The 21- to 27-year results of the Harris-Galante cementless total hip arthroplasty.

BACKGROUND: The Harris-Galante total hip arthroplasty (THA) is a first-generation cementless THA with a porous coating for biological fixation of the implant. Many studies report excellent long-term results for the acetabular cup, but few long-term studies exist for the femoral stem because of relatively poor short-term and midterm results. Here we present the 21- to 27-year results of the cup and the stem of the Harris-Galante THA. METHODS: From 1985 to 1991, 102 Harris-Galante THAs were inserted in 82 patients. At the time of the THA, the mean patient age was 54 years (range, 20-78 years). The primary diagnosis was secondary osteoarthritis due to developmental hip dysplasia (69 [68%] hips). The Japanese Orthopaedic Association (JOA) hip score and thigh pain were measures of clinical outcome. Radiographic review was performed retrospectively. Implant survival was evaluated by Kaplan-Meier analysis. RESULTS: Of 102 hips, 35 hips were from 31 deceased patients, 5 patients (6 hips) were lost to follow-up, 12 hips were revised, and 49 hips were from patients living at the latest follow-up. Among the living patients, 36 hips had a clinical evaluation and 42 hips had a radiograph obtained more than 21 years. The JOA hip score improved from 42 points preoperatively to 83.5 points at the latest follow-up. Thigh pain was reported in 13 hips. One cup and four stems were loose at the latest radiographic review. Most cup revisions were related to acetabular osteolysis. Fifteen hips showed severe stress shielding. Kaplan-Meier analysis of survivorship with any revision, acetabular reoperation, stem revision, and stem loosening as the end point was 87.0%, 90.3%, 95.7% and 86.4%, respectively, at 24.6 years. CONCLUSIONS: Long-term implant survival and clinical results of the Harris-Galante THA were good. Acetabular osteolysis-related cup loosening was a problem of the cup. Loosening, thigh pain, and stress shielding were problems of the stem.

The role of CCL5 in the ability of adipose tissue-derived mesenchymal stem cells to support repair of ischemic regions.

Mesenchymal stem cells (MSC) are multipotent and possess high proliferative activity, and thus are thought to be a reliable cell source for cell therapies. Here, we isolated MSC from adult tissues--bone marrow (BM-MSC), dental tissue (DT-MSC), and adipose tissue (AT-MSC)--to compare how autotransplantation of these MSC effectively supports the repair of bone fracture and ischemic tissue. An analysis by in vitro differentiation assays showed no significant difference among these MSC. The degree of calcification at the joint region of bone fracture was higher in mice transplanted with AT-MSC than in mice transplanted with BM-MSC or DT-MSC. To compare the abilities of MSC, characterize how those MSC affect the repair of ischemic tissue, vascular occlusion was performed by ligation of the femoral artery and vein. Of note, the blood flow in the ischemic region rapidly increased in mice injected with AT-MSC, as contrasted with mice injected with BM- or DT-MSC. The number of CD45- and F4/80-positive cells at the femoral region was higher in AT-MSC recipients than in recipients of BM-MSC or DT-MSC. We evaluated the mRNA expression of angiogenic and migration factors in MSC and found the expression of CCL5 mRNA was higher in AT-MSC than in BM-MSC or DT-MSC. Transplantation of AT-MSC with impaired expression of CCL5 clearly showed a significant delay in the recovery of blood flow compared with the control. These findings have fundamental implications for the modulation of AT-MSC in the repair of vasculature and bone fracture.

Osseointegration of porous titanium implants with and without electrochemically deposited DCPD coating in an ovine model.

BACKGROUND: Uncemented fixation of components in joint arthroplasty is achieved primarily through de novo bone formation at the bone-implant interface and establishment of a biological and mechanical interlock. In order to enhance bone-implant integration osteoconductive coatings and the methods of application thereof are continuously being developed and applied to highly porous and roughened implant substrates. In this study the effects of an electrochemically-deposited dicalcium phosphate dihydrate (DCPD) coating of a porous substrate on implant osseointegration was assessed using a standard uncemented implant fixation model in sheep. METHODS: Plasma sprayed titanium implants with and without a DCPD coating were inserted into defects drilled into the cancellous and cortical sites of the femur and tibia. Cancellous implants were inserted in a press-fit scenario whilst cortical implants were inserted in a line-to-line fit. Specimens were retrieved at 1, 2, 4, 8 and 12 weeks postoperatively. Interfacial shear-strength of the cortical sites was assessed using a push-out test, whilst bone ingrowth, ongrowth and remodelling were investigated using histologic and histomorphometric endpoints. RESULTS: DCPD coating significantly improved cancellous bone ingrowth at 4 weeks but had no significant effect on mechanical stability in cortical bone up to 12 weeks postoperatively. Whilst a significant reduction in cancellous bone ongrowth was observed from 4 to 12 weeks for the DCPD coating, no other statistically significant differences in ongrowth or ingrowth in either the cancellous or cortical sites were observed between TiPS and DCPD groups. CONCLUSION: The application of a DCPD coating to porous titanium substrates may improve the extent of cancellous bone ingrowth in the early postoperative phase following uncemented arthroplasty.

Bone regeneration induced by adenoviral vectors carrying til-1/Cbfa1 genes implanted with biodegradable porous materials in animal models of osteonecrosis of the femoral head.

A new approach for bone regeneration is needed for idiopathic osteonecrosis of the femoral head (ION). Core binding factor alpha1 (Cbfa1) was reported in 1997 as the most important transcription factor for osteoblastic differentiation. The transgenics of transcription factors affecting bone formation might be useful tools for the bone regeneration. The purpose of this study was to investigate the effects of the implantation of adenoviral vectors carrying Cbfa1 genes implanted with biodegradable porous materials on bone formation in an animal model of ION. Robust and rapid bone regeneration in large bone defects was achieved with the implantation of adenoviral vectors carrying Cbfa1 genes. These results suggest that the Cbfa1 genes induce a rapid osteoblastic differentiation and the biodegradable scaffold successfully functioned as a delivery vehicle for the Cbfa1 gene, as they induced osteogenic repair in vivo, even in necrotic bone.

Grit-blasted and hydroxyapatite-coated total hip arthroplasty: an 11- to 14-year follow-up study.

We report long-term results of the first clinical trial of hydroxyapatite-coated total hip arthroplasty conducted in Japan. The hemispherical cup and the straight-tapered stem were made of titanium alloy with a grit-blasted, hydroxyapatite-coated surface. The surface roughness before and after hydroxyapatite coating was 1.4 microm and 3.4 microm, respectively. Thirty-three patients (35 hips) were followed prospectively; of these, 1 patient was lost to follow-up, 5 were deceased at the latest follow-up, and 27 were followed for 11 to 14 years. Two cups and one stem (two patients) were revised. Survivorship, with radiological acetabular loosening as the endpoint, was 62.3% at 14 years. At the latest radiological follow-up, stable fixation with bone ongrowth was achieved in 46% of the acetabular cups and 89% of the femoral stems. Acetabular cups with host bone coverage of less than 60% had a high rate of failure. The suboptimal result of the hydroxyapatite-coated smooth cup indicates that porous coatings under the hydroxyapatite coating would be beneficial for hydroxyapatite-coated total hip implants, especially for the acetabular components.