Factors associated with the municipal provision of orthodontics in the Brazilian Unified Health System.

BACKGROUND: The Brazilian federal government issued Ministerial Ordinance No. 718 in 2010 to expand the funding of orthodontic treatment provided by Brazilian municipalities via the Unified Health System (SUS in Portuguese). AIM: To identify social and structural factors associated with Brazilian municipalities that provide fixed orthodontic appliance therapy and interceptive orthodontic therapy. METHODS: Official Brazilian government databases were used for data collection. Poisson regression with robust variance was used for statistical analysis. RESULTS: Municipalities hosting Dental Specialty Centers (DSCs) with greater installed capacity (type III DSC with 7 dental chairs or over), which employed dentists specializing in pediatric dentistry and orthodontics, were more likely to offer orthodontic services via SUS. CONCLUSIONS: Federal, state, and municipal managers need to review the funding of orthodontic services via SUS, which can be used for creating DSCs and hiring professionals with expertise in orthodontics.

RECONSTRUCTION OF THE ZYGOMATIC BONE WITH SMARTBONE®: CASE REPORT.

The repair of complex craniofacial bone defects is challenging and a successful result depends on the defect size, the quality of the soft tissue covering the defect and the choice of reconstructive method. Autologous bone grafts are the gold standard for bone replacement. Tissue engineered constructs are temporary substitutes developed to treat damaged or lost tissue. Recent advances in materials science have provided an abundance of innovations, underlining the increasing importance of polymer in this field. The Galeazzi Orthopedical institute of Milan received a Serbian soldier who reported a deep wound, due to the explosion of a grenade, during former-Yugoslavia’s war. His left cheekbone was completely lost, together with the floor of the left eye. SmartBone® technology allowed the realization of custom-made grafts which perfectly fitted the bone defect thanks to mechanical strength, also at small thicknesses, and the ability to be shaped without powder formation or unpredicted fractures. Tissue engineering approaches to regeneration utilize 3-dimensional (3D) biomaterial matrices that interact favorably with cells. The potential benefits of using a tissue engineering approach include reduced donor site morbidity, shortened operative time, decreased technical difficulty of the repair, ability to closely mimic the in vivo microenvironment in an attempt to recapitulate normal craniofacial development: this 36-month case study allowed to prove that SmartBone® custom-made bone grafts are an effective solution, gathering such benefits and being available now for daily routine.

STRAIN ANALYSIS OF MASSETER MUSCLE BY ULTRASOUND.

The masseter muscle represents an area of important functional interest. The present study aims to verify the feasibility of ultrasound imaging for quantifying the muscular deformation pattern in the masseter. Fifteen consecutive subjects were enrolled and underwent masseter ultrasound according to a repeatable protocol. Ultrasound was carried out during teeth clenching in natural conditions and after the insertion of a medical device that alters the distance between the dental arches, and was repeated on 3 different days. Results showed that masseter deformation is not uniform within the muscle. The same strain patterns were repeated in the different ultrasounds of the same patient and were modified after the introduction of a medical device. This was supported by quantitative comparisons in the deep portion of the muscle (standard deviation on the three measures: 3% normal conditions, 2% with medical device) showing a systematic reduction with the prosthesis (30% on average). This study demonstrated that masseter strain analysis is a repeatable and sensitive tool for the study of functional analysis of the masticatory organ. This opens new technical perspectives for the diagnosis and therapy of dysfunctional pathologies of the masticatory organ.

Effect of bismuth oxide on white mineral trioxide aggregate: chemical characterization and physical properties.

AIM: To assess the effect of bismuth oxide (Bi2 O3 ) on the chemical characterization and physical properties of White mineral trioxide aggregate (MTA) Angelus. METHODOLOGY: Commercially available White MTA Angelus and White MTA Angelus without Bi2 O3 provided by the manufacturer especially for this study were subjected to the following tests: Rietveld X-ray diffraction analysis (XRD), energy-dispersive X-ray analysis (EDX), scanning electron microscopy (SEM), compressive strength, Vickers microhardness test and setting time. Chemical analysis data were reported descriptively, and physical properties were expressed as means and standard deviations. Data were analysed using Student's t-test and Mann-Whitney U test (P = 0.05). RESULTS: Calcium silicate peaks were reduced in the diffractograms of both hydrated materials. Bismuth particles were found on the surface of White MTA Angelus, and a greater amount of particles characterized as calcium hydroxide was observed by visual examination on White MTA without Bi2 O3 . The material without Bi2 O3 had the shortest final setting time (38.33 min, P = 0.002), the highest Vickers microhardness mean value (72.35 MPa, P = 0.000) and similar compressive strength results (P = 0.329) when compared with the commercially available White MTA Angelus containing Bi2 O3 . CONCLUSION: The lack of Bi2 O3 was associated with an increase in Vickers microhardness, a reduction in final setting time, absence of Bi2 O3 peaks in diffractograms, as well as a large amount of calcium and a morphology characteristic of calcium hydroxide in EDX/SEM analysis.

