemented HA and an anterior minimally invasive approach. Immediate full-weight bearing was allowed postoperatively. Pelvic radiographs were examined for subsidence immediately postoperatively and 6 weeks later. We treated 109 patients (74% women; mean age, 93 years; range, 90-102 years) by HA from January 2010 to March 2016. The 30-day mortality rate was 16%, and the morbidity rate was 47%. There were 11 (12%) intraoperative fractures: 8 (Vancouver B 2 ) had to be addressed immediately during the primary operation, while 3 (1 Vancouver B 1 and 2 Vancouver A G ) were treated conservatively. One periprosthetic femoral fracture (Vancouver B 1 ) was documented during follow-up. In 17 patients, subsidence of >2.0 mm (median, 3.9 mm; range, 2.5-9.0 mm) was documented. Early subsidence was low in this very old cohort treated with an uncemented stem and not showing a periprosthetic fracture. The risk of intraoperative periprosthetic fractures was high. The use of uncemented implants in osteoporotic bone continues to be an intervention with high risk and should only be performed by experienced surgeons. Level III, Therapeutic study.

  13. Transplantation of hypoxia preconditioned bone marrow mesenchymal stem cells enhances angiogenesis and osteogenesis in rabbit femoral head osteonecrosis.

    Science.gov (United States)

    Fan, Lihong; Zhang, Chen; Yu, Zefeng; Shi, Zhibin; Dang, Xiaoqian; Wang, Kunzheng

    2015-12-01

    Osteonecrosis of the femoral head may be a disease resulting from abnormal proliferation or differentiation of mesenchymal stem cells. The present investigation explored the novel strategy of hypoxia-preconditioned BMMSCs to reverse the impairment of osteonecrosis BMMSCs and enhance the therapeutic potential of hypoxia-treated BMMSC transplantation. BMMSCs from the anterior superior iliac spine region of osteonecrosis rabbit were cultured under 20% O2 or 2% O2 conditions. Normal BMMSCs were cultured under 20% O2 condition as control. Growth factors secreted were examined by enzyme-linked immunosorbent assay. 20% O2 or 2% O2 BMMSCs were injected into the femoral head of rabbits after core decompression. Cell viability and apoptosis were assessed in vitro, and TUNEL staining of the femoral head was analyzed after transplantation. Angiogenesis (capillary-like structure formation, CD31 immunohistochemical staining and ink infusion angiography) and osteogenesis (Alizarin red-S staining, micro-CT scanning and OCN immunohistochemical staining) tests were conducted as well. 2% O2 exposure up-regulated growth factor secretion in BMMSCs. Apoptosis in 2% O2 group was lower when compared with that in 20% O2 osteonecrosis group. Cell viability in 2% O2 was significantly higher when compared with that in 20% O2 osteonecrosis group. Growth factor secretion, cell viability, apoptosis, capillary-like structure formation, Alizarin red-S staining, and ALP staining showed no difference between the 2% O2 BMMSC and normal BMMSC groups. Transplantation of 2% O2 versus 20% O2 mesenchymal stem cells after core decompression resulted in an increase in angiogenesis function and a decrease in local tissue apoptosis. Our study also found that osteogenesis function was improved after hypoxic stem cell transplantation. Hypoxic preconditioning of BMMSCs is an effective means of reversing the impairment of osteonecrosis BMMSCs, promoting their regenerative capability and therapeutic potential for

  14. Performance and safety of femoral central venous catheters in pediatric autologous peripheral blood stem cell collection.

    Science.gov (United States)

    Cooling, Laura; Hoffmann, Sandra; Webb, Dawn; Yamada, Chisa; Davenport, Robertson; Choi, Sung Won

    2017-12-01

    Autologous peripheral blood hematopoietic progenitor cell collection (A-HPCC) in children typically requires placement of a central venous catheter (CVC) for venous access. There is scant published data regarding the performance and safety of femoral CVCs in pediatric A-HPCC. Seven-year, retrospective study of A-HPCC in pediatric patients collected between 2009 and January 2017. Inclusion criteria were an age ≤ 21 years and A-HPCC using a femoral CVC for venous access. Femoral CVC performance was examined by CD34 collection rate, inlet rate, collection efficiency (MNC-FE, CD34-FE), bleeding, flow-related adverse events (AE), CVC removal, and product sterility testing. Statistical analysis and graphing were performed with commercial software. A total of 75/119 (63%) pediatric patients (median age 3 years) met study criteria. Only 16% of children required a CVC for ≥ 3 days. The CD34 collect rate and CD34-FE was stable over time whereas MNC-FE decreased after day 4 in 80% of patients. CD34-FE and MNC-FE showed inter- and intra-patient variability over time and appeared sensitive to plerixafor administration. Femoral CVC showed fewer flow-related AE compared to thoracic CVC, especially in pediatric patients (6.7% vs. 37%, P = 0.0005; OR = 0.12 (95%CI: 0.03-0.45). CVC removal was uneventful in 73/75 (97%) patients with hemostasis achieved after 20-30 min of pressure. In a 10-year period, there were no instances of product contamination associated with femoral CVC colonization. Femoral CVC are safe and effective for A-HPCC in young pediatric patients. Femoral CVC performance was maintained over several days with few flow-related alarms when compared to thoracic CVCs. © 2017 Wiley Periodicals, Inc.

  15. Clinical and Radiologic Outcomes of a Fully Hydroxyapatite-Coated Femoral Revision Stem: Excessive Stress Shielding Incidence and its Consequences.

    Science.gov (United States)

    Sanli, Ilknur; Arts, Jacobus Johannes Christiaan; Geurts, Jan

    2016-01-01

    Stress shielding remains a concern in total hip arthroplasty. The consequences of stress shielding in hydroxyapatite-coated femoral component revisions were evaluated in a prospective cohort study. A total of 106 patients operated on by revision total hip arthroplasty were identified. Sixty-three patients were eligible for clinical and radiologic assessment of osseointegration, bone remodeling, and stress shielding. Five patients showed evidence of excessive stress shielding. One patient experienced a periprosthetic fracture. No adverse events occurred in the remaining patients with a low rate of thigh pain and reliable osseointegration. This is the only available study concerning mid- to long-term consequences of excessive stress shielding in hydroxyapatite-coated revision stems. We advocate surgeons using these stems to remain vigilant and be aware of possible stress shielding side effects. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Still no single gold standard for using cementless femoral stems routinely in total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Joseph T. Moskal, MD

    2016-12-01

    Conclusions: Using evidence-based data should be better guidance in selecting the most reliable implants for THA. Although cementless femoral fixation for THA has evolved to the “new standard,” it has not been proven to be the “gold standard” for all patients.

  17. The influence of cemented femoral stem choice on the incidence of revision for periprosthetic fracture after primary total hip arthroplasty: an analysis of national joint registry data.

    Science.gov (United States)

    Palan, J; Smith, M C; Gregg, P; Mellon, S; Kulkarni, A; Tucker, K; Blom, A W; Murray, D W; Pandit, H

    2016-10-01

    Periprosthetic fracture (PF) after primary total hip arthroplasty (THA) is an uncommon but potentially devastating complication. This study aims to investigate the influence of cemented stem designs on the risk of needing a revision for a PF. We analysed data on 257 202 primary THAs with cemented stems and 390 linked first revisions for PF recorded in the National Joint Registry (NJR) of England, Wales and Northern Ireland to determine if a cemented femoral stem brand was associated with the risk of having revision for a PF after primary THA. All cemented femoral stem brands with more than 10 000 primary operations recorded in the NJR were identified. The four most commonly used cemented femoral stems were the Exeter V40 (n = 146 409), CPT (n = 24 300), C-Stem (n = 15 113) and Charnley (n = 20 182). We compared the revision risk ratios due to PF amongst the stems using a Poisson regression model adjusting for patient factors. Compared with the Exeter V40, the age, gender and ASA grade adjusted revision rate ratio was 3.89 for the cemented CPT stem (95% confidence interval (CI) 3.07 to 4.93), 0.89 for the C-Stem (95% CI 0.57 to 1.41) and 0.41 for the Charnley stem (95% CI 0.24 to 0.70). The limitations of the study include incomplete data capture, analysis of only PF requiring revision and that observation does not imply causality. Nevertheless, this study demonstrates that the choice of a cemented stem may influence the risk of revision for PF. Cite this article: Bone Joint J 2016;98-B:1347-54. ©2016 The British Editorial Society of Bone & Joint Surgery.

  18. Cotransplantation of bone marrow mononuclear cells and umbilical cord mesenchymal stem cells in avascular necrosis of the femoral head.

    Science.gov (United States)

    Cai, J; Wu, Z; Huang, L; Chen, J; Wu, C; Wang, S; Deng, Z; Wu, W; Luo, F; Tan, J

    2014-01-01

    We sought to investigate the therapeutic effects of cotransplantation of autologous bone marrow mononuclear cells (BMMNCs) and allogeneic umbilical cord mesenchymal stem cells (UC-MSCs) on avascular necrosis of the femoral head (ANFH). In all, 30 patients (49 hips; 24 males and 6 females) with ANFH were enrolled. According to the system of the Association Research Circulation Osseous, there were 24 hips in phase II and 25 hips in phase Ⅲ. Blood supply to the femoral head was evaluated by using digital subtraction angiography. Generally, 60 to 80 mL of autologous BMMNCs and 30 to 50 mL of UC-MSCs were infused into the femoral head artery. Harris scores including pain and joint function were used to evaluate the effects before and 3, 6, 9, and 12 months after transplantation. Computed tomography and radiographs were performed before and 12 months after the treatment. Clinical symptoms of pain and claudication were gradually improved. After the treatment, 93.3% (28/30), 86.7% (26/30), and 86.7% (26/30) of patients showed relief of hip pain, improvement of joint function, and extended walking distances, respectively. The Harris scores were increased significantly at 3, 6, and 12 months posttransplant compared with those pretransplant. In addition, the bone lesions in 89.7% of hips (44/49) were improved as showed on computed tomography after transplantation. Cotransplantation of autologous BMMNCs and allogeneic UC-MSCs showed therapeutic effect on ANFH without severe adverse effects. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Exosomes Secreted from Human-Induced Pluripotent Stem Cell-Derived Mesenchymal Stem Cells Prevent Osteonecrosis of the Femoral Head by Promoting Angiogenesis.

    Science.gov (United States)

    Liu, Xiaolin; Li, Qing; Niu, Xin; Hu, Bin; Chen, Shengbao; Song, Wenqi; Ding, Jian; Zhang, Changqing; Wang, Yang

    2017-01-01

    Background: Local ischemia is the main pathological performance in osteonecrosis of the femoral head (ONFH). There is currently no effective therapy to promote angiogenesis in the femoral head. Recent studies revealed that exosomes secreted by induced pluripotent stem cell-derived mesenchymal stem cells (iPS-MSC-Exos) have great therapeutic potential in ischemic tissues, but whether they could promote angiogenesis in ONFH has not been reported, and little is known regarding the underlying mechanism. Methods: iPS-MSC-Exos were intravenously injected to a steroid-induced rat osteonecrosis model. Samples of the femoral head were obtained 3 weeks after all the injections. The effects were assessed by measuring local angiogenesis and bone loss through histological and immunohistochemical (IHC) staining, micro-CT and three-dimensional microangiography. The effects of exosomes on endothelial cells were studied through evaluations of proliferation, migration and tube-forming analyses. The expression levels of angiogenic related PI3K/Akt signaling pathway of endothelial cells were evaluated following stimulation of iPS-MSC-Exos. The promoting effects of exosomes were re-evaluated following blockade of PI3K/Akt. Results: The in vivo study revealed that administration of iPS-MSC-Exos significantly prevented bone loss, and increased microvessel density in the femoral head compared with control group. We found that iPS-MSC-Exos significantly enhanced the proliferation, migration and tube-forming capacities of endothelial cells in vitro . iPS-MSC-Exos could activate PI3K/Akt signaling pathway in endothelial cells. Moreover, the promoting effects of iPS-MSC-Exos were abolished after blockade of PI3K/Akt on endothelial cells. Conclusions: Our findings suggest that transplantation of iPS-MSC-Exos exerts a preventative effect on ONFH by promoting local angiogenesis and preventing bone loss. The promoting effect might be attributed to activation of the PI3K/Akt signaling pathway on

  20. Preclinical Study of Cell Therapy for Osteonecrosis of the Femoral Head with Allogenic Peripheral Blood-Derived Mesenchymal Stem Cells.

    Science.gov (United States)

    Fu, Qiang; Tang, Ning Ning; Zhang, Qian; Liu, Yi; Peng, Jia Chen; Fang, Ning; Yu, Li Mei; Liu, Jin Wei; Zhang, Tao

    2016-07-01

    To explore the value of transplanting peripheral blood-derived mesenchymal stem cells from allogenic rabbits (rPBMSCs) to treat osteonecrosis of the femoral head (ONFH). rPBMSCs were separated/cultured from peripheral blood after granulocyte colony-stimulating factor mobilization. Afterwards, mobilized rPBMSCs from a second passage labeled with PKH26 were transplanted into rabbit ONFH models, which were established by liquid nitrogen freezing, to observe the effect of rPBMSCs on ONFH repair. Then, the mRNA expressions of BMP-2 and PPAR-γ in the femoral head were assessed by RT-PCR. After mobilization, the cultured rPBMSCs expressed mesenchymal markers of CD90, CD44, CD29, and CD105, but failed to express CD45, CD14, and CD34. The colony forming efficiency of mobilized rPBMSCs ranged from 2.8 to 10.8 per million peripheral mononuclear cells. After local transplantation, survival of the engrafted cells reached at least 8 weeks. Therein, BMP-2 was up-regulated, while PPAR-γ mRNA was down-regulated. Additionally, bone density and bone trabeculae tended to increase gradually. We confirmed that local transplantation of rPBMSCs benefits ONFH treatment and that the beneficial effects are related to the up-regulation of BMP-2 expression and the down-regulation of PPAR-γ expression.

  1. The Fate and Distribution of Autologous Bone Marrow Mesenchymal Stem Cells with Intra-Arterial Infusion in Osteonecrosis of the Femoral Head in Dogs

    Directory of Open Access Journals (Sweden)

    Hongting Jin

    2016-01-01

    Full Text Available This study aimed to investigate if autologous bone marrow mesenchymal stem cells (MSCs could treat osteonecrosis of the femoral head (ONFH and what the fate and distribution of the cells are in dogs. Twelve Beagle dogs were randomly divided into two groups: MSCs group and SHAM operated group. After three weeks, dogs in MSCs group and SHAM operated group were intra-arterially injected with autologous MSCs and 0.9% normal saline, respectively. Eight weeks after treatment, the necrotic volume of the femoral heads was significantly reduced in MSCs group. Moreover, the trabecular bone volume was increased and the empty lacunae rate was decreased in MSCs group. In addition, the BrdU-positive MSCs were unevenly distributed in femoral heads and various vital organs. But no obvious abnormalities were observed. Furthermore, most of BrdU-positive MSCs in necrotic region expressed osteocalcin in MSCs group and a few expressed peroxisome proliferator-activated receptor-γ (PPAR-γ. Taken together, these data indicated that intra-arterially infused MSCs could migrate into the necrotic field of femoral heads and differentiate into osteoblasts, thus improving the necrosis of femoral heads. It suggests that intra-arterial infusion of autologous MSCs might be a feasible and relatively safe method for the treatment of femoral head necrosis.

  2. Mechanical behaviour of umbrella-shaped, Ni-Ti memory alloy femoral head support device during implant operation: a finite element analysis study.

    Directory of Open Access Journals (Sweden)

    Wei Yi

    Full Text Available A new instrument used for treating femoral head osteonecrosis was recently proposed: the umbrella-shaped, Ni-Ti memory femoral head support device. The device has an efficacy rate of 82.35%. Traditional radiographic study provides limited information about the mechanical behaviour of the support device during an implant operation. Thus, this study proposes a finite element analysis method, which includes a 3-step formal head model construction scheme and a unique material assignment strategy for evaluating mechanical behaviour during an implant operation. Four different scenarios with different constraints, initial positions and bone qualities are analyzed using the simulation method. The max radium of the implanted device was consistent with observation data, which confirms the accuracy of the proposed method. To ensure that the device does not unexpectedly open and puncture the femoral head, the constraint on the impact device should be strong. The initial position of sleeve should be in the middle to reduce the damage to the decompression channel. The operation may fail because of poor bone quality caused by severe osteoporosis. The proposed finite element analysis method has proven to be an accurate tool for studying the mechanical behaviour of umbrella-shaped, Ni-Ti memory alloy femoral head support device during an implant operation. The 3-step construct scheme can be implemented with any kind of bone structure meshed with multiple element types.

  3. Femoral Component Revision with Use of Impaction Bone-Grafting and a Cemented Polished Stem: A Concise Follow-up, at Fifteen to Twenty Years, of a Previous Report*

    NARCIS (Netherlands)

    Te Stroet, M.A.; Gardeniers, J.W.M.; Verdonschot, N.J.; Rijnen, W.H.C.; Slooff, T.J.J.H.; Schreurs, B.W.

    2012-01-01

    We previously reported our results for thirty-three consecutive femoral component revisions with impaction bone-grafting, performed with the X-change femoral revision system and a cemented polished Exeter stem, at a minimum of eight years of follow-up. The present updated study shows the results

  4. Outcome of a modular tapered uncemented titanium femoral stem in revision hip arthroplasty.

    Science.gov (United States)

    Hoberg, Maik; Konrads, Christian; Engelien, Jana; Oschmann, Dorothee; Holder, Michael; Walcher, Matthias; Rudert, Maximilian

    2015-09-01

    Revision hip arthroplasty using a modular tapered design gives the possibility for customising the prostheses to the individual anatomy intra-operatively. The success of this kind of surgery is still controversial due to the relative lack of medium- to long-term follow-up. Therefore we analysed the clinical and radiological outcome of the modular MRP-TITAN stem with diaphyseal fixation in revision hip surgery. In this retrospective study we included 136 consecutive patients with MRP-TITAN stem implanted during revision hip arthroplasty. The average follow-up was 55 months. For clinical evaluation we used the Harris Hip Score and the Merle d'Aubigné and Postel score. The health-related quality of life was determined with the visual analogue pain scale. The surgeries were performed 109 months after primary total hip arthroplasty on average. The main indications for the MRP-TITAN revision stem were aseptic loosening, infection, and periprosthetic fracture. In the clinical outcome, patients achieved 75.1 points in the Harris Hip Score and 14.4 points in the Merle d'Aubigné and Postel Score. Mean level of persisting pain was 0.7 (VAS). The overall survival of the MRP stem in revision hip arthroplasty revealed 85.6% survival at 9.75 years' follow-up with a repeat revision rate of 6.8%. Performing revision hip arthroplasty using the MRP-TITAN stem revealed a good clinical outcome. There is a tendency for better results in comparison with the information given in literature for cementless modular revision stems including a lower rate in re-revisions.

  5. Efficacy of umbilical cord-derived mesenchymal stem cell-based therapy for osteonecrosis of the femoral head: A three-year follow-up study.

    Science.gov (United States)

    Chen, Chun; Qu, Zhiguo; Yin, Xiaoguang; Shang, Chunyu; Ao, Qiang; Gu, Yongquan; Liu, Ying

    2016-11-01

    This is a retrospective analysis of the clinical effects of transplant of mesenchymal stem cells (MSCs) derived from human umbilical cord-derived MSCs (hUC‑MSCs) for the treatment of osteonecrosis of the femoral head (ONFH). The biological characteristics of hUC-MSCs were assessed using flow cytometry. Nine eligible patients were enrolled in the study as they adhered to the Association Research Circulation Osseous (ARCO) classification of stage Ⅱ‑Ⅲa, and hUC‑MSCs were grafted by intra‑arterial infusion. Organize effective perfusion was assessed using the oxygen delivery index (ODI). The results showed that the ODI was increased at three days post‑operation. The MRI results revealed that at 12 and 24 months after treatment, the necrotic volume of the femoral heads was significantly reduced. No obvious abnormalities were observed. Taken together, these data indicate that intra‑arterially infused hUC‑MSCs migrate into the necrotic field of femoral heads and differentiate into osteoblasts, thus improving the necrosis of femoral heads. This finding suggested that intra‑arterial infusion of hUC‑MSCs MSCs is a feasible and relatively safe method for the treatment of femoral head necrosis.

  6. Loosening of the femoral component of total hip replacement after plugging the femoral canal.

    Science.gov (United States)

    Harris, W H; McCarthy, J C; O'Neill, D A

    1982-01-01

    A roentgen follow-up study was done of 171 total hip replacements at an average of 3.3 years (range 2 to 5 years) after insertion to assess the loosening rate in older adult patients (average age 60 years) in whom the medullary canal was plugged. The cement (Simplex P) was introduced using a cement gun. The femoral components used were CAD and HD-2 in design, made of chrome cobalt alloy. Evaluation was made according to three categories of loosening: definite (requiring evidence of migration of the component or the cement), probable (requiring a continuous radiolucent zone around the cement mantle in one or more radiographic views), or possible (requiring a radiolucent zone that occupied 50% or more of the cement-bone interface in one or more views but was not continuous). One hip was revised for a loose femoral component. Another patient has asymptomatic subsidence of the femoral component. Thus the total incidence of definitely loose femoral components was 1.1%. No hip was classified as probably loose. Seven hips (4%) were rated as possibly loose. Compared to four other reported series of similar groups of patients followed for like duration, this incidence of definitely loose components is statistically significantly less than in nonplugged canals. The other differences among the series compared, such as stem design, type of cement introduction, modulus of elasticity of the metal used, presence or absence of a collar, and dates during which the surgery was done, are also discussed. Plugging the femoral canal; introducing the cement with a cement gun; using a femoral stem that largely fills the medullary canal, has a collar, and has a rounded rectangular cross section with no medial stress risers made of a superalloy with a modulus of elasticity of about 200 GPa--all these factors were associated with a low (1.1%) incidence of femoral component loosening at 3 years.

  7. Short stem total hip arthroplasty for osteonecrosis of the femoral head in patients 60 years or younger: a 3- to 10-year follow-up study.

    Science.gov (United States)

    Capone, Antonio; Bienati, Fabrizio; Torchia, Stefania; Podda, Daniele; Marongiu, Giuseppe

    2017-07-17

    In young patients with osteonecrosis of the femoral head (ONFH), short-stem total hip arthroplasty (THA) could allow a potential advantage in preserving metaphyseal bone-stock, when revision surgery might become necessary. However, only a few studies have evaluated the outcome of short-stem THAs in ONFH. We reviewed the prospectively collected data of a cementless partial neck-retaining short-stem with ceramic-on-ceramic bearings in ONFH patients. Thirty patients (37 hips) younger than 60 years (mean age at surgery, 51.5 years) underwent THA with the NANOS® stem (Smith and Nephew, Marl, Germany) from January 2006 to December 2012. All patients received a 32-mm or 36 mm ceramic femoral head. Harris hip score, WOMAC and UCLA activity score were recorded. Postoperative radiographs were evaluated for bone-implant fixation and osteolysis. Further analysis correlated clinical findings with implants characteristics and patient demographics at mean 5.6 years' follow-up (range, 3-10 years). The clinical and functional results improved significantly (p femoral head did not influence the clinical outcome (p = 0.661). All hips showed bone ingrowth fixation of the acetabular and femoral components. No patients showed osteolysis. No revision for any reason was performed during the study period. The excellent clinical results and fixation pattern at mean 5.6 years' follow-up reveal this implant as a reliable option in advanced stage of ONFH either. Further investigations are crucial to determine the long-term durability and to assess whether the association of ceramic-on-ceramic bearings, can be useful to achieve longer survivorship and lower complications rates. Registry number: ISRCTN 91336248 ; date of registration: 04/07/2017.

  8. Revision hip arthroplasty with an extensively 
porous-coated stem - excellent long-term 
results also in severe femoral bone stock loss.

    Science.gov (United States)

    Thomsen, Per B; Jensen, Niels J F; Kampmann, Jens; Bæk Hansen, Torben

    2013-01-01

    During the last 25 years uncemented hip stem revision relying on diaphyseal fixation has shown improving clinical results and stem survival. The purpose of this study was to present the long-term results of hip revision with the SOLUTION stem (DePuy, Warsaw Indiana).
Ninety-three consecutive SOLUTION hip stem revisions in 84 patients with a mean age of 69 years (range 33-86 years) were reviewed. Of these, clinical and radiographic follow-up examination by an independent observer was possible in 36 hips/29 patients after mean 14 years (range 10-18 years). Stem re-revision was documented by our own files and by the Danish Hip Arthroplasty Registry. 
Stem re-revision had been performed in two hips for aseptic loosening, one due to deep infection and in one patient due to stem fracture. The 18 years cumulative survival, free of re-revision for any reason was calculated as 94.4% (88.9-99.8)% and for aseptic loosening to 97.6% (94.3-100%). Intraoperative complications were frequent with incidence of shaft fractures (14/93) and perforations (9/93) showing a significant learning curve. Mean Harris Hip Score was 85 (range 53-99). Osseointegration was seen in 34/36 stems with two stems fibrous fixated. Stress shielding was significant associated with stem diameters ≥15 mm. Severe preoperative bone deficiency had no negative bearing on stem survival and no significant influence on osseointegration of the stem or on Harris Hip Score. 
 Femoral stem revision with an extensively porous-coated monoblock chrome-cobalt stem seems to be a reliable and reproducible technique resulting in excellent long-term survivorship and clinical outcome. It can be used in femurs with deficient bone stock.

  9. Stem cell therapy for the treatment of early stage avascular necrosis of the femoral head: a systematic review

    Science.gov (United States)

    2014-01-01

    Background Avascular necrosis (AVN) of the femoral head (FH) is believed to be caused by a multitude of etiologic factors and is associated with significant morbidity in younger populations. Eventually, the disease progresses and results in FH collapse. Thus, a focus on early disease management aimed at joint preservation by preventing or delaying progression is key. The use of stem cells (SC) for the treatment of AVN of the FH has been proposed. We undertook a systematic review of the medical literature examining the use of SC for the treatment of early stage (precollapse) AVN of the FH, in both pre-clinical and clinical studies. Methods Data collected included: Pre-clinical studies – model of AVN, variety and dosage of SC, histologic and imaging analyses. Clinical studies – study design, classification and etiology of AVN, SC dosage and treatment protocol, incidence of disease progression, patient reported outcomes, volume of necrotic lesion and hip survivorship. Results In pre-clinical studies, the use of SC uniformly demonstrated improvements in osteogenesis and angiogenesis, yet source of implanted SC was variable. In clinical studies, groups treated with SC showed significant improvements in patient reported outcomes; however hip survivorship was not affected. Discrepancies regarding dose of SC, AVN etiology and disease severity were present. Conclusions Routine use of this treatment method will first require further research into dose and quality optimization as well as confirmed improvements in hip survivorship. PMID:24886648

  10. Effect of a collar on subsidence and local micromotion of cementless femoral stems: in vitro comparative study based on micro-computerised tomography.

    Science.gov (United States)

    Malfroy Camine, Valérie; Rüdiger, Hannes A; Pioletti, Dominique P; Terrier, Alexandre

    2018-01-01

    The aim of this study is to quantitatively compare the difference in primary stability between collarless and collared versions of the same femoral stem. Specifically, we tested differences in subsidence and micromotion. Collarless and collared versions of the same cementless femoral stem were implanted in two groups of six fresh-frozen cadaveric femurs. Each implanted femur was then subsequently tested for axial compressive and torsional loadings. A micro-CT based technique was applied to quantify implant subsidence and compute the map of local micromotion around the femoral stems. Micromotion of collarless and collared stems was compared in each Gruen zone. Subsidence was higher but not significantly (p = 0.352) with collarless (41.0 ± 29.9 μm) than with collared stems (37.0 ± 44.6 μm). In compression, micromotion was lower (p = 0.257) with collarless (19.5 ± 5 μm) than with collared stems (43.3 ± 33.1 μm). In torsion, micromotion was also lower (p = 0.476) with collarless (96.9 ± 59.8 μm) than collared stems (118.7 ± 45.0 μm). Micromotion was only significantly lower (p = 0.001) in Gruen zone 1 and for compression with collarless (7.0 ± 0.6 μm) than with collared stems (22.6 ± 25.5 μm). Primary stability was achieved for both stem designs, with a mean micromotion below the osseointegration threshold. Under loading conditions similar to those observed in normal daily activity and with good press-fit, the collar had no influence on subsidence or micromotion. Further studies are required to test the potential advantage of collar with higher loads, undersized stems, or osteoporotic femurs.

  11. Biocompatibility of nanoactuators: stem cell growth on laser-generated nickel-titanium shape memory alloy nanoparticles

    Energy Technology Data Exchange (ETDEWEB)

    Barcikowski, Stephan, E-mail: s.barcikowski@lzh.de; Hahn, Anne [Laser Zentrum Hannover e.V. (Germany); Guggenheim, Merlin; Reimers, Kerstin [Medical School Hannover, Department of Plastic, Hand and Reconstructive Surgery (Germany); Ostendorf, Andreas [Laser Zentrum Hannover e.V. (Germany)

    2010-06-15

    Nanoactuators made from nanoparticulate NiTi shape memory alloy show potential in the mechanical stimulation of bone tissue formation from stem cells. We demonstrate the fabrication of Ni, Ti, and NiTi shape memory alloy nanoparticles and their biocompatibility to human adipose-derived stem cells. The stoichiometry and phase transformation property of the bulk alloy is preserved during attrition by femtosecond laser ablation in liquid, giving access to colloidal nanoactuators. No adverse effect on cell growth and attachment is observed in proliferation assay and environmental electron scanning microscopy, making this material attractive for mechanical stimulation of stem cells.

  12. Biocompatibility of nanoactuators: stem cell growth on laser-generated nickel-titanium shape memory alloy nanoparticles

    Science.gov (United States)

    Barcikowski, Stephan; Hahn, Anne; Guggenheim, Merlin; Reimers, Kerstin; Ostendorf, Andreas

    2010-06-01

    Nanoactuators made from nanoparticulate NiTi shape memory alloy show potential in the mechanical stimulation of bone tissue formation from stem cells. We demonstrate the fabrication of Ni, Ti, and NiTi shape memory alloy nanoparticles and their biocompatibility to human adipose-derived stem cells. The stoichiometry and phase transformation property of the bulk alloy is preserved during attrition by femtosecond laser ablation in liquid, giving access to colloidal nanoactuators. No adverse effect on cell growth and attachment is observed in proliferation assay and environmental electron scanning microscopy, making this material attractive for mechanical stimulation of stem cells.

  13. Vascular endothelial growth factor/bone morphogenetic protein-2 bone marrow combined modification of the mesenchymal stem cells to repair the avascular necrosis of the femoral head

    Science.gov (United States)

    Ma, Xiao-Wei; Cui, Da-Ping; Zhao, De-Wei

    2015-01-01

    Vascular endothelial cell growth factor (VEGF) combined with bone morphogenetic protein (BMP) was used to repair avascular necrosis of the femoral head, which can maintain the osteogenic phenotype of seed cells, and effectively secrete VEGF and BMP-2, and effectively promote blood vessel regeneration and contribute to formation and revascularization of tissue engineered bone tissues. To observe the therapeutic effect on the treatment of avascular necrosis of the femoral head by using bone marrow mesenchymal stem cells (BMSCs) modified by VEGF-165 and BMP-2 in vitro. The models were avascular necrosis of femoral head of rabbits on right leg. There groups were single core decompression group, core decompression + BMSCs group, core decompression + VEGF-165/BMP-2 transfect BMSCs group. Necrotic bone was cleared out under arthroscope. Arthroscopic observation demonstrated that necrotic bone was cleared out in each group, and fresh blood flowed out. Histomorphology determination showed that blood vessel number and new bone area in the repair region were significantly greater at various time points following transplantation in the core decompression + VEGF-165/BMP-2 transfect BMSCs group compared with single core decompression group and core decompression + BMSCs group (P < 0.05). These suggested that VEGF-165/BMP-2 gene transfection strengthened osteogenic effects of BMSCs, elevated number and quality of new bones and accelerated the repair of osteonecrosis of the femoral head. PMID:26629044

  14. Use of a long distally fixed intramedullary stem to treat a periprosthetic femoral fracture following total hip arthroplasty using a thrust plate hip prosthesis: A case report.

    Science.gov (United States)

    Hatanaka, Hiroyuki; Motomura, Goro; Ikemura, Satoshi; Sonoda, Kazuhiko; Kubo, Yusuke; Utsunomiya, Takeshi; Yamamoto, Takuaki; Nakashima, Yasuharu

    2017-01-01

    The thrust plate hip prosthesis (TPP; Zimmer, Winterthur, Switzerland) is a hip prosthesis that is no longer in production. Few reports have focused on periprosthetic fractures following total hip arthroplasty (THA) with the use of a TPP. We report a 57-year-old woman with a periprosthetic femoral fracture 13 years after THA with the use of a TPP. A plain radiograph showed a displaced subtrochanteric fracture of the right femur just below the distal tip of the lateral plate without implant loosening. She underwent revision surgery with a long distally fixed intramedullary stem in conjunction with a plate and cable system. Three months after surgery, bone union was confirmed using radiography and the patient was clinically asymptomatic. We encountered three major problems while planning surgical treatment, these being, discontinuation of the TPP system, loss of proximal femoral cancellous bone, and difficulties with the type of subtrochanteric fracture. After considering these problems, we planned revision surgery using a long distally fixed intramedullary stem in conjunction with a plate and cable system. This case shows that sufficient implant preparation based on precise preoperative planning is necessary to obtain good clinical results for the surgical treatment of periprosthetic femoral fractures following THA with the use of a TPP. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  15. Posterior Femoral Single Limb Osteotomy for the Removal of Well-Fixed Modular Femoral Neck Components

    Directory of Open Access Journals (Sweden)

    Keith A Fehring

    2017-07-01

    Full Text Available Modular neck femoral components were introduced to optimize femoral neck anteversion, leg length, offset, and stability in total hip arthroplasty. However, concerns have been raised in recent years regarding early failure of these implants due to corrosion, pseudotumor, as well as fracture of the modular neck. Removing modular neck femoral implants is challenging as removal of the modular femoral neck leaves a proximally coated femoral stem level with the proximal bone of the femoral neck. We describe a posterior femoral single limb osteotomy  (posterior cut of an extended trochanteric osteotomy for the removal of a modular neck femoral component.

  16. Clinical Effects of Novel Nanoscaled Core Decompression Rods Combined with Umbilical Cord Mesenchymal Stem Cells on the Treatment of Early Osteonecrosis of the Femoral Head

    Directory of Open Access Journals (Sweden)

    Hongyang Gao

    2015-01-01

    Full Text Available Osteonecrosis of the femoral head (ONFH is one of the most common diseases in orthopedics. In this study, we investigated the clinical effects of novel nanoscaled core decompression rods combined with mesenchymal stem cells on the treatment of the ONFH. 12 adult patients with early ONFH (at the stage of Ficat II received the treatment using the implantation of novel nanoscaled core decompression rods combined with umbilical cord mesenchymal stem cells. The grade of the patients’ hip was scored by Harris marking system before and after the surgery, and then paired t-test was done. We assessed the curative efficiency based on the change of the patients before and after the surgery. In particular, the survival rate of femoral head was assessed at 12 months after the surgery. The results demonstrated that according to the standard of Harris Scoring, the average grade of hip joint before the surgery was 54.16 ± 4.23 points while average grade of hip joint at 12 months after the surgery was 85.28 ± 3.65 points. So, the implantation of the novel nanoscaled core decompression rods combined with mesenchymal stem cells had satisfactory clinical effects, suggesting that this implantation should be effective to treat early ONFH.

  17. Cementless Stem for Femoral Neck Fractures in a Patient’s 10th Decade of Life: High Rate of Periprosthetic Fractures

    Science.gov (United States)

    Kabelitz, Method; Fritz, Yannick; Grueninger, Patrick; Meier, Christoph; Fries, Patrick

    2018-01-01

    Background: Subsidence of cementless femoral stems in hemiarthroplasty (HA) and increased fracture rates are ongoing concerns of orthopedic surgeons when treating fractures in very old patients. Additionally, bone cement implantation syndrome may result in perioperative cardiac or pulmonary complications, especially in older patients, leading to morbidity and mortality. This study was performed to analyze possible subsidence and intraoperative fractures in a cohort of very old patients treated with cementless stems. Methods: We retrospectively analyzed a consecutive cohort of patients aged ≥90 years with femoral neck fractures treated by uncemented HA and an anterior minimally invasive approach. Immediate full-weight bearing was allowed postoperatively. Pelvic radiographs were examined for subsidence immediately postoperatively and 6 weeks later. Results: We treated 109 patients (74% women; mean age, 93 years; range, 90-102 years) by HA from January 2010 to March 2016. The 30-day mortality rate was 16%, and the morbidity rate was 47%. There were 11 (12%) intraoperative fractures: 8 (Vancouver B2) had to be addressed immediately during the primary operation, while 3 (1 Vancouver B1 and 2 Vancouver AG) were treated conservatively. One periprosthetic femoral fracture (Vancouver B1) was documented during follow-up. In 17 patients, subsidence of >2.0 mm (median, 3.9 mm; range, 2.5-9.0 mm) was documented. Conclusion: Early subsidence was low in this very old cohort treated with an uncemented stem and not showing a periprosthetic fracture. The risk of intraoperative periprosthetic fractures was high. The use of uncemented implants in osteoporotic bone continues to be an intervention with high risk and should only be performed by experienced surgeons. Level of Evidence: Level III, Therapeutic study. PMID:29623237

  18. Exosomes from Human Synovial-Derived Mesenchymal Stem Cells Prevent Glucocorticoid-Induced Osteonecrosis of the Femoral Head in the Rat.

    Science.gov (United States)

    Guo, Shang-Chun; Tao, Shi-Cong; Yin, Wen-Jing; Qi, Xin; Sheng, Jia-Gen; Zhang, Chang-Qing

    2016-01-01

    Osteonecrosis of the femoral head (ONFH) represents a debilitating complication following glucocorticoid (GC)-based therapy. Synovial-derived mesenchymal stem cells (SMSCs) can exert protective effect in the animal model of GC-induced ONFH by inducing cell proliferation and preventing cell apoptosis. Recent studies indicate the transplanted cells exert therapeutic effects primarily via a paracrine mechanism and exosomes are an important paracrine factor that can be directly used as therapeutic agents for tissue engineering. Herein, we provided the first demonstration that the early treatment of exosomes secreted by human synovial-derived mesenchymal stem cells (SMSC-Exos) could prevent GC-induced ONFH in the rat model. Using a series of in vitro functional assays, we found that SMSC-Exos could be internalized into bone marrow derived stromal cells (BMSCs) and enhance their proliferation and have anti-apoptotic abilities. Finally, SMSC-Exos may be promising for preventing GC-induced ONFH.

  19. Cytotoxicity assessment of adipose-derived mesenchymal stem cells on synthesized biodegradable Mg-Zn-Ca alloys.

    Science.gov (United States)

    Fazel Anvari-Yazdi, Abbas; Tahermanesh, Kobra; Hadavi, Seyed Mohammad Mehdi; Talaei-Khozani, Tahereh; Razmkhah, Mahboobeh; Abed, Seyedeh Mehr; Mohtasebi, Maryam Sadat

    2016-12-01

    Magnesium (Mg)-based alloys have been extensively considered as biodegradable implant materials for orthopedic surgery. Mg and its alloys are metallic biomaterials that can degrade in the body and promote new bone formation. In this study, the corrosion behavior and cytotoxicity of Mg-Zn-Ca alloys are evaluated with adipose-derived mesenchymal stem cells (ASCs). Mg-2Zn and Mg-2Zn-xCa (x=1, 2 and 3wt.%) alloys were designated. Mg alloys were analyzed with scanning electron microscopy and potentiodynamic polarization. To understand the in-vitro biocompatibility and cytotoxicity of Mg-2Zn and Mg-2Zn-xCa alloys, ASCs were cultured for 24 and 72h in contact with 10%, 50% and 100% extraction of all alloys prepared in DMEM. Cell cytotoxicity and viability of ASCs were examined by MTT assay. Alloying elements including Zn and Ca improved the corrosion resistance of alloys were compared with pure Mg. The cytotoxicity results showed that all alloys had no significant adverse effects on cell viability in 24h. After 72h, cell viability and proliferation increased in the cells exposed to pure Mg and Mg-2Zn-1Ca extracts. The release of Mg, Zn and Ca ions in culture media had no toxic impacts on ASCs viability and proliferation. Mg-2Zn-1Ca alloy can be suggested as a good candidate to be used in biomedical applications. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. Effects of Focused Extracorporeal Shock Waves on Bone Marrow Mesenchymal Stem Cells in Patients with Avascular Necrosis of the Femoral Head.

    Science.gov (United States)

    Zhai, Lei; Sun, Nan; Zhang, Bo; Liu, Shui-Tao; Zhao, Zhe; Jin, Hai-Chao; Ma, Xin-Long; Xing, Geng-Yan

    2016-03-01

    To observe the effect of extracorporeal shock waves (ESWs) on bone marrow mesenchymal stem cells (MSCs) in patients with avascular necrosis of the femoral head, we collected bone marrow donated by patients and then cultivated and passaged MSCs in vitro using density gradient centrifugation combined with adherence screening methods. The P3 generation MSCs were divided into the ESW group and the control group. The cell counting kit for MSCs detected some proliferation differences. Cytochemistry, alkaline phosphatase staining and Alizarin red staining were used to determine alkaline phosphatase content. Simultaneously, real-time polymerase factor α1, osteocalcin and peroxisome proliferator-activated receptor γ. Together, the results of our study first indicate that moderate ESW intensity, which is instrumental in enhancing MSC proliferation, inducing conversion of MSCs into osteoblasts, and inhibiting differentiation of MSCs into adipocytes from MSCs, is one of the effective mechanisms for treating avascular necrosis of the femoral head. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  1. Combining Concentrated Autologous Bone Marrow Stem Cells Injection With Core Decompression Improves Outcome for Patients with Early-Stage Osteonecrosis of the Femoral Head: A Comparative Study.

    Science.gov (United States)

    Tabatabaee, Reza Mostafavi; Saberi, Sadegh; Parvizi, Javad; Mortazavi, Seyed Mohammad Javad; Farzan, Mahmoud

    2015-09-01

    The management of early-stage osteonecrosis of the femoral head (ONFH) remains challenging. This study aimed to evaluate the effects of core decompression and concentrated bone marrow implantation on ONFH. The study recruited 28 hips with early ONFH randomly assigned into two groups of core decompression with (group A) and without (group B) bone marrow injection. Patients were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, Visual Analogue Scale (VAS) pain index, and MRI. The mean WOMAC and VAS scores in all patients improved significantly (P<0.001). MRI showed a significant improvement in group A (P=0.046) and significant worsening in group B (P<0.001). Bone marrow stem cell injection with core decompression can be effective in early ONFH. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Is instillation of bone marrow stem cells at the time of core decompression useful for osteonecrosis of the femoral head?

    Directory of Open Access Journals (Sweden)

    Jorge Cabrolier

    2016-03-01

    Full Text Available La osteonecrosis de cabeza femoral lleva a degeneración de la cabeza y finalmente al desarrollo de artrosis de cadera. La descompresión constituye el tratamiento más utilizado, sin embargo su eficacia es limitada. Se ha planteado que la instilación de células madre en conjunto con la descompresión tendría mejores resultados. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos dos revisiones sistemáticas que en conjunto incluyen dos estudios controlados aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que instilar células madre de médula ósea al momento de la descompresión ósea en la osteonecrosis de cabeza femoral probablemente disminuye la progresión a artrosis de cadera y podría disminuir la necesidad de cirugías posteriores. No está claro si tiene algún efecto sobre la funcionalidad porque la certeza de la evidencia es muy baja.

  3. In vitro osteoinduction of human mesenchymal stem cells in biomimetic surface modified titanium alloy implants.

    Science.gov (United States)

    Santander, Sonia; Alcaine, Clara; Lyahyai, Jaber; Pérez, Maria Angeles; Rodellar, Clementina; Doblaré, Manuel; Ochoa, Ignacio

    2014-01-01

    Interaction between cells and implant surface is crucial for clinical success. This interaction and the associated surface treatment are essential for achieving a fast osseointegration process. Several studies of different topographical or chemical surface modifications have been proposed previously in literature. The Biomimetic Advanced Surface (BAS) topography is a combination of a shot blasting and anodizing procedure. Macroroughness, microporosity of titanium oxide and Calcium/Phosphate ion deposition is obtained. Human mesenchymal stem cells (hMCSs) response in vitro to this treatment has been evaluated. The results obtained show an improved adhesion capacity and a higher proliferation rate when hMSCs are cultured on treated surfaces. This biomimetic modification of the titanium surface induces the expression of osteblastic differentiation markers (RUNX2 and Osteopontin) in the absence of any externally provided differentiation factor. As a main conclusion, our biomimetic surface modification could lead to a substantial improvement in osteoinduction in titanium alloy implants.

  4. Evaluation of magnesium alloys with alternative surface finishing for the proliferation and chondro-differentiation of human mesenchymal stem cells

    International Nuclear Information System (INIS)

    Trinidad, J; Arruebarrena, G; De Argandona, E Saenz; De Eguino, G Ruiz; Infante, A; RodrIguez, C I

    2010-01-01

    Articular cartilage has little capacity for self-repair. As a result, continuous mechanical stress can lead to the degradation of articular cartilage, culminating in progressive damage and joint degeneration. Tissue engineering has arisen as a promising therapeutic approach to cartilage repair. Magnesium alloys are one of the most important metallic biomaterials emerging in this area due to their biocompatibility, bio-absorbability and especially to their mechanical properties. These properties make magnesium alloys a promising biomaterial in the regeneration of cartilage tissue. Objective. This study was undertaken to analyze the influence of surface characteristics of magnesium alloys in the adhesion, proliferation and differentiation of human mesenchymal stem cells (MSCs). Methods. Two commercial magnesium alloys (AZ31B and ZM21) were subjected to different treatments in order to obtain four different surfaces in each alloy. Human MSCs were seeded into the magnesium alloys and analyzed for their proliferation and chondrogenesis differentiation ability. Results. Human MSCs showed a greater proliferation and chondro-differentiation when cultured in the ZM21 magnesium alloy with a surface finishing of fine sanding, polishing, and etching.

  5. Hip stem fatigue: : The implications of increasing patient mass.

    Science.gov (United States)

    Westerman, Ashley P; Moor, Andrew R; Stone, Martin H; Stewart, Todd D

    2018-03-01

    General trends of increasing body mass index have been observed in many western countries along with an increasing demand for joint replacement. Standards have been developed for testing the fatigue properties of femoral stems; however, the loads that these apply are based on a historic patient weight and may not be valid in the current patient population. Several fatigue tests were conducted using distally fixed titanium alloy stems positioned according to the ISO standard but with a cyclic load based on a current 75th percentile patient sample. Smaller sized stems (currently not weight restricted) fractured in; 30,000 cycles, while larger sized stems were found to have excellent durability under loads simulating walking and stumbling. The results suggest that while the fatigue properties of medical grade titanium are very good, the ISO pre-clinical durability testing standard does not represent the influence of femoral offset or stem size sufficiently to reflect safe design practice.

  6. Optimization of a Functionally Graded Material Stem in the Femoral Component of a Cemented Hip Arthroplasty: Influence of Dimensionality of FGM

    Directory of Open Access Journals (Sweden)

    Abdellah Ait Moussa

    2017-01-01

    Full Text Available The longevity of hip prostheses is contingent on the stability of the implant within the cavity of the femur bone. The cemented fixation was mostly adopted owing to offering the immediate stability from cement-stem and cement-bone bonding interfaces after implant surgery. Yet cement damage and stress shielding of the bone were proven to adversely affect the lifelong stability of the implant, especially among younger subjects who tend to have an active lifestyle. The geometry and material distribution of the implant can be optimized more efficiently with a three-dimensional realistic design of a functionally graded material (FGM. We report an efficient numerical technique for achieving this objective, for maximum performance stress shielding and the rate of early accumulation of cement damage were concurrently minimized. Results indicated less stress shielding and similar cement damage rates with a 2D-FGM implant compared to 1D-FGM and Titanium alloy implants.

  7. Complete resolution of avascular necrosis of the human femoral head treated with adipose tissue-derived stem cells and platelet-rich plasma.

    Science.gov (United States)

    Pak, Jaewoo; Lee, Jung Hun; Jeon, Jeong Ho; Lee, Sang Hee

    2014-12-01

    We report a case of a 43-year-old man with early stage (stage 1) avascular necrosis (AVN) of the femoral head treated with adipose tissue-derived stem cells (ASCs) and platelet-rich plasma (PRP). ASC-containing stromal vascular fraction was mixed with PRP and hyaluronic acid. This mixture was then injected into the diseased hip under ultrasound guidance. The affected hip was reinjected weekly with additional PRP for 4 weeks. The patient was followed-up with sequential magnetic resonance imaging (MRI) scans at 3, 18, and 21 months after treatment, together with Visual Analogue Scale (VAS) Walking Index, Functional Rating Index, Harris Hip Score, and Range of Motion (ROM) assessments. The patient's severe hip pain was considerably improved at 3 months after treatment, with pain scores, ROM and MRI showing near complete resolution of AVN. Pain scores, ROM and MRI at 18 and 21 months after treatment indicated complete resolution of AVN. This case represents the first evidence of complete resolution of early stage AVN of the hip following treatment with ASCs/PRP. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  8. Autologous Bone Marrow Mesenchymal Stem Cells Associated with Tantalum Rod Implantation and Vascularized Iliac Grafting for the Treatment of End-Stage Osteonecrosis of the Femoral Head

    Directory of Open Access Journals (Sweden)

    Dewei Zhao

    2015-01-01

    Full Text Available Tantalum rod implantation with vascularized iliac grafting has been reported to be an effective method for the treatment of young patients with osteonecrosis of the femoral head (ONFH to avert the need for total hip arthroplasty (THA. However, there have been unsatisfactory success rates for end-stage ONFH. The authors describe a modified technique using bone marrow mesenchymal stem cells (BMMSCs associated with porous tantalum rod implantation combined with vascularized iliac grafting for the treatment of end-stage ONFH. A total of 24 patients (31 hips with end-stage ONFH were treated with surgery; ARCO IIIc stage was observed in 19 hips and ARCO IV stage was observed in 12 hips. All patients were followed for a mean time of 64.35 ± 13.03 months (range 26–78. Operations on only five hips were converted to THA. The joint-preserving success rate of the entire group was 89.47% for ARCO stage IIIc and 75% for ARCO stage IV. The mean Harris hip score of the 31 hips improved significantly from 38.74 ± 5.88 points (range 22–50 to 77.23 ± 14.75 points (range 33–95. This intervention was safe and effective in delaying or avoiding total hip replacement for end-stage ONFH.

  9. Autologous Bone Marrow Mesenchymal Stem Cells Associated with Tantalum Rod Implantation and Vascularized Iliac Grafting for the Treatment of End-Stage Osteonecrosis of the Femoral Head

    Science.gov (United States)

    Zhao, Dewei; Liu, Baoyi; Wang, Benjie; Yang, Lei; Xie, Hui; Huang, Shibo; Zhang, Yao; Wei, Xiaowei

    2015-01-01

    Tantalum rod implantation with vascularized iliac grafting has been reported to be an effective method for the treatment of young patients with osteonecrosis of the femoral head (ONFH) to avert the need for total hip arthroplasty (THA). However, there have been unsatisfactory success rates for end-stage ONFH. The authors describe a modified technique using bone marrow mesenchymal stem cells (BMMSCs) associated with porous tantalum rod implantation combined with vascularized iliac grafting for the treatment of end-stage ONFH. A total of 24 patients (31 hips) with end-stage ONFH were treated with surgery; ARCO IIIc stage was observed in 19 hips and ARCO IV stage was observed in 12 hips. All patients were followed for a mean time of 64.35 ± 13.03 months (range 26–78). Operations on only five hips were converted to THA. The joint-preserving success rate of the entire group was 89.47% for ARCO stage IIIc and 75% for ARCO stage IV. The mean Harris hip score of the 31 hips improved significantly from 38.74 ± 5.88 points (range 22–50) to 77.23 ± 14.75 points (range 33–95). This intervention was safe and effective in delaying or avoiding total hip replacement for end-stage ONFH. PMID:25802840

  10. [Prediction of femoral remodeling after implantation of artifical femoral head].

    Science.gov (United States)

    Gao, Zhongli; Zhao, Changfu; Yu, Qingwei; Wu, Dankai; Yu, Jingwei

    2003-06-01

    By integrating bone-remodeling theory with finite element (FEM) models, the behavior of femoral remodeling after implantation of artificial femoral head was simulated and the stress shield effect of artificial femoral head on the femur was analyzed quantitatively. Bone was calculated with finite element code of the FEM model. The normal loading condition of femur was used as Model One, and the stress condition that bone was fixed by the bone-cement of the artificial head with collar was used as Model Two. It has been shown that bone was stress-shielded by the artificial femoral head and femur resorbed. Bone resorption near the proximal artificial stem was very severe. Its cross-section resorbed the greatest. The ratio of cross-sectional resorption was psi = 31.3% and the ratio of loss of the anti-bend cross-sectional modulus was zeta = 54.58%.

  11. Tuning Mesenchymal Stem Cell Response onto Titanium-Niobium-Hafnium Alloy by Recombinant Fibronectin Fragments.

    Science.gov (United States)

    Herranz-Diez, C; Mas-Moruno, C; Neubauer, S; Kessler, H; Gil, F J; Pegueroles, M; Manero, J M; Guillem-Marti, J

    2016-02-03

    Since metallic biomaterials used for bone replacement possess low bioactivity, the use of cell adhesive moieties is a common strategy to improve cellular response onto these surfaces. In recent years, the use of recombinant proteins has emerged as an alternative to native proteins and short peptides owing to the fact that they retain the biological potency of native proteins, while improving their stability. In the present study, we investigated the biological effect of two different recombinant fragments of fibronectin, spanning the 8-10th and 12-14th type III repeats, covalently attached to a new TiNbHf alloy using APTES silanization. The fragments were studied separately and mixed at different concentrations and compared to a linear RGD, a cyclic RGD and the full-length fibronectin protein. Cell culture studies using rat mesenchymal stem cells demonstrated that low to medium concentrations (30% and 50%) of type III 8-10th fragment mixed with type III 12-14th fragment stimulated cell spreading and proliferation compared to RGD peptides and the fragments separately. On the other hand, type III 12-14th fragment alone or mixed at low volume percentages ≤50% with type III 8-10th fragment increased alkaline phosphatase levels compared to the other molecules. These results are significant for the understanding of the role of fibronectin recombinant fragments in cell responses and thus to design bioactive coatings for biomedical applications.

  12. Cytotherapy of osteonecrosis of the femoral head: a mini review

    OpenAIRE

    Gao, You-Shui; Zhang, Chang-Qing

    2010-01-01

    The pathogenesis and aetiology of nontraumatic osteonecrosis of the femoral head has not been revealed completely. However, with advances in stem cell research and regenerative medicine, it is believed that the onset of osteonecrosis of the femoral head probably has a cellular origin, and the possible therapy of osteonecrosis of the femoral head based on cytotherapy has great potential. In this review, the aetiology of osteonecrosis of the femoral head, animal experiments and clinical applica...

  13. Femoral revision with impaction allografting and an uncemented femoral component

    DEFF Research Database (Denmark)

    Nickelsen, T N; Erenbjerg, M; Retpen, J B

    2008-01-01

    A technique for uncemented revision of the femoral component which combines impaction allografting and the use of a long-stemmed proximally coated titanium prostheses (Bimetric, Biomet Inc.) is described. The results after a mean follow-up of 112 months are reported. From 1991 to 1995 femoral...... implants 88% had no pain, 10% had slight pain and only 2% had severe pain. Thirty-eight patients had radiographic signs of remodelling of the graft and/or cortical repair. In cases with a successful outcome, the results have been encouraging in relation to clinical performance, regeneration of bone...

  14. Subsidence of titanium straight stems in combination with highly viscous bone cement

    OpenAIRE

    Hendrich, Christian; Sauer, Ulf; Albrecht, Tobias; Rader, Christof P.

    2005-01-01

    Varying results and a high rate of subsidence have been reported for the straight femoral stem (M.E. Müller) made of titanium alloy. We examined subsidence in 135 titanium-alloy straight stems implanted with high viscosity cement after 68.8±11.5 months using a digital high-precision method (EBRA-FCA). One revised implant showed a subsidence of 14.6 mm and another 2.5 mm over 5 years. A third implant without migration was found to be loose. The 122 implants without loosening showed a mean subs...

  15. In vitro analysis with human bone marrow stem cells on Ti-15Mo alloy for dental and orthopedic implants application

    Directory of Open Access Journals (Sweden)

    N.T.C. Oliveira

    2011-03-01

    Full Text Available Aim: Nowadays, research on orthopedic and dental implants is focused on titanium alloys for their mechanical properties and corrosion resistance in the human body environment. Another important aspect to be investigated is their surface topography, which is very important to osseointegration. With laser beam irradiation for roughening the implants surface an easier control of the microtopography is achieved, and surface contamination is avoided. The aim of this study was to assess human bone marrow stem cells response to a newly developed titanium alloy, Ti-15Mo, with surface topography modified by laser beam irradiation. Materials and methods: A total of 10 Ti machined disks (control, 10 Ti-15Mo machined disks and 10 Ti-15Mo disks treated by laser beam-irradiation were prepared. To study how Ti-15Mo surface topografy can induce osteoblast differentiation in mesenchymal stem cells, the expression levels of bone related genes and mesenchymal stem cells marker were analyzed, using real time Reverse Transcription-Polymerase Chain Reaction. Results: In Test 1 (comparison between Ti-15Mo machined disks and Ti-machined disks quantitative real-time RT–PCR showed a significant induction of ALPL, FOSL1 and SPP1, which increase 20% or more. In Test 2 (comparison between Ti-15Mo laser treated disks and Ti-machined disks all investigated genes were up-regulated. By comparing Test 1 and Test 2 it was detected that COL1A1, COL3A1, FOSL1 and ENG sensibly increased their expression whereas RUNX2, ALPL and SPP1 expression remained substantially unchanged. Conclusion: The present study demonstrated that laser treated Ti-15Mo alloys are promising materials for implants application.

  16. Long-Duration Spaceflight During the Bion-M1 Spaceflight Experiment Resulted in Significant Bone Loss in the Femoral Head and Alterations in Stem Cell Differentiation Potential in Male Mice

    Science.gov (United States)

    Blaber, Elizabeth; Almeida, Eduardo; Grigoryan, Eleonora; Globus, Ruth

    Scientific understanding of the effects of microgravity on mammalian physiology has been limited to short duration spaceflight experiments (10-15 days). As long duration and inter-planetary missions are being initiated, there is a great need to understand the long-term effects of spaceflight on various physiological processes, including stem cell-based tissue regeneration. Bion-M1, for the first time, enabled the possibility of studying the effects of 30-days of microgravity exposure on a mouse model with sufficient sample size to enable statistical analysis. In this experiment, we hypothesized that microgravity negatively impacts stem cell based tissue regeneration, such as bone remodeling and regeneration from hematopoietic and mesenchymal precursors, thereby resulting in tissue degeneration in mice exposed to spaceflight. To test this hypothesis we collected the pelvis and proximal femur from space-flown mice and asynchronous ground controls and analyzed bone and bone marrow using techniques including Microcomputed Tomography (MicroCT), and in-vitro differentiation and differentiating cell motility assays. To determine the effects of 30-days spaceflight on bone tissue mass, we used MicroCT to analyze the trabecular bone of the femoral head and the cortical bone of the femoral neck and mid-shaft. We found that spaceflight caused a 45% decrease in bone volume ratio, a 17% decrease in trabecular thickness, a 25% decrease in trabecular number, and a 17% increase in trabecular spacing of trabecular bone. Furthermore, structural model index and trabecular pattern factor were increased by 32% and 82% respectively indicating that 30-days spaceflight resulted not only in a large loss of trabecular bone but also in a decrease of bone strength indicators. Analysis of the femoral neck cortical bone showed an increase in marrow area and cortical porosity indicating an overall widening of the femoral neck. Interestingly, no significant alterations were found in the cortical

  17. Use of a long distally fixed intramedullary stem to treat a periprosthetic femoral fracture following total hip arthroplasty using a thrust plate hip prosthesis: A case report

    Directory of Open Access Journals (Sweden)

    Hiroyuki Hatanaka

    2017-01-01

    Conclusion: This case shows that sufficient implant preparation based on precise preoperative planning is necessary to obtain good clinical results for the surgical treatment of periprosthetic femoral fractures following THA with the use of a TPP.

  18. The effect of phosphoric and phosphonic acid primers on bone cement bond strength to total hip stem alloys.

    Science.gov (United States)

    Jakubowitz, Eike; Liehn, Louisa; Jahnke, Alexander; Wöstmann, Bernd; Rickert, Markus; Niem, Thomas

    2017-05-01

    Aseptic loosening at alloy-cement interfaces constitutes a main failure mechanism of cemented total hip replacements (THR). As a potential solution we investigated the effect of metal primers containing phosphoric and phosphonic acid on shear bond strength (SBS) of bone cement to THR alloys (CoCrMo, TiAlNb) and pure tin (Sn) substrates (20×8×3 mm). Metal surfaces were modified by polishing or Al 2 O 3 blasting and primer application. Substrates without primer treatment served as references. Cylindrical cement pins (Ø 5mm) were polymerised onto substrate surfaces and aging (1, 5, 14 and 150 days) was simulated in aqueous NaCl solution (0.9%) before SBS determination and failure mode evaluation. Regardless of surface roughness and aging time, SBS for THR alloys and Sn was always significantly higher with primer treatment. Compared to untreated reference specimens (≤0.2MPa) SBS values increased even up to 350 fold (TiAlNb, 14 days) or 400 fold (CoCrMo, 5 days). In general, the phosphoric acid containing primer revealed significant higher SBS values on THR alloys compared to the phosphonic acid containing one. Al 2 O 3 blasted specimens showed generally higher SBS values than polished ones with the exception of Sn which showed high SBS values in general. With primer treatment on polished Sn a significant reduction of SBS could not be detected even up to 150 days, whereas THR alloys showed only an SBS improvement in the short term (≤14 days). A NaCl-pitting corrosion probably led to an increasing and durable SBS on polished Sn surfaces over time. Compared to modern THR in clinical practice that shows survival rates of 10, 15, 20 or more years, the receivable bond strength enhancements described in this study appeared to be very short. The improved SBS on THR alloys lasted only a few days before it was lost again. In contrast, the phosphoric acid primer treatment of polished Sn appeared to be very promising and may play a key role in further investigations dealing

  19. Tratamento da Osteonecrose da Cabeça Femoral com celulas progenitoras autólogas em anemia falciforme Femoral Head Necrosis treatment with autologous stem cells in sickle cell disease

    Directory of Open Access Journals (Sweden)

    Gildásio Cerqueira Daltro

    2008-01-01

    Full Text Available OBJETIVO: Avaliação da segurança e eficácia do uso de células progenitoras autólogas da medula óssea (CMMO no tratamento da Osteonecrose da Cabeça Femoral (OCF de pacientes portadores de anemia falciforme. MÉTODOS: Foram estudados 8 pacientes portadores de anemia falciforme, com OCF nos estágios I e II (classificação de Ficat e Arlet. As CMMO retiradas da crista ilíaca posterior foram concentradas e reinfundidas na área central da osteonecrose. Os principais parâmetros avaliados foram segurança, sintomas clínicos e progressão da doença, através da avaliação clínica (Harris Hip Score e radiológica. RESULTADOS: A maior parte dos pacientes (7 em 8 referiu melhora dos sintomas após o tratamento. Não houve complicações durante o procedimento anestésico e cirúrgico. A medida do escore (Harris Hip Score no pré-operatório foi 78,5 +/- 6,2 pontos, com aumento significativo destes valores no pós-operatório (98,3 +/- 2,5 pontos (pPURPOSE: To assess the efficacy and safety of autologous bone-marrow mononuclear cells (BMMC implantation in necrotic lesions of the femoral head in patients with sickle cell disease. METHODS: We studied eight patients with stage-I or -II femoral head osteonecrosis according to the system by Ficat and Arlet. BMMCs were harvested and re-infused into the necrotic zone. The primary endpoints studied were safety, clinical symptoms and disease progression, these being assessed according to the Harris hip score (HHS and to X-ray studies. RESULTS: After eight months, seven of the eight patients reported improvement from symptoms. There were no complications during anesthetic and surgery procedures. There was a significant postoperative increase in the HHS (98.3 +/- 2.5 points compared to preoperative HHS (78.5 +/- 6.2 points (p< 0.001. X-ray evaluation and cell parameters were found to be favorable. CONCLUSION: The autologous bone-marrow mononuclear cells implantation seems to be a safe and effective

  20. Effects of material properties of femoral hip components on bone remodeling

    NARCIS (Netherlands)

    Weinans, Harrie; Huiskes, Rik; Grootenboer, H.J.

