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Sample records for metal-on-metal hip arthroplasty

  1. Metal-on-Metal Hip Resurfacing Arthroplasty

    Science.gov (United States)

    Sehatzadeh, S; Kaulback, K; Levin, L

    2012-01-01

    Background Metal-on-metal (MOM) hip resurfacing arthroplasty (HRA) is in clinical use as an appropriate alternative to total hip arthroplasty in young patients. In this technique, a metal cap is placed on the femoral head to cover the damaged surface of the bone and a metal cup is placed in the acetabulum. Objectives The primary objective of this analysis was to compare the revision rates of MOM HRA using different implants with the benchmark set by the National Institute of Clinical Excellence (NICE). The secondary objective of this analysis was to review the literature regarding adverse biological effects associated with implant material. Review Methods A literature search was performed on February 13, 2012, to identify studies published from January 1, 2009, to February 13, 2012. Results The revision rates for MOM HRA using 6 different implants were reviewed. The revision rates for MOM HRA with 3 implants met the NICE criteria, i.e., a revision rate of 10% or less at 10 years. Two implants had short-term follow-ups and MOM HRA with one of the implants failed to meet the NICE criteria. Adverse tissue reactions resulting in failure of the implants have been reported by several studies. With a better understanding of the factors that influence the wear rate of the implants, adverse tissue reactions and subsequent implant failure can be minimized. Many authors have suggested that patient selection and surgical technique affect the wear rate and the risk of tissue reactions. The biological effects of high metal ion levels in the blood and urine of patients with MOM HRA implants are not known. Studies have shown an increase in chromosomal aberrations in patients with MOM articulations, but the clinical implications and long-term consequences of this increase are still unknown. Epidemiological studies have shown that patients with MOM HRA implants did not have an overall increase in mortality or risk of cancer. There is insufficient clinical data to confirm the

  2. Outcome of Revision Total Hip Arthroplasty in Management of Failed Metal-on-Metal Hip Arthroplasty.

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    Rahman, Wael A; Amenábar, Tomás; Hetaimish, Bandar M; Safir, Oleg A; Kuzyk, Paul R; Gross, Allan E

    2016-11-01

    This is a retrospective review of the functional outcomes and complications of revision total hip arthroplasty (THA) of failed metal-on-metal (MoM) hip arthroplasty. A total of 20 revision THAs were performed in 19 patients. Of them, 2 cases were failed hip resurfacing, and 18 cases were failed (MoM) THA. The mean age at revision (THA) was 59.35 years (standard deviation [SD] 9.83). The mean follow-up was 45 months (SD 13.98). The indications of revision were aseptic loosening of acetabular component without adverse local tissue reaction (ALTR; 10 hips), aseptic loosening of the acetabular and femoral components without ALTR (1 hip), painful hip associated with ALTR (6 hips), iliopsoas impingement associated with a large-diameter femoral head or malpositioned acetabular component (3 hips). The acetabular components were revised in 18 hips using Trabecular Metal Modular cups. The femoral components were revised in 3 hips. A constrained acetabular liner was used in 5 hips. The Harris hip score significantly improved from 48.4 (SD 12.98) to 83.25 (SD 10.08). There were 2 complications (1 foot drop and 1 superficial infection) and 1 failure (recurrent dislocation) that required revision to a constrained liner. Early results of revision THA of failed MoM hip arthroplasty showed improvement in pain and functional outcome. No case of failed bone ingrowth was noted with the use of Trabecular Metal Modular cups. Extensive soft tissue and abductor muscles dysfunctions were common. A constrained acetabular component with repair of the hip abductors might be beneficial. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. 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.

  4. Self-reported neurological clinical manifestations of metal toxicity in metal-on-metal hip arthroplasty

    NARCIS (Netherlands)

    van Lingen, Christiaan P.; Ettema, Harmen B.; Van Der Straeten, Catherine; Kollen, Bouwdewijn J.; Verheyen, Cees C. P. M.

    2014-01-01

    Adverse reactions to metal particle debris have been increasingly reported as a complication following large head metal-on-metal (MoM) hip arthroplasty. Elevated metal ion levels are a cause for concern. The aim of this study is to evaluate whether exposure to cobalt is associated with patient

  5. Revision rates for metal-on-metal hip resurfacing and metal-on-metal total hip arthroplasty - a systematic review.

    Science.gov (United States)

    Ras Sørensen, Sofie-Amalie L; Jørgensen, Henrik L; Sporing, Sune L; Lauritzen, Jes B

    2016-11-10

    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. The PubMed database was queried for potentially relevant articles addressing MoMTHA and MoMHRS, a total of 51 articles were included. The review includes a total number of 5,399 MoMHRS and 3,244 THA prosthesis and the reasons for prosthesis failure were divided into 7 categories and the main causes discussed. The overall MoMTHA revision rate was 4.7% after 6.9 years. MoMHRS revision rate was 5.9% after 5.7 years. 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 was 1.09 (0.82:1.43) 95% CI (0 = 0.56) (MoMTHA vs. MoMHRS). Long-term revision rate for MoMTHA was 5.2% after 7.7 years and 8.2% after 7.6 years for MoMHRS. The odds ratio was 1.58 (1.53:1.96) 95% CI (p = 0.0001) (MoMHRS vs. MoMTHA).Revision causes were divided into 7 main categories. The most common cause for revision for both MoMTHA and MoMHRS was loosening 47.6% vs. 37.7%, fracture (MoMTHA 7.69%; MoMHRS 19.62%), metal reactions (MoMTHA 7.69%; MoMHRS 26.92%) infection (MoMTHA 12.08%; MoMHRS 6.54%), instability (MoMTHA 9.13%; MoMHRS 2.69%), manufacturer defect 6.73% for MoMTHA and nonreported for MoMHRS, and miscellaneous (MoMTHA 7.69%; MoMHRS 6.54%) was stated. The comparison of MoMHRS and MoMTHA revision rates showed no difference in the short term, however in the longer term, the revision rate of MoMHRS was significantly higher than for MoMTHA. The linear increase in revision rate of MoMHRS may indicate a progression in failure.

  6. 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.

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

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    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.

  8. Longitudinal magnetic resonance imaging of pseudotumors following metal-on-metal total hip arthroplasty.

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    Hasegawa, Masahiro; Miyamoto, Noriki; Miyazaki, Shinichi; Wakabayashi, Hiroki; Sudo, Akihiro

    2014-12-01

    The purpose of the study was to determine the natural history of pseudotumors following metal-on-metal total hip arthroplasty (THA) using magnetic resonance imaging (MRI). Initial MRI was conducted at a mean of 36months postoperatively. Follow-up MRI was performed at a mean of 20months after the detection of 24 asymptomatic pseudotumors. Pseudotumor size was determined on MRI. The mean pseudotumor size changed from 729mm(2) to 877mm(2). Pseudotumors increased in size in eight and decreased in six. Ten hips showed no changes. The bigger the pseudotumor size, the more likely the size would increase. In conclusion, pseudotumors frequently change in size. A single MRI study in the clinical decision-making process should be avoided and a longitudinal study should be performed. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. 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....

  10. Revision rates for metal-on-metal hip resurfacing and metal-on-metal total hip arthroplasty – a systematic review

    DEFF Research Database (Denmark)

    Ras Sørensen, Sofie-amalie L.; Jørgensen, Henrik L.; Sporing, Sune L.

    2016-01-01

    Purpose To compare revision rates of metal-on-metal (MoM) hip resurfacing (HRS) and MoM total hip arthroplasty (THA), as well as the primary causes for revisions. Methods The PubMed database was queried for potentially relevant articles addressing MoMTHA and MoMHRS, a total of 51 articles were...... cause for revision for both MoMTHA and MoMHRS was loosening 47.6% vs. 37.7%, fracture (MoMTHA 7.69%; MoMHRS 19.62%), metal reactions (MoMTHA 7.69%; MoMHRS 26.92%) infection (MoMTHA 12.08%; MoMHRS 6.54%), instability (MoMTHA 9.13%; MoMHRS 2.69%), manufacturer defect 6.73% for MoMTHA and nonreported...

  11. Poor Acetabular Component Orientation Increases Revision Risk in Metal-on-Metal Hip Arthroplasty.

    Science.gov (United States)

    Tauriainen, Tuomas J T; Niinimäki, Tuukka T; Niinimäki, Jaakko L; Nousiainen, Tomi O P; Leppilahti, Juhana I

    2017-07-01

    The rate of and the reasons for the failure of metal-on-metal (MoM) bearings have recently been discussed in literature. The aim of this study was to evaluate the influence of acetabular cup inclination and version angles on revision risk in patients with MoM hip arthroplasty. We retrospectively reviewed 825 patients (976 hips) who underwent a MoM hip arthroplasty between 2000 and 2013. There were 474 men and 351 women, with a mean age of 58 (19-86) years. Acceptable cup orientation was considered to be inside the Lewinnek's safe zone. The mean acetabular inclination angle was 48.9° (standard deviation, 8.1°; range, 16°-76°) and version angle 20.6° (standard deviation, 9.9°; range, -25 to 46°). The cup was found to be outside the Lewinnek's safe zone in 571 hips (58.5%). Acetabular cup revision surgery was performed in 157 hips (16.1%). The cup angles were outside Lewinnek's safe zone in 69.2% of the revised hips. The mean interobserver reliability and intraobserver repeatability of the measurements of cup inclination and version angles were excellent (intraclass correlation coefficients >0.90). The odds ratio for revision in hips outside vs inside the Lewinnek's safe zone was 1.82 (95% confidence interval, 1.26-2.62; P = .0014). Our findings provide compelling evidence that a cup position outside the Lewinnek's safe zone is associated with increased revision risk in patients with MoM arthroplasty. Copyright © 2017. Published by Elsevier Inc.

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

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    van Raaij Jos JAM

    2008-10-01

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

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

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    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.

  14. Nano-analyses of wear particles from metal-on-metal and non-metal-on-metal dual modular neck hip arthroplasty.

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    Xia, Zhidao; Ricciardi, Benjamin F; Liu, Zhao; von Ruhland, Christopher; Ward, Mike; Lord, Alex; Hughes, Louise; Goldring, Steven R; Purdue, Edward; Murray, David; Perino, Giorgio

    2017-04-01

    Increased failure rates due to metallic wear particle-associated adverse local tissue reactions (ALTR) is a significant clinical problem in resurfacing and total hip arthroplasty. Retrieved periprosthetic tissue of 53 cases with corrosion/conventional metallic wear particles from 285 revision operations for ALTR was selected for nano-analyses. Three major classes of hip implants associated with ALTR, metal-on-metal hip resurfacing arthroplasty (MoM HRA) and large head total hip replacement (MoM LHTHA) and non-metal-on-metal dual modular neck total hip replacement (Non-MoM DMNTHA) were included. The size, shape, distribution, element composition, and crystal structure of the metal particles were analyzed by conventional histological examination and electron microscopy with analytic tools of 2D X-ray energy dispersive spectrometry and X-ray diffraction. Distinct differences in size, shape, and element composition of the metallic particles were detected in each implant class which correlate with the histological features of severity of ALTR and variability in implant performance. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  15. Blood metal ion concentrations in metal-on-metal total hip arthroplasty.

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    Ohtsuru, Tadahiko; Morita, Yuji; Murata, Yasuaki; Shimamoto, Shuji; Munakata, Yutaro; Kato, Yoshiharu

    2017-05-01

    The hip placement with a metal-on-metal (MOM) bearing has been used for both surface replacement and total hip arthroplasty (THA). Use of MOM bearing for hip replacement reduces the wear compared to conventional bearings. We prospectively assessed 30 patients who underwent unilateral MOM THA. A control group of 30 patients who underwent metal-on-polyethylene THA using the implants as the other group, except for bearing, were accessed. Blood samples were collected preoperatively and at 3- , 6- , 9- , 12- , 15- , 18- , and 24-month intervals. Changes in mean blood metal ion concentration were compared between the MOM and metal-on-polyethylene groups. A statistically significant positive correlation was observed between blood cobalt and chromium concentrations in all of the patients. The mean blood ion concentrations of the MOM were significantly higher than those of the metal-on-polyethylene. A statistically significant negative correlation was found between maximum blood cobalt concentration and cup version angle. The maximum blood chromium concentrations in the patients who had larger cup version angles were more likely to decrease. We considered that cup version angle is one of the factors that have the greatest effect on blood metal ion concentration, and the target cup version angle that did not induce an increase in blood metal ion concentrations was approximately 20°.

  16. Large-diameter metal-on-metal total hip arthroplasties: a page in orthopedic history?

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    Singh, Gurpal; Meyer, Heiko; Ruetschi, Marcel; Chamaon, Kathrin; Feuerstein, Bernd; Lohmann, Christoph H

    2013-11-01

    Large-diameter metal-on-metal (MoM) bearings evolved from the success of hip resurfacing. These implants were used in revision surgery in cases with well-fixed acetabular cups but loose or failed femoral stems, to avoid cup revision. Early data showed low rates of dislocation and potentially low wear profiles due to better fluid film lubrication. The risk of impingement was also thought to be low due to the increased head-neck ratio. Subsequently large-diameter MoM heads gained popularity in primary hip replacement. Recent data has emerged on the unacceptably high revision rates among patients with large-diameter MoM total hip arthroplasties (THAs), high blood levels of metal ions, and adverse tissue reactions. The head-neck (cone-taper) modular interface probably represents the weak link in large metal heads that have been used on conventional tapers. Increased torque of the large head, micromotion, and instability at the cone-taper interface, synergistic interactions between corrosion and wear, edge loading, low clearance, and psoas impingement are the likely causes for early failure of these prostheses. Copyright © 2013 Wiley Periodicals, Inc.

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

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    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.

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

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    Hawar Akrawi

    2016-01-01

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

  19. Current Insights Regarding Metal-on-Metal Bearings for Hip Arthroplasty

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    Catherine Van Der Straeten

    2017-09-01

    Full Text Available Modern small diameter metal-on-metal (MoM bearings for total hip arthroplasty (THA have been developed in the nineteen-eighties to address the problem of polyethylene wear related osteolysis. Subsequently large diameter MoM hip resurfacings (HRA were designed for young and active patients to preserve bone and avoid dislocation. Large diameter MoM THA were originally meant as an easy femoral component-only revision solution for femoral neck fractures in HRA, but were then advocated for primary THA as well. In the last decade however, increasing numbers of revisions for adverse local tissues reactions (ALTR to metal debris have been reported. These ALTR are due to excessive wear of the MoM bearings, usually related to malpositioning of the components leading to edge loading, or in rare cases to metal sensitivity. Besides the immunological reactions, metal particles and ions have a potential local and systemic toxicity. Wear and tribocorrosion at the taper-trunnion connections of MoM THA but also THA with polyethylene and ceramic bearings have also been recognized as a cause of ALTR with extensive tissue destruction. Despite the fact that the long-term survivorship and functional results of certain MoM HRA are excellent and better than THA in the young and active patients group, MoM bearings have become very unpopular and are likely to be replaced by bearing couples of other materials.

  20. Natural Remission of Major Periprosthetic Osteolysis following Total Hip Arthroplasty with Metal-on-Metal Bearings

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    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.

  1. Growth of an intrapelvic pseudotumor associated with a metal-on-metal total hip arthroplasty after revision arthroplasty causing a femoral nerve neuropathy

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    Patrick Leung, MD

    2016-09-01

    Full Text Available The development of pseudotumors is not uncommon with metal-on-metal total hip arthroplasty. Pseudotumors that dissect into the retroperitoneal space can cause symptoms of nerve compression. We describe a case of a 53-year-old male with a metal-on-metal total hip arthroplasty who developed mild symptoms of a femoral nerve neuropathy 6 years postoperatively. Revision arthroplasty to a ceramic-on-polyethylene articulation and debridement of the pseudotumor was performed. Postoperatively, the patient's femoral neuropathy progressed and a repeat magnetic resonance imaging showed an increase in size of the pseudotumor despite the removal of the offending metal-on-metal articulation. The patient subsequently underwent a laparoscopic excision of the retroperitoneal pseudotumor. By 17 months post laparoscopic excision of the pseudotumor, the patient's motor deficits resolved, however, sensory deficits persisted in the anteromedial thigh.

  2. Increased risk of revision of cementless stemmed total hip arthroplasty with metal-on-metal bearings

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    Pedersen, Alma B; Mäkelä, Keijo; Eskelinen, Antti; Havelin, Leif Ivar; Furnes, Ove; Kärrholm, Johan; Garellick, Göran; Overgaard, Søren

    2015-01-01

    Background and purpose Data from the national joint registries in Australia and England and Wales have revealed inferior medium-term survivorship for metal-on-metal (MoM) total hip arthroplasty (THA) than for metal-on-polyethylene (MoP) THA. Based on data from the Nordic Arthroplasty Register Association (NARA), we compared the revision risk of cementless stemmed THA with MoM and MoP bearings and we also compared MoM THA to each other. Patients and methods We identified 32,678 patients who were operated from 2002 through 2010 with cementless stemmed THA with either MoM bearings (11,567 patients, 35%) or MoP bearings (21,111 patients, 65%). The patients were followed until revision, death, emigration, or the end of the study period (December 31, 2011), and median follow-up was 3.6 (interquartile range (IQR): 2.4–4.8) years for MoM bearings and 3.4 (IQR: 2.0–5.8) years for MoP bearings. Multivariable regression in the presence of competing risk of death was used to assess the relative risk (RR) of revision for any reason (with 95% confidence interval (CI)). Results The cumulative incidence of revision at 8 years of follow-up was 7.0% (CI: 6.0–8.1) for MoM bearings and 5.1% (CI: 4.7–5.6) for MoP bearings. At 6 years of follow-up, the RR of revision for any reason was 1.5 (CI: 1.3–1.7) for MoM bearings compared to MoP bearings. The RR of revision for any reason was higher for the ASR (adjusted RR = 6.4, CI: 5.0–8.1), the Conserve Plus (adjusted RR = 1.7, CI: 1.1–2.5) and “other” acetabular components (adjusted RR = 2.4, CI: 1.5–3.9) than for MoP THA at 6 years of follow-up. Interpretation At medium-term follow-up, the survivorship for cementless stemmed MoM THA was inferior to that for MoP THA, and metal-related problems may cause higher revision rates for MoM bearings with longer follow-up. PMID:25715878

  3. Do cobalt and chromium levels predict osteolysis in metal-on-metal total hip arthroplasty?

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    Renner, Lisa; Schmidt-Braekling, Tom; Faschingbauer, Martin; Boettner, Friedrich

    2016-12-01

    Serum metal ions are part of the regular follow-up routine of patients with metal-on-metal total hip arthroplasties (MoM-THA). Increased cobalt levels have been suggested to indicate implant failure and corrosion. (1) Is there a correlation between the size of the osteolysis measured on a CT scan and metal ion levels? (2) Can metal ion levels predict the presence of osteolysis in MoM-THA? (3) Are cobalt and chromium serum levels or the cobalt-chromium-ratio diagnostic for osteolysis? CT scans of patients (n = 75) with a unilateral MoM-THA (Birmingham Hip System, Smith & Nephew, TN, USA) implanted by a single surgeon were reviewed to determine the presence of osteolysis. Statistical analysis was performed to detect its association with metal ion levels at the time of the imaging exam. The incidence of osteolysis was the same in men and women (35.6 vs 35.7 %). The cobalt-chromium-ratio correlates with the size of the osteolysis on the CT scan and the femoral component size in the overall study population (p = 0.050, p = 0.001) and in men (p = 0.002, p = 0.001) but not in women (p = 0.312, p = 0.344). The AUC for the cobalt-chromium-ratio to detect osteolysis was 0.613 (p = 0.112) for the overall population, 0.710 for men (p = 0.021) and 0.453 (p = 0.684) for women. The data suggest that a cut off level of 1.71 for the cobalt-chromium-ratio has a sensitivity of 62.5 % and specificity of 72.4 % to identify male patients with osteolysis. The disproportional increase of cobalt over chromium, especially in male patients with large component sizes can not be explained by wear alone and suggests that other processes (corrosion) might contribute to metal ion levels and might be more pronounced in patients with larger component sizes.

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

    International Nuclear Information System (INIS)

    Toms, A.P.; Marshall, T.J.; Cahir, J.; Darrah, C.; Nolan, J.; Donell, S.T.; Barker, T.; Tucker, J.K.

    2008-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-01-15

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

  6. The natural history of inflammatory pseudotumors in asymptomatic patients after metal-on-metal hip arthroplasty.

    Science.gov (United States)

    Almousa, Sulaiman A; Greidanus, Nelson V; Masri, Bassam A; Duncan, Clive P; Garbuz, Donald S

    2013-12-01

    Although pseudotumors have been reported in 32% of asymptomatic metal-on-metal hips, the natural history of asymptomatic pseudotumors is unknown. The purpose of this study was to assess changes over time in asymptomatic pseudotumors and the effect of revision on pseudotumor mass. Followup ultrasound was performed a mean of 25.8 months (range, 21-31 months) after the detection of 15 pseudotumors and five isolated fluid collections in a cohort of 20 asymptomatic patients (13 metal-on-metal, three metal-on-polyethylene, and four hip resurfacings) [42]. Changes in pseudotumors and fluid collections size and nature, and serum ion levels were determined. Among the 15 nonrevised patients, pseudotumors increased in size in six (four solid and two cystic) of 10 patients, three of which had clinically important increases (13-148 cm(3); 28-74 cm(3); 47-104 cm(3)). Three pseudotumors (one solid and two cystic) disappeared completely (the largest measured 31 cm(3)). One solid pseudotumor decreased in size (24 to 18 cm(3)). In five revised patients, pseudotumors completely disappeared in four patients. The fifth patient had two masses that decreased from 437 cm(3) to 262 cm(3) and 43 cm(3) to 25 cm(3). All revision patients had a reduction of chromium (40.42 μ/L to 2.69 μ/L) and cobalt ions (54.19 μ/L to 0.64 μ/L). Of five isolated fluid collections, four completely disappeared (two metal-on-metal and two metal-on-polyethylene) and one (metal-on-metal) increased from 26 cm(3) to 136 cm(3). Our observations suggest pseudotumors frequently increase in size in asymptomatic patients with occasional remission of small masses. Revision resulted in remission of pseudotumors.

  7. INCIDENTALOMA FOUND IN A METAL-ON-METAL REVISION TOTAL HIP ARTHROPLASTY: A CASE REPORT.

    Directory of Open Access Journals (Sweden)

    Gabriele Falzarano

    2014-04-01

    Full Text Available Metal-on-metal coupling in total hip replacements has traditionally been a valid alternative to other total hip bearings for young adults and very active elderly patients. Unfortunately, clinical experience has revealed that the difference in strength between the titanium alloy stem and the cobalt alloy-bearing surface leads to a conflict between the acetabular component and the head, which inturn leads to abnormal wear and osteolysis. The major problems are osteolysis, metal ion intoxication, potential genome toxicity, neoplasms, allergies and implant failure. The authors present an incidental finding of a pseudotumour of the external rotators of the hip in a total hip replacement (THR revision in a 68 year old female patient.

  8. Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty.

    Science.gov (United States)

    Penrose, Colin T; Seyler, Thorsten M; Wellman, Samuel S; Bolognesi, Michael P; Lachiewicz, Paul F

    2016-10-01

    Isolated revision of the acetabular component in the setting of total hip arthroplasty has an increased risk of dislocation. With local soft tissue destruction frequently associated with failed metal-on-metal (MoM) bearings, it is presumed that acetabular revision of these hips will have even greater risk of complications. However, no study directly compares the complications of MoM with metal-on-polyethylene (MoP) acetabular revisions. In the context of a large database analysis, we asked the following questions: (1) Are there differences in early medical or wound complications after isolated acetabular revision of MoM and MoP bearing surfaces? (2) Are there differences in the frequency of dislocation, deep infection, and rerevision based on the bearing surface of the original implant? A review of the 100% Medicare database from 2005 to 2012 was performed using International Classification of Diseases, 9th Revision and Current Procedural Terminology codes. We identified 451 patients with a MoM bearing and 628 patients with a MoP bearing who had an isolated acetabular revision and a minimum followup of 2 years. The incidence, odds ratios, and 95% confidence intervals for early medical or wound complications were calculated using a univariate analysis at 30 days with patient sex and age group-adjusted analysis for blood transfusion. The incidence, odds ratio, and 95% confidence intervals for dislocation, deep infection, and rerevision were calculated using a univariate analysis at 30 day, 90 days, 1 year, and 2 years using a subgroup analysis with the Cochran-Mantel-Haenszel test to adjust for patient gender and age groups. There were no differences between the MoM and MoP isolated acetabular revisions in the incidence of 30-day local complications. There was a greater risk of transfusion in the MoP group than the MoM group (134 of 451 [30%] versus 230 of 628 [37%]; odds ratio [OR], 0.731; 95% confidence interval [CI], 0.565-0.948; p = 0.018). There were no

  9. Histologic, serologic, and tribologic findings in failed metal-on-metal total hip arthroplasty: AAOS exhibit selection.

    Science.gov (United States)

    Pelt, Christopher E; Erickson, Jill; Clarke, Ian; Donaldson, Thomas; Layfield, Lester; Peters, Christopher L

    2013-11-06

    Despite multiple changes in second-generation metal-on-metal hip implants, greater-than-expected revision rates have led to alarm. We hypothesized that the finding of intraoperative metallosis would be associated with a high metal load on histologic analysis and that both would be associated with increased wear, greater serum metal ion levels, and predictable biologic responses in the histologic sections. We evaluated the implant positioning, serum ion levels, intraoperative findings of metallosis, wear characteristics of retrieved implants (tribology), histology, and outcomes in a series of eighteen large-diameter metal-on-metal total hip arthroplasties. The arthroplasties were divided into two groups on the basis of the intraoperative finding of metallosis and into two groups on the basis of the metal load score. Intraoperative metallosis was not associated with a high metal load score (p = 0.15). The finding of intraoperative metallosis was associated with greater serum metal ion levels, greater wear rates, and greater complication rates. Aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) scores were similar between the metallosis and non-metallosis groups (p = 0.49) as well as between the high and low-metal-load groups (p = 0.56).

  10. 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

  11. Outcomes after revision of metal on metal hip resurfacing to total arthroplasty using the direct anterior approach.

    Science.gov (United States)

    Bouveau, Victoire; Haen, Thomas-Xavier; Poupon, Joel; Nich, Christophe

    2018-03-08

    Function after revision total hip arthroplasty (THA) in failed metal-on-metal (MoM) hip resurfacing arthroplasty (HRA) is variable, but post-operative complication rates are reportedly high. We hypothesized HRA conversion to THA using the direct anterior approach (DAA) would be associated with optimal outcome. Seventeen MoM-HRAs in 15 patients (seven males, eight females) were revised through the DAA. The mean age was 45 years (28-59 yrs). The most common indications for revision were aseptic loosening of the acetabular component or of the femoral component and femoral neck fracture. In 16 hips, a conversion to a ceramic-on-ceramic (CoC) (13 hips) or to a metal-on polyethylene (MOP) (2), or to a large-head MoM (1) THA was done. An isolated femoral revision was done in one hip. After 6.7 ± 3 years, no hip had required a re-revision. The Postel-Merle d'Aubigne (PMA) functional score improved from 9 (4-14) to 16 (12-18) (p hip) and dysesthesia of the lateral femoral cutaneous nerve (four hips) were reported. Mean serum chromium concentration decreased from 33.2 μg/L (11.8-62 μg/L) pre-operatively to 5.8 μg/L (0.4-35.5 μg/L) post-operatively (p Revision of failed MoM-HRA using the DAA resulted in an acceptable clinical outcome, no specific complication and no further surgery. A consistent decline in serum ion levels may be expected following HRA conversion to THA.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-02-15

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

  13. Outcome of revision arthroplasty for failed metal-on-metal total hip replacements; is there a relation with metal ions?

    Science.gov (United States)

    Iqbal, Hafiz J; Al-Azzani, Waheeb A K; Jackson-Taylor, Esther; Clatworthy, Elizabeth; John, Alun

    2017-05-12

    We aimed to assess the early outcome following revision arthroplasty for failed metal-on-metal (MoM) total hip replacements (THR) due to adverse reaction to metal debris (ARMD). We reviewed 106 consecutive revision arthroplasties. Case notes and radiological investigations were reviewed to assess the complications. Oxford Hip Score (OHS) and Euroqol (EQ-5D-3L) scores were used to assess the functional outcome and improvement of quality of life. At a mean follow-up of 20 months (12-48 months), the mean OHS was 28.7. Pain improved in 61% patients. A majority of patients were in level 2 for all the EQ-5D-3L dimensions. The overall complication rate was 16%. Survivorship free from further revision for any cause was 94.3% at 48 months. There was no correlation between pre-revision blood metal ions and the final outcome. Revision surgery for failed MoM hip replacement due to ARMD is associated with a relatively higher rate of complications and risk of chronic pain. There is poor correlation between serum metal ions and development of ARMD and outcome following revision surgery.

  14. 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

  15. Comparison of Complications Following Revision of Metal-on-Metal Versus Metal-on-Polyethylene Total Hip Arthroplasty.

    Science.gov (United States)

    Nishio, Shoji; Fukunishi, Shigeo; Yoshiya, Shinichi; Sing, David C; Hansen, Erik N; Vail, Thomas P

    2017-01-01

    The aim of this study was to examine the clinical characteristics of patients who required revision and the rate of early complications after revision for metal-on-metal total hip arthroplasty (MOM THA) and metal-on-polyethylene total hip arthroplasty (MOP THA). Matched cohorts were selected by retrospective review from a single-center database of revision THAs for failed MOM and MOP THAs from 2010 to 2014. A total of 140 hips in 140 patients comprised the study population; 39 revisions were performed for failed MOM THAs (MOM group), and 101 revisions were performed for failed MOP THAs (MOP group). Data included patient demographics, reason for revision, type of revision procedure, any complication within 90 days after surgery, admission type, and discharge disposition. Primary diagnosis, time from primary THA to revision, operative time, blood loss, and length of stay were reviewed. The analysis showed the time from the index primary procedure to first revision was earlier (P=.01) in the MOM group despite no significant intergroup differences in age, gender, primary diagnosis, or body mass index. Surgical morbidity, as indicated by operative time, blood loss, and length of stay, was lower in the MOM group. The stem was retained more often in the MOM group. There was no significant difference between the groups in overall complication rate. These findings indicate that when performed at an earlier time period before extensive soft tissue reaction to metal ions, revision following MOM THA is not associated with an increased complication rate compared with revision following MOP THA. [Orthopedics. 2017; 40(1):e164-e169.]. Copyright 2016, SLACK Incorporated.

  16. Crowe Type I and II DDH managed by large diameter metal-on-metal total hip arthroplasty.

    Science.gov (United States)

    Yalcin, Nadir; Kilicarslan, Kasim; Cicek, Hakan; Kayaalp, Cetin; Yildirim, Hasan

    2011-01-01

    Large bearing metal-on-metal (MOM) total hip arthroplasty (THA) may offer advantages relating to stability and range of motion in patients with Crowe Type I and II developmental dysplasia of the hip (DDH). The purpose of this study was to provide an analysis of the clinical and radiological results of MOM THA in this context and compare the results with a cohort of patients treated with metal-on-polyethylene (MOP) bearing surfaces. 75 hips in 65 patients were treated with cementless MOM THA using large femoral heads (36-56 mm). The mean age of the patients was 47.4 years (29 to 59) and 54 were female. A group of 47 hips (41 patients) treated with conventional THA (screwed cup-polyethylene insert-28 mm head) was used for comparison. The study group was followed up for a mean of 62.1 months (32 to 76). No difference was found between the two groups in relation to improvement in Harris hip score (HHS) (43.1 to 90.3 points in the study group, 42.6 to 89.5 points in the control group, p>0.05). Although the preoperative range of motion in all planes were similar in both groups, the large head group demonstrated greater motion in all planes postoperatively, which was significant (all p=0.001). Additionally, there was a significant difference between groups in relation to the necessity for acetabular structural graft (8% and 31.9%, respectively; p=0.001). No major complications or adverse reactions to metal debris (ARMD) were observed in the study group. The results of large head MOM THA in young and active patients with DDH are similar to conventional THA at early follow-up, but the former offers the advantages of secure acetabular fixation without screws, greater range of motion, and lower risk of dislocation.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-02-15

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

  18. 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.

  19. Outcomes following revision surgery performed for adverse reactions to metal debris in non-metal-on-metal hip arthroplasty patients

    Science.gov (United States)

    Judge, A.; Murray, D. W.; Pandit, H. G.

    2017-01-01

    Objectives Few studies have assessed outcomes following non-metal-on-metal hip arthroplasty (non-MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD). We assessed outcomes following non-MoMHA revision surgery performed for ARMD, and identified predictors of re-revision. Methods We performed a retrospective observational study using data from the National Joint Registry for England and Wales. All non-MoMHAs undergoing revision surgery for ARMD between 2008 and 2014 were included (185 hips in 185 patients). Outcome measures following ARMD revision were intra-operative complications, mortality and re-revision surgery. Predictors of re-revision were identified using Cox regression. Results Intra-operative complications occurred in 6.0% (n = 11) of the 185 cases. The cumulative four-year patient survival rate was 98.2% (95% CI 92.9 to 99.5). Re-revision surgery was performed in 13.5% (n = 25) of hips at a mean time of 1.2 years (0.1 to 3.1 years) following ARMD revision. Infection (32%; n = 8), dislocation/subluxation (24%; n = 6), and aseptic loosening (24%; n = 6) were the most common re-revision indications. The cumulative four-year implant survival rate was 83.8% (95% CI 76.7 to 88.9). Multivariable analysis identified three predictors of re-revision: multiple revision indications (hazard ratio (HR) = 2.78; 95% CI 1.03 to 7.49; p = 0.043); selective component revisions (HR = 5.76; 95% CI 1.28 to 25.9; p = 0.022); and ceramic-on-polyethylene revision bearings (HR = 3.08; 95% CI 1.01 to 9.36; p = 0.047). Conclusions Non-MoMHAs revised for ARMD have a high short-term risk of re-revision, with important predictors of future re-revision including selective component revision, multiple revision indications, and ceramic-on-polyethylene revision bearings. Our findings may help counsel patients about the risks of ARMD revision, and guide reconstructive decisions. Future studies attempting to validate the predictors identified should also assess the

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

    Science.gov (United States)

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

    2017-04-01

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

  1. Revision of Metal-on-metal Hip Arthroplasty with Well Fixed and Positioned Acetabular Component Using a Dual-mobility Head and Review of Literature.

    Science.gov (United States)

    Figueras, Guillem; Planell, Ramón Vives; Fernàndez, Ramón Serra; Biayna, Joan Camí

    2016-01-01

    As a consequence of use of metal-on-metal hip arthroplasties some patients have precised revision for pain or metal hipersensivity reactions among other causes. We propose to salvage monoblock acetabular component and femoral component using a dual-mobility head and perform a lower morbidity operation in young patients preserving host bone stock in cases with well fixed and positioned components. (1) What clinical problems have been reported in patients with Metal-on-metal hip arthroplasties? (2) Could the tribocorrosion potentially cause a fracture of neck femoral component? (3) Can be the dual-mobility head a recourse in metal-on-metal hip revision? Ten patients were revised for pain or/and raised Cobalt/Chromium levels between August 2012 and December 2015. In three cases femoral neck component was fractured and femoral revision was necessary. In four hips, acetabular and femoral components could be maintained. Age, body index mass, ion levels, acetabular position, size of acetabular component and femoral head, approach, blood transfunsion and time of hospitalization were analized. At a mean follow-up of 25,6 months (6 to 45) the mean postoperative HHS was 92. It was not statistically significant because several patients were low sintomatic before surgery, but had raised Cobalt/Chromium levels in the blood. All patients had near-normal levels of Cobalt/Chromium during the first 6 months after revision surgery. No relevant complications were reported. The use of dual-mobility head can be an acceptable option to revise metal-on-metal arthroplasties correctly oriented with abscence of loosening or infection signs and keeping bone stock in young patients.

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    The aim of the present study was to determine the frequency of adverse reaction to metal on metal total hip arthroplasty using a M2a-38 articulation and a Magnum articulation, (Biomet Warsaw, Indiana).All patients who had received a Metal on Metal bearing prosthesis, in two centres in Copenhagen...... arthroplasty, who had an adverse reaction on one side. In addition the study showed that females had higher values of Co and Cr, and that younger patient reported groin pain more often.The conclusion of this study is that the number of adverse reactions is low, despite the time of observation being relatively...... short, no high frequency of adverse reactions to this prosthesis is expected....

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

    Directory of Open Access Journals (Sweden)

    B G Pijls

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

  4. Small diameter metal-on-metal total hip arthroplasty at 13 years - a follow-up study.

    Science.gov (United States)

    Tardy, N; Maqdes, A; Boisrenoult, P; Beaufils, P; Oger, P

    2015-12-01

    Theoretically, the properties of second-generation metal-on-metal (MoM) bearings are better for wear, osteolysis and longevity. However, follow-up studies of more than 10 years are rare, in particular with hybrid fixation (cemented stainless steel stems and cementless cup), therefore we evaluated the results of this combination after a mean follow-up of 12.8 years: (1) to analyze the survival rate, (2) to compare it with the survival rate in the same series after 6.4 years (95.8% cup, 94.8% stem), (3) to evaluate clinical and radiographic outcome and (4) to analyze these failures. The number of revisions would increase after 10 years. We evaluated 106 total hip arthroplasties (THA) (Cedior™ press-fit cup with cemented Acora™ (n=50) and Exafit™ (n=56) stems and 28mm Metasul™ bearings performed between January 1999 and December 2002. The survival rate was calculated by the Kaplan-Meier method. The clinical assessment included the Postel Merle d'Aubigné (PMA) and Oxford scores. The radiographic assessment evaluated radiolucencies and osteolysis on standard X-rays. A histological analysis was only performed during revision THA. After a mean 12.8 years of follow-up (10-16), 53 THA were reviewed in 48 patients. Thirteen THA revisions (14%) were performed including 11 aseptic revisions (5 stem fractures, 2 cases of impingement and 3 loosenings [1 bipolar and 3 cups] and one case of osteolysis). Overall survival, taking into account revision for aseptic loosening, was 87.6% (CI 95%=77.3 to 99.3%). The mean PMA and Oxford scores at the final follow-up were 17.6±0.8 points (16-18) and 16.5±5.2 points (12-38) respectively. The radiological follow-up mainly identified radiolucencies around the stem in Gruen zones 1 and 7 (17 and 21% respectively). The survival rate of hybrid MoM THA in this series decreased after 10 years and is lower than studies evaluating cementless THA with the 28-mm Metasul™ bearings (90.9 to 100% survival). Although the clinical results are

  5. Distributed Analysis of Hip Implants Using Six National and Regional Registries: Comparing Metal-on-Metal with Metal-on-Highly Cross-Linked Polyethylene Bearings in Cementless Total Hip Arthroplasty in Young Patients

    Science.gov (United States)

    Furnes, Ove; Paxton, Elizabeth; Cafri, Guy; Graves, Stephen; Bordini, Barbara; Comfort, Thomas; Rivas, Moises Coll; Banerjee, Samprit; Sedrakyan, Art

    2014-01-01

    Background: The regulation of medical devices has attracted controversy recently because of problems related to metal-on-metal hip implants. There is growing evidence that metal-on-metal implants fail early and cause local and systemic complications. However, the failure associated with metal-on-metal head size is not consistently documented and needs to be communicated to patients and surgeons. The purpose of this study is to compare implant survival of metal on metal with that of metal on highly cross-linked polyethylene. Methods: Using a distributed health data network, primary total hip arthroplasties were identified from six national and regional total joint arthroplasty registries (2001 to 2010). Inclusion criteria were patient age of forty-five to sixty-four years, cementless total hip arthroplasties, primary osteoarthritis diagnosis, and exclusion of the well-known outlier implant ASR (articular surface replacement). The primary outcome was revision for any reason. A meta-analysis of survival probabilities was performed with use of a fixed-effects model. Metal-on-metal implants with a large head size of >36 mm were compared with metal-on-highly cross-linked polyethylene implants. Results: Metal-on-metal implants with a large head size of >36 mm were used in 5172 hips and metal-on-highly cross-linked polyethylene implants were used in 14,372 hips. Metal-on-metal total hip replacements with a large head size of >36 mm had an increased risk of revision compared with metal-on-highly cross-linked polyethylene total hip replacements with more than two years of follow-up, with no difference during the first two years after implantation. The results of the hazard ratios (and 95% confidence intervals) from the multivariable model at various durations of follow-up were 0.95 (0.74 to 1.23) at zero to two years (p = 0.698), 1.42 (1.16 to 1.75) at more than two years to four years (p = 0.001), 1.78 (1.45 to 2.19) at more than four years to six years (p implants and

  6. 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

  7. Preoperative Risk Factors Associated With Poor Outcomes of Revision Surgery for "Pseudotumors" in Patients With Metal-on-Metal Hip Arthroplasty.

    Science.gov (United States)

    Liow, Ming Han Lincoln; Dimitriou, Dimitris; Tsai, Tsung-Yuan; Kwon, Young-Min

    2016-12-01

    Revision surgery of failed metal-on-metal (MoM) total hip arthroplasty (THA) for adverse tissue reaction (pseudotumor) can be challenging as a consequence of soft tissue and muscle necrosis. The aims of this study were to (1) report the revision outcomes of patients who underwent revision surgery for failed MoM hip arthroplasty due to symptomatic pseudotumor and (2) identify preoperative risk factors associated with revision outcomes. Between January 2011 and January 2013, a total of 102 consecutive large head MoM hip arthroplasties in 97 patients (male: 62, female: 35), who underwent revision surgery were identified from the database of a multidisciplinary referral center. At minimum follow-up of 2 years (range: 26-52 months), at least one complication had occurred in 14 of 102 revisions (14%). Prerevision radiographic loosening (P = .01), magnetic resonance imaging (MRI) findings of solid lesions with abductor deficiency on MRI (P revision complications. The reoperation rate of revised MoM THA was 7% (7 of 102 hips). Implant survivorship was 88% at 3 years. Metal ion levels declined in most patients after removal of MoM articulation. Revision outcomes of revision surgery for failed MoM THA due to symptomatic pseudotumor demonstrated 14% complication rate and 7% re-revision rate at 30-month follow-up. Our study identified prerevision radiographic loosening, solid lesions/abductor deficiency on MRI, and high grade intraoperative tissue damage as risk factors associated with poorer revision outcomes. This provides clinically useful information for preoperative planning and perioperative counseling of MoM THA patients undergoing revision surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. 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.

  9. Local tissue reaction and necrosis-induced femoral nerve palsy in a patient with a metal-on-metal total hip arthroplasty: a case report.

    Science.gov (United States)

    Wodowski, Andrew J; Rider, Carson M; Mihalko, William M

    2014-01-01

    This case report describes a 54-year-old Hispanic male who developed femoral nerve palsy approximately 1 year after metal-on-metal total hip arthroplasty (MOM THA). Cobalt and chromium levels were 4.8 ppb and undetectable, respectively. MRI demonstrated a well-encapsulated pseudotumor that communicated with the anterior portion of the right hip, and EMG showed neuropraxic femoral nerve injury. As a result, the patient experienced motor and sensory loss in the femoral and proximal saphenous nerve distributions. Surgical revision to ceramic-on-poly THA with debridement and decompression of the pseudotumor improved the patient's neurological status. Similar acute local tissue reactions have been described but the serum levels of cobalt and chrome associated with these reactions have been variable. Wear particles and products produced from corrosion at the head taper junction from MOM THA can potentially lead to cellular dysfunction with subsequent pseudotumer formation, but these reactions and fluid collections have also been found. In this patient, serum cobalt levels were elevated, while serum chromium levels remained undetectable. The purpose of this case report is to describe one patient's response and to review the recent literature regarding potential complications of MOM THA.

  10. What Is the Natural History of "Asymptomatic" Pseudotumours in Metal-on-Metal Hip Arthroplasty? Minimum 4-Year Metal Artifact Reduction Sequence Magnetic Resonance Imaging Longitudinal Study.

    Science.gov (United States)

    Kwon, Young-Min; Liow, Ming Han Lincoln; Dimitriou, Dimitris; Tsai, Tsung-Yuan; Freiberg, Andrew A; Rubash, Harry E

    2016-09-01

    Metal Artifact Reduction Sequence Magnetic Resonance Imaging (MARS-MRI) is an important cross-sectional imaging modality in detection of metal-on-metal (MoM) hip arthroplasty (HA) pseudotumours. Potential evolution of pseudotumours detected by MARS-MRI in "asymptomatic" patients with MoMHA arthroplasty beyond 2 years remains largely unknown. The aims of this longitudinal study were to (1) determine the natural history of pseudotumours in "asymptomatic" MoMHA patients under MARS-MRI surveillance and (2) characterize MRI feature(s) associated with progressive pseudotumours. A total of 37 MoMHA (32 patients, mean 56 years old) with pseudotumours on MARS-MRI were evaluated longitudinally using a standardized MARS-MRI protocol. Serum cobalt and chromium levels, pseudotumour size, thickness of the cyst wall, and MRI signal intensity of the abnormality were recorded and analyzed. At minimum of 4-year follow-up (range 49-54 months), 4 Type II pseudotumours (11%) demonstrated MRI evidence of progression. Five Type I pseudotumours (14%) were found to have "regressed." No measurable MRI progression was detected in remaining patients (75%). MRI features associated with progressive pseudotumours included the presence of increased cystic wall thickness and "atypical" mixed fluid signal. MRI pseudotumour progression was not associated with metal ion levels. The natural history of type I cystic pseudotumours continues to be nonprogressive in most "asymptomatic" MoMHA patients at minimum 4 years, suggesting the importance of patient symptoms and MRI characteristic features in the clinical decision-making process. Routine follow-up MARS-MRI evaluation of "asymptomatic" patients with low-grade cystic pseudotumours in the absence of interval clinical changes may not be indicated. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Block-step asymmetry 5 years after large-head metal-on-metal total hip arthroplasty is related to lower muscle mass and leg power on the implant side.

    Science.gov (United States)

    Hjorth, M H; Stilling, M; Lorenzen, N D; Jakobsen, S S; Soballe, K; Mechlenburg, I

    2014-06-01

    Metal-on-metal articulations mimic the human hip anatomy, presumably lower dislocation rates and increase the range-of-motion. This study aims to measure the muscle mass and power of both legs in patients with unilateral metal-on-metal total hip arthroplasty, and to investigate their effect on block-step test, spatio-temporal gait parameters and self-reported function. Twenty-eight patients (7 women), mean age 50 (28-68) years, participated in a 5-7 year follow-up. Patients had received one type unilateral large-head metal-on-metal total hip articulation, all of which were well-functioning at follow-up. Mean muscle mass was measured by the total-body Dual energy X-ray Absorption scans, and muscle power was measured in a leg extensor power rig. Block-step test and spatio-temporal gait parameters were measured with an inertial measurement unit. Self-reported function was assessed by the Hip Disability and Osteoarthritis Outcome Score. We found a significant difference between the mean muscle mass of the implant-side leg and the non-implant-side leg in hip, thigh and calf areas (Ppower (P=0.025). Correlations between mean muscle mass and mean muscle power were significant for both the implant-side leg (r=0.45, P=0.018) and the non-implant-side leg (r=0.51, P=0.007). The difference in mean muscle power between legs correlated with block-step test asymmetry during ascending (r=0.40, P=0.047) and descending (r=0.53, P=0.006). Correlations between self-reported function and power of the implant-side leg were not significant. Young patients have not fully regained muscle mass, muscle power and function 5-7 years after metal-on-metal total hip arthroplasty. Copyright © 2014. Published by Elsevier Ltd.

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

    DEFF Research Database (Denmark)

    Frølich, Christina; Hansen, Torben Bæk

    2015-01-01

    Adverse reactions to metal-on-metal (MoM) prostheses are well known from total hip joint resurfacing arthroplasty with elevated serum chrome or cobalt, pain and pseudo tumor formation. It may, however, also be seen after total joint replacement of the trapeziometacarpal joint using MoM articulation...

  13. 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.)

  14. Increased metal allergy in patients with failed metal-on-metal hip arthroplasty and peri-implant T-lymphocytic inflammation.

    Science.gov (United States)

    Thomas, P; Braathen, L R; Dörig, M; Auböck, J; Nestle, F; Werfel, T; Willert, H G

    2009-08-01

    In 16 patients with revised metal-on-metal arthroplasty and peri-implant lymphocytic inflammation, we verified the role of metal hypersensitivity by patch testing (PT) and lymphocyte transformation test (LTT). In the 16 patients with lymphocyte dominated periprosthetic inflammation, allergy history was obtained by a questionnaire, specific serum IgE to aeroallergens was measured to assess atopy, PT to standard and metal series was performed and metal sensitivity was further assessed by LTT using blood mononuclear cells. Revision surgery was performed because of pain (8/16), osteolysis (4/16), dislocation (3/16) and loosening of the stem (1/16). Histological examination showed perivascular infiltrates of T lymphocytes, high endothelial venules, fibrin exudation and accumulation of macrophages with drop-like inclusions. Five patients had a history of cutaneous metal allergy and atopy was found in 25% of the patients. In 13/16 patients (81%), systemic metal sensitivity was found based on PT and/or LTT. Patch test reactions were seen in 11/16 patients (69%; partly multiple reactions/patient): 7/16 to Cobalt (Co), 7/16 to Chromium (Cr), 4/16 to Nickel (Ni), and one each to Molybdenum (Mo) and Manganese (Mn). Ten of 16 patients (62%) showed enhanced LTT reactivity to metals: 7/16 to Ni, 7/16 to Co, 5/16 to Cr, 5/16 to Mo and 4/16 to Mn. The lymphocyte dominated peri-implant inflammation may well reflect an allergic hyper-reactivity in these patients, given the high rate of concomitantly found metal allergy. Despite the overall incidence of metal implant allergy being low, allergic reactions should be included as differential diagnosis in failed metal-on-metal arthroplasty.

