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Sample records for cemented metal-on-metal hip

  1. A randomised controlled trial of cemented and cementless femoral components for metal-on-metal hip resurfacing: a bone mineral density study.

    Science.gov (United States)

    Tice, A; Kim, P; Dinh, L; Ryu, J J; Beaulé, P E

    2015-12-01

    The primary purpose of this study of metal-on-metal (MoM) hip resurfacing was to compare the effect of using a cementless or cemented femoral component on the subsequent bone mineral density (BMD) of the femoral neck. This was a single-centre, prospective, double-blinded control trial which randomised 120 patients (105 men and 15 women) with a mean age of 49.4 years (21 to 68) to receive either a cemented or cementless femoral component. Follow-up was to two years. Outcome measures included total and six-point region-of-interest BMD of the femoral neck, radiological measurements of acetabular inclination, neck-shaft and stem-shaft angles, and functional outcome scores including the Harris hip score, the Western Ontario and McMaster Universities Osteoarthritis Index and the University of California at Los Angeles activity scale. In total, 17 patients were lost to follow-up leaving 103 patients at two years. There were no revisions in the cementless group and three revisions (5%) in the cemented group (two because of hip pain and one for pseudotumour). The total BMD was significantly higher in the cementless group at six months (p < 0.001) and one year (p = 0.01) than in the cemented group, although there was a loss of statistical significance in the difference at two years (p = 0.155). All patient outcomes improved significantly: there were no significant differences between the two groups. The results show better preservation of femoral neck BMD with a cementless femoral component after two years of follow-up. Further investigation is needed to establish whether this translates into improved survivorship.

  2. Metal-on-metal hip joint tribology.

    Science.gov (United States)

    Dowson, D; Jin, Z M

    2006-02-01

    The basic tribological features of metal-on-metal total hip replacements have been reviewed to facilitate an understanding of the engineering science underpinning the renaissance of these hard-on-hard joints. Metal-on-polymer hip replacements operate in the boundary lubrication regime, thus leading to the design guidance to reduce the femoral head diameter as much as is feasible to minimize frictional torque and volumetric wear. This explains why the gold-standard implant of this form from the past half-century had a diameter of only 22.225 mm (7/8 in). Metal-on-metal implants can operate in the mild mixed lubrication regime in which much of the applied load is supported by elastohydrodynamic films. Correct tribological design leads to remarkably low steady state wear rates. Promotion of the most effective elastohydrodynamic films calls for the largest possible head diameters and the smallest clearances that can reasonably be adopted, consistent with fine surface finishes, good sphericity and minimal structural elastic deformation of the cup on its foundations. This guidance, which is opposite in form to that developed for metal-on-polymer joints, is equally valid for solid (monolithic) metallic heads on metallic femoral stems and surface replacement femoral shells. Laboratory measurements of friction and wear in metal-on-metal joints have confirmed their potential to achieve a very mild form of mixed lubrication. The key lies in the generation of effective elastohydrodynamic lubricating films of adequate thickness compared with the composite roughness of the head and cup. The calculation of the film thickness is by no means easy, but the full procedure is outlined and the use of an empirical formula that displays good agreement with calculations based upon the full numerical solutions is explained. The representation of the lambda ratio, lambda, embracing both film thickness and composite roughness, is described.

  3. Groin pain after metal-on-metal hip resurfacing prosthesis

    Directory of Open Access Journals (Sweden)

    Daniel Hernández-Vaquero

    2014-08-01

    Full Text Available Total hip replacement continues to be a widely successful operation, but persistent groin pain following a metal-on-metal hip resurfacing remains a problem for some patients. The concern regarding the safety and efficacy of metal-on-metal total hip replacements has been rising. We present the case of a 47-year-old man with groin pain after metal-on-metal hip resurfacing. We observed high metal ion levels detected in blood analytical studies and a pseudotumor in magnetic resonance imaging. Our patient was treated with a revision surgery. The progressive elevation of blood and urine metal levels in the presence of periarticular cysts and/or groin pain is a complication of metal-on-metal hip arthroplasty and needs revision surgery.

  4. No Superiority of Cemented Metal-on-Metal vs Metal-on-Polyethylene THA at 5-Year Follow-up

    NARCIS (Netherlands)

    Zijlstra, Wierd P.; Cheung, John; Sietsma, Maurits S.; van Raay, Jos J. A. M.; Deutman, Robert

    2009-01-01

    A randomized controlled trial was performed to compare the cemented Stanmore metal-on-metal (Biomet, Warsaw, Indiana) total hip arthroplasty (THA; 102 hips) to the cemented Stanmore metal-on-polyethylene (Biomet) THA (98 hips). The primary outcome was clinical performance. Radiological performance,

  5. The tribology of metal-on-metal total hip replacements.

    Science.gov (United States)

    Scholes, S C; Unsworth, A

    2006-02-01

    Total hip surgery is an effective way of alleviating the pain and discomfort caused by diseased or damaged joints. However, in the majority of cases, these joints have a finite life. The main reason for failure is osteolysis (bone resorption). It is well documented that an important cause of osteolysis, and therefore the subsequent loosening and failure of conventional metal- or ceramic-on-ultra-high molecular weight polyethylene joints, is the body's immunological response to the polyethylene wear particles. To avoid this, interest has been renewed in metal-on-metal joints. The intention of this paper is to review the studies that have taken place within different laboratories to determine the tribological performance of new-generation metal-on-metal total hip replacements. These types of joint offer a potential solution to enhance the longevity of prosthetic hip systems; however, problems may arise owing to the effects of metal ion release, which are, as yet, not fully understood.

  6. Metal-on-metal hip resurfacings. A radiological perspective

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Zhongbo [University of Oxford, Medical School, Oxford (United Kingdom); Pandit, Hemant; Taylor, Adrian; Gill, Harinderjit; Murray, David [University of Oxford, Nuffield Department of Orthopaedic Surgery, Oxford (United Kingdom); Ostlere, Simon [Nuffield Orthopaedic Centre, Department of Radiology, Oxford (United Kingdom)

    2011-03-15

    It is important to be aware of the various complications related to resurfacing arthroplasty of the hip (RSA) and the spectrum of findings that may be encountered on imaging. The bone conserving metal-on-metal (MOM) hip resurfacing has become increasingly popular over the last ten years, especially in young and active patients. Initial reports have been encouraging, but long-term outcome is still unknown. Early post operative complications are rare and have been well documented in the literature. Medium and long term complications are less well understood. A rare but important problem seen at this stage is the appearance of a cystic or solid periarticular reactive mass, which occurs predominately in women and usually affects both hips when seen in patients with bilateral RSAs. The following imaging findings are illustrated and their significance discussed; Uncomplicated hip resurfacing arthroplasty, radiolucency around the femoral peg, femoral neck fracture, loosening and infection, suboptimal component position, femoral notching, dislocation, heterotopic ossification, femoral neck thinning and reactive masses. The radiologist should be aware of the normal radiographic appearances and the variety of complications that may occur following RSA and should recommend ultrasound or MRI in patients with an unexplained symptomatic hip and normal radiographs. (orig.)

  7. High Re-Operation Rates Using Conserve Metal-On-Metal Total Hip Articulations

    DEFF Research Database (Denmark)

    Mogensen, S L; Jakobsen, Thomas; Christoffersen, Hardy;

    2016-01-01

    INTRODUCTION: Metal-on-metal hip articulations have been intensely debated after reports of adverse reactions and high failure rates. The aim of this study was to retrospectively evaluate the implant of a metal-on.metal total hip articulation (MOM THA) from a single manufacture in a two...

  8. Inflammatory pseudotumor causing deep vein thrombosis after metal-on-metal hip resurfacing arthroplasty.

    LENUS (Irish Health Repository)

    Memon, Adeel Rasool

    2013-01-01

    Metal-on-metal hip resurfacings have recently been associated with a variety of complications resulting from adverse reaction to metal debris. We report a case of extensive soft tissue necrosis associated with a huge pelvic mass causing extensive deep vein thrombosis of the lower limb secondary to mechanical compression of the iliac vein. This is a rare and unusual cause of deep vein thrombosis after metal-on-metal hip resurfacing arthroplasty.

  9. Metal on metal hip resurfacing versus uncemented custom total hip replacement - early results

    Directory of Open Access Journals (Sweden)

    Muirhead-Allwood Sarah K

    2010-02-01

    Full Text Available Abstract Introduction There is no current consensus on the most appropriate prosthesis for treating symptomatic osteoarthritis (OA of the hip in young, active patients. Modern metal on metal hip resurfacing arthroplasty (HR has gained popularity as it is theoretically more stable, bone conserving and easier to revise than total hip arthroplasty. Early results of metal on metal resurfacing have been encouraging. We have compared two well matched cohorts of patients with regard to function, pain relief and patient satisfaction. Methods This prospective study compares 2 cohorts of young, active patients treated with hip resurfacing (137 patients, 141 hips and custom uncemented (CADCAM stems (134 patients, 141 hips. All procedures were performed by a single surgeon. Outcome measures included Oxford, WOMAC and Harris hip scores as well as an activity score. Statistical analysis was performed using the unpaired student's t-test. Results One hundred and thirty four and 137 patients were included in the hip replacement and resurfacing groups respectively. The mean age of these patients was 54.6 years. The mean duration of follow up for the hip resurfacing group was 19.2 months compared to 13.4 months for the total hip replacement group. Pre operative oxford, Harris and WOMAC scores in the THA group were 41.1, 46.4 and 50.9 respectively while the post operative scores were 14.8, 95.8 and 5.0. In the HR group, pre- operative scores were 37.0, 54.1 and 45.9 respectively compared to 15.0, 96.8 and 6.1 post operatively. The degree of improvement was similar in both groups. Conclusion There was no significant clinical difference between the patients treated with hip resurfacing and total hip arthroplasty in the short term.

  10. Retrieval analysis of 240 metal-on-metal hip components, comparing modular total hip replacement with hip resurfacing.

    Science.gov (United States)

    Matthies, A; Underwood, R; Cann, P; Ilo, K; Nawaz, Z; Skinner, J; Hart, A J

    2011-03-01

    This study compared component wear rates and pre-revision blood metal ions levels in two groups of failed metal-on-metal hip arthroplasties: hip resurfacing and modular total hip replacement (THR). There was no significant difference in the median rate of linear wear between the groups for both acetabular (p = 0.4633) and femoral (p = 0.0872) components. There was also no significant difference in the median linear wear rates when failed hip resurfacing and modular THR hips of the same type (ASR and Birmingham hip resurfacing (BHR)) were compared. Unlike other studies of well-functioning hips, there was no significant difference in pre-revision blood metal ion levels between hip resurfacing and modular THR. Edge loading was common in both groups, but more common in the resurfacing group (67%) than in the modular group (57%). However, this was not significant (p = 0.3479). We attribute this difference to retention of the neck in resurfacing of the hip, leading to impingement-type edge loading. This was supported by visual evidence of impingement on the femur. These findings show that failed metal-on-metal hip resurfacing and modular THRs have similar component wear rates and are both associated with raised pre-revision blood levels of metal ions.

  11. Asymptomatic pseudotumours after metal-on-metal hip resurfacing show little change within one year

    NARCIS (Netherlands)

    van der Weegen, W.; Brakel, K.; Horn, R. J.; Hoekstra, H. J.; Sijbesma, T.; Pilot, P.; Nelissen, R. G. H. H.

    2013-01-01

    The aim of this study was to establish the natural course of unrevised asymptomatic pseudotumours after metal-on-metal (MoM) hip resurfacing during a six- to 12-month follow-up period. We used repeated metal artefact reduction sequence (MARS)-magnetic resonance imaging (MRI), serum metal ion analysi

  12. Metal-on-metal hip arthroplasty : local tissue reactions and clinical outcome

    NARCIS (Netherlands)

    Weegen, Walter van der

    2014-01-01

    Hip replacements using a metal-on-metal (MoM) bearing surface were reintroduced with the promise of low wear rates and easy revision in case of the resurfacing design. Although initially mid-term results were promising, local adverse soft tissure reactions to metal debris were detected around the ye

  13. The effect of the metal-on-metal hip controversy on internet search activity.

    LENUS (Irish Health Repository)

    Phelan, Nigel

    2014-01-04

    The recall of the articular surface replacement (ASR) hip prosthesis in 2010 represents one of the most controversial areas in orthopaedic surgery in recent years. The aim of this study was to compare the impact of the metal-on-metal hip controversy on Internet search activity in four different regions and determine whether the number of related news reports affected Internet search activity. The Google Trends, Keywords and News applications were used to record the number of news articles and Internet search activity for the terms "hip recall", "metal-on-metal hip" and "ASR hip" from October 2009 to October 2012 in the USA, the UK, Australia and Ireland. There was a large increase in search activity following the official recall in August 2010 in all countries. There was significantly greater search activity after the recall in Ireland compared with the UK for the search term "hip recall" (P = 0.004). For the term "metal-on-metal hip", the UK had significantly more search activity (P = 0.0009). There was a positive correlation between the number of news stories in UK and Ireland with Internet search activity but not in the USA or Australia. Differences between countries affected by the same recall highlight the complex effects of the media on public awareness. The data demonstrates a window of opportunity prior to the official recall for the development of an awareness campaign to provide patients with accurate information.

  14. MRI of early symptomatic metal-on-metal total hip arthroplasty: a retrospective review of radiological findings in 20 hips

    Energy Technology Data Exchange (ETDEWEB)

    Toms, A.P. [Department of Radiology, Norfolk and Norwich University Hospital, Norwich, Norfolk (United Kingdom)], E-mail: andoni.toms@nnuh.nhs.uk; Marshall, T.J.; Cahir, J. [Department of Radiology, Norfolk and Norwich University Hospital, Norwich, Norfolk (United Kingdom); Darrah, C.; Nolan, J. [Department of Orthopaedics, Norfolk and Norwich University Hospital, Norwich, Norfolk (United Kingdom); Donell, S.T. [Institute of Health, University of East Anglia, Norwich, Norfolk (United Kingdom); Barker, T. [Department of Pathology, Norfolk and Norwich University Hospital, Norwich, Norfolk (United Kingdom); Tucker, J.K. [Department of Orthopaedics, Norfolk and Norwich University Hospital, Norwich, Norfolk (United Kingdom)

    2008-01-15

    Aim: To perform a retrospective review of all the conventional radiographic and magnetic resonance imaging (MRI) studies performed in patients with early postoperative pain following cobalt-chrome metal-on-metal total hip arthroplasty. Methods: A retrospective review of the radiology, surgical findings and histology in nineteen patients who had undergone a total of 20 hip arthroplasties using a cobalt-chromium on cobalt-chromium alloy prosthesis was undertaken. Results: Measures of implant placement on the immediate postoperative radiographs were all within the normal ranges (n = 20). Where more than one postoperative radiograph was available statistical analysis revealed no evidence of progressive change before the MRI examination (14). The median postoperative time to MRI was 35 months (range 11-63 months). Abnormalities were demonstrated using MRI in all symptomatic hips (n = 20). These comprised: periprosthetic fluid collections (20), which were isointense to muscle on T1-weighted images in 19 cases and hyperintense on T2-weighted images in 18 cases, periprosthetic bone marrow oedema (n = 6), muscle oedema (n = 4), avulsion of the gluteus minimus and medius tendons (n = 5), atrophy of piriformis (n = 15) and obturator internus (n = 17), and fracture of the medial calcar (n = 1). Operative findings in patients who had undergone revision surgery (n = 15) included: fluid-filled cavities (n = 11), soft tissue necrosis (n = 8), gluteal tendon avulsion (n = 5), proximal femoral diaphyseal necrosis (n = 4), and pitting and corrosion of the femoral stems (n = 8), which were, in all cases, firmly fixed to the cement mantle. Histology revealed viable tissue in six hips with necrosis (n = 12) and fibrin deposition (n = 15) being the predominate findings. Other findings included a perivascular lymphocytic infiltrate (n = 5), features of active inflammation (n = 4), and metallosis (n = 1). Conclusion: A significant number of patients with metal-on-metal hip replacements

  15. Revision of Failed Hip Resurfacing and Large Metal-on-Metal Total Hip Arthroplasty Using Dual-Mobility Components.

    Science.gov (United States)

    Snir, Nimrod; Park, Brian K; Garofolo, Garret; Marwin, Scott E

    2015-06-01

    Revision of metal-on-metal (MoM) total hip arthroplasty (THA) or hip resurfacing is associated with high complication rates. The authors propose dual-mobility components as a surgical option and present short- to mid-term results of MoM hips revised with dual-mobility components. Eighteen consecutive hips that underwent revision of MoM THA or hip resurfacing using dual-mobility components were identified. At final follow-up (mean, 17.5 months), the visual analog scale, modified Harris Hip Score, and SF-12 scores had all improved (Phip resurfacing using a dual-mobility device is an effective strategy.

  16. Lubrication and friction prediction in metal-on-metal hip implants

    Energy Technology Data Exchange (ETDEWEB)

    Wang, F C; Brockett, C; Williams, S; Udofia, I; Fisher, J; Jin, Z M [Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT (United Kingdom)], E-mail: f.c.wang@bath.ac.uk

    2008-03-07

    A general methodology of mixed lubrication analysis and friction prediction for a conforming spherical bearing in hip implants was developed, with particular reference to a typical metal-on-metal hip replacement. Experimental measurement of frictional torque for a similar implant was carried out to validate the theoretical prediction. A ball-in-socket configuration was adopted to represent the articulation between the femoral head and the acetabular cup under cyclic operating conditions of representative load and motion. The mixed lubrication model presented in this study was first applied to identify the contact characteristics on the bearing surfaces, consisting of both fluid-film and boundary lubricated regions. The boundary lubricated contact was assumed to occur when the predicted fluid film thickness was less than a typical boundary protein layer absorbed on the bearing surfaces. Subsequently, the friction was predicted from the fluid-film lubricated region with viscous shearing due to both Couette and Poiseuille flows and the boundary protein layer contact region with a constant coefficient of friction. The predicted frictional torque of the typical metal-on-metal hip joint implant was compared with the experimental measurement conducted in a functional hip simulator and a reasonably good agreement was found. The mixed lubrication regime was found to be dominant for the conditions considered. Although the percentage of the boundary lubricated region was quite small, the corresponding contribution to friction was quite large and the resultant friction factor was quite high.

  17. Lubrication and friction prediction in metal-on-metal hip implants.

    Science.gov (United States)

    Wang, F C; Brockett, C; Williams, S; Udofia, I; Fisher, J; Jin, Z M

    2008-03-07

    A general methodology of mixed lubrication analysis and friction prediction for a conforming spherical bearing in hip implants was developed, with particular reference to a typical metal-on-metal hip replacement. Experimental measurement of frictional torque for a similar implant was carried out to validate the theoretical prediction. A ball-in-socket configuration was adopted to represent the articulation between the femoral head and the acetabular cup under cyclic operating conditions of representative load and motion. The mixed lubrication model presented in this study was first applied to identify the contact characteristics on the bearing surfaces, consisting of both fluid-film and boundary lubricated regions. The boundary lubricated contact was assumed to occur when the predicted fluid film thickness was less than a typical boundary protein layer absorbed on the bearing surfaces. Subsequently, the friction was predicted from the fluid-film lubricated region with viscous shearing due to both Couette and Poiseuille flows and the boundary protein layer contact region with a constant coefficient of friction. The predicted frictional torque of the typical metal-on-metal hip joint implant was compared with the experimental measurement conducted in a functional hip simulator and a reasonably good agreement was found. The mixed lubrication regime was found to be dominant for the conditions considered. Although the percentage of the boundary lubricated region was quite small, the corresponding contribution to friction was quite large and the resultant friction factor was quite high.

  18. Metal-on-Metal Hip Arthroplasty: A Review of Adverse Reactions and Patient Management

    Directory of Open Access Journals (Sweden)

    James Drummond

    2015-06-01

    Full Text Available Recent alarming joint registry data highlighting increased revision rates has prompted further research into the area of metal-on-metal hip replacements and resurfacings. This review article examines the latest literature on the topic of adverse reactions to metal debris and summarises the most up-to-date guidelines on patient management. Adverse reactions to metal debris can cause significant damage to soft tissue and bone if not diagnosed early. Furthermore, not every patient with an adverse reaction to metal debris will be symptomatic. As such, clinicians must remain vigilant when assessing and investigating these patients in order to detect failing implants and initiate appropriate management.

  19. Edge loading in metal-on-metal hips: low clearance is a new risk factor

    Science.gov (United States)

    Zografos, Angelos; Sayles, Ritchie S; Hart, Alister; Cann, Philippa

    2012-01-01

    The revision rate of large head metal-on-metal and resurfacing hips are significantly higher than conventional total hip replacements. The revision of these components has been linked to high wear caused by edge loading; which occurs when the head–cup contact patch extends over the cup rim. There are two current explanations for this; first, there is loss of entrainment of synovial fluid resulting in breakdown of the lubricating film and second, edge loading results in a large local increase in contact pressure and consequent film thickness reduction at the cup rim, which causes an increase in wear. This paper develops a method to calculate the distance between the joint reaction force vector and the cup rim – the contact patch centre to rim (CPCR) distance. However, the critical distance for the risk of edge loading is the distance from the contact patch edge to rim (CPER) distance. An analysis of explanted hip components, divided into edge worn and non-edge-worn components showed that there was no statistical difference in CPCR values, but the CPER value was significantly lower for edge worn hips. Low clearance hips, which have a more conformal contact, have a larger diameter contact patch and thus are more at risk of edge loading for similarly positioned hips. PMID:22558836

  20. Corrosion on the acetabular liner taper from retrieved modular metal-on-metal total hip replacements.

    Science.gov (United States)

    Gascoyne, Trevor C; Dyrkacz, Richard M; Turgeon, Thomas R; Burnell, Colin D; Wyss, Urs P; Brandt, Jan-M

    2014-10-01

    Eight retrieved metal-on-metal total hip replacements displayed corrosion damage along the cobalt-chromium alloy liner taper junction with the Ti alloy acetabular shell. Scanning electron microscopy indicated the primary mechanism of corrosion to be grain boundary and associated crevice corrosion, which was likely accelerated through mechanical micromotion and galvanic corrosion resulting from dissimilar alloys. Coordinate measurements revealed up to 4.3mm(3) of the cobalt-chromium alloy taper surface was removed due to corrosion, which is comparable to previous reports of corrosion damage on head-neck tapers. The acetabular liner-shell taper appears to be an additional source of metal corrosion products in modular total hip replacements. Patients with these prostheses should be closely monitored for signs of adverse reaction towards corrosion by-products.

  1. Balancing innovation and medical device regulation: the case of modern metal-on-metal hip replacements

    Directory of Open Access Journals (Sweden)

    Howard JJ

    2016-08-01

    Full Text Available Jason J Howard1,2 1Division of Orthopedic Surgery, Department of Surgery, Sidra Medical and Research Center, 2Department of Orthopedic Surgery, Weill Cornell Medical College, Doha, Qatar Abstract: Due to problems with wear particle generation and subsequent loosening using conventional metal-on-polyethylene total hip replacements, there has been a shift toward alternative bearing systems, including metal-on-metal (MoM, for younger, more active patients with degenerative joint disease. Based on positive results from early short-term clinical studies, MoM hip replacements were readily adopted by orthopedic surgeons with thousands being implanted worldwide over the past decade. Unacceptably high revision rates reported by two national joint registries called into question the rigorousness of the regulatory approval process for these implants, particularly with respect to premarket data requirements to prove safety, effectiveness, and the appropriateness of the regulatory pathway chosen. The purpose of this review was to investigate the balance between facilitating the introduction of new medical technologies and the need to ensure safety and effectiveness through comprehensive regulatory assessment. The case of MoM hip replacement devices was used to frame the investigation and subsequent discussions. The regulatory approval processes and post-market surveillance requirements associated with three common MoM hip replacements (two resurfacings: the Birmingham and articular surface replacement and the articular surface replacement XL total hip replacement were investigated. With respect to modern MoM hip replacement devices, the balance between facilitating the introduction of these new medical technologies and the need to ensure safety and effectiveness through comprehensive regulatory assessment was not achieved. The lessons learned from these experiences have application beyond joint replacements to the introduction of new medical technologies in

  2. Asymptomatic pseudotumours after metal-on-metal hip resurfacing show little change within one year.

    Science.gov (United States)

    van der Weegen, W; Brakel, K; Horn, R J; Hoekstra, H J; Sijbesma, T; Pilot, P; Nelissen, R G H H

    2013-12-01

    The aim of this study was to establish the natural course of unrevised asymptomatic pseudotumours after metal-on-metal (MoM) hip resurfacing during a six- to 12-month follow-up period. We used repeated metal artefact reduction sequence (MARS)-magnetic resonance imaging (MRI), serum metal ion analysis and clinical examination to study 14 unrevised hips (mean patient age 52.7 years, 46 to 68, 5 female, 7 male) with a pseudotumour and 23 hips (mean patient age 52.8 years, 38 to 69, 7 female, 16 male) without a pseudotumour. The mean post-operative time to the first MARS-MRI scan was 4.3 years (2.2 to 8.3), and mean time between the first and second MARS-MRI scan was eight months (6 to 12). At the second MRI scan, the grade of severity of the pseudotumour had not changed in 35 hips. One new pseudotumour (Anderson C2 score, moderate) was observed, and one pseudotumour was downgraded from C2 (moderate) to C1 (mild). In general, the characteristics of the pseudotumours hardly changed. Repeated MARS-MRI scans within one year in patients with asymptomatic pseudotumours after MoM hip resurfacing showed little or no variation. In 23 patients without pseudotumour, one new asymptomatic pseudotumour was detected. This is the first longitudinal study on the natural history of pseudotumours using MARS-MRI scans in hip resurfacing, and mirrors recent results for 28 mm diameter MoM total hip replacement.

  3. Chromium and cobalt ion concentrations in blood and serum following various types of metal-on-metal hip arthroplasties

    DEFF Research Database (Denmark)

    Jantzen, Christopher; Jørgensen, Henrik L; Duus, Benn R

    2013-01-01

    Widely different metal ion concentrations in blood and serum have been reported with metal-on-metal (MoM) implants. We reviewed the literature on blood and serum ion concentrations of chromium (Cr) and cobalt (Co) following various MoM hip arthroplasties.......Widely different metal ion concentrations in blood and serum have been reported with metal-on-metal (MoM) implants. We reviewed the literature on blood and serum ion concentrations of chromium (Cr) and cobalt (Co) following various MoM hip arthroplasties....

  4. Explant analysis of the Biomet Magnum/ReCap metal-on-metal hip joint

    Science.gov (United States)

    Hunt, B. J.; Richardson, V. M.; Langton, D. J.; Smith, E.; Joyce, T. J.

    2017-01-01

    Objectives The high revision rates of the DePuy Articular Surface Replacement (ASR) and the DePuy ASR XL (the total hip arthroplasty (THA) version) have led to questions over the viability of metal-on-metal (MoM) hip joints. Some designs of MoM hip joint do, however, have reasonable mid-term performance when implanted in appropriate patients. Investigations into the reasons for implant failure are important to offer help with the choice of implants and direction for future implant designs. One way to assess the performance of explanted hip prostheses is to measure the wear (in terms of material loss) on the joint surfaces. Methods In this study, a coordinate measuring machine (CMM) was used to measure the wear on five failed cementless Biomet Magnum/ReCap/ Taperloc large head MoM THAs, along with one Biomet ReCap resurfacing joint. Surface roughness measurements were also taken. The reason for revision of these implants was pain and/or adverse reaction to metal debris (ARMD) and/or elevated blood metal ion levels. Results The mean wear rate of the articulating surfaces of the heads and acetabular components of all six joints tested was found to be 6.1 mm3/year (4.1 to 7.6). The mean wear rate of the femoral head tapers of the five THAs was 0.054 mm3/year (0.021 to 0.128) with a mean maximum wear depth of 5.7 µm (4.3 to 8.5). Conclusion Although the taper wear was relatively low, the wear from the articulating surfaces was sufficient to provide concern and was potentially large enough to have been the cause of failure of these joints. The authors believe that patients implanted with the ReCap system, whether the resurfacing prosthesis or the THA, should be closely monitored. Cite this article: S. C. Scholes, B. J. Hunt, V. M. Richardson, D. J. Langton, E. Smith, T. J. Joyce. Explant analysis of the Biomet Magnum/ReCap metal-on-metal hip joint. Bone Joint Res 2017;6:113–122. DOI: 10.1302/2046-3758.62.BJR-2016-0130.R2. PMID:28246095

  5. Balancing innovation and medical device regulation: the case of modern metal-on-metal hip replacements

    Science.gov (United States)

    Howard, Jason J

    2016-01-01

    Due to problems with wear particle generation and subsequent loosening using conventional metal-on-polyethylene total hip replacements, there has been a shift toward alternative bearing systems, including metal-on-metal (MoM), for younger, more active patients with degenerative joint disease. Based on positive results from early short-term clinical studies, MoM hip replacements were readily adopted by orthopedic surgeons with thousands being implanted worldwide over the past decade. Unacceptably high revision rates reported by two national joint registries called into question the rigorousness of the regulatory approval process for these implants, particularly with respect to premarket data requirements to prove safety, effectiveness, and the appropriateness of the regulatory pathway chosen. The purpose of this review was to investigate the balance between facilitating the introduction of new medical technologies and the need to ensure safety and effectiveness through comprehensive regulatory assessment. The case of MoM hip replacement devices was used to frame the investigation and subsequent discussions. The regulatory approval processes and post-market surveillance requirements associated with three common MoM hip replacements (two resurfacings: the Birmingham and articular surface replacement and the articular surface replacement XL total hip replacement) were investigated. With respect to modern MoM hip replacement devices, the balance between facilitating the introduction of these new medical technologies and the need to ensure safety and effectiveness through comprehensive regulatory assessment was not achieved. The lessons learned from these experiences have application beyond joint replacements to the introduction of new medical technologies in general, particularly for those who have a significant potential for harm. In this regard, a series of recommendations have been developed to contribute to the evolution of the medical device regulatory process

  6. Cost-utility of metal-on-metal hip resurfacing compared to conventional total hip replacement in young active patients with osteoarthritis

    NARCIS (Netherlands)

    Heintzbergen, S.; Kulin, N.A.; IJzerman, M.J.; Steuten, L.M.G.; Werle, J.; Khong, H.; Marshall, D.A.

    2013-01-01

    Background: Metal-on-metal hip resurfacing arthroplasty (MoM HRA) has emerged as an alternative to total hip arthroplasty (THA) for younger active patients with osteoarthritis (OA). Birmingham hip resurfacing is the most common MoM HRA in Alberta, and is therefore compared with conventional THA. Obj

  7. Large head metal-on-metal cementless total hip arthroplasty versus 28mm metal-on-polyethylene cementless total hip arthroplasty : design of a randomized controlled trial

    NARCIS (Netherlands)

    Zijlstra, Wierd P.; Bos, Nanne; van Raaij, Jos J. A. M.

    2008-01-01

    Background: Osteoarthritis of the hip is successfully treated by total hip arthroplasty with metal-on-polyethylene articulation. Polyethylene wear debris can however lead to osteolysis, aseptic loosening and failure of the implant. Large head metal-on-metal total hip arthroplasty may overcome polyet

  8. Metal-on-metal bearings in total hip arthroplasties : Influence of cobalt chromium ions on bacterial growth and biofilm formation

    NARCIS (Netherlands)

    Hosman, Anton H.; van der Mei, Henny C.; Bulstra, Sjoerd K.; Busscher, Henk J.; Neut, Danielle

    2009-01-01

    Metal-on-metal (MOM) bearings involving cobalt-chromium (Co-Cr) alloys in total hip arthroplasties are becoming more and more popular due to their low wear. Consequences of corrosion products of Co-Cr alloys are for the most part unclear, and the influence of cobalt and chromium ions on biofilm form

  9. The Inflammatory Phenotype in Failed Metal-On-Metal Hip Arthroplasty Correlates with Blood Metal Concentrations.

    Directory of Open Access Journals (Sweden)

    Erja-Leena Paukkeri

    Full Text Available Hip arthroplasty is the standard treatment of a painful hip destruction. The use of modern metal-on-metal (MOM bearing surfaces gained popularity in total hip arthroplasties during the last decade. Recently, worrisome failures due to adverse reaction to metal debris (ARMD, including pseudotumor response, have been widely reported. However, the pathogenesis of this reaction remains poorly understood. The aim of the present study was to investigate the ARMD response by flow cytometry approach.Sixteen patients with a failed Articular Surface Replacement (ASR hip prosthesis were included in the study. Samples of pseudotumor tissues collected during revision surgery were degraded by enzyme digestion and cells were typed by flow cytometry. Whole blood chromium and cobalt concentrations were analyzed with mass spectrometry before revision surgery.Flow cytometry analysis showed that the peri-implant pseudotumor tissue expressed two principal phenotypes, namely macrophage-dominated and T-lymphocyte-dominated response; the average portions being 54% (macrophages and 25% (T-lymphocytes in macrophage-dominated inflammation and 20% (macrophages and 54% (T-lymphocytes in T-lymphocyte-dominated response. The percentages of B-lymphocytes and granulocytes were lower in both phenotypes. Interestingly, the levels of blood chromium and cobalt were significantly higher in patients with macrophage-dominated response.The results suggest that the adverse tissue reactions induced by MOM wear particles contain heterogeneous pathogeneses and that the metal levels are an important factor in the determination of the inflammatory phenotype. The present results support the hypothesis that higher metal levels cause cytotoxicity and tissue injury and macrophages are recruited to clear the necrotic debris. On the other hand, the adverse response developed in association with lower metal levels is T-lymphocyte-dominated and is likely to reflect hypersensitivity reaction.

  10. The imaging spectrum of peri-articular inflammatory masses following metal-on-metal hip resurfacing

    Energy Technology Data Exchange (ETDEWEB)

    Fang, Christopher S.J.; Ostlere, Simon [Nuffield Orthopaedic Centre, Department of Radiology, Oxford (United Kingdom); Harvie, Paul; Gibbons, Christopher L.M.H.; Whitwell, Duncan [Nuffield Orthopaedic Centre, Department of Orthopaedic Surgery, Oxford (United Kingdom); Athanasou, Nicholas A. [Nuffield Orthopaedic Centre, Department of Pathology, Oxford (United Kingdom)

    2008-08-15

    Resurfacing metal-on-metal hip arthroplasty is increasing in popularity, especially in younger patients. To date, studies indicate that the procedure is associated with a good outcome in the medium-term. Formation of a peri-articuar mass is a rarely reported complication. In this study we analyse the imaging findings in patients with resurfacing implants presenting to our institution with peri-articular masses identified on cross sectional imaging. All patients with documented peri-articular masses following resurfacing arthroplasty were included. The available imaging related to the masses was reviewed and the findings documented along with the patient's demographics. There were 10 patients (13 joints). All patients were female. Patients presented with periprosthetic anterior or posterolateral solid and cystic masses. The anterior masses involved psoas muscle and were predominately solid. The posterolateral masses were predominately cystic. In the three cases with bilateral arthroplasties, masses were detected in both hips. Histology in six cases showed features compatible with a type IV hypersensitivity reaction. The preponderance of females, the bilateral nature of the masses and the histological features suggest that peri-articular masses following resurfacing arthroplasty is due to the metal hypersensitivity. (orig.)

  11. Microfocus study of metal distribution and speciation in tissue extracted from revised metal on metal hip implants

    Energy Technology Data Exchange (ETDEWEB)

    Hart, Alister J [Department of Orthopaedic Surgery, Imperial College and Imperial College Healthcare NHS Trust, Charing Cross Hospital Campus, Fulham Palace Rd, London W6 8RF (United Kingdom); Sandison, Ann [Department of Histopathology, Imperial College and Imperial College Healthcare NHS Trust, Charing Cross Hospital Campus, Fulham Palace Rd, London W6 8RF (United Kingdom); Quinn, Paul; Mosselmans, J Frederick W [Science Division, Diamond Light Source, Harwell Science and Innovation Campus, Didcot, Oxon, OX11 0DE (United Kingdom); Sampson, Barry [Department of Clinical Biochemistry, Imperial College and Imperial College Healthcare NHS Trust, Charing Cross Hospital Campus, Fulham Palace Rd, London W6 8RF (United Kingdom); Atkinson, Kirk D [8 Nuclear Department Defence Academy College of Management and Technology HMS Sultan Military Road Gosport PO12 3BY (United Kingdom); Skinner, John A [Department of Orthopaedics, Royal National Orthopaedic Hospital, HA7 4LP (United Kingdom); Goode, Angela [Dept of Materials, Imperial College London, SW7 2AZ (United Kingdom); Powell, Jonathan J, E-mail: Paul.Quinn@diamond.ac.u [Medical Research Council Human Nutrition Research Centre, Cambridge CB1 9NL (United Kingdom)

    2009-11-15

    Unexplained tissue inflammation in metal-on-metal hip replacements is suspected to be caused by implant-derived nanoparticles. The aim of this study was to investigate the nature of the metal particles in tissue surrounding metal-on-metal (MOM) hips that has been extracted during revision. Mapping of tissue surrounding the failed MOM hips was performed using microfocus X-ray Fluorescence (XRF). This revealed mainly Cr which was localized to the cellular regions. There was co-localisation of Co, were present, to areas of high Cr abundance. XANES of the tissue and appropriate standards revealed that the most common species were Cr(III) and Co(II). EXAFS analysis of the tissue and various metal standards revealed that the most abundant implant-related species was Cr(III) phosphate. Different tissue preparation methods, including frozen sectioning, were examined but were found not to affect the distribution or speciation of the metals in the tissue.

  12. Lessons learnt from metal-on-metal hip arthroplasties will lead to safer innovation for all medical devices.

    Science.gov (United States)

    Hart, Alister J; Sabah, Shiraz A; Henckel, Johann; Lloyd, Gwynneth; Skinner, John A

    2015-01-01

    Metal-on-metal bearings were re-popularised in the late 1990s with the introduction of modern hip resurfacing. Large diameter (LD) metal-on-metal (MoM) hips became more prevalent and have been the least successful group of hip implants ever used. They were rapidly adopted from 2004 until the British Hip Society stopped their use in 2012. Well functioning MoM hip results (including the BHR and Metasul) are hidden in the mire of poor results from the group of all MoM bearings.We have reviewed what happened and we make 3 observations. Firstly, collaboration between surgeons and then between surgeons and other disciplines, first identified and then solved the clinical management problems. Secondly, the problems with MoM hips occurred because hip simulation was inadequate at predicting performance in patients. They gave no indications of the biological effects of wear in the human environment. Lastly, retrieval of failed implants was essential to understanding why failure occurred.These lessons must never be forgotten and must form the basis by which new or altered implants are introduced and how they should be monitored. This will enable safer innovation for patients, surgeons and manufacturers. The problems with MoM hips will not have been in vain.

  13. Few adverse reactions to metal on metal articulation in total hip arthroplasty in a review study on 358 consecutive cases with 1 to 5 years follow-up

    DEFF Research Database (Denmark)

    Stürup, Jens; Dahl, Line; Jensen, Karl Erik;

    2012-01-01

    The aim of the present study was to determine the frequency of adverse reaction to metal on metal total hip arthroplasty using a M2a-38 articulation and a Magnum articulation, (Biomet Warsaw, Indiana).All patients who had received a Metal on Metal bearing prosthesis, in two centres in Copenhagen...

  14. Wear behaviour of cobalt-chromium-molybdenum alloys used in metal-on-metal hip implants

    Science.gov (United States)

    Varano, Rocco

    The influence of carbon (C) content, microstructure, crystallography and mechanical properties on the wear behaviour of metal-on-metal (MM) hip implants made from commercially available cobalt-chromium-molybdenum (CoCrMo) alloys designated as American Society of Testing and Materials (ASTM) grade F1537, F75 and as-cast were studied in this work. The as-received bars of wrought CoCrMo alloys (ASTM F1537 of either about 0.05% or 0.26% C) were each subjected to various heat treatments to develop different microstructures. Pin and plate specimens were fabricated from each bar and were tested against each other using a linear reciprocating pin-on-plate apparatus in 25% by volume bovine serum solution. The applied normal load was 9.81 N and the reciprocating plate had a sinusoidal velocity with an average speed of 26 mm/s. The wear was measured gravimetrically and it was found to be most strongly affected by alloy C content, irrespective of grain size or carbide morphology. More precisely, the wear behaviour was directly correlated to the dissolved C content of the alloys. Increased C in solid-solution coincided with lower volumetric wear since C helps to stabilize the face-centred cubic (FCC) crystal structure thus limiting the amount of strain induced transformation (SIT) to the hexagonal close-packed crystal structure (HCP). Based on the observed surface twinning in and around the contact zone and the potentially detrimental effect of the HCP phase, it was postulated that the MM wear behaviour of CoCrMo alloys in the present study was controlled by a deformation mechanism, rather than corrosion or tribochemical reactions.

  15. Large head metal-on-metal cementless total hip arthroplasty versus 28mm metal-on-polyethylene cementless total hip arthroplasty: design of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    van Raaij Jos JAM

    2008-10-01

    Full Text Available Abstract Background Osteoarthritis of the hip is successfully treated by total hip arthroplasty with metal-on-polyethylene articulation. Polyethylene wear debris can however lead to osteolysis, aseptic loosening and failure of the implant. Large head metal-on-metal total hip arthroplasty may overcome polyethylene wear induced prosthetic failure, but can increase systemic cobalt and chromium ion concentrations. The objective of this study is to compare two cementless total hip arthroplasties: a conventional 28 mm metal-on-polyethylene articulation and a large head metal-on-metal articulation. We hypothesize that the latter arthroplasties show less bone density loss and higher serum metal ion concentrations. We expect equal functional scores, greater range of motion, fewer dislocations, fewer periprosthetic radiolucencies and increased prosthetic survival with the metal-on-metal articulation. Methods A randomized controlled trial will be conducted. Patients to be included suffer from non-inflammatory degenerative joint disease of the hip, are aged between 18 and 80 and are admitted for primary cementless unilateral total hip arthroplasty. Patients in the metal-on-metal group will receive a cementless titanium alloy acetabular component with a cobalt-chromium liner and a cobalt-chromium femoral head varying from 38 to 60 mm. Patients in the metal-on-polyethylene group will receive a cementless titanium alloy acetabular component with a polyethylene liner and a 28 mm cobalt-chromium femoral head. We will assess acetabular bone mineral density by dual energy x-ray absorptiometry (DEXA, serum ion concentrations of cobalt, chromium and titanium, self reported functional status (Oxford hip score, physician reported functional status and range of motion (Harris hip score, number of dislocations and prosthetic survival. Measurements will take place preoperatively, perioperatively, and postoperatively (6 weeks, 1 year, 5 years and 10 years. Discussion

  16. Effect of simplifications of bone and components inclination on the elastohydrodynamic lubrication modeling of metal-on-metal hip resurfacing prosthesis.

    Science.gov (United States)

    Meng, Qingen; Liu, Feng; Fisher, John; Jin, Zhongmin

    2013-05-01

    It is important to study the lubrication mechanism of metal-on-metal hip resurfacing prosthesis in order to understand its overall tribological performance, thereby minimize the wear particles. Previous elastohydrodynamic lubrication studies of metal-on-metal hip resurfacing prosthesis neglected the effects of the orientations of the cup and head. Simplified pelvic and femoral bone models were also adopted for the previous studies. These simplifications may lead to unrealistic predictions. For the first time, an elastohydrodynamic lubrication model was developed and solved for a full metal-on-metal hip resurfacing arthroplasty. The effects of the orientations of components and the realistic bones on the lubrication performance of metal-on-metal hip resurfacing prosthesis were investigated by comparing the full model with simplified models. It was found that the orientation of the head played a very important role in the prediction of pressure distributions and film profiles of the metal-on-metal hip resurfacing prosthesis. The inclination of the hemispherical cup up to 45° had no appreciable effect on the lubrication performance of the metal-on-metal hip resurfacing prosthesis. Moreover, the combined effect of material properties and structures of bones was negligible. Future studies should focus on higher inclination angles, smaller coverage angle and microseparation related to the occurrences of edge loading.

  17. Metal-on-metal hip prostheses and systemic health: a cross-sectional association study 8 years after implantation.

    Directory of Open Access Journals (Sweden)

    Jennifer R Prentice

    Full Text Available There is public concern over the long term systemic health effects of metal released from hip replacement prostheses that use large-diameter metal-on-metal bearings. However, to date there has been no systematic study to determine which organs may be at risk, or the magnitude of any effect. We undertook a detailed cross-sectional health screen at a mean of 8 years after surgery in 35 asymptomatic patients who had previously received a metal-on-metal hip resurfacing (MoMHR versus 35 individually age and sex matched asymptomatic patients who had received a conventional hip replacement. Total body bone mineral density was 5% higher (mean difference 0.05 g/cm², P = 0.02 and bone turnover was 14% lower (TRAP 5b, mean difference -0.56IU/L, P = 0.006; osteocalcin, mean difference -3.08 ng/mL, P = 0.03 in the hip resurfacing versus conventional hip replacement group. Cardiac ejection fraction was 7% lower (mean absolute difference -5%, P = 0.04 and left ventricular end-diastolic diameter was 6% larger (mean difference 2.7 mm, P = 0.007 in the hip resurfacing group versus those patients who received a conventional hip replacement. The urinary fractional excretion of metal was low (cobalt 5%, chromium 1.5% in patients with MoMHR, but creatinine clearance was normal. Diuretic prescription was associated with a 40% increase in the fractional excretion of chromium (mean difference 0.5%, P = 0.03. There was no evidence of difference in neuropsychological, renal tubular, hepatic or endocrine function between groups (P>0.05. Our findings of differences in bone and cardiac function between patient groups suggest that chronic exposure to low elevated metal concentrations in patients with well-functioning MoMHR prostheses may have systemic effects. Long-term epidemiological studies in patients with well-functioning metal on metal hip prostheses should include musculoskeletal and cardiac endpoints to quantitate the risk of clinical disease.

  18. A comparison of leg length and femoral offset discrepancies in hip resurfacing, large head metal-on- metal and conventional total hip replacement: a case series

    Directory of Open Access Journals (Sweden)

    Herman Katie A

    2011-12-01

    Full Text Available Abstract Background A discrepancy in leg length and femoral offset restoration is the leading cause of patient dissatisfaction in hip replacement surgery and has profound implications on patient quality of life. The aim of this study is to compare biomechanical hip reconstruction in hip resurfacing, large-diameter femoral head hip arthroplasty and conventional total hip replacement. Method Sixty patient's post-operative radiographs were reviewed; 20 patients had a hip resurfacing (HR, 20 patients had a Large Head Metal-on-metal (LHM hip replacement and 20 patients had a conventional small head Total Hip Replacement (THR. The leg length and femoral offset of the operated and unoperated hips were measured and compared. Results Hip resurfacing accurately restored hip biomechanics with no statistical difference in leg length (P = 0.07 or femoral offset (P = 0.95 between the operated and non-operative hips. Overall HR was superior for reducing femoral offset discrepancies where it had the smallest bilateral difference (-0.2%, P = 0.9. The traditional total hip replacement was least effective at restoring the hip anatomy. Conclusion The use of a larger-diameter femoral head in hip resurfacing does not fully account for the superior biomechanical restoration, as LHM did not restore femoral offset as accurately. We conclude that restoration of normal hip biomechanics is best achieved with hip resurfacing.

  19. Contact mechanics and elastohydrodynamic lubrication in a novel metal-on-metal hip implant with an aspherical bearing surface.

    Science.gov (United States)

    Meng, Qingen; Gao, Leiming; Liu, Feng; Yang, Peiran; Fisher, John; Jin, Zhongmin

    2010-03-22

    Diameter and diametral clearance of the bearing surfaces of metal-on-metal hip implants and structural supports have been recognised as key factors to reduce the dry contact and hydrodynamic pressures and improve lubrication performance. On the other hand, application of aspherical bearing surfaces can also significantly affect the contact mechanics and lubrication performance by changing the radius of the curvature of a bearing surface and consequently improving the conformity between the head and the cup. In this study, a novel metal-on-metal hip implant employing a specific aspherical bearing surface, Alpharabola, as the acetabular surface was investigated for both contact mechanics and elastohydrodynamic lubrication under steady-state conditions. When compared with conventional spherical bearing surfaces, a more uniform pressure distribution and a thicker lubricant film thickness within the loaded conjunction were predicted for this novel Alpharabola hip implant. The effects of the geometric parameters of this novel acetabular surface on the pressure distribution and lubricant thickness were investigated. A significant increase in the predicted lubricant film thickness and a significant decrease in the dry contact and hydrodynamic pressures were found with appropriate combinations of these geometric parameters, compared with the spherical bearing surface.

  20. The effectiveness of metal on metal hip resurfacing: a systematic review of the available evidence published before 2002

    Directory of Open Access Journals (Sweden)

    McCormack Kirsty

    2004-12-01

    Full Text Available Abstract Background Conventional total hip replacement (THR may be felt to carry too high a risk of failure over a patient's lifetime, especially in young people. There is increasing interest in metal on metal hip resurfacing arthroplasty (MoM as this offers a bone-conserving option for treating those patients who are not considered eligible for THR. We aim to evaluate the effectiveness of MoM for treatment of hip disease, and compare it with alternative treatments for hip disease offered within the UK. Methods A systematic review was carried out to identify the relevant literature on MoM published before 2002. As watchful waiting and total hip replacement are alternative methods commonly used to alleviate the symptoms of degenerative joint disease of the hip, we compared MoM with these. Results The data on the effectiveness of MoM are scarce, as it is a relatively new technique and at present only short-term results are available. Conclusion It is not possible to make any firm conclusions about the effectiveness of MoM based on these early results. While the short-term results are promising, it is unclear if such results would be replicated in more rigorous studies, and what the long-term performance might be. Further research is needed which ideally should involve long-term randomised comparisons of MoM with alternative approaches to the clinical management of hip disease.

  1. Combined Vascular and Orthopaedic Approach for a Pseudotumor Causing Deep Vein Thrombosis after Metal-on-Metal Hip Resurfacing Arthroplasty

    Directory of Open Access Journals (Sweden)

    Hossam Abdel-Hamid

    2015-01-01

    Full Text Available Introduction. Metal-on-metal (MoM hip resurfacings have been associated with a variety of complications resulting from adverse reaction to metal debris. Pseudotumors have rarely been reported to cause deep venous thrombosis (DVT. Study Design. A case report and a review of the literature. Case Presentation. A 75-year-old female who had left metal-on-metal\thip resurfacing 6 years ago presented with left groin pain associated with unilateral lower limb edema and swelling. By duplex and MRI studies, our patient had an extensive soft tissue necrosis associated with a large pelvic mass causing extensive DVT of the lower limb secondary to mechanical compression of the left iliac vein. Results. Our case was initially treated for DVT followed by dual surgical approach. The pseudotumor was excised through a separate iliofemoral approach and revision of the hip implant was undertaken through a posterior approach in the same setting. An inferior vena cava (IVC filter was inserted to minimise the perioperative risks of handling the iliac veins. Conclusion. A combined approach with vascular surgeons is required. Combined resection of the pseudotumor and revision of the metal bearing surfaces is essential, in order to achieve a good surgical outcome in this rare complication.

  2. A MRI classification of periprosthetic soft tissue masses (pseudotumours) associated with metal-on-metal resurfacing hip arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Hauptfleisch, Jennifer; Ostlere, Simon [Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Department of Radiology, Oxford (United Kingdom); Pandit, Hemant; Grammatopoulos, George; Gill, Harinderjit S.; Murray, David W. [Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Oxford (United Kingdom)

    2012-02-15

    Metal-on-metal hip resurfacing arthroplasty (MoMHRA) has become a popular option for young patients requiring hip replacement. A recognised complication is the formation of a symptomatic reactive periprosthetic soft tissue mass (pseudotumour). We present a radiological classification system for these reactive masses, dividing them into three groups: Type I are thin-walled cystic masses (cyst wall <3 mm), Type II are thick-walled cystic masses (cyst wall >3 mm, but less than the diameter of the cystic component) and Type III are predominantly solid masses. We reviewed all MRI performed over a 4-year period in patients with primary MoMHRA referred to our institution. In all cases the masses were assessed on MRI according to size, anatomical position, signal intensity and involvement of bone, muscle or neighbouring neurovascular bundles. Periprosthetic masses were seen in 33 hips in 17 female (7 bilateral) and 8 male patients (1 bilateral). The Type I lesions were the most common and more likely to be posterior to the hip joint. The Type III masses were significantly larger than the cystic lesions and were more likely to be located anterior to the hip joint. To date 22 patients have undergone revision surgery with conversions to total hip replacement. Severity of symptoms and revision rates were lowest in the Type I group and highest in the Type III group. Solid anterior pseudotumours were most likely to have the more severe symptoms and require revision surgery. (orig.)

  3. The chemical form of metallic debris in tissues surrounding metal-on-metal hips with unexplained failure.

    Science.gov (United States)

    Hart, Alister J; Quinn, Paul D; Sampson, Barry; Sandison, Ann; Atkinson, Kirk D; Skinner, John A; Powell, Jonathan J; Mosselmans, J Fred W

    2010-11-01

    Implant-derived material from metal-on-metal (MOM) hip arthroplasties may be responsible for an unexplained tissue inflammatory response. The chemical form of the metal species in the tissues is predominantly chromium (Cr), but the currently used techniques have not been able to determine whether this is Cr(III) phosphate or Cr(III) oxide. The analytical challenge must overcome the fact that the metal in the tissues is at a relatively low concentration and tissue preparation or the microscopy beam used can affect the results. Microfocus X-ray spectroscopy using a synchrotron beam is useful in addressing both these issues. Using this technique we compared tissue from failed MOM hips with: (1) tissue from metal-on-polyethylene (MOP) hips; (2) chemical standards; (3) metal discs cut from MOM hips. The most abundant implant-related species in all MOM hip tissues contained Cr. Comparison with standards revealed the chemical form was Cr(III) phosphate, which did not vary with manufacturer type (four types analysed) or level of blood metal ions. Cobalt (Co) and molybdenum (Mo) were occasionally present in areas of high Cr. Co was normally found in a metallic state in the tissue, while Mo was found in an oxidized state. The variety of metallic species may have arisen from corrosion, wear or a combination of both. No evidence of Cr(VI) was seen in the tissues examined.

  4. Changes in metal levels and chromosome aberrations in the peripheral blood of patients after metal-on-metal hip arthroplasty.

    Science.gov (United States)

    Ladon, Dariusz; Doherty, Ann; Newson, Roger; Turner, Justine; Bhamra, Manjit; Case, C Patrick

    2004-12-01

    A prospective study was performed to investigate changes in metal levels and chromosome aberrations in patients within 2 years of receiving metal-on-metal hip arthroplasties. There was a statistically significant increase of cobalt and chromium concentrations, with a small increase in molybdenum, in whole blood at 6, 12, and 24 months after surgery. There was also a statistically significant increase of both chromosome translocations and aneuploidy in peripheral blood lymphocytes at 6, 12, and 24 months after surgery. The changes were generally progressive with time, but the change in aneuploidy was much greater than in chromosome translocations. No statistically significant correlations were found in secondary analyses between chromosome translocation indices and cobalt or chromium concentration in whole blood. Although the clinical consequences of these changes, if any, are unknown, future epidemiological studies could usefully include direct comparisons of patients with implants of different composition.

  5. Cobalt to Chromium Ratio is Not a Key Marker for Adverse Local Tissue Reaction (ALTR) in Metal on Metal Hips.

    Science.gov (United States)

    Fehring, Thomas K; Carter, Joshua L; Fehring, Keith A; Odum, Susan M; Griffin, William L

    2015-09-01

    The diagnosis of adverse local tissue reaction (ALTR) after metal-on-metal total hip arthroplasty (MoMTHA) presents a significant challenge. No single biomarker is specific for ALTR. The purpose of this study was to determine if the ratio of cobalt to chromium ions is useful for diagnosing ALTR in MoMTHA. In 89 bearing-related revision THAs, preoperative cobalt and chromium ion levels were compared to an intraoperative soft tissue damage grading scale. The average cobalt to chromium ratio was 2.96 (0-20). There was no correlation between the tissue scale and the cobalt to chromium ratio (R=0.095; P=0.41). Many variables affecting ion production/excretion mitigate the use of the ion ratio. The cobalt to chromium ratio is not a predictive biomarker for ALTR in MoMTHA.

  6. [Bionic surface design in metal on metal bearings for total hip arthroplasty--optimization of tribological characteristics].

    Science.gov (United States)

    Böhling, U; Scholz, J; Thomas, W; Grundei, H

    2005-04-01

    Bionic systems are aiming to integrate natural observing into mechanical solutions. This has been realized in the design of metal on metal bearing in total hip resurface arthroplasty. The articular side of the femoral cup is covered with a dimple like surface. Under laboratory condition this so called "surf-metal-cup" achieved a reduction of the mechanical wear to almost a third part in comparison to a metal-cup with plane surface. This advantage, caused by the reduced friction-coefficient due to improved hydrodynamic lubrication could also be proved under laboratory conditions. The clinical introduction is expected to offer a significant extension of durability in this prosthetic system and needs to be proved in a long-term study.

  7. Clinical results of the conserve plus metal on metal hip resurfacing: an independent series.

    Science.gov (United States)

    Zylberberg, Alejandro D; Nishiwaki, Toru; Kim, Paul R; Beaulé, Paul E

    2015-01-01

    The purpose of the present study was to report the clinical and radiographic results of an independent series of the Conserve Plus hip resurfacing. Five hundred forty-eight consecutive hip resurfacings were performed using the Conserve Plus prosthesis in 458 patients (350 males) with a mean age of 48.3 years (range 19 to 66). No patients were lost to follow-up. At a mean follow-up of 6.6 years (3.9 to 11.9) thirty (5.4%) hips required conversion to a total hip arthroplasty (THA) (20 males, 10 females, mean age=48.3±7.3 years). Five-year survival with as revision endpoint was 94.5% (95% CI: 93.5% to 95.5%). This study confirms the good clinical results previously reported with the Conserve Plus hip resurfacing device.

  8. Metal ion levels and revision rates in metal-on-metal hip resurfacing arthroplasty: a comparative study.

    Science.gov (United States)

    Robinson, Patrick G; Wilkinson, Andrew J; Meek, Robert M D

    2014-01-01

    Metal-on-metal (MoM) bearings in hip surgery are related to increased blood levels of metal ions. The nature of the relationship between ion levels and failure is still not fully understood. This study compares three cohorts of patients, 120 patients in each cohort, treated with a hip resurfacing arthroplasty, grouped by brand and diameter of femoral component on average four years postoperatively: Birmingham Hip Resurfacing ≥50 mm, Durom resurfacing ≥50 mm and Durom resurfacing resurfacing than the other two cohorts (P<0.05). The large BHR and large Durom HRA had revision rates of 3.3%. The small Durom HRA had a revision rate of 8.3%. Elevated blood ion levels can indicate a failing MoM bearing. The large BHR and large Durom HRA have similar revision rates yet the large Durom HRA had significantly lower metal ion levels. When similar ion levels were reported for BHR and small Durom the latter had significantly higher revision rates. This suggests ion levels do not absolutely predict the rate of HRA failure. Since MoM generation of metal ions is not the sole reason of failure, regular clinical and radiographic follow-up should also be in place for patients with these joints.

  9. Current expert views on metal-on-metal hip resurfacing arthroplasty. Consensus of the 6th advanced Hip resurfacing course, Ghent, Belgium, May 2014.

    Science.gov (United States)

    Van Der Straeten, Catherine; De Smet, Koen A

    2016-01-01

    This paper reports the consensus of an international faculty of expert metal-on-metal (MoM) hip resurfacing surgeons, with a combined experience of over 40,000 cases, on the current status of hip resurfacing arthroplasty. Indications, design and metallurgy issues, release of metal ions and adverse soft tissue reactions to particles, management of problematic cases and revisions, as well as required experience and training are covered. The overall consensus is that MoM hip resurfacing should not be banned and should be viewed separately from MoM total hip arthroplasty (THA) with a large diameter head because of the different design and wear behaviour related to the taper/trunnion connection. The use of hip resurfacing has decreased worldwide but specialist centres continue to advocate hip resurfacing in young and active male patients. Regarding age the general recommendation is to avoid hip resurfacing in men older than 65 and in women older than 55, depending on the patient activity and bone quality. Female gender is considered a relative contraindication. Most surgeons would not implant a MoM hip in women who would still like a child. Regardless of gender, there is a consensus not to perform hip resurfacing in case of a femoral head size smaller than 46 mm and in patients with renal insufficiency or with a known metal allergy. Regarding follow-up of hip resurfacing and detection of adverse local tissue reactions, metal ion measurements, MRI and ultrasound are advocated depending on the local expertise. The consensus is that hip resurfacing should be limited to high volume hip surgeons, who are experienced in hip resurfacing or trained to perform hip resurfacing in a specialist centre.

  10. Acetabular bone density and metal ions after metal-on-metal versus metal-on-polyethylene total hip arthroplasty; short-term results

    NARCIS (Netherlands)

    Zijlstra, Wierd P.; van der Veen, Hugo C.; van den Akker-Scheek, Inge; Zee, Mark J. M.; Bulstra, Sjoerd K.; van Raay, Jos J. A. M.

    2014-01-01

    Information on periprosthetic acetabular bone density is lacking for metal-on-metal total hip arthroplasties. These bearings use cobalt-chromium instead of titanium acetabular components, which could lead to stress shielding and hence periprosthetic bone loss. Cobalt and chromium ions have detriment

  11. Laboratory studies on the tribology of hard bearing hip prostheses: ceramic on ceramic and metal on metal.

    Science.gov (United States)

    Vassiliou, K; Scholes, S C; Unsworth, A

    2007-01-01

    Total hip replacements offer relief to a great many patients every year around the world. With an expected service life of around 25 years on most devices, and with younger and younger patients undergoing this surgery, it is of great importance to understand the mechanisms of their function. Tribological testing of both conventional and hard bearing joint combinations have been conducted in many centres throughout the world, and, after being initially abandoned owing to premature failures, hard bearing combinations have been revisited as viable options for joint replacements. Improved design, manufacturing procedures, and material compositions have led to improved performance over first-generation designs in both metal-on-metal and ceramic-on-ceramic hip prostheses. This paper offers a review of the work conducted in an attempt to highlight the most important factors affecting joint performance and tribology of hard bearing combinations. The tribological performance of these joints is superior to that of conventional metal- or ceramic-on-polymer designs.

  12. Comparison of different pseudotumor grading systems in a single cohort of metal-on-metal hip arthroplasty patients

    Energy Technology Data Exchange (ETDEWEB)

    Weegen, W. van der; Wullems, J.A.; Das, H.P. [St. Anna Hospital, Department of Orthopaedic Surgery, Geldrop (Netherlands); Brakel, K.; Horn, R.J. [St. Anna Hospital, Department of Radiology, Geldrop (Netherlands); Pilot, P. [Reinier de Graaf Gasthuis, Department of Orthopaedic Surgery, Delft (Netherlands); Nelissen, R.G. [Leids Universitair Medisch Centrum, Department of Orthopaedic Surgery, Leiden (Netherlands)

    2014-02-15

    Follow-up of pseudotumors observed with metal-artefact reducing sequence (MARS)-magnetic resonance imaging (MRI) following metal-on-metal total hip arthroplasty (MoMTHA) depends on how severe these pseudotumors are graded. Several pseudotumor grading systems for MARS-MRI have emerged but little is known of their validity. We studied the intra- and interobserver reliability of three different pseudotumor grading systems in a single cohort of MoMTHA. Two experienced musculoskeletal radiologists independently used three different pseudotumor grading systems for classifying MARS-MRI results of the same cohort of 42 MoMTHA patients (49 hips, mean follow-up 5.2 years). Intraobserver and interobserver reliability for each grading system was measured using Cohen's kappa (κ). Variance in pseudotumor severity grading between systems was analyzed. Intraobserver reliability on grading pseudotumor severity with the Anderson, Matthies, and Hauptfleisch grading system scored 0.47, 0.10, and 0.35 (observer 1), and 0.75, 0.38, and 0.42 (observer 2), respectively. Interobserver reliability scores for pseudotumor severity were 0.58, 0.23, and 0.34, respectively. Intraobserver reliability for grading pseudotumor severity on MARS-MRI ranged from poor to good, dependent on observer and grading system used. Interobserver reliability scored best with the Anderson system. A more succinct pseudotumor severity grading system is needed for clinical use. (orig.)

  13. Current status of modern fully porous coated metal-on-metal hip resurfacing arthroplasty.

    Science.gov (United States)

    Gross, Thomas P; Liu, Fei

    2014-01-01

    Between March 2007 and July 2010, 1000 consecutive fully porous coated hip resurfacing arthroplasties (HRA) were performed by a single surgeon in 871 patients. The average length of follow-up was 3 ± 1 years. Three cases (0.3%) in three patients showed adverse wear related failures. Another 17 (1.7%) failures were identified at the time of this study. Using any failure of any component as the endpoint, the survivorship rate was 98.8% at two years and 97.4% at five years. Excluding the failed cases, all components were radiographically stable; there was only one partial femoral radiolucency seen. The clinical and radiological outcomes of this fully porous coated hip resurfacing were comparable to, if not better than, those reported by others using hybrid fixation methods at five years post-operatively.

  14. On the matter of synovial fluid lubrication: implications for Metal-on-Metal hip tribology.

    Science.gov (United States)

    Myant, Connor; Cann, Philippa

    2014-06-01

    Artificial articular joints present an interesting, and difficult, tribological problem. These bearing contacts undergo complex transient loading and multi axes kinematic cycles, over extremely long periods of time (>10 years). Despite extensive research, wear of the bearing surfaces, particularly metal-metal hips, remains a major problem. Comparatively little is known about the prevailing lubrication mechanism in artificial joints which is a serious gap in our knowledge as this determines film formation and hence wear. In this paper we review the accepted lubrication models for artificial hips and present a new concept to explain film formation with synovial fluid. This model, recently proposed by the authors, suggests that interfacial film formation is determined by rheological changes local to the contact and is driven by aggregation of synovial fluid proteins. The implications of this new mechanism for the tribological performance of new implant designs and the effect of patient synovial fluid properties are discussed.

  15. Characterization of protein degradation in serum-based lubricants during simulation wear testing of metal-on-metal hip prostheses.

    Science.gov (United States)

    Maskiewicz, Victoria K; Williams, Paul A; Prates, Sarah J; Bowsher, John G; Clarke, Ian C

    2010-08-01

    A size exclusion high performance liquid chromatography (SEC-HPLC) method has been developed which is capable of separation and quantitation of bovine serum albumin (BSA) and bovine serum globulin (BSG) components of serum-based lubricant (SBL) solutions. This allowed characterization of the stability profiles of these proteins when acting as lubricants during hip wear simulation, and identification of wear-specific mechanisms of degradation. Using cobalt-chromium metal-on-metal (MOM) hip joints, it was observed that BSA remained stable for up to 3 days (215K cycles) of wear testing after which the protein degraded in a fairly linear fashion. BSG on the other hand, began to degrade immediately and in a linear fashion with a rate constant of 5% per day. Loss of both proteins occurred via the formation of high molecular weight aggregates which precipitated out of solution. No fragmentation of the polypeptide backbone of either protein was observed. Data obtained suggest that protein degradation was not due to microbial contamination, denaturation at the air-water interface, or frictional heating of articulating joint surfaces in these studies. We conclude that the primary source of protein degradation during MOM simulation testing occurs via high shear rates experienced by SBL solutions at articulating surfaces, possibly coupled with metal-protein interactions occurring as new and reactive metal surfaces are generated during wear testing. The development of this analytical methodology will allow new studies to clarify the role of SBL solutions in wear simulation studies and the interactions and lubricating properties of serum proteins with prosthetic surfaces other than MOM.

  16. Effect of 3D physiological loading and motion on elastohydrodynamic lubrication of metal-on-metal total hip replacements.

    Science.gov (United States)

    Gao, Leiming; Wang, Fengcai; Yang, Peiran; Jin, Zhongmin

    2009-07-01

    An elastohydrodynamic lubrication (EHL) simulation of a metal-on-metal (MOM) total hip implant was presented, considering both steady state and transient physiological loading and motion gait cycle in all three directions. The governing equations were solved numerically by the multi-grid method and fast Fourier transform in spherical coordinates, and full numerical solutions were presented included the pressure and film thickness distribution. Despite small variations in the magnitude of 3D resultant load, the horizontal anterior-posterior (AP) and medial-lateral (ML) load components were found to translate the contact area substantially in the corresponding direction and consequently to result in significant squeeze-film actions. For a cup positioned anatomically at 45 degrees , the variation of the resultant load was shown unlikely to cause the edge contact. The contact area was found within the cup dimensions of 70-130 degrees and 90-150 degrees in the AP and ML direction respectively even under the largest translations. Under walking conditions, the horizontal load components had a significant impact on the lubrication film due to the squeeze-film effect. The time-dependent film thickness was increased by the horizontal translation and decreased during the reverse of this translation caused by the multi-direction of the AP load during walking. The minimum film thickness of 12-20 nm was found at 0.4s and around the location at (95, 125) degrees. During the whole walking cycle both the average and centre film thickness were found obviously increased to a range of 40-65 nm, compared with the range of 25-55 nm under one load (vertical) and one motion (flexion-extension) condition, which suggested the lubrication in the current MOM hip implant was improved under 3D physiological loading and motion. This study suggested the lubrication performance especially the film thickness distribution should vary greatly under different operating conditions and the time and

  17. Transient elastohydrodynamic lubrication analysis of a novel metal-on-metal hip prosthesis with a non-spherical femoral bearing surface.