    1992-01-01

    Bone loss around femoral hip stems is one of the problems threatening the long-term fixation of uncemented stems. Many believe that this phenomenon is caused by reduced stresses in the bone (stress shielding). In the present study the mechanical consequences of different femoral stem materials were

  1. Use of a long distally fixed intramedullary stem to treat a periprosthetic femoral fracture following total hip arthroplasty using a thrust plate hip prosthesis: A case report

    OpenAIRE

    Hatanaka, Hiroyuki; Motomura, Goro; Ikemura, Satoshi; Sonoda, Kazuhiko; Kubo, Yusuke; Utsunomiya, Takeshi; Yamamoto, Takuaki; Nakashima, Yasuharu

    2017-01-01

    Introduction: The thrust plate hip prosthesis (TPP; Zimmer, Winterthur, Switzerland) is a hip prosthesis that is no longer in production. Few reports have focused on periprosthetic fractures following total hip arthroplasty (THA) with the use of a TPP. Presentation of case: We report a 57-year-old woman with a periprosthetic femoral fracture 13 years after THA with the use of a TPP. A plain radiograph showed a displaced subtrochanteric fracture of the right femur just below the distal tip ...

  2. Exosomes secreted from mutant-HIF-1α-modified bone-marrow-derived mesenchymal stem cells attenuate early steroid-induced avascular necrosis of femoral head in rabbit.

    Science.gov (United States)

    Li, Haile; Liu, Danping; Li, Chen; Zhou, Shanjian; Tian, Dachuan; Xiao, Dawei; Zhang, Huan; Gao, Feng; Huang, Jianhua

    2017-12-01

    Mesenchymal stem cells (MSCs)-derived exosomes exhibit protective effects on damaged or diseased tissues. Hypoxia-inducible factor 1α (HIF-1α) plays a critical role in bone development. However, HIF-1α is easily biodegradable under normoxic conditions. The bone-marrow-derived mesenchymal stem cells (BMSCs) were transfected with adenovirus carrying triple point-mutations (amino acids 402, 564, and 803) in the HIF-1α coding sequence (CDS). The mutant HIF-1α can efficiently express functional proteins under normoxic conditions. To date, no study has reported the role of exosomes secreted by mutant HIF-1α modified BMSCs in the recovery of the early steroid-induced avascular necrosis of femoral head (SANFH). In this study, we firstly analyzed exosomes derived from BMSCs modified by mutant (BMSC-Exos MU ) or wild-type HIF-1α (BMSC-Exos WT ). In vitro, we investigated the osteogenic differentiation capacity of BMSCs modified by BMSC-Exos MU or BMSC-Exos WT , and the angiogenesis effects of BMSC-Exos MU and BMSC-Exos WT on human umbilical vein endothelial cells (HUVECs). Besides, the healing of the femoral head was also assessed in vivo. We found that the potential of osteogenic differentiation of BMSCs treated with BMSC-Exos MU was higher than the wild-type group in vitro. In addition, BMSC-Exos MU stimulated the proliferation, migration, and tube formation of HUVECs in a dose-dependent manner. Compared with the BMSC-Exos WT or PBS control group, the injection of BMSC-Exos MU into the necrosis region markedly accelerated the bone regeneration and angiogenesis, which were indicated by the increased trabecular reconstruction and microvascular density. Taken together, our data suggest that BMSC-Exos MU facilitates the repair of SANFH by enhancing osteogenesis and angiogenesis. © 2017 International Federation for Cell Biology.

  3. Temporary total hip arthroplasty-like spacer for treating an infected periprosthetic femoral fracture using a long stem: A case report

    Directory of Open Access Journals (Sweden)

    Youngwoo Kim

    2017-01-01

    Conclusions: Temporary antibiotic-loaded cement-coated THA-like spacer using a long stem facilitated the eradication of infection, fracture stabilization, and enables partial weight bearing without pain.

  4. Periprosthetic femoral fracture within two years after total hip replacement:

    DEFF Research Database (Denmark)

    Thien, T. M.; Chatziagorou, G.; Garellick, G.

    2014-01-01

    BACKGROUND: We used the Nordic Arthroplasty Register Association database to evaluate whether age, sex, preoperative diagnosis, fixation, and implant design influence the risk of revision arthroplasty due to periprosthetic fracture within two years from operation of a primary total hip replacement....... METHODS: Included in the study were 325,730 cemented femoral stems and 111,899 uncemented femoral stems inserted from 1995 to 2009. Seven frequently used stems (two cemented stems [Exeter and Lubinus SP II] and five uncemented stems [Bi-Metric, Corail, CLS Spotorno, ABG I, and ABG II]) were specifically...... studied. RESULTS: The incidence of revision at two years was low: 0.47% for uncemented stems and 0.07% for cemented stems. Uncemented stems were much more likely to have this complication (relative risk, 8.72 [95% confidence interval, 7.37 to 10.32]; p

  5. Modified Masquelet technique using allogeneic umbilical cord-derived mesenchymal stem cells for infected non-union femoral shaft fracture with a 12 cm bone defect: A case report.

    Science.gov (United States)

    Dilogo, Ismail Hadisoebroto; Primaputra, Muhammad Rizqi Adhi; Pawitan, Jeanne Adiwinata; Liem, Isabella Kurnia

    2017-01-01

    Non-union due to large bone loss often causes significant long-term morbidity. We incorporate the use of allogeneic umbilical cord-derived mesenchymal stem cells (UC-MSCs) as part of the diamond concept of regenerative medicine in a case of infected non-union fracture. We reported a 54-year-old female patient presenting with pain on the right thigh. She was previously diagnosed with a closed fracture of the right femoral shaft and underwent four surgeries before finally being referred to Dr. Cipto Mangunkusumo General Hospital with infected non-union of the right femoral shaft. The patient was treated with a combination of UC-MSCs, bone morphogenetic protein-2 (BMP-2), Hydroxyapatite (HA), and mechanical stabilization using Masquelet Technique. The combination of allogeneic MSCs, BMP2, HA, and Masquelet Technique was successful in creating new bone with no apparent side effects. Bone loss might be caused by external factors (true defects), or structural loss of the existing bone. The combination of allogeneic UC-MSCs, BMP-2, HA and an induced membrane technique pioneered by Masquelet allowed for faster regeneration process and more optimal bone healing. This paper aims to assess and compare the result of such procedures with the previous four surgeries done to the patient, which did not yield satisfactory results. The application of allogeneic UC-MSC, BMP-2, HA and Masquelet technique as proposed in the diamond concept is a viable method in treating critical-sized bone defect and provides an effective way to overcome non-union caused by large defect. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. Bone mesenchymal stem cell functions on the hierarchical micro/nanotopographies of the Ti-6Al-7Nb alloy.

    Science.gov (United States)

    Ren, Nan; Zhang, Shuyin; Li, Yongfeng; Shen, Shuning; Niu, Qiang; Zhao, Yimin; Kong, Liang

    2014-12-01

    We investigated the response of rat bone mesenchymal stem cells (BMSC) placed on the titanium-6aluminium-7niobiuim (Ti-6Al-7Nb) alloy modified by hydrofluoric acid etch combined with subsequent anodic oxidation. Pure titanium (Ti) discs and Ti-6Al-7Nb discs were treated by hydrofluoric acid etch and anodic oxidation, and polished pure Ti discs and Ti-6Al-7Nb discs without surface modification served as controls (n=35 in each group). Scanning electron microscopy, atomic force microscopy, and radiographic photoelectron spectroscopy assays were used to detect the properties of the samples' surface. The morphology, adhesion, proliferation, and alkaline phosphatase activity of BMSC were examined using various techniques of microscopic and biological characterisation. The results showed that both Ti-6Al-7Nb samples and the pure Ti samples showed hierarchical micro/nanotopographies, and fluorine emerged on the surfaces of the samples after modification. The hierarchical micro/nanotopographies significantly increased the spreading, adhesion, and proliferation of BMSC and activity of alkaline phosphatase. In addition, modified samples of Ti-6Al-7Nb showed significantly higher alkaline phosphatase activity than modified pure Ti samples (pmicro/nanotopographies treated by hydrofluoric acid etch and anodic oxidation possessed good biocompatibility, and may be a promising candidate for dental implants. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  7. Thigh Pain Occurrence Rate in a Short, Tapered, Porous, Proximally-Coated Cementless Femoral Stem - Clinical and Radiological Results at 2-Year Follow-Up

    Directory of Open Access Journals (Sweden)

    Michele Ulivi

    2017-03-01

    Full Text Available Introduction: Short stems have been designed with the purpose of preserving bone tissue, decreasing the incidence of thigh pain and facilitating surgical techniques. The aim of our study was to assess whether a shortened tapered conventional stem was able to reduce the incidence of thigh pain. Methods: Between March 2010 and December 2012, 200 patients were enrolled in the study. Visual analogue scale (VAS that included mapping of the pain, Harris Hip Score (HHS, Short Form-12 (SF-12 and radiographic outcomes were evaluated prior to surgery as well as at 6, 12 and 24 months post-operatively. Results: After 6 months, 6 patients (3% had thigh pain. After 12 months, 3 patients (1.5% complained about thigh pain. After 2 years, 2 patients (1% had thigh pain. There was no correlation between pain and clinical, radiological, or demographic variables. Conclusion: The shortened tapered conventional stem resulted in a lower incidence of thigh pain for up to 2-years following surgery, compared with conventional or other short stems.

  8. Improving stress shielding following total hip arthroplasty by using a femoral stem made of β type Ti-33.6Nb-4Sn with a Young's modulus gradation

    NARCIS (Netherlands)

    Yamako, Go; Janssen, Dennis; Hanada, Shuji; Anijs, Thomas; Ochiai, Kiyohide; Totoribe, Koji; Chosa, Etsuo; Verdonschot, Nico

    2017-01-01

    Stress shielding-related bone loss occurs after total hip arthroplasty because the stiffness of metallic implants differs from that of the host femur. Although reducing stem stiffness can ameliorate the bone resorption, it increases stress at the bone–implant interface and can inhibit fixation. To

  9. Femoral bowing plane adaptation to femoral anteversion.

    Science.gov (United States)

    Akman, Alp; Demirkan, Fahir; Sabir, Nuran; Oto, Murat; Yorukoglu, Cagdas; Kiter, Esat

    2017-01-01

    Femoral bowing plane (FBP) is the unattended subject in the literature. More over the femoral shaft with its bowing is neglected in established anteversion determination methods. There is limited information about the relationship between FBP and anteversion. Thus we focused on this subject and hypothesized that there could be an adaptation of FBP to anteversion. FBP is determined on three-dimensional solid models derived from the left femoral computerized tomography data of 47 patients which were taken before for another reason and comparatively evaluated with anteversion. There were 20 women and 27 men. The mean age of patients was 56 years (range 21-84 years). The anteversion values were found as the angle between a distal condylar axis (DCA) and femoral neck anteversion axis (FNAA) along an imaginary longitudinal femoral axis (LFA) in the true cranio-caudal view. The FBP was determined as a plane that passes through the centre-points of three pre-determinated sections on the femoral shaft. The angles between DCA, FNAA and FBP were comparatively evaluated. The independent samples t -test was used for statistical analysis. At the end, it was found that FBP lies nearly perpendicular to the anteversion axis for the mean of our sample which is around 89° in females and 93° in males (range 78-102°). On the other hand, FBP does not lie close to the sagittal femoral plane (SFP); instead, there is an average 12.5° external rotation relative to the SFP. FBP is correlated well with anteversion in terms of FBP inclination from SFP and femoral torsion (i.e., angle between FBP and femoral neck anteversion axis ( P < 0.001; r = 0.680 and r = -0.682, respectively). Combined correlation is perfect ( R 2 = 1) as the FBP, SFP, and posterior femoral plane forms a triangle in the cranio-caudal view. We found that FBP adapts to anteversion. As FBP lies close to perpendicularity for the mean, femoral component positioning perpendicular to the FBP can be an alternate way in the

  10. Femoral bowing plane adaptation to femoral anteversion

    Directory of Open Access Journals (Sweden)

    Alp Akman

    2017-01-01

    Full Text Available Background: Femoral bowing plane (FBP is the unattended subject in the literature. More over the femoral shaft with its bowing is neglected in established anteversion determination methods. There is limited information about the relationship between FBP and anteversion. Thus we focused on this subject and hypothesized that there could be an adaptation of FBP to anteversion. Materials and Methods: FBP is determined on three-dimensional solid models derived from the left femoral computerized tomography data of 47 patients which were taken before for another reason and comparatively evaluated with anteversion. There were 20 women and 27 men. The mean age of patients was 56 years (range 21-84 years. Results: The anteversion values were found as the angle between a distal condylar axis (DCA and femoral neck anteversion axis (FNAA along an imaginary longitudinal femoral axis (LFA in the true cranio-caudal view. The FBP was determined as a plane that passes through the centre-points of three pre-determinated sections on the femoral shaft. The angles between DCA, FNAA and FBP were comparatively evaluated. The independent samples t-test was used for statistical analysis. At the end, it was found that FBP lies nearly perpendicular to the anteversion axis for the mean of our sample which is around 89° in females and 93° in males (range 78-102°. On the other hand, FBP does not lie close to the sagittal femoral plane (SFP; instead, there is an average 12.5° external rotation relative to the SFP. FBP is correlated well with anteversion in terms of FBP inclination from SFP and femoral torsion (i.e., angle between FBP and femoral neck anteversion axis (P0 < 0.001; r = 0.680 and r = −0.682, respectively. Combined correlation is perfect (R[2] = 1 as the FBP, SFP, and posterior femoral plane forms a triangle in the cranio-caudal view. Conclusions: We found that FBP adapts to anteversion. As FBP lies close to perpendicularity for the mean, femoral component

  11. Characterization of Briquette from the Corncob Charcoal and Sago Stem Alloys

    Science.gov (United States)

    Lestari, Lina; Inda Variani, Viska; Nyoman Sudiana, I.; Purnama Sari, Dewi; Ode Sitti Ilmawati, Wa; Sahaluddin Hasan, Erzam

    2017-05-01

    The briquettes fabricated from charcoal of corncob (zea mays,L) and sago stem (metroxilon sago rottb) have been produced and characterized. The samples were prepared step by step carefully. The charcoal powder filtered by strainer with mesh size of 70-80 to get the homogeneous particle size. Briquettes are made by mixing corncob charcoal powder, sago stem charcoal and sago adhesive with a mass ratio of 4:5:1, 4.5: 4.5: 1, 5:4:1. The materials are mixed with hot water and stirred to get homogeneous blend. Then they are compacted by pressure of 34.66kg/cm2, 69.32kg/cm2, and 103.98kg/cm2 to form a cylindrical shape with diameter of 4 cm. The cylindrical briquettes then were dried at temperature of 60°C for 48 hours. After dried, the samples where then characterized their density and water, ash, volatile matter, fixed carbon contents. The burning rate, combustion temperature, and ignition time were also determined. The experimental results show that the briquettes have average densities from 0.602 to 0.717gr/cm3. The density increase with the increasing of forming pressure. The increasing of pressure also result in the decreasing of moisture content from 2.669% to 0.842%. The ash content is found from 3.459% to 8.766%. Volatile matter and fixed carbon are varies from 13.658% and 21.168% and 67.667% to 80.758% respectively. The lowest burning rate is 0.0898gr/s and the optimum burning temperature is 499.2°C with the lowest ignition time of 1.58 minutes. These briquette’s parameters agree wit the quality standard of industrial briquette.

  12. Trunnion Corrosion and Early Failure in Monolithic Metal-on-Polyethylene TMZF Femoral Components: A Case Series

    Directory of Open Access Journals (Sweden)

    Peter Walker

    2016-09-01

    Full Text Available We describe four patients who were treated with primary total hip arthroplasty (THA at two tertiary academic Australian teaching hospitals that experienced premature failure of head-neck trunnions through dissociation of the head-neck taper junction. This retrospective case series have similar clinical presentations and macroscopic pathology with severe head-neck taper junction loss of material, corrosion and early catastrophic failure. It is proposed that the accelerated wear is related to use of varus offset neck in a proprietary beta titanium alloy (Ti-12Mo-6Zr-2Fe  or TMZFÒ Stryker Osteonics, Mahwah NJ, USA TMZF femoral stem, longer head-neck combination in a relatively active, older, male patient population. In this limited case series presentation was on average 80 months (range 53-92 following index procedure. In three of the four patients, a prodromal period of groin or buttock pain was reported for between 1 week and 2 months prior to acute presentation. Significant metallosis and local tissue damage including gluteal muscle insufficiency was evident. Each stem revised was well fixed. An extended trochanteric osteotomy was required in two of the four cases for stem extraction. We recommend caution and further evaluation on the relationship between TMZF metal alloy and its longevity in higher demand patients with high neck offset, varus stem geometry and large CoCr bearing heads.

  13. Stem Cell Therapy for Avascular Necrosis of Femoral Head in Sickle Cell Disease: Report of 11 Cases and Review of Literature.

    Science.gov (United States)

    Sadat-Ali, Mir; Azam, Md Q; Elshabouri, Ezzat M; Tantawy, Ahmad M; Acharya, Sadananda

    2017-11-30

    Sickle cell disease (SCD) is quite common in eastern Saudi Arabia and Avascular necrosis of femoral head (ANFH) occurs in 30% of the young patients leading to early joint arthroplasty. This study was conducted to assess the benefits of injection of osteoblasts in the avascular lesions of the head of femur. A preset technique was used, 10 CC of bone marrow aspiration was performed under local anesthesia and aseptic technique. Osteoblasts were separated from the bone marrow cells. The avascular area was drilled and 10 million osteoblasts were transplanted at the lesion site. Patients were seen in the out patient clinic after two weeks for removal of the suture and addressed the questionnaire and examined for the range of movement. The follow up MRI was performed at 4 months. The average age was 20.2±3.9 years. The mean hemoglobin S was 81.6±4.8 percent. Quality of Life Score for Chronic Hip Disease was assessed and found at 8.6 (1 being the severe limitation and 10 being normal), whereas Harris hip score improved from 41.7±5.1 to 88.93±3.6 (p avascular lesions. The short term results were good and we believe the injection of osteoblast in the avascular lesion of head of femur is a less invasive procedure devoid of any untoward complications and merits such treatment in large patient group with longer follow up.

  14. Graphene coating on the surface of CoCrMo alloy enhances the adhesion and proliferation of bone marrow mesenchymal stem cells.

    Science.gov (United States)

    Zhang, Qi; Li, Kewen; Yan, Jinhong; Wang, Zhuo; Wu, Qi; Bi, Long; Yang, Min; Han, Yisheng

    2018-02-19

    The objective was to investigate whether a graphene coating could improve the surface bioactivity of a cobalt-chromium-molybdenum-based alloy (CoCrMo). Graphene was produced by chemical vapor deposition and transferred to the surface of the CoCrMo alloy using an improved wet transfer approach. The morphology of the samples was observed, and the adhesion force and stabilization of graphene coating were analyzed by a nanoscratch test and ultrasonication test. In an in vitro studies, the adhesion and proliferation of bone marrow mesenchymal stem cells (BMSCs) cultured on the samples were quantified via an Alamar Blue assay and cell counting kit-8 (CCK-8) assay. The results showed that it is feasible to apply graphene to modify the surface of a CoCrMo alloy, and the enhancement of the adhesion and proliferation of BMSCs was also shown in the present study. In conclusion, graphene exhibits considerable potential for enhancing the surface bioactivity of CoCrMo alloy. Copyright © 2018. Published by Elsevier Inc.

  15. Alloy synthesis using the mach stem region in an axial symmetric implosive shock: Understanding the pressure strain-temperature contributions

    Energy Technology Data Exchange (ETDEWEB)

    Staudhammer, Karl P.

    2004-01-01

    The Mach stem region in an axial symmetric shock implosion has generally been avoided in the dynamic consolidation of powders for a number of reasons. The prime reason being that the convergence of the shock waves in the cylindrical axis produce enormous pressures and concomitant temperatures that have melted tungsten. This shock wave convergence consequently results in a discontinuity in the hydro-code calculations. Dynamic deformation experiments on gold plated 304L stainless steel powders were undertaken. These experiments utilized pressures of 0.08 to 1.0 Mbar and contained a symmetric radial melt region along the central axis of the sample holder. To understand the role of deformation in a porous material, the pressure, and temperature as well as the deformation heat and associated defects must be accounted for. When the added heat of consolidation deformation exceeds the melt temperature of the 304 powders, a melt zone results that can consume large regions of the compact while still under the high-pressure pulse. As the shock wave traverses the sample and is removed in a momentum trap, its pressure/temperature are quenched. It is within this region that very high diffusion/alloying occurs and has been observed in the gold plated powders. Anomalous increases of gold diffusion into 304 stainless steel have been observed via optical microscopy, scanning electron microscopy and EDAX measurements. Values exceeding 1200 m/sec have been measured and correlated to the powder sizes, size distribution and packing density, concomitant with sample container strains ranging from 2.0% to 26%.

  16. 21 CFR 888.3570 - Knee joint femoral (hemi-knee) metallic uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... prosthesis. 888.3570 Section 888.3570 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... femoral (hemi-knee) metallic uncemented prosthesis. (a) Identification. A knee joint femoral (hemi-knee) metallic uncemented prosthesis is a device made of alloys, such as cobalt-chromium-molybdenum, intended to...

  17. Adenovirus-Mediated Expression of BMP-2 and BFGF in Bone Marrow Mesenchymal Stem Cells Combined with Demineralized Bone Matrix For Repair of Femoral Head Osteonecrosis in Beagle Dogs

    Directory of Open Access Journals (Sweden)

    Wu-Xun Peng

    2017-10-01

    Full Text Available Background: This study investigated the effect of using adenovirus-mediated expression of bone morphogenetic protein 2 (Ad-BMP-2 and basic fibroblast growth factor (bFGF in bone marrow mesenchymal stem cells (BMSCs in combination with a demineralized bone matrix (DBM to repair osteonecrosis of the femoral head (ONFH in Beagle dogs. Methods: A total of 30 Beagle dogs were selected for the isolation of BMSCs, which were cultured and transfected with the recombinant adenovirus vector Ad-BMP2-bFGF-GFP (carrying BMP-2 and bFGF or a control adenovirus plasmid (encoding green fluorescent protein (Ad-GFP. The expression of the transfected BMP-2 and bFGF proteins was detected by Western blotting. After transfection, the BMSCs were induced to undergo osteoblastic differentiation. The DBM was prepared to construct a DBM/BMSC complex. Beagle models of canine femoral head defects and necrosis were established and divided into control, DBM, DBM/BMSC, vector Ad-BMP2-bFGF-GFP and Ad-GFP groups. The composite graft was then implanted, and new bone morphology was visualized via X-ray at 3, 6 and 12 weeks after the operation. Hematoxylin and eosin (HE staining and Masson’s trichrome staining were used to identify new bone formation. Immunohistochemistry was performed to calculate the density of new blood vessels. The compressive and bending strength of the BMSCs was evaluated at 12 weeks after the operation. Results: BMSCs were successfully isolated. The protein expression of BMP-2 and bFGF was significantly higher in the Ad-BMP-2/bFGF group than the normal and Ad-GFP groups. Compared with the control group, at 12 weeks after the operation, the DBM, DBM/BMSC, vector Ad-BMP2-bFGF-GFP and Ad-GFP groups showed a larger area of new bone, higher X-ray scores, greater neovascularization density, and increased compressive and bending strength. The most significant modifications occurred in thevector Ad-BMP2-bFGF-GFP group. Conclusion: The results indicate that the use

  18. Adenovirus-Mediated Expression of BMP-2 and BFGF in Bone Marrow Mesenchymal Stem Cells Combined with Demineralized Bone Matrix For Repair of Femoral Head Osteonecrosis in Beagle Dogs.

    Science.gov (United States)

    Peng, Wu-Xun; Wang, Lei

    2017-01-01

    This study investigated the effect of using adenovirus-mediated expression of bone morphogenetic protein 2 (Ad-BMP-2) and basic fibroblast growth factor (bFGF) in bone marrow mesenchymal stem cells (BMSCs) in combination with a demineralized bone matrix (DBM) to repair osteonecrosis of the femoral head (ONFH) in Beagle dogs. A total of 30 Beagle dogs were selected for the isolation of BMSCs, which were cultured and transfected with the recombinant adenovirus vector Ad-BMP2-bFGF-GFP (carrying BMP-2 and bFGF) or a control adenovirus plasmid (encoding green fluorescent protein (Ad-GFP)). The expression of the transfected BMP-2 and bFGF proteins was detected by Western blotting. After transfection, the BMSCs were induced to undergo osteoblastic differentiation. The DBM was prepared to construct a DBM/BMSC complex. Beagle models of canine femoral head defects and necrosis were established and divided into control, DBM, DBM/BMSC, vector Ad-BMP2-bFGF-GFP and Ad-GFP groups. The composite graft was then implanted, and new bone morphology was visualized via X-ray at 3, 6 and 12 weeks after the operation. Hematoxylin and eosin (HE) staining and Masson's trichrome staining were used to identify new bone formation. Immunohistochemistry was performed to calculate the density of new blood vessels. The compressive and bending strength of the BMSCs was evaluated at 12 weeks after the operation. BMSCs were successfully isolated. The protein expression of BMP-2 and bFGF was significantly higher in the Ad-BMP-2/bFGF group than the normal and Ad-GFP groups. Compared with the control group, at 12 weeks after the operation, the DBM, DBM/BMSC, vector Ad-BMP2-bFGF-GFP and Ad-GFP groups showed a larger area of new bone, higher X-ray scores, greater neovascularization density, and increased compressive and bending strength. The most significant modifications occurred in thevector Ad-BMP2-bFGF-GFP group. The results indicate that the use of Ad-BMP-2/bFGF-modified BMSCs in conjunction with DBM

  19. Atherosclerotic femoral artery aneurysms

    DEFF Research Database (Denmark)

    Levi-Mazloum, Niels Donald; Schroeder, T V

    1996-01-01

    Based on a clinical suspicion of an increase in the proportion of deep femoral aneurysms, we reviewed the case records of patients who underwent reconstructive procedures for femoral aneurysms to investigate if this could be confirmed and explained by selection of patient or modality of diagnosis...

  20. Osteonecrosis of the femoral head extending into the femoral neck.

    Science.gov (United States)

    Sakamoto, Yuma; Yamamoto, Takuaki; Motomura, Goro; Sakamoto, Akio; Yamaguchi, Ryosuke; Iwasaki, Kenyu; Zhao, Garida; Karasuyama, Kazuyuki; Iwamoto, Yukihide

    2013-03-01

    Osteonecrosis of the femoral head (ONFH) is an ischemic disorder that can lead to femoral head collapse and secondary osteoarthritis. Although the condition is usually limited to the femoral head, we report a rare case of biopsy-proven ONFH extending into the femoral neck, which required hip replacement surgery. We emphasize the imaging features of this condition and briefly discuss its potential relevance.

  1. Femoral head avascular necrosis

    International Nuclear Information System (INIS)

    Chrysikopoulos, H.; Sartoris, D.J.; Resnick, D.L.; Ashburn, W.; Pretorius, T.

    1988-01-01

    MR imaging has been shown to be more sensitive and specific than planar scintigraphy for avascular necrosis (AVN) of the femoral head. However, experience with single photon emission CT (SPECT) is limited. The authors retrospectively compared 1.5-T MR imaging with SPECT in 14 patients with suspected femoral head AVN. Agreement between MR imaging and SPECT was present in 24 femurs, 14 normal and ten with AVN. MR imaging showed changes of AVN in the remaining four femoral heads. Of these, one was normal and the other three inconclusive for AVN by SPECT. The authors conclude that MR imaging is superior to SPECT for the evaluation of AVN of the hip

  2. Decreased femoral periprosthetic bone mineral density: a comparative study using DXA in patients after cementless total hip arthroplasty with osteonecrosis of the femoral head versus primary osteoarthritis.

    Science.gov (United States)

    Craiovan, Benjamin; Woerner, Michael; Winkler, Sebastian; Springorum, Hans-Robert; Grifka, Joachim; Renkawitz, Tobias; Keshmiri, Armin

    2016-05-01

    Trabecular properties in osteonecrosis of the femoral head (ONFH) are altered for bone volume and structure in the femoral head and proximal femoral canal. We analysed the periprosthetic bone mineral density (BMD) as a correlate to bony ingrowth in patients with ONFH who received a cementless THA. We performed a matched-pair analysis of 100 patients with ONFH (n = 50) and primary osteoarthritis (n = 50) who received the same, unilateral cementless THA. We compared the periprosthetic BMD 5 years after surgery by means of dual energy X-ray absorptiometry (DXA) analysing the seven femoral regions of interest (ROIs) according to Gruen. Within the ONFH group, significantly lower BMD values were found in the ROI 1 and 7 (p femoral stem in THA. Surgeons need to consider coating and fixation philosophy of cementless implants when choosing the right stem for patients with ONFH.

  3. Quantification of elemental segregation to lath and grain boundaries in low-alloy steel by STEM X-ray mapping combined with the zeta-factor method

    CERN Document Server

    Watanabe, M

    2003-01-01

    Elemental segregation to two types of boundaries in a low-alloy steel were studied by X-ray mapping using scanning transmission electron microscopy (STEM). To quantify the acquired X-ray maps, the zeta-factor method was applied, and then the compositional maps and the thickness map were obtained. Based on these quantified maps, further information about the analytical sensitivity of solute-element detection and the spatial resolution of segregation analysis were extracted. Furthermore, maps of the number of excess atoms on the boundary were also calculated from the compositional and thickness maps. It was concluded that Cr, Ni and Mo are co-segregated on the prior-austenite grain boundary and only Ni was segregated on the lath boundary. (orig.)

  4. In-situ STEM imaging of growth and phase change of individual CuAlX precipitates in Al alloy

    NARCIS (Netherlands)

    C. Liu, (Chunhui); S.K. Malladi, (Sairam); Q. Xu, (Qiang); J. Chen, (Jianghua); F.D. Tichelaar, (Frans); X. Zhuge (Jason); H.W. Zandbergen, (Henny)

    2017-01-01

    textabstractAge-hardening in Al alloys has been used for over a century to improve its mechanical properties. However, the lack of direct observation limits our understanding of the dynamic nature of the evolution of nanoprecipitates during age-hardening. Using in-situ (scanning) transmission

  5. Alloy Microstructure Dictates Corrosion Modes in THA Modular Junctions.

    Science.gov (United States)

    Pourzal, Robin; Hall, Deborah J; Ehrich, Jonas; McCarthy, Stephanie M; Mathew, Mathew T; Jacobs, Joshua J; Urban, Robert M

    2017-12-01

    Adverse local tissue reactions (ALTRs) triggered by corrosion products from modular taper junctions are a known cause of premature THA failure. CoCrMo devices are of particular concern because cobalt ions and chromium-orthophosphates were shown to be linked to ALTRs, even in metal-on-polyethylene THAs. The most common categories of CoCrMo alloy are cast and wrought alloy, which exhibit fundamental microstructural differences in terms of grain size and hard phases. The impact of implant alloy microstructure on the occurring modes of corrosion and subsequent metal ion release is not well understood. The purpose of this study was to determine whether (1) the microstructure of cast CoCrMo alloy varies broadly between manufacturers and can dictate specific corrosion modes; and whether (2) the microstructure of wrought CoCrMo alloy is more consistent between manufacturers and has low implications on the alloy's corrosion behavior. The alloy microstructure of four femoral-stem and three femoral-head designs from four manufacturers was metallographically and electrochemically characterized. Three stem designs were made from cast alloy; all three head designs and one stem design were made from wrought alloy. Alloy samples were sectioned from retrieved components and then polished and etched to visualize grain structure and hard phases such as carbides (eg, M 23 C 6 ) or intermetallic phases (eg, σ phase). Potentiodynamic polarization (PDP) tests were conducted to determine the corrosion potential (E corr ), corrosion current density (I corr ), and pitting potential (E pit ) for each alloy. Four devices were tested within each group, and each measurement was repeated three times to ensure repeatable results. Differences in PDP metrics between manufacturers and between alloys with different hard phase contents were compared using one-way analysis of variance and independent-sample t-tests. Microstructural features such as twin boundaries and slip bands as well as corrosion

  6. Femoral shaft fractures

    International Nuclear Information System (INIS)

    Bender, C.E.; Campbell, D.C. II

    1985-01-01

    The femur is the longest, largest, and strongest bone in the body. Because of its length, width, and role as primary weight-bearing bone, it must tolerate the extremes of axial loading and angulatory stresses. Massive musculature envelopes the femur. This masculature provides abundant blood supply to the bone, which also allows great potential for healing. Thus, the most significant problem relating to femoral shaft fractures is not healing, but restoration of bone length and alignment so that the femoral shaft will tolerate the functional stresses demanded of it

  7. Using 'subcement' to simulate the long-term fatigue response of cemented femoral stems in a cadaver model: could a novel preclinical screening test have caught the Exeter matt problem?

    Science.gov (United States)

    Race, A; Miller, M A; Mann, K A

    2010-01-01

    Previously, cement was formulated with degraded fatigue properties (subcement) to simulate long-term fatigue in short-term cadaver tests. The present study determined the efficacy of subcement in a 'preclinical' test of a design change with known clinical consequences: the 'polished'-to-'matt' transition of the Exeter stem (revision rates for polished stems were twice those for matt stems). Contemporary stems were bead blasted to give Ra = 1 microm (matt finish). Matt and polished stems were compared in cadaver pairs under stair-climbing loads (three pairs of size 1; three pairs of size 3). Stem micromotion was monitored during loading. Post-test transverse sections were examined for cement damage. Cyclic retroversion decreased for polished stems but increased for matt stems (p implied that polished size-3 stems might be superior to size-1 stems).

  8. [Trochanteric femoral fractures].

    Science.gov (United States)

    Douša, P; Čech, O; Weissinger, M; Džupa, V

    2013-01-01

    At the present time proximal femoral fractures account for 30% of all fractures referred to hospitals for treatment. Our population is ageing, the proportion of patients with post-menopausal or senile osteoporosis is increasing and therefore the number of proximal femoral fractures requiring urgent treatment is growing too. In the age category of 50 years and older, the incidence of these fractures has increased exponentially. Our department serves as a trauma centre for half of Prague and part of the Central Bohemia Region with a population of 1 150 000. Prague in particular has a high number of elderly citizens. Our experience is based on extensive clinical data obtained from the Register of Proximal Femoral Fractures established in 1997. During 14 years, 4280 patients, 3112 women and 1168 men, were admitted to our department for treatment of proximal femoral fractures. All patients were followed up until healing or development of complications. In the group under study, 82% were patients older than 70 years; 72% of those requiring surgery were in their seventies and eighties. Men were significantly younger than women (pfractures were 2.3-times more frequent in women than in men. In the category under 60 years, men significantly outnumbered women (pfractures were, on the average, eight years older than the patients with intertrochanteric fractures, which is a significant difference (pTrochanteric fractures accounted for 54.7% and femoral neck fractures for 45.3% of all fractures. The inter-annual increase was 5.9%, with more trochanteric than femoral neck fractures. There was a non-significant decrease in intertrochanteric (AO 31-A3) fractures. On the other hand, the number of pertrochanteric (AO 31-A1+2) fractures increased significantly (pfractures were treated with a proximal femoral nail; a short nail was used in 1260 and a long nail in 134 of them. A dynamic hip screw (DHS) was employed to treat 947 fractures. Distinguishing between pertrochanteric (21-A1

  9. Phase Identification of Nanometric Precipitates in Al-Si-Cu Aluminum Alloy by Hr-Stem Investigations

    Directory of Open Access Journals (Sweden)

    Pawlyta M.

    2016-09-01

    Full Text Available Aluminium recycling is cost-effective and beneficial for the environment. It is expected that this trend will continue in the future, and even will steadily increase. The consequence of the use of recycled materials is variable and difficult to predict chemical composition. This causes a significant reduction in the production process, since the properties of produced alloy are determined by the microstructure and the presence of precipitates of other phases. For this reason, the type and order of formation of precipitates were systematically investigated in recent decades. These studies involved, however, only the main systems (Al-Cu, Al-Mg-Si, Al-Cu-Mg, Al-Mg-Si-Cu, while more complex systems were not analysed. Even trace amounts of additional elements can significantly affect the alloy microstructure and composition of precipitates formed. This fact is particularly important in the case of new technologies such as laser surface treatment. As a result of extremely high temperature and temperature changes after the laser remelting large amount of precipitates are observed. Precipitates are nanometric in size and have different morphology and chemical composition. A full understanding of the processes that occur during the laser remelting requires their precise but also time effectively phase identification, which due to the diversity and nanometric size, is a major research challenge. This work presents the methodology of identification of nanometer phase precipitates in the alloy AlSi9Cu, based on the simultaneous TEM imaging and chemical composition analysis using the dispersion spectroscopy using the characteristic X-ray. Verification is performed by comparing the simulation unit cell of the identified phase with the experimental high-resolution image.

  10. Iodixanol in femoral arteriography

    International Nuclear Information System (INIS)

    Thorstensen, Oe.; Albrechtsson, U.; Calissendorff, B.; Larusdottir, H.; Norgren, L.; Tengvar, M.; Bolstad, B.; Aspelin, P.

    1994-01-01

    Two contrast media, iodixanol (Visipaque, Nycomed) 270 mg I/ml and iohexol (Omnipaque, Nycomed) 300 mg I/ml, were compared in femoral arteriography, in 147 patients. Both contrast media were diagnostically effective for use in femoral arteriography, without any significant difference. Pain was reported in connection with injection of iohexol by 36% of the patients, after injection of iodixanol none reported pain. Seventy-two percent of the patients in the iodixanol group reported a sensation of warmth in connection with contrast injection versus 90% in the iohexol group. The average intensity of the warmth was greater with iohexol than with iodixanol. Fourteen percent of patients in the iodixanol group and 1% in the iohexol group reported one or more subjective adverse events. (orig.)

  11. Proximal femoral fractures

    DEFF Research Database (Denmark)

    Palm, Henrik; Teixidor, Jordi

    2015-01-01

    BACKGROUND: In hip fracture surgery, the exact choice of implant often remains somewhat unclear for the individual surgeon, but the growing literature consensus has enabled publication of evidence-based surgical treatment pathways. The aim of this article was to review author pathways and national...... guidelines for hip fracture surgery and discuss a method for future pathway/guideline implementation and evaluation. METHODS: By a PubMed search in March 2015 six studies of surgical treatment pathways covering all types of proximal femoral fractures with publication after 1995 were identified. Also we......-displaced femoral neck fractures and prosthesis for displaced among the elderly; and sliding hip screw for stabile- and intramedullary nails for unstable- and sub-trochanteric fractures) but they are based on a variety of criteria and definitions - and often leave wide space for the individual surgeons' subjective...

  12. Femoral Hernia At Mulago Hospital, Uganda

    African Journals Online (AJOL)

    user

    2004-12-02

    Dec 2, 2004 ... the peritoneal sac of the femoral hernia may expand into an acquired defect of fascia transversalis in the femoral sheath to eventually herniate outside the canal. Therefore, femoral hernias can be classified into 5 groups as follows: 1. Femoral canal hernia: This is the commonest variety of femoral hernia. It.

  13. Femoral Hernia At Mulago Hospital, Uganda

    African Journals Online (AJOL)

    user

    2004-12-02

    Dec 2, 2004 ... Therefore, femoral hernias can be classified into 5 groups as follows: 1. Femoral canal hernia: This is the commonest variety of femoral hernia. It enters the thigh via the most medial compartment of the femoral sheath, the femoral canal. 2. Prevascular hernia (Narath's hernia) - The hernial sac emerges from ...

  14. Effect of laser treatment on the attachment and viability of mesenchymal stem cell responses on shape memory NiTi alloy.

    Science.gov (United States)

    Chan, C W; Hussain, I; Waugh, D G; Lawrence, J; Man, H C

    2014-09-01

    The objectives of this study were to investigate the effect of laser-induced surface features on the morphology, attachment and viability of mesenchymal stem cells (MSCs) at different periods of time, and to evaluate the biocompatibility of different zones: laser-melted zone (MZ), heat-affected zone (HAZ) and base metal (BM) in laser-treated NiTi alloy. The surface morphology and composition were studied by scanning electron microscope (SEM) and X-ray photoemission spectroscopy (XPS), respectively. The cell morphology was examined by SEM while the cell counting and viability measurements were done by hemocytometer and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) colorimetric assay. The results indicated that the laser-induced surface features, such as surface roughening, presence of anisotropic dendritic pattern and complete surface Ni oxidation were beneficial to improve the biocompatibility of NiTi as evidenced by the highest cell attachment (4 days of culture) and viability (7 days of culture) found in the MZ. The biocompatibility of the MZ was the best, followed by the BM with the HAZ being the worst. The defective and porous oxide layer as well as the coarse grained structure might attribute to the inferior cell attachment (4 days of culture) and viability (7 days of culture) on the HAZ compared with the BM which has similar surface morphology. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. Femoral Neck Fracture

    Directory of Open Access Journals (Sweden)

    Jonathan Lee

    2016-09-01

    Full Text Available History of present illness: A 74-year-old male presented to the emergency department with left hip pain after falling off his bicycle. Pain is 3/10 in severity and exacerbated by movement. Patient denied head trauma. Exam showed left hip tenderness, 3/5 left lower extremity strength secondary to pain, and 5/5 right lower extremity strength. Sensation and pulses were intact in bilateral lower extremities. Left hip X-ray and pelvic CT revealed comminuted, impacted transcervical and subcapital fracture of the left femoral neck. Significant findings: In the anteroposterior view bilateral hip x-ray, there is an evident loss of Shenton’s line on the left (red line when compared to the normal right (white line, indicative of a fracture in the left femoral neck. This correlates with findings seen on pelvic CT, which reveals both a subcapital fracture (blue arrow and transcervical fracture (yellow arrow. The neck of the femur is displaced superiorly relative to the head of the femur while the head of the femur remains in its anatomical position within the acetabulum. Discussion: Femoral neck fractures are one of the most common types of hip fractures, accounting for 49.4% of all hip fractures.1 Diagnosing a femoral neck fracture can be made with plain x-ray, CT, or MRI. Plain film radiographs have been found to be at least 90% sensitive for hip fractures CT’s have been found to be 87%-100% sensitive and 100% specific for occult hip fractures in which plain radiographs were read as negative, but the patient still complained of hip pain Although MRI is currently the gold standard for detecting occult hip fractures (sensitivity and specificity = 100%, given MRI’s limited accessibility in the ED as well as the high sensitivity and specificity of CT scans for occult hip fractures, it is generally recommended to obtain CT scans for patients with suspected occult hip fractures as a first-line investigation

  16. Femoral pseudoaneurysms in drug addicts

    DEFF Research Database (Denmark)

    Levi-Mazloum, Niels Donald; Rørdam, Peter; Jensen, L P

    1997-01-01

    OBJECTIVE: To evaluate the outcome of treatment of femoral pseudoaneurysms in drug addicts. METHODS: The records of eight patients undergoing vascular surgery for femoral pseudoaneurysms from substance abuse identified from a vascular database were reviewed. RESULTS: Were good in four out of five...

  17. Femoral neck pseudoarthrosis in a polio patient treated with closed reduction and cell therapy

    Directory of Open Access Journals (Sweden)

    M.A. Codesido

    2017-04-01

    Full Text Available Poliomyelitis disease affects the anterior horns cells of the spinal cord and certain motor nuclei of the brain stem. Paralysis type is flaccid and asymmetrical and result in muscular imbalance.Due to this, in case of having a hip muscles involvement, degenerative or posttraumatic, total hip arthroplasty is normally contraindicated because of the excessive risk of hip dislocation. In cases of subcapital femoral neck fractures the femoral head vascularization is a main concern, and in cases of neglected fracture with pseudoarthrosis the vascular status to the head must be investigated prior to further decisions.We report the case of a femoral neck fracture non-union after a missed femoral neck fracture in a polio affected leg treated with cannulated screws and percutaneous autologous injection of processed total nuclear cells (TNC mixed with putty demineralized bone matrix. Keywords: Pseudoarthrosis, Poliomyelitis, Cell therapy, Femoral neck

  18. Focal femoral condyle resurfacing.

    LENUS (Irish Health Repository)

    Brennan, S A

    2013-03-01

    Focal femoral inlay resurfacing has been developed for the treatment of full-thickness chondral defects of the knee. This technique involves implanting a defect-sized metallic or ceramic cap that is anchored to the subchondral bone through a screw or pin. The use of these experimental caps has been advocated in middle-aged patients who have failed non-operative methods or biological repair techniques and are deemed unsuitable for conventional arthroplasty because of their age. This paper outlines the implant design, surgical technique and biomechanical principles underlying their use. Outcomes following implantation in both animal and human studies are also reviewed. Cite this article: Bone Joint J 2013;95-B:301-4.

  19. An integrated CAD/CAM/robotic milling method for custom cementless femoral prostheses.

    Science.gov (United States)

    Wen-ming, Xi; Ai-min, Wang; Qi, Wu; Chang-hua, Liu; Jian-fei, Zhu; Fang-fang, Xia

    2015-09-01

    Aseptic loosening is the primary cause of cementless femoral prosthesis failure and is related to the primary stability of the cementless femoral prosthesis in the femoral cavity. The primary stability affects both the osseointegration and the long-term stability of cementless femoral prostheses. A custom cementless femoral prosthesis can improve the fit and fill of the prosthesis in the femoral cavity and decrease the micromotion of the proximal prosthesis such that the primary stability of the custom prosthesis can be improved, and osseointegration of the proximal prosthesis is achieved. These results will help to achieve long-term stability in total hip arthroplasty (THA). In this paper, we introduce an integrated CAD/CAM/robotic method of milling custom cementless femoral prostheses. The 3D reconstruction model uses femoral CT images and 3D design software to design a CAD model of the custom prosthesis. After the transformation matrices between two units of the robotic system are calibrated, consistency between the CAM software and the robotic system can be achieved, and errors in the robotic milling can be limited. According to the CAD model of the custom prosthesis, the positions of the robotic tool points are produced by the CAM software of the CNC machine. The normal vector of the three adjacent robotic tool point positions determines the pose of the robotic tool point. In conclusion, the fit rate of custom pig femur stems in the femoral cavities was 90.84%. After custom femoral prostheses were inserted into the femoral cavities, the maximum gaps between the prostheses and the cavities measured less than 1 mm at the diaphysis and 1.3 mm at the metaphysis. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

  20. Radiographic femoral varus measurement is affected unpredictably by femoral rotation

    DEFF Research Database (Denmark)

    Miles, James Edward

    Radiographic measurements of femoral varus are used to determine if intervention to correct femoral deformity is required, and to calculate the required correction. The varus angle is defined as the angle between the proximal femoral long axis (PFLA) and an axis tangential to the distal femoral...... condyles. Ideal positioning of the femur in terms of zero elevation relative to the radiographic plane or zero rotation along the long axis of the femur may be difficult to obtain in practice. The clinician may thus be tempted to determine varus values from less than ideal radiographs. Fourteen isolated...... and externally by 5° and 10° using plastic wedges. Accuracy of rotation was within +1°. Digital radiographs were obtained at each position. Varus angles were measured using ImageJ, employing two definitions of PFLA. Mean varus angles increased with 10° of either internal or external rotation with both PFLA...

  1. Radiographic femoral varus measurement is affected unpredictably by femoral rotation

    DEFF Research Database (Denmark)

    Miles, James Edward

    and externally by 5° and 10° using plastic wedges. Accuracy of rotation was within +1°. Digital radiographs were obtained at each position. Varus angles were measured using ImageJ, employing two definitions of PFLA. Mean varus angles increased with 10° of either internal or external rotation with both PFLA...... rotation angles. The effect of rotation on varus angle measurements in these femoral specimens contradicts a previous report using CT. The most probable explanation is the difference in femoral positioning: the CT study used a slightly elevated position compared to that in this study, resulting in better...... visualisation of the condylar articular surfaces. Zero elevation frequently results in the articular surfaces being obscured by the trochlear ridges, even when positioned perfectly. Varus measurements vary unpredictably as a result of femoral rotation and this effect is likely further influenced by femoral...

  2. Treatment of femoral shaft fractures with a titanium intramedullary nail.

    Science.gov (United States)

    Im, Gun-Il; Shin, Seong-Ryong

    2002-08-01

    Ninety-nine femoral shaft fractures were treated with locked intramedullary nails made from titanium alloy. One of the distal interlocking screws failed in six fractures (6%) and both screws failed in two fractures (2%). Delayed union was associated with all of the eight fractures that had locking screw failure. Young, heavier patients who had nails of small diameter had an increased risk of screw failure. Additional surgery was needed when both screws failed. The authors still use this nail, but currently prefer to ream the medullary canal more so that larger nails can be inserted. Decisions concerning weightbearing are made on an individual basis for each patient, and currently full weightbearing is delayed for young, active, and heavy patients. Two distal interlocking screws should be inserted for treatment of femoral shaft fracture when a Ti locked intramedullary nail is used.

  3. Femoral head necrosis; Hueftkopfnekrose

    Energy Technology Data Exchange (ETDEWEB)

    Kramer, J.; Scheurecker, G.; Scheurecker, A.; Stoeger, A.; Huber, A. [Roentgeninstitut am Schillerpark, Linz (Austria); Hofmann, S. [Orthopaedisches Landeskrankenhaus Stolzalpe (Austria)

    2009-05-15

    The epidemiology and pathohistogenesis of avascular femoral head necrosis has still not been clarified in detail. Because the course of the disease runs in stages and over a long time period nearly always culminates in the necessity for a total hip prosthesis, an exact radiological evaluation is of paramount importance for the treatment. There is a need for a common staging system to enable comparison of different therapy concepts and especially their long-term results. In this article the ARCO staging system is described in full detail, which includes all radiological modalities as well as histopathological alterations. (orig.) [German] Bei der avaskulaeren Femurkopfnekrose handelt es sich um ein Krankheitsbild, dessen Ursachen noch immer nicht vollstaendig geklaert sind. Da die Erkrankung stadienhaft verlaeuft und ueber einen laengeren Zeitraum betrachtet nahezu immer in einem prothetischen Hueftersatz muendet, ist eine genaue radiologische Abklaerung fuer die Behandlung von enormer Bedeutung. Um Langzeiterfolge verschiedener Therapiekonzepte vergleichen zu koennen, sind eine exakte Beschreibung und darauf basierend die Verwendung einer einheitlichen Stadieneinteilung wuenschenswert. In der vorliegenden Arbeit wird die ARCO-Stadieneinteilung im Detail beschrieben, die alle bildgebenden Methoden beruecksichtigt und histopathologische Veraenderungen mit einbezieht. (orig.)

  4. Cortical Strut Allograft Support of Modular Femoral Junctions During Revision Total Hip Arthroplasty.

    Science.gov (United States)

    Lim, Chin Tat; Amanatullah, Derek F; Huddleston, James I; Hwang, Katherine L; Maloney, William J; Goodman, Stuart B

    2017-05-01

    There is risk of junction failure when using modular femoral stems for revision total hip arthroplasty (THA), especially with loss of bone stock in the proximal femur. Using a cortical strut allograft may provide additional support of a modular femoral construct in revision THA. We reviewed prospectively gathered clinical and radiographic data for 28 revision THAs performed from 2004 to 2014 using cementless modular femoral components with cortical strut allograft applied to supplement proximal femoral bone loss: 5 (18%) were fluted taper designs and 23 (82%) were porous cylindrical designs All the patients had a Paprosky grade IIIA or greater femoral defect. The mean follow-up was 5.4 ± 3.9 years. The Harris Hip Scores improved from 26 ± 10 points preoperatively to 71 ± 10 points at final follow-up (P hips) of all revision or conversion THAs were in place at final follow-up. Three (11%) patients underwent reoperations, 2 for infection and 1 for periprosthetic fracture. There was no statistical significant change in femoral component alignment (P = .161) at final follow-up. Mean subsidence was 1.8 ± 1.3 mm at final follow-up. Femoral diameter increased from initial postoperative imaging to final follow-up imaging by a mean of 9.1 ± 5.1 mm (P hips (96%) achieved union between the cortical strut allograft and the host femur. The use of a modular femoral stem in a compromised femur with a supplementary cortical strut allgraft is safe and provides satisfactory clinical and radiological outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Properties of open-cell porous metals and alloys for orthopaedic applications.

    Science.gov (United States)

    Lewis, Gladius

    2013-10-01

    One shortcoming of metals and alloys used to fabricate various components of orthopaedic systems, such as the femoral stem of a total hip joint replacement and the tibial plate of a total knee joint replacement, is well-recognized. This is that the material modulus of elasticity (E') is substantially larger than that of the contiguous cancellous bone, a consequence of which is stress shielding which, in turn, has been postulated to be implicated in a cascade of events that culminates in the principal life-limiting phenomenon of these systems, namely, aseptic loosening. Thus, over the years, a host of research programs have focused on the synthesis of metallic biomaterials whose E' can be tailored to match that of cancellous bone. The present work is a review of the extant large volume of literature on these materials, which are called open-cell porous metals/alloys (or, sometimes, metal foams or cellular materials). As such, its range is wide, covering myriad aspects such as production methods, characterization studies, in vitro evaluations, and in vivo performance. The review also includes discussion of seven areas for future research, such as parametric studies of the influence of an assortment of process variables (such as the space holder material and the laser power in the space holder method and the laser-engineered net-shaping process, respectively) on various properties (notably, permeability, fatigue strength, and corrosion resistance) of a given porous metal/alloy, innovative methods of determining fatigue strength, and modeling of corrosion behavior.

  6. Trombo flutuante em veia femoral

    Directory of Open Access Journals (Sweden)

    Matheus Bertanha

    2017-12-01

    Full Text Available Resumo O trombo venoso flutuante em veia femoral é um tipo de trombo com alto potencial de embolização pulmonar. Entretanto, ainda é controversa a conduta mais apropriada nesses casos. Tratamentos clínicos com anticoagulantes ou fibrinolíticos e trombectomias abertas ou por meio de dispositivos endovasculares vêm sendo empregados ainda sem um critério de indicação bem definido. Apresentamos três casos clínicos de trombos flutuantes em veia femoral, de etiologias distintas, cujos tratamentos e respectivas evoluções serão discutidos.

  7. Femoral varus: what's the angle

    DEFF Research Database (Denmark)

    Miles, James Edward; Svalastoga, Eiliv Lars; Eriksen, Thomas

    Agreement and reliability of femoral varus measurements: a comparison of four techniques Three different techniques have been described for measuring femoral varus radiographically in the dog, but how the measurements from these techniques compare is unknown. Further, measurement reliability has...... only been assessed for one technique. Seven grossly normal right femora were radiographed with the diaphysis positioned horizontally and inclined at both 12.5° and 25° to the horizontal. Radiographs were blinded, randomised and read twice by one observer using ImageJ. Using coordinate data, varus...... on varus measurement was assessed using a mixed model ANOVA. Two of the reported techniques varied significantly (P

  8. Successful transplant of mesenchymal stem cells in induced osteonecrosis of the ovine femoral head: preliminary results Sucesso no transplante de células tronco mesenquimais em ovinos com osteonecrose induzida da cabeça do fêmur: resultados preliminares

    Directory of Open Access Journals (Sweden)

    Matheus Levi Tajra Feitosa

    2010-10-01

    Full Text Available PURPOSE: Evaluate the bone tissue recovery following transplantation of ovine mesenchymal stem cells (MSC from bone marrow and human immature dental-pulp stem cells (hIDPSC in ovine model of induced osteonecrosis of femoral head (ONFH. METHODS: Eight sheep were divided in three experimental groups. First group was composed by four animals with ONFH induced by ethanol through central decompression (CD, for control group without any treatment. The second and third group were compose by two animals, six weeks after ONFH induction received transplantation of heterologous ovine MSC (CD + oMSC, and hIDPSC (CD + hIDPSC, respectively. In both experiments the cells were transplanted without application of any type of immunosupression protocol. RESULTS: Our data indicate that both cell types used in experiments were able to proliferate within injured site providing bone tissue recovery. The histological results obtained from CD+hIDPSC suggested that the bone regeneration in such animals was better than that observed in CD animals. CONCLUSION: Mesenchymal stem cell transplant in induced ovine osteonecrosis of femoral head by central decompression technique is safe, and apparently favors bone regeneration of damaged tissues.OBJETIVO: Verificar os efeitos das células-tronco mesenquimais da medula óssea de ovinos e da polpa dentária imatura humana em ovinos com osteonecrose induzida, da cabeça do fêmur. MÉTODOS: Oito ovelhas foram distribuídas em três grupos experimentais. O primeiro grupo foi composto por quatro animais com osteonecrose da cabeça do fêmur induzida por etanol através da descompressão central, que não receberam nenhum tratamento. O segundo e o terceiro grupo, cada um composto por dois animais, receberam transplante heterólogo de células tronco mesenquimais de ovinos e polpa dentária imatura humana seis semanas após a indução da osteonecrose da cabeça do fêmur, respectivamente. Em ambos os grupos experimentais as c

  9. Femoral Reconstruction Using External Fixation

    Directory of Open Access Journals (Sweden)

    Yevgeniy Palatnik

    2011-01-01

    Full Text Available Background. The use of an external fixator for the purpose of distraction osteogenesis has been applied to a wide range of orthopedic problems caused by such diverse etiologies as congenital disease, metabolic conditions, infections, traumatic injuries, and congenital short stature. The purpose of this study was to analyze our experience of utilizing this method in patients undergoing a variety of orthopedic procedures of the femur. Methods. We retrospectively reviewed our experience of using external fixation for femoral reconstruction. Three subgroups were defined based on the primary reconstruction goal lengthening, deformity correction, and repair of nonunion/bone defect. Factors such as leg length discrepancy (LLD, limb alignment, and external fixation time and complications were evaluated for the entire group and the 3 subgroups. Results. There was substantial improvement in the overall LLD, femoral length discrepancy, and limb alignment as measured by mechanical axis deviation (MAD and lateral distal femoral angle (LDFA for the entire group as well as the subgroups. Conclusions. The Ilizarov external fixator allows for decreased surgical exposure and preservation of blood supply to bone, avoidance of bone grafting and internal fixation, and simultaneous lengthening and deformity correction, making it a very useful technique for femoral reconstruction.

  10. Is there a role for femoral offset restoration during total hip arthroplasty? A systematic review.

    Science.gov (United States)

    De Fine, M; Romagnoli, M; Toscano, A; Bondi, A; Nanni, M; Zaffagnini, S

    2017-05-01

    Benefits of femoral offset restoration during total hip arthroplasty should be the reduction of bearing surfaces wear, implant loosening and dislocation rates. Modular neck stems ensure offset customization but fretting corrosion and catastrophic failures are well-documented complications. Since clinical evidences are needed to substantiate the effectiveness of femoral offset restoration and promote modular neck choice, we systematically reviewed the literature to ascertain whether femoral offset itself has a proven clinical influence: (1) on bearing surfaces wear, (2) implant loosening, (3) and dislocation rates. A systematic literature screening was conducted to find papers dealing with the influence of femoral offset on wear, dislocation and loosening, including articles with conventional radiographic femoral offset assessment and with comparative design. Observational studies, case reports, instructional course lectures, cadaveric and animal studies as well as biomechanical studies, letters to the editor, surgical techniques or technical notes were all excluded. No limits about publication date were supplied but only papers in English were taken into account. Data were extracted into an anonymous spreadsheet. Offset values, dislocation rates, wear rates, follow-up and surgical approaches were all detailed. Ten manuscripts were finally selected. A statistically significant correlation between femoral offset restoration and the reduction of conventional ultrahigh-molecular-weight polyethylene wear was found in two out of three papers investigating this issue, but no correlations were found between femoral offset and dislocation rates or implant loosening. Femoral offset modification influences ultrahigh-molecular-weight polyethylene liners wear, but no correlation was found with dislocation rates or implant loosening. Advantages on wear can be counterbalanced by the use of hard bearing surfaces or highly cross-linked polyethylene liners, besides the availability

  11. Immediate results of treatment periprosthetic femoral fractures after hip replacement

    Directory of Open Access Journals (Sweden)

    V. V. Khominets

    2015-01-01

    Full Text Available Periprosthetic fractures are one of the most serious complications after hip replacement. Nineteen periprosthetic femoral fractures operated on during the period 2011-2015 were followed-up retrospectively. Periprosthetic fractures were classified according to the Vancouver classification. The functional results were evaluated using Harrison scale. Bone healing and implant stability were evaluated clinically, on plain radiographs and computed tomography. The periprosthetic fractures in all patients occurred in the postoperative period. Time from operation until fracture varied from 2 weeks to 11 years. A wedge-shaped cemented or cementless stems were implanted during the first surgery: Versys ET, Spotorno, CPT (Zimmer, США: cementless fixation was performed in 16 (84,2% patients, hybrid -in 2 (10,5% and cemented fixation - in 1 (5,3% patient. The fractures of greater trochanter were diagnosed in all patients with type A periprosthetic fractures. In type B1 periprosthetic fracture (8 patients open reduction, cerclage wiring and internal plate osteosynthesis were applied. Loosening stems in 3 patients with type B2 fractures were replaced with Wagner cementless revision component (Wagner SL Revision Stem. Angle-stable plate osteosynthesis and cerclage wiring were also performed. Closed reduction and internal minimal invasive plate osteosynthesis were performed in patients with type C periprosthetic fractures. Bone consolidation was achieved in 18 (94,7% patients, the average term was 14,3±5,2 weeks. The average Harris hip score in all patients 3 months after treatment was 64,9±16,7 points, and in 12 patients (63,2% after a year - 86,5±15,9. Femoral periprosthetic fractures require a specialized approach to choosing the treatment tactic depending on the fracture type and quality of bone tissue. It is necessary to evaluate the femoral component stability, especially in differential diagnosis of type B1 and B2 periprosthetic fractures. Computed

  12. Alloy materials

    Energy Technology Data Exchange (ETDEWEB)

    Hans Thieme, Cornelis Leo (Westborough, MA); Thompson, Elliott D. (Coventry, RI); Fritzemeier, Leslie G. (Acton, MA); Cameron, Robert D. (Franklin, MA); Siegal, Edward J. (Malden, MA)

    2002-01-01

    An alloy that contains at least two metals and can be used as a substrate for a superconductor is disclosed. The alloy can contain an oxide former. The alloy can have a biaxial or cube texture. The substrate can be used in a multilayer superconductor, which can further include one or more buffer layers disposed between the substrate and the superconductor material. The alloys can be made a by process that involves first rolling the alloy then annealing the alloy. A relatively large volume percentage of the alloy can be formed of grains having a biaxial or cube texture.

  13. Ideal femoral head size in total hip arthroplasty balances stability and volumetric wear.

    Science.gov (United States)

    Cross, Michael B; Nam, Denis; Mayman, David J

    2012-10-01

    Over the last several years, a trend towards increasing femoral head size in total hip arthroplasty to improve stability and impingement free range of motion has been observed. The specific questions we sought to answer in our review were: (1) What are the potential advantages and disadvantages of metal-on-metal, ceramic-on-ceramic, and metal-on-polyethylene bearings? (2) What is effect that femoral head size has on joint kinematics? (3) What is the effect that large femoral heads have on bearing surface wear? A PubMed search and a review of 2012 Orthopaedic Research Society abstracts was performed and articles were chosen that directly answered components of the specific aims and that reported outcomes with contemporary implant designs or materials. A review of the literature suggests that increasing femoral head size decreases the risk of postoperative dislocation and improves impingement free range of motion; however, volumetric wear increases with large femoral heads on polyethylene and increases corrosion of the stem in large metal-on-metal modular total hip arthroplasty (THA); however, the risk of potentially developing osteolysis or adverse reactions to metal debris respectively is still unknown. Further, the effect of large femoral heads with ceramic-on-ceramic THA is unclear, due to limited availability and published data. Surgeons must balance the benefits of larger head size with the increased risk of volumetric wear when determining the appropriate head size for a given patient.

