Application and survival curve of total hip arthroplasties: a systematic comparative analysis using worldwide hip arthroplasty registers.

PURPOSE: The aim of the study was to compare primary total hip arthroplasty (THA) implantations between different countries in terms of THA number per inhabitant, age, and procedure type and to compare the survival curve including all THAs using hip arthroplasty registers. METHODS: THA registers were compared between different countries with respect to the number of primary implantations per inhabitant and age, procedure type and survival curve. We performed a literature search for all national hip arthroplasty registers providing annual reports for 2009 or, if not available, a more recent period. The data from these reports were analysed in terms of number, age distribution and procedure type of primary THAs and survival curves. RESULTS: We identified nine hip arthroplasty registers, which comprised sufficient data to be included. A large variation was found in the annual number of primary THA implantations per inhabitant. The procedure type varied greatly as well, e.g. in Sweden 67 % are cemented THAs whereas in Emilia-Romagna (Italy) 89 % are cementless THAs. CONCLUSIONS: This study revealed large differences in terms of the annual number of primary THAs per inhabitant and primary THA procedure type across countries. These data can be used to rank local primary THA implantations within an international context.

Infraglenoidal scapular notching in reverse total shoulder replacement: a prospective series of 60 cases and systematic review of the literature.

BACKGROUND: The impact of infraglenoidal scapular notching in reversed total shoulder arthroplasty (RTSA) is still controversially discussed. Our goal was to evaluate its potential influence on subjective shoulder stability and clinical outcome. We hypothesized that subjective instability and clinical outcome after implantation of RTSA correlates with objective scapular notching. METHODS: Sixty shoulders were assessed preoperatively and at minimum 2-year follow-up for active range of motion and by use of the Oxford instability score, Rowe score for instability, Constant score for pain, Constant shoulder score, DASH score. All shoulders were evaluated on anterior-posterior and axillary lateral radiographic views. These X-ray scans were classified twice by two orthopaedic surgeons with respect to infraglenoidal scapular notching according to the classification of Nerot. Notching was tested for correlation with clinical outcome scores to the evaluated notching. RESULTS: We found no significant correlation between infraglenoidal scapular notching and clinical outcomes after a mid-term follow-up from 24 to 60 months, but at the final follow-up of 60 months and more, we did see statistically significant, positive correlations between infraglenoidal scapular notching and the Constant pain score as well as active range of motion. At mean follow-up of 42 months (range from 24 to 96 months) we found no significant correlation between subjective instability and infraglenoidal scapular notching. CONCLUSIONS: We conclude that patients' subjective impression on their shoulders' stability is not correlating with radiological signs of infraglenoidal scapular notching. Nevertheless clinical parameters are affected by infraglenoidal scapular notching, at least in the long term.

Comparing effects of perfusion and hydrostatic pressure on gene profiles of human chondrocyte.

Hydrostatic pressure and perfusion have been shown to regulate the chondrogenic potential of articular chondrocytes. In order to compare the effects of hydrostatic pressure plus perfusion (HPP) and perfusion (P) we investigated the complete gene expression profiles of human chondrocytes under HPP and P. A simplified bioreactor was constructed to apply loading (0.1 MPa for 2 h) and perfusion (2 ml) through the same piping by pressurizing the medium directly. High-density monolayer cultures of human chondrocytes were exposed to HPP or P for 4 days. Controls (C) were maintained in static cultures. Gene expression was evaluated by sequencing (RNAseq) and quantitative real-time PCR analysis. Both treatments changed gene expression levels of human chondrocytes significantly. Specifically, HPP and P increased COL2A1 expression and decreased COL1A1 and MMP-13 expression. Despite of these similarities, RNAseq revealed a list of cartilage genes including ACAN, ITGA10 and TNC, which were differentially expressed by HPP and P. Of these candidates, adhesion related molecules were found to be upregulated in HPP. Both HPP and P treatment had beneficial effects on chondrocyte differentiation and decreased catabolic enzyme expression. The study provides new insight into how hydrostatic pressure and perfusion enhance cartilage differentiation and inhibit catabolic effects.

Subject-specific finite element simulation of the human femur considering inhomogeneous material properties: a straightforward method and convergence study.