  15. Metal allergy and second-generation metal-on-metal arthroplasties.

    Science.gov (United States)

    Cousen, Philippa J; Gawkrodger, David J

    2012-02-01

    There are concerns about the induction of metal allergy with second-generation metal-on-metal prostheses, and the role that this may play in the development of complications such as 'pseudotumours' or failure of the implant. In this review, we attempt to set out the current knowledge on this subject. From a review of the literature, it is apparent that the first-generation metal-on-metal replacement hips did cause metal sensitization, and that joint failure was associated with this, although it is still not clear which one led to the other. Highly engineered second-generation metal-on-metal arthroplasties used in joint resurfacings are now increasingly employed. Several studies have recently shown an association between metal sensitization and peri-implant hypersensitivity reactions and implant loosening and failure, although the overall risk appears to be low. The pragmatic approach adopted by most contact dermatologists for patients known to be allergic to nickel, cobalt or chromium and who require joint replacement is to recommend prostheses made of titanium-based alloys. Patch testing continues to be a useful tool as laboratory investigations for metal hypersensitivity continue to emerge. The development of guidelines on the management of patients receiving metal-on-metal arthroplasties suspected of being metal-allergic is desirable. © 2011 John Wiley & Sons A/S.

  16. 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

  17. Comparison of metal ion concentrations and implant survival after total hip arthroplasty with metal-on-metal versus metal-on-polyethylene articulations.

    Science.gov (United States)

    Dahlstrand, Henrik; Stark, André; Wick, Marius C; Anissian, Lucas; Hailer, Nils P; Weiss, Rüdiger J

    2017-10-01

    Background and purpose - Large metal-on-metal (MoM) articulations are associated with metal wear and corrosion, leading to increased metal ion concentrations and unacceptable revision rates. There are few comparative studies of 28-mm MoM articulations with conventional metal-on-polyethylene (MoP) couplings. We present a long-term follow-up of a randomized controlled trial comparing MoM versus MoP 28-mm articulations, focused on metal ions and implant survival. Patients and methods - 85 patients with a mean age of 65 years at surgery were randomized to a MoM (Metasul) or a MoP (Protasul) bearing. After 16 years, 38 patients had died and 4 had undergone revision surgery. 13 patients were unavailable for clinical follow-up, leaving 30 patients (n = 14 MoM and n = 16 MoP) for analysis of metal ion concentrations and clinical outcome. Results - 15-year implant survival was similar in both groups (MoM 96% [95% CI 88-100] versus MoP 97% [95% CI 91-100]). The mean serum cobalt concentration was 4-fold higher in the MoM (1.5 μg/L) compared with the MoP cohort (0.4 μg/L, p concentration was double in the MoM (2.2 μg/L) compared with the MoP cohort (1.0 μg/L, p = 0.05). Mean creatinine levels were similar in both groups (MoM 93 μmol/L versus MoP 92 μmol/L). Harris hip scores differed only marginally between the MoM and MoP cohorts. Interpretation - This is the longest follow-up of a randomized trial on 28-mm MoM articulations, and although implant survival in the 2 groups was similar, metal ion concentrations remained elevated in the MoM cohort even in the long term.

  18. Comparison of metal ion concentrations and implant survival after total hip arthroplasty with metal-on-metal versus metal-on-polyethylene articulations

    OpenAIRE

    Dahlstrand, Henrik; Stark, André; Wick, Marius C; Anissian, Lucas; Hailer, Nils P; Weiss, Rüdiger J

    2017-01-01

    Background and purpose Large metal-on-metal (MoM) articulations are associated with metal wear and corrosion, leading to increased metal ion concentrations and unacceptable revision rates. There are few comparative studies of 28-mm MoM articulations with conventional metal-on-polyethylene (MoP) couplings. We present a long-term follow-up of a randomized controlled trial comparing MoM versus MoP 28-mm articulations, focused on metal ions and implant survival. Patients and methods 85 patients w...

  19. Pseudotumour formation and subsequent resolution in metal-on-metal total hip arthroplasty following revision: Instructional review and an illustrative case report with revision using a dual mobility design.

    Science.gov (United States)

    Sassoon, A A; Barrack, R L

    2016-06-01

    The use of large-diameter metal-on-metal (MoM) components in total hip arthroplasty (THA) is associated with an increased risk of early failure due to adverse local tissue reaction to metal debris (ARMD) in response to the release of metal ions from the bearing couple and/or head-neck taper corrosion. The aim of this paper was to present a review of the incidence and natural history of ARMD and the forms of treatment, with a focus on the need for and extent of resection or debulking of the pseudotumour. An illustrative case report is presented of a patient with an intra-pelvic pseudotumour associated with a large diameter MoM THA, which was treated successfully with revision of the bearing surface to a dual mobility couple and retention of the well-fixed acetabular and femoral components. The pseudotumour was left in situ Resolution of the intra-pelvic mass and normalisation of metal ion levels was observed seven months post-operatively. Cite this article: Bone Joint J 2016;98-B:736-40. ©2016 The British Editorial Society of Bone & Joint Surgery.

  20. The Management of the Symptomatic Patient With a Metal-on-Metal Hip Prosthesis.

    Science.gov (United States)

    Harrington, Kate; Phelan, Emma; Torreggiani, William C; Doody, Orla

    2016-02-01

    Metal-on-metal (MoM) hip implants have gained popularity due to their greater stability and reduction in implant failure compare to metal-on-polyethylene prostheses. However, as well as carrying general risks of hip implantation, risks specifically associated with MoM implants have been well documented in recent years. Conditions such as pseudotumours or aseptic lymphocyte-dominated vasculitis-associated lesions are specific to MoM hip implants. In this review we discuss the typical patient presentation, the investigations that should be performed, the typical findings on various imaging modalities, and the treatment options of symptomatic patients with MoM hip arthroplasties. Copyright © 2016 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

  1. 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.

  2. Outcome and serum ion determination up to 11 years after implantation of a cemented metal-on-metal hip prosthesis.

    Science.gov (United States)

    Lazennec, Jean-Yves; Boyer, Patrick; Poupon, Joel; Rousseau, Marc-Antoine; Roy, Carine; Ravaud, Philippe; Catonné, Yves

    2009-04-01

    Little is known about the long-term outcome of cemented metal-on-metal hip arthroplasties. We evaluated a consecutive series of metal-on-metal polyethylene-backed cemented hip arthroplasties implanted in patients under 60 years of age. 109 patients (134 joint replacements) were followed prospectively for mean 9 (7-11) years. The evaluation included clinical score, radiographic assessment, and blood sampling for ion level determination. At the final review, 12 hips had been revised, mainly because of aseptic loosening of the socket. Using revision for aseptic loosening as the endpoint, the survival rate at 9 years was 91% for the cup and 99% for the stem. In addition, 35 hips showed radiolucent lines at the bone-cement interface of the acetabulum and some were associated with osteolysis. The median serum cobalt and chromium levels were relatively constant over time, and were much higher than the detection level throughout the study period. The cobalt level was 1.5 microg/L 1 year after implantation, and 1.44 microg/L 9 years after implantation. Revisions for aseptic loosening and radiographic findings in the sockets led us to halt metal-on-metal-backed polyethylene cemented hip arthroplasty procedures. If the rigidity of the cemented socket is a reason for loosening, excessive release of metal ions and particles may be involved. Further investigations are required to confirm this hypothesis and to determine whether subluxation, microseparation, and hypersensitivity also play a role.

  3. Patients with metal-on-metal articulation in trapeziometacarpal total joint arthroplasty may have elevated serum chrome and cobalt.

    Science.gov (United States)

    Hansen, T B; Dremstrup, L; Stilling, M

    2013-10-01

    Serum chrome and cobalt was measured in 50 patients with trapeziometacarpal total joint replacement with metal-on-metal articulation and compared with serum chrome and cobalt values in 23 patients with trapeziometacarpal total joint replacement with metal-on-polyethylene articulation. In 10 of 50 (20%) patients with metal-on-metal articulation, slightly elevated serum chrome or cobalt values were found compared with only one in 23 (4%) patients with metal-on-polyethylene articulation. All metal values were lower than accepted 'normal values' for metal-on-metal hip arthroplasty and so considered not to be a general health risk. However, the mean disabilities of the arm, shoulder and hand (DASH) score was 24 in patients with elevated serum chrome or cobalt compared with 10 in patients with normal metal values (p chrome or cobalt values. We recommend that patients with trapeziometacarpal total joint replacement with metal-on-metal articulation are followed with DASH score and radiological examination every 3-5 years and serum chrome and cobalt should be analysed in symptomatic cases to learn more about possible local complications leading to, or arising from, metal debris.

  4. Metal on metal surface replacement of the hip. Experience of the McMinn prothesis.

    Science.gov (United States)

    McMinn, D; Treacy, R; Lin, K; Pynsent, P

    1996-08-01

    The historical failure of surface replacement has been due to the production of wear debris with subsequent bone resorption, loosening, and failure. To avoid these problems, a surface replacement using a metal on metal bearing allowing thin components and femoral design and instrumentation to avoid varus alignment has been designed. Two hundred thirty-five joints have been resurfaced with this prosthesis in almost 5 years. There have been no femoral neck fractures and no dislocations. There have been 4 designs differing in the method of fixation. In the press fit group, 6 of 70 hips had to be revised for aseptic loosening. In the cemented group, debonding of the cup occurred in 3 of 43 cases. Six patients had hydroxyapatite coated components and have had excellent clinical outcomes. The current design uses a peripherally expanded hydroxyapatite coated cup and a cemented metal head; 116 of this design have been implanted during a 19-month period with excellent outcome. Despite short followup the authors are hopeful that the combination of a polar metal on metal bearing with appropriate fixation will yield a method of preserving bone stock in the younger patient requiring arthroplasty.

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

    Science.gov (United States)

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

    2013-05-01

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

  6. 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.

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  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. 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

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    INTRODUCTION: Metal-on-metal hip articulations have been intensely debated after reports of adverse reactions and high failure rates. The aim of this study was to retrospectively evaluate the implant of a metal-on.metal total hip articulation (MOM THA) from a single manufacture in a two...... of 53 months. 4 pseudotumors were diagnosed at time of follow up but no substantiated link was made between adverse reactions and re-operations. CONCLUSION: The high re-operation rates found in this study raised concern about the usage of the MOM THA and subsequently lead to the termination......-center study. MATERIALS AND METHODS: 108 CONSERVE(®) MOM THA were implanted in 92 patients between November 2005 and December 2010. Patients had at time of retrospective evaluation their journals reviewed for re-operations and adverse reactions. RESULTS: 20 hips were re-operated (18.4%) at a mean follow up...

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

    Science.gov (United States)

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

    2015-09-01

    The diagnosis of adverse local tissue reaction (ALTR) after metal-on-metal total hip arthroplasty (MoMTHA) presents a significant challenge. No single biomarker is specific for ALTR. The purpose of this study was to determine if the ratio of cobalt to chromium ions is useful for diagnosing ALTR in MoMTHA. In 89 bearing-related revision THAs, preoperative cobalt and chromium ion levels were compared to an intraoperative soft tissue damage grading scale. The average cobalt to chromium ratio was 2.96 (0-20). There was no correlation between the tissue scale and the cobalt to chromium ratio (R=0.095; P=0.41). Many variables affecting ion production/excretion mitigate the use of the ion ratio. The cobalt to chromium ratio is not a predictive biomarker for ALTR in MoMTHA. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Uncemented metal-on-metal acetabular component: follow-up of 112 hips for a minimum of 5 years.

    Science.gov (United States)

    Vassan, Uma T; Sharma, Sanjeev; Chowdary, Koganti P; Bhamra, Manjit S

    2007-08-01

    Aseptic loosening is the major cause of implant failure. In cemented hip arthroplasty, failure of the acetabular side is mainly due to lysis caused by wear particles. By using an implant with low wear characteristics and by enhancing acetabular fixation using an uncemented implant, we aimed to reduce acetabular lysis and thereby loosening. This was a retrospective cohort study of 119 hips (101 patients) that had the Uncemented Fitmore cup (Sulzer Orthopedics). In 66 patients, the femoral component was CF-30 (Sulzer) used with cement. In the remaining 35 patients, thrust plate prosthesis (TPP) (Sulzer) was used. Of the 101 patients, 94 (112 hips) were available for study. Mean follow-up of the 94 patients was 7 (5-13) years. The mean preoperative Harris hip score was 38 and the mean postoperative Harris hip score was 89 at the last follow-up. Taking aseptic loosening as the endpoint, the survival rate of the Fitmore cup was 100% at 11 years. The uncemented Fitmore acetabular cup with second generation metal-on-metal articulation showed good results with regard to aseptic loosening in the medium term.

  13. 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

    2016-01-01

    (THA) and to investigate its relationship to serum metal-ion levels and hypersensitivity to metal. METHODS: Forty-one patients (31 males), mean age 52 (28-68) years, with a total of 49 large-head MoM THA participated in a 5-7-year follow-up study. Patients underwent ultrasonography, serum metal-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...... metal-ion levels were similar to those observed in patients with no pseudotumors (p > 0.36). The capsule-stem distance of mean 8.6 mm (SD 3.82, 95% CI: 5.40-11.79) was wider (p = 0.02) in patients with pseudotumours than in patients without pseudotumors of mean 5.6 mm (SD 2.89, 95% CI: 4...

  14. 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.

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

    Directory of Open Access Journals (Sweden)

    Howard JJ

    2016-08-01

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

  16. [History of hip arthroplasty].

    Science.gov (United States)

    Płomiński, Janusz; Kwiatkowski, Krzysztof

    2007-02-01

    The authors present the history of hip prosthesis in treatment of coxarthrosis. Despite eighty years of experience the problem of gaining good and long-term results still exist and is difficult to solve. Even changing the way on cementless stabilization of prosthesis doesn't has result in solving the problem of aseptic loosening of hip arthroplasty. Problems of wear derbies made the producers find new to reduce particulate debris. The future of hip arthroplasty is connected with hip resurfacing. Moreover, the higher number of primary hip plasty the more prosthesis are loosening. The treatment is far more difficult and more expensive.

  17. Imaging of hip arthroplasty

    International Nuclear Information System (INIS)

    Breitenseher, M.J.; Mayerhoefer, M.; Gottsauner-Wolf, F.; Krestan, C.; Imhof, H.; Toma, C.D.

    2002-01-01

    Hip arthroplasty has become a common and still increasing procedure for the treatment of osteoarthritis, advanced head necrosis, post-inflammatory arthritis or rheumatoid arthritis.Radiography is the most important imaging modality for monitoring the normal, asymptomatic hip arthroplasty. Radiographs are obtained at the end of a surgical treatment, to exclude complications like fracture or component misplacement. In the follow-up radiographs are used for the diagnosis of loosening and infection of the hip arthroplasty as well as soft tissue ossification. Together with the history and clinical information, the analysis of morphological findings allows to find the grade of loosening. MRI has been advocated in the diagnosis of infection, in particular in the localisation of soft tissue involvement.Imaging, especially by radiographs, is used for the evaluation of the normal and complicated follow-up of hip arthroplasty. (orig.) [de

  18. Histological characterization of periprosthetic tissue responses for metal-on-metal hip replacement

    Science.gov (United States)

    Phillips, Eual A.; Klein, Gregg R.; Cates, Harold E.; Kurtz, Steven M.; Steinbeck, Marla J.

    2014-01-01

    The histology of periprosthetic tissue from metal-on-metal (MOM) hip devices has been characterized by a variety of methods. The purpose of this study was to compare and evaluate the suitability of two previously developed aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL) scoring systems for periprosthetic hip tissue responses retrieved from MOM THR systems revised for loosening. Two ALVAL scoring systems (Campbell and Oxford) were used to perform histological analysis of soft tissues from seventeen failed MOM THRs. The predominant reactions for this patient cohort were macrophage infiltration and necrosis, with less than half of the patients (41%) showing a significant lymphocytic response or a high ALVAL reaction (6%). Other morphological changes which varied among patients included hemosiderin accumulation, cartilage formation and heterotopic ossification. Both scoring systems correlated with macrophage and lymphocyte responses and with each other, however given the diversity and variability of the current responses the Oxford-ALVAL system was more suitable for scoring tissues from MOM THR patients revised for loosening. It is important that standardized methods to score MOM tissue responses be used consistently so multiple study results can be compared to one another and a consensus can be generated. PMID:24941402

  19. What is the natural history of asymptomatic pseudotumours in metal-on-metal hip resurfacing patients?

    Science.gov (United States)

    Matharu, Gulraj S; Ostlere, Simon J; Pandit, Hemant G; Murray, David W

    2016-11-10

    We assessed the natural history of asymptomatic pseudotumours associated with metal-on-metal hip resurfacings (MoMHRs), and factors associated with future revision. In 2007-2008, we identified 25 MoMHRs (21 patients; mean age 59.9 years; 76% female) with asymptomatic pseudotumours. All patients underwent identical initial assessment (ultrasound, blood metal ions, radiographs, Oxford Hip Score [OHS]) and were considered asymptomatic because they denied experiencing hip symptoms, were satisfied with their MoMHR surgery, and had good or excellent OHSs (≥34). In 2012-2013, repeat assessments were performed in all non-revised patients. Revision for pseudotumour was performed/recommended in 15 MoMHRs (60%) at a mean 2.7 years (range 0.4-6.4 years) from initial assessment, with 14 developing symptoms before revision. Non-revised MoMHRs (n = 10) underwent repeat ultrasound at a mean 5.1 years (range 4.0-6.5 years) later, with no changes in pseudotumour volume (p = 0.956) or OHS (p = 0.065) between assessments. High blood cobalt (p = 0.0048) and chromium (p = 0.0162), large pseudotumours (p = 0.0458), low OHS (p = 0.0183), and bilateral MoMHRs (p = 0.049) predicted future revision. Patients with blood metal ions above established unilateral/bilateral thresholds and/or initial pseudotumours >30 cm3 had an 86.7% sensitivity, 70.0% specificity, 81.2% positive predictive value, and 77.8% negative predictive value for future revision. MoMHR patients with initially asymptomatic pseudotumours often become symptomatic and require revision. Patients with high blood metal ions and/or pseudotumours >30 cm3 should remain under annual surveillance or be considered for revision (especially in patients also having lower initial OHSs, bilateral MoMHRs, and/or those becoming symptomatic). Less regular surveillance of patients outside these parameters appears acceptable.

  20. Albumin as marker for susceptibility to metal ions in metal-on-metal hip prosthesis patients.

    Science.gov (United States)

    Facchin, F; Catalani, S; Bianconi, E; Pasquale, D De; Stea, S; Toni, A; Canaider, S; Beraudi, A

    2017-04-01

    Metal-on-metal (MoM) hip prostheses are known to release chromium and cobalt (Co), which negatively affect the health status, leading to prosthesis explant. Albumin (ALB) is the main serum protein-binding divalent transition metals. Its binding capacity can be affected by gene mutations or modification of the protein N-terminal region, giving the ischaemia-modified albumin (IMA). This study evaluated ALB, at gene and protein level, as marker of individual susceptibility to Co in MoM patients, to understand whether it could be responsible for the different management of this ion. Co was measured in whole blood, serum and urine of 40 MoM patients. A mutational screening of ALB was performed to detect links between mutations and metal binding. Finally, serum concentration of total ALB and IMA were measured. Serum total ALB concentration was in the normal range for all patients. None of the subjects presented mutations in the investigated gene. Whole blood, serum and urine Co did not correlate with serum total ALB or IMA, although IMA was above the normal limit in most subjects. The individual susceptibility is very important for patients' health status. Despite the limited results of this study, we provide indications on possible future investigations on the toxicological response to Co.

  1. 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.

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

    International Nuclear Information System (INIS)

    Boomsma, Martijn F.; Warringa, Niek; Edens, Mireille A.; Lingen, Christiaan P. van; Ettema, Harmen B.; Verheyen, Cees C.P.M.; Maas, Mario

    2015-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-08-15

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

  4. Jogging after total hip arthroplasty.

    Science.gov (United States)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2010-03-22

    Diameter and diametral clearance of the bearing surfaces of metal-on-metal hip implants and structural supports have been recognised as key factors to reduce the dry contact and hydrodynamic pressures and improve lubrication performance. On the other hand, application of aspherical bearing surfaces can also significantly affect the contact mechanics and lubrication performance by changing the radius of the curvature of a bearing surface and consequently improving the conformity between the head and the cup. In this study, a novel metal-on-metal hip implant employing a specific aspherical bearing surface, Alpharabola, as the acetabular surface was investigated for both contact mechanics and elastohydrodynamic lubrication under steady-state conditions. When compared with conventional spherical bearing surfaces, a more uniform pressure distribution and a thicker lubricant film thickness within the loaded conjunction were predicted for this novel Alpharabola hip implant. The effects of the geometric parameters of this novel acetabular surface on the pressure distribution and lubricant thickness were investigated. A significant increase in the predicted lubricant film thickness and a significant decrease in the dry contact and hydrodynamic pressures were found with appropriate combinations of these geometric parameters, compared with the spherical bearing surface. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

  6. Total hip arthroplasty in Denmark

    DEFF Research Database (Denmark)

    Pedersen, Alma Becic; Johnsen, Søren Paaske; Overgaard, Søren

    2005-01-01

    The annual number of total hip arthroplasties (THA) has increased in Denmark over the past 15 years. There is, however, limited detailed data available on the incidence of THAs.......The annual number of total hip arthroplasties (THA) has increased in Denmark over the past 15 years. There is, however, limited detailed data available on the incidence of THAs....

  7. 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

  8. 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

  9. 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

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

    Directory of Open Access Journals (Sweden)

    Mauricio de Moraes

    2008-01-01

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

  11. Relationship between Pelvic Incidence Angle and Blood Concentration of Chromium and Cobalt Ions after Metal-on-Metal Hip Replacement: A Brief Report.

    Science.gov (United States)

    Pernaa, K; Saltychev, M; Mäkelä, K

    2018-03-01

    The wear of metal-on-metal hip implants may increase chromium or cobalt ion blood level. This phenomenon may depend among other things on the particularity of spinopelvic anatomy. The effect of pelvic incidence angle on the wear of metal-on-metal hip implants is not known. The objective of the study was to investigate whether such effect does exist. The pelvic incidence and inclination of acetabular component angles of 89 patients after unilateral metal-on-metal hip replacement were compared with blood level of chromium and cobalt ions using Pearson correlation coefficient. No significant correlations between pelvic incidence angle and the metal ion blood levels were observed. The correlation coefficients varied from -0.02 to 0.2 and all p values were >0.05. No evidence was found on the effect of pelvic incidence angle on metal wear after metal-on-metal hip replacement when measured by the blood levels of chromium and cobalt ions. It is reasonable to assume that other factors than pelvic tilt may affect the rate of implant wear.

  12. Clinical usefulness of blood metal measurements to assess the failure of metal-on-metal hip implants

    Science.gov (United States)

    Sampson, Barry; Hart, Alister

    2012-01-01

    In April 2010, a Medicines and Healthcare Products Regulatory Agency safety alert concerning all metal-on-metal (MOM) hip replacements recommended measuring chromium and cobalt concentrations when managing patients with painful prostheses. The need for this review is illustrated by the recent surge in requests for these blood tests from orthopaedic surgeons following this alert. The aim is to provide guidance to laboratories in assessing these requests and advising clinicians on interpretation. First, we summarize the basic terminology regarding the types of hip replacements, with emphasis on the MOM type. Second, we describe the clinical concerns over implant-derived wear debris in the local tissues and distant sites. Analytical aspects of the measurement of the relevant metal ions and what factors affect the levels measured are discussed. The application of inductively coupled plasma mass spectrometry techniques to the measurement of these metals is considered in detail. The biological effects of metal wear products are summarized with local toxicity and systemic biological effects considered, including carcinogenicity, genotoxicity and systemic toxicity. Clinical cases are used to illustrate pertinent points. PMID:22155921

  13. 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.

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

    Science.gov (United States)

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

    2010-08-01

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

  15. 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.

  16. CURBSIDE CONSULTATION IN HIP ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    Scott M. Sporer

    2009-03-01

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

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

    Science.gov (United States)

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

    2011-01-01

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

  18. The Danish Hip Arthroplasty Register

    DEFF Research Database (Denmark)

    Gundtoft, Per Hviid; Varnum, Claus; Pedersen, Alma Becic

    2016-01-01

    AIM OF DATABASE: The aim of the Danish Hip Arthroplasty Register (DHR) is to continuously monitor and improve the quality of treatment of primary and revision total hip arthroplasty (THA) in Denmark. STUDY POPULATION: The DHR is a Danish nationwide arthroplasty register established in January 1995...... complications. Completeness of primary and revision surgery is evaluated annually and validation of a number of variables has been carried out. DESCRIPTIVE DATA: A total of 139,525 primary THAs and 22,118 revisions have been registered in the DHR between January 1, 1995 and December 31, 2014. Since 1995....... All Danish orthopedic departments - both public and private - report to the register, and registration is compulsory. MAIN VARIABLES: The main variables in the register include civil registration number, indication for primary and revision surgery, operation date and side, and postoperative...

  19. 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

  20. 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.

  1. 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.

  2. Imaging of hip joint arthroplasty

    International Nuclear Information System (INIS)

    Mayerhoefer, M.E.; Fruehwald-Pallamar, J.; Czerny, C.

    2009-01-01

    The hip joint is the largest joint in the human body and consequently, its evaluation by diagnostic imaging is highly important. This includes imaging of hip joint arthroplasty, which is used to avoid joint immobility following a wide spectrum of diseases, such as end-stage degenerative disease, avascular necrosis of the femoral head or post-traumatic fractures. Conventional radiography is still the standard imaging modality for the evaluation of hip arthroplasty both directly following surgery and for periodical follow-up. In the majority of cases conventional radiography enables adequate assessment of early and late complications that can arise following hip arthroplasty, such as loosening, prosthetic or periprosthetic fracture, luxation, infection and soft tissue calcification. If the diagnosis cannot be established by means of radiography, advanced imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI), with or without injection of contrast media, may provide additional information. This is particularly true for the depiction of inflammatory processes. Regardless of the imaging modality used patients' clinical symptoms must also be taken into account in order to establish the correct diagnosis. (orig.) [de

  3. 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.

  4. 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.

  5. CT and MRI of hip arthroplasty

    International Nuclear Information System (INIS)

    Cahir, J.G.; Toms, A.P.; Marshall, T.J.; Wimhurst, J.; Nolan, J.

    2007-01-01

    Plain films are the initial imaging method of choice for evaluation of hip arthroplasty. Recent advances in technology and imaging techniques have largely overcome the problems of beam hardening in computed tomography (CT) and magnetic susceptibility artefact in magnetic resonance imaging (MRI). CT and MRI have now become useful imaging techniques in the assessment of hip arthroplasty

  6. 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.)

  7. 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.)

  8. Hip resurfacing arthroplasty and perioperative blood testing.

    Science.gov (United States)

    Cook, Andrew; Cook, Steven; Smith, Ian; Weinrauch, Patrick

    2014-01-01

    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 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.

  10. Conversion total hip arthroplasty: Primary or revision total hip arthroplasty.

    Science.gov (United States)

    Schwarzkopf, Ran; Baghoolizadeh, Mahta

    2015-11-18

    Total hip arthroplasty (THA) is an increasingly common procedure among elderly individuals. Although conversion THA is currently bundled in a diagnosis related group (DRG) with primary THA, there is a lack of literature supporting this classification and it has yet to be identified whether conversion THA better resembles primary or revision THA. This editorial analyzed the intraoperative and postoperative factors and functional outcomes following conversion THA, primary THA, and revision THA to understand whether the characteristics of conversion THA resemble one procedure or the other, or are possibly somewhere in between. The analysis revealed that conversion THA requires more resources both intraoperatively and postoperatively than primary THA. Furthermore, patients undergoing conversion THA present with poorer functional outcomes in the long run. Patients undergoing conversion THA better resemble revision THA patients than primary THA patients. As such, patients undergoing conversion THA should not be likened to patients undergoing primary THA when determining risk stratification and reimbursement rates. Conversion THA procedures should be planned accordingly with proper anticipation of the greater needs both in the operating room, and for in-patient and follow-up care. We suggest that conversion THA be reclassified in the same DRG with revision THA as opposed to primary THA as a step towards better allocation of healthcare resources for conversion hip arthroplasties.

  11. Infection after primary hip arthroplasty

    Science.gov (United States)

    2011-01-01

    Background and purpose The aim of the present study was to assess incidence of and risk factors for infection after hip arthroplasty in data from 3 national health registries. We investigated differences in risk patterns between surgical site infection (SSI) and revision due to infection after primary total hip arthroplasty (THA) and hemiarthroplasty (HA). Materials and methods This observational study was based on prospective data from 2005–2009 on primary THAs and HAs from the Norwegian Arthroplasty Register (NAR), the Norwegian Hip Fracture Register (NHFR), and the Norwegian Surveillance System for Healthcare–Associated Infections (NOIS). The Norwegian Patient Register (NPR) was used for evaluation of case reporting. Cox regression analyses were performed with revision due to infection as endpoint for data from the NAR and the NHFR, and with SSI as the endpoint for data from the NOIS. Results The 1–year incidence of SSI in the NOIS was 3.0% after THA (167/5,540) and 7.3% after HA (103/1,416). The 1–year incidence of revision due to infection was 0.7% for THAs in the NAR (182/24,512) and 1.5% for HAs in the NHFR (128/8,262). Risk factors for SSI after THA were advanced age, ASA class higher than 2, and short duration of surgery. For THA, the risk factors for revision due to infection were male sex, advanced age, ASA class higher than 1, emergency surgery, uncemented fixation, and a National Nosocomial Infection Surveillance (NNIS) risk index of 2 or more. For HAs inserted after fracture, age less than 60 and short duration of surgery were risk factors of revision due to infection. Interpretation The incidences of SSI and revision due to infection after primary hip replacements in Norway are similar to those in other countries. There may be differences in risk pattern between SSI and revision due to infection after arthroplasty. The risk patterns for revision due to infection appear to be different for HA and THA. PMID:22066562

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-07-15

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

  13. The Effectiveness of Blood Metal Ions in Identifying Patients with Unilateral Birmingham Hip Resurfacing and Corail-Pinnacle Metal-on-Metal Hip Implants at Risk of Adverse Reactions to Metal Debris.

    Science.gov (United States)

    Matharu, Gulraj S; Berryman, Fiona; Brash, Lesley; Pynsent, Paul B; Treacy, Ronan B C; Dunlop, David J

    2016-04-20

    -Pinnacle group. These thresholds had good sensitivities (88.5% for the BHR group and 80.0% for the Corail-Pinnacle group) and specificities (84.5% for the BHR group and 76.2% for the Corail-Pinnacle group), high negative predictive values (98.8% for the BHR group and 98.1% for the Corail-Pinnacle group), and low positive predictive values (34.3% for the BHR group and 20.0% for the Corail-Pinnacle group). The authority thresholds proposed by the United States (3 μg/L and 10 μg/L) and the United Kingdom (7 μg/L) missed more patients with adverse reactions to metal debris at 2.0% to 4.7% (twelve to twenty-eight patients) compared with our implant-specific thresholds at 1.2% (seven patients missed). Patients who underwent metal-on-metal hip arthroplasty performed with unilateral BHR or Corail-Pinnacle implants and who had blood metal ions below our implant-specific thresholds were at low risk of adverse reactions to metal debris. These thresholds could be used to rationalize follow-up resources in asymptomatic patients. Analysis of cobalt alone is acceptable. Implant-specific thresholds were more effective than currently recommended fixed authority thresholds for identifying patients at risk of adverse reactions to metal debris requiring further investigation. Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

  14. Fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik

    2012-01-01

    thromboembolic complications in particular (V); feasibility studies showing excellent outcomes following fast-track bilateral simultaneous total knee arthroplasty (VI) and non-septic revision knee arthroplasty (VII); how acute pain relief in total hip arthroplasty is not enhanced by the use of local infiltration......Fast-track hip and knee arthroplasty aims at giving the patients the best available treatment at all times, being a dynamic entity. Fast-track combines evidence-based, clinical features with organizational optimization including a revision of traditions resulting in a streamlined pathway from...... on clinical and organizational aspects of fast-track hip and knee arthroplasty (I–IX). A detailed description of the fast-track set-up and its components is provided. Major results include identification of patient characteristics to predict length of stay and satisfaction with different aspects...

  15. 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.

  16. Hip Resurfacing Arthroplasty and Perioperative Blood Testing

    OpenAIRE

    Cook, Andrew; Cook, Steven; Smith, Ian; Weinrauch, Patrick

    2014-01-01

    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 testin...

  17. Systemic cobalt toxicity from total hip arthroplasties: review of a rare condition Part 1 - history, mechanism, measurements, and pathophysiology.

    Science.gov (United States)

    Cheung, A C; Banerjee, S; Cherian, J J; Wong, F; Butany, J; Gilbert, C; Overgaard, C; Syed, K; Zywiel, M G; Jacobs, J J; Mont, M A

    2016-01-01

    Recently, the use of metal-on-metal articulations in total hip arthroplasty (THA) has led to an increase in adverse events owing to local soft-tissue reactions from metal ions and wear debris. While the majority of these implants perform well, it has been increasingly recognised that a small proportion of patients may develop complications secondary to systemic cobalt toxicity when these implants fail. However, distinguishing true toxicity from benign elevations in cobalt ion levels can be challenging. The purpose of this two part series is to review the use of cobalt alloys in THA and to highlight the following related topics of interest: mechanisms of cobalt ion release and their measurement, definitions of pathological cobalt ion levels, and the pathophysiology, risk factors and treatment of cobalt toxicity. Historically, these metal-on-metal arthroplasties are composed of a chromium-cobalt articulation. The release of cobalt is due to the mechanical and oxidative stresses placed on the prosthetic joint. It exerts its pathological effects through direct cellular toxicity. This manuscript will highlight the pathophysiology of cobalt toxicity in patients with metal-on-metal hip arthroplasties. Patients with new or evolving hip symptoms with a prior history of THA warrant orthopaedic surgical evaluation. Increased awareness of the range of systemic symptoms associated with cobalt toxicity, coupled with prompt orthopaedic intervention, may forestall the development of further complications. ©2016 The British Editorial Society of Bone & Joint Surgery.

  18. Total hip arthroplasty: an editiorial comment.

    Science.gov (United States)

    Peterson, L F

    1977-09-01

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

  19. Total hip arthroplasty for giant cell tumour.

    Directory of Open Access Journals (Sweden)

    Kulkarni S

    1996-07-01

    Full Text Available A 32 month follow up of an uncommon case of a Giant Cell Tumour affecting the proximal end of femur is presented. Following a wide excision, the hip was reconstructed using Charnley type of low friction total hip arthroplasty. At a 32 month review, there was no recurrence and the function was good.

  20. Reverse hybrid total hip arthroplasty

    Science.gov (United States)

    Wangen, Helge; Havelin, Leif I; Fenstad, Anne M; Hallan, Geir; Furnes, Ove; Pedersen, Alma B; Overgaard, Søren; Kärrholm, Johan; Garellick, Göran; Mäkelä, Keijo; Eskelinen, Antti; Nordsletten, Lars

    2017-01-01

    Background and purpose The use of a cemented cup together with an uncemented stem in total hip arthroplasty (THA) has become popular in Norway and Sweden during the last decade. The results of this prosthetic concept, reverse hybrid THA, have been sparsely described. The Nordic Arthroplasty Register Association (NARA) has already published 2 papers describing results of reverse hybrid THAs in different age groups. Based on data collected over 2 additional years, we wanted to perform in depth analyses of not only the reverse hybrid concept but also of the different cup/stem combinations used. Patients and methods From the NARA, we extracted data on reverse hybrid THAs from January 1, 2000 until December 31, 2013. 38,415 such hips were studied and compared with cemented THAs. The Kaplan-Meier method and Cox regression analyses were used to estimate the prosthesis survival and the relative risk of revision. The main endpoint was revision for any reason. We also performed specific analyses regarding the different reasons for revision and analyses regarding the cup/stem combinations used in more than 500 cases. Results We found a higher rate of revision for reverse hybrids than for cemented THAs, with an adjusted relative risk of revision (RR) of 1.4 (95% CI: 1.3–1.5). At 10 years, the survival rate was 94% (CI: 94–95) for cemented THAs and 92% (95% CI: 92–93) for reverse hybrids. The results for the reverse hybrid THAs were inferior to those for cemented THAs in patients aged 55 years or more (RR =1.1, CI: 1.0–1.3; p revision due to periprosthetic femoral fracture for reverse hybrids than for cemented THAs in patients aged 55 years or more (RR =3.1, CI: 2.2–4.5; p revision than cemented THAs in patients aged 55 or more. The difference in survival was mainly caused by a higher incidence of early revision due to periprosthetic femoral fracture in the reversed hybrid THAs. PMID:28095724

  1. 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.)

  2. Metal-on-metal hip resurfacing: correlation between clinical and radiological assessment, metal ions and ultrasound findings.

    Science.gov (United States)

    Scaglione, M; Fabbri, L; Bianchi, N; Dell'Omo, D; Guido, G

    2015-04-01

    We report the clinical, radiological and wear analysis of 52 consecutive MoM hip resurfacings (performed on 49 younger patients) to a mean follow-up of 9.2 years. Every patient underwent X-ray and clinical evaluation (HHS). Ultrasonography of the hip was performed in all patients in order to identify possible cystic or solid mass in periprosthetic tissue. In case of mass >20 mm, further MRI was performed to better analyse the characteristics of lesion. Five patients (five hips) had a revision. The overall survival rate was 90.38 %. The average HHS at follow-up examination was 95.5 points. No progressive radiolucent areas and no sclerosis or osteolysis around the implants were found. The US and RMI imaging showed a pseudotumour formation in two patients (correlated with high metal ion levels in blood and urine), both asymptomatic. A significant positive correlation between inclination of the acetabular component and serum metal ion levels was found (r = 0.64 and r = 0.62 for cobalt and chromium, respectively).

  3. Gemella haemolysans Infection in Total Hip Arthroplasty.

    Science.gov (United States)

    Rose, Barry; Jeer, Parminder J S; Spriggins, Anthony J

    2012-01-01

    Gemella haemolysans is a Gram-positive coccus and commensal of the upper respiratory tract and oral mucosa that rarely causes clinically important infections. There is only one previous report of this organism causing periprosthetic infection, in a total knee arthroplasty. We present a case of septic loosening of an uncemented total hip arthroplasty due to G. haemolysans, in an asplenic patient with insulin dependent diabetes mellitus. Treatment with two-stage revision has been successful at 7 years of follow-up.

  4. Early death following revision total hip arthroplasty.

    Science.gov (United States)

    Jones, Mark D; Parry, Michael; Whitehouse, Michael R; Blom, Ashley W

    2017-12-04

    The frequency of primary total hip arthroplasty procedures is increasing, with a subsequent rise in revision procedures. This study aims to describe timing and surgical mortality associated with revision total hip arthroplasty (THA) compared to those on the waiting list. All patients from a single institution who underwent revision total hip arthroplasty or were added to the waiting list for the same procedure between 2003 and 2013 were recorded. Mortality rates were calculated at 30 and 90 days following surgery or addition to the waiting list. 561 patients were available for the survivorship analysis in the surgical group. Following exclusion, 901 and 484 patients were available for the 30 and the 90-day analysis in the revision THA waiting list group.30- and 90-day mortality rates were significantly greater for the revision THA group compared to the waiting list group (excess surgical mortality at 30 days = 0.357%, p = 0.037; odds ratio of 5.22, excess surgical mortality at 90 days = 0.863%, p = 0.045). Revision total hip arthroplasty is associated with a significant excess surgical mortality rate until 90 days post-operation when compared to the waiting list population. We would encourage other authors with access to larger samples to use our method to quantify excess mortality after both primary and revision arthroplasty procedures.

  5. Effects of chronic cobalt and chromium exposure after metal-on-metal hip resurfacing: An epigenome-wide association pilot study.

    Science.gov (United States)

    Steinberg, Julia; Shah, Karan M; Gartland, Alison; Zeggini, Eleftheria; Wilkinson, Jeremy Mark

    2017-10-01

    Metal-on-metal (MOM) hip resurfacing has recently been a popular prosthesis choice for the treatment of symptomatic arthritis, but results in the release of cobalt and chromium ions into the circulation that can be associated with adverse clinical effects. The mechanism underlying these effects remains unclear. While chromosomal aneuploidy and translocations are associated with this exposure, the presence of subtle structural epigenetic modifications in patients with MOM joint replacements remains unexplored. Consequently, we analyzed whole blood DNA methylation in 34 OA patients with MOM hip resurfacing (MOM HR) compared to 34 OA patients with non-MOM total hip replacements (non-MOM THR), using the genome-wide Illumina HumanMethylation 450k BeadChip. No probes showed differential methylation significant at 5% false-discovery rate (FDR). We also tested association of probe methylation levels with blood chromium and cobalt levels directly; there were no significant associations at 5% FDR. Finally, we used the "epigenetic clock" to compare estimated to actual age at sample for all individuals. We found no significant difference between MOM HR and non-MOM THR, and no correlation of age acceleration with blood metal levels. Our results suggest the absence of large methylation differences systemically following metal exposure, however, larger sample sizes will be required to identify potential small effects. Any DNA methylation changes that may occur in the local periprosthetic tissues remain to be elucidated. © 2017 The Authors. Orthopaedic Research Society. Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 35:2323-2328, 2017. © 2017 The Authors. Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  6. 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

  7. 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.

  8. Technical note: Comparison of metal-on-metal hip simulator wear measured by gravimetric, CMM and optical profiling methods

    Science.gov (United States)

    Alberts, L. Russell; Martinez-Nogues, Vanesa; Baker Cook, Richard; Maul, Christian; Bills, Paul; Racasan, R.; Stolz, Martin; Wood, Robert J. K.

    2018-03-01

    Simulation of wear in artificial joint implants is critical for evaluating implant designs and materials. Traditional protocols employ the gravimetric method to determine the loss of material by measuring the weight of the implant components before and after various test intervals and after the completed test. However, the gravimetric method cannot identify the location, area coverage or maximum depth of the wear and it has difficulties with proportionally small weight changes in relatively heavy implants. In this study, we compare the gravimetric method with two geometric surface methods; an optical light method (RedLux) and a coordinate measuring method (CMM). We tested ten Adept hips in a simulator for 2 million cycles (MC). Gravimetric and optical methods were performed at 0.33, 0.66, 1.00, 1.33 and 2 MC. CMM measurements were done before and after the test. A high correlation was found between the gravimetric and optical methods for both heads (R 2  =  0.997) and for cups (R 2  =  0.96). Both geometric methods (optical and CMM) measured more volume loss than the gravimetric method (for the heads, p  =  0.004 (optical) and p  =  0.08 (CMM); for the cups p  =  0.01 (optical) and p  =  0.003 (CMM)). Two cups recorded negative wear at 2 MC by the gravimetric method but none did by either the optical method or by CMM. The geometric methods were prone to confounding factors such as surface deformation and the gravimetric method could be confounded by protein absorption and backside wear. Both of the geometric methods were able to show the location, area covered and depth of the wear on the bearing surfaces, and track their changes during the test run; providing significant advantages to solely using the gravimetric method.

  9. Technical pearls in total hip arthroplasty

    NARCIS (Netherlands)

    Mulier, M.; Raaijmaakers, M.; van den Bekerom, M.

    2010-01-01

    Total hip arthroplasty (THA) has had a big impact on the quality of life of millions of patients. Primary THA has a very high success rate and implant survival time of more than 30 years have been reported. However, because of the high number of procedures performed, the small percentage of patients

  10. POSTERIOR APPROACH FOR HIP ARTHROPLASTY: A SINGLE ...

    African Journals Online (AJOL)

    The most common indication was osteoarthritis. Two complications were encountered; surgical site infection and post-operative cerebrovascular accident. There were no dislocations. Conclusions: The posterior approach is a viable approach for hip arthroplasty for use in Kenya with low complication rates. INTRODUCTION.

  11. Gemella haemolysans Infection in Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Barry Rose

    2012-01-01

    Full Text Available Gemella haemolysans is a Gram-positive coccus and commensal of the upper respiratory tract and oral mucosa that rarely causes clinically important infections. There is only one previous report of this organism causing periprosthetic infection, in a total knee arthroplasty. We present a case of septic loosening of an uncemented total hip arthroplasty due to G. haemolysans, in an asplenic patient with insulin dependent diabetes mellitus. Treatment with two-stage revision has been successful at 7 years of follow-up.

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

    NARCIS (Netherlands)

    Horstmann, W.G.

    2011-01-01

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

  13. Registration in the danish hip arthroplasty registry: completeness of total hip arthroplasties and positive predictive value of registered diagnosis and postoperative complications

    DEFF Research Database (Denmark)

    Pedersen, Alma Becic; Johnsen, Søren Paaske; Overgaard, Søren

    2004-01-01

    There are few publications regarding the validity of data in hip arthroplasty registers. The Danish Hip Arthroplasty Registry (DHR) is a nationwide clinical database of THAs and revisions in Denmark.......There are few publications regarding the validity of data in hip arthroplasty registers. The Danish Hip Arthroplasty Registry (DHR) is a nationwide clinical database of THAs and revisions in Denmark....

  14. Diagnosis of infection after total hip arthroplasty

    International Nuclear Information System (INIS)

    Itasaka, Toshio; Kawai, Akira; Sato, Toru; Mitani, Shigeru; Inoue, Hajime

    2001-01-01

    Forty-eight total hip arthroplasties for which revision surgery was performed were reviewed to determine the accuracy of laboratory tests, plain radiographs, hip aspiration, and technetium-99m MDP and gallium-67 scans in demonstrating the presence or absence of infection of the prosthesis. Six of the 48 hips were diagnosed as having an infection at the revision surgery. The erythrocyte sedimentation rate and the C-reactive protein levels were significantly higher in the patients with infected prostheses. The difference in the white blood cell count was not significant. There was no significant relationship between the presence of infection and the severity of loosening and instability of the implants diagnosed by plain radiographs. The accuracy of hip aspiration in diagnosing the infection was 83%, with a sensitivity of 40% and a specificity of 92%. The accuracy of technetium-99m MDP bone scan was 79%, with a sensitivity of 83%, and a specificity of 79%. Gallium-67 scan had an accuracy of 96%, a sensitivity of 67%, and a specificity of 100%. The findings in the present study indicated that diagnostic tests consisting of laboratory tests and plain radiography, followed by hip aspiration and sequential use of technetium-99m MDP and gallium-67 scintigraphies, are suitable for differentiation between mechanical loosening and infection of total hip arthroplasty. (author)

  15. Diagnosis of infection after total hip arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Itasaka, Toshio; Kawai, Akira; Sato, Toru; Mitani, Shigeru; Inoue, Hajime [Okayama Univ. (Japan). School of Medicine

    2001-07-01

    Forty-eight total hip arthroplasties for which revision surgery was performed were reviewed to determine the accuracy of laboratory tests, plain radiographs, hip aspiration, and technetium-99m MDP and gallium-67 scans in demonstrating the presence or absence of infection of the prosthesis. Six of the 48 hips were diagnosed as having an infection at the revision surgery. The erythrocyte sedimentation rate and the C-reactive protein levels were significantly higher in the patients with infected prostheses. The difference in the white blood cell count was not significant. There was no significant relationship between the presence of infection and the severity of loosening and instability of the implants diagnosed by plain radiographs. The accuracy of hip aspiration in diagnosing the infection was 83%, with a sensitivity of 40% and a specificity of 92%. The accuracy of technetium-99m MDP bone scan was 79%, with a sensitivity of 83%, and a specificity of 79%. Gallium-67 scan had an accuracy of 96%, a sensitivity of 67%, and a specificity of 100%. The findings in the present study indicated that diagnostic tests consisting of laboratory tests and plain radiography, followed by hip aspiration and sequential use of technetium-99m MDP and gallium-67 scintigraphies, are suitable for differentiation between mechanical loosening and infection of total hip arthroplasty. (author)

  16. Coloarticular fistula: A rare complication of revision total hip arthroplasty

    OpenAIRE

    Long, Suzanne S.; Tawa, Nicholas E.; Ayres, Douglas K.; Abdeen, Ayesha; Wu, Jim S.

    2011-01-01

    Fistula formation between bowel and total hip arthroplasty or revision arthroplasty hardware is rare. We present a case of a 78-year-old woman with protrusio of left hip arthroplasty and acetabular reconstruction hardware that caused direct perforation of the sigmoid colon and fistula formation between the sigmoid colon and the left hip joint. The patient underwent several joint debridements, sigmoid colectomy, and removal of all orthopedic hardware; she ultimately died after two prolonged ho...

  17. Adverse Outcomes in Hip Arthroplasty: Long-Term Trends

    Science.gov (United States)

    Wolf, Brian R.; Lu, Xin; Li, Yue; Callaghan, John J.; Cram, Peter

    2012-01-01

    Background: Total hip arthroplasty is a common surgical procedure, but little is known about longitudinal trends in associated adverse outcomes. Our objective was to describe long-term trends in demographics, comorbidities, and adverse outcomes for older patients who underwent primary and revision total hip arthroplasty. Methods: We identified a retrospective, observational cohort of 1,405,379 Medicare beneficiaries who underwent primary total hip arthroplasty and 337,874 who underwent revision total hip arthroplasty between 1991 and 2008. The primary outcome was a composite representing the occurrence of one or more of the following adverse outcomes during the index admission or during readmission within ninety days after discharge: death, hemorrhage, infection, pulmonary embolism, sepsis, deep venous thrombosis, and myocardial infarction. Secondary outcomes included each of these outcomes assessed individually. Results: Between 1991 and 2008, the mean age and the mean comorbidity burden increased for all total hip arthroplasty patients. The length of hospital stay after primary and revision total hip arthroplasty declined by approximately 50% over the study period. However, the rate of readmission for any cause has recently increased and has surpassed 10% for primary total hip arthroplasty and 20% for revision total hip arthroplasty. The composite rate of adverse outcomes after primary total hip arthroplasty declined from 4% to 3.4% over the study period, whereas the composite adverse outcome rate after revision total hip arthroplasty slowly increased from 7% to 10.9%. We observed a steady decline in the rates of most individual adverse outcomes after primary total hip arthroplasty over the majority of the study period. Many of these rates stabilized or began to increase slightly near the end of the study period. In contrast, an increase in the rates of many adverse outcomes was observed in the revision total hip arthroplasty population even after accounting for

  18. Endotoxins in surgical instruments of hip arthroplasty

    OpenAIRE

    Goveia, Vania Regina; Mendoza, Isabel Yovana Quispe; Guimarães, Gilberto Lima; Ercole, Flavia Falci; Couto, Bráulio Roberto Gonçalves Marinho; Leite, Edna Marilea Meireles; Stoianoff, Maria Aparecida Resende; Ferreira, José Antonio Guimarães

    2016-01-01

    Abstract OBJECTIVE To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. METHOD A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60...