  14. Rotational stability of femoral osteosynthesis in femoral fractures - navigated measurements.

    Science.gov (United States)

    Citak, Mustafa; Kendoff, Daniel; Gardner, Michael J; Oszwald, Markus; O'Loughlin, Padhraig F; Olivier, Lucien C; Krettek, Christian; Hüfner, Tobias; Citak, Musa

    2009-01-01

    Rotational malalignment after intramedullary nailing of femoral fractures is common, and symptoms occur when malrotation reaches 15 degrees . Intraoperative measurement of rotation remains difficult, and multiple techniques have been described to address this. Regardless of the method used, rotational toggling may occur between the interlocking screws and the screw holes. We hypothesized that a clinically significant amount of rotation may occur with standard statically locked intramedullary nails. Mid-shaft diaphyseal fractures were created in 24 cadaveric femurs. Specimens were divided into 4 groups, and were stabilized with a statically locked intramedullary nail, a dynamically locked intramedullary nail, a compression plate, and a locking plate. Six additional femurs were kept intact as a control group. Specimens were mounted in a custom holding jig, which stabilized the constructs proximally and allowed free rotation distally. A computer navigation system was applied, and the femoral anteversion was measured. 4 N-m of internal and external torque was applied, and the change in version was measured. The statically locked nails rotated 14.2 degrees , and the dynamically locked group rotated 15.7 degrees . Both intramedullary nail groups showed significantly greater rotation than the plated groups. The compression plate specimens rotated 6.5 degrees on average, and the locked plate group rotated 3.8 degrees . Intramedullary femoral nailing with static or dynamic interlocking allows 15 degrees of rotation of the femur around the nail under physiologic load. This may exacerbate intraoperative errors in determining and setting rotation. Angular stable plates or nails may minimize this problem.

  15. In vitro and in vivo studies on biodegradable magnesium alloy

    Directory of Open Access Journals (Sweden)

    Lida Hou

    2014-10-01

    Full Text Available The microstructure, mechanical property, electrochemical behavior and biocompatibility of magnesium alloy (BioDe MSM™ were studied in the present work. The experimental results demonstrated that grain refining induced by extrusion improves the alloy strength significantly from 162 MPa for the as-cast alloy to 241 MPa for the as-extruded one. The anticorrosion properties of the as-extruded alloy also increased. Furthermore, the hemolysis ratio was decreased from 4.7% for the as-cast alloy to 2.9% for the as-extruded one, both below 5%. BioDe MSM™ alloy shows good biocompatibility after being implanted into the dorsal muscle and the femoral shaft of the New Zealand rabbit, respectively, and there are no abnormalities after short-term implantation. In vivo observation indicated that the corrosion rate of this alloy varies with different implantation positions, with higher degradation rate in the femur than in the muscle.

  16. Effects of teriparatide on cementless bipolar hemiarthroplasty in patients with osteoporotic femoral neck fractures.

    Science.gov (United States)

    Huang, Tsan-Wen; Huang, Kuo-Chin; Lin, Shih-Jie; Chuang, Po-Yao; Shih, Hsin-Nung; Lee, Mel S; Hsu, Robert Wen-Wei; Shen, Wun-Jer

    2016-07-19

    For osteoporotic femoral neck fractures, suitable bone-implant stability is critical for pain relief, early return to daily activities and reduction of complications. Teriparatide (parathyroid hormone [PTH1-34]) can improve bone-implant stability in some basic studies. However it's use in osteoporotic femoral neck fractures treated by cementless hemiarthroplasties for the beneficial effects on bone-implant stability is sparse in the literature. The aim of this study was to determine if post-operative teriparatide administration can reduce femoral stem migration and improve early functional recovery and health-related quality of life (HRQoL). Between 2010 and 2014, patients with osteoporotic femoral neck fracture who underwent cementless bipolar hemiarthroplasty were included into this retrospective cohort study. Group A included patients treated with cementless bipolar hemiarthroplasty only; Group B patients had additional teriparatide. Demographic data, complications, radiographic and functional outcomes as well as health-related quality of life (HRQoL) were compared. There were 52 hips in group A (no teriparatide) and 40 hips in group B (patient who received teriparatide). The subsidence of the femoral stem tended to be significantly decreased in the teriparatide group at 6 and 12 weeks post-operatively (p = 0.003 and p = 0.008, respectively). The Harris Hip Score (HHS) increased significantly from pre-operation to 6 weeks post-operatively and thereafter up to one year in both groups. However, there were no significant differences in terms of subsequent fracture, mortality, HHS, and HRQoL between two groups during the entire study period. Teriparatide significantly reduces the subsidence of the cementless femoral stem in elderly patients in the early post-operative period, but this benefit does not reflect better functional outcomes and HRQoL. Further prospective randomized large-scale cohort study is warranted for evidence-based recommendations.

  17. Corrosion-wear of β-Ti alloy TMZF (Ti-12Mo-6Zr-2Fe) in simulated body fluid.

    Science.gov (United States)

    Yang, Xueyuan; Hutchinson, Christopher R

    2016-09-15

    Titanium alloys are popular metallic implant materials for use in total hip replacements. Although, α+β titanium alloys such as Ti-6Al-4V have been the most commonly used alloys, the high Young's modulus (∼110GPa) leads to an undesirable stress shielding effect. An alternative is to use β titanium alloys that exhibit a significantly lower Young's modulus (∼70GPa). Femoral stems made of a β titanium alloy known as TMZF (Ti-12Mo-6Zr-2Fe (wt.%)) have been used as part of modular hip replacements since the early 2000's but these were recalled in 2011 by the US Food & Drug Administration (FDA) due to unacceptable levels of 'wear debris'. The wear was caused by small relative movement of the stem and neck at the junction where they fit together in the modular hip replacement design. In this study, the corrosion and wear properties of the TMZF alloy were investigated in simulated body fluid to identify the reason for the wear debris generation. Ti64 was used as a control for comparison. It is shown that the interaction between the surfaces of Ti64 and TMZF with simulated body fluid is very similar, both from the point of view of the products formed and the kinetics of the reaction. The dry wear behaviour of TMZF is also close to that of Ti64 and consistent with expectations based on Archard's law for abrasive wear. However, wear of Ti64 and TMZF in simulated body fluid show contrasting behaviours. A type of time-dependent wear test is used to examine the synergy between corrosion and wear of TMZF and Ti64. It is shown that the wear of TMZF accelerated rapidly in SBF whereas that of Ti64 is reduced. The critical role of the strain hardening capacity of the two materials and its role in helping the surface resist abrasion by hydroxyapatite particles formed as a result of the reaction with the SBF is discussed and recommendations are made for modifications that could be made to the TMZF alloy to improve the corrosion-wear response. TMZF is a low modulus β-Ti alloy

  18. [Femoral nail osteosynthesis. Mechanical factors influencing the femoral antetorsion].

    Science.gov (United States)

    Citak, M; Kendoff, D; Citak, M; Gardner, M J; Oszwald, M; Krettek, C; Hüfner, T

    2008-04-01

    Antegrade or retrograde intramedullary nailing is a common and well established procedure for the treatment of femoral shaft fractures. One drawback of this technique is the high incidence of clinically relevant malalignment. Despite intra-operative and radiological improvements this problem has not yet been solved efficiently. The aim of this study was the evaluation of the mechanical influence on the antetorsion angle of intramedullary nails during and after interlocking in femoral shaft fractures. A mechanical instrument was developed allowing a defined torque to be administered to the distal femur fragment. As an optical measurement system for the assessment of the antetorsion angle, a navigation system was applied. Initially the influence of the interlocking mechanism of the nail on the antetorsion deviation was investigated. The distal interlocking hole was fixed free handed or by using a navigation system. The multidirectional movement of the distal femur fragment was documented. Furthermore, the influence of the rotational stability on the antetorsion angle after mechanical stress of 4 NM was investigated by measuring the remaining rotational capacity of the distal femur fragment. The average remaining rotational capacity of the distal femur fragment was 5.8 degrees after locking the nail by hand. The navigated locking resulted in a deviation of only 2 degrees , a significant difference compared to the free-hand procedure. The rotational stability under stress showed an average of 15.4 degrees deviation of the distal fragment. Even after complete interlocking of the intramedullary nail a 14.2 degrees rotational deviation was observed. It could be shown that mechanical stability as well as the interlocking itself of femoral nails have a relevant impact on the antetorsional angle of the femur. Potential sources of error of the femoral antetorsion angle can be caused by the interlocking process as well as by forced rotation of the femur after interlocking

  19. [Femoral shaft fractures in children].

    Science.gov (United States)

    Dietz, H-G; Schlickewei, W

    2011-05-01

    Femoral shaft fractures in children represent 1.5% of all fractures in childhood. Up to the age of 4 years, conservative treatment in a hip spica or short-term overhead traction is the therapy of choice. Femoral shaft fractures between the age of 5 and 16 years should be treated surgically. In over 90% of these cases elastic stable intramedullary nailing (ESIN) is the premier treatment option. Additional end caps can be used for unstable fractures and in length discrepancy. The external fixator and the locking plate are reserved for fractures with severe soft tissue injuries, vascular problems and some specific situations mentioned later on. By adhering to these standards good results can be achieved with a low complication rate.

  20. Management of femoral shaft fractures.

    Science.gov (United States)

    Neumann, M V; Südkamp, N P; Strohm, P C

    2015-01-01

    Femoral shaft fractures are severe injuries and are often associated with a high impact trauma mechanism, frequently seen in multiple injured patients. In contrast an indirect trauma mechanism can lead to a complex femoral shaft fracture especially in elderly patients with minor bone stock quality. Hence management of femoral shaft fractures is often directed by co-morbidities, additional injuries and the medical condition of the patient. Timing of fracture stabilization is depended on the overall medical condition of the patient, but definite fracture fixation can often be implemented in the early total care concept in management of multiple injured patients. The treatment of choice is intramedullary fracture fixation. Further development of existing intramedullary nailing systems now offer comfortable handling and different locking options. Ipsilateral fractures of the neck and shaft are therefore facilitated in management. Then again increasing numbers of obese patient are representing a new patient group with challenging co-factors in fracture management. Sufficient preoperative planning is helpful to choose the most adequate fixation device. Correct reduction of the fracture and perioperative control of the axis and rotation is mandatory to avoid postoperative malrotation, which still represents the most frequent complication.

  1. Tribological behavior of Ti-6Al-4V and Ti-6Al-7Nb Alloys for Total Hip Prosthesis

    Directory of Open Access Journals (Sweden)

    Mamoun Fellah

    2014-01-01

    Full Text Available The aim of the study is to evaluate the friction and wear behavior of high-strength alloys Ti-6Al-7Nb used in femoral stem and compare it with a Ti-6Al-4V alloy cylindrical bar corresponding to ISO 5832-3 part 3/01-07-199 standard. The tribological behavior was investigated by wear tests, using ball-on-disc and pin-on-disc tribometers. These tests consisted of measuring the weight loss and the friction coefficient of samples. The oscillating friction and wear tests have been carried out in ambient with oscillating tribotester in accordance with standards ISO 7148, ASTM G99-95a, and ASTM G133-95 under different conditions of normal loads (3, 6, and 10 N and sliding speeds (1, 15, and 25 mm·s−1. As counter pairs, a 100Cr6 steel ball with 10 mm in diameter was used. Results show that the two alloys had similar friction and wear performance, although their grain structures and compositions are different. Occurrence of large frictional occurred, is probably caused by formation and periodic, localized fracture of a transfer layer. Higher friction with larger fluctuation and higher wear rate was observed at the higher siding speed. The Ti-6Al-4V wear mechanism transforms from ploughing and peeling off wear at low sliding speed to plastic deformation and adhesive wear.

  2. Risk of femoral hernia after inguinal herniorrhaphy

    DEFF Research Database (Denmark)

    Mikkelsen, T; Bay-Nielsen, M; Kehlet, H

    2002-01-01

    BACKGROUND: Small case series have suggested an increased risk of femoral hernia after previous inguinal herniorrhaphy, but no large-scale data with complete follow-up are available. METHODS: Data were extracted from the Danish Hernia Database covering the interval from 1 January 1998 to 1 July...... 2001, and included 34 849 groin hernia repairs. RESULTS: Of 1297 femoral hernia repairs, 71 patients had previously had an operation for inguinal hernia within the observation period. These 71 femoral hernias represented 7.9 per cent of all reoperations for groin hernia recorded in the database....... The median time to reoperation for a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 7 months, compared with 10 months for inguinal recurrences. The risk of developing a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 15 times higher than the rate of femoral hernia...

  3. Superselective intra-arterial DSA in patients with femoral head necrosis and femoral neck fracture

    International Nuclear Information System (INIS)

    Langer, R.; Scholz, A.; Langer, M.; Astinet, F.; Ferstl, F.; Felix, R.; Schwetlick, G.

    1991-01-01

    The prospective study includes 25 patients without pathology of the femoral head for the evaluation of the normal femoral head perfusion. In addition 34 patients with femoral head necrosis underwent i.a. DSA preoperatively before pedicled pelvic bone grafting. 15 patients after pelvic bone graft operation and 7 patients with medial femoral head fracture were also examined via superselective DSA. In cases with femoral head necrosis a rarefaction or interruption of the rami nutricii proximales, or an occlusion of the medial circumflex femoral artery were observed. Patients with medial femoral neck fracture showed an interruption of the rami nutricii proximales of the femoral head. Postoperative DSA - after pedicled pelvic bone graft - revealed a regular arterial graft perfusion in 82%. (orig.) [de

  4. Evaluation of perfusion of the femoral head after femoral neck fracture using bone scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Yamaguchi, Satoshi; Ishido, Yasuhiro [Saiseikai Sendai Hospital, Kagoshima (Japan); Okano, Toshihiro [Ibusuki National Hospital, Kagoshima (Japan); Komiya, Setsuro [Kagoshima Univ. (Japan). Faculty of Medicine

    2002-09-01

    We treated 13 patients for femoral neck fracture. They consisted of 2 males and 11 females, and were classified according to Garden stage classification; Stage I, 3 cases; Stage II, 2 cases; Stage III, 2 cases; Stage IV, 4 cases. Two trochanteric fracture cases were used by control. We evaluated perfusion of the femoral head after femoral neck fracture using bone scintigraphy, which is considered useful for evaluation of perfusion of the femoral neck before operation. (author)

  5. Evaluation of perfusion of the femoral head after femoral neck fracture using bone scintigraphy

    International Nuclear Information System (INIS)

    Yamaguchi, Satoshi; Ishido, Yasuhiro; Okano, Toshihiro; Komiya, Setsuro

    2002-01-01

    We treated 13 patients for femoral neck fracture. They consisted of 2 males and 11 females, and were classified according to Garden stage classification; Stage I, 3 cases; Stage II, 2 cases; Stage III, 2 cases; Stage IV, 4 cases. Two trochanteric fracture cases were used by control. We evaluated perfusion of the femoral head after femoral neck fracture using bone scintigraphy, which is considered useful for evaluation of perfusion of the femoral neck before operation. (author)

  6. Comparing return to sport activities after short metaphyseal femoral arthroplasty with resurfacing and big femoral head arthroplasties.

    Science.gov (United States)

    Karampinas, Panagiotis K; Papadelis, Eustratios G; Vlamis, John A; Basiliadis, Hlias; Pneumaticos, Spiros G

    2017-07-01

    Young patients feel that maintaining sport activities after total hip arthroplasty constitutes an important part of their quality of life. The majority of hip surgeons allow patients to return to low-impact activities, but significant caution is advised to taking part in high-impact activities. The purpose of this study is to compare and evaluate the post-operative return to daily living habits and sport activities following short-metaphyseal hip and high functional total hip arthroplasties (resurfacing and big femoral head arthroplasties). In a study design, 48 patients (55 hips) were enrolled in three different comparative groups, one with the short-metaphyseal arthroplasties, a second with high functional resurfacing arthroplasties and a third of big femoral head arthroplasties. Each patient experienced a clinical examination and evaluated with Harris Hip Score, WOMAC, Sf-36, UCLA activity score, satisfaction VAS, anteroposterior and lateral X-rays of the hip and were followed in an outpatient setting for 2 years. Statistical analysis revealed no notable differences between the three groups regarding their demographic data however significant differences have been found between preoperative and postoperative clinical scores of each group. Also, we fail to reveal any significant differences when comparing data of all three groups at the final 2 years postoperative control regarding their clinical scores. The overall outcome of all three groups was similar, all the patients were satisfied and returned to previous level of sport activities. Short metaphyseal hip arthroplasties in young patients intending to return to previous and even high impact sport activities, similar to high functional resurfacing, big femoral head arthroplasties. Short stems with hard on hard bearing surfaces might become an alternative to standard stems and hip resurfacing.

  7. Total hip arthroplasty after failed osteosynthesis of proximal femoral fractures: Revision and mortality of 80 patients.

    Science.gov (United States)

    Müller, Franz; Galler, Michael; Zellner, Michael; Bäuml, Christian; Füchtmeier, Bernd

    2017-01-01

    Total hip arthroplasty (THA) after failed osteosynthesis for proximal femoral fractures is associated with higher revision rates, particularly for dislocation. The purpose of this study was to report our results with THA after failed osteosynthesis within a treatment period of 10 years. A retrospective cohort study including 80 consecutive patients was conducted. After a minimum follow-up of 1 year, we evaluated revision for any cause including dislocation, outcome, and mortality. We performed 48 THAs with standard components only and 32 THAs with revision implants. Routinely, a 36-mm femoral head was used, and trochanteric fixation was performed in one-third of the cases. Total revision rate for any cause was 21%, which included six infections, six periprosthetic fractures, and five hematomas. One hip dislocation was also treated. Treatment with uncemented revision stem revealed significantly higher number of revisions-compared to standard cemented or uncemented stem. The mortality rate after 1 year was 9%, and the mean Parker score at follow-up was 6.6 (range: 0-9). THA was associated with an increased surgical revision rate, but hip dislocation was documented only once. In most cases, a standard implant with a large 36-mm femoral head size was sufficient. Uncemented revision stem revealed significantly higher number of revisions-compared to standard cemented or uncemented stem. One-year mortality was lower than expected.

  8. Reduced sintering of mass-selected Au clusters on SiO2 by alloying with Ti: an aberration-corrected STEM and computational study

    DEFF Research Database (Denmark)

    Niu, Yubiao; Schlexer, Philomena; Sebök, Béla

    2018-01-01

    Au nanoparticles represent the most remarkable example of a size effect in heterogeneous catalysis. However, a major issue hindering the use of Au nanoparticles in technological applications is their rapid sintering. We explore the potential of stabilizing Au nanoclusters on SiO2 by alloying them...... in the Au/Ti clusters, but in line with the model computational investigation, Au atoms were still present on the surface. Thus size-selected, deposited nanoalloy Au/Ti clusters appear to be promising candidates for sustainable gold-based nanocatalysis....

  9. Stem Cells

    Science.gov (United States)

    Stem cells are cells with the potential to develop into many different types of cells in the body. They serve as a repair ... body. There are two main types of stem cells: embryonic stem cells and adult stem cells. Stem ...

  10. Osteonecrosis of Femoral Head Occurred after Stent Placement of Femoral Artery

    Directory of Open Access Journals (Sweden)

    Akiyoshi Shimatani

    2014-01-01

    Full Text Available We present a case of osteonecrosis of femoral head (ONFH that occurred after stent angiography of femoral artery for the treatment of arteriosclerosis obliterans (ASO of left inferior limb in a 76-year-old woman. No case of late collapse of femoral head as a complication of endovascular procedure such as stent placement has been previously documented. We considered that ONFH occurred after detaining stent at a junction of left deep femoral artery for the treatment of the ischemia of left lateral and medial femoral circumflex artery.

  11. Reduced femoral component subsidence with improved impaction grafting at revision hip arthroplasty.

    Science.gov (United States)

    Howie, D W; Callary, S A; McGee, M A; Russell, N C; Solomon, L B

    2010-12-01

    Despite stem subsidence being a major complication of femoral impaction bone grafting in cemented revision hip arthroplasty, few studies have distinguished subsidence at the prosthesis-cement interface from that at the cement-bone interface. It is unknown how technique developments intended to improve the procedure influence stability of the stem. We used a sensitive technique to measure subsidence of a cemented polished collarless double-taper stem at each interface after femoral impaction grafting and compared subsidence, radiographic loosening, complications, and reoperations over three series of hips defined by technique developments. Three series were defined: Series 1 (n = 23, irradiated allograft), Series 2 (n = 12, double-washed, size-profiled graft, nonirradiated bone, long stems as required), and Series 3 (n = 21, modular tamps). Stem subsidence was analyzed with Ein Bild Röntgen Analyse software. Radiographic loosening, complications, and reoperations were also determined. The median subsidence at 12 months for Series 1, 2, and 3 were 2.1, 0.5, and 0.7 mm at the prosthesis-cement interface and 1.3, 0.1, and 0.1 mm at the cement-bone interface. There were two postoperative Vancouver B periprosthetic fractures in Series 1, four hips were revised for loosening in Series 1, and there were no fractures or loosening in Series 2 and 3 at minimum 2 years' followup. There were no surviving hips radiographically classified as possibly or probably loose. Evolution in techniques of femoral impaction grafting in this study were associated with reduced subsidence of the stem at both the prosthesis-cement interface and cement-bone interface when compared to the original series. Concurrent with reduced stem subsidence was the absence of periprosthetic fracture, radiographic loosening, and complications requiring rerevision.

  12. Computer navigation experience in hip resurfacing improves femoral component alignment using a conventional jig.

    Science.gov (United States)

    Morison, Zachary; Mehra, Akshay; Olsen, Michael; Donnelly, Michael; Schemitsch, Emil

    2013-11-01

    The use of computer navigation has been shown to improve the accuracy of femoral component placement compared to conventional instrumentation in hip resurfacing. Whether exposure to computer navigation improves accuracy when the procedure is subsequently performed with conventional instrumentation without navigation has not been explored. We examined whether femoral component alignment utilizing a conventional jig improves following experience with the use of imageless computer navigation for hip resurfacing. Between December 2004 and December 2008, 213 consecutive hip resurfacings were performed by a single surgeon. The first 17 (Cohort 1) and the last 9 (Cohort 2) hip resurfacings were performed using a conventional guidewire alignment jig. In 187 cases, the femoral component was implanted using the imageless computer navigation. Cohorts 1 and 2 were compared for femoral component alignment accuracy. All components in Cohort 2 achieved the position determined by the preoperative plan. The mean deviation of the stem-shaft angle (SSA) from the preoperatively planned target position was 2.2° in Cohort 2 and 5.6° in Cohort 1 (P = 0.01). Four implants in Cohort 1 were positioned at least 10° varus compared to the target SSA position and another four were retroverted. Femoral component placement utilizing conventional instrumentation may be more accurate following experience using imageless computer navigation.

  13. Computer navigation experience in hip resurfacing improves femoral component alignment using a conventional jig

    Directory of Open Access Journals (Sweden)

    Zachary Morison

    2013-01-01

    Full Text Available Background:The use of computer navigation has been shown to improve the accuracy of femoral component placement compared to conventional instrumentation in hip resurfacing. Whether exposure to computer navigation improves accuracy when the procedure is subsequently performed with conventional instrumentation without navigation has not been explored. We examined whether femoral component alignment utilizing a conventional jig improves following experience with the use of imageless computer navigation for hip resurfacing. Materials and Methods:Between December 2004 and December 2008, 213 consecutive hip resurfacings were performed by a single surgeon. The first 17 (Cohort 1 and the last 9 (Cohort 2 hip resurfacings were performed using a conventional guidewire alignment jig. In 187 cases, the femoral component was implanted using the imageless computer navigation. Cohorts 1 and 2 were compared for femoral component alignment accuracy. Results:All components in Cohort 2 achieved the position determined by the preoperative plan. The mean deviation of the stem-shaft angle (SSA from the preoperatively planned target position was 2.2° in Cohort 2 and 5.6° in Cohort 1 ( P = 0.01. Four implants in Cohort 1 were positioned at least 10° varus compared to the target SSA position and another four were retroverted. Conclusions: Femoral component placement utilizing conventional instrumentation may be more accurate following experience using imageless computer navigation.

  14. Revision hip arthroplasty in patients with a previous total hip replacement for osteonecrosis of the femoral head.

    Science.gov (United States)

    Park, Youn-Soo; Moon, Young-Wan; Lee, Keun-Ho; Lim, Seung-Jae

    2014-12-01

    Patients with osteonecrosis of the femoral head are typically relatively young and active and often require high rates of revision after primary total hip arthroplasty. However, outcomes of revision hip arthroplasty in this patient population have rarely been reported in the literature. The authors conducted a retrospective review of 72 patients (75 hips) who underwent revision hip arthroplasty with a primary diagnosis of osteonecrosis of the femoral head. Mean age at index revision was 53.3 years (range, 34-76). Components of acetabular revision included a cementless porous-coated cup in 58 hips and an acetabular cage in 3 hips. Components of femoral revision included a fully grit-blasted tapered stem in 30 hips and a proximally porous-coated modular stem in 9 hips. Mean duration of follow-up was 7 years (range, 3-17). Mean Harris Hip Score improved from 49 points preoperatively to 90 points postoperatively. At final follow-up, 11 hips (14.7%) required reoperation because of aseptic loosening (6 hips), infection (2 hips), recurrent dislocation (1 hip), periprosthetic fracture (1 hip), and ceramic fracture (1 hip). Kaplan-Meier survivor-ship with an endpoint of re-revision for any reason was 81% and for mechanical failure was 87.5% for the cup and 100% for the stem at 10 years. Unlike the previous report, the authors' study showed a lower failure rate of the femoral stem after revision hip arthroplasty using modern cementless femoral components in patients with osteonecrosis of the femoral head. Aseptic cup loosening or osteolysis is the most common mechanism of failure at medium-term follow-up. Copyright 2014, SLACK Incorporated.

  15. Locking compression plate versus revision-prosthesis for Vancouver type B2 periprosthetic femoral fractures after total hip arthroplasty.

    Science.gov (United States)

    Joestl, Julian; Hofbauer, Marcus; Lang, Nikolaus; Tiefenboeck, Thomas; Hajdu, Stefan

    2016-04-01

    Revision arthroplasty is currently the recommended treatment for periprosthetic femoral fractures after primary total hip arthroplasty (THA) and stem loosening (Vancouver B2). However, open reduction and internal fixation (ORIF) utilizing locking compression plate (LCP) might be an effective treatment with a reduced surgical time and less complex procedure in a typically elderly patient collective with multiple comorbidities. The purpose of this study was to compare the functional and radiographic outcomes in two cohorts with Vancouver B2 periprosthetic femoral fractures after primary THA, treated either by ORIF with LCP fixation, or by revision arthroplasty utilizing a non-cemented long femoral stem. 36 patients with Vancouver B2 periprosthetic femoral fractures following THA, who had been treated between 2000 and 2014, were reviewed. Eight fractures were treated with LCP fixation, fourteen fractures with the first-generation revision prosthesis (Helios), and fourteen fractures with the second-generation revision prosthesis (Hyperion). The patients were assessed clinically with the Parker mobility score and radiographically. A total of ten males and 26 females formed the basis of this report with an average age of 81 years (range, 64 to 96 years). All fractures treated with LCP fixation alone healed uneventfully and there were no signs of secondary stem migration, malalignement or plate breakage. The average surgical time was shorter in the ORIF cohort; however, the results were not statistically significant. The postoperative Parker mobility score at latest follow-up showed no difference between the groups. According to the results of the current study, we conclude that the use of LCP fixation can be a sufficient option for the treatment of Vancouver B2 periprosthetic femoral fractures correspondingly with femoral stem loosening. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Good performance of a titanium femoral component in cementless hip arthroplasty in younger patients: 97 arthroplasties followed for 5-11 years

    DEFF Research Database (Denmark)

    Jacobsen, Steffen; Jensen, Frank Krieger; Poulsen, Klaus

    2003-01-01

    We performed 97 uncemented primary total hip arthroplasties in 80 patients having an average age of 50 years. The femoral implant was a titanium stem with a proximal circumferential plasma spray-coating. Three different acetabular components were used: a threaded and partly porous-coated design i...... titanium femoral component with a circumferential porous coating performed well in these patients, most of whom were young. As reported previously, aseptic loosening of threaded acetabular components was common....

  17. The mechanical effect of the existing cement mantle on the in-cement femoral revision.

    LENUS (Irish Health Repository)

    Keeling, Parnell

    2012-08-01

    Cement-in-cement revision hip arthroplasty is an increasingly popular technique to replace a loose femoral stem which retains much of the original cement mantle. However, some concern exists regarding the retention of the existing fatigued and aged cement in such cement-in-cement revisions. This study investigates whether leaving an existing fatigued and aged cement mantle degrades the mechanical performance of a cement-in-cement revision construct.

  18. Midterm outcomes of titanium modular femoral necks in total hip arthroplasty.

    Science.gov (United States)

    Collet, Thurial; Atanasiu, Jean-Pierre; de Cussac, Jean-Baptiste; Oufroukhi, Kamal; Bothorel, Hugo; Saffarini, Mo; Badatcheff, François

    2017-10-01

    Modular femoral necks present surgical and biomechanical advantages in total hip arthroplasty (THA), but their benefits remain controversial due to risks of corrosion and fracture at the additional junction. This study aimed to report 10-year survival and clinical outcomes of a titanium femoral stem with a titanium modular neck in consecutive series. The authors reviewed the records of 97 patients (99 THAs) using uncemented modular stem and ceramic-on-ceramic acetabular components. Patients were evaluated at minimum follow-up of 5 years using the Harris Hip Score (HHS) and Postel Merle-D'Aubigné score (PMA). Survival was calculated using the Kaplan-Meier (KM) method with any reoperation or revision as endpoint. From the original cohort, 14 patients died, 6 were lost to follow-up, and 5 had revision operations with exchange of the femoral stem. The KM survival at 10 years was 94.2% (CI, 86.5-97.5). Clinical assessment was performed on 67 of the 72 patients (69 of the 74 hips) presently living with their original THA components. At mean follow-up of 9.4±1.0 years (median, 10; range, 5-11), the HHS was 93.6±8.2 and the PMA score 17.0±1.6. The X-rays revealed no signs of adverse reactions or bone loss. The uncemented titanium hip stem with modular titanium neck provided a satisfactory 10-year survival and clinical outcomes. Neck modularity enabled restoration of patient-specific femoral offset and limb length thanks to five possible neck configurations, though greater follow up is required to confirm the long-term benefits and safety of this design concept.

  19. The thrust plate prosthesis in patients with aseptic osteonecrosis of the femoral head.

    Science.gov (United States)

    Fink, Bernd; Schneider, Thomas; Conrad, Silke; Jaeger, Marcus; Protzen, Michael; Rüther, Wolfgang

    2002-12-01

    extension of the necrotic area into the femoral neck are contraindications for TPP. Excluding these patients, the TPP shows comparable mid-term results to cementless stemmed prostheses and supplies advantages especially for younger patients, because of its metaphyseal, bone-preserving fixation. However, evaluation of the clinical impact of the TPP in comparison with other cementless femoral stem systems requires long-term examinations in the future.

  20. Femoral neck fracture following hardware removal.

    Science.gov (United States)

    Shaer, James A; Hileman, Barbara M; Newcomer, Jill E; Hanes, Marina C

    2012-01-16

    It is uncommon for femoral neck fractures to occur after proximal femoral hardware removal because age, osteoporosis, and technical error are often noted as the causes for this type of fracture. However, excessive alcohol consumption and failure to comply with protected weight bearing for 6 weeks increases the risk of femoral neck fractures.This article describes a case of a 57-year-old man with a high-energy ipsilateral inter-trochanteric hip fracture, comminuted distal third femoral shaft fracture, and displaced lateral tibial plateau fracture. Cephalomedullary fixation was used to fix the ipsilateral femur fractures after medical stabilization and evaluation of the patient. The patient healed clinically and radiographically at 6 months. Despite conservative treatment for painful proximal hardware, elective hip screw removal was performed 22.5 months after injury. Seven weeks later, he sustained a nontraumatic femoral neck fracture.In this case, it is unlikely that the femoral neck fracture occurred as a result of hardware removal. We assumed that, in addition to the patient's alcohol abuse and tobacco use, stress fractures may have attributed to the femoral neck fracture. We recommend using a shorter hip screw to minimize hardware prominence or possibly off-label use of an injectable bone filler, such as calcium phosphate cement. Copyright 2012, SLACK Incorporated.

  1. Subchondral insufficiency fractures of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Davies, M.; Cassar-Pullicino, V.N. [Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, SY10 7AG, Shropshire (United Kingdom); Darby, A.J. [Department of Pathology, Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, SY10 7AG, Shropshire (United Kingdom)

    2004-02-01

    The aim of this study was to increase awareness of, and to show the variable clinical and radiological features of, subchondral insufficiency fractures of the femoral head. The clinical and radiological findings in 7 patients with subchondral insufficiency fractures of the femoral head were reviewed retrospectively. The diagnosis was confirmed histologically in 4 patients. Radiographs were performed in all patients, MRI in 5 and scintigraphy in 4 patients. Radiographs showed varying degrees of femoral head collapse in 4 patients. In the remaining 3 patients radiographs showed a normal femoral head, regional osteoporosis and focal sclerosis, respectively. Magnetic resonance imaging showed a low-signal band on T1- and T2-weighted images in the subchondral bone adjacent or parallel to the articular surface associated with bone marrow oedema. Scintigraphy showed increased uptake in the femoral head. Insufficiency fractures of the femoral head are easily overlooked or confused with avascular necrosis and, when there is significant joint destruction, osteoarthritis. Unsuspected insufficiency fracture of the femoral head can lead to significant and rapid loss of bone stock in osteoporotic patients waiting for arthroplasty for osteoarthritis. Increased awareness of this condition will hopefully lead to earlier diagnosis and a successful outcome of conservative treatment. (orig.)

  2. Femoral fit predicts radiologic changes, but not clinical results, in Mallory-head total hip arthroplasties.

    Science.gov (United States)

    Gosens, Taco; Sluimer, Judith C; Kester, Arnold D; van Langelaan, Evert J

    2005-03-01

    We prospectively studied the clinical and radiologic results of three groups of patients: 89 patients who had standard primary total hip replacements; 63 patients with hip dysplasia who had primary total hip replacements; and 48 patients who had revision total hip replacements. We studied the differences in clinical and radiologic behaviors of a titanium hydroxyapatite-coated stem with variations in the tightness of fit of the prosthesis in the femoral canal, operative group, stem size, grade of osteoporosis, and morphometric features of the femur. The clinical results in all three groups are slightly favorable for the standard primary group. Pain relief and stem survival in the three groups were similar to those reported in other studies regarding cementless prostheses. Nontight femoral fit significantly positively influenced the development of cancellous densification; however, the presence of osteoporosis also contributed to the formation of cancellous densification. Only tight femoral canal fit significantly positively influenced the development of cortical thickening independent of other parameters. There was no correlation between clinical parameters and the radiologic phenomena in either of the groups.

  3. Frequency of ipsilateral femoral neck fractures in patients with ...

    African Journals Online (AJOL)

    Background: Ipsilateral associated femoral neck and shaft fractures are reported to occur in 2.5-6% of all femoral shaft fractures. Objective: To establish the frequency of ipsilateral femoral neck fractures amongst all patients presenting with femoral shaft fractures in Mulago Hospital. Methodology: This was a descriptive ...

  4. Arteriosclerotic femoral artery aneurysms. A short review

    DEFF Research Database (Denmark)

    Levi, N; Schroeder, T V

    1997-01-01

    classified by Cutler and Darling in 1973 as type 1 and type 2 according to their relationship to the common femoral bifurcation. Case reports of isolated superficial and profunda femoral artery aneurysms have been published, but these are exceedingly rare although isolated aneurysms of the profunda femoris...... occurs in 0-26% of cases. Acute thrombosis occurs in around 15% of cases. Rupture is uncommon and varies between 10% and 14%. Aneurysmal dilatation of the profunda femoris artery is uncommon and occurs in only 1% to 2.6% of all femoral artery aneurysms. Individualized operative approaches are based...

  5. A biomechanical comparison of proximal femoral nails and locking proximal anatomic femoral plates in femoral fracture fixation

    Science.gov (United States)

    Ozkan, Korhan; Türkmen, İsmail; Sahin, Adem; Yildiz, Yavuz; Erturk, Selim; Soylemez, Mehmet Salih

    2015-01-01

    Background: The incidence of fractures in the trochanteric area has risen with the increasing numbers of elderly people with osteoporosis. Although dynamic hip screw fixation is the gold standard for the treatment of stable intertrochanteric femur fractures, treatment of unstable intertrochanteric femur fractures still remains controversial. Intramedullary devices such as Gamma nail or proximal femoral nail and proximal anatomic femur plates are in use for the treatment of intertrochanteric femur fractures. There are still many investigations to find the optimal implant to treat these fractures with minimum complications. For this reason, we aimed to perform a biomechanical comparison of the proximal femoral nail and the locking proximal anatomic femoral plate in the treatment of unstable intertrochanteric fractures. Materials and Methods: Twenty synthetic, third generation human femur models, obtained for this purpose, were divided into two groups of 10 bones each. Femurs were provided as a standard representation of AO/Orthopedic Trauma Associationtype 31-A2 unstable fractures. Two types of implantations were inserted: the proximal femoral intramedullary nail in the first group and the locking anatomic femoral plate in the second group. Axial load was applied to the fracture models through the femoral head using a material testing machine, and the biomechanical properties of the implant types were compared. Result: Nail and plate models were locked distally at the same level. Axial steady load with a 5 mm/m velocity was applied through the mechanical axis of femur bone models. Axial loading in the proximal femoral intramedullary nail group was 1.78-fold greater compared to the plate group. All bones that had the plate applied were fractured in the portion containing the distal locking screw. Conclusion: The proximal femoral intramedullary nail provides more stability and allows for earlier weight bearing than the locking plate when used for the treatment of

  6. Subtrochanteric femoral fracture during trochanteric nailing for the treatment of femoral shaft fracture.

    Science.gov (United States)

    Yun, Ho Hyun; Oh, Chi Hun; Yi, Ju Won

    2013-09-01

    We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nailing for femoral shaft fractures to improve its application and prevent implant-derived complications.

  7. Nonswelling alloy

    International Nuclear Information System (INIS)

    Harkness, S.D.

    1975-01-01

    An aluminum alloy containing one weight percent copper has been found to be resistant to void formation and thus is useful in all nuclear applications which currently use aluminum or other aluminum alloys in reactor positions which are subjected to high neutron doses

  8. Osteonecrosis of the femoral head: An update in year 2012

    Science.gov (United States)

    Kaushik, Anjan P; Das, Anusuya; Cui, Quanjun

    2012-01-01

    Osteonecrosis is a phenomenon involving disruption to the vascular supply to the femoral head, resulting in articular surface collapse and eventual osteoarthritis. Although alcoholism, steroid use, and hip trauma remain the most common causes, several other etiologies for osteonecrosis have been identified. Basic science research utilizing animal models and stem cell applications continue to further elucidate the pathophysiology of osteonecrosis and promise novel treatment options in the future. Clinical studies evaluating modern joint-sparing procedures have demonstrated significant improvements in outcomes, but hip arthroplasty is still the most common procedure performed in these affected younger adults. Further advances in joint-preserving procedures are required and will be widely studied in the coming decade. PMID:22655222

  9. Hygroma following endovascular femoral aneurysm exclusion

    DEFF Research Database (Denmark)

    Wad, Morten; Pedersen, Brian Lindegaard; Lönn, Lars

    2013-01-01

    Endovascular treatment of aneurysms in the superficial femoral artery (SFA) and popliteal segments is a suggested alternative to open surgical repair. Careful selection of patients for endovascular treatment of SFA aneurysms is mandatory.......Endovascular treatment of aneurysms in the superficial femoral artery (SFA) and popliteal segments is a suggested alternative to open surgical repair. Careful selection of patients for endovascular treatment of SFA aneurysms is mandatory....

  10. Bilateral femoral neck fractures following pelvic irradiation

    International Nuclear Information System (INIS)

    Mitsuda, Kenji; Nishi, Hosei; Oba, Hiroshi

    1977-01-01

    Over 300 cases of femoral neck fractures following radiotherapy for intrapelvic malignant tumor have been reported in various countries since Baensch reported this disease in 1927. In Japan, 40 cases or so have been reported, and cases of bilateral femoral neck fractures have not reached to ten cases. The authors experienced a case of 75 year-old female who received radiotherapy for cancer of the uterus, and suffered from right femoral neck fracture 3 months after and left femoral neck fracture one year and half after. As clinical symptoms, she had not previous history of trauma in bilateral femurs, but she complained of a pain in a hip joint and of gait disturbance. The pain in left femoral neck continued for about one month before fracture was recognized with roentgenogram. As histopathological findings, increase of fat marrow, decrease of bone trabeculae, and its marked degeneration were recognized. Proliferation of some blood vessels was found out, but thickness of the internal membrane and thrombogenesis were not recognized. Treatment should be performed according to degree of displacement of fractures. In this case, artificial joint replacement surgery was performed to the side of fracture of this time, because this case was bilateral femoral neck fractures and the patient had received artificial head replacement surgery in the other side of fracture formerly. (Tsunoda, M.)

  11. Femoral head wedge resection for the treatment of avascular necrosis of the femoral head after pediatric femoral neck fracture: a case report.

    Science.gov (United States)

    Kim, Ha Yong; Cha, Yong Han; Choy, Won Sik; Jeung, Sang Wook; Min, Yeon Seung

    2018-05-01

    This research focuses on femoral head wedge resection for the treatment of avascular necrosis (AVN) of the femoral head. A 9-year-old girl presented to the emergency room complaining of right hip pain that occurred after a pedestrian car accident. After 8 months of internal fixation using cannulated screws for Delbet-type 2 fracture of the femoral neck, AVN of the femoral head developed in the patient. Even though valgus-derotation-extension intertrochanteric osteotomy was performed for the treatment of AVN, it progressed further and femoral head wedge resection was performed to recover the femoral head sphericity. After 3 years of follow-up, radiograph results showed appropriate and satisfactory congruency and containment. This research shows that the treatment of AVN of the femoral head using femoral head wedge resection is an effective method that can yield excellent results.

  12. Evaluation of Complications from Stainless-Steel Flexible Intramedullary Nailing in Children's Femoral Shaft Fractures and Recommendations for Continued Use.

    Science.gov (United States)

    Sultan, Asif; Bhat, M Rafiq; Khursheed, Omar; Maqbool Wani, Mubashir; Ahmad Kawoosa, Altaf; Kotwal, Hilal Ahmad; Manzoor, Qazi Waris

    2017-05-10

    [b]Background.[/b] Flexible intramedullary nailing is currently considered the treatment of choice for femoral diaphyseal fractures in school-aged children. The purpose of our study was to critically evaluate and analyze the complications of stainless steel flexible intramedullary nailing in children's femoral shaft fractures. (mean age, 8.2 years) with a femoral shaft fracture treated with stainless steel flexible intramedullary nailing from January 1, 2009 to July 31, 2015 and evaluated for complications.[b]Results.[/b] All fractures united in a mean time of 9.2 weeks. Minor complications were noted in 19 patients, and major complications were noted in two patients. The Flynn score was excellent in 74 patients, satisfactory in 23 patients, and poor in three patients.[b]Conclusions.[/b] 1. Stainless steel flexible intramedullary nailing in children's femoral shaft fractures is associated with minimal complications. 2. These complications are not related to the alloy of the implant and are mostly due to the long nail end; these complications can be prevented easily. 3. Stainless steel flexible intramedullary nailing is also cost effective, and we recommend its use be enhanced for the treatment of femoral shaft fractures in children.

  13. Biomechanical comparisons between a new avascular necrosis of femaral head stem based on Chinese patients with avascular necrosis and two other designs.

    Science.gov (United States)

    Zhang, Qiang; Cheng, Cheng-Kung; Wei, Hung-Wen; Dong, Xiang; Chen, Yi-Ting; Lai, Yu-Shu; Wang, Yan

    2013-01-01

    There is a relatively high failure rate of the femoral component in patients with avascular necrosis at the intermediate-term follow-up. Improving the geometrical fit of the femoral stem against the medullary canal may help to provide long-term survivorship of the hip replacement for patients with avascular necrosis. We designed a specific stem, based on morphometric studies of proximal femoral canals in Chinese avascular necrosis patients and evaluated the stem by finite element analyses, comparing the novel stem with two commercially available and commonly used stems. The morphometric data from avascular necrosis patients showed specific geometric differences in the proximal femoral canal, including profile curves in both the sagittal and coronary planes than the patients with femoral neck fracture. The shorter stemmed prostheses (Fitmore(®) and our stem) performed better than the longer stemmed prosthesis (VerSys(®)). This is the first study to investigate the femoral geometries of Chinese avascular necrosis patients. Our stem provides better stability and is theoretically beneficial to bone ingrowth, which may increase the long-term stability and fixation of the implant.

  14. Subtrochanteric Femoral Fracture during Trochanteric Nailing for the Treatment of Femoral Shaft Fracture

    OpenAIRE

    Yun, Ho Hyun; Oh, Chi Hun; Yi, Ju Won

    2013-01-01

    We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nai...

  15. Femoral neck shortening after internal fixation of a femoral neck fracture

    NARCIS (Netherlands)

    Zielinski, Stephanie M.; Keijsers, Noël L.; Praet, Stephan F. E.; Heetveld, Martin J.; Bhandari, Mohit; Wilssens, Jean Pierre; Patka, Peter; van Lieshout, Esther M. M.; Devereaux, Philip J.; Guyatt, Gordon; Jeray, Kyle; Liew, Susan; Richardson, Martin J.; Schemitsch, Emil H.; Swiontkowski, Marc; Tornetta, Paul; Walter, Stephen; Sprague, Sheila; Simunovic, Helena Viveiros Nicole; Heels-Ansdell, Diane; Buckingham, Lisa; Duraikannan, Aravin; Swiontkowski, Marc F.; Agel, Julie; Goslings, J. Carel; Haverlag, Robert; Ponsen, Kees Jan; Bronkhorst, Maarten W. G. A.; Guicherit, O. R.; Eversdijk, Martin G.; Peters, Rolf; den Hartog, Dennis; van Waes, Oscar J. F.; Oprel, Pim; de Rijcke, Piet A. R.; Koppert, C. L.; Buijk, Steven E.; Groenendijk, Richard P. R.; Dawson, I.; Tetteroo, G. W. M.; Bruijninckx, Milko M. M.; Doornebosch, Pascal G.; de Graaf, E. J. R.; Gasthuis, Kennemer; Visser, Gijs A.; Stockmann, Heyn; Silvis, Rob; Snellen, J. P.; Rijbroek, A.; Scheepers, Joris J. G.; Vermeulen, Erik G. J.; Siroen, M. P. C.; Vuylsteke, Ronald; Brom, H. L. F.; Ryna, H.; Roukema, Gert R.; Josaputra, H.; Keller, Paul; de Rooij, P. D.; Kuiken, Hans; Boxma, Han; Cleffken, Barry I.; Liem, Ronald; Rhemrev, Steven J.; Bosman, C. H. R.; van Otterloo, Alexander de Mol; Hoogendoorn, Jochem; de Vries, Alexander C.; Meylaerts, Sven A. G.; Poolman, Rudolf W.; Simons, Maarten P.; van der Heijden, Frank H. W. M.; Willems, W. J.; de Meulemeester, Frank R. A. J.; van der Hart, Cor P.; Turckan, Kahn; Festen, Sebastiaan; de Nies, F.; Out, Nico J. M.; Bosma, J.; van der Elst, Maarten; van der Pol, Carmen C.; van 't Riet, Martijne; Karsten, T. M.; de Vries, M. R.; Stassen, Laurents P. S.; Schep, Niels W. L.; Schmidt, G. B.; Hoffman, W. H.; Segers, Michiel J. M.; Zijl, Jacco A. C.; Verhoeven, Bart; Smits, Anke B.; de Vries, J. P. P. M.; Fioole, Bram; van der Hoeven, H.; Theunissen, Evert B. M.; de Vries Reilingh, Tammo S.; Govaert, Lonneke; Wittich, Philippe; de Brauw, Maurits; Wille, Jan; Go, Peter M. N. Y. M.; Ritchie, Ewan D.; Wessel, R. N.; Hammacher, Eric R.; Verhofstad, Michiel H. J.; Meijer, Joost; van Egmond, Teun; van der Brand, Igor; van der Vis, Harm M.; Campo, Martin; Verhagen, Ronald; Albers, G. H. R.; Zurcher, A.; van Kampen, A.; Biert, Jan; van Vugt, Arie B.; Edwards, Michael J. R.; Blokhuis, Taco J.; Frölke, Jan Paul M.; Geeraedts, L. M. G.; Gardeniers, J. W. M.; Tan, Edward T. C. H.; Poelhekke, L. M. S. J.; de Waal Malefijt, M. C.; Schreurs, Bart; Simmermacher, Rogier K. J.; van Mulken, Jeroen; van Wessem, Karlijn; van Gaalen, Steven M.; Leenen, Luke P. H.; Frihagen, Frede; Nordsletten, Lars; Stoen, Ragnhild Oydna; Brekke, Kine; Tetsworth, Kevin; Weinrauch, Patrick; Pincus, Paul; Donald, Geoff; yang, Steven; Halliday, Brett; Gervais, Trevor; Holt, Michael; Flynn, Annette; Pirpiris, Marinis; Love, David; Bucknill, Andrew; Farrugia, Richard J.; Dowrick, Adam; Donohue, Craig; Bedi, Harvinder; Li, Doug; Edwards, Elton; Csongvay, Steven; Miller, Russell; Wang, Otis; Chia, Andrew; Jain, Arvind; Mammen, Mathan; Murdoch, Zoe; Sage, Claire; Kumar, Anil; Pankaj, Amite; Singh, Ajay Pal; Pesantez, Rodrigo; Martinez, Adriana; Novoa, Catherine; Buckley, Richard E.; Duffy, Paul; Korley, Robert; Johnston, Kelly; Puloski, Shannon; Carcary, Kimberly; Avram, Victoria; Bicknell, Ryan; Yach, Jeff; Bardana, Davide; Lambert, Sue; Sanders, David W.; Howard, Jamie; Macleod, Mark; Bartly, C. T.; Tieszer, Christina; Peterson, Devin; Zalzal, Paul; Maumetz, Victor; Brien, Heather; Weening, Brad; Wai, Eugene K.; Roffey, Darren; McCormack, Robert; Stone, Trevor; Perey, Bertrand; Viskontas, Darius; Boyer, Dory; Perey, Bert; Zomar, Mauri; Moon, Karyn; Oatt, Amber; McKee, Michael; Hall, Jeremy; Ahn, Henry; Vicente, Milena R.; Wild, Lisa M.; Kreder, Hans J.; Stephen, David J. G.; Nousianinen, Markku; Cagaanan, Ria; Kunz, Monica; Syed, Khalid; Azad, Tania; Coles, Chad; Leighton, Ross; Johnstone, David; Glazebrook, Mark; Alexander, David; Trask, Kelly; Dobbin, Gwendolyn; Oliver, Todd M.; Jones, Vicky; Ronan, James; Brown, Desmond T.; Carlilse, Hope; Shaughnessy, Lisa; Schwappach, John; Davis, Craig A.; Weingarten, Peter; Weinerman, Stewart; Newman, Heike; Baker, Janell; Browner, Kieran; Hurley, Meghan; Zura, Robert; Manson, Maria J.; Goetz, David; Broderick, Scott J.; Porter, Scott; Pace, Thomas; Tanner, Stephanie L.; Snider, Becky; Schmidt, Andrew H.; Haas, Jonathan; Templeman, David; Westberg, Jerald R.; Mullis, Brian; Ertl, J. P.; Shively, Karl; Frizzel, Valda; Marcantonio, Andrew J.; Iorio, Richard; Lobo, Margaret; Kain, Michael; Specht, Lawrence; Garfi, John; Prayson, Michael J.; Davis, Craig; Laughlin, Richard; Rubino, Joe; Lawless, Mathew; DiPaola, Matt; Gaydon, Chris; Dulaney, Liz; Vallier, Heather A.; Wilber, John; Sontich, John; Patterson, Brendan; Dolenc, Andrea; Robinson, Chalitha; Wilber, Roger; DePaolo, Charles J.; Alosky, Rachel; Shell, Leslie E.; Keeve, Jonathan P.; Anderson, Chris; McDonald, Michael; Hoffman, Jodi; Baele, Joseph; Weber, Tim; Edison, Matt; Musapatika, Dana; Jones, Clifford; Ringler, James; Endres, Terrance; Gelbke, Martin; Jabara, Michael; Sietsema, Debra L.; Engerman, Susan M.; Switzer, Julie A.; Li, Mangnai; Marston, Scott; Cole, Peter; Vang, Sandy X.; Foley, Amy; McBeth, Jessica; Comstock, Curt; Ziran, Navid; Shaer, James; Hileman, Barbara; Karges, David; Cannada, Lisa; Kuldjanov, Djoldas; Watson, John Tracy; Mills, Emily; Simon, Tiffany; Abdelgawad, Amr; Shunia, Juan; Jenkins, Mark; Zumwalt, Mimi; Romero, Amanda West; Lowe, Jason; Goldstein, Jessica; Zamorano, David P.; Lawson, Deanna; Archdeacon, Michael; Wyrick, John; Hampton, Shelley; Lewis, Courtland G.; Ademi, Arben; Sullivan, Raymond; Caminiti, Stephanie; Graves, Matthew; Smith, Lori; Della Rocca, Gregory J.; Crist, Brett D.; Murtha, Yvonne; Anderson, Linda K.; Kliewer, Toni K.; McPherson, Melinda K.; Sullivan, Kelly M.; Sagebien, Carlos; Seuffert, Patricia; Mehta, Samir; Esterhai, John; Ahn, Jaimo; Tjoumakaris, Fotios; Horan, Annamarie D.; Kaminski, Christine; Tarkin, Ivan; Siska, Peter; Luther, Arlene; Irrgang, James; Farrell, Dana; Gorczyca, John T.; Gross, Jonathan M.; Kates, Stephen Lloyd; Colosi, Jen; Hibsch, Nancy; Noble, Krista; Agarwal, Animesh; Wright, Rebecca; Hsu, Joseph R.; Ficke, James R.; Napierala, Matthew A.; Charlton, Michael T.; Fan, Mary K.; Obremskey, William T.; Richards, Justin E.; Robinson, Kenya; Carroll, Eben; Kulp, Brenda

    2013-01-01

    This study assesses femoral neck shortening and its effect on gait pattern and muscle strength in patients with femoral neck fractures treated with internal fixation. Seventy-six patients from a multicenter randomized controlled trial participated. Patient characteristics and Short Form 12 and

  16. A tissue engineering strategy for the treatment of avascular necrosis of the femoral head.

    Science.gov (United States)

    Aarvold, A; Smith, J O; Tayton, E R; Jones, A M H; Dawson, J I; Lanham, S; Briscoe, A; Dunlop, D G; Oreffo, R O C

    2013-12-01

    Skeletal stem cells (SSCs) and impaction bone grafting (IBG) can be combined to produce a mechanically stable living bone composite. This novel strategy has been translated to the treatment of avascular necrosis of the femoral head. Surgical technique, clinical follow-up and retrieval analysis data of this translational case series is presented. SSCs and milled allograft were impacted into necrotic bone in five femoral heads of four patients. Cell viability was confirmed by parallel in vitro culture of the cell-graft constructs. Patient follow-up was by serial clinical and radiological examination. Tissue engineered bone was retrieved from two retrieved femoral heads and was analysed by histology, microcomputed tomography (μCT) and mechanical testing. Three patients remain asymptomatic at 22- to 44-month follow-up. One patient (both hips) required total hip replacement due to widespread residual necrosis. Retrieved tissue engineered bone demonstrated a mature trabecular micro-architecture histologically and on μCT. Bone density and axial compression strength were comparable to trabecular bone. Clinical follow-up shows this to be an effective new treatment for focal early stage avascular necrosis of the femoral head. Unique retrieval analysis of clinically translated tissue engineered bone has demonstrated regeneration of tissue that is both structurally and functionally analogous to normal trabecular bone. Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  17. Maintenance of bone mineral density after implantation of a femoral neck hip prosthesis.

    Science.gov (United States)

    Decking, Ralf; Rokahr, Christoph; Zurstegge, Matthias; Simon, Ulrich; Decking, Jens

    2008-01-31

    Stress shielding of the proximal femur has been observed in a number of conventional cementless implants used in total hip arthroplasty. Short femoral-neck implants are claiming less interference with the biomechanics of the proximal femur. The goal of this study was to investigate the changes of bone-mineral density in the proximal femur and the clinical outcome after implantation of a short femoral-neck prosthesis. We prospectively assessed the clinical outcome and the changes of bone mineral density of the proximal femur up to one year after implantation of a short femoral neck prosthesis in 20 patients with a mean age of 47 years (range 17 to 65). Clinical outcome was assessed using the Harris Hip Score. The WOMAC was used as a patient-relevant outcome-measure. The bone mineral density was determined using dual energy x-ray absorptiometry, performed 10 days, three months and 12 months after surgery. The Harris Hip Score improved from an average preoperative score of 46 to a postoperative score at 12 months of 89 points, the global WOMAC index from 5,3 preoperatively to 0,8 at 12 months postoperatively. In contrast to conventional implants, the DEXA-scans overall revealed a slight increase of bone mineral density in the proximal femur in the 12 months following the implantation. The short femoral neck stem lead to a distinct bone reaction. This was significantly different when compared to the changes in bone mineral density reported after implantation of conventional implants.

  18. Conservative surgery for the treatment of osteonecrosis of the femoral head: current options

    Science.gov (United States)

    Gasbarra, Elena; Perrone, Fabio Luigi; Baldi, Jacopo; Bilotta, Vincenzo; Moretti, Antimo; Tarantino, Umbertto

    2015-01-01

    Summary The prevention of femoral head collapse and the maintenance of hip function would represent a substantial achievement in the treatment of osteonecrosis of the femoral head; however it is difficult to identify appropriate treatment protocols to manage patients with pre-collapse avascular necrosis in order to obtain a successful outcome in joint preserving procedures. Conservative treatments, including pharmacological management and biophysical modalities, are not supported by any evidence and require further investigation. The appropriate therapeutic approach has not been identified. The choice of surgical procedures is based on patient clinical conditions and anatomopathological features; preservation of the femoral head by core decompression may be attempted in younger patients without head collapse. Biological factors, such as bone morphogenetic proteins and bone marrow stem cells, would improve the outcome of core decompression. Another surgical procedure proposed for the treatment of avascular necrosis consists of large vascularized cortical bone grafts, but its use is not yet common due to surgical technical issues. Use of other surgical technique, such as osteotomies, is controversial, since arthroplasty is considered as the first option in case of severe femoral head collapse without previous intervention. PMID:27134632

  19. The internal calcar septum (femoral thigh spur) in computed tomography and conventional radiography

    Energy Technology Data Exchange (ETDEWEB)

    Adam, F. [Orthopaedic Dept., University Hospital of Saarland, Homburg/Saar (Germany); Universitaetskliniken des Saarlandes, Orthopaedische Klinik und Poliklinik, 66421 Homburg/Saar (Germany); Hammer, D.S.; Pape, D.; Kohn, D. [Orthopaedic Dept., University Hospital of Saarland, Homburg/Saar (Germany)

    2001-02-01

    Objective. The femoral ''thigh spur'', a cortical septum in the region of the lesser trochanter of the human femur, was first described and named by the German anatomist Merkel in 1874, but it was never examined in detail. To evaluate the frequency and the shape of this structure, a combined anatomical and radiological study was performed using saw-cuts from specimens, high-resolution CT and conventional radiography.Design. Thirty human cadaveric femora of central European origin were analyzed by high-precision computed tomography (CT) using thin slices and high-resolution imaging. The CT data were image processed with thresholding to obtain a reconstruction of high-density bone formations and for three-dimensional imaging. Additionally three macerated femur specimens were cut exactly corresponding to the CT slices. The computed images were validated with the anatomical saw-cuts.Results. A dense trabecular ridge protruding endosteally from the posteromedial cortex was found in all femora. This cortical septum reaching from the femoral neck to the distal part of the lesser trochanter separated the femoral cavity from the cancellous bone inside the lesser trochanter. On conventional radiography the femoral thigh spur could be visualized best in the frog-lateral view of the hip.Conclusion. The internal calcar septum is a constant cortical structure. It should be recognized when radiographs or CT images of the proximal femur are interpreted. It could be of importance for metaphyseal fitting of an endoprosthetic stem. (orig.)

  20. Evaluation of a pig femoral head osteonecrosis model

    Science.gov (United States)

    2010-01-01

    Background A major cause of osteonecrosis of the femoral head is interruption of a blood supply to the proximal femur. In order to evaluate blood circulation and pathogenetic alterations, a pig femoral head osteonecrosis model was examined to address whether ligature of the femoral neck (vasculature deprivation) induces a reduction of blood circulation in the femoral head, and whether transphyseal vessels exist for communications between the epiphysis and the metaphysis. We also tested the hypothesis that the vessels surrounding the femoral neck and the ligamentum teres represent the primary source of blood flow to the femoral head. Methods Avascular osteonecrosis of the femoral head was induced in Yorkshire pigs by transecting the ligamentum teres and placing two ligatures around the femoral neck. After heparinized saline infusion and microfil perfusion via the abdominal aorta, blood circulation in the femoral head was evaluated by optical and CT imaging. Results An angiogram of the microfil casted sample allowed identification of the major blood vessels to the proximal femur including the iliac, common femoral, superficial femoral, deep femoral and circumflex arteries. Optical imaging in the femoral neck showed that a microfil stained vessel network was visible in control sections but less noticeable in necrotic sections. CT images showed a lack of microfil staining in the epiphysis. Furthermore, no transphyseal vessels were observed to link the epiphysis to the metaphysis. Conclusion Optical and CT imaging analyses revealed that in this present pig model the ligatures around the femoral neck were the primary cause of induction of avascular osteonecrosis. Since the vessels surrounding the femoral neck are comprised of the branches of the medial and the lateral femoral circumflex vessels, together with the extracapsular arterial ring and the lateral epiphyseal arteries, augmentation of blood circulation in those arteries will improve pathogenetic alterations in

  1. Evaluation of a pig femoral head osteonecrosis model

    Directory of Open Access Journals (Sweden)

    Kim Harry

    2010-03-01

    Full Text Available Abstract Background A major cause of osteonecrosis of the femoral head is interruption of a blood supply to the proximal femur. In order to evaluate blood circulation and pathogenetic alterations, a pig femoral head osteonecrosis model was examined to address whether ligature of the femoral neck (vasculature deprivation induces a reduction of blood circulation in the femoral head, and whether transphyseal vessels exist for communications between the epiphysis and the metaphysis. We also tested the hypothesis that the vessels surrounding the femoral neck and the ligamentum teres represent the primary source of blood flow to the femoral head. Methods Avascular osteonecrosis of the femoral head was induced in Yorkshire pigs by transecting the ligamentum teres and placing two ligatures around the femoral neck. After heparinized saline infusion and microfil perfusion via the abdominal aorta, blood circulation in the femoral head was evaluated by optical and CT imaging. Results An angiogram of the microfil casted sample allowed identification of the major blood vessels to the proximal femur including the iliac, common femoral, superficial femoral, deep femoral and circumflex arteries. Optical imaging in the femoral neck showed that a microfil stained vessel network was visible in control sections but less noticeable in necrotic sections. CT images showed a lack of microfil staining in the epiphysis. Furthermore, no transphyseal vessels were observed to link the epiphysis to the metaphysis. Conclusion Optical and CT imaging analyses revealed that in this present pig model the ligatures around the femoral neck were the primary cause of induction of avascular osteonecrosis. Since the vessels surrounding the femoral neck are comprised of the branches of the medial and the lateral femoral circumflex vessels, together with the extracapsular arterial ring and the lateral epiphyseal arteries, augmentation of blood circulation in those arteries will improve

  2. Femoral rotation unpredictably affects radiographic anatomical lateral distal femoral angle measurements

    DEFF Research Database (Denmark)

    Miles, James Edward

    2016-01-01

    Objective: To describe the effects of internal and external femoral rotation on radiographic measurements of the anatomical lateral distal femoral angle (a-LDFA) using two methods for defining the anatomical proximal femoral axis (a-PFA). Methods: Digital radiographs were obtained of 14 right...... femora at five degree intervals from 10° external rotation to 10° internal rotation. Using freely available software, a-LDFA measurements were made using two different a-PFA by a single observer on one occasion. Results: Mean a-LDFA was significantly greater at 10° external rotation than at any other...... rotation. The response of individual femora to rotation was unpredictable, although fairly stable within ±5° of zero rotation. Mean a-LDFA for the two a-PFA methods differed by 1.5°, but were otherwise similarly affected by femoral rotation. Clinical significance: If zero femoral elevation can be achieved...

