WorldWideScience

Sample records for metal hip resurfacing

  1. 21 CFR 888.3400 - Hip joint femoral (hemi-hip) metallic resurfacing prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint femoral (hemi-hip) metallic resurfacing... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3400 Hip joint femoral (hemi-hip) metallic resurfacing prosthesis. (a) Identification. A hip joint femoral (hemi-hip...

  2. Biomimetic Composite-Metal Hip Resurfacing Implant

    Directory of Open Access Journals (Sweden)

    Habiba Bougherara

    2008-01-01

    Full Text Available Hip resurfacing technique is a conservative arthroplasty used in the young patient in which the femoral head is reshaped to accept metal cap with small guide stem. In the present investigation, a hybrid composite-metal resurfacing implant is proposed. The cup is made of carbon fiber/polyamide 12 (CF/PA12 covered with a thin layer of cobalt chrome (Co-Cr. Finite element (FE method was applied to analyze and compare the biomechanical performances of the hybrid hip resurfacing (HHR and the conventional Birmingham (BHR. Results of the finite element analysis showed that the composite implant leads to an increase in stresses in the cancellous bone by more than 15% than BHR, indicating a lower potential for stress shielding and bone fracture and higher potential for bone apposition with the HHR.

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

    International Nuclear Information System (INIS)

    Chen, Zhongbo; Pandit, Hemant; Taylor, Adrian; Gill, Harinderjit; Murray, David; Ostlere, Simon

    2011-01-01

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

  4. Metal-on-Metal Total Hip Resurfacing Arthroplasty

    Science.gov (United States)

    2006-01-01

    Executive Summary Objective 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. Clinical Need 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. The Technology 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

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

    LENUS (Irish Health Repository)

    Memon, Adeel Rasool

    2013-01-01

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

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

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/polymer or ceramic/polymer... Devices § 888.3410 Hip joint metal/polymer or ceramic/polymer semiconstrained resurfacing cemented prosthesis. (a) Identification. A hip joint metal/polymer or ceramic/polymer semi-constrained resurfacing...

  7. 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

  8. 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....... The odds ratio was 1.25 (1.03:1.53) 95% CI (p = 0.03) (MoMHRS vs. MoMTHA). The studies of hip prostheses were separated into 2 categories of short- and long-term (more or less than 5 years). Short-term revision rate for MoMTHA was 4.5% after 4.8 years, and for MoMHRS 4.0% after 4.2 years. The odds ratio...

  9. Hip Resurfacing: An Alternative to Conventional Hip Replacement?

    Science.gov (United States)

    ... Is hip resurfacing a good alternative to hip replacement? Answers from Mark Spangehl, M.D. Hip resurfacing has lost favor with many surgeons ... women with poor bone quality. Unlike traditional hip replacement, hip resurfacing doesn't completely replace the "ball" ...

  10. "Tripolar" hip arthroplasty for failed hip resurfacing: nineteen years follow-up.

    Science.gov (United States)

    Scheerlinck, T; Casteleyn, P P

    2001-10-01

    The authors describe the case of a 37-year-old patient who sustained a subcapital femoral neck fracture six months after ICLH double-cup hip resurfacing. As the polyethylene acetabular resurfacing component was undamaged and well fixed, a standard femoral stem with a bipolar head was inserted. The outer diameter of the bipolar head was chosen to fit the resurfacing socket. The "tripolar" hip arthroplasty has functioned well for 19 years and was revised for aseptic cup loosening. The cemented femoral stem was still well fixed and was not revised. Although the "tripolar" hip has functioned well in our case, we believe it is not indicated for metal on metal bearings. In this case the use of an appropriate modular head with a correct head-socket clearance is preferred.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-03-25

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

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

    International Nuclear Information System (INIS)

    Lazik, Andrea; Lauenstein, Thomas C.; Theysohn, Jens M.; Landgraeber, Stefan; Schulte, Patrick; Kraff, Oliver

    2015-01-01

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

  13. Short-term clinical experience with hip resurfacing arthroplasty.

    Science.gov (United States)

    Cieliński, Łukasz; Kusz, Damian; Wojciechowski, Piotr; Dziuba, Anna

    2007-01-01

    This paper discusses the authors' experience with hip resurfacing arthroplasty. Although introduced many years ago, the method did not gain wide popularity because of poor long-term outcomes. At present, owing to the introduction of metal-on-metal bearings and hybrid fixation techniques, short- and mid-term results are very good and encourage wider use of this technique, especially in the younger and more active patients whose results with standard total hip replacements would be unsatisfactory. We performed 13 hip resurfacing arthroplasties at our institution between August 1, 2005, and May 1, 2006. Twelve patients reported for the scheduled follow-up and were included in the study. Treatment outcomes were assessed according to the Harris Hip Score. The short-term outcomes of hip resurfacing arthroplasties are encouraging. In the study group there were no intraoperative complications, infections, peripheral nerve palsy, hip dislocations or clinically overt vein thrombosis. All of the patients reported complete or major pain relief. Clinical assessment according to the Harris Hip Score revealed improvement from an average of 57.7 (20.1) points preoperatively to an average of 87.7 (12) points after the surgery. Crutches were used for a maximum of 6 weeks postoperatively. All of the patients are currently able to walk without crutches with full weight-bearing. 1) Hip resurfacing arthroplasty seems to be an advisable method of operative management of younger, active patients, in whom standard THR would be associated with a high risk of failure; it allows THR to be postponed and carried out as a revision surgery with the acetabular component already in place. 2) Despite the good short- and mid-term results, the utility of this method should be evaluated with caution due to the lack of adequate long-term follow-up data.

  14. Hip resurfacing arthroplasty: current status and future perspectives

    Directory of Open Access Journals (Sweden)

    K Corten

    2011-03-01

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

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

    International Nuclear Information System (INIS)

    Fritz, Jan; Thawait, Gaurav K.; Fritz, Benjamin; Raithel, Esther; Nittka, Mathias; Gilson, Wesley D.; Mont, Michael A.

    2016-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-10-15

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

  17. Hip resurfacing in a district general hospital: 6-year clinical results using the ReCap hip resurfacing system

    Directory of Open Access Journals (Sweden)

    van der Weegen Walter

    2012-12-01

    Full Text Available Abstract Background The purpose of our study was to prospectively report the clinical results of 280 consecutive hips (240 patients who received a ReCap Hip Resurfacing System implant (Biomet Inc., Warsaw, USA in a single district general hospital. Literature reports a large variation in clinical results between different resurfacing designs and published results using this particular design are scarce. Methods Mean follow up was 3.3 years (1.0 to 6.3 and four patients were lost to follow-up. All patients were diagnosed with end-stage hip osteoarthritis, their mean age was 54 years and 76.4% of all patients were male. Results There were 16 revisions and four patients reported a Harris Hip Score Conclusions This independent series confirms that hip resurfacing is a demanding procedure, and that implant survival of the ReCap hip resurfacing system is on a critical level in our series. In non-revised patients, reported outcomes are generally excellent. Trial registration ClinicalTrials.gov Identifier: NCT00603395

  18. Metal release and metal allergy after total hip replacement with resurfacing versus conventional hybrid prosthesis 5-year follow-up of 52 patients

    DEFF Research Database (Denmark)

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

    2014-01-01

    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....... RESULTS: A statistically significant 10- to 20-fold increase in urinary levels of cobalt and chromium was observed throughout the entire follow-up in the MOM group. The prevalence of metal allergy was similar between groups. INTERPRETATION: While we observed significantly increased levels of metal ions...

  19. Primary total hip replacement versus hip resurfacing - hospital considerations.

    Science.gov (United States)

    Ward, William G; Carter, Christina J; Barone, Marisa; Jinnah, Riyaz

    2011-01-01

    Multiple factors regarding surgical procedures and patient selection affect hospital staffing needs as well as hospital revenues. In order to better understand the potential impact on hospitals that hip arthroplasty device selection (standard total hip arthroplasty vs. resurfacing) creates, a review of all primary hip arthroplasties performed at one institution was designed to identify factors that impacted hospital staffing needs and revenue generation. All primary hip arthroplasties undertaken over three fiscal years (2008 to 2010) were reviewed, utilizing only hospital business office data and medical records data that had been previously extracted prior for billing purposes. Analysis confirmed differing demographics for two hip arthroplasty populations, with the resurfacing patients (compared to the conventional total hip arthroplasty population) consisting of younger patients (mean age, 50 vs. 61 years), who were more often male (75% vs. 45%), were more likely to have osteoarthritis as their primary diagnosis (83 vs. 67%) and were more often covered by managed care or commercial insurance (83 vs. 34%). They also had shorter hospital stays (mean length of stay, 2.3 vs. 4.1 days) and consequently provided a more favorable financial revenue stream to the hospital on a per patient basis. Several trends appeared during the study periods. There was a steady increase in all procedures in all groups except for the resurfacings, which decreased 26% in males and 53% in females between 2009 and 2010. Differences were observed in the demographics of patients presenting for resurfacing, compared to those presenting for conventional total hip arthroplasty. In addition to the revenue stream considerations, institutions undertaking a resurfacing program must commit the resources and planning in order to rehabilitate these patients more expeditiously than is usually required with conventional hip arthroplasty patients.

  20. 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 whil...... a matching metal cup is placed in the acetabulum (pelvis socket)....

  1. 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.

  2. The effect of motion patterns on edge-loading of metal-on-metal hip resurfacing.

    Science.gov (United States)

    Mellon, S J; Kwon, Y-M; Glyn-Jones, S; Murray, D W; Gill, H S

    2011-12-01

    The occurrence of pseudotumours (soft tissue masses relating to the hip joint) following metal-on-metal hip resurfacing arthroplasty (MoMHRA) has been associated with high serum metal ion levels and consequently higher than normal bearing wear. We investigated the relationship between serum metal ion levels and contact stress on the acetabular component of MoMHRA patients for two functional activities; gait and stair descent. Four subjects with MoMHRA, who had their serum metal ion levels measured, underwent motion analysis followed by CT scanning. Their motion capture data was combined with published hip contact forces and finite element models representing 14% (peak force) and 60% (end of stance) of the gait cycle and 52% (peak force) of stair descent activity were created. The inclination angle of the acetabular component was increased by 10° in 1° intervals and the contact stresses were determined at each interval for each subject. When the inclination angle was altered in such a way as to cause the hip contact force to pass through the edge of the acetabular component edge-loading occurred. Edge-loading increased the contact stress by at least 50%; the maximum increase was 108%. Patients with low serum metal ion levels showed no increase in contact stress at peak force during gait or stair descent. Patients with high serum metal ion levels exhibited edge-loading with an increase to the inclination angle of their acetabular components. The increase in inclination angle that induced edge-loading for these subjects was less than the inter-subject variability in the angle of published hip contact forces. The results of this study suggest that high serum metal ion levels are the result of inclination angle influenced edge-loading but that edge-loading cannot be attributed to inclination angle alone and that an individual's activity patterns can reduce or even override the influence of a steep acetabular component and prevent edge-loading. Copyright © 2011 IPEM

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

    Science.gov (United States)

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

    2015-10-15

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

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

    Directory of Open Access Journals (Sweden)

    James K. Lord

    2015-10-01

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

  5. What Is the Rerevision Rate After Revising a Hip Resurfacing Arthroplasty? Analysis From the AOANJRR.

    Science.gov (United States)

    Wong, James Min-Leong; Liu, Yen-Liang; Graves, Stephen; de Steiger, Richard

    2015-11-01

    rerevision between acetabular revision and combined femoral and acetabular revision (hazard ratio [HR], 1.06 [0.47-2], p = 0.888), femoral revision and combined femoral and acetabular revision (HR, 1.00 [0.65-2], p = 0.987), and acetabular revision and femoral revision (HR, 1.06 [0.47-2], p = 0.893). There was no difference in the rate of rerevision when comparing different bearing surfaces (metal-on-metal versus ceramic-on-ceramic HR, 0.46 [0.16-1.29], p = 0.141; metal-on-metal versus ceramic-on-crosslinked polyethylene HR, 0.51 [0.15-1.76], p = 0.285; metal-on-metal versus metal-on-crosslinked polyethylene HR, 0.62 [0.20-1.89], p = 0.399; and metal-on-metal versus oxinium-on-crosslinked polyethylene HR, 0.53 [0.14-2.05], p = 0.356). Revision of a primary hip resurfacing arthroplasty is associated with a high risk of rerevision. This study may help surgeons guide their patients about the outcomes in the longer term after the first revision of hip resurfacing arthroplasty. Level III, therapeutic study.

  6. Adverse reaction to metal debris in a consecutive series of DUROM™ hip resurfacing: pseudotumour incidence and metal ion concentration.

    Science.gov (United States)

    Hartmann, Albrecht; Kieback, Jan-Dirk; Lützner, Jörg; Günther, Klaus-Peter; Goronzy, Jens

    2017-07-25

    The aim of this study was to evaluate the incidence of adverse reactions to metal debris (ARMD) in a consecutive series of DUROM™ Hip Resurfacing Arthroplasty (HRA) at mid-term follow-up. Between October 2003 and March 2007 a total of 134 consecutive DUROM™ HRA in 121 patients were performed at our institution. Follow-up could be obtained in 101 unrevised patients (83%) at a mean time of 8.51 ± 0.97 years postoperatively and included patient-related outcome measurement, plain radiographs, MARS-MRI as well as whole blood metal ion assessment. 17 (16.5%) out of 103 hips revealed pseudotumour occurrence in MRI investigation, 1 (10.6%) with a diameter of ≥2 cm. Higher incidence of pseudotumours was found patients with femoral component size 7 μg/l. In contrast to cobalt determination, only elevated chromium values showed a positive association with pseudotumour occurrence and size. A significant proportion of patients developed pseudotumours and metal ion elevation in a consecutive cohort of DUROM™ HRA after mid-term follow-up. The incidence, however, seems not to differ from results of other well performing resurfacing brands; clinical relevance of our findings is unclear. Regarding potential local as well as systemic effects of metal particle release, close follow-up of patients is essential, even with clinically well-performing implants.

  7. The Role of Hip Arthroscopy in Investigating and Managing the Painful Hip Resurfacing Arthroplasty.

    Science.gov (United States)

    Mei-Dan, Omer; Pascual-Garrido, Cecilia; Moreira, Brett; McConkey, Mark O; Young, David A

    2016-03-01

    To determine the safety and efficacy of hip arthroscopy performed in the peripheral compartment as a diagnostic and therapeutic treatment option for patients with hip pain after hip resurfacing surgery. Indications for hip arthroscopy after hip resurfacing included patients with a symptomatic hip-resurfaced arthroplasties who did not respond to nonoperative treatment. Patients who underwent a hip arthroscopy after a painful hip resurfacing were included with a minimum of 1 year follow-up. Subgroup analysis was performed according to whether an established diagnosis was made before arthroscopic intervention or not. Subjective measures were based on Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, and results were calculated and analyzed. We included 68 patients (26 male [38%] and 42 female [62%]) who underwent subsequent hip arthroscopy from a population of 978 consecutive hip-resurfaced arthroplasties performed between 1999 and 2010. The average age was 58 (range, 37 to 78 years). The mean follow-up after hip arthroscopy was 3.4 years (range, 12 months to 5.8 years). Patients who had an established diagnosis (n = 41) before hip arthroscopy showed statistical improvement in their WOMAC scores (7 to 2, P arthroscopy showed statistical worsening of the WOMAC (15 to 21, P = .002). Ten (37%) of these 27 patients without a diagnosis failed and needed to be converted to a THR. A significant correlation was found between the collections found on ultrasound (psoas bursa and/or in the hip joint) and the need for synovectomy (P = .01). The overall revision rate to THR after hip resurfacing in our group of patients was 1.3% (n = 13). Female patients were more likely to require postresurfacing hip arthroscopy with 42 (60%) female to only 26 (40%) male patients undergoing this procedure. In our study population, 70% (14/21, P arthroscopy. Hip arthroscopy is a safe surgical treatment option for those patients with a painful hip resurfacing

  8. Hip Resurfacing Arthroplasty and Perioperative Blood Testing

    Directory of Open Access Journals (Sweden)

    Andrew Cook

    2014-01-01

    Full Text Available It is standard practice in many institutions to routinely perform preoperative and postoperative haemoglobin level testing in association with hip joint arthroplasty procedures. It is our observation, however, that blood transfusion after uncomplicated primary hip arthroplasty in healthy patients is uncommon and that the decision to proceed with blood transfusion is typically made on clinical grounds. We therefore question the necessity and clinical value of routine perioperative blood testing about the time of hip resurfacing arthroplasty. We present analysis of perioperative blood tests and transfusion rates in 107 patients undertaking unilateral hybrid hip resurfacing arthroplasty by the senior author at a single institution over a three-year period. We conclude that routine perioperative testing of haemoglobin levels for hip resurfacing arthroplasty procedures does not assist in clinical management. We recommend that postoperative blood testing only be considered should the patient demonstrate clinical signs of symptomatic anaemia or if particular clinical circumstances necessitate.

  9. Hip resurfacing arthroplasty in treatment of avascular necrosis of the femoral head.

    Science.gov (United States)

    Pyda, Michał; Koczy, Bogdan; Widuchowski, Wojciech; Widuchowska, Małgorzata; Stołtny, Tomasz; Mielnik, Michał; Hermanson, Jacek

    2015-01-25

    Hip resurfacing is a conservative type of total hip arthroplasty but its use is controversial, especially in patients with osteonecrosis. The aim of this study was analysis of the clinical and radiographic outcomes of hip resurfacing in patients with osteonecrosis. Between 2007 and 2008, 30 hip resurfacing arthroplasties were performed due to osteoarthritis secondary to avascular necrosis of femoral head staged as Ficat III and IV. Patients were qualified to resurfacing arthroplasty when the extent of avascular necrosis using Kerboul's method was avascular necrosis and head-neck junction was >20°. All patients were evaluated clinically and radiologically before and 60 months after the operation. The mean Harris Hip Score (HHS) score increased from 47.8 to 94.25 (p<0.05). Physical activity level (University of California, Los Angeles activity score--UCLA activity score) improved from 3.7 to 7.55 (p<0.05). No implant migration was observed. Management of osteonecrosis of the hip with resurfacing arthroplasty seems to be effective in strictly-selected patients.

  10. High-impact sport after hip resurfacing: The Ironman triathlon.

    Science.gov (United States)

    Girard, J; Lons, A; Pommepuy, T; Isida, R; Benad, K; Putman, S

    2017-09-01

    Returning to high-impact sport is an increasingly frequent functional demand following hip replacement. The literature, however, is sparse on the subject and nonexistent regarding triathlon. We therefore conducted a retrospective study of hip resurfacing in triathlon players, to determine: (1) whether it is possible to return to this kind of sport; (2) if so, whether it is possible to return to the same level; and (3) how a resurfaced hip behaves under these conditions. Hip resurfacing allows return to competition level in long-distance triathlon. A single-center single-operator retrospective study included patients undergoing hip resurfacing with the Conserve Plus implant inserted through a posterolateral approach, who had ceased long-distance triathlon practice due to osteoarthritis of the hip. Fifty-one of the 1688 patients undergoing resurfacing during the inclusion period were long-distance triathlon players. The series comprised 48 patients: 51 implants; 43 male, 5 female; mean age, 44.8 years (range, 28.2-58.9 years). At a mean 4.7 years' follow-up (range, 2.2-7.6 years), all clinical scores showed significant improvement; Merle d'Aubigné and Harris scores rose respectively from 12.3 (5-16) and 42 (37-56) preoperatively to 17.5 (13-18) and 93.2 (73-100) (Pdistance=70.3km and 19 with distance=140.6km. At follow-up, 28 patients had taken part in an Ironman competition: 21 with distance=70.3km and 7 with distance=140.6km. Mean competition performance did not differ between pre and postoperative periods. Return-to-sport rates were good following hip resurfacing. Non-impact sports (swimming, cycling) predominated postoperatively, whereas the rate of impact sport (running) diminished. Return to competition-level sport (extreme triathlon) was possible for 28/48 patients (58%). Implant survival seemed unaffected by this high-impact sports activity at a mean 4.7 years' follow-up. IV, retrospective, non-controlled. Copyright © 2017 Elsevier Masson SAS. All rights

  11. Evaluation of a patient specific femoral alignment guide for hip resurfacing.

    Science.gov (United States)

    Olsen, Michael; Naudie, Douglas D; Edwards, Max R; Sellan, Michael E; McCalden, Richard W; Schemitsch, Emil H

    2014-03-01

    A novel alternative to conventional instrumentation for femoral component insertion in hip resurfacing is a patient specific, computed tomography based femoral alignment guide. A benchside study using cadaveric femora was performed comparing a custom alignment guide to conventional instrumentation and computer navigation. A clinical series of twenty-five hip resurfacings utilizing a custom alignment guide was conducted by three surgeons experienced in hip resurfacing. Using cadaveric femora, the custom guide was comparable to conventional instrumentation with computer navigation proving superior to both. Clinical femoral component alignment accuracy was 3.7° and measured within ± 5° of plan in 20 of 24 cases. Patient specific femoral alignment guides provide a satisfactory level of accuracy and may be a better alternative to conventional instrumentation for initial femoral guidewire placement in hip resurfacing. Crown Copyright © 2014. All rights reserved.

  12. Intertrochanteric Fracture After Hip Resurfacing Arthroplasty Managed with a Reconstruction Nail

    Directory of Open Access Journals (Sweden)

    Jason Chow

    2013-12-01

    Full Text Available Periprosthetic fractures after hip resurfacings are rare occurrences that can pose a challenge to orthopaedic surgeons. With hip resurfacings becoming more common, the prevalence of these fractures is likely to increase because these patients are usually younger and more active. We report a case of traumatic periprosthetic proximal femur fracture treated with a reconstruction intramedullary nail technique.

  13. Bone mineral density of the femoral neck in resurfacing hip arthroplasty

    DEFF Research Database (Denmark)

    Penny, Jeannette Østergaard; Ovesen, Ole; Brixen, Kim

    2010-01-01

    Resurfacing total hip arthroplasty (RTHA) may preserve the femoral neck bone stock postoperatively. Bone mineral density (BMD) may be affected by the hip position, which might bias longitudinal studies. We investigated the dependency of BMD precision on type of ROI and hip position....

  14. Indications for MARS-MRI in Patients Treated With Metal-on-Metal Hip Resurfacing Arthroplasty.

    Science.gov (United States)

    Connelly, James W; Galea, Vincent P; Matuszak, Sean J; Madanat, Rami; Muratoglu, Orhun; Malchau, Henrik

    2018-06-01

    Currently, there are no universally accepted guidelines on when to obtain metal artifact reduction sequence magnetic resonance imaging (MARS-MRI) in metal-on-metal (MoM) hip resurfacing arthroplasty (HRA) patients. Our primary aims were to identify which patient and clinical factors are predictive of adverse local tissue reaction (ALTR) and create an algorithm for indicating MARS-MRI in patients with Articular Surface Replacement (ASR) HRA. The secondary aim was to compare our algorithm to existing guidelines on when to perform MARS-MRI in MoM HRA patients. The study cohort consisted of 182 patients with unilateral ASR HRA from a prospective, multicenter study. Subjects received MARS-MRI at a mean of 7.8 years from surgery, regardless of symptoms. We determined which variables were predictive of ALTR and generated cutoffs for each variable. Finally, we created an algorithm to predict ALTR and indicate MARS-MRI in ASR HRA patients using these cutoffs and compared it to existing guidelines. We found high blood cobalt (Co) (odds ratio = 1.070; P = .011) and high blood chromium (Cr) (odds ratio = 1.162; P = .002) to be significant predictors of ALTR presence. Our algorithm using a blood Co cutoff of 1.15 ppb and a Cr cutoff of 1.09 ppb achieved 96.6% sensitivity and 35.3% specificity in predicting ALTR, which outperformed the existing guidelines. Blood Co and Cr levels are predictive of ALTR in ASR HRA patients. Our algorithm considering blood Co and Cr levels predicts ALTR in ASR HRA patients with higher sensitivity than previously established guidelines. Copyright © 2018 Elsevier Inc. All rights reserved.

  15. Cobalt deposition in mineralized bone tissue after metal-on-metal hip resurfacing: Quantitative μ-X-ray-fluorescence analysis of implant material incorporation in periprosthetic tissue.

    Science.gov (United States)

    Hahn, Michael; Busse, Björn; Procop, Mathias; Zustin, Jozef; Amling, Michael; Katzer, Alexander

    2017-10-01

    Most resurfacing systems are manufactured from cobalt-chromium alloys with metal-on-metal (MoM) bearing couples. Because the quantity of particulate metal and corrosion products which can be released into the periprosthetic milieu is greater in MoM bearings than in metal-on-polyethylene (MoP) bearings, it is hypothesized that the quantity and distribution of debris released by the MoM components induce a compositional change in the periprosthetic bone. To determine the validity of this claim, nondestructive µ-X-ray fluorescence analysis was carried out on undecalcified histological samples from 13 femoral heads which had undergone surface replacement. These samples were extracted from the patients after gradient time points due to required revision surgery. Samples from nonintervened femoral heads as well as from a MoP resurfaced implant served as controls. Light microscopy and µ-X-ray fluorescence analyses revealed that cobalt debris was found not only in the soft tissue around the prosthesis and the bone marrow, but also in the mineralized bone tissue. Mineralized bone exposed to surface replacements showed significant increases in cobalt concentrations in comparison with control specimens without an implant. A maximum cobalt concentration in mineralized hard tissue of up to 380 ppm was detected as early as 2 years after implantation. Values of this magnitude are not found in implants with a MoP surface bearing until a lifetime of more than 20 years. This study demonstrates that hip resurfacing implants with MoM bearings present a potential long-term health risk due to rapid cobalt ion accumulation in periprosthetic hard tissue. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1855-1862, 2017. © 2016 Wiley Periodicals, Inc.

  16. Clinical and radiological evolution of Intervened patients of total arthroplasty of hip with prostheses of resuperficialization metal-metal - Preliminary report

    International Nuclear Information System (INIS)

    Galvan Villamarin, Fernando; Bernal Torres, Fabio A; Paez, Jose Mauricio and others

    2006-01-01

    The articular degeneration of the hip in young patients requires including therapeutical alternatives for the management of this population. The resurfacing prostheses with metal-metal surfaces is an alternative for this type of patients. Reports with short and medium follow up are very promising, besides the different studies of laboratory that bear, the theoretical bases for their success. In this descriptive study, observational cases series type is described the radiological and clinical evolution of patients intervened of total arthroplasty of hip with resurfacing prostheses metal-metal in the hospital el Tunal of Bogota. The results of 31 hips are presented (27 patients) with an age average of 50 years old and a medium follow up of 16 months, with a good post surgical functional result with a median of 96 in the Harris Scores. The complications presented in the patient series are described and their relation with the different factors analyzed

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

    Science.gov (United States)

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

    2013-11-01

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

  18. Breast milk metal ion levels in a young and active patient with a metal-on-metal hip prosthesis.

    Science.gov (United States)

    Nelis, Raymond; de Waal Malefijt, Jan; Gosens, Taco

    2013-01-01

    Metal-on-metal resurfacing arthroplasty of the hip has been used increasingly over the last 10 years in younger active patients. The dissolution of the metal wear particles results in measurable increases in cobalt and chromium ions in the serum and urine of patients with a metal-on-metal bearing. We measured the cobalt, chromium, and molybdenum ion levels in urine; serum; and breast milk in a young and active patient with a metal-on-metal hip prosthesis after a pathologic fracture of the femoral neck. Metal-on-metal hip prosthesis leads to increasing levels of molybdenum in breast milk in the short-term follow-up. There are no increasing levels of chromium and cobalt ions in breast milk. Besides the already known elevated concentrations in serum of chromium and cobalt after implantation of a metal-on-metal hip prosthesis, we found no increasing levels of chromium and cobalt in urine. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. A Randomized Seven-Year Study on Performance of the Stemmed Metal M2a-Magnum and Ceramic C2a-Taper, and the Resurfacing ReCap Hip Implants

    DEFF Research Database (Denmark)

    Borgwardt, Arne; Borgwardt, Lotte; Zerahn, Bo

    2018-01-01

    BACKGROUND: The large-diameter metal-on-metal hip prostheses were expected to have low wear and reduced dislocation rate compared to the traditional metal-on-polyethylene implants. We compare 2 such prostheses, the ReCap resurfacing implant and the M2a-Magnum stemmed implant, with the C2a ceramic......-on-ceramic stemmed implant as to clinical performance, serum concentrations of prosthesis metals, and the durability of the implants in a randomized, controlled clinical trial at 7 years of follow-up. METHODS: All included patients had osteoarthritis. Preoperatively, the size of the implants was estimated from...... of the soft tissue adjacent to the implant as well as MRI with metal artifact reduction sequence (MARS-MRI) when indicated. RESULTS: One hundred fifty-two hips in 146 patients were included. The serum cobalt and chromium concentrations were significantly higher for the 2 metal-on-metal prostheses than...

  20. Comparison of hip function and quality of life of total hip arthroplasty and resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint at 5 years.

    Science.gov (United States)

    Costa, Matthew L; Achten, Juul; Foguet, Pedro; Parsons, Nicholas R

    2018-03-12

    To compare the medium-term clinical effectiveness of total hip arthroplasty and resurfacing arthroplasty. Single centre, two-arm, parallel group, assessor blinded, randomised controlled trial with 1:1 treatment allocation. A large teaching hospital in England. 122 patients older than 18 years with severe arthritis of the hip joint, suitable for resurfacing arthroplasty of the hip. Patients were excluded if they were considered to be unable to adhere to trial procedures or complete questionnaires. Total hip arthroplasty (replacement of entire femoral head and neck); hip resurfacing arthroplasty (replacement of the articular surface of femoral head only, femoral neck remains intact). Both procedures replaced the articular surface of the acetabulum. The outcome measures were hip function assessed using the Oxford Hip Score (OHS) and health-related quality of life assessed using the EuroQol (EQ-5D). Patients were followed up annually for a minimum of 5 years. Outcome data were modelled using the generalised estimating equation methodology to explore temporal variations during follow-up. 60 patients were randomly assigned to hip resurfacing arthroplasty and 62 to total hip arthroplasty. 95 (78%) of the 122 original study participants provided data at 5 years. There was a small decrease in both hip functions and quality of life in both groups of patients each year during the 5-year follow-up period. However, there was no evidence of a significant difference between treatments group in the OHS (P=0.333) or the EQ-5D (P=0.501). We previously reported no difference in outcome in the first year after surgery. The current medium-term results also show no evidence of a difference in hip function or health-related quality of life in the 5 years following a total hip arthroplasty versus resurfacing arthroplasty. ISRCTN33354155. UKCRN 4093. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use

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

    Directory of Open Access Journals (Sweden)

    Zachary Morison

    2013-01-01

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

  2. A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint.

    Science.gov (United States)

    Achten, Juul; Parsons, Nick R; Edlin, Richard P; Griffin, Damian R; Costa, Matthew L

    2010-01-14

    Hip replacement (arthroplasty) surgery is a highly successful treatment for patients with severe symptomatic arthritis of the hip joint. For older patients, several designs of Total Hip Arthroplasty have shown excellent results in terms of both function and value for money. However, in younger more active patients, there is approximately a 50% failure rate at 25 years for traditional implants. Hip resurfacing is a relatively new arthroplasty technique. In a recent review of the literature on resurfacing arthroplasty it was concluded that the short-term functional results appear promising but some potential early disadvantages were identified, including the risk of femoral neck fracture and collapse of the head of the femur. The aim of the current study is to assess whether there is a difference in functional hip scores at one year post-operation between Total Hip Arthroplasty and Resurfacing Arthroplasty. Secondary aims include assessment of complication rates for both procedures as well cost effectiveness. All patients medically fit for surgery and deemed suitable for a resurfacing arthroplasty are eligible to take part in this study. A randomisation sequence will be produced and administered independently. After consenting, all patients will be clinically reviewed and hip function, quality of life and physical activity level will be assessed through questionnaires. The allocated surgery will then be performed with the preferred technique of the surgeon. Six weeks post-operation hip function will be assessed and complications recorded. Three, six and 12 months post-operation hip function, quality of life and physical activity level will be assessed. Additional information about patients' out-of-pocket expenses will also be collected. Current Controlled Trials ISRCTN33354155. UKCLRN portfolio ID 4093.

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

    Science.gov (United States)

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

    2014-01-01

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

  4. Direct to consumer advertising via the Internet, a study of hip resurfacing.

    Science.gov (United States)

    Ogunwale, B; Clarke, J; Young, D; Mohammed, A; Patil, S; Meek, R M D

    2009-02-01

    With increased use of the internet for health information and direct to consumer advertising from medical companies, there is concern about the quality of information available to patients. The aim of this study was to examine the quality of health information on the internet for hip resurfacing. An assessment tool was designed to measure quality of information. Websites were measured on credibility of source; usability; currentness of the information; content relevance; content accuracy/completeness and disclosure/bias. Each website assessed was given a total score, based on number of scores achieved from the above categories websites were further analysed on author, geographical origin and possession of an independent credibility check. There was positive correlation between the overall score for the website and the score of each website in each assessment category. Websites by implant companies, doctors and hospitals scored poorly. Websites with an independent credibility check such as Health on the Net (HoN) scored twice the total scores of websites without. Like other internet health websites, the quality of information on hip resurfacing websites is variable. This study highlights methods by which to assess the quality of health information on the internet and advocates that patients should look for a statement of an "independent credibility check" when searching for information on hip resurfacing.

  5. Periacetabular Bone Mineral Density Changes After Resurfacing Hip Arthroplasty Versus Conventional Total Hip Arthroplasty. A Randomized Controlled DEXA Study

    NARCIS (Netherlands)

    Smolders, J.M.H.; Pakvis, D.F.; Hendrickx, B.W.; Verdonschot, Nicolaas Jacobus Joseph; van Susante, J.L.C.

    2013-01-01

    A randomized controlled trial was performed to evaluate acetabular bone mineral density (BMD) changes after hip resurfacing (RHA) versus an established conventional total hip arthroplasty (THA). A total of 71 patients were allocated randomly to receive either an RHA press-fit cobalt–chromium cup (n

  6. Editorial Commentary: Hip Arthroscopy Plays a Role in Painful Hip Resurfacing Arthroplasty but a Prearthroscopy Diagnosis Is Critical to Outcome.

    Science.gov (United States)

    Rossi, Michael J

    2016-03-01

    Whereas hip arthroscopy plays a role in the investigation and treatment of the painful hip resurfacing arthroplasty, a diagnosis before arthroscopy is critical to improved outcome. The rate of conversion to total hip arthroplasty jumps from 7% to 37% when a pre-arthroscopy diagnosis is not known. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  7. Influence of bone density on the cement fixation of femoral hip resurfacing components.

    Science.gov (United States)

    Bitsch, Rudi G; Jäger, Sebastian; Lürssen, Marcus; Loidolt, Travis; Schmalzried, Thomas P; Clarius, Michael

    2010-08-01

    In clinical outcome studies, small component sizes, female gender, femoral shape, focal bone defects, bad bone quality, and biomechanics have been associated with failures of resurfacing arthroplasties. We used a well-established experimental setup and human bone specimens to analyze the effects of bone density on cement fixation of femoral hip resurfacing components. Thirty-one fresh frozen femora were prepared for resurfacing using the original instruments. ASR resurfacing prostheses were implanted after dual-energy X-ray densitometer scans. Real-time measurements of pressure and temperature during implantation, analyses of cement penetration, and measurements of micro motions under torque application were performed. The associations of bone density and measurement data were examined calculating regression lines and multiple correlation coefficients; acceptability was tested with ANOVA. We found significant relations between bone density and micro motion, cement penetration, cement mantle thickness, cement pressure, and interface temperature. Mean bone density of the femora was 0.82 +/- 0.13 g/cm(2), t-score was -0.7 +/- 1.0, and mean micro motion between bone and femoral resurfacing component was 17.5 +/- 9.1 microm/Nm. The regression line between bone density and micro motion was equal to -56.7 x bone density + 63.8, R = 0.815 (p density scans are most helpful for patient selection in hip resurfacing, and a better bone quality leads to higher initial component stability. A sophisticated cementing technique is recommended to avoid vigorous impaction and incomplete seating, since increasing bone density also results in higher cement pressures, lower cement penetration, lower interface temperatures, and thicker cement mantles. Copyright 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  8. Confronting hip resurfacing and big femoral head replacement gait analysis

    Directory of Open Access Journals (Sweden)

    Panagiotis K. Karampinas

    2014-03-01

    Full Text Available Improved hip kinematics and bone preservation have been reported after resurfacing total hip replacement (THRS. On the other hand, hip kinematics with standard total hip replacement (THR is optimized with large diameter femoral heads (BFH-THR. The purpose of this study is to evaluate the functional outcomes of THRS and BFH-THR and correlate these results to bone preservation or the large femoral heads. Thirty-one patients were included in the study. Gait speed, postural balance, proprioception and overall performance. Our results demonstrated a non-statistically significant improvement in gait, postural balance and proprioception in the THRS confronting to BFH-THR group. THRS provide identical outcomes to traditional BFH-THR. The THRS choice as bone preserving procedure in younger patients is still to be evaluated.

  9. Comparison of Patient-Reported Outcome from Neck-Preserving, Short-Stem Arthroplasty and Resurfacing Arthroplasty in Younger Osteoarthritis Patients

    Directory of Open Access Journals (Sweden)

    Marius Dettmer

    2015-01-01

    Full Text Available Hip resurfacing has been considered a good treatment option for younger, active osteoarthritis patients. However, there are several identified issues concerning risk for neck fractures and issues related to current metal-on-metal implant designs. Neck-preserving short-stem implants have been discussed as a potential alternative, but it is yet unclear which method is better suited for younger adults. We compared hip disability and osteoarthritis outcome scores (HOOS from a young group of patients (n=52, age 48.9 ± 6.1 years who had received hip resurfacing (HR with a cohort of patients (n=73, age 48.2 ± 6.6 years who had received neck-preserving, short-stem implant total hip arthroplasty (THA. Additionally, durations for both types of surgery were compared. HOOS improved significantly preoperatively to last followup (>1 year in both groups (p<0.0001, η2=0.69; there were no group effects or interactions. Surgery duration was significantly longer for resurfacing (104.4 min ± 17.8 than MiniHip surgery (62.5 min ± 14.8, U=85.0, p<0.0001, η2=0.56. The neck-preserving short-stem approach may be preferable to resurfacing due to the less challenging surgery, similar outcome, and controversy regarding resurfacing implant designs.

  10. Ten different hip resurfacing systems: biomechanical analysis of design and material properties.

    Science.gov (United States)

    Heisel, Christian; Kleinhans, Jennifer A; Menge, Michael; Kretzer, Jan Philippe

    2009-08-01

    This study gives an overview of the main macro- and microstructural differences of ten commercially available total hip resurfacing implants. The heads and cups of resurfacing hip implants from ten different manufacturers were analysed. The components were measured in a coordinate measuring machine. The microstructure of the heads and cups was inspected by scanning electron microscopy. The mean radial clearance was 84.86 microm (range: 49.47-120.93 microm). The implants were classified into three groups (low, medium and high clearance). All implants showed a deviation of roundness of less than 10 microm. It was shown that all implants differ from each other and a final conclusion about the ideal design and material combination cannot be given based on biomechanical data. Widespread use of specific designs can only be recommended if clinical long-term follow-up studies are performed and analysed for each design.

  11. How accurate is image-free computer navigation for hip resurfacing arthroplasty? An anatomical investigation

    International Nuclear Information System (INIS)

    Schnurr, C.; Nessler, J.; Koenig, D.P.; Meyer, C.; Schild, H.H.; Koebke, J.

    2009-01-01

    The existing studies concerning image-free navigated implantation of hip resurfacing arthroplasty are based on analysis of the accuracy of conventional biplane radiography. Studies have shown that these measurements in biplane radiography are imprecise and that precision is improved by use of three-dimensional (3D) computer tomography (CT) scans. To date, the accuracy of image-free navigation devices for hip resurfacing has not been investigated using CT scans, and anteversion accuracy has not been assessed at all. Furthermore, no study has tested the reliability of the navigation software concerning the automatically calculated implant position. The purpose of our study was to analyze the accuracy of varus-valgus and anteversion using an image-free hip resurfacing navigation device. The reliability of the software-calculated implant position was also determined. A total of 32 femoral hip resurfacing components were implanted on embalmed human femurs using an image-free navigation device. In all, 16 prostheses were implanted with the proposed position generated by the navigation software; the 16 prostheses were inserted in an optimized valgus position. A 3D CT scan was undertaken before and after operation. The difference between the measured and planned varus-valgus angle averaged 1 deg (mean±standard deviation (SD): group I, 1 deg±2 deg; group II, 1 deg±1 deg). The mean±SD difference between femoral neck anteversion and anteversion of the implant was 4 deg (group I, 4 deg±4 deg; group II, 4 deg±3 deg). The software-calculated implant position differed 7 deg±8 deg from the measured neck-shaft angle. These measured accuracies did not differ significantly between the two groups. Our study proved the high accuracy of the navigation device concerning the most important biomechanical factor: the varus-valgus angle. The software calculation of the proposed implant position has been shown to be inaccurate and needs improvement. Hence, manual adjustment of the

  12. Management of metal-on-metal hip implant patients: Who, when and how to revise?

    Science.gov (United States)

    Berber, Reshid; Skinner, John A; Hart, Alister J

    2016-05-18

    The debate on how best to manage patients with metal-on-metal (MOM) hip implants continues. With over 1 million patients affected worldwide, the impact is far reaching. The majority of the aggressive failures of MOM hip implants have been dealt with by revision hip surgery, leaving patients with a much more indolent pattern of failure of devices that have been in situ for more than 10 years. The longer-term outcome for such patients remains unknown, and much debate exists on how best to manage these patients. Regulatory guidance is available but remains open to interpretation due to the lack of current evidence and long-term studies. Metal ion thresholds for concern have been suggested at 7 ppb for hip resurfacing arthroplasty and below this level for large diameter total hip arthroplasties. Soft tissue changes including pseudotumours and muscle atrophy have been shown to progress, but this is not consistent. New advanced imaging techniques are helping to diagnose complications with metal hips and the reasons for failure, however these are not widely available. This has led to some centres to tackle difficult cases through multidisciplinary collaboration, for both surgical management decisions and also follow-up decisions. We summarise current evidence and consider who is at risk, when revision should be undertaken and how patients should be managed.

  13. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be implanted...

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

    Directory of Open Access Journals (Sweden)

    Albrecht Hartmann

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

  15. Metal Ion Concentrations in Body Fluids after Implantation of Hip Replacements with Metal-on-Metal Bearing – Systematic Review of Clinical and Epidemiological Studies

    Science.gov (United States)

    Hartmann, Albrecht; Hannemann, Franziska; Lützner, Jörg; Seidler, Andreas; Drexler, Hans; Günther, Klaus-Peter; Schmitt, Jochen

    2013-01-01

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

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

    Science.gov (United States)

    Underwood, Richard J; Zografos, Angelos; Sayles, Ritchie S; Hart, Alister; Cann, Philippa

    2012-03-01

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

  17. High incidence of pseudotumours after hip resurfacing even in low risk patients; results from an intensified MRI screening protocol.

    NARCIS (Netherlands)

    Weegen, W. van der; Smolders, J.M.; Sijbesma, T.; Hoekstra, H.J.; Brakel, K.; Susante, J.L.C. van

    2013-01-01

    We intensified our screening protocol for the presence of pseudotumours in a consecutive series of patients with a hip resurfacing arthroplasty (HRA), to establish whether we should be alert to the presence of 'silent' pseudotumours. Patients categorised with high risk (11 hips) and low risk (10

  18. Augmented Reality Based Navigation for Computer Assisted Hip Resurfacing: A Proof of Concept Study.

    Science.gov (United States)

    Liu, He; Auvinet, Edouard; Giles, Joshua; Rodriguez Y Baena, Ferdinando

    2018-05-23

    Implantation accuracy has a great impact on the outcomes of hip resurfacing such as recovery of hip function. Computer assisted orthopedic surgery has demonstrated clear advantages for the patients, with improved placement accuracy and fewer outliers, but the intrusiveness, cost, and added complexity have limited its widespread adoption. To provide seamless computer assistance with improved immersion and a more natural surgical workflow, we propose an augmented-reality (AR) based navigation system for hip resurfacing. The operative femur is registered by processing depth information from the surgical site with a commercial depth camera. By coupling depth data with robotic assistance, obstacles that may obstruct the femur can be tracked and avoided automatically to reduce the chance of disruption to the surgical workflow. Using the registration result and the pre-operative plan, intra-operative surgical guidance is provided through a commercial AR headset so that the user can perform the operation without additional physical guides. To assess the accuracy of the navigation system, experiments of guide hole drilling were performed on femur phantoms. The position and orientation of the drilled holes were compared with the pre-operative plan, and the mean errors were found to be approximately 2 mm and 2°, results which are in line with commercial computer assisted orthopedic systems today.

  19. 21 CFR 888.3580 - Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint patellar (hemi-knee) metallic... § 888.3580 Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis is a device made of...

  20. Dual energy X-ray absorptiometry analysis of peri-prosthetic stress shielding in the Birmingham resurfacing hip replacement.

    LENUS (Irish Health Repository)

    Harty, J A

    2012-02-03

    INTRODUCTION: Numerous reports in the literature refer to the femoral neck fracture rate in hip resurfacing. The aim of this study was to determine the bone mineral density and evidence of stress shielding around the femoral component of the Birmingham resurfacing prosthesis. MATERIAL AND METHODS: Twenty-eight patients with primary unilateral osteoarthritis had a Birmingham resurfacing prosthesis. DEXA analysis of the proximal femur and femoral neck was performed and compared with the opposite unaffected side. RESULTS: Total periprosthetic bone mineral density was 0.49% greater than the control, but this did not achieve statistical significance. Although the BMD of the femoral neck was slightly increased on the prosthetic side (1.002 g\\/cm2) as opposed to the control side, this difference did not reach statistical significance. CONCLUSION: The Birmingham resurfacing prosthesis does not appear to reduce femoral neck bone mineral density in comparison to the normal femoral neck bone density. We conclude that femoral neck fractures are unlikely to be due to stress shielding related to the prosthesis.

  1. 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

    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. Trial registration: NCT01229293....... 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...

  2. Periprosthetic fractures in the resurfaced hip--A case report and review of the literature.

    LENUS (Irish Health Repository)

    Brennan, Stephen A

    2013-02-01

    Traumatic periprosthetic fractures adjacent a hip resurfacing prosthesis are rare. When proximal fractures are encountered the obvious surgical solution is to revise to a large head stemmed femoral component. A previously well functioning implant may however be retained as various non-operative and operative treatment options exist. This paper reports the case history of a traumatic periprosthetic fracture successfully treated with cannulated screw fixation and reviews the current literature.

  3. 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

  4. Inferior outcome after hip resurfacing arthroplasty than after conventional arthroplasty. Evidence from the Nordic Arthroplasty Register Association (NARA) database, 1995 to 2007

    DEFF Research Database (Denmark)

    Johanson, Per-Erik; Fenstad, Anne Marie; Furnes, Ove

    2010-01-01

    The reported outcomes of hip resurfacing arthroplasty (HRA) vary. The frequency of this procedure in Denmark, Norway, and Sweden is low. We therefore determined the outcome of HRA in the NARA database, which is common to all 3 countries, and compared it to the outcome of conventional total hip...

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    BACKGROUND AND PURPOSE: Large-size hip articulations may improve range of motion (ROM) and function compared to a 28-mm THA, and the low risk of dislocation allows the patients more activity postoperatively. On the other hand, the greater extent of surgery for resurfacing hip arthroplasty (RHA......° (35), 232° (36), and 225° (30) respectively, but the differences were not statistically significant. The 3 groups were similar regarding Harris hip score, UCLA activity score, step rate, and sick leave. INTERPRETATION: Head size had no influence on range of motion. The lack of restriction allowed...... for large articulations did not improve the clinical and patient-perceived outcomes. The more extensive surgical procedure of RHA did not impair the rehabilitation. This project is registered at ClinicalTrials.gov under # NCT01113762....

  6. Femoral component loosening after hip resurfacing arthroplasty

    International Nuclear Information System (INIS)

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

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Vicky Bouffard

    2011-01-01

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

  8. Reliability of using DXA around RTHAs. Bone Mineral Density of the femoral neck in resurfacing hip arthroplasty. Precision biased by region of interest and rotation of the hip

    DEFF Research Database (Denmark)

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

    2009-01-01

      Introduction:  Resurfacing Total Hip Arthroplasty (RTHA) may preserve the femoral neck bone-stock post-operatively. Bone Mineral Density (BMD), could theoretically be affected by the hip-position, and bias longitudinal studies. We aimed to investigate BMD precision dependency on type of ROI...... the hip was rotated in increments of 15° and 30°, the mean CVs rose to 7.2%, 7.3% and 11.8%.  Rotation affected the precision most in the model that divided the neck in 6 sub regions, predominantly in the lateral and distal regions. For larger-region models, some rotation could be allowed without...

  9. Reliability of using DXA around RTHAs. Bone Mineral Density of the femoral neck in resurfacing hip arthroplasty

    DEFF Research Database (Denmark)

    Penny, Jeannette Østergaard; Ovesen, Ole; Brixen, Kim

    2010-01-01

      Background and purpose: Resurfacing Total Hip Arthroplasty (RTHA) may preserve the femoral neck bone-stock post-operatively. Bone Mineral Density (BMD), could theoretically be affected by the hip-position, and bias longitudinal studies. We aimed to investigate BMD precision dependency on type...... was rotated in increments of 15° and 30°, the mean CVs rose to 7.2%, 7.3% and 11.8%.  Rotation affected the precision most in the model that divided the neck in 6 sub regions, predominantly in the lateral and distal regions. For larger-region models, some rotation could be allowed without compromising...

  10. Metal ion levels and lymphocyte counts

    DEFF Research Database (Denmark)

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

    2013-01-01

    BACKGROUND AND PURPOSE: Wear particles from metal-on-metal arthroplasties are under suspicion for adverse effects both locally and systemically, and the DePuy ASR Hip Resurfacing System (RHA) has above-average failure rates. We compared lymphocyte counts in RHA and total hip arthroplasty (THA) an....../ppb. INTERPRETATION: Circulating T-lymphocyte levels may decline after surgery, regardless of implant type. Metal ions-particularly cobalt-may have a general depressive effect on T- and B-lymphocyte levels. Registered with ClinicalTrials.gov under # NCT01113762.......BACKGROUND AND PURPOSE: Wear particles from metal-on-metal arthroplasties are under suspicion for adverse effects both locally and systemically, and the DePuy ASR Hip Resurfacing System (RHA) has above-average failure rates. We compared lymphocyte counts in RHA and total hip arthroplasty (THA....... RESULTS: The T-lymphocyte counts for both implant types declined over the 2-year period. This decline was statistically significant for CD3(+)CD8(+) in the THA group, with a regression coefficient of -0.04 × 10(9)cells/year (95% CI: -0.08 to -0.01). Regression analysis indicated a depressive effect...

  11. [Ex vivo microCT analysis of possible microfractures of the femoral head during implantation of a cementless hip resurfacing femoral component].

    Science.gov (United States)

    Lerch, M; Olender, G; von der Höh, N; Thorey, F; von Lewinski, G; Meyer-Lindenberg, A; Windhagen, H; Hurschler, C

    2009-01-01

    Microfractures of the femoral head during implantation of the femoral components are suspected to be a cause of fractures at the implant/neck junction which represent a common failure mode in hip resurfacing arthroplasty. Callus formation observed in femoral head retrievals suggests the occurrence of microfractures inside the femoral head, which might be inadvertently caused by the surgeon during implantation. The aim of this biomechanical study was to analyse whether or not the implantation of a cementless femoral component hip resurfacing system causes microfractures in the femoral head. After the preparation of 20 paired human cadaveric femoral heads, the cementless femoral component ESKA Typ BS (ESKA Implants GmbH & Co., Lübeck) was implanted on 9 specimens with an impaction device that generates 4.5 kN impaction force. On 9 specimens the femoral component was implanted by hand. One head was used as a fracture model, 1 specimen served as control without manipulation. The femoral component used for impaction was equipped with hinges to enable its removal without further interfering with the bone stock. Specimens were scanned with a microCT device before and after impaction and the microCT datasets before and after impaction were compared to identify possible microfractures. Twenty strikes per hand or with the impaction device provided sufficient implant seating. Neither the macroscopic examination nor the 2-dimensional microCT analysis revealed any fractures of the femoral heads after impaction. At least macroscopically and in the 2-dimensional microCT analysis, implantation of the cementless hip resurfacing femoral component ESKA Typ BS with 4.5 kN or by hand does not seem to cause fractures of the femoral head. Georg Thieme Verlag KG Stuttgart, New York.

  12. A new approach to managing patients with problematic metal hip implants: the use of an Internet-enhanced multidisciplinary team meeting: AAOS exhibit selection.

    Science.gov (United States)

    Berber, Reshid; Pappas, Yannis; Khoo, Michael; Miles, Jonathan; Carrington, Richard; Skinner, John; Hart, Alister

    2015-02-18

    Over one million patients worldwide are estimated to have a metal-on-metal hip arthroplasty. To improve the management of these patients and reduce surgeon uncertainty regarding decision-making, we designed an Internet-enhanced multidisciplinary team (iMDT) working approach. From August 2012 to April 2014, the iMDT discussed 215 patients with 266 metal-on-metal hip arthroplasties. Of these, 236 primary arthroplasties (132 hip resurfacing and 104 total hip) were analyzed. The remaining thirty cases involved problematic revised hips and were therefore excluded. The possible recommendations of the iMDT were monitoring, further investigation, or surgery. The concordance between the recommendation and the actual management was used to assess the usefulness of this approach in reducing uncertainty in surgeon-level decision-making. The median Oxford Hip Score was 35 (range, 4 to 48), and median cobalt and chromium levels in whole blood were 3.54 ppb (range, 0.18 to 161.46 ppb) and 3.17 ppb (range, 0.20 to 100.67 ppb), respectively. Magnetic resonance imaging revealed abductor muscle atrophy in ninety-two (39%) of the hips and a pseudotumor in eighty (34%). The iMDT recommended monitoring of 146 (61.9%) of the hips, further investigation of thirty (12.7%), and surgery in sixty (25.4%). The actual outcome was concordant with the recommendation in 211 (91.7%) of the hips. Our iMDT approach to the metal-on-metal hip burden combines the tacit knowledge of an expert panel, regulatory guidance, and up-to-date evidence to improve decision-making among surgeons. The high level of concordance between the recommendation and the actual outcome, combined with the feasibility of the methods used, suggest that this method effectively reduces uncertainty among surgeons and may lead to improved patient outcomes. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  13. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint (hemi-hip) acetabular metal cemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3370 Hip joint (hemi-hip) acetabular metal cemented prosthesis. (a) Identification. A hip joint (hemi-hip) acetabular...

  14. 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

  15. 21 CFR 888.3360 - Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint femoral (hemi-hip) metallic cemented or... Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis is a device intended to be implanted...

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

    Science.gov (United States)

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

    2017-07-01

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

  17. 21 CFR 888.3390 - Hip joint femoral (hemi-hip) metal/polymer cemented or uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint femoral (hemi-hip) metal/polymer... § 888.3390 Hip joint femoral (hemi-hip) metal/polymer cemented or uncemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) metal/polymer cemented or uncemented prosthesis is a two-part...

  18. 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-center st......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...

  19. Detection of incorrect manufacturer labelling of hip components

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-01-15

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

  20. 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

  1. 21 CFR 888.3380 - Hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint femoral (hemi-hip) trunnion-bearing... Devices § 888.3380 Hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis is a two...

  2. 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.

  3. A Comparison of the Outcomes for Cartilage Defects of the Knee Treated With Biologic Resurfacing Versus Focal Metallic Implants.

    Science.gov (United States)

    Pascual-Garrido, Cecilia; Daley, Erika; Verma, Nikhil N; Cole, Brian J

    2017-02-01

    To compare the results of focal metallic resurfacing with biologic procedures in patients more than 35 years of age with isolated, full thickness defects of the femoral condyle. A total of 61 patients met the selection criteria resulting in 30 patients treated with biological procedures, including debridement, microfracture, osteochondral autograft transplantation, osteochondral allograft, and autologous chondrocyte implantation (BIO group), and 32 patients treated with focal metallic resurfacing (CAP group). The BIO and CAP groups were matched according to treatment location, defect grade and size, and age profile. Outcomes included Western Ontario and McMaster Osteoarthritis Index (WOMAC), Short Form-12, and satisfaction. The primary combination endpoint was determined as a 20% improvement (minimum clinically important difference-20) on WOMAC pain and function at 2 years and no additional index lesion-related surgical intervention. Safety and effectiveness were also reported. Thirty patients in the BIO group (mean age of 44.6, range 35-64) had an average follow-up of 2.6 years and 32 patients in the CAP group (mean age 47.9, range 37-68) were followed for 2.0 years. Fifty-three percent in the BIO group and 75% in the CAP group achieved success per the endpoint definition. The mean total WOMAC score improved significantly for both groups (BIO: 57-78; P metal resurfacing procedures for the treatment of isolated focal chondral lesions of the femoral condyle in the knee. Focal metallic resurfacing results in similar clinical outcomes and provides excellent success rates at short-term follow-up. Level III comparative study. Copyright © 2016. Published by Elsevier Inc.

  4. Imaging of hip arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-12-15

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

  5. 21 CFR 888.3358 - Hip joint metal/polymer/metal semi-constrained porous-coated uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/polymer/metal semi-constrained... Devices § 888.3358 Hip joint metal/polymer/metal semi-constrained porous-coated uncemented prosthesis. (a) Identification. A hip joint metal/polymer/metal semi-constrained porous-coated uncemented prosthesis is a device...

  6. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/metal semi-constrained, with a... Devices § 888.3320 Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented acetabular...

  7. 21 CFR 888.3330 - Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/metal semi-constrained, with an... Devices § 888.3330 Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with an uncemented acetabular...

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

    LENUS (Irish Health Repository)

    Phelan, Nigel

    2014-01-04

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

  9. 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

  10. Metal-on-metal hip joint tribology.

    Science.gov (United States)

    Dowson, D; Jin, Z M

    2006-02-01

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

  11. 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

  12. 21 CFR 888.3340 - Hip joint metal/composite semi-constrained cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/composite semi-constrained... Hip joint metal/composite semi-constrained cemented prosthesis. (a) Identification. A hip joint metal... hip joint. The device limits translation and rotation in one or more planes via the geometry of its...

  13. Muscle atrophy and metal-on-metal hip implants: a serial MRI study of 74 hips.

    Science.gov (United States)

    Berber, Reshid; Khoo, Michael; Cook, Erica; Guppy, Andrew; Hua, Jia; Miles, Jonathan; Carrington, Richard; Skinner, John; Hart, Alister

    2015-06-01

    Muscle atrophy is seen in patients with metal-on-metal (MOM) hip implants, probably because of inflammatory destruction of the musculo-tendon junction. However, like pseudotumors, it is unclear when atrophy occurs and whether it progresses with time. Our objective was to determine whether muscle atrophy associated with MOM hip implants progresses with time. We retrospectively reviewed 74 hips in 56 patients (32 of them women) using serial MRI. Median age was 59 (23-83) years. The median time post-implantation was 83 (35-142) months, and the median interval between scans was 11 months. Hip muscles were scored using the Pfirrmann system. The mean scores for muscle atrophy were compared between the first and second MRI scans. Blood cobalt and chromium concentrations were determined. The median blood cobalt was 6.84 (0.24-90) ppb and median chromium level was 4.42 (0.20-45) ppb. The median Oxford hip score was 34 (5-48). The change in the gluteus minimus mean atrophy score between first and second MRI was 0.12 (p = 0.002). Mean change in the gluteus medius posterior portion (unaffected by surgical approach) was 0.08 (p = 0.01) and mean change in the inferior portion was 0.10 (p = 0.05). Mean pseudotumor grade increased by 0.18 (p = 0.02). Worsening muscle atrophy and worsening pseudotumor grade occur over a 1-year period in a substantial proportion of patients with MOM hip implants. Serial MRI helps to identify those patients who are at risk of developing worsening soft-tissue pathology. These patients should be considered for revision surgery before irreversible muscle destruction occurs.

  14. Laser resurfacing pearls.

    Science.gov (United States)

    Shah, Sonia; Alam, Murad

    2012-08-01

    Ablative skin resurfacing using the carbon dioxide laser was long considered the gold standard for treatment of photoaging, acne scars, and rhytids. However, conventional full-face carbon dioxide resurfacing is associated with significant risk of side effects and a prolonged postoperative recovery period. Fractional resurfacing has recently revolutionized laser surgery by offering close to comparable results with minimal side effects and a more rapid recovery. Although fractional devices have grown in popularity, and have essentially replaced traditional resurfacing, fractional resurfacing can still be a challenging modality to control precisely due to hardware variations across comparable devices, the range of settings that can be used, and patient-specific considerations. Certain precautions and rules of thumb can reduce the risk associated with fractional resurfacing, and increase the likelihood of a good outcome.

  15. 21 CFR 888.3350 - Hip joint metal/polymer semi-constrained cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/polymer semi-constrained cemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3350 Hip joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. A hip joint metal/polymer semi...

  16. 21 CFR 888.3300 - Hip joint metal constrained cemented or uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal constrained cemented or uncemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3300 Hip joint metal constrained cemented or uncemented prosthesis. (a) Identification. A hip joint metal constrained...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-11-15

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

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

    International Nuclear Information System (INIS)

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

    2009-01-01

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

  19. 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.

  20. [Radiographic appraisal between metal and bone interosculate backfill after total hip arthroplasty with trabecular metal cup].

    Science.gov (United States)

    Li, Wei; Zhou, Yi-Xin; Wu, Jian; Xu, Hui; Ji, Song-Jie

    2009-02-15

    To evaluate the bone refilling in the interface between the trabecular metal (TM) acetabular shell and the bone surface according to consecutive X film measuring after surgery. From July 2006 to July 2007, 35 patients (40 hips) accepted total hip replacement using trabecular metal monoblock acetabular cup system (TM). The cup was made of a ellipse shaped press fit Tantalum shell and high cross-linked PE liner (Longevity) with 28 mm inner diameter. The patients demography was: 16 male (20 hips), 19 female (20 hips), 5 bilateral hip replacements, age from 41 - 71 (mean 53), including 18 avascular necrosis hips, 16 osteoarthritis hips (including those secondary to a dysplasia hip), 4 avascular necrosis hips after femoral neck fracture, 2 Ankylosis Spondylitis. All the 40 total hip replacements used posterior approach, using hemispherical acetabular reamer and 2 mm press fit of final metal shell without screw fixation. The consecutive X film was taken at the end time of surgery and 2, 6, 12, 24 weeks, and 12 months. The clinical results was evaluate according to Harris scoring system, and the standard pelvis AP X film was measured at the interface between metal shell and the acetabular bone surface, witch was divided into five regions (A, B, C, D, E). Totally 32 patients (37 hips) were followed with average 8.7 months (7 - 12 months). The Harris before surgery was 50.5 (32 - 85), promoted to 91.0 (72 - 100), including 29 excellent, 6 good, 2 fair, and the total excellent and good rate was 94.6%. Complications include 4 patients leg length discrepancy from 1 - 2 cm, 3 patients moderate thigh pain and released after conservative therapy. No infection and dislocation was found. Twenty-one patients (23 hips) were found lucent line at the bone-metal interface from 1 - 5 mm, most common in B region and BC boundary than C, D, and CD boundary. All the patients followed was found the lucent line disappeared and refilled with bone at X film 24 weeks after surgery, however, no

  1. The spectrum of laser skin resurfacing: nonablative, fractional, and ablative laser resurfacing.

    Science.gov (United States)

    Alexiades-Armenakas, Macrene R; Dover, Jeffrey S; Arndt, Kenneth A

    2008-05-01

    The drive to attain cosmetic facial enhancement with minimal risk and rapid recovery has inspired the field of nonsurgical skin rejuvenation. Laser resurfacing was introduced in the 1980s with continuous wave carbon dioxide (CO(2)) lasers; however, because of a high rate of side effects, including scarring, short-pulse, high-peak power, and rapidly scanned, focused-beam CO(2) lasers and normal-mode erbium-doped yttrium aluminium garnet lasers were developed, which remove skin in a precisely controlled manner. The prolonged 2-week recovery time and small but significant complication risk prompted the development of non-ablative and, more recently, fractional resurfacing in order to minimize risk and shorten recovery times. Nonablative resurfacing produces dermal thermal injury to improve rhytides and photodamage while preserving the epidermis. Fractional resurfacing thermally ablates microscopic columns of epidermal and dermal tissue in regularly spaced arrays over a fraction of the skin surface. This intermediate approach increases efficacy as compared to nonablative resurfacing, but with faster recovery as compared to ablative resurfacing. Neither nonablative nor fractional resurfacing produces results comparable to ablative laser skin resurfacing, but both have become much more popular than the latter because the risks of treatment are limited in the face of acceptable improvement. At the completion of this learning activity, participants should be familiar with the spectrum of lasers and light technologies available for skin resurfacing, published studies of safety and efficacy, indications, methodologies, side effects, complications, and management.

