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Sample records for cementless total hip

  1. Cementless isoelastic RM total hip prosthesis1

    OpenAIRE

    Bombelli, Renato; Mathys, Robert

    1982-01-01

    Some surgeons are beginning to doubt the reliability of bone cement in joint replacements. In 1967 Robert Mathys conceived the idea of an isoelastic prosthesis made of plastic, which would anchor into the bone without cement. He developed the idea by extensive tests in animals and, in 1973, the first human RM cementless hip prosthesis was inserted by E Morscher. In this paper the concept of the cementless isoelastic prosthesis is developed by Robery Mathys, and Professor Bombelli records his ...

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

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    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

  3. Short term results of cementless total hip arthroplasty in sicklers

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    Yash Gulati

    2015-01-01

    Conclusion: THA in sicklers involves considerable challenge for the orthopedic surgeon. Management requires a multidisciplinary approach involving the anesthetist, hematologist and the orthopedic surgeon. Contrary to previous reports, THA in sicklers now has a predictable outcome especially with the use of cementless implants.

  4. Total hip arthroplasty in patients with avascular necrosis of the hip. Follow-up observations on cementless and cemented operations.

    Science.gov (United States)

    Katz, R L; Bourne, R B; Rorabeck, C H; McGee, H

    1992-08-01

    Thirty-one patients with avascular necrosis of the hip were treated by 34 total hip arthroplasties (THAs). All patients were observed prospectively with a minimum two-year follow-up evaluation (average, 46 months; range, 24-84 months). Twenty had cemented arthroplasties using contemporary cementing techniques. This included insertion of a medullary plug, cleansing of the canal with a medullary brush, pulsatile lavage irrigation, and insertion of the cement with a cement gun. In 14 hips, a cementless prosthesis was used. Patients were rated using a modified Harris hip score. Sequential postoperative roentgenograms were analyzed in each patient. The overall Harris hip score ratings were 88 in the cemented and 84 in the noncemented groups. Mechanical failure with loosening of the femoral component occurred in one patient who developed deep sepsis. Significant thigh pain occurred in four patients in the noncemented group. Previous studies in the literature have generally reported unfavorable results in patients with avascular necrosis of the hip treated with THA. Using cementless and cemented fixation with contemporary cementing techniques, improved results can be expected. A high incidence of thigh pain (29%) in the cementless group remains a problem. PMID:1499201

  5. Total hip arthroplasty with cementless cups and femoral head autografts for patients with hip dysplasia and osteoarthritis

    Institute of Scientific and Technical Information of China (English)

    吴立东; 金礼斌; 严世贵; 杨泉森; 戴雪松; 王祥华

    2004-01-01

    Objective:To evaluate the outcome of total hip arthroplasty (THA) with cementless cups and femoral head autografts for patients with hip dysplasia and osteoarthritis.Methods: Between 1995 and 2002, we implanted 23cementless cups and femoral head autografts in 20 patients with hip dysplasia and osteoarthritis. In this study, a retrospective study was made on 21 hips in 20 patients (18females and 2 males, aged 50 years on an average) with developmental hip dysplasia treated by THA with acementless cup and femoral head autograft. The acetabular cup was placed at the level of the true acetabuinm and all the patients required autogenous femoral head grafts due to acetabular deficiency. The average rate of the acetabular cup covered by the femoral head autograft was 31%(ranging from 10% to 45%). Eight hips had less than 25%cup coverage and thirteen between 25% and 50%. The average follow-up period was 4.7 years (range, 1-8 years).The replacing outcome was evaluated by modified Harris hip score. Preoperative and follow-up radiographs were made.Results: All the autografts were united to the host bones. No autograft was collapsed or no component from the hip was loosed in all the patients. According to the modified Harris hip score, the average hip score increased from 46 before operation to 89 at the final review. Before operation, the leg-length discrepancy was greater than 2 cm in all the patients except one with bilateral hip dysplasia.After operation, only 2 out of 20 patients had a leg-length discrepancy greater than 1 cm. Three hips showed minor bone resorption in the lateral portion of the graft, which did not support the cup. Three hips developed Grade 1Brooker heterotopic ossification and one developed Grade 2.Conclusions: THA with a cementless cup and a femoral head autograft for patients with osteoarthritis resulted from hip dysplasia can result in favorable outcomes. This method can provide reliable acetabular fixation and restore the acetabular bone stock in

  6. Radiographic and clinical analysis of cementless acetabular fixation in total hip arthroplasty

    Institute of Scientific and Technical Information of China (English)

    ZHANG Hui; PEI Fu-xing; YANG Jing; SHEN Bin; SHI Rui

    2005-01-01

    Objective: To investigate the factors affecting the fixation, loosening and therapeutic effect of cementless acetabular prosthesis through following up the patients with total hip arthroplasty clinically and radiographically.Methods: From February 1998 to May 1999, 139 patients (148 hips) underwent total hip arthroplasty with cementless acetabular prosthesis in our department. In this study, the clinical therapeutic effect and the anteroposterior radiographs of the pelvis and anteroposterior and lateral radiographs of the hips of 109 patients (116 hips) made before operation, at 1 week, 3, 6, and 12 months after operation and annually thereafter were analyzed retrospectively. The clinical therapeutic effects were evaluated with Harris hip score. Radiographs were used to observe the position of prostheses and the bone changes around the implant, and to measure the wearing speed and direction of the acetabular cup. All evaluations were made by an independent examiner who did not participate in the operation. The patients were followed up for 5-6 years.Results: The mean Harris score was 44 points (range, 10-70 points) before operation, but it increased to 92.4 points (range, 80-100 points) at the latest review after operation, which was significantly higher than that before operation (P<0.05). No acetabular component was revised because of infection or aseptic loosening. And no acetabular component migrated. There was no revision of fixed acetabular component because of pelvic osteolysis secondary to polyethylene wear. The mean linear wear rate was 0.15 mm per year. All the acetabular prostheses were classified as stable on the radiographs.Conclusions: In terms of fixation, total hip arthroplasty with cementless acetabular components was successful. Although there is no aseptic loosening and a low incidence of osteolysis at the latest follow-up evaluation, polyethylene wear cannot be avoided and can lead to expansile osteolysis near the cups. This kind of osteolysis

  7. Delayed cementless total hip arthroplasty for neglected dislocation of hip combined with complex acetabular fracture and deficient bone stock

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    Gavaskar Ashok S

    2012-12-01

    Full Text Available 【Abstract】Total hip arthroplasty (THA for an un-treated acetabular fracture is technically challenging and the long-term result is not so favorable. A 45-year-old fe-male patient with untreated column and comminuted poste-rior wall fracture of the acetabulum was treated in our insti-tution by reconstruction of the posterior wall using iliac strut autograft and plate stabilization of the posterior col-umn with cancellous grafting and cementless THA in a single stage. At 3 years’ follow-up, the patient was independently mobile without limb length discrepancy. Radiological evalu-ation showed well integrated components and bone grafts. No evidence of aseptic loosening or osteolysis was found. This report aims to emphasize that bony acetabular recon-struction allows the use of primary hip components, which improves prosthesis longevity and preserves bone stock for a future revision. Key words: Acetabulum; Fractures, bone; Hip dislocation; Arthroplasty, replacement, hip

  8. Treatment of Hip Dysplasia in a Dog after a Failed Triple Pelvic Osteotomy with a Zurich Cementless Total Hip Replacement

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    SY Heo and H.B Lee*

    2013-07-01

    Full Text Available An Alaskan Malamute (2-year-old, castrated male, 41kg was referred with bilateral hind limb lameness. The dog had a history of a bilateral triple pelvic osteotomy (TPO to correct hip dysplasia one year previously, a surgery that was unsuccessful. On physical examination, pain and crepitus were noted in both hip joints. There was hip joint subluxation and mild degenerative changes bilaterally seen by radiograph. A Zurich cementless total hip replacement (ZCTHR was planned for the right hind limb. After a craniolateral approach, an acetabular cup and a cementless femoral stem were implanted. The femoral head was placed in the femoral stem, and the prosthetic joint was then reduced. At a 9 month postoperative checkup, there was no pain on palpation or manipulation of the right pelvic limb, and the range of motion was within normal limits. On radiological examination, there was no implant loosening. The ZCTHR can thus be applied in a failed TPO patient as a revision surgery.

  9. Delayed cementless total hip arthroplasty for neglected dislocation of hip combined with complex acetabular fracture and deficient bone stock

    Institute of Scientific and Technical Information of China (English)

    Ashok S Gavaskar; Naveen Chowdary Tummala

    2012-01-01

    Total hip arthroplasty (THA) for an untreated acetabular fracture is technically challenging and the long-term result is not so favorable.A 45-year-old female patient with untreated column and comminuted posterior wall fracture of the acetabulum was treated in our institution by reconstruction of the posterior wall using iliac strut autograft and plate stabilization of the posterior column with cancellous grafting and cementless THA in a single stage.At 3 years' follow-up,the patient was independently mobile without limb length discrepancy.Radiological evaluation showed well integrated components and bone grafts.No evidence of aseptic loosening or osteolysis was found.This report aims to emphasize that bony acetabular reconstruction allows the use of primary hip components,which improves prosthesis longevity and preserves bone stock for a future revision.

  10. 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

  11. A multicenter approach evaluating the impact of vitamin E-blended polyethylene in cementless total hip replacement

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    Marcus Jäger

    2014-04-01

    Full Text Available Since polyethylene is one of the most frequently used biomaterials as a liner in total hip arthroplasty, strong efforts have been made to improve design and material properties over the last 50 years. Antioxidants seems to be a promising alternative to further increase durability and reduce polyethylene wear in long term. As of yet, only in vitro results are available. While they are promising, there is yet no clinical evidence that the new material shows these advantages in vivo. To answer the question if vitamin-E enhanced ultra-high molecular weight polyethylene (UHMWPE is able to improve long-term survivorship of cementless total hip arthroplasty we initiated a randomized long-term multicenter trial. Designed as a superiority study, the oxidation index assessed in retrieval analyses of explanted liners was chosen as primary parameter. Radiographic results (wear rate, osteolysis, radiolucency and functional outcome (Harris Hip Scores, University of California-Los Angeles, Hip Disability and Osteoarthritis Outcome Score, Visual Analogue Scale will serve as secondary parameters. Patients with the indication for a cementless total hip arthroplasty will be asked to participate in the study and will be randomized to either receive a standard hip replacement with a highly cross-linked UHMWPE-X liner or a highly cross-linked vitamin-E supplemented UHMWPE-XE liner. The follow-up will be 15 years, with evaluation after 5, 10 and 15 years. The controlled randomized study has been designed to determine if Vitamin-E supplemented highly cross-linked polyethylene liners are superior to standard XLPE liners in cementless total hip arthroplasty. While several studies have been started to evaluate the influence of vitamin-E, most of them evaluate wear rates and functional results. The approach used for this multicenter study, to analyze the oxidation status of retrieved implants, should make it possible to directly evaluate the ageing process and development

  12. Migration pattern of cementless press fit cups in the presence of stabilizing screws in total hip arthroplasty

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    Zilkens C

    2011-03-01

    Full Text Available Abstract The aim of this study was to evaluate the initial acetabular implant stability and late acetabular implant migration in press fit cups combined with screw fixation of the acetabular component in order to answer the question whether screws are necessary for the fixation of the acetabular component in cementless primary total hip arthroplasty. One hundred and seven hips were available for follow-up after primary THA using a cementless, porous-coated acetabular component. A total of 631 standardized radiographs were analyzed digitally by the "single-film-x-ray-analysis" method (EBRA. One hundred 'and one (94.4% acetabular components did not show significant migration of more than 1 mm. Six (5.6% implants showed migration of more than 1 mm. Statistical analysis did not reveal preoperative patterns that would identify predictors for future migration. Our findings suggest that the use of screw fixation for cementless porous- coated acetabular components for primary THA does not prevent cup migration.

  13. Migration pattern of cementless press fit cups in the presence of stabilizing screws in total hip arthroplasty.

    Science.gov (United States)

    Zilkens, C; Djalali, S; Bittersohl, B; Kälicke, T; Kraft, C N; Krauspe, R; Jäger, Marcus

    2011-03-28

    The aim of this study was to evaluate the initial acetabular implant stability and late acetabular implant migration in press fit cups combined with screw fixation of the acetabular component in order to answer the question whether screws are necessary for the fixation of the acetabular component in cementless primary total hip arthroplasty. One hundred and seven hips were available for follow-up after primary THA using a cementless, porous-coated acetabular component. A total of 631 standardized radiographs were analyzed digitally by the "single-film-x-ray-analysis" method (EBRA). One hundred and one (94.4 %) acetabular components did not show significant migration of more than 1 mm. Six (5.6%) implants showed migration of more than 1 mm. Statistical analysis did not reveal preoperative patterns that would identify predictors for future migration. Our findings suggest that the use of screw fixation for cementless porous-coated acetabular components for primary THA does not prevent cup migration. PMID:21486725

  14. The dimensional accuracy of preparation of femoral cavity in cementless total hip arthroplasty

    Institute of Scientific and Technical Information of China (English)

    WU Li-dong (吴立东); HAHNE H.J.; HASSENPFLUG J.

    2004-01-01

    Objective: To observe the accuracy of femoral preparation and the position of the cementless prosthesis in femoral cavity, and to compare the results between the computer-assisted surgical group (CASPAR) and the conventional group. Methods: Ten femoral components were implanted either manually or by CASPAR in cadaver femurs. The specimens were cut to 3 mm thick slices. Microradiograms of every slice were sent to a computer for analysis with special software (IDL). The gaps and the medullary cavities between component and bone, the direct bone contact area of the implant surface,the gap width and the percentage of gap and bone contact area were measured in every slice. Results: In the proximal implant coated with HA of the CASPAR group, the average percentage of bone contact reached 93.2% (ranging from 87.6% to 99.7%); the average gap percentage was 2.9% (ranging from 0.3% to 7.8%); the maximum gap width was 0.81 mm and the average gap width was only 0.20 mm. While in the conventional group, the average percentage of bone contact reached 60.1% (ranging from 49.2% to 70.4%); the average gap percentage was 32.8% (ranging from 25.1% to 39.9%); the maximum gap width was 2.97 mm and the average gap width was 0.77 mm. The average gap around the implant in the CASPAR group was only 9% of that in the manual group; the maximum and average gap widths were only about 26% of those in the manual group. On the other hand, the CASPAR group showed 33% higher bone contact than the manual group. Conclusion: With the use of robotics-assisted system, significant progress can be achieved for femoral preparation in total hip arthroplasty.

  15. The dimensional accuracy of preparation of femoral cavity in cementless total hip arthroplasty

    Institute of Scientific and Technical Information of China (English)

    吴立东; HAHNEH.J.; HASSENPFLUGJ.

    2004-01-01

    Objective: To observe the accuracy of femoral preparation and the position of the cementless prosthesis in femoral cavity, and to compare the results between the computer-assisted surgical group (CASPAR) and the conventional group. Methods: Ten femoral components were implanted either manually or by CASPAR in cadaver femurs. The specimens were cut to 3mm thick slices. Microradiograms of every slice were sent to a computer for analysis with special software (IDL). The gaps and the medullary cavities between component and bone, the direct bone contact area of the implant surface, the gap width and the percentage of gap and bone contact area were measured in every slice. Results: In the proximal implant coated with HA of the CASPAR group, the average percentage of bone contact reached 93.2% (ranging from 87.6% to 99.7%); the average gap percentage was 2.9% (ranging from 0.3% to 7.8%); the maximum gap width was 0.81mm and the average gap width was only 0.20mm. While in the conventional group, the average percentage of bone contact reached 60.1% (ranging from 49.2% to 70.4%); the average gap percentage was 32.8% (ranging from 25.1% to 39.9%); the maximum gap width was 2.97mm and the average gap width was 0.77mm. The average gap around the implant in the CASPAR group was only 9% of that in the manual group; the maximum and average gap widths were only about 26% of those in the manual group. On the other hand, the CASPAR group showed 33% higher bone contact than the manual group. Conclusion: With the use of robotics-assisted system, significant progress can be achieved for femoral preparation in total hip arthroplasty.

  16. Cementless Hydroxyapatite Coated Hip Prostheses

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    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.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    BACKGROUND: The objective of this 5-year prospective study of 51 hips was to assess migration of a cementless tapered femoral stem using radiostereometric analysis (RSA), plain radiographs (radiolucencies), and patient-reported outcome measures (PROMs). METHODS: Forty-seven patients (51 hips...

  18. Failure of Polyethylene Inlays in Cementless Total Hip Arthroplasty: A Retrieval Analysis

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    Ulrike Mueller

    2016-01-01

    Full Text Available A retrieval analysis has been performed on 50 polyethylene inlays of cementless screw ring implants (Mecring, Mecron, Berlin, Germany to investigate the failure mechanism of this specific open cup hip arthroplasty design that has shown a high clinical failure rate. Design-specific damage modes like rim creep, collar fatigue, and backside wear were assessed. Furthermore, the inlays were measured using a CMM to determine deformation. In 90% backside wear was observed and collar fatigue occurred in 68% of the cases. Rim creep was present in 38% of the polyethylene inlays. In 90% of the cases the cup opening diameter was 32.1 mm or less and 46% had a diameter less than 32 mm. It seems that creep and deformation of the polyethylene leads to a reduced diameter at the cup opening and consequently decreased clearance. To avoid this type of failure, polyethylene inlays should be supported at the back by the cup to reduce the risk of ongoing creep deformation.

  19. Biomechanical evaluation of adjunctive cerclage wire fixation for the prevention of periprosthetic femur fractures using cementless press-fit total hip replacement.

    Science.gov (United States)

    Christopher, Scott A; Kim, Stanley E; Roe, Simon; Pozzi, Antonio

    2016-08-01

    Periprosthetic femoral fractures are a common complication associated with cementless press-fit total hip arthroplasty. The use of prophylactic cerclage wire fixation has been advocated to reduce this complication. The objective of this study was to evaluate whether a double loop cerclage wire, used as adjunctive fixation, increased the peak torsional load to failure in femora implanted with press-fit cementless stems. Peak torsional load to failure was compared between femora without adjunctive fixation and femora receiving a 1 mm double loop cerclage wire placed proximally to the lesser trochanter. Femora treated with adjunctive cerclage wire fixation failed at 20% greater peak torque (P = 0.0001). In conclusion, a double loop cerclage wire may aid in the prevention of periprosthetic fractures associated with press-fit cementless femoral stems. PMID:27387718

  20. The effects of pulsed low frequency magnetic field in early rehabilitation of patients with cementless total hip arthroplasty

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    Đurović Aleksandar

    2006-01-01

    Full Text Available Introduction: Early rehabilitation of patients with cementless total hip arthroplasty (cTHA includes different physical modalities and pulsed low frequency magnetic field (PLFMF, which effects have not been explored yet. Objective: To investigate the effects of PLFMF which was applied in different doses in early rehabilitation of patients with cTHA. Method: Prospective, controlled, clinical study included 90 patients, divided in three groups with 30 patients each. First two groups were treated with high (group A or low (group B doses of PLFMF, in addition to kinesitherapy. Control group C was treated only with kinesitherapy. Study was completed in three weeks. Results: Subjects of group A had significantly lower pain than group B (p<0.01 and group C (p<0.001 subjects in the first postoperative week. Pain in group B subjects was significantly lower than in group C in all three postoperative weeks (p<0.01. In relation to other two groups, subjects of group A had higher hip Harris score values at the end of the third postoperative week (p<0.05, and they were faster on 10-meter distance at the end of the first postoperative week (p<0.01. Conclusion: PLFMF used in low and high doses for patients with cTHA had significant effects on pain abatement, especially at higher doses. Improvement of function was earlier and more manifested in the group treated with high doses of PLFMF.

  1. Functional and radiographic evaluation and quality of life analysis after cementless total hip arthroplasty with ceramic bearings: minimum of 5 years follow-up

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    Rafael Borghi Mortat

    2013-12-01

    Full Text Available Objective: The aim of the study is to analyze and correlate functional and radiographic results and quality of life in patients undergoing cementless total hip arthroplasty with ceramic surface, performed at Hospital Servidor Publico de Sao Paulo from 2001 to 2006. Methods: We retrospectively analyzed 35 hips treated with cementless total hip arthroplasty with ceramic surfaces with a minimum follow-up of 5 years. Functional evaluation was based on the Harris Hip Score (HHS. Radiographic evaluation was based on the method proposed by Charles Engh for evaluation of femoral osseointegration and on DeLee and Charnley zones for acetabulum. Quality of life was assessed by SF-36 questionnaire. Results: The HHS presented excellent and good results in 91% of patients postoperatively (mean of 93.14 points HHS. As for radiographic evaluation, we found excellent results in 100% of evaluated hips (proven osseointegration. SF-36 scores were not compared to the control group for the following components: pain, vitality, mental health and social aspects. The difference between HHS pre and postoperatively had a statistically significant correlation with physical functioning of the SF-36. Conclusion: Total hip arthroplasty with ceramic surface is a treatment that enables functional improvement of the hip and increases quality of life of patients to levels close to those of people without joint diseases.

  2. Cementless total hip arthroplasty with the rectangular titanium Zweymuller stem. A concise follow-up, at a minimum of fifteen years, of a previous report.

    Science.gov (United States)

    Grübl, Alexander; Chiari, Catharina; Giurea, Alexander; Gruber, Martin; Kaider, Alexandra; Marker, Martina; Zehetgruber, Harald; Gottsauner-Wolf, Florian

    2006-10-01

    Between October 1986 and November 1987, 208 total hip arthroplasties were performed with use of the cementless Zweymüller stem and a threaded cup in 200 consecutive patients. Of 102 patients (108 hips) who were available for follow-up at a minimum of 180 months postoperatively, eighty-three (eighty-nine hips) had the primary joint replacement still intact. No stem had been revised because of aseptic loosening, but we found various degrees of osteolysis around sixteen (18%) of the implants. The probability of survival of the stem at fifteen years was 0.98 (95% confidence interval, 0.96 to 1.00). The probability of survival of the cup was 0.85 (95% confidence interval, 0.79 to 0.91). PMID:17015598

  3. Migration measurement of acetabular components in cementless total hip arthroplasty; Messung der Pfannenwanderung bei zementfreien Hueftimplantaten

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    Eckardt, A.; Karbowski, A.; Schwitalle, M.; Vogel, J.; Boden, F.; Seeleitner, C. [Mainz Univ. (Germany). Orthopaedische Klinik und Poliklinik; Schunk, K. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Mayrhofer, P. [Innsbruck Univ. (Austria). Inst. fuer Mathematik und Geometrie

    1998-08-01

    Migration measurements of acetabular components using a special computer aided method (EBRA = abbrevation for the German term ``Ein-Bild-Roentgenanalyse``) were performed to evaluate early results of the implants and predict aseptic loosening. Methods: Standard ap-radiographs of the pelvis were marked, specific points were digitised. Simulating the spatial situation the programme computes lengitudinal and vertical migration of the cup. 74 acetabular components in 71 patients could be studied by migration measurements. Results: 14 patients showed migration of more than 1 mm, which is the confidence limit of this method. Each of these patients showed diverse reasons for the migration, i.e. osteoporosis of the acetabular bone stock or problems concerning the surgical technique which means malposition of the cup or insufficient reaming of the bone. There were some patients with severe congenital dysplasia of the hip and in some cases the inclination angle of the cup was too great. Conclusion: The technique applied for measuring migration of acetabular components can be useful for evaluating early instability of the implant and can be helpful in detecting problems concerning the surgical technique. (orig.) [Deutsch] Mittels der Ein-Bild-Roentgenanalyse wurden Pfannenwanderungen nach Implantation von zementfreien, sphaerischen Hueftgelenkspfannen erfasst, um Praediktoren fuer die langfristige Prognose der Implantate zu evaluieren. Methoden: Nach Markierung von Referenzpunkten in den Beckenuebersichtsaufnahmen wurden diese digitalisiert, vom Programm verrechnet und die Wanderung des Implantats im Verlauf angegeben. Bei 71 Patienten wurden von 74 Pfannen ueber einen Mindestnachuntersuchungszeitraum von 12 Monaten Migrationsmessungen durchgefuehrt. Das Konfidenzintervall der Methode liegt bei <1 mm. Bei jedem dieser Patienten fanden sich Hinweise entweder auf ein schlechtes Knochenlager, auf operationsbedingte Probleme, wenn keine ausreichende Primaerstabilitaet der Pfanne

  4. Interface Micromotion of Cementless Hip Stems in Simulated Hip Arthroplasty

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    Mohammed R.A. Kadir

    2009-01-01

    Full Text Available Problem statement: The design of hip prostheses has evolved over time due to various complications found after hip replacement surgery. The currently commercially available cementless femoral stems can be categorized into one of three major types, straight cylindrical, tapered rectangular and anatomical. Each type proposes a unique concept to achieve primary stability-a major requirement for bone healing process. Virtual analyses have been made on individual implants, but comparison between the three major types is required to determine the strength and weaknesses of the design concepts. Approach: Three types of implants were modeled in three dimensions-the straight cylindrical, rectangular taper and anatomical. The size of the three implants was carefully designed to fit and fill the canal of a femur reconstructed from a computed tomography image dataset. Hip arthroplasty was simulated virtually by inserting the hip stem into the femoral canal. Finite element method was used in conjunction with a specialized sub-routine to measure micromotion at the bone-implant interface under loads simulating physiological walking and stair-climbing. Another sub-routine was used to assign bone properties based on the grayscale values of the CT image. Results: All the three types of cementless hip stems were found to be stable under both walking and stair climbing activities. Large micromotion values concentrated around the proximal and distal part of the stems. Conclusion/Recommendations: The three major types of hip stems were compared in this study and all of them were found to be stable after simulated physiological activities.

  5. Impaction grafting in the femur in cementless modular revision total hip arthroplasty: a descriptive outcome analysis of 243 cases with the MRP-TITAN revision implant

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    Wimmer Matthias D

    2013-01-01

    Full Text Available Abstract Background We present a descriptive and retrospective analysis of revision total hip arthroplasties (THA using the MRP-TITAN stem (Peter Brehm, Weisendorf, GER with distal diaphyseal fixation and metaphyseal defect augmentation. Our hypothesis was that the metaphyseal defect augmentation (Impaction Bone Grafting improves the stem survival. Methods We retrospectively analyzed the aggregated and anonymized data of 243 femoral stem revisions. 68 patients with 70 implants (28.8% received an allograft augmentation for metaphyseal defects; 165 patients with 173 implants (71.2% did not, and served as controls. The mean follow-up was 4.4 ± 1.8 years (range, 2.1–9.6 years. There were no significant differences (p > 0.05 between the study and control group regarding age, body mass index (BMI, femoral defects (types I-III as described by Paprosky, and preoperative Harris Hip Score (HHS. Postoperative clinical function was evaluated using the HHS. Postoperative radiologic examination evaluated implant stability, axial implant migration, signs of implant loosening, periprosthetic radiolucencies, as well as bone regeneration and resorption. Results There were comparable rates of intraoperative and postoperative complications in the study and control groups (p > 0.05. Clinical function, expressed as the increase in the postoperative HHS over the preoperative score, showed significantly greater improvement in the group with Impaction Bone Grafting (35.6 ± 14.3 vs. 30.8 ± 15.8; p ≤ 0.05. The study group showed better outcome especially for larger defects (types II C and III as described by Paprosky and stem diameters ≥ 17 mm. The two groups did not show significant differences in the rate of aseptic loosening (1.4% vs. 2.9% and the rate of revisions (8.6% vs. 11%. The Kaplan-Meier survival for the MRP-TITAN stem in both groups together was 93.8% after 8.8 years. [Study group 95.7% after 8.54 years ; control group 93

  6. Modified cementless total coxofemoral prosthesis: development, implantation and clinical evaluation

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    S.A. Arias

    2013-12-01

    Full Text Available The aim of this study was to modify canine coxofemoral prostheses and the clinical evaluation of the implantation. Fifteen canine hips and femora of cadavers were used in order to study the surface points of modification in prostheses and develop a perforation guide. Femoral stems and acetabular components were perforated and coated with biphasic calcium phosphate layer. Twelve young adult male mongrel dogs were implanted with coxofemoral prostheses. Six were operated upon and implanted with cemented canine modular hip prostheses, establishing the control group. The remaining six were implanted with a novel design of cementless porous tricalcic phosphate-hydroxyapatite coated hip prostheses. Clinical and orthopedic performance, complications, and thigh muscular hypotrophy were assessed up to the 120th post-operatory day. After 120 days, animals with cementless prostheses had similar clinical and orthopedic performance compared to the cemented group despite the increased pain thigh hypotrophy. Animals that underwent cementless hip prosthesis evidenced more pain, compared to animals with cemented hip prosthesis that required longer recuperation time. No luxations, two fractures and two isquiatic neurapraxies were identified in the course of the study. Using both the cemented and the bioactive coated cementless model were suitable to dogs, showing clinical satisfactory results. Osseointegration and biological fixation were observed in the animals with the modified cementless hip prosthesis.

  7. Cementless Hip Arthroplasty in Southern Iran, Midterm Outcome and Comparison of Two Designs

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    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.

  8. Effect of proximal femoral osteoporosis on cementless hip arthroplasty: A short-term clinical analysis

    Institute of Scientific and Technical Information of China (English)

    LOU Xian-feng; LI Yu-hong; LIN Xiang-jin

    2007-01-01

    Objective: The aim of this retrospective investigation was to explore the influence of femoral osteoporosis on short-term curative effects of cementless hip arthroplasty and to evaluate the femoral metaphyseal bone mineral density (BMD) for femoral osteoporosis in order to guide prosthesis choice and rehabilitation. Methods: We performed 127 total arthroplasty operations between June 1999 to February 2003 and investigated 49 cementless hip replacements with the Metalcancellous cementless Lubeck Ⅱ system being used in all hips. There were twenty men and twenty-nine women whose mean age at the time of the operation was 60 years (range, 52~81 years). The patients were divided into osteoporosis or normal groups according to the femoral metaphyseal BMD measured preoperatively. The average duration of follow-up was 30 months (range, 8~52 months). We evaluated all of the patients from a clinical standpoint with use of a standard-terminology questionnaire with respect to the short-term curative effects and patients' satisfaction. Hip pain status and functional ability were important indicators of treatment efficacy. Results: Harris hip score and patients' satisfaction in femoral osteoporosis patients who underwent noncemented hip arthroplasty were lower (P=0.004, P=0.03) while the incidence of thigh pain was higher (P=0.03) than the patients with non-osteoporosis. Conclusion: The higher incidence of pain, as well as the decrease in function experienced by the patients in osteoporosis group, supports the case that cementless arthroplasty is not a better choice for those patients and that we had better select prosthesis based on the femoral metaphyseal BMD.

  9. Effects of femoral component material properties on cementless fixation in total hip arthroplasty. A comparison study between carbon composite, titanium alloy, and stainless steel.

    Science.gov (United States)

    Otani, T; Whiteside, L A; White, S E; McCarthy, D S

    1993-02-01

    Carbon-fiber-reinforced-carbon composite material is an attractive implant material because its modulus of elasticity can be made similar to that of cortical bone. This study investigated the effect of femoral prosthesis elastic modulus on cementless implant fixation. Distal, as well as proximal, relative micromovements between implant and bone were measured in two testing protocols (axial-load and torsional-load), comparing identically shaped carbon composite (modulus of elasticity = 18.6 GPa), Ti6Al4V (100 GPa), and 630 stainless steel (200 GPa) prostheses. In the axial-load test, proximal mediolateral micromotions were significantly larger in the flexible composite stem than in the two metals. In the torsional-load test, rotational micromotions and "slop" displacements in the flexible stem were significantly larger proximally and significantly smaller distally than in the two metals. While these results suggest that proximal stress transfer may be improved by a flexible stem, they raise the possibility of increased proximal micromotion, and suggest that improved proximal fixation may be necessary to achieve clinical success with flexible composite femoral components.

  10. A biodegradable gentamicin-hydroxyapatite-coating for infection prophylaxis in cementless hip prostheses

    NARCIS (Netherlands)

    Neut, D.; Dijkstra, R. J. B.; Thompson, J. I.; Kavanagh, C.; van der Mei, H. C.; Busscher, H. J.

    2015-01-01

    A degradable, poly (lactic-co-glycolic acid) (PLGA), gentamicin-loaded prophylactic coating for hydroxyapatite (HA)-coated cementless hip prostheses is developed with similar antibacterial efficacy as offered by gentamicin-loaded cements for fixing traditional, cemented prostheses in bone. We descri

  11. Correlative analysis of MRI-evident abductor hip muscle degeneration and power after minimally invasive versus conventional unilateral cementless THA.

    Science.gov (United States)

    Vasilakis, Ioannis; Solomou, Ekaterini; Vitsas, Vasilis; Fennema, Peter; Korovessis, Panagiotis; Siamblis, Dimitrios K

    2012-12-01

    The 2 main null hypotheses of this study were: (1) the 4-year surgical trauma-related degeneration within the hip abductor muscles after a minimally invasive approach to total hip arthroplasty would be similar to that following a conventional approach; and (2) no differences in perioperative blood loss or postoperative hip pain would be observed between the minimally invasive and conventional approaches.In 40 consecutive randomly selected adult patients with unilateral primary hip osteoarthritis, a cementless Zweymüller-Plus THA (Smith & Nephew Orthopaedics, Baar, Switzerland) was implanted by a single surgeon in 1 institution during the same period. Twenty patients underwent a minimally invasive approach (group A), and 20 patients underwent a conventional anterolateral approach (group B). Four years postoperatively, the operated and contralateral nonoperated hips of 37 available patients from both groups were examined with magnetic resonance imaging to show any changes in the gluteus medius and tensor fascia latae. Simultaneously, hip abductor power was measured bilaterally in both groups. Anthropometric data, blood loss, Short Form 36 self-assessment questionnaire, visual analog pain score, and walking distance were also analyzed.The reliability of magnetic resonance imaging and hip abductor power measurements was high. No difference was found in hip abductor power on the operated side between the 2 groups, whereas hip abductor power on the nonoperated side was significantly higher in both groups. This study revealed no mechanical and functional benefits in favor of patients undergoing minimally invasive vs conventional total hip arthroplasty.

  12. H/G非骨水泥人工全髋关节置换术后聚乙烯内杯磨损临床研究%Polyethylene wear and osteolysis in H/G cementless total hip arthroplasty

    Institute of Scientific and Technical Information of China (English)

    文立成; 李军; 马忠泰

    2009-01-01

    目的 对H/G非骨水泥人工全髋关节置换术后聚乙烯内杯的磨损及髋臼周围骨溶解的情况进行总结.方法 我院1991至1995年共进行58例(65髋)H/G非骨水泥人工全髋关节置换,其中35例(40髋)获得10年以上随访.对这35例(40髋)患者获得随访的病例,采用计算机数字化方法测量髋臼聚乙烯内杯的二维线性磨损.结果 35例40髋均有不同程度的磨损,磨损范围2~8 mm,平均磨损为(0.32±0.31)mm/年.10髋聚乙烯磨损超过6 mm,髋臼假体周围的骨溶解严重,并伴有金属假体的移位,其中5髋聚乙烯内杯完伞磨透,金属股骨头与金属髋臼相接触;5髋聚乙烯内杯磨损严重伴明显骨溶解,内杯松动.2髋聚乙烯内杯脱位.共实施翻修手术12例,包括更换聚乙烯内杯和金属股骨头2例、金属闩杯翻修2例、全髋翻修8例.28髋在髋臼侧发现骨溶解,其中14髋股骨侧亦有骨溶解发生.结论 本组病例所观测到的H/G髋臼聚乙烯内杯的磨损程度超过文献所报道,而且由于磨损产生的大量磨屑,导致假体周围出现明显骨溶解,直接影响到假体的稳定.关节置换术后应定期随访,避免出现严重骨溶解后增加翻修手术的困难.%Objectives To measure the linear polyethelene wear with use of a computer-assisted two-dimensional method, and to evaluate the relationship between wear and long-term clinic-radiological findings. Methods Between December 1991 and December 1995, the senior author performed 40 primary total hip arthroplasties with use of H/G porous-coated acetabular component Radiographs of 40 H/G cementless total hip arthroplasies were examined for osteolysis, radiolucent line, cup migration and so on. To measure the linear polyethylene wear, migration in the femoral head center relative to the cup shell center was calculated on digitized consecutive radiographs with special computer software program. Results The minimum follow-up was 10 years. Total linear wear

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

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    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.

  14. Total hip arthroplasty

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    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.

  15. 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

  16. UNCEMENTED PRIMARY TOTAL HIP ARTHROPLASTY FOR OSTEONECROSIS OF HIP WITH SECONDARY OSTEOARTHRITIS IN YOUNG ADULTS

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    Chatla

    2016-03-01

    Full Text Available BACKGROUND Osteonecrosis of the femoral head is a progressive disease that generally affects patients in the third through fifth decade of life, if left untreated. Currently, 18% of all Total Hip Arthroplasty performed in USA are done for Osteonecrosis.(1 The aetiology for the Osteonecrosis varies from idiopathic, alcohol intoxication, steroid abuse or due to childhood hip disorders and hip trauma. We have selected 40 patients suffering from advanced femoral head osteonecrosis with subchondral collapse leading to Osteoarthritis of hip in young adults, treated by uncemented primary total hip replacement. This study is aimed to suggest that uncemented total hip arthroplasty can be applied predictably to this younger, potentially more active patient population. MATERIAL AND METHODS We have done 54 uncemented primary hips in 40 cases with mean follow-up of 5.5 years. The average age of the patient at the time of surgery was 43 years. All the hips are clinically and radiologically examined both pre- and post-operatively. All the cases are operated through postero-lateral approach and have used the fully Hydroxyapatite coated femoral straight stem designed for press fit insertion and hemispherical HA-coated cup inserted with press fit and in few cases we used an HA-coated screw. The patients are under regular follow-up. RESULTS All the patients are reviewed at 6 weeks, 3 months, 6 months and yearly thereafter. The clinical and functional status was recorded using the Harris Hip Score and WOMAC Hip Score. The mean Harris score has improved from an average of 44 points to an average of 93 points postoperatively; 94% showed good-to-excellent results, 2% of cases had shortening, one case developed hip dislocation after two weeks due to unguarded physiotherapy. CONCLUSION The short-term results of cementless total hip arthroplasty in patients with Osteonecrosis of the femoral head were encouraging. We await further follow-up to see if these promising

  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. The effect of abductor muscle and anterior-posterior hip contact load simulation on the in-vitro primary stability of a cementless hip stem

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    Frei Hanspeter

    2010-06-01

    Full Text Available Abstract Background In-vitro mechanical tests are commonly performed to assess pre-clinically the effect of implant design on the stability of hip endoprostheses. There is no standard protocol for these tests, and the forces applied vary between studies. This study examines the effect of the abductor force with and without application of the anterior-posterior hip contact force in the in-vitro assessment of cementless hip implant stability. Methods Cementless stems (VerSys Fiber Metal were implanted in twelve composite femurs which were divided into two groups: group 1 (N = 6 was loaded with the hip contact force only, whereas group 2 (N = 6 was additionally subjected to an abductor force. Both groups were subjected to the same cranial-caudal hip contact force component, 2.3 times body weight (BW and each specimen was subjected to three levels of anterior-posterior hip contact load: 0, -0.1 to 0.3 BW (walking, and -0.1 to 0.6 BW (stair climbing. The implant migration and micromotion relative to the femur was measured using a custom-built system comprised of 6 LVDT sensors. Results Substantially higher implant motion was observed when the anterior-posterior force was 0.6BW compared to the lower anterior-posterior load levels, particularly distally and in retroversion. The abductor load had little effect on implant motion when simulating walking, but resulted in significantly less motion than the hip contact force alone when simulating stair climbing. Conclusions The anterior-posterior component of the hip contact load has a significant effect on the axial motion of the stem relative to the bone. Inclusion of the abductor force had a stabilizing effect on the implant motion when simulating stair climbing.

  19. Preoperative planning and postoperative evaluation of total hip arthroplasty that takes combined anteversion.

    Science.gov (United States)

    Imai, Hiroshi; Miyawaki, Joji; Kamada, Tomomi; Takeba, Jun; Mashima, Naohiko; Miura, Hiromasa

    2016-07-01

    The purpose of this study was to investigate whether postoperative combined anteversion (CA) can be kept within the safe zone while using cementless total hip arthroplasty (THA) using the operative technique which prepares the socket first for developmental dysplasia of the hip (DDH), by estimating the anteversion of the metaphyseal fit stem using preoperative three-dimensional (3D) computerized planning and by adjusting the anteversion of the socket using a navigation system that considers CA. Our subjects were 65 patients (65 hips) that had undergone cementless THA for DDH that could be observed for 1 year or more. Clinical assessments were made using the Japanese Orthopaedic Association's (JOA) hip score. For a radiological evaluation, we investigated 3D-planned stem versions, postoperative stem versions, preoperative and postoperative CA, and the relationship between CA and dislocation tendencies with temporary intraoperative reductions. JOA hip scores improved from 52.3 ± 11.4 points to 88.9 ± 8.6 points. CT evaluations revealed that 3D-planned stem versions were strongly correlated with postoperative stem versions (r = 0.80; p hips. No intraoperative dislocation tendencies were observed in any hips. By estimating the anteversion of the cementless metaphyseal fit stem using 3D planning preoperatively and adjusting the angle of anteversion of the socket using a navigation system that considers CA intraoperatively, postoperative CA can very frequently be kept within the safe zone, even with cementless THA using the operative technique which prepares the socket first for DDH. PMID:27154291

  20. Do Rerevision Rates Differ After First-time Revision of Primary THA With a Cemented and Cementless Femoral Component?

    DEFF Research Database (Denmark)

    Gromov, Kirill; Pedersen, Alma B; Overgaard, Søren;

    2015-01-01

    Worldwide use of cementless fixation for total hip arthroplasty (THA) is on the rise despite some evidence from the world's registries suggesting inferior survivorship compared with cemented techniques. The patterns of bone loss associated with failed cementless and cemented THAs may prejudice...

  1. Five-year results of a cementless short-hip-stem prosthesis

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    Ralf H. Wittenberg

    2013-03-01

    Full Text Available Hip prosthesis stems with a short stem length and proximal fixation geometry support a bone-preserving and muscle-sparing implantation and should also allow for revision surgery with a standard hip stem. We present 250 prospectively documented clinical and radiological results from the Metha Short Hip Stem prosthesis (B. Braun-Aesculap, Tuttlingen, Germany after an average follow-up of 4.9 years. The average patient age at surgery was 60 years. Indication for total hip replacement was primary osteoarthrosis (OA (78% of patients, OA based on developmental dyspla- sia of the hip (16%, and other indications (6%. At the last follow-up, the average Harris Hip Score was 97 points. 85% of patients were very satisfied and 14% were satisfied after surgery, whereas 1% were dissatisfied. Pain according to the Visual Analogue Scale improved from 7.4 (min 1.6, max 9.5 pre-operatively to 0.23 (min 0, max 6.6. No joint dislocations occurred when predominantly using 28 mm and 32 mm prosthesis heads. Nine short-stems were revised: three after bacterial infections, two after primary via valsa with penetration of the femoral cortex two and three months after surgery, and three after early aseptic cases of loosening within the first year. A further nine osseously consolidated short-stems had to be replaced due to breakage of the modular titanium cone adapter after an average of 3.1 years (min 1.9, max 4.4. All surgical revisions were performed using primary standard stems. Without taking the material-related adapter failures into account, a five year Kaplan-Meier survival rate of 96.7% (95% confidence interval 93.4-98.3 was determined for the short-stem prostheses. There were no radiological signs of loosening in any of the short-stem prostheses at the last examination. Fine sclerotic lines were detected in Gruen’s AP zones 1 (19% and 2 (10.5%, individual hypertrophies in zone 3 (3.5%, fine seams in zones 4 (5.5% and 5 (4%, without pedestal formations in zone 4

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

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    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.

  3. Total hip arthroplasty in a patient with congenital insensitivity to pain: a case report

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    Erdil Mehmet

    2012-07-01

    Full Text Available Abstract Introduction Congenital insensitivity to pain, a rare neurological entity, is characterized by varying degrees of sensory loss and autonomic dysfunction. Orthopedic manifestations of congenital insensitivity to pain include delayed diagnosis of fractures, nonunions, malunions, Charcot arthropathy, acro-osteolysis, avascular necrosis, osteomyelitis, heterotopic ossification and joint dislocations. We here report the case of a patient with congenital insensitivity to pain who had multiple lower extremity fractures at varying intervals, the most recent being a femoral neck fracture managed by total hip replacement. To the best of our knowledge, this is the first report of cementless hip arthroplasty in such a patient. Case presentation A 37-year-old Caucasian woman was admitted to our hospital complaining of painless swellings in her lower limb and limping. She had been diagnosed with multiple lower extremity fractures at different times. On physical examination, we found multiple perioral mucosal ulcers, shortening of her nails and acro-osteolysis, a prematurely aged facial appearance, undersized skeletal structure, Charcot arthropathy of her right ankle, anosmia, insensitivity to temperature differences and evidence of mild intellectual disability. A right subtrochanteric femur fracture was treated with an intramedullary nail. Eighteen months later, she presented with similar symptoms and we diagnosed a right femoral neck fracture. We removed the nail and performed cementless total right hip arthroplasty. Conclusions Congenital insensitivity to pain is a rare condition that is associated with severe orthopedic problems. This case report, which will be of particular interest to orthopedic surgeons, presents several difficulties in the management of patients with congenital insensitivity to pain and notes the importance of close follow-up and early recognition of complications. Cementless total hip arthroplasty may be a good therapeutic

  4. 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.

  5. Total hip replacement in young adults with hip dysplasia

    OpenAIRE

    Engesæter, Ingvild Ø; Lehmann, Trude; Laborie, Lene B; Lie, Stein Atle; Rosendahl, Karen; Engesæter, Lars B

    2011-01-01

    Background and purpose Dysplasia of the hip increases the risk of secondary degenerative change and subsequent total hip replacement. Here we report on age at diagnosis of dysplasia, previous treatment, and quality of life for patients born after 1967 and registered with a total hip replacement due to dysplasia in the Norwegian Arthroplasty Register. We also used the medical records to validate the diagnosis reported by the orthopedic surgeon to the register. Methods Subjects born after Janua...

  6. Radiation-blocking shields to localize periarticular radiation precisely for prevention of heterotopic bone formation around uncemented total hip arthroplasties

    International Nuclear Information System (INIS)

    Sixteen patients (18 hips) were treated with localized radiation therapy limited to periarticular regions surrounding the femoral neck by shielding the prosthesis and the adjacent regions to prevent heterotopic bone formation around the uncemented prosthesis. All hips received 1500 rads. Eight of these hips were irradiated after excising severe heterotopic bone, five because they developed extensive heterotopic ossification in the opposite hip, and five others because they were considered to be at high risk for developing heterotopic ossification. Only two of the 18 hips developed a small amount of heterotopic bone after localized periarticular radiation. All wounds healed primarily. No progressive radiolucencies developed at the bone-prosthesis interface. There was only one trochanteric nonunion of six trochanteric osteotomies. Localized periarticular radiation therapy with precision shielding of the prosthetic components and adjacent skeletal structures is an effective means to prevent heterotopic bone formation around cementless total hip arthroplasties. It also has the advantage of not adversely affecting the healing of the trochanteric osteotomy

  7. The modern, hybrid total hip arthroplasty for primary osteoarthritis at the Hospital for Special Surgery.

    Science.gov (United States)

    González Della Valle, A; Sharrock, N; Barlow, M; Caceres, L; Go, G; Salvati, E A

    2016-01-01

    We describe our technique and rationale using hybrid fixation for primary total hip arthroplasty (THA) at the Hospital for Special Surgery. Modern uncemented acetabular components have few screw holes, or no holes, polished inner surfaces, improved locking mechanisms, and maximised thickness and shell-liner conformity. Uncemented sockets can be combined with highly cross-linked polyethylene liners, which have demonstrated very low wear and osteolysis rates after ten to 15 years of implantation. The results of cement fixation with a smooth or polished surface finished stem have been excellent, virtually eliminating complications seen with cementless fixation like peri-operative femoral fractures and thigh pain. Although mid-term results of modern cementless stems are encouraging, the long-term data do not show reduced revision rates for cementless stems compared with cemented smooth stems. In this paper we review the conduct of a hybrid THA, with emphasis on pre-operative planning, surgical technique, hypotensive epidural anaesthesia, and intra-operative physiology. PMID:26733642

  8. Simultaneous and staged bilateral total hip arthroplasty

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Joergensen, Christoffer Calov; Husted, Henrik;

    2013-01-01

    Bilateral total hip arthroplasty (BTHA) and bilateral simultaneous total hip arthroplasty (BSTHA) are done increasingly. Previous studies evaluating outcomes after bilateral procedures have found different results. The aim of this study was to investigate length of hospital stay (LOS), 30 days...

  9. Anterior Approach Total Hip Replacement

    Medline Plus

    Full Text Available ... the benefits of the Taperloc Microplasty stem and E-poly antioxidant-infused technology during a hip replacement ... to your questions that you send in by e-mail. The e- mail button is at the ...

  10. Anterior Approach Total Hip Replacement

    Medline Plus

    Full Text Available ... Taperloc Microplasty stem and E-poly antioxidant-infused technology during a hip replacement through the anterior supine ... renewed interest at this time due to several advantages that it brings. The approach that is performed ...

  11. Anterior Approach Total Hip Replacement

    Medline Plus

    Full Text Available ... means that I’m looking at using a Delta ceramic. So now we’re going to take ... out of bed and get to the commode. Delta ceramic hip, this is the next generation ceramic. ...

  12. Anterior Approach Total Hip Replacement

    Medline Plus

    Full Text Available ... we’re doing a right hip. She has mild dysplasia with cystic changes and loss of joint ... different. Yeah. But, you know, even with this mild dysplasia and slight anteversion. Yeah. The point here ...

  13. 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

  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. Anterior Approach Total Hip Replacement

    Medline Plus

    Full Text Available ... and I’m able to use a modern generation highly cross-linked, highly eradiated, and then vitamin ... commode. Delta ceramic hip, this is the next generation ceramic. 32 enlarger, there’s been no reported fractures. ...

  16. Anterior Approach Total Hip Replacement

    Medline Plus

    Full Text Available ... of the Taperloc Microplasty stem and E-poly antioxidant-infused technology during a hip replacement through the ... a little diaper so we’re seeing less skin and more -- Here we go. Here’s what we’ ...

  17. Fracture After Total Hip Replacement

    Science.gov (United States)

    ... Della Valle CJ, Haidukewych GJ, Callaghan JJ: Periprosthetic fractures of the hip and knee: a problem on the rise but better solutions. ... weeks in a skilled nursing facility or a rehabilitation center in order to improve your ... can be serious. The most common complications include: • ...

  18. Total Hip Replacement (Arthroplasty) (Beyond the Basics)

    Science.gov (United States)

    ... stiffening caused by extra bone formation, also called heterotopic ossification, is a process in which some soft ... replacement (prosthetic) parts, with the goal of relieving pain and improving function. ● Most patients require total hip ...

  19. Primary total hip arthroplasty for acetabular fracture

    Institute of Scientific and Technical Information of China (English)

    WANG Zi-ming; SUN Hong-zhen; WANG Ai-min; DU Quan-yin; WU Siyu; ZHAO Yu-feng; TANG Ying

    2006-01-01

    Objective: To explore the operative indications and operative methods of primary total hip arthroplasty for acetabular fracture and to observe the clinical curative effect.Methods: We retrospectively summarized and analyzed the traumatic conditions, fracture types, complications,operative time, operative techniques, and short-term curative effect of 11 patients( 10 males and 1 female, with a mean age of 42. 4 years ) with acetabular fracture who underwent primary total hip arthroplasty.Results: The patients were followed up for 6-45 months ( mean = 28 months). Their average Harris score of postoperative hip joint was 78.Conclusion: Under strict mastery of indications,patients with acetabular fracture may undergo primary total hip arthroplasty, but stable acetabular components should be made.

  20. 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.

  1. Intraoperative measurement of rotational stability of femoral components of total hip arthroplasty.

    Science.gov (United States)

    Harris, W H; Mulroy, R D; Maloney, W J; Burke, D W; Chandler, H P; Zalenski, E B

    1991-05-01

    High out-of-plane forces acting on the hip joint can produce important rotational micromotion of the femoral component. This micromotion at the prosthesis interface may be detrimental to the stability of the implant. In cementless femoral implants this could prevent bone ingrowth, and in the cemented component this could cause generation of particulate debris, lysis, and loosening. The introduction of the torque wrench micrometer for assessment of intraoperative femoral component stability can quantify the initial stability of primary cementless femoral components and critically evaluate the stability (at either the initial or revision arthroplasty) of both cemented and cementless femoral components. It allows the surgeon to produce a known torque in the direction and magnitude of the out-of-plane forces that load the hip in vivo. PMID:2019039

  2. Total Hip Arthroplasty in Mucopolysaccharidosis Type IH

    Directory of Open Access Journals (Sweden)

    S. O'hEireamhoin

    2011-01-01

    Full Text Available Children affected by mucopolysaccharidosis (MPS type IH (Hurler Syndrome, an autosomal recessive metabolic disorder, are known to experience a range of musculoskeletal manifestations including spinal abnormalities, hand abnormalities, generalised joint stiffness, genu valgum, and hip dysplasia and avascular necrosis. Enzyme therapy, in the form of bone marrow transplantation, significantly increases life expectancy but does not prevent the development of the associated musculoskeletal disorders. We present the case of a 23-year-old woman with a diagnosis of Hurler syndrome with a satisfactory result following uncemented total hip arthroplasty.

  3. Vaginal mass following uncemented total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Young-Soo Shin

    2014-01-01

    Full Text Available A 53-year-old woman developed a vaginal mass following an uncemented total hip arthroplasty. The mass was in direct communication with the hip through an acetabular medial wall defect after loosening of the acetabular component. The mass formation was caused simultaneously by changes secondary to polyethylene wear, a tiny delamination of the porous titanium mesh coating and a broken antirotational tab on the acetabular cup, all of which may have served as sources of metal particles. A careful evaluation of the patient′s history, symptoms, X-ray findings and computed tomography scans should always be performed to ensure accurate diagnosis.

  4. Pelvic Discontinuity Caused by Acetabular Overreaming during Primary Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Iori Takigami

    2011-01-01

    Full Text Available Intraoperative acetabular fracture is a rare complication of primary total hip arthroplasty (THA, typically occurring during impaction of the cementless acetabular component. Here we report an unusual case of pelvic discontinuity caused by overreaming of the acetabulum during primary THA. Restoration of posterior columnar continuity was achieved with an autologous fibular graft and a reconstruction plate. Wall defects and cavitary defects were reconstructed with metal mesh and femoral head allograft, followed by placement and fixation of a Kerboull-type acetabular reinforcement device. Previous reports of acetabular fracture during THA have indicated that it has a relatively good prognosis without extensive treatment. However, to our knowledge, there has been no report of pelvic discontinuity necessitating acetabular reconstruction surgery as an intraoperative complication of primary THA.

  5. Intra-articular injection of tranexamic acid via a drain plus drain-clamping to reduce blood loss in cementless total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Mutsuzaki Hirotaka

    2012-09-01

    Full Text Available Abstract Background Patients undergoing cementless total knee arthroplasty (TKA sometimes suffer large blood loss. In a retrospective study, we explored whether postoperative intra-articular retrograde injection of tranexamic acid (TA and leaving a drain clamp in place for 1 h reduced blood loss. Patients and methods Patients (n = 140 treated with unilateral primary cementless TKA (posterior cruciate ligament retained were divided into two groups: those who had an intra-articular injection of TA (1000 mg and drain clamping for 1 h postoperatively (study group, n = 70 and those who were not given TA and did not undergo clamping of their drains (control group, n = 70. Postoperative total blood loss, volume of drainage, hemoglobin level, transfusion amounts and rates, D-dimer level at postoperative day (POD 7, and complications were recorded. Results Total blood loss, total drainage, mean transfusion volume, and transfusion rates were lower in the study group than in controls (P P P  Conclusions Immediately postoperative intra-articular retrograde injection of TA and 1 h of drain-clamping effectively reduced blood loss and blood transfusion after cementless TKA. We believe that this method is simple, easy, and suitable for these patients.

  6. 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

  7. Comparison of Venous Thromboembolism after Total Hip Arthroplasty between Ankylosing Spondylitis and Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Dongquan Shi

    2014-01-01

    Full Text Available Objective. Ankylosing spondylitis (AS, an inflammatory rheumatic disease, will gradually lead to severe hip joint dysfunction. Total hip arthroplasty is a useful method to improve patients’ quality of life. The aim of this study was to compare the incidence and risk factors of deep vein thrombosis (DVT between AS and hip osteoarthritis. Methods. In a retrospective study, a total of 149 subjects who underwent cementless THA were studied. Clinical data, biochemical data, and surgery-related data were measured between AS and OA groups. Results. The incidence of DVT in AS group was lower than that of OA group, although no significant difference was detected (P=0.89. The patients of AS group were much younger (P<0.0001 and thinner (P=0.018 compared with those of OA group. AS patients had higher ejection fraction (EF (P=0.016, higher platelet counts (P<0.0001, and lower hypertension rate (P=0.0004. The values of APTT, PT, and INR in AS patients were higher than those in OA patients (all P<0.0001. The values of D-dimer and APTT were both significantly higher in DVT subjects than those in non-DVT subjects. Conclusion. AS patients potentially had a lower incidence of DVT compared with OA patients.

  8. Fracture of femoral total hip replacement components

    International Nuclear Information System (INIS)

    The biomechanical factors responsible for fatigue fracture of femoral total hip component stems were studied by laboratory loading simulations using implants which were instrumented with strain gauges. Stress levels were low when the prosthesis was rigidly fixed in acrylic along its entire length. Significantly higher stresses were recorded in stems which were loose in the acrylic or which were fixed in their distal portion only

  9. Future Bearing Surfaces in Total Hip Arthroplasty

    OpenAIRE

    Chang, Jun-Dong

    2014-01-01

    One of the most important issues in the modern total hip arthroplasty (THA) is the bearing surface. Extensive research on bearing surfaces is being conducted to seek an ideal bearing surface for THA. The ideal bearing surface for THA should have superior wear characteristics and should be durable, bio-inert, cost-effective, and easy to implant. However, bearing surfaces that are currently being implemented do not completely fulfill these requirements, especially for young individuals for whom...

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

    Directory of Open Access Journals (Sweden)

    Moretti Lorenzo

    2011-02-01

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

  11. Segmental blood pressure after total hip replacement

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Soelberg, M; Henriksen, Jens Henrik Sahl

    1992-01-01

    Twenty-nine patients due to have a total hip replacement had their systemic systolic and segmental blood pressures measured prior to operation and 1 and 6 weeks postoperatively. No patients had signs of ischemia. The segmental blood pressure was measured at the ankle and at the toes. A significant...... drop was found in all pressures 1 week postoperatively. The decrease followed the systemic pressure and was restored to normal after 6 weeks. In a group of six patients with preoperatively decreased ankle pressure, a significant transient further decrease in the ankle-toe gradient pressure was found...

  12. Early periprosthetic femoral bone remodelling using different bearing material combinations in total hip arthroplasties: a prospective randomised study

    Directory of Open Access Journals (Sweden)

    Nygaard M.

    2004-12-01

    Full Text Available The present study was performed to test the hypothesis that different bearing materials have an impact on femoral bone remodelling within the first year after a total hip arthroplasty. A total of 225 patients with osteoarthrosis of the hip or avascular necrosis of the femoral head were included in this randomised prospective study. All patients had an identical hybrid total hip arthroplasty (cemented BiMetric stem and cementless RingLoc acetabular cup except for the bearing materials: polyethylene-on-zirconia (n = 78, CoCr-on-CoCr (n = 71, or alumina-on-alumina (n = 76. Bone mineral density (BMD was measured with Dual-energy X-ray absorptiometry (DEXA in seven Gruen zones adjacent to the femoral implant. The DEXA scan was performed within one week after surgery and was repeated one year postoperatively. There was no significant difference in periprosthetic BMD change between the three groups. After twelve months the relative BMD decrease was highest in the proximal part of the femur, - 6.2% in the greater trochanter region and - 12.7% in the lesser trochanter region. In the distal zones the relative BMD decrease was -5.3, -4.2, -2.1, -2.3, and -5.6%, respectively. The use of different bearing materials had no significant impact on femoral bone remodelling adjacent to the cemented hip stem within one year after surgery.

  13. Segmental blood pressure after total hip replacement

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Soelberg, M; Henriksen, Jens Henrik

    1992-01-01

    Twenty-nine patients due to have a total hip replacement had their systemic systolic and segmental blood pressures measured prior to operation and 1 and 6 weeks postoperatively. No patients had signs of ischemia. The segmental blood pressure was measured at the ankle and at the toes. A significant...... on the operated side. None of the patients had symptoms from the lowered pressure. We conclude that in patients without signs of ischemia, the postoperative segmental pressure decrease is reversible and therefore not dangerous....... drop was found in all pressures 1 week postoperatively. The decrease followed the systemic pressure and was restored to normal after 6 weeks. In a group of six patients with preoperatively decreased ankle pressure, a significant transient further decrease in the ankle-toe gradient pressure was found...

  14. Space orientation of total hip prosthesis

    International Nuclear Information System (INIS)

    A method for in vivo determination of orientation and relation in space of components of total hip prosthesis is described. The method allows for determination of the orientation of the prosthetic components in well defined anatomic planes of the body. Furthermore the range of free motion from neutral position to the point of contact between the edge of the acetabular opening and the neck of the femoral component can be determined in various directions. To assess the accuracy of the calculations a phantom prosthesis was studied in nine different positions and the measurements of the space oriented parameters according to the present method correlated to measurements of the same parameters according to Selvik's stereophotogrammetric method. Good correlation ws found. The role of prosthetic malpositioning and component interaction evaluated with the present method in the development of prosthetic loosening and displacement is discussed. (orig.)

  15. 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.

  16. Incidence of Heterotopic Ossification after Surface and Conventional Total Hip Arthroplasty: A Comparative Study Using Anterolateral Approach and Indomethacin Prophylaxis

    Directory of Open Access Journals (Sweden)

    Dario Regis

    2013-01-01

    Full Text Available The incidence and severity of heterotopic ossification (HO in two homogeneous groups of patients that received surface replacement arthroplasty (SRA and conventional total hip arthroplasty (THA were evaluated retrospectively. Thirty-nine patients undergoing 42 hip resurfacing procedures and 41 primary cementless THAs through an anterolateral approach received a 10-day course of 150 mg/die of indomethacin postoperatively. The median surgical time was 190 minutes and 156 minutes, respectively (. At a minimum 1-year followup, the development of HO was assessed on standard X-ray using Brooker grading. Ectopic bone formation was detected in five cases (11.9%, two Brooker grade I and three grade II in the SRA group and in 14 hips (34.1%, 12 grade I and two grade II treated with conventional THA, but the difference was not significant (. No clinically relevant periprosthetic ossification (Brooker III or IV occurred in both groups. Although the difference was not statistically significant, the incidence of HO after SRA was lower than conventional THA. More extensive soft tissue trauma, bone debris, and longer operative time in hip resurfacing are not likely to be absolute risk factors for HO. Further investigations including larger patient populations are needed to confirm these findings.

  17. The influence of metallic shell deformation on the contact mechanics of a ceramic-on-ceramic total hip arthroplasty.

    Science.gov (United States)

    Qiu, Changdong; Wang, Ling; Li, Dichen; Jin, Zhongmin

    2016-01-01

    Total hip arthroplasty of ceramic-on-ceramic bearing combinations is increasingly used clinically. The majority of these implants are used with cementless fixation that a metal-backing shell is press-fitted into the pelvic bone. This usually results in the deformation of the metallic shell, which may also influence the ceramic liner deformation and consequently the contact mechanics between the liner and the femoral head under loading. The explicit dynamic finite element method was applied to model the implantation of a cementless ceramic-on-ceramic with a titanium shell and subsequently to investigate the effect of the metallic shell deformation on the contact mechanics. A total of three impacts were found to be necessary to seat the titanium alloy shell into the pelvic bone cavity with a 1 mm diameter interference and a 1.3 kg impactor at 4500 mm s(-1) velocity. The maximum deformation of the metallic shell was found to be 160 µm in the antero-superior and postero-inferior direction and 97 µm in the antero-inferior and postero-superior direction after the press-fit. The corresponding values were slightly reduced to 67 and 45 µm after the ceramic liner was inserted and then modified to 74 and 43 µm under loading, respectively. The maximum deformation and the maximum principal stress of the ceramic liner were 31 µm and 144 MPa (tensile stress), respectively, after it was inserted into the shell and further increased to 52 µm and 245 MPa under loading. This research highlights the importance of the press-fit of the metallic shell on the contact mechanics of the ceramic liner for ceramic-on-ceramic total hip arthroplasties and potential clinical performances.