  3. Superficial femoral artery nitinol stent in a patient with nickel allergy.

    Science.gov (United States)

    Jetty, Prasad; Jayaram, Srinidhi; Veinot, John; Pratt, Melanie

    2013-11-01

    We present a case of a patient who developed a systemic allergic reaction following placement of a nitnol stent in the superficial femoral artery for claudication symptoms. Shortly after, he was tested for contact dermatitis and found to have a severe reaction to nickel. His symptoms of severe itch and generalized rash resolved within days following stent explantation and reconstruction with a vein graft. The epidemiology and clinical significance of nickel allergy and the concomitant use of nickel-alloy stents are discussed. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  4. Correlation of ultrasound appearance, gross anatomy, and histology of the femoral nerve at the femoral triangle.

    Science.gov (United States)

    Lonchena, Tiffany K; McFadden, Kathryn; Orebaugh, Steven L

    2016-01-01

    Correlation between ultrasound appearance, gross anatomic characteristics, and histologic structure of the femoral nerve (FN) is lacking. Utilizing cadavers, we sought to characterize the anatomy of the FN, and provide a quantitative measure of its branching. We hypothesize that at the femoral crease, the FN exists as a group of nerve branches, rather than a single nerve structure, and secondarily, that this transition into many branches is apparent on ultrasonography. Nineteen preserved cadavers were investigated. Ultrasonography was sufficient to evaluate the femoral nerve in nine specimens; gross dissection was utilized in all 19. Anatomic characteristics were recorded, including distances from the inguinal ligament to femoral crease, first nerve branch, and complete arborization of the nerve. The nerves from nine specimens were excised for histologic analysis. On ultrasound, the nerve became more flattened, widened, and less discrete as it coursed distally. Branching of the nerve was apparent in 12 of 18 images, with mean distance from inguinal ligament of 3.9 (1.0) cm. However, upon dissection, major branching of the femoral nerve occurred at 3.1 (1.0) cm distal to the inguinal ligament, well proximal to the femoral crease. Histologic analysis was consistent with findings at dissection. The femoral nerve arborizes into multiple branches between the inguinal ligament and the femoral crease. Initial branching is often high in the femoral triangle. As hypothesized, the FN exists as a closely associated group of nerve branches at the level of the femoral crease; however, the termination of the nerve into multiple branches is not consistently apparent on ultrasonography.

  5. Comparison of femoral morphology and bone mineral density between femoral neck fractures and trochanteric fractures.

    Science.gov (United States)

    Maeda, Yuki; Sugano, Nobuhiko; Saito, Masanobu; Yonenobu, Kazuo

    2011-03-01

    Many studies that analyzed bone mineral density (BMD) and skeletal factors of hip fractures were based on uncalibrated radiographs or dual-energy xray absorptiometry (DXA). Spatial accuracy in measuring BMD and morphologic features of the femur with DXA is limited. This study investigated differences in BMD and morphologic features of the femur between two types of hip fractures using quantitative computed tomography (QCT). Forty patients with hip fractures with normal contralateral hips were selected for this study between 2003 and 2007 (trochanteric fracture, n=18; femoral neck fracture, n=22). Each patient underwent QCT of the bilateral femora using a calibration phantom. Using images of the intact contralateral femur, BMD measurements were made at the point of minimum femoral-neck cross-sectional area, middle of the intertrochanteric region, and center of the femoral head. QCT images also were used to measure morphologic features of the hip, including hip axis length, femoral neck axis length, neck-shaft angle, neck width, head offset, anteversion of the femoral neck, and cortical index at the femoral isthmus. No significant differences were found in trabecular BMD between groups in those three regions. Patients with trochanteric fractures showed a smaller neck shaft angle and smaller cortical index at the femoral canal isthmus compared with patients with femoral neck fractures. We conclude that severe osteoporosis with thinner cortical bone of the femoral diaphysis is seen more often in patients with trochanteric fracture than in patients with femoral neck fracture. Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

  6. Custom total knee replacement in a dog with femoral condylar bone loss.

    Science.gov (United States)

    Liska, William D; Marcellin-Little, Denis J; Eskelinen, Esa V; Sidebotham, Christopher G; Harrysson, Ola L A; Hielm-Björkman, Anna K

    2007-06-01

    To report surgical planning, technique, and outcome of custom total knee replacement (TKR) performed to manage a medial femoral condylar nonunion in a dog. Clinical case report. A 3-year-old, 20 kg Karelian Bear Hound. Computed tomographic scan of the left pelvic limb was used to build a stereolithography model of the distal portion of the femur. The model was used to create a custom augment to replace the missing medial femoral condyle and a custom stem for intramedullary condylar cemented fixation. The augment and stem were adapted to femoral and tibial components already available. The model was used to rehearse the surgery and then the custom prosthesis was implanted. Weight bearing returned 8 hours after surgery and improved thereafter. Joint alignment was normal and prosthetic joint motion was 60-165 degrees postoperatively. The dog resumed moose hunting 3 months after surgery. Peak vertical force and impulse of the operated limb measured 17 months after surgery were 65% and 47% of the normal, contralateral limb. Based on short-term follow-up, cemented canine TKR was successfully achieved for management of a severely abnormal stifle joint. With further refinement and development of commercially available prostheses, TKR should be possible for canine patients.

  7. Modular titanium alloy neck adapter failures in hip replacement - failure mode analysis and influence of implant material

    Directory of Open Access Journals (Sweden)

    Bloemer Wilhelm

    2010-01-01

    Full Text Available Abstract Background Modular neck adapters for hip arthroplasty stems allow the surgeon to modify CCD angle, offset and femoral anteversion intraoperatively. Fretting or crevice corrosion may lead to failure of such a modular device due to high loads or surface contamination inside the modular coupling. Unfortunately we have experienced such a failure of implants and now report our clinical experience with the failures in order to advance orthopaedic material research and joint replacement surgery. The failed neck adapters were implanted between August 2004 and November 2006 a total of about 5000 devices. After this period, the titanium neck adapters were replaced by adapters out of cobalt-chromium. Until the end of 2008 in total 1.4% (n = 68 of the implanted titanium alloy neck adapters failed with an average time of 2.0 years (0.7 to 4.0 years postoperatively. All, but one, patients were male, their average age being 57.4 years (36 to 75 years and the average weight 102.3 kg (75 to 130 kg. The failures of neck adapters were divided into 66% with small CCD of 130° and 60% with head lengths of L or larger. Assuming an average time to failure of 2.8 years, the cumulative failure rate was calculated with 2.4%. Methods A series of adapter failures of titanium alloy modular neck adapters in combination with a titanium alloy modular short hip stem was investigated. For patients having received this particular implant combination risk factors were identified which were associated with the occurence of implant failure. A Kaplan-Meier survival-failure-analysis was conducted. The retrieved implants were analysed using microscopic and chemical methods. Modes of failure were simulated in biomechanical tests. Comparative tests included modular neck adapters made of titanium alloy and cobalt chrome alloy material. Results Retrieval examinations and biomechanical simulation revealed that primary micromotions initiated fretting within the modular tapered neck

  8. Modular titanium alloy neck adapter failures in hip replacement--failure mode analysis and influence of implant material.

    Science.gov (United States)

    Grupp, Thomas M; Weik, Thomas; Bloemer, Wilhelm; Knaebel, Hanns-Peter

    2010-01-04

    Modular neck adapters for hip arthroplasty stems allow the surgeon to modify CCD angle, offset and femoral anteversion intraoperatively. Fretting or crevice corrosion may lead to failure of such a modular device due to high loads or surface contamination inside the modular coupling. Unfortunately we have experienced such a failure of implants and now report our clinical experience with the failures in order to advance orthopaedic material research and joint replacement surgery.The failed neck adapters were implanted between August 2004 and November 2006 a total of about 5000 devices. After this period, the titanium neck adapters were replaced by adapters out of cobalt-chromium. Until the end of 2008 in total 1.4% (n = 68) of the implanted titanium alloy neck adapters failed with an average time of 2.0 years (0.7 to 4.0 years) postoperatively. All, but one, patients were male, their average age being 57.4 years (36 to 75 years) and the average weight 102.3 kg (75 to 130 kg). The failures of neck adapters were divided into 66% with small CCD of 130 degrees and 60% with head lengths of L or larger. Assuming an average time to failure of 2.8 years, the cumulative failure rate was calculated with 2.4%. A series of adapter failures of titanium alloy modular neck adapters in combination with a titanium alloy modular short hip stem was investigated. For patients having received this particular implant combination risk factors were identified which were associated with the occurRence of implant failure. A Kaplan-Meier survival-failure-analysis was conducted. The retrieved implants were analysed using microscopic and chemical methods. Modes of failure were simulated in biomechanical tests. Comparative tests included modular neck adapters made of titanium alloy and cobalt chrome alloy material. Retrieval examinations and biomechanical simulation revealed that primary micromotions initiated fretting within the modular tapered neck connection. A continuous abrasion and

  9. Aseptic loosening of the femoral implant after cemented total hip arthroplasty in dogs: 11 cases in 10 dogs (1991-1995)

    International Nuclear Information System (INIS)

    Edwards, M.R.; Egger, E.L.; Schwarz, P.D.

    1997-01-01

    Objective-To determine clinical signs, radiographic findings, results of surgical management, and potential causes of aseptic loosening of the femoral implant (ALFI) in dogs that have undergone cemented total hip arthroplasty (THA). Design-Retrospective study. Animals-11 cases of ALFI in 10 dogs. Procedure-Medical records of all dogs undergoing THA revision surgery were reviewed. Only dogs with ALFI were included. The prosthesis and cement were removed by creating a longitudinal osteotomy of the cranial femoral cortex. Postoperative radiographs of all dogs that underwent THA during the study period were reviewed. Results-The most common clinical sign was intermittent, subtle. or non-weight-bearing lameness. On radiographs obtained after THA, contact of the distal stem tip with cortical endosteum was evident in all dogs. Radiographic changes at the time of diagnosis of ALFI included asymmetric periosteal reaction along the femoral diaphysis, radiolucent lines between the prosthesis and cement, altered implant position, and femoral fracture. Surgical revision yielded good or excellent results in 9 cases. In 1 dog. the implant became infected; in another, aseptic loosening recurred. Aseptic loosening was significantly more common in dogs in which there was contact between the distal stem tip and cortical endosteum than in dogs in which there was no contact. Clinical Implications-ALFI is an uncommon, but important, complication of THA, and radiography is warranted in dogs with clinical signs of ALFI. Initial centering of the prosthetic stem within the femoral shaft may reduce the incidence of ALFI

  10. Prospective five-year subsidence analysis of a cementless fully hydroxyapatite-coated femoral hip arthroplasty component.

    Science.gov (United States)

    Clauss, Martin; Van Der Straeten, Catherine; Goossens, Marc

    2014-01-01

    Early subsidence >1.5 mm is considered to be a predictive factor for later aseptic loosening of the femoral component following total hip arthroplasty (THA). The aim of this study was to assess five-year subsidence rates of the cementless hydroxyapatite-coated twinSys stem (Mathys Ltd., Bettlach, Switzerland).This prospective single-surgeon series examined consecutive patients receiving a twinSys stem at Maria Middelares Hospital, Belgium. Patients aged >85 years or unable to come to follow-up were excluded. Subsidence was assessed using Ein Bild Roentgen Analyse--Femoral Component Analysis (EBRA-FCA). Additional clinical and radiographic assessments were performed. Follow-ups were prospectively scheduled at two, five, 12, 24, and 60 months.In total, 218 THA (211 patients) were included. At five years, mean subsidence was 0.66 mm (95% CI: 0.43-0.90). Of the 211 patients, 95.2% had an excellent or good Harris Hip Score. There were few radiological changes. Kaplan-Meier analysis indicated five-year stem survival to be 98.4% (95% CI: 97.6-100%).Subsidence levels of the twinSys femoral stem throughout the five years of follow-up were substantially lower than the 1.5 mm level predictive of aseptic loosening. This was reflected in the high five-year survival rate.

  11. Pseudoarthrosis in atypical femoral fracture: case report.

    Science.gov (United States)

    Giannotti, S; Bottai, V; Dell'Osso, G; De Paola, G; Ghilardi, M; Guido, G

    2013-11-01

    Atypical femoral fractures can be subsequent to a long-term biphosphonates treatment; they have a high frequency of delayed healing. The authors describe a femoral pseudoarthrosis of an atypical fracture treated with intramedullary nailing in a female after prolonged alendronate therapy. Atypical femoral fractures can be subsequent to a long-term biphosphonates treatment even if, in the literature, there is no clarity on the exact pathogenetic mechanism. The Task Force of the American Society for Bone and Mineral Research described the major and minor features to define atypical fractures and recommends that all the five major features must be present while minor features are not necessary. Another controversial aspect regarding the atypical femoral fractures is the higher frequency of the delayed healing that can be probably related to a suppressed bone turnover caused by a prolonged period of bisphosphonates treatment. This concept could be corroborated by the Spet Tc exam. In the case of a pseudoarthrosis, there is not a standardization of the treatment. In this report, the authors describe a femoral pseudoarthrosis of an atypical fracture treated with intramedullary nailing in a female after prolonged alendronate therapy; the patient was studied with clinical, bioumoral end SPECT-Tc exam of both femurs. Many studies show the relationship between bisphosphonates and the presence of atypical fractures. These fractures should be monitored more closely due to the risk of nonunion and they require considering an initial treatment with pharmacological augmentation to reduce the complications for the patient and the health care costs.

  12. Femoral head vitality after intracapsular hip fracture

    International Nuclear Information System (INIS)

    Stroemqvist, B.

    1983-01-01

    Femoral head vitality before, during and at various intervals from the operation was determined by tetracycline labeling and/or 99 sp (m)Tc-MDP scintimetry. In a three-year follow-up, healing prognosis could be determined by scintimetry 3 weeks from operation; deficient femoral head vitality predicting healing complications and retained vitality predicting uncomplicated healing. A comparison between pre- and postoperative scintimetry indicated that further impairment of the femoral head vitality could be caused by the operative procedure, and as tetracycline labeling prior to and after fracture reduction in 370 fractures proved equivalent, it was concluded that the procedure of osteosynthesis probably was responsible for capsular vessel injury, using a four-flanged nail. The four-flanged nail was compared with a low-traumatic method of osteosynthesis, two hook-pins, in a prospective randomized 14 month study, and the postoperative femoral head vitality was significantly better in the hook-pin group. This was also clearly demonstrated in a one-year follow-up for the fractures included in the study. Parallel to these investigations, the reliability of the methods of vitality determination was found satisfactory in methodologic studies. For clinical purpose, primary atraumatic osteosynthesis, postoperative prognostic scintimetry and early secondary arthroplasty when indicated, was concluded to be the appropriate approach to femoral neck fracture treatment. (Author)

  13. Avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Kokubo, Takeshi; Takatori, Yoshio; Kamogawa, Morihide; Nakamura, Toshitaka; Ninomiya, Setsuo; Yoshikawa, Kohki; Itai, Yuji; Iio, Masahiro; Mitamura, Tadayuki

    1990-01-01

    T1-weighted MR images of thirty-six hips in 25 patients with avascular necrosis of the femoral head were obtained two to five times during the course of 2 to 26 months. We investigated these MR images in the light of the chronological change and compared them with plain radiographs. MR images changes in 16 femoral head; in general, the abnormal low intensity area in the femoral head reduced in extent and the internal high intensity area became smaller of disappeared. Thirteen femoral heads among them became more flattened on plain radiographs in the same period. It is noted that four different zones are defined in the femoral head after bone necrosis takes place: the dead bone marrow, the dead marrow which still contains fat, the reactive interface and the hyperemic bone marrow. In T1-weighted MR images, the dead bone marrow, the reactive interface and the hyperemic bone marrow are demonstrated as low intensity area, while the dead marrow containing fat may remain high in intensity. On the basis of this knowledge of histopathology and MR images of this disease, we suggest that reduction of the abnormal low intensity area and disappearance of the internal high intensity area on MR images can be regarded as diminution of hyperemia in the living bone marrow and loss of fat in the dead bone marrow, respectively. (author)

  14. 99mTc-MDP scintigraphy of femoral head necrosis following femoral neck fracture

    International Nuclear Information System (INIS)

    Lee, Soon Jin; Lee, Jun Hyung; Kim, Eun Kyung; Lee, Sun Wha; Kim, Soon Yong

    1985-01-01

    Secondary ischemic necrosis of femoral head due to loss of blood supply following to femoral neck fracture is well known. The regional distribution of bone-seeking radiopharmaceuricals in the skeleton can depend on a number of factors, but bone blood flow is a major physiological determinant of regional skeletal uptake of Tc-99m polyphosphate and bone imaging may thus be used for the evaluation of vascularity of the femoral head. The authors made a comparative study of scintigraphic findings and operative findings of 28 cases of femoral neck fracture treated at Kyung Hee University Hospital from April 1980 to May 1984. The results were as follows: 1. In 16 cases of proven avascular necorsis of femoral head, scintigraphy showed absent or decreased activity in 14 cases (87.5%), while radiography showed increased density in 10 cases (62.5%). 2. In 12 cases of proven vital femoral head, scintigraphy showed increased activity in 9 cases (75%) and radiography showed decreased density in 9 cases (75%). 3. 99mTc-MDP scintigraphy was an excellent and useful method for assessing bone vitality of femoral head

  15. Pathology of osteonecrosis of the femoral head

    International Nuclear Information System (INIS)

    Sissons, H.A.; Nuovo, M.A.; Steiner, G.C.

    1992-01-01

    Pathological examination of the resected femoral heads from approximately 2000 total hip replacement operations carried out at the Hospital for Joint Diseases from 1984 to 1989 identified the presence of osteonecrosis in 345 patients (377 femoral heads). In 232 patients the osteonecrosis, referred to as 'idiopathic,' had occurred in the absence of a subcapital fracture. The present paper describes the pathology of the necrotic lesions in these 232 patients. The use of undecalcified sections and microradiography provides evidence of bone marrow calcification which, at the margin of the lesion, is sufficient to influence the radiographic features of the lesion significantly. Although a subchondral fracture is an almost constant feature of osteonecrosis when it occurs in a femoral head with a normal articular cartilage, no such fracture was found in cases in which osteonecrosis had occurred in an osteoarthritic joint. (orig.)

  16. Outcome of an uncemented hydroxyapatite coated hemiarthroplasty for displaced femoral neck fractures

    DEFF Research Database (Denmark)

    Eschen, Jacob; Kring, Søren; Brix, Michael

    2012-01-01

    discouraged their use. There is limited evidence for the use of modern uncemented femoral stems in the treatment of DFNF, and we wished to investigate the clinical and radiographic performance of an uncemented hydroxyapatite coated hemiarthroplasty at 2-year follow-up. Patients and methods: We included 97...... consecutive patients who had an uncemented, hydroxyapatite coated hemiarthroplasty (Corail, Depuy) inserted during a 1-year period. Due to unwillingness or cognitive impairment (n = 6) and death before follow-up (n = 44), a total of 47 patients (39 females) with a mean age of 81 years were available. Results......-up. Conclusion: The results suggest that an uncemented hydroxyapatite coated hemiarthroplasty can be used to treat displaced intracupsular femoral neck fractures with good clinical and radiographic outcomes at short term follow-up....

  17. Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures

    Directory of Open Access Journals (Sweden)

    Sampat S Dumbre Patil

    2016-01-01

    Full Text Available Background: When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN or surface implants like Dynamic Condylar Screw (DCS are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations. Materials and Methods: Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22-65 years and mean followup period was 52.1 months (range 27-72 months. Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery. Results: All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture. Conclusions: Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion.

  18. Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures.

    Science.gov (United States)

    Dumbre Patil, Sampat S; Karkamkar, Sachin S; Patil, Vaishali S Dumbre; Patil, Shailesh S; Ranaware, Abhijeet S

    2016-01-01

    When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN) or surface implants like Dynamic Condylar Screw (DCS) are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP) of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations. Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22-65 years) and mean followup period was 52.1 months (range 27-72 months). Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery. All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture. Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion.

  19. Cost comparison of femoral head banking versus bone substitutes.

    Science.gov (United States)

    Leung, Hon-Bong; Fok, Margaret Woon-Man; Chow, Lorraine Chi-Yan; Yen, Chi-Hung

    2010-04-01

    To compare the costs of femoral head banking versus bone substitutes. Records of femoral head banking from 1998 to 2008 were reviewed. The cost of allogenic cancellous bone graft was calculated by estimating the direct expenditure of femoral head procurement, screening tests, and storage, and then divided by the amount of bone harvested. 326 females and 141 males (mean age, 80.3 years) donated 470 femoral heads. Each transplantable femoral head costs US$978. Each gram of transplantable allogenic bone graft costs US$86, compared with US$9 to 26 per gram for commercially available bone substitutes. Compared with bone substitutes, femoral head banking in Hong Kong was less economical. Unless allografts yield superior outcomes, harvesting femoral heads for general usage (such as filling bone voids for fresh fractures) is not justified from a financial perspective, especially in banks dedicated to procuring bone from femoral heads only.

  20. Electrical Resistance Alloys and Low-Expansion Alloys

    DEFF Research Database (Denmark)

    Kjer, Torben

    1996-01-01

    The article gives an overview of electrical resistance alloys and alloys with low thermal expansion. The electrical resistance alloys comprise resistance alloys, heating alloys and thermostat alloys. The low expansion alloys comprise alloys with very low expansion coefficients, alloys with very low...

  1. Femoral component loosening after hip resurfacing arthroplasty

    International Nuclear Information System (INIS)

    Zustin, Jozef; Sauter, Guido; Hahn, Michael; Morlock, Michael M.; Ruether, Wolfgang; Amling, Michael

    2010-01-01

    Before the re-introduction of the current generation of total hip resurfacing arthroplasty, component loosening and osteolysis were of great concern to the orthopaedic community. Early, mid- and long-term clinical results are encouraging, but component loosening still exists. Macroscopic, contact radiographic and histopathological analyses after undecalcified preparation of bone tissue specimens were performed. To investigate the frequency and morphological patterns of the loosening of the femoral component, we analysed a series of 190 retrieved femoral remnants that were revised for aseptic failures. Thirty-five (18.4%) hips were revised for clinical and/or radiographic loosening of the femoral component. Pseudoarthrosis (n = 17; median in situ time: 16 weeks, interquartile range [IQR]: 9 to 34), collapsed osteonecrosis (n = 5; median in situ time: 79 weeks, IQR: 63 to 97), cement-socket debonding (n = 3; median in situ time: 89 weeks, IQR: 54 to 97) and at later follow-up bone-cement loosening (n = 10; median in situ time: 175 weeks; IQR 112 to 198; p =0.005) were distinct patterns of the femoral remnant-implant loosening. Fibrocartilaginous metaplasia of interface bone trabeculae (n = 38; median in situ time: 61 weeks, IQR: 32 to 138) was strongly associated with femoral component loosening (p = 0.009). Both the trabecular hyperosteoidosis (n = 32; median in situ time: 71 weeks, IQR 50 to 129) and excessive intraosseous lymphocyte infiltration (n = 12; median in situ time: 75 weeks, IQR 51 to 98) at the bone-cement interface correlated strongly with fibrocartilaginous metaplasia (p = 0.001 and p = 0.016 respectively) and all three lesions were associated with the female gender (p = 0.021, p = 0.009, and p = 0.051). Femoral component loosening at early follow-up was mostly caused by pathological changes of the femoral remnant bone tissue: pseudoarthrosis and collapsed osteonecrosis. Fibrocartilaginous metaplasia was frequently observed in hips with femoral

  2. Management of femoral head osteonecrosis: Current concepts

    Science.gov (United States)

    Tripathy, Sujit Kumar; Goyal, Tarun; Sen, Ramesh Kumar

    2015-01-01

    Osteonecrosis of femoral head (ONFH) is a disabling condition of young individuals with ill-defined etiology and pathogenesis. Remains untreated, about 70-80% of the patients progress to secondary hip arthritis. Both operative and nonoperative treatments have been described with variable success rate. Early diagnosis and treatment is the key for success in preserving the hip joint. Once femoral head collapses (>2 mm) or if there is secondary degeneration, hip conservation procedures become ineffective and arthroplasty remains the only better option. We reviewed 157 studies that evaluate different treatment modalities of ONFH and then a final consensus on treatment was made. PMID:25593355

  3. Earlier pathological character and mechanisms of irradiation necrosis on femoral head

    International Nuclear Information System (INIS)

    Xu Xiaoya; Jin Weifang; Wang Hongfu; Gao Jianjun

    2009-01-01

    Objective: To observe the earlier pathological character and mechanism of radiation osteonecrosis in femoral head, in order to provide evidences for the earlier diagnosis and prevention of radiation osteonecrosis of femoral head. Methods: Single femoral head of rats were irradiated singly with 30 Gy of 137 Cs γ-ray. The rats were executed after 2, 6 and 12 weeks, then the femurs were stained with HE and histopatholngical changes were observed by light microscope. The bone marrow mesenchymal stem cells (BMSCs) were cultured after 2 weeks and its proliferation and the colony formation were observed. The rats were endo-perfused with microfili contrast medium 12 weeks later, and the 3-dimensional structure of capillaries by Micro-CT was reestabhshed to detect the pathological changes of capillaries after irradiation. Result: The irradiated femur showed deranged cbondrocyte, decreased osteocyte, shrinking nucleus, increased empty bone lacuna and reduced bone trabocnla (P < 0.05). Micro-CT showed the discontinued small vessels and absence (6.65 %) capillaries in irradiated femur were obviously less than those of the unirradiated (12.3 %) (P < 0.001). The proliferation of BMSCs was slowed, the number of colony in irradiated group (10 %) was less than that of control (21 %) (P < 0.001). Conclusions: The preliminary histopathological changes of osteoradionecrosis on femoral head could be increased the empty bone lacuna, and the bone lacuna above 30 % was the sign of the earlier period of osteoradionecrosis. The osteonecrosis of femoral head induced by radiation is not only correlated to the damages to the bone, but also to the damages to BMSCs and capillaries. (authors)

  4. Management of osteonecrosis of the femoral head: A novel technique

    Directory of Open Access Journals (Sweden)

    Ahmed M Samy

    2016-01-01

    Full Text Available Background: Osteonecrosis of the femoral head (ONFH is a debilitating disease in orthopedics, frequently progressing to femoral head collapse and osteoarthritis. It is thought to be a multifactorial disease. ONFH ultimately results in femoral head collapse in 75-85% of untreated patients. Total hip arthroplasty (THA yields satisfactory results in the treatment of the end stage of the disease. However, disease typically affects males between the ages of 20 and 40 years and joint replacement is not the ideal option for younger patients. Recently, mesenchymal stem cells and platelet rich plasma (PRP have been used as an adjunct to core decompression to improve clinical success in the treatment of precollapse hips. Materials and Methods: A prospective study of 40 hips in 30 patients was done. There were 19 males and 11 females with a mean age 36.7 ± 6.93 years. The indication for the operation was restricted primarily to modified Ficat stages IIb and III. 16 hips (40% had stage IIb and 24 hips (60% had stage III ONFH. The period of follow up ranged between 36-50 months with a mean 41.4 ± 3.53 months. All patients were assessed clinically during pre- and post-operative period according to the Harris Hip Score (HHS, Visual Analog Score (VAS and radiologically by X-rays. Magnetic resonance imaging (MRI was done preoperatively to confirm the diagnosis and every 6 months postoperatively for assessment of healing. The operative procedure include removal of necrotic area with drilling then the cavity was filled with a composite of bone graft mixed with PRP. Results: The mean HHS improved from 46.0 ± 7.8 preoperatively to 90.28 ± 19 at the end of followup ( P < 0.0001. The mean values of VAS were 78 ± 21 and 35 ± 19 at preoperatively period and final followup, respectively, with an average reduction of 43 points. Conclusion: We found that the use of PRP with collagen sheet can increase the reparable capacity after drilling of necrotic segment in stage

  5. Angiographic analysis of avascular necrosis of a femoral head -selective angiography of medial femoral circumflex artery-

    International Nuclear Information System (INIS)

    Ryu, Kyung Nam; Yoon, Yup; Lee, Sun Wha; Lim, Jae Hoon

    1991-01-01

    The degree of anatomical revascularization of a necrotic femoral head and traumatic hip would provide information about treatment and prognosis. The authors analyzed the vascular changes of femoral head among unilateral avascular necrosis, bilateral avascular necrosis, and traumatic hips. Forty - four patients with avascular necrosis and 19 patients with traumatic hips were examined by selective angiography of the medial femoral circumflex artery. In the traumatic hip cases, 12 (63%) showed occlusion, 2 (11%) hypertrophy of the capsular branches, and 5 ( 26 % ) were normal . In the avascular necrosis cases, 15 (25%) showed occlusion, 39 (67%) had hypertrophy of the capsular branches, and 4 (7%) had normal findings. Hypertrophy of the superior capsular branch of the medial femoral circumflex artery is more frequently observed in avascular necrosis than in traumatic hip. Bilateral avascular necrosis reveals more frequent incidences than unilateral cases. Selective angiography could help in the therapy plan and also provide information about the contralateral side

  6. Transvenous liver biopsy via the femoral vein

    International Nuclear Information System (INIS)

    Khosa, F.; McNulty, J.G.; Hickey, N.; O'Brien, P.; Tobin, A.; Noonan, N.; Ryan, B.; Keeling, P.W.N.; Kelleher, D.P.; McDonald, G.S.A.

    2003-01-01

    AIM: To study the safety, effectiveness and diagnostic value of transvenous forceps biopsy of the liver in 54 patients with coagulopathy, gross ascites or morbid obesity and suspected liver disease in whom percutaneous liver biopsy was contraindicated. MATERIAL AND METHODS: Forceps biopsy of the liver via the femoral vein was attempted in 54 adult patients with advanced liver disease of unknown aetiology who had coagulation disorders (41 cases), gross ascites (11 cases) or morbid obesity (two cases). In each patient two to six biopsies (average four) were taken using a radial jaw forceps inserted via the right or left femoral vein. RESULTS: The procedure was successful in 53 cases. Hepatic vein catheterization failed in one patient. Adequate liver tissue for diagnosis was obtained in 84% of cases. One patient developed delayed haemorrhage at 12 h from a capsular leak that was undetected during the biopsy procedure. This patient required blood transfusions and laparotomy to control bleeding. There were no deaths in the 53 patients studied. Transient minor chest and shoulder pain was encountered during sheath insertion into a hepatic vein in 23 patients. Three patients developed a femoral vein haematoma, which resolved with conservative treatment. CONCLUSION: Transvenous liver biopsy via the femoral vein is another safe, effective, simple alternative technique of biopsy when the percutaneous route is contraindicated

  7. EPIDEMIOLOGICAL STUDY OF CHILDREN DIAPHYSEAL FEMORAL FRACTURES.

    Science.gov (United States)

    Hoffmann, Cassiano Ricardo; Traldi, Eduardo Franceschini; Posser, Alexandre

    2012-01-01

    To evaluate the personal, fracture, treatment and complication characteristics among patients with pediatric femoral shaft fractures attended at the pediatric orthopedic service of the Joana de Gusmão Children's Hospital. This was a retrospective cross-sectional study on a population consisting of patients with femoral shaft fractures, aged between birth and 14 years and 11 months, who were divided into four age groups. Information was obtained from medical records and was transferred to a survey questionnaire to present personal, fracture, treatment and complication variables. The study population consisted of 96 patients. Their mean age was 6.8 years. The cases were predominantly among males, comprising closed fractures on the right side, in the middle third with a single line. Regarding fracture etiology, traffic accidents predominated overall in the sample. Most of the patients (74 to 77.1%) presented femoral fractures as their only injury. Conservative treatment predominated in the group younger than six years of age, and surgical treatment in the group aged 6 to 14 years and 11 months. The complications observed until bone union were: discrepancy, infection and movement limitation. The mean time taken for consolidation was 9.6 ± 2.4 weeks, varying with age. The features of these fractures were similar to those described in the literature and the treatment used showed good results. The Joana de Gusmão Children's Hospital has used the treatment proposed in the literature for pediatric femoral shaft fractures.

  8. Aseptic necrosis of femoral head complicating thalassemia

    International Nuclear Information System (INIS)

    Orzincolo, C.; Castaldi, G.; Scutellary, P.N.; Bariani, L.; Pinca, A.

    1986-01-01

    Aseptic necrosis of the femoral head is described in 4 patients, selected from 280 patients with homozygous β-thalassemia (Cooley anemia). The incidence of the complication appears to be very high (14.5per mille) in thalassemia, compared to the general population. The possible mechanism are discussed. (orig.)

  9. Proximal femoral derotation osteotomy for idiopathic excessive femoral anteversion and intoeing gait

    Directory of Open Access Journals (Sweden)

    Naqvi Gohar

    2017-01-01

    Full Text Available Aim: The purpose of this study is to assess the symptoms caused by excessive femoral anteversion and the outcomes of femoral derotation osteotomy. Methods: We reviewed data on patients who underwent proximal femoral derotation osteotomy for symptomatic intoeing gait caused by femoral anteversion. Only symptomatic patients were considered for corrective derotation osteotomy. Degree of femoral anteversion was confirmed on computed tomography (CT scan. Results: Thirty-five extremities were operated in 21 patients with an average age of 13.3 (8–18 years. Mean follow-up was 16 months (6–36 months. Mean femoral anteversion angle was 40.8° (28°–53°. External rotation of extended hips improved significantly, from 30° to 51.8° (p < 0.0001. Mean foot progressing angle improved from 15.2° internally rotated preoperatively to 7.7° externally rotated. Intoeing completely resolved in all except two patients. Thirteen out of 21 children complained about tripping and frequent falling while running and playing sports, eight patients had hip pain while 13 children had knee pain preoperatively. Tripping, falling and hip pain resolved in all patients postoperatively, while three patients whose primary complaint was knee pain failed to improve postsurgery. Eighteen of the 21 parents were satisfied with the decision to perform surgical correction. Conclusion: Excessive femoral anteversion can present with unexplained hip or knee pain refractory to conservative treatments. Careful assessment of lower limb malalignment is a valuable tool in such circumstances and derotation proximal femoral osteotomy can certainly be a procedure of choice in carefully selected cases.

  10. Preoperative virtual reduction reduces femoral malrotation in the treatment of bilateral femoral shaft fractures.

    Science.gov (United States)

    Omar, Mohamed; Suero, Eduardo M; Hawi, Nael; Decker, Sebastian; Krettek, Christian; Citak, Musa

    2015-10-01

    In bilateral femoral shaft fractures, significant malrotation (>15°) occurs in about 40 % of cases after intramedullary nailing. Most of the methods that provide rotational control during surgery are based on a comparison to the intact femur and, thus, not applicable for bilateral fractures. In this study, we evaluated if preoperative virtual reduction can help improving rotational alignment in patients with bilateral femoral shaft fractures. Seven patients with bilateral femoral shaft fractures were initially treated with external fixation of both femurs. After obtaining a CT scan of both legs, the fractures were reduced virtually using the software program VoXim®, and the amount and direction of rotational correction were calculated. Subsequently, the patients were treated by antegrade femoral nailing and rotation was corrected to the preoperatively calculated amount. After external fixation, the mean rotational difference between both legs was 15.0° ± 10.2°. Four out of seven patients had a significant malrotation over 15°. Following virtual reduction, the mean rotational difference between both legs was 2.1° ± 1.2°. After intramedullary nailing, no case of malrotation occurred and the mean rotational difference was 6.1° ± 2.8°. Preoperative virtual reduction allows determining the pretraumatic femoral antetorsion and provided useful information for the definitive treatment of bilateral femoral shaft fractures. We believe that this procedure is worth being implemented in the clinical workflow to avoid malrotation after intramedullary nailing.

  11. Rotational position of femoral and tibial components in TKA using the femoral transepicondylar axis.

    Science.gov (United States)

    Aglietti, Paolo; Sensi, Lorenzo; Cuomo, Pierluigi; Ciardullo, Antonio

    2008-11-01

    Proper femoral and tibial component rotational positioning in TKA is critical for outcomes. Several rotational landmarks are frequently used with different advantages and limitations. We wondered whether coronal axes in the tibia and femur based on the transepicondylar axis in the femur would correlate with anteroposterior deformity. We obtained computed tomography scans of 100 patients with arthritis before they underwent TKA. We measured the posterior condylar angle on the femoral side and the angle between Akagi's line and perpendicular to the projection of the femoral transepicondylar axis on the tibial side. On the femoral side, we found a linear relationship between the posterior condylar angle and coronal deformity with valgus knees having a larger angle than varus knees, ie, gradual external rotation increased with increased coronal deformity from varus to valgus. On the tibial side, the angle between Akagi's line and the perpendicular line to the femoral transepicondylar axis was on average approximately 0 degrees , but we observed substantial interindividual variability without any relationship to gender or deformity. A preoperative computed tomography scan was a useful, simple, and relatively inexpensive tool to identify relevant anatomy and to adjust rotational positioning. We do not, however, recommend routine use because on the femoral side, we found a relationship between rotational landmarks and coronal deformity.

  12. Femoral neck fracture following groin irradiation

    International Nuclear Information System (INIS)

    Grigsby, Perry W.; Roberts, Heidi L.; Perez, Carlos A.

    1995-01-01

    Purpose: The incidence and risk factors are evaluated for femoral neck fracture following groin irradiation for gynecologic malignancies. Methods and Materials: The radiation therapy records of 1313 patients with advanced and recurrent cancer of the vagina, vulva, cervix, and endometrium, treated at the Mallinckrodt Institute of Radiology from 1954 to 1992, were reviewed. Median follow-up was 12.7 years. From this group, 207 patients were identified who received irradiation to the pelvis and groins with anterposterior-posterior anterior (AP-PA), 18 MV photons. Data were reviewed regarding irradiation dose to the femoral neck and other presumed risk factors including age, primary site, stage, groin node status, menopausal status, estrogen use, cigarette use, alcohol consumption, and osteoporosis. Results: The per-patient incidence of femoral neck fracture was 4.8% (10 out of 207). Four patients developed bilateral fractures. However, the cumulative actuarial incidence of fracture was 11% at 5 years and 15% at 10 years. Cox multivariate analysis of age, weight, and irradiation dose showed that only irradiation dose may be important to developing fracture. Step-wise logistic regression of presumed prognostic factors revealed that only cigarette use and x-ray evidence of osteoporosis prior to irradiation treatment were predictive of fracture. Conclusion: Femoral head fracture is a common complication of groin irradiation for gynecologic malignancies. Fracture in our database appears to be related to irradiation dose, cigarette use, and x-ray evidence of osteoporosis. Special attention should be given in treatment planning (i.e., shielding of femoral head/neck and use of appropriate electron beam energies for a portion of treatment) to reduce the incidence of this complication

  13. Organization of haemopoietic stem cells: the generation-age hypothesis

    International Nuclear Information System (INIS)

    Rosendaal, M.; Hodgson, G.S.; Bradley, T.R.

    1978-01-01

    This paper proposes that the previous division history of each stem cell is one determinant of the functional organisation of the haemopoietic stem cell population. Older stem cell are used to form blood before younger ones. The stem cells generating capacity of a lineage is finite, and cells are eventually lost to the system by forming two committed precursors of the cell lines, and the next oldest stem cell takes over. Hence the proposed term 'generation-age hypothesis', supported by experimental evidence. Older stem cells from normal bone marrow and 13 day foetal liver were stripped away with phase-specific drugs revealing a younger population of stem cells with three-to four-fold greater stem cell generating capacity. Normal stem cells aged by continuous irradiation and serial retransplantation had eight-fold reduced generating capacity. That of stem cells in the bloodstream was half to a quarter that of normal bone marrow stem cells. There were some circulating stem cells, identified by reaction to brain-associated antigen, positive for 75% of normal femoral stem cells but not their progeny, whose capacity for stem cell generation was an eighth to one fortieth that of normal cells. (U.K.)

  14. CT study of avascular necrosis of femoral head in adults

    International Nuclear Information System (INIS)

    Liu Jihua; Du Yuqing; Xu Aide

    2000-01-01

    Objective: To study the early and new CT signs of avascular necrosis of femoral head in adults. Methods: The CT scans of 127 cases with this condition were analyzed. Results: There were 90 hip joints with femoral head normal in shape, including 67 femoral heads with only high-density sclerosis and 23 ones with high-density and low-density areas. In 111 hip joints, the femoral head was depressed and manifested purely high-density sclerosis in 25 and mixed-density areas in 86. Air-filled cysts appeared in 43 femoral heads. In follow-up cases, the changes in shape and density of femoral head followed some rules. Conclusion: Purely high-density sclerosis is an early sign and is of great diagnostic value combined with its special shape. Air in femoral heads is also a sign of the disease

  15. Multicriteria Decision Analysis in Improving Quality of Design in Femoral Component of Knee Prostheses: Influence of Interface Geometry and Material

    Directory of Open Access Journals (Sweden)

    Ali Jahan

    2015-01-01

    Full Text Available Knee prostheses as medical products require careful application of quality and design tool to ensure the best performance. Therefore, quality function deployment (QFD was proposed as a quality tool to systematically integrate consumer’s expectation to perceived needs by medical and design team and to explicitly address the translation of customer needs into engineering characteristics. In this study, full factorial design of experiment (DOE method was accompanied by finite element analysis (FEA to evaluate the effect of inner contours of femoral component on mechanical stability of the implant and biomechanical stresses within the implant components and adjacent bone areas with preservation of the outer contours for standard Co-Cr alloy and a promising functionally graded material (FGM. The ANOVA revealed that the inner shape of femoral component influenced the performance measures in which the angle between the distal and anterior cuts and the angle between the distal and posterior cuts were greatly influential. In the final ranking of alternatives, using multicriteria decision analysis (MCDA, the designs with FGM was ranked first over the Co-Cr femoral component, but the original design with Co-Cr material was not the best choice femoral component, among the top ranked design with the same material.

  16. Wear and migration of highly cross-linked and conventional cemented polyethylene cups with cobalt chrome or Oxinium femoral heads: a randomized radiostereometric study of 150 patients.

    Science.gov (United States)

    Kadar, Thomas; Hallan, Geir; Aamodt, Arild; Indrekvam, Kari; Badawy, Mona; Skredderstuen, Arne; Havelin, Leif Ivar; Stokke, Terje; Haugan, Kristin; Espehaug, Birgitte; Furnes, Ove

    2011-08-01

    This randomized study was performed to compare wear and migration of five different cemented total hip joint articulations in 150 patients. The patients received either a Charnley femoral stem with a 22.2 mm head or a Spectron EF femoral stem with a 28 mm head. The Charnley articulated with a γ-sterilized Charnley Ogee acetabular cup. The Spectron EF was used with either EtO-sterilized non-cross-linked polyethylene (Reflection All-Poly) or highly cross-linked (Reflection All-Poly XLPE) cups, combined with either cobalt chrome (CoCr) or Oxinium femoral heads. The patients were followed with repeated RSA measurements for 2 years. After 2 years, the EtO-sterilized non-cross-linked Reflection All-Poly cups had more than four times higher proximal penetration than its highly cross-linked counterpart. Use of Oxinium femoral heads did not affect penetration at 2 years compared to heads made of CoCr. Further follow-up is needed to evaluate the benefits, if any, of Oxinium femoral heads in the clinical setting. The Charnley Ogee was not outperformed by the more recently introduced implants in our study. We conclude that this prostheses still represents a standard against which new implants can be measured. Copyright © 2011 Orthopaedic Research Society.

  17. Types of Stem Cells

    Science.gov (United States)

    ... PDF) Download an introduction to stem cells and stem cell research. Stem Cell Glossary Stem cell terms to know. ... stem cells blog from the International Society for Stem Cell Research. Learn About Stem Cells From Lab to You ...

  18. Comparison of mechanical stress and change in bone mineral density between two types of femoral implant using finite element analysis.

    Science.gov (United States)

    Hirata, Yasuhide; Inaba, Yutaka; Kobayashi, Naomi; Ike, Hiroyuki; Fujimaki, Hiroshi; Saito, Tomoyuki

    2013-12-01

    Stress shielding after total hip arthroplasty (THA) remains an unsolved issue. Various patterns of mechanical stress appear according to the type of femoral stem used. To compare differences in mechanical stress conditions between Zweymuller type and fit-and-fill type stems, finite element analysis (FEA) was performed. Differences in bone mineral density (BMD) changes in the femur were also compared. Maximum stress was confirmed in Gruen zone 4, whereas zone 1 had the minimum amount of stress with both types of implant. The Zweymuller stem group had less mechanical stress and lower BMD in zone 7 than the fit-and-fill stem group. In conclusion, differences in mechanical stress may be related to changes in BMD after THA. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. Results of cemented bipolar hemiarthroplasty for fracture of the femoral neck - 10 year study

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    Maini P

    2006-01-01

    Full Text Available Background : One of the most common treatments of displaced fracture of femoral neck in elderly is bipolar hemiarthroplasty. Method : Two hundred and seventy patients of displaced fracture of femoral neck were treated by bipolar hemiarthroplasty. The Mean age of the patients at the time of surgery was 69.80 years. Results : Follow up ranged between 12 months and 120 months. There were 8 cases each of acetabular erosion and protrusion with 10 cases of femoral stem loosening. Eight cases had post operative dislocation requiring open reduction. Eighteen patients got revision surgery to total hip replacement. The overall incidence of DVT/PE was 9.9% which declined after regular use of low molecular weight heparin. Eleven patients had post operative infection. There were 54.2 % excellent results, 21.0 % good results, 10.7 % fair and 3.7% poor results. Conclusion : Elderly patients with displaced fracture of neck femur are able to ambulate early after Cemented bipolar hemi arthroplasty. The complication rate is low, the component survival long and pre injury functional status is restored in majority of patients.

  20. Alumina-on-alumina total hip replacement for femoral neck fracture in healthy patients

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    Moretti Lorenzo

    2011-02-01

    Full Text Available Abstract Background Total hip replacement is considered the best option for treatment of displaced intracapsular fractures of the femoral neck (FFN. The size of the femoral head is an important factor that influences the outcome of a total hip arthroplasty (THA: implants with a 28 mm femoral head are more prone to dislocate than implants with a 32 mm head. Obviously, a large head coupled to a polyethylene inlay can lead to more wear, osteolysis and failure of the implant. Ceramic induces less friction and minimal wear even with larger heads. Methods A total of 35 THAs were performed for displaced intracapsular FFN, using a 32 mm alumina-alumina coupling. Results At a mean follow-up of 80 months, 33 have been clinically and radiologically reviewed. None of the implants needed revision for any reason, none of the cups were considered to have failed, no dislocations nor breakage of the ceramic components were recorded. One anatomic cementless stem was radiologically loose. Conclusions On the basis of our experience, we suggest that ceramic-on-ceramic coupling offers minimal friction and wear even with large heads.

  1. Late Nontraumatic Dissociation of the Femoral Head and Trunnion in a Total Hip Arthroplasty

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    Simon J. M. Parker

    2015-01-01

    Full Text Available Background. Modular total hip arthroplasties are increasingly popular because customisation allows optimal restoration of patient biomechanics. However, the introduction of component interfaces provides greater opportunities for failure. We present a case of late nontraumatic dissociation of the head-neck interface, more than 10 years after insertion. Case Description. A 58-year-old woman had a left metal-on-metal total hip arthroplasty in 2002 for hip dysplasia. Following an uneventful 10-year period, she presented to hospital in severe pain after standing from a seated position, and radiographs demonstrated complete dissociation of the modular femoral head from the stem, with the femoral head remaining in its cup. There was no prior trauma or infection. Mild wear and metallosis were present on the articulating surface between the femoral head and trunnion. Soft tissues were unaffected. Discussion and Conclusions. This is the latest occurrence reported to date for nontraumatic component failure in such an implant by more than 7 years. The majority of cases occur in the context of dislocation and attempted closed reduction. We analyse and discuss possible mechanisms for failure, aiming to raise awareness of this potential complication and encouraging utmost care in component handling and insertion, as well as the long term follow-up of such patients.

  2. Femoral neck fractures: a changing paradigm.

    Science.gov (United States)

    Su, E P; Su, S L

    2014-11-01

    Surgical interventions consisting of internal fixation (IF) or total hip replacement (THR) are required to restore patient mobility after hip fractures. Conventionally, this decision was based solely upon the degree of fracture displacement. However, in the last ten years, there has been a move to incorporate patient characteristics into the decision making process. Research demonstrating that joint replacement renders superior functional results when compared with IF, in the treatment of displaced femoral neck fractures, has swayed the pendulum in favour of THR. However, a high risk of dislocation has always been the concern. Fortunately, there are newer technologies and alternative surgical approaches that can help reduce the risk of dislocation. The authors propose an algorithm for the treatment of femoral neck fractures: if minimally displaced, in the absence of hip joint arthritis, IF should be performed; if arthritis is present, or the fracture is displaced, then THR is preferred. ©2014 The British Editorial Society of Bone & Joint Surgery.

  3. Intracorporeal knotting of a femoral nerve catheter

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    Ghanem, Mohamed

    2015-01-01

    Full Text Available Peripheral nerve catheters are effective and well-established tools to provide postoperative analgesia to patients undergoing orthopedic surgery. The performance of these techniques is usually considered safe. However, placement of nerve catheters may be associated with a considerable number of side effects and major complications have repeatedly been published. In this work, we report on a patient who underwent total knee replacement with spinal anesthesia and preoperative insertion of femoral and sciatic nerve catheters for postoperative analgesia. During insertion of the femoral catheter, significant resistance was encountered upon retracting the catheter. This occurred due to knotting of the catheter. The catheter had to be removed by operative intervention which has to be considered a major complication. The postoperative course was uneventful. The principles for removal of entrapped peripheral catheters are not well established, may differ from those for neuroaxial catheters, and range from cautious manipulation up to surgical intervention.

  4. Spontaneous stress fractures of the femoral neck

    International Nuclear Information System (INIS)

    Dorne, H.L.; Lander, P.H.

    1985-01-01

    The diagnosis of spontaneous stress fractures of the femoral neck, a form of insufficiency stress fracture, can be missed easily. Patients present with unremitting hip pain without a history of significant trauma or unusual increase in daily activity. The initial radiographic features include osteoporosis, minor alterations of trabecular alignment, minimal extracortical or endosteal reaction, and lucent fracture lines. Initial scintigraphic examinations performed in three of four patients showed focal increased radionuclide uptake in two and no focal abnormality in one. Emphasis is placed on the paucity of early findings. Evaluation of patients with persistent hip pain requires a high degree of clinical suspicion and close follow-up; the sequelae of undetected spontaneous fractures are subcapital fracture with displacement, angular deformity, and a vascular necrosis of the femoral head

  5. Radionuclide evaluation of spontaneous femoral osteonecrosis

    International Nuclear Information System (INIS)

    Greyson, N.D.; Lotem, M.M.; Gross, A.E.; Houpt, J.B.

    1982-01-01

    Spontaneous osteonecrosis of the femoral condyle in 40 knees was followed by sequential radiographs and three-phase bone scans using 99 /sup m/Tc-methylene diphosphonate. The characteristic bone scan appearance of focal increased uptake by the medial femoral condyle in blood flow, blood pool, and delayed images helped to make the specific diagnosis in 11 knees that had no characteristic radiographic findings at the time of presentation. The three phases of the bone scan demonstrated a pattern that was useful in determining the activity of the process. There was a gradual loss of hyperemia as healing progressed. Late bone scans were normal or showed nonspecific findings. Radionuclide bone scans were able to confirm or exclude this disease and were superior to radiographs in demonstrating the disease in the acute phase

  6. Intra-pelvic migration of femoral head trial in total hip arthroplasty, a rare intra-operative complication: a systematic literature review.

    Science.gov (United States)

    Abouel-Enin, S; Fraig, H; Griffiths, J; Latham, J

    2016-08-01

    Trial reduction while performing total hip replacement is an essential step of the procedure. This is to check the stability of the hip joint with the selected implant sizes and to assess the leg length to avoid discrepancy. Disengagement of the femoral head trial from the femoral rasp stem with subsequent migration of the trial head into the pelvic cavity is a rare occurrence, but can be a very frustrating complication to both the surgeon and occasionally the patient. We present our experience with this exceptional situation and different management options, together with systematic review of the literature.

  7. Radiofrequency ablation of two femoral head chondroblastomas

    Energy Technology Data Exchange (ETDEWEB)

    Petsas, Theodore [Department of Radiology, University of Patras (Greece); Megas, Panagiotis [Department of Orthopaedic Surgery, University of Patras (Greece)]. E-mail: panmegas@med.upatras.gr; Papathanassiou, Zafiria [Department of Radiology, University of Patras (Greece)

    2007-07-15

    Chondroblastoma is a rare benign cartilaginous bone tumor. Surgical resection is the treatment of choice for pain relief and prevention of further growth. Open surgical techniques are associated with complications, particularly when the tumors are located in deep anatomical sites. The authors performed RF ablation in two cases of subarticular femoral head chondroblastomas and emphasize its positive impact. The clinical course, the radiological findings and the post treatment results are discussed.

  8. Ipsilateral femoral neck and trochanter fracture

    Directory of Open Access Journals (Sweden)

    Devdatta S Neogi

    2011-01-01

    Full Text Available Ipsilateral fractures in the neck and trochanteric region of the femur are very rare and seen in elderly osteoporotic patients. We present a case of a young man who presented with ipsilateral fracture of the femoral neck and a reverse oblique fracture in the trochanteric region following a motor vehicle accident. A possible mechanism, diagnostic challenge, and awareness required for identifying this injury are discussed.

  9. [Avascular necrosis of the femoral head].

    Science.gov (United States)

    Porubský, Peter; Trč, Tomáš; Havlas, Vojtěch; Smetana, Pavel

    Avascular necrosis of the femoral head in adults is not common, but not too rare diseases. In orthopedic practice, it is one of the diseases that are causing implantation of hip replacement at a relatively early age. In the early detection and initiation of therapy can delay the implantation of prosthesis for several years, which is certainly more convenient for the patient and beneficial. This article is intended to acquaint the reader with the basic diagnostic procedures and therapy.

  10. Proximal focal femoral deficiency: A case report

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    Shashank Sharma

    2015-01-01

    Full Text Available Proximal focal femoral deficiency (PFFD is a rare congenital anomaly resulting in limb shortening and disability in young. The exact cause of the disease is not known and it may present as varying grades of affection involving the proximal femur and the acetabulum. Recognition of this rare abnormality on radiographs can help manage these cases better since early institution of therapy may help in achieving adequate growth of the femur.

  11. [Pregnancy-associated femoral nerve affection].

    Science.gov (United States)

    Pildner von Steinburg, S; Kühler, A; Herrmann, N; Fischer, T; Schneider, K T

    2004-10-01

    Common neuropathies during pregnancy are carpal tunnel syndrome or peripheral facial paralysis. However, there is little information about femoral nerve affection during pregnancy. We report on a female at 30 weeks of gestation, complaining of pain in hips and thighs and gait difficulty. Pregnancy was normally developed. Neurological examination showed a bilateral weakness in both quadriceps and iliopsoas muscles combined with soreness in hips and thighs, without deficits of sensibility. Laboratory findings and results of a lumbar punction were normal. Pelvic ultrasound and an MRI scan of the spine and pelvis showed no mass or disc prolaps. Neuromyographic evaluation bilaterally revealed acute signs of denervation of the muscles innervated by femoral nerve. Caesarean section was performed at 32 gestational weeks, as pain was unbearable and refractory to treatment with even opiates. Post partum, pain relieved immediately, and after weeks of physiotherapy, complete remission was achieved. This unusual manifestation of a neuropathy in pregnancy could be due to pressure on the femoral nerve. The patients' anxiety can be eliminated, as the described cases in literature show an excellent prognosis. However, the severity of symptoms can lead us to necessity of premature delivery.

  12. Femoral Head Bone Loss Following Short and Long-Duration Spaceflight

    Science.gov (United States)

    Blaber, Elizabeth A.; Cheng-Campbell, Margareth A.; Almeida, Eduardo A. C.

    2016-01-01

    Exposure to mechanical unloading during spaceflight is known to have significant effects on the musculoskeletal system. Our ongoing studies with the mouse bone model have identified the failure of normal stem cell-based tissue regeneration, in addition to tissue degeneration, as a significant concern for long-duration spaceflight, especially in the mesenchymal and hematopoietic tissue lineages. The 30-day BionM1 and the 37-day Rodent Research 1 (RR1) missions enabled the possibility of studying these effects in long-duration microgravity experiments. We hypothesized that the inhibition of stem cell-based tissue regeneration in short-duration spaceflight would continue during long-duration spaceflight and furthermore would result in significant tissue alterations. MicroCT analysis of BionM1 femurs revealed 31 decrease in bone volume ratio, a 14 decrease in trabecular thickness, and a 20 decrease in trabecular number in the femoral head of space-flown mice. Furthermore, high-resolution MicroCT and immunohistochemical analysis of spaceflight tissues revealed a severe disruption of the epiphyseal boundary, resulting in endochondral ossification of the femoral head and perforation of articular cartilage by bone. This suggests that spaceflight in microgravity may cause rapid induction of an aging-like phenotype with signs of osteoarthritic disease in the hip joint. However, mice from RR1 exhibited significant bone loss in the femoral head but did not exhibit the severe aging and disease-like phenotype observed during BionM1. This may be due to increased physical activity in the RH hardware. Immunohistochemical analysis of the epiphyseal plate and investigation of cellular proliferation and differentiation pathways within the marrow compartment and whole bone tissue is currently being conducted to determine alterations in stem cell-based tissue regeneration between these experiments. Our results show that the observed inhibition of stem cell-based tissue regeneration

  13. Bone Like Arterial Calcification in Femoral Atherosclerotic Lesions: Prevalence and Role of Osteoprotegerin and Pericytes.

    Science.gov (United States)

    Davaine, J-M; Quillard, T; Chatelais, M; Guilbaud, F; Brion, R; Guyomarch, B; Brennan, M Á; Heymann, D; Heymann, M-F; Gouëffic, Y

    2016-02-01

    Arterial calcification, a process that mimics bone formation, is an independent risk factor of cardiovascular morbidity and mortality, and has a significant impact on surgical and endovascular procedures and outcomes. Research efforts have focused mainly on the coronary arteries, while data regarding the femoral territory remain scarce. Femoral endarterectomy specimens, clinical data, and plasma from a cohort of patients were collected prospectively. Histological analysis was performed to characterize the cellular populations present in the atherosclerotic lesions, and that were potentially involved in the formation of bone like arterial calcification known as osteoid metaplasia (OM). Enzyme linked immunosorbent assays and cell culture assays were conducted in order to understand the cellular and molecular mechanisms underlying the formation of OM in the lesions. Twenty-eight of the 43 femoral plaques (65%) displayed OM. OM included osteoblast and osteoclast like cells, but very few of the latter exhibited the functional ability to resorb mineral tissue. As in bone, osteoprotegerin (OPG) was significantly associated with the presence of OM (p = .04). Likewise, a high plasma OPG/receptor activator for the nuclear factor kappa B ligand (RANKL) ratio was significantly associated with the presence of OM (p = .03). At the cellular level, there was a greater presence of pericytes in OM+ compared with OM- lesions (5.59 ± 1.09 vs. 2.42 ± 0.58, percentage of area staining [region of interest]; p = .04); in vitro, pericytes were able to inhibit the osteoblastic differentiation of human mesenchymal stem cells, suggesting that they are involved in regulating arterial calcification. These results suggest that bone like arterial calcification (OM) is highly prevalent at femoral level. Pericyte cells and the OPG/RANK/RANKL triad seem to be critical to the formation of this ectopic osteoid tissue and represent interesting potential therapeutic targets to reduce the clinical

  14. Revisiones de cadera en defectos óseos femorales Paprosky II y IIIA Utilización de prótesis no cementada, modular, de fijación proximal y anclaje distal. [Revision total hip arthroplasty in Paprosky II and IIIA femoral bone defects. Use of modular uncemented stems with proximal fixation ].

    Directory of Open Access Journals (Sweden)

    German Garabano

    2016-05-01

    Full Text Available Introducción: El objetivo de este estudio retrospectivo fue observar el comportamiento de un tallo modular de fijación proximal y anclaje distal en revisiones de cadera con defectos femorales II y IIIA (Praposky, evaluando la estabilidad protésica y articular, la restauración del off-set y la discrepancia de longitud. Materiales: Analizamos 22 RRTC de los cuales 12 (56,5% fueron mujeres y 10 varones con un promedio de edad de 62,38 años. El seguimiento promedio fue de 62 meses. El tallo femoral utilizado fue el S-ROM ® (Depuy – J&J. Los defectos óseos femorales fueron 15 tipo II y 7 IIIA de Praposky. Para la evaluación clínica se utilizó el Score de cadera de Harris (HHS. Radiológicamente se analizó el comportamiento del tallo, su integración, la discrepancia de longitud y el off-set femoral, considerándose como correcto una diferencia menor a 5mm. Resultados: el offset fue restaurado en 16 (72,3% casos y la longitud de miembros se restauró en 15 (68,2%. Hubo un solo hundimiento del tallo, y de acuerdo con Engh se observaron 17 (77,27% uniones óseas. Hubieron 7 (31,8% complicaciones, 2 luxaciones que requirieron revisión, 4 fracturas intra-operatorias y una paresia de CPE.   Conclusión este tallo impresiona ser una alternativa valida para resolver un problema complejo. Por su versatilidad, permite resolver mecánicamente el defecto óseo, devuelve la longitud al miembro y el off set a la articulación, presentando un índice de complicaciones aceptables.

  15. Evaluation of the hemodynamics of the femoral head compared with the ilium, femoral neck and femoral intertrochanteric region in healthy adults. Measurement with positron emission tomography (PET)

    International Nuclear Information System (INIS)

    Nakamura, Fuminori; Fujioka, Mikihiro; Takahashi, Kenji A.; Ueshima, Keiichiro; Arai, Yuji; Imahori, Yoshio; Itani, Kenji; Nishimura, Tsunehiko; Kubo, Toshikazu

    2005-01-01

    Non-traumatic osteonecrosis of the femoral head (ONF) is considered to be a disease that occurs primarily due to ischemia of the femoral head, while its etiology and pathology are not fully understood. It is therefore necessary to identify the characteristics of the hemodynamics of the femoral head. In this study, the hemodynamics in the ilium and proximal regions of the femur, including the femoral head, was investigated using positron emission tomography (PET). The subjects of this study consisted of 8 hip joints of four healthy male adults and 3 hip joints on the contralateral side of a femoral neck fracture, avulsion fracture of the greater trochanter and coxarthrosis (1 case each, all females) for a total of 11 hip joints of 7 subjects. The ages of the subjects ranged from 25 to 87 years (average age: 54 years). Blood flow was measured by means of the H 2 15 O dynamic study method and blood volume was measured by means of the 15 O-labeled carbon monoxide bolus inhalation method. Blood flow was determined to be 9.1±4.8 ml/min/100 g in the ilium and among proximal regions of the femur (femoral head, neck and intertrochanteric region), 1.8±0.7 ml/min/100 g in the femoral head, 2.1±0.6 ml/min/100 g in the femoral neck, and 2.6±0.7 ml/min/100 g in the intertrochanteric region. In addition, blood volume was 4.7±1.3 ml/100 g in the ilium, and among proximal regions of the femur, 1.1±0.5 ml/100 g in the femoral head, 2.1±0.7 ml/100 g in the femoral neck, and 2.6±0.9 ml/100 g in the intertrochanteric region. The results showed that both blood flow and volume were lowest in the femoral head. Blood flow and volume were significantly lower in the proximal regions of the femur (femoral head, neck and intertrochanteric region) than in the ilium (p<0.01). The present study demonstrated that the femoral head is in a hypoemic state as compared with other osseous tissue, indicating that even the slightest exacerbation of hemodynamics in the femoral head can trigger an

  16. Ipsilateral femoral neck and shaft fractures: An overlooked association

    International Nuclear Information System (INIS)

    Daffner, R.H.; Riemer, B.L.; Butterfield, S.L.

