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Sample records for hybrid total hip

  1. Modular hybrid total hip arthroplasty. Experimental study in dogs

    Directory of Open Access Journals (Sweden)

    Ranzani José JT

    2011-07-01

    Full Text Available Abstract Background This prospective experimental study evaluated the surgical procedure and results of modular hybrid total hip arthroplasty in dogs. Methods Ten skeletally mature healthy mongrel dogs with weights varying between 19 and 27 kg were used. Cemented modular femoral stems and uncemented porous-coated acetabular cups were employed. Clinical and radiographic evaluations were performed before surgery and at 30, 60, 90, 120, 180 and 360 days post-operation. Results Excellent weight bearing was noticed in the operated limb in seven dogs. Dislocation followed by loosening of the prosthesis was noticed in two dogs, which were therefore properly treated with a femoral head osteotomy. Femoral fracture occurred in one dog, which was promptly treated with full implant removal and femoral osteosynthesis. Conclusions The canine modular hybrid total hip arthroplasty provided excellent functionality of the operated limb.

  2. Cemented, cementless, and hybrid prostheses for total hip replacement: cost effectiveness analysis

    OpenAIRE

    Pennington, Mark; Grieve, Richard; Sekhon, Jasjeet S; Gregg, Paul; Black, Nick; van der Meulen, Jan H

    2013-01-01

    OBJECTIVE To compare the cost effectiveness of the three most commonly chosen types of prosthesis for total hip replacement. DESIGN Lifetime cost effectiveness model with parameters estimated from individual patient data obtained from three large national databases. SETTING English National Health Service. PARTICIPANTS Adults aged 55 to 84 undergoing primary total hip replacement for osteoarthritis. INTERVENTIONS Total hip replacement using either cemented, cementless, or hybrid prostheses. M...

  3. Cemented, cementless, and hybrid prostheses for total hip replacement: cost effectiveness analysis.

    Science.gov (United States)

    Pennington, Mark; Grieve, Richard; Sekhon, Jasjeet S; Gregg, Paul; Black, Nick; van der Meulen, Jan H

    2013-02-27

    To compare the cost effectiveness of the three most commonly chosen types of prosthesis for total hip replacement. Lifetime cost effectiveness model with parameters estimated from individual patient data obtained from three large national databases. English National Health Service. Adults aged 55 to 84 undergoing primary total hip replacement for osteoarthritis. Total hip replacement using either cemented, cementless, or hybrid prostheses. Cost (£), quality of life (EQ-5D-3L, where 0 represents death and 1 perfect health), quality adjusted life years (QALYs), incremental cost effectiveness ratios, and the probability that each prosthesis type is the most cost effective at alternative thresholds of willingness to pay for a QALY gain. Lifetime costs were generally lowest with cemented prostheses, and postoperative quality of life and lifetime QALYs were highest with hybrid prostheses. For example, in women aged 70 mean costs were £6900 ($11 000; €8200) for cemented prostheses, £7800 for cementless prostheses, and £7500 for hybrid prostheses; mean postoperative EQ-5D scores were 0.78, 0.80, and 0.81, and the corresponding lifetime QALYs were 9.0, 9.2, and 9.3 years. The incremental cost per QALY for hybrid compared with cemented prostheses was £2500. If the threshold willingness to pay for a QALY gain exceeded £10 000, the probability that hybrid prostheses were most cost effective was about 70%. Hybrid prostheses have the highest probability of being the most cost effective in all subgroups, except in women aged 80, where cemented prostheses were most cost effective. Cemented prostheses were the least costly type for total hip replacement, but for most patient groups hybrid prostheses were the most cost effective. Cementless prostheses did not provide sufficient improvement in health outcomes to justify their additional costs.

  4. The effect of collar on aseptic loosening and proximal femoral bone resorption in hybrid total hip arthroplasty.

    Science.gov (United States)

    Caglar, Omur; Atilla, Bulent; Tokgozoglu, Mazhar; Alpaslan, Mumtaz

    2008-03-01

    This study compared proximal femoral bone resorption in hybrid total hip arthroplasty cases that had poor or good contact between the collar and proximal medial femoral neck. A total of 94 patients (102 hips) comprised the study group. Mean patient age was 52 years, and mean follow-up was 4.86 years. Bone resorption of the proximal femur was evaluated with immediate postoperative and follow-up anteroposterior and lateral radiographs. Statistical analysis using the Mann-Whitney test showed no significant difference between the groups that had good or poor contact. The collar did not prevent calcar resorption even when ideal contact was achieved.

  5. Metal release and metal allergy after total hip replacement with resurfacing versus conventional hybrid prosthesis

    DEFF Research Database (Denmark)

    Gustafson, Klas; Jakobsen, Stig Storgaard; Lorenzen, Nina D

    2014-01-01

    BACKGROUND: Metal-on-metal (MOM) total hip arthroplasties were reintroduced because of the problems with osteolysis and aseptic loosening related to polyethylene wear of early metal-on-polyethylene (MOP) arthroplasties. The volumetric wear rate has been greatly reduced with MOM arthroplasties......; however, because of nano-size wear particles, the absolute number has been greatly increased. Thus, a source of metal ion exposure with the potential to sensitize patients is present. We hypothesized that higher amounts of wear particles result in increased release of metal ions and ultimately lead...... to an increased incidence of metal allergy. METHODS: 52 hips in 52 patients (median age 60 (51-64) years, 30 women) were randomized to either a MOM hip resurfacing system (ReCap) or a standard MOP total hip arthoplasty (Mallory Head/Exeter). Spot urine samples were collected preoperatively, postoperatively, after...

  6. Radiographic and tomographic evaluation of total hybrid hip replacement in dogs; Avaliacao radiografica e tomografica de caes submetidosa artroplastia coxofemoral total hibrida

    Energy Technology Data Exchange (ETDEWEB)

    Minto, B.W., E-mail: brunowminto@gmail.com [Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Jaboticabal, SP (Brazil); Brandao, C.V.S.; Pereira, G.J.C.; Babicsak, V.R.; Vulcano, L.C.; Rossetto, V.J.V. [Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Botucatu, SP (Brazil)

    2016-11-15

    The total hip arthroplasty is the most effective surgical technique for the treatment of severe canine hip dysplasia. Currently, the radiographic examination is the most common method used to assess this procedure in dogs, but has some limitations. CT scan by computed tomography instead enables the acquisition of images without overlap, thereby determining the positioning of prosthetic components with greater accuracy. This research aimed to evaluate by radiography and CT scan examinations the use of a hybrid modular total hip prosthesis developed and made in Brazil, applied experimentally in healthy dogs. Six skeletally mature dogs, which previously underwent surgery on the left hip joint were used. The dogs underwent CT scan at 360 days and three years after surgery. All animals showed good positioning of prosthetic components, and proper joint reduction. In the CT scan, however, it was possible to detect irregular fill areas in some animals. In addition, CT scan allowed the detection and monitoring of areas of bone resorption around the acetabular component. Therefore, the CT scan was useful in the evaluation of prosthetic joints, with the advantage of optimum sharpness of the images and allowing for the possibility of quantifying peri-prosthetic changes and measure joint, fundamental relations for late postoperative follow-up. (author)

  7. 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)

  8. Total Hip Replacement

    Science.gov (United States)

    ... can occur after surgery. Avoiding Problems After Surgery Hip implant dislocation. Recognizing the Signs of a Blood Clot Follow ... Other Precautions To assure proper recovery and prevent dislocation of the ... your hip replacement. Prior to discharge from the hospital, your ...

  9. INNOPLANT Total Hip Replacement System.

    Science.gov (United States)

    Harper, Tisha A M

    2017-07-01

    Total hip replacement is a salvage procedure that is done to alleviate discomfort secondary to osteoarthritis in the hip, which is most often a result of hip dysplasia. Commercially available total hip replacement implants for small animal patients are classified as cemented or cementless. The INNOPLANT Total Hip Replacement system includes modular, screw-in cementless components that were developed to improve implant stability by maintaining as much normal anatomic structure, and by extension biomechanics of the coxofemoral joint, as possible. As a newer system, there are few data and no long-term studies available in the veterinary literature. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. 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

  11. Obesity in total hip replacement.

    Science.gov (United States)

    Andrew, J G; Palan, J; Kurup, H V; Gibson, P; Murray, D W; Beard, D J

    2008-04-01

    A prospective, multi-centre study was carried out on 1421 total hip replacements between January 1999 and July 2007 to examine if obesity has an effect on clinical outcomes. The patients were categorised into three groups: non-obese (body mass index (BMI) 40 kg/m(2)). The primary outcome measure was the change in Oxford hip score at five years. Secondary outcome measures included dislocation and revision rates, increased haemorrhage, deep infection, deep-vein thrombosis and pulmonary embolism, mean operating time and length of hospital stay. Radiological analysis assessing heterotopic ossification, femoral osteolysis and femoral stem positioning was performed. Data were incomplete for 362 hips (25.5%) There was no difference in the change in the Oxford hip score, complication rates or radiological changes at five years between the groups. The morbidly obese group was significantly younger and required a significantly longer operating time. Obese and morbidly obese patients have as much to gain from total hip replacement as non-obese patients.

  12. Fracture After Total Hip Replacement

    Science.gov (United States)

    ... osteolysis. Symptoms The most common symptoms of periprosthetic hip fracture include: • Pain around the hip or thigh • Swelling ... o en very painful, someone with a periprosthetic hip fracture will most likely go directly to the emergency ...

  13. Jogging after total hip arthroplasty.

    Science.gov (United States)

    Abe, Hirohito; Sakai, Takashi; Nishii, Takashi; Takao, Masaki; Nakamura, Nobuo; Sugano, Nobuhiko

    2014-01-01

    Jogging has been classified as a high-impact sport, and jogging after total hip arthroplasty (THA) has not been well documented. To investigate the participation rate for postoperative jogging as well as jogging parameters and the influence of jogging on implant stability and bearing wear. Case-control study; Level of evidence, 3. Included in this study were 804 hips in 608 patients (85 men, 523 women) who underwent THA between 2005 and 2011 with follow-up longer than 1 year. The mean patient age was 62 years (range, 26-98 years), and mean follow-up duration was 4.8 years (range, 2.3-7.8 years). Hip resurfacing arthroplasty (HRA) was performed in 81 patients and conventional THA in 527 patients. During routine postsurgical visits, patients were given a questionnaire concerning preoperative and postoperative jogging routines. For joggers, frequency, distance, duration, and velocity of jogging were recorded. Patients who did not jog postoperatively were asked to provide reasons for not jogging. Radiographs concerning implant migration and polyethylene wear were evaluated with specialized software, and serum cobalt and chromium ion concentrations were investigated for patients with metal-on-metal articulation. A total of 33 patients (5.4%) performed jogging preoperatively, and 23 patients (3.8%) performed jogging postoperatively. Of the 23 who jogged postoperatively, conventional THA was performed in 13 patients and HRA in 10 patients. Postoperatively, joggers trained a mean of 4 times (range, 1-7 times) per week, covering a mean distance of 3.6 km (range, 0.5-15 km) in a mean time of 29 minutes (range, 5-90 minutes) per session and at a mean speed of 7.7 km/h (range, 3-18 km/h). No patient complained of pain or showed serum cobalt and chromium ion elevation greater than 7 ppb. No hip showed loosening, abnormal component migration, or excessive wear at a mean 5-year follow-up. There were 74 postoperative non-joggers with an interest in jogging. The reasons given for

  14. Simultaneous bilateral total hip arthroplasties in nonagenarians.

    Science.gov (United States)

    Power, F R; Cawley, D T; Curtin, P D

    2017-11-01

    Total hip arthroplasty (THA) is an effective and durable treatment option for hip osteoarthritis (OA). As life expectancy continues to increase, so too will the demand for joint arthroplasty in the 10th decade of life, frequently in cases involving osteoarthritis of both hips. Simultaneous bilateral total hip arthroplasty (SBTHA) is a valuable therapeutic option in appropriately selected patients with bilateral degenerative hip disease, although its use in the very elderly is poorly reported on in the literature. A case of bilateral hip OA successfully treated with SBTHA in a nonagenarian is presented and the literature is reviewed.

  15. 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 re...

  16. Total hip arthroplasty: an editiorial comment.

    Science.gov (United States)

    Peterson, L F

    1977-09-01

    Total hip arthroplasty has become an accepted method of management of severe painful problems of the hip. It has undergone some dramatic changes, the major thrust now being to more nearly match the mechanical characteristics of the implant to the bone and cartilage they replace.

  17. Results of total hip arthroplasty using a bionic hip stem.

    Science.gov (United States)

    Fokter, Samo K; Sarler, Taras; Strahovnik, Andrej; Repše-Fokter, Alenka

    2015-06-01

    The trabecular-orientated bionic hip stem was designed to mimic the natural force transmission through the femur in total hip arthroplasty, resulting in supposedly longer prosthesis survivability. The aim of this study was to compare the second-generation bionic hip stem to a standard uncemented hip stem. A group of 18 patients (21 hips) who underwent total hip arthroplasty with a bionic stem (bionic group) was compared with a historic group of 12 patients (12 hips) treated with standard anatomic hip stem (control group). During the first year after the procedure, the densitometric measurements of the bone around the prosthesis were taken. Radiographic and clinical assessments were additionally performed preoperatively and at the three month, six month, one year and three year follow-ups in the bionic group. In the bionic group, one patient was revised for aseptic loosening and 16 patients (19 hips) were available to the final follow-up. A significant decrease of bone mineral density was found in Gruen zones 3, 4 and 5 in the bionic group, and in zone 7 in both groups. The bionic group had a significantly higher bone mineral density in Gruen zone 1 at the one year follow-up. At the final follow-up, all prostheses were radiologically stable in both groups. Provided that a good implant position is achieved, comparable short-term results can be obtained using a bionic stem. Still, a decrease of bone mineral density in Gruen zone 7 occurred in both groups. Further studies are required to determine survivability of the bionic stem.

  18. Failure rate of cemented and uncemented total hip replacements

    DEFF Research Database (Denmark)

    Makela, K. T.; Matilainen, M.; Pulkkinen, P.

    2014-01-01

    Objective To assess the failure rate of cemented, uncemented, hybrid, and reverse hybrid total hip replacements in patients aged 55 years or older. Design Register study. Setting Nordic Arthroplasty Register Association database (combined data from Sweden, Norway, Denmark, and Finland). Participa......Objective To assess the failure rate of cemented, uncemented, hybrid, and reverse hybrid total hip replacements in patients aged 55 years or older. Design Register study. Setting Nordic Arthroplasty Register Association database (combined data from Sweden, Norway, Denmark, and Finland......). Participants 347 899 total hip replacements performed during 1995-2011. Main outcome measures Probability of implant survival (Kaplan-Meier analysis) along with implant survival with revision for any reason as endpoint (Cox multiple regression) adjusted for age, sex, and diagnosis in age groups 55-64, 65.......8% to 96.1%, respectively) was higher than that of uncemented (92.9%, 92.3% to 93.4% and 93.0%, 91.8% to 94.0%), hybrid (91.6%, 90.9% to 92.2% and 93.9%, 93.1% to 94.5%), and reverse hybrid (90.7%, 87.3% to 93.2% and 93.2%, 90.7% to 95.1%) implants. The survival of cemented (92.2%, 91.8% to 92...

  19. 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, Hugo 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

  20. Total hip arthroplasty instability in Italy.

    Science.gov (United States)

    Falez, Francesco; Papalia, Matteo; Favetti, Fabio; Panegrossi, Gabriele; Casella, Filippo; Mazzotta, Gianluca

    2017-03-01

    Hip dislocation is a major and common complication of total hip arthroplasty (THA), which appears with an incidence between 0.3% and 10% in primary total hip arthroplasties and up to 28% in revision THA. The hip dislocations can be classified into three groups: early, intermediate and late. Approximately two-thirds of cases can be treated successfully with a non-operative approach. The rest require further surgical intervention. The prerequisite to developing an appropriate treatment strategy is a thorough evaluation to identify the causes of the dislocation. In addition, many factors that contribute to THA dislocation are related to the surgical technique, mainly including component orientation, femoral head diameter, restoration of femoral offset and leg length, cam impingement and condition of the soft tissues. The diagnosis of a dislocated hip is relatively easy because the clinical situation is very typical. Having identified a dislocated hip, the first step is to perform a closed reduction of the implant. After reduction you must perform a computed tomography scan to evaluate the surgical options for treatment of recurrent dislocation that include: revision arthroplasty, modular components exchange, dual-mobility cups, large femoral heads, constrained cups, elimination of impingement and soft tissue procedures. The objective is to avoid further dislocation, a devastating event which is increasing the number of operations on the hip. To obtain this goal is useful to follow an algorithm of treatment, but the best treatment remains prevention.

  1. Aberrant pelvis and hip kinematics impair hip loading before and after total hip replacement.

    Science.gov (United States)

    Lenaerts, G; Mulier, M; Spaepen, A; Van der Perre, G; Jonkers, I

    2009-10-01

    Musculoskeletal loading is an important factor affecting the development of osteoarthritis, bone remodelling and primary fixation of total hip replacement (THR). In this study, we analyzed the relation between muscular force, gait kinematics and kinetics and hip loading in 20 patients before and six weeks after THR. Hip contact forces were calculated from gait analysis data using musculoskeletal modelling, inverse dynamics and static optimization. We found aberrant pelvis and hip kinematics and kinetics before and six weeks after surgery, confirming previous findings in literature. Furthermore, we found a decrease in the total contact force and its vertical component. These changes result in a decrease of the associated inclination angles of the total hip contact force in the sagittal and transverse planes, changing the orientation towards more vertical implant loading after THR. These changes in hip loading were related to observed gait kinematics and kinetics. Most importantly, excessive pelvic obliquity and associated hip adduction related to impaired implant loading. We concluded, therefore, that physical therapy in the early post-operative phase should primarily focus on stretching of anterior and medial structures and strengthening of hip flexors and abductors to achieve normalization of the hip and pelvis kinematics and consequently normalize hip loading.

  2. 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 significan...

  3. Late complications after total hip arthroplasty

    OpenAIRE

    Mathiesen, Erik B.

    1996-01-01

    The present study concerns late complications after total hip arthroplasty inrelation to implant material, design, and mode of implant fixation. Frictional characteristics inretrieved and new acetabular sockets was studied under dry and lubricated conditionscomparing conventional polyethylene sockets with polyacetal sockets from the Christiansenprosthesis. No difference between new sockets of the two materials was found, whereas thefriction in 12 retrieved polyacetal sockets was significantly...

  4. Resurfacing total hip replacement--a therapeutical approach in postmenopausal women with osteoporosis and hip arthrosis

    National Research Council Canada - National Science Library

    Popescu, D; Ene, R; Cirstoiu, C

    2011-01-01

    Patients with incipient hip arthrosis may benefit from a relatively new therapeutical approach using resurfacing total hip replacement, but in those with associated osteoporosis, this type of surgical...

  5. Perioperative blood saving measures in total hip and knee arthroplasty

    NARCIS (Netherlands)

    Horstmann, W.G.

    2011-01-01

    This dissertation explores and discusses different aspects of blood loss and blood-saving measures in total hip and knee arthroplasty. Background: Worldwide, approximately 1 million total hip and 1 million total knee prostheses are implanted each year. Total hip arthroplasty and total

  6. Renal function after elective total hip replacement

    DEFF Research Database (Denmark)

    Perregaard, Helene; Damholt, Mette B; Solgaard, Søren

    2016-01-01

    Background and purpose - Acute kidney injury (AKI) is associated with increased short-term and long-term mortality in intensive care populations and in several surgical specialties, but there are very few data concerning orthopedic populations. We have studied the incidence of AKI...... involving all primary elective total hip replacements performed from January 2003 through December 2012. Patient demographics and creatinine values were registered. We evaluated the presence of CKD and AKI according to the international guidelines for kidney disease (KDIGO Acute Kidney Injury Workgroup 2013...... reduced kidney function, was seen in 374 individuals (11%). Interpretation - Development of acute kidney injury appears to be a substantial problem compared to other complications related to elective total hip arthroplasty, i.e. luxation and infection. Patients with pre-existing chronic kidney disease may...

  7. Total hip arthroplasty through anterior minimal incision

    Directory of Open Access Journals (Sweden)

    Bogdan Negru-Aman

    2010-06-01

    Full Text Available Total hip arthroplasty through minimum anterior incision is a minimally invasive technique that allows access to the joint capsule without posting the skeletal muscle surrounding areas. Anterior surgical approach is advantageous because the hip joint is located closer to the front than the rear part of the limb. The surgical approach follows a internervous plane between superior and inferior gluteal nerves (in the side and femoral nerve (medially, without involving the muscle removal. This technique provides good access, through the same incision, both to the acetabul and the femur. It also allows better control of the acetabular cup, keeping the limb length, a decrease of dislocations rate and reduced post-operative precautions.

  8. Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip Arthroplasty

    OpenAIRE

    Peters, Rinne M.; Pax Willemse; Rijk, Paul C; Mels Hoogendoorn; Zijlstra, Wierd P

    2017-01-01

    This case illustrates the potential for systemic cobalt toxicity in non-metal-on-metal bearings and its potentially devastating consequences. We present a 71-year-old male with grinding sensations in his right hip following ceramic-on-ceramic total hip arthroplasty (THA). After diagnosing a fractured ceramic liner, the hip prosthesis was revised into a metal-on-polyethylene bearing. At one year postoperatively, X-rays and MARS-MRI showed a fixed reversed hybrid THA, with periarticular densiti...

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    of primary surgery, and most notably in the first 3 months. The risk of revision due to infection increased in all 4 countries. Risk factors for revision due to infection were male sex, hybrid fixation, cement without antibiotics, and THA performed due to inflammatory disease, hip fracture, or femoral head......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...... explain this increase. We believe that there has been an actual increase in the incidence of prosthetic joint infections after THA....

  10. Lower Limb Ischaemia Complicating Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Shiu-Wai Chan

    2012-06-01

    Full Text Available This article is about two patients having vascular injuries complicating total hip arthroplasty because of intraoperative indirect injuries. One patient had a delayed presentation of acute lower limb ischaemia, in which he required amputation of his left second toe because of ischaemic gangrene. The other patient had acute lower limb ischaemia leading to permanent muscle and nerve damage because of delayed recognition. Both patients had vascular interventions for the indirect vascular injuries. Preoperative workup for suspicious underlying peripheral vascular disease, intraoperative precautions, and perioperative period of vascular status monitoring are essential for prevention and early detection of such sinister events.

  11. No clinical difference between large metal-on-metal total hip arthroplasty and 28-mm-head total hip arthroplasty?

    NARCIS (Netherlands)

    Zijlstra, Wierd P; van den Akker-Scheek, Inge; Zee, Mark J M; van Raay, Jos J A M

    2011-01-01

    PURPOSE: We aimed to test the claim of greater range of motion (ROM) with large femoral head metal-on-metal total hip arthroplasty. METHODS: We compared 28-mm metal-on-polyethylene (MP) total hip arthroplasty with large femoral head metal-on-metal (MM) total hip arthroplasty in a randomised clinical

  12. Total Hip Replacement as a Treatment Option for Osteoarthritis of ...

    African Journals Online (AJOL)

    As the age of the population increases, total hip arthroplasty as a treatment option for osteoarthritis will assume greater significance. The aim of this study is to document the problems encountered with total hip arthroplasty in treating patients with osfeoarthrifis ofthe hip at the National Orthropaedic Hospital, Dala Kanso ...

  13. Progress in Wear Resistant Materials for Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Rohit Khanna

    2017-07-01

    Full Text Available Current trends in total hip arthroplasty (THA are to develop novel artificial hip joints with high wear resistance and mechanical reliability with a potential to last for at least 25–30 years for both young and old active patients. Currently used artificial hip joints are mainly composed of femoral head of monolithic alumina or alumina-zirconia composites articulating against cross-linked polyethylene liner of acetabular cup or Co-Cr alloy in a self-mated configuration. However, the possibility of fracture of ceramics or its composites, PE wear debris-induced osteolysis, and hypersensitivity issue due to metal ion release cannot be eliminated. In some cases, thin ultra-hard diamond-based, TiN coatings on Ti-6A-4V or thin zirconia layer on the Zr-Nb alloy have been fabricated to develop high wear resistant bearing surfaces. However, these coatings showed poor adhesion in tribological testing. To provide high wear resistance and mechanical reliability to femoral head, a new kind of ceramic/metal artificial hip joint hybrid was recently proposed in which 10–15 μm thick dense layer of pure α-alumina was formed onto Ti-6Al-4V alloy by deposition of Al metal layer by cold spraying or cold metal transfer methods with 1–2 μm thick Al3Ti reaction layer formed at their interface to improve adhesion. An optimal micro-arc oxidation treatment transformed Al to dense α-alumina layer, which showed high Vickers hardness 1900 HV and good adhesion to the substrate. Further tribological and cytotoxicity analyses of these hybrids will determine their efficacy for potential use in THA.

  14. [Rehabilitation and sport following total hip replacement].

    Science.gov (United States)

    Schmitt-Sody, M; Pilger, V; Gerdesmeyer, L

    2011-06-01

    The number of total hip replacement (THR) surgeries has increased significantly over the last few years and patients undergoing surgery are of decreasing age. In consequence the question of the influencing factors for the survival of artificial hip joints becomes more and more urgent. The expected survival time of an implant is nowadays 15-20 years and it seems that factors for a shorter lifetime are female gender, overweight, younger age and certain indications which led to surgery, such as rheumatoid arthritis or fractures. In the early phase of rehabilitation, measures against dislocation including training of the abductor muscles are most important. Starting rehabilitation programs early after surgery has positive effects on outcome, especially when strengthening programs are included. There are different opinions concerning the question how the lifetime of a THR is influenced by sports activities. However, it seems to have been demonstrated that suitable sports activities have a positive effect and do not necessarily correlate with higher loosening rates after THR. In general, high-impact sports should be avoided. Recommended activities are cycling, swimming, aquajogging, hiking, rowing and dancing.

  15. 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...... 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...... 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....

  16. Radiological evaluation of painful total hip replacement

    Energy Technology Data Exchange (ETDEWEB)

    Tehranzadeh, J.; Schneider, R.; Freiberger, R.H.

    1981-01-01

    Ninety-four cases of clinically failed, cemented, total hip prostheses requiring surgery were reviewed to determine the accuracy of preoperative plain radiography, culture of aspirated fluid, arthrography, and bone scanning. When radiopaque cement had been used to embed the prosthesis, plain radiography was highly accurate in detecting a loose femoral component, less so in detecting a loose acetabular component. Culture of aspirated fluid was accurate in diagnosing infection. A positive arthrogram identified loosening with good accuracy; however, a negative arthrogram did not reliably exclude loosening. /sup 99/mTc bone scans frequently differentiated loosening from loosening with infection. The suggested sequence of diagnostic tests is plain radiography followed by bone scanning. If the bone scan shows diffuse augmented uptake, culture of aspirated fluid followed by arthrography is indicated.

  17. Postoperative pain treatment after total hip arthroplasty

    DEFF Research Database (Denmark)

    Højer Karlsen, Anders Peder; Geisler, Anja; Petersen, Pernille Lykke

    2015-01-01

    Treatment of postoperative pain should rely on results from randomized controlled trials and meta-analyses of high scientific quality. The efficacy of a particular intervention may depend on the type of surgical procedure, which supports the reporting of "procedure-specific" interventions. The ai......, but the available randomized placebo-controlled trials does not allow a designation of a "best proven intervention" for THA.......Treatment of postoperative pain should rely on results from randomized controlled trials and meta-analyses of high scientific quality. The efficacy of a particular intervention may depend on the type of surgical procedure, which supports the reporting of "procedure-specific" interventions. The aim...... of this systematic review was to document the procedure-specific evidence for analgesic interventions after total hip arthroplasty (THA). This PRISMA-compliant and PROSPERO-registered review includes randomized placebo-controlled trials (RCTs) of medication-based analgesic interventions after THA. Endpoints were...

  18. Tribology of total hip arthroplasty prostheses

    Science.gov (United States)

    Rieker, Claude B.

    2016-01-01

    Articulating components should minimise the generation of wear particles in order to optimize long-term survival of the prosthesis. A good understanding of tribological properties helps the orthopaedic surgeon to choose the most suitable bearing for each individual patient. Conventional and highly cross-linked polyethylene articulating either with metal or ceramic, ceramic-on-ceramic and metal-on-metal are the most commonly used bearing combinations. All combinations of bearing surface have their advantages and disadvantages. An appraisal of the individual patient’s objectives should be part of the assessment of the best bearing surface. Cite this article: Rieker CB. Tribology of total hip arthroplasty prostheses: what an orthopaedic surgeon should know. EFORT Open Rev 2016;1:52-57. DOI: 10.1302/2058-5241.1.000004. PMID:28461928

  19. [Ideal total hip prosthesis in 1993].

    Science.gov (United States)

    Delagoutte, J P; Mainard, D

    Although it is a hazardous adventure to define what is an ideal in any field, it would appear that there is a certain consensus about total hip prostheses. The fundamental principle of the total hip replacement was based on the articulation of a spheric segment, a mobile head contained in a hemispheric non-retaining element. To date, the first material is a titanium in a alloy containing 6% aluminum and 4% vanadium. The second material facing the titanium is polyethylene or alumine. Thus the joint couple could be "polyethylene-metal", or "polyethylene-alumine" or even "alumine-alumine". The hemispheric element can be a massive piece of polyethylene or formed by a peripheral metal (an open hemisphere) filled with the joint surface, itself made of polyethylene. This solution offers the possibility of changing the prosthesis in case of wear without interrupting the implant-bone contact. The first type is cemented to the bone with methyl polymethacrylate. With the second, the metallic part need not to be cemented and can be fitted to the bone by simple pressing. Several points are essential in the femoral piece. It should include a removable head so the length of the neck can be adjusted. It must fill the medullary canal as closely as possible and fill the methaphyseal space. It is fixed by a self-fitting system leading to stable secondary long-term fixation-a porous covering, sometimes with hydroxy apatite can also be useful. In certain cases it must be cemented, although the cement must only play the role of adaptation.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Total hip replacement for the treatment of atraumatic slipped femoral capital epiphysis in dogs.

    Science.gov (United States)

    Gemmill, T J; Pink, J; Clarke, S P; McKee, W M

    2012-08-01

    To evaluate dogs diagnosed with slipped femoral capital epiphysis which were treated by total hip replacement. Clinical and radiographic records of consecutive cases of slipped femoral capital epiphysis treated by total hip replacement were reviewed. Longer-term follow-up was by owner questionnaire. Fifteen cases were identified; 14 were affected unilaterally, 1 bilaterally. Median age at presentation was 13 months (range 6 to 30); median weight was 35 kg (range 10 to 66). Radiographically, proximal femoral sclerosis was evident in 13 of 16 hips. Thirteen hybrid and three cemented total hip replacements were performed. One dog had a stem complication five months postoperatively necessitating explantation. All other total hip replacements remained functional. At four weeks postoperatively lameness and pain scores were improved in all cases. Fourteen total hip replacements were examined after three months. Lameness was mild in 2 limbs and absent in 12; pain on manipulation was not apparent in any case. Significant radiographic complications were not encountered. Telephone questionnaires were performed for 14 cases (15 total hip replacements) at a median of 22 months postoperatively (range 8 to 45). Lameness was reportedly absent for 12 limbs and intermittent in 3. All owners felt that their dogs' quality of life was good. Total hip replacement can be a successful technique to treat slipped femoral capital epiphysis. © 2012 British Small Animal Veterinary Association.

  1. Total Hip Arthroplasty in Failed Hip Fractures: A Case Series

    Directory of Open Access Journals (Sweden)

    Syed Shahid Noor

    2015-01-01

    Full Text Available Osteoporosis is epidemic in Asian countries. It is a major cause of fractures that orthopaedic surgeons deal in Pakistan, though proper epidemiological data is not available. Habiba U et al found that 75.3% of post menopausal women of Pakistan were predisposed to Osteoporosis; whereas Baig L has described an average T - score of -1.833±0.65 on bone mineral density calculation of post menopausal females of Pakistan. Osteoporotic hip fractures constitute a major cause of elderly mortality worldwide and recent figures supporting the idea that these patients have survival rates comparable to breast and thyroid cancer patients. Pakistan is a developing country with large burden of hip fractures. Patients living in remote areas are the ones which suffer more because of inadequate awareness, fear of surgical treatment and lack of availability of standard treatment. These patients are dealt by surgeons of various expertise and levels of experience. Lack of facilities in hospitals is well known and usage of sub-standard implant is a major cause of failure. Therefore these patients either because of their bone fragility or mal-treatment suffer frequently from failure of hip fracture surgeries. Being in a tertiary care centre we come across these types of cases very frequently. Six to eight such cases present to outpatient department of Liaquat National Hospital every month being referred from every part of the country. These patients may have been operated once, twice or even multiple times. Special attention is required to acquire an informative history from these cases and perform a comprehensive examination. Moreover previous records and radiographs provide invaluable information regarding cause of failure and deciding course of further treatment. We herein discuss few of the cases of failure of hip fractures which were treated by hip arthroplasty.

  2. Cemented total hip arthroplasty following acetabular fracture.

    Science.gov (United States)

    Scott, C E H; MacDonald, D; Moran, M; White, T O; Patton, J T; Keating, J F

    2017-10-01

    To evaluate the outcomes of cemented total hip arthroplasty (THA) following a fracture of the acetabulum, with evaluation of risk factors and comparison with a patient group with no history of fracture. Between 1992 and 2016, 49 patients (33 male) with mean age of 57 years (25 to 87) underwent cemented THA at a mean of 6.5 years (0.1 to 25) following acetabular fracture. A total of 38 had undergone surgical fixation and 11 had been treated non-operatively; 13 patients died at a mean of 10.2 years after THA (0.6 to 19). Patients were assessed pre-operatively, at one year and at final follow-up (mean 9.1 years, 0.5 to 23) using the Oxford Hip Score (OHS). Implant survivorship was assessed. An age and gender-matched cohort of THAs performed for non-traumatic osteoarthritis (OA) or avascular necrosis (AVN) (n = 98) were used to compare complications and patient-reported outcome measures (PROMs). The mean time from fracture to THA was significantly shorter for patients with AVN (2.2 years) or protrusio (2.2 years) than those with post-traumatic OA (9.4 years) or infection (8.0 years) (p = 0.03). Nine contained and four uncontained defects were managed with autograft (n = 11), bulk allograft (n = 1), or trabecular metal augment (n = 1). Initial fracture management (open reduction and internal fixation or non-operative), timing of THA (>// 10 mm) were significantly higher following acetabular fracture compared with atraumatic OA/AVN and OHSs were inferior: one-year OHS (35.7 v ersus 40.2, p = 0.026); and final follow-up OHS (33.6 v ersus 40.9, p = 0.008). Cemented THA is a reasonable option for the sequelae of acetabular fracture. Higher complication rates and poorer PROMs, compared with patients undergoing THA for atraumatic causes, reflects the complex nature of these cases. Cite this article: Bone Joint J 2017;99-B:1399-1408. ©2017 The British Editorial Society of Bone & Joint Surgery.

  3. 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.

  4. Blood Loss and Influencing Factors in Primary Total Hip Arthroplasties

    African Journals Online (AJOL)

    Introduction: Orthopaedic surgery results in significant blood loss. There are no studies that can aid the surgeon in the African region estimate the expected blood loss after total hip replacement. We conducted a study to quantify the blood loss following total hip arthroplasty and to determine the factors associated with this ...

  5. Small stem total hip arthroplasty in hypoplasia of the femur

    NARCIS (Netherlands)

    de Man, F. Harald R.; Haverkamp, Daniel; van der Vis, Harm M.; Besselaar, Philip P.; Marti, René K.

    2008-01-01

    Total hip arthroplasty in hypoplastic femurs is technically difficult and the incidence of complications and aseptic loosening is relatively high. Cemented, uncemented, off-the-shelf, and custom-made stems all have been advocated in these cases. From 1978 to 1997, we performed 86 total hip

  6. Ceramic-on-ceramic total hip arthroplasty early dislocation rate.

    Science.gov (United States)

    Colwell, Clifford W; Hozack, William J; Mesko, J Wesley; D'Antonio, James A; Bierbaum, Benjamin E; Capello, William N; Jaffe, William L; Mai, Kenny T

    2007-12-01

    Wear debris from metal-on-polyethylene articulation in conventional total hip arthroplasty can limit the implant's longevity. Modern ceramic material with high wear resistance and low fracture risk has the potential to extend the lifetime of total hip arthroplasty, which makes the procedure potentially more suitable for young, active patients. Concerns with brittle ceramic material include fracture risk, the "squeak" phenomenon, and potentially a higher dislocation rate secondary to limited neck lengths and liner options. We therefore determined the early dislocation rate in modern ceramic-on-ceramic total hip arthroplasty. In 1635 total hip arthroplasties performed over the 9-year period (1996-2005), we observed three anterior and 15 posterior dislocations (1.1%). All were treated successfully, one with a revision and 17 with closed reduction under general anesthesia. Ceramic-on-ceramic total hip arthroplasty can be a good alternative bearing surface with a low dislocation rate.

  7. Late dislocation is associated with recurrence after total hip arthroplasty.

    Science.gov (United States)

    Itokawa, Takashi; Nakashima, Yasuharu; Yamamoto, Takuaki; Motomura, Goro; Ohishi, Masanobu; Hamai, Satoshi; Akiyama, Mio; Hirata, Masanobu; Hara, Daisuke; Iwamoto, Yukihide

    2013-08-01

    This study was conducted to examine the risk factors for recurrent dislocation after total hip arthroplasty (THA) and test the hypothesis that late dislocations are associated with recurrence. A total of 1,250 hips in 1,017 patients were retrospectively reviewed. All operations were performed through the posterolateral approach with posterior soft tissue repair. An early or late dislocation was defined as a dislocation occurring before or after one year postoperatively, respectively. Dislocation occurred in 36 hips (2.9 %) and 20 of them experienced recurrence. Recurrent dislocations were observed in ten out of 25 hips (40.0 %) with early dislocation; however, ten out of 11 hips (90.9 %) with late dislocation experienced recurrence (p = 0.0046). Multivariate analysis revealed that late dislocation was significantly associated with recurrence with odds ratio of 5.94 per year. Seven in 20 hips with recurrent dislocation required surgical treatment. Late dislocation significantly contributed to the development of recurrent dislocations.

  8. 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...

  9. Digital versus analogue preoperative planning of total hip arthroplasties: a randomized clinical trial of 210 total hip arthroplasties.

    NARCIS (Netherlands)

    The, B.; Verdonschot, N.J.J.; Horn, J.R. van; Ooijen, PM van; Diercks, R.L.

    2007-01-01

    The objective of this randomized clinical trial was to compare the clinical and technical results of digital preoperative planning for primary total hip arthroplasties with analogue planning. Two hundred and ten total hip arthroplasties were randomized. All plans were constructed on standardized

  10. Digital versus analogue preoperative planning of total hip arthroplasties - A randomized clinical trial of 210 total hip arthroplasties

    NARCIS (Netherlands)

    The, Bertram; Verdonschot, Nico; van Horn, Jim R.; van Ooijen, Peter M. A.; Diercks, Ron L.

    The objective of this randomized clinical trial was to compare the clinical and technical results of digital preoperative planning for primary total hip arthroplasties with analogue planning. Two hundred and ten total hip arthroplasties were randomized. All plans were constructed on standardized

  11. TOTAL HIP REPLACEMENTS AT KIKUYU HOSPITAL, KENYA

    African Journals Online (AJOL)

    Thrombosis, one sciatic nerve neuropraxia, one haematoma formation and one intraoperative femoral fracture. Out of the 97 patients 40 of them had the surgery performed more than six months after a proper diagnosis was made and hip arthroplasty recommended. This is mainly due to lack of finances. At operation two ...

  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. Dislocation Following Total Hip Replacement: The Avon Orthopaedic Centre Experience

    Science.gov (United States)

    Blom, Ashley W; Rogers, Mark; Taylor, Adrian H; Pattison, Giles; Whitehouse, Sarah; Bannister, Gordon C

    2008-01-01

    INTRODUCTION The aim of this study was to determine the incidence and outcome of dislocation after total hip arthroplasty at our unit. PATIENTS AND METHODS In total, 1727 primary total joint arthroplasties and 305 revision total hip arthroplasties were performed between 1993 and 1996 at our unit. We followed up 1567 (91%) of the primary hip arthroplasties and 284 (93%) of the revision hip arthroplasties at 8–11 years after surgery. Patients were traced by postal questionnaire, telephone interview or examination of case notes of the deceased. RESULTS The dislocation rates by approach were 23 out of 555 (4.1%) for the posterior approach, 0 out of 120 (0%) for the Omega approach and 30 out of 892 (3.4%) for the modified Hardinge approach. Of dislocations after primary total hip arthroplasty, 58.5% were recurrent. The mean number of dislocations per patient was 2.81. Overall, 8.1% of revision total hip arthroplasties dislocated. 70% of these became recurrent. The mean number of dislocations per patient was 2.87. The vast majority of dislocations occurred within 2 months of surgery. DISCUSSION To our knowledge, this is the largest multisurgeon audit of dislocation after total hip arthroplasty published in the UK. The follow-up of 8–11 years is longer than most comparable studies. The results of this study can be used to inform patients as to the risk and outcome of dislocation, as well as to the risk of further dislocation. PMID:18828962

  14. 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

    INTRODUCTION: Primary hip osteoarthritis, radiographic as well as symptomatic, is highly associated with increasing age in both genders. However, little is known about the mechanisms behind this, in particular if this increase is caused by genetic factors. This study examined the risk......-associated genetic influence onwards from 60 years of age. CONCLUSION: The cumulative incidence in primary hip osteoarthritis leading to total hip arthroplasty increases in particular after the age of 50 years in both genders. Family factors of genes and shared environment are highly significant and account for 68...... and heritability of primary osteoarthritis of the hip leading to a total hip arthroplasty, and if this heritability increased with increasing age. METHODS: In a nationwide population-based follow-up study 118,788 twins from the Danish Twin Register and 90,007 individuals from the Danish Hip Arthroplasty Register...

  15. Analgesia after total hip replacement: epidural versus psoas ...

    African Journals Online (AJOL)

    combined with a sciatic nerve block. Ho et al. used this approach for the reduction of a hip fracture in a patient with severe aortic stenosis.10. Buckenmaier et al. used it for total hip replacement surgery.11 However,. Adams et al. found that the surgical stress response is controlled better after epidural anaesthesia than after a ...

  16. [Complications within two years after revision of total hip prostheses

    NARCIS (Netherlands)

    Witjes, Suzanne; Schrier, J.C.; Gardeniers, J.W.M.; Schreurs, B.W.

    2007-01-01

    OBJECTIVE: To describe the complications within 2 years after revision of failed total hip prostheses. DESIGN: Descriptive. METHOD: Using prospective registration, data were collected on the complications that had occurred in patients who had undergone hip revision in 2002 and 2003 on the

  17. Prevention of heterotopic ossification after total hip replacement with NSAIDs

    NARCIS (Netherlands)

    Fijn, R; Koorevaar, RT; Brouwers, JRBJ

    Introduction: non steroidal anti-inflammatory drugs ( NSAIDs) and prophylactic radiotherapy can prevent ectopic bone formation around the hip after total hip arthroplasty. Methods: We retrieved from Medline, Embase and the Cochrane Register ( clinical) trials and other relevant literature on the

  18. Activity and Quality of Life after Total Hip Arthroplasty.

    Science.gov (United States)

    Świtoń, Anna; Wodka-Natkaniec, Ewa; Niedźwiedzki, Łukasz; Gaździk, Tadeusz; Niedźwiedzki, Tadeusz

    2017-10-31

    Coxarthrosis is a chronic musculoskeletal condition that causes severe pain and considerable limi-tation of the patient's motor performance. Total hip arthroplasty is one of the most common and effective methods used in the treatment of advanced degenerative changes. The aim of the present study was to evaluate the activity and quality of life of patients after unilateral total hip arthroplasty. The study was conducted in a group of 189 patients who had undergone unilateral total hip arthroplasty. Goniometry was used to determine the range of motion of both hip joints. Patients' physical ability and pain severity were assessed based on the Harris Hip Score (HHS) questionnaire. The examination of the range of motion in the lower extremities revealed statistically significant diffe-rences in flexion (p<0.01), abduction (p=<0.01), adduction (p<0.01) and external rotation (p<0.01) between the operated and the healthy extremity. The greatest limitation of motion was demonstrated for external rotation (<14°). Approximately 14% of the patients were not able to perform this motion in their healthy hip joint, while 17.5% of them could not do so in the affected hip joint. Analysis of HHS results (mean = 79 pts) revealed that more than 50% of the patients described their functional ability and quality of life as good and excellent. It was demonstrated that 54% of patients did not suffer from pain, whereas minor or mild pain was noted in 35%. 1. A subjective clinical assessment of patients after total hip arthroplasty showed that their quality of life had improved. 2. It is necessary to perform physiotherapy after total hip arthroplasty, on both the operated and healthy side. 3. Exacerbation of pain and impaired activity in patients after total hip arthroplasty were associated with the female sex to a considerable extent.

  19. Complex total hip replacement for dysplastic or hypoplastic hips using miniature or microminiature components.

    Science.gov (United States)

    Woolson, S T; Harris, W H

    1983-10-01

    We analyzed the preoperative and perioperative data on sixty-nine consecutive complex total hip replacements performed in fifty-seven patients using miniature or microminiature custom-made femoral components. The patients' average age was 45.7 years. The preoperative diagnosis was congenital dysplasia or dislocation of the hip in 72 per cent of the hips. Acetabular bone grafts were required in thirty-seven of the sixty-nine hips. Operative complications occurred in thirteen (19 per cent) and postoperative dislocation occurred in eleven (16 per cent) of the sixty-nine hips. Fifty-five hips in forty-seven patients were followed for a minimum of two years, the average follow-up being 4.8 years and the longest, 9.8 years. All acetabular grafts united. Loosening of one or both prosthetic components occurred in ten (18 per cent) of the fifty-five hips (twelve of the 110 components became loose). There were no instances of a stem bending or fracturing, despite the small size of the femoral components. Eight hips (14.5 per cent) had undergone revision, six for painful loose components and two for recurrent dislocation. For the forty-seven hips that were not revised, the average Harris hip score rose from 43 points preoperatively to 80 points postoperatively.

  20. 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.

  1. Mild to Moderate Hip OA: Joint Preservation or Total Hip Arthroplasty?

    Science.gov (United States)

    Peters, Christopher L

    2015-07-01

    Treatment of structural hip disease such as FAI and acetabular dysplasia has increased dramatically over the past decade with the goal of preservation of the native hip joint. A number of patient and disease specific parameters including the amount of underlying hip osteoarthrosis can help predict success with joint preservation surgery. Total hip arthroplasty remains a very good option in young patients who are not ideal candidates for joint preservation surgery. Future developments will help to better identify ideal surgical candidates and improve understanding of the disease processes. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. 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.

  3. Measuring functional outcome after total hip replacement with subject-specific hip joint loading

    NARCIS (Netherlands)

    Weber, Tim; Dendorfer, Sebastian; Dullien, Silvia; Grifka, Joachim; Verkerke, Gijsbertus Jacob; Renkawitz, Tobias

    2012-01-01

    Total hip replacement is an often-performed orthopedic surgical procedure; the amount of procedures undertaken will increase since our life expectancy is growing. In order to optimize function, hip biomechanics should be restored to as near normal as possible. The goal of this pilot study was to

  4. Primary extra-cranial meningioma following total hip replacement

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, T.J.; Beggs, I. [Royal Infirmary, Department of Radiology, Edinburgh (United Kingdom); Patton, J.T.; Porter, D. [Royal Infirmary, Department of Orthopaedics, Edinburgh (United Kingdom); Salter, D.M.; Al-Nafussi, A. [Royal Infirmary, Department of Pathology, Edinburgh (United Kingdom)

    2009-01-15

    A 61-year-old man presented with pain at the left hip and decreased mobility 10 years after total hip replacement. Imaging demonstrated a large destructive expansile mass adjacent to the prosthesis. Histological analysis confirmed the presence of an extra-cranial meningioma. Primary tumours after total hip replacement are rare and include soft tissue sarcomas, bone sarcomas and lymphomas. To our knowledge, no previous cases of primary extracranial meningioma have been identified. The imaging features, histology, pathogenesis and differential diagnosis are discussed. (orig.)

  5. [Gluteal compartment syndrome after total hip replacement. A presentation of two cases].

    Science.gov (United States)

    Villalba, J; Solernou, X

    2013-01-01

    Many postoperative complications have been described after a total hip arthroplasty, with early and acute, as well as late, complications being reported. Two cases of compartment syndrome of the buttock are described following a hybrid total hip arthroplasty (cemented stem and press-fit and screwed acetabulum) performed on 2 patients of 60 and 68 years old, both diagnosed and treated 24-48 hours after the surgery. Both cases had a primary prosthesis with no previous significant pathological findings. This condition is still rare, and few cases have been described at the medical literature. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

  6. Cementless Total Hip Arthroplasty Involving Trochanteric Osteotomy without Subtrochanteric Shortening for High Hip Dislocation.

    Science.gov (United States)

    Lee, Soong Joon; Yoo, Jeong Joon; Kim, Hee Joong

    2017-03-01

    Total hip arthroplasty with subtrochanteric shortening osteotomy is widely performed for high hip dislocation. However, suboptimal leg length discrepancy correction and nonunion of the osteotomy site remain concerns. Although total hip arthroplasty using trochanteric osteotomy without subtrochanteric osteotomy was introduced, cemented implants have been more commonly used than contemporary cementless implants in this procedure. We evaluated the long-term results of cementless total hip arthroplasty with trochanteric osteotomy without subtrochanteric osteotomy for high hip dislocation. From 1990 to 2002, 27 cementless total hip arthroplasties using trochanteric osteotomy without subtrochanteric osteotomy were performed in 26 patients with Crowe III or IV high hip dislocation and a mean age of 36.4 ± 12.9 years. Seven ceramic-on-ceramic, 8 ceramic-on-polyethylene, 10 metal-on-polyethylene, and 2 metal-on-metal bearings were inserted. Mean follow-up was 15.1 ± 3.7 years. We retrospectively reviewed medical records and radiographic data and evaluated the clinical and radiological results including the Harris hip score, implant survival, correction of leg length discrepancy, and occurrence of complications. The mean Harris hip score and leg length discrepancy improved significantly from 73.3 to 94.9 points and from 4.3 cm to 1.0 cm, respectively. With revision for loosening set as the end point, implant survival rates at 10 and 15 years postoperatively were 96.0% and 90.9% for stems and 74.1% and 52.3% for cups. In 8 of 10 hips with the metal-on-polyethylene bearing and 4 of 8 hips with the ceramic-on-polyethylene bearing, revision surgery was performed for aseptic loosening. However, no revision was performed in hips with the ceramic-on-ceramic bearing or the metal-on-metal bearing. Implant survival was significantly different by the type of bearing surface. Two permanent neurologic complications occurred in patients with a limb lengthening over 3.5 cm. With proper

  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

    ). Consequently, an increased risk of revision for hips with a previous pediatric hip disease was seen (risk ratio (RR) 1.4, 95% CI: 1.3-1.5). However, after adjustment for differences in sex and age of the patients, and in fixation of the prostheses, no difference in survival was found (93.6% after pediatric hip......Background The results of primary total hip arthroplasties (THAs) after pediatric hip diseases such as developmental dysplasia of the hip (DDH), slipped capital femoral epiphysis (SCFE), or Perthes' disease have been reported to be inferior to the results after primary osteoarthritis of the hip (OA.......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. MULTIMODAL ANALGESIA AFTER TOTAL HIP ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    I. G. Mukutsa

    2012-01-01

    Full Text Available Purpose - to assess the effect of multimodal analgesia in the early rehabilitation of patients after hip replacement. Materials and methods. A prospective single-centre randomized research, which included 32 patients. Patients of the 1st group received paracetamol, ketorolac and tramadol, the 2nd group of patients - ketorolac intravenously and the 3rd group of patients - etoricoxib and gabapentin. Patients of the 2nd and the 3rd groups underwent epidural analgesia with ropivacaine. Multimodal analgesia was carried out for 48 hours after the surgery. Assessment of pain intensity was performed by the VAS (visual analogue scale, a neuropathic pain component - on the DN4 questionnaire . Time was recorded during the first and second verticalization of patients, using the distance walkers and by fixing the distance covered with in 2 minutes. Results. The intensity of pain for more than 50 mm on VAS at movement at least once every 48 hours after the surgery was occurred among 9% of the 1st group, 22% of patients from the 2nd group and 8% of patients of the 3rd group. Number of patients with neuropathic pain component decreased from 25% to 3% (p ≤ 0.05. The first verticalization was performed 10 ± 8 hours after the surgery, the second - 21 ± 8 hours later. Two-minute walk distance was 5 ± 3 and 8 ± 4 m, respectively. It is noted more frequent adverse events in patients of the 1st group was noted compared to patients of the 2nd and the 3rd groups during first (91%, 33% and 25%, p ≤ 0.05 and the second verticalization (70%, 25% and 17%, p ≤ 0.05. Multimodal analgesia allows to proceed with the successful activation of patients after hip replacement with in the first day after the surgery. The 3rd group patients are noted with a tendency for the optimal combination of efficient and safe of analgetic therapy.

  9. Evaluation of a metal-on-metal total hip arthroplasty

    OpenAIRE

    Dahlstrand, Henrik

    2017-01-01

    Background After the introduction of the Metasul system by Weber in 1988, total hip arthroplasty (THA) with metal-on-metal (MoM) bearings became increasingly popular in the 1990s. MoM bearings aimed to reduce the problem of aseptic loosening associated with polyethylene wear particles from conventional polyethylene cups. The following introduction of hip resurfacing added positive factors as bone sparing and large caliber heads, reducing the risk of dislocations. After alm...

  10. Primary cemented total hip arthroplasty: 10 years follow-up

    Directory of Open Access Journals (Sweden)

    Nath Rajendra

    2010-01-01

    Full Text Available Background: Primary cemented total hip arthroplasty is a procedure for non-traumatic and traumatic affections of the hip. Long term follow-up is required to assess the longevity of the implant and establish the procedure. Indo-Asian literature on long term result of total hip arthroplasty is sparse. We present a 10-year follow-up of our patients of primary cemented total hip arthroplasty. Materials and Methods: We operated 31 hips in 30 patients with primary cemented total hip arthroplasty. We followed the cases for a minimum period of 10 years with a mean follow-up period of 12.7 years. The mean age of the patients was 60.7 years (range 37-82 yrs male to female ratio was 2:1. The clinical diagnoses included - avascular necrosis of femoral head (n=15, sero positive rheumatoid arthritis (n=5, seronegative spondylo-arthropathy (n=4, neglected femoral neck fractures (n=3, healed tubercular arthritis (n=2 and post traumatic osteoarthritis of hip (n=2. The prostheses used were cemented Charnley′s total hip (n=12 and cemented modular prosthesis (n=19. The results were assessed according to Harris hip score and radiographs taken at yearly intervals. Results: The mean follow-up is 12.7 yrs (range 11-16 yrs Results in all operated patients showed marked improvement in Harris hip score from preoperative mean 29.2 to 79.9 at 10 years or more followup. However, the non-inflammatory group showed more sustained long term improvement as compared to the inflammatory group, as revealed by the Harris hip score. Mean blood loss was 450ml (±3.7 ml, mean transfusion rate was 1.2 units (±.3. The complications were hypotension (n=7, shortening> 1.5 cm (n=9, superficial infection (n=2 and malposition of prosthesis (n=1. Conclusion: The needs of Indian Asian patients, vary from what is discussed in literature. The pain tolerance is greater than western population and financial constraints are high. Thus revision surgery among Indian-Asian patients is less compared

  11. Outcome of treatment for dislocation after primary total hip replacement.

    Science.gov (United States)

    Kotwal, R S; Ganapathi, M; John, A; Maheson, M; Jones, S A

    2009-03-01

    We have studied the natural history of a first episode of dislocation after primary total hip replacement (THR) to clarify the incidence of recurrent dislocation, the need for subsequent revision and the quality of life of these patients. Over a six-year period, 99 patients (101 hips) presented with a first dislocation of a primary THR. A total of 61 hips (60.4%) had dislocated more than once. After a minimum follow-up of one year, seven patients had died. Of the remaining 94 hips (92 patients), 47 underwent a revision for instability and one awaits operation (51% in total). Of these, seven re-dislocated and four needed further surgery. The quality of life of the patients was studied using the Oxford Hip Score and the EuroQol-5 Dimension (EQ-5D) questionnaire. A control group of patients who had not dislocated was also studied. At a mean follow-up of 4.5 years (1 to 20), the mean Oxford Hip Score was 26.7 (15 to 47) after one episode of dislocation, 27.2 (12 to 45) after recurrent dislocation, 34.5 (12 to 54) after successful revision surgery, 42 (29 to 55) after failed revision surgery and 17.4 (12 to 32) in the control group. The EuroQol-5 dimension questionnaire revealed more health problems in patients undergoing revision surgery.

  12. The History of Biomechanics in Total Hip Arthroplasty.

    Science.gov (United States)

    Houcke, Jan Van; Khanduja, Vikas; Pattyn, Christophe; Audenaert, Emmanuel

    2017-01-01

    Biomechanics of the hip joint describes how the complex combination of osseous, ligamentous, and muscular structures transfers the weight of the body from the axial skeleton into the appendicular skeleton of the lower limbs. Throughout history, several biomechanical studies based on theoretical mathematics, in vitro, in vivo as well as in silico models have been successfully performed. The insights gained from these studies have improved our understanding of the development of mechanical hip pathologies such as osteoarthritis, hip fractures, and developmental dysplasia of the hip. The main treatment of end-stage degeneration of the hip is total hip arthroplasty (THA). The increasing number of patients undergoing this surgical procedure, as well as their demand for more than just pain relief and leading an active lifestyle, has challenged surgeons and implant manufacturers to deliver higher function as well as longevity with the prosthesis. The science of biomechanics has played and will continue to play a crucial and integral role in achieving these goals. The aim of this article, therefore, is to present to the readers the key concepts in biomechanics of the hip and their application to THA.

  13. 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.

  14. TOTAL HIP ARTHROPLASTY IN OSTEOPETROSIS – REPORT OF A CASE

    Directory of Open Access Journals (Sweden)

    Zmago Krajnc

    2004-04-01

    Full Text Available Background. Authors introduced a case of a 27-year men with osteopetrosis with hip arthrosis. He has an autosomal – dominant form of disease and he needed total hip arthroplasty. There are seven cases described in literature with developed hip arthrosis by osteopetrosis.Methods. TEP implantation represents the greates surgical challenge in this patients, especially creation of intramedullary canal in femur and implantation of the femoral stem because of the very dense and brittle bones. This article describes the operative technique used in the case involved. It proved to be a very good solution.Results. The patient was released from the hospital ten days after implantation of total hip endoprosthesis. Three months after the operation the patient started to walk without aid of canes, he had non pain, and his range of motion was almost normal.Conclusions. Severe coxarthrosis is a rare complication of osteopetrosis. Great care must be taken with implantation of total hip endoprosthesis, especially with preparation of medular canal. It was recommended hand drilling under x-rays to exercise maximal control because reaming can cause false root of stem and greater probability of fracture.

