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1.
J Bone Joint Surg Am ; 101(17): 1563-1568, 2019 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-31483399

RESUMEN

BACKGROUND: Osteonecrosis of the hip is the underlying etiology for 3% to 12% of total hip arthroplasties (THAs). Compared with patients who undergo THA because of osteoarthritis, those who do so because of osteonecrosis typically are younger, have a greater number of underlying diagnoses, and have inferior clinical outcomes and implant survivorship. The purpose of this study was to compare the long-term implant survivorship (median follow-up, 10 years), functional outcomes, and radiographic results of contemporary THAs with a highly cross-linked polyethylene (HXLPE) liner between patients with osteonecrosis and those with osteoarthritis. METHODS: All patients who underwent primary THA with an HXLPE liner from 1999 to 2007 were identified from our institutional total joint registry. Patients with a primary diagnosis of osteonecrosis were matched 1:1, on the basis of age, sex, and body mass index (BMI), to patients with a diagnosis of osteoarthritis. This resulted in 461 hips in 413 patients with osteonecrosis matched to 461 hips in 427 patients with osteoarthritis (mean age, 59 years; 47% female; and mean BMI, 29 kg/m). Long-term implant survivorship, patient-reported outcomes, and radiographic findings were compared. In addition, a subgroup analysis of the osteonecrosis group was performed to see whether certain underlying etiologies portended poor outcomes. The median follow-up was 10 years. RESULTS: The 15-year cumulative rates of revision were 6.6% and 4.5% in the osteonecrosis and osteoarthritis groups, respectively (hazard ratio [HR] = 1.8, p = 0.09). The 15-year cumulative rates of any reoperation were 10.5% and 6.4% in the osteonecrosis and osteoarthritis groups, respectively (HR = 2.2, p = 0.008). There were no radiographic signs of component loosening or osteolysis in the entire cohort. Despite a lower median preoperative Harris hip score (HHS) for patients with osteonecrosis, both groups had marked improvements in their scores, which were similar at all time points after surgery. The cumulative rate of reoperations at 15 years was 0% for hips with radiation-induced osteonecrosis, 6.3% for those with alcohol-induced osteonecrosis, 9.0% for those with posttraumatic osteonecrosis, 12.1% for those with steroid-induced osteonecrosis, and 25% for those with idiopathic osteonecrosis. CONCLUSIONS: Contemporary THA with an HXLPE liner offers excellent long-term implant survivorship and functional outcomes for patients with osteonecrosis; however, the risk of a reoperation is higher when compared with patients with osteoarthritis. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Osteonecrosis/cirugía , Polietileno/uso terapéutico , Artroplastia de Reemplazo de Cadera/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/cirugía , Estudios Prospectivos , Falla de Prótesis , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento
2.
BMJ ; 366: l4230, 2019 07 02.
Artículo en Inglés | MEDLINE | ID: mdl-31266745

RESUMEN

The studyFawsitt C, Thom H, Hunt L. Choice of prosthetic implant combinations in total hip replacement: cost-effectiveness analysis using UK and Swedish hip joint registries data. Value Health 2019;22:303-12.This study was funded by the NIHR Research for Patient Benefit Programme (project number PB-PG-0613-31032).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000771/a-traditional-hip-implant-is-as-effective-as-more-expensive-newer-types-for-older-people.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Diseño de Equipo , Prótesis de Cadera , Complicaciones Posoperatorias , Reoperación , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/métodos , Cerámica/uso terapéutico , Análisis Costo-Beneficio , Diseño de Equipo/métodos , Diseño de Equipo/normas , Femenino , Prótesis de Cadera/clasificación , Prótesis de Cadera/normas , Humanos , Masculino , Prótesis Articulares de Metal sobre Metal , Osteoartritis de la Cadera/cirugía , Polietileno/uso terapéutico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Falla de Prótesis/efectos adversos , Reoperación/métodos , Reoperación/estadística & datos numéricos , Reino Unido
3.
Eur J Orthop Surg Traumatol ; 29(6): 1243-1251, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30929082