    1991-01-01

    A total of 304 patients with injuries to the femoral shaft and ipsilateral hip presented between 1984 and 1990. Some 253 of them suffered fractures of the femoral shaft and dislocated hips or fractures of the acetabulum, and 51 of these sustained fractures of the femoral shaft and neck or trochanteric region. All of the trochanteric injuries were demonstrated on the initial radiographs. However, in 11 of the patients with combined femoral shaft and neck fractures, the diagnosis was delayed by as much as 4 weeks. This delay related to the fact that these fractures tended not to separate in the initial evaluation period and that there was external rotation of the proximal femoral fragment due to the femoral shaft fracture. (orig./GDG)

  17. Ipsilateral femoral neck and shaft fractures: An overlooked association

    Energy Technology Data Exchange (ETDEWEB)

    Daffner, R.H. (Dept. of Diagnostic Radiology, Allegheny General Hospital, Pittsburgh, PA (USA) Medical Coll. of Pennsylvania, Pittsburgh, PA (USA)); Riemer, B.L.; Butterfield, S.L. (Dept. of Orthopedic Surgery, Allegheny General Hospital, Pittsburgh, PA (USA) Medical Coll. of Pennsylvania, Pittsburgh, PA (USA))

    1991-05-01

    A total of 304 patients with injuries to the femoral shaft and ipsilateral hip presented between 1984 and 1990. Some 253 of them suffered fractures of the femoral shaft and dislocated hips or fractures of the acetabulum, and 51 of these sustained fractures of the femoral shaft and neck or trochanteric region. All of the trochanteric injuries were demonstrated on the initial radiographs. However, in 11 of the patients with combined femoral shaft and neck fractures, the diagnosis was delayed by as much as 4 weeks. This delay related to the fact that these fractures tended not to separate in the initial evaluation period and that there was external rotation of the proximal femoral fragment due to the femoral shaft fracture. (orig./GDG).

  18. MR evaluation of femoral neck version and tibial torsion

    International Nuclear Information System (INIS)

    Koenig, James Karl; Dwek, Jerry R.; Pring, Maya E.

    2012-01-01

    Abnormalities of femoral neck version have been associated with a number of hip abnormalities in children, including slipped capital femoral epiphysis, proximal femoral focal deficiency, coxa vara, a deep acetabulum and, rarely, developmental dysplasia of the hip. Orthopedic surgeons also are interested in quantifying the femoral neck anteversion or retroversion in children especially to plan derotational osteotomies. Historically, the angle of femoral version and tibial torsion has been measured with the use of radiography and later by CT. Both methods carry with them the risks associated with ionizing radiation. Techniques that utilize MR are used less often because of the associated lengthy imaging times. This article describes a technique using MRI to determine femoral neck version and tibial torsion with total scan times of approximately 10 min. (orig.)

  19. Computerized tomography in evaluation of decreased acetabular and femoral anteversion

    International Nuclear Information System (INIS)

    Toennis, D.; Skamel, H.J.

    2003-01-01

    Computerized tomography has received a new importance. It has been shown that decreased anteversion of femur and acetabulum, when both have decreased angles, are causing pain and osteoarthritis of the hip joint. Operative treatment should be performed before osteoarthritis develops. Exact measurements therefore are necessary. The investigation should be performed in prone position to have the pelvis lying in a defined and normal position. Femoral torsion is measured between the transverse axis of the knee and the femoral neck. The transverse axis for measurement of the femoral anteversion is defined by a rectangular line to the sagittal plane. For evaluation of the femoral anteversion in total the angle of the condyles has to be added to the femoral neck angle when the knee is found in internal rotation. Acetabular anteversion should be measured at the level where the femoral head is still in full contact and congruence with the anterior margin of the acetabulum. (orig.) [de

  20. Incidence of Avascular Necrosis of the Femoral Head After Intramedullary Nailing of Femoral Shaft Fractures

    Science.gov (United States)

    Kim, Ji Wan; Oh, Jong-Keon; Byun, Young-Soo; Shon, Oog-Jin; Park, Jai Hyung; Oh, Hyoung Keun; Shon, Hyun Chul; Park, Ki Chul; Kim, Jung Jae; Lim, Seung-Jae

    2016-01-01

    Abstract The goal of this study was to determine the incidence of avascular necrosis of the femoral head (AVNFH) after intramedullary nailing of femoral shaft fractures and to identify risk factors for developing AVNFH. We retrospectively reviewed all patients with femoral shaft fractures treated with antegrade intramedullary nailing at 10 institutions. Among the 703 patients enrolled, 161 patients were excluded leaving 542 patients in the study. Average age was 42.1 years with average follow-up of 26.3 months. Patient characteristics and fracture patterns as well as entry point of femoral nails were identified and the incidence of AVNFH was investigated. Patients were divided into 2 groups according to open versus closed physis, open versus closed fractures, and age (<20 versus ≥20 years). Overall incidence of AVNFH was 0.2% (1 of 542): the patient was 15-year-old boy. Of 25 patients with open physis, the incidence of AVNFH was 4%, whereas none of 517 patients with closed physis developed AVNFH (P < 0.001). The incidence of AVNFH in patients aged < 20 versus ≥20 years was 1.1% (1 of 93) and 0.0% (0 of 449), respectively (P = 0.172), which meant that the incidence of AVNFH was 0% in adult with femur shaft fracture. Of 61 patients with open fractures, the incidence of AVNFH was 0%. The number of cases with entry point at the trochanteric fossa or tip of the greater trochanter (GT) was 324 and 218, respectively, and the incidence of AVNFH was 0.3% and 0.0%, respectively (P = 0.412). In patients aged ≥20 years with isolated femoral shaft fracture, there was no case of AVNFH following antegrade intramedullary nailing regardless of the entry point. Therefore, our findings suggest that the risk of AVNFH following antegrade femoral nailing is extremely low in adult patients. PMID:26844518

  1. Changes of the bone mineral density in proximal femur following total hip resurfacing arthroplasty in osteonecrosis of femoral head.

    Science.gov (United States)

    Lian, Yong-yun; Pei, Fu-xing; Yoo, Myung-chul; Cheng, Jing-qiu; Fatou, Camara-yagouba

    2008-04-01

    Total hip resurfacing arthroplasty (THRA) is being performed with increasing frequency for osteonecrosis of femoral head (ONFH). To evaluate femoral bone remodeling in ONFH after THRA and determine the impact of stem-neck angle (SNA) of inserted femoral component on bone remodeling, we monitored the changes in BMD in proximal femur in 23 patients with ONFH after surgery. Patients were divided into group A (SNA >or= 5 degrees ) and group B (SNA < 5 degrees ). The BMD was measured in seven Gruen zones and two neck zones using dual-energy X-ray absorptiometry preoperatively, then at 3, 6, 12, and 24 months after surgery. At all ROIs, the BMD decreased significantly by 3 months postoperatively. The BMD ceased to decrease and reversed by 6 months. The BMD in neck increased significantly in group A, compared with group B at 24 months. The BMD increased 2% at ROI1 at 24 months in both groups, and at ROI7, the BMD in group A reversed to baseline value by 6 months and increased 5.81% at 24 months. These findings implied that the bone stock of proximal femur in ONFH can be well reserved after total hip resurfacing arthroplasty with valgus positioning of the femoral component.

  2. Wear resistance of laser-deposited boride reinforced Ti-Nb-Zr-Ta alloy composites for orthopedic implants

    International Nuclear Information System (INIS)

    Samuel, Sonia; Nag, Soumya; Scharf, Thomas W.; Banerjee, Rajarshi

    2008-01-01

    The inherently poor wear resistance of titanium alloys limits their application as femoral heads in femoral (hip) implants. Reinforcing the soft matrix of titanium alloys (including new generation β-Ti alloys) with hard ceramic precipitates such as borides offers the possibility of substantially enhancing the wear resistance of these composites. The present study discusses the microstructure and wear resistance of laser-deposited boride reinforced composites based on Ti-Nb-Zr-Ta alloys. These composites have been deposited using the LENS TM process from a blend of elemental Ti, Nb, Zr, Ta, and boron powders and consist of complex borides dispersed in a matrix of β-Ti. The wear resistance of these composites has been compared with that of Ti-6Al-4V ELI, the current material of choice for orthopedic femoral implants, against two types of counterfaces, hard Si 3 N 4 and softer SS440C stainless steel. Results suggest a substantial improvement in the wear resistance of the boride reinforced Ti-Nb-Zr-Ta alloys as compared with Ti-6Al-4V ELI against the softer counterface of SS440. The presence of an oxide layer on the surface of these alloys and composites also appears to have a substantial effect in terms of enhanced wear resistance

  3. Delayed appearance of hypaesthesia and paralysis after femoral nerve block

    OpenAIRE

    Landgraeber, Stefan; Albrecht, Thomas; Reischuck, Ulrich; von Knoch, Marius

    2012-01-01

    We report on a female patient who underwent an arthroscopy of the right knee and was given a continuous femoral nerve block catheter. The postoperative course was initially unremarkable, but when postoperative mobilisation was commenced, 18 hours after removal of the catheter, the patient noticed paralysis and hypaesthesia. Examination confirmed the diagnosis of femoral nerve dysfunction. Colour duplex sonography of the femoral artery and computed tomography of the lumbar spine and pelvis yie...

  4. Hip geometry and femoral neck fractures: A meta-analysis.

    Science.gov (United States)

    Fajar, Jonny Karunia; Taufan, Taufan; Syarif, Muhammad; Azharuddin, Azharuddin

    2018-04-01

    Several studies have reported hip geometry to predict the femoral neck fractures. However, they showed inconsistency. To determine the association between hip geometry and femoral neck fractures. Published literature from PubMed and Embase databases (until May 25 th , 2017) was searched for eligible publications. The information related to (1) name of first author; (2) year of publication; (3) country of origin; (4) sample size of cases and controls and (5) mean and standard deviation of cases and controls were extracted. The pooled odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between hip geometry and femoral neck fractures were assessed using random or fixed effect model. A Comprehensive Meta-analysis software, version 2.0, was used to analyse the data. A total of 11 studies were included in this study. Our results showed that increase in hip axis length (OR 95% CI = 1.53 [1.06-2.21], p  = 0.025), femoral neck angle (OR 95% CI = 1.47 [1.01-2.15], p  = 0.044) and neck width (OR 95% CI = 2.68 [1.84-3.91], p  < 0.001) was associated with the risk of femoral neck fractures, whereas we could not find the correlation between femoral neck axis length and the risk of femoral neck fractures. There is strong evidence that elevated hip axis length, femoral neck angle and neck width are the risk factor for femoral neck fractures. The Translational Potential of this Article : Determining the hip axis length, femoral neck angle and neck width that are most highly associated with femoral neck fracture may allow clinicians to more accurately predict which individuals are likely to experience femoral neck fractures in the future.

  5. Femoral neck structure and function in early hominins.

    Science.gov (United States)

    Ruff, Christopher B; Higgins, Ryan

    2013-04-01

    All early (Pliocene-Early Pleistocene) hominins exhibit some differences in proximal femoral morphology from modern humans, including a long femoral neck and a low neck-shaft angle. In addition, australopiths (Au. afarensis, Au. africanus, Au. boisei, Paranthropus boisei), but not early Homo, have an "anteroposteriorly compressed" femoral neck and a small femoral head relative to femoral shaft breadth. Superoinferior asymmetry of cortical bone in the femoral neck has been claimed to be human-like in australopiths. In this study, we measured superior and inferior cortical thicknesses at the middle and base of the femoral neck using computed tomography in six Au. africanus and two P. robustus specimens. Cortical asymmetry in the fossils is closer overall to that of modern humans than to apes, although many values are intermediate between humans and apes, or even more ape-like in the midneck. Comparisons of external femoral neck and head dimensions were carried out for a more comprehensive sample of South and East African australopiths (n = 17) and two early Homo specimens. These show that compared with modern humans, femoral neck superoinferior, but not anteroposterior breadth, is larger relative to femoral head breadth in australopiths, but not in early Homo. Both internal and external characteristics of the australopith femoral neck indicate adaptation to relatively increased superoinferior bending loads, compared with both modern humans and early Homo. These observations, and a relatively small femoral head, are consistent with a slightly altered gait pattern in australopiths, involving more lateral deviation of the body center of mass over the stance limb. Copyright © 2013 Wiley Periodicals, Inc.

  6. Magnetic resonance imaging and histopathology in the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Takatori, Yoshio; Kamogawa, Morihide; Nakamura, Toshitaka; Ninomiya, Setsuo; Kokubo, Takashi

    1989-05-01

    To correlate the magnetic resonance (MR) images with the histopathological findings in the femoral head, the histopathology of 24 femoral heads, 15 with osteonecrosis, five with osteoarthritis and four with other hip disorders were subjected to preoperative MR imaging which demonstrated low intensity areas due to long T1 relaxation time in the femoral head. The MR signal was low where fibrovascular tissue, disintegrated fibrovascular tissue, amorphous necrotic material, bone, or cartilagenous tissue occupied the medullary space. From this study, it seems possible to predict the histopathologic changes in the femoral head using MR images. (author).

  7. Correlation Between Residual Displacement and Osteonecrosis of the Femoral Head Following Cannulated Screw Fixation of Femoral Neck Fractures.

    Science.gov (United States)

    Wang, Chen; Xu, Gui-Jun; Han, Zhe; Jiang, Xuan; Zhang, Cheng-Bao; Dong, Qiang; Ma, Jian-Xiong; Ma, Xin-Long

    2015-11-01

    The aim of the study was to introduce a new method for measuring the residual displacement of the femoral head after internal fixation and explore the relationship between residual displacement and osteonecrosis with femoral head, and to evaluate the risk factors associated with osteonecrosis of the femoral head in patients with femoral neck fractures treated by closed reduction and percutaneous cannulated screw fixation.One hundred and fifty patients who sustained intracapsular femoral neck fractures between January 2011 and April 2013 were enrolled in the study. All were treated with closed reduction and percutaneous cannulated screw internal fixation. The residual displacement of the femoral head after surgery was measured by 3-dimensional reconstruction that evaluated the quality of the reduction. Other data that might affect prognosis were also obtained from outpatient follow-up, telephone calls, or case reviews. Multivariate logistic regression analysis was applied to assess the intrinsic relationship between the risk factors and the osteonecrosis of the femoral head.Osteonecrosis of the femoral head occurred in 27 patients (18%). Significant differences were observed regarding the residual displacement of the femoral head and the preoperative Garden classification. Moreover, we found more or less residual displacement of femoral head in all patients with high quality of reduction based on x-ray by the new technique. There was a close relationship between residual displacement and ONFH.There exists limitation to evaluate the quality of reduction by x-ray. Three-dimensional reconstruction and digital measurement, as a new method, is a more accurate method to assess the quality of reduction. Residual displacement of the femoral head and the preoperative Garden classification were risk factors for osteonecrosis of the femoral head. High-quality reduction was necessary to avoid complications.

  8. A micro-architectural evaluation of osteoporotic human femoral heads to guide implant placement in proximal femoral fractures

    OpenAIRE

    Jenkins, Paul J; Ramaesh, Rishikesan; Pankaj, Pankaj; Patton, James T; Howie, Colin R; Goffin, J?r?me M; van der Merwe, Andrew; Wallace, Robert J; Porter, Daniel E; Simpson, A Hamish

    2013-01-01

    Background and purpose The micro-architecture of bone has been increasingly recognized as an important determinant of bone strength. Successful operative stabilization of fractures depends on bone strength. We evaluated the osseous micro-architecture and strength of the osteoporotic human femoral head. Material and methods 6 femoral heads, obtained during arthroplasty surgery for femoral neck fracture, underwent micro-computed tomography (microCT) scanning at 30 ?m, and bone volume ratio (BV/...

  9. Translating VDM to Alloy

    DEFF Research Database (Denmark)

    Lausdahl, Kenneth

    2013-01-01

    specifications. However, to take advantage of the automated analysis of Alloy, the model-oriented VDM specifications must be translated into a constraint-based Alloy specifications. We describe how a sub- set of VDM can be translated into Alloy and how assertions can be expressed in VDM and checked by the Alloy...

  10. Mechanical failure of hydroxyapatite-coated titanium and cobalt-chromium-molybdenum alloy implants. An animal study

    DEFF Research Database (Denmark)

    Nimb, L; Gotfredsen, K; Steen Jensen, J

    1993-01-01

    a histological and biomechanical evaluation of HA-coated titanium and cobalt-chromium-molybdenum alloy implants in a non-weight-bearing model. Twelve cylindrical plugs were inserted into the medial femoral condyle on 6 mongrel dogs. HA-coatings of 80-120 microns thickness were applied to 6 Cr-Co-Mo implants...

  11. Persistent knee complaints after retrograde unreamed nailing of femoral shaft fractures

    NARCIS (Netherlands)

    El Moumni, Mostafa; Schraven, Pim; ten Duis, Henk Jan; Wendt, Klaus

    Retrograde nailing is an attractive method for stabilisation of femoral shaft fractures in cases of polytrauma, ipsilateral pelvic, acetabular, tibial and femoral neck fractures, bilateral femoral fractures, obese and pregnant patients. However, retrograde nailing may result in complaints about the

  12. To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures

    International Nuclear Information System (INIS)

    Kaushik, Abhishek; Sankaran, Balu; Varghese, Mathew

    2010-01-01

    Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union. Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties. Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity after femoral neck fracture are 87%, 88% and 87%, respectively. Type A or Type B curve pattern is a positive factor to successful osteosynthesis with p value <0.0001 (Chi-square test). This is a statistically significant value. From this finding it can be suggested that the reliability of dynamic curves A and B in predicting maintained vascularity of femoral head is high. This investigation can be used to predict the vascularity of femoral head after intracapsular femoral neck fractures. There was a good correlation between the outcomes of fractures and dynamic MRI curves done within 48 h of injury. This signifies the role of dynamic MRI in predicting the vascularity of femoral head as early as 48 h. A treatment algorithm can be suggested on the basis of dynamic MRI curves. The fractures with Type C dynamic curve should be considered as fractures with poor vascularity of femoral head and measures to enhance the vascularity of femoral head along with rigid internal fixation should be undertaken to promote

  13. To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures

    Energy Technology Data Exchange (ETDEWEB)

    Kaushik, Abhishek, E-mail: abhiortho27@gmail.co [Department of Orthopedics, 513, Thermal Colony, Sector-22, Faridabad 121005, Haryana (India); Sankaran, Balu; Varghese, Mathew [Department of Orthopedics, St Stephen' s Hospital, Tis hazari, Delhi, New Delhi 110054 (India)

    2010-09-15

    Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union. Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties. Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity after femoral neck fracture are 87%, 88% and 87%, respectively. Type A or Type B curve pattern is a positive factor to successful osteosynthesis with p value <0.0001 (Chi-square test). This is a statistically significant value. From this finding it can be suggested that the reliability of dynamic curves A and B in predicting maintained vascularity of femoral head is high. This investigation can be used to predict the vascularity of femoral head after intracapsular femoral neck fractures. There was a good correlation between the outcomes of fractures and dynamic MRI curves done within 48 h of injury. This signifies the role of dynamic MRI in predicting the vascularity of femoral head as early as 48 h. A treatment algorithm can be suggested on the basis of dynamic MRI curves. The fractures with Type C dynamic curve should be considered as fractures with poor vascularity of femoral head and measures to enhance the vascularity of femoral head along with rigid internal fixation should be undertaken to promote

  14. Effect of implantation of biodegradable magnesium alloy on BMP-2 expression in bone of ovariectomized osteoporosis rats

    Energy Technology Data Exchange (ETDEWEB)

    Guo, Yue, E-mail: 373073766@qq.com [Liaoning Medical University, 40 Songpo Road, Jinzhou, 121000 (China); Ren, Ling, E-mail: lren@imr.ac.cn [Institute of Metal Research, Chinese Academy of Sciences, 72 Wenhua Road, Shenyang, 110016 (China); Liu, Chang, E-mail: meixifan1971@163.com [Liaoning Medical University, 40 Songpo Road, Jinzhou, 121000 (China); Yuan, Yajiang, E-mail: yuan925@163.com [Liaoning Medical University, 40 Songpo Road, Jinzhou, 121000 (China); Lin, Xiao, E-mail: linx@imr.ac.cn [Institute of Metal Research, Chinese Academy of Sciences, 72 Wenhua Road, Shenyang, 110016 (China); Tan, Lili, E-mail: lltan@imr.ac.cn [Institute of Metal Research, Chinese Academy of Sciences, 72 Wenhua Road, Shenyang, 110016 (China); Chen, Shurui, E-mail: 272146792@qq.com [Liaoning Medical University, 40 Songpo Road, Jinzhou, 121000 (China); Yang, Ke, E-mail: kyang@imr.ac.cn [Institute of Metal Research, Chinese Academy of Sciences, 72 Wenhua Road, Shenyang, 110016 (China); Mei, Xifan, E-mail: meixifan1971@163.com [Liaoning Medical University, 40 Songpo Road, Jinzhou, 121000 (China)

    2013-10-01

    The study was focused on the implantation of a biodegradable AZ31 magnesium alloy into the femoral periosteal of the osteoporosis modeled rats. The experimental results showed that after 4 weeks implantation of AZ31 alloy in the osteoporosis modeled rats, the expression of BMP-2 in bone tissues of the rats was much enhanced, even higher than the control group, which should promote the bone formation and be beneficial for reducing the harmful effect of osteoporosis. Results of HE stains showed that the implantation of AZ31 alloy did not have obvious pathological changes on both the liver and kidney of the animal. - Highlights: • Mg alloy greatly increased expression of BMP-2 in osteoporosis modeled rat bone. • Mg alloy showed good biological safety. • Mg alloy is beneficial for reducing the symptom of osteoporosis.

  15. The Femoral Epicondylar Frame to track femoral rotation in optoelectronic gait analysis

    NARCIS (Netherlands)

    Zurcher, A.W.; Wolterbeek, N.; Valstar, E.R.; Nelissen, R.G.H.H.; Poll, R.G.; Harlaar, J.

    2011-01-01

    Relative movement of skin markers to underlying bone limits a valid interpretation of axial femorotibial rotation in noninvasive optoelectronic gait analysis. A distal femoral clamp is a practical solution for thigh marker placement, however, existing devices are still susceptible to measurement

  16. [Retrograde locking nail osteosynthesis of distal femoral fractures with the distal femoral nail (DFN)].

    Science.gov (United States)

    Grass, R; Biewener, A; Rammelt, S; Zwipp, H

    2002-04-01

    Non-operative treatment with immobilization or isometric traction has been abandoned as treatment for fractures of the distal femur at the end of the 1960ies. The technique of open reduction and internal fixation with a condylar plate as suggested by the AO has been the golden standard since the 1970ies. However, anatomic reconstruction of the condylar region with interfragmentary screw fixation and axial realignment of the femur shaft with a plate are challenging procedures especially in the presence of severely compromised soft tissues and put periosteal blood supply at risk. Soft tissue complications, axial malalignment and delayed fracture healing times led to the consideration of alternative techniques, such as intramedullary nailing which has been practiced with success since the 1940ies by Gerhard Küntscher and colleagues for femoral shaft fractures with minimal complication rates and improved results after closed reduction. The era of retrograde femoral nailing began with the systematic approach through the intercondylar notch by Green. This paper reviews the biomechanical properties, indication, technique as well as potential hazards and pitfalls of fracture management with the AO "distal femoral nail" (DFN). With appropriate application this technique is suitable for all fractures of the distal third of the femoral shaft including highly instable bicondylar fractures without damage to the soft tissues and the knee joint.

  17. Role of Sonography in Clinically Occult Femoral Hernias.

    Science.gov (United States)

    Brandel, David W; Girish, Gandikota; Brandon, Catherine J; Dong, Qian; Yablon, Corrie; Jamadar, David A

    2016-01-01

    The purpose of this article is to evaluate the diagnostic accuracy of sonography in clinically occult femoral hernias and to describe our sonographic technique. The clinical and imaging data for 93 outpatients referred by general surgeons, all of whom underwent sonographic evaluation and surgery, were reviewed retrospectively. Of these, 55 patients who underwent surgical exploration for groin hernias within 3 months of sonography and met all inclusion criteria were included in the study. The sonographic technique involves using the pubic tubercle as an osseous landmark to identify and appropriately visualize the femoral canal. The Valsalva maneuver is then used to differentiate the movement of normal fat (a potential pitfall) from true herniation in the femoral canal. Surgical findings were used as the reference standard by which sonographic results were judged. Two-by-two contingency tables were used to calculate the sensitivity, specificity, positive predictive value, and negative predictive value. In these 55 patients, surgery revealed 15 femoral hernias. Eight femoral hernias occurred in women, and 7 occurred in men. For diagnosing femoral hernias, sonography demonstrated sensitivity of 80%, specificity of 88%, a positive predictive value of 71%, and a negative predictive value of 92%. True-positive cases of femoral hernias have a sonographic appearance of a hypoechoic sac with speckled internal echoes. When examining during the Valsalva maneuver, a femoral hernia passes deep to the inguinal ligament, expands the femoral canal, displacing the normal canal fat, and effaces the femoral vein. Sonography can exclude femoral hernias with high confidence in light of its exceptional negative predictive value. With attention to technique and imaging criteria, the diagnostic accuracy of sonography can be enhanced.

  18. [Treatment for ipsilateral fractures of the femoral neck and shaft].

    Science.gov (United States)

    Liu, Shao-Jun; He, Wei; Zhang, De-Xing; Fan, Yue-Guang

    2008-05-01

    To investigate the curative effect of different internal fixation for ipsilateral fractures of the femoral neck and shaft. By retrospective study of 27 patients who sustained ipsilateral femoral shaft and neck fractures from June 1993 to March 2004. There were 22 male and 5 female, with an average age of 35 years (range in 14 to 65 years). The femoral neck and shaft fractures were stabilized with dynamic hip screw system (DHS) in 3 cases,with dynamic compression plate and cannulated lag screw in 12 cases, with constructive nail in 8 cases, with antegrade intramedullary locking nail and cannulated lag screw in 4 cases. There were 13 cases used of the temporary fixation of Kirschner wire before the pexia of the femoral neck fractures. All of the patients were followed up for 36 to 75 months, with an average of 44 months. The average healing period of femoral neck fracture was 4.5 months in 25 cases, nonunion of femoral neck fractures in 2. The average healing period of femoral shaft fracture was 6 months in 27 cases. In 14 cases that not using temporary fixation of femoral neck with Kirschner wire, there were nonunion of femoral neck in 2 and slight coxa vara in 3. There are a wide choice of internal fixation method for treatment of ipsilateral fracture of the femoral neck and shaft, the fixation with dynamic compression plate and cannulated lag screw is a handy method. It would be avoided to the replacement and trauma, emporary fixing the fracture with Kirschner wire before the pexia of the femoral neck fracture.

  19. Biogeometry of femoral neck for implant placement

    Directory of Open Access Journals (Sweden)

    Patwa J

    2006-01-01

    Full Text Available Background : Treatment of fracture neck femur with three cannulated cancellous screws in an apex proximal configuration is practised in many parts of the world. Methods : Dimensions of femoral neck at the middle of transcervical neck using CT scan (live neck and vernier caliper (dry cadeveric neck in 20 subjects respectively were measured. Results : Inferior half of the neck is narrower than superior half. Conclusion : Biogeometry of the neck of femur does not accomodate two inferior screws and thus fixation of fracture neck femur with three canulated cancellous screws in an apex distal configuration is recommended.

  20. Cement-in-cement revision for selected Vancouver Type B1 femoral periprosthetic fractures: a biomechanical analysis.

    Science.gov (United States)

    Brew, Christopher J; Wilson, Lance J; Whitehouse, Sarah L; Hubble, Matthew J W; Crawford, Ross W

    2013-03-01

    The aim of this study was to perform a biomechanical analysis of the cement-in-cement (c-in-c) technique for fixation of selected Vancouver Type B1 femoral periprosthetic fractures and to assess the degree of cement interposition at the fracture site. Six embalmed cadaveric femora were implanted with a cemented femoral stem. Vancouver Type B1 fractures were created by applying a combined axial and rotational load to failure. The femora were repaired using the c-in-c technique and reloaded to failure. The mean primary fracture torque was 117 Nm (SD 16.6, range 89-133). The mean revision fracture torque was 50 Nm (SD 16.6, range 29-74), which is above the torque previously observed for activities of daily living. Cement interposition at the fracture site was found to be minimal. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. STEM Education

    OpenAIRE

    Xie, Yu; Fang, Michael; Shauman, Kimberlee

    2015-01-01

    Improving science, technology, engineering, and mathematics (STEM) education, especially for traditionally disadvantaged groups, is widely recognized as pivotal to the U.S.’s long-term economic growth and security. In this article, we review and discuss current research on STEM education in the U.S., drawing on recent research in sociology and related fields. The reviewed literature shows that different social factors affect the two major components of STEM education attainment: (1) attainmen...

  2. Comparison of Radial Access, Guided Femoral Access, and Non-Guided Femoral Access Among Women Undergoing Percutaneous Coronary Intervention.

    Science.gov (United States)

    Koshy, Linda M; Aberle, Laura H; Krucoff, Mitchell W; Hess, Connie N; Mazzaferri, Ernest; Jolly, Sanjit S; Jacobs, Alice; Gibson, C Michael; Mehran, Roxana; Gilchrist, Ian C; Rao, Sunil V

    2018-01-01

    This study was conducted to determine the association between radial access, guided femoral access, and non-guided femoral access on postprocedural bleeding and vascular complications after percutaneous coronary intervention (PCI). Bleeding events and major vascular complications after PCI are associated with increased morbidity, mortality, and cost. While the radial approach has been shown to be superior to the femoral approach in reducing bleeding and vascular complications, whether the use of micropuncture, fluoroscopy, or ultrasound mitigates these differences is unknown. We conducted a post hoc analysis of women in the SAFE-PCI for Women trial who underwent PCI and had the access method identified (n = 643). The primary endpoint of postprocedure bleeding or vascular complications occurring within 72 hours or at discharge was adjudicated by an independent clinical events committee and was compared based on three categories of access technique: radial, guided femoral (fluoroscopy, micropuncture, ultrasound), or non-guided femoral (none of the aforementioned). Differences between the groups were determined using multivariate logistic regression using radial access as the reference. Of the PCI population, 330 underwent radial access, 228 underwent guided femoral access, and 85 underwent non-guided femoral access. There was a statistically significant lower incidence of the primary endpoint with radial access vs non-guided femoral access; however, there was no significant difference between radial approach and femoral access guided by fluoroscopy, micropuncture, or ultrasound. This post hoc analysis demonstrates that while radial access is safer than non-guided femoral access, guided femoral access appears to be associated with similar bleeding events or vascular complications as radial access.

  3. Femoral neck fractures: A prospective assessment of the pattern ...

    African Journals Online (AJOL)

    OBJECTIVE: To review the pattern of femoral neck fractures, complications and outcome following fixation with Austin-Moore endoprosthesis. METHOD: A two year prospective study in patients who had fracture of the femoral neck based on strict inclusion criteria. All the patients were treated by Austin-Moore ...

  4. Bilateral impacted femoral neck fracture in a renal disease patient ...

    African Journals Online (AJOL)

    Spontaneous bilateral femoral neck facture in a renal disease patient is not common. We report a case of 47-year-old female patient with chronic renal failure and on regular hemodialysis for the past 5 years who sustained bilateral impacted femoral neck fracture without history of trauma and injury and refused any surgical ...

  5. Femoral Shaft Fractures: Management and Outcome in Nigerian ...

    African Journals Online (AJOL)

    Infection rate was 3.2% and mal-union occurred in one (3.2%) patient who had osteogenesis imperfecta. Compression plating is a suitable option in treatment of childhood and adolescent femoral fractures. Keywords: Femoral shaft fracture, Compression plating, traditional bone setters, children and adolescents.

  6. Management of Femoral Shaft Fractures in a Tertiary Centre, South ...

    African Journals Online (AJOL)

    males (95% CI 2.1-2.4)5. Treatment of femoral shaft fractures has spanned centuries .The rich history of femoral shaft fracture management reflects the challenges of maintaining anatomic alignment while encouraging early functional rehabilitation.6 Hippocrates (460-377BC) used manual reduction while emphasizing knee.

  7. Femoral bifurcation with ipsilateral tibia hemimelia: Early outcome of ...

    African Journals Online (AJOL)

    Hereby, we present a case report of a 2-year-old boy who first presented in our orthopedic clinic as a 12-day-old neonate, with a grossly deformed right lower limb from a combination of complete tibia hemimelia and ipsilateral femoral bifurcation. Excision of femoral exostosis, knee disarticulation and prosthetic fitting gives ...

  8. Current indications for open Kuntscher nailing of femoral shaft ...

    African Journals Online (AJOL)

    Current indications for open Kuntscher nailing of femoral shaft fractures. A S Bajwa FCS(SA)ORTH. E Schnaid FCS(SA)ORTH. M E B Sweet MD PhD(rned). University of Witwatersrand, Johannesburg, South Africa. Key Words: Kuntscher nail, intramedullary nail, femoral fracture. We retrospectively reviewed 32 patients with.

  9. frequency of ipsilateral femoral neck fractures in patients with ...

    African Journals Online (AJOL)

    closed, middle or upper third; and AO classes A2, C1 and C3. The femoral neck ... associated injuries. - mechanism of injury. (iii) Femoral radiographs: - shaft fracture characteristics. - neck fracture characteristics. The following procedures were used: (i) All patients .... the lower extremity at the scene of accident and during.

  10. Proximal Focal Femoral Deficiency in Ibadan a Developing ...

    African Journals Online (AJOL)

    The cultural aversion to amputation in our environment makes it difficult to employ that option of treatment. Proximal focal femoral deficiency in Ibadan a developing country's perspective and a review of the literature. Keywords: Proximal focal femoral deficiency , congenital malformations , limb malformations , lower limb ...

  11. Slipped capital femoral epiphysis: A modern treatment protocol

    Directory of Open Access Journals (Sweden)

    Slavković Nemanja

    2009-01-01

    Full Text Available The treatment of a patient with slipped capital femoral epiphysis begins with an early diagnosis and accurate classification. On the basis of symptom duration, clinical findings and radiographs, slipped capital femoral epiphysis is classified as pre-slip, acute, acute-on-chronic and chronic. The long-term outcome of slipped capital femoral epiphysis is directly related to severity and the presence or absence of avascular necrosis and/or chondrolysis. Therefore, the first priority in the treatment of slipped capital femoral epiphysis is to avoid complications while securing the epiphysis from further slippage. Medical treatment of patients with acute and acute-on-chronic slipped capital femoral epiphysis, as well as those presented in pre-slip stage, is the safest, although time-consuming. Manipulations, especially forced and repeated, are not recommended due to higher avascular necrosis risk. The use of intraoperative fluoroscopy to assist in the placement of internal fixation devices has markedly increased the success of surgical treatment. Controversy remains as to whether the proximal femoral epiphysis in severe, chronic slipped capital femoral epiphysis should be realigned by extracapsular osteotomies or just fixed in situ. The management protocol for slipped capital femoral epiphysis depends on the experience of the surgeon, motivation of the patient and technical facilities.

  12. Treatment of femoral head osteonecrosis using bone impaction grafting.

    NARCIS (Netherlands)

    Rijnen, W.H.C.; Gardeniers, J.W.M.; Buma, P.; Yamano, K.; Slooff, T.J.J.H.; Schreurs, B.W.

    2003-01-01

    Even in extensive osteonecrosis of the femoral head in younger patients, a femoral head-preserving method is preferable. We developed a new technique using the lateral approach as used in traditional core biopsy; the osteonecrotic lesion was removed and impacted bone grafts were used to regain

  13. Sugioka's osteotomy for femoral-head necrosis in young Caucasians.

    NARCIS (Netherlands)

    Rijnen, W.H.C.; Gardeniers, J.W.M.; Westrek, B.; Buma, P.; Schreurs, B.W.

    2005-01-01

    The transtrochanteric rotational osteotomy described by Sugioka is used to preserve the femoral head and to prevent secondary osteoarthritis in young patients with osteonecrosis of the femoral head. Several Japanese studies have shown favourable results, but European and American studies were

  14. Domiciliary treatment of femoral shaft fracture in children | Ogunlade ...

    African Journals Online (AJOL)

    Domiciliary treatment of femoral shaft fracture in children. ... West African Journal of Medicine ... A total of 20 children presenting in Accident and Emergency (A&E) Department of University College Hospital, Ibadan, Nigeria with femoral shaft fracture treated with straight leg fixed traction in a domiciliary setting is presented.

  15. Heat transfer analysis of frictional heat dissipation during articulation of femoral implants.

    Science.gov (United States)

    Davidson, J A; Gir, S; Paul, J P

    1988-12-01

    Previous studies have shown the tendency for frictional heating to occur during articulation of total hip systems in vitro under simulated hip loading conditions. The magnitude of this heating is sufficient to accelerate wear, creep, and oxidation degradation of the UHMWPE bearing surface. It was shown that ceramic articulating systems generate less frictional heating than polished cobalt alloy against UHMWPE. This frictional heating is expected to occur primarily for younger, heavier, and more active patients. Thus, long-term performance of the articulating hip system in these patients may not be that predicted from current, body-temperature wear, creep, and degradation studies. Although the tendency to generate frictional heat has been observed only during in vitro simulated hip loading, a heat transfer analysis of this phenomenon is presented to evaluate the ability of the hip joint to dissipate such heating in vivo. Additional experiments were performed using controlled resistance heaters inside a cobalt femoral head to verify the calculated levels of frictional heat and to assess the heat dissipation under simulated in vivo conditions. The effect of blood perfusion on the effective thermal conductivity of the joint capsule is also discussed. The present study describes and analyzes the various heat dissipation mechanisms present both in vitro and in vivo during articulation of metal and ceramic hip systems. From these tests and analyses, it is concluded that frictional heating in the reconstructed hip cannot be effectively removed, and that degredative elevated temperature processes can be expected to occur in vivo to both the UHMWPE and adjacent tissue under extended periods of excessive patient activity. This is particularly true for metal cobalt alloy femoral heads articulating on UHMWPE versus ceramic heads which generate significantly lower levels of heat.

  16. Frequent complications and severe bone loss associated with the repiphysis expandable distal femoral prosthesis.

    Science.gov (United States)

    Cipriano, Cara A; Gruzinova, Irina S; Frank, Rachel M; Gitelis, Steven; Virkus, Walter W

    2015-03-01

    future revision using standard stem fixation. The bone loss around the stem of this prosthesis limits subsequent revision options, often resulting in a total femoral prosthesis. Although the decision to use the Repiphysis device must be made on an individual basis, surgeons should recognize the potential for significant bone compromise limiting revision options and consider other options. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

  17. Magnetic resonance imaging of the femoral head necrosis

    International Nuclear Information System (INIS)

    Narita, Shinya; Asada, Kanji; Yoshida, Kenjiro

    1986-01-01

    Ten patients with avascular femoral head necrosis and four normal adults were examined by magnetic resonance imaging (MRI). In addition, the relationship between MRI and pathophysiology of three operated-on avascular femoral heads was evaluated. The medullary cavities of the normal femoral heads had a strong signal intensity on the saturation recovery (SR) image due to fat marrow, and the T 1 relaxation time was 160 ± 11 msec. In avascular femoral head necrosis, the necrotic area had a low signal intensity on the SR image and a prolonged T 1 relaxation time, while the reactive fibrous area had more prolonged T 1 relaxation time. For these reasons, MRI was found to show the pathological changes of avascular femoral head necrosis and can be expected to be useful for making early diagnoses and operation planning. (author)

  18. Outcomes of trochanteric femoral fractures treated with proximal femoral nail: an analysis of 100 consecutive cases

    Directory of Open Access Journals (Sweden)

    Korkmaz MF

    2014-04-01

    Full Text Available Mehmet Fatih Korkmaz,1 Mehmet Nuri Erdem,2 Zeliha Disli,3 Engin Burak Selcuk,4 Mustafa Karakaplan,1 Abdullah Gogus5 1Department of Orthopedics and Traumatology, Inonu University School of Medicine, Malatya, Turkey; 2Department of Orthopedics and Traumatology, Nisantasi University School of Medicine, Istanbul, Turkey; 3Department of Anesthesiology, Malatya Government Hospital, Malatya, Turkey; 4Department of Family Medicine, Inonu University School of Medicine, Malatya, Turkey; 5Department of Orthopedics and Traumatology, Florence Nightingale Hospital, Istanbul, Turkey Purpose: In this study, we aimed to report the results of a retrospective study carried out at our institute regarding cases of patients who had suffered proximal femoral fractures between January 2002 and February 2007, and who were treated with a proximal femoral nail. Materials and methods: One hundred consecutive cases were included in the study. A case documentation form was used to obtain intraoperative data including age, sex, mechanism of injury, type of fracture according to Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF classification and the American Society of Anesthesiologists' (ASA physical status classification (ASA grade. Clinical and radiographic examinations were performed at the time of admission and at the 6th week; subsequent visits were organized on the 3rd month, 6th month, and 12th month, and in patients with longer follow-up and annually postoperatively. The Harris score of hip function was used, and any change in the position of the implants and the progress of the fracture union, which was determined radiologically, was noted. Results: The mean age of the patients was 77.66 years (range: 37–98 years, and the sex distribution was 32 males and 68 females. Seventy-three fractures were reduced by closed means, whereas 27 needed limited open reduction. The mean follow-up time for the study group was 31.3 months (range

  19. Mesenchymal stem cell therapy for nonmusculoskeletal diseases: emerging applications.

    Science.gov (United States)

    Kuo, Tom K; Ho, Jennifer H; Lee, Oscar K

    2009-01-01

    Mesenchymal stem cells are stem/progenitor cells originated from the mesoderm and can different into multiple cell types of the musculoskeletal system. The vast differentiation potential and the relative ease for culture expansion have established mesenchymal stem cells as the building blocks in cell therapy and tissue engineering applications for a variety of musculoskeletal diseases, including repair of fractures and bone defects, cartilage regeneration, treatment of osteonecrosis of the femoral head, and correction of genetic diseases such as osteogenesis imperfect. However, research in the past decade has revealed differentiation potentials of mesenchymal stem cells beyond lineages of the mesoderm, suggesting broader applications than originally perceived. In this article, we review the recent developments in mesenchymal stem cell research with respect to their emerging properties and applications in nonmusculoskeletal diseases.

  20. STEM Education

    Science.gov (United States)

    Xie, Yu; Fang, Michael; Shauman, Kimberlee

    2015-01-01

    Improving science, technology, engineering, and mathematics (STEM) education, especially for traditionally disadvantaged groups, is widely recognized as pivotal to the U.S.’s long-term economic growth and security. In this article, we review and discuss current research on STEM education in the U.S., drawing on recent research in sociology and related fields. The reviewed literature shows that different social factors affect the two major components of STEM education attainment: (1) attainment of education in general, and (2) attainment of STEM education relative to non-STEM education conditional on educational attainment. Cognitive and social psychological characteristics matter for both major components, as do structural influences at the neighborhood, school, and broader cultural levels. However, while commonly used measures of socioeconomic status (SES) predict the attainment of general education, social psychological factors are more important influences on participation and achievement in STEM versus non-STEM education. Domestically, disparities by family SES, race, and gender persist in STEM education. Internationally, American students lag behind those in some countries with less economic resources. Explanations for group disparities within the U.S. and the mediocre international ranking of US student performance require more research, a task that is best accomplished through interdisciplinary approaches. PMID:26778893

  1. Stem Cells

    DEFF Research Database (Denmark)

    Sommerlund, Julie

    2004-01-01

    '. This paper is about tech-noscience, and about the proliferation of connections and interdependencies created by it.More specifically, the paper is about stem cells. Biotechnology in general has the power to capture the imagination. Within the field of biotechnology nothing seems more provocative...... and tantalizing than stem cells, in research, in medicine, or as products....

  2. Finite Element Simulation of NiTi Umbrella-Shaped Implant Used on Femoral Head under Different Loadings

    Directory of Open Access Journals (Sweden)

    Reza Mehrabi

    2017-03-01

    Full Text Available In this study, an umbrella-shaped device that is used for osteonecrosis treatment is simulated. The femoral head is subjected to various complex loadings as a result of a person’s daily movements. Implant devices used in the body are made of shape memory alloy materials because of their remarkable resistance to wear and corrosion, good biocompatibility, and variable mechanical properties. Since this NiTi umbrella-shaped implant is simultaneously under several loadings, a 3-D model of shape memory alloy is utilized to investigate the behavior of the implant under different conditions. Shape memory and pseudo-elasticity behavior of NiTi is analyzed using a numerical model. The simulation is performed within different temperatures and in an isothermal condition with varied and complex loadings. The objective of this study is to evaluate the performance of the device under thermal and multi-axial forces via numerically study. Under tensile loading, the most critical points are on the top part of the implant. It is also shown that changes in temperature have a minor effect on the Von Mises stress. Applied forces and torques have significant influence on the femoral head. Simulations results indicate that the top portion of the umbrella is under the most stress when embedded in the body. Consequently, the middle, curved portion of the umbrella is under the least amount of stress.

  3. Cement-in-cement femoral component revision in the multiply revised total hip arthroplasty: results with a minimum follow-up of five years.

    Science.gov (United States)

    Sandiford, N A; Jameson, S S; Wilson, M J; Hubble, M J W; Timperley, A J; Howell, J R

    2017-02-01

    We present the clinical and radiological results at a minimum follow-up of five years for patients who have undergone multiple cement-in-cement revisions of their femoral component at revision total hip arthroplasty (THA). We reviewed the outcome on a consecutive series of 24 patients (10 men, 14 women) (51 procedures) who underwent more than one cement-in-cement revision of the same femoral component. The mean age of the patients was 67.5 years (36 to 92) at final follow-up. Function was assessed using the original Harris hip score (HHS), Oxford Hip Score (OHS) and the Merle D'Aubigné Postel score (MDP). The mean length of follow-up was 81.7 months (64 to 240). A total of 41 isolated acetabular revisions were performed in which stem removal facilitated access to the acetabulum, six revisions were conducted for loosening of both components and two were isolated stem revisions (each of these patients had undergone at least two revisions). There was significant improvement in the OHS (p = 0.041), HHS (p = 0.019) and MDP (p = 0.042) scores at final follow-up There were no stem revisions for aseptic loosening. Survival of the femoral component was 91.9% (95% confidence intervals (CI) 71.5 to 97.9) at five years and 91.7% (95% CI 70 to 97) at ten years (number at risk 13), with stem revision for all causes as the endpoint. Cement-in-cement revision is a viable technique for performing multiple revisions of the well cemented femoral component during revision total hip arthroplasty at a minimum of five years follow-up. Cite this article: Bone Joint J 2017;99-B:199-203. ©2017 The British Editorial Society of Bone & Joint Surgery.

  4. Subchondral insufficiency fracture of the femoral head and medial femoral condyle

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Takuaki [Department of Orthopaedic Surgery, Faculty of Medicine, Kyushu University, Fukuoka (Japan); Bullough, P.G. [Department of Laboratory Medicine, Hospital for Special Surgery, New York, NY (United States)

    2000-01-01

    This case report documents the clinical, radiographic, and histologic findings in a 69-year-old obese man, who had subchondral insufficiency fracture both in the femoral head and medial femoral condyle. On plain radiographs, both lesions underwent subchondral collapse. Magnetic resonance images of the left hip showed a bone marrow edema pattern with associated low-intensity band on T1-weighted images, which was convex to the articular surface. The histopathologic findings in the hip and knee were characterized by the presence of a subchondral fracture with associated callus and granulation tissue along both sides of a fracture line. There was no evidence of antecedent osteonecrosis. To our knowledge, this is the first case report to describe the multiple occurrence of collapsed subchondral insufficiency fracture. (orig.)

  5. [Application of an amphiphilic bonder in a goat model to increase the femoral cement-bone adhesion in cemented hip arthroplasty].

    Science.gov (United States)

    Müller-Rath, R; Wirtz, D; Andereya, S; Gravius, S; Hermanns-Sachweh, B; Marx, R; Mumme, T

    2007-01-01

    Cemented revision of femoral components in total hip arthroplasty has shown high rates of early loosening due to reduced micro- and macroretention of the cement to the endostal bone stock. Enhanced stability can be reached by an amphiphilic bonder, which offers a covalent bonding of the hydrophobic cement to the hydrophilic bone. The aim of this study is to evaluate the biocompatibility of such a bonder and its effects on the mechanical stability of cemented hip arthroplasty stems in vivo. Total cemented hip arthroplasties were performed in 20 sheep. In the verum group (n = 10) the implant bed was preconditioned by application of the bonder prior to femoral stem implantation. To study the biocompatibility around the bone-cement interface fluorescent marking of osteoblasts was applied in vivo throughout the observation period of 9 months. Native X-rays of the hip joints were obtained immediately after implantation and after euthanasia. The bone-cement interface was examined histologically. All stems of the verum group showed firm bonding of cement to bone in manual testing, while in 7 of the 10 controls the stems with adherent cement could be easily pulled out off the bony implant bed. This was coherent with significantly higher rates of progredient radiolucent lines and soft-tissue interpositions between bone and cement in the control group. The bonder was biocompatible. When preconditioned with an amphiphilic bonder, cemented stems showed a markedly higher adhesive strength to the cancellous bone without signs of inflammation or neoplasia. This procedure might offer enhanced longevity of cemented femoral revision stems in hip arthroplasty.

  6. Learn About Stem Cells

    Science.gov (United States)

    ... PDF) Download an introduction to stem cells and stem cell research. Stem Cell Glossary Stem cell terms to know. ... ISSCR Get Involved Media © 2015 International Society for Stem Cell Research Terms of Use Disclaimer Privacy Policy

  7. Contralateral reversed distal femoral locking plate for fixation of subtrochanteric femoral fractures.

    Science.gov (United States)

    Gogna, Paritosh; Mukhopadhyay, Reetadyuti; Singh, Amanpreet; Devgan, Ashish; Arora, Sahil; Batra, Amit; Yadav, Sushil Kumar

    2015-01-01

    Subtrochanteric fractures of the femur are being managed successfully with various intramedullary and extramedulary implants with reasonable success. However, these implants require precise placement under image intensifier guidance, which exposes the surgeon to substantial amount of radiation. It also restricts the management of these fractures at peripheral centers where facility of image intensifiers is not available. Keeping this in mind we designed this study to identify if contralateral reversed distal femoral locking plate can be used successfully without the use of image intensifier. Twenty-four consecutive patients (18 men and 6 women) with a mean age of 28 years (range 19-47 years) suffering subtrochanteric fractures of the femur underwent open reduction and internal fixation with reversed contralateral distal femoral locking plate. The outcome was assessed at the mean follow-up period of 3.2 years (range 2-4.6 years) using the Harris hip score. Twenty-one fractures united with the primary procedure, with a mean time of consolidation being 11 weeks (range, 9-16 weeks). One patient developed superficial suture line infection, which resolved with oral antibiotics. Another patient had a fall 3 weeks after surgery and broke the plate. Repeat surgery with reversed distal femoral locking compression plate was performed along with bone grafting and the fracture united. Two cases had nonunion, which went in for union after bone grafting. The mean Harris hip score at the time of final follow-up was 90.63 (range 82-97). The reversed contralateral distal femoral plate is a biomechanically sound implant, which when used for fixation of the subtrochanteric fractures with minimal soft tissue stripping shows results comparable to those achieved by using other extramedullary implants as well as intramedullary devices. The added advantage of this implant is its usability in the absence of an image intensifier.

  8. Outcomes of trochanteric femoral fractures treated with proximal femoral nail: an analysis of 100 consecutive cases.

    Science.gov (United States)

    Korkmaz, Mehmet Fatih; Erdem, Mehmet Nuri; Disli, Zeliha; Selcuk, Engin Burak; Karakaplan, Mustafa; Gogus, Abdullah

    2014-01-01

    In this study, we aimed to report the results of a retrospective study carried out at our institute regarding cases of patients who had suffered proximal femoral fractures between January 2002 and February 2007, and who were treated with a proximal femoral nail. One hundred consecutive cases were included in the study. A case documentation form was used to obtain intraoperative data including age, sex, mechanism of injury, type of fracture according to Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF) classification and the American Society of Anesthesiologists' (ASA) physical status classification (ASA grade). Clinical and radiographic examinations were performed at the time of admission and at the 6th week; subsequent visits were organized on the 3rd month, 6th month, and 12th month, and in patients with longer follow-up and annually postoperatively. The Harris score of hip function was used, and any change in the position of the implants and the progress of the fracture union, which was determined radiologically, was noted. The mean age of the patients was 77.66 years (range: 37-98 years), and the sex distribution was 32 males and 68 females. Seventy-three fractures were reduced by closed means, whereas 27 needed limited open reduction. The mean follow-up time for the study group was 31.3 months (range: 12-75 months). Postoperative radiographs showed a near-anatomical fracture reduction in 78% of patients. The Harris hip score was negatively correlated with the ASA score and patient age. No cases of implant failure were observed. Three patients died before discharge (one due to pulmonary embolism, two due to cardiac arrest), and five patients died due to unrelated medical conditions within the first 3 months of the follow-up. Our study showed that proximal femoral nail is a reliable fixation with good fracture union, and it is not associated with major complications in any type of trochanteric femoral fracture.

  9. Avascular necrosis of the femoral head after osteosynthesis of femoral neck fracture.

    Science.gov (United States)

    Min, Byung-Woo; Kim, Sung-Jin

    2011-05-18

    The reported incidence of avascular necrosis after femoral neck fracture fixation varies widely, and there is no consensus regarding its risk factors. We evaluated the incidence of avascular necrosis of the femoral head with the use of contemporary techniques for femoral neck fracture fixation. We then sought to determine what potential risk factors influenced the development of avascular necrosis.Between 1990 and 2005, one hundred sixty-three intracapsular femoral neck fractures in 163 patients were treated with internal fixation at our level-I trauma center. All patients were monitored until conversion to total hip arthroplasty or for a minimum of 2 years postoperatively. Ten patients (10 hips) died and 7 patients (7 hips) were lost to follow-up. The remaining 146 patients (146 hips) had a mean 5.2 years of follow-up (range, 3 months to 17 years). The incidence of avascular necrosis was 25.3% (37 hips). The average time to diagnosis of avascular necrosis was 18.8 months (range, 3-47 months). Patient sex, age, interval from injury to surgery, and mechanism of injury were statistically not associated with the development of avascular necrosis. The quality of fracture reduction, adequacy of fixation, degree of displacement, and comminution of the posterior cortex were significantly associated. After we controlled for patient and radiographic characteristics, multivariate analyses indicated that the important predictors for avascular necrosis are poor reduction (odds ratio=13.889) and initial displacement of the fracture (odds ratio=4.693). Copyright 2011, SLACK Incorporated.

  10. Isolated femoral profundoplasty using endarterectomised superficial femoral artery for limb salvage in the elderly.

    Science.gov (United States)

    Witz, M; Shnacker, A; Lehmann, J M

    2000-12-01

    The deep femoral artery provides the primary blood supply to the thigh, and in addition serves as the major collateral channel for bypassing the obstructed superficial femoral artery. The purpose of isolated profundoplasty is to relieve a significant stenosis and improve perfusion of the ischaemic leg. Twenty-seven patients with critical limb ischaemia underwent isolated profundoplasty in the Vascular Unit of Meir General Hospital, using endarterectomised superficial femoral artery (ESFA) as an arterial patch. Nineteen patients were men. The average age was 72 (65-79). The presenting symptoms: rest pain: 18 (67%), ischaemic foot ulcer: 7 (28%), pedal gangrene: 2 (7%). Selection criteria for isolated profundoplasty: 1) > 50%: stenosis of arteria profunda femoris lumen. 2) Adequate profunda: popliteal collateral system. 3) Adequate arterial inflow: common femoral artery. There was no operative mortality or immediate operative failure. All 27 limbs were improved: relief of rest pain, healing of ischaemic ulcers and good healing after minor amputations (transphalangeal, transmetatarsal). Follow-up period ranged from 12 to 45 months (mean 30 months) and was based on clinical investigation + ankle/brachial Doppler measurements. All patients remained asymptomatic with improvement of limb function--either to the present or until their death. In view of our favourable experience, we feel that isolated profundoplasty still has a place in vascular surgery practice--when limb revascularization in elderly patients considered at high risk is dangerous and when there is impossible below knee vascular reconstruction. We recommend the use of ESFA as a patch for long segment profundoplasty--with all advantages of an autogenous material.

  11. Hip stability during lengthening in children with congenital femoral deficiency.

    Science.gov (United States)

    Eidelman, Mark; Jauregui, Julio J; Standard, Shawn C; Paley, Dror; Herzenberg, John E

    2016-12-01

    Congenital femoral deficiency (CFD) is one of the most challenging and complex conditions for limb lengthening. We focused on the problem of hip instability during femoral lengthening because subluxation and dislocation are potentially catastrophic for hip function. We assessed for hip stability in 69 children (91 femoral lengthenings) who had CFD Paley type 1a (43 children) and 1b (26 children). The mean age at first lengthening was 6.4 years. Hip subluxation/dislocation occurred during 14 (15 %) of 91 lengthenings. Thirty-three pelvic osteotomies were performed before lengthening in an attempt to stabilize hips. Thirteen patients (type 1a, eight; type 1b, five) had acetabular dysplasia at initiation of lengthening. One of the eight with type 1a experienced mild femoral head subluxation; four of the five with type 1b experienced three dislocations and one subluxation. Eight patients (type 1b) experienced hip instability although they had pelvic osteotomies. Proximal femoral lengthening was a significant factor for hip subluxation. Patients with hip subluxation more likely underwent monolateral fixation and the original superhip procedure. Age ±six years was not a contributing factor for hip instability. Important risk factors for hip instability during femoral lengthening are severity of CFD, residual acetabular dysplasia, and proximal femoral lengthening. We recommend routine performance of pelvic osteotomy for patients with Paley type 1b CFD and distal lengthening. Therapeutic Level IV.

  12. Femoral neck buttressing: a radiographic and histologic analysis

    International Nuclear Information System (INIS)

    Dixon, T.; Benjamin, J.; Lund, P.; Graham, A.; Krupinski, E.

    2000-01-01

    Objective. To examine the incidence, radiographic and histologic findings of medial femoral neck buttressing in a consecutive group of patients undergoing total hip arthroplasty.Design. Biomechanical parameters were evaluated on standard anteroposterior pelvic radiographs of 113 patients prior to hip replacement surgery. Demographic information on all patients was reviewed and histologic evaluation was performed on specimens obtained at the time of surgery.Results. The incidence of medial femoral neck buttressing was found to be 50% in a consecutive series of patients undergoing total hip arthroplasty. The incidence was slightly higher in women (56% vs 41%). Patients with buttressing had increased neck-shaft angles and smaller femoral neck diameters than were seen in patients without buttressing. Histologic evaluation demonstrated that the buttress resulted from deposition bone by the periosteum on the femoral neck in the absence of any evidence of femoral neck fracture.Conclusion. It would appear that femoral neck buttressing occurs in response to increased joint reactive forces seen at the hip being transmitted through the femoral neck. The increased joint reactive force can be related to the increased neck shaft angle seen in patients with buttressing. (orig.)

  13. Simultaneous avascular necrosis of both medial and lateral femoral condyles

    International Nuclear Information System (INIS)

    Mansberg, R.

    2002-01-01

    Full text: Avascular necrosis (AVN) of a femoral condyle is a common orthopaedic condition. While both medial and lateral femoral condyles may be involved either singly or sequentially the simultaneous occurrence of AVN of both femoral condyles is extremely uncommon. A 57-year-old male is presented who developed the onset of severe left sided knee pain suddenly at rest. Plain and tomographic radiography was unremarkable and a bone scan was performed. Markedly increased vascularity was demonstrated in the left knee with intense osteoblastic activity in the left medial and femoral condyles more marked in the lateral femoral condyle. A diagnosis of AVN of both femoral condyles was made and a MRI exam was performed to confirm this unusual diagnosis. The MRI showed a diffuse increase in intensity bilaterally with subtle bony change in the subarticular bone consistent with AVN more marked in the left lateral femoral condyle. The patients' symptoms resolved with supportive treatment. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  14. Postmortem Femoral Blood Concentrations of Risperidone

    DEFF Research Database (Denmark)

    Linnet, Kristian; Johansen, Sys Stybe

    2014-01-01

    Postmortem femoral blood concentrations of the antipsychotic drug risperidone and the active metabolite 9-hydroxyrisperidone were determined by an achiral LC-MS/MS method in 38 cases. The cause of death was classified as unrelated to risperidone in 30 cases, in which the sum of the concentration...... of the drug and metabolite ranged from below the limit of quantification to 0.058 mg/kg (median 0.0098 mg/kg). This concentration range, which largely corresponds to published in vivo plasmalevels under therapy, may serve as a reference for judgment of postmortem cases involving risperidone. In one case......, risperidone was judged to be a contributing factor to death, and the sum of concentrations was 0.29 mg/kg. This concentration is of the same order of magnitude as observed for plasma levels in clinical intoxication cases. For the remaining seven cases, the cause of death was unclear. The measurements observed...

  15. Controlled Thermal Expansion Alloys

    Data.gov (United States)

    National Aeronautics and Space Administration — There has always been a need for controlled thermal expansion alloys suitable for mounting optics and detectors in spacecraft applications.  These alloys help...

  16. Alloy Fabrication Laboratory

    Data.gov (United States)

    Federal Laboratory Consortium — At NETL’s Alloy Fabrication Facility in Albany, OR, researchers conduct DOE research projects to produce new alloys suited to a variety of applications, from gas...

  17. PEEK-OPTIMA™ as an alternative to cobalt chrome in the femoral component of total knee replacement: A preliminary study

    Science.gov (United States)

    Cowie, Raelene M; Briscoe, Adam; Fisher, John; Jennings, Louise M

    2016-01-01

    preliminary findings showed that PEEK-OPTIMA™ gives promise as an alternative bearing material to cobalt chrome alloy in the femoral component of a total knee replacement with respect to wear performance. PMID:27637723

  18. Study of localized corrosion in AA2024 aluminium alloy using electron tomography

    International Nuclear Information System (INIS)

    Zhou, X.; Luo, C.; Hashimoto, T.; Hughes, A.E.; Thompson, G.E.

    2012-01-01

    Highlights: ► SEM tomography of localized corrosion has been achieved. ► Nanotomography provides evidence that links microstructure and corrosion propagation path. ► IGC stemmed from localized corrosion associated with buried clusters of intermetallics. ► IGC started beneath the alloy surface and may emerge on the alloy surface. - Abstract: SEM based tomography of localized corrosion has been achieved using selective detection of backscattered electrons. The high resolution tomography provides direct evidence that links the surface appearance of corroded alloy, the alloy microstructure and the corrosion propagation path. Stable localized corrosion of AA2024-T351 aluminium alloy was initiated at locations where large clusters of S phase particles were buried beneath the surface. Propagating away from the initiation sites, corrosion developed preferentially along the grain boundary network. The grain boundary attack started beneath the alloy surface, proceeded along preferred grain boundaries and may emerge at the alloy surface.