  15. Computed tomography in analysis of total hip endoprosthesis

    Energy Technology Data Exchange (ETDEWEB)

    Fruehwald, F.; Huebsch, P.; Kainberger, F.; Fellinger, E.; Zweymueller, K.; Schurawitzki, H.

    1988-08-01

    16 patients with total hip endoprosthesis were investigated by high resolution computed tomography (CT) to analyse possible advantages of CT over conventional radiography. The quality of the examinations was good only in pure titanium systems: examinations of chromium-molybdenum alloys were severely deteriorated by strike artifacts. Positioning of implants is well defined in radiographs; CT provides better visualisation of the relation between implant and cortical bone. Evaluation of the contact of the shaft to the femoral corticalis is difficult in radiographs but facilitated in axial scans. Determination of relevance of CT analysis of total hip endoprosthesis remains subject to a future long-term follow-up study.

  16. 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. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  17. Magnetic resonance imaging in the diagnosis and management of hip pain after total hip arthroplasty.

    Science.gov (United States)

    Cooper, H John; Ranawat, Amar S; Potter, Hollis G; Foo, Li Foong; Jawetz, Shari T; Ranawat, Chitranjan S

    2009-08-01

    Evaluation of pain following total hip arthroplasty (THA) can be challenging in the absence of radiographic pathology. This study aimed to examine the diagnostic utility of magnetic resonance imaging (MRI) in the evaluation of enigmatic hip pain following THA. We reviewed a series of patients who were evaluated with MRI after presenting with enigmatic hip pain following THA. MRI was able to demonstrate pathology in the periprosthetic tissues in all hips with minimal artifact. Patients underwent a range of conservative and operative interventions depending on the underlying pathology. If used discriminately in situations where pathology cannot be detected by conventional methods, MRI is a highly effective modality that can aid in the diagnosis of a wide range of disorders thereby allowing the clinician to determine the most appropriate intervention.

  18. 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.

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

    Science.gov (United States)

    Scholes, S C; Unsworth, A

    2006-02-01

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

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

    DEFF Research Database (Denmark)

    Heitmann, B L; Lissner, L

    2011-01-01

    obesity and/or waist circumference. These studies have been remarkable in terms of their consistency, and in the unexpected finding of an adverse effect of small hip size, after statistically correcting for differences in general and abdominal size. The hazard related to a small hip size may be stronger...... for women than men, but is evident in both genders. In this 'viewpoint', we wish to draw attention to the emerging body of evidence and to encourage researchers to continue collecting measures of lower body size in their surveys....

  1. 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

    and hip kinematics compared to standard total hip arthroplasty in younger hip arthritis patients. Maximal isolated leg muscle strength was a predictor of horizontal gait performance, and thus provides an important and valid functional outcome measure for individuals undergoing total hip arthroplasty....... 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...

  2. 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.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    BACKGROUND: We used the Nordic Arthroplasty Register Association database to evaluate whether age, sex, preoperative diagnosis, fixation, and implant design influence the risk of revision arthroplasty due to periprosthetic fracture within two years from operation of a primary total hip replacemen...

  4. survival of primary cemented total hip arthroplasties in east africa

    African Journals Online (AJOL)

    2017-09-11

    Sep 11, 2017 ... Introduction:Total Hip Arthroplasties (THA) have been carried out in East Africa for over two decades. Data from. European and American centres suggests that cemented implants have survivorship of over 80% at 25 years. There is a paucity of data concerning survivorship of implants in Africa. This study ...

  5. Recovery of gait after short-stay total hip arthroplasty

    NARCIS (Netherlands)

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

    Objective: To describe recovery of gait after total hip arthroplasty (THA) based on the assessment of spatiotemporal gait parameters determined with an ambulatory system. Design: A 6-month inception cohort study. Setting: Inpatient and outpatient setting in an academic hospital. Participants:

  6. Total hip replacement for Mseleni Joint Disease undertaken in a ...

    African Journals Online (AJOL)

    after dislocation and acetabular fracture treatment by mold arthroplasty J Bone Joint. Surg (Am) 1969;51A:737-55. 10. Fender D, Harper WM, Gregg PJ. Outcome of Charnley total hip replacement across a single health region in England. J Bone Joint. Surg (Br) 1999;81-B(4):577-81. 11. Havelin LI, Espehaug B, Vollset SE,.

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

    NARCIS (Netherlands)

    Verdonschot, N.J.J.

    2005-01-01

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

  8. 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...

  9. Cementless total hip arthroplasty for patients previously treated with femoral osteotomy for hip dysplasia: the incidence of periprosthetic fracture

    National Research Council Canada - National Science Library

    Ohishi, Masanobu; Nakashima, Yasuharu; Yamamoto, Takuaki; Motomura, Goro; Fukushi, Jun-ichi; Hamai, Satoshi; Kohno, Yusuke; Iwamoto, Yukihide

    2016-01-01

    Femur deformities can make stem fixation difficult in total hip arthroplasty (THA). We report the clinical results of cementless THA using a press-fit stem in patients who had previously undergone femoral osteotomy for hip...

  10. 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....... 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 postoperative serum creatinine was considered indicative of postoperative renal injury. The Welch two-sample test...

  11. Constrained liners for recurrent dislocations in total hip arthroplasty

    DEFF Research Database (Denmark)

    Knudsen, R; Ovesen, O; Kjaersgaard-Andersen, P

    2009-01-01

    This study reports the results and complications from treating recurrent hip dislocations with a constrained liner (CL) after total hip arthroplasty (THA). Forty patients who had a CL inserted as a secondary prophylactic treatment were retrospectively reviewed after a median observation period...... of 27 months (range 7-77 months). During the observation period five patients had to be revised: one for deep infection and four on account of re-dislocations. Our results indicate that patients with recurrent THA dislocations can be treated with a CL and has a satisfactory low complication rate...... and a relatively low risk of re-dislocation....

  12. Hip score and disease activity correlation in patients with rheumatoid arthritis after total hip arthroplasty.

    Science.gov (United States)

    Wakabayashi, Hiroki; Hasegawa, Masahiro; Yoshida, Kakunoshin; Nishioka, Kusuki; Sudo, Akihiro

    2013-07-01

    The disease activity score including 28 joints (DAS28), the simplified disease activity index and the clinical disease activity index (CDAI) were developed in order to provide a quantifiable measure of rheumatoid arthritis (RA) activity. Although inflamed hip joints greatly impact activities of daily living (ADL) and walking ability, the hip joint was not included in the DAS28, SDAI or CDAI assessments. Although excellent clinical results have been reported for total hip arthroplasty (THA) in RA patients, correlations between disease activity and hip function in RA patients after THA remain unknown. We analysed the effect of RA disease activity on a hip function score in an observational cohort of RA patients after THA. Twenty-five registered RA patients who had undergone THA (33 joints) were included. Hip function was recorded and RA disease activity was measured on the same day. The mean age of the patients was 65.17 years. They were followed up for a mean of 5.24 years after surgery. The mean duration of disease following RA diagnosis for this patient group was 19.47 years. The Japanese Orthopaedic Association (JOA) hip score was used as a clinical outcome measure for hip dysfunction. RA disease activity and health-related quality of life were measured using the DAS28, SDAI, CDAI and the modified health assessment questionnaire (MHAQ). The mean JOA score for hip function was 80.48 at the final follow-up. The mean DAS28-ESR, DAS28-CRP, SDAI, CDAI and MHAQ measuring RA disease activity levels were 3.38, 2.65, 9.59, 8.63 and 0.44, respectively, at the final follow-up. There was a significant negative correlation between the JOA hip score and all disease activity assessments observed after THA (DAS-ESR [P = 0.0067], DAS-CRP [P = 0.0008]), SDAI [P = 0.0034], CDAI [P = 0.0003]) and MHAQ [P = 0.0002]). We found significant negative correlations between JOA hip scores and all disease activity assessments in RA patients treated with THA.

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

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Brandsborg, Birgitte; Lucht, Ulf

    2006-01-01

    BACKGROUND: Chronic post-operative pain is a well-recognized problem after various types of surgery, but little is known about chronic pain after orthopedic surgery. Severe pre-operative pain is the primary indication for total hip arthroplasty (THA). Therefore, we examined the prevalence...... 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...

  14. Is tantalum protective against infection in revision total hip arthroplasty?

    Science.gov (United States)

    Tokarski, A T; Novack, T A; Parvizi, J

    2015-01-01

    We hypothesised that the use of tantalum (Ta) acetabular components in revision total hip arthroplasty (THA) was protective against subsequent failure due to infection. We identified 966 patients (421 men, 545 women and 990 hips) who had undergone revision THA between 2000 and 2013. The mean follow up was 40.2 months (3 months to 13.1 years). The mean age of the men and women was 62.3 years (31 to 90) and 65.1 years (25 to 92), respectively. Titanium (Ti) acetabular components were used in 536 hips while Ta components were used in 454 hips. In total, 73 (7.3%) hips experienced subsequent acetabular failure. The incidence of failure was lower in the Ta group at 4.4% (20/454) compared with 9.9% (53/536) in the Ti group (p < 0.001, odds ratio 2.38; 95% CI 1.37 to 4.27). Among the 144 hips (64 Ta, 80 Ti) for which revision had been performed because of infection, failure due to a subsequent infection was lower in the Ta group at 3.1% (2/64) compared with 17.5% (14/80) for the Ti group (p = 0.006). Thus, the use of Ta acetabular components during revision THA was associated with a lower incidence of failure from all causes and Ta components were associated with a lower incidence of subsequent infection when used in patients with periprosthetic joint infection. ©2015 The British Editorial Society of Bone & Joint Surgery.

  15. Effects of neuromuscular reeducation on hip mechanics and functional performance in patients after total hip arthroplasty: A case series.

    Science.gov (United States)

    Judd, Dana L; Winters, Joshua D; Stevens-Lapsley, Jennifer E; Christiansen, Cory L

    2016-02-01

    Following total hip arthroplasty, patients demonstrate compensatory movement strategies during activities of daily living such as walking and stair climbing. Movement compensations are important markers of functional decline in older adults and are related to poor functional capacity. Despite increased utilization of hip arthroplasty, persistent movement compensation, and functional performance deficits, no consensus on postoperative rehabilitation exists. Neuromuscular reeducation techniques offer a strategy to improve movement quality by emphasizing hip abductor performance and pelvic stability. This case series illustrates changes in movement strategy around the hip in response to targeted neuromuscular reeducation techniques after hip arthroplasty. Five participants received an 8-week exercise program following total hip arthroplasty, emphasizing targeted neuromuscular reeducation techniques hallmarked by specific, weight-bearing exercise to improve hip abductor performance and pelvic stability. Five additional participants were supervised and followed for comparison. Participants in the neuromuscular reeducation program improved their internal hip abductor moments and vertical ground reaction forces during walking and stair climbing. They also improved their functional performance and hip abductor strength outcomes. Targeted neuromuscular reeducation techniques after total hip arthroplasty provided a positive effect on biomechanical outcomes, functional performance, and muscle strength. Through focused use of the hip abductor muscles, increased internal hip abductor moments were observed. This intervention potentially promotes pelvic stability, and may contribute to improved performance on tasks such as stair climbing, fast walking, and balance. The results suggest that neuromuscular reeducation offers a unique effect on movement strategy and function for patients following total hip arthroplasty. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Hip contact forces in asymptomatic total hip replacement patients differ from normal healthy individuals: Implications for preclinical testing.

    Science.gov (United States)

    Li, Junyan; Redmond, Anthony C; Jin, Zhongmin; Fisher, John; Stone, Martin H; Stewart, Todd D

    2014-08-01

    Preclinical durability testing of hip replacement implants is standardised by ISO-14242-1 (2002) which is based on historical inverse dynamics analysis using data obtained from a small sample of normal healthy individuals. It has not been established whether loading cycles derived from normal healthy individuals are representative of loading cycles occurring in patients following total hip replacement. Hip joint kinematics and hip contact forces derived from multibody modelling of forces during normal walking were obtained for 15 asymptomatic total hip replacement patients and compared to 38 normal healthy individuals and to the ISO standard for pre-clinical testing. Hip kinematics in the total hip replacement patients were comparable to the ISO data and the hip contact force in the normal healthy group was also comparable to the ISO cycles. Hip contact forces derived from the asymptomatic total hip replacement patients were comparable for the first part of the stance period but exhibited 30% lower peak loads at toe-off. Although the ISO standard provides a representative kinematic cycle, the findings call into question whether the hip joint contact forces in the ISO standard are representative of those occurring in the joint following total hip replacement. Copyright © 2014. Published by Elsevier Ltd.

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

    Directory of Open Access Journals (Sweden)

    Dhaon B

    2005-01-01

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

  18. Psychological factors as risk factors for poor hip function after total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Benditz A

    2017-02-01

    Full Text Available Achim Benditz,1 Petra Jansen,2 Jan Schaible,1 Christina Roll,1 Joachim Grifka,1 Jürgen Götz1 1Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, 2Department of Sport Science, University of Regensburg, Regensburg, Germany Abstract: Recovery after total hip arthroplasty (THA is influenced by several psychological aspects, such as depression, anxiety, resilience, and personality traits. We hypothesized that preoperative depression impedes early functional outcome after THA (primary outcome measure. Additional objectives were perioperative changes in the psychological status and their influence on perioperative outcome. This observational study analyzed depression, anxiety, resilience, and personality traits in 50 patients after primary unilateral THA. Hip functionality was measured by means of the Harris Hip Score. Depression, state anxiety, and resilience were evaluated preoperatively as well as 1 and 5 weeks postoperatively. Trait anxiety and personality traits were measured once preoperatively. Patients with low depression and anxiety levels had significantly better outcomes with respect to early hip functionality. Resilience and personality traits did not relate to hip functionality. Depression and state anxiety levels significantly decreased within the 5-week stay in the acute and rehabilitation clinic, whereas resilience remained at the same level. Our study suggests that low depression and anxiety levels are positively related to early functionality after THA. Therefore, perioperative measurements of these factors seem to be useful to provide the best support for patients with risk factors. Keywords: total hip arthroplasty, psychological factors, depression, state anxiety, trait anxiety, resilience, personality traits

  19. Miserable case of total hip replacement caused by postirradiation necrosis

    Energy Technology Data Exchange (ETDEWEB)

    Ihara, Fumitoshi; Okue, Akira; Kumagai, Hiroyuki; Ohzuma, Masakazu; Wada, Fumio (Saga Prefectural Hospital (Japan))

    1983-06-01

    We experienced a miserable case of postirradiation femoral head necrosis. Osteomyelitis due to a screw penetration into the cecum was followed by total hip replacement. The patient is a sixty seven years old woman. As she was injured by inoperable uterus cancer at fifty one years old, /sup 60/Co irradiation therapy was done. As postirradiation necrosis occurred 5 years after irradiation, total hip replacement (Mckee-Farrar type) was done. However, bone necrosis area in iliac bone due to irradiation progressed gradually, and anchoring screw migrated proximally into the cecum. Then the fistula formed at the region of right major trochanter. In fistulography, contrast medium leaked out into the cecum. So after iliocecectomy and anastomosis of colon, removal of prosthesis and local continuous suction irrigation was done twice. Since then, there has been no recurrence.

  20. Lumbar chance fracture after direct anterior total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Michael Pitta, MD

    2017-12-01

    Full Text Available This report describes a patient with ankylosing spondylitis (AS who underwent total hip arthroplasty (THA by the direct anterior approach and sustained a L4-5 extension fracture dislocation with neural deficits. A magnetic resonance imaging revealed an epidural hematoma at the site of the fracture causing critical stenosis. The patient was taken to the operating room for a L3-S1 posterior decompression with L2-pelvis posterior spinal fusion. AS and diffuse idiopathic skeletal hyperostosis create a stiff spine that predisposes to fractures because of the larger moment arms experienced than normal spines. The arthroplasty surgeon performing THA should be aware and take precautions to reduce stress on the spine. Keywords: Direct anterior total hip arthroplasty, Ankylosing spondylitis, Specialized table, Lumbar chance fracture, Complication

  1. [Modern tribology in total hip arthroplasty: pros and cons].

    Science.gov (United States)

    Gómez-García, F

    2014-01-01

    The wear products and adverse reactions that occur on bearing surfaces represent one of the greatest challenges in prosthetic replacements, as the latter experience increasing demands due to the large number of young and older adult patients that have a long life expectancy and remarkable activity. The purpose of this review is to analyze the pros and cons of the new advances in the bearing components of the articular surfaces of current total hip arthroplasties. We also discuss the strategies used historically, their problems, results and the surgeon's role in prescribing the tribologic couple that best fits each patient's needs. We conclude with practical recommendations for the prescription and management of the latest articular couples for total hip arthroplasty.

  2. The local effects of metal corrosion in total hip arthroplasty.

    Science.gov (United States)

    Cooper, H John

    2014-01-01

    Corrosion has long been recognized to occur in total hip arthroplasty, but the local effects of this process have only recently become better understood. This article provides an overview of corrosion at modular junctions, and discusses the various etiologic factors for corrosion and the biologic response to metal debris released from this junction. Algorithms are provided for diagnosis and treatment, in accordance with the best available data. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. 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.

  4. On loosening and revision in total hip arthroplasty

    OpenAIRE

    Eisler, Thomas

    2003-01-01

    Periprosthetic bone resorbtion (osteolysis) and aseptic loosening constitute the major long-term complication in total hip arthroplasty. It has been suggested that osteolysis is the result of the action of osteoclasts generated by prosthetic wear-debris-triggered macrophages. In an electron-microscopic study of biopsies retrieved from periprosthetic osteolytic lesions, however, we were unable to show more osteoclasts than what would be expected in normal adult bone. Macropha...

  5. Vibroacoustography for the assessment of total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Hermes A.S. Kamimura

    2013-04-01

    Full Text Available OBJECTIVES: This paper proposes imaging with 3-dimensional vibroacoustography for postoperatively assessing the uncovered cup area after total hip arthroplasty as a quantitative criterion to evaluate implant fixation. METHODS: A phantom with a bone-like structure covered by a tissue-mimicking material was used to simulate a total hip arthroplasty case. Vibroacoustography images of the uncovered cup region were generated using a two-element confocal ultrasound transducer and a hydrophone inside a water tank. Topological correction based on the geometry of the implant was performed to generate a 3-dimensional representation of the vibroacoustography image and to accurately evaluate the surface. The 3-dimensional area obtained by the vibroacoustography approach was compared to the area evaluated by a 3-dimensional motion capture system. RESULTS: The vibroacoustography technique provided high-resolution, high-contrast, and speckle-free images with less sensitivity to the beam incidence. Using a 3-dimensional-topology correction of the image, we accurately estimated the uncovered area of the implant with a relative error of 8.1% in comparison with the motion capture system measurements. CONCLUSION: Measurement of the cup coverage after total hip arthroplasty has not been well established; however, the covered surface area of the acetabular component is one of the most important prognostic factors. The preliminary results of this study show that vibroacoustography is a 3-dimensional approach that can be used to postoperatively evaluate total hip arthroplasty. The favorable results also provide an impetus for exploring vibroacoustography in other bone or implant surface imaging applications.

  6. Revision for recurrent dislocation of total hip replacement.

    Science.gov (United States)

    Rogers, Mark; Blom, Ashley W; Barnett, Andrew; Karantana, Alexia; Bannister, Gordon C

    2009-01-01

    Dislocation is one of the commonest complications of total hip arthroplasty with an incidence of between 0.5 and 9.2%. Despite this, little is known of the outcome of treatment strategies for dislocation. The aim of this study was to establish the optimal strategy for the operative management of recurrent dislocation following THA taking account of the surgical approach employed in the replacement that became unstable and the direction of the instability that followed. We reviewed 70 patients who underwent revision surgery for recurrent dislocation after total hip arthroplasty (THA), 38 through the transgluteal (Hardinge) and 32 through the posterior approach.52 of these followed primary and 18 followed revision THA for reasons other than instability.We recorded the surgical approach, the direction of dislocation and the operative strategy employed for each case. We achieved stability in 75% of patients who dislocated after primary and 50% after revision THA. 77% of dislocations performed initially through the transgluteal approach were anterior and 88% through the posterior approach were posterior. Following the transgluteal approach, we stabilised anterior dislocation in 54% of cases. Following the posterior approach we stabilised posterior dislocation in 79%. The most successful operative strategy overall was cup augmentation which conferred stability in 90% of cases. Instability after primary total hip replacement is easier to treat (75% chance of success) than after revision total hip replacement (50% chance of success). Although previous studies have shown that the posterior approach has a slightly higher risk of dislocation, this study has shown that achieving stability after a posterior dislocation is more likely than after an anterior dislocation. The outcome of revision for instability depends on the surgical approach used initially, and the direction of dislocation.

  7. In vivo comparison of hip mechanics for minimally invasive versus traditional total hip arthroplasty.

    Science.gov (United States)

    Glaser, Diana; Dennis, Douglas A; Komistek, Richard D; Miner, Todd M

    2008-02-01

    Minimally invasive surgery has been developed to reduce incision length, muscle damage, and rehabilitation time. However, reduced exposure of anatomical landmarks may result in technical errors and inferior implant survivorship. The objective of this study was to compare in vivo motions and hip joint contact forces during gait in total hip arthroplasty subjects, performed with either minimally invasive surgery or standard surgical approaches. Fifteen subjects implanted using either minimally invasive surgery anterolateral, minimally invasive surgery posterolateral, or traditional posterolateral total hip arthroplasty were evaluated using fluoroscopy while performing gait on a treadmill. Kinematics, obtained using 3D-to-2D image registration technique, were input as temporal functions in a 3D inverse dynamic mathematical model that determines in vivo soft tissue and hip contact forces. The subjects implanted with posterolateral and anterolateral minimally invasive surgery demonstrated significantly less separation than those implanted with the traditional approach (P<0.01). The minimally invasive surgery subjects also experienced lower average maximum peak forces, with 3.2 body weight for the anterolateral minimally invasive surgery and 2.9 body weight for the posterolateral minimally invasive surgery subjects, compared to 3.5 body weight for the traditional subjects (P=0.02 and P=0.03, respectively). This is the first study to compare in vivo weight-bearing kinematics, separation and kinetics for traditional, anterolateral minimally invasive surgery and posterolateral minimally invasive surgery total hip arthroplasty subject groups. Our data indicated in all analyzed parameters differences between the minimally invasive surgery and the traditional groups, with favorable results for the minimally invasive surgery subjects. This may be related, to a reduction in stabilizing soft tissues after a minimally invasive surgery procedure, leading to lower bearing surface

  8. Total hip arthroplasty with cementless cup after acetabular fracture

    Directory of Open Access Journals (Sweden)

    Marcelo Alfonso Lugones

    2012-12-01

    Full Text Available Background Acetabular fractures are a common cause of degenerative hip arthritis. The incidence of post-traumatic osteoarthritis has been reported between 12% and 57% and avascular necrosis of the femoral head may occur in 2% to 40% after posterior fracture dislocation. The fracture is often caused by major trauma in road accidents, at work or during sports, and patients usually present for total hip replacement (THR at an earlier age than the general arthritic population. We describe and analyze our patients with uncemented acetabular reconstruction in post-traumatic arthritis and compare them with THR in non-traumatic arthritis. Methods We retrospectively evaluated 19 patients who underwent uncemented acetabular reconstruction due to post-traumatic arthritis secondary to acetabular fracture. Results The average age at the time of arthroplasty was 52.2 years (19-83. The age at the time of fracture was 47.9 years (16-81. The average time between the acetabular fracture and THR was 52.4 months (4-360. The average follow-up was 4.25 years. No acetabular component loosening or infections were seen in either group. The Harris Hip Score at an average follow-up of 4.25 years was 89.3 (57-99. The follow-up in the control group with non-traumatic arthritis was 4.9 years, and the Harris Hip Score was 94.1 points (78-100. There were no significant difference in the Harris Hip Score between groups (p = 0.24. Conclusion Uncemented acetabular reconstruction in post-traumatic arthritis secondary to acetabular fracture is a more difficult procedure than routine arthroplasty in patient with non-traumatic arthritis. In the short-term there are no clinical or radiographic differences in THR with uncemented acetabular cups in post-traumatic arthritis patients compared to patients with non-traumatic arthritis.

  9. One-stage revision of an infected cementless total hip replacement.

    Science.gov (United States)

    Ficklin, Michael G; Kowaleski, Michael P; Kunkel, Kevin A R; Suber, Jonathan T

    2016-11-23

    A two-year-old, 44 kg dog with a right Helica cementless total hip replacement (THR) was radiographically diagnosed with implant loosening eight months after the index total hip replacement procedure. Subsequent synoviocentesis and synovial fluid culture revealed a methicillin-resistant coagulase-negative Staphylococcus spp infection of the right THR. A one-stage revision using a hybrid BFX cementless acetabular cup and CFX cemented femoral stem was performed. Vancomycin and micro-silver antimicrobial powder impregnated cement were used in the revision. At re-evaluation 27 months following the revision procedure, the patient did not exhibit any signs of lameness. Radiographic images confirmed stable implants, with bone ingrowth into the cup and no signs of implant loosening. Our report demonstrates the success of a one-stage THR revision when faced with a multi-drug resistant periprosthetic infection, when combined with the use of micro-silver antimicrobial powder and culture-based antibiotic impregnated cement therapy.

  10. Impingement and Dislocation in Total HIP Arthroplasty: Mechanisms and Consequences

    Science.gov (United States)

    Brown, Thomas D; Elkins, Jacob M; Pedersen, Douglas R; Callaghan, John J

    2014-01-01

    In contemporary total hip arthroplasty, instability has been a complication in approximately 2% to 5% of primary surgeries and 5% to 10% of revisions. Due to the reduction in the incidence of wear-induced osteolysis that has been achieved over the last decade, instability now stands as the single most common reason for revision surgery. Moreover, even without frank dislocation, impingement and subluxation are implicated in a set of new concerns arising with advanced bearings, associated with the relatively unforgiving nature of many of those designs. Against that backdrop, the biomechanical factors responsible for impingement, subluxation, and dislocation remain under-investigated relative to their burden of morbidity. This manuscript outlines a 15-year program of laboratory and clinical research undertaken to improve the scientific basis for understanding total hip impingement and dislocation. The broad theme has been to systematically evaluate the role of surgical factors, implant design factors, and patient factors in predisposing total hip constructs to impinge, sublux, and/or dislocate. Because this class of adverse biomechanical events had not lent itself well to study with existing approaches, it was necessary to develop (and validate) a series of new research methodologies, relying heavily on advanced finite element formulations. Specific areas of focus have included identifying the biomechanical challenges posed by dislocation-prone patient activities, quantifying design parameter effects and component surgical positioning effects for conventional metal-on-polyethylene implant constructs, and the impingement/dislocation behavior of non-conventional constructs, quantifying the stabilizing role of the hip capsule (and of surgical repairs of capsule defects), and systematically studying impingement and edge loading of hard-on-hard bearings, fracture of ceramic liners, confounding effects of patient obesity, and subluxation-mediated worsening of third body

  11. 10-year experience with short stem total hip arthroplasty.

    Science.gov (United States)

    von Lewinski, Gabriela; Floerkemeier, Thilo

    2015-03-01

    Since 1998, short stem total hip arthroplasty (THA) has been performed at the authors' institution. Currently, 30% of THAs are performed with short stems. This article reports on complications that required revision of a short stem THA. Between September 2005 and February 2012, a total of 1953 Metha short stem THAs were performed; of these, 38 required revision due to mechanical complications. In 12 cases, the modular titanium neck adapter failed. In 19 cases, aseptic implant loosening occurred; of these, 11 cases were due to major stem subsidence. In 2 cases, via falsa (cortical penetration) implantation occurred. In 5 cases, periprosthetic fractures led to revision. This corresponds to an aseptic total revision rate of 1.3% for 26 short stems and 1.9% including the cases of all 38 documented revision cases. Thirty-four cases were revised with cementless standard hip stems, 2 cases were revised with short stems, and 2 cases were revised with long revision stems. Undersizing was analyzed in 58% of aseptic revisions. Fifty-four percent of revisions were performed in male patients - 23% with osteonecrosis of the femoral head, and 7% with short hip stems positioned in varus in coxa vara deformities. Seventy-two percent of revisions after marked early stem subsidence and position change into valgus were performed in female patients. Dysplastic hips with coxa valga did not show elevated revision rates. No revisions were performed for dislocation or femoral thigh pain. Short stem THA with the Metha implant is a bone-preserving option for various indications in select patient groups. Copyright 2015, SLACK Incorporated.

  12. 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.

  13. Total hip arthroplasty: areview of advances, advantages and limitations

    Science.gov (United States)

    Liu, Xin-Wei; Zi, Ying; Xiang, Liang-Bi; Wang, Yu

    2015-01-01

    The therapeutic outcomes of Osteoarthritis (OA) has been unsatisfactory and often surgeries such as total hip arthroplasty (THA) is required. THA is an effective treatment for patients with end-stage arthritic hip conditions. Cemented THA has been the treatment of choice for elderly patients with OA. An improvement in Timed “Up and Go” (TUG) before surgery might contribute to a decrease in the occurrence of DVT after THA, though post-thrombotic syndrome (PTS), a chronic condition in the lower extremity does not appear to be a major complication after DVT in patients undergoing THA. For OA, four domains to be evaluated: pain, physical function, joint imaging, and patient global assessment. Thus, THA can be cost saving or, at least cost- effective in improving quality-adjusted life expectancy. The purpose of this review is to discuss the recent advances as well as advantages and limitations of THA. PMID:25784971

  14. Hip dislocations after 2,734 elective unilateral fast-track total hip arthroplasties

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer C; Kjaersgaard-Andersen, Per; Solgaard, Søren

    2014-01-01

    STUDY DESIGN: Retrospective review of prospectively collected data. OBJECTIVE: To investigate the incidence of hip dislocation 90 days after total hip arthroplasty in relation to time after surgery, mechanism of dislocation and predisposing factors. METHODS: Prospective data on preoperative patient...... of dislocations. Unadjusted comparisons were made using t test/Chi-square analyses, while evaluation of risk factors potentially predisposing to dislocations was done using uni- and multivariate regression analysis. RESULTS: A total of 2,734 consecutive unselected procedures were available for analysis, of which...... 65 (2.4 %) had dislocations. Of these, eight were during index admission and five were treated and discharged from the emergency room. Mechanisms of dislocation were most often movement while supine or sitting for the first 30 days and due to squatting/bending from day 31 to 90. The 65 patients...

  15. Efficacy evaluation of a protocol for safe hip surgery (total hip arthroplasty) ☆

    OpenAIRE

    Barros, Antônio Augusto Guimarães; Mendes, Carlos Henrique Cardoso; Temponi, Eduardo Frois; Costa, Lincoln Paiva; Vassalo, Carlos Cesar; Guedes, Euler de Carvalho

    2017-01-01

    Objective To propose a multidisciplinary protocol to standardize the care of patients undergoing total hip arthroplasty (THA) and evaluate it effectiveness after implementation. Methods Retrospective evaluation of 95 consecutive patients undergoing THA divided into two groups, one group of 47 patients operated before the protocol implementation and 48 after. Results Assessing the re-admission rate, among 47 patients evaluated prior to implementation of the protocol, seven (14.9%) were re-admi...

  16. Does total hip replacement affect sexual quality of life?

    Science.gov (United States)

    Harmsen, Rita Th E; Haanstra, Tsjitske M; Sierevelt, Inger N; Jansma, Elise P; Nolte, Peter A; Nicolai, Melianthe P J; Wall, Peter D H; Van Royen, Barend J

    2016-05-04

    Total Hip Replacement (THR) is an effective treatment for end-stage hip osteoarthritis. Since the introduction of total joint replacement, the effect on the Sexual Quality of Life (SQoL) following THR has been addressed in scant studies. The aim of our study was to systematically review the literature, to summarise effects of THR on patients' SQoL. We searched PubMed, EMBASE and PsycINFO between January 1970 and February 9th, 2015 with search terms including Total Hip, Osteoarthritis, SQoL, and THR. Eligible studies were identified and two independent authors extracted data including details of SQoL, study quality and risk of bias. There were 12 eligible studies, which included a total of 2099 patients with an age range of 20-85 years. The methodological quality of ten studies was rated as low, and of two as moderate. Amongst the majority of patients, SQoL improved after surgery, both in terms of physical-functional and psychosocial well-being. However, changes between pre-operative and postoperative SQoL ranged extensively: for example, Sexual Dysfunction Δ 8-51% and Sexual Activity (SA) Δ 0-77%. Three studies reported that some patients never resumed SA again after surgery. In over 40 years of THR treatment, scant studies have examined the effect of THR on patients' SQoL. This review suggests that SQol improves after THR, although the magnitude of effects varies highly. However, the quality of the supporting evidence was rated as low to moderate. This suggests a need for more high quality evidence about the effects of THR on SQoL.

  17. Pseudotumor associated with metal-on-polyethylene total hip arthroplasty.

    Science.gov (United States)

    Scully, William F; Teeny, Steven M

    2013-05-01

    This case report details the presentation, imaging results, and operative findings of a pseudotumor associated with a press-fit metal-on-polyethylene total hip arthroplasty (THA). An 80-year-old man presented approximately 7 years after undergoing THA with worsening right groin and lateral hip pain with an associated proximal thigh mass. Physical examination demonstrated a tender, large anterolateral thigh mass that was also evident on metal artifact reduction sequence magnetic resonance imaging.An exploratory operative procedure revealed extensive tissue necrosis involving nearly the entire hip capsule, short external rotators, and tendinous portion of the gluteus medius muscle. In addition, marked surface corrosion was discovered about the taper at the head-neck junction of the prosthetic femoral component and the trunnion within the femoral head. The press-fit THA components were solidly fixed. The metallic head was replaced with a ceramic component, and the polyethylene liner was exchanged. The patient had complete resolution of his preoperative symptoms but had persistent problems with dislocations.Although reports of pseudotumor and local soft tissue reactions associated with metal-on-metal THAs have become increasingly ubiquitous in the literature, similar reports involving metal-on-polyethylene THA implants are less common. Copyright 2013, SLACK Incorporated.

  18. Computer assisted navigation in total knee and hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Deep Kamal

    2017-01-01

    Full Text Available Introduction: Computer assisted surgery was pioneered in early 1990s. The first computer assisted surgery (CAS total knee replacement with an imageless system was carried out in 1997. In the past 25 years, CAS has progressed from experimental in vitro studies to established in vivo surgical procedures. Methods: A comprehensive body of evidence establishing the advantages of computer assisted surgery in knee and hip arthroplasty is available. Established benefits have been demonstrated including its role as an excellent research tool. Its advantages include dynamic pre-operative and per-operative assessment, increased accuracy in correction of deformities, kinematics and mechanical axis, a better alignment of components, better survival rates of prostheses and a better functional outcome. Adoption of computer navigation in the hip arthroplasty is still at an early stage compared to knee arthroplasty, though the results are well documented. Evidence suggests improved accuracy in acetabular orientation, positioning, hip offset and leg length correction. Results: Among the orthopaedic surgeons, navigated knee arthroplasty is gaining popularity though slowly. The uptake rates vary from country to country. The Australian joint registry data shows increased navigated knee arthroplasty from 2.4% in 2003 to 28.6% in 2015 and decreased revision rates with navigated knee arthroplasty in comparison with traditional instrumented knee arthroplasty in patient cohort under the age of 55 years. Conclusion: Any new technology has a learning curve and with practice the navigation assisted knee and hip arthroplasty becomes easy. We have actively followed the evidence of CAS in orthopaedics and have successfully adopted it in our routine practice over the last decades. Despite the cautious inertia of orthopaedic surgeons to embrace CAS more readily; we are certain that computer technology has a pivotal role in lower limb arthroplasty. It will evolve to become a

  19. Computer assisted navigation in total knee and hip arthroplasty.

    Science.gov (United States)

    Deep, Kamal; Shankar, Shivakumar; Mahendra, Ashish

    2017-01-01

    Computer assisted surgery was pioneered in early 1990s. The first computer assisted surgery (CAS) total knee replacement with an imageless system was carried out in 1997. In the past 25 years, CAS has progressed from experimental in vitro studies to established in vivo surgical procedures. A comprehensive body of evidence establishing the advantages of computer assisted surgery in knee and hip arthroplasty is available. Established benefits have been demonstrated including its role as an excellent research tool. Its advantages include dynamic pre-operative and per-operative assessment, increased accuracy in correction of deformities, kinematics and mechanical axis, a better alignment of components, better survival rates of prostheses and a better functional outcome. Adoption of computer navigation in the hip arthroplasty is still at an early stage compared to knee arthroplasty, though the results are well documented. Evidence suggests improved accuracy in acetabular orientation, positioning, hip offset and leg length correction. Among the orthopaedic surgeons, navigated knee arthroplasty is gaining popularity though slowly. The uptake rates vary from country to country. The Australian joint registry data shows increased navigated knee arthroplasty from 2.4% in 2003 to 28.6% in 2015 and decreased revision rates with navigated knee arthroplasty in comparison with traditional instrumented knee arthroplasty in patient cohort under the age of 55 years. Any new technology has a learning curve and with practice the navigation assisted knee and hip arthroplasty becomes easy. We have actively followed the evidence of CAS in orthopaedics and have successfully adopted it in our routine practice over the last decades. Despite the cautious inertia of orthopaedic surgeons to embrace CAS more readily; we are certain that computer technology has a pivotal role in lower limb arthroplasty. It will evolve to become a standard practice in the future in various forms like navigation

  20. Total hip arthroplasty after failed treatment of proximal femur fracture.

    Science.gov (United States)

    Tetsunaga, Tomonori; Fujiwara, Kazuo; Endo, Hirosuke; Noda, Tomoyuki; Tetsunaga, Tomoko; Sato, Toru; Shiota, Naofumi; Ozaki, Toshifumi

    2017-03-01

    Total hip arthroplasty (THA) is a good option as a salvage procedure after failed treatment of proximal femur fracture. The anatomy of the proximal femur, however, makes this surgery complicated and challenging. The purpose of this study was to evaluate the radiographic and clinical outcomes of THA after failed treatment of proximal femur fractures. We retrospectively analysed 50 consecutive THAs (42 women, 8 men; mean age 77 years) after failed treatment of a proximal femur fracture. Mean postoperative follow-up was 58.1 months. Preoperative diagnoses were femoral neck fracture in 18 hips and trochanteric fracture in 32 hips, including three that were infected. Failure resulted from cutout in 22 cases, osteonecrosis in 12, non-union with failed fixation in nine, postoperative osteoarthritis in four, and infection in three. Factors compared included radiographic assessment, complication rate, visual analogue scale (VAS), and Harris Hip Scores (HHS). Radiographic variables included femoral neck anteversion and cup and stem alignment. Absolute values of the differences in femoral neck anteversion between the affected and healthy sides were 6.0° in the femoral neck fracture group and 19.2° in the trochanteric fracture group (p = 0.01). There were no significant differences in cup anteversion (p = 0.20) or stem anteversion (p = 0.08). The complication rate was significantly higher in the trochanteric fracture group than in the femoral neck fracture group (25 vs 0%, p fracture group included three periprosthetic fractures (9.4%), two dislocations (6.3%), two surgical-site infections (6.3%), and one stem penetration (3.1%). Although no significant differences between groups were seen in the VAS or HHS at final follow-up (p = 0.32, 0.09, respectively), these measures were significantly improved at final follow-up in both groups (p fractures requires consideration of complication risk and incorrect femoral neck anteversion.

  1. [A new hip milling machine for preparation of the hip acetabulum for total hip prothesis (author's transl)].

    Science.gov (United States)

    Weigand, H

    1976-08-19

    The problemes of the exact preparation of the hip acetabulum for implantation of total hip prothesis have caused the development of several milling machines. Two sorts of construction predominate. Their disadvantages, especially the fact, that there is now mechanism, while is able to carry of the milled tissue, gave rise to construct a new milling machine. In cooperation with engineers of the branch mechanical engineering a new model was developed. The characteristic features are described and explained by pictures. The milling basket will be fastened on the ground plate by a quick fastener. In this way we get a hemisphere cavity, which is able to absorb all the milled tissue without any residue. A grasp will be connected with the drive shaft and guarantee an exact and rightangeled direction. The clinical tests have shown, that the new milling machine with the grasp especially is qualified for use in the osteoporotic senil bone too.

  2. Trabecular metal acetabular components in primary total hip arthroplasty

    DEFF Research Database (Denmark)

    Laaksonen, Inari; Lorimer, Michelle; Gromov, Kirill

    2018-01-01

    Background and purpose - Trabecular metal (TM) cups have demonstrated favorable results in acetabular revision and their use in primary total hip arthroplasty (THA) is increasing. Some evidence show that TM cups might decrease periprosthetic infection (PPI) incidence. We compared the survivorship...... of TM cups with that of other uncemented cups in primary THA, and evaluated whether the use of TM cups is associated with a lower risk of PPI. Patients and methods - 10,113 primary THAs with TM cup and 85,596 THAs with other uncemented cups from 2 high-quality national arthroplasty registries were...

  3. Cheating the Acetabular Component Horizontally in Total Hip Arthroplasty.

    Science.gov (United States)

    Eskildsen, Scott M; Moskal, Peter T; Olcott, Christopher W; Del Gaizo, Daniel J

    2016-11-01

    To avoid inadvertent vertical positioning of the acetabular component during total hip arthroplasty (THA), the authors routinely "cheat" component abduction an additional 10° horizontal (goal=30°). This likely increases the incidence of components placed into abduction of less than 30°, the clinical consequences of which are not well studied. The purpose of this study was to determine the clinical and radiographic outcomes in patients undergoing THA with acetabular components positioned in less than 30° of abduction as compared with those with components positioned between 30° and 50°. A retrospective review was performed of consecutive patients undergoing primary THA with horizontally cheated acetabular component position performed by a single surgeon. Patients were grouped into cohorts with either component abduction less than 30° or between 30° and 50°. Demographic data, operative data, and complications were recorded. Harris Hip Scores (HHS) and radiographic analysis were obtained from preoperative and most recent clinic visits. Between September 2004 and September 2010, 320 consecutive THA procedures were performed. A total of 149 hips had component abduction less than 30° (mean, 25.8°; range, 15.7°-29.4°). No components had greater than 50° of abduction. At an average 37-month follow-up, no significant difference in HHS was found between the 2 cohorts (P=.137). The horizontal cohort had no dislocations, component loosening, or osteolysis. By cheating the acetabular component more horizontal, an excessively vertical position was avoided. Component abduction less than 30° yielded equivalent clinical outcomes to component abduction between 30° and 50°. [Orthopedics. 2016; 39(6):e1092-e1096.]. Copyright 2016, SLACK Incorporated.

  4. Metallic Modular Taper Junctions in Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Timothy McTighe

    2015-08-01

    Full Text Available The emergence of modularity in total hip arthroplasty (THA in the 1980s and 1990s was based on the fact that the benefit of these design features outweighed the risk. The use of metallic modular junctions presents a unique set of advantages and problems for use in THA. The advantages include improvement in fit and fill of the implant to bone, restoration of joint mechanics, reduced complications in revision surgery and reduction of costly inventory. However, the risks or concerns are a little harder to identify and deal with. Certainly corrosion, and fatigue failure are the two most prevalent concerns but now the specifics of fretting wear and corrosive wear increasing particulate debris and the potential biological response is having an impact on the design and potential longevity of the reconstructed hip. Material and designs are facing a shorter life expectancy than what was previously thought, mostly due to an increasing level of physical activity by the patient. Because there are no accurate laboratory test whereby the service life and performance of these implants can be predicted, early controlled clinical evaluations are necessary. Early publication of testing and clinical impressions should be encouraged in an attempt to reduce exposure to potential at risk patients, implants and material. The reduction and possible elimination of risks will require a balancing of all the variables requiring a multidisciplinary endeavor. This paper is designed to review the risk factors, and benefits of modular junctions in total hip arthroplasty (THA. Also some basic engineering principals that can reduce risk factors and improve functionality of modular junctions.

  5. [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

    The elevated prevalence of osteoarthritis in Western countries, the high costs of hip and knee arthroplasty, and the wide variations in the clinical practice have generated considerable interest in comparing the associated costs before and after surgery. To determine the influence of a number of variables on the costs of total knee and hip arthroplasty surgery during the hospital stay and during the one-year post-discharge. A prospective multi-center study was performed in 15 hospitals from three Spanish regions. Relationships between the independent variables and the costs of hospital stay and postdischarge follow-up were analyzed by using multilevel models in which the "hospital" variable was used to group cases. Independent variables were: age, sex, body mass index, preoperative quality of life (SF-12, EQ-5 and Womac questionnaires), surgery (hip/knee), Charlson Index, general and local complications, number of beds and economic-institutional dependency of the hospital, the autonomous region to which it belongs, and the presence of a caregiver. The cost of hospital stay, excluding the cost of the prosthesis, was 4,734 Euros, and the post-discharge cost was 554 Euros. With regard to hospital stay costs, the variance among hospitals explained 44-46% of the total variance among the patients. With regard to the post-discharge costs, the variability among hospitals explained 7-9% of the variance among the patients. There is considerable potential for reducing the hospital stay costs of these patients, given that more than 44% of the observed variability was not determined by the clinical conditions of the patients but rather by the behavior of the hospitals.

  6. Subsequent Total Joint Arthroplasty After Primary Total Knee or Hip Arthroplasty: A 40-Year Population-Based Study.

    Science.gov (United States)

    Sanders, Thomas L; Maradit Kremers, Hilal; Schleck, Cathy D; Larson, Dirk R; Berry, Daniel J

    2017-03-01

    Despite the large increase in total hip arthroplasties and total knee arthroplasties, the incidence and prevalence of additional contralateral or ipsilateral joint arthroplasty are poorly understood. The purpose of this study was to determine the rate of additional joint arthroplasty after a primary total hip arthroplasty or total knee arthroplasty. This historical cohort study identified population-based cohorts of patients who underwent primary total hip arthroplasty (n = 1,933) or total knee arthroplasty (n = 2,139) between 1969 and 2008. Patients underwent passive follow-up through their medical records beginning with the primary total hip arthroplasty or total knee arthroplasty. We assessed the likelihood of undergoing a subsequent total joint arthroplasty, including simultaneous and staged bilateral procedures. Age, sex, and calendar year were evaluated as potential predictors of subsequent arthroplasty. During a mean follow-up of 12 years after an initial total hip arthroplasty, we observed 422 contralateral total hip arthroplasties (29% at 20 years), 76 contralateral total knee arthroplasties (6% at 10 years), and 32 ipsilateral total knee arthroplasties (2% at 20 years). Younger age was a significant predictor of contralateral total hip arthroplasty (p hip arthroplasties (3% at 20 years), and 29 ipsilateral total hip arthroplasties (2% at 20 years). Older age was a significant predictor of ipsilateral or contralateral total hip arthroplasty (p hip arthroplasty or total knee arthroplasty can be informed of a 30% to 45% chance of a surgical procedure in a contralateral cognate joint and about a 5% chance of a surgical procedure in noncognate joints within 20 years of initial arthroplasty. Increased risk of contralateral total knee arthroplasty following an initial total hip arthroplasty may be due to gait changes prior to and/or following total hip arthroplasty. The higher prevalence of bilateral total hip arthroplasty in younger patients may result from

  7. Hospital costs of total hip arthroplasty for developmental dysplasia of the hip.

    Science.gov (United States)

    Ashraf, Ali; Larson, A Noelle; Maradit-Kremers, Hilal; Kremers, Walter K; Lewallen, David G

    2014-07-01

    Developmental dysplasia of the hip (DDH) is a leading cause of total hip arthroplasty (THA) in younger patients. It is unknown how the hospital costs of THA in patients with DDH compare with patients with degenerative arthritis. We undertook this study to determine (1) the hospital cost and length of stay associated with primary THA in patients with dysplasia compared with nondysplastic control subjects; (2) the hospital cost and length of stay of THA in severely dysplastic hips compared with mildly dysplastic hips; and (3) perioperative complications in patients with DDH compared with patients without dysplasia. This matched-cohort study included 354 patients undergoing primary THA for DDH and 1029 age-, sex-, and calendar year-matched patients undergoing THA for primary osteoarthritis between 2000 and 2008. DDH severity was measured by the Crowe classification. An institutional database was used to calculate the cost of care. Using line item details (date, type, frequency, and billed charge) for every procedure or service billed at our institution for each patient, bottom-up microcosting valuation techniques were used to generate standardized inflation-adjusted estimates of the cost of each service or procedure in constant dollars. Generalized linear random effects models were used to compare length of stay and costs during hospitalization and the 90-day period after surgery. Query of a longitudinal institutional database was used to identify documented complications. Patients with DDH undergoing primary THA incurred higher hospital costs than patients with primary osteoarthritis (USD 16,949 versus USD 16,485, p = 0.012). Operating room costs (USD 3471 versus USD 3417, p = 0.0085) and implant costs (USD 3896 versus USD 3493, p economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.

  8. Total hip replacement in an alpaca using a cementless implant.

    Science.gov (United States)

    Schulz, Kara L; Roush, James K; Anderson, David E; Hoots, Eric

    2009-01-01

    To report use of a cementless total hip prosthesis in an alpaca. Case report. Alpaca (n=1) with chronic craniodorsal coxofemoral luxation. A 2.5-year-old Suri alpaca, 3 months pregnant, was admitted for evaluation of acute onset severe left hind limb lameness (grade 4/5) of 6 weeks duration. After diagnosis of craniodorsal luxation of the left femoral head, total hip replacement (THR) using a cementless implant was performed because of the poor prognosis for reduction of a chronic luxation. A press-fit prosthesis was used and the alpaca delivered a live cria 8 months later. Persistent mild mechanical lameness remained after surgery, with moderate reduction in mobility of the coxofemoral joint. The prosthesis was stable and correctly positioned at 7 weeks and at 9 months. There was mild exostosis surrounding the proximal aspect of the femur at 9 months, and Steinmann pins used to repair the trochanteric osteotomy were removed because of migration. At 1 year, the alpaca has a slight gait abnormality, remains with the herd on pasture and has been re-bred. Chronic coxofemoral luxation in an alpaca can be managed by THR. THR is a viable treatment option in alpacas with severe coxofemoral disease.

  9. Prospective study comparing functional outcomes and revision rates between hip resurfacing and total hip arthroplasty: preliminary results for 2 years

    Directory of Open Access Journals (Sweden)

    Régis Pailhé

    2013-07-01

    Full Text Available There is a need of independent prospective studies about modern generation of hip resurfacing implants. The aim of this propective observational study was to compare the functional outcomes and revision rates with hip resurfacing arthroplasty and total hip arthroplasty and to present the preliminary results at 2 years. Patients included were recruited prospectively in the Partial Pelvic Replacement Hip Project by a single surgeon between January 2007 and January 2010. Patients were assessed with the Harris Hip Score (HHS and Postel-Merle d’Aubigné (MDA score and Devane Score. The end point of the study was reoperation for any cause related to the prosthesis. At a mean follow up of 38.6 months there were a total of 142 patients with hip resurfacing (group 1 [100 Durom® (Zimmer Inc., Warsaw, IN, USA and 42 Birmingham Hip Resurfacing® (Smith & Nephew, Memphis, TN, USA] and 278 patients with total hip arthroplasty (group 2. The results showed significantly greater gain of HHS, MDA and Devane score with hip resurfacing procedures. However, considering all the complications, the rate was significantly higher in group 16.4% vs 1.79% in group 2 (P<0.0001. In group 1 we observed 6 complications only concerned males with Durom® implants. The follow up of this cohort is still on going and may deliver more information on the evolution of these results in time.

  10. Five Year Follow-up of One Stage Bilateral Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    CC Tai

    2007-04-01

    Full Text Available We report on the medium term outcome of five patients (ten hips who underwent one stage bilateral total hip arthroplasty. Both Harris Hip Scores and Oxford Hip Scores improved postoperatively as did range of motion. There was no radiographic evidence of loosening in any hip arthroplasty involved in this study, however one revision surgery was needed due to periprosthetic fracture. There were no increased medical complications. Based on our limited experience, we believe that one stage bilateral total hip arthroplasty is safe in selected patients.

  11. Preoperative therapeutic exercise in frail elderly scheduled for total hip replacement: A randomized pilot trial

    NARCIS (Netherlands)

    Hoogeboom, T.J.; Dronkers, J.J.; Ende, C.H.M. van den; Oosting, E.; Meeteren, N.L.U. van

    2010-01-01

    Objective: To evaluate the feasibility and preliminary effectiveness of therapeutic exercise before total hip replacement in frail elderly. Design: A single-blind, randomized clinical pilot trial. Setting: Outpatient physiotherapy department. Subjects: Frail elderly with hip osteoarthritis awaiting

  12. A modified S-ROM stem in primary total hip arthroplasty for developmental dysplasia of the hip.

    Science.gov (United States)

    Tamegai, Hideaki; Otani, Takuya; Fujii, Hideki; Kawaguchi, Yasuhiko; Hayama, Tetsuo; Marumo, Keishi

    2013-12-01

    This study examined the clinical outcome of 220 hips in 196 Asian patients who underwent primary total hip arthroplasty (THA) for treatment of developmental dysplasia of the hip (DDH) using a modified S-ROM modular (S-ROM-A) stem designed for Asians, after 2-5 years (mean, 3.3 years) of follow-up. The stem was placed so that the anteversion angle of the neck was decreased against the sleeve in 56% of the hips and increased in 18% of the hips. Bone ingrown fixation was achieved in 99.5% of the hips on X-ray at final follow-up. There were 2 (0.9%) dislocations postoperatively. In primary THA for treatment of DDH accompanied by femoral rotational deformity, the freely-rotatable modular stem provided favorable short-term outcomes by affording both morphological and functional advantages. Copyright © 2013 Elsevier Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

    Nissen, Nina; 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 while...

  14. The Use of Modularity in Total Hip Arthroplasty.

    Science.gov (United States)

    Cherubino, Paolo; Surace, Michele F

    2011-12-01

    Modularity is defined as separation of a system into independent parts or modules that can be treated as logical and may be separated and recombined. Historically, the modularity represents the evolution of the concept of "low friction arthroplasty" developed by Sir J. Charnely in 1960. The disadvantage of a one-piece stem is the difficulty of restoring the biomechanical feature of the hip. Thus, the natural evolution was the introduction of modularity on both sides, the acetabulum and the femur. Modularity allows the surgeon to accurately match the anatomic characteristics of each patient to obtain improved range of motion, joint stability, abductor strength, and leg length equality. Disadvantages are related to the introduction of different interfaces, which could be sites of wear and corrosion. In accordance with the most recent literature, in primary total hip arthroplasty (THA) the modularity can be reduced to the head and the acetabular component, while a one-piece stem can manage the majority of cases. On the other hand, we believe that during revision surgery, a complete modularity is necessary.

  15. Radiographic templating of total hip arthroplasty for femoral neck fractures.

    Science.gov (United States)

    Lakstein, Dror; Bachar, Ira; Debi, Ronen; Lubovsky, Omri; Cohen, Ornit; Tan, Zachary; Atoun, Ehud

    2017-04-01

    The purpose of this study was to evaluate the use of pre-operative digital templating to minimize complications including limb length discrepancy (LLD), intraoperative fractures and early dislocations in patients with intracapsular femoral neck fractures. We retrospectively compared 23 patients undergoing total hip arthroplasty (THA) for intracapsular femoral fractures with pre-operative digital templating and 48 patients without templating. The mean post-operative LLD was significantly lower in patients who had pre-operative templating than in the control group (6.7 vs. 11.5 mm, p = 0.023). Only three patients (13 %) with templating had LLD greater than 1.5 cm, compared to the 15 patients (31 %) without templating (p = 0.17). In eight cases the final femoral stem size matched the templated size, while 19 patients were within two size increments. Complications included one dislocation and one intra-operative fracture in the control group. The present study demonstrated that careful pre-operative planning may reduce LLD in patients undergoing THA due to intracapsular hip fractures.

  16. Resumption of car driving after total hip replacement.

    Science.gov (United States)

    Abbas, Ghulam; Waheed, Abdul

    2011-04-01

    To assess periods required for resuming car driving in 130 patients who had undergone total hip replacement (THR). 80 men and 50 women aged 39 to 80 years who had been driving automatic (n=49) or manual (n=81) cars in the previous 3 months and underwent unilateral primary THR of the right (n=85) or left (n=45) hip were recruited. Patients were advised to resume driving after 6 weeks if they felt comfortable to do so. 105 (81%) patients were able to resume driving at week 6 to 8; 67 (64%) had had a right THR and 65 (62%) were manual car drivers. 22 (17%) patients were able to do so at week 12. The remaining 3 (2%) patients were not confident to drive even at week 12. No patient reported deterioration in driving ability, whereas 48 (38%) felt a subjective improvement in their driving ability. The time to resume driving varies in different patients. The advice should be individualised, depending on the patient's recovery and confidence level.

  17. [Luxation of the prothesis after total hip arthroplasty].

    Science.gov (United States)

    Białecki, Piotr; Gusta, Andrzej; Bohatyrewicz, Andrzej; Ferenc, Marcin

    2006-01-01

    In this report we evaluated the incidence of complications following the total hip arthroplasty. We have focused on the role of the surgical approach as thepatient cause of the luxation of the prosthesis. Retrospective analysis of 393 endoprosthetic surgeries performed in the Department of Orthopedics and Traumatology, Pomeranian Medical University, between April 2002 and December 2003 was conducted. Out of 9 patients with prosthesis luxation 6 patients were operated using the posterior approach. A comparative analysis of selected groups did not reveal any significant differences in clinical condition of the patient, the implantation technique or the type of the applied prosthesis. We suggest that the main cause of prosthesis luxation were mistakes that led to misaligment of the prosthetic elements, and the posterior approach was believed to be the the predisposing factor.

  18. Complications after total hip replacement. Komplikationen nach Hueftgelenksendoprothesen

    Energy Technology Data Exchange (ETDEWEB)

    Engelbrecht, E.; Siegel, A. (Endo-Klinik, Hamburg (Germany, F.R.))