    Science.gov (United States)

    Meng, Q E; Liu, F; Fisher, J; Jin, Z M

    2011-01-01

    Effective lubrication performance of metal-on-metal hip implants only requires optimum conformity within the main loaded area, while it is advantageous to increase the clearance in the equatorial region. Such a varying clearance can be achieved by using non-spherical bearing surfaces for either acetabular or femoral components. An elastohydrodynamic lubrication model of a novel metal-on-metal hip prosthesis using a non-spherical femoral bearing surface against a spherical cup was solved under loading and motion conditions specified by ISO standard. A full numerical methodology of considering the geometric variation in the rotating non-spherical head in elastohydrodynamic lubrication solution was presented, which is applicable to all non-spherical head designs. The lubrication performance of a hip prosthesis using a specific non-spherical femoral head, Alpharabola, was analysed and compared with those of spherical bearing surfaces and a non-spherical Alpharabola cup investigated in previous studies. The sensitivity of the lubrication performance to the anteversion angle of the Alpharabola head was also investigated. Results showed that the non-spherical head introduced a large squeeze-film action and also led to a large variation in clearance within the loaded area. With the same equatorial clearance, the lubrication performance of the metal-on-metal hip prosthesis using an Alpharabola head was better than that of the conventional spherical bearings but worse than that of the metal-on-metal hip prosthesis using an Alpharabola cup. The reduction in the lubrication performance caused by the initial anteversion angle of the non-spherical head was small, compared with the improvement resulted from the non-spherical geometry.

  18. Increased Mortality in Metal-on-Metal versus Non-Metal-on-Metal Primary Total Hip Arthroplasty at 10 Years and Longer Follow-Up: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Meessen, J. M. T. A.; Fiocco, M.; van der Heide, H. J. L.; Sedrakyan, A.; Nelissen, R. G. H. H.

    2016-01-01

    Importance There are concerns about increased mortality in patients with metal-on-metal bearings in total hip arthroplasty (THA). Objective To determine the mortality and the morbidity in patients with metal-on-metal articulations (MOM THA) compared to patients with non-metal-on-metal articulations (non-MOM THA) after primary total hip arthroplasty. Data Sources Search of PubMed, MEDLINE, EMBASE, Web of Science, Cochrane, CINAHL, AcademicSearchPremier, ScienceDirect, Wiley and clinical trial registers through March 2015, augmented by a hand search of references from the included articles. No language restrictions were applied. Study Selection Two reviewers screened and identified randomised controlled trials and observational studies of primary total hip arthroplasty comparing MOM THA with non-MOM THA. Data Extraction and Synthesis Two reviewers independently extracted study data and assessed risk of bias. Risk differences (RD) were calculated with random effect models. Meta-regression was used to explore modifying factors. Main Outcomes and Measures Difference in mortality and difference in morbidity expressed as revisions and medical complications between patients with MOM THA and non-MOM THA. Results Forty-seven studies were included, comprising 4,000 THA in randomised trials and over 500,000 THA in observational studies. For mortality, random effects analysis revealed a higher pooled RD of 0.7%, 95%, confidence interval (CI) [0.0%, 2.3%], I-square 42%; the heterogeneity was explained by differences in follow-up. When restricted to studies with long term follow-up (i.e. 10 years or more), the RD for mortality was 8.5%, 95%, CI [5.8%, 11.2%]; number needed to treat was 12. Further subgroup analyses and meta-regression random effects models revealed no evidence for other moderator variables (study level covariates, e.g. resurfacing vs. non-resurfacing MOM) than follow-up duration. The quality of the evidence presented in this meta-analysis was characterized as

  19. Increased Mortality in Metal-on-Metal versus Non-Metal-on-Metal Primary Total Hip Arthroplasty at 10 Years and Longer Follow-Up: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    B G Pijls

    Full Text Available There are concerns about increased mortality in patients with metal-on-metal bearings in total hip arthroplasty (THA.To determine the mortality and the morbidity in patients with metal-on-metal articulations (MOM THA compared to patients with non-metal-on-metal articulations (non-MOM THA after primary total hip arthroplasty.Search of PubMed, MEDLINE, EMBASE, Web of Science, Cochrane, CINAHL, AcademicSearchPremier, ScienceDirect, Wiley and clinical trial registers through March 2015, augmented by a hand search of references from the included articles. No language restrictions were applied.Two reviewers screened and identified randomised controlled trials and observational studies of primary total hip arthroplasty comparing MOM THA with non-MOM THA.Two reviewers independently extracted study data and assessed risk of bias. Risk differences (RD were calculated with random effect models. Meta-regression was used to explore modifying factors.Difference in mortality and difference in morbidity expressed as revisions and medical complications between patients with MOM THA and non-MOM THA.Forty-seven studies were included, comprising 4,000 THA in randomised trials and over 500,000 THA in observational studies. For mortality, random effects analysis revealed a higher pooled RD of 0.7%, 95%, confidence interval (CI [0.0%, 2.3%], I-square 42%; the heterogeneity was explained by differences in follow-up. When restricted to studies with long term follow-up (i.e. 10 years or more, the RD for mortality was 8.5%, 95%, CI [5.8%, 11.2%]; number needed to treat was 12. Further subgroup analyses and meta-regression random effects models revealed no evidence for other moderator variables (study level covariates, e.g. resurfacing vs. non-resurfacing MOM than follow-up duration. The quality of the evidence presented in this meta-analysis was characterized as moderate according to the CLEAR-NPT (for non-pharmacological trials and Cochrane risk of bias Table

  20. Metal ion levels and functional results following resurfacing hip arthroplasty versus conventional small-diameter metal-on-metal total hip arthroplasty; a 3 to 5year follow-up of a randomized controlled trial

    NARCIS (Netherlands)

    Bisseling, P.; Smolders, J.M.; Hol, A.; Susante, J.L.C. van

    2015-01-01

    We present an update of a randomized controlled trial on 71 patients (<65 years) who received either a resurfacing hip arthroplasty (RHA) (n=38) or cementless 28-mm metal-on-metal (MoM) total hip arthroplasty (THA) (n=33). Metal ion levels and functional outcome scores were analyzed with a mean f

  1. Influence of the clearance on in-vitro tribology of large diameter metal-on-metal articulations pertaining to resurfacing hip implants.

    Science.gov (United States)

    Rieker, Claude B; Schön, Rolf; Konrad, Reto; Liebentritt, Gernot; Gnepf, Patric; Shen, Ming; Roberts, Paul; Grigoris, Peter

    2005-04-01

    Large-diameter metal-on-metal articulations may provide an opportunity for wear reduction in total hip implants because earlier studies have shown that the formation of a fluid film that completely separates the bearing surfaces is theoretically possible. In such a lubrication mode and under ideal conditions, there is theoretically no amount of wear. Studies have suggested that the two primary parameters controlling the lubrication mode are the diameter and the clearance of the articulation. The goal of the present study was to experimentally investigate the influence of these two parameters on the wear behavior of large-diameter metal-on-metal articulations pertaining to resurfacing hip implants. The results of this in vitro investigation showed that longer running-in periods and higher amounts of running-in wear were associated with larger clearances.

  2. Advanced metal artifact reduction MRI of metal-on-metal hip resurfacing arthroplasty implants: compressed sensing acceleration enables the time-neutral use of SEMAC

    Energy Technology Data Exchange (ETDEWEB)

    Fritz, Jan; Thawait, Gaurav K. [Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Section of Musculoskeletal Radiology, Baltimore, MD (United States); Fritz, Benjamin [University of Freiburg, Department of Radiology, Freiburg im Breisgau (Germany); Raithel, Esther; Nittka, Mathias [Siemens Healthcare GmbH, Erlangen (Germany); Gilson, Wesley D. [Siemens Healthcare USA, Inc., Baltimore, MD (United States); Mont, Michael A. [Cleveland Clinic Foundation, Department of Orthopedic Surgery, Cleveland, OH (United States)

    2016-10-15

    Compressed sensing (CS) acceleration has been theorized for slice encoding for metal artifact correction (SEMAC), but has not been shown to be feasible. Therefore, we tested the hypothesis that CS-SEMAC is feasible for MRI of metal-on-metal hip resurfacing implants. Following prospective institutional review board approval, 22 subjects with metal-on-metal hip resurfacing implants underwent 1.5 T MRI. We compared CS-SEMAC prototype, high-bandwidth TSE, and SEMAC sequences with acquisition times of 4-5, 4-5 and 10-12 min, respectively. Outcome measures included bone-implant interfaces, image quality, periprosthetic structures, artifact size, and signal- and contrast-to-noise ratios (SNR and CNR). Using Friedman, repeated measures analysis of variances, and Cohen's weighted kappa tests, Bonferroni-corrected p-values of 0.005 and less were considered statistically significant. There was no statistical difference of outcomes measures of SEMAC and CS-SEMAC images. Visibility of implant-bone interfaces and pseudocapsule as well as fat suppression and metal reduction were ''adequate'' to ''good'' on CS-SEMAC and ''non-diagnostic'' to ''adequate'' on high-BW TSE (p < 0.001, respectively). SEMAC and CS-SEMAC showed mild blur and ripple artifacts. The metal artifact size was 63 % larger for high-BW TSE as compared to SEMAC and CS-SEMAC (p < 0.0001, respectively). CNRs were sufficiently high and statistically similar, with the exception of CNR of fluid and muscle and CNR of fluid and tendon, which were higher on intermediate-weighted high-BW TSE (p < 0.005, respectively). Compressed sensing acceleration enables the time-neutral use of SEMAC for MRI of metal-on-metal hip resurfacing implants when compared to high-BW TSE and image quality similar to conventional SEMAC. (orig.)

  3. Usefulness of metal artifact reduction with WARP technique at 1.5 and 3T MRI in imaging metal-on-metal hip resurfacings

    Energy Technology Data Exchange (ETDEWEB)

    Lazik, Andrea; Lauenstein, Thomas C.; Theysohn, Jens M. [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Landgraeber, Stefan; Schulte, Patrick [University Hospital Essen, Department of Orthopedics, Essen (Germany); Kraff, Oliver [University of Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany)

    2015-03-25

    To evaluate the usefulness of the metal artifact reduction technique ''WARP'' in the assessment of metal-on-metal hip resurfacings at 1.5 and 3T in the context of image quality and imaging speed. Nineteen patients (25 hip resurfacings) were randomized for 1.5 and 3T MRI, both including T1 and T2 turbo spin-echo as well as turbo inversion recovery magnitude sequences with and without view angle tilting and high bandwidth. Additional 3T sequences were acquired with a reduced number of averages and using the parallel acquisition technique for accelerating imaging speed. Artifact size (diameter, area), image quality (5-point scale) and delineation of anatomical structures were compared among the techniques, sequences and field strengths using the Wilcoxon sign-rank and paired t-test with Bonferroni correction. At both field strengths, WARP showed significant superiority over standard sequences regarding image quality, artifact size and delineation of anatomical structures. At 3T, artifacts were larger compared to 1.5T without affecting diagnostic quality, and scanning time could be reduced by up to 64 % without quality degradation. WARP proved useful in imaging metal-on-metal hip resurfacings at 1.5T as well as 3T with better image quality surrounding the implants. At 3T imaging could be considerably accelerated without losing diagnostic quality. (orig.)

  4. 金属对金属髋关节表面置换术的研究进展%Progress of metal-on-metal hip resurfacing arthroplasty

    Institute of Scientific and Technical Information of China (English)

    马立峰; 郭艾

    2014-01-01

    Metal-on-metal hip resurfacing is a viable alternative for younger patients because it is a bone conserving procedure which can easily be converted to a total hip arthroplasty if necessary,and the results were satisfactory for short-term follow-up. In the same time,the operation will bring about some problems such as femoral neck fracture,femoral head collapse and release of metal ion into the bloodstream. So it is important for the surgeons to select the ideal patients who are underwent hip resurfacing arthroplasty in order to avoid the complications of hip resurfacing arthroplasty. Here is to make a review of the research progress of metal-on-metal hip resurfacing arthroplasty.%对于年轻髋关节疾病的患者,金属对金属髋关节表面置换术是一个不错的治疗方法,因为它能够很好地保留股骨的骨量,以及根据病情需要能够转而进行全髋关节置换术,并且在短期随访中获得良好的效果。但是该手术也会产生一些问题比如:股骨颈骨折、股骨头塌陷以及金属离子释放入循环系统。因此,对于骨科医师,正确地选择适合接受髋关节表面置换术的患者十分重要,以避免该手术并发症的发生。本文就金属对金属髋关节表面置换术的研究进展进行综述。

  5. N-Acetyl-Cysteine as Effective and Safe Chelating Agent in Metal-on-Metal Hip-Implanted Patients: Two Cases

    Directory of Open Access Journals (Sweden)

    Andrea Giampreti

    2016-01-01

    Full Text Available Systemic toxicity associated with cobalt (Co and chromium (Cr containing metal hip alloy may result in neuropathy, cardiomyopathy, and hypothyroidism. However clinical management concerning chelating therapy is still debated in literature. Here are described two metal-on-metal hip-implanted patients in which N-acetyl-cysteine decreased elevated blood metal levels. A 67-year-old male who underwent Co/Cr hip implant in September 2009 referred to our Poison Control Centre for persisting elevated Co/Cr blood levels (from March 2012 to November 2014. After receiving oral high-dose N-acetyl-cysteine, Co/Cr blood concentrations dropped by 86% and 87% of the prechelation levels, respectively, and persisted at these latter concentrations during the following 6 months of follow-up. An 81-year-old female who underwent Co/Cr hip implant in January 2007 referred to our Centre for detection of high Co and Cr blood levels in June 2012. No hip revision was indicated. After a therapy with oral high-dose N-acetyl-cysteine Co/Cr blood concentrations decreased of 45% and 24% of the prechelation levels. Chelating agents reported in hip-implanted patients (EDTA, DMPS, and BAL are described in few cases. N-acetyl-cysteine may provide chelating sites for metals and in our cases reduced Co and Cr blood levels and resulted well tolerable.

  6. Dislocation and spontaneous reduction of the femoral implant against the femoral neck in an infected metal on metal hip resurfacing with complex collection

    Energy Technology Data Exchange (ETDEWEB)

    Tins, Bernhard, E-mail: Bernhard.Tins@rjah.nhs.uk [Department of Radiology, RJAH Orthopaedic Hospital, Oswestry, Shropshire, SY 107 AG (United Kingdom)

    2011-07-15

    Metal on metal resurfacing hip implants are known to have complications unique to this type of implant. The case presented adds a further previously not described complication, the dislocation and spontaneous reduction of the pin of the femoral component against the femoral neck. The radiographic and CT findings are demonstrated. The dislocation was aided by bone loss due to an infection with a large periarticular collection. Periarticular collections in hip resurfacings are often due to a hypersensitivity type reaction to metal debris. However in the case presented it was due to infection. MRI was not able to discern the infection from a sterile collection. CT demonstrated bone loss and periosteal reaction suggestive of infection. In addition calcification of the pseudocapsule was seen, this is not a recognized feature of sterile collections.

  7. Patterns of risk of cancer in patients with metal-on-metal hip replacements versus other bearing surface types: a record linkage study between a prospective joint registry and general practice electronic health records in England.

    Directory of Open Access Journals (Sweden)

    Arief Lalmohamed

    Full Text Available BACKGROUND: There are concerns that metal-on-metal hip implants may cause cancer. The objective of this study was to evaluate patterns and timing of risk of cancer in patients with metal-on-metal total hip replacements (THR. METHODS: In a linkage study between the English National Joint Registry (NJR and the Clinical Practice Research Datalink (CPRD, we selected all THR surgeries (NJR between 2003 and 2010 (n = 11,540. THR patients were stratified by type of bearing surface. Patients were followed up for cancer and Poisson regression was used to derive adjusted relative rates (RR. RESULTS: The risk of cancer was similar in patients with hip resurfacing (RR 0.69; 95% Confidence Interval [CI] 0.39-1.22 or other types of bearing surfaces (RR 0.96; 95% CI 0.64-1.43 compared to individuals with stemmed metal-on-metal THR. The pattern of cancer risk over time did not support a detrimental effect of metal hip implants. There was substantial confounding: patients with metal-on-metal THRs used fewer drugs and had less comorbidity. CONCLUSIONS: Metal-on-metal THRs were not associated with an increased risk of cancer. There were substantial baseline differences between the different hip implants, indicating possibility of confounding in the comparisons between different types of THR implants.

  8. Similar incidence of periprosthetic fluid collections after ceramic-on-polyethylene total hip arthroplasties and metal-on-metal resurfacing arthroplasties: results of a screening metal artefact reduction sequence-MRI study

    NARCIS (Netherlands)

    Bisseling, P.; Wit, B.W. de; Hol, A.M.; Gorp, M.J. van; Kampen, A. van; Susante, J.L. van

    2015-01-01

    Patients from a randomised trial on resurfacing hip arthroplasty (RHA) (n = 36, 19 males; median age 57 years, 24 to 65) comparing a conventional 28 mm metal-on-metal total hip arthroplasty (MoM THA) (n = 28, 17 males; median age 59 years, 37 to 65) and a matched control group of asymptomatic patien

  9. A safe zone for acetabular component position in metal-on-metal hip resurfacing arthroplasty: winner of the 2012 HAP PAUL award.

    Science.gov (United States)

    Liu, Fei; Gross, Thomas P

    2013-08-01

    A safe zone for acetabular component positioning in hip resurfacing (RAIL: Relative Acetabular Inclination Limit) was calculated based on implant size and acetabular inclination angle (AIA). For AIA below the RAIL, there were no adverse wear failures or dislocations, and only 1% of cases with ion levels above 10 μg/L. Other than high inclination angle and small bearing size, female gender was the only other factor that correlated with high ion levels in the multivariate analysis. Seven hundred sixty-one hip resurfacing cases are included in this study. The UCLA activity score, femoral shaft angle, body mass index, weight, American Society of Anesthesiologists score, combined range of motion, diagnosis, age, gender, implant brand, AIA, bearing size, and duration of implantation were analyzed to determine the potential risk factors for elevated metal ion levels. These findings apply to sub hemispheric metal-on-metal bearings with similar coverage arcs as the Biomet and Corin hip resurfacing brands. Additional problems may occur when these bearings are connected with trunions on stems for total hip arthroplasty.

  10. Asymptomatic prospective and retrospective cohorts with metal-on-metal hip arthroplasty indicate acquired lymphocyte reactivity varies with metal ion levels on a group basis.

    Science.gov (United States)

    Hallab, Nadim J; Caicedo, Marco; McAllister, Kyron; Skipor, Anastasia; Amstutz, Harlan; Jacobs, Joshua J

    2013-02-01

    Some tissues from metal-on-metal (MoM) hip arthroplasty revisions have shown evidence of adaptive-immune reactivity (i.e., excessive peri-implant lymphocyte infiltration/activation). We hypothesized that, prior to symptoms, some people with MoM hip arthroplasty will develop quantifiable metal-induced lymphocyte reactivity responses related to peripheral metal ion levels. We tested three cohorts (Group 1: n = 21 prospective longitudinal MoM hip arthroplasty; Group 2: n = 17 retrospective MoM hip arthroplasty; and Group 3: n = 20 controls without implants). We compared implant position, metal-ion release, and immuno-reactivity. MoM cohorts had elevated (p metal-reactivity (vs. 5% pre-op, metal-LTT, SI > 2), compared with 76% of Group 2, and 15% of Group 3 controls (patch testing was a poor diagnostic indicator with only 1/21 Group 1 positive). Higher cup-abduction angles (50° vs. 40°) in Group 1 were associated with higher serum Cr (p reactive versus non-reactive Group-1 participants (p metal-reactive versus non-reactive Group 1 participants. Our results showed that lymphocyte reactivity to metals can develop within the first 1-4 years after MoM arthroplasty in asymptomatic patients and lags increases in metal ion levels. This increased metal reactivity was more prevalent in those individuals with extreme cup angles and higher amounts of circulating metal.

  11. Pseudotumour incidence, cobalt levels and clinical outcome after large head metal-on-metal and conventional metal-on-polyethylene total hip arthroplasty MID-TERM RESULTS OF A RANDOMISED CONTROLLED TRIAL

    NARCIS (Netherlands)

    van der Veen, H. C.; Reininga, I. H. F.; Zijlstra, W. P.; Boomsma, M. F.; Bulstra, S. K.; van Raay, J. J. A. M.

    2015-01-01

    We compared the incidence of pseudotumours after large head metal-on-metal (MoM) total hip arthroplasty (THA) with that after conventional metal-on-polyethylene (MoP) THA and assessed the predisposing factors to pseudotumour formation. From a previous randomised controlled trial which compared large

  12. Grading the severity of soft tissue changes associated with metal-on-metal hip replacements: reliability of an MR grading system

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, Helen; Cahir, John G.; Goodwin, Richard W. [Norfolk and Norwich University Hospital, Department of Radiology, Norwich, Norfolk (United Kingdom); Toms, Andoni Paul [Norfolk and Norwich University Hospital, Department of Radiology, Norwich, Norfolk (United Kingdom); Norwich Radiology Academy, Norwich (United Kingdom); Wimhurst, James; Nolan, John F. [Norfolk and Norwich University Hospital, Department of Orthopaedics, Norwich, Norfolk (United Kingdom)

    2011-03-15

    Metal-on-metal (MoM) soft tissue reactions or aseptic lymphocytic vasculitis-associated lesions (ALVAL) are being recognised using metal artefact reduction (MAR) MR with increasing frequency following the advent of second generation metal-on-metal bearings, but there is no standardised technique for reporting of MR appearances in this disease. The aim of this study was to measure the reliability of a grading system designed for scoring the severity of MoM disease on MRI. MRI examinations of 73 hips in 59 patients were retrospectively selected and then anonymised, randomised and reviewed by three independent observers (musculoskeletal radiologists). Each MR examination was scored as either A: normal, B: infection, C1: mild MoM disease, C2: moderate MoM disease or C3: severe MoM disease according to pre-defined criteria. Kappa correlation statistics were used to compare the observations. There was substantial agreement among all three observers; the correlation coefficient between the two most experienced observers was {kappa} = 0.78 [95% confidence intervals (CI): 0.68-0.88] and when compared with the least experienced observer coefficients were {kappa} = 0.69 (95% CI: 0.57-0.80) and {kappa} = 0.66 (95% CI: 0.54-0.78). The strongest correlation occurred for grades A, C2 and C3. The weakest correlations occurred for grades B and C1. The grading system described in this study is reliable for evaluating ALVAL in MoM prostheses using MR but is limited in differentiating mild disease from infection. (orig.)

  13. Effects of metal-on-metal wear on the host immune system and infection in hip arthroplasty

    NARCIS (Netherlands)

    Hosman, Anton H.; van der Mei, Henny C.; Bulstra, Sjoerd K.; Busscher, Henk J.; Neut, Danielle

    2010-01-01

    Methods We reviewed the available literature on the influence of degradation products of MOM bearings in total hip arthroplasties on infection risk. Results Wear products were found to influence the risk of infection by hampering the immune system, by inhibiting or accelerating bacterial growth, and

  14. Poor mid-term survival of the low-carbide metal-on-metal Zweymüller-plus total hip arthroplasty system: a concise follow-up, at a minimum of ten years, of a previous report*.

    Science.gov (United States)

    Repantis, Thomas; Vitsas, Vasilis; Korovessis, Panagiotis

    2013-03-20

    Between 1994 and 1999, 217 metal-on-metal total hip arthroplasties with a low-carbide bearing surface were performed with use of the cementless Zweymüller SL-Plus stem and the Bicon-Plus threaded cup in 194 consecutive patients. After a minimum follow-up of ten years, 181 living patients (203 hips) were available for evaluation. The revision rate after an average of twelve years was 18% (thirty-six hips in thirty-six patients were revised). The main reason for revision was aseptic loosening of one or both components. The probability of survival of the stem at fifteen years was 77% (95% confidence interval [CI], 65% to 86%). The probability of survival of the cup was 80% (95% CI, 62% to 90%). These high failure rates at mid-term follow-up led us to abandon the use of low-carbide metal-on-metal total hip arthroplasty components.

  15. Effect of acetabular cup design on metal ion release in two designs of metal-on-metal hip resurfacing.

    Science.gov (United States)

    Cadossi, Matteo; Tedesco, Giuseppe; Savarino, Lucia; Baldini, Nicola; Mazzotti, Antonio; Greco, Michelina; Giannini, Sandro

    2014-10-01

    The purpose of this observational prospective cohort study was to evaluate the serum concentrations of cobalt (Co), chromium (Cr), and nickel (Ni) at a 2-year follow-up in patients operated on with a novel design of hip resurfacing: Romax resurfacing system (RRS). RRS is characterized by the presence of an acetabular notch which theoretically provides a wider range of motion and a reduced incidence of groin pain. The presence of radiolucencies and functional outcome, assessed using the Harris hip score (HHS) and the University of California Activity scale (UCLA), were secondary endpoints. Moreover, these results were compared with those obtained in our previous study from a similar cohort of patients implanted using the Birmingham Hip Resurfacing (BHR) system. At a 2-year follow-up, the serum levels of Co in patients operated on using the RRS were five times higher (p = 0.0002) than those found before surgery (Co, means: 1.04 and 0.20 ng/mL, respectively); similarly, Cr levels were 13 times higher (p < 0.0001) at a 2-year follow-up than before surgery (Cr, means: 1.69 and 0.13 ng/mL, respectively). Ni concentrations (0.42 and 0.78 ng/mL) were not significantly different (p = 0.16), even if they increased 86% after surgery. In the RRS patients, an inverse correlation was found between Co and Cr concentrations and length of follow-up (Co: r = -0.64, p = 0.0096; Cr: r= -0.45, p = 0.08). The serum levels of Co and Cr were not significantly different between RRS (Co: 1.04 ng/mL and Cr: 1.69 ng/mL) and BHR (Co: 1.39 ng/mL and Cr: 2.30 ng/mL) patients at 2 years (p = 0.95 and 0.26 for Co and Cr, respectively). Our results showed that RRS patients achieved an excellent clinical outcome with limited metal ion release.

  16. Lubrication of metal-on-metal hip joints: the effect of protein content and load on film formation and wear.

    Science.gov (United States)

    Myant, C; Underwood, R; Fan, J; Cann, P M

    2012-02-01

    Lubricant films were measured for a series of bovine serum and protein containing (albumin, globulin) saline solutions for CoCrMo femoral component sliding against a glass disc. Central film thickness was measured by optical interferometry as a function of time (constant mean speed: 0 and 10 mm/s) and variable mean speed (0-50 mm/s). The effect of load (5-20 N) on film thickness was also studied. The development of the wear scar on the CoCrMo surface was monitored by measuring the width of the contact zone during the film thickness tests. The results showed film thickness increased with time for both the static and sliding tests. Films formed in the static, loaded test were typically in the range of 3-40 nm. The globulin containing solutions formed the thickest films. In the sliding tests a wear scar rapidly formed on the implant component for the bovine serum and albumin fluids, negligible wear was observed for the globulin solutions. Film thickness increased with sliding time for all test solutions and was much greater than predicted by isoviscous EHL models. The film increase was found to correlate with increasing wear scar size and thus decreasing contact pressure. A new lubricating mechanism is proposed whereby during sliding the fluid undergoes bulk phase separation rheology, so that an elevated protein phase forms in the inlet zone. This protein phase is a high-viscosity biphasic matrix, which is periodically entrained into the contact forming a thick protective hydro-gel film. One of the main findings of this study is that film thickness was very sensitive to load; to a much greater extent than predicted by EHL models. Thus film formation in MoM hip joints is very susceptible to high contact pressures which might be due to implant misalignment and edge-loading.

  17. Metal ion concentrations in body fluids after implantation of hip replacements with metal-on-metal bearing--systematic review of clinical and epidemiological studies.

    Directory of Open Access Journals (Sweden)

    Albrecht Hartmann

    Full Text Available INTRODUCTION: The use of metal-on-metal (MoM total hip arthroplasty (THA increased in the last decades. A release of metal products (i.e. particles, ions, metallo-organic compounds in these implants may cause local and/or systemic adverse reactions. Metal ion concentrations in body fluids are surrogate measures of metal exposure. OBJECTIVE: To systematically summarize and critically appraise published studies concerning metal ion concentrations after MoM THA. METHODS: Systematic review of clinical trials (RCTs and epidemiological studies with assessment of metal ion levels (cobalt, chromium, titanium, nickel, molybdenum in body fluids after implantation of metalliferous hip replacements. Systematic search in PubMed and Embase in January 2012 supplemented by hand search. Standardized abstraction of pre- and postoperative metal ion concentrations stratified by type of bearing (primary explanatory factor, patient characteristics as well as study quality characteristics (secondary explanatory factors. RESULTS: Overall, 104 studies (11 RCTs, 93 epidemiological studies totaling 9.957 patients with measurement of metal ions in body fluids were identified and analyzed. Consistently, median metal ion concentrations were persistently elevated after implantation of MoM-bearings in all investigated mediums (whole blood, serum, plasma, erythrocytes, urine irrespective of patient characteristics and study characteristics. In several studies very high serum cobalt concentrations above 50 µg/L were measured (detection limit typically 0.3 µg/L. Highest metal ion concentrations were observed after treatment with stemmed large-head MoM-implants and hip resurfacing arthroplasty. DISCUSSION: Due to the risk of local and systemic accumulation of metallic products after treatment with MoM-bearing, risk and benefits should be carefully balanced preoperatively. The authors support a proposed "time out" for stemmed large-head MoM-THA and recommend a restricted

  18. Risk factor analysis for early femoral failure in metal-on-metal hip resurfacing arthroplasty: the effect of bone density and body mass index

    Directory of Open Access Journals (Sweden)

    Gross Thomas P

    2012-01-01

    Full Text Available Abstract Background The importance of appropriately selecting patients based on factors such as bone mineral density, body mass index, age, gender, and femoral component size has been demonstrated in many studies as an aid in decreasing the rate of revisions and improving the outcomes for patients after hip resurfacing arthroplasty (HRA; however, there are few published studies quantitatively specifying the potential risk factors that affect early femoral component failures. Therefore, the purpose of this study was to investigate the specific causes of early femoral component failures in hip resurfacing separately and more carefully in order to develop strategies to prevent these failures, rather than excluding groups of patients from this surgical procedure. Methods This retrospective study included 373 metal-on-metal HRAs performed by a single surgeon using the vascular sparing posterior minimally invasive surgical approach. The average length of follow-up was 30 ± 6 months. In order to understand the causes of early femoral failure rate, a multivariable logistic regression model was generated in order to analyze the effects of bone mineral density (T-score, gender, diagnosis, body mass index, femoral implant fixation type, age, and femoral component size. Results The average post-operative Harris hip score was 92 ± 11 points and the average post-operative UCLA score was 7 ± 2 points. There were three revisions due to femoral neck fracture and two for femoral component loosening. These occurred in two female and three male patients. In the multi-variable regression model, only T-score and body mass index showed significant effects on the failure rate of femoral components. Patients with a lower T-score and a higher body mass index had a significantly increased risk of early femoral component failure. Conclusion We recommend that dual energy x-ray absorptiometry scan T-score tests should be routinely performed on all hip resurfacing patients

  19. Metal ion levels and functional results following resurfacing hip arthroplasty versus conventional small-diameter metal-on-metal total hip arthroplasty; a 3 to 5year follow-up of a randomized controlled trial.

    Science.gov (United States)

    Bisseling, Pepijn; Smolders, José M H; Hol, Annemiek; van Susante, Job L C

    2015-01-01

    We present an update of a randomized controlled trial on 71 patients (resurfacing hip arthroplasty (RHA) (n=38) or cementless 28-mm metal-on-metal (MoM) total hip arthroplasty (THA) (n=33). Metal ion levels and functional outcome scores were analyzed with a mean follow-up of 58 months (SD 8.1). No clear shifts in relatively good outcome was encountered between RHA and THA. Metal ion levels appear to equalize between groups after 3 years. Median cobalt and chromium remained below 1.3 μg/L throughout follow-up in both groups. Six revisions were performed, of which three for pseudotumor formation (one THA, two RHA). In conclusion there were no clinical differences between the two groups and metal ion levels were lower than other series remained low, however, pseudotumor formation was not eliminated.

  20. Cemented total hip arthroplasty with Boneloc bone cement.

    Science.gov (United States)

    Markel, D C; Hoard, D B; Porretta, C A

    2001-01-01

    Boneloc cement (WK-345, Biomet Inc, Warsaw, Ind) attempted to improve cement characteristics by reducing exotherm during polymerization, lowering residual monomer and solubility, raising molecular weight, and lowering airborne monomer and aromatic amines. To study the efficacy of this cement, a selected group of 20 patients were prospectively enrolled and followed up after hip arthroplasty. All components were cemented. During the enrollment period, approximately 70 other hip arthroplasties were performed. Clinical evaluation was based on the Harris hip score. Radiographic evaluation was based on assessment of position of the components, subsidence, and/or presence of radiolucencies. Patients had follow-up for an average of 42 months (11 to 58 months); 1 was lost to follow-up. Of these, 7 (35%) had failure at last follow-up. Despite its initial promise, Boneloc cement had an unacceptably high failure rate over a relatively short follow-up period and is not recommended for use. Despite the longevity and odor toxicity problems with conventional bone cement, new cement technologies must be approached with caution.

  1. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... prosthesis. 888.3370 Section 888.3370 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... (hemi-hip) acetabular metal cemented prosthesis. (a) Identification. A hip joint (hemi-hip) acetabular metal cemented prosthesis is a device intended to be implanted to replace a portion of the hip...

  2. 21 CFR 888.3360 - Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... uncemented prosthesis. 888.3360 Section 888.3360 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis is a device intended to be...

  3. 大直径金属-金属全髋关节置换的早期疗效%Short-term outcome of metal-on-metal total hip arthroplasty with large diameter head

    Institute of Scientific and Technical Information of China (English)

    袁东堂; 左文山; 刘开样; 戴志唐; 徐用亿

    2011-01-01

    BACKGROUND: Dislocation after total hip replacement is still one of the mam complications of traditional metal-on-polyethylenetotal hip replacement. Melal-on-metal lolai hip arthroplasty with large diameter head has a good stability, suitable for young andactive patients with higher requirement of movement.OBJECTIVE: To evaluate the short-term therapeutic effect of total hip arthroplasty with metal-on-metal bearings and largediameter head hip prosthesis.METHODS: A retrospective analysis was done in 48 patients (54 hips) with advanced stage hip disease treated by primary totalhip arthroplasty with metal-on-metal bearings and large diameter head hip prosthesis. The mean diameter of femoral headprosthesis was 44 mm (38 to 48 mm). The postoperative short-term effect was evaluated with Harris scores and X-ray plain.RESULTS AND CONCLUSION: Ail patients received the foliow-up of 18 to 36 months. The mean Harris hip score was 93.6 (91 to96) at the last follow-up. Trie mean range of hip motion was 232.6° (182° to 257°) at the last follow-up. There were no infection, nohip and thigh pain, no vessel and nerve complications, no dislocation. Posl-opretive X-ray plain revealed fine position of theprostheses without any loosening. Short-term results show that large diameter metal-on-metal total hip arthroplasty hasadvantages of lower wearing, large range of motion and few dislocations.%背景:髋关节置换后脱位仍然是传统的金属对聚乙烯全髋关节置换的主要并发症之一,大直径金属对金属的全髋关节置换后具有良好的稳定性,适合年轻、活动要求高的患者.目的:验证大直径金属-金属全髋关节置换治疗终末期髋关节疾病的早期疗效.方法:回顾性分析48例(54髋)初次大直径金属-金属全髋关节置换后的早期临床疗效.假体股骨头直径平均为44 mm(38-48 mm),采用Harris评分和X射线检查评估早期疗效.结果与结论:所有患者都获得18~36个月

  4. The immunobiology of cobalt: demonstration of a potential aetiology for inflammatory pseudotumours after metal-on-metal replacement of the hip.

    Science.gov (United States)

    Lawrence, H; Deehan, D; Holland, J; Kirby, J; Tyson-Capper, A

    2014-09-01

    Abnormal wear of cobalt-containing metal-on-metal joints is associated with inflammatory pseudotumours. Cobalt ions activate human toll-like receptor 4 (TLR4), which normally responds to bacterial lipopolysaccharide (LPS) in sepsis. Activation of TLR4 by LPS increases the expression of chemokines IL-8 and CXCL10, which recruit leukocytes and activated T-cells, respectively. This study was designed to determine whether cobalt induces a similar inflammatory response to LPS by promoting the expression of IL-8 and CXCL10. A human monocytic cell line, derived from acute monocytic leukaemia, was treated with cobalt ions and expression of IL-8 and CXCL10 measured at mRNA and protein levels. Cobalt-treated macrophages showed a 60-fold increase in IL-8 mRNA, and an eightfold increase in production of the mature chemokine (both p cobalt (both p cobalt-mediated increase in IL-8 and CXCL10 expression. These findings suggest that cobalt ions induce inflammation similar to that observed during sepsis by the simultaneous activation of two TLR4-mediated signalling pathways. These pathways result in increased production of IL-8 and CXCL10, and may be implicated in pseudotumour formation following metal-on-metal replacement.

  5. 金属对金属髋关节表面置换术并发症的研究%Complications after Metal-on-Metal Hip Resurfacing Arthroplasty

    Institute of Scientific and Technical Information of China (English)

    刘二涛

    2012-01-01

    Metal-on-metal hip resurfacing arthroplasty has undergone a recent resurgence as an alternative treatment option for young and active patients,since it preserves bone stock for subsequent revision procedures and restores anatomic hip mechanics. At the same time, some complications such as femoral neck fracture,prosthesis loosening,especially the high levels of cobalt-chromium metal ions in blood and urine from the elevated levels of metal ions could have a negative impact on the body. Here is to make a review on the complications commonly associated with metal-on-metal hip resurfacing arthroplasty and the influence on the body.%金属髋关节表面置换术通过保留股骨近端骨量从而恢复髋关节正常的生物力学特性及关节的稳定性,为年轻及活动量大的患者提供了一个良好的治疗方案.与此同时,这一手术方案存在其特有的并发症,如股骨颈骨折、假体松动,特别是假体置换术后产生大量的金属离子使机体内血液尿液中金属离子水平升高,从而可能对机体产生不利影响.现就金属对金属全髋假体置换术后出现的特有并发症及其对机体的影响进行综述.

  6. In Vitro Analyses of the Toxicity, Immunological, and Gene Expression Effects of Cobalt-Chromium Alloy Wear Debris and Co Ions Derived from Metal-on-Metal Hip Implants

    Directory of Open Access Journals (Sweden)

    Olga M. Posada

    2015-07-01

    Full Text Available Joint replacement has proven to be an extremely successful and cost-effective means of relieving arthritic pain and improving quality of life for recipients. Wear debris-induced osteolysis is, however, a major limitation and causes orthopaedic implant aseptic loosening, and various cell types including macrophages, monocytes, osteoblasts, and osteoclasts, are involved. During the last few years, there has been increasing concern about metal-on-metal (MoM hip replacements regarding adverse reactions to metal debris associated with the MoM articulation. Even though MoM-bearing technology was initially aimed to extend the durability of hip replacements and to reduce the requirement for revision, they have been reported to release at least three times more cobalt and chromium ions than metal-on-polyethylene (MoP hip replacements. As a result, the toxicity of metal particles and ions produced by bearing surfaces, both locally in the periprosthetic space and systemically, became a concern. Several investigations have been carried out to understand the mechanisms responsible for the adverse response to metal wear debris. This   review aims at summarising in vitro analyses of the toxicity, immunological, and gene expression effects of cobalt ions and wear debris derived from MoM hip implants.

  7. 金属对金属全髋关节表面置换术研究进展%The research advances on metal on metal hip resurfacing arthroplasty

    Institute of Scientific and Technical Information of China (English)

    何志勇; 吴海山

    2009-01-01

    金属对金属全髋关节表面置换术(metal on metal hip resurfacing arthroplasty,MOM—HRA)从1948年Smith—Petersen首先推出的髋关节表面术演变至今,经过了50多年的变革和发展。在上世纪70年代,由于当时材料抗磨损性能差、磨屑颗粒诱导的骨溶解以及高松动率,使得第1代髋关节表面置换假体被放弃了,但在当时仍被认为是治疗年轻而活跃患者的首选方法。

  8. Metal on Metal Surface Replacement of Hip in Young Patients with Rheumatoid Arthritis of Aseptic Necrosis of Femoral Head%金属对金属人工全髋表面置换术的临床应用

    Institute of Scientific and Technical Information of China (English)

    夏庆; 陈统一; 姜晓幸; 姚振钧

    2001-01-01

    Purpose Present study investigated the role of metal on metal surface replacement of the hip in treating the young patients suffering rheumatoid arthritis or aseptic necrosis of femoral head. Methods Between Jan. 1995 and Dec. 1996.16 patients with 17 hips( rheumatoid arthritis 14, aseptic necrosis of femoral head 3) were resurfaced with hybrid metal on metal surface replacement prothesis. Patients were evaluated by self assessment form,hip function examination. Radiographs and Harris hip score. The average follow up time was 58.2 months. Results No patient received revision. Radiographs showed that all implants were in position satisfyingly. No loosening were revealed. The result of self assessment showed that patients were satisfied with 16 hips. The Harris score rose from preoperative 44(31 - 52) to postoperative 91 (79- 96). Conclusions The metal on metal surface replacement of hip is a useful treatment to release pain and keep the hip function of young patients suffering rheumatoid arthritis or aseptic necrosis of femoral head.%目的探讨金属对金属人工全髋表面置换术治疗类风湿性关节炎和股骨头无菌性坏死的临床价值。 方法从1995年1月至1996年12月,对16例患者17个髋关节(其中类风湿性关节炎14个,股骨头无菌性坏 死3个)行混合型金属对金属人工全髋表面置换术,术后行问卷调查、髋关节功能检查、X线和Harris评分分析, 平均随访58.2月。结果所有患者没有一例行翻修手术,X线显示所有表面置换假体植入位置满意,没有假体 松动、移位现象出现。问卷调查显示患者对16个髋关节的术后情况表示非常满意。Harris评分平均指数从术前 的44(31~52)分提高到术后的91(79~96)分。结论金属对金属人工全髋表面置换术不失为患类风湿性关节 炎和股骨头无菌性坏死的年青患者为保存关节功能,改善疼痛的一种有价值的治疗方法。

  9. 21 CFR 888.3380 - Hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... metal/polyacetal cemented prosthesis. 888.3380 Section 888.3380 Food and Drugs FOOD AND DRUG... Devices § 888.3380 Hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis is a...

  10. 21 CFR 888.3390 - Hip joint femoral (hemi-hip) metal/polymer cemented or uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... cemented or uncemented prosthesis. 888.3390 Section 888.3390 Food and Drugs FOOD AND DRUG ADMINISTRATION... § 888.3390 Hip joint femoral (hemi-hip) metal/polymer cemented or uncemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) metal/polymer cemented or uncemented prosthesis is a...

  11. Prevalence of Failure due to Adverse Reaction to Metal Debris in Modern, Medium and Large Diameter Metal-on-Metal Hip Replacements--The Effect of Novel Screening Methods: Systematic Review and Metaregression Analysis.

    Directory of Open Access Journals (Sweden)

    Aleksi Reito

    Full Text Available Metal-on-metal (MoM hip replacements were used for almost a decade before adverse reactions to metal debris (ARMD were found to be a true clinical problem. Currently, there is a paucity of evidence regarding the usefulness of systematic screening for ARMD. We implemented a systematic review and meta-analysis to establish the prevalence of revision confirmed ARMD stratified by the use of different screening protocols in patients with MoM hip replacements. Five levels of screening were identified: no screening (level 0, targeted blood metal ion measurement and/or cross-sectional imaging (level 1, metal ion measurement without imaging (level 2, metal ion measurement with targeted imaging (level 3 and comprehensive screening (both metal ions and imaging for all; level 4. 122 studies meeting our eligibility criteria were included in analysis. These studies included 144 study arms: 100 study arms with hip resurfacings, 33 study arms with large-diameter MoM total hip replacements (THR, and 11 study arms with medium-diameter MoM THRs. For hip resurfacing, the lowest prevalence of ARMD was seen with level 0 screening (pooled prevalence 0.13% and the highest with level 4 screening (pooled prevalace 9.49%. Pooled prevalence of ARMD with level 0 screening was 0.29% and with level 4 screening 21.3% in the large-diameter MoM THR group. In metaregression analysis of hip resurfacings, level 4 screening was superior with regard to prevalence of ARMD when compared with other levels. In the large diameter THR group level 4 screening was superior to screening 0,2 and 3. These outcomes were irrespective of follow-up time or study publication year. With hip resurfacings, routine cross-sectional imaging regardless of clinical findings is advisable. It is clear, however, that targeted metal ion measurement and/or imaging is not sufficient in the screening for ARMD in any implant concepts. However, economic aspects should be weighed when choosing the preferred screening

  12. The effect of 'running-in' on the tribology and surface morphology of metal-on-metal Birmingham hip resurfacing device in simulator studies.

    Science.gov (United States)

    Vassiliou, K; Elfick, A P D; Scholes, S C; Unsworth, A

    2006-02-01

    It is well documented that hard bearing combinations show a running-in phenomenon in vitro and there is also some evidence of this from retrieval studies. In order to investigate this phenomenon, five Birmingham hip resurfacing devices were tested in a hip wear simulator. One of these (joint 1) was also tested in a friction simulator before, during, and after the wear test and surface analysis was conducted throughout portions of the testing. The wear showed the classical running in with the wear rate falling from 1.84 mm3 per 10(6) cycles for the first 10(6) cycles of testing to 0.24 mm3 per 10(6) cycles over the final 2 x 10(6) cycles of testing. The friction tests suggested boundary lubrication initially, but at 1 x 10(6) cycles a mixed lubrication regime was evident. By 2 x 10(6) cycles the classical Stribeck curve had formed, indicating a considerable contribution from the fluid film at higher viscosities. This continued to be evident at both 3 x 10(6) and 5 x 10(6) cycles. The surface study complements these findings.

  13. 金属对金属全髋关节表面置换术的近期疗效%Preliminary results after metal-on-metal hip resurfacing arthroplasty

    Institute of Scientific and Technical Information of China (English)

    何志勇; 狄正林; 曾智敏; 陶崑; 凌晶; 章军辉; 冯建翔

    2012-01-01

    Objective To introduce the technique of metal-on-metal hip resurfacing arthroplasty,evaluate its preliminary clinical results and review the factors which affect the results.Methods From January 2006 to October 2010,104 patients (116 hips) with osteonecrosis of the femoral head,hip osteoarthritis,hip dyplasia,or ankylosing spondylitis were treated with the total hip resurfacing arthroplasty.Among them,59 patients (66 hips) were male,and 45 patients (50 hips) were female,with an average age of 39.7 years (range,16-67 years).Standard operation technique was performed for all patients with Conserve Plus prosthesis.Each patient was followed up at 1 month,3 months,6 months,1 year postoperatively.Results Three patients (4 hips) were lost,so 101 patients (112 hips) were followed up for an average period of 33 months (range,9-66 months).The average Harris hip score was improved significantly from 37.6±6.3 preoperatively to 91.3±5.3 at final follow-up; 104 hips were excellent,7 hips were good,1 hip was poor,and the excellent and good rate was 99.1%.At final follow-up,the average abduction angle of the acetabutar cup was 42.7°(range,36°-55°); the average femoral prothesis stem-shaft angle was 138.5° (range,132°-146°).Two patients presented with heterotopic ossification (Brook Ⅲ and Brook Ⅱ ).One patient presented with prothesis dislocation,which healed after being treated with manual reduction.There was no femoral neck fracture,infection,or prosthesis loosening.Conclusion With strict patient selection criteria and optimized technique,the short-term results of metal-on-metal hip resurfacing arthroplasty are satisfactory.%目的 分析金属对金属全髋关节表面置换术的近期疗效,探讨其适应证选择和技术要点.方法 2006年1月至2010年10月因股骨头坏死、髋关节骨关节炎、髋关节发育不良、强直性脊柱炎接受全髋关节表面置换术104例(116髋),其中男59例(66髋),女45例(50髋);年龄16~67岁,平均39.7

  14. Failure of total hip arthroplasty with Boneloc bone cement.

    Science.gov (United States)

    Gebuhr, P; Stentzer, K; Thomsen, F; Levi, N

    2000-12-01

    Early failure of Boneloc cemented total hip arthroplasty is well documented. However, information regarding the long term prognosis is scanty. The aim of this study was therefore to assess the long term failure rate of total hip replacement with Boneloc bone cement. Between January 1991 and March 1992, Boneloc bone cement (Polymers Recontructive A/S, Farum, Denmark) was used in 42 consecutive total hip replacements in 42 patients. The average age of the patients was 75 years. There were 25 women and 17 men. The diagnosis at operation was osteoarthritis in all cases. A cemented Muller Taperloc femoral stem was used with a cemented Muller acetabular cup (Biomet, Warsaw, USA). The follow-up time was 9 years. All patients underwent radiographic control the first postoperative year and annually after 1995. To date 21 patients have been revised for aseptic loosening at a mean of 5 years (range: one year to 8 years). Three other patients have definite radiographic evidence of loosening. The overall failure rate is therefore 24/42 = 57%. Our results confirm the previously reported poor results of Boneloc bone cement for hip arthroplasty and support the recommendation of indefinite follow-up for surviving prostheses. New prosthesis designs and new cements should have documentation, including laboratory tests and randomized clinical studies with radiostereometric evaluation. However, the ethical responsibility rests heavily on the shoulders of the clinician to make a correct analysis of the need for a new product before he begins to use it.

  15. Similar incidence of periprosthetic fluid collections after ceramic-on-polyethylene total hip arthroplasties and metal-on-metal resurfacing arthroplasties: results of a screening metal artefact reduction sequence-MRI study.

    Science.gov (United States)

    Bisseling, P; de Wit, B W K; Hol, A M; van Gorp, M J; van Kampen, A; van Susante, J L C

    2015-09-01

    Patients from a randomised trial on resurfacing hip arthroplasty (RHA) (n = 36, 19 males; median age 57 years, 24 to 65) comparing a conventional 28 mm metal-on-metal total hip arthroplasty (MoM THA) (n = 28, 17 males; median age 59 years, 37 to 65) and a matched control group of asymptomatic patients with a 32 mm ceramic-on-polyethylene (CoP) THA (n = 33, 18 males; median age 63 years, 38 to 71) were cross-sectionally screened with metal artefact reducing sequence-MRI (MARS-MRI) for pseudotumour formation at a median of 55 months (23 to 72) post-operatively. MRIs were scored by consensus according to three different classification systems for pseudotumour formation. Clinical scores were available for all patients and metal ion levels for MoM bearing patients. Periprosthetic lesions with a median volume of 16 mL (1.5 to 35.9) were diagnosed in six patients in the RHA group (17%), one in the MoM THA group (4%) and six in the CoP group (18%). The classification systems revealed no clear differences between the groups. Solid lesions (n = 3) were exclusively encountered in the RHA group. Two patients in the RHA group and one in the MoM THA group underwent a revision for pseudotumour formation. There was no statistically significant relationship between clinical scoring, metal ion levels and periprosthetic lesions in any of the groups. Periprosthetic fluid collections are seen on MARS-MRI after conventional CoP THA and RHA and may reflect a soft-tissue collection or effusion. Currently available MRI classification systems seem to score these collections as pseudotumours, causing an-overestimatation of the incidence of pseudotumours.

  16. MR imaging with metal artifact-reducing sequences and gadolinium contrast agent in a case-control study of periprosthetic abnormalities in patients with metal-on-metal hip prostheses

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, Gunilla M.; Mueller, Markus F.; Ekberg, Olle [Lund University, Skaane University Hospital, Department of Radiology, Malmoe (Sweden); Maansson, Sven [Lund University, Skaane University Hospital, Department of Medical Radiation Physics, Malmoe (Sweden); Schewelov, Thord von [Lund University, Skaane University Hospital, Department of Orthopedic Surgery, Malmoe (Sweden); Nittka, Mathias [Siemens AG, Healthcare Sector, Erlangen (Germany); Lundin, Bjoern [Lund University, Skaane University Hospital, Department of Radiology, Lund (Sweden)

    2014-08-15

    To apply and compare magnetic resonance imaging (MRI) metal artifact reducing sequences (MARS) including subtraction imaging after contrast application in patients with metal-on-metal (MoM) hip prostheses, investigate the prevalence and characteristics of periprosthetic abnormalities, as well as their relation with pain and risk factors. Fifty-two MoM prostheses (35 cases with pain and or risk factors, and 17 controls) in 47 patients were examined in a 1.5-T MR scanner using MARS: turbo spin echo (TSE) with high readout bandwidth with and without view angle tilting (VAT), TSE with VAT and slice encoding for metal artifact correction (SEMAC), short tau inversion recovery (STIR) with matched RF pulses, and post-contrast imaging. The relations of MRI findings to pain and risk factors were analyzed and in five revised hips findings from operation, histology, and MRI were compared. TSE VAT detected the highest number of osteolyses. Soft tissue mass, effusion, and capsular thickening were common, whereas osteolysis in acetabulum and femur were less frequent. Contrast enhancement occurred in bone, synovia, joint capsule, and the periphery of soft tissue mass. There was no significant relation between MRI findings and pain or risk factors. MARS and gadolinium subtraction imaging are useful for evaluation of complications to MoM prosthesis. TSE VAT had the highest sensitivity for osteolysis. Contrast enhancement might indicate activation of aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL). Pain, small head, or steep prosthesis inclination angle are not useful predictors of periprosthetic abnormalities, and wide indications for MR follow-up are warranted. (orig.)

  17. Wear debris in cemented total hip arthroplasty.

    Science.gov (United States)

    Huo, M H; Salvati, E A; Buly, R L

    1991-03-01

    One of the most prevalent clinical problems in long-term follow up of total hip arthroplasty patients is loosening of prosthetic fixation. Factors contributing to mechanical failure of total hip reconstruction are complex and multiple. It has become increasingly apparent that wear debris from the prosthetic components may contribute significantly to this process. The authors summarize some of the current concepts concerning the detrimental effects of metallic debris in total hip arthroplasty.

  18. Hybrid metal-on-metal hip surface arthroplasty in 18 cases: 2 -year follow-up study%混合型金属对金属人工全髋表面置换术18例:2年随访

    Institute of Scientific and Technical Information of China (English)

    茹江英; 刘璠; 胡玉华; 胡传亮; 王长峰

    2008-01-01

    . Subsequently to install the femoral head prosthesis, femoral cup was laid on the ready caput femoris and impacted by the presser to make the metal cup paste close-up with sclerotin when the concocted bone cement was overlaid on the prefabricated caput femoris surface and internal surface of prosthesis. Further, short-term of femoral cup should be kept the conformity with axial ray of the femoral neck. ②Patients were allowed to make the function exercise such as initiative stretch and contract of quadriceps muscle of thigh, passive motion of the knee joint and initiative motion of the knee joint under the non-weight loading on bed. Then they were encouraged to walk with two walking sticks two weeks after operation, progressing to get out of the two walking sticks six weeks postoperatively. All affected extremities were fixated with T-shaped tabula shoes in the abduction position after operation. ③All patients were reviewed with taking the anteroposterior radiographs of pelvis, evaluation of the clinically curative effect on the procedure of metal-on-metal hip surface arthroplasty and biocompatibility between the prosthesis and the host one year and two years after operation. Moreover, Harris score was assessed for all affected hips preoperatively, one year and two years postoperatively.MAIN OUTCOME MEASURES: ①The clinically curative effect on metal on metal hip surface arthroplasty; ②Biocompatibility;③The Harris score for the affected hips; ④The pain status of hip after operation.RESULTS: Eighteen cases were all brought into the outcome analysis at last.①The curative effect on the metal-on-metal hip surface arthroplasty: The femoral component of one case had a varus deformation of 10°six weeks after operation, but such complications as component loosening and femoral neck fractures, etc. Did not occur during the coming follow-up. The locations of rest prosthesis were satisfactory. Substantial radiolucencies were found at the rim of acetabular component (1 and 2

  19. Philosophies of stem designs in cemented total hip replacement.

    NARCIS (Netherlands)

    Verdonschot, N.J.J.

    2005-01-01

    Stem designs, which have different design features, may produce similar clinical survival curves. Alteratively, some designs that are considered to be similar in design produce different survival rates. In this paper, design aspects of cemented femoral total hip replacement stems, how they can be gr

  20. The behavior of the micro-mechanical cement-bone interface affects the cement failure in total hip replacement

    NARCIS (Netherlands)

    Waanders, D.; Janssen, D.; Mann, K.A.; Verdonschot, N.J.J.

    2011-01-01

    In the current study, the effects of different ways to implement the complex micro-mechanical behavior of the cement-bone interface on the fatigue failure of the cement mantle were investigated. In an FEA-model of a cemented hip reconstruction the cement-bone interface was modeled and numerically im

  1. CoCr wear particles generated from CoCr alloy metal-on-metal hip replacements, and cobalt ions stimulate apoptosis and expression of general toxicology-related genes in monocyte-like U937 cells

    Energy Technology Data Exchange (ETDEWEB)

    Posada, Olga M., E-mail: O.M.PosadaEstefan@leeds.ac.uk [Biomedical Engineering Department, University of Strathclyde, Wolfson Centre, Glasgow G4 0NW (United Kingdom); Gilmour, Denise [Pure and Applied Chemistry Department, University of Strathclyde, Thomas Graham Building, Glasgow G1 1XL (United Kingdom); Tate, Rothwelle J., E-mail: r.j.tate@strath.ac.uk [Strathclyde Institute for Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE (United Kingdom); Grant, M. Helen [Biomedical Engineering Department, University of Strathclyde, Wolfson Centre, Glasgow G4 0NW (United Kingdom)

    2014-11-15

    Cobalt-chromium (CoCr) particles in the nanometre size range and their concomitant release of Co and Cr ions into the patients' circulation are produced by wear at the articulating surfaces of metal-on-metal (MoM) implants. This process is associated with inflammation, bone loss and implant loosening and led to the withdrawal from the market of the DePuy ASR™ MoM hip replacements in 2010. Ions released from CoCr particles derived from a resurfacing implant in vitro and their subsequent cellular up-take were measured by ICP-MS. Moreover, the ability of such metal debris and Co ions to induce both apoptosis was evaluated with both FACS and immunoblotting. qRT-PCR was used to assess the effects on the expression of lymphotoxin alpha (LTA), BCL2-associated athanogene (BAG1), nitric oxide synthase 2 inducible (NOS2), FBJ murine osteosarcoma viral oncogene homolog (FOS), growth arrest and DNA-damage-inducible alpha (GADD45A). ICP-MS showed that the wear debris released significant (p < 0.05) amounts of Co and Cr ions into the culture medium, and significant (p < 0.05) cellular uptake of both ions. There was also an increase (p < 0.05) in apoptosis after a 48 h exposure to wear debris. Analysis of qRT-PCR results found significant up-regulation (p < 0.05) particularly of NOS2 and BAG1 in Co pre-treated cells which were subsequently exposed to Co ions + debris. Metal debris was more effective as an inducer of apoptosis and gene expression when cells had been pre-treated with Co ions. This suggests that if a patient receives sequential bilateral CoCr implants, the second implant may be more likely to produce adverse effects than the first one. - Highlights: • Effects of CoCr nanoparticles and Co ions on U937 cells were investigated. • Ions released from wear debris play an important role in cellular response, • Toxicity of Co ions could be related to NO metabolic processes and apoptosis. • CoCr particles were a more effective inducer of apoptosis after cell

  2. 21 CFR 888.3340 - Hip joint metal/composite semi-constrained cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... cemented prosthesis. 888.3340 Section 888.3340 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Hip joint metal/composite semi-constrained cemented prosthesis. (a) Identification. A hip joint metal/composite semi-constrained cemented prosthesis is a two-part device intended to be implanted to replace...

  3. Analysis of Femoral Components of Cemented Total Hip- Arthroplasty

    CERN Document Server

    Singh, Shantanu

    2014-01-01

    In cemented Total Hip Arthroplasty (THA), material chosen for femoral stem and cross section of stem itself, proved to be critical parameters for, stress distribution in the femoral components, interfacial stresses and micro movements. Titanium alloy (Ti6Al4V), when used as a material for femoral stem, recorded large displacement as compared to Chromium alloy (CoCrMo) stems. This large displacement in case of Ti6Al4V caused the stem to bend inside the cement mantle, thus destroying it. Thus, CoCrMo proved to be a better in cemented THA. Failure in THA may occur at cement-stem or cement-bone interface, thus interfacial stresses and micro movements were analysed in the present study. Comparison between trapezium and circular cross section showed that, femoral stem with trapezium cross section underwent lesser amount of sliding and debonding, at both interfaces, as compared to circular cross section. Moreover, trapezium cross section also generated lower peak stresses in femoral stem and cortical femur. The pres...

  4. 21 CFR 888.3350 - Hip joint metal/polymer semi-constrained cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... prosthesis. 888.3350 Section 888.3350 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... metal/polymer semi-constrained cemented prosthesis. (a) Identification. A hip joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace a hip joint. The device...

  5. 21 CFR 888.3300 - Hip joint metal constrained cemented or uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... prosthesis. 888.3300 Section 888.3300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... metal constrained cemented or uncemented prosthesis. (a) Identification. A hip joint metal constrained cemented or uncemented prosthesis is a device intended to be implanted to replace a hip joint. The...

  6. 21 CFR 888.3310 - Hip joint metal/polymer constrained cemented or uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... uncemented prosthesis. 888.3310 Section 888.3310 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Hip joint metal/polymer constrained cemented or uncemented prosthesis. (a) Identification. A hip joint metal/polymer constrained cemented or uncemented prosthesis is a device intended to be implanted...

  7. A Biomimetic Hip Joint Simulator and its Application in in vitro Study of the Integrity of Replacement Cemented Hip

    Institute of Scientific and Technical Information of China (English)

    Liu Chao-zong; S.M.Green; N.D.Watkins; A.W.McCaskie

    2005-01-01

    A biomimetic hip joint simulator that can be used to evaluate the outcome of the cemented total hip replacement has been designed, manufactured and evaluated. The simulator produces motion in the extension/flexion plane, with a socket to rotate internal/externally. At the same time a dynamic loading cycle is applied. A validation test was performed on a cemented femoral stem within a novel composite femur. The bone quality has a strong effect on the stem migration and on the integrity of the interfaces. The migration of the stem is a combination of 3-D translation and rotation of the stem. Under the same loading conditions, weak bone allows more stem migration than strong bone. There is a great decrease in the strength of the stem-cement interface after the dynamic test, and the weak bone composite exhibited a greater reduction in interfacial strength than the strong bone composite. The decrease of the interfacial strength indicates that the primary bonding between the stem and the cement mantle had deteriorated and the integrity of stem-cement interface was damaged.The study demonstrates the value of using a hip joint simulator to investigate stem migration and interface integrity within the cemented hip replacement, suggesting that method can be used for in vitro evaluation of the biomaterials used in the cemented hip replacements.

  8. Hip-joint and abductor-muscle forces adequately represent in vivo loading of a cemented total hip reconstruction.

    NARCIS (Netherlands)

    Stolk, J.; Verdonschot, N.J.J.; Huiskes, R.

    2001-01-01

    Using finite element analyses, we investigated which muscle groups acting around the hip-joint most prominently affected the load distributions in cemented total hip reconstructions with a bonded and debonded femoral stem. The purpose was to determine which muscle groups should be included in pre-cl

  9. Effects of metal-inlay thickness in polyethylene cups with metal-on-metal bearings.

    NARCIS (Netherlands)

    Verdonschot, N.J.J.; Vena, P.; Stolk, J.; Huiskes, R.

    2002-01-01

    A way to prevent polyethylene wear in total hip replacements is to use metal-on-metal bearings. The cup design of these bearings may be a metal inlay in a polyethylene cup. However, these metal inlays are relatively thin and may deform on loading. The purpose of the current study was to determine wh

  10. Boneloc bone-cement: experience in hip arthroplasty during a 3-year period.

    Science.gov (United States)

    Abdel-Kader, K F; Allcock, S; Walker, D I; Chaudhry, S B

    2001-10-01

    Polymethyl methacrylate (PMMA) bone-cement was introduced in the 1960s for fixation of total hip arthroplasty replacement components. Long-term results of cement fixation for hip and knee arthroplasty have been extremely good. Although the use of PMMA bone-cement has enabled long-term survival of joint arthroplasty implants, there has been concern about aseptic loosening. This concern led to the introduction of Boneloc bone-cement (Biomet, Warsaw, IN) in the early 1990s. It was hoped that with the improved physical and chemical characteristics of Boneloc, there would be less aseptic loosening in the long-term. A clinical trial was conducted to evaluate Boneloc bone-cement in cementing the femoral component of the Bimetric total hip arthroplasty prosthesis in 33 hips in 32 patients. On follow-up, 7 stems (24%) developed definite loosening, and 3 stems (10%) were possibly loose. Of the 7 definite loose stems, 5 (17%) were revised because of increasing pain or progressive loosening. Despite the biologic advantages of Boneloc, this study suggests that the chemicals substituted in Boneloc bone-cement led to an alteration in its mechanical properties. These properties proved to be inferior to conventional PMMA bone-cement. There is possible time-dependent deterioration of mechanical properties leading to early aseptic loosening. The conventional PMMA bone-cement has stood the test of time. Research and experimental studies should continue to improve the mechanical properties of Boneloc before further human trials.

  11. A fluoroscopy-based planning and guidance software tool for minimally invasive hip refixation by cement injection

    NARCIS (Netherlands)

    Malan, D.F.; Van der Walt, S.J.; Raidou, R.G.; Van den Berg, B.; Stoel, B.C.; Botha, C.P.; Nelissen, R.G.H.H.; Valstar, E.R.

    2015-01-01

    Purpose In orthopaedics, minimally invasive injection of bone cement is an established technique. We present HipRFX, a software tool for planning and guiding a cement injection procedure for stabilizing a loosening hip prosthesis. HipRFX works by analysing a pre-operative CT and intraoperative C-arm

  12. Percutaneous bone cement refixation of aseptically loose hip prostheses: the effect of interface tissue removal on injected cement volumes

    Energy Technology Data Exchange (ETDEWEB)

    Malan, Daniel F. [Leiden University Medical Center, Department of Orthopaedics, Leiden (Netherlands); Delft University of Technology, Department of Intelligent Systems, Delft (Netherlands); Valstar, Edward R. [Leiden University Medical Center, Department of Orthopaedics, Leiden (Netherlands); Delft University of Technology, Department of Biomechanical Engineering, Delft (Netherlands); Nelissen, Rob G.H.H. [Leiden University Medical Center, Department of Orthopaedics, Leiden (Netherlands)

    2014-11-15

    To quantify whether injected cement volumes differed between two groups of patients who underwent experimental minimally invasive percutaneous cement injection procedures to stabilize aseptically loose hip prostheses. One patient group was preoperatively treated using gene-directed enzyme prodrug therapy to remove fibrous interface tissue, while the other group received no preoperative treatment. It was hypothesized that cement penetration may have been inhibited by the presence of fibrous interface tissue in periprosthetic lesions. We analyzed 17 patients (14 female, 3 male, ages 72-91, ASA categories 2-4) who were treated at our institution. Osteolytic lesions and injected cement were manually delineated using 3D CT image segmentation, and the deposition of injected cement was quantified. Patients who underwent preoperative gene-directed enzyme therapy to remove fibrous tissue exhibited larger injected cement volumes than those who did not. The observed median increase in injected cement volume was 6.8 ml. Higher cement leakage volumes were also observed for this group. We conclude that prior removal of periprosthetic fibrous interface tissue may enable better cement flow and penetration. This might lead to better refixation of aseptically loosened prostheses. (orig.)

  13. Early clinical effects and complications of metal-on-metal hip resurfacing arthroplasty%金属对金属髋关节表面置换术的早期临床疗效及其并发症

    Institute of Scientific and Technical Information of China (English)

    陈伟义; 李奇; 林荔军

    2009-01-01

    髋关节表面置换术从20世纪50年代开始已经运用于临床,但由于早期的技术不成熟、股骨颈骨折发生率高、关节假体易磨损、假体早期松动率高等缺点,髋关节表面置换术到80年代几近消失。而全髋关节置换术(total hip arthroplasty,THA)在老年髋关节疾病患者中取得了良好的临床效果,但对年轻患者和对活动要求高的患者却不能提供理想的长久的临床疗效。从20世纪90年代中期以来,

  14. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    Science.gov (United States)

    2010-04-01

    ... cemented acetabular component, prosthesis. 888.3320 Section 888.3320 Food and Drugs FOOD AND DRUG..., prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis is a two-part device intended to be implanted to replace a hip joint. The...

  15. 21 CFR 888.3353 - Hip joint metal/ceramic/polymer semi-constrained cemented or nonporous uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... cemented or nonporous uncemented prosthesis. 888.3353 Section 888.3353 Food and Drugs FOOD AND DRUG... prosthesis. (a) Identification. A hip joint metal/ceramic/polymer semi-constrained cemented or nonporous uncemented prosthesis is a device intended to be implanted to replace a hip joint. This device...