Left atrial shortening fraction in fetuses with and without myocardial hypertrophy in diabetic pregnancies.

OBJECTIVE: To test the hypothesis that, in diabetic pregnancies, left atrial shortening fraction (LASF) is decreased in fetuses with myocardial hypertrophy, compared to those without hypertrophy and to fetuses of non-diabetic mothers. METHODS: Fetal echocardiography was performed in women with pre-existing or gestational diabetes and in non-diabetic controls between 25 weeks' gestation and term. LASF was calculated using the formula: (end-systolic diameter-end-diastolic diameter)/end-systolic diameter, and data were compared between diabetic women with and without fetal myocardial hypertrophy and controls. RESULTS: The study population comprised 53 diabetic women and 45 controls. Out of the 53 fetuses of diabetic women, 14 had myocardial hypertrophy and 39 had normal septal thickness. Gestational age at the time of examination did not differ significantly between the control group and the two diabetic subgroups (P = 0.57). Fetuses with myocardial hypertrophy presented a mean ( +/- SD) LASF of 0.32 +/- 0.11, those without myocardial hypertrophy 0.46 +/- 0.12, and those of normal mothers 0.53 +/- 0.09 (P < 0.001). A significant inverse linear correlation was observed between LASF and septal thickness (r = - 0.51, P < 0.001). CONCLUSIONS: In diabetic pregnancies, LASF is lower in fetuses with myocardial hypertrophy than it is in those without hypertrophy and in fetuses of non-diabetic women, suggesting that LASF could be a useful alternative parameter in the assessment of fetal diastolic function.

Myocardial tissue Doppler assessment of diastolic function in the growth-restricted fetus.

OBJECTIVES: Myocardial tissue Doppler (MTD) is a technique for the measurement of myocardial velocities in systole and diastole. This study evaluates the use of MTD in the assessment of cardiac diastolic function in fetuses with intrauterine growth restriction (IUGR) with placental insufficiency and in appropriate-for-gestational age (AGA) fetuses with hypertensive mothers. METHODS: This study included 14 IUGR fetuses with placental insufficiency (Group 1), 13 AGA fetuses with hypertensive mothers (Group 2), and 29 AGA fetuses with healthy mothers (Group 3). Patients with other diseases were excluded. All fetuses had a gestational age of at least 25 weeks. MTD assessment was performed with the sample volume placed at the basal segment of the left ventricular side wall (LV), the interventricular septum (IVS) and the right ventricular free wall (RV). E'/A' ratios were calculated for each location. Mitral and tricuspid flows were assessed by conventional spectral pulsed Doppler. RESULTS: Significant differences were found between groups for E'/A' at the IVS (P < 0.001) and LV (P = 0.009), with a higher mean (+/- SD) value in Group 1 (IVS: 0.92 +/- 0.28; LV: 0.85 +/- 0.19) than in Groups 2 (IVS: 0.62 +/- 0.09; LV: 0.68 +/- 0.14) and 3 (IVS: 0.71 +/- 0.14; LV: 0.69 +/- 0.15). In the RV, there was no statistically significant difference in the E'/A' ratio (P = 0.2). No differences were observed for mitral and tricuspid flow velocities and ratios. CONCLUSIONS: Using MTD, the ratios between early and late diastolic myocardial velocities are higher in IUGR fetuses than in AGA fetuses at the IVS and the LV, regardless of the presence of maternal hypertension. MTD may be more sensitive than atrioventricular spectral Doppler for the detection of ventricular diastolic dysfunction in IUGR fetuses.

Surgiplanner: a new method for one step oral rehabilitation of severe atrophic maxilla.