  18. Reliability analysis for cementless hip prosthesis using a new optimized formulation of yield stress against elasticity modulus relationship

    International Nuclear Information System (INIS)

    Highlights: • We develop a new formulation between the yield stress and Young’s modulus of bone. • We validate the optimized formulation for cortical and trabecular bone. • We integrate the reliability analysis into artificially hip replacement design. - Abstract: Using classical design optimization methods for implant-bone studies does not completely guarantee a safety and satisfactory performance, due in part to the randomness of bone properties and loading. Here, the material properties of the different bone layers are considered as uncertain parameters. So their corresponding yield stress values will not be deterministic, that leads to integrate variable limitations into the optimization process. Here there is a strong need to find a reliable mathematical relationship between yield stress and material properties of the different bone layers. In this work, a new optimized formulation for yield stress against elasticity modulus relationship is first developed. This model is based on some experimental results. A validation of the proposed formulation is next carried out to show its accuracy for both bone layers (cortical and cancellous). A probabilistic sensitivity analysis is then carried out to show the role of each input parameter with respect to the limit state function. The new optimized formulation is next integrated into a reliability analysis problem in order to assess the reliability level of the stem–bone study where we deal with variable boundary limitations. An illustrative application is considered as a bi-dimensional example (contains only two variables) in order to present the results in an illustrative 2D space. Finally, a multi-variable problem considering several daily loading cases on a hip prosthesis shows the applicability of the proposed strategy

  19. Muscular strength after total hip arthroplasty

    Science.gov (United States)

    Winther, Siri B; Husby, Vigdis S; Foss, Olav A; Wik, Tina S; Svenningsen, Svein; Engdal, Monika; Haugan, Kristin; Husby, Otto S

    2016-01-01

    Background and purpose Minimizing the decrease in muscular strength after total hip arthroplasty (THA) might allow patients to recover faster. We evaluated muscular strength in patients who were operated on using 3 surgical approaches. Patients and methods In a prospective cohort study, 60 patients scheduled for primary THA were allocated to the direct lateral, posterior, or anterior approach. Leg press and abduction strength were evaluated 2 weeks or less preoperatively, 2 and 8 days postoperatively, and at 6-week and 3-month follow-up. Results Differences in maximal strength change were greatest after 2 and 8 days. The posterior and anterior approaches produced less decrease in muscular strength than the direct lateral approach. 6 weeks postoperatively, the posterior approach produced greater increase in muscular strength than the direct lateral approach, and resulted in a greater increase in abduction strength than the anterior approach. At 3-month follow-up, no statistically significant differences between the groups were found. The operated legs were 18% weaker in leg press and 15% weaker in abduction than the unoperated legs, and the results were similar between groups. Interpretation The posterior and anterior approaches appeared to have the least negative effect on abduction and leg press muscular strength in the first postoperative week; the posterior approach had the least negative effect, even up to 6 weeks postoperatively. THA patients have reduced muscle strength in the operated leg (compared to the unoperated leg) 3 months after surgery. PMID:26141371

  20. Process optimized minimally invasive total hip replacement

    Directory of Open Access Journals (Sweden)

    Philipp Gebel

    2012-02-01

    Full Text Available The purpose of this study was to analyse a new concept of using the the minimally invasive direct anterior approach (DAA in total hip replacement (THR in combination with the leg positioner (Rotex- Table and a modified retractor system (Condor. We evaluated retrospectively the first 100 primary THR operated with the new concept between 2009 and 2010, regarding operation data, radiological and clinical outcome (HOOS. All surgeries were perfomed in a standardized operation technique including navigation. The average age of the patients was 68 years (37 to 92 years, with a mean BMI of 26.5 (17 to 43. The mean time of surgery was 80 min. (55 to 130 min. The blood loss showed an average of 511.5 mL (200 to 1000 mL. No intra-operative complications occurred. The postoperative complication rate was 6%. The HOOS increased from 43 points pre-operatively to 90 (max 100 points 3 months after surgery. The radiological analysis showed an average cup inclination of 43° and a leg length discrepancy in a range of +/- 5 mm in 99%. The presented technique led to excellent clinic results, showed low complication rates and allowed correct implant positions although manpower was saved.

  1. 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.

  2. Muscle mass and function after total hip arthroplasty

    OpenAIRE

    Rasch, Anton

    2009-01-01

    Osteoarthritis (OA) of the hip is a common disease among elderly causing pain, joint stiffness and reduced mobility. Outcome studies have shown total hip arthroplasy (THA) to be a successful surgical procedure. Studies of muscle strength and function after THA are more scarce and results vary. It has been suggested that unloading of the OA limb due to pain, results in hip and thigh muscle weakness and atrophy causing an abnormal gait and impaired postural control. Muscle atr...

  3. Do pessimists report worse outcomes after total hip arthroplasty?

    OpenAIRE

    Singh, Jasvinder A; Colligan, Robert C.; O’Byrne, Megan M.; David G Lewallen

    2016-01-01

    Background Seligman’s theory of causal attribution predicts that patients with a pessimistic explanatory style will have less favorable health outcomes. We investigated this hypothesis using self-reported hip pain and hip function 2- years after total hip arthroplasty (THA). Methods Most THA patients had completed the Minnesota Multiphasic Personality Inventory (MMPI) during their usual clinical care long before THA (median, 14.7 to 16.6 years). Scores from the MMPI Optimism-Pessimism (PSM) s...

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

    DEFF Research Database (Denmark)

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

    2003-01-01

    We performed 97 uncemented primary total hip arthroplasties in 80 patients having an average age of 50 years. The femoral implant was a titanium stem with a proximal circumferential plasma spray-coating. Three different acetabular components were used: a threaded and partly porous-coated design i...

  5. Future bearing surfaces in total hip arthroplasty.

    Science.gov (United States)

    Chang, Jun-Dong

    2014-03-01

    One of the most important issues in the modern total hip arthroplasty (THA) is the bearing surface. Extensive research on bearing surfaces is being conducted to seek an ideal bearing surface for THA. The ideal bearing surface for THA should have superior wear characteristics and should be durable, bio-inert, cost-effective, and easy to implant. However, bearing surfaces that are currently being implemented do not completely fulfill these requirements, especially for young individuals for whom implant longevity is paramount. Even though various new bearing surfaces have been investigated, research is still ongoing, and only short-term results have been reported from clinical trials. Future bearing surfaces can be developed in the following ways: (1) change in design, (2) further improvement of polyethylene, (3) surface modification of the metal, (4) improvement in the ceramic, and (5) use of alternative, new materials. One way to reduce wear and impingement in THA is to make changes in its design by using a large femoral head, a monobloc metal shell with preassembled ceramic liner, dual mobility cups, a combination of different bearing surfaces, etc. Polyethylene has improved over time with the development of highly crosslinked polyethylene. Further improvements can be made by reinforcing it with vitamin E or multiwalled carbon nanotubes and by performing a surface modification with a biomembrane. Surface modifications with titanium nitride or titanium niobium nitride are implemented to try to improve the metal bearings. The advance to the fourth generation ceramics has shown relatively promising results, even in young patients. Nevertheless, further improvement is required to reduce fragility and squeaking. Alternative materials like diamond coatings on surfaces, carbon based composite materials, oxidized zirconium, silicon nitride, and sapphire are being sought. However, long-term studies are necessary to confirm the efficacy of these surfaces after enhancements

  6. 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...

  7. Hybrid SPECT/CT for the assessment of a painful hip after uncemented total hip arthroplasty

    OpenAIRE

    Dobrindt, Oliver; Amthauer, Holger; Krueger, Alexander; Ruf, Juri; Wissel, Heiko; Grosser, Oliver S.; Seidensticker, Max; Lohmann, Christoph H

    2015-01-01

    Background The diagnosis of hip pain after total hip replacement (THR) represents a highly challenging question that is of increasing concern to orthopedic surgeons. This retrospective study assesses bone scintigraphy with Hybrid SPECT/CT for the diagnosis of painful THR in a selected cohort of patients. Methods Bone SPECT/CT datasets of 23 patients (mean age 68.9 years) with a painful hip after THR were evaluated. Selection of the patients required an inconclusive radiograph, normal serum le...

  8. Early total hip arthroplasty for severe displaced acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    YANG Shu-hua; ZHANG Yu-kun; XU Wei-hua; LI Jin; LIU Guo-hui; YANG Cao; LIU Yong; TIAN Hong-tao

    2006-01-01

    Objective : To investigate the effect of early total hip arthroplasty for severe displaced acetabular fractures.Methods: Total hip arthroplasty was performed on 17 cases of severe fracture of the acetabulum from 1997 to 2003. The mean follow-up was 2.1 years (1-6 years) and the average period from fracture to operation was 8 days (5-21 day). The average age of the patients was 53 years (26-69 years).Results: At the final follow-up the Harris hip score averaged 82(69-100) points and 15 cases have got a good outcome. There was one case of heterotopic bone formation. There were no radiographic evidences of late loosening of the prosthesis. One patient had severe central displacement of the cup.Conclusions: In patients with severe displaced acetabular fractures, particularly in elderly patients, early total hip arthroplasty is probably an alternative efficient way to achieve a painless and stable hip.

  9. [Acetabular Osteolysis in Total Hip Replacement - When to Retain the Cup?].

    Science.gov (United States)

    Lutz, B; Faschingbauer, M; Bieger, R; Reichel, H; Kappe, T

    2016-08-01

    Periacetabular osteolysis is a frequent long-term complication of cementless total hip arthroplasty. The decision whether to retain or to revise a cup in the presence of osteolysis remains a challenge. The options are regular clinical and radiological check-ups, isolated liner exchange with and without bone grafting, and complete cup revision. Thorough preoperative diagnostics, including a medical history, examination and imaging, are mandatory for correct decision making. In most patients, computed tomography is useful to assess periacetabular osteolysis. If the cup is well-fixed and positioned in an asymptomatic patient without progressive osteolysis and no implant defect or higher grade polyethylene wear and no signs of infection, continuous clinical and radiological monitoring is preferred. If imaging reveals cup loosening, malposition, osteolysis localised in a weight-bearing area, imminent or present periprosthetic fractures, rapid progressive osteolysis, implant defects or massive inlay wear, surgical treatment may be preferred. Cup revision is usually performed in such patients. If the cup is well-positioned and well-fixed in the X-ray, the procedure has to be discussed with the patient individually. Apart from patient-specific risk factors, the risk of further progression has to be assessed. Isolated liner exchange can be performed if the patient is asymptomatic and the cup proves to be stable intraoperatively. It is still unclear whether filling osteolyses through screw holes or osseous windows is of long-term benefit. PMID:27249047

  10. Total Hip Arthroplasty in Mucopolysaccharidosis Type IH

    OpenAIRE

    S. O'hEireamhoin; Bayer, T.; Mulhall, K. J.

    2012-01-01

    Children affected by mucopolysaccharidosis (MPS) type IH (Hurler Syndrome), an autosomal recessive metabolic disorder, are known to experience a range of musculoskeletal manifestations including spinal abnormalities, hand abnormalities, generalised joint stiffness, genu valgum, and hip dysplasia and avascular necrosis. Enzyme therapy, in the form of bone marrow transplantation, significantly increases life expectancy but does not prevent the development of the associated musculoskeletal disor...

  11. Contralateral Total Hip Arthroplasty After Hindquarter Amputation

    Science.gov (United States)

    Sommerville, Scott M. M.; Patton, James T.; Luscombe, Jonathan C.; Grimer, Robert J.

    2006-01-01

    We describe the management and outcome of a 62-year old lady who developed severe osteoarthritis of the hip, nine years after a hindquarter amputation for radiation-induced sarcoma of the contralateral pelvis. The difficulties of stabilising the pelvis intraoperatively and the problems of postoperative rehabilitation are outlined. The operation successfully relieved her pain and restored limited mobility. PMID:17496994

  12. Contralateral Total Hip Arthroplasty After Hindquarter Amputation

    Directory of Open Access Journals (Sweden)

    Scott M. M. Sommerville

    2006-01-01

    Full Text Available We describe the management and outcome of a 62-year old lady who developed severe osteoarthritis of the hip, nine years after a hindquarter amputation for radiation-induced sarcoma of the contralateral pelvis. The difficulties of stabilising the pelvis intraoperatively and the problems of postoperative rehabilitation are outlined. The operation successfully relieved her pain and restored limited mobility.

  13. 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.

  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. Association between trochanteric bursitis, osteoarthrosis and total hip arthroplasty,

    OpenAIRE

    Carlos Roberto Schwartsmann; Felipe Loss; Leandro de Freitas Spinelli; Roque Furian; Marcelo Faria Silva; Júlia Mazzuchello Zanatta; Leonardo Carbonera Boschin; Ramiro Zilles Gonçalves; Anthony Kerbes Yépez

    2014-01-01

    OBJECTIVE: this was an epidemiological study on trochanteric bursitis at the time of performing total hip arthroplasty.METHODS: sixty-two sequential patients who underwent total hip arthroplasty due to osteoarthrosis, without any previous history of trochanteric bursitis, were evaluated. The bursas were collected and evaluated histologically.RESULTS: there were 35 female patients (56.5%) and 27 male patients (43.5%), with a mean age of 65 years (±11). Trochanteric bursitis was conformed histo...

  16. 螺旋臼全髋关节置换术治疗发育性髋关节发育不良%Developmental hip dysplasia treated with total hip arthroplasty with threaded cup

    Institute of Scientific and Technical Information of China (English)

    魏威; 寇伯龙; 王小梅; 吕厚山

    2008-01-01

    目的 探讨使用螺旋臼假体治疗发育性髋关节发育不良 (DDH) 继发骨性关节炎患者的临床疗效.方法 自2003年5月至2007年12月,使用Zweymüller螺旋臼假体治疗40例(43髋)DDH继发骨性关节炎患者,其中男6例(6髋),女34例(37髋),平均年龄47.6岁(22~70岁);单侧37例,双侧3例;Crowe分型:Ⅰ级6例,Ⅱ级24例,Ⅲ级10例,Ⅳ级3例.平均随访24.6个月,术前Harris评分最高61分,最低22分,平均43.5分.结果 所有患者术后疼痛基本消失,双下肢长度差异平均1.2 cm,2例术后出现股神经损伤症状,术后6个月症状基本消失,Harris评分最高97分,最低62分,平均85.3分.结论 使用Zweymüller螺旋臼假体治疗DDH继发骨性关节炎的患者,可以达到良好的恢复关节功能的临床疗效,手术不需大块植骨和骨水泥,初期临床效果满意.%Objective The objective of this study was to determine the outcome of total hip arthroplasty with a cementless threaded cup (Zweymuller-SL system) in patients with osteoarthritis secondary to developmental dysplasia of hip (DDH). Methods From May 2003 to December 2007, forty patients (43 hips) with developmental hip dysplasia who were treated with cementless total hip arthroplasty were followed up.The acetabular reconstruction was done with a cementless threaded cup.Among 40 patients, 6 were male, 34 were female and an average age was 47.6 years (range, 22~70 years).37 cases were unilateral DDH and 3 cases were bilateral.According to Crower′s classification, 6 were class Ⅰ, 24 caseswere class Ⅱ, 10 cases were class Ⅲ and 3 cases were class Ⅳ.The meaning following-up period was 24.6 months(range, 4~58 months).The mean preoperative Harris score was 43.5 points (range, 22~61 points).Results The pain of all patients was completely relieved.The postoperative difference of the two leg length reduced to average 1.2 cm.Sciatic palsy happened in 2 patients, but both recovered after 6 months postoperatively

  17. Ability of lower teardrop edge to restore anatomical hip center height in total hip arthroplasty

    Institute of Scientific and Technical Information of China (English)

    Lu Yufeng; Cheng Liming; Guo Wanshou; Yu Qingsheng; Gao Fuqiang; Zhang Qidong; Liu Zhaohui

    2014-01-01

    Background The acetabular teardrop is often used to guide acetabular component placement in total hip arthroplasty (THA).Placing the lower acetabular component aspect at the same level as the lower teardrop edge was assumed to restore the hip center of rotation.Here we radiographically analyzed the relationship between cup center and normal contralateral acetabulum center height on unilateral THA using this placement method.Methods A total of 106 unilateral THA cases with normal contralateral acetabula were reviewed and the vertical and horizontal distances in relation to the lower acetabular teardrop edge from both hip joint centers,cup inclination,and anteversion were measured radiographically.The paired t-test was used to compare left and right hip center heights.Scatter plots and Pearson's correlation coefficients were used to evaluate differences in hip center heights,cup anteversion,inclination angles,and medialized cup center distance compared to the contralateral hip joint.Results Cup center height was significantly greater (P <0.01) than contralateral hip joint center height (93.4% in the 0-5 mm range,6.6% >5 mm).There was a weak correlation between hip center height difference and inclination (r=0.376,P <0.01) and between difference and anteversion (r=0.310,P <0.01) but no correlation between difference and outer cup diameter (r=0.184,P=0.058) or difference and medialized cup center distance (r=-0.098,P=0.318).Conclusions Although this method did not exactly replicate anatomic hip center height,the clinical significance of cup center height and anatomic hip center height differences is negligible.This acetabular component placement method has high simplicity,reliability,and stability.

  18. A Water Rehabilitation Program in Patients with Hip Osteoarthritis Before and After Total Hip Replacement.

    Science.gov (United States)

    Łyp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; Włostowska, Ewa; Stanisławska, Iwona; Szypuła, Jan; Tomaszewski, Wiesław

    2016-01-01

    BACKGROUND Pain associated with coxarthrosis, typically occurring in middle-aged and elderly patients, very commonly causes considerable limitation of motor fitness and dependence on pharmacotherapy. This article provides an assessment of a rehabilitation program with tailored water exercises in patients with osteoarthritis before and after total hip replacement. MATERIAL AND METHODS A total of 192 patients (the mean age 61.03±10.89) suffering from hip osteoarthritis (OA) were evaluated before and after total hip replacement (THR). The clinical study covered measurements of hip active ranges of motion (HAROM) and the forces generated by pelvis stabilizer muscles. Pain intensity was assessed according to analogue-visual scale of pain (VAS) and according to the Modified Laitinen Questionnaire. The patients were divided into 6 groups (4 treatment and 2 control). We compared 2 rehabilitation programs using kinesitherapy and low-frequency magnetic field. One of them also had specially designed exercises in the water. Statistical analysis was carried out at the significance level α=0.05. This was a cross-sectional study. RESULTS A positive effect of water exercises on a number of parameters was found in patients with OA both before and after total hip replacement surgery. We noted a significant reduction of pain (ptreatment process (pwater exercises most significantly reduced pain in patients with OA before and after total hip replacement surgery. 2. Inclusion of water exercises in a rehabilitation program can reduce the use of medicines in patient with OA and after THR. PMID:27455419

  19. A Water Rehabilitation Program in Patients with Hip Osteoarthritis Before and After Total Hip Replacement.

    Science.gov (United States)

    Łyp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; Włostowska, Ewa; Stanisławska, Iwona; Szypuła, Jan; Tomaszewski, Wiesław

    2016-07-25

    BACKGROUND Pain associated with coxarthrosis, typically occurring in middle-aged and elderly patients, very commonly causes considerable limitation of motor fitness and dependence on pharmacotherapy. This article provides an assessment of a rehabilitation program with tailored water exercises in patients with osteoarthritis before and after total hip replacement. MATERIAL AND METHODS A total of 192 patients (the mean age 61.03±10.89) suffering from hip osteoarthritis (OA) were evaluated before and after total hip replacement (THR). The clinical study covered measurements of hip active ranges of motion (HAROM) and the forces generated by pelvis stabilizer muscles. Pain intensity was assessed according to analogue-visual scale of pain (VAS) and according to the Modified Laitinen Questionnaire. The patients were divided into 6 groups (4 treatment and 2 control). We compared 2 rehabilitation programs using kinesitherapy and low-frequency magnetic field. One of them also had specially designed exercises in the water. Statistical analysis was carried out at the significance level α=0.05. This was a cross-sectional study. RESULTS A positive effect of water exercises on a number of parameters was found in patients with OA both before and after total hip replacement surgery. We noted a significant reduction of pain (prehabilitation program including water exercises most significantly reduced pain in patients with OA before and after total hip replacement surgery. 2. Inclusion of water exercises in a rehabilitation program can reduce the use of medicines in patient with OA and after THR.

  20. Recovery of physical functioning after total hip arthroplasty

    OpenAIRE

    2014-01-01

    Purpose. The overall aim of this thesis was to examine recovery of physical functioning in patients with hip osteoarthritis (OA) during the first year after total hip arthroplasty (THA). The specific aims were 1) to examine the desires of a group of patients regarding improvements in physical functioning before they underwent THA and at three and 12 months after surgery, 2) to examine changes in physical functioning during the first year of recovery and examine which preoperative measures pre...

  1. Management of failed metal-on-metal total hip arthroplasty

    OpenAIRE

    Griffin, Justin W.; D’Apuzzo, Michele; Browne, James A.

    2012-01-01

    The theoretical advantages of metal-on-metal (MOM) bearing couples in total hip arthroplasty (THA) have been recently balanced by concerns regarding adverse local and systemic effects. Higher than anticipated early revision rates have been reported by several joint registries. Failed MOM hips present with a spectrum of symptoms and findings and traditional methods of failure must be considered in addition to the failure modes that appear to be unique to the MOM bearing couple. Metal hypersens...

  2. Total Hip Prosthesis in Coxarthrosis due to Congenital Dislocation or Subluxation of the Hip

    OpenAIRE

    Aritamur, Ayhan; Cakmak, Mehmet; Taser, Omer

    2004-01-01

    At our clinic, total hip prostheses were adapted in 4 cases with coxarthrosis accompanied by severe acetabular insufficiency due to congenital hip dislocation or Subluxation. For the reconstruction of acetabuler insufficiency, femoral head was employed as graft in compliance with the Harris technique. This technique was realized on the patient in between two stages with the purpose of avoding femoral resection, yet temporary neurologic symptoms appeared posfoperatively in this case of ours. O...

  3. The migration of femoral components after total hip replacement surgery: accuracy and precision of software-aided measurements

    Energy Technology Data Exchange (ETDEWEB)

    Decking, J. [Dept. of Orthopaedic Surgery, Univ. of Mainz School of Medicine, Mainz (Germany); Schuetz, U.; Decking, R.; Puhl, W. [Orthopaedic Dept., Univ. of Ulm, School of Medicine (Germany)

    2003-09-01

    Objective: To assess the accuracy and precision of a software-aided system to measure migration of femoral components after total hip replacement (THR) on digitised radiographs. Design and patients: Subsidence and varus-valgus tilt of THR stems within the femur were measured on digitised anteroposterior pelvic radiographs. The measuring software (UMA, GEMED, Germany) relies on bony landmarks and comparability parameters of two consecutive radiographs. Its accuracy and precision were calculated by comparing it with the gold standard in migration measurements, radiostereometric analysis (RSA). Radiographs and corresponding RSA measurements were performed in 60 patients (38-69 years) following cementless THR surgery. Results and conclusions: The UMA software measured the subsidence of the stems with an accuracy of {+-}2.5 mm and varus-valgus tilt with an accuracy of {+-}1.8 (95% confidence interval). A good interobserver and intraobserver reliability was calculated with Cronbach's alpha ranging from 0.86 to 0.97. Measuring the subsidence of THR stems within the femur is an important parameter in the diagnosis of implant loosening. Software systems such as UMA improve the accuracy of migration measurements and are easy to use on routinely performed radiographs of operated hip joints. (orig.)

  4. Association between trochanteric bursitis, osteoarthrosis and total hip arthroplasty,

    Directory of Open Access Journals (Sweden)

    Carlos Roberto Schwartsmann

    2014-06-01

    Full Text Available OBJECTIVE: this was an epidemiological study on trochanteric bursitis at the time of performing total hip arthroplasty.METHODS: sixty-two sequential patients who underwent total hip arthroplasty due to osteoarthrosis, without any previous history of trochanteric bursitis, were evaluated. The bursas were collected and evaluated histologically.RESULTS: there were 35 female patients (56.5% and 27 male patients (43.5%, with a mean age of 65 years (±11. Trochanteric bursitis was conformed histologically in nine patients (14.5%, of whom six were female (66.7% and three were male (33.3%.CONCLUSIONS: 14.5% of the bursas analyzed presented inflammation at the time that the primary total hip arthroplasty due to osteoarthrosis was performed, and the majority of the cases of bursitis were detected in female patients.

  5. Pelvic pseudotumor following total hip arthroplasty – case report,

    Directory of Open Access Journals (Sweden)

    Nelson Franco Filho

    2014-10-01

    Full Text Available Loosening is a well-known complication of total hip arthroplasty. The accumulation of detritus resulting from mechanical wear forms inflammatory cells that have the function of phagocytizing this debris. Over the long term, these cells may give rise to a local granulomatous reaction. Here, we present a report on a case of pelvic pseudotumor subsequent to total hip arthroplasty, which is considered rare in the literature. The patient was a 48-year-old black man who started to be followed up medically eight months earlier because of uncharacteristic abdominal pains, dysuria and pollakiuria. He had undergone left total hip arthroplasty 17 years previously. Through clinical investigation and complementary examinations, an extra-articular granulomatous mass was diagnosed, constituting a pelvic pseudotumor.

  6. Lower limb length and offset in total hip arthroplasty.

    Science.gov (United States)

    Flecher, X; Ollivier, M; Argenson, J N

    2016-02-01

    Restoration of normal hip biomechanics is a key goal of total hip arthroplasty (THA) and favorably affects functional recovery. Furthermore, a major concern for both the surgeon and the patient is preservation or restoration of limb length equality, which must be achieved without compromising the stability of the prosthesis. Here, definitions are given for anatomic and functional limb length discrepancies and for femoral and hip offset, determined taking anteversion into account. Data on the influence of operated-limb length and offset on patient satisfaction, hip function, and prosthesis survival after THA are reviewed. Errors may adversely impact function, quality of life, and prosthetic survival and may also generate conflicts between the surgeon and patient. Surgeons rely on two- or three-dimensional preoperative templating and on intraoperative landmarks to manage offset and length. Accuracy can be improved by using computer-assisted planning or surgery and the more recently introduced EOS imaging system. The prosthetic's armamentarium now includes varus-aligned and lateralized implants, as well as implants with modular or custom-made necks, which allow restoration of the normal hip geometry, most notably in patients with coxa vara or coxa valga. Femoral anteversion must also receive careful attention. The most common errors are limb lengthening and a decrease in hip offset. When symptoms are caused by an error in length and/or offset, revision arthroplasty may deserve consideration. PMID:26797005

  7. Perioperative Pain Management in Total Hip Arthroplasty: Korean Hip Society Guidelines.

    Science.gov (United States)

    Min, Byung-Woo; Kim, Yeesuk; Cho, Hong-Man; Park, Kyung-Soon; Yoon, Pil Whan; Nho, Jae-Hwi; Kim, Sang-Min; Lee, Kyung-Jae; Moon, Kyong-Ho

    2016-03-01

    Effective perioperative pain management techniques and accelerated rehabilitation programs can improve health-related quality of life and functional status of patients after total hip arthroplasty. Traditionally, postoperative analgesia following arthroplasty was provided by intravenous patient-controlled analgesia or epidural analgesia. Recently, peripheral nerve blockade has emerged alternative analgesic approach. Multimodal analgesia strategy combines analgesics with different mechanisms of action to improve pain management. Intraoperative periarticular injection of multimodal drugs is one of the most important procedures in perioperative pain control for total hip arthroplasty. The goal of this review article is to provide a concise overview of the principles of multimodal pain management regimens as a practical guide for the perioperative pain management for total hip arthroplasty. PMID:27536639

  8. Wear testing of total hip replacements under severe conditions.

    Science.gov (United States)

    Zietz, Carmen; Fabry, Christian; Reinders, Joern; Dammer, Rebecca; Kretzer, Jan Philippe; Bader, Rainer; Sonntag, Robert

    2015-07-01

    Controlled wear testing of total hip replacements in hip joint simulators is a well-established and powerful method, giving an extensive prediction of the long-term clinical performance. To understand the wear behavior of a bearing and its limits under in vivo conditions, testing scenarios should be designed as physiologically as possible. Currently, the ISO standard protocol 14242 is the most common preclinical testing procedure for total hip replacements, based on a simplified gait cycle for normal walking conditions. However, in recent years, wear patterns have increasingly been observed on retrievals that cannot be replicated by the current standard. The purpose of this study is to review the severe testing conditions that enable the generation of clinically relevant wear rates and phenomena. These conditions include changes in loading and activity, third-body wear, surface topography, edge wear and the role of aging of the bearing materials. PMID:26048088

  9. A Rare Case of Femoral Neuropathy Associated with Ilio-Psoas Bursitis After 10 Years of Total Hip Arthroplasty

    OpenAIRE

    Singh, Vivek; Shon, Won Yong; Lakhotia, Devendra; Kim, Jong Hoon; Kim, Tae Wan

    2015-01-01

    We describe a case of femoral nerve palsy caused due to non-infective large iliopsoas bursitis after 10 years of cementless ceramic-on-metal THA. Bursectomy and exploration of femoral nerve were done to relieve the compressive symptoms of femoral nerve. Patient neurological symptoms were recovered within six months. Iliopsoas bursitis after THA can lead to anterior hip pain, lump in inguinal area or abdomen, limb swelling due to venous compression or more rarely neurovascular compressive symp...

  10. Functional rehabilitation after total hip arthroplasty with uncemented prosthesis

    Directory of Open Access Journals (Sweden)

    Nicolae-Bogdan Negru-Aman

    2011-12-01

    Full Text Available Arthritis is a disease that acts irreversibly on joint surfaces with significant consequences especially in the third quarter of life. About 7% of our population is affected by arthritis localized at a certain level and stage of development, and this percentage is expected to reach a much higher value in future years. Aim: The aim of this study is to propose a rehabilitation program for functional recovery after total hip arthroplasty and a set of recommendations for post surgery period. Material and methods: There were included 13 subjects (10 female and 3 male aged between 51 and 78 years old, ready for total hip arthroplasty with uncemented prosthesis. The subjects were selected in Orthopaedics and Traumatology department of Military Clinical Emergency Hospital ”Dr. Victor Popescu” Timisoara. The evaluations regarding programs’ efficiency were made using 3 questionnaires (Oxford Hip Score, Harris Hip Score, Outcome Hip Score and goniometry. The subjects were tested initially before the surgery and 3 times after (at one month, at 3 months and at 6 months. Results: The results showed a remarcable increase for the scores of majority, in both questionnaire and goniometry values. Conclusions: functional rehabilitation exercises proved to be particularly important in regaining independence, control of the prosthetic leg, pain reduction and functional and social reintegration.

  11. Neurovascular lesion after total hip arthroplasty in congenital hip dysplasia: Case report

    Directory of Open Access Journals (Sweden)

    Stojković-Jovanović Tatjana

    2013-01-01

    Full Text Available Introduction. Nowadays, the total hip arthroplasty is a very frequent surgical intervention. In some cases, vascular and nerve injuries may happen around the hip with total hip arthroplasty. Although they are very rare, they may be very dangerous for the patient in some cases. This paper presents a case of a female patient, in whom the nervous fibularis lesion was detected after the total hip arthroplasty, and the occlusion of the iliac femoral artery was revealed later during physical therapy. Case Report. We described a case of a 32-year-old female patient, in whom the nervous fibularis lesion was detected after the total hip arthroplasty. The patient was referred to a ward for physical therapy. On the 19th postoperative day, she felt a vigorous ache and numbness on the left operated leg during stimulation of the paretic fibular musculature. Clinically weak inguinal arterial pulse was detected. After the examination, iliac-femoral occlusion was diagnosed. The patient was referred to the vascular surgeon. In the next few months, she was treated conservatively and eventually underwent surgery. The revascularization was achieved with a satisfactory effect. A year after the total hip replacement, the patient continued with rehabilitation and physical treatment, which lasted one and a half month and had an incomplete functional result - the patient walked with a walking stick and had weak fibular musculature of a severe degree. The vascular status of the leg was good. Conclusion. In this case, neurovascular lesions led to an incomplete functional recovery of the patient and compromised the expected treatment outcome. According to the scoring system used to assess the functionality, the result was marked as poor.

  12. A Water Rehabilitation Program in Patients with Hip Osteoarthritis Before and After Total Hip Replacement

    Science.gov (United States)

    Łyp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; Włostowska, Ewa; Stanisławska, Iwona; Szypuła, Jan; Tomaszewski, Wiesław

    2016-01-01

    Background Pain associated with coxarthrosis, typically occurring in middle-aged and elderly patients, very commonly causes considerable limitation of motor fitness and dependence on pharmacotherapy. This article provides an assessment of a rehabilitation program with tailored water exercises in patients with osteoarthritis before and after total hip replacement. Material/Methods A total of 192 patients (the mean age 61.03±10.89) suffering from hip osteoarthritis (OA) were evaluated before and after total hip replacement (THR). The clinical study covered measurements of hip active ranges of motion (HAROM) and the forces generated by pelvis stabilizer muscles. Pain intensity was assessed according to analogue-visual scale of pain (VAS) and according to the Modified Laitinen Questionnaire. The patients were divided into 6 groups (4 treatment and 2 control). We compared 2 rehabilitation programs using kinesitherapy and low-frequency magnetic field. One of them also had specially designed exercises in the water. Statistical analysis was carried out at the significance level α=0.05. This was a cross-sectional study. Results A positive effect of water exercises on a number of parameters was found in patients with OA both before and after total hip replacement surgery. We noted a significant reduction of pain (pdegree of degenerative deforming lesions and the effects of the treatment process (p<0.01). Conclusions 1. The rehabilitation program including water exercises most significantly reduced pain in patients with OA before and after total hip replacement surgery. 2. Inclusion of water exercises in a rehabilitation program can reduce the use of medicines in patient with OA and after THR. PMID:27455419

  13. Alternative outcome measures in young total hip arthroplasty patients

    DEFF Research Database (Denmark)

    Klit, Jakob; Jacobsen, Steffen; Schmiegelow, Victoria;

    2015-01-01

    In this prospective multicentre cohort study we studied subjects younger than 60 years of age scheduled for primary total hip arthroplasty (THA). The study assessed patients' overall satisfaction, fulfillment of preoperative expectations, the effect on socioeconomic parameters, and quality of sex...

  14. The association between metal allergy, total hip arthroplasty, and revision

    DEFF Research Database (Denmark)

    Thyssen, Jacob Pontoppidan; Jakobsen, Stig Storgaard; Engkilde, Kåre;

    2009-01-01

    BACKGROUND AND PURPOSE: It has been speculated that the prevalence of metal allergy may be higher in patients with implant failure. We compared the prevalence and cause of revisions following total hip arthroplasty (THA) in dermatitis patients suspected to have contact allergy and in patients in ...

  15. Internal iliac artery pseudoaneurysm in primary total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Sanjay Agarwala

    2016-01-01

    Full Text Available Vascular injury is one of the rare complications of primary total hip arthroplasty (THA. We report an unusual case of lobulated pseudoaneurysm arising from one of the branches of the left internal iliac artery during acetabulum preparation in THA, which was successfully treated with coil embolization and multidisciplinary care. After 6 years follow up, patient did not have any symptoms related to the hip replacement. We recommend that surgeons should be extremely cautious while drilling medial wall of the acetabulum for depth assessment. Aggressive multidisciplinary approach, including possible support from an interventional radiologist is required for the treatment of such vascular injuries.

  16. Risk factors for renal dysfunction after total hip joint replacement

    DEFF Research Database (Denmark)

    Hassan, Basim Kamil; Sahlström, Arne; Dessau, Ram Benny Christian

    2015-01-01

    BACKGROUND AND PURPOSE OF THE STUDY: Renal injury and dysfunction are serious complications after major surgery, which may lead to increased morbidity and mortality. The objective of our study was to identify the possible risk factors for renal dysfunction after total hip joint replacement surgery......, hypertension, general anesthesia, high ASA scores, low intra-operative systolic BP, and prophylactic dicloxacillin as significant risk factors. Low baseline systolic BP, low baseline diastolic blood pressure, and hip fracture diagnosis were independent risk factors for postoperative increase in serum...... creatinine. Smoking, diabetes mellitus, high BMI, gender, and duration of surgery were not identified as significant risk factors....

  17. Fourth-generation ceramic-on-ceramic total hip arthroplasty in patients of 55 years or younger: short-term results and complications analysis

    Institute of Scientific and Technical Information of China (English)

    Wang Weiguo; Guo Wanshou; Yue Debo; Shi Zhencai; Zhang Nianfei; Liu Zhaohui; Sun Wei

    2014-01-01

    Background The incidence of total hip replacement in the younger and more active patients is ever increasing.The ceramic-on-ceramic (COC) bearing was developed to reduce wear debris-induced osteolysis and loosening and to improve the longevity of hip arthroplasties.Few studies have reported the clinical results and complications of the new zirconia-toughened ceramic total hip arthroplasty (THA).Methods A consecutive series of 132 young patients (177 hips) that underwent primary cementless THAs between January 2010 and December 2012 were included in this study.These arthroplasties all had fourth-generation COC bearings performed through a posterolateral approach.The average age was (41.8±8.3) years (ranging from 22 to 55 years),and the mean follow-up period was (24.5±9.4) months (ranging from 12 to 47 months).The results were evaluated both clinically and radiographically.Harris hip score (HHS) was determined before surgery and at the time of each follow-up.Presence of postoperative groin or thigh pain and squeaking were recorded.Other complications such as dislocations,periprosthetic fractures,and ceramic components fractures were diagnosed and treated in emergency.Results The average HHSs improved from preoperative 60.3±10.7 (ranging from 29 to 76) to 91.0±5.1 (ranging from 74 to 100) at the final follow-up (t=-45.064,P <0.05),and 97.7% of cases were scored as excellent and good results.At the last follow-up,incidental inguinal pain was found in three hips (1.7%) and thigh pain in 11 hips (6.2%).Radiographs showed a high rate of new bone formation around the acetabular and stem components.No obvious osteolysis or prosthesis loosening was detected.Complications occurred in six hips (3.4%):posterior dislocation in two hips (1.1%),periprosthetic femoral fracture in one hip (0.6%),asymptomatic squeaking in two hips (1.1%),and ceramic liner fracture in one hip (0.6%).Conclusions The fourth-generation COC THA showed excellent clinical results in

  18. Evaluation of Two Total Hip Bearing Materials for Resistance to Wear Using a Hip Simulator

    Directory of Open Access Journals (Sweden)

    Kenneth R. St. John

    2015-06-01

    Full Text Available Electron beam crosslinked ultra high molecular weight polyethylene (UHMWPE 32 mm cups with cobalt alloy femoral heads were compared with gamma-irradiation sterilized 26 mm cups and zirconia ceramic heads in a hip wear simulator. The testing was performed for a total of ten million cycles with frequent stops for cleaning and measurement of mass losses due to wear. The results showed that the ceramic on UHMWPE bearing design exhibited higher early wear than the metal on highly crosslinked samples. Once a steady state wear rate was reached, the wear rates of the two types of hip bearing systems were similar with the ceramic on UHMPWE samples continuing to show a slightly higher rate of wear than the highly crosslinked samples. The wear rates of each of the tested systems appear to be consistent with the expectations for low rates of wear in improved hip replacement systems.

  19. The influence of heterotopic ossification on functional status of hip joint following total hip arthroplasty

    International Nuclear Information System (INIS)

    Purpose: The functional failure induced by heterotopic ossification (HO) following total hip arthroplasty (THA) was analyzed and correlated to the radiologic failure. Patients and methods: From July 1997 to July 2001, 315 patients (345 hips) received THA indicated by a hypertrophic osteoarthritis of higher degree (Kellgren grade III, IV). All patients were irradiated prophylactically for prevention of HO on the evening before surgery with a 7-Gy single fraction. The patients' median age was 66.3 years. Radiologic failure was assessed by comparison of pre- and postoperative hip X-rays (immediately and 6 months after surgery). Analysis of radiographs was performed according to the Brooker Score. Clinical failure was appraised by measurement of passive range of motion (ROM) of the hip joint with a standard goniometer. The t-test was used for statistical analysis. Results: 281 patients (81.5%) did not develop HO. HO of Brooker grade I or II was found in 58 patients (16.8%). Six patients (1.7%) developed HO Brooker grade III or IV. There was a significant negative correlation between the degree of radiologic and clinical failure. ROM differed significantly between patients with HO Brooker grade 0, I, II and patients with HO Brooker grade III, IV. Comparing the pre- and postoperative ROM, all patients with Brooker grade 0, I and II showed a significant improvement of flexion, internal and external rotation, abduction and adduction movement. Patients with HO Brooker grade III and IV showed no improvement of ROM in the postoperative follow-up. Conclusion: The development of HO following THA influences the physical function of the hip joint dependent on the degree of ossification. HO of lower degree (Brooker I, II) does not influence the clinical outcome, whereas HO of higher degree (Brooker III, IV) reduces the function of hip arthroplasty. Therefore, the purpose of a prophylactic therapy must be to reduce HO of higher degree. (orig.)

  20. Conventional Versus Cross-Linked Polyethylene for Total Hip Arthroplasty.

    Science.gov (United States)

    Surace, Michele F; Monestier, Luca; Vulcano, Ettore; Harwin, Steven F; Cherubino, Paolo

    2015-09-01

    The clinical and radiographic outcomes of 88 patients who underwent primary total hip arthroplasty with either conventional polyethylene or cross-linked polyethylene (XLPE) from the same manufacturer were compared. There were no significant differences between the 2 subpopulations regarding average age, gender, side affected, or prosthetic stem and cup size. The average follow-up was 104 months (range, 55 to 131 months). To the authors' knowledge, this is the longest follow-up for this particular insert. Clinical and radiographic evaluations were performed at 1, 3, 6, and 12 months and then annually. Results showed that XLPE has a significantly greater wear reduction than that of standard polyethylene in primary total hip arthroplasty. At the longest available follow-up for these specific inserts, XLPE proved to be effective in reducing wear. PMID:26375527

  1. Can pelvic tilting be ignored in total hip arthroplasty?

    Directory of Open Access Journals (Sweden)

    Won Yong Shon

    2014-01-01

    CONCLUSION: The sagittal position of pelvis is a key factor in impingement and dislocation after total hip arthroplasty. Pelvic tilting affects the position of acetabular component in the sagittal plane of the body as compared with its anatomic position in the pelvis. We suggest a preoperative lateral view of spine-pelvis, in upright and supine position for evaluation of a corrective adaptation of the acetabular cup accordingly with pelvic balance.

  2. Increasing risk of prosthetic joint infection after total hip arthroplasty

    DEFF Research Database (Denmark)

    Dale, Håvard; Fenstad, Anne M; Hallan, Geir;

    2012-01-01

    Background and purpose The risk of revision due to infection after primary total hip arthroplasty (THA) has been reported to be increasing in Norway. We investigated whether this increase is a common feature in the Nordic countries (Denmark, Finland, Norway, and Sweden). Materials and methods The...... explain this increase. We believe that there has been an actual increase in the incidence of prosthetic joint infections after THA....

  3. Probability and heritability estimates on primary osteoarthritis of the hip leading to total hip arthroplasty

    DEFF Research Database (Denmark)

    Skousgaard, Søren Glud; Hjelmborg, Jacob; Skytthe, Axel;

    2015-01-01

    additive genetic component of 47 % (12:79), a shared environmental component of 21 % (2:76) and a unique environment component of 32 % (21:41) accounted for the variation in population liability to total hip arthroplasty. The sex-adjusted proband-wise concordance and heritability on age indicated an...... significant and account for 68 % of the variation in the population liability to total hip arthroplasty; however, the genetic influence increases significantly from 60 years of age onwards....... for the period 1995 to 2010 were examined. Our main outcomes were the cumulative incidence, proband-wise concordance and heritability on age, within-pair correlations in monozygotic and dizygotic twin pairs, and the genetic and environmental influence estimated in models taking into account that...

  4. Minimally invasive total hip replacement: the posterolateral approach.

    Science.gov (United States)

    Bottner, Friedrich; Delgado, Samuel; Sculco, Thomas P

    2006-05-01

    Our experience with the posterolateral mini-incision technique over the last 8 years has shown that total hip arthroplasty can be performed safely and effectively in properly selected patients through a much smaller incision than the one traditionally used. The main advantage of the posterolateral approach compared with other mini-incisions is its simplicity, with shortened operating time as a result. While the surgical time for a posterior approach is an average of 37 to 70 minutes throughout the literature, the 2-incision approach prolongs the surgery by a factor of 2 or 3. Compared with the anterior or 2-incision approach, the posterolateral and anterolateral approaches also have a much lower incidence of perioperative complications, with the rate being similar to rates seen with a standard incision. For the 2-incision technique and the anterior mini-incision approach, perioperative periprosthetic fracture rates of up to 8.7% and 8.4%, respectively, have been described. Surgeons who traditionally used an anterolateral standard approach might prefer an anterolateral mini-incision. The anterolateral mini-incision total hip arthroplasty has demonstrated excellent results; in the past it was suggested that the anterolateral approach has a higher incidence of heterotopic bone formation and impaired early abductor function, but more recent studies show no difference in abductor strength and limping between the anterolateral and posterior approaches. On the other hand, the posterior approach has been associated with an increased risk of postoperative dislocations. We did not encounter an increased incidence of postoperative dislocation at our institution. This might be related to the routine repair of the external rotators and the capsule in all patients. In summary, both the anterolateral and the posterior mini-incision approaches are reasonable alternatives, and surgeons should choose the approach that they feel most comfortable with. Statements in the press and by

  5. Estudo da estabilidade dos componentes na artroplastia total do joelho sem cimento Study on implant stability in cementless total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Luís Eduardo Passarelli Tírico

    2012-01-01

    Full Text Available OBJETIVO: Comparar dois métodos de avaliação da estabilidade dos componentes tibial e femoral nas artroplastias de joelho não cimentadas com plataforma rotatória. MÉTODOS: Para isso foram avaliados 20 pacientes (20 joelhos através de uma análise de radiografias dinâmicas com intensificador de imagem e manobras de estresse em varo e valgo, que foram comparadas com radiografias estáticas em frente e perfil dos joelhos, analisadas por dois cirurgiões experientes, cegos um em relação ao outro. RESULTADOS: Os resultados das análises estáticas e dinâmicas foram comparados e demonstraram forte correlação estatística (pObjetives: Determine the stability of tibial and femoral components of 20 cementless knee arthroplasties with rotating platform. METHODS: The 20 patients (20 knees underwent an analysis of dynamic radiographs with an image amplifier and maneuvers of varus and valgus which were compared to static frontal and lateral radiographs of the knees and analyzed by two experienced surgeons in a double-blind way. RESULTS: We could observe in this study that both methods showed very similar results for the stability of the tibial and femoral components (p<0,001 using the Kappa method for comparison. CONCLUSION: The tibial component was more unstable in relation to the femoral component in both static and dynamic studies. Level of evidence IV, Case Series.

  6. Total Hip Arthroplasty – over 100 years of operative history

    Directory of Open Access Journals (Sweden)

    Stephen Richard Knight

    2011-11-01

    Full Text Available Total hip arthroplasty (THA has completely revolutionised the nature in which the arthritic hip is treated, and is considered to be one of the most successful orthopaedic interventions of its generation (1. With over 100 years of operative history, this review examines the progression of the operation from its origins, together with highlighting the materials and techniques that have contributed to its development. Knowledge of its history contributes to a greater understanding of THA, such as the reasons behind selection of prosthetic materials in certain patient groups, while demonstrating the importance of critically analyzing research to continually determine best operative practice. Finally, we describe current areas of research being undertaken to further advance techniques and improve outcomes.

  7. Inequalities in use of total hip arthroplasty for hip fracture: population based study

    Science.gov (United States)

    Metcalfe, David; Griffin, Xavier L; Costa, Matthew L

    2016-01-01

    Objectives To determine whether the use of total hip arthroplasty (THA) among individuals with a displaced intracapsular fracture of the femoral neck is based on national guidelines or if there are systematic inequalities. Design Observational cohort study using the National Hip Fracture Database (NHFD). Setting All hospitals that treat adults with hip fractures in England, Wales, and Northern Ireland. Participants Patients within the national database (all aged ≥60) who received operative treatment for a non-pathological displaced intracapsular hip fracture from 1 July 2011 to 31 April 2015. Main outcome measures Provision of THA to patients considered eligible under criteria published by the National Institute for Health and Care Excellence (NICE). Results 114 119 patients with hip fracture were included, 11 683 (10.2%) of whom underwent THA. Of those who satisfied the NICE criteria, 32% (6780)received a THA. Of patients who underwent THA, 42% (4903) did not satisfy the NICE criteria. A recursive partitioning algorithm found that the NICE eligibility criteria did not optimally explain which patients underwent THA. A model with superior explanatory power drew distinctions that are not supported by NICE, which were an age cut off at 76 and a different ambulation cut off. Among patients who satisfied the NICE eligibility, the use of THA was less likely with higher age (odds ratio 0.88, 95% confidence interval 0.87 to 0.88), worsening abbreviated mental test scores (0.49 (0.41 to 0.58) for normal cognition v borderline cognitive impairment)), worsening American Society of Anesthesiologists score (0.74, 0.66 to 0.84), male sex (0.85, 0.77 to 0.93), worsening ambulatory status (0.32, 0.28 to 0.35 for walking with a stick v independent ambulation), and fifths of worsening socioeconomic area deprivation (0.76 (0.66 to 0.88) for least v most deprived fifth). Patients receiving treatment during the working week were more likely to receive THA than at the

  8. Development of Imageless Computer Navigation for Acetabular Component Position in Total Hip Replacement

    OpenAIRE

    Dorr, Lawrence D.; Hishiki, Yuji; Wan, Zhinian; Newton, Deanne; Yun, Andrew

    2005-01-01

    The purpose of this study was to develop an imageless (without preoperative computerized tomography (CT) scans or intraoperative fluoroscopy) computer navigation system for total hip replacement. One-hundred and ninety-five hips were operated with imageless computer navigation. Eighty-five hips were operated prior to obtaining precise results, with precision refined in the subsequent 110 hips. Computer accuracy for cup-adjusted anteversion was achieved in 100% of the final 40 hips, and for ad...

  9. Increased body mass index is a predisposition for treatment by total hip replacement

    OpenAIRE

    Jacobsen, Steffen; Sonne-Holm, Stig

    2005-01-01

    We investigated the radiological and epidemiological data of 4,151 subjects followed up from 1976 to 2003 to determine individual risk factors for hip osteoarthritis (OA), hip pain and/or treatment by total hip replacement (THR). Pelvic radiographs recorded in 1992 were assessed for evidence of hip-joint degeneration and dysplasia. Sequential body mass index (BMI) measurements from 1976 to 1992, age, exposure to daily lifting and hip dysplasia were entered into logistic regression analyses. T...

  10. Minimally invasive two-incision total hip arthroplasty:a short-term retrospective report of 27 cases

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xian-long; WANG Qi; SHEN Hao; JIANG Yao; ZENG Bing-fang

    2007-01-01

    Background Total hip arthroplasty (THA) is widely applied for the treatment of end-stage painful hip arthrosis.Traditional THA needed a long incision and caused significant soft tissue trauma. Patients usually required long recovery time after the operation. In this research we aimed to study the feasibility and clinical outcomes of minimally invasive two-incision THA.Methods From February 2004 to March 2005, 27 patients, 12 males and 15 females with a mean age of 71 years (55-76), underwent minimally invasive two-incision THA in our department. The patients included 9 cases of osteoarthritis, 10 cases of osteonecrosis, and 8 cases of femoral neck fracture. The operations were done with VerSys cementless prosthesis and minimally invasive instruments from Zimmer China. Operation time, blood loss, length of incision, postoperative hospital stay, and complications were observed.Results The mean operation time was 90 minutes (80-170 min). The mean blood loss was 260 ml (170-450 ml) and blood transfusion was carried out in 4 cases of femoral neck fracture (average 400 ml). The average length of the anterior incision was 5.0 cm (4.6-6.5 cm) and of the posterior incision 3.7 cm (3.0-4.2 cm). All of the patients were ambulant the day after surgery. Nineteen patients were discharged 5 days post-operatively and 8 patients 7 days post-operatively. The patients were followed for 18 months (13-25 months). One patient was complicated by a proximal femoral fracture intraoperatively. No other complications, including infections, dislocations, and vascular injuries, occurred. The mean Harris score was 94.5 (92-96).Conclusions Two-incision THA has the advantage of being muscle sparing and minimally invasive with less blood loss and rapid recovery. However, this technique is time consuming, technically demanding, and requires fluoroscopy.

  11. Patients' perception of leg length discrepancy post total hip arthroplasty.

    Science.gov (United States)

    Sykes, Alice; Hill, Janet; Orr, John; Humphreys, Patricia; Rooney, Aidan; Morrow, Esther; Beverland, David

    2015-01-01

    Perception of a leg length discrepancy post total hip arthroplasty (THA) is one of the most common sources of patient dissatisfaction and can have a direct influence on the considered success of the operation.This research examined postoperative perception of imposed limb discrepancies in a group of THA patients compared to a group of participants with no previous hip surgery. Two subgroups of THA patients were involved: those who did not perceive a difference in limb length following THA and those that did.Discrepancies were imposed in 2.5 mm increments. For discrepancies ≥5 mm, a significant number of participants were aware of a difference (74%). There was no significant difference in perception of imposed discrepancies between THA patients and participants with no previous hip surgery. THA patients who perceived a difference in their limb lengths postoperatively had significantly worse pain and oxford scores when compared to THA patients who perceived their limb lengths to be equal. Knowing the boundaries between LLDs that go undetected and those that patients are aware of could guide surgeons when evaluating the balance between correct soft tissue tension and the resulting unequal leg length. From these findings, discrepancies >5 mm are likely to be perceived. Whether this perception would lead directly to a negative outcome score and patient dissatisfaction is more complex to project and likely to be patient specific. Intraoperative methods to aid the controlled positioning of implanted components could help maintain and restore leg length to within an acceptable amount that patients cannot perceive.

  12. TOTAL HIP REPLACEMENT IN LEGG-CALVÉ-PERTHES DISEASE

    DEFF Research Database (Denmark)

    Froberg, Lonnie; Christensen, Finn; Pedersen, Niels Wisbech;

    2009-01-01

    to follow-up and 3) patients with previous surgery to pelvis or lower limbs. 135 patients (156 hips) were enrolled in this study and 32 patients (35 hips) were excluded. RESULTS 20 hips out of 156 hips in patients with LCP have had a THR. Mean age at operation for the women was 50 years and 44 years...

  13. Outcome of total hip arthroplasty as a salvage procedure for failed infected internal fixation of hip fractures

    OpenAIRE

    Shubhranshu S Mohanty; Agashe, Mandar V.; Sheth, Binoti A; Kumar K. Dash

    2013-01-01

    Background: Failed infected internal fixation produces significant pain and functional disability. In infected internal fixation of hip fractures with partial or complete head destruction, total hip arthroplasty (THA) can be technically challenging; however, it restores hip biomechanics. The present study is to evaluate the results and assess the complications of THA following failed infected internal fixation of these fractures. Materials and Methods: A retrospective review of prospectiv...

  14. Increased body mass index is a predisposition for treatment by total hip replacement

    DEFF Research Database (Denmark)

    Jacobsen, Steffen; Sonne-Holm, Stig

    2005-01-01

    -joint degeneration and dysplasia. Sequential body mass index (BMI) measurements from 1976 to 1992, age, exposure to daily lifting and hip dysplasia were entered into logistic regression analyses. The prevalence of hip dysplasia ranged from 5.4% to 12.8% depending on the radiographical index used. Radiological hip OA...... prevalence was 1.0--2.5% in subjects <60 years of age and 4.4--5.3% in subjects >or=60 years of age. While radiological OA was significantly influenced by hip dysplasia in men and hip dysplasia and age in women, the risk of THR being performed was only influenced by BMI assessed in 1976. Hip......We investigated the radiological and epidemiological data of 4,151 subjects followed up from 1976 to 2003 to determine individual risk factors for hip osteoarthritis (OA), hip pain and/or treatment by total hip replacement (THR). Pelvic radiographs recorded in 1992 were assessed for evidence of hip...

  15. Total arthroplasty in patients with developmental dysplasia of hip fractures: Two case reports

    OpenAIRE

    Çitlak, Atilla; KERİMOĞLU, Servet; BAKİ, Mehmet Emre

    2015-01-01

    Treatment of fractures in patients with developmental dysplasia of hip is not clear. In patients without any pre-existing hip pathology, open or closed reduction and internal fixation is used to treat hip fractures. Total arthroplasty is used as a salvage procedure in hip fractures of young patients. Total arthroplasty serves perfect functional results in elderly patients with developmental dysplasia of hip. We presented two multi-trauma patients with developmental dysplasia of hip, and their...

  16. Comparison of patient and surgeon expectations of total hip arthroplasty.

    Directory of Open Access Journals (Sweden)

    Claire Jourdan

    Full Text Available OBJECTIVES: Analysis of discrepancies between patient and surgeon expectations before total hip arthroplasty (THA should enable a better understanding of motives of dissatisfaction about surgery, but this question has been seldom studied. Our objectives were to compare surgeons' and patients' expectations before THA, and to study factors which affected surgeon-patient agreement. METHODS: 132 adults (mean age 62.8+/-13.7 years, 52% men on waiting list for THA in three tertiary care centres and their 16 surgeons were interviewed to assess their expectations using the Hospital for Special Surgery Total Hip Replacement Expectations Survey (range 0-100. Patients' and surgeons' answers were compared, for the total score and for the score of each item. Univariate analyses tested the effect of patients' characteristics on surgeons' and patients' expectations separately, and on surgeon-patient differences. RESULTS: Surgeon and patient expectations' mean scores were high (respectively 90.9+/-11.1 and 90.0+/-11.6 over 100. Surgeons' and patients' expectations showed no systematic difference, but there was little agreement on Bland and Altman graph and correlation coefficient was low. Patients had higher expectations than surgeons for sports. Patients rated their expectations according to trust in physician and mental quality of life, surgeons considered disability. More disabled patients and patients from a low-income professional category were often "more optimistic" than their surgeons. CONCLUSION: Surgeons and patients often do not agree on what to expect from THA. More disabled patients expect better outcomes than their surgeons.

  17. The use of cementless acetabular component in revision surgery without pelvic discontinuity.

    Science.gov (United States)

    Cherubino, Paolo; D'Angelo, Fabio; Surace, Michele Francesco; Murena, Luigi; Vulcano, Ettore

    2010-10-01

    Reconstruction of the failed acetabular component in total hip arthroplasty (THA) can be challenging. Although there are multiple reconstructive options available, a cementless acetabular component inserted with screws has been shown to have good intermediate-term results and is the reconstructive method of choice for the majority of acetabular revisions This reconstruction is feasible provided at least 50% of the implant contacts host bone. When such contact is not possible, and there is adequate medial and peripheral bone, techniques using alternative uncemented implants can be used for acetabular reconstruction. An uncemented cup can be placed at a "high hip center." Alternatively, the acetabular cavity can be progressively reamed to accommodate extra-large cups. Oblong cups, which take advantage of the oval-shaped cavity resulting from many failed acetabular components, can also be used. The success of these cementless techniques depends on the degree and location of bone loss. The correct indication to revision and the choice of the correct implant is the keystone for the success of this type of surgery and follows an accurate preoperative planning in order to understand the specific pathologic scenario. The aim of this paper is to review some technical options for the revision of the acetabular component also taking into account our personal experiences and series. PMID:21082580

  18. Recovery in horizontal gait after hip resurfacing vs. total hip arthroplasty at 6-month follow-up - a RCT study

    DEFF Research Database (Denmark)

    Jensen, Carsten; Aagaard, Per; Overgaard, Søren

    2012-01-01

    in walking ability and kinematics have been suggested after R-THA, but no study sofar has objectively assessed this aspect in a randomized trial including S-THA. Purpose: To test the hypothesis that (i) a superior recovery in gait would be observed following resurfacing total hip arthroplasty compared...... to standard total hip arthroplasty and (ii) to investigate the hypothesized relationship between mechanical hip and knee muscle performance and horizontal gait function in patients with total hip replacement. Methods: Forty-three patients were randomized into either standard or resurfacing THA. Three......-dimensional gait data were collected at self-selected normal and maximal walking speed. Primary outcome was gait speed while secondary outcomes comprised selected temporospatial and kinematic parameters obtained during horizontal walking. Explorative outcome was the relationship between isolated mechanical hip...

  19. 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

  20. Patient-reported outcome of hip resurfacing arthroplasty and standard total hip replacement after short-term follow-up

    DEFF Research Database (Denmark)

    Nissen, Tina Koerner; Douw, Karla; Overgaard, Søren

    2011-01-01

    The purpose of this study was to investigate patientreported outcome in terms of satisfaction in two study groups that had undergone hip resurfacing arthro-plasty (HRA) or total hip replacement (THR). The procedure consists of placing a hollow, mushroom-shaped metal cap over the femoral head whil...... a matching metal cup is placed in the acetabulum (pelvis socket)....

  1. Changes in bone mineral density of the acetabulum, femoral neck and femoral shaft, after hip resurfacing and total hip replacement

    DEFF Research Database (Denmark)

    Penny, J O; Brixen, K; Varmarken, J E;

    2012-01-01

    It is accepted that resurfacing hip replacement preserves the bone mineral density (BMD) of the femur better than total hip replacement (THR). However, no studies have investigated any possible difference on the acetabular side. Between April 2007 and March 2009, 39 patients were randomised into ...

  2. Association between contact hip stress and RSA-measured wear rates in total hip arthroplasties of 31 patients.

    NARCIS (Netherlands)

    The, B.; Hosman, A.; Kootstra, J.; Kralj-Iglic, V.; Flivik, G.; Verdonschot, N.J.J.; Diercks, R.

    2008-01-01

    BACKGROUND: The main concern in the long run of total hip replacements is aseptic loosening of the prosthesis. Optimization of the biomechanics of the hip joint is necessary for optimization of long-term success. A widely implementable tool to predict biomechanical consequences of preoperatively pla

  3. Association between contact hip stress and RSA-measured wear rates in total hip arthroplasties of 31 patients

    NARCIS (Netherlands)

    The, Bertram; Hosman, Anton; Kootstra, Johan; Kralj-Iglic, Veronika; Flivik, Gunnar; Verdonschot, Nico; Diercks, Ron

    2008-01-01

    Background: ne main concern in the long run of total hip replacements is aseptic loosening of the prosthesis. Optimization of the biomechanics of the hip joint is necessary for optimization of long-term success. A widely implementable tool to predict biomechanical consequences of preoperatively plan

  4. Minimal stress shielding with a Mallory-Head titanium femoral stem with proximal porous coating in total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Lombardi Adolph V

    2009-12-01

    Full Text Available Abstract Background As longevity of cementless femoral components enters the third decade, concerns arise with long-term effects of fixation mode on femoral bone morphology. We examined the long-term consequences on femoral remodeling following total hip arthroplasty with a porous plasma-sprayed tapered titanium stem. Methods Clinical data and radiographs were reviewed from a single center for 97 randomly selected cases implanted with the Mallory-Head Porous femoral component during primary total hip arthroplasty. Measurements were taken from preoperative and long-term follow-up radiographs averaging 14 years postoperative. Average changes in the proximal, middle and diaphyseal zones were determined. Results On anteroposterior radiographs, the proximal cortical thickness was unchanged medially and the lateral zone increased 1.3%. Middle cortical thickness increased 4.3% medially and 1.2% laterally. Distal cortical thickness increased 9.6% medially and 1.9% laterally. Using the anteroposterior radiographs, canal fill at 100 mm did not correlate with bony changes at any level (Spearman's rank correlation coefficient of -0.18, 0.05, and 0.00; p value = 0.09, 0.67, 0.97. On lateral radiographs, the proximal cortical thickness increased 1.5% medially and 0.98% laterally. Middle cortical thickness increased 2.4% medially and 1.3% laterally. Distal cortical thickness increased 3.5% medially and 2.1% laterally. From lateral radiographs, canal fill at 100 mm correlated with bony hypertrophy at the proximal, mid-level, and distal femur (Spearman's rank correlation coefficient of 0.85, 0.33, and 0.28, respectively; p value = 0.001, 0.016, and 0.01, respectively. Conclusion Stress shielding is minimized with the Mallory-Head titanium tapered femoral stem with circumferential proximal plasma-sprayed coating in well-fixed and well-functioning total hip arthroplasty. Additionally, the majority of femora demonstrated increased cortical thickness in all zones

  5. 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.