  2. 21 CFR 888.3310 - Hip joint metal/polymer constrained cemented or uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/polymer constrained cemented or... Hip joint metal/polymer constrained cemented or uncemented prosthesis. (a) Identification. A hip joint... replace a hip joint. The device prevents dislocation in more than one anatomic plane and has components...

  3. Do large heads enhance stability and restore native anatomy in primary total hip arthroplasty?

    Science.gov (United States)

    Lombardi, Adolph V; Skeels, Michael D; Berend, Keith R; Adams, Joanne B; Franchi, Orlando J

    2011-06-01

    Dislocation remains a serious complication in hip arthroplasty. Resurfacing proponents tout anatomic femoral head restoration as an advantage over total hip arthroplasty. However, advances in bearings have expanded prosthetic head options from traditional sizes of 22, 26, 28, and 32 mm to diameters as large as 60 mm. Large heads reportedly enhance stability owing to increased range of motion before impingement and increased jump distance to subluxation. Available larger diameter material combinations include metal- or ceramic-on-highly crosslinked polyethylene and metal-on-metal, each with distinct advantages and disadvantages. We sought to determine (1) if using larger diameter heads has lowered our dislocation rate; and (2) how closely an anatomic metal-on-metal bearing with diameters to 60 mm replicates native femoral head size. We retrospectively reviewed 2020 primary arthroplasties performed with large heads (≥ 36 mm) in 1748 patients and noted dislocation incidence. In a prospective subset of 89 cases using anatomic heads, native femoral head diameter was measured intraoperatively with calipers by an independent observer and later compared with implanted size. One dislocation has occurred in 2020 hips for an incidence of 0.05%. The prosthetic head averaged 0.7 mm larger than the native head with 68 of 89 (76%) reconstructed to within ± 2 mm of native size. Larger diameter heads have contributed to lower dislocation rates and large-diameter metal-on-metal articulation can provide close anatomic restoration in primary THA.

  4. Magnetic resonance imaging of metal artifact reduction sequences in the assessment of metal-on-metal hip prostheses

    Directory of Open Access Journals (Sweden)

    Aboelmagd SM

    2014-05-01

    Full Text Available Sharief M Aboelmagd, Paul N Malcolm, Andoni P Toms Department of Radiology, Norfolk and Norwich University Hospital National Health Service Trust, Norwich, UK Abstract: Recent developments in metal artifact reduction techniques in magnetic resonance (MR have, in large part, been stimulated by the advent of soft tissue complications associated with modern metal-on-metal total hip replacements. Metallic orthopedic implants can result in severe degradation of MR images because ferromagnetic susceptibility causes signal loss, signal pile-up, geometric distortion, and failure of fat suppression. There are several approaches to controlling these susceptibility artifacts. Standard fast spin echo sequences can be adapted by modifying echo times, matrix, receiver bandwidth, slice thickness, and echo trains to minimize frequency encoding misregistration. Short tau inversion recovery and 2-point Dixon techniques are both more resistant to susceptibility artifacts than spectral fat suppression. A number of dedicated metal artifact reduction sequences are now available commercially. The common approach of these multispectral techniques is to generate three dimensional datasets from which the final images are reconstructed. Frequency encoding misregistration is controlled using a variety of techniques, including specific resonant frequency acquisition, view-angle tilting, and phase encoding. Metal artifact reduction MR imaging has been the key to understanding the prevalence, severity, and prognosis of adverse reactions to metal debris in metal-on-metal hip replacements. Conventional radiographs are typically normal or demonstrate minimal change and are unable to demonstrate the often extensive soft tissue abnormalities, which include necrosis, soft tissue masses and fluid collections, myositis, muscle atrophy, tendon avulsions, and osteonecrosis. These MR findings correlate poorly with clinical and serological measures of disease, and therefore MR imaging is

  5. Cardiac transplant due to metal toxicity associated with hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Sheldon Moniz, MBBS (UWA

    2017-09-01

    Full Text Available Concerns regarding metal-on-metal (MoM bearing couples in total hip arthroplasty are well documented in the literature with cobalt (Co and chromium (Cr toxicity causing a range of both local and systemic adverse reactions. We describe the case of a patient undergoing cardiac transplantation as a direct result of Co and Cr toxicity following a MoM hip replacement. Poor implant positioning led to catastrophic wear generating abundant wear particles leading to Co and Cr toxicity, metallosis, bony destruction, elevated metal ion levels, and adverse biological responses. Systemic symptoms continued for 3 years following cardiac transplantation with resolution only after revision hip arthroplasty. There was no realization in the initial cardiac assessment and subsequent transplant workup that the hip replacement was the likely cause of the cardiac failure, and the hip replacement was not recognized as the cause until years after the heart transplant. This case highlights the need for clinicians to be aware of systemic MoM complications as well as the importance of positioning when using these prostheses.

  6. Laser Resurfacing Pearls

    OpenAIRE

    Shah, Sonia; Alam, Murad

    2012-01-01

    Ablative skin resurfacing using the carbon dioxide laser was long considered the gold standard for treatment of photoaging, acne scars, and rhytids. However, conventional full-face carbon dioxide resurfacing is associated with significant risk of side effects and a prolonged postoperative recovery period. Fractional resurfacing has recently revolutionized laser surgery by offering close to comparable results with minimal side effects and a more rapid recovery. Although fractional devices have...

  7. 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

  8. Cartilage Health in Knees Treated with Metal Resurfacing Implants or Untreated Focal Cartilage Lesions: A Preclinical Study in Sheep.

    Science.gov (United States)

    Martinez-Carranza, Nicolas; Hultenby, Kjell; Lagerstedt, Anne Sofie; Schupbach, Peter; Berg, Hans E

    2017-07-01

    Background Full-depth cartilage lesions do not heal and the long-term clinical outcome is uncertain. In the symptomatic middle-aged (35-60 years) patient, treatment with metal implants has been proposed. However, the cartilage health surrounding these implants has not been thoroughly studied. Our objective was to evaluate the health of cartilage opposing and adjacent to metal resurfacing implants. Methods The medial femoral condyle was operated in 9 sheep bilaterally. A metallic resurfacing metallic implant was immediately inserted into an artificially created 7.5 mm defect while on the contralateral knee the defect was left untreated. Euthanasia was performed at 6 months. Six animals, of similar age and study duration, from a previous study were used for comparison in the evaluation of cartilage health adjacent to the implant. Cartilage damage to joint surfaces within the knee, cartilage repair of the defect, and cartilage adjacent to the implant was evaluated macroscopically and microscopically. Results Six animals available for evaluation of cartilage health within the knee showed a varying degree of cartilage damage with no statistical difference between defects treated with implants or left untreated ( P = 0.51; 95% CI -3.7 to 6.5). The cartilage adjacent to the implant (score 0-14; where 14 indicates no damage) remained healthy in these 6 animals showing promising results (averaged 10.5; range 9-11.5, SD 0.95). Cartilage defects did not heal in any case. Conclusion Treatment of a critical size focal lesion with a metal implant is a viable alternative treatment.

  9. CT-based quantification of bone stock in large head metal-on-metal unilateral total hip replacements

    NARCIS (Netherlands)

    Boomsma, Martijn F.; Slouwerhof, Inge; van Lingen, Christiaan; Pakvis, Dean F. M.; van Dalen, Jorn A.; Edens, Mireille A.; Ettema, Harmen B.; Verheyen, Cees C. P. M.; Maas, Mario

    2016-01-01

    To explore ipsilateral and contralateral acetabular roof bone stock density in unilateral large head MoM THA whether there is a significant lower acetabular bone stock in the hip with a metal-on-metal (MoM) total hip replacement compared to the contralateral side. Second part of this study is to

  10. Bone mineral density of the proximal femur after hip resurfacing arthroplasty: 1-year follow-up study

    Directory of Open Access Journals (Sweden)

    Anttila Esa

    2011-05-01

    Full Text Available Abstract Background Hip resurfacing arthroplasty (HRA is considered a bone-preserving procedure and may eliminate proximal femoral stress shielding and osteolysis. However, in addition to implant-related stress-shielding factors, various patient-related factors may also have an effect on bone mineral density (BMD of the proximal femur in patients with HRA. Thus, we studied the effects of stem-neck angle, demographic variables, and physical functioning on the BMD of the proximal femur in a one-year follow-up. Methods Thirty three patients (9 females and 24 males with a mean (SD age of 55 (9 years were included in the study. BMD was measured two days and 3, 6, and 12 months postoperatively and 10 regions of interest (ROI were used. Stem-neck angle was analyzed from anteroposterior radiographs. Results Three months postoperatively, BMD decreased in six out of 10 regions of interest (ROI on the side operated on and in one ROI on the control side (p Conclusions After an early drop, the BMD of the upper femur was restored and even exceeded the preoperative level at one year follow-up. From a clinical standpoint, the changes in BMD in these HRA patients could not be explained by stem-neck angle or patient related factors.

  11. The possibilities of magnetic resonance imaging in the diagnostics of complications after metal-on-metal hip arthroplasty

    Directory of Open Access Journals (Sweden)

    A. A. Vergay

    2013-01-01

    Full Text Available Objective: to find adverse periprosthetic local tissue reactions after metal-on-metal hip arthroplasty with ASR XL heads. Material and methods: 119 patients with 134 ASR XL head - Corail prostheses were treated in 2007-2009. The results were studied in 94 cases (105 prostheses - 84%. Average follow-up time consisted 62 ± 3 months. MRI was performed in 12 patients (13 hips who had clinical nonsatisfaction. Obtained data were compared with 21 MRI (24 hips of controlled group with good and perfect clinical results. Results. We found variations of normal periprosthetic tissue condition. Adverse reactions were identified in 10 cases. To improve the quality of pictures we developed special MRI adjustments and regimes of work. Conclusion: MRI diagnostics is indicated for the patients with metal-on-metal total hip arthroplasty in order to identify adverse local tissue reactions. The improvement of picture quality needs special adjustment of MRI equipment.

  12. No association between pseudotumors, high serum metal-ion levels and metal hypersensitivity in large-head metal-on-metal total hip arthroplasty at 5-7-year follow-up

    DEFF Research Database (Denmark)

    Hjorth, Mette Holm; Stilling, Maiken; Soballe, Kjeld

    2015-01-01

    -ion concentrations were measured, metal allergy and atopic dermatitis were evaluated, and the questionnaires of the Oxford Hip Score (OHS), Harris Hip Score (HHS) and the Short-Form Health Survey (SF-36) were completed. RESULTS: Pseudotumors were found in eight patients, but they were asymptomatic and their serum...... pseudotumor formation, serum metal-ion levels, metal patch test reactivity, and atopic dermatitis. However, clinicians should be aware of asymptomatic pseudotumors, and we advise further exploration into the mechanisms involved in the pathogenesis of pseudotumors.......OBJECTIVE: The relationship between metal wear debris, pseudotumor formation and metal hypersensitivity is complex and not completely understood. The purpose of this study was to assess the prevalence of pseudotumor formation in a consecutive series of metal-on-metal (MoM) total hip arthroplasty...

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Andrea Giampreti

    2016-01-01

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

  15. High performance sinter-HIP for hard metals

    International Nuclear Information System (INIS)

    Hongxia Chen; Deming Zhang; Yang Li; Jingping Chen

    2001-01-01

    The horizontal sinter-HIP equipment with great charge capacity and high performance, developed and manufactured by Central Iron and Steel Research Institute(CISRI), is mainly used for sintering and condensation of hard metals. This equipment is characterized by large hot zone, high heating speed, good temperature uniformity and fast cooling system. The equipment can provide uniform hot zone with temperature difference less than 6 o C at 1500-1600 o C and 6-10 MPa by controlling temperature, pressure and circulation of gas precisely. Using large scale horizontal sinter-HIP equipment to produce hard matals have many advantages such as stable quality, high efficiency of production, high rate of finished products and low production cost, so this equipment is a good choice for manufacturer of hard metals. (author)

  16. Adventure sports and sexual freedom hip replacement: the tripolar hip.

    Science.gov (United States)

    Pritchett, James W

    2018-01-01

    Certain athletic activities and lifestyles require a completely stable and very mobile hip. Total hip replacement with a natural femoral head size and two mobile-bearing surfaces (i.e., a "tripolar" prosthesis) is the most stable prosthesis. Elegant design and wear-resistant bearing surfaces are the keys to long-term implant survivorship. The hypothesis is that a ceramic-coated tripolar prosthesis using highly cross-linked polyethylene can provide full function and complete stability with low wear. This study sought to determine: (1) patient-reported outcomes, (2) functional outcomes, (3) implant survivorship and complications, and (4) postoperative sexual limitations. Between 1998 and 2011, the author performed 160 primary total hip replacements using tripolar prostheses in patients participating in adventure sports and other physically demanding activities. The institutional review board approved this study. The inclusion criteria were patients who needed unrestricted activity and who were not candidates for or did not choose hip resurfacing. Patients were followed every second year and assessed with radiographs, Harris Hip Score, WOMAC, SF-12, and UCLA functional outcome scores. Patients were asked about symptoms of instability and satisfaction with their hip replacement. Patients were asked both preoperatively and 2 years postoperatively four questions about their sexual activity. Mean follow-up was 11 years. At 2 years' postoperatively, 98% of patients reported their satisfaction as excellent or good and 99% were not limited for sexual activity following surgery. Seventy-four percent of patients reported they were recovered within 6 weeks of surgery. There were no dislocations. There were three revision procedures for implant loosening, infection, and periprosthetic fracture, but there were no failures of the tripolar articulation. The mean postoperative UCLA score was the highly athletic score of 8. There were no signs of osteolysis, wear, or metal

  17. A preliminary biomechanical study of a novel carbon-fibre hip implant versus standard metallic hip implants.

    Science.gov (United States)

    Bougherara, Habiba; Zdero, Rad; Dubov, Anton; Shah, Suraj; Khurshid, Shaheen; Schemitsch, Emil H

    2011-01-01

    Total hip arthroplasty is a widespread surgical approach for treating severe osteoarthritis of the human hip. Aseptic loosening of standard metallic hip implants due to stress shielding and bone loss has motivated the development of new materials for hip prostheses. Numerically, a three-dimensional finite element (FE) model that mimicked hip implants was used to compare a new hip stem to two commercially available implants. The hip implants simulated were a novel CF/PA12 carbon-fibre polyamide-based composite hip stem, the Exeter hip stem (Stryker, Mahwah, NJ, USA), and the Omnifit Eon (Stryker, Mahwah, NJ, USA). A virtual axial load of 3 kN was applied to the FE model. Strain and stress distributions were computed. Experimentally, the three hip stems had their distal portions rigidly mounted and had strain gauges placed along the surface at 3 medial and 3 lateral locations. Axial loads of 3 kN were applied. Measurements of axial stiffness and strain were taken and compared to FE analysis. The overall linear correlation between FE model versus experimental strains showed reasonable results for the lines-of-best-fit for the Composite (Pearson R(2)=0.69, slope=0.82), Exeter (Pearson R(2)=0.78, slope=0.59), and Omnifit (Pearson R(2)=0.66, slope=0.45), with some divergence for the most distal strain locations. From FE analysis, the von Mises stress range for the Composite stem was much lower than that in the Omnifit and Exeter implants by 200% and 45%, respectively. The preliminary experiments showed that the Composite stem stiffness (1982 N/mm) was lower than the metallic hip stem stiffnesses (Exeter, 2460 N/mm; Omnifit, 2543 N/mm). This is the first assessment of stress, strain, and stiffness of the CF/PA12 carbon-fibre hip stem compared to standard commercially-available devices. Copyright © 2010 IPEM. Published by Elsevier Ltd. All rights reserved.

  18. PMS49 – Empirical comparison of discrete choice experiment and best-worst scaling to estimate stakeholders' risk tolerance for hip replacement surgery

    NARCIS (Netherlands)

    van Dijk, J.D.; Groothuis-Oudshoorn, Karin; Marshall, D.; IJzerman, Maarten Joost

    2013-01-01

    Objectives Empirical comparison of two preference elicitation methods, discrete choice experiment (DCE) and profile case best-worst scaling (BWS), regarding the estimation of the risk tolerance for hip replacement surgery (total hip arthroplasty and total hip resurfacing arthroplasty). Methods An

  19. The acting wear mechanisms on metal-on-metal hip joint bearings: in-vitro results

    NARCIS (Netherlands)

    Wimmer, M.A.; Loos, J.; Nassutt, R.; Heitkemper, M.; Fischer, A.

    2001-01-01

    Metal-on-metal (MOM) hip joint bearings are currently under discussion as alternatives to metal-on-polymer (MOP) bearings. Some criteria under scrutiny are the wear resistance, the influence of wear particles on the surrounding tissue, as well as the frictional torque. In order to understand and

  20. Early results of metal on metal articulation total hip arthroplasty in young patients.

    Science.gov (United States)

    Mohamad, J A; Kwan, M K; Merican, A M; Abbas, A A; Kamari, Z H; Hisa, M K; Ismail, Z; Idrus, R M

    2004-12-01

    We report our early experience of 20 cases of metal on metal articulation total hip arthroplasty in 19 young patients. Avascular necrosis of the femoral head (63%) was the commonest diagnosis for patients undergoing this procedure, followed by osteoarthritis (21%). In general, most of the patients were young and physically active with an average age of 43.1 years (range, 25 to 58 years). The average follow-up period was 18 months (range, 7 to 46 months). The mean total Harris Hip Score preoperatively and at final follow-up was 31 points and 89 points respectively. The mean total Pain Score improved from an average of 11.5 to 41.1 points at final follow-up. Sixteen (84%) of the patients had a good to excellent hip score. There was one dislocation, which stabilized after reduction and conservative management. One case of early infection underwent a two-staged revision.

  1. Histologic effects of resurfacing lasers.

    Science.gov (United States)

    Freedman, Joshua R; Greene, Ryan M; Green, Jeremy B

    2014-02-01

    By utilizing resurfacing lasers, physicians can significantly improve the appearance of sun-damaged skin, scars, and more. The carbon dioxide and erbium:yttrium-aluminum-garnet lasers were the first ablative resurfacing lasers to offer impressive results although these earlier treatments were associated with significant downtime. Later, nonablative resurfacing lasers such as the neodymium:yttrium-aluminum-garnet laser proved effective, after a series of treatments with less downtime, but with more modest results. The theory of fractional photothermolysis has revolutionized resurfacing laser technology by increasing the safety profile of the devices while delivering clinical efficacy. A review of the histologic and molecular consequences of the resurfacing laser-tissue interaction allows for a better understanding of the devices and their clinical effects. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. Friction of ceramic and metal hip hemi-endoprostheses against cadaveric acetabula.

    Science.gov (United States)

    Müller, L P; Degreif, J; Rudig, L; Mehler, D; Hely, H; Rommens, P M

    2004-12-01

    Studies of hip arthroplasty have dealt mainly with total endoprosthesis, while tribology measurement values of hemi-endoprosthetic implants are rare. The small amount of experimental tribological data concerning materials of hemi-endoprosthetic implants in the form of pendulum trials, animal experiments, in vivo measurements on human hip joints and pin on disc studies report friction coefficients between 0.014 and 0.57; the friction coefficients measured in fresh human cadaver hip joints were determined between 0.001 and 0.08. The HEPFlEx-hip simulator was constructed to test the friction coefficients of unipolar femur head hemi-endoprostheses made of metal or ceramic against fresh cadaveric acetabula. Its plane of movement is uniaxial with a flexion-extension movement of +30/-18 degrees . The force is produced pneumatically dynamic with amounts of 2.5 kN. Newborn calf serum serves as a lubricant. We mounted 20 fresh porcine acetabula and 10 fresh human cadaver acetabula in the HEPFlEx-hip simulator and compared the two unipolar femur head hemi-endoprostheses (metal vs. ceramic). The mean friction coefficients against porcine acetabula were micro=0.017-0.082 for ceramic and micro=0.020-0.101 for metal; against human cadaver acetabula micro=0.017-0.083 for ceramic and micro=0.019-0.118 for metal. The frictional coefficient deltas (metal-ceramic) values of all measurements were Deltamicro=0.004 for porcine acetabula and Deltamicro=0.001 for cadaver acetabula. Box-plots graphics document significantly lower frictional coefficients of the ceramics. The lower frictional coefficients of ceramic compared to metal against fresh cadaveric acetabula may have a clinical impact on the process of the protrusion of the corresponding femoral head through the acetabulum.

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

    NARCIS (Netherlands)

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

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

  4. Laser Resurfacing at the Time of Rhytidectomy.

    Science.gov (United States)

    Scheuer, Jack F; Costa, Christopher R; Dauwe, Phillip B; Ramanadham, Smita R; Rohrich, Rod J

    2015-07-01

    Laser resurfacing with simultaneous rhytidectomy has been used to augment aesthetic results and decrease overall patient recuperative time, yet presents a potential dual insult to the microvasculature supply of facial skin flaps. This study describes the authors' experience with rhytidectomy and simultaneous laser resurfacing. Between May of 1999 and January of 2013, 85 face lifts with concomitant erbium laser resurfacing were reviewed retrospectively. Seven procedures were excluded for incomplete charting. Patient demographics, treatment zone, concomitant procedures, and secondary/tertiary face lifts were analyzed for associations with postoperative complications attributable to laser resurfacing. No complications were reported in the perioral resurfacing group. There was one instance of delayed wound healing and prolonged erythema in the full face group, and one instance of moderate hyperpigmentation in the central face group. No instances of hypopigmentation or flap necrosis attributable to laser resurfacing were noted. The overall complication rate was 3.8 percent. There was a statistically significant difference when comparing the number of complications between the facial laser resurfacing zones (p = 0.037). When analyzing zone of laser resurfacing as an independent risk factor for complications, no significant association was derived, but full face zone resurfacing approached statistical significance (p = 0.063). Although a significant difference in the number of complications between treatment groups existed, the authors were not able to definitively attribute this solely to the extent of laser resurfacing. Simultaneous laser resurfacing and rhytidectomy can be performed safely in select patients using ablative mode only over the undermined flap. Therapeutic, IV.

  5. International metal-on-metal multidisciplinary teams: do we manage patients with metal-on-metal hip arthroplasty in the same way? An analysis from the International Specialist Centre Collaboration on MOM Hips (ISCCoMH).

    Science.gov (United States)

    Berber, R; Skinner, J; Board, T; Kendoff, D; Eskelinen, A; Kwon, Y-M; Padgett, D E; Hart, A

    2016-02-01

    There are many guidelines that help direct the management of patients with metal-on-metal (MOM) hip arthroplasties. We have undertaken a study to compare the management of patients with MOM hip arthroplasties in different countries. Six international tertiary referral orthopaedic centres were invited to participate by organising a multi-disciplinary team (MDT) meeting, consisting of two or more revision hip arthroplasty surgeons and a musculoskeletal radiologist. A full clinical dataset including history, blood tests and imaging for ten patients was sent to each unit, for discussion and treatment planning. Differences in the interpretation of findings, management decisions and rationale for decisions were compared using quantitative and qualitative methods. Overall agreement between the orthopaedic centres and the recommended treatment plans for the ten patients with MOM hip implants was moderate (kappa = 0.6). Full agreement was seen in a third of cases, however split decisions were also seen in a third of cases. Units differed in their interpretation of the significance of the investigation findings and put varying emphasis on serial changes, in the presence of symptoms. In conclusion, the management of raised or rising blood metal ions, cystic pseudotumours and peri-acetabular osteolysis led to inconsistency in the agreement between centres. Coordinated international guidance and MDT panel discussions are recommended to improve consensus in decision making. A lack of evidence and the subsequent variation in regulator guidance leads to differences in opinions, the clinical impact of which can be reduced through a multi-disciplinary team approach to managing patients with MOM hip implants. Cite this article: Bone Joint J 2016;98-B:179-86. ©2016 The British Editorial Society of Bone & Joint Surgery.

  6. Current role of resurfacing lasers.

    Science.gov (United States)

    Hantash, B M; Gladstone, H B

    2009-06-01

    Resurfacing lasers have been the treatment of choice for diminishing rhytids and tightening skin. The carbon dioxide and erbium lasers have been the gold and silver standards. Despite their effectiveness, these resurfacing lasers have a very high risk profile including scarring, hyperpigmentation and hypopigmentation. Because of these side effects, various practitioners have tried alternative settings for these lasers as well as alternative wavelengths, particularly in the infrared spectrum. These devices have had less downtime, but their effectiveness has been limited to fine wrinkles. As with selective photothemolysis, a major advance in the field has been fractionated resurfacing which incorporates grids of microthermal zones that spares islands of skin. This concept permits less tissue damage and quicker tissue regeneration. Initially, fractionated resurfacing was limited to the nonablative mid-infrared spectrum. These resurfacing lasers is appropriate for those patients with acne scars, uneven skin tone, mild to moderate photodamage, and is somewhat effective for melasma. Importantly, because there is less overall tissue damage and stimulation of melanocytes, these lasers can be used in darker skin types. Downtime is 2-4 days of erythema and scaling. Yet, these nonablative fractionated devices required 5-6 treatments to achieve a moderate effect. Logically, the fractionated resurfacing has now been applied to the CO2 and the Erbium:Yag lasers. These devices can treat deeper wrinkles and tighten skin. Downtime appears to be 5-7 days. The long term effectiveness and the question of whether these fractionated devices will approach the efficacy of the standard resurfacing lasers is still in question. Ultimately either integrated devices which may use fractionated resurfacing, radiofrequency and a sensitizer, or combining different lasers in a single treatment may prove to be the most effective in reducing rhtyides, smoothing the skin topography and tightening the

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

    DEFF Research Database (Denmark)

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

    2009-01-01

    BACKGROUND AND PURPOSE: It has been speculated that the prevalence of metal allergy may be higher in patients with implant failure. We compared the prevalence and cause of revisions following total hip arthroplasty (THA) in dermatitis patients suspected to have contact allergy and in patients...... in general with THA. Furthermore, we compared the prevalence of metal allergy in dermatitis patients with and without THA. MATERIALS AND METHODS: The Danish Hip Arthroplasty Registry (DHAR) contained detailed information on 90,697 operations. The Gentofte patch-test database contained test results...... was similar in cases (12%) and in patients from the DHAR (13%). The prevalence of metal allergy was similar in cases and controls. However, the prevalence of metal allergy was lower in cases who were patch-tested after operation (6%) than in those who were patch-tested before operation (16%) (OR = 2.9; 95% CI...

  8. Ablative skin resurfacing.

    Science.gov (United States)

    Agrawal, Nidhi; Smith, Greg; Heffelfinger, Ryan

    2014-02-01

    Ablative laser resurfacing has evolved as a safe and effective treatment for skin rejuvenation. Although traditional lasers were associated with significant thermal damage and lengthy recovery, advances in laser technology have improved safety profiles and reduced social downtime. CO2 lasers remain the gold standard of treatment, and fractional ablative devices capable of achieving remarkable clinical improvement with fewer side effects and shorter recovery times have made it a more practical option for patients. Although ablative resurfacing has become safer, careful patient selection and choice of suitable laser parameters are essential to minimize complications and optimize outcomes. This article describes the current modalities used in ablative laser skin resurfacing and examines their efficacy, indications, and possible side effects. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  9. Anesthesia Methods in Laser Resurfacing

    OpenAIRE

    Gaitan, Sergio; Markus, Ramsey

    2012-01-01

    Laser resurfacing technology offers the ability to treat skin changes that are the result of the aging process. One of the major drawbacks of laser resurfacing technologies is the pain associated with the procedure. The methods of anesthesia used in laser resurfacing to help minimize the pain include both noninvasive and invasive procedures. The noninvasive procedures can be divided into topical, cryoanesthesia, and a combination of both. The invasive methods of anesthesia include injected fo...

  10. The treatment of hypopigmentation after skin resurfacing.

    Science.gov (United States)

    Fulton, James E; Rahimi, A David; Mansoor, Sohail; Helton, Peter; Shitabata, Paul

    2004-01-01

    Hypopigmentation has plagued all methods of skin resurfacing. Whether the physician uses chemical peels, dermabrasion or laser resurfacing hypopigmentation can develop. To examine the pathogenesis and treatment of hypopigmentation after resurfacing. Areas of hypopigmentation after skin resurfacing were blended in with laser-assisted chemabrasion (LACA). The process begins with preconditioning of the skin with vitamin A/glycolic skin conditioning lotions. Then the area is resurfaced with the LACA. This resurfacing usually requires three to four freeze-sand cycles to remove the areas of hypopigmentation associated with dermal fibrosis. The resurfaced skin is then occluded with a combination of polyethylene/silicone sheeting during the acute phase of wound healing. Ultraviolet photography and histologic examination were used to demonstrate the improvement in dermal fibrosis and hypopigmentation. The LACA improved areas of hypopigmentation in the 22 cases studied. Under occlusive wound dressings, the melanocytes migrated into the areas of hypopigmentation, and the wounds healed without extensive fibrosis. This produced a blending of skin color. It is possible with skin preconditioning, LACA, and occlusive wound healing to provide for a wound healing environment that blends in areas of hypopigmentation that have developed after previous skin resurfacing.

  11. Formation of a pseudotumor in total hip arthroplasty using a tribological metal-polyethylene pair

    Directory of Open Access Journals (Sweden)

    Lorenzo Fagotti

    2015-12-01

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

  12. Anesthesia Methods in Laser Resurfacing

    Science.gov (United States)

    Gaitan, Sergio; Markus, Ramsey

    2012-01-01

    Laser resurfacing technology offers the ability to treat skin changes that are the result of the aging process. One of the major drawbacks of laser resurfacing technologies is the pain associated with the procedure. The methods of anesthesia used in laser resurfacing to help minimize the pain include both noninvasive and invasive procedures. The noninvasive procedures can be divided into topical, cryoanesthesia, and a combination of both. The invasive methods of anesthesia include injected forms (infiltrative, nerve blocks, and tumescent anesthesia) and supervised anesthesia (monitored anesthesia care and general anesthesia). In this review, the authors summarize the types of anesthesia used in laser resurfacing to aid the provider in offering the most appropriate method for the patient to have as painless a procedure as possible. PMID:23904819

  13. A clinical, radiological and biomechanical study of the TARA hip prosthesis

    NARCIS (Netherlands)

    Waal Malefijt, de M.C.; Huiskes, H.W.J.

    1993-01-01

    We reviewed 60 patients with 72 TARA (total articular replacement arthroplasty) resurfacing hip prostheses. To analyse the behaviour of the femoral component a radiographic study was done and a two-dimensional finite element model was constructed. The stem of the femoral component plays a role in

  14. Information for Patients Who Have Metal-on-Metal Hip Implants

    Science.gov (United States)

    ... both the right and left sides) Patients with resurfacing systems with small femoral heads (device sizes less ... groin area, including the symptoms related to your skin, heart, nervous system, kidneys, or thyroid gland, it ...

  15. Focal femoral condyle resurfacing.

    LENUS (Irish Health Repository)

    Brennan, S A

    2013-03-01

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

  16. Skin resurfacing procedures: new and emerging options.

    Science.gov (United States)

    Loesch, Mathew M; Somani, Ally-Khan; Kingsley, Melanie M; Travers, Jeffrey B; Spandau, Dan F

    2014-01-01

    The demand for skin resurfacing and rejuvenating procedures has progressively increased in the last decade and has sparked several advances within the skin resurfacing field that promote faster healing while minimizing downtime and side effects for patients. Several technological and procedural skin resurfacing developments are being integrated into clinical practices today allowing clinicians to treat a broader range of patients' skin types and pathologies than in years past, with noteworthy outcomes. This article will discuss some emerging and developing resurfacing therapies and treatments that are present today and soon to be available.

  17. Tribology and wear of metal-on-metal hip prostheses: influence of cup angle and head position.

    Science.gov (United States)

    Williams, Sophie; Leslie, Ian; Isaac, Graham; Jin, Zhongmin; Ingham, Eileen; Fisher, John

    2008-08-01

    Clinical studies have indicated that the angular position of the acetabular cup may influence wear in metal-on-metal total hip bearings. A high cup angle in comparison to the anatomical position may lead to the head being constrained by the superior lateral surface and rim of the cup, thus potentially changing the location of the contact zone between the head and the cup. The aim of this study was to test the hypothesis that both a steep cup angle and a lateralized position of the head can increase head contact on the superior rim of the cup, with the consequence of increased wear. Hip-joint simulator studies of metal-on-metal bearings were undertaken with cup angles of 45 degrees and 55 degrees . The femoral head was either aligned to the center of the cup or placed in a position of microlateralization. Wear was measured gravimetrically over 5 million cycles. A steep cup angle of 55 degrees showed significantly higher long-term steady-state wear than a standard cup angle of 45 degrees (p < 0.01). The difference was fivefold. Microlateralization of the head resulted in a fivefold increase in steady-state wear compared with a centralized head. The combination of a steep cup angle and a microlateralized head increased the steady-state wear rate by tenfold compared with a standard cup angle with a centralized head. These studies support the hypothesis that both an increased cup angle and a lateral head position increase wear in metal-on-metal hip prostheses.

  18. Bilateral hip arthroplasty: is 1-week staging the optimum strategy?

    Directory of Open Access Journals (Sweden)

    Willis-Owen Charles A

    2010-11-01

    Full Text Available Abstract Seventy-nine patients underwent bilateral hip arthroplasty staged either at 1 week (Group 1 or after greater intervals (as suggested by the patients, mean 44 weeks, range 16-88 weeks (Group 2, over a five year period at one Institution. Sixty-eight patients (29 bilateral hip resurfacings and 39 total hip replacements completed questionnaires regarding their post-operative recovery, complications and overall satisfaction with the staging of their surgery. There was no significant age or ASA grade difference between the patient groups. Complication rates in the two groups were similar and overall satisfaction rates were 84% in Group 1 (n = 32 and 89% in Group 2 (n = 36. Cumulative hospital lengths of stay were significantly longer in Group 1 patients (11.9 days vs 9.1 days(p The mean time to return to part-time work was 16.4 weeks for Group 1, and a cumulative 17.2 weeks (8.8 and 8.4 weeks for Group 2. The time to return to full-time work was significantly shorter for Group 1 patients (21.0 weeks, compared with a cumulative 29.7 weeks for Group 2(p Hip resurfacing patients in Group 2 had significantly shorter durations of postoperative pain and were able to return to part-time and full time work sooner than total hip arthroplasty patients. There was a general trend towards a faster recovery and resumption of normal activities following the second operation in Group 2 patients, compared with the first operation. Bilateral hip arthroplasty staged at a 1-week interval resulted in an earlier resolution of hip pain, and an earlier return to full-time work (particularly following total hip replacement surgery, with high levels of patient satisfaction and no increased risk in complications; however the hospital length of stay was significantly longer. The decision for the timing of staged bilateral surgery should be made in conjunction with the patient, making adjustments to accommodate their occupational needs and functional demands.

  19. Routine patellar resurfacing using an inset patellar technique.

    LENUS (Irish Health Repository)

    Hurson, Conor

    2012-02-01

    The management of the patella in total knee arthroplasty still causes controversy. Whether or not to resurface the patella in primary total knee arthroplasty remains unclear. In this study we examined 220 consecutive total knee replacements, by a single surgeon, where the patella was routinely resurfaced using the inset technique. All patellae were suitable for resurfacing. Patellar thickness was not altered in 54.5% of patellae. In 97.2% the patella was within 2 mm of the original thickness. There were no significant complications. In this study we have found that the inset technique of patella resurfacing in total knee replacement is a simple and safe resurfacing procedure.

  20. Hip Implant Systems

    Science.gov (United States)

    ... Implants and Prosthetics Metal-on-Metal Hip Implants Hip Implants Share Tweet Linkedin Pin it More sharing options Linkedin Pin it Email Print Hip implants are medical devices intended to restore mobility ...

  1. Erythema after laser skin resurfacing.

    Science.gov (United States)

    Ruiz-Esparza, J; Barba Gomez, J M; Gomez de la Torre, O L; David, L

    1998-01-01

    Erythema after laser skin resurfacing is seen by many as a necessary evil in order to get good results from the procedure. A critical review of widely accepted concepts may lead to diminishing the length of postoperative erythema in patients undergoing laser resurfacing. The authors report on two previously unrecognized factors in the causation of this problem.

  2. Perioral Rejuvenation With Ablative Erbium Resurfacing.

    Science.gov (United States)

    Cohen, Joel L

    2015-11-01

    Since the introduction of the scanning full-field erbium laser, misconceptions regarding ablative erbium resurfacing have resulted in its being largely overshadowed by ablative fractional resurfacing. This case report illustrates the appropriateness of full-field erbium ablation for perioral resurfacing. A patient with profoundly severe perioral photodamage etched-in lines underwent full-field ablative perioral resurfacing with an erbium laser (Contour TRL, Sciton Inc., Palo Alto, CA) that allows separate control of ablation and coagulation. The pre-procedure consultations included evaluation of the severity of etched-in lines, and discussion of patient goals, expectations, and appropriate treatment options, as well as a review of patient photos and post-treatment care required. The author generally avoids full-field erbium ablation in patients with Fitzpatrick type IV and above. For each of 2 treatment sessions (separated by approximately 4 months), the patient received (12 cc plain 2% lidodaine) sulcus blocks before undergoing 4 passes with the erbium laser at 150 μ ablation, no coagulation, and then some very focal 30 μ ablation to areas of residual lines still visualized through the pinpoint bleeding. Similarly, full-field ablative resurfacing can be very reliable for significant wrinkles and creping in the lower eyelid skin--where often a single treatment of 80 μ ablation, 50 μ coagulation can lead to a nice improvement. Standardized digital imaging revealed significant improvement in deeply etched rhytides without significant adverse events. For appropriately selected patients requiring perioral (or periorbital) rejuvenation, full-field ablative erbium resurfacing is safe, efficacious and merits consideration.

  3. Safety measures in hip arthroscopy and their efficacy in minimizing complications: a systematic review of the evidence.

    Science.gov (United States)

    Gupta, Asheesh; Redmond, John M; Hammarstedt, Jon E; Schwindel, Leslie; Domb, Benjamin G

    2014-10-01

    The purpose of this systematic review was to evaluate the literature to determine complications of hip arthroscopy, with a secondary focus on how to minimize complications and risks. Two independent reviewers performed a search of PubMed for articles that contained at least 1 of the following terms: complications and hip arthroscopy, hip impingement, femoral acetabular impingement and complications, or femoroacetabular impingement (FAI) and complications. The search was limited to articles published between 1999 and June 2013. An additional search was performed for articles evaluating techniques on how to minimize complications. We identified 81 studies (5,535 patients; 6,277 hips). The mean age was 35.48 years, and the mean body mass index was 25.20 kg/m(2). Of the participants, 52% were male and 48% were female. The majority of studies were Level IV Evidence (63%). A total of 285 complications were reported, for an overall rate of 4.5%. There were 26 major complications (0.41%) and a 4.1% minor complication rate. The overall reoperation rate was 4.03%. A total of 94 hips underwent revision arthroscopy. Regarding open procedures, 150 patients (93%) underwent either total hip arthroplasty or a hip resurfacing procedure. The conversion rate to total hip arthroplasty or a resurfacing procedure was 2.4%. Overall, primary hip arthroscopy is a successful procedure with low rates of major (0.41%) and minor (4.1%) complications. The reoperation rate was 4.03% in our review. There is admittedly a learning curve to performing hip arthroscopy, and we present a systematic review of the complications and how to minimize these complications with careful technique and planning. Level IV, systematic review of Level II to V studies. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Myant, Connor; Cann, Philippa

    2014-06-01

    Artificial articular joints present an interesting, and difficult, tribological problem. These bearing contacts undergo complex transient loading and multi axes kinematic cycles, over extremely long periods of time (>10 years). Despite extensive research, wear of the bearing surfaces, particularly metal-metal hips, remains a major problem. Comparatively little is known about the prevailing lubrication mechanism in artificial joints which is a serious gap in our knowledge as this determines film formation and hence wear. In this paper we review the accepted lubrication models for artificial hips and present a new concept to explain film formation with synovial fluid. This model, recently proposed by the authors, suggests that interfacial film formation is determined by rheological changes local to the contact and is driven by aggregation of synovial fluid proteins. The implications of this new mechanism for the tribological performance of new implant designs and the effect of patient synovial fluid properties are discussed. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. State of the art in hard-on-hard bearings: how did we get here and what have we achieved?

    Science.gov (United States)

    Zywiel, Michael G; Sayeed, Siraj A; Johnson, Aaron J; Schmalzried, Thomas P; Mont, Michael A

    2011-03-01

    Total hip arthroplasty has shown excellent results in decreasing pain and improving function in patients with degenerative disease of the hip. Improvements in prosthetic materials, designs and implant fixation have now resulted in wear of the bearing surface being the limitation of this technology, and a number of hard-on-hard couples have been introduced to address this concern. The purpose of this article is to review the origins, development, survival rates and potential advantages and disadvantages of the following hard-on-hard bearings for total hip arthroplasty: metal-on-metal standard total hip arthroplasty; metal-on-metal hip resurfacing arthroplasty, ceramic-on-ceramic total hip arthroplasty; and ceramic-on-metal bearings. Improvements in the manufacturing of metal-on-metal bearings over the past 50 years have resulted in implants that provide low wear rates and allow for the use of large femoral heads. However, concerns remain regarding elevated serum metal ion levels, potential teratogenic effects and potentially devastating adverse local tissue reactions, whose incidence and pathogenesis remains unclear. Modern total hip resurfacing has shown excellent outcomes over 10 years in the hands of experienced surgeons. Current ceramic-on-ceramic bearings have demonstrated excellent survival with exceptionally low wear rates and virtually no local adverse effects. Concerns remain for insertional chipping, in vivo fracture and the variable incidence of squeaking. Contemporary ceramic-on-metal interfaces are in the early stages of clinical use, with little data reported to date. Hard-on-hard bearings for total hip arthroplasty have improved dramatically over the past 50 years. As bearing designs continue to improve with new and modified materials and improved manufacturing techniques, it is likely that the use of hard-on-hard bearings will continue to increase, especially in young and active patients.

  6. Clinical and biomechanical assessment of patella resurfacing in total knee arthroplasty.

    Science.gov (United States)

    Berti, Lisa; Benedetti, Maria Grazia; Ensini, Andrea; Catani, Fabio; Giannini, Sandro

    2006-07-01

    Currently there is a limited understanding of the factors influencing range of motion by comparing patellar resurfacing vs non-resurfacing in total knee arthroplasty during activities of daily living. A recent meta-analysis of patellar replacement confirms better outcome with patella resurfacing; however, the result can be influenced by many other factors, such as: component design, surgeon experience, and technical aspects of the surgery. This study compares the biomechanics of the knee in patients after total knee arthroplasty with and without patellar resurfacing during stair climbing. Forty-seven patients with total knee arthroplasty were assessed at the mean follow-up of 24 months. In all of them a posterior stabilised fixed bearing prosthesis (Optetrak PS, Exactech) was implanted. Twenty-six patients were treated without patellar resurfacing and 21 with patellar resurfacing. Clinical evaluations were performed using the International Knee Society and the Hospital for Special Surgery scores. Ten patients with patellar resurfacing and 10 patients without patellar resurfacing were also studied with motion analysis during stair climbing; 10 healthy subjects were studied for statistical comparison. Clinical passive knee flexion, International Knee Society Function and Hospital for Special Surgery scores were significantly higher in the patellar resurfacing group. During stair climbing, active knee joint range of motion during the stance phase was greater in patients with patellar resurfacing. The maximum adduction moment was significantly higher in the group without patellar resurfacing. Patients with patellar resurfacing demonstrated better clinical scores, and kinematic and kinetic data while ascending stairs.

  7. Low cycle fatigue lifetime of HIP bonded Bi-metallic first wall structures of fusion reactors

    Energy Technology Data Exchange (ETDEWEB)

    Hatano, Toshihisa; Sato, Satoshi; Furuya, Kazuyuki; Kuroda, Toshimasa; Enoeda, Mikio; Takatsu, Hideyuki [Japan Atomic Energy Research Inst., Naka, Ibaraki (Japan). Naka Fusion Research Establishment; Hashimoto, Toshiyuki; Kitamura, Kazunori

    1998-10-01

    A HIP bonded bi-metallic panel composed of a dispersion strengthened copper (DSCu) layer and type 316L stainless steel (SS316L) cooling pipes is the reference design of the ITER first wall. To examine the fatigue lifetime of the first wall panel under cyclic mechanical loads, low cycle fatigue tests of HIP bonded bi-metallic specimens made of SS316L and DSCu were conducted with the stress ratio of -1.0 and five nominal strain range conditions ranging from 0.2 to 1.0%. Elasto-plastic analysis has also been conducted to evaluate local strain ranges under the nominal strains applied. Initial cracks were observed at the inner surface of the SS316L cooling pipes for all of the specimens tested, which was confirmed by the elasto-plastic analysis that the maximum strains of the test specimens were developed at the same locations. It was found that the HIP bonded bi-metallic test specimens had a fatigue lifetime longer than that of the SS316L raw material obtained by round bar specimens. Similarly, the fatigue lifetime of the DSCu/SS316L HIP interface was also longer than the round bar test results for the HIP joints. From these results, it has been confirmed that the bi-metallic first wall panel with built-in cooling pipes made by HIP bonding has a sufficient fatigue lifetime in comparison with the raw fatigue data of the materials, which also suggests that the fatigue lifetime evaluation has an adequate margin against fracture if it follows the design fatigue curve based on the material fatigue data. (author)

  8. Fractionated laser skin resurfacing treatment complications: a review.

    Science.gov (United States)

    Metelitsa, Andrei I; Alster, Tina S

    2010-03-01

    Fractional photothermolysis represents a new modality of laser skin resurfacing that was developed to provide a successful clinical response while minimizing postoperative recovery and limiting treatment complications. To review all of the reported complications that develop as a result of fractional ablative and nonablative laser skin resurfacing. A literature review was based on a MEDLINE search (1998-2009) for English-language articles related to laser treatment complications and fractional skin resurfacing. Articles presenting the highest level of evidence and the most recent reports were preferentially selected. Complications with fractional laser skin resurfacing represent a full spectrum of severity and can be longlasting. In general, a greater likelihood of developing post-treatment complications is seen in sensitive cutaneous areas and in patients with intrinsically darker skin phototypes or predisposing medical risk factors. Although the overall rate of complications associated with fractional laser skin resurfacing is much lower than with traditional ablative techniques, recent reports suggest that serious complications can develop. An appreciation of all of the complications associated with fractional laser skin resurfacing is important, especially given that many of them can be potentially prevented. The authors have indicated no significant interest with commercial supporters.

  9. 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.

  10. Skin resurfacing procedures: new and emerging options

    Directory of Open Access Journals (Sweden)

    Loesch MM

    2014-08-01

    Full Text Available Mathew M Loesch,1 Ally-Khan Somani,1 Melanie M Kingsley,1 Jeffrey B Travers,1–3 Dan F Spandau1,41Department of Dermatology, 2Department of Pharmacology and Toxicology, 3Department of Pediatrics, 4Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USAAbstract: The demand for skin resurfacing and rejuvenating procedures has progressively increased in the last decade and has sparked several advances within the skin resurfacing field that promote faster healing while minimizing downtime and side effects for patients. Several technological and procedural skin resurfacing developments are being integrated into clinical practices today allowing clinicians to treat a broader range of patients' skin types and pathologies than in years past, with noteworthy outcomes. This article will discuss some emerging and developing resurfacing therapies and treatments that are present today and soon to be available.Keywords: rejuvenation, wounding, non-melanoma skin cancer, therapy

  11. SU-E-J-230: Effect of Metal Hip Prosthesis On the Accuracy of Electromagnetic Localization and Tracking

    International Nuclear Information System (INIS)

    Butler, W; Merrick, G; Kurko, B; Bittner, N

    2014-01-01

    Purpose: To quantify the effect of metal hip prosthesis on the ability to track and localize electromagnetic transponders. Methods: Three Calypso transponders were implanted into two prostate phantoms. The geometric center of the transponders were identified on computed tomography and set as the isocenter. With the phantom stationary on the treatment table and the tracking array 14-cm above the isocenter, data was acquired by the Calypso system at 10 Hz to establish the uncertainty in measurements. Transponder positional data was acquired with unilateral hip prostheses of different metallic compositions and then with bilateral hips placed at variable separation from the phantom. Results: Regardless of hip prosthesis composition, the average vector displacement in the presence of a unilateral prosthesis was < 0.5 mm. The greatest contribution to overall vector displacement occurred in the lateral dimension. With bilateral hip prosthesis, the average vector displacement was 0.3 mm. The displacement in the lateral dimension was markedly reduced compared with a unilateral hip, suggesting that there was a countervailing effect with bilateral hip prosthesis. The greatest average vector displacement was 0.6 mm and occurred when bilateral hip prostheses were placed within 4 cm of the detector array. Conclusion: Unilateral and bilateral hip prostheses did not have any meaningful effect on the ability to accurately track electromagnetic transponders implanted in a prostate phantom. At clinically realistic distances between the hip and detection array, the average tracking error is negligible

  12. Fractional nonablative laser resurfacing: is there a skin tightening effect?

    Science.gov (United States)

    Kauvar, Arielle N B

    2014-12-01

    Fractional photothermolysis, an approach to laser skin resurfacing that creates microscopic thermal wounds in skin separated by islands of spared tissue, was developed to overcome the high incidence of adverse events and prolonged healing times associated with full coverage ablative laser procedures. To examine whether fractional nonablative laser resurfacing induces skin tightening. A literature review was performed to evaluate the clinical and histologic effects of fractional nonablative laser resurfacing and full coverage ablative resurfacing procedures. Fractional nonablative lasers produce excellent outcomes with minimal risk and morbidity for a variety of clinical conditions, including photodamaged skin, atrophic scars, surgical and burn scars. Efforts to induce robust fibroplasia in histologic specimens and skin tightening in the clinical setting have yielded inconsistent results. A better understanding of the histology of fractional laser resurfacing will help to optimize clinical outcomes.

  13. Evolution of laser skin resurfacing: from scanning to fractional technology.

    Science.gov (United States)

    Aslam, Arif; Alster, Tina S

    2014-11-01

    Laser skin resurfacing was popularized for photoaged and scarred skin 2 decades ago. Since then, several technologic advancements have led to a new generation of delivery systems that produce excellent clinical outcomes with reduced treatment risks and faster recovery times. To review the evolution of laser skin resurfacing from pulsed and scanned infrared laser technology to the latest techniques of nonablative and ablative fractional photothermolysis. All published literature regarding laser skin resurfacing was analyzed and collated. A comprehensive review of laser skin resurfacing was outlined and future developments in the field of fractionated laser skin treatment were introduced. Laser skin resurfacing has evolved such that excellent clinical outcomes in photodamaged and scarred skin are achieved with rapid wound healing. As newer devices are developed, the applications of this technology will have a dramatic effect on the delivery of medical and aesthetic dermatology.

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  15. Resurfacing Graphics

    Directory of Open Access Journals (Sweden)

    Prof. Patty K. Wongpakdee

    2013-06-01

    Full Text Available “Resurfacing Graphics” deals with the subject of unconventional design, with the purpose of engaging the viewer to experience the graphics beyond paper’s passive surface. Unconventional designs serve to reinvigorate people, whose senses are dulled by the typical, printed graphics, which bombard them each day. Today’s cutting-edge designers, illustrators and artists utilize graphics in a unique manner that allows for tactile interaction. Such works serve as valuable teaching models and encourage students to do the following: 1 investigate the trans-disciplines of art and technology; 2 appreciate that this approach can have a positive effect on the environment; 3 examine and research other approaches of design communications and 4 utilize new mediums to stretch the boundaries of artistic endeavor. This paper examines how visuals communicators are “Resurfacing Graphics” by using atypical surfaces and materials such as textile, wood, ceramics and even water. Such non-traditional transmissions of visual language serve to demonstrate student’s overreliance on paper as an outdated medium. With this exposure, students can become forward-thinking, eco-friendly, creative leaders by expanding their creative breadth and continuing the perpetual exploration for new ways to make their mark.

  16. Resurfacing Graphics

    Directory of Open Access Journals (Sweden)

    Prof. Patty K. Wongpakdee

    2013-06-01

    Full Text Available “Resurfacing Graphics” deals with the subject of unconventional design, with the purpose of engaging the viewer to experience the graphics beyond paper’s passive surface. Unconventional designs serve to reinvigorate people, whose senses are dulled by the typical, printed graphics, which bombard them each day. Today’s cutting-edge designers, illustrators and artists utilize graphics in a unique manner that allows for tactile interaction. Such works serve as valuable teaching models and encourage students to do the following: 1 investigate the trans-disciplines of art and technology; 2 appreciate that this approach can have a positive effect on the environment; 3 examine and research other approaches of design communications and 4 utilize new mediums to stretch the boundaries of artistic endeavor. This paper examines how visuals communicators are “Resurfacing Graphics” by using atypical surfaces and materials such as textile, wood, ceramics and even water. Such non-traditional transmissions of visual language serve to demonstrate student’s overreliance on paper as an outdated medium. With this exposure, students can become forward-thinking, eco-friendly, creative leaders by expanding their creative breadth and continuing the perpetual exploration for new ways to make their mark. 

  17. Diagnosis and management of skin resurfacing-related complications.

    Science.gov (United States)

    Zhang, Alexandra Y; Obagi, Suzan

    2009-02-01

    The field of skin resurfacing is undergoing rapid evolution with many new technologies that have developed, providing more choices for physicians and patients. Knowing the potential adverse effects associated with each skin resurfacing modality is paramount in selecting the appropriate approach for each candidate, thereby minimizing complications and achieving optimal results.

  18. Resurfacing the Penis of Complex Hypospadias Repair ("Hypospadias Cripples").

    Science.gov (United States)

    Fam, Mina M; Hanna, Moneer K

    2017-03-01

    After the creation of a neourethra in a "hypospadias cripple," resurfacing the penis with healthy skin is a significant challenge because local tissue is often scarred and unusable. We reviewed our experience with various strategies to resurface the penis of hypospadias cripples. We retrospectively reviewed the records of 215 patients referred after multiple unsuccessful hypospadias repairs from 1981 to 2014. In 130 of 215 patients we performed resurfacing using local penile flaps using various techniques, including Byars flaps, Z-plasty or double Z-plasty, or a dorsal relaxing incision. Of the 215 patients 85 did not have adequate healthy local penile skin to resurface the penis after urethroplasty. Scrotal skin was used to resurface the penis in 54 patients, 6 underwent tissue expansion of the dorsal penile skin during a 12 to 16-week period prior to penile resurfacing, 23 underwent full-thickness skin grafting and another 4 received a split-thickness skin graft. Of the 56 patients who underwent fasciomyocutaneous rotational flaps, tissue expansion or a combination of both approaches 54 (96.4%) finally had a successful outcome. All 6 patients who underwent tissue expansion had a successful outcome without complications and were reported on previously. All 23 full-thickness skin grafts took with excellent results. All 4 patients who underwent fenestrated split-thickness skin grafting had 100% graft take but secondary contraction and ulceration were associated with sexual activity. In our experience scrotal skin flaps, tissue expansion of the dorsal penile skin and full-thickness skin grafts serve as reliable approaches in resurfacing the penis in almost any hypospadias cripple lacking healthy local skin. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  19. Assessing for Cardiotoxicity from Metal-on-Metal Hip Implants with Advanced Multimodality Imaging Techniques.

    Science.gov (United States)

    Berber, Reshid; Abdel-Gadir, Amna; Rosmini, Stefania; Captur, Gabriella; Nordin, Sabrina; Culotta, Veronica; Palla, Luigi; Kellman, Peter; Lloyd, Guy W; Skinner, John A; Moon, James C; Manisty, Charlotte; Hart, Alister J

    2017-11-01

    High failure rates of metal-on-metal (MoM) hip implants prompted regulatory authorities to issue worldwide safety alerts. Circulating cobalt from these implants causes rare but fatal autopsy-diagnosed cardiotoxicity. There is concern that milder cardiotoxicity may be common and underrecognized. Although blood metal ion levels are easily measured and can be used to track local toxicity, there are no noninvasive tests for organ deposition. We sought to detect correlation between blood metal ions and a comprehensive panel of established markers of early cardiotoxicity. Ninety patients were recruited into this prospective single-center blinded study. Patients were divided into 3 age and sex-matched groups according to implant type and whole-blood metal ion levels. Group-A patients had a ceramic-on-ceramic [CoC] bearing; Group B, an MoM bearing and low blood metal ion levels; and Group C, an MoM bearing and high blood metal-ion levels. All patients underwent detailed cardiovascular phenotyping using cardiac magnetic resonance imaging (CMR) with T2*, T1, and extracellular volume mapping; echocardiography; and cardiac blood biomarker sampling. T2* is a novel CMR biomarker of tissue metal loading. Blood cobalt levels differed significantly among groups A, B, and C (mean and standard deviation [SD], 0.17 ± 0.08, 2.47 ± 1.81, and 30.0 ± 29.1 ppb, respectively) and between group A and groups B and C combined. No significant between-group differences were found in the left atrial or ventricle size, ejection fraction (on CMR or echocardiography), T1 or T2* values, extracellular volume, B-type natriuretic peptide level, or troponin level, and all values were within normal ranges. There was no relationship between cobalt levels and ejection fraction (R = 0.022, 95% confidence interval [CI] = -0.185 to 0.229) or T2* values (R = 0.108, 95% CI = -0.105 to 0.312). Using the best available technologies, we did not find that high (but not extreme) blood cobalt and chromium levels

  20. Particulate metallic debris in cemented total hip arthroplasty.

    Science.gov (United States)

    Salvati, E A; Betts, F; Doty, S B

    1993-08-01

    Several studies conducted by the authors in the last six years demonstrate that the generation of metallic debris is more severe with titanium alloy than with cobalt-chrome alloy femoral components in cemented total hip arthroplasty (THA). The debris is generated from the articulating surface, particularly if entrapped acrylic debris produces three-body wear, and from the stem surface when the component loosens and abrades against fragmented cement. In selected cases in which the titanium metallic debris is copious, premature failure and severe progressive bone loss occurs. Electron microscopy demonstrates that the particles of metallic debris can be extremely small (a few hundredths of 1 micron). They are phagocytized by the macrophages and transported to the phagolysosomes. In this highly corrosive environment, the very high surface area of the particles may release toxic concentrations of the constituents of the alloy intracellularly, probably leading to progressive cell degeneration and death, with subsequent release of intracellular enzymes and ingested metallic debris. This cycle most likely repeats itself, leading to tissue necrosis. The results presented do not support the use of titanium alloy femoral components for cemented THA, particularly for the articulating surface.

  1. Plasma skin resurfacing: personal experience and long-term results.

    Science.gov (United States)

    Bentkover, Stuart H

    2012-05-01

    This article presents a comprehensive clinical approach to plasma resurfacing for skin regeneration. Plasma technology, preoperative protocols, resurfacing technique, postoperative care, clinical outcomes, evidence-based results, and appropriate candidates for this procedure are discussed. Specific penetration depth and specific laser energy measurements are provided. Nitrogen plasma skin regeneration is a skin-resurfacing technique that offers excellent improvement of mild to moderate skin wrinkles and overall skin rejuvenation. It also provides excellent improvement in uniformity of skin color and texture in patients with hyperpigmentation with Fitzpatrick skin types 1 through 4. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. Analysis of erythema after Er:YAG laser skin resurfacing.

    Science.gov (United States)

    Ko, Na Young; Ahn, Hyo-Hyun; Kim, Soo-Nam; Kye, Young-Chul

    2007-11-01

    Postoperative erythema can be expected to occur in every patient after laser resurfacing, and pigmentary disturbances may be related to the intensity and the duration of erythema. This study was undertaken to assess the clinical features of erythema, the factors that influence its duration, and the relation between the duration of erythema and the incidence of hyperpigmentation and hypopigmentation in skin of Asian persons after Er:YAG laser resurfacing. A total of 218 patients (skin phototypes III to V) were recruited and treated with a short-pulsed Er:YAG laser, a variable-pulsed Er:YAG laser, or a dual-mode Er:YAG laser for skin resurfacing. Clinical assessments were performed retrospectively using medical charts and serial photographs. Postoperative erythema was observed in all patients after Er:YAG laser resurfacing with a mean duration of 4.72 months. In 98.2% of patients, erythema faded completely within 12 months. Postinflammatory hyperpigmentation was observed in 38.1% of patients after Er:YAG laser resurfacing. Skin phototype, level of ablation, and depth of thermal damage caused by a long-pulsed laser appear to be important factors that affect the duration of erythema. Moreover, prolonged erythema was related to the risk of postinflammatory hyperpigmentation.

  3. What Are Normal Metal Ion Levels After Total Hip Arthroplasty? A Serologic Analysis of Four Bearing Surfaces.

    Science.gov (United States)

    Barlow, Brian T; Ortiz, Philippe A; Boles, John W; Lee, Yuo-Yu; Padgett, Douglas E; Westrich, Geoffrey H

    2017-05-01

    The recent experiences with adverse local tissue reactions have highlighted the need to establish what are normal serum levels of cobalt (Co), chromium (Cr), and titanium (Ti) after hip arthroplasty. Serum Co, Cr, and Ti levels were measured in 80 nonconsecutive patients with well-functioning unilateral total hip arthroplasty and compared among 4 bearing surfaces: ceramic-on-ceramic (CoC); ceramic-on-polyethylene (CoP); metal-on-polyethylene (MoP), and dual mobility (DM). The preoperative and most recent University of California, Los Angeles (UCLA) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were compared among the different bearing surfaces. No significant difference was found among serum Co and Cr levels between the 4 bearing surface groups (P = .0609 and P = .1577). Secondary analysis comparing metal and ceramic femoral heads demonstrated that the metal group (MoP, modular dual mobility (Stryker Orthopedics, Mahwah, NJ) [metal]) had significant higher serum Co levels compared with the ceramic group (CoC, CoP, MDM [ceramic]) (1.05 mg/L ± 1.25 vs 0.59 mg/L ± 0.24; P = .0411). Spearman coefficient identified no correlation between metal ion levels and patient-reported outcome scores. No serum metal ion level differences were found among well-functioning total hip arthroplasty with modern bearing couples. Significantly higher serum Co levels were seen when comparing metal vs ceramic femoral heads in this study and warrants further investigation. Metal ion levels did not correlate with patient-reported outcome measures. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Skin resurfacing procedures: new and emerging options

    OpenAIRE

    Loesch MM; Somani AK; Kingsley MM; Travers JB; Spandau DF

    2014-01-01

    Mathew M Loesch,1 Ally-Khan Somani,1 Melanie M Kingsley,1 Jeffrey B Travers,1–3 Dan F Spandau1,41Department of Dermatology, 2Department of Pharmacology and Toxicology, 3Department of Pediatrics, 4Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USAAbstract: The demand for skin resurfacing and rejuvenating procedures has progressively increased in the last decade and has sparked several advances within the skin resurfacing fie...

  5. Digital tomosynthesis with metal artifact reduction for assessing cementless hip arthroplasty: a diagnostic cohort study of 48 patients

    Energy Technology Data Exchange (ETDEWEB)

    Tang, Hao; Yang, Dejin; Guo, Shengjie; Tang, Jing; Liu, Jian; Wang, Dacheng; Zhou, Yixin [Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Department of Orthopaedic Surgery, Beijing (China)

    2016-11-15

    For postoperative imaging assessment of cementless hip arthroplasty, radiography and computed tomography (CT) were restricted by overlapping structures and metal artifacts, respectively. A new tomosynthesis with metal artifact reduction (TMAR) is introduced by using metal extraction and ordered subset-expectation maximization (OS-EM) reconstruction. This study investigated the effectiveness of TMAR in assessing fixation stability of cementless hip arthroplasty components. We prospectively included 48 consecutive patients scheduled for revision hip arthroplasty in our hospital, with 41 femoral and 35 acetabular cementless components available for evaluation. All patients took the three examinations of radiography, CT, and TMAR preoperatively, with intraoperative mechanical tests, and absence or presence of osteointegration on retrieved prosthesis as reference standards. Three senior surgeons and four junior surgeons evaluated these images independently with uniform criteria. For TMAR, 82 % diagnoses on the femoral side and 84 % diagnoses on the acetabular side were accurate. The corresponding values were 44 and 67 % for radiography, and 39 % and 74 % for CT. Senior surgeons had significantly higher accuracy than junior surgeons by radiography (p < 0.05), but not by TMAR or CT. By minimizing metal artifacts in the bone-implant interface and clearly depicting peri-implant trabecular structures, the TMAR technique improved the diagnostic accuracy of assessing fixation stability of cementless hip arthroplasty, and shortened the learning curve of less experienced surgeons. Level II, diagnostic cohort study. (orig.)

  6. Laser Resurfacing

    OpenAIRE

    Janik, Joseph P.; Markus, Jodi L.; Al-Dujaili, Zeena; Markus, Ramsey F.

    2007-01-01

    In a society desiring images of beauty and youthfulness, the world of cutaneous surgery offers the gifts of facial rejuvenation for those determined to combat the signs of aging. With the development of novel laser and plasma technology, pigmentary changes, scarring, and wrinkles can be conquered providing smoother, healthier, younger-looking skin. This review highlights five of the most popular resurfacing technologies in practice today including the carbon dioxide (CO2) laser, the erbium:yt...