  16. Gait analysis of patients with resurfacing hip arthroplasty compared with metal-on-metal bigfemoral-head total hip arthroplasty%全髋表面置换与金属对金属大直径股骨头全髋置换术后的步态分析比较

    Institute of Scientific and Technical Information of China (English)

    陈云苏; 赵松; 曹乐; 张先龙

    2010-01-01

    目的 比较全髋关节表面置换术与金属对金属大直径股骨头全髋关节置换术患者术后1年的步态有无差异.方法 选择2006年6月至2009年3月期间行全髋关节表面置换术与金属对金属大直径股骨头全髋关节置换术的连续病例各30例,利用Vicon步态分析仪测得两组患者术后平均1年左右的步态参数和步态周期中的髋、膝关节活动度,计算自身患侧/健侧比值进行比较分析.结果 两组患者术后平均1年左右步频、单腿支撑时间等比值和美国特种外科医院评分及加州大学洛杉矶分校评分比较差异无统计学意义,但全髋关节表面置换组患者步态周期中的髋屈伸度、收展度、旋转度及膝关节屈伸度患/健比分别为1.0323、0.9747、1.0558、1.0027,明显高于大直径股骨头全髋关节置换组(患/健比分别为0.8615、0.7824、0.8162、0.9472),P值分别为0.007、0.005、0.006、0.037.结论 (1)全髋关节表面置换术与金属对金属大直径股骨头全髋关节置换术患者术后1年的步态参数接近正常;(2)全髋关节表面置换术后患者行走时的关节活动度优于金属对金属大直径股骨头全髋关节置换术患者;(3)采用全髋关节表面置换除了能够保留骨量,还能最大程度恢复患者的关节功能.%Objective To compare gait patterns in patients with metal-on-metal resurfacing hip arthroplasty(RHA)and big-femoral-head total hip arthroplasty(BHA)at one year postoperatively.Methods From June 2006 to March 2009,two groups of 30 RHA and BHA patients participated in the study.Gait parameters,knee and hip joint range of motions(ROMs)in gait cycles were measured at one year postoperatively by Vicon gait analysis system,and the values were used to calculate affected/unaffected ratios of patients themselves.Results No significant difference were found in affected/unaffected ratios of cadence,single limb support time,foot off,peak value of vertical ground

  17. 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.

  18. Impact of implant size on cement filling in hip resurfacing arthroplasty.

    Science.gov (United States)

    de Haan, Roel; Buls, Nico; Scheerlinck, Thierry

    2014-01-01

    Larger proportions of cement within femoral resurfacing implants might result in thermal bone necrosis. We postulate that smaller components are filled with proportionally more cement, causing an elevated failure rate. A total of 19 femoral heads were fitted with polymeric replicas of ReCap (Biomet) resurfacing components fixed with low-viscosity cement. Two specimens were used for each even size between 40 and 56 mm and one for size 58 mm. All specimens were imaged with computed tomography, and the cement thickness and bone density were analyzed. The average cement mantle thickness was 2.63 mm and was not correlated with the implant size. However, specimen with low bone density had thicker cement mantles regardless of size. The average filling index was 36.65% and was correlated to both implant size and bone density. Smaller implants and specimens with lower bone density contained proportionally more cement than larger implants. According to a linear regression model, bone density but not implant size influenced cement thickness. However, both implant size and bone density had a significant impact on the filling index. Large proportions of cement within the resurfacing head have the potential to generate thermal bone necrosis and implant failure. When considering hip resurfacing in patients with a small femoral head and/or osteoporotic bone, extra care should be taken to avoid thermal bone necrosis, and alternative cementing techniques or even cementless implants should be considered. This study should help delimiting the indications for hip resurfacing and to choose an optimal cementing technique taking implant size into account.

  19. Femoral and obturator nerves palsy caused by pelvic cement extrusion after hip arthroplasty.

    Directory of Open Access Journals (Sweden)

    Pawel Zwolak

    2011-05-01

    Full Text Available Cement extrusion into the pelvis with subsequent palsy of the obturator and femoral nerves is a rare entity after hip replacement surgery. Cemented fixation of the acetabular cup has been considered as a safe and reliable standard procedure with very good long term results. We present a case of fifty year old female patient after hip arthroplasty procedure which suffered an obturator and femoral nerve palsy caused by extrusion of bone cement into the pelvis. Postoperative X-rays and CT-scan of the pelvis demonstrated a huge mass consisted of bone cement in close proximity of femoral and obturator nerves. The surgery charts reported shallow and weak bony substance in postero-superior aspect of the acetabulum. This weak bony acetabular substance may have caused extrusion of bone cement during press-fitting of the polyethylene cup into the acetabulum, and the following damage of the both nerves produced by polymerization of bone cement. The bone cement fragment has been surgically removed 3 weeks after arthroplasty. The female patient underwent intensive postoperative physical therapy and electro stimulation which resulted in full recovery of the patient to daily routine and almost normal electromyography results.

  20. Clinical application and therapeutic effectiveness of large diameter head metal-on-metal total hip replacement%金属对金属大直径股骨头全髋关节置换术的临床应用及近期疗效观察

    Institute of Scientific and Technical Information of China (English)

    刘二涛; 徐皓; 陈建梅; 姚晓东; 李金泉

    2013-01-01

    Objective To explore the short-term results of total hip replacement THR ) using large diameter heads( LDH )in metal-on-metal( MOM )articulation. Methods A consecutive series of 34 patients( 34 hips )who underwent THR using LDH in MOM articulation were studied. The results were e-valuated both clinically and radio graphically. Clinical outcomes were evaluated according to the Harris e-valuation score and the R0M( Range of motion ). Acetabular position, components migration and bone changes around the implant were measured radiographically. Results The average follow-up period of all 34 patients was 18. 7 months. There was no bright line around the prosthesis. No complications such as os-teolysis, prosthetic loosening, heterotopic ossification and prosthesis fracture occurred. The average Harris hip score at the last follow-up was significantly improved compared with the preoperative scores( 87. 82 points versus 35. 29 points ). The postoperative ROM of all patients improved remarkably. Conclusion The short-term results of LDH in MOM total hip replacement on hip osteoarthritis, aseptic femoral head necrosis, femur neck fracture and congenital hip hypoplasia are excellent. But the long-term results of THR using LDH in MOM articulation still need further investigation.%目的 总结金属对金属大直径股骨头全髋关节置换术(total hip replacement,THR)的近期疗效.方法 回顾性分析行金属对金属大直径股骨头THR患者34例34髋.临床评估以Harris评分及髋关节活动度为标准.影像学根据双髋关节正位片,观察髋臼、股骨假体的位置及周围骨质的改变.结果 34例患者平均随访18.7个月.术后均无假体周围透亮线产生,无骨溶解、假体松动、异位骨化及假体断裂等并发症.Harris评分由术前的20~48分,平均(35.29±8.59)分,提高至术后随访时的76~96分,平均(87.82±5.12)分.所有患者髋关节活动度术后显著提高.结论 采用金属对金属大直径股骨

  1. Complications Related to Metal-on-Metal Articulation in Trapeziometacarpal Joint Total Joint Arthroplasty

    Directory of Open Access Journals (Sweden)

    Christina Frølich

    2015-05-01

    Full Text Available Adverse reactions to metal-on-metal (MoM prostheses are well known from total hip joint resurfacing arthroplasty with elevated serum chrome or cobalt, pain and pseudo tumor formation. It may, however, also be seen after total joint replacement of the trapeziometacarpal joint using MoM articulation, and we present two cases of failure of MoM prostheses due to elevated metal-serum levels in one case and pseudo tumor formation in another case. Furthermore, we suggest a diagnostic algorithm for joint pain after MoM trapeziometacarpal joint replacement based on published experiences from MoM hip prostheses and adverse reactions to metal.

  2. Complications Related to Metal-on-Metal Articulation in Trapeziometacarpal Joint Total Joint Arthroplasty

    DEFF Research Database (Denmark)

    Frølich, Christina; Hansen, Torben Bæk

    2015-01-01

    Adverse reactions to metal-on-metal (MoM) prostheses are well known from total hip joint resurfacing arthroplasty with elevated serum chrome or cobalt, pain and pseudo tumor formation. It may, however, also be seen after total joint replacement of the trapeziometacarpal joint using MoM articulation......, and we present two cases of failure of MoM prostheses due to elevated metal-serum levels in one case and pseudo tumor formation in another case. Furthermore, we suggest a diagnostic algorithm for joint pain after MoM trapeziometacarpal joint replacement based on published experiences from MoM hip...

  3. Infection or metal hypersensitivity? The diagnostic challenge of failure in metal-on-metal bearings.

    LENUS (Irish Health Repository)

    Galbraith, John G

    2011-04-01

    The use of second generation metal-on-metal hip articulations has gained favour in the past few years. A hypersensitivity reaction to the metal-on-metal bearing, although rare, is a reported complication and is a novel mode of failure of these implants. Differentiating failure secondary to infection from failure secondary to metal hypersensitivity represents a significant diagnostic challenge. A retrospective review of all cases of hip arthroplasty using metal-on-metal bearings over a 5-year period at a tertiary referral centre identified 3 cases of failure secondary to metal hypersensitivity. Clinical presentation, serological markers, radiological imaging and histological analysis of all cases identified were evaluated. Histological analysis of periprosthetic tissue in all 3 cases identified characteristic features such as perivascular lymphocytic aggregates and chronic inflammation consistent with aseptic lymphocytic vasculitis-associated lesions (ALVAL). This study highlights that failure secondary to metal hypersensitivity must be considered in patients presenting with the reappearance of persistent pain, marked joint effusion, and the development of early osteolysis in the absence of infection.

  4. Resultados preliminares da artroplastia do quadril metal-metal de superfície: análise dos primeiros 40 casos com seguimento médio de 3 anos Preliminary outcomes of hip metal-on-metal resurfacing arthroplasty: an analysis of the first 40 cases with mean follow-up time of 3 years

    Directory of Open Access Journals (Sweden)

    Mauricio de Moraes

    2008-01-01

    Full Text Available Quarenta quadris (39 pacientes foram submetidos à artroplastia total metal-metal de superficie "resurfacing" entre 2002 e 2005. Todos foram estudados e analisados clinicamente e radiograficamente. Foram utilizados critérios clínicos, no pré e pós-operatório, pela avaliação de D'Aubigné e Postel. Radiograficamente, as áreas de radiolucência ao redor do acetábulo foram classificadas de acordo com DeLee e Charnley e, no fêmur nas zonas descritas por Amstutz et al. A idade média foi de 54,40 anos. O seguimento mínimo foi de 14 meses e o máximo de 51(média de 37,36 meses. 94,44% dos resultados clínicos foram satisfatórios no pós-operatório. Ocorreram 2 casos de soltura asséptica. Não houve fratura do fêmur durante o seguimento. Os autores consideraram esta opção técnica e de implante satisfatória e, com bons resultados no seguimento médio de 3 anos.Forty hips (39 patients were submitted to metal-on-metal hip replacement (resurfacing between 2002 and 2005. Evaluation was provided by clinical examination and X-ray tests. The authors performed clinical evaluations before and after surgery. The specific criterion applied was the D'Aubigné and Postel's classification. X-ray images showed radiolucent lines around the acetabular component on the zones described by DeLee and Charnley and around the femoral component on the zones described by Amstutz et al. The mean age was 54.40 years. The minimum follow-up period was 14 months (range:12 to 51 months. The outcomes of 94.44% of the patients in the study were postoperatively rated as satisfactory. There were 2 cases of aseptic loose and no neck-femoral fractures during the follow-up period. The authors concluded that this technique and implant alternative is satisfactory, with good early outcomes in a mean follow-up time of three years.

  5. Intraoperative monitoring for safety of total hip arthroplasty using third-generation cementing technique

    Institute of Scientific and Technical Information of China (English)

    LI Zi-jian; ZHANG Ke; YANG Hong; LIU Yan; L(U) Jing-qiao

    2009-01-01

    Background Controversies on the safety of the cement application between cemented and uncemented total hip arthroplasty (THA) have been existing for decades. The purpose of this study was to observe the changes in mean arterial pressure (MAP), heart rate (HR) and oxygen pressure (PaO2) during cemented THA, and to evaluate the intraoperative safety of using the third-generation cementing technique and investigate whether the intraoperative risk is higher in acute femoral neck fracture patients than non-traumatic patients. Methods Forty-two patients who underwent cemented THA between November 2005 and September 2007 were prospectively included in this study. The third-generation cementing technique as vacuum mixing and pulsatile lavage was used strictly. The MAP and HR were monitored and documented during each operation. Blood gas analysis was performed at exposure, cup implantation, stem implantation and wound closure. MAP, HR and PaO2 were compared between pre- and post-cement application. Comparisons of MAP, HR and PaO2 between patients with acute femoral neck fracture and non-traumatic patiens were performed as well. Results No intraoperative cardiopulmonary complication occurred in these cases. No obvious changes were observed in MAP, HR and PaO2 after cement application. There was no significant difference in MAP, HR and PaO2 between acute femoral fracture patients (18 patients) and non-traumatic patients (24 patients).Conclusions The results of this study suggested that the invasive blood pressure monitoring and blood gas analysis are essential for patients undergoing cemented THA, especially for patients with femoral neck fracture. The third-generation cementing technique is safe to use in THA.

  6. 21 CFR 888.3410 - Hip joint metal/polymer or ceramic/polymer semiconstrained resurfacing cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... semiconstrained resurfacing cemented prosthesis. 888.3410 Section 888.3410 Food and Drugs FOOD AND DRUG... prosthesis. (a) Identification. A hip joint metal/polymer or ceramic/polymer semi-constrained resurfacing cemented prosthesis is a two-part device intended to be implanted to replace the articulating surfaces...

  7. Primary and revision total hip replacement without cement and with associated femoral osteotomy.

    Science.gov (United States)

    Holtgrewe, J L; Hungerford, D S

    1989-12-01

    Nine porous-coated total hip prostheses were implanted without cement in nine patients who had a major proximal femoral deformity. Six patients had revision and three, primary total hip replacement. In all nine patients, as well placed corrective osteotomy was needed to successfully perform the arthroplasty. The average time until union of the proximal femoral osteotomy was fifteen weeks for the patients who had a primary arthroplasty and twenty-seven weeks for the patients who had a revision arthroplasty. The average Harris hip-rating score was 94 points for the patients who had a primary arthroplasty and 84 points (range, 60 to 93 points) for those who had a revision arthroplasty. The length of follow-up averaged forty-seven months.

  8. Outcomes of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw

    Directory of Open Access Journals (Sweden)

    Rakesh Kumar Gupta

    2012-01-01

    Full Text Available Background: Dynamic hip screw (DHS has been the standard treatment for stable trochanteric fracture patterns, but complications of lag screw cut out from a superior aspect, due to inadequate bone anchorage, occur frequently in elderly osteoporotic patients. Polymethylmethacrylate (PMMA has been used as an augmentation tool to facilitate fixation stability in cadaveric femora for biomechanical studies and in pathological fractures. However, there are very few reports on the utilization of PMMA cement to prevent these complications in fresh intertrochanteric fractures. A prospective study was conducted to evaluate the outcome and efficacy of PMMA augmented DHS in elderly osteoporotic patients with intertrochanteric fractures. Materials and Methods: The study included 64 patients (AO type31-A2.1 in eight, A2.2 in 29, A2.3 in 17 patients, and 31-A3.1 in five, A3.2 in three, and A3.3 in two patients with an average age of 72 years (60 − 94 years of which 60 were available for final followup. PMMA augmentation of DHS was performed in all cases by injecting PMMA cement into the femoral head with a custommade gun designed by the authors. The clinical outcome was rated as per the Salvati and Wilson scoring system at the time of final followup of one year. Results were graded as excellent (score > 31, good (score 24 − 31, fair (score 16 − 23, and poor (score < 16. Results: Fracture united in all patients and the average time to union was 13.8 weeks (range 12 − 16 weeks. At an average followup of 18 months (range 12 − 24 months, no incidence of varus collapse or superior screw cut out was observed in any of the patients in spite of weightbearing ambulation from the early postoperative period. There was no incidence of avascular necrosis (AVN or cement penetration into the joint in our series. Most of the patients were able to regain their prefracture mobility status with a mean hip pain score of 8.6. Conclusion: Cement augmentation of DHS appears

  9. Computer simulation on fatigue behavior of cemented hip prostheses: a physiological model.

    Science.gov (United States)

    Hung, Jui-Pin; Chen, Jian-Horng; Chiang, Hsiu-Lu; Wu, James Shih-Shyn

    2004-11-01

    This paper is concerned with the investigation on the fatigue failure of implant fixation by numerical approaches. A computer algorithm based on finite element analysis and continuum damage mechanics was proposed to quantify the fatigue damage rate of cement mantle under physiological conditions. In examining the interfacial debonding effect, the interface elements were introduced at cement-stem interfaces and calibrated with the increase of loading cycles. Current results reveal that the major sites for failure initiation are in the proximal anterior-medial regions and at the distal prosthesis tip, which clearly demonstrate the same failure scenario as observed in clinical studies. Such fatigue failures not only result in the corruption of cement-stem interfaces, but also greatly affect the cement stress distribution and the damage rate in subsequent loading cycles. Another significant result is that the predicted damage rate increases steadily with gait cycles. This trend in damage development is consistent with the findings obtained from fatigue tests available in literature. It is anticipated that presented methodology can serve as a pre-clinical validation of cemented hip prostheses.

  10. Hip resurfacing arthroplasty: mid-term results in 486 cases and current indication in our institution.

    Science.gov (United States)

    Ribas, Manuel; Cardenas, Carlomagno; Astarita, Emanuele; Moya, Esther; Bellotti, Vittorio

    2014-10-02

    In the previous decade, metal-on-metal hip resurfacing has been considered an attractive option and theoretically advantageous over conventional total hip arthroplasty, especially in young active patients. Different authors have reported favourable mid-term clinical and functional results with acceptable survival rates. Proper indication and planning, as accurate technical execution have been advocated to be crucial elements for success.Concerns regarding serum metal ion levels and possible clinical implications have led in the last years to a decline in the use of metal-on-metal hip resurfacing and metal-on-metal bearings in general.The aim of this study is to present the results of our first 486 cases of hybrid hip resurfacing arthroplasties with a second generation cementing technique, and to describe our current restricted indication of this type of prosthesis, in the light of recent findings in the literature about the possible complications related to metallosis or improper patient selection. Global survivorship of our series was 97.9% at a mean follow-up of 7.2 years.In the second season of our experience the indication is restrictive. The candidate for a resurfacing hip replacement is a young and active male patient, with good bone quality, that has been made aware of the risks and benefits of this type of prosthesis.

  11. 缺血性股骨头坏死塌陷程度与金属对金属全髋表面置换术疗效的关系%Relationship between the collapse level of avascular necrosis of femoral fead and clinical results of metal-on-metal hip resurfacing

    Institute of Scientific and Technical Information of China (English)

    茹江英; 刘璠; 胡玉华; 王长峰; 胡传亮

    2008-01-01

    [目的]探讨缺血性股骨头坏死(avascular necrosis of femoral head, ANFH)塌陷程度与金属对金属全髋表面置换术(metal-on-metal hip resurfacing, MOMHR)疗效的关系,为术前合理选择缺血性股骨头坏死患者提供依据.[方法]从2003年11月~2006年9月,先后对27例(36髋)缺血性股骨头坏死患者行混合型金属对金属全髋表面置换术(conserve plus, wright),平均年龄43岁(28~54岁),平均体重指数(RMI)27.3(20.5~44.8).按国际骨循环研究会(association for research circulation osseous, ARCO)的建议分类法,将手术病例分为ⅢA、ⅢB、ⅢC、Ⅳ期四组,并分别进行术前、后的Harris评分,术后疼痛情况,术前后膝关节屈曲度及双下肢长度差异的测量及X线分析.[结果]平均随访29.6个月(16~50个月).最后一次随访时,36髋中3髋发生轻微疼痛,1髋严重疼痛.X线结果显示2例髋臼假体周围1、2区可见透光区;1例股骨假体松动而行全髋置换(THR)翻修术;1例股骨假体内翻成角10°,但未见假体松动迹象,全组无股骨颈骨折、股骨颈狭窄及假体断裂等并发症发生.术后ⅢA+ⅢB期组在Harris评分、疼痛发生及双下肢长度差异方面的恢复程度均显著高于ⅡC+Ⅳ期组(P<0.05),而在屈曲度改善方面ⅢA+ⅢB期组却显著低于ⅢC+Ⅳ期组(P<0.05).[结论]对于ARCOⅢ、Ⅳ期缺血性股骨头坏死患者,塌陷程度≤4 mm且未累及髋臼病变的病例应用金属对金属全髋表面置换,术后的早期疗效较为满意.

  12. 性别对金属对金属全髋表面置换术后血清钴铬钼离子水平的影响%Gender difference in metal ion levels following metal-on-metal resurfacing hip arthroplasty

    Institute of Scientific and Technical Information of China (English)

    王伟; 刘璠; 刘华; 陶然; 杨洪伟; 刘雅克

    2015-01-01

    目的 探讨性别对金属对金属全髋表面置换术(RHA)后血清钴、铬、钼离子水平的影响. 方法 收集2008年11月至2013年3月因交通伤导致的24例单侧股骨头骨折患者,根据性别不同分为两组:男性组12例,平均年龄为(54.7±5.9)岁,股骨头骨折分型:31-C1型5例,31-C2型7例;女性组12例,平均年龄为(53.9±5.8)岁,股骨头骨折分型:31-C1型6例,31-C2型6例.所有患者均行金属对金属RHA治疗.分别于术前、术后3个月、6个月、9个月及12个月应用电化学微量元素测定法测量患者血清中钴、铬、钼离子的浓度,并比较两组患者的差异. 结果 男性组和女性组患者术后血清钴、铬离子浓度明显升高,术后6个月达到高峰,此后开始下降.男性组患者术后3、6、9及12个月时血清钴离子浓度平均分别为(1.37±0.50)、(2.51 ±0.78)、(1.99±0.46)、(1.26±0.60)μg/L,铬离子浓度平均分别为(0.98 ±0.18)、(1.39±0.44)、(1.12±0.21)、(0.74±0.15) μg/L.女性组患者术后血清钴离子浓度平均分别为(1.23±0.59)、(2.17 ±0.82)、(1.79 ±0.43)、(1.23±0.11)μg/L,铬离子浓度平均分别为(0.90 ±0.20)、(1.19±0.31)、(1.03±0.20)、(0.74±0.17)μg/L.两组患者术后3、6、9及12个月血清钼离子浓度无明显变化.除了术后9个月男性组患者铬离子浓度显著高于女性组患者(P<0.05)外,其他时间点两组患者钴、铬、钼离子浓度比较差异均无统计学意义(P>0.05). 结论 除术后9个月男性患者铬离子浓度显著高于女性患者外,其他时间点男性与女性患者钴、铬、钼离子浓度差异不明显.%Objective To study the effect of gender on the serum ion levels of Co,Cr and Mo in the patients who have undergone metal-on-metal resurfacing hip arthroplasty.Methods Enrolled in the present study were 24 patients with fracture of uni-lateral femoral head who were injured from November 2008 to March 2013 in traffic accidents.There were 12 men,with an

  13. Development and first validation of a simplified CT-based classification system of soft tissue changes in large-head metal-on-metal total hip replacement: intra- and interrater reliability and association with revision rates in a uniform cohort of 664 arthroplasties

    Energy Technology Data Exchange (ETDEWEB)

    Boomsma, Martijn F.; Warringa, Niek [Isala Hospital, Department of Radiology, Zwolle (Netherlands); Edens, Mireille A. [Isala Hospital, Department of Innovation and Science, Zwolle (Netherlands); Lingen, Christiaan P. van; Ettema, Harmen B.; Verheyen, Cees C.P.M. [Isala Hospital, Department of Orthopaedics, Zwolle (Netherlands); Maas, Mario [AMC, Department of Radiology, Amsterdam (Netherlands)

    2015-08-15

    After implantation of a metal-on-metal total hip arthroplasty (MoM THA), a large incidence of pseudotumor formation has been described recently. Several centers have invited patients for follow-up in order to screen for pseudotumor formation. The spectrum of abnormalities found by CT in MoM THA patients can be unfamiliar to radiologists and orthopedic surgeons. Previously, a CT five-point grading scale has been published. In this paper, a simplification into a three-point classification system gives insight in the morphological distinction of abnormalities of the postoperative hip capsule in MoM implants in relation to the decision for revision. The reliability of this simplified classification regarding intra- and interrater reliability and its association with revision rate is investigated and discussed. All patients who underwent MoM THA in our hospital were invited for screening. Various clinical measures and CT scan were obtained in a cross-sectional fashion. A decision on revision surgery was made shortly after screening. CT scans were read in 582 patients, of which 82 patients were treated bilaterally. CT scans were independently single read by two board-certified radiologists and classified into categories I-V. In a second meeting, consensus was obtained. Categories were subsequently rubricated in class A (categories I and II), B (category III), and C (categories IV and V). Intra- and inter-radiologist agreement on MoM pathology was assessed by means of the weighted Cohen's kappa. Categorical data were presented as n (%), and tested by means of Fisher's exact test. Continuous data were presented as median (min-max) and tested by means of Mann-Whitney U test (two group comparison) or Kruskal-Wallis test (three group comparison). Logistic regression analysis was performed in order to study independence of CT class for association with revision surgery. Univariate statistically significant variables were entered in a multiple model. All statistical

  14. Total hip replacement: A meta-analysis to evaluate survival of cemented, cementless and hybrid implants

    Science.gov (United States)

    Phedy, Phedy; Ismail, H Dilogo; Hoo, Charles; Djaja, Yoshi P

    2017-01-01

    AIM To determine whether cemented, cementless, or hybrid implant was superior to the other in terms of survival rate. METHODS Systematic searches across MEDLINE, CINAHL, and Cochrane that compared cemented, cementless and hybrid total hip replacement (THR) were performed. Two independent reviewers evaluated the risk ratios of revision due to any cause, aseptic loosening, infection, and dislocation rate of each implants with a pre-determined form. The risk ratios were pooled separately for clinical trials, cohorts and registers before pooled altogether using fixed-effect model. Meta-regressions were performed to identify the source of heterogeneity. Funnel plots were analyzed. RESULTS Twenty-seven studies comprising 5 clinical trials, 9 cohorts, and 13 registers fulfilled the research criteria and analyzed. Compared to cementless THR, cemented THR have pooled RR of 0.47 (95%CI: 0.45-0.48), 0.9 (0.84-0.95), 1.29 (1.06-1.57) and 0.69 (0.6-0.79) for revision due to any reason, revision due to aseptic loosening, revision due to infection, and dislocation respectively. Compared to hybrid THR, the pooled RRs of cemented THR were 0.82 (0.76-0.89), 2.65 (1.14-6.17), 0.98 (0.7-1.38), and 0.67 (0.57-0.79) respectively. Compared to hybrid THR, cementless THR had RRs of 0.7 (0.65-0.75), 0.85 (0.49-1.5), 1.47 (0.93-2.34) and 1.13 (0.98-1.3). CONCLUSION Despite the limitations in this study, there was some tendency that cemented fixation was still superior than other types of fixation in terms of implant survival.

  15. Stem surface roughness alters creep induced subsidence and 'taper-lock' in a cemented femoral hip prosthesis.

    Science.gov (United States)

    Norman, T L; Thyagarajan, G; Saligrama, V C; Gruen, T A; Blaha, J D

    2001-10-01

    The clinical success of polished tapered stems has been widely reported in numerous long term studies. The mechanical environment that exists for polished tapered stems, however, is not fully understood. In this investigation, a collarless, tapered femoral total hip stem with an unsupported distal tip was evaluated using a 'physiological' three-dimensional (3D) finite element analysis. It was hypothesized that stem-cement interface friction, which alters the magnitude and orientation of the cement mantle stress, would subsequently influence stem 'taper-lock' and viscoelastic relaxation of bone cement stresses. The hypothesis that creep-induced subsidence would result in increases to stem-cement normal (radial) interface stresses was also examined. Utilizing a viscoelastic material model for the bone cement in the analysis, three different stem-cement interface conditions were considered: debonded stem with zero friction coefficient (mu=0) (frictionless), debonded stem with stem-cement interface friction (mu=0.22) ('smooth' or polished) and a completely bonded stem ('rough'). Stem roughness had a profound influence on cement mantle stress, stem subsidence and cement mantle stress relaxation over the 24-h test period. The frictionless and smooth tapered stems generated compressive normal stress at the stem-cement interface creating a mechanical environment indicative of 'taper-lock'. The normal stress increased with decreasing stem-cement interface friction but decreased proximally with time and stem subsidence. Stem subsidence also increased with decreasing stem-cement interface friction. We conclude that polished stems have a greater potential to develop 'taper-lock' fixation than do rough stems. However, subsidence is not an important determinant of the maintenance of 'taper-lock'. Rather subsidence is a function of stem-cement interface friction and bone cement creep.

  16. Two-stage revision total hip arthroplasty for periprosthetic infections using antibiotic-impregnated cement spacers of various types and materials.

    Science.gov (United States)

    Uchiyama, Katsufumi; Takahira, Naonobu; Fukushima, Kensuke; Moriya, Mitsutoshi; Yamamoto, Takeaki; Minegishi, Yojiro; Sakai, Rina; Itoman, Moritoshi; Takaso, Masashi

    2013-01-01

    Antibiotic-impregnated hip cement spacers of various types and materials have been used in the treatment of periprosthetic hip infections. We developed a handmade spacer by using polymethylmethacrylate (PMMA) and/or α -tricalcium phosphate ( α -TCP). In this study, we retrospectively reviewed the surgical outcomes in 36 consecutive patients treated with 2-stage revision total hip arthroplasty by using our antibiotic-impregnated hip cement spacers. We aimed to analyze the infection control and reinfection rates after revision surgery. Moreover, we analyzed the possible predictors of postoperative reinfection. After exclusion of 1 patient who died immediately after the first-stage surgery, infection was controlled in 33 of the 36 hips (success rate, 91.7%). Two of these 33 hips underwent resection arthroplasty. Of the 36 hips that had been treated with the antibiotic-cement spacer, 31 hips (86.1%) were eligible for the second-stage prosthesis re-implantation. The 31 protocol hip joints of patients followed up for >6 months (mean, 48.6 months). Ten of these 31 hips (32.3%) became reinfected. No possible predictor examined differed significantly between the reinfection-positive and reinfection-negative groups. However, spacers consisting of PMMA cement alone were associated with the highest risk of reinfection. Therefore, α -TCP-containing antibiotic-impregnated hip cement spacers might decrease the reinfection rate in patients undergoing re-implantation.

  17. Mechanical implications of interfacial defects between femoral hip implants and cement: a finite element analysis of interfacial gaps and interfacial porosity.

    NARCIS (Netherlands)

    Scheerlinck, T.; Broos, J.; Janssen, D.; Verdonschot, N.J.J.

    2008-01-01

    Two types of defect between femoral hip implants and cement have been identified. Interfacial porosity arises from cement shrinkage during curing and presents as pores randomly located along the stem. Interfacial gaps are much larger stem-cement separations caused by air introduced during stem inser

  18. Effect of cementing technique and cement type on thermal necrosis in hip resurfacing arthroplasty - a numerical study

    NARCIS (Netherlands)

    Janssen, D.; Srinivasan, P.; Scheerlinck, T.; Verdonschot, N.J.J.

    2012-01-01

    Femoral fractures within resurfacing implants have been associated with bone necrosis, possibly resulting from heat generated by cement polymerization. The amount of heat generated depends on cement mantle volume and type of cement. Using finite element analysis, the effect of cement type and volume

  19. Bond strength analysis of the bone cement- stem interface of hip arthroplasties

    Institute of Scientific and Technical Information of China (English)

    Lan-Feng Zhang; Shi-Rong Ge; Hong-Tao Liu; Kai-Jin Guo; Shu-Yang Han; Juan-Yan Qi

    2014-01-01

    Objective:To study and establish the preliminary linear and modified models for the interface shear mechanics performance between implant and bone cement and to explore its damage significance.Method:The loosening research between artificial hip joint prosthesis stem and bone cement interface performance can be evaluated by the push-in test.Based on the debonding performance test, the analytical expressions of the average load and displacement from the debonding failure and splitting failure process were deduced and determined.The correlations of the expressions of the average load-displacement and statistical experimental data were analyzed.Results:It demonstrated that the interface debonding failure mechanical model could be characterized as interface bond strength mechanical performance.Based on analysis of models and experimental data by the three statistical analysis methods, the results indicated the modified model could be better represented by the interfacial debonding strength properties. The bond stressτand relative slidings distribution along the embedment regional were coupling affected by both pressure arch effect and shear lag effect in bone cement.Two stress peaks of implant have been found at the distance from0.175La loading tip to0.325Lafree tip, which also verified the early loosening clinical reports for the proximal and latter region.As the bone cement arch effect, the bond stress peak tend to move to the free tip when the debonding failure would be changed into the splitting failure, which presents a preliminary study on the mechanism of early debonding failurefor the stem-cement interface.Conclusions:Functional models of the stem-bone cement interfacial debonding failure are developed to analyze the relevant mechanism.The different locational titanium alloy stress, and the interfacial bond stress and the relative slides are evaluated to acquire a guide of the different positions of interfacial damage.The coupling effect which is original from

  20. Improve the performance of coated cemented hip stem through the advanced composite materials.

    Science.gov (United States)

    Hedia, H S; Fouda, N

    2015-01-01

    Design of hip joint implant using functionally graded material (FGM) (advanced composite material) has been used before through few researches. It gives great results regarding the stress distribution along the implant and bone interfaces. However, coating of orthopaedic implants has been widely investigated through many researches. The effect of using advanced composite stem material, which mean by functionally graded stem material, in the total hip replacement coated with the most common coated materials has not been studied yet. Therefore, this study investigates the effect of utilizing these two concepts together; FGM and coating, in designing new stem material. It is concluded that the optimal FGM cemented stem is consisting from titanium at the upper stem layers graded to collagen at a lower stem layers. This optimal graded stem coated with hydroxyapatite found to reduce stress shielding by 57% compared to homogenous titanium stem coated with hydroxyapatite. However, the optimal functionally graded stem coated with collagen reduced the stress shielding by 51% compared to homogenous titanium stem coated with collagen.

  1. Comparison of Biocompatibility of Cemented vs. Cementless Hip Joint Endoprostheses Based on Postoperative Evaluation of Proinflammatory Cytokine Levels

    Science.gov (United States)

    Szypuła, Jan; Cabak, Anna; Kiljański, Marek; Boguszewski, Dariusz; Tomaszewski, Wiesław

    2016-01-01

    Background The yearly increase in the number of procedures involving implantation of hip joint endoprostheses forces prosthetics manufacturers to search for biologically neutral implants. The goal of this study was to assess the concentration of Interleukin-6 (IL-6) and its correlation with C-reactive protein (CRP), depending on the type of hip joint endoprosthesis (cemented or cementless endoprosthesis) in order to determine implant biotolerance during the early postoperative period. Material/Methods The sample comprised 200 patients [mean age=64 (31–81) years] with coxarthrosis. All patients underwent hip joint arthroplasty using a cemented or cementless endoprosthesis. Blood samples were collected 3 times: before the procedure, on the first day after the procedure, and after 6 weeks. IL-6 and CRP levels were assayed using immunoenzymatic methods. The results were subjected to statistical analysis using the Shapiro-Wilk test. Results On the 1st day after the procedure, CRP and IL-6 concentration increased rapidly after implantation of both cemented and cementless endoprostheses. At 6 weeks postoperatively, the CRP value remained at a similar level in patients after cemented arthroplasty and was almost 2-fold lower in patients who underwent cementless arthroplasty. The IL-6 value returned to the baseline level in patients after cementless arthroplasty and showed an ongoing increasing tendency in patients after cemented arthroplasty. Conclusions 1. The measurement of C-reactive protein and Interleukin-6 is a high-sensitivity test, assessing implant biotolerance. 2. The implantation of a cemented endoprosthesis induces a higher increase in the level of proinflammatory cytokines as compared with a cementless endoprosthesis. 3. For a complete assessment of both early and later body responses to implantation and the related surgical procedure, further studies using available approaches and tools are recommended. PMID:27935873

  2. Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials.

    LENUS (Irish Health Repository)

    Abdulkarim, Ali

    2013-02-22

    The optimal method of fixation for primary total hip replacements (THR), particularly fixation with or without the use of cement is still controversial. In a systematic review and metaanalysis of all randomized controlled trials comparing cemented versus uncemented THRS available in the published literature, we found that there is no significant difference between cemented and uncemented THRs in terms of implant survival as measured by the revision rate. Better short-term clinical outcome, particularly an improved pain score can be obtained with cemented fixation. However, the results are unclear for the long-term clinical and functional outcome between the two groups. No difference was evident in the mortality and the post operative complication rate. On the other hand, the radiographic findings were variable and do not seem to correlate with clinical findings as differences in the surgical technique and prosthesis design might be associated with the incidence of osteolysis. We concluded in our review that cemented THR is similar if not superior to uncemented THR, and provides better short term clinical outcomes. Further research, improved methodology and longer follow up are necessary to better define specific subgroups of patients in whom the relative benefits of cemented and uncemented implant fixation can be clearly demonstrated.

  3. Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Ali Abdulkarim

    2013-03-01

    Full Text Available The optimal method of fixation for primary total hip replacements (THR, particularly fixation with or without the use of cement is still controversial. In a systematic review and metaanalysis of all randomized controlled trials comparing cemented versus uncemented THRS available in the published literature, we found that there is no significant difference between cemented and uncemented THRs in terms of implant survival as measured by the revision rate. Better short-term clinical outcome, particularly an improved pain score can be obtained with cemented fixation. However, the results are unclear for the long-term clinical and functional outcome between the two groups. No difference was evident in the mortality and the post operative complication rate. On the other hand, the radiographic findings were variable and do not seem to correlate with clinical findings as differences in the surgical technique and prosthesis design might be associated with the incidence of osteolysis. We concluded in our review that cemented THR is similar if not superior to uncemented THR, and provides better short term clinical outcomes. Further research, improved methodology and longer follow up are necessary to better define specific subgroups of patients in whom the relative benefits of cemented and uncemented implant fixation can be clearly demonstrated.

  4. [Favourable long-term results from cemented total hip arthroplasty combined with acetabular bone impaction grafting in patients under the age of 50

    NARCIS (Netherlands)

    Busch, V.J.; Gardeniers, J.W.M.; Slooff, T.J.J.H.; Veth, R.P.H.; Schreurs, B.W.

    2007-01-01

    OBJECTIVE: Determination of long-term results of hip replacements in patients who, at the time of operation, were under the age of 50. Procedures whereby an existing acetabulum defect was filled with bone chips that were impacted into a strong layer, after which a cemented total hip prosthesis was i

  5. Resurfacing hip replacement and cemented total hip replacement have equivalent outcome at one year in a disease matched population: a case-control study of patient reported outcome measures.

    Science.gov (United States)

    Ray, Robbie; Goudie, Ewan B; Jenkins, Paul; Gaston, Paul

    2013-01-01

    Resurfacing hip replacement has demonstrated good survival and outcomes for cohorts of younger male patients, but few controlled studies exist. In this study we compared patient reported outcome measures and satisfaction scores at one year following resurfacing hip replacement in 69 male patients with two control groups of equal numbers undergoing cemented total hip replacement: aged-matched patients and disease matched patients. At one year we found no difference in improvement in patient reported outcome measures between patients undergoing resurfacing hip replacement and disease matched patients, whereas patients undergoing resurfacing hip replacement had a statistically significant improvement in Oxford Hip Score compared to the age-matched controls (pResurfacing hip replacement and total 
hip replacement both confer increase in patient reported outcome scores and high patient satisfaction at one year. The results of this study will allow better counselling of patients and help inform 
treatment decisions.

  6. [Intrafemoral pressure measurement in different cement removal procedures during hip prosthesis replacement operations--experimental study with cadaver femora].

    Science.gov (United States)

    Porsch, M; Schmidt, J; Brimmers, P; Menne, A; Merkle, W

    1998-03-01

    During primary hip arthroplasty an increase in intramedullary pressure (IMP) of up to 1000 mm Hg can be observed. As a result of this increased intrafemoral pressure, intramedullary constituents can pass into the venous circulation creating a risk of fat embolism syndrome (FES). In the present experimental study on 9 femora obtained from human corpses, we investigated the question as to whether various methods of cement removal during total hip revision arthroplasty are also associated with increased intramedullary pressure and a risk of FES. The IMP was recorded with a standardized experimental set-up during removal of cement from the proximal and distal regions, including removal of the cement "tip" and the intramedullary plug. The methods employed for this purpose included the osteotome and mallet, a compressed air powered chisel, and a modified intracorporal lithotripter. All the methods induced fluctuations in the IMP the highest values being recorded for the conventional method using the osteotome and mallet (45 mm Hg) and the lowest values for the intracorporeal lithotripter (7.5 mm Hg). Working on the distal cement caused higher fluctuations in comparison with the proximal region. The study failed to reveal any increase in mean IMP, and all measured values were in the low pressure range (considerably below 150 mm Hg). While there seems to be no apparent risk of an FES developing during removal of cement, careless manipulation of the distal cement plug may result in higher intrafemoral pressures--above 150 mm Hg--thus increasing the risk of a fat embolism syndrome.

  7. A STUDY OF PRIMARY CEMENTED BIPOLAR HEMIARTHROPLASTY OF HIP IN ELDERLY PATIENTS WITH OSTEOPOROTIC, UNSTABLE INTERTROCHANTERIC FRACTURE

    Directory of Open Access Journals (Sweden)

    Maheshwar

    2015-08-01

    Full Text Available BACKGROUND: Intertrochanteric fractures are a major cause of morbidity and mortality in geriatric population. Osteoporosis contributes significantly to the comminution and instability in such fractures. Internal fixations in unstable intertrochanteric fractures are a ssociated with high rates of implant failures and gross restriction of hip movements. This study was undertaken to evaluate the efficacy of cemented bipolar hemiart h roplasty in elderly patients with osteoporotic, unstable intertrochanteric fractures. PATIE NTS AND METHODS: 52 patients aged above 60 years with unstable, comminuted intertrochanteric fractures with Singh’s index < 4 were operated with primary cemented bipolar hemireplacement arthroplasty. All the patients were mobilized early with full weight b earing in the post - operative period as permitted. 50 patients were evaluated for the functional outcome with Harris Hip score. RESULTS: The average age of patients was 65 years with female predominance (64%. Left side (56% was commonly involved and the c ommonest mode of injury was due to a trivial fall at home. Hypertension (30% was the commonest co - morbid condition. Limb shortening was the commonest complication (8%. The mean ± S.D. of the Harris Hip score was 85.6 ± 10.59 with a range from 56 to 96. Resul ts were excellent in 62%, good in 22%, fair in 12% and poor in 4% of cases. CONCLUSION: Elderly osteoporotic patients with comminuted, unstable intertrochanteric fractures have an increased prevalence of unsatisfactory functional results with conventional internal fixation devices. Primary cemented bipolar hemiarthroplasty with anatomical reconstruction of the trochanters allows early mobilization, improved functional outcome with relatively low incidence of associated complications.

  8. Comparative study of material loss at the taper interface in retrieved metal-on-polyethylene and metal-on-metal femoral components from a single manufacturer.

    Science.gov (United States)

    Bills, Paul; Racasan, Radu; Bhattacharya, Saugatta; Blunt, Liam; Isaac, Graham

    2017-04-01

    There have been a number of reports on the occurrence of taper corrosion and/or fretting and some have speculated on a link to the occurrence of adverse local tissue reaction specifically in relation to total hip replacement which have a metal-on-metal bearing. As such a study was carried out to compare the magnitude of material loss at the taper in a series of retrieved femoral heads used in metal-on-polyethylene bearings with that in a series of retrieved heads used in metal-on-metal bearings. A total of 36 metal-on-polyethylene and 21 metal-on-metal femoral components were included in the study all of which were received from a customer complaint database. Furthermore, a total of nine as-manufactured femoral components were included to provide a baseline for characterisation. All taper surfaces were assessed using an established corrosion scoring method and measurements were taken of the female taper surface using a contact profilometry. In the case of metal-on-metal components, the bearing wear was also assessed using coordinate metrology to determine whether or not there was a relationship between bearing and taper material loss in these cases. The study found that in this cohort the median value of metal-on-polyethylene taper loss was 1.25 mm(3) with the consequent median value for metal-on-metal taper loss being 1.75 mm(3). This study also suggests that manufacturing form can result in an apparent loss of material from the taper surface determined to have a median value of 0.59 mm(3). Therefore, it is clear that form variability is a significant confounding factor in the measurement of material loss from the tapers of femoral heads retrieved following revision surgery.

  9. Has Metal-On-Metal Resurfacing Been a Cost-Effective Intervention for Health Care Providers?—A Registry Based Study

    Science.gov (United States)

    Pulikottil-Jacob, Ruth; Connock, Martin; Kandala, Ngianga-Bakwin; Mistry, Hema; Grove, Amy; Freeman, Karoline; Costa, Matthew; Sutcliffe, Paul; Clarke, Aileen

    2016-01-01

    Background Total hip replacement for end stage arthritis of the hip is currently the most common elective surgical procedure. In 2007 about 7.5% of UK implants were metal-on-metal joint resurfacing (MoM RS) procedures. Due to poor revision performance and concerns about metal debris, the use of RS had declined by 2012 to about a 1% share of UK hip procedures. This study estimated the lifetime cost-effectiveness of metal-on-metal resurfacing (RS) procedures versus commonly employed total hip replacement (THR) methods. Methodology/Principal Findings We performed a cost-utility analysis using a well-established multi-state semi-Markov model from an NHS and personal and social services perspective. We used individual patient data (IPD) from the National Joint Registry (NJR) for England and Wales on RS and THR surgery for osteoarthritis recorded from April 2003 to December 2012. We used flexible parametric modelling of NJR RS data to guide identification of patient subgroups and RS devices which delivered revision rates within the NICE 5% revision rate benchmark at 10 years. RS procedures overall have an estimated revision rate of 13% at 10 years, compared to hip replacement, or by patients concerned about the likelihood of revision, regardless of patient age or gender. PMID:27802289

  10. Oxinium modular femoral heads do not reduce polyethylene wear in cemented total hip arthroplasty at five years: a randomised trial of 120 hips using radiostereometric analysis.

    Science.gov (United States)

    Jonsson, B A; Kadar, T; Havelin, L I; Haugan, K; Espehaug, B; Indrekvam, K; Furnes, O; Hallan, G

    2015-11-01

    We report the five-year outcome of a randomised controlled trial which used radiostereometric analysis (RSA) to assess the influence of surface oxidised zirconium (OxZr, Oxinium) on polyethylene wear in vivo. A total of 120 patients, 85 women and 35 men with a mean age of 70 years (59 to 80) who were scheduled for primary cemented total hip arthroplasty were randomly allocated to four study groups. Patients were blinded to their group assignment and received either a conventional polyethylene (CPE) or a highly cross-linked (HXL) acetabular component of identical design. On the femoral side patients received a 28 mm head made of either cobalt-chromium (CoCr) or OxZr. The proximal head penetration (wear) was measured with repeated RSA examinations over five years. Clinical outcome was measured using the Harris hip score. There was no difference in polyethylene wear between the two head materials when used with either of the two types of acetabular component (p = 0.3 to 0.6). When comparing the two types of polyethylene there was a significant difference in favour of HXLPE, regardless of the head material used (p < 0.001). In conclusion, we found no advantage of OxZr over CoCr in terms of polyethylene wear after five years of follow-up. Our findings do not support laboratory results which have shown a reduced rate of wear with OxZr. They do however add to the evidence on the better resistance to wear of HXLPE over CPE.

  11. Hip Resurfacing Implants.

    Science.gov (United States)

    Cadossi, Matteo; Tedesco, Giuseppe; Sambri, Andrea; Mazzotti, Antonio; Giannini, Sandro

    2015-08-01

    EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Describe the advantages of hip resurfacing. 2. Describe the disadvantages of hip resurfacing. 3. Identify the population in which hip resurfacing is most often indicated. 4. Demonstrate how to properly postoperatively manage patients with metal-on-metal prostheses. Hip resurfacing offers a suitable solution for young patients affected by hip disease who have high function demands and good bone quality. Bone stock preservation, restoration of the normal proximal femur anatomy, the lack of stress shielding, and the possibility of resuming sporting activity are proven advantages of hip resurfacing. However, there are some disadvantages, such as fracture of the femoral neck, onset of neck narrowing, and possible complications due to the metal-on-metal bearings, including pseudotumors, peri-implant osteolysis, and chronic elevation of metal ions in serum levels. Recent data suggest that the ideal candidate for hip resurfacing is an active male, younger than 65 years, with primary or posttraumatic osteoarthritis, and with a femoral head diameter larger than 50 to 54 mm. Based on these selection criteria, the literature reports implant survival to be similar to that of total hip arthroplasty. The current authors' experience confirms a low failure rate and excellent functional outcomes, with metal ion serum levels becoming stable over time in well-functioning implants. Proper surgical technique, correct patient selection, and the right choice of a well-established prosthetic model are essential elements for the long-term success of these implants.

  12. Simulation of the mechanical behavior of a HIP implant. Implant fixed to bone by cementation under arbitrary load

    Energy Technology Data Exchange (ETDEWEB)

    Oldani, C R [Materials Department - FCEFyN - Universidad Nacional de Cordoba, Av.Velez Sarsfield 1611 (5016) Cordoba (Argentina); Dominguez, A A [INTI Cordoba, Av. Velez Sarsfield 1561 (5016) Cordoba (Argentina)

    2007-11-15

    In a previous work a finite elements model was constructed to simulate a fatigue assay according to the norm IRAM 9422-3. Three materials were studied, two of them are the most used in this type of implant (Stainless steel 3161 and alloy T16A14V) and the third was a new developed titanium alloy (Ti35Nb7Zr5Ta). Static loads were applied to the model according to the highest requirements of the norm and the stress - strain distribution were determined. In this study a simplified analysis of the material's fatigue was done according to the previous work. The best behavior of the titanium alloys vs. the stainless steel was evident. With the objective of studying the behavior of both: the implant and the femur bone, new finite elements models were realized, in which the presence of the bone was considered. Inside the bone, the femoral component of the implant was placed in a similar way of a cemented prosthesis in a total hip arthroplasty. The advantage of the titanium implant related to the stainless steel one, was very clear.

  13. Finite element modelling of rheological and penetration characteristics of curing PMMA bone cement in total hip replacement

    OpenAIRE

    2006-01-01

    This thesis is concerned with the study of the rheological properties of PMMA bone cement that is used as a grout for bone and prosthesis in THR and TKR Interdigitation of bone cement through porous cancellous bone depends on the rheological characteristics of bone cement and porosity of the cancellous bone. The rheological characteristics of the bone cement are thus an important factor effecting the optimum penetration of bone cement through cancellous bone. In this project the rheologic...

  14. Sex differences in the morphological failure patterns following hip resurfacing arthroplasty

    Directory of Open Access Journals (Sweden)

    Rüther Wolfgang

    2011-10-01

    Full Text Available Abstract Background Metal-on-metal hybrid hip resurfacing arthroplasty (with a cementless acetabular component and a cemented femoral component is offered as an alternative to traditional total hip arthroplasty for the young and active adult with advanced osteoarthritis. Although it has been suggested that women are less appropriate candidates for metal-on-metal arthroplasty, the mechanisms of prosthesis failure has not been fully explained. While specific failure patterns, particularly osteonecrosis and delayed type hypersensitivity reactions have been suggested to be specifically linked to the sex of the patient, we wished to examine the potential influence of sex, clinical diagnosis, age of the patient and the size of the femoral component on morphological failure patterns in a large cohort of retrieved specimens following aseptic failure of hip resurfacing arthroplasty. Methods Femoral remnants retrieved from 173 hips with known patient's sex were morphologically analyzed for the cause of failure. The results were compared with the control group of the remaining 31 failures from patients of unknown sex. The odds ratios (OR and 95% confidence intervals (CI of the following morphologically defined variables were calculated using logistic regression analysis: periprosthetic fractures (n = 133, osteonecrosis (n = 151, the presence of excessive intraosseous lymphocyte infiltration (n = 11, and interface hyperosteoidosis (n = 30. Logistic regression analysis was performed both unadjusted and after adjustment for sex, age, the size of the femoral component, and preoperative clinical diagnosis. Results Femoral remnants from female patients had a smaller OR for fracture (adjusted OR: 0.29, 95% CI 0.11, 0.80, P for difference = 0.02 and for the presence of osteonecrosis (adjusted OR: 0.16, 95% CI 0.04, 0.63, P for difference = 0.01. However, women had a higher OR for both the presence of excessive intraosseous lymphocyte infiltration (adjusted OR: 10

  15. The increase in cobalt release in metal-on-polyethylene hip bearings in tests with third body abrasives.

    Science.gov (United States)

    de Villiers, Danielle; Traynor, Alison; Collins, Simon N; Shelton, Julia C

    2015-09-01

    Hypersensitivity reactions in patients receiving metal-on-metal hip replacements have been attributed to corrosion products as observed by elevated cobalt and chromium ions in the blood. Although the majority of cases are reported in metal-on-metal, incidences of these reactions have been reported in the metal-on-polyethylene patient population. To date, no in vitro study has considered cobalt release for this bearing combination. This study considered four 28 mm and seven 52 mm diameter metal-on-polyethylene bearings tested following ISO standard hip simulator conditions as well as under established abrasive conditions. These tests showed measurable cobalt in all bearings under standard conditions. Cobalt release, as well as polyethylene wear, increased with diameter, increasing from 52 to 255 ppb. The introduction of bone cement particles into the articulation doubled polyethylene wear and cobalt release while alumina particles produced significant damage on the heads demonstrated by cobalt levels of 70,700 ppb and an increased polyethylene wear from a mean value of 9-160 mm(3)/mc. Cobalt release was indicative of head damage and correlated with polyethylene wear at the next gravimetric interval. The removal of third body particles resulted in continued elevated cobalt levels in the 52 mm diameter bearings tested with alumina compared to standard conditions but the bearings tested with bone cement particles returned to standard levels. The polyethylene wear in the bone cement tested bearings also recovered to standard levels, although the alumina tested bearings continued to wear at a higher rate of 475 mm(3)/mc. Cobalt release was shown to occur in metal-on-polyethylene bearings indicating damage to the metal head resulting in increased polyethylene wear. While large diameter metal-on-polyethylene bearings may provide an increased range of motion and a reduced dislocation risk, increased levels of cobalt are likely to be released and this needs to be fully

  16. 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.

  17. Acute Delayed or Late Infection of Revision Total Hip Arthroplasty Treated with Debridement/Antibiotic-loaded Cement Beads and Retention of the Prosthesis

    Science.gov (United States)

    Chang, Jun-Dong; Kim, In-Sung; Lee, Sang-Soo

    2017-01-01

    Purpose The treatment of infected revision total hip arthroplasty (THA) is very challenging due to retained revision prosthesis, poor bone stock and soft tissue condition derived from previous revision surgeries, and comorbidities. The purpose of this study was to investigate the effectiveness and short-term outcomes of aggressive debridement and use of antibiotic-loaded cement beads with retention of the prosthesis for acute delayed or late infection of revision THAs. Materials and Methods Ten consecutive patients with symptoms or signs of less than one-week evolution and well-fixed prostheses, were treated with this procedure and a postoperative course of organism-specific antibiotics for a minimum of 6 weeks. All hips presented with acute delayed or late infection of revision THAs. Patients with a mean age of 68.1 years (range, 59-78 years) underwent an average of 1.9 previous revision THAs (1-4) before the index surgery. The minimal follow-up was 2 years with a mean of 46.2 months (range, 24-64 months). Results There were 8 cures (80.0%) and 2 failures with no mortality during the study period. The 2 failures involved the same and resistant bacteria implicated in the primary infection (methicillin-resistant Staphylococcus aureus and Prevotella oralis, respectively). The mean Harris hip score was 65.2 (range, 26-83) and the mean visual analogue scale was 2.6 (range, 1-4) at final follow-up. Conclusion With a favorable success rate and no mortality, our procedure may be considered a safe and effective alternative for the treatment of acute delayed or late infection of revision THAs with well-fixed prostheses. PMID:28316961

  18. Revision of hip resurfacing arthroplasty.

    Science.gov (United States)

    Wera, Glenn D; Gillespie, Robert J; Petty, Carter; Petersilge, William J; Kraay, Matthew J; Goldberg, Victor M

    2010-08-01

    Metal-on-metal (MOM) hip resurfacing has become an increasingly popular treatment for young, active patients with degenerative disease of the hip, as bearing surfaces with better wear properties are now available. One proposed advantage of resurfacing is its ability to be successfully revised to total hip arthroplasty (THA). In addition, radiographic parameters that may predict failure in hip resurfacing have yet to be clearly defined. Seven MOM resurfacing arthroplasties were converted to conventional THAs because of aseptic failure. Using Harris Hip Scores (HHS) and Short Form 12 (SF-12) questionnaire scores, we compared the clinical outcomes of these patients with those of patients who underwent uncomplicated MOM hip resurfacing. In addition, all revisions were radiographically evaluated. Mean follow-up periods were 51 months (revision group) and 43 months (control group). There was no significant difference between the 2 groups' HHS or SF-12 scores. There was no dislocation or aseptic loosening after conversion of any resurfacing arthroplasty. Valgus neck-shaft angle (P hip resurfacing. Conversion of aseptic failure of hip resurfacing to conventional THA leads to clinical outcomes similar to those of patients who undergo uncomplicated hip resurfacing. The orientation of the femur and the components placed play a large role in implant survival in hip resurfacing. More work needs to be done to further elucidate these radiographic parameters.

  19. 金属对金属髋关节表面置换术%Metal-on-Metal Hip Resurfacing Arthroplasty

    Institute of Scientific and Technical Information of China (English)

    Andrew Shimmin; Paul E.Beaule; Pat Campbell; 卢伟杰; 余楠生

    2008-01-01

    @@ 髋关节表面置换的主要优点是为患者保留骨质,以便将来可能进行人工关节置换.早期尝试髋关节表面置换失败的原因主要包括薄的聚乙烯髋臼假体过度磨损和股骨假体固定不良.

  20. Large diameter metal on metal total hip replacement for femoral neck fractures with neurological conditions A retrospective assessment

    Directory of Open Access Journals (Sweden)

    Jia Li

    2014-01-01

    Conclusion: We believe the use of L-MoM can diminish the rate of instability or dislocation, after operation. The L-MoM is an option for patients with Parkinson′s disease and poliomyelitis with femoral neck fracture.

  1. Review of cobalt toxicokinetics following oral dosing: Implications for health risk assessments and metal-on-metal hip implant patients.

    Science.gov (United States)

    Tvermoes, Brooke E; Paustenbach, Dennis J; Kerger, Brent D; Finley, Brent L; Unice, Kenneth M

    2015-05-01

    Cobalt (Co) can stimulate erythropoietin production in individuals at doses exceeding 25 mg CoCl2/day. Co has also been shown to exert effects on the thyroid gland, heart and nervous system at sufficient doses. The biological activity of Co is dictated by the concentration of free (unbound) ionic Co(2+). Blood concentrations, as well as, urinary excretion rates of Co are reliable biomarkers for systemic Co exposure. A recent series of human volunteer Co-supplement studies simultaneously measured Co blood and urine concentrations, as well as, Co speciation in serum, and a number of biochemical and clinical parameters. It was found in these studies that peak Co whole blood concentration as high as 117 μg/L were not associated with changes in hematological parameters such as increased red blood cell (RBC) count, hemoglobin (Hgb) or hematocrit (Hct) levels, nor with changes in cardiac, neurological or, thyroid function. Using a Co biokinetic model, the estimated Co systemic tissue concentrations (e.g., liver, kidney, and heart) following 90-days of Co-dietary supplementation with ∼1 mg Co/day were found to be similar to estimated tissue concentrations in implant patients after 10 years of exposure at continuous steady state Co blood concentration of ∼10 μg/L. This study is the first to present modeled Co tissue concentrations at various doses following sub-chronic and chronic exposure. The modeled steady state tissue Co concentrations in combination with the data on adverse health effects in humans should help in the characterization of potential hazards associated with increased blood Co concentrations due to exposure to dietary supplements or cobalt-chromium (Co-Cr) containing implants.

  2. Uncemented prosthesis revision of failed cemented hip arthroplasty:mid-term results%非骨水泥假体翻修失败的骨水泥型人工髋关节:中期效果评价

    Institute of Scientific and Technical Information of China (English)

    李朋; 朱智奇; 侯明; 史占军

    2015-01-01

    BACKGROUND:The uncemented prosthesis in primary total hip arthroplasty has obtained good outcomes, but its application in revision especialy in failed cemented hip arthroplasty deserves further investigations. OBJECTIVE: To observe the mid-term results of uncemented revision of failed cemented hip arthroplasty. METHODS: 41 patients (47 hips) with uncemented revision of failed cemented hip arthroplasty were folowed up from November 1997 to February 2013. In the 47 hips, 24 hips replaced the cemented stem component while 23 hips underwent the cemented acetabular revision. Prosthesis change was observed in radiographs. Harris functions were evaluated and prosthesis survival rate was analyzed. RESULTS AND CONCLUSION: A total of 33 patients (38 hips) were folowed up for 1.3-14.8 years. The mean preoperative Harris hip score increased from 34 (range, 11-66) points to 85 (range, 55-94) points at the time of final folow-up (P   目的:观察以非骨水泥假体翻修失败的骨水泥型人工髋关节的中期效果。  方法:对1997年11月至2013年2月以非骨水泥假体对失败的骨水泥型人工髋关节翻修的41例(47髋)患者进行随访,其中翻修骨水泥柄24髋、骨水泥臼23髋。随访X射线片上的假体变化情况,对髋关节行Harris功能评定并分析假体生存率。  结果与结论:共33例38髋获得随访,随访时间1.3-14.8年,患者的平均Harris评分由术前的34分(11-66分)增加到末次随访时的85分(55-94分),差异有显著性意义(P <0.01)。36髋(95%)假体获得良好稳定性;2髋发生骨溶解并假体移位(股骨1髋,髋臼1髋)需要再翻修;9髋发生异位骨化(24%)。聚乙烯衬垫年平均磨损量为0.08 mm(0-0.25 mm),磨损率仅与外展角变化存在相关性(P <0.01)。以影像学证明假体松动作为失败标准,利用Kaplan-Meier生存分析法计算非骨水泥假体7年总体存活率为89%,其中髋臼假体和股骨

  3. A randomised controlled trial comparing highly cross-linked and contemporary annealed polyethylene after a minimal eight-year follow-up in total hip arthroplasty using cemented acetabular components.

    Science.gov (United States)

    Langlois, J; Atlan, F; Scemama, C; Courpied, J P; Hamadouche, M

    2015-11-01

    Most published randomised controlled trials which compare the rates of wear of conventional and cross-linked (XL) polyethylene (PE) in total hip arthroplasty (THA) have described their use with a cementless acetabular component. We conducted a prospective randomised study to assess the rates of penetration of two distinct types of PE in otherwise identical cemented all-PE acetabular components. A total of 100 consecutive patients for THA were randomised to receive an acetabular component which had been either highly XL then remelted or moderately XL then annealed. After a minimum of eight years follow-up, 38 hips in the XL group and 30 hips in the annealed group had complete data (mean follow-up of 9.1 years (7.6 to 10.7) and 8.7 years (7.2 to 10.2), respectively). In the XL group, the steady state rate of penetration from one year onwards was -0.0002 mm/year (sd 0.108): in the annealed group it was 0.1382 mm/year (sd 0.129) (Mann-Whitney U test, p XLPE cemented acetabular component.

  4. High Prevalence of Pseudotumors in Patients with a Birmingham Hip Resurfacing Prosthesis A Prospective Cohort Study of One Hundred and Twenty-nine Patients

    NARCIS (Netherlands)

    Bisschop, R.; Boomsma, M. F.; Van Raay, J. J. A. M.; Tiebosch, A. T. M. G.; Maas, M.; Gerritsma, C. L. E.

    2013-01-01

    Background: Recently, concern has emerged about pseudotumors (lesions that are neither malignant nor infective in the soft tissues surrounding total hip arthroplasty components) after hip arthroplasties with metal-on-metal bearings. Patients treated in our hospital for degenerative arthritis of the

  5. Walking function follow up in near future after treatment of senile femoral neck fracture with bony cemented artificial hip replacement%骨水泥型人工髋关节置换治疗老年股骨颈骨折术后近期行走功能随访

    Institute of Scientific and Technical Information of China (English)

    胡明鉴; 郑晨希; 张玉鑫; 石化洋; 陈伶; 马红兵; 刘强; 龚文斌; 蒋伟

    2002-01-01

    Objective To investigate the effect of cemented artificial hip replacement in the treatment of senile femoral neck fracture.Method Follow up the 18 patients with senile femoral neck fracture who received bony cemented artificial hip replacement during January 1999 to September 2001.Mean following- up duration:15.7 months(3~ 23).Result Harris score:15 cases got excellent result,3 cases got good result,none got fair result.Total X ray plain film:Position of prothesis was normal with no loosing,heterotopic ossification or dislocation. Conclusion (1)Variant cemented artificial hip replacements all have satisfying effect in near future.(2)It is feasible for patients with poor economic condition to choose native prothesis in arthroplasty.(3)Di- polar artificial thigh bone replacement is a better choice for weak patient with great age.

  6. Results of hip resurfacing for developmental dysplasia of the hip of Crowe type Ⅰ and Ⅱ

    Institute of Scientific and Technical Information of China (English)

    XU Wei-dong; LI Jia; ZHOU Zhen-hua; WU Yue-song; LI Ming

    2008-01-01

    Background Recently, the new generation of metal-on-metal total hip resurfacing arthroplasty is well known for preserving the proximal femoral bone stock, minimizing the risk of postoperative dislocation using large femoral heads, and expecting low wear of metal-on-metal articulation for longer prosthesis survival. It also has the advantage in biomechanical loading in the proximal femur. The osteoarthritis secondary to developmental dysplasia of the hip (DDH) has been the most common reason for total hip arthroplasty. Most of the patients are young and active, who require improved range of motion of the hip besides relief of the pain, even expect to resume the ability to run and jump after the joint arthroplasty, thus to be allowed an active lifestyle. The objective of the current study was to evaluate the early outcome of resurfacing arthroplasty for the mild DDH cases (Crowe type Ⅰ and Ⅱ).Methods Between September 2005 and May 2007, twenty-one consecutive patients (twenty-six hips) with the diagnosis of osteoarthritis secondary to DDH underwent metal-on-metal resurfacing arthroplasty. The average age at the time of surgery was 46.5 years (range, 37-59 years). Six patients (28.6%) were male and fifteen (71.4%) were female. Clinical and radiographic results were observed. The follow-up was performed at 6 weeks, 3, 6, 9 months and then yearly.Results All patients were followed for a mean of 18 months (9-29 months). During the follow-up period no complications, such as dislocation of hip joints, infection or femoral neck fracture occurred. The clinical outcomes, as rated with the Harris hip score, improved significantly compared with the preoperative ratings. The mean postoperative Harris hip score was 90.7, compared to 35.5 preoperatively. The radiographic analysis showed that all prostheses were fixed with no radiolucencies. All of the patients who had equal limb lengths preoperatively had equal lengths postoperatively. Of the nine patients with preoperative

  7. Imaging evaluation of complications of hip arthroplasty: review of current concepts and imaging findings.

    Science.gov (United States)

    Awan, Omer; Chen, Lina; Resnik, Charles S

    2013-11-01

    Total hip arthroplasty has evolved along with improvements in component materials and design. The radiologist must accurately diagnose associated complications with imaging methods and stay informed about newer complications associated with innovations in surgical technique, prosthetic design, and novel materials. This pictorial essay presents clinical and imaging correlation of modern hip arthroplasty complications, with an emphasis on the most common complications of instability, aseptic loosening, and infection as well as those complications associated with contemporary metal-on-metal arthroplasty.

  8. Mid-long term effect analysis of primary cemented total hip arthroplasty%初次骨水泥型人工全髋关节置换术的中远期疗效分析

    Institute of Scientific and Technical Information of China (English)

    温亮; 潘江; 曲铁兵; 林源; 王进军; 方超华

    2014-01-01

    Objective To evaluate the mid-long term clinical and radiographic effects of the primary cemented total hip arthroplasty ( THA).Methods One hundred and eighty-seven patients (201 hips) who had undergone primary cemented THA from July 1991 to June 2006 were followed up for their post-operative complications and imaging findings .Harris score and bone density value were used for statistical analysis .The survival rate of the implants was determined by using the revision of either prosthetic component for any reason as the end-point during the follow-up.Results One hundred and seventeen patients (126 hips) were followed up for 13.5 years averagely in the end .Harris score improved significantly from (32.8 ±22.5) points to (90.3 ±7.3) points (t =-27.91,P 0.05).There was late infection in one hip, dislocation in three hips, DVT in four hips, inequality of lower limb in four hips , periprosthetic fracture in two hips , heterotopic ossification in six hips and aseptic loosening in five hips.Seven hips were revised after a mean time of 11.3 years.The survival rate of the implants was 94.4%.Conclusion The study suggests that the cemented THA may be suitable for treating all kinds of severe diseases of the hip joint for the senile osteoporosis patients and it can acheive good clinical outcomes .The cemented implant has satisfactory long-term results.%目的:回顾性分析初次骨水泥型全髋关节置换术( THA)的中远期临床及影像学疗效、假体的生存率及其相关影响因素。方法对1991年7月至2006年6月间接受初次骨水泥型THA的患者187例(201髋)进行随访。观察并发症情况、影像学表现,并对Harris评分和骨密度结果值进行统计学分析,以假体翻修为随访终点,计算假体的生存率。结果共117例(126髋)获得完整随访,平均随访时间为13.5年。 Harris评分由术前的(32.8±22.5)分提高至末次随访时的(90.3±7.3)分,差异有统计学意义( t

  9. Antibiotic-loaded cement femoral prosthesis in treatment of hip arthroplasty infection%抗生素骨水泥股骨头临时假体治疗髋关节置换术后感染

    Institute of Scientific and Technical Information of China (English)

    何爱珊; 廖威明; 傅明; 盛璞义; 孟繁纲

    2012-01-01

    Objective To evaluate the effectiveness of antibiotic-loaded cement femoral prosthesis implantation after primary debridement and two-stage hip prosthesis revision in the treatment of hip arthroplasty infection. Methods Between January 2006 and November 2010, 11 cases(12 hips) of hip arthroplasty infection were treated by two-stage revision. There were seven men (eight hips) and four women (four hips) with a mean age of 60 years (range, 29 -80years). The Harris scores was (32 ± 7. 63) (range, 17-45) . All the patients were treated as follows: in the first stage, the infected prosthesis was removed, debridement was performed, and an antibiotic-loaded cement femoral prosthesis was then implanted for 4 to 20 months (average, 12 months). When the results of C reactive protein, leukocyte count and erythorocyte sedimentation rate were back to normal and no infective sign was found around the incision, a two-stage revision was performed. All cases were regularly followed up for 4 to 40 months (average, 20 months). Results All 11 patients achieved healing of incision by first intention, and no complications occurred. No reinfection was found in the follow-up. The function of hip was improved. The Harris score was (87 ± 7. 72) (range, 65 - 96) in the follow-up, showing significant improvement compared with preoperative score (t =38.81, P < 0. 01) . Conclusions The implantation of antibiotic-loaded cement femoral prosthesis in the first stage after surgical debridement is effective for treatment of hip arthroplasty infection. The antibiotic-loaded cement femoral prosthesis can also help to reduce shortening deformity in extremities. According to the patients' conditions, cement or cementless hip prosthesis may be used in the two-stage hip prosthesis revision to get satisfactory clinical effect.%目的 总结评估Ⅰ期清创后采用自制抗生素骨水泥股骨头假体控制感染,Ⅱ期翻修重建治疗人工髋关节置换术后感染的临床效果.方法 自2006

  10. Results of hip resurfacing

    Science.gov (United States)

    Favetti, Fabio; Casella, Filippo; Papalia, Matteo; Panegrossi, Gabriele

    2011-01-01

    Background The renewed popularity of resurfacing hip arthroplasty in the last 10 years has generated a remarkable quantity of scientific contributions based on mid- and short-term follow-up. More than one paper has reported a consistent early revision rate as a consequence of biological or biomechanical failure. Two major complications are commonly described with resurfacing implants: avascular necrosis and femoral-neck fracture. A close relationship between these two events has been suggested, but not firmly demonstrated, whereas cementing technique seems to be better understood as potential cause of failure. Methods We performed an in vitro study in which four different resurfacing implants were evaluated with a simulated femoral head, two types of cement, (low and high viscosity) and two cementing techniques: direct (cement apposition directly on the femoral head) and indirect (cement poured into the femoral component). Results High-viscosity cement showed homogeneous distribution over the entire femoral head. Low-viscosity cement showed a massive polar concentration with insufficient, if not absent, distribution in the equatorial zone. Conclusion Polar cement concentration could be a risk factor for early implant failure due to two effects on the femoral head: biological (excessive local exothermic reaction could cause osteocyte necrosis) and biomechanical (which could lead to uneven load distribution on the femoral head). PMID:21234563

  11. Hip Ultrasound

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z Hip Ultrasound Hip ultrasound uses sound waves to produce pictures ... of Ultrasound Imaging of the Hip? What is Ultrasound Imaging of the Hip? Ultrasound images of the ...