  6. Pseudotumor Caused by Titanium Particles From a Total Hip Prosthesis.

    Science.gov (United States)

    Sakamoto, Masaaki; Watanabe, Hitoshi; Higashi, Hidetaka; Kubosawa, Hitoshi

    2016-01-01

    A 77-year-old woman underwent metal-on-polyethylene total hip arthroplasty for osteoarthritis of the right hip at another institution. During surgery, the greater trochanter was broken and internal fixation was performed with a trochanteric cable grip reattachment. Although postoperative recovery was uneventful, approximately 6 years later, the patient had severe right hip pain with apparent swelling, and she was referred to the authors' institution. Plain radiographs showed evidence of severe osteolysis in the proximal femur and cable breakage; however, preoperative aspiration culture findings were negative for bacterial growth. Magnetic resonance imaging showed a well-circumscribed mass, presumed to be a pseudotumor. Serum cobalt and chromium levels were within normal limits, and the serum titanium level was high. During surgery, the mass was excised and removal of the cable system revealed a sharp deficit in the bare femoral stem. Gross surgical findings showed no obvious evidence of infection and no corrosion at the head-neck junction; therefore, all components were retained besides the cable system, which resulted in clinical recovery. All of the cultures from specimens were negative for bacterial growth, and histologic findings were compatible with a pseudotumor, such as histiocytes containing metal particles, abundant plasma cells, and CD8-positive cells. Quantitative analysis by inductively coupled plasma atomic emission spectrometry showed that the main source of metal debris in the pseudotumor was the femoral stem, which was made of titanium alloy, not the broken cable, which was made of cobalt-chromium alloy. The findings suggest that titanium particles can form symptomatic solid pseudotumors. PMID:26709566

  7. Pseudotumor Caused by Titanium Particles From a Total Hip Prosthesis.

    Science.gov (United States)

    Sakamoto, Masaaki; Watanabe, Hitoshi; Higashi, Hidetaka; Kubosawa, Hitoshi

    2016-01-01

    A 77-year-old woman underwent metal-on-polyethylene total hip arthroplasty for osteoarthritis of the right hip at another institution. During surgery, the greater trochanter was broken and internal fixation was performed with a trochanteric cable grip reattachment. Although postoperative recovery was uneventful, approximately 6 years later, the patient had severe right hip pain with apparent swelling, and she was referred to the authors' institution. Plain radiographs showed evidence of severe osteolysis in the proximal femur and cable breakage; however, preoperative aspiration culture findings were negative for bacterial growth. Magnetic resonance imaging showed a well-circumscribed mass, presumed to be a pseudotumor. Serum cobalt and chromium levels were within normal limits, and the serum titanium level was high. During surgery, the mass was excised and removal of the cable system revealed a sharp deficit in the bare femoral stem. Gross surgical findings showed no obvious evidence of infection and no corrosion at the head-neck junction; therefore, all components were retained besides the cable system, which resulted in clinical recovery. All of the cultures from specimens were negative for bacterial growth, and histologic findings were compatible with a pseudotumor, such as histiocytes containing metal particles, abundant plasma cells, and CD8-positive cells. Quantitative analysis by inductively coupled plasma atomic emission spectrometry showed that the main source of metal debris in the pseudotumor was the femoral stem, which was made of titanium alloy, not the broken cable, which was made of cobalt-chromium alloy. The findings suggest that titanium particles can form symptomatic solid pseudotumors.

  8. Nursing in fast-track total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Specht, Kirsten; Kjaersgaard-Andersen, Per; Kehlet, Henrik;

    2015-01-01

    must still focus on the individual patient. Nurses need to have enough education to manage the complex tasks and increased responsibility. To prevent undesirable outcomes in the future, there is a need to pay attention to the nursing quality in balance with the nursing budget. It may, therefore......AIM: To describe the increased activity in total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2002 to 2012 in a single orthopaedic department, the organisation of fast-track and its consequences for nursing care. METHODS: Retrospective, descriptive design. Data collection; from...... gained tasks from surgeons and physiotherapists and thus gained more responsibility, for example, for pain management and mobilisation. Staffing levels in the ward in 2002 and 2012 were almost unchanged; 16.0 and 15.8 respectively. Nurses were undertaking more complicated tasks. CONCLUSION: Nursing care...

  9. Sciatic nerve palsy associated with total hip arthroplasty.

    Science.gov (United States)

    Dhillon, M S; Nagi, O N

    1992-01-01

    Six cases of clinically evident sciatic or peroneal nerve palsy occurred in a consecutive series of 380 total hip arthroplasties (THA). An additional eight cases of peroneal nerve palsy due to pressure from Thomas splint or tight bandages were seen. Factors apparently causing nerve palsy were significant lateralization and lengthening in four cases and dislocation of the hip in one case. The cases with neuroapraxia of the peroneal nerve were seen from the third to the fifth day of Thomas splint immobilization. EMG studies were conducted in all six group 1 patients; at the end of one year the results were good in two cases, fair in three cases, and poor in one case. The results suggest that limb lengthening should be limited to 4 cm to minimize this complication. It was also seen that patients with peroneal nerve palsy due to local compression do well, though some are bothered by mild residual dysesthesia over the dorsum of the foot. In contrast, patients with sciatic nerve palsy do not have such a good outlook. PMID:1345646

  10. Economics of thromboprophylaxis in total hip replacement surgery.

    Science.gov (United States)

    Harrison, J; Warwick, D J; Coast, J

    1997-07-01

    In 1997, 50,000 hip replacements will be performed in the UK, and over 1 million worldwide. Venous thromboembolism is the most frequent serious complication following joint replacement; its effective and economic management is essential. Antithrombotic prophylaxis can be used to reduce the incidence of venous thromboembolic disease, which presents as either deep vein thrombosis or pulmonary embolism. A number of published studies have shown that prophylaxis against venous thromboembolism is financially beneficial in terms of reduced diagnostic and treatment costs. Cost-effectiveness studies have provided a comparison of the costs and consequences resulting from alternative prophylactic programmes. This article reviews the epidemiology of venous thromboembolism after total hip replacement, prophylaxis against it and a model for cost-effectiveness analysis. Its aim is to highlight inadequacies in the available data and areas of uncertainty within the model that require further research. Pharmacoeconomic studies published to date have all used a similar framework to allow prophylactic options to be compared. However, assumptions made about the frequency of clinical disease have varied widely between studies. This degree of uncertainty calls into question the validity of reported incremental cost savings between treatments. Some studies have also failed to address the cost of complications resulting from the prophylactic method under consideration. Future studies must carefully consider the validity of their models, understand the limitations on current knowledge of outcome rates, and carefully consider all outcomes (both beneficial and detrimental) that result from the intervention. PMID:10169386

  11. Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes

    OpenAIRE

    Petis, Stephen; Howard, James L.; Lanting, Brent L.; Vasarhelyi, Edward M.

    2015-01-01

    Total hip arthroplasty (THA) has revolutionized the treatment of hip arthritis. A number of surgical approaches to the hip joint exist, each with unique advantages and disadvantages. The most commonly used approaches include the direct anterior, direct lateral and posterior approaches. A number of technical intricacies allow safe and efficient femoral and acetabular reconstruction when using each approach. Hip dislocation, abductor insufficiency, fracture and nerve injury are complications of...

  12. Two Different Total Hip Arthroplasties for Hartofilakidis Type C1 Developmental Dysplasia of Hip in Adults

    Institute of Scientific and Technical Information of China (English)

    Ya-Ming Chu; Yi-Xin Zhou; Na Han; De-Jin Yang

    2016-01-01

    Background: Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) is more complex than the normal hip, with large replacement risks and many complications.Although nonosteotomy THA is convenient to perform, femoral osteotomy shortening can avoid blood vessel and nerve traction injuries.This study aimed to compare osteotomy THA with nonosteotomy to determine reasonable options for operative management of DDH.Methods: Data on 48 DDH patients who underwent THA were analyzed retrospectively.The patients were divided into two groups: Group A 29 cases (nonosteotomy), and group B 19 cases (osteotomy).Harris and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, limb length discrepancy (LLD), radiological data on the hip, and claudication were evaluated.Data were analyzed by using paired-sample Student's t-test, independent-sample Student's t-test, and Pearson's Chi-square test;the test level was α =0.05.Results: Postoperative Harris (90.7 ± 5.1) and WOMAC scores (88.0 ± 10.6) were significantly improved compared with preoperative Harris (44.8 ± 5.7) and WOMAC scores (42.0 ± 5.3) in group A (P < 0.05).Postoperative Harris (90.4 ± 2.8) and WOMAC scores (88.2 ± 5.9) were significantly improved compared with preoperative Harris (44.4 ± 4.2) and WOMAC scores (43.2 ± 4.3) in group B (P < 0.05).One case of dislocation occurred in group A;after closed reduction, dislocation did not recur.In group A, 2 patients developed cutaneous branch injury of the femoral nerve, which spontaneously recovered without treatment.Postoperative LLD >2 cm was seen in one case in group A and five cases in group B.Postoperative claudication showed no significant difference between the two groups (P > 0.05).No patients developed infection;postoperative X-rays showed that the location of the prosthesis was satisfactory, and the surrounding bone was not dissolved.Conclusions: THA is effective and safe for DDH.For unilateral high dislocation

  13. Sexual Function before and after Total Hip Replacement: Narrative Review

    Directory of Open Access Journals (Sweden)

    Rotem Meiri, BPT

    2014-12-01

    Conclusions: The ability to move comfortably is included among the many physical and psychosocial factors influencing sexual functioning. Practitioners should be encouraged to question their THR patients about sexual concerns and to provide counseling related to physical and functional aspects of sexual activity. Rehabilitation that focuses specifically on activities of daily living of sex should include sexual counseling, therapeutic exercise, and advice regarding sexual positions. Rehabilitation provided by physical therapists may help decrease pain, and facilitate greater self‐awareness, self‐confidence, and improved body image, all of which encourage and affirm optimal sexual health. Meiri R, Rosenbaum TY, and Kalichman L. Sexual function before and after total hip replacement: Narrative review. Sex Med 2014;2:159–167.

  14. Catastrophic failure of ceramic-polyethylene bearing total hip arthroplasty.

    Science.gov (United States)

    Needham, Justin; Burns, Travis; Gerlinger, Tad

    2008-06-01

    Complications of ceramic-polyethylene bearing total hip arthroplasty (THA) include osteolysis, loosening, dislocation, and component failure. Catastrophic acetabular component failure involves severe damage to both the polyethylene liner and metal shell. This case study presents the first reported complete wear-through of the acetabular portion of a ceramic-polyethylene arthroplasty presenting as a dislocation and a review of the literature. In this study, a patient's alumina ceramic femoral head penetrated the polyethylene liner and titanium shell and presented as a dislocated THA. The contributing factors for this catastrophic failure include young patient age, high activity level, thin polyethylene liner, backside wear, component positioning, polyethylene sterilization with gamma irradiation in air, and lack of appropriate follow-up. Revision THA was performed without complications. PMID:18514888

  15. Cemented total hip prosthesis: Radiographic and scintigraphic evaluation

    International Nuclear Information System (INIS)

    Conventional radiographs, technetium-99m bone scans, and gallium-67 scans were reviewed in 44 patients who had undergone cemented total hip joint replacement and were imaged because of suspicion of prosthesis loosening or infection. A complete radiolucent line of 2 mm or wider along the bone-cement interface or metal-cement lucency on conventional radiographs was used as the criterion for prosthetic loosening with or without infection and proved to be 54% sensitive and 96% specific. Scintigraphic criteria for prosthetic loosening were increased focal uptake of the radiopharmaceutical for the femoral component and increased focal or diffuse uptake for the acetabular component. For bone scintigraphy, sensitivity was 73% and specificity was 96%. Combining the results of conventional radiographs and bone scans increased sensitivity to 84% and decreased specificity to 92% for the diagnosis of loosening, infection, or both. The study also showed that Ga-67 scintigraphy has a low sensitivity for the detection of infection

  16. 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.

  17. Complications in primary total hip arthroplasty: avoidance and management: wear.

    Science.gov (United States)

    Ries, Michael D

    2003-01-01

    Many factors, including polyethylene processing, sterilization method, counterface material, femoral head size, femoral offset, acetabular component position, implant design, and patient activity level, affect the rate of wear in total hip arthroplasty. For patients with life expectancy that exceeds the longevity of the conventional implant materials, an alternative bearing surface (highly cross-linked polyethylene, metal-on-metal, or ceramic-on-ceramic) may be considered. Although laboratory wear tests with these materials are very favorable, clinical outcomes have not been clearly established. When osteolysis does develop in response to particulate debris, the location and progression of the lesions may be quite variable. Asymptomatic stable lesions can be followed clinically and radiographically while symptomatic or enlarging lesions or those that may compromise the integrity of the periprosthetic bone stock require surgery. If acetabular component revision is necessary and an adequate rim of host bone is maintained to support a revision acetabular component, defects can be filled with particulate bone graft. Large segmental defects generally require structural allografts. If the acetabular shell is well fixed in good position and the osteolytic defects are accessible, treatment with curettage and bone grafting of the lesions with liner revision is appropriate to avoid use of a structural allograft. Proximal femoral defects around a well-fixed stem can be managed in a similar manner with curettage and bone grafting. Distal lesions associated with risk of periprosthetic femur fracture or implant loosening require stem revision. Osteoclastic resportion of bone in response to particulate debris can be impaired with use of some drugs such as alendronate. However, the safety and efficacy of alendronate in the clinical management of osteolysis associated with total hip arthroplasty has not been established. PMID:12690853

  18. Reconstruction of the Acetabulum in Developmental Dysplasia of the Hip in total hip replacement

    OpenAIRE

    Vasileios Sakellariou; Michael Christodoulou; Gregory Sasalos; George Babis

    2014-01-01

    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...

  19. Uncemented Total Hip Replacement Stem Loosening after Long Term Compressive Stress Application: A Simulated FEA Study of Cortical Bone Remodeling

    Science.gov (United States)

    Jung, Duk-Young; Tsutsumi, Sadami; Nakai, Ryusuke; Ikeuchi, Ken; Sekel, Ron

    The purpose of this study is to predict with the use of FEA, the differing predisposition to cortical bone resorption and subsequent distal migration of an un-cemented femoral hip replacement stem subjected to long term biomechanical high compressive stresses, while varying the load angles, the material properties of the stem, and the stem length. A two-dimensional hip model was constructed to estimate the minimum principle stresses (P3) and migration magnitudes. Bone remodeling at the interface between the bone and the prosthesis was performed by comparison of the local compressive stress to physiological stress values governing bone resorption. With respect to load angles, migrations of the hip prosthesis did not occur with load angles between 63° and 74° load angle in relation to the longitudinal axis of the bony femur, as the compressive stress generated on the cortical bone was under the criteria threshold for bone resorption (-50MPa). In addition, the magnitude of migration (17%decrease) was relatively more sensitive to changes in stem length than those (92%decrease) of changes of material properties. In conclusion, using an FEA model for bone remodeling, based on the high compressive stresses exerted on distal cortical bone, it is possible to estimate migration magnitudes of cementless hip prostheses in the long term. The load angles have been shown to be an important parameter affecting the migration magnitudes and furthermore, it can be demonstrated that the stiffer materials and reduction of stem length can decrease the migration of cementless hip prosthesis in the long term.

  20. Total hip replacement in osteoarthritis: the role of bone metabolism and its complications.

    Science.gov (United States)

    Bottai, Vanna; Dell'Osso, Giacomo; Celli, Fabio; Bugelli, Giulia; Cazzella, Niki; Cei, Elena; Guido, Giulio; Giannotti, Stefano

    2015-01-01

    Osteoarthritis is one of the most common joint disorder. For treatment of hip symptomatic osteoarthritis, when conservative medical therapy has failed, total hip arthroplasty (THA) is a successful orthopaedic procedures that reduces pain and improves function and quality of life. Incidence of osteoarthritis is constantly increasing with raising life expectancy. This aging process also has led to an increasing number of patients with osteoporosis who need hip replacement for osteoarthritis. Osteoporosis have 3 major potential complications in total hip arthroplasty: perioperative fracture, an increased risk of periprosthetic fracture, and late aseptic loosening. The purpose of the present study was to examine the effects of osteoporosis on total hip replacement procedure outcome and highlight the importance of adequate study of calcium-phosphorus metabolism in patient candidate for hip surgery, and the need to start a suitable therapy to recover the bone mass before surgery. Bone quality of the hip joint has become an important risk factor limiting the durability of THA. PMID:26811704

  1. Analysis of Femoral Components of Cemented Total Hip Arthroplasty

    Science.gov (United States)

    Singh, Shantanu; Harsha, A. P.

    2015-10-01

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

  2. Applications of porous tantalum in total hip arthroplasty.

    Science.gov (United States)

    Levine, Brett; Della Valle, Craig J; Jacobs, Joshua J

    2006-11-01

    Porous tantalum is an alternative metal for total joint arthroplasty components that offers several unique properties. Its high volumetric porosity (70% to 80%), low modulus of elasticity (3 MPa), and high frictional characteristics make it conducive to biologic fixation. Tantalum has excellent biocompatibility and is safe to use in vivo. The low modulus of elasticity allows for more physiologic load transfer and relative preservation of bone stock. Because of its bioactive nature and ingrowth properties, tantalum is used in primary as well as revision total hip arthroplasty components, with good to excellent early clinical results. In revision arthroplasty, standard and custom augments may serve as a structural bone graft substitute. Formation of a bone-like apatite coating in vivo affords strong fibrous ingrowth properties and allows for substantial soft-tissue attachment, indicating potential for use in cases requiring reattachment of muscles and tendons to a prosthesis. Development of modular components and femoral stems also is being evaluated. The initial clinical data and basic science studies support further investigation of porous tantalum as an alternative to traditional implant materials. PMID:17077337

  3. Blood Conservation Strategies in Total Hip and Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    David Liu

    2015-01-01

    Full Text Available Peri-operative blood management is one of a number of components important for successful patient care in total joint arthroplasty and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risks of blood transfusion whilst at the same time maximizing haemaglobin in the post-operative period, thereby leading to a positive effect on early and long term outcomes and costs. An individualized strategy based on patient specific risk factors, anticipated blood loss and co-morbidities is useful in achieving this aim. Multiple blood conservation strategies are available in the pre-operative, intra-operative and post-operative periods and can be utilised either individually or in combination. Recent literature has highlighted the importance of identifying and correcting pre-operative anaemia, salvaging peri-operative red cells and the use of tranexamic acid in reducing blood loss. Given total hip and knee arthroplasty is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal.

  4. [What are the recommendations for sport activity following total hip or total knee arthroplasty?].

    Science.gov (United States)

    Tsur, Azmon; Volpin, Gershon

    2013-11-01

    Total hip and knee arthroplasty are surgical procedures usually performed in older adults aged 65-70 years and more, who suffer from arthritic joint degeneration, in order to relieve pain and improve functioning. In the past decade there have been more and more documentations of younger people, 50-60 years old and even less, who expect to participate in physical activity following these procedures. The trend today is to recommend activities which exert mild pressure on the implants such as swimming, cycling, golf, bowling, walking and cycling. It is not recommended to participate in sports activities that place greater pressure on the implants such as soccer, football, volleyball, handball, basketball, hockey and jogging. Such high-stress activities may cause early loosening of implants, as described in the article by Keren et al. in this issue: "Sport activity after hip and knee arthroplasty". PMID:24416821

  5. Initial Stability of Subtrochanteric Oblique Osteotomy in Uncemented Total Hip Arthroplasty: A Preliminary Finite Element Study

    OpenAIRE

    Li, Liangtao; Yu, Mingyang; Ma, Renshi; Zhu, Dong; Gu, Guishan

    2015-01-01

    Background Subtrochanteric oblique osteotomy (SOO) has been widely used to reconstruct highly dislocated hips in uncemented total hip arthroplasty. The occurrence of complications can be attributed to the instability of the osteotomy region. The aim of this study was to evaluate the initial stability of SOO in uncemented total hip arthroplasty. Material/Methods A 3-dimensional finite element femur-stem model was created, and a virtual SOO was performed at 4 oblique angles: 30°, 45°, 60°, and ...

  6. Clinical and radiographic results of total hip arthroplasty in dogs: 96 cases (1986-1992)

    International Nuclear Information System (INIS)

    Results of total hip arthroplasty in 84 dogs (96 hips) were evaluated. Eight (9.5% of) the 84 dogs developed 1 or move complications after total hip arthroplasty. Complications resolved or were corrected in 4 of the dogs; all 4 ultimately achieved good or excellent hip function. Complications necessitated removal of the Prosthesis in the other 4 dogs; 3 ultimately achieved fair hip function and 1 had only poor hip function. Therefore, after resolution of complications, 96% of the hips had good or excellent function. Force plate analysis was performed on 6 dogs with excellent hip function; peak vertical force for the limb that had been operated on was greater than or equal to peak vertical force for the contralateral limb. Radiographically, a radiolucent zone was visible around the acetabular component in 89% of the hips and around the femoral component in 26%. The radiolucent zone around the acetabular and femoral components widened in 14% (6 of 43) and 27% (3 of 11), respectively, of the hips with adequate radiographic follow-up. Aseptic loosening of the acetabular component developed in 3 (3%) of 96 hips, one was successfully revised. Aseptic loosening of the femoral component was not apparent in any of the dogs in this study. Other complications included femoral fracture (n = 3), neurapraxia (3), luxation(1), and unexplained lameness that required implant removal (1). None of the dogs had evidence of wound infection

  7. Low revision rate after total hip arthroplasty in patients with pediatric hip diseases

    DEFF Research Database (Denmark)

    Engesæter, Lars B; Engesæter, Ingvild Ø; Fenstad, Anne Marie;

    2012-01-01

    .9%) were operated due to pediatric hip diseases (3.1% for Denmark, 8.8% for Norway, and 1.9% for Sweden) and 288,435 THAs (77.8%) were operated due to OA. Unadjusted 10-year Kaplan-Meier survival of THAs after pediatric hip diseases (94.7% survival) was inferior to that after OA (96.6% survival...

  8. Gait analysis after total knee arthroplasty with cemented versus cementless type%骨水泥型与非骨水泥型全膝关节置换后的步态差异

    Institute of Scientific and Technical Information of China (English)

    张旻; 江澜; 沈晓艳

    2011-01-01

    背景:全膝关节置换已经被证明是一种有效治疗膝骨性关节炎的方法,但是不同类型的全膝关节置换假体固定方式术后所产生的膝关节下肢生物力学差异至今仍不明确.目的:通过三维步态分析骨水泥固定和非骨水泥固定两种不同的全膝关节置换术后患者的膝关节生物力学差异.方法:分别选取骨水泥型全膝关节置换以及非骨水泥型全膝关节置换患者各16例,通过测力台以及三维步态分析系统比较2组患者术前以及术后3个月的膝关节生物力学变化并进行对比.结果与结论:与手术前相比两组患者术后步速及步长均明显增加,支撑相在整个步态周期中的百分比明显减小, 膝关节屈在支撑相及摆动相中最大屈曲角度均明显增加,膝关节外翻角度增加.两种患者术后膝关节内翻角度以及膝关节内收力矩均明显减小.提示,骨水泥型与非骨水泥型全膝关节置换术均能有效改善膝骨性关节炎患者的步行能力以及下肢关节功能,两者间未见明显生物力学差异.%BACKGROUND: Total knee arthroplasty (TKA) has been proved to be a very effective method for patients with knee osteoarthritis. But the biomedical changes at knee joint between two different types of TKA (cemented and cementless) after operation remain not clear.OBJECTIVE: To explore the different biomechanical changes between the cemented and cementless TKA through three-dimensional gait analysis.METHODS: A total of 16 knee osteoarthritis patients treated with cemented TKA and 16 with cementless TKA were included.Force plates and three-dimensional gait analysis system were used to compare differences in biomechanics before and 3 months after operations.RESULTS AND CONCLUSION: Both groups showed significant increased walking speed and stride length, but decreased percentage of stance phase in gait cycle after operation, significant increased knee flexion angle in stance phase and swing

  9. Early Serum Procalcitonin Level after Primary Total Hip Replacement

    Directory of Open Access Journals (Sweden)

    Samy Bouaicha

    2013-01-01

    Full Text Available Background. Procalcitonin (PCT is a useful surrogate marker for the differentiation of postoperative infection and unspecific inflammatory reaction after surgery. It is known that postoperative course of the PCT serum level varies with type of surgery. No data exists about the postoperative course of serum PCT levels after primary total hip replacement (THR. Purpose. To characterize early postoperative serum PCT levels in uneventful primary THR compared to postoperative levels of different frequently used inflammatory blood parameters. Method. We prospectively investigated 31 patients. Blood samples were taken preoperatively and for 5 days postoperatively. PCT levels were compared with C-reactive protein (CRP, interleukin-6 (IL-6, and blood leucocyte counts (WBC. Results. In uneventful THR PCT levels showed a uniform low-level course with a peak at the second postoperative day. At the fifth day values returned to almost preoperative levels. On contrary, CRP levels remained high during the entire observational period. Only IL-6 levels showed a peak at postoperative day one with a quick and uniform return to preoperative levels. Conclusion. Similar to observations in cardiothoracic, intestinal, and neural surgeries, postoperative course of PCT after primary THR showed a uniform low-level course with a peak at the second postoperative day but below expected levels in systemic infections.

  10. 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...

  11. Minimally Invasive Total Hip and Knee Arthroplasty-Implications for the Elderly Patient

    NARCIS (Netherlands)

    Reininga, Inge H. F.; Stevens, Martin; Wagenmakers, Robert; Bulstra, Sjoerd K.; van den Akker-Scheek, Inge

    2012-01-01

    Total hip arthroplasty and total knee arthroplasty have proven to be effective surgical procedures for the treatment of hip and knee osteoarthritis. In recent decades, there have been considerable efforts to improve the component designs, modes of fixation, and surgical techniques. Minimally invasiv

  12. Measuring acetabular cup orientation on antero-posterior radiographs of the hip after total hip arthroplasty with a vector arithmetic radiological method. Is it valid and verified for daily clinical practice?

    Energy Technology Data Exchange (ETDEWEB)

    Craiovan, B.; Weber, M.; Worlicek, M.; Schneider, M.; Springorum, H.R.; Grifka, J.; Renkawitz, T. [University Medical Center Regensburg, Bad Abbach/Regensburg (Germany). Orthopedic Surgery; Zeman, F. [University Medical Center Regensburg, Bad Abbach/Regensburg (Germany). Center for Clinical Studies

    2016-06-15

    The aim of this prospective study is to validate a vector arithmetic method for measuring acetabular cup orientation after total hip arthroplasty (THA) and to verify the clinical practice. We measured cup anteversion and inclination of 123 patients after cementless primary THA twice by two examiners on AP pelvic radiographs with a vector arithmetic method and compared with a 3D-CT based reconstruction model within the same radiographic coronal plane. The mean difference between the radiographic and the 3D-CT measurements was -1.4 ±3.9 for inclination and 0.8 ±7.9 for anteversion with excellent correlation for inclination (r=0.81, p < 0.001) and moderate correlation for anteversion (r=0.65, p < 0.001). The intraclass correlation coefficient for measurements on radiographs ranged from 0.98 (95%-CI: 0.98; 0.99) for the first observer to 0.94 (95%-CI: 0.92; 0.96) for the second observer. The interrater reliability was 0.96 (95%-CI: 0.93; 0.98) for inclination and 0.93 (95%-CI: 0.85; 0.96) for anteversion. The largest errors in measurements were associated with an extraordinary pelvic tilt. In order to get a valuable measurement for measuring cup position after THA on pelvic radiographs by this vector arithmetic method, there is a need for a correct postoperative ap view, with special regards to the pelvic tilt for the future.

  13. Gluteal silicone injections and total hip arthroplasty: a case report

    OpenAIRE

    Seeger, Jörn B; Ahmed, Gafar A; Basad, Erhan; Rickert, Markus; Ishaque, Bernd A

    2014-01-01

    Introduction Silicone injection is a common procedure in cosmetic surgery. Granuloma formation and migration are the most commonly observed complications. Case presentation We report an unusual case of avascular necrosis of the hip in a 41-year-old woman from Thailand presenting with hip pain. Subcutaneous nodules were observed in the clinical examination. A pelvic X-ray revealed necrosis of the right femoral head and histological analysis of the punctuated nodules showed a reaction of foreig...

  14. Revision total hip replacement with a cemented long femoral component: minimum 9-year follow-up results.

    OpenAIRE

    So, Kazutaka; Kuroda, Yutaka; Matsuda, Shuichi; Akiyama, Haruhiko

    2013-01-01

    [Background] Surgical revision after failed total hip replacement is a technically challenging procedure. The aim of this study was to analyze the long-term results of revision total hip replacement using a cemented long femoral component and identify factors that influence the results. [Methods] We retrospectively reviewed 34 hips in 33 patients who had undergone revision total hip replacement using a cemented long femoral component between 1994 and 2001. Hip function was evaluated according...

  15. Total hip arthroplasty in paralytic dislocation from poliomyelitis.

    Science.gov (United States)

    Laguna, Rafael; Barrientos, Jesús

    2008-02-01

    This article presents a case of a patient with degenerative hip disease in paralytic dislocation by poliomyelitis. Poliomyelitis is an acute infection disease caused by a group of neurotrophic viruses, which has a special affinity by the anterior horns cells of the spinal cord and for certain motor nuclei of the brain stem. Paralysis is a flaccid type and characteristically paralysis is asymmetrical. It is said that the joints of the affected limb by poliomyelitis are protected from the development of osteoarthritis. Hip dislocation in poliomyelitis is an acquired deformity caused by flaccid paralysis and the resulting muscular imbalance. In young children, when the gluteus maximus and medius muscles are paralyzed and the hip flexors and adductors are of normal strength, eventual luxation of the hip is almost inevitable. Hip osteoarthritis in a limb with poliomyelitis is an unusual entity because these limbs do not support excessive loads. In patients who present with the residual effects of poliomyelitis including degenerative disease and hip dysplastic, surgery is one of the most difficult challenges faced by reconstructive surgeons. In such cases, surgeons should attempt to optimize the component position and choice, surgical approach, and soft tissue tensioning because stability of the prosthesis can be problematic. PMID:19292189

  16. A clinical comparative study of anatomic parameters before and after total hip replacement on congenital dysplasia.

    Science.gov (United States)

    Huang, Ziqiang; Zhou, Yonggang; Chai, Wei; Ji, Weiping; Cui, Guopeng; Ma, Miaoqun; Zhu, Yin

    2016-07-01

    [Purpose] To study preoperative and postoperative hip circumference data of various types of congenital dysplasia of the hip treated with total hip replacement, including the femoral offset, femoral neck length, height, and hip abductor arm parameters. [Subjects and Methods] This study included seventy-eight cases of congenital dysplasia of the hip (I-III type). Furthermore, four parameters were measured, including the preoperative and postoperative femoral offset. Statistical data analysis was performed using the SPSS 13.0 software. [Results] The femoral offset was 33.3 ± 8.4 mm (preoperative) and 39.1 ± 7.1 mm (postoperative). The femoral head height was 59.5 ± 8.7 mm (preoperative) and 68.8 ± 11.0 mm (postoperative). The femoral neck length was 50.8 ± 10.8 mm (preoperative) and 61.5 ± 10.4 mm (postoperative). The hip abductor arm was 54.3 ± 9.6 mm (preoperative) 64.7 ± 10.1 mm (postoperative). The preoperative and postoperative parameters showed statistical differences. Furthermore, no significant differences were evidenced when comparing the postoperative hip parameters with the normal data parameters. [Conclusion] Total hip replacement on congenital dysplasia of the hip could lead to the rebuilt of an almost normal physiological anatomy for each hip case (type I-III). PMID:27512242

  17. Mortality rates at 10 years after metal-on-metal hip resurfacing compared with total hip replacement in England: retrospective cohort analysis of hospital episode statistics

    OpenAIRE

    Kendal, Adrian R.; Prieto-Alhambra, Daniel; Arden, Nigel K; Carr, Andrew; Judge, Andrew

    2013-01-01

    Objectives To compare 10 year mortality rates among patients undergoing metal-on-metal hip resurfacing and total hip replacement in England. Design Retrospective cohort study. Setting English hospital episode statistics database linked to mortality records from the Office for National Statistics. Population All adults who underwent primary elective hip replacement for osteoarthritis from April 1999 to March 2012. The exposure of interest was prosthesis type: cemented total hip replacement, un...

  18. QUALITY OF LIFE PARAMETERS IMPROVEMENT FOLLOWING TOTAL HIP REPLACEMENT

    Directory of Open Access Journals (Sweden)

    Carmen GRIEROSU

    2012-07-01

    Full Text Available Large joint replacement regarding lower limbs include hip and knee arthroplasty surgical procedures, meant toimprove Quality Of Life (QOL parameters, an optimal representation for patient recovery toward an independent lifestyle. The present study is a consequence of an imperative requirement from the nursing staff, which, in closecooperation with the surgeon, the physical therapist and the psychologist intend a better understanding regardingpatient perception of the so-called post-discharge health-related quality of life (HRQOL. Material and method: Ourstudy included a pilot retrospective study performed on a group of 26 patients investigated and operated for total hipreplacement, between June 2010 – June 2011 in the Orthopaedic Clinic in the Rehabilitation Hospital in Iasi, Romania.We have evaluated QOL by applying a WOMAC scoring system and questionnaire to this group of patiens. We haveobtained data from those patients in preoperative step but also at 3 months postoperatively. All patients in this studywere operated by the same orthopaedic surgeon and followed the same rehabilitation program started during hospitalstay and continued under thorough supervision at home or in hospital linked institutions. Preoperative andpostoperative at 3 months data were reported and gathered for each patient in the form of Western Ontario andMcMaster Universities Osteoarthritis Index (WOMAC scores. Results: Following this evaluation we have looked foreach main index correlation in the WOMAC pre and postoperatively. For the pain item correlations we have obtained a0.617 between preoperative and 3 months postoperative pain. For the stiffness item correlations we have obtained a0.071 between preoperative and 3 months postoperative stiffness. For the functionality item correlations we haveobtained a 0.808 between preoperative and 3 months postoperative pain.

  19. Chronic pain following total hip arthroplasty: a nationwide questionnaire study

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Brandsborg, Birgitte; Lucht, Ulf;

    2006-01-01

    of chronic pain after THA in relation to pre-operative pain and early post-operative pain. METHODS: A questionnaire was sent to 1231 consecutive patients who had undergone THA 12-18 months previously, and whose operations had been reported to the Danish Hip Arthroplasty Registry. RESULTS: The response rate...... was 93.6%. Two hundred and ninety-four patients (28.1%) had chronic ipsilateral hip pain at the time of completion of the questionnaire, and pain limited daily activities to a moderate, severe or very severe degree in 12.1%. The chronic pain state was related to the recalled intensity of early post...

  20. 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...

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

    OpenAIRE

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

    2008-01-01

    Abstract Background Stress shielding of the proximal femur has been observed in a number of conventional cementless implants used in total hip arthroplasty. Short femoral-neck implants are claiming less interference with the biomechanics of the proximal femur. The goal of this study was to investigate the changes of bone-mineral density in the proximal femur and the clinical outcome after implantation of a short femoral-neck prosthesis. Methods We prospectively assessed the clinical outcome a...

  2. Patient-reported outcomes for total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Collins, Natalie J; Roos, Ewa M.

    2012-01-01

    in the developmental process (HOOS, KOOS, WOMAC, Oxford Hip and Knee Scores) can more consistently be considered "good" patient-reported outcomes for THA and TKA. Clinicians wishing to evaluate a broader range of dimensions may choose to complement these with one of the generic measures evaluated, bearing in mind...

  3. Early catastrophic acetabular failure in Furlong total hip replacements

    OpenAIRE

    Knox, David; Hamilton, Steven W.; Wardlaw, Douglas; Gibson, Peter H.

    2009-01-01

    The use of uncemented hip arthroplasty prostheses with ceramic articulations are popular, especially in the young, because of a perceived reduction in wear. We highlight a complication of ceramic on polyethylene articulating couples not previously described in the Furlong replacement. Despite widespread metalosis and particulate debris, osteolysis was not initially seen. The contamination compromised subsequent revision.

  4. Early catastrophic acetabular failure in Furlong total hip replacements.

    Science.gov (United States)

    Knox, David; Hamilton, Steven W; Wardlaw, Douglas; Gibson, Peter H

    2009-03-01

    The use of uncemented hip arthroplasty prostheses with ceramic articulations are popular, especially in the young, because of a perceived reduction in wear. We highlight a complication of ceramic on polyethylene articulating couples not previously described in the Furlong replacement. Despite widespread metalosis and particulate debris, osteolysis was not initially seen. The contamination compromised subsequent revision. PMID:19384635

  5. Actis Total Hip System 2 Year Follow-up

    Science.gov (United States)

    2016-08-09

    Osteoarthritis; Traumatic Arthritis; Rheumatoid Arthritis; Congenital Hip Dysplasia; Avascular Necrosis of the Femoral Head; Acute Traumatic Fracture of the Femoral Head or Neck; Certain Cases of Ankylosis; Non-union of Femoral Neck Fractures; Certain High Sub-Capital and Femoral Neck Fractures in the Elderly

  6. Perfusion MRI in hips with metal-on-metal and metal-on-polyethylene total hip arthroplasty

    OpenAIRE

    Anwander, H; Cron, G. O.; Rakhra, K.; Beaule, P. E.

    2016-01-01

    Objectives Hips with metal-on-metal total hip arthroplasty (MoM THA) have a high rate of adverse local tissue reactions (ALTR), often associated with hypersensitivity reactions. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) measures tissue perfusion with the parameter Ktrans (volume transfer constant of contrast agent). Our purpose was 1) to evaluate the feasibility of DCE-MRI in patients with THA and 2) to compare DCE-MRI in patients with MoM bearings with metal-on-polyethyl...

  7. Total Hip Arthroplasty for the Paralytic and Non-paralytic Side in Patient with Residual Poliomyelitis

    Science.gov (United States)

    Sonohata, Motoki; Kitajima, Masaru; Kawano, Shunsuke; Mawatari, Masaaki

    2016-01-01

    Background: Total hip arthroplasty (THA) for poliomyelitis is a problematic procedure due to difficulty in positioning the cup of the prosthesis in the true acetabulum and the risk of dislocation after THA due to the low muscle tone. Methods: We herein present a case of bilateral hip pain with a history of poliomyelitis. Radiograph showed bilateral hip osteoarthritis caused by hip dysplasia due to residual poliomyelitis in right hip joint or developing dysplasia of the hip joint in left hip joint. THA was performed to bilateral hip joints. Results: Six years after bilateral THA, bilateral hip pain significantly improved. Additionally, the muscle strength on the paralyzed right side partially improved. However, the muscle strength on the non-paralyzed left side did not significantly improve. No complications related to the surgery were observed. Conclusion: Promising early results were obtained for THA in our patient with residual poliomyelitis. However, surgeons should pay attention to the potential development of complications concerning THA that may arise due to the residual poliomyelitis. PMID:27347238

  8. Hip disability and osteoarthritis outcome score (HOOS)--validity and responsiveness in total hip replacement

    DEFF Research Database (Denmark)

    Nilsdotter, Anna K; Lohmander, L Stefan; Klässbo, Maria;

    2003-01-01

    The aim of the study was to evaluate if physical functions usually associated with a younger population were of importance for an older population, and to construct an outcome measure for hip osteoarthritis with improved responsiveness compared to the Western Ontario McMaster osteoarthritis score...

  9. Favorable outcome of a total hip arthroplasty with insufficient bone coverage of the roof reinforcement ring

    Directory of Open Access Journals (Sweden)

    Fernando M. Judas

    2015-01-01

    Conclusion: This result can be supported by the good fixation of the metal ring to the pelvis with screws, the adequate orientation of both components of the total hip arthroplasty, and the bone graft incorporation.

  10. Predictors of patient relevant outcome after total hip replacement for osteoarthritis

    DEFF Research Database (Denmark)

    Nilsdotter, A-K; Petersson, I F; Roos, Ewa M.;

    2003-01-01

    To investigate prospectively long term patient relevant outcomes after unilateral total hip replacement (THR) for osteoarthritis (OA). To identify non-responders to this intervention and patient related predictors of unsatisfactory outcome....

  11. A Simple Mathematical Standardized Measurement of Acetabulum Anteversion after Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Chen-Kun Liaw

    2008-01-01

    Full Text Available We invented a standardization method to measure the cup's anteversion after total hip arthroplasty without the influence of patient's position. We measured 68 radiographs of 10 patients after total hip replacement (THR and calculated the error of each measurement, defined as the difference with the average of the same measuring method on the same patient. We also calculated the repeatability standard deviation (RSD of each method according to the American Society for Testing and Materials, ASTM E691.

  12. Possibilities of physiotherapy in patients with complications after total hip endoprosthesis in

    OpenAIRE

    FEREBAUEROVÁ, Martina

    2013-01-01

    There is an increase of number of the total hip joint prosthesis arthroplasties in last years and also the patient age limit is falling down. This leads (for prosthesis determined lifetime) also to the increasing of the number of re-surgeries because of aseptic release. This kind of surgery is for patient more strenuous than primary surgery and so brings higher risks of the possible complications. Complications are not rare even after the primary surgery of the total hip joint prosthesis arth...

  13. No influence of immigrant background on the outcome of total hip arthroplasty

    OpenAIRE

    Krupic, Ferid; Eisler, Thomas; Eliasson, Tore; Garellick, Göran; Gordon, Max; Kärrholm, Johan

    2013-01-01

    Background and purpose Total Hip Replacement (THA) is one of the most successful and cost-effective operations. Despite its benefits, marked ethnic differences in the utilization of THA are well documented. However, very little has been published on the influence of ethnicity on outcome. We investigate whether the outcome—in terms of reoperation within 2 years or revision up to 14 years after the primary operation—varies depending on ethnic background. Methods Records of total hip arthroplast...

  14. Micro-separation in vitro produces clinically relevant wear of ceramic-ceramic total hip replacements

    Energy Technology Data Exchange (ETDEWEB)

    Nevelos, J.; Fisher, J. [Leeds Univ. (United Kingdom). School of Mechanical Engineering; Ingham, E. [Leeds Univ. (United Kingdom). Div. of Microbiology; Doyle, C. [Stryker Howmedica Osteonics, Newbury (United Kingdom); Streicher, R. [Stryker Howmedica Osteonics, Kilchberg (Switzerland); Nevelos, A. [Bradford Royal Infirmary, Bradford (United Kingdom)

    2001-07-01

    Typical clinical wear rates for well-positioned first generation ceramic-ceramic total hip arthroplasties (THAs) were of the order of 1-5 mm{sup 3}/year. This wear took the form of a 'stripe' of worn area on the heads with an Ra of approximately 0.1 {mu}m. As-manufactured unworn areas have an average Ra of 0.005 {mu}m Ra. This wear pattern has not been recorded following standard simulator testing with typical wear rates of less than 0.1 mm{sup 3} per million cycles. Therefore new material combinations for ceramic-ceramic total hip arthroplasty cannot be validated using standard hip simulator testing methods. However, recent fluoroscopy studies have shown that the head and cup of total hip replacements can separate during normal gait. This separation would lead to rim contact upon heel strike as shown in Figure 1. (orig.)

  15. 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.

  16. Review of quality of x-rays for templating for total hip arthroplasty.

    Science.gov (United States)

    Khan, Faiz; Ahmad, Tayyab; Condon, Finbarr; Lenehan, Brian

    2015-03-01

    Digital templating of x-rays for total hip arthroplasty is used routinely for pre-operative planning. This is to assure that appropriately sized implants are selected to replicate patient's hip biomechanics. Multiple studies have shown that templating does not always correspond to the final implants used. The aim of this study was to assess the suitability of the x-rays taken pre-operatively for templating for total hip arthroplasty. We undertook a review of a series of pre-operative templating pelvis x-rays in 100 consecutive patients undergoing total hip arthroplasty. These x-rays were compared against set criteria to determine their suitability for use for templating. We determined that six x-rays met the criteria whereas ninety four x-rays did not meet the criteria for suitable x-rays. Twenty patients had repeat x-rays. The reasons for unsuitability were inadequate opposite femur (66%), absence or incomplete template (54%), inadequate femur length (47%), external rotation (39%), absence of opposite hip (4%). The twenty repeated x-rays were also reviewed for the same parameters and two (10%) satisfied the established criteria. It is imperative that x-rays for templating for total hip arthroplasty are done to a strict standard to obtain an x-ray that is appropriate for templating and there is minimal exposure of the patient to irradiation.

  17. Initial Results of an Acetabular Center Axis Registration Technique in Navigated Hip Arthroplasty with Deformed Acetabular Rims

    OpenAIRE

    Wada, Hiroshi; Mishima, Hajime; Yoshizawa, Tomohiro; Sugaya, Hisashi; Nishino, Tomofumi; Yamazaki, Masashi

    2016-01-01

    Background In cementless total hip arthroplasty, imageless computer-assisted navigation is usually used to register the anterior pelvic plane (APP). The accuracy of this method is influenced by the subcutaneous tissues overlying the registration landmarks. On the other hand, the acetabular center axis (ACA) is determined from the acetabular rim. Precise registration of the ACA is possible because of direct palpation using a pointer. Imageless navigation using the ACA usually targets patients ...

  18. Use of postoperative irradiation for the prevention of heterotopic bone formation after total hip replacement

    Energy Technology Data Exchange (ETDEWEB)

    Sylvester, J.E.; Greenberg, P.; Selch, M.T.; Thomas, B.J.; Amstutz, H.

    1988-03-01

    Formation of heterotopic bone (HTB) following total hip replacement may partially or completely ankylose the joint space, causing pain and/or limiting the range of motion. Patients at high risk for formation of HTB postoperatively include those with previous HTB formation, heterotopic osteoarthritis, and active rheumatoid spondylitis. Patients in these high risk groups have a 63-69% incidence of post-operative HTB formation, usually seen radiographically by 2 months post-operation. From 1980-1986 twenty-nine hips in 28 consecutively treated patients were irradiated post-operatively at the UCLA Center for the Health Sciences. The indication for irradiation was documented HTB formation previously in 26 of the 27 hips presented below. From 1980-1982 patients received 20 Gray (Gy) in 2 Gy fractions; from 1982-1986 the dose was reduced to 10 Gy in 2 Gy fractions. Twenty-seven hips in 26 patients completed therapy and were available for evaluation, with a minimum of 2 month follow-up, and a median follow-up of 12 months. Three of 27 hips developed significant HTB (Brooker grade III or IV) post-operatively, whereas 5 of 27 hips developed minor, nonsymptomatic HTB (Brooker grade I). When irradiation was begun by postoperative day 4, 0 of 17 hips formed significant HTB. If irradiation began after post-operative day 4, 3 of 10 hips formed significant HTB (Brooker grade III or IV). These 3 hips received doses of 10 Gy in one hip and 20 Gy in the other 2 hips. There were no differences in the incidence or severity of side effects in the 10 Gy vs. the 20 Gy treatment groups. Eighteen hips received 10 Gy, 8 hips 20 Gy and, 1 hip 12 Gy. In conclusion, 10 Gy in 5 fractions appears as effective as 20 Gy in 10 fractions at preventing post-operative formation of HTB. For optimal results, treatment should begin as early as possible prior to post-operative day 4.

  19. Perfusion MRI in hips with metal-on-metal and metal-on-polyethylene total hip arthroplasty

    Science.gov (United States)

    Anwander, H.; Cron, G. O.; Rakhra, K.

    2016-01-01

    Objectives Hips with metal-on-metal total hip arthroplasty (MoM THA) have a high rate of adverse local tissue reactions (ALTR), often associated with hypersensitivity reactions. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) measures tissue perfusion with the parameter Ktrans (volume transfer constant of contrast agent). Our purpose was 1) to evaluate the feasibility of DCE-MRI in patients with THA and 2) to compare DCE-MRI in patients with MoM bearings with metal-on-polyethylene (MoP) bearings, hypothesising that the perfusion index Ktrans in hips with MoM THA is higher than in hips with MoP THA. Methods In this pilot study, 16 patients with primary THA were recruited (eight MoM, eight MoP). DCE-MRI of the hip was performed at 1.5 Tesla (T). For each patient, Ktrans was computed voxel-by-voxel in all tissue lateral to the bladder. The mean Ktrans for all voxels was then calculated. These values were compared with respect to implant type and gender, and further correlated with clinical parameters. Results There was no significant difference between the two bearing types with both genders combined. However, dividing patients by THA bearing and gender, women with MoM bearings had the highest Ktrans values, exceeding those of women with MoP bearings (0.067 min−1 versus 0.053 min−1; p-value stud. Bone Joint Res 2016;5:73–79. DOI: 10.1302/2046-3758.53.2000572. PMID:26935768

  20. Assessment of the primary rotational stability of uncemented hip stems using an analytical model: Comparison with finite element analyses

    Directory of Open Access Journals (Sweden)

    Van der Perre Georges

    2008-09-01

    Full Text Available Abstract Background Sufficient primary stability is a prerequisite for the clinical success of cementless implants. Therefore, it is important to have an estimation of the primary stability that can be achieved with new stem designs in a pre-clinical trial. Fast assessment of the primary stability is also useful in the preoperative planning of total hip replacements, and to an even larger extent in intraoperatively custom-made prosthesis systems, which result in a wide variety of stem geometries. Methods An analytical model is proposed to numerically predict the relative primary stability of cementless hip stems. This analytical approach is based upon the principle of virtual work and a straightforward mechanical model. For five custom-made implant designs, the resistance against axial rotation was assessed through the analytical model as well as through finite element modelling (FEM. Results The analytical approach can be considered as a first attempt to theoretically evaluate the primary stability of hip stems without using FEM, which makes it fast and inexpensive compared to other methods. A reasonable agreement was found in the stability ranking of the stems obtained with both methods. However, due to the simplifying assumptions underlying the analytical model it predicts very rigid stability behaviour: estimated stem rotation was two to three orders of magnitude smaller, compared with the FEM results. Conclusion Based on the results of this study, the analytical model might be useful as a comparative tool for the assessment of the primary stability of cementless hip stems.

  1. Hidden blood loss and its influential factors after total hip arthroplasty

    OpenAIRE

    Miao, Kaisong; Ni, Su; Zhou, Xianju; Xu, Nanwei; Sun, Rongbin; Zhuang, Chao; Wang, Yuji

    2015-01-01

    Background Total hip arthroplasty (THA) is a vital therapy for various hip joint diseases. However, patients have lower hemoglobin level post-operatively, remarkably inconsistent with the measured blood loss. The inconsistence is majorly attributed to hidden blood loss (HBL). In this study, we investigated the HBL and its influential factors among patients after THA. Methods From January 2008 to June 2014, 322 patients (99 males and 223 females) undergoing THA were enrolled in this study. All...

  2. Risk factors for renal dysfunction after total hip joint replacement; a retrospective cohort study

    OpenAIRE

    Hassan, Basim Kamil; Sahlström, Arne; Dessau, Ram Benny Christian

    2015-01-01

    Background and purpose of the study Renal injury and dysfunction are serious complications after major surgery, which may lead to increased morbidity and mortality. The objective of our study was to identify the possible risk factors for renal dysfunction after total hip joint replacement surgery. Methods A retrospective study was conducted among 599 consecutive primary hip joint replacements performed between January 2011 and December 2013. According to the RIFLE criteria, increased postoper...

  3. Center of Mass Compensation during Gait in Hip Arthroplasty Patients: Comparison between Large Diameter Head Total Hip Arthroplasty and Hip Resurfacing.

    Science.gov (United States)

    Bouffard, Vicky; Nantel, Julie; Therrien, Marc; Vendittoli, Pascal-André; Lavigne, Martin; Prince, François

    2011-01-01

    Objective. To compare center of mass (COM) compensation in the frontal and sagittal plane during gait in patients with large diameter head total hip arthroplasty (LDH-THA) and hip resurfacing (HR). Design. Observational study. Setting. Outpatient biomechanical laboratory. Participants. Two groups of 12 patients with LDH-THA and HR recruited from a larger randomized study and 11 healthy controls. Interventions. Not applicable. Main Outcome Measures. To compare the distance between the hip prosthetic joint center (HPJC) and the COM. The ratio (R(HPJC-COM)) and the variability (CV(HPJC-COM)) were compared between groups. Hip flexor, abductor, and adductor muscle strength was also correlated between groups while radiographic measurements were correlated with the outcome measures. Results. In the frontal plane, HR shows less variability than healthy controls at push-off and toe-off and R(HPJC-COM) is correlated with the muscle strength ratios (FR(ABD)) at heel contact, maximal weight acceptance, and mid stance. In the sagittal plane, LDH-THA has a higher R(HPJC-COM) than healthy controls at push-off, and CV(HPJC-COM) is significantly correlated with FR(FLEX). Conclusions. One year after surgery, both groups of patients, LDH-THA and HR, demonstrate minor compensations at some specific instant of the gait cycle, in both frontal and sagittal planes. However, their locomotion pattern is similar to the healthy controls. PMID:22110976

  4. Center of Mass Compensation during Gait in Hip Arthroplasty Patients: Comparison between Large Diameter Head Total Hip Arthroplasty and Hip Resurfacing

    Directory of Open Access Journals (Sweden)

    Vicky Bouffard

    2011-01-01

    Full Text Available Objective. To compare center of mass (COM compensation in the frontal and sagittal plane during gait in patients with large diameter head total hip arthroplasty (LDH-THA and hip resurfacing (HR. Design. Observational study. Setting. Outpatient biomechanical laboratory. Participants. Two groups of 12 patients with LDH-THA and HR recruited from a larger randomized study and 11 healthy controls. Interventions. Not applicable. Main Outcome Measures. To compare the distance between the hip prosthetic joint center (HPJC and the COM. The ratio (RHPJC-COM and the variability (CVHPJC-COM were compared between groups. Hip flexor, abductor, and adductor muscle strength was also correlated between groups while radiographic measurements were correlated with the outcome measures. Results. In the frontal plane, HR shows less variability than healthy controls at push-off and toe-off and RHPJC-COM is correlated with the muscle strength ratios (FRABD at heel contact, maximal weight acceptance, and mid stance. In the sagittal plane, LDH-THA has a higher RHPJC-COM than healthy controls at push-off, and CVHPJC-COM is significantly correlated with FRFLEX. Conclusions. One year after surgery, both groups of patients, LDH-THA and HR, demonstrate minor compensations at some specific instant of the gait cycle, in both frontal and sagittal planes. However, their locomotion pattern is similar to the healthy controls.

  5. Anterior Longitudinal Osteotomy of the Greater Trochanter in Total Hip Arthroplasty.

    Science.gov (United States)

    Surace, Michele F; Regazzola, Gianmarco M V; Vulcano, Ettore; Monestier, Luca; Cherubino, Paolo

    2015-08-01

    The extra-articular impingement of the greater trochanter against the ileum is an underrated cause of early dislocation in total hip arthroplasty. In this preliminary study, the authors assess the effectiveness of an anterior longitudinal osteotomy of the greater trochanter for preventing dislocation. A total of 115 patients underwent a total hip arthroplasty through a posterolateral approach. All patients underwent clinical and radiological follow-up at 1, 3, and 6 months. No dislocation was reported. All patients demonstrated fast recovery of range of motion and walking. No trochanter fractures were observed. The osteotomy of the greater trochanter is an effective surgical technique that decreases anterior impingement and consequently lowers the dislocation rate in primary total hip arthroplasty. [Orthopedics. 2015; 38(8):490-493.]. PMID:26313167

  6. Systematic review: Do patient expectations influence treatment outcomes in total knee and total hip arthroplasty?

    Directory of Open Access Journals (Sweden)

    Haanstra Tsjitske M

    2012-12-01

    Full Text Available Abstract Objective This systematic review aims to summarise all the available evidence related to the association between pre-operative patient expectations (outcome expectations, process expectations and self efficacy expectations and 5 different treatment outcomes (overall improvement, pain, function, stiffness and satisfaction in patients with total knee or total hip arthroplasty at three different follow-op periods (>6 weeks; >6 weeks- ≤6 months; >6 months. Methods English and Dutch language articles were identified through PubMed, EMBASE.com, PsycINFO, CINAHL and The Cochrane Library from inception to September 2012. Articles assessing the association between pre-operative patient expectations and treatment outcomes for TKA/THA in either adjusted or unadjusted analysis were included. Two reviewers, working independently, determined eligibility, rated methodological quality and extracted data on study design, population, expectation measurements, outcome measurements and strength of the associations. Methodological quality was rated by the same reviewers on a 19 item scale. The scores on the quality assessment were taken into account when drawing final conclusions. Results The search strategy generated 2252 unique references, 18 articles met inclusion criteria. Scores on the methodological quality assessment ranged between 6% and 79%. Great variety was seen in definitions and measurement methods of expectations. No significant associations were found between patient expectations and overall improvement, satisfaction and stiffness. Both significant positive and non-significant associations were found for the association between expectations and pain and function. Conclusions There was no consistency in the association between patients’ pre-operative expectations and treatment outcomes for TKA and THA indentified in this systematic review. There exists a need for a sound theoretical framework underlying the construct of

  7. Compatibility of the totally replaced hip. Reduction of wear by amorphous diamond coating.

    Science.gov (United States)

    Santavirta, Seppo

    2003-12-01

    Particulate wear debris in totally replaced hips causes adverse local host reactions. The extreme form of such a reaction, aggressive granulomatosis, was found to be a distinct condition and different from simple aseptic loosening. Reactive and adaptive tissues around the totally replaced hip were made of proliferation of local fibroblast like cells and activated macrophages. Methylmethacrylate and high-molecular-weight polyethylene were shown to be essentially immunologically inert implant materials, but in small particulate form functioned as cellular irritants initiating local biological reactions leading to loosening of the implants. Chromium-cobalt-molybdenum is the most popular metallic implant material; it is hard and tough, and the bearings of this metal are partially self-polishing. In total hip implants, prerequisites for longevity of the replaced hip are good biocompatibility of the materials and sufficient tribological properties of the bearings. The third key issue is that the bearing must minimize frictional shear at the prosthetic bone-implant interface to be compatible with long-term survival. Some of the approaches to meet these demands are alumina-on-alumina and metal-on-metal designs, as well as the use of highly crosslinked polyethylene for the acetabular component. In order to avoid the wear-based deleterious properties of the conventional total hip prosthesis materials or coatings, the present work included biological and tribological testing of amorphous diamond. Previous experiments had demonstrated that a high adhesion of tetrahedral amorphous carbon coatings to a substrate can be achieved by using mixing layers or interlayers. Amorphous diamond was found to be biologically inert, and simulator testing indicated excellent wear properties for conventional total hip prostheses, in which either the ball or both bearing surfaces were coated with hydrogen-free tetrahedral amorphous diamond films. Simulator testing with such total hip prostheses

  8. Recovery in mechanical muscle strength following resurfacing vs standard total hip arthroplasty - a randomised clinical trial

    DEFF Research Database (Denmark)

    Jensen, Carsten; Aagaard, Per; Overgaard, S

    2011-01-01

    in maximal lower limb muscle strength (in 2/6 muscle groups) compared to S-THA. Notably, the attenuated strength recovery following R-THA was most markedly manifested in the late phase (1 yr) of post-surgical recovery, and appeared to be due to the detachment of the lower half of the gluteus maximus muscle...... randomised into (A) standard total hip arthroplasty (S-THA) and (B) resurfacing total hip arthroplasty (R-THA). Pre-surgery assessment and follow-up were conducted (8, 26 and 52 wks). Maximal isometric muscle strength (Nm) and between-limb asymmetry for the knee extensors/flexors, hip adductors....../abductors, hip extensors/flexors were analysed. RESULTS: Maximal knee extensor and hip abductor strength were higher in S-THA than R-THA at 52 wks post-surgery (P ≤ 0.05) and hip extensors tended to be higher in S-THA at 52 wks (P = 0.06). All muscle groups showed substantial between-limb strength asymmetry (7...

  9. Small increase of actual physical activity 6 months after total hip or knee arthroplasty

    NARCIS (Netherlands)

    I.B. de Groot (Ingrid); J.B.J. Bussmann (Hans); H.J. Stam (Henk); J.A.N. Verhaar (Jan)

    2008-01-01

    textabstractLimitation in daily physical activity is one of the reasons for total hip arthroplasty (THA) or total knee arthroplasty (TKA). However, studies of the effects of THA or TKA generally do not determine actual daily activity as part of physical functioning. We determined the effect of THA o

  10. Infection of a total hip arthroplasty with actinomyces israelii: Report of a case

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    Feiran Wu

    2011-01-01

    Full Text Available Context : Infection of following total hip arthroplasties can be classified based on the timing of infection. Late infections with Actinomyces israelii are extremely rare with only 3 previously reported cases in literature. We present another case of a late infection with Actinomyces israelii in a total hip arthroplasty 9 years following implantation. Case Report : A 71-year-old male with diabetes mellitus presented with right hip pain 9 years following a total hip arthroplasty. Physical examination revealed localised pain and biochemical investigations showed elevated inflammatory markers. X-rays were suspicious for infection and a collection around the prosthesis was confirmed by MRI scan. The patient underwent debridement and removal of prosthesis. Peri-operative specimen cultures isolated Actinomyces israelii. The patient responded to a combination of vancomycin followed by ciprofloxacin and linezolid therapy before undergoing a successful second-stage reimplantation surgery. Conclusion : This is the first reported case of late haematogenous infection by Actinomyces israelii in a total hip arthroplasty in a patient with diabetes mellitus as the only risk factor. The patient was successfully treated with antibiotic therapy and two-stage reimplantation arthroplasty.