  19. Anthropometric study of angle of femoral torsion in Maharashtrian population

    Directory of Open Access Journals (Sweden)

    Anil Kumar Dwivedi

    2016-01-01

    Full Text Available Introduction: Angle of femoral torsion is a normal torsion or twist present in femur that plays an important role in stability and function of the hip joint. The angle of femoral torsion can be defined as the angle formed by femoral condyle′s plane (bicondylar plane and a plane passing through center of neck and femoral head. Abnormal angle of femoral torsion has been implicated in the etiology of hip osteoarthrosis and developmental dysplasia of hip joint. Materials and Methods: This study was carried out on unpaired 280, adult human femora devoid of any gross pathology, 139 male (65 right and 74 left, and 141 female (71 right and 70 left from bone banks of three medical colleges of Maharashtra. The gender of each specimen was determined by the established practice. Femora were evaluated by Kingsley Olmsted method, and data were tabulated and statistically analyzed. Results: The average angle of femoral torsion 13.39° and 11.23° on the right and left side respectively in male, 16.21° and 13.23° on the right and left side, respectively, in female. Statistical analysis using Student′s "t"-test revealed significant difference (P < 0.05, greater angle of femoral torsion in female and on the right side. Conclusion: Knowledge of angle of femoral torsion is becoming significant nowadays with an increase in demand for total hip replacement, as the angle of femoral torsion is crucial to attain a normal activity of the replaced joint.

  20. Treatment of the femoral neck peudoarthrosis in childhood: Case report

    Directory of Open Access Journals (Sweden)

    Vukašinović Zoran

    2013-01-01

    Full Text Available Introduction. Femoral neck fractures in children and adolescents are rare. However, their complications are frequent - avascular necrosis, femoral neck pseudoarthrosis, premature physeal closure with consequent growth disturbance and coxa vara deformity. Case Outline. A 9.5­year­old boy was injured in a car accident, and femoral neck fracture was diagnosed. Prior to admission at our hospital he was surgically treated several times. He was admitted at our hospital eight months following the accident. On the X­ray transcervical pseudoarthrosis of the femoral neck was found, as well as coxa vara deformity and metaphyseal avascular necrosis. He was operated at our hospital; all previously placed ostefixation material was removed, valgus osteotomy of 30 degrees was done as well as additional local osteoplasty using the commercial osteoindactive agent (Osteovit®. Postoperatively, we applied skin traction, bed rest and physical therapy. At the final follow­up, the patient was recovered completely. He is now painless, the legs are of equal length, range of movements in the left hip is full, life activity is normal. The X­ray shows that the femoral neck pseudoarthrosis is fully healed. Conclusion. This case is presented in order to encourage other colleagues to challenge the problematic situation such as this one. Also, we would like to remind them what one should think about and what should be taken into consideration in the primary treatment of femoral neck fractures in children. Valgus femoral osteotomy, as a part of the primary treatment of femoral neck fracture in children (identically as in the adults can prevent the occurrence of femoral neck pseudoarthrosis.

  1. Ipsilateral femoral shaft and vertical patella fracture: a case report

    Science.gov (United States)

    Ozkan, Korhan; Eceviz, Engin; Sahin, Adem; Ugutmen, Ender

    2009-01-01

    Introduction A femoral shaft fracture with an ipsilateral patella fracture has been, to our knowledge, given only cursory attention in English-speaking literature. Case presentation A 15 year old male patient had hitten by a car to his motorcycle came to emergency room and he had been operated for his femoral shaft freacture and vertical patellar fracture which was iniatally missed. Conclusion To us it is vital to obtain CT scan of the patient’s knee if there is an ipsilateral femoral fracture with an ipsilateral knee effusion and a punction which reveals hematoma even in the absence of a fracture line seen in AP and lateral projections. PMID:19829933

  2. Avascular osteonecrosis of the femoral condyle after arthroscopic surgery

    International Nuclear Information System (INIS)

    Al-Kaar, M.; Garcia, J.; Fritschy, D.; Bonvin, J.C.

    1997-01-01

    Avascular osteonecrosis of the femoral condyle after arthroscopic surgery. Retrospective review of 10 patients who presented with avascular necrosis of the ipsilateral femoral condyle following arthroscopic meniscectomy (9 medial, 1 lateral). The bone lesions were evaluated by radiography and MRI, which were repeated for few patients. MRI allows earlier diagnosis of avascular necrosis of the femoral condyle and offers an evaluation of extent of the lesions whose evolution is variable: 3 patients required a knee prosthesis, the other 7 patients were treated medically. (authors)

  3. Use of Huckstep nail in the periimplant femoral shaft fracture.

    Science.gov (United States)

    Kim, Hong Kyun; Noh, Kyu Cheol; Chung, Kook Jin; Hwang, Ji Hyo

    2012-11-01

    87-year-old female underwent open reduction of distal femoral fracture and internal fixation with locking compression plate and bone graft. She was operated for ipsilateral proximal femoral fractures and stabilized by intramedullary interlocked nail 5 years ago. She developed stress fracture proximal to locked plate. We inserted Huckstep nail after removal of the previous operated proximal femoral nail without removing the remaining plate and screws. At 15 month followup the fractures have united. The Huckstep nail has multiple holes available for screw fixation at any level in such difficult situations.

  4. Total Hip Arthroplasty Using a Polished Tapered Cemented Stem in Hereditary Multiple Exostosis

    Directory of Open Access Journals (Sweden)

    Akio Kanda

    2016-01-01

    Full Text Available A 61-year-old Japanese man underwent right total hip arthroplasty for hereditary multiple exostosis. At first presentation, he had suffered from coxalgia for a long time. On radiographic images, there was a gigantic femoral head, increased shaft angle, and large diameter of the femoral neck. He had also developed coxarthrosis and severe pain of the hip joint. The transformation of the proximal femur bone causes difficulty in setting a cementless total hip prosthesis. Therefore, total hip arthroplasty using a cemented polished tapered stem was performed via a direct lateral approach. Using a cemented polished tapered stem allowed us to deal with the femoral bone transformation and bone substance defectiveness due to exostosis and also minimized the invasiveness of the operation.

  5. The threshold force required for femoral impaction grafting in revision hip surgery.

    LENUS (Irish Health Repository)

    Flannery, Olivia M

    2010-06-01

    BACKGROUND AND PURPOSE: Femoral impaction grafting requires vigorous impaction to obtain adequate stability without risk of fracture, but the force of impaction has not been determined. We determined this threshold force in a preliminary study using animal femurs. METHODS: Adult sow femurs were used because of their morphological similarity to human femurs in revision hip arthroplasty. 35 sow femurs were impacted with morselized bone chips and an increasing force was applied until the femur fractured. This allowed a threshold force to be established. 5 other femurs were impacted to this force and an Exeter stem was cemented into the neomedullary canal. A 28-mm Exeter head was attached and loaded by direct contact with a hydraulic testing machine. Axial cyclic loading was performed and the position sensor of the hydraulic testing machine measured the prosthetic head subsidence. RESULTS: 29 tests were completed successfully. The threshold force was found to be 4 kN. There was no statistically significant correlation between the load at fracture and the cortex-to-canal ratio or the bone mineral density. Following impaction with a maximum force of 4 kN, the average axial subsidence was 0.28 mm. INTERPRETATION: We achieved a stable construct without fracture. Further studies using human cadaveric femurs should be done to determine the threshold force required for femoral impaction grafting in revision hip surgery.

  6. Vitamin K2 Prevents Glucocorticoid-induced Osteonecrosis of the Femoral Head in Rats.

    Science.gov (United States)

    Zhang, Yue-Lei; Yin, Jun-Hui; Ding, Hao; Zhang, Wei; Zhang, Chang-Qing; Gao, You-Shui

    2016-01-01

    Glucocorticoid medication is one of the most common causes of atraumatic osteonecrosis of the femoral head (ONFH), and vitamin K2 (VK2) has been shown to play an important and beneficial role in bone metabolism. In this study, we hypothesized that VK2 could decrease the incidence of glucocorticoid-induced ONFH in a rat model. Using in vitro studies, we investigated how bone marrow-derived stem cells in the presence of methylprednisolone proliferate and differentiate, specifically examining osteogenic-related proteins, including Runx2, alkaline phosphatase and osteocalcin. Using in vivo studies, we established glucocorticoid-induced ONFH in rats and investigated the preventive effect of VK2. We employed micro-CT scanning, angiography of the femoral head, and histological and immunohistochemical analyses, which demonstrated that VK2 yielded beneficial effects for subchondral bone trabecula. In conclusion, VK2 is an effective antagonist for glucocorticoid on osteogenic progenitors. The underlying mechanisms include acceleration of BMSC propagation and promotion of bone formation-associated protein expression, which combine and contribute to the prevention of glucocorticoid-induced ONFH in rats.

  7. Extensively coated revision stems in proximally deficient femur: Early results in 15 patients

    Directory of Open Access Journals (Sweden)

    Marya SKS

    2008-01-01

    Full Text Available Background: Hip replacement following failed internal fixation (dynamic hip screw for intertrochanteric fractures or previous hip arthroplasty presents a major surgical challenge. Proximal fitting revision stems do not achieve adequate fixation. Distal fixation with long-stemmed extensively coated cementless implants (like the Solution™ system affords a suitable solution. We present our early results of 15 patients treated with extensively coated cementless revision stems. Materials and Methods: Fifteen patients with severely compromised proximal femora following either failed hip arthroplasty or failed internal fixation (dynamic hip screw fixation for intertrochanteric fractures were operated by the senior author over a two-year period. Eight patients had aseptic loosening of their femoral stems following cemented hip replacements, with severe thinning of their proximal cortices and impending stress fractures. Seven had secondary hip arthritis following failure of long implants for comminuted intertrochanteric or subtrochanteric femoral fractures. All patients were treated by removal of implant (cemented stems/DHS implants and insertion of long-stemmed extensively coated cementless revision (′ Solution™; DePuy, Warsaw (IN, US′ stems along with press-fit acetabular component (Duraloc Cup, DePuy, Warsaw (IN, US. All eight hip revisions needed extended trochanteric osteotomies. Results: All patients were primarily kept in bed on physiotherapy for six weeks and then gradually progressed to weight-bearing walking over the next six to eight weeks. The Harris Hip Scores and patient satisfaction were used for final evaluation. We achieved good results in the short term studied. In our first three patients (all following failed cemented total hip replacements, we resorted to cerclage wiring to hold osteotomised segments (done to facilitate stem removal. The subsequent 12 proceeded without the need for cerclage wiring. One patient had a

  8. Revision Total Hip Arthroplasty With a Monoblock Splined Tapered Grit-Blasted Titanium Stem.

    Science.gov (United States)

    Hellman, Michael D; Kearns, Sean M; Bohl, Daniel D; Haughom, Bryan D; Levine, Brett R

    2017-12-01

    In revision total hip arthroplasty (THA), proximal femoral bone loss creates a challenge of achieving adequate stem fixation. The purpose of this study was to examine the outcomes of a monoblock, splined, tapered femoral stem in revision THA. Outcomes of revision THA using a nonmodular, splined, tapered femoral stem from a single surgeon were reviewed. With a minimum of 2-year follow-up, there were 68 cases (67 patients). Paprosky classification was 3A or greater in 85% of the cases. Preoperative and postoperative Harris Hip Scores (HHS), radiographic subsidence and osseointegration, limb length discrepancy, complications, and reoperations were analyzed. The Harris Hip Score improved from 37.4 ± SD 19.4 preoperatively to 64.6 ± SD 21.8 at final follow-up (P revision procedures-8 for septic indications and 8 for aseptic indications. Subsidence occurred at a rate of 3.0% and dislocation at 7.4%. Limb length discrepancy of more than 1 cm after revision was noted in 13.6% of patients. Bone ingrowth was observed in all but 4 patients (94.1%). At 4-year follow-up, Kaplan-Meier estimated survival was 72.9% (95% confidence interval [CI] 57.0-83.8) for all causes of revision, 86.6% (95% CI 72.0-93.9) for all aseptic revision, and 95.5% (95% CI 86.8-98.5) for aseptic femoral revision. Although complications were significant, revision for femoral aseptic loosening occurred in only 3 patients. Given the ability of this monoblock splined tapered stem to adequately provide fixation during complex revision THA, it remains a viable option in the setting of substantial femoral bone defects. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Processing and alloying of tungsten heavy alloys

    International Nuclear Information System (INIS)

    Bose, A.

    1993-01-01

    Tungsten heavy alloys are two-phase metal matrix composites with a unique combination of density, strength, and ductility. They are processed by liquid-phase sintering of mixed elemental powders. The final microstructure consists of a contiguous network of nearly pure tungsten grains embedded in a matrix of a ductile W-Ni-Fe alloy. Due to the unique property combination of the material, they are used extensively as kinetic energy penetrators, radiation shields. counterbalances, and a number of other applications in the defense industry. The properties of these alloys are extremely sensitive to the processing conditions. Porosity levels as low as 1% can drastically degrade the properties of these alloys. During processing, care must be taken to reduce or prevent incomplete densification, hydrogen embrittlement, impurity segregation to the grain boundaries, solidification shrinkage induced porosity, and in situ formation of pores due to the sintering atmosphere. This paper will discuss some of the key processing issues for obtaining tungsten heavy alloys with good properties. High strength tungsten heavy alloys are usually fabricated by swaging and aging the conventional as-sintered material. The influence of this on the shear localization tendency of a W-Ni-Co alloy will also be demonstrated. Recent developments have shown that the addition of certain refractory metals partially replacing tungsten can significantly improve the strength of the conventional heavy alloys. This development becomes significant due to the recent interest in near net shaping techniques such as powder injection moldings. The role of suitable alloying additions to the classic W-Ni-Fe based heavy alloys and their processing techniques will also be discussed in this paper

  10. Avascular osteonecrosis of the femoral condyle after arthroscopic surgery; Osteonecrose aseptique du condyle femoral apres meniscectomie par voie arthroscopique

    Energy Technology Data Exchange (ETDEWEB)

    Al-Kaar, M.; Garcia, J. [Hopital Cantonal Geneve, Geneva (Switzerland); Fritschy, D.; Bonvin, J.C. [Policlinique de Chirurgie, Hopital Cantonal Universitaire, Geneve (Switzerland)

    1997-04-01

    Avascular osteonecrosis of the femoral condyle after arthroscopic surgery. Retrospective review of 10 patients who presented with avascular necrosis of the ipsilateral femoral condyle following arthroscopic meniscectomy (9 medial, 1 lateral). The bone lesions were evaluated by radiography and MRI, which were repeated for few patients. MRI allows earlier diagnosis of avascular necrosis of the femoral condyle and offers an evaluation of extent of the lesions whose evolution is variable: 3 patients required a knee prosthesis, the other 7 patients were treated medically. (authors). 21 refs.

  11. Biarticular total femur spacer for massive femoral bone loss: the mobile solution for a big problem

    Directory of Open Access Journals (Sweden)

    Pablo Sanz-Ruiz, PhD, MD

    2018-03-01

    Full Text Available Bone cement spacers loaded with antibiotic are the gold standard in septic revision. However, the management of massive bone defects constitutes a surgical challenge, requiring the use of different nails, expensive long stems, or cement-coated tumor prostheses for preparing the spacer. In most cases, the knee joint must be sacrificed. We describe a novel technique for preparing a biarticular total femur spacer with the help of a trochanteric nail coated with antibiotic loaded cement, allowing mobility of the hip and knee joints and assisted partial loading until second step surgery. This technique is helpful to maintain the length of the leg, prevent soft tissue contracture, and help eradicate the infection preserving the patient comfort and autonomy while waiting to receive total femoral replacement.

  12. Biarticular total femur spacer for massive femoral bone loss: the mobile solution for a big problem.

    Science.gov (United States)

    Sanz-Ruiz, Pablo; Calvo-Haro, Jose Antonio; Villanueva-Martinez, Manuel; Matas-Diez, Jose Antonio; Vaquero-Martín, Javier

    2018-03-01

    Bone cement spacers loaded with antibiotic are the gold standard in septic revision. However, the management of massive bone defects constitutes a surgical challenge, requiring the use of different nails, expensive long stems, or cement-coated tumor prostheses for preparing the spacer. In most cases, the knee joint must be sacrificed. We describe a novel technique for preparing a biarticular total femur spacer with the help of a trochanteric nail coated with antibiotic loaded cement, allowing mobility of the hip and knee joints and assisted partial loading until second step surgery. This technique is helpful to maintain the length of the leg, prevent soft tissue contracture, and help eradicate the infection preserving the patient comfort and autonomy while waiting to receive total femoral replacement.

  13. Treatment of osteonecrosis of the femoral head using autologous cultured osteoblasts: a case report

    Directory of Open Access Journals (Sweden)

    Kim Seok-Jung

    2008-02-01

    Full Text Available Abstract Introduction Osteonecrosis of the femoral head is a progressive disease that leads to femoral head collapse and osteoarthritis. Our goal in treating osteonecrosis is to preserve, not to replace, the femoral head. Case presentation We present the case of a patient with bilateral osteonecrosis of the femoral head treated with autologous cultured osteoblast injection. Conclusion Although our experience is limited to one patient, autologous cultured osteoblast transplantation appears to be effective for treating the osteonecrosis of femoral head.

  14. Atomic-level Electron Microscopy of Metal and Alloy Electrocatalysts

    DEFF Research Database (Denmark)

    Deiana, Davide

    , the elemental distribution of the PtxY, before and after the electrochemical tests, has been determined. A core-shell structure is formed after the ORR chemical treatment, with an alloyed core embedded by a ~1 nm Pt-rich shell, due to the segregation of the Y from the first few atomic layers of the particle...... was the only matching structure. In the case of Pd−Hg, a core-shell structure has been found, with a pure Pd core and a Pd-Hg shell. Through atomic resolution STEM, the structure of the alloy in the shell of different particles has been revealed, showing the formation of an ordered alloy structure....... flat surfaces and exposed to different sintering conditions. Ex situ STEM imaging has been used to monitor the variation of the particle dimensions through the analysis of particle area distributions. Clusters with a monomodal size distribution exhibited intrinsic sintering resistance on different...

  15. Castability of Magnesium Alloys

    Science.gov (United States)

    Bowles, A. L.; Han, Q.; Horton, J. A.

    There is intense research effort into the development of high pressure die cast-able creep resistant magnesium alloys. One of the difficulties encountered in magnesium alloy development for creep resistance is that many additions made to improve the creep properties have reportedly resulted in alloys that are difficult to cast. It is therefore important to have an understanding of the effect of alloying elements on the castability. This paper gives a review of the state of the knowledge of the castability of magnesium alloys.

  16. Posterior versus lateral approach for hemiarthroplasty after femoral neck fracture: Early complications in a prospective cohort of 583 patients.

    Science.gov (United States)

    Svenøy, Stian; Westberg, Marianne; Figved, Wender; Valland, Haldor; Brun, Ole Christian; Wangen, Helge; Madsen, Jan Erik; Frihagen, Frede

    2017-07-01

    To compare early complications after the posterior and the direct lateral (transgluteal) approach, when using hemiarthroplasty in the treatment of displaced femoral neck fractures in the elderly. A prospective clinical study from four Norwegian hospitals, consisting of 583 patients with 1year follow-up. All the hospitals used the same uncemented femoral stem and bipolar heads. Data were collected for gender, age, surgical approach, prosthetic dislocation, postoperative infection, perioperative fracture, duration of surgery, ASA score, diabetes, alcoholism, cognitive failure, BMI, 30-day mortality and 1-year mortality. Mean age was 83 years (SD 7.8) and 434/583 (74%) were female. There were no relevant differences between the treatment groups. A higher risk was found for prosthetic dislocation in the posterior group compared to the lateral group (15/186 (8%) vs. 4/397 (1%); RR=8.0, 95% CI 2.7-23.8, p-valueapproach was identified. There were no differences between the approach groups for other complications. There was an 8-fold increased risk for prosthetic dislocations after the posterior approach compared to lateral approach. There was a high risk for recurrent prosthetic dislocations and a subsequent risk for further surgeries and a poor end result. The potential advantages of the posterior approach have not been demonstrated after femoral neck fractures and we advise against its continued use. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Cost of treatment of paediatric femoral shaft fractures: compression ...

    African Journals Online (AJOL)

    one case of osteogenesis imperfecta is on record) and indication for surgery. Results: Thirty-one patients who had ORIF and 31 matched controls were recruited from a pool of 775 children who sustained femoral fractures over the study period.

  18. Delayed appearance of hypaesthesia and paralysis after femoral nerve block

    Science.gov (United States)

    Landgraeber, Stefan; Albrecht, Thomas; Reischuck, Ulrich; von Knoch, Marius

    2012-01-01

    We report on a female patient who underwent an arthroscopy of the right knee and was given a continuous femoral nerve block catheter. The postoperative course was initially unremarkable, but when postoperative mobilisation was commenced, 18 hours after removal of the catheter, the patient noticed paralysis and hypaesthesia. Examination confirmed the diagnosis of femoral nerve dysfunction. Colour duplex sonography of the femoral artery and computed tomography of the lumbar spine and pelvis yielded no pathological findings. Overnight the neurological deficits decreased without therapy and were finally no longer detectable. We speculate that during the administration of the local anaesthetic a depot formed, localised in the medial femoral intermuscular septa, which was leaked after first mobilisation. To our knowledge no similar case has been published up to now. We conclude that patients who are treated with a nerve block should be informed and physician should be aware that delayed neurological deficits are possible. PMID:22577509

  19. Delayed appearance of hypaesthesia and paralysis after femoral nerve block

    Directory of Open Access Journals (Sweden)

    Stefan Landgraeber

    2012-03-01

    Full Text Available We report on a female patient who underwent an arthroscopy of the right knee and was given a continuous femoral nerve block catheter. The postoperative course was initially unremarkable, but when postoperative mobilisation was commenced, 18 hours after removal of the catheter, the patient noticed paralysis and hypaesthesia. Examination confirmed the diagnosis of femoral nerve dysfunction. Colour duplex sonography of the femoral artery and computed tomography of the lumbar spine and pelvis yielded no pathological findings. Overnight the neurological deficits decreased without therapy and were finally no longer detectable. We speculate that during the administration of the local anaesthetic a depot formed, localised in the medial femoral intermuscular septa, which was leaked after first mobilisation. To our knowledge no similar case has been published up to now. We conclude that patients who are treated with a nerve block should be informed and physician should be aware that delayed neurological deficits are possible.

  20. Effectiveness of plate augmentation for femoral shaft nonunion after nailing

    Directory of Open Access Journals (Sweden)

    Chin-Jung Lin

    2012-08-01

    Conclusion: Plate augmentation with retention of the nail with autologous bone grafting may be an effective and reliable alternative in treating nonunion of the femoral shaft fracture after open reduction and internal fixation with intramedullary nail.

  1. Osteonecrosis of the femoral head after renal transplantation

    International Nuclear Information System (INIS)

    Meneghello, A.; Bertoli, M.; Ruffatti, A.

    1988-01-01

    In 5 out of 16 renal transplantation patients, osteonecrosis of the femoral head developed in the presence (p < 0.01) of significant uremic neuropathy; its possible pathogenetic role is discussed. (orig.)

  2. Cell therapy for avascular osteonecrosis of femoral head

    Directory of Open Access Journals (Sweden)

    Tomoki Aoyama

    2009-04-01

    Full Text Available Avascular osteonecrosis of femoral head causes severe musculoskeletal disability. There is not standard treatment to cure avascular osteonecrosis.? Recently, cell therapy using bone marrow stromal cells has begun for this disease.

  3. Cell therapy for avascular osteonecrosis of femoral head

    OpenAIRE

    Tomoki Aoyama; Junya Toguchida

    2009-01-01

    Avascular osteonecrosis of femoral head causes severe musculoskeletal disability. There is not standard treatment to cure avascular osteonecrosis.? Recently, cell therapy using bone marrow stromal cells has begun for this disease.

  4. 'Femoral head necrosis' in metabolic and hormonal osteopathies

    International Nuclear Information System (INIS)

    Heuck, F.H.W.; Treugut, H.

    1984-01-01

    The pathogenesis of bone necrosis is discussed with special attention and with respect to metabolic, hormonal, and vascular factors. The influence of statics and dynamics of the hip joint bones for the development of aseptic necrosis are discussed. 45 patients with ''idiopathic femoral head necroses'' were observed, including 6 cases of renal osteopathy following renal transplantation and immune suppression therapy, 14 cases of long term corticoid therapy, and 11 cases of liver diseases of different genesis. The femoral head necrosis understood as complication of an osteopathy. In our patients there were 31 males and 14 females - which means higher involvement of males. Plain radiological findings and CT-findings of changes of the femoral heat structure in different stages of the disease are described. Early diagnosis of metabolic and hormonal osteopathies is demanded for a joint keeping therapy of the beginning femoral head necrosis. (orig.) [de

  5. Biocompatibility of dental alloys

    Energy Technology Data Exchange (ETDEWEB)

    Braemer, W. [Heraeus Kulzer GmbH and Co. KG, Hanau (Germany)

    2001-10-01

    Modern dental alloys have been used for 50 years to produce prosthetic dental restorations. Generally, the crowns and frames of a prosthesis are prepared in dental alloys, and then veneered by feldspar ceramics or composites. In use, the alloys are exposed to the corrosive influence of saliva and bacteria. Metallic dental materials can be classified as precious and non-precious alloys. Precious alloys consist of gold, platinum, and small amounts of non-precious components such as copper, tin, or zinc. The non-precious alloys are based on either nickel or cobalt, alloyed with chrome, molybdenum, manganese, etc. Titanium is used as Grade 2 quality for dental purposes. As well as the dental casting alloys, high purity electroplated gold (99.8 wt.-%) is used in dental technology. This review discusses the corrosion behavior of metallic dental materials with saliva in ''in vitro'' tests and the influence of alloy components on bacteria (Lactobacillus casei and Streptococcus mutans). The test results show that alloys with high gold content, cobalt-based alloys, titanium, and electroplated gold are suitable for use as dental materials. (orig.)

  6. A Case of Bilateral Aseptic Necrosis of the Femoral Head

    OpenAIRE

    KAMAL, DIANA; TR?ISTARU, RODICA; KAMAL, C.K.; ALEXANDRU, D.O.; MOGOANT?, L.; GRECU, D.C.

    2014-01-01

    Aseptic necrosis of the femoral head is a disease whose etiology is not completely elucidated and generally affects young adults aged between 30 and 50 years. In a significant number of patients bilateral disease occurs, which makes detection in its early stages constitute an important objective. We present the case of a male patient, aged 23 years, with the following risk factors: smoking and chronic alcohol consumption, who is diagnosed with aseptic necrosis of the left femoral head, ARCO s...

  7. Interlocked intramedullary nailing for treatment of open femoral shaft fractures.

    Science.gov (United States)

    Baixauli, F; Baixauli, E J; Sánchez-Alepuz, E; Baixauli, F

    1998-05-01

    Twenty-eight patients with open femoral shaft fractures treated by reamed intramedullary nailing were reviewed retrospectively. Nine patients had Gustilo Grade I injuries; 14, Grade II; and five, Grade IIIA. Twenty cases had static locking, two cases had dynamic locking, and six cases were not locked. Average time to union was 20 weeks. The infection and nonunion rates were 0%. The data suggest that interlocked reamed intramedullary nailing is a safe treatment option for treating open femoral shaft fractures.

  8. Primary hybrid THA using a polymethyl methacrylate-precoated stem: A single-center experience with a 10-year minimum follow-up.

    Science.gov (United States)

    Kim, Wanlim; Yoon, Pil Whan; Kwak, Hong Suk; Yoo, Jeong Joon; Kim, Hee Joong; Yoon, Kang Sup

    2017-07-01

    The high failure rate of cemented femoral components in the 1970s facilitated the improvement of the cementing technique and surface finishes such as polymethylmethacrylate (PMMA)-precoated stems, reporting a survival rate of >95% at 10 years from some studies. However, controversy persists regarding whether precoated femoral stems are associated with a longer revision-free prosthesis survival. The purpose of this study was to evaluate the clinical and radiological outcomes of PMMA-precoated femoral stems, and analyze factors associated with implant survival. We retrospectively reviewed 73 primary hybrid total hip arthroplasties performed using PMMA-precoated femoral stems. The mean age of the patients was 61 years. During the mean follow-up period of 13 years, 18 hips (24.7%) underwent aseptic loosening, and all of the loosened stems were subjected to revision surgery 8.8 years (range 4.6-15.5 years) from the index surgery. Younger age and poor cementing were significantly associated with aseptic loosening (P = 0.013 and P < 0.001, respectively). However, the aseptic loosening rate was also high at 13.1% even with a good cementing technique. In conclusion, the PMMA-precoated stem failed to show expected advantages and needs to be replaced with other surface finish stem designs. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1300-1306, 2017. © 2016 Wiley Periodicals, Inc.

  9. Femoral Neck Shaft Angle in Men with Fragility Fractures

    Directory of Open Access Journals (Sweden)

    S. P. Tuck

    2011-01-01

    Full Text Available Introduction. Femoral neck shaft angle (NSA has been reported to be an independent predictor of hip fracture risk in men. We aimed to assess the role of NSA in UK men. Methods. The NSA was measured manually from the DXA scan printout in men with hip (62, 31 femoral neck and 31 trochanteric, symptomatic vertebral (91, and distal forearm (67 fractures and 389 age-matched control subjects. Age, height, weight, and BMD (g/cm2: lumbar spine, femoral neck, and total femur measurements were performed. Results. There was no significant difference in mean NSA between men with femoral neck and trochanteric hip fractures, so all further analyses of hip fractures utilised the combined data. There was no difference in NSA between those with hip fractures and those without (either using the combined data or analysing trochanteric and femoral neck shaft fractures separately, nor between fracture subjects as a whole and controls. Mean NSA was smaller in those with vertebral fractures (129.2° versus 131°: P=0.001, but larger in those with distal forearm fractures (129.8° versus 128.5°: P=0.01. Conclusions. The conflicting results suggest that femoral NSA is not an important determinant of hip fracture risk in UK men.

  10. OUTCOME OF INTERTROCHANTERIC FRACTURES TREATED WITH SHORT FEMORAL NAIL

    Directory of Open Access Journals (Sweden)

    Yadkikar Shriniwas V, Yadkikar Vishnu S, Patel Mayank, Dhruvilkumar Gandhi, Kunkulol Rahul

    2015-07-01

    Full Text Available Aim: To study the functional and anatomical outcome of Inter trochanteric fractures of femur treated with Short femoral nail. Method: This was retrospective study carried out in which 60 patients (50 Male & 10 Female of 5th to 8th decade of life who underwent Short femoral nail fixation for both Stable & unstable Inter Trochanteric fractures. From the records each patient data was assessed for time required for mobilization, average fracture healing time, degree and grade of hip range of movements, complications, anatomical reduction achieved using Short femoral nail fixation. Results: 55 cases achieved Anatomical reduction. Good to Excellent Hip range of Motion was in 55 (90 % cases. Fracture union was seen in all cases. No evidence of Z Effect, AVN of femoral head, Implant failure, Fracture of femoral shaft below the Nail tip was seen in any case, However Reverse Z Effect was seen in 4 & shortening of less than 2 cm was seen in 2 cases, External rotation of 10 degree was seen in1 case. Average fracture Union time was 14 weeks. Conclusion: Short femoral nail appears to be better implant for fixation of both Stable & unstable Inter Trochanteric fractures as it fulfills the biomechanical demands being minimally invasive, less blood loss , it prevents excessive varus collapse at fracture site, produces less stress riser effect below the nail tip, Short operative time, Facilitates early mobilization & functional recovery of patients. But Anatomical fracture reduction & optimal implant placement are absolutely must for better results.

  11. Use of the term "superficial femoral vein" in ultrasound.

    Science.gov (United States)

    Thiagarajah, Ramya; Venkatanarasimha, Nanda; Freeman, Simon

    2011-01-01

    To determine the frequency of use of the term "superficial femoral vein" (SFV) in the radiologic reports from a sample of sonographic investigations for suspected deep vein thrombosis and to assess the potential for clinical error in their interpretation. Retrospective review of 425 consecutive reports from medical patients attending the Imaging Department over a 6-month period for the presence of the term "superficial femoral vein" and for the presence of thrombus. A questionnaire was sent to a sample of referring clinicians to assess their understanding of the anatomy of the deep venous system of the leg and indications for anticoagulant treatment. Of the 425 sonographic investigations reviewed, 90 (21.2%) used the term "superficial femoral vein," and 12 (13.3%) were positive for SFV thrombus. Among 87 clinicians, 74.7% believed the SFV to be part of the superficial venous system and that its thrombosis did not require anticoagulant treatment, although anticoagulation is now indicated in selected cases of superficial venous thrombosis. Seventy-five percent of clinicians do not recognize the SFV as being part of the deep venous system and that its thrombosis requires anticoagulant treatment. In this study, 13% of SFV examined were positive for thrombus, and four patients (4.4%) had an isolated SFV thrombus that could have been left untreated due to this misunderstanding. Use of the term "superficial femoral vein" is prone to misinterpretation by clinicians and potentially hazardous to patients. It should be replaced by "common femoral vein" and "femoral vein" in reports.

  12. [Results after replacement of femoral neck prostheses - thrust plate prosthesis (TPP) versus ESKA cut prosthesis].

    Science.gov (United States)

    Ishaque, B A; Gils, J; Wienbeck, S; Donle, E; Basad, E; Stürz, H

    2009-01-01

    The aim of this study was to analyse and evaluate comparatively loosening mechanisms, failure frequency, surgical changing strategies and results after replacement of thrust plate prostheses (TPP) and ESKA Cut prostheses. Between 1993 und 2007, 465 TPP and in the years 2000 and 2001 82 ESKA Cut prostheses were performed and evaluated prospectively. Until 2007 46 change interventions of the TPP and 35 of the CUT prosthesis became necessary. All patients who received a stem revision procedure in our hospital were included within this study. Besides the evaluation of clinical results according to the criteria of the Harris Hip Score on the average at 15.6 months (+/- 14.4) postoperatively, radiological loosening processes and surgical difficulties were registered. Furthermore, an analysis of perioperative data was performed according to some criteria of the German Federal Office of Quality Assurance (BQS), such as duration of the surgery, intraoperative blood loss and complications. Statistical investigations for comparative analysis as well as survival analysis of both groups were calculated using SPSS for Windows 13.0. The mean age of the 46 patients who had to undergo revision surgery after TPP was 60.1 years, that of 35 patients in whom revision surgery was necessary after receiving an ESKA Cut femoral neck stem was 56.6 years. The survival rate analysis according to Kaplan-Meier at 13 years was 89.4 % (TPP) and 53.6 % at 66 months (ESKA Cut). In all cases the partial osteointegration of the tripod surface of the loosened Cut prosthesis complicated the explantation. It led on the one hand to a significant difference of the surgery duration and on the other hand to an increased frequency of fractures of the trochanteric region. The conversion of the TPP on standard type stems was usually free of problems. The HHS increased significantly to the averages of 86.6 (TPP) or, respectively, 91.69 (ESKA Cut) after revision. In comparison with the usually problem

  13. Subcapital femoral neck fracture after fixation of an intertrochanteric fracture with a proximal femoral nail: a report of two cases.

    Science.gov (United States)

    Kaneko, Haruka; Matsuda, Keiji; Kim, Sungon; Maeda, Kouichi; Ikegami, Takashi; Kubota, Reiko; Nagayama, Masataka; Nozawa, Masahiko

    2009-12-01

    Subcapital femoral neck fractures are a rare complication after fixation of an intertrochanteric fracture with a proximal femoral nail. We report 2 such cases where the patients had severe osteoporosis, based on Singh's index and pathological findings. In one case there was a technical error leading to a tip-apex distance of more than 20 mm, but osteoporosis appeared to be a more significant cause than any technical problems.

  14. Effect of collapse on the deformity of the femoral head-neck junction in osteonecrosis of the femoral head.

    Science.gov (United States)

    Kubo, Yusuke; Motomura, Goro; Ikemura, Satoshi; Sonoda, Kazuhiko; Yamamoto, Takuaki; Nakashima, Yasuharu

    2017-07-01

    The purpose of this study was to morphologically assess the effect of collapse on the deformity of the femoral head-neck junction in patients with nontraumatic osteonecrosis of the femoral head (ONFH). From January 2005 through March 2016, magnetic resonance (MR) imaging including the oblique view was repeatedly performed before and after collapse in 24 hips of patients with ONFH (16 men, 8 women; mean age 43 years; range 23-68 years), that were the subjects of this study. The interval of MR imaging before and after collapse was 8.0 months (range 1-32 months). In addition, 82 asymptomatic hips in patients without ONFH as identified by MR imaging taken at the same duration were used as controls. The oblique MR image was used to measure the radiological parameters of the femoral head-neck junction, including the α-angle and head-neck offset ratio (HNOR). The α-angle and HNOR after collapse (58.3° ± 10.0° and 0.138 ± 0.033, respectively) indicated significantly decreased anterior femoral head-neck offset compared with those before collapse (46.2° ± 5.7° and 0.178 ± 0.018, respectively; p femoral head collapse (p femoral head-neck offset observed in patients with ONFH was a consequence of collapse.

  15. Thrust plate prosthesis for osteonecrosis of the femoral head: short-term results of 15 patients followed 2-6 years.

    Science.gov (United States)

    Karatosun, Vasfi; Gunal, Izge; Unver, Bayram; Gultekin, Alper

    2006-10-01

    The thrust plate prosthesis is an implant with a metaphyseal fixation at the proximal femur that transmits the load forces of the hip onto the femoral neck. In this prospective study, 15 patients (8 women, 7 men) with 19 cementless thrust plate prostheses because of femoral head necrosis were examined. A clinical and radiologic evaluation was performed preoperatively, at 3, 6, 12, 18, and 24 months postoperatively, and every year thereafter. The mean follow-up period was 44 (range, 24-72) months. The average age at the time of surgery was 49 (27-70) years. The pathogenesis of femoral head necrosis included alcoholism (6 joints of 3 cases), Gaucher disease (1 joint of 1 case), Sheehan syndrome (2 joints of 1 case), and idiopathic (10 joints of 10 cases). The Harris hip score increased from 53 (range, 15-71) to 97 (92-100) points on the final evaluation. Although mean preoperative hip flexion and abduction were 78 degrees (45 degrees -110 degrees ) and 24 degrees (10 degrees -45 degrees ), respectively, these increased to 114 degrees (75 degrees -125 degrees ) and 47 degrees (45 degrees -50 degrees ) 12 months after surgery and remained stable up to the latest follow-up. None of the patients displayed mechanical problems, and revision was not necessary in any case. The thrust plate prosthesis shows midterm results comparable to those of the cementless stemmed prosthesis and supplies advantages, especially for younger patients with femoral head necrosis, because of its metaphyseal bone-preserving fixation.

  16. Stem Cell Information: Glossary

    Science.gov (United States)

    ... Long-term self-renewal Meiosis Mesenchymal stem cells Mesoderm Microenvironment Mitosis Multipotent Neural stem cell Neurons Oligodendrocyte ... layers. The three layers are the ectoderm , the mesoderm , and the endoderm . Hematopoietic stem cell - A stem ...

  17. Prevention of excessive postoperative sliding of the short femoral nail in femoral trochanteric fractures.

    Science.gov (United States)

    Ito, Juji; Takakubo, Yuya; Sasaki, Kan; Sasaki, Junya; Owashi, Kazuya; Takagi, Michiaki

    2015-05-01

    Lag screw cut-out is one of the major postoperative complications on femoral trochanteric fractures. However, precise analyses of excessive sliding and lag screw cut-out were limited. The purpose of this study was to investigate the factors that induce this unfavorable event. From April 2010 to April 2013, 226 patients were operated in our institute using a short femoral nail. Among them, 177 patients (29 males and 148 females) with a mean age of 84 years (60-97 years), who were followed up >3 months, were included in this study. The postoperative sliding distance, fracture type (AO/OTA classification), tip-apex distance (TAD), reduction pattern in the postoperative X-ray (antero-posterior and lateral views), bone quality (canal flare and cortical indices), walking ability at the time of pre-injury and final follow-up, and complications were investigated retrospectively. The mean sliding distance was 3.7 mm, and one cut-out case (0.6 %) was observed. The sliding distance of the AO/OTA 31-A2 fractures was significantly longer than that of the A1 fractures (p fractures, an accurate reduction in the lateral view at surgery is important, particularly in unstable fractures.

  18. Correlation between the distal anterior femoral cortical axis and femoral rotational alignment: an anatomic study.

    Science.gov (United States)

    Sathappan, S S; Tan, M Wp; Ginat, D; Walsh, M G; Schweitzer, M E; Di Cesare, P E

    2016-08-01

    To determine the correlation between the distal anterior femoral cortical axis (DAFCA) and the femoral rotational alignment/axis. Magnetic resonance images (MRI) of 82 knees in 34 men and 23 women aged 16 to 47 (mean, 33.4) years were reviewed by a musculoskeletal radiologist. Their diagnoses included meniscal tear (n=4), chondromalacia (n=25), anterior cruciate ligament tears (n=11), and normal (n=42). In all patients the collateral ligaments were intact. The transepicondylar axis (TEA), posterior condylar axis (PCA), Whiteside line (WL), and joint line were drawn on the images, and the condylar twist angle (CTA), TEA-WL angle, DAFCA, epicondylar cortical angle (ECA), and condylar cortical angle (CCA) were measured. The correlations among ECA, CCA, and CTA (control) were assessed. The mean distances between the joint line and the TEA, PCA, and DAFCA were 30.8, 22.1, and 62.2 mm, respectively. The angles subtended by the intersection between the standard axes (TEA, PCA, and WL) and the DAFCA were determined. There was correlation between the CTA and ECA (r=0.34, protational alignment when the standard landmarks are distorted by severe soft tissue and bone loss.

  19. Modular Fluted Tapered Stems in Aseptic Revision Total Hip Arthroplasty.

    Science.gov (United States)

    Abdel, Matthew P; Cottino, Umberto; Larson, Dirk R; Hanssen, Arlen D; Lewallen, David G; Berry, Daniel J

    2017-05-17

    Modular fluted tapered stems have become the most commonly employed category of femoral component in revision hip arthroplasty in North America as a result of favorable early results and simplicity of use. Despite wide adoption, the majority of published data are limited to relatively small series with modest follow-up. The goal of the current study was to determine the success rate and factors associated with success, failure, and complications of the use of modular fluted tapered stems in aseptic revision total hip arthroplasties (THAs) in a large patient cohort. We identified 519 aseptic femoral revisions during which a modular fluted tapered stem was utilized. Clinical outcomes, Kaplan-Meier survivorship, radiographic outcomes, and complications were assessed. The mean age at revision arthroplasty was 70 years, the mean body mass index (BMI) was 29 kg/m, and the mean duration of follow-up was 4.5 years (range, 2 to 14 years). The mean Harris hip score (HHS) improved significantly from 51 points preoperatively to 76 points at 2 years (p revisions had been performed: 6 because of aseptic loosening, 4 because of infection, 3 because of instability, 2 because of periprosthetic fracture, and 1 because of stem fracture. The 10-year survivorship was 96% with revision for any reason as the end point and 90% with any reoperation as the end point. Of the patients who were alive and had not undergone revision at the time of final follow-up, 12 had stem subsidence but all but 1 of these stems had stabilized after subsiding. Postoperative complications were noted in 12% of the cases. Repeat revision due to femoral component loosening was not correlated with the preoperative bone-loss category or patient demographic factors. In this large series, femoral revision with a modular fluted tapered stem provided a high rate of osseointegration and sustained improvement in clinical scores at the time of the last follow-up. There was also a high rate of successful implant fixation

  20. Femoral Condyle Fracture during Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Selahattin Ozyurek

    2015-07-01

    Full Text Available Dear Editor,We have greatly enjoyed reading the case report entitled “‘Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature in the issue of Arch Bone Jt Surg. 2015;3(2 with great interest. We would like to commend the authors for their detailed and valuable work. Although various case reports have described postoperative distal femur fracture at a range of time intervals (1,2 intraoperative intra-articular distal femur fracture is a unique entity.However, we believe that some important additional observations seem necessary to be contributed through this study. In this article, the authors stated that, to the best of their knowledge, there is no other case report in the literature introducing a femoral condyle fracture during arthroscopic ACL reconstruction or revision reconstruction. Nevertheless, we would like to call the attention of the readers to the fact that that the literature contains one additional case report re‌porting on intraoperative distal femoral coronal plane (Hoffa fracture during primary ACL reconstruction (2. Werner BC and Miller MD presented of case report of an intraoperative distal femoral coronal plane (Hoffa fracture that occurred during independent femoral tunnel drilling and dilation in a primary ACL reconstruction. As in the their case, this type of fracture can occur with appropriately placed femoral tunnels, but the risk can increase with larger graft diameters in patients with smaller lateral femoral condyles The patient was treated with open reduction and internal fixation, without compromise of graft stability and with good recovery of function. We believe that tailoring graft size to the size of the patient is important to prevent similar adverse events.

  1. Structural and functional studies of bioobjects prepared from femoral heads

    Energy Technology Data Exchange (ETDEWEB)

    Kirilova, I. A., E-mail: IKirilova@niito.ru; Podorozhnaya, V. T., E-mail: VPodorognaya@niito.ru [Research Institute of Traumatology and Orthopedics n.a. Ya.L. Tsivyan, 17, Frunze, Novosibirsk, 630091 (Russian Federation); Sharkeev, Yu. P., E-mail: sharkeev@ispms.tsc.ru [Institute of Strength Physics and Materials Science SB RAS, 2/4, pr. Akademicheskii, Tomsk, 634021 (Russian Federation); National Research Tomsk Polytechnic University, 30, Lenin Avenue, Tomsk, 634050 (Russian Federation); Popova, K. S., E-mail: kseniya@ispms.tsc.ru; Uvarkin, P. V., E-mail: uvarkin@ispms.tsc.ru [Institute of Strength Physics and Materials Science SB RAS, 2/4, pr. Akademicheskii, Tomsk, 634021 (Russian Federation)

    2015-11-17

    Results of examination of physicomechanical characteristics of samples of medial femoral head cuts are presented. The samples of medial femoral head cuts resected in 6 patients with coxarthrosis in primary endoprosthetic replacement of a coxofemoral joint have been tested for micro- and nanohardness. Young’s modulus and elemental composition of bone tissue have been investigated. To estimate the architectonics of cancellous tissue of the femoral head, adjacent cuts of the same patient have been analyzed. The porosity of bone tissue was estimated from macroscopic images obtained using macrophotography. The total porosity is calculated as the ratio of the total length of straight line segments overlapping pores to the total length of secants. A three-point bending test of the samples has shown that their strength changed from 0.187 to 1.650 MPa and their elasticity modulus changes from 1.69 to 8.15 MPa. The microhardness of the samples changes in the range 220–265 MPa and the average microhardness of medial femoral head cuts is 240 MPa. The elemental composition of medial femoral head cuts is represented by basic Ca, P, O, Na and Mg elements as well as by Sn, S, Fe, Cr, and C in microamounts. The atomic Ca to P ratio for bone tissue is 1.55. It is revealed that pores of the upper part of the femoral head have a more regular shape and in the lower part they are more elongated along the cut and occupy a larger volume. The lower part of the femoral head has a higher porosity (39 and 33%) than the upper part (34 and 30%). The total porosity of all samples does not exceed 37%.

  2. Apoptosis in the osteonecrosis of the femoral head.

    Science.gov (United States)

    Youm, Yoon-Seok; Lee, Soo-Youn; Lee, Soo-Ho

    2010-12-01

    Osteonecrosis of the femoral head is classified into idiopathic and secondary forms. A number of etiological factors in the development of osteonecrosis have been suggested but the biological mechanisms are still unclear. Recently, some reports suggested that the apoptosis is closely related to osteonecrosis of the femoral head. Therefore, this study examined the expression of apoptosis in osteonecrosis of the femoral head. Of the patients diagnosed preoperatively with osteonecrosis and underwent total hip replacement arthroplasty between August 2004 and July 2005, 58 patients (58 hips) were available for this study. Their diagnoses were confirmed by the postoperative pathology findings. Tissue samples of the femoral head sections were terminal deoxynucleotydyl transferase mediated dUTP nick-end labeling (TUNEL) stained using an in situ cell death detection POD kit. The number of total and TUNEL-positive osteocytes, and the average ratio of TUNEL-positive cells were calculated and analyzed according to the cause. Osteonecrosis was steroid-induced in 8 cases (13.8%), alcohol-induced in 29 cases (50%), post-traumatic in 6 cases (10.3%) and idiopathic in 15 cases (25.9%). The percentage of TUNEL-positive osteocytes was high in patients with steroid- and alcohol-induced osteonecrosis of the femoral head but low in patients with post-traumatic and idiopathic osteonecrosis. The difference in the percentage of TUNEL-positive osteocytes between these groups was significant (p osteonecrosis of the femoral head induced by steroid and alcohol. These findings highlight a need for further research into the role of apoptosis in the development of osteonecrosis of the femoral head.

  3. [Femoral artery pseudoaneurysms encountered in orthopedics and traumatology].

    Science.gov (United States)

    Raherinantenaina, F; Rajaonanahary, T M A; Rakoto Ratsimba, H N

    2015-12-01

    Most published articles regarding orthopedic- and trauma-related femoral artery pseudoaneurysms (FAPs) are case reports in English. Reported cases are often associated with a literature review but actually provide little robust data. We wanted to summarize the current knowledge on diagnostic and therapeutic features of these FAPs. A new case of superficial FAP is described followed by a review of the literature. A bibliographic search was performed online (PubMed, ScinceDirect) from 1964 to 2015 using the descriptors "traumatic femoral pseudoaneurysm, orthopedic surgery, osteochondroma". A total of 64 cases of FAPs was analyzed. There were 50 men with an average age of 40.72±26.45 years old. The most common clinical presentation was painful swelling (34%). Arteriography was the commonest radiological investigation used (63%). The main etiologies were orthopedic injuries (47%), surgery of the upper thigh (30%) and femoral osteochondromas (23%). Arterial injuries included superficial femoral (47%) and profunda femoris artery (50%). The treatment was open surgery (56%) or endovascular repair (36%). Deep femoral artery and its branches were embolized (47%) or ligated (38%). Endovascular stenting was performed in 30% of posttraumatic FAPs. All FAPs relating to osteochondromas were repaired surgically. Postoperative courses were uneventful in 95% of patients. Endovascular embolization is preferred in management of postsurgical FAPs which have usually involved the deep femoral artery. Endovascular stenting graft may be proposed for posttraumatic FAPs, for which the superficial femoral trunk is the most often involved vessel. Surgical repair should be performed when endovascular stenting graft is not feasible. Surgical repair is mandatory for all FAPs secondary to traumatic exostoses. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  4. Radiological assessment of the femoral bowing in Japanese population

    Directory of Open Access Journals (Sweden)

    Abdelaal Ahmed Hamed Kassem

    2016-01-01

    Full Text Available Introduction: Differences in the magnitude of bowing between races are well-known characteristics of the femur. Asian races have an increased magnitude of femoral bowing but most of the orthopedic implants designed for the femur do not match this exaggerated bowing. We calculated the sagittal and coronal femoral bowing in the Japanese population at different levels of the femur and addressed its surgical significance. Material and methods: We calculated the sagittal and coronal bowing of 132 Japanese femora using CT scan of the femur. A mathematical calculation of the radius of curvature at proximal, middle, and distal regions of the femur was used to determine the degree of femoral bowing. Results: Mean sagittal bowing of the femur was 581, 188, and 161 mm for the proximal, middle, and distal thirds of the femur and mean lateral bowing was 528, 5092, and 876 mm, respectively. Mean sagittal and coronal bowing for the whole femur was 175 and 2640 mm, respectively. No correlation was found between age, gender, length of femur, and the degree of bowing. Conclusion: Our study reveals that femoral bowing in the Japanese population is 175 mm in the sagittal plane and 2640 mm in the coronal plane; these values are greater than the femoral bowing in other ethnic groups studied in the literature. This may result in varying degrees of mismatch between the western-manufactured femoral intramedullary implants and the Japanese femur. We recommend that orthopedic surgeons to accurately perform preoperative evaluation of the femoral bowing to avoid potential malalignment, rotation, and abnormal stresses between the femur and implant.

  5. Catalyst Alloys Processing

    Science.gov (United States)

    Tan, Xincai

    2014-10-01

    Catalysts are one of the key materials used for diamond formation at high pressures. Several such catalyst products have been developed and applied in China and around the world. The catalyst alloy most widely used in China is Ni70Mn25Co5 developed at Changsha Research Institute of Mining and Metallurgy. In this article, detailed techniques for manufacturing such a typical catalyst alloy will be reviewed. The characteristics of the alloy will be described. Detailed processing of the alloy will be presented, including remelting and casting, hot rolling, annealing, surface treatment, cold rolling, blanking, finishing, packaging, and waste treatment. An example use of the catalyst alloy will also be given. Industrial experience shows that for the catalyst alloy products, a vacuum induction remelt furnace can be used for remelting, a metal mold can be used for casting, hot and cold rolling can be used for forming, and acid pickling can be used for metal surface cleaning.

  6. Cement augmentation in the proximal femur to prevent stem subsidence in revision hip arthroplasty with Paprosky type II/IIIa defects.

    Science.gov (United States)

    Tsai, Shang-Wen; Chen, Cheng-Fong; Wu, Po-Kuei; Chen, Chao-Ming; Chen, Wei-Ming

    2018-02-07

    Subsidence remains a common complication after revision hip arthroplasty which may lead to prolonged weight-bearing restrictions, leg-length discrepancies or considerable loss of function. We evaluated the effectiveness of cement augmentation in the proximal femoral metaphysis during a revision of femoral components to prevent post-operative stem subsidence. Forty patients were enrolled. Follow-up averaged 67.7 months (range: 24-149). Twenty-seven patients had a Paprosky type II defect and 13 had a type IIIa defect. All revision hip arthroplasty used a cementless, cylindrical, non-modular cobalt-chromium stem. The defect in the metaphysis was filled with antibiotic-loaded bone cement. Thirteen patients who had undergone stem revision only was allowed to walk immediately without weight-bearing restrictions. Twenty-seven patients who had undergone revision total hip arthroplasty was allowed partial weight-bearing within 6 weeks after surgery in the consideration of acetabular reconstruction. Three patients (7.5%) had post-surgery stem subsidences of three mm, five mm, and 10 mm, respectively, at three, one, and 14 months. There were no acute surgical site infections. There were three femoral stem failures: two delayed infections and one periprosthetic Vancouver B2 fracture. Both five- and 10-year survivorships of the femoral implant were 90.1%. An adequate length of the scratch-fit segment and diaphyseal ingrowth remain of paramount importance when revising femoral components. To fill metaphyseal bone defects with antibiotic-loaded bone cement may be an alternative method in dealing with proximal femoral bone loss during a femoral revision. Copyright © 2018. Published by Elsevier Taiwan LLC.

  7. Femoral shaft bowing in the coronal plane has more significant effect on the coronal alignment of TKA than proximal or distal variations of femoral shape.

    Science.gov (United States)

    Kim, Jong-Min; Hong, Soo-Heon; Kim, Jong-Min; Lee, Bum-Sik; Kim, Dong-Eun; Kim, Kyung-Ah; Bin, Seong-Il

    2015-07-01

    The aim of this study was to determine (1) variations in the shape of the proximal, middle, and distal femur in a series of Korean patients who had undergone total knee arthroplasty (TKA), (2) the preoperative relationship between these three parameters and the distal valgus cutting angle referenced off the femoral intramedullary guide, and (3) whether there was any relationship between femoral bowing and variations in the shape of the proximal or distal femur in the coronal plane. The preoperative long-standing anteroposterior radiographs of 316 consecutive osteoarthritis patients who underwent primary TKA from 2009 to 2011 were examined. The femoral neck shaft angle, the femoral shaft bowing angle, and the mechanical lateral distal femoral angle were measured to assess the shape of the proximal, middle, and distal femur, respectively. The valgus cutting angle of the femur was defined as the angle between the distal anatomical and mechanical axes of the femur. The study population showed large variations in femoral shape. The mean femoral intramedullary guide angle was 6.5° ± 1.3° (range: 4°-13°). The femoral shaft bowing angle was the factor that showed the strongest correlation with this angle (P shaft angle showed no correlation (n.s.). The femoral shaft bowing angle showed a weak correlation with the mechanical lateral distal femoral angle (P = 0.001), but was not significantly correlated with the femoral neck shaft angle (n.s.). Apparent femoral bowing (>3° of lateral or medial bowing) was found in 42 (13.3 %) of cases (37 cases of lateral bowing and five of medial bowing). Cases with lateral apparent femoral bowing >3° had a distal cutting angle of 8.6° ± 2.2° relative to the femoral intramedullary guide. The femoral intramedullary guide angle was mainly influenced by femoral shaft bowing among femoral deformities in the coronal plane. Therefore, to increase the accuracy of distal femoral cut during TKA, it is necessary to confirm femoral

  8. Corrosion and Fretting of a Modular Hip System: A Retrieval Analysis of 60 Rejuvenate Stems.

    Science.gov (United States)

    De Martino, Ivan; Assini, Joseph B; Elpers, Marcella E; Wright, Timothy M; Westrich, Geoffrey H

    2015-08-01

    Femoral stems with dual-taper modularity were introduced to allow independent control of length, offset, and version. Corrosion and fretting related to micromotion at the neck-stem junction are thought to stimulate an adverse local tissue reaction (ALTR). Analysis of 60 consecutively retrieved modular-neck stem implants (Rejuvenate, Stryker) revised primarily for ALTR was done to determine the variables influencing corrosion and fretting patterns at the neck-stem interface. Taper damage evaluation was performed with stereomicrocopic analysis with two observers. Evidence of fretting and corrosion was seen at the neck-stem taper in all implants, including three implants revised for periprosthetic fractures within four weeks of the index surgery indicating that this process starts early. Femoral stems paired with the long overall neck lengths had significantly higher corrosion scores. Correlation of the corrosion severity at particular locations with the length of implantation suggests that the neck-stem junction experiences cyclic cantilever bending in vivo. The positive correlation between the length of implantation and fretting/corrosion scores bodes poorly for patients who still have this implant. Scanning electron microscopy on a subset of specimens was also performed to evaluate the black corrosion material. We strongly urge frequent follow-up exams for every patient with this particular modular hip stem. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. High strength alloy

    International Nuclear Information System (INIS)

    Smelikov, V.G.; Obukhov, A.S.; Ryzhkov, I.V.; Koshelev, V.I.

    1995-01-01

    The magnesium-based alloy in question contains alloy components in the form of elements chosen from the Al, Zn, Mn, Zr and rare earth group, and compounds of nitrogen and oxygen with any of these elements in the following proportions (wt%): alloy components chosen from the Al, Zn, Mn, Zr, Th and rare earth group 0.6-8.0, compound of nitrogen and oxygen with any of the above 0.1-6.0, magnesium the remainder. (author)

  10. Validation of the femoral component placement during hip resurfacing: a comparison between the conventional jig, patient-specific template, and CT-based navigation.

    Science.gov (United States)

    Kitada, Makoto; Sakai, Takashi; Murase, Tsuyoshi; Hanada, Toshihisa; Nakamura, Nobuo; Sugano, Nobuhiko

    2013-06-01

    Appropriate insertion of a femoral guidewire is essential for hip resurfacing. A simulation study was planned using synthetic femoral bone models and the accuracy and precision of femoral guidewire alignment and insertion point were compared between conventional jigs, patient-specific templates, and computed tomography (CT) based navigation techniques. Anteversion, stem-shaft angle, and the three-dimensional insertion point were measured postoperative with CT. Errors between planned and postoperative measurement and precision were evaluated. There were no statistically significant differences in error for anteversion or insertion point, although the mechanical jig showed greater error in the stem-shaft angle than the others. Patient-specific template and CT-based navigation showed good precision with high intraclass correlation (ICC) (template, 0.908 to 1.000; navigation, 0.929 to 0.995) and small root mean square error (RMSE) (0.954 to 2.969; 1.468 to 3.213). The mechanical jig group performance was inferior to the others. Patient-specific templates and CT-based navigation had good accuracy and precision. The mechanical jig technique was inferior to the others. Copyright © 2013 John Wiley & Sons, Ltd.

  11. A biomechanical comparison of proximal femoral nails and locking proximal anatomic femoral plates in femoral fracture fixation A study on synthetic bones

    Directory of Open Access Journals (Sweden)

    Korhan Ozkan

    2015-01-01

    Conclusion: The proximal femoral intramedullary nail provides more stability and allows for earlier weight bearing than the locking plate when used for the treatment of unstable intertrochanteric fractures of the femur. Clinicians should be cautious for early weight bearing with locking plate for unstable intertrochanteric femur fractures.

  12. Femoral articular geometry and patellofemoral stability.

    Science.gov (United States)

    Iranpour, Farhad; Merican, Azhar M; Teo, Seow Hui; Cobb, Justin P; Amis, Andrew A

    2017-06-01

    Patellofemoral instability is a major cause of anterior knee pain. The aim of this study was to examine how the medial and lateral stability of the patellofemoral joint in the normal knee changes with knee flexion and measure its relationship to differences in femoral trochlear geometry. Twelve fresh-frozen cadaveric knees were used. Five components of the quadriceps and the iliotibial band were loaded physiologically with 175N and 30N, respectively. The force required to displace the patella 10mm laterally and medially at 0°, 20°, 30°, 60° and 90° knee flexion was measured. Patellofemoral contact points at these knee flexion angles were marked. The trochlea cartilage geometry at these flexion angles was visualized by Computed Tomography imaging of the femora in air with no overlying tissue. The sulcus, medial and lateral facet angles were measured. The facet angles were measured relative to the posterior condylar datum. The lateral facet slope decreased progressively with flexion from 23°±3° (mean±S.D.) at 0° to 17±5° at 90°. While the medial facet angle increased progressively from 8°±8° to 36°±9° between 0° and 90°. Patellar lateral stability varied from 96±22N at 0°, to 77±23N at 20°, then to 101±27N at 90° knee flexion. Medial stability varied from 74±20N at 0° to 170±21N at 90°. There were significant correlations between the sulcus angle and the medial facet angle with medial stability (r=0.78, pgeometry with knee flexion to patellofemoral stability. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Machinability of Titanium Alloys

    Science.gov (United States)

    Rahman, Mustafizur; Wong, Yoke San; Zareena, A. Rahmath

    Titanium and its alloys find wide application in many industries because of their excellent and unique combination of high strength-to-weight ratio and high resistance to corrosion. The machinability of titanium and its alloys is impaired by its high chemical reactivity, low modulus of elasticity and low thermal conductivity. A number of literatures on machining of titanium alloys with conventional tools and advanced cutting tool materials is reviewed. The results obtained from the study on high speed machining of Ti-6Al-4V alloys with cubic boron nitride (CBN), binderless cubic boron nitride (BCBN) and polycrystalline diamond (PCD) are also summarized.

  14. Advances in titanium alloys

    International Nuclear Information System (INIS)

    Seagle, S.R.; Wood, J.R.

    1993-01-01

    As described above, new developments in the aerospace market are focusing on higher temperature alloys for jet engine components and higher strength/toughness alloys for airframe applications. Conventional alloys for engines have reached their maximum useful temperature of about 1000 F (540 C) because of oxidation resistance requirements. IMI 834 and Ti-1100 advanced alloys show some improvement, however, the major improvement appears to be in gamma titanium aluminides which could extend the maximum usage temperature to about 1500 F (815 C). This puts titanium alloys in a competitive position to replace nickel-base superalloys. Advanced airframe alloys such as Ti-6-22-22S, Beta C TM , Ti-15-333 and Ti-10-2-3 with higher strength than conventional Ti-6-4 are being utilized in significantly greater quantities, both in military and commercial applications. These alloys offer improved strength with little or no sacrifice in toughness and improved formability, in some cases. Advanced industrial alloys are being developed for improved corrosion resistance in more reducing and higher temperature environments such as those encountered in sour gas wells. Efforts are focused on small precious metal additions to optimize corrosion performance for specific applications at a modest increase in cost. As these applications develop, the usage of titanium alloys for industrial markets should steadily increase to approach that for aerospace applications. (orig.)

  15. Stem Cells

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 12; Issue 3. Stem Cells: A Dormant Volcano Within Our Body? Devaveena Dey Annapoorni Rangarajan. General Article Volume 12 Issue 3 March 2007 pp 27-34. Fulltext. Click here to view fulltext PDF. Permanent link:

  16. Why STEM?

    Science.gov (United States)

    Mitts, Charles R.