  7. Bearing Change to Metal-On-Polyethylene for Ceramic Bearing Fracture in Total Hip Arthroplasty; Does It Work?

    Science.gov (United States)

    Lee, Soong Joon; Kwak, Hong Suk; Yoo, Jeong Joon; Kim, Hee Joong

    2016-01-01

    We evaluated the short-term to midterm results of reoperation with bearing change to metal-on-polyethylene (MoP) after ceramic bearing fracture in ceramic-on-ceramic total hip arthroplasty. Nine third-generation ceramic bearing fractures (6 heads and 3 liners) were treated with bearing change to MoP. Mean age at reoperation was 52.7 years. Mean follow-up was 4.3 years. During follow-up, 2 of 3 liner-fractured hips and 1 of 6 head-fractured hips showed radiologic signs of metallosis and elevated serum chromium levels. Re-reoperation with bearing rechange to a ceramic head was performed for the hips with metallosis. One liner-fractured hip had periprosthetic joint infection. Dislocation occurred in 3 hips. From our experience, bearing change to MoP is not a recommended treatment option for ceramic bearing fracture in total hip arthroplasty. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Optimizing Outcomes in Pharyngoesophageal Reconstruction and Neck Resurfacing: 10-Year Experience of 294 Cases.

    Science.gov (United States)

    Sharaf, Basel; Xue, Amy; Solari, Mario G; Boa, Olivier; Liu, Jun; Hanasono, Matthew M; Skoracki, Roman; Yu, Peirong; Selber, Jesse C

    2017-01-01

    Pharyngoesophageal reconstruction is a complex endeavor that poses many challenges. This 10-year series examines factors impacting the need for neck skin resurfacing and evaluates the impact of reconstructive modalities on outcomes. A review identified 294 patients who underwent pharyngoesophageal reconstruction from 2002 to 2012. Patients were divided based on neck skin resurfacing requirements. Patients undergoing neck resurfacing were further subdivided into reconstructive technique, including a second skin paddle or muscle component from the same free flap pedicle, a local flap, or a second free flap. All groups were compared by comorbidities, complications, and functional outcomes. Of 294 patients, 179 (60.9 percent) required neck skin resurfacing. In the resurfaced group, there were 90 circumferential defects (50.3 percent) and 89 partial defects (49.7 percent). In the resurfaced group, 110 (61.4 percent) underwent reconstruction with a second skin paddle from the same free flap pedicle, 21 (11.7 percent) underwent reconstruction with a muscle component from the same pedicle, and 25 (13.9 percent) received a pectoralis major flap. There were five external paddle flap losses in the resurfaced group (2.8 percent) and no internal flap losses. Overall complications were similar among groups. The resurfaced group had a lower pharyngocutaneous fistula rate (4.5 percent) compared with the primary closure group (11.3 percent) (p = 0.026). Prior neck surgery and radiation therapy were strong predictors of neck skin resurfacing (p resurfacing is often required in salvage pharyngoesophageal reconstruction. Providing additional vascularized tissue over the neoconduit is predictive of lower pharyngocutaneous fistula rates. An algorithmic approach to neck resurfacing is presented.

  9. Fractionated laser resurfacing corrects the inappropriate UVB response in geriatric skin.

    Science.gov (United States)

    Spandau, Dan F; Lewis, Davina A; Somani, Ally-Khan; Travers, Jeffrey B

    2012-06-01

    Non-melanoma skin cancer is a disease primarily afflicting geriatric patients as evidenced by the fact that 80% of all non-melanoma skin cancers are diagnosed in patients over the age of 60 years. As such, geriatric skin responds to cancer-inducing UVB irradiation in a manner that allows the establishment of tumor cells. Currently, the only effective treatment for non-melanoma skin cancer is the removal of the tumors after they appear, indicating the need for a more cost-effective prophylactic therapy. Geriatric volunteers were treated with fractionated laser resurfacing therapy on either sun-protected (upper buttocks) or chronically sun-exposed (dorsal forearm) skin. Fractionated laser resurfacing therapy was shown to decrease the occurrence of senescent fibroblasts in geriatric dermis, increase the dermal expression of IGF-1, and correct the inappropriate UVB response observed in untreated geriatric skin. These responses to fractionated laser resurfacing were equal to the effects seen previously using the more aggressive wounding following dermabrasion. Furthermore, fractionated laser resurfacing was equally effective in both sun-protected and sun-exposed skin. The ability of fractionated laser resurfacing treatment to protect against the occurrence of UVB-damaged proliferating keratinocytes indicates the potential of fractionated laser resurfacing to reduce or prevent aging-associated non-melanoma skin cancer.

  10. Isolated patellofemoral arthroplasty reproduces natural patellofemoral joint kinematics when the patella is resurfaced.

    Science.gov (United States)

    Vandenneucker, Hilde; Labey, Luc; Vander Sloten, Jos; Desloovere, Kaat; Bellemans, Johan

    2016-11-01

    The objectives of this in vitro project were to compare the dynamic three-dimensional patellofemoral kinematics, contact forces, contact areas and contact pressures of a contemporary patellofemoral prosthetic implant with those of the native knee and to measure the influence of patellar resurfacing and patellar thickness. The hypothesis was that these designs are capable to reproduce the natural kinematics but result in higher contact pressures. Six fresh-frozen specimens were tested on a custom-made mechanical knee rig before and after prosthetic trochlear resurfacing, without and with patellar resurfacing in three different patellar thicknesses. Full three-dimensional kinematics were analysed during three different motor tasks, using infrared motion capture cameras and retroflective markers. Patellar contact characteristics were registered using a pressure measuring device. The patellofemoral kinematic behaviour of the patellofemoral arthroplasty was similar to that of the normal knee when the patella was resurfaced, showing only significant (p patellofemoral kinematics acceptable well when the patella was resurfaced. From a kinematic point of view, patellar resurfacing may be advisable. However, the substantially elevated patellar contact pressures remain a point of concern in the decision whether or not to resurface the patella. This study therefore not only adds a new point in the discussion whether or not to resurface the patella, but also supports the claimed advantage that a patellofemoral arthroplasty is capable to reproduce the natural knee kinematics.

  11. 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...

  12. Metal artifact reduction software used with abdominopelvic dual-energy CT of patients with metal hip prostheses: assessment of image quality and clinical feasibility.

    Science.gov (United States)

    Han, Seung Chol; Chung, Yong Eun; Lee, Young Han; Park, Kwan Kyu; Kim, Myeong Jin; Kim, Ki Whang

    2014-10-01

    The objective of our study was to determine the feasibility of using Metal Artifact Reduction (MAR) software for abdominopelvic dual-energy CT in patients with metal hip prostheses. This retrospective study included 33 patients (male-female ratio, 19:14; mean age, 63.7 years) who received total hip replacements and 20 patients who did not have metal prostheses as the control group. All of the patients underwent dual-energy CT. The quality of the images reconstructed using the MAR algorithm and of those reconstructed using the standard reconstruction was evaluated in terms of the visibility of the bladder wall, pelvic sidewall, rectal shelf, and bone-prosthesis interface and the overall diagnostic image quality with a 4-point scale. The mean and SD attenuation values in Hounsfield units were measured in the bladder, pelvic sidewall, and rectal shelf. For validation of the MAR interpolation algorithm, pelvis phantoms with small bladder "lesions" and metal hip prostheses were made, and images of the phantoms both with and without MAR reconstruction were evaluated. Image quality was significantly better with MAR reconstruction than without at all sites except the rectal shelf, where the image quality either had not changed or had worsened after MAR reconstruction. The mean attenuation value was changed after MAR reconstruction to its original expected value at the pelvic sidewall (p software with dual-energy CT decreases metal artifacts and increases diagnostic confidence in the assessment of the pelvic cavity but also introduces new artifacts that can obscure pelvic structures.

  13. Quantifying metal artefact reduction using virtual monochromatic dual-layer detector spectral CT imaging in unilateral and bilateral total hip prostheses

    Energy Technology Data Exchange (ETDEWEB)

    Wellenberg, R.H.H., E-mail: r.h.wellenberg@amc.uva.nl [Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands); Boomsma, M.F., E-mail: m.f.boomsma@isala.nl [Department of Radiology, Isala, Zwolle (Netherlands); Osch, J.A.C. van, E-mail: j.a.c.van.osch@isala.nl [Department of Radiology, Isala, Zwolle (Netherlands); Vlassenbroek, A., E-mail: alain.vlassenbroek@philips.com [Philips Medical Systems, Brussels (Belgium); Milles, J., E-mail: julien.milles@philips.com [Philips Medical Systems, Eindhoven (Netherlands); Edens, M.A., E-mail: m.a.edens@isala.nl [Department of Innovation and Science, Isala, Zwolle (Netherlands); Streekstra, G.J., E-mail: g.j.streekstra@amc.uva.nl [Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands); Slump, C.H., E-mail: c.h.slump@utwente.nl [MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede (Netherlands); Maas, M., E-mail: m.maas@amc.uva.nl [Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands)

    2017-03-15

    Highlights: • Dual-layer detector CT reduces metal artefacts at high monochromatic energies (keV). • 130 keV images were optimal based on quantitative analysis on CNRs. • Optimal keVs varied from 74 to 150 keV for different hip prostheses configurations. • The Titanium alloy resulted in less severe artefacts compared to the Cobalt alloy. • Severe metal artefacts, caused by extensive photon-starvation, were not reduced. - Abstract: Purpose: To quantify the impact of prosthesis material and design on the reduction of metal artefacts in total hip arthroplasties using virtual monochromatic dual-layer detector Spectral CT imaging. Methods: The water-filled total hip arthroplasty phantom was scanned on a novel 128-slice Philips IQon dual-layer detector Spectral CT scanner at 120-kVp and 140-kVp at a standard computed tomography dose index of 20.0 mGy. Several unilateral and bilateral hip prostheses consisting of different metal alloys were inserted and combined which were surrounded by 18 hydroxyapatite calcium carbonate pellets representing bone. Images were reconstructed with iterative reconstruction and analysed at monochromatic energies ranging from 40 to 200 keV. CT numbers in Hounsfield Units (HU), noise measured as the standard deviation in HU, signal-to-noise-ratios (SNRs) and contrast-to-noise-ratios (CNRs) were analysed within fixed regions-of-interests placed in and around the pellets. Results: In 70 and 74 keV virtual monochromatic images the CT numbers of the pellets were similar to 120-kVp and 140-kVp polychromatic results, therefore serving as reference. A separation into three categories of metal artefacts was made (no, mild/moderate and severe) where pellets were categorized based on HU deviations. At high keV values overall image contrast was reduced. For mild/moderate artefacts, the highest average CNRs were attained with virtual monochromatic 130 keV images, acquired at 140-kVp. Severe metal artefacts were not reduced. In 130 keV images

  14. Time series trends of the safety effects of pavement resurfacing.

    Science.gov (United States)

    Park, Juneyoung; Abdel-Aty, Mohamed; Wang, Jung-Han

    2017-04-01

    This study evaluated the safety performance of pavement resurfacing projects on urban arterials in Florida using the observational before and after approaches. The safety effects of pavement resurfacing were quantified in the crash modification factors (CMFs) and estimated based on different ranges of heavy vehicle traffic volume and time changes for different severity levels. In order to evaluate the variation of CMFs over time, crash modification functions (CMFunctions) were developed using nonlinear regression and time series models. The results showed that pavement resurfacing projects decrease crash frequency and are found to be more safety effective to reduce severe crashes in general. Moreover, the results of the general relationship between the safety effects and time changes indicated that the CMFs increase over time after the resurfacing treatment. It was also found that pavement resurfacing projects for the urban roadways with higher heavy vehicle volume rate are more safety effective than the roadways with lower heavy vehicle volume rate. Based on the exploration and comparison of the developed CMFucntions, the seasonal autoregressive integrated moving average (SARIMA) and exponential functional form of the nonlinear regression models can be utilized to identify the trend of CMFs over time. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Automatic assessment of volume asymmetries applied to hip abductor muscles in patients with hip arthroplasty

    Science.gov (United States)

    Klemt, Christian; Modat, Marc; Pichat, Jonas; Cardoso, M. J.; Henckel, Joahnn; Hart, Alister; Ourselin, Sebastien

    2015-03-01

    Metal-on-metal (MoM) hip arthroplasties have been utilised over the last 15 years to restore hip function for 1.5 million patients worldwide. Althoug widely used, this hip arthroplasty releases metal wear debris which lead to muscle atrophy. The degree of muscle wastage differs across patients ranging from mild to severe. The longterm outcomes for patients with MoM hip arthroplasty are reduced for increasing degrees of muscle atrophy, highlighting the need to automatically segment pathological muscles. The automated segmentation of pathological soft tissues is challenging as these lack distinct boundaries and morphologically differ across subjects. As a result, there is no method reported in the literature which has been successfully applied to automatically segment pathological muscles. We propose the first automated framework to delineate severely atrophied muscles by applying a novel automated segmentation propagation framework to patients with MoM hip arthroplasty. The proposed algorithm was used to automatically quantify muscle wastage in these patients.

  16. Surgical Approach May Influence Survival of Large-Diameter Head Metal-on-Metal Total Hip Arthroplasty: A 6- to 10-Year Follow-Up Study

    Directory of Open Access Journals (Sweden)

    Chih-Chien Hu

    2017-01-01

    Full Text Available Large-diameter head (LDH metal-on-metal (MoM total hip arthroplasty (THA has lost popularity because of metal allergy or ALTRs (adverse local tissue reactions in the past decade. Whether the surgical approach may influence the survival of LDH-MoM-THA has not been reported. From 2006 to 2009, we performed 96 LDH-MoM-THAs on 80 patients using an in situ head-neck assembly technique through a modified Watson-Jones approach. With a mean follow-up of 8.4 years (range, 6.3–10.1 years, the implant survival rate was 100%. All patients were satisfied with the results and the Harris Hip Score improved from 52 points to 98 points. No ALTRs were found, but 17.7% of the 96 hips (17 adverse events experienced adverse events related to the cup, including 5 cases of outlier cup malposition, 11 cases of inadequate cup seating, and 1 acetabular fracture. The tissue tension that was improved by a muscle-sparing approach might lessen the chance of microseparation or edge-loading that is taken as the major risk for early implant failure. Further investigation of whether these LDH-MoM-THAs would fail or not would require a longer follow-up or even retrieval analysis in the future.

  17. Marker-based or model-based RSA for evaluation of hip resurfacing arthroplasty? A clinical validation and 5-year follow-up.

    Science.gov (United States)

    Lorenzen, Nina Dyrberg; Stilling, Maiken; Jakobsen, Stig Storgaard; Gustafson, Klas; Søballe, Kjeld; Baad-Hansen, Thomas

    2013-11-01

    The stability of implants is vital to ensure a long-term survival. RSA determines micro-motions of implants as a predictor of early implant failure. RSA can be performed as a marker- or model-based analysis. So far, CAD and RE model-based RSA have not been validated for use in hip resurfacing arthroplasty (HRA). A phantom study determined the precision of marker-based and CAD and RE model-based RSA on a HRA implant. In a clinical study, 19 patients were followed with stereoradiographs until 5 years after surgery. Analysis of double-examination migration results determined the clinical precision of marker-based and CAD model-based RSA, and at the 5-year follow-up, results of the total translation (TT) and the total rotation (TR) for marker- and CAD model-based RSA were compared. The phantom study showed that comparison of the precision (SDdiff) in marker-based RSA analysis was more precise than model-based RSA analysis in TT (p CAD RSA analysis (p = 0.002), but showed no difference between the marker- and CAD model-based RSA analysis regarding the TR (p = 0.91). Comparing the mean signed values regarding the TT and the TR at the 5-year follow-up in 13 patients, the TT was lower (p = 0.03) and the TR higher (p = 0.04) in the marker-based RSA compared to CAD model-based RSA. The precision of marker-based RSA was significantly better than model-based RSA. However, problems with occluded markers lead to exclusion of many patients which was not a problem with model-based RSA. HRA were stable at the 5-year follow-up. The detection limit was 0.2 mm TT and 1° TR for marker-based and 0.5 mm TT and 1° TR for CAD model-based RSA for HRA.

  18. 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.

  19. Carbon dioxide laser resurfacing of rhytides and photodamaged skin

    OpenAIRE

    Kelly, KM; Nelson, JS

    1998-01-01

    Carbon dioxide (CO 2 ) laser resurfacing has been used as a method to treat rhytides and photodamaged skin. This laser offers several advantages over previously utilised modalities but its use has several inherent risks. This article will review important aspects of CO 2 laser resurfacing including laser-skin interactions, patient selection, effective pre- and post-operative regimens and potential complications.

  20. Reduction of metal artifacts from hip prostheses on CT images of the pelvis: value of iterative reconstructions.

    Science.gov (United States)

    Morsbach, Fabian; Bickelhaupt, Sebastian; Wanner, Guido A; Krauss, Andreas; Schmidt, Bernhard; Alkadhi, Hatem

    2013-07-01

    To assess the value of iterative frequency split-normalized (IFS) metal artifact reduction (MAR) for computed tomography (CT) of hip prostheses. This study had institutional review board and local ethics committee approval. First, a hip phantom with steel and titanium prostheses that had inlays of water, fat, and contrast media in the pelvis was used to optimize the IFS algorithm. Second, 41 consecutive patients with hip prostheses who were undergoing CT were included. Data sets were reconstructed with filtered back projection, the IFS algorithm, and a linear interpolation MAR algorithm. Two blinded, independent readers evaluated axial, coronal, and sagittal CT reformations for overall image quality, image quality of pelvic organs, and assessment of pelvic abnormalities. CT attenuation and image noise were measured. Statistical analysis included the Friedman test, Wilcoxon signed-rank test, and Levene test. Ex vivo experiments demonstrated an optimized IFS algorithm by using a threshold of 2200 HU with four iterations for both steel and titanium prostheses. Measurements of CT attenuation of the inlays were significantly (P algorithm for CT image reconstruction significantly reduces metal artifacts from hip prostheses, improves the reliability of CT number measurements, and improves the confidence for depicting pelvic abnormalities.

  1. Chemistry-driven structural alterations in short-term retrieved ceramic-on-metal hip implants: Evidence for in vivo incompatibility between ceramic and metal counterparts.

    Science.gov (United States)

    Zhu, Wenliang; Pezzotti, Giuseppe; Boffelli, Marco; Chotanaphuti, Thanainit; Khuangsirikul, Saradej; Sugano, Nobuhiko

    2017-08-01

    Ceramic-on-metal (CoM) hip implants were reported to experience lower wear rates in vitro as compared to metal-on-metal (MoM) bearings, thus hinting metal-ion release at lower levels in vivo. In this article, we show a spectroscopic study of two short-term retrieval cases of zirconia-toughened alumina (ZTA) femoral heads belonging to CoM hip prostheses, which instead showed poor wear performances in vivo. Metal contamination and abnormally high fractions of tetragonal-to-monoclinic (t→m) polymorphic transformation of the zirconia phase could be found on both ZTA heads, which contrasted with the optimistic predictions of in vitro experiments. At the molecular scale, incorporation of metal ions into the ceramic lattices could be recognized as due to frictionally assisted phenomena occurring at the ceramic surface. Driven by abnormal friction, diffusion of metal ions induced lattice shrinkage in the zirconia phases, while residual stress fields became stored at the surface of the femoral head. Diffusional alterations destabilized the chemistry of the ceramic surface and resulted in an abnormal increase in t→m phase transformation in vivo. Frictionally driven metal transfer to the ceramic lattice thus hinders the in vivo performance of CoM prostheses. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1469-1480, 2017. © 2016 Wiley Periodicals, Inc.

  2. Early rehabilitation in Resurfacing, standard and large head THA patients

    DEFF Research Database (Denmark)

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

    2009-01-01

    in the resurfacing patient may impair the early rehabilitation. We aimed to investigate early differences in rehabilitation parameters amongst the different groups. Materials and methods We randomized to resurfacing (n=20), standard 28 mm THA (n=19) and large head MoM THA (n=12). We recorded operation time, blood...

  3. Revision Hip Arthroscopy Indications and Outcomes: A Systematic Review.

    Science.gov (United States)

    Sardana, Vandit; Philippon, Marc J; de Sa, Darren; Bedi, Asheesh; Ye, Lily; Simunovic, Nicole; Ayeni, Olufemi R

    2015-10-01

    To identify the indications and outcomes in patients undergoing revision hip arthroscopy. The electronic databases Embase, Medline, HealthStar, and PubMed were searched from 1946 to July 19, 2014. Two blinded reviewers searched, screened, and evaluated the data quality of the studies using the Methodological Index for Non-Randomized Studies scale. Data were abstracted in duplicate. Agreement and descriptive statistics are presented. Six studies were included (3 prospective case series and 3 retrospective chart reviews), with a total of 448 hips examined. The most common indications for revision hip arthroscopy included residual femoroacetabular impingement (FAI), labral tears, and chondral lesions. The mean interval between revision arthroscopy and the index procedure was 25.6 months. Overall, the modified Harris Hip Score improved by a mean of 33.6% (19.3 points) from the baseline score at 1-year follow-up. In 14.6% of patients, further surgical procedures were required, including re-revision hip arthroscopy (8.0%), total hip replacement (5.6%), and hip resurfacing (1.0%). Female patients more commonly underwent revision hip arthroscopy (59.7%). The current evidence examined in this review supports revision hip arthroscopy as a successful intervention to improve functional outcomes (modified Harris Hip Score) and relieve pain in patients with residual symptoms after primary FAI surgery, although the outcomes are inferior when compared with a matched cohort of patients undergoing primary hip arthroscopy for FAI. The main indication for revision is a candidate who has symptoms due to residual cam- or pincer-type deformity that was either unaddressed or under-resected during the index operation. However, it is important to consider that the studies included in this review are of low-quality evidence. Surgeons should consider incorporating a minimum 2-year follow-up for individuals after index hip-preservation surgery because revisions tended to occur within this

  4. Nonablative fractional laser resurfacing in Asian skin--a review.

    Science.gov (United States)

    Sachdeva, Silonie

    2010-12-01

    Skin resurfacing has been a part of cosmetic dermatology for more than two decades now, and most of it has been ablative with traditional aggressive lasers including the CO(2) and erbium. The last few years have seen a revolutionary change with the invention of nonablative lasers for skin tightening. Fractional resurfacing is a new concept of cutaneous remodeling whereby laser-induced zones of microthermal injury are surrounded by normal untreated tissue that helps in quicker healing. The various wavelengths used are 1320, 1440, and 2940 nm with depth of penetration ranging from 25 μ to 1.2 mm. This article reviews the history of nonablative fractional laser resurfacing, its indications, contraindications, and a review of use in Asian skin with Fitzpatrick type III-VI. © 2010 Wiley Periodicals, Inc.

  5. Pseudotumor from Metal-on-Metal Total Hip Arthroplasty Causing Unilateral Leg Edema: Case Presentation and Literature Review

    Directory of Open Access Journals (Sweden)

    Caleb W. Grote

    2018-03-01

    Full Text Available Metal-on-metal (MoM total hip arthroplasty (THA can be associated with adverse metal reactions, including pseudotumors. This case report describes a 58-year-old female with an MoM THA-related pseudotumor that caused unilateral leg edema from compression of her external iliac vein. After thorough preoperative workup to rule out infection and deep vein thrombosis and consultation with a vascular surgeon, the patient underwent revision THA and excision of her pseudotumor. She had complete resolution of her swelling at 4 years after surgery. Review of all available case reports for this rare complication revealed that almost all patients were female. All patients underwent revision THA, with resolution of their symptoms. Literature review demonstrates that women are disproportionally affected by complications associated with MoM THA. We recommend close monitoring of patients with MoM THA, particularly women, for development of adverse metal reactions.

  6. Quantifying metal artefact reduction using virtual monochromatic dual-layer detector spectral CT imaging in unilateral and bilateral total hip prostheses

    NARCIS (Netherlands)

    Wellenberg, R. H. H.; Boomsma, M. F.; van Osch, J. A. C.; Vlassenbroek, A.; Milles, J.; Edens, M. A.; Streekstra, G. J.; Slump, C. H.; Maas, M.

    2017-01-01

    To quantify the impact of prosthesis material and design on the reduction of metal artefacts in total hip arthroplasties using virtual monochromatic dual-layer detector Spectral CT imaging. The water-filled total hip arthroplasty phantom was scanned on a novel 128-slice Philips IQon dual-layer

  7. Implant Optimisation for Primary Hip Replacement in Patients over 60 Years with Osteoarthritis: A Cohort Study of Clinical Outcomes and Implant Costs Using Data from England and Wales.

    Directory of Open Access Journals (Sweden)

    Simon S Jameson

    Full Text Available Hip replacement is one of the most commonly performed surgical procedures worldwide; hundreds of implant configurations provide options for femoral head size, joint surface material and fixation method with dramatically varying costs. Robust comparative evidence to inform the choice of implant is needed. This retrospective cohort study uses linked national databases from England and Wales to determine the optimal type of replacement for patients over 60 years undergoing hip replacement for osteoarthritis.Implants included were the commonest brand from each of the four types of replacement (cemented, cementless, hybrid and resurfacing; the reference prosthesis was the cemented hip procedure. Patient reported outcome scores (PROMs, costs and risk of repeat (revision surgery were examined. Multivariable analyses included analysis of covariance to assess improvement in PROMs (Oxford hip score, OHS, and EQ5D index (9159 linked episodes and competing risks modelling of implant survival (79,775 procedures. Cost of implants and ancillary equipment were obtained from National Health Service procurement data.EQ5D score improvements (at 6 months were similar for all hip replacement types. In females, revision risk was significantly higher in cementless hip prostheses (hazard ratio, HR = 2.22, p<0.001, when compared to the reference hip. Although improvement in OHS was statistically higher (22.1 versus 20.5, p<0.001 for cementless implants, this small difference is unlikely to be clinically important. In males, revision risk was significantly higher in cementless (HR = 1.95, p = 0.003 and resurfacing implants, HR = 3.46, p<0.001, with no differences in OHS. Material costs were lowest with the reference implant (cemented, range £1103 to £1524 and highest with cementless implants (£1928 to £4285. Limitations include the design of the study, which is intrinsically vulnerable to omitted variables, a paucity of long-term implant survival data (reflecting the

  8. The sensitization potential of sunscreen after ablative fractional skin resurfacing using modified human repeated insult patch test.

    Science.gov (United States)

    Boonchai, Waranya; Sathaworawong, Angkana; Wongpraparut, Chanisada; Wanitphakdeedecha, Rungsima

    2015-10-01

    Ablative fractional skin resurfacing has become popular and proven to be useful in treating scars, photoaging and wrinkles. Although post-inflammatory hyperpigmentation (PIH) is the most common complication especially in dark-skinned patients like Asian. Several modalities have been used to overcome the PIH. To determine the sensitization potential of sunscreen applied immediately after ablative fractional skin resurfacing. Sixty volunteers were recruited. Of these 30 subjects were from previous ablative fractional skin resurfacing study who applied broad-spectrum sunscreen containing anti-inflammatory agent starting on the first day after resurfacing and another 30 non-resurfacing subjects had applied the same sunscreen on the intact skin. All subjects were patch/photopatch tested for sensitization study by using modified human repeated insult patch test (HRIPT). There were significantly higher sensitization rate of UV-filter, octocrylene and the sunscreen in resurfacing group than in non-resurfacing group. Early application of sunscreen after ablative fractional skin resurfacing has increased the incidence of sensitization potential of sunscreen. The sunscreen is recommended to start using from D3 after fractional ablative skin resurfacing to ensure the complete recovery of skin barrier and minimize the risk of sensitization.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-11-15

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

  10. Unusual presentation of failed metal-on-metal total hip arthroplasty with features of neoplastic process

    Directory of Open Access Journals (Sweden)

    Robert P. Runner, MD

    2017-06-01

    Full Text Available Metal-on-metal (MoM total hip arthroplasty (THA is associated with increased incidence of failure from metallosis, adverse tissue reactions, and the formation of pseudotumors. This case highlights a 53-year-old female with an enlarging painful thigh mass 12 years status post MoM THA. Radiographs and advanced imaging revealed an atypical mass with cortical bone destruction and spiculation, concerning for periprosthetic malignancy. Open frozen section biopsy was performed before undergoing revision THA in a single episode of care. This case illustrates that massive pseudotumors can be locally aggressive causing significant femoral bone destruction and may mimic malignancy. It is important that orthopaedic surgeons, radiologists and pathologists understand the relative infrequency of periprosthetic malignancy in MoM THA to mitigate patient concerns, misdiagnosis, and allow for an evidence based discussion when treating massive pseudotumors.

  11. Facelift combined with simultaneous fractional laser resurfacing: Outcomes and complications.

    Science.gov (United States)

    Wright, Eric J; Struck, Steve K

    2015-10-01

    The combination of simultaneous surgical rhytidectomy with ablative resurfacing has been a controversial procedure due to the concern of postoperative wound healing. Traditional ablative resurfacing lasers are believed to have higher rates of complications, leading to delayed healing and skin flap loss when combined with face rhytidectomy surgeries. With the development of fractionated ablative laser therapy, there has been increased interest in combining these two procedures. The objective of this study is to evaluate the clinical outcomes of patients undergoing simultaneous full-face rhytidectomy in combination with fractionated ablative skin resurfacing. A retrospective chart analysis was performed for all patients who had a combined procedure of facelift and ablative fractional laser resurfacing from 2008 to 2013 by the senior author (SKS). Postoperative recovery and complications were recorded. The surgical technique used for performing the facelift was an extended supraplatysmal dissection with SMAS plication. Fraxel Re:Pair 10,600-nm fractional carbon dioxide laser was used to perform an ablative resurfacing including the elevated skin flaps. A total of 86 patients were included. Average age was 60.01 years (range of 45-78 years). Longest follow up was five years. The average size of the elevated skin flaps was 100 cm(2). Average skin type was a Fitzpatrick type 2. All patients had complete re-epithelialization by one week after their procedure. Four patients (4.6%) experienced acne outbreaks. Four patients (4.6%) had facial erythema that persisted greater than two weeks. Of these four patients, all resolved by five weeks postoperatively. There was no delayed wound healing or skin flap loss observed. Our results indicate that simultaneous rhytidectomy with fractionated ablative laser resurfacing does not cause an increase in wound healing or skin loss. Due to improved patient outcomes with combining these procedures, we believe that this can be increasingly

  12. Resurfacing hemiarthroplasty compared to stemmed hemiarthroplasty for glenohumeral osteoarthritis

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe V; Olsen, Bo S; Sorensen, Anne Kathrine

    2015-01-01

    PURPOSE: The aim of this study was to conduct a randomised, clinical trial comparing stemmed hemiarthroplasty and resurfacing hemiarthroplasty in the treatment of glenohumeral osteoarthritis. METHODS: A total of 40 shoulders (35 patients) were randomised to stemmed hemiarthroplasty or resurfacing...... hemiarthroplasty and evaluated three and 12 months postoperatively using the Constant-Murley score (CMS) and Western Ontario Osteoarthritis of the Shoulder (WOOS) index. RESULTS: There were no statistically significant differences in age, gender or pre-operative scores except for WOOS at baseline. Two patients...

  13. Metal-metal-hofteproteser

    DEFF Research Database (Denmark)

    Ulrich, Michael; Overgaard, Søren; Penny, Jeannette

    2014-01-01

    In Denmark 4,456 metal-on-metal (MoM) hip prostheses have been implanted. Evidence demonstrates that some patients develope adverse biological reactions causing failures of MoM hip arthroplasty. Some reactions might be systemic. Failure rates are associated with the type and the design of the Mo...

  14. Assessment of Patients with a DePuy ASR Metal-on-Metal Hip Replacement: Results of Applying the Guidelines of the Spanish Society of Hip Surgery in a Tertiary Referral Hospital

    Directory of Open Access Journals (Sweden)

    Jenaro Fernández-Valencia

    2014-01-01

    Full Text Available The prognosis associated with the DePuy ASR hip cup is poor and varies according to the series. This implant was withdrawn from use in 2010 and all patients needed to be assessed. We present the results of the assessment of our patients treated with this device, according to the Spanish Society of Hip Surgery (SECCA algorithm published in 2011. This retrospective study evaluates 83 consecutive ASR cups, followed up at a mean of 2.9 years. Serum levels of chromium and cobalt, as well as the acetabular abduction angle, were determined in order to assess their possible correlation with failure, defined as the need for revision surgery. The mean Harris Hip Score was 83.2 (range 42–97. Eight arthroplasties (13.3% required revision due to persistent pain and/or elevated serum levels of chromium/cobalt. All the cups had a correct abduction angle, and there was no correlation between elevated serum levels of metal ions and implant failure. Since two previous ASR implants were exchanged previously to the recall, the revision rate for ASR cups in our centre is 18.2% at 2.9 years.

  15. Wear mechanisms in ceramic hip implants.

    Science.gov (United States)

    Slonaker, Matthew; Goswami, Tarun

    2004-01-01

    The wear in hip implants is one of the main causes for premature hip replacements. The wear affects the potential life of the prosthesis and subsequent removals of in vivo implants. Therefore, the objective of this article is to review various joints that show lower wear rates and consequently higher life. Ceramics are used in hip implants and have been found to produce lower wear rates. This article discusses the advantages and disadvantages of ceramics compared to other implant materials. Different types of ceramics that are being used are reviewed in terms of the wear characteristics, debris released, and their size together with other biological factors. In general, the wear rates in ceramics were lower than that of metal-on-metal and metal-on-polyethylene combinations.

  16. Pseudotumor of the Hip due to Fungal Prosthetic Joint Infection

    Directory of Open Access Journals (Sweden)

    Stefano Artiaco

    2013-01-01

    Full Text Available Pseudotumors associated with total hip arthroplasty have been associated with metal-on-metal and metal-on-polyethylene total hip arthroplasties due to a granulomatous foreign-body reaction to methyl methacrylate, polyethylene, or metal ion release, but they have not been related to prosthetic joint infections. In this paper, we report an unusual case of Candida albicans total hip arthroplasty infection, causing a large inflammatory pseudotumor of the hip joint. Fungal periprosthetic joint infections are a rare clinical entity and difficult to diagnose, and a pseudotumor may be part of their clinical presentation. They should be suspected in immunodeficient host patients when clinical symptoms of prosthetic joint infections are observed.

  17. A study of TiN-coated metal-on-polymer bearing materials for hip prosthesis

    Science.gov (United States)

    Lee, Sung Bai; Choi, Jin Young; Park, Won Woong; Jeon, Jun Hong; Won, Sung Ok; Byun, Ji Young; Lim, Sang Ho; Han, Seung Hee

    2010-08-01

    The TiN-coated metal-on-polymer hip prosthetic pair has the potential to reduce wear debris of UHMWPE (ultra-high molecular weight polyethylene) and to prevent metallic-ion-induced cytotoxicity. However, high quality and adherent film is a key to the clinical success of hip prostheses. In this study, titanium nitride (TiN) films were deposited on stainless steel using plasma immersion ion implantation & deposition (PIII&D) technique to create high-quality film and an adherent interface. The chemical state and composition were analyzed by X-ray photoelectron spectroscopy (XPS), Auger electron spectroscopy (AES) and energy dispersive spectroscopy (EDS). The mechanical properties of the films were characterized using a micro-hardness tester and a pin-on-disk wear tester, and an x-ray diffractometer (XRD) was used for a crystallographic analysis. The PIII&D-treated TiN films showed a stoichiometric and (200) preferred orientation and micro-hardness up to 150 % higher than untreated film. A TiN-coated specimen using the PIII&D process also showed less UHMWPE wear compared to untreated specimens. The volumetric wear rate of UHMWPE could be reduced by as much as 42 % compared to when Co-Cr alloy was used. The results of this study show that advanced TiN-coating via the PIII&D process is a viable means of reducing UHMWPE wear in the metal-on-polymer bearing couple.

  18. Fractional laser skin resurfacing.

    Science.gov (United States)

    Alexiades-Armenakas, Macrene R; Dover, Jeffrey S; Arndt, Kenneth A

    2012-11-01

    Laser skin resurfacing (LSR) has evolved over the past 2 decades from traditional ablative to fractional nonablative and fractional ablative resurfacing. Traditional ablative LSR was highly effective in reducing rhytides, photoaging, and acne scarring but was associated with significant side effects and complications. In contrast, nonablative LSR was very safe but failed to deliver consistent clinical improvement. Fractional LSR has achieved the middle ground; it combined the efficacy of traditional LSR with the safety of nonablative modalities. The first fractional laser was a nonablative erbium-doped yttrium aluminum garnet (Er:YAG) laser that produced microscopic columns of thermal injury in the epidermis and upper dermis. Heralding an entirely new concept of laser energy delivery, it delivered the laser beam in microarrays. It resulted in microscopic columns of treated tissue and intervening areas of untreated skin, which yielded rapid reepithelialization. Fractional delivery was quickly applied to ablative wavelengths such as carbon dioxide, Er:YAG, and yttrium scandium gallium garnet (2,790 nm), providing more significant clinical outcomes. Adjustable laser parameters, including power, pitch, dwell time, and spot density, allowed for precise determination of percent surface area, affected penetration depth, and clinical recovery time and efficacy. Fractional LSR has been a significant advance to the laser field, striking the balance between safety and efficacy.

  19. Does Choice of Head Size and Neck Geometry Affect Stem Migration in Modular Large-Diameter Metal-on-Metal Total Hip Arthroplasty? A Preliminary Analysis.

    Science.gov (United States)

    Georgiou, Cs; Evangelou, Kg; Theodorou, Eg; Provatidis, Cg; Megas, Pd

    2012-01-01

    Due to their theoretical advantages, hip systems combining modular necks and large diameter femoral heads have gradually gained popularity. However, among others, concerns regarding changes in the load transfer patterns were raised. Recent stress analyses have indeed shown that the use of modular necks and big femoral heads causes significant changes in the strain distribution along the femur. Our original hypothesis was that these changes may affect early distal migration of a modular stem. We examined the effect of head diameter and neck geometry on migration at two years of follow-up in a case series of 116 patients (125 hips), who have undergone primary Metal-on-Metal total hip arthroplasty with the modular grit-blasted Profemur®E stem combined with large-diameter heads (>36 mm). We found that choice of neck geometry and head diameter has no effect on stem migration. A multivariate regression analysis including the potential confounding variables of the body mass index, bone quality, canal fill and stem positioning revealed only a negative correlation between subsidence and canal fill in midstem area. Statistical analysis, despite its limitations, did not confirm our hypothesis that choice of neck geometry and/or head diameter affects early distal migration of a modular stem. However, the importance of correct stem sizing was revealed.

  20. Safety and efficacy of 2,790-nm laser resurfacing for chest photoaging.

    Science.gov (United States)

    Grunebaum, Lisa D; Murdock, Jennifer; Cofnas, Paul; Kaufman, Joely

    2015-01-01

    Chest photodamage is a common cosmetic complaint. Laser treatment of the chest may be higher risk than other areas. The objective of this study was to assess the safety and efficacy of 2,790-nm chest resurfacing for photodamage. Twelve patients with Fitzpatrick skin types I-III were enrolled in this university IRB-approved study. Photo documentation was obtained at baseline and each visit. A test spot with the 2,790-nm resurfacing laser was performed on the chest. Patients who did not have adverse effects from the test spot went on to have a full chest resurfacing procedure. Patients were instructed on standardized aftercare, including sunscreen. A 5-point healing and photodamage improvement scale was used to rate improvement by both investigators and the patients and was obtained at 2 weeks, 1 month, 2 months, and 3 months. One pass chest treatment with the 2,790-nm resurfacing laser at fluences greater than or equal to 3.0 mJ with 10% overlap leads to unacceptable rates of hyperpigmentation. Double pass chest treatment at fluences less than or equal to 2.5 mJ with 10% overlap leads to mild improvement in chest photodamage parameters without significant or persistent adverse effects. Laser treatment of aging/photodamaged chest skin remains a challenge due to the delicacy of chest skin. Mild improvement may be obtained with double pass resurfacing with the 2,790-nm wavelength.

  1. Optimization of metal artefact reduction (MAR) sequences for MRI of total hip prostheses

    Energy Technology Data Exchange (ETDEWEB)

    Toms, A.P., E-mail: andoni.toms@nnuh.nhs.u [Department of Radiology, Norfolk and Norwich University Hospital Trust, Norwich, Norfolk NR4 7UY (United Kingdom); Smith-Bateman, C.; Malcolm, P.N.; Cahir, J. [Department of Radiology, Norfolk and Norwich University Hospital Trust, Norwich, Norfolk NR4 7UY (United Kingdom); Graves, M. [University Department of Radiology, Addenbrooke' s Hospital, Cambridge (United Kingdom)

    2010-06-15

    Aim: 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. Methods and materials: A phantom was created using a Charnley total hip replacement. Mid-coronal T1-weighted (echo time 12 ms, repetition time 400 ms) images through the prosthesis were acquired with increasing bandwidths (150, 300, 454, 592, and 781 Hz/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. Results: Over 90% of the achievable reduction in artefacts was obtained with matrixes of 256 x 256 or greater and a receiver bandwidth of approximately 400 Hz/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. Conclusion: Over 90% of the achievable metal artefact reduction can be realized with mid-range matrices and receiver bandwidths on a clinical 1.5 T 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.

  2. Youth subcultures and problem behaviours in Slovakia : Hip-Hop, Techno-scene, Metal, Punk, Skinheads and Roma

    NARCIS (Netherlands)

    Bobakova, Daniela

    2013-01-01

    Jongeren die deel uitmaken van jeugdsubculturen als hip-hop, techno-scene, metal, punk en skinheads, gebruiken vaker drugs, zijn vaker dronken, spijbelen vaker en beginnen eerder aan seks. Roma-jongeren zijn minder vaak dronken. Dat concludeert Daniela Bobáková op basis van een onderzoek onder deze

  3. Fractional CO2 Laser Resurfacing as Monotherapy in the Treatment of Atrophic Facial Acne Scars.

    Science.gov (United States)

    Majid, Imran; Imran, Saher

    2014-04-01

    While laser resurfacing remains the most effective treatment option for atrophic acne scars, the high incidence of post-treatment adverse effects limits its use. Fractional laser photothermolysis attempts to overcome these limitations of laser resurfacing by creating microscopic zones of injury to the dermis with skip areas in between. The aim of the present study is to assess the efficacy and safety of fractional CO2 laser resurfacing in atrophic facial acne scars. Sixty patients with moderate to severe atrophic facial acne scars were treated with 3-4 sessions of fractional CO2 laser resurfacing at 6-week intervals. The therapeutic response to treatment was assessed at each follow up visit and then finally 6 months after the last laser session using a quartile grading scale. Response to treatment was labelled as 'excellent' if there was >50% improvement in scar appearance and texture of skin on the grading scale while 25-50% response and resurfacing as monotherapy is effective in treating acne scars especially rolling and superficial boxcar scars with minimal adverse effects.

  4. Total hip arthroplasty survival in femoral head avascular necrosis versus primary hip osteoarthritis: Case-control study with a mean 10-year follow-up after anatomical cementless metal-on-metal 28-mm replacement.

    Science.gov (United States)

    Ancelin, D; Reina, N; Cavaignac, E; Delclaux, S; Chiron, P

    2016-12-01

    Total hip arthroplasty is the most widely used procedure to treat avascular necrosis (AVN) of the femoral head. Few studies have compared the outcomes of THA in femoral head AVN and primary hip osteoarthritis. Therefore we performed a case-control study to compare THA for femoral head AVN vs. primary hip osteoarthritis in terms of: (1) prosthesis survival, (2) complication rates, (3) functional outcomes and radiographic outcomes, (4) and to determine whether specific risk factors for THA failure exist in femoral head AVN. THA survival is similar in femoral head AVN and primary hip osteoarthritis. We compared two prospective cohorts of patients who underwent THA before 65 years of age, one composed of cases with femoral head AVN and the other of controls with primary hip osteoarthritis. In both cohorts, a cementless metal-on-metal prosthesis with a 28-mm cup and an anatomical stem was used. Exclusion criteria were THA with other types of prosthesis, posttraumatic AVN, and secondary osteoarthritis. With α set at 5%, to obtain 80% power, 246 patients were required in all. Prosthesis survival was assessed based on time to major revision (defined as replacement of at least one implant fixed to bone) and time to aseptic loosening. The other evaluation criteria were complications, Postel-Merle d'Aubigné (PMA) score, and the Engh and Agora Radiographic Assessment (ARA) scores for implant osseointegration. The study included 282 patients, 149 with AVN and 133 with osteoarthritis. Mean age was 47.8±10.2 years (range, 18.5-65) and mean follow-up was 11.4±2.8 years (range, 4.5-18.3 years). The 10-year survival rates were similar in the two groups: for major revision, AVN group, 92.5% (95% confidence interval [95% CI], 90.2-94.8) and osteoarthritis group, 95.3% (95% CI, 92.9-97.7); for aseptic loosening, AVN group, 98.6% (95% CI, 97.6-98.6) and osteoarthritis, 99.2% (95% CI, 98.4-100). The AVN group had higher numbers of revision for any reason (19 vs. 6, P=0.018) and

  5. Fractional resurfacing in the Asian patient: Current state of the art.

    Science.gov (United States)

    Wat, Heidi; Wu, Douglas C; Chan, Henry Hin Lee

    2017-01-01

    Fractionated photothermolysis (FP) has revolutionized modern laser technology. By creating selective columns of microthermal damage, fractionated devices allows for greater treatment depths to be achieved without the prolonged downtime and risk of complications seen in traditional fully ablative laser resurfacing. Fractional resurfacing is a proven method to treat a variety of cutaneous conditions. In the Caucasian patient, a wide range of devices and treatment settings can be utilized safely and effectively. However, ethnic skin requires special consideration due to its unique pigmentary characteristics and clinical presentations. In this review article, we detail the current indications and strategies to optimize results and mitigate complications when utilizing fractional resurfacing for the Asian patient. A review of the MEDLINE English literature was conducted on fractionated laser devices studied in the Asian population. Articles included describe non-ablative devices including fractionated erbium glass, thulium fiber, diode, and radiofrequency devices; and ablative devices including fractionated carbon dioxide (CO 2 ) laser, erbium yttrium aluminum garnet and yttrium scandium gallium garnet (YSGG) laser. These data were integrated with the expert opinion of the authors. Taking into account the unique characteristics and cosmetic concerns of the Asian population, fractional resurfacing can be considered a safe and effective option for the treatment of atrophic and hypertrophic scarring, and photorejuvenation in ethnic skin types. Select cases of melasma may be treated with fractionated non-ablative devices, but utilized with caution. The predominant complication associated with fractional resurfacing for these conditions is post-inflammatory hyperpigmentation (PIH) and rebound worsening of melasma. A greater number of treatments at lower density settings and wider treatment intervals typically produce the lowest risks of PIH without compromising treatment

  6. Characterization of wear debris from metal-on-metal hip implants during normal wear versus edge-loading conditions.

    Science.gov (United States)

    Kovochich, Michael; Fung, Ernest S; Donovan, Ellen; Unice, Kenneth M; Paustenbach, Dennis J; Finley, Brent L

    2018-04-01

    Advantages of second-generation metal-on-metal (MoM) hip implants include low volumetric wear rates and the release of nanosized wear particles that are chemically inert and readily cleared from local tissue. In some patients, edge loading conditions occur, which result in higher volumetric wear. The objective of this study was to characterize the size, morphology, and chemistry of wear particles released from MoM hip implants during normal (40° angle) and edge-loading (65° angle with microseparation) conditions. The mean primary particle size by volume under normal wear was 35 nm (range: 9-152 nm) compared with 95 nm (range: 6-573 nm) under edge-loading conditions. Hydrodynamic diameter analysis by volume showed that particles from normal wear were in the nano- (edge-loading conditions generated particles that ranged from Edge-loading conditions generated more elongated particles (4.5%) (aspect ratio ≥ 2.5) and more CoCr alloy particles (9.3%) compared with normal wear conditions (1.3% CoCr particles). By total mass, edge-loading particles contained approximately 640-fold more cobalt than normal wear particles. Our findings suggest that high wear conditions are a potential risk factor for adverse local tissue effects in MoM patients who experience edge loading. This study is the first to characterize both the physical and chemical characteristics of MoM wear particles collected under normal and edge-loading conditions. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 986-996, 2018. © 2017 Wiley Periodicals, Inc.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-08-15

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

  8. Adverse reaction to metal debris with concomitant incidental crystalline arthropathy in hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Edward J. Testa, BS

    2017-03-01

    Full Text Available Adverse reaction to metal debris (ARMD is a known cause of failed metal in hip arthroplasty. Diagnosis of this type of prosthesis failure may be difficult, and the hallmark is an abnormally elevated serum cobalt level. Concomitant diagnoses may also be present, such as infection, instability, and loosening, and this may confuse interpretation of abnormal laboratories. We present here, for the first time, 2 patients with ARMD and crystalline arthropathy. In each case, the patient chose surgery for ARMD, with resolution of symptoms and no recurrence of the crystalline arthropathy. We present these cases to alert the orthopaedist that crystalline arthropathy may be present at the same time as ARMD, but is likely not the primary cause of symptoms.

  9. Computed Tomography Imaging of a Hip Prosthesis Using Iterative Model-Based Reconstruction and Orthopaedic Metal Artefact Reduction: A Quantitative Analysis.

    Science.gov (United States)

    Wellenberg, Ruud H H; Boomsma, Martijn F; van Osch, Jochen A C; Vlassenbroek, Alain; Milles, Julien; Edens, Mireille A; Streekstra, Geert J; Slump, Cornelis H; Maas, Mario

    To quantify the combined use of iterative model-based reconstruction (IMR) and orthopaedic metal artefact reduction (O-MAR) in reducing metal artefacts and improving image quality in a total hip arthroplasty phantom. Scans acquired at several dose levels and kVps were reconstructed with filtered back-projection (FBP), iterative reconstruction (iDose) and IMR, with and without O-MAR. Computed tomography (CT) numbers, noise levels, signal-to-noise-ratios and contrast-to-noise-ratios were analysed. Iterative model-based reconstruction results in overall improved image quality compared to iDose and FBP (P < 0.001). Orthopaedic metal artefact reduction is most effective in reducing severe metal artefacts improving CT number accuracy by 50%, 60%, and 63% (P < 0.05) and reducing noise by 1%, 62%, and 85% (P < 0.001) whereas improving signal-to-noise-ratios by 27%, 47%, and 46% (P < 0.001) and contrast-to-noise-ratios by 16%, 25%, and 19% (P < 0.001) with FBP, iDose, and IMR, respectively. The combined use of IMR and O-MAR strongly improves overall image quality and strongly reduces metal artefacts in the CT imaging of a total hip arthroplasty phantom.

  10. Upper Eyelid Fractional CO2 Laser Resurfacing With Incisional Blepharoplasty.

    Science.gov (United States)

    Kotlus, Brett S; Schwarcz, Robert M; Nakra, Tanuj

    2016-01-01

    Laser resurfacing, performed at the same time as blepharoplasty, has most commonly been applied to the lower eyelid skin but can effectively be used on the upper eyelid to reduce rhytidosis and improve skin quality. The authors evaluate the safety and efficacy of this procedure. Fractional CO2 laser resurfacing was performed in conjunction with incisional upper blepharoplasty. The ultrapulsed laser energy was applied to the sub-brow skin, the upper medial canthal skin, and the pretarsal skin in 30 patients. Photos were obtained preoperatively and at 3 months. All patients demonstrated reduction in upper eyelid rhytidosis without any serious complications. Independent rhytidosis grading (0-4) showed a mean improvement of 42%. One patient experienced wound dehiscence that satisfactorily resolved without intervention. Upper eyelid laser resurfacing is effective and can be safely performed at the same time as upper blepharoplasty. This approach reduces or eliminates the need for medial incisions to address medial canthal skin redundancy and rhytidosis and it directly treats upper eyelid wrinkles on residual eyelid and infra-brow skin during blepharoplasty.

  11. Direct quantitative comparison of molecular responses in photodamaged human skin to fractionated and fully ablative carbon dioxide laser resurfacing.

    Science.gov (United States)

    Orringer, Jeffrey S; Sachs, Dana L; Shao, Yuan; Hammerberg, Craig; Cui, Yilei; Voorhees, John J; Fisher, Gary J

    2012-10-01

    Fractionated ablative laser resurfacing has become a widely used treatment modality. Its clinical results are often found to approach those of traditional fully ablative laser resurfacing. To directly compare the molecular changes that result from fractionated and fully ablative carbon dioxide (CO(2)) laser resurfacing in photodamaged human skin. Photodamaged skin of 34 adult volunteers was focally treated at distinct sites with a fully ablative CO(2) laser and a fractionated CO(2) laser. Serial skin samples were obtained at baseline and several time points after treatment. Real-time reverse transcriptase polymerase chain reaction technology and immunohistochemistry were used to quantify molecular responses to each type of laser treatment. Fully ablative and fractionated CO(2) laser resurfacing induced significant dermal remodeling and collagen induction. After a single treatment, fractionated ablative laser resurfacing resulted in collagen induction that was approximately 40% to 50% as pronounced as that induced by fully ablative laser resurfacing. The fundamental cutaneous responses that result from fully ablative and fractionated carbon dioxide laser resurfacing are similar but differ in magnitude and duration, with the fully ablative procedure inducing relatively greater changes including more pronounced collagen induction. However, the molecular data reported here provide substantial support for fractionated ablative resurfacing as an effective treatment modality for improving skin texture. © 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

  12. Structural-Geometric Functionalization of the Additively Manufactured Prototype of Biomimetic Multispiked Connecting Ti-Alloy Scaffold for Entirely Noncemented Resurfacing Arthroplasty Endoprostheses

    Directory of Open Access Journals (Sweden)

    Ryszard Uklejewski

    2017-01-01

    Full Text Available The multispiked connecting scaffold (MSC-Scaffold prototype, inspired by the biological system of anchorage of the articular cartilage in the periarticular trabecular bone by means of subchondral bone interdigitations, is the essential innovation in fixation of the bone in resurfacing arthroplasty (RA endoprostheses. The biomimetic MSC‐Scaffold, due to its complex geometric structure, can be manufactured only using additive technology, for example, selective laser melting (SLM. The major purpose of this work is determination of constructional possibilities for the structural-geometric functionalization of SLM‐manufactured MSC‐Scaffold prototype, compensating the reduced ability—due to the SLM technological limitations—to accommodate the ingrowing bone filling the interspike space of the prototype, which is important for the prototype bioengineering design. Confocal microscopy scanning of components of the SLM‐manufactured prototype of total hip resurfacing arthroplasty (THRA endoprosthesis with the MSC‐Scaffold was performed. It was followed by the geometric measurements of a variety of specimens designed as the fragments of the MSC-Scaffold of both THRA endoprosthesis components. The reduced ability to accommodate the ingrowing bone tissue in the SLM‐manufactured prototypes versus that in the corresponding CAD models has been quantitatively determined. Obtained results enabled to establish a way of compensatory structural‐geometric functionalization, allowing the MSC‐Scaffold adequate redesigning and manufacturing in additive SLM technology.

  13. The unipolar ASR : Viable option in unsalvageable femoral head conditions in the young patient

    Directory of Open Access Journals (Sweden)

    Marya SKS

    2006-01-01

    Full Text Available Background: The management of unsalvageable femoral head conditions in the young patient has remained an unresolved dilemma. Articular surface replacement of the hip has recently made some headway in terms of providing near-normal hip joint mechanics and function. However, this surgery has been limited to early stages of arthritis only with reasonable maintenance of head-neck congruity and morphology. Femoral neck fractures, osteonecrosis with large segment collapse, advanced arthritis with femoral incongruity, etc are traditional contraindications to the resurfacing technique. Methods: We present here a report on our series of 20 cases of unsalvageable femoral heads in young patients (age range, 27 to 52yrs, over a twelve month period (Aug 2004 to Jul 2005, treated with the unipolar ASR prosthesis. Fifteen patients (two had bilateral hip pathology had primary or secondary arthritis (degenerative, post-traumatic, ankylosing spondylitis and post-avascular necrosis while three had old operated femoral neck fractures. All patients underwent hip replacement surgery using the Unipolar ASR prosthesis. Results: Clinical and radiological results at 6-month follow up have been very encouraging and warrant further study. At an average of 4 months post-operatively, patients were able to squat, sit on the ground and perform light sporting activities. Conclusions: The Unipolar ASR prosthesis is an extension of the articular resurfacing technique employing similar principles (large size bearings, metal-on-metal interfaces, and has incorporated the advantages of the uncemented technique. We propose that this technique be more frequently used so as to brighten the prognosis of the young active patient with unsalvageable hip conditions, especially in the Asian scenario.

  14. Fractional ablative laser skin resurfacing: a review.

    Science.gov (United States)

    Tajirian, Ani L; Tarijian, Ani L; Goldberg, David J

    2011-12-01

    Ablative laser technology has been in use for many years now. The large side effect profile however has limited its use. Fractional ablative technology is a newer development which combines a lesser side effect profile along with similar efficacy. In this paper we review fractional ablative laser skin resurfacing.

  15. Reduction of metallosis in hip implant using thin film coating

    Science.gov (United States)

    Rajeshshyam, R.; Chockalingam, K.; Gayathri, V.; Prakash, T.

    2018-04-01

    Hip implant finds its emerging attraction due to it continuous demand over the years. The hip implants (femoral head) and acetabulum cup) mainly fabricated by metals such as stainless steel, cobalt chrome and titanium alloys, other than that ceramics and polyethylene have been used. The metal-on-metal hip implant was found to be best implant material for most of the surgeons due to its high surface finish, low wear rate and low chance of dislocation from its position after implanting. Where in metal based hip implant shows less wear rate of 0.01mm3/year. Metal-on-metal implant finds its advantage over other materials both in its mechanical and physical stability against human load. In M-O-M Cobalt- chromium alloys induce metal allergy. The metal allergy (particulate debris) that is generated by wear, fretting, fragmentation and which is unavoidable when a prosthesis is implanted, can induce an inflammatory reaction in some circumstances. The objectives of this research to evaluate thin film coating with Nano particle additives to reduce the wear leads to regarding metal ion release. Experimental results reveals that thin film Sol-Gel coating with 4wt. % of specimen reduced the cobalt and chromium ion release and reduces the wear rate. Wear rate reduced by 98% for 4wt. % graphene in 20N and 95% for 4wt. % graphene in 10N.

  16. Early results of patellofemoral inlay resurfacing arthroplasty using the HemiCap Wave prosthesis.

    Science.gov (United States)

    Patel, Akash; Haider, Zakir; Anand, Amarjit; Spicer, Dominic

    2017-01-01

    Common surgical treatment options for isolated patellofemoral osteoarthritis include arthroscopic procedures, total knee replacement and patellofemoral replacement. The HemiCap Wave patellofemoral resurfacing prosthesis is a novel inlay design introduced in 2009 with scarce published data on its functional outcomes. We aim to prospectively evaluate early functional outcomes and complications, for patients undergoing a novel inlay resurfacing arthroplasty for isolated patellofemoral arthrosis in an independent centre. From 2010 to 2013, 16 consecutive patients underwent patellofemoral resurfacing procedures using HemiCap Wave (Arthrosurface Inc., Franklin, Massachusetts, USA) for anterior knee pain with confirmed radiologically and/or arthroscopically isolated severe patellofemoral arthrosis. Standardized surgical technique, as recommended by the implant manufacturer, was followed. Outcome measures included range of movement, functional knee scores (Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Short Form-36 (SF-36)), radiographic disease progression, revision rates and complications. Eight men and eight women underwent patellofemoral HemiCap Wave resurfacing, with an average age of 63 years (range: 46-83). Average follow-up was 24.1 months (6-34). Overall, post-operative scores were excellent. There was a statistically significant improvement in the post-operative OKS, KOOS and SF-36 scores ( p patellofemoral resurfacing prosthesis has excellent early results in terms of functional outcomes, radiological outcomes and low complication rates. At the very least, early results show that the HemiCap Wave is comparable to more established onlay prostheses. The HemiCap Wave thus provides a safe and effective surgical option in the treatment of isolated patellofemoral osteoarthritis in selected patients.

  17. Ablative skin resurfacing with a novel microablative CO2 laser.

    Science.gov (United States)

    Gotkin, Robert H; Sarnoff, Deborah S; Cannarozzo, Giovanni; Sadick, Neil S; Alexiades-Armenakas, Macrene

    2009-02-01

    Carbon dioxide (CO2) laser skin resurfacing has been a mainstay of facial rejuvenation since its introduction in the mid 1990s. Recently, a new generation of fractional or microablative CO2 lasers has been introduced to the marketplace. According to the concept of fractional photothermolysis, these lasers ablate only a fraction of the epidermal and dermal architecture in the treatment area. An array of microscopic thermal wounds is created that ablates the epidermis and dermis within very tiny zones; adjacent to these areas, the epidermis and dermis are spared. This microablative process of laser skin resurfacing has proven safe and effective not only for facial rejuvenation, but elsewhere on the body as well. It is capable of improving wrinkles, acne scars, and other types of atrophic scars and benign pigmented lesions associated with elastotic, sun-damaged skin. Because of the areas of spared epidermis and dermis inherent in a procedure that employs fractional photothermolysis, healing is more rapid compared to fully ablative CO2 laser skin resurfacing and downtime is proportionately reduced. A series of 32 consecutive patients underwent a single laser resurfacing procedure with the a new microablative CO2 laser. All patients were followed for a minimum of 6 months and were asked to complete patient satisfaction questionnaires; a 6 month postoperative photographic evaluation by an independent physician, not involved in the treatment, was also performed. Both sets of data were graded and reported on a quartile scale. Results demonstrated greater than 50% improvement in almost all patients with those undergoing treatment for wrinkles, epidermal pigment or solar elastosis deriving the greatest change for the better (>75%).

  18. Viscous relaxation as a prerequisite for tectonic resurfacing on Ganymede: Insights from numerical models of lithospheric extension

    Science.gov (United States)

    Bland, Michael T.; McKinnon, William B.

    2018-05-01

    Ganymede's bright terrain formed during a near-global resurfacing event (or events) that produced both heavily tectonized and relatively smooth terrains. The mechanism(s) by which resurfacing occurred on Ganymede (e.g., cryovolcanic or tectonic), and the relationship between the older, dark and the younger, bright terrain are fundamental to understanding the geological evolution of the satellite. Using a two-dimensional numerical model of lithospheric extension that has previously been used to successfully simulate surface deformation consistent with grooved terrain morphologies, we investigate whether large-amplitude preexisting topography can be resurfaced (erased) by extension (i.e., tectonic resurfacing). Using synthetically produced initial topography, we show that when the total relief of the initial topography is larger than 25-50 m, periodic groove-like structures fail to form. Instead, extension is localized in a few individual, isolated troughs. These results pose a challenge to the tectonic resurfacing hypothesis. We further investigate the effects of preexisting topography by performing suites of simulations initialized with topography derived from digital terrain models of Ganymede's surface. These include dark terrain, fresh (relatively deep) impact craters, smooth bright terrain, and a viscously relaxed impact crater. The simulations using dark terrain and fresh impact craters are consistent with our simulations using synthetic topography: periodic groove-like deformation fails to form. In contrast, when simulations were initialized with bright smooth terrain topography, groove-like deformation results from a wide variety of heat flow and surface temperature conditions. Similarly, when a viscously relaxed impact crater was used, groove-like structures were able to form during extension. These results suggest that tectonic resurfacing may require that the amplitude of the initial topography be reduced before extension begins. We emphasize that viscous

  19. Current Status of Fractional Laser Resurfacing.

    Science.gov (United States)

    Carniol, Paul J; Hamilton, Mark M; Carniol, Eric T

    2015-01-01

    Fractional lasers were first developed based on observations of lasers designed for hair transplantation. In 2007, ablative fractional laser resurfacing was introduced. The fractionation allowed deeper tissue penetration, leading to greater tissue contraction, collagen production and tissue remodeling. Since then, fractional erbium:YAG resurfacing lasers have also been introduced. These lasers have yielded excellent results in treating photoaging, acne scarring, and dyschromia. With the adjustment of microspot density, pulse duration, number of passes, and fluence, the surgeon can adjust the treatment effects. These lasers have allowed surgeons to treat patients with higher Fitzpatrick skin types (types IV to VI) and greater individualize treatments to various facial subunits. Immunohistochemical analysis has demonstrated remodeling effects of the tissues for several months, producing longer lasting results. Adjuvant treatments are also under investigation, including concomitant face-lift, product deposition, and platelet-rich plasma. Finally, there is a short recovery time from treatment with these lasers, allowing patients to resume regular activities more quickly. Although there is a relatively high safety profile for ablative fractionated lasers, surgeons should be aware of the limitations of specific treatments and the associated risks and complications.

  20. Fractional versus ablative erbium:yttrium-aluminum-garnet laser resurfacing for facial rejuvenation: an objective evaluation.