  11. 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

  12. Chronic Lymphedema of the Lower Limb: A Rare Cause of Dislocation of Total Hip Arthroplasty.

    Science.gov (United States)

    Vaishya, Raju; Agarwal, Amit Kumar; Gupta, Nishint; Vijay, Vipul

    2016-01-01

    Total hip arthroplasty (THA) in a patient with chronic lymphedema of both lower limbs is rarely reported in the literature. Chronic lymphedema is a challenging condition associated with various complications especially in a patient with THA. However, dislocation of the total hip prosthesis due to acute exacerbation of lower limb swelling in the postoperative period is an extremely rare complication. The cause that led to the dislocation of the prosthesis is intricate and difficult to assess, as this has not been discussed in the literature yet. We believe that the excessive weight of the limb due to chronic lymphedema had a deleterious effect on the biomechanics of total hip prosthesis, thereby increasing the tendency for dislocation. This case illustrates that chronic lymphedema of the lower limb should be dealt with aggressively using various modalities like intermittent pneumatic compression pumps and compression stockings after THA in such patients. PMID:27226940

  13. Association between trochanteric bursitis, osteoarthrosis and total hip arthroplasty☆☆☆

    Science.gov (United States)

    Schwartsmann, Carlos Roberto; Loss, Felipe; de Freitas Spinelli, Leandro; Furian, Roque; Silva, Marcelo Faria; Zanatta, Júlia Mazzuchello; Boschin, Leonardo Carbonera; Gonçalves, Ramiro Zilles; Yépez, Anthony Kerbes

    2014-01-01

    Objective this was an epidemiological study on trochanteric bursitis at the time of performing total hip arthroplasty. Methods sixty-two sequential patients who underwent total hip arthroplasty due to osteoarthrosis, without any previous history of trochanteric bursitis, were evaluated. The bursas were collected and evaluated histologically. Results there were 35 female patients (56.5%) and 27 male patients (43.5%), with a mean age of 65 years (±11). Trochanteric bursitis was conformed histologically in nine patients (14.5%), of whom six were female (66.7%) and three were male (33.3%). Conclusions 14.5% of the bursas analyzed presented inflammation at the time that the primary total hip arthroplasty due to osteoarthrosis was performed, and the majority of the cases of bursitis were detected in female patients. PMID:26229811

  14. Early Outcomes of Primary Total Hip Arthroplasty for Osteonecrosis of the Femoral Head in Patients with Human Immunodeficiency Virus in China

    Directory of Open Access Journals (Sweden)

    Chang-Song Zhao

    2015-01-01

    Full Text Available Background: Studies have reported that patients with human immunodeficiency virus (HIV have a high incidence of osteonecrosis of the femoral head (ONFH. Total hip arthroplasty (THA is an effective management of ONFH. However, little data exist regarding the use of THA for the HIV patients with ONFH in China. This study reviewed the outcomes of HIV-positive patients who underwent THA for ONFH, compared with HIV-negative individuals. Methods: The patients who underwent THA for ONFH from September 2012 to September 2014 in Beijing Ditan Hospital, Capital Medical University were retrospectively studied. Twenty-eight HIV-positive patients and 35 HIV-negative patients underwent 48 THAs and 45 THAs with cementless components, respectively. Medical records and follow-up data were reviewed. Harris Hip Score (HHS was applied to evaluate the pain and function of the hips before and after THA. Complications such as wound healing, surgical site infection, deep venous thrombosis, pulmonary embolism, sepsis, mortality, and complications from the prosthesis were reviewed. The operation time, blood loss, and hospital stay were compared between the two groups. Results: The mean follow-up period was 19.5 ± 5.8 months (ranging from 6 to 30 months. The mean age of the HIV-positive patients with osteonecrosis at the time of surgery was 35 years old, which was significantly lower than that of the HIV-negative group (42 years old (P 0.05. The HHSs of two groups significantly improved after THAs (P < 0.05, without significant difference between two groups. No wound complication, sepsis, mortality, prosthesis complication, and occupational exposure occurred, except for two cases of heterotopic ossification and one case of humeral head necrosis. Conclusions: ONFH is more likely to occur bilaterally in younger HIV-positive males. The development of osteonecrosis seems faster in HIV-positive patients than in HIV-negative patients. This should be cautionary for asymptomatic

  15. Zweymuller 螺旋臼假体治疗类风湿关节炎股骨头中心性脱位的临床研究%Total hip arthroplasty for protrusio acetabulic with Zweymuller thread prosthesis in rheumatoid arthritis

    Institute of Scientific and Technical Information of China (English)

    魏威; 林剑浩; 寇伯龙

    2011-01-01

    Objective Rheumatoid arthritis ( RA) is often associated with intrapelvic protrusion of the femoral head ( protrusion acetabuli). During the operation, the bone grafting and/or cement acetabular prosthesis is usually used to reconstruct acetabular. This paper aimed to discuss using the cementless Zweymuller prosthesis in treatment of protrusion acetabuli. Methods From June 2006 to October2009, 26 patients (27 hips) were admitted for primary total hip arthroplasty surgeries due to intrapelvic protrusion of the femoral head with RA, including three cases ( four hips) of male , and 23 cases (23 hips) of female , and the average age was 52(37 - 62) . Total hip arthroplasty was performed in all patients using Zweymuller cementless prosthesis. and bone grafting were used in four hips. Results The patients were followed up for 6 monthes to 6.4 years. The average Harris hip score was 30. 5pre-operation and 84 post-operation. There were no loosening in all cases. One case had infection in early stage, hut this patient was doing well after treatment with antibiotics lasting for six weeks. Conclusions Treatment with Zweymuller actebular prosthesis in intrapelvic acetabuli with RA will achieve good result optionally using bone grafting, and satisfactory stability can be achieved in medium-term results.%目的 探讨使用Zweymuller螺旋臼假体治疗类风湿关节炎(RA)髋臼骨缺损中股骨头中心性脱位的临床疗效.方法 自2004年6月至2009年10月,26例(27髋)RA髋臼中心性脱位患者,其中男3例(4髋),女23例(23髋),平均年龄52岁(37~62岁),使用螺旋臼治疗,术中有 4例行髋臼底部植骨.结果 平均随访6个月~6年3个月,术前Harris 评分30.5分,术后平均84分,术后均未发现假体松动,1例出现假体早期感染,予以抗生素治疗6周后好转.结论 RA股骨头中心性脱位使用Zweymuller螺旋臼治疗,可以或不需在臼底植骨,中期稳定性良好.

  16. Functional outcome, revision rates and mortality after primary total hip replacement--a national comparison of nine prosthesis brands in England.

    Directory of Open Access Journals (Sweden)

    Mark Pennington

    Full Text Available The number of prosthesis brands used for hip replacement has increased rapidly, but there is little evidence on their effectiveness. We compared patient-reported outcomes, revision rates, and mortality for the three most frequently used brands within each prosthesis type: cemented (Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite Plus Ogee, cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed, and hybrid (Exeter V40 Trilogy, Exeter V40 Trilogy, and CPT Trilogy.We used three national databases of patients who had hip replacements between 2008 and 2011 in the English NHS to compare functional outcome (Oxford Hip Score (OHS ranging from 0 (worst to 48 (best in 43,524 patients at six months. We analysed revisions and mortality in 187,201 patients. We used multiple regression to adjust for pre-operative differences. Prosthesis type had an impact on post-operative OHS and revision rates (both p<0.001. Patients with hybrid prostheses had the best functional outcome (mean OHS 39.4, 95%CI 39.1 to 39.7 and those with cemented prostheses the worst (37.7, 37.3 to 38.1. Patients with cemented prostheses had the lowest reported 5-year revision rates (1.3%, 1.2% to 1.4% and those with cementless prostheses the highest (2.2%, 2.1% to 2.4%. Differences in mortality according to prosthesis type were small and not significant (p = 0.06. Functional outcome varied according to brand among cemented (p = 0.05, with Exeter V40 Duration having the best and cementless prostheses (p = 0.01, with Corail Pinnacle having the best. Revision rates varied according to brand among hybrids (p = 0.05, with Exeter V40 Trident having the lowest.Functional outcomes were better with cementless cups and revision rates were lower with cemented stems, which underlies the good overall performance of hybrids. The hybrid Exeter V40 Trident seemed to produce the best overall results. This brand should be considered as a benchmark in randomised trials.

  17. Palacos compared to Palamed bone cement in total hip replacement: a randomized controlled trial.

    Science.gov (United States)

    Meinardi, Joris E; Valstar, Edward R; Van Der Voort, Paul; Kaptein, Bart L; Fiocco, Marta; Nelissen, Rob G H H

    2016-10-01

    Background and purpose - Stability and survival of cemented total hip prostheses is dependent on a multitude of factors, including the type of cement that is used. Bone cements vary in viscosity, from low to medium and high. There have been few clinical RSA studies comparing the performance of low- and high-viscosity bone cements. We compared the migration behavior of the Stanmore hip stem cemented using novel low-viscosity Palamed bone cement with that of the same stem cemented with conventional high-viscosity Palacos bone cement. Patients and methods - We performed a randomized controlled study involving 39 patients (40 hips) undergoing primary total hip replacement for primary or secondary osteoarthritis. 22 patients (22 hips) were randomized to Palacos and 17 patients (18 hips) were randomized to Palamed. Migration was determined by RSA. Results - None of these 40 hips had been revised at the 10-year follow-up mark. To our knowledge, the patients who died before they reached the 10-year endpoint still had the implant in situ. No statistically significant or clinically significant differences were found between the 2 groups for mean translations, rotations, and maximum total-point motion (MTPM). Interpretation - We found similar migration of the Stanmore stem in the high-viscosity Palacos cement group and the low-viscosity Palamed cement group. We therefore expect that the risk of aseptic loosening with the new Palamed cement would be comparable to that with the conventional Palacos cement. The choice of which type of bone cement to use is therefore up to the surgeon's preference. PMID:27329869

  18. Effect of hydroxyapatite coating on risk of revision after primary total hip arthroplasty in younger patients: findings from the Danish Hip Arthroplasty Registry

    DEFF Research Database (Denmark)

    Paulsen, Aksel; Pedersen, Alma B; Johnsen, Søren P;

    2007-01-01

    BACKGROUND: The effect of hydroxyapatite (HA) on implant survival in the medium and long term is uncertain. We studied the effect of HA coating of uncemented implants on the risk of cup and stem revision in primary total hip arthroplasty (THA). PATIENTS AND METHODS: Using the Danish Hip Arthropla...

  19. Closed reduction and internal fixation versus total hip arthroplasty for displaced femoral neck fracture

    Institute of Scientific and Technical Information of China (English)

    Cao Liehu; Wang Bin; Li Ming; Song Shaojun; Weng Weizong; Li Haihang; Su Jiacan

    2014-01-01

    Objective:To compare the clinical effects between closed reduction and internal fixation (CRIF) and total hip arthroplasty (THA) for displaced femoral neck fracture.Methods:In this prospective randomized study,285 patients aged above 65 years with hip fractures (Garden Ⅲ or Ⅳ) were included from January 2001 to December 2005.The cases were randomly allocated to either the CRIF group or THA group.Patients with pathological fractures (bone tumors or metabolic bone disease),preoperative avascular necrosis of the femoral head,osteoarthritis,rheumatoid arthritis,hemiplegia,long-term bed rest and complications affecting hip functions were excluded.Results:During the 5-year follow-up,CRIF group had significantly higher rates of complication in hip joint,general complication and reoperation than THA group (38.3% vs.12.7%,P<0.01; 45.3% vs.21.7%,P<0.01; 33.6% vs.10.2%,P<0.05 respectively).There was no difference in mortality between the two groups.Postoperative function of the hip joint in THA group recovered favorably with higher Harris scores.Conclusion:For displaced fractures of the femoral neck in elderly patients,THA can achieve a lower rate of complication and reoperation,as well as better postoperative recovery of hip joint function compared with CRIF.

  20. Fast track in total hip and knee arthroplasty--experiences from Hvidovre University Hospital, Denmark

    DEFF Research Database (Denmark)

    Husted, Henrik; Holm, Gitte

    2006-01-01

    This study investigated whether unselected patients operated on with total hip arthroplasty (THA) or total knee arthroplasty (TKA) could accomplish a self-developed accelerated track, ANORAK-HH, with a planned length of stay (LOS) of maximum 5 days and patient satisfaction at all parts of the track....... 307 patients who sustained 329 hip and knee arthroplasties were included in the study with the main material constituted from 243 primary unilateral THA and TKA arthroplasties. ANORAK-HH includes pre-operative patient clinic, patient motivation, dedicated staff, unchanged criteria for discharge and a...

  1. 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.)

  2. Bone mineral density after implantation of a femoral neck hip prosthesis – a prospective 5 year follow-up

    OpenAIRE

    Steens, Wolfram; Boettner, Friedrich; Bader, Rainer; Skripitz, Ralf; Schneeberger, Alberto

    2015-01-01

    Background Bone resorption in the proximal femur due to stress shielding has been observed in a number of conventional cementless implants used in total hip arthroplasty. Short femoral-neck implants are claiming less interference with the biomechanics of the proximal femur. The goal of this study was to prospectively investigate the in vivo changes of bone-mineral density as a parameter of bone remodeling around a short, femoral neck prosthesis over the first 5 years following implantation. T...

  3. Optimal sterilization method for the zirconia/alumina composites used for total hip replacements.

    Science.gov (United States)

    Nam, Kwang Woo; Yoo, Jeong Joon; Koo, Kyung-Hoi; Yoon, Kang Sup; Kim, Hee Joong

    2009-08-01

    Zirconia/alumina composite ceramics have been recently developed for total hip arthroplasty because of their excellent mechanical properties and tribologic characteristics. All such materials used clinically must be easily sterilized, but no report has been issued concerning methods for sterilizing zirconia/alumina composite hip prostheses. Here, we show that 50 kGy of gamma irradiation effectively sterilizes both the surfaces and interiors of these materials. In addition, it was found that the commonly used ethylene oxide and 25-kGy gamma irradiation sterilization methods inadequately sterilize deep inside the femoral head. Moreover, no changes in the chemical or mechanical properties of the composites were noted after exposure to 50-kGy gamma irradiation. We suggest that 50-kGy gamma irradiation is an optimal sterilization method for zirconia/alumina composite total hip replacements. PMID:19441113

  4. 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.

  5. Oral bisphosphonate use and total knee/hip implant survival

    DEFF Research Database (Denmark)

    Prieto-Alhambra, Daniel; Lalmohamed, Arief; Abrahamsen, Bo;

    2014-01-01

    was conducted within the Danish nationwide registries (5.5 million residents). Using procedure codes of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, we identified patients age ≥40 years undergoing total joint replacement in 1998-2007. We excluded users...... (medication possession ratio), and timing of therapy initiation (preoperative/postoperative). RESULTS: Of 95,392 patients with a primary total joint replacement, 80,342 (84.2%) were eligible. We identified 1,590 bisphosphonate users (2.0%), and 1,558 of them (98.0%) were matched to 8,966 bisphosphonate...

  6. Peri-acetabular bone mineral density in total hip replacement

    OpenAIRE

    Gauthier, L.(University of Illinois at Chicago (UIC), Chicago, USA); Dinh, L.; Beaulé, P. E.

    2013-01-01

    Objectives To quantify and compare peri-acetabular bone mineral density (BMD) between a monoblock acetabular component using a metal-on-metal (MoM) bearing and a modular titanium shell with a polyethylene (PE) insert. The secondary outcome was to measure patient-reported clinical function. Methods A total of 50 patients (25 per group) were randomised to MoM or metal-on-polyethlene (MoP). There were 27 women (11 MoM) and 23 men (14 MoM) with a mean age of 61.6 years (47.7 to 73.2). Measurement...

  7. Physical functioning before and after total hip arthroplasty : Perception and performance

    NARCIS (Netherlands)

    van den Akker-Scheek, Inge; Zijlstra, Wiebren; Groothoff, Johan W.; Bulstra, Sjoerd K.; Stevens, Martin

    2008-01-01

    Background and Purpose. Self-report and performance-based measures of physical functioning in people before and after total hip arthroplasty seem to present different information. The relationship between these different measures is not well understood, and little information is available about chan

  8. Comparative responsiveness of measures of pain and function after total hip replacement

    DEFF Research Database (Denmark)

    Nilsdotter, A K; Roos, Ewa M.; Westerlund, J P;

    2001-01-01

    To compare the responsiveness of the Functional Assessment System (FAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Medical Outcomes Study 36-item Short Form (SF-36) in patients with osteoarthritis (OA) scheduled for total hip replacement....

  9. Physical Activity Participation Among Patients After Total Hip and Knee Arthroplasty

    NARCIS (Netherlands)

    Stevens, Martin; Reininga, Inge H. F.; Bulstra, Sjoerd K.; Wagenmakers, Robert; van den Akker-Scheek, Inge

    2012-01-01

    Total hip (THA) and knee arthroplasty (TKA) are successful operative interventions, yet little is known about the physical activity behavior of patients after THA/TKA. For older adults, there are beneficial effects of regular physical activity after THA/TKA. The objective of this paper is to review

  10. Habitual physical activity behavior of patients after primary total hip arthroplasty

    NARCIS (Netherlands)

    Wagenmakers, Robert; Stevens, Martin; Zijlstra, Wiebren; Jacobs, Monique L.; van den Akker-Scheek, Inge; Groothoff, Johan W.; Bulstra, Sjoerd K.

    2008-01-01

    Background and Purpose. Despite recognized health benefits of physical activity, little is known about the habitual physical activity behavior of patients after total hip arthroplasty (THA). The purpose of this study was to analyze this behavior and the fulfillment of guidelines for health-enhancing

  11. Femoral nerve palsy caused by ileopectineal bursitis after total hip replacement: a case report

    Directory of Open Access Journals (Sweden)

    Bähr Mathias

    2011-05-01

    Full Text Available Abstract Introduction Infectious ileopectineal bursitis is a rare complication after total hip replacement and is associated mainly with rheumatoid arthritis. The main complications are local swelling and pain, but communication of the inflamed bursa with the joint can occur, leading to subsequent cartilage damage and bone destruction. Case presentation We report a case of a 47-year-old Caucasian woman without rheumatoid arthritis who reported pain and palsy in her left leg almost one year after total hip replacement. She was diagnosed with an ileopectineal bursitis after total hip replacement, leading to femoral nerve palsy. The diagnosis was obtained by thorough clinical examination, the results of focused computed tomography and magnetic resonance imaging. Conclusion To the best of our knowledge, this is the first report of non-infectious ileopectineal bursitis in a patient without rheumatoid arthritis as a complication of total hip replacement. This rare case underlines the importance of proper neurologic examination of persistent conditions after orthopedic intervention in otherwise healthy individuals. We believe this case should be useful for a broad spectrum of medical specialties, including orthopedics, neurology, radiology, and general practice.

  12. Understanding total hip replacement recovery towards the design of a context-aware system

    NARCIS (Netherlands)

    Jimenez Garcia, Juan

    2011-01-01

    Total Hip Replacement (THR) is a common procedure to improve the mobility of elderly with osteoarthritis. Presently information about the recovery process after discharge is unclear. As consequence patients and physiotherapists face uncertainties to follow an adequate trajectory for recovery. Curren

  13. Groningen orthopaedic exit strategy : Validation of a support program after total hip or knee arthroplasty

    NARCIS (Netherlands)

    van den Akker-Scheek, Inge; Zijlstra, Wiebren; Groothoff, Johan W.; van Horn, Jim R.; Bulstra, Sjoerd K.; Stevens, Martin

    2007-01-01

    Objective: Validation of the program theory of the Groningen orthopaedic exit strategy (GOES), a theory-driven program aiming to improve the rehabilitation of total hip and knee arthroplasty patients after shortened hospital stay. First part of the program theory is the action theory, hypothesising

  14. Adverse sequelae following revision of a total hip replacement for a fractured ceramic component: case report

    Directory of Open Access Journals (Sweden)

    Lee Ling Hong

    2015-01-01

    Full Text Available Revision total hip replacement following a fractured ceramic bearing component presents a challenge in the choice of the new bearing implant. A femoral head made of equal or harder material should be implanted to prevent catastrophic wear. Despite this, patients and surgeons must be wary of potential complications.

  15. Imaging of ceramic liner fractures in total hip arthroplasty: the value of CT

    Energy Technology Data Exchange (ETDEWEB)

    Endo, Yoshimi; Mintz, Douglas N. [Hospital for Special Surgery, Department of Radiology and Imaging, New York, NY (United States); Renner, Lisa; Schmidt-Braekling, Tom; Boettner, Friedrich [Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Division, New York, NY (United States)

    2015-08-15

    Fracture of a ceramic liner of a total hip arthroplasty is rare and is radiographically occult if not displaced. We report on two patients in whom ceramic liner fracture was radiographically occult but was diagnosed on subsequent CT scan through appropriate windowing. (orig.)

  16. Functional exercise after total hip replacement (FEATHER): a randomised control trial.

    LENUS (Irish Health Repository)

    Monaghan, Brenda

    2012-11-01

    Prolonged physical impairments in range of movement, postural stability and walking speed are commonly reported following total hip replacement (THR). It is unclear from the current body of evidence what kind of exercises should be performed to maximize patient function and quality of life.

  17. Outcome assessment of total hip arthroplasty in The Netherlands and Sweden

    NARCIS (Netherlands)

    Ostendorf, Marieke

    2004-01-01

    From the studies described in this thesis, investigating different aspects of outcome assessment in total hip arthroplasty, the following conclusions and recommendations can be made: To ensure good quality of life and adequate mobility for future elderly generations, adequate measures need to be ta

  18. Total hip arthroplasty in a patient with arthrogryphosis and an ipsilateral above knee amputation.

    LENUS (Irish Health Repository)

    Leonard, Michael

    2010-10-01

    The authors present the case of a young man with arthrogryphosis multiplex congenita and an above knee amputation who underwent an ipsilateral total hip replacement. The unique aspects of the case and technical difficulties are highlighted. Follow-up at five years revealed an excellent clinical and radiological outcome.

  19. Outcome of total hip arthroplasty, but not of total knee arthroplasty, is related to the preoperative radiographic severity of osteoarthritis

    Science.gov (United States)

    Tilbury, Claire; Holtslag, Maarten J; Tordoir, Rutger L; Leichtenberg, Claudia S; Verdegaal, Suzan H M; Kroon, Herman M; Fiocco, Marta; Nelissen, Rob G H H; Vliet Vlieland, Thea P M

    2016-01-01

    Background and purpose There is no consensus on the impact of radiographic severity of hip and knee osteoarthritis (OA) on the clinical outcome of total hip arthroplasty (THA) and total knee arthroplasty (TKA). We assessed whether preoperative radiographic severity of OA is related to improvements in functioning, pain, and health-related quality of life (HRQoL) 1 year after THA or TKA. Patients and methods This prospective cohort study included 302 THA patients and 271 TKA patients with hip or knee OA. In the THA patients, preoperatively 26% had mild OA and 74% had severe OA; in the TKA patients, preoperatively 27% had mild OA and 73% had severe OA. Radiographic severity was determined according to the Kellgren and Lawrence (KL) classification. Clinical assessments preoperatively and 1 year postoperatively included: sociodemographic characteristics and patient-reported outcomes (PROMs): Oxford hip/knee score, hip/knee injury and osteoarthritis outcome score (HOOS/KOOS), SF36, and EQ5D. Change scores of PROMs were compared with mild OA (KL 0–2) and severe OA (KL 3–4) using a multivariate linear regression model. Results Adjusted for sex, age, preoperative scores, BMI, and Charnley score, radiographic severity of OA in THA was associated with improvement in HOOS “Activities of daily living”, “Pain”, and “Symptoms”, and SF36 physical component summary (“PCS”) scale. In TKA, we found no such associations. Interpretation The decrease in pain and improvement in function in THA patients, but not in TKA patients, was positively associated with the preoperative radiographic severity of OA. PMID:26484651

  20. 人工全髋关节置换术后双下肢长度的变化%Clinical changes of leg length after total hip arthroplasty

    Institute of Scientific and Technical Information of China (English)

    王义生; 陈宾; 李军伟; 张弛

    2012-01-01

    目的:观察人工全髋关节置换术后双下肢长度的变化.方法:2009年1月至2011年6月接受单侧和双侧人工全髋关节置换术的患者117例(152髋),术前下肢等长35例,不等长82例.所有病例均使用生物型假体关节行全髋关节置换.测量术后1周内的下肢长度,计算术后双下肢长度之差,视双下肢长度之差≤10 mm者为等长.结果:117例患者中,术后下肢等长116例(99.2%),双下肢长度相差11 mm者1例(0.9%);116例中术后双下肢完全等长108例(92.3%),相差<6 mm者5例,相差6~10 mm者3例.结论:充分掌握各种术中测量下肢长度的方法,综合运用于平衡下肢长度,术中多次比对可降低术后下肢不等长的发生率.%Aim:To investigate the changes of leg length after total hip arthroplasty. Methods: A total of 117 patients ( 152 hip joints ) from January 2009 to June 2011 were followed up routinely. Before the operation there were 35 cases whose lower limbs were defined as the equal length, and 82 cases, unequal length. The artificial joints of all the cases were cement-less prosthesis. The leg length after the operation( within a week ) were measured. Results:In all the 117 cases, there were 116 cases whose lower limbs were equal long,and 1 case whose leg length discrepancy( LLD ) was 11 mm;among the 116cases,108 cases( 92. 3% ) whose LLD was 0 mm,5 cases whose LLD was less than 6 mm,and 3 cases whose LLD was between 6 ~ 10 mm. Conclusion: The various intraoperative methods of measuring leg length can significantly reduce the incidence of postoperative LLD.

  1. Minimal-invasive posterior approach for total hip arthroplasty versus standard lateral approach.

    Science.gov (United States)

    Schleicher, Iris; Haas, Holger; Adams, Tim S; Szalay, Gabor; Klein, Heiko; Kordelle, Jens

    2011-08-01

    In this prospective study we compared clinical and radiological results and rehabilitation progress of 64 patients who underwent total hip arthroplasty using the standard lateral approach with 64 patients operated with a minimal-invasive (MIS) posterior approach. The outcome of our study did not show any significant differences with regard to patient's safety such as complication rate and radiological assessment of the cup position. There was no difference in the duration of surgery, blood loss, hospital stay and postoperative leg length discrepancy. Rehabilitation milestones were achieved earlier by MIS patients and three and six months postoperatively, the Harris Hip Score of the MIS group was significantly higher.

  2. [Total knee and hip prosthesis: variables associated with costs].

    Science.gov (United States)

    Herrera-Espiñeira, Carmen; Escobar, Antonio; Navarro-Espigares, José Luis; Castillo, Juan de Dios Lunadel; García-Pérez, Lidia; Godoy-Montijano, Amparo

    2013-01-01

    antecedentes: la alta prevalencia de artrosis en los países occidentales, el elevado costo de las intervenciones de artroplastia de cadera y rodilla y las amplias variaciones en la práctica médica generan gran interés por comparar los costos asociados antes y después de la cirugía. Objetivo: conocer el costo de las intervenciones de reemplazo total de cadera y rodilla durante la estancia hospitalaria y al año de seguimiento posterior al alta. material y métodos: estudio multicéntrico y prospectivo efectuado en 15 hospitales de tres comunidades autónomas. La relación entre las variables independientes con el costo de la estancia y costo post-alta, se analizó con modelos multinivel y para agrupar los casos se utilizó la variable "hospital." Las variables independientes fueron: edad, sexo, índice de masa corporal, calidad de vida prequirúrgica (cuestionarios ED-5D, SF-12 y Womac), intervención (cadera-rodilla), índice Charlson, complicaciones, número de camas y dependencia económico-institucional del hospital, comunidad autó-noma y presencia de cuidador. Resultados: el costo promedio por paciente, sin incluir el costo de la prótesis, fue de 4,734 Euros ± 2,136 y el costo del seguimiento post alta de 554 Euros ± 509. Si se incluye el costo de la prótesis, al final del año el costo total asciende a 7,645 Euros ± 2,248. Conclusiones: existe un margen considerable en la reducción de los costos de estancia; más de 44% de la variabilidad observada no está determinada por las condiciones clínicas de los pacientes sino por el comportamiento de los centros hospitalarios.

  3. Surgery-induced changes and early recovery of hip-muscle strength, leg-press power, and functional performance after fast-track total hip arthroplasty

    DEFF Research Database (Denmark)

    Holm, Bente; Thorborg, Kristian; Husted, Henrik;

    2013-01-01

    By measuring very early changes in muscle strength and functional performance after fast-track total hip arthroplasty (THA), post-operative rehabilitation, introduced soon after surgery, can be designed to specifically target identified deficits.......By measuring very early changes in muscle strength and functional performance after fast-track total hip arthroplasty (THA), post-operative rehabilitation, introduced soon after surgery, can be designed to specifically target identified deficits....

  4. Risk Factors of Heterotopic Ossification Following Total Hip Arthroplasty in Patients With Ankylosing Spondylitis.

    Science.gov (United States)

    Thilak, Jai; Panakkal, Jiss Joseph; Kim, Tae-Young; Goodman, Susan M; Lee, Sang-Soo; Salvati, Eduardo A

    2015-12-01

    This study was to identify the risk factors of heterotopic ossification (HO) after total hip arthroplasty (THA) in ankylosing spondylitis. We analyzed 47 hips (24 patients) with ankylosing spondylitis that underwent primary THA. The incidence of HO was 14.9%. The risk factors were divided into modifiable and nonmodifiable factors. Female gender (P=0.008), preoperative ankylosed hip (P<0.001), occurrence of HO in previous surgery (P=0.036) were nonmodifiable risk factors which increased the prevalence of HO. Of the various modifiable risk factors, elevated preoperative ESR (P=0.007), elevated preoperative CRP (P=0.004) and prolonged duration of surgery (P=0.014) were associated with increased occurrence of HO. Perioperative medical intervention to reduce inflammation (ESR and CRP) may help to decrease HO.

  5. The use of the Gait Deviation Index for the evaluation of participants following total hip arthroplasty

    DEFF Research Database (Denmark)

    Jensen, Carsten; Rosenlund, Signe; Nielsen, Dennis B;

    2015-01-01

    INTRODUCTION: In this paper, the Gait Deviation Index (GDI) was used as a convenient method to evaluate pre-to-postoperative gait pattern changes after total hip arthroplasty and identify factors which might be predictive of outcome. DESIGN: Three-dimensional gait data from a randomized clinical...... trial was used to determine changes in gait quality in participants walking at self-selected speed. Upon completion of the first assessment, the participants were randomly assigned to either resurfacing hip arthroplasty or conventional hip arthroplasty. The outcome was changes in overall gait 'quality......-operated and the operated limbs; 0.3 [95%CI: -2.3 to 1.7]. However, the score for the two groups (pooled data) improved after surgery by 4.4 [95%CI: 1.8-7.0]. The single level regression analysis identified the preoperative GDI score as a strong predictor of outcome (p

  6. Predictors of pain and physical function at 3 and 12 months after total hip arthroplasty

    DEFF Research Database (Denmark)

    Plews, Sarah; Løvlund Nielsen, Randi; Overgaard, Søren;

    Background: Few studies have combined preoperative patient-reported and objective outcome measures to predict outcomes after total hip arthroplasty (THA). Purpose / Aim of Study: to identify predictors of outcome 3 and 12 months after THA Materials and Methods: A cohort of 107 consecutive patients...... with primary hip osteoarthritis responded to Hip dysfunction and Osteoarthritis Outcome Score (HOOS) questionnaires prior to and 3 and 12 months after THA. Preoperative pain intensity; joint space width (JSW), age, gender, and body mass index (BMI) were used to predict changes in pain and physical...... function after surgery. Preoperative pain level scores were categorized into; none (76-100, reference), mild (51-75), moderate (26- 50) and severe (0-25). Single and multilevel repeated measures random effects linear regression models (MLM) were used Findings / Results: Preoperative pain levels predicted...

  7. Staged Custom, Intramedullary Antibiotic Spacers for Severe Segmental Bone Loss in Infected Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Atul F. Kamath

    2011-01-01

    Full Text Available Introduction. Total hip arthroplasty (THA infections with severe bone loss pose significant reconstructive challenges. We present our experience with two-stage hip reimplantation using an intramedullary, antibiotic-impregnated nail. Methods. Three patients with infected THA with severe proximal femoral bone loss (Mallory type IIIB or greater were treated using a custom antibiotic spacer. Clinical outcomes and any complications were recorded. Average followup was 49 months from final reimplantation. Results. Mean age at spacer placement (stage 1 was 53 years. The mean Harris Hip Score at final followup was 80. Two patients had asymptomatic heterotopic ossification, and one patient had a 2 cm leg-length discrepancy. Conclusions. A custom intramedullary nail antibiotic spacer is a reliable option in the staged management of the infected THA with severe proximal femoral bone loss. Benefits of this technique include limb salvage with maintenance of leg length, soft tissue tension, and functional status.

  8. 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

  9. Clinical Outcomes of Total Hip Arthroplasty in Patients with Ankylosed Hip

    Directory of Open Access Journals (Sweden)

    Babak Siavashi

    2014-03-01

    Full Text Available Background:   Various drugs are administered intra-articularly to provide postoperative analgesia after arthroscopic knee surgery. The purpose of this study was to assess the analgesic effects of intra-articular injection of a dexmedetomidine   following knee arthroscopy.     Methods:   Forty six patients schadualed for arthroscopic knee surgery under general anaesthesia, were randomly devided into two groups. Intervention group received 1μg/kg dexmedetomidine (D and isotonic saline. Control group   received 25ml isotonic saline (P. Analgesic effects were evaluated by measuring pain intensity (VAS scores and   duration of analgesia.     Results:   There was no significant difference between the two groups in terms of age, sex and weight. The mean of post-operation pain severity in 1, 3, 6,12, and 24 h was significantly lower in the intervention group (D in comparison   with the control group (P. the mean of the total dose of tramadol consumption was significantly lower in the interven       tion group in comparison with the control group (     P

  10. Acoustic monitoring (RFM of total hip arthroplasty results of a cadaver study

    Directory of Open Access Journals (Sweden)

    Unger AC

    2009-06-01

    Full Text Available Abstract Introduction At present there are no reliable non-traumatic and non-invasive methods to analyse the healing process and loosening status after total hip replacement. Therefore early as well as late loosening of prosthesis and interface component problems are difficult to be found or diagnosed at any time. Methods In a cadaver study the potential application of Resonance Frequency Monitoring (RFM will be evaluated as a non-invasive and non-traumatic method to monitor loosening and interface problems in hip replacement. In a 65 year old female cadaver different stability scenarios for a total hip replacement (shaft, head/modular head and cup, ESKA, Luebeck, Germany are simulated in cemented and cement less prosthesis and then analysed with RFM. The types of stability vary from secure/press-fit to interface-shaft disruption. Results The RFM shows in cemented as well as cement less prosthesis significant intra-individual differences in the spectral measurements with a high dynamic (20 dB difference corresponding to the factor 100 (10000%, regarding the simulated status of stability in the prosthesis system. Conclusion The results of the study demonstrate RFM as a highly sensitive non-invasive and non-traumatic method to support the application of RFM as a hip prosthesis monitoring procedure. The data obtained shows the possibility to use RFM for osteointegration surveillance and early detection of interface problems, but will require further evaluation in clinical and experimental studies.

  11. The preoperative measurement of template and postoperative assessment in artificial total hip replacement

    Institute of Scientific and Technical Information of China (English)

    Jin Jin; Chen Bin; Xu Hongguang; Li Qiyi; Li Yijia; Qiu Guixing

    2005-01-01

    Objective: To study the accuracy and importance of preoperative template measurement in total hip replacement (THR). Methods: Between Oct. 2003 and Sep. 2004, 19 patients (19 hips), including 11 male and 8female, ranged from 40 to 74 years old (mean 58.7 years old), underwent unilateral primary total hip replacement.Limb length and offset was measured, radiographic template was done preoperatively to anticipate optimal implantation component position and determine level of expected femoral neck cut, and plan to restore equality of limbs.After surgery, all factors above were reevaluated. Results: Fifteen patients with limb length difference obtained a significant improvement, it is decreased from 8.4mm to 4.4mm, 73.7% of them the limb length discrepancies was controlled within 5mm. Bilateral offset difference decreased from 6.3mm to 3.0mm. Coincidence rate between planned and actually used components was 52.6% on the acetabular side and 63.2% on the femoral side. Conclusion: Accurate and careful preoperative template measurement has significant value in balanced hip reconstruction by correcting leg length differences and restoring offset.

  12. Increased Long-Term Cardiovascular Risk After Total Hip Arthroplasty: A Nationwide Cohort Study.

    Science.gov (United States)

    Gordon, Max; Rysinska, Agata; Garland, Anne; Rolfson, Ola; Aspberg, Sara; Eisler, Thomas; Garellick, Göran; Stark, André; Hailer, Nils P; Sköldenberg, Olof

    2016-02-01

    Total hip arthroplasty is a common and important treatment for osteoarthritis patients. Long-term cardiovascular effects elicited by osteoarthritis or the implant itself remain unknown. The purpose of the present study was to determine if there is an increased risk of late cardiovascular mortality and morbidity after total hip arthroplasty surgery.A nationwide matched cohort study with data on 91,527 osteoarthritis patients operated on, obtained from the Swedish Hip Arthroplasty Register. A control cohort (n = 270,688) from the general Swedish population was matched 1:3 to each case by sex, age, and residence. Mean follow-up time was 10 years (range, 7-21).The exposure was presence of a hip replacement for more than 5 years. The primary outcome was cardiovascular mortality after 5 years. Secondary outcomes were total mortality and re-admissions due to cardiovascular events.During the first 5 to 9 years, the arthroplasty cohort had a lower cardiovascular mortality risk compared with the control cohort. However, the risk in the arthroplasty cohort increased over time and was higher than in controls after 8.8 years (95% confidence interval [CI] 7.0-10.5). Between 9 and 13 years postoperatively, the hazard ratio was 1.11 (95% CI 1.05-1.17). Arthroplasty patients were also more frequently admitted to hospital for cardiovascular reasons compared with controls, with a rate ratio of 1.08 (95% CI 1.06-1.11).Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation when compared with controls. PMID:26871792

  13. An unusual case of persistent groin pain after total hip arthroplasty: a case report

    Directory of Open Access Journals (Sweden)

    Friederich Niklaus F

    2011-02-01

    Full Text Available Abstract Introduction Arthroplasty is a well-established routine elective surgical procedure in orthopaedics. To a great extent, diagnosis, treatment and post-operative rehabilitation in these patients is standardised. In a busy clinic, surgeons from time to time tend to focus their attention on common causes of joint pain, but it may lead them to overlook sinister but less common pathologies. Here we report a case of a patient with groin pain due to pre-operatively undetected pelvic metastases from a pyeloureteral carcinoma who underwent total hip arthroplasty. There are several case reports which deal with primary or secondary tumours which were either discovered at the time of replacement surgery or developed at the site of prosthesis years after total hip or knee replacement. To the best of our knowledge, this is the first case report in which a metastatic cancer was missed pre-operatively and intra-operatively both by the radiologist and by the orthopaedic surgeon and should be reported so that surgeons are reminded to be careful when dealing with seemingly routine cases. Case presentation A 79-year-old Caucasian woman presented to the arthroplasty clinic with groin pain. Initial radiographs showed subtle bilateral abnormalities in the pelvis. Neither the radiologist nor the orthopaedic surgeon recognized it. A diagnosis of osteoarthritis of the hip was established, and she underwent total hip arthroplasty. Despite initial improvement, the patient came back with worsening hip pain three months later. Further radiological examination revealed multiple metastatic lesions throughout the pelvis due to a pyeloureteral carcinoma. Conclusions This case report emphasizes the importance of meticulous, unbiased pre-operative assessment of patients and their radiographs, even in so-called routine clinical cases. Often subtle radiological changes are classed as normal, especially if they are bilateral. Further radiological imaging should be recommended

  14. Physiotherapy Exercise After Fast-Track Total Hip and Knee Arthroplasty: Time for Reconsideration?

    DEFF Research Database (Denmark)

    Bandholm, Thomas; Kehlet, Henrik

    2012-01-01

    Bandholm T, Kehlet H. Physiotherapy exercise after fast-track total hip and knee arthroplasty: time for reconsideration? Major surgery, including total hip arthroplasty (THA) and total knee arthroplasty (TKA), is followed by a convalescence period, during which the loss of muscle strength......-track methodology or enhanced recovery programs. It is the nature of this methodology to systematically and scientifically optimize all perioperative care components, with the overall goal of enhancing recovery. This is also the case for the care component "physiotherapy exercise" after THA and TKA. The 2 latest...... meta-analyses on the effectiveness of physiotherapy exercise after THA and TKA generally conclude that physiotherapy exercise after THA and TKA either does not work or is not very effective. The reason for this may be that the "pill" of physiotherapy exercise typically offered after THA and TKA does...

  15. Reliability and Validity of the Dutch Version of the International Physical Activity Questionnaire in Patients After Total Hip Arthroplasty or Total Knee Arthroplasty

    NARCIS (Netherlands)

    Blikman, Tim; Stevens, Martin; Bulstra, Sjoerd K.; van den Akker-Scheek, Inge; Reininga, Inge H. F.

    2013-01-01

    STUDY DESIGN: Psychometric assessment. OBJECTIVES: To determine test-retest reliability and concurrent validity of the International Physical Activity Questionnaire (IPAQ) in patients after total hip arthroplasty or total knee arthroplasty. BACKGROUND: Despite recognized benefits of regular physical

  16. 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.

  17. A prospective randomised study comparing the jubilee dressing method to a standard adhesive dressing for total hip and knee replacements.

    LENUS (Irish Health Repository)

    Burke, Neil G

    2012-08-01

    It is important to reduce potential wound complications in total hip and total knee arthroplasty procedures. The purpose of this study was to compare the jubilee dressing method to a standard adhesive dressing.

  18. Risk of cancer following primary total hip replacement or primary resurfacing arthroplasty of the hip: a retrospective cohort study in Scotland

    OpenAIRE

    Brewster, D H; Stockton, D L; Reekie, A; Ashcroft, G. P.; Howie, C R; Porter, D E; Black, R. J.

    2013-01-01

    Background: Release and dispersion of particles arising from corrosion and wear of total hip arthroplasty (THA) components has raised concerns about a possible increased risk of cancer. Concerns have been heightened by a recent revival in the use of metal-on-metal (MoM) hip prostheses. Methods: From a linked database of hospital discharge, cancer registration, and mortality records, we selected a cohort of patients who underwent primary THA (1990–2009) or primary resurfacing arthroplasty (mai...

  19. 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.

  20. Risk of dislocation using large- vs. small-diameter femoral heads in total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Plate Johannes F

    2012-10-01

    Full Text Available Abstract Background Dislocation remains a difficult problem in total hip arthroplasty. Large-diameter femoral heads may lower the incidence of dislocation by enhancing the jump distance and decreasing impingement, but their performance against small-diameter heads has not been assessed. This study compared the mid-term radiographic and functional outcomes of two matched cohorts of patients undergoing total hip arthroplasty who had a high pre-operative risk for dislocation and who received either small-diameter (26- or 28-millimeters or large-diameter (≥36-millimeters femoral heads. Methods All patients who received large-diameter heads (≥36-millimeter between 2002 and 2005, and who had pre-operative risk factors for dislocation, were identified in the institution’s joint registry. Forty-one patients (52 hips who received large-diameter heads were identified, and these patients were matched to 48 patients (52 hips in the registry who received small-diameter femoral heads. Results At mean final follow-up of 62 months (range, 49 to 101 months, both groups achieved excellent functional outcomes as measured by Harris Hip scores, with slightly better final scores in the large-diameter group (90 vs. 83 points. No patient showed any radiographic signs of loosening. No patient dislocated in the large-diameter femoral head group; the smaller-diameter group had a greater rate of dislocation (3.8%, 2 out of 52. Conclusions Large-diameter femoral head articulations may reduce dislocation rates in patients who have a high pre-operative risk for dislocation while providing the same functional improvements and safety as small-diameter bearings.

  1. Initial mechanical stability of cementless highly-porous titanium tibial components

    Energy Technology Data Exchange (ETDEWEB)

    Stone, Timothy Brandon [Los Alamos National Laboratory; Amer, Luke D [Los Alamos National Laboratory; Warren, Christopher P [Los Alamos National Laboratory; Cornwell, Phillip [Los Alamos National Laboratory; Meneghini, R Michael [UNIV OF CONNECTICUT HEALTH CENTER

    2008-01-01

    Cementless fixation in total knee replacement has seen limited use since reports of early failure surfaced in the late 80s and early 90s. However the emergence of improved biomaterials, particularly porous titanium and tantalum, has led to a renewed interest in developing a cementless tibial component to enhance long-term survivorship of the implants. Cement is commonly employed to minimize micromotion in new implants but represents a weak interface between the implant and bone. The elimination of cement and application of these new biomaterials, which theoretically provide improved stability and ultimate osseointegration, would likely result in greater knee replacement success. Additionally, the removal of cement from the procedure would help minimize surgical durations and get rid of the time needed for curing, thereby the chance of infection. The purpose of this biomechanical study was twofold. The first goal was to assess whether vibration analysis techniques can be used to evaluate and characterize initial mechanical stability of cementless implants more accurately than the traditional method of micromotion determination, which employs linear variable differential transducers (LVDTs). Second, an evaluative study was performed to determine the comparative mechanical stability of five designs of cementless tibial components under mechanical loading designed to simulate in vivo forces. The test groups will include a cemented Triathlon Keeled baseplate control group, three different 2-peg cementless baseplates with smooth, mid, and high roughnesses and a 4-peg cement/ess baseplate with mid-roughness.

  2. Tribological characterisation of UHMWPE used in dual mobility total hip prosthesis

    Science.gov (United States)

    Essefi, I.; Hakkouna, H.; Ouenzerfi, G.; Mollon, G.; Hamza, S.; Renault, E.; Berthier, Y.; Trunfio-Sfarghiu, A.-M.

    2016-08-01

    Total hip arthroplasty represents an effective solution for bone and joint diseases. Nevertheless, the hip prosthesis has a limited lifetime, in the average around fifteen years. Their improvement, especially their dual mobility is the objective of this study. Therefore, our strategy is focused on improving the material by comparing three types of polyethylene to determine the best one from a friction mechanism and wear rate minimization standpoint. A dual mobility hip prosthesis, containing a two-sided steel and cobalt chrome cup, was tested with a TORNIER hip joint simulator in calf serum. The rubbed surfaces were characterized using scanning electron microscopy (SEM), contact angle measurements, atomic force microscopy (AFM) and confocal fluorescence microscopy. All these multiscale characterization techniques (from nanoscale to millimeter and micro- scale) showed that the velocity accommodation mechanism is different from one type of polyethylene to another. The wear in the case of standard polyethylene was noticeable and the particles were large and scattered between the surface of polyethylene, the surface of the cup and in the calf serum. For the crosslinked polyethylene, the particles coming from the wear, were not as large, but they were spread the same way as the first case. Even though it shares the same accommodation principle on the detachment of the material with the crosslinked polyethylene the wear particles for the crosslinked vitaminized polyethylene were large and they were only found on the surface of the polyethylene.

  3. 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.

  4. Total Hip Arthroplasty for Implant Rupture after Surgery for Atypical Subtrochanteric Femoral Fracture

    Directory of Open Access Journals (Sweden)

    Yu Ozaki

    2016-01-01

    Full Text Available Treatment methods for delayed union and nonunion of atypical femoral fracture are still controversial. Moreover, no treatment method has been established for implant rupture caused by delayed union and nonunion. We encountered a 74-year-old female in whom nonunion-induced implant rupture occurred after treatment of atypical subtrochanteric femoral fracture with internal fixation using a long femoral nail. It was unlikely that sufficient fixation could be obtained by repeating osteosynthesis alone. Moreover, the patient was elderly and early weight-bearing activity was essential for early recovery of ADL. Based on these reasons, we selected one-stage surgery with total hip arthroplasty and osteosynthesis with inverted condylar locking plate as salvage procedures. Bone union was achieved at 6 months after surgery. This case illustrated that osteosynthesis-combined one-staged total hip arthroplasty could be considered as one of the options for nonunion-induced implant rupture of atypical femoral subtrochanteric fracture.

  5. Age Related Macular Degeneration and Total Hip Replacement Due to Osteoarthritis or Fracture: Melbourne Collaborative Cohort Study.

    Directory of Open Access Journals (Sweden)

    Elaine W Chong

    Full Text Available Osteoarthritis is the leading cause of total hip replacement, accounting for more than 80% of all total hip replacements. Emerging evidence suggests that osteoarthritis has a chronic inflammatory component to its pathogenesis similar to age-related macular degeneration. We evaluated the association between age-related macular degeneration and total hip replacement as proxy for severe osteoarthritis or fractured neck of femur in the Melbourne Collaborative Cohort Study. 20,744 participants had complete data on both age-related macular degeneration assessed from colour fundus photographs taken during 2003-2007 and total hip replacement. Total hip replacements due to hip osteoarthritis and fractured neck of femur during 2001-2011 were identified by linking the cohort records to the Australian Orthopedic Association National Joint Replacement Registry. Logistic regression was used to examine the association between age-related macular degeneration and risk of total hip replacement due to osteoarthritis and fracture separately, adjusted for confounders. There were 791 cases of total hip replacement for osteoarthritis and 102 cases of total hip replacement due to fractured neck of femur. After adjustment for age, sex, body mass index, smoking, and grouped country of birth, intermediate age-related macular degeneration was directly associated with total hip replacement for osteoarthritis (odds ratio 1.22, 95% CI 1.00-1.49. Late age-related macular degeneration was directly associated with total hip replacement due to fractured neck of femur (odds ratio 5.21, 95% CI2.25-12.02. The association between intermediate age-related macular degeneration and an increased 10-year incidence of total hip replacement due to osteoarthritis suggests the possibility of similar inflammatory processes underlying both chronic diseases. The association of late age-related macular degeneration with an increased 10-year incidence of total hip replacement due to fractured

  6. Assessment Of Patient Problems Encountered With Total Hip Replacement At Baghdad Teaching Hospitals

    Directory of Open Access Journals (Sweden)

    Faris Fauze Ahmed

    2015-08-01

    Full Text Available Abstract Background Total hip replacements conduct highly effective in relieving pain dysfunction for patients who suffer from hip inflammation and a variety of reasons however after several decades of success in hip replacement there was also an increase in cases of fractures after you perform a detailed switch and attributed this The increase in the prevalence of a large fraction of the increase in the number of switch detailed and increasing age and poverty operations. Objectives The study aims toAssess the pre operation physical and psychosocial problems of patients with total hip replacement. To Assess the post operation physical and psychosocial problems of patients with total hip replacement. To find out the relationship between pre post physical and psychosocial problems with age gender duration of illness and type of operation. Design of the study A descriptive design study was carried out in Nursing Home hospital and Ghazi AL-Hariri for specialized surgical hospitals starting from January 13th 2015 to September 1st 2015 The study Sample A non- probability purposive sample of 50 patients undergoing total hip replacement surgery who have several problems before and after surgery. The study Instrument The study instrument was composed of three parts which as socio demographic information was included age group gender marital status level of education occupational economic part two consist of medical information was comprised of 7 items and part three contain physical and psychosocial problems through Hamilton anxiety scale consist of 84 items. Validity and Reliability The content validity of the instrument was established through a panel of 14 experts the reliability of the items was based on the internal consistency of the questionnaire was assessed by calculating Cronbach s Coefficient alpha which as 0.73. Statistical Analysis The researchers used the appropriate statistical methods for data analysis which include the descriptive data

  7. Femoral nerve palsy caused by ileopectineal bursitis after total hip replacement: a case report

    OpenAIRE

    Bähr Mathias; von Gottberg Philipp; Liman Jan; Kermer Pawel

    2011-01-01

    Abstract Introduction Infectious ileopectineal bursitis is a rare complication after total hip replacement and is associated mainly with rheumatoid arthritis. The main complications are local swelling and pain, but communication of the inflamed bursa with the joint can occur, leading to subsequent cartilage damage and bone destruction. Case presentation We report a case of a 47-year-old Caucasian woman without rheumatoid arthritis who reported pain and palsy in her left leg almost one year af...

  8. Haemodynamic performance of neuromuscular electrical stimulation (NMES) during recovery from total hip arthroplasty

    OpenAIRE

    Broderick, Barry J.; Breathnach, Oisin; Condon, Finbarr; Masterson, Eric; ÓLaighin, Gearóid

    2013-01-01

    Background Patients post total hip arthroplasty (THA) remain at high risk of developing Deep Vein Thrombosis (DVT) during the recovery period following surgery despite the availability of effective pharmacological and mechanical prophylactic methods. The use of calf muscle neuromuscular electrical stimulation (NMES) during the hospitalised recovery period on this patient group may be effective at preventing DVT. However, the haemodynamic effectiveness and comfort characteristics of NMES in po...

  9. Range of motion caused by design of the total hip prosthesis

    Energy Technology Data Exchange (ETDEWEB)

    Herrlin, K.; Selvik, G.; Pettersson, H.; Lidgren, L.

    In a clinical material of total hip prostheses, a study was performed of the range of femoral motion until impingement occurred between the neck of the femoral stem and the rim of the acetabular socket. The results were compared with the physiologic range of motion, and the clinically relevant motion restriction was measured. Restriction was most common in flexion. There was a correlation between the prosthetic design and the restriction due to impingement.

  10. A novel classification to guide total hip arthroplasty for adult acetabular dysplasia

    OpenAIRE

    Zhu, Chen; CHENG, MENG-QI; Cheng, Tao; MA, RUI-XIANG; Kong, Rong; GUO, YONG-YUAN; Qin, Hui; SHI, SI FENG; Zhang, Xian-long

    2013-01-01

    In the field of hip arthroplasties, the secondary fixation of the implants depends directly on the quality of the primary stability. A good acetabular fit and metaphyseal filling between the prostheses and implants improve the initial stabilization, and optimize the transmission of forces to the bone. A precise knowledge of the three-dimensional acetabular or femoral shape is essential to the selection of adapted implants. A total of 63 patients diagnosed with developmental dysplasia were ana...

  11. Soft tissue balancing in the total hip arthroplasty for severe developmental dysplasia of the hip in adults%软组织平衡在全髋关节置换术治疗成人高位髋关节发育不良中的应用

    Institute of Scientific and Technical Information of China (English)

    张雷; 余列道; 杨国敬

    2008-01-01

    Objective To assess clinical reanh of soft tissue balancing in primary total hip arthroplasty for severe developmental dysplasia of the hip in adults.Methods From December 2000 to August 2006, 26 primary cementless total hip arthroplasties combined with soft tissue balancing were performed in 21 cases for the treatment of severe developmental dysplasia of the hip.Patients were classified as type Ⅲ(20 hips) and type Ⅳ(6 hips) according to Crowe classification.All acetabular cups were placed in their original anatomic location by soft tissue releasing and subtrochanteric shortening osteotomy.Thereafter, postoperative clinical and radiological results were evaluated.Results The mean length of follow-up was 4.8 yeats (range, 13 months-7 years).Limp improved by at least one grade in 62% of the cases.Leg-length discrepancy was corrected significantly and osteotomy was undertaken in 13 hips with a mean decrease length of 0.9 cm by effective releasing.Harris scores improved significantly from a mean of 41.2 preoperatively to 89.6 postoperatively.No dislocations, infections and prosthesis loosening were found at the final follow-up evaluation.Conclusion Soft tissue balancing in total hip arthropalsty can facilitate acetabular reconstruction to normalize the hip center in severe developmental dysplasia of the hip, as a result, satisfactory short-term resttlt can be obtained by restoring normal function and anatomic structure.%目的 评价软组织平衡技术在全髋关节置换术治疗成人高位髋关节发育不良的效果.方法 2000年12月至2006年8月应用全髋关节置换术治疗21例(26髋)高位髋关节发育不良患者(CreweⅢ型20髋;Ⅳ型6髋).通过软组织松解及股骨转子下短缩截骨重建髋臼于真臼水平,评价其术后临床及影像学结果.术前Harris评分平均41.2分.结果 21例患者获得13个月~7年随访,平均随访时间4.8年.16例患者术后跛行程度明显改善;通过软组织松解可显著纠正下肢

  12. Pre-surgical sensorimotor training for patients undergoing total hip replacement: a randomised controlled trial.

    Science.gov (United States)

    Bitterli, R; Sieben, J M; Hartmann, M; de Bruin, E D

    2011-09-01

    The aim of this study was to investigate whether pre-operative, sensorimotor training results in improved physical function, quality of life, sensorimotor function and reduced disability in total hip replacement patients. 80 subjects awaiting total hip replacement at a Swiss hospital were recruited for this randomised controlled trial. The intervention group participated in a pre-operative home exercise sensorimotor training programme; the control group received no therapy. Primary outcome measure was physical function, secondary outcome measures were quality of life, disability and sensorimotor function. Outcomes were measured using generic and disease-specific questionnaires as well as objectively assessed balance ability. Measurements were taken one day before surgery and 10 days, 4 and 12 months after surgery. The intervention showed improved quality of life and sensorimotor function before surgery. These effects were lost following surgery. The intervention group experienced more disability at 4 months than the control group. At one year follow-up group-membership influenced quality of life scores depending on the measurement-time-point. It can be concluded that no useful effect was identified for a pre-operative sensory-motor training-programme. The psychological aspects following total hip replacement need to be considered in order to facilitate coping-strategies, reduce unrealistic expectations and increase satisfaction. PMID:21630176

  13. A modified two-incision technique for primary total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Bal B

    2008-01-01

    Full Text Available Background: Minimally invasive surgery can be technically demanding but minimizes surgical trauma, pain and recovery. Two-incision minimally invasive surgery allows only intermittent visualization and may require fluoroscopy for implant positioning. We describe a modified technique for primary total hip arthroplasty, using two small incisions with a stepwise approach and adequate visualization to reliably and reproducibly perform the surgery without fluoroscopy. Materials and Methods: One hundred and two patients with an average age of 60 years underwent modified two-incision minimally invasive technique for primary THA without fluoroscopy. The M/L taper femoral stem (Zimmer, Warsaw, IN and Trilogy (Zimmer hemispherical titanium shell, with a highly cross-linked polyethylene liner, was used. Operative time, blood loss, postoperative hospital stay, radiographic outcomes and complications were recorded. Results: The mean operating time was 77 min. The mean blood loss was 335 cc. The mean hospital stay was 2.4 days. Mean cup abduction angle was 43.8°. Mean leg length discrepancy was 1.7 mm. Thirteen patients had lateral thigh numbness and two patients had wound complications that resolved without any treatment. Conclusion: A modified two-incision technique without fluoroscopy for primary total hip arthroplasty has the advantage of preserving muscles and tendons, shorter recovery and return to function with minimal complications. Provided that the surgeon has received appropriate training, primary total hip arthroplasty can be performed safely with the modified two-incision technique.

  14. Dislocation of a dual mobility total hip replacement following fracture of the polyethylene liner.

    Science.gov (United States)

    Vedrine, Bertrand; Guillaumot, Pierre; Chancrin, Jean-Luc

    2016-05-18

    An eight-year-old male English Setter was referred for management of a dislocation of a cemented dual mobility canine total hip prosthesis that occurred four months after the initial surgery. Revision surgery showed that the dislocation was associated with fracture of the ultra-high molecular weight polyethylene liner. The dislocation was successfully reduced after replacing the liner. A dual mobility acetabular component is composed of a mobile polyethylene liner inside a metallic cemented cup. Chronic wear of the components of a canine dual mobility total hip replacement has not been described previously. The use of this type of implant is fairly recent and limited long term follow-up of the implanted cases may be the explanation. Acute rupture of a polyethylene liner has never been described in humans, the only case of rupture of a polyethylene liner occurred 10 years after implantation. The case presented here of rupture of the polyethylene liner of a dual mobility total hip replacement is a hitherto unreported failure mode in this model of acetabular cup in the dog. PMID:26991949

  15. Botulinum toxin type A in the treatment of painful adductor muscle contracture after total hip arthroplasty.

    Science.gov (United States)

    Santamato, Andrea; Ranieri, Maurizio; Panza, Francesco; Solfrizzi, Vincenzo; Frisardi, Vincenza; Lapenna, Luisa Maria; Moretti, Biagio; Fiore, Pietro

    2009-10-01

    Painful adductor muscle contracture is an important cause of failure during rehabilitation following total hip arthroplasty (THA). Adductor muscle contracture may be caused by postoperative muscle retractions, adhesive capsulitis, postoperative leg-length inequalities caused by implant failure, or preexisting hip pathologies. A 34-year-old woman experienced a persistent painful contracture into the left adductor magnus muscle after THA. She had no leg-length inequalities and, according to the Medical Research Council scale (grades 0-5), muscle strength of the quadriceps was 5/5 for the right side and 3/5 for the left. The degree of functionality according to the Harris hip score (HHS) was 16/100 in the left hip. The pain level, measured with the visual analog scale (VAS), was 7/10. The patient was unable to fully adhere to the rehabilitation program and walked with a limp during the stance phase of gait. After 7 days of treatment with injections of botulinum toxin type A into the left adductor magnus muscle (dose, 150 UM) and subsequent rehabilitation, a great reduction of painful contracture was observed (VAS score, 2/10). The procedure was well tolerated and no adverse effects were noted. After 20 days, hip articular range of motion and gait had improved (HHS score, 75/100). The clinical effects of botulinum toxin type A were present at 2-month follow-up. This treatment may be a viable alternative for the management of painful adductor muscle contracture after THA, without significant side effects. PMID:19824593

  16. Methods of the physical medicine therapy in prevention of heterotopic ossification after total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Kojović Zoran

    2006-01-01

    Full Text Available Background/aim: In the prevention of periarticular heterotopic ossification (HO, a common complication after total hip arthroplasty (THA, nonsteroidal antiinflammatory drugs (NSAID and irradiation are used. Some theories presume that local hypoxia of the soft tissue causes HO. The aim of this study was to investigate if the early use of pulsed electromagnetic fields (PEMF could prevent this ossification since it accelerates the circulation and oxigenation of soft tissue. Methods. The study included three groups of the patients with primary THA. The group C consisted of 66 patients/79 hips who had only kinesitherapy in postoperative rehabilitation. The group B consisted of 117 patients/ 131 hips who had PEMF and interferential current (IC which, on average, started on the 14th day after the surgery combined with the standard kinesitherapy. The group A consisted of 117 patients/131 hips who had PEMF from the third postoperative day and IC from, on average, the 14th postoperative day with the standard kinesitherapy. The classification of HO was done on a standard AP roentgenograms of the hips, taken at least one year after the surgery. Results. The overall HO was seen in 50.63% of the group C patients, in 43.51% of the B group and in 16.67% of the group A. Severe HO (III and IV class according to Brooker was seen in 26.58% of the group C patients and in 6.10% of the group B, but none in the group A. Conclusion. According to the obtained results an early treatment with PEMF could prevent severe HO and reduce the overall HO.

  17. A Comparative Evaluation of Primary Total Hip Arthroplasty via Lateral and Posterolateral Approaches

    Directory of Open Access Journals (Sweden)

    Kaveh Gharanizade

    2016-02-01

    Full Text Available Background: Total hip arthroplasty (THA is regarded as the most successful and common surgical approach in orthopedic surgeries. Several surgical approaches have been described for THA to introduce minimally invasive surgical exposures. Posterolateral and lateral approaches are traditional and still most commonly used approaches for primary THA. In deciding which approach to use, consideration of complications, and clinical and radiological outcomes, using one approach or another should be evaluated. Objectives: The purpose of this study was to compare the early postoperative outcomes of posterolateral and lateral surgical approaches. Patients and Methods: The current study was conducted on a group of 134 primary hip arthroplasty of 120 patients who had undergone THA surgery at Shafa Orthopedic Hospital in Tehran, Iran, from March 2011 to October 2014. The lateral approach was used in 79 hips and, posterolateral approach was used in 55 hip based on surgeon’s preference. Two groups were assessed considering the following outcomes: clinical evaluation including Harris hip score (HHS, blood loss, blood transfusion, hemoglobin level, infections, deep vein thrombosis (DVT and dislocation, as well as radiological evaluation including the proximal femur fracture, limb length discrepancy and cup inclination angle. The follow-up for both groups was at 6, 12, 24, 36 and 48 weeks after the surgery. Results: There was no significant difference between the two approaches regarding demographic characteristics, HHS, blood loss, transfusion, hemoglobin level, dislocation and cup inclination angle. However, there was a significant difference in the incidences of infections, DVT, proximal femur fracture and discrepancy of limb length between the two approaches. Conclusions: The results of this study indicate that both lateral and posterolateral approaches offer similar early clinical outcomes and some different radiological outcomes.

  18. Serum albumin and total lymphocyte count as predictors of outcome in hip fractures.

    LENUS (Irish Health Repository)

    O'Daly, Brendan J

    2012-02-01

    BACKGROUND & AIMS: Hip fractures are a significant cause of mortality and morbidity in the elderly. Malnutrition is a significant contributor to this, however no consensus exists as to the detection or management of this condition. We hypothesise that results of admission serum albumin and total lymphocyte count (TLC), as markers of Protein Energy Malnutrition (PEM) can help predict clinical outcome in hip fracture patients aged over 60 years. METHODS: This retrospective study evaluated the nutritional status of patients with hip fractures using albumin and TLC assays and analysed their prognostic relevance. Clinical outcome parameters studied were delay to operation, duration of in-patient stay, re-admission and in-patient, 3- and 12-month mortality. RESULTS: Four hundred and fifteen hip fracture patients were evaluated. Survival data were available for 377 patients at 12 months. In-hospital mortality for PEM patients was 9.8%, compared with 0% for patients without. Patients with PEM had a higher 12-month mortality compared to patients who had normal values of both laboratory parameters (Odds Ratio 4.6; 95% CI: 1.0-21.3). Serum albumin (Hazard Ratio 0.932, 95% CI: 0.9-1.0) and age (Hazard Ratio 1.04, 95% CI: 1.0-1.1) were found to be significant independent prognostic factors of mortality by Cox regression analysis. CONCLUSIONS: These results highlight the relevance of assessing the nutritional status of patients with hip fractures at the time of admission and emphasises the correlation between PEM and outcome in these patients.

  19. 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.

