Early results of revision acetabular cup using antiprotrusio reconstruction rings and allografts.

BACKGROUND: Hip arthroplasty is one of the most frequently performed orthopedic procedures with high scores of success while its most common complication is aseptic loosening of the acetabular component, which may result from host bone loss or even from pelvis discontinuity. The purpose of the study was to evaluate results in patients after revision acetabular arthroplasty with reconstruction rings and allografts. MATERIALS AND METHODS: Retrospective data was collected from 69 revisions of acetabular components, performed in a group of 69 treated patients (the mean age 65.1 years). Before surgery, the patients had bone defects of type IIb (n = 5), IIc (n = 20), IIIa (n = 27) or IIIb (n = 17), according to Paprosky et al. RESULTS: The mean followup period of the patients was 7.2 years (range 3-19 years). A Kaplan-Meier analysis showed that a 3- and 10 year survival rate was 92.8% and 84.8% respectively, using further revision for any reason of the acetabular device as an end point. Eight patients revealed implant related complications. Four patients presented with ring loosening, one with a loose acetabular polyethylene cup, two hips demonstrated recurrent dislocations and one patient was with deep infection. Regarding the remaining 61 patients without re-revision surgery, the mean Harris hip score improved from 30.5 to 73.8 points. CONCLUSION: A modified, antiprotrusion cage provides an acceptable survival rate and radiological results, but complications could still be expected. It seems that the observed massive bone loss with pelvic discontinuity and an insufficient fixation of the cage to the ischium may result in implant loosening. Stable fixation of the ischial ring flange with screws is an essential condition to expect a good outcome.

Metallographic evaluation of hip joint implants wear and electrochemical implants potential.

We performed metallographic evaluations of implants, removed during revision hip arthroplasty. The implants were evaluated for electrochemical potentials and the presence of wear products on the implants surface. A total of 50 patients (50 hips) underwent revision hip arthroplasty during the years 2007-2009 for aseptic loosening. The mean follow-up from primary hip replacement to revision was 10.1 years (from six months to 17 years). All hip joint implants removed during the revision arthroplasty were submitted to metallographic analysis and all heads were submitted to analysis under a scanning microscope. All polyethylene (PE) cups and inserts showed numerous features of wear (friction wear, plastic deformation and creeping, fatigue wear and degradation), six PE cups were broken. In six ceramic cups, only friction wear features were found; one of them was mechanically broken. In all heads articulating on PE not one had any mechanical damage. Heads of ceramic implants in ceramic-ceramic articulation undergo abrasive wear. None of the studied stems (cemented or uncemented) revealed any features of wear. Areas of titanium crystals (formed by electrolytic sedimentation of metals) were macroscopically identified on the sliding surface of six heads that was confirmed by chemical composition and scanning microscope.In the course of prosthesis use, wear products are produced and transferred onto the sliding surfaces of implant heads and cups via ways other than purely mechanical contact. It has been confirmed that metals used for implant construction, make galvanic cells with different electrochemical potentials.

Metal debris concentrations in soft tissues adjacent to loosened femoral stems is higher in uncemented than cemented implants.

BACKGROUND: There are still many questions related to aseptic femoral stem loosening. Systemic and local immune responses to the implanted "foreign body" is one of the reasons for loosening. The purpose of the study was to measure metal ion concentration (Ti, Co, Cr, Mo, Ni, Al) around loosened femoral stems and compare their levels around uncemented and cemented implants. METHODS: This paper reports 50 hips operated for isolated stem loosening, in 50 patients at the mean age of 57 years (from 21 to 87). There were 25 cemented (Co,Cr29,Mo,Ni) and 25 uncemented (Ti, Al) stems. The mean follow-up from primary hip replacement to revision was 10.1 years (from 0.5 to 17). During the procedure, scar tissue around the stem was taken for analysis of metal ions. RESULTS: The concentrations of titanium and aluminium in soft tissues around uncemented loosened stems were higher than cemented ones (p < 0.001, p < 0.001 respectively). However, no statistically significant differences were observed between both types of stems in terms of ions of the metal of which cemented implants had been made of (Co, Cr, Mo, Ni). CONCLUSIONS: In soft tissue around a loosened stem, the concentrations of metal ions from implants are much higher in case of uncemented stems than of cemented ones. Metal ions from vitalium femoral heads were found around uncemented stems in similar values to cemented streams.

[Clinical and metallographic evaluation of the causes of mechanical loosening of revision baskets Recon Ring--description of 3 cases]. / Kliniczna i metalograficzna ocena przyczyn mechanicznego obluzowania koszy rewizyjnych Recon Ring--opis 3 przypadków.

Aim of this study is to assess the causes of mechanical loosening of revision Recon Ring baskets (Aesculap / BBrown, Germany). This analysis was done by assessing the circumstances of baskets loosening of revision in 3 patients. Intraoperative images and radiographs of patients with these clinical complications were analyzed, and removed damaged bins and bolts of revision metallographic expertise. It was found that the most likely cause mechanical damage to the implant was originally unstable or re-fixing their ischial part, causing movable canopy closer to the basket is balanced by the screws and in turn causing fracture or bending arms, and follow-up baskets of hip bone loss. Our observations suggest that the most important is proper attachment of acetabular basket, especially his arm sciatic.