The implant-prosthetic rehabilitation of edentulous upper jaws has always been complex for surgeons and dentists. The lack of bone in both vertical and horizontal dimension does not allow the correct insertion of dental implants. In addition, patients with edentulous upper and lower arch have a loss of vertical dimension of the face and an aged expression. Many surgical techniques have been proposed to increase the bone volume, height and thickness, such as the Le Fort I osteotomy, the bone grafts and the placement of dental implants. Planning these surgical procedures is difficult, because it is not possible to reproduce the movements of osteotomized bone segments in three planes of space. This article describes the treatment of severe atrophy maxilla with a new approach using a new instrument named "Surgiplanner". Surgiplanner is a method that, only using a computerized axial tomography (CAT), allows to obtain a totally predetermined therapeutic result from both an aesthetic and functional point of view, with surgery of severe resorbed jaws. Surgiplanner allows repositioning of segment of the skeleton of the patient's face in a predetermined and controlled way for the best implant-supported oral rehabilitation.

In vivo imaging techniques: a new era for histochemical analysis.

In vivo imaging techniques can be integrated with classical histochemistry to create an actual histochemistry of water. In particular, Magnetic Resonance Imaging (MRI), an imaging technique primarily used as diagnostic tool in clinical/preclinical research, has excellent anatomical resolution, unlimited penetration depth and intrinsic soft tissue contrast. Thanks to the technological development, MRI is not only capable to provide morphological information but also and more interestingly functional, biophysical and molecular. In this paper we describe the main features of several advanced imaging techniques, such as MRI microscopy, Magnetic Resonance Spectroscopy, functional MRI, Diffusion Tensor Imaging and MRI with contrast agent as a useful support to classical histochemistry.

Ultrasound and analysis of the deformation patterns of the masseter muscle: comparing surgical anatomy, ultrasound and functional anatomy.

PURPOSE: We have tried to demonstrate whether the analysis of the muscle strain allows us to identify the three distinct functional areas of the architecture of the masseter, as one would see them by performing or viewing an anatomical dissection of said muscle, and whether these sections have behave differently in terms of origin and coping of the strain they face (quantitative analysis). MATERIALS AND METHODS: This work has been elaborated by the use of an ultrasound machine (MicrUs ext-1H Telemed Medical Systems Milano) and a linear probe (L12-5l40S-3 5-12 MHz 40 mm) which allowed us to record a 45 frame per second video (DCM). Videos has been elaborated by use of an ultrasound machine (MicrUs ext-1H Telemed Medical Systems Milano) and a linear probe (L12-5l40S-3 5-12 MHz 40 mm) which allowed us to record a 45 frame per second video (DCM). We applied to the resulting video a software (Mudy 1.7.7.2 AMID Sulmona Italy) for the analysis of muscle deformation patters (contraction, dilatation, cross-plane, vertical strain, horizontal strain, vertical shear, horizontal shear, horizontal displacement, vertical displacement). The number of videos of masseter muscles in contraction at maximum exertion due to dental clenching made during this research is around 12,000. Out of these we chose 1,200 videos which examine 200 patients (100 females, 100 males). RESULTS: The deformation pattern analysis of the skeletal muscle on ultrasound basis seems to be an adequate instrument to use during the investigation of the functional structure of the masseter muscle given its ability to highlight the distinct activity of each separate part of the muscle. CONCLUSIONS: Moreover the strain does not apply to the muscle uniformly; instead it varies according to the observed area.

Management and control of isotonic contraction generated stress: evaluation of masseter muscle deformation pattern by means of ecography.

PURPOSE: The objective of the following study is to observe the behavior of the six layers of the masseter during an isometric contraction at maximum exertion with the deformation pattern analysis method. MATERIALS AND METHODS: This study has been conducted by use of an ultrasound machine (MicrUs ext-1H Telemed Medical Systems Milano) and a linear probe (L12-5l40S-3 5-12 MHz 40 mm) which allowed us to record a video (DCM) comprised of 45 frames per second. The probe was fixed to a brace and the patient was asked to clench their teeth as hard as possible, obtain the muscle's maximum exertion, for 5 seconds three times, with 30 seconds intervals in between. Both right and left masseter muscles were analyzed. Then we applied to the resulting video a software (Mudy 1.7.7.2 AMID Sulmona Italy) for the analysis of muscle deformation patterns (contraction, dilatation, cross-plane, vertical strain, horizontal strain, vertical shear, horizontal shear, horizontal displacement, vertical displacement). The number of videos of masseter muscles in contraction at maximum exertion due to dental clenching made during this research is around 12,000. Out of these we chose 1,200 videos which examine 200 patients (100 females, 100 males). RESULTS: The analysis of the deformation patterns of the masseter allows us to observe how the six layers of the muscle have different and specific functions each, which vary depending on the applied force (application point, magnitude and direction) so that we find it impossible to assign to one of the three sections of the muscle a mechanical predominance. Therefore it appears that the three parts of the muscle have specific and synergistic tasks.