  20. Three-dimensional modeling of in vitro hip kinematics under micro-separation regime for ceramic on ceramic total hip prosthesis: an analysis of vibration and noise.

    Science.gov (United States)

    Sariali, Elhadi; Stewart, Todd; Jin, Zongmin; Fisher, John

    2010-01-19

    Micro-separation corresponds to a medial-lateral hip laxity after total hip replacement (THR). This laxity has been shown to generate higher wear rates and a specific pattern of stripe wear caused by edge loading of the head on the rim of the cup. Recently some authors have implicated edge loading as a source of noise generation and in particular squeaking. The goal of this study was to model hip kinematics under the micro-separation regime in a computational simulation of total hip prosthesis including joint laxity and to analyze the vibration frequencies and the potential for noise generation. A three-dimensional computer model of the Leeds II hip simulator was developed using ADAMS((R)) software, simulating a controlled micro-separation during the swing phase of the walking cycle and replicating the experimental conditions previously reported. There was an excellent correlation between the theoretical values and the experimental values of the medial-lateral separation during the walking cycle. Vibratory frequencies were in the audible zone but were lower in magnitude than those reported clinically in relation to squeaking. Micro-separation and rim loading may explain the generation of some sounds from noisy hips after THR. However, the computational model, and the experimental model of micro-separation were unable to replicate the higher frequency squeaking reported clinically. In contrast, other experimental studies involving normal kinematics in combination with third-body particles have replicated clinically relevant frequencies and noises.

  1. Cost of Radiotherapy Versus NSAID Administration for Prevention of Heterotopic Ossification After Total Hip Arthroplasty

    International Nuclear Information System (INIS)

    Purpose: Heterotopic ossification (HO), or abnormal bone formation, is a common sequela of total hip arthroplasty. This abnormal bone can impair joint function and must be surgically removed to restore mobility. HO can be prevented by postoperative nonsteroidal anti-inflammatory drug (NSAID) use or radiotherapy (RT). NSAIDs are associated with multiple toxicities, including gastrointestinal bleeding. Although RT has been shown to be more efficacious than NSAIDs at preventing HO, its cost-effectiveness has been questioned. Methods and Materials: We performed an analysis of the cost of postoperative RT to the hip compared with NSAID administration, taking into account the costs of surgery for HO formation, treatment-induced morbidity, and productivity loss from missed work. The costs of RT, surgical revision, and treatment of gastrointestinal bleeding were estimated using the 2007 Medicare Fee Schedule and inpatient diagnosis-related group codes. The cost of lost wages was estimated using the 2006 median salary data from the U.S. Census Bureau. Results: The cost of administering RT was estimated at $899 vs. $20 for NSAID use. After accounting for the additional costs associated with revision total hip arthroplasty and gastrointestinal bleeding, the corresponding estimated costs were $1,208 vs. $930. Conclusion: If the costs associated with treatment failure and treatment-induced morbidity are considered, the cost of NSAIDs approaches that of RT. Other NSAID morbidities and quality-of-life differences that are difficult to quantify add to the cost of NSAIDs. These considerations have led us to recommend RT as the preferred modality for use in prophylaxis against HO after total hip arthroplasty, even when the cost is considered

  2. Correlation between patient age at total hip replacement surgery and lifeexpectancy

    Science.gov (United States)

    Schwartsmann1, Carlos Roberto; Spinelli, Leandro de Freitas; Boschin, Leonardo Carbonera; Yépez, Anthony Kerbes; Crestani, Marcus Vinicius; Silva, Marcelo Faria

    2015-01-01

    ABSTRACT Total hip arthroplasty (THA) is one of the most cost-effective hip surgeries among orthopedic procedures. We conducted an extensive literature review with 5,394 papers regarding survival rates after THA. We searched PubMed, Embase and the Cochrane library from January 1st, 1970 to July 31th, 2014 looking for all citations about total hip arthroplasty with a long term follow-up (longer than 10 years). The criteria were rigorous: no loss of follow-up, and follow-up more than 10 years. The authors should have known the complete history of patients (whether the patient is alive or dead). Considering the criteria, we found only 15 papers. To evaluate the relationship between follow-up and survival, a linear regression analysis was applied. Considering the papers analysed, and applying the search criteria, we obtained a mean age for the patients above 57.5 years. The chance of survival at 15 years was 57.6%, at 20 years it was 34.6% and at 25 years it is only 11.6%. The relationship between follow-up and survival was significantly linear (p <0.001). Only 11.6% of patients undergoing THA will be still alive 25 years after the surgical procedure. Level of Evidence I, Prognostic Study. PMID:27057147

  3. 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.

  4. Dislocation of primary total hip arthroplasty and the risk of redislocation.

    LENUS (Irish Health Repository)

    Brennan, Stephen A

    2012-09-01

    6554 primary total hip arthroplasties were reviewed. Risk factors for dislocation were analysed to assess which were important in terms of predicting recurrent instability. The patients risk of having a second dislocation was independently associated with the surgical approach adopted (p = 0.03) and the time to first dislocation from the primary hip replacement (p = 0.002). Early dislocators whose surgery was performed through an anterolateral approach had less recurrence than late dislocators through a posterior or transtrochanteric approach. None of the other risk factors including head size (p = 0.59), modularity (p = 0.54), mechanism of dislocation (p = 0.23), leg length discrepancy (p = 0.69) and acetabular inclination (p = 0.31) were influential. The use of an abduction brace was not useful in preventing a further dislocation with 69.2% of those braced re-dislocating compared to 68.5% who were not braced (p = 0.96).

  5. A novel blood-saving plan for less-invasive primary total hip replacement.

    Science.gov (United States)

    Hourlier, Hervé; Fennema, Peter; Liné, Bernhard

    2008-12-01

    We conducted a quality improvement program to examine the effect of a blood-saving plan during primary total hip replacement (THR) performed using a nonvascular less invasive approach (LI-THR) and compared the results with historical control subjects. Erythropoietin and tranexamic acid (TA) were administered for selected patients. Analysis of 221 (study group) and 186 (historic group) LI-THRs showed reductions in total blood loss by 20% in a group of 133 patients compared to a control group of 82 patients who did not receive TA. This novel blood plan for LI-THR changed practice, improved quality of care, and allowed all patients to remain blood transfusion free.

  6. Failure of total hip implants: metals and metal release in 52 cases

    DEFF Research Database (Denmark)

    Jakobsen, Stig Storgaard; Lidén, Carola; Søballe, Kjeld;

    2014-01-01

    Background . The pathogenesis of total joint replacement failure is multifactorial. One hypothesis suggests that corrosion and wear of alloys result in metal ion release, which may then cause sensitization and even implant failure, owing to the acquired immune reactivity. Objectives . To assess...... cobalt, nickel and chromium(VI) release from, and the metal composition of, failed metal-on-ethylene total hip replacements. Materials/methods . Implant components from 52 revision cases were evaluated with spot tests for free nickel, cobalt, and chromium (VI) ions. Implant composition was determined...... observed. Metal ions and particles corroded from metal-on-polyethylene may play a role in the complex aetiopathology of implant failure....

  7. Identifying the procedural gap and improved methods for maintaining accuracy during total hip arthroplasty.

    Science.gov (United States)

    Gross, Allan; Muir, Jeffrey M

    2016-09-01

    Osteoarthritis is a ubiquitous condition, affecting 26 million Americans each year, with up to 17% of adults over age 75 suffering from one variation of arthritis. The hip is one of the most commonly affected joints and while there are conservative options for treatment, as symptoms progress, many patients eventually turn to surgery to manage their pain and dysfunction. Early surgical options such as osteotomy or arthroscopy are reserved for younger, more active patients with less severe disease and symptoms. Total hip arthroplasty offers a viable solution for patients with severe degenerative changes; however, post-surgical discrepancies in leg length, offset and component malposition are common and cause significant complications. Such discrepancies are associated with consequences such as low back pain, neurological deficits, instability and overall patient dissatisfaction. Current methods for managing leg length and offset during hip arthroplasty are either inaccurate and susceptible to error or are cumbersome, expensive and lengthen surgical time. There is currently no viable option that provides accurate, real-time data to surgeons regarding leg length, offset and cup position in a cost-effective manner. As such, we hypothesize that a procedural gap exists in hip arthroplasty, a gap into which fall a large majority of arthroplasty patients who are at increased risk of complications following surgery. These complications and associated treatments place significant stress on the healthcare system. The costs associated with addressing leg length and offset discrepancies can be minor, requiring only heel lifts and short-term rehabilitation, but can also be substantial, with revision hip arthroplasty costs of up to $54,000 per procedure. The need for a cost-effective, simple to use and unobtrusive technology to address this procedural gap in hip arthroplasty and improve patient outcomes is of increasing importance. Given the aging of the population, the projected

  8. In Vitro Bioactivity Study of RGD-Coated Titanium Alloy Prothesis for Revision Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Zhentao Man

    2016-01-01

    Full Text Available Total hip arthroplasty (THA is a common procedure for the treatment of end-stage hip joint disease, and the demand for revision THA will double by 2026. Ti6Al4V (Titanium, 6% Aluminum, and 4% Vanadium is a kind of alloy commonly used to make hip prothesis. To promote the osseointegration between the prothesis and host bone is very important for the revision THA. The peptide Arg-Gly-Asp (RGD could increase cell attachment and has been used in the vascular tissue engineering. In this study, we combined the RGD with Ti6Al4V alloy using the covalent cross-linking method to fabricate the functional Ti6Al4V alloy (FTA. The distribution of RGD oligopeptide on the FTA was even and homogeneous. The FTA scaffolds could promote mouse osteoblasts adhesion and spreading. Furthermore, the result of RT-qPCR indicated that the FTA scaffolds were more beneficial to osteogenesis, which may be due to the improvement of osteoblast adhesion by the RGD oligopeptide coated on FTA. Overall, the FTA scaffolds developed herein pave the road for designing and building more efficient prothesis for osseointegration between the host bone and prothesis in revision THA.

  9. Outcome in Patients with High Body Mass Index following Primary Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Zuned Hakim

    2015-01-01

    Full Text Available Obesity is becoming a critical problem in the developed world and is associated with an increased incidence of osteoarthritis of the hip. The Oxford Hip Score was used to determine if Body Mass Index (BMI is an independent factor in determining patient outcome following primary total hip arthroplasty (THA. Using data from 353 operations we found that patients with BMI ≥ 30 had an absolute score that was lower preoperatively and postoperatively compared to those with a BMI < 30. There was no difference in pre- and postoperative point score change within each group; Kendall’s rank correlation was 0.00047 (95% CI, −0.073 to 0.074 (p=0.99 and demonstrated no trend. There was no statistically significant difference in change between those with BMI ≥ 30 and < 30 (p=0.65. We suggest that those with a higher BMI be considered for THA as they can expect the same degree of improvement as those with a lower BMI. Given the on-going increase in obesity these findings could be significant for the future of THA.

  10. Treatment of Arthritis Associated With Legg-Calve-Perthes Disease With Modular Total Hip Arthroplasty.

    Science.gov (United States)

    Seufert, Christopher R; McGrory, Brian J

    2015-10-01

    Legg-Calve-Perthes (LCP) disease can result in morphological deformities and associated adult hip arthritis. Thirty-five consecutive total hip arthroplasties (THA) were performed in 28 patients with a history of LCP using a non-cemented modular femoral component. There was one revision for late hematogenous infection and no evidence of prosthesis failure. Harris hip scores, on average, improved from 49.8 (26-73) to 93.9 (82-100) (P<0.05) after a minimum of 2 years follow-up (average, 8.2 years, range 2-14 years). Clinically, patients demonstrated diminished or no limping (94%, 33/35) and improved leg length equality post-operatively (100%, 35/35). This style of stem accommodated metaphyseal/diaphyseal size mismatch in 80% (28/35), allowed for abnormal anteversion in 71% (25/35), and resulted in radiographic improvements in trochanteric height (P<0.05), body weight lever arm (P<0.05), and leg length (P<0.05). PMID:25979188

  11. Early follow-up after primary total knee and total hip arthroplasty with rapid recovery : Focus groups.

    Science.gov (United States)

    van Egmond, Jeroen C; Verburg, Hennie; Vehmeijer, Stephan B W; Mathijssen, Nina M C

    2015-09-01

    Rapid recovery protocols reduce the length of hospital stay after Total Knee Arthroplasty (TKA) and Total Hip Arthroplasty (THA). However, little is known about the early postoperative phase. The purpose of this study was to examine which problems patients encountered during the first six weeks after primary TKA or THA surgery with rapid recovery. We invited twenty patients for a focus group meeting which discussed various subjects regarding the first six weeks after hospital discharge. The focus group meetings were analysed qualitatively. Patients were mostly satisfied by the short length of hospital stay. Patients who lived alone needs more care and would like to stay longer in the hospital. After THA surgery all patients complained of inability to sleep. More patients experienced pain after TKA surgery compared to THA surgery. All patients had various experiences regarding physical therapy therefore an evidence based rehabilitation protocol might be needed.

  12. A prospective randomised study of periprosthetic femoral bone remodeling using four different bearings in hybrid total hip arthroplasty

    DEFF Research Database (Denmark)

    Zerahn, Bo; Borgwardt, Lotte; Ribel-Madsen, Søren;

    2011-01-01

    Abstract: We performed a study to assess whether different bearing materials have an impact on femoral bone remodeling within the first four years after a hybrid total hip arthroplasty. 205 of 300 patients were available for 4 years follow-up after being randomly allocated to four prosthetic...... 1, 6, and 7.Bone remodeling after total hip arthroplasty may depend on the composition of bearing materials, but age, height, weight, and stem size are also related to changes in BMD....

  13. The geometry of the bone structure associated with total hip arthroplasty.

    Directory of Open Access Journals (Sweden)

    Zhang Yang

    Full Text Available Close adaptation of the prosthesis to the bone is the key to achieving optimal stability and fixation for total hip arthroplasty (THA. However, there have been no adequate studies of bone morphology, especially in different races. The aim of this study was to analyze the geometry of the acetabulum and proximal femur of people from South China, based on three-dimensional reconstruction, and to detect differences between different population subsets. CT scans were performed on 80 healthy volunteers (160 hips from South China, comprising 40 males (80 hips and 40 females (80 hips. The images were imported into Mimics 10.01 to perform 3D reconstruction. THA-associated anatomical parameters were measured and compared with other published data. In comparison with published data, it seemed that people from South China have smaller acetabular abduction angle, larger acetabular supro-inferior diameter, larger neck-shaft angle, smaller offset, thinner femoral shaft and more proximal isthmus, which needed to be further confirmed. There were significant differences between the genders in most parameters. As significant differences in canal flare index (CFI and distal canal flare index (DCFI were found between genders, it was concluded the most significant differences lay in the isthmus of the femur. Among the femora, according to Noble's classification we identified more normal types and fewer stovepipe and champagne-flute types than expected from the literature, indicating that uncemented prostheses would be suitable for most people from South China. Our findings reveal that simply choosing the smallest of a series of prostheses would not necessarily provide a good fit, due to the different trends from the proximal to the distal part of the femur. Significant variation exists in THA-associated anatomy between genders and population subsets. It is therefore imperative that each patient receives individual consideration rather than assuming all patients have

  14. Variation in age and physical status prior to total knee and hip replacement surgery

    DEFF Research Database (Denmark)

    Ackerman, Ilana N; Dieppe, Paul A; March, Lyn M;

    2009-01-01

    OBJECTIVE: To investigate whether variation exists in the preoperative age, pain, stiffness, and physical function of people undergoing total knee replacement (TKR) and total hip replacement (THR) at several centers in Australia and Europe. METHODS: Individual Western Ontario and McMaster Univers......OBJECTIVE: To investigate whether variation exists in the preoperative age, pain, stiffness, and physical function of people undergoing total knee replacement (TKR) and total hip replacement (THR) at several centers in Australia and Europe. METHODS: Individual Western Ontario and Mc......Master Universities Osteoarthritis Index data (range 0-100, where 0 = best and 100 = worst) collected within 6 weeks prior to primary TKR and THR were extracted from 16 centers (n = 2,835) according to specified eligibility criteria. Analysis of covariance was used to evaluate differences in pain, stiffness...... in the timing of joint replacement across the centers studied, with potential for compromised surgical outcomes due to premature or delayed surgery. Possible contributing factors include patient preferences, the absence of concrete indications for surgery, and the capacity of the health care systems....

  15. Effect of rotator cuff dysfunction on the initial mechanical stability of cementless glenoid components

    NARCIS (Netherlands)

    D.R. Suárez (Daniel); E.R. Valstar (Edward); J.C. Linden (Jacqueline); F. van Keulen (Fred); P.M. Rozing (Piet)

    2009-01-01

    textabstractThe functional outcome of shoulder replacement is related to the condition of the rotator cuff. Rotator cuff disease is a common problem in candidates for total shoulder arthroplasty; this study relates the functional status of the rotator cuff to the initial stability of a cementless gl

  16. Th1 type lymphocyte reactivity to metals in patients with total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Finnegan Alison

    2008-02-01

    Full Text Available Abstract Background All prostheses with metallic components release metal debris that can potentially activate the immune system. However, implant-related metal hyper-reactivity has not been well characterized. In this study, we hypothesized that adaptive immunity reaction(s, particularly T-helper type 1 (Th1 responses, will be dominant in any metal-reactivity responses of patients with total joint replacements (TJAs. We tested this hypothesis by evaluating lymphocyte reactivity to metal "ions" in subjects with and without total hip replacements, using proliferation assays and cytokine analysis. Methods Lymphocytes from young healthy individuals without an implant or a history of metal allergy (Group 1: n = 8 were used to assess lymphocyte responses to metal challenge agents. In addition, individuals (Group 2: n = 15 with well functioning total hip arthroplasties (average Harris Hip Score = 91, average time in-situ 158 months were studied. Age matched controls with no implants were also used for comparison (Group 3, n = 8, 4 male, 4 female average age 70, range 49–80. Group 1 subjects' lymphocyte proliferation response to Aluminum+3, Cobalt+2, Chromium+3, Copper+2, Iron+3, Molybdenum+5, Manganeese+2, Nickel+2, Vanadium+3 and Sodium+2 chloride solutions at a variety of concentrations (0.0, 0.05, 0.1, 0.5, 1.0 and 10.0 mM was studied to establish toxicity thresholds. Mononuclear cells from Group 2 and 3 subjects were challenged with 0.1 mM CrCl3, 0.1 mM NiCl2, 0.1 mM CoCl2 and approx. 0.001 mM titanium and the reactions measured with proliferation assays and cytokine analysis to determine T-cell subtype prominence. Results Primary lymphocytes from patients with well functioning total hip replacements demonstrated a higher incidence and greater magnitude of reactivity to chromium than young healthy controls (p 2 fold stimulation index response, p 10 mM. The differential secretion of signature T-cell subsets' cytokines (Th1 and Th2 lymphocytes

  17. Comparison of complications in transtrochanteric and anterolateral approaches in primary total hip arthroplasty.

    LENUS (Irish Health Repository)

    Cashman, James P

    2008-11-01

    Three surgical approaches to primary total hip arthroplasty (THA) have been in use since Charnley popularized the transtrochanteric approach. This study was designed to examine the difference in morbidity between the transtrochanteric approach and the anterolateral approach in primary THA. Information on 891 patients who underwent primary THA performed by a single surgeon was collected prospectively between 1998 and 2003 using a modified SF-36 form, preoperatively, intraoperatively, and at 3 months postoperatively. The transtrochanteric group had higher morbidity and more patients who were dissatisfied with their THA. There was a greater range of motion in the anterolateral group.

  18. Development of a protocol for the kinematic analysis of movement in patients with total hip arthroplasty

    OpenAIRE

    Mateu Pla, Joan

    2015-01-01

    The aim of this final degree project is to study and analyze the kinematics of the human body lower limbs. First of all, it is extremely important to establish a protocol in order to compare two patients operated with two different techniques of total hip arthroplasty. The three usual movements that are employed to make this comparison are gait, sit-to-stand and stairs climbing. A three-dimensional full body model is implemented and the kinematic parameters (angles) necessary for the st...

  19. Navigated non-image-based positioning of the acetabulum during total hip replacement

    OpenAIRE

    Jenny, Jean-Yves; Boeri, Cyril; Dosch, Jean-Claude; Uscatu, Marius; Ciobanu, Eugen

    2007-01-01

    We tested the hypothesis that the non-image-based navigation system used in our department was able to measure accurately the 3D positioning of the acetabular cup of a total hip replacement (THR) and to increase the accuracy of its implantation during THR. We studied 50 consecutive navigated implantations of a THR and compared the intra-operative measurement of the cup by the navigation system to the post-operative measurement by computed tomography (CT) scan. The mean difference between the ...

  20. Quality-adjusted life years gained in patients aged over 65 years after total hip replacement

    DEFF Research Database (Denmark)

    Hørdam, Britta; Pedersen, P.U.; Søballe, Kjeld;

    2011-01-01

    Background: Total hip replacement (THR) is an effective, but also cost-intensive health care procedure for the elderly. Because of demographic changes in Western Europe, THR-associated financial investment for health care has become a question of priorities in society. To provide a quantitative...... reported significant changes in quality adjusted life years from preoperative status to 3 and 9 months after surgery. Patients in the interventions group had a significantly higher raise in qualy from baseline to 3 months after surgery. Interpretation: There was a significant gain in QALYs in both groups...

  1. Experimental and analytical validation of a modular acetabular prosthesis in total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Aram Luke

    2007-05-01

    Full Text Available Abstract A finite element model has been developed to predict in vivo micro motion between a modular acetabular cup and liner after cement less total hip arthroplasty. The purpose of this study is to experimentally validate the model. Six LVDT sensors were used to monitor the micromotion of the liner when subjected to loading conditions ranging from 250 N to 5000 N. Deformations at points of interest for both the experiment and FEM were compared. Results of the FEM with different coefficient of friction between the liner and the cup were investigated to correlate with the experimental results.

  2. Early Outcomes of Primary Total Hip Arthroplasty for Osteonecrosis of the Femoral Head in Patients with Human Immunodeficiency Virus in China

    Institute of Scientific and Technical Information of China (English)

    Chang-Song Zhao; Xin Li; Qiang Zhang; Sheng Sun; Ru-Gang Zhao; Juan Cai

    2015-01-01

    Background:Studies have reported that patients with human immunodeficiency virus (HIV) have a high incidence of osteonecrosis of the femoral head (ONFH).Total hip arthroplasty (THA) is an effective management of ONFH.However,little data exist regarding the use of THA for the HIV patients with ONFH in China.This study reviewed the outcomes of HIV-positive patients who underwent THA for ONFH,compared with HIV-negative individuals.Methods:The patients who underwent THA for ONFH from September 2012 to September 2014 in Beijing Ditan Hospital,Capital Medical University were retrospectively studied.Twenty-eight HIV-positive patients and 35 HIV-negative patients underwent 48 THAs and 45 THAs with cementless components,respectively.Medical records and follow-up data were reviewed.Harris Hip Score (HHS) was applied to evaluate the pain and function of the hips before and after THA.Complications such as wound healing,surgical site infection,deep venous thrombosis,pulmonary embolism,sepsis,mortality,and complications from the prosthesis were reviewed.The operation time,blood loss,and hospital stay were compared between the two groups.Results:The mean follow-up period was 19.5 ± 5.8 months (ranging from 6 to 30 months).The mean age of the HIV-positive patients with osteonecrosis at the time of surgery was 35 years old,which was significantly lower than that of the HIV-negative group (42 years old) (P < 0.05).The HIV-positive patients underwent surgery a mean of 2.5 years after their original symptoms,which was significantly shorter than the HIV-negatives' (mean 4 years) (P < 0.05).Among HIV-positive patients,the prevalence of being male and rate of bilateral procedures were significantly higher than those in the HIV-negative group (P < 0.05).The operation time in HIV-positive patients was significantly longer than that in HIV-negative patients (P < 0.05).There were no significant differences in blood loss or hospital stay between the two groups (P > 0.05).The HHSs

  3. An automated method for assessing routine radiographs of patients with total hip replacements.

    Science.gov (United States)

    Redhead, A L; Kotcheff, A C; Taylor, C J; Porter, M L; Hukins, D W

    1997-01-01

    This paper describes a new, fully automated method of locating objects on radiographs of patients with total joint replacements (TJRs). A statistical computer model, known as an active shape model, was trained to identify the position of the femur, pelvis, stem and cup marker wire on radiographs of patients with Charnley total hip prostheses. Once trained, the model was able to locate these objects through a process of automatic image searching, despite their appearance depending on the orientation and anatomy of the patient. Experiments were carried out to test the accuracy with which the model was able to fit to previously unseen data and with which reference points could be calculated from the model points. The model was able to locate the femur and stem with a mean error of approximately 0.8 mm and a 95 per cent confidence limit of 1.7 mm. Once the model had successfully located these objects, the midpoint of the stem head could be calculated with a mean error of approximately 0.2 mm. Although the model has been trained on Charnley total hip replacements, the method is generic and so can be applied to radiographs of patients with any TJR. This paper shows that computer models can form the basis of a quick, automatic method of taking measurements from standard clinical radiographs.

  4. Outcome Analysis of Hemiarthroplasty vs. Total Hip Replacement in Displaced Femoral Neck Fractures in the Elderly

    Science.gov (United States)

    Awasthi, Bhanu; Kumar, Krishna; Kohli, Navneet; Katoch, Punit

    2016-01-01

    Introduction Management of displaced fracture neck femur in the elderly population is frequently done by Hemiarthroplasty or Total Hip Replacement (THR). It avoids high rates of nonunion and avascular necrosis which usually occur after internal fixation of neck femur fractures in this age group. Aim The present study aimed to evaluate patient function and complications following hemiarthroplasty and total hip replacement in elderly population with displaced femoral neck fractures. Materials and Methods Patients above 60 years of age with displaced fracture neck femur were studied over the period of four years. All the clinical parameters and co-morbid conditions were noted at the time of presentation. The patients associated with co-morbid conditions and underlying pathology were excluded from study. Garden’s classification was used for classification of neck femur fractures. After due informed consent patients of displaced fracture neck femur were randomized by simple randomization and allocated for hemiarthroplasty or THR. Antibiotics were given preoperatively at the time of induction and postoperatively for 5-7 days. Surgery was carried out by Modified Gibson approach. Any complications during pre and postoperative period were noted. Follow-up of patients was done 1 month, 3 months, 6 months and 1 year interval with the help of Harris hip score. Results Total 80 patients were enrolled in the study group, with 40 patients in each group. The mean age of patients was 73 years in hemiarthroplasty group and 78 years in THR group. Female to male ratio was 55:45. Mean operative time was 35 minutes in hemiarthroplasty group and 45 minutes in THR. Average intraoperative blood loss was 200cc and 300cc in hemiarthroplasty and THR respectively. The mean hospital stay was 14 days in both the groups. Superficial wound infection was noted in hemiarthroplasty group while in THR group deep wound infection (n=1) and prolonged ICU stay (n=1) were noted. The mean Harris hip score

  5. Assessment of changes in gait parameters and vertical ground reaction forces after total hip arthroplasty

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    Bhargava P

    2007-01-01

    Full Text Available The principal objectives of arthroplasty are relief of pain and enhancement of range of motion. Currently, postoperative pain and functional capacity are assessed largely on the basis of subjective evaluation scores. Because of the lack of control inherent in this method it is often difficult to interpret data presented by different observers in the critical evaluation of surgical method, new components and modes of rehabilitation. Gait analysis is a rapid, simple and reliable method to assess functional outcome. This study was undertaken in an effort to evaluate the gait characteristics of patients who underwent arthroplasty, using an Ultraflex gait analyzer. Materials and Methods: The study was based on the assessment of gait and weight-bearing pattern of both hips in patients who underwent total hip replacement and its comparison with an age and sex-matched control group. Twenty subjects of total arthroplasty group having unilateral involvement, operated by posterior approach at our institution with a minimum six-month postoperative period were selected. Control group was age and sex-matched, randomly selected from the general population. Gait analysis was done using Ultraflex gait analyzer. Gait parameters and vertical ground reaction forces assessment was done by measuring the gait cycle properties, step time parameters and VGRF variables. Data of affected limb was compared with unaffected limb as well as control group to assess the weight-bearing pattern. Statistical analysis was done by′t′ test. Results: Frequency is reduced and gait cycle duration increased in total arthroplasty group as compared with control. Step time parameters including Step time, Stance time and Single support time are significantly reduced ( P value < .05 while Double support time and Single swing time are significantly increased ( P value < .05 in the THR group. Forces over each sensor are increased more on the unaffected limb of the THR group as compared to

  6. Postoperative changes in in vivo measured friction in total hip joint prosthesis during walking.

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    Philipp Damm

    Full Text Available Loosening of the artificial cup and inlay is the most common reasons for total hip replacement failures. Polyethylene wear and aseptic loosening are frequent reasons. Furthermore, over the past few decades, the population of patients receiving total hip replacements has become younger and more active. Hence, a higher level of activity may include an increased risk of implant loosening as a result of friction-induced wear. In this study, an instrumented hip implant was used to measure the contact forces and friction moments in vivo during walking. Subsequently, the three-dimensional coefficient of friction in vivo was calculated over the whole gait cycle. Measurements were collected from ten subjects at several time points between three and twelve months postoperative. No significant change in the average resultant contact force was observed between three and twelve months postoperative. In contrast, a significant decrease of up to 47% was observed in the friction moment. The coefficient of friction also decreased over postoperative time on average. These changes may be caused by 'running-in' effects of the gliding components or by the improved lubricating properties of the synovia. Because the walking velocity and contact forces were found to be nearly constant during the observed period, the decrease in friction moment suggests an increase in fluid viscosity. The peak values of the contact force individually varied by 32%-44%. The friction moment individually differed much more, by 110%-129% at three and up to 451% at twelve months postoperative. The maximum coefficient of friction showed the highest individual variability, about 100% at three and up to 914% at twelve months after surgery. These individual variations in the friction parameters were most likely due to different 'running-in' effects that were influenced by the individual activity levels and synovia properties.

  7. Revision of failed hip resurfacing to total hip arthroplasty rapidly relieves pain and improves function in the early post operative period

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    Muirhead-Allwood Sarah K

    2010-11-01

    Full Text Available Abstract We reviewed the results of 25 consecutive patients who underwent revision of a hip resurfacing prosthesis to a total hip replacement. Revisions were performed for recurrent pain and effusion, infection and proximal femoral fractures. Both components were revised in 20 cases. There were 12 male and 13 female patients with average time to revision of 34.4 and 26.4 months respectively. The mean follow up period was 12.7 months (3 to 31. All patients reported relief of pain and excellent satisfaction scores. Two patients experienced stiffness up to three months post operatively. Pre operative Oxford, Harris and WOMAC hip scores were 39.1, 36.4 and 52.2 respectively. Mean post operative scores at last follow up were 17.4, 89.8 and 6.1 respectively (p

  8. Anterolateral muscle sparing approach total hip arthroplasty: an anatomic and clinical study

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xian-long; SHEN Hao; QIN Xiao-long; WANG Qi

    2008-01-01

    Background Many kinds of approaches have been used for minimally invasive surgery of total hip arthroplasty (MIS-THA). However, until now when considering the balance of efficacy and associated surgical injury there is no approach widely accepted for MIS-THA. In this study, a modified anterolateral muscle sparing approach was developed to optimize MIS-THA. Methods Twenty adult cadaver specimens (40 hips) were used for anatomic research. The distance from anterior origin of the gluteus medius on the lilac crest to the anterior superior lilac spine was measured; the course of the superior gluteal nerve and the distances from the nerve to the regional anatomic landmarks were recorded. Simulated surgeries were performed in three fresh cadaver specimens to evaluate the soft tissues injury around incisions. From October 2004 to June 2006, 57 patients (57 hips) were treated with anterolateral muscle sparing minimally invasive total hip arthroplasty, of which 17 were femoral neck fractures, 9 osteoarthritis, 16 developmental dysplasia of hip (DDH) and 15 avascular necrosis (AVN). All the operations were performed by the same senior surgeon. Operation time, blood loss and drainage volume were recorded and the correlation between the local complications and the native anatomical characteristics was especially noted. All cases were followed for at least 12 months.Results The distance from the anterior origin of the gluteus medius to anterior superior lilac spine along the lilac crest was (61±4) mm (range, 55-68 mm), and the distance from inferior branch of the superior gluteal nerve to the anterior tubercle of the greater trochanter was (74±6)mm (range, 60-88 mm). In simulated surgeries, excessive distraction of tissue was found to be the main cause of the anterior border injury of the gluteus medius muscle. Of the 57 patients treated with anterolateral muscle sparing MIS-THA, the average incision length was 9 cm (range 7.5-13 cm). Blood transfusions were performed in 11

  9. Cemented total hip arthroplasty with impacted morcellized bone-grafts to restore acetabular bone defects in congenital hip dysplasia.

    NARCIS (Netherlands)

    Bolder, S.B.T.; Melenhorst, J.; Gardeniers, J.W.M.; Slooff, T.J.J.H.; Veth, R.P.H.; Schreurs, B.W.

    2001-01-01

    We evaluated the results of 27 acetabular reconstructions in 21 patients with secondary osteoarthritis resulting from congenital dysplasia of the hip in which the acetabular bone defects were restored with impacted morcellized bone-grafts in combination with a cemented cup. At an average follow-up o

  10. Wear of polyethylene cups in total hip arthroplasty: a parametric mathematical model.

    Science.gov (United States)

    Pietrabissa, R; Raimondi, M; Di Martino, E

    1998-04-01

    This paper presents a parametric mathematical model of the head-cup wear coupling in total hip arthroplasty (THA). The model evaluates the dependence of acetabular volumetric wear upon the characteristic parameters of patient and hip prosthesis. Archard's law is assumed to calculate the wear coupling behaviour. The wear factor is taken from pin-on-disc wear tests as a function of materials and finishing of the articular joint. The forces acting on the hip joint are taken from experimental data found in the literature whilst the load distribution is calculated under the hypotheses of perfectly rigid ideal wear coupling. The sliding distance is obtained by combining the three elementary displacements -- due to rotations around the three axes -- at the generic bearing surface location. The simulations show that the polymeric wear volume per step cycle decreases ranging from fast walking speeds to low running speeds, it increases linearly with patient body weight and with femoral head diameter, it decreases slightly for positive variations of the socket inclination angle and it increases exponentially with femoral head roughness. The volumetric wear rate per year calculated for a standard reference patient is 5.8 mm3. The relevant iso-wear maps show a marginal pattern with the maximum located near the cup superior borderline. At the instant of peak load, the iso-stress maps show a paracentral pattern with the maximum superior to the cup polar point, and the iso-sliding distance maps show a marginal pattern with two maxima located near the cup's superior and inferior borderlines. PMID:9690490

  11. Case Study and Failure Analysis of a total hip Stem Fracture

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    Mierzejewska Ż. A.

    2015-06-01

    Full Text Available A total hip replacement is a procedure that requires removal of the affected joint lesions and replacing it with artificial elements. Nevertheless, like any invasive surgery, it is associated with the risk of complications, including joint infection, fracture of the bone during and after surgery, scarring and limitation of motion of the hip, and loosening of the prosthesis. In this work we present and describe the results of its investigations. In order to determine the mechanism of failure, a broken stem components were analyzed by means of macroscopic and microscopic observations and hardness measurements. The hardness, microstructure and chemical composition of the broken part of the hip stem were analyzed. Microscopic examination revealed numerous defects in material. Among them are pores and emptiness, located on the outskirts of the tested samples and a plurality of micro-cracking, debonding and delamination of the material due to the overloading of a fatigue character. There were no changes caused by intergranular corrosion or pitting, which may indicate for an even distribution of the major alloying components such as chromium and nickel. Observations of the material by using scanning electron microscopy (SEM, clearly proved that the destruction was caused by material fatigue. The investigation showed that the crack had originated due to a high stress concentration on the lateral corner section of the stem. Large surface of the fatigue crack zone area indicated for small stresses and small crack propagation velocities. There was a clear correlation between the grain size of the steel hardness. The results of hardness test revealed a significant increase hardness of stem in relation to the normative values. In addition, the measured average grain size is less than the standard accepted. Using Solid Works simulation and FEM a model of the stem was created and analyzed in terms of strength and rated the distribution of the generated stress

  12. Bone remodeling around cementless tantalum cups

    NARCIS (Netherlands)

    Grillo, J. -C.; Flecher, X.; Bouvenot, J.; Argenson, J. -N.

    2008-01-01

    Purpose of the study.-Most studies have reported a significant decrease in periacetabular bone stock one year after implantation of a cementless cup. The purpose of this work was to study the bone-implant interface of the tantalum cup using plain X-rays and dual-energy X-ray absorptiometry (DEXA). M

  13. Midterm results of 36 mm metal-on-metal total hip arthroplasty

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    Hawar Akrawi

    2016-01-01

    Full Text Available Background: Despite the many perceived benefits of metal-on-metal (MoM articulation in total hip arthroplasty (THA, there have been growing concerns about metallosis and adverse reaction to metal debris (ARMD. Analysis of size 36 mm MoM articulation THAs is presented. These patients were evaluated for patient characteristics, relationship between blood metal ions levels and the inclination as well as the version of acetabular component, cumulative survival probability at final followup and functional outcome at final followup. Materials and Methods: 288, size 36 mm MoM THAs implanted in 269 patients at our institution from 2004 to 2010 were included in this retrospective study. These patients were assessed clinically for hip symptoms, perioperative complications and causes of revision arthroplasty were analysed. Biochemically, blood cobalt and chromium metal ions level were recorded and measurements of acetabular inclination and version were examined. Radiological evaluation utilizing Metal Artefact Reduction Sequence (MARS MRI was undertaken and implant cumulative survivorship was evaluated. Results: The mean followup was 5 years (range 2–7 years, mean age was 73 years and the mean Oxford hip score was 36.9 (range 5–48. Revision arthroplasty was executed in 20 (7.4% patients, of which 15 patients underwent single-stage revision THA. The causes of revision arthroplasty were: ARMD changes in 6 (2.2% patients, infection in 5 (1.9% patients and aseptic loosening in 5 (1.9% patients. Three (1.1% patients had their hips revised for instability, 1 (0.3% for raised blood metal ions levels. The implant cumulative survival rate, with revision for any reason, was 68.9% at 7 years. Conclusions: Although medium-sized MoM THA with a 36 mm head has a marginally better survivorship at midterm followup, compared to larger size head MoM articulating THA, our findings nonetheless are still worryingly poor in comparison to what has been quoted in the

  14. An Unusual Cause of Fever in a Patient with Total Hip Replacement.

    Science.gov (United States)

    Vaishya, Raju; Agarwal, Amit Kumar; Vijay, Vipul

    2016-01-01

    Pyrexia of unknown origin (PUO) in a patient with acquired immunodeficiency syndrome (AIDS) is a challenging clinical problem despite recent advances in the diagnostic modalities. The diagnosis of the cause of fever is especially difficult in the postoperative period as the focus remains on the operative site. We present an unusual cause of PUO in a patient with advanced HIV disease during an immediate postoperative period following total hip arthroplasty (THA) for osteoarthritis (OA) of the left hip. The fever started on the eighth postoperative day, and after an extensive workup to rule out infection it was found that the patient was allergic to sulfa drugs. The fever subsided after discontinuation of trimethoprim/sulfamethoxazole. Fever in an immunocompromised patient should not be attributed only to infection. A high index of suspicion along with careful history making is required to diagnose drug fever. An early diagnosis of drug fever can reduce hospital stay and the costs of investigations and treatment. PMID:27014530

  15. Computed tomography for preoperative planning in total hip arthroplasty: what radiologists need to know

    Energy Technology Data Exchange (ETDEWEB)

    Huppertz, Alexander [Charite - University Hospitals Berlin, Department of Radiology, Berlin (Germany); Imaging Science Institute Charite, Berlin (Germany); Radmer, Sebastian [Proendo, Orthopedic Surgery, Berlin (Germany); Wagner, Moritz; Hamm, Bernd [Charite - University Hospitals Berlin, Department of Radiology, Berlin (Germany); Roessler, Torsten [Klinikum Ernst von Bergmann, Department of Trauma and Orthopedic Surgery, Potsdam (Germany); Sparmann, Martin [Proendo, Orthopedic Surgery, Berlin (Germany); Charite - University Hospital, Berlin (Germany)

    2014-08-15

    The number of total hip arthroplasties is continuously rising. Although less invasive surgical techniques, sophisticated component design, and intraoperative navigation techniques have been introduced, the rate of peri- and postoperative complications, including dislocations, fractures, nerve palsies, and infections, is still a major clinical problem. Better patient outcome, faster recovery and rehabilitation, and shorter operation times therefore remain to be accomplished. A promising strategy is to use minimally invasive techniques in conjunction with modular implants, aimed at independently reconstructing femoral offset and leg length on the basis of highly accurate preoperative planning. Plain radiographs have clear limitations for the correct estimation of hip joint geometry and bone quality. Three-dimensional assessment based on computed tomography (CT) allows optimizing the choice and positions of implants and anticipating difficulties to be encountered during surgery. Postoperative CT is used to monitor operative translation and plays a role in arthroplastic quality management. Radiologists should be familiar with the needs of orthopedic surgeons in terms of CT acquisition, post-processing, and data transfer. The CT protocol should be optimized to enhance image quality and reduce radiation exposure. When dedicated orthopedic CT protocols and state-of-the-art scanner hardware are used, radiation exposure can be decreased to a level just marginally higher than that of conventional preoperative radiography. Surgeons and radiologists should use similar terminology to avoid misunderstanding and inaccuracies in the transfer of preoperative planning. (orig.)

  16. Rehabilitation following total hip arthroplasty evaluation over short follow-up time: Randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Carolina Sant'anna Umpierres, MSc

    2015-03-01

    Full Text Available Hip osteoarthritis (OA is a degenerative disease, and total hip arthroplasty (THA is one of the surgical procedures of choice to improve the OA patient’s quality of life. Without a rehabilitation program, THA patients will develop functional limitations. A randomized double-blind trial was performed between July 2009 and October 2011 to compare over a short follow-up time two groups of patients who underwent THA for OA. The THA protocol (THAP group received verbal instructions and physiotherapy exercise demonstrations, and the THA physiotherapy care protocol (THAPCP group received the same verbal instructions and demonstrations associated with daily exercise practice guided by a physiotherapist. The outcomes that were assessed preoperatively and 15 d postoperatively in 106 patients were muscle strength force, goniometry, Medical Outcomes Study 36-Item Short Form Health Survey, and Merle d’Aubigné and Postel score. Higher muscle strength force scores and degrees in range of motion were found in the THAPCP group. Greater improvements were also observed for the THAPCP group than the THAP group in the Merle d’Aubigné and Postel score. At the end of the follow-up period, the intervention in the THAPCP group improved functional capacity, quality of life, mobility, muscle strength, goniometry, and pain. It appears to be a safe tool for accelerating recovery in THA patients.

  17. Friction of total hip replacements with different bearings and loading conditions.

    Science.gov (United States)

    Brockett, Claire; Williams, Sophie; Jin, Zhongmin; Isaac, Graham; Fisher, John

    2007-05-01

    Metal-on-ultra-high molecular weight polyethylene (UHMWPE) total hip replacements have been the most popular and clinically successful implants to date. However, it is well documented that the wear debris from these prostheses contributes to osteolysis and ultimate failure of the prosthesis, hence alternative materials have been sought. A range of 28 mm diameter bearings were investigated using a hip friction simulator, including conventional material combinations such as metal-on-UHWMPE, ceramic-on-ceramic (CoC), and metal-on-metal (MoM), as well as novel ceramic-on-metal (CoM) pairings. Studies were performed under different swing-phase load and lubricant conditions. The friction factors were lowest in the ceramic bearings, with the CoC bearing having the lowest friction factor in all conditions. CoM bearings also had low friction factors compared with MoM, and the trends were similar to CoC bearings for all test conditions. Increasing swing phase load was shown to cause an increase in friction factor in all tests. Increased serum concentration resulted in increased friction factor in all material combinations, except MoM, where increased serum concentration produced a significant reduction in friction factor.

  18. Size of metallic and polyethylene debris particles in failed cemented total hip replacements

    Science.gov (United States)

    Lee, J. M.; Salvati, E. A.; Betts, F.; DiCarlo, E. F.; Doty, S. B.; Bullough, P. G.

    1992-01-01

    Reports of differing failure rates of total hip prostheses made of various metals prompted us to measure the size of metallic and polyethylene particulate debris around failed cemented arthroplasties. We used an isolation method, in which metallic debris was extracted from the tissues, and a non-isolation method of routine preparation for light and electron microscopy. Specimens were taken from 30 cases in which the femoral component was of titanium alloy (10), cobalt-chrome alloy (10), or stainless steel (10). The mean size of metallic particles with the isolation method was 0.8 to 1.0 microns by 1.5 to 1.8 microns. The non-isolation method gave a significantly smaller mean size of 0.3 to 0.4 microns by 0.6 to 0.7 microns. For each technique the particle sizes of the three metals were similar. The mean size of polyethylene particles was 2 to 4 microns by 8 to 13 microns. They were larger in tissue retrieved from failed titanium-alloy implants than from cobalt-chrome and stainless-steel implants. Our results suggest that factors other than the size of the metal particles, such as the constituents of the alloy, and the amount and speed of generation of debris, may be more important in the failure of hip replacements.

  19. Short-term results with the Zweymueller-SL metal-on-metal total hip arthroplasty.

    Science.gov (United States)

    Korovessis, Panagiotis; Petsinis, Georgios; Repanti, Maria; Papazisis, Zisis; Iliopoulos, Panagiotis; Soucacos, Panagiotis N

    2002-01-01

    In a prospective study we followed 266 consecutive patients who received 350 Zweymueller-SL uncemented total hip replacements with metal-on-metal articulation for osteoarthritis. Mean follow-up was 52 (range 37-92) months. Patient age at the time of surgery was 55±9 (25-70) years. Pre-operative Harris score of 45±19 was increased post-operatively to 96±4. Pre-operative invalidity was significantly improved post-operatively (Pmetalosis (Mirra grades 1 and 2) was shown in all revised hips. The reasons for early loosening were unrelated to the metal-on-metal bearing but rather were the result of either low-grade deep infection or inadequate surgical technique. Survival rate for Zweymueller screw socket and stem 7.6 years after implantation was 99.4% and 96.8% respectively. There was no evidence that metal-on-metal articulation gives rise to new problems or complications. PMID:24570158

  20. Modified minimally invasive two-incision total hip arthroplasty using large diameter femoral head

    Directory of Open Access Journals (Sweden)

    Kyung Soon Park

    2012-01-01

    Full Text Available Background: Minimally invasive (MI total hip arthroplasty (THA is an alternative to standard THA, but has created much controversy among orthopedic surgeons. The authors modified the original minimally invasive two-incision THA technique and used large-diameter (32 mm, 36 mm ceramic-on-ceramic articulation. Materials and Methods: One hundred and seventy patients that underwent unilateral MI two-incision THA were retrospectively reviewed, and surgical morbidity, functional recovery, radiological properties, and complications were assessed. Results: Mean Harris hip score (HHS improved from 41.8 to 96.1 at last followup, and mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC score from 66.2 to 26.9. The mean lateral opening angle of the acetabular component was 38.2° and the mean stem position was valgus 1.9°. There was an intraoperative femur fracture and one revision surgery due to stem subsidence. No patient had dislocation. Conclusions: Our data suggest that this modified technique combined with large ceramic femoral head is safe and reproducible in terms of achieving proper implant positioning and early functional recovery.

  1. Effect of early progressive resistance training compared with home-based exercise after total hip replacement

    DEFF Research Database (Denmark)

    Mikkelsen, Lone Ramer; Mechlenburg, Inger; Søballe, Kjeld;

    Introduction Muscle strength and physical function deficits persist after total hip replacement (THR). Training effect evidence after THR is lacking. This study investigates the effect of supervised progressive resistance training in early post-THR rehabilitation on muscle strength and functional...... performance. Material and Method 73 THR patients with preoperative self-assessed disability (HOOS ADL score≤67) were randomly assigned to a control group (CG, home-based exercise 7 days/week) or an intervention group (IG, home-based exercise 5 days/week and resistance training of hip and thigh muscles 2 days...... in CG (1.58 [0.8;2.4] sec) (p=0.05). No significant differences were found in stair test; yet, borderline significance (p=0.06-0.09) favoured IG in STS and isometric strength. Conclusion 7 days/week of home-based exercise was just as effective as 5 days/week of home-based exercise plus 2 days/week of...

  2. Dynamic bone study in total prosthesis of the hip (RM isoelastic type)

    International Nuclear Information System (INIS)

    Over a period of 33 months, an evaluation was made of the development of 78 asymptomatic patients (average age: 62.27 ± 8.12 years), fitted with uncemented total prostheses of the hip, and a control group of 30 patients without prostheses (average age: 64.12 ± 10 years). All of them underwent bone scintigraphy modified three times: angioscintigraphy, sequenced scintigraphy and static scintigraphy. The following areas of interest were evaluated qualitatively: in the first phase, the gluteal, articular and diaphyseal regions; in the second and third phases, the cotyloid region, the trochanter, the intermediate area of the stem and the vertex of the prosthesis. The presence of any calcifications in the articular interface was sought. The natural development of bone repair activity in patients with hip prostheses showed that the areas of maximum stress, in decreasing order, are the following regions: trochanteric, cotyloid, vertex and intermediate area of the stem; the early presence of articular calcifications was observed in 20.5% of the cases studied. On the other hand, perfusion of the periprosthetic tissue showed no significant changes with respect to the control group. On the contrary, sequential scintigraphy was very sensitive in the detection of changes in the rate of bone repair, differentiating between the post-surgical period proper and the subsequent period in which the prothesis was stabilized; this was not the case with static scintigraphy, the sensitivity of which is inferior. (author). 14 refs, 3 figs

  3. The Current State of Screening and Decolonization for the Prevention of Staphylococcus aureus Surgical Site Infection After Total Hip and Knee Arthroplasty.

    Science.gov (United States)

    Weiser, Mitchell C; Moucha, Calin S

    2015-09-01

    The most common pathogens in surgical site infections after total hip and knee arthroplasty are methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA), and coagulase-negative staphylococci. Patients colonized with MSSA or MRSA have an increased risk for a staphylococcal infection at the site of a total hip or knee arthroplasty. Most colonized individuals who develop a staphylococcal infection at the site of a total hip or total knee arthroplasty have molecularly identical S. aureus isolates in their nares and wounds. Screening and nasal decolonization of S. aureus can potentially reduce the rates of staphylococcal surgical site infection after total hip and total knee arthroplasty.

  4. Functional exercise after total hip replacement (FEATHER a randomised control trial

    Directory of Open Access Journals (Sweden)

    Monaghan Brenda

    2012-11-01

    Full Text Available Abstract Background Prolonged physical impairments in range of movement, postural stability and walking speed are commonly reported following total hip replacement (THR. It is unclear from the current body of evidence what kind of exercises should be performed to maximize patient function and quality of life. Methods/design This will be a single blind multi centre randomized control trial with two arms. Seventy subjects post primary total hip arthroplasty will be randomized into either an experimental group (n=35, or to a control group (n=35. The experimental group will attend a functional exercise class twice weekly for a six week period from week 12 to week 18 post surgery. The functional exercise group will follow a circuit based functional exercise class supervised by a chartered Physiotherapist. The control group will receive usual care. The principal investigator (BM will perform blinded outcome assessments on all patients using validated measures for pain, stiffness, and function using the Western Ontario and Mc Master Universities Osteoarthritis index (WOMAC. This is the primary outcome measurement tool. Secondary outcome measurements include Quality of life (SF-36, 6 min walk test, Visual Analogue Scale, and the Berg Balance score. The WOMAC score will be collated on day five post surgery and repeated at week twelve and week eighteen. All other measurements will be taken at week 12 and repeated at week eighteen. In addition a blinded radiologist will measure gluteus medius cross sectional area using real time ultrasound for all subjects at week 12 and at week 18 to determine if the functional exercise programme has any effect on muscle size. Discussion This randomised controlled trial will add to the body of evidence on the relationship between muscle size, functional ability, balance, quality of life and time post surgery in patients following total hip arthroplasty. The CONSORT guidelines will be followed to throughout. Ethical

  5. Recovery after short-stay total hip and knee arthroplasty. Evaluation of a support program and outcome determination

    NARCIS (Netherlands)

    Akker-Scheek, Inge van den

    2007-01-01

    As a result of the increasing demand for total hip arthroplasties (THA) and total knee arthroplasties (TKA), waiting lists are growing. To cope with this problem, many hospitals have introduced short-stay programs; a consequence is increased responsibility of the patient regarding his own rehabilita

  6. Total hip replacement in young adults with hip dysplasia. Age at diagnosis, previous treatment, quality of life, and validation of diagnoses reported to the Norwegian Arthroplasty Register between 1987 and 2007

    OpenAIRE

    Engesæter, Ingvild Øvstebø; Lehmann, Trude; Laborie, Lene Bjerke; Lie, Stein Atle; Rosendahl, Karen; Engesæter, Lars B

    2011-01-01

    Background and purpose: Dysplasia of the hip increases the risk of secondary degenerative change and subsequent total hip replacement. Here we report on age at diagnosis of dysplasia, previous treatment, and quality of life for patients born after 1967 and registered with a total hip replacement due to dysplasia in the Norwegian Arthroplasty Register. We also used the medical records to validate the diagnosis reported by the orthopedic surgeon to the register.Methods: Sub...

  7. An Automated Size Recognition Technique for Acetabular Implant in Total Hip Replacement

    CERN Document Server

    Shapi'i, Azrulhizam; Hasan, Mohammad Khatim; Kassim, Abdul Yazid Mohd; 10.5121/ijcsit.2011.3218

    2011-01-01

    Preoperative templating in Total Hip Replacement (THR) is a method to estimate the optimal size and position of the implant. Today, observational (manual) size recognition techniques are still used to find a suitable implant for the patient. Therefore, a digital and automated technique should be developed so that the implant size recognition process can be effectively implemented. For this purpose, we have introduced the new technique for acetabular implant size recognition in THR preoperative planning based on the diameter of acetabulum size. This technique enables the surgeon to recognise a digital acetabular implant size automatically. Ten randomly selected X-rays of unidentified patients were used to test the accuracy and utility of an automated implant size recognition technique. Based on the testing result, the new technique yielded very close results to those obtained by the observational method in nine studies (90%).

  8. In-Hospital Cost Analysis of Total Hip Arthroplasty: Does Surgical Approach Matter?

    Science.gov (United States)

    Petis, Stephen M; Howard, James L; Lanting, Brent A; Marsh, Jacquelyn D; Vasarhelyi, Edward M

    2016-01-01

    The purposes of this study were to determine the impact of surgical approach on costs of total hip arthroplasty (THA) from a hospital perspective and to provide an updated cost estimation of THA. A prospective, microcosting analysis was performed on 118 patients undergoing a THA through an anterior, lateral, or posterior approach. We determined that overall costs (intraoperative costs and hospital stay) were significantly less for the anterior ($7300.22; 95% confidence interval [CI], 7064.49-7535.95) vs lateral ($7853.10; 95% CI, 7577.29-8128.91; P = .031) and anterior vs posterior approach ($8287.46; 95% CI, 7906.42-8668.51; P costs from a hospital perspective.

  9. Design parameters dependences on contact stress distribution in gait and jogging phases after total hip arthroplasty.

    Science.gov (United States)

    Rixrath, E; Wendling-Mansuy, S; Flecher, X; Chabrand, P; Argenson, J N

    2008-01-01

    We have developed a mathematical model to calculate the contact stress distribution in total hip arthroplasty (THA) prosthesis between the articulating surfaces. The model uses the clearance between bearing surfaces as well as the inclination and thickness of the Ultra High Molecular Weight Poly-Ethylene (UHMWPE) cup to achieve this. We have used this mathematical model to contrast the maximal force during normal gait and during jogging. This is based on the assumption that the contact stress is proportional to the radial deformation of the cup. The results show that the magnitude of the maximal contact stress remains constant for inclination values in the range of [0-35 degrees ] and increase significantly with the cup clearance and liner thickness for inclination values in the range of [35-65 degrees ]. A major use for this model would be the calculation of spatial contact stress distribution during normal gait or jogging for different couples of bearing surfaces. PMID:18234204

  10. Vascular complications following total hip arthroplasty: a case study and a review of the literature.

    Science.gov (United States)

    Barbier, Olivier; Pierret, Charles; Bazile, Fabrice; De Kerangal, Xavier; Duverger, Vincent; Versier, Gilbert

    2012-11-01

    Vascular complications after total hip arthroplasty (THA) are rare but represent a real risk. The diversity of clinical presentations can make diagnosis difficult. They could manifest as an immediate and acute hemorrhage or subsequent ischemia. We report the case of a patient who presented a thrombosis of the femoral artery associated with a sciatic palsy after THA for a coxa profunda. The diagnosis was actually made 3 years after surgery because of atypical symptoms. The mechanism involved was either a crash of the artery by a retractor on the anterior wall of the acetabulum, or a stretching of the artery. A review of the literature of vascular complications occurring after THA recalls the multiplicity of clinical presentations and the diagnostic difficulties. They could manifest as an immediate and acute hemorrhage or deferred ischemia, as in our case. Knowledge of these complications should help prevent them, and the diagnosis should be considered in atypical sequences after THA.

  11. Three-dimensional printing for preoperative planning of total hip arthroplasty revision: case report.

    Science.gov (United States)

    Zerr, Joseph; Chatzinoff, Yonatan; Chopra, Rajiv; Estrera, Kenneth; Chhabra, Avneesh

    2016-10-01

    Three dimensional (3D) printing can be used to create material models to aid preoperative planning of complex orthopedic procedures as exemplified by this case of total hip arthroplasty failure due to infection with resulting severe acetabular bone stock deficiency. The 3D model allowed for trialing of the acetabular component to determine cup size, position, and screw placement. Most importantly, the model confirmed that there was not a pelvic discontinuity and the revision shell would be sufficient for the reconstruction. Previously, the cost and complexity of utilization of 3D printers were prohibitive. Recent improvements in commercially available 3D printers have made rapid prototype model creation a realistic option, which can facilitate difficult surgery.

  12. Surrogate markers of long-term outcome in primary total hip arthroplasty

    Science.gov (United States)

    Malak, T. T.; Broomfield, J. A. J.; Palmer, A. J. R.; Hopewell, S.; Carr, A.; Brown, C.; Prieto-Alhambra, D.

    2016-01-01

    Objectives High failure rates of metal-on-metal hip arthroplasty implants have highlighted the need for more careful introduction and monitoring of new implants and for the evaluation of the safety of medical devices. The National Joint Registry and other regulatory services are unable to detect failing implants at an early enough stage. We aimed to identify validated surrogate markers of long-term outcome in patients undergoing primary total hip arthroplasty (THA). Methods We conducted a systematic review of studies evaluating surrogate markers for predicting long-term outcome in primary THA. Long-term outcome was defined as revision rate of an implant at ten years according to National Institute of Health and Care Excellence guidelines. We conducted a search of Medline and Embase (OVID) databases. Separate search strategies were devised for the Cochrane database and Google Scholar. Each search was performed to include articles from the date of their inception to June 8, 2015. Results Our search strategy identified 1082 studies of which 115 studies were included for full article review. Following review, 17 articles were found that investigated surrogate markers of long-term outcome. These included one systematic review, one randomised control trial (RCT), one case control study and 13 case series. Validated surrogate markers included Radiostereometric Analysis (RSA) and Einzel-Bild-Röntgen-Analyse (EBRA), each measuring implant migration and wear. We identified five RSA studies (one systematic review and four case series) and four EBRA studies (one RCT and three case series). Patient Reported Outcome Measures (PROMs) at six months have been investigated but have not been validated against long-term outcomes. Conclusions This systematic review identified two validated surrogate markers of long-term primary THA outcome: RSA and EBRA, each measuring implant migration and wear. We recommend the consideration of RSA in the pre-market testing of new implants. EBRA can

  13. Support for total hip replacement surgery: Structures modeling, Gait Data Analysis and Report system

    Directory of Open Access Journals (Sweden)

    Gianluca Mario Izzo

    2012-03-01

    Full Text Available For the treatment of advanced damages of hip joints, Total Hip Arthroplasty is well proven. Due to the different mechanical properties of the prosthesis material and the bone tissue, a partial unloading of the periprosthetic bone occurs. The bone cement causes reduction in bone density as a result of removal of normal stress from the bone, leading to weakening of the bone in that area and the fracture risk increases. Bone loss is identified as one of the main reasons for loosening of the stem. Otherwise, thanks to the press-fit of the non-cemented stem achieved by surgery, the bone layers immediately adjacent to the stem are preloaded, thus encouraged growing, and the bone getting stronger. The non-cemented stem would be the better choice for every patient, but the question remains if the femur can handle the press- fitting surgery. This studies aim to develop a monitoring techniques based on Gait analysis and bone density changes to assess patient recovery after Total Hip Arthroplasty. Furthermore, to validate computational processes based on 3D modeling and Finite Element Methods for optimizing decision making in the operation process and selecting the suited surgical procedure. A vision could be minimizing risk of periprosthetic fracture during and after surgery. Patients: The sample presents 11 patients receiving cemented implant and 13 for the uncemented. Patients are grouped by type of implant. Three checkpoints were considered: before, after operation and one year later. CT scans, gaitrite and kinepro measurements have been realized. Main outcome measures: Fracture risk probability is higher in bone with low bone mineral density; therefore bones are more fragile in elderly people. BMD is indeed one parameter considered among all the observations. Periprosthetic fracture of the femur is a rare but complex complication of THA, and requires demanding surgery. As such, they result in considerable morbidity and dysfunction. Thus, tests of

  14. Cancer risk estimates from radiation therapy for heterotopic ossification prophylaxis after total hip arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Mazonakis, Michalis; Berris, Theoharris; Damilakis, John [Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003 Iraklion, Crete (Greece); Lyraraki, Efrossyni [Department of Radiotherapy and Oncology, University Hospital of Iraklion, 71110 Iraklion, Crete (Greece)

    2013-10-15

    Purpose: Heterotopic ossification (HO) is a frequent complication following total hip arthroplasty. This study was conducted to calculate the radiation dose to organs-at-risk and estimate the probability of cancer induction from radiotherapy for HO prophylaxis.Methods: Hip irradiation for HO with a 6 MV photon beam was simulated with the aid of a Monte Carlo model. A realistic humanoid phantom representing an average adult patient was implemented in Monte Carlo environment for dosimetric calculations. The average out-of-field radiation dose to stomach, liver, lung, prostate, bladder, thyroid, breast, uterus, and ovary was calculated. The organ-equivalent-dose to colon, that was partly included within the treatment field, was also determined. Organ dose calculations were carried out using three different field sizes. The dependence of organ doses upon the block insertion into primary beam for shielding colon and prosthesis was investigated. The lifetime attributable risk for cancer development was estimated using organ, age, and gender-specific risk coefficients.Results: For a typical target dose of 7 Gy, organ doses varied from 1.0 to 741.1 mGy by the field dimensions and organ location relative to the field edge. Blocked field irradiations resulted in a dose range of 1.4–146.3 mGy. The most probable detriment from open field treatment of male patients was colon cancer with a high risk of 564.3 × 10{sup −5} to 837.4 × 10{sup −5} depending upon the organ dose magnitude and the patient's age. The corresponding colon cancer risk for female patients was (372.2–541.0) × 10{sup −5}. The probability of bladder cancer development was more than 113.7 × 10{sup −5} and 110.3 × 10{sup −5} for males and females, respectively. The cancer risk range to other individual organs was reduced to (0.003–68.5) × 10{sup −5}.Conclusions: The risk for cancer induction from radiation therapy for HO prophylaxis after total hip arthroplasty varies considerably by

  15. A Literature Review of Total Hip Arthroplasty in Patients with Ankylosing Spondylitis: Perioperative Considerations and Outcome.