  19. Total Hip Arthroplasty in Mucopolysaccharidosis Type IH

    Directory of Open Access Journals (Sweden)

    S. O'hEireamhoin

    2011-01-01

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

  20. [Sport activity after hip and knee arthroplasty].

    Science.gov (United States)

    Keren, Amit; Berkovich, Yaron; Berkovitch, Yaron; Soudry, Michael

    2013-11-01

    Joint arthroplasty is one of the commonest surgical procedures in orthopedic surgery. In recent years there was an increase in the number of procedures, patient satisfaction and implant survival. Originally, these operations were designed for old patients in order to relieve pain and to enable ambulation. Over the past few years, these operations have become common in younger patients which desire to return to activity, including sports activities. The importance of physical activity is a well known fact. In recent years it became clear that with the proper physical activity the outcomes of the operations are better. There are several types of arthroplasty. Many factors influence the outcome of the operation apart from the post-surgery physical activity. These factors include patient factors, surgical technique and type of arthroplasty. This review summarizes the recommendations for sports activities after hip and knee arthroplasties. These activities are evaluated according to surgeons' recommendations, stress applied on the implant and long term outcomes. The recommended sports activities after joint arthroplasties are walking, swimming and cycling. Soccer, basketball and jogging are not advised. Tennis, downhill skiing and horse riding are recommended with previous experience. There are many more sports activities that patients can participate in, and it is important that the patient discuss the different options prior to the operation. Since these operations are so common, many non-orthopedic physicians encounter these patients in their practice. They should be acquainted with the recommendations for sports activities and encourage them.

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

    Science.gov (United States)

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

    2015-06-01

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

  2. Reverse hybrid total hip arthroplasty

    DEFF Research Database (Denmark)

    Wangen, Helge; Havelin, Leif I.; Fenstad, Anne M

    2017-01-01

    . Patients and methods - From the NARA, we extracted data on reverse hybrid THAs from January 1, 2000 until December 31, 2013. 38,415 such hips were studied and compared with cemented THAs. The Kaplan-Meier method and Cox regression analyses were used to estimate the prosthesis survival and the relative risk...

  3. Metal-on-metal bearings a clinical practicum

    CERN Document Server

    Jones, Lynne C; Greenwald, A Seth

    2014-01-01

    This book addresses the background and significance of factors potentially influencing clinical and biological outcomes of metal-on-metal hip implants. Includes discussion of reported complications including pseudotumors and other lymphocytic-based responses.

  4. Total hip arthroplasty: a still evolving technique

    Directory of Open Access Journals (Sweden)

    Carlos Roberto Galia

    Full Text Available ABSTRACT It has been advocated that total hip arthroplasty (THA is probably the most successful surgical intervention performed in Medicine. In the 1960s, Sir John Charnley not only introduced, but also modified and improved the technique of cemented arthroplasties. The concepts on biological , fixation established by Pillar and Galante served as the foundation for the development of uncemented implants that are now used worldwide. Currently, THA is a worldwide widespread surgery performed on millions of people. However, keeping abreast of the large number of information available on these procedures, especially on implant fixation, designs, different tribological pairings, and the long-term results can be challenging at times. This article is a brief update on the main aspects of THA.

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

    Directory of Open Access Journals (Sweden)

    Simon J. M. Parker

    2015-01-01

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

  6. Systemic cobalt toxicity from total hip arthroplasties: review of a rare condition Part 2. measurement, risk factors, and step-wise approach to treatment.

    Science.gov (United States)

    Zywiel, M G; Cherian, J J; Banerjee, S; Cheung, A C; Wong, F; Butany, J; Gilbert, C; Overgaard, C; Syed, K; Jacobs, J J; Mont, M A

    2016-01-01

    As adverse events related to metal on metal hip arthroplasty have been better understood, there has been increased interest in toxicity related to the high circulating levels of cobalt ions. However, distinguishing true toxicity from benign elevations in cobalt levels can be challenging. The purpose of this review is to examine the use of cobalt alloys in total hip arthroplasty, to review the methods of measuring circulating cobalt levels, to define a level of cobalt which is considered pathological and to review the pathophysiology, risk factors and treatment of cobalt toxicity. To the best of our knowledge, there are 18 published cases where cobalt metal ion toxicity has been attributed to the use of cobalt-chromium alloys in hip arthroplasty. Of these cases, the great majority reported systemic toxic reactions at serum cobalt levels more than 100 μg/L. This review highlights some of the clinical features of cobalt toxicity, with the goal that early awareness may decrease the risk factors for the development of cobalt toxicity and/or reduce its severity. Severe adverse events can arise from the release of cobalt from metal-on-metal arthroplasties, and as such, orthopaedic surgeons should not only be aware of the presenting problems, but also have the knowledge to treat appropriately. ©2016 The British Editorial Society of Bone & Joint Surgery.

  7. Modular taper junction corrosion and failure: how to approach a recalled total hip arthroplasty implant.

    Science.gov (United States)

    Pivec, Robert; Meneghini, R Michael; Hozack, William J; Westrich, Geoffrey H; Mont, Michael A

    2014-01-01

    Corrosion at the modular neck-stem taper junction has become an increasingly important topic as several reports have identified this couple as a possible source for early failure with findings similar to failed metal-on-metal hip arthroplasties. Recently, two different modular stem systems from a single manufacturer were voluntarily recalled due to concerns of failure of the modular taper junction. We discuss how to approach the diagnosis and management of patients with these particular stem systems. We further reviewed the literature to evaluate whether this is a manufacturer-specific defect or indicative of a broader trend. Recent studies appear to implicate the basic design of the neck-stem taper junction, rather than a single manufacturer, which is at high risk for fretting and corrosion. © 2013.

  8. 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.

  9. [Sir John Charnley and total hip arthroplasty].

    Science.gov (United States)

    Burgers, Paul T P W; van Gijn, Jan

    2011-01-01

    Sir John Charnley (1911-1982), pioneer of the total hip prosthesis, saved countless elderly people from immobility. During the Second World War he assisted Dudley Buxton, orthopaedic surgeon to the British armed forces in the Middle East, in developing new instruments and splints. After the war he first studied healing of bone fractures and the role of compression, and then completely dedicated himself to arthroplasty of the hip. Through countless experiments he found the optimal diameter for the head of the stainless steel prosthesis as well as the optimal polymer for the socket; he also advocated tight cementing of the shaft into the femur. Sir John Charnley received the Lasker Award in 1974 and was knighted in 1977.

  10. 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.

  11. Hip arthroplasty in failed intertrochanteric fractures in elderly

    Directory of Open Access Journals (Sweden)

    Javahir A Pachore

    2013-01-01

    Full Text Available Background: Failed intertrochanteric fractures in elderly patients are surgical challenge with limited options. Hip arthroplasty is a good salvage procedure even though it involves technical issues such as implant removal, bone loss, poor bone quality, trochanteric nonunion and difficulty of surgical exposure. Materials and Methods: 30 patients of failed intertrochanteric fractures where hip arthroplasty was done between May 2008 and December 2011 were included in study. 13 were males and 17 were females with average age of 67.3 years. There were 2 cemented bipolar arthroplasties, 19 uncemented bipolar, 4 cemented total hip arthroplasty and 5 uncemented total hip arthroplasties. 16 patients had a trochanteric nonunion, which was treated by tension band principles. Total hip was considered where there was acetabular damage due to the penetration of implant. Results: The average followup was 20 months (range 6-48 months. Patients were followed up from 6 to 48 months with average followup of 20 months. None of the patients were lost to followup. There was no dislocation. All patients were ambulatory at the final followup. Conclusion: A predictable functional outcome can be achieved by hip arthroplasty in elderly patients with failed intertrochanteric fractures. Though technically demanding, properly performed hip arthroplasty can be a good salvage option for this patient group.

  12. Total hip arthroplasty for surgical management of advanced tuberculous hip arthritis: Case report

    OpenAIRE

    Tan, Shi Ming; Chin, Pak Lin

    2015-01-01

    Tuberculosis (TB) arthritis of the hip is a debilitating disease that often results in severe cartilage destruction and degeneration of the hip. In advanced cases, arthrodesis of the hip confers benefits to the young, high-demand and active patient. However, many of these patients go on to develop degenerative arthritis of the spine, ipsilateral knee and contralateral hip, necessitating the need for a conversion to total hip arthroplasty. Conversion of a previously fused hip to a total hip ar...

  13. Minimally invasive total hip arthroplasty: in opposition.

    Science.gov (United States)

    Hungerford, David S

    2004-06-01

    At the Knee Society Winter Meeting in 2003, Seth Greenwald and I debated about whether there should be new standards (ie, regulations) applied to the release of information to the public on "new developments." I argued for the public's "right to know" prior to the publication of peer-reviewed literature. He argued for regulatory constraint or "proving by peer-reviewed publication" before alerting the public. It is not a contradiction for me to currently argue against the public advertising of minimally invasive (MIS) total hip arthroplasty as not yet being in the best interest of the public. It is hard to remember a concept that has so captured both the public's and the surgical community's fancy as MIS. Patients are "demanding" MIS without knowing why. Surgeons are offering it as the next best, greatest thing without having developed the skill and experience to avoid the surgery's risks. If you put "minimally invasive hip replacement" into the Google search engine (http://www.google.com), you get 5,170 matches. If you put the same words in PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi), referencing the National Library of Medicine database, you get SEVENTEEN; none is really a peer-reviewed article. Most are 1 page papers in orthopedics from medical education meetings. On the other hand, there are over 6,000 peer-reviewed articles on total hip arthroplasty. Dr. Thomas Sculco, my couterpart in this debate, wrote an insightful editorial in the American Journal of Orthopedic Surgery in which he stated: "Although these procedures have generated incredible interest and enthusiasm, I am concerned that they may be performed to the detriment of our patients." I couldn't agree with him more. Smaller is not necessarily better and, when it is worse, it will be the "smaller" that is held accountable.

  14. Two-Stage Cementless Revision Total Hip Arthroplasty for Infected Primary Hip Arthroplasties.

    Science.gov (United States)

    Camurcu, Yalkin; Sofu, Hakan; Buyuk, Abdul Fettah; Gursu, Sarper; Kaygusuz, Mehmet Akif; Sahin, Vedat

    2015-09-01

    The main purpose of the present study was to analyze the clinical features, the most common infective agents, and the results of two-stage total hip revision using a teicoplanin-impregnated spacer. Between January 2005 and July 2011, 41 patients were included. At the clinical status analysis, physical examination was performed, Harris hip score was noted, isolated microorganisms were recorded, and the radiographic evaluation was performed. The mean Harris hip score was improved from 38.9 ± 9.6 points to 81.8 ± 5.8 points (Phips. Radiographic evidence of stability was noted in 37 acetabular revision components, and all femoral stems. Two-stage revision of the infected primary hip arthroplasty is a time-consuming but a reliable procedure with high rates of success. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    International Nuclear Information System (INIS)

    Oliveira, Adriana L.; Azevedo, Debora C.; Eajazi, Alireza; Palmer, William E.; Bredella, Miriam A.; Kwon, Young-Min; Torriani, Martin

    2015-01-01

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-12-15

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

  17. Fatal cobalt toxicity after total hip arthroplasty revision for fractured ceramic components.

    Science.gov (United States)

    Fox, Kimberly A; Phillips, Todd M; Yanta, Joseph H; Abesamis, Michael G

    2016-11-01

    Post-arthroplasty metallosis, which refers to metallic corrosion and deposition of metallic debris in the periprosthetic soft tissues of the body, is an uncommon complication. Systemic cobalt toxicity post-arthroplasty is extremely rare. The few known fatal cases of cobalt toxicity appear to be a result of replacing shattered ceramic heads with metal-on-metal or metal-on-polyethylene implants. Friction between residual shards of ceramic and cobalt-chromium implants allows release of cobalt into the synovial fluid and bloodstream, resulting in elevated whole blood cobalt levels and potential toxicity. This is a single patient chart review of a 60-year-old woman with prior ceramic-on-ceramic right total hip arthroplasty complicated by fractured ceramic components and metallosis of the joint. She underwent synovectomy and revision to a metal-on-polyethylene articulation. Ten months post-revision, she presented to the emergency department (ED) with right hip pain, dyspnea, worsening hearing loss, metallic dysgeusia, and weight loss. Chest CTA revealed bilateral pulmonary emboli (PE), and echocardiogram revealed new cardiomyopathy with global left ventricular hypokinesis with an ejection fraction (EF) of 35-40% inconsistent with heart strain from PE. Whole blood cobalt level obtained two days into her admission was 424.3 mcg/L and 24-h urine cobalt level was 4830.5 mcg/L. Although the patient initially clinically improved with regard to her PE and was discharged to home on hospital day 5, she returned 10 days later with a right hip dislocation and underwent closed reduction of the hip. The patient subsequently decompensated, developing cardiogenic shock, and respiratory failure. She went into pulseless electrical activity (PEA) and expired. Autopsy revealed an extensive metallic effusion surrounding the right hip prosthesis that tested positive for cobalt (41,000 mcg/L). There was also cobalt in the heart muscle tissue (2.5 mcg/g). A whole blood cobalt level

  18. Trunnionosis in total hip arthroplasty: a review.

    Science.gov (United States)

    Mistry, Jaydev B; Chughtai, Morad; Elmallah, Randa K; Diedrich, Aloise; Le, Sidney; Thomas, Melbin; Mont, Michael A

    2016-03-01

    Trunnionosis is defined as wear of the femoral head-neck interface and has recently been acknowledged as a growing cause of total hip arthroplasty failure. Some studies have reported that it accounts for up to 3 % of all revisions. The exact cause of trunnionosis is currently unknown; however, postulated etiologies include modular junction wear, corrosion damage, and metal ion release. Additionally, implant design and trunnion geometries may contribute to the progression of component failure. In order to aid in our understanding of this phenomenon, our aim was to present the current literature on (1) the effect of femoral head size on trunnionosis, (2) the effect of trunnion design on trunnionosis, (3) localized biological reactions associated with trunnionosis, and (4) gross trunnion failures. It is hoped that this will encourage further research and interest aimed at minimizing this complication.

  19. Endotoxins in surgical instruments of hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Vania Regina Goveia

    2016-06-01

    Full Text Available Abstract OBJECTIVE To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. METHOD A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60 surgical instruments, which were tested for endotoxins in three different stages. The EndosafeTM Gel-Clot LAL (Limulus Amebocyte Lysate method was used. RESULT There was consistent gel formation with positive analysis in eight instruments, corresponding to 13.3%, being four femoral rasps and four bone reamers. CONCLUSION Endotoxins in quantity ≥0.125 UE/mL were detected in 13.3% of the instruments tested.

  20. Postoperative pain treatment after total hip arthroplasty

    DEFF Research Database (Denmark)

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

    2015-01-01

    Treatment of postoperative pain should rely on results from randomized controlled trials and meta-analyses of high scientific quality. The efficacy of a particular intervention may depend on the type of surgical procedure, which supports the reporting of "procedure-specific" interventions. The aim...... of this systematic review was to document the procedure-specific evidence for analgesic interventions after total hip arthroplasty (THA). This PRISMA-compliant and PROSPERO-registered review includes randomized placebo-controlled trials (RCTs) of medication-based analgesic interventions after THA. Endpoints were......, and lumbar plexus block reduced nausea and pruritus. The GRADE-rated quality of evidence ranged from low to very low throughout the analyses. This review demonstrated, that some analgesic interventions may have the capacity to reduce mean opioid requirements and/or mean pain intensity compared with controls...

  1. Total hip arthroplasty at the rothman institute.

    Science.gov (United States)

    Austin, Matthew S; Higuera, Carlos A; Rothman, Richard H

    2012-07-01

    Total hip arthroplasty (THA) is one of the most successful surgical interventions devised in modern times. Attempts to change the current THA procedure with unproven innovations bring the risk of increased failure rates while trying to improve the benefit of the surgery. This manuscript examines the evolution of THA at the Rothman Institute illustrating the key elements that lead the success of this procedure at this institution. These key elements include femoral stem design, use of highly crossed-linked polyethylene and use of pain and rehabilitation protocols. We attempted to describe the long-term results regarding safety, effectiveness, and durability of specific THA implant designs used at this institution drawing on reported evidence in the literature. The authors performed a review of peer-reviewed articles related to the Rothman Institute's experience with THA. Total hip arthroplasty is an efficient, safe, and durable procedure. It is a highly successful operation to restore function and improve pain. The survivorship of THA procedures at the Rothman Institute is higher than 99% at 10 years based on mechanical failure. The use of collarless, tapered wedge femoral stem, highly crossed-linked polyethylene, and improved pain rehabilitation protocols have contributed to this success. There is a well-documented long-term survivorship after THA. Future innovation in THA should address new challenges with younger and more demanding patients, rather than change current methods that have a proven good survivorship. This innovation depends mainly upon improvements in the bearing surfaces and advances in pain control and rehabilitation.

  2. Revision for prosthetic joint infection following hip arthroplasty

    Science.gov (United States)

    Lenguerrand, E.; Whitehouse, M. R.; Beswick, A. D.; Jones, S. A.; Porter, M. L.

    2017-01-01

    Objectives We used the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) to investigate the risk of revision due to prosthetic joint infection (PJI) for patients undergoing primary and revision hip arthroplasty, the changes in risk over time, and the overall burden created by PJI. Methods We analysed revision total hip arthroplasties (THAs) performed due to a diagnosis of PJI and the linked index procedures recorded in the NJR between 2003 and 2014. The cohort analysed consisted of 623 253 index primary hip arthroplasties, 63 222 index revision hip arthroplasties and 7585 revision THAs performed due to a diagnosis of PJI. The prevalence, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression. Results We demonstrated a prevalence of revision THA due to prosthetic joint infection of 0.4/100 procedures following primary and 1.6/100 procedures following revision hip arthroplasty. The prevalence of revision due to PJI in the three months following primary hip arthroplasty has risen 2.3-fold (95% confidence interval (CI) 1.3 to 4.1) between 2005 and 2013, and 3.0-fold (95% CI 1.1 to 8.5) following revision hip arthroplasty. Over 1000 procedures are performed annually as a consequence of hip PJI, an increase of 2.6-fold between 2005 and 2013. Conclusions Although the risk of revision due to PJI following hip arthroplasty is low, it is rising and, coupled with the established and further predicted increased incidence of both primary and revision hip arthroplasty, this represents a growing and substantial treatment burden. Cite this article: E. Lenguerrand, M. R. Whitehouse, A. D. Beswick, S. A. Jones, M. L. Porter, A. W. Blom. Revision for prosthetic joint infection following hip arthroplasty: Evidence from the National Joint Registry. Bone Joint Res 2017;6:391–398. DOI: 10.1302/2046-3758.66.BJR-2017-0003.R1. PMID:28642256

  3. Arthroscopic bursectomy for recalcitrant trochanteric bursitis after hip arthroplasty.

    Science.gov (United States)

    Van Hofwegen, Christopher; Baker, Champ L; Savory, Carlton G; Baker, Champ L

    2013-01-01

    This study evaluated the use of arthroscopic bursectomy for pain relief in patients with trochanteric bursitis after hip arthroplasty. In this retrospective case series of 12 patients undergoing arthroscopic treatment of recalcitrant trochanteric bursitis after hip arthroplasty, outcomes were assessed via phone interview with a numeric pain rating scale from 1 to 10 and were compared with preoperative pain ratings. Patients were asked the percentage of time they had painless hip function and whether they would have the surgery again. At an average 36-month follow-up (range, 4-85 months), the average numeric pain scale rating improved from 9.3 to 3.3. At an average of 62% of the time, patients had painless use of the hip. Ten of 12 patients in the study felt the pain relief gained was substantial enough to warrant having procedure again. In these patients, arthroscopic bursectomy was a viable option for patients with recalcitrant bursitis after hip arthroplasty.

  4. Sports Activity Following Cementless Metaphyseal Hip Joint Arthroplasty.

    Science.gov (United States)

    Czech, Szymon; Hermanson, Jacek; Rodak, Piotr; Stołtny, Tomasz; Rodak, Łukasz; Kasperczyk, Sławomir; Koczy, Bogdan; Mielnik, Michał

    2017-12-01

    An adequate level of physical activity has a substantial effect on both mental and physical human health. Physical activity is largely dependent on the function of the musculoskeletal and articular system. One of the most frequent diseases of this system is degenerative joint disease. Due to the changing and more demanding lifestyles and patients' willingness to be involved in sports activity, the expectations of hip joint arthroplasty are becoming increasingly high. Alleviating pain ceases to be the only reason for which patients choose surgical interventions, while the expectations often include involvement in various sports. Only few studies contain recommendations concerning the frequency, type and intensity of sports activity which are acceptable after hip joint arthroplasty. The aim of the study was to evaluate function and physical activity of people following cementless short-stem hip joint arthroplasty in the observation of at least five years. The study group comprised 106 patients who underwent total hip arthroplasty due to degenerative joint diseases, chosen according to inclusion criteria. Patients underwent routine physical examinations following the Harris Hip Score protocol, responded to the UCLA scale and questionnaires concerning pre-surgical and current physical activity. Our results demonstrated that hip joint arthroplasty in people suffering from degenerative joint diseases has a beneficial effect on their level of functioning and physical activity. Although physical activity and the level of functioning obviously reduced as a person aged, the level of physical activity continued to be very high in both groups, with function of the hip joint evaluated as very good.

  5. [PROGNOSIS OF DEEP INFECTIOUS COMPLICATIONS IN HIP ARTHROPLASTY].

    Science.gov (United States)

    Dorofeev, Yu L; Ptashnikov, D A; Tkachenko, A N; Bakhtin, M Yu; Kalimullina, A F

    2015-01-01

    The retrospective research analyzed the data of 893 patients undergoing total hip arthroplasty. There were used the data about patients undergoing hip arthroplasty without complications (the first group--808 cases) and patients with developed deep surgical site infection following total joint arthroplasty after 12 months (the second group--85 patients). It was applied as the training matrix in creation of mathematical prognosis and algorithm of prophylaxis of deep infection in patients undergoing the primary total hip arthroplasty. There were revealed 21 prognostic significant criteria of deep infection development in surgical site. The program was tested in prospective investigation (293 clinical cases) with follow-up term of 12 months after operation. The rate of development of postoperative deep infection in surgical wound reduced as compared with the rate in group of retrospective research from 1.7% to 0.7%. The efficacy of proposed program was 80%.

  6. CUSTOMIZED ACETABULAR COMPONENTS IN REVISION HIP ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    G. M. Kavalersky

    2016-01-01

    Full Text Available In recent years, there is a trend of increasing demand for revision hip arthroplasty. Among these patients there are many with complex acetabular defects, including patients with pelvic discontinuity. To ensure stability for revised acetabular components in such cases becomes a challenging or unachievable task. Such defects give indications for printing customized tri-flange acetabular component. The authors analysed own experience of creating and applying custom made acetabular components in 3 patients with complex acetabular defects. Material and methods. Among the patients there were 2 women and 1 man. Average age was 60,3±19,4 years (38 to 78 years. Two patients had III B defects with pelvic discontinuity and one patient had III A defect by Paprosky classification. As the first step, the authors in collaboration with engineers printed a plaster full size pelvic 3D model, as the second step a customized tri-flange acetabular component was designed and printed. Harris Hip Score was evaluated preoperatively and 3 months postoperatively. Results. Average follow-up period was 5,3±2,5 months (3 to 8 months. The authors observed no cases of implant loosening, dislocation or deep periprosthetic infection. Average Harris Hip Score before surgery was 27,13 and after surgery – 74,1 indicating a significant improvement in 3 months postoperatively. Conclusion. Indications for use of individual acetabular components in reported patients correspond to indications formulated by Berasi et al. The authors obtained encouraging early follow-up outcomes that correspond to data of other authors. In one patient certain difficulties were reported due to insufficient pelvic distraction. Component’s flanges prevented achieving adequate pelvic distraction. Nevertheless, good primary stability was achieved. Modern software and 3D metal printers can significantly reduce the production cost of customized acetabular components. Application of this technology can be

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

    African Journals Online (AJOL)

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

  8. bladder injury during infected total hip arthroplasty prosthesis

    African Journals Online (AJOL)

    Severe intrapelvic protrusions after total hip arthroplasty may occur in cases of chronic infection. During hip surgery, the components threating the neighboring organs were most often cement and screws than the cup itself. As expected, infection is another problem related to all implant surgeries. Bach et al (8) suggested that.

  9. Local and systemic toxicity of nanoscale debris particles in total hip arthroplasty.

    Science.gov (United States)

    Polyzois, Ioannis; Nikolopoulos, Dimitrios; Michos, Ioannis; Patsouris, Efstratios; Theocharis, Stamatios

    2012-04-01

    Over the past 30 years joint replacement prostheses have been developed and refined to enhance durability and reproducibility. Total hip joint arthroplasty is being performed in an increasing number of younger patients; therefore orthopaedic surgeons seek implants with a longer life span. With regards to the progress of mechanical behaviour of the biomaterials used in an arthroplasty, little is known about the long-term biological effects of wear debris. Owing to the composition of the prostheses currently in use, systemic exposure to chromium (Cr), cobalt (Co), nickel (Ni) and aluminium (Al) alloys occurs as a result of the formation of metal wear nano-particles that are released both from metal-on-metal and polyethylene-on-metal bearings, resulting in a postoperative increase in metal ion levels at different organ sites. These particles circulate both locally and systemically, penetrate cell plasma membranes, bind to cellular proteins and enzymes and modulate cytokine expression. Their physiologic effects are poorly understood and their potential toxicity, hypersensitivity and carcinogenicity remain a cause for concern. In this article we will address the issue of whether these nanoscale degradation products are associated with adverse, clinically significant local or systemic toxicologic sequelae. Copyright © 2012 John Wiley & Sons, Ltd.

  10. Computer assisted navigation in total knee and hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Deep Kamal

    2017-01-01

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

  11. 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

  12. Surgical approaches for total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Vincent M Moretti

    2017-01-01

    Full Text Available Total hip arthroplasty (THA has become one of the most reliable and patient-requested surgical interventions in all medicine. The procedure can be performed using a variety of surgical approaches, but the posterior approach, direct lateral approach, and direct anterior approach are by far the most common across the globe. This article highlights the history and technique for each of these common approaches. A review of outcomes and complications for each approach are also provided. Each approach has its own unique advantages and disadvantages, but all can be safely and successful utilized for THA. Strong, convincing, high-quality studies comparing the different approaches are lacking at this time. Surgeons are therefore recommended to choose whichever approach they are most comfortable and experienced using. Though not described here, THA can also be done using the anterolateral approach (also known as the Watson Jones approach as well as the two-incision approach. In addition, recently, some surgeons are utilizing the so-called direct superior approach for THA. While these approaches are far less commonly utilized, they are recognized as viable alternatives to traditional approaches.

  13. Tribology of total hip arthroplasty prostheses

    OpenAIRE

    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 t...

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

    Directory of Open Access Journals (Sweden)

    Vladimir E. Baskov

    2017-03-01

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

  15. 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

  16. Are Females at Greater Risk for Revision Surgery After Hip Resurfacing Arthroplasty With the Articular Surface Replacement Prosthesis?

    Science.gov (United States)

    Donahue, Gabrielle S; Lindgren, Viktor; Galea, Vincent P; Madanat, Rami; Muratoglu, Orhun; Malchau, Henrik

    2016-10-01

    associated with implant survival, using any revision as the end point, and presence of adverse local tissue reaction. In patients who had unilateral surgery, the only variable found to be associated with revision surgery was HHS (hazard ratio [HR], 0.96; 95% CI, 0.94-0.97; p hip resurfacing arthroplasty with implantation of the ASR(TM) prosthesis should be followed with equal vigilance as both are at similar risk of revision surgery and adverse local tissue reaction. Metal ion levels and HHS should be obtained at followup to monitor for risk of revision and as a screening tool for MRI. Further research is necessary to evaluate if these relationships persist in patients with other metal-on-metal prostheses. Level II, therapeutic study.

  17. Readmissions after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Kristian Stahl; Kristensen, Billy B

    2010-01-01

    With the implementation of fast-track surgery with optimization of both logistical and clinical features, the postoperative convalescence has been reduced as functional milestones have been achieved earlier and consequently length of stay (LOS) in hospital has been reduced. However, it has been s...... speculated that a decrease in LOS may be associated with an increase in readmissions in general, including risk of dislocation after total hip arthroplasty (THA) or manipulation after total knee arthroplasty (TKA)....

  18. Transfusion practice in hip arthroplasty - a nationwide study

    DEFF Research Database (Denmark)

    Jans, Øivind; Kehlet, H; Hussain, Zubair Butt

    2011-01-01

    ) in Denmark. Materials and Methods We performed a retrospective cohort study of all patients undergoing THA or RTHA in Denmark in 2008. Primary outcomes were intercentre variation in red blood cell (RBC) transfusion rates and the timing of transfusion related to surgery. Results Six thousand nine hundred......Background and Objectives The optimal transfusion strategy in hip arthroplasty remains controversial despite existing guidelines. The aim of this study was to evaluate the transfusion practice in patients undergoing primary total hip arthroplasty (THA) or revision total hip arthroplasty (RTHA...... thirty-two THA patients and 1132 RTHA patients were included for analysis of which 1674 (24%) THA and 689 (61%) RTHA patients received RBC transfusion. Of these, 47% of THA and 73% of RTHA patients received transfusion on the day of surgery. Transfusion rates between centres varied from 7 to 71...

  19. History and factors of survival of total hip arthroplasty.

    Science.gov (United States)

    Kolundžić, Robert; Trkulja, Vladimir; Orlić, Dubravko

    2012-02-01

    Since the 1960s total hip arthroplasty (THA) has represented one of the greatest accomplishments in orthopedic surgery. It improves the functionality, working ability and quality of life of patients with non-functional hip joint due to various reasons. This article reviews general and regional history of THA, current knowledge and concepts regarding the long-term outcomes of the procedure and emphasizes the need for establishing national (and international) THA registries as an essential way of gathering data critical for decision making in daily practice as well as in defining national healthcare policies in respect to arthroplasty procedures.

  20. Gait during hydrokinesitherapy following total hip arthroplasty.

    Science.gov (United States)

    Giaquinto, Salvatore; Ciotola, Elena; Margutti, Ferdinando; Valentini, Fabio

    2007-05-15

    To obtain gait parameters during hydrotherapy (HT) in patients who were referred for rehabilitation after total hip arthroprostheses. The study had a cohort prospective design. Patients who underwent primary total hip arthroplasty (THA) followed a HT rehabilitation program. Twenty-one consecutive patients were enrolled. Five of them dropped out for various reasons, independently of HT. Therefore 16 patients could be evaluated (5 men and 11 women). Sixteen age-matched healthy volunteers were the control subjects. Nine patients had a right THA and 7 a left THA. On average HT duration was 15.7 days (SD 3.8). The patients presented with a mean speed of 749 meters per hour (SD 146) at the baseline. At the last session the mean speed was 1175 meters per hour (SD 396). The mean stance duration was 1.59 s (SD 0.28) on the operated side and 1.67 (SD 0.27) on the non-operated side. By contrast, the mean swing duration was 1.02 s (SD 0.20) on the operated side and 0.95 s (SD 0.16) on the non-operated side. The differences in balance were statistically significant. The step duration was the same on both sides. At the beginning of HT the stance/swing ratio was 1.62 (SD 0.40) on the operated side, whereas it was 1.74 (SD 0.42) on the non-operated side. In the controls the ratio was 1.45. During HT both values fluctuated but the trend was toward a better coherence over time. At the beginning the mean stride length was 0.484 meters (SD 0.116) and the value became 0.628 (SD 0.131) after 15 training sessions. At the individual level, recovery occurred in a non-linear fashion, but the mean regression line had a coefficient of 27.1 and the intercept was at 560.3. The study design permits accurate definition of stride parameters during rehabilitation which allows optimization of the programme. Increase in speed and regain of balance are monitored on a daily basis and they appear as the targets of a HT programme.

  1. Cemented total hip arthroplasty following acetabular fracture.

    Science.gov (United States)

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

    2017-10-01

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

  2. Sports Activity Following Cementless Metaphyseal Hip Joint Arthroplasty

    Directory of Open Access Journals (Sweden)

    Czech Szymon

    2017-12-01

    Full Text Available An adequate level of physical activity has a substantial effect on both mental and physical human health. Physical activity is largely dependent on the function of the musculoskeletal and articular system. One of the most frequent diseases of this system is degenerative joint disease. Due to the changing and more demanding lifestyles and patients’ willingness to be involved in sports activity, the expectations of hip joint arthroplasty are becoming increasingly high. Alleviating pain ceases to be the only reason for which patients choose surgical interventions, while the expectations often include involvement in various sports. Only few studies contain recommendations concerning the frequency, type and intensity of sports activity which are acceptable after hip joint arthroplasty. The aim of the study was to evaluate function and physical activity of people following cementless short-stem hip joint arthroplasty in the observation of at least five years. The study group comprised 106 patients who underwent total hip arthroplasty due to degenerative joint diseases, chosen according to inclusion criteria. Patients underwent routine physical examinations following the Harris Hip Score protocol, responded to the UCLA scale and questionnaires concerning pre-surgical and current physical activity. Our results demonstrated that hip joint arthroplasty in people suffering from degenerative joint diseases has a beneficial effect on their level of functioning and physical activity. Although physical activity and the level of functioning obviously reduced as a person aged, the level of physical activity continued to be very high in both groups, with function of the hip joint evaluated as very good.

  3. Medium-term results of hip arthroplasty with ASR XL (DePuy

    Directory of Open Access Journals (Sweden)

    V. V. Danilyak

    2015-01-01

    Full Text Available The purpose - to identify factors affect on instability and to access the medium-term survivorship of metal-on-metal X-large heads total hip prostheses. Material and methods. From January 2007 March 2009 we performed 134 ASR XL head - Corail total hip arthroplasties in 119 patients. The medium-term results were studied in 94 (105 hips. Mean follow-up was 76±3 months. Radiological evaluation was carried out in standard views. Clinical and functional results were accessed with Harris Hip Score. We determined metal ions concentration in whole blood with atomic absorption spectrometry (AAS and mass spectrometry in the induced coupled plasma (ICP-MS. Changes in periprosthetic tissues were studied at high field magnetic resonance imaging (MRI with subsequent histological confirmation. “Gamma test” was applied for statistic analysis revision risk factors. Results. Medium-term survivorship of studied implants amounted to 85.5% (95% CI 78.7% to 92.3%. Average ions concentration in the whole blood of amounted to 3.2 ppb and 2.9 ppb foe Co and Cr respectively Specific risk factors of instability were gender (female, small size of the cups, and high angle of abduction (>45°. The main reason for revision was cup loosening (over 50%. Conclusions. Patients in this cohort are in a great danger of early aseptic loosening, especially in the presence of specific risk factors. So the annual monitoring is considered mandatory for them. The indications for revision surgery are not only the evident implant instability, but also the pathological changes in periprosthetic tissues associated with high ions level in whole blood.

  4. Revision rate of Birmingham Hip Resurfacing arthroplasty: comparison of published literature and arthroplasty register data.

    Science.gov (United States)

    Schuh, Reinhard; Neumann, Daniel; Rauf, Rauend; Hofstaetter, Jochen; Boehler, Nikolaus; Labek, Gerold

    2012-07-01

    Hip resurfacing arthroplasty has gained popularity for treating young and active patients who have arthritis. There are two major data sources for assessing outcome and revision rate after total joint arthroplasty: sample-based clinical trials and national arthroplasty registers. The purpose of this study was to evaluate the outcome of the Birmingham Hip Resurfacing (BHR) arthroplasty in terms of revision rate as reported in clinical studies and recorded by national arthroplasty registers. A comprehensive literature research was performed from English-language, peer-reviewed journals and annual reports from national joint arthroplasty registers worldwide. Only publications from MEDLINE-listed journals were included. The revision rate was used as the primary outcome parameter. In order to allow for direct comparison of different data sets, calculation was based on revisions per 100 observed component years. For statistical analysis, confidence intervals (CI) were calculated. A total of 18,708 implants, equivalent to 106,565 observed component years, were analysed in the follow-up studies. The register reports contained 9,806 primary cases corresponding to 44,294 observed component years. Statistical analysis revealed a significant difference in revisions per 100 observed component years between the development team (0.27; CI: 0.14-0.40) and register data (0.74; CI: 0.72-0.76). The BHR arthroplasty device shows good results in terms of revision rate in register data as well as in clinical studies. However, the excellent results reported by the development team are not reproducible by other surgeons. Based on the results of our study, we believe that comprehensive national arthroplasty registers are the most suitable tool for assessing hip arthroplasty revision rate.

  5. Recovery of physical functioning after total hip arthroplasty

    OpenAIRE

    Heiberg, Kristi Elisabeth

    2014-01-01

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

  6. 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...

  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 ...

  8. High-volume infiltration analgesia in bilateral hip arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse Ø; Otte, Niels Kristian Stahl; Husted, Henrik

    2011-01-01

    Background and purpose High-volume infiltration analgesia may be effective in postoperative pain management after hip arthroplasty but methodological problems prevent exact interpretation of previous studies. Methods In a randomized, double-blind placebo-controlled trial in 12 patients undergoing...

  9. Prospective psychometric characterization of hip and knee arthroplasty patients

    DEFF Research Database (Denmark)

    Gylvin, Silas Hinsch; Fink-Jensen, Anders; Kehlet, Henrik

    2018-01-01

    BACKGROUND: Psychiatric conditions and psychopharmacological treatments have been demonstrated to be important risk-factors for prolonged hospital length of stay, readmission and morbidity, following fast-track total hip (THA) and total knee arthroplasty (TKA). AIMS: The aim of the study was to p...

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

    NARCIS (Netherlands)

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

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

  11. 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.

  12. Endotoxins in surgical instruments of hip arthroplasty.

    Science.gov (United States)

    Goveia, Vania Regina; Mendoza, Isabel Yovana Quispe; Guimarães, Gilberto Lima; Ercole, Flavia Falci; Couto, Bráulio Roberto Gonçalves Marinho; Leite, Edna Marilea Meireles; Stoianoff, Maria Aparecida Resende; Ferreira, José Antonio Guimarães

    2016-01-01

    To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60 surgical instruments, which were tested for endotoxins in three different stages. The EndosafeTM Gel-Clot LAL (Limulus Amebocyte Lysate method) was used. There was consistent gel formation with positive analysis in eight instruments, corresponding to 13.3%, being four femoral rasps and four bone reamers. Endotoxins in quantity ≥0.125 UE/mL were detected in 13.3% of the instruments tested. Investigar endotoxinas em instrumentais cirúrgicos esterilizados empregados em artroplastias do quadril. Estudo exploratório, descritivo, desenvolvido em um hospital público de ensino. Foram selecionados seis tipos de instrumentais, a saber: raspa acetabular, raspa femural, saca-cabeça de fêmur, formão box, fresa de fêmur e cabeça de prova de fêmur. A seleção foi feita a partir da análise da dificuldade para a remoção de resíduos de sangue e osso durante a limpeza. A amostra foi constituída por 60 instrumentais cirúrgicos, que foram testados para endotoxinas em três momentos distintos. Foi utilizado o método de gel-clot pelo Limulus Amebócito Lisado (LAL) Endosafe(tm). Houve formação de gel consistente com análise positiva em oito instrumentais, o que corresponde a 13,3%, sendo quatro raspas de fêmur e quatro fresas de fêmur. Foram detectadas endotoxinas em quantidade ≥0,125 UE/mL em 13,3% dos instrumentais testados.

  13. Resection arthroplasty of the hip in paralytic dislocations.

    Science.gov (United States)

    Kalen, V; Gamble, J G

    1984-06-01

    The chronically dislocated paralytic hip causes postural difficulties, nursing and hygiene problems, and pain. Therapeutic options are limited. This study reviews the results of resection arthroplasty on 18 hips of 15 such patients. This procedure has many complications, including hip ankylosis, heterotopic ossification, abduction contracture and bony overgrowth. Despite this, all of the nursing goals were achieved and most patients had relief of pain. The operation is most successful in the skeletally mature patients, and it relies on soft-tissue interposition between the bony fragments and postoperative positioning to ensure optimum posture.

  14. Bilaterally Primary Cementless Total Hip Arthroplasty for Severe Hip Ankylosis with Ankylosing Spondylitis.

    Science.gov (United States)

    Feng, Dong-Xu; Zhang, Kun; Zhang, Yu-Min; Nian, Yue-Wen; Zhang, Jun; Kang, Xiao-Min; Wu, Shu-Fang; Zhu, Yang-Jun

    2016-08-01

    Total hip arthroplasty is a reliable therapeutic intervention in patients with ankylosing spondylitis, in whom the aims of surgery are to reduce pain, restore hip function and improve quality of life. The current study is a retrospective analysis of the clinical and radiographic findings in a consecutive series of patients with hip ankylosis associated with severe ankylosing spondylitis who underwent bilateral primary total hip arthroplasty using non-cemented components. From June 2008 to May 2012, total hip arthroplasty was performed on 34 hips in 17 patients with bilateral ankylosis caused by ankylosing spondylitis. The study patients included 13 men and 4 women with a mean age of 24.2 years. The mean duration of disease was 8.3 years and the average duration of hip involvement was 7.6 years. All patients had severe hip pain and dysfunction with bilateral bony ankylosis and no range of motion preoperatively and all underwent bilateral cementless total hip arthroplasty performed by a single surgeon. Joint pain, range of motion (ROM), and Harris hip scores were assessed to evaluate the postoperative results. At a mean follow-up of 31.7 months, all patients had experienced significant clinical improvement in function, ROM, posture and ambulation. At the final follow-up, the mean postoperative flexion ROM was 134.4° compared with 0° preoperatively. Similar improvements were seen in hip abduction, adduction, internal rotation and external rotation. Postoperatively, 23 hips were completely pain-free, six had only occasional discomfort, three mild to moderate pain and two severe pain. The average Harris Hip Score improved from 23.7 preoperatively to 65.8 postoperatively. No stems had loosened at the final follow-up in any patient, nor had any revision surgery been required. Bilateral severe hip ankylosis in patients with ankylosing spondylitis can be treated with cementless bilateral synchronous total hip arthroplasty, which can greatly improve hip joint function and

  15. Total Hip Arthroplasty after Treatment of Pseudojoint Infection in a Patient with a Highly Dislocated Hip

    Directory of Open Access Journals (Sweden)

    Kyung-Soon Park

    2013-01-01

    Full Text Available Infection at the pseudoacetabulum in a patient with a high hip dislocation has not been reported previously in the English literature. We report a case of total hip arthroplasty in a 28-year-old female who presented to us with hip pain following debridement of the infected pseudojoint in a case of neglected developmental dysplasia of the hip. The infection was treated with thorough debridement and drainage. However, even after achieving complete infection control, this patient complained of disabling right hip joint pain. Total hip arthroplasty with subtrochanteric osteotomy was performed to relieve the pain and improve gait. After surgery, the patient's symptoms were relieved. We consider that in this case of acute pseudojoint infection simple arthrotomy and debridement combined with irrigation and drainage provide effective treatment. But muscle weakness and more increased joint laxity can cause hip pain even after infection control. So total hip arthroplasty is likely to be necessary after the infection has been controlled in a patient with a highly dislocated hip.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-08-15

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

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

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    Nath Rajendra

    2010-01-01

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

  18. Effect of total hip arthroplasty on recreational and sporting activity.

    Science.gov (United States)

    Chatterji, Urjit; Ashworth, Mark J; Lewis, Peter L; Dobson, Peter J

    2004-06-01

    Common concerns of patients undergoing total hip arthroplasty are whether they can continue with certain recreational and sporting activities or even commence new ones after the procedure. The present paper describes preoperative and postoperative activities, the numbers participating and the time to resume these activities. Between 1 and 2 years after total hip arthroplasty, 216 patients, who had undergone a total of 235 arthroplasties, were surveyed by postal questionnaire to ascertain how the arthroplasty had affected their recreational and sporting ability. Their preoperative and postoperative activity along with the time to resume was recorded. A general hip score and estimate of physical activity was also collected. The number of patients participating in sport increased from 188 preoperatively to 196 postoperatively. Patients stated that the surgery had a beneficial effect on their performance of sporting activities although the number of sporting events decreased. By multiplying individuals by the number of sports they participated in, there were 434 occurrences of sport preoperatively giving a mean for the group of 1.9 sports per patient. Postoperatively this had reduced to 382, giving a mean of 1.7. Five sports showed a significant change for individual patients from pre to postoperation. Those which showed an increase were exercise walking, where 38 patients (16.8%) who did not walk before surgery took up walking afterwards (P aqua aerobics, where 15 took up this activity postoperatively for the first time (P = 0.002). There were three sports which decreased significantly from pre to postoperation. They were, golf where 13 out of 39 (P = 0.005), tennis 13 out of 14 (P = 0.01) and jogging where six out of seven (P = 0.01) patients stopped participating. This study has shown that patients are adopting lower impact activities to participate in after total hip arthroplasty. The total number of patients performing a sport increases postoperatively but the

  19. Tranexamic Acid Reduces Blood Transfusions in Revision Total Hip Arthroplasty.

    Science.gov (United States)

    Park, Kwan J; Couch, Cory G; Edwards, Paul K; Siegel, Eric R; Mears, Simon C; Barnes, C Lowry

    2016-12-01

    The use of tranexamic acid (TEA) can significantly reduce the need for allogenic blood transfusions in elective primary joint arthroplasty. Revision total hip arthroplasty (THA) requires increased utilization of postoperative blood transfusions for acute blood loss anemia compared with elective primary hip arthroplasty. There is limited literature to support the routine use of TEA in revision THA. We performed a retrospective review of 161 consecutive patients who underwent revision THA from 2012 to 2014 at a single institution by 2 fellowship-trained surgeons. We compared the transfusion requirements and the postoperative hemoglobin drop of the TEA group (109 patients, 114 hips) vs the no-TEA group (52 patients, 56 hips). Our standard protocol for administering TEA is 1000 mg IV at incision and the same dose repeated 2 hours later. The no-TEA group did not receive the medication because of previous hospital contraindication criteria. The transfusion rate was significantly less for the TEA group (7%) compared with the no-TEA group (34%; P revision THA demonstrated a significant reduction in allogenic blood transfusion rates. The postoperative hemoglobin drop was also significantly less with the use of TEA. We recommend the routine use of TEA during revision THA. Published by Elsevier Inc.

  20. Cognitive function and cerebral emboli after primary hip arthroplasty.

    Science.gov (United States)

    Gray, A C; Torrens, L; Howie, C R; Christie, J; Robinson, C M

    2008-01-01

    Transcranial Doppler ultrasound has been used to detect cerebral emboli after hip arthroplasty. The cognitive effects of these embolic events are unclear. The aim of this study was to assess cognitive change after primary cemented hip arthroplasty using a range of neuropsychological tests and to measure intraoperative cerebral embolic load. Twenty primary cemented total hip arthroplasties underwent a series of cognitive tests before and at four days after surgery. A range of validated tests assessed: global cognitive function; verbal fluency and speed; immediate and delayed memory recall; attention and mental processing speeds. Intra-operative transcranial Doppler ultrasound monitoring of the middle cerebral artery for embolic signals was also performed. A one-sample Wilcoxon signed-rank test compared median cognitive results post-pre surgery and a Mann-Whitney U test established if there was a cognitive difference between those patients who had detectable cerebral emboli and those who did not. Scatter plot graphs were also used to establish any correlation between the embolic load and clinical cognitive dysfunction. A significant (pmental processing speed, visual searching and sustained and divided attention following surgery. Intra-operative cerebral embolic signals were detected in 11 out of 20 patients and the majority occurred with femoral component cementation and hip reduction. There was no difference in cognitive dysfunction between those patients who had detectable cerebral embolic signals and those who did not and there appeared to be no direct correlation between the size of the embolic load and the level of cognitive dysfunction.

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

    DEFF Research Database (Denmark)

    Jensen, Carsten; Aagaard, Per; Overgaard, Søren

    2012-01-01

    Background: Standard total hip arthroplasty (S-THA) is the established surgical treatment for patients older than 65 years with progressive osteoarthritis. However, implant survivorship curves decline more rapidly in patients younger than 50 years. Resurfacing total hip arthroplasty (R-THA) has t...

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

    Science.gov (United States)

    Gómez-García, F

    2014-01-01

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

  3. Knitted outer gloves in primary hip and knee arthroplasty.

    Science.gov (United States)

    Tanner, J; Wraighte, P; Howard, P

    2006-01-01

    A randomised trial was carried out to determine the rate of perforation to inner gloves when comparing latex with knitted gloves during hip and knee arthroplasty. Members of the surgical team were randomised to wear either two pairs of latex gloves (standard double gloving) or a knitted glove on top of a latex glove. In addition, participants completed a visual analogue assessment of their overall satisfaction with the gloves. A total of 406 inner gloves were tested for perforations over a four-month period: 23% of inner gloves were perforated when latex outer gloves were used and 6% of inner gloves were perforated when knitted outer gloves were used. In total, there were 64 perforations to the inner gloves; only one of these perforations was detected by the glove wearer. Wearing knitted outer gloves during hip and knee arthroplasty statistically significantly reduces the risk of perforation to inner latex gloves (p<0.0001).