    Science.gov (United States)

    El-Domyati, Moetaz; Abd-El-Raheem, Talal; Abdel-Wahab, Hossam; Medhat, Walid; Hosam, Wael; El-Fakahany, Hasan; Al Anwer, Mustafa

    2013-01-01

    Laser is one of the main tools for skin resurfacing. Erbium:yttrium-aluminum-garnet (Er:YAG) was the second ablative laser, after carbon dioxide, emitting wavelength of 2940 nm. Fractional laser resurfacing has been developed to overcome the drawbacks of ablative lasers. We aimed to objectively evaluate the histopathological and immunohistochemical effects of Er:YAG 2940-nm laser for facial rejuvenation (multiple sessions of fractional vs single session of ablative Er:YAG laser). Facial resurfacing with single-session ablative Er:YAG laser was performed on 6 volunteers. Another 6 were resurfaced using fractional Er:YAG laser (4 sessions). Histopathological (hematoxylin-eosin, orcein, Masson trichrome, and picrosirius red stains) and immunohistochemical assessment for skin biopsy specimens were done before laser resurfacing and after 1 and 6 months. Histometry for epidermal thickness and quantitative assessment for neocollagen formation; collagen I, III, and VII; elastin; and tropoelastin were done for all skin biopsy specimens. Both lasers resulted in increased epidermal thickness. Dermal collagen showed increased neocollagen formation with increased concentration of collagen types I, III, and VII. Dermal elastic tissue studies revealed decreased elastin whereas tropoelastin concentration increased after laser resurfacing. Neither laser showed significant difference between their effects clinically and on dermal collagen. Changes in epidermal thickness, elastin, and tropoelastin were significantly more marked after ablative laser. The small number of patients is a limitation, yet the results show significant improvement. Multiple sessions of fractional laser have comparable effects to a single session of ablative Er:YAG laser on dermal collagen but ablative laser has more effect on elastic tissue and epidermis. Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  1. Commercialization of an electric propulsion unit for ecological ice resurfacers

    Energy Technology Data Exchange (ETDEWEB)

    Giroux, M. [MG Service, L' Assomption, PQ (Canada); Sylvestre, P. [Environment Canada, Montreal, PQ (Canada)

    2000-03-01

    Community health departments (CHD) and the general public are greatly concerned about the air quality at indoor skating rinks. A solution now exists whereby municipalities can convert their internal combustion resurfacers to electricity, using a system proposed by MG Service. This electric propulsion unit was developed and designed by MG Service, in conjunction with the Centre d'experimentation des vehicules electriques du Quebec (CEVEQ) and TPR Inc., an engineering firm. The main advantage of this technology is the ease of integration into the chassis of conventional resurfacers currently in use throughout the various municipalities. The propulsion unit is battery-powered and designed to replace the internal combustion engine. As a result, it eliminates carbon monoxide and nitrogen dioxide emissions, and more than meets the requirements set by health boards with regard to air quality at indoor skating rinks. Recyclable, maintenance-free and manufactured according to the standards set by the Underwriters Laboratories of Canada (ULC), the gel-sealed batteries display great advantages. The cost effectiveness of the electric propulsion unit is more impressive when considering that electricity is clean and costs five times less than conventional fuels currently in use. Regular verifications and calibrations are not required and the maintenance is minimal. The ventilation requirements are also reduced, leading to savings in energy costs required for the aeration of the indoor skating rink. Finally, the elimination of tank rental and fuel costs represent an added benefit. A detailed description of the components is provided. Following a series of trials, the operators were impressed by the surface gripability, traction and manoeuvrability. The resurfacers also gave an impression of greater raw power and were very quiet and easy to use, resulting in better overall operation when compared to conventional resurfacers. 1 fig.

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

    Science.gov (United States)

    Yan, Yu; Dowson, Duncan; Neville, Anne

    2013-02-01

    The second generation Metal-on-Metal (MoM) hip replacements have been considered as an alternative to commonly used Polyethylene-on-Metal (PoM) joint prostheses due to polyethylene wear debris induced osteolysis. However, the role of corrosion and the biofilm formed under tribological contact are still not fully understood. Enhanced metal ion concentrations have been reported widely from hair, blood and urine samples of patients who received metal hip replacements and in isolated cases when abnormally high levels have caused adverse local tissue reactions. An understanding of the origin of metal ions is really important in order to design alloys for reduced ion release. Reciprocating pin-on-plate wear tester is a standard instrument to assess the interaction of corrosion and wear. However, more realistic hip simulator can provide a better understanding of tribocorrosion process for hip implants. It is very important to instrument the conventional hip simulator to enable electrochemical measurements. In this study, simple reciprocating pin-on-plate wear tests and hip simulator tests were compared. It was found that metal ions originated from two sources: (a) a depassivation of the contacting surfaces due to tribology (rubbing) and (b) corrosion of nano-sized wear particles generated from the contacting surfaces. Copyright © 2012 Elsevier Ltd. All rights reserved.

  3. Face resurfacing using a cervicothoracic skin flap prefabricated by lateral thigh fascial flap and tissue expander.

    Science.gov (United States)

    Li, Qingfeng; Zan, Tao; Gu, Bin; Liu, Kai; Shen, Guoxiong; Xie, Yun; Weng, Rui

    2009-01-01

    Resurfacing of facial massive soft tissue defect is a formidable challenge because of the unique character of the region and the limitation of well-matched donor site. In this report, we introduce a technique for using the prefabricated cervicothoracic skin flap for facial resurfacing, in an attempt to meet the principle of flap selection in face reconstructive surgery for matching the color and texture, large dimension, and thinner thickness (MLT) of the recipient. Eleven patients with massive facial scars underwent resurfacing procedures with prefabricated cervicothoracic flaps. The vasculature of the lateral thigh fascial flap, including the descending branch of the lateral femoral circumflex vessels and the surrounding muscle fascia, was used as the vascular carrier, and the pedicles of the fascial flap were anastomosed to either the superior thyroid or facial vessels in flap prefabrication. A tissue expander was placed beneath the fascial flap to enlarge the size and reduce the thickness of the flap. The average size of the harvested fascia flap was 6.5 x 11.7 cm. After a mean interval of 21.5 weeks, the expanders were filled to a mean volume of 1,685 ml. The sizes of the prefabricated skin flaps ranged from 12 x 15 cm to 15 x 32 cm. The prefabricated skin flaps were then transferred to the recipient site as pedicled flaps for facial resurfacing. All facial soft tissue defects were successfully covered by the flaps. The donor sites were primarily closed and healed without complications. Although varied degrees of venous congestion were developed after flap transfers, the marginal necrosis only occurred in two cases. The results in follow-up showed most resurfaced faces restored natural contour and regained emotional expression. MLT is the principle for flap selection in resurfacing of the massive facial soft tissue defect. Our experience in this series of patients demonstrated that the prefabricated cervicothoracic skin flap could be a reliable alternative

  4. Hip implants - Paper VI - Ion concentrations

    Energy Technology Data Exchange (ETDEWEB)

    Sargeant, A. [Department of Biological Sciences, Ohio Northern University, Ada, OH 45810 (United States); Goswami, T. [Department of Mechanical Engineering, Ohio Northern University, Ada, OH 45810 (United States)]. E-mail: t-goswami@onu.edu

    2007-07-01

    Total hip-joint arthroplasty is performed in increasing numbers where it translates to about 0.16-0.2% of population per year in industrial countries. In most cases, an implant is a metallic component articulating with a metal, ceramic or poly-ethylene liner as seen in the case of hip, knee and spine. The metal implants release ions in vivo. Therefore, there is a need to study metallic implants and ions released as a result. Toxic concentrations of ions can lead to many adverse physiological effects, including cytotoxicity, genotoxicity, carcinogenicity, and metal sensitivity. There is a need to map ion concentrations establishing boundaries between normal and toxic levels; which however, does not exist. Reference levels of ion concentrations in body fluids and tissues determined by many studies are compiled, reviewed, and presented in this paper. The concentrations of ions released from different alloys, including cobalt, chromium, nickel, molybdenum titanium, aluminum, and vanadium, are presented in this paper. This paper reviews the literature pertaining to clinical data on metal ion concentrations in patients with metal joint prostheses, and laboratory data on the physiological effects of the metals.

  5. Optimization of scan time in MRI for total hip prostheses. SEMAC tailoring for prosthetic implants containing different types of metals

    Energy Technology Data Exchange (ETDEWEB)

    Deligianni, X. [University of Basel Hospital, Basel (Switzerland). Div. of Radiological Physics; Merian Iselin Klinik, Basel (Switzerland). Inst. of Radiology; Bieri, O. [University of Basel Hospital, Basel (Switzerland). Div. of Radiological Physics; Elke, R. [Orthomerian, Basel (Switzerland); Wischer, T.; Egelhof, T. [Merian Iselin Klinik, Basel (Switzerland). Inst. of Radiology

    2015-12-15

    Magnetic resonance imaging (MRI) of soft tissues after total hip arthroplasty is of clinical interest for the diagnosis of various pathologies that are usually invisible with other imaging modalities. As a result, considerable effort has been put into the development of metal artifact reduction MRI strategies, such as slice encoding for metal artifact correction (SEMAC). Generally, the degree of metal artifact reduction with SEMAC directly relates to the overall time spent for acquisition, but there is no specific consensus about the most efficient sequence setup depending on the implant material. The aim of this article is to suggest material-tailored SEMAC protocol settings. Five of the most common total hip prostheses (1. Revision prosthesis (S-Rom), 2. Titanium alloy, 3. Mueller type (CoNiCRMo alloy), 4. Old Charnley prosthesis (Exeter/Stryker), 5. MS-30 stem (stainless-steel)) were scanned on a 1.5 T MRI clinical scanner with a SEMAC sequence with a range of artifact-resolving slice encoding steps (SES: 2 - 23) along the slice direction (yielding a total variable scan time ranging from 1 to 10 min). The reduction of the artifact volume in comparison with maximal artifact suppression was evaluated both quantitatively and qualitatively in order to establish a recommended number of steps for each case. The number of SES that reduced the artifact volume below approximately 300 mm{sup 3} ranged from 3 to 13, depending on the material. Our results showed that although 3 SES steps can be sufficient for artifact reduction for titanium prostheses, at least 11 SES should be used for prostheses made of materials such as certain alloys of stainless steel. Tailoring SES to the implant material and to the desired degree of metal artifact reduction represents a simple tool for workflow optimization of SEMAC imaging near total hip arthroplasty in a clinical setting.

  6. Optimization of scan time in MRI for total hip prostheses. SEMAC tailoring for prosthetic implants containing different types of metals

    International Nuclear Information System (INIS)

    Deligianni, X.; Wischer, T.; Egelhof, T.

    2015-01-01

    Magnetic resonance imaging (MRI) of soft tissues after total hip arthroplasty is of clinical interest for the diagnosis of various pathologies that are usually invisible with other imaging modalities. As a result, considerable effort has been put into the development of metal artifact reduction MRI strategies, such as slice encoding for metal artifact correction (SEMAC). Generally, the degree of metal artifact reduction with SEMAC directly relates to the overall time spent for acquisition, but there is no specific consensus about the most efficient sequence setup depending on the implant material. The aim of this article is to suggest material-tailored SEMAC protocol settings. Five of the most common total hip prostheses (1. Revision prosthesis (S-Rom), 2. Titanium alloy, 3. Mueller type (CoNiCRMo alloy), 4. Old Charnley prosthesis (Exeter/Stryker), 5. MS-30 stem (stainless-steel)) were scanned on a 1.5 T MRI clinical scanner with a SEMAC sequence with a range of artifact-resolving slice encoding steps (SES: 2 - 23) along the slice direction (yielding a total variable scan time ranging from 1 to 10 min). The reduction of the artifact volume in comparison with maximal artifact suppression was evaluated both quantitatively and qualitatively in order to establish a recommended number of steps for each case. The number of SES that reduced the artifact volume below approximately 300 mm 3 ranged from 3 to 13, depending on the material. Our results showed that although 3 SES steps can be sufficient for artifact reduction for titanium prostheses, at least 11 SES should be used for prostheses made of materials such as certain alloys of stainless steel. Tailoring SES to the implant material and to the desired degree of metal artifact reduction represents a simple tool for workflow optimization of SEMAC imaging near total hip arthroplasty in a clinical setting.

  7. Benefits of Hot Isostatic Pressure/Powdered Metal (HIP/PM) and Additive Manufacturing (AM) To Fabricate Advanced Energy System Components

    Energy Technology Data Exchange (ETDEWEB)

    Horton, Nancy [Energy Industries of Ohio, Cleveland, OH (United States); Sheppard, Roy [Energy Industries of Ohio, Cleveland, OH (United States)

    2016-12-31

    Advanced Energy systems require large, complex components produced from materials capable of withstanding severe operating environments (high temperature, pressure, corrosivity). Such parts can be difficult to source, as conventional material processing technologies must be tailored to ensure a safe and cost effective approach to large-scale manufacture of quality structural advanced alloy components that meet the performance specifications of AE systems. (HIP/PM) has shown advantages over other manufacturing methods when working with these materials. For example, using HIP’ing in lieu of casting means significant savings in raw material costs, which for expensive, high-nickel alloys can be considerable for large-scale production. Use of HIP/PM also eliminates the difficulties resulting from reactivity of these materials in the molten state and facilitates manufacture of the large size requirements of the AE industry, producing a part that is defect and porosity free, thus further reducing or eliminating time and expense of post processing machining and weld repair. New advances in Additive Manufacturing (AM) techniques make it possible to further expand the benefits of HIP/PM in producing AE system components to create an even more robust manufacturing approach. Traditional techniques of welding and forming sheet metal to produce the HIP canisters can be time consuming and costly, with limitations on the complexity of part which can be achieved. A key benefit of AM is the freedom of design that it offers, so use of AM could overcome such challenges, ultimately enabling redesign of complete energy systems. A critical step toward this goal is material characterization of the required advanced alloys, for use in AM. Using Haynes 282, a high nickel alloy of interest to the Fossil Energy community, particularly for Advanced-UltraSuperCritical (AUSC) operating environments, as well as the crosscutting interests of the aerospace, defense and medical markets, this

  8. Resurfacing asteroids from YORP spin-up and failure

    Science.gov (United States)

    Graves, Kevin J.; Minton, David A.; Hirabayashi, Masatoshi; DeMeo, Francesca E.; Carry, Benoit

    2018-04-01

    The spectral properties of S and Q-type asteroids can change over time due to interaction with the solar wind and micrometeorite impacts in a process known as 'space weathering.' Space weathering raises the spectral slope and decreases the 1 μm absorption band depth in the spectra of S and Q-type asteroids. Over time, Q-type asteroids, which have very similar spectra to ordinary chondrite meteorites, will change into S-type asteroids. Because there are a significant number of Q-type asteroids, there must be some process which is resurfacing S-type asteroids into Q-types. In this study, we use asteroid data from the Sloan Digital Sky Survey to show a trend between the slope through the g‧, r‧, and i‧ filters, called the gri-slope, and size that holds for all populations of S and Q-type asteroids in the inner solar system, regardless of orbit. We model the evolution of a suite of asteroids in a Monte Carlo YORP rotational evolution and space weathering model. We show that spin-up and failure from YORP is one of the key resurfacing mechanisms that creates the observed weathering trends with size. By varying the non-dimensional YORP coefficient and running time of the present model over the range 475-1425 Myr, we find a range of values for the space weathering timescale, τSW ≈ 19-80 Myr at 2.2 AU. We also estimate the time to weather a newly resurfaced Q-type asteroid into an S-complex asteroid at 1 AU, τQ → S(1AU) ≈ 2-7 Myr.

  9. One step HIP canning of powder metallurgy composites

    Science.gov (United States)

    Juhas, John J. (Inventor)

    1990-01-01

    A single step is relied on in the canning process for hot isostatic pressing (HIP) powder metallurgy composites. The binders are totally removed while the HIP can of compatible refractory metal is sealed at high vacuum and temperature. This eliminates outgassing during hot isostatic pressing.

  10. Edge loading has a paradoxical effect on wear in metal-on-polyethylene total hip arthroplasties.

    Science.gov (United States)

    Harris, William H

    2012-11-01

    Edge wear is an adverse factor that can negatively impact certain THAs. In some metal-on-metal THAs, it can lead to adverse tissue reactions including aseptic lymphocytic vasculitis-associated lesions and even to pseudotumor formation. In some ceramic-on-ceramic THAs, it can lead to squeaking and/or stripe wear. Edge wear in metal-on-metal and ceramic-on-ceramic THAs can also be associated with accelerated wear across the articulation of these joints. I asked: Does edge wear occur in metal-on-polyethylene (MOP) articulations? And if so, does it increase joint wear? I examined the evidence in the literature for edge wear occurring in MOP THA and then assessed the evidence in the literature for data supporting the concept that edge wear in MOP hips could accelerate wear across the articulation over time. Extensive data in the literature confirm edge wear is common in MOP THA. Surprisingly, the evidence does not support that it accelerates wear across the articulation. In fact, substantial data support the concept that it does not. These observations suggest, in terms of edge wear accelerating overall wear, MOP articulation may have a privileged position compared to hard-on-hard THA articulations.

  11. Molecular effects of fractional carbon dioxide laser resurfacing on photodamaged human skin.

    Science.gov (United States)

    Reilly, Michael J; Cohen, Marc; Hokugo, Akishige; Keller, Gregory S

    2010-01-01

    Objective To elucidate the sequential changes in protein expression that play a role in the clinically beneficial results seen with fractional carbon dioxide (CO(2)) laser resurfacing of the face and neck. Methods Nine healthy volunteers were recruited for participation from the senior author's facial plastic surgery practice. After informed consent was obtained, each volunteer underwent a 2-mm punch biopsy from a discrete area of infra-auricular neck skin prior to laser treatment. Patients then immediately underwent laser resurfacing of photodamaged face and neck skin at a minimal dose (30 W for 0.1 second) with the Pixel Perfect fractional CO(2) laser. On completion of the treatment, another biopsy specimen was taken adjacent to the first site. Additional biopsy specimens were subsequently taken from adjacent skin at 2 of 3 time points (day 7, day 14, or day 21). RNA was extracted from the specimens, and reverse transcriptase-polymerase chain reaction and protein microarray analysis were performed. Comparisons were then made between time points using pairwise comparison testing. Results We found statistically significant changes in the gene expression of several matrix metalloproteinases (MMPs). The data demonstrate a consistent up-regulation of MMPs 1, 3, 9, and 13, all of which have been previously reported for fully ablative CO(2) laser resurfacing. There was also a statistically significant increase in MMP-10 and MMP-11 levels in this data set. Conclusion This study suggests that the molecular mechanisms of action are similar for both fractional and fully ablative CO(2) laser resurfacing.

  12. Do different types of bearings and noise from total hip arthroplasty influence hip-related pain, function, and quality of life postoperatively?

    DEFF Research Database (Denmark)

    Varnum, Claus; Pedersen, Alma B; Kjærsgaard-Andersen, Per

    2016-01-01

    with metal-on-metal (MoM) THAs to scores from patients with metal-on-polyethylene (MoP) THAs, and to determine the influence of THA-related noise on PROM scores. Patients and methods - We conducted a nationwide cross-sectional questionnaire survey in a cohort of patients identified from the Danish Hip......, and 12% with MoP THAs reported noise from their hip. For the 3 types of bearings, PROM scores from patients with a noisy THA were statistically significantly worse than those from patients with a silent MoP THA. The exception was noisy CoC and MoM THAs, which had the same mean UCLA activity score...

  13. The Effects of a Daily Skincare Regimen on Maintaining the Benefits Obtained from Previous Chemical Resurfacing Treatments.

    Science.gov (United States)

    Bruce, Suzanne; Roberts, Wendy; Teller, Craig; Colvan, Lora

    2016-09-01

    Chemical peels are versatile treatments that involve chemical exfoliation of the skin for cosmetic improvement. Deeper peels produce more significant results, but can be associated with longer healing time and potential complications. Novel chemical resurfacing treatments (AGE and MELA) were developed in Europe to produce skin resurfacing via controlled inflammation to promote cell regeneration with minimum negative effects associated with conventional peelings. The AGE Resurfacing regimen is indicated for the treatment of photoaging, and consists of multi-ingredient peeling solution with trichloroacetic acid, pyruvic acid, salicylic acid, mandelic acid, and lactobionic acid. The MELA Resurfacing regimen addresses hyperpigmentation concerns and contains mandelic acid, potassium azeloyl diglycinate, retinol, salicylic acid, phytic acid, lactobionic acid, and lactic acid. Results of previously conducted US clinical experience trial of AGE and MELA resurfacing protocols rated 81% of subjects with some level of improvement according to physician assessment. To evaluate whether a daily skin care regimen used for 12 weeks could maintain the benefits achieved with AGE and MELA chemical resurfacing treatments. Subjects who completed participation in the AGE and MELA skin resurfacing clinical trial were recruited to participate in a continuation trial and used a daily regimen of MDRejuvena facial products for 12 weeks. No other facial products were permitted. Physicians assessed the severity of individual skin parameters at baseline and week 12 and provided global assessment. Subjects assessed improvement of individual skin parameters at week 12 and provided an overall assessment. Thirteen subjects participated in the 12-week continuation trial. According to the physician's global assessment, all subjects demonstrated some level of improvement at week 12 compared to baseline. Physician assessment showed a decrease in severity of all skin parameters assessed at week 12

  14. Apparent Skin Discoloration about the Knee Joint: A Rare Sequela of Metallosis after Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    Narlaka Jayasekera

    2015-01-01

    Full Text Available Introduction. Metallosis is a phenomenon most commonly associated with hip replacement. However it can occur in any metallic implant subject to wear. Wear creates metal debris, which is deposited in the surrounding soft tissue. This leads to many local adverse reactions including, but not limited to, implant loosening/osteolysis, pain, and effusion. In the deeper joints, for example, the hip, metal deposits are mostly only seen intraoperatively. Case Study. A 74-year-old lady represented to orthopaedic outpatient clinic. Her principle complaint was skin discolouration, associated with pain and swelling over the left knee, on the background of a previous total knee replacement with a metal backed patella resurfacing six years. A plain radiograph revealed loosening of the patellar prosthesis. A diagnosis of metallosis was made; the patient underwent debridement of the stained soft tissue and primary revision of the prosthesis. She remained symptom-free five years after revision. Discussion. Metallosis results in metallic debris which causes tissue staining, often hidden within the soft tissue envelope of the hip, but more apparent in the knee. Metallosis may cause pain, effusion, and systemic symptoms because of raised levels of serum-metal ions. Surgical intervention with revision and debridement can have good functional results.

  15. Finite element analysis of 2-Station hip himulator

    Science.gov (United States)

    Fazli, M. I. M.; Yahya, A.; Shahrom, A.; Nawawi, S. W.; Zainudin, M. R.; Nazarudin, M. S.

    2017-10-01

    This paper presented the analysis of materials and design architecture of 2-station hip simulator. Hip simulator is a machine used to conduct the joint and wear test of hip prosthetic. In earlier work, the hip simulator was modified and some improvement were made by using SolidWorks software. The simulator consists of 3DOF which controlled by separate stepper motor and a static load that set up by manual method in each station. In this work, finite element analysis (FEA) of hip simulator was implemented to analyse the structure of the design and selected materials used for simulator component. The analysis is completed based on two categories which are safety factor and stress tests. Both design drawing and FEA was done using SolidWorks software. The study of the two categories is performed by applying the peak load up to 4000N on the main frame that is embedded with metal-on-metal hip prosthesis. From FEA, the value of safety factor and degree of stress formation are successfully obtained. All the components exceed the value of 2 for safety factor analysis while the degree of stress formation shows higher value compare to the yield strength of the material. With this results, it provides information regarding part of simulator which are susceptible to destruct. Besides, the results could be used for design improvement and certify the stability of the hip simulator in real application.

  16. The Symmetry of Adverse Local Tissue Reactions in Patients with Bilateral Simultaneous and Sequential ASR Hip Replacement.

    Science.gov (United States)

    Madanat, Rami; Hussey, Daniel K; Donahue, Gabrielle S; Potter, Hollis G; Wallace, Robert; Bragdon, Charles R; Muratoglu, Orhun K; Malchau, Henrik

    2015-10-01

    The purpose of this study was to evaluate whether patients with bilateral metal-on-metal (MoM) hip replacements have symmetric adverse local tissue reactions (ALTRs) at follow-up. An MRI of both hips was performed at a mean time of six years after surgery in 43 patients. The prevalence and severity of ALTRs were found to be similar in simultaneous hips but differences were observed in sequential hips. The order and timing of sequential hip arthroplasties did not affect the severity of ALTRs. Thus, in addition to metal ion exposure from an earlier MoM implant other factors may also play a role in the progression of ALTRs. Bilateral implants should be given special consideration in risk stratification algorithms for management of patients with MoM hip arthroplasty. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Large Metal Heads and Vitamin E Polyethylene Increase Frictional Torque in Total Hip Arthroplasty.

    Science.gov (United States)

    Meneghini, R Michael; Lovro, Luke R; Wallace, Joseph M; Ziemba-Davis, Mary

    2016-03-01

    Trunnionosis has reemerged in modern total hip arthroplasty for reasons that remain unclear. Bearing frictional torque transmits forces to the modular head-neck interface, which may contribute to taper corrosion. The purpose of this study is to compare frictional torque of modern bearing couples in total hip arthroplasty. Mechanical testing based on in vivo loading conditions was used to measure frictional torque. All bearing couples were lubricated and tested at 1 Hz for more than 2000 cycles. The bearing couples tested included conventional, highly crosslinked (XLPE) and vitamin E polyethylene, CoCr, and ceramic femoral heads and dual-mobility bearings. Statistical analysis was performed using Student t test for single-variable and analysis of variance for multivariant analysis. P ≤ .05 was considered statistically significant. Large CoCr metal heads (≥36 mm) substantially increased frictional torque against XLPE liners (P = .01), a finding not observed in ceramic heads. Vitamin E polyethylene substantially increased frictional torque compared with XLPE in CoCr and ceramic heads (P = .001), whereas a difference between conventional and XLPE was not observed (P = .69) with the numbers available. Dual-mobility bearing with ceramic inner head demonstrated the lowest mean frictional torque of all bearing couples. In this simulated in vivo model, large-diameter CoCr femoral heads and vitamin E polyethylene liners are associated with increased frictional torque compared with smaller metal heads and XLPE, respectively. The increased frictional torque of vitamin E polyethylene and larger-diameter femoral heads should be considered and further studied, along with reported benefits of these modern bearing couples. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Lymphoid Aggregates That Resemble Tertiary Lymphoid Organs Define a Specific Pathological Subset in Metal-on-Metal Hip Replacements

    Science.gov (United States)

    Barone, Francesca; Hardie, Debbie L.; Matharu, Gulraj S.; Davenport, Alison J.; Martin, Richard A.; Grant, Melissa; Mosselmans, Frederick; Pynsent, Paul; Sumathi, Vaiyapuri P.; Addison, Owen; Revell, Peter A.; Buckley, Christopher D.

    2013-01-01

    Aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) has been used to describe the histological lesion associated with metal-on-metal (M-M) bearings. We tested the hypothesis that the lymphoid aggregates, associated with ALVAL lesions resemble tertiary lymphoid organs (TLOs). Histopathological changes were examined in the periprosthetic tissue of 62 M-M hip replacements requiring revision surgery, with particular emphasis on the characteristics and pattern of the lymphocytic infiltrate. Immunofluorescence and immunohistochemistry were used to study the classical features of TLOs in cases where large organized lymphoid follicles were present. Synchrotron X-ray fluorescence (XRF) measurements were undertaken to detect localisation of implant derived ions/particles within the samples. Based on type of lymphocytic infiltrates, three different categories were recognised; diffuse aggregates (51%), T cell aggregates (20%), and organised lymphoid aggregates (29%). Further investigation of tissues with organised lymphoid aggregates showed that these tissues recapitulate many of the features of TLOs with T cells and B cells organised into discrete areas, the presence of follicular dendritic cells, acquisition of high endothelial venule like phenotype by blood vessels, expression of lymphoid chemokines and the presence of plasma cells. Co-localisation of implant-derived metals with lymphoid aggregates was observed. These findings suggest that in addition to the well described general foreign body reaction mediated by macrophages and a T cell mediated type IV hypersensitivity response, an under-recognized immunological reaction to metal wear debris involving B cells and the formation of tertiary lymphoid organs occurs in a distinct subset of patients with M-M implants. PMID:23723985

  19. The effect of a metal hip prosthesis on the radiation dose in therapeutic photon beam irradiations

    International Nuclear Information System (INIS)

    Lin, S.-Y.; Chu, T.-C.; Lin, J.-P.; Liu, M.-T.

    2002-01-01

    Prostate and cervical cancer patients are often treated with external X-ray beams of bi-lateral incidence. Such treatment may incur some dose effect that cannot be predicted precisely in commercial treatment planning systems (TPS) for patients having undergone total hip replacement. This study performs a Monte Carlo (MC) simulation and an analytical calculation (convolution superposition algorithm which is implemented in ADAC TPS) of a 6 MV, 5x5 cm 2 X-ray beam incident into water with the existence of hip prosthesis, e.g. Ti6Al4V and CoCrMo alloy. The results indicate that ADAC TPS cannot precisely account for the scatter and backscatter radiation that a metal hip prosthesis causes. For percent depth dose (PDD) curves, the maximum underdosage of ADAC TPS up to 5 mm above the interface between dense material and water is 5%, 20% and 27% for PDD Bone , PDD Ti and PDD Co , respectively. The dose re-buildup, which occurs behind the hip region, becomes more and more obvious for denser medium existed in water. Increasing inhomogeneity also enhances the underdosage of ADAC for greater depth (>10 cm), as the figures of nearly 2% in PDD Bone , PDD Ti and 4-5% in PDD Co reveal. Overestimating the attenuated power of high-density non-water material in ADAC TPS causes this underdosage. For dose profiles, no significant differences were found in Profile Bone at any depth. Profile Ti reveals that MC slightly exceeds ADAC at off-axis position 1.0-2.0 cm. Profile Co reveals this more obviously. This finding means that scatter radiation from these denser materials is significant and cannot be predicted precisely in ADAC

  20. Tribo-biological deposits on the articulating surfaces of metal-on-polyethylene total hip implants retrieved from patients

    Science.gov (United States)

    Cui, Zhiwei; Tian, Yi-Xing; Yue, Wen; Yang, Lei; Li, Qunyang

    2016-06-01

    Artificial total hip arthroplasty (THA) is one of the most effective orthopaedic surgeries that has been used for decades. However, wear of the articulating surfaces is one of the key failure causes limiting the lifetime of total hip implant. In this paper, Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM) were employed to explore the composition and formation mechanism of the tribo-layer on the articulating surfaces of metal-on-polyethylene (MoPE) implants retrieved from patients. Results showed that, in contrast to conventional understanding, the attached tribo-layer contained not only denatured proteins but also a fraction of polymer particles. The formation of the tribo-layer was believed to relate to lubrication regime, which was supposed to be largely affected by the nature of the ultra-high-molecule-weight-polyethylene (UHMWPE). Wear and formation of tribo-layer could be minimized in elasto-hydrodynamic lubrication (EHL) regime when the UHMWPE was less stiff and have a morphology containing micro-pits; whereas the wear was more severe and tribo-layer formed in boundary lubrication. Our results and analyses suggest that enhancing interface lubrication may be more effective on reducing wear than increasing the hardness of material. This finding may shed light on the design strategy of artificial hip joints.

  1. Selection of contact bearing couple materials for hip prosthesis using finite element analysis under static conditions

    Science.gov (United States)

    Arirajan, K. A.; Chockalingam, K.; Vignesh, C.

    2018-04-01

    Implants are the artificial parts to replace the missing bones or joints in human anatomy to give mechanical support. Hip joint replacement is an important issue in orthopaedic surgery. The main concern limiting the long-run success of the total hip replacement is the limited service life. Hip replacement technique is widely used in replacing the femur head and acetabular cup by materials that are highly biocompatible. The success of the artificial hip replacement depends upon proper material selection, structure, and shape of the hip prosthesis. Many orthopaedic analyses have been tried with different materials, but ended with partial success on the application side. It is a critical task for selecting the best material pair in the hip prosthesis design. This work develops the finite element analysis of an artificial hip implant to study highest von Mises stress, contact pressure and elastic strain occurs for the dissimilar material combination. The different bearing couple considered for the analysis are Metal on Metal, Metal on Plastic, Metal on Ceramic, Ceramic on Plastic, Ceramic on Ceramic combinations. The analysis is carried out at different static positions of a human (i.e) standing, sitting. The results reveals that the combination with metal in contact with plastic (i.e) Titanium femoral head paired with Ultra High Molecular Weight Poly Ethylene acetabular cup reduces maximum von Mises stress and also it gives lowest contact pressure than other combination of bearing couples.

  2. Nonablative Fractional Laser Resurfacing in Skin of Color: Evidence-based Review

    OpenAIRE

    Kaushik, Shivani B.; Alexis, Andrew F.

    2017-01-01

    Background: Nonablative laser resurfacing represents one of the major advances in procedural dermatology over the past decade. However, its use in darker skin types is limited by safety concerns and a relative lack of available data.

  3. Patellar resurfacing versus nonresurfacing in total knee arthroplasty for osteoarthritis: experience at a tertiary care institution in Pakistan

    Directory of Open Access Journals (Sweden)

    Lakdawala RH

    2012-02-01

    Full Text Available Akil Fazal1, Riaz H Lakdawala21Clinical Fellow, NYU Hospital for Joint Disease, New York, US; 2Associate Professor and Chief, Section of Orthopedics, Department of Surgery, The Aga Khan University Hospital, Karachi, PakistanObjective: To determine the effect of patellar resurfacing in patients offered total knee arthroplasty for osteoarthritis.Design: Randomized control study.Place and duration of study: The Aga Khan University Hospital, Karachi, Pakistan from January 3, 2005 to January 9, 2010.Patients and methods: Patients undergoing primary total knee arthroplasty for osteoarthritis were assigned to either the patellar resurfacing or nonresurfacing arm using systematic sampling. This consisted of patients undergoing unilateral and bilateral knee arthroplasty. Preoperatively, Knee Society Knee and Function Scores were calculated. After a minimum of 3 years postoperatively Knee Society Knee and Function Scores as well as the Clinical Anterior Knee Pain Rating were calculated and analysis done to check for differences.Results: Seventy-five patients were recruited in each arm; 135 patients had bilateral and 15 had unilateral knee arthroplasty. The mean preoperative knee score was 40.4 for the resurfacing group and 40.60 for the nonresurfacing group (P = 0.45. This improved postoperatively to 93.67 and 94.23 respectively, with no difference between the two groups (P = 0.67. The mean preoperative function score was 45.50 for resurfaced patellae and 45.83 for nonresurfaced. This improved to 89.67 and 90.50, respectively, again with no difference (P = 0.51. Postoperative Clinical Anterior Knee Pain Rating was a mean of 0.1 for resurfaced and 0.13 for nonresurfaced patellas, with no difference on analysis (P = 0.06. However, patients who had bilateral knee arthroplasty had a slightly higher Clinical Anterior Knee Pain Rating than those who had single knee surgery (P = 0.046 irrespective of whether the patellar was resurfaced or not.Conclusion: In

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-03-15

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

  5. The effect of a metal hip prosthesis on the radiation dose in therapeutic photon beam irradiations

    Energy Technology Data Exchange (ETDEWEB)

    Lin, S.-Y.; Chu, T.-C. E-mail: tcchu@mx.nthu.edu.tw; Lin, J.-P.; Liu, M.-T

    2002-07-01

    Prostate and cervical cancer patients are often treated with external X-ray beams of bi-lateral incidence. Such treatment may incur some dose effect that cannot be predicted precisely in commercial treatment planning systems (TPS) for patients having undergone total hip replacement. This study performs a Monte Carlo (MC) simulation and an analytical calculation (convolution superposition algorithm which is implemented in ADAC TPS) of a 6 MV, 5x5 cm{sup 2} X-ray beam incident into water with the existence of hip prosthesis, e.g. Ti6Al4V and CoCrMo alloy. The results indicate that ADAC TPS cannot precisely account for the scatter and backscatter radiation that a metal hip prosthesis causes. For percent depth dose (PDD) curves, the maximum underdosage of ADAC TPS up to 5 mm above the interface between dense material and water is 5%, 20% and 27% for PDD{sub Bone}, PDD{sub Ti} and PDD{sub Co}, respectively. The dose re-buildup, which occurs behind the hip region, becomes more and more obvious for denser medium existed in water. Increasing inhomogeneity also enhances the underdosage of ADAC for greater depth (>10 cm), as the figures of nearly 2% in PDD{sub Bone}, PDD{sub Ti} and 4-5% in PDD{sub Co} reveal. Overestimating the attenuated power of high-density non-water material in ADAC TPS causes this underdosage. For dose profiles, no significant differences were found in Profile{sub Bone} at any depth. Profile{sub Ti} reveals that MC slightly exceeds ADAC at off-axis position 1.0-2.0 cm. Profile{sub Co} reveals this more obviously. This finding means that scatter radiation from these denser materials is significant and cannot be predicted precisely in ADAC.

  6. The impact of surface and geometry on coefficient of friction of artificial hip joints.

    Science.gov (United States)

    Choudhury, Dipankar; Vrbka, Martin; Mamat, Azuddin Bin; Stavness, Ian; Roy, Chanchal K; Mootanah, Rajshree; Krupka, Ivan

    2017-08-01

    Coefficient of friction (COF) tests were conducted on 28-mm and 36-mm-diameter hip joint prostheses for four different material combinations, with or without the presence of Ultra High Molecular Weight Polyethylene (UHMWPE) particles using a novel pendulum hip simulator. The effects of three micro dimpled arrays on femoral head against a polyethylene and a metallic cup were also investigated. Clearance played a vital role in the COF of ceramic on polyethylene and ceramic on ceramic artificial hip joints. Micro dimpled metallic femoral heads yielded higher COF against a polyethylene cup; however, with metal on metal prostheses the dimpled arrays significantly reduced the COF. In situ images revealed evidence that the dimple arrays enhanced film formation, which was the main mechanism that contributed to reduced friction. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Standard guidelines of care: CO2 laser for removal of benign skin lesions and resurfacing.

    Science.gov (United States)

    Krupashankar, D S

    2008-01-01

    Resurfacing is a treatment to remove acne and chicken pox scars, and changes in the skin due to ageing. MACHINES: Both ablative and nonablative lasers are available for use. CO 2 laser is the gold standard in ablative lasers. Detailed knowledge of the machines is essential. INDICATIONS FOR CO 2 LASER: Therapeutic indications: Actinic and seborrheic keratosis, warts, moles, skin tags, epidermal and dermal nevi, vitiligo blister and punch grafting, rhinophyma, sebaceous hyperplasia, xanthelasma, syringomas, actinic cheilitis angiofibroma, scar treatment, keloid, skin cancer, neurofibroma and diffuse actinic keratoses. CO 2 laser is not recommended for the removal of tattoos. AESTHETIC INDICATIONS: Resurfacing for acne, chicken pox and surgical scars, periorbital and perioral wrinkles, photo ageing changes, facial resurfacing. PHYSICIANS' QUALIFICATIONS: Any qualified dermatologist (DVD or MD) may practice CO 2 laser. The dermatologist should possess postgraduate qualification in dermatology and should have had specific hands-on training in lasers either during postgraduation or later at a facility which routinely performs laser procedures under a competent dermatologist/plastic surgeon, who has experience and training in using lasers. For the use of CO 2 lasers for benign growths, a full day workshop is adequate. As parameters may vary in different machines, specific training with the available machine at either the manufacturer's facility or at another centre using the machine is recommended. CO 2 lasers can be used in the dermatologist's minor procedure room for the above indications. However, when used for full-face resurfacing, the hospital operation theatre or day care facility with immediate access to emergency medical care is essential. Smoke evacuator is mandatory. Detailed counseling with respect to the treatment, desired effects, possible postoperative complications, should be discussed with the patient. The patient should be provided brochures to study and

  8. Standard guidelines of care: CO 2 laser for removal of benign skin lesions and resurfacing

    Directory of Open Access Journals (Sweden)

    Krupashankar D

    2008-03-01

    Full Text Available Resurfacing is a treatment to remove acne and chicken pox scars, and changes in the skin due to ageing. Machines : Both ablative and nonablative lasers are available for use. CO 2 laser is the gold standard in ablative lasers. Detailed knowledge of the machines is essential. Indications for CO 2 laser: Therapeutic indications: Actinic and seborrheic keratosis, warts, moles, skin tags, epidermal and dermal nevi, vitiligo blister and punch grafting, rhinophyma, sebaceous hyperplasia, xanthelasma, syringomas, actinic cheilitis angiofibroma, scar treatment, keloid, skin cancer, neurofibroma and diffuse actinic keratoses. CO 2 laser is not recommended for the removal of tattoos. Aesthetic indications: Resurfacing for acne, chicken pox and surgical scars, periorbital and perioral wrinkles, photo ageing changes, facial resurfacing. Physicians′ qualifications: Any qualified dermatologist (DVD or MD may practice CO 2 laser. The dermatologist should possess postgraduate qualification in dermatology and should have had specific hands-on training in lasers either during postgraduation or later at a facility which routinely performs laser procedures under a competent dermatologist/plastic surgeon, who has experience and training in using lasers. For the use of CO 2 lasers for benign growths, a full day workshop is adequate. As parameters may vary in different machines, specific training with the available machine at either the manufacturer′s facility or at another centre using the machine is recommended. Facility: CO 2 lasers can be used in the dermatologist′s minor procedure room for the above indications. However, when used for full-face resurfacing, the hospital operation theatre or day care facility with immediate access to emergency medical care is essential. Smoke evacuator is mandatory. Preoperative counseling and Informed consent Detailed counseling with respect to the treatment, desired effects, possible postoperative complications, should be

  9. Cemented total hip replacement cable debris and acetabular construct durability.

    Science.gov (United States)

    Altenburg, Aaron J; Callaghan, John J; Yehyawi, Tameem M; Pedersen, Douglas R; Liu, Steve S; Leinen, Jessica A; Dahl, Kevin A; Goetz, Devon D; Brown, Thomas D; Johnston, Richard C

    2009-07-01

    Third-body wear can adversely affect the outcome of total hip arthroplasty by causing increased polyethylene wear, osteolysis, and component loosening. We hypothesized that there would be greater generation and migration of metal debris to the bearing surfaces in hips in which cobalt-chromium cables were used to reattach the osteotomized greater trochanter when compared with hips in which stainless steel wires were used. Between June 1981 and December 1983, 196 consecutive total hip arthroplasties were performed with use of an Iowa stem and a titanium-backed cemented acetabular component, with cobalt-chromium cable trochanteric reattachment. After nineteen to twenty years of follow-up, the patients were evaluated with regard to the depth of head penetration into the polyethylene (as a surrogate for wear), osteolysis, loosening, and the need for revision. The results were compared with those for a series of 304 total hip arthroplasties that were performed by the same surgeon from January 1984 to December 1985 with use of the same components and the same surgical technique, but with stainless steel wire trochanteric reattachment. The two groups had a comparable nineteen to twenty-year follow-up. All living patients (fifty-nine hips in the cable group and ninety-two hips in the wire group) had minimum ten-year follow-up radiographs. The polyethylene wear rate was 0.101 mm/yr for the cable group and 0.082 mm/yr for the wire group (p = 0.039). For the living patients, the rate of revision of the acetabular component because of aseptic loosening was 37.3% (twenty-two hips) for the cable group and 20.7% (nineteen hips) for the wire group (p = 0.025). The rate of acetabular osteolysis was 44% (twenty-six hips) for the cable group and 26% (twenty-four hips) for the wire group (p = 0.022). Kaplan-Meier analysis with revision of the acetabular component because of aseptic loosening as the end point demonstrated survival rates of 73.7% +/- 9% and 83% +/- 7% for the cable and

  10. The effect of metal artefact reduction on CT-based attenuation correction for PET imaging in the vicinity of metallic hip implants. A phantom study

    International Nuclear Information System (INIS)

    Harnish, R.; Lang, T.F.; Prevrhal, S.; Alavi, A.; Zaidi, H.

    2014-01-01

    To determine if metal artefact reduction (MAR) combined with a priori knowledge of prosthesis material composition can be applied to obtain CT-based attenuation maps with sufficient accuracy for quantitative assessment of 18 F-fluorodeoxyglucose uptake in lesions near metallic prostheses. A custom hip prosthesis phantom with a lesion-sized cavity filled with 0.2 ml 18 F-FDG solution having an activity of 3.367 MBq adjacent to a prosthesis bore was imaged twice with a chrome-cobalt steel hip prosthesis and a plastic replica, respectively. Scanning was performed on a clinical hybrid PET/CT system equipped with an additional external 137 Cs transmission source. PET emission images were reconstructed from both phantom configurations with CT-based attenuation correction (CTAC) and with CT-based attenuation correction using MAR (MARCTAC). To compare results with the attenuation-correction method extant prior to the advent of PET/CT, we also carried out attenuation correction with 137 Cs transmission-based attenuation correction (TXAC). CTAC and MARCTAC images were scaled to attenuation coefficients at 511 keV using a trilinear function that mapped the highest CT values to the prosthesis alloy attenuation coefficient. Accuracy and spatial distribution of the lesion activity was compared between the three reconstruction schemes. Compared to the reference activity of 3.37 MBq, the estimated activity quantified from the PET image corrected by TXAC was 3.41 MBq. The activity estimated from PET images corrected by MARCTAC was similar in accuracy at 3.32 MBq. CTAC corrected PET images resulted in nearly 40% overestimation of lesion activity at 4.70 MBq. Comparison of PET images obtained with the plastic and metal prostheses in place showed that CTAC resulted in a marked distortion of the 18 F-FDG distribution within the lesion, whereas application of MARCTAC and TXAC resulted in lesion distributions similar to those observed with the plastic replica. (author)

  11. Fractional CO 2 laser resurfacing as monotherapy in the treatment of atrophic facial acne scars

    Directory of Open Access Journals (Sweden)

    Imran Majid

    2014-01-01

    Full Text Available Background: While laser resurfacing remains the most effective treatment option for atrophic acne scars, the high incidence of post-treatment adverse effects limits its use. Fractional laser photothermolysis attempts to overcome these limitations of laser resurfacing by creating microscopic zones of injury to the dermis with skip areas in between. Aim: The aim of the present study is to assess the efficacy and safety of fractional CO 2 laser resurfacing in atrophic facial acne scars. Materials and Methods: Sixty patients with moderate to severe atrophic facial acne scars were treated with 3-4 sessions of fractional CO 2 laser resurfacing at 6-week intervals. The therapeutic response to treatment was assessed at each follow up visit and then finally 6 months after the last laser session using a quartile grading scale. Response to treatment was labelled as ′excellent′ if there was >50% improvement in scar appearance and texture of skin on the grading scale while 25-50% response and <25% improvement were labelled as ′good′ and ′poor′ response, respectively. The overall satisfaction of the patients and any adverse reactions to the treatment were also noted. Results: Most of the patients showed a combination of different morphological types of acne scars. At the time of final assessment 6 months after the last laser session, an excellent response was observed in 26 patients (43.3% while 15 (25% and 19 patients (31.7% demonstrated a good and poor response respectively. Rolling and superficial boxcar scars responded the best while pitted scars responded the least to fractional laser monotherapy. The commonest reported adverse effect was transient erythema and crusting lasting for an average of 3-4 and 4-6 days, respectively while three patients developed post-inflammatory pigmentation lasting for 8-12 weeks. Conclusions: Fractional laser resurfacing as monotherapy is effective in treating acne scars especially rolling and superficial boxcar

  12. Manual resurfacing and trichloroacetic acid for the treatment of patients with widespread actinic damage. Clinical and histologic observations.

    Science.gov (United States)

    Cooley, J E; Casey, D L; Kauffman, C L

    1997-05-01

    A facial resurfacing regimen combining manual abrasion of the skin and 25% trichloroacetic acid has been reported to produce excellent results, but the histologic depth of injury produced by this technique has not been studied. To describe our experience with this technique treating patients with extensive actinic damage and to determine the histologic depth of injury produced. We treated 40 patients using manual resurfacing and trichloroacetic acid, primarily for widespread actinic keratoses. Resurfacing tools included silicone carbide sandpaper, drywall screen, electrocautery tip cleaners, abrasive pads, scalpel blades, and curettes. Four patients underwent sequential biopsies to evaluate the depth of wounding using this technique. Manual resurfacing combined with trichloroacetic acid consistently produced excellent cosmetic results and nearly complete eradication of actinic keratoses. Histologically, treated areas showed replacement of the dermal elastotic band by newly formed collagen, a significantly deeper level of wounding than the Jessner's/35% trichloroacetic acid peel. There was no evidence for foreign body granulomas clinically or histologically as a result of the abrasive materials. The deeper level of this peel explains the improved cosmetic outcome and greater eradication of actinic keratoses. This treatment is particularly well suited for patients with extensive photodamage and widespread actinic keratoses.

  13. Prefabricated neck expanded skin flap with the superficial temporal vessels for facial resurfacing.

    Science.gov (United States)

    Lazzeri, Davide; Su, Weijie; Qian, Yunliang; Messmer, Caroline; Agostini, Tommaso; Spinelli, Giuseppe; Marcus, Jeffrey R; Levin, L Scott; Zenn, Micheal R; Zhang, Yi Xin

    2013-05-01

    The achievement of a normal-appearing face after surgical resurfacing remains an elusive goal. This is due in part to insufficient color matching, restoration of contours, and the persistence of visible scars. Flap prefabrication is a staged procedure that provides an independent axial blood supply to local expanded tissues. We describe a new reconstructive alternative with superior reconstructive surgical options for facial resurfacing that better matches damaged or discarded facial tissues. A superficial temporal fascial flap was harvested as the vascular supply of the prefabricated neck flap and located in a subcutaneous neck pocket over a tissue expander. After a 5-month period for expansion and maturation, the prefabricated skin flap was raised, islanded, and rotated to resurface the facial defect. Four patients with hemifacial postburn contracture and two patients affected by hemifacial vascular malformations aged 17 to 42 years (mean 29 years) were successfully treated with no major complication after a mean period of 15 months. Prefabricated neck-expanded skin flap demonstrated an excellent color and texture match with facial skin that surrounded the repair sites, and optimal aesthetic results were obtained. Importantly, facial expression was completely maintained due to thinness and pliability of the rotated skin. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

    LENUS (Irish Health Repository)

    Galbraith, John G

    2011-04-01

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

  15. The prevalence and risk factors of post-inflammatory hyperpigmentation after fractional resurfacing in Asians.

    Science.gov (United States)

    Chan, Henry H L; Manstein, D; Yu, C S; Shek, S; Kono, T; Wei, W I

    2007-06-01

    Ablative laser resurfacing is considered to be the main therapeutic option for the treatment of wrinkles and acne scarring. However, in Asians, post-inflammatory hyperpigmentation (PIH) is a common adverse effect of laser resurfacing. Fractional resurfacing is a new concept of skin rejuvenation whereby zones of micro thermal injury are generated in the skin with the use of a 1,540-nm laser. The risk and prevalence of hyperpigmentation in dark-skinned patients using this approach have not been studied. To assess the prevalence and risk factors of PIH that is associated with the use of fractional resurfacing in Asians. A retrospective study of 37 Chinese patients who were treated with fractional resurfacing for acne scarring, skin rejuvenation, and pigmentation was carried out. In all of the cases, pre- and post-treatment clinical photographs (from standardized and cross-polarized views) were taken using the Canfield CR system. Two independent observers assessed the photographs. A prospective study of treatments of nine different density and energy levels that were applied to the forearms of 18 volunteers was also performed. Clinical photographs were assessed pre- and post-treatment for evidence of PIH. In the retrospective study, 119 treatment sessions were performed. Sixty-eight treatment sessions were high energy, low density; 51 sessions were low energy, high density. Patients who underwent a high energy but low-density treatment (range of energy 7-20 mJ; average energy 16.3 mJ, 1,000 MTZ) were associated with a lower prevalence of generalized PIH (7.1% vs. 12.4%) than those who underwent a low energy but high-density (range of energy 6-12 mJ; average energy 8.2 mJ, 2,000 MTZ) treatment. However, the difference was not statistically significant. Localized PIH occurred in the peri-oral area among patients who did not receive air cooling as an adjunctive therapy. Both the density and energy of the treatment determines the risk of PIH in dark-skinned patients

  16. Problems and complications of full-face carbon dioxide laser resurfacing for pathological lesions of the skin.

    Science.gov (United States)

    Read-Fuller, Andrew M; Yates, David M; Vu, David D; Hoopman, John E; Finn, Richard A

    2017-01-01

    Facial resurfacing with a CO 2 laser has been used for treatment of pathologic lesions and for cosmetic purposes. Postoperative complications and problems after laser resurfacing include infections, acneiform lesions, and pigment changes. This retrospective study describes the most common problems and complications in 105 patients and assesses postoperative pain in 38 patients. All patients received CO 2 laser resurfacing for treatment of malignant/premalignant lesions and had postoperative follow-up to assess problems and complications. Some had follow-up to assess postoperative pain. All patients had Fitzpatrick I-III skin types and underwent the same perioperative care regimen. There were 11 problems and 2 complications. Problems included infection, acneiform lesion/milia, and uncontrolled postoperative pain. Complications included hyperpigmentation. Among the postoperative pain group, 53% reported no pain and the rest had mild or moderate pain. Complications are rare. Infection and acneiform lesions/milia were the most common problems, as previously reported. Most patients do not experience postoperative pain. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. The use of a prosthetic inlay resurfacing as a salvage procedure for a failed cartilage repair.

    Science.gov (United States)

    Dhollander, Aad Alfons Maria; Almqvist, Karl Fredrik; Moens, Kris; Vandekerckhove, Pieter-Jan; Verdonk, René; Verdonk, Peter; Victor, Jan

    2015-08-01

    This study was designed to describe the clinical and radiographical outcome of the HemiCAP(®) resurfacing system as a salvage treatment for a failed index cartilage procedure. Fourteen patients were treated consecutively and clinically prospectively followed for a mean period of 26.1 ± 12.8 months. All patients were previously treated for their cartilage lesion. Radiographical data were analysed based on the Kellgren and Lawrence system. The patients involved in this study demonstrated a gradual clinical improvement in time. However, radiographically significant osteoarthritic changes were observed during the follow-up period. The position of the HemiCAP(®) resurfacing system was adequate in all cases, and no signs of loosening were observed during the follow-up period. The HemiCAP(®) resurfacing system is feasible as a salvage treatment for a failed index cartilage procedure and resulted in a gradual clinical improvement. However, the favourable clinical outcome was not confirmed by the radiographical findings. IV.

  18. Metal artefact suppression at 3 T MRI: comparison of MAVRIC-SL with conventional fast spin echo sequences in patients with Hip joint arthroplasty

    International Nuclear Information System (INIS)

    Kretzschmar, Martin; Nardo, Lorenzo; Han, Misung M.; Heilmeier, Ursula; Sam, Craig; Joseph, Gabby B.; Krug, Roland; Link, Thomas M.; Koch, Kevin M.

    2015-01-01

    The aim of our study was to evaluate the clinical feasibility and diagnostic value of a new MRI metal artefact reduction pulse sequence called MAVRIC-SL in a 3 T MRI environment. Two MAVRIC-SL sequences obtained in 61 patients with symptomatic total hip replacement were compared with standard FSE-STIR sequences optimized for imaging around metal. Artefact size was measured on the slice of greatest extent. Image quality, fat saturation, image distortion, visibility of anatomical structures, and detectability of joint abnormalities were visually assessed and graded on qualitative scales. Differences between MAVRIC-SL and FSE sequences were tested with the Wilcoxon signed-rank test. MAVRIC-SL sequences at 3 T showed significantly smaller metal artefacts compared to FSE-STIR sequences (p < 0.0001). The general image quality of MAVRIC-SL sequences was reduced with regard to spatial resolution, noise and contrast (p = 0.001), and fat saturation (p < 0.0001). The reduction of artefact size and image distortion significantly improved visualization of joint anatomy (p < 0.0001) and diagnostic confidence regarding implant-associated abnormalities (p = 0.0075 to <0.0001). Although the image quality of MAVRIC-SL sequences is limited at 3 T, its clinical application is feasible and provides important additional diagnostic information for the workup of patients with symptomatic hip replacement through substantially reduced metal artefacts. (orig.)

  19. Metal artefact suppression at 3 T MRI: comparison of MAVRIC-SL with conventional fast spin echo sequences in patients with Hip joint arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Kretzschmar, Martin; Nardo, Lorenzo; Han, Misung M.; Heilmeier, Ursula; Sam, Craig; Joseph, Gabby B.; Krug, Roland; Link, Thomas M. [University of California San Francisco, Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Koch, Kevin M. [Medical Collage of Wisconsin, Departments of Biophysics and Radiology, Milwaukee, WI (United States)

    2015-08-15

    The aim of our study was to evaluate the clinical feasibility and diagnostic value of a new MRI metal artefact reduction pulse sequence called MAVRIC-SL in a 3 T MRI environment. Two MAVRIC-SL sequences obtained in 61 patients with symptomatic total hip replacement were compared with standard FSE-STIR sequences optimized for imaging around metal. Artefact size was measured on the slice of greatest extent. Image quality, fat saturation, image distortion, visibility of anatomical structures, and detectability of joint abnormalities were visually assessed and graded on qualitative scales. Differences between MAVRIC-SL and FSE sequences were tested with the Wilcoxon signed-rank test. MAVRIC-SL sequences at 3 T showed significantly smaller metal artefacts compared to FSE-STIR sequences (p < 0.0001). The general image quality of MAVRIC-SL sequences was reduced with regard to spatial resolution, noise and contrast (p = 0.001), and fat saturation (p < 0.0001). The reduction of artefact size and image distortion significantly improved visualization of joint anatomy (p < 0.0001) and diagnostic confidence regarding implant-associated abnormalities (p = 0.0075 to <0.0001). Although the image quality of MAVRIC-SL sequences is limited at 3 T, its clinical application is feasible and provides important additional diagnostic information for the workup of patients with symptomatic hip replacement through substantially reduced metal artefacts. (orig.)

  20. Comparative study of fat-suppression techniques for hip arthroplasty MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Moliere, Sebastien [University Hospital of Strasbourg, Imaging Department, Strasbourg (France); Dillenseger, Jean-Philippe; Kremer, Stephane; Bierry, Guillaume [University Hospital of Strasbourg, Imaging Department, Strasbourg (France); ICube UMR 7357, University of Strasbourg, Strasbourg (France); Ehlinger, Matthieu [ICube UMR 7357, University of Strasbourg, Strasbourg (France); University Hospital of Strasbourg, Orthopaedic Department, Strasbourg (France)

    2017-09-15

    The goal of this study was to evaluate different fat-suppressed fluid-sensitive sequences in association with different metal artifacts reduction techniques (MARS) to determine which combination allows better fat suppression around metallic hip implants. An experimental study using an MRI fat-water phantom quantitatively evaluated contrast shift induced by metallic hip implant for different fat-suppression techniques and MARS. Then a clinical study with patients addressed to MRI unit for painful hip prosthesis compared these techniques in terms of fat suppression quality and diagnosis confidence. Among sequences without MARS, both T2 Dixon and short tau inversion recuperation (STIR) had significantly lower contrast shift (p < 0.05), Dixon offering the best fat suppression. Adding MARS (view-angle tilting or slice-encoding for metal artifact correction (SEMAC)) to STIR gave better results than Dixon alone, and also better than SPAIR and fat saturation with MARS (p < 0.05). There were no statistically significant differences between STIR with view-angle tilting and STIR with SEMAC in terms of fat suppression quality. STIR sequence is the preferred fluid-sensitive MR sequence in patients with metal implant. In combination with MARS (view-angle tilting or SEMAC), STIR appears to be the best option for high-quality fat suppression. (orig.)

  1. Comparative study of fat-suppression techniques for hip arthroplasty MR imaging.

    Science.gov (United States)

    Molière, Sébastien; Dillenseger, Jean-Philippe; Ehlinger, Matthieu; Kremer, Stéphane; Bierry, Guillaume

    2017-09-01

    The goal of this study was to evaluate different fat-suppressed fluid-sensitive sequences in association with different metal artifacts reduction techniques (MARS) to determine which combination allows better fat suppression around metallic hip implants. An experimental study using an MRI fat-water phantom quantitatively evaluated contrast shift induced by metallic hip implant for different fat-suppression techniques and MARS. Then a clinical study with patients addressed to MRI unit for painful hip prosthesis compared these techniques in terms of fat suppression quality and diagnosis confidence. Among sequences without MARS, both T2 Dixon and short tau inversion recuperation (STIR) had significantly lower contrast shift (p < 0.05), Dixon offering the best fat suppression. Adding MARS (view-angle tilting or slice-encoding for metal artifact correction (SEMAC)) to STIR gave better results than Dixon alone, and also better than SPAIR and fat saturation with MARS (p < 0.05). There were no statistically significant differences between STIR with view-angle tilting and STIR with SEMAC in terms of fat suppression quality. STIR sequence is the preferred fluid-sensitive MR sequence in patients with metal implant. In combination with MARS (view-angle tilting or SEMAC), STIR appears to be the best option for high-quality fat suppression.

  2. Comparative study of fat-suppression techniques for hip arthroplasty MR imaging

    International Nuclear Information System (INIS)

    Moliere, Sebastien; Dillenseger, Jean-Philippe; Kremer, Stephane; Bierry, Guillaume; Ehlinger, Matthieu

    2017-01-01

    The goal of this study was to evaluate different fat-suppressed fluid-sensitive sequences in association with different metal artifacts reduction techniques (MARS) to determine which combination allows better fat suppression around metallic hip implants. An experimental study using an MRI fat-water phantom quantitatively evaluated contrast shift induced by metallic hip implant for different fat-suppression techniques and MARS. Then a clinical study with patients addressed to MRI unit for painful hip prosthesis compared these techniques in terms of fat suppression quality and diagnosis confidence. Among sequences without MARS, both T2 Dixon and short tau inversion recuperation (STIR) had significantly lower contrast shift (p < 0.05), Dixon offering the best fat suppression. Adding MARS (view-angle tilting or slice-encoding for metal artifact correction (SEMAC)) to STIR gave better results than Dixon alone, and also better than SPAIR and fat saturation with MARS (p < 0.05). There were no statistically significant differences between STIR with view-angle tilting and STIR with SEMAC in terms of fat suppression quality. STIR sequence is the preferred fluid-sensitive MR sequence in patients with metal implant. In combination with MARS (view-angle tilting or SEMAC), STIR appears to be the best option for high-quality fat suppression. (orig.)

  3. Net-Shape HIP Powder Metallurgy Components for Rocket Engines

    Science.gov (United States)

    Bampton, Cliff; Goodin, Wes; VanDaam, Tom; Creeger, Gordon; James, Steve

    2005-01-01

    True net shape consolidation of powder metal (PM) by hot isostatic pressing (HIP) provides opportunities for many cost, performance and life benefits over conventional fabrication processes for large rocket engine structures. Various forms of selectively net-shape PM have been around for thirty years or so. However, it is only recently that major applications have been pursued for rocket engine hardware fabricated in the United States. The method employs sacrificial metallic tooling (HIP capsule and shaped inserts), which is removed from the part after HIP consolidation of the powder, by selective acid dissolution. Full exploitation of net-shape PM requires innovative approaches in both component design and materials and processing details. The benefits include: uniform and homogeneous microstructure with no porosity, irrespective of component shape and size; elimination of welds and the associated quality and life limitations; removal of traditional producibility constraints on design freedom, such as forgeability and machinability, and scale-up to very large, monolithic parts, limited only by the size of existing HIP furnaces. Net-shape PM HIP also enables fabrication of complex configurations providing additional, unique functionalities. The progress made in these areas will be described. Then critical aspects of the technology that still require significant further development and maturation will be discussed from the perspective of an engine systems builder and end-user of the technology.

  4. BLEPHAROPLASTY AND PERIOCULAR SKIN RESURFACING WITH NEW GENERATION ER:YAG LASER

    Directory of Open Access Journals (Sweden)

    Brigita Drnovšek-Olup

    2002-12-01

    Full Text Available Background. In this study, a new type of Er:YAG laser, emitting irradiation with variable pulse duration, has been used for blepharoplasty and skin resurfacing in periocular region.More than 40 patients have been treated with second generation Er:YAG laser (Fotona Fidelis for blepharoplasty and skin resurfacing. A focused laser beam (diameter 0.4 mm with very short pulse width (100 µs, that is significantly below the thermal relaxation time of skin, leads to a precise cut with no observable thermal effect on surrounding tissue. The depth of the cut is approximately 1–2 mm, precision comparable to a surgical scalpel. The high repetition rate of consecutive laser pulses (50 Hz at 120 mJ energy accounts for accumulation of thermal load in tissue, and thus leads to complete hemostasis of the cut tissue. Due to improved cutting abilities of the Er:YAG laser, excision of orbital fat is also performed with one pass of the laser beam. By changing the laser parameters to short pulses (300 µs, energy 500 mJ, spot diameter 5 mm and repetition rate 12–15 Hz, skin resurfacing was performed. No special pretreatment therapy was used. Anesthesia: 2% Xylocain inj. subcutaneously. Non adhesive dressing for 24 hours was applied after surgery.Epithelisation was complete after ten days. Redness persists up to 5 weeks. Discomfort of patients was mild. Cosmetic results are satisfying.Conclusions. New generation of Er:YAG laser offers a possibility to cut and coagulate the tissue simultaneously, and by changing the parameters to ablate the tissue with heating influence on skin collagen.