  12. Arthroplasty using a custom-made cemented total hip prosthesis for an extensive giant cell tumor of the proximal femur: report of a patient followed up for over 30 years.

    Science.gov (United States)

    Nakano, Shunji; Enishi, Tetsuya; Hasan, Mohamed Yehya; Hanaoka, Naoyoshi; Kawasaki, Yoshiteru; Egawa, Hiroshi; Kinoshita, Isamu; Yasui, Natsuo

    2009-09-01

    We report the case of a 26-year-old man who had a pathologic transtrochanteric fracture of the left femur due to a grade II giant cell tumor affecting the neck and the trochanteric area. This patient underwent complete resection of the tumor and arthroplasty using a custom-made cemented total hip prosthesis. The good radiologic and functional results of the surgery have been maintained for over 30 years without local recurrence or lung metastasis. Moreover, new bone formation was observed at the reattachment sites of abductors, iliopsoas tendons and vastus lateralis to the femoral component of the prosthesis although local bone resorption was detected at the upper lateral part of the femoral stem and zone I of the cup side.

  13. 普通非骨水泥股骨柄用于髋关节翻修的临床分析%Application of non-cement femoral stem in total hip revision

    Institute of Scientific and Technical Information of China (English)

    恩和; 陈继营; 杨瑞; 张玄; 李恒; 杨云建

    2013-01-01

    目的:评价普通非骨水泥股骨假体用于人工全髋关节翻修术的临床效果。方法对我科2008年1月-2011年11月期间行普通非骨水泥柄髋关节翻修手术的18例患者进行影像学和临床疗效评价。其中男性10例,女性8例;患者年龄45~76岁,平均58岁。行髋关节翻修的原因:假体周围感染10例,无菌性松动8例。所有患者翻修手术前后均行Harris评分和髋关节X线正侧位检查。结果18例均获得随访,随访时间6~42个月,平均30个月。术前Harris评分平均为39(23~53)分,截止最近一次随访评分均数增加至92(84~96)分。所有患者均在术后2~3个月完全负重,原有的疼痛也得到缓解。仅1例术后3个月门诊随访时诉大腿外侧有不适至轻度疼痛,口服双氯芬酸钠双释放胶囊75 mg 1/d,两周后症状消失。最近一次随访时,所有股骨假体均获得良好的骨长入。无明显并发症。仅1例术后两周脱位,给予手法复位单侧髋关节“人”字形石膏固定6周,随访6个月,未再脱位。结论普通非骨水泥股骨柄是部分髋关节翻修术中股骨假体翻修的良好选择,近期临床表现和X线检查结果令人满意。%Objective To assess the application of non-cement femoral stem prosthesis in total hip revision. Methods The clinical and radiographic outcomes in 18 patients (10 males and 8 females) aged 45-76 years (mean 58 years) after total hip revision with non-cement femoral prosthesis from January 2008 to November 2011 in our department were assessed. Ten patients underwent total hip revision due to infection of the prosthesis and 8 patients underwent total hip revision due to aseptic loosening of the prosthesis. The patients were scored according to the Harris scoring scale and their hip joint underwent anterioposterior and lateral X-ray examination before and after operation. Results The patients were followed up for 6-42 months (mean 30 months). The

  14. 医用骨水泥和人工韧带在犬髋关节脱位治疗中的应用%Application of Medical Bone Cement and Artificial Ligament in Treatment of Canine Hip Joint Dislocation

    Institute of Scientific and Technical Information of China (English)

    毛典荣; 刘汉文; 江颖; 李浓; 周庆国

    2014-01-01

    为了探索人工圆韧带植入术治疗犬髋关节脱位远期疗效降低的解决办法,选择体重6.5 kg~7.5 kg、年龄1岁左右的3只本地家犬,在使用外科丝线替代圆韧带植入髋关节后,使用医用骨水泥填充和封闭髋臼和股骨孔道,术后通过运动姿态观察、负重力测试、常规 X 线摄片、血清生化项目检测和病理剖检几个方面,分析评估人工圆韧带植入术使用医用骨水泥的效果。结果显示,随着犬肢运动状态逐渐改善,术肢负重力增加;但随着丝线断开或出现退行性关节病,术肢运动肢势改变和负重力降低;骨水泥填充、封闭人工圆韧带孔道效果可靠,关节滑液保持良好,血清重要生化指标均在参考范围。在动物试验基础上,选择医用人工韧带植入和将骨水泥用于犬髋关节脱位临床病例1例,经过9个月的动态观察,术肢运动状态、负重力和髋关节 X 线影像与健肢相比无任何异常。动物试验与临床疗效表明,联合使用医用骨水泥和人工韧带能够很好地重建髋关节结构和功能,维持人工圆韧带植入术治疗犬髋关节脱位的远期疗效。%To explore the solution for the lower long-term effects of the ligamentum teres implantation for canine hip joint dislocation,three hybrid dogs of about 1 year old,6.5 kg~7.5 kg body weight were select-ed.After surgical silk thread instead of the ligamentum teres was implanted into a hip joint,the acetabular and femoral holes were filled and closed with medical bone cement.Effect of the bone cement was analysed and evaluated by the observation of motion state,weight-bearing gravity test,conventional X-ray radio-graph,detection of serum biochemical items and pathological dissection.The results showed that the limb weight-bearing gravity increased with motion state gradually improved.But as the silk thread was discon-nected or degenerative joint disease appeared,the limb

  15. Clinical application and efficacy of hip resurfacing arthroplasty%髋关节表面置换术的临床应用及疗效

    Institute of Scientific and Technical Information of China (English)

    郭盛杰; 周一新; 周乙雄; 李玉军; 殷建华

    2012-01-01

    [Objective]To investigate the clinical application and efficacy of hip resurfacing arthroplasty by following-up and analyzing of the hip resurfacing cases. [Method]Thirty-two patients with 32 hips were treated with metal on metal hip resurfacing arthroplasty from Jan, 2004 to Jan. 2009. The study group consisted of twelve men and twenty women with the average age of 44. 8 years(range, 19 -65 years)and the average BMI of 25. 2(range, 18. 7 -33. 1). Thirteen patients were diagnozed as avascular necrosis of femoral head and nineteen patients were diagnozed as osteoarthritis secondary to developmental dysplasia of the hip. The hip resurfacing prosthesis system with cementless acetabular side and stemmed cement femoral side was used in operation. The mean follow-up were 56 months (range, 37 -75 months). [Result] One male patient with osteoarthritis was performed with total hip arthroplasty because of fracture of femoral neck at 1 month post-operation, and the other cases had no loosening or revision of the prosthesis till the terminal point of follow-up. Harris score was improved significantly and the function of hip recovered well. [ Conclusion] Metal on metal hip resurfacing arthroplasty has good clinical efficacy,and that is based on strict selection of patients and standardized operative technique.%[目的]通过对髋关节表面置换术病例的随访及分析,探讨该术式的临床应用及疗效.[方法]自2004年1月~2009年1月之间32例患者32髋施行了金属对金属的髋关节表面置换手术,其中男12例,女20例,平均年龄44.8岁(19~ 65岁),平均体重指数(BMI) 25.2 (18.7~33.1),术前诊断为股骨头缺血性坏死13例,髋臼发育不良继发骨关节炎19例.手术所采用的表面置换系统的髋臼侧均为生物型固定,股骨侧均为骨水泥型固定且带有导向柄.术后平均随访56个月(37~75个月).[结果]1例髋臼发育不良继发骨关节炎男性患者因术后1个月出现股骨颈骨折而改行全

  16. Feasibility of metal-on-metal prostheses for total knee arthroplasty in rabbits%兔用金属对金属表面人工膝关节假体置入的可行性

    Institute of Scientific and Technical Information of China (English)

    刘建华; 余世明; 胡俊勇; 徐栋梁

    2011-01-01

    BACKGROUND: The present studies of the anti -wear are focused on the improvement and choice of the joint surface. Thesurface of metal-on-metal is the most important direction of reform and investigation.OBJECTIVE: To explore the feasibility and the utilization information after 12 months of metal-on-metal prosthesis of total kneearthroplasty (TKA) in rabbits and evaluate the biomechanical characteristics of the prosthesis.METHODS: The prostheses were designed personally, surfaces of femoral and tibial prostheses were reformed by stainlesssteel-mesh, friction surfaces were used to match metal-on-metal. Ten adult New Zealand rabbits underwent TKA andnon-replacement of the patella were divided randomly into two groups (5 in each group). The experimental prosthesis was fixedbiologically and the control group was used with bone cement.RESULTS AND CONCLUSION: At 12 months after replacement, a great amount of bone reconstructions were found in theexperimental group. The difference of function of the knee joint between the two groups was not significant. Roentgenogramsproved that two groups were fixed well and no dislocation and no loosening. The maximal shear strength of prosthesis boneinterface in the experimental group was higher than that in the control group (P < 0.05).There were new bone formation of thethick stereo mesh surface of the prosthesis in the experimental group and no new bone formation of the surface of thecementless prosthesis in the control group under fluorescence microscopy. The metal-on-metal prosthesis of TKA is suitable tobe fixed biologically for the rabbits, no matter whether use bone cement or not. The fixation strength of prosthesis by two layerstainless steel-mesh is better than that of the bone cement prosthesis at 12 months after operation.%背景:目前抗磨损方面的研究主要集中在关节摩擦副的改进和选择,其中金属对金属摩擦副是重要的革新与探索方向之一.目的:观察兔用金属对金属表面人工

  17. A comparison of acetate and digital templating for hip resurfacing.

    Science.gov (United States)

    Bracey, Daniel N; Seyler, Thorsten M; Shields, John S; Leng, Xiaoyan; Jinnah, Riyaz H; Lang, Jason E

    2014-01-01

    This study sought to determine whether templating for metal-on-metal hip resurfacing is more accurate with digital or acetate methodology. The medical records of 102 consecutive patients who underwent hip resurfacing at our institution were retrospectively reviewed. Records lacking preoperative radiographs that included a magnification-establishing marker were excluded, leaving 78 records for study. Two investigators independently prepared acetate and digital templates of the preoperative radiographs, which had been calibrated to 120% magnification, to predict femoral and acetabular component size. Accuracy was measured by comparing the predicted component sizes to the surgically implanted component sizes. Digital templating was more accurate than acetate templating in predicting hip resurfacing component size when measuring accuracy of templates by the absolute error of predicted component sizes (femoral, P hip resurfacing procedures.

  18. Cement Conundrum

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    China aims to streamline the crowded cement industry Policymakers are looking to build a concrete wall around the cement-making industry as they seek to solidify the fluid cement market and cut excessive production.

  19. Metal ion levels in large-diameter total hip and resurfacing hip arthroplasty-Preliminary results of a prospective five year study after two years of follow-up

    Directory of Open Access Journals (Sweden)

    Maurer-Ertl W

    2012-04-01

    Full Text Available Abstract Background Metal-on-metal hip resurfacing is an alternative to metal-on-metal total hip arthroplasty, especially for young and physically active patients. However, wear which might be detected by increased serum ion levels is a matter of concern. Methods The aims of this preliminary study were to determine the raise of metal ion levels at 2-years follow-up in a prospective setting and to evaluate differences between patients with either resurfacing or total hip arthroplasty. Furthermore we investigated if the inclination of the acetabular component and the arc of cover would influence these findings. Therefore, 36 patients were followed prospectively. Results The results showed increments for Co and Cr in both implant groups. Patients treated with large-diameter total hip arthroplasty showed fourfold and threefold, respectively, higher levels for Co and Cr compared to the resurfacing group (Co: p  Discussion In order to clarify the biologic effects of ion dissemination and to identify risks concerning long-term toxicity of metals, the exposure should be monitored carefully. Therefore, long-term studies have to be done to determine adverse effects of Co and Cr following metal-on-metal hip replacement.

  20. Metal ion trend may be more predictive for malfunctioning metal-on-metal implants than a single measurement

    NARCIS (Netherlands)

    Smolders, J.M.; Hol, A.; Susante, J.L.C. van

    2013-01-01

    Forty-eight unilateral hip resurfacing arthroplasty patients were evaluated for cobalt and chromium levels. The metal ion trend of 42 well-functioning patients was compared with six sub-optimal functioning patients. Median metal ion levels were significantly higher for the sub-optimal group. For the

  1. [Choice of hip prosthesis in patients younger than 50 years

    NARCIS (Netherlands)

    Schreurs, B.W.; Busch, V.J.; Veth, R.P.H.

    2007-01-01

    There is no agreement about the most ideal type of hip prosthesis to be used in patients younger than 50 years. The most commonly used hip prostheses in patients younger than 50 years are uncemented or resurfacing prostheses and to a lesser extent cemented prostheses. A good result of a hip prosthes

  2. 人工髋关节表面置换术19例%Metal-on-metal Hip Resurfacing: Report of 19 Cases

    Institute of Scientific and Technical Information of China (English)

    夏春; 王承云; 王少杰; 张英; 石磊

    2010-01-01

    目的 总结人工髋关节表面置换术的初步经验与疗效. 方法 2007年8月~2009年6月对19例(19髋)髋关节疾病行人工髋关节表面置换术,假体均为金属对金属髋关节表面假体.取髋关节后外侧入路,直视下或定位器下钻入导向钉,根据股骨颈直径确定股骨头假体的大小,髋臼假体使用生物型压配技术固定,股骨头假体骨水泥固定. 结果 1例术后复查X线片时发现髋臼假体脱位再次手术复位成功;1例在股骨颈定位时发现导针严重偏差,重新定位定向后获得良好位置,术后X线位置良好;其余17例手术顺利和术后X线显示位置良好,出院时均屈髋达90°,步行出院.19例随访3~25个月,平均9.2月, 末次随访HSS评分为(91±11)分,较术前(43±10)分明显增高(t=14.465, P=0.000);UCLA 髋关节活动评分(7.4±1.6)分,较术前(4.4±1.3)分明显升高(t=8.364, P=0.000). 结论金属对金属髋关节表面置换术治疗某些髋关节疾病近期疗效优良,特别适合于年轻患者;但该术式有更长学习曲线,有一定的适用范围,且在行髋关节表面置换时需要准备全髋置换的器械.

  3. [Uncemented arthroplasty of the hip].

    Science.gov (United States)

    von Schulze Pellengahr, C; Fottner, A; Utzschneider, S; Schmitt-Sody, M; Teske, W; Lichtinger, T; Esenwein, S A

    2009-05-01

    Prognosis of cemented total hip replacement seems to be excellent for elderly patients. In younger age the outcome is less favourable and early revision is more common. Thus, different concepts with better prognosis and preservation of bone stock for possible revisions were needed. After more than 30 years of application with excellent short-term and long-term results, uncemented total hip arthroplasty is nowadays generally regarded as the standard procedure for younger patients. New bone-preserving implants, such as surface replacement or short-stemmed femoral shaft prostheses, have been introduced especially for younger patients. Some of these new procedures are still under development, and the long-term results of new implant concepts have to be evaluated over the next decades. Regarding recently published scientific studies an overview about non-cemented total hip arthroplasty is given and current concepts and developments are presented.

  4. 髋关节表面置换术中股骨头缺损区骨水泥填充和空置两种处理方法的生物力学比较%Biomechanical comparison of bone-cement filling and cement vacancy treatments for femoral head defect in hip resurfacing arthroplasty

    Institute of Scientific and Technical Information of China (English)

    何志勇; 李明; 陶崑; 方超华; 章军辉; 狄正林

    2014-01-01

    Objective To investigate the reliable treatment methods for the femoral head defect during the hip resurfacing arthroplasty,by comparing the biomechanical effects between bone cement filling and cement vacancy using three-dimensional (3-D) finite element analysis.Methods The 3-D finite element model of the normal femur was constructed based on the CT scanning.Four defect models were established by the computer assissted design technology.The defect diameter was 50%of the femoral head diameter in two models, and it was 80%of the femoral head diameter in the other two models.The femoral head defects were dealt with cement filling or vacancy.The models were loaded with the simulated standing stress, and the biomechanical indices of the femoral head and neck were compared and analyzed, including the stress peak and the equivalent strain.Results The stress concentration in the femoral head: in the model of 50%diameter defect, the stress concentration was not significant in the cement filling group, but it was significant in areaⅠof the femoral head in the vacancy group;in the model of 80%diameter defect filled with cement, the stress concentration exceeded 100% in area Ⅰ of the femoral head, while in the vacancy group, it exceeded 1000%in areaⅠ;the maximum stress concentration in areaⅡwas as high as 766.89%.The stress concentration in the femoral neck:in the model of 50% diameter defect, the stress concentration in the femoral neck was between -50% and 50% in both groups;in the model of 80%diameter defect, it was between -50% and 50% in the cement filling group, while it was extremely increased in the vacancy group.The equivalent strain in the femoral head:in the model of 50% diameter defect, the equivalent strain did not chang significantly in the cement filling group, while it increased significantly in the proximal part of the head in the vacancy group;in the model of 80%diameter defect, it increased significantly in the vacancy group.The equivalent strain in

  5. Conus hip prosthesis.

    Science.gov (United States)

    Wagner, H; Wagner, M

    2001-01-01

    50 years ago, prosthetic replacement of the hip joint ushered in a new epoch in orthopaedics. Total hip replacement made it possible to remove a severely diseased, painful hip and restore normal function and a normal quality of life to the afflicted patient. The early results of total hip replacement are almost all spectacular and hip replacement has become the most successful type of orthopaedic surgery. These good results using an approach that was technically relatively simple resulted in a temptation to implant prosthetic hip joints with ever increasing frequency in ever younger patients. This led to the emergence of new problems, which were not so clearly recognised at the outset: it emerged that the stability of prosthetic hip joints was of limited duration. This had the following consequence: If a total hip prosthesis is implanted in an elderly person whose remaining life-expectancy is shorter than the longevity of the prosthesis, hip replacement is a life-long solution. We can therefore say that, for a patient who has only 10 to 15 years left to live, their hip problem is solved by total hip replacement. For young people, who still have a long life expectancy in front of them, it is different. They will experience failure of the artificial joint and require further surgery. The commonest and most important type of failure in total hip prostheses is aseptic loosening, which is associated with resorption of bone at the site of the prosthesis. The cause of this phenomenon has only gradually been recognised in the course of the years. Initially, the unanimous opinion was that the methacrylate cement, used to fix the components of the prosthesis in the bone, was the definitive cause of aseptic loosening because fissures and fractures of the cement were almost always found during surgical revision of loosened joints. There was talk of "cement disease" and great efforts were made to improve the quality of the cement and the cementing technique. Moreover, even

  6. Detection of incorrect manufacturer labelling of hip components.

    Science.gov (United States)

    Durand-Hill, Matthieu; Henckel, Johann; Burwell, Matthew; Skinner, John; Hart, Alister

    2017-01-01

    We describe the case of a 53-year-old man who underwent a left metal-on-metal hip resurfacing in 2015. Component size mismatch (CSM) was suspected because of the patient's immediate post-operative mechanical symptoms and high metal ion levels. Surgical notes indicated the appropriate combinations of implants were used. However, we detected a mismatch using computed tomography. Revision was performed and subsequent measurements of explanted components confirmed the mismatch. To our knowledge, this case is the first report of a CT method being used in a patient to pre-operatively identify CSM.

  7. Detection of incorrect manufacturer labelling of hip components

    Energy Technology Data Exchange (ETDEWEB)

    Durand-Hill, Matthieu; Henckel, Johann; Skinner, John; Hart, Alister [University College London, Institute of Orthopaedics, London (United Kingdom); Burwell, Matthew [Royal United Hospital, Bath (United Kingdom)

    2017-01-15

    We describe the case of a 53-year-old man who underwent a left metal-on-metal hip resurfacing in 2015. Component size mismatch (CSM) was suspected because of the patient's immediate post-operative mechanical symptoms and high metal ion levels. Surgical notes indicated the appropriate combinations of implants were used. However, we detected a mismatch using computed tomography. Revision was performed and subsequent measurements of explanted components confirmed the mismatch. To our knowledge, this case is the first report of a CT method being used in a patient to pre-operatively identify CSM. (orig.)

  8. Biomechanical evaluation of dynamic hip screw with bone cement augmentation in normal bone%骨水泥强化正常骨质DHS固定的生物力学研究

    Institute of Scientific and Technical Information of China (English)

    黎宁; 彭阿钦; 聂喜增; 李锋; 赵永涛; 毕靖博; 韩长伶

    2008-01-01

    背景:DHS是治疗股骨转子间骨折的标准内固定,对于伴有骨质疏松的骨折,容易发生拉力螺钉切割.国内外文献建议骨水泥强化DHS以达到坚强内固定,但是对于正常骨质,骨水泥强化是否有效还缺少报道.目的:选取正常骨密度的股骨转子间骨折标本,观察骨水泥强化对DHS固定的生物力学影响.设计、时间及地点:同一标本两侧对比观察实验,于2005-03/05在河北省骨科研究所生物力学实验室完成.材料:选取河北医科大学解剖教研室提供的成年男性防腐尸体双侧股骨上段标本.X射线证实无结核、畸形、肿瘤.方法:取成年男性防腐尸体双侧股骨上段标本24对48侧,制备A2型股骨转子间骨折模型.右侧标本行骨水泥强化DHS固定(在股骨头近端钉道用刮匙扩大.股骨头朝下,注入2mL低黏稠度骨水泥,拧入拉力螺钉,保持位置不变直至骨水泥凝固.置入套筒,拧紧尾钉适当加压,皮质骨螺钉固定钢板),为强化组;左侧行DHS常规固定,为对照组.两组标本进行弯曲强度试验及扭转强度试验.主要观察指标:两组标本的最大负荷及最大扭矩.结果:强化组最大负荷及最大扭矩与对照组比较,差异均无统计学意义[最大负荷分别为:(3852.1602±143.6031)N和(3702.9667±133.8601)N;最大扭矩分别为(15.5±2.6)N·m,(14.7±3.4)N·m, P>0.0⑤.结论:对于正常骨密度的股骨转子间骨折,骨水泥强化对DHS固定强度及骨折整体稳定性无显著的影响.%BACKGROUND: Dynamic hip screw (DHS) is a standard internal fixation for intertrochanteric fracture, whereas the patient combined with osteoporosis, cut-out incidence of lag screw is common. The articles in China and abroad indicate bone cement augmentation of DHS to achieve firm fixation. As for normal bone, no reports is published that whether bone cement augmentation is effective.OBJECTIVE: To investigate the biomechanics of DHS with bone cement augmentation for

  9. Formation of a pseudotumor in total hip arthroplasty using a tribological metal–polyethylene pair☆

    Science.gov (United States)

    Fagotti, Lorenzo; Vicente, José Ricardo Negreiros; Miyahara, Helder Souza; de Oliveira, Pedro Vitoriano; Bernabé, Antônio Carlos; Croci, Alberto Tesconi

    2015-01-01

    The aim here was to report a case of a young adult patient who evolved with tumor formation in the left thigh, 14 years after revision surgery on hip arthroplasty. Davies in 2005 made the first description of this disease in patients undergoing metal-on-metal hip arthroplasty. Over the last decade, however, pseudotumors around metal-on-polyethylene surfaces have become more prevalent. Our patient presented with increased volume of the left thigh 8 years after hip arthroplasty revision surgery. Two years before the arising of the tumor in the thigh, a nodule in the inguinal region was investigated to rule out a malignant neoplastic process, but the results were inconclusive. The main preoperative complaints were pain, functional limitation and marked reduction in the range of motion of the left hip. Plain radiographs showed loosening of acetabular and femoral, and a large mass between the muscle planes was revealed through magnetic resonance imaging of the left thigh. The surgical procedure consisted of resection of the lesion and removal of the components through lateral approach. In respect of total hip arthroplasty, pseudotumors are benign neoplasms in which the bearing surface consists of metal-on-metal, but they can also occur in different tribological pairs, as presented in this case. PMID:27218090

  10. Cement Formation

    DEFF Research Database (Denmark)

    Telschow, Samira; Jappe Frandsen, Flemming; Theisen, Kirsten

    2012-01-01

    Cement production has been subject to several technological changes, each of which requires detailed knowledge about the high multiplicity of processes, especially the high temperature process involved in the rotary kiln. This article gives an introduction to the topic of cement, including...... an overview of cement production, selected cement properties, and clinker phase relations. An extended summary of laboratory-scale investigations on clinkerization reactions, the most important reactions in cement production, is provided. Clinker formations by solid state reactions, solid−liquid and liquid...

  11. Different pretreatments to prevent bone cement implantation syndrome in hip arthroplasty%多种干预措施预处理骨髓腔预防骨水泥植入综合征的研究

    Institute of Scientific and Technical Information of China (English)

    齐向北; 张英泽; 潘进社; 马利杰; 王建朝; 王琳

    2010-01-01

    Objective To investigate possible methods to prevent the adverse effect of bone cement implantation syndrome(BCIS)during hip arthroplasty by the rabbit model.Methods Forty-eight Belgium rabbits of either sexes,1.8-2.4 kg body weight,were armesthetized with intravenous pentobarbitone sodium (10 mg/kg body weight)and anaesthesia was maintained by additional doses of pentobarbitone sodium.The 48 Belgium rabbits(48 hips)were assigned to 8 groups randomly.The control group consisted of 6 rabbits,treated with conventional cementing technique:group 1-7 pretreated the medullary cavity with adrenaline (1:10000),drilling holes in femur,fibrin sealant or combined with these factors before having cement and femoral prosthesis inserted.Arterial blood pressure,central venous pressure and respiration rate were recorded at the carotid artery.the external jugular vein and the tracheal cannula by BL-420E+biological functional experimental system respectively.Data were collected and analyzed with SPSS.Specimens were taken from each lobe of the lung.11le tissue sections were observed.Results The decline in blood pressure in groups C (14.96±2.6)mm Hg,D(17.58±2.06)mm Hg,and G(21.67±5.52)mm Hg was more significant than that in the control group,and the duration of blood pressure drop was shorter in groups A(30.00±5.62)s,C(26.17±2.64)s,E(27.17±3.87)s,F(22.130±3.69)s,and G(20.17±5.04)s.Condusion Adrenaline saline.fibrin sealant and combined use of adrenaline and fibrin sealant.combined use of fibrin sealant and drilling holes.combined use of adrenaline and drilling holes can prevent the decline in blood pressure during the HA.Drilling holes have no effect,but can play a synergistic role with fibrin sealant.%目的 探讨兔髋关节置换术中扩髓后肾上腺素盐水、股骨扩髓区域钻孔及纤维蛋白医用胶(FS胶)对髓腔预处理及其联合应用对术中骨水泥植入综合征的预防作用.方法 采用2×2×2析因实验设计,将

  12. Efficacy of hip resurfacing arthroplasty: 6 year results from an international multisurgeon prospective cohort study.

    Science.gov (United States)

    Aulakh, Tajeshwar S; Jayasekera, Narlaka; Singh, Rohit; Patel, Amit; Roulahamin, Nick; Kuiper, Jan H; Richardson, James B

    2015-06-01

    Metal-on-metal hip resurfacing is undertaken worldwide. This procedure helps preserve femoral bone stock and allows patients to return to high activity sports. Most outcome studies are individual surgeon case series from single centers where the results and outcomes are evaluated by the same surgeon. One method of increasing the external validity of a follow-up study is to have a multi-centre study design with independent assessment of the outcomes. We present an independent assessment of eleven year follow-up of hip resurfacing outcomes from an international hip resurfacing register. The purpose of this study was to assess: Implant survival at maximum follow-up for revision due to any reason, implant survival at maximum follow-up for revision due to major causes of failure, hip function following hip resurfacing and factors affecting hip function, effect of gender and age on hip function and implant survival, effect of femoral component size on hip function and implant survival. 4535 patients (5000 hips) entered into the registry during 1997-2002 were studied. In summary, at a maximum follow-up of 11 years hip resurfacing has a good implant survival of 96.2% and excellent post-operative function. This is excellent given the international and multisurgeon nature of this cohort where majority of the surgeons were in their learning curve.

  13. Our Experience with Short Stem Hip Replacement Surgery

    Directory of Open Access Journals (Sweden)

    Sumeet Rastogi

    2016-07-01

    Full Text Available Context- A short anatomical metaphyseal femoral stem is a desirable hip implant for bone and soft tissue preserving hip replacing surgery in young arthritic patients. Physiological loading of the proximal femur prevents stress shielding and preserves bone stock of the femur in the long run. Thus it is an ideal hip implant suited for conservative hip surgeries in active young adults with arthritic hips. Materials and methods- 50 Proxima hip replacements were performed on 41 patients with a mean age of 45 over a 3-year period (between July 2006 and September 2009. Diagnosis of hip pathologies varied from osteoarthritis secondary to avascular necrosis, rheumatoid arthritis, post-tubercular arthritis to dysplastic hips. 9 of these patients had symptomatic bilateral hip involvement and underwent bilateral hip replacement in a single sitting. All patient had a Proxima metaphyseal stem implantation( DePuy, Warsaw with either a large diameter metal on metal or pinnacle articulation. Clinical and radiological evaluation was done at 3 months, 6 months, 1 year and then yearly thereafter. Statiscal analysis used- VAS and Harris hip score formed the basis of evaluation Results- These patients were followed up for a mean period of 49 months (Range 36-72 months. The average incision size was 14.38 cm (10-18 cm and blood loss was 269 ml (175-450 ml. There was no peri-operative mortality or serious morbidity in any patients. One patient had an intraoperative lateral cortex crack that required only delayed rehabilitation. Five of the 41 patients (12.1 % had complications with three recovering completely and one requiring revision of femoral stem for aseptic loosening. One patient was lost in follow-up. Harris hip score improved from 52 to 89.3 at last follow-up. Overall 95.1% (39/41 patients had an excellent outcome at last follow-up. Conclusion- We conclude that Proxima metaphyseal stem provided clinically and radiologically stable fixation through snug fit

  14. Revision Total Hip Replacement: A Case Report

    Directory of Open Access Journals (Sweden)

    Md Hafizur Rahman

    2013-07-01

    Full Text Available Total hip replacement is a reconstructive procedure that has improved the management of those diseases of the hip joint that have responded poorly to conventional medical therapy. Conventional, primary total hip replacement is a durable operation in the majority of patients. A hip replacement is a mechanical device with parts that are assembled before and during the operation. But the possible complications of total hip arthroplasty, and its clinical performance over time, is a challenging occasion to the surgeons, and such a challenge we faced with our presenting patient. A 68 year old lady with history of cemented bipolar hemiarthroplasty done in a tertiary care hospital, due to fracture neck of the left femur having the history of diabetes, chronic kidney disease, heart disease, anaemia, and mental disorders presented with loosened prosthesis, thinning of medial proximal cortex of the femur which had broken within few months after surgery. She complained of painful walking at left hip joint. There was also evidence of chronic infective and degenerative arthritis of acetabular component of the affected hip joint. Cemented revision total hip replacement surgery was performed with expert multidisciplinary involvement. On 2nd postoperative day the patient was allowed to walk on operated limb with the aid of walker. On 12th postoperative day all the stitches were removed and wound was found healthy.

  15. Total hip arthroplasty following failed fixation of proximal hip fractures

    Directory of Open Access Journals (Sweden)

    Srivastav Shekhar

    2008-01-01

    Full Text Available Background: Most proximal femoral fractures are successfully treated with internal fixation but a failed surgery can be very distressing for the patient due to pain and disability. For the treating surgeon it can be a challenge to perform salvage operations. The purpose of this study was to evaluate the short-term functional outcome and complications of total hip arthroplasty (THA following failed fixation of proximal hip fracture. Materials and Methods: In a retrospective study, 21 hips in 20 patients (13 females and seven males with complications of operated hip fractures as indicated by either established nonunion or fracture collapse with hardware failure were analysed. Mean age of the patients was 62 years (range 38 years to 85 years. Nine patients were treated for femoral neck fracture, 10 for intertrochanteric (I/T fracture and two for subtrochanteric (S/T fracture of the hip. Uncemented THA was done in 11 cases, cemented THA in eight hip joints and hybrid THA in two patients. Results: The average duration of follow-up was four years (2-13 years. The mean duration of surgery was 125 min and blood loss was 1300 ml. There were three dislocations postoperatively. Two were managed conservatively and one was operated. There was one superficial infection and one deep infection. Only one patient required a walker while four required walking stick for ambulation. The mean Harris Hip score increased from 32 preoperatively to 79 postoperatively at one year interval. Conclusion: Total hip arthroplasty is an effective salvage procedure after failed osteosynthesis of hip fractures. Most patients have good pain relief and functional improvements inspite of technical difficulties and high complication rates than primary arthroplasty.

  16. Long-term outcome of a metal-on-polyethylene cementless hip resurfacing.

    Science.gov (United States)

    Tan, Timothy L; Ebramzadeh, Edward; Campbell, Patricia A; Al-Hamad, Mariam; Amstutz, Harlan C

    2014-04-01

    Due to the well-documented problems surrounding metal-on-metal bearings, the use of hip resurfacing has declined. Since the potential benefits of hip resurfacing remain desirable, it may be beneficial to investigate the long-term outcome of hip resurfacings using metal-on-polyethylene in the 1980's. We report the long-term survivorship and modes of failure of a cementless metal-on-polyethylene resurfacing (n = 178) with different porous ingrowth surfaces. While acetabular loosening was absent, a high incidence of femoral failures (femoral loosening = 18.1%, osteolytic neck fracture = 21%) occurred despite using the same ingrowth surface for both components. Ongoing developments using the lessons learned from these previous generation components and utilizing modern low wear materials, e.g., cross-linked polyethylene, may lead to improved implants for future hip resurfacings.

  17. Comparison of Acetabular Bone Resection, Offset, Leg Length and Post Operative Function Between Hip Resurfacing Arthroplasty and Total Hip Arthroplasty.

    Science.gov (United States)

    Parry, Michael C; Povey, James; Blom, Ashley W; Whitehouse, Michael R

    2015-10-01

    Controversy exists regarding the amount of acetabular bone resection, biomechanics and function of patients receiving either total hip arthroplasty (THA) or hip resurfacing arthroplasty (HRA). A cohort of patients undergoing 36 mm ceramic-on-ceramic THA (89) or metal-on-metal HRA (86) were compared. No difference was observed when the ratio of native femoral head size was compared to the implanted acetabular component size (1.15 ± 0.1 HRA c.f. 1.13 ± 0.1 THA). No difference was observed in acetabular offset, vertical centre of rotation or function (OHS mean 47 in both groups) but leg length discrepancy (1.8 mm c.f. 5.5 mm) and femoral offset did differ (0.6 mm c.f. 4.1 mm). This demonstrates that 36 mm ceramic-on-ceramic THA is not associated with more bone resection than HRA and achieves equivalent function whilst avoiding the problems of metal-on-metal bearings.

  18. Investigation of Wear and Corrosion of a High-Carbon Stellite Alloy for Hip Implants

    Science.gov (United States)

    Hu, P. S.; Liu, R.; Liu, J.; McRae, G.

    2014-04-01

    Low-carbon Stellite 21 has been used as hip implant material for a number of decades; however, its limited metal-on-metal bearing has resulted in loosening between the femoral head and the acetabular cup of hip implants. In order to improve the metal-on-metal bearing, it is proposed that a high-carbon alloy, Stellite 720, surface coating be applied on Stellite 21 hip implants to improve mechanical and tribological performance. For this coating to be practical, it must also meet the requirements of corrosion resistance for orthopedic implant materials. In this research, Stellite 720 is investigated with pin-on-disk wear tests, and electrochemical and immersion corrosion tests in simulated human body fluid (Hank's solution; pH 7.4 at temperature of 37°C). The experimental results demonstrate that Stellite 720 exhibits much better wear resistance than Stellite 21, and has the potential for better corrosion resistance as well. The applicability of coating Stellite 21 hip implants with Stellite 720 is discussed.

  19. The influence of resting periods on friction in the artificial hip.

    Science.gov (United States)

    Nassutt, Roman; Wimmer, Markus A; Schneider, Erich; Morlock, Michael M

    2003-02-01

    Insufficient tribologic performance of total joint components is a major cause of prostheses failure. Wear has been studied intensively using testing machines that apply continuous motions. Human locomotion, however, is not well represented by continuous motions alone. Singular events and resting periods are a substantial part of daily activities. Resting does influence adhesion in the artificial joint with possible effects on friction, wear, and loosening. The current study evaluated the effects of resting on the frictional properties of hip prosthesis components. The activity measurements of 32 patients with artificial hip replacements were analyzed for resting durations of the hip. A pin-on-ball screening device was used to determine friction after characteristic resting periods and during continuous oscillating motion. All common articulation pairings were investigated. Prolonged and frequent resting periods of the hip were found for the patients. Initial friction increased with increasing resting duration for all tested materials (between 41% and 191%). The metal-on-metal articulations showed the highest friction level (0.098 for sliding) and the highest increase (191%) in friction with resting duration (0.285 after resting periods of 60 seconds). A high static frictional moment after resting periods might present a risk for aseptic implant loosening. Therefore, large head diameters of metal-on-metal joints should be used with caution, especially when additional unfavorable risk factors such as obesity, weak bone-implant interface, or high activity level are present.

  20. Comparative assessment of short term outcome of cementless prosthesis versus cemented femoral stem prosthesis in hip arthroplasty for elderly intertrochanteric fracture%生物型与骨水泥型人工髋关节置换治疗高龄转子间骨折早期疗效的比较

    Institute of Scientific and Technical Information of China (English)

    闫文龙; 杨小中; 张华; 张健

    2015-01-01

    Objective To compare the short-term clinical effect of the distal fixed prosthesis ( cementless prosthesis ) with cemented femoral stem prosthesis in hip arthroplasty for elderly intertrochanteric fracture .Methods Fifty-nine cases(54 cases followed-up) of unilateral intertrochanteric fracture in senile patients from Aug .2010 to Apr.2012 were retrospectively analyzed and randomly divided into 2 groups.In them,21 cases underwent hip ar-throplasty using the distal fixed prosthesis ( cementless group ) ,and the other 33 were treated with cemented hip ar-throplasty (cement group).The difference was compared in time of hospitalization , time of operation,blood loss, adverse effect,Harris scoring and radiological results .Results The average operation time were (42.3 ±7.2) mi-nutes in cementless group and (51.5 ±8.3) minutes in cement group,with significant difference (P0.05).Conclu-sion Hip arthroplasty using cementless prosthesis for treatment of elder patients with intertrochanteric fracture can a -chieve good short-term clinical effect alike cemented prosthesis .It helps reduce operative time ,blood loss and bone cement implantation syndrome during the operation .The medium and long term effect still needs further research . And preoperative evaluation on the shape and size of medullary cavity and the severity of osteoporosis is needed .%目的:比较远端固定生物型股骨假体与骨水泥型股骨假体行人工髋关节置换治疗高龄股骨转子间骨折的早期临床疗效。方法回顾性分析2010年8月~2012年4月在我院骨科行人工髋关节置换治疗的59例单侧股骨转子间骨折高龄患者的临床资料,实际随访54例。随机分成两组:生物固定组21例,骨水泥组33例。比较两组住院时间、手术时间、术中出血量、术后3d总失血量、术后并发症、Harris评分以及放射学效果。结果生物固定组手术时间、术中出血均明显少于骨水泥组;生物固定组术中、

  1. Hip resurfacing: history, current status, and future.

    Science.gov (United States)

    Amstutz, Harlan C; Le Duff, Michel J

    2015-01-01

    Hip resurfacing arthroplasty (HRA) presents several advantages over conventional total hip arthroplasty (THA), including conservation and preservation of bone, reduced risk of dislocation, easy replication of hip biomechanics and easy revision if needed. It is a particularly appealing procedure for young patients. HRA has been performed for over 40 years following the same technological advances as THA. The bearing material used by most designs is metal-on-metal (MoM), which has the best compromise between strength and wear properties. However, MoM HRA has a specific set of possible complications. Aseptic femoral failures were initially the most prevalent cause for revision but progress in patient selection and surgical technique seem to have resolved this problem. Wear-related failures (high metal ion levels and adverse local tissue reactions) are now the main concern, and are essentially associated with poor acetabular component design and orientation, to which MoM is more sensitive than other bearing materials. The concept of functional coverage is key to understanding how MoM bearings are affected by edge wear. Only a 3-D assessment of cup position (e.g., the contact patch to rim distance) provides the necessary information to determine the role of cup positioning in relationship with abnormal bearing wear.The concept of hip resurfacing is more valid today than ever as the age of the patients in need of hip arthroplasty keeps getting lower. The recent publication of several excellent long-term survivorship results suggests that selection of a well-designed resurfacing system and accuracy in the placement of the cup can achieve long-term durability.

  2. Clinical and radiological evaluation of hybrid hip replacement in various disorders of hip

    Directory of Open Access Journals (Sweden)

    Dhaon B

    2005-01-01

    Full Text Available Background: High rates of loosening of cemented implants led to change in technique of fixation of the implant. Methods: Fifty-nine hips were operated in 42 patients with non-cemented acetabular and cemented femoral components between January 1999 and July 2003. The average age of the patient was 45.2 years in our study. Preoperative diagnosis was avascular necrosis (28, ankylosing spondylitis (18, fracture neck femur (9, rheumatoid arthritis (2 and osteoarthritis (2. Results: At an average follow up of 3.6 years (range 1.2-5.8 years excellent to good results were obtained 92% according to Harris hip criteria. No radiological loosening was noted in any femoral or acetabular component on follow up. One poor result was seen in a case of bilateral ankylosing spondylitis operated on one side. Conclusion: Hybrid THA provides a viable and highly acceptable method of treatment of diseases of hip in young patients.

  3. Comparison of postoperative curative effect and the possible survival rate of prosthesis following cemented and cementless total hip replacement%人工全髋关节置换骨水泥和无骨水泥假体术后疗效及假体可能的生存率比较

    Institute of Scientific and Technical Information of China (English)

    张勇; 杨彤涛; 周勇; 马保安

    2006-01-01

    ,假体都没有达到理想固定的效果.假体类型的选择并不影响假体的寿命,要根据患者的年龄及是否还要行翻修术来决定假体类型;骨溶解与患者年龄、性别、假体类型无关.%BACKGROUND: Patients who suffered total hip replacement are most concerned about the survivorship of prosthesis. OBJECTIVE: To evaluate the postoperative curative effect following ce mented and cementless THR with a retrospective method, so as to provide experience for prolonging the survivoship of prosthesis. DESIGN: Randomized and controlled observation. SETTING: General Center of Orthopaedic Department, General Institute of Bone Oncology, Tangdu Hospital, Fourth Military Medical University of Chinese PLA. PARTICIPANTS: We admitted 356 patients who underwent THR from Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical U niversity of Chinese PLA between March 1993 and March 2004. Among them, 298 were contacted and 105 (108 hips) followed up. The patients participated in the review voluntarily. They were of either gender and had different types of prosthesis. Prosthesis made in China was adopted before 2000 and prosthesis made in American STRIKER company after 2000: Prosthesis made in China was made of home-made bone cement; Prosthesis bone cement (import) was provided by American STRIKER prosthesis company. Home-made bone cement and import have the same components. Barium was added in both bone cement . The whole operation was con ducted by the physicians who worked in the artificial joint department after examination. METHODS: According to informal discussion summary about total hip replacement of Chinese Journal of Surgery in 1982 and Evaluation Scale of Mayo Total Hip Replacement Curative Effect, we designed follow-up table by ourselves. Totally 105 (108 hips) patients were followed up, among them, 62 (63 hips) were in the cemented group, 43 (45 hips) in the ce mentless group. Pain, function and motion range of the patients and

  4. Hip Fracture

    Science.gov (United States)

    ... Medicine. 2014;161:189. Lewiecki EM. Prevention of osteoporosis. http://www.uptodate.com/home. Accessed Dec. 31, 2014. Hip fractures among older adults. Centers for Disease Control and Prevention. http://www. ...

  5. Rose Hip

    Science.gov (United States)

    ... dropsy or edema), gout, back and leg pain (sciatica), diabetes, high cholesterol, weight loss, high blood pressure, ... Painful menstruation. Some evidence suggests that applying an aromatherapy formula containing lavender, clary sage, and rose hip ...

  6. Hip ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    Martinoli, Carlo, E-mail: carlo.martinoli@libero.it [Radiologia, DISC, Università di Genova, Largo Rosanna Benzi 8, I-16132 Genoa (Italy); Garello, Isabella; Marchetti, Alessandra; Palmieri, Federigo; Altafini, Luisa [Radiologia, DISC, Università di Genova, Largo Rosanna Benzi 8, I-16132 Genoa (Italy); Valle, Maura [Radiologia, Gaslini Children Hospital, Genova (Italy); Tagliafico, Alberto [Radiologia, National Institute for Cancer Research, Genoa (Italy)

    2012-12-15

    In newborns, US has an established role in the detection and management of developmental dysplasia of the hip. Later in childhood, when the limping child is a major diagnostic dilemma, US is extremely helpful in the identification of the varied disease processes underlying this condition, as transient synovitis, septic arthritis, Perthes disease and slipped femoral capital epiphysis. In adolescent practicing sporting activities, US is an excellent means to identify apophyseal injures about the pelvic ring, especially when avulsions are undisplaced and difficult-to-see radiographically. Later on, in the adulthood, US is an effective modality to diagnose tendon and muscle injuries about the hip and pelvis, identify effusion or synovitis within the hip joint or its adjacent bursae and guide the treatment of these findings. The aim of this article is to provide a comprehensive review of the most common pathologic conditions about the hip, in which the contribution of US is relevant for the diagnostic work-up.

  7. Life Estimation of Hip Joint Prosthesis

    Science.gov (United States)

    Desai, C.; Hirani, H.; Chawla, A.

    2014-11-01

    Hip joint is one of the largest weight-bearing structures in the human body. In the event of a failure of the natural hip joint, it is replaced with an artificial hip joint, known as hip joint prosthesis. The design of hip joint prosthesis must be such so as to resist fatigue failure of hip joint stem as well as bone cement, and minimize wear caused by sliding present between its head and socket. In the present paper an attempt is made to consider both fatigue and wear effects simultaneously in estimating functional-life of the hip joint prosthesis. The finite element modeling of hip joint prosthesis using HyperMesh™ (version 9) has been reported. The static analysis (load due to the dead weight of the body) and dynamic analysis (load due to walking cycle) have been described. Fatigue life is estimated by using the S-N curve of individual materials. To account for progressive wear of hip joint prosthesis, Archard's wear law, modifications in socket geometry and dynamic analysis have been used in a sequential manner. Using such sequential programming reduction in peak stress has been observed with increase in wear. Finally life is estimated on the basis of socket wear.

  8. Biomechanical reconstruction of the hip in metal-on-metal total hip resurfacing%金属对金属全髋关节表面置换术后解剖学重建的相关研究

    Institute of Scientific and Technical Information of China (English)

    林荔军; 靳安民; 方国芳; 李鉴轶; 丁超; 陈伟义; 韦葛堇; 李奇

    2008-01-01

    目的 分析髋关节表面置换术后生物力学重建情况及其对髋关节表面置换术后的功能影响.方法 2005年1月~2008年1月对30例30髋患者行全髋关节表面置换,所有患者均行术前后HARRIS评分、X线检查及解剖学重建评估.结果 术后髋关节表面置换术后患者下肢平均短缩2.4mm,股骨偏心距短缩约5.45mm,与健侧相比无显著性差异.患者术后无一例发生髋关节脱位,术前和术后髋关节HARRIS评分分别为36.69±7.16.和89.63±3.36(P<0.01).结论 髋关节表面置换术后可达到良好的生物力学重建,同时其大假体设计可有效保证关节置换术后的稳定性及良好的关节功能重建.

  9. Dual mobility total hip replacement in a high risk population

    Science.gov (United States)

    Luthra, Jatinder Singh; Al Riyami, Amur; Allami, Mohamad Kasim

    2016-01-01

    Objective: The purpose of the study was to evaluate results of dual mobility total replacement in a high risk population who take hip into hyperflexed position while sitting and praying on the floor. Method: The study included 65 (35 primary total replacement and 30 complex total hip replacement) cases of total hip replacement using avantage privilege dual mobility cup system from biomet. A cemented acetabular component and on femoral side a bimetric stem, either cemented or uncemented used depending on the canal type. Ten cases were examined fluoroscopically in follow up. Result: There was dislocation in one patient undergoing complex hip replacement. Fluoroscopy study showed no impingement between the neck of prosthesis and acetabular shell at extremes of all movements. Conclusion: The prevalence of dislocation is low in our high risk population and we consider it preferred concept for patients undergoing complex total hip replacement. PMID:27924742

  10. Dual mobility total hip replacement in a high risk population

    Directory of Open Access Journals (Sweden)

    Luthra Jatinder Singh

    2016-01-01

    Full Text Available Objective: The purpose of the study was to evaluate results of dual mobility total replacement in a high risk population who take hip into hyperflexed position while sitting and praying on the floor. Method: The study included 65 (35 primary total replacement and 30 complex total hip replacement cases of total hip replacement using avantage privilege dual mobility cup system from biomet. A cemented acetabular component and on femoral side a bimetric stem, either cemented or uncemented used depending on the canal type. Ten cases were examined fluoroscopically in follow up. Result: There was dislocation in one patient undergoing complex hip replacement. Fluoroscopy study showed no impingement between the neck of prosthesis and acetabular shell at extremes of all movements. Conclusion: The prevalence of dislocation is low in our high risk population and we consider it preferred concept for patients undergoing complex total hip replacement.

  11. Alternative materials to improve total hip replacement tribology.

    Science.gov (United States)

    Santavirta, Seppo; Böhler, Max; Harris, William H; Konttinen, Yrjö T; Lappalainen, Reijo; Muratoglu, Orhun; Rieker, Claude; Salzer, Martin

    2003-08-01

    An improvement in tribology of bearing surfaces is an effective means of increasing the longevity of total hip replacement (THR). Currently, 3 approaches are available to achieve this aim: first, use of highly cross-linked UHMWPE; second, aluminum oxide ceramic bearings, and third, metal-on-metal bearings. Cross-linking reduces the wear resistance of UHMWPE markedly without impairment of other significant properties of the material. Simulator studies and some clinical long-term (10-22 years) follow-up surveys suggest an almost immeasurable wear of the highly cross-linked UHMWPE-based acetabular components during an expected clinical life span. Bioinert alumina ceramic (aluminum oxide) was introduced 3 decades ago for THR-bearing surfaces to improve performance and longevity. Alumina ceramic is entirely biostable and bioinert and has good mechanical properties. For correctly positioned alumina-on-alumina bearings, the annual linear wear rate has been reported to be 3.9 microm. Alumina heads have been successfully used in combination with polyethylene sockets, but as regards wear, the best results have been obtained with alumina-on-alumina bearings. In ceramic THR bearings, precise manufacture and contact surface geometry, including optimal clearance, are most important. For the currently available products, the component fracture risk is almost nonexistent (less than 1 per 1000). Metal-on-metal bearings were used in the early stage of THR surgery, although not all old designs were successful. More recent analyses of the early series have shown the advantages of metal-on-metal to be better and have led to a renaissance of this articulation. Initially, stainless steel was used because it was easy to manufacture and polish. Current metal-on-metal bearings are based on cobalt-chromium-molybdenum alloys with varying carbon contents. Such bearings are self-polishing. Linear wear rates remain at the level of a few microm a year. An improvement in technology has increased

  12. Development and clinical trial of a novel bioactive bone cement

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Strontium(Sr)and related compounds have become more attractive in the prevention and treatment of osteoporosis.Previously,we developed a novel bioactive bone cement which is mainly composed of strontium-containing hydroxyapatite(Sr-HA)filler and bisphenol A diglycidylether dimethacrylate(Bis-GMA)resin.This bone cement is superior to conventional polymethylmethacrylate (PMMA)bone cement in bioactivity,biocompatibility,and osseointegration.It also has shown sufficient mechanical strength properties for its use in percutaneous vertebroplasty(PVP)and total hip replacement(THR).In this paper,we review the in vitro,in vivo and clinical evidence for the effectiveness of this bioactive bone cement.

  13. Hip resurfacing: a large, US single-surgeon series.

    Science.gov (United States)

    Brooks, P J

    2016-01-01

    Hip resurfacing has been proposed as an alternative to traditional total hip arthroplasty in young, active patients. Much has been learned following the introduction of metal-on-metal resurfacing devices in the 1990s. The triad of a well-designed device, implanted accurately, in the correct patient has never been more critical than with these implants. Following Food and Drug Administration approval in 2006, we studied the safety and effectiveness of one hip resurfacing device (Birmingham Hip Resurfacing) at our hospital in a large, single-surgeon series. We report our early to mid-term results in 1333 cases followed for a mean of 4.3 years (2 to 5.7) using a prospective, observational registry. The mean patient age was 53.1 years (12 to 84); 70% were male and 91% had osteoarthritis. Complications were few, including no dislocations, no femoral component loosening, two femoral neck fractures (0.15%), one socket loosening (0.08%), three deep infections (0.23%), and three cases of metallosis (0.23%). There were no destructive pseudotumours. Overall survivorship at up to 5.7 years was 99.2%. Aseptic survivorship in males under the age of 50 was 100%. We believe this is the largest United States series of a single surgeon using a single resurfacing system.

  14. Comparison of Cobalt Chrome Molybdenum release after metal on metal replacement between THA and TKA%金属对金属全髋关节置换与全膝关节置换术后早期钴铬钼离子的释出

    Institute of Scientific and Technical Information of China (English)

    王晓永; 张卫国; 吕德成; 李洪敬

    2009-01-01

    Objective To explore and compare the level of Cobalt chromium and Molybdenum in the patients after metal on metal replacement between THA and TKA in 6 months after operation. Methods From May 2007 to March 2008, metal on metal replacement of 10 THA and 8 TKA were included in this study. Blood samples were collected before operation, 2 weeks, 6 weeks, 12 weeks and 24 weeks after opera-tion in each patient. The concentration of Chromium (Cr), Cobalt (Co) and Molybdenum (Mo) ions in the plasma were measured by Double-focusing Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Re-sults 1) The level of Cobalt, Chromium ion after metal on metal hip and knee replacement were signifi-cantly higher than normal. They increased sharply 2 weeks after operation, and reached the peak 6 weeks af-ter operation, then decreased gradually to the level of 2 weeks when it was 12 weeks after operation, and af-ter that they decreased slowly until 24 weeks after operation. 2) The concentration of Cobalt, Chromium ion in hip replacement group was lower than that of in knee replacement group. 3) The concentration of Cobalt and Chromium ion in patients using forging products were lower than those using casting products. 4) No sig-nificant changes were found in the concentration of Molybdenum ion in 6 months follow-up in two groups. Conclusion The concentration of Cobalt, Chromium ion increases after metal on metal replacement in THA and TKA. The concentration of Cobalt, Chromium ion in hip replacement group was lower than that of knee replacement group in 6 months after operation.%目的 研究金属对金属伞髋关节置换与全膝关节置换术后早期患者体内钴、铬、钼离子的释出情况.方法 选择2007年5月至2008年3月实施的金属对会属全髋关节置换10例,全膝关节置换8例.假体选择采取随机原则.分别于术前和术后第2、6、12、24周采集静脉全血,应用双聚焦电感耦合等离子体质谱法测量钴、铬、钼离子在

  15. Changes in bone mineral density and femoral neck narrowing in the proximal femur three to five years after hip resurfacing versus conventional total hip arthroplasty.

    Science.gov (United States)

    Gerhardt, Davey M J M; Smolders, José M H; Rijnders, Ton A J M; Hol, Annemiek; van Susante, Job L C

    2015-02-01

    We studied whether bone mineral density (BMD) is preserved without significant femoral neck narrowing (FNN) after hip resurfacing (RHA) (n=42) versus small diameter metal-on-metal total hip arthroplasty (MoM THA) (n=40). In this three to five year randomized trial BMD was measured in the calcar with dual energy absorptiometry (DXA) preoperatively, at three and six months, one, two, three and five years postoperatively. Four additional BMD regions of interest (ROIs) and femoral neck narrowing (FNN) were measured after RHA. BMD in the calcar increased to 107% (P<0.001) at one year and remained stable. Additional ROIs in the femoral neck and trochanter-area BMD changes fluctuated between 99.9% and 104.1%. FNN was minimal with a mean of 1.3% at three years. After THA BMD decreased in the calcar to 80% at one year (P<0.001) and stabilized. This bone stock preserving nature of RHA must be weighed against potential disadvantages caused by specific metal-on-metal bearing problems.

  16. Safety Issue of Hip Resurfacing

    Directory of Open Access Journals (Sweden)

    Timothy McTighe

    2015-10-01

    Full Text Available Hip Resurfacing (HR development of the 1970s was an attempt to address the failures of conventional cemented stems. Those early HR designs failed because problems with maintaining bone under the resurfaced femoral head, and loosening of the socket with substantial acetabular bone loss. However technology, knowledge and surgical techniques have evolved over the past 45 years. The more recent designs like the Birmingham Hip Resurfacing (BHR focused on metal to metal bearing surfaces. These devices are under attack and maybe they should be. However, lets not ignore the significant amount of information and potential improvements in both design technology and surgical techniques that have come about over the past few years.

  17. 人工全髋关节置换骨水泥和无骨水泥假体股骨近端广泛骨溶解的定量分析%Quantitative analysis of widespread osteolysis in the proximal end of cemented and cementless prostheses in total hip arthroplasty

    Institute of Scientific and Technical Information of China (English)

    张勇; 杨彤涛; 周勇; 马保安

    2006-01-01

    of osteolysis in proximal femur after total joint replacements (TJR) through the changing rules of bone density in proximal end of femur.DESIGN: Observation on patients before and after self-comparison.SETTING: Department of Orthopedics, Tangdu Hospital of Fourth Military Medical University of Chinese PLA.PARTICIPANTS: Twenty-eight hips in 26 patients received total hip replacements in the Department of Orthopedics, Tangdu Hospital of Fourth Military University from March 1994 to March 2004, including 16 hips in 14 male patients and 12 hips in 12 female patients, were selected. Types of prostheses: 17 hips in 16 patients with ameliorated Moore cemented prostheses were taken as cemented prosthesis group with a mean age of 57 years; 11 hips in 10 patients with microbores on the surface of implant were taken as cementless prosthesis group with a mean age of 55 years.Patients were diagnosed as traumatic arthritis before operation with the mean Harris score of 49 (20-77) points on hip. Age, gender and diagnosis after operation in patients of two groups were matched.METHODS: The gray degrees of X-ray in patients of two groups were measured with computer image analyzing, relative values were obtained,I.e. The average gray degrees of 1.0-2.0 cm2 area in femoral trochanter and iliac bone were measured with the same X-ray; Differences between them represented the relative value of bone density in greater trochanter of femur. Changing rules of bone density were quantitatively analyzed.MAIN OUTCOME MEASURES: Relative values of bone density in greater trochanter of femur of patients in two groups one week before and after operation, during the follow-up time were measured respectively.RESULTS: A total of 26 patients (28 hips) with the follow-up time of 9-126months were all involved in the analysis of results. Relative values of bone density were increased to different degree one week after operation. And rate of osteolysis was 100% with a mean value of 57.4 (9-118) in greater

  18. Low-cycle fatigue of surgical cements

    Directory of Open Access Journals (Sweden)

    A. Balin

    2007-01-01

    Full Text Available Purpose: In case when surgical cement is used to fix endoprostheses of joints the fatigue character of mechanicalinterraction in the cement seems to be a significant importance. The paper suggests to adapt the research methodof low cycle fatigue for modelling the loads on surgical cements in an artificial hip joint. Surgical cements havealso been modified in order to improve their functional properties.Design/methodology/approach: Low cycle fatigue tests were conducted on samples made from Palamedcement without an addition and on samples modified with glassy carbon and titanium. The tests were conductedon a servohydraulic fatigue testing machine, MTS-810, with displacement control.Findings: Fatigue tests proved viscoelastic character of all the tested materials. During the fatigue tests, thephenomenon of stress cyclic relaxation was observed.Research limitations/implications: Modelling the loadings of cement in endoprostheses of joints with the lowcycle fatigue method takes into account all high value stresses, while cement is being used for endoprosthesesfor many years in the conditions of random stress and deformation courses. Therefore the obtained stress anddeformation values are bigger than those which would have been obtained in real conditions in the same time.Practical implications: The low cycle fatigue tests carried out showed how important is the factor of timefor the behavior of surgical cement in the conditions of changeable loadings. This fact is essential to assessits usability for endoprosthesoplasty of joints, specially of a hip joint. Post deformation return which is acharacteristic feature for material viscoelasticity enables its regeneration conditioning expected durability ofendoprosthesis of joints.Originality/value: Low cycle fatigue testing method for modelling of loads on surgical cement in artificial hipjoint enables to carry out the tests in a shorter period of time.

  19. Comparison of cementless and bone-cement protheses in total hip arthroplasty for osteoporotic femoral neck fracture in elderly patients%生物型和骨水泥型股骨假体全髋关节置换术治疗老年骨质疏松性股骨颈骨折的临床效果对比

    Institute of Scientific and Technical Information of China (English)

    王华国; 叶劲; 邹仲兵; 白波

    2014-01-01

    Objective To compare the therapeutic effects of bone-cement stem and cementless stem used in the total hip arthroplasty ( THA) for treating the osteoporotic fracture of the femoral neck in the senile patients .Methods A retrospective study was carried out to analyse 100 cases of osteoporotic femoral neck fracture in the elderly patients who underwent THA in our hospital .The patients were divided into two groups by the operation methods:group A, 60 cases applied bone-cement stem in THA;group B, 40 cases applied cementless stem in THA .The hip joint function , the motion range of the joint , the imaging characteristics of the hip and posoperative pain were all compared between the two groups . Results Therewere significant differences in the clinical therapeutic effects between the two groups ( P<0.05).Conclusions The postoperative effects of the bone-cement stem is much better than the cementless stem in THA for the osteoporotic femoral neck fracture in elderly , but it may cause the risks of deep venous thromboembolism and bone cement crisis .%目的:对比老年骨质疏松股骨颈骨折使用生物型股骨假体柄与骨水泥型股骨假体柄行全髋关节置换术治疗效果。方法对本组进行老年骨质疏松股骨颈骨折100例(100髋)进行的全髋关节置换术根据手术方式分为A组(股骨假体柄骨水泥型全髋关节置换术,60髋), B组(股骨假体柄生物型全髋关节置换术,40髋)。对比两组髋关节功能、关节活动度、髋关节影像学特点及术后疼痛情况。结果老年骨质疏松股骨颈骨折行全髋关节置换术,采用生物型股骨假体柄与骨水泥型股骨假体柄的全髋关节置换术临床疗效对比差异显著( P<0.05)。结论对于老年骨质疏松股骨颈骨折行全髋关节置换术,应用骨水泥型者股骨假体柄术后近期疗效明显优于生物型,但它有诱发深静脉血栓栓塞和骨水泥危象的风险。

  20. CEMENT SLURRIES FOR GEOTHERMAL WELLS CEMENTING

    Directory of Open Access Journals (Sweden)

    Nediljka Gaurina-Međimurec

    1994-12-01

    Full Text Available During a well cementing special place belongs to the cement slurry design. To ensure the best quality of cementing, a thorough understanding of well parameters is essential, as well as behaviour of cement slurry (especially at high temperatures and application of proven cementing techniques. Many cement jobs fail because of bad job planning. Well cementing without regarding what should be accomplished, can lead to well problems (channels in the cement, unwanted water, gas or fluid production, pipe corrosion and expensive well repairs. Cementing temperature conditions are important because bot-tomhole circulating temperatures affect slurry thickening time, arheology, set time and compressive strength development. Knowing the actual temperature which cement encounters during placement allows the selection of proper cementing materials for a specific application. Slurry design is affected by well depth, bottom hole circulating temperature and static temperature, type or drilling fluid, slurry density, pumping time, quality of mix water, fluid loss control, flow regime, settling and free water, quality of cement, dry or liquid additives, strength development, and quality of the lab cement testing and equipment. Most Portland cements and Class J cement have shown suitable performances in geot-hermal wells. Cement system designs for geothermal wells differ from those for conventional high temperature oil and gas wells in the exclusive use of silica flour instead of silica sand, and the avoidance of fly ash as an extender. In this paper, Portland cement behaviour at high temperatures is described. Cement slurry and set cement properties are also described. Published in literature, the composition of cement slurries which were tested in geothermal conditions and which obtained required compressive strength and water permeability are listed. As a case of our practice geothermal wells Velika Ciglena-1 and Velika Ciglena-la are described.

  1. Histological, histomorphometric and microtomographic analyses of retrieval hip resurfacing arthroplasty failed at different times

    Directory of Open Access Journals (Sweden)

    Salamanna Francesca

    2013-01-01

    Full Text Available Abstract Background Metal-on-metal hip resurfacing arthroplasty (HR has been gaining popularity especially for young and active patients. Although different series report good mid-term results, the long-term outcome and failure mechanisms are still concerning. In this consecutive revision case series, 9 retrieved specimens of a failed Birmingham Hip Resurfacing (BHR were divided according to the time to fracture: 3 specimens failed at less than 6 months (Group 1, 3 failed between 6 months and 3 years (Group 2 and 3 failed later than 3 years (Group 3. The objective of the study was to examine by a specific quantitative histomorphometry and microtomography (micro-CT method the characteristics of bone quality and its microarchitecture in retrieved metal-on-metal HR. Methods A series of 948 BHR were performed between 2001 and 2009. Among these implants 10 failures occurred and nine of these underwent revision surgery and were examined by histomorphometry and micro-CT. Results Histomorphometry showed a significant increase in trabecular separation (Tb.Sp in Group 3 in comparison with Group 1 (113%, p  Conclusions This study showed that the morphometric parameters considered are crucial for a good understanding of mechanical properties of HR and may be of significant importance in the pathogenesis of HR failure particularly in the development of late fractures.

  2. Changes in bone mineral density of the acetabulum and proximal femur after total hip resurfacing arthroplasty.

    Science.gov (United States)

    Huang, Qiang; Shen, Bin; Yang, Jing; Zhou, Zong-ke; Kang, Peng-de; Pei, Fu-xing

    2013-12-01

    Our aim was to investigate the changes in bone mineral density (BMD) of acetabulum and proximal femur after total hip resurfacing arthroplasty. A comparative study was carried out on 51 hips in 48 patients. Group A consisted of 25 patients (26 hips) who had undergone total hip resurfacing and group B consisted of 23 patients (25 hips) who had had large-diameter metal-on-metal total hip arthroplasty (THA). BMDs around the acetabulum and proximal femur were measured using dual-energy x-ray absorptiometry (DEXA) at 2 weeks, 6 months, 1 year and annually thereafter during the 3 years after surgery. At final follow-up, the acetabular net mean BMD decreased by 11% in group A and 10% in group B with no differences between two groups (P = .35). For the femoral side, in Gruen zone 1, the mean BMD increased by 4% in group A, whereas it decreased by 11% in group B (P = .029). In Gruen zone 7, the mean BMD increased by 8% at the final follow-up in group A, whereas it decreased by 13% in group B (P = .02). In both groups the mean BMD increased by 3% in Gruen zones 3, 4, 5, and 6. Stress-related bone loss of the acetabulum was comparable for MOM THA and resurfacing devices, but proximal femoral bone density increased in the resurfacing group and decreased in the THA group.