RESUMEN

INTRODUCTION: The ideal method and implant to perform total hip arthroplasty (THA) is still a debated topic. Ceramic on ceramic (CoC) bearings have favourable wear properties, but squeaking has been reported as an unwanted side effect. We aimed to determine the rate of noise generation from CoC hips and investigate whether there is a relationship with patient satisfaction. METHODS: A total of 246 consecutive CoC bearing uncemented THA were retrospectively identified in a single institution. Post-operatively patients were sent a postal questionnaire to evaluate their reported sounds and satisfaction with their THA. Uni- and multi-variate analyses were performed to identify potential predictor variables for reported post-operative sounds. RESULTS: Questionnaires were returned by 172 patients (70% return rate). 24% reported sounds from their hips with 11% reporting a squeak. Median satisfaction levels were minimally, but significantly less for "noisy" (9/10) than "quiet" hips (10/10) (median difference = - 1, 95% CI - 2 to 0, p < 0.001). Compared to those with "noisy" hips, patients with "quiet" hips were 1.7 times (95% CI 1.3-2.5, p = 0.0002) more likely to report a "forgotten" hip. Younger age (p < 0.043) and increased anteversion (p < 0.021) were predictors for reported sounds. CONCLUSION: We have identified a high rate of "noisy" hips in this series of CoC THA with a significant inverse relationship between "noisy" hips and patient satisfaction levels. In our unit, we are moving towards the use of ceramic on cross-linked polyethylene bearings as a result of these findings and the excellent survivorship of this bearing combination.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Prótesis de Cadera/efectos adversos , Ruido/prevención & control , Complicaciones Posoperatorias , Falla de Prótesis/etiología , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Cerámica/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Satisfacción del Paciente , Polietileno/uso terapéutico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/psicología , Diseño de Prótesis , Estudios Retrospectivos , Encuestas y Cuestionarios
4.
J Bone Joint Surg Am ; 101(5): 421-428, 2019 Mar 06.
Artículo en Inglés | MEDLINE | ID: mdl-30845036

RESUMEN

BACKGROUND: Polyethylene (PE) liner and femoral head exchange is commonly used to treat periprosthetic osteolysis associated with PE wear after total hip arthroplasty (THA). The purpose of our study was to determine long-term implant survivorship, risk factors for mechanical failure, clinical outcomes, and complications following PE liner and head exchange. METHODS: We identified 116 hips in 110 patients treated with PE liner and head exchange from 1993 to 2004. There were 64 women (58%) in the series, the mean age at revision surgery was 58 years, and the mean follow-up was 11 years (range, 2 to 23 years). Radiographic review determined the location and size of osteolytic defects before the revision surgery. Implant survivorship was determined using Kaplan-Meier survival analysis. Cox regression analysis was used to determine factors that were predictive of failure. RESULTS: Implant survivorship free of repeat revision for any cause was 91% (95% confidence interval [CI] = 86% to 96%) at 5 years, 81% (95% CI = 74% to 90%) at 10 years, and 69% (95% CI = 55% to 84%) at 15 years. Reasons for repeat revision included aseptic acetabular loosening in 5 hips (4%) and subsequent wear of conventional PE with osteolysis in 5 hips (4%). No patient who underwent revision with highly cross-linked PE subsequently had a repeat revision due to wear. The absolute risk of acetabular component loosening was 23% for patients with osteolysis in 3 zones, 40% for those with osteolysis involving more than half the cup circumference, and 21% for those with osteolytic defects of >600 mm. The mean Harris hip score improved from 77 before the PE liner and head exchange to 87 after it (p < 0.001). The most common complication was dislocation, which occurred in 19 hips (16%). CONCLUSIONS: PE liner and head exchange provides acceptable long-term implant survivorship with good clinical outcomes. Complications are not uncommon, and steps should be taken to mitigate hip instability. Acetabular revision may be considered when in situ components have a poor track record or are malpositioned, or when preoperative radiographs demonstrate large osteolytic defects threatening cup fixation. Use of highly cross-linked PE at revision was protective against subsequent PE wear and osteolysis, although this did not reach significance. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Cabeza Femoral/cirugía , Polietileno/uso terapéutico , Acetábulo/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Artrografía , Artroplastia de Reemplazo de Cadera/métodos , Femenino , Prótesis de Cadera , Humanos , Masculino , Persona de Mediana Edad , Osteólisis/diagnóstico por imagen , Osteólisis/etiología , Complicaciones Posoperatorias/etiología , Diseño de Prótesis , Falla de Prótesis , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
6.
Acta Orthop ; 90(1): 67-73, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30526183