  5. Nonablative Fractional Laser Resurfacing in Skin of Color: Evidence-based Review.

    Science.gov (United States)

    Kaushik, Shivani B; Alexis, Andrew F

    2017-06-01

    Background: Nonablative laser resurfacing represents one of the major advances in procedural dermatology over the past decade. However, its use in darker skin types is limited by safety concerns and a relative lack of available data. Aim: To provide evidence-based recommendations for the use of fractional lasers in darker skin types. Evidence review: A broad literature search of PubMed/Medline database was conducted in April 2016 using the term fractional lasers. A free text search of keywords including fractional resurfacing, nonablative lasers, skin type, skin of color, ethnic skin, Fitzpatrick skin type, Asian skin, African Americans, Afro-Caribbean, and Hispanics was also executed. An in-depth review of all the relevant articles fitting the authors' inclusion/exclusion criteria was performed. Thereafter, each study was assigned levels of evidence per the Modified Criteria by Oxford Center of Evidence Based Medicine. A recommendation was made for a specific treatment based on the presence of at least one Level 1 study or more than three Level 2 or 3 studies that had concordant results. Findings: The available evidence strongly suggests that fractional lasers are a favorable treatment option for a variety of dermatological diseases in Fitzpatrick skin phototypes IV to VI. Level 1 evidence was found for the use of fractional lasers for treating acne, striae and skin rejuvenation. Level 2 evidence was found for their use in acne scars, melasma, and surgical/traumatic scars. Conclusion: Fractional resurfacing is a safe and efficacious treatment option for various dermatological disorders in darker skin types; however, there is a paucity of high-quality studies involving skin types V and VI.

  6. On the DEAP-3600 resurfacing

    Science.gov (United States)

    Giampa, P.

    2018-01-01

    The DEAP-3600 experiment is a single-phase detector that can hold up to 3600 kg of liquid argon to search for dark matter at SNOLAB in Sudbury Canada, 6800 ft. underground. The projected sensitivity to the spin-independent WIMP-nucleon cross-section is 10-46 cm2 for a WIMP mass of 100 GeV/c2. One of the primary background sources to the WIMP search are alpha decays occurring on the surface of the experiment, which only deposit a tiny fraction of their energy in the argon. The work reported here focuses on the development and operation of a custom designed robot, the Resurfacer, which was used to remove 500 micrometers from the inner-most layer of the detector's acrylic cryostat, thus removing contaminations introduced during construction.

  7. Hypertrophic Scarring of the Neck Following Ablative Fractional Carbon Dioxide Laser Resurfacing

    Science.gov (United States)

    Avram, Mathew M.; Tope, Whitney D.; Yu, Thomas; Szachowicz, Edward; Nelson, J. Stuart

    2009-01-01

    Background Ablative fractional carbon dioxide (CO2) laser treatments have gained popularity due to their efficacy, shortened downtime, and decreased potential for scarring in comparison to traditional ablative CO2 resurfacing. To date, scarring with fractional CO2 lasers has not been reported. Objective Five patients treated with the same fractional CO2 laser technology for photodamage of the neck were referred to our practices 1–3 months after treatment. Each patient developed scarring. Of the five cases, two are discussed in detail. The first was treated under general anesthesia on the face and anterior neck at a pulse energy of 30 mJ (859 μm depth) with 25% coverage. Eleven days after treatment, three non-healing areas along the horizontal skin folds of the anterior neck were noted. At 2 weeks after CO2 ablative fractional resurfacing, these areas had become thickened. These raised areas were treated with a non-ablative fractionated 1,550 nm laser to modify the wound healing milieu. One week later, distinct firm pale papules in linear arrays with mild hypopigmentation had developed along involved neck skin folds. Skin biopsy was performed. For the second patient, the neck was treated at a pulse energy of 20 mJ (630 μm depth) with 30% coverage of the exposed skin, with a total treatment energy of 5.0 kJ. Minimal crusting was noted on the neck throughout the initial healing phase of 2 weeks. She then experienced tightness on her neck. Approximately 3 weeks after treatment, she developed multiple vertical and horizontal hypertrophic scars (HS). Results Histopathology for the first case confirmed the presence of a hypertrophic scar. The papules in this case completely resolved with mild residual hypopigmentation after treatment with topical corticosteroids. HS failed to resolve in the second case to date after 1 month. Conclusion As with traditional ablative CO2 laser resurfacing, HS is a potential complication of ablative fractional CO2 laser resurfacing

  8. Recent Advances in Fractional Laser Resurfacing: New Paradigm in Optimal Parameters and Post-Treatment Wound Care

    Science.gov (United States)

    Hsiao, Francis C.; Bock, Gerald N.; Eisen, Daniel B.

    2012-01-01

    Background Laser plays an increasingly prominent role in skin rejuvenation. The advent of fractional photothermolysis revolutionizes its application. Microcolumns of skin are focally injured, leaving intervening normal skin to facilitate rapid wound healing and orderly tissue remodeling. The Problem Even with the popularity of fractional laser devices, we still have limited knowledge about the ideal treatment parameters and postlaser wound care. Basic/Clinical Science Advances Many clinicians believe that higher microbream energy in fractional laser devices results in better clinical outcome. Two recent studies argue against this assumption. One article demonstrates that lower fluence can induce comparable molecular changes with fewer side effects. Another study corroborates this by showing that lower-density settings produce similar clinical outcome in scar remodeling as higher-density ones, but with fewer side effects. To shed light on the optimal post-treatment wound care regimen from fractional ablative resurfacing, another paper shows that platelet-rich plasma (PRP) can reduce transepidermal water loss and skin color changes within 1 month after treatment. Clinical Care Relevance For fractional nonablative resurfacing, lower settings in fluence or density may produce similar dermal remodeling as higher settings and with a better side-effect profile. Moreover, autologous PRP appears to expedite wound healing after fractional ablative resurfacing. Conclusion Lower microbeam energy in fractional laser resurfacing produces similar molecular changes and clinical outcome with fewer side effects. The findings might portend a shift in the paradigm of treatment parameters. Autologous PRP can facilitate better wound healing, albeit modestly. Long-term follow-ups and larger studies are necessary to confirm these findings. PMID:24527307

  9. Microscopical analysis of synovial fluid wear debris from failing CoCr hip prostheses

    Science.gov (United States)

    Ward, M. B.; Brown, A. P.; Cox, A.; Curry, A.; Denton, J.

    2010-07-01

    Metal on metal hip joint prostheses are now commonly implanted in patients with hip problems. Although hip replacements largely go ahead problem free, some complications can arise such as infection immediately after surgery and aseptic necrosis caused by vascular complications due to surgery. A recent observation that has been made at Manchester is that some Cobalt Chromium (CoCr) implants are causing chronic pain, with the source being as yet unidentified. This form of replacement failure is independent of surgeon or hospital and so some underlying body/implant interface process is thought to be the problem. When the synovial fluid from a failed joint is examined particles of metal (wear debris) can be found. Transmission Electron Microscopy (TEM) has been used to look at fixed and sectioned samples of the synovial fluid and this has identified fine (< 100 nm) metal and metal oxide particles within the fluid. TEM EDX and Electron Energy Loss Spectroscopy (EELS) have been employed to examine the composition of the particles, showing them to be chromium rich. This gives rise to concern that the failure mechanism may be associated with the debris.

  10. Use of 1540nm fractionated erbium:glass laser for split skin graft resurfacing: a case study.

    Science.gov (United States)

    Narinesingh, S; Lewis, S; Nayak, B S

    2013-09-01

    The field of laser skin resurfacing has evolved rapidly over the past two decades from ablative lasers, to nonablative systems using near-infrared, intense-pulsed light and radio-frequency systems, and most recently fractional laser resurfacing. Although fractional thermolysis is still in its infancy, its efficacy in in the treatment of skin disorders have been clearly demonstrated. Here we present a case report on the safety and efficacy of a 1540nm erbium:glass laser in the treatment of the waffle pattern of a meshed skin graft in a 38-year-old patient with type V skin in the Caribbean.

  11. Hip dysplasia and congenital hip dislocation

    Energy Technology Data Exchange (ETDEWEB)

    Lingg, G.; Nebel, G.; von Torklus, D.

    1981-11-01

    In human genetics and orthopedics quite different answers have been given to the question of hereditary transmission and frequency of hip dysplasia in families of children with congenital hip dislocation. We therefore have made roentgenometric measurements of 110 parents of children with congenital hip dislocation. In 25% we found abnormal flat acetabulae, whereas 12% had pathologic deep hips. This may propose a new concept of morphology of congenital hip dysplasia.

  12. Facial resurfacing with a monoblock full-thickness skin graft after multiple malignant melanomas excision in xeroderma pigmentosum.

    Science.gov (United States)

    Ozmen, Selahattin; Uygur, Safak; Eryilmaz, Tolga; Ak, Betul

    2012-09-01

    Xeroderma pigmentosum is an autosomal recessive disease, characterized by vulnerability of the skin to solar radiation. Increase in sunlight-induced cancer is a direct consequence of an increase in mutated cells of the skin of patients with xeroderma pigmentosum. There is no specific technique for facial resurfacing in patients with xeroderma pigmentosum. In this article, a patient with xeroderma pigmentosum with multiple malignant melanomas on her face and radical excision of total facial skin followed by facial resurfacing with monoblock full-thickness skin graft from the abdomen is presented.

  13. 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.)

  14. HPLC/DAD Intercomparison on Phytoplankton Pigments (HIP-1, HIP-2, HIP-3 and HIP-4)

    OpenAIRE

    CANUTI Elisabetta; RAS Josephine; GRUNG Merete; ROTTGERS Rudiger; COSTA GOELA Priscilla; ARTUSO Florinda; CATALDI Dario

    2016-01-01

    From 2009 to 2015, in the context of the MERIS (Medium Resolution Imaging Spectrometer) validation activities, the JRC Marine Optical Laboratory organised four HPLC Intercomparison exercises for Phytoplankton Pigment measurements (HIP-1, HIP-2, HIP-3 and HIP-4), involving seven European accredited and reference laboratories. The objectives of these intercomparison exercises were: creating a reference community at European level for phytoplankton pigment analysis capable of supporting satel...

  15. Alumina-on-Polyethylene Bearing Surfaces in Total Hip Arthroplasty

    OpenAIRE

    Jung, Yup Lee; Kim, Shin-Yoon

    2010-01-01

    The long-term durability of polyethylene lining total hip arthroplasty (THA) mainly depends on periprosthetic osteolysis due to wear particles, especially in young active patients. In hip simulator study, reports revealed significant wear reduction of the alumina ceramic-on-polyethylene articulation of THA compared with metal-on-polyethylene bearing surfaces. However, medium to long-term clinical studies of THA using the alumina ceramic-on-polyethylene are few and the reported wear rate of th...

  16. A new patient classification for laser resurfacing and peels: predicting responses, risks, and results.

    Science.gov (United States)

    Fanous, Nabil

    2002-01-01

    Traditional classifications for skin treatment modalities are based on skin characteristics, the most important being skin color. Other factors are considered as well, such as oiliness, thickness, pathology, and sensitivity. While useful, these classifications are occasionally inadequate in predicting and explaining the outcome of some peels, dermabrasions, or laser resurfacing procedures. Why, for example, would a Korean patient with a light white skin inadvertently develop more hyperpigmentation than his darker skinned French counterpart? The new classification introduced here is based on the racial and genetic origins of patients. It suggests that racial genetic predisposition is the determining factor in human response to skin injury, including skin treatments. This classification takes into account both skin and features, rather than skin alone. It offers a new approach in evaluating patients scheduled for skin peels or laser resurfacing, in the hope of helping physicians to better predict reactions, select the appropriate type and intensity of the skin treatment and, ultimately, better control the outcome. Six categories (sub-races) are described: Nordics, Europeans, Mediterraneans, Indo-Pakistanis, Africans, and Asians. The reaction of each sub-race to peels, laser resurfacing, or dermabrasion is analyzed. The risks associated with each group are noted. This new classification provides physicians with a practical way to evaluate patients prior to treatment, with a view to determining each patient's suitability, postoperative reaction, the likelihood of complications, and likely result.

  17. Revision total hip arthoplasty: factors associated with re-revision surgery.

    Science.gov (United States)

    Khatod, Monti; Cafri, Guy; Inacio, Maria C S; Schepps, Alan L; Paxton, Elizabeth W; Bini, Stefano A

    2015-03-04

    highly cross-linked polyethylene bearing articulation decreases the hazard relative to metal on highly cross-linked polyethylene by a factor of 0.32 (95% confidence interval, 0.11 to 0.95). Metal on constrained bearing increases the hazard relative to metal on highly cross-linked polyethylene by a factor of 3.32 (95% confidence interval, 1.16 to 9.48). When evaluating patient, implant, and surgical factors at the time of revision total hip arthroplasty, age, surgeon experience, implant fixation, and bearing surfaces had significant impacts on the risk of re-revision. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  18. Metallosis: A diagnosis not only in patients with metal-on-metal prostheses

    International Nuclear Information System (INIS)

    Oliveira, Catarina A.; Candelária, Isabel S.; Oliveira, Pedro B.; Figueiredo, Antonio; Caseiro-Alves, Filipe

    2014-01-01

    Although the real actual incidence of metallosis is unknown, it is described as a rare diagnosis with a 5% estimated incidence in the hip prosthetic replacements. The adoption of non-metallic articular prosthetic devices, made of polyethylene and ceramic, is the main reason to the diminishing number of reported cases. We present a case of metallosis with a clinical systemic presentation in a patient with a non-metallic hip prosthesis, which occurred due to a fracture of the acetabular liner component, leading to abnormal metal–metal contact. The metallic debris leads to a massive local and systemic release of cytokines. Revision is necessary whenever osteolysis and loosening of the prosthesis occur. Imaging evaluation, especially CT, has a central role in diagnosis and planning the surgical treatment

  19. High mid-term revision rate after treatment of large, full-thickness cartilage lesions and OA in the patellofemoral joint using a large inlay resurfacing prosthesis

    DEFF Research Database (Denmark)

    Laursen, Jens Ole

    2017-01-01

    PURPOSE: The HemiCAP-Wave® implant for the patellofemoral resurfacing treatment of large cartilage lesions and osteoarthritis (OA) was introduced in 2009. The outcome of a prospective cohort study of 18 patients with large trochlea lesions or isolated OA treated with the HemiCAP-Wave® implant...... pain but high mid-term revision rate after patellofemoral inlay resurfacing using the HemiCAP-Wave® implant. Patellofemoral resurfacing implantation treatment with a large inlay prosthesis can offer temporary treatment for large isolated patellofemoral cartilage lesions or OA in younger patients...

  20. Numerical evaluation of bone remodelling and adaptation considering different hip prosthesis designs.

    Science.gov (United States)

    Levadnyi, Ievgen; Awrejcewicz, Jan; Gubaua, José Eduardo; Pereira, Jucélio Tomás

    2017-12-01

    The change in mechanical properties of femoral cortical bone tissue surrounding the stem of the hip endoprosthesis is one of the causes of implant instability. We present an analysis used to determine the best conditions for long-term functioning of the bone-implant system, which will lead to improvement of treatment results. In the present paper, a finite element method coupled with a bone remodelling model is used to evaluate how different three-dimensional prosthesis models influence distribution of the density of bone tissue. The remodelling process begins after the density field is obtained from a computed tomography scan. Then, an isotropic Stanford model is employed to solve the bone remodelling process and verify bone tissue adaptation in relation to different prosthesis models. The study results show that the long-stem models tend not to transmit loads to proximal regions of bone, which causes the stress-shielding effect. Short stems or application in the calcar region provide a favourable environment for transfer of loads to the proximal region, which allows for maintenance of bone density and, in some cases, for a positive variation, which causes absence of the aseptic loosening of an implant. In the case of hip resurfacing, bone mineral density changes slightly and is closest to an intact femur. Installation of an implant modifies density distribution and stress field in the bone. Thus, bone tissue is stimulated in a different way than before total hip replacement, which evidences Wolff's law, according to which bone tissue adapts itself to the loads imposed on it. The results suggest that potential stress shielding in the proximal femur and cortical hypertrophy in the distal femur may, in part, be reduced through the use of shorter stems, instead of long ones, provided stem fixation is adequate. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Immunological Responses to Total Hip Arthroplasty.

    Science.gov (United States)

    Man, Kenny; Jiang, Lin-Hua; Foster, Richard; Yang, Xuebin B

    2017-08-01

    The use of total hip arthroplasties (THA) has been continuously rising to meet the demands of the increasingly ageing population. To date, this procedure has been highly successful in relieving pain and restoring the functionality of patients' joints, and has significantly improved their quality of life. However, these implants are expected to eventually fail after 15-25 years in situ due to slow progressive inflammatory responses at the bone-implant interface. Such inflammatory responses are primarily mediated by immune cells such as macrophages, triggered by implant wear particles. As a result, aseptic loosening is the main cause for revision surgery over the mid and long-term and is responsible for more than 70% of hip revisions. In some patients with a metal-on-metal (MoM) implant, metallic implant wear particles can give rise to metal sensitivity. Therefore, engineering biomaterials, which are immunologically inert or support the healing process, require an in-depth understanding of the host inflammatory and wound-healing response to implanted materials. This review discusses the immunological response initiated by biomaterials extensively used in THA, ultra-high-molecular-weight polyethylene (UHMWPE), cobalt chromium (CoCr), and alumina ceramics. The biological responses of these biomaterials in bulk and particulate forms are also discussed. In conclusion, the immunological responses to bulk and particulate biomaterials vary greatly depending on the implant material types, the size of particulate and its volume, and where the response to bulk forms of differing biomaterials are relatively acute and similar, while wear particles can initiate a variety of responses such as osteolysis, metal sensitivity, and so on.

  2. Isolated scaphotrapeziotrapezoid osteoarthritis treatment using resurfacing arthroplasty with scaphoid anchorage.

    Science.gov (United States)

    Humada Álvarez, G; Simón Pérez, C; García Medrano, B; Faour Martín, O; Marcos Rodríguez, J J; Vega Castrillo, A; Martín Ferrero, M A

    The aim of this study is to show the results of scaphotrapeziotrapezoid (STT) joint osteoarthritis treatment performing resurfacing arthroplasty with scaphoid anchorage. An observational, descriptive and retrospective study was performed. Ten patients with isolated STT joint osteoarthritis were studied between 2013 and 2015. The mean follow-up time was 26months. Clinical results, functional and subjective scores were reviewed. The patients were satisfied, achieving an average of 2.1 (0-3) on the VAS score and 16 (2 to 28) in the DASH questionnaire, and returning to work in the first three months post-surgery. Recovery of range of motion compared to the contralateral wrist was 96% in extension, 95% in flexion, 87% in ulnar deviation and 91% in radial deviation. The average handgrip strength of the wrist was 95% and pinch strength was 95% compared to the contralateral side. There were no intraoperative complications or alterations in postoperative carpal alignment. Resurfacing arthroplasty is proposed as a good and novel alternative in treating isolated SST joint arthritis. Achieving the correct balance between the strength and mobility of the wrist, without causing carpal destabilisation, is important to obtain satisfactory clinical and functional results. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  3. Hip, Hip, Soret!

    Science.gov (United States)

    Müller-Plathe, Florian

    Many years ago, Ludwig did detect the behaviour now called the Soret effect. Sodium sulphate in eighteen-fifty-six did not obediently follow Fick's first law. But if he cooled down one side the salt went left, the water to the right. He was surprised in every way. Hip, hip, Soret!

  4. Development of HIP bonding procedure and mechanical properties of HIP bonded joints for reduced activation ferritic steel F-82H

    International Nuclear Information System (INIS)

    Oda, Masahiro; Kurasawa, Toshimasa; Kuroda, Toshimasa; Hatano, Toshihisa; Takatsu, Hideyuki

    1997-03-01

    Structural materials of blanket components in fusion DEMO reactors will receive a neutron wall load more than 3-5MW/m 2 as well as exposed by surface heat flux more than 0.5MW/m 2 . A reduced activation ferritic steel F-82H has been developed by JAERI in collaboration with NKK from viewpoints of resistance for high temperature and neutron loads and lower radioactivity. This study intends to obtain basic performance of F-82H to establish the fabrication procedure of the first wall and blanket box by using Hot Isostatic Pressing (HIP) bonding. Before HIP bonding tests, effects of heat treatment temperature and surface roughness on mechanical properties of joints were investigated in the heat treatment tests and diffusion bonding tests, respectively. From these results, the optimum HIP bonding conditions and the post heat treatment were selected. Using these conditions, the HIP bonding tests were carried out to evaluate HIP bondability and to obtain mechanical properties of the joints. Sufficient HIP bonding performance was obtained under the temperature of 1040degC, the compressive stress of 150MPa, the holding time of 2h, and the surface roughness ∼μ m. Mechanical properties of HIP bonded joints with these conditions were similar to those of as-received base metal. An oxide formation on the surface to be bonded would need to be avoided for sufficient bonding. The bonding ratio, Charpy impact value and fatigue performance of the joints strongly depended on the HIP conditions, especially temperature, while micro-structure, Vickers hardness and tensile properties had little dependence on the HIP temperature. The surface roughness strongly affected the bonding ratio and would be required to be in the level of a few μ m. In the HIP bonding test of the welded material, the once-melted surface could be jointed by the HIP bonding under the above-mentioned procedure. (J.P.N.)

  5. Use of medical tourism for hip and knee surgery in osteoarthritis: a qualitative examination of distinctive attitudinal characteristics among Canadian patients.

    Science.gov (United States)

    Crooks, Valorie A; Cameron, Keri; Chouinard, Vera; Johnston, Rory; Snyder, Jeremy; Casey, Victoria

    2012-11-21

    Medical tourism is the term that describes patients' international travel with the intention of seeking medical treatment. Some medical tourists go abroad for orthopaedic surgeries, including hip and knee resurfacing and replacement. In this article we examine the findings of interviews with Canadian medical tourists who went abroad for such surgeries to determine what is distinctive about their attitudes when compared to existing qualitative research findings about patients' decision-making in and experiences of these same procedures in their home countries. Fourteen Canadian medical tourists participated in semi-structured phone interviews, all of whom had gone abroad for hip or knee surgery to treat osteoarthritis. Transcripts were coded and thematically analysed, which involved comparing emerging findings to those in the existing qualitative literature on hip and knee surgery. Three distinctive attitudinal characteristics among participants were identified when interview themes were compared to findings in the existing qualitative research on hip and knee surgery in osteoarthritis. These attitudinal characteristics were that the medical tourists we spoke with were: (1) comfortable health-related decision-makers; (2) unwavering in their views about procedure necessity and urgency; and (3) firm in their desires to maintain active lives. Compared to other patients reported on in the existing qualitative hip and knee surgery literature, medical tourists are less likely to question their need for surgery and are particularly active in their pursuit of surgical intervention. They are also comfortable with taking control of health-related decisions. Future research is needed to identify motivators behind patients' pursuit of care abroad, determine if the attitudinal characteristics identified here hold true for other patient groups, and ascertain the impact of these attitudinal characteristics on surgical outcomes. Arthritis care providers can use the attitudinal

  6. Use of medical tourism for hip and knee surgery in osteoarthritis: a qualitative examination of distinctive attitudinal characteristics among Canadian patients

    Directory of Open Access Journals (Sweden)

    Crooks Valorie A

    2012-11-01

    Full Text Available Abstract Background Medical tourism is the term that describes patients’ international travel with the intention of seeking medical treatment. Some medical tourists go abroad for orthopaedic surgeries, including hip and knee resurfacing and replacement. In this article we examine the findings of interviews with Canadian medical tourists who went abroad for such surgeries to determine what is distinctive about their attitudes when compared to existing qualitative research findings about patients’ decision-making in and experiences of these same procedures in their home countries. Methods Fourteen Canadian medical tourists participated in semi-structured phone interviews, all of whom had gone abroad for hip or knee surgery to treat osteoarthritis. Transcripts were coded and thematically analysed, which involved comparing emerging findings to those in the existing qualitative literature on hip and knee surgery. Results Three distinctive attitudinal characteristics among participants were identified when interview themes were compared to findings in the existing qualitative research on hip and knee surgery in osteoarthritis. These attitudinal characteristics were that the medical tourists we spoke with were: (1 comfortable health-related decision-makers; (2 unwavering in their views about procedure necessity and urgency; and (3 firm in their desires to maintain active lives. Conclusions Compared to other patients reported on in the existing qualitative hip and knee surgery literature, medical tourists are less likely to question their need for surgery and are particularly active in their pursuit of surgical intervention. They are also comfortable with taking control of health-related decisions. Future research is needed to identify motivators behind patients’ pursuit of care abroad, determine if the attitudinal characteristics identified here hold true for other patient groups, and ascertain the impact of these attitudinal characteristics on

  7. Prediction of contact mechanics in metal-on-metal Total Hip Replacement for parametrically comprehensive designs and loads.

    Science.gov (United States)

    Donaldson, Finn E; Nyman, Edward; Coburn, James C

    2015-07-16

    Manufacturers and investigators of Total Hip Replacement (THR) bearings require tools to predict the contact mechanics resulting from diverse design and loading parameters. This study provides contact mechanics solutions for metal-on-metal (MoM) bearings that encompass the current design space and could aid pre-clinical design optimization and evaluation. Stochastic finite element (FE) simulation was used to calculate the head-on-cup contact mechanics for five thousand combinations of design and loading parameters. FE results were used to train a Random Forest (RF) surrogate model to rapidly predict the contact patch dimensions, contact area, pressures and plastic deformations for arbitrary designs and loading. In addition to widely observed polar and edge contact, FE results included ring-polar, asymmetric-polar, and transitional categories which have previously received limited attention. Combinations of design and load parameters associated with each contact category were identified. Polar contact pressures were predicted in the range of 0-200 MPa with no permanent deformation. Edge loading (with subluxation) was associated with pressures greater than 500 MPa and induced permanent deformation in 83% of cases. Transitional-edge contact (with little subluxation) was associated with intermediate pressures and permanent deformation in most cases, indicating that, even with ideal anatomical alignment, bearings may face extreme wear challenges. Surrogate models were able to accurately predict contact mechanics 18,000 times faster than FE analyses. The developed surrogate models enable rapid prediction of MoM bearing contact mechanics across the most comprehensive range of loading and designs to date, and may be useful to those performing bearing design optimization or evaluation. Published by Elsevier Ltd.

  8. Alumina-on-Polyethylene Bearing Surfaces in Total Hip Arthroplasty.

    Science.gov (United States)

    Jung, Yup Lee; Kim, Shin-Yoon

    2010-02-11

    The long-term durability of polyethylene lining total hip arthroplasty (THA) mainly depends on periprosthetic osteolysis due to wear particles, especially in young active patients. In hip simulator study, reports revealed significant wear reduction of the alumina ceramic-on-polyethylene articulation of THA compared with metal-on-polyethylene bearing surfaces. However, medium to long-term clinical studies of THA using the alumina ceramic-on-polyethylene are few and the reported wear rate of this articulation is variable. We reviewed the advantages and disadvantages of ceramicon- polyethylene articulation in THA, hip simulator study and retrieval study for polyethylene wear, in vivo clinical results of THA using alumina ceramic-on-polyethylene bearing surfaces in the literature, and new trial alumina ceramic-onhighly cross linked polyethylene bearing surfaces.

  9. The Infection Rate of Metal-on-Metal Total Hip Replacement Is Higher When Compared to Other Bearing Surfaces as Documented by the Australian Orthopaedic Association National Joint Replacement Registry.

    Science.gov (United States)

    Huang, Phil; Lyons, Matt; O'Sullivan, Michael

    2018-02-01

    Despite the well-documented decline in the use of metal-on-metal (MoM) implants over the last decade, there are still controversies regarding whether all MoM implants are created equally. Complications such as elevated serum metal ion levels, aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) and pseudotumours have all been well documented, but recent studies suggest increased risk of infection with MoM bearing surfaces. Most of these studies however have small patient numbers. The purpose of this study was to examine the cumulative incidence of revision for infection of MoM bearing surfaces in primary hip arthroplasty at a national and single-surgeon level. Data was collected from the Australian Orthopaedic Association National Joint Replacement Registry, which contains over 98% of all arthroplasties performed in Australia since 2001. The cumulative incidence of revision for infection was extracted at a national level and single-surgeon level. Two hundred seventy-six thousand eight hundred seventy-eight subjects were documented in the Australian registry. The 10-year cumulative percent revision for infection of MoM bearing surfaces in primary total hip replacement (THR) was 2.5% at a national level, compared to 0.8% for other bearing surfaces. The senior author contributed 1755 subjects with 7-year follow-up and a cumulative percent revision for infection of MoM bearing surfaces in primary THR of 36.9%, compared to 2.0% for other bearing surfaces. The cumulative percent of revision of MoM bearing surfaces is higher compared to other bearing surfaces; this is especially pronounced in cumulative percent of revision for infection. There was a higher cumulative percent of revision for infection in MoM bearings surfaces (in particular, large-head MoM) compared to other bearing surfaces at both the national and individual-surgeon level.

  10. Multicenter Analysis of Midterm Clinical Outcomes of Arthroscopic Labral Repair in the Hip: Minimum 5-Year Follow-up.

    Science.gov (United States)

    Hevesi, Mario; Krych, Aaron J; Johnson, Nick R; Redmond, John M; Hartigan, David E; Levy, Bruce A; Domb, Benjamin G

    2018-02-01

    The technique of hip arthroscopic surgery is advancing and becoming more commonly performed. However, most current reported results are limited to short-term follow-up, and therefore, the durability of the procedure is largely unknown. To perform a multicenter analysis of mid-term clinical outcomes of arthroscopic hip labral repair and determine the risk factors for patient outcomes. Cohort study; Level of evidence, 3. Prospectively collected data of primary hip arthroscopic labral repair performed at 4 high-volume centers between 2008 and 2011 were reviewed retrospectively. Patients were assessed preoperatively and postoperatively with the visual analog scale (VAS), modified Harris Hip Score (mHHS), and Hip Outcome Score-Sports-Specific Subscale (HOS-SSS) at a minimum of 5 years' follow-up. Factors including age, body mass index (BMI), Tönnis grade, and cartilage grade were analyzed in relation to outcome scores, and revision rates were determined. Failure was defined as subsequent ipsilateral hip surgery, including revision arthroscopic surgery and open hip surgery. A total of 303 patients (101 male, 202 female) with a mean age of 32.0 years (range, 10.7-58.9 years) were followed for a mean of 5.7 years (range, 5.0-7.9 years). Patients achieved mean improvements in VAS of 3.5 points, mHHS of 20.1 points, and HOS-SSS of 29.3 points. Thirty-seven patients (12.2%) underwent revision arthroscopic surgery, and 12 (4.0%) underwent periacetabular osteotomy, resurfacing, or total hip arthroplasty during the study period. Patients with a BMI >30 kg/m 2 had a mean mHHS score 9.5 points lower and a mean HOS-SSS score 15.9 points lower than those with a BMI ≤30 kg/m 2 ( P 35 years at surgery had a mean mHHS score 4.5 points lower and a HOS-SSS score 6.7 points lower than those aged ≤35 years ( P = .03). Patients with Tönnis grade 2 radiographs demonstrated a 12.5-point worse mHHS score ( P = .02) and a 23.0-point worse HOS-SSS score ( P SSS scores after arthroscopic

  11. Patellofemoral arthritis treated with resurfacing implant: Clinical outcome and complications at a minimum two-year follow-up.

    Science.gov (United States)

    Zicaro, Juan Pablo; Yacuzzi, Carlos; Astoul Bonorino, Juan; Carbo, Lisandro; Costa-Paz, Matias

    2017-12-01

    This study evaluated the clinical and radiographic outcomes of a series of patients treated with an anatomic inlay resurfacing implant, with a minimum two-year follow-up. Fifteen patients underwent patellofemoral-resurfacing procedures using a HemiCAP Wave Patellofemoral Inlay Resurfacing implant from 2010 to 2013. Clinical outcomes included: Visual Analog Scale (VAS), Lysholm score, Knee Society Score (KSS), and evaluation of Kujala, and Hospital for Special Surgery Patellofemoral score (HSS-PF). The postoperative complications were analyzed. Nineteen knees were evaluated; the average follow-up was 35.2months. Fourteen were women, with an average age of 54years. The pre-operative/postoperative clinical results presented a significant improvement: VAS 8/2.5, Lysholm 31.9/85.8, KSS 39.8/82.5, Kujala 32.1/79.3 and Hospital for Special Surgery Patellofemoral score (HSS-PF) 15.9/90.6. A total of 87% of patients were either satisfied or very satisfied with the overall outcome. There were no radiographic signs of loosening. Seven postoperative complications were recorded: two presented ongoing knee pain, one postoperative stiffness, one patellar bounce due to maltracking, two ilio-tibial band syndrome, and one tibial anterior tuberosity osteotomy nonunion. Two patients underwent a total knee arthroplasty conversion and were considered a failure. None of these complications were implant related. Patellofemoral inlay resurfacing for isolated patellofemoral arthritis was an effective and safe procedure with high levels of patient satisfaction. No mechanical implant failure was seen at a minimum two-year follow-up. This implant design appeared to be an alternative to the traditional patellofemoral prostheses. Concomitant osteochondral lesions, patellofemoral dysplasia or patellar maltracking might be poor prognostic factors for this type of implant. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Laser resurfacing of skin flaps: an experimental comparison

    Directory of Open Access Journals (Sweden)

    Srdan Babovic

    2011-05-01

    Full Text Available Objective. The influence of Coherent Ultrapulse, TruPulse and Erbium: YAG laser skin resurfacing on survival of the skin flaps when performed simultaneously was evaluated. Material and methods. We used twelve female Yucatan minipigs in the study. Skin flaps including paniculus carnosus were raised on the animals’ back. The flaps were sutured into the defect under tension. We designed 4 experimental groups: Control-Flaps only, Group 2-Flaps + 4 immediate TruPulse laser passes, Group 3-Flaps + 2 immediate Coherent UltraPulse laser passes, Group 4-Flaps – immediate 50J/cm2 total fluence with Erbium: YAG laser. Results. Flap survival in Control group was 98.8%. There was no flap in Group 2 with complete survival. Survival of the flaps in Group 2 (Tru-Pulse ranged from 75-90%, with average flap survival area of 85.2%. In Group 3 (UltraPulse all 24 flaps had some area of necrosis. Flap survival in Group 3 ranged from 75-95%, with an average of 85.6%. In Group 4 (Erbium: YAG flap survival area ranged from 70-95%, with all 24 flaps with some area of necrosis, with average flap survival area of 87.3%. There is a significant statistical difference in flap survival area between groups 2, 3 and 4 versus Control (p<0.001. Conclusion. The results of our study suggest that laser resurfacing of skin flaps sutured under tension in the same operative session is detrimental for skin flap survival. We also found no significant difference in flap survival area between TruPulse, Coherent UltraPulse and Erbium: YAG laser treated flaps.

  13. Hip joint replacement

    Science.gov (United States)

    Hip arthroplasty; Total hip replacement; Hip hemiarthroplasty; Arthritis - hip replacement; Osteoarthritis - hip replacement ... Your hip joint is made up of 2 major parts. One or both parts may be replaced during surgery: ...

  14. Combined fractional resurfacing (10600 nm/1540 nm): Tridimensional imaging evaluation of a new device for skin rejuvenation.

    Science.gov (United States)

    Mezzana, Paolo; Valeriani, Maurizio; Valeriani, Roberto

    2016-11-01

    In this study were described the results, by tridimensional imaging evaluation, of the new "Combined Fractional Resurfacing" technique with the first fractional laser that overtakes the limits of traditional ablative, nonablative fractional resurfacing by combining CO 2 ablative and GaAs nonablative lasers. These two wavelengths can work separately or in a mixed modality to give the best treatment choice to all the patients. In this study, it is demonstrated that the simultaneous combination of the CO 2 wavelength (10600 nm) and GaAs wavelength (1540 nm) reduced the downtime, reduced pain during the treatment, and produced better results on fine wrinkles reduction and almost the same results on pigmentation as seen with 3D analysis by Antera (Miravex).

  15. New application of the long-pulsed Nd-YAG laser as an ablative resurfacing tool for skin rejuvenation: a 7-year study.

    Science.gov (United States)

    Alshami, Mohammad Ali

    2013-09-01

    Carbon dioxide (CO2 ) and erbium-yttrium aluminum garnet (Er-YAG) lasers are the gold standards in ablative skin resurfacing. Neodymium-doped yttrium aluminum garnet (Nd-YAG) laser is considered a nonablative skin resurfacing laser whose usage is limited due to its high cost. To assess the efficacy and safety of Nd-YAG as an ablative resurfacing laser and to compare the results with those previously published for CO2 and Erbium-YAG lasers. A total of 296 patients (251 female and 45 male) with Fitzpatrick skin types III-IV and dermatological conditions amenable to ablative skin resurfacing participated in this study. Nd-YAG laser parameters assessed were wavelength (1064 nm), pulse duration (5 ms), fluence (10 J/cm(2) ), and spot size (8-10 mm). Efficacy of Nd-YAG laser was assessed by comparing pre- and posttreatment photographs. An improvement of 30-80% was observed in treated patients. The degree of improvement correlated positively with the number of laser sessions. The most common side effect was hyperpigmentation. Other side effects were less common and mild in intensity compared with published results for gold standard ablative lasers. Not only was the Nd-YAG laser found to be as effective as Er-YAG and CO2 lasers, but treated patients also had shorter recovery and treatment times, and at lower cost. © 2013 Wiley Periodicals, Inc.

  16. Large-Scale Skin Resurfacing of the Upper Extremity in Pediatric Patients Using a Pre-Expanded Intercostal Artery Perforator Flap.

    Science.gov (United States)

    Wei, Jiao; Herrler, Tanja; Gu, Bin; Yang, Mei; Li, Qingfeng; Dai, Chuanchang; Xie, Feng

    2018-05-01

    The repair of extensive upper limb skin lesions in pediatric patients is extremely challenging due to substantial limitations of flap size and donor-site morbidity. We aimed to create an oversize preexpanded flap based on intercostal artery perforators for large-scale resurfacing of the upper extremity in children. Between March 2013 and August 2016, 11 patients underwent reconstructive treatment for extensive skin lesions in the upper extremity using a preexpanded intercostal artery perforator flap. Preoperatively, 2 to 4 candidate perforators were selected as potential pedicle vessels based on duplex ultrasound examination. After tissue expander implantation in the thoracodorsal area, regular saline injections were performed until the expanded flap was sufficient in size. Then, a pedicled flap was formed to resurface the skin lesion of the upper limb. The pedicles were transected 3 weeks after flap transfer. Flap survival, complications, and long-term outcome were evaluated. The average time of tissue expansion was 133 days with a mean final volume of 1713 mL. The thoracoabdominal flaps were based on 2 to 6 pedicles and used to resurface a mean skin defect area of 238 cm ranging from 180 to 357 cm. In all cases, primary donor-site closure was achieved. Marginal necrosis was seen in 5 cases. The reconstructed limbs showed satisfactory outcome in both aesthetic and functional aspects. The preexpanded intercostal artery perforator flap enables 1-block repair of extensive upper limb skin lesions. Due to limited donor-site morbidity and a pedicled technique, this resurfacing approach represents a useful tool especially in pediatric patients.

  17. Outcome, revision rate and indication for revision following resurfacing hemiarthroplasty for osteoarthritis of the shoulder

    DEFF Research Database (Denmark)

    Rasmussen, J V; Polk, A; Sorensen, A K

    2014-01-01

    In this study, we evaluated patient-reported outcomes, the rate of revision and the indications for revision following resurfacing hemiarthroplasty of the shoulder in patients with osteoarthritis. All patients with osteoarthritis who underwent primary resurfacing hemiarthroplasty and reported...... to the Danish Shoulder Arthroplasty Registry (DSR), between January 2006 and December 2010 were included. There were 772 patients (837 arthroplasties) in the study. The Western Ontario Osteoarthritis of the Shoulder (WOOS) index was used to evaluate patient-reported outcome 12 months (10 to 14) post......-operatively. The rates of revision were calculated from the revisions reported to the DSR up to December 2011 and by checking deaths with the Danish National Register of Persons. A complete questionnaire was returned by 688 patients (82.2%). The mean WOOS was 67 (0 to 100). A total of 63 hemiarthroplasties (7...

  18. 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.

  19. Clinical Usefulness of SPECT-CT in Patients with an Unexplained Pain in Metal on Metal (MOM) Total Hip Arthroplasty.

    Science.gov (United States)

    Berber, Reshid; Henckel, Johann; Khoo, Michael; Wan, Simon; Hua, Jia; Skinner, John; Hart, Alister

    2015-04-01

    SPECT-CT is increasingly used to assess painful knee arthroplasties. The aim of this study was to evaluate the clinical usefulness of SPECT-CT in unexplained painful MOM hip arthroplasty. We compared the diagnosis and management plan for 19 prosthetic MOM hips in 15 subjects with unexplained pain before and after SPECT-CT. SPECT-CT changed the management decision in 13 (68%) subjects, Chi-Square=5.49, P=0.24. In 6 subjects (32%) pain remained unexplained however the result reassured the surgeon to continue with non-operative management. SPECT-CT should be reserved as a specialist test to help identify possible causes of pain where conventional investigations have failed. It can help reassure surgeons making management decisions for patients with unexplained pain following MOM hip arthroplasty. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. 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

  1. Polydeoxyribonucleotide improves wound healing of fractional laser resurfacing in rat model.

    Science.gov (United States)

    Yu, Mi; Lee, Jun Young

    2017-02-01

    Polydeoxyribonucleotide (PDRN) is an active compound that can promote wound healing. PDRN stimulates wound healing by enhancing angiogenesis and increasing fibroblast growth rates. Laser skin resurfacing is a popular cosmetic procedure for skin rejuvenation. Despite excellent improvement of photo-damaged skin and acne scarring, it is accompanied with drawbacks, such as prolonged erythema and crusting. This study was designed to assess the effect of PDRN on wounds induced by fractional laser resurfacing. Twelve male rats aged 8 weeks were randomly assigned to the PDRN treatment group and the control group. Wounds were induced using a fractional ablative CO 2 laser. The treatment group received daily injections of PDRN and the control group received injections of the vehicle. Wound healing assessed by clinical features and histopathologic findings. The process of wound healing was faster in the treatment group than in the control group. In the histopathological examination, the granulation tissue thickness score of the treatment group was significantly higher than that of the control group. Results of immunohistochemical staining showed a marked increase of VEGF-positive cells and PECAM-1/CD31-positive microvessels in the treatment group. PDRN may be a beneficial option to promote wound healing after laser treatment.

  2. HIP JOINT AND HIP ENDOPROSTHESIS BIOMECHANICS

    OpenAIRE

    Jakub Gryka

    2017-01-01

    This article contains a description of the basic issues related to anatomy, loading of hip joint and its endoprosthesis research methods. The methods of testing and simulating hip joint loads, factors that influence the selection of parameters during the design of prostheses, typical solutions to engineering problems related to this topic are presented. The article concludes with short summary of the finite element method for the design of hip replacements.

  3. The effect of metal artefact reduction on CT-based attenuation correction for PET imaging in the vicinity of metallic hip implants: a phantom study.

    Science.gov (United States)

    Harnish, Roy; Prevrhal, Sven; Alavi, Abass; Zaidi, Habib; Lang, Thomas F

    2014-07-01

    To determine if metal artefact reduction (MAR) combined with a priori knowledge of prosthesis material composition can be applied to obtain CT-based attenuation maps with sufficient accuracy for quantitative assessment of (18)F-fluorodeoxyglucose uptake in lesions near metallic prostheses. A custom hip prosthesis phantom with a lesion-sized cavity filled with 0.2 ml (18)F-FDG solution having an activity of 3.367 MBq adjacent to a prosthesis bore was imaged twice with a chrome-cobalt steel hip prosthesis and a plastic replica, respectively. Scanning was performed on a clinical hybrid PET/CT system equipped with an additional external (137)Cs transmission source. PET emission images were reconstructed from both phantom configurations with CT-based attenuation correction (CTAC) and with CT-based attenuation correction using MAR (MARCTAC). To compare results with the attenuation-correction method extant prior to the advent of PET/CT, we also carried out attenuation correction with (137)Cs transmission-based attenuation correction (TXAC). CTAC and MARCTAC images were scaled to attenuation coefficients at 511 keV using a trilinear function that mapped the highest CT values to the prosthesis alloy attenuation coefficient. Accuracy and spatial distribution of the lesion activity was compared between the three reconstruction schemes. Compared to the reference activity of 3.37 MBq, the estimated activity quantified from the PET image corrected by TXAC was 3.41 MBq. The activity estimated from PET images corrected by MARCTAC was similar in accuracy at 3.32 MBq. CTAC corrected PET images resulted in nearly 40 % overestimation of lesion activity at 4.70 MBq. Comparison of PET images obtained with the plastic and metal prostheses in place showed that CTAC resulted in a marked distortion of the (18)F-FDG distribution within the lesion, whereas application of MARCTAC and TXAC resulted in lesion distributions similar to those observed with the plastic replica. MAR combined

  4. Distribution of Early, Middle, and Late Noachian cratered surfaces in the Martian highlands: Implications for resurfacing events and processes

    Science.gov (United States)

    Irwin, Rossman P.; Tanaka, Kenneth L.; Robbins, Stuart J.

    2013-02-01

    Most of the geomorphic changes on Mars occurred during the Noachian Period, when the rates of impact crater degradation and valley network incision were highest. Fluvial erosion around the Noachian/Hesperian transition is better constrained than the longer-term landscape evolution throughout the Noachian Period, when the highland intercrater geomorphic surfaces developed. We interpret highland resurfacing events and processes using a new global geologic map of Mars (at 1:20,000,000 scale), a crater data set that is complete down to 1 km in diameter, and Mars Orbiter Laser Altimeter topography. The Early Noachian highland (eNh) unit is nearly saturated with craters of 32-128 km diameter, the Middle Noachian highland (mNh) unit has a resurfacing age of ~4 Ga, and the Late Noachian highland unit (lNh) includes younger composite surfaces of basin fill and partially buried cratered terrain. These units have statistically distinct ages, and their distribution varies with elevation. The eNh unit is concentrated in the high-standing Hellas basin annulus and in highland terrain that was thinly mantled by basin ejecta near 180° longitude. The mNh unit includes most of Arabia Terra, the Argyre vicinity, highland plateau areas between eNh outcrops, and the Thaumasia range. The lNh unit mostly occurs within highland basins. Crater depth/diameter ratios do not vary strongly between the eNh and mNh units, although crater losses to Noachian resurfacing appear greater in lower lying areas. Noachian resurfacing was spatially non-uniform, long-lived, and gravity-driven, more consistent with arid-zone fluvial and aeolian erosion and volcanism than with air fall mantling or mass wasting.

  5. Hip Fracture

    Science.gov (United States)

    ... hip fractures in people of all ages. In older adults, a hip fracture is most often a result of a fall from a standing height. In people with very weak bones, a hip fracture can occur simply by standing on the leg and twisting. Risk factors The rate of hip fractures increases substantially with ...

  6. Spine–hip relations in patients with hip osteoarthritis

    Science.gov (United States)

    Rivière, Charles; Lazic, Stefan; Dagneaux, Louis; Van Der Straeten, Catherine; Cobb, Justin; Muirhead-Allwood, Sarah

    2018-01-01

    Patients with hip osteoarthritis often have an abnormal spine-hip relation (SHR), meaning the presence of a clinically deleterious spine-hip and/or hip-spine syndrome. Definition of the individual SHR is ideally done using the EOS® imaging system or, if not available, with conventional lumbopelvic lateral radiographs. By pre-operatively screening patients with abnormal SHR, it is possible to refine total hip replacement (THR) surgical planning, which may improve outcomes. An important component of the concept of kinematically aligned total hip arthroplasty (KA THA) consists of defining the optimal acetabular cup design and orientation based on the assessment of an individual’s SHR, and use of the transverse acetabular ligament to adjust the cup positioning. The Bordeaux classification might advance the understanding of SHR and hopefully help improve THR outcomes. Cite this article: EFORT Open Rev 2018;3:39-44. DOI: 10.1302/2058-5241.3.170020 PMID:29657844

  7. Is Electrocautery of Patella Useful in Patella Non-Resurfacing Total Knee Arthroplasty?: A Prospective Randomized Controlled Study.

    Science.gov (United States)

    Kwon, Sae Kwang; Nguku, Levis; Han, Chang Dong; Koh, Yong-Gon; Kim, Dong-Wook; Park, Kwan Kyu

    2015-12-01

    There is controversy over the need for electrocauterization of the patella in non-resurfacing total knee arthroplasty (TKA). We investigated whether this procedure is beneficial through a prospective randomized controlled trial. Fifty patients who underwent electrocautery were compared with 50 patients who did not undergo this procedure. We determined cartilage status, preoperative and postoperative American Knee Society (AKS) score, the Western Ontario and McMaster Universities score (WOMAC) and the Patellofemoral (PF) scores for a minimum of 5 years. The two groups did not differ significantly in demographics, intraoperative cartilage status, or preoperative or postoperative outcomes. No complications were detected in either group. We found no benefits of electrocautery of the patella in patellar non-resurfacing TKA up to 5 years. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. In vivo animal histology and clinical evaluation of multisource fractional radiofrequency skin resurfacing (FSR) applicator.

    Science.gov (United States)

    Sadick, Neil S; Sato, Masaki; Palmisano, Diana; Frank, Ido; Cohen, Hila; Harth, Yoram

    2011-10-01

    Acne scars are one of the most difficult disorders to treat in dermatology. The optimal treatment system will provide minimal downtime resurfacing for the epidermis and non-ablative deep volumetric heating for collagen remodeling in the dermis. A novel therapy system (EndyMed Ltd., Cesarea, Israel) uses phase-controlled multi-source radiofrequency (RF) to provide simultaneous one pulse microfractional resurfacing with simultaneous volumetric skin tightening. The study included 26 subjects (Fitzpatrick's skin type 2-5) with moderate to severe wrinkles and 4 subjects with depressed acne scars. Treatment was repeated each month up to a total of three treatment sessions. Patients' photographs were graded according to accepted scales by two uninvolved blinded evaluators. Significant reduction in the depth of wrinkles and acne scars was noted 4 weeks after therapy with further improvement at the 3-month follow-up. Our data show the histological impact and clinical beneficial effects of simultaneous RF fractional microablation and volumetric deep dermal heating for the treatment of wrinkles and acne scars.

  9. Nonablative Fractional Laser Resurfacing for Acne Scarring in Patients With Fitzpatrick Skin Phototypes IV-VI.

    Science.gov (United States)

    Alexis, Andrew F; Coley, Marcelyn K; Nijhawan, Rajiv I; Luke, Janiene D; Shah, Sejal K; Argobi, Yahya A; Nodzenski, Michael; Veledar, Emir; Alam, Murad

    2016-03-01

    There is a paucity of studies investigating laser resurfacing in Fitzpatrick skin phototypes (SPT) IV to VI. To assess the efficacy and safety of fractional nonablative laser resurfacing in the treatment of acne scarring in patients with SPT IV to VI. The authors conducted a randomized, investigator-blinded and rater-blinded, split-face comparative study of adults with SPT IV to VI and facial acne scars treated with 2 different density settings and the same fluence. Quantitative global scarring grading system (QGSGS) scores were significantly improved from baseline at 16 and 24 weeks (p = .0277). Improvements in QGSGS scores after higher and lower density treatments were statistically similar (p = .96). The live-blinded dermatologist, the blinded dermatologist photoraters, and the patients rated scars as being significantly more improved by visual analog scale at weeks 16 and 24 compared with baseline (p skin types IV to VI. Self-limited postinflammatory hyperpigmentation was a common occurrence, especially with higher treatment densities.

  10. Effect of HIP temperature and cooling rate on microstructure and hardness of joints for ODS-RAFM steels and JLF-1 steel

    International Nuclear Information System (INIS)

    Fu, Haiying; Nagasaka, Takuya; Muroga, Takeo; Kimura, Akihiko; Ukai, Shigeharu

    2016-01-01

    Dissimilar-metal joints between ODS-RAFM (oxide-dispersion-strengthened reduced activation ferritic/martensitic) steels and JLF-1 steel were fabricated by hot isostatic pressing (HIP) at 1000 - 1100degC with a cooling rate of 5degC/min. After the HIP, it was always quenched martensite for JLF-1 steel. However, coarse precipitates were found in 9Cr-ODS. Additional annealing experiments to simulate HIP conditions were conducted for 9Cr-ODS with cooling rate ranged from 0.5 to 36degC/min at 800 - 1100degC. The results showed that, to form quenched martensite for 9Cr-ODS, the HIP temperature should be above 1000degC with cooling rate no less than 25dgeC/min. When the cooling rate is increased to 36degC/min, the microstructure of 9Cr-ODS is quenched martensite with precipitate size similar as that before HIP. If the limitation of precipitate size in 9Cr-ODS is 0.2 µm, HIP temperature above 1050degC with cooling rate no less than 30degC/min is needed. In this case, post-weld heat treatment (PWHT) with only tempering is necessary to recover the microstructure of 9Cr-ODS to tempered martensite. For 12Cr-ODS, the HIP temperature and cooling rate has no effect on hardness and precipitate size. PWHT is not necessary for the single-metal joint of 12Cr-ODS from the view point of precipitation control. However, for the dissimilar-metal joints between ODS-RAFM steels and JLF-1 steel, the PWHT condition should be comprehensively determined by considering microstructural evolution of each part in the joints after HIP. (author)

  11. Revision hip preservation surgery with hip arthroscopy: clinical outcomes.

    Science.gov (United States)

    Domb, Benjamin G; Stake, Christine E; Lindner, Dror; El-Bitar, Youseff; Jackson, Timothy J

    2014-05-01

    To analyze and report the clinical outcomes of a cohort of patients who underwent revision hip preservation with arthroscopy and determine predictors of positive and negative outcomes. During the study period from April 2008 to December 2010, all patients who underwent revision hip preservation with arthroscopy were included. This included patients who had previous open surgery and underwent revision with arthroscopy. Patient-reported outcome (PRO) scores were obtained preoperatively and at 3-month, 1-year, 2-year, and 3-year follow-up time points. Any revision surgeries and conversions to total hip arthroplasty were noted. A multiple regression analysis was performed to look for positive and negative predictive factors for improvement in PROs after revision hip arthroscopy. Forty-seven hips in 43 patients had completed 2 years' follow-up or needed total hip arthroplasty. The mean length of follow-up was 29 months (range, 24 to 47 months). Of the hips, 31 (66%) had either unaddressed or incompletely treated femoroacetabular impingement. There was a significant improvement in all PRO scores at a mean of 29 months after revision (P arthroscopy can achieve moderately successful outcomes and remains a viable treatment strategy after failed primary hip preservation surgery. Preoperative predictors of success after revision hip arthroscopy include segmental labral defects, unaddressed or incompletely addressed femoroacetabular impingement, heterotopic ossification, and previous open surgery. Level IV, therapeutic case series. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  12. Randomized, Split-Face/Décolleté Comparative Trial of Procedure Enhancement System for Fractional non-Ablative Laser Resurfacing Treatment.

    Science.gov (United States)

    Robinson, Deanne Mraz; Frulla, Ashton P

    2017-07-01

    INTRODUCTION: A topical proprietary procedural enhancement system (PES) containing a combination of active ingredients including a tripeptide and hexapeptide (TriHex Technology™, Alastin Procedure Enhancement Invasive System, ALASTIN Skincare™, Inc., Carlsbad, CA) has been used successfully to aid in healing and improve symptomatology following resurfacing procedures. METHODS: PES (Gentle Cleanser, Regenerating Skin Nectar with TriHex Technology™, Ultra Nourishing Moisturizer with TriHex Technology™, Soothe + Protect Recovery Balm, Broad Spectrum 30+ Sunscreen) was compared to a basic regimen (Aquaphor™, Cerave™ cleanser, Vanicream™, Alastin Broad Spectrum 30+ Sunscreen) in a split face/ décolleté trial following fractional non-ablative thulium-doped resurfacing treatment to the face or décolleté. The skin was pre-conditioned and treated during and after the procedure using the two regimens. RESULTS: A blinded investigator rated the PES statistically superior to the basic regimen on healing post-laser treatment on day 4 based on lentigines, texture, and Global Skin Quality. Subjects also reported 'better looking and feeling' skin on the PES side. CONCLUSION: PES appears to improve healing post-non ablative thulium-doped resurfacing treatment to the face/décolleté in comparison with standard of care. J Drugs Dermatol. 2017;16(7):707-710..

  13. Does the grading of chondromalacia patellae influence anterior knee pain following total knee arthroplasty without patellar resurfacing?

    Science.gov (United States)

    Zha, Guo-Chun; Feng, Shuo; Chen, Xiang-Yang; Guo, Kai-Jin

    2018-03-01

    The influence of chondromalacia patellae (CMP) on post-operative anterior knee pain (AKP) following total knee arthroplasty (TKA) remains controversial, and few studies have focused on the relationship between them. The purpose of this study was to determine whether different CMP grades affect the incidence of AKP after TKA without patellar resurfacing. We performed a retrospective analysis of prospectively collected data on 290 TKAs with the use of the low contact stress mobile-bearing prosthesis, without patellar resurfacing in 290 patients from February 2009 to January 2013. Patients were assessed by the Outerbridge classification for CMP, visual analog scale for AKP, the Knee Society clinical scoring system of knee score (KS), function score (FS), the patellar score (PS) for clinical function, and patients' satisfaction. The intra-operative grading of CMP: grade I in 30 patients, grade II in 68 patients, grade III in 97 patients, and grade IV in 95 patients. The incidence of AKP at 36-month follow-up was 10.3% (30/290). No statistical difference was detected among the different CMP grades in terms of the incidence of AKP (p = 0.995), patients' satisfaction (p = 0.832), KS (p = 0.228), FS (p = 0.713), and PS (p = 0.119) at 36-month follow-up. The findings may suggest no relevant influence of CMP grading on the incidence of AKP after TKA without patellar resurfacing.

  14. Hip instability: a review of hip dysplasia and other contributing factors

    Science.gov (United States)

    Kraeutler, Matthew J.; Garabekyan, Tigran; Pascual-Garrido, Cecilia; Mei-Dan, Omer

    2016-01-01

    Summary Background Hip instability has classically been associated with developmental dysplasia of the hip (DDH) in newborns and children. However, numerous factors may contribute to hip instability in children, adolescents, and adults. Purpose This review aims to concisely present the literature on hip instability in patients of all ages in order to guide health care professionals in the appropriate diagnosis and treatment of the various disorders which may contribute to an unstable hip. Methods We reviewed the literature on the diagnosis and surgical management of hip dysplasia and other causes of hip instability. Conclusions Multiple intra- and extra-articular variables may contribute to hip instability, including acetabular bony coverage, femoral torsion, femoroacetabular impingement, and soft tissue laxity. Physical examination and advanced imaging studies are essential to accurately diagnose the pathology contributing to a patient’s unstable hip. Conservative management, including activity modification and physical therapy, may be used as a first-line treatment in patients with intra-articular hip pathology. Patients who continue to experience symptoms of pain or instability should proceed with arthroscopic or open surgical treatment aimed at correcting the underlying pathology. Level of evidence V. PMID:28066739

  15. Complete horizontal skin cell resurfacing and delayed vertical cell infiltration into porcine reconstructive tissue matrix compared to bovine collagen matrix and human dermis.

    Science.gov (United States)

    Mirastschijski, Ursula; Kerzel, Corinna; Schnabel, Reinhild; Strauss, Sarah; Breuing, Karl-Heinz

    2013-10-01

    Xenogenous dermal matrices are used for hernia repair and breast reconstruction. Full-thickness skin replacement is needed after burn or degloving injuries with exposure of tendons or bones. The authors used a human skin organ culture model to study whether porcine reconstructive tissue matrix (Strattice) is effective as a dermal tissue replacement. Skin cells or split-thickness skin grafts were seeded onto human deepidermized dermis, Strattice, and Matriderm. Cellular resurfacing and matrix infiltration were monitored by live fluorescence imaging, histology, and electron microscopy. Proliferation, apoptosis, cell differentiation, and adhesion were analyzed by immunohistochemistry. Epithelial resurfacing and vertical proliferation were reduced and delayed with both bioartificial matrices compared with deepidermized dermis; however, no differences in apoptosis, cell differentiation, or basement membrane formation were found. Vertical penetration was greatest on Matriderm, whereas no matrix infiltration was found on Strattice in the first 12 days. Uncompromised horizontal resurfacing was greatest with Strattice but was absent with Matriderm. Strattice showed no stimulatory effect on cellular inflammation. Matrix texture and surface properties governed cellular performance on tissues. Although dense dermal compaction delayed vertical cellular ingrowth for Strattice, it allowed uncompromised horizontal resurfacing. Dense dermal compaction may slow matrix decomposition and result in prolonged biomechanical stability of the graft. Reconstructive surgeons should choose the adequate matrix substitute depending on biomechanical requirements at the recipient site. Strattice may be suitable as a dermal replacement at recipient sites with high mechanical load requirements.

  16. 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

    During the past decade a series of published reports have examined the value of studying the relation between hip circumferences and cardiovascular end points. Specifically, in a series of recent studies the independent effects of hip circumference have been studied after adjustment for general o...... 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....... 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...

  17. Unilateral hip osteoarthritis: can we predict the outcome of the other hip?

    International Nuclear Information System (INIS)

    Vossinakis, I.C.; Georgiades, G.; Hartofilakidis, G.; Kafidas, D.

    2008-01-01

    The objective of this study was to define, in unilateral hip osteoarthritis (OA), factors predicting the outcome of the other hip. We examined the anteroposterior radiographs of the pelvis of 95 white patients with unilateral idiopathic (56 patients) or secondary to congenital hip diseases (39 patients) OA. The other hip was free from symptoms (pain or limping) at the initial examination and without radiographic evidence of OA; it was what we call a ''normal'' hip. Two parameters were evaluated: (1) the type of osteoarthritis of the involved hip and (2) the range of four radiographic indices of the contralateral hip: the sourcil inclination (weight-bearing surface), the acetabular angle, the Wiberg's center-edge angle, and the neck-shaft angle. Follow-up radiographs for the hips that remained OA-free were available for 10 to 35 years and for those that developed OA, at the time of initial symptoms, range 2 to 31 years. Logistic regression analysis showed that the presence of idiopathic OA in one hip had a statistically significant effect on the development of OA on the other hip (p<0.001). Minor deviations of radiographic indices of the contralateral hip is not a predictive factor for its outcome. When the radiographic indices are examined together with the pathology of the involved hip, only WBS was shown to have a significant effect to the development of OA and its type (p < 0.001). The following conclusions can be drawn from this study: 1. Patient with idiopathic OA of one hip is at increased risk of developing OA in the other hip. 2. The outcome of the other hip cannot be predicted only on the basis of the evaluation of its radiographic indices. 3. Among the different indices, WBS seems to have a strong influence toward the development of OA. (orig.)

  18. The efficacy of autologous platelet rich plasma combined with ablative carbon dioxide fractional resurfacing for acne scars: a simultaneous split-face trial.

    Science.gov (United States)

    Lee, Jin Woong; Kim, Beom Joon; Kim, Myeung Nam; Mun, Seog Kyun

    2011-07-01

    Ablative carbon dioxide (CO(2) ) fractional resurfacing is a promising therapeutic intervention for the treatment of acne scars, although this technique is associated with prolonged surgical site erythema and edema, which may affect the daily lives of patients. Autologous platelet-rich plasma (PRP) is known to enhance wound healing and has applications in many areas of medicine. To evaluate the synergistic effects of autologous PRP with CO(2) fractional resurfacing for acne scars. A split-face trial was conducted in 14 Korean participants with acne scars. All participants received one session of ablative CO(2) fractional resurfacing. Immediately after resurfacing, facial halves were randomly assigned to receive treatment with autologous PRP injections on one side (experimental side) and normal saline injections on the other side (control side). The participants were monitored for degree of recovery and resurfacing-associated adverse events, including prolonged erythema, edema, and other effects on days 0, 2, 4, 6, 8, 15, and 30. The intensity of erythema was objectively measured using a chromometer at the same time intervals. After one additional treatment session using the same protocol, two independent dermatologists evaluated clinical improvement using a quartile grading scale. All participants completed the study. Erythema on the experimental side improved faster than on the control side and was significantly less at day 4 (p=.01). This difference was confirmed using a chromometer (p=.049). Total duration of erythema was an average of 10.4±2.7 days on the control side and 8.6±2.0 days on the experimental side (p=.047). Edema also improved faster on the experimental side than on the control side. The total duration of edema was an average of 7.1±1.5 days on the control side and 6.1±1.1 days on the experimental side (p=.04). Participants were also assessed for duration of post-treatment crusting, with a mean of 6.8±1.0 days on the control side and 5.9±1

  19. Reliability and Validity of the Hip Stability Isometric Test (HipSIT): A New Method to Assess Hip Posterolateral Muscle Strength.

    Science.gov (United States)

    Almeida, Gabriel Peixoto Leão; das Neves Rodrigues, Helena Larissa; de Freitas, Bruno Wesley; de Paula Lima, Pedro Olavo

    2017-12-01

    Study Design Cross-sectional study. Background The Hip Stability Isometric Test (HipSIT) evaluates the strength of the hip posterolateral stabilizers in a position that favors greater activation of the gluteus maximus and gluteus medius and lower activation of the tensor fascia lata. Objectives To check the validity and reliability of the HipSIT and to evaluate the HipSIT in women with patellofemoral pain (PFP). Methods The HipSIT was evaluated with a handheld dynamometer. During testing, the participants were sidelying, with their legs positioned at 45° of hip flexion and 90° of knee flexion. Participants were instructed to raise the knee of the upper leg while keeping the upper and lower heels in contact. To establish reliability and validity, 49 women were tested with the HipSIT by 2 different evaluators on day 1, and then again 7 days later. The strength of the hip extensors, abductors, and external rotators was also evaluated. Twenty women with unilateral PFP were also evaluated. Results The HipSIT has excellent intrarater and interrater reliability. The standard error of measurement was 0.01 kgf/kg, and the minimal detectable change was 0.036 kgf/kg. The HipSIT showed good validity in isolated hip abduction, external rotation, and extension (Pstrength deficits in women with PFP. J Orthop Sports Phys Ther 2017;47(12):906-913. Epub 9 Oct 2017. doi:10.2519/jospt.2017.7274.