Analysis of masseter deformation patterns during a maximum exertion clenching in patients with unilateral chewing.

PURPOSE: The aim of the following study is to examine both masseter muscles (left/right) in a group of patients suffering from unilateral chewing during a maximum exertion isometric contraction using the deformation pattern analysis of ultrasound videos and compare them with the results obtained by studying patients with alternate bilateral chewing patterns. MATERIALS AND METHODS: This study has been conducted by use of an ultrasound machine and a linear probe which allowed us to record a video (DCM) comprised of 45 frames per second (MicrUs ext-1H Telemed Medical Systems Milano) and a linear probe (L12-5l40S-3 5-12 MHz 40 mm). The probe was fixed to a brace and the patients were asked to clench their teeth as hard as possible, obtain the muscle's maximum exertion, for 5 seconds three times, with 30 seconds intervals in between. Both right and left masseter muscles were analyzed. We applied to the ultrasound video a dedicated software (Mudy 1.7.7.2 AMID Sulmona Italy) for the analysis of muscle deformation patterns. The total number of patients for this study is 150. Out of this number, 50 belong to Group A, mono lateral chewing on the left side arch, and 50 to Group B, mono lateral chewing on the right side arch. The remains patients belong to Group C, bilateral alternate chewing. The deformation pattern analysis of the skeletal muscles on ultrasound videos allows us to highlight with ease the clear difference in the clenching capabilities and strain management between the dominant masseter and the subordinate masseter in a unilaterally chewing patient. RESULTS: In the sample investigated both in Group A and Group B the unilateral chewing is associated with a series of parameters (number, shape, volume, position and orientation of the teeth) and is also associated with the extension of the cutting surface really available.

Characterization of magnetic nanoparticles from Magnetospirillum Gryphiswaldense as potential theranostics tools.

We investigated the theranostic properties of magnetosomes (MNs) extracted from magnetotactic bacteria, promising for nanomedicine applications. Besides a physico-chemical characterization, their potentiality as mediators for magnetic fluid hyperthermia and contrast agents for magnetic resonance imaging, both in vitro and in vivo, are here singled out. The MNs, constituted by magnetite nanocrystals arranged in chains, show a superparamagnetic behaviour and a clear evidence of Verwey transition, as signature of magnetite presence. The phospholipid membrane provides a good protection against oxidation and the MNs oxidation state is stable over months. Using an alternate magnetic field, the specific absorption rate was measured, resulting among the highest reported in literature. The MRI contrast efficiency was evaluated by means of the acquisition of complete NMRD profiles. The transverse relaxivity resulted as high as the one of a former commercial contrast agent. The MNs were inoculated into an animal model of tumour and their presence was detected by magnetic resonance images two weeks after the injection in the tumour mass.

New 4-O-substituted xylosyl units in the xyloglucan from leaves of Hymenaea courbaril.

A homogeneous fucogalactoxyloglucan, isolated from the leaves of Hymenaea courbaril, was analysed by methylation-GC-MS. These procedures involved derived partially O-methylated alditol acetates and acetylated aldononitriles, which demonstrated the presence of both 2-O- and 4-O-substituted Xylp units in the side-chains. The presence of the unusual, latter structure was confirmed by 2D NMR spectroscopy with a correlated HMQC C-4/H-4 signal at delta 77.8/3.73. A similar 4-O-substituted xylosyl structure was present in a decasaccharide Glc4Xyl3Gal2Fuc obtained via endo-glucanase treatment of the polysaccharide, which gave rise to a molecular ion with m/z 1555 (ESI-MS, Na+ form).

Evaluation of different techniques for percutaneous needle biopsy of synovial membrane in the dog.