  4. Vibroacoustography for the assessment of total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Hermes A.S. Kamimura

    2013-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Won Yong Shon

    2014-01-01

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

  6. Intraoperative Fluoroscopy Improves Component Position During Anterior Hip Arthroplasty.

    Science.gov (United States)

    Jennings, John D; Iorio, Justin; Kleiner, Matthew T; Gaughan, John P; Star, Andrew M

    2015-11-01

    The goal of this retrospective review was to determine whether fluoroscopic guidance improves acetabular cup abduction and anteversion alignment during anterior total hip arthroplasty. The authors retrospectively reviewed 199 patients (fluoroscopy group, 98; nonfluoroscopy group, 101) who underwent anterior total hip arthroplasty at a single center with and without C-arm fluoroscopy guidance. Included in the study were patients of any age who underwent primary anterior approach total hip arthroplasty performed by a single surgeon, with 6-month postoperative anteroposterior pelvis radiographs. Acetabular cup abduction and anteversion angles were measured and compared between groups. Mean acetabular cup abduction and anteversion angles were 43.4° (range, 26.0°-57.4°) and 23.1° (range, 17°-28°), respectively, in the fluoroscopy group. Mean abduction and anteversion angles were 45.9° (range, 29.7°-61.3°) and 23.1° (range, 17°-28°), respectively, after anterior total hip arthroplasty without the use of C-arm guidance (nonfluoroscopy group). The use of fluoroscopy was associated with a statistically significant difference in cup abduction (P=.002) but no statistically significant difference in anteversion angles. In the fluoroscopy group, 80% of implants were within the combined safe zone compared with 63% in the nonfluoroscopy group. A significantly higher percentage of both acetabular cup abduction angles and combined anteversion and abduction angles were in the safe zone in the fluoroscopy group. Fluoroscopy is not required for proper anteversion placement of acetabular components, but it may increase ideal safe zone placement of components. Copyright 2015, SLACK Incorporated.

  7. The rehabilitation management after hip arthroplasty: a case report

    OpenAIRE

    Adina BURCHICI

    2017-01-01

    Aim: In this paper we describe the physical therapy management of a 64-year-old female following a bilateral hip arthroplasty. Method: The patient featured in this study, after the surgical intervention had undergone specific recovery treatment consisting of: posture techniques, static (isometric contractions) and dynamic kinetic techniques (passive motion, passive-actives, actives, actives with resistance), massage, respiratory gymnastics and reeducation of walking. Results: At the end of t...

  8. Hip arthroplasty. Part 1: prosthesis terminology and classification

    International Nuclear Information System (INIS)

    Pluot, E.; Davis, E.T.; Revell, M.; Davies, A.M.; James, S.L.J.

    2009-01-01

    Hip arthroplasty is an extremely common orthopaedic procedure and there is a wide array of implants that are in current use in the UK. The follow-up of patients who have undergone insertion of a hip prosthesis is shifting from a consultant-lead hospital service towards primary care. As this change in patient care continues it becomes increasingly important that an accurate description of the radiographic features is communicated to the primary-care practitioner so appropriate specialist input can be triggered. This review focuses on the terminology and classification of hip prostheses. This acts as a precursor for Part 2 of this series, which describes the normal and abnormal radiographic findings following hip prosthesis insertion.

  9. The rehabilitation management after hip arthroplasty: a case report

    Directory of Open Access Journals (Sweden)

    Adina BURCHICI

    2017-03-01

    Full Text Available Aim: In this paper we describe the physical therapy management of a 64-year-old female following a bilateral hip arthroplasty. Method: The patient featured in this study, after the surgical intervention had undergone specific recovery treatment consisting of: posture techniques, static (isometric contractions and dynamic kinetic techniques (passive motion, passive-actives, actives, actives with resistance, massage, respiratory gymnastics and reeducation of walking. Results: At the end of the rehabilitation program, hip muscular strength and joint range of motion were improved significantly. The Harris hip score was significantly improved, in comparison to the preoperative one. Conclusion: This case illustrates the importance of the rehabilitation management after bilateral hip replacement.

  10. Hip arthroplasty in obese patients: rising prevalence – standard procedures?

    Directory of Open Access Journals (Sweden)

    Michael Skutek

    2016-06-01

    Full Text Available We examined our experience and, in particular, complications associated with total hip arthroplasty in obese and morbidly obese patients. We prospectively gathered 50 patients in a matched control series including 25 obese and morbidly obese patients. All patients were operated using the direct lateral approach and standard postoperative protocols. Operating room time, complications, dislocations, blood loss, cup position and clinical parameters using the Harris Hip Score and the Western Ontario and McMaster Universities Arthritis Index results were compared. Although there were some significant differences in clinical outcomes, standard procedures yielded good overall results and an acceptable rate of complications. Details approaching this patient entity are being discussed.

  11. Constrained liners for recurrent dislocations in total hip arthroplasty

    DEFF Research Database (Denmark)

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

    2009-01-01

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

  12. Pain and Function Recovery Trajectories following Revision Hip Arthroplasty: Short-Term Changes and Comparison with Primary Hip Arthroplasty in the ADAPT Cohort Study.

    Directory of Open Access Journals (Sweden)

    Erik Lenguerrand

    Full Text Available Patients report similar or better pain and function before revision hip arthroplasty than before primary arthroplasty but worse results are reported after revision surgery than after primary surgery. The trajectory of post-operative recovery during the first months and any differences by type of surgery have received little attention. We explored the trajectories of change in pain and function after revision hip arthroplasty to 12-months post-operatively and compare them with those observed after primary hip arthroplasty.This study is a prospective cohort study of patients undergoing primary (n = 80 with 92% for an indication of osteoarthritis and revision (n = 43 hip arthroplasties. WOMAC pain and function scores and walking speed were collected pre-operatively, at 3 and 12-months post-operatively. Multilevel regression models were used to chart and compare the trajectories of change (0-3 months and 3-12 months between types of surgery.The improvements in pain and function following revision arthroplasty occurred within the first 3-months with no evidence of further change beyond this initial period. While the pattern of recovery was similar to the one observed after primary arthroplasty, improvements in the first 3-months were smaller after revision compared to primary arthroplasty. Patients listed for revision surgery reported lower pre-operative pain levels but similar post-operative levels compared to those undergoing primary surgery. At 12-months post-operation patients who underwent a revision arthroplasty had not reached the same level of function achieved by those who underwent primary arthroplasty.The post-operative improvements in pain and function are larger following primary hip arthroplasty than following revision hip arthroplasty. Irrespectively of surgery type, most of the improvements occur in the first three post-operative months. More research is required to identify whether the recovery following revision surgery could be

  13. 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.

  14. [Effect of ceramic on ceramic total hip arthroplasty in Crowe IV developmental dysplasia of the hip].

    Science.gov (United States)

    Sun, Jing-Yang; Zhou, Yong-Gang; Du, Yin-Qiao; Piao, Shang; Wang, Sen; Gao, Zhi-Sen; Wu, Wen-Ming; Ma, Hai-Yang

    2018-02-25

    To observe the clinical effect of ceramic on ceramic total hip arthroplasty(THA)in Crowe IV developmental dysplasia of the hip(DDH). From April 2008 to December 2015, 137 hips of 111 Crowe IV DDH patients received THA using Forte or Delta ceramic on ceramic by one senior surgeon, which consists of 85 unilateral hips and 26 bilateral hips. The average age of the patients was(38.88±10.83) years old ranging from 18 to 68 years old. The mean follow-up was(41.16±21.50) months ranging from 12 to 96 months. All the patients were evaluated by Harris Hip Score. Radiographic evaluations were made preoperatively and during follow-up. Harris scores, the incidence of complications such as ceramic fracture, squeaking, dislocation were observed. The mean preoperative Harris score was 56.54±15.67, the mean postoperative Harris score was 88.30±6.86( P =0.017). Periprosthetic osteolysis was not deteced around any cup. No ceramic fracture occurred. There were 3 cases of revision surgery due to infection, losening of the stem and limb length discrepancy, respectively; 3 cases of dislocation occurred. Seventy-seven patients were recorded the gait and the hip mobility, the hip flexion of 69 patients were above 120 degrees. Ceramic on ceramic bearing showed an encouraging result in Crowe IV DDH total hip arthroplasty. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

  15. Functional rehabilitation after total hip arthroplasty with uncemented prosthesis

    Directory of Open Access Journals (Sweden)

    Nicolae-Bogdan Negru-Aman

    2011-12-01

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

  16. Preventive analgesia in hip or knee arthroplasty: a systematic review.

    Science.gov (United States)

    Díaz-Heredia, J; Loza, E; Cebreiro, I; Ruiz Iban, M Á

    2015-01-01

    To analyze the efficacy and safety of preventive analgesia in patients undergoing hip or knee arthroplasty due to osteoarthritis. A systematic literature review was performed, using a defined a sensitive strategy on Medline, Embase and Cochrane Library up to May 2013. The inclusion criteria were: patients undergoing knee and/or hip arthroplasty, adults with moderate or severe pain (≥4 on a Visual Analog Scale). The intervention, the use (efficacy and safety) of pharmacological treatment (preventive) close to surgery was recorded. Oral, topical and skin patch drugs were included. Systematic reviews, meta-analysis, controlled trials and observational studies were selected. A total of 36 articles, of moderate quality, were selected. The patients included were representative of those undergoing knee and/or hip arthroplasty in Spain. They had a mean age >50 years, higher number of women, and reporting moderate to severe pain (≥4 on a Visual Analog Scale). Possurgical pain was mainly evaluated with a Visual Analog Scale. A wide variation was found as regards the drugs used in the preventive protocols, including acetaminophen, classic NSAID, Cox-2, opioids, corticosteroids, antidepressants, analgesics for neuropathic pain, as well as others, such as magnesium, ketamine, nimodipine or clonidine. In general, all of them decreased post-surgical pain without severe adverse events. The use or one or more pre-surgical analgesics decreases the use of post-surgical drugs, at least for short term pain. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  17. 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...

  18. Rigid Patient Positioning is Unreliable in Total Hip Arthroplasty.

    Science.gov (United States)

    Milone, Michael T; Schwarzkopf, Ran; Meere, Patrick A; Carroll, Kaitlin M; Jerabek, Seth A; Vigdorchik, Jonathan

    2017-06-01

    To our knowledge, no study has assessed the ability of rigid patient positioning devices to afford arthroplasty surgeons with ideal acetabular orientation throughout surgery. The purpose of this study is to use robotic arm-assisted computer navigation to assess the reliability of pelvic position in total hip arthroplasty performed on patients positioned with rigid positioning devices. A prospective cohort of 100 hips (94 patients) underwent robotic-guided total hip arthroplasty in the lateral decubitus position from the posterior approach, 77 stabilized by universal lateral positioner, and 23 by peg board. Before reaming, computed tomography-templated computer software generated true values of pelvic anteversion and inclination based on the position of the robot arm registered to the patient's preoperative pelvic computed tomography. Mean alteration in anteversion and inclination values was 1.7° (absolute value, 5.3°; range, -20° to 20°) and 1.6° (absolute value, 2.6°; range, -8° to 10°), respectively. And 22% of anteversion values were altered by >10° and 41% by >5°. There was no difference between hip positioners used (P = .36). Anteversion variability was correlated with body mass index (P = .02). Despite the use of rigid patient positioning devices-a lateral hip positioner or peg board-this study reveals clinically important malposition of the pelvis in many cases, especially with regard to anteversion. These results show a clear need to pay particular attention to anatomic landmarks or computer-assisted techniques to assure accurate acetabular cup positioning. Patient positioning should not be solely trusted. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Acetabular cup position and risk of dislocation in primary total hip arthroplasty

    DEFF Research Database (Denmark)

    Seagrave, Kurt G; Troelsen, Anders; Malchau, Henrik

    2017-01-01

    Background and purpose - Hip dislocation is one of the most common complications following total hip arthroplasty (THA). Several factors that affect dislocation have been identified, including acetabular cup positioning. Optimal values for cup inclination and anteversion are debatable. We performed...

  20. The history of biomechanics in total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Jan Van Houcke

    2017-01-01

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

  1. The History of Biomechanics in Total Hip Arthroplasty.

    Science.gov (United States)

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

    2017-01-01

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

  2. Contralateral Total Hip Arthroplasty After Hindquarter Amputation

    Directory of Open Access Journals (Sweden)

    Scott M. M. Sommerville

    2006-01-01

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

  3. Joint Arthroplasties other than the Hip in Solid Organ Transplant Recipients

    Science.gov (United States)

    Sayed-Noor, Arkan S

    2009-01-01

    Transplantation Surgery has undergone a great development during the last thirty years and the survival of solid organ recipients has increased dramatically. Osteo-articular diseases such as osteoporosis, fractures, avascular bone necrosis and osteoarthritis are relatively common in these patients and joint arthroplasty may be required. The outcome of hip arthroplasty in patients with osteonecrosis of the femoral head after renal transplantation has been studied and documented by many researchers. However, the results of joint arthroplasties other than the hip in solid organs recipients were only infrequently reported in the literature. A systematic review of the English literature was conducted in order to investigate the outcome of joint arthroplasties other than the hip in kidney, liver or heart transplant recipients. Nine pertinent articles including 51 knee arthroplasties, 8 shoulder arthroplasties and 1 ankle arthroplasty were found. These articles reported well to excellent results with a complication rate and spectrum comparable with those reported in nontransplant patients. PMID:19572036

  4. 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.

  5. Imaging of hip joint arthroplasty; Bildgebung bei Hueftgelenkendoprothesen

    Energy Technology Data Exchange (ETDEWEB)

    Mayerhoefer, M.E.; Fruehwald-Pallamar, J.; Czerny, C. [Univ.-Klinik fuer Radiodiagnostik, Medizinische Universitaet Wien, Abteilung fuer Neuroradiologie und Muskuloskelettale Radiologie, Wien (Austria)

    2009-05-15

    The hip joint is the largest joint in the human body and consequently, its evaluation by diagnostic imaging is highly important. This includes imaging of hip joint arthroplasty, which is used to avoid joint immobility following a wide spectrum of diseases, such as end-stage degenerative disease, avascular necrosis of the femoral head or post-traumatic fractures. Conventional radiography is still the standard imaging modality for the evaluation of hip arthroplasty both directly following surgery and for periodical follow-up. In the majority of cases conventional radiography enables adequate assessment of early and late complications that can arise following hip arthroplasty, such as loosening, prosthetic or periprosthetic fracture, luxation, infection and soft tissue calcification. If the diagnosis cannot be established by means of radiography, advanced imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI), with or without injection of contrast media, may provide additional information. This is particularly true for the depiction of inflammatory processes. Regardless of the imaging modality used patients' clinical symptoms must also be taken into account in order to establish the correct diagnosis. (orig.) [German] Dem Hueftgelenk als groesstem Gelenk des menschlichen Koerpers kommt eine besondere Bedeutung in der muskuloskelettalen Radiologie zu. Entsprechend wichtig ist auch die radiologische Beurteilung von Hueftgelenkendoprothesen, die z. B. infolge degenerativer Gelenkerkrankungen, einer Hueftkopfnekrose oder einer Fraktur eingesetzt werden. Die Projektionsradiographie ist weiterhin die primaere Modalitaet zur Beurteilung von Hueftgelenkendoprothesen, direkt postoperativ und zur laengerfristigen Verlaufskontrolle. Diese Methode erlaubt in der Mehrzahl der Faelle eine suffiziente Antwort auf die Frage nach Lockerung, periprothetischer Fraktur oder Prothesenmaterialbruch, Luxation, Infektion und Weichteilkalzifikation

  6. Hip and knee arthroplasty waiting list – how accurate and fair ...

    African Journals Online (AJOL)

    Background. Resource-intensive procedures require the use of patient waiting lists in an attempt to increase fairness of access to surgery and improve surgical efficiency. Total hip and knee arthroplasty has waiting lists in excess of years. Objectives. To analyse our tertiary state institution's hip and knee arthroplasty waiting ...

  7. Regional variation in incidence of primary total hip arthroplasties and revisions in Denmark, 1996-2002

    DEFF Research Database (Denmark)

    Pedersen, Alma Becic; Johnsen, Søren Paaske; Overgaard, Søren

    2005-01-01

    We examined incidence rates (IR) of total hip arthroplasty (THA) in Denmark according to county and type of hospital, and investigated possible factors associated with any variations.......We examined incidence rates (IR) of total hip arthroplasty (THA) in Denmark according to county and type of hospital, and investigated possible factors associated with any variations....

  8. 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.

  9. 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.

  10. Changes in collagen metabolites in serum after cemented hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Joerring, S; Jensen, L T

    1993-01-01

    Markers of types I and III collagen turnover were measured in serial blood samples collected preoperatively and 60 days after surgery in 13 patients undergoing cemented total hip arthroplasty and 11 patients undergoing cemented total knee arthroplasty. The markers were the carboxyterminal extension....... We suggest that the changes in serum PICP and serum PIIINP reflect collagen formation in healing soft connective tissue 60 days after cemented hip or knee arthroplasty....

  11. Predictors of excellent early outcome after total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Smith George H

    2012-03-01

    Full Text Available Abstract Background Not all patients gain the same degree of improvement from total hip replacement and the reasons for this are not clear. Many investigators have assessed predictors of general outcome after hip surgery. This study is unique in its quest for the predictors of the best possible early outcome. Methods We prospectively collected data on 1318 total hip replacements. Prior to surgery patient characteristics, demographics and co-morbidities were documented. Hip function and general health was assessed using the Harris Hip score (HHS and the Short-Form 36 respectively. The HHS was repeated at three years. We took a maximal HHS of 100 to represent an excellent outcome (102 patients. Multiple logistic regression analysis was used to identify independent predictors of excellent outcome. Results The two strongest predictive factors in achieving an excellent result were young age and a high pre-operative HHS (p = 0.001. Conclusions It was the young and those less disabled from their arthritis that excelled at three years. When making a decision about the timing of hip arthroplasty surgery it is important to take into account the age and pre-operative function of the patient. Whether these patients continue to excel however will be the basis of future research.

  12. Pain and somatosensory findings in patients 3 years after total hip arthroplasty

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Kristensen, Anders D; Thillemann, Theis M

    2009-01-01

    BACKGROUND: Chronic hip pain after total hip arthroplasty (THA) is a significant problem, but the aetiology remains unclear. AIMS: To determine sensory function in patients with chronic hip pain 3 years after THA. Patients without hip pain after THA served as controls. METHODS: Eighteen patients ...

  13. 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

    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...... cohort study, 95 consecutive patients (106 hips) met the inclusion criteria. One observer performed radiographic measurements for malformations and radiographic OA. Inter- and intraobserver variability was assessed. RESULTS: From 95 patients (male n = 52 and female n = 43) age ranged from 35 to 59 years...

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  15. The use of subtraction arthrography in total hip arthroplasties

    International Nuclear Information System (INIS)

    Barentsz, J.O.; Lemmens, J.M.; Slooff, T.J.J.H.; Katholieke Univ. Nijmegen

    1986-01-01

    The results of plain film radiogrpahy and subtraction arthrography in 24 patients prior to revision surgery for a loosened total hip arthroplasty (T.H.A.) were compared with operative findings. Loosening of both the acetabular and the femoral components was evaluated. In plain film radiography the overall accurcy for evidence of loosening in 22 acetabular and 23 femoral components was 58% The overall accuracy with arthrography was 93%. Three results were false-negatives; arthrography showing no evidence of loosening, while the arthroplasty was found to be loose on surgical evaluation. The results of this study are compared with findings reported in the literature. Arthrography was performed by a lateral puncture technique. There were no complications. The use of the puncture technique has not been described previously. The extent of contrast leakage into the interfaces is described and discussed. (orig.) [de

  16. Use of subtraction arthrography in total hip arthroplasties

    Energy Technology Data Exchange (ETDEWEB)

    Barentsz, J.O.; Lemmens, J.M.; Slooff, T.J.J.H.

    1986-04-01

    The results of plain film radiogrpahy and subtraction arthrography in 24 patients prior to revision surgery for a loosened total hip arthroplasty (T.H.A.) were compared with operative findings. Loosening of both the acetabular and the femoral components was evaluated. In plain film radiography the overall accurcy for evidence of loosening in 22 acetabular and 23 femoral components was 58% The overall accuracy with arthrography was 93%. Three results were false-negatives; arthrography showing no evidence of loosening, while the arthroplasty was found to be loose on surgical evaluation. The results of this study are compared with findings reported in the literature. Arthrography was performed by a lateral puncture technique. There were no complications. The use of the puncture technique has not been described previously. The extent of contrast leakage into the interfaces is described and discussed.

  17. Total hip arthroplasty with cementless cup after acetabular fracture

    Directory of Open Access Journals (Sweden)

    Marcelo Alfonso Lugones

    2012-12-01

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

  18. The risk of venous thromboembolism with aspirin compared to anticoagulants after hip and knee arthroplasty.

    Science.gov (United States)

    Chu, Janet N; Maselli, Judith; Auerbach, Andrew D; Fang, Margaret C

    2017-07-01

    Recent guidelines include aspirin as an option to prevent venous thromboembolism (VTE) in selected patients undergoing hip or knee replacement surgery. However, the efficacy of aspirin after arthroplasty has not been well-defined, particularly in more contemporary patient populations. We compared rates of post-operative VTE between patients who received aspirin-only versus anticoagulants after hip or knee arthroplasty, using data from a large US-based administrative database. We conducted a retrospective cohort study of 231,780 adults who underwent total knee arthroplasty and 110,621 who underwent total hip arthroplasty in 2009-2012 and who received pharmacologic VTE prophylaxis (aspirin or anticoagulant) within the first 7days after surgery. We compared the risk of post-operative VTE between patients receiving aspirin-only vs. anticoagulants, controlling for clinical and hospital characteristics using multivariable logistic regression with propensity score adjustment. Aspirin-only prophylaxis was administered to 7.5% of patients after knee arthroplasty and 8.0% after hip arthroplasty. Post-operative VTE was diagnosed in 2217 (0.96%) patients after knee arthroplasty and 454 (0.41%) after hip arthroplasty. Compared to anticoagulants, aspirin was not associated with a higher risk for post-operative VTE either after knee arthroplasty (adjusted odds ratio and 95% confidence interval [OR] 0.34 [0.24-0.48]) or hip arthroplasty (OR 0.82 [0.45-1.51]). Aspirin was uncommonly administered as the sole prophylactic agent after hip or knee arthroplasty in this study. However, patients who received aspirin-only had similar rates of post-operative VTE compared to patients who received anticoagulants. Further research should focus on distinguishing which patients benefit more from anticoagulants versus aspirin after arthroplasty. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    Zmago Krajnc

    2004-04-01

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

  1. [Oblong implants for revision total hip arthroplasty].

    Science.gov (United States)

    Landor, I; Vavrík, P; Jahoda, D; Pokorný, D; Popelka, S; Sosna, A

    2009-12-01

    A prerequisite for the successful implantation of an acetabular component in a defective bone tissue is, in addition to providing sufficient primary fixation of the implant, reconstruction of the acetabular bone bed. To achieve this, one of the options involves the use of an oblong implant. Data published on this topic are sparse and therefore the aim of this study was to gain a deeper insight into this issue. In addition, we wanted to compare the results achieved with the oblong component with those obtained using its original model. One group comprised 111 patients with 133 sides who underwent acetabular revision for aseptic loosening or extraction of an infected acetabular component with subsequent implantation of an oblong cup (Langs-Ovale Revisionspfanne [L.O.R.], Allopro, Switzerland). The average age of this group at the time of surgery was 62.2 (range, 31-83) years, and average follow-up was 9.7 (range, 0.6-13.9) years. The other group consisted of 134 patients with 152 sides who for the same indications as the L.O.R. group received a Walter Oval cup (Medin Orthopaedics, Czech Republic). The average age at the time of surgery was 64.6 (22-86) years, and average follow-up was 7.3 (range, 1.1-9.8) years. The proportion and nature of defects and underlying clinical diagnoses in the two groups were statistically comparable. The patients requiring replacement or removal of the acetabular component were not included in clinical evaluation, but their data were used for survival analysis. The clinical evaluation included: in the L.O.R. group, 115 hip joints at an average follow-up of 10.8 (range, 4.5-13.9) years and, in the Walter Oval group, 144 hip joints at an average follow-up of 7.5 (range, 2.3-9.8) years. The data of patients who died during ;the study (L.O.R., 7 Walter Oval, 11) were included in the clinical evaluation as of the date of the final follow-up. The results for each group were evaluated using the Kaplan-Meier survival analysis, with a simple

  2. Hip Implant Systems

    Science.gov (United States)

    ... Orthopaedic Surgeons Information about Soft Tissue Imaging and Metal Ion Testing Information for All Health Care Professionals who Provide Treatment to Patients with a Metal-on-Metal Hip Implant Metal-on-Metal Hip ...

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

    DEFF Research Database (Denmark)

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

    1996-01-01

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

  4. Early morbidity after aseptic revision hip arthroplasty in Denmark

    DEFF Research Database (Denmark)

    Lindberg-Larsen, M.; Hansen, Torben Bæk

    2014-01-01

    aseptic revision THRs from 1st October 2009 to 30th September 2011 using the Danish National Patient Registry, with additional information from the Danish Hip Arthroplasty Registry. There were 1553 procedures (1490 patients) performed in 40 centres and we divided them into total revisions, acetabular......Data on early morbidity and complications after revision total hip replacement (THR) are limited. The aim of this nationwide study was to describe and quantify early morbidity after aseptic revision THR and relate the morbidity to the extent of the revision surgical procedure. We analysed all...... component revisions, femoral stem revisions and partial revisions. The mean age of the patients was 70.4 years (25 to 98) and the median hospital stay was five days (interquartile range 3 to 7). Within 90 days of surgery, the readmission rate was 18.3%, mortality rate 1.4%, re-operation rate 6...

  5. Pigmented Villonodular Synovitis in a Patient who Underwent Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Nevzat Dabak

    2014-09-01

    Full Text Available Pigmented villonodular synovitis (PVNS is a rare, benign, but a locally aggressive tumor. It is characterized by the proliferation of synovial membrane, but it can also be seen in tendon sheaths and bursae. Clinical presentation of solitary lesions include compression and locking of the joint suggesting loose bodies in the joint and a subsequent findings of an effusion, whereas diffuse lesions manifest with pain and chronic swelling. In this article, we presented a curious case of PVNS in a female patient who have been followed up due to an acetabular cystic lesion. She underwent total hip arthroplasty for severe osteoarthritis of the hip joint and associated pain. The diagnosis of PVNS was established intraoperatively. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 235-7

  6. Alternative outcome measures in young total hip arthroplasty patients

    DEFF Research Database (Denmark)

    Klit, Jakob; Jacobsen, Steffen; Schmiegelow, Victoria

    2015-01-01

    In this prospective multicentre cohort study we studied subjects younger than 60 years of age scheduled for primary total hip arthroplasty (THA). The study assessed patients' overall satisfaction, fulfillment of preoperative expectations, the effect on socioeconomic parameters, and quality of sex......-life. Questionnaires including Oxford Hip Score (OHS) and SF-36 were evaluated preoperatively and 3, 6 and 12 months postoperatively. OHS and SF-36 showed significant improvements (ppatients' socioeconomic status. Increased frequency of intercourse or better...... abilities in intercourse positions were experienced by 18 of 39 females due to reduced pain and increased range of motion. Patients sexually active before THA surgery remained active. These findings constitute important new information to young patients and surgeons during the decision making process....

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

    Directory of Open Access Journals (Sweden)

    Stephen Richard Knight

    2011-11-01

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

  8. Bilateral Total Hip Arthroplasty in 20 Years Old Female with Neglected Developmental Dysplasia of Hip.

    Science.gov (United States)

    Agarwal, Saurabh; Jain, Jitesh K; Sharma, Rajeev K

    2014-01-01

    Management of developmental dysplasia of hip in adult is challenging problem. Management protocols are not well defined in terms of operative technique. Patient may present very late. Usually they consult orthopaedic surgeons when osteoarthritic changes set in, leading to pain. Operative management is difficult because of difficult exposure, altered anatomy of soft tissue structures, hypoplastic femoral medullary canal and shallow and atypical acetabulum filled with soft tissues. Femoral head is up-ridden with contracted Abductors which resists reduction of femoral head into acetabulum. Altered anatomy of neurovascular structures also pose a risk of being injured during surgery. Here we are presenting a case of bilateral total hip arthroplasty in 20 years old female with developmental dysplasia of hip and sharing our experience of its operative management. We concluded from this case study that total hip arthroplasty in developmental dysplasia of hip is technically demanding but gives good functional and clinical result. For getting functionally good result contracted soft tissues around joint need special attention.

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

    Directory of Open Access Journals (Sweden)

    Dudani Baldev

    2005-01-01

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

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

    Science.gov (United States)

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

    2014-12-01

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

  11. Dual-Mobility Constructs in Revision Total Hip Arthroplasties.

    Science.gov (United States)

    Abdel, Matthew P

    2018-02-27

    Dislocation after revision total hip arthroplasty (THA) continues to be one of the most common and concerning complications after the procedure. As with every hip arthroplasty, it is essential to optimize component positioning, minimize impingement, and maintain the integrity of the abductor complex during the revision THAs. However, in several revision circumstances, additional strategies are required to mitigate the risk of dislocation, particularly those being revised for instability or those with cognitive or neuromuscular disorders. In such revision THAs, dual-mobility constructs offer lower rates of dislocations and re-revisions for dislocations in the midterm. However, it is important to note that dual-mobility constructs should not be considered as compensation for poor surgical technique or technical errors such as poor cup orientation or inappropriate restoration of soft-tissue tension. While intraprosthetic dislocations are a unique complication to dual-mobility constructs, they are exceedingly rare. Furthermore, additional follow-up is required with modular dual-mobility constructs utilized with increasing frequency during revision THAs in North America. Copyright © 2018 Elsevier Inc. All rights reserved.

  12. Survival of primary total hip arthroplasty in rheumatoid arthritis patients

    DEFF Research Database (Denmark)

    Rud-Sørensen, Christoffer; Pedersen, Alma B; Johnsen, Søren Paaske

    2010-01-01

    BACKGROUND AND PURPOSE: There has been a limited amount of research on survival of total hip arthroplasties (THAs) in rheumatoid arthritis (RA). We therefore performed a population-based, nationwide study to compare the survival of primary THAs in RA patients and in osteoarthritis (OA) patients. We...... also wanted to identify predictors of THA failure in RA patients. METHODS: Using the Danish Hip Arthroplasty Registry, we identified 1,661 primary THAs in RA patients and 64,858 in OA patients, all of which were inserted between 1995 and 2008. The follow-up period was up to 14 years for both groups......, both regarding revision due to aseptic loosening (adjusted RR = 0.58; 95% CI: 0.34-0.99) and for any reason (adjusted RR = 0.63; 95% CI: 0.45-0.88). In RA patients, males had a higher risk of revision than females concerning aseptic loosening of the stem, any revision of the stem, and any revision...

  13. Plasma endocannabinoid behaviour in total knee and hip arthroplasty.

    Science.gov (United States)

    Ottria, R; Cappelletti, L; Ravelli, A; Mariotti, M; Gigli, F; Romagnoli, S; Ciuffreda, P; Banfi, G; Drago, L

    2016-01-01

    Endocannabinoids are a class of lipid mediators involved in a wide range of physiological pathways including pain perception, and immunological defences. In particular, the involvement of endocannabinoids in bone metabolism and bone resorption has recently been studied. Moreover, one study on total knee arthroplasty describes the probable role of endocannabinoids in pain perception after surgery. The aim of the present study was to evaluate variations of endocannabinoid concentrations in patients undergoing total hip or total knee arthroplasty before and after surgery. Sera from 23 patients were collected at three different times: before surgery and at two different times during rehabilitation, and endocannabinoids were quantified by HPLC-MS/MS analysis. Mean values of endocannabinoids in presurgical serum samples were: 6.11±0.5 ng/ml for N-palmitoylethanolamide, 1.39±0.08ng/ml for N-stearoylethanolamide, 4.84±0.04 ng/ml for N-oleoylethanolamide, 0.44±0.03ng/ml for N-arachidonoylethanolamide, 0.84±0.05ng/ml for N-linoleoylethanolamide, 0.17±0.01ng/ml for N-α-linolenoylethanolamide. Statistical analysis showed a significant decrease of all the endocannabinoids after surgery, while there were no remarkable differences between total hip and total knee arthroplasties or between genders. Moreover, the results show no significant correlation between endocannabinoid concentrations and C-reactive protein and Erythrocyte sedimentation rate. The present study shows for the first time a specific and univocal behaviour of six endocannabinoids and N-acylethanolamides in orthopaedic surgery, suggesting the endocannabinoid system as a possible pharmacological target for presurgical therapeutics.

  14. An Unexpected Complication of Hip Arthroplasty: Knee Dislocation

    Directory of Open Access Journals (Sweden)

    Serdar Yilmaz

    2015-01-01

    Full Text Available An increasing number of patients with hip fracture have been seen with osteoporosis associated with osteoarthritis. Although knee dislocation is related to high-energy trauma, low-grade injuries can also lead to knee dislocation which is defined as “ultra-low velocity dislocation.” The case reported here is of an 82-year-old patient who presented with a left intertrochanteric hip fracture. Partial arthroplasty was planned because of osteoporosis. In the course of surgery, degenerative arthritic knee was dislocated during the hip reduction maneuver with the application of long traction. The neurovascular examination was intact, but the knee was grossly unstable and was dislocated even in a brace; thus a hinged knee prosthesis was applied nine days after surgery. The patient was mobilized with crutches after the knee prosthesis but exercise tolerance was diminished. In conclusion, it should be emphasized that overtraction must be avoided during the hip reduction maneuver in patients with advanced osteoarthritic knee.

  15. The innovation trap: modular neck in total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Samo Karel Fokter

    2017-04-01

    Full Text Available Background: Innovations play the key role in the success of orthopaedic surgery. However, even minor modifications in the established concepts and proven designs may result in disasters. The endemic of modular femoral neck fracture (24 cases of about 4000 implanted in fully modular total hip arthroplasty, popular in our country for the last 20 years, seems to challenge us with such an unfortunate consequences. The aim of this report was to analyze the extent and the causes of the problem on the one hand and to propose possible solutions on the other.Methods: Literature search for problems associated with Profemur Z (or earlier versions with the same taper-cone design fully-modular femoral stem made of titanium alloy (Ti6Al4V was performed, and hip arthroplasty registries were searched to evaluate the failure rates of the mentioned design. Mechanisms of failure were studied to get in-depth understanding of this particular hip reconstruction device.Results: Since 2010 onwards, several case reports on catastrophic modular femoral neck fractures of Profemur Z were published. Te frst Slovenian case was described in 2012. The first two larger series with modular femoral neck fractures were published in 2016. Te Australian Joint Replacement Registry was the first to discover increased revision rates due to fractures of this hip reconstruction system. Public Agency of the Republic of Slovenia for Medicinal Products and Medical Devices (JAZMP received frst two reports regarding Profemur Z modular neck complication from abroad in 2010, the first Slovenian report was received in 2012, and altogether 7 reports from Slovenian hospitals were received until December 2016. Corrosion at the neck-taper interface, where two equal or different materials are subject to constant wear in the presence of body fluids, is assumed to be responsible for the unacceptable high failure rate.Conclusions: Manufacturers are responsible to produce and market only safe devices

  16. Assessment of asymmetric leg loading before and after total hip arthroplasty using instrumented shoes.

    Science.gov (United States)

    Martínez-Ramírez, Alicia; Weenk, Dirk; Lecumberri, Pablo; Verdonschot, Nico; Pakvis, Dean; Veltink, Peter H

    2014-02-28

    Total hip arthroplasty is a successful surgical treatment in patients with osteoarthritis of the hip. Different questionnaires are used by the clinicians to assess functional capacity and the patient's pain, despite these questionnaires are known to be subjective. Furthermore, many studies agree that kinematic and kinetic parameters are crucial to evaluate and to provide useful information about the patient's evolution for clinicians and rehabilitation specialists. However, these quantities can currently only be obtained in a fully equipped gait laboratory. Instrumented shoes can quantify gait velocity, kinetic, kinematic and symmetry parameters. The aim of this study was to investigate whether the instrumented shoes is a sufficiently sensitive instrument to show differences in mobility performance before and after total hip arthroplasty. In this study, patients undergoing total hip arthroplasty were measured before and 6-8 months after total hip arthroplasty. Both measurement sessions include 2 functional mobility tasks while the subject was wearing instrumented shoes. Before each measurement the Harris Hip Score and the Traditional Western Ontario and McMaster Universities osteoarthritis index were administered as well. The stance time and the average vertical ground reaction force measured with the instrumented shoes during walking, and their symmetry index, showed significant differences before and after total hip arthroplasty. However, the data obtained with the sit to stand test did not reveal this improvement after surgery. Our results show that inter-limb asymmetry during a walking activity can be evaluated with the instrumented shoes before and after total hip arthroplasty in an outpatient clinical setting.

  17. Management of pelvic discontinuity in revision total hip arthroplasty: a review of the literature.

    Science.gov (United States)

    Abdelnasser, Mohammad K; Klenke, Frank M; Whitlock, Patrick; Khalil, Aly M; Khalifa, Yaser E; Ali, Hassan M; Siebenrock, Klaus A

    2015-01-01

    Pelvic discontinuity is a complex problem in revision total hip arthroplasty. Although rare, the incidence is likely to increase due to the ageing population and the increasing number of total hip arthroplasties being performed. The various surgical options available to solve this problem include plating, massive allografts, reconstruction rings, custom triflanged components and tantalum implants. However, the optimal solution remains controversial. None of the known methods completely solves the major obstacles associated with this problem, such as restoration of massive bone loss, implant failure in the short- and long-term and high complication rates. This review discusses the diagnosis, decision making, and treatment options of pelvic discontinuity in revision total hip arthroplasty.

  18. 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....

  19. 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...

  20. 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.

  1. Postoperative effects of neuromuscular exercise prior to hip or knee arthroplasty

    DEFF Research Database (Denmark)

    Villadsen, Allan; Overgaard, Søren; Holsgaard-Larsen, Anders

    2014-01-01

    neuromuscular exercise prior to total joint arthroplasty (TJA) of the hip or knee did not confer additional benefits 3 months postoperatively compared with TJA alone. However, the intervention group experienced a statistically significant short-term benefit in ADL and pain, suggesting an earlier onset......OBJECTIVE: To investigate the postoperative efficacy of a supervised programme of neuromuscular exercise prior to hip or knee arthroplasty. METHODS: In this assessor-blinded randomised controlled trial, we included 165 patients scheduled for hip or knee arthroplasty due to severe osteoarthritis (OA......). An 8-week preoperative neuromuscular supervised exercise programme was delivered twice a week for 1 h as adjunct treatment to the standard arthroplasty procedure and compared with the standard arthroplasty procedure alone. The primary outcome was self-reported physical function measured...

  2. Formation of a large rice body-containing cyst following total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Issack Paul S

    2012-06-01

    Full Text Available Abstract Background There are several well-described causes of a painful mass following total hip arthroplasty including polyethylene and metal wear debris, infection, expanding hematoma, dislocation, and synovial cysts. In addition to causing pain, these lesions, when large enough, may cause neurologic and vascular compromise. Rapid growth of the mass may clinically and radiographically resemble a sarcoma. Here, we report a case of a large painful hip mass which developed after total hip arthroplasty. The well-circumscribed mass was overlying and extending into the hip joint containing thousands of highly organized fibrin-containing “rice bodies”. To our knowledge, this is the first report of a large, highly organized (rice-body-containing cyst complicating total hip arthroplasty. Case presentation A 55-year old Caucasian woman developed a large, slowly enlarging, painful hip mass 2 1/2 years after primary total hip arthroplasty. Clinically and radiographically, the lesion resembled a soft tissue sarcoma. Surgical removal identified a well-circumscribed mass extending into the hip joint containing thousands of highly organized fibrin-containing “rice bodies”. Conclusion Identification and excision of this “pseudotumor” following hip arthroplasty is important for obtaining a definitive diagnosis, ruling out malignancy or infection and relieving any potential compression on surrounding neurovascular structures.

  3. Modular Fluted Tapered Stems in Aseptic Revision Total Hip Arthroplasty.

    Science.gov (United States)

    Abdel, Matthew P; Cottino, Umberto; Larson, Dirk R; Hanssen, Arlen D; Lewallen, David G; Berry, Daniel J

    2017-05-17

    Modular fluted tapered stems have become the most commonly employed category of femoral component in revision hip arthroplasty in North America as a result of favorable early results and simplicity of use. Despite wide adoption, the majority of published data are limited to relatively small series with modest follow-up. The goal of the current study was to determine the success rate and factors associated with success, failure, and complications of the use of modular fluted tapered stems in aseptic revision total hip arthroplasties (THAs) in a large patient cohort. We identified 519 aseptic femoral revisions during which a modular fluted tapered stem was utilized. Clinical outcomes, Kaplan-Meier survivorship, radiographic outcomes, and complications were assessed. The mean age at revision arthroplasty was 70 years, the mean body mass index (BMI) was 29 kg/m, and the mean duration of follow-up was 4.5 years (range, 2 to 14 years). The mean Harris hip score (HHS) improved significantly from 51 points preoperatively to 76 points at 2 years (p revisions had been performed: 6 because of aseptic loosening, 4 because of infection, 3 because of instability, 2 because of periprosthetic fracture, and 1 because of stem fracture. The 10-year survivorship was 96% with revision for any reason as the end point and 90% with any reoperation as the end point. Of the patients who were alive and had not undergone revision at the time of final follow-up, 12 had stem subsidence but all but 1 of these stems had stabilized after subsiding. Postoperative complications were noted in 12% of the cases. Repeat revision due to femoral component loosening was not correlated with the preoperative bone-loss category or patient demographic factors. In this large series, femoral revision with a modular fluted tapered stem provided a high rate of osseointegration and sustained improvement in clinical scores at the time of the last follow-up. There was also a high rate of successful implant fixation

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

    DEFF Research Database (Denmark)

    Nissen, Nina; Douw, Karla; Overgaard, Søren

    2011-01-01

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

  5. 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

  6. Indirect lateral surgical approach modified in hip arthroplasty

    International Nuclear Information System (INIS)

    Sanchez, Pedro Antonio; Arbelaez, William Rafael

    2006-01-01

    The authors show an another option to the surgical approach to the hip, a lateral indirect modified (ALIM) for the partial or total arthroplasty of primary hip replacement and for revision (RTC), in a retrospective study, series of cases, with average was 7,75 years of follow up (range 6 months-10 years); quick access, easy technically, provide a good orientation of the components of the placement of implants, and allow an excellent exhibition for the complex problems of the reconstruction of the acetabular and the femur. Leaves intact the greater trochanter, improving the rotational stability that is needed in its femoral implant, doesn't injured the gluteus medius and doesn't produces his deficit, reduce the time for the deambulation. This approach is designed for primary cases and complex cases of revision using the mini-incision, with better exposition and less morbid-mortality associated to the surgical technique due to the less bleeding, less incidence of dislocation, thromboembolism and infection because of the little damage and better control of the surrounding soft tissue; better stability, no paralysis or lesion of the sciatic or femoral nerve without incidence of heterotopic ossifications with a better range of external rotation in extension of the hip that with traditional approach of Hardinge, and greater versatility in its indications

  7. Dislocation and its recurrence after revision total hip arthroplasty.

    Science.gov (United States)

    Yoshimoto, Kensei; Nakashima, Yasuharu; Yamamoto, Takuaki; Fukushi, Jun-Ichi; Motomura, Goro; Ohishi, Masanobu; Hamai, Satoshi; Iwamoto, Yukihide

    2016-08-01

    Dislocation is a leading cause of failure after revision total hip arthroplasty (THA). This study was conducted to examine the risk factors for dislocation as well as their recurrence after revision THA. We retrospectively reviewed 178 revision THAs in 162 patients between 1998 and 2013. The mean patient age was 65.2 years at operation and the mean follow-up period was 6.7 years. Multivariate logistic regression was performed to identify risk factors for dislocation, and further comparison was made between patients with single and recurrent dislocations. Sixteen hips in 15 patients (9.0 %) dislocated at a mean of 9.1 months (range, 0-83 months) after revision THA. Multivariate analysis identified advanced age (odds ratio [OR] = 2.94/10 years) and osteonecrosis of the femoral head (OR = 7.71) as the independent risk factors for any dislocations. Risk factors for recurrent dislocations, which were observed in eight hips (50 %), were later dislocations (≥4 months) and lower BMI. Dislocation is a serious problem after revision THA with multiple risk factors. Although our findings were limited to revision THAs done through posterolateral approach, recognition of these factors is helpful in patient education and surgical planning.

  8. Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures.

    Science.gov (United States)

    Dicks, Kristen V; Baker, Arthur W; Durkin, Michael J; Anderson, Deverick J; Moehring, Rebekah W; Chen, Luke F; Sexton, Daniel J; Weber, David J; Lewis, Sarah S

    2015-12-01

    To determine the association (1) between shorter operative duration and surgical site infection (SSI) and (2) between surgeon median operative duration and SSI risk among first-time hip and knee arthroplasties. Retrospective cohort study A total of 43 community hospitals located in the southeastern United States. Adults who developed SSIs according to National Healthcare Safety Network criteria within 365 days of first-time knee or hip arthroplasties performed between January 1, 2008 and December 31, 2012. Log-binomial regression models estimated the association (1) between operative duration and SSI outcome and (2) between surgeon median operative duration and SSI outcome. Hip and knee arthroplasties were evaluated in separate models. Each model was adjusted for American Society of Anesthesiology score and patient age. A total of 25,531 hip arthroplasties and 42,187 knee arthroplasties were included in the study. The risk of SSI in knee arthroplasties with an operative duration shorter than the 25th percentile was 0.40 times the risk of SSI in knee arthroplasties with an operative duration between the 25th and 75th percentile (risk ratio [RR], 0.40; 95% confidence interval [CI], 0.38-0.56; Poperative duration did not demonstrate significant association with SSI for hip arthroplasties (RR, 1.04; 95% CI, 0.79-1.37; P=.36). Knee arthroplasty surgeons with shorter median operative durations had a lower risk of SSI than surgeons with typical median operative durations (RR, 0.52; 95% CI, 0.43-0.64; Poperative durations were not associated with a higher SSI risk for knee or hip arthroplasty procedures in our analysis.

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

    Directory of Open Access Journals (Sweden)

    Fernando M. Judas

    2015-01-01

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

  10. Changes in collagen metabolites in serum after cemented hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Joerring, S; Jensen, L T

    1993-01-01

    Markers of types I and III collagen turnover were measured in serial blood samples collected preoperatively and 60 days after surgery in 13 patients undergoing cemented total hip arthroplasty and 11 patients undergoing cemented total knee arthroplasty. The markers were the carboxyterminal extension...

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

    NARCIS (Netherlands)

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

    2008-01-01

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

  12. Low Risk of Thromboembolic Events After Routine Administration of Tranexamic Acid in Hip and Knee Arthroplasty

    DEFF Research Database (Denmark)

    Madsen, Rune V; Nielsen, Christian S.; Kallemose, Thomas

    2017-01-01

    BACKGROUND: The blood-conserving effect of intravenous (IV) tranexamic acid (TXA) is well-documented for total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, the risk of thromboembolic (TE) events after routine use of TXA is unclear and the safety profile is debated. This retr...

  13. People who undergo revision arthroplasty report more limitations but no decrease in physical activity compared with primary total hip arthroplasty : an observational study

    NARCIS (Netherlands)

    Stevens, Martin; Hoekstra, Tsjerk; Wagenmakers, Robert; Bulstra, Sjoerd K.; van den Akker-Scheek, Inge

    2009-01-01

    Question: Do people who have had revision arthroplasty report more limitations and less physical activity than those after primary total hip arthroplasty? Can degree of limitation and physical activity be predicted by revision arthroplasty, after adjustment for age, gender, and Charnley

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

    Science.gov (United States)

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

    2006-01-01

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

  15. Ropivacaine pharmacokinetics after local infiltration analgesia in hip arthroplasty.

    Science.gov (United States)

    Affas, Fatin; Eksborg, Staffan; Wretenberg, Per; Olofsson, Christina; Stiller, Carl-Olav

    2014-10-01

    In this study, we determined the plasma concentration of ropivacaine by liquid chromatography-mass spectrometry for 30 hours after local infiltration analgesia in 15 patients with elective hip arthroplasty. The 95% upper prediction bound of maximal unbound plasma concentration of ropivacaine was 0.032 mg/L. Side effects sufficient to stop an IV infusion have been reported at arterial concentrations of 0.34 to 0.85 mg/L. Alpha-1-acid glycoprotein did not correlate with the fraction of unbound ropivacaine during the first 24 hours after local infiltration analgesia. No signs or symptoms of systemic local anesthetic toxicity were observed. The Clopper-Pearson 95% upper confidence limit for adverse signs was 0.218.