    1989-10-01

    Complications seen after long-term follow-up examinations of total hip replacement should be treated immediately and completely. In the past decade a considerable increase in revisions has been noted. Radiographic assessment may be regarded as an effective means in diagnosing prosthetic complications from the surgeon's point of view. Examples are given. The difficulties in radiographic assessment of complications after cementless implanation or cemented prostheses without contrast media are mentioned. Prosthesis-related complications, such as mechanical loosening, infection with and without loosening, fatigue fractures and wear, fractures of the femur or pelvis, dislocations and surgical failures, are illustrated, as are clinical courses with gross loss of bone stock after repeated surgery and delayed revisions. Complications not related to the prosthesis such as periarticular ossification, muscle deficiencies, and nervous and vascular lesions are also explained using examples. (orig.).

  19. Hydrotherapy after total hip arthroplasty: a follow-up study.

    Science.gov (United States)

    Giaquinto, S; Ciotola, E; Dall'armi, V; Margutti, F

    2010-01-01

    The aim of the study was to evaluate the subjective functional outcome of total hip arthroplasty (THA) in patients who underwent hydrotherapy (HT) 6 months after discharge. A prospective randomized study was performed on 70 elderly inpatients with recent THA, who completed a rehabilitation program. After randomization, 33 of them were treated in conventional gyms (no-hydrotherapy group=NHTG) and 31 received HT (hydrotherapy group=HTG). Interviews with the Western-Ontario MacMasters Universities Osteoarthritis Index (WOMAC) were performed at admission, at discharge and 6 months later. Kruskal-Wallis, Mann-Whitney and Wilcoxon tests were applied for statistical analysis. Both groups improved. Pain, stiffness and function were all positively affected. Statistical analysis indicated that WOMAC sub-scales were significantly lower for all patients treated with HT. The benefits at discharge still remained after 6 months. We conclude that HT is recommended after THA in a geriatric population.

  20. 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.

  1. Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Rinne M. Peters

    2017-01-01

    Full Text Available This case illustrates the potential for systemic cobalt toxicity in non-metal-on-metal bearings and its potentially devastating consequences. We present a 71-year-old male with grinding sensations in his right hip following ceramic-on-ceramic total hip arthroplasty (THA. After diagnosing a fractured ceramic liner, the hip prosthesis was revised into a metal-on-polyethylene bearing. At one year postoperatively, X-rays and MARS-MRI showed a fixed reversed hybrid THA, with periarticular densities, flattening of the femoral head component, and a pattern of periarticular metal wear debris and pseudotumor formation. Before revision could take place, the patient was admitted with the clinical picture of systemic cobalt toxicity, supported by excessively high serum cobalt and chromium levels, and ultimately died. At autopsy dilated cardiomyopathy as cause of death was hypothesized. A third body wear reaction between ceramic remnants and the metal femoral head very likely led to excessive metal wear, which contributed systemic cobalt toxicity leading to neurotoxicity and heart failure. This case emphasizes that fractured ceramic-on-ceramic bearings should be revised to ceramic-on-ceramic or ceramic-on-polyethylene bearings, but not to metal-on-polyethylene bearings. We aim to increase awareness among orthopedic surgeons for clinical clues for systemic cobalt intoxication, even when there is no metal-on-metal bearing surface.

  2. USING TRABECULAR METAL AUGMENTS FOR TOTAL HIP REPLACEMENT IN PATIENTS AFTER ACETABULAR FRACTURES

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2011-01-01

    Full Text Available The authors presented the experience of treatment of two patients with hip arthritis after acetabular fracture. Both patients were treated with total hip replacement. During the operation, to manage posterior-superior bone defects of the acetabulum, augments of trabecular metal were used. Pain and limitation of motions in hip were indications for operative treatment. After a year of follow up there was no pain in hip; also recovery of motion and improved quality of life were observed.

  3. Which approach for total hip arthroplasty: anterolateral or posterior?

    Science.gov (United States)

    Palan, Jeya; Beard, David J; Murray, David W; Andrew, J G; Nolan, John

    2009-02-01

    The best approach to use when performing THA is controversial. We did a prospective, nonrandomized multicenter study of 1089 THAs to evaluate patient-centered hip scores and dislocation and revision rates when comparing anterolateral and posterior hip approaches at 5 years' followup. Patients were divided into two groups depending on which surgical approach was used: anterolateral or posterior. The primary outcome measure was change in Oxford hip score. At 5 years, there were no differences in change in Oxford hip score and in dislocation or revision rates between the groups. Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

  4. Current Concepts in Acetabular Positioning in Total Hip Arthroplasty

    Science.gov (United States)

    Bhaskar, Deepu; Rajpura, Asim; Board, Tim

    2017-01-01

    Being one of the most successful surgeries in the history of medicine, the indications for total hip arthroplasty have widened and are increasingly being offered to younger and fitter patients. This has also led to high expectations for longevity and outcomes. Acetabular cup position has a significant impact on the results of hip arthroplasty as it affects dislocation, abductor muscle strength, gait, limb lengths, impingement, noise generation, range of motion (ROM), wear, loosening, and cup failure. The variables in cup position are depth, height, and angular position (anteversion and inclination). The implications of change in depth of center of rotation (COR) are medialized versus anatomical positioning. As opposed to traditional medialization with beneficial effects on joint reaction force, the advantages of an anatomical position are increasingly recognized. The maintained acetabular offset offers advantages in terms of ROM, impingement, cortical rim press fit, and maintaining medial bone stock. The height of COR influences muscle activity and limb lengths and available bone stock for cup support. On the other hand, ideal angular position remains a matter of much debate and reliably achieving a target angular position remains elusive. This is not helped by variations in the way we describe angular position, with operative, radiologic, or anatomic definitions being used variably to describe anteversion and inclination. Furthermore, pelvic tilt plays a major role in functional positions of the acetabulum. In addition, commonly used techniques of positioning often do not inform us of the real orientation of the pelvis on operating table, with possibility of significant adduction, flexion, and external rotation of the pelvis being possibilities. This review article brings together the evidence on cup positioning and aims to provide a systematic and pragmatic approach in achieving the best position in individual cases. PMID:28790467

  5. Total Hip Bone Area Affects Fracture Prediction With FRAX® in Canadian White Women.

    Science.gov (United States)

    Leslie, William D; Lix, Lisa M; Majumdar, Sumit R; Morin, Suzanne N; Johansson, Helena; Odén, Anders; McCloskey, Eugene V; Kanis, John A

    2017-11-01

    Areal bone mineral density (BMD) measurements are confounded by skeletal size. Hip BMD is an input to the FRAX® tool (Centre for Metabolic Bone Diseases, University of Sheffield, United Kingdom), but it is unknown whether performance is affected by hip area. To examine whether fracture prediction by FRAX® is affected by hip area. Cohort study using a population-based BMD registry. A total of 58,108 white women aged ≥40 years. Incident major osteoporotic fracture (MOF; n = 4913) and hip fracture (n = 1369), stratified by total hip area quintile, before and after adjustment for hip axis length (HAL). Smaller hip area was associated with younger age and lower FRAX® scores, whereas incident fractures were greater in those with larger hip area (P for trend hip area quintile increased risk for MOF and hip fracture when adjusted for FRAX® score with BMD (P for trend hip area was associated with greater risk for incident MOF [adjusted hazard ratio (HR), 1.08; 95% confidence interval (CI), 1.05 to 1.11] and hip fracture (HR, 1.16; 95% CI, 1.11 to 1.21), but not after adjustment for HAL. FRAX® with BMD underestimated MOF risk in the largest hip area quintile and underestimated hip fracture risk in the three largest hip area quintiles. In Canadian white women, skeletal size based on hip area affects fracture risk assessment based on FRAX® score with BMD, with risk underestimated in those with larger hip areas. Including HAL in the risk assessment compensates for this confounding by skeletal size and provides for more accurate assessment of fracture risk.

  6. Total hip replacement surgery in Ethiopia | Gokcen | East and ...

    African Journals Online (AJOL)

    The hip implant used was a Stryker Omnfit Uncemented HA-coated prosthesis. The Visual Analog Scale (VAS) for pain and the Modified Oxford Hip Score were used to assess outcomes. Variables recorded for each patient included sociodemographic information, diagnosis, comorbidity, surgical approach, duration of ...

  7. Functioning Before and After Total Hip or Knee Arthroplasty

    NARCIS (Netherlands)

    I.B. de Groot (Ingrid)

    2009-01-01

    textabstractOsteoarthritis (OA) of the hip or knee is a common locomotor disease characterized by degradation of articular cartilage. In the Netherlands, in the year 2000 about 257,400 persons above the age of 55 years had hip OA and about 335,700 persons had knee OA. Because the prevalence of OA

  8. and Post‑operative Blood Loss in Total Hip Arthroplasty at the ...

    African Journals Online (AJOL)

    2017-05-18

    May 18, 2017 ... the independent t‑test and Levene's test for equality of variances. P =0.05 or less was taken as significant, at. 95% confidence interval. Outcome measure. The outcome measures were intra‑ and post‑operative blood loss after total hip replacement. Results. A total of 41 patients who had total hip arthroplasty.

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

    Directory of Open Access Journals (Sweden)

    van Raaij Jos JAM

    2008-10-01

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

  10. [Biological downsizing : Acetabular defect reconstruction in revision total hip arthroplasty].

    Science.gov (United States)

    Koob, S; Scheidt, S; Randau, T M; Gathen, M; Wimmer, M D; Wirtz, D C; Gravius, S

    2017-02-01

    Periacetabular bony defects remain a great challenge in revision total hip arthroplasty. After assessment and classification of the defect and selection of a suitable implant the primary stable fixation and sufficient biological reconstitution of a sustainable bone stock are essential for long term success in acetabular revision surgery. Biological defect reconstruction aims for the down-sizing of periacetabular defects for later revision surgeries. In the field of biological augmentation several methods are currently available. Autologous transplants feature a profound osseointegrative capacity. However, limitations such as volume restrictions and secondary complications at the donor site have to be considered. Structural allografts show little weight bearing potential in the long term and high failure rates. In clinical practice, the usage of spongious chips implanted via impaction bone grafting technique in combination with antiprotrusio cages for the management of contained defects have shown promising long time results. Nevertheless, when dealing with craniolateral acetabular and dorsal column defects, the additional implantation of macroporous metal implants or augments should be considered since biological augmentation has shown little clinical success in these particular cases. This article provides an overview of the current clinically available biological augmentation methods of peri-acetabular defects. Due to the limitations of autologous and allogeneic bone transplants in terms of size and availability, the emerging field of innovative implantable tissue engineering constructs gains interest and will also be discussed in this article.

  11. 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...

  12. Do patients lose weight after total hip arthroplasty?

    Science.gov (United States)

    Schwartsmann, Carlos Roberto; Ledur, Felipe Ribeiro; Spinelli, Leandro de Freitas; Germani, Bruno Lorandos; Boschin, Leonardo Carbonera; Gonçalves, Ramiro Zilles; Yépez, Anthony Kerbes; Ferreira, Marco Tonding; Silva, Marcelo Faria

    2014-01-01

    To investigate the effect of total hip arthroplasty (THA) on body mass index (BMI), from before to after the operation. 100 patients who underwent THA were retrospectively analyzed. They were stratified according to BMI, as proposed by the World Health Organization (WHO). There were 48 male patients and 52 female patients. Their mean age was 63.8 ± 13.5 years. The mean follow-up was 24.6 ± 0.6 months. The men had a mean preoperative BMI of 28.4 ± 3.6 kg/m(2) and the women, 27.5 ± 5.0 kg/m(2). The mean postoperative BMI was 28.9 ± 0.7 kg/m(2) for the men and 27.8 ± 0.7 kg/m(2) for the women. There was a general mean increase in BMI of 0.4 kg/m(2). The BMI increased both in patients with normal weight and in those who were overweight, but it decreased slightly in patients who were obese. BMI remained unchanged in the majority of the patients (73%). The improvement in mobility achieved through THA did not promote any reduction in anthropometric measurements in the majority of the patients.

  13. Periprosthetic microvasculature in loosening of total hip replacement.

    Science.gov (United States)

    Santavirta, S; Ceponis, A; Solovieva, S A; Hurri, H; Jin, J; Takagi, M; Suda, A; Konttinen, Y T

    1996-01-01

    This study was performed to quantitate vascularity in periprosthetic tissues of loose total hip replacements (THRs), because most likely revascularization and endothelial cells are important for implant osseointegration and loosening. Interface and pseudocapsular tissue samples obtained from loose THRs were stained with an immunohistochemical labelling (ABC technique) for von Willebrand factor. Non-inflammatory synovial samples served as controls. The results were quantitated by morphometry using the Kontron image analysis system. Evaluation of the mean endothelial index (EI; positively stained area micron/mm2 of tissue) revealed that in the control samples synovium was better vascularized than was the case in the cellular areas of the periprosthetic pseudocapsule (P = 0.0008) and interface (P = 0.0004) of loose THRs. There was no significant difference between mean EI of cellular areas in the interface and that of the pseudocapsule (P = 0.24). In the interface the vascularity was irregular. Vascular injury and decreased blood supply seem to occur at the implant-host interface, which may be one of the reasons for insufficient implant osseointegration and loosening.

  14. Femoral Nerve Catheters Improve Home Disposition and Pain in Hip Fracture Patients Treated With Total Hip Arthroplasty.

    Science.gov (United States)

    Arsoy, Diren; Huddleston, James I; Amanatullah, Derek F; Giori, Nicholas J; Maloney, William J; Goodman, Stuart B

    2017-11-01

    Opioids have been the mainstay of treatment in the physiologically young geriatric hip fracture patient undergoing total hip arthroplasty (THA). However opioid-related side effects increase morbidity. Regional anesthesia may provide better analgesia, while decreasing opioid-related side effects. The goal of this study was to examine the effect of perioperative continuous femoral nerve blockade with regards to pain scores, opioid-related side effects and posthospital disposition in hip fracture patients undergoing THA. Twenty-nine consecutive geriatric hip fracture patients (22 women/7 men) underwent THA. Average follow-up was 8.3 months (6 weeks-39 months). Fifteen patients were treated with standard analgesia (SA). Fourteen patients received an ultrasound-guided insertion of a femoral nerve catheter after radiographic confirmation of a hip fracture. All complications and readmissions that occurred within 6 weeks of surgery were noted. Continuous femoral nerve catheter (CFNC) patients were discharged home more frequently than SA patients (43% for CFNC vs 7% for SA; P = .023). CFNC patients reported lower average pain scores preoperatively (P home more frequently. Use of a CFNC decreased daily average patient-reported pain scores, preoperative opioid usage, and opioid-related side effects after THA for hip fracture. Based on these data, we recommend routine use of perioperative CFNC in hip fracture patients undergoing THA. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. 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

    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 treatment by THR do not necessarily share the same risk factors, and caution should be exercised in epidemiological studies in attributing one or the other as the end point of coxarthrosis....... prevalence was 1.0--2.5% 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...

  16. 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

    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

  17. Is there a risk of permanent renal dysfunction after primary total hip and knee joint replacements?

    DEFF Research Database (Denmark)

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

    2016-01-01

    primary total hip and knee joint replacements. METHODS: Long-term postoperative renal dysfunction was analyzed in a retrospective study of 1301 consecutive primary total hip and knee joint replacements performed between January 2009 and December 2013. According to the RIFLE criteria, increased serum...

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

    Directory of Open Access Journals (Sweden)

    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

  19. Efficacy evaluation of a protocol for safe hip surgery (total hip arthroplasty).

    Science.gov (United States)

    Barros, Antônio Augusto Guimarães; Mendes, Carlos Henrique Cardoso; Temponi, Eduardo Frois; Costa, Lincoln Paiva; Vassalo, Carlos Cesar; Guedes, Euler de Carvalho

    2017-01-01

    To propose a multidisciplinary protocol to standardize the care of patients undergoing total hip arthroplasty (THA) and evaluate it effectiveness after implementation. Retrospective evaluation of 95 consecutive patients undergoing THA divided into two groups, one group of 47 patients operated before the protocol implementation and 48 after. Assessing the re-admission rate, among 47 patients evaluated prior to implementation of the protocol, seven (14.9%) were re-admitted, and when observing the 48 patients evaluated after implementation, one (2.1%) was re-admitted, showing statistical significance (p protocol was eight times the chance of hospitalization after implementation (95% CI: 1.01 to 377.7). By comparing the clinical complications among the groups, it was observed that there was a lower rate of complications following implementation of the protocol (p = 0.006). The introduction of a multidisciplinary protocol to standardize the management of patients undergoing THA decreased the rates of rehospitalization and clinical complications after the procedure.

  20. Reverse-total shoulder arthroplasty cost-effectiveness: A quality-adjusted life years comparison with total hip arthroplasty.

    Science.gov (United States)

    Bachman, Daniel; Nyland, John; Krupp, Ryan

    2016-02-18

    To compare reverse-total shoulder arthroplasty (RSA) cost-effectiveness with total hip arthroplasty cost-effectiveness. This study used a stochastic model and decision-making algorithm to compare the cost-effectiveness of RSA and total hip arthroplasty. Fifteen patients underwent pre-operative, and 3, 6, and 12 mo post-operative clinical examinations and Short Form-36 Health Survey completion. Short form-36 Health Survey subscale scores were converted to EuroQual Group Five Dimension Health Outcome scores and compared with historical data from age-matched patients who had undergone total hip arthroplasty. Quality-adjusted life year (QALY) improvements based on life expectancies were calculated. The cost/QALY was $3900 for total hip arthroplasty and $11100 for RSA. After adjusting the model to only include shoulder-specific physical function subscale items, the RSA QALY improved to 2.8 years, and its cost/QALY decreased to $8100. Based on industry accepted standards, cost/QALY estimates supported both RSA and total hip arthroplasty cost-effectiveness. Although total hip arthroplasty remains the quality of life improvement "gold standard" among arthroplasty procedures, cost/QALY estimates identified in this study support the growing use of RSA to improve patient quality of life.

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

    NARCIS (Netherlands)

    Stubbe, J.H.; Gelsema, T.; Delnoij, D.M.J.

    2007-01-01

    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

  2. [Total hip arthroplasty for crowe type IV developmental dysplasia of the hip with S-ROM prosthesis].

    Science.gov (United States)

    Sun, Qi-Cai; Wang, Xiang-Hua; Song, Bai-Shan; Zhu, Fang-Bing; Yan, Shi-gui

    2013-02-01

    To develop the techniques of total hip arthroplasty(THA) for Crowe type IV developmental dysplasia of the hip (DDH) with S-ROM prosthesis,and to assess its clinical results. From October 2000 to October 2011,30 patients (36 hips) with Crowe type IV DDH underwent THA,including 6 patients with bilateral hip involved and 24 patients with unilateral. S-ROM prosthesis was adopted together with subtrochanteric transverse osteotomy. All the cementless acetabular cups were placed at the original anatomic location. The threaded cups were put in or near the level of the true acetabulum in all patients. Full coating stems were used in femoral side. All the patients were evaluated by using the Modified Harris Hip Score. Radiographic evaluations were made preoperatively and during follow-up. Two patients lost of follow-up. Twenty-seven patients with 32 hips were followed up,and the average duration was 48 months (ranging from 7 to 84 months). There was 1 patient with bilateral THA died from hemorrhagic shock. Two patients could walk freely with the visible fracture lines at 12th and 18th months postoperatively. There were no complications such as infection or nerve injuries. Modified Harris Hip Score improved from preoperative 41.7+/-3.7 to postoperative 89.1+/-2.9. There was no acetabular or femoral component revision because of mal-position or loosening of the prostheses in all patients. Postoperative X-ray showed that all the prostheses in place,good integration between acetabular cups,femoral prosthesis and host bone without loosening. All bone grafts were integrated. All the hips acquired union of osteotomy and bone in-growth. None of the patients had radiographic evidence of aseptic loosening of prosthesis. For the complex DDH, follow methods should be used to improve therapeutic effects:good exposure of the true acetabulum,deepen acetabulum, femoral shortening, oblique osteotomy, using the S-ROM prosthesis.

  3. Total hip replacements at Kikuyu Hospital, Kenya | Kingori | East ...

    African Journals Online (AJOL)

    ... one upper gastro intestinal bleeding, two Deep Vein Thrombosis, one sciatic nerve neuropraxia, one haematoma formation and one intraoperative femoral fracture. Out of the 97 patients 40 of them had the surgery performed more than six months after a proper diagnosis was made and hip arthroplasty recommended.

  4. Total hip replacement for Mseleni Joint Disease undertaken in a ...

    African Journals Online (AJOL)

    Girdlestones, without any deterioration in function or mobility. The X-ray appearance of loosening was common, although clinical symptoms were not associated with the findings. It was therefore found that hip surgery in this setting is of great benefit to Mseleni Joint Disease patients, although further attention needs to be ...

  5. Analgesia after total hip replacement: epidural versus psoas ...

    African Journals Online (AJOL)

    Methods Patients scheduled for hip arthroplasty received either a psoas compartment or epidural infusion of bupivacaine. The outcome measures that were examined were postoperative pain, local anaesthetic and morphine consumption, and side effects. Results There was no significant difference between the two groups ...

  6. [Is suction drainage necessary in elective total hip arthroplasty?].

    Science.gov (United States)

    Major, Tibor; Bikov, András; Holnapy, Gergely; Bejek, Zoltán; Bakos, Bernadett; Szendrői, Miklós; Skaliczki, Gábor

    2016-07-01

    Several studies have been published which questioned the use of suction drain during elective hip arthroplasty. In this prospective study the authors examined how the use of suction drainage affected complications related to perioperative blood loss and hemorrhage in patients undergoing elective hip arthroplasty. Eighty-six patients undergoing elective hip arthroplasty were divided into two groups. In 54 patients ("drain" group) suction drains were used during operation, whereas in 32 patients no suction drain was applied. Perioperative blood loss, use of tranexamic acid, method of thrombosis prophylaxis, transfusion requirement, incidental postoperative hemorrhage, septic complications, and all other postoperative complications were recorded. Perioperative blood loss was affected with the use of tranexamic acid but not with the use of drainage (p = 0.94). Patients without the use of drain showed a tendency of lower transfusion requirement (p = 0.08). There was no correlation between any complications and the use of drainage. In accordance with published results the authors conclude that the routine use of suction drainage during elective hip arthroplasty is not definitely necessary. Orv. Hetil., 2016, 157(29), 1171-1176.

  7. 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

    . 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 postoperative serum creatinine was considered indicative of postoperative renal injury. The Welch two-sample test...

  8. The effect of posterior capsule repair upon post-operative hip dislocation following primary total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Wang Chen-Ti

    2008-02-01

    Full Text Available Abstract Background Herein, we evaluated, retrospectively, the effect of posterior capsular repair upon postoperative hip dislocation subsequent to total hip arthroplasty (THA incorporating a posterolateral approach. Methods A total of 181 patients undergoing 204 primary non-complicated THA surgical procedures in the period from January 2000 to October 2005 inclusively were included in this study. The patients were separated into two groups by whether the posterior capsular repair had been incorporated in the surgical procedure. For the surgeon did not commence repairing the posterior capsule until July, 2003, all members in the group that did not undergo posterior capsular repair (142 hips from 131 patients were collected since January, 2000 to July, 2003, while the members in the group that underwent posterior capsular repair (62 hips from 52 patients were followed since July, 2003, to October, 2005. With a minimum follow-up period of 12 months, we evaluated the early post-operative dislocation rate. Results The early postoperative hip-dislocation rate for the group who did not undergo posterior capsular repair appeared to be substantially greater (6.38% versus 0% than the corresponding figure for the group the members of which underwent posterior capsular repair. In addition, patient demographics and the orientation of acetabular components for the replaced hip joints, as presented in postoperative radiographs, did not differ between the two groups. Conclusion Thus, surgeons should include posterior capsular repair as an important step in the surgical procedures of posterolateral approach for all THA in order to reduce the likelihood of early hip dislocation subsequent to THA.

  9. Alternative materials to improve total hip replacement tribology.

    Science.gov (United States)

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

    2003-08-01

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

  10. Total hip arthroplasty in skeletal dysplasias: patient selection, preoperative planning, and operative techniques.

    Science.gov (United States)

    Ain, Michael C; Andres, Brett M; Somel, Deniz S; Fishkin, Zair; Frassica, Frank J

    2004-01-01

    Patients with substantial skeletal dysplasia and hip arthritis are poor candidates for noncustom total hip arthroplasty (THA) because of hip size and deformity. To determine the efficacy of THA via modified prostheses and surgical techniques in this population, the authors analyzed 9 consecutive THAs in 7 small-stature adults (mean height, 118.6 cm; mean weight, 47.5 kg). The Student t-test was used to test for significant (P < 0.05) differences in outcome variables. Seven hips received custom femoral components based on imaging studies. Five hips required extensive soft-tissue releases secondary to severe contractures. Follow-up radiographs (range, 24-56 months) showed adequate position of all prostheses and no loosening. Follow-up mean pain and function scores (Harris Hip Score and WOMAC Arthritis Index) showed significant improvement from preoperative levels.

  11. A Report Of Two Cases Of Uncemented Total Hip Replacement In ...

    African Journals Online (AJOL)

    This is a report of two sickle cell patients (HbSS) with advanced osteoarthritis of the right hip. The patients were in Ficat and Arlet\\'s stage 3 and 4 respectively. Both were females aged 23 and 46 years and they had uncemented hydroxyapatite coated omnifit (Stryker Howmedica Osteonics) total hip prosthetic replacement.

  12. A longitudinal study of quality of life and functional status in total hip and total knee replacement patients.

    Science.gov (United States)

    Mandzuk, Lynda L; McMillan, Diana E; Bohm, Eric R

    2015-05-01

    Primary total hip and primary total knee surgeries are commonly performed to improve patients' quality of life and functional status. This longitudinal retrospective study (N = 851) examined self-reported quality of life and functional status over the preoperative and postoperative periods: 12 months prior to surgery, one month prior to surgery and 12 months following surgery. A linear mixed effects model was used to analyze the changes in quality of life and functional status over the sampling period. Patients in the convenience sample reported improvements in quality of life and functional status utilizing the SF-12 and Oxford Hip and Oxford Knee, although differences were noted by procedure and gender. Total hip patients tended to demonstrate greater improvement than total knee patients and males reported higher levels of physical and mental quality of life as well as functional status when compared to females. Of particular note was that mental health scores were consistently lower in both total hip and total knee replacement patients across the perioperative period and up to one year postoperative. This study identifies an opportunity for health care providers to proactively address the mental health of total hip and total knee replacement patients throughout their joint replacement trajectory. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. TOTAL HIP ARTHROPLASTY IN CHILDREN WHO HAVE UNDERGONE ARTHROPLASTY WITH DEMINERALIZED BONE-CARTILAGE ALLOCUPS

    Directory of Open Access Journals (Sweden)

    Vladimir E. Baskov

    2017-03-01

    Full Text Available Introduction. Treating children with degenerative dystrophic diseases of the hip joint has become one of the most acute problems in contemporary orthopedics. Until recently, we performed arthroplasty by demineralized bone-cartilage allocups (DBCA in the Clinic of the Hip Joint Pathology of the Turner Scientific and Research Institute for Children’s Orthopedics for patients showing clinical and radiological signs of irreversible destruction of the hip joint; we carried out this procedure to preserve the function of the lower limb. However, over the last 8 years, we have changed our protocol for children older than 12 years of age and have replaced DBCA with total hip replacement. In a number of cases, total hip replacement was performed after a previous intervention involving arthroplasty with DBCA. Objective. To determine the technical peculiarities of total hip replacement after a previous intervention involving arthroplasty with DBCA. Material and methods. We analyzed the results of treatment involving various types of hip pathology in 13 children (100% aged between 15 and 16 years [8 girls (61.5% and 5 boys (38.5%]. The medical histories of all 13 children (100% showed repeated operations on the hip joint, ultimately resulting in arthroplasty with DBCA. All 13 children (100% underwent a total hip replacement. Upon hip replacement, all 13 patients (100% showed a pronounced thinning and hardening of the edges and the bottom of the acetabulum, which created some difficulties in the process of acetabular component implantation. The transformation of DBCA was not evident in any of the 13 cases (100%. Results. During the observation period of 3–5 years following total hip arthroplasty, all 13 cases (100% showed recovery in the range of motion and absence of pain. An important criterion for evaluating the quality of care was the complete social and domestic adaptation of all 13 children (100% during the period from 6 to 9 months following total

  14. Total hip arthroplasty in advanced osteonecrosis: the short-term results by metal-on-metal hip resurfacing.

    Science.gov (United States)

    Madadi, Firooz; Eajazi, Alireza; Kazemi, Seyyed Morteza; Aalami Harandi, Armin; Madadi, Firoozeh; Sharifzadeh, Seyyed Reza

    2011-02-01

    Characteristically, osteonecrosis affects younger patients who typically refer to the orthopedic surgeon for the first time in the third to fifth decades of life, in the late stages of the disease. Femoral metal-on-metal hip resurfacing is as an alternative to conventional total hip arthroplasty in treating osteoarthritis of the hip. Since there are already many reports regarding the successful outcome of resurfacing in advanced osteoarthritis, the purpose of this study was to analyze the clinical outcomes of this procedure in patients with osteonecrosis of the femoral head and to compare them with a matched group of patients with osteoarthritis. This retrospective cohort study evaluated a consecutive series of 52 patients with end-stage osteonecrosis (28 patients) and osteoarthritis (24 patients) of the femoral head, managed by metal-on-metal hip resurfacing in a referral orthopedic center from Feb 2002 to May 2007. Pain, function and deformity were evaluated with the use of the Harris hip score after the operation. Patients were clinically followed for a mean of 41 months. The patients in the osteoarthritis group had a significantly higher mean age than those in the osteonecrosis group (47.88 ± 12.6 vs 30.86 ± 7.5, p=0.003). The clinical outcomes were similar for both groups. There was no significant difference in mean Harris hip score (p=0.347) and hip joint range of motion (p=0.346) between osteonecrosis and osteoarthritis groups after surgery. On the basis of these initial findings, we recommend MOM resurfacing as a viable treatment option for patients with advanced stages of osteonecrosis.

  15. Clinical Cold Welding of the Modular Total Hip Arthroplasty Prosthesis.

    Science.gov (United States)

    Whittaker, Robert K; Zaghloul, Ahmed M; Hothi, Harry S; Siddiqui, Imran A; Blunn, Gordon W; Skinner, John A; Hart, Alister J

    2017-02-01

    A head that is "clinically cold welded" to a stem is one of the commonest reasons for unplanned removal of the stem. It is not clear which hip designs are at greatest risk of clinical cold welding. This was a case-control study of consecutively received hip implant retrievals; we chose the design of hip that had the greatest number of truly cold-welded heads (n = 11). For our controls, we chose retrieved hips of the same design but without cold welding of the head (n = 35). We compared the clinical variables between these 2 groups using nonparametric Mann-Whitney tests to investigate the significance of differences between the cold-welded and non-cold-welded groups. The design that most commonly caused cold welding was a combination of a Ti stem and Ti taper: 11 out of 48 (23%) were truly cold welded. Comparison of the clinical data showed that no individual factor could be used to predict this preoperatively with none of the 4 predictors tested showing any significance: (1) time to revision (P = .687), (2) head size (P = .067), (3) patient age at primary (P = .380), and (4) gender (P = .054). We have shown that clinical cold welding is most prevalent in Ti-Ti combinations of the stem and taper; approximately 25% of cases received at our center were cold welded. Analysis of clinical variables showed that it is not possible to predict which will be cold welded preoperatively. Surgeons should be aware of this potential complication when revising a Ti-Ti stem/head junction. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Navigation reduces the learning curve in resurfacing total hip arthroplasty.

    Science.gov (United States)

    Cobb, Justin P; Kannan, Vijaraj; Brust, Klaus; Thevendran, Gow

    2007-10-01

    Hip resurfacing is a novel technique with a substantial learning curve resulting in poor outcomes for many patients. We asked whether navigation would influence this learning curve and accuracy of implantation. Twenty medical students earning their degree in surgical technology participated in a randomized trial. We provided instruction about the surgical technique, including the use of conventional instrumentation, the use of a computed tomography-based planner for hip resurfacing, and a navigation system. The 20 students were then split into three groups undertaking these tasks in three different orders. Synthetic femurs replicated normal, osteoarthritis, slipped capital femoral epiphysis, and coxa valga. The mean error using the conventional method to insert a guidewire was 23 degrees; using the computed tomography plan method it was 22 degrees; and using navigation was 7 degrees. Students produced similar accuracy, even in their first attempt, on difficult anatomy when provided navigation. Motivated students rapidly achieved an expert level of accuracy when provided with navigation. Learning a conventional method first did not improve performance, even in difficult cases. Our data suggest navigation may play an important role in reducing the learning curve in hip resurfacing arthroplasty and other tasks in arthroplasty in which a high degree of accuracy is clinically important.

  17. Hybrid Continuous-Flow Total Artificial Heart.

    Science.gov (United States)

    Fox, Carson; Chopski, Steven; Murad, Nohra; Allaire, Paul; Mentzer, Robert; Rossano, Joseph; Arabia, Francisco; Throckmorton, Amy

    2018-01-18

    Clinical studies using total artificial hearts (TAHs) have demonstrated that pediatric and adult patients derive quality-of-life benefits from this form of therapy. Two clinically-approved TAHs and other pumps under development, however, have design challenges and limitations, including thromboembolic events, neurologic impairment, infection risk due to large size and percutaneous drivelines, and lack of ambulation, to name a few. To address these limitations, we are developing a hybrid-design, continuous-flow, implantable or extracorporeal, magnetically-levitated TAH for pediatric and adult patients with heart failure. This TAH has only two moving parts: an axial impeller for the pulmonary circulation and a centrifugal impeller for the systemic circulation. This device will utilize the latest generation of magnetic bearing technology. Initial geometries were established using pump design equations, and computational modeling provided insight into pump performance. The designs were the basis for prototype manufacturing and hydraulic testing. The study results demonstrate that the TAH is capable of delivering target blood flow rates of 1-6.5 L/min with pressure rises of 1-92 mm Hg for the pulmonary circulation and 24-150 mm Hg for the systemic circulation at 1500-10 000 rpm. This initial design of the TAH was successful and serves as the foundation to continue its development as a novel, more compact, nonthrombogenic, and effective therapeutic alternative for infants, children, adolescents, and adults with heart failure. © 2018 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

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

    NARCIS (Netherlands)

    Heintzbergen, S.; Kulin, N.A.; IJzerman, Maarten Joost; Steuten, Lotte Maria Gertruda; Werle, J.; Khong, H.; Marshall, D.A.

    2013-01-01

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

  19. The efficacy of modified direct lateral versus posterior approach on gait function and hip muscle strength after primary total hip arthroplasty at 12months follow-up

    DEFF Research Database (Denmark)

    Rosenlund, Signe; Broeng, Leif; Overgaard, Søren

    2016-01-01

    BACKGROUND: The lateral and the posterior approach are the most commonly used procedures for total hip arthroplasty. Due to the detachment of the hip abductors, lateral approach is claimed to cause reduced hip muscle strength and altered gait pattern. However, this has not been investigated in a ...

  20. Development of quality of care indicators for patients undergoing total hip or total knee replacement.

    Science.gov (United States)

    SooHoo, N F; Lieberman, J R; Farng, E; Park, S; Jain, S; Ko, C Y

    2011-02-01

    The objective of this study was to develop evidence-based quality indicators to measure key aspects of care that can be targeted to decrease variations in complication rates between surgeons performing total joint replacement. RAND/University of California, Los Angeles (UCLA) modified-Delphi expert panel method. To accomplish this objective, a proposed set of quality of care indicators was developed through a comprehensive literature search and structured interviews with expert clinicians. An expert panel of orthopaedic surgeons was then convened to rate the validity of these quality indicators using the RAND/UCLA Appropriateness Method. Indicators were classified as valid by the panel based on the median panel rating and the amount of dispersion of panel ratings. There were 101 candidate indicators of quality identified in the six domains of preoperative processes of care, intraoperative processes, postoperative processes, implant selection and the use of new technology, privileging of hospitals and surgeons, and outcomes and comorbidity assessment. A total of 68 of the 101 indicators were rated as valid with statistical agreement. This study identifies measures of structure, process and outcome rated as valid quality indicators for hip and knee replacement. This project provides tools to measure and improve quality of care for patients undergoing total joint replacement.

  1. Cementless total hip arthroplasty for patients with Crowe type III or IV developmental dysplasia of the hip: two-stage total hip arthroplasty following skeletal traction after soft tissue release for irreducible hips.

    Science.gov (United States)

    Yoon, Pil Whan; Kim, Jung Il; Kim, Dong Ok; Yu, Cheol Hwan; Yoo, Jeong Joon; Kim, Hee Joong; Yoon, Kang Sup

    2013-09-01

    Total hip arthroplasty (THA) for severe developmental dysplasia of the hip (DDH) is a technically demanding procedure for arthroplasty surgeons, and it is often difficult to reduce the hip joint without soft tissue release due to severe flexion contracture. We performed two-stage THAs in irreducible hips with expected lengthening of the affected limb after THA of over 2.5 cm or with flexion contractures of greater than 30 degrees in order to place the acetabular cup in the true acetabulum and to prevent neurologic deficits associated with acute elongation of the limb. The purpose of this study is to evaluate the outcomes of cementless THA in patients with severe DDH with a special focus on the results of two-stage THA. Retrospective clinical and radiological evaluations were done on 17 patients with Crowe type III or IV developmental DDH treated by THA. There were 14 women and 3 men with a mean age of 52.3 years. Follow-ups averaged 52 months. Six cases were treated with two-stage THA followed by surgical hip liberalization and skeletal traction for 2 weeks. The mean Harris hip score improved from 40.9 to 89.1, and mean leg length discrepancy (LLD) in 13 unilateral cases was reduced from 2.95 to 0.8 cm. In the patients who underwent two-stage surgery, no nerve palsy was observed, and the single one-stage patient with incomplete peroneal nerve palsy recovered fully 4 weeks postoperatively. The short-term clinical and radiographic outcomes of primary cementless THA for patients with Crowe type III or IV DDH were encouraging. Two-stage THA followed by skeletal traction after soft tissue release could provide alternative solutions to the minimization of limb shortenings or LLD without neurologic deficits in highly selected patients.

  2. In vivo kinematic evaluation of total hip arthroplasty during stair climbing.

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    Dimitriou, Dimitris; Tsai, Tsung-Yuan; Li, Jing-Sheng; Nam, Kwang Woo; Park, Kwan Kyu; Kwon, Young-Min

    2015-07-01

    Stair climbing is a physically demanding task and a painful limitation for patients suffering from severe hip osteoarthritis. Although total hip arthroplasty (THA) is the definitive treatment for end-stage osteoarthritis, it is not well understood whether THA restores hip kinematics during strenuous activities. The purpose of this study was to compare the 3D kinematics of THA and native hip during physically demanding tasks and correlate potential differences with THA components orientations/positions in patients with unilateral THA. In vivo hip kinematics were determined during step-up and leg stance activities using a validated combination of 3D CT-based computer modeling and dual fluoroscopic imaging system (DFIS). The THA side demonstrated an average 3.4° (±6.5°, range: -5.9° to 15.2°) greater internal rotation than the contralateral native hip, during the step-up activity but not during leg stance. The difference in internal rotation was highly correlated to the difference in femoral anteversion and anterior translation of hip joint center between implanted and native hip (R(2)  = 0.71, p < 0.01). The results suggest the importance of accurate THA component placement in restoring normal hip kinematics during functional activities. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  3. Anterior dislocation after total hip replacement - effects of pelvic rotation and femoral head size.

    Science.gov (United States)

    Ng, Fu-Yuen; Wang, Qun; Chiu, Kwong-Yuen; Yan, Chun-Hoi

    2013-01-01

    We investigated the effects of pelvic rotation and femoral head diameter on the anterior stability of the hip joint after total hip replacement. Computer navigation and cadaveric bone were used to simulate the range of motion after total hip replacement. The hip was put at 0 degrees of flexion and it was gradually externally rotated until the hip dislocated. The degree of external rotation when the hip was dislocated was recorded. The test was repeated with the hip at +10, -10, -20, -30, -40 and -50 degrees of flexion. The acetabular component was positioned with abduction of 45 degrees and anteversion at 20 degrees. There was a significant difference amongst each group of pelvic rotation from 0 to -50 degrees in the degree of external rotation when the hip was dislocated. The degree became insignificant when pelvic rotation was increased from 0 to 10 degrees. From -10 to -50 degree of pelvic rotation, 36mm head had significant better stability compared with 32mm and 28mm femoral heads. The presence of significant pelvic sagittal malrotation can increase the risk of anterior dislocation. A larger femoral head is more stable than smaller heads. When pelvic sagittal malrotation is not present, there is no difference in stability between large and small femoral heads.

  4. Fixation of an Anatomically Designed Cementless Stem in Total Hip Arthroplasty

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    Shigeru Nakamura

    2012-01-01

    Full Text Available Purpose. The Anatomic Fiber Metal plus stem (Zimmer is one of the anatomically designed cementless stems to achieve stable fixation by metaphyseal fit. We studied outcomes of cementless total hip arthroplasty using this stem and possible effects of metaphyseal fit on outcomes. Methods. The cementless total hip arthroplasty using this stem was performed for 155 hips. One hundred and thirty-seven hips of 122 patients were followed for 5 to 16 (mean, 9.7 years and entered into the study. The metaphyseal fit was defined as good or poor in an anteroposterior radiograph after surgery. We studied the fixation of the stem and bone reaction on an anteroposterior radiograph at the final followup. Results. Twelve hips had revision, six acetabular components and six acetabular liners. No stem was revised. The biological fixation of the stem was bone ingrown fixation for 136 hips and unstable for one. The metaphyseal fit was good for 83 hips and poor for 54 hips. There were no differences for stem fixation and bone reaction between the two groups. Conclusions. The fixation of the stem was stable at a mean followup of 9.7 years independently from metaphyseal fit.

  5. Is etoricoxib effective in preventing heterotopic ossification after primary total hip arthroplasty?

    NARCIS (Netherlands)

    Brunnekreef, J.J.; Hoogervorst, P.; Ploegmakers, M.J.M.; Rijnen, W.H.C.; Schreurs, B.W.

    2013-01-01

    PURPOSE: Heterotopic ossification is a common complication after total hip arthroplasty. Non-steroidal anti-inflammatory drugs (NSAIDs) are known to prevent heterotopic ossifications effectively, however gastrointestinal complaints are reported frequently. In this study, we investigated whether

  6. Preoperative Quadriceps Strength as a Predictor for Short-Term Functional Outcome After Total Hip Replacement

    NARCIS (Netherlands)

    Holstege, Marije S.; Lindeboom, Robert; Lucas, Cees

    2011-01-01

    Objective: To determine the preoperative strength of the muscle group of the lower extremity that is most important in predicting functional recovery after primary unilateral total hip replacement (THR). Design: Prospective observational study with inception cohort. Settings: Joint care program

  7. 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.

  8. Total hip arthroplasty for femoral neck fracture with pyoderma gangrenosum patient: A case report

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    Guo Rong She

    2017-01-01

    Conclusion: We herein report a case of pyoderma gangrenosum patient underwent total hip arthroplasty, meanwhile raise the issue of management in perioperative period for pyoderma gangrenosum patient, especially explore series of standardized therapies for this disease during arthroplasty.

  9. Deep vein thrombosis prophylaxis: a comprehensive approach for total hip and total knee arthroplasty patient populations.

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    Miric, A; Lombardi, P; Sculco, T P

    2000-04-01

    One of the most catastrophic complications after total joint arthroplasty is a fatal pulmonary embolism. Thromboembolic disease is particularly a problem in lower extremity joint arthroplasty secondary to the development of deep vein thrombosis (DVT) and proximal propagation of the thrombus. The environment created during total hip and knee arthroplasty fulfills the criteria for DVT formation: vessel wall damage, venous stasis, and a hypercoagulable state. Evidence that suggests the insult and primary event in thrombogenesis occurs during surgery. Until recently, however, the main thrust of DVT prophylaxis has concentrated on the immediate postoperative period. A more global approach to patient care during the 6-week period beginning with surgery may result in more effective DVT prophylaxis. Operative interventions that have proven to be effective include hypotensive epidural anesthesia and intravenous administration of heparin. Postoperative pharmaceutical interventions range from standard doses of aspirin or warfarin to recently studied dosing regimens of low-molecular-weight heparins, antiplatelet agents, and antithrombotic agents. Mechanical prophylaxis has also proved to be a valuable adjunct in DVT prophylaxis during these periods. It is hoped that a more comprehensive approach incorporating several of the aforementioned treatments into a strategy that encompasses the intraoperative and early and late postoperative periods will maximize the effectiveness of DVT prophylaxis.

  10. Dislocation following total hip replacement: causes and cures.

    Science.gov (United States)

    Brooks, P J

    2013-11-01

    Dislocation is one of the most common causes of patient and surgeon dissatisfaction following hip replacement and to treat it, the causes must first be understood. Patient factors include age greater than 70 years, medical comorbidities, female gender, ligamentous laxity, revision surgery, issues with the abductors, and patient education. Surgeon factors include the annual quantity of procedures and experience, the surgical approach, adequate restoration of femoral offset and leg length, component position, and soft-tissue or bony impingement. Implant factors include the design of the head and neck region, and so-called skirts on longer neck lengths. There should be offset choices available in order to restore soft-tissue tension. Lipped liners aid in gaining stability, yet if improperly placed may result in impingement and dislocation. Late dislocation may result from polyethylene wear, soft-tissue destruction, trochanteric or abductor disruption and weakness, or infection. Understanding the causes of hip dislocation facilitates prevention in a majority of instances. Proper pre-operative planning includes the identification of patients with a high offset in whom inadequate restoration of offset will reduce soft-tissue tension and abductor efficiency. Component position must be accurate to achieve stability without impingement. Finally, patient education cannot be over-emphasised, as most dislocations occur early, and are preventable with proper instructions.

  11. The bone-vacuum cementing technique for the fixation of the stem in total hip arthroplasty.

    Science.gov (United States)

    Pitto, R P; Kessler, M; Schikora, N; di Muria, G V

    2001-01-01

    The bone-vacuum cementing technique is a promising method developed to obtain reliable fixation of the femoral component. Previous studies showed that intraoperative embolic complications, cardiopulmonary impairment, and deep venous thrombosis can be prevented when this technique is used. The specific aims of the present investigation were to provide additional treatment outcome information, to identify risk factors for poor results, and to define the need of surgical technique improvement by risk factor analysis. The first 118 consecutive patients (121 hips) who had primary total hip arthroplasty using the bone-vacuum cementing technique and an anatomical stem were followed-up for a mean of 2.5 years (1 to 4 years). The mean age of patients at index operation was 73 years. Current criteria were used for clinical and radiological assessment. At the time of the latest follow-up, 3 patients (3 hips, 2.5%) had been lost, and 9 patients (9 hips, 7.5%) had died. However, the status of the hip joint at the time of death could be verified in all patients. Thus, the clinical outcome of 115 patients (118 hips, 97.5%) was known. Radiographs were available for 102 patients (104 hips) who were alive for the entire follow-up period. The mean preoperative Harris Hip Score was rated 51, and it had improved to 92 at the time of follow-up. The score was good for 70 hips and excellent for 42 hips, so the rate of clinical success was 95%. Six patients (6 hips, 5%) had a fair result. Two of them had a fracture of the greater trochanter after the index operation, requiring internal fixation. Four hips with severe acetabular dysplasia had persistent limp and limited motion. The quality of the cement mantle was rated good (grade A and B) in 108 of 121 hips (89.5%). Nineteen of the 108 hips presented at least one small void in the cement mantle (grade C1). Insufficient thickness of the cement mantle (grade C2) was present in 10 hips (8%). Failure of cement to extend below the tip of the

  12. [Becker V-shaped lateral rotation osteotomy in total hip arthroplasty for Crowe type IV development dislocation of hip].

    Science.gov (United States)

    Li, Yongwang; Ma, Wenhai; Sun, Junying; Song, Xingjian; An, Ming; Zhang, Qian

    2013-09-01

    To summarize the surgical technique and the effectiveness of Becker V-shaped lateral rotation osteotomy in total hip arthroplasty (THA) for Crowe type IV development dislocation of the hip (DDH). Between January 2000 and December 2009, 18 patients (22 hips) with Crowe type IV DDH underwent THA. There were 3 males and 15 females with an average age of 54 years (range, 41-75 years). The unilateral hip was involved in 14 cases and bilateral hips in 4 cases. All patients had over anteversion of the femoral neck, with the acetabular anteversion angle of (21.28 +/- 4.87) degrees, the femoral neck anteversion angle of (59.06 +/- 1.44) degrees, and combined anteversion angle of (80.33 +/- 1.55) degrees. All the patients had limb-length discrepancy, ranged from 1.0 to 3.5 cm (mean, 2.5 cm). Before operation, gluteus medius muscle strength was grade 2 in 17 hips and grade 3 in 5 hips; severe or moderate claudication was observed in 13 and 5 patients, respectively. Trendelenburg sign was positive in all patients. Preoperative Harris score was 30.00 +/- 6.32. Cementless prosthesis was used. Becker V-shaped lateral rotation osteotomy and subtrochanteric shortening with overlapping femoral resection were performed, and proximal femoral shaft splitting was performed on 21 hips having narrow bone marrow cavity. All the cases achieved primary healing of incision. No complication of anterior dislocation, deep infection, nerve traction injury, or femoral uncontrolled fracture occurred. All the cases were followed up 3-12 years (mean, 8 years). Postoperative X-ray films showed that the initial fixation result of femoral prosthesis was excellent in 18 hips and good in 4 hips. Bone healing of osteotomy stump was obtained at 3-6 months (mean, 5 months) after operation. Affected limb prolonged for 2.5-3.5 cm (mean, 3.0 cm) at 1 year after operation; limb-length discrepancy was 0.5-1.5 cm (mean, 1.0 cm). The gluteus medius muscle strength was restored to grade 4 in 5 hips and grade 5 in 17

  13. Cirrhosis is a risk factor for total hip arthroplasty for avascular necrosis

    DEFF Research Database (Denmark)

    Deleuran, Thomas; Overgaard, Søren; Vilstrup, Hendrik

    2016-01-01

    Background and purpose - There are limited data on risk factors for avascular necrosis of the hip, but cirrhosis has been proposed as a risk factor. We examined the association between cirrhosis and incidence of total hip arthroplasty for avascular necrosis. Methods - We used nationwide healthcare...... necrosis. We used stratified Cox regression to estimate the hazard ratio (HR) for cirrhosis patients relative to reference individuals, adjusting for potential confounders. We used the cumulative incidence function to compute 5-year risks. Results - We included 25,421 cirrhosis patients and 114......,052 reference individuals. Their median age was 57 years, and 65% were men. 45 cirrhosis patients and 44 reference individuals underwent total hip arthroplasty for avascular necrosis. Cirrhosis patients' HR for a total hip arthroplasty for avascular necrosis was 10 (95% CI: 6-17), yet their 5-year risk...

  14. Abductor Biomechanics Clinically Impact the Total Hip Arthroplasty Dislocation Rate: A Prospective Long-Term Study.

    Science.gov (United States)

    García-Rey, Eduardo; García-Cimbrelo, Eduardo

    2016-02-01

    Factors related to the patient, implant, and surgery have been associated to the rate of dislocation for total hip arthroplasty (THA). We ask if the position of the cup and the reconstruction of the abductor mechanism actually lower the THA dislocation rate. We evaluated 1318 patients (1414 hips) undergoing cementless THA between 1992 and 2012. All THAs had a 28- or a 32-mm femoral head size. Hip reconstruction was radiologically assessed evaluating cup position and the hip rotation center according to Ranawat. The reconstruction of the abductor mechanism was measured using 2 variables: the lever arm distance and the height of the greater trochanter. There were 38 dislocations (2.7%). After controlling the relevant confounding variables, such as demographic and implant data, multivariate regression analysis showed that the most important factors associated with dislocation were a greater distance to the anatomic hip rotation center and hips outside 2 safe windows for cup position (acetabular inclination and version angles) and abductor mechanism (lever arm distance and height of the greater trochanter). A proper reconstruction of the hip is essential to decrease the risk of dislocation after primary THA. The weakness of the abductor muscles of the hip may be one of the most important causes for dislocation. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Radiographic changes of the femoral neck after total hip resurfacing.

    Science.gov (United States)

    Laffosse, J-M; Aubin, K; Lavigne, M; Roy, A; Vendittoli, P-A

    2011-05-01

    Significant femoral neck narrowing following hip resurfacing arthroplasty has been observed. Several factors contributing to the physiopathology of femoral neck narrowing have been suggested. The aim of this study was to evaluate the femoral neck radiographic changes observed after hip resurfacing at a minimum follow-up period of 5 years and to determine their causes. We conducted a prospective study of 57 hip resurfacing arthroplasties performed in 53 patients (30 men, 23 women) of mean age 49.2 years (32-65) at surgery. These patients were clinically reviewed (inguinal pain during walking, WOMAC and UCLA scores) at 2 years and radiographically examined at 1, 2 and 5 postoperative years. The accuracy of our computer-aided measurement method was 1mm. Measurement of femoral neck to implant ratio was performed to assess the amount of neck thinning at the femoral neck-implant junction (N/H) and midway between the implant and the inter-trochanteric line (N(1/2)H) on an AP radiograph. Neck-thinning greater than 10% was considered as significant. Any other radiographic morphologic change in the femoral neck was investigated. Metallic ion concentration in blood was measured. A uni- and multivariate analysis was performed to determine the correlation with radiographic changes. In one third of the patients, femoral neck narrowing was greater than 1mm at 2 and 5 postoperative years. Such result corresponds to a mean decrease in neck to implant ratio (N/H) of 5.9% (range, 2.3 to 9.4) at 2 years and 8.3% (range, 2.5 to 23.8) at 5 years. At 5 postoperative years, an overall neck thinning greater than 10% was reported in 3 patients (with a 10- to 17-% increase in femoral neck narrowing between the 2nd and the 5th postoperative year). In one case, neck thinning was associated with fracture of the femoral stem managed with revision surgery during which femoral neck necrosis was confirmed. Neck thinning was, in these cases, circumferential to the neck-implant junction. There was no

  16. Calcaneal stress fracture: an adverse event following total hip and total knee arthroplasty: a report of five cases.

    Science.gov (United States)

    Miki, Takaaki; Miki, Takahito; Nishiyama, Akihiro

    2014-01-15

    Stress fractures have been reported to occur in the pubis, femoral neck, proximal part of the tibia, and fabella during the postoperative period following total knee or total hip arthroplasty. However, to our knowledge, calcaneal stress fractures after total hip or total knee arthroplasty have not been reported in the English-language literature. Most orthopaedic surgeons are not familiar with calcaneal stress fractures that may occur in elderly patients after a total knee or total hip arthroplasty. We retrospectively reviewed the clinical features, imaging findings, and bone mineral content of the proximal part of the femur and the distal end of the radius in five patients who had a calcaneal stress fracture after a total knee or total hip arthroplasty. All patients were women with a mean age of 76.8 years. All fractures occurred in the calcaneus on the same side as the arthroplasty. The fracture appeared at a mean of 10.2 weeks postoperatively. All patients reported heel pain on walking. Swelling and local heat were found in four and three patients, respectively. Pain was elicited by squeezing the calcaneus in all patients. Early radiographs had normal findings in two patients, and an irregular sclerotic line appeared later in the radiographs of all patients. All fractures were treated conservatively. Four fractures healed uneventfully, but one fracture displaced. All patients had osteoporosis. Calcaneal stress fractures during the postoperative period following total knee or total hip arthroplasty may not be as rare as previously thought. Because clinical symptoms of the fracture appear insidiously and radiographic findings are absent or subtle in the early stage, a high index of suspicion is needed for orthopaedic surgeons to make the correct diagnosis. Magnetic resonance imaging or repeated radiographs may be necessary to make the correct diagnosis when no abnormality is apparent on the initial radiograph.

  17. [Prevention of prothesis dislocation after the revision of total hip arthroplasty].

    Science.gov (United States)

    Li, Yong-jiang; Zhang, Li-cheng; Yang, Guo-jing; Zhang, Chun-cai; Wang, Wei-liang; Lin, Rui-xin; Cai, Chun-yuan

    2008-03-01

    To explore the role of reconstruction of the posterior capsule and external rotators in prevention of postoperative dislocation in total hip arthroplasty revision following the posterolateral approach. Forty-five patients (47 hips) with the mean age of 65 years (55 to 78 years)of failed total hip arthroplasty were revised following the posterolateral approach. Posterior capsule was sutured to the anterosuperior portion of the capsule from where it had been detached, and the external rotators were then reattached to the soft tissue at the tip of the greater trochanter using 1.0 silk suture in surgery. The dislocation rate and risk factors were reviewed retrospectively to determine if closing the posterior capsule resulted in fewer dislocations. The femoral prosthesis and acetabular prosthesis were revised in 29 patients (31 hips), the liner was exchanged in 5 patients (5 hips), and the acetabular prosthesis or femoral components were revised in 10 patients (10 hips) and one patient (one hip) respectively. The procedure was the patient's first revision in 29 patients (30 hips), the second revision in 15 patients (16 hips), and the third revision in one patient(one hip). Radiographic evaluation included lower limb discrepancy, acetabular phase, femoral offset, anteversion angle, prosthetic loosening before and after revision. Function evaluation based on Harris score system. All patients were followed up with an average of 2.7 years. None of the patients sustained dislocation or infection, except one patient felt the anterior instability but without dislocation, X-ray revealed the acetabular component was in excessively anteversion. Lower leg discrepancy, acetabular abduction, anteversion femoral offest and collodiaphyseal angle were restored to normal level after operation on the basis of X-ray. One of the acetabular components and one of the femoral components were loose without dislocation. The Harris hip score improved from (49.13 +/- 15.53) points preoperatively

  18. Nuances of preoperative planning of total hip arthroplasty in patients with hip dysplasia

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    R. M. Tikhilov

    2015-01-01

    Full Text Available Purpose of the study - to evaluate in different groups of patients variability of anatomical changes that may affect the difference in the length of the lower extremities and affect on the results of the preoperative planning. Material and methods. As study material we used long film X-ays of 142 patients. A main group comprised 69 patients with varying severity of hip dysplasia. Control group consisted of 73 patients without hip pathology. All patients were performed long film X-rays, and measurements of relative and absolute lengths of the lower limbs, followed by analysis of the data. Results. Analysis of the measurements showed that none of the patients had absolutely equal length of the lower limbs, even in the control group in 56.2% of the observations noted the absolute difference of the lower extremities length more than 5 mm, and in 9.6% of patients - from 20 to 35 mm. In assessing the difference of the lower extremities length on AP pelvic view in the main group only one patient of 69 had the same length of the legs, and in 61 cases the difference was more than 5 mm, that it was clinically significant. Of practical interest is the fact that in the main group shortening of the operated limb was observed in 51 of 69 patients in AP views of the pelvis, but the results of measurements of the anatomical length of limbs long film X-rays compared with measurements of the relative shortening on the pelvis AP views showed that clinically significant difference exceeding 5 mm between measurements observed in 68.1% of cases. The greatest difference between the measurements of the limbs length on the pelvis AP views and long film X-rays observed in patients with unilateral hip dislocation and averaged 17.0 mm. Conclusion. Performing preoperative planning in patients with dysplasia only on pelvis AP views not allow properly compensate the difference of the lower extremities lengths, which may adversely affect the functional results of surgery and

  19. Total hip arthroplasty in young patients using the thrust plate prosthesis: clinical and radiological results.

    Science.gov (United States)

    Zelle, Boris A; Gerich, Torsten G; Bastian, Leonard; Shuler, Franklin D; Pape, Hans-Christoph; Krettek, Christian

    2004-06-01

    The standard treatment for patients who require total hip replacement is the implantation of an intramedullary diaphyseal anchored hip prosthesis. A bone-sparing thrust plate hip prosthesis (TPP) can be used as an alternative device for young patients. The TPP relies on proximal femoral metaphyseal fixation. The theoretical advantage of leaving diaphyseal bone intact is easier conversion to a stemmed prosthesis. This retrospective study evaluated the medium- and short-term results after total joint replacement using the third generation TPP. Between 1997 and 2001, 58 TPPs were used for 52 patients. Clinical and demographic data were obtained from the patients' charts and our electronic database. Their average age at time of surgery was 40.9+/-11.4 years. At follow-up, the Harris hip score, residual pain, required pain medication, and the ability to lie on the operated side were documented. Radiographic evaluation included standardized radiographs of the hip joint and the pelvis. Four patients required revision surgery (6.9%). For 51 of the remaining 54 TPPs, a postoperative functional and radiological status was obtained. The average follow-up was 26+/-11.0 months. 88% of the patients experienced some or complete relief of pain. The median Harris hip score at follow-up was 73+/-20.5 points. A postoperative hip dislocation occurred in 5 patients (8.6%). Since many patients experienced some or complete relief of pain, the TPP can be recommended as a feasible implant for the treatment of hip disorders requiring total hip arthroplasty in young patients. Revision surgeries are facilitated by the good bone stock remaining in the proximal femur.