  20. Random fractional ultrapulsed CO2 resurfacing of photodamaged facial skin: long-term evaluation.

    Science.gov (United States)

    Tretti Clementoni, Matteo; Galimberti, Michela; Tourlaki, Athanasia; Catenacci, Maximilian; Lavagno, Rosalia; Bencini, Pier Luca

    2013-02-01

    Although numerous papers have recently been published on ablative fractional resurfacing, there is a lack of information in literature on very long-term results. The aim of this retrospective study is to evaluate the efficacy, adverse side effects, and long-term results of a random fractional ultrapulsed CO2 laser on a large population with photodamaged facial skin. Three hundred twelve patients with facial photodamaged skin were enrolled and underwent a single full-face treatment. Six aspects of photodamaged skin were recorded using a 5 point scale at 3, 6, and 24 months after the treatment. The results were compared with a non-parametric statistical test, the Wilcoxon's exact test. Three hundred one patients completed the study. All analyzed features showed a significant statistical improvement 3 months after the procedure. Three months later all features, except for pigmentations, once again showed a significant statistical improvement. Results after 24 months were similar to those assessed 18 months before. No long-term or other serious complications were observed. From the significant number of patients analyzed, long-term results demonstrate not only how fractional ultrapulsed CO2 resurfacing can achieve good results on photodamaged facial skin but also how these results can be considered stable 2 years after the procedure.

  1. Hip fractures. Epidemiology, risk factors, falls, energy absorption, hip protectors, and prevention

    DEFF Research Database (Denmark)

    Lauritzen, J B

    1997-01-01

    have a high risk of hip fracture (annual rate of 5-6%), and the incidence of falls is about 1,500 falls/1,000 persons/year. Most hip fractures are a result of a direct trauma against the hip. The incidence of falls on the hip among nursing home residents is about 290 falls/1,000 persons/year and about......%, corresponding to 9 out of 247 residents saved from sustaining a hip fracture. The review points to the essentials of the development of hip fracture, which constitutes; risk of fall, type of fall, type of impact, energy absorption, and lastly bone strength, which is the ultimate and last permissive factor......The present review summarizes the pathogenic mechanisms leading to hip fracture based on epidemiological, experimental, and controlled studies. The estimated lifetime risk of hip fracture is about 14% in postmenopausal women and 6% in men. The incidence of hip fractures increases exponentially...

  2. The contact mechanics and occurrence of edge loading in modular metal-on-polyethylene total hip replacement during daily activities.

    Science.gov (United States)

    Hua, Xijin; Li, Junyan; Jin, Zhongmin; Fisher, John

    2016-06-01

    The occurrence of edge loading in hip joint replacement has been associated with many factors such as prosthetic design, component malposition and activities of daily living. The present study aimed to quantify the occurrence of edge loading/contact at the articulating surface and to evaluate the effect of cup angles and edge loading on the contact mechanics of a modular metal-on-polyethylene (MoP) total hip replacement (THR) during different daily activities. A three-dimensional finite element model was developed based on a modular MoP bearing system. Different cup inclination and anteversion angles were modelled and six daily activities were considered. The results showed that edge loading was predicted during normal walking, ascending and descending stairs activities under steep cup inclination conditions (≥55°) while no edge loading was observed during standing up, sitting down and knee bending activities. The duration of edge loading increased with increased cup inclination angles and was affected by the cup anteversion angles. Edge loading caused elevated contact pressure at the articulating surface and substantially increased equivalent plastic strain of the polyethylene liner. The present study suggested that correct positioning the component to avoid edge loading that may occur during daily activities is important for MoP THR in clinical practice. Copyright © 2016. Published by Elsevier Ltd.

  3. Periprosthetic fungal infection of a hip caused by Trichosporon inkin

    Directory of Open Access Journals (Sweden)

    Federico José Burgo, MD

    2018-03-01

    Full Text Available An immunocompromised patient with a history of multiple hip implant revisions extended courses of empiric antibiotic treatment, and a retained metallic rod in the femoral medullary canal was transferred for diagnostic studies and treatment. A high suspicion of fungal infection and utilization of extended and specific fungal cultures were the diagnostic keys for infection with Trichosporon inkin. The treatment consisted in a debridement surgery with the use of a functional spacer with cement supplemented with voriconazole and vancomycin plus a 6-month systemic treatment with voriconazole. After 2 years of follow-up, the patient is free of symptoms. Keywords: Hip arthroplasty, Periprosthetic fungal infection, Trichosporon inkin

  4. Combination of microneedle radiofrequency (RF), fractional RF skin resurfacing and multi-source non-ablative skin tightening for minimal-downtime, full-face skin rejuvenation.

    Science.gov (United States)

    Kaplan, Haim; Kaplan, Lilach

    2016-12-01

    In the recent years, there is a growth in demand for radiofrequency (RF)-based procedures to improve skin texture, laxity and contour. The new generation of systems allow non-invasive and fractional resurfacing treatments on one platform. The aim of this study was to evaluate the safety and efficacy of a new treatment protocol using a multisource RF, combining 3 different modalities in each patient: [1] non-ablative RF skin tightening, [2] fractional skin resurfacing, and [3] microneedling RF for non-ablative coagulation and collagen remodelling. 14 subjects were enrolled in this study using EndyMed PRO ™ platform. Each patient had 8 non-ablative treatments and 4 fractional treatments (fractional skin resurfacing and Intensif). The global aesthetic score was used to evaluate improvement. All patients had improvement in skin appearance. About 43% had excellent or very good improvement above 50%, 18% had good improvement between 25 and 50%, and the rest 39% had a mild improvement of skin texture, skin laxity and wrinkle reduction achieved using RF treatment platform.

  5. Sonography for hip joint effusion in adults with hip pain

    NARCIS (Netherlands)

    S.M. Bierma-Zeinstra (Sita); A.M. Bohnen (Arthur); J.A.N. Verhaar (Jan); A. Prins (Ad); J.S. Lameris; A.Z. Ginai (Abida)

    2000-01-01

    textabstractOBJECTIVE: To study the prevalence of ultrasonic hip joint effusion and its relation with clinical, radiological and laboratory (ESR) findings in adults with hip pain. METHODS: Patients (n = 224) aged 50 years or older with hip pain, referred by the general

  6. Gluteal tendinopathy and hip osteoarthritis: Different pathologies, different hip biomechanics.

    Science.gov (United States)

    Allison, Kim; Hall, Michelle; Hodges, Paul W; Wrigley, Tim V; Vicenzino, Bill; Pua, Yong-Hao; Metcalf, Ben; Grimaldi, Alison; Bennell, Kim L

    2018-03-01

    Gluteal tendinopathy (GT) and hip osteoarthritis (OA) are the most common causes of hip pain and associated disability in older adults. Pain and altered walking biomechanics are common to both conditions. This study aimed to compare three-dimensional walking biomechanics between individuals with unilateral, symptomatic GT and HOA. Sixty individuals with symptomatic unilateral GT confirmed by magnetic-resonance-imaging and 73 individuals with symptomatic unilateral HOA (Kellgren-Lawrence Grade ≥ 2) underwent three-dimensional gait analysis. Maximum and minimum values of the external sagittal hip moment, the first peak, second peak and mid-stance minimum of the hip adduction moment (HAM), sagittal plane hip excursion and hip joint angles, pelvic obliquity and trunk lean, at the three HAM time points during stance phase of walking were compared between groups. Compared to individuals with HOA, those with GT exhibited a greater hip peak extension moment (P < 0.001) and greater HAM throughout the stance phase of walking (P = 0.01-P < 0.001), greater hip adduction (P < 0.001) and internal rotation (P < 0.01-P < 0.001) angles and lower hip flexion angles and excursion (P = 0.02 - P < 0.001). Individuals with HOA exhibited a greater forward trunk lean (P ≤ 0.001) throughout stance, and greater ipsilateral trunk lean in the frontal plane (P < 0.001) than those with GT. Despite presence of pain in both conditions, hip kinematics and kinetics differ between individuals with symptomatic unilateral GT and those with symptomatic unilateral HOA. These condition-specific impairments may be targets for optimization of management of HOA and GT. Copyright © 2018 Elsevier B.V. All rights reserved.

  7. Conditioning in laser skin resurfacing - betulin emulsion and skin recovery.

    Science.gov (United States)

    Metelmann, Hans-Robert; Podmelle, Fred; Waite, Peter D; Müller-Debus, Charlotte Friederieke; Hammes, Stefan; Funk, Wolfgang

    2013-04-01

    Laser skin resurfacing of the face by CO₂-laser ablation is causing superficial wounds that need rapid recovery to reduce the risk of infection, the risk of chronification and as a result the risk of unaesthetic scars. The question being addressed by this study is to demonstrate benefit of betulin emulsion skin care after CO₂-laser wounds. The outcome of this aesthetic comparison between betulin emulsion, moist wound dressing and gauze covering in promoting the recovery process in laser skin ablation is to demonstrate improved aesthetic benefit for the patient. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  8. Hip Strength Testing of Soccer Players With Long-Standing Hip and Groin Pain

    DEFF Research Database (Denmark)

    Rafn, Bolette S; Tang, Lars; Nielsen, Peter Martin

    2016-01-01

    OBJECTIVE: To investigate whether self-reported pain during hip strength testing correlates to a large degree with hip muscle strength in soccer players with long-standing unilateral hip and groin pain. DESIGN: Cross-sectional study. SETTING: Clinical assessments at Sports Orthopaedic Research...... Center-Copenhagen (SORC-C), Arthroscopic Centre Amager, Copenhagen University Hospital, Denmark. PARTICIPANTS: Twenty-four male soccer players with unilateral long-standing hip and groin pain. INTERVENTIONS: The soccer players performed 5 reliable hip muscle strength tests (isometric hip flexion...... strength (Spearman rho = -0.44, P = 0.016). CONCLUSIONS: Self-reported pain during testing does not seem to correlate with the majority of hip muscle strength tests used in soccer players with long-standing hip and groin pain....

  9. Sonography for hip joint effusion in adults with hip pain

    NARCIS (Netherlands)

    Bierma-Zeinstra, S. M.; Bohnen, A. M.; Verhaar, J. A.; Prins, A.; Ginai-Karamat, A. Z.; Laméris, J. S.

    2000-01-01

    To study the prevalence of ultrasonic hip joint effusion and its relation with clinical, radiological and laboratory (ESR) findings in adults with hip pain. Patients (n = 224) aged 50 years or older with hip pain, referred by the general practitioner for radiological investigation, underwent a

  10. Densification of Y2O3 by HIP

    International Nuclear Information System (INIS)

    Valin, F.; Maire, P.; Boncoeur, M.

    1986-11-01

    Densification of Y 2 O 3 by HIP was investigated in the range 1250 0 C-1550 0 C at a pressure of 150 MPa. Runs were made in metallic capsules with 200 g of powder. The powder under investigation is 99.9% purity, supplied by RHONE-POULENC. The study reveals the importance of residual gases in the HIP technique of powder densification. The density of the final product is in the range 93% to 100% of theoretical density depending on pretreatment (or outgassing) of the powder. Residual gases have been identified. Final products have been characterized by microscopy (grain size, porosity, microhardness). Porosity and grain size depend on pretreatment conditions. In particular a 1200 0 C pretreatment results in zero porosity and significant decrease of grain size. 4 tables, 11 figs, 16 refs

  11. In vivo effect of carbon dioxide laser-skin resurfacing and mechanical abrasion on the skin's microbial flora in an animal model.

    Science.gov (United States)

    Manolis, Evangelos N; Tsakris, Athanassios; Kaklamanos, Ioannis; Markogiannakis, Antonios; Siomos, Konstadinos

    2006-03-01

    Although beam-scanning carbon dioxide (CO2) lasers have provided a highly efficient tool for esthetic skin rejuvenation there has been no comprehensive animal studies looking into microbial skin changes following CO2 laser skin resurfacing. To evaluate the in vivo effects of CO2 laser skin resurfacing in an experimental rat model in comparison with mechanical abrasion on the skin microbial flora. Four separate cutaneous sections of the right dorsal surface of 10 Wistar rats were treated with a CO2 laser, operating at 18 W and delivering a radiant energy of 5.76 J/cm2, while mechanical abrasions of the skin were created on four sections of the left dorsal surface using a scalpel. Samples for culture and biopsies were obtained from the skin surfaces of the rats on day 1 of application of the CO2 laser or mechanical abrasion, as well as 10, 30, and 90 days after the procedure. The presence of four microorganisms (staphylococci, streptococci, diphtheroids, and yeasts) was evaluated as a microbe index for the skin flora, and colony counts were obtained using standard microbiological methods. Skin biopsy specimens, following CO2 laser treatment, initially showed epidermal and papillary dermal necrosis and later a re-epithelization of the epidermis as well as the generation of new collagen on the upper papillary dermis. The reduction in microbial counts on day 1 of the CO2 laser-inflicted wound was statistically significant for staphylococci and diphtheroids compared with the baseline counts (p=.004 and pSkin resurfacing using CO2 lasers considerably reduces microbial counts of most microorganisms in comparison with either normal skin flora or a scalpel-inflicted wound. This might contribute to the positive clinical outcome of laser skin resurfacing.

  12. The current state of bearing surfaces in total hip replacement.

    Science.gov (United States)

    Rajpura, A; Kendoff, D; Board, T N

    2014-02-01

    We reviewed the literature on the currently available choices of bearing surface in total hip replacement (THR). We present a detailed description of the properties of articulating surfaces review the understanding of the advantages and disadvantages of existing bearing couples. Recent technological developments in the field of polyethylene and ceramics have altered the risk of fracture and the rate of wear, although the use of metal-on-metal bearings has largely fallen out of favour, owing to concerns about reactions to metal debris. As expected, all bearing surface combinations have advantages and disadvantages. A patient-based approach is recommended, balancing the risks of different options against an individual's functional demands.

  13. Hip Replacement Surgery

    Science.gov (United States)

    ... Outreach Initiative Breadcrumb Home Health Topics English Español Hip Replacement Surgery Basics In-Depth Download Download EPUB ... PDF What is it? Points To Remember About Hip Replacement Surgery Hip replacement surgery removes damaged or ...

  14. "Palmar pivot flap" for resurfacing palmar lateral defects of the fingers.

    Science.gov (United States)

    Yam, Andrew; Peng, Yeong-Pin; Pho, Robert Wan-Heng

    2008-12-01

    Soft tissue defects on the lateral borders of the digits are difficult to reconstruct using local or local-regional flaps. We describe a "palmar pivot flap" to resurface an adjacent defect on the palmar-lateral aspect of the digit. The surgical technique is described. This flap is an axial pattern flap based on the subcutaneous transverse branches of the digital artery. The flap is pivoted up to 90 degrees on the neurovascular bundle in its base, into an adjacent defect. The flap can be raised from either the proximal or the middle phalangeal segments. It can cover defects sited from the level of the proximal interphalangeal joint up to the fingertip. The donor defect is limited to the same digit and is covered with a full-thickness skin graft. We have used this flap on 3 patients with defects at the middle phalangeal segment, the distal interphalangeal joint, and the fingertip. All healed primarily. One patient had a mild flexion contracture of the proximal interphalangeal joint, whereas the other 2 had no complications. The patients with distal interphalangeal joint and fingertip defects had excellent sensation in the flap (2-point discrimination of 5-6 mm). The palmar pivot flap is useful for resurfacing otherwise difficult defects on the lateral borders of the digits around and distal to the proximal interphalangeal joint, including those at the fingertip. It provides sensate, glabrous skin. The donor defect is on the same digit and is well hidden, producing an aesthetic and functional reconstruction.

  15. Analysis of medical device materials with the local electrode atom probe

    International Nuclear Information System (INIS)

    Goodman, S.L.; Mengelt, T.J.; Ali, M.; Ulfig, R.M.; Martens, R.M.; Kelly, T.F.; Kostrna, S.L.P.; Kostrna, M.S.; Carmichael, W.J.

    2004-01-01

    Full text: As medical technology advances towards microsurgical and minimally invasive techniques, there is a drive to produce ever-smaller devices that demand higher material performance and hence enhanced nano and micro-scale control of material structure. These devices are made from stainless steel alloys, Nitinol, titanium, CoCrMo, and non-metals such as pyrolytic carbon and silicon. These applications are made possible due to suitable physical and mechanical properties, good corrosion resistance in biological environments, reasonable biocompatibility, and good manufacturability. With respect to the metals, the nano-structure and composition of the material surface, typically an oxide, is especially critical since biological responses and corrosion occur at the material-environment interface. Thus, there is an increasing need to understand the 3-D structure and composition of metallic biomaterials at the atomic scale. Three-dimensional atom probe microscopy can uniquely provide such atomic-level structural information. In the present study several of these medical device materials were examined. These include a 316L stainless steel alloy which is widely used in implanted spinal fixation devices, bone screws, cardiovascular and neurological stents, a cast CoCrMo acetabular hip cup of a Cormet metal-on-metal Hip Resurfacing System (Corin Group, Cirencester, England) that was rejected for clinical use, Nitinol wires specimens such as are used for stents and guide wires, and low temperature pyrolytic carbon as used in clinical heart valve prosthetics. (author)

  16. Hip arthroscopy

    Directory of Open Access Journals (Sweden)

    Henrique Antônio Berwanger de Amorim Cabrita

    2015-06-01

    Full Text Available Hip arthroscopy is a safe method for treating a variety of pathological conditions that were unknown until a decade ago. Femoroacetabular impingement is the commonest of these pathological conditions and the one with the best results when treated early on. The instruments and surgical technique for hip arthroscopy continue to evolve. New indications for hip arthroscopy has been studied as the ligamentum teres injuries, capsular repair in instabilities, dissection of the sciatic nerve and repair of gluteal muscles tears (injuries to the hip rotator cuff, although still with debatable reproducibility. The complication rate is low, and ever-better results with fewer complications should be expected with the progression of the learning curve.

  17. 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

    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......). 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...

  18. Current and future biocompatibility aspects of biomaterials for hip prosthesis

    Directory of Open Access Journals (Sweden)

    Amit Aherwar

    2015-12-01

    Full Text Available The field of biomaterials has turn into an electrifying area because these materials improve the quality and longevity of human life. The first and foremost necessity for the selection of the biomaterial is the acceptability by human body. However, the materials used in hip implants are designed to sustain the load bearing function of human bones for the start of the patient’s life. The most common classes of biomaterials used are metals, polymers, ceramics, composites and apatite. These five classes are used individually or in combination with other materials to form most of the implantation devices in recent years. Numerous current and promising new biomaterials i.e. metallic, ceramic, polymeric and composite are discussed to highlight their merits and their frailties in terms of mechanical and metallurgical properties in this review. It is concluded that current materials have their confines and there is a need for more refined multi-functional materials to be developed in order to match the biocompatibility, metallurgical and mechanical complexity of the hip prosthesis.

  19. [Revision hip arthroplasty by Waldemar Link custom-made total hip prosthesis].

    Science.gov (United States)

    Medenica, Ivica; Luković, Milan; Radoicić, Dragan

    2010-02-01

    The number of patients undergoing hip arthroplasty revision is constantly growing. Especially, complex problem is extensive loss of bone stock and pelvic discontinuity that requires reconstruction. The paper presented a 50-year old patient, who ten years ago underwent a total cement artrhroplasty of the left hip. A year after the primary operation the patient had difficulties in walking without crutches. Problems intensified in the last five years, the patient had severe pain, totally limited movement in the left hip and could not walk at all. Radiographically, we found loose femoral component, massive loss of bone stock of proximal femur, acetabular protrusion and a consequent pelvic discontinuity. Clinically, a completely disfunctional left hip joint was registered (Harris hip score--7.1). We performed total rearthroplasty by a custom-made Waldemar Link total hip prosthesis with acetabular antiprotrusio cage and compensation of bone defects with a graft from the bone bank. A year after the operation, we found clinically an extreme improvement in Harris hip score--87.8. Radiographically, we found stability of implanted components, a complete graft integration and bone bridging across the site of pelvic discontinuity. Pelvic discontinuity and massive loss of proximal femoral bone stock is a challenging and complex entity. Conventional prostheses cannot provide an adequate fixation and stability of the hip. Application of custom-made prosthesis (measured specificaly for a patient) and additional alografting bone defects is a good method in revision surgery after unsuccessful hip arthroplasty with extensive bone defects.

  20. Multisource radiofrequency for fractional skin resurfacing-significant reduction of wrinkles.

    Science.gov (United States)

    Dahan, Serge; Rousseaux, Isabelle; Cartier, Hugues

    2013-04-01

    Skin roughness, color change, wrinkles and skin laxity are the main characteristics of aging skin. Dermatologists and plastic surgeons look for a treatment that will provide both epidermal resurfacing for the improvement of skin roughness and deep volumetric heating that will trigger collagen remodeling in the dermis to reduce wrinkles and skin laxity. These goals should be achieved with minimal pain and downtime. The study included 10 subjects (Fitzpatrick's skin type 2-3) with Fitzpatrick wrinkle and elastosis scale of 5-8 (average 7.3). Treatment was done with the Fractional skin resurfacing handpiece of the EndyMed PRO multisource radiofrequency system (EndyMed Ltd, Cesarea, Israel). Treatment was repeated each month up to a total of three treatment sessions. Patients photographs were graded according to accepted scales by a board certified dermatologists. Patients' pain and satisfaction were scored using dedicated questionnaires. Doctors' satisfaction was also evaluated. Post treatment skin erythema was noted in all treated patients, lasting up to 10 hours. Fifty six percent of patients reported no pain after treatment, and the rest (44%) reported minimal pain. All patients showed significant reduction in the Fitzpatrick wrinkle score. Average Fitzpatrick wrinkle score was 7.3 at baseline, 4.9 at 1 month after the first treatment, 4.2 at 1 month after the second treatment, and 4.1 at 1 month after the third treatment. The score was similar at 3 months after the third treatment with a score of 4.1. When asked at the end of three treatment sessions, all patients answered they will recommend the treatment to their friends (66% "definitely yes" and 33% "yes"). When asked the same question 3 months after the end of treatment, all patients (100%) answered "definitely yes".

  1. Magnetic resonance imaging features of complications following hip replacement: A pictorial review

    Directory of Open Access Journals (Sweden)

    Khushboo Pilania

    2016-01-01

    Full Text Available Hip replacement surgery helps millions of people worldwide walk painlessly each year. With increasing life spans and decreased clinical threshold for surgery, this number will continue to rise. With the increase in the number of surgeries and the longevity of implants, the need for early and prompt diagnosis of complications is also rising. This essay underlines the fact that magnetic resonance imaging on a 1.5T scanner with specialized metal artefact reduction sequences is a viable technique to image the post-arthroplasty hip and has vast potential in the prompt and early diagnosis of complications in these patients.

  2. Magnetic resonance imaging features of complications following hip replacement: A pictorial review

    International Nuclear Information System (INIS)

    Pilania, Khushboo; Jankharia, Bhavin

    2016-01-01

    Hip replacement surgery helps millions of people worldwide walk painlessly each year. With increasing life spans and decreased clinical threshold for surgery, this number will continue to rise. With the increase in the number of surgeries and the longevity of implants, the need for early and prompt diagnosis of complications is also rising. This essay underlines the fact that magnetic resonance imaging on a 1.5T scanner with specialized metal artefact reduction sequences is a viable technique to image the post-arthroplasty hip and has vast potential in the prompt and early diagnosis of complications in these patients

  3. Do cadmium, lead, and aluminum in drinking water increase the risk of hip fractures? A NOREPOS study.

    Science.gov (United States)

    Dahl, Cecilie; Søgaard, Anne Johanne; Tell, Grethe S; Flaten, Trond Peder; Hongve, Dag; Omsland, Tone Kristin; Holvik, Kristin; Meyer, Haakon E; Aamodt, Geir

    2014-01-01

    The aim of this study was to investigate relations between cadmium, lead, and aluminum in municipality drinking water and the incidence of hip fractures in the Norwegian population. A trace metals survey in 566 waterworks was linked geographically to hip fractures from hospitals throughout the country (1994-2000). In all those supplied from these waterworks, 5,438 men and 13,629 women aged 50-85 years suffered a hip fracture. Poisson regression models were fitted, adjusting for age, region of residence, urbanization, and type of water source as well as other possibly bone-related water quality factors. Effect modification by background variables and interactions between water quality factors were examined (correcting for false discovery rate). Men exposed to a relatively high concentration of cadmium (IRR = 1.10; 95 % CI 1.01, 1.20) had an increased risk of fracture. The association between relatively high lead and hip fracture risk was significant in the oldest age group (66-85 years) for both men (IRR = 1.11; 95 % CI 1.02, 1.21) and women (IRR = 1.10; 95 % CI 1.04, 1.16). Effect modification by degree of urbanization on hip fracture risk in men was also found for all three metals: cadmium, lead, and aluminum. In summary, a relatively high concentration of cadmium, lead, and aluminum measured in drinking water increased the risk of hip fractures, but the associations depended on gender, age, and urbanization degree. This study could help in elucidating the complex effects on bone health by risk factors found in the environment.

  4. Implications of the Utopia Gravity Anomaly for the Resurfacing of the Northern Plains of Mars

    Science.gov (United States)

    Banerdt, W. B.

    2004-01-01

    Whereas the surface units of the northern plain of Mars generally exhibit ages ranging from late Hesperian to Amazonian, interpretation of precise topographic measurements indicate that the age of the underlying "basement" is early Noachian, or almost as old as the southern highlands. This suggests that widespread but relatively superficial resurfacing has occurred throughout the northern plains since the end of early heavy bombardment. In this abstract I examine some of the possible implications of the subsurface structure inferred for the Utopia basin from gravity data on the nature of this resurfacing. The large, shallow, circular depression in Utopia Planitia has been identified as a huge impact basin, based on both geological evidence and detailed analysis of MOLA topography. Its diameter (approx. 3000 km) is equivalent to that of the Hellas basin, as is its inferred age (early Noachian). However, whereas Hellas is extremely deep with rough terrain and large slopes, the Utopia basin is a smooth, shallow, almost imperceptible bowl. Conversely, Utopia displays one of the largest (non-Tharsis-related) positive geoid anomalies on Mars, in contrast to a much more subdued negative anomaly over Hellas.

  5. Hip biomechanics during stair ascent and descent in people with and without hip osteoarthritis.

    Science.gov (United States)

    Hall, Michelle; Wrigley, Tim V; Kean, Crystal O; Metcalf, Ben R; Bennell, Kim L

    2017-07-01

    Hip osteoarthritis (OA) is often associated with pain and impaired function. Understanding biomechanical alterations in patients with hip OA during challenging activities such as stair use is important to inform treatments. The aim of this study was to determine whether kinematics and kinetics during stair ambulation differed between people with hip OA and healthy controls. Fifteen participants with symptomatic and radiographic hip OA and 15 asymptomatic healthy controls underwent 3-D motion analysis during stair ascent and descent. Trunk, pelvis, and hip kinematics as well as hip kinetics were evaluated. Analyses were performed unadjusted and adjusted for speed and leg length. In both the unadjusted and adjusted analyses, participants with hip OA ascended stairs with less hip range of motion in all three planes and a lower peak external rotation moment compared to controls. In the unadjusted analysis, hip OA participants descended stairs with greater ipsilateral trunk lean, less sagittal plane range of motion, lower peak extension moment, lower peak external rotation moment, and greater hip adduction moment impulse compared to controls. In the adjusted results, peak internal rotation moment and hip adduction moment impulse were greater in hip OA participants compared to controls. Findings show that individuals with hip OA display limited range of hip joint movement, particularly during stair ascent, and overall indicate the use of strategies (e.g., trunk lean; lower peak external rotation moment; higher adduction moment impulse) that implicate altered hip abductor function. Future research is required to further understand the implications of these findings on hip OA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1505-1514, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  6. 3D surface reconstruction and FIB microscopy of worn alumina hip prostheses

    Energy Technology Data Exchange (ETDEWEB)

    Zeng, P; Inkson, B J; Rainforth, W M [Department of Engineering Materials, Mappin St., University of Sheffield, Sheffield, S1 3JD (United Kingdom); Stewart, T [School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT (United Kingdom)], E-mail: m.rainforth@sheffield.ac.uk

    2008-08-15

    Interest in alumina-on-alumina total hip replacements (THR) continues to grow for the young and active patient due to their superior wear performance and biocompatibility compared to the alternative traditional polymer/metal prostheses. While alumina on alumina bearings offer an excellent solution, a region of high wear, known as stripe wear, is commonly observed on retrieved alumina hip components that poses concern. These in-vivo stripe wear mechanisms can be replicated in vitro by the introduction of micro-separation during the simulated walking cycle in hip joint simulation. However, the understanding of the mechanisms behind the stripe wear processes is relatively poor. 3D topographic reconstructions of titled SEM stereo pairs from different zones have been obtained to determine the local worn surface topography. Focused ion beam (FIB) microscopy was applied to examine the subsurface damage across the stripe wear. The paper presents novel images of sub-surface microcracks in alumina along with 3D reconstructions of the worn ceramic surfaces and a classification of four distinct wear zones following microseparation in hip prostheses.

  7. Athletic Hip Injuries.

    Science.gov (United States)

    Lynch, T Sean; Bedi, Asheesh; Larson, Christopher M

    2017-04-01

    Historically, athletic hip injuries have garnered little attention; however, these injuries account for approximately 6% of all sports injuries and their prevalence is increasing. At times, the diagnosis and management of hip injuries can be challenging and elusive for the team physician. Hip injuries are seen in high-level athletes who participate in cutting and pivoting sports that require rapid acceleration and deceleration. Described previously as the "sports hip triad," these injuries consist of adductor strains, osteitis pubis, athletic pubalgia, or core muscle injury, often with underlying range-of-motion limitations secondary to femoroacetabular impingement. These disorders can happen in isolation but frequently occur in combination. To add to the diagnostic challenge, numerous intra-articular disorders and extra-articular soft-tissue restraints about the hip can serve as pain generators, in addition to referred pain from the lumbar spine, bowel, bladder, and reproductive organs. Athletic hip conditions can be debilitating and often require a timely diagnosis to provide appropriate intervention.

  8. Revision hip arthroplasty by Waldemar Link custom-made total hip prosthesis

    Directory of Open Access Journals (Sweden)

    Medenica Ivica

    2010-01-01

    Full Text Available Background. The number of patients undergoing hip arthroplasty revision is constantly growing. Especially, complex problem is extensive loss of bone stock and pelvic discontinuity that requires reconstruction. Case report. The paper presented a 50-year old patient, who ten years ago underwent a total cement artrhroplasty of the left hip. A year after the primary operation the patient had difficulties in walking without crutches. Problems intensified in the last five years, the patient had severe pain, totally limited movement in the left hip and could not walk at all. Radiographically, we found loose femoral component, massive loss of bone stock of proximal femur, acetabular protrusion and a consequent pelvic discontinuity. Clinically, a completely disfunctional left hip joint was registered (Harris hip score - 7.1. We performed total rearthroplasty by a custom- made Waldemar Link total hip prosthesis with acetabular antiprotrusio cage and compensation of bone defects with a graft from the bone bank. A year after the operation, we found clinically an extreme improvement in Harris hip score - 87.8. Radiographically, we found stability of implanted components, a complete graft integration and bone bridging across the site of pelvic discontinuity. Conclusion. Pelvic discontinuity and massive loss of proximal femoral bone stock is a challenging and complex entity. Conventional prostheses cannot provide an adequate fixation and stability of the hip. Application of custom-made prosthesis (measured specifically for a patient and additional alografting bone defects is a good method in revision surgery after unsuccessful hip arthroplasty with extensive bone defects.

  9. Hip dysplasia: a significant risk factor for the development of hip osteoarthritis. A cross-sectional survey

    DEFF Research Database (Denmark)

    Jacobsen, Steffen; Sonne-Holm, Stig

    2005-01-01

    joint space width (JSW) /=60 yr of age. Of factors entered into logistic regression analyses, only age (P LT 0.001 for right hips and P LT 0.001 for left hips) and hip dysplasia (P LT 0.001 for right hips and P = 0.004 for left hips) were significantly associated with hip OA prevalence in women. In men......, only hip dysplasia was associated with hip OA prevalence, P LT 0.001 in right hips and P = 0.001 in left hips. CONCLUSIONS: Of the individual risk factors investigated in this study, only age and hip dysplasia were associated with the development of hip osteoarthritis.......OBJECTIVES: The aim of this cross-sectional survey of 2232 women and 1336 men (age range 20-91 yr) was to investigate individual risk factors for hip joint osteoarthritis (OA). METHODS: Standardized, weight-bearing pelvic radiographs were evaluated. Radiological hip joint OA was defined as minimum...

  10. Comparison of radiographic and radionuclide hip arthrography in determination of femoral component loosening of hip arthroplasties

    International Nuclear Information System (INIS)

    Capello, W.N.; Uri, B.G.; Wellman, H.N.; Robb, J.A.; Stiver, P.L.

    1985-01-01

    Radiographic examination of a patient experiencing pain following total hip arthroplasty is an important step in the systematic approach to evaluating component loosening, even though the information yielded is often equivocal and nondiagnostic in assessing component loosening. The radiographic criteria for loosening are especially difficult to assess following revision surgery, for radiolucent lines frequently exist at the bone-cement interface immediately following implantation. The advent of noncemented hip prostheses poses another problem: the routinely noted disruption of bone-cement of prosthesis-cement interfaces is not present with uncemented prostheses. As the criteria for loosening of the noncemented prostheses are still evolving, plain radiographic examination is frequently nondiagnostic. Femoral component loosening is difficult to detect with standard contrast arthrography because the bone, metal, surrounding radiopaque cement and contrast agents have similar or identical radiographic appearances. In contrast arthrography, if the prosthesis is loose the injected agent opacifies the radiolucent zone encircling the prosthesis or cement mangle. Because of the similarity in the appearances of these agents and the surrounding structures on x-ray films, interpretation is difficult. The inclusion of subtraction techniques in routine contrast arthrography has improved its accuracy; however, these techniques require special equipment and demand precise patient positioning. The purpose of this study is to introduce a new form of hip arthrography using a radionuclide agent in place of the contrast agent. A comparison of the results using these two techniques is presented

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

    Science.gov (United States)

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

    2012-10-01

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

  12. Analysis of hip perfusion at early and reversible stages of aseptic hip necrosis

    International Nuclear Information System (INIS)

    Predic, P.; Dodig, D.; Karner, I.

    2002-01-01

    Aim: A proper early diagnosis of aseptic hip necrosis is very important for further therapy.Since there has always been a question of the amount of perfusion in hips at different stages of aseptic hip necrosis we tried to impartially examine the perfusion in hips at early and reversible stages of aseptic hip necrosis. Material and Methods:Study included 143 patients with aseptic hip necrosis.The 550-740 MBq of Tc-99m-DPD were on bolus injected.All patients were subjected to 3-phase scintigraphy of hips and quantitative calculation of relative perfusion in the artery phase (3T) at early and repeated at reversible stages of aseptic hip necrosis. Results: At the early stage of aseptic hip necrosis the obtained 3T was decreased from 0.94-0.69 (3T=0.80).Scintigrams showed a moderate increase or diffuse accumulation. At the reversible stages we obtained 3T decreased from 0.92-0.71 (3T=0.79) thus evidencing hypoperfusion.Scintigrams showed an diffuse increased accumulation. Conclusion: With the aseptic hip necrosis quantitative analysis of perfusion in the artery phase-3T indicates that the perfusion is decreased at all stages of the process which however shows a significantly falling trend with the progress of the disease

  13. Reduction of metal artifacts: beam hardening and photon starvation effects

    Science.gov (United States)

    Yadava, Girijesh K.; Pal, Debashish; Hsieh, Jiang

    2014-03-01

    The presence of metal-artifacts in CT imaging can obscure relevant anatomy and interfere with disease diagnosis. The cause and occurrence of metal-artifacts are primarily due to beam hardening, scatter, partial volume and photon starvation; however, the contribution to the artifacts from each of them depends on the type of hardware. A comparison of CT images obtained with different metallic hardware in various applications, along with acquisition and reconstruction parameters, helps understand methods for reducing or overcoming such artifacts. In this work, a metal beam hardening correction (BHC) and a projection-completion based metal artifact reduction (MAR) algorithms were developed, and applied on phantom and clinical CT scans with various metallic implants. Stainless-steel and Titanium were used to model and correct for metal beam hardening effect. In the MAR algorithm, the corrupted projection samples are replaced by the combination of original projections and in-painted data obtained by forward projecting a prior image. The data included spine fixation screws, hip-implants, dental-filling, and body extremity fixations, covering range of clinically used metal implants. Comparison of BHC and MAR on different metallic implants was used to characterize dominant source of the artifacts, and conceivable methods to overcome those. Results of the study indicate that beam hardening could be a dominant source of artifact in many spine and extremity fixations, whereas dental and hip implants could be dominant source of photon starvation. The BHC algorithm could significantly improve image quality in CT scans with metallic screws, whereas MAR algorithm could alleviate artifacts in hip-implants and dentalfillings.

  14. Biologic resurfacing of the patella bone versus patellectomy

    Directory of Open Access Journals (Sweden)

    Motamedi M

    1995-04-01

    Full Text Available In the past years, there was a tendency to excise the patella in pathologic conditions affecting this bone. The patella has many critical effects in the function of the knee joint. For example, after its exicision the force of quadriceps muscle decreases by forty percent (40% and the knee joint becomes prone to early osteoarthritic changes. For these reasons, in the recent years the "biologic resurfacing of patella" has been used in pathologic conditions instead of its complete removal. In this new method after resection of the diseased part of the bone, the fascia of the quadriceps muscle, with its intact base, is used to cover the resected part of the bone. In practice, after pain relief, the active motion of the joint is started. Then the limb is placed in a splint or brace and after a period of 3 weeks, passive motion is begun.

  15. Hip pain

    Science.gov (United States)

    ... from a chair, walking, climbing stairs, and driving Hamstring strain Iliotibial band syndrome Hip flexor strain Hip ... and cool down afterward. Stretch your quadriceps and hamstrings. Avoid running straight down hills. Walk down instead. ...

  16. Modular femoral component for conversion of previous hip surgery in total hip arthroplasty.

    Science.gov (United States)

    Goldstein, Wayne M; Branson, Jill J

    2005-09-01

    The conversion of previous hip surgery to total hip arthroplasty creates a durable construct that is anatomically accurate. Most femoral components with either cemented or cementless design have a fixed tapered proximal shape. The proximal femoral anatomy is changed due to previous hip surgery for fixation of an intertrochanteric hip fracture, proximal femoral osteotomy, or a fibular allograft for avascular necrosis. The modular S-ROM (DePuy Orthopaedics Inc., Warsaw, Ind) hip stem accommodates these issues and independently prepares the proximal and distal portion of the femur. In preparation and implantation, the S-ROM hip stem creates less hoop stresses on potentially fragile stress risers from screws and thin bone. The S-ROM hip stem also prepares a previously distorted anatomy by milling through cortical bone that can occlude the femoral medullar canals and recreate proper femoral anteversion and reduces the risk of intraoperative or postoperative periprosthetic fracture due to the flexible titanium-slotted stem. The S-ROM femoral stem is recommended for challenging total hip reconstructions.

  17. Results of Lateral Retinacular Release Plus Circumpatellar Electrocautery in Total Knee Arthroplasty without Patellar Resurfacing.

    Science.gov (United States)

    Wang, Yong; Sun, Jun-Ying; Zha, Guo-Chun

    2017-03-01

    Anterior knee pain (AKP) is integral to the overall success of total knee arthroplasty (TKA) without patellar resurfacing. Numerous studies have evaluated various factors that may contribute to AKP, including patellofemoral design, surgical technique, characteristics of the patient, and degree of chondromalacia. This study aims to explore whether patients who received lateral retinacular release (LRR) plus circumpatellar electrocautery (CE) in TKA attain a low incidence of AKP and whether the LRR plus CE increases postoperative complications. Between February 2001 and February 2009, all patients undergoing TKA without patellar resurfacing and LRR plus CE were evaluated. In total, 286 TKAs in 259 (88.7%) patients were available for assessment, with a mean of 9.3 ± 2.5 years (range: 6-14 years) after the index TKA. The patients were evaluated with a VAS and the Kujala patellofemoral score (KPS) for AKP and the Knee Society's clinical scoring system (KSS) for the clinical function. Satisfaction and LRR-related complications were also assessed. The mean KPS and KSS improved from 45.2 ± 12.9 and 75.4 ± 26.8 points preoperatively to 82.8 ± 10.0 and 151.6 ± 17.3 points at the final follow-up ( p  < 0.001), respectively. Subjectively, 5.6% (16 of 286) of patients suffered from AKP and 88.1% (252 of 286) were satisfied or very satisfied. Postoperative complications occurred in 15 (5.2%) patients, but these complications were mild and did not require reoperation. None of patients exhibited aseptic and septic prosthesis loosening and required revision surgery in the final follow-up. LRR plus CE appears to be a reasonable option in TKA without patellar resurfacing. It may achieve adequate mid-term results, with a low incidence of AKP and postoperative complications.The level of evidence of the study is therapeutic level IV. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  18. Hip supporting device

    DEFF Research Database (Denmark)

    2011-01-01

    The present invention relates to a device for limiting movements in one or more anatomical joints, such as a device for limiting movement in the human hip joint after hip replacement surgery. This is provided by a device for limiting movement in the human hip joint, said device comprising: at least...

  19. [Tripolar arthroplasty for recurrent total hip prosthesis dislocation].

    Science.gov (United States)

    Beaulé, P-E; Roussignol, X; Schmalzried, T-P; Udomkiat, P; Amstutz, H-C; Dujardin, F-H

    2003-05-01

    The purpose of this study was to assess the results of revision surgery for recurrent total hip prosthesis dislocation using a tripolar prosthesis composed of a conventional stem with a mobile head of an intermediary prosthesis measuring more than 40 mm and a modified cup. This technique was used in two centers in Rouen France and Los Angeles USA. Twenty-one hips in 21 patients were operated on. The mobile heads measured 40 to 47 mm. Mean patient age was 70 years (range 29-92). The indication for the tripolar prosthesis was reserved for extremely unstable hips in patients with major risk factors for recurrent dislocation. These 21 patients had experienced 95 dislocations. The acetabular cup was custom-made for the large-diameter heads. A cemented polyethylene cup was used in 14 cases and a press-fit metal-backed around a polyethylene insert in 7. The polyethylene thickness varied from 6.5 to 16 mm for the cemented cups and 4 to 5 mm for the press-fit cups. Fourteen femoral stems were left in place as were two press-fit cups where only the inserts were changed. Mean follow-up was 5.4 years (range 3-11.8). There has been no recurrent dislocation for 20 hips. One patient experienced a dislocation one week after surgery which required a second revision procedure to reposition the acetabular implant. Final outcome was good at 7.6 years for this hip. One patient who had not had any recurrent dislocation died 4 years after the revision surgery due to a cause unrelated to the prosthesis. Two patients were lost to follow-up at 3.7 and 6 years, both were pain free and had no radiological anomalies. Infection occurred in one patient undergoing chemotherapy for a myeloma; the head and neck had to be resected. For the 20 other patients, functional outcome, assessed with the UCLA score, showed improvement in pain (5.8 preoperatively, 9.2 at last follow-up), walking (4.8 and 8 respectively), function (4 and 6 respectively), and daily activities (3.3 and 5.2 respectively). A

  20. Safe and effective one-session fractional skin resurfacing using a carbon dioxide laser device in super-pulse mode: a clinical and histologic study.

    Science.gov (United States)

    Trelles, Mario A; Shohat, Michael; Urdiales, Fernando

    2011-02-01

    Carbon dioxide (CO(2)) laser ablative fractional resurfacing produces skin damage, with removal of the epidermis and variable portions of the dermis as well as associated residual heating, resulting in new collagen formation and skin tightening. The nonresurfaced epidermis helps tissue to heal rapidly, with short-term postoperative erythema. The results for 40 patients (8 men and 32 women) after a single session of a fractional CO(2) resurfacing mode were studied. The treatments included resurfacing of the full face, periocular upper lip, and residual acne scars. The patients had skin prototypes 2 to 4 and wrinkle degrees 1 to 3. The histologic effects, efficacy, and treatment safety in various clinical conditions and for different phototypes are discussed. The CO(2) laser for fractional treatment is used in super-pulse mode. The beam is split by a lens into several microbeams, and super-pulse repetition is limited by the pulse width. The laser needs a power adaptation to meet the set fluence per microbeam. Laser pulsing can operate repeatedly on the same spot or be moved randomly over the skin, using several passes to achieve a desired residual thermal effect. Low, medium, and high settings are preprogrammed in the device, and they indicate the strength of resurfacing. A single treatment was given with the patient under topical anesthesia. However, the anesthesia was injected on areas of scar tissue. Medium settings (2 Hz, 30 W, 60 mJ) were used, and two passes were made for dark skins and degree 1 wrinkles. High settings (2 Hz, 60 W, 120 mJ) were used, and three passes were made for degree 3 wrinkles and scar tissue. Postoperatively, resurfaced areas were treated with an ointment of gentamycin, Retinol Palmitate, and DL-methionine (Novartis; Farmaceutics, S.A., Barcelona, Spain). Once epithelialization was achieved, antipigment and sun protection agents were recommended. Evaluations were performed 15 days and 2 months after treatment by both patients and

  1. Don't forget the hip! Hip arthritis masquerading as knee pain

    Directory of Open Access Journals (Sweden)

    Florian F. Dibra, MD

    2018-03-01

    Full Text Available Background: Hip osteoarthritis typically manifests with groin or thigh pain. Other atypical pain patterns, including knee pain, have been described. Except for 2 case reports, there is no literature on this subject. Methods: From our institutional database, between 2011 and 2016, we identified 21 patients who were referred for treatment of knee pain but ultimately diagnosed with hip pathology as the cause of their pain. This group was evaluated for duration of symptoms prior to diagnosis, previous interventions, presence of walking aids, and symptom resolution after treatment of the hip pathology. Results: Fifteen of the 21 patients were referred from musculoskeletal providers (12 from orthopaedic surgeons. Prior to diagnosis of the hip etiology, 16 patients were reduced to major assistive devices including wheelchairs. Twelve of 21 patients had undergone surgical knee interventions, including total knee arthroplasty, with minimal to no relief of their pain. Seventeen of 21 referred patients underwent total hip arthroplasty at our institution. Fourteen patients had complete resolution of knee pain after total hip arthroplasty. Conclusions: Although knee pain referred from hip disease may be considered a basic and common knowledge, it continues to be an overlooked phenomenon. Most of the cases were misdiagnosed by musculoskeletal providers including orthopaedic surgeons and this highlights the need for continued education and awareness of this clinical scenario. Keywords: Hip pain, Knee pain, Referred pain, Delay in diagnosis, Unnecessary surgery

  2. Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis

    DEFF Research Database (Denmark)

    Svege, Ida; Nordsletten, Lars; Fernandes, Linda

    2015-01-01

    Exercise treatment is recommended for all patients with hip osteoarthritis (OA), but its effect on the long-term need for total hip replacement (THR) is unknown.......Exercise treatment is recommended for all patients with hip osteoarthritis (OA), but its effect on the long-term need for total hip replacement (THR) is unknown....

  3. [Efficacy analysis on hip replacement for hip-joint diseases with Parkinson disease].

    Science.gov (United States)

    Sun, Qi-Cai; Ru, Xuan-Liang; Xia, Yan-Fei; Liu, Xiao-Li; Song, Bai-Shan; Qiao, Song; Yan, Shi-Gui; Wang, Xiang-Hua

    2017-12-25

    To explore clinical efficacy of hip replacement for hip-joint diseases with Parkinson disease. From December 2011 to December 2016, 18 patients with hip-joint diseases with Parkinson disease treated by hip replacement, including 8 males and 10 females aged from 59 to 87 years old with an average of 71 years old. Among them, 3 cases were developmental dysplasia of hip, 3 cases were femoral head necrosis and 12 cases were femoral neck fracture. All patients manifested with obvious pain and limitation of stepping ability. Postoperative complications were observed and Harris score were used to compare hip joint function after operation. The incision were healed well, and pain were alleviated or disappeared, and hip joint function were improved. Eighteen patients were followed up from 1 to 3 years with an average of 2.3 years. At the latest follow up, 14 cases recovered freedom-walk, 2 cases could walk with walking stick, 1 case could walk with walking aid and 1 case was died. Among 18 patients, 2 cases were occurred dislocation, and 1 case were died for cardiac disease at 3 months after operation. Four patients were occurred slight pain. There were significant differences in Harris scores among preoperative (41.7±1.4), 6 months after operation(80.1±5.4) and the final follow-up (83.4±2.1), and 10 cases got excellent result, 4 good, 1 fair and 2 poor. Application of hip replacement for hip-joint diseases with Parkinson disease is a safe and effective clinical therapy, and has advantages of less complications and rapid recovery of hip joint function.

  4. HIPs at Ten

    Science.gov (United States)

    Kuh, George; O'Donnell, Ken; Schneider, Carol Geary

    2017-01-01

    2017 is the anniversary of the introduction of what are now commonly known as high-impact practices (HIPs). Many of the specific activities pursued under the HIPs acronym have been around in some form for decades, such as study abroad, internships, and student-faculty research. It was about ten years ago that, after conferring HIPs at Ten with…

  5. Evaluation of periprosthetic bone mineral density and postoperative migration of humeral head resurfacing implants

    DEFF Research Database (Denmark)

    Mechlenburg, Inger; Klebe, Thomas Martin; Døssing, Kaj Verner

    2014-01-01

    BACKGROUND: Implant migration, bone mineral density (BMD), length of glenohumeral offset (LGHO), and clinical results were compared for the Copeland (Biomet Inc, Warsaw, IN, USA) and the Global C.A.P. (DePuy Int, Warsaw, IN, USA) humeral head resurfacing implants (HHRIs). METHODS: The study...... improved over time for both implant groups (P migration and good clinical results. Periprosthetic BMD and LGHO both increased for the Copeland HHRI more than for the Global C.A.P HHRI....

  6. Invariant hip moment pattern while walking with a robotic hip exoskeleton.

    Science.gov (United States)

    Lewis, Cara L; Ferris, Daniel P

    2011-03-15

    Robotic lower limb exoskeletons hold significant potential for gait assistance and rehabilitation; however, we have a limited understanding of how people adapt to walking with robotic devices. The purpose of this study was to test the hypothesis that people reduce net muscle moments about their joints when robotic assistance is provided. This reduction in muscle moment results in a total joint moment (muscle plus exoskeleton) that is the same as the moment without the robotic assistance despite potential differences in joint angles. To test this hypothesis, eight healthy subjects trained with the robotic hip exoskeleton while walking on a force-measuring treadmill. The exoskeleton provided hip flexion assistance from approximately 33% to 53% of the gait cycle. We calculated the root mean squared difference (RMSD) between the average of data from the last 15 min of the powered condition and the unpowered condition. After completing three 30-min training sessions, the hip exoskeleton provided 27% of the total peak hip flexion moment during gait. Despite this substantial contribution from the exoskeleton, subjects walked with a total hip moment pattern (muscle plus exoskeleton) that was almost identical and more similar to the unpowered condition than the hip angle pattern (hip moment RMSD 0.027, angle RMSD 0.134, p<0.001). The angle and moment RMSD were not different for the knee and ankle joints. These findings support the concept that people adopt walking patterns with similar joint moment patterns despite differences in hip joint angles for a given walking speed. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Resultados de artroplastia total de joelho com e sem implante de recapeamento (resurfacing patelar Results of total knee replacement with/without resurfacing of the patella

    Directory of Open Access Journals (Sweden)

    Abdul Khan

    2012-01-01

    Full Text Available OBJETIVO: Estudar a diferença de dor, estalido e crepitação patelofemoral no pós-operatório em pacientes com ou sem recapeamento patelar após 5 anos, os quais tinham dor patelofemoral antes da cirurgia. Estudar a incidência de dor, estalido e crepitação patelofemoral depois de pateloplastia em ambos os grupos. MÉTODOS: Revisão retrospectiva de 765 pacientes submetidos a artroplastia total do joelho (ATJ com ou sem recapeamento patelar. Os pacientes foram perguntados sobre dor pré e pós-operatória, 5 anos depois da cirurgia. Foram examinados por enfermeiro especializado 5 anos, após a cirurgia para verificar estalidos ou crepitação patelofemoral (PF. RESULTADOS: 688 pacientes (89,9% tinham dor PF pré-operatória. De 688 pacientes, 449 tinham recapeamento patelar (R e 239 não tinham (NR. Trinta e seis pacientes do grupo NR tinham pateloplastia. A incidência de dor PF pós-operatória foi 13,3% no grupo R e 13,6% no grupo NR. A incidência de estalido PF pós-operatório no grupo R foi 10,4% e apenas 1,3% no grupo NR (estatisticamente significante, p OBJECTIVE: To study the difference of post-op patellofemoral pain, clunk and crepitus in patients with/without resurfacing at 5 years who had pre-op patellofemoral pain. To study the incidence of post-operative patellofemoral pain, clunk and crepitus following patelloplasty in both the groups. METHODS: Retrospective review of 765 patients who had total knee replacement with/without resurfacing.Patients were asked about both pre-operative pain and also post-operative pain 5 years after the operation. Patients were examined by a specialist nurse at 5 years post-operatively to check for any patellofemoral clunk/crepitus. RESULTS: 688 patients (89.9% had preoperative PF pain. Of 688 patients, 449 had patellar resurfacing and 239 had not (NR. Thirty-six patients from the NR group had patelloplasty. The incidence of postoperative PF pain was 13.3% in the R group and 13.6% in the NR group

  8. Clinical Evaluation of Fused/Ankylosed Hip with Severe Flexion Deformity after Conversion to Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Saroj Kumar Suwal

    2016-06-01

    Conclusions: THA is an effective treatment for ankylosed hip with severe flexion deformity although complications are noted more than routine hip arthroplasties. Keywords: ankylosed hip; fused hip; severe flexion deformity; total hip arthroplasty. | PubMed

  9. Hip morphology predicts posterior hip impingement in a cadaveric model.

    Science.gov (United States)

    Morris, William Z; Fowers, Cody A; Weinberg, Douglas S; Millis, Michael B; Tu, Leigh-Anne; Liu, Raymond W

    2018-05-01

    Posterior hip impingement is a recently-identified cause of hip pain. The purpose of this study is to characterise posterior femoroacetabular and ischiofemoral impingement and identify its predisposing morphologic traits. Two hundred and six cadaveric hips were randomly selected and taken through controlled motion in two pure axes associated with posterior hip impingement: external rotation (through the mechanical axis) and adduction (coronal plane). The range of motion and location of impingement was noted for each specimen. Morphologic traits including femoral/acetabular version, and true neck-shaft angle (TNSA) were also measured. External rotation impingement occurred between the femoral neck and acetabulum in 83.0% of hips, and between the lesser trochanter and ischial tuberosity in 17.0%. Adduction impingement occurred between the lesser trochanter and ischial tuberosity in 78.6% of hips, and between the femoral neck and acetabulum in 21.4%. Multiple regression revealed that increased femoral/acetabular version predicted earlier external rotation and adduction impingement. Unstandardised betas ranging from -0.39 to -0.64 reflect that each degree of increased femoral/acetabular version individually accounts for a loss of external rotation or adduction of approximately half a degree before impingement ( p < 0.001 for each). Increased TNSA was associated with earlier adduction impingement only (unstandardised beta -0.35, p = 0.005). Relative femoral/acetabular anteversion was associated with earlier posterior hip impingement. Coxa valga was associated with earlier adduction impingement, but protective against external rotation impingement. These findings highlight the importance of monitoring correction during femoral/acetabular osteotomies, as overcorrection of retroversion may predispose to earlier posterior impingement.

  10. Influence of hip dysplasia on the development of osteoarthritis of the hip

    NARCIS (Netherlands)

    A.M. Lievense (Annet); S.M. Bierma-Zeinstra (Sita); A.P. Verhagen (Arianne); J.A.N. Verhaar (Jan); B.W. Koes (Bart)

    2004-01-01

    textabstractBackground: It has been suggested that in some patients with primary hip osteoarthritis (OA), the disease occurs as a consequence of acetabular dysplasia or hip dysplasia (HD). Objective: To carry out a systematic review to investigate the association between acetabular dysplasia and hip

  11. Abductor dysfunction and related sciatic nerve palsy, a new complication of metal-on-metal arthroplasty.

    Science.gov (United States)

    Beaver, Walter B; Fehring, Thomas K

    2012-08-01

    The optimal bearing for use in young patients with hip arthritis remains elusive. Current options include metal-on-cross-linked polyethylene, ceramic-on-cross-linked polyethylene, ceramic on ceramic, and metal on metal. Each of these bearing couples has advantages and disadvantages. Metal-on-metal designs allow the use of large heads that decrease impingement and improve stability. This fact has made this bearing an attractive option for surgeons and patients alike. This case report will illustrate a severe adverse reaction to metal debris with necrosis of soft tissues and subsequent damage to the sciatic nerve. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Joining of metals to structural ceramics

    Energy Technology Data Exchange (ETDEWEB)

    Sistiaga, J M; Salvador, J M

    1988-01-01

    A wide review is made on metal-ceramics joining by brazing, mainly by active metal containing brazing filler alloys and solid state welding that is diffusion welding and hot isostatic pressure (HIP). Both the basic aspects of the processes and the mechanisms involved are considsered. At last, different joint testing ands evaluation procedures are presented. (Author)

  13. Joining of metals to structural ceramics

    International Nuclear Information System (INIS)

    Sistiaga, J.M.; Salvador, J.M.

    1988-01-01

    A wide review is made on metal-ceramics joining by brazing, mainly by active metal containing brazing filler alloys and solid state welding that is diffusion welding and hot isostatic pressure (HIP). Both the basic aspects of the processes and the mechanisms involved are considered. At last, different joint testing and evaluation procedures are presented. (Author)

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

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer Calov; Kjærsgaard-Andersen, Per; Kehlet, Henrik

    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.......31-3.40)] but not hospital stay of hip...

  15. Hip ultrasound

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-12-15

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

  16. Hip Injuries and Disorders

    Science.gov (United States)

    Your hip is the joint where your femur (thigh bone) meets your pelvis (hip bone). There are two main parts: a ball ... fits in a socket in the pelvis. Your hip is known as a ball-and-socket joint. ...

  17. Efficacy and Safety of Fractional CO2 Laser Resurfacing in Non-hypertrophic Traumatic and Burn Scars

    Science.gov (United States)

    Majid, Imran; Imran, Saher

    2015-01-01

    Background: Fractional photothermolysis is one of the most effective treatment options used to resurface scars of different aetiologies. Aim: To assess the efficacy and safety of fractional CO2 laser resurfacing treatment in the management of non-hypertrophic traumatic and burn scars. Materials and Methods: Twenty-five patients affected by non-hypertrophic traumatic and burn scars were treated with four sessions of fractional CO2 laser resurfacing treatment at 6-weekly intervals. Patients were photographed at each visit and finally, 3 months after the end of treatment schedule. Response to treatment was assessed clinically as well as by comparing the initial photograph of the patient with the one taken at the last follow-up visit 3-months after the final treatment session. Changes in skin texture, surface irregularity and pigmentation were assessed on a quartile grading scale and scored individually from 0 to 4. A mean of the three individual scores was calculated and the response was labelled as ‘excellent’ if the mean score achieved was >2. A score of 1-2 was labeled as good response while a score below 1 was labeled as ‘poor’ response. The subjective satisfaction of each patient with the treatment offered was also assessed at the last follow-up visit. Results: The commonest site of scarring treated was the face followed by hands. Response to treatment was rated as excellent in 60% (15/25) patients while 24% (6/25) and 16% (4/25) patients were labeled as good and poor responders, respectively. Skin texture showed better response than other variables with average score of 2.44. Linear post-traumatic scars were seen to respond less than other morphological types. Majority of the patients (19 out of 25) were highly satisfied with the treatment offered. No long-term adverse effects were noted in any patient. Conclusions: Fractional photothermolysis with a fractional CO2 laser gives excellent results in patients with post-burn scars with minimal adverse

  18. Efficacy and safety of fractional CO 2 laser resurfacing in non-hypertrophic traumatic and burn scars

    Directory of Open Access Journals (Sweden)

    Imran Majid

    2015-01-01

    Full Text Available Background: Fractional photothermolysis is one of the most effective treatment options used to resurface scars of different aetiologies. Aim: To assess the efficacy and safety of fractional CO 2 laser resurfacing treatment in the management of non-hypertrophic traumatic and burn scars. Materials and Methods: Twenty-five patients affected by non-hypertrophic traumatic and burn scars were treated with four sessions of fractional CO 2 laser resurfacing treatment at 6-weekly intervals. Patients were photographed at each visit and finally, 3 months after the end of treatment schedule. Response to treatment was assessed clinically as well as by comparing the initial photograph of the patient with the one taken at the last follow-up visit 3-months after the final treatment session. Changes in skin texture, surface irregularity and pigmentation were assessed on a quartile grading scale and scored individually from 0 to 4. A mean of the three individual scores was calculated and the response was labelled as ′excellent′ if the mean score achieved was >2. A score of 1-2 was labeled as good response while a score below 1 was labeled as ′poor′ response. The subjective satisfaction of each patient with the treatment offered was also assessed at the last follow-up visit. Results: The commonest site of scarring treated was the face followed by hands. Response to treatment was rated as excellent in 60% (15/25 patients while 24% (6/25 and 16% (4/25 patients were labeled as good and poor responders, respectively. Skin texture showed better response than other variables with average score of 2.44. Linear post-traumatic scars were seen to respond less than other morphological types. Majority of the patients (19 out of 25 were highly satisfied with the treatment offered. No long-term adverse effects were noted in any patient. Conclusions: Fractional photothermolysis with a fractional CO 2 laser gives excellent results in patients with post-burn scars with

  19. THE NATURE OF THE HYPER-RUNAWAY CANDIDATE HIP 60350

    International Nuclear Information System (INIS)

    Irrgang, Andreas; Przybilla, Norbert; Heber, Ulrich; Fernanda Nieva, M.; Schuh, Sonja

    2010-01-01

    Young, massive stars in the Galactic halo are widely supposed to be the result of an ejection event from the Galactic disk forcing some stars to leave their place of birth as so-called runaway stars. Here, we present a detailed spectroscopic and kinematic analysis of the runaway B star HIP 60350 to determine which runaway scenario-a supernova explosion disrupting a binary system or dynamical interaction in star clusters-may be responsible for HIP 60350's peculiar orbit. Based on a non-local thermodynamic equilibrium approach, a high-resolution optical echelle spectrum was examined to revise spectroscopic quantities and for the first time to perform a differential chemical abundance analysis with respect to the B-type star 18 Peg. The results together with proper motions from the Hipparcos Catalog further allowed the three-dimensional kinematics of the star to be studied numerically. The abundances derived for HIP 60350 are consistent with a slightly supersolar metallicity agreeing with the kinematically predicted place of birth ∼6 kpc away from the Galactic center. However, they do not exclude the possibility of an α-enhanced abundance pattern expected in the case of the supernova scenario. Its outstanding high Galactic rest-frame velocity of 530 ± 35 km s -1 is a consequence of ejection in the direction of Galactic rotation and slightly exceeds the local Galactic escape velocity in a standard Galactic potential. Hence, HIP 60350 may be unbound to the Galaxy.

  20. 3D Printing Aids Acetabular Reconstruction in Complex Revision Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Andrew J. Hughes

    2017-01-01

    Full Text Available Revision hip arthroplasty requires comprehensive appreciation of abnormal bony anatomy. Advances in radiology and manufacturing technology have made three-dimensional (3D representation of osseous anatomy obtainable, which provide visual and tactile feedback. Such life-size 3D models were manufactured from computed tomography scans of three hip joints in two patients. The first patient had undergone multiple previous hip arthroplasties for bilateral hip infections, resulting in right-sided pelvic discontinuity and a severe left-sided posterosuperior acetabular deficiency. The second patient had a first-stage revision for infection and recurrent dislocations. Specific metal reduction protocols were used to reduce artefact. The images were imported into Materialise MIMICS 14.12®. The models were manufactured using selective laser sintering. Accurate templating was performed preoperatively. Acetabular cup, augment, buttress, and cage sizes were trialled using the models, before being adjusted, and resterilised, enhancing the preoperative decision-making process. Screw trajectory simulation was carried out, reducing the risk of neurovascular injury. With 3D printing technology, complex pelvic deformities were better evaluated and treated with improved precision. Life-size models allowed accurate surgical simulation, thus improving anatomical appreciation and preoperative planning. The accuracy and cost-effectiveness of the technique should prove invaluable as a tool to aid clinical practice.