  3. In-situ electrochemical study of interaction of tribology and corrosion in artificial hip prosthesis simulators.

    Science.gov (United States)

    Yan, Yu; Dowson, Duncan; Neville, Anne

    2013-02-01

    The second generation Metal-on-Metal (MoM) hip replacements have been considered as an alternative to commonly used Polyethylene-on-Metal (PoM) joint prostheses due to polyethylene wear debris induced osteolysis. However, the role of corrosion and the biofilm formed under tribological contact are still not fully understood. Enhanced metal ion concentrations have been reported widely from hair, blood and urine samples of patients who received metal hip replacements and in isolated cases when abnormally high levels have caused adverse local tissue reactions. An understanding of the origin of metal ions is really important in order to design alloys for reduced ion release. Reciprocating pin-on-plate wear tester is a standard instrument to assess the interaction of corrosion and wear. However, more realistic hip simulator can provide a better understanding of tribocorrosion process for hip implants. It is very important to instrument the conventional hip simulator to enable electrochemical measurements. In this study, simple reciprocating pin-on-plate wear tests and hip simulator tests were compared. It was found that metal ions originated from two sources: (a) a depassivation of the contacting surfaces due to tribology (rubbing) and (b) corrosion of nano-sized wear particles generated from the contacting surfaces.

  4. Lunar cement

    Science.gov (United States)

    Agosto, William N.

    1992-01-01

    With the exception of water, the major oxide constituents of terrestrial cements are present at all nine lunar sites from which samples have been returned. However, with the exception of relatively rare cristobalite, the lunar oxides are not present as individual phases but are combined in silicates and in mixed oxides. Lime (CaO) is most abundant on the Moon in the plagioclase (CaAl2Si2O8) of highland anorthosites. It may be possible to enrich the lime content of anorthite to levels like those of Portland cement by pyrolyzing it with lunar-derived phosphate. The phosphate consumed in such a reaction can be regenerated by reacting the phosphorus product with lunar augite pyroxenes at elevated temperatures. Other possible sources of lunar phosphate and other oxides are discussed.

  5. Three-dimensional computerized selection of hip prostheses in patients with congenital dislocated hips.

    Science.gov (United States)

    Gelalis, L D; Xenakis, T A; Hantes, M; Vartziotis, K; Soucacos, P N

    2001-11-01

    This study assessed the effectiveness of the combined use of computed tomography (CT) and computer-aided design (CAD) in the preoperative evaluation and implant selection in 20 patients (20 hips) with congenital dislocation of the hip who were scheduled to undergo total hip arthroplasty. Computerized selection of the femoral implant with optimum fit and fill was made after a three-dimensional reconstruction of the femoral canal using CT data and CAD. Implantation of all sizes of 5 noncemented and 2 cemented femoral implants was simulated using CATIA software (IBM, Kingstone, NY). When patients underwent surgery, 18 of 20 preselected prostheses agreed by type and size with the prostheses implanted. The remaining 2 preselected implants agreed by type only. In patients with dislocated and dysplastic hips, combined use of CT and CAD allows effective preoperative planning by providing the surgeon with vital information about the proximal femoral canal geometry and the possible femoral implant with optimum fit and fill to be used.

  6. The contradictory effects of pores on fatigue cracking of bone cement.

    NARCIS (Netherlands)

    Janssen, D.; Aquarius, R.J.M.; Stolk, J.; Verdonschot, N.J.J.

    2005-01-01

    The beneficial effect of porosity reduction on the fatigue life of bone cement has been demonstrated in numerous experimental studies. Clinically, however, it seems that the beneficial effect of porosity reduction of cement around total hip replacement components can only be found in large follow-up

  7. Current status of noncemented hip implants.

    Science.gov (United States)

    Harris, W H

    1987-01-01

    Recently the operative techniques, instrumentation, design, and material properties of bony ingrowth total hip replacement have been greatly improved. I prefer a hemispherical acetabular component fixed with screws going through the metal shell. The titanium mesh allows microinterlock with new bone, and macrointerlock is obtained by adding bone graft into the unused screw holes. The femoral component, made of Tivanium with titanium mesh attached to it by a new process called diffusion bonding, retains superalloy fatigue strength characteristics. An intimate press fit is assured by the specific operative technique, and both the fiber mesh and the collar provide proximal stress transfer. The design affords a nondestructive method for removal if necessary. The short-term clinical results are promising; most patients function as well as with cemented total hip replacement. The incidence of thigh pain has been significantly reduced since prior reports of cementless total hip replacement; however, a few patients still have thigh pain. The results in revision surgery are also promising, but as in cemented total hip replacement, the functional capacity of revision cases is usually lower than primary cases. There is an increased capacity to correct complex and difficult acetabular problems with this acetabular component. Obviously, long-term data are needed to establish the behavior of these implants over the immediate and long term.

  8. In vivo implant fixation of carbon fiber-reinforced PEEK hip prostheses in an ovine model.

    Science.gov (United States)

    Nakahara, Ichiro; Takao, Masaki; Bandoh, Shunichi; Bertollo, Nicky; Walsh, William R; Sugano, Nobuhiko

    2013-03-01

    Carbon fiber-reinforced polyetheretherketone (CFR/PEEK) is theoretically suitable as a material for use in hip prostheses, offering excellent biocompatibility, mechanical properties, and the absence of metal ions. To evaluate in vivo fixation methods of CFR/PEEK hip prostheses in bone, we examined radiographic and histological results for cementless or cemented CFR/PEEK hip prostheses in an ovine model with implantation up to 52 weeks. CFR/PEEK cups and stems with rough-textured surfaces plus hydroxyapatite (HA) coatings for cementless fixation and CFR/PEEK cups and stems without HA coating for cement fixation were manufactured based on ovine computed tomography (CT) data. Unilateral total hip arthroplasty was performed using cementless or cemented CFR/PEEK hip prostheses. Five cementless cups and stems and six cemented cups and stems were evaluated. On the femoral side, all cementless stems demonstrated bony ongrowth fixation and all cemented stems demonstrated stable fixation without any gaps at both the bone-cement and cement-stem interfaces. All cementless cases and four of the six cemented cases showed minimal stress shielding. On the acetabular side, two of the five cementless cups demonstrated bony ongrowth fixation. Our results suggest that both cementless and cemented CFR/PEEK stems work well for fixation. Cup fixation may be difficult for both cementless and cemented types in this ovine model, but bone ongrowth fixation on the cup was first seen in two cementless cases. Cementless fixation can be achieved using HA-coated CFR/PEEK implants, even under load-bearing conditions.

  9. Heterotopic ossification after hip arthroplasty: a randomized double-blind multicenter study tenoxicam in 147 hips

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Sletgård, J; Dalsgård, J;

    1996-01-01

    147 patients due to have a cemented total hip arthroplasty were randomized to 4 groups. They received either tenoxicam 20 mg or 40 mg, or placebo, for 5 days or morphine on the day of operation and placebo for 4 days. During the first 5 days 14 patients were excluded. The patients were followed...... for 1 year, during which another 10 patients were excluded. At follow-up, significantly fewer patients had heterotopic ossifications in the tenoxicam groups than in the placebo and morphine groups. There was no significant difference between the 2 tenoxicam-treated groups, and we therefore conclude...... that tenoxicam 20 mg for 5 days postoperatively can reduce heterotopic ossification after cemented total hip arthroplasty....

  10. ULTRA-LIGHTWEIGHT CEMENT

    Energy Technology Data Exchange (ETDEWEB)

    Fred Sabins

    2002-07-30

    The objective of this project is to develop an improved ultra-lightweight cement using ultra-lightweight hollow glass spheres (ULHS). This report includes results from laboratory testing of ULHS systems along with other lightweight cement systems, including foamed and sodium silicate slurries. During this project quarter, a comparison study of the three cement systems examined the effect that cement drillout has on the three cement systems. Testing to determine the effect of pressure cycling on the shear bond properties of the cement systems was also conducted. This report discusses testing that was performed to analyze the alkali-silica reactivity of ULHS in cement slurries.

  11. Hip Resurfacing. Case presentation.

    Directory of Open Access Journals (Sweden)

    Pedro Gonzalo González González

    2008-12-01

    Full Text Available Hip resurfacing in youngest patients is an excellent surgical technique for Avascular Necrosis compare with a traditional Total Hip Replacement. Report about a 21 years old female patient involved in a car accident in February 2004 with Fracture of the neck of femur treated with compression hip screw Richard’s type. Two years later the patient was diagnose with avascular necrosis of the contra lateral hip. Hip resurfacing Metal-Metal was carry out in the above mentioned patient.

  12. O uso de enxerto homólogo na revisão de artroplastias do quadril com cimentação do componente acetabular Use of homologous graft in hip arthroplasty reviews with acetabular component cementation

    Directory of Open Access Journals (Sweden)

    Fábio Stuchi Devito

    2006-01-01

    Full Text Available A artroplastia total do quadril representa um grande avanço no tratamento das enfermidades ortopédicas que acometem o quadril. A soltura asséptica desta prótese pode causar lesões e perdas ósseas, representando um grande desafio para a reconstrução cirúrgica destas artroplastias. Uma das alternativas para a reconstrução é o uso do enxerto ósseo de banco de ossos, podendo este ser usado em bloco ou na forma picada. Este estudo, baseado em uma revisão da literatura sobre enxertos ósseos, teve como objetivo uma análise quanto à reconstrução com enxertos em bloco e picado e sua integração. O enxerto picado mostrou melhores resultados quanto à integração quando se consegue estabilidade da reconstrução. Quando não conseguimos uma boa estabilidade, o enxerto em bloco associado aos anéis de reforço sobressai como a melhor opção.Hip total arthroplasty represents a breakthrough in the treatment of orthopaedic illnesses affecting the hip. The aseptic loosening of this prosthesis may cause injuries and bone losses, representing a great challenge for the surgical reconstruction of those arthroplasties. One alternative to reconstruction is the use of bone graft sourced by bone bases, which may be used as a block or in pieces. This study, based on a literature review addressing bone grafts, had as an objective to analyze reconstruction with grafts in blocks and in pieces and its union. The graft in pieces showed better results concerning union when reconstruction stability is achieved. When a good stability cannot be achieved, the graft in block combined with reinforcement rings is highlighted as the best option.

  13. Short-term clinical follow-up of metal-on-metal hip resurfacing arthroplasty%金属对金属全髋关节表面置换术后近期随访

    Institute of Scientific and Technical Information of China (English)

    林茘军; 靳安民; 方国芳; 丁超; 陈伟义; 韦葛堇; 李奇

    2008-01-01

    目的 评价金属对金属全髋关节表面置换术后近期随访效果,分析影响髋关符表面置换术疗效的相关因素.方法 我科自2005~2007期问共完成髋关节表面置换术13例.所有病例均进行术前后Harris评分,并均进行规范随访.结果 和结论近期随访结果令人满意,在所有的病例中均无髋关节脱位、周用神经麻木、感染及下肢深静脉栓塞等并发症,所有病例术后疼痛均完全或大部分消失.术前Harris评分:36.69,术后评分升至89.63;术后拐杖使用最多为4周,所有病例均在4周后可完全负重行走.

  14. 金属对金属髋关节表面置换术的短期随访研究%Preliminary results after metal-on-metal hip resurfacing arthroplasty

    Institute of Scientific and Technical Information of China (English)

    何志勇; 狄正林; 章军辉; 陶崑; 冯建翔; 徐荣明; K.De.Smet

    2010-01-01

    目的 探讨金属对金属(MOM)混合固定型髋关节表面置换术(HRA)的近期疗效,分析手术技术要点.方法 2004年10月至2008年6月,对52例(58髋)股骨头缺血性坏死、骨关节炎、髋关节发育不良、强直性脊柱炎患者行MOM-HRA.其中男32例,女20例;年龄16~65岁,平均42.6岁.手术方法按照K.De.Smet标准方法进行,术后对Harris评分、关节活动度和X线片进行随访.结果 失访7例(8髋),45例(50髋)获得随访,随访时间平均22个月(12~54个月).术前平均Harris评分(37.0±1.2)分,术后22个月平均(93.0±1.0)分;术前屈髋度平均(25.3±1.6)°,术后22个月平均(105.0±1.8)°;术前外展度平均(18.8±0.8)°,术后22个月平均(40.6±1.0)°.评价:46髋优,3髋良,1髋差.无股骨颈骨折,无松动,无脱位,无感染,无翻修,1例异位骨化 Brooker Ⅲ型.结论 HRA具有保留股骨头骨量、术后关节活动度恢复快、近期结果好等优点,对于获得优良的术后结果,严格的患者选择和精确的手术技术至关重要.

  15. Metal-on-Metal Hip Arthroplasty in Patients Thirty Years of Age or Younger%30岁或更年轻患者的金属对金属假体全髋关节置换术

    Institute of Scientific and Technical Information of China (English)

    Julien Girard; Donatien Bocquet; Guillaume Autissier; Nicolas Fouilleron; Damien Fron; Henri Migaud; 庞清江; 叶奕; 陈先军

    2011-01-01

    背景:对30岁或更年轻的患者来说,全髋置换术是一项长期的挑战.如高强度运动所致的聚乙烯磨损一直是临床上面临的问题,硬对硬的负重面已经被证实可以减少磨损.本回顾性案例研究的目的是为了评估30岁或更年轻患者的金属对金属全髋置换术后临床和影像学的结果.方法:回顾分析34例(47髋)金属对金属全髋置换术后患者的临床及影像学资料,术后平均随访时间为108个月(范围,62.4~153.6个月).患者平均年龄25岁(范围,15~30岁).股骨头假体直径除5例为32mm外,其余均为28mm.所有患者均采用同样的金属对金属负重面假体.结果:患者术后Mede d'Aubigné评分平均从10.6分(范围,1~14分)升至17.1分(范围,12~18分).最近一次的影像学摄片虽未发现假体磨损,但股骨有3例,髋臼有2例发生骨性溶解.2例需要翻修,其中1例是因为位置不良导致臼杯撞击,另外1例是骨性溶解导致髋臼松动.Kaplan-Meier分析将翻修作为假体的生存率,假体10年生存率为94.5%(95%可信区间,80%~98.6%),而股骨柄的生存率为100%.结论:此项中期研究结果表明金属对金属负重面的全髋置换假体比较适合年轻以及喜欢运动的髋关节骨关节炎与股骨头坏死的患者.

  16. Assessment of total hip arthroplasty as a predisposing factor for ischiofemoral impingement

    Energy Technology Data Exchange (ETDEWEB)

    Oliveira, Adriana L.; Azevedo, Debora C.; Eajazi, Alireza; Palmer, William E.; Bredella, Miriam A. [Massachusetts General Hospital and Harvard Medical School, Division of Musculoskeletal Imaging and Intervention, Boston, MA (United States); Kwon, Young-Min [Massachusetts General Hospital and Harvard Medical School, Department of Orthopedics, Boston, MA (United States); Torriani, Martin [Massachusetts General Hospital and Harvard Medical School, Division of Musculoskeletal Imaging and Intervention, Boston, MA (United States); Massachusetts General Hospital, Division of Musculoskeletal Imaging and Intervention Department of Radiology, Boston, MA (United States)

    2015-12-15

    To examine the effect of total hip arthroplasty (THA) on ischiofemoral (IF) and quadratus femoris (QF) spaces with the hypothesis that THA does not affect ischiofemoral relationships. The study was IRB approved and complied with HIPAA guidelines. We identified consecutive MR examinations (pelvis and/or hip) obtained at our institution in adults (≥18 years old) screened for THA-related complications. Native hips from the same individuals served as controls. We collected medical record data including age, gender, surgical history, and THA designs. Two radiologists independently measured the IF-RAD and IF-MRI (IF space on radiographs and MR imaging, respectively) and QF space (on MR imaging). Groups were compared using ANCOVA controlled for gender. The study group comprised 250 hips (132 subjects; 162 post-THA and 88 native hips). Subjects were aged 59 ± 10 years, with 66 males and 66 females. Comparison of IF-MRI and QF spaces between native and post-THA hips showed no differences (P > 0.12) and IF-RAD was higher in post-THA subjects (P = 0.01). No differences in the IF-MRI and QF spaces were present between native hips and different THA designs (P > 0.4). IF-RAD of metal-on-metal THA was higher than that of native hips (P = 0.01) and trended higher than ceramic-on-polyethylene THA (P = 0.08), with the remaining comparisons showing no significant differences (P > 0.4). Radiographic- and MRI-based measures in patients with standard THA do not show narrowing of IF and QF spaces. (orig.)

  17. Metal-to-metal hip surface arthroplasty in 63 cases A follow-up assessment%金属对金属髋关节表面置换63例随访评价

    Institute of Scientific and Technical Information of China (English)

    徐卫东; 陈刚; 李甲; 徐凌; 梁志民

    2008-01-01

    involved in the follow-up. There were no cases of dislocation, deep venous embolism, deep infection or neurovascular complications that required further treatment. The mean Harris score was 38 points before operation and significantly increased to 90 points after operation. Two patients appeared a 2-mm crevice below acetabular prostheses, which disappeared 6 months after arthroplasty. Acetabular or femoral prostheses removal, or local osteolysis was detectable.CONCLUSION: Metal-on-metal hip surface arthroplasty has excellent early effects on young and active patients. The arthroplasty potentially offers the ultimate bone preservation and better restoration of hip articulation function in patients, without specific biocompatibility.%背景:随着制作假体T艺和于术技术的改进,髋关节表面置换后假体早期松动和股骨颈骨折等情况很少发生,能得到更佳的髋关节活动功能.目的:观察髋关节表面置换后材料与宿主的生物相容性及髋关节功能恢复情况.设计、时间及地点:回顾性病例分析,于2006-01/2007-08在解放军第二军医大学长海医院骨科进行.对象:52例髋关节疾病患者完成63侧髋关节表面置换,其中11例患者做了一期双侧置换.女25例,男27例,平均年龄47.6岁.方法:假体由Zimmer公司提供,髋关节以标准4mm厚非骨水泥型髋臼(金属臼杯厚3.7mm,外覆0.3mm等离子钛涂层)进行重建.髋臼杯是大直径、半圆形(165°),外覆等离子钛涂层用以非骨水泥固定.采用后外侧入路,髋臼假体均放置在髋关节解剖中心的位置,且覆盖髋臼假体面积超过90%以上.主要观察指标:①记录置换后脱位、感染等材料与宿主的生物相容性反应.②置换后1,3,6,12个月及其后每年一次采用Harris髋关节评分系统进行功能评估.③影像学资料按照DeLee和Charnley描述的区域,记录髋臼杯周围厚度>1mm的放射线可透区.结果:①所有患者均得到随访,没有发生脱位、没

  18. Hip fracture surgery

    Science.gov (United States)

    ... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery; Osteoarthritis-hip ... You may receive general anesthesia before this surgery. This means ... spinal anesthesia. With this kind of anesthesia, medicine is ...

  19. 股骨侧远端生物固定假体在高龄患者全髋关节翻修中的应用%Clinical application of un-cemented distal femoral prosthesis in elderly patients undergoing total hip revision

    Institute of Scientific and Technical Information of China (English)

    蒋林; 李舰; 简小飞; 张施展

    2011-01-01

    背景:对高龄患者行人工全髋关节翻修时如何正确选择股骨侧假体固定方式,可否应用组配式股骨假体处理此类难题?目的:验证股骨侧生物固定型假体在老年人全髋翻修后的效果.方法:采用远端固定生物型股骨假体对11例75岁以上股骨侧假体松动患者进行翻修.11例股骨骨缺损根据Paprosky分型,Ⅰ型2髋,Ⅱ型2髋,ⅢA型7髋.结果与结论:11例患者均随访16个月以上,患者Harris评分从翻修前的37分(22~49分)改善至随访结束时的89分(78~92分),优良率>90%,无患者发生再次松动.翻修后X射线片显示假体周围骨质密度和厚度明显增加.提示远端固定生物型假体可在股骨远端髓腔内获得可靠的轴向及抗旋转初始稳定性,尤其适用于伴有近端骨缺损的高龄患者的翻修治疗.%BACKGROUND: II is still a thorny problem faced by orthopedic surgeons how to select the right femoral prosthesis fixation in totalhip revision In elderly patients al present. Application of revision surgery with modular femoral prosthesis can effectively deal withsuch problemsOBJECTIVE; To evaluate the clinical outcomes of the application of un-cemented distal fixation stem in the total hip revision ofelderly patients,METHODS: Eleven patients aged over 75 years with aseptic loosening femoral stem were revised. According to Paproskyclassification system, type I was 2 cases, type N was 2 cases, type IIIA was 7 cases.RESULTS AND CONCLUSION: All cases were followed up for over 16 months. The average Harris hip score Increased from 37to 89. The excellent or good rate post-surgery was above 90%. No loosening occurred again after revision. The radiographs aftersurgery showed increased bone density and thickness around the prosthesis. Reliable axial and anti-rotational stability can beachieved with the application of un-cemented distal fixation stem. It is especially appropriate for the revision surgery in elderlypatients.

  20. How Do Metal Ion Levels Change over Time in Hip Resurfacing Patients? A Cohort Study

    Directory of Open Access Journals (Sweden)

    Lucia Savarino

    2014-01-01

    Full Text Available Metal-on-metal hip resurfacing (MOM-HR is offered as an alternative to traditional hip arthroplasty for young, active adults with advanced osteoarthritis. Nevertheless, concerns remain regarding wear and corrosion of the bearing surfaces and the resulting increase in metal ion levels. We evaluated three cohorts of patients with Birmingham hip resurfacing (BHR at an average follow-up of 2, 5, and 9 years. We asked whether there would be differences in ion levels between the cohorts and inside the gender. Nineteen patients were prospectively analyzed. The correlation with clinical-radiographic data was also performed. Chromium, cobalt, nickel, and molybdenum concentrations were measured by atomic absorption spectrophotometry. Chromium and cobalt levels demonstrated a tendency to decrease over time. Such tendency was present only in females. An inverse correlation between chromium, implant size, and Harris hip score was present at short term; it disappeared over time together with the decreased ion levels. The prospective analysis showed that, although metal ion levels remained fairly constant within each patient, there was a relatively large variation between subjects, so mean data in this scenario must be interpreted with caution. The chronic high exposure should be carefully considered during implant selection, particularly in young subjects, and a stricter monitoring is mandatory.

  1. Asphalt cement poisoning

    Science.gov (United States)

    ... petroleum material that hardens when it cools. Asphalt cement poisoning occurs when someone swallows asphalt. If hot ... found in: Road paving materials Roofing materials Tile cements Asphalt may also be used for other purposes.

  2. Ultrasound: Infant Hip

    Science.gov (United States)

    ... Old Feeding Your 1- to 2-Year-Old Ultrasound: Infant Hip KidsHealth > For Parents > Ultrasound: Infant Hip A A A What's in this ... en los lactantes What It Is A hip ultrasound is a safe and painless test that uses ...

  3. The Hip Restoration Algorithm

    Science.gov (United States)

    Stubbs, Allston Julius; Atilla, Halis Atil

    2016-01-01

    Summary Background Despite the rapid advancement of imaging and arthroscopic techniques about the hip joint, missed diagnoses are still common. As a deep joint and compared to the shoulder and knee joints, localization of hip symptoms is difficult. Hip pathology is not easily isolated and is often related to intra and extra-articular abnormalities. In light of these diagnostic challenges, we recommend an algorithmic approach to effectively diagnoses and treat hip pain. Methods In this review, hip pain is evaluated from diagnosis to treatment in a clear decision model. First we discuss emergency hip situations followed by the differentiation of intra and extra-articular causes of the hip pain. We differentiate the intra-articular hip as arthritic and non-arthritic and extra-articular pain as surrounding or remote tissue generated. Further, extra-articular hip pain is evaluated according to pain location. Finally we summarize the surgical treatment approach with an algorithmic diagram. Conclusion Diagnosis of hip pathology is difficult because the etiologies of pain may be various. An algorithmic approach to hip restoration from diagnosis to rehabilitation is crucial to successfully identify and manage hip pathologies. Level of evidence: V. PMID:28066734

  4. Hip Injuries and Disorders

    Science.gov (United States)

    ... problems. Osteoarthritis can cause pain and limited motion. Osteoporosis of the hip causes weak bones that break easily. Both of these are common in older people. Treatment for hip disorders may include rest, medicines, physical therapy, or surgery, including hip replacement.

  5. Criterio de predicción de la vida útil de la prótesis total de cadera en función de la falla del cemento en el componente femoral. // Life prediction criteria of hip prosthesis according to cement failure in femoral component.

    Directory of Open Access Journals (Sweden)

    G. García del pino

    2002-09-01

    Full Text Available En este trabajo se utiliza el Método de los Elementos Finitos para estudiar la combinación de diferentes parámetros, y suinfluencia en la vida útil de la prótesis total de cadera utilizando como criterio la falla del cemento que une estas prótesis alfémur, debido a que este tipo de falla es una de las fallas que mas provoca la perdida de la implantación. Los parámetrosestudiados aquí fueron el tipo de material del vástago de la prótesis dado por su modulo de elasticidad, la calidad del huesodada por la densidad y las cargas simulando diferentes actividades físicas y diferentes pesos del cuerpo.Los resultados obtenidos a través del Método de los Elementos Finitos, fueron procesados utilizando rutinas creadas enlenguaje C y técnicas de estadística, determinando las variables más influyentes y los valores más favorables para obteneruna transmisión apropiada de cargas, que garanticen una vida útil mayor.Palabras claves: biomecánica, ortopedia, elementos finitos, modulación__________________________________________________________________AbstractIn this paper the Finite Element Method is employ in order to study different parameters combination and their influence inthe duration of total hip prosthesis, taking as decision criteria the failure of cement that keep together femur and prosthesis,taking in account that this is the most common cause of implantation lost. The target parameters were: shank prosthesismaterial given by elasticity modulus, bone quality given by density, and finally, loads simulating different physicalactivities and body weight. The results were processed by means of statistical techniques and C language routines allowingto obtain the more influent variables to a proper load transmission and greater useful prosthesis life.Key words: Biomechanics, orthopaedic, finite elements, modulation

  6. Comparison of the Effect of Cemented Prosthesis and Biological Prosthesis in the Treatment of Patients with Development Dysplasia Hip%骨水泥型假体与生物型假体在髋关节发育不良患者中的疗效对比

    Institute of Scientific and Technical Information of China (English)

    阿卜杜瓦伊提·阿卜杜拉; 杜曼·吐鲁木汗; 史翀; 穆哈买提

    2014-01-01

    Objective To compare the effect of cemented prosthesis and biological prosthesis in the treatment of patients with development dysplasia hip (DDH).Methods 80 patients with DDH who would undergo total hip arthroplasty were randomly divided into research group (40 cases) and control group (40 cases). The total hip arthroplasty of research group was conducted with biological prosthesis while that of control group was conducted with cemented prosthesis. Then the safety and effectiveness of research group were compared with those of control group from the aspects of operation time, bleeding quantity, survival rate of prosthesis and Harris score.Results The average operation time of research group was (98.7±18.9) min while that of control group was (140.7±51.9) min. The average bleeding quantity of research group was (280.0±60) mL while that of control group was (360.0±100) mL. The survival rate of prosthesis of research group was 95% while that of control group was 82.5%. The Harris score calculated at the last follow-up of prosthesis of research group was (91.7±9.8) while that of control group was (82.9±11.3). There were signiifcant differences between research group and control group in operation time, bleeding quantity, survival rate of prosthesis and Harris score.Conclusion Total hip arthroplasty conducted with biological prosthesis which owns advantages such as high stability and ideal mid-term and long-term curative effect should be promoted in the treatment of patients with DDH.%目的:对比骨水泥型与生物型假体在髋关节发育不良患者中的疗效。方法将行全髋关节置换术的髋关节发育不良患者80例随机分为两组,研究组40例采用生物型假体进行置换术,对照组40例采用骨水泥型假体进行置换术。从手术时间、出血量、假体存活率、Harris评分等方面评价两组手术的安全性及疗效。结果研究组手术时间为(98.7±18.9)min,对照组为(140.7±51.9

  7. HIP-HOP教室

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    从现在开始我们要为了Hip-hop而奋斗,使身边的人改变对Hip-hop文化的看法,让他们知道什么是真正的Hip-hop,更要让大家学会怎样用肢体去表达,Yo,在这里,永远不会出现半吊子的Hip-hop,因为我们都是来真的,Yo,来真的,因为我要将Hip-hop发扬到底,Yeah!

  8. Hip resurfacing arthroplasty

    OpenAIRE

    2010-01-01

    Background and purpose Hip resurfacing arthroplasty is claimed to allow higher activity levels and to give better quality of life than total hip arthroplasty. In this literature review, we assessed the therapeutic value of hip resurfacing arthroplasty as measured by functional outcome. Methods An extensive literature search was performed using the PubMed, Embase, and Cochrane databases. Results 9 patient series, 1 case-control study, and 1 randomized controlled trial (RCT) were included. Clin...

  9. Imaging of hip arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Theodore T., E-mail: millertt@hss.edu [Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 (United States)

    2012-12-15

    The imaging evaluation of the prosthetic hip begins with radiography, but arthrography, aspiration, scintigraphy, sonography, CT and MR imaging all have roles in the evaluation of the painful prosthesis. This article will review the appearance of normal hip arthroplasty including hemiarthroplasty, total arthroplasty, and hip resurfacing, as well as the appearances of potential complications such as aseptic loosening and osteolysis, dislocation, infection, periprosthetic fracture, hardware failure, and soft tissue abnormalities.

  10. The concentric all-polyethylene Exeter acetabular component in primary total hip replacement.

    Science.gov (United States)

    Veitch, S W; Whitehouse, S L; Howell, J R; Hubble, M J W; Gie, G A; Timperley, A J

    2010-10-01

    We report the outcome of the flangeless, cemented all-polyethylene Exeter acetabular component at a mean of 14.6 years (10 to 17) after operation. Of the 263 hips in 243 patients, 122 prostheses are still in situ; 112 patients (119 hips) have died, 18 hips have been revised, and three patients (four hips) were lost to follow-up. Radiographs at the final review were available for 110 of the 122 surviving hips. There were acetabular radiolucent lines in 54 hips (49%). Two acetabular components had migrated but neither patient required revision. The Kaplan-Meier survivorship at 15 years with 61 hips at risk with revision for any cause as the endpoint was 89.9% (95% confidence interval (CI) 84.6 to 95.2) and for aseptic loosening of the acetabular component or lysis 91.7% (95% CI 86.6 to 96.8). In 210 hips with a diagnosis of primary osteoarthritis, survivorship with revision for any cause as the endpoint was 93.2% (95% CI 88.1 to 98.3), and for aseptic loosening of the acetabular component 95.0% (95% CI 90.3 to 99.7). The cemented all-polyethylene Exeter acetabular component has an excellent long-term survivorship.

  11. Hip fracture - discharge

    Science.gov (United States)

    Inter-trochanteric fracture repair - discharge; Subtrochanteric fracture repair - discharge; Femoral neck fracture repair - discharge; Trochanteric fracture repair - discharge; Hip pinning surgery - discharge

  12. The Tribology of Explanted Hip Resurfacings Following Early Fracture of the Femur

    Directory of Open Access Journals (Sweden)

    James K. Lord

    2015-10-01

    Full Text Available A recognized issue related to metal-on-metal hip resurfacings is early fracture of the femur. Most theories regarding the cause of fracture relate to clinical factors but an engineering analysis of failed hip resurfacings has not previously been reported. The objective of this work was to determine the wear volumes and surface roughness values of a cohort of retrieved hip resurfacings which were removed due to early femoral fracture, infection and avascular necrosis (AVN. Nine resurfacing femoral heads were obtained following early fracture of the femur, a further five were retrieved due to infection and AVN. All fourteen were measured for volumetric wear using a co-ordinate measuring machine. Wear rates were then calculated and regions of the articulating surface were divided into “worn” and “unworn”. Roughness values in these regions were measured using a non-contacting profilometer. The mean time to fracture was 3.7 months compared with 44.4 months for retrieval due to infection and AVN. Average wear rates in the early fracture heads were 64 times greater than those in the infection and AVN retrievals. Given the high wear rates of the early fracture components, such wear may be linked to an increased risk of femoral neck fracture.

  13. The Tribology of Explanted Hip Resurfacings Following Early Fracture of the Femur.

    Science.gov (United States)

    Lord, James K; Langton, David J; Nargol, Antoni V F; Meek, R M Dominic; Joyce, Thomas J

    2015-10-15

    A recognized issue related to metal-on-metal hip resurfacings is early fracture of the femur. Most theories regarding the cause of fracture relate to clinical factors but an engineering analysis of failed hip resurfacings has not previously been reported. The objective of this work was to determine the wear volumes and surface roughness values of a cohort of retrieved hip resurfacings which were removed due to early femoral fracture, infection and avascular necrosis (AVN). Nine resurfacing femoral heads were obtained following early fracture of the femur, a further five were retrieved due to infection and AVN. All fourteen were measured for volumetric wear using a co-ordinate measuring machine. Wear rates were then calculated and regions of the articulating surface were divided into "worn" and "unworn". Roughness values in these regions were measured using a non-contacting profilometer. The mean time to fracture was 3.7 months compared with 44.4 months for retrieval due to infection and AVN. Average wear rates in the early fracture heads were 64 times greater than those in the infection and AVN retrievals. Given the high wear rates of the early fracture components, such wear may be linked to an increased risk of femoral neck fracture.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Femoral component loosening after hip resurfacing arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Zustin, Jozef; Sauter, Guido [University Medical Centre Hamburg-Eppendorf, Institute of Pathology, Hamburg (Germany); Hahn, Michael [University Medical Centre Hamburg-Eppendorf, Center for Biomechanics and Skeletal Biology, Hamburg (Germany); Morlock, Michael M. [TUHH Hamburg University of Technology, Biomechanics Section, Hamburg (Germany); Ruether, Wolfgang [University Medical Centre Hamburg-Eppendorf, Department of Orthopaedics, Hamburg (Germany); Amling, Michael [University Medical Centre Hamburg-Eppendorf, Center for Biomechanics and Skeletal Biology, Hamburg (Germany); University Medical Centre Hamburg-Eppendorf, Department of Trauma, Hand and Reconstructive Surgery, Hamburg (Germany)

    2010-08-15

    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

  16. TREATMENT OF HIP DYSPLASIA

    Directory of Open Access Journals (Sweden)

    Iulian ICLEANU

    2015-11-01

    Full Text Available In this thesis, our purpose is to show that using physiotherapy on patients with hip dysplasia from the very beginning, in the first months of life, helps treating them faster. Common literature proposes to use physiotherapy on patients with hip dysplasia either after their recovery or in the terminal phase of recovery, claiming that any earlier intervention will prolong the hip recovery. The effects of hip dysplasia reflect over the whole musculoskeletal system, while it hinders the knees (genu valgum, the ankles (ankle valgus, calcaneal valgus and the spine (scoliosis especially at the lumbar level. The most spectacular are at the hip level, that is why we made an analytical evaluation only for this joint. To show the importance of physiotherapy for children with hip dysplasia we started from the hypothesis: untimely treatment for children with hip dysplasia has improved results in functional recovery and in obtaining a better stability, without the necessity of orthopedics or surgical interventions. The research methods used in this study are: the observation method, the bibliographic study method, the experimental method, the graphics method and the statistical mathematical method to process the data and to represent the results graphically. In the end, the results obtained are significantly different from the initial evaluations and we came to the conclusion that starting an untimely analytical kinetic treatment and globally personalizing it to every patient improves stability and biomechanical parameters for the hip.

  17. Hip joint replacement

    Science.gov (United States)

    ... You will be asked to start moving and walking as soon as the first day after surgery. Some people need a short stay in a rehabilitation center ... may need a second replacement. Younger, more active people may wear out parts of their new hip. It may need to be replaced ... Hip fracture Osteoarthritis vs. rheumatoid ...

  18. Hip joint pathology

    DEFF Research Database (Denmark)

    Tijssen, M; van Cingel, R E H; de Visser, E

    2016-01-01

    The purpose of this retrospective cohort study was to (a) describe the clinical presentation of femoroacetabular impingement (FAI) and hip labral pathology; (b) describe the accuracy of patient history and physical tests for FAI and labral pathology as confirmed by hip arthroscopy. Patients (18-6...

  19. Formed HIP Can Processing

    Energy Technology Data Exchange (ETDEWEB)

    Clarke, Kester Diederik [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-07-27

    The intent of this report is to document a procedure used at LANL for HIP bonding aluminum cladding to U-10Mo fuel foils using a formed HIP can for the Domestic Reactor Conversion program in the NNSA Office of Material, Management and Minimization, and provide some details that may not have been published elsewhere. The HIP process is based on the procedures that have been used to develop the formed HIP can process, including the baseline process developed at Idaho National Laboratory (INL). The HIP bonding cladding process development is summarized in the listed references. Further iterations with Babcock & Wilcox (B&W) to refine the process to meet production and facility requirements is expected.

  20. Influence of the femoral head size on early postoperative gait restoration after total hip arthroplasty

    Institute of Scientific and Technical Information of China (English)

    ZHOU Yi-xin; GUO Sheng-jie; LIU Qing; TANG Jing; LI Yu-jun

    2009-01-01

    Background We investigated the effects of using large-diameter femoral heads in total hip prostheses on eady postoperative gait restoration in patients undergoing total hip arthroplasty (THA). Methods We collected data for 19 primary THAs using 28-mm metal-on-polyethylene heads (conventional group) and for 12 THAs (BHR group) using metal-on-metal femoral heads with an average size of 45 mm (range, 40-49 mm). All patients had unilateral femoral head avascular necrosis. All patients underwent Harris Hip Scores evaluation and gait analysis with the IDEEA device at the same 3 time points which were before surgery and then at 1 month and again at 3 months after surgery, and the parameters measured were walking speed, stride length (SL), single limb support (SLS), cycle duration (CD), and swing power (SP). Harris Hip Scores and gait analysis parameters for both groups were compared.Results Intraclass comparison indicated that Harris Hip Scores, speed scores, and gait parameter measures in both groups improved significantly with the passage of time; Interclass comparison showed no significance between Harris1m postop - Harrispreop and Harris3m postop- Harrispreop in both groups. The speed in the BHR group at 1 month and at 3 months after surgery was significantly higher than that of conventional group. At 1 month after surgery, each mean for SLnormal-SLaffected, (SLSnormal - SLSaffected)/CD, and SPnormal - SPaffocted in the BHR group was significantly lower than that for the conventional group. At 3 months after surgery, the differences between means for both groups for SLnormal - SLaffected.(SLSnormal- SLSaffected)/CD, and SPnormal - SPaffected were not significant, but the mean of SPnormal - SPaffected in the BHR group was significantly lower than that in the conventional group.Conclusions Our data suggest that large-diameter femoral heads in THA provide better early gait restoration than conventional-size femoral heads.

  1. ULTRA-LIGHTWEIGHT CEMENT

    Energy Technology Data Exchange (ETDEWEB)

    Fred Sabins

    2002-01-23

    The objective of this project is to develop an improved ultra-lightweight cement using ultra-lightweight hollow glass spheres (ULHS). This report includes results from laboratory testing of ULHS systems along with other lightweight cement systems: foamed and sodium silicate slurries. Comparison studies of the three cement systems examined several properties: tensile strength, Young's modulus, water permeability, and shear bond. Testing was also done to determine the effect that temperature cycling has on the shear bond properties of the cement systems. In addition, analysis was carried out to examine alkali silica reactivity of slurries containing ULHS. Data is also presented from a study investigating the effects of mixing and pump circulation on breakage of ULHS. Information is also presented about the field application of ULHS in cementing a 7-in. intermediate casing in south Texas.

  2. The other hip in unilateral hip dysplasia

    DEFF Research Database (Denmark)

    Jacobsen, Steffen; Rømer, Lone; Søballe, Kjeld

    2006-01-01

    We reviewed transverse pelvic computed tomography scans of 197 consecutively referred adult patients with hip pain thought to be secondary to developmental dysplasia. A center-edge angle of 20 degrees or less was considered the upper normal value. Four groups were identified: 69 patients with app...

  3. Bone cement spacers and Link spacers for treatment of infection due to total hip arthroplasty:a comparative study%两种占位器治疗人工全髋关节置换术后感染的疗效比较

    Institute of Scientific and Technical Information of China (English)

    孙立; 田晓滨; 胡如印; 田家亮; 韩伟; 刘兆成

    2012-01-01

    目的 比较自制含万古霉素的骨水泥占位器和Link感染治疗型占位器的疗效,探讨人工髋关节置换术后慢性感染Ⅱ期翻修中占位器的选择.方法 26例人工髋关节置换术后感染患者,年龄32~82岁,平均69.5岁.彻底清创、取出假体后,14例置入含万古霉素的骨水泥占位器,12例采用Link感染治疗型占位器.术后静脉滴注抗生素2周后,改为口服抗生素6周;术后定期复查血白细胞、红细胞沉降率(ESR)和C-反应蛋白(CRP).Ⅱ期行人工髋关节翻修术.手术前、后以Harris髋关节评分标准评估临床治疗效果.结果 26例患者在彻底清创、取出假体、自制含万古霉素的骨水泥占位器或Link感染治疗型占位器置入后,伤口均Ⅰ期愈合.Ⅱ期翻修手术间隔时间平均5.2个月(3~11.5个月),翻修术后随访平均20.8个月(12~33个月),未出现感染复发征象.Harris髋关节评分Ⅰ期术前平均27.9分,Ⅱ期术前平均52.9分,最后随访时平均83.6分(P<0.05).含万古霉素骨水泥占位器患者Ⅱ期术前有1例断裂,Link感染治疗型占位器患者Ⅱ期术前无断裂.结论 (1)Ⅱ期翻修术具有感染清除率高、缓解疼痛、有效保留关节功能等优点,是治疗人工髋关节置换术后感染的有效方法;(2)使用自制含万古霉素的骨水泥占位器和Link感染治疗型占位器,均能有效感染控制和恢复部分患肢功能;(3)Link感染治疗型占位器术中操作简便,治疗间歇期患肢功能恢复较好,但置管易堵,不能长期缓释抗生素,费用较高,适用于体质较好、感染不严重、两次手术间隔期患肢功能要求较高的患者.%Objective To compare the efficacy of self-made bone cement spacers containing vancomycin(vancomycin spacer)and Link infection-treating spacers(Link type spacer)for chronic infection after total hip arthroplasty(HTA)and investigate the choice of spacers for the two-stage revision of infection.Methods The study

  4. Prevention of hip fractures.

    Science.gov (United States)

    Meunier, P J

    1993-11-30

    For a 50-year old Caucasian woman today, the risk of a hip fracture over her remaining life-time is about 17%. Tomorrow the situation will clearly be worse because the continuous increase in life expectancy will cause a three-fold increase in worldwide fracture incidence over the next 60 years. Through diagnostic bone mass measurements at the hip and assessment of biochemical parameters, a great deal has been learned in recent years about reduction of hip fracture risk. Preventive strategies are based on prevention of falls, use of hip protectors, and prevention of bone fragility. The latter includes the optimization of peak bone mass during childhood, postmenopausal estrogen replacement therapy, and also late prevention consisting in reversing senile secondary hyperparathyroidism, which plays an important role in the decrease of skeletal strength. This secondary hyperparathyroidism, which results from both vitamin D insufficiency and low calcium intake, is preventable with vitamin D3 and calcium supplements. They have recently been shown capable of providing effective prevention of hip fractures in elderly women living in nursing homes, with a reduction of about 25% in the number of hip fractures noted in a 3-year controlled study in 3,270 women (intention-to-treat analysis). In conclusion, it is never too early to reduce the risk of osteoporosis and never too late to prevent hip fractures.

  5. Total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Slavković Nemanja

    2012-01-01

    Full Text Available Total hip arthroplasty is most common reconstructive hip procedure in adults. In this surgery we replace some parts of the upper femur and acetabulum with biocompatible materials. The main goal of this surgery is to eliminate pain and regain full extent of joint motion, maintaining hip stability. Surgical technique, biomaterials, design of the prosthesis and fixation techniques have evolved with time adjusting to each other. After total hip arthroplasty patients’ quality of life should be improved. There are many various postoperative complications. Some of them are fatal, and some are minor, which may become manifested years after surgery. Each next surgical procedure following previous hip surgery is associated with considerably lower chances to be successful. Therefore, in primary total hip arthroplasty, preoperative evaluation and preparation of patients are essential. Every orthopaedic surgeon needs to improve already adopted surgical skills applying them with precision and without compromise, with the main goal to achieve long-term durability of the selected implant. The number of total hip arthroplasties will also increase in future, and newer and higher quality materials will be used.

  6. Modified femoral pressuriser generates a longer lasting high pressure during cement pressurisation

    Directory of Open Access Journals (Sweden)

    Kjellson Fred

    2011-10-01

    Full Text Available Abstract Background The strength of the cement-bone interface in hip arthroplasty is strongly related to cement penetration into the bone. A modified femoral pressuriser has been investigated, designed for closer fitting into the femoral opening to generate higher and more constant cement pressure compared to a commercial (conventional design. Methods Femoral cementation was performed in 10 Sawbones® models, five using the modified pressuriser and five using a current commercial pressuriser as a control. Pressure during the cementation was recorded at the proximal and distal regions of the femoral implant. The peak pressure and the pressure-time curves were analysed by student's t-test and Two way ANOVA. Results The modified pressuriser showed significantly and substantially longer durations at higher cementation pressures and slightly, although not statistically, higher peak pressures compared to the conventional pressuriser. The modified pressuriser also produced more controlled cement leakage. Conclusion The modified pressuriser generates longer higher pressure durations in the femoral model. This design modification may enhance cement penetration into cancellous bone and could improve femoral cementation.

  7. Revision rates after primary hip and knee replacement in England between 2003 and 2006.

    Directory of Open Access Journals (Sweden)

    Nokuthaba Sibanda

    2008-09-01

    Full Text Available BACKGROUND: Hip and knee replacement are some of the most frequently performed surgical procedures in the world. Resurfacing of the hip and unicondylar knee replacement are increasingly being used. There is relatively little evidence on their performance. To study performance of joint replacement in England, we investigated revision rates in the first 3 y after hip or knee replacement according to prosthesis type. METHODS AND FINDINGS: We linked records of the National Joint Registry for England and Wales and the Hospital Episode Statistics for patients with a primary hip or knee replacement in the National Health Service in England between April 2003 and September 2006. Hospital Episode Statistics records of succeeding admissions were used to identify revisions for any reason. 76,576 patients with a primary hip replacement and 80,697 with a primary knee replacement were included (51% of all primary hip and knee replacements done in the English National Health Service. In hip patients, 3-y revision rates were 0.9% (95% confidence interval [CI] 0.8%-1.1% with cemented, 2.0% (1.7%-2.3% with cementless, 1.5% (1.1%-2.0% CI with "hybrid" prostheses, and 2.6% (2.1%-3.1% with hip resurfacing (p < 0.0001. Revision rates after hip resurfacing were increased especially in women. In knee patients, 3-y revision rates were 1.4% (1.2%-1.5% CI with cemented, 1.5% (1.1%-2.1% CI with cementless, and 2.8% (1.8%-4.5% CI with unicondylar prostheses (p < 0.0001. Revision rates after knee replacement strongly decreased with age. INTERPRETATION: Overall, about one in 75 patients needed a revision of their prosthesis within 3 y. On the basis of our data, consideration should be given to using hip resurfacing only in male patients and unicondylar knee replacement only in elderly patients.

  8. HIP osteoarthritis and work.

    Science.gov (United States)

    Harris, E Clare; Coggon, David

    2015-06-01

    Epidemiological evidence points strongly to a hazard of hip osteoarthritis from heavy manual work. Harmful exposures may be reduced by the elimination or redesign of processes and the use of mechanical aids. Reducing obesity might help to protect workers whose need to perform heavy lifting cannot be eliminated. Particularly high relative risks have been reported in farmers, and hip osteoarthritis is a prescribed occupational disease in the UK for long-term employees in agriculture. Even where it is not attributable to employment, hip osteoarthritis impacts importantly on the capacity to work. Factors that may influence work participation include the severity of disease, the physical demands of the job, age and the size of the employer. Published research does not provide a strong guide to the timing of return to work following hip arthroplasty for osteoarthritis, and it is unclear whether patients should avoid heavy manual tasks in their future employment.

  9. Hip Implant Systems

    Science.gov (United States)

    ... made of metal or ceramic, and the socket (acetabulum) is removed and replaced with a prosthetic cup. ... its socket in the hip bone (pelvis) Bone fracture Joint infection Local nerve damage with numbness/weakness ...

  10. Tympanoplasty with ionomeric cement

    DEFF Research Database (Denmark)

    Kjeldsen, A D; Grøntved, A M

    2000-01-01

    with isolated erosion of the long incus process have been treated with a new surgical technique in which the ossicular chain was rebuilt with ionomeric cement. The results in hearing performance (mean pure-tone average (PTA) 0.5, 1 and 2 kHz) were evaluated pre- and post-surgery, and compared to those...... of > 10 dB, in 4 there was a slight improvement and in 2 a decline. The difference was not statistically significant. Hearing improvement using ionomeric cement in type II tympanoplasty was satisfactory. Reconstruction of the ossicular chain with ionomeric cement is recommended, as the procedure is easy...

  11. Cement and concrete

    Science.gov (United States)

    Corley, Gene; Haskin, Larry A.

    1992-01-01

    To produce lunar cement, high-temperature processing will be required. It may be possible to make calcium-rich silicate and aluminate for cement by solar heating of lunar pyroxene and feldspar, or chemical treatment may be required to enrich the calcium and aluminum in lunar soil. The effects of magnesium and ferrous iron present in the starting materials and products would need to be evaluated. So would the problems of grinding to produce cement, mixing, forming in vacuo and low gravity, and minimizing water loss.

  12. POZZOLAN AND CEMENTS WITH POZZOLAN

    OpenAIRE

    Hasan KAPLAN; Hanifi BİNİCİ

    1995-01-01

    Cement, one of the basic material of construction engineering, has an important place in view of strength and cost of structures. Cement consumption is increasing parallel to development of building construction sector. For cement producers, minimal cost is desired by using new and economical material sources. On the other hand, the controllers and contractors need cheaper, safer and higher strength materials. From this respect cement industry tends to use cement with pozzolan. In Türkiye, ce...

  13. Hip-Hop

    Institute of Scientific and Technical Information of China (English)

    张敬伟

    2008-01-01

    Hip-Hop是一种美国街头黑人文化,可分成五个要素:音乐、舞蹈、涂鸦、刺青和衣著。源自80年代美国纽约的黑人社区BRONX,他们将生活上的娱乐发展成为现今多样的HIP-HOP文化,发挥黑

  14. A new design of cemented stem using functionally graded materials (FGM).

    Science.gov (United States)

    Hedia, H S; Aldousari, S M; Abdellatif, A K; Fouda, N

    2014-01-01

    One of the most frequent complications of total hip replacement (THR) is aseptic loosening of femoral component which is primarily due to changes of post-operative stress distribution pattern with respect to intact femur. Stress shielding of the femur is known to be a principal factor in aseptic loosening of hip replacements. Many designers show that a stiff stem shields the surrounding bone from mechanical loading causing stress shielding. Others show that reducing stem stiffness promotes higher proximal interface shear stress which increases the risk of proximal interface failure. Therefore, the task of this investigation is to solve these conflicting problems appeared in the cemented total hip replacement. The finite element method and optimization technique are used in order to find the optimal stem material which gives the optimal available stress distribution between the proximal medial femoral bone and the cement mantle interfaces. The stem is designed using the concept of functionally graded material (FGM) instead of using the conventional most common used stem material. The results showed that there are four feasible solutions from the optimization runs. The best of these designs is to use a cemented stem graded from titanium at the upper stem layer to collagen at the lower stem layer. This new cemented stem design completely eliminates the stress shielding problem at the proximal medial femoral region. The stress shielding using the cemented functionally graded stem is reduced by 98% compared to titanium stem.

  15. Hip resurfacing arthroplasty: current status and future perspectives

    Directory of Open Access Journals (Sweden)

    K Corten

    2011-03-01

    Full Text Available Hip resurfacing arthroplasty (HRA is a concept of hip replacement that allows treating young active patients with a femoral bone preserving procedure. The proposed advantages of resuming an active lifestyle with increased frequency and duration of sports activities have been shown to be realistic. The 30-year cost-effectiveness in young male patients has been shown to be higher in resurfacing compared to conventional total hip replacement (THA. However, prognosticators of an inferior outcome have also been identified. The most important patient related factors are secondary osteoarthritis as the indication for surgery such as post-childhood hip disorders or AVN, female gender, smaller component sizes and older age (>65 years for males and >55 years for females. In addition, surgical technique (approach and cementing technique and component design are also important determinant factors for the risk of failure. Moreover, concerns have surfaced with respect to high metal ion concentrations and metal ion hypersensitivities. In addition, the presumed ease of revising HRA has not reflected in improved or equal survivorship in comparison to a primary THA. This highlights the importance of identifying patient-, surgery-, and implant-related prognosticators for success or failure of HRA. Rather than vilifying the concept of hip resurfacing, detailed in depth analysis should be used to specify indications and improve implant design and surgical techniques.

  16. Are component positioning and prosthesis size associated with hip resurfacing failure?

    Directory of Open Access Journals (Sweden)

    Seyler Thorsten M

    2010-10-01

    Full Text Available Abstract Background Recent studies suggest that there is a learning curve for metal-on-metal hip resurfacing. The purpose of this study was to assess whether implant positioning changed with surgeon experience and whether positioning and component sizing were associated with implant longevity. Methods We evaluated the first 361 consecutive hip resurfacings performed by a single surgeon, which had a mean follow-up of 59 months (range, 28 to 87 months. Pre and post-operative radiographs were assessed to determine the inclination of the acetabular component, as well as the sagittal and coronal femoral stem-neck angles. Changes in the precision of component placement were determined by assessing changes in the standard deviation of each measurement using variance ratio and linear regression analysis. Additionally, the cup and stem-shaft angles as well as component sizes were compared between the 31 hips that failed over the follow-up period and the surviving components to assess for any differences that might have been associated with an increased risk for failure. Results Surgeon experience was correlated with improved precision of the antero-posterior and lateral positioning of the femoral component. However, femoral and acetabular radiographic implant positioning angles were not different between the surviving hips and failures. The failures had smaller mean femoral component diameters as compared to the non-failure group (44 versus 47 millimeters. Conclusions These results suggest that there may be differences in implant positioning in early versus late learning curve procedures, but that in the absence of recognized risk factors such as intra-operative notching of the femoral neck and cup inclination in excess of 50 degrees, component positioning does not appear to be associated with failure. Nevertheless, surgeons should exercise caution in operating patients with small femoral necks, especially when they are early in the learning curve.

  17. In-situ polymerization behaviour of bone cements.

    Science.gov (United States)

    Maffezzoli, A; Ronca, D; Guida, G; Pochini, I; Nicolais, L

    1997-02-01

    The polymerization behaviour of bone cements during total hip replacements is characterized by a fast and highly non-isothermal bulk reaction. In the first part of this paper the reaction kinetics are analysed by calorimetric analysis in order to determine the rates of polymerization in isothermal and non-isothermal conditions. A phenomenological kinetic model, accounting for the effects of autoacceleration and vitrification, is presented. This model, integrated with an energy balance, is capable of predicting the temperature across the prosthesis, the cement and the bone and the degree of reaction in the cement, during in situ polymerization. The temperature and the degree of reaction profiles are calculated, as a function of the setting time, taking into account the system geometry, the thermal diffusivity of bone, prosthesis and cement, and the heat rate generated by the reaction according to the kinetic model. Material properties, boundary and initial conditions are the input data of the heat transfer model. Kinetic and heat transfer models are coupled and a numerical solution method is used. The model is applied in order to study the effects of different application procedures on temperature and degree of reaction profiles across the bone-cement-prosthesis system.

  18. Hard-on-hard lubrication in the artificial hip under dynamic loading conditions.

    Directory of Open Access Journals (Sweden)

    Robert Sonntag

    Full Text Available The tribological performance of an artificial hip joint has a particularly strong influence on its success. The principle causes for failure are adverse short- and long-term reactions to wear debris and high frictional torque in the case of poor lubrication that may cause loosening of the implant. Therefore, using experimental and theoretical approaches models have been developed to evaluate lubrication under standardized conditions. A steady-state numerical model has been extended with dynamic experimental data for hard-on-hard bearings used in total hip replacements to verify the tribological relevance of the ISO 14242-1 gait cycle in comparison to experimental data from the Orthoload database and instrumented gait analysis for three additional loading conditions: normal walking, climbing stairs and descending stairs. Ceramic-on-ceramic bearing partners show superior lubrication potential compared to hard-on-hard bearings that work with at least one articulating metal component. Lubrication regimes during the investigated activities are shown to strongly depend on the kinematics and loading conditions. The outcome from the ISO gait is not fully confirmed by the normal walking data and more challenging conditions show evidence of inferior lubrication. These findings may help to explain the differences between the in vitro predictions using the ISO gait cycle and the clinical outcome of some hard-on-hard bearings, e.g., using metal-on-metal.

  19. Hard-on-hard lubrication in the artificial hip under dynamic loading conditions.

    Science.gov (United States)

    Sonntag, Robert; Reinders, Jörn; Rieger, Johannes S; Heitzmann, Daniel W W; Kretzer, J Philippe

    2013-01-01

    The tribological performance of an artificial hip joint has a particularly strong influence on its success. The principle causes for failure are adverse short- and long-term reactions to wear debris and high frictional torque in the case of poor lubrication that may cause loosening of the implant. Therefore, using experimental and theoretical approaches models have been developed to evaluate lubrication under standardized conditions. A steady-state numerical model has been extended with dynamic experimental data for hard-on-hard bearings used in total hip replacements to verify the tribological relevance of the ISO 14242-1 gait cycle in comparison to experimental data from the Orthoload database and instrumented gait analysis for three additional loading conditions: normal walking, climbing stairs and descending stairs. Ceramic-on-ceramic bearing partners show superior lubrication potential compared to hard-on-hard bearings that work with at least one articulating metal component. Lubrication regimes during the investigated activities are shown to strongly depend on the kinematics and loading conditions. The outcome from the ISO gait is not fully confirmed by the normal walking data and more challenging conditions show evidence of inferior lubrication. These findings may help to explain the differences between the in vitro predictions using the ISO gait cycle and the clinical outcome of some hard-on-hard bearings, e.g., using metal-on-metal.

  20. Coupling of dynamics and contact mechanics of artificial hip joints in a pendulum model.

    Science.gov (United States)

    Liu, H; Ellison, P J; Xu, H; Jin, Z

    2010-01-01

    To date, fully coupled dynamics and contact mechanics analysis is still limited by expensive computational cost and long computing time and has not been addressed comprehensively, particularly in the hip joint. To understand the influence of different parameters on the biomechanics of the total hip replacement (THR) and improve its design, two numerical approaches were developed and implemented in finite element models to investigate the coupling between the dynamics response and the contact mechanics for three different THR configurations, metal-on-polyethylene (MOP), metal-on-metal (MOM), and ceramic-on-ceramic (COC). The dynamic force and the contact pressure distribution at the bearing surfaces from the two methods were predicted and compared. The influences of various parameters (motion angle, load applied in the pendulum, friction coefficient, geometry, and material properties) were subsequently investigated. From the comparisons, the decoupled method, based on the rigid-body dynamics and the quasi-static elastic contact mechanics, was adequate to predict the performance of the THRs efficiently. The load had the greatest influence on the dynamics/contact mechanics among other factors.

  1. Outcome measures of bipolar hip arthroplasty for atraumatic hip disorders - A preliminary report

    Directory of Open Access Journals (Sweden)

    Dudani Baldev

    2005-01-01

    Full Text Available Background: Bipolar hip arthroplasty was devised for fracture neck femur in elderly patients. Subsequently, indications have been expanded to include conditions affecting acetabulum like rheumatoid arthritis, osteoarthritis and avascular necrosis of femoral head. Materials and methods: We have studied the results of bipolar hip arthroplasty in 38 such patients, with severely involved acetabulum due to rheumatoid arthritis, avascular necrosis of femoral head and primary osteoarthritis. Acetabulum was reamed to get a tight ′equatorial′ or ′rim′ fit of the prosthesis. Prosthesis selected was 1 mm bigger than the maximum size of reamer used. Cement was used in femur whenever there was marked osteoporosis or wide medullary canal. Post operatively all patients were regularly screened for pain, range of movement, protrusio acetabuli, loosening / sinking of prosthesis and radiographic assessment of movement in the two bearings of prosthesis. Results: Overall results achieved were good to excellent in 80% of patients. Conclusions: The ultimate outcome is comparable to total hip arthroplasty. The added advantage is of low cost, simplicity of procedure and easy future revision.

  2. Improving Planning and Post-Operative Assessment for Total Hip Arthroplasty

    Science.gov (United States)

    Pétursson, Þröstur; Edmunds, Kyle; Magnúsdóttir, Gígja; Halldórsson, Grétar; jr., Halldór Jónsson; Gargiulo, Paolo

    2015-01-01

    Total Hip Arthroplasty (THA) remains the gold standard of treatment for patients who suffer with a variety of hip-related pathological degeneration or trauma. These patients often exhibit significantly less post-operative pain and an increase in the range of motion of the joint, but there are still relatively common instances of debilitating periprosthetic complications that call into question the method for pre-surgical implant choice. Currently, there are two principal options for THA prostheses: cemented or non cemented. Utilizing the cemented procedure ensures a faster acquisition of adequate implant stability than with the non cemented procedure, but can eventually lead to an increased periprosthetic fracture risk. Non cemented prosthetic stems are more frequently revised within the first few years following THA due to periprosthetic fracture, but non cemented revision surgeries generally result in fewer complications than those of cemented implants. Surgeons typically rely on experience or simple patient metrics such as age and sex to prescribe which implant procedure is optimal, and while this may work for most patients, there is a clear need to analyze more rigoriously patient conditions that correlate to optimal post-THA outcomes. The results from the investigation reported herein indicate that an understanding of how the percent composition and quality of a patient's quadriceps muscle in both healthy and operated legs may be a better indicator for prosthetic choice. Additionally, these data emphasize that the traditional metrics of age and sex inadequately predict changes in quadriceps composition and quality and thereby have comparatively minor utility in determining the patient-appropriate prosthetic type. Key Words: Total Hip Arthroplasty, Prosthetic selection, Muscle size and quality, Anatomical modeling, Surgical planning. PMID:26913152

  3. Poor 10-year survivorship of hip resurfacing arthroplasty

    Science.gov (United States)

    Seppänen, Matti; Karvonen, Mikko; Virolainen, Petri; Remes, Ville; Pulkkinen, Pekka; Eskelinen, Antti; Liukas, Antti; Mäkelä, Keijo T

    2016-01-01

    Background and purpose In a previous registry report, short-term implant survival of hip resurfacing arthroplasty (HRA) in Finland was found to be comparable to that of total hip arthroplasty (THA). Since then, it has become evident that adverse reactions to metal debris (ARMDs) may also be associated with HRA, not only with large-diameter head metal-on-metal THA. The aim of the study was to assess medium- to long-term survivorship of HRA based on the Finnish Arthroplasty Register (FAR). Patients and methods 5,068 HRAs performed during the period 2001–2013 in Finland were included. Kaplan-Meier survival analysis was used to calculate survival probabilities and their 95% confidence intervals (CIs). Cox multiple regression, with adjustment for age, sex, diagnosis, femoral head size, and hospital volume was used to analyze implant survival of HRA devices with revision for any reason as endpoint. The reference group consisted of 6,485 uncemented Vision/Bimetric and ABG II THAs performed in Finland over the same time period. Results The 8-year survival, with any revision as an endpoint, was 93% (CI: 92–94) for Birmingham Hip Resurfacing (BHR), 86% (CI: 78–94) for Corin, 91% (CI: 89–94) for ReCap, 92% (CI: 89–96) for Durom, and was 72% (CI: 69–76) for the Articular Surface Replacement (ASR). The 10-year survival, with any revision as an endpoint, for reference THAs was 92% (CI: 91–92) and for all HRAs it was 86% (CI: 84–87%). Female HRA patients had about twice the revision risk of male patients. ASR had an inferior outcome: the revision risk was 4-fold higher than for BHR, the reference implant. Interpretation The 10-year implant survival of HRAs is 86% in Finland. According to new recommendations from NICE (The National Institute for Health and Care Excellence), an HRA/THA should have a revision rate of 5% or less at 10 years. None of the HRAs studied achieved this goal. PMID:27759474

  4. HIP-HOP

    Institute of Scientific and Technical Information of China (English)

    QunyKing; 人在羽中; 钱李明

    2005-01-01

    自从一群摇滚青年开始跟风 Elvis 的《Blue SuedeShoes》风格,hip-hop 似乎就成为了全球最具影响力的音乐风格。它最初起源于美国的黑人和拉丁美洲人,之后迅速在全世界流行,成为80年代、90年代和新千年的主流音乐。无论是在广告界还是在电影业,从各类排行榜到各种酒吧,hip-hop 的影响逐年增加。在1997年,英国的 hip-hop 还只是一种地下音

  5. Developmental Dysplasia of the Hip

    Science.gov (United States)

    ... in the motion of the hip and obvious shortening of the affected leg in older kids, an ... socket. During the procedure, doctors loosen the tight muscles and tissues around the hip joint and then ...

  6. ULTRA-LIGHTWEIGHT CEMENT

    Energy Technology Data Exchange (ETDEWEB)

    Fred Sabins

    2001-10-23

    The objective of this project is to develop an improved ultra-lightweight cement using ultra-lightweight hollow glass spheres (ULHS). Work reported herein addresses tasks performed in the fourth quarter as well as the other three quarters of the past year. The subjects that were covered in previous reports and that are also discussed in this report include: Analysis of field laboratory data of active cement applications from three oil-well service companies; Preliminary findings from a literature review focusing on problems associated with ultra-lightweight cements; Summary of pertinent information from Russian ultra-lightweight cement literature review; and Comparison of compressive strengths of ULHS systems using ultrasonic and crush methods Results reported from the fourth quarter include laboratory testing of ULHS systems along with other lightweight cement systems--foamed and sodium silicate slurries. These comparison studies were completed for two different densities (10.0 and 11.5 lb/gal) and three different field application scenarios. Additional testing included the mechanical properties of ULHS systems and other lightweight systems. Studies were also performed to examine the effect that circulation by centrifugal pump during mixing has on breakage of ULHS.

  7. Hip resurfacing: a technology reborn

    OpenAIRE

    2006-01-01

    In recent years there has been a resurgence of interest in the concept of hip resurfacing. Much of this interest has stemmed from the work of McMinn in the West Midlands. Hip resurfacing is now emerging as a viable alternative to conventional hip replacement. In this article, we discuss the conceptual advantages offered by hip resurfacing and review the early clinical results and the ongoing clinical concerns regarding this technology.

  8. X-Ray Exam: Hip

    Science.gov (United States)

    ... Old Feeding Your 1- to 2-Year-Old X-Ray Exam: Hip KidsHealth > For Parents > X-Ray Exam: Hip A A A What's in ... español Radiografía: cadera What It Is A hip X-ray is a safe and painless test that ...

  9. Worse health-related quality of life and hip function in female patients with elevated chromium levels

    Science.gov (United States)

    Hussey, Daniel K; Madanat, Rami; Donahue, Gabrielle S; Rolfson, Ola; Muratoglu, Orhun K; Malchau, Henrik

    2016-01-01

    Background and purpose Blood metal ion levels can be an indicator for detecting implant failure in metal-on-metal (MoM) hip arthroplasties. Little is known about the effect of bilateral MoM implants on metal ion levels and patient-reported outcomes. We compared unilateral patients and bilateral patients with either an ASR hip resurfacing (HR) or an ASR XL total hip replacement (THR) and investigated whether cobalt or chromium was associated with a broad spectrum of patient outcomes. Patients and methods From a registry of 1,328 patients enrolled in a multicenter prospective follow-up of the ASR Hip System, which was recalled in 2010, we analyzed data from 659 patients (311 HR, 348 THR) who met our inclusion criteria. Cobalt and chromium blood metal ion levels were measured and a 21-item patient-reported outcome measures (PROMs) questionnaire was used mean 6 years after index surgery. Results Using a minimal threshold of ≥7 ppb, elevated chromium ion levels were found to be associated with worse health-related quality of life (HRQoL) (p hip function (p < 0.05) in women. These associations were not observed in men. Patients with a unilateral ASR HR had lower levels of cobalt ions than bilateral ASR HR patients (p < 0.001) but similar levels of chromium ions (p = 0.09). Unilateral ASR XL THR patients had lower chromium and cobalt ion levels (p < 0.005) than bilateral ASR XL THR patients. Interpretation Chromium ion levels of ≥7 ppb were associated with reduced functional outcomes in female MoM patients. PMID:27459602

  10. PART II. HYDRATED CEMENTS

    Directory of Open Access Journals (Sweden)

    Milan Drabik

    2014-09-01

    Full Text Available Essential focus of the study has been to acquire thermoanalytical events, incl. enthalpies of decompositions - ΔH, of technological materials based on two types of Portland cements. The values of thermoanalytical events and also ΔH of probes of technological compositions, if related with the data of a choice of minerals of calcium-silicate-sulfate-aluminate hydrates, served as a valued input for the assessment of phases present and phase changes due to the topical hydraulic processes. The results indicate mainly the effects of "standard humidity" or "wet storage" of the entire hydration/hydraulic treatment, but also the presence of cement residues alongside calcium-silicate-sulfate-aluminate hydrates (during the tested period of treatment. "A diluting" effect of unhydrated cement residues upon the values of decomposition enthalpies in the studied multiphase system is postulated and discussed

  11. Cement Mason's Curriculum. Instructional Units.

    Science.gov (United States)

    Hendirx, Laborn J.; Patton, Bob

    To assist cement mason instructors in providing comprehensive instruction to their students, this curriculum guide treats both the skills and information necessary for cement masons in commercial and industrial construction. Ten sections are included, as follow: related information, covering orientation, safety, the history of cement, and applying…

  12. Reducing cement's CO2 footprint

    Science.gov (United States)

    van Oss, Hendrik G.