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

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    Lidder Surjit

    2009-08-01

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

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

    OpenAIRE

    Man, Zhentao; Sha, Dan; Sun, Shui; Li, Tao; Li, Bin; Yang, Guang; Zhang, Laibo; Wu, Changshun; Jiang, Peng; Han, Xiaojuan; Li, Wei

    2016-01-01

    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, ...

  2. Incidence of Heterotopic Ossification in Patients Receiving Radiation Therapy following Total Hip Arthroplasty

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    Panagiotis Koulouvaris

    2014-01-01

    Full Text Available Heterotopic ossification (HO is a frequent complication of hip surgery. In this study the incidence of HO is analyzed in high risk patients who received radiation therapy (RT after total hip replacement (THA with regular and miniposterolateral hip approach. Two hundred and thirty five high risk patients received a single dose of 700 rad after THA. The incidence of HO was 15.7%. The incidence of HO in the high risk subgroup with the miniincision was lower (5.7% but not significantly different (P=0.230. Hypertrophic osteoarthritis was demonstrated to be the consistent predisposing factor for HO formation (P=0.005.

  3. A Large Rice Body-Containing Cyst Mimicking Infection following Total Hip Arthroplasty: A Case Report

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    Wael Bayoud

    2017-01-01

    Full Text Available Introduction. Soft tissue mass following total hip arthroplasty raises several differential diagnoses not limited to infection, hematoma, wear debris, malignancy, and bursitis. Rice body formation in the hip region is an uncommon process denoting a chronic inflammation. We report here the second case of its kind in the medical literature of a wide symptomatic rice-like body cyst complicating a total hip arthroplasty. Case Presentation. This is the case of an 82-year-old white female, presenting with a warm, red, and inflated groin five years after revision of right total hip arthroplasty. Surgical intervention reveals a large well circumscribed cyst containing well-organized rice-like bodies. This eventuality was never reported in differential diagnosis of hip periprosthetic soft tissue masses before. Conclusion. This case report helps widening the array of the differential diagnosis in patients presenting with a slow growing soft tissue mass following total hip arthroplasty, making rice-like bodies cyst a valid one to consider.

  4. Can Surgeons Reduce the Risk for Dislocation After Primary Total Hip Arthroplasty Performed Using the Posterolateral Approach?

    DEFF Research Database (Denmark)

    Seagrave, Kurt G; Troelsen, Anders; Madsen, Bjørn G

    2017-01-01

    BACKGROUND: Hip dislocation is one of the most common postoperative complications after total hip arthroplasty (THA). Potential contributors include patient- and surgical-related factors. We performed a retrospective cohort study to identify risk factors for postoperative dislocation in patients ...

  5. Case Study of Physiotherapy Treatment of a Patient with the Diagnosis of Total Hip Replacement

    OpenAIRE

    Papageorgiou, Chrystalla

    2014-01-01

    The abstract of my study concerns the treatment of the case of my patient who had an operation of total hip replacement on the right hip joint, caused by post dysplastic arthrosis. My practice was performed at Fakultni Nemocnice Kralovske Vinohrady. Physiotherapy program started on Tuesday 29th of January 2013 and ended on Friday 1st of February 2013. My Bachelor Thesis is divided in two parts: 1) Theoretical part 2) Practical part. In the theoretical part I analyse everything concerning the ...

  6. Acetabular component position of the noncemented total hip endoprosthesis after previous Chiari pelvic osteotomy.

    Science.gov (United States)

    Slavković, N; Vukašinović, Z; Sešlija, I; Bukumirić, Z; Baščarević, Z; Spasovski, D

    2013-01-01

    The aim of the study was to determine the validity of acetabular component position of the noncemented total hip endoprosthesis after Chiari pelvic osteotomy. The study involved 75 patients operated on at the Institute of Orthopedic Surgery "Banjica" in the period from 1990-2009. The first group consisted of 39 patients (46 hips) who underwent Chiari pelvic osteotomy and also later the implantation of a noncemented total hip endoprosthesis. A control group consisted of 36 patients (47 hips) who underwent total hip arthroplasty due to degenerative hip dysplasia. In the previously operated patients the centre of rotation of the hip was on the average placed more proximally, while in the control group of patients the position of the acetabular component was closer to the anatomical one. In the group of patients after Chiari osteotomy the mean acetabular cup abduction angle rated 41.8°±9.8°, while in the control group this value was on the average higher (45.4°±8.6°). There was a significant difference between the studied groups in relation to the distance between the acetabular component of endoprosthesis and the acetabular teardrop (t=-2.763; p=0.007). No statistically significant difference was determined in the mean value of the angle of acetabular abduction component of endoprosthesis between the studied groups of patients (t=1.878; p=0.064). Acetabular component position of the total hip endoprosthesis was not compromised by anatomic changes of the acetabulum caused by Chiari pelvic osteotomy.

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

    Science.gov (United States)

    Jensen, C; Aagaard, P; Overgaard, S

    2011-09-01

    To evaluate the effect of resurfacing vs standard total hip replacement on post-surgery hip and knee muscle strength recovery in a prospective randomised controlled trial at the Department of Orthopaedics, University Hospital, Odense, Denmark. Forty-three patients were 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. 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 (7-29%) with the affected side being weakest (P ≤ 0.05) and hip flexors being most affected. Asymmetry was present in half of the muscle groups at 26 wks (P ≤ 0.05), and remained present for the hip flexors and hip adductors at 52 wks (P ≤ 0.05). R-THA patients showed an attenuated and delayed recovery 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 rather than implant design per se. Thus, the present data failed to support the hypothesis that R-THA would result in an enhanced strength rehabilitation compared to S-THA. Further, between-limb asymmetry remained present for hip flexors and adductors after 52 wks. NCT01229293. Copyright © 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  8. Is dislocation rate higher in total hip arthroplasty done for acute displaced fracture neck of femur?

    Directory of Open Access Journals (Sweden)

    Ganesan Ram Ganesan

    2015-01-01

    Full Text Available Background Hip replacement has transformed the lives of hundreds of thousands of people regardless of the underlying aetiology. Debate about the role of arthroplasty for an acute displaced femoral neck fracture has been ongoing for decades. In this article we are going to evaluate whether dislocation rate is higher in total hip replacement done for acute displaced fracture neck of femur. Materials and Methods: Retrospective study of sixty two patients who underwent total hip replacement in Sri Ramachandra medical center. The minimum follow-up was taken as 5 years. Patients were divided into two group; traumatic and non traumatic group. We had 38 patient who underwent hip replacement for non traumatic indications. Traumatic group had 24 patients. The inclusion criteria for the traumatic group were acute displaced fracture neck of femur above 50 years and fracture neck with fracture head with dislocation above 50 years. We used the Harris hip score (Modified for clinical and functional evaluation. Results: We had 89% excellent/good results in non traumatic group 75% excellent/good result in traumatic group. We had one dislocation in non-traumatic group and four dislocations in traumatic group. Conclusions: There is an increase rate of dislocation in patient who underwent total hip replacement for a traumatic condition when compared to their non traumatic counterpart.

  9. Acetabular QCT in Total Hip Arthroplasty - a reliability study using porcine hips

    DEFF Research Database (Denmark)

    Mussmann, Bo Redder; Overgaard, Soren; Torfing, Trine

    previously shown better delineation of the interface between bone and prosthesis and may be beneficial in quantitative analysis of bone loss close to the implant as compared to single energy computed tomography (SECT). The purpose of this porcine ex-vivo study was to test the intra-observer agreement...... and reliability of bone mineral density measurements (BMD) in close proximity of the acetabular cup using SECT and DECT images and 3D segmentation software. Materials and methods 22 acetabular cups (12 cemented, 10 un-cemented) were inserted in porcine hip specimens ex vivo. A femoral stem was attached to each...... specimen and imaging was performed with SECT and DECT. The specimens were repositioned and scans repeated to obtain double measurements. For each scan BMD was measured in a hemispherical volume around the acetabular cup using in-house segmentation software. Results In the uncemented concept mean BMD...

  10. Epsilon Aminocaproic Acid to Reduce Blood Loss and Transfusion After Total Hip and Total Knee Arthroplasty.

    Science.gov (United States)

    Hobbs, Juliann C; Welsby, Ian J; Green, Cynthia L; Dhakal, Ishwori B; Wellman, Samuel S

    2018-01-01

    Total hip and knee arthroplasty (THA and TKA) are associated with significant blood loss and some patients require postoperative blood transfusion. While tranexamic acid has been studied extensively among this population, we tested the hypothesis that epsilon aminocaproic acid (EACA) can reduce blood loss and transfusion after joint arthroplasty. In April 2014, our Veterans Affairs Medical Center introduced a protocol to administer EACA during THA and TKA. No antifibrinolytics were used previously. We retrospectively compared blood loss and incidence of transfusion among patients who underwent primary arthroplasty in the year before standardized administration of EACA with patients having the same procedures the following year. Blood loss was measured as delta hemoglobin (preoperative hemoglobin - hemoglobin on postoperative day 1). All patients undergoing primary THA or TKA were included. Patients having revision surgery were excluded. We identified 185 primary arthroplasty patients from the year before and 184 from the year after introducing the EACA protocol. There were no changes in surgical technique or attending surgeons during this period. Delta hemoglobin was significantly lower in the EACA group (2.7 ± 0.8 mg/dL) compared to the control group (3.4 ± 1.1 mg/dL) (P < .0001). The incidence of blood transfusion was also significantly lower in the EACA group (2.7%) compared to the control group (25.4%) (P < .0001). There was no difference in venous thromboembolic complications between groups. We demonstrated reductions in hemoglobin loss and transfusion following introduction of the EACA protocol in patients undergoing primary arthroplasty. EACA offers a lower cost alternative to TXA for reducing blood loss and transfusion in this population. Published by Elsevier Inc.

  11. Experimental validation of finite element modelling of a modular metal-on-polyethylene total hip replacement.

    Science.gov (United States)

    Hua, Xijin; Wang, Ling; Al-Hajjar, Mazen; Jin, Zhongmin; Wilcox, Ruth K; Fisher, John

    2014-07-01

    Finite element models are becoming increasingly useful tools to conduct parametric analysis, design optimisation and pre-clinical testing for hip joint replacements. However, the verification of the finite element model is critically important. The purposes of this study were to develop a three-dimensional anatomic finite element model for a modular metal-on-polyethylene total hip replacement for predicting its contact mechanics and to conduct experimental validation for a simple finite element model which was simplified from the anatomic finite element model. An anatomic modular metal-on-polyethylene total hip replacement model (anatomic model) was first developed and then simplified with reasonable accuracy to a simple modular total hip replacement model (simplified model) for validation. The contact areas on the articulating surface of three polyethylene liners of modular metal-on-polyethylene total hip replacement bearings with different clearances were measured experimentally in the Leeds ProSim hip joint simulator under a series of loading conditions and different cup inclination angles. The contact areas predicted from the simplified model were then compared with that measured experimentally under the same conditions. The results showed that the simplification made for the anatomic model did not change the predictions of contact mechanics of the modular metal-on-polyethylene total hip replacement substantially (less than 12% for contact stresses and contact areas). Good agreements of contact areas between the finite element predictions from the simplified model and experimental measurements were obtained, with maximum difference of 14% across all conditions considered. This indicated that the simplification and assumptions made in the anatomic model were reasonable and the finite element predictions from the simplified model were valid. © IMechE 2014.

  12. 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......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...

  13. [Evaluation of the Function and Quality of Life after Total Hip Arthroplasty by Different Approaches].

    Science.gov (United States)

    Araújo, Paulo; Machado, Luís; Cadavez, Duarte; Mónaco, Lisete; Januário, Filipa; Luís, Lisete; Bártolo, Mafalda

    2017-09-29

    To assess the function and quality of life in patients undergoing total hip arthroplasty distinguishing two surgical approaches (posterior / anterolateral) used by the Orthopedics department of Centro Hospitalar de Leiria. Retrospective study of 94 patients subject to unilateral hip replacement surgery, using the 'Hip Osteoarthritis Outcome Score' (HOOS LK 2.0) questionnaire, the Trendelenburg test and evaluation of muscle strength of the hip abductor muscles with dynamometer. Patients were evaluated at six months, 12 months, 18 months and 24 months after surgery. The study revealed that 97.9% patients completed the rehabilitation program. The postoperative evolution (six to 24 months) does not appear to have any differences in results when comparing both approaches. At six months the patient operated by the anterolateral approach showed worse results when compared with the posterior approach, in particular in Hip Osteoarthritis Outcome Score pain, in Hip Osteoarthritis Outcome Score symptoms and Hip Osteoarthritis Outcome Score activities of daily living. After 24 months, no differences between the two surgical approaches were found. Of the 94 patients evaluated, the Trendelenburg test was positive in 31% of patients of which 81.9% corresponds to patients operated by the anterolateral approach. Muscle strength of the abductors of the operated hip was clearly lower in the anterolateral approach at six months, 12 months, and 24 months. This study showed that, in the first six months after total hip arthroplasty, the patients operated by the posterior approach were, according to the HOOS questionnaire, less symptomatic, and presented with better quality of life and less impact on activities of daily living and in sport and leisure when compared with the patients operated by the anterolateral approach. However, these differences were matched over the 24 months. Moreover, the results of muscle strength of the abductor muscles of the hip were clearly superior in

  14. Feasibility of Early-Initiated Progressive Resistance Training after Total Hip Replacement

    DEFF Research Database (Denmark)

    Mikkelsen, Lone Ramer; Mechlenburg, Inger; Petersen, Annemette Krintel

    Background: Muscle atrophy, reduced hip muscle strength and function are documented within the first weeks after Total Hip Replacement (THR). Purpose / Aim of Study: The purpose of this study was to evaluate the feasibility of early-initiated progressive resistance training (PRT) after THR....... Materials and Methods: 10 patients were followed 4 weeks post THR. The PRT was initiated 2-5 days after surgery, and performed twice a week for 4 weeks. Unilateral exercises were performed in 4 training machines applying 3 sets of 10 repetitions at 10 RM (repetition maximum). Absolute loading (kg) and pain......, mean (sd): 0.98 (0.26), 1.03 (0.29) Nm/kg, p=0.52. Conclusions: It seems feasible to commence PRT within the first week after THR, as hip pain remained the same or decreased, while the training load increased progressively. The included patients reached their preoperative hip-strength levels after 4...

  15. [Clinical apprehension on application of Tri-lock BPS total hip arthroplasty].

    Science.gov (United States)

    Chen, Wen-Liang; Zhang, Lei; Huang, Yi-Jiang; Cai, Chun-Yuan; Lin, Rui-Xin; Yang, Guo-Jing

    2014-01-01

    To study short-term results and clinical application of Tri-lock BPS in total hip arthoplasty. From May 2010 to July 2011, 32 hips in 31 patients (18 males and 13 females, ranging in age from 50 to 77 years old, with an average of 60.5 years old) were treated by total hip arthroplasty with Tri-lock BPS, including 8 patients with osteonecrosis (ON), 13 patients with fresh femoral neck fracture, 10 patients with developmental dysplasia of the hip (DDH). The therapeutic effects were evaluated by self assessment form, preoperative and postoperative Harris hip score, radiographs, Engh score and bone in growth of femoral side described by Gruen. Based on the short-term results,its design characteristic and clinical properties were analyzed. All the incisions healed well and there were no complications such as femoral fracture, infection, dislocation and neurovascular injuries. All the patients were followed up with an average time of 12.2 months (ranged, 10 to 14 months). All the joints had good or excellent clinical results. The Harris score increased from preoperative 38.3 +/- 4.9 to 92.5 +/- 11.2 at the latest follow-up (t = 27.53, P BPS is more in line with human anatomy, and has the advantages in rapid recovery of hip function and retains more bone mass. It offers a newly valuable technology for the treatment of osteonecrosis, femoral neck fracture and DDH and so on.

  16. 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...

  17. High prevalence of noise following Delta ceramic-on-ceramic total hip arthroplasty.

    Science.gov (United States)

    Salo, P P; Honkanen, P B; Ivanova, I; Reito, A; Pajamäki, J; Eskelinen, A

    2017-01-01

    We evaluated the short-term functional outcome and prevalence of bearing-specific generation of audible noise in 301 patients (336 hips) operated on with fourth generation (Delta) medium diameter head, ceramic-on-ceramic (CoC) total hip arthroplasties (THAs). There were 191 female (63%) and 110 male patients (37%) with a mean age of 61 years (29 to 78) and mean follow-up of 2.1 years (1.3 to 3.4). Patients completed three questionnaires: Oxford Hip Score (OHS), Research and Development 36-item health survey (RAND-36) and a noise-specific symptom questionnaire. Plain radiographs were also analysed. A total of three hips (0.9%) were revised. There were 52 patients (54 hips, 17%) who reported noise, and in 25 (48%) of them the noise was frequently heard. In the multiple regression analysis, the only independent risk factor for noise was a specific THA brand, with a threefold increased risk (95% confidence intervals 1.39 to 6.45, p = 0.005) of noise compared with the reference THA brand. Patients with noisy hips had lower median OHS (43 versus 46.5, p = 0.002) and their physical functioning (p = 0.021) subscale in RAND-36 was reduced. Noise was surprisingly common in this population. Cite this article: Bone Joint J 2017;99-B:44-50. ©2017 The British Editorial Society of Bone & Joint Surgery.

  18. 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 tra...

  19. 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...

  20. BIOMECHANICAL JUSTIFICATION OF THE THREADED ELEMENT’S FORM OF THE TOTAL HIP ENDOPROSTHESIS’ ACETABULAR COMPONENT

    Directory of Open Access Journals (Sweden)

    PANCHENKO S. P.

    2017-03-01

    Full Text Available Abstract. Formulation of the problem. Total hip replacement (THR remains to be responsible for the markable clinical achievements of contemporal orthopaedic surgery [1; 2; 4]. It should be noted, that numerous efforts to create an “ideal” uncemented hip endoprosthesis’ construction were failed, but led into wide diversity of implants. Such a diversity allowes to individualize implant type selection and to improve implant’s survival and total THR’s clinical outcomes [1; 4]. Outcomes mentioned above determine successful application of total hip replacement as a treatment method. Consequently, development of new and improvement of existing hip endoprosthesis’ constructions seems to be of current interest for contemporal orthopaedic surgery. Purpose. To determine optimal parametres of threaded element’s geometry of total hip endoprosthesis’ threaded acetabular component. Conclusion. There were revealed that threaded element model with right-angled triangle transverse section shape seems to be the most effective considering hardness, while the triangle is leaned on the bone massive with its cathetus. At the same time, results of calculations represent pelvic bone stress-strain state during THR quantitavely and stipulate further research.

  1. Total hip arthroplasty (S-ROM stem) and subtrochanteric osteotomy for Crowe type IV developmental dysplasia of the hip.

    Science.gov (United States)

    Li, Liangtao; Yu, Mingyang; Yang, Chen; Gu, Guishan

    2016-01-01

    Developmental dysplasia of the hip (DDH) in adults with severe pain and disability is best treated by total hip arthroplasty (THA). The purpose of this study was to retrospectively evaluate the outcomes of subtrochanteric shortening osteotomy combined with THA using S-ROM stem for those severe patients with a special focus on the effect of two shapes in the subtrochanteric osteotomy ends: Oblique and transverse. Twenty one cases with mean age of 43.6 years who met inclusion criteria and were operated between February 2007 and February 2012 were included in the study. Those cases had been divided into two groups (oblique vs. transverse) and all records between the two groups were analyzed. The Harris hip score significantly improved from 30.6 (range 18-59) preoperatively to 91.2 (range 87-98) postoperatively by the latest followup. Complications including one deep venous thrombosis, one intraoperative fracture of femur and two dislocations occurred while they were addressed properly afterward. The oblique group showed significant advantages in operative time, union time and additional fixation in comparison with the transverse group. In the primary THA for the treatment of irreducible DDH, subtrochanteric oblique osteotomy combined with the freely-rotatable S-ROM stem provided favorable short term outcomes by affording both morphological and functional advantages.

  2. Total hip arthroplasty for acute displaced femoral neck fractures via the posterior approach: a protocol to minimise hip dislocation risk.

    Science.gov (United States)

    Ricci, William M; Langer, Jakub S; Leduc, Stéphane; Streubel, Philipp N; Borrelli, Joseph

    2011-01-01

    Total hip arthroplasty (THA) is considered superior to hip hemiarthroplasty (HHA) in long term pain relief and functional outcome after femoral neck fracture; high early dislocation rates may however negate these advantages. This study elucidates whether a protocol of careful patient selection, surgical technique algorithm and use of modern implants could yield low dislocation rates in hip fracture patients treated with THA via the posterior approach. Over a seven year period all patients admitted to our institution that were cognitively lucid, independent ambulators and without Parkinson's disease underwent THA for acute displaced femoral neck fractures using a posterior approach, large femoral heads, elevated acetabular liners and a surgical technique algorithm. Twenty-nine THAs were performed in 26 patients (mean age of 71 years, range 50-87 years) and were followed for a mean of 32 months (range 13-48 months). There was one dislocation 7 weeks postoperatively in a non-compliant patient resulting in reoperation. There were no other reoperations or major complications. Our results indicate that low dislocation rates can be accomplished for displaced femoral neck fractures treated with THA via the posterior approach using a protocol that includes careful patient selection, surgical technique focused on intraoperative stability, and the use of modern implants.

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

    OpenAIRE

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

    2017-01-01

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

  4. Metallosis in a Dog as a Long-Term Complication Following Total Hip Arthroplasty.

    Science.gov (United States)

    DiVincenzo, Mallory J; Frydman, Galit H; Kowaleski, Michael P; Vanderburg, Charles R; Lai, Barry; Oura, Trisha J; Jennings, Samuel H

    2017-09-01

    Metallosis is the accumulation of metallic debris in soft tissues resulting from wear following total joint replacement. A dog was evaluated for lameness 4 years after total hip arthroplasty using a titanium alloy and cobalt chromium total hip system. Radiographs revealed severe acetabular component wear, implant-bone interface deterioration, and peri-acetabular osteolysis. During surgical revision, black periarticular tissue surrounded the implants. Histologically, there was fibrosis and granulomatous inflammation with abundant, intra- and extracellular, black, granular material and smaller amounts of clear punctate to acicular material. Laser capture microdissection followed by x-ray fluorescence microscopy indicated the material contained large amounts of titanium with smaller amounts of vanadium, cobalt, and chromium, confirming the diagnosis of metallosis. The clear material was birefringent under cross-polarized light, stained positive with Oil-Red-O, and thus was consistent with polyethylene. Metallosis exhibits characteristic gross and histologic lesions and is a differential diagnosis for aseptic loosening of hip implants.

  5. 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

  6. AQUILA: assessment of quality in lower limb arthroplasty. An expert Delphi consensus for total knee and total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Van der Linden-Van der Zwaag Henrica MJ

    2011-07-01

    Full Text Available Abstract Background In the light of both the importance and large numbers of case series and cohort studies (observational studies in orthopaedic literature, it is remarkable that there is currently no validated measurement tool to appraise their quality. A Delphi approach was used to develop a checklist for reporting quality, methodological quality and generalizability of case series and cohorts in total hip and total knee arthroplasty with a focus on aseptic loosening. Methods A web-based Delphi was conducted consisting of two internal rounds and three external rounds in order to achieve expert consensus on items considered relevant for reporting quality, methodological quality and generalizability. Results The internal rounds were used to construct a master list. The first external round was completed by 44 experts, 35 of them completed the second external round and 33 of them completed the third external round. Consensus was reached on an 8-item reporting quality checklist, a 6-item methodological checklist and a 22-item generalizability checklist. Conclusions Checklist for reporting quality, methodological quality and generalizability for case series and cohorts in total hip and total knee arthroplasty were successfully created through this Delphi. These checklists should improve the accuracy, completeness and quality of case series and cohorts regarding total hip and total knee arthroplasty.

  7. AQUILA: assessment of quality in lower limb arthroplasty. An expert Delphi consensus for total knee and total hip arthroplasty.

    Science.gov (United States)

    Pijls, Bart G; Dekkers, Olaf M; Middeldorp, Saskia; Valstar, Edward R; van der Heide, Huub J L; Van der Linden-Van der Zwaag, Henrica M J; Nelissen, Rob G H H

    2011-07-22

    In the light of both the importance and large numbers of case series and cohort studies (observational studies) in orthopaedic literature, it is remarkable that there is currently no validated measurement tool to appraise their quality. A Delphi approach was used to develop a checklist for reporting quality, methodological quality and generalizability of case series and cohorts in total hip and total knee arthroplasty with a focus on aseptic loosening. A web-based Delphi was conducted consisting of two internal rounds and three external rounds in order to achieve expert consensus on items considered relevant for reporting quality, methodological quality and generalizability. The internal rounds were used to construct a master list. The first external round was completed by 44 experts, 35 of them completed the second external round and 33 of them completed the third external round. Consensus was reached on an 8-item reporting quality checklist, a 6-item methodological checklist and a 22-item generalizability checklist. Checklist for reporting quality, methodological quality and generalizability for case series and cohorts in total hip and total knee arthroplasty were successfully created through this Delphi. These checklists should improve the accuracy, completeness and quality of case series and cohorts regarding total hip and total knee arthroplasty.

  8. 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

  9. 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

    2016-01-01

    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

  10. [Total hip replacement in elderly and senile patients with initial femur neck fractures].

    Science.gov (United States)

    Ternovoĭ, N K; Samokhin, A V; Grebennikov, K A

    2003-12-01

    We carried out researches with the purpose of comparison of operative treatment results of femur neck fractures in elderly and senile patients with those in other countries. Total hip replacement technique was used over the period of 1991-2002 yy. for 123 patients with femur neck fractures. We have used "Smith & Nephews" or "Zimmer" prostheses with "Polacos" or "Osteobond" acrylcements. Surgical approach tactics is very important for prophylaxis of early and late postoperative complications. Active and of sound mind patients with femur neck fractures should undergo total hip replacement procedure. Rehabilitation is also an important factor in preventive early and late postoperative complications.

  11. Rehabilitation of patients aged 65 and over after total hip replacement

    DEFF Research Database (Denmark)

    Hørdam, Britta

    The overall aim of this thesis was to investigate improvement in health status of patients aged 65 and over after total hip replacement (THR) as a result of nursing rehabilitation. The projects conssits of three studies, first a description of patients´health status after THR, followed by a rando......The overall aim of this thesis was to investigate improvement in health status of patients aged 65 and over after total hip replacement (THR) as a result of nursing rehabilitation. The projects conssits of three studies, first a description of patients´health status after THR, followed...

  12. A simple technique to remove well-fixed acetabular components in revision of total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Xiaoqi Zhang, MD

    2017-12-01

    Full Text Available Removing well-fixed acetabular components can be a challenge for orthopaedic surgeons in revision of total hip arthroplasty. Acetabular bone loss, fracture, and other complications occurred in extracting implants may result in instability and fail of revision. Thus, instruments are developed to avoid such complications. We report a simple technique by drilling a tunnel on the superolateral quadrant of acetabulum and using an offset staff to remove acetabular components without many matching units. The procedure of removing well-fixed acetabular components is a simple, efficient, inexpensive, bone stock preserving technique. Keywords: Total hip arthroplasty, Acetabular revision, Removing acetabular components

  13. Introduction of total hip arthroplasty in Lithuania: results from the first 10 years.

    Science.gov (United States)

    Tarasevicius, Sarunas; Kesteris, Uldis; Robertsson, Otto; Smailys, Alfredas; Janusonis, Vinsas; Wingstrand, Hans

    2007-08-01

    Hip replacement as a routine procedure was introduced in Lithuania in 1991. At Klaipeda Hospital, one of the 2 hospitals at which this was begun, the arthroplasties were followed prospectively from the start. This study concerns the 10-year results from a country with no previous experience of hip replacement. The results are compared with those from a hospital with considerable experience of total hip replacement. We compared the revision rate for the first 658 primary ScanHip arthroplasties inserted at Klaipeda to that for the first 939 ScanHip primary arthroplasties inserted at Lund University Hospital, Sweden. Only patients with osteoarthritis were included, and the endpoint was revision for aseptic loosening with exchange of one or both components. We found that patients operated at Klaipeda Hospital had a significantly higher risk of revision (12%) than those operated in Lund (6%). Although we could not identify any specific reason for the Swedish results being better than the Lithuanian results, it is probable that previous surgical inexperience of hip replacement in Lithuania played a role. We believe that the findings will stimulate surgeons in Lithuania to analyze their failures and improve the results.

  14. 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.)

  15. Surgical challenges and clinical outcomes of total hip replacement in patients with Down's syndrome.

    Science.gov (United States)

    Zywiel, M G; Mont, M A; Callaghan, J J; Clohisy, J C; Kosashvili, Y; Backstein, D; Gross, A E

    2013-11-01

    Down's syndrome is associated with a number of musculoskeletal abnormalities, some of which predispose patients to early symptomatic arthritis of the hip. The purpose of the present study was to review the general and hip-specific factors potentially compromising total hip replacement (THR) in patients with Down's syndrome, as well as to summarise both the surgical techniques that may anticipate the potential adverse impact of these factors and the clinical results reported to date. A search of the literature was performed, and the findings further informed by the authors' clinical experience, as well as that of the hip replacement in Down Syndrome study group. The general factors identified include a high incidence of ligamentous laxity, as well as associated muscle hypotonia and gait abnormalities. Hip-specific factors include: a high incidence of hip dysplasia, as well as a number of other acetabular, femoral and combined femoroacetabular anatomical variations. Four studies encompassing 42 hips, which reported the clinical outcomes of THR in patients with Down's syndrome, were identified. All patients were successfully treated with standard acetabular and femoral components. The use of supplementary acetabular screw fixation to enhance component stability was frequently reported. The use of constrained liners to treat intra-operative instability occurred in eight hips. Survival rates of between 81% and 100% at a mean follow-up of 105 months (6 to 292) are encouraging. Overall, while THR in patients with Down's syndrome does present some unique challenges, the overall clinical results are good, providing these patients with reliable pain relief and good function.

  16. Value of scintiscanning in supporting the radiological diagnosis of loosening of total hip endoprotheses

    Energy Technology Data Exchange (ETDEWEB)

    Fritsche, H.J.; Kadner, P.; Schneider, G. (Karl-Marx-Universitaet, Leipzig (German Democratic Republic). Radiologische Klinik)

    1984-01-01

    In 80 cases of total hip endoprotheses with suspicion on loosening bone scintigraphy was performed and compared to clinical and radiological findings. The radiographs of total hip endoprotheses are often dubious and additional bone scintigrams can provide information for the evaluation of the femoral part of the prothesis. Increased radioactivity of the acetabulum can be interpreted only with caution as a sign of loosening of the prothesis. In evaluating the scintigram not only the quantity of the isotope but mainly its distribution and exact localization are of diagnostic relevance. A negative scintigram in painful hip one year following operation does not indicate instability of the prothesis, but it is highly important for the clinician.

  17. Lifestyle and health-related quality of life in Asian patients with total hip arthroplasties.

    Science.gov (United States)

    Fujita, Kimie; Xia, Zhenlan; Liu, Xueqin; Mawatari, Masaaki; Makimoto, Kiyoko

    2014-09-01

    Total hip arthroplasty reduces pain and restores physical function in patients with hip joint problems. This study examined lifestyle and health-related quality of life before and after total hip arthroplasty in Japanese and Chinese patients. Two hospitals in China recruited 120 patients and 120 Japanese patients matched by age and operative status were drawn from a prospective cohort database. Oxford Hip Score, EuroQol, and characteristics of Asian lifestyle and attitudes toward the operation were assessed. There were no differences between patients from the two countries in quality-of-life-scale scores: postoperative patients had significantly better quality-of-life scores than preoperative patients in both countries. In China, patients who reported that living at home was inconvenient had significantly worse Oxford Hip Scores than those who did not. Mean scores for anxiety items concerning possible dislocation and durability of the implant were significantly higher in Japanese than in Chinese subjects. Our findings suggest that providing information about housing conditions and lifestyles would result in improved quality of life and reduced anxiety in patients with implanted joints. © 2014 Wiley Publishing Asia Pty Ltd.

  18. Total hip and knee arthroplasty in patients with hereditary multiple exostoses.

    Science.gov (United States)

    Mesfin, Addisu; Goddard, Maria S; Tuakli-Wosornu, Yetsa A; Khanuja, Harpal S

    2012-12-01

    To the authors' knowledge, few reports have been published in the English literature of using total knee arthroplasty and total hip arthroplasty for the treatment of hereditary multiple exostoses. This article describes 2 patients with hereditary multiple exostoses, 1 treated with total hip arthroplasty and 1 treated with total knee arthroplasty. Bony deformities make arthroplasty uniquely challenging in patients undergoing total hip or knee arthroplasty. An expanded metaphysis of the proximal femur, coxa valga deformity, and the presence of hardware from previous reconstructive surgeries can make total hip arthroplasty technically difficult. Substantial bony deformity of the distal femur, valgus deformity of the knee, and sizing issues that necessitate custom implants can make total knee arthroplasty difficult. The most common bony deformities in hereditary multiple exostoses are short stature, limb-length discrepancy, valgus deformity at the knee and ankle, and asymmetry of the pectoral and pelvic girdles. Most reported surgical treatments for patients with hereditary multiple exostoses focus on the pediatric population or the management of malignant transformation of exostoses. Studies that specifically address the conditions associated with knee deformities focus on extra-articular deformity correction rather than arthroplasty.When arthroplasty is necessary in this patient population, an understanding of the commonly occurring deformities can help with preoperative planning and surgical management. All painful lesions must be evaluated for malignant transformation. Bone scans can be useful during workup. All specimens should be sent for pathologic evaluation. Such patients are challenging because of the distorted hip anatomy and valgus knee deformity. The current 2 cases illustrate specific challenges that can be anticipated and underscore key principles for arthroplasty in the management of hereditary multiple exostoses. Copyright 2012, SLACK Incorporated.

  19. A Review of Current Fixation Use and Registry Outcomes in Total Hip Arthroplasty

    DEFF Research Database (Denmark)

    Troelsen, Anders; Malchau, Erik; Sillesen, Nanna Hylleholt

    2013-01-01

    and to analyze age-stratified risk of revision comparing cemented, hybrid, and uncemented fixation as reported by national hip arthroplasty registries. METHODS: Data were extracted from the annual reports of seven national hip arthroplasty registries; we included all national registries for which annual reports...... were available in English or a Scandinavian language, if the registry had a history of more than 5 years of data collection. RESULTS: Current use of uncemented fixation in primary THAs varies between 15% in Sweden and 82% in Canada. From 2006 to 2010 the registries of all countries reported overall...... increases in the use of uncemented fixation; Sweden reported the smallest absolute increase (from 10% to 15%), and Denmark reported the greatest absolute increase (from 47% to 68%). Looking only at the oldest age groups, use of uncemented fixation also was increasing during the period. In the oldest age...

  20. "Pros and cons" of total hip arthroplasty with metaphyseal Proxima endoprosthesis.

    Science.gov (United States)

    Wraźen, Waldemar; Golec, Edward B; Tomaszewski, Krzysztof A; Golec, Piotr; Jaworowski, Michał de Lubicz; Dudkiewicz, Zbigniew

    2015-01-01

    The authors present their own experience concerning total hip arthroplasty with the metaphyseal prosthesis Proxima. Proxima, a metaphyseal prosthesis, provides an innovative supplement to total hip arthroplasty. In this study, the authors present their own experience using Proxima in patients with hip osteoarthritis. This study was performed between 2008 to 2013 and comprised of 62 patients, of which 38 were male (61.3%) and 24 female (38.7%). All patients were operated on due to hip osteoarthritis using total hip arthroplasty with the metaphyseal prosthesis Proxima. The age of patients included into the study ranged from 23 years to 62 years with the mean age of 46 years. The authors paid close attention to the "pros and cons" of surgical techniques and assessed clinical and radiological results in both the short and long-term observation periods. The clinical evaluation was based on the Harris Hip Score and radiological assessment of fixation of the acetabular cup of the endoprosthesis was based on Pradhan's criteria. The endoprosthesis Proxima stem was positioned using the manufacturer's recommended method, evaluating the direction, scope and duration of the displacement in the marrow cavity of the proximal stump of the femur. According to the authors' analysis, the surgery gives good functional and radiological results both in the short- and long-term observation periods. The effectiveness depends on precise qualification for surgery, proper surgical techniques and specific anatomical conditions of the proximal femur stump. The most common reasons for primary and secondary dislocations of the metaphyseal endoprosthesis Proxima stem occur during the first three months post surgery. This is due to incorrect surgical techniques, which disregard the importance of specific anatomical conditions of the proximal femoral stump, which affects Proxima implantation, and cause deviations towards a varus or valgus orientation.

  1. ANALYSIS ON QUALITY OF LIFE OF PATIENTS WITH OSTEOARTHROSIS UNDERGOING TOTAL HIP ARTHROPLASTY.

    Science.gov (United States)

    de Araújo Loures, Elmanq; Leite, Isabel Cristina Gonçalves

    2012-01-01

    The aim of the study was to evaluate the health-related quality of life among patients affected by hip osteoarthrosis who were treated by means of total hip arthroplasty. A cohort of 38 patients operated by a single surgeon in a regional referential teaching hospital during the year 2010 was prospectively studied and followed up for at least six months until they had achieved satisfactory rehabilitation. Each patient gave responses to the SF-36 form immediately before the operation and six months later and the Harris Hip Score was obtained at the same time. The pre and postoperative results were analyzed and compared with the literature. The pre and postoperative SF-36 results were as follows: physical function: 13.4-53.7; role physical: 9.21-48.0; body pain: 23.1-62.6; general health: 54.2-71.3; vitality: 40.3-69.9; social function: 40.8-74.3; role emotional: 23.7-64.9; and mental health: 52.6-80.4. The Harris Hip Score went from 36.1 to 92.1, on average. All the results were statistically significant (p quality of life among patients affected by osteoarthrosis of different etiologies who underwent total hip arthroplasty. Health-related quality of life evaluations cannot replace clinical evaluations provided by specific instruments and physicians' experience but can add important data through giving value to patients' sets of expectations regarding medical treatment. Moreover, such evaluations can be considered to be an efficient tool for analyzing the outcomes from total hip arthroplasty.

  2. 'Pathological' fracture of the femur -a complication of failed total hip ...

    African Journals Online (AJOL)

    Ten patients with a major femur fracture complicating total hip arthroplasty were seen at the Princess Alice Orthopaedic Hospital between June 1986 and May 1988. Four cases were intra-operative fractures sustained at revision surgery and 6 were late postoperative fractures of the femur associated with minimal trauma, ...

  3. 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.)

  4. 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

    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

  5. Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacements

    DEFF Research Database (Denmark)

    Schrama, Johannes Cornelis; Fenstad, Anne M; Dale, Håvard

    2015-01-01

    Background and purpose-Medical treatment of rheumatoid arthritis (RA) has changed dramatically over the last 15 years, including immune modulation. We investigated the risk of revision for infection after primary total hip replacement (THR) in patients with rheumatoid arthritis over a 16-year per...

  6. 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.

  7. 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....

  8. Incidence of low-grade infection in aseptic loosening of total hip arthroplasty.

    NARCIS (Netherlands)

    Moojen, D.J.; Hellemondt, G. van; Vogely, H.C.; Burger, B.J.; Walenkamp, G.H.; Tulp, N.J.; Schreurs, B.W.; Meulemeester, F.R. de; Schot, C.S.; Pol, I. van de; Fujishiro, T.; Schouls, L.M.; Bauer, T.W.; Dhert, W.J.

    2010-01-01

    PURPOSE: We investigated the hypothesis that many total hip arthroplasty revisions that are classified as aseptic are in fact low-grade infections missed with routine diagnostics. METHODS: In 7 Dutch hospitals, 176 consecutive patients with the preoperative diagnosis of aseptic loosening of their

  9. Outcomes of obese and nonobese patients undergoing revision total hip arthroplasty

    NARCIS (Netherlands)

    Luebbeke, Anne; Moons, Karel G. M.; Garavaglia, Guido; Hoffmeyer, Pierre

    2008-01-01

    Objective. To evaluate the effect of obesity on the incidence of adverse events (surgical site infection, dislocation, re-revision, or >= 1 adverse event), functional outcome, residual pain, and patient satisfaction after revision total hip arthroplasty (THA). Methods. We conducted a university

  10. Revision Total Hip Arthroplasty Complicated by Metastatic Malignant Gastrointestinal Stromal Tumour

    Directory of Open Access Journals (Sweden)

    Hok-Yin Alwin Li

    2014-06-01

    Full Text Available Periprosthetic malignancy causing failure of total hip arthroplasty is a rare entity. Metastasis of malignant tumour to the proximity of orthopaedic implants is even more uncommon. We present a case of a 74-year-old female with an infected Austin Moore prosthesis, requiring a two-stage revision total hip arthroplasty. Within 2 years postoperatively, erosion of the lesser trochanter was noted. Further revision surgery was performed with the insertion of a cement spacer. Despite the expectation of an infected prosthesis, intraoperative frozen section showed sarcoma and the final pathology was metastasis of a recurrent gastrointestinal stromal tumour (GIST. Metastatic GIST to total hip prosthesis had not been reported previously and this case illustrates how intraoperative frozen section can aid diagnosis and management. We also highlighted some diagnostic clues, differentiating this rare diagnosis from septic loosening and osteolysis. Malignant infiltration should be considered as a differential diagnosis in failed total hip arthroplasty, especially in patients with a previous history of malignancy.

  11. 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

    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

  12. 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.

  13. 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.

  14. Results of total hip arthroplasty differ in subtypes of high dislocation.

    Science.gov (United States)

    Hartofilakidis, George; Babis, George C; Lampropoulou-Adamidou, Kalliopi; Vlamis, John

    2013-09-01

    In a previous study, we described two subtypes of high dislocation of the hip depending on the presence (C1) or absence (C2) of a false acetabulum, yet we have already presented the concise followup of total hip arthroplasty (THA) in these patients as a group at a minimum of 15 years. In this retrospective study, we investigated differences in the results of THA in the C1 and C2 subtypes of high dislocation such as (1) survivorship of the reconstructions; (2) Merle d'Aubigné-Postel clinical scores; (3) leg lengthening and femoral shortening; and (4) site of reattachment and union rate of the greater trochanter. We included 49 hips of the C1 subtype and 30 hips of the C2 subtype operated on from 1976 to 1994. We evaluated survivorship (using reoperation for any reason as the end point) and performed chart and radiographic reviews. The 15-year survival was 84% (± 10% [95% CI]) for the C1 subtype and 60% (± 17% [95% CI]) for the C2 subtype (p = 0.001). Cox regression analysis, after adjustment for confounding factors, showed also statistically significantly worse survivorship in the C2 subtype (p = 0.021) and, after adjustment for possible predictive factors, found a statistically significant relationship of high dislocation subtype (p = 0.018) and trochanteric union (p = 0.005) with survival of THAs. Pain, function, and mobility scores improved from preoperative to last followup in C1 and C2 groups but they did not differ between C1 and C2 hips. C2 hips were lengthened more (p dislocation subtypes, including the risk of revision, which was higher in patients whose hips did not have a false acetabulum. These findings indicate that while reporting THA results in patients with high dislocation, mixing results of the two subtypes may lead to statistical bias.

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

    Science.gov (United States)

    Erceg, M; Becic, K

    2014-01-01

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

  16. The role of surgery in postoperative nerve injuries following total hip replacement.

    Science.gov (United States)

    Uskova, Anna A; Plakseychuk, Anton; Chelly, Jacques E

    2010-06-01

    Although postoperative nerve injury is infrequent in patients undergoing joint replacement, it is extremely distressing for the patient, surgeon, and anesthesiologist. The nature of nerve injury is often closely related to the type of surgery; this review details the potential surgical causes of nerve injuries following total hip arthroplasty. The current orthopedic literature (1943-2008) was reviewed to help anesthesiologists better understand the pathophysiology of surgery-related postoperative nerve injuries, including the relationship with hip joint anatomy and the surgical techniques. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  17. Hydroxyapatite coating does not improve uncemented stem survival after total hip arthroplasty!

    DEFF Research Database (Denmark)

    Hailer, Nils P; Lazarinis, Stergios; Mäkelä, Keijo T

    2015-01-01

    Background and purpose - It is still being debated whether HA coating of uncemented stems used in total hip arthroplasty (THA) improves implant survival. We therefore investigated different uncemented stem brands, with and without HA coating, regarding early and long-term survival. Patients...... to diagnoses other than osteoarthritis or pediatric hip disease, and procedures with missing information on the type of coating. 22 stem brands remained (which were used in 116,069 procedures) for analysis of revision of any component. 79,192 procedures from Denmark, Norway, and Sweden were analyzed...

  18. [Total hip replacement in psoriatic arthritis--raport of 4 cases].

    Science.gov (United States)

    Pietrzak, Krzysztof; Strzyzewski, Wojciech; Pucher, Andrzej; Kaczmarek, Wiesław

    2011-01-01

    It is unusual for the hips to be affected by psoriatic arthritis. But in that rare cases, totalhip replacement (THR) is at present an accepted treatment in patients with severe and painfull deformity. The aim of this paper is to evaluate the results of THR in patients suffering from psoriatic arthritis of the hip, operated from 2000 to 2008 in the Orthopaedic and Traumatologic Department of Poznan University of Medical Sciences. Material included 4 patients, 2 females and 2 males, on whom 5 THRs were performed, lateral approach was used in all cases. At the time of operation, the age of patients ranged from 48 to 61 years (mean 53). Follow-up ranged from 2 to 10 years (mean 6 years). The operative treatment was a multistage process (during one operation only one joint was replaced). Cementeless total hip arthroplasty was used during all of the THRs. The patients were clinically and radiologically evaluated preoperatively, postoperatively, and at final examination. The clinical state was evaluated with Harris hip score and WOMAC scale. We based our radiological examination on Hip Society system. The average preoperative Harris score for the group of patients was 31, WOMAC score 77. After an average of 6 years follow-up all hips were considered excellent, with average Harris score of 90, WOMAC Score of 5. All patients had increased function and decreased pain. The radiograms of all patients revealed that the acetabular and femoral components were correctly positioned with no radiographic evidence of loosening in the last examination. The inclination angle of the acetabular component was 30-48 (mean: 39 degrees) and the acetabular opening angle was 3-20 degrees (mean: 4 degrees). The stem was neutral-oriented in all hips. No ectopic ossification concentrations were found. The hip may be involved by the psoriatic arthritis. Clinical and radiological evaluation of our material showed that total hip replacement in the treatment of psoriatic arthritis allows regaining

  19. Outcomes of dual mobility components in total hip arthroplasty: a systematic review of the literature.

    Science.gov (United States)

    Darrith, B; Courtney, P M; Della Valle, C J

    2018-01-01

    Instability remains a challenging problem in both primary and revision total hip arthroplasty (THA). Dual mobility components confer increased stability, but there are concerns about the unique complications associated with these designs, as well as the long-term survivorship. We performed a systematic review of all English language articles dealing with dual mobility THAs published between 2007 and 2016 in the MEDLINE and Embase electronic databases. A total of 54 articles met inclusion criteria for the final analysis of primary and revision dual mobility THAs and dual mobility THAs used in the treatment of fractures of the femoral neck. We analysed the survivorship and rates of aseptic loosening and of intraprosthetic and extra-articular dislocation. For the 10 783 primary dual mobility THAs, the incidence of aseptic loosening was 1.3% (142 hips); the rate of intraprosthetic dislocation was 1.1% (122 hips) and the incidence of extra-articular dislocation was 0.46% (41 hips). The overall survivorship of the acetabular component and the dual mobility components was 98.0%, with all-cause revision as the endpoint at a mean follow-up of 8.5 years (2 to 16.5). For the 3008 revision dual mobility THAs, the rate of aseptic acetabular loosening was 1.4% (29 hips); the rate of intraprosthetic dislocation was 0.3% (eight hips) and the rate of extra-articular dislocation was 2.2% (67 hips). The survivorship of the acatabular and dual mobility components was 96.6% at a mean of 5.4 years (2 to 8). For the 554 dual mobility THAs which were undertaken in patients with a fracture of the femoral neck, the rate of intraprosthetic dislocation was 0.18% (one hip), the rate of extra-articular dislocation was 2.3% (13 hips) and there was one aseptic loosening. The survivorship was 97.8% at a mean of 1.3 years (0.75 to 2). Dual mobility articulations are a viable alternative to traditional bearing surfaces, with low rates of instability and good overall survivorship in primary and

  20. Impact of low-frequency pulsed electromagnetic fields and interference currents in the formation of heterotopic ossification after total hip instalation in the hip joint

    Directory of Open Access Journals (Sweden)

    Ivković S.

    2015-01-01

    Full Text Available Due to the extension of life expectancy, the number of elderly people increases, and thus the number of disease and injuries of the locomotor system, especially the hip joint. One of the persistent trend is an increasing trend in the number of patients with coxarthrosis and implanted total hip endoprosthesis. One of the postoperative complications that occurred after implantation a total hip endoprosthesis is heterotopic ossification (HO. HO is the most common complication that occurs after the implantation a total hip endoprosthesis with recorded cases in the range of 9-90%. HO are insufficiently understood phenomenon, which is characterized by the formation of bone in periarticular tissues. We prospectively followed patients who implanted total hip endoprostheses in the department of orthopedics ZC in Kos. Mitrovica in 2008. and 2009. year. We examined the influence of physical agents on the prevention of HO near the hip joint. In these patients the treatment was carried out kinesiotherapeutic at the Center for Rehabilitation Health Center Kosovska Mitrovica, as well as pulse therapy low frequency magnetic field frequency of 30 Hz, 30 minutes, 8 mT intensity and 15 minutes interferential current, 0-100 Hz frequency. All patients were on the rehabilitation of one month (20 days. Based on this research we confirmed the assumption that the use of low frequency pulsed magnetic fields, interference currents and kinesitherapy prevents HO in patients after implantation of total endoprosthesis of the hip joint.

  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

    /week). The IG trained with loads of 10 repetition maximum from week 1 to 10 after THR. Before surgery and after the intervention, performance was evaluated by leg extension power (primary outcome), isometric strength (hip abduction + flexion), sit-to-stand test (STS), stair test and 20 meter walking speed......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...

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

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    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.

  3. Pseudoacetabulum a subtle radiological feature of a chronic dislocated total hip replacement.

    Science.gov (United States)

    Odak, Saurabh; Mangwani, Jitendra; Ivory, John

    2012-10-06

    We report the presence of an unusual radiological feature of formation of pseudoacetabulum in a chronically dislocated and asymptomatic total hip arthroplasty. An elderly demented patient with a history of recurrent dislocations presented to us after an unwitnessed fall and leg length discrepancy. Radiographs showed a dislocated hip arthroplasty with a well-defined, concentric, radio-opaque shadow around the dislocated femoral head suggestive of a pseudoacetabulum. Previous radiographs revealed formation of heterotopic ossification in the soft tissues surrounding the hip. The dislocated joint was reduced under a general anaesthetic with difficulty. This case highlights the presence of heterotopic ossification and formation of pseudoacetabulum as subtle radiological features of chronic instability and dislocation.

  4. Total hip arthroplasty using a cylindrical cementless stem in patients with a small physique.

    Science.gov (United States)

    Nakamura, Yoshihide; Mitsui, Hiromasa; Kikuchi, Akira; Toh, Satoshi; Katano, Hiroshi

    2011-01-01

    We performed total hip arthroplasty using an anatomic medullary locking cementless stem for small-physique patients from 1988 to 1995. We conducted a retrospective study of 50 joints in 44 cases, including 40 developmentally dysplastic hips followed for 12 to 20 years (average, 15.1 years). Average height and body weight were 152 cm and 56 kg (5.0 ft and 124 lb), respectively, with an average body mass index of 24.2. Twelve joints (24%) were revised for acetabular-sided failures. Forty-eight stems (96%) showed bone ingrowth fixation, and there were no unstable stems. The simple cylindrical shape of the distal portion of the AML stem was less affected by deformity of the proximal femur of developmental dysplasia of the hip in patients with a small physique, and both clinically and radiologically good results were confirmed at long-term follow-up. Copyright © 2011 Elsevier Inc. All rights reserved.

  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. Do new and more expensive implants provide better outcomes in total hip arthroplasty?

    Directory of Open Access Journals (Sweden)

    A. N. Kovalenko

    2015-01-01

    Full Text Available Total hip arthroplasty (THA is one of the most successful surgeries in medical history. But rising demand in such procedures creates significant burden on national health systems all over the world so that researhers more often pay attention to economic impaction of THA. The use of new implants also increases a cost of arthroplasty. But it is a question whether new and more expensive implants could improve clinical outcomes. It became the purpose of our study. We studied available literature in Medline database about main trends of new hip endoprosthetic developments in previous decade and how they can impact to outcomes. Furthermore we studied our data of first revisions of domestic and import implants with comparison terms, structure and frequency of special revision implants using. According to our results new and expensive implants are not basic factor of reliable functioning of hip endoprosthesis.

  7. The biomechanical effect of the collar of a femoral stem on total hip arthroplasty.

    Science.gov (United States)

    Jeon, Insu; Bae, Ji-Yong; Park, Jin-Hong; Yoon, Taek-Rim; Todo, Mitsugu; Mawatari, Masaaki; Hotokebuchi, Takao

    2011-01-01

    To investigate the biomechanical effect of collars, finite element analyses are carried out through two hip joints that are implanted using collared and collarless stems, respectively, and an intact hip joint model. For the analyses, the sacrum, coxal bone, and the cancellous and cortical bones of a femur are modelled using finite elements based on X-ray computed tomographic images taken from a 27-year-old woman. From the results, it is found that a collar with perfect calcar contact prevents stem subsidence and decreases the proximal-lateral gap and the lateral stem tilting. Therefore, it can impart reasonable biomechanical stability for total hip arthroplasty. However, its low load transmission ability and increased stem tilting effect due to the imperfect contact between the collar and the calcar are found to be serious problems that need to be solved. Results of clinical follow-up are presented for supporting the computational results.

  8. 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...... of 53 months. 4 pseudotumors were diagnosed at time of follow up but no substantiated link was made between adverse reactions and re-operations. CONCLUSION: The high re-operation rates found in this study raised concern about the usage of the MOM THA and subsequently lead to the termination......-center study. MATERIALS AND METHODS: 108 CONSERVE(®) MOM THA were implanted in 92 patients between November 2005 and December 2010. Patients had at time of retrospective evaluation their journals reviewed for re-operations and adverse reactions. RESULTS: 20 hips were re-operated (18.4%) at a mean follow up...

  9. The validation of the visual analogue scale for patient satisfaction after total hip arthroplasty.

    Science.gov (United States)

    Brokelman, Roy B G; Haverkamp, Daniel; van Loon, Corné; Hol, Annemiek; van Kampen, Albert; Veth, Rene

    2012-06-01

    INTRODUCTION: Patient satisfaction becomes more important in our modern health care system. The assessment of satisfaction is difficult because it is a multifactorial item for which no golden standard exists. One of the potential methods of measuring satisfaction is by using the well-known visual analogue scale (VAS). In this study, we validated VAS for satisfaction. PATIENT AND METHODS: In this prospective study, we studied 147 patients (153 hips). The construct validity was measured using the Spearman correlation test that compares the satisfaction VAS with the Harris hip score, pain VAS at rest and during activity, Oxford hip score, Short Form 36 and Western Ontario McMaster Universities Osteoarthritis Index. The reliability was tested using the intra-class coefficient. RESULTS: The Pearson correlation test showed correlations in the range of 0.40-0.80. The satisfaction VAS had a high correlation between the pain VAS and Oxford hip score, which could mean that pain is one of the most important factors in patient satisfaction. The intra-class coefficient was 0.95. CONCLUSIONS: There is a moderate to mark degree of correlation between the satisfaction VAS and the currently available subjective and objective scoring systems. The intra-class coefficient of 0.95 indicates an excellent test-retest reliability. The VAS satisfaction is a simple instrument to quantify the satisfaction of a patient after total hip arthroplasty. In this study, we showed that the satisfaction VAS has a good validity and reliability.

  10. Flexion reminder device to discourage recurrent posterior dislocation of a total hip replacement: a case report

    Directory of Open Access Journals (Sweden)

    Wong King

    2008-07-01

    Full Text Available Abstract Introduction Recurrent dislocation of a total hip replacement prosthesis is a frustrating complication for both the surgeon and the patient. For positional dislocations with no indications for revision surgery, the current best treatment is physiotherapy, the use of abduction braces and avoidance of unsafe hip positions. Abduction braces can be cumbersome and have poor compliance. We report the successful use of a new lightweight flexion reminder device that can be used to treat people with this condition. Case presentation A 64-year-old British woman experienced recurrent positional posterior dislocation after primary hip replacement, particularly when involved in activities involving unsafe flexion of the operated hip. She disliked using an abduction brace and hence was given a simple 'flexion reminder device' that could be strapped to the thigh. Beyond the safe flexion limit, the padded top end of the device hitched against the groin crease and reminded her not to flex further, to avoid dislocation. She experienced no discomfort in wearing the device continuously throughout the day and was very satisfied. She has had no further dislocations in the 2 years since she began using it. Conclusion In cases of arthroplasty dislocation caused mainly by an unsafe hip position, and with no indication for revision surgery, this new lightweight and easily worn flexion reminder device may be a good option for avoiding such positional dislocations, particularly those caused by unsafe flexion.