Four different needles were evaluated for percutaneous needle biopsy (PNB) of the synovial membrane (SM) in six different joints (carpus, tarsus, elbow, shoulder, stifle, hip) from eight dog cadavers. Needle biopsies were retrieved with the Parker-Pearson (PP), a novel modified Parker-Pearson (PPM), the Tru-Cut (TC), and the Franklin-Silverman (FS) needles. The success rate of PNB to produce biopsies, of adequate histological quality, was assessed for each needle type and joint. The joints were subsequently surgically opened and standard open SM biopsies were harvested from an adjacent area. The articular cartilage was inspected and graded for damage caused by PNB sampling. The length of the intact synovial lining cell layer (SLCL) and the histological quality of the needle biopsies were compared to the open surgical biopsies. Success rates for the different needles were 49.2% (PPM), 37.5% (PP), 26.7% (TC), and 1.7% (FS). The highest success rates were achieved in the carpus and stifle; the lowest success rate was found in the hip joint. The intact SLCL from the PNB samples was an average of 3.4 times shorter than that of the surgical biopsies. The proportion of the samples with adequate histological quality was 81% for open surgical biopsies and 62% for PNB samples. The FS was found to produce the highest incidence of articular cartilage damage. The application of PNB for SM sampling is a valuable alternative to the open surgical biopsy in dogs. Modifications of the Parker Pearson needle by Arassy and Schumacher and novel modifications introduced by the authors, offer encouraging results, and merit further clinical and research investigations.

Mast cell proliferation and alterations in bFGF amount and localization are involved in the response of muscle to dystrophin deficiency in hypertrophic feline dystrophy.

To test the hypothesis that basic fibroblast growth factor and mast cells play a key role in the phenotypic differences between human dystrophinopathies and hypertrophic feline muscular dystrophy, serial sections of dystrophin-deficient, carrier and normal cat muscle biopsy specimens were examined. They were stained immunohistochemically for dystrophin and different markers of differentiation such as desmin, vimentin and utrophin. Basic fibroblast growth factor was increased in the myofibers of dystrophic cats compared to normal controls and carriers. An association of basic fibroblast growth factor with fiber regeneration and necrosis was shown. The amount of mast cells was markedly increased in muscle tissue of dystrophic cats with a clear predominance of tryptase-positive cells present in large amounts in the endomysium. Mast cells, like basic fibroblast growth factor, were concentrated in areas of muscle fiber regeneration and necrosis. Our data concerning basic fibroblast growth factor and mast cells are consistent with a highly abnormal cellular environment in feline dystrophic muscle with very high levels of basic fibroblast growth factor which is likely modulated by mast cells.

Molecular and immunodiagnostic investigations on bovine neosporosis in Switzerland.

Neospora caninum has gained considerable attention through its role in the aetiology of bovine abortion. Due to its close phylogenetic relationship with Toxoplasma gondii, respective unequivocal differential diagnosis deserves special consideration. In order to evaluate the diagnostic performance of molecular and immunodiagnostic techniques and to provide insights into the epidemiological significance of bovine neosporosis in Switzerland, we conducted a study on 83 cases of bovine abortion: of these, 24 (29%) foetal brains were positive by Neospora-PCR, six of these foetuses were simultaneously seropositive in Neospora-IFAT and/or somatic antigen-ELISA. Conversely, four (5%) foetal brains were considered positive by Toxoplasma-PCR, two of which were also seropositive in the Toxoplasma-P30-ELISA and/or direct agglutination test. The seroprevalence in 1689 cattle sera obtained from 113 diary farms was 11.5% (95% confidence interval: 9.2-13.8) by Neospora-somatic antigen-ELISA were and 10.7% (95% confidence interval: 8.3-12.6) by Toxoplasma-P30-ELISA. From the same samples, 1.1%, less than statistically expected, were positive in both ELISA. Within selected groups of cow-calf farms, the seroprevalence determined using the Neospora-somatic antigen-ELISA was 14% (95% confidence interval 5.0-23.0) for dams and 15% (95% confidence interval: 3.0-28.0) for offspring calves. Seroprevalences determined by Toxoplasma-P30-ELISA were 8% (95% confidence interval: 4.0-12.0) for dams and 3% (95% confidence interval: 0.3-6.0) for calves. None of the sera gave a positive reaction in both ELISA. Our data indicated that prenatal neosporosis appears as an important cause of bovine abortion in Switzerland.

Xyloglucan from the leaves of Hymenaea courbaril.