    2011-01-01

    The manufacturing process for Portland cement causes high levels of greenhouse gas emissions. However, environmental impacts can be reduced by using more energy-efficient kilns and replacing fossil energy with alternative fuels. Although carbon capture and new cements with less CO2 emission are still in the experimental phase, all these innovations can help develop a cleaner cement industry.

  13. Treatment of displaced neck fractures of the femur with total hip arthroplasty.

    Science.gov (United States)

    Rudelli, Sergio; Viriato, Sergio P; Meireles, Tadeu L O; Frederico, Tiago N

    2012-02-01

    We report our experience in unstable fractures of the femoral neck in a consecutive series of patients who underwent total hip arthroplasty. Over a period of 12 years, 88 patients were treated with a cemented total hip arthroplasty; 3 patients were lost to follow-up, leaving 86 fractures (85 patients) for retrospective analysis. Seven patients had dislocations, all but 1 of which were treated successfully without reoperation. Four patients required reoperation in the same hip undergoing arthroplasty. There was a graded increase in mortality rates across the continuum of risk groups at the time of surgery. The low incidence (4.6%) of a second procedure on the hip repaired initially, as well as low mortality rates, makes this treatment strategy quite satisfactory.

  14. Cementing a wellbore using cementing material encapsulated in a shell

    Energy Technology Data Exchange (ETDEWEB)

    Aines, Roger D.; Bourcier, William L.; Duoss, Eric B.; Floyd, III, William C.; Spadaccini, Christopher M.; Vericella, John J.; Cowan, Kenneth Michael

    2017-03-14

    A system for cementing a wellbore penetrating an earth formation into which a pipe extends. A cement material is positioned in the space between the wellbore and the pipe by circulated capsules containing the cement material through the pipe into the space between the wellbore and the pipe. The capsules contain the cementing material encapsulated in a shell. The capsules are added to a fluid and the fluid with capsules is circulated through the pipe into the space between the wellbore and the pipe. The shell is breached once the capsules contain the cementing material are in position in the space between the wellbore and the pipe.

  15. Cementing a wellbore using cementing material encapsulated in a shell

    Science.gov (United States)

    Aines, Roger D.; Bourcier, William L.; Duoss, Eric B.; Spadaccini, Christopher M.; Cowan, Kenneth Michael

    2016-08-16

    A system for cementing a wellbore penetrating an earth formation into which a pipe extends. A cement material is positioned in the space between the wellbore and the pipe by circulated capsules containing the cement material through the pipe into the space between the wellbore and the pipe. The capsules contain the cementing material encapsulated in a shell. The capsules are added to a fluid and the fluid with capsules is circulated through the pipe into the space between the wellbore and the pipe. The shell is breached once the capsules contain the cementing material are in position in the space between the wellbore and the pipe.

  16. INL HIP Plate Fabrication

    Energy Technology Data Exchange (ETDEWEB)

    B. H. Park; C. R. Clark; J. F. Jue

    2010-02-01

    This document outlines the process used to bond monolithic fuel plates by Hot Isostatic Pressing (HIP). This method was developed at Idaho National Laboratory (INL) for the Reduced Enrichment for Research and Test Reactors (RERTR) program. These foils have been used in a number of irradiation experiments in support of the United States Global Threat Reduction Initiative (GTRI) program.

  17. Technology Roadmaps: Cement

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2009-07-01

    To support its roadmap work focusing on key technologies for emissions reductions, the International Energy Agency (IEA) also investigated one particular industry: cement. Cement production includes technologies that are both specific to this industry and those that are shared with other industries (e.g., grinding, fuel preparation, combustion, crushing, transport). An industry specific roadmap provides an effective mechanism to bring together several technology options. It outlines the potential for technological advancement for emissions reductions in one industry, as well as potential cross-industry collaboration.

  18. Cement og politik

    DEFF Research Database (Denmark)

    Lund, Joachim

    2012-01-01

    as well as in the public sphere. Most of the extensive job creating measures he carried out as a minister for public works necessarily involved the use of great amounts of cement – the primary produce of F.L. Smidth & Co. Gunnar Larsen thus became an easy target for Communist propaganda, picturing him...... of the Soviet Union (including an F.L. Smidth & Co. cement plant in former Estonia). He spent the last 15 months of the occupation in Sweden and was arrested after having returned to Copenhagen in May, 1945. Although a Copenhagen city court prison sentence for economic collaboration was reversed, he had...

  19. Antibiotic-loaded acrylic cement: current concepts.

    Science.gov (United States)

    Buchholz, H W; Elson, R A; Heinert, K

    1984-11-01

    Antibiotic-loaded acrylic cement has been used routinely since 1972 at the authors' hospitals, where a series of some 22,000 joint arthroplasty operations was performed from 1964-1983. The current status of the material is presented with up-to-date follow-up statistics on prophylactic therapy and on established deep infections. The results of 869 exchange arthroplasties are compared with results published in 1981. In the future, results will be presented in the form of survival curves. The method by which survival tables and curves are constructed is critical. Investigators should use survival curves for ease of comparison and because of the wide range of possibilities in an analysis of covariable factors. A retrospective actuarial analysis was made of 825 one-stage reimplantations in which antibiotic-loaded acrylic cement was used for infected total hip arthroplasties. Staphylococcus aureus was the most commonly encountered organism. Failure rates of prostheses infected by S. aureus, S. species, and anaerobic corynebacteria did not differ statistically. A factor that significantly contributed to failure of this method of treatment was Pseudomonas infection. By actuarial analysis five years after operation, a success (survival) rate of 77% was calculated.

  20. Metal-on-metal hip resurfacing in patients with arthritis secondary to congenital dysplastic hip%全髋关节表面置换治疗成人先天性髋关节发育不良与近期疗效

    Institute of Scientific and Technical Information of China (English)

    郝鹏; 裴福兴; 沈彬; 杨静; 周宗科

    2006-01-01

    [目的]探讨全髋关节表面置换术治疗成人髋关节发育不良继发骨关节炎的疗效、安全性和有效性.[方法]2005年5~6月,对12例成人髋关节发育不良继发骨关节炎患者13个髋关节进行全髋关节表面置换术.男性4例,女性8例;年龄30~59岁,平均47岁,所有患者均为半脱位型.髋臼侧采用真臼位置重建,为非骨水泥固定,股骨头假体采用骨水泥固定.[结果]手术时间平均110 min,术中失血平均387 ml,术后引流量平均200 ml,肢体延长平均9 mm(术前短缩平均14mm).所有患者切口均一期愈合,无感染、股骨颈骨折、脱位、松动、神经血管损伤等并发症.全部随访12~13个月,临床效果满意,平均髋关节活动度屈曲由106.7°增加到120°,外展由25.8°增加到46.4°,外旋由20.8°增加到45°,内旋由3.3°增加到28.6°,Harris评分由术前的平均42分增加到术后的平均96分.X线片显示关节假体位置正常,人工髋臼平均外展角为39°,股骨头中心柄与股骨干夹角平均141°,髋关节旋转中心位置平均下移9 mm,内移11.5 mm.宿主骨对臼杯的平均覆盖率为89.5%,宿主骨与假体之间未见透亮线.[结论]全髋关节表面置换术治疗半脱位型的成人髋关节发育不良继发骨关节炎患者具有良好的近期疗效和应用前景,其远期疗效及其他类型髋关节发育不良患者的应用还需进一步研究.

  1. Efficacy and safety of metal-on-metal resurfacing of total hip in young patients with hip disease%中青年髋关节疾病行金属对金属全髋关节表面置换术的疗效及安全性

    Institute of Scientific and Technical Information of China (English)

    朱建炜; 刘璠; 董启榕; 李帅; 吴全明; 侍德

    2014-01-01

    目的 探讨中青年髋关节疾病患者行金属对金属人工全髋表面置换术的可行性.方法 选择各类髋关节疾病患者28例(35髋),年龄28 ~ 54岁,平均42岁;其中股骨头缺血性坏死16例、骨性关节炎5例、先天性髋关节发育不良4例和创伤性关节炎3例.患者均行混合型金属人工全髋表面置换术,术后检查髋关节功能、计数Harris评分、评估疼痛程度、观察髋关节影像学形态.结果 28例平均随访34个月,髋关节功能优32髋,良2髋,可1髋,优良率96.9%.未发现股骨颈骨折、股骨头坏死及假体固定失败等并发症.结论 金属对金属全髋关节表面置换术治疗中青年髋关节疾病近期疗效满意,可作为传统全髋置换术的过渡性手术.

  2. 重视金属对金属全髋关节置换及髋关节表面置换的临床评估——避免误读人工关节登记资料与临床研究报告%Attach importance to the clinical evaluation of metal-on-metal hip arthroplasty and hip resurfacing arthroplasty

    Institute of Scientific and Technical Information of China (English)

    吴海山

    2010-01-01

    @@ 近年来针对采用金属对金属摩擦界面的全髋关节置换术以及同样是金属界面的髋关节表面置换术的临床研究报告,与来自不同国家和地区的人工关节登记资料的发表,在人工关节专业领域产生了极大的争议[1].某些品牌的假体由于来自人工关节登记系统的高失败率而实施了召回措施[2].这一切在非专业媒体和患者人群中甚至导致了对这一已有长期应用历史的摩擦界面的误解与恐慌.来自各国的人工关节登记系统的资料以及来自临床医学中心的独立的临床研究报告的结果在某些方面有较高的一致性,而在另一些方面则大相径庭.而这正是导致争论的关键所在.

  3. 金属对金属全髋表面置换术治疗终末期髋关节疾病的短期疗效%Short term effect of metal-on-metal hip resurfacing arthroplasty for treating advanced hip disease

    Institute of Scientific and Technical Information of China (English)

    祝磊波; 吴立东

    2012-01-01

    目的 探讨金属对金属全髋关节表面置换术治疗年轻男性终末期髋关节疾病的近期临床疗效、并发症以及患者选择.方法 2006年9月至2011年9月对32例青年男性的终末期髋关节疾病患者的35髋施行金属对金属全髋关节表面置换术.术后平均随访51个月,采用Harris评分对髋关节功能进行手术前后定期随访评估,并摄常规X射线片观察、评定.结果 Harris评分由术前(50.7±5.9)分提升至随访时(97.3±3.7)分.优良率为100%,成功率为100%术后患者疼痛均完全消失.所有患者术后髋关节屈曲度均较术前明显改善,均未出现感染、假体脱位、股骨颈骨折,炎性假瘤等并发症,患者自述疗效满意.影像学检查未发现假体松动、移位迹象.髋臼以及股骨头假体周围未见明显透亮带.本组患者未出现异位骨化.结论 金属对金属全髋表面置换术治疗年轻男性髋关节终末期疾病短期疗效满意.

  4. 髋关节色素沉着绒毛结节性滑膜炎患者行全髋关节表面置换术的护理%Nursing care for patients with pigmented villonodular synovitis of the hip undergoing metal-on-metal hip resurfacing arthroplasty

    Institute of Scientific and Technical Information of China (English)

    胡艳; 雷鸣

    2011-01-01

    目的 探讨髋关节色素沉着绒毛结节性滑膜炎(PVNS)患者施行髋关节表面置换术(MOM-HRA)的护理方法.方法 对7例因PVNS行滑膜切除加MOM-HRA手术治疗的患者采取整体护理措施,重点进行术前功能指导、术后专科护理、功能锻炼和并发症的预防.结果 7例患者随访12~20个月,髋关节疼痛基本缓解,Harris评分提高,均未发生股骨颈骨折、下肢深静脉血栓形成、髋关节脱位等并发症.结论 MOM-HRA手术治疗PVNS患者的疗效满意,护理重点是重视并发症的预防,正确进行患肢功能锻炼和健康教育.

  5. Hip Arthroscopy: A Brief History.

    Science.gov (United States)

    Kandil, Abdurrahman; Safran, Marc R

    2016-07-01

    Hip arthroscopy is a fast-growing and evolving field. Like knee and shoulder arthroscopy, hip arthroscopy began as a diagnostic procedure and then progressed to biopsy and resection of abnormalities. Subsequently, it has evolved to repair of various tissues and treatment of underlying causes. As the understanding of the hip joint and its associated pathophysiology grows, indications will continue to expand for this diagnostic and therapeutic modality. This article outlines the historic developments of hip arthroscopy, including advancements in instrumentation and techniques from the days of the first hip arthroscopies to the present day.

  6. Metal type of the femoral stem in total hip arthroplasty

    OpenAIRE

    Tarasevičius, Šarūnas; Tarasevičius, Rimantas; Žegunis, Vidmantas; Smailys, Alfredas; Kalesinskas, Romas Jonas

    2005-01-01

    Objective. To compare the influence of two different cemented stems each made of different alloys on survival and outcome. Material and methods. We analyzed 341 total hip replacements performed in 1998–2001. Two types of prostheses were implanted. Biomet® Bi-Metric titanium stem, cobalt-chrome head and ultra high molecular weight all poly cup were implanted in 102 cases. Aesculap® Centrament cobalt-chrome stem, head and ultra high molecular weight all poly cup were implanted in 239 cases. All...

  7. Effect of curing characteristics on residual stress generation in polymethyl methacrylate bone cements.

    Science.gov (United States)

    Hingston, J A; Dunne, N J; Looney, L; McGuinness, G B

    2008-08-01

    Residual stresses resulting from the shrinkage of polymethyl methacrylate (PMMA) bone cement have been implicated in the formation of cracks in cement mantles following total hip arthroplasty. This study investigates whether two such cements, with differentiated solidification characteristics (i.e. working and setting times), display significant differences in their residual stress characteristics in an experiment designed to replicate the physical conditions of total hip arthroplasty. Experiments were performed using a representative femoral construct to measure and compare the temperatures and residual strains developed for standard PMMA cement mantles (CMW 1 Gentamicin) and slow curing cement mantles (SmartSet HV Gentamicin) during and following polymerization. These experimental results revealed no statistically significant difference (t-test, p > 0.05) for peak exotherm temperature and residual strain levels between the cements (measured after 3 h). The tailored polymerization characteristics of the slow-curing cement do not significantly affect residual stress generation, compared with the standard cement. It is often considered that residual stresses significantly relax following polymerization and before biomechanical loads are first applied during rehabilitation (up to 3 days later). This was examined for durations of 18 h to 3 days. Axial strains in the model femur and stem reduced by averages of 5.5 and 7.9 per cent respectively, while hoop strains in the stem exhibited larger reductions. An axisymmetric transient thermoelastic finite element model of the experiment was developed, allowing residual stresses to be predicted based on differential scanning calorimetry (DSC) measurements of the heat released throughout the exothermic curing reaction. The model predictions closely replicated the experimental measurements of both temperature and residual strain at 3 h, suggesting that residual strains can be fully accounted for by the thermal contraction

  8. Primary and revision anterior supine total hip arthroplasty: an analysis of complications and reoperations.

    Science.gov (United States)

    Berend, Keith R; Kavolus, Joseph J; Morris, Michael J; Lombardi, Adolph V

    2013-01-01

    Anterior total hip arthroplasty (THA) has been touted by some as a muscle-sparing, less invasive procedure. Reports have focused on the high intraoperative and postoperative complication rates, the increased transfusion risk, and its questionable clinical benefits. The senior author's experience regarding complications and reoperations that occurred after primary and revision THA using an anterior supine intermuscular approach has been generally favorable. An electronic database was used to identify 906 patients treated with 1,035 consecutive anterior supine intermuscular THAs performed by a single surgeon between January 2007 and December 2010, which included 986 primary THAs, 2 resurfacings, 2 conversions of failed open reduction and internal fixation for fracture, and 45 revision THAs. The surgical technique used an anterior approach with a modified Smith-Petersen interval and was performed with the patient supine on a standard operating table without traction. The transfusion rate was 5%. There were three intraoperative calcar cracks and one canal perforation, which was treated with cerclage cables. Four wound complications required débridement, four hips had substantial lateral femoral cutaneous nerve paresthesias that had not resolved by the 12-month follow-up, and one femoral nerve palsy was reported. At up to 40 month's follow-up, there have been 25 revisions (2.4%), including 9 periprosthetic femoral fractures; 1 stem subsidence; 4 hips with aseptic loosening; 5 metal-on-metal bearing complications; 1 cup malpositioning, which was corrected the same day; 4 dislocations; and 1 infection. This 4-year experience with primary and revision anterior THAs has showed acceptable rates of perioperative transfusion, complications, and revisions.

  9. Osteotransductive bone cements.

    Science.gov (United States)

    Driessens, F C; Planell, J A; Boltong, M G; Khairoun, I; Ginebra, M P

    1998-01-01

    Calcium phosphate bone cements (CPBCs) are osteotransductive, i.e. after implantation in bone they are transformed into new bone tissue. Furthermore, due to the fact that they are mouldable, their osteointegration is immediate. Their chemistry has been established previously. Some CPBCs contain amorphous calcium phosphate (ACP) and set by a sol-gel transition. The others are crystalline and can give as the reaction product dicalcium phosphate dihydrate (DCPD), calcium-deficient hydroxyapatite (CDHA), carbonated apatite (CA) or hydroxyapatite (HA). Mixed-type gypsum-DCPD cements are also described. In vivo rates of osteotransduction vary as follows: gypsum-DCPD > DCPD > CDHA approximately CA > HA. The osteotransduction of CDHA-type cements may be increased by adding dicalcium phosphate anhydrous (DCP) and/or CaCO3 to the cement powder. CPBCs can be used for healing of bone defects, bone augmentation and bone reconstruction. Incorporation of drugs like antibiotics and bone morphogenetic protein is envisaged. Load-bearing applications are allowed for CHDA-type, CA-type and HA-type CPBCs as they have a higher compressive strength than human trabecular bone (10 MPa).

  10. New developments in calcium phosphate bone cements: approaching spinal applications

    OpenAIRE

    Vlad, Maria Daniela

    2009-01-01

    La presente tesis doctoral (i.e., “New developments in calcium phosphate bone cements: approaching spinal applications”) aporta nuevos conocimientos en el campo de los cementos óseos de fosfato de calcio (CPBCs) en relación a su aplicación clínica en el campo de la cirugía vertebral mínimamente invasiva. La hipótesis central de esta investigación fue formulada en los siguientes términos: “Los cementos apatíticos pueden ser (si se optimizan) una alternativa mejor (debido a sus propiedades d...

  11. Unusual way of loosened total hip arthroplasty treatment with an Austin Moore endoprosthesis

    Directory of Open Access Journals (Sweden)

    M Erceg

    2014-01-01

    Full Text Available A 65-year-old female patient with aseptic loosening of total cemented hip endoprosthesis and pathologic fracture of the femur at the level of the stem of endoprosthesis was presented. As no appropriate endoprosthesis was available due to the war in Croatia and war priority, the problem was managed by femur osteosynthesis and implantation of a partial Austin Moore hip endoprosthesis. The endoprosthesis is still functioning well (for 20 years.To the best of the author′s knowledge, nobody has ever treated problem like this using this alternative, an unconventional method, with an Austin Moore endoprosthesis.

  12. Unusual way of loosened total hip arthroplasty treatment with an Austin Moore endoprosthesis.

    Science.gov (United States)

    Erceg, M; Becic, K

    2014-01-01

    A 65-year-old female patient with aseptic loosening of total cemented hip endoprosthesis and pathologic fracture of the femur at the level of the stem of endoprosthesis was presented. As no appropriate endoprosthesis was available due to the war in Croatia and war priority, the problem was managed by femur osteosynthesis and implantation of a partial Austin Moore hip endoprosthesis. The endoprosthesis is still functioning well (for 20 years).To the best of the author's knowledge, nobody has ever treated problem like this using this alternative, an unconventional method, with an Austin Moore endoprosthesis.

  13. [Juvenile hip pain. 2. Femur head epiphysiolysis, hip dysplasia, tumors].

    Science.gov (United States)

    Hackenbruch, W; von Gumppenberg, S; Karpf, P M

    1978-11-09

    The early symptom in hip joint diseases in children is pain. Pain is localized in the groin and thight, but mostly in the knee. Other important signs are limping and reduced internal rotation. If a hip disease is suspected it is necessary to take X-rays in two planes. If diagnosis is early and special therapy started immediately, the results are usually excellent without deformation of the hip. Otherwise early osteoarthritis can develop. This is important because osteoarthritis in the hip joint is in 75% of the cases due to hip joint diseases in childhood. The problems of diagnosis and treatment of the most common hip joint diseases in children (transient synovitis, rheumatoid arthritis, osteomyelitis, Legg-Perthes disease, slipped capital femoral epiphysis, dysplasia, tumors) are discussed.

  14. Nonarthritic hip joint pain.

    Science.gov (United States)

    Enseki, Keelan; Harris-Hayes, Marcie; White, Douglas M; Cibulka, Michael T; Woehrle, Judith; Fagerson, Timothy L; Clohisy, John C

    2014-06-01

    The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these clinical practice guidelines is to describe the peer-reviewed literature and make recommendations related to nonarthritic hip joint pain.

  15. Mineral resource of the month: hydraulic cement

    Science.gov (United States)

    van Oss, Hendrik G.

    2012-01-01

    Hydraulic cements are the binders in concrete and most mortars and stuccos. Concrete, particularly the reinforced variety, is the most versatile of all construction materials, and most of the hydraulic cement produced worldwide is portland cement or similar cements that have portland cement as a basis, such as blended cements and masonry cements. Cement typically makes up less than 15 percent of the concrete mix; most of the rest is aggregates. Not counting the weight of reinforcing media, 1 ton of cement will typically yield about 8 tons of concrete.

  16. Cement from magnesium substituted hydroxyapatite.

    Science.gov (United States)

    Lilley, K J; Gbureck, U; Knowles, J C; Farrar, D F; Barralet, J E

    2005-05-01

    Brushite cement may be used as a bone graft material and is more soluble than apatite in physiological conditions. Consequently it is considerably more resorbable in vivo than apatite forming cements. Brushite cement formation has previously been reported by our group following the mixture of nanocrystalline hydroxyapatite and phosphoric acid. In this study, brushite cement was formed from the reaction of nanocrystalline magnesium-substituted hydroxyapatite with phosphoric acid in an attempt to produce a magnesium substituted brushite cement. The presence of magnesium was shown to have a strong effect on cement composition and strength. Additionally the presence of magnesium in brushite cement was found to reduce the extent of brushite hydrolysis resulting in the formation of HA. By incorporating magnesium ions in the apatite reactant structure the concentration of magnesium ions in the liquid phase of the cement was controlled by the dissolution rate of the apatite. This approach may be used to supply other ions to cement systems during setting as a means to manipulate the clinical performance and characteristics of brushite cements.

  17. POZZOLAN AND CEMENTS WITH POZZOLAN

    Directory of Open Access Journals (Sweden)

    Hasan KAPLAN

    1995-02-01

    Full Text Available Cement, one of the basic material of construction engineering, has an important place in view of strength and cost of structures. Cement consumption is increasing parallel to development of building construction sector. For cement producers, minimal cost is desired by using new and economical material sources. On the other hand, the controllers and contractors need cheaper, safer and higher strength materials. From this respect cement industry tends to use cement with pozzolan. In Türkiye, cement with pozzolan is produced by adding the pozzolan, which has a large reservoir in the country, in cement in sertain amount. However this type of cement is consumed in the construction sector, sortage of scientific investigation and speculative news on the subject.are worried the users and producers. In this paper, prior to an experimental study on the cements having pozzolan additive, historical development of pozzolan, reservoir of Turkiye, and comparison with portland cement is carried out. Advantages and disadvantages of pozzolan are also discussed in some points.

  18. CURBSIDE CONSULTATION IN HIP ARTHROPLASTY

    OpenAIRE

    Sporer, Scott M.; Bernard R. Bach, Jr

    2009-01-01

    DESCRIPTION A user friendly reference for decision making in hip arthroplasty designed in a question formed clinical problem scenarios and answers format .The articles composed of the answers, containing current concepts and preferences of experts in primary and revision hip surgery are enhanced by several images, diagrams and references and written in the form of a curbside consultation by Scott M. Sporer, MD. and his collaborators. PURPOSE By this practical reference of hip arthroplasty, Sc...

  19. US cement industry

    Energy Technology Data Exchange (ETDEWEB)

    Nisbet, M.A.

    1997-12-31

    This paper describes the cement and concrete industry, and provides data on energy use and carbon dioxide emissions. The potential impact of an energy tax on the industry is briefly assessed. Opportunities identified for reducing carbon dioxide emissions include improved energy efficiency, alternative fuels, and alternative materials. The key factor in determining CO{sub 2} emissions is the level of domestic production. The projected improvement in energy efficiency and the relatively slow growth in domestic shipments indicate that CO{sub 2} emissions in 2000 should be about 5% above the 1990 target. However, due to the cyclical nature of cement demand, emissions will probably be above target levels during peak demand and below target levels during demand troughs. 7 figs., 2 tabs.

  20. Advances in Glass Ionomer Cements

    OpenAIRE

    KAYA, Dt. Tuğba; TİRALİ, Yard. Doç. Dr. Resmiye Ebru

    2013-01-01

    In recent years there have been a number of innovations and developments with respect to glass ionomer cements and their applications in clinical dentistry. This article considers some of the recent outstanding studies regarding the field of glass ionomer cement applications, adhesion and setting mechanisms, types, advantage and disadvantages among themselves and also to enhance the physical and antibacterial properties under the title of 'Advances in Glass Ionomer Cements'. As their biologic...

  1. Cement penetration after patella venting.

    Science.gov (United States)

    Jones, Christopher W; Lam, Li-On; Butler, Adam; Wood, David J; Walsh, William R

    2009-01-01

    There is a high rate of patellofemoral complications following total knee arthroplasty. Optimization of the cement-bone interface by venting and suction of the tibial plateau has been shown to improve cement penetration. Our study was designed to investigate if venting the patella prior to cementing improved cement penetration. Ten paired cadaver patellae were allocated prior to resurfacing to be vented or non-vented. Bone mineral density (BMD) was measured by DEXA scanning. In vented specimens, a 1.6 mm Kirschner wire was used to breach the anterior cortex at the center. Specimens were resurfaced with standard Profix instrumentation and Versabond bone cement (Smith and Nephew PLC, UK). Cement penetration was assessed from Faxitron and sectioned images by a digital image software package (ImageJ V1.38, NIH, USA). Wilcoxon rank sum test was used to assess the difference in cement penetration between groups. The relationship between BMD and cement penetration was analyzed by Pearson correlation coefficient. There was a strong negative correlation between peak BMD and cement penetration when analyzed independent of experimental grouping (r(2)=-0.812, p=0.004). Wilcoxon rank sum testing demonstrated no significant difference (rank sum statistic W=27, p=0.579) in cement penetration between vented (10.53%+/-4.66; mean+/-std dev) and non-vented patellae (11.51%+/-6.23; mean+/-std dev). Venting the patella using a Kirschner wire does not have a significant effect on the amount of cement penetration achieved in vitro using Profix instrumentation and Versabond cement.

  2. Abductor weakness and stresses around acetabular components of total hip arthroplasty: a finite element analysis

    OpenAIRE

    Sutherland, A. G.; D’Arcy, S.; Smart, D; Ashcroft, G. P.

    1999-01-01

    Abductor weakness, and the resulting Trendelenburg gait, after total hip arthroplasty is believed to be associated with a poor long-term outcome. We have constructed a two-dimensional finite element analysis using load cases to mimic this abductor weakness. The finite element analysis demonstrates slightly increased stresses, particularly at the bone-cement interface in the DeLee-Charnley zone I, which does not seem sufficient to explain the adverse effect of abductor weakness.

  3. Activation of Complement Following Total Hip Replacement.

    Science.gov (United States)

    Thordardottir, S; Vikingsdottir, T; Bjarnadottir, H; Jonsson, H; Gudbjornsson, B

    2016-03-01

    The aim of this study was to investigate whether complement activation, via the classical and alternative pathways, occurs following a cemented total hip replacement (THR) surgery due to osteoarthritis. Blood samples were collected systematically from 12 patients - six male and six women, with a median age of 75 (range: 59-90 years) - preoperatively, 6 h post-operatively and on the first, second and third post-operative day. Total function of classical (CH50) and alternative pathways (AH50) was evaluated, along with the determination of serum concentrations of the complement proteins C3, C4, C3d, the soluble terminal complement complex (sTCC) sC5b-9, as well as C-reactive protein (CRP) and albumin. Measurements of CRP and albumin levels elucidated a marked inflammatory response following the operation. The CH50, AH50 and C3 and C4 levels were significantly lower 6 h after the surgery compared with the preoperative levels, but elevated above the preoperative levels during the following 3 days. The complement activation product C3d levels increased continually during the whole observation period, from 13.5 AU/ml (range: 8-19 AU/ml) preoperative to 20 AU/ml (range: 12-34 AU/ml) on the third post-operative day. Furthermore, we observed an increase in the sC5b-9 levels between the preoperative and the third post-operative day. These results demonstrate a significant activation of the complement system following cemented THR. Further studies are needed to elucidate the time frame and the pathogenic role of this observed complement activation.

  4. Hip Hip Hurrah! Hip size inversely related to heart disease and total mortality

    DEFF Research Database (Denmark)

    Heitmann, B L; Lissner, L

    2011-01-01

    obesity and/or waist circumference. These studies have been remarkable in terms of their consistency, and in the unexpected finding of an adverse effect of small hip size, after statistically correcting for differences in general and abdominal size. The hazard related to a small hip size may be stronger......During the past decade a series of published reports have examined the value of studying the relation between hip circumferences and cardiovascular end points. Specifically, in a series of recent studies the independent effects of hip circumference have been studied after adjustment for general...

  5. Danish Hip Arthroscopy Registry

    DEFF Research Database (Denmark)

    Mygind-Klavsen, Bjarne; Grønbech Nielsen, Torsten; Maagaard, Niels

    2016-01-01

    and Pincer resection in 93.5% of the cases. Labral refixation or repair was done in 70.3% of the cases. The most common type of acetabular chondral damage was grade II lesions (36.6%). Grade III and IV changes were seen in 36.1% of the cases. The preoperative iHOT12 was 45 (mean) based on all 12 items. EQ-5D....... The problems with development and maintaining a large clinical registry are described and further studies are needed to validate data completeness. We consider the development of a national clinical registry for hip arthroscopy as a successful way of developing and maintaining a valuable clinical...

  6. Trochanteric osteotomy in total hip replacement for congenital hip disease.

    Science.gov (United States)

    Hartofilakidis, G; Babis, G C; Georgiades, G; Kourlaba, G

    2011-05-01

    We studied the effect of trochanteric osteotomy in 192 total hip replacements in 140 patients with congenital hip disease. There was bony union in 158 hips (82%), fibrous union in 29 (15%) and nonunion in five (3%). The rate of union had a statistically significant relationship with the position of reattachment of the trochanter, which depended greatly on the pre-operative diagnosis. The pre-operative Trendelenburg gait substantially improved in all three disease types (dysplasia, low and high dislocation) and all four categories of reattachment position. A persistent Trendelenburg gait post-operatively was noticed mostly in patients with defective union (fibrous or nonunion). Acetabular and femoral loosening had a statistically significant relationship with defective union and the position of reattachment of the trochanter. These results suggest that the complications of trochanteric osteotomy in total hip replacement for patients with congenital hip disease are less important than the benefits of this surgical approach.

  7. Conversion arthroplasty of the hip: mid-term results are good.

    Science.gov (United States)

    Zahar, Akos; Cross, Michael B; Lakatos, Tamas; Lakatos, Jozsef; Major, Balint; Kendoff, Daniel; Szendröi, Miklos

    2015-01-01

    The historical mid-term results of conversion total hip arthroplasty (THA) are acceptable; however, the complication rates are high. In total, 39 patients (45 hips) from 2 institutions underwent conversion THA from 1993-2006 and were retrospectively evaluated. The mean age was 48.3 years, the mean follow-up time was 8.7 years, and the mean duration arthrodesis prior to conversion THA was 18.2 years. The outcomes included operative time, blood loss, leg-length discrepancy (LLD), thigh circumference, Harris Hip Score (HHS), complications, and radiographic evaluation. A total of 34 THAs were cemented, and 11 were uncemented. The mean operative time was 102 minutes, and the mean blood loss was 1019 ml. The mean HHS improved from 32.4 to 82.5 (pTrendelenburg gait (6), early haematoma that required surgical evacuation (5), dislocation (2), deep infection (1), and early aseptic loosening of the components (2). In conclusion, the functional results of the conversion THA using predominantly cemented components are good at mid-term follow-up; although the complication rates remain higher than a standard primary THA, aseptic loosening rates of the cemented components is low at mid-term follow-up.

  8. Thermal Shock-resistant Cement

    Energy Technology Data Exchange (ETDEWEB)

    Sugama T.; Pyatina, T.; Gill, S.

    2012-02-01

    We studied the effectiveness of sodium silicate-activated Class F fly ash in improving the thermal shock resistance and in extending the onset of hydration of Secar #80 refractory cement. When the dry mix cement, consisting of Secar #80, Class F fly ash, and sodium silicate, came in contact with water, NaOH derived from the dissolution of sodium silicate preferentially reacted with Class F fly ash, rather than the #80, to dissociate silicate anions from Class F fly ash. Then, these dissociated silicate ions delayed significantly the hydration of #80 possessing a rapid setting behavior. We undertook a multiple heating -water cooling quenching-cycle test to evaluate the cement’s resistance to thermal shock. In one cycle, we heated the 200 and #61616;C-autoclaved cement at 500 and #61616;C for 24 hours, and then the heated cement was rapidly immersed in water at 25 and #61616;C. This cycle was repeated five times. The phase composition of the autoclaved #80/Class F fly ash blend cements comprised four crystalline hydration products, boehmite, katoite, hydrogrossular, and hydroxysodalite, responsible for strengthening cement. After a test of 5-cycle heat-water quenching, we observed three crystalline phase-transformations in this autoclaved cement: boehmite and #61614; and #61543;-Al2O3, katoite and #61614; calcite, and hydroxysodalite and #61614; carbonated sodalite. Among those, the hydroxysodalite and #61614; carbonated sodalite transformation not only played a pivotal role in densifying the cementitious structure and in sustaining the original compressive strength developed after autoclaving, but also offered an improved resistance of the #80 cement to thermal shock. In contrast, autoclaved Class G well cement with and without Class F fly ash and quartz flour failed this cycle test, generating multiple cracks in the cement. The major reason for such impairment was the hydration of lime derived from the dehydroxylation of portlandite formed in the autoclaved

  9. Phosphate based oil well cements

    Science.gov (United States)

    Natarajan, Ramkumar

    The main application of the cement in an oil well is to stabilize the steel casing in the borehole and protect it from corrosion. The cement is pumped through the borehole and is pushed upwards through the annulus between the casing and the formation. The cement will be exposed to temperature and pressure gradients of the borehole. Modified Portland cement that is being used presently has several shortcomings for borehole sealant. The setting of the Portland cement in permafrost regions is poor because the water in it will freeze even before the cement sets and because of high porosity and calcium oxide, a major ingredient it gets easily affected by the down hole gases such as carbon dioxide. The concept of phosphate bonded cements was born out of considerable work at Argonne National Laboratory (ANL) on their use in stabilization of radioactive and hazardous wastes. Novel cements were synthesized by an acid base reaction between a metal oxide and acid phosphate solution. The major objective of this research is to develop phosphate based oil well cements. We have used thermodynamics along with solution chemistry principles to select calcined magnesium oxide as candidate metal oxide for temperatures up to 200°F (93.3°C) and alumina for temperatures greater than 200°F (93.3°C). Solution chemistry helped us in selecting mono potassium phosphate as the acid component for temperatures less than 200°F (93.3°C) and phosphoric acid solution greater than 200°F (93.3°C). These phosphate cements have performance superior to common Portland well cements in providing suitable thickening time, better mechanical and physical properties.

  10. Social inequality and hip fracture

    DEFF Research Database (Denmark)

    Harvey, N. C.; Hansen, L.; Judge, A.

    2015-01-01

    Social inequality appears to be increasing in many countries. We explored whether risk of hip fracture was associated with markers of inequality and whether these relationships changed with time, using data from Danish Health Registries. Methods: All patients 60 years or older with a primary hip...

  11. Mixed-mode loading of the cement-bone interface: a finite element study.

    Science.gov (United States)

    Waanders, Daan; Janssen, Dennis; Bertoldi, Katia; Mann, Kenneth A; Verdonschot, Nico

    2011-02-01

    While including the cement-bone interface of complete cemented hip reconstructions is crucial to correctly capture their response, its modelling is often overly simplified. In this study, the mechanical mixed-mode response of the cement-bone interface is investigated, taking into account the effects of the well-defined microstructure that characterises the interface. Computed tomography-based plain strain finite element analyses models of the cement-bone interface are built and loaded in multiple directions. Periodic boundaries are considered and the failure of the cement and bone fractions by cracking of the bulk components are included. The results compare favourably with experimental observations. Surprisingly, the analyses reveal that under shear loading no failure occurs and considerable normal compression is generated to prevent interface dilation. Reaction forces, crack patterns and stress fields provide more insight into the mixed-mode failure process. Moreover, the cement-bone interface analyses provide details which can serve as a basis for the development of a cohesive law.

  12. Highly cross-linked polyethylene in hip resurfacing arthroplasty: long-term follow-up.

    Science.gov (United States)

    Amstutz, Harlan C; Takamura, Karren M; Ebramzadeh, Edward; Le Duff, Michel J

    2015-01-01

    Highly cross-linked polyethylene (XLPE) has improved wear properties. This study reports the results of a small series of patients treated over 10 years ago with a metal-on-XLPE hip resurfacing.A total of 21 hips in 20 patients received a hip resurfacing with a cobalt-chromium metal femoral head and metal-backed acetabular cup lined with a XLPE insert and were retrospectively studied. Kaplan-Meier Survivorship was calculated.Five patients who had initial extreme cystic disease in the femoral head failed due to femoral loosening. Survivorship was 95.2% at 5 years and 81.0% at 10 years.We found that XLPE wear was not implicated in these failures, which were primarily attributed to poor bone quality of the femoral head, early bone preparation, cementing technique and excessive head reaming to near the neck diameter, necessitated for the implantation of a thick two-part socket.

  13. Feasibility of asymmetric flow field-flow fractionation coupled to ICP-MS for the characterization of wear metal particles and metalloproteins in biofluids from hip replacement patients.

    Science.gov (United States)

    Loeschner, Katrin; Harrington, Chris F; Kearney, Jacque-Lucca; Langton, David J; Larsen, Erik H

    2015-06-01

    Hip replacements are used to improve the quality of life of people with orthopaedic conditions, but the use of metal-on-metal (MoM) arthroplasty has led to poor outcomes for some patients. These problems are related to the generation of micro- to nanosized metal wear particles containing Cr, Co or other elements, but the current analytical methods used to investigate the processes involved do not provide sufficient information to understand the size or composition of the wear particles generated in vivo. In this qualitative feasibility study, asymmetric flow field-flow fractionation (AF(4)) coupled with inductively coupled plasma mass spectrometry (ICP-MS) was used to investigate metal protein binding and the size and composition of wear metal particles present in serum and hip aspirates from MoM hip replacement patients. A well-established HPLC anion exchange chromatography (AEC) separation system coupled to ICP-MS was used to confirm the metal-protein associations in the serum samples. Off-line single particle ICP-MS (spICP-MS) analysis was used to confirm the approximate size distribution indicated by AF(4) of the wear particles in hip aspirates. In the serum samples, AF(4) -ICP-MS suggested that Cr was associated with transferrin (Tf) and Co with albumin (Alb) and an unidentified species; AEC-ICP-MS confirmed these associations and also indicated an association of Cr with Alb. In the hip aspirate sample, AF(4)-ICP-MS suggested that Cr was associated with Alb and Tf and that Co was associated with Alb and two unidentified compounds; AEC analysis confirmed the Cr results and the association of Co with Alb and a second compound. Enzymatic digestion of the hip aspirate sample, followed by separation using AF(4) with detection by UV absorption (280 nm), multi-angle light scattering and ICP-MS, suggested that the sizes of the Cr-, Co- and Mo-containing wear particles in a hip aspirate sample were in the range 40-150 nm. Off-line spICP-MS was used to confirm these

  14. Is cemented bipolar hemiarthroplasty a safe treatment for femoral neck fracture in elderly patients?

    Directory of Open Access Journals (Sweden)

    Yurdakul E

    2015-06-01

    Full Text Available Emre Yurdakul,1 Fatih Karaaslan,2 Murat Korkmaz,2 Fuat Duygulu,3 Ali Baktir41Department of Orthopedics and Traumatology, Osmaniye State Hospital, 2Department of Orthopedics and Traumatology, Faculty of Medicine, Bozok University, Yozgat, 3Department of Orthopedics and Traumatology, Kayseri Training Hospital, 4Department of Orthopedics and Traumatology, Modern Dünyam Hospital, Kayseri, TurkeyObjectives: Controversy exists regarding the use of cement in hemiarthroplasty when treating a displaced femoral neck fracture in elderly patients. The primary hypothesis of this study was that the use of cement would afford better visual analog pain and activity scores in elderly patients.Methods: This study included 133 patients over 65 years of age admitted to our clinics from 2006 to 2012 for the surgical treatment of a displaced femoral neck fracture. All patients were treated via hemiarthroplasty. The patients (66 males, 67 females; mean age: 78.16 years; range: 60–110 years were followed-up regularly. All patients were divided into one of two groups: group A was treated with cement; and group B without. Both groups were compared in terms of preoperative features (demographics and associated diseases, pre- and postoperative complications, mortality rates, pain and activity levels, and hip scores. Hospitalization time, average surgical duration, and time from fracture to operation were also recorded. Mean follow-up duration was 30.9 (range: 5–51 months.Results: We found no significant between-groups differences in terms of length of hospital stay, Harris Hip Score, complications, or follow-up mortality rates. Walking ability and pain scores were better in the cemented group in the early follow-up period. Duration of surgery and perioperative mortality rates were somewhat lower in the cementless group, but the difference was not statistically significant.Conclusion: The use of cement during hip hemiarthroplasty in patients over 65 years of age had

  15. Magnesium oxychloride cement concrete

    Indian Academy of Sciences (India)

    A K Misra; Renu Mathur

    2007-06-01

    The scope of magnesium oxychloride (MOC) cement in concrete works has been evaluated. MOC cement concrete compositions of varying strengths having good placing and finishing characteristics were prepared and investigated for their compressive and flexural strengths, -values, abrasion resistance etc. The durability of MOC concrete compositions against extreme environmental conditions viz. heating–cooling, freezing–thawing, wetting–drying and penetration and deposition of salts etc were investigated. The results reveal that MOC concrete has high compressive strength associated with high flexural strength and the ratio of compressive to flexural strength varies between 6 and 8. The elastic moduli of the compositions studied are found to be 23–85 GPa and the abrasion losses between 0.11 and 0.20%. While alternate heating–cooling cycles have no adverse effect on MOC concrete, it can be made durable against freezing–thawing and the excessive exposure to water and salt attack by replacing 10% magnesium chloride solution by magnesium sulphate solution of the same concentration.

  16. Grout cement. ; Grout cement to fill ground/grout cement to fill cracks. Chunyuyo cement. ; Jiban chunyuyo cement /hibiware chunyuyo cement

    Energy Technology Data Exchange (ETDEWEB)

    Okaue, H. (Nittetsu Cement Co. Ltd., Hokkaido (Japan))

    1991-09-01

    Ground grout cement is grouted into the ground under high pressure in high water ratio (100 to 1000%) in the form of milk differing from concrete in terms of the water-cement ratio. The grouted milk is governed by characteristics of the cement the milk itself possesses, resulting in variable grouting modes, which are divided in fracture grouting, permeation grouting and boundary grouting. Their applications include cutting off of water in dams, ground reinforcement, prevention of water gushing in tunnel excavation, natural ground reinforcement, improvement of sandy soil and prevention of its collapse, and stabilization of ground for urban civil engineering works such as subway, water supply and sewerage constructions. Grout cement to fill cracks in concrete structures is so grouted into cracks that the slurry fills up contiguous cracks to a certain level and goes upward while pushing out air or water existing in the cracks. The slurry filled into the cracks solidifies and hardens while being absorbed into the concrete, and finally integrates with the concrete. The grout cement is used to rework such concrete structures as dams, tunnels, and bridge bases. 6 figs., 4 tabs.

  17. The tribological behaviour of different clearance MOM hip joints with lubricants of physiological viscosities.

    Science.gov (United States)

    Hu, X Q; Wood, R J K; Taylor, A; Tuke, M A

    2011-11-01

    Clearance is one of the most influential parameters on the tribological performance of metal-on-metal (MOM) hip joints and its selection is a subject of considerable debate. The objective of this paper is to study the lubrication behaviour of different clearances for MOM hip joints within the range of human physiological and pathological fluid viscosities. The frictional torques developed by MOM hip joints with a 50 mm diameter were measured for both virgin surfaces and during a wear simulator test. Joints were manufactured with three different diametral clearances: 20, 100, and 200 microm. The fluid used for the friction measurements which contained different ratios of 25 percent newborn calf serum and carboxymethyl cellulose (CMC) with the obtained viscosities values ranging from 0.001 to 0.71 Pa s. The obtained results indicate that the frictional torque for the 20 microm clearance joint remains high over the whole range of the viscosity values. The frictional torque of the 100 microm clearance joint was low for the very low viscosity (0.001 Pa s) lubricant, but increased with increasing viscosity value. The frictional torque of the 200 microm clearance joint was high at very low viscosity levels, however, it reduced with increasing viscosity. It is concluded that a smaller clearance level can enhance the formation of an elastohydrodynamic lubrication (EHL) film, but this is at the cost of preventing fluid recovery between the bearing surfaces during the unloaded phase of walking. Larger clearance bearings allow a better recovery of lubricant during the unloaded phase, which is necessary for higher viscosity lubricants. The selection of the clearance value should therefore consider both the formation of the EHL film and the fluid recovery as a function of the physiological viscosity in order to get an optimal tribological performance for MOM hip joints. The application of either 25 per cent bovine serum or water in existing in vitro tribological study should

  18. 21 CFR 888.4200 - Cement dispenser.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cement dispenser. 888.4200 Section 888.4200 Food... DEVICES ORTHOPEDIC DEVICES Surgical Devices § 888.4200 Cement dispenser. (a) Identification. A cement dispenser is a nonpowered syringe-like device intended for use in placing bone cement (§ 888.3027)...

  19. Traumatic injuries of the hip.

    LENUS (Irish Health Repository)

    Marshall, Nina

    2009-11-01

    Traumatic lesions of the hip in athletes may be clinically challenging because of the overlap in clinical presentation due to differing pathologies and the presence of multiple injuries. Imaging of the hip in the athlete has undergone a recent resurgence of interest and understanding related to the increasing accessibility and use of hip arthroscopy, which expands the treatment options available for intra-articular pathology. MR imaging and MR arthrography have a unique role in diagnosis of these pathologies, guiding the surgeon, arthroscopist, and referring clinician in their management of bony and soft tissue injury.

  20. Chronic asymptomatic dislocation of a total hip replacement: a case report

    Directory of Open Access Journals (Sweden)

    Lidder Surjit

    2009-08-01

    Full Text Available Abstract Introduction Dislocation of a prosthetic hip is the second most common complication after thromboembolic disease in patients undergoing total hip arthroplasty, with an incidence reported as 0.5 to 20%. Although the period of greatest risk for dislocation has been reported to be within the first few months after surgery, late dislocation occurs more commonly then previously thought. Case presentation A 60-year-old man underwent a right Exeter cemented total hip replacement and was subsequently discharged after appropriate follow-up. He next presented 8 years later complaining of pain in the left groin. An anterioposterior radiograph of the pelvis revealed degenerative changes in the left hip and a dislocated right total hip replacement. The dislocated femoral component had formed a neoacetabulum within the ilium, in which it was freely articulating. He remained pain-free on this side, had 5 cm of true leg length shortening with a good range of movement and was very pleased with his hip replacement. He was later placed on the waiting list for a left total hip replacement. Conclusion This case illustrates that a dislocated total hip replacement may occasionally not cause symptoms that cause significant discomfort or reduction in range of movement. The prosthetic femoral head can form a neoacetabulum allowing a full range of pain-free movement. Furthermore it emphasises that with an increased trend to earlier hospital discharge and shorter follow-up, potential complications may be missed. We urge a low index of suspicion for potential complications and suggest that regular review with radiographic follow-up should be made.

  1. Cements containing by-product gypsum

    Energy Technology Data Exchange (ETDEWEB)

    Bensted, J. [University of Greenwich, London (United Kingdom). School of Biological and Chemical Sciences

    1995-12-31

    Chemical by-product gypsum can readily replace natural gypsum in Portland cements and in blended cements like Portland pfa cement and Portland blast furnace cement without technical detriment in many instances. Indeed, sometimes the technical performance of the cement can be enhanced. The hydration chemistry is often changed, in that where there is at least some retardation of setting, more AFT phase (ettringite) is formed during early hydration at the expense of calcium silicate hydrates. By-product gypsum can also replace natural gypsum in speciality products like calcium aluminate cement-Portland cement mixes for producing quick setting cements and in calcium sulphoaluminate-type expansive cements. However, by-products gypsum have proved to be less successful for utilization in API Classes of oilwell cements, because of the greater difficulty in obtaining batch-to-batch consistency in properties like thickening time and slurry rheology. 11 refs., 3 figs., 5 tabs.

  2. Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study

    Directory of Open Access Journals (Sweden)

    Logoluso Nicola

    2011-05-01

    Full Text Available Abstract Background Outcome data on two-stage revision surgery for deep infection after septic hip arthritis are limited and inconsistent. This study presents the medium-term results of a new, standardized two-stage arthroplasty with preformed hip spacers and cementless implants in a consecutive series of adult patients with septic arthritis of the hip treated according to a same protocol. Methods Nineteen patients (20 hips were enrolled in this prospective, non-randomized cohort study between 2000 and 2008. The first stage comprised femoral head resection, debridement, and insertion of a preformed, commercially available, antibiotic-loaded cement hip spacer. After eradication of infection, a cementless total hip arthroplasty was implanted in the second stage. Patients were assessed for infection recurrence, pain (visual analog scale [VAS] and hip joint function (Harris Hip score. Results The mean time between first diagnosis of infection and revision surgery was 5.8 ± 9.0 months; the average duration of follow up was 56.6 (range, 24 - 104 months; all 20 hips were successfully converted to prosthesis an average 22 ± 5.1 weeks after spacer implantation. Reinfection after total hip joint replacement occurred in 1 patient. The mean VAS pain score improved from 48 (range, 35 - 84 pre-operatively to 18 (range, 0 - 38 prior to spacer removal and to 8 (range, 0 - 15 at the last follow-up assessment after prosthesis implantation. The average Harris Hip score improved from 27.5 before surgery to 61.8 between the two stages to 92.3 at the final follow-up assessment. Conclusions Satisfactory outcomes can be obtained with two-stage revision hip arthroplasty using preformed spacers and cementless implants for prosthetic hip joint infections of various etiologies.

  3. Analysis of the installation of acetabulum of total hip resurfacing arthroplasty in surgery of developmental ysplasia of hip%髋关节骨性关节炎及髋臼发育不良对髋关节表面置换术中髋臼安装角度的影响

    Institute of Scientific and Technical Information of China (English)

    赵赞栋; 王健; 肖军; 兰天; 李郅涵; 卢坤; 周亚鹏; 史占军

    2011-01-01

    [ Objective] To observe the early clinical result and the location and angle of acetabulum of the total hip resurfacing arthroplasty (THRA) in surgery of osteoarthritis of hip and developmental dysplasia of hip (DDH) . [ Method ] A retrospective study was carried out in twenty patients (twenty - three hips) dealt with THRA from 2006 to 2009, including ten cases of osteoarthritis and thirteen cases of DDH. All patients were implanted with metal - on - metal prostheses of large diameter. Femoral head was fixed with cement and the acetabular cup was biologically fixed. [ Result] Totally twenty - three cases received the follow -up ,with an average 24 months(6 -36months)after discharge. There was no significantly statistical difference between the two groups in the Harris score. However, there were numerous disparities between the two groups in the anatomy parameter of acetabular prosthesis. In group of osteoarthritis, the average acetabular cup abduction angle was 43.9° ± 19.9° (25.6° ~ 56.0° ) and the average acetabular fraction of coverage was 95. 8%. In group of DDH,the average acetabular cup abduction angle was 46.8° ± 12.9° (22.4° -69.3°) and the average acetabular fraction of coverage was 84.3%. No complications such as dislocation or fracture were found. [ Conclusion]There is no statistical difference in the early clinical result of THRA between osteoarthritis and DDH. Meanwhile, because of the mismatching of the acetabular cup components due to malformation of acetabulum in DDH, it is more difficult to install the acetabulum prosthesis in a good angle and location.%[目的]研究全髋关节表面置换术中,单纯骨性关节炎及髋关节发育不良对髋臼安装角度的影响及两组病例疗效比较.[方法]自2006~2009年,本科共实施全髋表面关节置换术20例23髋,病因包括单纯骨性关节炎10髋及髋关节发育不良13髋.手术假体均采用金属对金属大直径表面置换假体,股骨侧骨水泥固定,髋臼

  4. Fatigue crack growth rate does not depend on mantle thickness: an idealized cemented stem construct under torsional loading.

    Science.gov (United States)

    Hertzler, Justin; Miller, Mark A; Mann, Kenneth A

    2002-07-01

    Retrieval studies indicate that cemented stem loosening in femoral components of total hip replacement can initiate at the stem-cement interface. The etiology of the crack propagation process from the stem-cement interface is not well understood, but cracks are typically associated with thin cement mantles. In this study, a combination of experimental and computational methods was used to investigate the fatigue crack propagation process from the stem-PMMA cement interface using a novel torsional loading model. Constructs with thin (1 mm), medium (3 mm) or thick (7 mm) cement mantles were evaluated. Crack growth was stable for all cases and the rate of crack growth diminished with increasing crack length. Crack growth rate did not depend on mantle thickness (p > 0.05) over the first 1 mm of crack length, but cracks in thin mantles reached the full thickness of the mantle in the fewest number of loading cycles. The fracture mechanics-based finite element models indicated decreased stress intensity factors with increasing crack length and were consistent with the experimental findings. When combined with a fatigue crack growth Paris-law for PMMA cement, the finite element models provided reasonable predictions of the crack growth process.

  5. Abstract: Lightweight Authentication for HIP

    Science.gov (United States)

    Heer, Tobias

    In recent years numerous solutions for overcoming the architectural constraints of the Internet have emerged. One of the most promising among them is the Host Identity Protocol (HIP) [2], which was recently approved as an experimental standard by the IETF. HIP adds an additional protocol layer between TCP and IP to implement the Identifier/Locator split. Apart from mobility and multihoming, HIP supports host authentication, payload encryption, and a cryptographic namespace without requiring changes to the network infrastructure or network applications. However, especially mobile devices with tightly limited CPU resources are slowed down by HIP. Its poor performance on these mobile devices is a result of the extensive use of public-key (PK) cryptography for securing the main protocol functions.

  6. Monoarticular Hip Involvement in Pseudogout

    Directory of Open Access Journals (Sweden)

    Figen Kocyigit

    2015-01-01

    Full Text Available Pseudogout is the acutest form of arthritis in the elderly. Although clinical manifestations vary widely, polyarticular involvement is typical mimicking osteoarthritis or rheumatoid arthritis. Monoarticular involvement is relatively rare and is generally provoked by another medical condition. There are reported cases of hip involvement by pseudogout in monoarticular form. However, all of the cases were presented as septic arthritis. In this report, we present a case of monoarticular hip involvement mimicking soft tissue abscess. We confirmed the pseudogout diagnosis after ultrasonographic evaluation of the involved hip joint and pathological and biochemical analysis of synovial fluid analysis. Diagnosis is important to avoid unnecessary medical and surgical treatment in cases of the bizarre involvement of hip in pseudogout.

  7. Hip: Anatomy and US technique

    OpenAIRE

    2011-01-01

    Ultrasound (US) has always had a relatively limited role in the evaluation of the hip due to the deep location of this joint. However, many hip diseases are well detectable at US, but before approaching such a study it is necessary to be thoroughly familiar with the normal anatomy and related US images. The study technique is particularly important as optimization of various parameters is required, such as probe frequency, focalization, positioning of the probe, etc. Also the patient’s positi...

  8. Conversion of hip arthrodesis to total hip arthroplasty.

    Science.gov (United States)

    Panagiotopoulos, K P; Robbins, G M; Masri, B A; Duncan, C P

    2001-01-01

    With the predictably good outcome now found with THA, hip arthrodesis has limited indications today. The procedure still has a role in the case of the young, heavy demand male with an isolated arthritic hip condition, and developments such as the Cobra head plate have considerably improved success rates. However, a long-term hip arthrodesis can have profound effects on a patient's daily function and activities of daily living. In addition, gait pattern is considerably affected as well as other joints such as the lower back, ipsilateral knee, and contralateral hip. Many patients with a hip arthrodesis will eventually require a takedown of the fused hip and conversion to a THA. The primary indications include fusion in malposition, pseudarthrosis, or severe pain in other joints. The surgeon undertaking such a task must be familiar with the arthrodesis techniques that have been used in the past as well as the equipment that may be required to extract the fixation hardware. Clinical assessment with particular attention to leg-length discrepancy, position of the arthrodesis, and function of the abductors is of paramount importance. The surgeon must carefully review preoperative radiographs to plan the procedure. The surgeon must also be aware of the presence of pathology in other joints. After takedown of a hip arthrodesis and conversion to a THA, patients cannot expect the result to equal the success rates of primary THA. Patients generally can expect an improvement in function and mobility. Back pain and ipsilateral knee pain are usually improved postoperatively, but the effect on contralateral hip pain is less predictable. Many patients will continue to show a positive Trendelenburg sign, but further improvement in strength of the hip abductors can be expected with time. Leg-length discrepancy is generally improved substantially after THA. However, a substantial number of patients will require a walking aid postoperatively. Overall, the risk of complications and the

  9. Total hip replacement for the treatment of end stage arthritis of the hip: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Alexander Tsertsvadze

    Full Text Available Evolvements in the design, fixation methods, size, and bearing surface of implants for total hip replacement (THR have led to a variety of options for healthcare professionals to consider. The need to determine the most optimal combinations of THR implant is warranted. This systematic review evaluated the clinical effectiveness of different types of THR used for the treatment of end stage arthritis of the hip.A comprehensive literature search was undertaken in major health databases. Randomised controlled trials (RCTs and systematic reviews published from 2008 onwards comparing different types of primary THR in patients with end stage arthritis of the hip were included.Fourteen RCTs and five systematic reviews were included. Patients experienced significant post-THR improvements in Harris Hip scores, but this did not differ between impact types. There was a reduced risk of implant dislocation after receiving a larger femoral head size (36 mm vs. 28 mm; RR = 0.17, 95% CI: 0.04, 0.78 or cemented cup (vs. cementless cup; pooled odds ratio: 0.34, 95% CI: 0.13, 0.89. Recipients of cross-linked vs. conventional polyethylene cup liners experienced reduced femoral head penetration and revision. There was no impact of femoral stem fixation and cup shell design on implant survival rates. Evidence on mortality and complications (aseptic loosening, femoral fracture was inconclusive.The majority of evidence was inconclusive due to poor reporting, missing data, or uncertainty in treatment estimates. The findings warrant cautious interpretation given the risk of bias (blinding, attrition, methodological limitations (small sample size, low event counts, short follow-up, and poor reporting. Long-term pragmatic RCTs are needed to allow for more definitive conclusions. Authors are encouraged to specify the minimal clinically important difference and power calculation for their primary outcome(s as well CONSORT, PRISMA and STROBE guidelines to ensure better

  10. Gait analysis, bone and muscle density assessment for patients undergoing total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Benedikt Magnússon

    2012-12-01

    Full Text Available Total hip arthroplasty (THA is performed with or without the use of bone cement. Facing the lack of reliable clinical guidelines on decision making whether a patient should receive THA with or without bone cement, a joint clinical and engineering approach is proposed here with the objective to assess patient recovery developing monitoring techniques based on gait analysis, measurements of bone mineral density and structural and functional changes of quadriceps muscles. A clinical trial was conducted with 36 volunteer patients that were undergoing THA surgery for the first time: 18 receiving cemented implant and 18 receiving non-cemented implant. The patients are scanned with Computer Tomographic (CT modality prior-, immediately- and 12 months post-surgery. The CT data are further processed to segment muscles and bones for calculating bone mineral density (BMD. Quadriceps muscle density Hounsfield (HU based value is calculated from the segmented file on healthy and operated leg before and after THA surgery. Furthermore clinical assessment is performed using gait analysis technologies such as a sensing carpet, wireless electrodes and video. Patients undergo these measurements prior-, 6 weeks post - and 52 weeks post-surgery. The preliminary results indicate computational tools and methods that are able to quantitatively analyze patient’s condition pre and post-surgery: The spatial parameters such as step length and stride length increase 6 weeks post op in the patient group receiving cemented implant while the angle in the toe in/out parameter decrease in both patient groups.

  11. Alternative Fuels in Cement Production

    DEFF Research Database (Denmark)

    Larsen, Morten Boberg

    for the most significant alternative fuel energy contributors in the German cement industry. Solid alternative fuels are typically high in volatile content and they may differ significantly in physical and chemical properties compared to traditional solid fossil fuels. From the process point of view......The substitution of alternative for fossil fuels in cement production has increased significantly in the last decade. Of these new alternative fuels, solid state fuels presently account for the largest part, and in particular, meat and bone meal, plastics and tyre derived fuels (TDF) accounted......, considering a modern kiln system for cement production, the use of alternative fuels mainly influences 1) kiln process stability (may accelerate build up of blockages preventing gas and/or solids flow), 2) cement clinker quality, 3) emissions, and 4) decreased production capacity. Kiln process stability...

  12. Magnesium substitution in brushite cements.

    Science.gov (United States)

    Alkhraisat, Mohammad Hamdan; Cabrejos-Azama, Jatsue; Rodríguez, Carmen Rueda; Jerez, Luis Blanco; Cabarcos, Enrique López

    2013-01-01

    The use of magnesium-doped ceramics has been described to modify brushite cements and improve their biological behavior. However, few studies have analyzed the efficiency of this approach to induce magnesium substitution in brushite crystals. Mg-doped ceramics composed of Mg-substituted β-TCP, stanfieldite and/or farringtonite were reacted with primary monocalcium phosphate (MCP) in the presence of water. The cement setting reaction has resulted in the formation of brushite and newberyite within the cement matrix. Interestingly, the combination of SAED and EDX analyses of single crystal has indicated the occurrence of magnesium substitution within brushite crystals. Moreover, the effect of magnesium ions on the structure, and mechanical and setting properties of the new cements was characterized as well as the release of Ca(2+) and Mg(2+) ions. Further research would enhance the efficiency of the system to incorporate larger amounts of magnesium ions within brushite crystals.

  13. Portland cement-blast furnace slag blends in oilwell cementing applications

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, D.T.; DiLullo, G.; Hibbeler, J. [and others

    1995-12-31

    Recent investigations of blast furnace slag cementing technologies. have been expanded to include Portland cement/blast furnace slag blends. Mixtures of Portland cement and blast furnace slag, while having a long history of use in the construction industry, have not been used extensively in oilwell cementing applications. Test results indicate that blending blast furnace slag with Portland cement produces a high quality well cementing material. Presented are the design guidelines and laboratory test data relative to mixtures of blast furnace slag and Portland cements. Case histories delineating the use of blast furnace slag - Portland cement blends infield applications are also included.

  14. CURBSIDE CONSULTATION IN HIP ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    Scott M. Sporer

    2009-03-01

    Full Text Available DESCRIPTION A user friendly reference for decision making in hip arthroplasty designed in a question formed clinical problem scenarios and answers format .The articles composed of the answers, containing current concepts and preferences of experts in primary and revision hip surgery are enhanced by several images, diagrams and references and written in the form of a curbside consultation by Scott M. Sporer, MD. and his collaborators. PURPOSE By this practical reference of hip arthroplasty, Scott M. Sporer, MD. and the contributors have aimed providing the reader practical and clinically relevant information, evidence-based advices, their preferences and opinions containing current concepts for difficult and controversial clinical situations in total hip replacement surgery which are often not addressed clearly in traditional references. FEATURES The book is composed of 9 sections and 49 articles each written by a different expert designed in a question and answers format including several images and diagrams and also essential references at the end of each article. In the first section preoperative questions is subjected. Second section is about preoperative acetabulum questions. Third section is about preoperative femur questions. Fourth section is about intraoperative questions. Intraoperative acetabulum question is subjected in the fifth section and the intraoperative femur questions in the sixth section. The seventh section is about postoperative questions. Eighth and ninth sections are about general questions about failure and failure of acetabulum in turn. AUDIENCE Mainly practicing orthopedic surgeons, fellows and residents who are interested in hip arthroplasty have been targeted but several carefully designed scenarios of controversial and difficult situations surrounding total hip replacement surgery and the current information will also be welcomed by experienced clinicians practicing in hip arthroplasty. ASSESSMENT Scott M. Sporer

  15. Calcium Orthophosphate Cements and Concretes

    Directory of Open Access Journals (Sweden)

    Sergey V. Dorozhkin

    2009-03-01

    Full Text Available In early 1980s, researchers discovered self-setting calcium orthophosphate cements, which are a bioactive and biodegradable grafting material in the form of a powder and a liquid. Both phases form after mixing a viscous paste that after being implanted, sets and hardens within the body as either a non-stoichiometric calcium deficient hydroxyapatite (CDHA or brushite, sometimes blended with unreacted particles and other phases. As both CDHA and brushite are remarkably biocompartible and bioresorbable (therefore, in vivo they can be replaced with newly forming bone, calcium orthophosphate cements represent a good correction technique for non-weight-bearing bone fractures or defects and appear to be very promising materials for bone grafting applications. Besides, these cements possess an excellent osteoconductivity, molding capabilities and easy manipulation. Furthermore, reinforced cement formulations are available, which in a certain sense might be described as calcium orthophosphate concretes. The concepts established by calcium orthophosphate cement pioneers in the early 1980s were used as a platform to initiate a new generation of bone substitute materials for commercialization. Since then, advances have been made in the composition, performance and manufacturing; several beneficial formulations have already been introduced as a result. Many other compositions are in experimental stages. In this review, an insight into calcium orthophosphate cements and concretes, as excellent biomaterials suitable for both dental and bone grafting application, has been provided.

  16. Low-friction arthroplasty with Boneloc bone-cement: outcome at 2 to 4 years.

    Science.gov (United States)

    Walczak, J P; D'Arcy, J C; Ross, K R; James, S E; Bonnici, A V; Koka, S R; Morris, R W

    2000-02-01

    We report the clinical and radiologic outcome of 109 Chamley low-friction arthroplasties implanted with Boneloc bone-cement (Biomet, Bridgend, South Wales, UK) into 104 patients. The mean follow-up was 30 months (range, 2-48 months). There were 72 women (mean age, 71 years) and 32 men (mean age, 72). Cartridge-packed cement was used in 37 cases and vacuum-packed cement in 72 cases. Survivorship analysis based on revision for aseptic loosening showed 79% survival at 4 years. Seventeen (15.5%) hips have been revised for aseptic loosening to date, in which all stems and 4 cups were loose. Extensive femoral osteolysis was always present and resulted in 4 cases of femoral cortical perforation at revision. Survivorship analysis based on revision and radiologic failure showed only 55% survival over the same period. When radiologic loosenings were included as failures, the vacuum-packed cement performed significantly worse than the cartridge-packed cement it replaced. These poor results were consistent with the withdrawal of Boneloc from clinical use in 1995, and we recommend indefinite follow-up for surviving prostheses.

  17. Osteochondritis Dissecans of the Hip

    Energy Technology Data Exchange (ETDEWEB)

    Linden, B. [Hoeglands Hospital, Eksjoe (Sweden). Dept. of Orthopedic Surgery; Jonsson, K. [Univ. Hospital, Lund (Sweden). Center for Medical Imaging and Physiology; Redlund-Johnell, I. [Univ. Hospital, Malmoe (Sweden). Dept. of Diagnostic Radiology

    2003-03-01

    Purpose: To investigate the clinical and radiological characteristics of osteochondritis dissecans (OD) of the hip and the outcome of this condition after treatment. Material and Methods: Twelve male and 3 female patients with OD were retrospectively studied. Six patients had a history of Legg-Calve-Perthes disease (LCPD) and among them 2 also had had a trauma to the hip. A further 5 had had trauma and 1 a developmental dislocation of the hip (DDH). The remaining 3 patients had no history of previous hip disease or trauma. All patients were examined with plain radiography, 7 with MR, 3 with CT and 2 with hip arthrography. Results: All OD lesions were detected at plain radiography, and most of them were located near the fovea. At MR the lesions had low signal intensity at T1-weighted sequences, and 6/7 had edema or fluid collection in or adjacent to the lesion on T2-weighted sequences. The early treatment in 7 patients was surgery, 2 had had conservative treatment and 6 no treatment. At follow-up 12 years after radiological diagnosis, 5 patients had hip arthrosis, 4 of whom were treated with arthroplasty. All but 3 had reduced hip rotation and all but 2 (with arthroplasty) had load pain. Three of the patients with earlier surgery had not developed arthrosis. Conclusions: OD lesions are usually well seen with plain radiography. There is a great risk of developing early arthrosis and it seems that early surgery is connected with arthrosis development. Thus only symptomatic treatment is recommended.