  11. Profiles of Biomarkers of Excess Alcohol Consumption in Patients Undergoing Total Hip Replacement: Correlation with Function

    Directory of Open Access Journals (Sweden)

    Paul J. Jenkins

    2011-01-01

    Full Text Available Aims. Patients who misuse alcohol may be at increased risk of surgical complications and poorer function following hip replacement. Identification and intervention may lead to harm reduction and improve the outcomes of surgery. The aim of this study was to determine the prevalence of biomarker elevation in patients undergoing hip replacement and to investigate any correlation with functional scores and complications. Methods. We performed a retrospective study that examined the profile of biomarkers of alcohol misuse in 1049 patients undergoing hip replacement. Results. Gamma-glutamyltransferase was elevated in 150 (17.6%, and mean corpuscular volume was elevated in 23 (4%. At one year general physical health was poorer where there was elevation of γGT, and the mental health and hip function was poorer with elevation of MCV. There were no differences in complications. Discussion. Raised biomarkers can alert clinicians to potential problems. They also provide an opportunity to perform further investigation and offer intervention. Future research should focus on the use in orthopaedic practice of validated screening questionnaires and more sensitive biomarkers of alcohol misuse. Conclusion. This study demonstrates a potential substantial proportion of unrecognised alcohol misuse that is associated with poorer functional scores in patients after total hip replacement.

  12. Total hip arthroplasty in steroid-induced osteonecrosis: early functional and radiological outcomes.

    Science.gov (United States)

    Rahman, Wael A; Garbuz, Donald S; Masri, Bassam A

    2013-02-01

    The proportion of total hip arhtoplasties (THAs) associated with corticosteroid use is uncertain, and the mechanisms of corticosteroid-induced osteonecrosis remain unknown. We sought to evaluate the clinical and radiographic outcomes, complications and satisfaction with THA among patients with corticosteroid-induced osteonecrosis. We retrospectively assessed functional outcome at a minimum 1-year follow-up using the Western Ontario and MacMaster Universities Arthritis Index (WOMAC); Oxford Hip Score; Short Form (SF)-12; University of California, Los Angeles (UCLA) Activity; and patient satisfaction scores. We included 31 patients (35 hips). The average follow-up was 20 (range 12- 55) months, and the average age at surgery was 47 (range 19-78) years. At follow-up, patients showed significant improvement in all 4 components of the WOMAC (means: function 84, stiffness 75, pain 86, global 84), Oxford-12 (mean 83) and SF-12 (means: mental 40 and physical 48) scores. However, there was no significant improvement in the UCLA Activity scores. Mean patient satisfaction scores were good for pain relief (86), function (80), recreation (77.5) and overall results of surgery (86). Radiographic review at follow-up showed that all components were well fixed with no evidence of loosening. The complication rate was high (17%), with 6 complications in 5 patients (6 of 35 hips). Four patients (4 of 35 hips; 11%) required reoperations. Total hip arthroplasty in patients with corticosteroid-induced osteonecrosis of the femoral head is successful in reducing pain and improving function; however, the rate of complications and reoperation is high.

  13. Gait and gait-related activities of daily living after total hip arthroplasty: a systematic review.

    Science.gov (United States)

    Kolk, Sjoerd; Minten, Michiel J M; van Bon, Geert E A; Rijnen, Wim H; Geurts, Alexander C H; Verdonschot, Nico; Weerdesteyn, Vivian

    2014-06-01

    Differences in the performance of gait and gait-related activities of daily living are known to persist after total hip arthroplasty compared to healthy controls, but the specific underlying deficits (spatiotemporal, kinematics and kinetics) are not completely understood. This review aimed to map the differences between patients and controls, and between the operated and non-operated limbs during various activities of daily living. A computerized search with broad search terms was performed in the MEDLINE database. Primary inclusion criteria were: primary osteoarthritis as indication, comparison with healthy controls or comparison between the operated and the non-operated limbs, and follow-up period at least six months after surgery. The literature search yielded 2177 citations, of which 35 articles were included. Compared to controls, reductions were identified in the operated hip in sagittal range of motion, peak extension, sagittal power generation, abduction moment and external rotation moment. During stair ascent, these reductions did not become more apparent, although deficits in hip kinetics in all three planes were found. Walking speed and step length were reduced compared to controls at longer-term follow-up, but not at short-term follow-up. The hip abduction moment deficit was present both in level walking and in stair ascent in total hip arthroplasty patients compared to controls. Reduced sagittal hip power generation and external rotation moment were also found, of which the clinical relevance remains to be established. Due to a low number of studies, many of the longer-term effects of THA on gait and gait-related ADL are not yet accurately known. Copyright © 2014 Elsevier Ltd. All rights reserved.

  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...... 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. [Autogenous femoral head bone grafting combined with total hip arthroplasty for the treatment of old dislocation of hip joint center in 16 cases].

    Science.gov (United States)

    Li, Shuai-lei; Sun, Yong-qiang

    2015-10-01

    To study effects of autogenous femoral head bone grafting combined with total hip replacement for the treatment of old center dislocation of hip joint, and to evaluate the superiority of acetabular defect reconstruction with autogenous bone. From March 2008 to December 2013, 16 patients (16 hips) with old center dislocation of hip joint were treated with autologous bone graft combined with total hip replacement. There were 11 males and 5 females, ranging in age from 41 to 72 years old, with an average of 56.3 years old. The duration of the disease ranged from 3.6 to 37.2 years. Twelve patients had injuries caused by traffic accidents and 4 patients were caused by falling down. The hip joint pain at the first month after operation, Harris score and hip joint movement of all patients were observed by using electronic case follow-up system. All the patients were followed up, and the duration ranged from 11 to 78 months, with an average of 27.3 months. The postoperative hip joint movement of (56.2±23.4)° VAS 86.3±7.2 and Harris score 32.6±12.6 were all better than preoperative (181.8±17.6)°, 11.1±2.6 and 86.3±7.2. The joint pain was reduced and the function limitation was improved after operation, and the prosthesis position was good. When the autologous femoral head bone grafting combined with total hip arthroplasty is used to treat old hip central dislocation, the initial and long-term stability of acetabular bone grafting is good, and the technique can avoid allogeneic bone complications, bone source rationally and reduce the economic burden of patients.

  16. Genetic evaluation of the total hip score of four populous breeds of dog, as recorded by the New Zealand Veterinary Association Hip Dysplasia Scheme (1991-2011).

    Science.gov (United States)

    Soo, M; Sneddon, N W; Lopez-Villalobos, N; Worth, A J

    2015-03-01

    To use estimated breeding value (EBV) analysis to investigate the genetic trend of the total hip score (to assess canine hip dysplasia) in four populous breeds of dogs using the records from the New Zealand Veterinary Association (NZVA) Canine Hip Dysplasia Scheme database (1991 to 2011). Estimates of heritability and EBV for the NZVA total hip score of individual dogs from the German Shepherd, Labrador Retriever, Golden Retriever and Rottweiler breeds were obtained using restricted maximum likelihood procedures with a within-breed linear animal model. The model included the fixed effects of gender, birth year, birth season, age at scoring and the random effect of animal. The pedigree file included animals recorded between 1990 and 2011. A total of 2,983 NZVA hip score records, from a pedigree of 3,172 animals, were available for genetic evaluation. Genetic trends of the NZVA total hip score were calculated as the regression coefficient of the EBV (weighted by reliabilities) on year of birth. The estimates of heritability for hip score were 0.32 (SE 0.08) in German Shepherd, 0.37 (SE 0.08) in Labrador Retriever, 0.29 (SE 0.08) in Golden Retriever and 0.52 (SE 0.18) in Rottweiler breeds. Genetic trend analysis revealed that only the German Shepherd breed exhibited a genetic trend towards better hip conformation over time, with a decline of 0.13 (SE 0.04) NZVA total hip score units per year (p0.1). Despite moderate heritability of the NZVA total hip score, there has not been substantial improvement of this trait for the four breeds analysed in the study period. Greater improvement in reducing the prevalence of canine hip dysplasia may be possible if screening were to be compulsory as a requirement for registration of pedigree breeding stock, greater selection pressure were to be applied and selection of breeding stock made on the basis on an individual's EBV rather than the NZVA total hip score alone.

  17. [The incidence of osteopenia and osteoporosis in patients with cementless total hip arthroplasty].

    Science.gov (United States)

    Lacko, M; Schreierová, D; Čellár, R; Vaško, G

    2015-01-01

    The aim of the study was to evaluate the incidence of osteopenia and osteoporosis in the patients elected to cementless total hip replacement. The group evaluated comprised 100 patients with primary or secondary forms of coxarthrosis who underwent cementless total hip arthroplasty (THA). The results of densitometric examination of the lumbar spine and proximal femur were analysed. Based on the lowest T-score value, the patients were divided into three groups, i.e., fist, normal bone density; second, osteopenia; third, osteoporosis. Clinical examination included patient medical history, Harris hip scores and visual analogue scale assessment for pain intensity; the Kellgren-Lawrence classification was used to measure the grade of hip osteoarthritis; blood tests were made to assess the levels of total calcium, ionised calcium, phosphorus, vitamin D and the markers of bone resorption and formation. Osteoporosis was found in 32 and osteopenia in 21 patients; 47 patients had normal bone density. Osteoporosis was detected in the lumbar spine of 21 patients, in the proximal femur of nine patients and at both sites in two patients. In 13 patients this diagnosis was made for the fist time. The patients with osteoporosis had a significantly lower body mass index. There were no differences in the other characteristics, i.e., age, functional, radiological and laboratory findings, among the groups; all three showed the mean vitamin D concentration below the lowest level of its physiological range. Insufficient vitamin D levels were found in 54 women and 18 men. Of all patients, only 13 women and four men took vitamin D supplements. DISCUSSION Osteoarthritis and osteoporosis are the most frequent complex musculoskeletal diseases. Several studies have suggested that these disorders are mutually exclusive. This assumption has been based on the absence of radiographic evidence of osteoarthritis seen in many elderly patients with femoral neck fractures. Our relatively frequent

  18. Differences in the trajectory of bone mineral density change measured at the total hip and femoral neck between men and women following hip fracture.

    Science.gov (United States)

    Rathbun, Alan M; Shardell, Michelle; Orwig, Denise; Hebel, J Richard; Hicks, Gregory E; Beck, Thomas; Hochberg, Marc C; Magaziner, Jay

    2016-01-01

    Research has not examined changes in bone mineral density (BMD) between men and women following hip fracture. The aim was to evaluate sex differences in BMD following hip fracture. Men experienced significant declines in BMD, while not statistically greater than women, underscoring the necessity for better osteoporosis care in men. Each year in the USA, approximately 260,000 older adults experience a hip fracture. Women experiencing hip fracture have excess decline in BMD in the year following fracture compared to expected decrements due to aging, but few studies have assessed sex differences in the sequelae of hip fracture. Thus, our objective was to examine sex differences in BMD change in the year after hip fracture. The sample (n = 286) included persons enrolled in the Baltimore Hip Studies 7th cohort, a study that matched (1:1) men and women experiencing hip fracture. Weighted estimating equations that accounted for missing data and selective survival were used to estimate sex differences in 12-month total hip (TH) and femoral neck (FN) BMD changes. Men had larger average adjusted percent decline in TH and FN BMD. Adjusted 12-month decreases at the FN showed a statistically significant decline of -4.60% (95% confidence interval [CI] -7.76%, -0.20%) in men and an insignificant change of -1.62% (95% CI -4.57%, 1.32%) in women. Yet, the difference in change between men and women was not statistically significant (P = 0.17). The estimated sex differences for TH BMD loss were smaller in magnitude. There is evidence of significant BMD loss among men at the FN in the year after hip fracture. Although not statistically greater than women, these clinically significant findings highlight the need for improved osteoporosis care among men prior to and after hip fracture.

  19. Vitamin D deficiency in patients with osteoarthritis undergoing total hip replacement: a cause for concern?

    Science.gov (United States)

    Nawabi, D H; Chin, K F; Keen, R W; Haddad, F S

    2010-04-01

    We measured the plasma 25-hydroxyvitamin D(3) (25(OH)D(3)) levels in 62 consecutive Caucasian patients undergoing total hip replacement for osteoarthritis. The patients were divided into two groups based on whether they were vitamin D sufficient or deficient. The groups were matched for age, gender and the American Society of Anaesthesiologists (ASA) grade. The prevalence of vitamin D deficiency in our patients was comparable with recent population-based studies performed in the United Kingdom. Patients with vitamin D deficiency had lower pre-operative Harris hip scores (Mann-Whitney test, p = 0.018) and were significantly less likely to attain an excellent outcome from total hip replacement (chi-squared test, p = 0.038). Vitamin D levels were found to positively correlate with both pre- and post-operative Harris hip scores. These results warrant further study of vitamin D deficiency in patients undergoing joint replacement as it is a risk factor for a suboptimal outcome which is relatively simple and cheap to correct.

  20. 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

    , 3, 6, and particularly zone 7, with a gain of 7.5% (95% confidence interval (CI) 2.6 to 12.5) compared with a loss of 14.6% (95% CI 7.6 to 21.6). Resurfacing replacements maintained the BMD of the medial femoral neck and increased that in the lateral zones between 12.8% (95% CI 4.3 to 21.4) and 25.......9% (95% CI 7.1 to 44.6). On the acetabular side, BMD was similar in every zone at each point in time. The mean BMD of all acetabular regions in the resurfaced group was reduced to 96.2% (95% CI 93.7 to 98.6) and for the total hip replacement group to 97.6% (95% CI 93.7 to 101.5) (p = 0.4863). A mean...

  1. 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...

  2. DIFFICULTIeS OF TOTAL HIP REPLACEMENT IN PATIENTS WITH ANKYLOSING SPONDYLITIS (case report

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2016-01-01

    Full Text Available A distinctive feature of patients with ankylosing spondylitis is the formation of hip ankylosis in an extremely unfavorable functional position combined with upset of sagittal balance of the body along with a thoracolumbar kyphosis. Treatment of these patients poses considerable technical difficulties and is often associated with complications. The authors report a clinical case of a female 40 years old patient with confirmed rhizomelic spondylitis. The patient mainly complained of fixed malposition of the right lower extremity (hip ankylosis in extreme 1450 flexion and 1500 abduction combined with a severe fixed spine deformity (thoracic kyphosis 920, lumbar lordosis 170. Considering significant sagittal balance disorder it was decided to go for a two-stage procedure. Total hip arthroplasty of the right joint was performed at the first stage. At the second stage the authors corrected thoracolumbar spinal deformity by Th12 (type PSO 4 and L2 (type PSO 3 wedge resections and converging resected vertebral bodies by a multilevel fixation system with transpedicular support elements. The interval between the stages was 11 months. Two-stage treatment of this patient al-lowed to avoid adverse postoperative complications and to achieve a significant functional improvement in one year after treatment started. The sum of points before and after the treat-ment amounted respectively to 46 and 79 on Harris Hip Score, 17 and 38 points on Oxford Hip Score (OHS. To summarize, comprehensive treatment with planning of all subsequent steps prior to hip replacement is the method of choice for avoidance of postoperative complications in patients with ankylosing spondylitis accompanied by a significant upset of sagittal balance.

  3. A novel locking screw hip stem to achieve immediate stability in total hip arthroplasty: A biomechanical study.

    Science.gov (United States)

    Grechenig, Stephan; Gueorguiev, Boyko; Berner, Arne; Heiss, Peter; Müller, Michael; Nerlich, Michael; Schmitz, Paul

    2015-10-01

    As total hip arthroplasty is now applicable for younger, healthier, and more active patients, bone preservation becomes even more essential, and proximal fixation, resulting in less stress shielding, draws special attention with focus on new strategies and implant designs. Recently, a new type of non-cemented fixation of the femoral component, featured with the locking screw hip (LSH) stem, was developed by Scyon Orthopaedics AG (Au-Waedenswil, Switzerland). The idea to rigidly fix the femoral component of a prosthesis for total hip replacement in this fashion evolved from the very good results achieved with the internal point-contact fixator PC-Fix. The purpose of this study was to investigate the unique characteristics of the LSH-stem and to assess its biomechanical performance in comparison to a conventional cemented prosthesis (Mueller straight stem). Six paired human cadaveric femora were preserved with the method of Thiel, split in two study groups, implanted with either cemented Mueller straight stem or LSH-stem prostheses and biomechanically tested under progressively increasing axial loading until catastrophic failure. Bone mineral density (BMD) of all femora was evaluated in the femoral head prior to implantation. Axial construct stiffness, failure load and cycles to failure were calculated from the machine data and statistically evaluated at a level of significance p = 0.05. No statistically significant difference between the LSH-stem and the Mueller straight stem was found in terms of axial construct stiffness (2031.5 N/mm ± 483.1 N/mm and 2403.6 N/mm ± 705.2 N/mm, p = 0.115), failure load (4958.8 N ± 1094.1 N and 5907.2 N ± 1562.8 N, p = 0.138) and cycles to failure (7917.7 ± 2188.1 and 9814.3 ± 3125.6, p = 0.138). BMD showed no significant difference between the two study groups, p = 0.616. The LSH-stem seems to be stable enough to carry loads experienced during the rehabilitation period of a patient after THR. Its stability, which is similar to

  4. Treatment of postoperative sciatic nerve palsy after total hip arthroplasty for postoperative acetabular fracture: A case report

    Directory of Open Access Journals (Sweden)

    Akio Kanda

    2016-11-01

    Full Text Available Acetabular fracture is usually treated with osteosynthesis. However, in the case of an intra-articular fracture, osteosynthesis can result in arthropathy of the hip joint and poor long-term results, hence, total hip arthroplasty is required. However, in total hip arthroplasty for postoperative acetabular fracture, sciatic nerve palsy tends to develop more commonly than after primary total hip arthroplasty. This is a case report of a 57-year-old Japanese male who had internal skeletal fixation for a left acetabular fracture that had occurred 2 years earlier. One year later, he developed coxarthrosis and severe pain of the hip joint and total hip arthroplasty was performed. After the second surgery, he experienced pain along the distribution of the sciatic nerve and weakness of the muscles innervated by the peroneal nerve, indicating sciatic nerve palsy. We performed a third operation, and divided adhesions around the sciatic nerve. Postoperatively, the anterior hip joint pain and the buttocks pain when the hip was flexed were improved. Abduction of the fifth toe was also improved. However, the footdrop and sensory disturbance were not improved. A year after the third operation, sensory disturbance was slightly improved but the footdrop was not improved. We believe the sciatic nerve palsy developed when we dislocated the hip joint as the sciatic nerve was excessively extended as the hip joint flexed and internally rotated. Sciatic nerve adhesion can occur easily in total hip replacement for postoperative acetabular fracture; hence, adhesiotomy should be conducted before performing hip dislocation to prevent injury caused by nerve tension. The patient agreed that the details of this case could be submitted for publication. The work has been reported in line with the CARE criteria and cite.

  5. Novas superfícies em artroplastia total do quadril New bearing surfaces in total hip replacement

    Directory of Open Access Journals (Sweden)

    Carlos Roberto Schwartsmann

    2012-04-01

    Full Text Available A artroplastia total do quadril tem sido indicada cada vez mais em pacientes mais jovens e ativos, além de haver uma natural e crescente demanda do procedimento em função do aumento da expectativa de vida dos pacientes. Os altos custos da cirurgia e as controvérsias da performance dos implantes fazem deste assunto objeto de constantes pesquisas na busca de novos materiais com melhores resistências ao desgaste e biocompatibilidade. O presente artigo abrange um estudo de revisão das novas superfícies em artroplastia total do quadril.Total hip arthroplasty is being increasingly indicated for younger and more active patients, in addition to a naturally growing demand for the procedure because of increasing life expectancy among patients. The high costs of this surgery and the controversies regarding implant performance have made this topic the subject of constant research, seeking new materials with better resistance to wear and better biocompatibility. The present article provides a review of new surfaces in total hip arthroplasty.

  6. 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.

  7. Combined radiotherapy and indomethacin for the prevention of heterotopic ossification after total hip arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Pakos, Emilios E.; Stafilas, Kosmas S.; Politis, Aggelos N.; Mitsionis, Gregory; Xenakis, Theodore A. [Dept. of Orthopedic Surgery, Univ. Hospital of Ioannina (Greece); Tsekeris, Pericles G. [Dept. of Radiation Therapy, Univ. Hospital of Ioannina (Greece)

    2009-08-15

    Background and Purpose: Heterotopic ossification (HO) is a frequent complication following total hip arthroplasty. The aim of this study was to evaluate the efficacy of combined radiotherapy and indomethacin as compared to indomethacin alone for the prevention of HO after hip arthroplasty. Patients and Methods: 96 patients were prospectively enrolled to receive either a single dose of postoperative radiotherapy of 7.0 Gy and indomethacin for the first 15 postoperative days or indomethacin alone for the same period. A historical group of 50 patients that received indomethacin alone served as control. Primary endpoint was the radiographic evidence of HO at 6 months. Secondary endpoints were the evaluation of factors related to HO development, side effects from each treatment, and group differences in the clinical assessment with the Merle d'Aubigne Score. Results: Four patients in the combined-therapy group developed HO compared to 13 patients in the indomethacin group (p < 0.05) and 13 patients in the historical group (p < 0.05). One patient each in the combined group and the historical group developed Brooker III HO (nonsignificant difference). Duration of surgery and congenital hip disease were associated with HO development in the indomethacin groups, while age and congenital hip disease showed such an association in the combined-therapy group. The side effects and mean Merle d'Aubigne Score did not differ significantly between the three groups. Conclusion: Combined radiotherapy and indomethacin was more efficacious in preventing HO after total hip arthroplasty compared to indomethacin alone and should be considered for future investigation. (orig.)

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

    Science.gov (United States)

    2012-01-01

    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. PMID:23039109

  9. Metal-on-metal total hip arthroplasty: risk factors for pseudotumours and clinical systematic evaluation.

    Science.gov (United States)

    Liow, Ming Han Lincoln; Kwon, Young-Min

    2017-05-01

    The potential advantages of contemporary MoM THA implants include less volumetric wear with subsequent reduction of polyethylene wear-induced osteolysis and greater component stability with use of large-diameter femoral heads. However, there have been concerns regarding significantly elevated revision rates in MoM THA due to MoM-related complications such as adverse local tissue reaction (pseudotumour) formation. The increased failure rate in MoM hip arthroplasty is associated with the generation of biologically active, nanometer sized metal particles from the MoM bearing surfaces and taper junctions, which result in the development of a localized, adverse periprosthetic soft tissue response. The focus of this article is to provide an update on (1) implant, surgical and patient factors associated with adverse local tissue reactions (pseudotumours) and (2) the clinical systematic evaluation and management of patients with MoM hip arthroplasty based on the currently available evidence. There should be a low threshold to conduct a systematic clinical evaluation of patients with MoM hip arthroplasty as early recognition and diagnosis will allow the initiation of prompt and appropriate treatment. As a symptomatic MoM total hip arthroplasty may have intrinsic and extrinsic causes, patients should be evaluated systematically, utilizing risk stratification algorithms. Although specialized laboratory tests such as metal ion levels and cross sectional imaging modalities such as MARS MRI can be used to facilitate clinical decision making, over-reliance on any single investigative tool in the clinical decision-making process should be avoided. Further research is required to obtain a better understanding of implant and patient risk factors associated with tribocorrosion in MoM total hip arthroplasty.

  10. 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.

  11. Routine one-stage exchange for chronic infection after total hip replacement.

    Science.gov (United States)

    Jenny, Jean-Yves; Lengert, Régis; Diesinger, Yann; Gaudias, Jeannot; Boeri, Cyril; Kempf, Jean-François

    2014-12-01

    We hypothesized that a routine one-stage exchange for treatment of chronically infected total hip replacement (THR) will lead to (1) a higher rate of infection recurrence and (2) a poorer hip outcome than the published rates after two-stage exchange. Sixty-five cases have been treated consecutively with one-stage exchange. All patients have been followed for a period of three to six years or until death or infection recurrence. The five-year rate for infection recurrence was 16%. The five-year survival rate for recurrence of the index infection was 8%. Forty-two percent of the hips had a good or excellent PMA score, and 46% a good or excellent OH score. Routine one-stage exchange was not associated with a higher recurrence rate and a poorer hip function than previously published series of two-stage exchange. Therefore, there is little support to choose two-stage exchange as the routine treatment for management of chronically infected THR.

  12. 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.

  13. High medium-term survivorship and durability of Zweymüller-Plus total hip arthroplasty.

    Science.gov (United States)

    Korovessis, Panagiotis; Repantis, Thomas; Zafiropoulos, Andreas

    2011-05-01

    The Zweymüller-Plus system (SL-Plus stem, Bicon-Plus threaded cup) for primary total hip arthroplasty (THA) was introduced in 1993, as a successor of the Alloclassic THA with a few modifications in the conical stem shape and a new biconical threaded cup with a spherical shape. The medium-term performance of this system is not well established. To better understand the potential impact these design changes have had on (1) survivorship, (2) implant stability and (3) periprosthetic osteolysis, we studied patients who underwent THA using the SL-Plus stem and Bicon-Plus. We retrospectively reviewed the cases of 148 patients (153 hips) who underwent Zweymüller-Plus primary THA after an average of 11 years. With revision for aseptic failure of biological fixation as the endpoint, survivorship was 98% for the stem and 100% for the cup. Focal osteolysis was observed in 6.6% of cups and 29% of stems. Four hips (2.6%) were revised because of aseptic failure of the biologic fixation and three hips (1.95%) for deep infection. As much as 146 stems and 149 cups were evaluated to be stable. Zweymüller-Plus THA resulted in high survivorship and durability at 11 years, although the rate of osteolysis around the stem indicated polyethylene wear.

  14. Interobserver and Intraobserver Reliability of Three-Dimensional Preoperative Planning Software in Total Hip Arthroplasty.

    Science.gov (United States)

    Wako, Yasushi; Nakamura, Junichi; Miura, Michiaki; Kawarai, Yuya; Sugano, Masahiko; Nawata, Kento

    2018-02-01

    The purpose of this study is to clarify interobserver and intraobserver reliabilities of the three-dimensional (3D) templating of total hip arthroplasty (THA). We selected preoperative computed tomography from 60 hips in 46 patients (14 men and 32 women) who underwent primary THA. To evaluate interobserver and intraobserver reliability, 6 orthopedic surgeons performed 3D templating twice over a 4-week interval. We investigated intraclass correlation coefficients (ICCs) and percent agreement of component size and alignment, comparing morphological differences in the hip. Reproducibility was also compared between groups with osteoarthritis (OA) and those with osteonecrosis (ON). The interobserver reliabilities for mean cup size and stem size were excellent, with ICC = 0.907 and 0.944, respectively. The value was significantly higher in the ON group than in the OA group. In the OA group, the reliability of cup size and alignment decreased in hips with severe subluxation. Percent agreement of stem size was significantly different between the shapes of femoral canal. For intraobserver reliability, the mean ICC of cup size was 0.965 overall, while the value in the ON group was significantly higher than in the OA group. The mean ICC of stem size was 0.972 overall. Computed tomography-based 3D templating showed excellent reliability for component size and alignment in THA. Deformity of the affected joint influenced the reliability of preoperative planning. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. The effects of the empowerment education program in older adults with total hip replacement surgery.

    Science.gov (United States)

    Huang, Tzu-Ting; Sung, Chia-Chun; Wang, Woan-Shyuan; Wang, Bi-Hwa

    2017-08-01

    To measure the effectiveness of an education empowerment program on primary (self-efficacy and self-care competence) and secondary outcomes (Activities of Daily Life, mobility, depressive mood and quality of life) for older adults with total hip replacement surgery. Degenerative arthritis is a common and serious chronic illness that impacts the quality of life of older adults. As joints continue to degenerate and the hip damaged by arthritis, activities of daily life will be difficult to perform due to severe hip pain and joint stiffness. Therefore, hip replacement surgery should be considered and effective nursing care should be provided to improve the recovery of older adults. A prospective randomized control trial. A trial was conducted from September 2013 - May 2014 in two hospitals in northern Taiwan. 108 participants were random assigned to either the education empowerment group or in the comparison group. The researchers collected baseline data at admission and outcomes on the day of discharge, one month after and three months after the discharge. After the interventions, the education empowerment group participants demonstrated significantly higher self-care competence and self-efficacy and lower depressive inclinations compared with those in the comparison group. Participants in both groups significantly improved on activities of daily life, mobility and quality of life over the course of the interventions. This education empowerment intervention was very effective in enhancing participants' outcomes. Moreover, involving both older adults and their caregivers for the participation this program is recommended for a greater impact. © 2017 John Wiley & Sons Ltd.

  16. 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

    2017-01-01

    OBJECTIVE: To describe a progressive resistance training intervention implemented shortly after total hip arthroplasty, including a detailed description of load progression, pain response and adverse events to the training. DESIGN: Secondary analyses of data from the intervention group...... in a randomized controlled trial. SUBJECTS: This study reports data from the intervention group ( n = 37). INTERVENTIONS: The protocol described supervised progressive resistance training of the operated leg two days/week in addition to home-based exercise five days/week and for 10 weeks. The relative load...... training as described in the present study can be implemented shortly following total hip arthroplasty with substantial load progression and no overall exacerbation of postoperative pain. Some patients may experience a short term pain response. Trial Registration (primary trial): NCT01214954....

  17. What do we know about taper corrosion in total hip arthroplasty?

    Science.gov (United States)

    Jacobs, J J; Cooper, H J; Urban, R M; Wixson, R L; Della Valle, C J

    2014-04-01

    Mechanically assisted crevice corrosion (MACC) at metal/metal modular junctions in which at least one of the components is fabricated from cobalt-chromium alloy, has reemerged as a potential clinically significant complication in total hip arthroplasty. The clinical manifestation of MACC may include the development of an adverse local tissue reaction (ALTR), similar to what has been described in association with metal-on-metal bearing total hip and resurfacing arthroplasty. The clinical presentation of MACC-associated ALTRs may include pain and possibly late recurrent dislocations. Abnormal metal artifact reduction sequence magnetic resonance images and elevated serum metal levels (cobalt elevations out of proportion to chromium elevations) can be helpful in the diagnosis of these MACC-associated ALTRs. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. 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

    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...... with X-ray fluorescence spectroscopy, and information on the reason for revision and complications in relation to surgery was collected from the medical charts whenpossible (72%). For 10 implants, corrosion was further characterized with scanning electron microscopy. Results . We detected cobalt release...... from three of 38 removed femoral heads and from one of 24 femoral stems. Nickel release was detected from one of 24 femoral stems. No chromium(VI) release was detected. Conclusions . We found that cobalt and nickel were released from some failed total hip arthroplasties, and corrosion was frequently...

  19. Cardiac cobaltism: a rare complication after bilateral metal-on-metal total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    John R. Martin, MD

    2015-12-01

    Full Text Available This is one of the first documented cases of metal-on-metal (MoM total hip arthroplasty cobalt cardiac toxicity that has led to patient death. A 69-year-old female presented to our institution with cardiac failure secondary to cobalt toxicity resulting from bilateral MoM total hip arthroplasty. Her presenting metal ion levels were a cobalt level of 199 ppb and a chromium level of 77 ppb. She underwent bilateral femoral revisions to remove the source of cobalt. On postoperative day 7, the patient sustained a cerebral infarct and eventually expired because of the insult. This case represents one of the first documented fatalities related to MoM cobalt cardiac toxicity.

  20. Retroperitoneal hematoma: an unusual cause of pain after total hip arthroplasty.

    Science.gov (United States)

    Pouliot, Michael A; Lee, Kevin B; Goodman, Stuart B

    2009-10-01

    Pain following total hip arthroplasty due to impingement of the iliopsoas is a recognized complication of the procedure with a reported incidence as high as 4.3%. The pain is most often due to direct mechanical irritation of the iliopsoas due to a malpositioned or oversized acetabular cup. Definitive treatment of iliopsoas impingement often requires surgical revision or iliopsoas tenotomy, although many cases remain undiagnosed or are managed conservatively. We present an unusual case of pain after total hip arthroplasty due to a large retroperitoneal hematoma secondary to acetabular cup irritation of the iliopsoas tendon. This case represents a potentially important complication of undiagnosed or conservatively managed iliopsoas impingement, particularly in patients taking anticoagulants or antiplatelet medications.

  1. 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

  2. Quality of life and functionality after total hip arthroplasty: a long-term follow-up study

    Directory of Open Access Journals (Sweden)

    Recano Pasquale

    2011-10-01

    Full Text Available Abstract Background There is a lack of data on the long-term outcome of total hip arthroplasty procedures, as assessed by validated tools. Methods We conducted a follow-up study to evaluate the quality of life and functionality of 250 patients an average of 16 years (range: 11-23 years after total hip arthroplasty using a validated assessment set including the SF-36 questionnaire, Harris Hip Score, WOMAC score, Functional Comorbidity Index, and a study specific questionnaire. Models of multiple stepwise linear and logistic regression analysis were constructed to evaluate the relationships between several explanatory variables and these functional outcomes. Results The SF-36 physical indexes of these patients compared negatively with the normative values but positively with the results obtained in untreated subjects with severe hip osteoarthritis. Similar results were detected for the Harris Hip Score and WOMAC score. There was a 96% rate of post-surgical satisfaction. Hip functionality and comorbidities were the most important determinants of physical measures on the SF-36. Conclusions Patients who had undergone total hip arthroplasty have impaired long-term self-reported physical quality of life and hip functionality but they still perform physically better than untreated patients with advanced hip osteoarthritis. However, the level of post-surgical satisfaction is high.

  3. 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.

  4. Predictors of revision, prosthetic joint infection and mortality following total hip or total knee arthroplasty in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Cordtz, Rene Lindholm; Zobbe, Kristian; Højgaard, Pil

    2017-01-01

    OBJECTIVES: To investigate predictors of 10-year risk of revision and 1-year risk of prosthetic joint infection (PJI) and death following total hip/total knee arthroplasty (THA/TKA) in (1) patients with rheumatoid arthritis (RA) compared with patients with osteoarthritis (OA); and (2) patients.......65-3.40)), PJI (SHR=1.61 (0.70-3.69)) nor death (HR=0.75 (0.24-2.33)) compared with non-treated. Glucocorticoid exposure (HR=2.87 (1.12-7.34)) and increasing DAS28 (HR=1.49 (1.01-2.20)) were risk factors for mortality. CONCLUSION: Patients with RA had a decreased 10-year risk of revision while the risk of death......) and the Danish Hip and Knee Arthroplasty Registers. Survival analyses were used to calculate confounder-adjusted sub-HRs (SHR) and HRs. RESULTS: In total, 3913 patients with RA with THA/TKA were compared with 120 499 patients with OA. Patients with RA had decreased risk of revision (SHR 0.71 (0...

  5. 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.

  6. Metal-on-Metal Total Hip Resurfacing Arthroplasty: An Evidence-Based Analysis.

    Science.gov (United States)

    2006-01-01

    The objective of this review was to assess the safety and effectiveness of metal on metal (MOM) hip resurfacing arthroplasty for young patients compared with that of total hip replacement (THR) in the same population. Total hip replacement has proved to be very effective for late middle-aged and elderly patients with severe degenerative diseases of the hips. As indications for THR began to include younger patients and those with a more active life style, the longevity of the implant became a concern. Evidence suggests that these patients experience relatively higher rates of early implant failure and the need for revision. The Swedish hip registry, for example, has demonstrated a survival rate in excess of 80% at 20 years for those aged over 65 years, whereas this figure was 33% by 16 years in those aged under 55 years. Hip resurfacing arthroplasty is a bone-conserving alternative to THR that restores normal joint biomechanics and load transfer. The technique has been used around the world for more than 10 years, specifically in the United Kingdom and other European countries. Metal-on-metal hip resurfacing arthroplasty is an alternative procedure to conventional THR in younger patients. Hip resurfacing arthroplasty is less invasive than THR and addresses the problem of preserving femoral bone stock at the initial operation. This means that future hip revisions are possible with THR if the initial MOM arthroplasty becomes less effective with time in these younger patients. The procedure involves the removal and replacement of the surface of the femoral head with a hollow metal hemisphere, which fits into a metal acetabular cup. Hip resurfacing arthroplasty is a technically more demanding procedure than is conventional THR. In hip resurfacing, the femoral head is retained, which makes it much more difficult to access the acetabular cup. However, hip resurfacing arthroplasty has several advantages over a conventional THR with a small (28 mm) ball. First, the large

  7. Total dislocation of the hip joint after arthroscopy and ileopsoas tenotomy.

    Science.gov (United States)

    Sansone, Mikael; Ahldén, Mattias; Jónasson, Páll; Swärd, Leif; Eriksson, Thomas; Karlsson, Jon

    2013-02-01

    The hip is a highly stable joint. Non-traumatic dislocation of the hip is extremely uncommon. In this article, we report two cases of non-traumatic hip dislocations following hip arthroscopy. In both cases, capsulotomy and ileopsoas tenotomy had been performed. These cases raise questions about the importance of the natural stabilisers of the hip. Level of evidence V.

  8. Demographics, clinical characteristics and predictive factors for total knee or hip replacement in patients with rheumatoid arthritis in Greece.

    Science.gov (United States)

    Pantos, Panayiotis G; Tzioufas, Athanasios G; Panagiotakos, Demosthenes B; Soucacos, Panayiotis N; Moutsopoulos, Haralampos M

    2013-01-01

    This paper aims to study the prevalence of total knee and hip replacements in Greek patients with rheumatoid arthritis (RA) and to identify possible predictive factors for future total hip or knee replacement. A retrospective medical record review was performed in 750 RA patients who were recruited during 1994 to 2008 in a single Greek medical centre. Of the reviewed patients, 489 with a minimum follow-up duration of 1 year were enrolled in the study. The occurrence of total hip or knee replacement was used as the primary outcome variable in the predictive analysis. Total hip or knee replacement associated with RA was performed in 21 patients (4.3%). Total disease duration was the most significant factor associated with increased likelihood of total joint replacement. Erythrocyte sedimentation rate (ESR) at baseline examination was positively associated with subsequent knee or hip joint replacement (OR=1.023, 95%CI 1.005-1.04). Inadequate response to treatment was associated with a 3.12-times higher likelihood of joint replacement (95%CI, 1.28-7.58). The patients who underwent total hip or knee replacement had significantly higher ESRs and DAS 28 levels (pjoint hip or knee replacement can improve pharmacological treatment to maintain function and prevent destruction of the affected joints. Longer disease duration and inadequate response to treatment after the first year of follow-up increases the likelihood ratio for total joint replacement during the course of disease in Greek RA patients.

  9. 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

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

    Science.gov (United States)

    Chong, Elaine W; Wang, Yuanyuan; Robman, Liubov D; Aung, Khin Zaw; Makeyeva, Galina A; Giles, Graham G; Graves, Stephen; Cicuttini, Flavia M; Guymer, Robyn H

    2015-01-01

    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 neck of femur may be

  11. Prospective evaluation of ground reaction forces in dogs undergoing unilateral total hip replacement.

    Science.gov (United States)

    Budsberg, S C; Chambers, J N; Lue, S L; Foutz, T L; Reece, L

    1996-12-01

    To evaluate clinical and biomechanical gait variables in a group of dogs before and after (for 1 year) total hip replacement. 16 dogs with degenerative joint disease of the coxofemoral joint secondary to hip dysplasia deemed candidates for total hip replacement. Before and at 1, 3, 6, and 12 months after surgery, each dog was trotted over a biomechanical force platform. Vertical force data evaluated for each stance phase of the treated and untreated hind limbs included peak force, impulse, and limb loading and unloading rates. Vertical peak and impulse data were also evaluated for the forelimbs. Measurements analyzed in the craniocaudal axis, divided into braking and propulsion phases, consisted of peak force and associated impulses. Also, orthopedic examination for each dog included subjective scoring for limb lameness at each evaluation period. Most ground reaction forces (GRF) were significantly lower before surgery for the proposed treated, compared with the proposed untreated, limb. This difference between limbs continued through postoperative month 1. Also at 1 month, some treated limb values were significantly lower than preoperative values. By 3 to 6 months, treated limb GRF increased so that no significant difference between limbs could be found. Vertical and craniocaudal propulsion impulse values were significantly higher in the treated than untreated limb from the 6-month evaluation period through the remainder of the study. Braking component of the craniocaudal axes measurements was unchanged throughout the study. GRF indicated that dogs of this study had significantly increased loading function of the treated hind limb by 6 months after unilateral total hip replacement. Data also indicated that some force was transferred from the untreated to treated hip over the study period. Loading rates also increased over the study period, indicating increased willingness to load the treated hip over time. Craniocaudal axis data indicated no improvement in braking

  12. 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.

  13. The role of arthroscopy in the treatment of groin pain after total hip arthroplasty: our experience.

    Science.gov (United States)

    Filanti, Mattia; Carubbi, Chiara; Del Piccolo, Nicolandrea; Rani, Nicola; Mazzotta, Alessandro; Dallari, Dante

    2016-05-14

    The purpose of the study was to present our arthroscopic surgical technique and the results in patient with pain after a hip replacement. Between November 2009 and September 2011, 35 patients with groin pain after total hip arthroplasty (THA) were treated arthroscopically. The patients underwent a preoperative examination consisting in careful history, physical examination, laboratory evaluation, diagnostic evaluation using x-rays and pelvis CT scans. In patients for whom the clinical picture suggested iliopsoas tendonitis, we also performed injection of local anaesthetic on the iliopsoas tendon sheath. All the patients were positioned in the supine decubitus position with traction applied, using 2 arthroscopic portals (AL, MID-A). An extensive debridement of adhesions, periprosthetic tissue and neocapsula were performed; when there were signs of iliopsoas impingement, a transcapsular tenotomy was performed according to Wettstein technique. The average age was 57 (29-77) years old. The average time to onset of symptoms was 10.8 (5-15) months after THA. The average preoperative Harris Hip Score (HHS) was 44.1 (range 32-56). The average preoperative Medical Research Council (MRC) scale for muscle strenght was 3.27 (range 3-4). After 24 months of follow-up patients show an average HHS of 75.73 (range 50-91). Patients who underwent iliopsoas release show a postoperative HHS of 83.28 (range 61-91). The average postoperative MRC scale was 4.45. Hip arthroscopy in treatment of reactive synovitis and adhesions shows good results according to literature. Hip arthroscopy in treatment of anterior iliopsoas impingement is the most useful instrument, being less invasive than the classic open technique.

  14. 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.

  15. Medium-term outcome of titanium uncemented stems in revision total hip arthroplasty.

    Science.gov (United States)

    Murray, Rachel C; Horne, J Geoffrey

    2011-08-01

    To assess the medium-term outcome of titanium uncemented modular tapered stems in revision total hip arthroplasty (THA). A questionnaire was mailed to 421 patients who underwent revision THA using a titanium uncemented modular tapered stem. 66 of whom underwent re-revision THA. The questionnaire was composed to reveal the Charnley classification, the modified 12-item Oxford hip score, and the Devane patient activity level. 323 (77%) of the patients responded. The mean follow-up time was 6.6 years. 12 patients underwent bilateral revision THA. The mean Oxford hip score was 35.7, compared to 35.8 for all-component revision at postoperative month 6 in the New Zealand Joint Registry. The median Oxford hip scores for the subgroups of the stem-only revision (n=92), all-component revision (n=215), and re-revision (n=16) were 38, 39.9, and 30, respectively. The difference was significant between all-component revision and re-revision (adjusted p=0.003), and between stem-only revision and re-revision (adjusted p=0.037). Regarding patient distribution according to the Charnley class and the Devane patient activity level, the difference was significant between the mean Oxford hip scores of Charnley classes B and C (adjusted p=0.017), and between the Devane patient activity levels of Charnley classes A and C (adjusted p=0.043). The medium-term outcome of revision THA using a titanium uncemented modular tapered stem was comparable to that reported for other stems.

  16. Use of Cortical Strut Allograft After Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty.

    Science.gov (United States)

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

    2017-05-01

    Cortical strut allografts restore bone stock and improve postoperative clinical scores after revision total hip arthroplasty (THA). However, use of a cortical strut allograft is implicated in delayed healing of an extended trochanteric osteotomy (ETO). To date, there are no reports directly comparing ETO with or without cortical strut allografts. We reviewed prospectively gathered data on 50 revision THAs performed from 2004-2014 using an ETO. We compared the demographic, radiological, and clinical outcome of patients with (16 hips) and without (34 hips) cortical strut allograft after an ETO. There were no significant differences in Western Ontario McMaster Universities Osteoarthritis Index or Harris Hip Score between the ETOs with and without a cortical strut allograft. Fifteen of the ETOs (94%) with a cortical strut allograft and 31 of the ETOs (91%) without a cortical strut allograft were in situ at final follow-up (P = 1.000). A higher proportion hips with cortical strut allograft (100%, 16 patients) had preoperative Paprosky grade bone loss more than IIIA compared to those without allograft (29%, 10 patients) (P < .001). There were no differences in femoral stem subsidence (P = .207), alignment (P = .934), or migration of the osteotomized fragment (P = .171). Fourteen of the ETOs (88%) in patients with cortical strut allograft united compared to 34 ETOs (100%) in patients without allograft (P = .095). Our study shows that the use of cortical strut allograft during revision THA with ETO does not reduce the rate of union, radiological or clinical outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Bilateral Total Hip Arthroplasty in Femoral Head Avascular Necrosis: Functional Outcomes and Complications

    Directory of Open Access Journals (Sweden)

    Afshin Taheriazam

    2016-06-01

    Full Text Available Total hip arthroplasty (THA is one of the successful and cost-benefit surgical treatments. One-stage bilateral THA (BTHA offers many benefits. However, there are concerns about the safety of the procedure and higher complications. We aimed to evaluate the complications and outcomes of one-stage BTHA with Hardinge approach for femoral head avascular necrosis patients. A total of 60 patients from April 2009 and May 2013, were underwent one-stage bilateral total hip arthroplasty (BTHA in Milad and Erfan hospitals, Tehran, Iran. A prospective analysis of the functional outcomes and complications of one-stage BTHA through Hardinge approach in patients with femoral head avascular necrosis (AVN performed. We evaluated all patients clinically and radiologically with serial follow-ups. A clinical hip score based upon the modified Harris Hip Score (MHHS was performed preoperatively and again postoperatively. During period of study 44 men (73.3% and 16 women (26.6% with a mean age of 31.40±4.08 years (range 25 to 36 years at the time of presentation were entered. The mean surgical time was 2.6±0.38 hrs. The mean hospital stay was 3 .50±0.72 days. Hemoglobin level decreased significa ntly after operation (P= 0.046. There was no reported patient with perioperative death, deep venous thrombosis, pulmonary embolism, infection, dislocation, periprosthetic fracture or heterotrophic ossification. The mean preoperative MHHS score was 47.93±7.33 in patients. MHHS score i mproved to 95.06±3.47 in the last follow-up (P=0.0001.Our results recommend the use of one-stage BTHA through Hardinge approach in femoral head avascular necrosis patients.

  18. 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

  19. Total hip arthroplasty using a posterior minimally invasive approach - results after six years.

    Science.gov (United States)

    Vicente, José Ricardo Negreiros; Miyahara, Helder Souza; Luzo, Carlos Malheiros; Gurgel, Henrique Melo; Croci, Alberto Tesconi

    2015-01-01

    To evaluate the medium-term clinical-functional results (minimum follow-up of six years) from total uncemented hip arthroplasty performed by means of a posterior minimally invasive access, in comparison with the traditional right lateral access. In a comparative prospective study, 224 adult patients underwent elective total hip arthroplasty due to a diagnosis of primary or secondary osteoarthrosis. A group of 103 patients with posterior minimally invasive access was compared with a group of 121 patients with the traditional right lateral access. The mean length of follow-up among the patients of this sample was 7.2 years. We evaluated the clinical-functional and radiographic results and occurrences of loosening, along with any complications that occurred, with a minimum follow-up of six years. The clinical-functional analyses before the surgical procedure and six years afterwards were similar in the two groups (p = 0.88 and p = 0.55). One patient in the minimally invasive group underwent revision of the acetabular component and two patients in the control group underwent the same procedure (p = 0.46). The Trendelenburg clinical test, which showed weakness of the hip abductor musculature, was present in five patients operated using the traditional lateral route and absent in all those who underwent the minimally invasive procedure (p = 0.06). There was no difference regarding the radiographic parameters obtained, either in acetabular or in femoral positioning (p = 0.32 and p = 0.58). The medium-term clinical and radiographic results and the complication rates were similar between the patients who underwent total hip arthroplasty by means of the posterior minimally invasive access and those with the traditional lateral access.

  20. Prospective monitoring improves outcomes of primary total hip replacement: a cohort study

    Directory of Open Access Journals (Sweden)

    Zayed Gamal

    2009-04-01

    Full Text Available Abstract Background Over the past decade several studies have questioned current standards of patient safety in health care delivery. In response, our institution started a clinical pathway for total hip replacement in 1996. Prospective monitoring with regular feedback sessions to the individuals involved in patient care did however not start until 2003. The present study evaluates the effect of prospective monitoring on outcomes of total hip replacement. Methods Clinical records of patients undergoing primary elective total hip replacement between 1997 and 2004 were reviewed. Data on adverse events as well as adherence to protocols for venous thromboembolism prophylaxis were extracted retrospectively for the period 1997 to 2001 and prospectively from 2003 to 2004. Results were compared and analyzed in order to establish possible improvement in outcomes. Data was analyzed with Chi-square or Fisher's Exact test for categorical variables and Student's t-test for continuous variables. Alpha was set as less than 5% and analysis was performed with Stata 9.0 for Macintosh. Results Two-hundred and eighty-three patients were included from 1997 to 2001, and 62 from 2003 to 2004. Mean age, male to female ratio and initial diagnosis were similar in both groups. At least one adverse event occurred in 45% of patients in 1997–2001 and in 21% in 2003–2004 (p Conclusion Overall rate of adverse events as well as in-hospital hip dislocations, oliguria and non-adherence to VTE prophylaxis protocols were significantly reduced during the second period. We conclude that clinical pathways alone are insufficient to improve patient safety and require prospective monitoring and continuous feedback to health care providers in order to achieve the desired effect.

  1. EXPERIMENTAL RESEARCH OF REGENERATIVE FEATURES IN BONE TISSUES AROUND IMPLANTS AFTER ONE-STAGE BILATERAL TOTAL HIP REPLACEMENT

    Directory of Open Access Journals (Sweden)

    V. M. Mashkov

    2012-01-01

    Full Text Available Objective: to research the specific features of regenerative processes of bone tissue around implants after one-stage bilateral total hip replacement in experiment. Material and methods: 27 total hip replacement operations have been performed in 18 rabbits of breed "chinchilla" to which bipolar femoral endoprosthesis made of titanic alloy PT-38, one type-size, with friction pair metal-on-metal and neck-shaft angle 165 degrees have been implanted: total unilateral hip replacement operations have been performed in 9 animals (control group, one-stage bilateral total hip replacement operations have been performed in 9 animals (experimental group. During research they have been on radiological and clinical checking-up. After the experiment the animals had histological tests of the tissues around endoprosthesis components. Results and conclusions: After one-stage bilateral total hip replacement in early terms of research more expressed changes of bone tissue in the form of its thinning and decompaction were found around implants. One-stage bilateral total hip replacement did not essentially influence on the speed of osteogenesis around endoprothesis components in comparison with unilateral total hip replacement, so in late terms of observation in both groups the fixing of endoprothesis components did not differ.

  2. No clinical value of post-operative routine X-ray following uncomplicated cementless primary total hip arthroplasty

    DEFF Research Database (Denmark)

    Christensen, Mikkel; Folkmar, Klaus

    2013-01-01

    There is no consensus among hip surgeons in Denmark on how to follow up patients after total hip arthroplasty (THA). Agreement on the need for radiographic examinations is also lacking. The purpose of this study was to evaluate if routine outpatient post-operative radiographs, obtained three and 12...

  3. Total hip arthroplasty in Jesenice General hospital 1985–2006 – what has been done and look forward

    Directory of Open Access Journals (Sweden)

    Tomaž Silvester

    2007-11-01

    Full Text Available Background: Total arthroplasty is one of the most interesting and fast developing fields in orthopaedic surgery. Practically every joint in the human body is involved, total hip arthroplasties (THA being most frequent and with the longest history. Information on long-term results and survival of different types of prosthesis is invaluable for both patients and surgeons.Patients and methods: Between 1985 and 2006 there were 1563 THAs performed in Jesenice General Hospital. Average age at the time of operation was 67 years, almost two thirds of patients were women. The reason for operation was in 72 % idiopathic arthrosis and in 14 % sequaele of dysplasia.Results: There were 1370 primary procedures and 193 revisions (12.6 %. Aseptic loosening of the implant was the most frequent reason for revision (74 % and infection was observed in 1.5 %. In the first ten years of this research hybrid type of prosthesis was most frequently used, but nowadays, non-cemented prosthesis is used in majority of cases.Conclusions: Total hip arthroplasty is well established procedure at the Jesenice General Hospital. It considerably improves quality of life of the patient, for both, short- and long term, results are very good. New minimal invasive surgical techniques make postoperative rehabilitation faster and easier. The Register of prosthesis enables us to regularly analyze the results and provides treatment outcome information concerning the choice of prosthesis and the optimal surgical technique. Jesenice General Hospital is well recognized as one of the centers for arthroplasties in our country.

  4. A Review of Periprosthetic Femoral Fractures Associated With Total Hip Arthroplasty

    Science.gov (United States)

    Marsland, Daniel; Mears, Simon C.

    2012-01-01

    Periprosthetic fractures of the femur in association with total hip arthroplasty are increasingly common and often difficult to treat. Patients with periprosthetic fractures are typically elderly and frail and have osteoporosis. No clear consensus exists regarding the optimal management strategy because there is limited high-quality research. The Vancouver classification facilitates treatment decisions. In the presence of a stable prosthesis (type-B1 and -C fractures), most authors recommend surgical stabilization of the fracture with plates, strut grafts, or a combination thereof. In up to 20% of apparent Vancouver type-B1 fractures, the femoral stem is loose, which may explain the high failure rates associated with open reduction and internal fixation. Some authors recommend routine opening and dislocation of the hip to perform an intraoperative stem stability test to rule out a loose component. Advances in plating techniques and technology are improving the outcomes for these fractures. For fractures around a loose femoral prosthesis (types B2 and 3), revision using an extensively porous-coated uncemented long stem, with or without additional fracture fixation, appears to offer the most reliable outcome. Cement-in-cement revision using a long-stem prosthesis is feasible in elderly patients with a well-fixed cement mantle. It is essential to treat the osteoporosis to help fracture healing and to prevent further fractures. We provide an overview of the causes, classification, and management of periprosthetic femoral fractures around a total hip arthroplasty based on the current best available evidence. PMID:23569704

  5. [Follow up of total hip prothesis: storage phosphor versus screen-film radiography].

    Science.gov (United States)

    Polet, K; de La Selle, H; Leroux, J; Ludig, T; Girard, F; Coudane, H; Blum, A

    2003-03-01

    Digital radiography may lead to interpretation difficulties in patients with hip prosthesis, especially when initial evaluation was performed using screen film radiography. The purpose of this study was to evaluate inter-observer and inter-technique reproducibility comparing digital and screen-film radiography. Twenty-eight patients with unilateral (n=24) or bilateral (n=4) hip prosthesis (total=32 prostheses) underwent screen-film and digital (storage phosphor) radiography. The bone-cement and metal-cement interfaces were evaluated for the presence of a lucent line in 14 different sectors reclassified into 3 regions. This evaluation was performed by two independent readers. Inter-observer and inter-technique reproducibility were calculated using kappa values. The inter-observer reproducibility was negligible, poor or average with Kappa values ranging from 0.07 to 0.47. The degree of agreement between the two methods was poor, average or good for both observers with Kappa values ranging from 0.10 to 0.66. Although inter-technique agreement is not high, it is better than inter-observer agreement. Therefore, storage phosphor technique should not be rejected for total hip prosthesis follow-up, even though previous films were screen-film radiographs.

  6. The trainer, the trainee and the surgeons' assistant: clinical outcomes following total hip replacement.

    Science.gov (United States)

    Palan, J; Gulati, A; Andrew, J G; Murray, D W; Beard, D J

    2009-07-01

    Balancing service provision and surgical training is a challenging issue that affects all healthcare systems. A multicentre prospective study of 1501 total hip replacements was undertaken to investigate whether there is an association between surgical outcome and the grade of the operating surgeon, and whether there is any difference in outcome if surgeons' assistants assist with the operation, rather than orthopaedic trainees. The primary outcome measure was the change in the Oxford hip score (OHS) at five years. Secondary outcomes included the rate of revision and dislocation, operating time, and length of hospital stay. There was no significant difference in DeltaOHS or complication rates between operations undertaken by trainers and trainees, or those at which surgeons' assistants and trainees were the assistant. However, there was a significant difference in the duration of surgery, with a mean reduction of 28 minutes in those in which a surgeons' assistant was the assistant. This study provides evidence that total hip replacements can be performed safely and effectively by appropriately trained surgeons in training, and that there are potential benefits of using surgeons' assistants in orthopaedic surgery.

  7. One-year incidence of prosthetic joint infection in total hip arthroplasty

    DEFF Research Database (Denmark)

    Gundtoft, P H; Pedersen, A B; Schønheyder, Henrik C.

    2017-01-01

    . The most common micro-organisms identified in the 271 PJI were Staphylococcus aureus (36%) and coagulase-negative staphylococci (CoNS) (33%); others commonly identified included Enterobacteriaceae, enterococci, and streptococci. Antimicrobial resistance to beta-lactams and gentamicin did not change during......OBJECTIVE: To examine the trend of Prosthetic Joint Infections (PJI) following primary total hip arthroplasty (THA) and the antimicrobial resistance of the bacteria causing these infections. MATERIALS AND METHODS: We identified a population-based cohort of patients in the Danish Hip Arthroplasty...... the study period. CONCLUSION: The risk of PJI within 1-year after primary THA and the antimicrobial resistance of the most prevalent bacteria remained unchanged during the 2005-2014 study period....