A fucosylated xyloglucan was isolated from the leaves of Hymenaea courbaril by alkaline extraction, followed by ethanol precipitation and ion-exchange chromatography. The isolated polysaccharide showed Glc:Xyl:Gal:Fuc in molar ratio of 8:5:2.5:1 and (D)(25) +40.5 degrees. Composition and linkage analyses, supported by NMR spectroscopic measurements, showed that the polysaccharide has a glucan backbone which is highly substituted at O-6 with D-xylopyranose residues, about a half of which are substituted at O-2 by D-galactopyranosyl units. Some of the galactose residues are further substituted by L-fucopyranose at O-2. The M(r), as determined by HPSEC, was 49,500.

Prevalence and infection risks of zoonotic enteropathogenic bacteria in Swiss cow-calf farms.

A longitudinal study was performed in 67 larger Swiss cow-calf farms from September 1996 through November 1997. The objectives of the study were to estimate prevalence and risk factors for colonization with potentially zoonotic enteropathogenic bacteria in younger calves and in calves at weaning age. The study included data from 395 calves with three to four fecal samples each. Fecal samples were analyzed for Campylobacter spp., verotoxin producing E. coli (VTEC), Yersinia spp. and Salmonella sp. Possible environmental and individual factors associated with colonization of these agents were examined. The calves were housed indoor during the first 3 months of life (winter 1996/1997). The prevalences within this time period were: C. coli 3.4%, C. fetus 15.5%, C. hyointestinalis 9.6%, C. jejuni 38.5%, VTEC 44.3% and Yersinia spp. 2%. At the end of the grazing season the prevalences at weaning (8-10 months of age) were: C. coli 1.7%, C. fetus 4.0%, C. hyointestinalis 25.9%, C. jejuni 13.3%, VTEC 38.2% and Yersinia spp. 0%. No salmonellae were present at any time of the study. The prevalences of C. jejuni and VTEC increased significantly within the first 3 months of life, whereas C. hyointestinalis decreased. None of the environmental factors such as housing or feeding had any consistent influences on colonization by the bacteria studied. VTEC, Campylobacter spp. and Yersinia spp. should probably be considered as normal inhabitants of the bovine intestinal tract. However, as they represent a source of gastrointestinal infections in humans, management factors limiting intestinal colonization of these bacteria should be considered in cow-calf operations.

Cloning and sequencing of a cDNA expressing a ribosomal P0 peptide from Culicoides nubeculosus (Diptera).

Insect bite dermal hypersensitivity (IBH) is an allergic dermatitis of horses caused by bites of Culicoides spp. and sometimes Simulium spp. The aim of the investigation presented here was to identify allergens causing IBH. A cDNA library expressing recombinant Culicoides nubeculosus proteins was screened using affinity-purified serum from an IBH-affected horse. Screening of the library resulted in identification of one immunoreactive clone. The sequence of the cDNA insert was determined and revealed a 600 bp insert with an open reading frame coding for a 78 amino acid long protein, called rCul n 1. Analysis of the deduced amino acid sequence revealed an identity of 67-78% to the C-terminal part of the 318 amino acid long ribosomal P0 protein from other Diptera. Furthermore, the 38 C-terminal amino acids displayed an identity of 57% with the C-terminal part of the acidic ribosomal protein P2 from Aspergillus fumigatus. The cDNA insert was subcloned and expressed as a [His]6-tagged protein in Escherichia coli and purified using Ni2(+)-chelate affinity chromatography. The 10kDa recombinant Cul n 1 protein bound the affinity-purified antibody fraction used for screening the expression library. Determination of IgE and IgG levels against rCul n 1 by ELISA in sera from 19 IBH-affected and 18 Swiss control horses and in sera from eight control horses living in Iceland showed no significant differences between the three groups of horses (median IgE levels = 60, 49 and 44 relative ELISA units, respectively). rCul n 1 did not induce sulfidoleukotriene (sLT) release from peripheral blood leukocytes of IBH-affected horses (N = 5), although sLT release was induced with the Culicoides whole body extract.

The relationship between cup design and the radiological signs of aseptic loosening in total hip arthroplasty.

We assessed differences in the incidence and appearance of the radiological signs of loosening of the cup for various types of design. This was an observational study based on hip registry data of 15,340 patients with 17,951 total hip arthroplasties collected over a period of 33 years in 49 hospitals in Central Europe. The threaded and the press-fit titanium cups showed significantly less aseptic loosening than the other systems. The direction of migration and the frequency of the radiological signs of loosening differed between the cup systems and were time-dependent. Our findings indicate the superiority of uncemented threaded cups and press-fit titanium cups over other designs of cup.