The DePuy Proxima™ short stem for total hip arthroplasty - Excellent outcome at a minimum of 7 years.

PURPOSE: Metaphyseal, proximally anchored uncemented stems for total hip arthroplasty provide bone preservation and decrease the incidence of proximal stress shielding and thigh pain. Our study investigated the clinical and radiological outcome of the DePuy Proxima™ short stem at a minimum of 7 years. METHODS: Eighty-one consecutive patients (86 procedures) under the age of 70 undergoing primary total hip replacement at two arthroplasty centres were enrolled. Follow-up was clinical (Harris Hip Score (HHS), thigh pain and satisfaction) and radiological (subsidence, malalignment and loosening) at 6 months and yearly thereafter. RESULTS: Average age was 50 (range 32-65) with 79% (68 of 86) being male. Preoperative diagnosis included primary osteoarthritis (OA) 36%, avascular necrosis of femoral head 51%, dysplasia 9% and post-traumatic OA 4%. HHS improved 51 points at latest follow-up (from 40 to 91). We had 3.5% (3 of 86) periprosthetic fractures, one requiring revision. We had one dislocation, no infections and no thigh pain. Malalignment rate (≥5° off neutral) was 12% (10 of 86), not affecting clinical results. CONCLUSION: Overall stem survival was over 97% at 7 years. The DePuy Proxima provides excellent clinical results at a minimum of 7 years post-operatively.

[The use of structural proximal tibial allografts coated with human albumin in treating extensive periprosthetic knee-joint bone deficiency and averting late complications. Case report]. / Humán albuminnal kezelt strukturális proximalis tibialis allograft alkalmazása kiterjedt térdízületi periprotetikus csonthiány esetén és a késoi szövodmény elhárítása.

The authors report the history of a 74-year-old patient who underwent surgical treatment for segmental knee-joint periprosthetic bone loss using structural proximal tibial allografts coated with serum albumin. Successful treatment of late complications which occurred in the postoperative period is also described. The authors emphasize that bone replacement with allografts is a physiological process that enables the stable positioning of the implant and the reconstruction of the soft tissues, the replacement of extensive bone loss, and also it is a less expensive operation. It has been already confirmed that treatment of lyophilised allografts with albumin improves the ability of bone marrow-derived mesenchymal stem cells to adhere and proliferate the surface of the allografts, penetrate the pores and reach deeper layers of the graft. Earlier studies have shown osteoblast activity on the surface and interior of the graft.

Albumin-coated structural lyophilized bone allografts: a clinical report of 10 cases.

Bone replacement and the use of bone supplementary biological substances have become widespread in clinical practice. Although autografts have excellent properties, their limited availability, difficulties with shaping and donor site morbidity have made allografts a viable and increasingly preferred alternative. The main drawback of allografts is that the preparation destroys osteogenic cells and results in denaturation of osteoinductive proteins. Serum albumin is a well-known constituent of stem cell culture media and we found that lyophilizing albumin onto bone allografts markedly improves stem-cell attachment and bone healing in animal models thus replacing some of the osteoinductive potential. As a first step in the clinical introduction of albumin coated grafts, we aimed to test surgical handling and early incorporation in aseptic revision arthroplasty in humans. We selected patients who needed large structural allografts and the current operation was the last attempt at preserving a moving joint. In a series of 10 cases of hip and knee revision surgery we did not experience any drawbacks of the albumin-coated grafts during handling and implantation. Twelve months radiographic and SPECT-CT follow-up showed that the graft was well received by the host and active remodelling was observed. The lack of graft-related complications and the good 1-year results indicate that controlled trials may be initiated in more common bone grafting indications where long-term effectiveness can be evaluated.

Successful treatment of late Salmonella infections in total hip replacement - report of two cases.

BACKGROUND: Salmonella species can be rarely isolated from periprosthetic joint infections, however when present, are usually part of a severe septic clinical picture. CASE PRESENTATIONS: Two patients presented with late infected hip replacements to our institution. The first patient with multiple comorbidities had a confirmed Salmonella Enteridis infection with an abscess in the groin, with loosening of both components. He underwent a successful one stage cemented revision hip replacement, followed by 6 weeks of antibiotic therapy (ciprofloxacin). He had no recurrence or complications. The second patient was admitted in a septic condition with ARDS to the Intensive Care Unit 7 years following an uncemented total hip replacement. From an ultrasound guided hip aspirate Salmonella cholerae-suis was isolated. He underwent a successful a two-stage revision hip replacement. CONCLUSIONS: Successful treatment of such potentially life threatening infections is achievable using modern orthopaedic techniques and close collaboration with the infectious diseases specialists.

Navigated total knee arthroplasty in a patient with severe diaphyseal deformities.

A 65-year-old patient presented with severe osteoarthritis of the knee, 47 years after a severe polytrauma in which he had presented diaphyseal fractures of the left femur and tibia. These fractures had been treated conservatively and had healed with major deformities. He underwent total knee arthroplasty with navigation assistance. This allowed for optimal component positioning and restoration of a correct limb alignment. The early functional result was excellent. Navigation assistance appears of particular interest for total knee arthroplasty in such cases with complex post-traumatic diaphyseal deformities.

Postural control in athletes participating in an ironman triathlon.

We studied the degree of dependence on vision of static postural control among ten male adult ironmen and ten healthy subjects (firemen, control group) who took part in regular physical activity, and the perturbations of equilibrium after prolonged exercise in ironmen. Static postural stability was measured during standing on a single-force platform alternating between eyes open and eyes closed. First, body sway was analysed on a force plate in both groups, and the athletes then took part in an ironman triathlon. The measurement was repeated after the race. The sway in both directions was subjected to spectral analysis. The frequency spectrum of the platform oscillations was calculated by fast Fourier transformation in the intervals 0-0.3, 0.3-1 and 1-3 Hz. The sway path in both directions and the total path were significantly lower in the ironmen than in the control group without vision, and the absence of visual control caused a significant increase in sway in both directions in the control group, but not in the ironmen. The frequency analysis revealed a higher level of stability in the medio-lateral direction with closed eyes. The endurance race caused increases in both the total sway path only with closed eyes, and these changes were significant at higher frequency bands. These results indicate that ironmen are more stable and less dependent on vision for postural control than the control subjects, and the prolonged stimulation of the proprioceptive, vestibular and visual inputs in the endurance race causes a significant disturbance in postural control.