  1. The Timing of Hip Arthroscopy After Intra-articular Hip Injection Affects Postoperative Infection Risk.

    Science.gov (United States)

    Wang, Dean; Camp, Christopher L; Ranawat, Anil S; Coleman, Struan H; Kelly, Bryan T; Werner, Brian C

    2017-11-01

    To evaluate the association of preoperative intra-articular hip injection with surgical site infection after hip arthroscopy. A large administrative database was used to identify all patients undergoing hip arthroscopy from 2007 to 2015 within a single private insurer and from 2005 to 2012 within Medicare in the United States. Those that received an ipsilateral preoperative intra-articular hip injection were identified. The patients were then divided into the following groups based on the interval between preoperative injection and ipsilateral hip arthroscopy: (1) 12 months) of preoperative hip injection. Patients developing a surgical site infection within 6 months following hip arthroscopy were identified using International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes associated with infection. Groups were compared using a multivariate logistic regression analysis to control for age, gender, body mass index, smoking status, alcohol usage, and multiple medical comorbidities including diabetes mellitus, hemodialysis use, inflammatory arthritis, and peripheral vascular disease. In total, 19% of privately insured and 6% of Medicare patients received a hip injection within 12 months of hip arthroscopy. The overall infection rate in privately insured and Medicare patients was 1.19% and 1.10%, respectively. Preoperative hip injection within 3 months of surgery was associated with a significantly higher risk of postoperative infection versus controls (2.16%, odds ratio [OR] 6.1, P arthroscopy increased when preoperative intra-articular hip injections were given within 3 months of surgery. Level III, retrospective comparative study. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  2. Transient osteoporosis of the hip

    International Nuclear Information System (INIS)

    McWalter, Patricia; Hassan Ahmed

    2007-01-01

    Transient osteoporosis of the hip is an uncommon cause of hip pain, mostly affecting healthy middle-aged men and also women in the third trimester of pregnancy. We present a case of transient osteoporosis of the hip in a 33-year-old non-pregnant female patient. This case highlights the importance of considering a diagnosis of transient osteoporosis of the hip in patients who present with hip pain. (author)

  3. Hip arthroscopy: prevalence of intra-articular pathologic findings after traumatic injury of the hip.

    Science.gov (United States)

    Khanna, Vickas; Harris, Adam; Farrokhyar, Forough; Choudur, Hema N; Wong, Ivan H

    2014-03-01

    The purpose of this study was to document and compare the incidence of intra-articular hip pathologic findings identified using arthroscopy versus conventional imaging in patients with acute trauma to the hip. This was a blinded prospective case series study designed to review the incidence of intra-articular pathologic disorders in patients with post-traumatic injury between the ages of 18 and 65 years who were referred to a single surgeon. Injuries included hip dislocation, proximal femur fracture, pelvic ring fracture, acetabular fracture, penetrating injury (gunshot wound), and soft tissue injury. Preoperative radiographs, computed tomographic (CT) scans, or magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) scans (or a combination of these) were obtained. Findings were documented and compared with intraoperative findings. A total of 29 post-traumatic hips were enrolled in this study. Hip arthroscopy identified 17 of 29 hips (59%) as having loose bodies, 11 of 29 (38%) hips as having an intra-articular step deformity, 14 of 29 (49%) hips as having an osteochondral lesion, and 27 of 29 (93%) hips as having a labral tear. Plain radiographs and CT scans yielded low sensitivity when compared with arthroscopy for the identification of loose bodies and step deformities. MRI/MRA comparison with arthroscopic findings suggest that MRI/MRA is an accurate tool for identification of labral tears, because 91% of tears seen on arthroscopy were also identified by MRI/MRA. In 4 hips, however, MRI/MRA failed to identify osteochondral lesions that were subsequently identified by arthroscopy. Traumatic injuries of the hip result in substantial intra-articular pathologic findings, including loose bodies, labral tears, step deformities, and osteochondral lesions. The arthroscope is a powerful tool in identifying these injuries. Plain radiographs and CT scans appear to underestimate the true incidence of loose bodies and step deformities within the joint when

  4. TREATMENT OF HIP DYSPLASIA

    OpenAIRE

    Iulian ICLEANU; Mariana CORDUN

    2015-01-01

    In this thesis, our purpose is to show that using physiotherapy on patients with hip dysplasia from the very beginning, in the first months of life, helps treating them faster. Common literature proposes to use physiotherapy on patients with hip dysplasia either after their recovery or in the terminal phase of recovery, claiming that any earlier intervention will prolong the hip recovery. The effects of hip dysplasia reflect over the whole musculoskeletal system, while it hinders the knees (g...

  5. Structural differences between hip endoprostheses, and implications on a hip kinetics

    Directory of Open Access Journals (Sweden)

    Mirza Biščević

    2005-11-01

    Full Text Available We compared kinetic characteristic of unipolar, bipolar and total hip endoprostheses, implanted after dislocated femoral neck fracture. Ninety patients were divided into three groups (30 patients in each group; a group with unipolar partial hip endoprosthesis (UPEP, a group with bipolar partial hip endoprosthesis (BPEP and a group with total hip endoprosthesis (TEP. The patients from different groups were paired by parameters which could influence the long term functional result: follow up period, comorbidities, functional capabilities before injury, etc. After the average follow up 3.8 +/- 1.9 years, a measuring of range of hip motions (ROM was conducted. The largest mean amplitudes in flexion (104 degrees, extension (13 degrees, abduction (35 degrees and external rotation (38 degrees was achieved BPEP, the largest adduction (14 degrees was achieved UPEP, and internal rotation (34 degrees TEP. Differences in ROMs are partially related to the clinical parameters such as: level of the hip pain, gait pattern, age and rehabilitation period (P < 0.05. Measuring of ROMs is the most reliable part of the clinical exam and it does not depend on subjectivity of patient, as opposed to other clinical parameters (level of pain, walking distance, aids usage, etc. The results obtained are favorable for the bipolar hip endoprosthesis, and they can be related to the biomechanical differences between the three types of hip endoprostheses. Kinetic advantages of the BPEP as compared to the UPEP, can be explained by the BPEP's structure: two-level mobility and a thinner neck which delays impingement in the late motion phase. In comparison to the TEP, clinical advantages of the BPEP can be attributed to less extensive surgery and scarring.

  6. X-Ray Exam: Hip

    Science.gov (United States)

    ... for Educators Search English Español X-Ray Exam: Hip KidsHealth / For Parents / X-Ray Exam: Hip What's in this article? What It Is Why ... You Have Questions Print What It Is A hip X-ray is a safe and painless test ...

  7. Bursitis of the Hip

    Science.gov (United States)

    ... difficile (C. diff.) InfectionHerpes Home Diseases and Conditions Bursitis of the Hip Condition Bursitis of the Hip Share Print Table of Contents1. ... Prevention5. Treatment6. Everyday Life7. Questions8. Resources What is bursitis of the hip? Bursitis is the painful swelling ...

  8. Hip fracture - discharge

    Science.gov (United States)

    ... neck fracture repair - discharge; Trochanteric fracture repair - discharge; Hip pinning surgery - discharge ... in the hospital for surgery to repair a hip fracture, a break in the upper part of ...

  9. Unconstrained tripolar implants for primary total hip arthroplasty in patients at risk for dislocation.

    Science.gov (United States)

    Guyen, Olivier; Pibarot, Vincent; Vaz, Gualter; Chevillotte, Christophe; Carret, Jean-Paul; Bejui-Hugues, Jacques

    2007-09-01

    We performed a retrospective study on 167 primary total hip arthroplasty (THA) procedures in 163 patients at high risk for instability to assess the reliability of unconstrained tripolar implants (press-fit outer metal shell articulating a bipolar polyethylene component) in preventing dislocations. Eighty-four percent of the patients had at least 2 risk factors for dislocation. The mean follow-up length was 40.2 months. No dislocation was observed. Harris hip scores improved significantly. Six hips were revised, and no aseptic loosening of the cup was observed. The tripolar implant was extremely successful in achieving stability. However, because of the current lack of data documenting polyethylene wear at additional bearing, the routine use of tripolar implants in primary THA is discouraged and should be considered at the present time only for selected patients at high risk for dislocation and with limited activities.

  10. 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.

  11. The incidence of total hip arthroplasty after hip arthroscopy in osteoarthritic patients

    Directory of Open Access Journals (Sweden)

    Haviv Barak

    2010-07-01

    Full Text Available Abstract Objective To assess the incidence of total hip arthroplasty (THA in osteoarthritic patients who were treated by arthroscopic debridement and to evaluate factors that might influence the time interval from the first hip arthroscopy to THA. Design Retrospective clinical series Methods Follow-up data and surgical reports were retrieved from 564 records of osteoarthritic patients that have had hip arthroscopy between the years 2002 to 2009 with a mean follow-up time of 3.2 years (range, 1-6.4 years. The time interval between the first hip arthroscopy to THA was modelled as a function of patient age; level of cartilage damage; procedures performed and repeated arthroscopies with the use of multivariate regression analysis. Results Ninety (16% of all participants eventually required THA. The awaiting time from the first arthroscopy to a hip replacement was found to be longer in patients younger than 55 years and in a milder osteoarthritic stage. Patients that experienced repeated hip scopes had a longer time to THA than those with only a single procedure. Procedures performed concomitant with debridement and lavage did not affect the time interval to THA. Conclusions In our series of arthroscopic treatment of hip osteoarthritis, 16% required THA over a period of 7 years. Factors that influence the time to arthroplasty were age, degree of osteoarthritis and recurrent procedures.

  12. The incidence of total hip arthroplasty after hip arthroscopy in osteoarthritic patients

    Science.gov (United States)

    2010-01-01

    Objective To assess the incidence of total hip arthroplasty (THA) in osteoarthritic patients who were treated by arthroscopic debridement and to evaluate factors that might influence the time interval from the first hip arthroscopy to THA. Design Retrospective clinical series Methods Follow-up data and surgical reports were retrieved from 564 records of osteoarthritic patients that have had hip arthroscopy between the years 2002 to 2009 with a mean follow-up time of 3.2 years (range, 1-6.4 years). The time interval between the first hip arthroscopy to THA was modelled as a function of patient age; level of cartilage damage; procedures performed and repeated arthroscopies with the use of multivariate regression analysis. Results Ninety (16%) of all participants eventually required THA. The awaiting time from the first arthroscopy to a hip replacement was found to be longer in patients younger than 55 years and in a milder osteoarthritic stage. Patients that experienced repeated hip scopes had a longer time to THA than those with only a single procedure. Procedures performed concomitant with debridement and lavage did not affect the time interval to THA. Conclusions In our series of arthroscopic treatment of hip osteoarthritis, 16% required THA over a period of 7 years. Factors that influence the time to arthroplasty were age, degree of osteoarthritis and recurrent procedures. PMID:20670440

  13. Biologic resurfacing of the patella: current status.

    Science.gov (United States)

    Scapinelli, Raphaele; Aglietti, Paolo; Baldovin, Marino; Giron, Francesco; Teitge, Robert

    2002-07-01

    The techniques of biologic resurfacing of the patella, like other joint surfaces, are still evolving. Currently none of them is free from criticism. In this regard it is our hope that progress in the basic science will offer in the near future new and more optimistic therapeutic possibilities (i.e., the restoration of a reparative cartilage that is structurally and functionally comparable to the native one). The greater expectancies come perhaps from the present experimental investigations about the combined use of tissue-engineered implants embedded with staminal cells and growth factors. Many problems remain to be solved, however, before reliable applicability in humans. From a general point of view, stem cells obtained from various sources (e.g., adult bone marrow, umbilical cord) offer the same finalities as the embryonic stem cells, without the ethical obstacles related to the latter. Therefore, it may be that restoration of part or all of the articular surface of a joint will be possible by way of these mesenchymal progenitors that have the ability to differentiate into the chondrogenic and osteogenic lines, which is required for the restoration of the various layers of a normal articular cartilage and subchondral bone.

  14. TREATMENT OF HIP DYSPLASIA

    Directory of Open Access Journals (Sweden)

    Iulian ICLEANU

    2015-11-01

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

  15. Economically and environmentally informed policy for road resurfacing: tradeoffs between costs and greenhouse gas emissions

    International Nuclear Information System (INIS)

    Reger, Darren; Madanat, Samer; Horvath, Arpad

    2014-01-01

    As road conditions worsen, users experience an increase in fuel consumption and vehicle wear and tear. This increases the costs incurred by the drivers, and also increases the amount of greenhouse gases (GHGs) that vehicles emit. Pavement condition can be improved through rehabilitation activities (resurfacing) to reduce the effects on users, but these activities also have significant cost and GHG emission impacts. The objective of pavement management is to minimize total societal (user and agency) costs. However, the environmental impacts associated with the cost-minimizing policy are not currently accounted for. We show that there exists a range of potentially optimal decisions, known as the Pareto frontier, in which it is not possible to decrease total emissions without increasing total costs and vice versa. This research explores these tradeoffs for a system of pavement segments. For a case study, a network was created from a subset of California’s highways using available traffic data. It was shown that the current resurfacing strategy used by the state’s transportation agency, Caltrans, does not fall on the Pareto frontier, meaning that significant savings in both total costs and total emissions can be achieved by switching to one of the optimal policies. The methods presented in this paper also allow the decision maker to evaluate the impact of other policies, such as reduced vehicle kilometers traveled or better construction standards. (letter)

  16. Economically and environmentally informed policy for road resurfacing: tradeoffs between costs and greenhouse gas emissions

    Science.gov (United States)

    Reger, Darren; Madanat, Samer; Horvath, Arpad

    2014-10-01

    As road conditions worsen, users experience an increase in fuel consumption and vehicle wear and tear. This increases the costs incurred by the drivers, and also increases the amount of greenhouse gases (GHGs) that vehicles emit. Pavement condition can be improved through rehabilitation activities (resurfacing) to reduce the effects on users, but these activities also have significant cost and GHG emission impacts. The objective of pavement management is to minimize total societal (user and agency) costs. However, the environmental impacts associated with the cost-minimizing policy are not currently accounted for. We show that there exists a range of potentially optimal decisions, known as the Pareto frontier, in which it is not possible to decrease total emissions without increasing total costs and vice versa. This research explores these tradeoffs for a system of pavement segments. For a case study, a network was created from a subset of California’s highways using available traffic data. It was shown that the current resurfacing strategy used by the state’s transportation agency, Caltrans, does not fall on the Pareto frontier, meaning that significant savings in both total costs and total emissions can be achieved by switching to one of the optimal policies. The methods presented in this paper also allow the decision maker to evaluate the impact of other policies, such as reduced vehicle kilometers traveled or better construction standards.

  17. Monte Carlo dose calculations for phantoms with hip prostheses

    International Nuclear Information System (INIS)

    Bazalova, M; Verhaegen, F; Coolens, C; Childs, P; Cury, F; Beaulieu, L

    2008-01-01

    Computed tomography (CT) images of patients with hip prostheses are severely degraded by metal streaking artefacts. The low image quality makes organ contouring more difficult and can result in large dose calculation errors when Monte Carlo (MC) techniques are used. In this work, the extent of streaking artefacts produced by three common hip prosthesis materials (Ti-alloy, stainless steel, and Co-Cr-Mo alloy) was studied. The prostheses were tested in a hypothetical prostate treatment with five 18 MV photon beams. The dose distributions for unilateral and bilateral prosthesis phantoms were calculated with the EGSnrc/DOSXYZnrc MC code. This was done in three phantom geometries: in the exact geometry, in the original CT geometry, and in an artefact-corrected geometry. The artefact-corrected geometry was created using a modified filtered back-projection correction technique. It was found that unilateral prosthesis phantoms do not show large dose calculation errors, as long as the beams miss the artefact-affected volume. This is possible to achieve in the case of unilateral prosthesis phantoms (except for the Co-Cr-Mo prosthesis which gives a 3% error) but not in the case of bilateral prosthesis phantoms. The largest dose discrepancies were obtained for the bilateral Co-Cr-Mo hip prosthesis phantom, up to 11% in some voxels within the prostate. The artefact correction algorithm worked well for all phantoms and resulted in dose calculation errors below 2%. In conclusion, a MC treatment plan should include an artefact correction algorithm when treating patients with hip prostheses

  18. Usefulness of Arthroscopic Treatment of Painful Hip after Acetabular Fracture or Hip Dislocation.

    Science.gov (United States)

    Hwang, Jung-Taek; Lee, Woo-Yong; Kang, Chan; Hwang, Deuk-Soo; Kim, Dong-Yeol; Zheng, Long

    2015-12-01

    Painful hip following hip dislocation or acetabular fracture can be an important signal for early degeneration and progression to osteoarthritis due to intraarticular pathology. However, there is limited literature discussing the use of arthroscopy for the treatment of painful hip. The purpose of this retrospective study was to analyze the effectiveness and benefit of arthroscopic treatment for patients with a painful hip after major trauma. From July 2003 to February 2013, we reviewed 13 patients who underwent arthroscopic treatment after acetabular fracture or hip dislocation and were followed up for a minimum of 2 postoperative years. The degree of osteoarthritis based on the Tonnis classification pre- and postoperatively at final follow-up was determined. Clinical outcomes were evaluated using visual analogue scale for pain (VAS) and modified Harris hip score (MHHS), and range of motion (ROM) of the hip pre- and postoperatively at final follow-up. There were nine male and four female patients with a mean age at surgery of 28 years (range, 20 to 50 years). The mean follow-up period of the patients was 59.8 months (range, 24 to 115 months), and the mean interval between initial trauma and arthroscopic treatment was 40.8 months (range, 1 to 144 months). At the final follow-up, VAS and MHHS improved significantly from 6.3 and 53.4 to 3.0 and 88.3, respectively (p = 0.002 and p hip flexion, abduction, adduction, external rotation, and internal rotation as minor improvements from 113.1°, 38.5°, 28.5°, 36.5°, and 22.7° to 118.5°, 39.0°, 29.2°, 38.9°, and 26.5° were observed, respectively (p = 0.070, p = 0.414, p = 0.317, p = 0.084, and p = 0.136, respectively). None of the patients exhibited progression of osteoarthritis of the hip at the final follow-up. Arthroscopic treatment after acetabular fracture or hip dislocation is effective and delays the progression of traumatic osteoarthritis.

  19. Osteoarthritis of the hip

    International Nuclear Information System (INIS)

    Kokubo, Takashi; Takatori, Yoshio; Sasaki, Yasuhito

    1993-01-01

    Magnetic resonance imaging (MRI) is the modality of choice for evaluation of joint disease. Forty-one hips in 33 patients with osteoarthritis of the hip joint were examined by MRI and the features were analyzed. MR examinations were performed on a 1.5 T superconducting unit using the spin echo (SE) technique with short TR (600 ms)/short TE (23, 28, 35 ms) and short TR (600 ms)/long TE (70, 75 ms) sequences. MRI revealed deformity of the femoral head in all hips. Some outgrowths, which were isointense with normal bone marrow, were shown on the periphery of the femoral head in 22 hips (54%). These outgrowths represented marginal osteophytes. Short TE images showed hypointense areas, which varied in size, in the superior or supero-anterior aspect of the femoral head in all hips, and in the opposite position of the acetabulum in 38 hips (93%). These lesions showed a heterogenous signal with predominant low signal on long TE images. These images may indicate the presence of several components including subchondral cysts, bony sclerosis and fibrous tissue. In the joint space, areas of low signal intensity were shown on short TE images, which were high to intermediate signal intensity on long TE images in 16 hips (39%). These areas were presumably consistent with synovial proliferation, cartilageous hypertrophy or joint effusion. Both MR images revealed a mass locating just anterior to the femoral head in 2 hips (5%). The mass showed a low signal on short TE images and a high signal on long TE images, representing the distended iliopsoas bursa. (author)

  20. Hip Labral Tear

    Science.gov (United States)

    ... that joint in the future. Prevention Hip labral tears are often associated with sports participation. If your sport puts a lot of strain on your hips, condition the surrounding muscles with strength and flexibility exercises. Try to avoid ...

  1. Transfer of metallic debris from the metal surface of an acetabular cup to artificial femoral heads by scraping: comparison between alumina and cobalt-chrome heads.

    Science.gov (United States)

    Chang, Chong Bum; Yoo, Jeong Joon; Song, Won Seok; Kim, Deug Joong; Koo, Kyung-Hoi; Kim, Hee Joong

    2008-04-01

    We aimed to investigate the transfer of metal to both ceramic (alumina) and metal (cobalt-chrome) heads that were scraped by a titanium alloy surface under different load conditions. The ceramic and metal heads for total hip arthroplasties were scraped by an acetabular metal shell under various loads using a creep tester. Microstructural changes in the scraped area were visualized with a scanning electron microscope, and chemical element changes were assessed using an energy dispersive X-ray spectrometry. Changes in the roughness of the scraped surface were evaluated by a three-dimensional surface profiling system. Metal transfer to the ceramic and metal heads began to be detectable at a 10 kg load, which could be exerted by one-handed force. The surface roughness values significantly increased with increasing test loads in both heads. When the contact force increased, scratching of the head surface occurred in addition to the transfer of metal. The results documented that metallic debris was transferred from the titanium alloy acetabular shell to both ceramic and metal heads by minor scraping. This study suggests that the greatest possible effort should be made to protect femoral heads, regardless of material, from contact with metallic surfaces during total hip arthroplasty.

  2. Hip Replacement: MedlinePlus Health Topic

    Science.gov (United States)

    ... invasive hip replacement (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Hip Replacement updates ... replacement - precautions Minimally invasive hip replacement Related Health Topics Hip Injuries and Disorders National Institutes of Health ...

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

    Directory of Open Access Journals (Sweden)

    Robert Sonntag

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

  4. Waist and hip circumferences and all-cause mortality: usefulness of the waist-to-hip ratio?

    DEFF Research Database (Denmark)

    Bigaard, J.; Frederiksen, K.; Tjønneland, A.

    2004-01-01

    inverse for both men and women, but only after adjustment for waist circumference, or BMI, or both. The mortality rate ratios of mutually adjusted waist and hip circumferences were 0.63 (95% CI: 0.56, 0.71), and 0.70 (95% CI: 0.63, 0.79) times higher per 10% larger hip circumference in men and women......, respectively, and 1.45 (95% CI: 1.34, 1.57) and 1.22 (95% CI: 1.14, 1.31) times higher per 10% larger waist circumference. The adequacy of the waist-to-hip ratio as a substitute for separate measurements of waist and hip circumferences depended on which other variables the analysis was adjusted for, indicating...... that the waist-to-hip ratio should be used with precaution. CONCLUSION: When mutually adjusted, waist and hip circumferences show opposite associations with all-cause mortality, probably due to different effects of adipose tissue in the abdominal and gluteofemoral regions. The waist-to-hip ratio cannot always...

  5. Phantom studies of triple photon absorptiometry and bone mineral measurement at a hip prosthesis

    International Nuclear Information System (INIS)

    Farrell, T.J.; Webber, C.E.

    1992-01-01

    The feasibility of using triple photon absorptiometry (TPA) for the measurement of bone mineral mass about a hip prosthesis was examined. A theoretical expression describing the variance of TPA measurements was verified using a triple photon source and phantom materials which simulate the soft tissue-bone mineral-metal prosthesis system. The expression for the variance was used to determine an optimized set of photon energies. It was shown that a precision of 3% could be obtained for reasonable measurement times using this optimized set of energies and that TPA should be a feasible approach for measurement of bone mineral about a hip prosthesis. (orig.)

  6. Metal artifact reduction image reconstruction algorithm for CT of implanted metal orthopedic devices: a work in progress

    International Nuclear Information System (INIS)

    Liu, Patrick T.; Pavlicek, William P.; Peter, Mary B.; Roberts, Catherine C.; Paden, Robert G.; Spangehl, Mark J.

    2009-01-01

    Despite recent advances in CT technology, metal orthopedic implants continue to cause significant artifacts on many CT exams, often obscuring diagnostic information. We performed this prospective study to evaluate the effectiveness of an experimental metal artifact reduction (MAR) image reconstruction program for CT. We examined image quality on CT exams performed in patients with hip arthroplasties as well as other types of implanted metal orthopedic devices. The exam raw data were reconstructed using two different methods, the standard filtered backprojection (FBP) program and the MAR program. Images were evaluated for quality of the metal-cement-bone interfaces, trabeculae ≤1 cm from the metal, trabeculae 5 cm apart from the metal, streak artifact, and overall soft tissue detail. The Wilcoxon Rank Sum test was used to compare the image scores from the large and small prostheses. Interobserver agreement was calculated. When all patients were grouped together, the MAR images showed mild to moderate improvement over the FBP images. However, when the cases were divided by implant size, the MAR images consistently received higher image quality scores than the FBP images for large metal implants (total hip prostheses). For small metal implants (screws, plates, staples), conversely, the MAR images received lower image quality scores than the FBP images due to blurring artifact. The difference of image scores for the large and small implants was significant (p=0.002). Interobserver agreement was found to be high for all measures of image quality (k>0.9). The experimental MAR reconstruction algorithm significantly improved CT image quality for patients with large metal implants. However, the MAR algorithm introduced blurring artifact that reduced image quality with small metal implants. (orig.)

  7. Evolution of the hip and pelvis.

    Science.gov (United States)

    Hogervorst, Tom; Bouma, Heinse W; de Vos, John

    2009-08-01

    Man's evolution features two unique developments: growing a huge brain and upright gait. Their combination makes the pelvis the most defining skeletal element to read human evolution. Recent revival in joint preserving hip surgery have brought to attention morphological variations of the human hip that appear similar to hips of extant mammals. In man, such variations can produce hip osteoarthrosis through motion. We reviewed the evolution of the hip and pelvis with special interest in morphology that can lead to motion induced osteoarthrosis in man. The combination of giving birth to big brained babies and walking upright has produced marked differences between the sexes in pelvis and hip morphology, each having their characteristic mode of hip impingement and osteoarthrosis.

  8. Taking care of your new hip joint

    Science.gov (United States)

    Hip arthroplasty - precautions; Hip replacement - precautions; Osteoarthritis - hip; Osteoarthritis - knee ... After you have hip replacement surgery, you will need to be careful how you move your hip, especially for the first few months ...

  9. Results of hip arthroplasty using Paavilainen technique in patients with congenitally dislocated hip

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2014-01-01

    Full Text Available The purpose of the study was to analyze the medium- and long-term results of hip arthroplasty using Paavilainen technique in patients with the congenitally dislocated hip. Methods: From 2001 to 2012 180 operations were carried out were using the Paavilainen technique in 140 patients with high dislocation of the hip (Crowe IV. All patients were clinically evaluated using the Harris Hip Score (HHS, VAS and radiography. Statistical analysis was performed using the Pearson correlation coefficients, multiple regression analysis and classification trees analysis. Results: The average Harris score improved from preoperative 41.6 (40,3-43,5 to 79.3 (77,9-82,7 at final follow-up, and the difference was significant. Early complications were 9% (the most frequent were fractures of the proximal femur, later - 16.7% (pseudoarthrosis of the greater trochanter, 13.9%; disclocations-1,1%, aseptic loosening of the components - 1.7%, reoperation performed in 8.3% of cases. Such factors as age and limb length has statistically significant effect on functional outcomes. Established predictive model allows to get the best possible functional outcome in such patients with severe dysplasia. Conclusions: Total Hip arthroplasty using the Paavilainen technique is an effective method of surgical treatment in patients with the congenitally dislocated hip, but it is technically difficult operation with a high incidence of complications in comparison with standard primary total hip replacement.

  10. Hip sonography in the newborn

    International Nuclear Information System (INIS)

    Riboni, G.; Serantoni, S.; De Simoni, M.; Bascape', P.; Facchini, R.; Pirovano, G.

    1991-01-01

    The authors report the data relative to 1507 cases studied with clinical and US examinations, in the neonatal period, in order to exclude hip dysplasia dislocation. US examination was carried out according to Graf's technique and the newborns were classified according to US hip type, to clinical examination and to possible risk factors. The patients were included in a protocol including orthopedic and US controls. Seventeen treated infants were considered as pathologic. Ten of them had IIc or D hips ar birth; the other 7, with IIa hips at birth, presented a X-ray pathologic hip after the 4th months of life. At about one year of age all infants could normally walk, excpet for one who was being treated with herness. No statistically significant differences were observed between the number of pathologic infants in the risk group (1.7%) and that in the no-risk group (0.8%). Clinical examination of the newborn has low sensitivity in detecting pathologic hips. On the basis of their results, thw authors belive US examination of the newborn to be a valuable screening method to diagnose hip dysplasia/dislocation. Moreover, Graf's morphologic method is the best one for US screening of the hip in the neonatal period

  11. The association between eccentric hip abduction strength and hip and knee angular movements in recreational male runners

    DEFF Research Database (Denmark)

    Brund, René B. Korsgaard; Rasmussen, Sten; Nielsen, Rasmus O.

    2018-01-01

    Weak hip abductors may be related with increased hip adduction and knee abduction angular movement, which may be risk factors of lower extremity injuries. As the role of eccentric hip abduction strength (EHAS) on hip adduction angular movement and knee abduction angular movement (KABD) remains...... and Codamotion active marker system. Using multiple linear regression models (n=186 legs), no relationships between EHAS and hip and knee kinematics were found. A possible reason for the lack of relationship between EHAS and hip and knee kinematics may be owing to differences in the running kinematics. Some...

  12. Correlation of histological findings of single session Er:YAG skin fractional resurfacing with various passes and energies and the possible clinical implications.

    Science.gov (United States)

    Trelles, Mario A; Vélez, Mariano; Mordon, Serge

    2008-03-01

    Ablative fractional resurfacing shows promise for skin resurfacing and tightening and also to improve treatment of epidermal and dermal pigmentary disorders. This study aimed at determining any correlation between epidermal ablation and effects on the dermis when using an Er:YAG laser in ablative fractional resurfacing mode. Ten female subjects participated in the study, mean age 52 years, Skin phototypes: 1 Fitzpatrick type II; 8 type III and 1 type IV. The degree of wrinkles (Glogau scale II or III) was similar in all cases. The laser used was the Pixel Er:YAG system (Alma Lasertrade mark, Israel) which delivers the laser beam via a hand-piece equipped with a beam splitter to divide the 2,940 nm beam into various microbeams of 850 microm in diameter in an 11 mmx11 mm treatment area. Using a constant energy of 1,400 mJ/cm(2), on a test area of 4 cmx2 cm. Two, 4, 6, and 8 passes on the preauricular area of the face were evaluated immediately after treatment. In all cases, the handpiece was kept in the same position, and rotated slightly around its perpendicular axis between passes, then moved on to the next spot. Biopsies were performed and tissue samples were routinely processed and stained with hematoxylin and eosin (H&E). No patient reported any noticeable discomfort, even at 8 passes. The histological findings revealed that, independent of the degree of the wrinkles, more laser passes produced more ablative removal of the epidermis. Residual thermal damage (RTD) with 2 laser passes was not observed but with 4 and 6 passes increased thermal effects and vacuole formation in the epidermal cells were noticed. With 8 laser passes, total epidermal removal was seen together with frank RTD-related changes in the upper part of the papillary dermis. In this study, we have demonstrated that high density fractional Er:YAG laser energy in a single session with multiple passes targeted not only the skin surface with elimination of the epidermis, but could also achieve heat

  13. Surgical Dislocation of the Hip for the Treatment of Pre-Arthritic Hip Disease.

    Science.gov (United States)

    Beaulé, Paul E; Singh, Amardeep; Poitras, Stéphane; Parker, Gillian

    2015-09-01

    The purpose of this study was to report the clinical results of surgical dislocation of the hip in the treatment of pre-arthritic hip disease. Between 2005 and 2010, eighty-two patients (89 hips) underwent a surgical dislocation of the hip at a mean age of 30.5 years (range 14.8-51.7); 10 females and 72 males. At a mean follow-up of 7.1 years (range 5-9.6) clinical function improved significantly. 6 patients were converted to total hip arthroplasty and 3 patients underwent an arthroscopy and an additional three patients had >1mm of joint space narrowing at latest follow-up giving us a 9-year cumulative Kaplan-Meier survivorship of 86.4% (CI, 79% to 94%). Thirty-four patients underwent internal fixation removal at a mean of 12.0 months (range 0.3-40.8 months). Although effective in the treatment of early hip disease, the surgical dislocation approach carries a high re-operation rate for removal of internal fixation; consequently, less invasive approaches should be considered for less complex deformities. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. The effects of therapeutic hip exercise with abdominal core activation on recruitment of the hip muscles.

    Science.gov (United States)

    Chan, Mandy Ky; Chow, Ka Wai; Lai, Alfred Ys; Mak, Noble Kc; Sze, Jason Ch; Tsang, Sharon Mh

    2017-07-21

    Core stabilization has been utilized for rehabilitation and prevention of lower limb musculoskeletal injuries. Previous studies showed that activation of the abdominal core muscles enhanced the hip muscle activity in hip extension and abduction exercises. However, the lack of the direct measurement and quantification of the activation level of the abdominal core muscles during the execution of the hip exercises affect the level of evidence to substantiate the proposed application of core exercises to promote training and rehabilitation outcome of the hip region. The aim of the present study was to examine the effects of abdominal core activation, which is monitored directly by surface electromyography (EMG), on hip muscle activation while performing different hip exercises, and to explore whether participant characteristics such as gender, physical activity level and contractile properties of muscles, which is assessed by tensiomyography (TMG), have confounding effect to the activation of hip muscles in enhanced core condition. Surface EMG of bilateral internal obliques (IO), upper gluteus maximus (UGMax), lower gluteus maximus (LGMax), gluteus medius (GMed) and biceps femoris (BF) of dominant leg was recorded in 20 young healthy subjects while performing 3 hip exercises: Clam, side-lying hip abduction (HABD), and prone hip extension (PHE) in 2 conditions: natural core activation (NC) and enhanced core activation (CO). EMG signals normalized to percentage of maximal voluntary isometric contraction (%MVIC) were compared between two core conditions with the threshold of the enhanced abdominal core condition defined as >20%MVIC of IO. Enhanced abdominal core activation has significantly promoted the activation level of GMed in all phases of clam exercise (P recruitment in Clam, HABD and PHE exercises, and this enhancement is correlated with higher physical activity and stiffer hip muscle. Our results suggest the potential application of abdominal core activation for

  15. BILATERAL PATHOLOGICAL HIP DISLOCATION IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Yuriy E. Garkavenko

    2017-03-01

    Full Text Available Introduction. Pathological dislocation of the hip is one of the most severe complications of acute hematogenous osteomyelitis. The program of treatment for children with pathological hip dislocation is complex, but it has been sufficiently developed and implemented very successfully. At the same time, the available literature provides no cases of treating children with bilateral pathological hip dislocations after hematogenous osteomyelitis. There is no information on the incidence of such cases or in regards to remote functional results. Materials and methods. The results of the treatment of 18 children with bilateral pathological dislocation of the hip after hematogenous osteomyelitis are presented, which constituted 23.1% of the total number of patients (78 who underwent surgery in 2000–2016 for the diagnosis of pathological hip dislocation. Both hip joints were surgically operated on in 12 patients, while one hip joint was operated on in 6 patients. To assess the anatomical and functional state of hip joints, the clinical and roentgenological diagnostic techniques were used. Results and discussion. To stabilize and restore the function of the hip joints, 18 children underwent 30 surgical interventions: simple open hip reduction (19 and open hip reduction with hip arthroplasty with one (6 or two (5 demineralized osteochondral allogeneic grafts. The decision regarding the possibility of performing surgical intervention on the second hip joint was made only after a child's check-up examination was complete and after positive information about the anatomical and functional state of the operated hip joint was obtained. According to these criteria, 14 (77.8% children underwent surgical treatment of the second hip joint 1–1.5 years after the course of conservative measures to restore the range of motion in the previously operated hip joint. Over a period of 1–12 years, 17 patients were examined, 10 of which underwent an operation on both

  16. Bone-preserving total hip arthroplasty in avascular necrosis of the hip-a matched-pairs analysis.

    Science.gov (United States)

    Merschin, David; Häne, Richard; Tohidnezhad, Mersedeh; Pufe, Thomas; Drescher, Wolf

    2018-07-01

    Short-stem hip arthroplasty has the potential advantage of femoral bone stock preservation, especially in view of the expected revisions in the often relatively young patients. Despite short-stem hip prosthesis are increasingly used for total hip arthroplasty, there are no sufficient mid- and long-term results especially for patients with avascular femoral head osteonecrosis. The present study investigates mid-term functional results as well as the revision rate following implantation of a short-stem prosthesis. In the period 06/2005 until 12/2013, a total of 351 short-stem hip prostheses were implanted. The study included 331 complete data sets. A retrospective analysis was performed using the Oxford Hip Score. All revisions were registered. In a total of 331 prostheses, the Oxford Hip Score was "excellent" in 66.2%, "good" in 12.7%, "fair" in 13.0%, and "poor" in 8.2% with a mean follow-up of 57.4 months (SD ± 29.8; range 24-115). In 26 cases, aseptic osteonecrosis of the hip was the indication (7.9%). The Oxford Hip Score was "excellent" in 66.7%, "good" in 0.0%, "fair" in 20.8%, and "poor" in 12.5%. The cumulated five year survival rate was 96.7%. In mid-term observation, the Metha® short-stem prosthesis shows no disadvantage in functional outcome and in survival time compared to a standard hip stem. Providing a correct indication, the Metha® short stem is a valuable option in total hip arthroplasty for younger patients with avascular osteonecrosis of the femoral head. Evaluation has shown no significant differences between aseptic osteonecrosis and other indications.

  17. Metal artefact reduction for accurate tumour delineation in radiotherapy

    DEFF Research Database (Denmark)

    Kovacs, David Gergely; Rechner, Laura A.; Appelt, Ane L.

    2018-01-01

    Background and purpose: Two techniques for metal artefact reduction for computed tomography were studied in order to identify their impact on tumour delineation in radiotherapy. Materials and methods: Using specially designed phantoms containing metal implants (dental, spine and hip) as well...... delineation significantly (pmetal implant....... as patient images, we investigated the impact of two methods for metal artefact reduction on (A) the size and severity of metal artefacts and the accuracy of Hounsfield Unit (HU) representation, (B) the visual impact of metal artefacts on image quality and (C) delineation accuracy. A metal artefact reduction...

  18. 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.

  19. Complications in Hip Arthroscopy

    Science.gov (United States)

    Nakano, Naoki; Khanduja, Vikas

    2016-01-01

    Summary Background Recent developments in hip arthroscopic techniques and technology have made it possible in many cases to avoid open surgical dislocation for treating a variety of pathology in the hip. Although early reports suggest favourable results’ using hip arthroscopy and it has been shown to be a relatively safe procedure, complications do exist and can sometimes lead to significant morbidity. Methods This is a review article. The aim of this manuscript is to present the most frequent and/or serious complications that could occur at or following hip arthroscopy and some guidelines to avoid these complications. Conclusion Most complications of hip arthroscopy are minor or transient but serious complications can occur as well. A lot of complication e.g. acetabular labral puncture go unreported. Appropriate education and training, precise and meticulous surgical technique with correct instrumentation, the right indication in the right patient and adherence to advice from mentors and experienced colleagues are all essential factors for a successful outcome. Level of evidence: V. PMID:28066747

  20. Assessment of the hip reduction angle for predicting osteoarthritis of the hip in the Labrador Retriever.

    Science.gov (United States)

    Corfield, G S; Read, R A; Eastley, K A; Richardson, J L; Robertson, I D; Day, R

    2007-06-01

    Hip palpation has been used to provide semiquantitative information regarding passive joint laxity and susceptibility to hip dysplasia. The purpose of this study was to: (1) evaluate the intra- and inter-examiner repeatability of the hip reduction angle measured at 4 months of age by three examiners using manual goniometry and an electromagnetic tracking system; (2) compare the hip reduction angle measured with manual goniometry to the hip reduction angle measured with the electromagnetic tracking system; and (3) evaluate the hip reduction angle, distraction index and Ortolani manoeuvre at 4 months of age as predictors of the development of hip osteoarthritis at 12 months of age in 11 Labrador Retriever dogs. Intra- and inter-examiner repeatability was demonstrated for both the manual and electromagnetic goniometric measurement of the hip reduction angle (coefficient of variation goniometry was moderately correlated to the hip reduction angle measured by the electromagnetic tracking system (r = 0.603, P goniometry was a poor predictor of osteoarthritis at 12 months of age (r = 0.231, P < 0.062, and r = 0.321, P < 0.01). The distraction index was moderately correlated with the development of osteoarthritis by 12 months of age (r = 0.493, P < 0.0000). The Ortolani sign was sensitive (100%) but not specific (41%) for the development of osteoarthritis at 12 months of age. The hip reduction angle did not further quantify the Ortolani manoeuvre as a predictor of osteoarthritis in Labrador Retrievers.

  1. An alternative method for facial resurfacing: supraclavicular skin prefabrication by perforator fascia flap.

    Science.gov (United States)

    Hocaoğlu, Emre

    2014-01-01

    Prefabrication of supraclavicular skin provides a useful source for flaps congruent with the face skin. Among various vascular sources that have been used for this purpose, anterolateral thigh fascia seems to represent a greater value because of having a long and strong vascular pedicle and negligible donor-site morbidity. In this regard, we present a technical report on using the lateral circumflex femoral artery perforator flap harvest technique in preparing an anterolateral thigh fascia flap for the prefabrication of the supraclavicular skin. The technique proved successful in resurfacing the facial skin of a young female patient with a giant congenital melanocytic hairy nevus on the left side of her face.

  2. An evaluation of three commercially available metal artifact reduction methods for CT imaging

    International Nuclear Information System (INIS)

    Huang, Jessie Y; Kerns, James R; Balter, Peter A; Followill, David S; Mirkovic, Dragan; Howell, Rebecca M; Kry, Stephen F; Nute, Jessica L; Liu, Xinming; Stingo, Francesco C

    2015-01-01

    Three commercial metal artifact reduction methods were evaluated for use in computed tomography (CT) imaging in the presence of clinically realistic metal implants: Philips O-MAR, GE’s monochromatic gemstone spectral imaging (GSI) using dual-energy CT, and GSI monochromatic imaging with metal artifact reduction software applied (MARs). Each method was evaluated according to CT number accuracy, metal size accuracy, and streak artifact severity reduction by using several phantoms, including three anthropomorphic phantoms containing metal implants (hip prosthesis, dental fillings and spinal fixation rods). All three methods showed varying degrees of success for the hip prosthesis and spinal fixation rod cases, while none were particularly beneficial for dental artifacts. Limitations of the methods were also observed. MARs underestimated the size of metal implants and introduced new artifacts in imaging planes beyond the metal implant when applied to dental artifacts, and both the O-MAR and MARs algorithms induced artifacts for spinal fixation rods in a thoracic phantom. Our findings suggest that all three artifact mitigation methods may benefit patients with metal implants, though they should be used with caution in certain scenarios. (paper)

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

    International Nuclear Information System (INIS)

    Cerezal, Luis; Arnaiz, Javier; Canga, Ana; Piedra, Tatiana; Altónaga, José R.; Munafo, Ricardo; Pérez-Carro, Luis

    2012-01-01

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

  4. Ideologia hip-hopowa na przykładzie tekstów hip-hopowych

    OpenAIRE

    Kozłowska, Monika

    2012-01-01

    The article is asort of analysis of hip hop lyrics in the context of their importance for identity formation process of young generation. Rap music, as one of the elements of hip hop culture, is a kind of special innovation for its audience. With rising interest for this musical genre and hip hop culture the discussion on formulating the issues through the prism of rap music’s message has been increasing. The article presents certain aspects of making sense to the reality, w...

  5. Fractional ablative carbon dioxide laser resurfacing for skin rejuvenation and acne scars in Asians.

    Science.gov (United States)

    Chan, Nicola P Y; Ho, Stephanie G Y; Yeung, Chi K; Shek, Samantha Y N; Chan, Henry H

    2010-11-01

    Ablative fractional resurfacing (AFR) is a new modality for photorejuvenation and acne scars which combines carbon dioxide (CO₂) laser ablation with fractional photothermolysis. The objective is to evaluate the efficacy and side effects of a new fractional CO₂ ablative device (Fraxel Re:pair) for skin rejuvenation and acne scars in Asians. Nine patients underwent one full-face treatment. The energy levels ranged from 30-70 mJ with coverage between 30% and 45%. Improvement in skin texture, laxity, wrinkles, enlarged pores, overall pigmentation irregularity, and adverse effects were assessed up to 6 months post-treatment. Standardized photographs using the Canfield Visia CR system® were assessed by two independent observers. Subjective improvement was assessed by patient questionnaires. Nine Chinese patients (skin types III and IV, mean age 44.8) were included. Statistically significant improvements were seen for skin texture, skin laxity, wrinkles, enlarged pores, and acne scars. The post-inflammatory hyperpigmentation rate was 55.5% and 11.1% at 1 and 6 months post-treatment, respectively. Eighty-six percent of patients were overall satisfied to very satisfied with the treatment. Ablative fractional CO₂ laser resurfacing was overall safe and effective for skin rejuvenation and acne scars in Asians. However, in view of the high post-inflammatory rate and the statistically significant but only mild to moderate improvement after a single treatment as observed in this study, there is a need to review the current role of fractional ablative CO₂ laser treatment as compared to fractional non-ablative for skin rejuvenation and acne scar treatment in Asians. © 2010 Wiley-Liss, Inc.

  6. Current Laser Resurfacing Technologies: A Review that Delves Beneath the Surface

    Science.gov (United States)

    Preissig, Jason; Hamilton, Kristy; Markus, Ramsey

    2012-01-01

    Numerous laser platforms exist that rejuvenate the skin by resurfacing its upper layers. In varying degrees, these lasers improve the appearance of lentigines and rhytides, eliminate photoaging, soften scarring due to acne and other causes, and treat dyspigmentation. Five major classes of dermatologic lasers are currently in common use: ablative and nonablative lasers in both fractionated and unfractionated forms as well as radiofrequency technologies. The gentler nonablative lasers allow for quicker healing, whereas harsher ablative lasers tend to be more effective. Fractionating either laser distributes the effect, increasing the number of treatments but minimizing downtime and complications. In this review article, the authors seek to inform surgeons about the current laser platforms available, clarify the differences between them, and thereby facilitate the identification of the most appropriate laser for their practice. PMID:23904818

  7. Recurrent Hip Fracture Prevention With Osteoporosis Management

    Directory of Open Access Journals (Sweden)

    A. Shahla

    2007-02-01

    Full Text Available Background:Osteoporosis is a major public health threat,and hip fracture is a serious consequence of osteoporosis.Apatient with an osteoporosis-related hip fracture has an increased risk for a second hip fracture.The effect of osteoporosis management on the risk of recurrent hip fracture was evaluated in this study.Methods:58 hip fracture patients older than 50yr and BMD < 2.5 were discharged from hospital with Ca-Vitamin D- Alendronate prescriptions, and followed up for 4 years to determine the rate of recurrent hip fractures. Rate of second hip fractures was compared with 58 hip fractures in the control group (without osteoporosis treatment which were also followed for 4 years. Results:72% of patients continued treatment for 2 years. There were no second hip fractures in the critical first 12 months in the treated group.Overall second hip fractures in osteoporosis treated and control groups were 3.4% and 8.6%(p<0.03, respectively.Conclusion:Management of hip fractures in the elderly should include bone mineral density determination and osteoporosis treatment to prevent further fractures.

  8. Comparison between the Harris- and Oxford Hip Score to evaluate outcomes one-year after total hip arthroplasty

    NARCIS (Netherlands)

    Weel, Hanneke; Lindeboom, Robert; Kuipers, Sander E.; Vervest, Ton M. J. S.

    2017-01-01

    Harris Hip Score (HHS) is a surgeon administered measurement for assessing hip function before and after total hip arthroplasties (THA). Patient reported outcome measurements (PROMs) such as the Oxford Hip Score (OHS) are increasingly used. HHS was compaired to the OHS assessing whether the HHS can

  9. Nationwide data on municipal drinking water and hip fracture: could calcium and magnesium be protective? A NOREPOS study.

    Science.gov (United States)

    Dahl, Cecilie; Søgaard, Anne Johanne; Tell, Grethe S; Flaten, Trond Peder; Hongve, Dag; Omsland, Tone Kristin; Holvik, Kristin; Meyer, Haakon E; Aamodt, Geir

    2013-11-01

    Norway has a high incidence of hip fractures, and the incidence varies by degree of urbanization. This variation may reflect a difference in underlying environmental factors, perhaps variations in the concentration of calcium and magnesium in municipal drinking water. A trace metal survey (1986-1991) in 556 waterworks (supplying 64% of the Norwegian population) was linked geographically to hip fractures from hospitals throughout the country (1994-2000). In all, 5472 men and 13,604 women aged 50-85years suffered a hip fracture. Poisson regression models were fitted, adjusting for age, urbanization degree, region of residence, type of water source, and pH. The concentrations of calcium and magnesium in drinking water were generally low. An inverse association was found between concentration of magnesium and risk of hip fracture in both genders (IRR men highest vs. lowest tertile=0.80, 95% CI: 0.74, 0.87; IRR women highest vs. lowest tertile=0.90, 95% CI: 0.85, 0.95), but no consistent association between calcium and hip fracture risk was observed. The highest tertile of urbanization degree (city), compared to the lowest (rural), was related to a 23 and 24% increase in hip fracture risk in men and women, respectively. The association between magnesium and hip fracture did not explain the variation in hip fracture risk between city and rural areas. Magnesium in drinking water may have a protective role against hip fractures; however this association should be further investigated. © 2013 Elsevier Inc. All rights reserved.

  10. Resolving controversies in hip fracture care: the need for large collaborative trials in hip fractures

    NARCIS (Netherlands)

    Bhandari, Mohit; Sprague, Sheila; Schemitsch, Emil H.; Einhorn, Thomas; Guyatt, Gordon H.; Haidukewych, George; Keating, John; Koval, Kenneth; Rosen, Clifford; Swiontkowski, Marc; Tornetta, Paul; Walter, Stephen D.; Motsitsi, Silas; Pei, Fuxing; Yang, Tian-fu; Zhou, Zong-ke; Arora, Shobha; Babhulkar, Sushrut; Bhargava, Rakesh; Desai, Mohan M.; Dhillon, Mandeep S.; Gill, Harpreet Singh; Goel, S. C.; Reddy, A. V. Gurava; Jain, Anil K.; Kalore, Niraj V.; Kammatkar, Nitin; Kumar, Vijay; Malhorta, Rajesh; Marthandam, S. S. K.; Pankaj, Amite; Patinharayil, Gopinathan; Rai, B. Sachidanand; Ramteke, Alankar Ambadas; Sancheti, Parag K.; Thakkar, Navin N.; Thomas, George S.; Robinson, Dror; Steinberg, Ely; Higuchi, Fujio; Kawamura, Sumito; Ohashi, Hirotsugu; Sawaguchi, Takeshi; Park, Myung-Sik; Yun, Ho Hyun; Poduval, Murali; Siddiqui, Ahmed; Chang, Je-Ken; Wang, Gwo-Jaw; Goslings, J. Carel

    2009-01-01

    Hip fractures are a significant cause of morbidity and mortality worldwide and the burden of disability associated with hip fractures globally vindicate the need for high-quality research to advance the care of patients with hip fractures. Historically, large, multi-centre randomized controlled

  11. Photovoltaic solar power in building engineering. Experience feedback in France of the European Hip Hip project. Advances and realizations; L'electricite solaire photovoltaique dans le batiment. Retour d'experience en France du Projet Europeen Hip Hip. Avancees et realisations

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2003-07-01

    The European demonstration project Hip Hip (house integrated photovoltaic high-tech in public) led the French photovoltaic market to reach a level comparable to those of the other European countries in terms of relevance of implemented solutions and costs. This document presents the best realizations and the experience gained through the Hip Hip project. Its aim is to convince the designers and managers of building projects of the advantages of photovoltaic installations integrated to the structure and connected to the power distribution grid: 1 - presentation of the technology; 2 - status of the Hip Hip demonstration project (goals, results: main innovations and impact on the French market); 3 - different possibilities of integration to the building structure; 4 - examples of projects realized in France in the framework of the Hip Hip project: integration in glass roof, frontage, added elements, fitting on roofs. (J.S.)

  12. Hip and ankle range of motion and hip muscle strength in young female ballet dancersand controls

    Science.gov (United States)

    Bennell, K.; Khan, K. M.; Matthews, B.; De Gruyter, M.; Cook, E.; Holzer, K.; Wark, J. D.

    1999-01-01

    OBJECTIVES: To compare the hip and ankle range of motion and hip muscle strength in 8-11 year old novice female ballet dancers and controls. METHODS: Subjects were 77 dancers and 49 controls (mean (SD) age 9.6 (0.8) and 9.6 (0.7) years respectively). Supine right active hip external rotation (ER) and internal rotation (IR) were measured using an inclinometer. A turnout protractor was used to assess standing active turnout range. The measure of ER achieved from below the hip during turnout (non-hip ER) was calculated by subtracting hip ER range from turnout range, and hip ER:IR was derived by dividing ER range by IR range. Range of right weight bearing ankle dorsiflexion was measured in a standing lunge using two methods: the distance from the foot to the wall (in centimetres) and the angle of the shank to the vertical via an inclinometer (in degrees). Right calf muscle range was measured in weight bearing using an inclinometer. A manual muscle tester was used to assess right isometric hip flexor, internal rotator, external rotator, abductor, and adductor strength. RESULTS: Dancers had less ER (pballetic training. 


 PMID:10522638

  13. Surface chemistry and microstructure of metallic biomaterials for hip and knee endoprostheses

    Science.gov (United States)

    Jenko, Monika; Gorenšek, Matevž; Godec, Matjaž; Hodnik, Maxinne; Batič, Barbara Šetina; Donik, Črtomir; Grant, John T.; Dolinar, Drago

    2018-01-01

    The surface chemistry and microstructures of titanium alloys (both new and used) and CoCrMo alloys used for hip and knee endoprostheses were determined using SEM (morphology), EBSD (phase analysis), AES and XPS (surface chemistry). Two new and two used endoprostheses were studied. The SEM SE and BE images showed their microstructures, while the EBSD provided the phases of the materials. During the production of the hip and knee endoprostheses, these materials are subject to severe thermomechanical treatments and physicochemical processes that are decisive for CoCrMo alloys. The AES and XPS results showed that thin oxide films on (a) Ti6Al4V are primarily a mixture of TiO2 with a small amount of Al2O3, while the V is depleted, (b) Ti6Al7Nb is primarily a mixture of TiO2 with a small amount of Al2O3 and Nb2O5, and (c) the CoCrMo alloy is primarily a mixture of Cr2O3 with small amounts of Co and Mo oxides. The thin oxide film on the CoCrMo alloy should prevent intergranular corrosion and improve the biocompatibility. The thin oxide films on the Ti alloys prevent further corrosion, improve the biocompatibility, and affect the osseointegration.

  14. Life Estimation of Hip Joint Prosthesis

    Science.gov (United States)

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

    2015-07-01

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

  15. Utility of immediate postoperative hip MRI in developmental hip dysplasia: closed vs. open reduction.

    Science.gov (United States)

    Jadhav, Siddharth P; More, Snehal R; Shenava, Vinitha; Zhang, Wei; Kan, J Herman

    2018-04-25

    Magnetic resonance imaging (MRI) of the hips is being increasingly used to confirm hip reduction after surgery and spica cast placement for developmental dysplasia of the hip (DDH). To review a single institutional experience with post-spica MRI in children undergoing closed or open hip reduction and describe the utility of MRI in directing the need for re-intervention. Seventy-four patients (52 female, 22 male) who underwent post-spica hip MRI over a 6-year period were retrospectively reviewed. One hundred and seven hips were included. Data reviewed included age at intervention, gender, type of intervention performed, MRI findings, the need for re-intervention and the interval between interventions. Gender was compared between the closed and open reduction groups via the Fisher exact test. Age at the first procedure was compared via the Wilcoxon rank test. Rates of re-intervention after closed and open reduction were calculated and the reasons for re-intervention were reviewed. The mean age at the time of the first intervention was 16.4 months (range: 4 to 63 months). Mean age for the closed reduction group was 10.5 months (range: 4-24 months) and for the open reduction group was 23.7 months (range: 5-63 months), which was significant (P-value open reduction, MRI was useful in deciding re-intervention in only 1 (2%). This patient had prior multiple failed closed and open reductions at an outside institute. Post intervention hip spica MRI is useful in determining the need for re-intervention after closed hip reduction, but its role after open reduction is questionable.

  16. Neocolagenização induzida pelo resurfacing com laser erbium:YAG isolado e associado a lifting cutâneo: estudo morfométrico comparativo em ratos Comparison of single erbium:YAG laser resurfacing to a combination with cutaneous lifting: a morphometric study of neocollagenization in rats

    Directory of Open Access Journals (Sweden)

    Lucia Noronha

    2005-10-01

    Full Text Available INTRODUÇÃO: Diferente do lifting, cuja tração mecânica é a responsável pelo efeito clínico de rejuvenescimento sobre rugas profundas, a fibroplasia (ou neocolagenização é a responsável direta pelo resultado final da ação do laser sobre a pele com rugas superficiais, conferindo-lhe aparência mais jovem. O uso combinado dessas duas técnicas pode ser vantajoso, pois permite um resultado estético melhor com um único procedimento anestésico e cirúrgico em um curto período de recuperação. OBJETIVOS: O presente estudo morfométrico se propõe a avaliar se ocorre alguma alteração na espessura da fibroplasia induzida pelo resurfacing a laser erbium:YAG quando este se associa ao lifting cutâneo. MÉTODO: Foram utilizados 50 ratos da linhagem Wistar, divididos em dois grupos de 25, sendo que o primeiro grupo foi submetido à aplicação exclusiva de laser erbium:YAG no dorso de cada animal e o outro sofreu a aplicação de laser Erbium: YAG combinada ao lifting, o qual foi representado, no animal de experimentação, por retalho cutâneo dorsal pediculado. A fibroplasia foi avaliada nos dois grupos com medidas morfométricas lineares realizadas após o sacrifício dos animais nos dias 14, 28, 56, 84 e 112 do pós-operatório. RESULTADO: Foi observado aumento da fibroplasia em ambos os grupos estudados, porém o crescimento do colágeno foi superior no grupo submetido à terapia isolada com laser Erbium: YAG. CONCLUSÃO: A espessura da fibroplasia induzida pelo resurfacing a laser Erbium: YAG foi influenciada pela associação de um segundo procedimento cirúrgico no mesmo tempo operatório, neste caso, o lifting cutâneo.INTRODUCTION: The fibroplasia is the responsible for the final aesthetic results induced by laser resurfacing upon skin with superficial wrinkles. On the other hand, the lifting is responsible for the deeper wrinkles removal, produced by mechanic results. The use of the combination of these two rejuvenation

  17. Hip joint replacement - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100006.htm Hip joint replacement - series—Normal anatomy To use the ... to slide 5 out of 5 Overview The hip joint is made up of two major parts: ...

  18. Femoral head fracture without hip dislocation

    Directory of Open Access Journals (Sweden)

    Aggarwal Aditya K

    2013-10-01

    Full Text Available 【Abstract】Femoral head fractures without dislocation or subluxation are extremely rare injuries. We report a neglected case of isolated comminuted fracture of femoral head without hip dislocation or subluxation of one year duration in a 36-year-old patient who sustained a high en- ergy trauma due to road traffic accident. He presented with painful right hip and inability to bear full weight on right lower limb with Harris hip score of 39. He received cementless total hip replacement. At latest follow-up of 2.3 years, functional outcome was excellent with Harris hip score of 95. Such isolated injuries have been described only once in the literature and have not been classified till now. The purpose of this report is to highlight the extreme rarity, possible mechanism involved and a novel classification system to classify such injuries. Key words: Femur head; Hip dislocation; Classification; Arthroplasty, replacement, hip

  19. Economic viability of geriatric hip fracture centers.

    Science.gov (United States)

    Clement, R Carter; Ahn, Jaimo; Mehta, Samir; Bernstein, Joseph

    2013-12-01

    Management of geriatric hip fractures in a protocol-driven center can improve outcomes and reduce costs. Nonetheless, this approach has not spread as broadly as the effectiveness data would imply. One possible explanation is that operating such a center is not perceived as financially worthwhile. To assess the economic viability of dedicated hip fracture centers, the authors built a financial model to estimate profit as a function of costs, reimbursement, and patient volume in 3 settings: an average US hip fracture program, a highly efficient center, and an academic hospital without a specific hip fracture program. Results were tested with sensitivity analysis. A local market analysis was conducted to assess the feasibility of supporting profitable hip fracture centers. The results demonstrate that hip fracture treatment only becomes profitable when the annual caseload exceeds approximately 72, assuming costs characteristic of a typical US hip fracture program. The threshold of profitability is 49 cases per year for high-efficiency hip fracture centers and 151 for the urban academic hospital under review. The largest determinant of profit is reimbursement, followed by costs and volume. In the authors’ home market, 168 hospitals offer hip fracture care, yet 85% fall below the 72-case threshold. Hip fracture centers can be highly profitable through low costs and, especially, high revenues. However, most hospitals likely lose money by offering hip fracture care due to inadequate volume. Thus, both large and small facilities would benefit financially from the consolidation of hip fracture care at dedicated hip fracture centers. Typical US cities have adequate volume to support several such centers.

  20. Development of a Sinter/HIP process for the superalloy Udimet 700 with investigations of the influence of the sinteratmosphere

    International Nuclear Information System (INIS)

    Wenning, L.

    1991-03-01

    The oxidation free treatment of reactive metalpowders like the nickel base alloy Udimet 700 demands sufficient oxygen free sinteratmospheres in nowadays sinter-HIP plants are not reachable. The reported work deals with the development of a sinter-HIP process which enables a sufficient low partial pressure of oxygen by scavenging the Udimet 700 powder packings with argon during vacuum sintering. By this the sinter hindering oxidation is avoided. Intensive investigations of the sinteratmosphere with a mass spectrometer and a zirconium oxide probe verify the reduction of the oxygen content of the residual gas atmosphere reached with different processes. In a second part the applicability of the scavenging gas process during the capsule free sinter-HIP treatment of metall injection moulded (MIM) samples is shown. (orig.) [de

  1. Featherless Dinosaurs and the Hip-Hop Simulacrum: Reconsidering Hip-Hop's Appropriateness for the Music Classroom

    Science.gov (United States)

    Kruse, Adam J.

    2016-01-01

    This article offers considerations for music teachers interested in including hip-hop music in their classrooms but who might feel concerned with or overwhelmed by issues of appropriateness. Two concerns related to hip-hop music are examined: language and negative social themes. Commercial interests in hip-hop music have created a simulacrum (or…

  2. Cobalt-alloy implant debris induce HIF-1α hypoxia associated responses: a mechanism for metal-specific orthopedic implant failure.

    Directory of Open Access Journals (Sweden)

    Lauryn Samelko

    Full Text Available The historical success of orthopedic implants has been recently tempered by unexpected pathologies and early failures of some types of Cobalt-Chromium-Molybdenum alloy containing artificial hip implants. Hypoxia-associated responses to Cobalt-alloy metal debris were suspected as mediating this untoward reactivity at least in part. Hypoxia Inducible Factor-1α is a major transcription factor involved in hypoxia, and is a potent coping mechanism for cells to rapidly respond to changing metabolic demands. We measured signature hypoxia associated responses (i.e. HIF-1α, VEGF and TNF-α to Cobalt-alloy implant debris both in vitro (using a human THP-1 macrophage cell line and primary human monocytes/macrophages and in vivo. HIF-1α in peri-implant tissues of failed metal-on-metal implants were compared to similar tissues from people with metal-on-polymer hip arthroplasties, immunohistochemically. Increasing concentrations of cobalt ions significantly up-regulated HIF-1α with a maximal response at 0.3 mM. Cobalt-alloy particles (1 um-diameter, 10 particles/cell induced significantly elevated HIF-1α, VEGF, TNF-α and ROS expression in human primary macrophages whereas Titanium-alloy particles did not. Elevated expression of HIF-1α was found in peri-implant tissues and synovial fluid of people with failing Metal-on-Metal hips (n = 5 compared to failed Metal-on-Polymer articulating hip arthroplasties (n = 10. This evidence suggests that Cobalt-alloy, more than other metal implant debris (e.g. Titanium alloy, can elicit hypoxia-like responses that if unchecked can lead to unusual peri-implant pathologies, such as lymphocyte infiltration, necrosis and excessive fibrous tissue growths.

  3. Total hip arthroplasty using a short-stem prosthesis: restoration of hip anatomy.

    Science.gov (United States)

    Amenabar, Tomas; Marimuthu, Kanniraj; Hawdon, Gabrielle; Gildone, Alessandro; McMahon, Stephen

    2015-04-01

    To evaluate hip parameters such as vertical centre of rotation (VCR), horizontal centre of rotation (HCR), femoral offset, and leg length after total hip arthroplasty (THA) using the Nanos short-stem prosthesis. Medical records of 73 men and 74 women aged 25 to 92 (mean, 63) years who underwent THA using the Nanos short-stem prosthesis by a single surgeon were reviewed. Prior to the surgery, the optimal cup and stem size, head length, and level of the neck osteotomy were determined using radiographs. Intra-operatively, the leg length and femoral offset were checked, and the level of neck resection and head length were adjusted. VCR, HCR, femoral offset, and leg length of the operated and contralateral sides were compared. Functional outcomes were assessed using the Harris Hip Score (HHS). Compared with the normal contralateral hips, the operated hips had a mean increase of 0.4 mm in VCR (p=0.032), a mean decrease of 1.4 mm in HCR (p=0.027), a mean increase of 0.6 mm in femoral offset (p=0.043), and a mean increase of 0.36 mm in leg length (p=0.035). For these respective parameters, the difference between the normal contralateral side and the operated side was within 5 mm in 89%, 80%, 71%, and 96% of patients. The HHS improved from a mean of 53 to 91 at one year (pNanos short-stem prosthesis enabled restoration of hip anatomy (VCR, HCR, femoral offset, and leg length).