  18. Low pH Cements

    Energy Technology Data Exchange (ETDEWEB)

    Savage, David; Benbow, Steven [Quintessa Ltd., Henley-on-Thames (United Kingdom)

    2007-05-15

    The development of low-pH cements for use in geological repositories for radioactive waste stems from concerns over the potential for deleterious effects upon the host rock and other EBS materials (notably bentonite) under the hyperalkaline conditions (pH > 12) of cement pore fluids. Low pH cement (also known as low heat cement) was developed by the cement industry for use where large masses of cement (e.g. dams) could cause problems regarding heat generated during curing. In low pH cements, the amount of cement is reduced by substitution of materials such as fly ash, blast furnace slag, silica fume, and/or non-pozzolanic silica flour. SKB and Posiva have ruled out the use of blast furnace slag and fly-ash and are focusing on silica fume as a blending agent. Currently, no preferred composition has been identified by these agencies. SKB and Posiva have defined a pH limit {<=} 11 for cement grout leachates. To attain this pH, blending agents must comprise at least 50 wt % of dry materials. Because low pH cement has little, or no free portlandite, the cement consists predominantly of calcium silicate hydrate (CSH) gel with a Ca/Si ratio {<=} 0.8. Although there are potential implications for the performance of the spent fuel and cladding due to the presence of hyperalkaline fluids from cement, the principal focus for safety assessment lies with the behaviour of bentonite. There are a number of potential constraints on the interaction of hyperalkaline cement pore fluids with bentonite, including mass balance, thermodynamic issues, mass transport, and kinetics, but none of these is likely to be limiting if conventional OPC cements are employed in repository construction. Nevertheless: Low-pH cements may supply approximately 50 % less hydroxyl ions than conventional OPC for a given volume of cement, but mass balance constraints are complicated by the uncertainty concerning the type of secondary minerals produced during cement-bentonite interaction. The change of aqueous

  19. Low pH Cements

    Energy Technology Data Exchange (ETDEWEB)

    Savage, David; Benbow, Steven [Quintessa Ltd., Henley-on-Thames (United Kingdom)

    2007-05-15

    The development of low-pH cements for use in geological repositories for radioactive waste stems from concerns over the potential for deleterious effects upon the host rock and other EBS materials (notably bentonite) under the hyperalkaline conditions (pH > 12) of cement pore fluids. Low pH cement (also known as low heat cement) was developed by the cement industry for use where large masses of cement (e.g. dams) could cause problems regarding heat generated during curing. In low pH cements, the amount of cement is reduced by substitution of materials such as fly ash, blast furnace slag, silica fume, and/or non-pozzolanic silica flour. SKB and Posiva have ruled out the use of blast furnace slag and fly-ash and are focusing on silica fume as a blending agent. Currently, no preferred composition has been identified by these agencies. SKB and Posiva have defined a pH limit {<=} 11 for cement grout leachates. To attain this pH, blending agents must comprise at least 50 wt % of dry materials. Because low pH cement has little, or no free portlandite, the cement consists predominantly of calcium silicate hydrate (CSH) gel with a Ca/Si ratio {<=} 0.8. Although there are potential implications for the performance of the spent fuel and cladding due to the presence of hyperalkaline fluids from cement, the principal focus for safety assessment lies with the behaviour of bentonite. There are a number of potential constraints on the interaction of hyperalkaline cement pore fluids with bentonite, including mass balance, thermodynamic issues, mass transport, and kinetics, but none of these is likely to be limiting if conventional OPC cements are employed in repository construction. Nevertheless: Low-pH cements may supply approximately 50 % less hydroxyl ions than conventional OPC for a given volume of cement, but mass balance constraints are complicated by the uncertainty concerning the type of secondary minerals produced during cement-bentonite interaction. The change of aqueous

  20. 21 CFR 888.3027 - Polymethylmethacrylate (PMMA) bone cement.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Polymethylmethacrylate (PMMA) bone cement. 888... Polymethylmethacrylate (PMMA) bone cement. (a) Identification. Polymethylmethacrylate (PMMA) bone cement is a device...: Polymethylmethacrylate (PMMA) Bone Cement.”...

  1. Emerging topics on the hip: Ligamentum teres and hip microinstability

    Energy Technology Data Exchange (ETDEWEB)

    Cerezal, Luis, E-mail: lcerezal@gmail.com [Diagnóstico Médico Cantabria, C/Castilla 6, 39002 Santander (Spain); Arnaiz, Javier; Canga, Ana; Piedra, Tatiana [Valdecilla University Hospital, 39011 Santander (Spain); Altónaga, José R. [Leon University, 24071 Leon (Spain); Munafo, Ricardo [CETEA, Buenos Aires (Argentina); Pérez-Carro, Luis [Valdecilla University Hospital, 39011 Santander (Spain)

    2012-12-15

    Microinstability and ligament teres lesions are emergent topics on the hip pathology. These entities are an increasingly recognized cause of persistent hip pain and should be considered in the differential diagnosis of the patient with hip pain. Conventional (non-arthrographic) CT and MR have a very limited role in the evaluation of these entities. CTa and MRa have emerged as the modalities of choice for pre-operative imaging of ligamentum teres injuries and microinstability. To date, pre-operative imaging detection of these pathologies is not widespread but with appropriate imaging and a high index of suspicion, preoperative detection should improve. This article discusses current concepts regarding anatomy, biomechanics, clinical findings, diagnosis and treatment of ligament teres lesions and microinstability.

  2. The economics of using prophylactic antibiotic-loaded bone cement in total knee replacement.

    Science.gov (United States)

    Gutowski, C J; Zmistowski, B M; Clyde, C T; Parvizi, J

    2014-01-01

    The rate of peri-prosthetic infection following total joint replacement continues to rise, and attempts to curb this trend have included the use of antibiotic-loaded bone cement at the time of primary surgery. We have investigated the clinical- and cost-effectiveness of the use of antibiotic-loaded cement for primary total knee replacement (TKR) by comparing the rate of infection in 3048 TKRs performed without loaded cement over a three-year period versus the incidence of infection after 4830 TKRs performed with tobramycin-loaded cement over a later period of time of a similar duration. In order to adjust for confounding factors, the rate of infection in 3347 and 4702 uncemented total hip replacements (THR) performed during the same time periods, respectively, was also examined. There were no significant differences in the characteristics of the patients in the different cohorts. The absolute rate of infection increased when antibiotic-loaded cement was used in TKR. However, this rate of increase was less than the rate of increase in infection following uncemented THR during the same period. If the rise in the rate of infection observed in THR were extrapolated to the TKR cohort, 18 additional cases of infection would have been expected to occur in the cohort receiving antibiotic-loaded cement, compared with the number observed. Depending on the type of antibiotic-loaded cement that is used, its cost in all primary TKRs ranges between USD $2112.72 and USD $112 606.67 per case of infection that is prevented.

  3. Cementation of Loose Sand Particles based on Bio-cement

    Institute of Scientific and Technical Information of China (English)

    RONG Hui; QIAN Chunxiang

    2014-01-01

    Loose sand particles could be cemented to sandstone by bio-cement (microbial induced magnesium carbonate). The bio-sandstone was firstly prepared, and then the compressive strength and the porosity of the sandstone cemented by microbial induced magnesium carbonate were tested to characterize the cementation effectiveness. In addition, the formed mineral composition and the microstructure of bio-sandstone were analyzed by X-ray diffraction (XRD) and scanning electron microscopy (SEM), respectively. The experimental results show that the feasibility of binding loose sand particles using microbial induced magnesium carbonate precipitation is available and the acquired compressive strength of bio-sandstone can be excellent at certain ages. Moreover, the compressive strength and the porosity could be improved with the increase of microbial induced magnesium carbonate content. XRD results indicate that the morphology of magnesium carbonate induced by microbe appears as needles and SEM results show that the cementation of loose sand particles to sandstone mainly relies on the microbial induced formation of magnesium carbonate precipitation around individual particles and at particle-particle contacts.

  4. Developmental dysplasia of the hip

    Directory of Open Access Journals (Sweden)

    Shahryar Noordin

    2010-10-01

    Full Text Available Developmental dysplasia of the hip (DDH is a spectrum of anatomical abnormalities of the hip joint in which the femoral head has an abnormal relationship with the acetabulum. Most studies report an incidence of 1 to 34 cases per 1,000 live births and differences could be due to different diagnostic methods and timing of evaluation. Risk factors include first born status, female sex, positive family history, breech presentation and oligohydramnios. Clinical presentations of DDH depend on the age of the child. Newborns present with hip instability, infants have limited hip abduction on examination, and older children and adolescents present with limping, joint pain, and/or osteoarthritis. Repeated, careful examination of all infants from birth and throughout the first year of life until the child begins walking is important to prevent late cases. Provocative testing includes the Barlow and Ortolani maneuvers. Other signs, such as shorting of the femur with hips and knees flexed (Galeazzi sign, asymmetry of the thigh or gluteal folds, and discrepancy of leg lengths are potential clues. Treatment depends on age at presentation and outcomes are much better when the child is treated early, particularly during the first six months of life.

  5. 金属对金属髋关节表面置换术治疗强直性脊柱炎的临床研究%The short-term outcome of metal-on-metal hip resurfacing arthroplasty for ankylosing spondylitis

    Institute of Scientific and Technical Information of China (English)

    迮仁浩; 杨述华; 许伟华; 叶树楠; 雷鸣; 范李

    2010-01-01

    目的 探讨金属对金属(MOM)髋关节表面置换术治疗强直性脊柱炎(AS)的早期临床疗效.方法 对18例AS累及髋关节患者(23髋)行MOM髋关节表面置换术,术后定期随访,比较手术前后Harris评分、UCLA活动评分和影像学变化.结果 术后平均随访20个月(6~36个月),Harris评分由术前(44±7)分上升到术后(89±6)分,UCLA活动评分由术前(2.4±1.15)分上升到术后(6.5±0.5)分,无感染、关节脱位、深静脉血栓形成、神经损伤和假体周围骨折等并发症的发生,术后X线检查假体无松动和移位.结论 MOM髋关节表面置换术治疗AS能够明显缓解患者症状,改善关节功能.

  6. 金属对金属髋关节表面置换术两种不同手术入路中假体位置的X线测量比较%Comparison of radiographic measurements of metal-on-metal hip resurfacing arthroplasty in two different approaches

    Institute of Scientific and Technical Information of China (English)

    李奇; Urban Rydholm; Uldis Kerteris; Gunna Flivik; Jian-Sheng Wang; 林荔军; 靳安民

    2006-01-01

    [目的]了解外侧入路和后外侧入路两种不同入路中髋关节表面置换中假体位置的差异.[方法]72个关节中,分为两组:A组21例病人,共26个髋关节,采用Hardinge的外侧入路.B组44例,共46个髋关节,采用改良的Gibson入路,股骨头由关节后方脱出.测量的指标包括:(1)术前颈干角和术后股骨假体柄干角;(2)髋臼假体的外展角;(3)股骨假体的中心偏移距;(4)术前髋臼前倾角和术后髋臼假体前倾角;(5)股骨假体侧方中心偏移距;(6)股骨假体的侧方偏移角.[结果]股骨假体的柄干角A组为139.5°,B组为140.5°,2种入路间的柄干角无显著性差异;髋臼假体的外展角A组为37.7°,B组为44.4°;前倾角A组为21.6°,B组为15.2°.[结论]髋关节表面置换可以采用外侧入路和后外侧入路,股骨假体安放位置在两种入路中差别不大,但在髋臼假体安放时,相差显著.与后外侧入路比较,外侧入路中,髋臼假体的外展角较小,但前倾角较大.

  7. Short-term clinical outcomes of metal-on-metal hip resurfacing in osteonecrosis of the femoral head%金属对金属髋关节表面置换术治疗重度股骨头无菌性坏死的短期临床效果

    Institute of Scientific and Technical Information of China (English)

    李甲; 徐卫东

    2008-01-01

    目的 探讨新一代的金属对金属髋关节表面置换术治疗重度股骨头无菌性坏死(Ficat Ⅲ、Ⅳ)的短期临床效果.方法 对28例(33髋)诊断为股骨头无菌性坏死的患者行金属对金属髋关节表面置换手术.股骨头无菌性坏死程度按照Ficat分期:Ⅲ期24例(27髋),Ⅳ期4例(6髋),手术时的平均年龄是48岁(21~77岁),其中男患者17例(60.7%),女患者11例(39.3%).术后随访内容包括所有患者的临床及影像学资料.结果 平均随访时间为24个月(11~35个月),在随访期内未发生髋关节脱位、深静脉栓塞、感染、股骨颈骨折等并发症.临床结果显示,Harris髋关节评分较术前显著提高,术后平均Harris评分为92.6分,术前平均Harris评分为48.5分.影像学资料显示所有假体在位,未观察到放射性透亮带.所有患者疼痛解除,髋关节活动度也明显改善,术后早期活动无任何受限.结论 金属对金属髋关节表面置换术治疗重度股骨头坏死的早期临床效果满意,其远期效果仍有待于观察.

  8. Developmental hip dysplasia in adolescence

    Directory of Open Access Journals (Sweden)

    Vukašinović Zoran

    2009-01-01

    Full Text Available The authors define adolescence and developmental dysplasia of the hip (DDH. Special attention is paid to pathological findings characteristic of DDH in adolescence (unrecognized and untreated DDH; treated DDH, but non-terminated treatment; DDH diagnosed with delay, inadequately treated, with complications. The authors emphasise that DDH treatment has to be successfully terminated well before the adolescence; possibilities are explained on management modes at the time of adolescence, and possible persons guilty for the persistence of later hip problems are indicated. Based on the authors' experience and having in mind all surgical possibilities for the treatment (pelvic osteotomies, femoral osteotomies, trochanteroplasties, leg length equalization procedures the authors propose treatment protocols. The intention is to provide better treatment results and to prevent secondary hip arthrosis. Furthermore, how to improve the struggle against DDH is suggested.

  9. Radiology of the resurfaced hip

    Energy Technology Data Exchange (ETDEWEB)

    Rahman, Luthfur [The London Hip Unit, London (United Kingdom); Hall-Craggs, Margaret [University College London Hospital, London (United Kingdom); Muirhead-Allwood, Sarah K. [The London Hip Unit, London (United Kingdom); The Royal National Orthopaedic Hospital, Middlesex (United Kingdom)

    2011-07-15

    Hip resurfacing arthroplasty is an increasingly common procedure for osteoarthritis. Conventional radiographs are used routinely for follow-up assessment, however they only provide limited information on the radiological outcome. Various complications have been reported in the scientific literature although not all are fully understood. In an effort to investigate problematic or failing hip resurfacings, various radiological methods have been utilized. These methods can be used to help make a diagnosis and guide management. This paper aims to review and illustrate the radiographic findings in the form of radiography, computerized tomography (CT), magnetic resonance imaging (MRI), and ultrasound of both normal and abnormal findings in hip resurfacing arthroplasty. However, imaging around a metal prosthesis with CT and MRI is particularly challenging and therefore the potential techniques used to overcome this are discussed. (orig.)

  10. Cementless Hydroxyapatite Coated Hip Prostheses

    Directory of Open Access Journals (Sweden)

    Antonio Herrera

    2015-01-01

    Full Text Available More than twenty years ago, hydroxyapatite (HA, calcium phosphate ceramics, was introduced as a coating for cementless hip prostheses. The choice of this ceramic is due to its composition being similar to organic apatite bone crystals. This ceramic is biocompatible, bioactive, and osteoconductive. These qualities facilitate the primary stability and osseointegration of implants. Our surgical experience includes the implantation of more than 4,000 cementless hydroxyapatite coated hip prostheses since 1990. The models implanted are coated with HA in the acetabulum and in the metaphyseal area of the stem. The results corresponding to survival and stability of implants were very satisfactory in the long-term. From our experience, HA-coated hip implants are a reliable alternative which can achieve long term survival, provided that certain requirements are met: good design selection, sound choice of bearing surfaces based on patient life expectancy, meticulous surgical technique, and indications based on adequate bone quality.

  11. Functional outcome following a large head total hip arthroplasty A retrospective analysis of mid term results

    Directory of Open Access Journals (Sweden)

    Sanjay Agarwala

    2014-01-01

    Conclusion: This study has shown that large head ceramic on ceramic THA is a good alternative to large head metal on metal THA with comparable dislocation rates and range of movements and without complications of metallosis in Asian patients.

  12. Seating load parameters impact on dental ceramic reinforcement conferred by cementation with resin-cements.

    LENUS (Irish Health Repository)

    Addison, Owen

    2010-09-01

    Cementation of all-ceramic restorations with resin-cements has been demonstrated to reduce the incidence of fracture in service. The aim was to investigate the influence of loading force and loading duration applied during cementation on the reinforcement conferred by a resin-cement on a leucite reinforced glass-ceramic.

  13. 76 FR 76760 - Gray Portland Cement and Cement Clinker From Japan

    Science.gov (United States)

    2011-12-08

    ... Portland Cement and Cement Clinker From Japan Determination On the basis of the record \\1\\ developed in the... antidumping duty order on gray Portland cement and cement clinker from Japan would be likely to lead to... the Commission are contained in USITC Publication 4281 (December 2011), entitled Gray Portland...

  14. 21 CFR 888.3400 - Hip joint femoral (hemi-hip) metallic resurfacing prosthesis.

    Science.gov (United States)

    2010-04-01

    ... prosthesis. 888.3400 Section 888.3400 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... femoral (hemi-hip) metallic resurfacing prosthesis. (a) Identification. A hip joint femoral (hemi-hip) metallic resurfacing prosthesis is a device intended to be implanted to replace a portion of the hip...

  15. Hip-Hop发烧友

    Institute of Scientific and Technical Information of China (English)

    文泉; 张鹏

    2005-01-01

    我出生在布朗克斯。我只有三十岁。我一直是争论的焦点。我一年可以赚数十亿美元,而且非常非常红。你知道我是谁吗?我是Hip-Hop。三十年前“hip hop”这个词儿还不存在,如今它已经成为一种几乎难以定义的包罗万象的生活方式。

  16. Antibacterial potential of contemporary dental luting cements.

    Science.gov (United States)

    Daugela, Povilas; Oziunas, Rimantas; Zekonis, Gediminas

    2008-01-01

    The aims of this investigation were to evaluate the antibacterial activities of different types of dental luting cements and to compare antibacterial action during and after setting. Agar diffusion testing was used to evaluate the antibacterial properties of seven types of dental luting cements (glass ionomer cements (GICs), resin modified GICs, resin composite, zinc oxide eugenol, zinc oxide non-eugenol, zinc phosphate, zinc polycarboxylate cements) on Streptococcus mutans bacteria. Instantly mixed zinc phosphate cements showed the strongest antibacterial activity in contrast to the non-eugenol, eugenol and resin cements that did not show any antibacterial effects. Non-hardened glass ionomer, resin modified and zinc polycarboxylate cements exhibited moderate antibacterial action. Hardened cements showed weaker antibacterial activities, than those ones applied right after mixing.

  17. Freezing resistance of high iron phoasphoaluminate cement

    Science.gov (United States)

    Zhang, S. X.; Lu, L. C.; Wang, S. D.; Zhao, P. Q.; Gong, C. C.

    2017-03-01

    The influence of freeze-thaw cycle on the mechanical properties of high iron phoasphoaluminate cement was investigated in the present study. The visual examination was conducted to evaluate the surface damage. The deterioration considering the weight loss, modulus loss of relative dynamic elastic and strength loss of mortar were also investigated. The morphology of hydration products were analysed by SEM. Compared with ordinary Portland cement and sulphoaluminate cement, the frost resistance of high iron phosphoraluminate cement is better. Hydration products of high iron phoasphoaluminate cement contain sheet crystals, and a lot of gel form a dense three-dimensional network structure, which results in a lower porosity. Different from ordinary Portland cement, the hydration product of high iron phoasphoaluminate cement does not contain Ca(OH)2, and low alkalinity reduces its osmotic pressure. The lower porosity and osmotic pressure are the two main reasons which causes in the higher frost resistance of high iron phoasphoaluminate cement.

  18. Ultrasonography of the hip and lower extremity.

    Science.gov (United States)

    Malanga, Gerard A; Dentico, Richard; Halperin, Jonathan S

    2010-08-01

    Musculoskeletal ultrasonographic evaluation of the proximal lower limb includes the evaluation of the soft tissue structures, including tendons, ligaments, or muscles, and the bony structures of this region, include the hip, pubic symphysis, and sacroiliac joints. The evaluation of the hip or proximal lower limb region can be performed in an efficient and systematic manner. Ultrasonography of the lateral hip, intra-articular hip, medial thigh, and posterior thigh are discussed in the article.

  19. Computed tomography in abnormalities of the hip

    Energy Technology Data Exchange (ETDEWEB)

    Visser, J.D.; Jonkers, A.; Klasen, H.J. (Rijksuniversiteit Groningen (Netherlands). Academisch Ziekenhuis); Hillen, B. (Rijksuniversiteit Groningen (Netherlands). Lab. voor Anatomie en Embryologie)

    1982-06-26

    The value of computed tomography in the assessment of abnormalities of the hip is demonstrated with the aid of an anatomical preparation and in patients with, respectively, congenital dislocation of a hip, dislocation of the hip in spina bifida, an acetabular fracture and a Ewing tumour. The anteversion of the acetabulum and femur and the instability index of the hip joint can be measured by means of computed tomography.

  20. On HIP-HOP%HIP-HOP运动论

    Institute of Scientific and Technical Information of China (English)

    王丽娜; 兰健

    2009-01-01

    运用文献资料等方法,从文化社会学的角度对传入我国的HIP-HOP运动的文化背景及其文化表现进行分析.认为:HIP-HOP运动主要包括:街舞、街头篮球、滑板等运动.HIP-HOP运动以其流行的社会文化要素和独特魅力吸引亿万青少年,使其狂热地投入到这股新兴的运动时尚潮流中,影响和改变着青少年的现代生活.HIP-HOP运动创造了一种非冲突性的、娱乐休闲的,以及有理想化价值的身体娱乐体系,有着独有的体育文化功能.

  1. 76 FR 24519 - Gray Portland Cement and Cement Clinker From Japan; Institution of a Five-Year Review Concerning...

    Science.gov (United States)

    2011-05-02

    ... COMMISSION Gray Portland Cement and Cement Clinker From Japan; Institution of a Five-Year Review Concerning the Antidumping Duty Order on Gray Portland Cement and Cement Clinker From Japan AGENCY: United States... determine whether revocation of the antidumping duty order on gray portland cement and cement clinker...

  2. 76 FR 50252 - Gray Portland Cement and Cement Clinker From Japan; Scheduling of an Expedited Five-Year Review...

    Science.gov (United States)

    2011-08-12

    ... COMMISSION Gray Portland Cement and Cement Clinker From Japan; Scheduling of an Expedited Five-Year Review Concerning the Antidumping Duty Order on Gray Portland Cement and Cement Clinker From Japan AGENCY: United... cement and cement clinker from Japan would be likely to lead to continuation or recurrence of...

  3. Subject-specific hip geometry and hip joint centre location affects calculated contact forces at the hip during gait.

    Science.gov (United States)

    Lenaerts, G; Bartels, W; Gelaude, F; Mulier, M; Spaepen, A; Van der Perre, G; Jonkers, I

    2009-06-19

    Hip loading affects the development of hip osteoarthritis, bone remodelling and osseointegration of implants. In this study, we analyzed the effect of subject-specific modelling of hip geometry and hip joint centre (HJC) location on the quantification of hip joint moments, muscle moments and hip contact forces during gait, using musculoskeletal modelling, inverse dynamic analysis and static optimization. For 10 subjects, hip joint moments, muscle moments and hip loading in terms of magnitude and orientation were quantified using three different model types, each including a different amount of subject-specific detail: (1) a generic scaled musculoskeletal model, (2) a generic scaled musculoskeletal model with subject-specific hip geometry (femoral anteversion, neck-length and neck-shaft angle) and (3) a generic scaled musculoskeletal model with subject-specific hip geometry including HJC location. Subject-specific geometry and HJC location were derived from CT. Significant differences were found between the three model types in HJC location, hip flexion-extension moment and inclination angle of the total contact force in the frontal plane. No model agreement was found between the three model types for the calculation of contact forces in terms of magnitude and orientations, and muscle moments. Therefore, we suggest that personalized models with individualized hip joint geometry and HJC location should be used for the quantification of hip loading. For biomechanical analyses aiming to understand modified hip joint loading, and planning hip surgery in patients with osteoarthritis, the amount of subject-specific detail, related to bone geometry and joint centre location in the musculoskeletal models used, needs to be considered.

  4. Total Hip Arthroplasty in Failed Hip Fractures: A Case Series

    Directory of Open Access Journals (Sweden)

    Syed Shahid Noor

    2015-01-01

    Full Text Available Osteoporosis is epidemic in Asian countries. It is a major cause of fractures that orthopaedic surgeons deal in Pakistan, though proper epidemiological data is not available. Habiba U et al found that 75.3% of post menopausal women of Pakistan were predisposed to Osteoporosis; whereas Baig L has described an average T - score of -1.833±0.65 on bone mineral density calculation of post menopausal females of Pakistan. Osteoporotic hip fractures constitute a major cause of elderly mortality worldwide and recent figures supporting the idea that these patients have survival rates comparable to breast and thyroid cancer patients. Pakistan is a developing country with large burden of hip fractures. Patients living in remote areas are the ones which suffer more because of inadequate awareness, fear of surgical treatment and lack of availability of standard treatment. These patients are dealt by surgeons of various expertise and levels of experience. Lack of facilities in hospitals is well known and usage of sub-standard implant is a major cause of failure. Therefore these patients either because of their bone fragility or mal-treatment suffer frequently from failure of hip fracture surgeries. Being in a tertiary care centre we come across these types of cases very frequently. Six to eight such cases present to outpatient department of Liaquat National Hospital every month being referred from every part of the country. These patients may have been operated once, twice or even multiple times. Special attention is required to acquire an informative history from these cases and perform a comprehensive examination. Moreover previous records and radiographs provide invaluable information regarding cause of failure and deciding course of further treatment. We herein discuss few of the cases of failure of hip fractures which were treated by hip arthroplasty.

  5. PERFORMANCE OF PULVERIZED SLAG-SUBSTITUTED CEMENT

    Institute of Scientific and Technical Information of China (English)

    1999-01-01

    The Portland cement is equivalently substituted by slag micropowders with various specific areas. The workability,activity and acid-corrosion resistance of the slag-substituted cements are investigated,the activation of gypsum is discussed,also the porosity and pore distribution of mortars of the slag micropowders cement are determined by mercury intrusion porosimetry.

  6. 21 CFR 872.3275 - Dental cement.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Dental cement. 872.3275 Section 872.3275 Food and... DENTAL DEVICES Prosthetic Devices § 872.3275 Dental cement. (a) Zinc oxide-eugenol—(1) Identification... filling or as a base cement to affix a temporary tooth filling, to affix dental devices such as crowns...

  7. Cementation in adhesive dentistry: the weakest link

    NARCIS (Netherlands)

    Jongsma, L.A.

    2012-01-01

    Het succesvol bevestigen van tandrestauraties is een belangrijke en veeleisende procedure. Met behulp van cement wordt het restauratiemateriaal aan de tandstructuur verbonden. Op die manier worden twee hechtvlakken gecreëerd: het raakvlak tussen tand en cement, en het raakvlak tussen cement en resta

  8. Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study

    OpenAIRE

    Kim, Chan; Nevitt, Michael C.; Niu, Jingbo; Clancy, Mary M; Nancy E Lane; Link, Thomas M.; Vlad, Steven; Tolstykh, Irina; Jungmann, Pia M.; Felson, David T.; Guermazi, Ali

    2015-01-01

    Study question Is there concordance between hip pain and radiographic hip osteoarthritis? Methods In this diagnostic test study, pelvic radiographs were assessed for hip osteoarthritis in two cohorts: the Framingham Osteoarthritis Study (community of Framingham, Massachusetts) and the Osteoarthritis Initiative (a multicenter longitudinal cohort study of osteoarthritis in the United States). Using visual representation of the hip joint, participants reported whether they had hip pain on most d...

  9. ADVANCED CEMENTS FOR GEOTHERMAL WELLS

    Energy Technology Data Exchange (ETDEWEB)

    SUGAMA,T.

    2007-01-01

    Using the conventional well cements consisting of the calcium silicate hydrates (CaO-SiO{sub 2}-H{sub 2}O system) and calcium aluminum silicate hydrates (CaO-Al{sub 2}O{sub 3}-SiO{sub 2}-H{sub 2}O system) for the integrity of geothermal wells, the serious concern confronting the cementing industries was their poor performance in mechanically supporting the metallic well casing pipes and in mitigating the pipe's corrosion in very harsh geothermal reservoirs. These difficulties are particularly acute in two geological regions: One is the deep hot downhole area ({approx} 1700 m depth at temperatures of {approx} 320 C) that contains hyper saline water with high concentrations of CO{sub 2} (> 40,000 ppm) in conjunction with {approx} 100 ppm H{sub 2}S at a mild acid of pH {approx} 5.0; the other is the upper well region between the well's surface and {approx} 1000 m depth at temperatures up to 200 C. The specific environment of the latter region is characterized by highly concentrated H{sub 2}SO{sub 4} (pH < 1.5) brine containing at least 5000 ppm CO{sub 2}. When these conventional cements are emplaced in these harsh environments, their major shortcoming is their susceptibility to reactions with hot CO{sub 2} and H{sub 2}SO4, thereby causing their deterioration brought about by CO{sub 2}-catalyzed carbonation and acid-initiated erosion. Such degradation not only reduced rapidly the strength of cements, lowering the mechanical support of casing pipes, but also increased the extent of permeability of the brine through the cement layer, promoting the rate of the pipe's corrosion. Severely carbonated and acid eroded cements often impaired the integrity of a well in less than one year; in the worst cases, casings have collapsed within three months, leading to the need for costly and time-consuming repairs or redrilling operations. These were the reasons why the geothermal well drilling and cementing industries were concerned about using conventional well

  10. Hip-Hop Pop Art

    Science.gov (United States)

    Talley, Clarence, Sr.

    2011-01-01

    Art has a way of helping students better understand and appreciate the world around them, particularly the things that are most important to them. Hip hop is one of those generational genres that capture the attention of young students like few other things do. Drawing on this genre to get students to create art is an excellent way to demonstrate…

  11. Excess mortality following hip fracture

    DEFF Research Database (Denmark)

    Abrahamsen, B; van Staa, T; Ariely, R;

    2009-01-01

    Summary This systematic literature review has shown that patients experiencing hip fracture after low-impact trauma are at considerable excess risk for death compared with nonhip fracture/community control populations. The increased mortality risk may persist for several years thereafter, highlig...

  12. Improving hip surgery patients’ outcomes:

    DEFF Research Database (Denmark)

    Bagger, Bettan; Poulsen, Dorthe Varning; Taylor Kelly, Hélène;

    2013-01-01

    This presentation focuses upon the improvement of hip surgery patients’ outcomes with respect to health promotion and rehabilitation. The overall aims of the EU financed orthopedic nursing project will be introduced. Speakers highlight the project’s contribution to: -the development of nurse...

  13. A Review of Current Fixation Use and Registry Outcomes in Total Hip Arthroplasty

    DEFF Research Database (Denmark)

    Troelsen, Anders; Malchau, Erik; Sillesen, Nanna Hylleholt

    2013-01-01

    and to analyze age-stratified risk of revision comparing cemented, hybrid, and uncemented fixation as reported by national hip arthroplasty registries. METHODS: Data were extracted from the annual reports of seven national hip arthroplasty registries; we included all national registries for which annual reports...... were available in English or a Scandinavian language, if the registry had a history of more than 5 years of data collection. RESULTS: Current use of uncemented fixation in primary THAs varies between 15% in Sweden and 82% in Canada. From 2006 to 2010 the registries of all countries reported overall...... increases in the use of uncemented fixation; Sweden reported the smallest absolute increase (from 10% to 15%), and Denmark reported the greatest absolute increase (from 47% to 68%). Looking only at the oldest age groups, use of uncemented fixation also was increasing during the period. In the oldest age...

  14. [Influence of implant position of a hip prosthesis on alignment exemplified by the CLS shaft].

    Science.gov (United States)

    Schneider, U; Breusch, S J; Thomsen, M; Wirtz, D C; Lukoschek, M

    2002-01-01

    We performed a clinical and radiological analysis to evaluate the significance of the stem position of cementless CLS components with respect to function and survival. We used patient material from a multi-center study of 3,732 CLS stems with a mean follow-up of 43 months (range: 12-142 months). The clinical outcome was assessed using Merle D'Aubigné Scores and stem alignment was determined as the deviation of the longitudinal stem axis from the longitudinal femur axis. We found no correlation between stem alignment and function, survival, implant migration or periprosthetic radiolucent lines. In patients with rheumatoid arthritis and hip ankylosis the neutral stem position was less often achieved than in patients with other diagnoses. The results of our study cast doubt on whether the varus position of the femoral component of cementless tapered CLS-type stem designs is as critical as in cemented total hip arthroplasty.

  15. Thoughts on the Current Cement Industry Development

    Institute of Scientific and Technical Information of China (English)

    Gan Zhihe

    2003-01-01

    According to the analysis of cement capacity andits relations with macro economy running index, the mainreasons for the present rapid development of cement capacityare the rapid development of economy and the shot up ofwhole society fixed asset investment. According to the presentspeed of economy development, cement still enjoys a po-tential increase, So here has not been an overall excessivepopularity of cement industry. The best way to prevent lowlevel repeated construction is to promote the development ofnew dry- process cement as well as try to get rid of blindness.

  16. Cementless Hip Arthroplasty in Southern Iran, Midterm Outcome and Comparison of Two Designs

    Directory of Open Access Journals (Sweden)

    Gholam Hossein Shahcheraghi

    2015-09-01

    Full Text Available Background: Cementless hip prosthesis was designed to provide biologic fixation, without the use of cement. The second generation components have shown more reliable bone ingrowths and survival rates. We are reporting a midterm result of two designs of cementless prosthesis in a unique culture with different social habits and expectations. Methods: 52 primary cementless total hip arthroplasty in 42 patients with the mean age of 48.8 years were retrospectively studied. Two groups of prosthesis had been implanted: Harris-Galante II (HGII in 15 and Versys-Trilogy (V-T in 37 hips, both from Zimmer company. The patients were assessed clinically, radiographically and with Harris hip score, SF36, WOMAC, and MACTAR questionnaires, with 65 months (26-136 mean follow-up. Results: All the V-T prostheses had survived well. Eight of HG II were revised by the last follow-up in 19-102 months. All had undergone acetabular revision and 2 combined with femoral revision. Broken tines of HGII cups were seen in 4 radiographs. The 65 months overall survival was 96.2% for femoral and 84.6% for acetabular components. 90% had good or excellent Harris hip scores. The functional scores were poorer in the HG II group. Pain relief and improved walking were the two main patients’ expectations fulfilled in 97.6% and 92.8%, respectively. Conclusions: The outcome of cementless total hip arthroplasty (THA is satisfactory and comparable with the literature based on the results of function and survival of this small comparative group. The use of HGII acetabular component should be abandoned.

  17. Techniques and results for open hip preservation

    Directory of Open Access Journals (Sweden)

    David eLevy

    2015-12-01

    Full Text Available While hip arthroscopy grows in popularity, there are still many circumstances under which open hip preservation is most appropriately indicated. This article specifically reviews open hip preservation procedures for a variety of hip conditions. Femoral acetabular impingement may be corrected using an open surgical hip dislocation. Acetabular dysplasia may be corrected using a periacetabular osteotomy. Acetabular protrusio may require surgical hip dislocation with rim trimming and a possible valgus intertrochanteric osteotomy. Legg-Calve ́-Perthes disease produces complex deformities that may be better served with osteotomies of the proximal femur and/ or acetabulum. Chronic slipped capital femoral epiphysis (SCFE may also benefit from a surgical hip dislocation and/or proximal femoral osteotomy.

  18. Hip Imaging in Athletes: Sports Imaging Series.

    Science.gov (United States)

    Agten, Christoph A; Sutter, Reto; Buck, Florian M; Pfirrmann, Christian W A

    2016-08-01

    Hip or groin pain in athletes is common and clinical presentation is often nonspecific. Imaging is a very important diagnostic step in the work-up of athletes with hip pain. This review article provides an overview on hip biomechanics and discusses strategies for hip imaging modalities such as radiography, ultrasonography, computed tomography, and magnetic resonance (MR) imaging (MR arthrography and traction MR arthrography). The authors explain current concepts of femoroacetabular impingement and the problem of high prevalence of cam- and pincer-type morphology in asymptomatic persons. With the main focus on MR imaging, the authors present abnormalities of the hip joint and the surrounding soft tissues that can occur in athletes: intraarticular and extraarticular hip impingement syndromes, labral and cartilage disease, microinstability of the hip, myotendinous injuries, and athletic pubalgia. (©) RSNA, 2016.

  19. 髋关节表面置换术治疗先天性髋关节发育不良%Hip resurfacing arthroplasty for secondary osteoarthrltis after developmental dysplasia of hip

    Institute of Scientific and Technical Information of China (English)

    王琦; 张先龙; 蒋垚; 陈云苏; 沈灏; 邵俊杰

    2008-01-01

    Objective To study the clinical results of metal on metal hip resurfacing arthroplasty for developmental dysplasia patients.Methods From March 2005 to December 2006, 34 eases of developmental dysplasia patients ( Crowe Ⅰ , Crowe Ⅱ ) were attempted to have metal on metal hip resurfacing arthroplasty.There were 29 females (32 hips), 5 males (5 hips).The average age was 45 (26-57 ) years old.Radiographic and clinical evaluations were taken at 6 weeks, 3 months, 1 year and then once a year postoperatively.The average Harris score was 35 (25-44).Hip flexion was 101°, abduction 24°,adduction 15°.Results Three patients were turned to total hip arthroplasty during operations.Thirty-one patients (34 hips) received hip resurfacing surgery. These 31 patients were followed for average 21.4 months (12-33 months).The average Harris score was 94 (82-100) at the latest follow-up, and there was statistical difference compared with the preoperative score ( P < 0.01 ).Hip flexion increased to 133°,abduction to 48°, adduction to 26°.No radiolueency line was found at both acetabular and femoral sides in all the patients.The average abduction angle of acetabular cup was 43°(40°-53°) , and the average stern shaft angle was 139°(130°-145°).Conclusions The short term result is excellent.While the mid to long term results for hip resurfscing arthroplasty in developmental dysplasia patients are still looking forward, and the rneticulous surgical technique and strict patient selection are the key of the good results.%目的 探讨髋关节表面置换术治疗先天性髋关节发育不良的临床疗效.方法 2005年3月至2006年12月对34例(37髋)先天性髋关节发育不良患者行髋关节表面置换术,其中Crowe Ⅰ型28例(31髋)、Crowe Ⅱ型6例(6髋).其中女性29例(32髋),男性5例(5髋),患者平均年龄45岁(26~57岁).患者在术后6周、3个月、1年,及此后每年1次进行随访,接受放射学及临床

  20. Acute fracture of the acetabulum secondary to a convulsive seizure 3 years after total hip arthroplasty.

    Science.gov (United States)

    Atilla, Bulent; Caglar, Omur; Akgun, Rahmi Can

    2008-03-01

    While aseptic loosening, osteolysis, and infection are the most common causes of failure after total hip arthroplasty (THA), late hip pain can also be the result of acetabular fracture related to trauma and resultant prosthetic failure. However, atraumatic fracture of the acetabulum around a well-fixed acetabular component is unusual. We present a patient with an acetabular fracture resulting from a generalized convulsive attack 3 years after an uncomplicated primary THA. A 33-year-old man presented with acute left hip pain. He had chronic renal insufficiency and had undergone bilateral THA due to avascular necrosis. The night prior to his admission, he suffered a generalized convulsive attack with severe extremity contractions. Afterwards, he had acute left groin pain and had difficulty walking. Physical examination revealed moderate left hip pain as well as a 1-cm shortening of the affected limb. Radiological examination demonstrated an acetabular fracture with medial wall comminution. The acetabular component had migrated medially and rotated horizontally. Revision of the acetabular component with a reinforcement ring and implantation of a cemented acetabular component was realized. Severe muscle spasms during generalized seizures are known to lead to various musculoskeletal injuries (fractures of the proximal humerus, femur, acetabulum, and dislocation of the shoulder). Seizures could also lead to acute periprosthetic fracture of the acetabulum in patients with osteopenia. Therefore careful reaming is required to avoid overmedialization of the acetabular component in those patients.

  1. CO2 Capture by Cement Raw Meal

    DEFF Research Database (Denmark)

    Pathi, Sharat Kumar; Lin, Weigang; Illerup, Jytte Boll

    2013-01-01

    The cement industry is one of the major sources of CO2 emissions and is likely to contribute to further increases in the near future. The carbonate looping process has the potential to capture CO2 emissions from the cement industry, in which raw meal for cement production could be used...... as the sorbent. Cyclic experiments were carried out in a TGA apparatus using industrial cement raw meal and synthetic raw meal as sorbents, with limestone as the reference. The results show that the CO2 capture capacities of the cement raw meal and the synthetic raw meal are comparable to those of pure limestone...... that raw meal could be used as a sorbent for the easy integration of the carbonate looping process into the cement pyro process for reducing CO2 emissions from the cement production process....

  2. Understanding cement mechanical behavior in SAGD wells

    Energy Technology Data Exchange (ETDEWEB)

    Xie, J.; Zahacy, T. A. [C-FER Technologies (Canada)

    2011-07-01

    In the heavy oil industry, the steam assisted gravity drainage process is often used to enhance oil recovery but it can cause cracks in the cement sheath. These cracks are the result of high steam temperatures and thermal expansion. In order to mitigate this risk, improved well designs are required. The aim of this paper is to present the mechanical behavior of the cement sheath during the heating phase. An analysis of the impact of design and operating parameters was conducted through thermal hydraulic and thermal mechanical analyses to assess cement integrity. These analyses were then performed on an example of an SAGD project in the southern part of the Athabasca oilsands region to assess the performance of the cement sheath. Results showed that potential damage to the cement can be reduced by slow heating and a lower Young's modulus cement blend. This paper makes recommendations for optimizing cement design in thermal recovery wells.

  3. Subject-specific hip geometry affects predicted hip joint contact forces during gait.

    Science.gov (United States)

    Lenaerts, G; De Groote, F; Demeulenaere, B; Mulier, M; Van der Perre, G; Spaepen, A; Jonkers, I

    2008-01-01

    Hip loading affects bone remodeling and implant fixation. In this study, we have analyzed the effect of subject-specific modeling of hip geometry on muscle activation patterns and hip contact forces during gait, using musculoskeletal modeling, inverse dynamic analysis and static optimization. We first used sensitivity analysis to analyze the effect of isolated changes in femoral neck-length (NL) and neck-shaft angle (NSA) on calculated muscle activations and hip contact force during the stance phase of gait. A deformable generic musculoskeletal model was adjusted incrementally to adopt a physiological range of NL and NSA. In a second similar analysis, we adjusted hip geometry to the measurements from digitized radiographs of 20 subjects with primary hip osteoarthrosis. Finally, we studied the effect of hip abductor weakness on muscle activation patterns and hip contact force. This analysis showed that differences in NL (41-74 mm) and NSA (113-140 degrees ) affect the muscle activation of the hip abductors during stance phase and hence hip contact force by up to three times body weight. In conclusion, the results from both the sensitivity and subject-specific analysis showed that at the moment of peak contact force, altered NSA has only a minor effect on the loading configuration of the hip. Increased NL, however, results in an increase of the three hip contact-force components and a reduced vertical loading. The results of these analyses are essential to understand modified hip joint loading, and for planning hip surgery for patients with osteoarthrosis.

  4. Some durability aspects of hybrid alkaline cements

    Directory of Open Access Journals (Sweden)

    Donatello S.

    2014-04-01

    Full Text Available Blended cements that contain a high content of fly ash and a low content of Portland cement typically suffer from low early strength development and long setting times. Recently, one method of overcoming these problems has been to use an alkali activator to enhance the reactivity of fly ash particles at early ages. Such cements can be grouped under the generic term “hybrid alkaline cements”, where both cement clinker and fly ash, encouraged by the presence of alkalis, are expected to contribute to cementitious gel formation. The work presented here examines some of the durability aspects of high fly ash content hybrid alkaline cement. Specifically, the aspects investigated were: exposure at high temperatures (up to 1000°C, resistance to immersion in aggressive solutions and susceptibility to the alkali aggregate reaction. All tests were repeated with a commercially available sulfate resistant Portland cement for comparison. When exposed to high temperatures, the hybrid alkaline cement showed strikingly different behaviour compared to the control Portland cement, showing fewer micro-cracks and maintaining residual compressive strengths at least equal to original strengths. Beyond 700°C, the hybrid alkaline cement began to sinter, which resulted in shrinkage of around 5% and a 100% increase in residual compressive strengths. No such sintering event was noted in the control Portland cement, which showed a drastic loss in residual compressive strengths upon heating. In immersion tests, the hybrid alkaline cement possessed excellent resistance to sulfate and seawater attack, similar to the control sulfate resistant cement. Both cements were however severely degraded by immersion in 0.1M HCl for 90 days. Both binders complied with the accelerated alkali-aggregate test but when this test was extended, the hybrid alkaline binder showed much greater dimensional stability. Possible reasons for the differences in durability behaviour in both cements

  5. CALCAR PRESERVING OSTEOTOMY IN CEMENTED BIPOLAR HEMIARTHROPLASTY FOR UNSTABLE TROCHANTERIC FRACTURES

    Directory of Open Access Journals (Sweden)

    Mohammed Ashraf

    2016-03-01

    Full Text Available INTRODUCTION Intertrochanteric fractures in osteoporotic bones which are grossly comminuted are highly unstable and difficult to treat. Conservative treatment with traction and prolonged immobilisation lands up with many complications and often fatality. Rate of failure with internal fixation has been found to be high, especially in osteoporotic bones. Revision osteosynthesis is technically demanding and it leads to complications, a second surgical procedure for revision synthesis, arthroplasty or removal of a symptomatic implant is again a risky procedure in elderly patients with lot of comorbidities. The aim of this study was to assess the efficacy of a cemented bipolar hemiarthroplasty with calcar preserving intracapsular osteotomy in the management of unstable trochanteric fractures in elderly patients with osteoporosis. Hemiarthroplasty in unstable trochanteric fractures have been described in the past with varying outcome. The reasons for poor outcome were shortening, varus positioning and abductor insufficiency. This was mainly due to the deficient medial support due to the removal of lesser trochanter and calcar. Recently, free calcar grafting excised from the removed neck for medial support was reported, but in our technique we are preserving the calcar and lesser trochanter with all its soft tissue and muscle attachments. MATERIALS AND METHODS 52 patients with mean age 71.4 (range from 65 to 89 who underwent cemented bipolar hemiarthroplasty with calcar preserving osteotomy for unstable intertrochanteric fractures were prospectively evaluated. Posterior approach was used in all patients. Harris hip score was used for the clinical evaluation. The mean followup period was 5 years. RESULT In our study, which was done on 52 cases which had a mean age 71.4 years. The average Harris hip score was 81. Excellent to fair results were obtained at followup in 50 (96% cases, and in 2(4% cases the results were poor. Average hospital stay was 14

  6. Pathogenesis of osteoporotic hip fractures.

    Science.gov (United States)

    McClung, Michael R

    2003-01-01

    Osteoporosis is characterized late in the course of the disease by an increased risk of fracture, particularly in the elderly. It occurs in both sexes, affecting approximately 8 million women and 2 million men aged > or = 50 years (1). While low bone density is a predictor of fractures, it is not the only determinant of fracture risk. Other factors include advanced age, altered bone quality, a personal or family history of falls, frailty, poor eyesight, debilitating diseases, and high bone turnover. A diet with sufficient calcium and vitamin D is important to minimize bone loss and, along with regular exercise, to maintain muscle strength. Bisphosphonates have been shown to reduce the risk of hip fracture. For elderly patients, the use of hip protectors may be used as a treatment of last resort. Regardless of the age of the patient, individual patient risk factors must be considered to target appropriate treatment and prevent fracture.

  7. Economic viability of geriatric hip fracture centers.

    Science.gov (United States)

    Clement, R Carter; Ahn, Jaimo; Mehta, Samir; Bernstein, Joseph

    2013-12-01

    Management of geriatric hip fractures in a protocol-driven center can improve outcomes and reduce costs. Nonetheless, this approach has not spread as broadly as the effectiveness data would imply. One possible explanation is that operating such a center is not perceived as financially worthwhile. To assess the economic viability of dedicated hip fracture centers, the authors built a financial model to estimate profit as a function of costs, reimbursement, and patient volume in 3 settings: an average US hip fracture program, a highly efficient center, and an academic hospital without a specific hip fracture program. Results were tested with sensitivity analysis. A local market analysis was conducted to assess the feasibility of supporting profitable hip fracture centers. The results demonstrate that hip fracture treatment only becomes profitable when the annual caseload exceeds approximately 72, assuming costs characteristic of a typical US hip fracture program. The threshold of profitability is 49 cases per year for high-efficiency hip fracture centers and 151 for the urban academic hospital under review. The largest determinant of profit is reimbursement, followed by costs and volume. In the authors’ home market, 168 hospitals offer hip fracture care, yet 85% fall below the 72-case threshold. Hip fracture centers can be highly profitable through low costs and, especially, high revenues. However, most hospitals likely lose money by offering hip fracture care due to inadequate volume. Thus, both large and small facilities would benefit financially from the consolidation of hip fracture care at dedicated hip fracture centers. Typical US cities have adequate volume to support several such centers.

  8. Total hip replacement in dancers.

    Science.gov (United States)

    Buyls, Inge R A E; Rietveld, A B M Boni; Ourila, Tiia; Emerton, Mark E; Bird, H A

    2013-04-01

    A case report of a professional contemporary dancer who successfully returned to the stage after bilateral total hip replacements (THR) for osteoarthritis is presented, together with her own commentary and a retrospective cohort study of total hip replacements in dancers. In the presented cohort, there were no post-operative dislocations or infections, the original pain had been relieved, rehabilitation was objectively normal and all resumed their dance (teaching) activities. Nevertheless, they were disappointed about the prolonged rehabilitation. Due to their high demands as professional dancers, post-operative expectations were too optimistic in view of the usual quick and favourable results of THR in the older and less physically active, general population. In all dancers with unilateral osteoarthritis, the left hip was involved, which may reflect the tendency to use the left leg as standing leg and be suggestive that strenuous physical activity may lead to osteoarthritis. Better rehabilitation guidelines are needed for dancer patients undergoing THR, especially drawing their attention to realistic post-operative expectations.

  9. Research of magnesium phosphosilicate cement

    Science.gov (United States)

    Ding, Zhu

    Magnesium phosphosilicate cement (MPSC) is a novel phosphate bonded cement, which consists mainly of magnesia, phosphate and silicate minerals. The traditional magnesium phosphate cements (MPCs) usually composed by ammonium phosphate, and gaseous ammonia will emit during mixing and in service. There is no noxious ammonia released from MPSC, furthermore, it can recycle a large volume of the non-hazardous waste. The goal of this research is to investigate the composition, reaction products, reaction mechanism, microstructure, properties, durability and applications of the MPSC. MPSC sets rapidly and has high early strength. It reacts better with solid industrial waste when compared to Portland cement. Many solid industrial wastes, such as fly ash, steel slag, coal gangue, red coal gangue, red mud, barium-bearing slag, copper slag, silica fume, and ground granulated blast furnace slag, have been used as the main component (40% by weight) in MPSC. The research has found that these aluminosilicate (or ironsilicate, or calciumsilicate) minerals with an amorphous or glass structure can enhance the performance of MPSC. The disorganized internal structure of amorphous materials may make it possess higher reactivity compared to the crystalline phases. Chemical reaction between phosphate and these minerals may form an amorphous gel, which is favorable to the cementing. Borax, boric acid and sodium tripolyphosphate have been used as retardants in the MPSC system. It is found that boric acid has a higher retarding effect on the setting of cement, than borax does. However, sodium polyphosphate accelerates the reaction of MPSC. The hydration of MPSC is exothermic reaction. The heat evolution may prompt hydrates formation, and shorten the setting process. Modern materials characterization techniques, XRD, DSC, TG-DTA FTIR, XPS, MAS-NMR, SEM, TEM, MIP, etc. were used to analyze the phase composition, micro morphology, and microstructure of hardened MPSC. The main hydration product

  10. Adhesion of metal on metal. The Pt on Co case

    Science.gov (United States)

    Légaré, P.; Castellani, N. J.; Cabeza, G. F.

    2002-01-01

    The adhesion of Pt overlayers in pseudomorphic epitaxy on hcp Co(0 0 0 1) and fcc Co(1 0 0) was investigated with first-principles calculations. This was compared to the adhesion of the Pt surface layers on Pt(1 1 1) and Pt(1 0 0). We show that adhesion can be analyzed by taking into account the interplay between the chemical and structural properties at the interface. The free Pt planes with the bulk Pt-Pt distance are submitted to tensile stress which can be relaxed by 6.6% and 9.1% contraction for the (1 1 1) and (1 0 0) symmetries respectively. This results in equilibrium interatomic distances which are not far from that of the Co substrate. Consequently the stress energy in a pseudomorphic Pt monolayer on a Co substrate is lower than the stress energy of pure Pt(1 1 1) or Pt(1 0 0) surfaces. However, this is at the expense of the Pt chemical reactivity towards the Co substrate. This is in agreement with the general dependence between chemical reactivity and stress of a metal surface.

  11. Alternative Fuels in Cement Production

    OpenAIRE

    2007-01-01

    Substitutionen af fossilt med alternativt brændsel i cement produktionen er steget betydeligt i den sidste dekade. Af disse nye alternative brændsler, udgør de faste brændsler p.t. den største andel, hvor kød- og benmel, plastic og dæk i særdeleshed har været de alternative brændsler der har bidraget med mest alternativ brændsels energi til den tyske cement industri. De nye alternative brændsler er typisk karakteriseret ved et højt indhold af flygtige bestanddele og adskiller sig typisk fra t...

  12. A Twofold Comparison between Dual Cure Resin Modified Cement and Glass Ionomer Cement for Orthodontic Band Cementation

    Science.gov (United States)

    Attar, Hanaa El; Elhiny, Omnia; Salem, Ghada; Abdelrahman, Ahmed; Attia, Mazen

    2016-01-01

    AIM: To test the solubility of dual cure resin modified resin cement in a food simulating solution and the shear bond strength compared to conventional Glass ionomer cement. MATERIALS AND METHOD: The materials tested were self-adhesive dual cure resin modified cement and Glass Ionomer (GIC). Twenty Teflon moulds were divided into two groups of tens. The first group was injected and packed with the modified resin cement, the second group was packed with GIC. To test the solubility, each mould was weighed before and after being placed in an analytical reagent for 30 days. The solubility was measured as the difference between the initial and final drying mass. To measure the Shear bond strength, 20 freshly extracted wisdom teeth were equally divided into two groups and embedded in self-cure acrylic resin. Four mm sections of stainless steel bands were cemented to the exposed buccal surfaces of teeth under a constant load of 500 g. Shear bond strength was measured using a computer controlled materials testing machine and the load required to deband the samples was recorded in Newtons. RESULTS: GIC showed significantly higher mean weight loss and an insignificant lower Shear bond strength, compared to dual cure resin Cement. CONCLUSION: It was found that dual cure resin modified cement was less soluble than glass ionomer cement and of comparable bond strength rendering it more useful clinically for orthodontic band cementation. PMID:28028417

  13. Influence of the temperature on the cement disintegration in cement-retained implant restorations.

    Science.gov (United States)

    Linkevicius, Tomas; Vindasiute, Egle; Puisys, Algirdas; Linkeviciene, Laura; Svediene, Olga

    2012-01-01

    The aim of this study was to estimate the average disintegration temperature of three dental cements used for the cementation of the implant-supported prostheses. One hundred and twenty metal frameworks were fabricated and cemented on the prosthetic abutments with different dental cements. After heat treatment in the dental furnace, the samples were set for the separation to test the integration of the cement. Results have shown that resin-modified glass-ionomer cement (RGIC) exhibited the lowest disintegration temperature (pcement (ZPC) and dual cure resin cement (RC) (p>0.05). Average separation temperatures: RGIC - 306 ± 23 °C, RC - 363 ± 71 °C, it could not be calculated for the ZPC due to the eight unseparated specimens. Within the limitations of the study, it could be concluded that RGIC cement disintegrates at the lowest temperature and ZPC is not prone to break down after exposure to temperature.

  14. Center for Cement Composite Materials

    Science.gov (United States)

    1990-01-31

    pastes have shown that the matrix is microporous; mesopores are absent unless the material is allowed to dry out. This results in water adsorption at low...only to water. When subsequently dried a portion of3 the porosity is converted to larger mesopores . • Only about one third of the cement reacts in a...Frictional sliding, in this case was characterized by a decreasing slope in the loading curve followed by hysteresis in the unload/reloading curves

  15. ROTARY SCREW SYSTEMS IN CEMENT

    OpenAIRE

    2016-01-01

    The article presents results of research of rotary-screw systems in relation to the creation of rotary kilns for the annealing of-cuttings in the preparation of cement clinker. Using the proposed design, in comparison with known designs of similar purpose, it significantly improves performance, reduces size and power consumption through the use of rotary screw systems in the form of screw rotors and drums made hollow with sidewalls assembled from separate strips or plates of different geometr...

  16. Hip and Spine in Cerebral Palsy

    OpenAIRE

    Persson-Bunke, Måns

    2015-01-01

    Abstract Background: Children with cerebral palsy (CP) have an increased risk of scoliosis, contractures including windswept hip deformity (WS), and hip dislocation. In 1994, a follow-up program and registry for children and adolescents with CP (CPUP) was initiated in Sweden to allow the early detection and prevention of hip dislocations and other musculoskeletal deformities. Purpose: To analyze the prevalence of scoliosis and WS in children with CP and to study the effect of CPUP. To e...

  17. HIP RESURFACING - FIRST IMPRESSIONS AND NEW OPPORTUNITIES

    Directory of Open Access Journals (Sweden)

    G. V. Kuropatkin

    2010-01-01

    Full Text Available Midi-time follow-up results of hip resurfacing were retrospectively analyzed. 117 operations in 109 patients with average age 36,2 years were performed. From one to four years follow-up results showed good clinical and functional result with proximal hip bone stock preservation. In spite of technical difficulties of resurfacing, complication level was not more, than in standard total hip arthroplasty. This surgical procedure may be recommends for young, active patients.

  18. Pelvic Incidence in Patients with Hip Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Ibrahim Raphael

    2016-04-01

    Full Text Available Background: Hip osteoarthritis (OA is a major cause of pain and disability that results in considerable social and medical costs. Mechanics such as posture, alignment and orientation of the hips and the spinal column and the relationship between these factors have been implicated in the development of both hip and spine pathologies. This study aims to test the hypothesis if pelvic incidence varies in patients with and without osteoarthritis. We assessed the relationship between spinopelvic alignment as measured by pelvic incidence (PI and the presence of hip OA. Methods: We collected supine pelvis CT scans of 1,012 consecutive patients not known to have hip OA. Our first group consisted of 95 patients with moderate to severe hip OA as per radiology reports. The second group included 87 patients with no evidence of hip OA. Power analysis revealed the need for 77 patients per group to find a mean difference in PI of 5º or less between both groups. Two trained physicians independently measured the PI to account for inter-observer reliability. Results: Patients with moderate to severe hip OA had a mean PI of 56.5º±12.8º. The mean PI for patients without hip OA was 57.2º±7.5º. An independent samples t-test revealed no significant difference between the PI values of the two groups. Spearman’s correlation coefficient of 0.754 demonstrated a high inter-observer reliability. Conclusion: There was no difference in PI angle of hip OA patients and "healthy" patients. Our measurements of patients without OA were almost identical to the reported normal PI values in the literature. It appears that hip OA is not associated with PI angle, refuting the hypothesis made in previous studies, stating that elevated PI contributes to the future development of hip arthritis. CT scan seems to be a reliable and accurate way of assessing pelvic incidence.

  19. [Treatment of infected total hip endoprostheses].

    Science.gov (United States)

    Zilkens, K W; Forst, R; Casser, H R

    1989-07-01

    In total hip arthroplasty the most serious complication besides aseptic loosening is infection. The results observed in 42 cases of infected hip arthroplasties are presented. In contrast to early superficial infection, deep infection following total hip replacement is difficult to treat. Depending on the general condition of the patient, a well-defined, adequate treatment is required. In patients at vital risk the provocation of a permanent fistula can be recommended as an alternative method in preference to revision arthroplasty.

  20. WHITE CEMENT IN SUSTAINABLE DEVELOPMENT

    Directory of Open Access Journals (Sweden)

    Y.C.P RAMANA BABU

    2013-04-01

    Full Text Available India is one among the fast developing countries in the world in the areas of Infrastructure. Now a day, Carbon monoxide (CO and carbon dioxide (CO2 are the temporary atmospheric pollutants in the environment chiefly emitted from the fuel burning vehicles and street lights which lead to global warming and pose a major threat tothe survival and sustainable development. This paper deals with the principal purpose of use of white cement in pavement design which will take care of the Green house gases (i.e., CO and CO2 and also saves lot of money in the long run process. A small amount of these gases in environment can cause major problems over time. Use of white cement in composite pavement design where there is heavy traffic loads are acting as well as number of vehicles are more such as junctions, bus stops, check posts etc., can perform better and acts asenvironment friendly. Its light colour reflects more than bituminous pavement so that it can be easily identified and avoid accidents to some extent. White cement helps to lower the average bus stop, junction temperature providing comfort to the people because it has high solar reflectance there by reducing “urban heat island” effect. In addition to this it has some more advantages which increase the sustainability, durability and workability of the pavements.

  1. Bone and muscle assessment in patients undergoing total hip arthroplasty using HU based analysis

    Directory of Open Access Journals (Sweden)

    Þröstur Pétursson

    2012-09-01

    Full Text Available Total hip arthroplasty (THA is performed with or without the use of bone cement. The lack of reliable clinical guidelines for deciding which one to implement has encouraged this approach of joint clinical and engineering with the following objectives: 1. Validate quadriceps muscles and femur bone atrophy by extracting the mineral density from Computer Tomographic (CT images. 2. Validate computational processes based on 3-D modeling and Finite Element Methods (FEM. A clinical trial was started, where 36 volunteer patients underwent THA surgery for the first time: 18 receiving cemented implant and 18 receiving uncemented implant. The patients were CT scanned prior-, immediately after and 12 months post-surgery. The CT data are further processed to segment muscles and bones and to create 3D-models for the simulation and for calculating bone mineral density (BMD. Furthermore quadriceps muscle density Hounsfield (HU based value is calculated from the segmented file on healthy and operated leg. These preliminary results indicate computational tools and methods that are able to quantitatively analyse patient’s condition pre and post-surgery. The BMD and muscle density measurement in correlation with the fracture risk analysis display a potential method for eligibility to receive non-cemented implant; the preliminary results show that also elderly that according with current clinical evaluation receives a cemented implant are suitable for the non-cemented type. The risk for structural failure during THA surgery is estimated by calculating femoral bone fracture risk index (FRI as a ratio between compressive stress during surgery and estimated failure stress on bone. The correlations with the BMD observations during the clinical trial will assess and validate this potential predictor tool.

  2. Sustainable Development of the Cement Industry and Blended Cements to Meet Ecological Challenges

    OpenAIRE

    Konstantin Sobolev

    2003-01-01

    The world production of cement has greatly increased in the past 10 years. This trend is the most significant factor affecting technological development and the updating of manufacturing facilities in the cement industry. Existing technology for the production of cement clinker is ecologically damaging; it consumes much energy and natural resources and also emits pollutants. A new approach to the production of blended or high-volume mineral additive (HVMA) cement helps to improve its ecologi...

  3. Secondary capsular laxity of the hip.

    Science.gov (United States)

    Blakey, Caroline M; Field, Michael H; Singh, Parminder J; Tayar, Rene; Field, Richard E

    2010-01-01

    We describe a hip condition with a recognisable pattern of clinical signs and radiological findings thought to result from chronic capsular injury. Between June 2006 and October 2009, ten patients (11 hips), four men and six women, were identified with an abnormality of external rotation at the hip joint. A detailed history and clinical examination was undertaken for each patient. Dynamic magnetic resonance imaging of symptomatic and control hips were evaluated for bony and soft tissue appearances. The relative positions of the femoral head and the acetabulum were assessed through a range of hip rotation. In affected hips, a loss of normal log roll recoil was observed. Three distortions of the iliofemoral ligament were identified on axial MR images; thinning at the lateral insertion of the ligament, attenuation of the iliofemoral ligament most noticeably on maximum external rotation (60º) and the appearance of laxity despite full external rotation. Stability of the hip is dependent on the interaction of bony and soft tissue structures. Hip instability is recognised in dysplasia and is known to lead to premature degeneration of the joint. Chronic capsular injury may destabilise previously asymptomatic hips with subsequent development of pain in young, active patients.

  4. COMPLEX FUNCTIONAL ASSESSMENT OF THE HIP JOINT.

    Directory of Open Access Journals (Sweden)

    Maya S. Krastanova

    2015-09-01

    Full Text Available Introduction: In relation to the study reporting the effects of applying phased complex rehabilitation in patients with total hip arthroplasty, it has been concluded that the everyday clinical practice in Bulgaria does not apply complex examination, giving an objective picture about the extent of functional status of patients with trauma and diseases of the hip. Aim: The main goal of this report is to present a test which incorporates all known and routine research and in which the total number of points determines the functional status of patients with trauma and diseases of the hip. Material and Methods: Based on the Hip dysfunction and Osteoarthritis Outcome Score, the Harris Hip Score modified test, scale D’Aubigne and Postel and Iowa’s test for complex functional evaluation of the hip joint, we have developed a test including information about the degree of pain; goniometry and manual muscle testing of the hip; locomotor test – type of gait and adjuvants; test for Daily Activities of Life. The test has been developed on the basis of expert assessment by doctors and physiotherapists of the proposed indicators for evaluation and determination of the weighting factors’ contribution to the general condition of the patient. Conclusion: The developed and tested method of complex functional assessment of the hip joint enables our colleagues, dealing with trauma and diseases of the hip, to use it in various research and scientific projects, as well as in general medical practice.

  5. Water dynamics in glass ionomer cements

    Science.gov (United States)

    Berg, M. C.; Jacobsen, J.; Momsen, N. C. R.; Benetti, A. R.; Telling, M. T. F.; Seydel, T.; Bordallo, H. N.

    2016-07-01

    Glass ionomer cements (GIC) are an alternative for preventive dentistry. However, these dental cements are complex systems where important motions related to the different states of the hydrogen atoms evolve in a confined porous structure. In this paper, we studied the water dynamics of two different liquids used to prepare either conventional or resin-modified glass ionomer cement. By combining thermal analysis with neutron scattering data we were able to relate the water structure in the liquids to the materials properties.

  6. Pulmonary Cement Embolism following Percutaneous Vertebroplasty

    Directory of Open Access Journals (Sweden)

    Ümran Toru

    2014-01-01

    Full Text Available Percutaneous vertebroplasty is a minimal invasive procedure that is applied for the treatment of osteoporotic vertebral fractures. During vertebroplasty, the leakage of bone cement outside the vertebral body leads to pulmonary cement embolism, which is a serious complication of this procedure. Here we report a 48-year-old man who was admitted to our hospital with dyspnea after percutaneous vertebroplasty and diagnosed as pulmonary cement embolism.

  7. Hip Strength Testing of Soccer Players With Long-Standing Hip and Groin Pain

    DEFF Research Database (Denmark)

    Rafn, Bolette S; Tang, Lars; Nielsen, Peter Martin;

    2016-01-01

    OBJECTIVE: To investigate whether self-reported pain during hip strength testing correlates to a large degree with hip muscle strength in soccer players with long-standing unilateral hip and groin pain. DESIGN: Cross-sectional study. SETTING: Clinical assessments at Sports Orthopaedic Research...

  8. Hip fractures. Epidemiology, risk factors, falls, energy absorption, hip protectors, and prevention

    DEFF Research Database (Denmark)

    Lauritzen, J B

    1997-01-01

    on the hip. Women with hip fractures have a lower body weight compared with controls, and they may also have less soft tissue covering the hip even when adjusted for body mass index, indicating a more android body habitus. Experimental studies show that the passive energy absorption in soft tissue covering...

  9. The influence of ultrasound on removal of prefabricated metal post cemented with different resin cements

    Directory of Open Access Journals (Sweden)

    Atiyeh Feiz

    2013-01-01

    Conclusion: Ultrasonic energy did not decrease the retention of posts cemented with Panavia or Maxcem Elite cements. Furthermore, it seems that there is no significant difference between removal force of self-etch (Panavia and the self-etch self-adhesive (Maxcem Elite resin cements.

  10. Effects of cement flue dusts from a Nigerian cement plant on air, water and planktonic quality.

    Science.gov (United States)

    Olaleye, Victor F; Oluyemi, Emmanuel A

    2010-03-01

    Effects of cement flue dust from Ewekoro cement Kilns were monitored at some aquatic receptor locations. High levels of total suspended particulates (TSPs) and atmospheric deposition rates (ADRs) were recorded within the factory compared to ancillary locations outside the factory. The TSP and ADR levels which were location dependent were significantly higher (P cement factory catchment areas.

  11. The mechanical effects of different levels of cement penetration at the cement-bone interface.

    NARCIS (Netherlands)

    Waanders, D.; Janssen, D.; Mann, K.A.; Verdonschot, N.J.J.