  16. Risk Factors for Early Revision after Total Hip Arthroplasty

    Science.gov (United States)

    Dy, Christopher J.; Bozic, Kevin J.; Pan, Ting Jung; Wright, Timothy M.; Padgett, Douglas E.; Lyman, Stephen

    2014-01-01

    Objective Revision total hip arthroplasty (THA) is associated with increased cost, morbidity, and technical challenge compared to primary THA. A better understanding of the risk factors for early revision is needed to inform strategies to optimize patient outcomes. Methods 207,256 patients who underwent primary THA between 1997–2005 in California and New York were identified from statewide databases. Unique patient identifiers were used to identify early revision THA (revision. Results The probabilities of undergoing early aseptic revision and early septic revision were 4% and less than 1% at 5 years, respectively. Women were 29% less likely than men to undergo early septic revision (prevision than privately-insured patients (p=0.01; prevision compared to hospitals performing >400 THA annually (prevision THA. Patient-level characteristics distinctly affect the risk of revision within 10 years, particularly if due to infection. Our findings reinforce the need for continued investigation of the predictors of early failure following THA. PMID:24285406

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

    Science.gov (United States)

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

    2010-01-01

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

  18. Should gram stains have a role in diagnosing hip arthroplasty infections?

    Science.gov (United States)

    Johnson, Aaron J; Zywiel, Michael G; Stroh, D Alex; Marker, David R; Mont, Michael A

    2010-09-01

    The utility of Gram stains in diagnosing periprosthetic infections following total hip arthroplasty has recently been questioned. Several studies report low sensitivity of the test, and its poor ability to either confirm or rule out infection in patients undergoing revision total hip arthroplasty. Despite this, many institutions including that of the senior author continue to perform Gram stains during revision total hip arthroplasty. We assessed the sensitivity, specificity, accuracy, and positive and negative predictive values of Gram stains from surgical-site samplings taken from procedures on patients with both infected and aseptic revision total hip arthroplasties. A review was performed on patients who underwent revision total hip arthroplasty between 2000 and 2007. Eighty-two Gram stains were performed on patients who had infected total hip arthroplasties and underwent revision procedures. Additionally, of the 410 revision total hip arthroplasties performed on patients who were confirmed infection-free, 120 Gram stains were performed. Patients were diagnosed as infected using multiple criteria at the time of surgery. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated from these Gram stain results. The Gram stain demonstrated a sensitivity and specificity of 9.8% and 100%, respectively. In this series, the Gram stain had a negative predictive value of 62%, a positive predictive value of 100%, and an accuracy of 63%. Gram stains obtained from surgical-site samples had poor sensitivity and poor negative predictive value. Based on these findings, as well as those of other authors, we believe that Gram stains should no longer be considered for diagnosing infections in revision total hip arthroplasty. Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

  19. Assessment and management of chronic pain in patients with stable total hip arthroplasty

    OpenAIRE

    Classen, Tim; Zaps, Daniela; Landgraeber, Stefan; Li, Xinning; Jäger, Marcus

    2012-01-01

    Total hip arthroplasty (THA) is one of the most successful operations that can restore function and relieve pain. Although a majority of the patients achieve significant pain relief after THA, there are a number of patients that develop chronic pain for unknown reasons. A literature search was performed looking for chronic pain after total hip arthroplasty and stable THA. Major causes of chronic pain include aseptic loosening or infection. However, there is a subset of patients with a stable ...

  20. Total femoral allograft with simultaneous revision total hip and knee arthroplasty: 18 year follow-up

    Directory of Open Access Journals (Sweden)

    Ryan N. Harris, DO

    2015-09-01

    Full Text Available Massive allograft can be a useful option in revision total joint arthroplasty for treatment of significant bone loss. In rare cases, revision hip and knee arthroplasty procedures can be performed simultaneously using massive allograft-prosthetic composites. We present an 18 year follow up of a patient who received a simultaneous revision hip and knee total femoral allograft and discuss recent literature as it relates to this case.

  1. Simultaneous Periprosthetic Fractures of the Femur and the Acetabulum After Bipolar Hip Arthroplasty

    OpenAIRE

    Verettas, Dionysios-Alexandros; Chloropoulou, Pelagia-Paraskevi; Drosos, Georgios; Vogiatzaki, Theodosia; Tilkeridis, Konstantinos; Kazakos, Konstantinos

    2016-01-01

    Patient: Female, 68 Final Diagnosis: Periprosthetic fractures of the acetabulum and femur after bipolar hip arthroplasty Symptoms: Inability to walk Medication: ? Clinical Procedure: Revision cup and internal fixation femur Specialty: Orhopedics and Traumatology Objective: Rare co-existance of disease or pathology Background: Although periprosthetic fractures of the femur are a recognized complication of total hip arthroplasty, periprosthetic fractures of the acetabulum are rare. Simultaneous...

  2. The result of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a polyethylene liner.

    Science.gov (United States)

    Kwak, Hong Suk; Yoo, Jeong Joon; Lee, Young-Kyun; Koo, Kyung-Hoi; Yoon, Kang Sup; Kim, Hee Joong

    2015-03-01

    Wear cannot be completely prevented after total hip arthroplasty. If severe polyethylene (PE) liner wear develops, the so-called catastrophic failure occurs and metallosis develops. We postulated that longevity of the new implant may be affected after revision surgery for metallosis following a catastrophic failure of a PE liner due to the substantial amount of PE wear particles and infiltration of the metal particles in this catastrophic condition. Twenty-three hips of 23 patients were identified because they showed metallosis during revision total hip arthroplasties performed in Seoul National University Hospital between January 1996 and August 2004. They were followed for at least 6.5 years after the index revision total hip arthroplasty. The clinical and radiological results of revision total hip arthroplasties in these patients were evaluated. The median Harris hip score increased from 60 points before revision total hip arthroplasties to 90 points at the final follow-up. Osteolysis was detected at an average of 9.3 years after revision total hip arthroplasties in 13 hips and acetabular cup loosening at average 9.8 years after revision total hip arthroplasties in 9 hips. With radiographic evidence of osteolysis and loosening as the end points, the 15-year survival rates were 28.2% and 56.0%, respectively. The survival rate of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a PE liner was low.

  3. Early loosening and secondary dislocation due to a broken trochanteric osteotomy wire following a Charnley total hip arthroplasty: a case report

    OpenAIRE

    Shahin, Yousef; Choudhary, Rakesh; Al-Naser, Saeed; Mullins, Mark

    2009-01-01

    We report a case of interposition of a broken trochanteric wire in the hip joint. This caused early wear of the prosthesis and dislocation of the Charnley total hip arthroplasty. The patient was treated with a revision total hip arthroplasty. This rare complication should be taken into consideration when performing a trochanteric osteotomy fixation with wiring in Charnley total hip arthroplasty.

  4. Challenges in Total Hip Arthroplasty in the Setting of Developmental Dysplasia of the Hip.

    Science.gov (United States)

    Greber, Eric M; Pelt, Christopher E; Gililland, Jeremy M; Anderson, Mike B; Erickson, Jill A; Peters, Christopher L

    2017-09-01

    Developmental dysplasia of the hip (DDH) is a recognized cause of secondary arthritis, which may eventually lead to total hip arthroplasty (THA). An understanding of the common acetabular and femoral morphologic abnormalities will aid the surgeon in preparing for the complexity of the surgical case. We present the challenges associated with acetabular and femoral morphologies that may be present in the dysplastic hip and discuss surgical options to consider when performing THA. In addition, common complications associated with this population are reviewed. The complexity of THA in the DDH patient is due to a broad range of pathomorphologic changes of the acetabulum and femur, as well as the diverse and often younger age of these patients. As such, THA in the DDH patient may offer a typical primary hip arthroplasty or be a highly complex reconstruction. It is important to be familiar with all the subtleties associated with DDH in the THA population. The surgeon must be prepared for bone deficiency when reconstructing the acetabulum and should place the component low and medial (at the anatomic hip center), and avoid oversizing the acetabular component. Femoral dysplasia is also complex and variable, and the surgeon must be prepared for different stem choices that allow for decoupling of the metaphyseal stem fit from the implanted stem version. In Crowe III and IV dysplasia, femoral derotation/shortening osteotomy may be required. Many complications associated with THA in the DDH patient may be mitigated with careful planning and surgical technique. Performed correctly, THA can yield excellent results in this complex patient population. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Régis Pailhé

    2013-07-01

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

  6. Revision for prosthetic joint infection following hip arthroplasty: Evidence from the National Joint Registry.

    Science.gov (United States)

    Lenguerrand, E; Whitehouse, M R; Beswick, A D; Jones, S A; Porter, M L; Blom, A W

    2017-06-01

    We used the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) to investigate the risk of revision due to prosthetic joint infection (PJI) for patients undergoing primary and revision hip arthroplasty, the changes in risk over time, and the overall burden created by PJI. We analysed revision total hip arthroplasties (THAs) performed due to a diagnosis of PJI and the linked index procedures recorded in the NJR between 2003 and 2014. The cohort analysed consisted of 623 253 index primary hip arthroplasties, 63 222 index revision hip arthroplasties and 7585 revision THAs performed due to a diagnosis of PJI. The prevalence, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression. We demonstrated a prevalence of revision THA due to prosthetic joint infection of 0.4/100 procedures following primary and 1.6/100 procedures following revision hip arthroplasty. The prevalence of revision due to PJI in the three months following primary hip arthroplasty has risen 2.3-fold (95% confidence interval (CI) 1.3 to 4.1) between 2005 and 2013, and 3.0-fold (95% CI 1.1 to 8.5) following revision hip arthroplasty. Over 1000 procedures are performed annually as a consequence of hip PJI, an increase of 2.6-fold between 2005 and 2013. Although the risk of revision due to PJI following hip arthroplasty is low, it is rising and, coupled with the established and further predicted increased incidence of both primary and revision hip arthroplasty, this represents a growing and substantial treatment burden. Cite this article : E. Lenguerrand, M. R. Whitehouse, A. D. Beswick, S. A. Jones, M. L. Porter, A. W. Blom. Revision for prosthetic joint infection following hip arthroplasty: Evidence from the National Joint Registry. Bone Joint Res 2017;6:391-398. DOI: 10.1302/2046-3758.66.BJR-2017-0003.R1. © 2017 Lenguerrand et al.

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

    DEFF Research Database (Denmark)

    Deleuran, Thomas; Overgaard, Søren; Vilstrup, Hendrik

    2016-01-01

    Background and purpose - There are limited data on risk factors for avascular necrosis of the hip, but cirrhosis has been proposed as a risk factor. We examined the association between cirrhosis and incidence of total hip arthroplasty for avascular necrosis. Methods - We used nationwide healthcare......,052 reference individuals. Their median age was 57 years, and 65% were men. 45 cirrhosis patients and 44 reference individuals underwent total hip arthroplasty for avascular necrosis. Cirrhosis patients' HR for a total hip arthroplasty for avascular necrosis was 10 (95% CI: 6-17), yet their 5-year risk...... of avascular necrosis was only 0.2%. For the reference individuals, the 5-year risk was 0.02%. Interpretation - Cirrhosis is a strong risk factor for avascular necrosis of the hip, but it is rare even in cirrhosis patients....

  8. Midterm Outcomes of Revision Total Hip Arthroplasty Using a Modular Revision Hip System.

    Science.gov (United States)

    Smith, Marie Anne; Deakin, Angela H; Allen, David; Baines, Joe

    2016-02-01

    The growth in hip arthroplasty surgery has meant a corresponding escalating revision burden with increasing challenges for the orthopaedic surgeon. The purpose of this study was to review clinical outcomes of a modular revision hip system within a single institution. We retrospectively reviewed a cohort of modular revision hip system stems performed in our institution between January 2005 and October 2012 giving a potential minimum follow-up of 2 years. Clinical outcomes data on complications, Oxford Hip Score (OHS, 0-48) and patient satisfaction were collected. Radiographic outcomes including subsidence were assessed. Implant survival was estimated using Kaplan Meier analysis. 115 stems in 106 patients were identified. All cause survival was 82% (95%CIs: 73%-89%) at 6.1 years; survival excluding infection being 99% (95%CIs: 93%-100%). There was a low incidence of subsidence (seven stems) and no peri-prosthetic fractures. Primary cause of re-revision in this series was re-infection with only one re-revision for mechanical failure. Median Oxford Hip Score at mean follow up 4.1 years (2-9) was 40 (14-48) and 93% of patients reported being satisfied with their revision surgery. This study showed good clinical outcomes and survival using a modular revision stem with low mechanical failure and subsidence. Recurrence of infection remains a challenge in revision surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Total hip arthroplasty through a minimal posterior approach using imageless computer-assisted hip navigation.

    Science.gov (United States)

    Wixson, Richard L; MacDonald, Margot A

    2005-10-01

    With decreased exposure in a minimal posterior hip incision, navigation with computer assistance provides an alternative method to accurately place the components. This study compares the results of a series of 82 navigated total hips to a retrospective cohort of 50 hips done with conventional instruments. The surgical incision split the gluteus maximus but did not extend distally into the fascia. The goal of cup placement was 40 degrees to 45 degrees of abduction (ABD) and 17 degrees to 23 degrees of flexion (FLX). Postoperative radiographs were digitized and analyzed. In the study group, 82 hips were done with computer assistance and compared with 50 done with conventional methods (manual) through the same incision. Radiographic analysis showed that there were significantly fewer cases inside the desired range of ABD and FLX in the manual group (6%) compared with the navigation group (30%), P = .001, with significant differences in the variances of ABD and FLX (P = .011 and .028). Improved accuracy of cup placement was found with increased experience in the use of navigation by the surgeon over the time of the series. The use of a computer-assisted surgery navigation system with a minimal posterior incision for a total hip arthroplasty results in significantly more reproducible acetabular component placement.

  10. Hemorrhagic iliopsoas bursitis complicating well-functioning ceramic-on-ceramic total hip arthroplasty.

    Science.gov (United States)

    Park, Kyung Soon; Diwanji, Sanket R; Kim, Hyung Keun; Song, Eun Kyoo; Yoon, Taek Rim

    2009-08-01

    Iliopsoas bursitis has been increasingly recognized as a complication of total hip arthroplasty and is usually associated with polyethylene wear. Here, the authors report a case of hemorrhagic iliopsoas bursitis complicating an otherwise well-functioning ceramic-on-ceramic arthroplasty performed by minimal invasive modified 2-incision technique. The bursitis in turn resulted in femoral nerve palsy and femoral vein compression. In this report, there was no evidence to support that the bursitis was due to an inflammatory response to ceramic wear particles or any other wear particles originating from the total hip arthroplasty.

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

    Science.gov (United States)

    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). Materials and methods We compared the survival of primary THAs performed during the period 1995–2009 due to previous DDH, SCFE, Perthes’ disease, or primary OA, using merged individual-based data from the Danish, Norwegian, and Swedish arthroplasty registers, called the Nordic Arthroplasty Register Association (NARA). Cox multiple regression, with adjustment for age, sex, and type of fixation of the prosthesis was used to calculate the survival of the prostheses and the relative revision risks. Results 370,630 primary THAs were reported to these national registers for 1995–2009. Of these, 14,403 THAs (3.9%) 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 diseases and 93.8% after OA) (RR 1.0, CI: 1.0–1.1). Nevertheless, during the first 6 postoperative months more revisions were reported for THAs secondary to pediatric hip diseases (RR 1.2, CI: 1.0–1.5), mainly due to there being more revisions for dislocations (RR 1.8, CI: 1.4–2.3). Comparison between the different diagnosis groups showed that the overall risk of revision after DDH was higher than after OA (RR 1.1, CI: 1.0–1.2), whereas the combined

  12. Responsiveness and minimal important differences after revision total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Chiu Herng-Chia

    2010-11-01

    Full Text Available Abstract Background The health-related quality of life (HRQoL is currently weighted more heavily when evaluating health status, particularly regarding medical treatments and interventions. However, it is rarely used by physicians to compare responsiveness. Additionally, responsiveness estimates derived by the Harris Hip Score (HHS and the Short Form 36 (SF-36 before and after revision total hip arthroplasty (THA have not been clinically compared. This study compared responsiveness and minimal important differences (MID between HHS and SF-36. Methods All revision THA patients completed the disease-specific HHS and the generic SF-36 before and 6 months after surgery. Scores using these instruments were interpreted by generalized estimating equation (GEE before and after revision THA. The bootstrap estimation and modified Jacknife test were used to derive 95% confidence intervals for differences in the responsiveness estimates. Results Comparisons of effect size (ES, standardized response means (SRM, relative efficiency (RE (>1 and MID indicated that the responsiveness of HHS was superior to that of SF-36. The ES and SRM for pain and physical functions in the HHS were significantly larger than those of the SF-36 (p Conclusion The data in this study indicated that clinicians and health researchers should weight disease-specific measures more heavily than generic measures when evaluating treatment outcomes.

  13. Clinical Results and Serum Metal Ion Concentrations following Ceramic-on-Metal Total Hip Arthroplasty at a Mean Follow-Up of 60 Months

    Science.gov (United States)

    Maurer-Ertl, W.; Pranckh-Matzke, D.; Bratschitsch, G.; Maier, M.

    2017-01-01

    Background. Increased metal ion levels following total hip arthroplasty (THA) with metal-on-metal bearings are a highly debated topic. Local soft tissue reactions with chronic pain and systemic side effects such as neuropathy are described. The aim of the current study was to determine the serum metal ion concentrations of Cobalt (Co) and Chrome (Cr) after THA with a ceramic-on-metal (CoM) bearing. Patients and Methods. Between 2008 and 2010, 20 patients underwent THA using a CoM bearing. Clinical function was evaluated by standardized scores systems (Harris Hip Score and WOMAC Score) and radiological examination included X-rays. Patient's blood samples were obtained for metal ion analysis and correlation analysis was done between these results and implant position. Results. Overall, 13 patients with 14 CoM devices were available for the current series. The mean age at time of surgery was 61 years (range, 41 to 85). The postoperative follow-up ranged from 49 to 68 months (mean, 58). Metal ion determination showed mean concentrations of 3,1 µg/L (range, 0,3–15,2 µg/L) for Co and 1,6 µg/L (range, 0,1–5,5 µg/L) for Cr, respectively. A correlation between cup anteversion and Co and Cr concentrations was shown. Conclusion. The current series showed increments for Co and Cr following CoM THA. However, these levels are lower compared to metal ion concentrations in patients with metal-on-metal bearings and the international accepted threshold for revision of MoM devices. We recommend routine follow-up including at least one obligatory evaluation of serum metal ion concentrations and an MRI once to exclude local soft tissue reactions. PMID:28373980

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

    DEFF Research Database (Denmark)

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

    Introduction Periprosthetic bone loss is considered a predictor of aseptic loosening of the acetabular component in total hip arthroplasty. However, no studies have shown this association. This may be explained by the limitations of imaging methods previously used. Dual energy CT (DECT) has...... previously shown better delineation of the interface between bone and prosthesis and may be beneficial in quantitative analysis of bone loss close to the implant as compared to single energy computed tomography (SECT). The purpose of this porcine ex-vivo study was to test the intra-observer agreement...... and reliability of bone mineral density measurements (BMD) in close proximity of the acetabular cup using SECT and DECT images and 3D segmentation software. Materials and methods 22 acetabular cups (12 cemented, 10 un-cemented) were inserted in porcine hip specimens ex vivo. A femoral stem was attached to each...

  15. Longitudinal morphological change of acetabular subchondral bone cyst after total hip arthroplasty in developmental dysplasia of the hip.

    Science.gov (United States)

    Takada, Ryohei; Jinno, Tetsuya; Miyatake, Kazumasa; Yamauchi, Yuki; Koga, Daisuke; Yagishita, Kazuyoshi; Okawa, Atsushi

    2018-01-03

    The purpose of this study is to clarify morphological changes of acetabular subchondral bone cyst after total hip arthroplasty for osteoarthritis secondary to developmental dysplasia of the hip. Two hundred and sixty-one primary cementless total hip arthroplasties of 208 patients, 18 males, 190 females, were retrospectively reviewed. Morphological changes of subchondral bone cyst were evaluated by computed tomography (CT). The mean cross-sectional area of the cyst from CT scans at 3 months postoperatively and after 7-10 years (average 8.4 years) were compared. Acetabular subchondral bone cysts were found in 49.0% of all cases in preoperative CT scans. There was no cyst which was newly recognized in CT scan performed after postoperative 7-10 years. All the cross-sectional areas of the cysts evaluated in this study were reduced postoperatively. This study revealed that acetabular subchondral bone cysts do not increase or expand after total hip arthroplasty and indicated that the longitudinal morphological change of acetabular bone cysts in patients of developmental dysplasia of the hip do not influence long-term implant fixation in total hip arthroplasty.

  16. LEAK study : design of a nationwide randomised controlled trial to find the best way to treat wound leakage after primary hip and knee arthroplasty

    NARCIS (Netherlands)

    Löwik, Claudia A M; Wagenaar, Frank-Christiaan; van der Weegen, Walter; Poolman, Rudolf W; Nelissen, Rob G H H; Bulstra, Sjoerd K; Pronk, Yvette; Vermeulen, Karin M; Wouthuyzen-Bakker, Marjan; van den Akker-Scheek, Inge; Stevens, Martin; Jutte, Paul C

    2017-01-01

    INTRODUCTION: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are highly successful treatment modalities for advanced osteoarthritis. However, prolonged wound leakage after arthroplasty is linked to prosthetic joint infection (PJI), which is a potentially devastating complication. On

  17. Tissue preserving total hip arthroplasty using superior capsulotomy.

    Science.gov (United States)

    Capuano, N; Del Buono, A; Maffulli, N

    2015-08-01

    The goals of a tissue-preserving minimally invasive approach to the hip are to allow early short-term recovery, achieve hip joint stability, minimize muscle strength loss from surgery, spare the peri-articular soft tissues, and allow unrestricted motion in the long term. Hip arthroplasty in patients with no pre-existing hardware, with a sufficient space between the acetabular rim and greater trochanter; management of subcapital femoral fractures in older patients. Protrusio acetabuli. Joint stiffness. This is the main concern when undertaking the superior capsulotomy. Stiffness may result from bone causes, including ankylosis, large osteophytes, bone bridges etc., extra-articular retraction of surrounding soft tissues with capsular contracture of both ligaments and muscles, or a combination of bony and soft tissues causes, resulting in limited adduction. Indeed, maximal adduction is necessary to increase the distance between the apex of the greater trochanter and the superior acetabular edge. In the approach described in the present article, the real limitation is the impossibility to introduce a straight stem through the trochanteric fossa without weakening the trochantericarea. If adduction is restricted, excessive lateralization of the femoral stem would result in postoperative pain and discomfort, especially as we advocate immediate full weight bearing. Even though patients fare better when the trochanteric area is intact, many types of stem such as the GTS (Biomet), or stem Microplasty (Biomet) or even stem Parva (Adler Ortho) may pressurize the internal bone of the trochanteric structures. Therefore, these stems may be implanted in maximal hip adduction. This is the case in coxa profunda or coxa vara, which require more invasive and destabilizing surgical approaches. Lateral position, 5-8 cm incision from the tip of the greater trochanter, identification and transaction of piriformis tendon. Anterior mobilization of the gluteus minimus and exposure of the

  18. The Exeter Contemporary flanged cemented acetabular component in primary total hip arthroplasty.

    Science.gov (United States)

    Maggs, J L; Smeatham, A; Whitehouse, S L; Charity, J; Timperley, A J; Gie, G A

    2016-03-01

    We report on the outcome of the Exeter Contemporary flanged cemented all-polyethylene acetabular component with a mean follow-up of 12 years (10 to 13.9). This study reviewed 203 hips in 194 patients. 129 hips in 122 patients are still in situ; 66 hips in 64 patients were in patients who died before ten years, and eight hips (eight patients) were revised. Clinical outcome scores were available for 108 hips (104 patients) and radiographs for 103 hips (100 patients). A retrospective review was undertaken of a consecutive series of 203 routine primary cemented total hip arthroplasties (THA) in 194 patients. There were no acetabular component revisions for aseptic loosening. Acetabular revision was undertaken in eight hips. In four hips revision was necessitated by periprosthetic femoral fractures, in two hips by recurrent dislocation, in one hip for infection and in one hip for unexplained ongoing pain. Oxford and Harris hip scores demonstrated significant clinical improvement (all p Contemporary flanged cemented acetabular component demonstrates excellent survivorship at 12.5 years. The Exeter Contemporary flanged cemented acetabular component has excellent clinical outcomes and survivorship when used with the Exeter stem in total hip arthroplasty. ©2016 The British Editorial Society of Bone & Joint Surgery.

  19. Single-dose radiation therapy for prevention of heterotopic ossification after total hip arthroplasty

    International Nuclear Information System (INIS)

    Healy, W.L.; Lo, T.C.; Covall, D.J.; Pfeifer, B.A.; Wasilewski, S.A.

    1990-01-01

    Single-dose radiation therapy was prospectively evaluated for its efficacy in prevention of heterotopic ossification in patients at high risk after total hip arthroplasty. Thirty-one patients (34 hips) were treated between 1981 and 1988. Risk factors for inclusion in the protocol included prior evidence of heterotopic ossification, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis. Patients with hypertrophic osteoarthritis or traumatic arthritis with osteophytes were not included. Operations on 34 hips included 19 primary total and 11 revision total hip arthroplasties and 4 excisions of heterotopic ossification. All patients received radiotherapy to the hip after operation with a single dose of 700 centigray. Radiotherapy is recommended on the first postoperative day. After this single-dose radiation treatment, no patient had clinically significant heterotopic ossification. Recurrent disease developed in two hips (6%), as seen on radiography (grades 2 and 3). This series documents a 100% clinical success rate and a 94% radiographic success rate in preventing heterotopic ossification in patients at high risk after total hip arthroplasty. Single-dose radiotherapy is as effective as other radiation protocols in preventing heterotopic ossification after total hip arthroplasty. It is less expensive and easier to administer than multidose radiotherapy

  20. Revision rate after short-stem total hip arthroplasty: a systematic review of 49 studies

    NARCIS (Netherlands)

    van Oldenrijk, Jakob; Molleman, Jeroen; Klaver, Michel; Poolman, Rudolf W.; Haverkamp, Daniel

    2014-01-01

    The aim of short-stem total hip arthroplasty is to preserve proximal bone stock for future revisions, to improve biomechanical reconstruction, and to make minimally invasive approaches easier. It is therefore being increasingly considered to be a sound alternative to conventional total hip

  1. Single-dose radiation therapy for prevention of heterotopic ossification after total hip arthroplasty

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    Healy, W.L.; Lo, T.C.; Covall, D.J.; Pfeifer, B.A.; Wasilewski, S.A. (Lahey Clinic Medical Center, Burlington, MA (USA))

    1990-12-01

    Single-dose radiation therapy was prospectively evaluated for its efficacy in prevention of heterotopic ossification in patients at high risk after total hip arthroplasty. Thirty-one patients (34 hips) were treated between 1981 and 1988. Risk factors for inclusion in the protocol included prior evidence of heterotopic ossification, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis. Patients with hypertrophic osteoarthritis or traumatic arthritis with osteophytes were not included. Operations on 34 hips included 19 primary total and 11 revision total hip arthroplasties and 4 excisions of heterotopic ossification. All patients received radiotherapy to the hip after operation with a single dose of 700 centigray. Radiotherapy is recommended on the first postoperative day. After this single-dose radiation treatment, no patient had clinically significant heterotopic ossification. Recurrent disease developed in two hips (6%), as seen on radiography (grades 2 and 3). This series documents a 100% clinical success rate and a 94% radiographic success rate in preventing heterotopic ossification in patients at high risk after total hip arthroplasty. Single-dose radiotherapy is as effective as other radiation protocols in preventing heterotopic ossification after total hip arthroplasty. It is less expensive and easier to administer than multidose radiotherapy.

  2. A randomised, controlled clinical study on total hip arthroplasty using 4 different bearings

    DEFF Research Database (Denmark)

    Borgwardt, Arne; Zerahn, Bo; Fabricius, Sandra D

    2017-01-01

    PURPOSE: To compare 4 different bearings in total hip arthroplasty (THA) in a randomised controlled clinical study on clinical performance. METHODS: 393 patients with osteoarthritis of the hip or avascular necrosis were included and allocated to 1 of the head-and-cup couples zirconia...

  3. Prophylactic GSV surgery in elderly candidates for hip or knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Quarto Gennaro

    2016-01-01

    Full Text Available Aging is one of the major risk factors for varicose veins. The same is for Knee and Hip Osteoarthritis. Most of the patients undergoing to Hip (THA or Knee (TKA arthroplasty are over sixteen. Varicose veins, excluding thrombophilia, are the most significant risk factors for VTE after THA and TKA.

  4. An Insight into Methods and Practices in Hip Arthroplasty in Patients with Rheumatoid Arthritis

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    Mohammad Saeed Mosleh-shirazi

    2015-01-01

    Full Text Available Total hip arthroplasty (THA has improved the quality of life of patients with hip arthritis. Orthopedic community is striving for excellence to improve surgical techniques and postoperative care. Despite these efforts, patients continue facing postoperative complications. In particular, patients with rheumatoid arthritis display a higher risk of certain complications such as dislocation, periprosthetic infection, and shorter prosthesis durability. In this review we present the current knowledge of hip arthroplasty in patients with rheumatoid arthritis with more insight into common practices and interventions directed at enhancing recovery of these patients and current shortfalls.

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

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  6. The sit-to-stand movement: differences in performance between patients after primary total hip arthroplasty and revision total hip arthroplasty with acetabular bone impaction grafting

    NARCIS (Netherlands)

    Boonstra, M.C.; Schreurs, B.W.; Verdonschot, N.J.J.

    2011-01-01

    BACKGROUND: Little is known about the functional performance of patients after revision total hip arthroplasty with major acetabular bone impaction grafting. In general, these patients are assumed to perform worse due to a more advanced stage of periarticular tissue degeneration and multiple

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

    DEFF Research Database (Denmark)

    Löschner, Katrin; Harrington, Chris F.; Kearney, Jacque-Lucca

    2015-01-01

    Hip replacements are used to improve the quality of life of people with orthopaedic conditions, but the use of metal-on-metal (MoM) arthroplasty has led to poor outcomes for some patients. These problems are related to the generation of micro- to nanosized metal wear particles containing Cr, Co o...

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

    Science.gov (United States)

    2012-01-01

    Background and purpose The risk of revision due to infection after primary total hip arthroplasty (THA) has been reported to be increasing in Norway. We investigated whether this increase is a common feature in the Nordic countries (Denmark, Finland, Norway, and Sweden). Materials and methods The study was based on the Nordic Arthroplasty Register Association (NARA) dataset. 432,168 primary THAs from 1995 to 2009 were included (Denmark: 83,853, Finland 78,106, Norway 88,455, and Sweden 181,754). Adjusted survival analyses were performed using Cox regression models with revision due to infection as the endpoint. The effect of risk factors such as the year of surgery, age, sex, diagnosis, type of prosthesis, and fixation were assessed. Results 2,778 (0.6%) of the primary THAs were revised due to infection. Compared to the period 1995–1999, the relative risk (with 95% CI) of revision due to infection was 1.1 (1.0–1.2) in 2000–2004 and 1.6 (1.4–1.7) in 2005–2009. Adjusted cumulative 5–year revision rates due to infection were 0.46% (0.42–0.50) in 1995–1999, 0.54% (0.50–0.58) in 2000–2004, and 0.71% (0.66–0.76) in 2005–2009. The entire increase in risk of revision due to infection was within 1 year of primary surgery, and most notably in the first 3 months. The risk of revision due to infection increased in all 4 countries. Risk factors for revision due to infection were male sex, hybrid fixation, cement without antibiotics, and THA performed due to inflammatory disease, hip fracture, or femoral head necrosis. None of these risk factors increased in incidence during the study period. Interpretation We found increased relative risk of revision and increased cumulative 5–year revision rates due to infection after primary THA during the period 1995–2009. No change in risk factors in the NARA dataset could explain this increase. We believe that there has been an actual increase in the incidence of prosthetic joint infections after THA. PMID

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

    NARCIS (Netherlands)

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

    2002-01-01

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

  10. Gait symmetry and hip strength in women with developmental dysplasia following hip arthroplasty compared to healthy subjects : A cross-sectional study

    NARCIS (Netherlands)

    Leijendekkers, Ruud A.; Marra, Marco A.; Kolk, Sjoerd; Van Bon, Geert; Schreurs, B. Wim; Weerdesteyn, Vivian; Verdonschot, Nico

    2018-01-01

    Introduction: Untreated unilateral developmental dysplasia of the hip (DDH) results in asymmetry of gait and hip strength and may lead to early osteoarthritis, which is commonly treated with a total hip arthroplasty (THA). There is limited knowledge about the obtained symmetry of gait and hip

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

    Science.gov (United States)

    Deleuran, Thomas; Overgaard, Søren; Vilstrup, Hendrik; Jepsen, Peter

    2016-06-01

    Background and purpose - There are limited data on risk factors for avascular necrosis of the hip, but cirrhosis has been proposed as a risk factor. We examined the association between cirrhosis and incidence of total hip arthroplasty for avascular necrosis. Methods - We used nationwide healthcare data to identify all Danish residents diagnosed with cirrhosis in 1994-2011, and matched them 1:5 by age and sex to non-cirrhotic reference individuals from the general population. We excluded people with a previous total hip arthroplasty, a previous hip fracture, or a previous diagnosis of avascular necrosis. We used stratified Cox regression to estimate the hazard ratio (HR) for cirrhosis patients relative to reference individuals, adjusting for potential confounders. We used the cumulative incidence function to compute 5-year risks. Results - We included 25,421 cirrhosis patients and 114,052 reference individuals. Their median age was 57 years, and 65% were men. 45 cirrhosis patients and 44 reference individuals underwent total hip arthroplasty for avascular necrosis. Cirrhosis patients' HR for a total hip arthroplasty for avascular necrosis was 10 (95% CI: 6-17), yet their 5-year risk of avascular necrosis was only 0.2%. For the reference individuals, the 5-year risk was 0.02%. Interpretation - Cirrhosis is a strong risk factor for avascular necrosis of the hip, but it is rare even in cirrhosis patients.

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

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    Gavaskar Ashok S

    2012-12-01

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

  13. Infection burden in total hip and knee arthroplasties: an international registry-based perspective.

    Science.gov (United States)

    Springer, Bryan D; Cahue, September; Etkin, Caryn D; Lewallen, David G; McGrory, Brian J

    2017-06-01

    Infection remains a leading cause of failure of hip and knee replacements. Infection burden is the ratio of implants revised for infection to the total number of arthroplasties in a specific period, measuring the steady state of infection in a registry. We hypothesized infection burden would be similar among arthroplasty registries. We evaluated publicly reported data from 6 arthroplasty registries (Australian Orthopaedic Association National Joint Replacement Registry [AOANJRR], New Zealand Joint Registry, Swedish Hip Arthroplasty Register, Swedish Knee Arthroplasty Register, National Joint Registry of England, Wales, Northern Ireland, and the Isle of Man, and the American Joint Replacement Registry) for revisions performed with an infection diagnosis over the last 6 years. The 2015 hip infection burden varied between registries from 0.76% (AOANJRR) to 1.24% (Swedish Hip Arthroplasty Register), and the unweighted overall average for hip infection burden was 0.97%. In 2012, 2013, and 2014, average hip infection burden held steady at 0.87%, 0.93%, and 0.94%, respectively, higher than the preceding 2 years. The 2015 knee infection burden varied from 0.88% (AOANJRR) to 1.28% (Swedish Knee Arthroplasty Register), and the unweighted average was 1.03%. In 2012, 2013, and 2014, knee infection burden was 1.04%, 1.11%, and 1.02%, respectively. These numbers were also higher than the preceding 2 years. Infection burden may be one measure of the overall success in registry populations as well as monitoring the steady state of infection worldwide. Despite global efforts to reduce postoperative infection, infection burden has actually increased in the selected registries over time.

  14. Analysis of Femoral Components of Cemented Total Hip Arthroplasty

    Science.gov (United States)

    Singh, Shantanu; Harsha, A. P.

    2016-10-01

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

  15. Complications After Revision Total Hip Arthroplasty in the Medicare Population.

    Science.gov (United States)

    Badarudeen, Sameer; Shu, Albert C; Ong, Kevin L; Baykal, Doruk; Lau, Edmund; Malkani, Arthur L

    2017-06-01

    The purpose of this study was to identify the incidence and types of complications after revision total hip arthroplasty (THA) within the first year, and determine the relative risk factors for these complications and of re-revision. The sample size of 5% Medicare claims data from 1998-2011 was studied. Primary THA patients who underwent subsequent revision were identified using ICD-9-CM codes. Outcomes and complications after revision THA were assessed. Multivariate Cox regression was used to evaluate the effect of patient demographic characteristics on the adjusted complication risk for revision THA patients. Of the 64,260 primary THA patients identified between 1998 and 2011, 3555 patients (5.71%) underwent revision THA. Etiology of primary hip failure included mechanical complications such as loosening and wear (40.7%), dislocation (14.0%), and infection (11.3%). Complications after revision THA included infection and redo revision, 17.3% and 15.8% followed by venous thromboembolic disease (VTE) at 11.1%, dislocation at 5.43%, PE at 3.24%, and death at 2.11%. The rate of "new" infections after an aseptic revision was 8.13%. Patients in the 85+-year-old age group had a 100% greater adjusted risk of VTE (P revision THA (P = .011). Advanced age is a clear risk factor for VTE and mortality, but not for dislocation, infection, or re-revision. Higher Charlson index was found to be a risk factor for every complication after revision except dislocation. Greater attention is required to address the high rate of infection and re-do revision after revision THA (17.3% and 15.8%). Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Clinical Outcomes and 90-Day Costs Following Hemiarthroplasty or Total Hip Arthroplasty for Hip Fracture.

    Science.gov (United States)

    Nichols, Christine I; Vose, Joshua G; Nunley, Ryan M

    2017-09-01

    In the era of bundled payments, many hospitals are responsible for costs from admission through 90 days postdischarge. Although bundled episodes for hip fracture will have a separate target price for the bundle, little is known about the 90-day resource use burden for this patient population. Using Medicare 100% Standard Analytic Files (2010-2014), we identified patients undergoing hemiarthroplasty or total hip arthroplasty (THA). Patients were aged 65 and older with admitting diagnosis of closed hip fracture, no concurrent fractures of the lower limb, and no history of hip surgery in the prior 12 months baseline. Continuous Medicare-only enrollment was required. Complications, resource use, and mortality from admission through 90 days following discharge (follow-up) were summarized. Four cohorts met selection criteria for analysis: (1) hemiarthroplasty diagnosis-related group (DRG) 469 (N = 19,634), (2) hemiarthroplasty DRG 470 (N = 77,744), (3) THA DRG 469 (N = 1686), and (4) THA DRG 470 (N = 9314). All-cause mortality during the study period was 51.6%, 29.5%, 48.1%, and 24.9% with mean 90-day costs of $28,952, $19,243, $29,763, and $18,561, respectively. Most of the patients waited 1 day from admission to surgery (41%-51%). Incidence of an all-cause complication was approximately 70% in each DRG 469 cohort and 14%-16% in each DRG 470 cohort. This study confirms patients with hip fracture are a costly subpopulation. Tailored care pathways to minimize post-acute care resource use are warranted for these patients. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  17. Calibration Markers for Digital Templating in Total Hip Arthroplasty.

    Directory of Open Access Journals (Sweden)

    Christoph Kolja Boese

    Full Text Available Digital templating with external calibration markers is the standard method for planning total hip arthroplasty. We determined the geometrical basis of the magnification effect, compared magnification with external and internal calibration markers, and examined the influence on magnification of the position of the calibration markers, patient weight, and body mass index (BMI. A formula was derived to calculate magnification with internal and external calibration markers, informed by 100 digital radiographs of the pelvis. Intraclass correlations between the measured and calculated values and the strength of relationships between magnification, position and distance of calibration markers and height, weight, and BMI were sought. There was a weak correlation between magnification of internal and external calibration markers (r = 0.297-0.361; p < 0.01. Intraclass correlations were 0.882-1.000 (p = 0.000 for all parameters. There were also weak correlations between magnification of internal and external calibration markers and weight and BMI (r = 0.420, p = 0.000; r = 0.428, p = 0.000, respectively. The correlation between external and internal calibration markers was poor, indicating the need for more accurate calibration methods. While weight and BMI weakly correlated with the magnification of markers, future studies should examine this phenomenon in more detail.

  18. Calibration Markers for Digital Templating in Total Hip Arthroplasty.

    Science.gov (United States)

    Boese, Christoph Kolja; Lechler, Philipp; Rose, Leonard; Dargel, Jens; Oppermann, Johannes; Eysel, Peer; Geiges, Hansjörg; Bredow, Jan

    2015-01-01

    Digital templating with external calibration markers is the standard method for planning total hip arthroplasty. We determined the geometrical basis of the magnification effect, compared magnification with external and internal calibration markers, and examined the influence on magnification of the position of the calibration markers, patient weight, and body mass index (BMI). A formula was derived to calculate magnification with internal and external calibration markers, informed by 100 digital radiographs of the pelvis. Intraclass correlations between the measured and calculated values and the strength of relationships between magnification, position and distance of calibration markers and height, weight, and BMI were sought. There was a weak correlation between magnification of internal and external calibration markers (r = 0.297-0.361; p < 0.01). Intraclass correlations were 0.882-1.000 (p = 0.000) for all parameters. There were also weak correlations between magnification of internal and external calibration markers and weight and BMI (r = 0.420, p = 0.000; r = 0.428, p = 0.000, respectively). The correlation between external and internal calibration markers was poor, indicating the need for more accurate calibration methods. While weight and BMI weakly correlated with the magnification of markers, future studies should examine this phenomenon in more detail.

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

    Science.gov (United States)

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

    2017-02-01

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

  20. 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

  1. 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

    2018-03-22

    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.

  2. Hip-inspired implant for revision of failed reverse shoulder arthroplasty with severe glenoid bone loss

    OpenAIRE

    Uri, Ofir; Bayley, Ian; Lambert, Simon

    2014-01-01

    Background and purpose Glenoid reconstruction and inverted glenoid re-implantation is strongly advocated in revisions of failed reverse shoulder arthroplasty (RSA). Nevertheless, severe glenoid deficiency may preclude glenoid reconstruction and may dictate less favorable solutions, such as conversion to hemiarthropasty or resection arthropasty. The CAD/CAM shoulder (Stanmore Implants, Elstree, UK), a hip arthroplasty-inspired implant, may facilitate glenoid component fixation in these challen...

  3. Modifiable Risk Factors Are Common in Early Revision Hip and Knee Arthroplasty.

    Science.gov (United States)

    Kee, James R; Mears, Simon C; Edwards, Paul K; Barnes, C Lowry

    2017-12-01

    Obesity, smoking, uncontrolled diabetes, and poor dental health are modifiable risk factors for revision total joint arthroplasty. To protect patients from revision surgery while also reducing cost, some joint arthroplasty practices use these conditions as contraindications until they are improved. However, this practice is variable among joint arthroplasty surgeons. We hypothesize that a relatively high rate of revision arthroplasty patients had modifiable risk factors at the time of primary surgery. A retrospective review of all revision total hip and knee arthroplasties performed at an academic, tertiary referral center within 2 years of primary surgery was conducted. The presence of body mass index >40, hemoglobin A1c >8, poor dentition, and smoking status were obtained from the electronic medical record. Risk factors were described and compared between infected revisions and noninfected revisions. A total of 128 revision arthroplasties were performed at our institution in one year. And 23 of 57 (40.4%) total hip revision and 31 of 71 (43.7%) total knee revision patients had at least 1 modifiable risk factor. Infected hip revision patients were more likely to have increased body mass index compared to noninfected patients. Infected knee revision patients were more likely to smoke, have poor dentition, and have >1 contraindication compared to noninfected patients. A high percentage of patients undergoing early revision arthroplasty had at least 1 modifiable risk factor for a primary joint arthroplasty. Joint arthroplasty surgeons may help reduce revision surgery through counseling and appropriate referral for modification of risk factors. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Wael Bayoud

    2017-01-01

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

  5. 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.

  6. Direct Repair of the Superior Band of Bigelow's Ligament After Hip Arthroplasty: a Surgical Technique.

    Science.gov (United States)

    Liu, Joseph; McLawhorn, Alexander S; Christ, Alexander B; Dzenis, Peteris; Healey, John H

    2016-07-01

    The posterolateral approach is one of the most common approaches used during hip arthroplasty. A posterior soft tissue repair is necessary to limit the risk of postoperative dislocation. For a trapezoidal capsulotomy, the proximal limb divides the superior band of the iliofemoral ligament (Bigelow's ligament). A transosseous repair frequently leaves a defect in this region, which may elevate the risk for dislocation. The purpose of this article is to describe a simple, rational technique for reinforcing the posterior capsular repair. A meticulous exposure of the hip capsule is performed during the posterolateral surgical approach. A trapezoidal capsulotomy is performed. After implantation of the arthroplasty implants, retractors are placed to expose the superior capsule. Prior to transosseous repair of the capsule and short external rotator tendons, the proximal limb of the capsulotomy is reapproximated anatomically and repaired with non-absorbable sutures. If anatomical repair is not possible, leg length and femoral offset should be reassessed carefully. The described modification may further minimize the risk of dislocation following hip arthroplasty, as the superior band of Bigelow's ligament is an additional checkrein to internal and external rotation. This repair provides a secondary intraoperative assessment of leg length and femoral offset to ensure proper biomechanical reconstruction of the hip joint. It is the authors' preferred technique of all hip hemiarthroplasties and total hip arthroplasties, whenever possible.

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

    International Nuclear Information System (INIS)

    Massat, B.J.; Vasseur, P.B.

    1994-01-01

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

  8. Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty.

    Science.gov (United States)

    Anderson, David R; Dunbar, Michael; Murnaghan, John; Kahn, Susan R; Gross, Peter; Forsythe, Michael; Pelet, Stephane; Fisher, William; Belzile, Etienne; Dolan, Sean; Crowther, Mark; Bohm, Eric; MacDonald, Steven J; Gofton, Wade; Kim, Paul; Zukor, David; Pleasance, Susan; Andreou, Pantelis; Doucette, Steve; Theriault, Chris; Abianui, Abongnwen; Carrier, Marc; Kovacs, Michael J; Rodger, Marc A; Coyle, Doug; Wells, Philip S; Vendittoli, Pascal-Andre

    2018-02-22

    Clinical trials and meta-analyses have suggested that aspirin may be effective for the prevention of venous thromboembolism (proximal deep-vein thrombosis or pulmonary embolism) after total hip or total knee arthroplasty, but comparisons with direct oral anticoagulants are lacking for prophylaxis beyond hospital discharge. We performed a multicenter, double-blind, randomized, controlled trial involving patients who were undergoing total hip or knee arthroplasty. All the patients received once-daily oral rivaroxaban (10 mg) until postoperative day 5 and then were randomly assigned to continue rivaroxaban or switch to aspirin (81 mg daily) for an additional 9 days after total knee arthroplasty or for 30 days after total hip arthroplasty. Patients were followed for 90 days for symptomatic venous thromboembolism (the primary effectiveness outcome) and bleeding complications, including major or clinically relevant nonmajor bleeding (the primary safety outcome). A total of 3424 patients (1804 undergoing total hip arthroplasty and 1620 undergoing total knee arthroplasty) were enrolled in the trial. Venous thromboembolism occurred in 11 of 1707 patients (0.64%) in the aspirin group and in 12 of 1717 patients (0.70%) in the rivaroxaban group (difference, 0.06 percentage points; 95% confidence interval [CI], -0.55 to 0.66; Paspirin group and in 5 (0.29%) in the rivaroxaban group (difference, 0.18 percentage points; 95% CI, -0.65 to 0.29; P=0.42). Clinically important bleeding occurred in 22 patients (1.29%) in the aspirin group and in 17 (0.99%) in the rivaroxaban group (difference, 0.30 percentage points; 95% CI, -1.07 to 0.47; P=0.43). Among patients who received 5 days of rivaroxaban prophylaxis after total hip or total knee arthroplasty, extended prophylaxis with aspirin was not significantly different from rivaroxaban in the prevention of symptomatic venous thromboembolism. (Funded by the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT01720108 .).

  9. Are Trends in Total Hip Arthroplasty Bearing Surface Continuing to Change? 2007-2015 Usage in a Large Database Cohort.

    Science.gov (United States)

    Bedard, Nicholas A; Burnett, Robert A; DeMik, David E; Gao, Yubo; Liu, Steve S; Callaghan, John J

    2017-12-01

    Bearing surface issues related to trunnionosis or metal-on-metal (MoM) articulations have likely impacted recent trends in bearing surface choice. The purpose of this study is to evaluate trends in total hip arthroplasty (THA) bearing surface use, including 2015 data, with respect to the date of operation and patient demographics. The Humana dataset was reviewed from 2007 through 2015 to analyze bearing surface usage in primary THA. Four bearing surface types were identified by International Classification of Disease, 10th Revision codes and trended throughout the years: metal-on-polyethylene (MoP), ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoP), and MoM. Prevalence was analyzed as a function of age and sex. Of the 28,504 primary THA procedures, the most commonly used bearing was MoP (46.1%), followed by CoP (33.2%), MoM (17.1%), and ceramic-on-ceramic (3.6%). The use of CoP bearings significantly increased from 6.4% in 2007 to 52.0% in 2015, while MoM bearings decreased during this period. MoP bearings decreased over 2012-2015 (P bearings increased with a transition occurring at 65-69 years of age. Women were more likely to receive MoP bearings (odds ratio [OR] 1.2), while men were more likely to receive MoM and CoP bearings (OR 1.1). Multivariate logistic regression showed age to be an independent predictor of bearing surface choice with patients 65 and older more likely to receive MoP bearings (OR 3.2). Bearing surface choice in primary THA has changed tremendously from 2007 to 2015. MoM bearing use has decreased as a result of adverse effects. Age continues to remain a significant factor in bearing surface choice. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Total Hip Arthroplasty Bearing Surface Trends in the United States From 2007 to 2014: The Rise of Ceramic on Polyethylene.

    Science.gov (United States)

    Heckmann, Nathanael D; Sivasundaram, Lakshmanan; Stefl, Michael D; Kang, Hyunwoo Paco; Basler, Eric T; Lieberman, Jay R

    2018-01-09

    Wear of the bearing surface is a critical element in determining the longevity of a total hip arthroplasty (THA). Over the past decade, concerns related to modern metal-on-metal (MoM) bearings and corrosion at the femoral head-neck interface have influenced surgeon selection of bearing surfaces. The purpose of this study is to analyze trends in THA bearing surface selection from 2007 through 2014 using a large national database. The Nationwide Inpatient Sample database was used to extract bearing surface data from patients who underwent a primary THA between 2007 and 2014. Patients were grouped by bearing surface type: metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), MoM, and ceramic-on-ceramic (CoC) bearings. Descriptive statistics were employed to describe trends. Univariate and multivariate analyses were performed to identify differences between bearing surface groups. During the study period, 2,460,640 THA discharges were identified, of which 1,059,825 (43.1%) had bearing surface data. A total of 496,713 (46.9%) MoP, 307,907 (29.1%) CoP, 210,381 (19.9%) MoM, and 44,823 (4.2%) CoC cases were identified. MoM utilization peaked in 2008 representing 40.1% of THAs implanted that year and steadily declined to 4.0% in 2014. From 2007 to 2014, the use of CoP bearing surfaces increased from 11.1% of cases in 2007 to 50.8% of cases in 2014. In 2014, CoP utilization surpassed MoP which represented 42.1% of bearing surfaces that year. During the study period, MoM bearing surfaces decreased precipitously, while CoP surpassed MoP as the most popular bearing surface used in a THA. Copyright © 2018 Elsevier Inc. All rights reserved.