    2016-01-01

    The International Technology and Engineering Educators Association (ITEEA) defines STEM as a new transdisciplinary subject in schools that integrates the disciplines of science, technology, engineering, and mathematics into a single course of study. There are three major problems with this definition: There is no consensus in support of the ITEEA…

  17. The distribution trends and site preferences of alloying elements in precipitates within a Zr alloy: A combined first-principles and experimental study

    Energy Technology Data Exchange (ETDEWEB)

    Luan, B.F., E-mail: bfluan@cqu.edu.cn [College of Materials Science and Engineering, Chongqing University, Chongqing 400044 (China); Wang, J.M.; Qiu, R.S.; Tao, B.R.; He, W.J. [College of Materials Science and Engineering, Chongqing University, Chongqing 400044 (China); Zhang, X.Y.; Liu, R.P. [State Key Laboratory of Metastable Materials Science and Technology, Yanshan University, Qinhuangdao 066004 (China); Liu, Q., E-mail: qingliu@cqu.edu.cn [College of Materials Science and Engineering, Chongqing University, Chongqing 400044 (China)

    2016-09-05

    Energy dispersive X-ray spectroscopy in scanning transmission electron microscope (STEM-EDS) technique and first-principles calculation are jointly utilized to investigate the distribution trends and site preferences of alloying elements in the precipitates within Zr-1.0Cr-0.4Fe-0.4Mo-0.4Bi alloy. Based on selected area electron diffraction (SAED) and energy dispersive X-ray spectroscopy (EDS) results, the precipitates within the studied alloy are confirmed to be ZrCr{sub 2}-based Laves phase with FCC (C15) type structure. The STEM-EDS elemental mapping is acquired to clarify the distribution trends of alloying elements in precipitates, i.e. Fe>Mo>Bi. To better verify this distribution behavior, substitutional formation energies and equilibrium concentrations of ternary alloying elements in ZrCr{sub 2} Laves phase are calculated by first-principles. The calculated results show a good consistence with the STEM-EDS results. In addition, the site preferences of ternary alloying elements in ZrCr{sub 2} Laves phase are predicted by the calculation of transfer energies. Finally, the reasons accounting for different distribution trends and site preferences of alloying elements in ZrCr{sub 2} Laves phase are discussed in terms of density of states, which attributed to the pseudogap effect and hybridizations between atoms. - Highlights: • Clarified the distribution trends of Fe>Mo>Bi in precipitates by STEM-EDS. • Verified the experimental results by first-principles calculation. • Predicted the site preferences of alloying elements by first-principles calculation. • Hybridization and pseudogap lead to the strong distribution and site preferences.

  18. Bilateral femoral neck stress fractures in a fire academy student.

    Science.gov (United States)

    Wright, Russell C; Salzman, Garrett A; Yacoubian, Stephan V; Yacoubian, Shahan V

    2010-10-11

    Unilateral femoral neck stress fractures are well documented in active patients; however, the risk of a subsequent contralateral stress fracture remains unknown in patients who continue to be active. This article describes a 24-year-old male fire academy student who sustained a left femoral neck stress fracture, followed approximately 11 months later by a right femoral neck stress fracture, both of which went on to completely displace. A review of the index radiographs of each hip from outside institutions revealed femoral neck stress fractures that went undiagnosed until they displaced. The patient was referred to our institution and underwent closed reduction and internal fixation using cannulated screws in both cases. A full endocrine evaluation was performed in the following weeks and proved unremarkable. Although it is difficult to extrapolate the results from 1 patient beyond the case studied, there is cause for concern in patients who remain active following femoral neck stress fractures. Our case highlights the significance of obtaining a complete and thorough medical history on physical examination and appropriately counseling patients regarding activity level. Until further research explores this possible relationship, physicians evaluating patients with a history of a stress fracture are encouraged to be vigilant of subsequent contralateral fractures and educate patients of this potentially avoidable injury. Copyright 2010, SLACK Incorporated.

  19. Avascular necrosis of the femoral head in HIV infected patients

    Directory of Open Access Journals (Sweden)

    Marcos Almeida Matos

    Full Text Available Avascular necrosis (AVN of the femoral head is an emerging complication in HIV infected patients. It has been suggested that the increased incidence of AVN in this population may be caused by an increased prevalence of predisposing factors for osteonecrosis, including protease inhibitors, hyperlipidemia, corticosteroid use, alcohol and intravenous drug abuse. The aim of this study was to assess the risk factors for avascular necrosis developing in the femoral head of HIV infected individuals. This study consisted of meta-analysis of the secondary data extracted from current literature. The selected articles allowed two study groups to be drawn up for comparison. Group 1 comprised 324 individuals infected by the HIV virus, who did not present femoral head AVN. Group 2 comprised 32 HIV positive patients, who presented femoral head AVN. The parameters used for analysis were as follows: age, gender, sexual preference, use of intravenous drugs, time of diagnosis, CD4+ cell count, use of antiretroviral agents and duration, serum cholesterol and serum triglycerides. The present study found a statistically significant association between hypertriglyceridemia, hypercholesterolemia, sexual preference and intravenous drug abuse. The authors concluded that femoral head osteonecrosis is associated with hyperlipidemia (hypercholesterolemia and hypertriglyceridemia and intravenous drug abuse. This study supports the hypothesis that protease inhibitors play a role in the development of osteonecrosis through a tendency to cause hyperlipidemia.

  20. Osteonecrosis of the femoral head associated with pigmented villonodular synovitis.

    Science.gov (United States)

    Baba, Shoji; Motomura, Goro; Fukushi, Junichi; Ikemura, Satoshi; Sonoda, Kazuhiko; Kubo, Yusuke; Utsunomiya, Takeshi; Hatanaka, Hiroyuki; Nakashima, Yasuharu

    2017-05-01

    A 23-year-old Japanese woman with no history of corticosteroid intake or alcohol abuse presented with a 10-month history of left hip pain without any antecedent trauma. An anteroposterior radiograph performed 10 months after the onset of pain showed slight joint space narrowing and bone erosions surrounded by sclerotic lesions in both the acetabular roof and femoral neck. Magnetic resonance images of the left hip showed a feature of osteonecrosis of the femoral head and a mass with villus proliferation extending from the posterior intertrochanteric area to the anteromedial aspect of the femoral neck. In addition, the left quadratus femoris muscle, which is generally located just above the nutrient vessels of the femoral head, was not detected. Based on these findings, the patient was diagnosed with osteonecrosis of the femoral head caused by impairment of the nutrient vessels from invasion of the pigmented villonodular synovitis. She underwent radical synovectomy of the left hip 16 months after the onset of pain, and her hip pain improved after the surgery.

  1. [Treatment of femoral shaft fractures with expandable intramedullary nail].

    Science.gov (United States)

    Cilli, Feridun; Mahiroğullari, Mahir; Pehlivan, Ozcan; Keklikçi, Kenan; Kuşkucu, Mesih; Kiral, Ahmet; Avşar, Serdar

    2009-07-01

    Femoral shaft fractures are usually seen in the young population as a result of high energy traumas and are often accompanied by major organ injuries. In this paper, we aimed to assess the clinical results of expandable femoral intramedullary nails in the treatment of 20 femoral shaft fractures. The average age was 34.7. One fracture was the result of a gunshot wound, type 3A open fracture, and the other 19 fractures were closed. Under fluoroscopic control, all patients underwent elective closed reduction and internal fixation with intramedullary expandable femoral nails (Fixion, Disc-O-Tech; Israel). In case of failed or unacceptable closed reduction, open reduction was achieved with a second incision over the fracture site. Average operation time was 26.3 minutes. Full union was achieved in all patients. The shortest union time was 12 weeks and the longest 24 weeks, with an average of 15.2 weeks. Results in 15 patients (75%) were excellent, in 4 patients (20%) good and in 1 patient (5%) moderate according to Thorensen criteria. Use of expandable nails provides union without major complications and offers advantages such as less exposure to radiation as seen in distal locking of classical intramedullary nails. In conclusion, the good results of this study show that the expandable femoral intramedullary nail provides a successful option to classical intramedullary nails.

  2. Valgus Slipped Capital Femoral Epiphysis in Patient with Hypopituitarism

    Directory of Open Access Journals (Sweden)

    Yoshihiro Kotoura

    2017-01-01

    Full Text Available Slipped capital femoral epiphysis (SCFE is a common disease of adolescent and the epiphysis is positioned more posteromedially in relation to the femoral neck shaft with varus SCFE; however, posterolateral displacement of the capital epiphysis, valgus SCFE, occurs less frequently. We report a case of valgus SCFE in a 17-year-old boy with hypopituitarism. After falling down, he experienced difficulty in walking. The radiographs were inconclusive; however three-dimensional computed tomography images showed lateral displacement of the epiphysis on the right femoral head. Valgus SCFE was diagnosed. The patient underwent in situ pinning of both sides. In situ pinning on the left side was performed as a prophylactic pinning because of endocrine abnormalities. At the 1-year follow-up, he could walk without any difficulty and there were no signs of pain. The epiphysis is commonly positioned more posteromedially in relation to the femoral neck shaft with most SCFE, but, in this case, the epiphysis slipped laterally. Differential diagnosis included femoral neck fracture (Delbet-Colonna type 1; however, this was less likely due to the absence of other clinical signs. Therefore, we diagnosed the patient as SCFE. When children complain of leg pain and limp, valgus SCFE that may not be visualized on anteroposterior radiographs needs to be considered.

  3. Laser surface alloying of aluminium-transition metal alloys

    International Nuclear Information System (INIS)

    Almeida, A.; Vilar, R.

    1998-01-01

    Laser surface alloying has been used as a tool to produce hard and corrosion resistant Al-transition metal (TM) alloys. Cr and Mo are particularly interesting alloying elements to produce stable high-strength alloys because they present low diffusion coefficients and solid solubility in Al. To produce Al-TM surface alloys a two-step laser process was developed: firstly, the material is alloyed using low scanning speed and secondly, the microstructure is modified by a refinement step. This process was used in the production of Al-Cr, Al-Mo and Al-Mo and Al-Nb surface alloys by alloying Cr, Mo or Nb powder into an Al and 7175 Al alloy substrate using a CO 2 laser . This paper presents a review of the work that has been developed at Instituto Superior Tecnico on laser alloying of Al-TM alloy, over the last years. (Author) 16 refs

  4. A Dual Biomechanical Failure: Exeter Stem and Pubic Rami Insufficiency Fracture, following Hybrid Total Hip Arthroplasty.

    Science.gov (United States)

    Samra, Inderpaul; Paliobeis, Christos

    2015-01-01

    Introduction. Incidence of Exeter stem fracture is extremely uncommon. Pubic rami insufficiency fractures following arthroplasty are also rare. To our knowledge no cases of spontaneous stem failure with previous insufficiency fractures have yet been reported. Case Presentation. This report describes a case of spontaneous fracture through a cemented Exeter stem in a 66-year-old patient who had previously undergone a hybrid total hip replacement and was found to have bifocal pubic rami insufficiency fractures. The patient presented 18-year postprimary surgery with spontaneous fracture of the middle third of the cemented femoral stem and adjacent proximal femur. Conclusion. This report demonstrates a unique case of Exeter stem fracture with previous pelvic insufficiency fractures. The case adds to the rare occurrences of Exeter stem failure in the literature and highlights the risk of potential insufficiency fractures in patients undergoing total hip replacement.

  5. Clinical use of femoral artery hemostasis sticking after interventional procedure via femoral artery access

    International Nuclear Information System (INIS)

    Zhu Zhongsheng; Chen Shaoliang; Ye Fei; Zhang Junjie; Zhou Jie; Tian Nailiang; Lin Song; Liu Zhizhong; Xiao Pingxi; Qu Hong

    2010-01-01

    Objective: To observe the clinical effect of the use of femoral artery hemostasis sticking V+PAD after the interventional procedure via femoral artery access. Methods: By using random permutation list 80 patients, who decided to receive coronary angiography and percutaneous transluminal coronary angioplasty, were randomly selected. Of the 80 patients, hemostasis sticking V + PAD was employed in 40 patients with even numbers (trial group), only manual compression was adopted to stop bleeding in another 40 patients with odd numbers (control group). All the patients were informed about this trial and had to sign a consent letter. The pressure time, the treatment method of access site after hemostasis, the posture in bed, the immobilization time, the comfort degree of patients, the complications of access site prior to discharge, etc. were observed and the results were compared between two groups. Results: There was no significant difference between two groups as respect to age, gender ratios,activated clotting time (ACT) value and blood pressure. However, significantly difference in the compression time and bed rest time existed between the two groups. The compression time in trial group and control group was (7.9 ± 0.5) min and (19.8 ± 5.1) min respectively (P<0.01), while the bed rest time in trial group and control group was (6.1 ± 5.0) hours and (23.9 ± 0.2) hours respectively (P<0.01). All patients in trial group was supine in bed with the head side of the bed raised at 30 degree immediately after the procedure, and the head side of the bed was further raised to 90 degree one hour later. The puncture site was bandaged with conventional compression and immobilization was not employed. Patients could lie in bed with free posture and the patient's comfort degree was greatly improved. During hospitalization no complications related to puncture site occurred in all patients except one obese woman in trial group who developed pseudoaneurysm. Conclusion: Femoral

  6. Electrochemical comparison and biological performance of a new CoCrNbMoZr alloy with commercial CoCrMo alloy

    Energy Technology Data Exchange (ETDEWEB)

    Andrei, M. [Department of General Chemistry, University Politehnica Bucharest, Spl. Independentei 313, 060042 Bucharest (Romania); Galateanu, B. [Department of Biochemistry and Molecular Biology, University of Bucharest, 91–95 Spl. Independentei, Bucharest 050095 (Romania); Institute of Life Sciences, Vasile Goldis Western University of Arad, 86 Rebreanu, 310414 Arad (Romania); Hudita, A. [Department of General Chemistry, University Politehnica Bucharest, Spl. Independentei 313, 060042 Bucharest (Romania); Costache, M. [Department of Biochemistry and Molecular Biology, University of Bucharest, 91–95 Spl. Independentei, Bucharest 050095 (Romania); Osiceanu, P.; Calderon Moreno, J.M. [Institute of Physical Chemistry “Ilie Murgulescu” of Romanian Academy, Spl. Independentei 202, 060021 Bucharest (Romania); Drob, S.I., E-mail: sidrob@chimfiz.icf.ro [Institute of Physical Chemistry “Ilie Murgulescu” of Romanian Academy, Spl. Independentei 202, 060021 Bucharest (Romania); Demetrescu, I. [Department of General Chemistry, University Politehnica Bucharest, Spl. Independentei 313, 060042 Bucharest (Romania)

    2016-02-01

    A new CoCrNbMoZr alloy, with Nb and Zr content is characterized from the point of view of surface features, corrosion resistance and biological performance in order to be proposed as dental restorative material. Its properties are discussed in comparison with commercial Heraenium CE alloy based on Co, Cr and Mo as well. The microstructure of both alloys was revealed by scanning electron microscopy (SEM). The composition and thickness of the alloy native passive films were identified by X-ray photoelectron spectroscopy (XPS). The surface characteristics were analyzed by atomic force microscopy (AFM) and contact angle techniques. The quantity of ions released from alloys in artificial saliva was evaluated with inductively coupled plasma-mass spectroscopy (ICP-MS) measurements. The electrochemical stability was studied in artificial Carter–Brugirard saliva, performing open circuit potentials, polarization resistances and corrosion currents and rates. The biological performance of the new alloy was tested in vitro in terms of human adipose stem cells (hASCs) morphology, viability and proliferation status. The new alloy is very resistant to the attack of the aggressive ions from the artificial saliva. The surface properties, the roughness and wettabiliy sustain the cell behavior. The comparison of the new alloy behavior with that of existing commercial CoCrMo alloy showed the superior properties of the new metallic biomaterial. - Highlights: • SEM evinced finer microstructure of new CoCrNbMoZr alloy comparing with commercial one. • XPS data showed a thicker, more resistant native passive film on new alloy surface. • Ion release is very low for the new alloy proving its very high stability. • New alloy exhibits very good corrosion resistance in artificial Carter–Brugirard saliva • CoCrNbMoZr revealed an increased overall biocompatibility as compared with Heraenium CE.

  7. Modified minimally invasive two-incision total hip arthroplasty using large diameter femoral head

    Directory of Open Access Journals (Sweden)

    Kyung Soon Park

    2012-01-01

    Full Text Available Background: Minimally invasive (MI total hip arthroplasty (THA is an alternative to standard THA, but has created much controversy among orthopedic surgeons. The authors modified the original minimally invasive two-incision THA technique and used large-diameter (32 mm, 36 mm ceramic-on-ceramic articulation. Materials and Methods: One hundred and seventy patients that underwent unilateral MI two-incision THA were retrospectively reviewed, and surgical morbidity, functional recovery, radiological properties, and complications were assessed. Results: Mean Harris hip score (HHS improved from 41.8 to 96.1 at last followup, and mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC score from 66.2 to 26.9. The mean lateral opening angle of the acetabular component was 38.2° and the mean stem position was valgus 1.9°. There was an intraoperative femur fracture and one revision surgery due to stem subsidence. No patient had dislocation. Conclusions: Our data suggest that this modified technique combined with large ceramic femoral head is safe and reproducible in terms of achieving proper implant positioning and early functional recovery.

  8. Three-Dimensional Analysis of the Contact Pattern between the Cortical Bone and Femoral Prosthesis after Cementless Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Hiroshi Wada

    2016-01-01

    Full Text Available The cementless stem Excia (B. Braun, Melsungen, Germany implant has a rectangular cross-sectional shape with back-and-forth flanges and a plasma-sprayed, dicalcium phosphate dihydrate coating from the middle to proximal portion to increase initial fixation and early bone formation. Here, the conformity of the Excia stem to the femoral canal morphology was three-dimensionally assessed using computed tomography. Forty-three patients (45 hips were examined after primary total hip arthroplasty with a mean follow-up of 27 ± 3 months (range: 24–36 months. Spot welds occurred at zone 2 in 16 hips and at zone 6 in 24 hips, with 83% (20/24 hips of those occurring within 3 months after surgery. First- (n=12 hips, second- (n=32, and third- (n=1 degree stress shielding were observed. The stem was typically in contact with the cortical bone in the anterolateral mid-portion (100% and posteromedial distal portions (85%. Stress shielding did not progress, even in cases where the stems were in contact with the distal portions. The anterior flange was in contact with the bone in all cases. The stability of the mid-lateral portion with the dicalcium phosphate dihydrate coating and the anterior flange may have inhibited the progression of stress shielding beyond the second degree.

  9. Avascular Necrosis of the Femoral Head: Are Any Genes Involved?

    Science.gov (United States)

    Pouya, Farzaneh; Kerachian, Mohammad Amin

    2015-01-01

    Avascular necrosis of the femoral head (ANFH) is a pathologic process that results from interruption of blood supply to the femur bone resulting in the death of bone cells and collapse of the femoral head. Nontraumatic ANFH continues to be a significant challenge to orthopedic surgeons. While the exact mechanisms remain elusive, many new insights have emerged from research in the last decade that has given us a clearer picture of the pathogenesis of nontraumatic ANFH. Progression to the end stage of ANFH appears to be related to five main mechanisms: hypercoagulable conditions, angiogenesis suppressions, hyperadipogenesis, heritable states, and switching the bone remodelling into bone resorption. Researchers have been examining the pathogenic mechanisms of ANFH but none of these theories have been firmly confirmed although some appear more plausible than the others. All of these factors can switch bone remodelling into bone resorption, which can further lead to ANFH progression ending up to femoral head collapse. PMID:26213697

  10. Avascular Necrosis of the Femoral Head: Are Any Genes Involved?

    Directory of Open Access Journals (Sweden)

    Farzaneh Pouya

    2015-07-01

    Full Text Available Avascular necrosis of the femoral head (ANFH is a pathologic process that results from interruption of blood supply to the femur bone resulting in the death of bone cells and collapse of the femoral head. Nontraumatic ANFH continuesto be a significant challenge to orthopedic surgeons. While the exact mechanisms remain elusive, many new insights have emerged from research in the last decade that has given us a clearer picture of the pathogenesis of nontraumatic ANFH. Progression to the end stage of ANFH appears to be related to five main mechanisms: hypercoagulable conditions, angiogenesis suppressions, hyperadipogenesis, heritable states, and switching the bone remodelling into bone resorption. Researchers have been examining the pathogenic mechanisms of ANFH but none of these theories have been firmly confirmed although some appear more plausible than the others. All of these factors can switch bone remodelling into bone resorption, which can further lead to ANFH progression ending up to femoral head collapse.

  11. A case of a C-stem fracture at the head-neck junction and a review of the literature.

    Science.gov (United States)

    Morley, David; Starks, Ian; Lim, Justin

    2012-01-01

    We report the first case of a fracture of the standard C-stem in combination with a large metal-on-metal articulation. This occurred at the head-neck junction. Analysis of the fractured stem showed evidence of fatigue failure with possible corrosion. The use of large femoral heads with neck adaptors and narrow tapers should be used with caution, especially in heavy, active patients.

  12. A Case of a C-Stem Fracture at the Head-Neck Junction and a Review of the Literature

    Directory of Open Access Journals (Sweden)

    David Morley

    2012-01-01

    Full Text Available We report the first case of a fracture of the standard C-stem in combination with a large metal-on-metal articulation. This occurred at the head-neck junction. Analysis of the fractured stem showed evidence of fatigue failure with possible corrosion. The use of large femoral heads with neck adaptors and narrow tapers should be used with caution, especially in heavy, active patients.

  13. Bone-preserving prosthesis with a single axis for treating osteonecrosis of the femoral head: midterm results for the thrust plate hip prosthesis.

    Science.gov (United States)

    Yasunaga, Yuji; Goto, Toshihiko; Hisatome, Takashi; Tanaka, Ryuji; Yamasaki, Takuma; Ochi, Mitsuo

    2003-01-01

    We studied 27 patients (31 joints) who underwent total hip arthroplasty (THA) using the thrust plate hip prosthesis (TPP) for osteonecrosis of the femoral head. The mean follow-up period was 56 months (range 38-72 months). Clinical evaluation by the Merle d'Aubigne and Postel system showed a significant improvement from a preoperative mean score of 8.1 to a final mean follow-up score of 16.6. Mechanical loosening developed about 1 year postoperatively in one joint with a bone defect. Grade 1 stress shielding was observed in four joints. Although indications for the TPP are restricted to certain cases, unlike the conventional intramedullary stem, much can be expected of TPP. It is an outstanding prosthesis for osteonecrosis of the femoral head of young patients in terms of bone preservation and physiological load transfer.

  14. A STUDY OF UNSTABLE INTERTROCHANTERIC FEMORAL FRACTURES TREATED BY TROCHANTERIC FEMORAL NAIL

    Directory of Open Access Journals (Sweden)

    Sreenivasa Neikar

    2017-11-01

    Full Text Available BACKGROUND Intertrochanteric fracture is one of the most common fracture of the hip especially in the elderly. The incidence of intertrochanteric fracture is rising because of the increase in number of elderly population along with superadded osteoporosis. MATERIALS AND METHODS Study included cases of unstable intertrochanteric fractures (AO and OTA Classification 31-A2 and 31-A3 fracture patterns that were operated with the short trochanteric femoral nail, which fitted into the inclusion criteria done in medical college hospital, Vijayanagara Institute of Medical Sciences, Bellary, from February 2015 to September 2016. RESULTS The age distribution was from 40 to 80 years. The largest group of patients were from 61 to 70 years. The average age was 60.5 years. The number of male patients in our series was 20 (66.7% and female was 10 (33.3%. Right side was affected in 11 cases (36.7% and left side in 19 cases (63.3%. Good reduction was achieved in 23 patients (76.7%. Acceptable reduction was achieved in 7 (23.3% patients due to severe comminution. In our study, 25 patients (83.33% had no complications. We encountered one intraoperative complication in the form of greater trochanter splintering, while inserting the nail. In our study, we encountered following postoperative complications. We noticed one case of delayed union, one case of Z effect and 2 cases of varus malunion. CONCLUSION We conclude that short trochanteric femoral nail provides good fixation for unstable intertrochanteric fractures if proper preoperative planning, good reduction and surgical technique are followed leading to high rate of bone union and minimal soft tissue damage especially for Asian patients with relatively small femora.

  15. Biophysical stimulation in osteonecrosis of the femoral head

    Directory of Open Access Journals (Sweden)

    Massari Leo

    2009-01-01

    Full Text Available Osteonecrosis of the femoral head is the endpoint of a disease process that results from insufficient blood flow and bone-tissue necrosis, leading to joint instability, collapse of the femoral head, arthritis of the joint, and total hip replacement. Pain is the most frequent clinical symptom. Both bone tissue and cartilage suffer when osteonecrosis of the femoral head develops. Stimulation with pulsed electromagnetic fields (PEMFs has been shown to be useful for enhancing bone repair and for exerting a chondroprotective effect on articular cartilage. Two Italian studies on the treatment of avascular necrosis of the femoral head with PEMFs were presented in this review. In the first study, 68 patients suffering from avascular necrosis of the femoral head were treated with PEMFs in combination with core decompression and autologous bone grafts. The second one is a retrospective analysis of the results of treatment with PEMFs of 76 hips in 66 patients with osteonecrosis of the femoral head. In both studies clinical information and diagnostic imaging were collected at the beginning of the treatment and at the time of follow up. Statistical analysis was performed using chi-square test. Both authors hypothesize that the short-term effect of PEMF stimulation may be to protect the articular cartilage from the catabolic effect of inflammation and subchondral bone-marrow edema. The long-term effect of PEMF stimulation may be to promote osteogenic activity at the necrotic area and prevent trabecular fracture and subchondral bone collapse. PEMF stimulation represents an important therapeutic opportunity to resolve the Ficat stage-I or II disease or at least to delay the time until joint replacement becomes necessary.

  16. Subchondral bone density distribution in the human femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Wright, David A.; Meguid, Michael; Lubovsky, Omri; Whyne, Cari M. [Sunnybrook Research Institute, Orthopaedic Biomechanics Laboratory, Toronto, Ontario (Canada)

    2012-06-15

    This study aims to quantitatively characterize the distribution of subchondral bone density across the human femoral head using a computed tomography derived measurement of bone density and a common reference coordinate system. Femoral head surfaces were created bilaterally for 30 patients (14 males, 16 females, mean age 67.2 years) through semi-automatic segmentation of reconstructed CT data and used to map bone density, by shrinking them into the subchondral bone and averaging the greyscale values (linearly related to bone density) within 5 mm of the articular surface. Density maps were then oriented with the center of the head at the origin, the femoral mechanical axis (FMA) aligned with the vertical, and the posterior condylar axis (PCA) aligned with the horizontal. Twelve regions were created by dividing the density maps into three concentric rings at increments of 30 from the horizontal, then splitting into four quadrants along the anterior-posterior and medial-lateral axes. Mean values for each region were compared using repeated measures ANOVA and a Bonferroni post hoc test, and side-to-side correlations were analyzed using a Pearson's correlation. The regions representing the medial side of the femoral head's superior portion were found to have significantly higher densities compared to other regions (p < 0.05). Significant side-to-side correlations were found for all regions (r {sup 2} = 0.81 to r {sup 2} = 0.16), with strong correlations for the highest density regions. Side-to-side differences in measured bone density were seen for two regions in the anterio-lateral portion of the femoral head (p < 0.05). The high correlation found between the left and right sides indicates that this tool may be useful for understanding 'normal' density patterns in hips affected by unilateral pathologies such as avascular necrosis, fracture, developmental dysplasia of the hip, Perthes disease, and slipped capital femoral head epiphysis. (orig.)

  17. Image features of herniation pit of the femoral neck

    International Nuclear Information System (INIS)

    Zhang Xuezhe; Li Guangming; Wang Cunli; Wang Guimin

    2008-01-01

    Objective: To evaluate imaging appearances of herniation pit of the femoral neck. Methods: We retrospectively analyzed the X-ray, CT and MRI findings of 9 patients with herniation pit of the femoral neck. All nine patients were male with the age ranging from 21 to 73 years. They had pain in the hip from two months to two years duration. Results: The bilateral hips were affected in six patients, the right hips in the other 3 patients. Of the nine patients, X-ray plain films (2 cases), CT scanning(6 cases), and MR scanning (5 cases ) were performed. The size of the lesions ranged from 0.5 cm x 0.6 cm to 1.0 cm x 1.5 cm, located in the anterosuperior portion of the femoral neck (n=7) or anteroinferior portion (n=2). X-ray plain films showed an osteolytic lesion surrounded by a sclerotic rim. CT scanning showed the lesion just below the cortex of the femoral neck surrounded by a rim of sclerosis or associated with a small cortical break in two patients. MR scanning showed low signal intensity in five patients on T 1 WI and high signal intensity surrounded by a rim of low signal intensity (n=3) or low signal intensity (n=2) on T 2 WI, and high signal intensity on fat suppression MR image. A small joint effusion was observed in two cases on T 2 WI. Conclusion: The CT and MRI findings of herniation pit of the femoral neck are characteristic, it is useful in defining the diagnosis of the herniation pit of the femoral neck. (authors)

  18. [Antegrade femoral intramedullary nailing in a lateral position].

    Science.gov (United States)

    Friederichs, J; von Rüden, C; Hierholzer, C; Bühren, V

    2015-04-01

    Intramedullary nailing is the gold standard for the treatment of femoral shaft fractures; however, rotational malalignment remains a common complication. The patient can be positioned on the fracture table in a supine position or alternatively in the lateral decubitus position without any traction. The aim of this article is to describe an effective method to control intraoperative torsion of the femur. The surgical technique described in this article is the standard procedure for femoral shaft fractures and subtrochanteric fractures in this level 1 trauma center. The patient is positioned in a lateral position on a radiolucent table with free draping of the injured leg. Using the C-arm, reduction can be performed with this technique with precise placing of the nails and torsion can be exactly adjusted and controlled with the aid of the femoral neck axis, the distal locking holes and both parallel femoral condyles. The described technique represents an effective method for the intraoperative control of femoral torsion. With an acceptable and most probably clinically irrelevant bias, this technique is able to avoid significant rotational malalignment. It does not prolong the operative procedure and does not require additional navigation settings. It has also been shown to be helpful in the treatment of subtrochanteric fractures. The surgical technique of anterograde intramedullary nailing using the lateral decubitus position without any traction device and free draping of the injured leg represents a safe and reliable treatment concept and offers logistical advantages compared to the supine position of the patient on a fracture table. Together with other described methods of intraoperative torsional control of femoral fractures, the radiological technique described in this study is an easily applicable and safe method, which needs to be confirmed in clinical studies.

  19. Retrograde femoral nailing in elderly patients: outcome and functional results.

    Science.gov (United States)

    Neubauer, Thomas; Krawany, Manfred; Leitner, Lukas; Karlbauer, Alois; Wagner, Michael; Plecko, Michael

    2012-06-01

    Functional outcome after retrograde femoral intramedullary nailing was investigated in 35 patients older than 60 years (mean, 86 years) with 36 fractures, comprising 15 (41.7%) shaft and 21 (58.3%) distal fractures; overall, 7 (19.4%) periprosthetic fractures occured. Twenty-two (62.9%) of 35 patients were evaluated at a mean 16.5-month follow-up with the Lyshom-Gillquist score and the SF-8 questionaire. Primary union rate was 97.8%, with no significant differences in duration of surgery, bone healing, mobilization, and weight bearing among different fracture types; periprosthetic fractures revealed a significantly delayed mobilization (P=.03). Complications occured significantly more often among distal femoral fractures (P=.009), including all revision surgeries. The most frequently encountered complication was loosening of distal locking bolts (n=3). Lysholm score results were mainly influenced by age-related entities and revealed fair results in all fractures (mean in the femoral shaft fracture group, 78.1 vs mean in the distal femoral fracture group, 74.9; P=.69), except in the periprosthetic subgroup, which had good results (mean, 84.8; P=.23). This group also had increased physical parameters according to SF-8 score (P=.026). No correlation existed between SF-8 physical parameters and patient age or surgery delay, whereas a negative correlation existed between patient age and SF-8 mental parameters (P=.012). Retrograde femoral intramedullary nailing is commonly used in elderly patients due to reliable bone healing, minimal soft tissue damage, and immediate full weight bearing. It also offers a valid alternative to antegrade nailing in femoral shaft fractures. Copyright 2012, SLACK Incorporated.

  20. Stress fracture of the femoral neck in a child (stress fracture)

    International Nuclear Information System (INIS)

    Coldwell, D.; Gross, G.W.; Boal, D.K.

    1984-01-01

    Femoral neck stress fracture is extremely rare in childhood. We report a case of femoral neck stress fracture in an 11-year-old girl. Differentials diagnosis and a brief review of the literature follow. (orig.)

  1. Imaging diagnosis of the early aseptic osteonecrosis of the femoral head

    International Nuclear Information System (INIS)

    Liang Jingyin; Liu Yiqiang; Pan Zhifeng

    2006-01-01

    Objective: To study the early imaging signs of aseptic osteonecrosis of the femoral head in adults. Methods: The X-ray plain films and CT scans of 80 cases with this condition were analyzed. Results: There were 40 hip joints with the femoral head normal in shape, including 49 femoral heads with only high-density sclerosis and 26 ones with high-density and low-density areas. Air-filled cysts appeared in 12 femoral heads. In the other 40 hip joints, the femoral heads were depressed and manifested purely high-density sclerosis in 8 and mixed-density areas in 63. Air-filled cysts appeared in 22 femoral heads. Conclusions: Purely high-density sclerosis and air density in the femoral heads are the early signs of aseptic osteonecrosis of the femoral head. The special CT signs are of great diagnostic value and can provide more information for the surgeons. (authors)

  2. The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating.

    Science.gov (United States)

    Park, Jin; Kim, Sul Gee; Yoon, Han Kook; Yang, Kyu Hyun

    2010-02-01

    The purpose of this study was to compare the results between exchange nailing (EN) and augmentation plating (AP) with a nail left in situ for nonisthmal femoral shaft nonunion after femoral nailing. : Retrospective data analysis, November 1996-March 2006. A level I trauma center. Eighteen patients with 18 nonisthmal femoral nonunions. Seven patients with 7 fractures treated for nonisthmal femoral shaft nonunions after femoral nailing with EN and 11 patients with 11 fractures treated for nonisthmal femoral shaft nonunions after nailing with AP combined with bone grafting. Union and complications. Five nonunions in the EN group failed to achieve union (72% failure rate), whereas all 11 pseudarthroses in the AP group obtained osseous union. Fisher exact test showed a higher nonunion rate of EN compared with AP for nonisthmal femoral shaft nonunion (odds ratio, 6.5; P = 0.002). AP with autogenous bone grafting may be a better option than EN for nonisthmal femoral nonunions.

  3. Shape memory alloys

    International Nuclear Information System (INIS)

    Kaszuwara, W.

    2004-01-01

    Shape memory alloys (SMA), when deformed, have the ability of returning, in certain circumstances, to their initial shape. Deformations related to this phenomenon are for polycrystals 1-8% and up to 15% for monocrystals. The deformation energy is in the range of 10 6 - 10 7 J/m 3 . The deformation is caused by martensitic transformation in the material. Shape memory alloys exhibit one directional or two directional shape memory effect as well as pseudoelastic effect. Shape change is activated by temperature change, which limits working frequency of SMA to 10 2 Hz. Other group of alloys exhibit magnetic shape memory effect. In these alloys martensitic transformation is triggered by magnetic field, thus their working frequency can be higher. Composites containing shape memory alloys can also be used as shape memory materials (applied in vibration damping devices). Another group of composite materials is called heterostructures, in which SMA alloys are incorporated in a form of thin layers The heterostructures can be used as microactuators in microelectromechanical systems (MEMS). Basic SMA comprise: Ni-Ti, Cu (Cu-Zn,Cu-Al, Cu-Sn) and Fe (Fe-Mn, Fe-Cr-Ni) alloys. Shape memory alloys find applications in such areas: automatics, safety and medical devices and many domestic appliances. Currently the most important appears to be research on magnetic shape memory materials and high temperature SMA. Vital from application point of view are composite materials especially those containing several intelligent materials. (author)

  4. Thermofluency in zirconium alloys

    International Nuclear Information System (INIS)

    Orozco M, E.A.

    1976-01-01

    A summary is presented about the theoretical and experimental results obtained at present in thermofluency under radiation in zirconium alloys. The phenomenon of thermofluency is presented in a general form, underlining the thermofluency at high temperature because this phenomenon is similar to the thermofluency under radiation, which ocurrs in zirconium alloys into the operating reactor. (author)

  5. Aluminum battery alloys

    Science.gov (United States)

    Thompson, David S.; Scott, Darwin H.

    1985-01-01

    Aluminum alloys suitable for use as anode structures in electrochemical cs are disclosed. These alloys include iron levels higher than previously felt possible, due to the presence of controlled amounts of manganese, with possible additions of magnesium and controlled amounts of gallium.

  6. Ductile transplutonium metal alloys

    Science.gov (United States)

    Conner, William V.

    1983-01-01

    Alloys of Ce with transplutonium metals such as Am, Cm, Bk and Cf have properties making them highly suitable as sources of the transplutonium element, e.g., for use in radiation detector technology or as radiation sources. The alloys are ductile, homogeneous, easy to prepare and have a fairly high density.

  7. Can femoral dialysis catheter insertion cause a life threatening complication?

    Directory of Open Access Journals (Sweden)

    Nurkay Katrancıoğlu

    2014-09-01

    Full Text Available Venous catheter (VC insertion may be necessary for the patients with renal failure facing vascular access problem. Femoral VCs are commonly used for their lower complication rates especially in emergency clinics. The incidence of bleeding associated with VC is reported 0.5-1.6%, however, life threatening hemorrhage and complications requiring surgical intervention are very rare. In this manuscript, we aimed to present a case with hemolytic uremic syndrome complicated with retroperitoneal hematoma after femoral VC insertion. J Clin Exp Invest 2014; 5 (3: 472-474

  8. Postoperative hemoglobin level in patients with femoral neck fracture

    OpenAIRE

    Nagra, Navraj; van Popta, Dmitri; Whiteside, Sigrid; Holt, Edward

    2018-01-01

    Objective: The aim of this study was to analyze the changes of hemoglobin levels in patients undergoing fixation for femoral neck fracture.Methods: Peroperative hemoglobin levels of patients who underwent either dynamic hip screw (DHS) fixation (n=74; mean age: 80 years) or hip hemiarthroplasty (n=104; mean age: 84 years) for femoral neck fracture was monitored.Results: There was a statistically and clinically significant mean drop of 31.1 g/L between the preoperative (D0) and postoperative D...

  9. Repair of femoral trochanteric osteotomy in the dog

    International Nuclear Information System (INIS)

    Whitelock, R.G.; Dyce, J.; Houlton, J.E.F.

    1997-01-01

    The records and radiographs of 24 dogs that underwent femoral trochanteric osteotomy repair were reviewed. Osteotomy repair was performed with either a pin and tension band wire or a lag screw technique. Significant clinical complications associated with the osteotomy were identified in one dog (4 per cent) six weeks after surgery, although abnormal radiographic changes were evident in 15 dogs (62 per cent). The method of repair did not influence healing and there were comparable radiographic complication rates. It is concluded that femoral trochanteric osteotomy is not associated with significant clinical problems, despite a high incidence of abnormal radiographic findings

  10. Avascular necrosis associated with nailing of femoral neck fracture

    International Nuclear Information System (INIS)

    Stroemqvist, B.; Hansson, L.I.

    1983-01-01

    Two patients with femoral neck fractures, one displaced and one undisplaced, are presented. Preoperative intravital staining with tetracycline and Tc-MDP scintimetry both showed intact femoral head circulation while Tc-MDP-scintimetry 1 week after operation showed pronounced circulatory deficiency. SR 85 -scintimetry performed at the same time was inconclusive. Segmental collapse was observed radiographically, 8 and 12 months postoperatively. The major vascular injury resulting in avascularity most probably occured during the procedure of osteosynthesis, and Tc-MDP-scintimetry was found suitable for early postoperative recognition of avascular necrosis in both fractures. (author)

  11. Identification of avascular necrosis in the dysplastic proximal femoral epiphysis

    International Nuclear Information System (INIS)

    Mandell, G.A.; Harcke, H.T.; MacKenzie, W.G.; Bassett, G.S.; Scott, C.I. Jr.; Wills, J.S.

    1989-01-01

    Bilateral radiographic irregularities and deformities of the proximal femoral epiphyses are features of both multiple epiphyseal dysplasia and bilateral idiopathic avascular necrosis. In the past these entities have been difficult to differentiate. This report documents radiographically the occurrence of avascular necrosis in 10 patients with multiple epiphyseal dysplasia by recognizing the superimposition of sclerosis and subchondral fissuring on pre-existing symmetrically irregular proximal femoral ossification centers. Scintigraphic (photopenia) or magnetic resonance (loss of signal) criteria of avascular necrosis confirm its added presence and help to establish an imaging scheme to identify avascular necrosis superimposed on multiple epiphyseal dysplasia. (orig.)

  12. [SURGICAL HIP DISLOCATION APPROACH FOR TREATMENT OF FEMORAL HEAD FRACTURE].

    Science.gov (United States)

    Tang, Yanfeng; Liu, Youwen; Zhu, Yingjie; Li, Jianming; Li, Wuyin; Li, Qiyi; Jia, Yudong

    2015-11-01

    To discuss the value of surgical hip dislocation approach in the treatment of femoral head fracture. A retrospectively analysis was made on the clinical data of 15 patients with femoral head fractures treated through surgical hip dislocation approach between January 2010 and February 2013. There were 11 men and 4 women with an average age of 30.8 years (range, 15-63 years). The causes included traffic accident injury in 9 cases, falling injury from height in 5 cases, and sports injury in 1 case. According to Pipkin typing, 2 cases were rated as type I, 7 cases as type II, 1 case as type III, and 5 cases as type IV. The interval of injury and operation was 2-10 days (mean, 4.1 days). Reduction was performed in 10 patients within 6 hours after injury, and then bone traction was given for 4-6 weeks except 5 patients who received reduction in the other hospital. Primary healing of incision was obtained in all patients after surgery without complications of dislocation and lower limbs deep venous thrombosis. The mean follow-up time was 29.9 months (range, 25-36 months). During follow-up, there was no infection, breakage of internal fixation, or nonunion of femoral greater trochanter fracture. In 3 patients having necrosis of the femoral head, 2 had no obvious symptoms [staging as IIa and IIb respectively according to Association Research Circulation Osseous (ARCO) staging system], and 1 (stage IIIb) had nonunion of the femoral neck fracture, who underwent total hip arthroplasty (THA). In 4 patients having myositis ossificans (2 cases of grade I, 1 case of grade II, and 1 case of grade III based on Brooker grading), no treatment was given in 3 cases and the focus was removed during THA in 1 case. According to the Thompson-Epstein scale at last follow-up, the results were excellent in 9 cases, good in 3 cases, fair in 1 case, and poor in 2 cases, and the excellent and good rate was 80%. Surgical hip dislocation approach can not only protect the residual vessels of the

  13. Alloys in energy development

    Energy Technology Data Exchange (ETDEWEB)

    Frost, B.R.T.

    1984-02-01

    The development of new and advanced energy systems often requires the tailoring of new alloys or alloy combinations to meet the novel and often stringent requirements of those systems. Longer life at higher temperatures and stresses in aggressive environments is the most common goal. Alloy theory helps in achieving this goal by suggesting uses of multiphase systems and intermediate phases, where solid solutions were traditionally used. However, the use of materials under non-equilibrium conditions is now quite common - as with rapidly solidified metals - and the application of alloy theory must be modified accordingly. Under certain conditions, as in a reactor core, the rate of approach to equilibrium will be modified; sometimes a quasi-equilibrium is established. Thus an alloy may exhibit enhanced general diffusion at the same time as precipitate particles are being dispersed and solute atoms are being carried to vacancy sinks. We are approaching an understanding of these processes and can begin to model these complex systems.

  14. Fractura por fatiga de un tallo de revisión femoral modular cónico estriado de fijación distal.

    Directory of Open Access Journals (Sweden)

    Martin Buttaro

    2013-03-01

    Full Text Available 1. Engelbrecht E, Heinert K. Klassifikation und Behandlungsrichtlinien von Knochensubsanzverlusten bei Revisionsoperationen am Huftgelenk mittelfrsige Ergebnisse. Primare und Revisionsalloarthroplastik Hrsg-Endo-Klinik, Hamburg: Springer-Verlag, Berlin; 1987:189. 2. Merle d’Aubigné R, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 1954;36:451. 3. Hood RW, Wright TM, Burstein AH. Retrieval analysis of total knee prostheses: a method and its application to 48 total condylar prostheses. J Biomed Mat Res 1983;17:829. 4. Carlsson AS, Gentz CF, Stenport J. Fracture of the femoral prosthesis in total hip replacement according to Charnley. Acta Orthop Scand 1977;48:650-5. 5. Chao EYS, Coventry MB. Fracture of the femoral component after total hip replacement. An analysis of fifty-eight cases. J Bone Joint Surg Am 1981;63:1078-94. 6. Charnley J. Fracture of femoral prostheses in total hip replacement. A clinical study. Clin Orthop 1975;111:105. 7. Buttaro M, Mayor M, Van Citters D, Piccaluga F. Fracture of a proximally modular, distally fluted uncemented implant with diaphyseal fixation. J Arthroplasty 2007;22(5:780-3. 8. Bohm P, Bischel O. Femoral revision with the Wagner SL revision stem: evaluation of one hundred and twenty-nine revisions followed for a mean of 4.8 years. J Bone Joint Surg Am 2001;83(7:1023. 9. Woolson ST, Milbauer JP, Bobyn JD, Yue S, Maloney WJ. Fatigue fracture of a forged cobalt-chromium-molybdenum femoral component inserted with cement. A report of ten cases. J Bone Joint Surg Am 1997;79(12:1842.

  15. Radiographic Subsidence in Asymptomatic Patients After THR Using the Furlong Active HAP Stem.

    Science.gov (United States)

    Cordero-Ampuero, José; Peñalver, Pablo; Antón, Rodrigo; Galán, María; Cordero, Enrique

    2013-07-01

    The short, tapered, collarless Furlong Active stem has been recently associated in the published literature with significant subsidence using Roentgen stereophotogrammetric analysis. The purpose of this study was to analyze the short-term radiographic subsidence in Furlong Active HAP stems and correlate the results with the age, gender, bone morphology, and bone quality of the proximal femur, stem diameter, and medullary canal filling. Sixty-five consecutive patients (70 hips) receiving the Furlong Active HAP stems were enrolled in this prospective series. The average follow-up was 2.99 ± 1.38 years. All patients were evaluated clinically using the Harris Hip Score (HHS) and radiographically for femoral stem subsidence. In addition, proximal femoral osteopenia, proximal femur morphology, and medullary canal filling were also evaluated. The average subsidence was 2.4 mm (from 0 to 13 mm) at the end of the follow-up period. The average HHS score at the end of follow-up was 90 (range, 81-98). There was one intraoperative fracture. Of the Furlong Active stems 61% subsided with initial weight bearing. Subsidence is higher in males, but no correlation has been found with age, stem diameter, morphology, osteopenia, or canal filling.

  16. Combined antegrade femoral artery and retrograde popliteal artery recanalization for chronic occlusions of the superficial femoral artery.

    Science.gov (United States)

    Shi, Weihao; Yao, Ye; Wang, Wei; Yu, Bo; Wang, Song; Que, Huafa; Xiang, Huanyu; Li, Qiong; Zhao, Qiufeng; Zhang, Zhen; Xu, Jienan; Liu, Xiaodong; Shen, Liang; Xing, Jie; Wang, Yunfei; Shan, Wei; Zhou, Jie

    2014-09-01

    To evaluate the efficacy and safety of a dual femoral-popliteal approach in the supine position after failed antegrade recanalization attempts in chronic total occlusion (CTO) of the superficial femoral artery (SFA). From May 2011 to October 2012, 21 patients underwent dual femoral-popliteal recanalization for CTO of the SFA, with a mean lesion length of 87.4 mm ± 5.8. When contralateral antegrade recanalization of SFA occlusions via the common femoral artery could not be achieved, the occlusions were intrainterventionally accessed by retrograde approach via the popliteal artery, which was punctured anteriorly with gently flexed knee and crus extorsion. When the SFA had been recanalized, further angioplasty and stent placement procedures were completed via the femoral artery. A technical success rate of 100% (entailing puncture of the popliteal artery and SFA recanalization) was achieved, and no hemorrhage, hematoma, pseudoaneurysm, arteriovenous fistula, or other complications developed. During a mean follow-up of 9.8 months ± 1.5, claudication severity, rest pain, and toe ulcers improved significantly. The pulse of the distal arteries, as well as the filling of the veins, could be distinctly felt. Ankle-brachial index changed from 0.48 ± 0.17 to 0.84 ± 0.11 at 1 year after intervention (P < .001), and patency rates at 1, 6, and 12 months after interventions were 100%, 80%, and 42%, respectively. A dual femoral-popliteal approach in the supine position is an alternative backup option after failed attempts at the antegrade approach for patients with proximal barriers in CTO or lesions with major extending collateral vessels. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

  17. Assessment of femoral component migration in total hip arthroplasty: digital measurements compared to RSA.

    Science.gov (United States)

    Schütz, Uwe; Decking, Jens; Decking, Ralf; Puhl, Wolfhart

    2005-02-01

    The aim of this study was to determine the accuracy of the software system "Düsseldorf Migration Analysis - Femoral Component Analysis" (DMA-FCA) in measuring stem migration in total hip arthroplasty (THA) on digitised anteroposterior radiographs of the pelvis. Bony and implant landmarks on two consecutive radiographs were used for measurements of subsidence and varus-valgus tilt. The accuracy of the method was determined by reference to radiostereometric measurements (RSA). Using specific comparability limits, comparability analysis of radiographs with respect to femoral positioning is possible with DMA. DMA-FCA and RSA measurements were performed after cementless THR in a population of 60 patients aged 38 to 69 years. With a Cronbach's alpha-index of 0.89 and 0.99 for subsidence and 0.90 and 0.98 for classic varus-valgus-tilt, the intraobserver and interobserver reliability for the DMA-FCA-method was calculated as good. Using RSA as reference method, the accuracy of DMA-FCA was calculated to be 2.51 mm for subsidence and 2.49 degrees for varus-valgus-tilt (95% confidence interval). Without comparison to RSA, DMA measured 1.94 mm for subsidence and 2.35 degrees for varus-valgus-tilt. Based on a comparison with RSA, our results show lower accuracy for DMA-FCA than for EBRA-FCA, but DMA-FCA is easier to use in everyday clinical practice. It is hoped that the use of digital measuring methods such as DMA will become standard for long-term observation and will be integrated into clinical routine in the context of quality assurance of THR.

  18. The stability of the femoral component of a minimal invasive total hip replacement system.

    NARCIS (Netherlands)

    Willems, M.M.M.; Kooloos, J.G.M.; Gibbons, P.; Minderhoud, N.; Weernink, T.; Verdonschot, N.J.J.

    2006-01-01

    In this study, the initial stability of the femoral component of a minimal invasive total hip replacement was biomechanically evaluated during simulated normal walking and chair rising. A 20 mm diameter canal was created in the femoral necks of five fresh frozen human cadaver bones and the femoral

  19. Evaluation in femoral neck fracture scintimetry: modes of region of interest selection and influence on results

    Energy Technology Data Exchange (ETDEWEB)

    Holmberg, S.; Mesko, L.; Stroemqvist, B.; Thorngren, K.G.

    1985-04-01

    Different sized ROIs within the femoral head and different modes of calculation were used in (/sup 99m/Tc)MDP scintimetry after femoral neck fracture. In preoperative scintimetry, correction for increased trochanteric uptake gave the best discrimination, whereas in postoperative scintimetry the direct ratio fractured/intact femoral head was superior. The change in ROI size had little influence.

  20. Evaluation in femoral neck fracture scintimetry: modes of region of interest selection and influence on results

    International Nuclear Information System (INIS)

    Holmberg, S.; Mesko, L.; Stroemqvist, B.; Thorngren, K.G.

    1985-01-01

    Different sized ROIs within the femoral head and different modes of calculation were used in [/sup 99m/Tc]MDP scintimetry after femoral neck fracture. In preoperative scintimetry, correction for increased trochanteric uptake gave the best discrimination, whereas in postoperative scintimetry the direct ratio fractured/intact femoral head was superior. The change in ROI size had little influence

  1. Alloying principles for magnesium base heat resisting alloys

    International Nuclear Information System (INIS)

    Drits, M.E.; Rokhlin, L.L.; Oreshkina, A.A.; Nikitina, N.I.

    1982-01-01

    Some binary systems of magnesium-base alloys in which solid solutions are formed, are considered for prospecting heat resistant alloys. It is shown that elements having essential solubility in solid magnesium strongly decreasing with temperature should be used for alloying maqnesium base alloys with high strength properties at increased temperatures. The strengthening phases in these alloys should comprise essential quantity of magnesium and be rather refractory

  2. Comparison of Various Functionally Graded Femoral Prostheses by Finite Element Analysis

    Science.gov (United States)

    Seyed Shirazi, Seyed Farid; Bayat, Mehdi; Yau, Yat Huang; Tarlochan, Faris; Abu Osman, Noor Azuan

    2014-01-01

    This study is focused on finite element analysis of a model comprising femur into which a femoral component of a total hip replacement was implanted. The considered prosthesis is fabricated from a functionally graded material (FGM) comprising a layer of a titanium alloy bonded to a layer of hydroxyapatite. The elastic modulus of the FGM was adjusted in the radial, longitudinal, and longitudinal-radial directions by altering the volume fraction gradient exponent. Four cases were studied, involving two different methods of anchoring the prosthesis to the spongy bone and two cases of applied loading. The results revealed that the FG prostheses provoked more SED to the bone. The FG prostheses carried less stress, while more stress was induced to the bone and cement. Meanwhile, less shear interface stress was stimulated to the prosthesis-bone interface in the noncemented FG prostheses. The cement-bone interface carried more stress compared to the prosthesis-cement interface. Stair climbing induced more harmful effects to the implanted femur components compared to the normal walking by causing more stress. Therefore, stress shielding, developed stresses, and interface stresses in the THR components could be adjusted through the controlling stiffness of the FG prosthesis by managing volume fraction gradient exponent. PMID:25302331

  3. Comparison of Various Functionally Graded Femoral Prostheses by Finite Element Analysis

    Directory of Open Access Journals (Sweden)

    Azim Ataollahi Oshkour

    2014-01-01

    Full Text Available This study is focused on finite element analysis of a model comprising femur into which a femoral component of a total hip replacement was implanted. The considered prosthesis is fabricated from a functionally graded material (FGM comprising a layer of a titanium alloy bonded to a layer of hydroxyapatite. The elastic modulus of the FGM was adjusted in the radial, longitudinal, and longitudinal-radial directions by altering the volume fraction gradient exponent. Four cases were studied, involving two different methods of anchoring the prosthesis to the spongy bone and two cases of applied loading. The results revealed that the FG prostheses provoked more SED to the bone. The FG prostheses carried less stress, while more stress was induced to the bone and cement. Meanwhile, less shear interface stress was stimulated to the prosthesis-bone interface in the noncemented FG prostheses. The cement-bone interface carried more stress compared to the prosthesis-cement interface. Stair climbing induced more harmful effects to the implanted femur components compared to the normal walking by causing more stress. Therefore, stress shielding, developed stresses, and interface stresses in the THR components could be adjusted through the controlling stiffness of the FG prosthesis by managing volume fraction gradient exponent.

  4. Sex determination from femoral head diameters in black Malawians ...

    African Journals Online (AJOL)

    Objectives: To determine the sex of black Malawians from femoral head diameters. Design: A retrospective study on patients investigated in three x-ray departments. Setting: Radiographs were collected from the archives of Queen Elizabeth Central, Chikwawa and Balaka hospitals. Subject: X-ray films of 496 pelves of adult ...

  5. Femoral nailing in adults : doctor and patient reported outcomes

    NARCIS (Netherlands)

    El Moumni, Mostafa

    2016-01-01

    The treatment of traumatic femoral shaft fractures using an unreamed nail is associated with good results. Both antegrade and retrograde unreamed nailing techniques result in high union rates and low rates of complications, such as non-union, deep infection and septic arthritis. These results are

  6. Treatment of femoral neck fracture by Moore Prosthesis in Cotonou ...

    African Journals Online (AJOL)

    Treatment of femoral neck fracture by Moore Prosthesis in Cotonou. AHM Akue, M Lawson, S Madougou, R Zannou, J Padonou. Abstract. Keywords: Benin; hip; Moore prosthesis; results. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  7. Isolated femoral hypoplasia: an intrauterine differential diagnosis to campomelia

    Energy Technology Data Exchange (ETDEWEB)

    Koerber, Friederike; Benz-Bohm, Gabriele [University of Cologne, Department of Paediatric Radiology, Cologne (Germany); Schoenau, Eckard [University of Cologne, Department of Paediatrics, Cologne (Germany); Horwitz, A.Eldad [Klinikum Krefeld, Department of Paediatric Radiology, Krefeld (Germany)

    2005-06-01

    The isolated form of femoral bowing is an important differential diagnosis of campomelia. Therefore, knowledge of isolated anomalies is fundamental for prenatal diagnosis, especially for the differential diagnosis from severe syndromes. Four cases are presented to discuss the differential diagnosis of femoral bowing including a review of the literature. We report four newborn babies with unilateral bowing and shortening of the femur. Three had no further anomaly; one child had additional abnormalities due to coumarin embryopathy. The radiological findings were shortened femora with bowing and varus deformity and cortical thickening on the concave side. All other parts showed normal bone structure. The aetiology of femoral bowing is unknown. Early damage of the cartilaginous model followed by remodelling with thickening on the concave side of the bone similar to the healing of malaligned fractures is suspected. The isolated form of femoral bowing without any other anomalies has to be differentiated from complex and more often severe congenital syndromes such as campomelia. Postpartum radiological examination should be reduced to a single exposure of the affected limb and follow-up should be done by clinical examination. (orig.)

  8. Incidental finding of hypertension and diminished femoral pulses ...

    African Journals Online (AJOL)

    2012-06-08

    Jun 8, 2012 ... Case Study: Incidental finding of hypertension and diminished femoral pulses. 168. Vol 55 No 2. S Afr Fam Pract 2013. Introduction. Coarctation of the aorta is ... Surgery of the aorta and its branches. Philadelphia: WB Saunders Company, 2000; p. 3-10. 2. Rao PS. Coarctation of the aorta. Curr Cardiol Rep.

  9. Incidental finding of hypertension and diminished femoral pulses ...

    African Journals Online (AJOL)

    Incidental finding of hypertension and diminished femoral pulses: short-segment stenosis of the aorta just distal to the origin of the left subclavian artery. ... Young patients may present within the first few weeks of life with poor feeding, tachypnea and lethargy. They usually progress to overt congestive heart failure and shock.

  10. Transient Femoral Nerve Palsy Following Ilioinguinal Nerve Block ...

    African Journals Online (AJOL)

    Intramuscular sodium diclofenac 75 mg was administered intraoperatively into the contralateral gluteal muscle. A 5–6‑cm oblique incision was made from the .... Mechanism of femoral nerve palsy complicating percutaneous ilioinguinal field block. Br J Anaesth 1997;78:314‑6. 19. Chan PY, Lee MP, Cheung HY, Chung CC, ...

  11. Ender’s Nail fixation in paediatric femoral shaft fractures.

    Directory of Open Access Journals (Sweden)

    Rajeev Dwivedi

    2013-12-01

    Flynn criteria 34 had excellent and 6 had satisfactory results. No poor results were seen. Conclusion: Ender’s nail fixation can be preferred method of treatment for femoral shaft fractures in age group 5 -15 years as the results are excellent and satisfactory. It is technically simple and can be done in a closed manner. It spares the vascularity and growth plate.

  12. ediatric femoral shaft fractures treated by flexible intramedullary nailing.

    Science.gov (United States)

    Kapil Mani, K C; Dirgha Raj, R C; Parimal, Acharya

    2015-01-01

    Nowadays pediatric femoral fractures are more commonly managed with operative treatment rather than conservative treatment because of more rapid recovery and avoidance of prolonged immobilization. Children between the ages of 5-13 years are treated either by traction plus hip spica and flexible/elastic stable retrograde intramedullary nail, or external fixators in the case of open fractures. The aim of this study is to evaluate the outcome of pediatric femoral shaft fractures treated by stainless steel flexible intramedullary nail in children between 5 and 13 years of age. There were 32 cases of femoral shaft fractures which were all fixed with stainless steel flexible intramedullary nail under fluoroscopy. Long leg cast was applied at the time of fixation. Partial weight bearing was started 2 weeks after surgery. Patients were evaluated in follow-up study to observe the alignment of fracture, infection, delayed union, nonunion, limb length discrepancy, motion of knee joint, and time to unite the fracture. We were able to follow up 28 out of 32 patients. The patients were 8.14 years of age on average. The mean hospital stay after operation was 4 days and fracture union time was 9.57 weeks. There were 3 cases of varus angulation, 2 cases of anterior angulation, and 4 cases of limb lengthening. Patients aged between 5 and 13 years treated with flexible intramedullary nail for closed femoral shaft fracture have rapid union and recovery, short rehabilitation period, less immobilization and psychological impact, and cost-effective.

  13. Short-term outcome of patients with closed comminuted femoral ...

    African Journals Online (AJOL)

    Short-term outcome of patients with closed comminuted femoral shaft fracture treated with locking intramedullary sign nail at Muhimbili Orthopaedic Institute in Tanzania. ... and fracture tables are not readily available. They have excellent to good outcomes in rate of callus formation, limb length and limb alignment outcomes.

  14. Management of Bilateral Femoral Fractures in Pregnancy: A Case ...

    African Journals Online (AJOL)

    OBJECTIVE: We report here the management of bilateral femoral fractures in a pregnant woman who was presented to us at about 35 weeks of gestation following a road traffic accident. CASE REPORT: A 39 year old pregnant civil servant was referred to us 9 days after sustaining injuries to both lower limbs from a road ...

  15. Surgical blood order equation in femoral fracture surgery

    NARCIS (Netherlands)

    Kajja, I.; Bimenya, G. S.; Eindhoven, G. B.; ten Duis, H. Jan; Sibinga, C. T. S.

    Aim: This study aimed at establishing the clinical utility of the surgical blood order equation (SBOE) in patients undergoing femoral fracture surgery. Background: A blood ordering schedule defines the perioperative blood use in elective surgery. It lists the number of units of blood required for

  16. Management of a femoral fracture complicated by clostridial myositis

    International Nuclear Information System (INIS)

    Thomson, M.J.; Eger, C.E.

    1997-01-01

    A clinical case of clostridial myositis secondary to a comminuted femoral fracture is described. This case is unusual because, despite the severe degree of obvious muscle necrosis and gas production, the dog had minimal signs of systemic toxicity. Union of the fracture was achieved but six months postoperatively muscular contracture had resulted in permanent stifle extension

  17. Pattern of femoral fractures and associated injuries in a Nigerian ...

    African Journals Online (AJOL)

    2014-10-09

    Oct 9, 2014 ... femoral fractures and the associated injuries in our region while recommending possible means of averting these injuries. Materials and Methods: A .... are acquired will help in planning preventive measures for some of these ... was a direct impact to other areas of the musculoskeletal systems, but all the ...

  18. Scaling in Theropod Dinosaurs: Femoral Bone Strength and Locomotion II

    Science.gov (United States)

    Lee, Scott

    2015-01-01

    In the second paper of this series, the effect of transverse femoral stresses due to locomotion in theropod dinosaurs of different sizes was examined for the case of an unchanging leg geometry. Students are invariably thrilled to learn about theropod dinosaurs, and this activity applies the concepts of torque and stress to the issue of theropod…

  19. Radiological assessment of the femoral bicondylar angle in a ...

    African Journals Online (AJOL)

    Background: Femoral bicondylar angle is the angle between the diaphysis of the femur and a line perpendicular to the infracondylar plane. It is indispensable in bipedal locomotion as it serves to place the knee and foot under the body's center of gravity during the single support phase of gait. Although the mechanism for the ...

  20. Beware: The femoral haemodialysis catheter – a surgeon's ...

    African Journals Online (AJOL)

    organ donation (1.4 per million population (pmp)) and renal transplantation rates (4.7 pmp)[1] demand optimal utilisation of this precious resource. This article is based on recent adverse events encountered during renal transplantation at our institution, possibly associated with the prolonged use of femoral haemodialysis ...