    Science.gov (United States)

    Putnis, S E; Wartemberg, G K; Khan, W S; Agarwal, S

    2015-01-01

    Ankylosing spondylitis is a spondyloarthropathy affecting the sacro-iliac joints with subsequent progression to the spine and the hip joints. The hip joints are affected by synovitis, enthesial inflammation, involvement of medullary bone, progressive degeneration and secondary osteoarthritis. Clinical presentation is usually in the form of pain and stiffness progressing to disabling fixed flexion contractures and in some instances, complete ankylosis. Hip arthroplasty should be considered for hip pain, postural and functional disability, or pain in adjacent joints due to hip stiffness. We conducted a literature review to determine peri-operative considerations and outcome in ankylosing spondylitis patients undergoing hip arthroplasty. In this review, we have discussed pre-operative surgical planning, thromboprophylaxis, anaesthetic considerations and heterotopic ossification. Outcomes of arthroplasty include range of movement, pain relief, survivorship and complications. PMID:26587066

  16. The Consumer Quality Index Hip Knee Questionnaire measuring patients' experiences with quality of care after a total hip or knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Delnoij Diana MJ

    2007-04-01

    Full Text Available Abstract Background The Dutch Consumer Quality Index Hip Knee Questionnaire (CQI Hip Knee was used to assess patients' experiences with and evaluations of quality of care after a total hip (THA or total knee arthroplasty (TKA. The aim of this study is to evaluate the construct validity and internal consistency reliability of this new instrument and to assess its ability to measure differences in quality of care between hospitals. Methods Survey data of 1,675 subjects who underwent a THA or TKA were used to evaluate the psychometric properties. Exploratory factor analyses were performed and item-total correlations and inter-factor correlations were calculated to assess the construct validity of the instrument. Reliability analyses included tests of internal consistency (Cronbach's alpha coefficients. Finally, multilevel analyses were performed to assess the ability of the instrument to discriminate between hospitals in quality of care. Results Exploratory factor analyses indicated that the survey consisted of 21 items measuring five aspects of care (i.e. communication with nurses, communication with doctors, communication with general practitioner, communication about new medication, and pain control. Cronbach's alpha coefficients ranged from 0.76 to 0.90 indicating good internal consistency. The survey's ability to discriminate between hospitals was partly supported by multilevel analysis. Two scales (i.e. communication with nurses and communication with doctors were able to measure differences between hospitals with respect to patients' experiences with quality of care. Logistic multilevel analyses indicated that hospitals explained part of the variation between patients in receiving information. Conclusion These findings suggest that the CQI Hip Knee is reliable and valid for use in Dutch health care. Health care providers or health plans can use this survey to measure patients' experiences with hospital care and to identify variations in care

  17. Persistent pain after total knee or hip arthroplasty: differential study of prevalence, nature, and impact

    Directory of Open Access Journals (Sweden)

    Pinto PR

    2013-09-01

    Full Text Available Patrícia R Pinto,1–3 Teresa McIntyre,4,5 Ramón Ferrero,6 Vera Araújo-Soares,3,7 Armando Almeida1,2 1Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal; 2Life and Health Sciences Research Institute/3Bs, PT Government Associate, Braga/Guimarães, Portugal; 3Health Psychology Group, Newcastle University, Newcastle, UK; 4Texas Institute for Measurement, Evaluation and Statistics, 5Department of Psychology, University of Houston, TX, USA; 6Alto Ave Hospital Center, Orthopedics Unit, Guimarães, Portugal; 7Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle, UK Abstract: This study compares the incidence, nature, and impact of persistent post-surgical pain after total knee arthroplasty (TKA and total hip arthroplasty (THA and investigates differences between these procedures, with the focus on potential presurgical and post-surgical issues that could be related to the distinct persistent post-surgical pain outcomes between these two groups. A consecutive sample of 92 patients was assessed prospectively 24 hours before, 48 hours, and 4–6 months after surgery. The data show that TKA patients had a higher likelihood of developing persistent post-surgical pain, of reporting higher pain levels, and of using more neuropathic descriptors when classifying their pain. In addition, TKA patients more often reported interference from pain on functional domains, including general activity, walking ability, and normal work. Demographic factors, like gender and age, along with presurgical clinical factors like disease onset, existence of medical comorbidities, and other pain problems, may have contributed to these differences, whereas baseline psychologic factors and functionality levels did not seem to exert an influence. Heightened acute post-surgical pain experience among TKA patients could also be related to distinct outcomes for persistent post

  18. Friction in total hip joint prosthesis measured in vivo during walking.

    Directory of Open Access Journals (Sweden)

    Philipp Damm

    Full Text Available Friction-induced moments and subsequent cup loosening can be the reason for total hip joint replacement failure. The aim of this study was to measure the in vivo contact forces and friction moments during walking. Instrumented hip implants with Al2O3 ceramic head and an XPE inlay were used. In vivo measurements were taken 3 months post operatively in 8 subjects. The coefficient of friction was calculated in 3D throughout the whole gait cycle, and average values of the friction-induced power dissipation in the joint were determined. On average, peak contact forces of 248% of the bodyweight and peak friction moments of 0.26% bodyweight times meter were determined. However, contact forces and friction moments varied greatly between individuals. The friction moment increased during the extension phase of the joint. The average coefficient of friction also increased during this period, from 0.04 (0.03 to 0.06 at contralateral toe off to 0.06 (0.04 to 0.08 at contralateral heel strike. During the flexion phase, the coefficient of friction increased further to 0.14 (0.09 to 0.23 at toe off. The average friction-induced power throughout the whole gait cycle was 2.3 W (1.4 W to 3.8 W. Although more parameters than only the synovia determine the friction, the wide ranges of friction coefficients and power dissipation indicate that the lubricating properties of synovia are individually very different. However, such differences may also exist in natural joints and may influence the progression of arthrosis. Furthermore, subjects with very high power dissipation may be at risk of thermally induced implant loosening. The large increase of the friction coefficient during each step could be caused by the synovia being squeezed out under load.

  19. Is the use of antidepressants associated with patient-reported outcomes following total hip replacement surgery?

    Science.gov (United States)

    Greene, Meridith E; Rolfson, Ola; Gordon, Max; Annerbrink, Kristina; Malchau, Henrik; Garellick, Göran

    2016-10-01

    Background and purpose - Patients with anxiety and/or depression tend to report less pain reduction and less satisfaction with surgical treatment. We hypothesized that the use of antidepressants would be correlated to patient-reported outcomes (PROs) 1 year after total hip replacement (THR), where increased dosage or discontinuation would be associated with worse outcomes. Patients and methods - THR cases with pre- and postoperative patient-reported outcome measures (PROMs) were selected from the Swedish Hip Arthroplasty Register (n = 9,092; women: n = 5,106). The PROMs were EQ-5D, visual analog scale (VAS) for pain, Charnley class, and VAS for satisfaction after surgery. These cases were merged with a national database of prescription purchases to determine the prevalence of antidepressant purchases. Regression analyses were performed where PROs were dependent variables and sex, age, Charnley class, preoperative pain, preoperative health-related quality of life (HRQoL), patient-reported anxiety/depression, and antidepressant use were independent variables. Results - Antidepressants were used by 10% of the cases (n = 943). Patients using antidepressants had poorer HRQoL and higher levels of pain before and after surgery and they experienced less satisfaction. Preoperative antidepressant use was independently associated with PROs 1 year after THR regardless of patient-reported anxiety/depression. Interpretation - Antidepressant usage before surgery was associated with reduced PROs after THR. Cases at risk of poorer outcomes may be identified through review of the patient's medical record. Clinicians are encouraged to screen for antidepressant use preoperatively, because their use may be associated with PROs after THR. PMID:27482877

  20. Accuracy of a Simple Digital Templating in Primary Uncemented Total Hip Arthroplasty

    Institute of Scientific and Technical Information of China (English)

    Hai-bo Si; Yi Zeng; Fei Cao; Fu-xing Pei; Bin Shen

    2015-01-01

    Objective To introduce a simple preoperative digital templating in uncemented total hip arthroplasty (THA) and to determine its accuracy for preoperative size selection of the prostheses. Methods A prospective study of digital planned THAs was performed on 90 hips with different types of prostheses from August 2013 to Angust 2014. The plastic templates of different types of prostheses were scanned for desired digital templating and the scanned images were then processed to the transparent, digital templates using Photoshop software. We calibrated the scales of the digital templates with the preoperative radiographs, and then selected the right size of the component. The preoperatively digital planned component sizes were compared to the actual sizes used in the operation, as well as the preoperatively traditional planned sizes. Results In either cup or stem templating, no difference was found among the groups with different types of prostheses, and the accuracy of digital templating was statistically higher than traditional templating. In cup templating, digital planned and implanted cup sizes were identical in 43.33% of the cases, 78.89% of the cup sizes were predicted within 1 size (± 2mm) and 95.56% were predicted within 2 sizes (±4 mm), all significantly higher than the results of traditional planned sizes (30.00%,P=0.044; 61.11%,P=0.007; 82.22%,P=0.004). The exact femoral stem size was predicted in 40.00% of cases using the digital templating, 84.44% of stem sizes were predicted within 1 size, and 93.33% within 2 sizes, better than using traditional templating (25.56%,P=0.028; 53.33%,P<0.001; 77.77%,P=0.003). Conclusion This simple digital preoperative templating is an accurate and reproducible process to preoperatively predict the implant size of uncemented THA.

  1. Cementless total hip arthroplasty for the developmental dislocation of hip in adults with high dislocation%非骨水泥型全髋关节置换治疗成人高位发育性髋脱位

    Institute of Scientific and Technical Information of China (English)

    曹力; 郭海龙; 普拉提; 阿斯卡尔; 张晓岗

    2004-01-01

    目的分析和总结成人高位发育性髋脱位患者的非骨水泥型全髋关节置换手术方法及疗效.方法对1999年5月~2002年7月接受Zweymuller非骨水泥型全髋关节置换术的9例(11髋)成人高位发育性髋脱位患者进行随访.男1例,女8例,平均年龄29.4岁,均为HartofilakidisⅢ型.临床症状主要为患髋疼痛、不稳定和跛行.术前Harris评分平均为40.2分.双下肢长度差异平均4.1 cm,脱位高度平均4.8 cm.术中臼杯均安装于真臼处,臼杯骨量覆盖80%以上.脱位高度5 cm以上4髋,采用股骨小转子下截骨,余7髋经单纯软组织松解后复位.结果平均随访18.2个月.临床症状基本消失,双下肢长度差异平均1.1 cm.1例术中股神经不全损伤,术后4个月恢复.Harris评分平均90分.所有患者最后随访时对治疗结果满意.结论非骨水泥型全髋关节置换对成人高位发育性髋脱位的治疗是一种较理想的方法,能很大程度地改善患者的生活质量.脱位高度小于5 cm者,经软组织松解后能完全下拉复位,不会造成股神经及坐骨神经永久性麻痹.手术操作相对简单,即使发生松动也便于翻修.

  2. Clinical application of Zweymuller cementless hip prosthesis in total hip arthroplasty%Zweymuller非骨水泥型全髋关节置换术的临床应用体会

    Institute of Scientific and Technical Information of China (English)

    张绍安; 张云飞; 李奎; 谢瑞卿; 徐向峰; 李景华; 王鲜颖

    2003-01-01

    目的:探讨Zweymuller非骨水泥型全髋关节置换术临床应用的有效性.方法:应用Zweymuller非骨水泥型人工髋关节对47例(52个髋关节)行置换手术.结果:所有病例切口一期愈合,50个髋关节获得5~72个月随访,无1例出现假体脱位、松动等并发症,术后Harris评分由术前的平均48.5分增至术后的平均88.5分,髋关节功能优良率94%.结论:Zweymuller非骨水泥型人工髋关节假体的临床初期稳定性及初期随访效果满意.

  3. Determinants of demand for total hip and knee arthroplasty: a systematic literature review

    Directory of Open Access Journals (Sweden)

    Mota Rubén E

    2012-07-01

    Full Text Available Abstract Background Documented age, gender, race and socio-economic disparities in total joint arthroplasty (TJA, suggest that those who need the surgery may not receive it, and present a challenge to explain the causes of unmet need. It is not clear whether doctors limit treatment opportunities to patients, nor is it known the effect that patient beliefs and expectations about the operation, including their paid work status and retirement plans, have on the decision to undergo TJA. Identifying socio-economic and other determinants of demand would inform the design of effective and efficient health policy. This review was conducted to identify the factors that lead patients in need to undergo TJA. Methods An electronic search of the Embase and Medline (Ovid bibliographic databases conducted in September 2011 identified studies in the English language that reported on factors driving patients in need of hip or knee replacement to undergo surgery. The review included reports of elective surgery rates in eligible patients or, controlling for disease severity, in general subjects, and stated clinical experts’ and patients’ opinions on suitability for or willingness to undergo TJA. Quantitative and qualitative studies were reviewed, but quantitative studies involving fewer than 20 subjects were excluded. The quality of individual studies was assessed on the basis of study design (i.e., prospective versus retrospective, reporting of attrition, adjustment for and report of confounding effects, and reported measures of need (self-reported versus doctor-assessed. Reported estimates of effect on the probability of surgery from analyses adjusting for confounders were summarised in narrative form and synthesised in odds ratio (OR forest plots for individual determinants. Results The review included 26 quantitative studies−23 on individuals’ decisions or views on having the operation and three about health professionals’ opinions-and 10 qualitative

  4. Clinical Effect of Total Hip Arthroplasty in Treatment of Dysplasia of Hip Joint%全髋置换术治疗髋关节发育不良

    Institute of Scientific and Technical Information of China (English)

    涂兴卫

    2016-01-01

    Objective To research the clinical effect of total hip arthroplasty in treatment of dysplasia of hip joint. Methods 29 cases of patients with dysplasia of hip joint treated in our hospital from January 2009 to January 2015 were randomly se-lected as the observation group (33 hips) and the patients were treated with total hip arthroplasty, 29 cases of patients with dysplasia of hip joint treated in our hospital at the same period were randomly selected as the control group (33 hips) and the patients were treated with routine method, the excellent and good rate of recovery, Harris score, pain score and inci-dence of complications of the two groups were compared. Results The excellent and good rate of recovery, Harris score, pain score and incidence of complications were respectively 91.2%,(89.0±3.3)marks,(37.4±2.2)marks and 0 in the obser-vation group and 78.4%,(70.9±2.6)marks,(84.1±2.9)marks and 17.2% in the control group , the clinical effect in the ob-servation group was obviously better than that in the control group (P﹤0.05). Conclusion Total hip arthroplasty treatment has an obvious effect and it is an ideal treatment method.%目的:研究全髋置换术治疗髋关节发育不良的临床效果。方法随机选取该院2009年1月—2015年1月收治的髋关节发育不良患者29例(33髋)作为观察组,均采用全髋置换术治疗,另选取于该院采取常规治疗的29例(33髋)患者作为对照组,分别比较两组患者的恢复优良率、Harris评分、疼痛评分、并发症发生率。结果观察组和对照组的恢复优良率分别为91.2%和78.4%,髋关节功能Harris评分分别为(89.0±3.3)分和(70.9±2.6)分,疼痛评分分别为(37.4±2.2)分和(84.1±2.9)分,并发症发生率分别为0%和17.2%,结果显示观察组均明显优于对照组(P﹤0.05)。结论全髋关节置换治疗,效果显著,是比较理想的治疗方式。

  5. Ceramic-on-Ceramic Total Hip Arthroplasty in a Twelve-Year-Old Patient: Case Report with a 27-Year Follow-Up.

    Science.gov (United States)

    Save, Ameya V; Varthi, Arya; Talusan, Paul G; Gala, Raj; Nelson, Stephen; Keggi, Kristaps J

    2016-01-01

    Total hip arthroplasty in the juvenile patient with a severely diseasedjoint can provide long-term pain relief and improvement in function. We present a patient with juvenile rheumatoid arthritis who underwent a Mittelmeier ceramic-on-ceramic total hip arthroplasty at age 12 in 1986. The implant provided the patient with a functioning hip for 24 years, but subsequently required revision due to femoral component loosening. This case report represents the longest reported clinical follow-up of noncemented, ceramic-on-ceramic total hip arthroplasty in a juvenile patient and depicts an excellent outcome at 27 years. Our case is also unique in that the Mittelmeier ceramic acetabulum was left in place during revision surgery. In this report, we also describe the senior author's choice of the Mittelmeier hip prosthesis within its historical context and provide a brief review of the literature as it relates to total hip arthroplasty in the juvenile patient. PMID:27509640

  6. Description of load progression and pain response during progressive resistance training early after total hip arthroplasty

    DEFF Research Database (Denmark)

    Mikkelsen, Lone R; Petersen, Annemette K; Mechlenburg, Inger;

    2016-01-01

    progressed from 12 repetition maximum to 8 repetition maximum during 10 weeks for the exercises: knee extension, hip abduction, -flexion and -extension. MAIN MEASURES: Training load in kilograms (kg) for each exercise, hip pain during, before and after exercise using the Visual Analog Scale and adverse...

  7. Similar range of motion and function after resurfacing large-head or standard total hip arthroplasty

    DEFF Research Database (Denmark)

    Penny, Jeannette Østergaard; Ovesen, Ole; Varmarken, Jens-Erik;

    2013-01-01

    BACKGROUND AND PURPOSE: Large-size hip articulations may improve range of motion (ROM) and function compared to a 28-mm THA, and the low risk of dislocation allows the patients more activity postoperatively. On the other hand, the greater extent of surgery for resurfacing hip arthroplasty (RHA) c...

  8. 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.

  9. Measurement of polyethylene wear and its clinical significance in total hip arthroplasty%全髋关节置换术后聚乙烯内衬磨损的测量及其临床意义

    Institute of Scientific and Technical Information of China (English)

    戴雪松; 严世贵; 潘志军; 黄宗坚

    2001-01-01

    Objective To measure the linear polyethylene wear with use of a computer-assisted two-dimensional method, and to evaluate the relationship between wear and long-term clinic-radiological findings. Methods Radiographs of 104 cementless total hip arthroplasties were examined for osteolysis, radiolucent line, cup abduction angle, cup migration, cancellous condensation, stem subsidence, distal pedestal formation and so on. To measure the linear polyethylene wear, migration in the femoral head center relative to the cup shell center was calculated on digitized consecutive radiographs with special computer software program, the degree and direction of wear were also determined. Patients were followed-up for an average period of 8.4 years. Results The average Harris Hip Score was 53.8 points preoperatively and 88.5 points at the latest follow-up. Fourteen hips ( 13.5 % ) were loose. Total linear wear was 1. 14 mm,wear rate was 0. 15 mm/year. Acetabular osteolysis was correlated to polyethylene wear, and a high wear rate was associated with loosening of the components. Multivariate regression analysis showed a lack of correlation between wear rate and patients' age, body weight, cup size, cup abduction angle, activity level and Harris Hip Score. Conclusion The method is preferable for measuring the polyethylene wear of metal-backed acetabular component and other components of various designs. There was clear relationship between wear and acetabular osteolysis or loosening of the prostheses. Therefore, polyethylene wear is important in evaluating the clinical and radiological outcomes of total hip arthroplasty.%目的以计算机数字化方法计测人工全髋假体二维线性磨损,并探讨磨损程度与长期随访结果的临床相关性.方法利用计算机软件测量股骨头中心相对于髋臼中心的矢量位移,来决定关节面磨损的大小和方向.对104髋非骨水泥型人工假体进行磨损计测、临床和放射学检查,平均随访时间为8

  10. Anesthesia Strategies and Perioperative Optimization for Patients with Ankylosing Spondylitis Undergoing Total Hip Replacement Surgery.

    Science.gov (United States)

    2016-06-10

    Objective To identify the characteristics of anesthesia and perioperative management for ankylosing spondylitis (AS) patients undergoing total hip arthroplasty (THA). Methods Totally 63 patients scheduled for single THA in PUMC Hospital from January 1st 2013 to June 1st 2015 were included in this retrospective analysis,among whom 21 patients were diagnosed of AS. The perioperative clinical data included:demographic data,American Society of Anesthesiologists (ASA) classification,medical history,airway assessment,preoperative laboratory examinations,electrocardiogram,pulmonary function tests,intubation information,operation time,intraoperative intake and output volume,postoperative hospital stay,and postoperative complications. Results Significantly fewer AS patients undergoing THA were evaluated as ASA classification I than non-AS patients (9.5% vs. 33.3%,P=0.041). AS patients had significantly higher level of preoperative high-sensitivity C-reactive protein [(17.0±14.8)mg/L vs.(4.3±7.1)mg/L,P0.05). Conclusions AS patients undergoing THA have elevated preoperative inflammatory markers,with high incidence of pulmonary function abnormality and difficult airway. In consideration of high risk of surgery and anesthesia,adequate airway evaluation and optimization of perioperative management are needed to ensure the patients' safety. PMID:27469916

  11. Serum C-Reactive Protein and Procalcitonin Kinetics in Patients Undergoing Elective Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Sandra Battistelli

    2014-01-01

    Full Text Available Background. The sensitivity and the specificity of different methods to detect periprosthetic infection have been questioned. The current study aimed to investigate the kinetics of C-reactive protein (CRP and procalcitonin (PCT in patients undergoing uncomplicated elective total hip arthroplasty (THA, to provide a better interpretation of their levels in noninfectious inflammatory reaction. Methods. A total of 51 patients were included. Serum CRP and PCT concentrations were obtained before surgery, on the 1st, 3rd, and 7th postoperative days and after discharge on the 14th and 30th days and at 2 years. Results. Both markers were confirmed to increase after surgery. The serum CRP showed a marked increase on the 3rd postoperative day while the peak of serum PCT was earlier, even if much lower, on the first day. Then, they declined slowly approaching the baseline values by the second postoperative week. PCT mean values never exceed concentrations typically related to bacterial infections. Conclusions. CRP is very sensitive to inflammation. It could be the routine screening test in the follow-up of THA orthopaedic patients, but it should be complemented by PCT when there is the clinical suspicion of periprosthetic infection.

  12. Role of negative pressure wound therapy in total hip and knee arthroplasty.

    Science.gov (United States)

    Siqueira, Marcelo Bp; Ramanathan, Deepak; Klika, Alison K; Higuera, Carlos A; Barsoum, Wael K

    2016-01-18

    Negative-pressure wound therapy (NPWT) has been a successful modality of wound management which is in widespread use in several surgical fields. The main mechanisms of action thought to play a role in enhancing wound healing and preventing surgical site infection are macrodeformation and microdeformation of the wound bed, fluid removal, and stabilization of the wound environment. Due to the devastating consequences of infection in the setting of joint arthroplasty, there has been some interest in the use of NPWT following total hip arthroplasty and total knee arthroplasty. However, there is still a scarcity of data reporting on the use of NPWT within this field and most studies are limited by small sample sizes, high variability of clinical settings and end-points. There is little evidence to support the use of NPWT as an adjunctive treatment for surgical wound drainage, and for this reason surgical intervention should not be delayed when indicated. The prophylactic use of NPWT after arthroplasty in patients that are at high risk for postoperative wound drainage appears to have the strongest clinical evidence. Several clinical trials including single-use NPWT devices for this purpose are currently in progress and this may soon be incorporated in clinical guidelines as a mean to prevent periprosthetic joint infections. PMID:26807353

  13. Fall-related admissions after fast-track total hip and knee arthroplasty - cause of concern or consequence of success?

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer Calov; Kehlet, Henrik; Hip, Lundbeck Foundation Centre for Fast-track;

    2013-01-01

    Total hip (THA) and knee arthroplasty (TKA) are common procedures in elderly persons, who are at potential increased risk of postoperative fall due to loss of muscle strength and impaired balance. Fast-track surgery with early mobilization and opioid-sparing analgesia have improved outcomes after...

  14. Contributions of human tissue analysis to understanding the mechanisms of loosening and osteolysis in total hip replacement

    DEFF Research Database (Denmark)

    Gallo, Jiri; Vaculova, Jana; Goodman, Stuart B;

    2014-01-01

    Aseptic loosening and osteolysis are the most frequent late complications of total hip arthroplasty (THA) leading to revision of the prosthesis. This review aims to demonstrate how histopathological studies contribute to our understanding of the mechanisms of aseptic loosening/osteolysis developm...

  15. The "true" incidence of surgically treated deep prosthetic joint infection after 32,896 primary total hip arthroplasties

    DEFF Research Database (Denmark)

    Gundtoft, Per Hviid; Overgaard, Søren; Schønheyder, Henrik Carl;

    2015-01-01

    BACKGROUND AND PURPOSE: It has been suggested that the risk of prosthetic joint infection (PJI) in patients with total hip arthroplasty (THA) may be underestimated if based only on arthroplasty registry data. We therefore wanted to estimate the "true" incidence of PJI in THA using several data...

  16. 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

  17. Physical Activity Behavior of Patients 1 Year After Primary Total Hip Arthroplasty : A Prospective Multicenter Cohort Study

    NARCIS (Netherlands)

    Wagenmakers, Robert; Stevens, Martin; Groothoff, Johan W.; Zijlstra, Wiebren; Bulstra, Sjoerd K.; van Beveren, Jan; van Raaij, Jos J. A. M.; van den Akker-Scheek, Inge

    2011-01-01

    Background. Besides the important beneficial effects of regular physical activity on general health, some of the musculoskeletal effects of physical activity are of particular interest for older adults after total hip arthroplasty (THA). However, research on physical activity behavior of patients af

  18. Preoperative or postoperative self-efficacy : Which is a better predictor of outcome after total hip or knee arthroplasty?

    NARCIS (Netherlands)

    van den Akker-Scheek, Inge; Stevens, Martin; Groothoff, Johan W.; Bulstra, Sjoerd K.; Zijlstra, Wiebren

    2007-01-01

    Objective: Self-efficacy is considered an important determinant of outcome after total hip or knee arthroplasty. Aim of this study is to evaluate the contributions of preoperative and short-term postoperative self-efficacy in predicting long-term outcome. Methods: Self-efficacy was determined in 103

  19. Porous titanium particles for acetabular reconstruction in total hip replacement show extensive bony armoring after 15 weeks

    NARCIS (Netherlands)

    Walschot, L.H.; Aquarius, R.; Verdonschot, N.J.; Buma, P.; Schreurs, B.W.

    2014-01-01

    Background and purpose - The bone impaction grafting technique restores bone defects in total hip replacement. Porous titanium particles (TiPs) are deformable, like bone particles, and offer better primary stability. We addressed the following questions in this animal study: are impacted TiPs osteoc

  20. 髋关节发育不良人工全髋关节置换术中髋臼中心重建%RECONSTRUCTION OF HIP CENTER IN TOTAL HIP ARTHROPLASTY FOR DEVELOPMENTAL DYSPLASIA OF HIP

    Institute of Scientific and Technical Information of China (English)

    李雄峰; 管国华; 李建有

    2012-01-01

    目的 探讨髋关节发育不良(developmental dysplasia of hip,DDH)的人工全髋关节置换(total hip arthroplasty,THA)术中髋臼中心重建方法及疗效. 方法 2004年1月-2010年1月,对29例(32髋)DDH患者行THA.男6例(6髋),女23例(26髋);年龄45~67岁,平均50.6岁.左侧22髋,右侧10髋.DDH按照Crowe分型标准:Ⅰ型12髋,Ⅱ型20髋.患者双下肢不等长,相差1.9~4A cm.髋关节Harris评分为(50.7±8.6)分. 结果 术后患者切口均Ⅰ期愈合;1例1髋发生髋关节后脱位.29例均获随访,随访时间2年~4年6个月,平均2.3年.术后下肢延长0.5~5.8 cm,平均2.5 cm.术后1年髋关节Harris评分为(87.7±5.9)分,与术前比较差异有统计学意义(t=21.77,P=-0.00).X线片检查示,术后1例1髓髋臼杯假体松动,1例1髋髋臼杯假体外移且外展角过大;其余患者随访期间无髋臼杯及股骨假体松动和下沉.术后1年髋臼中心水平位置、髋臼中心与泪滴连线垂直距离、髋臼垂直外展角、股骨偏心距均较术前显著改善,差异均有统计学意义(P< 0.05). 结论 对DDH行THA时重建髋臼中心能有效延长患者肢体,提高关节功能,降低关节置换失败率.%Objective To explore the surgical technique and the effectiveness of reconstructing the hip center in total hip arthroplasty (THA) for developmental dysplasia of hip (DDH), Methods Between January 2004 and January 2010, 29 patients (32 hips) with DDH underwent THA. There were 6 males (6 hips) and 23 females (26 hips), aged 45-67 years (mean, 50.6 years)- The locations were left side in 22 hips and right side in 10 hips. According to Crowe classification 12 hips were rated as Crowe I and 20 hips as Crowe II The patients had limb length discrepancy of 1.9-4.4 cm. The Harris score was 50.7 ± 8.6, Results All incisions healed by first intension. Posterior hip dislocation occurred in 1 case (1 hip) after operation. All patients were followed up 2 years-4 years and 6 months (mean, 2,3 years

  1. The Effect of Hydroxyapatite Coating on Long-term Results of Total Hip Arthroplasty with Hydroxyapatite-coated Anatomic Femoral Stem

    Science.gov (United States)

    Im, Chae-Hyun; Kim, Dae-Hee; Heo, Ju-Yeong; Jang, Young-Jae

    2014-01-01

    Purpose To evaluate the clinical and radiological results, as well as the survival rate, associated with total hip arthroplasty using a hydroxyapatite (HA)-coated anatomical femoral stem at a follow-up of ≥12 years. Materials and Methods From April 1992 to May 1997, 86 patients (102 hips) underwent total hip arthroplasty with a HA-coated ABG I (Anatomical Benoist Giraud; Howmedica) hip prosthesis. The average age at the time of surgery was 53.4 years and the mean duration of follow-up was 17.1 years (range, 12.1-21.0 years). The Harris hip score (HHS) and radiographic assessments of thigh pain were used to evaluate the clinical results. We observed osteointegration, cortical hypertrophy, reactive line, calcar resorption and osteolysis around the femoral stems. The survival rate of the femoral stems was evaluated by using the span of time to a revision operation for any reasons was defined as the end point. Results The mean HHS was 50.5 preoperatively and 84.2 at the time of last follow-up. Osteolysis only around the HA-coated proximal portion of the femoral stem was observed in 72 hips, cortical hypertrophy all around the distal portion of the femoral stem was observed in 38 hips, and calcar resorption was observed in 44 hips. A reactive line was observed in 13 hips, but was unrelated to component loosening. Stem revision operations were performed in 24 (23%) hips due to osteolysis (14 hips), fracture (5 hips) and infection (5 hips). The femoral stem survival rate was 75% over the mean duration of follow-up. Conclusion Total hip arthroplasty using a HA-coated anatomical femoral stem showed necessitated a high rate of revision operations due to osteolysis around the femoral stem in this long term follow-up study.

  2. Can gait deviation index be used efectively for the evaluation of gait pathology in total hip arthroplasty

    DEFF Research Database (Denmark)

    Jensen, Carsten; Rosenlund, Signe; Nielsen, Dennis Brandborg;

    In this poster, the Gait Deviation Index (GDI) was used as a convenient method to evaluate pre-to-postoperative gait quality changes after total hip arthroplasty and identify factors which might be predictive of outcome. Design: Three-dimensional gait data from a randomized clinical trial was used...... to determine changes in gait quality in participants walking at self-selected speed. Upon completion of the first assessment, the participants were randomly assigned to either resurfacing hip arthroplasty or conventional hip arthroplasty. The outcome was changes in overall gait quality measured with GDI during...... limbs; 0.3 [95%CI: -2.3 to 1.7]. However, the score for the two groups (pooled data) improved after surgery by 4.4 [95%CI: 1.8 to 7.0]. The single level regression analysis identified the preoperative GDI score as a strong predictor of outcome (p

  3. Can Gait Deviation Index be used effectively for the evaluation of gait pathology in total hip arthroplasty?

    DEFF Research Database (Denmark)

    Jensen, Carsten; Rosenlund, Signe; Nielsen, Dennis Brandborg;

    Introduction: In this paper, the Gait Deviation Index (GDI) was used as a convenient method to evaluate pre-to-postoperative gait pattern changes after total hip arthroplasty and identify factors which might be predictive of outcome. Design: Three-dimensional gait data from a randomized clinical...... trial was used to determine changes in gait quality in participants walking at self-selected speed. Upon completion of the first assessment, the participants were randomly assigned to either resurfacing hip arthroplasty or conventional hip arthroplasty. The outcome was changes in overall gait ‘quality......-operated and the operated limbs; 0.3 [95%CI: 2.3 to 1.7]. However, the score for the two groups (pooled data) improved after surgery by 4.4 [95%CI: 1.8–7.0]. The single level regression analysis identified the preoperative GDI score as a strong predictor of outcome (p

  4. Thigh and knee circumference, knee-extension strength, and functional performance after fast-track total hip arthroplasty

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten Tange; Husted, Henrik;

    2011-01-01

    OBJECTIVE: To (1) quantify changes in knee-extension strength and functional-performance at discharge after fast-track total hip arthroplasty (THA) and (2) investigate whether these changes correlate to changes in thigh and knee circumference (ie, swelling) or pain. DESIGN: A prospective......, descriptive, hypothesis-generating study. SETTING: A special unit for fast-track hip and knee arthroplasty operations at a university hospital. PARTICIPANTS: Twenty-four patients (20 women and 4 men; ages 69 ± 6.1 years) scheduled for primary unilateral THA. METHODS: All patients were evaluated before surgery...... and on the day of hospital discharge. MAIN OUTCOME MEASURES: Knee-extension strength, thigh and knee joint circumference, hip pain, and functional performance (Timed Up & Go, 30-Second Chair Stand, and 10-Meter Walk tests). RESULTS: All investigated variables changed significantly from before to after...

  5. Total Hip Arthroplasty Using the S-ROM-A Prosthesis for Anatomically Difficult Asian Patients

    Directory of Open Access Journals (Sweden)

    Akira Hozumi

    2015-01-01

    Full Text Available Background. The S-ROM-A prosthesis has been designed for the Asian proximal femur with a small deformed shape and narrow canal. In this study, the clinical and radiological results using the S-ROM-A prosthesis for Japanese patients with severe deformity due to dysplasia and excessive posterior pelvic tilt were examined. Methods. 94 hips were followed up for a mean of 55 months, with a mean age at surgery of 61 years. The primary diagnoses were 94 coxarthritis cases, including 51 dysplasia and 37 primary OA, 1 avascular necrosis, 2 traumatic arthritis, and 3 Perthes disease. Thirty-one hips had been treated with osteotomy of the hip joints. Preoperative intramedullary canal shapes were stovepipe in 23 hips, normal in 51 hips, and champagne-flute in 5 hips. The maximum pelvic inclination angle was 56°. Results. The mean JOA score improved from 46 points preoperatively to 80 points at final follow-up. On radiological evaluation of the fixation of the implants according to the Engh classification, 92 (97% hips were classified as “bone ingrown fixation.” Conclusion. In primary THA, using the S-ROM-A prosthesis for Asian patients with proximal femoral deformity, even after osteotomy and with posterior pelvic tilt, provided good short- to midterm results.

  6. Clinical observation of particulate cancellous bone impaction grafting in combination with total hip arthroplasty for acetabular reconstruction

    Institute of Scientific and Technical Information of China (English)

    LIU Xian-zhe; YANG Shu-hua; XU Wei-hua; LIU Guo-hui; YANG Cao; LI Jin; YE Zhe-wei; LIU Yong; ZHANG Yu-kun

    2008-01-01

    Objective: To investigate the effect of particulate cancellous bone impaction grafting in combination with total hip arthroplasty (THA) for acetabular reconstruction in patients with posttraumatic arthritis and bone loss afteracetabular fractures.Methods: Totally 15 consecutive cases with unilateral acetabular fracture were treated with bone impaction grafting in combination with THA in our department.There were 10 males and 5 females with mean age of 48.2 years (ranging from 36 to 73 years).Eight cases had the fracture at left hips,7 at right hips.The average age at injury was 28 years (ranging from 18 to 68 years).The mean follow-up period was 4.3 years (ranging from 2 to 7 years).Results: Compared with mean 42 points (ranging from 10 to 62) of the preoperative Harris score,the survival cases at the final follow-up had mean 84 points (ranging from 58 to 98).One patient had mild pain in the hip.No revision of the acetabular or femoral component was undertaken during the follow-up.Normal rotational centre of most hips was recovered except 2 cases in which it was 0.8 mm higher than that in opposite side.All of them had a stable radiographic appearance.Progressive radiolucent fines were observed in I,III zones in 2 cases.One patient had a nonprogressive radiolucent fine in zone III.The cup prosthesis was obviously displaced (6 mm) in one patient,but had not been revised.Conclusion: Particulate cancellous bone impaction grafting in combination with THA as a biological solution is an attractive procedure for acetabular reconstruction in patients with posttraumatic arthritis and bone loss after acetabular fracture,which can not only restore acetabular bone stock but also repair normal hip anatomy and its function.

  7. Clinical and roentgenographic evaluation of hydroxyapatite-augmented and nonaugmented porous total hip arthroplasty.

    Science.gov (United States)

    Ciccotti, M G; Rothman, R H; Hozack, W J; Moriarty, L

    1994-12-01

    Sixty osteoarthritic patients undergoing primary, uncemented total hip arthroplasty were matched for age and weight and randomized into one of four groups with respect to implant coating and postoperative, protected weight-bearing status: group 1, hydroxyapatite-augmented, 12 weeks; group 2, nonaugmented, 12 weeks; group 3, hydroxyapatite-augmented, 6 weeks; and group 4, nonaugmented, 6 weeks. Tantalum spheres were implanted periprosthetically into the femur at the time of the arthroplasty, thus providing constant references for stereoscopic radiographs. Patients were then evaluated over a 2-year period with clinical examination, plain radiography, and roentgen stereophotogrammetric analysis. Clinical evaluation using the Charnley scoring system showed no significant preoperative or postoperative intergroup differences, whereas visual analog testing noted less thigh pain with hydroxyapatite-augmented stems at the 12-week and 6-month follow-up evaluations. Plain radiographic analysis produced no significant differences, with no instability detected, and bony ingrowth was uniform in all groups. Stereographic evaluation showed migration in all groups, but there were no significant differences between the augmented and nonaugmented stems or the 6-week and 12-week partial weight-bearing protocols. Charnley, plain radiographic, and stereogrammetric evaluations all suggest that migration is unaltered by enhanced surfaces and early, unprotected weight bearing does not jeopardize implant fixation regardless of coating design. The lower incidence of visual analog thigh pain with the hydroxyapatite-augmented stems, however, may be a reflection of bony ingrowth and, as such, add some validity to the theoretic advantages of enhanced surface prostheses. PMID:7699376

  8. Comparison of functional outcome of total hip arthroplasties involving four surgical approaches.

    Science.gov (United States)

    Mostardi, R A; Askew, M J; Gradisar, I A; Hoyt, W A; Snyder, R; Bailey, B

    1988-01-01

    One hundred thirty-seven total hip arthroplasty patients had a follow-up evaluation consisting of an orthopaedic physical evaluation, isokinetic strength testing, and collection of demographic and surgical information from medical records. The intraoperative variables of surgical time and blood loss and the functional outcome status of the subjects, as demonstrated by D'Aubigne--Postel ratings and isokinetic strength tests, were compared for various trochanteric management techniques: no osteotomy; complete Charnley-type osteotomy; sharp abductor release; and a wafer technique, in which a wafer of bone was osteotomized from the trochanter to release the abductors. A comparison of the mean values for the variables indicated that the wafer and sharp techniques were superior to the complete and no osteotomy techniques. The wafer technique resulted in statistically significant superior isokinetic strength measured in adduction, flexion, and extension. Surgical time was significantly greater in the complete osteotomy cases and blood loss was least in the wafer cases, although these differences were not significant. PMID:3183682

  9. Stop of loss of cognitive performance during rehabilitation after total hip arthroplasty-Prospective controlled study

    Directory of Open Access Journals (Sweden)

    Matthias H. Brem, MD, MHBA

    2010-12-01

    Full Text Available Prolonged hospitalization is known to be associated with a loss of cognitive performance. Does playing video games (VGs developed to improve cognitive properties delay this loss or even lead to an increase in cognitive performance? We performed a 10-day longitudinal study of patients who received total hip arthroplasty. We compared 16 patients (6 male aged 66 ± 9 years (mean ± standard deviation who played Dr. Kawashima's Brain Training: How Old Is Your Brain? (Nintendo; Redmond, Washington on a Nintendo DS handheld console with 16 control patients (6 male aged 69 ± 14 years. We measured cognitive performance 1 day preoperation, as well as on days 2 and 9 postoperation. With the daily exercise of a specific VG by the play group, the patients' fluid intelligence (median intelligence quotient 99-106, working memory capacity, and rate of information processing significantly improved over the course of 7 postoperative days. The cognitive performance of the control group did not increase. However, the memory spans of both groups did not systematically change. Exercise with VGs can prevent the loss of cognitive performance during prolonged hospitalization.

  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. Instrumental and laboratory assessment of stressful remodelling processes in bone tissue at total hip replacement

    Directory of Open Access Journals (Sweden)

    E.V. Karjakina

    2010-06-01

    Full Text Available Research objective is to estimate stressful remodelling features of bone tissue according to the densitometry data and to the level of biochemical markers of bone resorption and formation in total hip replacement (THR. Bone tissue mineral density (BTMD, condition of calcium-phosphoric metabolism and biochemical markers of bone formation (osteocalcin and bone isoenzyme of alkaline phosphatase and resorption (С-terminal bodypeptide of the I type collagen have been determined in 52 patients with coxarthrosis of ll-lll stages with marked joint dysfunction before and after THR. The control group included 24 donors. The data were considered to be reliable when the probability index was р<0,05. The reliable (р<0,05 change of BTMD was determined only in 3-6 months after the operation, whereas the change of biochemical markers of remodeling had already been done after 1,5-3 months, allowing to define the group of patients with obvious negative bone balance: strong predominance of resorption processes without compensation of the subsequent adequate osteogenesis, that subsequently could lead to significant bone tissue deficiency in the area adjacent to the endoprosthesis. Changes of indices of calcium-phosphoric metabolism were not certain during the investigation term. ln conclusion it is to state that biochemical markers of remodeling in comparison with BTMD allow to estimate objectively features of adaptive bone tissue remodeling after THR in earlier periods and to define group of patients with sharp intensification of metabolism and obvious negative bone balance

  12. Midterm to long-term follow-up study after hybrid total hip arthroplasty%混合型初次全髋关节置换术后中远期随访研究

    Institute of Scientific and Technical Information of China (English)

    黄强; 沈彬; 杨静; 周宗科; 康鹏德; 裴福兴

    2012-01-01

    目的 回顾性分析混合型初次全髋关节置换术的临床和影像学疗效及其相关影响因素.方法 对1999年1月至2001年12月期间接受混合型初次全髋关节置换术治疗髓部疾病的患者126例(135髋)进行中远期随访.观察假体位置及其周围骨质变化,计算聚乙烯内衬磨损率.采用Kaplan-Meier方法估算假体10年生存率,以无菌性松动、单纯骨溶解病灶清除植骨术及翻修为随访终点.结果 共有79例(85髋)患者获得随访.以无菌性松动为随访终点,髋臼假体10生存率为97.6%,股骨假体10年生存率为100%;以无菌性松动、单纯骨溶解病灶清除植骨术为随访终点,髋臼假体生存率为95.2%,股骨假体生存率为98.8%.结论 混合型初次全髋关节置换术后假体中远期生存率令人满意;采用第3代骨水泥技术固定的股骨假体取得与现代非骨水泥假体相近的中远期生存率.%Objective To evaluate clinical and radiaographic results and influencing factors of hybrid total hip arthroplasty (THA).Methods Totally 126 patients ( 135 hips) from January 1999 to December 2001 accepted hybrid THA were followed up. Components migration, periprosthetic bone changes,the polyethylene wear rate were mcasured radiologically.Kaplan-Meier analysis was performed to evaluate the survivalship of the acetabular and femoral components. End point was obvious radiological loosening or revision either or both of the acetabular and femoral components for aseptic loosening,infection or osteolysis debridement surgery.Results A total of 79 cases (85 hips) had been given follow-up.Using rcvision as the end point,the survival rate of acetabular was 95.2%,cemented femoral components was 98.8%.Using loosening as the end point for failure,the survival rate of acetabular was 97.6%,cemented femoral components was 100%.Conclusions The hybrid total hip prothesis long-term survival rate was satisfactory,especially in the femoral side.As a

  13. 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.

  14. 自体骨植骨在成人先天性髋臼发育不良全髋关节置换术中的疗效分析%Autogenous bone grafting in total hip arthroplasty for congenital acetabular dysplasia

    Institute of Scientific and Technical Information of China (English)

    周垂宝; 李明; 张元凯

    2012-01-01

    To discuss the effect of the femoral-head autograft in uncemented total hip arthroplasty for congenital acetabular dysplasia. Methods 21 patients(24 hips) with acetabular dysplasia (Crowe type Ⅱ orⅢ ) from August 2007 to May 2010 received femoral head autograft in cementless total hip arthroplasty for acetabular dysplasia to reconstruct acetabula. Classified Harris Hip Score (CHHS) and imaging examination were used in the follow-up visit. Results There was a significant difference between the pre and post operation according to CHHS (P <0.05). At an average follow-up of 27 months,all the patients had excellent clinical results. Neither acetabular autograft resorption nor non-union was observed. Conclusion Using femoral-head autograft was an effect method in uncemented total hip arthroplasty for the acetabular dysplasia.%目的 分析成人先天性髋臼发育不良全髋关节置换术中使用自体骨结构性移植重建髋臼的疗效.方法 2007年8月至2010年5月手术治疗先天性髋臼发育不良CroweⅡ、Ⅲ型患者21例(24髋),男3例(3髋),女18例(21髋),行非骨水泥型全髋关节置换术,应用自体股骨头植骨重建髋臼,随访指标为Harris评分和影像学检查.结果 Harris评分统计分析显示,术前与术后差异有统计学意义(P<0.05),移植骨愈合,无移植骨的吸收.结论 自体骨结构性植骨在非骨水泥型全髋关节置换治疗先天性髋臼发育不良中有良好疗效.

  15. [Pelvic lymphadenitis after total hip arthroplasty : Mimicking of lymph node metastases in a patient with prostate cancer].

    Science.gov (United States)

    Sevinc, S; Westhoff, C C; Schrader, A J; Olbert, P J; Hofmann, R; Hegele, A

    2010-08-01

    This report describes the case of a 65-year-old patient who underwent radical prostatectomy in our department. Intraoperatively we detected suspicious lymph nodes on the left side. The histopathological examination revealed histiocytosis and foreign body giant cells but no sign of tumor. The enlarged lymph nodes were ascribed to an ipsilateral total hip arthroplasty performed 14 years previously because of progressive coxarthrosis. Lymphadenitis after total hip arthroplasty is frequently observed. Histopathologically and with the use of polarized light microscopy, histiocytosis and wear particles such as titanium, polyethylene, and polyethylene-methylacrylate may be detected. When operating on patients with arthroplasty of a lower limb, particularly those with a total endoprosthesis, the surgeon should bear in mind that changes in lymph node consistency and size do not necessarily indicate tumor involvement or metastases.

  16. Blood Transfusions in Total Hip and Knee Arthroplasty: An Analysis of Outcomes

    Directory of Open Access Journals (Sweden)

    Thomas Danninger

    2014-01-01

    Full Text Available Background. Various studies have raised concern of worse outcomes in patients receiving blood transfusions perioperatively compared to those who do not. In this study we attempted to determine the proportion of perioperative complications in the orthopedic population attributable to the use of a blood transfusion. Methods. Data from 400 hospitals in the United States were used to identify patients undergoing total hip or knee arthroplasty (THA and TKA from 2006 to 2010. Patient and health care demographics, as well as comorbidities and perioperative outcomes were compared. Multivariable logistic regression models were fitted to determine associations between transfusion, age, and comorbidities and various perioperative outcomes. Population attributable fraction (PAF was determined to measure the proportion of outcome attributable to transfusion and other risk factors. Results. Of 530,089 patients, 18.93% received a blood transfusion during their hospitalization. Patients requiring blood transfusion were significantly older and showed a higher comorbidity burden. In addition, these patients had significantly higher rates of major complications and a longer length of hospitalization. The logistic regression models showed that transfused patients were more likely to have adverse health outcomes than nontransfused patients. However, patients who were older or had preexisting diseases carried a higher risk than use of a transfusion for these outcomes. The need for a blood transfusion explained 9.51% (95% CI 9.12–9.90 of all major complications. Conclusions. Advanced age and high comorbidity may be responsible for a higher proportion of adverse outcomes in THA and TKA patients than blood transfusions.

  17. 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.

  18. Predictors of physical functioning after total hip arthroplasty: a systematic review

    Science.gov (United States)

    Buirs, L D; Van Beers, L W A H; Scholtes, V A B; Pastoors, T; Sprague, S; Poolman, R W

    2016-01-01

    Objective The objective of this systematic review of the literature was to identify the predictors of functional outcome after total hip arthroplasty (THA). Method A systematic literature search in Web of Science, CINAHL, EMBASE and PubMed was conducted on 23 June 2015. The articles were selected based on their quality, relevance and measurement of the predictive factor. The level of evidence of all studies was determined using the GRADE rating scheme. Results The initial search resulted in 1092 citations. After application of the inclusion and exclusion criteria, 33 articles met our eligibility criteria and were graded. Included studies were classified as level of evidence low (11), moderate (17) or high (5). Of the included studies, 18 evaluated body mass index (BMI), 17 evaluated preoperative physical functions, 15 evaluated age, 15 evaluated gender and 13 evaluated comorbidity. There was strong evidence suggesting an association between BMI, age, comorbidity, preoperative physical functions and mental health with functional outcome after THA. There was weak evidence suggesting an association between quadriceps strength and education with functional outcome after THA. The evidence was inconsistent for associations with gender and socioeconomic status and functional outcome following THA. We found limited evidence suggesting that alcohol consumption, vitamin D insufficiency and allergies were predictors of functional outcome following THA. Conclusions We have identified multiple predictors of functional outcome after THA, which will enable general practitioners and orthopaedic surgeons to better predict the improvement in physical functioning for their patients with THA. They can use this information to provide patient-specific advice regarding the referral for THA and the expected outcomes after THA. Further research with consistent measurement tools, outcomes and duration of follow-up across studies is needed to confirm the influence of these factors. PMID

  19. A visual-aided wireless monitoring system design for total hip replacement surgery.

    Science.gov (United States)

    Chen, Hong; Gao, Jiyang; Su, Shaojie; Zhang, Xu; Wang, Zhihua

    2015-04-01

    To improve the positioning accuracy of implants in Total Hip Replacement (THR) surgeries, a visual-aided wireless monitoring system for THR surgery is proposed in this paper. This system aims to measure and display the contact distribution and relative pose between femoral head and acetabulum prosthesis during the surgery to help surgeons obtain accurate position of implants. The system consists of two parts: the Sensors Array Measuring System (SAMS) and the display part. The SAMS is composed of a sensors array (including contact sensors and an image sensor), signal conditioning circuits, a low power microcontroller (MCU), and a low-power transceiver. The SAMS is designed to estimate the relative pose of femoral head component to acetabular component. The display part processes the data from sensors and demonstrates the contact distribution and the pose of the prothesis during the surgery in 3-D graphics. The two parts of the system communicate with each other on an RF link at the band of 400 MHz. The signal conditioning circuits have been designed and fabricated in 0.18 μm CMOS process. Testing results show that the resolution of the signal conditioning circuits is 60.1 μ Vpp (1.35 g) with ±100 mVpp input. The chip can operate under 1.2-to-3.6 V supply voltage for single battery applications with 116-160 μ A current consumption. The system has been verified by the simulation with rotation quaternion and translation vector. The experimental results show that the contact distribution and relative pose of the two components could be measured and demonstrated in real time. The relative error of rotation is less than 8% and the actual relative error of translation is less than 10%. PMID:25879970

  20. Tantalum-based multilayer coating on cobalt alloys in total hip and knee replacement

    International Nuclear Information System (INIS)

    Cobalt–chromium–molybdenum (CoCrMo) alloys are widely used in total hip and knee joint replacement, due to high mechanical properties and resistance to wear and corrosion. They are able to form efficient artificial joints by means of coupling metal-on-polymer or metal-on-metal contacts. However, a high concentration of stress and direct friction between surfaces leads to the formation of polyethylene wear debris and the release of toxic metal ions into the human body, limiting, as a consequence, the lifetime of implants. The aim of this research is a surface modification of CoCrMo alloys in order to improve their biocompatibility and to decrease the release of metal ions and polyethylene debris. Thermal treatment in molten salts was the process employed for the deposition of tantalum-enriched coating. Tantalum and its compounds are considered biocompatible materials with low ion release and high corrosion resistance. Three different CoCrMo alloys were processed as substrates. An adherent coating of about 1 μm of thickness, with a multilayer structure consisting of two tantalum carbides and metallic tantalum was deposited. The substrates and modified layers were characterized by means of structural, chemical and morphological analysis. Moreover nanoindentation, scratch and tribological tests were carried out in order to evaluate the mechanical behavior of the substrates and coating. The hardness of the coated samples increases more than double than the untreated alloys meanwhile the presence of the coating reduced the wear volume and rate of about one order of magnitude. - Highlights: ► Thermal treatment in molten salts deposits a Ta-based coating on Co-based alloys. ► Coating is composed by one or two tantalum carbides and/or metallic tantalum. ► The coating structure depends on thermal temperature and substrates carbon content. ► Coating is able to enhance biocompatibility, wear resistance and hardness.

  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. Does Physical Activity Increase After Total Hip or Knee Arthroplasty for Osteoarthritis? A Systematic Review.

    Science.gov (United States)

    Arnold, John B; Walters, Julie L; Ferrar, Katia E

    2016-06-01

    Study Design Systematic review. Background Despite improvements in self-reported symptoms and perceived functional ability after total hip arthroplasty (THA) and total knee arthroplasty (TKA), it is unclear whether changes in objectively measured physical activity (PA) occur after surgery. Objective To determine if objectively measured PA increases after THA and TKA in adults with osteoarthritis. Methods Five electronic databases were searched from inception to March 3, 2015. All study designs objectively measuring PA before and after THA or TKA were eligible, including randomized controlled trials, cohort studies, and case-control studies. Two reviewers independently screened abstracts and full texts and extracted study demographic, PA, and clinical outcome data. Standardized mean differences (SMDs) and 95% confidence intervals were calculated for accelerometer- and pedometer-derived estimates of PA. Risk of methodological bias was assessed with Critical Appraisal Skills Programme checklists. Results Eight studies with a total of 373 participants (238 TKA, 135 THA) were included. Findings were mixed regarding improvement in objectively measured PA at 6 months after THA (SMDs, -0.20 to 1.80) and TKA (SMDs, -0.36 to 0.63). Larger improvements from 2 studies at 1 year postsurgery were generally observed after THA (SMDs, 0.39 to 0.79) and TKA (SMDs, 0.10 to 0.85). However, at 1 year, PA levels were still considerably lower than those of healthy controls (THA SMDs, -0.25 to -0.77; TKA SMDs, -1.46 to -1.80). Risk-of-bias scores ranged from 3 to 9 out of 11 (27%-82%) for cohort studies, and from 3 to 8 out of 10 (30%-80%) for case-control studies. Conclusion The best available evidence indicates negligible changes in PA at 6 months after THA or TKA, with limited evidence for larger changes at 1 year after surgery. In the 4 studies that reported control-group data, postoperative PA levels were still considerably less than those of healthy controls. Improved perioperative

  3. Incidence, risk factors and the healthcare cost of falls postdischarge after elective total hip and total knee replacement surgery: protocol for a prospective observational cohort study

    Science.gov (United States)

    Hill, Anne-Marie; Ross-Adjie, Gail; McPhail, Steven M; Monterosso, Leanne; Bulsara, Max; Etherton-Beer, Christopher; Powell, Sarah-Jayne; Hardisty, Gerard

    2016-01-01

    Introduction The number of major joint replacement procedures continues to increase in Australia. The primary aim of this study is to determine the incidence of falls in the first 12 months after discharge from hospital in a cohort of older patients who undergo elective total hip or total knee replacement. Methods and analyses A prospective longitudinal observational cohort study starting in July 2015, enrolling patients aged ≥60 years who are admitted for elective major joint replacement (n=267 total hip replacement, n=267 total knee replacement) and are to be discharged to the community. Participants are followed up for 12 months after hospital discharge. The primary outcome measure is the rate of falls per thousand patient-days. Falls data will be collected by 2 methods: issuing a falls diary to each participant and telephoning participants monthly after discharge. Secondary outcomes include the rate of injurious falls and health-related quality of life. Patient-rated outcomes will be measured using the Oxford Hip or Oxford Knee score. Generalised linear mixed modelling will be used to examine the falls outcomes in the 12 months after discharge and to examine patient and clinical characteristics predictive of falls. An economic evaluation will be conducted to describe the nature of healthcare costs in the first 12 months after elective joint replacement and estimate costs directly attributable to fall events. Ethics and dissemination The results will be disseminated through local site networks and will inform future services to support older people undergoing hip or knee joint replacement and also through peer-reviewed publications and medical conferences. This study has been approved by The University of Notre Dame Australia and local hospital human research ethics committees. Trial registration number ACTRN12615000653561; Pre-results. PMID:27412102

  4. Good outcome of total hip replacement in patients with cerebral palsy

    Science.gov (United States)

    King, Garry; Hunt, Linda P; Wilkinson, J Mark; Blom, Ashley W

    2016-01-01

    Background and purpose — People with cerebral palsy (CP) often have painful deformed hips, but they are seldom treated with hip replacement as the surgery is considered to be high risk. However, few data are available on the outcome of hip replacement in these patients. Patients and methods — We linked Hospital Episode Statistics (HES) records to the National Joint Registry for England and Wales to identify 389 patients with CP who had undergone hip replacement. Their treatment and outcomes were compared with those of 425,813 patients who did not have CP. Kaplan-Meier estimates were calculated to describe implant survivorship and the curves were compared using log-rank tests, with further stratification for age and implant type. Reasons for revision were quantified as patient-time incidence rates (PTIRs). Nationally collected patient-reported outcomes (PROMS) before and 6 months after operation were compared if available. Cumulative mortality (Kaplan-Meier) was estimated at 90 days and at 1, 3, and 5 years. Results — The cumulative probability of revision at 5 years post-surgery was 6.4% (95% CI: 3.8–11) in the CP cohort as opposed to 2.9% (CI 2.9–3%) in the non-CP cohort (p < 0.001). Patient-reported outcomes showed that CP patients had worse pain and function preoperatively, but had equivalent postoperative improvement. The median improvement in Oxford hip score at 6 months was 23 (IQR: 14–28) in CP and it was 21 (14–28) in non-CP patients. 91% of CP patients reported good or excellent satisfaction with their outcome. The cumulative probability of mortality for CP up to 7 years was similar to that in the controls after stratification for age and sex. Interpretation — Hip replacement for cerebral palsy appears to be safe and effective, although implant revision rates are higher than those in patients without cerebral palsy. PMID:26863583

  5. Comparative study of extended versus short term thromboprophylaxis in patients undergoing elective total hip and knee arthroplasty in Indian population

    OpenAIRE

    Velu Nair; Ratheesh Kumar; Bikram Kumar Singh; Ajay Sharma; Gururaj R Joshi; Kamal Pathak

    2013-01-01

    Background: Postoperative thromboprophylaxis with low molecular weight heparin (LMWH) for an extended period of 4 weeks is now preferred over short term thromboprophylaxis in patients undergoing total hip/knee arthroplasty (THA/TKA). However, most of the data demonstrating the efficacy and safety of extended thromboprophylaxis and short term thromboprophylaxis is from clinical trials done in the West. In India, the data of the incidence of venous thromboembolism (VTE) following THA/TKA has be...

  6. Demographics and clinical and economic characteristics of patients receiving total hip arthroplasty with and without muscle atrophy/weakness

    OpenAIRE

    Wu N; Chen SY; Lee YC; Zhao Y

    2013-01-01

    Nin Wu,1 Shih-Yin Chen,1 Yuan-Chi Lee,1 Yang Zhao2 1United BioSource Corporation, Lexington, MA, USA; 2Eli Lilly and Company, Indianapolis, IN, USA Abstract: This study analyzed administrative claims by a US population with commercial or Medicare supplemental insurance to compare demographics, comorbid medical conditions, and health care utilization and costs among patients undergoing total hip arthroplasty (THA) with and without muscle atrophy/weakness (MAW). Patients were classified into t...

  7. Do we need hip-ankle radiographs to assess the coronal alignment and implant position after total knee replacement?

    Science.gov (United States)

    Dargel, Jens; Oppermann, Johannes; Eysel, Peer; Penning, Lenhard

    2016-01-01

    Aims and Objectives: Restoration of the coronal alignment of the knee is known to be one of the major criteria of a successful total knee arthroplasty (TKA). It therefore appears to be mandatory to routinely assess the postoperative limb alignment using hip-ankle radiographs and to identify implants that may be at risk of premature failure. However, there is no clear consensus whether weight-bearing hip-ankle radiographs or rather standardized a-p knee-radiographs should be used to assess implant position and coronal alignment after TKA. It is the aim of the present study to investigate if implant position and the mechanical alignment after TKA can reproducibly be assessed using standardized a-p knee-radiographs or rather if weight-bearing hip-ankle radiographs are needed. Materials and Methods: This study was performed on 100 postoperative weight-bearing hip-ankle radiographs after conventional primary TKA. The true mechanical and anatomical femorotibial angle as well as coronal implant position (MPTA, LDFA) was assessed using the MediCAD software, which served as a control. The hip-ankle radiographs were then digitally cropped to 80%, 60% and 40% of the leg-length. In each cropped radiograph, tibial coronal implant position was assessed by referencing against the visible mid-shaft, whereas femoral implant position was referenced against the visible mid-shaft (anatomical axis) or against a surrogate mechanical axis, which was drawn perpendicular to the distal tangent of the femoral component. Each measurement was performed by three independent observers. The difference between the alignment parameters in the hip-ankle radiographs were statistically compared with the cropped radiographs and the inter-observer correlation coefficient (ICC) was calculated for each parameter. Results: The ICC for inter-observer agreement of measurement of the mechanical femorotibial angle was significantly higher in hip-ankle radiographs (.95) when compared with a radiograph cropped

  8. Primary total hip arthroplasty:a minimum five-year follow-up study%初次全髋关节置换术后5年以上随访结果与分析

    Institute of Scientific and Technical Information of China (English)

    康焱; 廖威明; 邬培慧; 张紫机; 傅明; 盛璞义; 何爱珊; 杨子波; 杨忠汉; 徐栋梁

    2011-01-01

    目的 评估初次全髋关节置换术(THA)后5年以上患者的临床疗效、并发症及其影响因素.方法 对中山大学附属第一医院关节外科2006年6月前行THA的273例患者(305髋)进行随访,截至末次随访时,191例(206髋)患者获得随访,随访时间平均为9.3年(5~21年),临床随访内容包括SF-36量表、术前、术后Harris评分及各种并发症.影像学评估包括骨盆正位、患髋正侧位片,判断人工假体位置、假体周围骨质以及并发症情况.结果 随访率为69.96%,SF-36体能方面总分由术前的(30.92±3.90)分(24~39分)提高至(53.69±3.97)分(44~62分),在精神方面的总分则由术前的(45.91±5.63)分(37~56分)提高至(57.06±7.26)分(43~72分).术前Harris评分为(46.71±10.76)分(5~68分),末次随访时为(92.83±4.88)分(56~100分).假体的5年生存率为98.06%,10年生存率为94.17%,15年生存率为85.92%,20年生存率为81.55%.混合型假体、非骨水泥型假体的翻修率分别为2.4%、5.6%.术后并发症包括跛行(17例)、脱位(3例3髋)、深静脉血栓(1例1髋)、假体周围骨折(1例1髋)、无菌性松动(9例9髋)、异位骨化(6髋)和感染(0例)等.结论 本组病例整体疗效满意、假体生存期长,但随访率偏低,病例数偏少,需进一步完善随访机制,提高随访率.%Objective To evaluate clinical efficacy, complications and impact factors of the primary total hip arthroplasty (THA) for more than five years. Methods From Jan 1990 to Jun 2006, primary THA was performed on 305 hips (273 patients) , and 206 hips ( 191 patients) with complete clinical data were available for follow-up at a mean time of 9. 3 years (5 to 21 years) postoperatively. Clinical follow-up included SF-36 scores, preoperative and postoperative Harris hip score and complications. Components migration, bone remodeling around the implant and complications were also assessed in the anterior posterior and lateral X-ray of the hips. Results The

  9. Risk factors for osteoarthritis and total hip replacement in Legg-Calvé-Perthes disease

    DEFF Research Database (Denmark)

    Froberg, Lonnie; Christensen, Finn; Pedersen, Niels Wisbech;

    2009-01-01

    and patients with previous operation at pelvis/lower limbs. Fifty-two patients (55 hips) were enrolled in the study. The follow-up period was 47 years. In study C emigrated persons, persons lost to follow-up and patients with previous operation at pelvis/lower limb were excluded. 135 patients (156 hips) were...... performed and to our knowledge no case-control studies exist. The strengths of our study were that all the patients had the same conservative treatment regime. The reviewed Stulberg classification was used which is known to have good inter- and intraobserver agreement. Our study has some weaknesses: Extreme...