In numerical finite element (FE) simulations of human bones subject-specific models are necessary to reproduce the physiological conditions, which include the determination of inhomogeneous material properties from computed tomography (CT) scans and their implementation in the numerical model. In the present approach common software packages are directly used for the entire simulation process from segmentation of CT scans, surface reconstruction, mesh generation, calculation of mean element densities to FE simulation. The influence of the mesh discretisation level on the maximum displacement, the total system energy and the principal surface stress distribution of eight human femurs was analysed. Both the maximum displacement and the total system energy showed typical convergence behaviour towards an asymptotic value with decreasing element size. The principal surface stress distribution followed similar qualitative trends at all mesh discretisation levels studied for the same femur. However, the stress distributions did not converge with decreasing element size and still differed significantly between the two smallest element sizes studied of approximately 2mm and 1mm. The magnitude of convergence differed among the individual femurs. Thus, individual convergence studies in terms of local stress or strain distributions are necessary for accurately predicting local stress and strain values in subject-specific FE bone models.

The transport of wear particles in the prosthetic hip joint: a computational fluid dynamics investigation.

The joint fluid mechanics and transport of wear particles in the prosthetic hip joint were analyzed for subluxation and flexion motion using computational fluid dynamics (CFD). The entire joint space including a moving capsule boundary was considered. It was found that particles suspended in the joint space are drawn into the joint gap between prosthesis cup and head during subluxation, which was also documented by Lundberg et al. (2007; Journal of Biomechanics 40, 1676-1685), however, wear particles remain in the joint gap. Wear particles leave the joint gap during flexion and can finally migrate to the proximal boundaries including the acetabular bone, where the particle deposition can cause osteolysis according to the established literature. Thus, the present study supports the theory of polyethylene wear particle induced osteolysis of the acetabular bone as a major factor in the loosening of hip prosthesis cups.

The interrelation of trabecular microstructural parameters of the greater tubercle measured for different species.

In the present study the trabecular microstructural parameters (bone volume fraction, trabecular thickness, trabecular separation, trabecular number, connectivity density, degree of anisotropy, and structure model index) of the greater tubercle of the humeral head were measured for human healthy, human osteopenic, ovine, bovine, and porcine bones using micro-computed tomography. Except for trabecular thickness and degree of anisotropy the values of the trabecular microstructural parameters generally differed significantly between species. Thus, only the species for which the implant is designed should be used for in vitro mechanical tests on the stability of implants in trabecular bone. Multivariate regression analysis showed that the microstructural parameters have similar principal interrelations in all species. The most significant relations were found between trabecular thickness and bone volume fraction (median (over all species) p < 0.001), trabecular number and bone volume fraction (p = 0.001), the structural change from plates to rods and bone volume fraction (p < 0.001) as well as between connectivity density and trabecular number (p < 0.001). Trabecular thickness, trabecular number, and the structural change from plates to rods each contributed to the bone volume fraction approximately to the same extent. Based on the similar principal interrelations of the trabecular microstructural parameters found in all investigated species the design of trabecular microstructure in the greater tubercle follows similar phenomenological mechanisms in all species. Thus, in vivo experiments on trabecular bone healing and osteoporosis research for application in humans can be conducted in ovine, bovine, or porcine species.

What humeri are suitable for comparative testing of suture anchors? An ultrastructural bone analysis and biomechanical study of ovine, bovine and human humeri and four different anchor types.

For testing of fixation devices such as suture anchors used in rotator cuff repair often animal bones are used. They are easily obtained, inexpensive and some have been found to be similar to human bone. But can we rely on the results drawn from these studies in our daily surgical practice? The purpose of this study was to compare the trabecular bone mineral density, the trabecular bone volume fraction and the cortical layer thickness in the greater tubercle in different species to evaluate their influence on primary stability of suture anchors under a cyclic loading protocol representing the physiologic forces placed on rotator cuff repairs in vivo. Bovine and ovine humeri are not suitable for suture anchor testing. The statistical significances for pullout forces between the anchors varied from species to species. Therefore, no very applicable information can be obtained from testing suture anchors in ovine or bovine humeri with regard to ultimate failure loads in human humeri. The ultimate failure load seems to depend mainly on the cortical thickness and on the subcortical trabecular bone quality.