  1. Blood flow and microdialysis in the human femoral head

    DEFF Research Database (Denmark)

    Bøgehøj, Morten; Emmeluth, Claus; Overgaard, Søren

    2007-01-01

    BACKGROUND: If it would be possible to detect lack of flow and/or the development of ischemia in bone, we might have a way of predicting whether a broken bone will heal. We established microdialysis (MD) and laser Doppler (LD) flow measurement in the human femoral head in order to be able to detect...

  2. Retained portion of latex glove during femoral nailing. Case report.

    Science.gov (United States)

    Sadat-Ali, M; Marwah, S; al-Habdan, I

    1996-11-01

    A case of retained glove during Kuntscher intramedullary nailing is described. An abscess around the glove could have lead to osteomyelitis. One need to be cautious feeling the top end of the nail while femoral nailing to avoid such a complication.

  3. Femoral head injuries: Which treatment strategy can be recommended?

    NARCIS (Netherlands)

    Henle, Philipp; Kloen, Peter; Siebenrock, Klaus A.

    2007-01-01

    Despite different operative and non-operative treatment regimens, the outcome after femoral head fractures has changed little over the past decades. The initial trauma itself as well as secondary changes such as posttraumatic osteoarthritis, avascular necrosis or heterotopic ossification is often

  4. Early micromovement of the Articular Surface Replacement (ASR) femoral component

    DEFF Research Database (Denmark)

    Penny, J O; Ding, M; Varmarken, J E

    2012-01-01

    Radiostereometric analysis (RSA) can detect early micromovement in unstable implant designs which are likely subsequently to have a high failure rate. In 2010, the Articular Surface Replacement (ASR) was withdrawn because of a high failure rate. In 19 ASR femoral components, the mean micromovement...

  5. Traumatic separation of the upper femoral epiphysis in a neonate ...

    African Journals Online (AJOL)

    Other terminologies that have been used to describe the injury include traumatic proximal femoral epiphysiolysis and apparent dislocation of the hip. This injury is ... Her mother noticed she had reduced movement in her right lower extremity five days after delivery and this necessitated an orthopaedic consultation. After a ...

  6. Non-Vascularised Fibular Grafting After Resection of Distal Femoral ...

    African Journals Online (AJOL)

    Background: Vascularized fibular grafting, allografting, megaprosthesis and allograft-prosthesis composite are suitable limb salvage techniques after resection of ... the initial observation showed such a wide non-vascularized fibular grafting for arthrodesis of the knee after resection of the distal femoral tumours is a feasible ...

  7. Outcome of Femoral Plate Osteosynthesis in a Teaching Hospital in ...

    African Journals Online (AJOL)

    There were 12 (5.9%) nonunions, 10 (4.9%) infected implants and 4 (2%) broken implants. Conclusion: Plate osteosynthesis is vital in the management of femoral fractures especially in developing countries where the cost of care is entirely borne by the patients and relations. Careful patient selection and meticulous ...

  8. Femoral Intercondylar Notch (ICN) width in Nigerians: Its ...

    African Journals Online (AJOL)

    It is suggested that the difference could be the result of dominant use of one foot over the other or to occupational habit. This needs further investigation. The Femoral Intercondylar Notch (ICN) width is not related to Femur length as no relationship was found to exist between the two (p > 0.05). We conclude that since ...

  9. [Femoral hypoplasia-unusual facies syndrome: A case report].

    Science.gov (United States)

    García V, Daniel; Aragón V, Carlos R; Treviño A, M Guadalupe; Rivera S, Gerardo

    2016-01-01

    Femoral hypoplasia-unusual facies syndrome is a rare disease with variable expressivity, although cases have been reported with an autosomal dominant pattern. It particularly affects the structures of the face associated with hypoplasia of the femur. Its aetiology is relatively unknown. However, this syndrome has been associated with maternal diabetes, drug exposure, viral infections, radiation, and oligohydramnios. The case of a newborn with this syndrome is presented. Newborn of 41 weeks gestation with small nose, thin upper lip, micrognathia, long philtrum, low set ears, epicanthal folds, dysplastic hips showing flexion, and adduction of the right leg, and shortening at the expense of the thigh. X-ray images revealed femoral hypoplasia and dysplastic acetabular roof. Different physicians from other specialties who excluded other associated malformations performed a complete evaluation. Surgical bone lengthening of lower limb is scheduled at 5 months of age, with the purpose that she walks with her own feet; at the same time she began management with kinesiotherapy. Femoral hypoplasia-unusual facies syndrome is a rare condition. A multidisciplinary health care team must treat individuals with femoral hypoplasia-unusual facies syndrome. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Internal fixation of an oblique femoral fracture in a German ...

    African Journals Online (AJOL)

    A 6 month old puppy with oblique femoral fracture on the right hind limb was treated by surgical manipulation which required internal stabilization using a lagscrew fixed in a craniocaudual direction, and a bone plate fixed laterally. Bone healing occurred without complications and the dog's limb was restored to its normal ...

  11. Non-operative ambulatory treatment osteonecrosis of the femoral ...

    African Journals Online (AJOL)

    Osteonecrosis of the femoral head of the femur (ONFH) is a common disabling complication in Sickle cell Disease (SCD). Sickle cell disorder include patients homozygous for hemoglobin S (HbSS) patients with sickle cell c (Hbsc) disease, those with sickle cell beta thalsaemia, and those who have other rare conditions in ...

  12. exchange femoral nailings at kenyatta national hospital abstract ...

    African Journals Online (AJOL)

    conventional Kuntscher nail and a Russel-Taylor interlocking nail. Conclusions: Exchange femoral nailing was undertaken in only 0.24% of Kuntscher nailings over this ten year's study period. INTRODUCTION. Intramedullary nailing has been the standard treatment method for acute adult femur shaft fracture for decades(1).

  13. fibular osteosynthesis of neglected femoral neck fracture in a young

    African Journals Online (AJOL)

    As soon as a diagnosis of non-displaced fracture of his right hip was made he discharged himself ... in dogs that cortical grafts provided structural support to the necrotic femoral head preventing its collapse ... possibility of future osteoarthritis of the index hip and the need for regular follow-up. In conclusion, the use of ...

  14. Unilateral proximal focal femoral deficiency, fibular aplasia, tibial ...

    African Journals Online (AJOL)

    Rabah M. Shawky

    2014-04-30

    Apr 30, 2014 ... Unilateral proximal focal femoral deficiency, fibular aplasia, tibial campomelia and oligosyndactyly in an Egyptian child – Probable. FFU syndrome. Rabah M. ... We report for the first time an Egyptian child with a rare unilateral .... 4th and 5th metatarsal bones are absent), absent middle phalanx of the 2nd ...

  15. Posterior Hip Dislocation with Ipsilateral Femoral Neck Fracture ...

    African Journals Online (AJOL)

    fracture of the right ankle. (Fig. 3 3). Total hip athroplasty was advised but due to financial constraints they could not afford to buy the implant. A decision was made to perform a hemi athroplasty with a bipolar implant. The intact femoral head was found lodged in the partly lacerated gluteal muscles and the the acetabulum ...

  16. Arthroscopic internal fixation of osteochondritis dissecans of the femoral head.

    Science.gov (United States)

    Matsuda, Dean K; Safran, Marc R

    2013-05-01

    Osteochondritis dessicans of the femoral head is an uncommon problem. Limited literature reports the incidence of osteochondritis dessicans and its treatment. The surgical technique used and outcomes for a 40-year-old man with symptomatic femoral head osteochonditis dissecans who was treated 11 years previously with retrograde drilling and hip arthroscopy are discussed.Despite temporary symptomatic improvement without subchondral collapse after his index procedure, increasing pain a decade later was thought to be caused by a large apical osteochondritic fragment and chondrolabral dysfunction from femoroacetabular impingement. Acetabuloplasty of acetabular overcoverage permitted arthroscopic internal fixation of the bone fragment by improving screw trajectory. Labral refixation and femoroplasty were subsequently performed. At 18-month follow-up, his nonarthritic hip score improved from 53 to 76 and his osteochondritic lesion had healed radiographically.Although clinical improvement with radiographic union has been reported following open screw fixation of femoral head osteochondritis dissecans, to the authors' knowledge this is the first published case with a similar outcome using arthroscopic techniques. Clinical improvement and union of even long-standing osteochondritis dissecans of the femoral head may occur with arthroscopic fragment fixation. Hip arthroscopy may play significant therapeutic and diagnostic roles in the treatment of this condition while offering a less invasive alternative to open osteosynthesis. Copyright 2013, SLACK Incorporated.

  17. Femoral neck fractures - Can physiologic status determine treatment choice?

    NARCIS (Netherlands)

    Heetveld, Martin J.; Raaymakers, Ernst L. F. B.; Luitse, Jan S. K.; Nijhof, Marc; Gouma, Dirk J.

    2007-01-01

    In patients with displaced femoral neck fractures, metaanalysis data show revision rates of 35% after internal fixation and 16% after hemiarthroplasty. A published physiologic status score management protocol, which selects for either treatment, suggests lower revision rates can be achieved but it

  18. Mechanical properties of femoral trabecular bone in dogs

    Directory of Open Access Journals (Sweden)

    Nolte Ingo

    2005-03-01

    Full Text Available Abstract Background Studying mechanical properties of canine trabecular bone is important for a better understanding of fracture mechanics or bone disorders and is also needed for numerical simulation of canine femora. No detailed data about elastic moduli and degrees of anisotropy of canine femoral trabecular bone has been published so far, hence the purpose of this study was to measure the elastic modulus of trabecular bone in canine femoral heads by ultrasound testing and to assess whether assuming isotropy of the cancellous bone in femoral heads in dogs is a valid simplification. Methods From 8 euthanized dogs, both femora were obtained and cubic specimens were cut from the centre of the femoral head which were oriented along the main pressure and tension trajectories. The specimens were tested using a 100 MHz ultrasound transducer in all three orthogonal directions. The directional elastic moduli of trabecular bone tissue and degrees of anisotropy were calculated. Results The elastic modulus along principal bone trajectories was found to be 11.2 GPa ± 0.4, 10.5 ± 2.1 GPa and 10.5 ± 1.8 GPa, respectively. The mean density of the specimens was 1.40 ± 0.09 g/cm3. The degrees of anisotropy revealed a significant inverse relationship with specimen densities. No significant differences were found between the elastic moduli in x, y and z directions, suggesting an effective isotropy of trabecular bone tissue in canine femoral heads. Discussion This study presents detailed data about elastic moduli of trabecular bone tissue obtained from canine femoral heads. Limitations of the study are the relatively small number of animals investigated and the measurement of whole specimen densities instead of trabecular bone densities which might lead to an underestimation of Young's moduli. Publications on elastic moduli of trabecular bone tissue present results that are similar to our data. Conclusion This study provides data about directional elastic

  19. Early Experience with a Short, Tapered Titanium Porous Plasma Sprayed Stem with Updated Design.

    Science.gov (United States)

    Lombardi, Adolph V; Manocchio, Antonio G; Berend, Keith R; Morris, Michael J; Adams, Joanne B

    2018-03-12

    Short stem femoral components in primary total hip arthroplasty (THA) have increased in popularity since the advent of minimally invasive surgical techniques. The concept of a short stem is particularly compatible with tapered designs where the goal is to offload forces proximally in the femur. The purpose of this retrospective review was to review our early experience with a short, tapered titanium femoral component with updated design features. Beginning in November 2011 through February 2012, 92 consented patients (93 hips), at a single center, were treated with primary cementless THA using a short stem, tapered femoral component (Taperloc® Complete Microplasty; Zimmer Biomet, Warsaw, Indiana) and were available for review with a minimum two-year follow-up. Mean patient age at surgery was 63.2 years and body mass index (BMI) was 30.8 kg/m2. Mean stem length used was 110.3mm (range, 95-125). Mean follow-up was 4.5 years (2-6). Harris hip scores improved from 52.5 preoperatively to 84.7 at most recent. One stem was revised the same day for periprosthetic fracture. One patient with early infection was treated with single-stage exchange followed by recurrence that was treated successfully with two-stage exchange. A non-healing wound in one patient was treated with incision and debridement. Radiographic assessment demonstrated no evidence of loosening, osteolysis, distal hypertrophy, or pedestal formation in any hip, and all components appeared well fixed and in appropriate alignment. In this series of patients treated with primary THA using a short, tapered titanium porous plasma-sprayed femoral component with updated design features, good results were achieved with a low incidence of complications and revision. No aseptic loosening or osteolysis has occurred. Radiographic assessment was excellent for all patients.

  20. [Clinical observation of proximal femoral anti-rotation nail for the treatment of femoral intertrochanteric fracture].

    Science.gov (United States)

    Sun, Fang-Gui; Wang, De-Xin; Hu, Yu-Tong; Xu, Rong-Ming

    2017-10-25

    To explore the curative effect and the recessive loss of blooding of PFNA for the treatment of intertrochanteric fractures of femur. From January 2012 to January 2015, a total of 49 patients with intertrochanteric fractures of femur were treated with proximal femoral anti-rotation nail including 41 males and 8 females with an average age of 79 years old ranging from 65 to 91 years old. According to the modified Evans type, 1 case was type I, 12 cases were type II, 36 cases were type III. All cases were fresh fractures. Patients had hip pain, movement limited, joint swelling, bruising, extorsion deformity, X-ray and CT examination showed completely fractures. All patients were treated by closed reduction and PFNA internal fixation. Three comminuted fractures using closed reduction were not satisfied, then were treated by limited PFNA fixation after open reduction. The patients' incision got the grade A healing, no complications such as infection and internal fixation failure happened. All patients were followed up from 6 to 36 months (means 22 months). The pain VAS score decreased from preoperative 7.70±1.97 to 1.00±0.26 at 6 months after operation( P <0.01). Harris hip score improved from preoperative 8.70±4.19 to 91.70±5.31 at 6 months after operation( P <0.01). The outcome at 6 months after operation was excellent in 34 cases, good in 7, poor in 1. The fracture healing time was from 8 to 16 weeks with an average of 12 weeks after operation. One patient with osteoporosis, crushing broken, poor compliance, associated with schizophrenia at the same time, appeared with the displacement of the femoral greater trochanter, with conservative treatment for healing. Intertrochanteric fractures of femur are common in the elderly trauma, in pain relief, recovery of hip function, to provide quality of life for the patients, PFNA achieved satisfactory effect, but its existence is worth to pay close attention to the recessive loss of blood.

  1. Study of the anatomical position of the femoral nerve by magnetic resonance imaging in patients with fractured neck of femur: relevance to femoral nerve block.

    LENUS (Irish Health Repository)

    Mehmood, Shehzad

    2012-01-31

    STUDY OBJECTIVE: To determine the anatomical location of the femoral nerve in patients who have sustained fracture of the neck of femur, and its relevance to femoral nerve block technique. DESIGN: Prospective, observational clinical study. SETTING: Orthopedic and Radiology departments of a regional hospital. SUBJECTS: 10 consecutive adult ASA physical status II and III patients (mean age, 78.5 yrs) and 4 adult healthy volunteers. INTERVENTIONS: A T1 magnetic resonance imaging scan was performed of both upper thighs in patients and healthy volunteers successfully. MEASUREMENTS: The distance (mm) between the midpoint of the femoral artery and the midpoint of the femoral nerve, and the distance of the femoral nerve from the skin was measured at the mid-inguinal ligament, the pubic tubercle, and at the mid-inguinal crease. Data are shown as means (SD). Differences between both sides were compared using paired Student\\'s t-tests. P < 0.05 was significant. MAIN RESULTS: In patients the mean distance (mm) between the midpoint of the femoral nerve from the midpoint of femoral artery at the mid-inguinal crease on the fractured and non-fractured sides was 10.7 and 11.0, respectively (P = 0.87). The mean distance (mm) between the midpoint of the femoral nerve from the midpoint of the femoral artery at the mid-inguinal ligament on the fractured and non-fractured sides was 9.64 and 12.5, respectively (P = 0.03). The mean distance (mm) between the midpoint of the femoral nerve from the midpoint of the femoral artery at the pubic tubercle on the fractured and non-fractured sides was 8.74 and 10.49, respectively (P = 0.18). CONCLUSIONS: Blockade of the femoral nerve may be easier to perform at the mid-inguinal crease in patients with fractured neck of femur.

  2. [Clinical and radiological results of the thrust plate prosthesis in patients with aseptic necrosis of the femoral head].

    Science.gov (United States)

    Ishaque, B A; Wienbeck, S; Basad, E; Stürz, H

    2005-01-01

    analysis for 5 and 10 years was 95.1% (95% - 0.95 +/- 0.05). Our study suggests that, in spite of a slightly higher aseptic loosening rate in comparison with cementless stem prosthesis, the thrust plate prosthesis proved worthwhile. On account of our previous experience we consider the TPP to be a good alternative implant, especially for young patients. Due to excellent clinical results and nearly identical findings in the survivorship analysis in comparison to cementless stem prostheses, the TPP is also a good alternative implant for total hip arthroplasty in patients with femoral head necrosis. For a successful implantation of the TPP a good bone quality of the proximal femur is necessary. Therefore we cannot recommend the use of a thrust plate prosthesis in patients with femoral head necrosis and simultaneous osteopeny.

  3. Radiographic anatomy of the proximal femur: femoral neck fracture vs. transtrochanteric fracture

    Directory of Open Access Journals (Sweden)

    Ana Lecia Carneiro Leão de Araújo Lima

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the correlation between radiographic parameters of the proximal femur with femoral neck fractures or transtrochanteric fractures. METHODS: Cervicodiaphyseal angle (CDA, femoral neck width (FNW, hip axis length (HAL, and acetabular tear drop distance (ATD were analyzed in 30 pelvis anteroposterior view X-rays of patients with femoral neck fractures (n = 15 and transtrochanteric fractures (n = 15. The analysis was performed by comparing the results of the X-rays with femoral neck fractures and with transtrochanteric fractures. RESULTS: No statistically significant differences between samples were observed. CONCLUSION: There was no correlation between radiographic parameters evaluated and specific occurrence of femoral neck fractures or transtrochanteric fractures.

  4. Morphometric findings in avascular necrosis of the femoral head.

    Science.gov (United States)

    Kamal, Diana; Trăistaru, Rodica; Alexandru, D O; Kamal, C K; Pirici, D; Pop, O T; Mălăescu, D Gh

    2012-01-01

    Avascular necrosis of the femoral head is an illness with a controversial etiology, the trigger event being the suppression of blood flow to the femoral head. The disease affects mostly young adults within their third and fifth decade, the majority of the patients being men. The main risk factors are trauma, chronic alcohol consumption, smoking, corticotherapy. The main goal of our study is to describe the morphometric changes found in the bone tissue of patients diagnosed with avascular necrosis of the femoral head, with different risk factors, by comparing the area of bone trabeculae inside the area of necrosis with that from the adjacent viable tissue. The morphometric study used biological material from 16 patients with ages between 29 and 57 years, who underwent surgery for avascular necrosis of the femoral head. They were admitted in the Orthopedics Department at the Emergency County Hospital in Craiova between 2010 and 2011 and were split into four groups. Group I presented trauma as the main risk factor, Group II had corticotherapy as the defining risk factor, Group III presented chronic alcohol consumption and Group IV was represented by the patients who smoked and exhibited chronic alcohol consumption. There was not a significant statistical difference between the areas of bone trabeculae of the four groups when we compared viable bone tissue to the necrotized one. Knowing the risk factors of the avascular necrosis of the femoral head is critical to the management of the disease, because diagnosing it in an early stage is a necessity for obtaining a good result for conservative treatment.

  5. Current concepts on osteonecrosis of the femoral head

    Science.gov (United States)

    Moya-Angeler, Joaquin; Gianakos, Arianna L; Villa, Jordan C; Ni, Amelia; Lane, Joseph M

    2015-01-01

    It is estimated that 20000 to 30000 new patients are diagnosed with osteonecrosis annually accounting for approximately 10% of the 250000 total hip arthroplasties done annually in the United States. The lack of level 1 evidence in the literature makes it difficult to identify optimal treatment protocols to manage patients with pre-collapse avascular necrosis of the femoral head, and early intervention prior to collapse is critical to successful outcomes in joint preserving procedures. There have been a variety of traumatic and atraumatic factors that have been identified as risk factors for osteonecrosis, but the etiology and pathogenesis still remains unclear. Current osteonecrosis diagnosis is dependent upon plain anteroposterior and frog-leg lateral radiographs of the hip, followed by magnetic resonance imaging (MRI). Generally, the first radiographic changes seen by radiograph will be cystic and sclerotic changes in the femoral head. Although the diagnosis may be made by radiograph, plain radiographs are generally insufficient for early diagnosis, therefore MRI is considered the most accurate benchmark. Treatment options include pharmacologic agents such as bisphosphonates and statins, biophysical treatments, as well as joint-preserving and joint-replacing surgeries. the surgical treatment of osteonecrosis of the femoral head can be divided into two major branches: femoral head sparing procedures (FHSP) and femoral head replacement procedures (FHRP). In general, FHSP are indicated at pre-collapse stages with minimal symptoms whereas FHRP are preferred at post-collapse symptomatic stages. It is difficult to know whether any treatment modality changes the natural history of core decompression since the true natural history of core decompression has not been delineated. PMID:26396935

  6. Hemodynamic changes in osteonecrosis treatment of the femoral head with iliac bone flaps pedicled with the lateral femoral circumflex artery ascending branch: A 10-year report.

    Science.gov (United States)

    Liu, YuPeng; Zhao, DeWei; Wang, W M; Wang, B J; Zhang, Y; Li, Z G

    2016-04-29

    Vascularized bone grafting was used in the treatment of osteonecrosis femoral head, which may directly influence the pathologic event of femoral head. This paper evaluates hemodynamic changes in osteonecrosis treatment of the femoral head (ONFH) with iliac bone flaps from the lateral femoral circumflex artery ascending branches via digital subtraction angiography. A total of 48 patients, (31 males and 17 females; 38 at stage II and 10 at stage III), were treated with iliac bone flaps pedicled with the ascending branch of the lateral femoral circumflex artery. DSA was performed on all 48 patients preoperatively and 6 months postoperatively, and 10 years postoperatively on 1 patient. Six months after surgery, femoral head blood supplies were distinctly visualized in the selective DSA in 44 cases. 4 patients showed poor or failed vessel pedicle filling in the transplanted bone flaps. Total hip arthroplasty was performed on these 4 patients. DSA was conducted 10 years post-operation in 1 case; the subject showed normal blood supply of the femoral head. The anatomical position of the ascending branch of the lateral femoral circumflex artery was constant. Digital subtraction angiography successfully examined hemodynamic changes in osteonecrosis treatment of the femoral head with vascularized bone flaps.

  7. Wear resistance of poly(2-methacryloyloxyethyl phosphorylcholine)-grafted carbon fiber reinforced poly(ether ether ketone) liners against metal and ceramic femoral heads.

    Science.gov (United States)

    Yamane, Shihori; Kyomoto, Masayuki; Moro, Toru; Hashimoto, Masami; Takatori, Yoshio; Tanaka, Sakae; Ishihara, Kazuhiko

    2018-04-01

    Younger, active patients who undergo total hip arthroplasty (THA) have increasing needs for wider range of motion and improved stability of the joint. Therefore, bearing materials having not only higher wear resistance but also mechanical strength are required. Carbon fiber-reinforced poly(ether ether ketone) (CFR-PEEK) is known as a super engineering plastic that has great mechanical strength. In this study, we focused on poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC)-grafted CFR-PEEK and investigated the effects of PMPC grafting and the femoral heads materials on the wear properties of CFR-PEEK liners. Compared with untreated CFR-PEEK, the PMPC-grafted CFR-PEEK surface revealed higher wettability and lower friction properties under aqueous circumstances. In the hip simulator wear test, wear particles generated from the PMPC-grafted CFR-PEEK liners were fewer than those of the untreated CFR-PEEK liners. There were no significant differences in the size and the morphology of the wear particles between the differences of PMPC-grafting and the counter femoral heads. Zirconia-toughened alumina (ZTA) femoral heads had significantly smoother surfaces compared to cobalt-chromium-molybdenum alloy femoral heads after the hip simulator test. Thus, we conclude that the bearing combination of the PMPC-grafted CFR-PEEK liner and ZTA head is expected to be a lifelong bearing interface in THA. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1028-1037, 2018. © 2017 Wiley Periodicals, Inc.

  8. [Comparison of in vivo characteristics of polyethylene wear particles produced by a metal and a ceramic femoral component in total knee replacement].

    Science.gov (United States)

    Veigl, D; Vavřík, P; Pokorný, D; Slouf, M; Pavlova, E; Landor, I

    2011-01-01

    The aim of the study was to evaluate in vivo and compare, in terms of the quality and number of ultra high-molecular polyethylene (UHMWPE) wear particles, total knee replacements of identical construction differing only in the material used for femoral component production, i.e., CoCrMo alloy or ZrO2 ceramics. Samples of peri-prosthetic granuloma tissue were collected in two patients with total knee replacement suffering from implant migration, who were matched in relevant characteristics. The primary knee replacement in Patient 1 with a CoCrMo femoral component was done 7.2 years and in Patient 2 with a ZrO2 implant 6.8 years before this assessment. The polyethylene wear-induced granuloma was analysed by the MORF method enabling us to assess the shape and size of wear debris and the IRc method for assessment of particle concentration. In the granuloma tissue samples of Patient 1, on the average, particles were 0.30 mm in size and their relative volume was 0.19. In the Patient 2 tissue samples, the average size of particles was 0.33 mm and their relative volume was 0.26. There was no significant difference in either particle morphology or their concentration in the granuloma tissue between the two patients. One of the options of how to reduce the production of polyethylene wear particles is to improve the tribological properties of contacting surfaces in total knee replacement by substituting a cobalt-chrome femoral component with a zirconia ceramic femoral component. The previous in vitro testing carried out with a mechanical simulator under conditions approaching real weight-bearing in the human body did show a nearly three-fold decrease in the number of UHMWPE wear particles in zirconia components. The evaluation of granuloma tissue induced by the activity of a real prosthetic joint for nearly seven years, however, did not reveal any great difference in either quality or quantity of polyethylene debris between the two replacements. The difference of surface

  9. The Effect of Pelvic Tilt and Femoral Head Size on Hip Range-of-Motion to Impingement.

    Science.gov (United States)

    McCarthy, Thomas F; Nevelos, Jim; Elmallah, Randa K; Chughtai, Morad; Khlopas, Anton; Alipit, Vincent; Wagner, Timothy C; Mont, Michael A

    2017-11-01

    About 50%-70% of dislocators have cups placed within so-called "safe zones." It has been postulated that factors such as femoral head size and pelvic tilt, obliquity, or rotation may influence postoperative stability. Therefore, we assessed varying degrees of pelvic tilt and head sizes on the range of motion (ROM) to impingement. A hip simulator was used to import models of 10 subjects who performed object pickup, squatting, and low-chair rising. Parameters were set for pelvic tilt, stem version, and the specific motions as defined by the subjects. Femur-to-pelvis relative motions were determined for abduction/adduction, internal/external rotation, and flexion/extension. Varying tilt angles were tested. Thirty-two millimeter and 36-mm head with a standard cup and 42-mm dual mobility cup were tested. Cup orientations for abduction and anteversion combinations were chosen, and computations of minimum clearances or impingement between components were made. The ROM to impingement varied with the different pelvic tilts and femoral head sizes and with the different motions. The larger the head size, the larger the impingement-free ROM. Negative 10° of pelvic tilt led to the largest impingement-free zone, whereas 10° of forward tilt was associated with fewer impingement-free cup anteversion and abduction angle combinations. Variations in pelvic tilt had the greatest influence on object pickup and affected the impingement-free "safe zone." Targets for impingement-free motion may be smaller when considering varying pelvic tilts and femoral head sizes, particularly for certain activities, such as object pickup. These findings may indicate the need for more individualized patient planning. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Trochanteric entry femoral nails yield better femoral version and lower revision rates-A large cohort multivariate regression analysis.

    Science.gov (United States)

    Yoon, Richard S; Gage, Mark J; Galos, David K; Donegan, Derek J; Liporace, Frank A

    2017-06-01

    Intramedullary nailing (IMN) has become the standard of care for the treatment of most femoral shaft fractures. Different IMN options include trochanteric and piriformis entry as well as retrograde nails, which may result in varying degrees of femoral rotation. The objective of this study was to analyze postoperative femoral version between three types of nails and to delineate any significant differences in femoral version (DFV) and revision rates. Over a 10-year period, 417 patients underwent IMN of a diaphyseal femur fracture (AO/OTA 32A-C). Of these patients, 316 met inclusion criteria and obtained postoperative computed tomography (CT) scanograms to calculate femoral version and were thus included in the study. In this study, our main outcome measure was the difference in femoral version (DFV) between the uninjured limb and the injured limb. The effect of the following variables on DFV and revision rates were determined via univariate, multivariate, and ordinal regression analyses: gender, age, BMI, ethnicity, mechanism of injury, operative side, open fracture, and table type/position. Statistical significance was set at ptrochanteric entry nails (n=67). Univariate regression analysis revealed that a lower BMI was significantly associated with a lower DFV (p=0.006). Controlling for possible covariables, multivariate analysis yielded a significantly lower DFV for trochanteric entry nails than piriformis or retrograde nails (7.9±6.10 vs. 9.5±7.4 vs. 9.4±7.8°, ptrochanteric entry nails also had a significantly lower revision rate, even when controlling for all other variables (ptrochanteric nails had a significantly lower DFV and a lower revision rate, even after regression analysis. However, this is not to state that the other nail types exhibited abnormal DFV. Translation to the clinical impact of a few degrees of DFV is also unknown. Future studies to more in-depth study the intricacies of femoral version may lead to improved technology in addition to

  11. Intra- and inter-observer variation during femoral jig rotational alignment in knee arthroplasty.

    Science.gov (United States)

    Wraighte, Philip J; Sikand, Manoj; Livesley, Peter J

    2011-09-01

    Rotational alignment of the femoral prosthesis is important in total knee arthroplasty to improve performance and reduce complications. This study investigates the differences between two popular referencing methods and evaluates the variability of surgeons' techniques (inter-observer) and their reproducibility (intra-observer) of femoral alignment. Eight surgeons each established the femoral rotational alignment on four duplicate sets of six cadaveric femoral bone casts, referencing from the epicondylar axis and from the posterior femoral condyles. These derived axes were compared against a reference Whiteside's line (anteroposterior axis). There was no significant difference between referencing techniques and a tendency to align the femoral component in slight external rotation. Femoral rotational alignment was reproducible by each surgeon. Extensive and significant variation in alignment exists between surgeons, independent of other factors (p < 0.001).

  12. Uranium-Niobium alloys

    International Nuclear Information System (INIS)

    Moura Neto, C. de

    1985-01-01

    The basic characteristics of the phase diagram of the U-Nb alloy are presented. Structural and morphological aspects of the kinectics of phase transformation are discussed, based in the phase diagram. (Author) [pt

  13. Good performance of a titanium femoral component in cementless hip arthroplasty in younger patients: 97 arthroplasties followed for 5-11 years

    DEFF Research Database (Denmark)

    Jacobsen, Steffen; Jensen, Frank Krieger; Poulsen, Klaus

    2003-01-01

    We performed 97 uncemented primary total hip arthroplasties in 80 patients having an average age of 50 years. The femoral implant was a titanium stem with a proximal circumferential plasma spray-coating. Three different acetabular components were used: a threaded and partly porous-coated design...... osteolysis associated with a deep infection, but no signs of proximal loosening. 3 femora had areas of minor proximal osteolysis. 16 acetabular components (14 threaded) had been revised in 13 patients. The average Harris hip score was 91 points at the latest follow-up. We conclude that the uncemented...

  14. Is Assessment of Femoral Head Perfusion During Modified Dunn for Unstable Slipped Capital Femoral Epiphysis an Accurate Indicator of Osteonecrosis?

    Science.gov (United States)

    Novais, Eduardo N; Sink, Ernest L; Kestel, Lauryn A; Carry, Patrick M; Abdo, João C M; Heare, Travis C

    2016-08-01

    The modified Dunn procedure, which is an open subcapital realignment through a surgical dislocation approach, has gained popularity for the treatment of unstable slipped capital femoral epiphysis (SCFE). Intraoperative monitoring of the femoral head perfusion has been recommended as a method of predicting osteonecrosis; however, the accuracy of this assessment has not been well documented. We asked (1) whether intraoperative assessment of femoral head perfusion would help identify hips at risk of developing osteonecrosis; (2) whether one of the four methods of assessment of femoral head perfusion is more accurate (highest area under the curve) at identifying hips at risk of osteonecrosis; and (3) whether specific clinical features would be associated with osteonecrosis occurrence after a modified Dunn procedure for unstable SCFE. Between 2007 and 2014, we performed 29 modified Dunn procedures for unstable SCFE (16 boys, 11 girls; median age, 13 years; range, 8-17 years); two were lost to followup before 1 year. During this period, six patients with unstable SCFE were treated by other procedures. All patients undergoing modified Dunn underwent assessment of epiphyseal perfusion by the presence of active bleeding and/or by intracranial pressure (ICP) monitoring. In the initial five patients perfusion was recorded once, either before dissection of the retinacular flap or after fixation by one of the two methods. In the remaining 22 patients (81%), perfusion was systematically assessed before dissection of the retinacular flap and after fixation by both methods. Minimum followup was 1 year (median, 2.5 years; range, 1-8 years) because osteonecrosis typically develops within the first year after surgery. Patients were assessed for osteonecrosis by the presence of femoral head collapse at radiographs obtained every 3 months during the first year after surgery. Seven (26%) of the 27 patients developed osteonecrosis. Measures of diagnostic accuracy including sensitivity

  15. Characteristics of mechanical alloying of Zn-Al-based alloys

    International Nuclear Information System (INIS)

    Zhu, Y.H.; Hong Kong Polytechnic; Perez Hernandez, A.; Lee, W.B.

    2001-01-01

    Three pure elemental powder mixtures of Zn-22%Al-18%Cu, Zn-5%Al-11%Cu, and Zn-27%Al-3%Cu (in wt.%) were mechanically alloyed by steel-ball milling processing. The mechanical alloying characteristics were investigated using X-ray diffraction, scanning electron microscopy, and transmission electron microscopy techniques. It was explored that mechanical alloying started with the formation of phases from pure elemental powders, and this was followed by mechanical milling-induced phase transformation. During mechanical alloying, phases stable at the higher temperatures formed at the near room temperature of milling. Nano-structure Zn-Al-based alloys were produced by mechanical alloying. (orig.)

  16. Machining of titanium alloys

    CERN Document Server

    2014-01-01

    This book presents a collection of examples illustrating the resent research advances in the machining of titanium alloys. These materials have excellent strength and fracture toughness as well as low density and good corrosion resistance; however, machinability is still poor due to their low thermal conductivity and high chemical reactivity with cutting tool materials. This book presents solutions to enhance machinability in titanium-based alloys and serves as a useful reference to professionals and researchers in aerospace, automotive and biomedical fields.

  17. Refractory alloy component fabrication

    International Nuclear Information System (INIS)

    Young, W.R.

    1984-01-01

    Purpose of this report is to describe joining procedures, primarily welding techniques, which were developed to construct reliable refractory alloy components and systems for advanced space power systems. Two systems, the Nb-1Zr Brayton Cycle Heat Receiver and the T-111 Alloy Potassium Boiler Development Program, are used to illustrate typical systems and components. Particular emphasis is given to specific problems which were eliminated during the development efforts. Finally, some thoughts on application of more recent joining technology are presented. 78 figures

  18. Transtrochanteric rotational osteotomy for avascular necrosis of the femoral head after unstable slipped capital femoral epiphysis: 10-year clinical results.

    Science.gov (United States)

    Nakashima, Yasuharu; Yamamoto, Takuaki; Fukushi, Jun-Ichi; Motomura, Goro; Hamai, Satoshi; Kohno, Yusuke; Iwamoto, Yukihide

    2016-11-01

    Avascular necrosis of the femoral head (AVN) is the most serious complication after unstable slipped capital femoral epiphysis (SCFE), and is often unsalvageable. We report a minimum 10 years of clinical results for transtrochanteric rotational osteotomy of the femoral head (TRO) for AVN. This study included 7 patients (7 hips) with a mean age at surgery of 13.3 years, and the follow-up period was 15.8 years. All patients had prior treatment via closed reduction and pinning of the unstable SCFE, and showed severely collapsed femoral heads. The direction of rotation was anterior in 3 hips and posterior in 4. The Merle d'Aubigné-Postel score (MDPS) was used for clinical assessment, and joint degeneration was assessed with the Kellgren and Lawrence classification (KL-grade). The spherical intact area of the femoral head was moved to the weight-bearing portion, and subluxation was corrected via rotation combined with intentional varus positioning. The mean MDPS improved from 10.3 points to 15.6 points at 5 years, and it was maintained at 15.0 points by 10 years; 3 hips were excellent, 1 was good, 2 were fair, and 1 showed poor outcomes. No patient experienced re-collapse after TRO or required conversion to hip replacement or arthrodesis. After 10 years, degenerative changes became evident over time, and 2 hips progressed to KL-4 with a decreased MDPS. Although some joint degeneration is inevitable in the long-term, TRO is an effective salvage procedure for treating AVN after unstable SCFE. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  19. Femoral head allograft disinfection system using moderate heat

    International Nuclear Information System (INIS)

    Knaepler, H.; Von Garrel, T.

    1999-01-01

    The employment of a reliable thermal viral inactivation process, which minimally manipulates tissues, for surgically retrieved femoral head allografts addresses the increased concerns with virus transmissibility while minimizing the loss of biological properties. The newest European and German surgical bone banking guidelines have incorporated the use of independently validated then-nal viral inactivation methods in place of repeat serological testing of donor. Our investigations have shown that heat treatment at 80 degree C for a minimum of 10 minutes provides safe, good quality cancellous bone allografts and increases the cost-effectiveness and simplicity of managing a hospital frozen femoral head bone bank. Human femoral head centers were contaminated with different vegetative bacterial and viral suspensions. A core temperature of 80 degree C for 10 minutes was sufficient to fully inactivate 3 x 106 ml Staphylococcus aureus and Streptococcus faecalis, and >5 loglo steps of cytomeglia (herpes group), polio (enterovirus), and yellow fever (arbovirus) viruses. A one hour treatment in a water bath set at 80 degree sufficient to fully inactivate E. coli, proteus vulgaris, and Pseudomonas aerog. vegetative suspensions; 20 minutes was sufficient to fully inactivate the D antigen (rhesus factor) but had no effect on A or B antigens. Several biomechanical and biological properties of bone following a one hour treatment in a water bath set at 80 degree C were investigated. Employing compression and tension tests, 80 degree C treated human and porcine cancellous bone blocks showed reductions in properties ranging from 8-19% compared to untreated control groups. Osteointegration at 3 months following treatment of explanted and then reimplanted autograft rat diaphyseal segment was 15% less than untreated controls. Subsequently, a thermal disinfection system for femoral heads from living donors (Lobator Marburg Bone Bank System, Telos GmbH, Hungen, Germany) was developed. A

  20. Soft-tissue balance in short and straight stem total hip arthroplasty.

    Science.gov (United States)

    Windhagen, Henning; Chincisan, Andra; Choi, Hon Fai; Thorey, Fritz

    2015-03-01

    The growing numbers of short stem hip implants have redefined total hip arthroplasty with new stem geometries and possible functional differences. Several systematic reviews have reported good clinical results with this new class of stems, although kinematic alterations are still unclear in many aspects. The good clinical results obtained at the authors' institution led to the current study. The authors hypothesized that the geometric alignment of the prosthetic components may be closer to the anatomy of the healthy hip joint, thus leading to better function and clinical satisfaction. An examination via finite element analysis was chosen to model the hip joint and virtually implant a short and a standard straight stem. Findings indicated that anchoring of the short stem allowed favorable positioning in the proximal femur, with the femoral head already in the center of the cup. This positioning was not possible for the straight stem, which required further reduction of the femur by a significant translation into the cup, leading to abnormal soft-tissue balancing. The results from the simulation showed an absolute average deviation of ligamentous fiber strains of 6% for the short stem in 30° of flexion and extension versus 29% and 36% for the standard straight stem in 30° of flexion and extension, respectively. A femoral neck guided orientation of the short stem implant seems to allow a more anatomical reconstruction and thus a more balanced hip in terms of the modeled soft tissues. In contrast, the straight stem alters the head position and induces nonphysiological capsular strains. Copyright 2015, SLACK Incorporated.

  1. The migration of femoral components after total hip replacement surgery: accuracy and precision of software-aided measurements

    Energy Technology Data Exchange (ETDEWEB)

    Decking, J. [Dept. of Orthopaedic Surgery, Univ. of Mainz School of Medicine, Mainz (Germany); Schuetz, U.; Decking, R.; Puhl, W. [Orthopaedic Dept., Univ. of Ulm, School of Medicine (Germany)

    2003-09-01

    Objective: To assess the accuracy and precision of a software-aided system to measure migration of femoral components after total hip replacement (THR) on digitised radiographs. Design and patients: Subsidence and varus-valgus tilt of THR stems within the femur were measured on digitised anteroposterior pelvic radiographs. The measuring software (UMA, GEMED, Germany) relies on bony landmarks and comparability parameters of two consecutive radiographs. Its accuracy and precision were calculated by comparing it with the gold standard in migration measurements, radiostereometric analysis (RSA). Radiographs and corresponding RSA measurements were performed in 60 patients (38-69 years) following cementless THR surgery. Results and conclusions: The UMA software measured the subsidence of the stems with an accuracy of {+-}2.5 mm and varus-valgus tilt with an accuracy of {+-}1.8 (95% confidence interval). A good interobserver and intraobserver reliability was calculated with Cronbach's alpha ranging from 0.86 to 0.97. Measuring the subsidence of THR stems within the femur is an important parameter in the diagnosis of implant loosening. Software systems such as UMA improve the accuracy of migration measurements and are easy to use on routinely performed radiographs of operated hip joints. (orig.)

  2. Wiring Techniques for the Fixation of Trochanteric Fragments during Bipolar Hemiarthroplasty for Femoral Intertrochanteric Fracture: Clinical Study and Technical Note.

    Science.gov (United States)

    Lee, Joong-Myung; Cho, Yongsuk; Kim, Junhyun; Kim, Dong-Won

    2017-03-01

    Femoral intertrochanteric fractures are common in the elderly. Appropriate surgical fixation of trochanteric fracture fragments can restore normal anatomical structure and ambulation, and can aid in the recovery of biomechanical function of the hip. We evaluated clinical outcomes of bipolar hemiarthroplasty using a wiring technique for trochanteric fracture fragment fixation. From September 2006 to February 2015, a total of 260 cases underwent simultaneous bipolar hemiarthroplasty and wire fixation. A total of 65 patients (69 hips) with an average age of 78 years and more than one year of follow-up was included in the study. Using pre-, postoperative and follow-up radiograms, we evaluated wire fixation failure and also assessed changes in walking ability. Loosening or osteolysis around the stem was not observed; however, we did observe bone growth around the stem (54 cases), cortical hypertrophy (6 cases), a wide range of sclerotic lines but no stem subsidence (1 case), wire breakage (9 cases), and fracture fragment migration with no significant functional deficiency (2 cases). Our study showed that additional wiring for trochanteric fracture fragment fixation following bipolar hemiarthroplasty can help restore normal anatomy. The added stability results in faster rehabilitation, and good clinical and radiographic outcomes. We recommend this procedure in this type of fracture.

  3. Intra-operative periprosthetic fractures associated with press fit stems in revision total knee arthroplasty: incidence, management, and outcomes.

    Science.gov (United States)

    Cipriano, Cara A; Brown, Nicholas M; Della Valle, Craig J; Moric, Mario; Sporer, Scott M

    2013-09-01

    The purpose of this study is to report the incidence, management, and outcomes of periprosthetic fractures associated with the insertion of press-fit stems during revision total knee arthroplasty (TKA). Immediate and six week post-operative radiographs from 634 stemmed implants (307 femoral, 327 tibial) from 420 consecutive revision TKAs were reviewed. Sixteen tibial (4.9%) and 3 femoral (1%) fractures (combined incidence 3.0%) were identified. All healed uneventfully without operative intervention, with no evidence of implant loosening at a mean of 23 months (range 12 to 47 months). The technique of tightly press fitting stems into the diaphysis is associated with a small rate (3%) of periprosthetic fractures; most were non or minimally displaced, all healed uneventfully with non-operative management and were not associated with implant loosening. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Correlation between baseline femoral neck marrow status and the development of femoral head osteonecrosis in corticosteroid-treated patients: A longitudinal study by MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Vande Berg, Bruno C. [Radiology Department, Universite Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels (Belgium)]. E-mail: vandeberg@rdgn.ucl.ac.be; Gilon, Raphael [Radiology Department, Universite Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels (Belgium); Malghem, Jacques [Radiology Department, Universite Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels (Belgium); Lecouvet, Frederic [Radiology Department, Universite Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels (Belgium); Depresseux, Genevieve [Rheumatology Department, Universite Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels (Belgium); Houssiau, Frederic A. [Rheumatology Department, Universite Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels (Belgium)

    2006-06-15

    Objective: To test the hypothesis that the development of corticosteroid (CS)-associated femoral head osteonecrosis (ON) is influenced by baseline femoral neck marrow status. Patients and methods: The population consisted of 20 untreated patients with a newly diagnosed rheumatic disease in whom a standardized CS regimen was planned. Before CS treatment, baseline femoral neck marrow status was determined by magnetic resonance (MR) imaging on T1-weighted images (proportion of surface area of femoral neck and intertrochanteric area occupied by fatty marrow; index of marrow conversion [IMC]) and on a quantitative MR sequence (bulk T1 values of femoral head and neck). The presence of ON was assessed by coronal T1-weighted MR images of the hips at 6 and 12 months. Results: None of the patients suffered from ON at baseline. Four patients (20%) developed bilateral femoral head ON at 6 months. The mean percentage of fat marrow in the femoral neck before treatment was significantly higher in ON-positive than in ON-negative patients (p = 0.0025). The mean baseline femoral neck IMC value, which parallels the degree of red to yellow marrow conversion, was higher in ON-positive than in ON-negative patients (p = 0.089). The mean baseline bulk T1 value of the femoral neck (but not of the femoral head), which inversely correlates with the amount of fat marrow, was significantly shorter in ON-positive than in ON-negative patients (p = 0.0298). Conclusion: The development of CS-associated femoral head ON is correlated with a high fat content in the proximal femur before CS therapy.

  5. Correlation between baseline femoral neck marrow status and the development of femoral head osteonecrosis in corticosteroid-treated patients: A longitudinal study by MR imaging

    International Nuclear Information System (INIS)

    Vande Berg, Bruno C.; Gilon, Raphael; Malghem, Jacques; Lecouvet, Frederic; Depresseux, Genevieve; Houssiau, Frederic A.

    2006-01-01

    Objective: To test the hypothesis that the development of corticosteroid (CS)-associated femoral head osteonecrosis (ON) is influenced by baseline femoral neck marrow status. Patients and methods: The population consisted of 20 untreated patients with a newly diagnosed rheumatic disease in whom a standardized CS regimen was planned. Before CS treatment, baseline femoral neck marrow status was determined by magnetic resonance (MR) imaging on T1-weighted images (proportion of surface area of femoral neck and intertrochanteric area occupied by fatty marrow; index of marrow conversion [IMC]) and on a quantitative MR sequence (bulk T1 values of femoral head and neck). The presence of ON was assessed by coronal T1-weighted MR images of the hips at 6 and 12 months. Results: None of the patients suffered from ON at baseline. Four patients (20%) developed bilateral femoral head ON at 6 months. The mean percentage of fat marrow in the femoral neck before treatment was significantly higher in ON-positive than in ON-negative patients (p = 0.0025). The mean baseline femoral neck IMC value, which parallels the degree of red to yellow marrow conversion, was higher in ON-positive than in ON-negative patients (p = 0.089). The mean baseline bulk T1 value of the femoral neck (but not of the femoral head), which inversely correlates with the amount of fat marrow, was significantly shorter in ON-positive than in ON-negative patients (p = 0.0298). Conclusion: The development of CS-associated femoral head ON is correlated with a high fat content in the proximal femur before CS therapy

  6. Stemmed femoral knee prostheses: effects of prosthetic design and fixation on bone loss.

    NARCIS (Netherlands)

    Lenthe, G.H. van; Willems, P.C.P.H.; Verdonschot, N.J.J.; Waal Malefijt, M.C. de; Huiskes, R.

    2002-01-01

    Although the revision rates for modern knee prostheses have decreased drastically, the total number of revisions a year is increasing because many more primary knee replacements are being done. At the time of revision, bone loss is common, which compromises prosthetic stability. To improve

  7. Young femoral neck fractures: are we measuring outcomes that matter?

    Science.gov (United States)

    Sprague, Sheila; Slobogean, Gerard P; Scott, Taryn; Chahal, Manraj; Bhandari, Mohit

    2015-03-01

    Femoral neck fractures in younger aged patients are particularly devastating injuries with profound impairments of quality of life and function. As there are multiple differences in patient and injury characteristics between young and elderly femoral neck fracture patients, the geriatric hip fracture literature is unlikely to be generalisable to patients under age 60. We conducted a systematic review to determine if clinically relevant outcome measures have been used in previously published clinical studies of internal fixation in young adults with femoral neck fractures. We conducted a comprehensive literature search using multiple electronic databases and conference proceedings to identify studies which used internal fixation for the management of femoral neck fractures in patients between the ages of 15 to 60. Eligibility screening and data abstraction were performed in duplicate. We classified the reported outcomes into the following categories: operative and hospital outcomes, radiographic outcomes, clinical outcomes, and functional outcomes and health-related quality of life. We calculated the frequencies of reported outcomes. Fort-two studies met our inclusion criteria. Operative and hospital outcomes were poorly reported with less than one-quarter of studies reporting relevant data. Important radiographic outcomes were also inadequately reported with only one-third of studies reporting the quality of the fracture reduction, and methods for assessment were highly variable. The assessment of avascular necrosis was reported in almost all the included studies (95.2%); however, the assessment of nonunion was only reported in three-quarters of the studies. Re-operations were reported in 73.8% of the included studies and the assessment of fracture healing was only reported in two-thirds of the studies. Less than half of the studies reported functional outcomes or health-related quality of life (overall patient evaluation scales and systems (45.2%), patient

  8. Differences in Femoral Geometry and Structure Due to Immobilization

    Science.gov (United States)

    Kiratli, Beatrice Jenny; Yamada, M.; Smith, A.; Marcus, R. M.; Arnaud, S.; vanderMeulen, M. C. H.; Hargens, Alan R. (Technical Monitor)

    1996-01-01

    Reduction in bone mass of the lower extremity is well documented in individuals with paralysis resulting from spinal cord injury (SCI). The consequent osteopenia leads to elevated fracture risk with fractures occurring more commonly in the femoral shaft and supracondylar regions than the hip. A model has recently been described to estimate geometry and structure of the femoral midshaft from whole body scans by dual X-ray absorptiometry (DXA). Increases in femoral geometric and structural properties during growth were primarily related to mechanical loading as reflected by body mass. In this study, we investigate the relationship between body mass and femoral geometry and structure in adults with normal habitual mechanical loading patterns and those with severely reduced loading. The subjects were 78 ambulatory men (aged 20-72 yrs) and 113 men with complete paralysis from SCI of more than 4 years duration (aged 21 73 yrs). Subregional analysis was performed on DXA whole body scans to obtain bone mineral content (BMC, g), cortical thickness (cm), crosssectional moment of inertia (CSMI, cm4), and section modulus (cm3) of the femoral midshaft. All measured bone variables were significantly lower in SCI compared with ambulatory subjects: -29% (BMC), -33% (cortical thickness), -23% (CSMI), and -22% (section modulus) while body mass was not significantly different. However, the associations between body mass and bone properties were notably different; r2 values were higher for ambulatory than SCI subjects in regressions of body mass on BMC (0.48 vs 0.20), CSMI (0.59 vs 0.32), and section modulus (0.59 vs 0.31). No association was seen between body mass and cortical thickness for either group. The greatest difference between groups is in the femoral cortex, consistent with reduced bone mass via endosteal expansion. The relatively lesser difference in geometric and structural properties implies that there is less effect on mechanical integrity than would be expected from

  9. Texture in low-alloyed uranium alloys

    International Nuclear Information System (INIS)

    Sariel, J.

    1982-08-01

    The dependence of the preferred orientation of cast and heat-treated polycrystalline adjusted uranium and uranium -0.1 w/o chromium alloys on the production process was studied. The importance of obtaining material free of preferred orientation is explained, and a survey of the regular methods to determine preferred orientation is given. Dilatometry, tensile testing and x-ray diffraction were used to determine the extent of the directionality of these alloys. Data processing showed that these methods are insufficient in a case of a material without any plastic forming, because of unreproducibility of results. Two parameters are defined from the results of Schlz's method diffraction test. These parameters are shown theoretically and experimentally (by extreme-case samples) to give the deviation from isotropy. Application of these parameters to the examined samples showes that cast material has preferred orientation, though it is not systematic. This preferred orientation was reduced by adequate heat treatments

  10. Correlation between diffusion barriers and alloying energy in binary alloys

    DEFF Research Database (Denmark)

    Vej-Hansen, Ulrik Grønbjerg; Rossmeisl, Jan; Stephens, Ifan

    2016-01-01

    In this paper, we explore the notion that a negative alloying energy may act as a descriptor for long term stability of Pt-alloys as cathode catalysts in low temperature fuel cells.......In this paper, we explore the notion that a negative alloying energy may act as a descriptor for long term stability of Pt-alloys as cathode catalysts in low temperature fuel cells....

  11. Three-Dimensional Analysis of the Characteristics of the Femoral Canal Isthmus: An Anatomical Study

    Directory of Open Access Journals (Sweden)

    Xiu-yun Su

    2015-01-01

    Full Text Available Purpose. To establish a new approach for measuring and locating the femoral intramedullary canal isthmus in 3-dimensional (3D space. Methods. Based on the computed tomography data from 204 Chinese patients, 3D models of the whole femur and the corresponding femoral isthmus tube were reconstructed using Mimics software (Materialise, Haasrode, Belgium. The anatomical parameters of the femur and the isthmus, including the femur length and radius, and the isthmus diameter and height, were measured accordingly. Results. The mean ratio of the isthmus height versus the femoral height was 55 ± 4.8%. The mean diameter of the isthmus was 10.49 ± 1.52 mm. The femoral length, the isthmus diameter, and the isthmus tube length were significantly larger in the male group. Significant correlations were observed between the femoral length and the isthmus diameter (r=0.24, p<0.01 and between the femoral length and the isthmus height (r=0.6, p<0.01. Stepwise linear regression analyses demonstrated that the femoral length and radius were the most important factors influencing the location and dimension of the femoral canal isthmus. Conclusion. The current study developed a new approach for measuring the femoral canal and for optimization of customer-specific femoral implants.

  12. Importance of sagittal MR imaging in nontraumatic femoral head osteonecrosis in children

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Alice S. [Hospital of the University of Pennsylvania, Department of Radiology, Philadelphia, PA (United States); Wells, Lawrence [Children' s Hospital of Philadelphia, Department of Orthopedic Surgery, Philadelphia, PA (United States); Jaramillo, Diego [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States)

    2008-11-15

    In nontraumatic femoral head osteonecrosis, characterization of femoral head collapse is important in staging disease progression and planning treatment. Few prior studies have quantitatively compared the ability of sagittal and coronal MR images to detect femoral head collapse. We hypothesized that sagittal MR images show a greater degree and angular span of femoral head collapse than coronal images. We reviewed 38 hip MRI scans of nontraumatic femoral head osteonecrosis from 34 pediatric patients. In both sagittal and coronal images, the maximal extent and angular location along with the angular span of the femoral head collapse were measured. Differences were evaluated using a paired t-test. The extent of bone and cartilage loss from the femoral head was evaluated. Sagittal MR images showed 29% maximal femoral head radius collapse, whereas coronal images showed 16% collapse (P<0.001). Sagittal images showed a larger angular span of collapse (115 ) than coronal images (55 , P<0.001). Sagittal images showed greater epiphyseal bone loss in the anterior than in the posterior portion (P<0.001), whereas coronal images did not show a significant difference in bone loss between the medial and lateral portion (P=0.32). Sagittal images show greater femoral head collapse than coronal images in nontraumatic femoral head osteonecrosis. (orig.)

  13. Importance of sagittal MR imaging in nontraumatic femoral head osteonecrosis in children

    International Nuclear Information System (INIS)

    Ha, Alice S.; Wells, Lawrence; Jaramillo, Diego

    2008-01-01

    In nontraumatic femoral head osteonecrosis, characterization of femoral head collapse is important in staging disease progression and planning treatment. Few prior studies have quantitatively compared the ability of sagittal and coronal MR images to detect femoral head collapse. We hypothesized that sagittal MR images show a greater degree and angular span of femoral head collapse than coronal images. We reviewed 38 hip MRI scans of nontraumatic femoral head osteonecrosis from 34 pediatric patients. In both sagittal and coronal images, the maximal extent and angular location along with the angular span of the femoral head collapse were measured. Differences were evaluated using a paired t-test. The extent of bone and cartilage loss from the femoral head was evaluated. Sagittal MR images showed 29% maximal femoral head radius collapse, whereas coronal images showed 16% collapse (P<0.001). Sagittal images showed a larger angular span of collapse (115 ) than coronal images (55 , P<0.001). Sagittal images showed greater epiphyseal bone loss in the anterior than in the posterior portion (P<0.001), whereas coronal images did not show a significant difference in bone loss between the medial and lateral portion (P=0.32). Sagittal images show greater femoral head collapse than coronal images in nontraumatic femoral head osteonecrosis. (orig.)

  14. Proximal Femoral Geometry and the Risk of Fractures: Literature Review

    Directory of Open Access Journals (Sweden)

    N.V. Grygorieva

    2016-02-01

    Full Text Available This article presents the literature review of the impact of the upper third of the femur geometry (hip axis length, femoral neck angle, inter-trochanteric length, horizontal offset, thickness of the cortical bone, etc. on the risk of fractures. The article demonstrates the capabilities of techniques for measurement of hip geometry, namely conventional X-ray of pelvic bones, dual-energy X-ray absorptiometry, computed tomography. Possible correlation is shown between some genetic markers and features of the geometry of the upper third of the femur. Also, there are presented the results of own researches of age and sex characteristics of proximal hip geometry parameters in patients without fractures, as well as in patients of older age groups with internal and extraarticular femoral fractures.

  15. Iliacus haematoma causing femoral nerve palsy: an unusual trampolining injury.

    Science.gov (United States)

    Chambers, Simon; Berg, Andrew James; Lupu, Andreea; Jennings, Andrew

    2015-07-27

    We report the case of a 15-year-old boy who presented to accident and emergency following a trampolining injury. Initially, the patient was discharged, diagnosed with a soft tissue injury, but he re-presented 48 h later with worsening low back pain and neurological symptoms in the left leg. Subsequent MRI revealed a left iliacus haematoma causing a femoral nerve palsy. The patient was managed conservatively and by 6 months post injury all symptoms had resolved. This is the first reported case of an iliacus haematoma causing a femoral nerve palsy, after a trampolining injury. We believe this case highlights to our fellow clinicians the importance of a detailed history when assessing patients with trampolining injuries to evaluate the true force of injury. It also acts as a reference for clinicians in managing similar cases in future. 2015 BMJ Publishing Group Ltd.

  16. Quality of life in old patients with proximal femoral fractures

    Directory of Open Access Journals (Sweden)

    T A Raskina

    2012-01-01

    Full Text Available Objective: to study quality of life in Kemerovo old patients with proximal femoral fractures. Patients and methods. Quality of life in osteoporotic fractures was analyzed in 219 patients (173 women and 46 men who had sustained the injury in January 2004 to December 2008. Results. In the patients with hip fractures, the lowest (41.94+31.16 scores values were recorded by the physical functioning scale reflecting the degree to which their health limited the performance of physical exercises (self-service, walking, going upstairs, weight carriage, etc.. The role functioning and life activity scales showed the highest values (50.96+19.04 and 51.44+26.51 scores, respectively. The mean value of the physical component scale was 46.42+28.26 scores. That of the psychological component scale was 49.56+19.55 scores. Conclusion. The patients with proximal femoral fractures were found to have lower scores on all SF-36 dimensions.

  17. Avascular necrosis of the femoral head and M. R. I

    Energy Technology Data Exchange (ETDEWEB)

    Gires, F.; Leroy-Willig, A; Chevrot, A.; Wolff, J.L. and others

    Normal and pathologic femoral heads have been studied by MRI at 1.5 Tesla. The study was centered upon avascular necrosis (53 lesions). Twenty normal subjects and three patients with algodystrophy were examined. The osteonecrosis patterns were established from known lesions. A low signal rim surrounds an upper polar zone of conserved (Type I) or decreased (Type II) signal. The lesions age correlates significatively with their type: amongst type I lesions, 6 are asymptomatic and the 21 others have a mean age of 5.5 months; Type II lesions have a mean age of 12.7 months. Fourteen lesions were not seen on plain radiographs and six were not detected by bone scan. The older lesions with femoral head deformation are better depicted by standard radiologic techniques. Conservely MRI is the most efficient examination for recent avascular necrosis lesions.

  18. Intramedullary nailing of the femoral shaft: a prospective, randomized study.

    Science.gov (United States)

    Cameron, C D; Meek, R N; Blachut, P A; O'Brien, P J; Pate, G C

    2014-08-01

    We conducted a prospective, randomized study on 84 consecutive patients with 88 acute, traumatic femoral shaft fractures using 32 Grosse-Kempf nails, 29 Russell-Taylor nails, and 27 Synthes nails. Although total operative times and proximal and distal locking times were similar for the three groups, the procedure was faster with the Grosse-Kempf nail. Three proximal fractures could not be locked with the Synthes nail. At first follow-up, we found no significant difference in terms of pain, limp, range of motion, or time to union; however, we removed fewer Synthes nails to resolve patient complaints of pain. Three delayed unions were attributed to fracture distraction. We conclude that all three nails are suitable for the treatment of almost all femoral shaft fractures. A careful analysis of intraoperative technique and instrumentation indicates that all three nails can be used safely and easily once experience is gained. Clinical outcome is similar regardless of the nail chosen.

  19. Confronting hip resurfacing and big femoral head replacement gait analysis

    Directory of Open Access Journals (Sweden)

    Panagiotis K. Karampinas

    2014-03-01

    Full Text Available Improved hip kinematics and bone preservation have been reported after resurfacing total hip replacement (THRS. On the other hand, hip kinematics with standard total hip replacement (THR is optimized with large diameter femoral heads (BFH-THR. The purpose of this study is to evaluate the functional outcomes of THRS and BFH-THR and correlate these results to bone preservation or the large femoral heads. Thirty-one patients were included in the study. Gait speed, postural balance, proprioception and overall performance. Our results demonstrated a non-statistically significant improvement in gait, postural balance and proprioception in the THRS confronting to BFH-THR group. THRS provide identical outcomes to traditional BFH-THR. The THRS choice as bone preserving procedure in younger patients is still to be evaluated.

  20. Endarterectomized superficial femoral artery as an arterial patch.

    Science.gov (United States)

    Rollins, D L; Towne, J B; Bernhard, V M; Baum, P L

    1985-03-01

    Eighty-six patients underwent 90 profundaplasties for lower extremity ischemia using endarterectomized superficial femoral artery (ESFA) or vein as an arterial patch. Standard length profundaplasty was performed in 60 limbs and extended profundaplasty in 28. Seventy-two were performed for limb salvage and 18 for severe claudication. Fifty-four limbs underwent inflow reconstruction and profundaplasty, while 36 others had profundaplasty alone. Three-year cumulative patency rates were employed to compare the type of autogenous patch material to the profundaplasty length, operative indications, and procedures. In all groups, ESFA performed as well as vein. Endarterectomized superficial femoral artery patch angioplasty provides comparable long-term results to vein patch in patients undergoing profundaplasty, and demonstrates its durability as a vascular patch in situations where autogenous tissue is required or preferred while preserving the saphenous vein for later use.