  8. Hydroxyapatite coating does not improve uncemented stem survival after total hip arthroplasty!

    DEFF Research Database (Denmark)

    Hailer, Nils P; Lazarinis, Stergios; Mäkelä, Keijo T

    2015-01-01

    Background and purpose - It is still being debated whether HA coating of uncemented stems used in total hip arthroplasty (THA) improves implant survival. We therefore investigated different uncemented stem brands, with and without HA coating, regarding early and long-term survival. Patients...... and methods - We identified 152,410 THA procedures using uncemented stems that were performed between 1995 and 2011 and registered in the Nordic Arthroplasty Register Association (NARA) database. We excluded 19,446 procedures that used stem brands less than 500 times in each country, procedures performed due...... to diagnoses other than osteoarthritis or pediatric hip disease, and procedures with missing information on the type of coating. 22 stem brands remained (which were used in 116,069 procedures) for analysis of revision of any component. 79,192 procedures from Denmark, Norway, and Sweden were analyzed...

  9. Occlusion of the common femoral artery by cement after total hip arthroplasty: a case report

    Directory of Open Access Journals (Sweden)

    Reilingh Mikel L

    2009-10-01

    Full Text Available Abstract Introduction The incidence of vascular injuries after total hip arthroplasty is extremely low. In this report we describe an unusual injury to the common femoral artery. Case presentation A 59-year-old Caucasian woman presented with rest pain, numbness and cramps in the operated limb after hip replacement. Cement leakage under the transverse ligament had caused occlusion of the common femoral artery necessitating vascular reconstruction. She had a good functional recovery at follow-up. Conclusion To the best of our knowledge, this is the first well-documented case reporting this pathomechanism of vascular lesion to the femoral artery. This case report highlights the potential risk of such a limb-threatening complication, and awareness should lead to prevention by meticulous surgical technique (correct technique of pressurization or to early detection of the lesion.

  10. Cervical Myelopathy Doubles the Rate of Dislocation and Fracture After Total Hip Arthroplasty.

    Science.gov (United States)

    Blizzard, Daniel J; Klement, Mitchell R; Penrose, Colin T; Sheets, Charles Z; Bolognesi, Michael P; Seyler, Thorsten M

    2016-09-01

    Cervical spondylotic myelopathy (CSM) is a common and underdiagnosed cause of gait dysfunction, rigidity, and falls in the elderly. Given the frequent concurrency of CSM and hip osteoarthritis, this study is designed to evaluate the relative risk of CSM on perioperative and short-term outcomes after total hip arthroplasty (THA). The Medicare Standard Analytical Files were searched from 2005 to 2012 to identify all patients undergoing primary THA and the subset of patients with preexisting CSM. Risk ratios with 95% confidence intervals were calculated for 90-day, 1-year, and overall follow-up for common postoperative complications: periprosthetic dislocation, fracture, infection, revision THA, and wound complications. The risk ratios of all surgical complications, including dislocation, periprosthetic fractures, and prosthetic joint infection, were increased approximately 2-fold at all postoperative time points for patients. Preexisting CSM is a significant risk factor for primary THA complications including dislocation, periprosthetic fractures, and prosthetic joint infection. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. The impingement-dislocation risk of total hip replacement: effects of cup orientation and patient maneuvers.

    Science.gov (United States)

    Ghaffari, M; Nickmanesh, R; Tamannaee, N; Farahmand, F

    2012-01-01

    Hip dislocation is one of the most frequent complications after total hip arthroplasty. Impingement and dislocation might be caused due to misalignment of the acetabular cup during surgery, or performing dislocation-prone activities afterwards. A finite element model was developed to predict the impingement and dislocation behavior of the prosthetic joint, for different combinations of cup orientation and patient maneuver. Four dislocation-prone activities of daily life and 25 cup orientations were analyzed to determine how close they are to the impingement and subsequent dislocation events. The angular margin results obtained indicated that the sit-to-stand and standing while bending at the waist are prone to dislocation, in particular when the cup anteversion angle is small.

  12. 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).

  13. Responsiveness and ceiling effects of the Forgotten Joint Score-12 following total hip arthroplasty.

    Science.gov (United States)

    Hamilton, D F; Giesinger, J M; MacDonald, D J; Simpson, A H R W; Howie, C R; Giesinger, K

    2016-03-01

    To assess the responsiveness and ceiling/floor effects of the Forgotten Joint Score -12 and to compare these with that of the more widely used Oxford Hip Score (OHS) in patients six and 12 months after primary total hip arthroplasty. We prospectively collected data at six and 12 months following total hip arthroplasty from 193 patients undergoing surgery at a single centre. Ceiling effects are outlined with frequencies for patients obtaining the lowest or highest possible score. Change over time from six months to 12 months post-surgery is reported as effect size (Cohen's d). The mean OHS improved from 40.3 (sd 7.9) at six months to 41.9 (sd 7.2) at 12 months. The mean FJS-12 improved from 56.8 (sd 30.1) at six months to 62.1 (sd 29.0) at 12 months. At six months, 15.5% of patients reached the best possible score (48 points) on the OHS and 8.3% obtained the best score (100 points) on the FJS-12. At 12 months, this percentage increased to 20.8% for the OHS and to 10.4% for the FJS-12. In terms of the effect size (Cohen's d), the change was d = 0.10 for the OHS and d = 0.17 for the FJS-12. The FJS-12 is more responsive to change between six and 12 months following total hip arthroplasty than is the OHS, with the measured ceiling effect for the OHS twice that of the FJS-12. The difference in effect size of change results in substantial differences in required sample size if aiming to detect change between these two time points. This has important implications for powering clinical trials with patient-reported measures as the primary outcome.Cite this article: Dr D. F. Hamilton. Responsiveness and ceiling effects of the Forgotten Joint Score-12 following total hip arthroplasty. Bone Joint Res 2016;5:87-91. DOI: 10.1302/2046-3758.53.2000480. © 2016 Hamilton et al.

  14. Monocular Vision- and IMU-Based System for Prosthesis Pose Estimation During Total Hip Replacement Surgery.

    Science.gov (United States)

    Su, Shaojie; Zhou, Yixin; Wang, Zhihua; Chen, Hong

    2017-06-01

    The average age of population increases worldwide, so does the number of total hip replacement surgeries. Total hip replacement, however, often involves a risk of dislocation and prosthetic impingement. To minimize the risk after surgery, we propose an instrumented hip prosthesis that estimates the relative pose between prostheses intraoperatively and ensures the placement of prostheses within a safe zone. We create a model of the hip prosthesis as a ball and socket joint, which has four degrees of freedom (DOFs), including 3-DOF rotation and 1-DOF translation. We mount a camera and an inertial measurement unit (IMU) inside the hollow ball, or "femoral head prosthesis," while printing customized patterns on the internal surface of the socket, or "acetabular cup." Since the sensors were rigidly fixed to the femoral head prosthesis, measuring its motions poses a sensor ego-motion estimation problem. By matching feature points in images of the reference patterns, we propose a monocular vision based method with a relative error of less than 7% in the 3-DOF rotation and 8% in the 1-DOF translation. Further, to reduce system power consumption, we apply the IMU with its data fused by an extended Kalman filter to replace the camera in the 3-DOF rotation estimation, which yields a less than 4.8% relative error and a 21.6% decrease in power consumption. Experimental results show that the best approach to prosthesis pose estimation is a combination of monocular vision-based translation estimation and IMU-based rotation estimation, and we have verified the feasibility and validity of this system in prosthesis pose estimation.

  15. Incidence of perioperative complications in total hip and knee arthroplasty in patients with Parkinson disease.

    Science.gov (United States)

    Sharma, Tankamani; Hönle, Wolfgang; Handschu, René; Adler, Werner; Goyal, Tarun; Schuh, Alexander

    2018-02-15

    The aim of this study is to evaluate the difference in perioperative complication rate in total hip, bipolar hemiarthroplasties and total knee arthroplasty in patients with Parkinson disease in trauma and elective surgery in our Musculoskeletal Center during a period of 10 years. Between 2006 and 2016, 45 bipolar hemiarthroplasties in trauma surgery, 15 total knee and 19 total hip arthroplasties in patients with Parkinson's disease were performed. We divided the patients in two groups. Group I included trauma cases (45) and group II elective surgery cases (34). Complications were documented and divided into local minor and major complications and general minor and major complications. Fisher's exact test was used for statistical evaluation. In both groups, there was one local major complication (p > 0.05): In group I, there was one case of loosening of a K-wire which was removed operatively. In group II, there was one severe intraarticular bleeding requiring puncture of the hematoma. In group I, there were 38 general complications; in group II, there were 17 general complications. There was no statistical difference in complication rate (p > 0.05). Total hip arthroplasty, bipolar hemiarthroplasties and knee arthroplasty in patients with Parkinson disease is possible in elective and trauma surgery. Complication rate is higher in comparison with patients not suffering from Parkinson disease, but there is no difference in complication rate in elective and trauma surgery. Nevertheless, early perioperative neurological consultation in patients with Parkinson disease is recommended to minimize complications and improve early outcomes after arthroplasty.

  16. [Surgical technique and early clinical outcomes of direct anterior approach to total hip arthroplasty].

    Science.gov (United States)

    Lv, M; Zhang, J Q; Wang, X S; Huang, Y; Li, W; Zhang, C Y

    2017-04-18

    To describe the surgical technique of direct anterior approach to total hip arthroplasty and to report the early clinical outcomes. A series of 100 consecutive, unselected patients who had 116 primary total hip arthroplasty surgeries (16 bilateral) done through direct anterior approach from March 11 2015 to June 21 2016 was reviewed. There were 50 male patients and 50 female patients. The average patient age was 51 years, and the average body mass index was 24.69 kg/m2. The preoperative diagnosis included avascular necrosis of femoral head, hip osteoarthritis, osteoarthritis secondary to acetabular dysplasia, sequelae of hip old infection, ankylosing spondylitis, rheumatoid arthritis and avascular necrosis of femoral head after cannulated screws fixation of femoral neck fracture. There were 7 hips which had surgical history prior to the index hip arthroplasty, including 3 cases with bone graft treatment for avascular necrosis of femoral head through Smith-Peterson approach, 2 cases with acetabular shelf procedures for acetabular dysplasia through Smith-Peterson approach, and 2 cases with cannulated screws fixation for femoral neck fracture (internal fixation residual). All were uncemented hips. The stems used in this study included 67 Triloc stems (DePuy company, USA), 45 Corail stems (DePuy company, USA), 2 Accolade stems (Stryker company, USA), 1 Synergy stem (Smith-Nephew company, USA) and 1 Polarstem (Smith-Nephew company, USA). The average follow up period was 8.5 months, the average incision scar length was 10 cm, and the average postoperative Harris score was 93.62. There was 95% postoperative leg length discrepancy within 3 mm. The average cup inclination angle was 38.7° with 94.8% in the range of 30° to 50°. The average cup anteversion angle was 14.3° with 94.2% within the target range of 5° to 25°.The were 15 (12.9%) operative complications, including two femoral perforations (changing stem from Triloc to Corail), three calcar fractures (treated

  17. Causes for revision surgery in total hip replacement. A retrospective epidemiological analysis.

    Science.gov (United States)

    Capón-García, D; López-Pardo, A; Alves-Pérez, M T

    2016-01-01

    To determine the impact of each cause of revision surgery in total hip arthroplasty during the period 2009-2013. To analyse the relationship between these causes with different variables. A study was conducted on 127 patients who had hip replacement revision surgery in our hospital during this period. Parameters, such as age, sex, date of primary arthroplasty, prosthetic replacement date, and main cause of the revision were recorded. Those revisions performed within 5 years after the primary arthroplasty were considered as early rescue. The most common cause of rescue was aseptic loosening in 38 (30%) followed by instability in 30 (24%). In terms of age at the time of rescue, statistically significant differences were found, with it being significantly higher in patients re-operated for a fracture. Differences in age at first surgery were found to be 7 years younger than those with late rescue (63.40) with respect to early (70.21). Similar results to ours have been observed in other published series, except for the higher incidence of instability in early rescue. This study demonstrates aseptic loosening and instability as the most frequent causes of revision surgery in our hospital. Age is a very influential factor in relation to longevity of primary arthroplasty. Complications were higher in when the primary hip replacement is implanted in older patients. Copyright © 2016 SECOT. Published by Elsevier Espana. All rights reserved.

  18. 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.

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

    Science.gov (United States)

    Man, Zhentao; Sha, Dan; Sun, Shui; Li, Tao; Li, Bin; Yang, Guang; Zhang, Laibo; Wu, Changshun; Jiang, Peng; Han, Xiaojuan; Li, Wei

    2016-01-01

    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.

  20. Long Term Outcomes of Total Hip Arthroplasty in Young Patients under 30

    Directory of Open Access Journals (Sweden)

    Emilios Pakos

    2014-09-01

    Full Text Available Background:  We aimed to report outcomes of total hip arthroplasty (THA in very young patients under the year of 30.   Methods:  Thirty patients (45 hips with various indications for THA were retrospectively reviewed radiologically and clinically and analyzed regarding survival, reasons of failure, factors associated with outcomes and postoperative complications.   Results:  Within a mean follow-up time of 116 months the 10-year survival rate was 90.3%. All hips were revised due to aseptic loosening. No association was found among the tested parameters with increased revision rates.Three complications associated with the THA were recorded and managed conservatively. All patients had statistically significant improved clinical scores compared to the pre-operative period, despite the underlying disorder that compromised the condition in the majority of the patients. Conclusions:  Our study showed excellent long term outcomes of THA in patients younger than 30 years of age, comparable with those in older patients.

  1. Preoperative Joint Space Width Predicts Patient-Reported Outcomes After Total Hip Arthroplasty in Young Patients.

    Science.gov (United States)

    Stambough, Jeffrey B; Xiong, Ao; Baca, Geneva R; Wu, Ningying; Callaghan, John J; Clohisy, John C

    2016-02-01

    In a new health care economy, there is an emerging need to understand and quantify predictors of total hip arthroplasty (THA) outcomes. We investigated the association between preoperative radiographic disease (as measured quantitatively by joint space width [JSW]) and patient-reported function, activity, pain, and quality of life after THA. We retrospectively analyzed 146 patients (146 hips) 55 years or younger with a diagnosis of osteoarthritis who underwent cementless THA between January 2009 and December 2010. Preoperative pelvic radiographs were measured by 1 author blinded to clinical outcomes to establish JSW, defined as the shortest distance between the femoral head margin and the superolateral weight-bearing portion of the acetabulum. The JSW value was treated as a continuous variable when applied to statistical modeling. The relationship between the JSW and the improvement of clinical outcome was examined via a general linear modeling approach with adjustments for patients' age, body mass index, and sex. We identified an inverse relationship between preoperative JSW and improvements in functional, activity, pain, and quality of life. We found that, as JSW decreased by 1 mm, the outcome measure improvements were modified Harris Hip Score of 6.3 (pjoint space have less predictable improvement in terms of function, pain relief, and activity. These findings suggest that THA in young patients with a JSW less than 1.5 to 2 mm provides more predictable improvements in pain and functional outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Acute Stress Fracture of the Pelvis after Total Hip Arthroplasty: A Case Report.

    Science.gov (United States)

    Akinbo, Oluwaseun; Tyagi, Vineet

    2017-01-01

    Acute hip pain following total hip arthroplasty (THA) could have numerous causes to include stress fracture of the pelvis. Stress fractures of the pelvis are rare and have been reported to involve the medial wall and the pubic ramus. A unique case is presented demonstrating the clinical presentation and management of an acute stress fracture of ilium and anterior column following a THA. A 72-year-old man underwent an uncomplicated right THA. He was noted to have femoral head resorption and thin osteoporotic bone intraoperatively. He initially did well postoperatively and ambulating without pain or assistive devices. Within 1 month of surgery, he returned with acute right hip pain without any traumatic event. Radiographs showed migration of the acetabular component and computed tomography scan confirmed a fracture through the ilium. The patient underwent revision surgery, where the fracture was reduced and internal fixation was achieved with a reconstruction plate and acetabular cage construct. At 9 months postoperatively, the patient remained pain-free with full weight bearing and with stable radiographs. Elderly patients who undergo THA may have low bone mineral density. These patients can develop stress fractures in their pelvis after surgery. These fractures may involve the medial wall, posterior column, or posterior wall. In patients who develop atraumatic pain postoperatively, it is important to consider for potential stress fractures of the ilium and evaluate appropriately with imaging. In these cases, revision surgery can be necessary to provide fixation of the stress fracture.

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

    Science.gov (United States)

    Man, Zhentao; Sha, Dan; Sun, Shui; Li, Tao; Li, Bin; Yang, Guang; Wu, Changshun; Jiang, Peng

    2016-01-01

    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. PMID:27493968

  4. 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). Copyright © 2015. Published by Elsevier Inc.

  5. A case report of severely damaged hip joint caused by SAPHO syndrome treated with 2-stage total hip arthroplasty.

    Science.gov (United States)

    Yeo, Ingwon; Cha, Hoon-Suk; Yoon, Young Cheol; Park, Youn-Soo; Lim, Seung-Jae

    2016-07-01

    Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is an increasingly recognized entity. The hip joint is known as a less frequently affected site in SAPHO syndrome, and there has been limited reports about hip joint diseases caused by SAPHO syndrome, and as such adequate treatment for this disease spectrum is still not fully elucidated. We describe the case of a 52-year-old man admitted for SAPHO syndrome who went on to be diagnosed with advanced secondary hip arthritis associated with disabling right hip pain. The diagnosis of SAPHO syndrome was delayed; the patient was given a clinical diagnosis of osteomyelitis and treated with prolonged courses of antibiotics and open surgical debridement at previous tertiary health facility. The patient underwent 2-stage joint replacement surgery in our hospital. At 1 year after the surgery, he is well, with minimal right hip pain and the prosthesis is functioning well. This case shows the safety and effectiveness of the 2-stage joint replacement in treating destructive hip disease caused by SAPHO syndrome mimicking infectious arthritis.

  6. Femoral Nerve Palsy Following Total Hip Arthroplasty: Incidence and Course of Recovery.

    Science.gov (United States)

    Fleischman, Andrew N; Rothman, Richard H; Parvizi, Javad

    2017-11-04

    Femoral nerve palsy (FNP) is a relatively uncommon complication following total hip arthroplasty (THA). There is little recent literature regarding the incidence of FNP and the natural course of recovery. Using our institutional database, we identified postoperative FNPs from 17,350 consecutive primary THAs performed from 2011 to 2016. Hip exposures were performed using a direct lateral (modified Hardinge), direct anterior (Smith-Peterson), anterolateral (Watson-Jones), or posterolateral (Southern or Moore) approach. Patients with FNP were contacted to provide a subjective assessment of convalescence and underwent objective muscle testing to determine the extent of motor recovery. The overall incidence of FNP was 0.21% after THA, with the incidence 14.8-fold higher in patients undergoing anterior hip surgery using either a direct anterior (0.40%) or anterolateral (0.64%) approach. Significant recovery from FNP did not commence for a majority of patients until greater than 6 months postoperatively. Motor weakness had resolved in 75% of patients at 33.3 months, with remaining patients suffering from mild residual weakness that typically did not necessitate an assistive walking device or a knee brace. Nearly all patients had improved sensory manifestations, but such symptoms had completely resolved in less than 20% of patients. FNP after hip surgery remains relatively uncommon, but may increase with a growing interest in anterior THA exposures. A near complete recovery with only mild motor deficits can be expected for a majority of patients in less than 2 years, although sensory symptoms may persist. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2017-05-01

    There is risk of junction failure when using modular femoral stems for revision total hip arthroplasty (THA), especially with loss of bone stock in the proximal femur. Using a cortical strut allograft may provide additional support of a modular femoral construct in revision THA. We reviewed prospectively gathered clinical and radiographic data for 28 revision THAs performed from 2004 to 2014 using cementless modular femoral components with cortical strut allograft applied to supplement proximal femoral bone loss: 5 (18%) were fluted taper designs and 23 (82%) were porous cylindrical designs All the patients had a Paprosky grade IIIA or greater femoral defect. The mean follow-up was 5.4 ± 3.9 years. The Harris Hip Scores improved from 26 ± 10 points preoperatively to 71 ± 10 points at final follow-up (P < .001). The Western Ontario McMaster Universities Osteoarthritis Index scores improved from 45 ± 12 points preoperatively to 76 ± 12 points at final follow-up (P < .001). Eighty-nine percent (25 hips) of all revision or conversion THAs were in place at final follow-up. Three (11%) patients underwent reoperations, 2 for infection and 1 for periprosthetic fracture. There was no statistical significant change in femoral component alignment (P = .161) at final follow-up. Mean subsidence was 1.8 ± 1.3 mm at final follow-up. Femoral diameter increased from initial postoperative imaging to final follow-up imaging by a mean of 9.1 ± 5.1 mm (P < .001) and cortical width increased by a mean of 4.5 ± 2.2 mm (P < .001). Twenty-seven hips (96%) achieved union between the cortical strut allograft and the host femur. The use of a modular femoral stem in a compromised femur with a supplementary cortical strut allgraft is safe and provides satisfactory clinical and radiological outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. 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

  9. Time-based analysis of total cost of patient episodes: a case study of hip replacement.

    Science.gov (United States)

    Peltokorpi, Antti; Kujala, Jaakko

    2006-01-01

    Healthcare in the public and private sectors is facing increasing pressure to become more cost-effective. Time-based competition and work-in-progress have been used successfully to measure and improve the efficiency of industrial manufacturing. Seeks to address this issue. Presents a framework for time based management of the total cost of a patient episode and apply it to the six sigma DMAIC-process development approach. The framework is used to analyse hip replacement patient episodes in Päijät-Häme Hospital District in Finland, which has a catchment area of 210,000 inhabitants and performs an average of 230 hip replacements per year. The work-in-progress concept is applicable to healthcare--notably that the DMAIC-process development approach can be used to analyse the total cost of patient episodes. Concludes that a framework, which combines the patient-in-process and the DMAIC development approach, can be used not only to analyse the total cost of patient episode but also to improve patient process efficiency. Presents a framework that combines patient-in-process and DMAIC-process development approaches, which can be used to analyse the total cost of a patient episode in order to improve patient process efficiency.

  10. Increased use of an expensive, elective procedure: total hip replacements in the 1980s.

    Science.gov (United States)

    Friedman, B; Elixhauser, A

    1993-07-01

    Between 1980 and 1987, the number of hospital discharges with total hip replacement (THR) increased by more than 90%, while total hospital discharges fell by more than 10%. Total hip replacement is one of the most costly hospital inpatient procedures, both per case and in total Medicare expenses. Explanations for the growth in use of THR may clarify some of the major forces driving national health care costs. This study assumes that treatment choices are made by (or for) each patient to maximize expected net benefits. Within this framework, the use of THR might have increased because of improved safety for the procedure, longer life expectancy and better control of many serious illnesses that led to increased demand for quality-enhancing procedures, and increased out-of-pocket cost for alternative treatments that are not covered well by insurance. These possible explanations imply changes in the characteristics of THR recipients over time. An upward shift was found in the age distribution of patients, more than simply because of an aging of the population. Sharply increased proportions of patients were also found with serious comorbidities such as cancer and dementia. The safety of the procedure seems to have improved, in terms of the death rate in the hospital. The results suggest that demands for expensive, elective procedures have been increasing for patients previously regarded as too old or impaired to benefit sufficiently. This process leads to continuing increases in real health care expenses even without the invention of new technologies.

  11. Long-Term Outcome after Rehabilitation of Bilateral Total Hip Arthroplasty in Renal Transplant Recipient – A Case Report

    Directory of Open Access Journals (Sweden)

    Erieta Nikolikj Dimitrova

    2016-02-01

    CONCLUSION: Rehabilitation is integral part of multidisciplinary treatment of renal transplant recipient after total hip arthroplasty. Regular exercise training of these patients is very important for improving of their long-term outcome.

  12. Comparison of femoral neck fracture healing and affected limb pain after anterolateral-approach minimally invasive total hip replacement and hemiarthroplasty

    Directory of Open Access Journals (Sweden)

    Xiao-Dong Cao

    2017-04-01

    Full Text Available Objective: To study the differences in femoral neck fracture healing and affected limb pain after anterolateral-approach minimally invasive total hip replacement and hemiarthroplasty. Methods: A total of 92 patients with femoral neck fracture who received hip replacement in our hospital between May 2013 and December 2015 were selected and randomly divided into total hip and half hip group, total hip group received anterolateral-approach minimally invasive total hip replacement, half hip group received anterolateral-approach minimally invasive hemiarthroplasty, and 1 month after operation, serum was collected to detect the levels of bone metabolism markers, osteocyte cytokines, SP and CGRP. Results: 1 month after operation, serum PINP, PICP, BMP, TGF-β, FGF, IGF-I and IGF-II levels of total hip group were significantly higher than those of half hip group while TRAP5b and CatK levels were significantly lower than those of half hip group; the day after operation, serum pain media SP and CGRP levels were not significantly different between the two groups of patients; 36 h after operation, serum SP and CGRP levels of total hip group were significantly lower than those of half hip group. Conclusion: The bone metabolism after anterolateral-approach minimally invasive total hip replacement is better than that after hemiarthroplasty, and the degree of pain is less than that after hemiarthroplasty.

  13. Serious renal and urological complications in fast-track primary total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Bjerregaard, Lars S; Jørgensen, 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...

  14. 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.

  15. Preoperative optimisation of anaemia for primary total hip arthroplasty: a systematic review.

    Science.gov (United States)

    Alexander, Dinesh P; Frew, Nicholas

    2017-11-21

    The 2009 NHS Blood and Transplant national comparative audit on blood use following primary total hip arthroplasty (THR) highlighted that preoperative anaemia was common and undertreated. They recommended that hospitals have a written policy for treating anaemia preoperatively. In our centre, we found that preoperative optimisation of anaemia, significantly reduced blood transfusion rate to optimisation of anaemia. The main barrier to wider implementation remains the cost effectiveness. We recommend using our validated protocol, which has shown to significantly reduce transfusion rates, length of stay and remain cost effective.

  16. Feasibility of day-case total hip arthroplasty: a single-centre observational study.

    Science.gov (United States)

    Larsen, Jens Rolighed; Skovgaard, Birgitte; Prynø, Thomas; Bendikas, Laimonas; Mikkelsen, Lone R; Laursen, Malene; Høybye, Mette T; Mikkelsen, Søren; Jørgensen, Lene Bastrup

    2017-02-21

    Recent reports indicate that total hip arthroplasty (THA) can be further accelerated and might be managed as day-case. This could provide benefits to health care expenditure, lower patient risks and change patient satisfaction. We evaluated the feasibility, efficacy, safety and patient satisfaction of same-day (study. THA was managed as day-case (case THA. Safety, complications and overall patient acceptance were satisfactory. Light spinal anaesthesia facilitated quick transit through postanaesthesia care unit to early mobilisation. Support persons and patient education may play a part in high patient acceptance of day-case surgery.

  17. Automatic Tools for Diagnosis Support of Total Hip Replacement Follow-up

    Directory of Open Access Journals (Sweden)

    SULTANA, A.

    2011-11-01

    Full Text Available Total hip replacement is a common procedure in today orthopedics, with high rate of long-term success. Failure prevention is based on a regular follow-up aimed at checking the prosthesis fit and state by means of visual inspection of radiographic images. It is our purpose to provide automatic means for aiding medical personnel in this task. Therefore we have constructed tools for automatic identification of the component parts of the radiograph, followed by analysis of interactions between the bone and the prosthesis. The results form a set of parameters with obvious interest in medical diagnosis.

  18. Association between fixation technique and revision risk in total hip arthroplasty patients younger than 55 years of age. Results from the Nordic Arthroplasty Register Association

    DEFF Research Database (Denmark)

    Pedersen, A B; Mehnert, F; Havelin, L I

    2014-01-01

    Objectives: To evaluate implant survival following primary total hip replacement (THR) in younger patients. To describe the diversity in use of cup-stem implant combinations. Design: 29,558 primary THRs osteoarthritis (OA) patients younger than 55 years of age performed from 1995 through 2011 were...... to Norway, Sweden and Finland. Conclusions: Uncemented implants perform better in relation to long-term risk of aseptic loosening, whereas both uncemented and hybrid rather than cemented implants in patients younger than 55 years had more short-term revisions because problems due to dislocation...

  19. A novel hybrid total variation minimization algorithm for compressed sensing

    Science.gov (United States)

    Li, Hongyu; Wang, Yong; Liang, Dong; Ying, Leslie

    2017-05-01

    Compressed sensing (CS) is a technology to acquire and reconstruct sparse signals below the Nyquist rate. For images, total variation of the signal is usually minimized to promote sparseness of the image in gradient. However, similar to all L1-minimization algorithms, total variation has the issue of penalizing large gradient, thus causing large errors on image edges. Many non-convex penalties have been proposed to address the issue of L1 minimization. For example, homotopic L0 minimization algorithms have shown success in reconstructing images from magnetic resonance imaging (MRI). Homotopic L0 minimization may suffer from local minimum which may not be sufficiently robust when the signal is not strictly sparse or the measurements are contaminated by noise. In this paper, we propose a hybrid total variation minimization algorithm to integrate the benefits of both L1 and homotopic L0 minimization algorithms for image recovery from reduced measurements. The algorithm minimizes the conventional total variation when the gradient is small, and minimizes the L0 of gradient when the gradient is large. The transition between L1 and L0 of the gradients is determined by an auto-adaptive threshold. The proposed algorithm has the benefits of L1 minimization being robust to noise/approximation errors, and also the benefits of L0 minimization requiring fewer measurements for recovery. Experimental results using MRI data are presented to demonstrate the proposed hybrid total variation minimization algorithm yields improved image quality over other existing methods in terms of the reconstruction accuracy.

  20. 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.

  1. Thermally induced strains and total shrinkage of the polymethyl-methacrylate cement in simplified models of total hip arthroplasty.

    Science.gov (United States)

    Griza, Sandro; Ueki, Marcelo M; Souza, Dárcio H G; Cervieri, André; Strohaecker, Telmo R

    2013-02-01

    An evaluation of transient and stabilized strains in the cement mantle during polymerization was carried out in simplified cemented total hip arthroplasty (THA) model. A mathematical approach combined with a simple finite element simulation was used to compare measured and calculated stabilized strain values and to provide the Von Mises stresses at the stem/cement interface due to shrinkage related to temperature decrease after exothermal reaction. A second similar model was carried out to measure stem/cement/mold interfacial shear strength and dimensional changes of the cement mantle to obtain total shrinkage due to temperature decrease plus cement polymerization. The results indicated that positive strain peaks found during the exothermic stage of polymerization have the potential to produce pre-loading cracking. After the initial expansion, it was observed a progressive strain decrease pattern down to stabilized values that takes place near 2h after the cementation. Even though there is a great deal of dispersion in the measured stabilized strain values, in average those values match quite well with the numerical simulations, indicating 4,7 MPa von Mises interfacial stress due to thermal shrinkage. The total cement shrinkage leads to a negative radial stress of 11 MPa and 14 MPa von Mises interfacial stress. Finally, total shrinkage has the potential to enhance gaps in the cement/mold interface. Copyright © 2012 Elsevier Ltd. All rights reserved.

  2. Selective sequential separation of ABS/HIPS and PVC from automobile and electronic waste shredder residue by hybrid nano-Fe/Ca/CaO assisted ozonisation process.

    Science.gov (United States)

    Mallampati, Srinivasa Reddy; Lee, Byoung Ho; Mitoma, Yoshiharu; Simion, Cristian

    2017-02-01

    The separation of plastics containing brominated flame retardants (BFR) like (acrylonitrile-butadiene-styrene (ABS), high-impact polystyrene (HIPS), and polyvinyl chloride (PVC)) from automobile and electronic waste shredder residue (ASR/ESR) are a major concern for thermal recycling. In laboratory scale tests using a hybrid nano-Fe/Ca/CaO assisted ozonation treatment has been found to selectively hydrophilize the surface of ABS/HIPS and PVC plastics, enhancing ABS wettability and thereby promoting its separation from ASR/ESR by means of froth flotation. The water contact angles, of ABS/HIPS and PVC decreased, about 18.7°, 18.3°, and 17.9° in ASR and about 21.2°, 20.7°, and 20.0° in ESR respectively. SEM-EDS, FT-IR, and XPS analyses demonstrated a marked decrease in [Cl] and a significant increase in the number of hydrophilic groups, such as CO, CO, and (CO)O, on the PVC or ABS surface. Under froth flotation conditions at 50rpm, about 99.1% of combined fraction of ABS/HIPS in ASR samples and 99.6% of ABS/HIPS in ESR samples were separated as settled fraction. After separation, the purity of the recovered combined ABS/HIPS fraction was 96.5% and 97.6% in ASR and ESR samples respectively. Furthermore, at 150rpm a 100% PVC separation in the settled fraction, with 98% and 99% purity in ASR and ESR plastics, respectively. Total recovery of non-ABS/HIPS and PVC plastics reached nearly 100% in the floating fraction. Further, this process improved the quality of recycled ASR/ESR plastics by removing surface contaminants or impurities. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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

  4. Effect of tranexamic acid administration on bleeding in primary total hip arthroplasty.

    Science.gov (United States)

    Fernández-Cortiñas, A B; Quintáns-Vázquez, J M; Gómez-Suárez, F; Murillo, O Simón; Sánchez-López, B R; Pena-Gracía, J M

    To study the efficacy of tranexamic acid to decrease perioperative bleeding in patients who have undergone a total hip arthroplasty operation and to evaluate drug safety. Observational, prospective, controlled and randomized study on the efficacy of tranexamic acid as a method to reduce bleeding in primary hip replacement surgery. We included 134 patients operated during 2014 in our centre, who were divided into 2 groups according to whether or not they had received tranexamic acid. The main study variables were haemoglobin and haematocrit levels, the amount of blood collected from the post-operative drain in the first 12, 24 and 48hours and transfusion requirements. Post-operative haemoglobin and haematocrit levels were statistically higher (P<.001) in the group with treatment. During the first 48hours bleeding values from the group that did not receive TAX were higher compared to patients treated with tranexamic acid. Statistically significant differences (P=.001) were found as to the need for transfusion according to group, more transfusions were performed in the cohort that had not received tranexamic acid: 25.37% compared to 4.48% for the group with tranexamic acid. No adverse events related to administration of tranexamic acid were recorded. Administration of tranexamic acid has proved to be an effective and safe method to reduce peri-operative bleeding in patients who underwent total hip arthroplasty and avoids allogenic blood transfusion. Therefore, tranexamic acid treatment could entail a financial saving for the healthcare system and expose the patient to less risk. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Metal-on-Metal Total Hip Arthroplasty: Quality of Online Patient Information.

    Science.gov (United States)

    Crozier-Shaw, Geoff; Queally, Joseph M; Quinlan, John F

    2017-03-01

    Metal-on-metal total hip arthroplasty (THA) has generated much attention in the media because of early failure of certain implant systems. This study assessed the quality, accuracy, and readability of online information on metal-on-metal THA. The search terms "metal-on-metal hip replacement" and "metal hip replacement" were entered into the 3 most popular search engines. Information quality was assessed with the DISCERN score and a specific metal-on-metal THA content score. Accuracy of information was assessed with a customized score. Readability of the websites was assessed with the Flesch-Kincaid grade level score. A total of 61 unique websites were assessed. For 56% of websites, the target audience was patients. Media or medicolegal sources accounted for 44% of websites. As assessed by DISCERN (range, 16-80) and metal-on-metal THA (range, 0-25) scores, quality of the websites was moderate at best (47.1 and 9.6, respectively). Accuracy (range, 0-8) of the information presented also was moderate, with a mean score of 6.6. Media and medicolegal websites had the lowest scores for both quality and accuracy, despite making up the greatest proportion of sites assessed. Only 1 website (2%) had a Flesch-Kincaid grade level at or less than the recommended level of 8th grade. This study found that online information on metal-on-metal THA was of poor quality, often was inaccurate, and was presented at an inappropriately high reading level, particularly for media and medicolegal websites. Health care providers should counsel patients on the quality of information available and recommend appropriate online resources. [Orthopedics. 2017; 40(2):e262-e268.]. Copyright 2016, SLACK Incorporated.

  6. Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study

    NARCIS (Netherlands)

    P.T.P.W. Burgers (Paul); M. Hoogendoorn (Martine); E.A.C. Van Woensel; R.W. Poolman (Rudolf); M. Bhandari (Mohit); P. Patka (Peter); E.M.M. van Lieshout (Esther)

    2016-01-01

    textabstractSummary: The aim of this study was to determine the total medical costs for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The mean total costs per patient at 2 years of follow-up were €26,399. These results contribute to cost

  7. Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study

    OpenAIRE

    Burgers, Paul; Hoogendoorn, Martine; Van Woensel, E.A.C.; Poolman, Rudolf; Bhandari, Mohit; Patka, Peter; Lieshout, Esther

    2016-01-01

    Summary The aim of this study was to determine the total medical costs for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The mean total costs per patient at 2?years of follow-up were ?26,399. These results contribute to cost awareness. Introduction The absolute number of hip fractures is rising and increases the already significant burden on society. The aim of this study was to determine the mean total medical costs per patient for tr...

  8. A post-marketing assessment of major bleeding in total hip and total knee replacement surgery patients receiving rivaroxaban.

    Science.gov (United States)

    Kwong, Louis M; Turpie, Alexander G G; Tamayo, Sally; Peacock, W Frank; Yuan, Zhong; Sicignano, Nicholas; Hopf, Kathleen Pillsbury; Patel, Manesh R

    2017-09-01

    Rivaroxaban is a novel oral anticoagulant indicated for prophylaxis against deep vein thrombosis and pulmonary embolism in patients undergoing total hip replacement (THR) or total knee replacement (TKR) surgery. To evaluate major bleeding (MB) in THR/TKR patients receiving post-operative rivaroxaban. Electronic medical records of nearly 10 million US Department of Defense (DoD) beneficiaries were queried from 1 January 2013 through 30 June 2015. Using the validated Cunningham case-finding algorithm, post-surgical MB events in rivaroxaban users were identified and analyzed. The incidence of MB was determined, and descriptive statistics were used to compare patient characteristics and other covariates in those with and without MB. Two additional methods were used to explore and identify bleeding cases that were not considered MB events per the study case-finding algorithm. A total of 12,429 patients received THR and/or TKR surgery, and were post-operatively prescribed rivaroxaban. Nine patients had MB, yielding an incidence proportion of 0.07% (95% CI 0.02-0.13). The alternative case-finding methods found bleeding incidences of 0.46% and 0.21%, though it is not clear whether these are clinical MB cases, since the alternative methods were not validated. The incidence of MB in this retrospective analysis is lower than that observed in the clinical trials of rivaroxaban. Whether this is due to lower real-world MB rates or challenges with case-finding algorithms is unclear.

  9. Measurement and restoration of equality in length of the lower limbs in total hip replacement.

    Science.gov (United States)

    Hoikka, V; Paavilainen, T; Lindholm, T S; Turula, K B; Ylikoski, M

    1987-01-01

    Alteration of the length of the lower limb was measured in 39 patients undergoing total hip replacement. Radiographs were taken in the erect posture prior to operation and 6 months postoperatively. The inequality of limb length was measured by the difference between the height of the vertices of the femoral heads and by the difference between the lowest points of the ischial tuberosities. The change of the length was measured intraoperatively as the difference observed between two reference points: one above the acetabulum and the other on the proximal femur. Good correlation was obtained between the change of the limb length made intraoperatively and the change in the limb length using the ischial tuberosities as reference points; no correlation was observed when the vertices of the femoral heads were the reference points. Inequality of limb length can be radiologically determined before and after total hip arthroplasty. Femoral and prosthetic heads are not good reference points for measurement. The difference in the height of the ischial tuberosities demonstrates inequality of limb functional length as it reflects the tilting of the pelvis.

  10. Cobalt toxicity after revision total hip replacement due to fracture of a ceramic head.

    Science.gov (United States)

    Pelayo-de Tomás, J M; Novoa-Parra, C; Gómez-Barbero, P

    Symptomatic cobalt toxicity from a failed total hip replacement is a rare, but devastating complication. Potential clinical findings include cardiomyopathy, hypothyroidism, skin rash, visual and hearing impairment, polycythaemia, weakness, fatigue, cognitive impairment, and neuropathy. The case is presented of a 74year-old man in whom, after a ceramic-ceramic replacement and two episodes of prosthetic dislocation, it was decided to replace it with a polyethylene-metal total hip arthroplasty (THA). At 6months after the revision he developed symptoms of cobalt toxicity, confirmed by analytical determination (serum cobalt level=651.2μg/L). After removal of the prosthesis, the levels of chromium and cobalt in blood and urine returned to normal, with the patient currently being asymptomatic. It is recommended to use a new ceramic on ceramic bearing at revision, in order to minimise the risk of wear-related cobalt toxicity following breakage of ceramic components. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Development of computer-tailored education program for patients with total hip replacement.

    Science.gov (United States)

    Jeong, Yeo Won; Kim, Jung A

    2014-10-01

    The purpose of this study was to develop a Web-based computer-tailored education program to promote self-care for patients with total hip replacement. The program was developed in five phases. Phase 1: Program content was developed, including the educational needs of patients with total hip replacement, based on a review of previous research and literature. Phase 2: A computer-tailored algorithm written as a series of 'if-then' statements was developed to offer the appropriate type of intervention based on an individual's personal health characteristics. Phase 3: A professional Web programmer produced then the program for use on the Web. Phase 4: An expert evaluation was performed focusing on two aspects, Web contents and website design. SPSS ver. 16.0 was used for the analysis, and grade point averages were used to compare each evaluation item. Phase 5: Based on comments from the experts' evaluation, modifications and revisions were made, and the program was completed. The developed program presented tailored messages using animations, video and flash considering the individual health status and characteristics of the primary target generation. In addition, the expert evaluation confirmed the validity of the program's content and design.

  12. Microscale wear behavior and crosslinking of PEG-like coatings for total hip replacements.

    Science.gov (United States)

    Kane, Sheryl R; Ashby, Paul D; Pruitt, Lisa A

    2010-04-01

    The predominant cause of late-state failure of total hip replacements is wear-mediated osteolysis caused by wear particles that originate from the ultrahigh molecular weight polyethylene (UHMWPE) acetabular cup surface. One strategy for reducing wear particle formation from UHMWPE is to modify the surface with a hydrophilic coating to increase lubrication from synovial fluid. This study focuses on the wear behavior of hydrophilic coatings similar to poly(ethylene glycol) (PEG). The coatings were produced by plasma-polymerizing tetraglyme on UHMWPE in a chamber heated to 40 degrees C or 50 degrees C. Both temperatures yielded coatings with PEG-like chemistry and increased hydrophilicity relative to uncoated UHMWPE; however, the 40 degrees C coatings were significantly more resistant to damage induced by atomic force microscopy nanoscratching. The 40 degrees C coatings exhibited only one damage mode (delamination) and often showed no signs of damage after repeated scratching. In contrast, the 50 degrees C coatings exhibited three damage modes (roughening, thinning, and delamination), and always showed visible signs of damage after no more than two scratches. The greater wear resistance of the 40 degrees C coatings could not be explained by coating chemistry or hydrophilicity, but it corresponded to an approximately 26-32% greater degree of crosslinking relative to the 50 degrees C surfaces, suggesting that crosslinking should be a significant design consideration for hydrophilic coatings used for total hip replacements and other wear-dependent applications.

  13. Measurement and restoration of equality in length of the lower limbs in total hip replacement

    Energy Technology Data Exchange (ETDEWEB)

    Hoikka, V.; Paavilainen, T.; Lindholm, T.S.; Turula, K.B.; Ylikoski, M.

    1987-08-01

    Alteration of the length of the lower limb was measured in 39 patients undergoing total hip replacement. Radiographs were taken in the erect posture prior to operation and 6 months postoperatively. The inequality of limb length was measured by the difference between the height of the vertices of the fermoral heads and by the difference between the lowest points of the ischial tuberosities. The change of the length was measured intraoperatively as the difference observed between two reference points: One above the acetabulum and the other on the proximal femur. Good correlation was obtained between the change of the limb length made intraoperatively and the change in the limb length using the ischial tuberosities as reference points; no correlation was observed when the vertices of the femoral heads were the reference points. Inequality of limb length can be radiologically determined before and after total hip arthroplasty. Femoral and prosthetic heads are not good reference points for measurement. The difference in the height of ischial tuberosities demonstrates inequality of limb functional length as it reflects the tilting of the pelvis.

  14. Coxofemoral arthroscopy and total hip arthroplasty for management of intermediate grade fibrosarcoma in a dog.

    Science.gov (United States)

    Scherrer, William; Holsworth, Ian; Goossens, Marielle; Schulz, Kurt

    2005-01-01

    To report the use of arthroscopy and total hip arthroplasty (THA) for management of intermediate grade fibrosarcoma of the femoral head in a dog. Clinical case report. A 6-year-old spayed female Rottweiler presented for evaluation of acute-onset of lameness of the right pelvic limb of approximately 10 days duration. Coxofemoral arthroscopy was performed to obtain fine needle aspiration and Jamshidi biopsy of a lytic lesion of the femoral head. A cemented THA was performed removing as much of the femoral neck and proximal femur as possible while not compromising implant or joint stability. Histologic evaluation of specimens from the femoral head and neck remnants confirmed an intermediate grade fibrosarcoma. Fifteen months after THA, subjectively there was normal use of the right limb with only limited decrease in range of motion and mild muscular atrophy. Radiographs demonstrated stationary positioning of the THA implants. Arthroscopy of the coxofemoral joint is an effective diagnostic tool for evaluation of disease of the articular structures and canine total hip replacement may be an appropriate means of limb salvage in rare cases of disease of the femoral head. This case provides support for the use of coxofemoral arthroscopy as a diagnostic tool as well as an aid in acquiring representative intraarticular tissue samples. Additionally, the case presented demonstrates the potential use of THA as a limb sparing technique in cases of disease affecting the femoral head of dogs.

  15. Risk factors for revision of primary total hip arthroplasty: a systematic review

    Directory of Open Access Journals (Sweden)

    Prokopetz Julian JZ

    2012-12-01

    Full Text Available Abstract Background Numerous papers have been published examining risk factors for revision of primary total hip arthroplasty (THA, but there have been no comprehensive systematic literature reviews that summarize the most recent findings across a broad range of potential predictors. Methods We performed a PubMed search for papers published between January, 2000 and November, 2010 that provided data on risk factors for revision of primary THA. We collected data on revision for any reason, as well as on revision for aseptic loosening, infection, or dislocation. For each risk factor that was examined in at least three papers, we summarize the number and direction of statistically significant associations reported. Results Eighty-six papers were included in our review. Factors found to be associated with revision included younger age, greater comorbidity, a diagnosis of avascular necrosis (AVN as compared to osteoarthritis (OA, low surgeon volume, and larger femoral head size. Male sex was associated with revision due to aseptic loosening and infection. Longer operating time was associated with revision due to infection. Smaller femoral head size was associated with revision due to dislocation. Conclusions This systematic review of literature published between 2000 and 2010 identified a range of demographic, clinical, surgical, implant, and provider variables associated with the risk of revision following primary THA. These findings can inform discussions between surgeons and patients relating to the risks and benefits of undergoing total hip arthroplasty.

  16. Patient-Reported Outcomes After Revision of Metal-on-Metal Total Bearings in Total Hip Arthroplasty.

    Science.gov (United States)

    Mata-Fink, Ana; Philipson, Daniel J; Keeney, Benjamin J; Ramkumar, Dipak B; Moschetti, Wayne E; Tomek, Ivan M

    2017-04-01

    Failure of metal-on-metal (MOM) total hip arthroplasty (THA) bearings is often accompanied by an aggressive local reaction associated with destruction of bone, muscle, and other soft tissues around the hip. Little is known about whether patient-reported physical and mental function following revision THA in MOM patients is compromised by this soft tissue damage, and whether revision of MOM THA is comparable with revision of hard-on-soft bearings such as metal-on-polyethylene (MOP). We identified 75 first-time MOM THA revisions and compared them with 104 first-time MOP revisions. Using prospective patient-reported measures via the Veterans RAND-12, we compared Physical Component Score and Mental Component Score function at preoperative baseline and postoperative follow-up between revision MOM THA and revision MOP THA. Physical Component Score did not vary between the groups preoperatively and at 1 month, 3 months, and 1 year postoperatively. Mental Component Score preoperatively and 1 and 3 months postoperatively were lower in patients in the MOM cohort compared with patients with MOP revisions (baseline: 43.7 vs 51.3, P MOM THA patients does not differ significantly from the outcomes of revised MOP THA. Mental function is markedly lower in MOM patients at baseline and early in the postoperative period, but does not differ from MOP patients at 1 year after revision. This information should be useful to surgeons and physicians facing MOM THA revision. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. 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

    Directory of Open Access Journals (Sweden)

    Jensen Carsten

    2013-01-01

    Full Text Available Abstract Background The age- and gender-specific incidence of total hip replacement surgery has increased over the last two decades in all age groups. Recent studies indicate that non-surgical interventions are effective in reducing pain and disability, even at later stages of the disease when joint 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, blinded, parallel-group multi-center trial (2 sites, with balanced randomization [1:1]. Patients with hip osteoarthritis and an indication for hip replacement surgery, aged 40 years and above, will be consecutively recruited and randomized into two treatment groups. The active treatment group 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-point for assessing the effectiveness of the intervention is 12 months after baseline. However, follow-ups will also be performed once a year for at least 5 years. The primary outcome measure is the time to hip replacement surgery measured on a Kaplain-Meier survival curve from time of inclusion. Secondary outcome measures are the five subscales of the Hip disability and Osteoarthritis Outcome Score, physical activity level (UCLA activity score, and patient’s global perceived effect. Other measures include pain after exercise, joint-specific adverse events, exercise adherence, general health status (EQ-5D-5L, mechanical muscle strength and performance in physical tests. A cost-effectiveness analysis will also be performed. Discussion To our knowledge, this is the first

  18. HFE C282Y homozygosity is associated with an increased risk of total hip replacement for osteoarthritis.

    Science.gov (United States)

    Wang, Yuanyuan; Gurrin, Lyle C; Wluka, Anita E; Bertalli, Nadine A; Osborne, Nicholas J; Delatycki, Martin B; Giles, Graham G; English, Dallas R; Hopper, John L; Simpson, Julie A; Graves, Stephen; Allen, Katrina J; Cicuttini, Flavia M

    2012-06-01

    The evidence for an association between mutations in the HFE (hemochromatosis) gene and the risk of hip or knee osteoarthritis is inconsistent. Total joint replacement is considered a surrogate measure for symptomatic end-stage osteoarthritis. We examined the relationship between HFE gene mutations and risk of total hip and knee replacement using a prospective cohort study. The Melbourne Collaborative Cohort Study recruited participants between 1990 and 1994. Participants born in Australia, New Zealand, the United Kingdom, or Ireland (n = 27,848) were genotyped for the HFE C282Y mutation. Total hip and knee replacements for osteoarthritis during 2001 to 2009 were ascertained from the Australian Orthopaedic Association National Joint Replacement Registry. Hazard ratios (HR)/odds ratios (OR) and confidence intervals (CI) were obtained from Cox regression or logistic regression. Compared with those with no C282Y mutation, C282Y homozygotes had an increased risk of single total hip replacement (HR 1.94, 95% CI 1.04-3.62) and bilateral total hip replacement (OR 5.86, 95% CI 2.36-14.57) for osteoarthritis, adjusting for age, sex, body mass index, and educational level. Only 3 C282Y homozygotes had single total knee replacement; the HR was 0.51 (95% CI 0.16-1.57). C282Y/H63D compound heterozygosity was not related to the risk of total hip or knee replacement. HFE C282Y homozygosity was associated with an increased risk of both single and bilateral total hip replacement for osteoarthritis. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

  19. Heavy reading in heavy metal : Unraveling the mystery of hip tissue in metal on metal total hip arthroplasty

    NARCIS (Netherlands)

    Boomsma, M.F.

    2017-01-01

    In this thesis, we investigated the use of computer tomography (CT) for the screening of patients with a metal-on-metal (MoM) hip prosthesis in two patient cohorts. With a self-established CT grading scale, we have shown that CT is a reliable method for the diagnosis of postoperative pathological

  20. 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

    Background: The age- and gender-specific incidence of total hip replacement surgery has increased over the last two decades in all age groups. Recent studies indicate that non-surgical interventions are effective in reducing pain and disability, even at later stages of the disease when joint...... 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...

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

    Directory of Open Access Journals (Sweden)

    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

  2. Nerve injuries in total hip arthroplasty with a mini invasive anterior approach.

    Science.gov (United States)

    Macheras, George A; Christofilopoulos, Panayiotis; Lepetsos, Panagiotis; Leonidou, Andreas O; Anastasopoulos, Panagiotis P; Galanakos, Spyridon P

    2016-07-25

    Minimal invasive techniques in total hip arthroplasty (THA) have become increasingly popular during recent years. Despite much debate over the outcome of several minimal invasive techniques, complications arising from the use of anterior minimally invasive surgery (AMIS) for THA on a traction table are not well documented. Our study aims to focus on nerve damage during the AMIS procedure and the possible explanations of these injuries. We reviewed all primary THAs performed with the AMIS technique using a traction table, over 5 years and recorded all intraoperative and postoperative complications up to the latest follow-up. We focused on nerve injuries and nerve function impairment following the aforementioned technique. Our study included 1,512 THAs performed with the AMIS technique in 2 major hip reconstruction centres (KAT General Hospital, Athens, Greece and University Hospital of Geneva, Switzerland), on 1,238 patients (985 women, 253 men; mean age 65.24 years). Mean follow-up was 29.4 months. We observed 51 cases of transient lateral femoral cutaneous nerve neuropraxia (3.37%), 4 cases of femoral nerve paralysis (3 permanent, 1 transient [0.26%]) and 1 case of permanent sciatic nerve paralysis (0.06%). No case of obturator or pudendal nerve injury was noticed. Mean age of these cases was 68.97 years. Sciatic and femoral nerve injuries were confirmed by electromyography, showing axonotmesis of the damaged nerve. Neurological injuries are a rare but distinct complication of THAs using the AMIS technique. Possible explanations for such referred nerve injuries are direct nerve injury, extreme traction, hyperextension, extreme external rotation of the leg, use of retractors and coexisting spinal deformities. Controlled use of traction in hip extension, cautious use of retractors and potential use of dynamometers may be useful, so that neurological damage can be avoided. Further studies are needed to fully elucidate the role of the above factors in AMIS

  3. The evaluation of two references for restoring proximal femoral anatomy during total hip arthroplasty.

    Science.gov (United States)

    Unnanuntana, Aasis; Toogood, Paul; Hart, Daniel; Cooperman, Daniel; Grant, Richard E

    2010-04-01

    The morphologic features of the proximal femur are used in preoperative planning prior to total hip arthroplasty (THA). In this study we evaluated two references that have been widely used during THA to restore the normal anatomy of the proximal femur: (1) the distance from the lesser trochanter to the center of femoral head and (2) the anatomic relationship between the greater trochanter and the center of femoral head. We used digital photographs to compare 200 cadaveric femora in individuals who died prior to 40 years of age. Preoperative measurement of the distance from lesser trochanter to the center of femoral head from the contralateral hip is accurate to predict the measurement on the operated hip with correlation coefficients (r(2)) of 0.87. The ratio between femoral head diameter and distance from the lesser trochanter to the center of femoral head was consistent and reliable between genders and sides with an average value of 1.01 +/- 0.12. Thus, when the distance from the lesser trochanter to the center of femoral head is not discernible, this ratio can be used as a guide to determine proximal femoral geometry. Conversely, only 59% of the specimens had femoral head centers within 5 mm of the tip of greater trochanter. The correlation between sides of the relationship between the greater trochanter and the center of femoral head was moderate (r(2) = 0.46). Therefore, this relationship should not be used as the sole method to determine the normal anatomy of proximal femur. 2010 Wiley-Liss, Inc.

  4. Dual mobility cups: an effective prosthesis in revision total hip arthroplasties for preventing dislocations.

    Science.gov (United States)

    Jauregui, Julio J; Pierce, Todd P; Elmallah, Randa K; Cherian, Jeffrey J; Delanois, Ronald E; Mont, Michael A

    2016-01-01

    Postoperative dislocation is one of the most common complications following total hip arthroplasty (THA), and dual mobility articulations have been designed to provide greater hip stability. However, there are few studies that have assessed outcomes of these designs in revision THAs. Our purpose was to evaluate differences in dislocation rates, aseptic survivorship, and patient outcomes between dual mobility articulations and conventional arthroplasties in the revision setting. Patients who underwent revision THA with dual mobility articulations (n = 60) were matched (1:2) to patients who had conventional single articulation prostheses (n = 120). They were matched for body mass index, age, gender, and Paprosky acetabular defect classification, and were followed up for a mean of 30 months (range, 18 to 52 months). The outcomes were evaluated preoperatively and at final follow-up using Harris Hip Scores, the University of California Los Angeles activity scale, and the Short Form-36 questionnaires. The dual mobility group had lower dislocation (1.7% (1 out of 60) versus 5.8% (7 out of 120)) and aseptic loosening rates (1.7% (1 out of 60) versus 4.2% (5 out of 120)) compared to the control group. There were no significant differences in functional outcomes, activity level, or overall physical and mental health status between the 2 cohorts. When used in the revision setting, dual mobility bearings had fewer dislocations. We believe that these designs may lead to clinically significant improvements in complications while also improving patient reported and functional outcomes, but larger cohort studies are necessary for evaluation.

  5. Tribology and total hip joint replacement: current concepts in mechanical simulation.

    Science.gov (United States)

    Affatato, S; Spinelli, M; Zavalloni, M; Mazzega-Fabbro, C; Viceconti, M

    2008-12-01

    Interest in the rheology and effects of interacting surfaces is as ancient as man. This subject can be represented by a recently coined word: tribology. This term is derived from the Greek word "tribos" and means the "science of rubbing". Friction, lubrication, and wear mechanism in the common English language means the precise field of interest of tribology. Wear of total hip prosthesis is a significant clinical problem that involves, nowadays, a too high a number of patients. In order to acquire further knowledge on the tribological phenomena that involve hip prosthesis wear tests are conducted on employed materials to extend lifetime of orthopaedic implants. The most basic type of test device is the material wear machine, however, a more advanced one may more accurately reproduce some of the in vivo conditions. Typically, these apparatus are called simulators, and, while there is no absolute definition of a joint simulator, its description as a mechanical rig used to test a joint replacement, under conditions approximating those occurring in the human body, is acceptable. Simulator tests, moreover, can be used to conduct accelerated protocols that replicate/simulate particularly extreme conditions, thus establishing the limits of performance for the material. Simulators vary in their level of sophistication and the international literature reveals many interpretations of the design of machines used for joint replacement testing. This paper aims to review the current state of the art of the hip joint simulators worldwide. This is specified through a schematic overview by describing, in particular, constructive solutions adopted to reproduce in vivo conditions. An exhaustive commentary on the evolution and actually existing simulation standards is proposed by the authors. The need of a shared protocol among research laboratories all over the world could lead to a consensus conference.

