RESUMO
The improved cemented cup technique has attained excellent long-term results in primary total hip arthroplasty. When cup revision surgery was performed, the cemented cup, which was loosened at the bone-cement interface, was easily removed. However, with a well-fixed bone-cement interface, it remains difficult to remove the cemented cup for a revision in the event of a recurring dislocation. In addition, protrusions in the cement can cause unpredictable bone defects. A new removal device was created and used successfully to remove a well-fixed cemented cup safely and efficiently. This report introduces the device and the technique used in cemented cup removal.
Assuntos
Artroplastia de Quadril , Cimentos Ósseos , Remoção de Dispositivo/instrumentação , Reoperação/instrumentação , Idoso , Feminino , HumanosRESUMO
Artificial bones have often used for bone regeneration due to their strength, but they cannot provide an adequate environment for cell penetration and settlement. We therefore attempted to explore various materials that may allow the cells to penetrate and engraft in bone defects. PuraMatrix is a self-assembling peptide scaffold that produces a nanoscale environment allowing both cellular penetration and engraftment. The objective of this study was to investigate the effect of PuraMatrix on bone regeneration in a mouse bone defect model of the calvaria. Matrigel was used as a control. The expression of bone-related genes (alkaline phosphatase, Runx2, and Osterix) in the PuraMatrix-injected bone defects was stronger than that in the Matrigel-injected defects. Soft X-ray radiographs revealed that bony bridges were clearly observed in the defects treated with PuraMatrix, but not in the Matrigel-treated defects. Notably, PuraMatrix treatment induced mature bone tissue while showing cortical bone medullary cavities. The area of newly formed bones at the site of the bone defects was 1.38-fold larger for PuraMatrix than Matrigel. The strength of the regenerated bone was 1.72-fold higher for PuraMatrix (146.0 g) than for Matrigel (84.7 g). The present study demonstrated that PuraMatrix injection favorably induced functional bone regeneration.
Assuntos
Regeneração Óssea/efeitos dos fármacos , Substitutos Ósseos/uso terapêutico , Transplante Ósseo/métodos , Crânio/cirurgia , Fosfatase Alcalina/genética , Animais , Subunidade alfa 1 de Fator de Ligação ao Core/genética , Feminino , Expressão Gênica/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos BALB C , Camundongos SCID , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Crânio/metabolismo , Crânio/fisiopatologia , Fator de Transcrição Sp7 , Fatores de Transcrição/genéticaRESUMO
The present retrospective study assessed radiographs to determine socket wear in total hip arthroplasty (THA) with 22-mm zirconia or COP (Cobalt-Chrome alloy rich in Cobalt and Phosphorous) heads, and in cemented stems at more than 10 years after operation. Sockets of ultra high molecular weight polyethylene were used in each of two THA groups (13 hips each) in a clinical trial in our hospital between 1989 and 1990. Three observers carried out masked assessments of the radiographs. Upon final examination, there was no remarkable loosening in the zirconia or COP group, and no case had required revision surgery as of 2005. There was a statistically significant difference between the 2 groups in average annual linear wear, at 0.093 mm/year and 0.046 mm/year in the zirconia and COP groups, respectively. Volume wear and average annual volume wear were also significantly greater in the zirconia group despite its superior mechanical strength and toughness in vitro. Our present findings do not confirm early expectations of lower wear in long-term results of 22-mm zirconia femoral heads used in THA.