  10. Modular titanium alloy neck failure in total hip replacement: analysis of a relapse case.

    Science.gov (United States)

    Ceretti, Marco; Falez, Francesco

    2016-01-01

    Modular neck hip prosthesis born in the 1990 with the aim of allowing the surgeon to modify CCD angle, offset and femoral anteversion intra-operatively restoring patient's original biomechanics. In order to achieve the best biomechanics of the reconstructed hip, preoperative planning is essential. In the last few years modularity has been questioned and an argument made for the return to mono block stems due to events of breakage or disconnection of modular components. Fretting or crevice corrosion may lead to failure of such modular device due to the contamination inside the modular coupling or to high loads. We present a case of repetitive modular femoral neck prosthesis fracture. PMID:27163109

  11. Leg length equalization for total hip joint replacement patients%人工全髋关节置换术中肢体长度的平衡

    Institute of Scientific and Technical Information of China (English)

    马保安; 范清宇; 周勇; 张勇; 杨彤涛; 陈军

    2002-01-01

    Objective To investigate the methods to maintain leg equalization for patients undergoing primary total hip joint replacement. Methods 40 patients,45 hips with various diseases were treated by total hip joint replacement from Jan 2000 to Sep 2001.Before operation, the perpendicular length from center of femoral head to the summit of great tuberosity and the tip of less tuberosity to the line of bilateral ischial tuberosity were measured; the length from anterior superior iliac spine to medial malleolus were measured at same time.Leg length was decided and corrected according to these lines. Results Before operation, shortening of limbs were presented in 39 hips, 1 to 4 cm, average 2.4 cm.After operation, discrepancy of both legs was 0~ 0.8 cm.Apparent limps were not observed in all patients. Conclusion This measurement is a useful method to maintain and recover leg length in total hip joint replacement.

  12. 解剖型生物固定股骨柄假体的设计特征与临床应用效果%Design features and clinical results of anatomic femoral stem in total hip arthroplasty

    Institute of Scientific and Technical Information of China (English)

    蒋涛; 孙俊英; 查国春; 游镇君; 王涛

    2014-01-01

    BACKGROUND:Ribbed anatomic femoral stem meets the biomechanical features of the femur, and has achieved satisfactory clinical efficacy with good initial stability, rapid bone growth and low stress shielding. OBJECTIVE:To evaluate the design features and clinical results of the cementless anatomic Ribbed femoral stem (Ribbed stem) in total hip arthroplasty. METHODWe retrospectively analyzed 52 patients (52 hips) with hip joint disease who were treated with Ribbed stem in total hip arthroplasty between March 2010 and March 2012. There were 20 males and 32 females. The mean age was 59 years (range 22-78 years). The mean fol ow-up was 3.1 years (range 2-4 years). The preoperative and postoperative Harris hip scores, the rate of postoperative thigh pain, the incidence of intraoperative femoral fracture, wound healing, dislocation and revision were recorded. Radiographic evaluation was used to evaluate the rate of stem fil , subsidence of femoral stem, periprosthetic radiolucent line, bone ingrowth, stress shielding, and osteolysis. RESULTS AND CONCLUSION:The incidence of intraoperative femoral fracture was 6%. Al incisions were healed. There were no cases of hip dislocation and revision;the rate of thigh pain was 6%, no patient had thigh pain after 1 year postoperatively. The mean preoperative Harris hip score was 48 points, which improved to a mean of 96 points at the final fol ow-up. Postoperative X-ray showed that al patients had a satisfactory femoral fil in both planes and al of the femoral stems were wel-fixed at the final fol ow-up. The average fil ing rate was 91%, 88%and 86%by normotopia imaging, while 88%, 85%and 81%by lateral imaging, at the metaphysic, middle and distal ends respectively. At the final fol ow-up, 49 hips (92%) showed stable bone ingrowth, 3 hips showed stable fiber ingrowth. No osteolysis around the components at the femur or acetabulum was observed. 5 (10%) hips appeared the subsidence of femoral stems, which were  目的:探

  13. [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

  14. Survival, clinical and radiological outcome of the Zweymuller SL/Bicon-Plus total hip arthroplasty : a 15-year follow-up study

    NARCIS (Netherlands)

    Ottink, Karsten; Barnaart, Lex; Westerbeek, Robin; van Kampen, Karin; Bulstra, Sjoerd; van Jonbergen, Hans-Peter

    2015-01-01

    Aim: The primary aim of this study is to analyse the long-term results of the third generation of the " Zweymuller" total hip arthroplasty (THA) comprising the SL-Plus Stem and the Bicon-Plus cup. Methods: We evaluated 208 patients with a SL/Bicon-Plus primary THA (218 hips). Survival analysis was p

  15. Impact of an Automated Surveillance to Detect Surgical-Site Infections in Patients Undergoing Total Hip and Knee Arthroplasty in Brazil.

    Science.gov (United States)

    Perdiz, Luciana B; Yokoe, Deborah S; Furtado, Guilherme H; Medeiros, Eduardo A S

    2016-08-01

    In this retrospective study, we compared automated surveillance with conventional surveillance to detect surgical site infection after primary total hip or knee arthroplasty. Automated surveillance demonstrated better efficacy than routine surveillance in SSI diagnosis, sensitivity, and predictive negative value in hip and knee arthroplasty. Infect Control Hosp Epidemiol 2016;37:991-993. PMID:27072598

  16. Low in vitro third-body wear on total hip prostheses induced by calcium sulphate used for local antibiotic therapy

    Directory of Open Access Journals (Sweden)

    R Heuberger

    2014-10-01

    Full Text Available In case of implant associated infection, implant preservation is associated with high failure rates. Therefore, a removal or exchange of the implant is most often mandatory for treatment success. Alternatively, under certain conditions, local antibiotic delivery can be applied – preserving the implant, using for example calcium sulphate as a resorbable carrier. In this work, third-body wear on total hip prostheses caused by calcium sulphate particles was tested in a hip simulator. Inlays made of ultra-high-molecular-weight polyethylene (UHMWPE and cross-linked polyethylene (XLPE against 28 mm CoCrMo heads and 36 mm alumina pairings were tested in triplicate, both with and without calcium sulphate particles in the test liquid. Neither the alumina articulations nor the CoCrMo heads were affected by the calcium sulphate particles since calcium sulphate is a relatively soft material. The polyethylene inlays showed 39-89 % higher wear during exposure compared to references, but wear returned to normal when no more particles were added. Thus, calcium sulphate might be used as antibiotic carrier even in the presence of total hip prostheses without fearing excessive third-body wear.

  17. Tribo-biological deposits on the articulating surfaces of metal-on-polyethylene total hip implants retrieved from patients

    Science.gov (United States)

    Cui, Zhiwei; Tian, Yi-Xing; Yue, Wen; Yang, Lei; Li, Qunyang

    2016-01-01

    Artificial total hip arthroplasty (THA) is one of the most effective orthopaedic surgeries that has been used for decades. However, wear of the articulating surfaces is one of the key failure causes limiting the lifetime of total hip implant. In this paper, Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM) were employed to explore the composition and formation mechanism of the tribo-layer on the articulating surfaces of metal-on-polyethylene (MoPE) implants retrieved from patients. Results showed that, in contrast to conventional understanding, the attached tribo-layer contained not only denatured proteins but also a fraction of polymer particles. The formation of the tribo-layer was believed to relate to lubrication regime, which was supposed to be largely affected by the nature of the ultra-high-molecule-weight-polyethylene (UHMWPE). Wear and formation of tribo-layer could be minimized in elasto-hydrodynamic lubrication (EHL) regime when the UHMWPE was less stiff and have a morphology containing micro-pits; whereas the wear was more severe and tribo-layer formed in boundary lubrication. Our results and analyses suggest that enhancing interface lubrication may be more effective on reducing wear than increasing the hardness of material. This finding may shed light on the design strategy of artificial hip joints. PMID:27345704

  18. Tribo-biological deposits on the articulating surfaces of metal-on-polyethylene total hip implants retrieved from patients

    Science.gov (United States)

    Cui, Zhiwei; Tian, Yi-Xing; Yue, Wen; Yang, Lei; Li, Qunyang

    2016-06-01

    Artificial total hip arthroplasty (THA) is one of the most effective orthopaedic surgeries that has been used for decades. However, wear of the articulating surfaces is one of the key failure causes limiting the lifetime of total hip implant. In this paper, Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM) were employed to explore the composition and formation mechanism of the tribo-layer on the articulating surfaces of metal-on-polyethylene (MoPE) implants retrieved from patients. Results showed that, in contrast to conventional understanding, the attached tribo-layer contained not only denatured proteins but also a fraction of polymer particles. The formation of the tribo-layer was believed to relate to lubrication regime, which was supposed to be largely affected by the nature of the ultra-high-molecule-weight-polyethylene (UHMWPE). Wear and formation of tribo-layer could be minimized in elasto-hydrodynamic lubrication (EHL) regime when the UHMWPE was less stiff and have a morphology containing micro-pits; whereas the wear was more severe and tribo-layer formed in boundary lubrication. Our results and analyses suggest that enhancing interface lubrication may be more effective on reducing wear than increasing the hardness of material. This finding may shed light on the design strategy of artificial hip joints.

  19. Low in vitro third-body wear on total hip prostheses induced by calcium sulphate used for local antibiotic therapy.

    Science.gov (United States)

    Heuberger, R; Wahl, P; Krieg, J; Gautier, E

    2014-01-01

    In case of implant associated infection, implant preservation is associated with high failure rates. Therefore, a removal or exchange of the implant is most often mandatory for treatment success. Alternatively, under certain conditions, local antibiotic delivery can be applied - preserving the implant, using for example calcium sulphate as a resorbable carrier. In this work, third-body wear on total hip prostheses caused by calcium sulphate particles was tested in a hip simulator. Inlays made of ultra-high-molecular-weight polyethylene (UHMWPE) and cross-linked polyethylene (XLPE) against 28 mm CoCrMo heads and 36 mm alumina pairings were tested in triplicate, both with and without calcium sulphate particles in the test liquid. Neither the alumina articulations nor the CoCrMo heads were affected by the calcium sulphate particles since calcium sulphate is a relatively soft material. The polyethylene inlays showed 39-89 % higher wear during exposure compared to references, but wear returned to normal when no more particles were added. Thus, calcium sulphate might be used as antibiotic carrier even in the presence of total hip prostheses without fearing excessive third-body wear. PMID:25340804

  20. Factors influencing health-related quality of life after total hip replacement - a comparison of data from the Swedish and Danish hip arthroplasty registers

    DEFF Research Database (Denmark)

    Gordon, Max; Paulsen, Aksel; Overgaard, Søren;

    2013-01-01

    There is an increasing focus on measuring patient-reported outcomes (PROs) as part of routine medical practice, particularly in fields such as joint replacement surgery where pain relief and improvement in health-related quality of life (HRQoL) are primary outcomes. Between-country comparisons of...... health-related quality of life (HRQoL) one year after total hip replacement (THR) surgery in Sweden and in Denmark.......There is an increasing focus on measuring patient-reported outcomes (PROs) as part of routine medical practice, particularly in fields such as joint replacement surgery where pain relief and improvement in health-related quality of life (HRQoL) are primary outcomes. Between-country comparisons...

  1. Comparison of Different Materials and Proximal Coatings Used for Femoral Components in One-Stage Bilateral Total Hip Arthroplasty.

    Science.gov (United States)

    Miyatake, Kazumasa; Jinno, Tetsuya; Koga, Daisuke; Yamauchi, Yuki; Muneta, Takeshi; Okawa, Atsushi

    2015-12-01

    To evaluate the mid-term effects of different materials and coatings used for femoral components, we prospectively performed 21 one-stage bilateral total hip arthroplasties using 2 anatomical stems which have identical geometries, randomized to side. One stem was made of Ti6Al4V alloy and had a hydroxyapatite coating on grit-blasted surface proximally, and the other was made of TMZF™ alloy and had a proximal coating of hydroxyapatite in addition to an arc-deposited titanium surface coating. Although we found extensions of radiopaque lines to the surface of coatings of seven grit-blasted stems whereas we found none in the case of the arc-deposited titanium stems, all hips showed excellent clinical and radiological outcomes as shown by radiographs and bone mineral density at the final follow-up, average 5.5 years postoperatively. PMID:26190568

  2. 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.

  3. Development dysplasia of hip combined with osteoarthritis treated by total hip replacement%全髋关节置换治疗髋关节发育不良伴骨性关节炎

    Institute of Scientific and Technical Information of China (English)

    符东林; 崔西龙; 郭标; 潘檀

    2014-01-01

    Objective To explore the method of total hip replacement treating development dysplasia of hip combined with osteoarthritis within different levels. Methods 32 patients(35 hips) with development dysplasia of hip com-bined with osteoarthritis were treated with total hip replacement. Results All patients were followed up for 7 ~60 months. The Harris score was improved from 25~60 to 75~98. 25 hips got excellent hip function, 8 good and 4 fair with an excellent or good rate of 94%. No signs of loosening were found in X-ray. Conclusions Total hip replace-ment is a good and effective treatment of development dysplasia of hip associated with osteoarthritis, with joint pain relieving and function reconstruction.%目的:探讨不同分度的髋关节发育不良伴骨性关节炎患者进行关节置换的处理方法。方法对32例成人髋关节发育不良伴骨性关节炎患者(35髋)进行全髋关节置换。结果患者均获随访,时间7个月~5年。 Harris评分从术前25~60分提高到75~98分。末次随访时髋关节功能:优25髋,良8髋,可2髋,优良率为94%。 X线示无假体松动迹象。结论全髋关节置换是治疗髋关节发育不良伴骨性关节炎的良好方法,可以解决关节疼痛,恢复关节功能。

  4. Effects of Materials of Cementless Femoral Stem on the Functional Adaptation of Bone

    Institute of Scientific and Technical Information of China (English)

    He Gong; Wei Wu; Juan Fang; Xin Dong; Meisheng Zhao; Tongtong Guo

    2012-01-01

    The objective of this paper is to identify the effects of materials of cementless femoral stem on the functional adaptive behaviors of bone.The remodeling behaviors of a two-dimensional simplified model of cementless hip prosthesis with stiff stem,flexible 'iso-elastic' stem,one-dimensional Functionally Graded Material (FGM) stem and two-dimensional FGM stem for the period of four years after prosthesis replacement were quantified by incorporating the bone remodeling algorithm with finite element analysis.The distributions of bone density,von Mises stress,and interface shear stress were obtained.The results show that two-dimensional FGM stem may produce more mechanical stimuli and more uniform interface shear stress compared with the stems made of other materials,thus the host bone is well preserved.Accordingly,the two-dimensional FGM stem is an appropriate femoral implant from a biomechanical point of view.The numerical simulation in this paper can provide a quantitative computational paradigm for the changes of bone morphology caused by implants,which can help to improve the design of implant to reduce stress shielding and the risk of bone-prosthesis interface failure.

  5. Does reduced movement restrictions and use of assistive devices affect rehabilitation outcome after total hip replacement?

    DEFF Research Database (Denmark)

    Mikkelsen, Lone Ramer; Petersen, Annemette Krintel; Søballe, Kjeld;

    2014-01-01

    ). This group was compared to patients included the following 3 months with less restricted hip movement and use of assistive devices according to individual needs (unrestricted group). Questionnaires on function, pain, quality of life (HOOS), anxiety (HADS), working status and patient satisfaction were.......004). Return to work 6 weeks after THR for the unrestricted group compared to restricted group was: 53% versus 32% (P=0.045). No significant differences between groups in pain, symptoms, quality of life, anxiety/depression, hip dislocations and patient satisfaction. CONCLUSION: This study showed slightly...... slower recovery in patient-reported function after reduction in movement restrictions and use of assistive devices, but the difference was eliminated after 6 weeks. Reduced movement restrictions did not affect the other patient-reported outcomes and led to earlier return to work. CLINICAL REHABILITATION...

  6. Modular titanium alloy neck failure in total hip replacement: analysis of a relapse case

    Science.gov (United States)

    Ceretti, Marco; Falez, Francesco

    2016-01-01

    Modular neck hip prosthesis born in the 1990 with the aim of allowing the surgeon to modify CCD angle, offset and femoral anteversion intra-operatively restoring patient’s original biomechanics. In order to achieve the best biomechanics of the reconstructed hip, preoperative planning is essential. In the last few years modularity has been questioned and an argument made for the return to mono block stems due to events of breakage or disconnection of modular components. Fretting or crevice corrosion may lead to failure of such modular device due to the contamination inside the modular coupling or to high loads. We present a case of repetitive modular femoral neck prosthesis fracture. PMID:27163109

  7. Modular titanium alloy neck failure in total hip replacement: analysis of a relapse case

    Directory of Open Access Journals (Sweden)

    Ceretti Marco

    2016-01-01

    Full Text Available Modular neck hip prosthesis born in the 1990 with the aim of allowing the surgeon to modify CCD angle, offset and femoral anteversion intra-operatively restoring patient’s original biomechanics. In order to achieve the best biomechanics of the reconstructed hip, preoperative planning is essential. In the last few years modularity has been questioned and an argument made for the return to mono block stems due to events of breakage or disconnection of modular components. Fretting or crevice corrosion may lead to failure of such modular device due to the contamination inside the modular coupling or to high loads. We present a case of repetitive modular femoral neck prosthesis fracture.

  8. [50 years of total hip prosthesis--a tribute to Prof. Sir John Charnley].

    Science.gov (United States)

    Mikić, Zelimir Dj; Lesić, Aleksandar R

    2013-01-01

    November 2012 marked the 50th anniversary of the first implantation of a successful and long-lived hip endoprosthesis, which was performed by Prof Sir John Charnley in the "Centre for Hip Surgery" at a small country place in the north-west England. John Charnley (1911-1982) finished medical school at the Victoria University of Manchester in 1935, and than started training in orthopaedics at the Manchester Royal Infirmary, and completed it after the Second World War, in which he served as a volunteer. After that he continued working in the same hospital, and, apart from that he worked as a lecturer at the University of Manchester, and from 1949 as a visiting surgeon in the Wrightington Hospital. In 1958 Charnley decided to put his efforts into the development of hip replacement research and surgery, and initiated the foundation of the "Centre for Hip Surgery" with Biomechanical laboratory in the Wrightington Hospital in 1960, where the intesive basic and clinical research started, and becuase of that Charnley in 1962 left Manchester and moved with a full time practice at the Wrightington Hospital. That period of research time was not easy, there were many "trial and tribulations", but, owing to the tenacity and inventive mind of Charnley, in 1962 a new prosthesis consisting of a cemented metal stem with a 22 mm head articulating with a cemented polyethilene acetabular component, and with a low frictional torque was designed. The first such prosthesis, which later produced excellent long-term results, was implanted on November 22nd, 1962, and today, when we look back over a distance of fifty years, we can conclude that that day could be considered as a beginning of a modem aloarthroplastic surgery, and certainly as one of the greatest orthopaedic advance in the whole of the 20th century; and all that was initiated and promoted by Prof. Sir John Charnley.

  9. Surface and Subsurface Analyses of Metal-on-Polyethylene Total Hip Replacement Retrievals.

    Science.gov (United States)

    Vuong, Vicky; Pettersson, Maria; Persson, Cecilia; Larsson, Sune; Grandfield, Kathryn; Engqvist, Håkan

    2016-05-01

    Metal-on-polyethylene (MoP) articulations are one of the most reliable implanted hip prostheses. Unfortunately, long-term failure remains an obstacle to the service life. There is a lack of higher resolution research investigating the metallic surface component of MoP hip implants. This study investigates the surface and subsurface features of metallic cobalt chromium molybdenum alloy (CoCrMo) femoral head components from failed MoP retrievals. Unused prostheses were used for comparison to differentiate between wear-induced defects and imperfections incurred during implant manufacturing. The predominant scratch morphology observed on the non-implanted references was shallow and linear, whereas the scratches on the retrievals consisted of largely nonlinear, irregular scratches of varying depth (up to 150 nm in retrievals and up to 60 nm in reference samples). Characteristic hard phases were observed on the surface and subsurface material of the cast samples. Across all samples, a 100-400 nm thick nanocrystalline layer was visible in the immediate subsurface microstructure. Although observation of the nanocrystalline layer has been reported in metal-on-metal articulations, its presence in MoP retrievals and unimplanted prostheses has not been extensively examined. The results suggest that manufacturing-induced surface and subsurface microstructural features are present in MoP hip prostheses prior to implantation and naturally, these imperfections may influence the in vivo wear processes after implantation. PMID:26399989

  10. Differences in health status of older people aged 65 and above after total hip replacement compared with the normal population: a cross-sectional study

    DEFF Research Database (Denmark)

    Hørdam, Britta

    2009-01-01

    experienced by patients in the postoperative period. Relevance to clinical practice.  Patients health status is a predictor for well-being, quality of life and survival. Older people need rehabilitation after surgery to reduce dysfunction and improve perception of health. Our results demonstrate a need......The aim of the study was to describe the health status of older patients with osteoarthrosis following total hip replacement and to compare their health status with population norms in order to analyse the need for a rehabilitation programme after total hip replacement. Background.  Total hip...... replacement is a very efficient operation in terms of pain relief and improvement of walking ability. However, after the operation some patients still report low health status. Method.  A cross-sectional study including 287 older patients aged 65-74 and 75+ years who had had total hip replacement within...

  11. Ultrasound guided single injection caudal epidural anesthesia of isobaric bupivacaine with/without dexamethasone for geriatric patients undergoing total hip replacement surgery

    Directory of Open Access Journals (Sweden)

    H.A. El Gendy

    2014-07-01

    Conclusion: Adding dexamethasone with isobaric bupivacaine caudal anesthesia prolongs the duration of postoperative analgesia and decreased postoperative analgesic requirement in geriatric patients undergoing total hip replacement surgery in comparison isobaric bupivacaine alone.

  12. A Multi-centre Study to Assess the Long-term Performance of the Summit™ Hip in Primary Total Hip Replacement

    Science.gov (United States)

    2016-08-03

    Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis

  13. A Randomised Multi-centre Study to Compare the Long-term Performance of the Future Hip to 3 Other Implants in Primary Total Hip Replacement

    Science.gov (United States)

    2011-09-01

    Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis; Perthes Disease

  14. Highly Cross-Linked Polyethylene in Total Hip and Knee Replacement: Spatial Distribution of Molecular Orientation and Shape Recovery Behavior

    Directory of Open Access Journals (Sweden)

    Yasuhito Takahashi

    2014-01-01

    Full Text Available The present study investigated effects of processing procedures on morphology of highly cross-linked and re-melted UHMWPE (XLPE in total hip and knee arthroplasty (THA, TKA. The shape recovery behavior was also monitored via uniaxial compression test at room temperature after non-destructive characterizations of the in-depth microstructure by confocal/polarized Raman spectroscopy. The goal of this study was to relate the manufacturing-induced morphology to the in vivo micromechanical performance, and ultimately to explore an optimal structure in each alternative joint bearing. It was clearly confirmed that the investigated XLPE hip and knee implants, which were produced from different orthopaedic grade resins (GUR 1050 and GUR 1020, consisted of two structural regions in the as-received states: the near-surface transitional anisotropic layer (≈100 μm thickness and the bulk isotropic structural region. These XLPEs exhibited a different crystalline anisotropy and molecular texture within the near-surface layers. In addition, the knee insert showed a slightly higher efficiency of shape recovery against the applied strain over the hip liner owing to a markedly higher percentage of the bulk amorphous phase with intermolecular cross-linking. The quantitative data presented in this study might contribute to construct manufacturing strategies for further rationalized structures as alternative bearings in THA and TKA.

  15. Optimization of scan time in MRI for total hip prostheses. SEMAC tailoring for prosthetic implants containing different types of metals

    Energy Technology Data Exchange (ETDEWEB)

    Deligianni, X. [University of Basel Hospital, Basel (Switzerland). Div. of Radiological Physics; Merian Iselin Klinik, Basel (Switzerland). Inst. of Radiology; Bieri, O. [University of Basel Hospital, Basel (Switzerland). Div. of Radiological Physics; Elke, R. [Orthomerian, Basel (Switzerland); Wischer, T.; Egelhof, T. [Merian Iselin Klinik, Basel (Switzerland). Inst. of Radiology

    2015-12-15

    Magnetic resonance imaging (MRI) of soft tissues after total hip arthroplasty is of clinical interest for the diagnosis of various pathologies that are usually invisible with other imaging modalities. As a result, considerable effort has been put into the development of metal artifact reduction MRI strategies, such as slice encoding for metal artifact correction (SEMAC). Generally, the degree of metal artifact reduction with SEMAC directly relates to the overall time spent for acquisition, but there is no specific consensus about the most efficient sequence setup depending on the implant material. The aim of this article is to suggest material-tailored SEMAC protocol settings. Five of the most common total hip prostheses (1. Revision prosthesis (S-Rom), 2. Titanium alloy, 3. Mueller type (CoNiCRMo alloy), 4. Old Charnley prosthesis (Exeter/Stryker), 5. MS-30 stem (stainless-steel)) were scanned on a 1.5 T MRI clinical scanner with a SEMAC sequence with a range of artifact-resolving slice encoding steps (SES: 2 - 23) along the slice direction (yielding a total variable scan time ranging from 1 to 10 min). The reduction of the artifact volume in comparison with maximal artifact suppression was evaluated both quantitatively and qualitatively in order to establish a recommended number of steps for each case. The number of SES that reduced the artifact volume below approximately 300 mm{sup 3} ranged from 3 to 13, depending on the material. Our results showed that although 3 SES steps can be sufficient for artifact reduction for titanium prostheses, at least 11 SES should be used for prostheses made of materials such as certain alloys of stainless steel. Tailoring SES to the implant material and to the desired degree of metal artifact reduction represents a simple tool for workflow optimization of SEMAC imaging near total hip arthroplasty in a clinical setting.

  16. In-vivo 6 degrees-of-freedom kinematics of metal-on-polyethylene total hip arthroplasty during gait.

    Science.gov (United States)

    Tsai, Tsung-Yuan; Li, Jing-Sheng; Wang, Shaobai; Scarborough, Donna; Kwon, Young-Min

    2014-05-01

    Knowledge of accurate in-vivo 6 degree-of-freedom (6-DOF) kinematics of total hip arthroplasty (THA) during daily activities is critical for improvement of longevity of the components. Previous studies assessed in-vivo THA kinematics using skin marker-based motion analysis. However, skin markers are prone to move with respect to the underlying bones. A non-invasive dual fluoroscopic imaging system (DFIS) based tracking technique has been used to avoid skin artifacts and provide accurate 6-DOF kinematic measurement. This study aimed to quantify in-vivo 6-DOF THA kinematics during gait using DFIS. Twenty eight well-functioning THAs were evaluated during treadmill gait under DFIS surveillance. The maximum translations of the femoral head were 0.46±0.10mm and 0.45±0.10mm during the stance and swing phases (p=0.57), respectively. The range of hip flexion was from 8.7° to 47.6°, adduction from 3.0° to 12.5° and external rotation from 19.2° to 29.7°. The THA was flexed, externally rotated and adducted throughout the gait. The magnitudes of the femoral head translations were found to be within the manufacture tolerance of the components, suggesting that in-vivo hip "pistoning" during gait cycle may be minimal in well-functioning THAs. The 6-DOF kinematics could be used as the baseline knowledge for further improvement of wear-testing of hip implant, implants manufacturing and implant positioning during surgery.

  17. 全髋关节置换的康复护理%Total hip replacement of rehabilitation nursing

    Institute of Scientific and Technical Information of China (English)

    任丽清

    2015-01-01

    目的:探讨全髋关节置换术的患者的康复护理方法。方法对22例接受全髋关节置换术的患者实施康复护理。主要措施为:心理健康指导;术前康复训练;术后康复训练;出院前指导。结果22例患者均取得了满意的效果。结论正确的康复护理是全髋关节置换术成功的重要环节,指导患者术后进行早期功能锻炼是康复护理的重点,这样能有效地改善和增进血液循环、增加肌肉力量、预防并发症,尽早恢复满意的肢体功能。%Objective:To study the rehabilitation nursing of patients with total hip replacement method. Methods:22 cases of patients receiving total hip replacement rehabilitation nursing. The main measures for: mental health guidance; Preoperative rehabilitation training; Postoperative rehabilitation training; Before discharge guidance. Results: 22 patients were satisfactory results have been achieved. Conclusion: Rehabilitation nursing of the right is an important part of total hip replacement success, guiding patients with postoperative early functional exercise is the key of rehabilitation nursing, this can effectively improveblood circulation, increase muscle strength, prevent complications,as soon as possible to restore limb function.

  18. Risk Factors for Periacetabular Osteolysis and Wear in Asymptomatic Patients with Uncemented Total Hip Arthroplasties

    OpenAIRE

    Buster Sandgren; Joakim Crafoord; Henrik Olivecrona; Göran Garellick; Lars Weidenhielm

    2014-01-01

    Osteolysis is a silent disease leading to aseptic loosening. This has not been studied in a cohort of asymptomatic patients. The aim of this study was to detect factors that might be associated with the development of periacetabular osteolysis and wear around an uncemented cup. We assessed 206 patients with an uncemented cup, measuring wear and periacetabular osteolysis using computed tomography with a median follow-up of 10 years after surgery (range 7–14 years). EQ5D, pain from the hip, and...

  19. Development of a bone tissue-engineered construct to enhance new bone formation in revision total hip replacement

    OpenAIRE

    García Gareta, E.

    2012-01-01

    The main issue associated with revision total hip replacements (rTHRs) is how to generate new bone and restore bone stock for fixation of the revision stem. Bone tissue engineering (BTE) seeks the generation of constructs ex vivo in order to replace damaged or lost bone. The aim of this thesis was to develop a bone tissue-engineered construct with a calcium-phosphate (CaP) coated porous metal scaffold seeded throughout its structure with mesenchymal stem cells (MSCs) in order to enhance new b...

  20. Risk Factors for Moderate and Severe Persistent Pain in Patients Undergoing Total Knee and Hip Arthroplasty: A Prospective Predictive Study

    OpenAIRE

    Pinto, Patrícia R.; McIntyre,Teresa; Ferrero, Ramón; Almeida, Armando; Araújo-Soares, Vera

    2013-01-01

    Persistent post-surgical pain (PPSP) is a major clinical problem with significant individual, social and health care costs. The aim of this study was to examine the joint role of demographic, clinical and psychological risk factors in the development of moderate and severe PPSP after Total Knee and Hip Arthroplasty (TKA and THA, respectively). This was a prospective study wherein a consecutive sample of 92 patients were assessed 24 hours before (T1), 48 hours after (T2) and 4–6 months (T3) af...

  1. Radionuclide bone imaging as a means of differentiating loosening and infection in patients with a painful total hip prosthesis

    International Nuclear Information System (INIS)

    Twenty patients with 23 painful total hip prostheses were examined by radionuclide imaging (20 cases), arthrography (11 cases), needle aspriation (9 cases), and surgery (19 cases) for the purpose of assessing loosening and/or infection. Bone imaging was most accurate, showing three main distributions of activity: (a) ectopic calcification, (b) focal increased activity at the upper and lower ends of the femoral prosthesis, and (c) diffuse activity. These findings suggest that infection and loosening can be differentiated in many instances. None of the patients with focal activity had infection, compared to 2 of the 3 patients with diffuse uptake

  2. Differences in urinary prothrombin fragment 1 + 2 levels after total hip replacement in relation to venous thromboembolism and bleeding events

    DEFF Research Database (Denmark)

    Borris, L C; Breindahl, M; Lassen, M R;

    2008-01-01

    events. PATIENTS/METHODS: This study was conducted in parallel with a prospective, dose-finding study evaluating the efficacy and safety of different doses of rivaroxaban (Xarelto, Bayer HealthCare AG, Wuppertal, Germany) for thromboprophylaxis, relative to enoxaparin. Deep vein thrombosis was diagnosed......BACKGROUND: Prothrombin fragment 1 + 2 is excreted in urine (uF1 + 2) as a result of thrombin generation and, therefore, may be a useful marker of coagulation status. OBJECTIVES: To assess uF1 + 2 levels after total hip replacement (THR) in patients with venous thromboembolism (VTE) and bleeding...

  3. Serious renal and urological complications in fast-track primary total hip and knee arthroplasty; a detailed observational cohort study

    DEFF Research Database (Denmark)

    Bjerregaard, Lars S; Jorgensen, Christoffer C; Kehlet, Henrik

    2016-01-01

    BACKGROUND: Overall medical complications have been reduced after fast-track total hip (THA) and knee arthroplasty (TKA), but data on specific renal and urological (RU) complications are limited. METHODS: To describe the incidence and consequences of serious RU complications resulting in length...... postoperatively. Seven complications . (0.08 %) were urological, mainly haematuria after bladder catheterisation, whereas 5 (0.06 were urosepsis/pyelonephritis. CONCLUSION: The overall incidence of serious RU complications after fast-track THA and TKA was 0.61 %. AKI occurred in 0.49% and was most often due...

  4. Post-operative auto-transfusion in total hip or knee arthroplasty: a meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Zhao Haien

    Full Text Available BACKGROUND: Total hip or knee arthroplasty is an elective procedure that is usually accompanied by substantial blood loss, which may lead to acute anemia. As a result, almost half of total joint arthroplasty patients receive allogeneic blood transfusions (ABT. Many studies have shown that post-operative auto-transfusion (PAT significantly reduces the need for ABT, but other studies have questioned the efficacy of this method. METHODS: The protocol for this trial and supporting CONSORT checklist are available as supporting information; see Checklist S1. To evaluate the efficacy of PAT, we conducted a Cochrane systematic review that combined all available data from randomized controlled trials. Data from the six included trials were pooled for analysis. We then calculated relative risks with 95% confidence intervals (CIs for dichotomous outcomes and mean differences with 95% CIs for continuous outcomes. FINDINGS AND CONCLUSION: To our knowledge, this is the first meta-analysis to compare the clinical results between PAT and a control in joint replacement patients. This meta-analysis has proven that the use of a PAT reinfusion system reduced significantly the demand for ABT, the number of patients who require ABT and the cost of hospitalization after total knee and hip arthroplasty. This study, together with other previously published data, suggests that PAT drains are beneficial. Larger, sufficiently powered studies are necessary to evaluate the presumed reduction in the incidence of infection as well as DVT after joint arthroplasty with the use of PAT.

  5. 自体股骨头重建髋臼治疗髋关节发育不良的中期疗效%Midterm outcomes of autologous femoral head grafting in total hip arthroplasty for developmental dysplasia of the hip

    Institute of Scientific and Technical Information of China (English)

    翟吉良; 翁习生; 林进; 金今; 钱文伟; 边焱焱; 彭慧明

    2015-01-01

    Objective To evaluate the midterm outcomes of autologous femoral head grafting in total hip arthroplasty for developmental dysplasia of the hip.Methods From October 2001 to December 2011,36 patients (36 hips) with developmental dysplasia of the hip were treated by total hip arthroplasty with autologous femoral head grafting,of which 34 cases were followed up for at least 30 months.There were 6 males and 28 females.16 patients were involved in the left hip and 18 in right hip.The average age at the operation was 51 years (range,28-68 years).According to Crowe classification for developmental dysplasia of the hip,12 were type Ⅱ,16 type Ⅲ,and 6 type Ⅳ.Cementless prostheses were used for all,but one patient,who received a hybrid prosthesis.Clinical outcomes were evaluated according to Harris score and complications.Components migration,periprosthetic bone changes,the polyethylene wear rate were measured radiologically.Components position and bone healing were assessed in the anteriorposterior and lateral X-ray of the hips.Results Thirty-four patients (34 hips) were followed up for an average duration of 64.1 months (range,31-153 months).The average Harris score was 35.4 (range,23-56) preoperatively,and was 89 (range,82-95) at the latest follow-up.Twenty-eight were classified as excellent,and 6 were good,and the excellent and good rate was 100%.10 cases presented with bone absorption 2-8 months postoperatively.Four patients suffered from dislocation after surgery.All the cases were treated successfully with close reduction,except one with redislocation.Close reduction was performed for this case,and no dislocation occurred again.One patient had periprosthetic fracture due to a fall and open reduction and plate fixation was performed.The fracture was healed at 1 year follow-up,with good position of the implants.Another patient had hypertensive intracerebral hemorrhage 1 year after the surgery,who was treated by conservative treatment and had hemiplegia and

  6. Deep rolling of titanium rods for application in modular total hip arthroplasty.

    Science.gov (United States)

    Schuh, Alexander; Zeller, Christian; Holzwarth, Ulrich; Kachler, Werner; Wilcke, Gerhard; Zeiler, Günther; Eigenmann, Bernd; Bigoney, Jean

    2007-05-01

    Compressive residual stresses are commonly introduced into the near-surface regions of morse taper junctions of modular hip endoprostheses to prolong fatigue life. An increasing number of publications report that contamination of shot-peened surfaces can lead to enhanced corrosion and third body wear. This study evaluates deep rolling of titanium alloy rods as a possible alternative to shot peening. Ten rods of Ti6Al7Nb alloy with a diameter of 15 mm were deep rolled with various rolling parameters. The resulting surface topography and residual contamination was analyzed using a scanning electron microscope (SEM). The near-surface residual stress states after deep rolling were characterized by means of X-ray diffraction. The roughness of the surfaces before deep rolling was about R(z) = 14 microm, and after deep rolling surface roughness values of R(z) 0.4-7.5 microm were achieved. The results of the SEM and EDAX analyses of the sample surface showed no evidence of surface contamination by particles or abrasion products caused by any process. At a pressure of 300 bar, compressive stress reached the maximum of -1150 MPa at a depth of 0.1 mm. Deep rolling thus allows a smooth and particle-free surface to be obtained and therefore shows promise as a surface treatment for mating surfaces of morse tapers in modular hip endoprostheses.

  7. Determinación del desgaste del componente acetabular en prótesis totales de cadera. // Wear determination of acetabular component in total hip prosthesis.

    Directory of Open Access Journals (Sweden)

    G. García del Pino

    2002-01-01

    Full Text Available En este trabajo se realiza un estudio a través del Método de los Elementos Finitos “MEF” sobre el desgaste del componenteacetabular durante el ciclo de marcha y considerando algunos casos extremos de cargas como subir y bajar escaleras,levantarse de una silla, etc. Utilizando el MEF fueron modelados independientemente los componentes acetabular yfemoral de la prótesis total de cadera y puestos en contacto posteriormente. Fueron estudiadas varias posiciones delacetábulo así como diferentes casos de carga simulando pacientes con diferente peso corporal y actividades físicas. Paraevaluar los resultados se crearon rutinas en lenguaje C que organizaron los mismos para un tratamiento estadísticoposterior.Palabras claves: biomecánica, ortopedia, elementos finitos, modelación, desgaste, prótesis de cadera.___________________________________________________________________________Abstract.A wear study of acetabular component during the marching cycle, considering some extreme loads cases as: ascend anddescend stairways, get up from a seat, etc , by means of Finite Elements Method ( FEM , is carried out. The acetabular andfemoral component of the total hip prosthesis were independently modeled and placed in contact lastly. Several acetabulpositions were studied as well as different load cases, simulating patients with different body weight and different physicalactivities. To evaluate the results routines in C language were created in order to organized the same ones for a laterstatistical treatment.Key words. biomechanics, ortophedy, finite elements, modelation, wear, hip bone prosthesis.

  8. Position of the prosthesis and the incidence of dislocation following total hip replacement

    Institute of Scientific and Technical Information of China (English)

    HE Rong-xin; YAN Shi-gui; WU Li-dong; WANG Xiang-hua; DAI Xue-song

    2007-01-01

    Background Dislocation is the second most common complication of hip replacement surgery, and impact of the prosthesis is believed to be the fundamental reason. The present study employed Solidworks 2003 and MSC-Nastran software to analyze the three dimensional variables in order to investigate how to prevent dislocation following hip replacement surgery.Methods Computed tomography (CT) imaging was used to collect femoral outline data and Solidworks 2003 software was used to construct the cup model with variabilities. Nastran software was used to evaluate dislocation at different prosthesis positions and different geometrical shapes. Three dimensional movement and results from finite element method were analyzed and the values of dislocation resistance index (DRI), range of motion to impingement (ROM-I),range of motion to dislocation (ROM-D) and peak resisting moment (PRM) were determined. Computer simulation was used to evaluate the range of motion of the hip joint at different prosthesis positions.Results Finite element analysis showed: (1) Increasing the ratio of head/neck increased the ROM-I values and moderately increased ROM-D and PRM values. Increasing the head size significantly increased PRM and to some extent ROM-I and ROM-D values, which suggested that there would be a greater likelihood of dislocation. (2) Increasing the anteversion angle increased the ROM-I, ROM-D, PRM, energy required for dislocation (ENERGY-D) and DRI values,which would increase the stability of the joint. (3) As the chamber angle was increased, ROM-I, ROM-D, PRM, Energy-D and DRI values were increased, resulting in improved joint stability. Chamber angles exceeding 55(°-) resulted in increases in ROM-I and ROM-D values, but decreases in PRM, Energy-D, and DRI values, which, in turn, increased the likelihood of dislocation. (4) The cup, which was reduced posteriorly, reduced ROM-I values (2.1-5.3(°-)) and increased the DRI value (0.073). This suggested that the posterior high side

  9. Efficacy of stereoscopic visualization and six degrees of freedom interaction in preoperative planning of total hip replacement.

    Science.gov (United States)

    Testi, Debora; Lattanzi, Riccardo; Benvegnù, Marco; Petrone, Marco; Zannoni, Cinzia; Viceconti, Marco; Toni, Aldo

    2006-09-01

    The aim of this study was to assess the accuracy of a six-degrees-of-freedom application for pre-operative planning of total hip replacement in a virtual reality (VR) environment. A test was performed estimating the system inherent accuracy. The users can move objects in the VR environment with an intrinsic accuracy almost four orders of magnitude greater than the object dimension. A second unambiguous and relevant task was defined to assess the accuracy achievable with the interface in a specific planning task. The results were compared with those obtained with 2D interfaces for both the stem and the cup component. The RMSE was assumed as an indicator of the achievable accuracy. The accuracy of the immersive interface was comparable with that achievable with a standard mouse - monitor interface. The users were consistent using the VR interface, confirming the high usability of the new interface and the steep learning curve of users unfamiliar with the new environment. This study has demonstrated that the application of VR environment for pre-operative planning of total hip replacement may help to shorten the duration of the positioning and to yield consistent results even with first-time users. PMID:16954057

  10. Vision-based approach for long-term mobility monitoring: Single case study following total hip replacement

    Directory of Open Access Journals (Sweden)

    Elham Dolatabadi, MSc

    2014-11-01

    Full Text Available This article presents a single case study on the feasibility of using a low-cost and portable vision-based system (a Microsoft Kinect sensor to monitor changes in movement patterns before and after a total hip replacement surgery. The primary subject was an older male adult with total hip replacement who performed two different functional tasks: walking and sit-to-stand. The tasks were recorded with a Kinect multiple times, starting from 1 d before the surgery until 9 wk after the surgery. An automated algorithm has been developed to extract the important spatiotemporal characteristics from the video recorded functional tasks (walking and sit-to-stand. Statistical analysis was then performed by TryonC statistic to study changes in spatiotemporal characteristics between different stages before and after the surgery. The statistical analysis indicated significant difference and slight improvement between all measures from the presurgery to each postsurgery date. The study confirmed that the Kinect sensor and an automated algorithm have the potential to be integrated into a patient’s home to monitor changes in mobility during the recovery period.

  11. Quantifying gait quality in patients with large-head and conventional total hip arthroplasty

    DEFF Research Database (Denmark)

    Jensen, Carsten; Penny, Jeannette Østergaard; Nielsen, Dennis Brandborg;

    2015-01-01

    We used the Gait Deviation Index (GDI) as method to compare preoperative to postoperative gait changes after uncemented 50mm(median) large-head and 28/32mmtotal hip arthroplasty (THA). We also identified predictors of improvements in GDI. Gait analysis and patient-reported (WOMAC) datawere recorded...... in 35 patients before, 2 and 6-months after treatment. Twenty age-matched adults provided normative gait data. Contrary to our hypothesis, patientswho received large-head THA had less improvement in GDI compared with patients who received 28/32 mm THA. The preoperative GDI score was identified...... as a predictor of postoperative GDI improvement, while WOMAC, age, gender and walking speed were not. This study provides useful information for clinicians and rehabilitation specialists about gait improvement that can be expected after THA....

  12. The Treatment of Developmental Dysplasia Hip with Total Hip Replacement%人工全髋置换治疗成人髋臼发育不良合并骨关节炎

    Institute of Scientific and Technical Information of China (English)

    庞彤; 李泉; 梁柱德; 宁金沛

    2011-01-01

    目的 探讨人工全髋关节置换术治疗成人髋臼发育不良的方法.方法 2002年5月至2009年1月,对17 例21髋成人髋臼发育不良患者,应用人工全髋关节置换术予以治疗.其中男4 例,女13 例,年龄40~72 岁.双髋4 例,单髋13 例.髋关节脱位按Crowe分期,Ⅰ期4髋,Ⅱ期9髋,Ⅲ期7髋,Ⅳ期1髋.结果 本组均获随访,随访时间6个月~6年,平均3.2年.采用Harris髋关节评分法进行评分,平均83.4分.结论 人工全髋置换是治疗成人髋臼发育不良型骨关节炎的有效方法,但手术较常规置换复杂,宜严格手术适应证.%Objective To investigate the treatment of developmental dysplasia hip with total hip replacement. Methods 17 patients with 21 developmental dysplasia hips were treated with total hip arthroplasty. Results 17 cases were followed up,the mean time 3.2 years. Harris hip score averaged 83.4 points. Conclusion Total hip replacement is an effective treatment of adult developmental dysplasia hip with osteoarthritis,but it is more complicated than conventional replacement surgery,surgical indications should be stricter.

  13. The relation of body mass index, demographic and health-related variables to length of stay for patients at an acute rehabilitation hospital after total hip arthroplasty

    OpenAIRE

    Kroll, Thilo

    2010-01-01

    Karin Greenberg1, Thilo Kroll21Medical Rehabilitation, Inc, Pittsburgh, PA, USA; 2National Rehabilitation Hospital (NRH), Washington DC, WA, USAAbstract: Obesity is a growing public health concern world-wide. At the same time, knee and hip replacements are becoming an increasingly regular treatment for osteoarthritis. There are conflicting reports in the literature as to what extent body mass affects the length of stay (LOS) of patients undergoing total hip replacements. This chart review aim...

  14. Acetabular Dysplasia and Surgical Approaches Other Than Direct Anterior Increases Risk for Malpositioning of the Acetabular Component in Total Hip Arthroplasty

    DEFF Research Database (Denmark)

    Gromov, Kirill; Greene, Meridith E; Huddleston, James I;

    2016-01-01

    BACKGROUND: Persistent acetabular dysplasia (AD) after periacetabular osteotomy has been hypothesized to increase the risk for malpositioning of the acetabular component. In this study, we investigate whether AD is an independent risk factor for cup malpositioning during primary total hip...... arthroplasty (THA). METHODS: Patient demographics, surgical approach, presence of AD assessed using the lateral center-edge angle, and acetabular cup positioning determined using Martell Hip Analysis Suite were investigated in 836 primary THA patients enrolled in a prospective multicenter study. RESULTS: We...

  15. 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.

  16. Preoperative anaemia and newly diagnosed cancer 1 year after elective total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jørgensen, C. C.; Jans; Kehlet, H.;

    2015-01-01

    BACKGROUND: Preoperative anaemia is a well-established risk factor for use of blood transfusions and postoperative morbidity. Consequently, focus on preoperative evaluation of haemoglobin levels is increasing. In this context, iron deficiency anaemia may be a symptom of undiscovered...... gastrointestinal (GI) cancer requiring further investigation. However, the association between preoperative anaemia and cancer 1 year after elective total hip (THA) and total knee arthroplasty (TKA) is unknown. We evaluated 1-year cancer diagnoses, particularly GI cancers, in anaemic and non-anaemic THA and TKA......·3%) and 79 (1·6%) new cancers in anaemic and non-anaemic patients, respectively (OR: 1·38; 95% CI: 0·81-2·35, P = 0·228). After propensity matching of 661 anaemic and 1305 non-anaemic patients, we found no association between preoperative anaemia and cancer (OR: 0·94; 95% CI: 0·51-1·73, P = 0·837) or with GI...

  17. Artroplastia total do quadril não cimentada em pacientes com artrite reumatóide Uncemented total hip arthroplasty in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Bruno Tavares Rabello

    2008-08-01

    Full Text Available OBJETIVO: Analisar os resultados clínico-funcional e radiográfico das artroplastias totais do quadril não cimentadas em pacientes com artrite reumatóide. MÉTODOS: Estudo retrospectivo de 24 pacientes (28 quadris portadores de artrite reumatóide submetidos à artroplastia total do quadril, utilizando-se a prótese femoral não cimentada Secur Fit Osteonics®, com seguimento mínimo de dois anos. Clinicamente, os pacientes foram avaliados utilizando os critérios de Merle D'Aubigné, e os critérios de Engh, na avaliação radiográfica. RESULTADOS: O tempo médio de seguimento foi de 5,6 anos (dois anos a oito anos e 11 meses. Clinicamente, resultados bons e excelentes foram observados em 22 pacientes, com destaque para a melhora do parâmetro dor. Não foi evidenciado qualquer caso de afrouxamento. Complicações foram observadas em dois casos, um paciente apresentou trombose venosa profunda (TVP, comprovada com doppler, e um caso de fratura peroperatória distal ao calcar, tratada com cerclagem, sem repercussão na qualidade dos resultados clínico e radiográfico do paciente. CONCLUSÃO: Os resultados sugerem, após seguimento médio de 5,6 anos, que a artroplastia total do quadril não cimentada pode ser opção satisfatória nas coxartroses de pacientes portadores de artrite reumatóide.OBJECTIVE: To analyze clinical, functional, and radiographic results of uncemented total hip arthroplasties in patients with rheumatoid arthritis. METHODS: Retrospective study of 24 patients (28 hips with rheumatoid arthritis submitted to total hip arthroplasty, using uncemented femoral prosthesis Secur Fit Osteonics®, with minimum follow-up of two years. The patients were clinically evaluated using the Merle D'Aubigné criteria and the Engh criteria in radiographic evaluation. RESULTS: Mean follow-up time was 5.6 years (two years to eight years and 11 months. Clinically, good and excellent results were observed in 22 patients, with emphasis on pain

  18. Tribological characterization of surface-treated commercially pure titanium for femoral heads in total hip replacement: a feasibility study.

    Science.gov (United States)

    Cotogno, G; Holzwarth, U; Franchi, M; Rivetti, S; Chiesa, R

    2006-12-01

    Most noncemented total hip replacements combine a titanium alloy stem, a CoCrMo femoral head and an ultra-high molecular weight polyethylene (UHMWPE) acetabular cup. In spite of its nickel content of up to 1% and the resulting biocompatibility issues in some clinical situations, the higher cost and some difficulties in machining, CoCrMo alloy is preferred to titanium alloys thanks to its outstanding tribological properties, higher hardness and elastic modulus. Nowadays most of the heads of hip prostheses use CoCrMo as bearing material. The present study investigates the effect of various surface treatments and combinations of treatments, such as electrochemical oxidation (anodization), laser surface melting and barrel polishing, on the tribological properties of commercially pure grade 2 titanium. The aim of the study was to characterize surface treatments capable of improving the tribological properties of titanium surface to the same extent as CoCrMo. The tribological properties were characterized by multidirectional pin-on-flat screening wear tests, using UHMWPE pins as bearing surface. The experiments showed the possibility of improving the wear resistance of titanium to the degree of CoCrMo. Although further efforts will be required to optimize the treatments studied, the results are encouraging enough to warrant pursuing this direction of investigation.

  19. Assessment of Head Wear More Than Ten Years after Total Hip Arthroplasty: 22-mm Zirconia VS. Metal Heads.

    Directory of Open Access Journals (Sweden)

    Mitani,Shigeru

    2006-12-01

    Full Text Available The present retrospective study assessed radiographs to determine socket wear in total hip arthroplasty (THA with 22-mm zirconia or COP (Cobalt-Chrome alloy rich in Cobalt and Phosphorous heads, and in cemented stems at more than 10 years after operation. Sockets of ultra high molecular weight polyethylene were used in each of two THA groups (13 hips each in a clinical trial in our hospital between 1989 and 1990. Three observers carried out masked assessments of the radiographs. Upon fi nal examination, there was no remarkable loosening in the zirconia or COP group, and no case had required revision surgery as of 2005. There was a statistically signifi cant diff erence between the 2 groups in average annual linear wear, at 0.093 mm/year and 0.046 mm/year in the zirconia and COP groups, respectively. Volume wear and average annual volume wear were also signifi cantly greater in the zirconia group despite its superior mechanical strength and toughness in vitro. Our present fi ndings do not confi rm early expectations of lower wear in long-term results of 22-mm zirconia femoral heads used in THA.

  20. The contact mechanics and occurrence of edge loading in modular metal-on-polyethylene total hip replacement during daily activities.

    Science.gov (United States)

    Hua, Xijin; Li, Junyan; Jin, Zhongmin; Fisher, John

    2016-06-01

    The occurrence of edge loading in hip joint replacement has been associated with many factors such as prosthetic design, component malposition and activities of daily living. The present study aimed to quantify the occurrence of edge loading/contact at the articulating surface and to evaluate the effect of cup angles and edge loading on the contact mechanics of a modular metal-on-polyethylene (MoP) total hip replacement (THR) during different daily activities. A three-dimensional finite element model was developed based on a modular MoP bearing system. Different cup inclination and anteversion angles were modelled and six daily activities were considered. The results showed that edge loading was predicted during normal walking, ascending and descending stairs activities under steep cup inclination conditions (≥55°) while no edge loading was observed during standing up, sitting down and knee bending activities. The duration of edge loading increased with increased cup inclination angles and was affected by the cup anteversion angles. Edge loading caused elevated contact pressure at the articulating surface and substantially increased equivalent plastic strain of the polyethylene liner. The present study suggested that correct positioning the component to avoid edge loading that may occur during daily activities is important for MoP THR in clinical practice.

  1. Are morbidly obese patients undergoing total hip arthroplasty at an increased risk for component malpositioning?

    Science.gov (United States)

    Elson, Leah C; Barr, Christopher J; Chandran, Shaun E; Hansen, Viktor Johannes; Malchau, Henrik; Kwon, Young-Min

    2013-09-01

    Acetabular cup positioning is a critical factor in determining adverse clinical outcomes in THA. This evaluation was performed to determine if morbid obesity (BMI ≥35kg/m(2)) is a contributing risk factor to cup malpositioning. Two groups of patients were obtained from a local arthroplasty registry and match-controlled for gender, age, and diagnosis (n=211 morbidly obese; n=211 normal). Intraoperative data and postoperative AP pelvis and cross-table lateral radiographs were obtained for each patient. The Martell Hip Analysis Suite was used to calculate cup positioning (successful positioning defined as 30°-45° of abduction, and 5°-25° of anteversion), as well as varus-valgus alignment of the femoral stem. There was a significant correlation between morbid obesity with respect to underanteversion; using multivariate analysis, there was a trend toward a combined underanteversion/overabduction of the acetabular cup. Of all variables considered, high BMI was the most significant risk factor leading to malpositioning. PMID:23910510

  2. Cold forging stem of total hip prosthesis with hybrid mechanical properties; Forjamento a frio de hastes de protese total de quadril com propriedades mecanicas hibridas

    Energy Technology Data Exchange (ETDEWEB)

    Lopes, E.S.N.; Contieri, R.J.; Cardoso, F.F.; Cremasco, A.; Button, S.T.; Caram, R., E-mail: ederlopes@fem.unicamp.b [Universidade Estadual de Campinas (FEM/UNICAMP), SP (Brazil). Fac. de Engenharia Mecanica. Dept. de Engenharia de Materiais

    2010-07-01

    Type {beta} Ti alloy is one of the most versatile groups of materials with regard to mechanical properties. Aspects such as alloying elements selection, mechanical processing and heat treatment routes empower these materials in applications where hybrid mechanical behavior is necessary. The aim of this study is to produce stems of total hip prostheses with hybrid mechanical properties using Ti-Nb alloys. Ingots were produced by using arc melting. Following, samples were subjected to specific heat treatment aiming to make cold forging. Sample characterization includes X-ray diffraction, scanning electron microscopy, Vickers hardness tests and tensile test. The experiments performed allowed to examine the effects of heat treatment parameters on the microstructure and mechanical behavior. Finally, results obtained show that the application of specific heat treatments of quenching and aging makes feasible the manufacturing of orthopedic devices with hybrid mechanical properties with regions where high mechanical strength was prioritized, while in others, low elastic modulus was the main concern. (author)

  3. Differences in gait characteristics between total hip, knee, and ankle arthroplasty patients: a six-month postoperative comparison

    Science.gov (United States)

    2013-01-01

    Background The recovery of gait ability is one of the primary goals for patients following total arthroplasty of lower-limb joints. The aim of this study was to objectively compare gait differences of patients after unilateral total hip arthroplasty (THA), total knee arthroplasty (TKA) and total ankle arthroplasty (TAA) with a group of healthy controls. Methods A total of 26 TAA, 26 TKA and 26 THA patients with a mean (± SD) age of 64 (± 9) years were evaluated six months after surgery and compared with 26 matched healthy controls. Subjects were asked to walk at self-selected normal and fast speeds on a validated pressure mat. The following spatiotemporal gait parameters were measured: walking velocity, cadence, single-limb support (SLS) time, double-limb support (DLS) time, stance time, step length and step width. Results TAA and TKA patients walked slower than controls at normal (pTKA>THA). THA patients demonstrated no gait differences compared with controls. In contrast, TAA and TKA patients still demonstrated gait differences compared to controls, with slower walking velocity and reduced SLS in the involved limb. In addition, TAA patients presented marked side-to-side asymmetries in gait characteristics. PMID:23731906

  4. Total hip replacement rate in a cohort of patients affected by symptomatic hip osteoarthritis following intra-articular sodium hyaluronate (MW 1,500-2,000 kDa) ORTOBRIX study.

    Science.gov (United States)

    Migliore, Alberto; Bella, Antonino; Bisignani, Massimariano; Calderaro, Michele; De Amicis, Daniele; Logroscino, Giandomenico; Mariottini, Fabio; Moreschini, Oreste; Massafra, Umberto; Bizzi, Emanuele; Laganà, Bruno; Piscitelli, Prisco; Tormenta, Sandro

    2012-08-01

    Hip osteoarthritis is very common and costly. The European League Against Rheumatology Committee agenda asks for research to investigate treatments able to slow down the progression of hip osteoarthritis (OA), to delay joint replacement, and to determine the comparative effectiveness and cost-effectiveness of non-surgical and surgical treatment modalities as well as criteria relating to the indications for and timing of total hip replacement (THR). After publishing the results of a randomized controlled trial and a cohort study on the efficacy of Intra-articular sodium hyaluronate (MW 1,500-2,000 kDa) on symptomatic hip OA, we performed this retrospective study in patients suffering from hip OA treated with ultrasound-guided intra-articular injections of HyalOne (Hyalubrix 60 Italian brand name) involving a group of THR expert orthopedic surgeons to appraise whether or not considered eligible for THR and the frequency and timing of THR. Six orthopedists, not routinely performing hip intra-articular injections, each independently assessed whether 176 patients suffering from hip OA and treated with ultrasound-guided intra-articular injections of sodium hyaluronate (MW 1,500-2,000 kDa) were candidates for THR according to the clinical data (age, body mass index, Pain Visual Analog Scale, Lequesne Algofunctional Index, global patient assessment, global physician assessment, nonsteroidal anti-inflammatory drug intake, and hip X-ray) collected at the first intra-articular sodium hyaluronate injection visit and provided as anonymous electronic data. At 24 months, 159 out of 76 (90 %) patients did not undergo to THR. At 48 months, 82 % (N = 144) of the study population treated with intra-articular hyaluronic acid avoided THR. In the group of 93 patients considered candidates for THR (that is, in which 4, 5, or 6 orthopedic surgeons agreed that the patient was a suitable candidate for THR), only 17 had undergone THR, with survival results of 82 % at 24 months. At 48 months

  5. 全髋关节置换术治疗强直性脊柱炎髋关节强直%Total hip arthroplasty in the treatment of ankylosing spondilitis with hip ankylosis

    Institute of Scientific and Technical Information of China (English)

    王贵清; 蔡显义; 汤勇智; 杨立群; 黎昭华; 利洪艺

    2011-01-01

    目的 探讨全髋关节置换术治疗强直性脊柱炎髋关节强直的临床效果.方法 对11例强直性脊柱炎髋关节强直患者(22髋)进行全髋关节置换术,术后行踝关节及足趾屈伸等功能锻练.结果 术后髋关节活动度明显改善,屈曲畸形基本矫正.11例均获随访,时间2~6年.未出现关节脱位和假体松动.Harris评分由术前9~58(36±9.8)分提高到末次随访时64~94(81.2±10.6)分,优13髋,良6髋,中3髋.结论 全髋关节置换术治疗强直性脊柱炎髋关节强直能显著改善髋关节功能,矫正髋关节畸形,近期疗效满意.%Objective To study the curative effect of total hip arthroplasty( THA )in the treatment of ankylosing spondilitis with hip ankylosis.Methods 11 cases of ankylosing spondilitis with hip ankylosis( 22 hips ) were performed by THA and ankle and foot exercises were done after operation.Results Function of hip joint improved evidently after operation, and flexion deformity disappeared basically.After following up for 2 ~ 6 years, there was no sign of loosening, dislocation.The clinical results were evaluated by the Harris hip scoring system.Harris hip score improved from 9 ~58( 36 ±9.8 ) points preoperatively to 64 ~ 94( 81.2 ± 10.6 ) points at the final postoperatively evaluation.13 hips were excellent effect, 6 good and 3 fair.Conclusions THA can greatly improve the function and rectify deformity of hip joint of patients with ankylosing spondilitis with hip ankylosis.The short term curative effect is satisfactory.