  6. OPTIMAL IMPROVEMENT IN FUNCTION AFTER TOTAL HIP AND KNEE REPLACEMENT: HOW DEEP DO YOU KNOW YOUR PATIENT’S MIND?

    Science.gov (United States)

    De Caro, M F; Vicenti, G; Abate, A; Picca, G; Leoncini, V; Lomuscio, M; Casalino, A; Solarino, G; Moretti, B

    2015-01-01

    Osteoarthritis (OA) of the hip and knee causes pain and loss of joint mobility, leading to limitations in physical function. When conservative treatment fails total hip and knee replacement is a cost-effective surgical option. Patients have high expectations regarding functional outcome after these procedures. If such expectations are not met, they may still be dissatisfied with the outcome of a technically successful procedure. Recently, numerous studies reported that psychological factors can influence the outcome of total knee replacement (tkr) and total hip artrhoplasty with total hip replacement (thr). We conducted a prospective study on a consecutive sample of 280 patients affected by hip or knee OA who underwent total joint replacement. At patients’ admission, Harris Hip Score (HHS) and Knee Society Score (KSS) were used to assess pain and function. Furthermore, SF-36, Mini-Mental Status Examination (MMSE), Symptom Checklist-90-R (SCL-90-R), Coping Orientation to Problems Experienced (BRIEF-COPE) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) were administered. Patients had clinical and radio graphical follow up at 1, 3 and 6 months post-operatively. The HHS and KSS values before surgery showed a linear correlation with both SCL-90-R and MMSE. None of the investigated variables influenced post-operative HHS and KSS scores; however, the improvement of functional scores resulted conditioned by SCL-90-R values, VAS score, schooling and MMSE. Psychological factors and mental status in primary total hip and knee replacement can affect outcome and patient satisfaction. Strategies focused on identification and facing of these conditions must be considered to improve outcome of total replacement.

  7. Comprehensive Operative Note Templates for Primary and Revision Total Hip and Knee Arthroplasty.

    Science.gov (United States)

    Electricwala, Ali J; Amanatullah, Derek F; Narkbunnam, Rapeepat I; Huddleston, James I; Maloney, William J; Goodman, Stuart B

    2016-01-01

    Adequate preoperative planning is the first and most crucial step in the successful completion of a revision total joint arthroplasty. The purpose of this study was to evaluate the availability, adequacy and accuracy of operative notes of primary surgeries in patients requiring subsequent revision and to construct comprehensive templates of minimum necessary information required in the operative notes to further simplify re-operations, if they should become necessary. The operative notes of 144 patients (80 revision THA's and 64 revision TKA's) who underwent revision total joint arthroplasty at Stanford Hospital and Clinics in the year 2013 were reviewed. We assessed the availability of operative notes and implant stickers prior to revision total joint arthroplasty. The availability of implant details within the operative notes was assessed against the available surgical stickers for adequacy and accuracy. Statistical comparisons were made using the Fischer-exact test and a P-value of less than 0.05 was considered statistically significant. The primary operative note was available in 68 of 144 revisions (47%), 39 of 80 revision THAs (49%) and 29 of 66 revision TKAs (44%, p = 0.619). Primary implant stickers were available in 46 of 144 revisions (32%), 26 of 80 revision THAs (32%) and 20 of 66 revision TKAs (30%, p = 0.859). Utilizing the operative notes and implant stickers combined identified accurate primary implant details in only 40 of the 80 revision THAs (50%) and 34 of all 66 revision TKAs (52%, p = 0.870). Operative notes are often unavailable or fail to provide the necessary information required which makes planning and execution of revision hip and knee athroplasty difficult. This emphasizes the need for enhancing the quality of operative notes and records of patient information. Based on this information, we provide comprehensive operative note templates for primary and revision total hip and knee arthroplasty.

  8. Intraoperative chlorhexidine irrigation to prevent infection in total hip and knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Nicholas B. Frisch, MD, MBA

    2017-12-01

    Full Text Available Background: Surgical site irrigation during total hip (THA and total knee (TKA arthroplasty is a routine practice among orthopaedic surgeons to prevent periprosthetic joint infection. The purpose of this study was to evaluate the effect of chlorhexidine gluconate (CHG irrigation on infection rates following THA and TKA. Methods: Arthroplasties performed before September 2014 served as controls. THA performed before September 2014 (N = 253 underwent intraoperative irrigation with 0.9% saline followed by a 2-minute soak with <2% dilute povidone-iodine. TKA (N = 411 patients underwent only intraoperative saline irrigation. After October 2014, all patients (248 TKA and 138 THA received intraoperative irrigation with 0.9% saline and periodic 0.05% CHG solution followed by a final 1-minute soak in CHG with immediate closure afterward. Results: In this 2:1 comparison of consecutive patients, there were no differences in patient demographics between the 2 groups. No difference was noted in wound healing concerns subjectively, and no statistically significant association in nonsurgical site infections, superficial surgical site infection, and deep surgical site infection rates between the 2 groups (nonsurgical site infections [THA: P = .244, TKA: P = .125]; superficial surgical site infection [THA: P = .555, TKA: P = .913]; and deep surgical site infection [THA: P = .302, TKA: P = .534]. Conclusions: We were unable to discern a difference in infection rates between chlorhexidine irrigation and our prior protocols using dilute Betadine for THA and 0.9% saline for TKA. The theoretic advantages of dilute CHG retention during closure appear to be safe without infectious concerns. Keywords: Total hip arthroplasty (THA, Total knee arthroplasty (TKA, Irrigation, Lavage, Periprosthetic joint infection (PJI

  9. 3D Crack Behavior in the Orthopedic Cement Mantle of a Total Hip Replacement

    Directory of Open Access Journals (Sweden)

    Abderahmen Sahli

    2014-01-01

    Full Text Available The total hip replacement is an operation that replaces a diseased hip with a mechanical articulation. Both components of the mechanical articulation (stem and the cup are bonded to bone using orthopedic cement, whose reliability determines the longevity of the implant. The cement around the metallic stem forms a mantle whose strength and toughness determine its resistance to fatigue and failure by fracture. Typical cements are acrylic polymers that often suffer from internal cracks and other defects created during polymerization. This study is a systematic analysis of preexisting 3D crack behavior in the orthopedic cement mantle when subjected to external body forces. Different crack orientations and angular positions around the mantle are studied to identify which locations will propagate the crack. This is accomplished by a global stress analysis of the mantle followed by a failure analysis. Amongst others, the existence of a crack in the proximal region of the orthopedic cement is identified as a critical area, especially in the lateral sides of the stem in the radial direction.

  10. [Risk factors for total hip arthroplasty dislocation and its functional outcomes].

    Science.gov (United States)

    Sanz-Reig, J; Lizaur-Utrilla, A; Miralles-Muñoz, F

    2015-01-01

    To evaluate risk factors for dislocation after primary total hip arthroplasty (THA), and its functional outcomes. A retrospective study was conducted on 22 cases with dislocation and 431 controls without dislocation, all performed with lateral access. The data were collected prospectively with a minimum follow-up of 5 years. Patient related factors, from primary surgery, and position of components on simple radiographs were analyzed. Harris and Merle D'Aubigné hip scores, and short Womac questionnaire were used. Demographic, patient-related or surgical technique factors were not risk predictors of dislocation. With regard to position of components, an acetabular abduction >50° (p = 0.003) and anteversion lower or higher than 10°- 20° (p = 0.044) were risk factors. Controls and dislocation treated conservatively had similar outcomes, and in both were better than in those treated with surgical revision (p = 0.03). Factors relating to the patient and soft tissues status may influence the stability of the arthroplasty, but malposition of the acetabular component seems to be the most important and common risk factor for dislocation. Copyright © 2014. Published by Elsevier Espana.

  11. Expression of CD11c in periprosthetic tissues from failed total hip arthroplasties.

    Science.gov (United States)

    Chamaon, Kathrin; Barber, Henriette; Awiszus, Friedemann; Feuerstein, Bernd; Lohmann, Christoph H

    2016-01-01

    In this work, we characterize integrin CD11c (αXß2) expression in periprosthetic tissues of 45 hip revisions. Tissues were retrieved from 23 ceramic-on-ultra-high molecular weight polyethylene (UHMWPE), 20 metal-on-UHMWPE, and 2 metal-on-metal total hip arthroplasties (THAs). Capsular tissue retrieved during primary THA from 19 patients served as controls. We identified a system to identify important immunohistochemical markers that are expressed in aseptic loosening. We focused on CD11c, CD68 and CD14. We observed that the CD11c molecule possesses four different cellular patterns in the periprosthetic tissues. Three of them are associated with the occurrence of UHMWPE abrasive material. Double staining with CD14 and CD68 was used for a more detailed analysis of the CD11c expressing cells. We observed that all forms of CD11c positive cells are CD68 positive however, only two forms of CD11c expressing cells are positive for CD14. Providing cellular diversity of CD11c expression in periprosthetic tissue, our results provide a contribution toward the further understanding of different cellular mechanisms to foreign body material. © 2015 Wiley Periodicals, Inc.

  12. An appraisal of rehabilitation regimes used for improving functional outcome after total hip replacement surgery

    Directory of Open Access Journals (Sweden)

    Okoro Tosan

    2012-02-01

    Full Text Available Abstract This study aimed to systematically review the literature with regards to studies of rehabilitation programmes that have tried to improve function after total hip replacement (THR surgery. 15 randomised controlled trials were identified of which 11 were centre-based, 2 were home based and 2 were trials comparing home and centre based interventions. The use of a progressive resistance training (PRT programme led to significant improvement in muscle strength and function if the intervention was carried out early ( 1 month following surgery in a home based setting (2/2 home based studies used PRT. In direct comparison, there was no difference in functional measures between home and centre based programmes (2 studies, with PRT not included in the regimes prescribed. A limitation of the majority of these intervention studies was the short period of follow up. Centre based program delivery is expensive as high costs are associated with supervision, facility provision, and transport of patients. Early interventions are important to counteract the deficit in muscle strength in the affected limb, as well as persistent atrophy that exists around the affected hip at 2 years post-operatively. Studies of early home-based regimes featuring PRT with long term follow up are needed to address the problems currently associated with rehabilitation following THR.

  13. Connection between implantation positioning and loosening of the acetabular component of total endoprostheses of the hip

    Energy Technology Data Exchange (ETDEWEB)

    Gebauer, D.; Bluemel, G.; Munz, T.; Hug, F.

    1983-08-01

    Aseptic loosening of hip endoprostheses can be due to several causes. From the viewpoint of surgical technique, the question is of particular interest whether certain positions of the two endoprosthesis components during implantation will predispose the endoprosthesis for subsequent loosening. Within the framework of extensive analyses of damaged endoprostheses, the authors determined for the purpose of detecting representative positional changes in clinically manifest acetabular lossening of total endoprostheses of the hip in 23 patients: the position of the centre of the acetabulum in the pelvis and the degree of antetorsion and angle of inclination of the acetabulum at the time of implantation and shortly before reoperation, using standardized X-ray films as basis. The relative movement of the acetabulum during the implantation period was determined by observing the difference between the positions during these two points. In addition, the direct comparison of loosened and non-loosened prostheses was carried out in eight patients in whom endoprostheses had been implanted on both sides. On the whole, no sign was found that certain roentgenological positions of the acetabulum would point towards a predisposition for loosening. Loosened and non-loosened acetabuli do not reveal any significant differences in respect of change of position for the duration of implantation. Hence, the positioning of the acetabulum can be considered as being of minor importance in respect of loosening, with the exception of extreme deviations from the recommended position.

  14. Micro total hip replacement for dogs and cats: surgical technique and outcomes.

    Science.gov (United States)

    Liska, William D

    2010-10-01

    To describe the surgical technique for the micro total hip replacement (Micro THR) system and report clinical outcomes. Prospective study. Dogs (n=49) and cats (n=8) with coxofemoral arthropathy. Small breed dogs and cats with coxofemoral arthritis were enrolled for Micro THR. Patient data were recorded. Implant positioning and cement mantle quality were evaluated radiographically. Orthopedic examinations and client interviews were used to assess outcome. Micro THR was performed unilaterally (40 dogs, 8 cats) and staged bilaterally (9 dogs) to resolve pain associated with osteoarthritis or trauma. Mean body weight was 7.2 kg. Postoperative complications included prosthesis luxation (9), cup aseptic loosening (1), and sciatic neurapraxia (1). Mean radiographic follow up was 96.1 weeks; 10 joints were followed for ≥3.0 years. Sixty of the 66 (91%) Micro THRs had excellent outcomes. Two dogs (dogs with unmanageable luxation had explantation. Micro THR is considered a satisfactory procedure for management of small breed dogs and cats with coxofemoral disease unresponsive to medical management. Micro THR is a viable option to treat disabling disorders of the hip. More than 170 cat and small dog breeds, and many mixed breeds, could benefit from Micro THR surgery. © Copyright 2010 by The American College of Veterinary Surgeons.

  15. Incidence of delirium in postoperative patients treated with total knee and hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Felipe de Santana Bosmak

    Full Text Available Summary Introduction: Delirium is a common disorder that can potentiate mortality and comorbidity rates of patients hospitalized in intensive care units. Patients undergoing major orthopedic surgeries, such as knee and hip arthroplasty, are particularly vulnerable as they often have multiple risk factors for this disorder. Method: Descriptive study of the incidence of delirium in patients treated with total knee and hip arthroplasty, given the advanced age and comorbidities in this population. We evaluated the medical records of patients who had previously undergone the designated surgeries for identification of postoperative delirium. Results: We observed in this study an incidence of 8.92% of delirium, mostly affecting females with a mean age of 73 years and hypertension. Conclusion: The incidence of delirium in our study is similar to that observed in the general population, according to the literature. We found no correlation with sleep disorders, smoking or diabetes mellitus in this study, even though the importance of these factors for the onset of delirium is well-established in the literature.

  16. Same Same but Different? 12/14 Stem and Head Tapers in Total Hip Arthroplasty.

    Science.gov (United States)

    Mueller, Ulrike; Braun, Steffen; Schroeder, Stefan; Sonntag, Robert; Kretzer, J Philippe

    2017-10-01

    Taper corrosion has been identified to be a major concern in total hip arthroplasty during the past years. So far, the mechanisms that lead to taper corrosion in modular taper junctions are not fully understood. However, it has been shown that corrosion is also influenced by the geometry and topography of the taper, and these parameters vary among the implant manufacturers. The purpose of this study was to investigate the variations of common stem and head tapers regarding design and surface characteristics. An analysis of selected commercially available 12/14 stem and head tapers was performed. As geometric parameters, the taper angle, the opening taper diameter, and the taper length were measured using a coordinate measuring machine. Several topographic parameters were determined using a tactile roughness measurement instrument. Although all investigated tapers are so-called 12/14 tapers, this study showed that the stem and head tapers differ among the manufacturers. The stem tapers were clearly different in both geometry and topography, and the range in variation of the topographic parameter was greater than it was for the geometric parameter. In contrast, the head tapers were different in their geometry, although not in topography. Ultimately, this study provides an overview on the characteristics and variations of modular hip taper connections, and in addition, a new classification system regarding the surface finish is presented. These findings could be further considered in experimental corrosion or retrieval studies. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. 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.

  18. Natural Remission of Major Periprosthetic Osteolysis following Total Hip Arthroplasty with Metal-on-Metal Bearings

    Directory of Open Access Journals (Sweden)

    Tatsuya Tamaki

    2017-01-01

    Full Text Available The natural course of adverse events following the use of metal-on-metal (MoM bearings in total hip arthroplasty (THA is not well known. In this article, we report the case of a patient with asymptomatic major acetabular osteolysis following MoM THA that diminished gradually without any surgical intervention. A 58-year-old male underwent one-stage bilateral MoM THA for bilateral osteoarthritis. Four years after THA, major acetabular osteolysis developed in his right hip without any local or systemic symptoms. The patient underwent a careful radiographic and clinical observation without any surgical intervention because he did not want to undergo revision surgery. The lesion gradually diminished after 7 years, and most of the osteolytic area was replaced by newly formed bone at 10 years. He continues to be followed with no evidence of cup loosening or migration. Our observation suggests that a periprosthetic osteolytic change related to the use of MoM bearings has the potential for natural remission.

  19. Severe Polyethylene Wear Requiring Revision Total Hip Arthroplasty in Three Dogs.

    Science.gov (United States)

    Nesser, Valerie E; Kowaleski, Michael P; Boudrieau, Randy J

    2016-07-01

    To describe the occurrence of severe polyethylene wear of the acetabular component in 3 dogs that ultimately led to implant failure, and to report the outcome of revision of total hip arthroplasty (THA) in these cases. Case report Dogs (n=3). Three dogs with hip dysplasia underwent routine THA before 2 years of age. All dogs became acutely lame 4-5 years after THA. Radiographs revealed acetabular cup wear in all cases, shell fragmentation in 2 cases, and additional stem failure in 1 case. All dogs underwent successful revision surgery, during which severe polyethylene wear and metallosis was observed. Revision surgery provided an excellent clinical outcome in all dogs from 10 months to 4 years post revision. Polyethylene wear and implant failure may be a significant long-term complication of THA not previously recognized, which may be especially true when placed at an early age in a large breed, active dog, or in a dog with significant morbidity associated with other limbs. A successful revision was achieved in all 3 dogs. Additional investigation is warranted to document the risk factors associated with severe polyethylene wear in canine THA. © Copyright 2016 by The American College of Veterinary Surgeons.

  20. Down Syndrome Increases the Risk of Short-Term Complications After Total Hip Arthroplasty.

    Science.gov (United States)

    Boylan, Matthew R; Kapadia, Bhaveen H; Issa, Kimona; Perfetti, Dean C; Maheshwari, Aditya V; Mont, Michael A

    2016-02-01

    Down syndrome is the most common chromosomal abnormality and is associated with degenerative hip disease. Because of the recent increase in life expectancy for patients with this syndrome, orthopaedic surgeons are likely to see an increasing number of these patients who are candidates for total hip arthroplasty (THA). Using Nationwide Inpatient Sample (NIS) data from 1998 to 2010, we compared the short-term adverse outcomes of THA among 241 patients with Down syndrome and a matched 723-patient cohort. Specifically, we assessed: (1) incidence of THA; (2) perioperative medical and surgical complications during the primary hospitalization; (3) length of stay; and (4) hospital charges. The annual mean number of patients with Down syndrome undergoing THA was 19. Compared to matched controls, Down syndrome patients had an increased risk of perioperative (OR, 4.33; PDown syndrome patients had significantly higher incidence rates of pneumonia (P=.001), urinary tract infection (PDown syndrome patients were 26% longer (Pevaluation and pre-operative consultation for a patient with Down syndrome who is a candidate for THA, orthopaedic surgeons should educate the patient, family and their clinical decision makers about the increased risk of medical complications (pneumonia and urinary tract infections), surgical complications (wound hemorrhage), and lengths of stay compared to the general population. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Spinopelvic parameter changes and low back pain improvement due to femoral neck anteversion in patients with severe unilateral primary hip osteoarthritis undergoing total hip replacement.

    Science.gov (United States)

    Piazzolla, Andrea; Solarino, Giuseppe; Bizzoca, Davide; Montemurro, Viola; Berjano, Pedro; Lamartina, Claudio; Martini, Carlotta; Moretti, Biagio

    2017-03-16

    The study of the interrelation between hip and spine disorders is gaining increasing importance in the last years, but the link between Hip Osteoarthritis (HOA) and Low Back Pain (LBP) remains still unclear. Aim of the study is to assess the relationship between Femoral Neck Anteversion (FNA), LBP, and spinopelvic parameters in patients undergoing Total Hip Replacement (THR) for unilateral severe primary HOA. 91 patients were recruited. Inclusion criteria were: grade 5 or 6 unilateral HOA, according to Turmezei, and Harris Hip score (HHS) spondylolisthesis; history of spine fractures; previous bone tuberculosis or any spine infections; any contraindications to CT; BMI >30. Patients were divided into two homogeneous Groups according to the presence (Group-A) or not of concomitant LBP (Group-B). All patients underwent preoperatively a hip CT scan to evaluate FNA, Acetabular Anteversion (AA), and Combined Anteversion (CA = FNA + AA). ΔFNA, ΔAA and ΔCA were calculated as the differences between the arthritic hip and the normal hip angles in each Group. Full spinal X-rays in upstanding position were performed before (baseline) and 6 months after THR (follow-up) to calculate spinopelvic parameters. The health-related quality of life (HRQoL) was evaluated at baseline and at follow-up using Visual Analogue Scale (VAS), HHS, Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RM), and Short-Form Health Survey (SF-36). The intra-group and inter-group variability were assessed using, respectively, paired and unpaired t tests. At baseline, the association between HRQoL scores and ΔFNA, ΔAA, and ΔCA was analysed by the Pearson correlation test. At baseline, in Group-A, there was a significant difference between arthritic FNA and normal hip FNA, while no differences were found in AA between the two hips. A close correlation was observed between ΔFNA and Spine-VAS (r = 0.788), ODI (r = 0.824), and RM (r = 0.775). In Group-B, there was not a

  2. Risk factors for dislocation after revision total hip arthroplasty: A systematic review and meta-analysis.

    Science.gov (United States)

    Guo, Lele; Yang, Yanjiang; An, Biao; Yang, Yantao; Shi, Linyuan; Han, Xiangzhen; Gao, Shijun

    2017-02-01

    No formal systematic review or meta-analysis was performed up to now to summarize the risk factors of dislocation after revision total hip arthroplasty(THA). The present study aimed to quantitatively and comprehensively conclude the risk factors of dislocation after revision total hip arthroplasty. A search was applied to CNKI, Embase, Medline, and Cochrane central database (all up to October 2016). All studies assessing the risk factors of dislocation after revision THA without language restriction were reviewed, and qualities of included studies were assessed using the Newcastle-Ottawa Scale. Data were pooled and a meta-analysis completed. A total of 8 studies were selected, which altogether included 4656 revision THAs. 421 of them were cases of dislocation occurred after surgery, suggesting the accumulated incidence of 9.04%. Results of meta-analyses showed that age at surgery (standardized mean difference -0.222; 95% CI -0.413-0.031), small-diameter femoral heads (≤28 mm) (OR 1.451; 95%CI 1.056-1.994), history of instability (OR 2.739; 95%CI 1.888-3.974), number of prior revisions ≥ 3 (OR, 2.226; 95% CI, 1.569-3.16) and number of prior revisions ≥ 2 (OR 1.949; 95% CI 1.349-2.817), acetabular components with elevated rim liner were less likely to develop dislocation after revision THA (OR 0.611; 95% CI 0.415-0.898). Related prophylaxis strategies should be implemented in patients involved with above-mentioned risk factors to prevent dislocation after revision THA. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  3. Developmental hip dysplasia treated by total hip arthroplasty using a cementless Wagner cone stem in young adult patients with a small physique.

    Science.gov (United States)

    Zhen, Ping; Liu, Jun; Lu, Hao; Chen, Hui; Li, Xusheng; Zhou, Shenghu

    2017-05-15

    Developmental hip dysplasia (DDH) may lead to severe acetabular and femoral abnormalities that can render total hip arthroplasty (THA) challenging, especially in DDH patients with a small physique. Most conventional cemented or cementless femoral components are often difficult to implant in the narrow femoral canal and require slight version correction during surgery. The aim of this study was to present the mid-term results of THA in the treatment of DDH patients with a small physique using a cementless Wagner cone prosthesis (Zimmer®, US). Between January 2006 and March 2010, we retrospectively reviewed 50 patients who were treated at our center. A total of 50 patients (52 hips; 45 women, five men; mean age 32.5 years; range 27 to 38 years) who underwent THA were observed. The mean femoral medullary canal dimension at the isthmus was 7.6 mm (range 6.0 to 8.7). According to the Crowe classification, 19 hips presented dysplasia of grade I, while 33 presented dysplasia of grade II. All patients were treated with THA using a cementless Wagner cone prosthesis. Clinical and radiologic evaluations were performed on all patients. The mean duration of follow-up was 7.7 years (range 5.4 to 10.5). The Harris hip score (HHS) improved from 63 ± 9 (range 55 to 70) pre-operatively to 92 ± 8 (range 88 to 100) at the last follow-up. The HHS at the most recent follow-up was excellent in 66% of patients (34 hips), good in 26% (14 hips), fair in 6% (3 hips), and poor in 2% (1 hip). Radiographic evaluation demonstrated excellent osteointegration of the implants. Stem subsidence was present in three stems, and the range of stem subsidence was 2 mm in two stems (3.9%) and 3 mm in one stem (1.9%). Femoral osteolysis was observed in nine hips (18%) in the proximal zones, and no distal osteolysis was noted. Heterotopic ossification was observed in three hips (5.8%); of these, two were classified as Brooker's grade 1, and one was classified as Brooker's grade 2 at the most

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

    Science.gov (United States)

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

    2017-05-01

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

  5. Postoperative morbidity and mortality in type-2 diabetics after fast-track primary total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer C; Madsbad, Sten; Kehlet, Henrik

    2015-01-01

    BACKGROUND: Diabetes is a risk factor for postoperative morbidity, which includes total hip and knee arthroplasty. However, no previous studies have been done in a fast-track setting with optimized perioperative care, including spinal anesthesia, multimodal opioid-sparing analgesia, early...... mobilization, and discharge to home, which improved postoperative outcome. METHODS: We performed an observational cohort study using prospective data in primary total hip and total knee arthroplasty with a standardized fast-track approach. Eight hundred ninety type 2 diabetics were successfully propensity......-∞) and 115 (35-∞), respectively. Insulin-treated type 2 diabetes was associated with increased risk of specific "diabetes-related" morbidity (1.95 [1.13-3.35]; P = 0.016). CONCLUSIONS: Type 2 diabetes per se has limited influence on postoperative morbidity in fast-track total hip and knee arthroplasty....

  6. Can Optimism, Pessimism, Hope, Treatment Credibility and Treatment Expectancy Be Distinguished in Patients Undergoing Total Hip and Total Knee Arthroplasty?

    Directory of Open Access Journals (Sweden)

    Tsjitske M Haanstra

    Full Text Available The constructs optimism, pessimism, hope, treatment credibility and treatment expectancy are associated with outcomes of medical treatment. While these constructs are grounded in different theoretical models, they nonetheless show some conceptual overlap. The purpose of this study was to examine whether currently available measurement instruments for these constructs capture the conceptual differences between these constructs within a treatment setting.Patients undergoing Total Hip and Total Knee Arthroplasty (THA and TKA (Total N = 361; 182 THA; 179 TKA, completed the Life Orientation Test-Revised for optimism and pessimism, the Hope Scale, the Credibility Expectancy Questionnaire for treatment credibility and treatment expectancy. Confirmatory factor analysis was used to examine whether the instruments measure distinct constructs. Four theory-driven models with one, two, four and five latent factors were evaluated using multiple fit indices and Δχ2 tests, followed by some posthoc models.The results of the theory driven confirmatory factor analysis showed that a five factor model in which all constructs loaded on separate factors yielded the most optimal and satisfactory fit. Posthoc, a bifactor model in which (besides the 5 separate factors a general factor is hypothesized accounting for the commonality of the items showed a significantly better fit than the five factor model. All specific factors, except for the hope factor, showed to explain a substantial amount of variance beyond the general factor.Based on our primary analyses we conclude that optimism, pessimism, hope, treatment credibility and treatment expectancy are distinguishable in THA and TKA patients. Postdoc, we determined that all constructs, except hope, showed substantial specific variance, while also sharing some general variance.

  7. Can Optimism, Pessimism, Hope, Treatment Credibility and Treatment Expectancy Be Distinguished in Patients Undergoing Total Hip and Total Knee Arthroplasty?

    Science.gov (United States)

    Haanstra, Tsjitske M; Tilbury, Claire; Kamper, Steven J; Tordoir, Rutger L; Vliet Vlieland, Thea P M; Nelissen, Rob G H H; Cuijpers, Pim; de Vet, Henrica C W; Dekker, Joost; Knol, Dirk L; Ostelo, Raymond W

    2015-01-01

    The constructs optimism, pessimism, hope, treatment credibility and treatment expectancy are associated with outcomes of medical treatment. While these constructs are grounded in different theoretical models, they nonetheless show some conceptual overlap. The purpose of this study was to examine whether currently available measurement instruments for these constructs capture the conceptual differences between these constructs within a treatment setting. Patients undergoing Total Hip and Total Knee Arthroplasty (THA and TKA) (Total N = 361; 182 THA; 179 TKA), completed the Life Orientation Test-Revised for optimism and pessimism, the Hope Scale, the Credibility Expectancy Questionnaire for treatment credibility and treatment expectancy. Confirmatory factor analysis was used to examine whether the instruments measure distinct constructs. Four theory-driven models with one, two, four and five latent factors were evaluated using multiple fit indices and Δχ2 tests, followed by some posthoc models. The results of the theory driven confirmatory factor analysis showed that a five factor model in which all constructs loaded on separate factors yielded the most optimal and satisfactory fit. Posthoc, a bifactor model in which (besides the 5 separate factors) a general factor is hypothesized accounting for the commonality of the items showed a significantly better fit than the five factor model. All specific factors, except for the hope factor, showed to explain a substantial amount of variance beyond the general factor. Based on our primary analyses we conclude that optimism, pessimism, hope, treatment credibility and treatment expectancy are distinguishable in THA and TKA patients. Postdoc, we determined that all constructs, except hope, showed substantial specific variance, while also sharing some general variance.

  8. Sensor-based hip control with hybrid neuroprosthesis for walking in paraplegia.

    Science.gov (United States)

    To, Curtis S; Kobetic, Rudi; Bulea, Thomas C; Audu, Musa L; Schnellenberger, John R; Pinault, Gilles; Triolo, Ronald J

    2014-01-01

    The objectives of this study were to test whether a hybrid neuroprosthesis (HNP) with an exoskeletal variable-constraint hip mechanism (VCHM) combined with a functional neuromuscular stimulation (FNS) controller can maintain upright posture with less upper-limb support and improve gait speed as compared with walking with either an isocentric reciprocating gait orthosis (IRGO) or FNS only. The results show that walking with the HNP significantly reduced forward lean in FNS-only walking and the maximum upper-limb forces by 42% and 19% as compared with the IRGO and FNS-only gait, respectively. Walking speed increased significantly with VCHM as compared with 1:1 reciprocal coupling and by 15% when using the sensor-based FNS controller as compared with HNP with fixed baseline stimulation without the controller active.

  9. Vitamin E diffused highly cross-linked polyethylene in total hip arthroplasty at five years

    DEFF Research Database (Denmark)

    Nebergall, A. K.; Greene, M. E.; Laursen, M. B.

    2017-01-01

    Aims: The objective of this five-year prospective, blinded, randomised controlled trial (RCT) was to compare femoral head penetration into a Vitamin E diffused highly cross-linked polyethylene (HXLPE) liner with penetration into a medium cross-linked polyethylene control liner using...... radiostereometric analysis. Patients and Methods: Patients scheduled for total hip arthroplasty (THA) were randomised to receive either the study E1 (32 patients) or the control ArComXL polyethylene (35 patients). The median age (range) of the overall cohort was 66 years (40 to 76). Results: The five-year median......-reported outcomes (PROs) improved significantly from the pre-operative interval compared with those at one year, and remained favourable at five years. There were no differences between the two groups at any interval. Conclusion: The five-year results showed that E1 polyethylene does not wear more than the control...

  10. Does pre-operative psychological distress affect patient satisfaction after primary total hip arthroplasty?

    Directory of Open Access Journals (Sweden)

    Nolan John

    2011-06-01

    Full Text Available Abstract Background There are concerns that pre-operative psychological distress might be associated with reduced patient satisfaction after total hip replacement (THR. Methods We investigated this in a multi-centre prospective study between January 1999 and January 2002. We dichotomised the patients into the mentally distressed (MHS ≤ 56 and the not mentally distressed (MHS > 56 groups based on their pre-operative Mental Health Score (MHS of SF36. Results 448 patients (340 not distressed and 108 distressed completed the patient satisfaction survey. Patient satisfaction rate at five year was 96.66% (415/448. There was no difference in patient satisfaction or willingness to have the surgery between the two groups. None of pre-operative variables predicted five year patient satisfaction in logistic regression. Conclusions Patient satisfaction after surgery may not be adversely affected by pre-operative psychological distress.

  11. 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...... rationale for a discussion within Western European health care systems, we undertook a prospective assessment of the benefit of THR from the patients´ perspective and as measured by quality-adjusted life years (QALYs). Aim: To measure the difference in health related quality of life between an intervention...... treatment and telephone intervention. QALYs were calculated from measures of health-related quality of life using questionnaire SF-36. These scores were transformed to QALYs using a formula based on the method developed by Brazier (Brazier 1998). Results: Both the control and the intervention patients...

  12. Position of nuclear-medical techniques for evaluation of loosened total hip endroprostheses

    Energy Technology Data Exchange (ETDEWEB)

    Katz, G.; Fridrich, R.; Maecke, H.; Morschner, E.

    1985-10-01

    For diagnosis of loosening or infection after implantation of a single-side or double-side total hip endoprosthesis 59 patients being in pain were investigated by a combination of bone scan (Technetium-99m DPD) and leucocyte scan (Indium-111 labelled leucocytes). The correlation between clinical results and scintigraphic findings revealed: bone scintigraphy detects loosening of prostheses with 95% sensitivity (45/47); bone scintigraphy excludes an instable prosthesis with 89% specificity (3/27). 45% of the loosened prostheses revealed an infection (21/47): leucocyte scintigraphy could detect 17 correct positive. Three leucocyte scans of 53 prostheses without clinical signs of infection were false positive. Therefore, leucocyte scintigraphy had a sensitivity of 91% and a specificity of 94% for detecting infection. Bone scintigraphy can detect loosening of prostheses with 93% accuracy, Indium-111 labelled leucocyte scintigraphy can detect infection of the prosthesis with 91% accuracy. (orig.).

  13. Cerclage wiring technique after proximal femoral fracture in total hip arthroplasty.

    Science.gov (United States)

    Fishkin, Z; Han, S M; Ziv, I

    1999-01-01

    Cerclage wires have been used to stabilize proximal femoral cracks after stem insertion in cementless total hip arthroplasty. The objective of this study was to determine the optimal number and orientation of cerclage wires necessary to prevent stem subsidence and crack propagation. The crack was stabilized by 1, 2, or 3 wires placed either normal to the femoral neck axis or normal to the crack. The femora were compressed to 2,670 N while measuring crack opening and stem subsidence. Wires placed normal to the crack allowed less stem subsidence by 3.17 mm and less crack opening by 1.55 mm compared with wires placed normal to the neck. The addition of multiple wires reduced subsidence by 50% and reduced crack opening to <1 mm. Medial and anterior calcar cracks are best stabilized by at least 2 cerclage wires that are placed normal to the crack.

  14. Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacements

    DEFF Research Database (Denmark)

    Schrama, J. C.; Fenstad, A. M.; Dale, H.

    2015-01-01

    Background and purpose-Medical treatment of rheumatoid arthritis (RA) has changed dramatically over the last 15 years, including immune modulation. We investigated the risk of revision for infection after primary total hip replacement (THR) in patients with rheumatoid arthritis over a 16-year...... period, and compared it with that in THR patients with osteoarthritis (OA).Patients and methods-We identified 13,384 THRs in RA patients and 377,287 THRs in OA patients from 1995 through 2010 in a dataset from the Nordic Arthroplasty Register Association (NARA). Kaplan-Meier survival curves......, with revision for infection as the endpoint, were constructed. Cox regression analyses were performed to calculate the relative risk (RR) of revision for infection adjusted for age, sex, fixation technique, and year of primary surgery.Results-RA patients had a 1.3 times (95% CI 1.0-1.6) higher risk of revision...

  15. Managing femoral bone loss in revision total hip replacement: fluted tapered modular stems.

    Science.gov (United States)

    Cross, M B; Paprosky, W G

    2013-11-01

    If a surgeon is faced with altered lesser trochanter anatomy when revising the femoral component in revision total hip replacement, a peri-prosthetic fracture, or Paprosky type IIIb or type IV femoral bone loss, a modular tapered stem offers the advantages of accurately controlling femoral version and length. The splines of the taper allow rotational control, and improve the fit in femoral canals with diaphyseal bone loss. In general, two centimetres of diaphyseal contact is all that is needed to gain stability with modular tapered stems. By allowing the proximal body trial to rotate on a well-fixed distal segment during trial reduction, appropriate anteversion can be obtained in order to improve intra-operative stability, and decrease the dislocation risk. However, modular stems should not be used for all femoral revisions, as implant fracture and corrosion at modular junctions can still occur.

  16. Post-anaesthesia care unit stay after total hip and knee arthroplasty under spinal anaesthesia

    DEFF Research Database (Denmark)

    Lunn, T H; Kristensen, B B; Gaarn-Larsen, L

    2012-01-01

    BACKGROUND: Post-anaesthesia care unit (PACU) admission must be well founded and the stay as short as possible without compromising patient safety. However, within the concept of fast-track surgery, studies are limited in addressing the question: why are patients staying in the PACU? METHODS: All...... patients operated with primary unilateral total hip or knee arthroplasty (THA or TKA) under spinal anaesthesia were included in this hypothesis-generating, prospective, observational cohort study during a 4-month period. Surgical technique, analgesia, and perioperative care were standardized. Well...... complications at the surgical ward at follow-up 24 h post-operatively. RESULTS: One hundred sixty-three patients were included in the final analysis (69 THA and 94 TKA). Time to meet PACU discharge criteria was [median (interquartile range)(95% confidence interval)]: 15¿min (15-15)(15-116) for THA and 15¿min...

  17. Comparison between bipolar hemiarthroplasty and total hip arthroplasty for unstable intertrochanteric fractures in elderly osteoporotic patients.

    Directory of Open Access Journals (Sweden)

    Lihong Fan

    Full Text Available The present study was conducted to compare bipolar hemiarthroplasty (BA with total hip arthroplasty (THA in treatment of unstable intertrochanteric fractures in elderly osteoporotic patients. The THA group included 14 males and 26 females with a mean age of 73.4 years, and the BA group included 27 males and 45 females with a mean age of 76.5 years. Significant difference existed between the two groups in operation time, blood loss, transfusion volume and cost of hospitalization, while no remarkable difference was identified in hospitalization period, general complications, joint function, pain, rate of revision and mortality. No dislocation was observed in BA group while 3 occurred in THA group. The results indicated that for unstable intertrochanteric fractures in elderly osteoporotic patients, BA seems to be a better or more reasonable choice compared with THA for the reason of less blood loss, shorter operation time, lower cost and no dislocation.

  18. Three cases of type-1 complex regional pain syndrome after elective total hip replacement

    Directory of Open Access Journals (Sweden)

    Zanotti Gerardo

    2017-01-01

    Full Text Available Complex regional pain syndrome (CRPS constitutes an atypical cause of pain after orthopaedic procedures. To our knowledge, there is a paucity of literature reporting this syndrome after total hip arthroplasty (THR, since only two case reports have been published. We thenceforth describe the clinical outcome of three cases of type-1 CRPS developed after elective THR, two of them initially diagnosed with secondary osteoarthritis whereas the remaining one presented a sequel of a failed osteosynthesis that required conversion to THR. Remission of disease was found at an average seven months (range: 4–9. Medical treatment involved a combined therapy of pain management, bisphosphonates and intense physical therapy. One patient was additionally treated with a corticosteroid blockade of his right sympathetic lumbar ganglia. None of the patients required surgical treatment. At final follow-up, physical examinations and imaging were negative for disease.

  19. Designing a Safety Reporting Smartphone Application to Improve Patient Safety After Total Hip Arthroplasty.

    Science.gov (United States)

    Krumsvik, Ole Andreas; Babic, Ankica

    2017-01-01

    This paper presents a safety reporting smartphone application which is expected to reduce the occurrence of postoperative adverse events after total hip arthroplasty (THA). A user-centered design approach was utilized to facilitate optimal user experience. Two main implemented functionalities capture patient pain levels and well-being, the two dimensions of patient status that are intuitive and commonly checked. For these and other functionalities, mobile technology could enable timely safety reporting and collection of patient data out of a hospital setting. The HCI expert, and healthcare professionals from the Haukeland University Hospital in Bergen have assessed the design with respect to the interaction flow, information content, and self-reporting functionalities. They have found it to be practical, intuitive, sufficient and simple for users. Patient self-reporting could help recognizing safety issues and adverse events.

  20. Use of iPhone technology in improving acetabular component position in total hip arthroplasty

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    Xiau Wei Tay, MBBS

    2017-09-01

    Full Text Available Improper acetabular cup positioning is associated with high risk of complications after total hip arthroplasty. The aim of our study is to objectively compare 3 methods, namely (1 free hand, (2 alignment jig (Sputnik, and (3 iPhone application to identify an easy, reproducible, and accurate method in improving acetabular cup placement. We designed a simple setup and carried out a simple experiment (see Method section. Using statistical analysis, the difference in inclination angles using iPhone application compared with the freehand method was found to be statistically significant (F[2,51] = 4.17, P = .02 in the “untrained group”. There is no statistical significance detected for the other groups. This suggests a potential role for iPhone applications in junior surgeons in overcoming the steep learning curve.

  1. Pose measurement of Anterior Pelvic Plane based on inertial measurement unit in total hip replacement surgeries.

    Science.gov (United States)

    Zhe Cao; Shaojie Su; Hong Chen; Hao Tang; Yixin Zhou; Zhihua Wang

    2016-08-01

    In Total Hip Replacement (THR), inaccurate measurement of Anterior Pelvic Plane (APP), which is usually used as a reference plane, will lead to malposition of the acetabular prosthesis. As a result, the risk of impingement, dislocation and wear will increase and the safe range of motion will be limited. In order to acquire the accurate pose of APP, a measurement system is designed in this paper, which includes two parts: one is used to estimate the initial pose of APP and the other is used to trail dynamic motion of APP. Both parts are composed of an Inertial Measurement Unit (IMU) and magnetometer sensors. An Extended Kalman Filter (EKF) is adopted to fuse the data from IMU and the magnetometer sensors to estimate the orientation of the pelvis. The test results show that the error angle between calculated axis and true axis of the pelvis in geodetic coordinate frame is less than 1.2 degree, which meets the requirement of the surgery.

  2. 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.

  3. Insufficiency fracture in the medial wall of the acetabulum after total hip arthroplasty.

    Science.gov (United States)

    Kanaji, Arihiko; Ando, Kenichi; Nakagawa, Masato; Fukaya, Eiichi; Date, Hideki; Yamada, Harumoto

    2007-08-01

    Insufficiency fracture following total hip arthroplasty (THA) frequently occurs in the superior and inferior pubic ramus, the puboischial rami, or the ischium around the obturator foramen, while it rarely occurs in the medial wall of the acetabulum. Here, we report three cases showing insufficiency fracture in the medial wall of the acetabulum following THA. In our three cases, two fractures resulted from the development of bone fragility due to osteolysis at the prosthesis site, and the convergence of mechanical stress on the acetabular load bearing point due to loosening of the cup. We consider it appropriate to describe these fractures as another entity of stress fracture, namely, osteolytic fracture, rather than either pathologic fracture or insufficiency fracture.

  4. Biomechanical Study on Distal Filling Effects in Cementless Total Hip Replacement

    Science.gov (United States)

    Chae, Soo-Won; Lee, Jun-Hyoung; Choi, Hyung-Yun

    In cementless total hip replacement, initial stability of the femoral component is important in the long term fixation of the femoral stem. Initial stability is closely related to the relative displacement between the prosthesis and the cancellous bone of the proximal femur. After implantation of the prosthesis, the surrounding bone is partially shielded from load carrying and starts to resorb. Stress shielding causes the loss of the proximal bone. The stress distribution of femur must be assessed to predict stress shielding. The initial stability and the stress shielding were investigated for two loading conditions approximating a single leg stance and stair climbing. Two types of stems involving a distal filling and a distal short stem were studied by the finite element method to investigate the biomechanical distal filling effects. The distal short stem produced less stress shielding at the proximal bone than the distal filling stem, while both types of stems seemed to satisfy the initial stability requirement.

  5. Limb shortening osteotomy in a patient with achondroplasia and leg length difference after total hip arthroplasty

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    Christian L. Galata

    2013-07-01

    Full Text Available Introduction: Achondroplasia is the most common reason for disproportionate short stature. Normally, orthopedic limb lengthening procedures must be discussed in the course of this genetic disorder and have been successful in numerous achondroplastic patients in the past. In some cases, the disease may lead to leg length differences with need for surgical correction. Case Report: We report a case of achondroplastic dysplastic coxarthrosis with symptomatic leg length difference after bilateral total hip arthroplasty in a 52-year-old female patient, in which a distal femoral shortening osteotomy was successfully performed. Conclusion: Femoral shortening osteotomy is very uncommon in patients with achondroplasia. We conclude, however, that in rare cases it can be indicated and provide the advantage of shorter operation time, less perioperative complications and faster recovery compared to leg lengthening procedures. Keywords: Achondroplasia, dysplastic coxarthrosis, limb shortening, distal femur osteotomy.

  6. Tribology of total hip arthroplasty prostheses: What an orthopaedic surgeon should know.

    Science.gov (United States)

    Rieker, Claude B

    2016-02-01

    Articulating components should minimise the generation of wear particles in order to optimize long-term survival of the prosthesis.A good understanding of tribological properties helps the orthopaedic surgeon to choose the most suitable bearing for each individual patient.Conventional and highly cross-linked polyethylene articulating either with metal or ceramic, ceramic-on-ceramic and metal-on-metal are the most commonly used bearing combinations.All combinations of bearing surface have their advantages and disadvantages. An appraisal of the individual patient's objectives should be part of the assessment of the best bearing surface. Cite this article: Rieker CB. Tribology of total hip arthroplasty prostheses: what an orthopaedic surgeon should know. EFORT Open Rev 2016;1:52-57. DOI: 10.1302/2058-5241.1.000004.

  7. Fuzzy Support System for Total Hip Arthroplasty Stem by Ultrasonic Intraoperative Measurement

    Directory of Open Access Journals (Sweden)

    Naomi Yagi

    2012-01-01

    Full Text Available This paper describes a fuzzy system of stem implantation on total hip arthroplasty by an ultrasonic device. The system can perform automatic and accurate assessment in the surgery. In this system, we employ a single ultrasonic probe whose center frequency is 1,000 Hz. We detect the acoustic signals when knocking the inserted stem with a hammer. We then have a correlation between the degree of tightening and the attenuation time of acoustic signal. That is, the higher tightened degree implies shorter attenuation period. The support system selects the most suitable stem size by fuzzy inference with respect to the attenuation time and its difference time from correct stem to one larger size stem which dynamically adapts to each patient. As a result, we successfully determined the suitable stem in comparison to the results of the practical surgery.

  8. 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

  9. Osteoporosis and vitamin-D deficiency among postmenopausal women with osteoarthritis undergoing total hip arthroplasty.

    Science.gov (United States)

    Glowacki, Julie; Hurwitz, Shelley; Thornhill, Thomas S; Kelly, Michael; LeBoff, Meryl S

    2003-12-01

    Several epidemiological studies have shown a lower prevalence of osteoporotic hip fractures in patients with osteoarthritis. Other studies have demonstrated elevated bone mineral density in patients with osteoarthritis. The prevailing view is that there may be an inverse relationship between osteoarthritis and osteoporosis. The purposes of the present study were to describe a subgroup of patients with osteoarthritis who were found to have osteoporosis and to assess the vitamin-D status and other risk factors for low bone density in osteoarthritic subjects with and without osteoporosis. The bone mineral density of the spine, the proximal part of the femur, and the total body was measured with dual-energy x-ray absorptiometry in sixty-eight postmenopausal white women who were scheduled to undergo total hip replacement for advanced osteoarthritis. The serum levels of 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, intact parathyroid hormone, osteocalcin, and bone-specific alkaline phosphatase and the urinary level of N-telopeptide were measured. Information from validated lifestyle, dietary, and demographic questionnaires was also evaluated. Seventeen (25%) of the sixty-eight women had occult osteoporosis (as indicated by a T score of less than -2.5). Fifteen (22%) of the sixty-eight subjects had vitamin-D deficiency, and three (4%) had an elevated serum parathyroid hormone level. Only two of the seventeen osteoporotic women had vitamin-D deficiency. On the basis of these numbers, vitamin-D status was not correlated with bone density (p = 0.32). Analysis of the relationship between the number of years since menopause and osteoporosis or markers of elevated bone turnover showed that osteoporosis was detected throughout the postmenopausal period. A substantial portion of these sixty-eight white women with osteoarthritis of the hip had occult osteoporosis and hypovitaminosis D. Vitamin-D deficiency was not restricted to the group with low bone density. These results

  10. Clinical and Wear Analyses of 9 Large Metal-on-Metal Total Hip Prostheses.

    Science.gov (United States)

    Koper, M C; Mathijssen, N M C; Witt, F; Morlock, M M; Vehmeijer, S B W

    2016-01-01

    Metal-on-Metal (MoM) total hip arthroplasties (THA) are associated with pseudotumor formation and high revision rates. This prospective study analysed the clinical and wear analyses of 9 large Metal-on-Metal (MoM) total hip arthroplasties (THA) to understand the underlying mechanisms of failure. The MoM bearings were revised for multiple reasons; the main reason was pseudotumor formation. From 2006 till 2010 the Reinier de Graaf Hospital implanted 160 large head M2a-Magnum™ (Biomet Inc. Warsaw, Indiana, USA) THAs in 150 patients. The first year, 9 bearings were revised and analysed at the Biomechanics Section, Hamburg University of Technology, Germany. We performed clinical (Harris Hip Score, radiographic analysis, blood cobalt and chromium) and wear analysis (implant, tissue and fluid) of the 9 bearings. Since this study did not fall under the scope of the Medical Research Involving Human Subjects Act in The Netherlands, no ethical approval was necessary. In this prospective study all patient details were anonymized by the corresponding author, all other authors were blinded during the research and wear analyses. Patients with bilateral MoM implants were excluded. The 9 bearings had a median (IQR) survival of 41.0 (25) months in situ. From these bearings, three showed no noticeable wear. The median (IQR) head wear volume was 3.2 (3.6) mm3 and maximum wear depth 0.02 (0.02) mm. For the cup the median (IQR) wear volume was 0.23 (0.3) mm3 with a maximum wear depth of 0.03 (0.05) mm. An early identification of parameters related to failure of the MoM THA, such as pain, decreased range of motion, radiographic changes and high levels of blood cobalt and chromium is of great importance for patient's quality of life. Especially now patients and surgeons face the long term effects of all these bearings still in situ. This study reports the clinical and wear analyses of 9 MoM THA. In the majority of this group the reason for revision was pseudotumor formation. Most

  11. 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

  12. Bone penetration of intravenous flucloxacillin and gentamicin as antibiotic prophylaxis during total hip and knee arthroplasty.

    Science.gov (United States)

    Torkington, M S; Davison, M J; Wheelwright, E F; Jenkins, P J; Anthony, I; Lovering, A M; Blyth, M; Jones, B

    2017-03-01

    To investigate the bone penetration of intravenous antibiotic prophylaxis with flucloxacillin and gentamicin during hip and knee arthroplasty, and their efficacy against Staphylococcus (S.) aureus and S. epidermidis. Bone samples from the femoral head, neck and acetabulum were collected from 18 patients undergoing total hip arthroplasty (THA) and from the femur and tibia in 21 patients during total knee arthroplasty (TKA). The concentration of both antibiotics in the samples was analysed using high performance liquid chromatography. Penetration was expressed as a percentage of venous blood concentration. The efficacy against common infecting organisms was measured against both the minimum inhibitory concentration 50, and the more stringent epidemiological cutoff value for resistance (ECOFF). The bone penetration of gentamicin was higher than flucloxacillin. Relative to ECOFF, flucloxacillin concentrations were effective against S. aureus and S. epidermidis in all THAs and 20 (95%) TKAs. Gentamicin concentrations were effective against S. epidermidis in all bone samples. Gentamicin was effective against S. aureus in 11 (61.1%) femoral neck samples in THA. Effective concentrations of gentamicin against S. aureus were only achieved in four (19%) femoral and six (29%) tibial samples in TKA. Flucloxacillin and gentamicin were found to penetrate bone during THA and TKA. Gentamicin was effective against S. epidermidis in both THA and TKA, while levels were subtherapeutic against S. aureus in most TKAs. Bone penetration of both antibiotics was less in TKA than THA, and may relate to the use of a tourniquet. Using this antibiotic combination, effective cover against the two common infective organisms was achieved in all THAs and all but one TKA. Cite this article: Bone Joint J 2017;99-B:358-64. ©2017 The British Editorial Society of Bone & Joint Surgery.

  13. Optimization of metal artefact reduction (MAR) sequences for MRI of total hip prostheses.

    Science.gov (United States)

    Toms, A P; Smith-Bateman, C; Malcolm, P N; Cahir, J; Graves, M

    2010-06-01

    To describe the relative contribution of matrix size and bandwidth to artefact reduction in order to define optimal sequence parameters for metal artefact reduction (MAR) sequences for MRI of total hip prostheses. A phantom was created using a Charnley total hip replacement. Mid-coronal T1-weighted (echo time 12ms, repetition time 400ms) images through the prosthesis were acquired with increasing bandwidths (150, 300, 454, 592, and 781Hz/pixel) and increasing matrixes of 128, 256, 384, 512, 640, and 768 pixels square. Signal loss from the prosthesis and susceptibility artefact was segmented using an automated tool. Over 90% of the achievable reduction in artefacts was obtained with matrixes of 256x256 or greater and a receiver bandwidth of approximately 400Hz/pixel or greater. Thereafter increasing the receiver bandwidth or matrix had little impact on reducing susceptibility artefacts. Increasing the bandwidth produced a relative fall in the signal-to-noise ratio (SNR) of between 49 and 56% for a given matrix, but, in practice, the image quality was still satisfactory even with the highest bandwidth and largest matrix sizes. The acquisition time increased linearly with increasing matrix parameters. Over 90% of the achievable metal artefact reduction can be realized with mid-range matrices and receiver bandwidths on a clinical 1.5T system. The loss of SNR from increasing receiver bandwidth, is preferable to long acquisition times, and therefore, should be the main tool for reducing metal artefact. Copyright 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  14. MR imaging of soft tissue alterations after total hip arthroplasty: comparison of classic surgical approaches

    Energy Technology Data Exchange (ETDEWEB)

    Agten, Christoph A.; Sutter, Reto; Pfirrmann, Christian W.A. [Balgrist University Hospital, Radiology, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland); Dora, Claudio [Balgrist University Hospital, Orthopedic Surgery, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland)

    2017-03-15

    To compare soft-tissue changes after total hip arthroplasty with posterior, direct-lateral, anterolateral, or anterior surgical approaches. MRI of 120 patients after primary total hip arthroplasty (30 per approach) were included. Each MRI was assessed by two readers regarding identification of surgical access, fatty muscle atrophy (Goutallier classification), tendon quality (0 = normal, 1 = tendinopathy, 2 = partial tear, 3 = avulsion), and fluid collections. Readers were blinded to the surgical approach. Surgical access was correctly identified in all cases. The direct lateral approach showed highest Goutallier grades and tendon damage for gluteus minimus muscle (2.07-2.67 and 2.00-2.77; p = 0.017 and p = 0.001 for readers 1 and 2, respectively) and tendon (2.30/1.67; p < 0.0005 for reader 1/2), and the lateral portion of the gluteus medius tendon (2.77/2.20; p < 0.0005 for reader 1/2). The posterior approach showed highest Goutallier grades and tendon damage for external rotator muscles (1.97-2.67 and 1.57-2.40; p < 0.0005-0.006 for reader 1/2) and tendons (1.41-2.45 and 1.93-2.76; p < 0.0005 for reader 1/2). The anterolateral and anterior approach showed less soft tissue damage. Fluid collections showed no differences between the approaches. MRI is well suited to identify surgical approaches after THA. The anterior and anterolateral approach showed less soft tissue damage compared to the posterior and direct lateral approach. (orig.)

  15. Pre-operative function, motivation and duration of symptoms predict sporting participation after total hip replacement.

    Science.gov (United States)

    Ollivier, M; Frey, S; Parratte, S; Flecher, X; Argenson, J N

    2014-08-01

    There is little in the literature on the level of participation in sports which patients undertake after total hip replacement (THR). Our aims in this study were to determine first, the level of sporting activity, second, the predictive factors for returning to sporting activity, and third, the correlation between participation in sports and satisfaction after THR. We retrospectively identified 815 patients who had undergone THR between 1995 and 2005. All were asked to complete a self-administered questionnaire regarding their sporting activity. A total of 571 patients (71%) met the inclusion criteria and completed the evaluation. At a mean follow-up of 9.8 years (sd 2.9), 366 patients (64%) returned to sporting activity as defined by a University of California at Los Angeles (UCLA) score of > 5. The main reasons that patients had for refraining from sports were fear of dislocation (65; 31.6%), avoiding wear (52; 25.4%), and the recommendation of the surgeon (34; 16.6%). There was a significant relationship between higher post-operative participation in sport in those patients with a higher pre-operative Harris hip score (HHS) (p = 0.0074), motivation to participate in sporting activities (p = 0.00022) and a shorter duration of symptoms (p = 0.0034). Finally, there was a correlation between age (p = 0.00013), UCLA score (p = 0.012) and pre-operative HHS (p = 0.00091) and satisfaction. In conclusion, we found that most patients participate in sporting activity after THR, regardless of the advice of their surgeon, and that there is a correlation between the level of participation and pre-operative function, motivation, duration of symptoms and post-operative satisfaction. ©2014 The British Editorial Society of Bone & Joint Surgery.

  16. Preliminary application of computer-assisted patient-specific acetabular navigational template for total hip arthroplasty in adult single development dysplasia of the hip.