  11. The direct anterior approach for acetabular augmentation in primary total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Erin Honcharuk, MD

    2018-03-01

    Full Text Available Addressing acetabular bone defects can be difficult and depends on the amount of bone loss. Augments, either with bone or highly porous metals, are options that still allow the use of a hemispherical cup. Almost all previous research and publication on acetabular augments have focused on revision hip arthroplasty utilizing either a modified lateral or a posterolateral surgical approach. We describe 3 cases of augmenting acetabular bone defects through a direct anterior approach for primary total hip arthroplasty. We achieved proper cup placement, alignment, and augment incorporation while reconstructing complex acetabular deficiencies. All patients had complete pain relief and a satisfactory clinical outcome with stable radiographs at follow-up. With appropriate training, acetabular augmentation can be performed safely and efficiently with excellent clinical results through this approach. Keywords: Total hip arthroplasty, Direct anterior approach, Acetabular augment, Acetabular defect

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

    Science.gov (United States)

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

    2015-09-01

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

  13. [Total hip arthroplasty : history and perspective of an iconic surgerical intervention].

    Science.gov (United States)

    Koulischer, S; Jennart, H; Zorman, D

    2017-01-01

    With nearly 2 million implants placed annually, total hip arthroplasty is one of the most frequently performed surgerical procedure. A historical review of this intervention reminds us of the times when surgery was done by barber, before the first attempts of interposition arthroplasty. It is only in 1970 that Sir John Charnley lay the foundations of modern arthroplasty. The pharmaceutical industry, by sharing this lucrative market of $ 5 billion annual revenue, is now playing a major role in the development of the next generation of implants.

  14. Comparative pooled survival and revision rate of Austin-Moore hip arthroplasty in published literature and arthroplasty register data.

    Science.gov (United States)

    Sadoghi, Patrick; Thaler, Martin; Janda, Wolfgang; Hübl, Michael; Leithner, Andreas; Labek, Gerold

    2013-09-01

    The aim was to evaluate the pooled survival and revision rate of Austin-Moore hip arthroplasty (AMHA) in published literature and arthroplasty register data. A comprehensive literature analysis of clinical publications and register reports was conducted with the main endpoints revision surgery and revision rate. Sixteen relevant clinical studies have been found to significantly underestimate revision rates by a ratio of 2.15 compared to register data sets. The medium-term outcome of AMHA showed significantly worse outcomes than the use of other bipolar implants, or modular cervicocephalic prostheses and data of journal publications on revision rates deviate significantly from data of arthroplasty registers. Copyright © 2013. Published by Elsevier Inc.

  15. Intraoperative femoral head dislodgement during total hip arthroplasty: a report of four cases

    Directory of Open Access Journals (Sweden)

    Ahmed Siddiqi, DO

    2018-03-01

    Full Text Available Dislodgment of trial femoral heads and migration into the pelvis during total hip arthroplasty is a rarely reported complication with limited published cases. There are three primary mechanisms of femoral head separation: dislodgement during reduction attempt, disassociation from anterior dislocation while assessing anterior stability, and during dislocation after implant trialing. If the trial femoral migrates beyond the pelvic brim, it is safer to finish the total hip arthroplasty and address the retained object after repositioning or in a planned second procedure with a general surgeon. We recommend operative retrieval since long-term complications from retention or clinical results are lacking.

  16.  MULTIMODAL ANALGESIA IN FAST TRACK HIP AND KNEE ARTHROPLASTY

    DEFF Research Database (Denmark)

    Holm, Bente; Bak, Mikkel; Kristensen, Billy Bjarne

    and amount of physiotherapy is required. This study is the first step towards developing guidelines for future physiotherapy for patients with hip or knee arthroplasty. DESCRIPTION: Material: Sixteen patients with unilateral, total hip arthroplasty (THA) and sixteen patients with unilateral, total knee....... Patients started mobilisation on the day of the operation with further physiotherapy the following days, including transfer and ambulation training, and specific joint and muscle exercises. In connection with all activities, pain scores were assessed, using a Visual Analog Scale (VAS). All patients......-up after rehabilitation are needed. IMPLICATIONS: Due to the short LOS goals and guidelines for outpatients physiotherapy treatment including functional tests and outcome measurements are needed....

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

    Directory of Open Access Journals (Sweden)

    Xiaoqi Zhang, MD

    2017-12-01

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

  18. Regional uptake an variations in orthopaedic enhanced recovery pathways in knee and hip total arthroplasty.

    Science.gov (United States)

    Mawdsley, M J; Baker, P N; Desai, A; Green, R N; Jevons, L

    2016-05-01

    The use of enhanced recovery (ER) pathways for hip and knee arthroplasty has increased over the last decade, and the adoption within orthopaedics is becoming more common. We have demonstrated a regional variation and institutional inconsistency of uptake and delivery of ER pathways in our region. Units that have a unified pathway were more likely to have consistency in treatment and early analgesia for patients. We would advocate that units use an agreed enhanced recovery pathway to optimise patient recovery from hip and knee arthroplasties.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    and to analyze age-stratified risk of revision comparing cemented, hybrid, and uncemented fixation as reported by national hip arthroplasty registries. METHODS: Data were extracted from the annual reports of seven national hip arthroplasty registries; we included all national registries for which annual reports...... were available in English or a Scandinavian language, if the registry had a history of more than 5 years of data collection. RESULTS: Current use of uncemented fixation in primary THAs varies between 15% in Sweden and 82% in Canada. From 2006 to 2010 the registries of all countries reported overall...

  20. Predictive Model of Surgical Time for Revision Total Hip Arthroplasty.

    Science.gov (United States)

    Wu, Albert; Weaver, Michael J; Heng, Marilyn M; Urman, Richard D

    2017-07-01

    Maximizing operating room utilization in orthopedic and other surgeries relies on accurate estimates of surgical control time (SCT). A variety of case and patient-specific variables can influence the duration of surgical time during revision total hip arthroplasty (THA). We hypothesized that these variables are better predictors of actual SCT (aSCT) than a surgeon's own prediction (pSCT). All revision THAs from October 2008 to September 2014 from one institution were accessed. Variables for each case included aSCT, pSCT, patient age, gender, body mass index, American Society of Anesthesiologists Physical Status class, active infection, periprosthetic fracture, bone loss, heterotopic ossification, and implantation/explantation of a well-fixed acetabular/femoral component. These were incorporated in a stepwise fashion into a multivariate regression model for aSCT with a significant cutoff of 0.15. This was compared to a univariate regression model of aSCT that only used pSCT. In total, 516 revision THAs were analyzed. After stepwise selection, patient age and American Society of Anesthesiologists Physical Status were excluded from the model. The most significant increase in aSCT was seen with implantation of a new femoral component (24.0 min), followed by explantation of a well-fixed femoral component (18.7 min) and significant bone loss (15.0 min). Overall, the multivariate model had an improved r 2 of 0.49, compared to 0.16 from only using pSCT. A multivariate regression model can assist surgeons in more accurately predicting the duration of revision THAs. The strongest predictors of increased aSCT are explantation of a well-fixed femoral component, placement of an entirely new femoral component, and presence of significant bone loss. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Quality of Life in Sickle Cell Patients After Cementless Total Hip Arthroplasty.

    Science.gov (United States)

    Azam, Md Quamar; Sadat-Ali, Mir

    2016-11-01

    Osteonecrosis of femoral head is a serious relentlessly progressive and disabling complication in 20%-50% of sickle cell patients, majority of whom are in their second to third decades. High perioperative medical complications and short survivorship have historically discouraged arthroplasty surgeons in offering total hip arthroplasty to sickle cell patients in their 30s for the fear of inevitable technically demanding revision. In this retrospective study, the primary objective was to assess the impact of early intervention on quality of life (QOL) at midterm follow-up of mean 7.5 years using uncemented porous-coated total hip arthroplasty. The secondary objective of this study was the survival of the prostheses within the same follow-up period and discussion of surgical challenges faced in this cohort of patients. A total of 67 (84 hip arthroplasties) sickle cell patients with advance osteonecrosis of femoral head who underwent cementless porous-coated proximal fixation are included in this study. Modified Harris Hip Score, visual analog scale, and QOL assessment criteria are used to assess the outcome. Revision surgery was required in 7 patients for aseptic loosening and in 1 patient due to late infection. Visual analog scale improved from average 7 (6-9) to 3 (2-5). Mean Harris Hip Score improved from 46 (32-58) to 81 (74-86). QOL score rose from a mean of 3 (range 1-4) to 7 (range 6-9). In terms of gender, survival in males was 94.30%, whereas in females, it was 88.767%. Revision surgery was required in 7 patients due to aseptic loosening and in 1 patient due to late infection at 7 years. We recommend early hip arthroplasty in sickle cell patients, if the hip has reached a stage of irreversible damage and patient's lifestyle is severely compromised to minimize chronic suffering and disability. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Operative Trends in the Treatment of Hip Fractures and the Role of Arthroplasty

    Science.gov (United States)

    Grau, Luis; Summers, Spencer; Rosas, Samuel; Ong, Alvin; Hernandez, Victor Hugo

    2018-01-01

    Introduction: There is a projected exponential increase in the number of hip fractures in the United States. Trends in patient demographics and the role of total hip arthroplasty (THA) and its associated outcomes following hip fractures surgery have not been well studied. Methods: Patients with proximal femur fractures between 1990 and 2007 were identified in the National Hospital Discharge Survey database. Demographics, comorbidities, perioperative complications, and discharge status for patients undergoing THA, hemiarthroplasty, or internal fixation were examined. Multivariable regression was performed to determine independent risk factors for perioperative complications. Results: Between 1990 and 2007, there was a statistically significant increase in patient age, adverse events, medical comorbidities, surgical complications, medical complications, and nonroutine discharge across all surgical treatment modalities. In the same time period, the utilization of THA for all fracture types decreased significantly. Discussion: Total hip arthroplasty was found to be an independent risk factor for perioperative complications. Orthopedic surgeons should be aware that the hip fracture population continues to get older, with more medical comorbidities and are at higher risk for perioperative complications. Conclusion: Total hip arthroplasty is associated with a higher rate of perioperative complications in the hip fracture population. PMID:29619275

  3. Effect of carbon ion implantation on the tribology of metal-on-metal bearings for artificial joints

    Directory of Open Access Journals (Sweden)

    Koseki H

    2017-05-01

    Full Text Available Hironobu Koseki,1 Masato Tomita,2 Akihiko Yonekura,2 Takashi Higuchi,1 Sinya Sunagawa,2 Koumei Baba,3,4 Makoto Osaki2 1Department of Locomotive Rehabilitation Science, Unit of Rehabilitation Sciences, 2Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan; 3Industrial Technology Center of Nagasaki, Ikeda, Omura, Nagasaki, Japan; 4Affiliated Division, Nagasaki University School of Engineering, Bunkyo, Nagasaki, Japan Abstract: Metal-on-metal (MoM bearings have become popular due to a major advantage over metal-on-polymer bearings for total hip arthroplasty in that the larger femoral head and hydrodynamic lubrication of the former reduce the rate of wear. However, concerns remain regarding adverse reactions to metal debris including metallosis caused by metal wear generated at the taper-head interface and another modular junction. Our group has hypothesized that carbon ion implantation (CII may improve metal wear properties. The purpose of this study was to investigate the wear properties and friction coefficients of CII surfaces with an aim to ultimately apply these surfaces to MoM bearings in artificial joints. CII was applied to cobalt-chromium-molybdenum (Co-Cr-Mo alloy substrates by plasma source ion implantation. The substrates were characterized using scanning electron microscopy and a 3D measuring laser microscope. Sliding contact tests were performed with a simple geometry pin-on-plate wear tester at a load of 2.5 N, a calculated contact pressure of 38.5 MPa (max: 57.8 MPa, a reciprocating velocity of 30 mm/s, a stroke length of 60 mm, and a reciprocating cycle count of 172,800 cycles. The surfaces of the CII substrates were generally featureless with a smooth surface topography at the same level as untreated Co-Cr-Mo alloy. Compared to the untreated Co-Cr-Mo alloy, the CII-treated bearings had lower friction coefficients, higher resistance to catastrophic damage, and

  4. Computer-assisted vs conventional mechanical jig technique in hip resurfacing arthroplasty.

    Science.gov (United States)

    Resubal, Jose Rafael E; Morgan, David A F

    2009-04-01

    To compare the effectiveness of computer-assisted surgery (CAS) and mechanical jig technique in hip resurfacing arthroplasty, we reviewed 176 hip resurfacing arthroplasty performed in 158 patients. The initial 131 hips were resurfaced using the conventional mechanical jig technique, and the remaining 45 hips with the CAS technique. The demographic data of the patients were similar for both techniques. Follow-up radiographs taken 2 months after the surgery showed patients in the CAS technique having a significantly better alignment of the femoral component on the frontal and sagittal planes. There was no difference in the risk of implant notching on the femoral neck for both techniques. The implant sizes were similar for both techniques; thus, the amount of bone stock preserved was not technique specific.

  5. An unusual presentation of catastrophic failure of hip arthroplasty with a thigh mass

    Directory of Open Access Journals (Sweden)

    Florian Dibra, MD

    2016-06-01

    Full Text Available In the advent of increasing demand for total hip arthroplasty, surveillance of these patients is imperative to identify potential complications requiring revision surgery. This is especially important in the young population, as revision is usually necessary during their lifetime. We present a case of a young female patient with a history of total hip arthroplasty 17 years prior, who presented with left hip pain and anterior thigh mass. The prosthetic hip had progressed to catastrophic failure with the cobalt-chrome femoral head having eroded through the polyethylene and acetabular socket. This was associated with significant metal debris and large fluid collection in the thigh. The patient required complex revision surgery but could have had a much lesser procedure with earlier intervention.

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

    Directory of Open Access Journals (Sweden)

    Akio Kanda

    2016-01-01

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

  7. Severe Pelvic Obliquity Affects Femoral Offset in Patients with Total Hip Arthroplasty but Not Leg-Length Inequality.

    Directory of Open Access Journals (Sweden)

    Xiaoxiao Zhou

    Full Text Available Leg-length inequality is an extensively studied complication of total hip arthroplasty in normal patients. However, few studies have focused on the pelvic obliquity of coronal pelvic malrotation. We hypothesized that pelvic obliquity with a fixed abduction/adduction contracture deformity of the hip may intraoperatively affect the release of soft tissues, ultimately resulting in a leg-length inequality. This study also investigated whether the femoral and vertical offsets of total hip arthroplasty were correlated with pelvic obliquity. This prospective study divided 98 patients into six groups based on the inclination of pelvic obliquity before total hip arthroplasty. Leg-length inequality, variation of pelvic obliquity, offset, and vertical offset were measured after total hip arthroplasty. Leg-length inequality and vertical offset were not significantly different among groups, whereas the variation of pelvic obliquity was significantly higher in type IIC pelvic obliquity than in other groups. Type IC pelvic obliquity had a significantly shorter offset than did the other groups, which may have been an important factor leading to type IC pelvic obliquity. Pelvic obliquity exhibited no significant effect on leg-length inequality in patients with total hip arthroplasty. A shorter offset may be caused by the higher tension of the abductor in the operated hip, which may result in the formation of type IC pelvic obliquity. Releasing the abductor contracture and restoring femoral offset are important for increasing hip stability and maintaining pelvic balance following total hip arthroplasty.

  8. Severe Pelvic Obliquity Affects Femoral Offset in Patients with Total Hip Arthroplasty but Not Leg-Length Inequality.

    Science.gov (United States)

    Zhou, Xiaoxiao; Wang, Qi; Zhang, Xianlong; Chen, Yunsu; Peng, Xiaochun; Mao, Yuanqing; Yang, Yang; Fu, Beigang; Wang, Xiuhui; Tang, Tingting

    2015-01-01

    Leg-length inequality is an extensively studied complication of total hip arthroplasty in normal patients. However, few studies have focused on the pelvic obliquity of coronal pelvic malrotation. We hypothesized that pelvic obliquity with a fixed abduction/adduction contracture deformity of the hip may intraoperatively affect the release of soft tissues, ultimately resulting in a leg-length inequality. This study also investigated whether the femoral and vertical offsets of total hip arthroplasty were correlated with pelvic obliquity. This prospective study divided 98 patients into six groups based on the inclination of pelvic obliquity before total hip arthroplasty. Leg-length inequality, variation of pelvic obliquity, offset, and vertical offset were measured after total hip arthroplasty. Leg-length inequality and vertical offset were not significantly different among groups, whereas the variation of pelvic obliquity was significantly higher in type IIC pelvic obliquity than in other groups. Type IC pelvic obliquity had a significantly shorter offset than did the other groups, which may have been an important factor leading to type IC pelvic obliquity. Pelvic obliquity exhibited no significant effect on leg-length inequality in patients with total hip arthroplasty. A shorter offset may be caused by the higher tension of the abductor in the operated hip, which may result in the formation of type IC pelvic obliquity. Releasing the abductor contracture and restoring femoral offset are important for increasing hip stability and maintaining pelvic balance following total hip arthroplasty.

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

    NARCIS (Netherlands)

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

    2007-01-01

    Background: The Dutch Consumer Quality Index Hip Knee Questionnaire (CQI Hip Knee) was used to assess patients' experiences with and evaluations of quality of care after a total hip (THA) or total knee arthroplasty (TKA). The aim of this study is to evaluate the construct validity and internal

  10. Characterization of hip and knee arthroplasties and factors associated with infection

    Directory of Open Access Journals (Sweden)

    Cibele Zdebsky da Silva Pinto

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVE: To characterize arthroplasty procedures, calculate the surgical infection rate and identify related risk factors. METHODS: This was a retrospective cohort study. Data on operations performed between 2010 and 2012 were gathered from documental sources and were analyzed with the aid of statistical software, using Fisher's exact test, Student'sttest and the nonparametric Mann-Whitney and Wilcoxon tests. RESULTS: 421 total arthroplasty procedures performed on 346 patients were analyzed, of which 208 were on the knee and 213 on the hip. It was found that 18 patients (4.3% were infected. Among these, 15 (83.33% were reoperated and 2 (15.74% died. The prevalence of infection in primary total hip arthroplasty procedures was 3%; in primary total knee arthroplasty, 6.14%; and in revision of total knee arthroplasty, 3.45%. Staphylococcus aureuswas prevalent. The length of the surgical procedure showed a tendency toward being a risk factor ( p= 0.067. CONCLUSION: The prevalence of infection in cases of primary total knee arthroplasty was greater than in other cases. No statistically significant risk factors for infection were identified.

  11. Midterm Outcome of Cementless Total Hip Arthroplasty in Crowe IV-Hartofilakidis Type III Developmental Dysplasia of the Hip.

    Science.gov (United States)

    Mu, Wenbo; Yang, Desheng; Xu, Boyong; Mamtimin, Askar; Guo, Wentao; Cao, Li

    2016-03-01

    Developmental dysplasia of the hip (DDH) is widespread in developing countries, and treating Crowe IV-Hartofilakidis Type III DDH in adults requires the use of a highly demanding technique. We sought to determine the outcome of cementless total hip arthroplasty using Zweymüller components to treat Crowe IV-Hartofilakidis Type III DDH. Fifty-eight patients (71 hips) with a mean age of 35.8 years at time of index operation were included in our study. The average duration of follow-up was 70.5 months. The acetabular component was placed in the true acetabulum in all cases, and subtrochanteric shortening osteotomy was performed in 61 hips. With any component revision for any reason as the end point, Kaplan-Meier survivorship analysis at 98 months revealed a cumulative survival rate for implanted components of 91.40%. The mean Harris Hip Score improved from 35.6 preoperatively to 82.9 postoperatively. There were 20 cases of intraoperative fracture, 1 case of complete nerve palsy, and 7 cases of transient nerve palsy. Revision surgery was performed in 7 patients because of cup loosening in 1, severe polyethylene wear in 4, cup breakage in 1, and dislocation in 1. Midterm results for cementless total hip arthroplasty in patients with Crowe IV-Hartofilakidis Type III DDH was satisfactory; however, intraoperative fracture and polyethylene wear were major complications. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. The Natural History of the Development of Trevor Disease of the Hip and Subsequent Arthroplasty: A Case Report.

    Science.gov (United States)

    Shahcheraghi, Gholam Hossain; Javid, Mahzad

    2017-01-01

    Trevor disease (dysplasia epiphysealis hemimelica [DEH]) is a rare, intra-articular anomaly of cartilaginous overgrowth of the epiphysis. The usual presentation is on 1 side of the body and on 1 side of the epiphysis. The natural history of this disease is not clear because the lesions often are treated during childhood. Additionally, hip involvement is relatively uncommon; to our knowledge, total hip arthroplasty in a patient with DEH has not been reported previously. Our patient presented with previously untreated DEH of the hip joint, which had developed into a very unusual shape. He was treated with a total hip arthroplasty and had satisfactory functioning 2.5 years postsurgery. Untreated DEH of the hip can lead to a very misshapen hip with a deformed femoral head and loss of the shape of the acetabulum, as well as stiffness due to an unusual shape and osteoarthritic changes. A total hip arthroplasty can give satisfactory functional results.

  13. Hip Arthroplasty and its Revision in a Child: Case Report and Literature Review.

    Science.gov (United States)

    Gharehdaghi, Mohammad; Rahimi, Hasan; Eshraghi, Reza; Mousavian, Alireza; Assadian, Maryam

    2015-07-01

    Juvenile idiopathic arthritis is the leading cause of hip replacement in young children. However, arthroplasty in this population is challenging with several concerns about quality of the growing bone, young age for revision surgery, and difficulties in potential several revisions. In this study we introduce a case of a 12-year old who is one of the youngest patients to undergo revision hip arthroplasty. The index operation was done as a hybrid replacement, cemented for stem and press fit for acetabular component. Two years later revision was done with severe femoral deficiency. This second procedure was challenging but with short-term promising results. So we reviewed the literature for arthroplasty in this young population regarding recent findings and trends. According to the literature survival of the prosthesis is longer with a cemented acetabular component and press fit stem; however, there are evidences that show poor outcome of joint replacement after the first revision in juvenile idiopathic arthritis patients.

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

    DEFF Research Database (Denmark)

    Bjerregaard, Lars S; Jørgensen, Christoffer C; Kehlet, Henrik

    2016-01-01

    BACKGROUND: Overall medical complications have been reduced after fast-track total hip (THA) and knee arthroplasty (TKA), but data on specific renal and urological (RU) complications are limited. METHODS: To describe the incidence and consequences of serious RU complications resulting in length o...

  15. Orthostatic intolerance during early mobilization after fast-track hip arthroplasty

    DEFF Research Database (Denmark)

    Jans, O; Bundgaard-Nielsen, M; Solgaard, S

    2012-01-01

    BACKGROUND: /st>Early postoperative mobilization is a cornerstone in fast-track total hip arthroplasty (THA), but postoperative orthostatic intolerance (OI) may delay early recovery or lead to fainting, falls, and prosthesis dislocation or fracture. However, the prevalence and pathophysiology of OI...

  16. Patient Needs for an Ambulant Dislocation Alert System Following Total Hip Arthroplasty

    NARCIS (Netherlands)

    Huis in't Veld, Rianne; Peters, Anil; Vollenbroek-Hutten, Miriam Marie Rosé; Hermens, Hermanus J.; van den Hoven, Carmen

    2017-01-01

    INTRODUCTION: One of the major complications in total hip arthroplasty (THA) is dislocation of the prosthesis. To prevent early dislocation, patients are instructed with movement restrictions. The first goal in this development is to obtain insight in the movement restrictions that are reported to

  17. Subacute pain and function after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse Østergaard; Gaarn-Larsen, L; Kristensen, B B

    2009-01-01

    study. The purpose was to describe the prevalence and intensity of subacute postoperative pain and opioid related side effects, use of analgesics and functional ability 1-10 and 30 days postoperatively. Fast-track total hip and knee arthroplasty with early discharge (

  18. Early patient-reported outcomes versus objective function after total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Luna, I E; Kehlet, H; Peterson, B

    2017-01-01

    AIMS: The purpose of this study was to assess early physical function after total hip or knee arthroplasty (THA/TKA), and the correlation between patient-reported outcome measures, physical performance and actual physical activity (measured by actigraphy). PATIENTS AND METHODS: A total of 80 pati...

  19. Two-incision minimally invasive total hip arthroplasty - results and complications

    NARCIS (Netherlands)

    van Oldenrijk, Jakob; Hoogervorst, Paul; Schaap, Gerard R.; van Dijk, C. Niek; Schafroth, Matthias U.

    2011-01-01

    The purpose of this study was to determine the complication rate and functional result after two-incision minimally invasive total hip arthroplasty in a retrospective consecutive case series of the first 45 patients treated by a single surgeon. The mean follow up period was 2.1 years. There were 4

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

    Directory of Open Access Journals (Sweden)

    A. V. Sementkovsky

    2011-01-01

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

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

    NARCIS (Netherlands)

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

    2008-01-01

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

  2. Intra-abdominal migration of a k-wire during revision total hip arthroplasty

    OpenAIRE

    Kevin T. Hug, MD; Navin D. Fernando, MD, FRCS(C)

    2017-01-01

    Revision total hip arthroplasty in the setting of severe acetabular bone loss is a challenging problem that is becoming more common. Kirschner wires are often used during acetabular revision for temporary fixation of trial components. We describe an intraoperative migration of a Kirschner wire through the acetabulum into the peritoneal cavity, requiring acute laparoscopic removal.

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

    NARCIS (Netherlands)

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

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

  4. Designing a care pathway model : A case study of the outpatient total hip arthroplasty care pathway

    NARCIS (Netherlands)

    Oosterholt, R.I.; Simonse, W.L.; Boess, S.U.; Vehmeijer, S.B.W.

    2017-01-01

    Introduction: Although the clinical attributes of total hip arthroplasty (THA) care pathways have been thoroughly researched, a detailed understanding of the equally important organisational attributes is still lacking. The aim of this article is to contribute with a model of the outpatient THA

  5. Effect of high-dose preoperative methylprednisolone on recovery after total hip arthroplasty

    DEFF Research Database (Denmark)

    Lunn, T H; Andersen, Lasse Østergaard; Kristensen, B B

    2013-01-01

    BACKGROUND: /st>High-dose glucocorticoid may reduce postsurgical pain and improve recovery. We hypothesized that 125 mg methylprednisolone (MP) would reduce time to meet functional discharge criteria after total hip arthroplasty (THA). METHODS: /st>Forty-eight patients undergoing unilateral THA...

  6. Method for assessment of distribution of UHMWPE wear particles in periprosthetic tissues in total hip arthroplasty

    Czech Academy of Sciences Publication Activity Database

    Pokorný, D.; Šlouf, Miroslav; Horák, Zdeněk; Jahoda, D.; Entlicher, G.; Eklová, S.; Sosna, A.

    2006-01-01

    Roč. 73, č. 4 (2006), s. 243-250 ISSN 0001-5415 R&D Projects: GA ČR GA106/04/1118 Institutional research plan: CEZ:AV0Z40500505 Keywords : wear * polyethylene * total hip arthroplasty Subject RIV: CD - Macromolecular Chemistry http://www.achot.cz/cislo.php?cis=5

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

    NARCIS (Netherlands)

    Ostendorf, Marieke

    2004-01-01

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

  8. The relative merits of cemented and uncemented prostheses in total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Joanna Maggs

    2017-01-01

    Full Text Available The results of modern cemented and uncemented total hip arthroplasties are outstanding and both systems have their advantages and disadvantages. This paper aims to examine the designs of different types of prostheses, some history behind their development and the reported results. Particular emphasis is placed on cemented stem design and the details of cementing technique.

  9. Evaluation of the Function and Quality of Life after Total Hip Arthroplasty by Different Approaches

    Directory of Open Access Journals (Sweden)

    Paulo Araújo

    2017-09-01

    Conclusion: After 24 months post total hip arthroplasty there are no differences between the two approaches with regard to function or quality of life. However, the patients operated by the anterolateral approach had greater muscle strength deficits and higher percentage of positive Trendelenburg test.

  10. Postoperative physiopathological analysis of inflammatory parameters in patients undergoing hip or knee arthroplasty.

    Science.gov (United States)

    Moreschini, O; Greggi, G; Giordano, M C; Nocente, M; Margheritini, F

    2001-01-01

    Infection after total hip or knee arthroplasty is a major concern for the orthopedic surgeon. Because postoperative recovery in patients undergoing hip or knee replacement is always characterized by a shift in basal laboratory parameters, the value of the routine use of these parameters in the detection of this major complication is controversial. The aim of this study was to evaluate the physiological behavior of these parameters, the most reliable of which are C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell count (WBC). The pattern of these parameters was observed for 60 days after surgery in 74 patients (48 males and 26 females) who underwent total hip or total knee arthroplasty. Mean age was 65.4 years. ESR reached a peak on day 5 and then decreased as much as 3-fold by day 60. CRP displayed even greater sensitivity with a peak level on day 3 followed by a rapid return to basal levels. WBC also peaked on day 1. No significant differences were found between total hip arthroplasty and total knee arthroplasty. Observation of the pattern of these parameters identifies any nonphysiological modifications and enables suitable measures to be adopted.

  11. The Effect of Prior Hip Arthroscopy on Patient-Reported Outcomes After Total Hip Arthroplasty: An Institutional Registry-Based, Matched Cohort Study.

    Science.gov (United States)

    Konopka, Joseph F; Buly, Robert L; Kelly, Bryan T; Su, Edwin P; McLawhorn, Alexander S

    2018-02-02

    A significant number of patients who undergo hip arthroscopy will subsequently undergo total hip arthroplasty (THA) or hip resurfacing arthroplasty (HRA), although limited evidence exists regarding effects of prior hip arthroscopy on the outcomes of these procedures. Of 5091 patients who underwent hip arthroscopy, we identified 69 patients who underwent subsequent THA (46) or HRA (23). Patients were matched to patients with no history of hip arthroscopy. Preoperative and 2-year postoperative Hip disability and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form-12, Lower Extremity Activity Scale score, and satisfaction surveys were compared. Patients who underwent THA with history of arthroscopy had lower postoperative Hip disability and Osteoarthritis Outcome Score Pain (82 ± 16 vs 93 ± 9, P = .003), Stiffness (85 ± 16 vs 93 ± 15, P = .01), Sports and Recreation (71 ± 22 vs 88 ± 18, P = .003), Quality-of-Life (65 ± 22 vs 86 ± 11, P Hip arthroscopy before hip arthroplasty is associated with slightly lower results in several patient-reported outcomes. These results are relevant when assessing patients for hip arthroscopy and when counseling prospective arthroplasty patients with history of arthroscopy. Copyright © 2018 Elsevier Inc. All rights reserved.

  12. 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.

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

    Directory of Open Access Journals (Sweden)

    Shigeru Nakamura

    2012-01-01

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

  14. A protocol for staged arthroplasty to salvage infected nonunion of hip fractures.

    Science.gov (United States)

    Ebied, Ayman M; Elseedy, Adel I; Gamal, Osama

    2017-03-01

    Nonunion of hip fractures is not uncommon. Total hip arthroplasty is used to salvage cases of non union or secondary arthritis in these fractures. However, this option may not be available or may be difficult to achieve when infection has superseded the site of nonunion. The objective of this prospective study was to assess if a staged protocol of treatment yields good results in these difficult cases. Twenty-seven consecutive patients who had deep hip infection with failed treatment of hip fractures (intracapsular in 16 cases and extracapsular in 11) were treated between June 2007 and September 2011. Twenty-six completed the planned two-stage hip arthroplasty and one case was lost after the first stage. The average age of the patients was 48.9 years (range 26-74 years) with an average follow up period of 44 months (30-72 months). Analysis was done using the paired t test where P < 0.05 was considered significant. Infection was controlled in all cases that completed the treatment protocol with no recurrence in all cases at the latest follow up. The Harris hip score of the patients improved significantly from 29 preoperatively to 85 at the latest follow up (P < 0.0001). Two patients had hip dislocation with displacement of the trochanteric fragment while three other patients had fibrous union of the trochanter. Staged Arthroplasty procedure to salvage infected non-union of hip fractures is successful in eradicating infection and regaining hip function. Level of evidence IV.

  15. [Effect of femoral offset reconstruction on pelvic stability during gait after total hip arthroplasty].

    Science.gov (United States)

    Wu, Peihui; Fu, Ming; Mao, Yurong; Kang, Yan; Yang, Zibo; Fang, Shuying; Liao, Weiming

    2011-05-01

    To investigate the effect of femoral offset reconstruction on pelvic stability during gait after total hip arthroplasty. According to the inclusion criteria, 29 patients undergoing unilateral total hip arthroplasty between January 2000 and December 2005 were selected. There were 10 males and 19 females with an average age of 64.3 years (range, 33-75 years). The affected hips included 15 left hips and 14 right hips. The follow-up time was from 5 to 10 years (mean, 7.7 years). The Harris score was 90 to 100 (mean, 97) at last follow-up. The femoral offset ratio (FOR) was calculated by measuring the femoral offset of the bilateral hips on radiograph, and then the patients were divided into 2 groups: group A (the femoral offset of diseased hip was less than that of normal hip, n=10) and group B (the femoral offset of diseased hip was greater than that of normal hip, n=19). The pelvis kinematic variables were measured by three-dimensional gait analysis to collect the magnitude of pelvic oblique angle (POA). In group A, the FOR was 0.81 +/- 0.08 and the POA was (-0.42 +/- 0.91) degrees. In group B, the FOR was 1.27 +/- 0.15 and the POA was (1.02 +/- 0.94) degrees. For the normal hip, the POA was (1.15 +/- 0.85) degrees. The POA was significantly less in group A than in group B and the normal limb (P 0.05). The POA was positive relative with FOR (r = 0.534, P = 0.003), and the regression equation was y = -2.551 + 2.781x. The femoral offset reconstruction is crucial to improve hip abductor function and gait.

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

    OpenAIRE

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

    2016-01-01

    Total hip arthroplasty (THA) is a common procedure for the treatment of end-stage hip joint disease, and the demand for revision THA will double by 2026. Ti6Al4V (Titanium, 6% Aluminum, and 4% Vanadium) is a kind of alloy commonly used to make hip prothesis. To promote the osseointegration between the prothesis and host bone is very important for the revision THA. The peptide Arg-Gly-Asp (RGD) could increase cell attachment and has been used in the vascular tissue engineering. In this study, ...

  17. Management of severe periacetabular bone loss combined with pelvic discontinuity in revision hip arthroplasty.

    Science.gov (United States)

    Friedrich, Max J; Schmolders, Jan; Michel, Robert D; Randau, Thomas M; Wimmer, Matthias D; Kohlhof, Hendrik; Wirtz, Dieter C; Gravius, Sascha

    2014-12-01

    Revision of failed total hip arthroplasty with massive acetabular bone loss resulting in pelvic discontinuity represents a rare but challenging problem. The objective of this study was to present short to mid-term results of revision total hip arthroplasty with a custom-made acetabular implant in a consecutive series of patients with pelvic discontinuity. We retrospectively reviewed 18 consecutive patients with massive acetabular bone loss (Paprosky Type 3B) resulting in pelvic discontinuity reconstructed with revision total hip arthroplasty using a custom-made acetabular component. The prosthesis was created on the basis of a thin-cut 1-mm computed tomography (CT) scan of the pelvis. Initial stability of the implant was obtained by screw fixation. Harris hip score and sequential radiographs were used to evaluate the clinical and radiographic results. At an average follow up of 30 months (range 17-62 months) 16 of 18 (88.9%) custom-made implants were considered radiographically stable without signs of acetabular migration of more than 2 mm in the horizontal or vertical direction, implant rotation or screw breakage. Complications included two periprosthetic joint infections treated with explantation of the implant. Three patients had recurrent dislocations postoperatively. The mean Harris hip score improved from 28 ± 12 points preoperatively to 69 ± 13 points at the time of last follow up. Treatment of acetabular bone loss and pelvic discontinuity with a custom-made acetabular component can provide a durable solution with good clinical and radiographic results.

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

    Directory of Open Access Journals (Sweden)

    A. N. Kovalenko

    2015-01-01

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

  19. Outcome of total hip arthroplasty for avascular necrosis of the femoral head in systemic lupus erythematosus.

    Science.gov (United States)

    Woo, Min Su; Kang, Joon Soon; Moon, Kyoung Ho

    2014-12-01

    This study evaluated the result of total hip arthroplasty (THA) for avascular necrosis of the femur head (AVNFH) in systemic lupus erythematosus (SLE) patients. Nineteen THAs were performed on 13 patients with SLE. The results of these patients were compared with the results of the control group (19 patients) who had THR due to AVNFH with none-SLE conditions. The Harris hip score increased from a preoperative average of 65.3 points to 94.9 at the most recent follow-up. In the control group, the mean HHS was 67.2 preoperatively and 96.1 postoperatively at the last follow-up. No significant difference was found between SLE patients and non-SLE patients who underwent hip arthroplasty. In conclusion, THA is an acceptable treatment for achieving functional improvement in patients who had SLE and AVNFH. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Hip arthroplasty for treatment of advanced osteonecrosis: comprehensive review of implant options, outcomes and complications

    Directory of Open Access Journals (Sweden)

    Waewsawangwong W

    2016-06-01

    Full Text Available Warit Waewsawangwong, Pirapat Ruchiwit, James I Huddleston, Stuart B Goodman Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA Abstract: Surgical treatment for late stage (post-collapse osteonecrosis of the femoral head is controversial. In these situations, the outcome of joint preservation procedures is poor. There are several arthroplasty options for late-stage disease. The clinical outcomes of hemiarthroplasty and hemiresurfacing are unpredictable because of progressive acetabular cartilage degeneration. Total hip resurfacing may be associated with further vascular insult to the femoral head and early failure of the implant. Total hip replacement with metal-on-conventional polyethylene bearing surfaces has been the gold standard, but implant survivorship is limited in young active patients due to wear and osteolysis. Newer alternative bearing surfaces may have improved wear characteristics, but their durability must be confirmed in longer-term studies. Keywords: hip arthroplasty, advanced osteonecrosis, implant options, outcomes, complications

  1. The Lawrence D. Dorr Surgical Techniques & Technologies Award: Conversion Total Hip Arthroplasty: Is it a Primary or Revision Hip Arthroplasty.

    Science.gov (United States)

    Baghoolizadeh, Mahta; Schwarzkopf, Ran

    2016-09-01

    Total hip arthroplasty (THA) is an increasingly common procedure among elderly individuals. Although conversion THA is currently bundled in a diagnosis related group (DRG) with primary THA, no study has identified whether patients undergoing conversion THA better resemble patients undergoing primary THA or revision THA. The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database collects data from hospitals nationwide about preoperative characteristics, intraoperative factors, and 30-day postoperative complications. The purpose of our study was to use these variables in the ACS-NSQIP dataset to compare patients undergoing conversion THA to those undergoing primary and revision THA in order to ensure proper DRG classification of these procedures. Between 2009-2014, the ACS-NSQIP database identified 2,009 conversion THA patients, 5,089 revision THA patients, and 67,854 primary THA patients. Univariate analysis was used to compare fifty-three preoperative, intraoperative, and postoperative variables among these groups. A conservative Bonferroni-adjusted P-value of .0003 was calculated, and a less conservative P-value of .01 was used for comparison. Seventeen variables exhibited a significant difference (P ≤ .0003) only between conversion and primary THA, one variable exhibited a difference only between conversion and revision THA, and three variables exhibited a difference between both conversion and primary THA, and conversion and revision THA. With P ≤ .01, twenty-three, zero, and six differences were observed, respectively. The disproportionate number of differences between conversion and primary THAs suggests that patients undergoing conversion THAs better resemble patients undergoing revision THAs. DRGs are traditionally comprised of procedures that have similar diagnoses and require comparable levels of resources from a hospital, so these results suggest that conversion THA should rather be bundled in the same DRG as

  2. [Efficacies of percutaneous multiple needle puncturing for releasing hip adductor muscle during total hip arthroplasty].

    Science.gov (United States)

    Zhao, Yong; Liu, Kegui; Sun, Tao; Zhao, Yuchi; Zou, Dexin; Tan, Jiangwei; Li, Jingning; Zhang, Shudong; Liu, Yangde

    2014-12-09

    To summarize our experiences of applying percutaneous multiple needle puncturing technique for releasing adductor muscle during total hip arthroplasty (THA) for ischemic necrosis of femoral head and provide rationales for clinical practice. From January 2008 to December 2012, 36 adult patients with ischemic necrosis of femoral head (36 hips) and 36 adult patients with femoral neck fracture (36 hips) were recruited. The group of ischemic necrosis of femoral head was designated as experiment group in which there were 29 males and 7 females with an average age of 67.9 (60-78) years. According to the Ficat system, there were type III (n = 24) and type IV (n = 12) . The affected leg shortening of this group prior to surgery was over 2 cm. The group of femoral neck fracture was selected as control group in which there were 16 males and 20 females with an average age of 70.1 (60-82) years. According to the Garden system, there were type III (n = 16) and type IV (n = 20). All cases underwent THA with Press-fit prosthesis. After fixing prosthetic components, leg length discrepancy was corrected. And percutaneous multiple needle puncturing was applied for releasing adductor muscle in experiment group. The follow-up period was 2 years. The safety and efficiency were evaluated by HHS (Harris Hip Score) and the range of motion (ROM) of hip extorsion and abduction. There was no occurrence of such early complications as palsy of obturator nerve, hematoma in adductor muscle area or serious deep vein embolism.No serious complications of deep infection, femoral head dislocation, recurrent adductor muscle contracture, prosthesis loosening, subsidence, excursion or penetration occurred up until the final follow-up. The range of hip motion of extorsion and abduction: (1) in experimental group, the postoperative ROM (abduction:44.9 ± 0.8, extorsion:45.1 ± 0.9) was significantly larger than that of preoperative (abduction: 30.0 ± 4.6, extorsion:31.5 ± 4.6) ; (2) the postoperative ROM

  3. Evaluation of shelf arthroplasty as a treatment for hip dysplasia in dogs.

    Science.gov (United States)

    Oakes, M G; Lewis, D D; Elkins, A D; Hosgood, G; Dial, S M; Oliver, J

    1996-06-01

    To evaluate effects of shelf arthroplasty on coxofemoral joint laxity and progression of degenerative joint disease in young dogs with hip dysplasia. Prospective, controlled study. 10 dogs between 10 and 24 months old and weighing between 20 and 27 kg. All dogs had bilateral coxofemoral joint laxity (i.e., an Ortolani's sign). In all dogs, shelf arthroplasty was performed on the right coxofemoral joints, and a sham procedure was performed on the left. Dogs were evaluated before and after surgery by means of lameness assessment, coxofemoral joint palpation and goniometry, thigh circumference measurement, and radiography. There were no significant changes in coxofemoral joint mobility, range of motion, joint laxity, degree of degenerative joint disease, or thigh circumference during the study. A greater amount of periacetabular bone formed on the right side than on the left side; however, dogs did not develop large bony shelves, and the amount of periarticular bone decreased over time. The polymer implants remained in their original position and were encapsulated by fibrous tissue. There was no histologic evidence of osteoconduction by the implants. The polymer implants used in this procedure do not appear to be osteoconductive. Shelf arthroplasty was associated with minimal morbidity and was not associated with serious adverse sequelae in this study, but the procedure did not alter the progression of hip dysplasia in these dogs. We cannot advocate shelf arthroplasty using this polymer as a treatment for dogs with hip dysplasia.

  4. Total Hip Arthroplasty in Patients With Avascular Necrosis After Hematopoietic Stem Cell Transplantation.

    Science.gov (United States)

    Vijapura, Anita; Levine, Harlan B; Donato, Michele; Hartzband, Mark A; Baker, Melissa; Klein, Gregg R

    2018-03-01

    The immunosuppressive regimens required for hematopoietic stem cell transplantation predispose recipients to complications, including avascular necrosis. Cancer-related comorbidities, immunosuppression, and poor bone quality theoretically increase the risk for perioperative medical complications, infection, and implant-related complications in total joint arthroplasty. This study reviewed 20 primary total hip arthroplasties for avascular necrosis in 14 patients. Outcomes were assessed at routine clinical visits and Harris hip scores were calculated. Follow-up radiographs were evaluated for component malposition, loosening, polyethylene wear, and osteolysis. Average follow-up was 44.5 months for all patients. Postoperative clinical follow-up revealed good to excellent outcomes, with significant improvement in functional outcome scores. There were no periprosthetic infections or revisions for aseptic loosening. There was 1 dislocation on postoperative day 40, which was treated successfully with a closed reduction. Two patients with a prior history of venous thromboembolism developed a pulmonary embolus on postoperative day 13 and 77, respectively. Four patients died several months to years after arthroplasty of complications unrelated to the surgical procedure. Total hip arthroplasty can both be safely performed and greatly improve quality of life in recipients of hematopoietic stem cell transplantation who develop avascular necrosis. However, prolonged venous thromboembolism prophylaxis should be carefully considered in this high-risk patient population. [Orthopedics. 2018; 41(2):e257-e261.]. Copyright 2018, SLACK Incorporated.

  5. Two-year experience with cell salvage in total hip arthroplasty.

    Science.gov (United States)

    Buget, Mehmet I; Dikici, Fatih; Edipoğlu, İpek S; Yıldız, Eren; Valiyev, Natig; Kucukay, Suleyman

    2016-01-01

    The aim of this study was to determine the efficacy of the cell salvage system in total hip arthroplasty surgeries and whether the cell salvage system can reduce the allogeneic blood transfusion requirement in total hip arthroplasty patients. We reviewed retrospectively the medical records of patients who underwent hip arthroplasty surgeries between 2010 and 2012 in a university hospital. A total of 181 arthroplasty patients were enrolled in our study. In the cell salvage group, the mean perioperative rate of allogeneic blood transfusion was significantly lower (92.53±111.88mL) than that in the control group (170.14±116.79mL; pcontrol group (152.22±208.37mL), although the difference was not statistically significant. The number of patients receiving allogeneic blood transfusion in the CS group (n=29; 43.2%) was also significantly lower than control group (n=56; 73.6%; pde Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  6. [Two-year experience with cell salvage in total hip arthroplasty].

    Science.gov (United States)

    Buget, Mehmet I; Dikici, Fatih; Edipoğlu, İpek S; Yıldız, Eren; Valiyev, Natig; Kucukay, Suleyman

    2016-01-01

    The aim of this study was to determine the efficacy of the cell salvage system in total hip arthroplasty surgeries and whether the cell salvage system can reduce the allogeneic blood transfusion requirement in total hip arthroplasty patients. We reviewed retrospectively the medical records of patients who underwent hip arthroplasty surgeries between 2010 and 2012 in a university hospital. A total of 181 arthroplasty patients were enrolled in our study. In the cell salvage group, the mean perioperative rate of allogeneic blood transfusion was significantly lower (92.53±111.88mL) than that in the control group (170.14±116.79mL; pcontrol group (152.22±208.37mL), although the difference was not statistically significant. The number of patients receiving allogeneic blood transfusion in the CS group (n=29; 43.2%) was also significantly lower than control group (n=56; 73.6%; pde Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  7. Prevention of venous thromboembolic disease after total hip and knee arthroplasty.

    Science.gov (United States)

    Lieberman, Jay R; Hsu, Wellington K

    2005-09-01

    Patients undergoing total hip and knee arthroplasty are at increased risk for the development of venous thromboembolic disease, and there is general agreement that these patients require prophylaxis. The selection of a prophylactic agent involves a balance between efficacy and safety and often needs to be individualized for specific patients and institutions. Despite extensive research, the ideal agent for prophylaxis against deep venous thrombosis has not been identified. The results of randomized trials indicate that low-molecular-weight heparin, warfarin, and fondaparinux are the most effective prophylactic agents after total hip arthroplasty and that low-molecular-weight heparin, warfarin, fondaparinux, and pneumatic compression boots are the most effective agents after total knee arthroplasty. The duration of prophylaxis against deep venous thrombosis after total hip and knee arthroplasty remains controversial. Prophylaxis should be continued beyond hospital discharge. In the future, the determination of the duration of prophylaxis will be based on the risk stratification of individual patients. The practice of discharging patients from the hospital without prophylaxis, even when the decision is based on negative results of procedures that screen for the presence of deep venous thrombosis, is not cost-effective.

  8. Two-stage revision of infected hip arthroplasty using a shortened post-operative course of antibiotics.

    LENUS (Irish Health Repository)

    McKenna, Paul B

    2009-04-01

    We present a series of 30 consecutive patients with 31 infected total hip arthroplasties treated by a single surgeon over a 4-year period in whom a shortened post-operative course of antimicrobial chemotherapy was used.

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

    Directory of Open Access Journals (Sweden)

    Erieta Nikolikj Dimitrova

    2016-02-01

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

  10. Low infection rate after tumor hip arthroplasty for metastatic bone disease in a cohort treated with extended antibiotic prophylaxis

    DEFF Research Database (Denmark)

    Hettwer, Werner H; Horstmann, Peter Frederik; Hovgaard, Thea Bechmann

    2015-01-01

    Background. Compared to conventional hip arthroplasty, endoprosthetic reconstruction after tumor resection is associated with a substantially increased risk of periprosthetic joint infection (PJI), with reported rates of around 10% in a recent systematic review. The optimal duration of antibiotic...