  6. 全髋关节置换术治疗27例髋关节发育不良合并骨性关节炎%Total Hip Arthroplasty for 27 Cases with Hip Dysplasia and Osteoarthritis

    Institute of Scientific and Technical Information of China (English)

    罗育润

    2014-01-01

    Objective To explore the clinical effect of total hip arthroplasty on 27 cases with hip dysplasia and osteoarthritis. Methods 27 patients (33 hips) with hip dysplasia and osteoarthritis admitted in our hospital including 9 patients with Crowe type IV (12 hips), 12 patients with Crowe type Ⅲ (15 hips), 6 patients with Crowe typeⅡ(6 hips), were given total hip arthroplasty. The surgery time, hip function and corrective recovery were counted and analyzed; all the patients were followed for 3 years. Results All the operations of the patients were conducted successfully. The operation time was 65~120min; the bilateral difference in leg length was 0.5~3cm after the operation; X-ray showed that artificial acetabulums were located in the true hip socket, no prosthesis loosening;the result of the last visit showed that Harris hip score was significantly higher than the preoperative score (preoperative score was 45.15 ± 8.81; the score at 36-month visit was 87.88 ± 6.33); the range of motion was improved to some extent and the patients were satisfied with the treatment effect. Conclusion Total hip arthroplasty is an effective way for treating hip dysplasia complicated by osteoarthritis, which can correct the joint deformities, improve the joint function, and is worthy of popularization and application.%目的:探讨全髋关节置换术对髋关节发育不良合并骨性关节炎的临床疗效。方法对该院27例(33髋)髋关节发育不良合并骨性关节炎的患者施行全髋关节置换术,其中Crowe IV型患者9例(12髋),Crowe Ⅲ型患者12例(15髋),CroweⅡ型患者6例(6髋),对手术时间、髋关节功能、矫正恢复情况进行统计分析,所有患者随访3年。结果患者全部顺利完成手术,手术时间在65~120 min,术后双侧下肢长度差在0.5~3 cm,X片示人工髋臼均位于真髋关节窝内,假体无松动移位,末次回访髋关节Harris评分明显高于术前评分[分别为术前评分(45.15±8.81);36

  7. Postoperative Urinary Catheterization Thresholds of 500 versus 800 ml after Fast-track Total Hip and Knee Arthroplasty

    DEFF Research Database (Denmark)

    Bjerregaard, Lars S; Hornum, Ulla; Troldborg, Charlotte;

    2016-01-01

    BACKGROUND: No evidence-based threshold exists for postoperative urinary bladder catheterization. The authors hypothesized that a catheterization threshold of 800 ml was superior to 500 ml in reducing postoperative urinary catheterization and urological complications after fast-track total hip...... and understood Danish. Participants were randomly allocated to a catheterization threshold of 500 or 800 ml, using opaque sealed envelopes. Group assignment was unmasked. Ultrasound bladder scans were performed every second hour until the first voluntary micturition, with subsequent urinary catheterization......-protocol analysis (20 did not complete the study and 59 were excluded from the analysis). In the 500-ml group, 32.2% received catheterization (114 of 354) compared to 13.4% (49 of 367) in the 800-ml group (relative risk, 0.4; 95% CI, 0.3 to 0.6; P

  8. Tantalum acetabular augments in one-stage exchange of infected total hip arthroplasty: a case-control study.

    Science.gov (United States)

    Klatte, Till Orla; Kendoff, Daniel; Sabihi, Reza; Kamath, Atul F; Rueger, Johannes M; Gehrke, Thorsten

    2014-07-01

    During the one-stage exchange procedure for periprosthetic joint infection (PJI) after total hip arthroplasty (THA), acetabular defects challenge reconstructive options. Porous tantalum augments are an established tool for addressing acetabular destruction in aseptic cases, but their utility in septic exchange is unknown. This retrospective case-control study presents the initial results of tantalum augmentation during one-stage exchange for PJI. Primary endpoints were rates of re-infection and short-term complications associated with this technique. Study patients had no higher risk of re-infection with equivalent durability at early follow-up with a re-infection rate in both groups of 4%. In conclusion, tantalum augments are a viable option for addressing acetabular defects in one-stage exchange for septic THA. Further study is necessary to assess long-term durability when compared to traditional techniques for acetabular reconstruction. PMID:24559522

  9. Posterior dislocation of the elbow as an unusual presentation after a total hip replacement: a case report

    Directory of Open Access Journals (Sweden)

    Periasamy Kumar

    2008-02-01

    Full Text Available Abstract Introduction Posterior dislocation of the elbow is usually associated with trauma to the joint with a reported incidence of 3%to 6%. Chronic instability is usually symptomatic following the initial injury. Case presentation We report a case of posterior dislocation of the elbow occurring in a patient while using her arm to lift herself using a monkey pole on the second day following a total hip replacement. The dislocation was reduced under sedation in the ward. There were no signs or symptoms suggesting any joint hypermobility syndrome in the patient. Follow up 4 months following the injury revealed a complete recovery in the range of motion and a pain free elbow. There were no signs and symptoms of any instability. Conclusion This is the first time such a case is reported in the literature. It certainly demonstrates that even in the absence of instability a patient can be predisposed to low energy dislocation of the elbow.

  10. Biomechanical and histologic investigation of cemented total hip arthroplasties. A study of autopsy-retrieved femurs after in vivo cycling.

    Science.gov (United States)

    Maloney, W J; Jasty, M; Burke, D W; O'Connor, D O; Zalenski, E B; Bragdon, C; Harris, W H

    1989-12-01

    Eleven whole anatomic specimens of the femur were retrieved at autopsy from patients who previously had cemented total hip arthroplasty. Implant duration ranged from 0.5 to 210 months. Clinically and roentgenographically the implants were stable. A detailed biomechanical analysis evaluated bone strains and implant stability in both the single-limb stance and stair-climbing positions using a 100-pound spinal load. The stability offered by cement in these well-fixed prostheses was remarkable, with the maximum axial micromotion being 40 mu. This is a reflection of intimate osseointegration at the bone-cement interface with only rare intervening fibrous tissue. The strain gauge and photoelastic strain-coating studies revealed that marked stress shielding in the proximal medial femoral cortex persists long after a cemented femoral component is inserted. Even 17 years after surgery, the strain in the calcar region did not normalize. PMID:2582664

  11. Roles of Sagittal Anatomical Parameters of the Pelvis in Primary Total Hip Replacement for Patients with Ankylosing Spondylitis.

    Science.gov (United States)

    Gu, Minghui; Zhang, Zhiqi; Kang, Yan; Sheng, Puyi; Yang, Zibo; Zhang, Ziji; Liao, Weiming

    2015-12-01

    We examined the correlation between acetabular prostheses and sagittal anatomical parameters of the pelvis for the preoperative evaluation of total hip arthroplasty in 29 patients with ankylosing spondylitis between April 2004 and November 2011. No implant dislocation or subsidence was observed at 4.18 years. The relationship between sagittal parameters conformed to the equation Pelvic incidence (PI)=Pelvic tilt (PT)+Sacral slope (SS). Better outcomes were achieved in the SS>PT group, postoperative function was positively correlated with SS/PI. Functional abduction and anteversion were positively correlated with PT but negatively correlated with SS. Due to the compensatory changes in the pelvis and spine of patients with AS, the preoperative assessment of sagittal parameters plays pivotal roles in placing acetabular prostheses in optimal positions and preventing postoperative impingement and dislocation. PMID:26164560

  12. Prothrombin fragment 1+2 in urine as an indicator of sustained coagulation activation after total hip arthroplasty

    DEFF Research Database (Denmark)

    Borris, L.C.; Breindahl, M.; Ryge, C.;

    2007-01-01

    Purpose: Prothrombin fragment 1 + 2 measured in spot urine (uF1 + 2) is an indicator of thrombin generation. We examined whether measured levels of uF1 + 2 can be used to differentiate between patients who do and do not acquire sustained coagulation activation after total hip arthroplasty (THA). ...... (8.8%) in the second study suffered VTC or death, assumed to be caused by a coagulation problem. Analysis of variance revealed the following statistically significant associations: pre- vs. postoperative tog uF1 + 2 Levels (P...... and to examine the association between the uF1 + 2 concentrations and risk of vascular thrombotic complications (VTC) or death. Finally, we sought to define a cut-off concentration value that could be used to identify patients with a sustained uF1 + 2 elevation after the first postoperative week. The urine...

  13. Surface Characterization of Retrieved Metal-on-Metal Total Hip Implants from Patients with Adverse Reaction to Metal Debris

    Directory of Open Access Journals (Sweden)

    Maria Burbano

    2014-03-01

    Full Text Available The use of metal-on-metal (MoM total hip implants has decreased recently due to reports of high failure rates and adverse local tissue reaction (ALTR. It has been hypothesized that wear metal debris released from CoCr bearing surfaces may provoke delayed hypersensitivity reactions. The goal of this study is to evaluate the microscopic bearing surface characteristics of implants revised due to evidence of ALTR. The bearing surface of each head and cup was analyzed using multiple microscopy techniques for characterization of the surface features. The presence of severe mechanical scratching was a common characteristic found in all of the implants evaluated. Mechanical factors seemed to be the prevalent failure mode related to the appearance of ALTR with this particular set of retrieved implants.

  14. Relatives in older patients' fast-track treatment programme during total hip or knee replacement. A grounded theory study

    DEFF Research Database (Denmark)

    Berthelsen, Connie Bøttcher

    The aim of this Ph.D.-dissertation was to generate grounded theories of relatives, patients, and health professionals’ pattern of behaviour, respectively, in relation to the relatives of older patients’ fast-track treatment programmes during total hip or knee replacement. The dissertation includes...... three classic grounded theory studies discovered through Glaser’s theoretical and methodological framework. The constant comparative method was the guiding principle of simultaneous data collection, data analysis, and substantive and theoretical coding, while theoretical sampling and writing memos. Data...... was collected between 2010 and 2011 in the orthopaedic wards of two Copenhagen university hospitals, and guided by theoretical sampling. Study I: Seven relatives of patients over 70 years of age participated. Data consisted of 14 non-participant observations, 14 post-observational interviews, and five formal...

  15. [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.

  16. The effect of education and supervised exercise vs. education alone on the time to total hip replacement in patients with severe hip osteoarthritis. A randomized clinical trial protocol

    DEFF Research Database (Denmark)

    Jensen, Carsten; Roos, Ewa M.; Kjærsgaard-Andersen, Per;

    2013-01-01

    muscle function and performance in physical tests. A cost-effectiveness analysis will also be performed. Discussion: To our knowledge, this is the first randomized clinical trial comparing a patient education plus supervised exercise program to patient education alone in hip osteoarthritis patients...... replacement is considered. We hypothesize that the time to hip replacement can be postponed in patients with severe hip osteoarthritis following participation in a patient education and supervised exercise program when compared to patients receiving patient education alone. Methods/design: A prospective...... will receive 3 months of supervised exercise consisting of 12 sessions of individualized, goal-based neuromuscular training, and 12 sessions of intensive resistance training plus patient education (3 sessions). The control group will receive only patient education (3 sessions). The primary end...

  17. Preoperative progressive explosive-type resistance training is feasible and effective in patients with hip osteoarthritis scheduled for total hip arthroplasty

    DEFF Research Database (Denmark)

    Hermann, A; Holsgaard-Larsen, A; Zerahn, B;

    2016-01-01

    . The intervention group (IG) performed supervised preoperative progressive explosive-type RT twice a week for 10 weeks; four exercises (hip/thigh) performed in three series each (8-12 repetition maximum). The control group (CG) received 'care as usual'. Efficacy was reported as the between-group difference...... in the Hip Osteoarthritis Outcome Score (HOOS) (primary endpoint; ADL function), and leg muscle power at post intervention follow-up immediate before surgery. Intention-to-treat analyses were performed in a multilevel regression model adjusting for baseline, sex, age and weight. Feasibility was reported.......0001) compared to CG. CONCLUSION: Progressive explosive-type RT was feasible in the included group of hip OA patients scheduled for THA and resulted in significant improvement in self-reported outcomes and increased leg muscle power....

  18. Zweymueller螺旋臼在成人先天性髋臼发育不良外科治疗中的应用%Primary study of application with Zweymuller cementless total hip arthroplasty for adult congenital acetabular dysplasia

    Institute of Scientific and Technical Information of China (English)

    熊道海; 曹力; 张克远; 田百超

    2006-01-01

    目的:初步探讨Zweymueller型髋臼假体治疗成人先天性髋臼发育不良继发髋关节骨性关节炎的有效性.方法: 应用Zweymueller型人工全髋关节假体,对27例30个成人先天性髋关节发育不良继发髋关节骨性关节炎患者行全髋关节置换(THR).术前Harris评分最高56分,最低24分,平均42.6分.结果: 所有患者髋关节疼痛完全消失,关节活动度增加,髋臼假体稳定.Harris评分最高98分,最低78分,平均90分.X线评价无松动征像, 髋臼假体位置良好.结论: 特殊设计的Zweymueller型人工全髋关节假体髋臼重建初期稳定,手术不需大块植骨和骨水泥,初期随访效果满意.

  19. Effectiveness of autologous transfusion system in primary total hip and knee arthroplasty.

    LENUS (Irish Health Repository)

    Schneider, Marco M

    2014-01-01

    Autologous transfusion has become a cost-efficient and useful option in the treatment of patients with high blood loss following major orthopaedic surgery. However, the effectiveness of autologous transfusion in total joint replacement remains controversial.

  20. Retroperitoneal hematoma with bone resorption around the acetabular component after total hip arthroplasty: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Uchida Kenzo

    2012-09-01

    Full Text Available Abstract Introduction Vascular complications related to cup-fixating screws penetrating the medial acetabular wall during total hip arthroplasty are not uncommon but rarely are associated with serious adverse events in the late post-operative period. Case presentation We present the case of a 77-year-old Japanese woman who developed progressive extensive bone resorption and large hematoma in the acetabulum 13 years after total hip arthroplasty. On admission to our hospital, she was on oral warfarin (1.5mg/day for atrial fibrillation. About 5 months after the initiation of anticoagulant therapy, she suffered a major fall followed by massive subcutaneous and pelvic girdle bleeding, predominantly on the medial side of the right thigh, but a fracture or damage of total hip arthroplasty was not evident on an emergency orthopedic evaluation. One year after the accident, a routine follow-up examination showed an asymptomatic osteolytic lesion in the acetabulum on the right pelvis, and 2 years later our patient noticed progressive pain in her right hip during walking. A large osteolytic lesion was noted in the right acetabulum on a plain radiograph. On high-resolution computed tomography and magnetic resonance imaging, a huge granulomatous lesion in the acetabulum was suggestive of chronic hematoma in intrapelvic and extrapelvic gluteal regions. A closer computed tomography examination showed that one of the screws used for fixation of the acetabular component in the total hip arthroplasty had penetrated the acetabular bone and had reached the pelvic cavity. Surgery was performed in a single session by means of two approaches: anterior midline transperitoneal address to resect the low-density mass lesion followed by posterolateral acetabular implant re-settlement. Conclusions Though rare, total hip arthroplasty-related late vascular complications could be serious and potentially affect the limb and quality of life.

  1. Total hip replacement infected with Mycobacterium tuberculosis complicated by Addison disease and psoas muscle abscess: a case report

    Directory of Open Access Journals (Sweden)

    De Nardo Pasquale

    2012-01-01

    Full Text Available Abstract Introduction Prosthetic joint infection due to Mycobacterium tuberculosis is occasionally encountered in clinical practice. To the best of our knowledge, this is the first report of a prosthetic joint infection due to Mycobacterium tuberculosis complicated by psoas abscesses and secondary Addison disease. Case presentation A 67-year-old immunocompetent Caucasian woman underwent total left hip arthroplasty because of osteoarthritis. After 18 months, she underwent arthroplasty revision for a possible prosthetic infection. Periprosthetic tissue specimens for bacteria were negative, and empirical antibiotic therapy was unsuccessful. She was then admitted to our department because of complications arising 22 months after arthroplasty. A physical examination revealed a sinus tract overlying her left hip and skin and mucosal pigmentation. Her levels of C-reactive protein, basal cortisol, adrenocorticotropic hormone, and sodium were out of normal range. Results of the tuberculin skin test and QuantiFERON-TB Gold test were positive. Computed tomography revealed a periprosthetic abscess and the inclusion of the left psoas muscle. Results of microbiological tests were negative, but polymerase chain reaction of a specimen taken from the hip fistula was positive for Mycobacterium tuberculosis. Our patient's condition was diagnosed as prosthetic joint infection and muscle psoas abscess due to Mycobacterium tuberculosis and secondary Addison disease. She underwent standard treatment with rifampicin, ethambutol, isoniazid, and pyrazinamide associated with hydrocortisone and fludrocortisone. At 15 months from the beginning of therapy, she was in good clinical condition and free of symptoms. Conclusions Prosthetic joint infection with Mycobacterium tuberculosis is uncommon. A differential diagnosis of tuberculosis should be considered when dealing with prosthetic joint infection, especially when repeated smears and histology examination from infected

  2. Balance lower limb loads and 3D spine modifications after total hip joint replacement: effects of leg length discrepancy correction.

    Science.gov (United States)

    D'Amico, Moreno; Ciarrocca, Francesca; Liscio, Grazia; Serafini, Paolo; Tommasini, Maura; Vallasciani, Massimo

    2006-01-01

    Following total hip joint replacement (THJR), the durability of a prosthesis is limited by: wearing of frictional surfaces and loosening and migration of the prosthesis-cement-bone system. Literature review witnesses biomechanical studies focused mainly/only on hip functional state while none of them approached leg length discrepancy (LLD), posture unbalancing or spine related problems after THJR. Conversely, these latter could be critical elements for surgery and rehabilitation success, given the possible induction of asymmetric loading patterns. This study presents the results obtained by using a recently proposed methodology, to measure 3D subject posture balance and spine morphology and to evaluate its usefulness in individual therapy tuning/follow up. 3D subject's posture has been measured by means of 3D opto-electronic device, force platform and baropodography. 90 subjects after THJR have been included in this study. The subjects have been evaluated in two different epochs: 3 weeks after surgical intervention and after 3 months. 77/90 patients presented a LLD, pelvic obliquity and posture unbalancing. More than 90% of this group showed an overall postural re-balancing induced by the use of simple underfoot wedge. 70/77 patients needed wedge under the healthy side showing the surgical intervention produced a leg lengthening. 60/90 (52 LLD) patients underwent up to now to control and patients who wore the suggested wedge (63.4%) presented an improvement over all the considered quantitative parameters. Patients who wore a shorter than suggested wedge (23.1%), or that did not wear the suggested wedge (13.5%) presented a moderate or significant worsening of their postural balancing respectively.

  3. Computed tomography for preoperative planning in minimal-invasive total hip arthroplasty: Radiation exposure and cost analysis

    International Nuclear Information System (INIS)

    Computed tomography (CT) was used for preoperative planning of minimal-invasive total hip arthroplasty (THA). 92 patients (50 males, 42 females, mean age 59.5 years) with a mean body-mass-index (BMI) of 26.5 kg/m2 underwent 64-slice CT to depict the pelvis, the knee and the ankle in three independent acquisitions using combined x-, y-, and z-axis tube current modulation. Arthroplasty planning was performed using 3D-Hip Plan (Symbios, Switzerland) and patient radiation dose exposure was determined. The effects of BMI, gender, and contralateral THA on the effective dose were evaluated by an analysis-of-variance. A process-cost-analysis from the hospital perspective was done. All CT examinations were of sufficient image quality for 3D-THA planning. A mean effective dose of 4.0 mSv (SD 0.9 mSv) modeled by the BMI (p < 0.0001) was calculated. The presence of a contralateral THA (9/92 patients; p = 0.15) and the difference between males and females were not significant (p = 0.08). Personnel involved were the radiologist (4 min), the surgeon (16 min), the radiographer (12 min), and administrative personnel (4 min). A CT operation time of 11 min and direct per-patient costs of 52.80 Euro were recorded. Preoperative CT for THA was associated with a slight and justifiable increase of radiation exposure in comparison to conventional radiographs and low per-patient costs.

  4. Computed tomography for preoperative planning in minimal-invasive total hip arthroplasty: Radiation exposure and cost analysis

    Energy Technology Data Exchange (ETDEWEB)

    Huppertz, Alexander, E-mail: Alexander.Huppertz@charite.de [Imaging Science Institute Charite Berlin, Robert-Koch-Platz 7, D-10115 Berlin (Germany); Department of Radiology, Medical Physics, Charite-University Hospitals of Berlin, Chariteplatz 1, D-10117 Berlin (Germany); Radmer, Sebastian, E-mail: s.radmer@immanuel.de [Department of Orthopedic Surgery and Rheumatology, Immanuel-Krankenhaus, Koenigstr. 63, D-14109, Berlin (Germany); Asbach, Patrick, E-mail: Patrick.Asbach@charite.de [Department of Radiology, Medical Physics, Charite-University Hospitals of Berlin, Chariteplatz 1, D-10117 Berlin (Germany); Juran, Ralf, E-mail: ralf.juran@charite.de [Department of Radiology, Medical Physics, Charite-University Hospitals of Berlin, Chariteplatz 1, D-10117 Berlin (Germany); Schwenke, Carsten, E-mail: carsten.schwenke@scossis.de [Biostatistician, Scossis Statistical Consulting, Zeltinger Str. 58G, D-13465 Berlin (Germany); Diederichs, Gerd, E-mail: gerd.diederichs@charite.de [Department of Radiology, Medical Physics, Charite-University Hospitals of Berlin, Chariteplatz 1, D-10117 Berlin (Germany); Hamm, Bernd, E-mail: Bernd.Hamm@charite.de [Department of Radiology, Medical Physics, Charite-University Hospitals of Berlin, Chariteplatz 1, D-10117 Berlin (Germany); Sparmann, Martin, E-mail: m.sparmann@immanuel.de [Department of Orthopedic Surgery and Rheumatology, Immanuel-Krankenhaus, Koenigstr. 63, D-14109, Berlin (Germany)

    2011-06-15

    Computed tomography (CT) was used for preoperative planning of minimal-invasive total hip arthroplasty (THA). 92 patients (50 males, 42 females, mean age 59.5 years) with a mean body-mass-index (BMI) of 26.5 kg/m{sup 2} underwent 64-slice CT to depict the pelvis, the knee and the ankle in three independent acquisitions using combined x-, y-, and z-axis tube current modulation. Arthroplasty planning was performed using 3D-Hip Plan (Symbios, Switzerland) and patient radiation dose exposure was determined. The effects of BMI, gender, and contralateral THA on the effective dose were evaluated by an analysis-of-variance. A process-cost-analysis from the hospital perspective was done. All CT examinations were of sufficient image quality for 3D-THA planning. A mean effective dose of 4.0 mSv (SD 0.9 mSv) modeled by the BMI (p < 0.0001) was calculated. The presence of a contralateral THA (9/92 patients; p = 0.15) and the difference between males and females were not significant (p = 0.08). Personnel involved were the radiologist (4 min), the surgeon (16 min), the radiographer (12 min), and administrative personnel (4 min). A CT operation time of 11 min and direct per-patient costs of 52.80 Euro were recorded. Preoperative CT for THA was associated with a slight and justifiable increase of radiation exposure in comparison to conventional radiographs and low per-patient costs.

  5. Incidence and Future Projections of Periprosthetic Femoral Fracture Following Primary Total Hip Arthroplasty: An Analysis of International Registry Data.

    Science.gov (United States)

    Pivec, Robert; Issa, Kimona; Kapadia, Bhaveen H; Cherian, Jeffery J; Maheshwari, Aditya V; Bonutti, Peter M; Mont, Michael A

    2015-01-01

    As the number of total hip arthroplasties (THA) increases, the number of fractures will increase as well. The purpose of this study was to determine the incidence and prevalence of intra- and post-operative periprosthetic fractures following THA based on national joint registry data and to create a projection model that estimates the future fracture burden. Registry data from multiple joint registries were analyzed. Data on the incidence and prevalence of intra- and post-operative periprosthetic fractures were extracted. The prevalences between individual countries were analyzed to determine the mean prevalence. Three quantitative models were then generated to predict the fracture burden in the United States based on future population trends between 2015 and 2060. The mean incidence of post-operative periprosthetic fractures requiring revision was 0.8% while the incidence of intraoperative fractures was 0.8%. When all revision arthroplasties were assessed, the mean proportion of hips revised due to periprosthetic fracture was 6.6%. Projection models demonstrated that the number of periprosthetic fractures is expected to rise by a mean 4.6% every decade over the next 30 years. Periprosthetic fractures represent a small but important proportion of the revision THA burden worldwide. The incidence of both intra- and post-operative fractures is low, but the number is likely to steadily increase along with the number of surgeries performed. The number of fractures may rise even further as the incidence may potentially be higher in elderly, osteoporotic patients who are likely to represent a greater proportion of the arthroplasty population, particularly. PMID:26852635

  6. Taper Hip Prosthesis

    Medline Plus

    Full Text Available ... OR Live" Webcast on the Kinectiv Total Hip System. At this time, let’s join Dr. Maltry in ... going to be installing the Zimmer Kinectiv Hip System today and we'll walk you through that. ...

  7. Wear, bone density, functional outcome and survival in vitamin E-incorporated polyethylene cups in reversed hybrid total hip arthroplasty: design of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    van der Veen Hugo C

    2012-09-01

    Full Text Available Abstract Background Aseptic loosening of total hip arthroplasties is generally caused by periprosthetic bone resorption due to tissue reactions on polyethylene wear particles. In vitro testing of polyethylene cups incorporated with vitamin E shows increased wear resistance. The objective of this study is to compare vitamin E-stabilized highly cross-linked polyethylene with conventional cross-linked polyethylene in “reversed hybrid” total hip arthroplasties (cemented all-polyethylene cups combined with uncemented femoral stems. We hypothesize that the adjunction of vitamin E leads to a decrease in polyethylene wear in the long-term. We also expect changes in bone mineral density, less osteolysis, equal functional scores and increased implant survival in polyethylene cemented cups incorporated with vitamin E in the long-term. Design A double-blinded randomized controlled trial will be conducted. Patients to be included are aged under 70, suffer from non-inflammatory degenerative joint disease of the hip and are scheduled for a primary total hip arthroplasty. The study group will receive a reversed hybrid total hip arthroplasty with a vitamin E-stabilized highly cross-linked polyethylene cemented cup. The control group will receive a reversed hybrid total hip arthroplasty with a conventional cross-linked polyethylene cemented cup. Radiological follow-up will be assessed at 6 weeks and at 1, 3, 5, 7 and 10 years postoperatively, to determine polyethylene wear and osteolysis. Patient-reported functional status (HOOS, physician-reported functional status (Harris Hip Score and patients’ physical activity behavior (SQUASH will also be assessed at these intervals. Acetabular bone mineral density will be assessed by dual energy X-ray absorptiometry (DEXA at 6 weeks and at 1 year and 2 years postoperatively. Implant survival will be determined at 10 years postoperatively. Discussion In vitro results of vitamin E-stabilized polyethylene are promising

  8. Comparison of local infiltration and epidural analgesia for postoperative pain control in total knee arthroplasty and total hip arthroplasty: A systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Huan Yan

    2016-05-01

    Full Text Available Pain management after total knee arthroplasty (TKA and total hip arthroplasty should permit early mobilization with minimal pain. Local infiltration analgesia (LIA is a new popular method for decreasing postoperative pain. The goal of this meta-analysis is to evaluate the efficacy of LIA in comparison with epidural analgesia. A literature search was performed in PubMed, EMBASE, the OVID database, Web of Science, and the Cochrane Library databases. The risk of bias was assessed using the Cochrane collaboration tool. Outcomes of interest included visual analog scale score, range of flexion, length of stay, and complications. Nine trials involving 537 patients met the inclusion criteria. LIA provides better pain relief and larger range of motion in TKA patients compared to epidural analgesia at the late postoperative period. No significant difference was observed in regard to the length of stay and complications. The current evidence shows that the use of local infiltration is effective for postoperative pain management in TKA patients. More high-quality randomized controlled trials with long-term follow-up are required for examining the long-term efficacy and safety of local infiltration. 

  9. 全髋关节置换治疗CroweⅣ型成人髋关节发育性不良%Total hip arthroplasty for Crowe type IV developmental dysplasia of hip in adults

    Institute of Scientific and Technical Information of China (English)

    齐小鹏; 张元凯; 李德强; 李明

    2014-01-01

    BACKGROUND:Total hip arthroplasty is an optimal choice for patients with late hip dysplasia. Crowe type IV developmental dysplasia of the hip increases the difficulty of the operation, and the surgery is controversial. OBJECTIVE:To evaluate the clinical effects of total hip arthroplasty on Crowe type IV developmental dysplasia of the hip and the method of reconstruction of acetabulum and the treatment of proximal femur. METHODS:A total of 12 patients (14 hips) with Crowe type IV developmental dysplasia of the hip underwent total hip arthroplasty. Preoperative Harris hip score was averagely (35.0±6.8) points. Al hips were treated with smal acetabular components combined with medial protrusion technique in acetabular reconstruction, as wel as subtrochanteric shortening osteotomy in femur. Joint function of hips was evaluated according to the Harris hip score. RESULTS AND CONCLUSION:Al patients were fol owed up with an average of 4.6 years (ranged 1 to 7 years). Two cases (two hips) suffered from infraction of greater trochanter of femur during replacement, and it was fixed with wire. There was complete sciatic nerve injury in one case, which partial y restored after conservative treatment for 1 month. No infection, prosthesis loosening, or deep venous thrombosis with obvious clinical manifestations was visible. Bone union was observed at the site undergoing osteotomy at the side of femur. After replacement, final fol ow-up showed that Harris hip score was averagely (84.0±7.0) points. The mean amount of postoperative leg lengthening was 5 cm (range 4-6 cm). Shortened limbs were corrected satisfactorily. These results suggested that total hip arthroplasty using smal acetabular component, medial protrusion, and femoral subtrochanteric shortening osteotomy technique for the Crowe type IV developmental dysplasia of the hip can effectively restore hip function and leg length. The long-term curative effects require further investigations.%背景:人工全髋关节置

  10. Can Early Rehabilitation after Total Hip Arthroplasty Reduce Its Major Complications and Medical Expenses? Report from a Nationally Representative Cohort

    Directory of Open Access Journals (Sweden)

    Daniel Chiung-Jui Su

    2015-01-01

    Full Text Available Objective. To investigate whether early rehabilitation reduces the occurrence of posttotal hip arthroplasty (THA complications, adverse events, and medical expenses within one postoperative year. Method. We retrospectively retrieve data from Taiwan’s National Health Insurance Research Database. Patients who had undergone THA during the period from 1998 to 2010 were recruited, matched for propensity scores, and divided into 2 groups: early rehabilitation (Early Rehab and delayed rehabilitation (Delayed Rehab. Results. Eight hundred twenty of 999 THA patients given early rehabilitation treatments were matched to 205 of 233 THA patients given delayed rehabilitation treatments. The Delayed Rehab group had significantly (all p<0.001 higher medical and rehabilitation expenses and more outpatient department (OPD visits than the Early Rehab group. In addition, the Delayed Rehab group was associated with more prosthetic infection (odds ratio (OR: 3.152; 95% confidence interval (CI: 1.211–8.203; p<0.05 than the Early Rehab group. Conclusions. Early rehabilitation can significantly reduce the incidence of prosthetic infection, total rehabilitation expense, total medical expenses, and number of OPD visits within the first year after THA.

  11. Frequency of Osteoporosis and Osteopenia According To Bone Mineral Density of Proximal Femur Subregions in Normal and Osteopenic Postmenopausal Women With Respect to Total Hip Bone

    Directory of Open Access Journals (Sweden)

    Murat Ersöz

    2002-09-01

    Full Text Available In this study 29 normal (mean age: 65.6 ± 5.1 years and 33 osteopenic (mean age: 67.6 ± 4.9 years postmenopausal women according to total bone mineral density (BMD of the hip were evaluated for BMD values of subregions of proximal femur. The percentages for osteoporosis and osteopenia with respect to subregions were 13.8% and 58.6% for femoral neck and 20.7% and 41.4% for Ward’s triangle in normal group. In trochanteric and intertrochanteric measurements there were no T scores below –2.5 but 17.2% of the subjects were osteopenic with regard to trochanteric and 6.9% were osteopenic due to intertrochanteric BMD values. The percentages for osteoporosis and osteopenia with respect to subregion measurements were 57.6% and 42.4% for femoral neck, 60.6% and 36.4% for Ward’s triangle, 3% and 78.8% for trochanteric, 9.1% and 87.9% for intertrochanteric regions in osteopenic group according to total hip values. Knowing that hip fracture risk is increasing 2-3 fold for 1 standart deviation decrease from the young adult mean value for all subregions and knowing the relation between cervical hip fractures and BMD values of Ward’s triangle and femoral neck and the relation between intertrochanteric fractures and trochanteric BMD values, it is recommended to evaluate the BMD values of subregions of the hip besides the total hip values in daily practice.

  12. Clinical and radiographic results of primary total hip arthroplasty: an over-six-year follow-up%初次全髋关节置换术后6年以上随访的临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    李虎; 魏威; 袁燕林; 寇伯龙; 林剑浩

    2011-01-01

    Objective To evaluate the clinical results and complications of primary total hip arthroplasty (THA) over six years. Methods Between January 2001 to January 2005, 225 primary total hip arthroplasties were peformed in 210 consecutive patients in Beijing. There were 195 unilateral and 15 bilateral total hip arthroplasties, 10 hemiarthroplasties and 215 total arthroplasties. Eighteen hips were fixed with cement and 207 hips were cementless fixation. Peri-operative and postoperative treatments of patients were similar. Regular follow-up was carried out after operation. The mean follow-up period was 6. 5 years (5. 5 -8. 5 yr) . Results There were some peri-operative complications including six cases of femoral fracture, 28 cases of deep venous thrombosis of lower extremity without pulmonary embolism, four cases of wound infection, three dislocations four weeks after operation, three cases of transient disorder of consciousness. After 6. 5 years in average, 34 patients (42 hips) were lost for follow-up, and 176 patients (183 hips) were still available for clinical and radiographical follow-up. Longterm complications included one postoperative infection, two dislocations, four femoral fractures. The average Harris Hip Score increased from 40. 6 points( - 12 to 59 points) preoperatively to 80. 4 points (75 to 94 points) at the final follow-up (152 cases over 80 points, 19 cases between 70 and 80 points, five cases below 70 points). Radiographic analysis showed; small range of lucent line around the cup (three cases) and the femoral stem (four cases, six hips) ; ectopic ossification around hip joint in two patients (three hips). The stem position and the cup position were set with no evidence of prosthetic loosening or infection in other patients. Conclusion The results suggest that THA may be suitable to treat all kinds of severe diseases of hip joint, which has good clinical outcomes with less complications in this over-6-year follow-up.%目的 评价初

  13. Ranking hospitals for outcomes in total hip replacement - administrative data with or without additional patient surveys? - Part 1: Administrative data

    Directory of Open Access Journals (Sweden)

    Dörning, Hans

    2007-03-01

    Full Text Available Background: Many hospital rankings rely on the frequency of adverse outcomes and are based on administrative data. In the study presented here, we tried to find out, to what extent available administrative data of German Sickness Funds allow for an adequate hospital ranking and compared this with rankings based on additional information derived from a patient survey. Total hip replacement was chosen as an example procedure. In part I of the publication, we present the results of the approach based on administrative data. Methods: We used administrative data from the AOK-Lower Saxony of the years 2000, 2001 and 2002. The study population comprised all beneficiaries, who received total hip replacement in the years 2000 or 2001. Performance indicators used where “critical incident (Mortality or revision” and “number of revisions” within the first year. Hospitals were ranked if they performed at least 20 procedures on AOK-beneficiaries in each of the two years. Multivariate modelling (logistic and poisson regression was used to estimate the performance indicators by case-mix variables (age, sex, co-diagnoses and hospital characteristics (hospital size, surgical volume. The actual ranking was based on these multivariate models, excluding hospital variables and adding dummy-variables for each hospital. Hospitals were ranked by their case-mix adjusted odds ratio or SMR respectively with respect to a pre-selected reference hospital. The resulting rankings were compared with each other, with regard to temporal stability, and the impact of case-mix variables.Results: About 4500 beneficiaries received total hip replacement in each year (n2000: 4482; n2001: 4579. The ranking included 65 hospitals. Comparing the years 2000 and 2001, the temporal stability of the rankings based on a single performance indicator was low (Spearman rang correlation coefficients 0.158 and 0.191. The agreement of rankings based on different performance indicators in the

  14. Total hip replacement in treatment of hip dysplasia and osteoarthritis%全髋关节置换术治疗髋关节发育不良并骨性关节炎

    Institute of Scientific and Technical Information of China (English)

    龚春柱; 张卫红; 赫明堂

    2013-01-01

    Objective To investigate clinical effect of total hip arthroplasty( THA ) in treatment of hip dysplasia and osteoarthritis. Methods 19 patients ( 22 hips ) with hip dysplasia and osteoarthritis were treated by THA, The operation time, bleeding volume, the function of hip joint was analyzed and deformity correction. Results The operative time was 60 ~ 110( 85. 2 ± 11. 8 )min, the blood loss 300 ~ 1 200( 650. 3 ± 157. 7 )ml, Harris hip score improved from preoperative average of 47. 65 ±7. 85 points to 86. 54 ±6. 30 points. Shortening limbs were extended 1.5 ~4. 0 cm. 19 cases received follow-up 14 ~ 42 months, Follow-up imaging showed position of the prosthesis was normal; Joint activity was satisfied. 2 patients were still left slightly limp. Conclusions THA for hip dysplasia and osteoarthritis can significantly improve hip function, correct the deformity, and the short term effect is satisfactory.%目的 探讨全髋关节置换技术治疗髋关节发育不良并骨性关节炎的临床效果.方法 对19例(22髋)髋关节发育不良并骨性关节炎患者进行全髋关节置换术.对手术时间、术中出血量、髋关节功能及畸形矫正情况进行分析.结果 手术时间60~110(85.2±11.8)min,术中出血量300~1 200(650.3±157.7)ml.髋关节Harris评分由术前平均47.65±7.85分提高至86.54±6.30分.短缩肢体延长1.5~4.0 cm.19例均获随访,时间14~42个月,随访期内影像学显示假体位置正常;关节活动度满意.2例患者仍遗留轻度跛行.结论 全髋关节置换技术治疗髋关节发育不良并骨性关节炎能显著改善髋关节功能,纠正髋关节畸形,近期疗效满意.

  15. Predictive value of the Western Ontario and McMaster Universities Osteoarthritis Index for the amount of physical activity after total hip arthroplasty

    NARCIS (Netherlands)

    Wagenmakers, Robert; Stevens, Martin; van den Akker-Scheek, Inge; Zijlstra, Wiebren; Groothoff, Johan W.

    2008-01-01

    Background and Purpose Despite the recognized health benefits of physical activity, little is known about the amount of physical activity that patients perform after total hip arthroplasty (THA). To this end, the ability of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) t

  16. People who undergo revision arthroplasty report more limitations but no decrease in physical activity compared with primary total hip arthroplasty : an observational study

    NARCIS (Netherlands)

    Stevens, Martin; Hoekstra, Tsjerk; Wagenmakers, Robert; Bulstra, Sjoerd K.; van den Akker-Scheek, Inge

    2009-01-01

    Question: Do people who have had revision arthroplasty report more limitations and less physical activity than those after primary total hip arthroplasty? Can degree of limitation and physical activity be predicted by revision arthroplasty, after adjustment for age, gender, and Charnley classificati

  17. The difference between actual and prescribed weight bearing of total hip patients with a trochanteric osteotomy: long-term vertical force measurements inside and outside the hospital

    NARCIS (Netherlands)

    H.L.P. Hurkmans (Henri); J.B.J. Bussmann (Hans); R.W. Selles (Ruud); E. Benda (Eric); H.J. Stam (Henk); J.A.N. Verhaar (Jan)

    2007-01-01

    textabstractOBJECTIVE: To determine whether patients load the operated leg at a prescribed weight-bearing target load during postoperative recovery. DESIGN: A descriptive prospective study. SETTING: Orthopedic clinic and patients' homes. PARTICIPANTS: Fifty patients who had undergone total hip arthr

  18. Favourable results of a new intraoperative and postoperative filtered autologous blood re-transfusion system in total hip arthroplasty : A randomised controlled trial

    NARCIS (Netherlands)

    Horstmann, Wieger G.; Swierstra, Martzen J.; Ohanis, David; Rolink, Rob; Kollen, Boudewijn J.; Verheyen, Cees C. P. M.

    2014-01-01

    A new intraoperative filtered salvaged blood re-transfusion system has been developed for primary total hip arthroplasty (THA) that filters and re-transfuses the blood that is lost during THA. This system is intended to increase postoperative haemoglobin (Hb) levels, reduce perioperative net blood l

  19. 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

  20. Wear, bone density, functional outcome and survival in vitamin E-incorporated polyethylene cups in reversed hybrid total hip arthroplasty : design of a randomized controlled trial

    NARCIS (Netherlands)

    van der Veen, H.C.; Akker-Scheek, I.; Bulstra, S.K.; van Raay, J.J.A.M.

    2012-01-01

    Background: Aseptic loosening of total hip arthroplasties is generally caused by periprosthetic bone resorption due to tissue reactions on polyethylene wear particles. In vitro testing of polyethylene cups incorporated with vitamin E shows increased wear resistance. The objective of this study is to

  1. Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: A pilot randomized controlled trial

    NARCIS (Netherlands)

    Oosting, E.; Jans, M.P.; Dronkers, J.J.; Naber, R.H.; Dronkers-Landman, C.M.; Appelman-De Vries, S.M.; Meeteren, N.L. van

    2012-01-01

    Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial. Objective: To investigate the feasibility and preliminary effectiveness of a home-based intensive exercise

  2. Inter-tester Reliability of the Hand-held dynamometer and the Leg Extensor Power Rig applied on Patients after Total Hip Arthroplasty

    DEFF Research Database (Denmark)

    Mikkelsen, Lone Ramer; Mechlenburg, Inger; Petersen, Annemette Krintel;

    INTRODUCTION: Rehabilitation has an increasing focus on intensive resistance training early after joint replacement (1,2). This increases the requests for measuring changes in the muscle strength and muscle power over time. Hand-held dynamometer (HHD) is a device used to measure isometric muscle...... strength and Leg Extensor Power Rig (LEPR) is a tool for measuring muscle power. OBJECTIVES: To test the inter-tester reliability of the HHD in hip abduction and the LEPR in Total Hip Arthroplasty (THA) patients. METHODS: Two groups each consisting 20 subjects were included. Mean age was 68.4 years. All...

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

    Science.gov (United States)

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

    2015-12-01

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

  4. 全髋关节置换术在先天性髋臼发育不良继发骨性关节炎的应用%Application of total hip arthroplasty on severe developmental adult hip dysplasia

    Institute of Scientific and Technical Information of China (English)

    周耀辉; 黄文雅; 罗永发; 陈军福

    2013-01-01

      目的:探讨成人严重发育性髋关节发育不良(DDH)继发骨性关节炎进行人工全髋关节置换术(THA)的方法及治疗效果。方法:18例DDH继发骨性关节炎患者行THA,术中在软组织松解延长的基础上,重建髋关节旋转中心在真臼位置及髋关节外展功能。术后评估髋关节功能。结果:术后平均随访48个月,髋关节Harris评分平均为85分,双侧肢体长度得到恢复,CE角, Sharp角,髋臼骨对股骨头假体的覆盖率,颈干角,髋关节旋转中心垂直距离,髋关节旋转中心水平距离均较术前得到很好的恢复。结论:通过松解延长、重建关节功能、选择合适的假体,并注重对神经血管的保护,成人DDH继发骨性关节炎可以通过THA获得满意的治疗效果。%Objective:To explore the effect of the total hip arthroplasty on (DDH). Methods:18 severe developmental adult hip dysplasia patients were treated with the total hip arthroplasty. Evaluation of postoperative hip function with the Harris score standard. Results:After a mean follow-up of 48 months, the average Harris hip score was 85 points, the bilateral limb length was restored, CE angle, Sharp angle, acetabular coverage of the femoral head prosthesis, neck shaft angle, hip rotation centervertical distance and rotation horizontal distance were recovery. Conclusion: Through the reconstruction of joint function, choose the suitable prosthesis, and pay attention to the protection of the neurovascular, severe developmental adult hip dysplasia patients were get the good therapeutic effect.

  5. Can Gait Deviation Index be used effectively for the evaluation of gait pathology in total hip arthroplasty An explorative randomized trial

    DEFF Research Database (Denmark)

    Jensen, Carsten; Rosenlund, Signe; Nielsen, Dennis Brandborg;

    2014-01-01

    Purpose: Three-dimensional (3D) gait analysis is widely used in the quantitative evaluation of gait. However, 3D gait analysis produces a large volume of data, and simplifying such complex data into a single measure of patients overall gait ‘quality’ would be valuable in clinical practice. The Gait...... changes in patients with hip OA following two types of THA. Methods: A total of 38 patients (11 females and 27 males, age 56 5.6, BMI 27.8 3.6) with unilateral end-stage primary hip osteoarthritis were evaluated pre-operatively, two- and six-months after total hip arthroplasty, using 3D gait analysis...... Deviation Index (GDI), used to evaluate treatment in children with cerebral palsy, has been proposed as such a measure. The experience with GDI in osteoarthritis (OA) patients following total hip arthroplasty (THA) is unknown. The aim of our study was to use the GDI to evaluate post-operative gait quality...

  6. Cost-effectiveness of total hip and knee replacements for the Australian population with osteoarthritis: discrete-event simulation model.

    Directory of Open Access Journals (Sweden)

    Hideki Higashi

    Full Text Available BACKGROUND: Osteoarthritis constitutes a major musculoskeletal burden for the aged Australians. Hip and knee replacement surgeries are effective interventions once all conservative therapies to manage the symptoms have been exhausted. This study aims to evaluate the cost-effectiveness of hip and knee replacements in Australia. To our best knowledge, the study is the first attempt to account for the dual nature of hip and knee osteoarthritis in modelling the severities of right and left joints separately. METHODOLOGY/PRINCIPAL FINDINGS: We developed a discrete-event simulation model that follows up the individuals with osteoarthritis over their lifetimes. The model defines separate attributes for right and left joints and accounts for several repeat replacements. The Australian population with osteoarthritis who were 40 years of age or older in 2003 were followed up until extinct. Intervention effects were modelled by means of disability-adjusted life-years (DALYs averted. Both hip and knee replacements are highly cost effective (AUD 5,000 per DALY and AUD 12,000 per DALY respectively under an AUD 50,000/DALY threshold level. The exclusion of cost offsets, and inclusion of future unrelated health care costs in extended years of life, did not change the findings that the interventions are cost-effective (AUD 17,000 per DALY and AUD 26,000 per DALY respectively. However, there was a substantial difference between hip and knee replacements where surgeries administered for hips were more cost-effective than for knees. CONCLUSIONS/SIGNIFICANCE: Both hip and knee replacements are cost-effective interventions to improve the quality of life of people with osteoarthritis. It was also shown that the dual nature of hip and knee OA should be taken into account to provide more accurate estimation on the cost-effectiveness of hip and knee replacements.

  7. Adverse tissue reaction to corrosion at the neck-stem junction after modular primary total hip arthroplasty.

    Science.gov (United States)

    Gkagkalis, G; Mettraux, P; Omoumi, P; Mischler, S; Rüdiger, H A

    2015-02-01

    Complications related to the neck-stem junction of modular stems used for total hip arthroplasty (THA) are generating increasing concern. A 74-year-old male had increasing pain and a cutaneous reaction around the scar 1 year after THA with a modular neck-stem. Imaging revealed osteolysis of the calcar and a pseudo-tumour adjacent to the neck-stem junction. Serum cobalt levels were elevated. Revision surgery to exchange the stem and liner and to resect the pseudo-tumour was performed. Analysis of the stem by scanning electron microscopy and by energy dispersive X-ray and white light interferometry showed fretting corrosion at the neck-stem junction contrasting with minimal changes at the head-neck junction. Thus, despite dry assembly of the neck and stem on the back table at primary THA, full neck-stem contact was not achieved, and the resulting micromotion at the interface led to fretting corrosion. This case highlights the mechanism of fretting corrosion at the neck-stem interface responsible for adverse local tissue reactions. Clinical and radiological follow-up is mandatory in patients with dual-modular stems.

  8. Clinical and roentgenographic evaluation of hydroxyapatite-coated and uncoated porous total hip arthroplasty: a preliminary report.

    Science.gov (United States)

    Ciccotti, M G; Rothman, R H; Veress, S A; Hozack, W J; Moriarty, L; Beight, J

    1991-10-01

    Sixty osteoarthritic patients undergoing primary uncemented total hip arthroplasty were matched for age and weight and randomized into one of four groups with respect to implant coating and postoperative protected weight-bearing status: group 1, hydroxyapatite, 12 weeks; group 2, uncoated, 12 weeks; group 3, hydroxyapatite, 6 weeks; group 4, uncoated, 6 weeks. Tantalum spheres were implanted periprosthetically into the femur at the time of arthroplasty, thus providing constant references for stereoscopic radiographs. Patients were then evaluated over a 1-year period with clinical examination, plain radiography, and roentgen stereophotogrammetric analysis (RSA). Clinical evaluation using Charnley scoring showed no significant preoperative or postoperative intergroup differences, whereas visual analog testing noted less thigh pain with hydroxyapatite-coated stems at 12 weeks and 6 months follow-up. Plain radiographic analysis produced no significant differences, with no instability detected and bony ingrowth noted uniformly in all groups. The preliminary stereographic evaluation showed migration in all groups, but there were no significant differences between coated and uncoated stems or 6-week and 12-week partial weightbearing protocols. The Charnley, plain radiographic, and preliminary stereogrammetric evaluations all suggest that migration is unaltered by enhanced surfaces and that early unprotected weightbearing does not jeopardize implant fixation regardless of coating design. The lower incidence of visual analog thigh pain with the hydroxyapatite-coated stems, however, may be a reflection of bony ingrowth and as such add some validity to the theoretical advantages of enhanced surface prostheses. PMID:10149615

  9. The Impact of Hypotensive Epidural Anesthesia on Distal and Proximal Tissue Perfusion in Patients Undergoing Total Hip Arthroplasty

    Science.gov (United States)

    Danninger, Thomas; Stundner, Ottokar; Ma, Yan; Bae, James J; Memtsoudis, Stavros G

    2014-01-01

    Little data exists to detail the effect of hypotensive epidural anesthesia on differential tissue oxygenation changes above and below the level of neuraxial blockade. This study was designed to investigate tissue oxygenation in a clinical setting, using non-invasive near-infrared spectroscopy. Methods Patients aged 18 to 85 years scheduled to undergo primary total hip arthroplasty were enrolled. Muscle oxygenation saturation was measured above and below the level of neuraxial blockade (deltoid and vastus lateralis muscles). Other continuously recorded parameters included cardiac output, stroke volume, heart rate, invasive mean arterial blood pressure and arterial oxygen saturation. Recordings of muscle oxygenation were compared over time separately for upper and lower extremity. Results 10 patients were enrolled. We found an intermittent and significant unadjusted decline of mean muscle oxygenation saturation in the vastus lateralis muscle during first part of the surgery (nadir 2nd quintile: 71.0% vs. 63.3%, p<0.0001). This decline was followed by a return to baseline towards the end of the surgery (71.0% vs. 69.1%, p=0.3429). Mean muscle oxygenation saturation did not change for the same period of time in the deltoid muscle. When adjusting for covariates, the changes in muscle tissue oxygenation remained significant. Conclusion These results indicate that muscle oxygenation saturation, a surrogate parameter for tissue perfusion, is decreased by hypotensive epidural anesthesia, but only within the functional limits of the neuraxial blockade. The etiology of these findings remains to be elucidated. PMID:24563810

  10. Validity of a simple Internet-based outcome-prediction tool in patients with total hip replacement: a pilot study.

    Science.gov (United States)

    Stöckli, Cornel; Theiler, Robert; Sidelnikov, Eduard; Balsiger, Maria; Ferrari, Stephen M; Buchzig, Beatus; Uehlinger, Kurt; Riniker, Christoph; Bischoff-Ferrari, Heike A

    2014-04-01

    We developed a user-friendly Internet-based tool for patients undergoing total hip replacement (THR) due to osteoarthritis to predict their pain and function after surgery. In the first step, the key questions were identified by statistical modelling in a data set of 375 patients undergoing THR. Based on multiple regression, we identified the two most predictive WOMAC questions for pain and the three most predictive WOMAC questions for functional outcome, while controlling for comorbidity, body mass index, age, gender and specific comorbidities relevant to the outcome. In the second step, a pilot study was performed to validate the resulting tool against the full WOMAC questionnaire among 108 patients undergoing THR. The mean difference between observed (WOMAC) and model-predicted value was -1.1 points (95% confidence interval, CI -3.8, 1.5) for pain and -2.5 points (95% CI -5.3, 0.3) for function. The model-predicted value was within 20% of the observed value in 48% of cases for pain and in 57% of cases for function. The tool demonstrated moderate validity, but performed weakly for patients with extreme levels of pain and extreme functional limitations at 3 months post surgery. This may have been partly due to early complications after surgery. However, the outcome-prediction tool may be useful in helping patients to become better informed about the realistic outcome of their THR. PMID:24585892

  11. The stress response and anesthetic potency of unilateral spinal anesthesia for total Hip Replacement in geriatric patients.

    Science.gov (United States)

    Zhu, Li; Tian, Chun; Li, Min; Peng, Ming-Qing; Ma, Kun-Long; Wang, Zhong-Lin; Ding, Jia-Hui; Cai, Yi

    2014-11-01

    Recently, some scholars suggested that it is important to keep a stablehemodynamic state and prevent the stress responses in geriatric patients undergoing total hip replacement (THR). We conducted this randomized prospective study to observe anesthetic potency of unilateral spinal anesthesia and stress response to it in geriatric patients during THR. We compared the effect of unilateral spinal and bilateral spinal on inhibition of stress response through measuring Norepinephrine (NE), epinephrine (E) and cortisol (CORT). Plasma concentrations of NE, E and CORT were determined in blood samples using ELISA (enzyme-linked immunosorbent assays) at three time points: To (prior to anesthesia) T1 (at the time point of skin closure), T2 (twenty-four hours after the operation). Sixty patients were randomly divided into two groups: group A (unilateral spinal anesthesia) and group B (conventional bilateral spinal anesthesia). 7.5tymg of hypobaric bupivacaine were injected into subarachnoid cavity at group A and 12mg hypobaric bupivacaine were given at group B. The onset time of sensory and motor block, loss of pinprick sensation, degree of motor block, regression of sensory and motor blocks and hemodynamic changes were also recorded. These data were used to evaluate anesthetic potency of spinal anesthesia. The results of this experiment show that unilateral spinal anesthesia can provide restriction of sensory and motor block, minimize the incidence of hypotension and prevent the stress responses undergoing THR. It is optimal anesthesia procedure for geriatric patients by rapid subarachnoid injection of small doses of bupivacaine.

  12. Cost effectiveness of total hip arthroplasty in osteoarthritis: comparison of devices with differing bearing surfaces and modes of fixation.

    Science.gov (United States)

    Pulikottil-Jacob, R; Connock, M; Kandala, N-B; Mistry, H; Grove, A; Freeman, K; Costa, M; Sutcliffe, P; Clarke, A

    2015-04-01

    Many different designs of total hip arthroplasty (THA) with varying performance and cost are available. The identification of those which are the most cost-effective could allow significant cost-savings. We used an established Markov model to examine the cost effectiveness of five frequently used categories of THA which differed according to bearing surface and mode of fixation, using data from the National Joint Registry for England and Wales. Kaplan-Meier analyses of rates of revision for men and women were modelled with parametric distributions. Costs of devices were provided by the NHS Supply Chain and associated costs were taken from existing studies. Lifetime costs, lifetime quality-adjusted-life-years (QALYs) and the probability of a device being cost effective at a willingness to pay £20 000/QALY were included in the models. The differences in QALYs between different categories of implant were extremely small (< 0.0039 QALYs for men or women over the patient's lifetime) and differences in cost were also marginal (£2500 to £3000 in the same time period). As a result, the probability of any particular device being the most cost effective was very sensitive to small, plausible changes in quality of life estimates and cost. Our results suggest that available evidence does not support recommending a particular device on cost effectiveness grounds alone. We would recommend that the choice of prosthesis should be determined by the rate of revision, local costs and the preferences of the surgeon and patient. PMID:25820881

  13. 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.

  14. Effect of total hip replacement on lumbago in unilateral developmental hip dysplasla%全髋关节置换术后对单侧髋关节发育不良患者腰痛症状的影响

    Institute of Scientific and Technical Information of China (English)

    李桓毅; 吴海山; 李晓华; 吴宇黎; 祝云利; 赵辉

    2008-01-01

    Objective To assess the effect of total hip replacement on lumbago in patients with unilaterally developmental hip dysplasia.Methods From January 2001 to January 2006, 39 adult patients with unilateral developmental hip dysplasia coexiting lumbago were included.Among.them, there were 32 females and 7 males, age from 38 years to 73 years.According to Crowe classification system, there were 4 in type Ⅰ , 20 in type Ⅱ, 8 in type Ⅲ and 7 in type Ⅳ.They were performed total hip replacement.The Harris Hip Score and the Oswestry Disability Index were used to evaluate hip and spine symptoms in same patient before and 3, 24 months after operation.Results Thirty-nine patients were evaluated, both hip and spinal pain and function were significant improved.The mean Harris score increased from 44 to 84 ( P <0.01 ).The mean Oswestry Scores dropped from 36 to 25 ( P < 0.01 ).Conclusion Spinal function and lumbago is improved after total hip replacement in patients with unilateral developmental hip dysplasia at 3 months, which is maintained and enhanced in 2 years.%目的 评价单侧成人髋关节发育不良全髋关节置换术后患者腰痛症状的变化.方法 2001年1月至2006年1月,对39例合并腰痛的单侧成人髋关节发育不良患者行全髋关节置换术,其中男性7例,女性32例,患者平均年龄53岁(38-73岁).Crowe Ⅰ型4例,Crowe Ⅱ型20例,Ⅲ型8例,Ⅳ型7例.全部患者于真臼位置重建髋臼或小于2 cm的运动中心上移进行髋关节置换.分别于术前,术后3、24个月对同一患者进行髋关节Harris评分,腰痛Oswestry评分.髋关节术前Harris评分(44±7)分,Oswestry评分平均(36±4)分.结果 39例患者全部获得随访,髋部和腰部疼痛和功能均获得了显著改善,3个月后Harris评分(80±6)分(P<0.01),24个月为(84±6)分(P<0.05).术后3个月Oswestry评分为(25±4)分(P<0.01),24个月为(23±4)分(P>0.05).结论 对合并下腰痛的单侧髋关节发育不良患者行全髋

  15. 全髋关节置换后的康复训练程序%The rehabilitation procedure following total hip arthroplasty

    Institute of Scientific and Technical Information of China (English)

    秦晓勇; 熊杰; 詹曦菁

    2012-01-01

    背景 全髋关节置换后的康复训练对置换后患者肢体康复起非常重要的作用.目的 回顾分析全髋关节置换后康复训练程序的组成、方法、效果评价、发展及存在的问题.方法 以"全髋关节置换,康复,物理治疗,功能锻炼"为中文关键词,以"total hip arthroplasty;total hip replacement;physical rehabilitation;rehabilitation trainning"为英文关键词,采用计算机检索CNKI 和Medline 数据库1996-01/2012-02关于全髋关节置换后康复训练的文章.结果与结论 全髋关节置换后的康复训练内容主要以体位护理、运动疗法为主,并可配合以人工按摩及磁疗、电疗、超声波疗法等.采用运动疗法时,要注意循序渐进原则,由最初的被动运动,逐渐过渡到主动运动.根据手术类型、假体种类、患者情况等选择合适的康复训练程序可明显提高患者患侧髋关节功能恢复的速度和质量.%BACKGROUND: The rehabilitation training plays an important role in the physical rehabilitation of patients after total hip arthroplasty.OBJECTIVE: To take retrospective analysis of the articles about the composition, methods, outcome evaluation, development and problems of total hip arthroplasty rehabilitation procedure.METHODS: A computer-based online search of PubMed database and CNKI database was performed for articles regarding the rehabilitation training following total hip anthroplasty, with the key words of “total hip arthroplasty; total hip replacement; physical rehabilitation; rehabilitation trainning” in English and Chinese.RESULTS AND CONCLUSION: The rehabilitation training after total hip arthroplasty is mainly depend on posture nursing and physical therapy, combined with manual massage and magnetic therapy, electrotherapy and ultrasound therapy, etc. When using the exercise therapy, we should pay more attention to the proper sequence principle; the active exercise should be gradually transited from the initial passive

  16. Osseointegration: a review of the fundamentals for assuring cementless skeletal fixation

    Directory of Open Access Journals (Sweden)

    Isaacson BM

    2014-04-01

    Full Text Available Brad M Isaacson,1,2 Sujee Jeyapalina3,4 1Henry M Jackson Foundation for the Advancement of Military Medicine, 2The Center for Rehabilitation Sciences Research, Department of Physical Medicine and Rehabilitation, Uniformed Services University of Health Sciences, Bethesda, MD, USA; 3Department of Orthopedics, 4Orthopedic Research Laboratory, University of Utah, Salt Lake City, UT, USA Abstract: Direct skeletal fixation, termed osseointegration, has expanded in the last century and includes use in total joint replacements, the edentulous mandible and maxilla, and percutaneous osseointegrated prosthetics. Although it is well known that titanium and bone have the ability to form a durable bone–implant interface, new applications have emerged in the field of orthopedics, which requires a more thorough assessment of the literature. This review aims to introduce the basic biological principles for attaining osseointegration and discusses the major factors for assuring successful cementless fixation. Keywords: osseointegration, bone, skeletal attachment, total joint replacements, dental implants, percutaneous

  17. Adult Developmental Dysplasia of the Hip after Total Hip Arthroplasty Clinical Study%成人髋关节发育性不良行全髋关节置换术治疗临床研究

    Institute of Scientific and Technical Information of China (English)

    韩晓红

    2015-01-01

    目的:探究对于成人髋关节发育性不良行全髋关节置换术所存在的价值进行探究。方法选取我院近年来成人髋关节发育性不良的患者,共12例,采取全髋关节置换术治疗我院成人髋关节发育性不良的患者,在术前,记录这12例患者的症状,体征,肢体长度,骨骼程度等,术后再次进行测定以及在术后日常生活中定期访问记录康复情况,进行最终数据的对比分析,得出结论。结果通过这12例髋关节发育性不良患者的术后观察发现,并无感染症状。在患者术后出院之后进行又对他们进行定期的康复状况探访,持续半年至6年,得出4例患者未出现关节疼痛、不适等症状。3例患者出现稍微的关节疼痛感,但较以往减轻。2例患者出现肢体长度不一样的表现。结论通过术后感染症状的检测以及术后探访的观察,得出行全髋关节置换术对于治疗成人髋关节发育性不良很有价值,值得各大医院学习研究。%Objective To investigate the adult developmental dysplasia of the hip after total hip arthroplasty to explore the value of existence. MethodsIn our hospital in recent years, hip dysplasia of adult patients, a total of 12 cases, taking the total hip joint replacement surgery treatment of adult patients with dysplasia of the hip in our hospital before surgery, 12 patients recorded symptoms, signs limb length, bone degree, measurement and again after regular visits recorded in the postoperative recovery from daily life, comparative analysis of the final data, and draw conclusions.Results By hip dysplasia 12 cases of postoperative patients found no signs of infection. After patients were discharged to them again, regular visits to rehabilitation situation, the last six months to six years, four patients come to joint pain, discomfort and other symptoms did not appear. 3 patients feel a slight pain in the joints, but more in the past

  18. Bilateral Staged Total Hip Replacement and the Natural Progress of an Untreated Case of Developmental Dysplasia (Dislocation of the Hip: A Clinical Case Report by the Surgeon and the Patient

    Directory of Open Access Journals (Sweden)

    Hamid Honarpisheh

    2015-07-01

    Full Text Available The natural history of an untreated case of a Developmental Dysplasia (Dislocation of the Hip (DDH associated with multiple congenital abnormalities is reported in a 55-years-old man. The patient’s complaints and the varieties of the typical manifestations emerged in other parts of the body throughout the life are reviewed and discussed as comorbidities of a dysplastic condition. Two-stage bilateral total hip replacement (THR operations were performed at the age of 55. In addition, to relieve the pain, the walking disabilities were overcome, hence gaining normal walking in swing and stances. The leg length discrepancy was corrected by anatomically positioned prostheses, examined by the knee bending test and characterized and evidenced by radiological features and indices.

  19. Bilateral Staged Total Hip Replacement and the Natural Progress of an Untreated Case of Developmental Dysplasia (Dislocation) of the Hip: A Clinical Case Report by the Surgeon and the Patient.

    Science.gov (United States)

    Honarpisheh, Hamid; Ghazavi, Mohammad Taghi

    2015-07-01

    The natural history of an untreated case of a Developmental Dysplasia (Dislocation) of the Hip (DDH) associated with multiple congenital abnormalities is reported in a 55-years-old man. The patient's complaints and the varieties of the typical manifestations emerged in other parts of the body throughout the life are reviewed and discussed as comorbidities of a dysplastic condition. Two-stage bilateral total hip replacement (THR) operations were performed at the age of 55. In addition, to relieve the pain, the walking disabilities were overcome, hence gaining normal walking in swing and stances. The leg length discrepancy was corrected by anatomically positioned prostheses, examined by the knee bending test and characterized and evidenced by radiological features and indices. PMID:26170527

  20. Total Hip Replacement

    Science.gov (United States)

    ... the help of a walking support and a physical therapist the day after surgery. In some cases, patients ... walking on the actual day of surgery. The physical therapist will teach you specific exercises to strengthen your ...