    Science.gov (United States)

    Zhang, Yuan Z; Chen, Bin; Lu, Sheng; Yang, Yong; Zhao, Jian M; Liu, Rui; Li, Yan B; Pei, Guo X

    2011-12-01

    The considerable variation in anatomical abnormalities of hip joints associated with different types of developmental dysplasia of hip (DDH) makes reconstruction in total hip arthroplasty (THA) difficult. It is desirable to create patient-specific designs for THA procedures. In the cases of adult single DDH, an accuracy-improved method has been developed for acetabular cup prosthesis implantation of hip arthroplasty. From October 2007 to November 2008, 22 patients with single DDH (according to the Crowe standard, all dysplasia hips were classified as type I) were scanned with spiral CT pre-operatively. These patients scheduled for THA were randomly assigned to undergo either conventional THA (control group, n = 11) or navigation template implantation (NT group, n = 11). In the NT group, three-dimensional (3D) CT pelvis image data were transferred to a computer workstation and 3D models of the hip were reconstructed using the Mimics software. The 3D models were then processed by the Imageware software. In brief, a template that best fitted the location and shape of the acetabular cup was 'reversely' built from the 3D model, the rotation centre of the pathological hip determined by mirroring that of the healthy site, and a guiding hole in the template was then designed. The navigational templates were manufactured using a rapid prototyping machine. These navigation templates guide acetabular component placement. Based on the predetermined abduction angle 45° and anteversion angle 18°, after 1 year follow-up, the NT group showed significantly smaller differences (1.6° ± 0.4°, 1.9° ± 1.1°) from the predetermined angles than those in the control group (5.8° ± 2.9°, 3.9° ± 2.5°) (P < 0.05). The template designs facilitated accurate placement of acetabular components in dysplasia of acetabulum. The hip's center of rotation in DDH could be established using computer-aided design, which provides a useful method for the accurate

  17. Proximal Femur Bone Density Decreases up to 5 Years After Total Hip Arthroplasty in Young, Active Patients.

    Science.gov (United States)

    Nam, Denis; Barrack, Robert L; Clohisy, John C; Nunley, Ryan M

    2016-12-01

    The number of young, active patients undergoing hip arthroplasty continues to increase. The purpose of this study was to evaluate femoral bone density over a 5-year period after hip arthroplasty in young, active patients. A total of 96 patients (103 hips) with a presymptomatic University of California at Los Angeles (UCLA) score ≥6 who had a total hip arthroplasty (THA; 45 hips) or surface replacement arthroplasty (SRA; 58 hips) were prospectively enrolled. UCLA and Harris Hip Scores were collected preoperatively and postoperatively, and dual energy X-ray absorptiometry scans were performed at 6 weeks, 6 months, 1 year, 2 years, and 5 years postoperatively. Bone density was analyzed for 7 traditional Gruen zones in both groups and 6 femoral neck zones in the SRA group. Bone density ratios were calculated for change in bone density compared with baseline. No differences were present in the preoperative or postoperative UCLA or Harris Hip Scores between the SRA and THA cohorts (P = .07-.7). In the THA group, bone density never returned to baseline during the 5-year period in Gruen zones 1 (91.2% of baseline), 2 (94.8%), 6 (97.3%), and 7 (89.2%). There were no decreases in bone mineral density ratio for the femoral Gruen zones in the SRA group at any interval. Femoral neck bone density after SRA increased on the lateral, tension side up to 5 years postoperatively (P femur in Gruen zones 1, 2, and 7 over time. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Intellijoint HIP®: a 3D mini-optical navigation tool for improving intraoperative accuracy during total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Paprosky WG

    2016-11-01

    Full Text Available Wayne G Paprosky,1,2 Jeffrey M Muir3 1Department of Orthopedics, Section of Adult Joint Reconstruction, Department of Orthopedics, Rush University Medical Center, Rush–Presbyterian–St Luke’s Medical Center, Chicago, 2Central DuPage Hospital, Winfield, IL, USA; 3Intellijoint Surgical, Inc, Waterloo, ON, Canada Abstract: Total hip arthroplasty is an increasingly common procedure used to address degenerative changes in the hip joint due to osteoarthritis. Although generally associated with good results, among the challenges associated with hip arthroplasty are accurate measurement of biomechanical parameters such as leg length, offset, and cup position, discrepancies of which can lead to significant long-term consequences such as pain, instability, neurological deficits, dislocation, and revision surgery, as well as patient dissatisfaction and, increasingly, litigation. Current methods of managing these parameters are limited, with manual methods such as outriggers or calipers being used to monitor leg length; however, these are susceptible to small intraoperative changes in patient position and are therefore inaccurate. Computer-assisted navigation, while offering improved accuracy, is expensive and cumbersome, in addition to adding significantly to procedural time. To address the technological gap in hip arthroplasty, a new intraoperative navigation tool (Intellijoint HIP® has been developed. This innovative, 3D mini-optical navigation tool provides real-time, intraoperative data on leg length, offset, and cup position and allows for improved accuracy and precision in component selection and alignment. Benchtop and simulated clinical use testing have demonstrated excellent accuracy, with the navigation tool able to measure leg length and offset to within <1 mm and cup position to within <1° in both anteversion and inclination. This study describes the indications, procedural technique, and early accuracy results of the Intellijoint HIP

  19. Dual Mobility Acetabular Cups in Primary Total Hip Arthroplasty in Patients at High Risk for Dislocation.

    Science.gov (United States)

    Harwin, Steven F; Mistry, Jaydev B; Chughtai, Morad; Khlopas, Anton; Gwam, Chukwuweike; Newman, Jared M; Higuera, Carlos A; Bonutti, Peter M; Malkani, Arthur L; Kolisek, Frank R; Delanois, Ronald E; Mont, Michael A

    2017-07-25

    Postoperative dislocation occurs in approximately 2% of primary total hip arthroplasties (THAs). Risk factors associated with dislocation include: age of 70 years or older, body mass index (BMI) of 30 kg/m2 or greater, alcohol abuse, and neuro-degenerative diseases such as multiple sclerosis or Parkinson's disease. As a result, dual-mobility articulations, which have been typically used for revision procedures, have become an increasingly popular option for these "at risk" primary THAs. Few studies have assessed their use in this complex patient population. Therefore, the purpose of this study was to assess: 1) survivorship; 2) radiographic outcomes (cup migration, progressive radiolucencies, and changes in component position); 3) Harris Hip Scores; and 4) complications of the dual-mobility articulation in the setting of primary THA for patients at high risk for dislocation. Five participating surgeons performed 495 primary cementless THAs between January 2011 and December 2013. During this time, four of the five surgeons used dual-mobility articulations whenever the acetabular cup size was 52 mm or greater to allow for a 28 mm head, while one surgeon used it when the cup size was less than 52 mm to allow for an effective head size of 38 mm. The remaining surgeon used it for all THAs. Of the 495 patients, 453 (92%) received dual-mobility articulations, of which, 43 patients (10%) were lost to follow-up before the two year minimum. The remaining 410 patients were further assessed to determine those who were considered high risk for dislocation (age = 70 years, BMI =30 kg/m2, had a diagnosis of alcohol abuse, or had a neuro-degenerative disorder). Two hundred forty-nine patients were included in the analysis (103 men, 146 women) who had a mean age of 66 years (range, 24 to 90 years). The mean follow-up was 3.3 years (range, 2 to 5 years). Kaplan-Meier analysis was performed to assess aseptic and all-cause acetabular cup survivorship. Radiographs were evaluated for

  20. The Cost of Joint Replacement: Comparing Two Approaches to Evaluating Costs of Total Hip and Knee Arthroplasty.

    Science.gov (United States)

    Palsis, John A; Brehmer, Thomas S; Pellegrini, Vincent D; Drew, Jacob M; Sachs, Barton L

    2018-02-21

    In an era of mandatory bundled payments for total joint replacement, accurate analysis of the cost of procedures is essential for orthopaedic surgeons and their institutions to maintain viable practices. The purpose of this study was to compare traditional accounting and time-driven activity-based costing (TDABC) methods for estimating the total costs of total hip and knee arthroplasty care cycles. We calculated the overall costs of elective primary total hip and total knee replacement care cycles at our academic medical center using traditional and TDABC accounting methods. We compared the methods with respect to the overall costs of hip and knee replacement and the costs for each major cost category. The traditional accounting method resulted in higher cost estimates. The total cost per hip replacement was $22,076 (2014 USD) using traditional accounting and was $12,957 using TDABC. The total cost per knee replacement was $29,488 using traditional accounting and was $16,981 using TDABC. With respect to cost categories, estimates using traditional accounting were greater for hip and knee replacement, respectively, by $3,432 and $5,486 for personnel, by $3,398 and $3,664 for space and equipment, and by $2,289 and $3,357 for indirect costs. Implants and consumables were derived from the actual hospital purchase price; accordingly, both methods produced equivalent results. Substantial cost differences exist between accounting methods. The focus of TDABC only on resources used directly by the patient contrasts with the allocation of all operating costs, including all indirect costs and unused capacity, with traditional accounting. We expect that the true costs of hip and knee replacement care cycles are likely somewhere between estimates derived from traditional accounting methods and TDABC. TDABC offers patient-level granular cost information that better serves in the redesign of care pathways and may lead to more strategic resource-allocation decisions to optimize

  1. [Impact of joint capsule repair and external rotators suture on prognosis in primary total hip arthroplasty by posterolateral approach].

    Science.gov (United States)

    Shen, Pengcheng; Xu, Neng; Jiang, Fugui; Zhu, Lifan; Weng, Fengbiao; Wang, Youhua

    2012-11-01

    To investigate the impact of joint capsule repair and external rotators suture on the prognosis in primary total hip arthroplasty (THA) by posterolateral approach. Between January 2006 and June 2009, 159 patients with femoral neck fracture underwent primary THA by posterolateral approach, and were divided into 4 groups according to different treatments: joint capsule repair and external rotators suture were given in group A (n=38), only joint capsule repair in group B (n=39), only external rotators suture in group C (n=41), and no joint capsule repair or external rotators suture in group D (n=41). There was no significant difference in gender, age, cause of injure, disease duration, type of fracture, combined medical disease, or prosthesis selection among 4 groups (P > 0.05). The bleeding volume, drainage, postoperative hip dislocation rate, hip Harris score, and the hip range of motion (ROM) in internal rotation and external rotation were compared. There was no significant difference in operative time, bleeding volume, or drainage among 4 groups (P > 0.05). Postoperative hip dislocation occurred in 0, 0, 4 (9.8%), and 4 (9.8%) cases of groups A, B, C, and D, respectively, showing significant difference in incidence of postoperative hip dislocation among 4 groups (chi2=7.910, P=0.048). The hip Harris scores were significantly improved after operation when compared with preoperative scores in 4 groups (P hip Harris score at 6 weeks and 6 months after operation among 4 groups (P hip ROM in internal rotation among 4 groups at 6 weeks and 6, 12 months after operation (P > 0.05); but the hip ROM in external rotation were significantly bigger in groups A and C than in groups B and D at 6 weeks and 6 months after operation (P Joint capsule repair and external rotators suture in primary THA by posterolateral approach do not increase the bleeding volume and drainage, but can reduce the early postoperative hip dislocation risk, increase the Harris score, and recover the

  2. Quantitative analysis of orthopedic metal artefact reduction in 64-slice computed tomography scans in large head metal-on-metal total hip replacement, a phantom study

    NARCIS (Netherlands)

    Boomsma, Martijn F.; Warringa, Niek; Edens, Mireille A.; Mueller, Dirk; Ettema, Harmen B.; Verheyen, Cees C. P. M.; Maas, Mario

    2016-01-01

    Purpose: Quantification of the effect of O-MAR on decreasing metal artefacts caused by large head metal on metal total hip arthroplasty (MoM THA) in a dedicated phantom setup of the hip. Background: Pathological reactions of the hip capsule on Computed tomography (CT) can be difficult to diagnose

  3. Uncemented porous tantalum acetabular components: early follow-up and failures in 613 primary total hip arthroplasties.

    Science.gov (United States)

    Noiseux, Nicolas O; Long, William J; Mabry, Tad M; Hanssen, Arlen D; Lewallen, David G

    2014-03-01

    Uncemented tantalum acetabular components were introduced in 1997. The purpose was to determine the 2- to 10-year results with this implant material in primary total hip arthroplasty. Our registry identified all primary total hip cases with porous tantalum cups implanted from 1997 to 2004. Clinical outcomes and radiographs were studied. 613 cases were identified. Seventeen percent of patients were lost to follow-up. Twenty-five reoperations were performed (4.4%). Acetabular cup removal occurred in 6 cases (1.2%). No cups were revised for aseptic loosening. Incomplete radiolucent lines were found on 9.3% of initial postoperative radiographs. At 2 years, 67% had resolved. Zero new radiolucent lines were detected. Two- to 10-year results of porous tantalum acetabular components for primary total hip arthroplasty demonstrate high rates of initial stability and apparent ingrowth. © 2014.

  4. Revision rates for metal-on-metal hip resurfacing and metal-on-metal total hip arthroplasty – a systematic review

    DEFF Research Database (Denmark)

    Ras Sørensen, Sofie-amalie L.; Jørgensen, Henrik L.; Sporing, Sune L.

    2016-01-01

    Purpose To compare revision rates of metal-on-metal (MoM) hip resurfacing (HRS) and MoM total hip arthroplasty (THA), as well as the primary causes for revisions. Methods The PubMed database was queried for potentially relevant articles addressing MoMTHA and MoMHRS, a total of 51 articles were...... cause for revision for both MoMTHA and MoMHRS was loosening 47.6% vs. 37.7%, fracture (MoMTHA 7.69%; MoMHRS 19.62%), metal reactions (MoMTHA 7.69%; MoMHRS 26.92%) infection (MoMTHA 12.08%; MoMHRS 6.54%), instability (MoMTHA 9.13%; MoMHRS 2.69%), manufacturer defect 6.73% for MoMTHA and nonreported...... in revision rate of MoMHRS may indicate a progression in failure....

  5. Physiotherapy rehabilitation after total knee or hip replacement: an evidence-based analysis.

    Science.gov (United States)

    2005-01-01

    The objective of this health technology policy analysis was to determine, where, how, and when physiotherapy services are best delivered to optimize functional outcomes for patients after they undergo primary (first-time) total hip replacement or total knee replacement, and to determine the Ontario-specific economic impact of the best delivery strategy. The objectives of the systematic review were as follows: To determine the effectiveness of inpatient physiotherapy after discharge from an acute care hospital compared with outpatient physiotherapy delivered in either a clinic-based or home-based setting for primary total joint replacement patientsTo determine the effectiveness of outpatient physiotherapy delivered by a physiotherapist in either a clinic-based or home-based setting in addition to a home exercise program compared with a home exercise program alone for primary total joint replacement patientsTo determine the effectiveness of preoperative exercise for people who are scheduled to receive primary total knee or hip replacement surgery Total hip replacements and total knee replacements are among the most commonly performed surgical procedures in Ontario. Physiotherapy rehabilitation after first-time total hip or knee replacement surgery is accepted as the standard and essential treatment. The aim is to maximize a person's functionality and independence and minimize complications such as hip dislocation (for hip replacements), wound infection, deep vein thrombosis, and pulmonary embolism. THE THERAPY: The physiotherapy rehabilitation routine has 4 components: therapeutic exercise, transfer training, gait training, and instruction in the activities of daily living. Physiotherapy rehabilitation for people who have had total joint replacement surgery varies in where, how, and when it is delivered. In Ontario, after discharge from an acute care hospital, people who have had a primary total knee or hip replacement may receive inpatient or outpatient

  6. [Total hip replacement from a MIS-AL approach (comparison with a standard anterolateral approach)].

    Science.gov (United States)

    Kubes, J; Landor, I; Podskubka, A; Majernícek, M

    2009-08-01

    Minimally invasive surgery (MIS) techniques have recently become a powerful and effective marketing instruments that are often perceived by the patient as the criterion of the surgeon's and institution's standard. In addition to studies reporting the benefits of minimally invasive procedures, some authors have recently found no such benefits or even pointed out some disadvantages. In this paper we present our own view of this issue. Our definition of minimally invasive surgery: a minimally invasive procedure is such that an optimally placed incision using anatomical intervals without damage to muscle insertions allows us to gain a good view of the operating field and to safely perform the planned surgery. Because of this optimal approach it is possible to make skin incisions shorter. Between April 21, 2005, and December 28, 2006, the first 40 MIS hip procedures were performed at the Department of Orthopaedic Surgery of the ILF Bulovka. Forty patients who, in the same period, were operated on from an anterolateral standard approach and who met the same indication criteria, including age, comprised a control group. In both groups all routinely used types of implants were included. For objective assessment of potential differences between surgical outcomes of the two techniques, the following para- meters were recorded: operating time, peri-operative blood loss, pre- and post-operative Hb levels, Hb level on the first post- operative morning, amount of blood drained away with a Redon drain, number of anodyne applications (indirect evaluation of post-operative pain) and length of hospital stay. The parameters were compared for the cemented and the uncemented implants separately. The results were evaluated using the paired t-test, with the significance level set at a value of pMIS-AL results with those of the standard total hip replacement procedure did not show any significant differences, not even during further follow-up; by the end of 2008 no implant failure or

  7. Choice of implant combinations in total hip replacement: systematic review and network meta-analysis.

    Science.gov (United States)

    López-López, José A; Humphriss, Rachel L; Beswick, Andrew D; Thom, Howard H Z; Hunt, Linda P; Burston, Amanda; Fawsitt, Christopher G; Hollingworth, William; Higgins, Julian P T; Welton, Nicky J; Blom, Ashley W; Marques, Elsa M R

    2017-11-02

    Objective To compare the survival of different implant combinations for primary total hip replacement (THR). Design Systematic review and network meta-analysis. Data sources Medline, Embase, The Cochrane Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and the EU Clinical Trials Register.Review methods Published randomised controlled trials comparing different implant combinations. Implant combinations were defined by bearing surface materials (metal-on-polyethylene, ceramic-on-polyethylene, ceramic-on-ceramic, or metal-on-metal), head size (large ≥36 mm or small meta-analysis for revision. There was no evidence that the risk of revision surgery was reduced by other implant combinations compared with the reference implant combination. Although estimates are imprecise, metal-on-metal, small head, cemented implants (hazard ratio 4.4, 95% credible interval 1.6 to 16.6) and resurfacing (12.1, 2.1 to 120.3) increase the risk of revision at 0-2 years after primary THR compared with the reference implant combination. Similar results were observed for the 2-10 years period. 31 studies (2888 patients) were included in the analysis of Harris hip score. No implant combination had a better score than the reference implant combination.Conclusions Newer implant combinations were not found to be better than the reference implant combination (metal-on-polyethylene (not highly cross linked), small head, cemented) in terms of risk of revision surgery or Harris hip score. Metal-on-metal, small head, cemented implants and resurfacing increased the risk of revision surgery compared with the reference implant combination. The results were consistent with observational evidence and were replicated in sensitivity analysis but were limited by poor reporting across studies.Systematic review registration PROSPERO CRD42015019435. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go

  8. Characterization and tribology of PEG-like coatings on UHMWPE for total hip replacements.

    Science.gov (United States)

    Kane, Sheryl R; Ashby, Paul D; Pruitt, Lisa A

    2010-03-15

    A crosslinked hydrogel coating similar to poly(ethylene glycol) (PEG) was covalently bonded to the surface of ultrahigh molecular weight polyethylene (UHMWPE) to improve the lubricity and wear resistance of the UHWMPE for use in total joint replacements. The chemistry, hydrophilicity, and protein adsorption resistance of the coatings were determined, and the wear behavior of the PEG-like coating was examined by two methods: pin-on-disk tribometry to evaluate macroscale behavior, and atomic force microscopy (AFM) to simulate asperity wear. As expected, the coating was found to be highly PEG-like, with approximately 83% ether content by x-ray photoelectron spectroscopy and more hydrophilic and resistant to protein adsorption than uncoated UHMWPE. Pin-on-disk testing showed that the PEG-like coating could survive 3 MPa of contact pressure, comparable to that experienced by total hip replacements. AFM nanoscratching experiments uncovered three damage mechanisms for the coatings: adhesion/microfracture, pure adhesion, and delamination. The latter two mechanisms appear to correlate well with wear patterns induced by pin-on-disk testing and evaluated by attenuated total reflection Fourier transform infrared spectroscopy mapping. Understanding the mechanisms by which the PEG-like coatings wear is critical for improving the behavior of subsequent generations of wear-resistant hydrogel coatings. (c) 2009 Wiley Periodicals, Inc.

  9. Influence of personality psychology on outcome of total hip arthroplasty: a cross-sectional study on 69 patients.

    Science.gov (United States)

    Trevisan, C L; Klumpp, R; Recalcati, W; Compagnoni, R

    2015-12-01

    Patient's satisfaction after total hip arthroplasty is influenced by many surgical and rehabilitation aspects, but is not available in the literature, a study that analyses the correlation between patient's psychology and clinical results of this procedure. The aim of this study was to investigate the relationship between memory of pain, clinical outcome and subjective satisfaction with the Multidimensional Health Locus of Control. We conducted a cross-sectional study on a cohort of 69 patients operated of total hip arthroplasty in our department from November 2008 to August 2011. Pre- and post-operative hip function was assessed by the Harris Hip Score. At the follow-up visit, patient satisfaction was assessed by means of the Patient Satisfaction Questionnaire. The memory of pain was evaluated by a modified questionnaire of pain experience. Multidimensional Health Locus of Control was evaluated in all patients, and results were connected with patient's subjective satisfaction and pain indexes. Patients were divided into two groups about patient satisfaction, those with GPS > 15 and those with GPS ≤ 15. Patients very satisfied showed a significantly higher mean value of IHLC. Regarding pain experience, patients were divided into two categories: those recalling less pain with OvP score ≤11 (Q1 11. IHLC score resulted significantly higher in patients recalling less pain. Multidimensional Health Locus of Control can be considered a predictor of patient's satisfaction after an invasive surgical procedure as total hip arthroplasty.

  10. 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.

  11. Monitoring of blood pressure during total hip arthroplasty using the interface bioactive bone cement (IBBC) technique.

    Science.gov (United States)

    Fujita, Hiroshi; Okumura, Tomoo; Hara, Hiroaki; Toda, Hiroshi; Harada, Hideto; Nishimura, Ryuuichi; Tominaga, Tomohiro

    2015-03-01

    Cement implantation syndrome, which is characterized by hypotension, hypoxemia, and cardiac arrhythmia or arrest, has been reported in the literature. The purpose of the present study was to monitor the blood pressure changes that occur after cementing during primary total hip arthroplasty (THA). The present study examined 178 cases in which 204 joints were treated with primary THA. Study subjects had a mean age at the time of surgery of 64.5 years (range 35-89). Under general anesthesia, both hip components were cemented in place using an anterolateral approach. After cementing, systolic arterial blood pressure was measured at 1-min intervals for 5 min and then again at 10 min. The maximum regulation ratio (MRR) was calculated as follows: (maximum change in blood pressure - blood pressure before cement application) divided by blood pressure before cement application. No major complications, such as cardiac arrest, occurred in most cases; blood pressure increased until 4 mins on the acetabular side and until 2 min on the femoral side, and then gradually returned to the level observed prior to cement application. On the acetabular side, the mean MRR was 11.2 % [standard deviation (SD): 15.9; range -26 to -80], whereas it was 6.4 % (SD: 14.9; range -31 to -65) on the femoral side. Correlations were detected between MRR classification on the acetabular side and the subject's age at the time of the operation or bleeding control status on the acetabular side. When bleeding control was judged as complete, the tendency for blood pressure to decrease was reduced. Conversely, when bleeding control was judged as good, blood pressure showed a greater tendency to decrease. In the present study, no episodes of major hypotension occurred. During THA involving the interface bioactive bone cement (IBBC) technique, when bleeding control on the acetabular side was judged as complete the tendency for blood pressure to decrease was reduced.

  12. Vancouver type B2 and B3 periprosthetic fractures treated with revision total hip arthroplasty.

    Science.gov (United States)

    Amenabar, Tomas; Rahman, Wael A; Avhad, Vineet V; Vera, Ramiro; Gross, Allan E; Kuzyk, Paul R

    2015-10-01

    Periprosthetic fractures are the fourth most common cause for hip revision and a devastating complication. Our purpose is to report results and quality of life following revision THA for Vancouver B2 and B3 fractures. This was a retrospective review from January 2000 to November 2012 to identify all revision THA performed for Vancouver types B2 and B3 that had a minimum follow-up of two years. Routine post-operative and radiographic evaluation to assess patient survival, implant failure, complications and quality of life was involved. Statistical analysis was made with the Kaplan-Meier survival curve with 95 % confidence interval and the log rank (Mantel-Cox) test. A total of 76 fractures were included, with an average follow-up 74.4 months. Mean age at the revision surgery was 75.7 years (range, 41-97 years; SD, 12.4). Sixty-six cases were classified as Vancouver B2 and treated with distal fixation stem. Ten cases were Vancouver B3 and a proximal femoral allograft technique was used. The overall five-year Kaplan-Meier survival rate for the patients was 77.9 % (95 % CI, 67.4-88.4), and the ten-year rate was 65.1 % (95 % CI, 51.4-78.8). Five-year Kaplan-Meier survival rate for the implants was 89.6 % (95 % CI, 82.2-97); we presented seven failures. The mean SF-12 mental was 55.1 (range, 31-68; SD, 8.1) and the physical was 37.4 (range, 16-55; SD, 9.4). Mortality rate after periprosthetic fractures is high as compared to other hip surgeries; our Kaplan-Meier analysis showed that it tends to plateau after five years. In our series the failure rate was low and occurred early in the post-operative period.

  13. Preoperative quadriceps strength as a predictor for short-term functional outcome after total hip replacement.

    Science.gov (United States)

    Holstege, Marije S; Lindeboom, Robert; Lucas, Cees

    2011-02-01

    To determine the preoperative strength of the muscle group of the lower extremity that is most important in predicting functional recovery after primary unilateral total hip replacement (THR). Prospective observational study with inception cohort. Joint care program (hospital care/clinical division of a nursing home/outpatient physical therapy). Patients (N=55) undergoing primary unilateral THR. Not applicable. Baseline measures within 2 weeks preoperative and follow-up at 6 and 12 weeks postoperative included isometric strength measurement of the hip (flexors, extensors, abductors, adductors) and knee (flexors, extensors) musculature using a handheld dynamometer. Functional outcome was tested using performance-based (Timed Up and Go Test, 6-Minute Walk Test) and self-report measures (Western Ontario and McMaster Universities Osteoarthritis Index, subscale Physical Function [WOMAC PF], 36-Item Short Form Health Survey subscale Mental Health, visual analog scale for pain). Of the patients (N=55; mean age, 72.7±6.8y; 41 women) included; 18 dropped out, leaving 37 patients for analyses. After correction for WOMAC PF score at baseline, body mass index, sex, and age, the preoperative knee extensors strength measure of the operated site was the only muscle group showing a significant effect on functional outcome measured by using the WOMAC PF at 12 weeks postoperatively (R(2)=.355; β=-.105; P for β=.004). Preoperative greater knee extensor strength of the operated site is associated with better physical function, measured by using the WOMAC PF at 12 weeks postoperative. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  14. Primary total hip arthroplasty revision due to dislocation: prospective French multicenter study.

    Science.gov (United States)

    Girard, J; Kern, G; Migaud, H; Delaunay, C; Ramdane, N; Hamadouche, M

    2013-09-01

    Dislocation following total hip arthroplasty (THA) may require surgical revision, and is one of the most frequent causes for revision in national registers. The goals of this study were to determine the characteristics of revision THA for dislocation and identify the typical features of hips revised due to dislocation. A prospective multicenter study (30 centers) was performed in first revision THA performed between January 1, 2010 and December 31, 2011 (multiple revisions were excluded). Two hundred nineteen (10.4%) of all first revisions (2153 cases in 2107 patients) were for dislocation, which was the fifth cause of revision. There were 135 men and 84 women, mean age 65.9 years old (24.3-92.4) at primary THA and 72.9 years old (31.9-98.8) at revision. Revision surgery was performed a mean 7.1 years (± 7.1) after primary THA. The predictive risk factors for dislocation were: a 22.2mm diameter femoral head (risk × 2.4), a posterolateral approach (risk × 1.7), older age (risk × 1.1), an elevated rim liner for primary THA (risk × 6.6). The use of a dual mobility cup did not influence the rate of revision for dislocation (8.8%) compared to the use of a flat rim liner (9.1%). The 10.4% rate of revision of THA for dislocation seems markedly lower than the results in the literature both for frequency and ranking. The use of elevated rim or constrained liners designed to decrease the risk of dislocation does not improve results compared to standard liners. Level IV, prospective prognostic study without a control group. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  15. A Novel Approach for Dynamic Testing of Total Hip Dislocation under Physiological Conditions

    Science.gov (United States)

    Herrmann, Sven; Kluess, Daniel; Kaehler, Michael; Grawe, Robert; Rachholz, Roman; Souffrant, Robert; Zierath, János; Bader, Rainer; Woernle, Christoph

    2015-01-01

    Constant high rates of dislocation-related complications of total hip replacements (THRs) show that contributing factors like implant position and design, soft tissue condition and dynamics of physiological motions have not yet been fully understood. As in vivo measurements of excessive motions are not possible due to ethical objections, a comprehensive approach is proposed which is capable of testing THR stability under dynamic, reproducible and physiological conditions. The approach is based on a hardware-in-the-loop (HiL) simulation where a robotic physical setup interacts with a computational musculoskeletal model based on inverse dynamics. A major objective of this work was the validation of the HiL test system against in vivo data derived from patients with instrumented THRs. Moreover, the impact of certain test conditions, such as joint lubrication, implant position, load level in terms of body mass and removal of muscle structures, was evaluated within several HiL simulations. The outcomes for a normal sitting down and standing up maneuver revealed good agreement in trend and magnitude compared with in vivo measured hip joint forces. For a deep maneuver with femoral adduction, lubrication was shown to cause less friction torques than under dry conditions. Similarly, it could be demonstrated that less cup anteversion and inclination lead to earlier impingement in flexion motion including pelvic tilt for selected combinations of cup and stem positions. Reducing body mass did not influence impingement-free range of motion and dislocation behavior; however, higher resisting torques were observed under higher loads. Muscle removal emulating a posterior surgical approach indicated alterations in THR loading and the instability process in contrast to a reference case with intact musculature. Based on the presented data, it can be concluded that the HiL test system is able to reproduce comparable joint dynamics as present in THR patients. PMID:26717236

  16. The Direct Anterior Approach is Associated With Early Revision Total Hip Arthroplasty.

    Science.gov (United States)

    Eto, Shuichi; Hwang, Katherine; Huddleston, James I; Amanatullah, Derek F; Maloney, William J; Goodman, Stuart B

    2017-03-01

    The direct anterior approach for total hip arthroplasty (THA) has generated increased interest recently. The purpose of this study was to compare the duration to failure and reasons for revision of primary THA performed elsewhere and subsequently revised at our institution after the direct anterior vs other nonanterior surgical approaches to the hip. All primary THAs performed elsewhere and referred to our institution for revision were divided into the direct anterior approach (30 cases) or nonanterior approach groups (100 cases, randomly selected from 453 cases) based on the original surgical approach. Because all primary direct anterior THAs were originally performed after 2004 to eliminate temporal bias, we identified a subset of the nonanterior group in which the primary THA was performed after 2004 (known as the recent nonanterior group, 100 cases, randomly selected from 169 available cases). The mean duration from primary to revision THA was 3.0 ± 2.7 years (direct anterior approach), 12.0 ± 8.8 years (nonanterior approach), and 3.6 ± 2.8 years (recent nonanterior), respectively. There was a significant difference in time to revision between the direct anterior and nonanterior approach groups (P < .001). Aseptic loosening of the stem was significantly more frequent with the direct anterior approach group (9/30, 30.0%) when compared with the nonanterior group (8/100, 8.0%, P = .007) and the recent nonanterior group (7/100, 7.0%, P = .002). Revision of the femoral component for aseptic loosening is more commonly associated with the direct anterior approach in our referral practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Predictive factors for metal ion levels in metal-on-metal total hip arthroplasty.

    Science.gov (United States)

    Kasparek, Maximilian F; Renner, Lisa; Faschingbauer, Martin; Waldstein, Wenzel; Weber, Michael; Boettner, Friedrich

    2018-02-01

    Although metal-on-metal (MoM) total hip arthroplasty (THA) and hip resurfacings (HR) have similar bearing surfaces and comparable wear rates, metal ion levels and risk of failure are higher for MoM-THA. The mechanism behind the increased metal ion levels in large head MoM-THA is not completely understood. The current study aims to identify predictive factors for increased metal ion levels in unilateral and bilateral large head MoM-THA. 99 Birmingham modular MoM-THA in 87 patients with metal ion levels at least 36 months after index procedure were analyzed. Mean follow-up time was 61.3 months (range 37-108) and the relationship of the following variables (gender, age, BMI, follow-up time, UCLA Activity Score, cup inclination, femoral head size, bilateral surgery) on metal ion levels were analyzed with multivariate regression models. Multivariate regression analysis revealed that bilateral MoM-THA surgery (p MoM-THA (p = 0.004) were positively correlated with chromium levels. Positive independent predictors for the cobalt-chromium ratio in the multivariate analysis were overall follow-up time (p = 0.004), bilateral MoM-THA (p MoM-THA, increased patient activity levels and female gender are associated with increased chromium levels. Patients with larger component size, longer follow-up time and bilateral MoM-THAs have an increased cobalt-chromium ratio. These patients might be at increased risk for adverse local soft tissue reactions secondary to corrosion. Continuous close monitoring is recommended and bearing-surface change should be discussed if local tissue reactions occur.

  18. Gait abnormalities before and after total hip arthroplasty differ in men and women.

    Science.gov (United States)

    Foucher, Kharma C

    2016-10-03

    This study tested the hypothesis that men and women have different preoperative and postoperative gait impairment relative to sex-matched healthy controls, and that the extent of gait improvement after total hip arthroplasty (THA) is different between men and women. A group of 124 THA subjects was identified from a motion analysis data repository; age and BMI-matched male and female control groups were then identified from the same repository. Dynamic sagittal plane hip range of motion (HROM) and peak 3D external moments at subjects' normal walking speeds were analyzed. Each hypotheses was tested using linear regression models, to adjust for potential confounding effects of walking speed. Preoperatively, the THA vs. control group differences in the HROM and peak adduction moments were larger in women than they were in men (p=0.007). The THA group vs. control group difference in the peak external rotation moment was larger in men (p=0.004). After surgery, HROM increased more in women than in men (p=0.020). However, peak adduction moment decreased in men but increased in women (-0.11±0.93 vs. 0.28±1.3%BWH, p=0.045). Accordingly, postoperatively the THA group vs. control group differences in the peak external rotation moment remained larger in men than in women (p=0.016). There were no other sex-specific differences (p=0.072-0.876). This study suggests that men and women have slightly different patterns of gait recovery after THA and may benefit from sex-specific rehabilitation strategies. These differences also underscore the importance of accounting for sex in biomechanical studies. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Total Hip Arthroplasty Dislocations Are More Complex Than They Appear: A Case Report of Intraprosthetic Dislocation of an Anatomic Dual-Mobility Implant After Closed Reduction

    Science.gov (United States)

    Waddell, Bradford S.; De Martino, Ivan; Sculco, Thomas; Sculco, Peter

    2016-01-01

    Background: Total hip arthroplasty is a successful operation for the treatment of hip pain. One of the common complications of hip arthroplasty is dislocation. While reduction of standard prosthetic dislocations is highly successful, new prostheses add the potential for new complications. Case Report: We present the case of a patient who experienced intraprosthetic dislocation of an anatomic dual-mobility total hip prosthesis after a closed hip reduction and include the prereduction and postreduction radiographic findings. Conclusion: Emergency department physicians should be aware of intraprosthetic dislocation. This complication can be easily missed because the metal/ceramic femoral head appears to be reduced in the acetabulum. PMID:27303232

  20. Total Hip Arthroplasty Dislocations Are More Complex Than They Appear: A Case Report of Intraprosthetic Dislocation of an Anatomic Dual-Mobility Implant After Closed Reduction.

    Science.gov (United States)

    Waddell, Bradford S; De Martino, Ivan; Sculco, Thomas; Sculco, Peter

    2016-01-01

    Total hip arthroplasty is a successful operation for the treatment of hip pain. One of the common complications of hip arthroplasty is dislocation. While reduction of standard prosthetic dislocations is highly successful, new prostheses add the potential for new complications. We present the case of a patient who experienced intraprosthetic dislocation of an anatomic dual-mobility total hip prosthesis after a closed hip reduction and include the prereduction and postreduction radiographic findings. Emergency department physicians should be aware of intraprosthetic dislocation. This complication can be easily missed because the metal/ceramic femoral head appears to be reduced in the acetabulum.

  1. Determining Health-Related Quality-of-Life Outcomes Using the SF-6D Following Total Hip Arthroplasty.

    Science.gov (United States)

    Elmallah, Randa K; Chughtai, Morad; Adib, Farshad; Bozic, Kevin J; Kurtz, Steven M; Mont, Michael A

    2017-03-15

    Following total hip arthroplasty, patients' perception of their postoperative improvement and health plays a large role in satisfaction with and success of the surgical procedure. The Short Form-6D (SF-6D) is a health-related quality-of-life measure that assigns numerical value to the perception of patients' own health. The purpose was to determine SF-6D values of patients after total hip arthroplasty, to determine whether score changes were clinically relevant, and to compare these with postoperative functional improvements. We evaluated 188 patients who underwent primary total hip arthroplasty at 7 institutions and who had a mean age of 69 years (range, 47 to 88 years) and a mean body mass index of 28.8 kg/m (range, 19.8 to 38.9 kg/m). The SF-6D values were obtained from patients' SF-36 scores, and clinical relevance of value changes was determined using effect size. Using previous research, effect sizes were considered small between 0.2 and 0.5, moderate between 0.6 to 0.8, and large at >0.8. Clinical correlation was assessed using the Lower-Extremity Activity Scale and Harris hip scores. Patients were assessed preoperatively and postoperatively at 6 months and 1, 2, 3, and 5 years. The SF-6D scores improved from preoperatively and achieved significance (p total hip arthroplasty correlate with functional outcomes and have clinical relevance, as demonstrated by their effect size. Incorporating this straightforward and easy-to-use measurement tool when evaluating patients following total hip arthroplasty will facilitate future cost-utility analyses. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  2. Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study.

    Science.gov (United States)

    Burgers, P T P W; Hoogendoorn, M; Van Woensel, E A C; Poolman, R W; Bhandari, M; Patka, P; Van Lieshout, E M M

    2016-06-01

    The aim of this study was to determine the total medical costs for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The mean total costs per patient at 2 years of follow-up were €26,399. These results contribute to cost awareness. The absolute number of hip fractures is rising and increases the already significant burden on society. The aim of this study was to determine the mean total medical costs per patient for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The population was the Dutch sample of an international randomized controlled trial consisting of femoral neck fracture patients treated with hemi- or total hip arthroplasty. Patient data and health care utilization were prospectively collected during a total follow-up period of 2 years. Costs were separated into costs for hospital care during primary stay, hospital costs for clinical follow-up, and costs generated outside the hospital during rehabilitation. Multiple imputations were used to account for missing data. Data of 141 participants (mean age 81 years) were included in the analysis. The 2-year mortality rate was 19 %. The mean total cost per patient after 10 weeks of follow-up was €15,216. After 1 and 2 years of follow-up the mean total costs were €23,869 and €26,399, respectively. Rehabilitation was the main cost determinant, and accounted for 46 % of total costs. Primary hospital admission days accounted for 22 % of the total costs, index surgery for 11 %, and physical therapy for 7 %. The main cost determinants for hemi- or total hip arthroplasty after treatment of displaced femoral neck fractures (€26,399 per patient until 2 years) were rehabilitation and nursing homes. Most of the costs were made in the first year. Reducing costs after hip fracture surgery should focus on improving the duration and efficiency of the rehabilitation phase.

  3. 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

  4. The use of clinical analysis of movements in evaluation of motor functional status of patients after total hip replacement

    Directory of Open Access Journals (Sweden)

    Romakina N.A.

    2016-06-01

    Full Text Available Aim: to estimate functional status of coxarthrosis in patients requiring total hip replacement of the two hip joints. Material and methods. The biomechanical examination of 94 patients with bilateral primary coxarthrosis before and after total hip replacement was performed using clinical stabilometric software complex. The ability to perceive the mechanical load during standing and walking was evaluated at different stages of the treatment. The difference between the samples was estimated with the use of Mann — Whitney U-test. The rank correlation of biomechanical parameters was measured by Spearman coefficient. Results. It was revealed that the most responsive indicators are the transfer period, the first and second periods of double support and the deviation of the center of pressure relative to the average position in the frontal plane. Conclusion. After surgical treatment there was observed some improvement: the-left-and-right-step asymmetry decrease, rhythm rate increase, improved ability to maintain body balance, jog reactions increase.

  5. A cadaveric study of posterior dislocation after total hip replacement-effects of head diameter and acetabular anteversion.

    Science.gov (United States)

    Ng, Fu Yuen; Zhang, Jiang Tao; Chiu, Kwong Yuen; Yan, Chun Hoi

    2011-03-01

    The size of the femoral head and acetabular anteversion are crucial for stability in total hip replacements. This study examined the effects of head diameter and acetabular anteversion on the posterior instability after total hip replacement in an in vivo setting. The acetabular shell was inserted at 0-20° of anteversion at five degree intervals. By using different head sizes (28 mm, 32 mm, 36 mm), the degrees of dislocation were recorded by computer navigation. The 36-mm group consistently showed better stability compared with the 32- and 28-mm groups, regardless of the degree of cup anteversion. Within each group of head size, the hip was significantly more stable when the cup anteversion increased from 0° to 10°. The difference became insignificant when it increased from 15° to 20°.

  6. 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

  7. Reinfusion of whole blood after revision surgery for infected total hip and knee arthroplasties.

    Science.gov (United States)

    Lux, P S; Martin, J W; Whiteside, L A

    1993-04-01

    Because of its proven effectiveness in reducing the need for banked blood transfusions following total joint arthroplasty, the indications for postoperative blood retrieval were expanded to include seven cases of infected total knee or hip arthroplasties where a one-stage exchange procedure was performed. Each joint had been aspirated after surgery and had positive cultures but no gross pus at the time of revision surgery. Each of the operations included debridement with reimplantation of a cementless prosthesis under cover of intravenous antibiotics for 48 hours followed by oral treatment until discharge. Antibiotic-soaked morselized bone graft was used in all patients to restore deficient nonstructural bone. Wound drainage blood was retrieved and reinfused during the first 8 hours after surgery, averaging 958 cc. Banked blood usage averaged 2.4 U (88% homologous) with an average blood loss of 1,974 cc. One patient experienced shaking chills during a second reinfusion of 600 cc of blood without stoppage of the transfusion. Wound hematoma occurred in one patient but did not require surgical evacuation. No patient developed evidence of septicemia.

  8. Danish surgeons allow the most athletic activities after total hip and knee replacement.

    Science.gov (United States)

    Laursen, Mia K; Andersen, Jakob B; Andersen, Mikkel M; Simonsen, Ole H; Laursen, Mogens B

    2014-12-01

    Counselling patients for or against athletic activities after well performed total hip arthroplasty (THA) and total knee arthroplasty (TKA). Level of evidence is low, and the current international guidelines are based on North American expert opinions in 2001 and 2008. Could technical and operative development and social or cultural differences apply for different counselling? All Danish experts in head of departments performing more than 100 THAs or TKAs per year, were invited to fill in a questionnaire regarding the most popular sport activities in the Danish 60-69 years old population Response rate was 74 and 89% for the TKA and THA departments, respectively. A pronounced variation between the departments was observed and compared to the latest published US recommendations in 2007, the present Danish recommendations are significantly more liberal. Athletic activities are now allowed by 87% of the Danish arthroplasty departments. Of these 55% allow for high-impact activities after THA compared to 21% in US in 2007 (p activities after TKA compared to the 55% after THA (p < 0.0001). Based on the pronounced variation between departments and the fact that a highly significant trend was observed over 5 years on an undocumented basis it was concluded that there is an imminent need for a higher scientific level on this issue—which hopefully can develop in a few years using PROMs in large scale follow-up studies.

  9. [Quality of life in patients before and after total hip arthroplasty].

    Science.gov (United States)

    Lapaj, Lukasz; Kokoszka, Paweł; Jurga, Małgorzata; Markuszewski, Jacek; Wierusz-Kozłowska, Małgorzata

    2007-01-01

    Osteoarthritis is the most common joint disease in adults and according to WHO is one of the civilisation threats. Total joint replacement is the best method of treatment of severe osteoarthritis. The study group consisted of 62 (44 women, 18 men) patients, who due to the severe osteoarthritis underwent total hip replacement at the Department of Orthopaedics Poznań University of Medicine. The mean age was 63 (range 30-87). For the evaluation of the quality of life the modified questionnaire WHOQOL-100 was used. The first evaluation was performed before the surgery, the second one 12-18 (average 14) months postoperatively. At the final evaluation the improvement was observed in the following domains: physical, psychological, level of independence, environmental and the global quality of life. No change was observed in the domain "social relations". The greatest improvement was observed in the following subscales: "pain and discomfort", "vitality and fatigue", mobility, "everyday activities", "drug dependence", transportation. No significant change was found in the following subscales: "sleep and rest", "positive feelings", "ability to work and learn", "personal social relations" and accessibility and quality of healthcare.

  10. No Difference in Dislocation Seen in Anterior Vs Posterior Approach Total Hip Arthroplasty.

    Science.gov (United States)

    Maratt, Joseph D; Gagnier, Joel J; Butler, Paul D; Hallstrom, Brian R; Urquhart, Andrew G; Roberts, Karl C

    2016-09-01

    The direct anterior approach (DAA) for total hip arthroplasty (THA) has rapidly become popular, but there is little consensus regarding the risks and benefits of this approach in comparison with a modern posterior approach (PA). A total of 2147 patients who underwent DAA THA were propensity score matched with patients undergoing PA THA on the basis of age, gender, body mass index, and American Society of Anesthesia classification using data from a state joint replacement registry. Mean age of the matched cohort was 64.8 years, mean body mass index was 29.1 kg/m(2), and 53% were female. Multilevel logistic regression models using generalized estimating equations to control for grouping at the hospital level were used to identify differences in various outcomes. There was no difference in the dislocation rate between patients undergoing DAA (0.84%) and PA (0.79%) THA. Trends indicating a slightly longer length of stay with the PA and a slightly greater risk of fracture, increased blood loss, and hematoma with the DAA are consistent with previous studies. On the basis of short-term outcome and complication data, neither approach has a compelling advantage over each other, including no difference in the dislocation risk. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. A hybrid mock circulation loop for a total artificial heart.

    Science.gov (United States)

    Nestler, Frank; Bradley, Andrew P; Wilson, Stephen J; Timms, Daniel L; Frazier, O Howard; Cohn, William E

    2014-09-01

    Rotary blood pumps are emerging as a viable technology for total artificial hearts, and the development of physiological control algorithms is accelerated with new evaluation environments. In this article, we present a novel hybrid mock circulation loop (HMCL) designed specifically for evaluation of rotary total artificial hearts (rTAH). The rTAH is operated in the physical domain while all vasculature elements are embedded in the numerical domain, thus combining the strengths of both approaches: fast and easy exchange of the vasculature model together with improved controllability of the pump. Parameters, such as vascular resistance, compliance, and blood volume, can be varied dynamically in silico during operation. A hydraulic-numeric interface creates a real-time feedback loop between the physical and numerical domains. The HMCL uses computer-controlled resistance valves as actuators, thereby reducing the size and number of hydraulic elements. Experimental results demonstrate a stable interaction over a wide operational range and a high degree of flexibility. Therefore, we demonstrate that the newly created design environment can play an integral part in the hydraulic design, control development, and durability testing of rTAHs. Copyright © 2014 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  12. Patients' outcome after total hip arthroplasty: a comparison between the Western Ontario and McMaster Universities index and the Oxford 12-item hip score.

    Science.gov (United States)

    Garbuz, Donald S; Xu, Min; Sayre, Eric C

    2006-10-01

    This prospective cohort study included 402 patients who had primary total hip arthroplasty. The Western Ontario and McMaster Universities Index (WOMAC) and the Oxford 12-item Hip Score (OHS) were used to assess patients preoperatively and at 1 year postoperation. The OHS has a higher responsiveness than the WOMAC in the global scale and in the pain subscale. However, the WOMAC has better responsiveness in its function scale. The point estimate of relative precision of measuring postoperative quality of life shows that the OHS has a tendency toward a better performance than the WOMAC; however, this finding is not statistically significant. The OHS also demonstrates similar floor and ceiling effect patterns as does the WOMAC. We recommend that the choice should depend on which scale researchers are using to power a study.

  13. A Systematic Review of Arthroscopic Versus Open Tenotomy of Iliopsoas Tendonitis After Total Hip Replacement.

    Science.gov (United States)

    O'Connell, Robert S; Constantinescu, David S; Liechti, Daniel J; Mitchell, Justin J; Vap, Alexander R

    2018-01-17

    To conduct a systematic review of the literature comparing patient outcomes following arthroscopic and open operative management of iliopsoas tendonitis (IPT) following total hip replacement (THR). This review study was conducted in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. Inclusion criteria were as follows: outcome studies following open or arthroscopic iliopsoas tendon release after THR with at least 6 months of follow-up, English language, and human studies. The exclusion criteria included case reports, articles evaluating nonsurgical management or cup revision, and articles without a specific diagnosis of IPT or in which results between open and arthroscopic treatment were reported in conjunction. A total of 131 studies were initially retrieved, with 7 satisfying all inclusion criteria (4 studies on arthroscopic tenotomy and 3 studies on open tenotomy). The review included a total of 88 patients with IPT-61 patients treated arthroscopically and 27 patients treated with open tenotomy. In total, 77 of the 88 patients demonstrated successful outcomes following surgery. In the group treated with arthroscopy, 91.8% (56/61) of patients had successful outcomes, whereas in those treated with open tenotomy, 77.8% (21/27) of patients had successful outcomes. Of patients with signs of mechanical impingement from acetabular component overhang, those who underwent open tenotomy had complete pain relief in 6/8 patients (75%) compared to arthroscopic tenotomy in which there was relief in 40/43 patients (93%). Arthroscopic iliopsoas release for management of IPT is suggested to be an effective minimally invasive operative technique that may also yield a lower complication rate in comparison to open tenotomy. Tenotomy, both arthroscopic and open, are successful treatment options for IPT, including those with signs of mechanical impingement, and are recommended prior to cup revision. Level IV, systematic review of

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

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  15. 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

    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

  16. Successful Treatment of Candida Albicans-Infected Total Hip Prosthesis With Staged Procedure Using an Antifungal-Loaded Cement Spacer

    NARCIS (Netherlands)

    Deelstra, Jenneke J.; Neut, Danielle; Jutte, Paul C.

    We present a rare case of an immunocompetent host who developed a Candida albicans-infected total hip prosthesis. The infection could not be eradicated with debridement and extensive antifungal therapy. Our patient first underwent a resection of the proximal femur and local treatment with

  17. 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

  18. 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

  19. Preoperative prediction of inpatient recovery of function after total hip arthroplasty using performance-based tests: a prospective cohort study

    NARCIS (Netherlands)

    Oosting, E.; Hoogeboom, T.J.; Appelman-de Vries, S.A.; Swets, A.; Dronkers, J.J.; Meeteren, N.L. van

    2016-01-01

    PURPOSE: The aim of this study was to evaluate the value of conventional factors, the Risk Assessment and Predictor Tool (RAPT) and performance-based functional tests as predictors of delayed recovery after total hip arthroplasty (THA). METHOD: A prospective cohort study in a regional hospital in

  20. Postoperative autologous blood transfusion drain or no drain in primary total hip arthroplasty? A randomised controlled trial

    NARCIS (Netherlands)

    Horstmann, Wieger G.; Kuipers, Bart M.; Slappendel, Rob; Castelein, Rene M.; Kollen, Boudewijn J.; Verheyen, Cees C. P. M.

    2012-01-01

    Postoperative maintenance of high haemoglobin (Hb) levels and avoidance of homologous blood transfusions is important in total hip arthroplasty (THA). The introduction of a postoperative drainage autologous blood transfusion (ABT) system or no drainage following THA has resulted in reduction of

  1. 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...

  2. 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...

  3. 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). ...

  4. 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...

  5. Which patient characteristics influence length of hospital stay after primary total hip arthroplasty in a 'fast-track' setting?

    NARCIS (Netherlands)

    Hartog, Y.M. den; Mathijssen, N.M.C.; Hannink, G.J.; Vehmeijer, S.B.

    2015-01-01

    After implementation of a 'fast-track' rehabilitation protocol in our hospital, mean length of hospital stay for primary total hip arthroplasty decreased from 4.6 to 2.9 nights for unselected patients. However, despite this reduction there was still a wide range across the patients' hospital

  6. Large fixed-size metal-on-metal total hip arthroplasty : higher serum metal ion levels in patients with pain

    NARCIS (Netherlands)

    Smeekes, Christiaan; Ongkiehong, Bastiaan; van der Wal, Bart; Wolterbeek, Ron; Henseler, Jan Ferdinand; Nelissen, Rob

    2015-01-01

    Purpose: Recently, concerns have arisen about metal-on-metal (MoM) total hip arthroplasty (THA). Therefore, the purpose of this cross-sectional cohort study was to describe the incidence of pain, pseudotumours, revisions and the relation between elevated metal ion levels, functional outcome and

  7. Predictors of clinical outcome in total hip and knee replacement : a methodological appraisal of implants and patient factors

    NARCIS (Netherlands)

    Keurentjes, Johan Christiaan

    2014-01-01

    In this thesis, we studied both implants and patient and surgeon factors as predictors of clinical outcome after total hip and knee replacement. Additionally, we studied a number of methodological aspects of orthopaedic research, such as competing risks in estimating the probability of revision

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

    Science.gov (United States)

    Hozumi, Akira; Kobayashi, Kyousuke; Tsuru, Nobuhisa; Miyamoto, Chikara; Maeda, Jyunichiro; Chiba, Ko; Goto, Hisataka; Osaki, Makoto

    2015-01-01

    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. 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°. 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." 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.

  9. 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.

  10. Pulmonary Embolism Rates Following Total Hip Arthroplasty With Prophylactic Anticoagulation: Some Pulmonary Emboli Cannot Be Avoided.

    Science.gov (United States)

    Lieberman, Jay R; Cheng, Vincent; Cote, Mark P

    2017-03-01

    A symptomatic pulmonary embolism (PE) after total joint arthroplasty has been described as a "never event." Despite potent anticoagulants and improvements in patient care, PE continues to occur following total hip arthroplasty (THA). This study evaluates symptomatic PE rates over time in THA patients enrolled in multicenter randomized clinical trials (RCTs) assessing the efficacy of venous thromboembolism prophylaxis regimens. The MEDLINE and Cochrane Central Register of Controlled Trials were searched to identify clinical trials assessing prophylactic anticoagulation in patients undergoing THA between January 1995 and December 2015. Inclusion criteria consisted of RCTs evaluating prophylactic anticoagulation in patients undergoing THA. A random effect model was used to combine PE rates across studies. A total of 21 studies (34,764 patients) were included. Patients were administered low molecular weight heparin (13,590 patients), oral factor Xa inhibitors (6609 patients), oral direct thrombin inhibitors (5965 patients), indirect factors Xa/IIa inhibitors (3444 patients), aspirin (2427 patients), and warfarin (489 patients). Mobile compression was used in 199 patients, and placebo was used in 2041 patients. Across all included studies, the estimated PE rate was 0.21% (95% confidence interval: 0.13%, 0.32%). Between 1997 and 2013, the proportion of PEs did not change in regression analysis. Although the PE rate was low, it was consistent throughout the 17 years spanning these RCTs, which excluded patients with significant morbidity. These results suggest that even healthy THA patients receiving aggressive anticoagulation still have a risk for PE, and the "never event" designation requires reassessment. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Total hip arthroplasty for femoral neck fractures as an urgent procedure

    Directory of Open Access Journals (Sweden)

    Radoičić Dragan

    2017-01-01

    Full Text Available Background/Aim. Total hip arthroplasty (THA is one of the most widely accepted operative methods for femoral neck fracture (FNF in elderly. However, the data on the early THA for FNF are very limited. The aim of this study to determine if there were differences in postoperative complications and functional outcomes between an urgent and delayed THA following FNF. Methods. This prospective study included a total of 244 patients who had THA following FNF from January 2010 to January 2013. In the first group 41 FNF patients were treated with THA within less than 12 hours of admission. A total of 203 FNF patients were operated in delayed settings, of whom 162 required prolonged preoperative processing and comorbidities correction. The group II consisted of 41 FNF patients who were fit for the early surgery at admission, but the operation was delayed due to institution related reasons. Main outcome measurements included mortality, functional outcome assessement, cardiological and pulmonary complications, pressure ulcers, dislocations, infections, length of hospitalization and revisions. Results. There were no differences in terms of age, gender, type of implants, neither in mortality, nor complications. There were differences in hospital length of stay [t (51.72 = -10.25, p < 0.001]. The patients operated within less than 12 hours of admission, had significantly better scores at all three time points of functional outcome assessment: at discharge t (80 = 2.556, p < 0.012; one month t (80 = 4.731, p < 0.001; three months t (80 = 5.908, p < 0.001. Conclusion. THA for FNF as an urgent procedure is not a widely accepted concept. Our findings indicate that the early operative treatment, does not worsen clinical outcomes, and our results give an advantage to the policy of the early THA for FNF.

  12. Psychopharmacologic treatment and blood transfusion in fast-track total hip and knee arthroplasty.

    Science.gov (United States)

    Gylvin, Silas Hinsch; Jørgensen, Christoffer Calov; Fink-Jensen, Anders; Johansson, Pär I; Kehlet, Henrik

    2017-04-01

    Selective serotonin reuptake inhibitors (SSRIs) and other psychotropics are receiving increasing attention due to reports on inhibition of thrombocyte function and an increased bleeding risk in surgical settings. Studies in total hip and total knee arthroplasty (THA and TKA, respectively) have shown conflicting results, questioning whether the potential increased bleeding risk is of clinical importance. Prospective consecutive collection of data on preoperative comorbidity in patients undergoing primary unilateral THA or TKA was cross-referenced with regional transfusion databases and The Danish National Database of Reimbursed Prescriptions for information regarding blood transfusions and psychopharmacologic treatment. All participating orthopedic centers followed similar perioperative guidelines. Multiple logistic regression analysis was applied to calculate odds ratios (ORs) for transfusion between preoperative users and nonusers of psychotropics. Of 8402 patients, 569 (6.8%) were SSRI users versus 7833 (93.2%) nonusers. A total of 109 (19,2%) patients in the SSRI group and 700 (8.9%) in the "no-SSRI" group received blood intra- or postoperatively. Preoperative SSRI treatment was a risk factor for perioperative transfusion (OR, 1.98; 95% confidence interval [CI], 1.44-2.70). Other antidepressants (OAs) were associated with an increased risk of transfusion (OR, 1.69; 95% CI, 1.17-2.44) as well as the combination of SSRIs and OAs (OR, 3.31; 95% CI, 1.79-6.13). Singular use of antipsychotics (APs) increased the transfusion risk (OR, 2.37; 95% CI, 1.04-2.41), while AP medicine in combination with antidepressants did not. Preoperative treatment with SSRIs, OAs, or APs are independent risk factors for blood transfusion in elective fast-track THA and TKA. © 2017 AABB.

  13. Does the addition of