    2010-01-01

    The mechanical effects of varying the depth of cement penetration in the cement-bone interface were investigated using finite element analysis (FEA) and validated using companion experimental data. Two FEA models of the cement-bone interface were created from micro-computed tomography data and the p

  12. Substantial global carbon uptake by cement carbonation

    Science.gov (United States)

    Xi, Fengming; Davis, Steven J.; Ciais, Philippe; Crawford-Brown, Douglas; Guan, Dabo; Pade, Claus; Shi, Tiemao; Syddall, Mark; Lv, Jie; Ji, Lanzhu; Bing, Longfei; Wang, Jiaoyue; Wei, Wei; Yang, Keun-Hyeok; Lagerblad, Björn; Galan, Isabel; Andrade, Carmen; Zhang, Ying; Liu, Zhu

    2016-12-01

    Calcination of carbonate rocks during the manufacture of cement produced 5% of global CO2 emissions from all industrial process and fossil-fuel combustion in 2013. Considerable attention has been paid to quantifying these industrial process emissions from cement production, but the natural reversal of the process--carbonation--has received little attention in carbon cycle studies. Here, we use new and existing data on cement materials during cement service life, demolition, and secondary use of concrete waste to estimate regional and global CO2 uptake between 1930 and 2013 using an analytical model describing carbonation chemistry. We find that carbonation of cement materials over their life cycle represents a large and growing net sink of CO2, increasing from 0.10 GtC yr-1 in 1998 to 0.25 GtC yr-1 in 2013. In total, we estimate that a cumulative amount of 4.5 GtC has been sequestered in carbonating cement materials from 1930 to 2013, offsetting 43% of the CO2 emissions from production of cement over the same period, not including emissions associated with fossil use during cement production. We conclude that carbonation of cement products represents a substantial carbon sink that is not currently considered in emissions inventories.

  13. Frozen delivery of brushite calcium phosphate cements.

    Science.gov (United States)

    Grover, Liam M; Hofmann, Michael P; Gbureck, Uwe; Kumarasami, Balamurgan; Barralet, Jake E

    2008-11-01

    Calcium phosphate cements typically harden following the combination of a calcium phosphate powder component with an aqueous solution to form a matrix consisting of hydroxyapatite or brushite. The mixing process can be very important to the mechanical properties exhibited by cement materials and consequently when used clinically, since they are usually hand-mixed their mechanical properties are prone to operator-induced variability. It is possible to reduce this variability by pre-mixing the cement, e.g. by replacing the aqueous liquid component with non-reactive glycerol. Here, for the first time, we report the formation of three different pre-mixed brushite cement formulations formed by freezing the cement pastes following combination of the powder and liquid components. When frozen and stored at -80 degrees C or less, significant degradation in compression strength did not occur for the duration of the study (28 days). Interestingly, in the case of the brushite cement formed from the combination of beta-tricalcium phosphate with 2 M orthophosphoric acid solution, freezing the cement paste had the effect of increasing mean compressive strength fivefold (from 4 to 20 MPa). The increase in compression strength was accompanied by a reduction in the setting rate of the cement. As no differences in porosity or degree of reaction were observed, strength improvement was attributed to a modification of crystal morphology and a reduction in damage caused to the cement matrix during manipulation.

  14. Hidration kinetics study of tlie mixed cements

    OpenAIRE

    Duque Fernández, Gabriel . L; Díaz Quintanilla, David; Zapata Sierra, Manuel; Rubio Frías, Ester

    1993-01-01

    A study of the hydration process of cements with 10% and 20% addition of a tuff from "Las Carolinas" quarry (Cienfuegos, Cuba) by different methods was done. The results obtained by different methods showed a good agreement. It was proved an increment of the hydration products, an acceleration of alite hydration and a swelling of the fixed water in mixed cements. The resistance of the cement with 10% addition is similar to that of the pure cement for ages of 28 days, whereas with 20% addition...

  15. Total hip arthroplasty in Malaysia--the Universiti Kebangsaan Malaysia and Hospital Kuala Lumpur experience.

    Science.gov (United States)

    Tay, B H; Masbah, O; Razak, M; Ruslan, G N

    2000-09-01

    The results of 109 primary total hip arthroplasties in 92 patients performed in Hospital Kuala Lumpur from January 1987 to December 1996 were reviewed after a mean follow-up of 30.8 months. There were 22 males and 70 females with the average age of 49.9 years (range 19 to 94 years). Chinese females comprised the largest group of patients (52.2%). Avascular necrosis was the most common diagnosis (33.1%) followed by hip dysplasia and primary osteoarthritis (17.4%). The procedure was performed more on the right hip (64.2%) compared to the left (35.8%). All patients received prophylactic antibiotics but none were given deep vein thrombosis prophylaxis. The Charnley prosthesis was most commonly used and the majority of the arthroplasties were cemented (60.5%). About 80% of the THA were performed via the lateral approach. The functional hip score improved from an average of 8.9 to 15.0 with 66.3% of the patients categorized as good and excellent results. There were 16 patients (17.4%) with poor outcome. The most common complications encountered were dislocation (10.1%), aseptic loosening (9.2%) and periprosthetic fracture (5.5%). Other complications were deep infection (1.8%), deep vein thrombosis (0.9%), trochanteric osteotomy complications (1.8%), superficial infection (7.3%), urinary tract infection (5.5%), pressure sore (3.7%) and respiratory complication (1.8%). Fifteen hips (13.8%) required revision. The causes for revision were aseptic loosening, dislocation and infection. Technical anomalies were recognized as one of the factors contributing to poor results. Five-year survival rate was 87.3%. Better results can be expected with increasing experience and technical skulls.

  16. Surgical hip dislocation for treatment of cam femoroacetabular impingement

    Directory of Open Access Journals (Sweden)

    Milind M Chaudhary

    2015-01-01

    Conclusion: Cam femoroacetabular Impingement causing pain and limitation of hip movements was treated by open osteochondroplasty after surgical hip dislocation. This reduced pain, improved hip motion and gave good to excellent results in the short term.

  17. An experimental animal model of aseptic loosening of hip prostheses in sheep to study early biochemical changes at the interface membrane

    Directory of Open Access Journals (Sweden)

    Akens Margarete K

    2004-03-01

    Full Text Available Abstract Background Aseptic loosening of hip prosthesis as it occurs in clinical cases in human patients was attributed to wear particles of the implants, the response of the tissue dominated by macrophages and the production of inflammatory mediators and matrix degrading enzymes; however, the cascade of events initiating the process and their interaction regarding the time course is still open and discussed controversially. Therefore, the goal of this study was to establish an experimental animal model in sheep allowing to follow the cascade of early mechanical and biochemical events within the interface membrane and study the sequence of how they contribute to the pathological bone resorption necessary for aseptic loosening of the implant. Methods A cemented modular system (Biomedtrix was used as a hip replacement in 24 adult Swiss Alpine sheep, with one group receiving a complete cement mantle as controls (n = 12, and the other group a cement mantle with a standardized, lateral, primary defect in the cement mantle (n = 12. Animals were followed over time for 2 and 8.5 months (n = 6 each. After sacrifice, samples from the interface membranes were harvested from five different regions of the femur and joint capsule. Explant cell cultures were performed and supernatant of cultures were tested and assayed for nitric oxide, prostaglandin E2, caseinolytic and collagenolytic activity. RNA extraction and quantification were performed for inducible nitric oxide synthase, cyclooxygenase-2, interleukin 1, and interleukin 6. Overall differences between groups and time periods and interactions thereof were calculated using a factorial analysis of variance (ANOVA. Results The development of an interface membrane was noticed in both groups at both time points. However, in the controls the interface membrane regressed in thickness and biological activity, while both variables increased in the experimental group with the primary cement mantle defect over time

  18. The association between hip fracture and hip osteoarthritis: A case-control study

    Directory of Open Access Journals (Sweden)

    Englund Martin

    2010-11-01

    Full Text Available Abstract Background There have been reports both supporting and refuting an inverse relationship between hip fracture and hip osteoarthritis (OA. We explore this relationship using a case-control study design. Methods Exclusion criteria were previous hip fracture (same side or contralateral side, age younger than 60 years, foreign nationality, pathological fracture, rheumatoid arthritis and cases were radiographic examinations were not found in the archives. We studied all subjects with hip fracture that remained after the exclusion process that were treated at Akureyri University Hospital, Iceland 1990-2008, n = 562 (74% women. Hip fracture cases were compared with a cohort of subjects with colon radiographs, n = 803 (54% women to determine expected population prevalence of hip OA. Presence of radiographic hip OA was defined as a minimum joint space of 2.5 mm or less on an anteroposterior radiograph, or Kellgren and Lawrence grade 2 or higher. Possible causes of secondary osteoporosis were identified by review of medical records. Results The age-adjusted odds ratio (OR for subjects with hip fracture having radiographic hip OA was 0.30 (95% confidence interval [95% CI] 0.12-0.74 for men and 0.33 (95% CI 0.19-0.58 for women, compared to controls. The probability for subjects with hip fracture and hip OA having a secondary cause of osteoporosis was three times higher than for subjects with hip fracture without hip OA. Conclusion The results of our study support an inverse relationship between hip fractures and hip OA.

  19. Unilateral hip osteoarthritis: can we predict the outcome of the other hip?

    Energy Technology Data Exchange (ETDEWEB)

    Vossinakis, I.C. [General Hospital of Volos, Orthopaedic Department, Volos (Greece); Georgiades, G. [General Hospital of Tripoli, Tripoli Greece, Orthopaedic Department, Athens (Greece); Hartofilakidis, G. [University of Athens Medical School, Department of Orthopaedics, Athens (Greece); Kafidas, D.

    2008-10-15

    The objective of this study was to define, in unilateral hip osteoarthritis (OA), factors predicting the outcome of the other hip. We examined the anteroposterior radiographs of the pelvis of 95 white patients with unilateral idiopathic (56 patients) or secondary to congenital hip diseases (39 patients) OA. The other hip was free from symptoms (pain or limping) at the initial examination and without radiographic evidence of OA; it was what we call a ''normal'' hip. Two parameters were evaluated: (1) the type of osteoarthritis of the involved hip and (2) the range of four radiographic indices of the contralateral hip: the sourcil inclination (weight-bearing surface), the acetabular angle, the Wiberg's center-edge angle, and the neck-shaft angle. Follow-up radiographs for the hips that remained OA-free were available for 10 to 35 years and for those that developed OA, at the time of initial symptoms, range 2 to 31 years. Logistic regression analysis showed that the presence of idiopathic OA in one hip had a statistically significant effect on the development of OA on the other hip (p<0.001). Minor deviations of radiographic indices of the contralateral hip is not a predictive factor for its outcome. When the radiographic indices are examined together with the pathology of the involved hip, only WBS was shown to have a significant effect to the development of OA and its type (p < 0.001). The following conclusions can be drawn from this study: 1. Patient with idiopathic OA of one hip is at increased risk of developing OA in the other hip. 2. The outcome of the other hip cannot be predicted only on the basis of the evaluation of its radiographic indices. 3. Among the different indices, WBS seems to have a strong influence toward the development of OA. (orig.)

  20. Radiology of total hip replacement

    Energy Technology Data Exchange (ETDEWEB)

    Griffiths, H.J.; Lovelock, J.E.; McCollister Evarts, C.; Geyer, D.

    1984-06-01

    The radiology of total hip replacement (THR) and its complications is reviewed in conjunction with a long-term follow-up study on 402 patients with 501 prostheses. The indications, contraindications, biomechanics, and operative management of these patients is discussed. Clinical complications such as deep vein thrombosis, pulmonary embolism, and hemorrhage are mentioned. Postoperative infections including granulomatous pseudotumors, dislocations and fractures, true loosening of the prosthesis, and heterotopic bone formation (HBF) are discussed and illustrated. The importance of differentiating the lucent line from true loosening is stressed. Mechanical and other clinical complications which are largely ignored by radiologists are also discussed. The uses of arthrography and bone scanning are included.

  1. Burnishing Techniques Strengthen Hip Implants

    Science.gov (United States)

    2010-01-01

    In the late 1990s, Lambda Research Inc., of Cincinnati, Ohio, received Small Business Innovation Research (SBIR) awards from Glenn Research Center to demonstrate low plasticity burnishing (LPB) on metal engine components. By producing a thermally stable deep layer of compressive residual stress, LPB significantly strengthened turbine alloys. After Lambda patented the process, the Federal Aviation Administration accepted LPB for repair and alteration of commercial aircraft components, the U.S. Department of Energy found LPB suitable for treating nuclear waste containers at Yucca Mountain. Data from the U.S. Food and Drug Administration confirmed LPB to completely eliminate the occurrence of fretting fatigue failures in modular hip implants.

  2. A study on provisional cements, cementation techniques, and their effects on bonding of porcelain laminate veneers.

    Science.gov (United States)

    Vinod Kumar, G; Soorya Poduval, T; Bipin Reddy; Shesha Reddy, P

    2014-03-01

    Minimal tooth preparation is required for porcelain laminate veneers, but interim restorations are a must to protect their teeth against thermal insult, chemical irritation, and to provide aesthetics. Cement remaining after the removal of the provisional restoration can impair the etching quality of the tooth surface and fit and final bonding of the porcelain laminate veneer. This in vitro study examined the tooth surface for remaining debris of cement after removal of a provisional restoration. Determine the presence of cement debris on prepared tooth surface subsequent to the removal of provisional restoration. Determine the cement with the least residue following the cleansing procedures. Determine the effect of smear layer on the amount of residual luting cement. Eighty-four extracted natural anterior teeth were prepared for porcelain laminate veneers. For half of the teeth, the smear layer was removed before luting provisional restorations. Veneer provisional restorations were fabricated and luted to teeth with six bonding methods: varnish combined with glass ionomer cement (GIC), varnish combined with resin modified GIC, varnish, spot etching combined with dual-cure luting cement, adhesive combined with GIC, adhesive combined with resin modified GIC, and adhesive, spot etching combined with dual-cure luting cement. After removal of provisional restorations 1 week later, the tooth surface was examined for residual luting material with SEM. Traces of cement debris were found on all the prepared teeth surfaces for all six groups which were cemented with different methods. Cement debris was seen on teeth subsequent to the removal of provisional's. Dual-cure cement had the least residue following the cleansing procedures. Presence of smear layer had no statistical significance in comparison with cement residue. With the use of adhesive the cement debris was always found to be more than with the use of varnish. GIC showed maximum residual cement followed by dual-cure.

  3. Implant Optimisation for Primary Hip Replacement in Patients over 60 Years with Osteoarthritis: A Cohort Study of Clinical Outcomes and Implant Costs Using Data from England and Wales.

    Directory of Open Access Journals (Sweden)

    Simon S Jameson

    Full Text Available Hip replacement is one of the most commonly performed surgical procedures worldwide; hundreds of implant configurations provide options for femoral head size, joint surface material and fixation method with dramatically varying costs. Robust comparative evidence to inform the choice of implant is needed. This retrospective cohort study uses linked national databases from England and Wales to determine the optimal type of replacement for patients over 60 years undergoing hip replacement for osteoarthritis.Implants included were the commonest brand from each of the four types of replacement (cemented, cementless, hybrid and resurfacing; the reference prosthesis was the cemented hip procedure. Patient reported outcome scores (PROMs, costs and risk of repeat (revision surgery were examined. Multivariable analyses included analysis of covariance to assess improvement in PROMs (Oxford hip score, OHS, and EQ5D index (9159 linked episodes and competing risks modelling of implant survival (79,775 procedures. Cost of implants and ancillary equipment were obtained from National Health Service procurement data.EQ5D score improvements (at 6 months were similar for all hip replacement types. In females, revision risk was significantly higher in cementless hip prostheses (hazard ratio, HR = 2.22, p<0.001, when compared to the reference hip. Although improvement in OHS was statistically higher (22.1 versus 20.5, p<0.001 for cementless implants, this small difference is unlikely to be clinically important. In males, revision risk was significantly higher in cementless (HR = 1.95, p = 0.003 and resurfacing implants, HR = 3.46, p<0.001, with no differences in OHS. Material costs were lowest with the reference implant (cemented, range £1103 to £1524 and highest with cementless implants (£1928 to £4285. Limitations include the design of the study, which is intrinsically vulnerable to omitted variables, a paucity of long-term implant survival data (reflecting the

  4. A-mode ultrasound-based intra-femoral bone cement detection and 3D reconstruction in RTHR.

    Science.gov (United States)

    Heger, Stefan; Mumme, Thorsten; Sellei, Richard; De La Fuente, Matias; Wirtz, Dieter-C; Radermacher, Klaus

    2007-05-01

    Due to the difficulty of determining the 3D boundary of the cement-bone interface in Revision Total Hip Replacement (RTHR), the removal of the distal intra-femoral bone cement can be a time-consuming and risky operation. Within the framework of computer- and robot-assisted cement removal, the principles and first results of an automatic detection and 3D surface reconstruction of the cement-bone boundary using A-mode ultrasound are described. Sound propagation time and attenuation of cement were determined considering different techniques for the preparation of bone cement, such as the use of a vacuum system (Optivac, Biomet). A laboratory setup using a rotating, standard 5-MHz transducer was developed. The prototype enables scanning of bisected cement-prepared femur samples in a 90 degrees rotation range along their rotation axis. For system evaluation ex vivo, the distal femur of a human cadaver was prepared with bone cement and drilled (Ø 10 mm) to simulate the prosthesis cavity in a first approximation. The sample was cut in half and CT scanned (0.24 mm resolution; 0.5 mm distance; 0.5 mm thickness), and 3D voxel models of the manually segmented bone cement were reconstructed, providing the ground truth. Afterwards, 90 degrees segments of each ex-vivo sample were scanned by the A-mode ultrasound system. To obtain better ultrasound penetration, we used coded signal excitation and pulse compression filtering. A-mode ultrasound signal detection, filtering and segmentation were accomplished fully automatically. Subsequently, 3D voxel models of each sample were calculated. Accuracy evaluation of the measured ultrasound data was performed by ICP matching of each ultrasound dataset ( approximately 8000 points) to the corresponding CT dataset and calculation of the residual median distance error between the corresponding datasets. Prior to each ICP matching, an initial pre-registration was calculated using prominent landmarks in the corresponding datasets. This method

  5. Eccentric hip abductor weakness in patients with symptomatic external snapping hip

    DEFF Research Database (Denmark)

    Jacobsen, Julie Sandell; Thorborg, Kristian; Søballe, K;

    2012-01-01

    Symptomatic external snapping hip can be a long-standing condition affecting physical function in younger people between 15-40 years. Gluteal weakness has been suggested to be associated with the condition. The aim of this study was to investigate whether eccentric hip abduction strength is decre......Symptomatic external snapping hip can be a long-standing condition affecting physical function in younger people between 15-40 years. Gluteal weakness has been suggested to be associated with the condition. The aim of this study was to investigate whether eccentric hip abduction strength...... is decreased in patients with external snapping hip compared with healthy matched controls, and to examine isometric hip abduction, adduction, extension, flexion, internal rotation, and external rotation in patients with external snapping hip and matched controls. Thirteen patients with external snapping hip....... Eccentric hip abduction strength was 16% lower in patients with external snapping hip compared with healthy matched controls (1.50 ± 0.47 Nm/kg versus 1.82 ± 0.48 Nm/kg, P = 0.01). No other strength differences were measured between patients and controls (P > 0.05). Eccentric hip abductor weakness...

  6. SOFT TISSUE BALANCING IN TOTAL HIP ARTHROPLASTY.

    Directory of Open Access Journals (Sweden)

    Pencho Kosev

    2015-03-01

    Full Text Available We present our experience with the soft tissue balancing in total hip arthroplasty. Detailed indications, planning and surgical technique are presented. The described procedures are performed on 278 hips for a period of 6 years (2008-2014. We conclude that the outcome of a THA can be improved by balancing the stability, ROM, muscle strength and limb length equality.

  7. Dilemmas in Uncemented Total Hip Arthroplasty

    NARCIS (Netherlands)

    Goosen, J.H.M.

    2009-01-01

    In this thesis, different aspects that are related to the survivorship and clinical outcome in uncemented total hip arthroplasty are analysed. In Chapter 2, the survival rate, Harris Hip score and radiographic features of a proximally hydroxyapatite coated titanium alloy femoral stem (Bi-Metric, Bio

  8. TREATMENT OF NEUROLOGICAL CONGENITAL HIP LUXATION

    Directory of Open Access Journals (Sweden)

    Iulian ICLEANU

    2015-11-01

    Full Text Available Congenital hip luxation is a disorder which evolves in time. Teratological hip dislocation is a distinct form of hip luxation, which usually appears with other disorders. These hips are dislocated before birth. In this thesis we will try to elaborate a recovery program, through physical exercises, which will help us realize our treatment objectives: diminishing articular stiffness, increasing articular mobility, increasing muscle strength, recalibration of agonist and antagonist balances and reeducating gait. The specific objectives of the study consist of the particularization of the recovery programs based on age, illness stage (dysplasia or luxation and either surgical or non-surgical intervention. To show the importance of physiotherapy in gait rehabilitation of a child with hip dislocation we started from the hypothesis: using an adequate rehabilitation program after an individualized methodology, optimizes the functional recovery and ensures the gains of hip stability and the formation of an engram of gait as close as it could be to the normal one. We present a case of neurological congenital hip dislocation where the treatment initiated early is showing good results. Results obtained are significantly different and we came to the conclusion that starting an untimely analytical kinetic treatment and globally personalizing it to every patient has better biomechanical results for the hip.

  9. Hip Arthroscopy: Tales From the Crypt.

    Science.gov (United States)

    Matsuda, Dean K; Philippon, Marc J; Safran, Marc R; Sampson, Thomas G

    2016-01-01

    Complications after hip arthroscopy vary in frequency and severity, even for experienced surgeons. It is important for surgeons to be aware of some of the more dramatic, often unusual, and always memorable (nightmarish) complications of hip arthroscopy and understand how they are caused, how they can be treated, and how they can be prevented.

  10. Pressure ulcer risk in hip fracture patients

    NARCIS (Netherlands)

    Houwing, RH; Rozendaal, M; Wouters-Wesseling, W; Buskens, E; Keller, P; Haalboom, JRE

    2004-01-01

    Hip fracture patients have a high risk of pressure ulcers (PU). We followed 121 hip fracture patients for the development of pressure ulcers and evaluated a risk assessment tool for sensitivity and specificity. More than half of the patients presented with PU, mostly stage I. Risk factors for PU wer

  11. Hip-hop and urban studies

    NARCIS (Netherlands)

    Jaffe, R.

    2014-01-01

    How can urban studies research engage fruitfully with hip-hop? This contribution responds to the essays by David Beer and Martin Lamotte on ‘street music’, urban ethnography and ghettoized communities. It discusses how a social science engagement with hip-hop texts might differ from cultural studies

  12. Microbial analysis of biofilms on cement surfaces: An investigation in cement-associated peri-implantitis.

    Science.gov (United States)

    Korsch, Michael; Walther, Winfried; Marten, Silke-Mareike; Obst, Ursula

    2014-09-05

    The cementation of implant-supported restorations always poses the risk of excess cement retained in the peri-implant sulcus despite careful clinical control. Excess cement can become the basis of colonization by oral microorganisms. As a result of the biofilm formation peri-mucositis or peri-implantitis may develop. Complications were observed in the routine prosthetic restoration of implants when a methacrylate-based cement was used. These developed a few weeks after cementation of the suprastructure and caused bleeding on probing as well as suppuration from the peri-implant tissue. In the revision therapy, excess cement in the peri-implant sulcus was found in many cases. This excess cement was sampled from ten patients and investigated for biofilm formation. For this purpose, the cement samples were collected and analyzed for bacterial in situ colonization by 16S rDNA-based methods. In laboratory experiments, the methacrylate-based cement and two other dental cements were then investigated for their proneness to form biofilm. The results of the in situ and in vitro investigations revealed a strong tendency towards bacterial invasion of the methacrylate-based cement by opportunistic species and pathogens.

  13. IMAGING OF HIP JOINT PATHOLOGIES

    Directory of Open Access Journals (Sweden)

    Parul Dutta

    2016-08-01

    Full Text Available The hip joint is a large and complex articulation and can be involved by numerous pathologic conditions like congenital and developmental, infective, arthritic, and neoplastic. Early diagnosis and characterisation of pathology has vital role in proper management and follow up of the disease for the clinicians. Present study was conducted in 45 patients who underwent clinical, radiological, and pathological examination in GMCH. Maximum no of patient between age group of 10-30 yrs. male-female ratio was 1.8:1 and 30% cases are unilateral. FSE STAIR images were most useful in delineating pathologies. Gadolinium-enhanced scan were used to evaluate the extent of the disease and the pattern of involvement. AVN was the most common pathology detected comprising 29%. The next common abnormality detected was infective arthritis found in 26% of cases. In case of Legg-Calve-Perthes disease, there was abnormal linear increase in the signal intensity at junction of the epiphyseal cartilage. Ultrasonography is useful for the screening of paediatric hip cases and also for guided aspiration for histopathology. CT scan shows better resolution of soft tissue then the radiograph. The importance of early diagnosis can be gauzed from the fact that early initiation of treatment creates the difference between a responsible, worthwhile life, and a cripple handicapped life. The role of imaging can never be undermined considering the fact that early suspicion and detection is within the realms of imaging.

  14. Copper Slag Blended Cement: An Environmental Sustainable Approach for Cement Industry in India

    Directory of Open Access Journals (Sweden)

    Jagmeet Singh

    2016-04-01

    Full Text Available Indian cement industry is facing environmental issue of emission of carbon dioxide (CO2, a greenhouse gas. Blended cements including supplementary cementitious materials are substitute of Portland cement to reduce CO2 emission. The present paper investigates theappropriateness of copper slag (CS as supplementary cementitious material. Strength properties and hydration of mixes were determined at different replacement levels of CS with cement. Compressive, flexural and tensile strength of each mix was found out at different curing periods. The hydration of cement was investigated through X-ray diffraction (XRD. The strength test results showed that substitution of up to 20% of CS can significantly replace Portland cement.XRD test results were corresponding to strength test results. The present study encourages the utilization of CS as supplementary cementitious material to make economical and environmentally sustainable blended cement

  15. The influence of cement type and temperature on chloride binding in cement paste

    DEFF Research Database (Denmark)

    Jensen, Ole Mejlhede; Korzen, Migge Sofie Hoffmann; Skibsted, Jørgen

    1998-01-01

    This paper describes effects of cement type and temperature on chloride binding in cement paste, which is an important subject in relation to life-time modelling of reinforced concrete structures. The influence of cement type on chloride binding is investigated by substituting cement with pure...... cement clinker. Both theoretical considerations and experimental data for chloride binding in cement pastes are presented. A physico-chemically based model to describe the influence of temperature on physical binding of chloride is presented. Solid-state 27Al and 29Si magic-angle spinning (MAS) nuclear...... magnetic resonance (NMR) spectroscopy has been used for quantification of the anhydrous and hydrated aluminate and silicate phases in the chloride exposed cement pastes. The 27Al isotropic chemical shift and nuclear quadrupole coupling is reported for a synthetic sample of Friedel's salt, Ca2Al(OH)6Cl×2H2O....

  16. Pertunjukan Teater Karo Hip Hop Kontemporer KAI

    Directory of Open Access Journals (Sweden)

    Silvia Anggreni Purba

    2013-11-01

    Full Text Available Pertunjukan ini berawal dari sebuah ide untuk mengkolaborasikan tradisi Karo dengan budaya populer. Dengan cara seperti ini pertunjukan bisa dinikmati tanpa batasan bahasa dan budaya. Proses menggabungkan dua budaya yang berbeda merupakan bentuk budaya hibrida dan terjadi akibat proses globalisasi. Melalui proses pengendapan pengamatan dan kesan yang kuat, pertunjukan ini dibawa ke dalam bentuk Hip Hop. Pertunjukan ini merupakan bagian dari sebuah tragedi modern dengan karakter destruktif, mengeksplorasi emosi dan menyampaikannya kepada penonton. Eksplorasi budaya Karo dan tari Hip Hop sebagai bahasa simbol mampu memperkuat kata-kata. Gerak tidak diungkapkan dengan kata lisan tetapi disajikan melalui gerak tari Hip Hop. Penafsiran legenda dan teks ke dalam gerak, melalui proses pelatihan di laboratorium sebagai proses pencarian dan eksperimentasi diwujudkan dengan mempertimbangkan unsur-unsur dasar dari Hip Hop, unsur budaya Karo dan tontonan. Karo Hip Hop diharapkan menjadi bentuk estetika teater modern yang diinginkan tanpa kehilangan tradisi.Kata kunci: Tari Karo kontemporer, Hip-hop, budaya hibridaABSTRACTPertunjukan Teater Karo Hip Hop Kontemporer KAI. The performance of Karo Theater collaborated with Hip Hop stems from a simple idea to collaborate Karo cultural traditions with popular culture. The performances can be enjoyed without having limitation on the language and culture. The process of combining two different cultures is a form of hybrid culture, and it may occur due to the globalization process. Through the process of deposition of the observations and strong impression, this performance is then brought into the form of Hip Hop as a preferred form which is energetic, personal and global. This performance is part of a modern tragedy with its destructive character which has explored the emotion and has presented it to the audiences. The exploration of Karo cultural tradition and Hip Hop dance as a language of symbols is able to

  17. Hip Resurfacing Arthroplasty and Perioperative Blood Testing

    Directory of Open Access Journals (Sweden)

    Andrew Cook

    2014-01-01

    Full Text Available It is standard practice in many institutions to routinely perform preoperative and postoperative haemoglobin level testing in association with hip joint arthroplasty procedures. It is our observation, however, that blood transfusion after uncomplicated primary hip arthroplasty in healthy patients is uncommon and that the decision to proceed with blood transfusion is typically made on clinical grounds. We therefore question the necessity and clinical value of routine perioperative blood testing about the time of hip resurfacing arthroplasty. We present analysis of perioperative blood tests and transfusion rates in 107 patients undertaking unilateral hybrid hip resurfacing arthroplasty by the senior author at a single institution over a three-year period. We conclude that routine perioperative testing of haemoglobin levels for hip resurfacing arthroplasty procedures does not assist in clinical management. We recommend that postoperative blood testing only be considered should the patient demonstrate clinical signs of symptomatic anaemia or if particular clinical circumstances necessitate.

  18. Unstable total hip arthroplasty: detailed overview.

    Science.gov (United States)

    Berry, D J

    2001-01-01

    Hip dislocation is one of the most common complications of THA. Good preoperative planning, good postoperative patient education, accurate intraoperative component positioning, rigorous intraoperative testing of hip stability, and good repair of soft tissues during closure all help prevent dislocation. Early postoperative dislocations and first or second dislocations usually are treated with closed reduction and a hip guide brace or hip spica cast, but when dislocation becomes recurrent, surgical treatment usually is needed. When possible, surgical treatment is based on identifying and treating a specific problem leading to the dislocation, such as implant malposition, inadequate soft-tissue tension, or impingement. In selected circumstances, constrained implants or bipolar or tripolar implants provide powerful tools to restore hip stability.

  19. Femoral head fracture without hip dislocation

    Institute of Scientific and Technical Information of China (English)

    Aditya K Aggarwal; Ashwani Soni; Daljeet Singh

    2013-01-01

    Femoral head fractures without dislocation or subluxation are extremely rare injuries.We report a neglected case of isolated comminuted fracture of femoral head without hip dislocation or subluxation of one year duration in a 36-year-old patient who sustained a high energy trauma due to road traffic accident.He presented with painful right hip and inability to bear full weight on right lower limb with Harris hip score of 39.He received cementless total hip replacement.At latest follow-up of 2.3 years,functional outcome was excellent with Harris hip score of 95.Such isolated injuries have been described only once in the literature and have not been classified till now.The purpose of this report is to highlight the extreme rarity,possible mechanism involved and a novel classification system to classify such injuries.

  20. Contact dermatitis in cement workers in Isfahan

    Directory of Open Access Journals (Sweden)

    Iraji Fariba

    2006-01-01

    Full Text Available BACKGROUND: Due to recent industrialization and inadequately protected workers or in other words poor supervision on constructive workers habits in our large city of Isfahan cement contact dermatitis is relatively high especially among cement factory workers and constructive personnel. PURPOSES: To investigate the prevalence rate of cement contact dermatitis in cement factory workers in Isfahan. METHODS: A case-control clinical study was carried out by randomly selecing 150 factory workders and 150 official clerks in a cement factory in Isfahan in 2001. After a complete physical examination, data was recorded in observational checklists. FINDINGS: The percentages of contact dermatitis prevalences in the first and the second groups were 22% and 5.3% respectively. About 60% of cement workers with contact dermatitis were between 30-40 years of age. There was a direct relationship with age in both groups of the workers. In the high-exposure group, the hand eczema along was 70% but in the other group the percentage of involvement was the same in exposed and unexposed anatomical areas. CONCLUSIONS: There was a direct relationship between occurrence and the severity of involvement and duration of contact in the first group. Cent percent of cement workers had contact dermatitis after 10 or less years, but the percentage among the other group was 35%. LIMITATION: Irritant contact dermatitis to cement has not been detected.

  1. A note on cement in asteroids

    Science.gov (United States)

    Bilalbegović, G.

    2016-09-01

    Cement mineral tobermorite was formed in hydrothermal experiments on alternation of calcium-aluminum-rich inclusions (CAIs) in carbonaceous chondrite meteorites. Unidentified bands at 14 μm were measured for CAIs and the matrix of the Allende meteorite sample, as well as for Hektor and Agamemnon asteroids. The presence of cement nanoparticles may explain the feature at 14 μm.

  2. Basic Chemistry for the Cement Industry.

    Science.gov (United States)

    Turner, Mason

    This combined student workbook and instructor's guide contains nine units for inplant classes on basic chemistry for employees in the cement industry. The nine units cover the following topics: chemical basics; measurement; history of cement; atoms; bonding and chemical formulas; solids, liquids, and gases; chemistry of Portland cement…

  3. Investigation of a Hardened Cement Paste Grout

    DEFF Research Database (Denmark)

    Esteves, Luis Pedro; Sørensen, Eigil Verner

    This report documents a series of tests performed on a hardened cement paste grout delivered by the client, Det Norske Veritas A/S.......This report documents a series of tests performed on a hardened cement paste grout delivered by the client, Det Norske Veritas A/S....

  4. Chloride ingress in cement paste and mortar

    DEFF Research Database (Denmark)

    Jensen, Ole Mejlhede; Hansen, Per Freiesleben; Coats, Alison M.

    1999-01-01

    In this paper chloride ingress in cement paste and mortar is followed by electron probe microanalysis. The influence of several paste and exposure parameters on chloride ingress are examined (e.g., water-cement ratio, silica fume addition, exposure time, and temperature), The measurements...

  5. TECHNOLOGICAL CHANGES IN THE CEMENT MANUFACTURING INDUSTRY.

    Science.gov (United States)

    WESSON, CARL E.

    THE PURPOSE OF THIS STUDY IS TO PRESENT A PRELIMINARY PICTURE OF OCCUPATIONAL CHANGES BROUGHT ABOUT IN THE MANUFACTURE OF CEMENT AS A RESULT OF INTRODUCING AUTOMATED EQUIPMENT. ONE AUTOMATED AND SEVERAL CONVENTIONAL TYPE CEMENT PLANTS WERE STUDIED. ANALYSIS OF DATA OBTAINED THROUGH RESEARCH AND DATA COLLECTED DURING THE STUDY REVEALED THAT…

  6. A note on cement in asteroids

    CERN Document Server

    Bilalbegovic, G

    2016-01-01

    Cement mineral tobermorite was formed in hydrothermal experiments on alternation of calcium-aluminum-rich inclusions (CAIs) in carbonaceous chondrite meteorites. Unidentified bands at 14 microns were measured for CAIs and the matrix of the Allende meteorite sample, as well as for Hektor and Agamemnon asteroids. The presence of cement nanoparticles may explain the feature at 14 microns.

  7. Effect of hydrogen sulfide emissions on cement mortar specimens

    Energy Technology Data Exchange (ETDEWEB)

    Idriss, A. F. [Alberta Environment, Science and Technology Branch, Edmonton, AB (Canada); Negi, S. C.; Jofriet, J. C.; Haywoard, G. L. [Guelph Univ., Guelph, ON (Canada)

    2001-07-01

    Six different cement mortar specimens used in animal buildings, where they were exposed to hydrogen sulfide generated from anaerobic fermentation of manure during a period of one year, were investigated. Primary interest was on comparing the corrosion resistance of different cement mortar specimens under long term exposure to hydrogen sulfide. The impressed voltage technique was used to test the specimens in the laboratory. Results revealed that test specimens made with eight per cent silica fume cement replacement performed best and similar Portland cement mortar specimens with a water-cement ratio of 0.55 (PC55) the poorest. All other treatments, (Portland cement with a water to cement ratio of 045, Portland cement Type 50, Portland cement with fibre mesh and Portland cement Type 10 coated with linseed oil) all with water-cement ratios of 0.45, were less effective in preventing corrosion than silica fume replacement.

  8. [Use of the anatomical cemented femoral stem SAS I: mid-term results].

    Science.gov (United States)

    Mikláš, M; Pink, M; Valoušek, T

    2015-01-01

    PURPOSE OF THE STUDY In view of increasing interest in a relationship between the surface of an implant and its behaviour and longevity in total hip arthroplasty (THA), the aim of this study is to present the clinical and radiographic results, as well as complications, of hip replacement surgery using the cemented femoral stem SAS I. MATERIAL AND METHODS A total of 298 cemented femoral stems SAS I were implanted in 275 patients at our department between 1996 and 2005. The patient average age was 72.1 years, with the range from 64 to 92 years. The pre-operative diagnoses were as follows: primary osteoarthritis in 179 (30.1%); post-dysplastic osteoarthritis in 41 (13.7%); femoral neck fracture in 44 (14.8%); avascular necrosis of the femoral head in 23 (7.7%); rheumatoid arthritis in nine (3%) and other causes in two (0.7%) patients. Of the 275 patients who had the surgery, 186 (204 THAs) underwent clinical and X-ray examination at an average follow-up of 11.5 years (range, 8 to 17 years). The clinical results were used to calculate the Harris hip score and radiographic evaluation was based on antero-posterior views. RESULTS The group of 186 assessed patients (204 THAs) comprised 106 women and 80 men, who were on average 85.4 years old on evaluation (range, 72 to 92 years). Of the remaining patients, 62 patients (64 THAs) died from causes unrelated to the surgery and 27 patients (30 THAs) were lost to follow-up. The functional outcome of surgery assessed by the Harris hip score was excellent in 61 (32.8%), good in 94 (50.5%), satisfactory in 26 (14%) and poor in five (2.7%) patients. The 93.1% SAS I stem longevity was recorded in relation to aseptic loosening; reimplantation for this indication was performed in 14 THAs. No revision surgery for failure due to valgus/varus deviations of the stem was carried out. Of the 204 hips, 188 had femoral stems aligned in neutral, 12 (5.9%) in valgus and four (2%) in varus positions. DISCUSSION The anatomical femoral stem SAS I

  9. CO2 Capture for Cement Technology

    DEFF Research Database (Denmark)

    Pathi, Sharat Kumar

    Production of cement is an energy intensive process and is the source of considerable CO2emissions. Itis estimated that the cement industry contributes around 8% of total global CO2emissions. CO2is oneof the major greenhouse gases. In the atmosphere, the CO2concentration has increased from 310...... performed recently has focused on CO2capture from fossil fuel-based power plants. Inherently,this process is especially suitablefor cement plants, as CaO used for CO2capture is also a majoringredient for clinker production. Thus, a detailed investigation was carried outto study the applicationof...... the carbonate looping process to the cement industry. In order to study the application of thecarbonate looping process to cement industry, the project work is divided into three scales: 1) atparticle scale (TGA), 2) at reactor scale (Fluid-bed) and 3) at process scale (process modeling Pro/II).The results from...

  10. Shrinkage Properties of Cement Stabilized Gravel

    DEFF Research Database (Denmark)

    Lund, Mia Schou Møller; Hansen, Kurt Kielsgaard

    2014-01-01

    Cement stabilized gravel is an attractive material in road construction because its strength prop-erties are accommodating the increasingly higher requirements to the bearing capacity of a base course. However, reflection cracking of cement stabilized gravel is a major concern. In this pa......-per the shrinkage properties of cement stabilized gravel have been documented under various temperature and relative humidity conditions. Two cement contents corresponding to a 28-days compressive strength of 6.2 MPa and 12.3 MPa have been tested and compared. It is found that the coefficient of linear expansion...... for the two cement contents is 9.9 × 10-6 ⁰C-1 and 11.3 × 10-6 ⁰C-1, respectively. Furthermore, it is found that reflecting cracking can mainly be explained by temperature dependent shrinkage rather than moisture dependent shrinkage....

  11. Energetically Modified Cement (EMC) - Performance Mechanism

    Energy Technology Data Exchange (ETDEWEB)

    Ronin, Vladimir; Elfgren, Lennart [Luleaa Univ. of Technology (Sweden). Centre for High Performance Cement

    2003-03-01

    Energetically Modified Cements, EMC, made of intensively milled cement (50%) and fillers (50%) of quartz or fly ash have been compared to blends of Ordinary Portland Cement, OPC, and fillers. The EMCs have better properties than other blends and are comparable to unblended OPC. This remarkable fact can probably be explained as follows. The grinding process reduces the size of both cement grains and fillers. This combined with the creation of micro defects gives the ground cement a very high degree of hydration. The increased early hydration and a better distribution of hydration products results in an extensive pore size refinement of the hardened binder. This pore size refinement leads to a favorably reduced permeability and diffusivity and very good mechanical properties.

  12. Clinical and radiographic evaluation of long-stem femoral components following revision total hip arthroplasty.

    Science.gov (United States)

    Meding, J B; Ritter, M A; Keating, E M; Faris, P M

    1994-08-01

    Fifty-four consecutive, long-stem revision hip arthroplasties were performed in 53 patients. In order to evaluate periprosthetic femoral changes, all cases utilizing cement, requiring bone-grafts for prosthetic stability, or with a follow-up period of less than 2 years were omitted. Thus, 32 long-stem revision hip arthroplasties in 32 patients were reviewed. Twenty-three Porous Coated Anatomic (Howmedica, Rutherford, NJ) and nine Bi-Metric (Biomet, Warsaw, IN) stems were implanted, with an average follow-up period of 3.6 years (range, 2-6 years). Prosthetic canal fill averaged 94% proximally and 80% distally. Intraoperative complications included three femoral shaft fractures. Harris hip scores averaged 47.8 points, before surgery and 87.6 points at the final follow-up evaluation, with 81% of patients the pain-free. Only three cases of subsidence and one case of osteolysis were noted. By 1 year, proximal osteopenia (off-load) (P = .005), bony condensation about the porous surface (spot weld) (P = .01), and pedestal formation (P = .004) were observed. The presence of distal cortical hypertrophy, (P = .02) spot weld (P = .001), and pedestal formation (P = .05) correlated significantly with off-load. Pedestal formation and distal cortical hypertrophy were commonly found together (P = .001). Despite significant periprosthetic remodeling, adequate fixation and satisfactory early clinical scores were achieved in this setting. Contrary to similar reviews using extensive bone-grafts, acceptable pain-free clinical results were obtained with these components.

  13. Clinical and radiological outcome of the cemented Contemporary acetabular component in patients < 50 years of age.

    Science.gov (United States)

    Schmitz, M W J L; Timmer, C; Rijnen, W H C; Gardeniers, J W M; Schreurs, B W

    2013-12-01

    Despite the worldwide usage of the cemented Contemporary acetabular component (Stryker), no published data are available regarding its use in patients aged Contemporary acetabular component with the Exeter cemented stem between January 1999 and January 2006. There were 152 hips in 126 patients, 61 men and 65 women, mean age at surgery 37.6 years (16 to 49 yrs). One patient was lost to follow-up. Mean clinical follow-up of all implants was 7.6 years (0.9 to 12.0). All clinical questionnaire scores, including Harris hip score, Oxford hip score and several visual analogue scales, were found to have improved. The eight year survivorship of all acetabular components for the endpoints revision for any reason or revision for aseptic loosening was 94.4% (95% confidence interval (CI) 89.2 to 97.2) and 96.4% (95% CI 91.6 to 98.5), respectively. Radiological follow-up was complete for 146 implants. The eight year survival for the endpoint radiological loosening was 93.1% (95% CI 86.2 to 96.6). Three surviving implants were considered radiologically loose but were asymptomatic. The presence of acetabular osteolysis (n = 17, 11.8%) and radiolucent lines (n = 20, 13.9%) in the 144 surviving cups indicates a need for continued observation in the second decade of follow-up in order to observe their influence on long-term survival. The clinical and radiological data resulting in a ten-year survival rate > 90% in young patients support the use of the Contemporary acetabular component in this specific patient group.

  14. Creep behavior of hand-mixed Simplex P bone cement under cyclic tensile loading.

    Science.gov (United States)

    Verdonschot, N; Huiskes, R

    1994-01-01

    Acrylic cement, used for the fixation of total hip replacements and other orthopedic implants, is a subject of renewed scientific interest as a result of recent hypotheses about dynamic, long-term mechanical failure mechanisms suspected to play a role in prosthetic loosening. Little is known, however, about the long-term mechanical behavior of cement. In this study, the dynamic creep deformation of hand mixed acrylic cement was examined in laboratory tests. Strain patterns found represented the familiar creep process consisting of a primary, a secondary, and a tertiary creep phase. Specimens dynamically loaded with a maximum stress of 3 MPa from 0 were subject to creep of about 50% of the elastic strain after 250 000 loading cycles. A linear relationship between the logarithmic values of the creep-strain and the number of loading cycles was found. Specimens exposed to higher loads showed significantly higher creep-strains. No relationship could be established between the strain levels and the porosity of the specimens. Specimens dynamically loaded with a maximal stress of 7 or 11 MPa from 0 failed during the tests. The number of loading cycles to failure was similar to fatigue strength data reported in earlier literature.

  15. Pack cementation coatings for alloys

    Energy Technology Data Exchange (ETDEWEB)

    He, Yi-Rong; Zheng, Minhui; Rapp, R.A. [Ohio State Univ., Columbus, OH (United States)

    1996-08-01

    The halide-activated pack cementation process was modified to produce a Ge-doped silicide diffusion coating on a Cr-Cr{sub 2}Nb alloy in a single processing step. The morphology and composition of the coating depended both on the composition of the pack and on the composition and microstructure of the substrate. Higher Ge content in the pack suppressed the formation of CrSi{sub 2} and reduced the growth kinetics of the coating. Ge was not homogeneously distributed in the coatings. In cyclic and isothermal oxidation in air at 700 and 1050{degrees}C, the Ge-doped silicide coating protected the Cr-Nb alloys from significant oxidation by the formation of a Ge-doped silica film. The codeposition and diffusion of aluminum and chromium into low alloy steel have been achieved using elemental Al and Cr powders and a two-step pack cementation process. Sequential process treatments at 925{degrees}C and 1150{degrees}C yield dense and uniform ferrite coatings, whose compositions are close to either Fe{sub 3}Al or else FeAl plus a lower Cr content, when processed under different conditions. The higher content of Al in the coatings was predicted by thermodynamic calculations of equilibrium in the gas phase. The effect of the particle size of the metal powders on the surface composition of the coating has been studied for various combinations of Al and Cr powders.

  16. Cements with low Clinker Content

    Science.gov (United States)

    García-Lodeiro, I.; Fernández-Jiménez, A.; Palomo, A.

    2015-11-01

    Hybrid alkaline cements are multi-component systems containing a high percentage of mineral additions (fly ash, blast furnace slag), low proportions (clinker and scarce amounts of alkaline activators. The substantially lower amount of clinker needed to manufacture these binders in comparison to ordinary Portland cement is both economically and ecologically beneficial. Their enormous versatility in terms of the raw materials used has made them the object of considerable interest. The present study explored the mechanical strength of binary blends mixes; B1= 20% clinker (CK) + 80% fly ash (FA) and B2=20% clinker + 80% blast furnace slag (BFS), both hydrated in the presence and absence of an alkaline activator specifically designed for this purpose. The use of the activator enhanced the development of early age strength considerably. All the hydrated matrices were characterised with XRD, SEM/EDX and (29Si and 27Al) NMR. The use of the alkaline activator generated reaction products consisting primarily of a mix of gels ((N,C)-A-S-H and C-A-S-H) whose respective proportions were found to depend upon system composition and initial reactivity.

  17. Reconstruction of the Acetabulum in Developmental Dysplasia of the Hip in Total Hip Replacement

    Directory of Open Access Journals (Sweden)

    Vasileios Sakellariou

    2014-09-01

    Full Text Available Developmental dysplasia of the hip (DDH or congenital hip dysplasia (CDH is the most prevalent developmental childhood hip disorder. It includes a wide spectrum of hip abnormalities ranging from dysplasia to subluxation and complete dislocation of the hip joint. The natural history of neglected DDH in adults is highly variable. The mean age of onset of symptoms is 34.5 years for dysplastic DDH, 32.5 years for low dislocation, 31.2 years for high dislocation with a false acetabulum, and 46.4 years for high dislocation without a false acetabulum. Thorough understanding of the bony and soft tissue deformities induced by dysplasia is crucial for the success of total hip arthroplasty. It is important to evaluate the existing acetabular deformity three-dimensionally, and customize the correction in accordance with the quantity and location of ace tabular deficiencies. Acetabular reconstruction in patients with DDH is hallenging. Interpretation of published data is difficult and should be done with caution because most series include patients with different types of hip disease. In general, the complication rate associated with THA is higher in patients with hip dysplasia than it is in patients with osteoarthritis. Overall, clinical and functional outcomes following THA in patients hip dysplasia (DDH differ from those treated for primary hip osteoarthritis, possibly due to the lower age and level of activity. Although function scores decline with age, the scores for pain and range of motion presented with a statistically significant improvement in the long-term.

  18. Cement compositions for cementing wells, allowing pressure gas-channeling in the cemented annulus to be controlled

    Energy Technology Data Exchange (ETDEWEB)

    Parcevaux, P.A.; Piot, B.M.; Vercaemer, C.J.

    1987-01-27

    The invention relates to cement compositions for cementing oil and geothermal wells. These compositions allow pressure gas-channeling to be effectively controlled up to more than about 485/sup 0/F. The compositions according to the invention comprise four essential constituents: a cement, a styrene-butadiene latex, a latex stabilizer, and water. The cement is a hydraulic cement belonging to any class among those currently used for cementing oil wells. The useful stabilizers according to the invention are anionic polyelectrolytes such as lignosulfanates and their desulfonated and/or resulfonated derivatives; sulfonated lignin-Kraft products; melamine-formaldehyde resins modified by a sulfonic acid or sulfite; formaldehyde/sulfonated naphthalene resins; or the condensation products of bi-nuclear sulfonated phenols and of formaldehyde. Preferred are the sodium salts of the condensation product of mononaphthalenesulfonic acid and of formaldehyde. The patent also includes a description of tests of various cement compositions of the invention, plus scanning electron microscope observations. 10 figs., 7 tabs.

  19. Sustainable development of the cement industry and blended cements to meet ecological challenges.

    Science.gov (United States)

    Sobolev, Konstantin

    2003-05-05

    The world production of cement has greatly increased in the past 10 years. This trend is the most significant factor affecting technological development and the updating of manufacturing facilities in the cement industry. Existing technology for the production of cement clinker is ecologically damaging; it consumes much energy and natural resources and also emits pollutants. A new approach to the production of blended or high-volume mineral additive (HVMA) cement helps to improve its ecological compatibility. HVMA cement technology is based on the intergrinding of portland cement clinker, gypsum, mineral additives, and a special complex admixture. This new method increases the compressive strength of ordinary cement, improves durability of the cement-based materials, and--at the same time--uses inexpensive natural mineral additives or industrial by-products. This improvement leads to a reduction of energy consumption per unit of the cement produced. Higher strength, better durability, reduction of pollution at the clinker production stage, and decrease of landfill area occupied by industrial by-products, all provide ecological advantages for HVMA cement.

  20. Sustainable Development of the Cement Industry and Blended Cements to Meet Ecological Challenges

    Directory of Open Access Journals (Sweden)

    Konstantin Sobolev

    2003-01-01

    Full Text Available The world production of cement has greatly increased in the past 10 years. This trend is the most significant factor affecting technological development and the updating of manufacturing facilities in the cement industry. Existing technology for the production of cement clinker is ecologically damaging; it consumes much energy and natural resources and also emits pollutants. A new approach to the production of blended or high-volume mineral additive (HVMA cement helps to improve its ecological compatibility. HVMA cement technology is based on the intergrinding of portland cement clinker, gypsum, mineral additives, and a special complex admixture. This new method increases the compressive strength of ordinary cement, improves durability of the cement-based materials, and - at the same time - uses inexpensive natural mineral additives or industrial by-products. This improvement leads to a reduction of energy consumption per unit of the cement produced. Higher strength, better durability, reduction of pollution at the clinker production stage, and decrease of landfill area occupied by industrial by-products, all provide ecological advantages for HVMA cement.

  1. Pain in the hip joint

    Directory of Open Access Journals (Sweden)

    Yuri Aleksandrovich Olyunin

    2013-01-01

    Full Text Available Pathological changes that develop in the hip joints (HJ have different origins and mechanisms of development, but their main manifestation is pain. The nature of this pain cannot be well established on frequent occasions. The English-language medical literature currently classifies such disorders as greater trochanter pain syndrome (GTPS. Its major signs are chronic pain and local palpatory tenderness in the outer part of HJ. The development of GTPS may be associated with inflammation of the synovial bursae situated in the greater tronchanter, as well as with tendinitis, myorrhexis, iliotibial band syndrome, and other local changes in the adjacent tissues or with systemic diseases. So GTPS may be characterized as regional pain syndrome that frequently mimics pain induced by different diseases, including myofascial pain syndrome, osteoarthrosis, spinal diseases, etc.

  2. 结识Hip-Hop

    Institute of Scientific and Technical Information of China (English)

    尚劲

    2010-01-01

    Hip-Hop是一种美国街头黑人文化,可分成五个要素:音乐、舞蹈、涂鸦、刺青和衣着。源自80年代美国纽约的黑人社区BRONX,他们将生活上的娱乐发展成为现今多样的Hip—HOP文化,发挥黑人独有的特质,如节奏感及歌声进而舒缓情绪和消遣。因带有乐观开朗的特质,逐渐地在全美蔓延开来,进而扩散到全世界。

  3. Mechanical Evaluation of Polymer Composite Hip Protectors

    Directory of Open Access Journals (Sweden)

    Jose Daniel Diniz Melo

    2010-01-01

    Full Text Available Hip fractures often result in serious health implications, particularly in the geriatric population, and have been related to long-term morbidity and death. In most cases, these fractures are caused by impact loads in the area of the greater trochanter, which are produced in a fall. This work is aimed at developing hip protectors using composite materials and evaluating their effectiveness in preventing hip fractures under high impact energy (120 J. The hip protectors were developed with an inner layer of energy absorbing soft material and an outer rigid shell of fiberglass-reinforced polymer composite. According to the experimental results, all tested configurations proved to be effective at reducing the impact load to below the average fracture threshold of proximal femur. Furthermore, an addition of Ethylene Vinyl Acetate (EVA to the impacted area of the composite shell proved to be beneficial to increase impact strength of the hip protectors. Thus, composite hip protectors proved to be a viable alternative for a mechanically efficient and cost-effective solution to prevent hip fractures.

  4. Dehydration kinetics of Portland cement paste at high temperature

    NARCIS (Netherlands)

    Zhang, Q.; Ye, G.

    2012-01-01

    Portland cement paste is a multiphase compound mainly consisting of calcium-silicate-hydrate (CSH) gel, calcium hydroxide (CH) crystal, and unhydrated cement core. When cement paste is exposed to high temperature, the dehydration of cement paste leads to not only the decline in strength, but also th

  5. Low levels of human HIP14 are sufficient to rescue neuropathological, behavioural, and enzymatic defects due to loss of murine HIP14 in Hip14-/- mice.

    Directory of Open Access Journals (Sweden)

    Fiona B Young

    Full Text Available Huntingtin Interacting Protein 14 (HIP14 is a palmitoyl acyl transferase (PAT that was first identified due to altered interaction with mutant huntingtin, the protein responsible for Huntington Disease (HD. HIP14 palmitoylates a specific set of neuronal substrates critical at the synapse, and downregulation of HIP14 by siRNA in vitro results in increased cell death in neurons. We previously reported that mice lacking murine Hip14 (Hip14-/- share features of HD. In the current study, we have generated human HIP14 BAC transgenic mice and crossed them to the Hip14-/- model in order to confirm that the defects seen in Hip14-/- mice are in fact due to loss of Hip14. In addition, we sought to determine whether human HIP14 can provide functional compensation for loss of murine Hip14. We demonstrate that despite a relative low level of expression, as assessed via Western blot, BAC-derived human HIP14 compensates for deficits in neuropathology, behavior, and PAT enzyme function seen in the Hip14-/- model. Our findings yield important insights into HIP14 function in vivo.

  6. 21 CFR 890.3665 - Congenital hip dislocation abduction splint.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Congenital hip dislocation abduction splint. 890....3665 Congenital hip dislocation abduction splint. (a) Identification. A congenital hip dislocation abduction splint is a device intended for medical purposes to stabilize the hips of a young child...

  7. Dislocation following revision total hip arthroplasty.

    Science.gov (United States)

    Gioe, Terence J

    2002-04-01

    Dislocation is a relatively common complication following revision total hip arthroplasty. Risk factors include surgical approach, gender, underlying diagnosis, comorbidities, surgical experience, and previous surgery; for later dislocations, risk factors include wear/deformation of polyethylene, trauma, and decreased muscle strength. Prevention and precaution are the watchwords for dislocations following revision total hip arthroplasty. For dislocations that do occur, treatment rests first on identifying the source of instability. Most dislocations can be managed by closed reduction. Constrained components may increase success rates, but only for appropriate indications. Prevention and treatment of dislocations following revision total hip arthroplasty are discussed in this article.

  8. The hip abductors at MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Hoffmann, A., E-mail: adrienne.hoffmann@balgrist.ch [Department of Radiology, University Hospital Balgrist, Forchstrasse 340, CH-8008 Zürich (Switzerland); Pfirrmann, C.W.A., E-mail: christian.pfirrmann@balgrist.ch [Department of Radiology, University Hospital Balgrist, Forchstrasse 340, CH-8008 Zürich (Switzerland)

    2012-12-15

    Imaging of the hip abductors plays an increasing role for the evaluation of greater trochanteric pain in patients with and without total hip arthroplasty. This review article addresses the anatomy of the hip abductors and their intervening bursae. It highlights different possible imaging appearances such as tendinopathy or partial and full thickness tears of the gluteal tendons. Muscle atrophy or fatty degeneration of the gluteal muscles is an important reason for limping. Inflammatory diseases such as hydroxyapatite crystal deposition disease or spondylarthritis have to be considered. Knowledge of these different entities is important to achieve optimal treatment and outcomes.

  9. Total hip arthroplasty after previous fracture surgery.

    Science.gov (United States)

    Krause, Peter C; Braud, Jared L; Whatley, John M

    2015-04-01

    Total hip arthroplasty can be a very effective salvage treatment for both failed fracture surgery and hip arthritis that may occur after prior fracture surgery. The rate of complications is significantly increased including especially infection, dislocation, and loosening. Complications are more likely to occur after failed open reduction and internal fixation than after posttraumatic arthritis. Adequately ruling out infection before hip arthroplasty can be difficult. The best predictor of infection is a prior infection. Long-term outcomes can be comparable to outcomes in other conditions if complications are avoided.

  10. The ligamentum teres of the adult hip.

    Science.gov (United States)

    Bardakos, N V; Villar, R N

    2009-01-01

    Advances in hip arthroscopy have renewed interest in the ligamentum teres. Considered by many to be a developmental vestige, it is now recognised as a significant potential source of pain and mechanical symptoms arising from the hip joint. Despite improvements in imaging, arthroscopy remains the optimum method of diagnosing lesions of the ligamentum teres. Several biological or mechanical roles have been proposed for the ligament. Unless these are disproved, the use of surgical procedures that sacrifice the ligamentum teres, as in surgical dislocation of the hip, should be carefully considered. This paper provides an update on the development, structure and function of the ligamentum teres, and discusses associated clinical implications.

  11. 够胆,Hip-Hop欢迎你

    Institute of Scientific and Technical Information of China (English)

    E.B.

    2012-01-01

    Hip-Hop音乐至今不过30多年历史,这个从无到有杀出重围的野孩子,血液里跳动着的满是突破条条框框、建立新秩序的冲劲。一切没有的,我们皆生造。没有比Hip-Hop圈的进入门槛再低的了。不问出身不论背景,只要你够胆,Hip-Hop欢迎你。

  12. Dermatoses in cement workers in southern Taiwan.

    Science.gov (United States)

    Guo, Y L; Wang, B J; Yeh, K C; Wang, J C; Kao, H H; Wang, M T; Shih, H C; Chen, C J

    1999-01-01

    Construction workers are known to have occupational dermatoses. The prevalence of such dermatoses was unknown in Taiwanese construction workers. The objective of this study was to determine the work exposure, prevalence of skin manifestations, and sensitivity to common contact allergens in cement workers of southern Taiwan. A total of 1147 current regular cement workers were telephone-interviewed about skin problems during the past 12 months, work exposure, and personal protection. Among those interviewed, 166 were examined and patch tested with common contact allergens. A high % of cement workers reported skin problems in the past 12 months. More men (13.9%) reported skin problems possibly related to work than women (5.4%). Prevalence was associated with lower use of gloves, duration of work as cement worker, and more time in jobs involving direct manual handling of cement, especially tiling. A high % of dermatitis was noted in the 166 workers examined, which correlated with reported skin problems. On patch testing, construction workers had a high frequency of sensitivity to chromate. Sensitivity to chromate or cobalt was associated with reported skin problems, or dorsal hand dermatitis on examination. These workers' dermatitis was under-diagnosed and inadequately managed. It is concluded that cement workers in southern Taiwan had a high prevalence of skin problems related to cement use. Protective measures, work practice, and physician education should be improved to prevent or manage such problems.

  13. International development trends in low-energy cements

    Energy Technology Data Exchange (ETDEWEB)

    Stark, J.; Mueller, A.

    1988-04-01

    Besides the currently dominant tendency to increase the proportion of interground additive in cement, the following development trends are internationally emerging in the material composition of so-called low-energy cements with a view to minimizing energy input for cement manufacture: (1) active belite cement with the principal clinker minerals a'C/sub 2/S and C/sub 3/S; (2) belite sulphoaluminate cement (..beta.. C/sub 2/S, C/sub 4/A/sub 3/S); (3) belite sulphoferrite cement (..beta.. C/sub 2/S, C/sub 4/AF, C/sub 4/A/sub 3/S); (4) NTS cement (alinite).

  14. Comparison of acetabular reamings during hip resurfacing versus uncemented total hip arthroplasty.

    LENUS (Irish Health Repository)

    Brennan, S A

    2009-04-01

    PURPOSE: To compare the quantity of bone removed from the acetabulum during resurfacing hip arthroplasty versus uncemented total hip arthroplasty (THA). METHODS: 62 consecutive patients with osteoarthritis of the hip were prospectively studied. 24 men and 7 women aged 40 to 86 (mean, 59) years underwent Birmingham hip resurfacing. 13 men and 18 women aged 34 to 88 (mean, 61) years underwent uncemented THA using the trident acetabular cup. Obese elderly women at risk of femoral neck fracture and patients with large subchondral pseudocysts or a history of avascular necrosis of the femoral head were assigned to uncemented THA. Acetabular reamings were collected; marginal osteophytes were not included. The reamings were dehydrated, defatted, and weighed. RESULTS: The mean weight of acetabular reamings was not significantly different between patients undergoing hip resurfacing and uncemented THA (p=0.57). CONCLUSION: In hip resurfacing, the use of an appropriately small femoral component avoids oversizing the acetabular component and removal of excessive bone stock.

  15. Hemiarthroplasties after hip fractures in Norway and Sweden: a collaboration between the Norwegian and Swedish national registries.

    Science.gov (United States)

    Gjertsen, Jan-Erik; Fenstad, Anne Marie; Leonardsson, Olof; Engesæter, Lars Birger; Kärrholm, Johan; Furnes, Ove; Garellick, Göran; Rogmark, Cecilia

    2014-01-01

    National registration of hemiarthroplasties after hip fractures has been established in both Norway and Sweden. We aimed to investigate differences in demographics, choice of implant selection, surgical approaches, and reoperations between the Norwegian Hip Fracture Register (NHFR) and the Swedish Hip Arthroplasty Register (SHAR). As part of the Nordic Arthroplasty Register Association (NARA) project a common hemiarthroplasty dataset has been established. 36,989 primary hemiarthroplasties (HAs) for acute hip fractures reported to NHFR (n = 12,761) and SHAR (n = 24,228) for the period 2005-2010 were included. Cemented prostheses were used in 78% of the operations in Norway and in 95% of the patients in Sweden. In Norway HAs almost exclusively had bipolar design (98%), whereas in Sweden HAs with unipolar design were used in 42% of the cases. Monoblock (non-modular) prostheses were uncommon, but still more frequently used in Sweden than in Norway (6.9% and 2.1% respectively). The lateral approach was more common in Norway (83%) than in Sweden (52%), where the posterior approach was used in 42% of the cases. The five-year survival of all HAs was 95.5% (95% CI: 94.8-96.2) in Norway and 94.8% (95% CI: 94.4-95.3) in Sweden. We concluded that surprisingly large differences between the two countries in demographics, implant design, and surgical technique had been revealed. This common dataset enables further investigations of the impact of these differences on revision rates and mortality.

  16. The prevalence of predisposing deformity in osteoarthritic hip joints

    DEFF Research Database (Denmark)

    Klit, Jakob; Gosvig, Kasper; Jacobsen, Steffen;

    2011-01-01

    relationship in both sexes with the clinical presentation. The study cohort which fulfilled these inclusion criteria consisted of 322 females (149 right hips and 173 left hips) and 162 males (77 right hips and 85 left hips) with osteoarthritis. We found an overall prevalence of predisposing hip deformities...... in females of 62.4% and in males of 78.9%. Minor and major deformities showed the same prevalence. Both sexes had a comparable prevalence of minor and major hip joint deformity, except for pistol grip deformity, which was more prevalent in men. We concluded that 'idiopathic osteoarthritis' is uncommon......, and that even minor predisposing deformities are associated with hip osteoarthritis....

  17. Holocene cemented beach deposits in Belize

    Science.gov (United States)

    Gischler, Eberhard; Lomando, Anthony J.

    1997-06-01

    Two types of cemented beach deposits occur on reef islands off the coast of Belize. These are (1) intertidal beachrock that is dominantly cemented by marine aragonite and high-magnesium-calcite cements, and (2) supratidal cayrock that is cemented mainly by vadose low-magnesium-calcite cements. Besides differences in position relative to present sea level and resulting early diagenesic features, beachrock and cayrock can be distinguished on the basis of differences in composition, texture, geographical position, and age. Whereas the composition of beachrock is similar to that of the adjacent marginal reef sediments, cayrock is enriched in benthic foraminifera. Intertidal beachrock is moderately to well sorted and well cemented, while supratidal cayrock is very well sorted, poorly cemented and friable. Beachrock occurs preferentially on windward beaches of sand-shingle Gays on the middle and southern barrier reefs and on the isolated platforms Glovers and Lighthouse Reefs. Cayrock only occurs on larger mangrove-sand Gays of the isolated platforms Turneffe Islands, Lighthouse Reef, and the northern barrier reef. 14C-dating of ten whole-rock and mollusk shell samples produced calibrated dates between AD 345 and AD 1435 for beachrock and between BC 1085 and AD 1190 for cayrock. The large-scale distribution of beachrock in Belize supports the contention that physical processes such as water agitation rather than biological processes control beachrock formation and distribution. Only on windward sides of cays that are close to the reef crest, where large amounts of seawater flush the beaches, considerable amounts of cements can be precipitated to produce beachrock. Cayrock forms due to cementation in the vadose zone and is only preserved on larger, stable mangrove-sand cays.

  18. Comparison of Temperature Field Distribution between Cement Preclinkering Technology and Cement Precalcining Technology

    Institute of Scientific and Technical Information of China (English)

    XU Xun; WANG Lan

    2016-01-01

    Through the comparison of calcination conditions between cement preclinkering technology and cement precalcining technology, we studied the characteristics of temperature ifeld distribution of cement preclinkering technology systems including cyclone preheater, preclinkering furnace, and rotary kiln. We used numerical simulation method to obtain data of temperature ifeld distribution.Some results are found by system study. The ratio of tail coal of cement preclinkering technology is about 70%, and raw meal temperature can reach 1070℃. ShorterL/D kiln type of preclinkering technology can obtain more stable calcining zone temperature. The highest solid temperature of cement preclinkering technology is higher than 80℃, and high temperature region (>1450℃) length is 2 times, which is beneifcial for calcining clinker and higher clinker quality. So cement preclinkering technology can obtain more performance temperature ifled, which improves both the solid-phase reaction and liquid-phase reaction.

  19. Current practice in primary total hip replacement: results from the National Hip Replacement Outcome Project

    OpenAIRE

    Best, A. J.; Fender, D.; Harper, W. M.; McCaskie, A. W.; Oliver, K; Gregg, P J

    1999-01-01

    As part of the National Study of Primary Hip Replacement Outcome, 402 consultant orthopaedic surgeons from three regions were contacted by postal questionnaire which covered all aspects of total hip replacement (THR). There was a 70% response rate of which 71 did not perform hip surgery, a further 33 refused to take part, leaving 181 valid responses. Preoperative assessment clinics were used by 89% of surgeons, but anaesthetists and rehabilitation services were rarely involved at this stage. ...

  20. Changes in Hip and Knee Muscle Strength in Patients Following Total Hip Arthroplasty

    OpenAIRE

    Fukumoto, Yoshihiro; Ohata, Koji; Tsukagoshi, Rui; Kawanabe, Keiich; Akiyama, Haruhiko; Mata, Toshihiro; Kimura, Misaka; Ichihashi, Noriaki

    2013-01-01

    Objective: To investigate changes in hip and knee muscle strength in patients before and after total hip arthroplasty (THA) in comparison with that in healthy adults. Methods: The study included 21 women who underwent unilateral THA (THA group) and 21 age-matched healthy women (healthy group). Maximal isometric strengths of hip flexors, extensors, and abductors, and knee extensors and flexors were measured before surgery and at 4 weeks and 6 months after surgery. Results: Before surgery, musc...