[Hip revision arthroplasty in massive bone loss of acetabulum with the use of reinforcement ring]. / Zabiegi rewizyjne w duzych ubytkach panewki z zastosowaniem koszy wzmacniajacych.

The aim of the study was the assessment of results after acetabular revision arthtoplasty with the use of reinforcement ring ReconShell (BBrown - Aesculap) and homogenous bone grafts. There were 49 patients in the study (42 women and 7 men) in the age from 30 to 88 years. The follow-up period ranged from 4 to 48 months. Before operation the mean Harris hip score was 31.14 and at last follow-up 71.64 points. Aseptic loosening of reconstruction ring was found in 3 patients. During next revision good integration of bone grafts, that were implanted into acetabulum at previous operation was found. In one hip revision of loose polietylen cup was performed. Three patient had early dislocation of hip endoprothesis, that were treated successfully in abduction casts. Next 2 patients had re-revision performed for recurrent dislocations. One patient had implants removal for septic loosening. Prolonged wound healing was noticed in 5 patients. Two patients had temporary and one permanent common peroneal nerve palsy. Two patients had temporary femoral nerve palsy. The use of reconstruction rings in massive bone loss of the acetabulum after cup loosening gives satisfactory clinical results. After the procedure patients have stabile joint that allows for weight bearing. Despite relatively high number of complications (most of which are temporary) this procedure is worth recommending.

Cementless hip joint alloplasty complicated by intraoperative fracture of the femoral bone.

BACKGROUND: The aim of the study was to analyse the outcomes of hip replacement complicated by intraoperative femoral fractures and to analyse their effective management. MATERIALS AND METHODS: The medical records of 43 cases of intraoperative femoral fractures (1.4% of all hip replacements) were retrospectively reviewed. The patient group included 29 females. Patients' age ranged from 20 to 66 years (mean age: 48.4 years). Follow-up duration ranged from 8 to 89 months (mean duration: 44 months). RESULTS: There were 13 fractures of the greater trochanter, 21 fractures of the lesser trochanter involving the calcar, 7 at the implant stem level, and two below the implant stem. In 3 cases, the fracture was treated with a revision stem, with cerclage used in 17 other cases. In the remaining cases, the fractures were stable and did not require any internal fixation. Eighteen patients had very good final results, 19 had good and 6, fair results, according to Merle D'Aubigne- Postel's classification in Charnley's modification. None of our patients demonstrated evidence of stem loosening at the final follow-up. CONCLUSIONS: Unstable intraoperative femoral fractures during a hip replacement procedure are rare and occur mostly in patients with post-dysplastic hips with a narrow intramedullary canal. In cases of stable fractures of the trochanter and calcar region, 12 weeks of partial weight bearing without additional immobilization is a sufficient approach. The final results are satisfactory in most cases of intraoperative femoral fractures.

Proliferation and apoptosis in the guinea pig adrenal cortex during postnatal development.

The aim of the study was to determine the relation between involution of the FZ and the proliferation and apoptosis of the adrenal cortex cells. The study was carried out with adrenal glands from guinea pigs aged 1, 3, 9, 14, 21, 35 and 90 days. Paraffin slices were stained with Mayer haematoxylin and eosin and with acid fuchsin. For the immunohistochemical reaction the Anti -PCNA Clone PC10 (Dako) was used. Apoptosis evaluation was performed with use of the TUNEL method (Roche). The results support the theory of involution of the FZ cells realised mainly by way of apoptosis. Analysis of the distribution and number of PCNA-positive cells in the adrenal cortex on subsequent days of PD may also back up the migration theory of renewal of the adrenal cortex cells.

[Coronary disease in the past. An attempt at evaluating the dissertation by Jan Cenner "De angor pectoris" (1820) in the context of contemporary knowledge]. / Choroba wiencowa dawniej. Próba oceny wartosci pracy "De angore" pectoris Jana Cennera z 1820 roku, w realiach wiedzy wspólczesnej.

Following an abbreviated historical review of literature related to angina pectoris spanning the period from olden days to the beginning of the XIX th century, this paper analyses Jan Cenner's doctoral dissertation entitled "Dissertation inauguralis medica de angor pectoris", written in Cracow, Poland in 1820. A conciliation of the information regarding coronary artery disease with the current state of medical understanding is made in a tabular form and an attempt at an assessment of treatment rules (including prevention, general non-specific therapy, local treatment, dietary management and the use of pharmacological agents) according to updated medical criteria follows. The authors' goal is an objective evaluation of the real scientific value of Cenner's work in light of nearly two centuries of progress in medical knowledge. Emphasis is placed on those diagnostic findings and therapeutic paths relating to coronary artery disease that are currently used in medical practice.