  11. Persistent non-specific FDG uptake on PET imaging following hip arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Zhuang, Hongming; Chacko, Thomas K.; Hickeson, Marc; Stevenson, Karen; Feng, Qi; Ponzo, Fabio; Alavi, Abass [Division of Nuclear Medicine, Department of Radiology, The Hospital of University of Pennsylvania, 110 Donner Building, 3400 Spruce Street, Philadelphia, PA 19104 (United States); Garino, Jonathan P. [Department of Orthopedic Surgery, The Hospital of University of Pennsylvania, Philadelphia, PA 19802 (United States)

    2002-10-01

    Hip arthroplasty is a common surgical procedure, but the diagnosis of infection associated with hip arthroplasty remains challenging. Fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) has been shown to be a promising imaging modality in settings where infection is suspected. However, inflammatory reaction to surgery can result in increased FDG uptake at various anatomic locations, which may erroneously be interpreted as sites of infection. The purpose of this study was to assess the patterns and time course of FDG accumulation following total hip replacement over an extended period of time. Firstly, in a prospective study nine patients with total hip replacement were investigated to determine the patterns of FDG uptake over time. Three FDG-PET scans were performed in each patient at about 3, 6 and 12 months post arthroplasty. Secondly, in a retrospective analysis, the medical and surgical history and FDG-PET imaging results of 710 patients who had undergone whole-body scans for the evaluation of possible malignant disorders were reviewed. The history of arthroplasty and FDG-PET findings in the hip region were reviewed for this study. Patients with symptomatic arthroplasties or related complaints during FDG-PET scanning were excluded from the analysis. During the entire study period, all nine patients enrolled in the prospective study were demonstrated to have increased FDG uptake around the femoral head or neck portion of the prosthesis that extended to the soft tissues surrounding the femur. Among the patients reviewed in the retrospective study, 18 patients with a history of 21 hip arthroplasties who were asymptomatic at the time of FDG-PET scan met the criteria for inclusion. The time interval between the hip arthroplasty and the FDG-PET study ranged from 3 months to 288 months (mean{+-}SD: 80.4{+-}86.2 months). In 81% (17 of 21) of these prostheses, increased FDG uptake could be noted around the femoral head or neck portion of the

  12. Persistent non-specific FDG uptake on PET imaging following hip arthroplasty

    International Nuclear Information System (INIS)

    Zhuang, Hongming; Chacko, Thomas K.; Hickeson, Marc; Stevenson, Karen; Feng, Qi; Ponzo, Fabio; Alavi, Abass; Garino, Jonathan P.

    2002-01-01

    Hip arthroplasty is a common surgical procedure, but the diagnosis of infection associated with hip arthroplasty remains challenging. Fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) has been shown to be a promising imaging modality in settings where infection is suspected. However, inflammatory reaction to surgery can result in increased FDG uptake at various anatomic locations, which may erroneously be interpreted as sites of infection. The purpose of this study was to assess the patterns and time course of FDG accumulation following total hip replacement over an extended period of time. Firstly, in a prospective study nine patients with total hip replacement were investigated to determine the patterns of FDG uptake over time. Three FDG-PET scans were performed in each patient at about 3, 6 and 12 months post arthroplasty. Secondly, in a retrospective analysis, the medical and surgical history and FDG-PET imaging results of 710 patients who had undergone whole-body scans for the evaluation of possible malignant disorders were reviewed. The history of arthroplasty and FDG-PET findings in the hip region were reviewed for this study. Patients with symptomatic arthroplasties or related complaints during FDG-PET scanning were excluded from the analysis. During the entire study period, all nine patients enrolled in the prospective study were demonstrated to have increased FDG uptake around the femoral head or neck portion of the prosthesis that extended to the soft tissues surrounding the femur. Among the patients reviewed in the retrospective study, 18 patients with a history of 21 hip arthroplasties who were asymptomatic at the time of FDG-PET scan met the criteria for inclusion. The time interval between the hip arthroplasty and the FDG-PET study ranged from 3 months to 288 months (mean±SD: 80.4±86.2 months). In 81% (17 of 21) of these prostheses, increased FDG uptake could be noted around the femoral head or neck portion of the

  13. A blood-conservation algorithm to reduce blood transfusions after total hip and knee arthroplasty.

    Science.gov (United States)

    Pierson, Jeffery L; Hannon, Timothy J; Earles, Donald R

    2004-07-01

    Donation of autologous blood before total joint arthroplasty is inconvenient and costly, causes a phlebotomy-induced anemia, and may be wasteful and unnecessary for the nonanemic patient. We developed a blood-conservation algorithm that does not require predonation of autologous blood, employs selective use of epoetin alfa, and uses evidence-based transfusion criteria. Our hypothesis was that use of this algorithm would reduce the rate of transfusion after unilateral total hip and knee arthroplasty as compared with the rates described in previous reports. We retrospectively reviewed the records of 500 consecutive patients in whom unilateral primary total hip or knee arthroplasty had been performed by a single surgeon. The same blood-conservation algorithm was recommended to all patients. Two groups of patients were identified: the first group consisted of 433 patients in whom the algorithm was followed, and the second group consisted of sixty-seven patients in whom the algorithm was not followed. In the group in which the algorithm was followed, the rates of allogeneic transfusion after total knee and total hip arthroplasty were 1.4% (three of 220) and 2.8% (six of 213), respectively. The overall rate of transfusion in this group was only 2.1% (nine of 433). The prevalence of transfusion in the group in which the algorithm was not followed was 16.4% (eleven of sixty-seven). This difference was significant (p = 0.0001). The use of this blood-conservation algorithm resulted in a significant reduction in the need for allogeneic blood transfusions after unilateral total hip and knee arthroplasty, and the results compare favorably with the rates of transfusion described in previous reports.

  14. Reconstruction of neglected developmental dysplasia by total hip arthroplasty with subtrochanteric shortening osteotomy.

    Science.gov (United States)

    Atilla, Bülent

    2016-03-01

    Patients with neglected developmental dysplasia (DDH) face with early osteoarthritis of the hip, limb length inequality and marked disability while total hip reconstruction is the only available choice.DDH has severe morphologic consequences, with distorted bony anatomy and soft tissue contractures around the hip. It is critical to evaluate patients thoroughly before surgery.Anatomic reconstruction at the level of true acetabulum with uncemented implant is the mainstay of treatment. This requires a subtrochanteric shortening osteotomy, which can be realised using different osteotomy and fixation options.Although a demanding technique with a high rate of related complications, once anatomic reconstruction of the hip is achieved, patients have a remarkably good functional capacity and implant survival during long follow-up periods. Cite this article: Atilla B. Reconstruction of neglected developmental dysplasia by total hip arthroplasty with subtrochanteric shortening osteotomy. EFORT Open Rev 2016;1:65-71. DOI: 10.1302/2058-5241.1.000026.

  15. [More muscle mass in men: explanatory model for superior outcome after total hip arthroplasty].

    Science.gov (United States)

    Preininger, B; Schmorl, K; von Roth, P; Winkler, T; Matziolis, G; Perka, C; Tohtz, S

    2013-02-01

    Men show better functional results after total hip arthroplasty (THA). The aim of this study was a patient-specific analysis of the hip joint muscles in comparison to the joint geometry. In this study 93 computed tomography (CT) scans of the pelvis (45 men, 48 women) were analyzed to determine hip joint geometry and the volume of the gluteus medius (GMV), gluteus maximus (GXV) and tensor fasciae latae (TFL) muscles. The abduction muscle volumes were analyzed with respect to patient-specific adduction moments. The absolute total volume of the hip muscular system (TMV) was larger in men than in women (1913 ccm vs. 1479 ccm; p abduction muscle mass in order to balance adduction moments occurring in the hip joint and therefore have more muscle mass to compensate the inevitable intraoperative muscle damage during THA. This argument supports the extraordinary importance of muscle sparing surgical techniques in women.

  16. Anteversion of the acetabular component aligned with the transverse acetabular ligament in total hip arthroplasty.

    Science.gov (United States)

    Miyoshi, Hideaki; Mikami, Hiroshi; Oba, Koichi; Amari, Rui

    2012-06-01

    In total hip arthroplasty (THA), accurately positioning the cup is crucial for achieving an adequate postoperative range of motion and stability. For 47 THA cases in which the inferomedial rim of the cup had been positioned parallel to the transverse acetabular ligament, we retrospectively performed the measurements of the radiographic cup anteversion angle relative to the anterior pelvic plane using 3-dimensional reconstruction computed tomography. The mean anteversion angle was 21.2°, with no significant difference detected in mean cup anteversion between the dysplastic hip group (15 hips) and the control group (15 hips). We suggest that the transverse acetabular ligament is a practical anatomical landmark for determining cup anteversion in THA for both dysplastic and nondysplastic hip cases. Copyright © 2012 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2008-03-01

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

  18. Cementless Total Hip Arthroplasty With a High Hip Center for Hartofilakidis Type B Developmental Dysplasia of the Hip: Results of Midterm Follow-Up.

    Science.gov (United States)

    Chen, Min; Luo, Zheng-Liang; Wu, Ke-Rong; Zhang, Xiao-Qi; Ling, Xiao-Dong; Shang, Xi-Fu

    2016-05-01

    Acetabular reconstruction in adults with Hartofilakidis type B developmental dysplasia of the hip is a major technical challenge. The purpose of this retrospective study was to evaluate hip function and radiographic outcomes regarding high hip center at midterm follow-up. From January 1, 2007 to December 31, 2009, 37 patients who had Hartofilakidis type B developmental dysplasia of the hip underwent a primary total hip arthroplasty using a high hip center technique. Functional, radiographic, and survivorship outcomes were evaluated. Of the 37 patients, 31 patients (83.8%) were available for the mean follow-up of 6.1 years (range, 1.5-7.6 years). Thirty-one cementless cups were located at an average vertical distance of 38.1 ± 3.3 mm and at a mean horizontal distance of 35.5 ± 3.4 mm. The mean ratio of the height of the hip center was 2.4% (range, 2.0%-2.9%). The Harris Hip Scores were improved from 50.3 points (range, 38-63 points) preoperatively to 92.3 points (range, 85-100 points) at the final follow-up (P hip center technique in conjunction with a cementless acetabular component seems to be a valuable alternative to achieve satisfactory midterm outcomes for Hartofilakidis type B developmental dysplasia of the hip. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Manual therapy intervention for a patient with a total hip arthroplasty revision.

    Science.gov (United States)

    Howard, Paul D; Levitsky, Beth

    2007-12-01

    Case report. A 73-year-old active woman with a total hip arthroplasty, who later had revision surgery, developed left hip and buttock pain 2 years after the revision surgery, subsequent to lifting her foot while seated. This movement was performed so that her spouse could assist her in putting on her sock and shoe. During the first physical therapy session, the patient exhibited a forward-flexed trunk posture and difficulty weight bearing on the involved lower limb. The patient was successfully treated with manual therapy techniques and a home exercise program. The manual therapy techniques included long-axis hip distraction, lateral hip distraction, posterior-to-anterior hip joint mobilization, and a contract-relax proprioceptive neuromuscular facilitation technique. The patient's home program consisted of long-axis hip distraction, performed by her spouse, and standing lower limb pendular movements into flexion and extension. Pain scale ratings, posture and gait observations, strength, range of motion, and return to functional activities served as outcome measures. After 1 physical therapy visit, in which manual therapy techniques were utilized, the patient had a significant decrease in hip symptoms. The patient and spouse were compliant with the home exercise program and continued with physical therapy for 3 more visits, and the patient ultimately became symptom free. The patient returned to all previous activities, including household chores, cooking, and a walking program. The patient was contacted at 6 months, 1 year, and 4 years, and reported no recurrences of hip or buttock symptoms. Manual therapy techniques and home exercises described in this case report were apparently effective in eliminating symptoms and returning this patient, who had total hip arthroplasty and revision surgery 2 years earlier, to all previous functional activities after a dressing incident produced hip and buttock symptoms.

  20. Two-Stage Progressive Femoral Lowering Followed by Cementless Total Hip Arthroplasty for Treating Crowe IV-Hartofilakidis Type 3 Developmental Dysplasia of the Hip.

    Science.gov (United States)

    Binazzi, Roberto

    2015-05-01

    High developmental dysplasia of the hip is commonly treated with total hip arthroplasty and shortening osteotomy. We present a two stage technique, consisting of progressive femoral lowering followed by total hip arthroplasty. The clinico-radiographic results of eleven patients (twelve hips) who were operated on with the two-stage technique were evaluated at a mean follow-up of 11 ± 5 years. At the final follow-up, ten patients (eleven hips) had a mean Harris hip score of 85 ± 5 points with no implant loosening. One patient (one hip) was revised at 5 years due to infection. No neurovascular complications were observed in any patients. With this technique, we could place the cup in the anatomical position and obtain complete limb symmetry with excellent clinical results at long-term. Copyright © 2014 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2013-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Hok-Yin Alwin Li

    2014-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Friederich Niklaus F

    2011-02-01

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

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

    DEFF Research Database (Denmark)

    Jensen, Carsten; Aagaard, Per; Overgaard, S

    2011-01-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    The study was based on the Nordic Arthroplasty Register Association (NARA) dataset. 432,168 primary THAs from 1995 to 2009 were included (Denmark: 83,853, Finland 78,106, Norway 88,455, and Sweden 181,754). Adjusted survival analyses were performed using Cox regression models with revision due to infection...

  6. [EFFECTIVENESS OF ANATOMIC FEMORAL COMPONENT PROSTHESIS FOR SEVERE DEVELOPMENTAL DYSPLASIA OF THE HIP IN TOTAL HIP ARTHROPLASTY].

    Science.gov (United States)

    An, Xiao; Dong, Jiyuan; Gong, Ke; Zhang, Qi; Li, Xiang; Song, Wei

    2015-04-01

    To evaluate the effectiveness of anatomic femoral component prosthesis for severe development dysplasia of the hip (DDH) in total hip arthroplasty (THA). Between September 2009 and September 2013, 48 patients (51 hips) with severe DDH underwent THA with cementless anatomic femoral component prosthesis. There were 5 males (5 hips) and 43 females (46 hips) with an average age of 51 years (range, 28-67 years). The left hip was involved in 25 cases, the right hip in 20 cases, and bilateral hips in 3 cases. There were 39 cases (44 hips) of Crowe type III and 9 cases (7 hips) of Crowe type IV. The visual analogue scale (VAS) score was 5.72 +/- 1.84, and Harris score was 41.66 +/- 4.87 at preoperation. All patients had leg discrepancy with a length difference of (4.31 +/- 0.84) cm. The duration of surgery was 59-110 minutes (mean, 78.6 minutes), and the hospitalization days were 6-20 days (mean, 12.3 days). All patients obtained primary healing of incision without wound related complications of swelling, effusion, and infection. Two patients were found to have intramuscular venous thrombosis. All patients were followed up 10-54 months (mean, 29 months). Limp was observed at the early stage after operation in 9 patients and disappeared after 1 year, the other patients had normal gait. The VAS score 1.46?0.47, Harris score 88.66 +/- 3.48, and the leg length difference (1.15 +/- 0.33) cm at last follow-up all showed significant differences when compared with the preoperative values (Phip joint function and limb discrepancy. Short-term effectiveness was satisfactory, but the long-term effectiveness should still be observed in future.

  7. Bipolar hip arthroplasty for avascular necrosis of femoral head in young adults

    Science.gov (United States)

    Dudani, Baldev; Shyam, Ashok K; Arora, Pankush; Veigus, Arjun

    2015-01-01

    Background: Bipolar hip arthroplasty (BHA) is one of the options for treatment of avascular necrosis (AVN) of the femoral head. Acetabular erosion and groin pain are the most allowing for gross motion between the common complications. We propose that these complications are secondary to improper acetabular preparation allowing for motion between the BHA head and the acetabulum. Materials and Methods: The current study retrospectively evaluated patients’records from case files and also called them for clinical and radiological followup. 96 hips with AVN of the femoral head treated with BHA were included in the study. All patients were males with a mean age of 42 years (range 30-59 years). In all cases, the acetabulum was gently reamed till it became uniformly concentric to achieve tight fitting trial cup. Clinical followup using Harris hip score (HHS) and radiological study for cup migration were done at followup. Results: The mean followup was 7.52 years (range 4-16 years). The HHS significantly improved from a preoperative value of 39.3 (range, 54-30) to a postoperative value of 89.12 (range 74-96). According to HHS grades, the final outcome was excellent in 52 hips, good in 28 and fair in 16 hips. Hip and groin pain was reported in four hips (5%), but did not limit activity. Subsidence (less than 5 mm) of the femoral component was seen in 8 cases. Subgroup analysis showed patients with Ficat Stage 3 having better range of motion, but similar HHS as compared to Ficat Stage 4 patients. Conclusion: Bipolar hip arthroplasty (BHA) using tight fitting cup and acetabular reaming in AVN hip has a low incidence of groin pain, acetabular erosion and revision in midterm followup. Good outcome and mid term survival can be achieved irrespective of the Ficat Stage. PMID:26015634

  8. Functioning Before and After Total Hip or Knee Arthroplasty

    NARCIS (Netherlands)

    I.B. de Groot (Ingrid)

    2009-01-01

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

  9. Painful prosthesis: approaching the patient with persistent pain following total hip and knee arthroplasty

    Science.gov (United States)

    Piscitelli, Prisco; Iolascon, Giovanni; Innocenti, Massimo; Civinini, Roberto; Rubinacci, Alessandro; Muratore, Maurizio; D’Arienzo, Michele; Leali, Paolo Tranquilli; Carossino, Anna Maria; Brandi, Maria Luisa

    2013-01-01

    Summary Background Symptomatic severe osteoarthritis and hip osteoporotic fractures are the main conditions requiring total hip arthroplasty (THA), whereas total knee arthroplasty (TKA) is mainly performed for pain, disability or deformity due to osteoarthritis. After surgery, some patients suffer from “painful prosthesis”, which currently represents a clinical problem. Methods A systematic review of scientific literature has been performed. A panel of experts has examined the issue of persistent pain following total hip or knee arthroplasty, in order to characterize etiopathological mechanisms and define how to cope with this condition. Results Four major categories (non infective, septic, other and idiopathic causes) have been identified as possible origin of persistent pain after total joint arthroplasty (TJA). Time to surgery, pain level and function impairment before surgical intervention, mechanical stress following prosthesis implant, osseointegration deficiency, and post-traumatic or allergic inflammatory response are all factors playing an important role in causing persistent pain after joint arthroplasty. Diagnosis of persistent pain should be made in case of post-operative pain (self-reported as VAS ≥3) persisting for at least 4 months after surgery, or new onset of pain (VAS ≥3) after the first 4 months, lasting ≥2 months. Acute pain reported as VAS score ≥7 in patients who underwent TJA should be always immediately investigated. Conclusions The cause of pain needs always to be indentified and removed whenever possible. Implant revision is indicated only when septic or aseptic loosening is diagnosed. Current evidence has shown that peri-and/or post-operative administration of bisphosphonates may have a role in pain management and periprosthetic bone loss prevention. PMID:24133526

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

    Science.gov (United States)

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

    2018-02-15

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

  11. Prevention of post-operative anaemia in hip and knee arthroplasty - a systematic review

    DEFF Research Database (Denmark)

    Khan, Nissa; Troelsen, Anders; Husted, Henrik

    2015-01-01

    INTRODUCTION: Patient blood management strategies for total hip and knee arthroplasty are controversial. They range from pre-operative haemoglobin optimisation to intra- and post-operative interventions. The aim of this study was to assess the various treatment modalities with respect to blood loss......, haemoglobin levels and blood transfusions. METHODS: The analysis was based on the principles of a systematic review. The literature was searched in PubMed for the period from 2004 to November 2014. The articles were reviewed with respect to blood loss, post-operative haemoglobin drop, blood transfusions...... and length of hospital stay. The papers were evidence-graded. Non-randomised clinical studies and papers not concerning total hip or knee arthroplasty were excluded as were studies lacking a control group. Subanalyses were performed for tran-examic acid, tourniquet and fibrin use. RESULTS: A total of 49...

  12.  MULTIMODAL ANALGESIA IN FAST TRACK HIP AND KNEE ARTHROPLASTY

    DEFF Research Database (Denmark)

    Holm, Bente; Bak, Mikkel; Kristensen, Billy Bjarne

    and amount of physiotherapy is required. This study is the first step towards developing guidelines for future physiotherapy for patients with hip or knee arthroplasty. DESCRIPTION: Material: Sixteen patients with unilateral, total hip arthroplasty (THA) and sixteen patients with unilateral, total knee....... Patients started mobilisation on the day of the operation with further physiotherapy the following days, including transfer and ambulation training, and specific joint and muscle exercises. In connection with all activities, pain scores were assessed, using a Visual Analog Scale (VAS). All patients......, and for TKA patients from 3.9 to 3.5 days. At day one (day of operation) 28 of the 32 patients were able to walk with a walking aid. At the day of discharge patients used crutches as walking aids. Pain registered with VAS in connection with transfer showed a mean score of 3.2 at day one, reduced at discharge...

  13.  MULTIMODAL ANALGESIA IN FAST TRACK HIP AND KNEE ARTHROPLASTY

    DEFF Research Database (Denmark)

    Holm, Bente; Bak, Mikkel; Kristensen, Billy Bjarne

    2007-01-01

    scored mean nine out of possible ten points regarding their satisfaction with the entire stay including LOS. CONCLUSIONS: These results demonstrate, that LOS can be shortened without reducing the quality of the hospital stay. Further studies conducted as randomized controlled trials, including follow...... and dressing, and pain medication with only oral analgesics. RELEVANCE: Current efforts focus to shorten the LOS and improve pain management. However, a decreased LOS has to ensure restoration of functional ability to the same level achieved with traditional LOS. Accordingly a description of the content...... and amount of physiotherapy is required. This study is the first step towards developing guidelines for future physiotherapy for patients with hip or knee arthroplasty. DESCRIPTION: Material: Sixteen patients with unilateral, total hip arthroplasty (THA) and sixteen patients with unilateral, total knee...

  14. Outcomes of Modular Dual Mobility Acetabular Components in Revision Total Hip Arthroplasty.

    Science.gov (United States)

    Sutter, E Grant; McClellan, Taylor R; Attarian, David E; Bolognesi, Michael P; Lachiewicz, Paul F; Wellman, Samuel S

    2017-09-01

    There is a high rate of dislocation after revision total hip arthroplasty. This study evaluated the outcomes of 1 modular dual mobility component in revision total hip arthroplasty in patients at high risk of dislocation. We reviewed 64 revisions performed in 27 (42%) patients for recurrent dislocation, 16 (25%) for adverse local tissue reaction, 11 (17%) for reimplantation infection, and 10 (16%) for aseptic loosening, malposition, or fracture. Complications, reoperations, and survivorship were evaluated. Three-year survival was 98% with failure defined as aseptic loosening and 91% with failure as cup removal for any reason. With mean follow-up time of 38 months, there were 14 complications, including 2 dislocations treated with closed reduction, 9 infections, and 12 reoperations. All complications occurred in patients revised for instability, adverse local tissue reaction, or infection. The early results of this component are promising, with good overall survival and low rate of dislocation. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Arthroplasty of hip resection, handling with external fixation - Experience in the central military hospital

    International Nuclear Information System (INIS)

    Satizabal Azuero, Carlos E; Calderon Uribe, Oscar; Naquira Escobar, Luis F

    2006-01-01

    This is an observational retrospective study series of cases carried out between January 1998 and July 2004 in the central military hospital, 13 patients were treated with Girdlestone arthroplasty with external fixation, with a pursuit average of 53 months. Function, return to the daily activities and associate complications was evaluated. They were as complication; pain in the fixator site, osteitis, and fixator broke. All patients report at the end of the treatment no pain in the hip. Shortening in the patient without lenghting was 3,5 cm and in the group with lenghting was 1.5 cm. the obtained results demonstrate that Girdlestone arthroplasty with external fixation, is option, to improve the patient's pain and function of the hip

  16. Cost-effectiveness of positive contrast and nuclear arthrography in patients who underwent total hip arthroplasty

    International Nuclear Information System (INIS)

    Swan, J.S.; Braunstein, E.M.; Capello, W.; Wellman, H.

    1989-01-01

    The authors have compared the cost effectiveness of contrast arthrography (CA) and nuclear arthrography (NA), in which In-111 chloride is injected with the contrast material, of total hip arthroplasties. Their series included 48 cases of surgically proved loose femoral components. The cost per true-positive result was obtained by taking the total cost of the examinations in surgically proved cases and dividing by the number of true-position cases. The cost of CA was $297 and the cost of NA was $335. For CA, the cost per true positive was $1,018, and for the NA the cost per true positive was $946. In spite of higher initial cost, NA is more cost effective than CA on a cost per true-positive case basis. NA is cost effective in evaluating hip arthroplasties in which there is suspicion of a loose femoral component

  17. Early Clinical and Radiographic Results of Minimally Invasive Anterior Approach Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Tamara Alexandrov

    2014-01-01

    consecutive patients with 43 total hip arthroplasties performed through an anterior muscle sparing minimally invasive approach. We found the early complication rates and radiographic outcomes comparable to those reported from arthroplasties performed via traditional approaches. Complications included dislocation (2%, femur fracture (2%, greater trochanteric fracture (12%, postoperative periprosthetic intertrochanteric fracture (2%, femoral nerve palsy (5%, hematoma (2%, and postoperative iliopsoas avulsion (2%. Radiographic analysis revealed average cup anteversion of 19.6°±6.6, average cup abduction angle of 48.4°±7, stem varus of 0.9°±2, and a mean leg length discrepancy of 0.7 mm. The anterior approach to the hip is an attractive alternative to the more traditional approaches. Acceptable component placement with comparable complication rates is possible using a muscle sparing technique which may lead to faster overall recovery.

  18. Phase transformation of a zirconia ceramic head after total hip arthroplasty.

    Science.gov (United States)

    Haraguchi, K; Sugano, N; Nishii, T; Miki, H; Oka, K; Yoshikawa, H

    2001-09-01

    We report two cases of surface deterioration of a zirconia ceramic femoral head associated with phase transformation after total hip arthroplasty. One head was retrieved at revision due to recurrent dislocation after six years and the other because of failure of the locking mechanism of the polyethylene liner after three years. The monoclinic content of the zirconia ceramics rose from 1% to about 30% on the surface of the heads. SEM revealed numerous craters indicating extraction of the zirconia ceramics at the surface. Surface roughness increased from an initial value of 0.006 microm up to 0.12 microm. This is the first report to show that phase transformation of zirconia ceramics causes deterioration of the surface roughness of the head in vivo after total hip arthroplasty.

  19. A quantitative assessment of facial protection systems in elective hip arthroplasty.

    Science.gov (United States)

    Hirpara, Kieran Michael; O'Halloran, Emily; O'Sullivan, Michael

    2011-06-01

    We aimed to assess the risk to surgeons of blood splatter during total hip arthroplasty. Hoods from personal protection systems used in 34 consecutive total hip replacements were collected and the area of blood splatter was measured and compared to goggles and visors. Thirty one primary THA's (13 cemented, 4 hybrid, 14 uncemented) and 3 revisions (1 hybrid, 2 uncemented) were collected. Splashes were detected on all of the masks with a mean of 034% cover. Splatter was greatest for the operating surgeon, followed by the first assistant, though the difference was not statistically significant. Operating personnel were at greater risk of contamination during uncemented arthroplasty (p blood cover was outside the area protected by goggles and visors respectively. There was a significant difference between the Personal Protection Systems (PPS) and goggles (p = 0.0231; 95% CI) as well as between the PPS and visors (p = 0.0293; 95% CI).

  20. Oral Midodrine Hydrochloride for Prevention of Orthostatic Hypotension during Early Mobilization after Hip Arthroplasty

    DEFF Research Database (Denmark)

    Jans, Øivind; Mehlsen, Jesper; Kjærsgaard-Andersen, Per

    2015-01-01

    . The oral α-1 agonist midodrine hydrochloride increases vascular resistance, and the authors hypothesized that midodrine would reduce the prevalence of OH during mobilization 6 h after total hip arthroplasty relative to placebo. METHODS: This double-blind, randomized trial allocated 120 patients 18 yr...... or older and scheduled for total hip arthroplasty under spinal anesthesia to either 5 mg midodrine hydrochloride or placebo orally 1 h before mobilization at 6 and 24 h postoperatively. The primary outcome was the prevalence of OH (decrease in systolic or diastolic arterial pressures of > 20 or 10 mm......Hg, respectively) during mobilization 6 h after surgery. Secondary outcomes were OI and hemodynamic responses to mobilization at 6 and 24 h. RESULTS: At 6 h, 14 (25%; 95% CI, 14 to 38%) versus 23 (39.7%; 95% CI, 27 to 53%) patients had OH in the midodrine and placebo group, respectively, relative risk 0.63 (0...

  1. Does BMI influence hospital stay and morbidity after fast-track hip and knee arthroplasty?

    DEFF Research Database (Denmark)

    Husted, Henrik; Jørgensen, Christoffer C; Gromov, Kirill

    2016-01-01

    Background and purpose - Body mass index (BMI) outside the normal range possibly affects the perioperative morbidity and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in traditional care programs. We determined perioperative morbidity and mortality in such pat......Background and purpose - Body mass index (BMI) outside the normal range possibly affects the perioperative morbidity and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in traditional care programs. We determined perioperative morbidity and mortality...... in such patients who were operated with the fast-track methodology and compared the levels with those in patients with normal BMI. Patients and methods - This was a prospective observational study involving 13,730 procedures (7,194 THA and 6,536 TKA operations) performed in a standardized fast-track setting....... Complete 90-day follow-up was achieved using national registries and review of medical records. Patients were grouped according to BMI as being underweight, of normal weight, overweight, obese, very obese, and morbidly obese. Results - Median length of stay (LOS) was 2 (IQR: 2-3) days in all BMI groups. 30...

  2. [Comparative study of posterolateral conventional and minimally invasive total hip arthroplasty].

    Science.gov (United States)

    Sun, Shihua; Wang, Shuanke; Zhao, Lin; Wang, Xu

    2009-06-01

    To compare the clinical effect of total hip arthroplasty (THA) using posterolateral conventional or minimally invasive incision. From January 2007 to November 2007, 38 patients (41 hips) were treated with minimally invasive THA (mini-incision group), and 15 patients (15 hips) underwent conventional THA (conventional incision group). Mini-incision group: 23 males (25 hips) and 15 females (16 hips) aged (53.2 +/- 15.5) years old; body mass index (BMI) was 23.4 +/- 3.3; there were 20 cases (20 hips) of femoral neck fracture, 2 cases (2 hips) of primary osteoarthritis, 14 cases (16 hips) of stage III or IV aseptic necrosis of the femoral head, 2 cases (3 hips) of ankylosing spondylitis involving hip joint; Harris hip score was 47.7 +/- 5.5 and the course of disease was (4.5 +/- 4.3) years. Conventional incision group: 7 males (7 hips) and 8 females (8 hips) aged (54.8 +/- 10.8) years old; BMI was 26.1 +/- 5.1; there were 8 cases (8 hips) of femoral neck fracture, 1 case (1 hip) of primary osteoarthritis, 5 cases (5 hips) of stage III or IV aseptic necrosis of the femoral head, 1 case (1 hip) of ankylosing spondylitis involving hip joint; Harris hip score was 51.2 +/- 4.3 and the course of disease was (3.8 +/- 3.7) years. There were no statistically significant differences between two groups in the general information (P > 0.05). There were statistical differences between two groups in terms of incision length, perioperative blood loss, drainage volume and blood transfusion volume (P 0.05). All incisions healed by first intention and no early postoperative complications occurred. Two groups were followed for 12-22 months (average 18.3 months). All patients walked without the crutch at 2-3 months after operation. The Harris score of the mini-incision group and the conventional incision group 6 months after operation was 88.6 +/- 3.6 and 85.8 +/- 3.3, respectively, indicating there was no significant difference between two groups (P > 0.05), but there was significant

  3. Efficacy of intraoperative blood collection and reinfusion in revision total hip arthroplasty.

    Science.gov (United States)

    Zarin, Jeffrey; Grosvenor, David; Schurman, David; Goodman, Stuart

    2003-11-01

    Patients undergoing revision total hip arthroplasty frequently require perioperative blood transfusion, increasing the risk for blood-borne disease and anaphylactic and hemolytic reactions. The purpose of this retrospective study was to evaluate the effect of intraoperative blood collection and reinfusion on net blood loss in patients undergoing revision hip arthroplasty. The medical records of 126 patients who had had a revision total hip arthroplasty with intraoperative blood salvage, with use of a collection and reinfusion device, during a twenty-eight-month period were reviewed. For comparison, the medical records of ninety-six patients who had undergone revision hip arthroplasty without intraoperative blood salvage were reviewed. Each of the 222 patients was categorized into a group on the basis of the type of revision. Patients who had a revision of the femoral and acetabular components (Group C) had significantly higher mean intraoperative and total blood loss than did those who had a revision of the femoral component only (Group A [p = 0.009 and p = 0.02, respectively]) or a revision of the acetabular component only (Group B [p = 0.0001 for both]). Total blood loss was not significantly different between Groups A and B. The mean amount of blood reinfused intraoperatively was 356 mL for the patients in Group A, 374 mL for the patients in Group B, and 519 mL for the patients in Group C. Regression analysis showed a significant decrease in net blood loss with intraoperative collection and reinfusion in Groups B (p = 0.002) and C (p = 0.0001) but not in Group A. Intraoperative collection and reinfusion substantially decreased net perioperative blood loss in patients who had a revision of both components (Group C) and in those who had a revision of the acetabular component (Group B). The use of intraoperative blood collection and reinfusion appears to be a valuable method of preserving blood volume in the perioperative period.

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

    Directory of Open Access Journals (Sweden)

    Ai E Gamboa

    2015-08-01

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

  5. Transfusion-related mortality after primary hip arthroplasty - an analysis of mechanisms and confounders

    DEFF Research Database (Denmark)

    Jans, O; Kehlet, H; Johansson, P I

    2012-01-01

    Background and Objectives Bleeding and postoperative anaemia after total hip arthroplasty (THA) may trigger transfusion of red blood cells (RBC). However, large observational studies have reported associations between RBC transfusion and increased postoperative morbidity and mortality. As major...... bleeding or severe postoperative anaemia is intrinsically linked with RBC transfusion, direct causality between transfusion and adverse outcomes remains unclear. This study aimed to identify possible relations between RBC transfusion, severe bleeding or anaemia and mortality in all patients who died...

  6. A comparative evaluation of the antimicrobial activity of local antiseptics in revision hip arthroplasty

    OpenAIRE

    Loskutov A.E.; Digtiar A.V.; Stepanskiy D.A.

    2017-01-01

    In our study there is presented information on the research of antagonistic activity of medications octenidine, decamethoxine, dioxydine, myramistin, povidone-iodine, chlorhexidine in standard dosage form and in dilution (1:1 and 1:5) on microorganisms: S. aureus, S. epidermidis, S. haemolitycus, P. aeruginоsa, E. agglomerans, E. coli isolated from patients in revision hip arthroplasty. A considerable bacrteriostatic and bacreticidal activity of investigated medications on microorganisms was ...

  7. The Use of PROSTALAC in Two-stage Reimplantation of Septic Total Knee and Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    BL Wam

    2010-11-01

    Full Text Available The PROSTALAC (PROSThesis Antibiotic Loaded Acrylic Cement functional spacer is made with antibiotic-loaded acrylic cement. We use it as an interim spacer in two-stage exchange arthroplasty in cases of infected total knee or total hip replacement. PROSTALAC allows continuous rehabilitation between stages as it maintains good alignment and stability of the joint with a reasonable range of movement. It also helps to maintain the soft-tissue planes, thereby facilitating the second-stage procedure. We report here early outcomes of the use of PROSTALAC in 5 patients - 3 in total knee replacements, 1 in a total hip replacement and 1 in a bipolar hemiarthroplasty.

  8. Abductor Reconstruction with Gluteus Maximus Transfer in Primary Abductor Deficiency during Total Hip Arthroplasty.

    Science.gov (United States)

    Jang, Se Ang; Cho, Young Ho; Byun, Young Soo; Gu, Tae Hoe

    2016-09-01

    Abductor deficiency in native hip joint may cause severe limping and pain. It is more serious situation in case of arthroplasty due to instability and recurrent dislocation. Well-known causes of abductor deficiency are repeated surgery, chronic trochanteric bursitis, superior gluteal nerve injury, failure of repair of abductor tendon insertion to the greater trochanter. Author had experienced primary abductor deficiency during total hip replacement and treated successfully with the transfer of gluteus maximus. We'd like to introduce the operation technique with the review of literature.

  9. Contemporary ceramic total hip arthroplasty in patients with cerebral palsy: does it work?

    Science.gov (United States)

    Yoon, Byung-Ho; Lee, Young-Kyun; Ha, Yong-Chan; Koo, Kyung-Hoi

    2015-03-01

    Adult patients with cerebral palsy (CP), who have advanced degenerative arthritis of the hip, have been treated with resection arthroplasty and arthrodesis. Although total hip arthroplasty (THA) has also been used as one of the alternative options, there are few studies on contemporary bearings used in THA. Therefore, we evaluated the results of the contemporary ceramic-on-ceramic THA in adult patients with CP. From January 2005 to December 2007, five adult CP patients (5 hips) underwent THA using contemporary ceramic-on-ceramic bearings. All patients were able to stand or ambulate with intermittent use of assistive devices at home. We retrospectively reviewed the series to determine the results of THA in terms of pain relief, improved function, and durability of prosthesis. There were 3 men and 2 women with a mean age of 35.9 years. All patients had pain relief without decline in mobility postoperatively. One hip was dislocated, which was treated successfully with closed reduction and an abduction brace for 2 months. There was no ceramic fracture, loosening, or osteolysis during the mean follow-up of 6.8 years (range, 5.8 to 8.3 years). Cementless THA using contemporary ceramic-on-ceramic bearings is a useful option for the treatment of advanced degenerative arthritis of the hip in ambulatory adults with CP.

  10. Clinical results of cementless total hip arthroplasty with shortening osteotomy for high dislocation with developmental dysplasia.

    Science.gov (United States)

    Desteli, Engin Eren; Imren, Yunus; Tan, Erkan; Erdoğan, Murat; Özcan, Hüseyin

    2015-03-01

    Total hip arthroplasty for severe developmental dysplasia of the hip is a technically challenging procedure. Subtrochanteric femoral osteotomy enables reducing the femoral head and restoring abductor muscle strength without compromising proximal femoral bone stock in advanced dysplasia.We aimed to retrospectively evaluate Crowe type III or IV developmental dysplasia of the hip who underwent reconstruction with cementless total hip arthroplasty combined with a transverse subtrochanteric femoral osteotomy. Sixty hips of 52 patients (11 male, 49 female) with Crowe type III (n: 37) or IV (n: 23) developmental dysplasia of the hip were included. The average age was 51.4 years. Surgery was performed in lateral decubitis position with posterolateral approach. Subtrochanteric transverse femoral osteotomy were used with cementless components. 40 of the femoral components were Secur-Fit type, and 20 of them were secur-fit plus max type. Ceramic-ceramic coupling was used in 24 cases and metal-polyethylene coupling was used in 36 cases. Merle D'Aubigne and Harris Hip score were used to rate the clinical outcome at the final follow up. All femoral shortening osteotomies were united at a mean of 5.7 months. Mean Merle D'Aubigne pain score was increased from 3.1 to 5.4, and mean Harris Hip score improved from 39 to 92.8, postoperatively (p<0.01). There was no significant difference in time to union between different types of stems. 4 femoral stems had asymptomatic radiolucent lines. There was no significant difference in time to union between different types of stems.

  11. Anthropometric Computed Tomography Reconstruction Identifies Risk Factors for Cortical Perforation in Revision Total Hip Arthroplasty.

    Science.gov (United States)

    Guild, George N; Runner, Robert P; Rickels, Tracy D; Oldja, Ryan; Faizan, Ahmad

    2016-11-01

    The incidence of revision hip arthroplasty is increasing with nearly 100,000 annual procedures expected in the near future. Many surgeons use straight modular tapered stems in revisions; however, complications of periprosthetic fracture and cortical perforation occur, resulting in poor outcomes. Our objective was to identify patient demographics and femoral characteristics that predispose patients to cortical perforation when using the straight modular stems. We used a computed tomography database and modeling software to identify patient demographics and morphologic femoral characteristics that predispose patients to cortical perforation during revision hip arthroplasty. Overall, 561 femurs from patients of various backgrounds were used, and statistical analysis was performed via the 2-sample t test. Decreased patient height (mean 163.0 vs 168.8 cm), radius of curvature (818 vs 939 mm), anterior-posterior (8.5 vs 13.8 mm) and medial-lateral (7.9 vs 11.3 mm) width of the isthmus, and distance of the isthmus from the greater trochanter (179 vs 186 mm) were all statistically significant risk factors for cortical perforation (P revision hip arthroplasty using straight modular tapered stems and highlights the importance of preoperative planning especially in patients with shorter stature, proximal location of the femoral isthmus, narrow femoral canal, and smaller radius of curvature. Also, when using a mid-length modular tapered stem without an extended trochanteric osteotomy, consideration should be given to using a kinked stem to avoid anterior cortical perforation. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Perioperative Timing of Infliximab and the Risk of Serious Infection After Elective Hip and Knee Arthroplasty.

    Science.gov (United States)

    George, Michael D; Baker, Joshua F; Hsu, Jesse Yenchih; Wu, Qufei; Xie, Fenglong; Chen, Lang; Yun, Huifeng; Curtis, Jeffrey R

    2017-12-01

    The optimal timing of tumor necrosis factor antagonists before elective surgery is unknown. This study evaluated the association between infliximab timing and serious infection after elective hip or knee arthroplasty. A retrospective cohort study evaluated US Medicare patients with rheumatoid arthritis, inflammatory bowel disease, psoriasis, psoriatic arthritis, or ankylosing spondylitis who received infliximab within 6 months of elective knee or hip arthroplasty from 2007 to 2013. Propensity-adjusted analyses examined whether infliximab stop timing (time between the most recent infusion and surgery) was associated with hospitalized infection within 30 days or prosthetic joint infection (PJI) within 1 year. Hospitalized infection within 30 days occurred after 270 of 4,288 surgeries (6.3%). Infliximab stop timing 10 mg/day was associated with increased risk of 30-day infection (OR 2.11 [95% CI 1.30-3.40]) and PJI (HR 2.70 [95% CI 1.30-5.60]). Other risk factors for infection included elderly age, comorbidities, revision surgery, and previous hospitalized infection. Administering infliximab within 4 weeks of elective knee or hip arthroplasty was not associated with a higher risk of short- or long-term serious infection compared to withholding infliximab for longer time periods. Glucocorticoid use, especially >10 mg/day, was associated with an increased infection risk. © 2017, American College of Rheumatology.

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

    OpenAIRE

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

    2017-01-01

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

  14. Outcomes of different bearings in total hip arthroplasty - implant survival, revision causes, and patient-reported outcome.

    Science.gov (United States)

    Varnum, Claus

    2017-03-01

    Total hip arthroplasty (THA) is a common and successful treatment of patients suffering from severe osteoarthritis that significantly reduces pain and improves hip function and quality of life. Traditionally, the outcome of THA has been evaluated by orthopaedic surgeons and assessed in morbidity and mortality rates, and implant survival. As patients and surgeons may assess outcome after THA differently, patient-reported outcomes (PROMs) have gained much more interest and are today recognized as very important tools for evaluating the outcome and satisfaction after THA. One of the prognostic factors for the outcome of THA is the type of bearings. This PhD thesis focuses on the influence of different types of bearings on implant survival, revision causes, PROMs, and noises from THA. The aims of the thesis were: Study I: To examine the revision risk and to investigate the causes of revision of cementless ceramic-on-ceramic (CoC) THAs comparing them to those of "standard" metal-on-polyethylene (MoP) THAs. Study II: To compare the six-year revision risk for metal-on-metal (MoM) with that for MoP bearings in cementless stemmed THA, and further to study the revision risk for different designs of stemmed MoM THAs and the causes of revision. Study III: To examine the association between CoC, MoM, and MoP bearings and both generic and disease-specific PROMs, and furthermore to examine the incidence and types of noises from the three types of bearings and identify the effect of noises on PROM scores. In study I and III, we used data from the Danish Hip Arthroplasty Registry combined with data from the Civil Registration System and the Danish National Patient Registry. In study II, data from the Nordic Arthroplasty Register Association, containing data from hip arthroplasty registries in Denmark, Norway, Sweden, and Finland, was used. In study I, 11,096 patients operated from 2002 through 2009 with cementless THA were included. Of these, 16% had CoC THA and 84% had MoP THA. At

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

    DEFF Research Database (Denmark)

    Christensen, Mikkel; Folkmar, Klaus

    2013-01-01

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

  16. [Superficial femoral vein thrombosis due to large psoas bursitis secondary to particle disease in total hip arthroplasty].

    Science.gov (United States)

    Lax-Pérez, R; Salinas-Gilabert, J E; Lajara-Marco, F; Lax-Pérez, A; Corraliza-Zamorano, A; García-Gálvez, A; Izquierdo-Plazas, L

    2012-01-01

    Male, 76 year-old patient with a history of total hip arthroplasty who presents with a mass in the iliac fossa with swelling of the thigh and hip pain upon flexion and extension. Complementary ultrasound and computed tomography scan studies show a giant lobulated cystic mass in the left iliac fossa, 7 cm in diameter, near the prosthesis. Cyst formation caused by polyethylene disease after total hip arthroplasty is infrequent. We present a case of large psoas bursitis secondary to the release of polyethylene particles which caused superficial femoral vein compression and thrombosis.

  17. Outcomes and weight-bearing status during rehabilitation after arthroplasty for hip fractures.

    Science.gov (United States)

    Siebens, Hilary C; Sharkey, Phoebe; Aronow, Harriet U; Horn, Susan D; Munin, Michael C; DeJong, Gerben; Smout, Randall J; Radnay, Craig S

    2012-08-01

    To examine the association of weight-bearing status with patient-related variables and outcomes of inpatient rehabilitation after hip arthroplasty for acute hip fracture. A multi-site prospective observational cohort study. Eighteen skilled nursing and inpatient rehabilitation facilities. Patients with hip fractures (N = 224) treated with hip arthroplasty and admitted to either skilled nursing or inpatient rehabilitation facilities; a subset (N = 84) with telephone follow-up outcomes 8 months after rehabilitation discharge. Measurements included demographic variables, medical severity using the Comprehensive Severity Index, and functional levels using the Functional Independence Measure. MAIN OUTCOMES MEASUREMENT: Cognitive, motor, and total Functional Independence Measure scores at rehabilitation discharge and at 8-month follow-up; living location at discharge and follow-up. Patients on average (standard deviation) were 76.8 ± 11.4 years old, mainly women (78%), and mainly white (87%). In unadjusted analysis, weight bearing as tolerated (WBAT) was associated with less osteoarthritis (P = .025) and lower admission medical severity (ACSI) (P = .014). One participating facility had a significant preponderance of restricted weight-bearing cases. WBAT had no bivariate association with cognitive or motor function at discharge. Therapists cited restricted weight bearing as a barrier to therapy in 11% of cases. In logistic regressions, lower medical admission severity, older age, and one specified site significantly predicted WBAT (c statistic = 0.714). Significant predictors for home discharge included lower maximum severity (P < .001), younger age (P < .001), higher cognition (P = .037), and WBAT (P = .051) (c statistic = 0.863). WBAT is associated with a greater likelihood of home discharge and had similar functional outcomes compared with restricted weight bearing. These findings add support for allowing WBAT after arthroplasty for hip fracture. Copyright © 2012

  18. Cementless total hip arthroplasty for severely dislocated hips previously treated with Schanz osteotomy of the proximal femur.

    Science.gov (United States)

    Akman, Yunus Emre; Yavuz, Umut; Çetinkaya, Engin; Gür, Volkan; Gül, Murat; Demir, Bilal

    2018-03-01

    We report the short-term outcomes of total hip arthroplasty(THA) in patients previously treated with Schanz osteotomy (SO). Eighteen patients [2 male, 16 female; mean age, 55.4 (range, 50-66) years] who had undergone THA after SO were retrospectively evaluated. Clinical evaluation was performed based on the Harris hip score. Radiological evaluation was performed using full-length radiographs of the lower extremities, pelvis, and hip. The mean follow-up period was 30.8 (range, 18-56) months. Mean femoral shortening was 3.7 (range, 2-5) cm. Perioperative complications occurred in 4 (22.2%) patients. Nonunion was not found at the osteotomy sites. No dislocation was observed. The Trendelenburg sign was positive for five (27.7%) patients, postoperatively. The mean Harris hip score improved from 42.7 to 78.7 (p < 0.05). THA for hips previously treated with SO is technically demanding. If careful preoperative planning is performed, successful treatment can be achieved.

  19. Early Complications in Hip and Knee Arthroplasties in a Safety Net Hospital vs a University Center.

    Science.gov (United States)

    Jergesen, Harry E; Yi, Paul H

    2016-04-01

    Indigent populations face unique challenges that may increase surgical risk and adversely affect the outcomes of hip and knee arthroplasties. This study examines whether there is a difference in early postoperative complications in patients treated in a safety net hospital and in a nearby university center. A retrospective review was undertaken of 533 consecutive hip and knee arthroplasties performed by a single experienced surgeon in a safety net hospital and in a university medical center from 2008 to 2012. Patients were followed for a minimum of 2 years. The primary outcomes evaluated were total complications, deep infections, and reoperations. Statistical comparison of the data from the 2 patient groups was carried out using Fisher exact test. Despite the lower percentage of index revision procedures in the safety net group (8% vs 20.5%; P = .0003), the incidence of adverse outcomes was higher in this group than in the university group: for total complications, 12.3% vs 4.9% (P = .003); for deep infections, 3.2% vs 0.6% (P = .025); and for reoperations, 7.5% vs 2.6% (P = .009). For primary procedures in particular, differences in the incidences of these outcomes were even more significant. In this study, early complications were more frequent in patients who underwent hip and knee arthroplasties in a safety net hospital compared with those who underwent the same procedures in a nearby university center. Future prospective studies are warranted to determine which patient-related or care process-related factors should be optimized to improve arthroplasty outcomes in vulnerable, safety net populations. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Contemporary Surgical Indications and Referral Trends in Revision Total Hip Arthroplasty: A 10-Year Review.