  4. Potential role of resurfacing Subtropical Underwater in ENSO evolution

    Science.gov (United States)

    Qu, T.; Chi, J.

    2017-12-01

    Results from a model of the Estimating the Circulation and Climate of the Ocean (ECCO) have shown that the resurfacing of high salinity Subtropical Underwater contributes to the sea surface salinity variability in the equatorial Pacific. On interannual time scale, this contribution can account for as much as 25% of the surface freshwater flux anomalies and is believed to play a role in ENSO evolution. Having these results in mind, this study investigates the surface salinity budget and its primary controls in the equatorial Pacific using ECCO output for the period 1993-2016. Particular attention is paid to 2014/2015 and 2015/2016. Preliminary analyses of the model results suggest that enhanced subsurface processes and in particular enhanced entrainment of Subtropical Underwater are primarily responsible for the positive sea surface salinity anomalies in the central equatorial Pacific during 2014/2015, which represents an opposite phase of El Niño. These subsurface processes weakened during 2015/2016, diretly contributing to the development of the 2015/2016 El Niño. The mechanisms controlling these subsurface processes are discussed.

  5. Social inequality and hip fracture

    DEFF Research Database (Denmark)

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

    2015-01-01

    Social inequality appears to be increasing in many countries. We explored whether risk of hip fracture was associated with markers of inequality and whether these relationships changed with time, using data from Danish Health Registries. Methods: All patients 60 years or older with a primary hip...... fracture (ICD10: S720, S721, S722 and S729) were identified from 1 January 1995 to 31 December 2011. Hip fracture patients were matched 1:1 on age, gender and year of fracture to a non-hip fracture control. An individual's education attainment was defined as basic, secondary or higher, and their income...

  6. Histological evaluation of vertical laser channels from ablative fractional resurfacing

    DEFF Research Database (Denmark)

    Skovbølling Haak, Christina; Illes, Monica; Paasch, Uwe

    2011-01-01

    Ablative fractional resurfacing (AFR) represents a new treatment potential for various skin conditions and new laser devices are being introduced. It is important to gain information about the impact of laser settings on the dimensions of the created laser channels for obtaining a safe...... and efficient treatment outcome. The aim of this study was to establish a standard model to document the histological tissue damage profiles after AFR and to test a new laser device at diverse settings. Ex vivo abdominal pig skin was treated with a MedArt 620, prototype fractional carbon dioxide (CO(2)) laser...... (Medart, Hvidovre, Denmark) delivering single microbeams (MB) with a spot size of 165 µm. By using a constant pulse duration of 2 ms, intensities of 1-18 W, single and 2-4 stacked pulses, energies were delivered in a range from 2-144 mJ/MB. Histological evaluations included 3-4 high-quality histological...

  7. Histological evaluation of vertical laser channels from ablative fractional resurfacing

    DEFF Research Database (Denmark)

    Skovbølling Haak, Christina; Illes, Monica; Paasch, Uwe

    2011-01-01

    Ablative fractional resurfacing (AFR) represents a new treatment potential for various skin conditions and new laser devices are being introduced. It is important to gain information about the impact of laser settings on the dimensions of the created laser channels for obtaining a safe...... and efficient treatment outcome. The aim of this study was to establish a standard model to document the histological tissue damage profiles after AFR and to test a new laser device at diverse settings. Ex vivo abdominal pig skin was treated with a MedArt 620, prototype fractional carbon dioxide (CO(2)) laser...... (Medart, Hvidovre, Denmark) delivering single microbeams (MB) with a spot size of 165 μm. By using a constant pulse duration of 2 ms, intensities of 1-18 W, single and 2-4 stacked pulses, energies were delivered in a range from 2-144 mJ/MB. Histological evaluations included 3-4 high-quality histological...

  8. Fractional carbon dioxide laser resurfacing of rhytides and photoaged skin--a prospective clinical study on patient expectation and satisfaction.

    Science.gov (United States)

    Kohl, Elisabeth; Meierhöfer, Julia; Koller, Michael; Zeman, Florian; Groesser, Leopold; Karrer, Sigrid; Hohenleutner, Ulrich; Landthaler, Michael; Hohenleutner, Silvia

    2015-02-01

    Fractional CO2 -laser resurfacing is increasingly used for treating rhytides and photoaged skin because of its favorable benefit-risk ratio. A key outcome measure and treatment goal in aesthetic laser therapy is patient satisfaction. However, few data are available on patient-reported outcomes after fractional ablative skin-resurfacing. To compare patient expectations before and patient satisfaction after three fractional CO2 -laser treatments and to correlate objectively measured wrinkle reduction with patient satisfaction after treatment. We investigated patient expectation and satisfaction using a 14-item questionnaire in 24 female patients. We assessed the skin-related quality of life and patient satisfaction with skin appearance. We profilometrically measured wrinkle size in four facial areas before and three months after treatment and investigated correlations between wrinkle reduction and patient satisfaction. The high patient expectations before treatment (ceiling effect) were actually slightly exceeded. The average score of 14 items delineating patient satisfaction with laser treatment was higher (4.64 ± 0.82; n = 24) than the respective expectations before treatment (4.43 ± 0.88; n = 24). Skin-related quality of life and patient satisfaction with skin appearance had significantly improved after the last treatment. Patients dissatisfied with their skin appearance before treatment (mean 2.1 ± 1.5; evaluated on a scale ranging from 0-6) were satisfied (mean 5.1 ± 1.2) (P skin appearance at the follow-up. Patient satisfaction with skin appearance was not correlated to the profilometrically measured reduction of wrinkle size of any facial area. Our results show high patient satisfaction with ablative fractional skin resurfacing, also regarding improved self-esteem and self-satisfaction despite high pre-treatment expectations. Skin-specific quality of life had significantly improved. Thus, this treatment modality can be recommended

  9. Reduction of artefacts caused by hip implants in CT-based attenuation-corrected PET images using 2-D interpolation of a virtual sinogram on an irregular grid

    NARCIS (Netherlands)

    Abdoli, Mehrsima; de Jong, Johan R.; Pruim, Jan; Dierckx, Rudi A. J. O.; Zaidi, Habib

    2011-01-01

    Purpose Metallic prosthetic replacements, such as hip or knee implants, are known to cause strong streaking artefacts in CT images. These artefacts likely induce over-or underestimation of the activity concentration near the metallic implants when applying CT-based attenuation correction of positron

  10. The changing case-mix of hip fractures in Scotland - evidence from the Scottish Hip Fracture Audit.

    Science.gov (United States)

    Hannah, Stephen D; Ferguson, K B; Smith, R; Hutchison, J; Holt, G

    2017-11-01

    Until discontinued in 2008, the Scottish Hip Fracture Audit collected and reported on data relating to the quality of care of hip fracture patients in Scotland. In 2013, the audit was recommenced under the umbrella of the MSK Audit group, which audits high volume orthopaedic pathways across Scotland. Our aim is to report on the changes in the demographics of hip fracture patients in Scotland between 2003 and 2013. There was an increase in the proportion of male patients from 2003 to 2013 (22.4% to 29.5%; p < 0.0001). An increased percentage of hip fracture patients were admitted from their own home (63.9% to 73.1%; p < 0.0001). Both these factors have deleterious effects on the outcome, and use of necessary resources, following hip fracture. There was also an increase in the percentage of patients who were American Society of Anesthesiologists Grade 3 (52.9% to 56.4%). Over the last decade, there has been a shift in the demographics of Scotland's hip fracture patients. If hip fracture incidence increases as predicted, this potentially more-challenging case-mix will likely impact on multiple health resources.

  11. Danish Hip Arthroscopy Registry

    DEFF Research Database (Denmark)

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

    2016-01-01

    Danish Hip Arthroscopy Registry (DHAR) was initiated in 2012 as a web-based prospective registry. The purpose of this study was to evaluate and report the epidemiologic and perioperative data of the first 2000 procedures in a Danish hip arthroscopy population and to describe the development of DHAR...... was 0.65 and HAGOS sub-scores were 51 (pain), 49 (symptoms), 53 (ADL), 35 (sport), 20 (physical activity) and 29, respectively. We conclude that patients undergoing hip arthroscopy report considerable pain, loss of function, reduced level of activity and reduced quality-of-life prior to surgery....... The problems with development and maintaining a large clinical registry are described and further studies are needed to validate data completeness. We consider the development of a national clinical registry for hip arthroscopy as a successful way of developing and maintaining a valuable clinical...

  12. Metal artifact suppression at the hip: diagnostic performance at 3.0 T versus 1.5 Tesla

    Energy Technology Data Exchange (ETDEWEB)

    Nardo, Lorenzo; Han, Misung; Kretschmar, Martin; Krug, Roland; Link, Thomas M. [University of California San Francisco, Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Guindani, Michele [The University of Texas MD Anderson Cancer Center, Department of Biostatistics - Unit 1411, Houston, TX (United States); Koch, Kevin [Medical College of Wisconsin, Department of Biophysics, Milwaukee, WI (United States); Medical College of Wisconsin, Department of Radiology, Milwaukee, WI (United States); Vail, Thomas [University of California San Francisco, Department of Orthopedic Surgery, San Francisco, CA (United States)

    2015-11-15

    This work aimed to compare the diagnostic performance of a metal artifact suppression sequence (MAVRIC-SL) for imaging of hip arthroplasties (HA) at 1.5 and 3 Tesla (T) field strength. Eighteen patients (10 females; aged 27-74) with HA were examined at 3.0 and 1.5 T within 3 weeks. The sequence protocol included 3D-MAVRIC-SL PD (coronal), 3D-MAVRIC-SL STIR (axial), FSE T1, FSE PD and STIR sequences. Anatomical structures and pathological findings were assessed independently by two radiologists. Artifact extent and technical quality (image quality, fat saturation and geometric distortion) were also evaluated. Findings at 1.5 and 3.0 T were compared using a Wilcoxon signed rank test. While image quality was better at 1.5 T, visualization of anatomic structures and clinical abnormalities was not significantly different using the two field strengths (p > 0.05). Fat suppression and amount of artifacts were significantly better at 1.5 T (p < 0.01). Inter- and intra-reader agreement for different anatomic details, image quality and visualization of abnormalities ranged from k = 0.62 to k = 1.00. MAVRIC-SL at 1.5 T had a comparable diagnostic performance when compared MAVRIC-SL at 3.0 T; however, the higher field strength was associated with larger artifacts, limited image quality and worse fat saturation. (orig.)

  13. Metal artifact suppression at the hip: diagnostic performance at 3.0 T versus 1.5 Tesla

    International Nuclear Information System (INIS)

    Nardo, Lorenzo; Han, Misung; Kretschmar, Martin; Krug, Roland; Link, Thomas M.; Guindani, Michele; Koch, Kevin; Vail, Thomas

    2015-01-01

    This work aimed to compare the diagnostic performance of a metal artifact suppression sequence (MAVRIC-SL) for imaging of hip arthroplasties (HA) at 1.5 and 3 Tesla (T) field strength. Eighteen patients (10 females; aged 27-74) with HA were examined at 3.0 and 1.5 T within 3 weeks. The sequence protocol included 3D-MAVRIC-SL PD (coronal), 3D-MAVRIC-SL STIR (axial), FSE T1, FSE PD and STIR sequences. Anatomical structures and pathological findings were assessed independently by two radiologists. Artifact extent and technical quality (image quality, fat saturation and geometric distortion) were also evaluated. Findings at 1.5 and 3.0 T were compared using a Wilcoxon signed rank test. While image quality was better at 1.5 T, visualization of anatomic structures and clinical abnormalities was not significantly different using the two field strengths (p > 0.05). Fat suppression and amount of artifacts were significantly better at 1.5 T (p < 0.01). Inter- and intra-reader agreement for different anatomic details, image quality and visualization of abnormalities ranged from k = 0.62 to k = 1.00. MAVRIC-SL at 1.5 T had a comparable diagnostic performance when compared MAVRIC-SL at 3.0 T; however, the higher field strength was associated with larger artifacts, limited image quality and worse fat saturation. (orig.)

  14. TREATMENT OF NEUROLOGICAL CONGENITAL HIP LUXATION

    Directory of Open Access Journals (Sweden)

    Iulian ICLEANU

    2015-11-01

    Full Text Available Congenital hip luxation is a disorder which evolves in time. Teratological hip dislocation is a distinct form of hip luxation, which usually appears with other disorders. These hips are dislocated before birth. In this thesis we will try to elaborate a recovery program, through physical exercises, which will help us realize our treatment objectives: diminishing articular stiffness, increasing articular mobility, increasing muscle strength, recalibration of agonist and antagonist balances and reeducating gait. The specific objectives of the study consist of the particularization of the recovery programs based on age, illness stage (dysplasia or luxation and either surgical or non-surgical intervention. To show the importance of physiotherapy in gait rehabilitation of a child with hip dislocation we started from the hypothesis: using an adequate rehabilitation program after an individualized methodology, optimizes the functional recovery and ensures the gains of hip stability and the formation of an engram of gait as close as it could be to the normal one. We present a case of neurological congenital hip dislocation where the treatment initiated early is showing good results. Results obtained are significantly different and we came to the conclusion that starting an untimely analytical kinetic treatment and globally personalizing it to every patient has better biomechanical results for the hip.

  15. Delaying Shoulder Motion and Strengthening and Increasing Achilles Allograft Thickness for Glenoid Resurfacing Did Not Improve the Outcome for a 30-Year-Old Patient with Postarthroscopic Glenohumeral Chondrolysis

    Directory of Open Access Journals (Sweden)

    John G. Skedros

    2014-01-01

    Full Text Available Although interposition soft-tissue (biologic resurfacing of the glenoid with humeral hemiarthroplasty has been considered an option for end-stage glenohumeral arthritis, the results of this procedure are highly unsatisfactory in patients less than 40 years old. Achilles tendon allograft is popular for glenoid resurfacing because it can be made robust by folding it. But one reason that the procedure might fail in younger patients is that the graft is not initially thick enough for the young active patient. Most authors report folding the graft only once to achieve two-layer thickness. We report the case of a 30-year-old male who had postarthroscopic glenohumeral chondrolysis that was treated with Achilles tendon allograft resurfacing of the glenoid and humeral hemiarthroplasty. An important aspect of our case is that the tendon was folded so that it was 50–100% thicker than most allograft constructs reported previously. We also used additional measures to enhance allograft resiliency and bone incorporation: (1 multiple nonresorbable sutures to attach the adjacent graft layers, (2 additional resorbable suture anchors and nonresorbable sutures in order to more robustly secure the graft to the glenoid, and (3 delaying postoperative motion and strengthening. However, despite these additional measures, our patient did not have an improved outcome.

  16. RAZVOJ OBLAČIL V HIP HOP KULTURI

    OpenAIRE

    Marić, Sanja

    2010-01-01

    V diplomskem delu smo raziskovali, kako so se hip hop oblačila razvijala skozi obdobja v hip hop kulturi. V teoretičnem deli smo ugotavljali ozadje in dejavnike, ki so vplivali na razvoj hip hop kulture, v empiričnem delu diplomske naloge pa smo izvedli anketni vprašalnik z glavnimi akterji hip hop kulture na slovenski hip hop sceni. Rezultati, ki smo jih dobili, kažejo da so imela oblačila velik vpliv na prepoznavnost in razvoj hip hop kulture po celem svetu. K temu so največ pripomogli ustv...

  17. Comparison of the responsiveness of the Harris Hip Score with generic measures for hip function in osteoarthritis of the hip.

    NARCIS (Netherlands)

    Hoeksma, H.L.; Ende, C.H.M. van den; Ronday, H.K.; Heering, A.; Breedveld, F.C.; Dekker, J.

    2003-01-01

    OBJECTIVE: To compare responsiveness of the Harris Hip Score with generic measures (that is, the Short Form-36 (SF-36), and a test of walking speed and pain during walking) in patients with osteoarthritis (OA) of the hip. METHOD: The first 75 cases within the population of a randomised clinical

  18. Development of a copper alloy to beryllium HIP bonding technology for the ITER first wall

    International Nuclear Information System (INIS)

    Sherlock, P.; Peacock, A.T.; Mc Callum, A.D.

    2005-01-01

    The primary first wall (PFW) panels of the ITER blanket concept comprise a bi-metallic copper alloy/stainless steel water-cooled heatsink faced with a plasma facing material. Precipitation strengthened CuCrZr is one option for the copper alloy of the heatsink; beryllium, in the form of tiles is an option for the plasma facing material. Over recent years, the technology needed to HIP bond the beryllium tiles to CuCrZr alloy has been developed. This paper describes small samples and larger mock-ups produced during the development of this HIP bonding technology and outlines how structural analyses were used to gain an understanding of the bonding process and refine the design

  19. Effects of hip joint position and intra-capsular volume on hip joint intra-capsular pressure: a human cadaveric model

    Directory of Open Access Journals (Sweden)

    Tse Paul

    2009-04-01

    Full Text Available Abstract Background Increase in hip intra-capsular pressure has been implicated in various hip pathologies, such as avascular necrosis complicating undisplaced femoral neck fracture. Our study aimed at documenting the relationship between intra-capsular volume and pressure in various hip positions. Methods Fifty-two cadaveric hips were studied. An electronic pressure-monitoring catheter recorded the intra-capsular hip pressure after each instillation of 2 ml of normal saline and in six hip positions. Results In neutral hip position, the control position for investigation, intra-capsular pressure remained unchanged when its content was below 10 ml. Thereafter, it increased exponentially. When the intra-capsular volume was 12 ml, full abduction produced a 2.1-fold increase (p = 0.028 of the intra-capsular hip joint pressure; full external rotation and full internal rotation increased the pressure by at least 4-fold (p Conclusion Intra-capsular pressure increases with its volume, but with a wide variation with different positions. It would be appropriate to recommend that hips with haemarthrosis or effusion should be positioned in 45-degree flexion.

  20. Hip Imaging in Athletes: Sports Imaging Series.

    Science.gov (United States)

    Agten, Christoph A; Sutter, Reto; Buck, Florian M; Pfirrmann, Christian W A

    2016-08-01

    Hip or groin pain in athletes is common and clinical presentation is often nonspecific. Imaging is a very important diagnostic step in the work-up of athletes with hip pain. This review article provides an overview on hip biomechanics and discusses strategies for hip imaging modalities such as radiography, ultrasonography, computed tomography, and magnetic resonance (MR) imaging (MR arthrography and traction MR arthrography). The authors explain current concepts of femoroacetabular impingement and the problem of high prevalence of cam- and pincer-type morphology in asymptomatic persons. With the main focus on MR imaging, the authors present abnormalities of the hip joint and the surrounding soft tissues that can occur in athletes: intraarticular and extraarticular hip impingement syndromes, labral and cartilage disease, microinstability of the hip, myotendinous injuries, and athletic pubalgia. (©) RSNA, 2016.

  1. Correlation of Hip Fracture with Other Fracture Types: Toward a Rational Composite Hip Fracture Endpoint

    Science.gov (United States)

    Colón-Emeric, Cathleen; Pieper, Carl F.; Grubber, Janet; Van Scoyoc, Lynn; Schnell, Merritt L; Van Houtven, Courtney Harold; Pearson, Megan; Lafleur, Joanne; Lyles, Kenneth W.; Adler, Robert A.

    2016-01-01

    Purpose With ethical requirements to the enrollment of lower risk subjects, osteoporosis trials are underpowered to detect reduction in hip fractures. Different skeletal sites have different levels of fracture risk and response to treatment. We sought to identify fracture sites which cluster with hip fracture at higher than expected frequency; if these sites respond to treatment similarly, then a composite fracture endpoint could provide a better estimate of hip fracture reduction. Methods Cohort study using Veterans Affairs and Medicare administrative data. Male Veterans (n=5,036,536) aged 50-99 years receiving VA primary care between1999-2009 were included. Fractures were ascertained using ICD9 and CPT codes and classified by skeletal site. Pearson correlation coefficients, logistic regression and kappa statistics, were used to describe the correlation between each fracture type and hip fracture within individuals, without regards to the timing of the events. Results 595,579 (11.8%) men suffered 1 or more fractures and 179,597 (3.6%) suffered 2 or more fractures during the time under study. Of those with one or more fractures, rib was the most common site (29%), followed by spine (22%), hip (21%) and femur (20%). The fracture types most highly correlated with hip fracture were pelvic/acetabular (Pearson correlation coefficient 0.25, p<0.0001), femur (0.15, p<0.0001), and shoulder (0.11, p<0.0001). Conclusions Pelvic, acetabular, femur, and shoulder fractures cluster with hip fractures within individuals at greater than expected frequency. If we observe similar treatment risk reductions within that cluster, subsequent trials could consider use of a composite endpoint to better estimate hip fracture risk. PMID:26151123

  2. The Hyperflexible Hip

    Science.gov (United States)

    Weber, Alexander E.; Bedi, Asheesh; Tibor, Lisa M.; Zaltz, Ira; Larson, Christopher M.

    2015-01-01

    Context: Dance, gymnastics, figure skating, and competitive cheerleading require a high degree of hip range of motion. Athletes who participate in these sports use their hips in a mechanically complex manner. Evidence Acquisition: A search of the entire PubMed database (through December 2013) and additional searches of the reference lists of pertinent articles. Study Design: Systematic review. Level of Evidence: Level 3. Results: Whether innate or acquired, dancers and gymnasts have some hypermobility that allows their hips to be placed in potentially impinging or unstable positions required for their given activity. Such extremes of motion can result in both intra-articular and extra-articular impingement as well as compensatory osseous and muscular pathology. In addition, dancers and gymnasts are susceptible to impingement-induced instability. Dancers with innate generalized hyperlaxity are at increased risk of injury because of their activities and may require longer recovery times to return to play. Both nonoperative and operative treatments (arthroscopic and open) have an important role in returning flexibility athletes to their preoperative levels of sport and dance. Conclusion: Because of the extreme hip motion required and the compensatory soft tissue laxity in dancers and gymnasts, these athletes may develop instability, impingement, or combinations of both. This frequently occurs in the setting of subtle pathoanatomy or in patients with normal bony anatomy. With appropriate surgical indications and the correct operative technique, the treating surgeon can anticipate high levels of return to play for the gymnast and dancer with hip pain. PMID:26137181

  3. Dose uncertainties associated with a set density override of unknown hip prosthetic composition.

    Science.gov (United States)

    Rijken, James D; Colyer, Christopher J

    2017-09-01

    The dosimetric uncertainties associated with radiotherapy through hip prostheses while overriding the implant to a set density within the TPS has not yet been reported. In this study, the uncertainty in dose within a PTV resulting from this planning choice was investigated. A set of metallic hip prosthetics (stainless steel, titanium, and two different Co-Cr-Mo alloys) were CT scanned in a water bath. Within the TPS, the prosthetic pieces were overridden to densities between 3 and 10 g/cm 3 and irradiated on a linear accelerator. Measured dose maps were compared to the TPS to determine which density was most appropriate to override each metal. This was shown to be in disagreement with the reported literature values of density which was attributed to the TPS dose calculation algorithm and total mass attenuation coefficient differences in water and metal. The dose difference was then calculated for a set density override of 6 g/cm 3 in the TPS and used to estimate the dose uncertainty beyond the prosthesis. For beams passing through an implant, the dosimetric uncertainty in regions of the PTV may be as high as 10% if the implant composition remains unknown and a set density override is used. These results highlight limitations of such assumptions and the need for careful consideration by radiation oncologist, therapist, and physics staff. © 2017 Adelaide Radiotherapy Centre. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

  4. Extensive nevus comedonicus, complicated with recurrent abscesses, successfully treated with surgical resurfacing

    Directory of Open Access Journals (Sweden)

    Narender Manikavachakan

    2018-01-01

    Full Text Available Nevus comedonicus is a rare epidermal abnormality of the pilosebaceous unit, which is congenital in most patients but may also appear early in childhood. It may be localized or have an extensive involvement, the latter showing a unilateral predominance with only a few cases presenting bilaterally. Extensive nevus comedonicus can be associated with musculoskeletal defects, eye and neurological involvement, which constitutes nevus comedonicus syndrome. Uncomplicated nevus comedonicus can be treated with topical keratolytics, diode, erbium laser, and ultrapulse CO2 laser. Surgical excision can be performed to ensure complete removal and nonrecurrence. This case report refers to a young male patient with extensive nevus comedonicus present over left chest, left axilla, and left upper back without systemic involvement, treated with staged surgical excision and resurfacing.

  5. 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 and heritab......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...... 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...... not have had a total hip arthroplasty at the time of follow-up. RESULTS: There were 94,063 twins eligible for analyses, comprising 835 cases of 36 concordant and 763 discordant twin pairs. The probability increased particularly from 50 years of age. After sex and age adjustment a significant additive...

  6. Transient osteoporosis of hip

    Directory of Open Access Journals (Sweden)

    Mahesh M Choudhary

    2015-01-01

    Full Text Available We report a case of transient osteoporosis of the hip (TOH in a 50-year-old man including the clinical presentation, diagnostic studies, management, and clinical progress. TOH is a rare self-limiting condition that typically affects middle-aged men or, less frequently, women in the third trimester of pregnancy. Affected individuals present clinically with acute hip pain, limping gait, and limited ranges of hip motion. TOH may begin spontaneously or after a minor trauma. Radiographs are typically unremarkable but magnetic resonance (MR imaging studies yield findings consistent with bone marrow edema. TOH is referred to as regional migratory osteoporosis (RMO if it travels to other joints or the contralateral hip. TOH often resembles osteonecrosis but the two conditions must be differentiated due to different prognoses and management approaches. The term TOH is often used interchangeably and synonymously with transient bone marrow edema (TBME.

  7. Hip malformation is a very common finding in young patients scheduled for total hip arthroplasty

    DEFF Research Database (Denmark)

    Karimi, Dennis; Kallemose, Thomas; Troelsen, Anders

    2018-01-01

    and prevalences of hip malformations were; CAM-deformity 50.9 and 25.5%, coxa profunda 33 and 27.4%, acetabular retroversion 33 and 29.2%, and acetabular dysplasia 10.4 and 3.8%. All patients showed minimum of one malformation. Prevalences of Tönnis grade 0-1 were 22.6% and 2-3 were 77.4%. CONCLUSION: All......INTRODUCTION: In Denmark, 20% of all registered total hip arthroplasties (THA) from 1995 to 2014 has been patients younger than 60 years with primary idiopathic osteoarthritis (OA). It is speculated that hip malformations may be a major contributor to early OA development. It has been shown...... that hip malformation may compromise implant position and, therefore, identifying and knowing the incidence of malformations is important. Our aim was to assess the prevalence and type of hip malformations in a cohort of younger patients undergoing THA. MATERIALS AND METHODS: In this prospective two center...

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    Background . The pathogenesis of total joint replacement failure is multifactorial. One hypothesis suggests that corrosion and wear of alloys result in metal ion release, which may then cause sensitization and even implant failure, owing to the acquired immune reactivity. Objectives . To assess c...

  9. Impact of UHMWPE texture on friction and wear resistance of hip prosthesis

    Directory of Open Access Journals (Sweden)

    Eddoumy Fatima

    2013-11-01

    Full Text Available Ultra High Molecular Weight PolyEthylene (UHMWPE is a polymer widely used in hip implants (prostheses as a bearing surface against metal, because of its good mechanical properties and biocompatibility [1]. Nevertheless, the durability of such implants is limited because of failure resulting from osteolysis and aseptic loosening. These two phenomenons are due to the immune response of human body consecutive to the apparition of wear particles of UHMWPE with time.

  10. [The hip joint in neuromuscular disorders].

    Science.gov (United States)

    Strobl, W M

    2009-07-01

    Physiologic motor and biomechanical parameters are prerequisites for normal hip development and hip function. Disorders of muscle activity and lack of weight bearing due to neuromuscular diseases may cause clinical symptoms such as an unstable hip or reduced range of motion. Disability and handicap because of pain, hip dislocation, osteoarthritis, gait disorders, or problems in seating and positioning are dependent on the severity of the disease, the time of occurrence, and the means of prevention and treatment. Preservation of pain-free and stable hip joints should be gained by balancing muscular forces and by preventing progressive dislocation. Most important is the exact indication of therapeutic options such as movement and standing therapy as well as drugs and surgery.

  11. The Formation of "Hip-Hop Academicus"--How American Scholars Talk about the Academisation of Hip-Hop

    Science.gov (United States)

    Soderman, Johan

    2013-01-01

    Social activism and education have been associated with hip-hop since it emerged in New York City 38 years ago. Therefore, it might not be surprising that universities have become interested in hip-hop. This article aims to highlight this "hip-hop academisation" and analyse the discursive mechanisms that manifest in these academisation…

  12. Epidemiology of Hip Flexor and Hip Adductor Strains in National Collegiate Athletic Association Athletes, 2009/2010-2014/2015

    DEFF Research Database (Denmark)

    Eckard, Timothy G; Padua, Darin A; Dompier, Thomas P

    2017-01-01

    restriction time were examined. Injury rate ratios (IRRs) and proportion ratios were calculated to compare rates within and between sports by event type, sex, mechanism, recurrence, and participation restriction time. RESULTS: A total of 770 hip flexor and 621 hip adductor strains were reported, resulting....../2010-2014/2015 academic years. STUDY DESIGN: Descriptive epidemiology study. METHODS: Rates and patterns of hip flexor and adductor strains in collegiate sports were examined in a convenience sample of NCAA varsity teams from 25 sports. Rates and distributions of strains by mechanism, recurrence, and participation...... in overall injury rates of 1.60 and 1.29 per 10,000 athlete-exposures (AEs), respectively. In men, the rate of hip flexor strains was 1.81 per 10,000 AEs, and that for hip adductor strains was 1.71 per 10,000 AEs. In women, the rate of hip flexor strains was 1.59 per 10,000 AEs, and the rate of hip adductor...

  13. Unconstrained tripolar hip implants: effect on hip stability.

    Science.gov (United States)

    Guyen, Olivier; Chen, Qing Shan; Bejui-Hugues, Jacques; Berry, Daniel J; An, Kai-Nan

    2007-02-01

    Tripolar implants were developed to treat unstable total hip arthroplasties. However, there is limited confirmation that they achieve this purpose despite their increasing use. Because they have a larger effective head size, these implants are expected to increase range of motion to impingement and improve stability in situations at risk for impingement compared with conventional implants. We assessed the range of motion to impingement using a tripolar implant mounted to an automated hip simulator using 22.2-mm and 28-mm femoral head sizes. The 22 and 28-mm tripolar implants provided increases of 30.5 degrees in flexion, 15.4 degrees in adduction, and 22.4 degrees in external rotation compared with the conventional 22.2-mm femoral head diameter implant. At the critical position of 90 degrees hip flexion, there was an increase of 45.2 degrees in internal rotation. At 0 degrees and 30 degrees external rotation, extension increases were 18.8 degrees and 7.8 degrees, respectively. Bony impingement was the limiting factor. Tripolar implants increased the arc of motion before impingement in positions at risk for dislocation and are expected to provide greater stability.

  14. Synovial plicae of the hip: evaluation using MR arthrography in patients with hip pain

    International Nuclear Information System (INIS)

    Bencardino, Jenny T.; La Rocca Vieira, Renata; Kassarjian, Ara; Schwartz, Richard; Mellado, Jose M.; Kocher, Mininder

    2011-01-01

    The appearance and distribution of the intra-articular plicae of the hip have been addressed in few reports in the anatomic and radiological literature. This study aims to determine the prevalence of visible synovial hip plicae using MR arthrography and to measure the association of visible synovial hip plicae with MR arthrographic diagnosis of labral tears, femoroacetabular impingement, and osteoarthritis. Following institutional review board approval, 63 direct MR arthrographic examinations of the hip in 61 patients with a clinical history of hip pain were retrospectively reviewed by two experienced musculoskeletal radiologists in consensus. The following variables were measured using a binary system (0 = absent; 1 = present): labral plica, neck plica, ligamental plica, labral tear, femoroacetabular impingement, and osteoarthritis. The surgical reports and arthroscopic images of 10 patients were reviewed. Statistical analysis was performed using the Fisher's exact test. In all 63 cases at least one plica was visualized on MR-arthrographic images. Labral, neck, and ligamental plicae were found with a prevalence of 76, 97, and 78%, respectively. There was no statistically significant association between the presence of labral tears, femoroacetabular impingement, and osteoarthritis among patients with visible labral, neck, and ligamental plicae. The prevalence of labral tears, femoroacetabular impingement, and osteoarthritis in our patient population was 79, 28, and 28%, respectively. The presence of intra-articular plicae was the only MR-arthrographic finding in 5 of our 63 symptomatic cases. Visible labral, neck, and/or ligamental plicae are highly prevalent on MR-arthrographic images of the hip performed in the setting of hip pain. There was no statistically significant association between the presence of labral tears, femoroacetabular impingement, and osteoarthritis and visible labral, neck, and ligamental plicae. (orig.)

  15. Hip Strength Testing of Soccer Players With Long-Standing Hip and Groin Pain: What are the Clinical Implications of Pain During Testing?

    Science.gov (United States)

    Rafn, Bolette S; Tang, Lars; Nielsen, Martin P; Branci, Sonia; Hölmich, Per; Thorborg, Kristian

    2016-05-01

    To investigate whether self-reported pain during hip strength testing correlates to a large degree with hip muscle strength in soccer players with long-standing unilateral hip and groin pain. Cross-sectional study. Clinical assessments at Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Centre Amager, Copenhagen University Hospital, Denmark. Twenty-four male soccer players with unilateral long-standing hip and groin pain. The soccer players performed 5 reliable hip muscle strength tests (isometric hip flexion, adduction, abduction, isometric hip flexion-modified Thomas test, and eccentric hip adduction). Muscle strength was measured with a hand-held dynamometer, and the players rated the pain during testing on a numerical rating scale (0-10). In 4 tests (isometric hip adduction, abduction, flexion, and eccentric adduction), no significant correlations were found between pain during testing and hip muscle strength (Spearman rho = -0.28 to 0.06, P = 0.09-0.39). Isometric hip flexion (modified Thomas test position) showed a moderate negative correlation between pain and hip muscle strength (Spearman rho = -0.44, P = 0.016). Self-reported pain during testing does not seem to correlate with the majority of hip muscle strength tests used in soccer players with long-standing hip and groin pain.

  16. 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

  17. Hip Ultrasonography in the Diagnosis of Developmental Dysplasia of the Hip: Bakırköy Experience

    Directory of Open Access Journals (Sweden)

    Altuğ Duramaz

    2014-12-01

    Full Text Available Aim: The purpose of the study was to determine the prevalence, incidence, and etiology as well as the risk factors for developmental dysplasia of the hip in newborns in whom we performed ultrasonography for screening using Graff’s method in our clinic. Methods: We retrospectively evaluated 2632 hip ultrasonography records of 1316 babies performed between 2008 and 2013. We analyzed the questionnaires of the Turkish Pediatric Orthopaedic Society which were filled by the physician during examination. The babies were divided into two groups according to ultrasonographic hip angles as pathological and normal. Results: The study is made on 1316 babies [680 girls (51.6%, 636 boys (48.4%]. The risk for developmental dysplasia of the hip was higher in girls, babies with a family history, babies with metatarsus adductus and those have been swaddled before. The mean gestational age and gestational weight was statistically significantly lower in the pathological group (p=0.0011. Conclusion: In our cross-sectional study, the incidence of developmental dysplasia of the hip was 0.5%. Female gender, positive family history of developmental dysplasia of the hip,metatarsus adductus and swaddling are still risk factors. Researching risk factors carefully, patient education and adding hip ultrasonograpy to newborn routine screening program are important measures in preventing developmental dysplasia of the hip.

  18. Second hip fractures at Chiang Mai University Hospital.

    Science.gov (United States)

    Wongtriratanachai, Prasit; Chiewchantanakit, Siripong; Vaseenon, Tanawat; Rojanasthien, Sattaya; Leerapun, Taninnit

    2015-02-01

    Hip fractures are a major public health problem. Patients who have suffered a hip fracture have an increased risk of a subsequent hip fracture. This study examines the incidence ofsecondhip fractures and attempts to identify underlying risk factors. To examine the incidence ofsecond hip fractures in osteoporotic patients at Chiang Mai University Hospital and to identify risk factors related to second hip fractures. A retrospective review was conducted of all low-energy mechanism hip fracture patients admitted during 2008 and 2009. Analysis of second hip fractures was conducted using survival analysis and logistic regression analysis. A total of 191 patients were observed for 391.68 person-years (mean 2.05 person-years per patient). Among that group, nine second hip fractures were identified, an overall incidence rate of 0.023 second fractures per person-year. Second hip fractures tended to occur within the first year following an initial hip fracture. There were no significant differences related to either gender or comorbid medical conditions. Logistic regression analysis revealed that increased risk of a second hip fracture was associated with age (highest between 80 to 89 years) and patients who were not treated for osteoporosis following their initial fracture. The incidence of second hip fractures at Chiang Mai University Hospital was 0.023 per person-year Careful follow-up of older patients, especially those over 80, and treatment ofosteoporosis with bisphosphonate plus vitamin D and calcium supplements was correlated with a reduction in the incidence of second hip fractures.

  19. Dosimetric influence of hip prosthesis during radiotherapeutic treatment

    International Nuclear Information System (INIS)

    Gschwind, R.; Buffard, E.; Masset, H.; Makovicka, L.; David, C.; David, C.; Buffard, E.

    2008-01-01

    As the population become aged, many patients with hip prosthesis are treated for a pelvic cancer. The recommended ballistic must avoid to pass in the prosthesis, but sometimes it is inevitable. So it is essential to quantify with accuracy the dose modifications linked to the presence of metallic implant. The aim of this study is to analyze by Monte Carlo method these modifications in simple and complex models (anthropomorphic phantom) which take into account the geometry and the composition of the prosthesis and its coatings. Then, this methodology was used to study the behaviour of a treatment planning system in theses extreme conditions. (authors)

  20. In vitro simulation of fretting-corrosion in hip implant modular junctions: The influence of pH.

    Science.gov (United States)

    Royhman, Dmitry; Patel, Megha; Jacobs, Joshua J; Wimmer, Markus A; Hallab, Nadim J; Mathew, Mathew T

    2018-02-01

    The fretting-corrosion behavior of mixed metal contacts is affected by various mechanical and electrochemical parameters. Crevice conditions at the junction and patient-specific pathologies can affect the pH of the prosthetic environment. The main objective of this study is to understand the effect of pH variation at the stem/head junction of the hip implant under fretting corrosion exposure. We hypothesized that pH will have a significant influence on the fretting-corrosion behavior hip implant modular junctions. A custom-made setup was used to evaluate the fretting corrosion behavior of hip implant modular junctions. A Newborn calf serum solution (30 g/L protein content) was used to simulate the synovial fluid environment. A sinusoidal fretting motion, with a displacement amplitude of +50 µm, was applied to the Ti alloy rod. The effects of pathology driven, periprosthetic pH variation were simulated at four different pH levels (3.0, 4.5, 6.0 and 7.6). Electrochemical and mechanical properties were evaluated before, during, and after the applied fretting motion. The impedance of the system was increased in response to the fretting motion. The hysteresis tangential load/displacement behavior was not affected by pH level. The worn surfaces of CoCrMo pins exhibited the presence of tribolayer or organic deposits, in the pH 4.5 group, which may explain the lower drop in potential and mass loss observed in that group. Mechanically dominated wear mechanisms, namely, adhesive wear was shown in the pH 7.6 group, which may account for a higher potential drop and metal content loss. This study suggests that the fretting-corrosion mechanisms in hip implant are affected by the pH levels of the surrounding environment and patient-specific factors. Copyright © 2017. Published by Elsevier Ltd.

  1. Osteochondritis Dissecans of the Hip

    International Nuclear Information System (INIS)

    Linden, B.; Jonsson, K.; Redlund-Johnell, I.

    2003-01-01

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

  2. Osteochondritis Dissecans of the Hip

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-03-01

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

  3. Efficacy of Punch Elevation Combined with Fractional Carbon Dioxide Laser Resurfacing in Facial Atrophic Acne Scarring: A Randomized Split-face Clinical Study

    Science.gov (United States)

    Faghihi, Gita; Nouraei, Saeid; Asilian, Ali; Keyvan, Shima; Abtahi-Naeini, Bahareh; Rakhshanpour, Mehrdad; Nilforoushzadeh, Mohammad Ali; Hosseini, Sayed Mohsen

    2015-01-01

    Background: A number of treatments for reducing the appearance of acne scars are available, but general guidelines for optimizing acne scar treatment do not exist. The aim of this study was to compare the clinical effectiveness and side effects of fractional carbon dioxide (CO2) laser resurfacing combined with punch elevation with fractional CO2 laser resurfacing alone in the treatment of atrophic acne scars. Materials and Methods: Forty-two Iranian subjects (age range 18–55) with Fitzpatrick skin types III to IV and moderate to severe atrophic acne scars on both cheeks received randomized split-face treatments: One side received fractional CO2 laser treatment and the other received one session of punch elevation combined with two sessions of laser fractional CO2 laser treatment, separated by an interval of 1 month. Two dermatologists independently evaluated improvement in acne scars 4 and 16 weeks after the last treatment. Side effects were also recorded after each treatment. Results: The mean ± SD age of patients was 23.4 ± 2.6 years. Clinical improvement of facial acne scarring was assessed by two dermatologists blinded to treatment conditions. No significant difference in evaluation was observed 1 month after treatment (P = 0.56). Their evaluation found that fractional CO2 laser treatment combined with punch elevation had greater efficacy than that with fractional CO2 laser treatment alone, assessed 4 months after treatment (P = 0.02). Among all side effects, coagulated crust formation and pruritus at day 3 after fractional CO2 laser treatment was significant on both treatment sides (P < 0.05). Conclusion: Concurrent use of fractional laser skin resurfacing with punch elevation offers a safe and effective approach for the treatment of acne scarring. PMID:26538695

  4. Efficacy of punch elevation combined with fractional carbon dioxide laser resurfacing in facial atrophic acne scarring: A randomized split-face clinical study

    Directory of Open Access Journals (Sweden)

    Gita Faghihi

    2015-01-01

    Full Text Available Background: A number of treatments for reducing the appearance of acne scars are available, but general guidelines for optimizing acne scar treatment do not exist. The aim of this study was to compare the clinical effectiveness and side effects of fractional carbon dioxide (CO 2 laser resurfacing combined with punch elevation with fractional CO 2 laser resurfacing alone in the treatment of atrophic acne scars. Materials and Methods: Forty-two Iranian subjects (age range 18-55 with Fitzpatrick skin types III to IV and moderate to severe atrophic acne scars on both cheeks received randomized split-face treatments: One side received fractional CO 2 laser treatment and the other received one session of punch elevation combined with two sessions of laser fractional CO 2 laser treatment, separated by an interval of 1 month. Two dermatologists independently evaluated improvement in acne scars 4 and 16 weeks after the last treatment. Side effects were also recorded after each treatment. Results: The mean ± SD age of patients was 23.4 ± 2.6 years. Clinical improvement of facial acne scarring was assessed by two dermatologists blinded to treatment conditions. No significant difference in evaluation was observed 1 month after treatment (P = 0.56. Their evaluation found that fractional CO 2 laser treatment combined with punch elevation had greater efficacy than that with fractional CO 2 laser treatment alone, assessed 4 months after treatment (P = 0.02. Among all side effects, coagulated crust formation and pruritus at day 3 after fractional CO 2 laser treatment was significant on both treatment sides (P < 0.05. Conclusion: Concurrent use of fractional laser skin resurfacing with punch elevation offers a safe and effective approach for the treatment of acne scarring.

  5. Interfacial properties of HIP joint between beryllium and reduced activation ferritic/martensitic steel

    International Nuclear Information System (INIS)

    Hirose, T.; Ogiwara, H.; Enoeda, M.; Akiba, M.

    2007-01-01

    Full text of publication follows: ITER test blanket module is the most important components to validate energy production and fuel breeding process for future demonstration reactor. Reduced activation ferritic / martensitic steel is recognized as a promising structural material for breeding blanket systems. And Beryllium must be used as plasma facing materials for ITER in vessel components. In this work, interfacial properties of beryllium/reduced activation ferritic/martensitic steel (RAF/Ms) joint were investigated for a first wall of ITER test blanket module (TBM). The starting materials were ITER grade Beryllium, S65C and a Japanese RAF/M, F82H. The joint was produced by solid state hot isostatic pressing (HIP) method. Chromium layer with the thickness of 1 μm and 10 μm were formed by plasma vapor deposition on the beryllium surface as a diffusion barrier. The HIP was carried out at 1023 K and 1233 K which are determined by standard normalizing and tempering temperature of F82H. The joint made at 1233 K was followed by tempering at 1033 K. The bonding interface was characterized by electron probe microanalysis (EPMA). The bonding strength was also investigated by isometric four point bending tests at ambient temperature. EPMA showed chromium layer effectively worked as a diffusion barrier at 1023 K. However, the beryllium rich layer was formed in F82H after HIP at 1233 K followed by tempering. Bending tests revealed that thin chromium layer and low temperature HIP is preferable. The high temperature HIP introduce brittle BeFe inter metallic compounds along bonding interface. On the other hand, joint with thick chromium layer suffer from brittleness of chromium itself. (authors)

  6. Interfacial properties of HIP joint between beryllium and reduced activation ferritic/martensitic steel

    Energy Technology Data Exchange (ETDEWEB)

    Hirose, T. [Blanket Engineering Group, Japan Atomic Energy Agency, Naka, Ibaraki (Japan); Ogiwara, H. [Japan Atomic Energy Agency, Tokai-mura, Naga-gun, Ibaraki-ken (Japan); Enoeda, M. [Naka Fusion Research Establishment, J.A.E.R.I., Japan Atomic Energy Research Institute, Naka-gun, Ibaraki-ken (Japan); Akiba, M. [Naka Fusion Institute, Japan Atomic Energy Agency, Naka, Ibaraki (Japan)

    2007-07-01

    Full text of publication follows: ITER test blanket module is the most important components to validate energy production and fuel breeding process for future demonstration reactor. Reduced activation ferritic / martensitic steel is recognized as a promising structural material for breeding blanket systems. And Beryllium must be used as plasma facing materials for ITER in vessel components. In this work, interfacial properties of beryllium/reduced activation ferritic/martensitic steel (RAF/Ms) joint were investigated for a first wall of ITER test blanket module (TBM). The starting materials were ITER grade Beryllium, S65C and a Japanese RAF/M, F82H. The joint was produced by solid state hot isostatic pressing (HIP) method. Chromium layer with the thickness of 1 {mu}m and 10 {mu}m were formed by plasma vapor deposition on the beryllium surface as a diffusion barrier. The HIP was carried out at 1023 K and 1233 K which are determined by standard normalizing and tempering temperature of F82H. The joint made at 1233 K was followed by tempering at 1033 K. The bonding interface was characterized by electron probe microanalysis (EPMA). The bonding strength was also investigated by isometric four point bending tests at ambient temperature. EPMA showed chromium layer effectively worked as a diffusion barrier at 1023 K. However, the beryllium rich layer was formed in F82H after HIP at 1233 K followed by tempering. Bending tests revealed that thin chromium layer and low temperature HIP is preferable. The high temperature HIP introduce brittle BeFe inter metallic compounds along bonding interface. On the other hand, joint with thick chromium layer suffer from brittleness of chromium itself. (authors)

  7. A randomised, controlled trial of circumpatellar electrocautery in total knee replacement without patellar resurfacing.

    Science.gov (United States)

    van Jonbergen, H P W; Scholtes, V A B; van Kampen, A; Poolman, R W

    2011-08-01

    The efficacy of circumpatellar electrocautery in reducing the incidence of post-operative anterior knee pain is unknown. We conducted a single-centre, outcome-assessor and patient-blinded, parallel-group, randomised, controlled trial to compare circumpatellar electrocautery with no electrocautery in total knee replacement in the absence of patellar resurfacing. Patients requiring knee replacement for primary osteoarthritis were randomly assigned circumpatellar electrocautery (intervention group) or no electrocautery (control group). The primary outcome measure was the incidence of anterior knee pain. A secondary measure was the standardised clinical and patient-reported outcomes determined by the American Knee Society scores and the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. A total of 131 knees received circumpatellar electrocautery and 131 had no electrocautery. The overall incidence of anterior knee pain at follow-up at one year was 26% (20% to 31%), with 19% (12% to 26%) in the intervention group and 32% (24% to 40%) in the control group (p = 0.02). The relative risk reduction from electrocautery was 40% (9% to 61%) and the number needed to treat was 7.7 (4.3 to 41.4). The intervention group had a better mean total WOMAC score at follow-up at one year compared with the control group (16.3 (0 to 77.7) versus 21.6 (0 to 76.7), p = 0.04). The mean post-operative American Knee Society knee scores and function scores were similar in the intervention and control groups (knee score: 92.4 (55 to 100) versus 90.4 (51 to 100), respectively (p = 0.14); function score: 86.5 (15 to 100) versus 84.5 (30 to 100), respectively (p = 0.49)). Our study suggests that in the absence of patellar resurfacing electrocautery around the margin of the patella improves the outcome of total knee replacement.

  8. Dynamic ultrasound of the external snapping hip syndrome

    International Nuclear Information System (INIS)

    Choi, Yun Sun; Song, Baek Yong; Paik, Sang Hyun; Lee, Tae Gyu; Yoon, Yong Kyu; Lee, Sung Moon

    2002-01-01

    Snapping hip syndrome has been described as a hip pain accompanied by an audible snapping during motion of the hip or while walking. The variable causes of its external, internal, and intra-articular origins have been described. The most common extemal snapping hip has been associated with a thickened posterior border of the iliotibial band or of the anterior border of the gluteus maximus muscle slipping over the greater trochanter. The aim of this study was to evaluate the dynamic ultrasound findings of external snapping hip syndrome with review of the literature. We studied 5 patients (7 cases) with external snapping hip and pain over the greater trochanter during walking or hip motion (3 males and 2 females, age range, 14-32 years; mean, 19 years). Two patients reported bilateral snapping hips.

  9. Cryovolcanic Resurfacing on Pluto

    Science.gov (United States)

    Singer, K. N.; Schenk, P.; White, O. L.; Moore, J. M.; McKinnon, W. B.; Grundy, W. M.; Spencer, J. R.; Stern, A.; Cook, J. C.; Nimmo, F.; Howard, A. D.; Cruikshank, D. P.; Beyer, R. A.; Umurhan, O. M.; Lauer, T.; Weaver, H. A., Jr.; Young, L. A.; Ennico Smith, K.

    2017-12-01

    Pluto displays several different young geologic terrains with few-to-no identifiable impact craters. Distinct terrains to the southwest of the informally named Sputnik Planitia may have been resurfaced by cryovolcanic processes, of a type and scale so far unique to Pluto [1,2]. The most prominent structures are two very large mounds with deep central depressions. The informally named Wright Mons stands 4 km high and the main mound spans 150 km and Piccard Mons is 7 km high and 225 km wide. Hummocky terrain with a characteristic wavelength of 8-12 km covers the flanks of Wright Mons and much of the surrounding terrain. Smaller boulders, blocks, slabs, or ridges on the order of a few km are superimposed on the hummocks. The large-scale slopes across the broad flanks of the Wright Mons are 3-5°. The central depression walls are typically 10°, but reach 20° in some locations. A number of other cavi or irregular depressions of various sizes (a few to 30 km) are scattered throughout the terrain and do not appear to be impact craters. There are few signs of potential individual flows but the large-scale hummocky texture is suggestive of viscous flow. We will explore a number of potential mechanisms for creation of Wright and Piccard Mons and the nearby terrains. These unique terrains present modeling challenges for building relatively young, large cryovolcanic constructs on outer solar system bodies. Tidal heating is thought to end early in Pluto-system history [3] and radiogenic heating levels are relatively low [4], although a subsurface ocean may still persist into the present day [5]. We will discuss the possible volcanic materials on Pluto and their mobility under different heating scenarios, as well as other possible emplacement processes. [1] Moore et al., (2016) Science 351, 1284-1293. [2] Singer et al. (2016) LPSC absract 47, 2276. [3] Cheng et al. (2014) Icarus 233, 242-258. [4] McKinnon et al. (1997) In: Stern, S.A., Tholen, D.J. (Eds.), Pluto and Charon

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

    Science.gov (United States)

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

    2011-11-01

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

  11. CT osteodensitometry in the area directly adjacent to hip endoprotheses

    International Nuclear Information System (INIS)

    Sokiranski, R.; Marienfeld, D.; Felsenberg, D.; Rilinger, N.; Goerich, J.; Kalender, W.

    1996-01-01

    Purpose: The value of metal artifact reduction in quantitative bone density determination in the vicinity of metallic implants was studied. Method: Ten cadaver femora with hip endoprostheses implanted intra vitam were examined in CT with varying slice thicknesses, tube voltage, scan time and magnification factor. The artifact-laden images were then processed using a metal artifact reduction programme (MAR). The metallic implant was removed, allowing the bone slices to be examined again with the same imaging parameters, but without the bothersome metal artifacts. This allowed comparison of bone density values obtained before and after application of MAR with data obtained after implant removal. Results: A comparison of the bone density measurements between the sample group without implants and the group with indwelling implants prior to MAR showed an unexpected correlation coefficient r=0.975-0.977. The correlation coefficients after MAR rose to r=0.987-0.992 in 125 kV and r=0.989-0.991 in 85 kV modes. The reproducibility of the density measurements for the groups without implants and with implants following MAR showed variation coefficients (VC) of 1.16% and 0.75% respectively. The reproducibility of the manual definition of the region of interest (ROI) in bone showed a VC=2.19%. Conclusions: Bone density in the vicinity of metallic implants can be reliably and reproducibly determined using MAR. (orig.) [de

  12. Treatment of tuberculosis of the hip.

    African Journals Online (AJOL)

    The common presentation was a swollen hip, a limp, decreased range of hip movements, fixed flexion deformity and pain. Three patients had protrusio acetabuli and three had subluxed or dislocated hips. Twenty-three patients were anaemic and the erythrocyte sedimentation rate (ESR) was raised in all (mean. 6 5 d h r ...

  13. Influence of PEEK Coating on Hip Implant Stress Shielding: A Finite Element Analysis

    Directory of Open Access Journals (Sweden)

    Jesica Anguiano-Sanchez

    2016-01-01

    Full Text Available Stress shielding is a well-known failure factor in hip implants. This work proposes a design concept for hip implants, using a combination of metallic stem with a polymer coating (polyether ether ketone (PEEK. The proposed design concept is simulated using titanium alloy stems and PEEK coatings with thicknesses varying from 100 to 400 μm. The Finite Element analysis of the cancellous bone surrounding the implant shows promising results. The effective von Mises stress increases between 81 and 92% for the complete volume of cancellous bone. When focusing on the proximal zone of the implant, the increased stress transmission to the cancellous bone reaches between 47 and 60%. This increment in load transferred to the bone can influence mineral bone loss due to stress shielding, minimizing such effect, and thus prolonging implant lifespan.

  14. Quality of life following hip fractures: results from the Norwegian hip fracture register.

    Science.gov (United States)

    Gjertsen, Jan-Erik; Baste, Valborg; Fevang, Jonas M; Furnes, Ove; Engesæter, Lars Birger

    2016-07-07

    Patient-reported health-related quality of life is an important outcome measure when assessing the quality of hip fracture surgery. The frequently used EQ-5D index score has unfortunately important limitations. One alternative can be to assess the distribution of each of the five dimensions of the patients' descriptive health profile. The objective of this paper was to investigate health-related quality of life (HRQoL) after hip fractures. Data from hip fracture operations from 2005 through 2012 were obtained from The Norwegian Hip Fracture Register. Patient reported HRQoL, (EQ-5D-3L) was collected from patients preoperatively and at four and twelve months postoperatively n = 10325. At each follow-up the distribution of the EQ-5D-3L and mean pain VAS was calculated. Generally, a higher proportion of patients reported problems in all 5 dimensions of the EQ-5D-3L at all follow-ups compared to preoperative. Also a high proportion of patients with no preoperative problems reported problems after surgery; At 4 and 12 months follow-ups 71 % and 58 % of the patients reported walking problems, and 65 % and 59 % of the patients reported pain respectively. Patients with femoral neck fractures and the youngest patients (age < 70 years) reported least problems both preoperatively and at all follow-ups. A hip fracture has a dramatic impact on the patients' HRQoL, and the deterioration in HRQoL sustained also one year after the fracture. Separate use of the descriptive profile of the EQ-5D is informative when assessing quality of life after hip fracture surgery.

  15. 100-μsec pulsed CO2 laser resurfacing of lower eyelids: erythema and rhytides reduction

    Science.gov (United States)

    Bell, Thomas; Harris, David M.; Schachter, Daniel; Burkart, John

    1997-05-01

    Lower eyelid skin is very thin with a low density of adnexal structures. Attempts to remove rhytides and improve surface appearance with chemical peels and dermabrasion have been disappointing. Laser resurfacing offers a new modality that may improve the outcome. We evaluated a very short duration (100 microsecond(s) ec) pulsed carbon-dioxide laser (Tru-PulseTM) in terms of healing time (duration of erythema) and efficacy (wrinkle reduction). Female patients aged 35 - 75 received laser resurfacing in a variety of cosmetic zones but only data from lower lids are reported here. Dosimetry varied from total fluences of 5 to 20 J/cm2 (9 mm2 spot, 250 - 500 mJ pulse, 1 to 4 passes). Patients followed a strict regime of post-op wound care. Pre-treatment and follow-up photographs were taken in a studio with constant photographic parameters. Projected 35 mm slides were evaluated side-by-side for clinical improvement and presence of erythema. Within the first 4 days post-op all (100%) lower eyelids exhibited erythema and swelling, at 7 days: 71%, 12 days: 60%, 3 weeks: 25%, and one (1) month or longer 7%. In our sample the longest duration of post-op lower lid erythema lasted 5 weeks. Most patients experienced 70 -80% wrinkle reduction with a range of 0 - 100%. Regression analysis was used to evaluate the relationships between percent wrinkle reduction and the treatment, demographic, and evaluation variables. There was a significant trend for wrinkles to improve over the 3 to 9 month evaluation period. Older patients improved slightly more than younger patients. There was no relationship between total energy density and wrinkle reduction.

  16. The relationship of hip joint space to self reported hip pain

    DEFF Research Database (Denmark)

    Jacobsen, S.; Holm, S.S.; Lund, B.

    2004-01-01

    OBJECTIVES: (1) To evaluate the effect of pelvic orientation on measurements of hip joint space widths (JSW) in cadaver pelvic radiographs, thereby validating the pelvic radiographs of the Copenhagen City Heart Study: The Osteoarthritis Substudy (CCHS III) cohort of 4.152 subjects, and (2......) to investigate the relationship between minimal JSW and self reported hip pain of the cohort. METHODS: (1) Cadaver pelves and proximal femora of one male and one female donor were mounted in holding devices permitting independent rotation (total arc of 42 degrees), and inclination/reclination (total arc of 24...... degrees). At each 3 degrees increment an anteroposterior radiograph was recorded. Measurements of JSW were performed. (2) Self reported recurrent pain in or around the hip joint during 12 months prior to baseline examinations, and minimum JSW in pelvic radiographs of the cohort were registered...

  17. Hip-Hop Education Resources

    Science.gov (United States)

    Hall, Marcella Runell

    2009-01-01

    Hip-hop music and culture are often cited as being public pedagogy, meaning the music itself has intrinsic educational value. Non-profit organizations and individual educators have graciously taken the lead in utilizing hip-hop to educate. As the academy continues to debate its effectiveness, teachers and community organizers are moving forward.…

  18. Dose-dependent cytotoxicity of clinically relevant cobalt nanoparticles and ions on macrophages in vitro

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Young-Min; Xia Zhidao; Glyn-Jones, Sion; Beard, David; Gill, Harinderjit S; Murray, David W, E-mail: young-min.kwon@ndos.ox.ac.u [Nuffield Department of Orthopaedic Surgery, University of Oxford, Oxford OX3 7LD (United Kingdom)

    2009-04-15

    Despite the satisfactory short-term implant survivorship of metal-on-metal hip resurfacing arthroplasty, periprosthetic soft-tissue masses such as pseudotumours are being increasingly reported. Cytotoxic effects of cobalt or chromium have been suggested to play a role in its aetiology. The aim of this study was to investigate the effects of clinically relevant metal nanoparticles and ions on the viability of macrophages in vitro. A RAW 264.7 murine macrophage cell line was cultured in the presence of either: (1) cobalt, chromium and titanium nanoparticles sized 30-35 nm; or (2) cobalt sulphate and chromium chloride. Two methods were used to quantify cell viability: Alamar Blue assay and Live/Dead assay. The cytotoxicity was observed only with cobalt. Cobalt nanoparticles and ions demonstrated dose-dependent cytotoxic effects on macrophages in vitro: the cytotoxic concentrations of nanoparticles and ions were 1 x 10{sup 12} particles ml{sup -1} and 1000 {mu}M, respectively. The high concentration of cobalt nanoparticles required for cytotoxicity of macrophages in vitro suggests that increased production of cobalt nanoparticles in vivo, due to excessive MoM implant wear, may lead to local adverse biological effects. Therefore, cytotoxicity of high concentrations of metal nanoparticles phagocytosed by macrophages located in the periprosthetic tissues may be an important factor in pathogenesis of pseudotumours.

  19. Protocol of plain radiographs, hip ultrasound, and triple phase bone scans in the evaluation of the painful pediatric hip

    International Nuclear Information System (INIS)

    Alexander, J.E.; Seibert, J.J.; Aronson, J.; Williamson, S.L.; Glasier, C.M.; Rodgers, A.B.; Corbitt, S.L.

    1988-01-01

    A useful protocol for the evaluation of hip pain in the pediatric patient, using a combination of plain radiographs, hip ultrasound (US), and triple phase radionuclide bone scans is presented. Patients with hip pain were initially evaluated by plain radiographs of the pelvis and hips. If no diagnosis was reached, the hips were studied for effusions by real-time hip ultrasonography. If an effusion was present, the joint was aspirated for diagnosis. If no effusion was present by US or if no diagnosis was reached by aspiration, triple phase radionuclide bone scans were performed. Fifty patients were evaluated by this prospective protocol, and the diagnosis was reached in 48 of the 50 cases (10 by plain radiographs, 16 by US, and aspiration of the joint, and 22 by triple phase bone scans). Hip effusions were found in 20 patients by US, with no false positives or false negatives. Previous studies for detecting effusions by US have emphasized absolute measurements of the capsular width, but we report a typical appearance of the hip capsule when fluid is present (a bulging convex capsule). When no effusion is present, the capsule is concave and parallels the long axis of the femoral neck

  20. THE ASSOCIATIONS BETWEEN HIP STRENGTH AND HIP KINEMATICS DURING A SINGLE LEG HOP IN RECREATIONAL ATHLETES POST ACL RECONSTRUCTION COMPARED TO HEALTHY CONTROLS.

    Science.gov (United States)

    Tate, Jeremiah; Suckut, Tell; Wages, Jensen; Lyles, Heather; Perrin, Benjamin

    2017-06-01

    Only a small amount of evidence exists linking hip abductor weakness to dynamic knee valgus during static and dynamic activities. The associations of hip extensor strength and hip kinematics during the landing of a single leg hop are not known. Purpose: To determine if relationships exist between hip extensor and abductor strength and hip kinematics in both involved and uninvolved limb during the landing phase of a single leg hop in recreational athletes post anterior cruciate ligament (ACL) reconstruction. The presence of similar associations was also evaluated in healthy recreational athletes. Controlled Laboratory Study; Cross-sectional. Twenty-four recreational college-aged athletes participated in the study (12 post ACL reconstruction; 12 healthy controls). Sagittal and frontal plane hip kinematic data were collected for five trials during the landing of a single leg hop. Hip extensor and abductor isometric force production was measured using a hand-held dynamometer and normalized to participants' height and weight. Dependent and independent t-tests were used to analyze for any potential differences in hip strength or kinematics within and between groups, respectively. Pearson's r was used to demonstrate potential associations between hip strength and hip kinematics for both limbs in the ACL group and the right limb in the healthy control group. Independent t-tests revealed that participants post ACL reconstruction exhibited less hip extensor strength (0.18 N/Ht*BW vs. 0.25 N/Ht*BW, p=hip adduction (9.0 º vs. 0.8 º, p=hip extensor strength and maximum hip abduction/adduction angle in the involved limb. A moderate and direct relationship between hip abductor strength and maximum hip flexion angle was demonstrated in the both the involved ( r =.62) and uninvolved limb ( r =.65, p=.02). No significant associations were demonstrated between hip extensor or abductor strength and hip flexion and/or abduction/adduction angles in the healthy group. The