    Science.gov (United States)

    Haynes, Jacob A; Stambough, Jeffrey B; Sassoon, Adam A; Johnson, Staci R; Clohisy, John C; Nunley, Ryan M

    2016-03-01

    Revision total hip arthroplasty (THA) represents nearly 15% of all hip arthroplasty procedures in the United States and is projected to increase. The purpose of our study was to summarize the contemporary indications for revision THA surgery at a tertiary referral medical center. We also sought to identify the indications for early and late revision surgery and define the prevalence of outside institution referral for revision THA. Using our institution's arthroplasty registry, we identified a retrospective cohort of 870 consecutive patients who underwent revision THA at our hospital from 2004 to 2014. Records were reviewed to collect data on patient's primary and revision THA procedures, and the interval between primary THA and revision surgery was determined. Aseptic loosening (31.3%), osteolysis (21.8%), and instability (21.4%) were the overall most common indications for revision THA and the most common indications for revision surgery within 5 years of primary THA. Aseptic loosening and osteolysis were the most common indications for revision greater than 5 years from primary THA. Only 16.4% of revised hips had their index arthroplasty performed at our hospital, whereas 83.6% were referred to our institution. Aseptic loosening, osteolysis, and instability remain the most common contemporary indications for revision THA in an era of alternative bearings and modular components. Most of our revisions were referred from outside institutions, which highlights the transfer of a large portion of the revision THA burden to tertiary referral centers, a pattern that could be exacerbated under future bundled payment models. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Acute pseudo-obstruction of the colon as a postoperative complication of hip arthroplasty.

    Science.gov (United States)

    Clarke, H D; Berry, D J; Larson, D R

    1997-11-01

    Acute pseudo-obstruction of the colon (Ogilvie syndrome) results in massive colonic dilatation that may lead to a life-threatening perforation. This complication is known to occur after arthroplasty of the hip, yet the prevalence of the complication and its effects on the outcome of the procedure are unknown. We reviewed the records of thirty patients (mean age, 74.3 years; range, fifty-six to ninety years) in whom acute colonic pseudo-obstruction developed after hip arthroplasty between 1984 and 1993. During this ten-year period, 10,468 hip arthroplasties were performed at our institution; therefore, the prevalence of acute colonic pseudo-obstruction was 0.29 per cent. The most common presenting symptom was abdominal distention, which occurred a mean of 3.5 days (range, one to eleven days) postoperatively and was noted in twenty-seven of thirty patients. Nausea (fourteen patients), vomiting (eight patients), and abdominal pain (two patients) were observed less frequently. Twenty-one associated medical complications, including pulmonary embolism (four patients), upper gastrointestinal bleeding (three patients), and deep infection (not evident intraoperatively) at the site of the arthroplasty (two patients), developed in fifteen patients. Eighteen of the twenty-one complications occurred after the onset of colonic pseudo-obstruction. The associated medical problems resulted in four deaths (13 per cent). Recognition by the orthopaedic surgeon of the presenting features of acute colonic pseudo-obstruction is important in order to facilitate prompt initiation of treatment, which may hasten recovery and reduce the morbidity and the mortality associated with this complication.

  2. Severe Pelvic Obliquity Affects Femoral Offset in Patients with Total Hip Arthroplasty but Not Leg-Length Inequality

    OpenAIRE

    Zhou, Xiaoxiao; Wang, Qi; Zhang, Xianlong; Chen, Yunsu; Peng, Xiaochun; Mao, Yuanqing; Yang, Yang; Fu, Beigang; Wang, Xiuhui; Tang, Tingting

    2015-01-01

    Leg-length inequality is an extensively studied complication of total hip arthroplasty in normal patients. However, few studies have focused on the pelvic obliquity of coronal pelvic malrotation. We hypothesized that pelvic obliquity with a fixed abduction/adduction contracture deformity of the hip may intraoperatively affect the release of soft tissues, ultimately resulting in a leg-length inequality. This study also investigated whether the femoral and vertical offsets of total hip arthropl...

  3. Medium-term results of ceramic-on-polyethylene Zweymüller-Plus total hip arthroplasty.

    Science.gov (United States)

    Li, H; Zhang, S; Wang, X M; Lin, J H; Kou, B L

    2017-08-01

    The need for better durability and longevity in total hip arthroplasty for patients with various hip joint diseases remains a challenge. This study aimed to obtain medium-term results at a follow-up of >10 years for Zweymüller-Plus total hip arthroplasty with ceramic-on-polyethylene bearing. A retrospective study was conducted to review the results after a minimum of 12.4 years of 207 consecutive total hip arthroplasties in 185 patients in Peking University People's Hospital in China using the Zweymüller SL-Plus stem in combination with the Bicon-Plus threaded cup and ceramic-on-polyethylene bearing between October 1994 and April 2000. During the study period, two patients (2 hips) died and 25 patients (28 hips) were lost to follow-up. Two hips were revised for aseptic loosening of the Bicon-Plus cup. The mean clinical and radiological follow-up was 14.1 years (range, 12.4-16.5 years) for the remaining 156 patients (175 hips). The mean (standard deviation) Harris Hip score for the 175 hips increased significantly from 39.3 (3.8) preoperatively to 94.1 (2.5) postoperatively at a mean follow-up of 14.1 years (P100%). The high survival rate of the cementless Zweymüller-Plus system with ceramic-on-polyethylene bearing at mid-term follow-up makes this total hip arthroplasty system reliable for patients with various hip joint diseases.

  4. [Hip arthroplasty for the severe comminuted proximal femoral fracture with psilateral acetabulum fracture].

    Science.gov (United States)

    Lü, Bo; Wang, Yue; Zhu, Jian-Xin; Huang, Chong-Xin; Liao, Tian-Cheng; Wang, An

    2014-09-01

    To investigate the results of hip arthroplasty for the treatment of severe comminuted proximal femoral fracture with ipsilateral acetabulum fracture. From June 2007 to September 2013, 8 patients (8 hips) with severe comminuted proximal femoral fracture combined with ipsilateral acetabulum fracture were treated with hip arthroplasty. All patients were male and using biological prosthesis. Aged from 33 to 64 years old with an average of 41.9 years. According to Harris score in aspect of pain, function, range of motion to evaluate clinical effects. There was no untoward reaction in 8 patients. And bed rest at 3 months after operation, waiting for acetabulum fracture healed to out-of-bed activity. There was no complications such as pneumonia, bedsore and so on in the patients. Follow-up time was from 9 to 72 months with an average of 35.8 months, the wound healed, there was no the subsidence and loosening of prosthesis, no dislocation and infection. The mean of Harris score was 87.5 points after operation. The effect of the hip replacement in treating severe comminuted proximal femoral fracture with ipsilateral acetabulum fracture is confirmed. It can restore motor function and reduce traumatic complication, may serve as a substitute for internal fixation of difficult operation. The long-term efficacy is necessary to further observe.

  5. Patient-reported outcomes in patients who undergo total hip arthroplasty after periacetabular osteotomy.

    Science.gov (United States)

    Osawa, Yusuke; Hasegawa, Yukiharu; Seki, Taisuke; Takegami, Yasuhiko; Amano, Takafumi; Ishiguro, Naoki

    2017-11-26

    There has been constant discussion about whether the clinical outcome of THA after periacetabular osteotomy (PAO) is equivalent to that after primary total hip arthroplasty (THA). However, there have been few reports about patient-reported outcomes (PRO) for those who undergo THA after PAO. We compared the pre- and postoperative PRO of patients who underwent THA after PAO and those who underwent primary THA alone. We performed a case-control study. Twenty-seven patients (29 hips) underwent THA after PAO (osteotomy group); their mean age at surgery was 57.2 years, and they underwent postoperative follow-up for a mean period of 3.0 years. For the control group, after matching age, sex, and Crowe classification, we included 54 patients (58 joints) who underwent primary THA for hip dysplasia. Assessment performed preoperatively and at the last follow-up included the Harris hip score, the Short Form 36 (SF-36) for the Physical Component Summary (PCS), Mental Component Summary (MCS), and Role/Social Component Summary (RCS) domains, Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) for pain, movement, and mental health, and the visual analog scale (VAS) score of hip pain and satisfaction. The two groups demonstrated no significant difference in the preoperative Harris hip score, each domain of the SF-36, JHEQ, and the VAS score of hip pain and satisfaction. The osteotomy group demonstrated significantly poor Harris hip scores for gait and activity, and JHEQ for movement at the last follow-up. There was no significant difference in each domain of the SF-36 and the VAS score of hip pain and satisfaction at the last follow-up. Previous PAO affects the quality of physical function in patients who undergo subsequent THA. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  6. Computer navigation vs conventional mechanical jig technique in hip resurfacing arthroplasty: a meta-analysis based on 7 studies.

    Science.gov (United States)

    Liu, Hao; Li, Lin; Gao, Wei; Wang, Meilin; Ni, Chunhui

    2013-01-01

    The studies on the accuracy of femoral component in hip resurfacing arthroplasty with the help of computer-assisted navigation were not consistent. This study aims to assess at the functional outcomes after computer navigation in hip resurfacing arthroplasty by systematically reviewing and meta-analyzing the data, which were searched up to December 2011 in PubMed, MEDLINE, EMBASE, MetaMed, EBSCO HOST, and the Web site of Google scholar. Totally, 197 articles about hip resurfacing arthroplasty were collected; finally, 7 articles met the inclusion criteria and were included in this meta-analysis (520 patients with 555 hip resurfacing arthroplasty). The odds ratio for the number of outliers was 0.155 (95% confidence interval, 0.048-0.498; P < .003). In conclusion, this meta-analysis suggests that the computer-assisted navigation system makes the femoral component positioning in hip resurfacing arthroplasty easier and more precise. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    with primary hip osteoarthritis responded to Hip dysfunction and Osteoarthritis Outcome Score (HOOS) questionnaires prior to and 3 and 12 months after THA. Preoperative pain intensity; joint space width (JSW), age, gender, and body mass index (BMI) were used to predict changes in pain and physical function....... Conclusions: Preoperative pain predicted changes in pain and physical function up to one year after THA. Such knowledge should be taken into consideration, when assessing OA patients prior to surgery. This study provides useful insight for clinicians, regarding the overall improvement patients can expect......Background: Few studies have combined preoperative patient-reported and objective outcome measures to predict outcomes after total hip arthroplasty (THA). Purpose / Aim of Study: to identify predictors of outcome 3 and 12 months after THA Materials and Methods: A cohort of 107 consecutive patients...

  8. 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....

  9. Financial impact of a capitation matrix system on total knee and total hip arthroplasty.

    Science.gov (United States)

    Taylor, Benjamin; Fankhauser, Richard A; Fowler, Terry

    2009-08-01

    Total hip and total knee arthroplasty are high-volume surgical procedures that have a substantial economic impact for the healthcare system. This study analyzes the financial effect of a capitation matrix system on total knee and total hip implant costs over a 1-year period at a community hospital system. The matrix implant levels were based on implant characteristics, correlating increased technological sophistication of the various implants with increased but capitated payment to vendors. In the first year after the implementation of the matrix system, implant costs for the hospital decreased by 26.1% per implant for 369 total hip procedures and also by 26.1% per implant for 934 total knee procedures.

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

    International Nuclear Information System (INIS)

    Strauss, Jonathan B.; Chen, Sea S.; Shah, Anand P.; Coon, Alan B.; Dickler, Adam

    2008-01-01

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

  11. Nationwide review of mixed and non-mixed components from different manufacturers in total hip arthroplasty: A Dutch Arthroplasty Register study

    NARCIS (Netherlands)

    Peters, Rinne M.; van Steenbergen, Liza N.; Bulstra, Sjoerd K.; Zeegers, Adelgunde V. C. M.; Stewart, Roy E.; Poolman, Rudolf W.; Hosman, Anton H.

    Background and purpose - Combining components from different manufacturers in total hip arthroplasty (THA) is common practice worldwide. We determined the proportion of THAs used in the Netherlands that consist of components from different manufacturers, and compared the revision rates of these

  12. The role of the transverse acetabular ligament in total hip arthroplasty.

    Science.gov (United States)

    Jain, Sameer; Aderinto, Joseph; Bobak, Peter

    2013-04-01

    We performed a systematic literature review to evaluate the role of the transverse acetabular ligament as a reference aid when determining acetabular component anteversion in total hip arthroplasty. We conducted a literature search in the MEDLINE, EMBASE and Pubmed databases using the key words 'transverse acetabular ligament' and 'arthroplasty'. Four studies published between 2006 and 2011, reporting on 1,217 procedures met our inclusion and exclusion criteria and were eligible for final evaluation. Outcome measures were the ability to identify the transverse acetabular ligament, anteversion of the acetabular component and dislocation rate. The methodological quality of the studies was variable and they were not homogenous enough for metaanalysis. We found that there was good evidence for the use of the transverse acetabular ligament in terms of accuracy of acetabular component anteversion. However, the ligament could not be routinely identified intra-operatively and other methods of determining the correct anteversion are recommended in this situation. The dislocation rate using this technique was low but it must be stressed that the cause of postoperative dislocation in total hip arthroplasty is multi-factorial and cannot solely be attributed to acetabular component orientation.

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

    Directory of Open Access Journals (Sweden)

    Gholam Hossein Shahcheraghi

    2015-09-01

    Full Text Available Background: Cementless hip prosthesis was designed to provide biologic fixation, without the use of cement. The second generation components have shown more reliable bone ingrowths and survival rates. We are reporting a midterm result of two designs of cementless prosthesis in a unique culture with different social habits and expectations. Methods: 52 primary cementless total hip arthroplasty in 42 patients with the mean age of 48.8 years were retrospectively studied. Two groups of prosthesis had been implanted: Harris-Galante II (HGII in 15 and Versys-Trilogy (V-T in 37 hips, both from Zimmer company. The patients were assessed clinically, radiographically and with Harris hip score, SF36, WOMAC, and MACTAR questionnaires, with 65 months (26-136 mean follow-up. Results: All the V-T prostheses had survived well. Eight of HG II were revised by the last follow-up in 19-102 months. All had undergone acetabular revision and 2 combined with femoral revision. Broken tines of HGII cups were seen in 4 radiographs. The 65 months overall survival was 96.2% for femoral and 84.6% for acetabular components. 90% had good or excellent Harris hip scores. The functional scores were poorer in the HG II group. Pain relief and improved walking were the two main patients’ expectations fulfilled in 97.6% and 92.8%, respectively. Conclusions: The outcome of cementless total hip arthroplasty (THA is satisfactory and comparable with the literature based on the results of function and survival of this small comparative group. The use of HGII acetabular component should be abandoned.

  14. Bone morphogenic protein-2 use in revision total hip arthroplasty with acetabular defects.

    Science.gov (United States)

    Nodzo, Scott R; Boyle, Keely K; Pavlesen, Sonja; Rachala, Sridhar

    2018-04-01

    The restoration of acetabular bone stock during revision hip arthroplasty remains a challenge. There have been no clinical series reporting the efficacy of bone morphogenic protein-2 (rhBMP-2) in the revision hip setting. We retrospectively reviewed the radiographs and records of 15 patients who received rhBMP-2 mixed with allograft bone chips (+BMP), and 14 who received allograft bone chips alone (-BMP) for their acetabular defect during revision total hip arthroplasty with a mean two-year follow up. Radiographs were evaluated for acetabular defect size, superior cup migration, and changes in the lateral cup abduction angle. Modified Harris hip scores were used for evaluation of clinical outcomes. Patients in the +BMP group compared to the -BMP group had significantly larger amounts of cancellous bone chips used (72.1 ± 35.5 cc vs. 38.6 ± 14.1 cc; p = 0.003). Mean rhBMP-2 used per case was 7.4 ± 3.1 mg in the +BMP group. Three patients in the -BMP group had cup migration which was not observed in the +BMP group. Mean Harris hip scores (HHS) improved post-operatively in both groups (40.1 ± 20.9 to 71.9 ± 19, p revision THA. Cost of this synthetic biologic versus the added clinical benefit should be carefully considered when being used in the revision hip setting.

  15. USING CUSTOM TRIFLANGE IMPLANT IN REVISION HIP ARTHROPLASTY IN PATIENT WITH PELVIC DISCONTINUITY (CASE REPORT

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2016-01-01

    Full Text Available Revision hip arthroplasty rate is growing, and pelvic discontinuity rate ranges from 1% to 5% of acetabular component revision reasons. According to AAOS acetabular defects classification, pelvic discontinuity is fourth type defect in which cranial part of hip bone is separated from caudal part at acetabular level. Usually it occurs from bone loss secondary to osteolysis, infection, fracture or aseptic loosening. There are a lot of techniques for pelvis discontinuity treatment. Published results of bulk allografts and antiprotrusion cages have generally been poor. More preferable methods with acceptable rate of good results are cup-cage systems and custom triflange acetabular components(CTAC. CTACs are designed based on preoperative CT scans to build a custom titanium 3D-printed implant to address the patient's specific bone defect and provide secure fixation in the ilium, pubis, and ischium. We faced pelvic discontinuity, in which extensive iliac bone loss was added to caudal hip bone part medial displacement and pelvic ring deformity, in patient with multiple hip surgeries. Preoperative investigation called into question the possibility of using off-the-shelf hip implants, which could restore the biomechanics of the hip and provide reliable primary fixation at the same time. We present case report of the patient with pelvic discontinuity and massive bone loss treatment using a custom triflange component.

  16. Total hip arthroplasty for patients with Crowe type IV developmental dysplasia of the hip: Ten years results.

    Science.gov (United States)

    Zeng, Wei-Nan; Liu, Jun-Li; Wang, Fu-You; Zhang, Xin; Fan, Hua-Quan; Chen, Guang-Xing; Guo, Lin; Duan, Xiao-Jun; Zhou, Qiang; Yang, Liu

    2017-06-01

    The aim of this study was to determine the rate of union, functional results and complications in patients with Crowe IV developmental dysplasia of the hip (DDH) who underwent cementless total hip arthroplasty (THA) with S-ROM prostheses and subtrochanteric transverse shortening osteotomy. Forty-five patients (52 hips) operated between January 2005 and May 2008, with a mean age of 40.6 years at surgery were followed. The mean follow-up period was 9.8 years. Clinical outcomes, radiographic outcomes and complications were evaluated. Osteotomy union occurred in 52 of 52 femurs (100%). Mean Harris hip score improved from 33.7 ± 4.7 preoperatively to 81.2 ± 6.3, 90.8 ± 5.3 and 89.8 ± 7.1 at 1, 5 and 10 years postoperatively. Two patients had temporary sciatic nerve paralysis postoperatively, and 2 patients experienced early postoperative dislocation. Two patients complained about mild longer limb length than the non-operated limb at the last follow-up. Three hips showed osteolysis in Gruen zone 1, and 1 hip showed osteolysis in zone 1 and 7. No implants were revised, and no signs of component loosening and migration were observed at the last follow-up visit. S-ROM stem combined with transverse subtrochanteric shortening osteotomy in THA for patients with Crowe type IV DDH has good clinical results with small risk of complications. Copyright © 2017. Published by Elsevier Ltd.

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

    Science.gov (United States)

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

    2004-06-01

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

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

    OpenAIRE

    Tomaž Silvester; Boris Rjazancev; Andrej Prlja; Peter Ješe

    2007-01-01

    Background: Total arthroplasty is one of the most interesting and fast developing fields in orthopaedic surgery. Practically every joint in the human body is involved, total hip arthroplasties (THA) being most frequent and with the longest history. Information on long-term results and survival of different types of prosthesis is invaluable for both patients and surgeons.Patients and methods: Between 1985 and 2006 there were 1563 THAs performed in Jesenice General Hospital. Average age at the ...

  19. Trends in Primary and Revision Hip Arthroplasty Among Orthopedic Surgeons Who Take the American Board of Orthopedics Part II Examination.

    Science.gov (United States)

    Eslam Pour, Aidin; Bradbury, Thomas L; Horst, Patrick K; Harrast, John J; Erens, Greg A; Roberson, James R

    2016-07-01

    A certified list of all operative cases performed within a 6-month period is a required prerequisite for surgeons taking the American Board of Orthopaedic Surgery Part II oral examination. Using the American Board of Orthopaedic Surgery secure Internet database database containing these cases, this study (1) assessed changing trends for primary and revision total hip arthroplasty (THA) and (2) compared practices and early postoperative complications between 2 groups of examinees, those with and without adult reconstruction fellowship training. Secure Internet database was searched for all 2003-2013 procedures with a Current Procedural Terminology code for THA, hip resurfacing, hemiarthroplasty, revision hip arthroplasty, conversion to THA, or removal of hip implant (Girdlestone, static, or dynamic spacer). Adult reconstruction fellowship-trained surgeons performed 60% of the more than 33,000 surgeries identified (average 28.1) and nonfellowship-trained surgeons performed 40% (average 5.2) (P revision surgeries for infection (71% vs 29%)(P revision surgeries (29% vs 35.5%) (P revision hip arthroplasties are often performed by surgeons without adult reconstruction fellowship training. Complications are less frequently reported by surgeons with larger volumes of joint replacement surgery who perform either primary or more complex cases. Primary hip arthroplasty is increasingly performed by surgeons early in practice who have completed an adult reconstructive fellowship after residency training. This trend is even more pronounced for more complex cases such as revision or management of infection. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Cirrhosis patients have increased risk of complications after hip or knee arthroplasty

    DEFF Research Database (Denmark)

    Deleuran, T.; Vilstrup, H.; Overgaard, Søren

    2015-01-01

    Background and purpose: The risk of complications in cirrhosis patients after orthopedic surgery is unclear. We examined this risk after total hip arthroplasty (THA) or total knee arthroplasty (TKA). Patients and methods: Using Danish healthcare registries, we identified all Danish residents who...... risk of readmission within 30 days of discharge (15% vs. 8%; aOR = 1.8, CI: 1.3-2.4); and greater risk of deep prosthetic infection (3.1% vs. 1.4%) or revision (3.7% vs. 1.7%) within 1 year. The chance of having an uncomplicated procedure was 81.0% (CI: 76.6-85.0) for cirrhosis patients and 90.0% (CI...

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

    DEFF Research Database (Denmark)

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

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

  2. Total Hip Arthroplasty Loosening Due to Mycobacterium Tuberculosis: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Anis Tebourbi

    2017-04-01

    Full Text Available Context: Prosthetic joint infection due to Mycobacterium tuberculosis with no previous history of pulmonary or extra pulmonary tuberculosis is an extremely rare complication. Aims To report the case of a patient with tuberculous mycobacterial prosthetic hip infection, 14 years after surgery for post traumatic osteoarthritis, with no previous history of tuberculosis. Methods A 46-year-old male presented an acetabular loosening of a cemented total hip arthroplasty with subnormal biologic parameters. A one stage revision surgery was planned. Intraoperative findings suggested mycobacterial tuberculous infection with presence of periacetabular yellowish rice-shaped granules. Results A one-stage prosthesis exchange was performed; Culture on Löwenstein-Jensen medium grew MTB days after inoculation and histological examination confirmed tuberculous infection. Patient was treated by antituberculous agents for 12 months with optimal clinical and biological response and no prosthetic loosening signs at eighteen months follow up. Conclusions Total hip arthroplasty loosening due to mycobacterium tuberculosis is a rare entity, which should be evoked even when no inflammatory signs are shown. Discovery of yellowish rice-shaped granules is an indicator to investigate for tuberculosis. Management of prosthetic joint infection due to M.tuberculosis must involve both medical and surgical approach.

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

    DEFF Research Database (Denmark)

    Hailer, N. P.; Lazarinis, S.; MaKela, K. T.

    2015-01-01

    Background and purpose - It is still being debated whether HA coating of uncemented stems used in total hip arthroplasty (THA) improves implant survival. We therefore investigated different uncemented stem brands, with and without HA coating, regarding early and long-term survival. Patients and m...... this surface treatment had no clinically relevant effect on their outcome, and we thus question whether HA coating adds any value to well-functioning stem designs.......Background and purpose - It is still being debated whether HA coating of uncemented stems used in total hip arthroplasty (THA) improves implant survival. We therefore investigated different uncemented stem brands, with and without HA coating, regarding early and long-term survival. Patients...... to diagnoses other than osteoarthritis or pediatric hip disease, and procedures with missing information on the type of coating. 22 stem brands remained (which were used in 116,069 procedures) for analysis of revision of any component. 79,192 procedures from Denmark, Norway, and Sweden were analyzed...

  4. Three-Dimensional Templating for Acetabular Component Alignment During Total Hip Arthroplasty.

    Science.gov (United States)

    Elbuluk, Ameer M; Wojack, Paul; Eftekhary, Nima; Vigdorchik, Jonathan M

    2017-07-01

    Appropriate placement of the acetabular cup is an important determinant of implant stability and longevity. Malposition of acetabular cups negatively influences prosthesis survival and leads to an increased dislocation rate. The objective of the study was to determine the role of 3-dimensional templating in obtaining accurate acetabular component placement in total hip arthroplasty. In this computed tomography-based study, the authors identified 93 patients who underwent primary total hip arthroplasty with computer-assisted navigation. Using 3-dimensional planning, the authors templated the acetabular component at an inclination of 40° and anteversion of 20°. To classify acetabular cup coverage by bone, the acetabulum was used as a clock face with the center of the transverse acetabular ligament (TAL) as 6-o'clock. Analyses revealed that 72% of cups were uncovered between 9- to 1-o'clock for right hips. On the left side, 88% of cups were uncovered between 11- to 3-o'clock. Across all hips, 74% of cups had a 1-o'clock position at the most lateral aspect. Further analysis revealed that 46% of acetabular cups had a teardrop at the same level of the most inferior aspect of the cup, whereas only 37% of cups had a teardrop above the inferior aspect of the cup. Finally, the acetabular component was aligned with the TAL in 76% of hips, retroverted to the TAL in 16%, and anteverted to the TAL in 8%. The current study demonstrates a useful gross intraoperative reference tool to standardize cup position without the need for additional equipment and reliance on anatomical landmarks. [Orthopedics. 2017; 40(4):e708-e713.]. Copyright 2017, SLACK Incorporated.

  5. Variation in Use of Blood Transfusion in Primary Total Hip and Knee Arthroplasties.

    Science.gov (United States)

    Menendez, Mariano E; Lu, Na; Huybrechts, Krista F; Ring, David; Barnes, C Lowry; Ladha, Karim; Bateman, Brian T

    2016-12-01

    There is growing clinical and policy emphasis on minimizing transfusion use in elective joint arthroplasty, but little is known about the degree to which transfusion rates vary across US hospitals. This study aimed to assess hospital-level variation in use of allogeneic blood transfusion in patients undergoing elective joint arthroplasty and to characterize the extent to which variability is attributable to differences in patient and hospital characteristics. The study population included 228,316 patients undergoing total knee arthroplasty (TKA) at 922 hospitals and 88,081 patients undergoing total hip arthroplasty (THA) at 606 hospitals from January 1, 2009 to December 31, 2011 in the Nationwide Inpatient Sample database, a 20% stratified sample of US community hospitals. The median hospital transfusion rates were 11.0% (interquartile range, 3.5%-18.5%) in TKA and 15.9% (interquartile range, 5.4%-26.2%) in THA. After fully adjusting for patient- and hospital-related factors using mixed-effects logistic regression models, the average predicted probability of blood transfusion use in TKA was 6.3%, with 95% of the hospitals having a predicted probability between 0.37% and 55%. For THA, the average predicted probability of blood transfusion use was 9.5%, with 95% of the hospitals having a predicted probability between 0.57% and 66%. Hospital transfusion rates were inversely associated with hospital procedure volume and directly associated with length of stay. The use of blood transfusion in elective joint arthroplasty varied widely across US hospitals, largely independent of patient case-mix and hospital characteristics. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Elective hip and knee arthroplasty and the effect of rivaroxaban and enoxaparin thromboprophylaxis on wound healing.

    Science.gov (United States)

    Sindali, Katia; Rose, Barry; Soueid, Hassan; Jeer, Parminder; Saran, Deepak; Shrivastava, Raj

    2013-05-01

    Rivaroxaban is the first licensed oral direct inhibitor of factor Xa. Recent studies from the RECORD trials suggest rivaroxaban has superior efficacy compared to enoxaparin in preventing venous thromboembolism (VTE) with no significant increase in the major bleeding risk. Concerns remain regarding the incidence of minor bleeding, consequent delayed wound healing and subsequent risk of infection. The aim of this observational study was to assess the incidence of post-operative complications in patients receiving either rivaroxaban or enoxaparin thromboprophylaxis following elective hip and knee arthroplasty. A total of 258 patients undergoing elective total hip or knee arthroplasty within one NHS Trust were included. A total of 202 subjects (mean age, 70.7 years ± 10.0, 43 % men) received a daily dose of 10 mg of oral rivaroxaban and 56 (mean age, 70.9 years ± 9.8, 39 % men) had a daily subcutaneous injection of 40 mg of enoxaparin as thromboprophylaxis. Endpoints included VTE (deep vein thrombosis and pulmonary embolism), haemorrhagic wound complications, hospital re-admission, requirement for blood transfusion, minor and major bleeding and death. There were no significant differences in the incidence of VTE, requirement for blood transfusion and readmission rate between rivaroxaban and enoxaparin-treated patients. The incidence of minor bleeding (2.0 vs. 0 %) and haemorrhagic wound complications (5.0 vs. 1.8 %) were non-significantly higher in the rivaroxaban-treated group. There were no cases of pulmonary embolism, major bleeding or death in either group. Our experience with rivaroxaban in elective hip and knee arthroplasty showed no significant difference in the incidence of VTE or major bleeding. There was, however, a tendency to greater risk of minor bleeding and wound complications that were largely haemorrhagic in nature, which may have reached significance in a larger study.

  7. Acetabular reconstruction with impaction bone grafting and cemented polyethylene socket in total hip revision arthroplasty.

    Science.gov (United States)

    Kostensalo, I; Seppänen, M; Virolainen, P; Mokka, J; Koivisto, M; Mäkelä, K T

    2015-12-01

    Bone deficiency in revision total hip arthroplasty is a challenge to the surgeon. One option for restoration of the bone stock is impaction bone grafting and use of a cemented socket. The aim of this study was to evaluate the mid-term clinical outcome of impaction bone grafting and cemented socket revisions. A total of 59 patients (60 hips) underwent revision arthroplasty with impaction bone grafting and application of a cemented socket on the acetabular side in the Turku University Hospital from 1999 to 2004. The study end-point was re-revision for any reason. The cumulative percentages for survival were followed and estimated with Kaplan-Meier curves. Associations between occurrence of re-revision and potential risk factors were analyzed with logistic regression. Results were quantified by odd ratios and 95% confidence intervals. The mean age of the patients was 69 years (33% male). A total of 3% of the patients had a class I Paprosky acetabular defect, 38% had class II, and 55% had class III. The overall survival rate was 73%. The mean follow-up time was 7 years. The most common reason for re-revision was aseptic loosening of the acetabular component (13 patients, 81% of re-revisions). Cox's regression analysis did not identify any risk factors for re-revision. Our results were inferior compared to some previous studies. Impaction bone grafting of acetabular defects in revision total hip arthroplasty may not always provide a reliable bone stock in long-term. © The Finnish Surgical Society 2015.

  8. [Femoral superficial vein thrombosis due to a large iliopsoas bursitis secondary to polyethylene wear debris in total hip arthroplasty].

    Science.gov (United States)

    Lax Pérez, R; Salinas Gilabert, J E; Lajara Marco, F; Lax Pérez, A; Ferrero Manzanal, F; García-Gálvez, A; Izquierdo Plazas, L

    2012-01-01

    A 76 year old male patient with a history of implantation of a total hip arthroplasty Perfecta (Orthomet(®)), who presented with an iliac fossa mass, increased diameter of the thigh, and pain during hip flexion and extension. CT and ultrasound show the presence of a giant cystic mass in left iliac fossa about 7 cm in diameter next to the prosthesis. A pseudo-tumour secondary to wear debris after placement of a total arthroplasty is rare. We present a case of a large iliopsoas bursitis caused by polyethylene particles, which caused compression and thrombosis of the superficial femoral vein. Copyright © 2011 SECOT. Published by Elsevier Espana. All rights reserved.

  9. Gluteal muscle damage leads to higher in vivo hip joint loads 3 months after total hip arthroplasty.

    Science.gov (United States)

    Damm, Philipp; Zonneveld, Jip; Brackertz, Sophie; Streitparth, Florian; Winkler, Tobias

    2018-01-01

    Total hip arthroplasty (THA) is in most cases improving patients´ life quality immediately after surgery. However, a closer look at these patients, especially with modern gait analysis methods, reveals also negative consequences due to the surgical approach related injury to the pelvic muscles. We hypothesized that this damage will have a negative impact on hip joint contact forces during activities of daily living (ADL). 10 patients undergoing THA received an instrumented hip joint implant enabling real time in vivo measurements of hip joint loads using a direct lateral approach. Pre- and 3 months postoperative computed tomography (CT) scans were used for evaluation of the periarticular muscle status, using muscle volume, fat ratio and lean muscle volume as parameters. An analysis of in vivo hip contact forces was made 3 months after THA during ADL (walking, stair climbing, chair rising and sitting) and correlated with the morphology of the periarticular muscles. We found a significant decrease of volume by 25% (-3 to -45, p = 0.005) and increase in fat ratio of the Gluteus Minimus (Gmin), resulting in a decrease in lean muscle volume of 28% (-48 to 0, p = 0.008). This was accompanied by an inverse development in the Tensor Fasciae Latae (TFL) resulting in a lean muscle volume increase of 34% (-2 to -102, p = 0.013). Changes in Gluteus Medius (Gmed) and Gluteus Maximus (Gmax) have not been observed in the short-term follow up. A decreased Gmin lean muscle volume was found to strongly correlate with high in vivo joint contact forces in all tested ADL. The decrease of Gmin volume can be seen as a direct effect of THA surgery, whereas the increase of TFL might compensate for loss of Gmin volume. Lean muscle volume and fat ratio were better predictors for joint contact forces than total muscle volume. These effects were most pronounced during sitting down and standing up due to the higher demand on the gluteal muscles during these activities.

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

    LENUS (Irish Health Repository)

    Cashman, James P

    2008-11-01

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

  11. Comparison of Procedural Sedation for the Reduction of Dislocated Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Jonathan E. dela Cruz

    2014-02-01

    Full Text Available Introduction: Various types of sedation can be used for the reduction of a dislocated total hip arthroplasty. Traditionally, an Opiate/Benzodiazepine combination has been employed. The use of other pharmacologic agents, such as Etomidate and Propofol, has more recently gained popularity. Currently no studies directly comparing these sedation agents have been carried out. The purpose of this study is to compare differences in reduction and sedation outcomes including recovery times of these three different sedation agents. Methods: A retrospective chart review was performed examining 198 patient’s charts who presented with dislocated total hip arthroplasty at two academic affiliated medical centers. The patients were organized into groups according to the type of sedation agent used during their reduction. The percentages of reduction and sedation complications were calculated along with overall recovery times. Reduction complications included fracture, skin or neurovascular injury, and failure of reduction requiring general anesthesia. Sedation complications included use of bag-valve mask and artificial airway, intubation, prolonged recovery, use of a reversal agent, and inability to achieve sedation. The data were then compared for each sedation agent. Results: The reduction complications rates found were 8.7% in the Propofol group, 24.68% in the Etomidate, and 28.85% in the Opiate/Benzodiazepine groups. The reduction complication rate in the Propofol group was significantly different than those of the other two agents (p≤0.01. Sedation complications were found to happen 7.25% of the time in the Propofol group, 11.69% in the Etomidate group, and 21.25% in the Opiate/ Benzodiazepine group with Propofol having complication rates significantly different than that of the Opiate/Benzodiazepine group (p=0.02. Average lengths of recovery were 25.17 minutes for Propofol, 30.83 minutes for Etomidate, and 44.35 minutes for Opiate/ Benzodiazepine with

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

    Directory of Open Access Journals (Sweden)

    Bhargava P

    2007-01-01

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

  13. Digital subtraction arthrography in preoperative evaluation of painful total hip arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Ginai, A.Z. [Dept. of Radiology, Univ. Hospital Dijkzigt, Rotterdam (Netherlands); Biezen, F.C. van [Dept. of Orthopaedics, Univ. Hospital Dijkzigt and Erasmus Univ., Rotterdam (Netherlands); Kint, P.A.M. [Dept. of Radiology, Univ. Hospital Dijkzigt, Rotterdam (Netherlands); Oei, H.Y. [Dept. of Nuclear Medicine, Univ. Hospital Dijkzigt and Erasmus Univ., Rotterdam (Netherlands); Hop, W.C.J. [Dept. of Biostatistics, Univ. Hospital Dijkzigt and Erasmus Univ., Rotterdam (Netherlands)

    1996-05-01

    Digital subtraction arthrograms, scintigrams and plain radiographs of 70 consecutive patients who underwent revision hip arthroplasty were scored individually and in masked fashion for the presence or absence of features indicating loosening of femoral and/or acetabular components. The operative findings acted as the gold standard. Digital subtraction arthrography was best for predicting a loose acetabular component, while no significant additional predictive value was found for plain radiographs and scintigraphy. Digital subtraction arthrography was also the most important modality for predicting a loose femoral component, while the plain radiograph was of significant additional value and scintigraphy was of no additional value on multivariate analysis. (orig./MG)

  14. Digital subtraction arthrography in preoperative evaluation of painful total hip arthroplasty

    International Nuclear Information System (INIS)

    Ginai, A.Z.; Biezen, F.C. van; Kint, P.A.M.; Oei, H.Y.; Hop, W.C.J.

    1996-01-01

    Digital subtraction arthrograms, scintigrams and plain radiographs of 70 consecutive patients who underwent revision hip arthroplasty were scored individually and in masked fashion for the presence or absence of features indicating loosening of femoral and/or acetabular components. The operative findings acted as the gold standard. Digital subtraction arthrography was best for predicting a loose acetabular component, while no significant additional predictive value was found for plain radiographs and scintigraphy. Digital subtraction arthrography was also the most important modality for predicting a loose femoral component, while the plain radiograph was of significant additional value and scintigraphy was of no additional value on multivariate analysis. (orig./MG)

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

    Directory of Open Access Journals (Sweden)

    Aram Luke

    2007-05-01

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

  16. Hip fracture evaluation with alternatives of total hip arthroplasty versus hemiarthroplasty (HEALTH): protocol for a multicentre randomised trial.

    Science.gov (United States)

    Bhandari, Mohit; Devereaux, P J; Einhorn, Thomas A; Thabane, Lehana; Schemitsch, Emil H; Koval, Kenneth J; Frihagen, Frede; Poolman, Rudolf W; Tetsworth, Kevin; Guerra-Farfán, Ernesto; Madden, Kim; Sprague, Sheila; Guyatt, Gordon

    2015-02-13

    Hip fractures are a leading cause of mortality and disability worldwide, and the number of hip fractures is expected to rise to over 6 million per year by 2050. The optimal approach for the surgical management of displaced femoral neck fractures remains unknown. Current evidence suggests the use of arthroplasty; however, there is lack of evidence regarding whether patients with displaced femoral neck fractures experience better outcomes with total hip arthroplasty (THA) or hemiarthroplasty (HA). The HEALTH trial compares outcomes following THA versus HA in patients 50 years of age or older with displaced femoral neck fractures. HEALTH is a multicentre, randomised controlled trial where 1434 patients, 50 years of age or older, with displaced femoral neck fractures from international sites are randomised to receive either THA or HA. Exclusion criteria include associated major injuries of the lower extremity, hip infection(s) and a history of frank dementia. The primary outcome is unplanned secondary procedures and the secondary outcomes include functional outcomes, patient quality of life, mortality and hip-related complications-both within 2 years of the initial surgery. We are using minimisation to ensure balance between intervention groups for the following factors: age, prefracture living, prefracture functional status, American Society for Anesthesiologists (ASA) Class and centre number. Data analysts and the HEALTH Steering Committee are blinded to the surgical allocation throughout the trial. Outcome analysis will be performed using a χ(2) test (or Fisher's exact test) and Cox proportional hazards modelling estimate. All results will be presented with 95% CIs. The HEALTH trial has received local and McMaster University Research Ethics Board (REB) approval (REB#: 06-151). Outcomes from the primary manuscript will be disseminated through publications in academic journals and presentations at relevant orthopaedic conferences. We will communicate trial

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

    Science.gov (United States)

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

    2017-05-01

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

  18. [Retrospective analysis on total hip arthroplasty for the treatment of developmental dysplasia of the hip in 29 adults].

    Science.gov (United States)

    Cao, Yin-Sheng; Lu, Min; Yao, Gong-He; Li, Wei-Ning; Zhu, Fu-Ping; Zhang, Bo

    2013-11-01

    To study the results of the total hip arthroplasty (THA) in the treatment of developmental dysplasia of the hip (DDH) with severe osteoarthritis in adults. From March 2004 to February 2011, 29 patients (32 hips) with DDH were treated by THA with an cementless cup. There were 11 males and 18 females,with an average age of 52.6 years (ranging from 37 to 73 years). Unilateral DDH occurred in 26 patients and bilateral DDH occurred in 3 patients. Based on the Crowe classification, there were 18 hips in 17 patients of type I ,7 hips in 6 patients of type II, 4 hips in 3 patients of type III, 3 hips in 3 patients of type IV. Except for 3 patients with bilateral DDH, the other patients' ill lower limbs were 1 to 6 cm shorter than the healthy lower ones. All the patients were followed up,and the duration ranged from 8 months to 5.3 years(averaged 3.7 years) without infection, dislocation, and sciatic nerves injury after the operation. One patient with proximal femoral fracture, intraoperation used wire binding, after 4 years of follow-up, fracture healed without evidence of prosthesis loosening. All grafts and subtrochanteric osteotomy healing were achieved. In 21 patients, the pain was completely relieved and the function of the hip joints was good. Five patients still had mild limping, but reduced significantly than preoperation. In 3 patients, the ill lower limbs were more than 1 cm shorter than the healthy lower ones and the other patients' ill lower limbs were less than 1 cm shorter than the healthy lower ones. Two patients' lower limbs were lengthened 4 to 5 cm. The Harris scores were 43.6 +/- 7.1 preoperatively and 86.7 +/- 5.3 postoperatively (P < 0.05). THA with deepening the medial wall of the acetabulum at the true acetabulum, according to different characteristics of Crowe classification, using different operation program, cementless cup in adult could obtain favorable results.

  19. [Mid-term effectiveness of total hip arthroplasty with collum femoris preserving prosthesis].

    Science.gov (United States)

    Li, Mingqing; Hu, Yihe; Li, Kanghua; Liao, Qiande; Wen, Ting; Zhong, Da

    2012-08-01

    To discuss the clinical application of total hip arthroplasty (THA) with collum femoris preserving (CFP) prosthesis and to analyze the mid-term effectiveness. Between January 2004 and February 2007, 45 patients (48 hips) underwent THA with CFP prosthesis. There were 29 males (31 hips) and 16 females (17 hips) with an average age of 48.8 years (range, 38-60 years), including 20 left hips, 22 right hips, and 3 bilateral hips. The causes of hip replacement were osteoarthritis (20 cases), avascular necrosis of femoral head (13 cases), dysplasia (4 cases), rheumatoid arthritis (3 cases), posttraumatic osteoarthritis (2 cases), ankylosing spondylitis (2 cases), and Perths disease (1 case). The average disease duration was 6.1 years (range, 2-13 years). Harris scores, visual analogue scale (VAS) score, and the hip range of motion (ROM) were recorded at pre- and post-operation. The X-ray films were taken at pre- and post-operation to observe the position, loosening of the prosthesis, and ectopic ossification. The gait of patients were also evaluated during follow-up. Short-form 36 health survey scale (SF-36) was used to evaluate the life quality of patients. All 45 patients were followed up 5-8 years with an average of 6.4 years. All the incisions healed by first intention. No infection, hip dislocation, nerve injury, or deep vein thrombosis occurred. Six cleavage fractures (13.3%) of the lateral femoral diaphysis at the distal prosthesis occurred during operation, which healed at 8 months postoperatively without any treatment. Mild ectopic ossification occurred in 4 patients (8.9%) who had no discomfort. Five patients (11.1%) had bone mineral density loss in the region of the proximal femur. The survival rates of the cups and stems were all 100% at last follow-up. The results of Harris score, VAS score, and ROM of the hip joint at 1 year postoperatively and last follow-up were significantly better than preoperative ones (P 0.05) except the Harris score (P fair in 6 hips

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

    Science.gov (United States)

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

    2016-01-01

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

  1. Cementless arthroplasty with a distal femoral shortening for the treatment of Crowe type IV developmental hip dysplasia.

    Science.gov (United States)

    Guo, Chang-Yong; Liang, Bo-Wei; Sha, Mo; Kang, Liang-Qi; Wang, Jiang-Ze; Ding, Zhen-Qi

    2015-01-01

    Severe developmental dysplasia of the hip is a surgical challenge. The purpose of this study is to describe the cementless arthroplasty with a distal femoral shortening osteotomy for Crowe type IV developmental hip dysplasia and to report the results of this technique. 12 patients (2 male and 10 female) of Crowe type IV developmental hip dysplasia operated between January 2005 and December 2010 were included in the study. All had undergone cementless arthroplasty with a distal femoral shortening osteotomy. Acetabular cup was placed at the level of the anatomical position in all the hips. The clinical outcomes were assessed and radiographs were reviewed to evaluate treatment effects. The mean followup for the 12 hips was 52 months (range 36-82 months). The mean Harris hip score improved from 41 points (range 28-54) preoperatively to 85 points (range 79-92) at the final followup. The mean length of bone removed was 30 mm (range 25-40 mm). All the osteotomies healed in a mean time of 13 weeks (range 10-16 weeks). There were no neurovascular injuries, pulmonary embolism or no infections. Our study suggests that cementless arthroplasty with a distal femoral shortening is a safe and effective procedure for severe developmental dysplasia of the hip.

  2. Morbid obesity: a significant risk factor for failure of two-stage revision total hip arthroplasty for infection.

    Science.gov (United States)

    Houdek, Matthew T; Wagner, Eric R; Watts, Chad D; Osmon, Douglas R; Hanssen, Arlen D; Lewallen, David G; Mabry, Tad M

    2015-02-18

    Morbid obesity (BMI [body mass index], ≥40 kg/m2) is associated with a higher risk of complications, including infection and implant failure, following primary total hip arthroplasty. The purpose of this study was to compare the results of two-stage revision total hip arthroplasty for infection in a morbidly obese patient cohort (BMI, ≥40 kg/m2) and nonobese patients (BMI, total joint registry, we reviewed the medical records of 653 patients treated with two-stage revision total hip arthroplasty for periprosthetic joint infection over a twenty-year period (1987 to 2007). Patients were stratified according to preoperative BMI. Thirty-three patients (fourteen male and nineteen female) with a BMI of ≥40 kg/m2 were identified. These patients were matched 1:2 with a cohort of sixty-six patients (twenty-eight male and thirty-eight female) of the same sex and similar age (91% within two years) who were not obese (BMI, revision (42% compared with 11%, pHip Score had been 50.6 in the morbidly obese group and 48.8 in the nonobese group, and these scores improved significantly in both groups postoperatively (prevision total hip arthroplasty for periprosthetic joint infection. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

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

    DEFF Research Database (Denmark)

    Collins, Natalie J; Roos, Ewa M.

    2012-01-01

    , and high personal and financial cost associated with THA and TKA, patient-reported outcomes are required to ensure optimal selection of patients, and that postoperative outcomes outweigh the burden associated with surgical procedures. It is clear from the information presented that clinicians need......, particularly to fill some of the gaps regarding known psychometric properties of patient-reported outcomes for THA and TKA. Based on data acquired in THA and TKA patients for the instruments reviewed, it appears that OA-specific and TJA-specific measures for which patients have been involved...... in the developmental process (HOOS, KOOS, WOMAC, Oxford Hip and Knee Scores) can more consistently be considered "good" patient-reported outcomes for THA and TKA. Clinicians wishing to evaluate a broader range of dimensions may choose to complement these with one of the generic measures evaluated, bearing in mind...

  4. Sleep disturbances after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Krenk, L; Jennum, P; Kehlet, H

    2012-01-01

    on the fourth postoperative night. There was no association between opioid use, pain scores, and inflammatory response with a disturbed sleep pattern. CONCLUSIONS: /st>Despite ultra-short LOS and provision of spinal anaesthesia with multimodal opioid-sparing analgesia, REM sleep was almost eliminated......BACKGROUND: /st>Major surgery is followed by pronounced sleep disturbances after traditional perioperative care potentially leading to prolonged recovery. The aim was to evaluate the rapid eye movement (REM) sleep duration and sleep architecture before and after fast-track hip and knee replacement......, and on the fourth postoperative night at home. Sleep staging was performed according to the American Academy of Sleep Medicine manual. Opioid use, pain, and inflammatory response (C-reactive protein) were also evaluated. RESULTS: /st>The mean LOS was 1.5 (1-2) days. The mean REM sleep time decreased from a mean...

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

    Science.gov (United States)

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

    2014-09-01

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

  6. What is the lifetime risk of revision for patients undergoing total hip arthroplasty? a 40-year observational study of patients treated with the Charnley cemented total hip arthroplasty.

    Science.gov (United States)

    Abdel, M P; Roth, P von; Harmsen, W S; Berry, D J

    2016-11-01

    The purpose of this study was to determine the lifetime risk of revision surgery for patients undergoing Charnley cemented total hip arthroplasty (THA), with 40-year follow up, using death as a competing risk. We retrospectively reviewed 2000 cemented Charnley THAs, with 51 living hips available at 40 years. The cumulative risk of revision or removal for any reason was 13% (95% confidence interval (CI) 12 to 15). Patients aged under 50 years at the time of surgery had a 35% (95% CI 28 to 42) risk of revision or removal for any reason (Hazard Ratio (HR) 3.6; 95% CI 2.5 to 5.2; p revision or removal for any reason (HR 2.1; 95% CI 1.7 to 2.7; p revision, we have been able to develop a 'rule of thumb' for lif