RESUMEN

Background and purpose - Hydroxyapatite (HA)-coated implants have been associated with high polyethylene wear in hip arthroplasties. HA coating as a promoter of wear in knee arthroplasties has not been investigated. We compared the wear-rate of the polyethylene bearing for cemented and cementless HA-coated Oxford medial unicondylar knee arthroplasties (UKA). Secondarily, we investigated whether wear-rates were influenced by overhang or impingement of the bearing. Patients and methods - 80 patients (mean age 64 years), treatment-blinded, were randomized to 1 of 3 Oxford medial UKA versions: cemented with double-pegged or single-pegged femoral component or cementless HA-coated with double-pegged femoral component (ratios 1:1:1). We compared wear between the cemented (n = 55) and cementless group (n = 25) (ratio 2:1). Wear, impingement, and overhang were quantified between surgery and 5-year follow-up using radiostereometry. Clinical outcome was evaluated with the Oxford Knee Score. Results - The mean wear-rate for patients without bearing overhang was 0.04 mm/year (95% CI 0.02-0.07) for the cemented group and 0.05 mm/year (CI 0.02-0.08) for the cementless group. The mean difference in wear was 0.008 mm/year (CI -0.04 to 0.03). No impingement was identified. Half of the patients had medial bearing overhang, mean 2.5 mm (1-5). Wear increased by 0.014 mm/year for each mm increment in overhang. The mean Oxford Knee Score was 39 for the cementless group and 38 for the cemented group at the 5-year follow-up. Interpretation - The wear-rates were similar for the 2 fixation methods, which supports further use of the cementless Oxford medial UKA. However, a caveat is a relatively large 95% CI of the mean difference in wear-rate. Component size and position is important as half of the patients presented with an additional increase in wear-rate due to medial bearing overhang.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Cementos para Huesos/uso terapéutico , Prótesis de la Rodilla/efectos adversos , Polietileno/uso terapéutico , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/instrumentación , Artroplastia de Reemplazo de Rodilla/métodos , Cementación/métodos , Materiales Biocompatibles Revestidos/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Diseño de Prótesis , Falla de Prótesis , Análisis Radioestereométrico , Resultado del Tratamiento
7.
Gen Dent ; 66(6): e6-e10, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30444714

RESUMEN

The aim of this study was to evaluate the effect of polyethylene fibers incorporated in a composite resin matrix on the gingival marginal adaptation of Class II slot restorations. Sixty Class II slot cavity preparations were divided into 2 groups. A fiber-reinforced resin (FRR) group received restorations of composite resin mixed with strips of polyethylene fiber, and an unreinforced resin (UR) group was restored with only composite resin. The groups were subdivided on the basis of the adhesive system (etch-and-rinse or self-etch) that was used. Shrinkage stress was evaluated by placing a strain gauge at the buccal surface of the teeth. A scanning electron microscope was used to evaluate marginal adaptation in terms of a continuous margin (CM) at the gingival margin. Statistical analysis included a 2-way analysis of variance with the Holm-Sidak correction for multiple comparisons at a significance level of 0.05. The mean strain value was significantly smaller in the FRR group (185 [SD 37] µm/m) than in the UR group (295 [SD 21] µm/m). The FRR group presented with a mean CM value of 80.2% (SD 4.6%), which was significantly higher than that of the UR group, which had an overall CM value of 64.4% (SD 4.2%). There was no statistically significant difference between the adhesive subgroups with regard to strain or percentage of CM. The results showed that the incorporation of polyethylene fibers in a composite resin matrix can help to improve gingival marginal adaptation in Class II cavities.


Asunto(s)
Resinas Compuestas/uso terapéutico , Adaptación Marginal Dental , Restauración Dental Permanente/métodos , Polietileno/uso terapéutico , Análisis del Estrés Dental , Humanos
8.
Biomed Res Int ; 2018: 1982726, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30420957

RESUMEN

Purpose: Pterional craniotomy is a useful approach for the treatment of a variety of intracranial pathologies. However, it can result in temporal hollowing, which causes significant craniomaxillofacial asymmetry and esthetic deformity. The present study was performed to determine the postoperative outcomes of patients following frontotemporal depression reconstruction using a high-density porous polyethylene (HDPE) implant (Medpor®; Stryker, Kalamazoo, MI) after pterional craniotomy. Materials and Methods: The patients had undergone reconstruction of frontotemporal depression using Medpor® implants after pterional craniotomy at our medical institution during the period from February 2010 to March 2014. We evaluated the thickness and volume of both the temporalis muscle and Medpor® implant through a retrospective review of the medical records and computed tomography (CT) scans of 92 patients. Results: The mean temporalis muscle thickness ratio (muscle thickness of the affected side/nonaffected side) was 0.61 ± 0.16. The mean reconstructed temporalis muscle thickness ratio (muscle and Medpor® implant thickness of affected side/muscle thickness of nonaffected side) was 1.15 ± 0.02. The mean temporalis muscle volume ratio (muscle volume of affected side/nonaffected side) was 0.67 ± 0.02. The mean reconstructed temporalis muscle volume ratio (muscle and Medpor® implant volume of affected side/muscle volume of nonaffected side) was 1.18 ± 0.02. Conclusions: Temporalis muscle thickness and volume were significantly decreased on the affected side after pterional craniotomy. Reconstruction of frontotemporal lesions using Medpor® implants after the pterional approach improved temporal hollowing without additional complications.


Asunto(s)
Craneotomía/efectos adversos , Hueso Frontal/cirugía , Prótesis e Implantes , Procedimientos Quirúrgicos Reconstructivos/métodos , Hueso Temporal/cirugía , Humanos , Polietileno/uso terapéutico , Estudios Retrospectivos , Músculo Temporal/cirugía
9.
Surg Technol Int ; 33: 265-270, 2018 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-30276781

RESUMEN

INTRODUCTION: To help limit wear, newer polyethylene liners, such as the highly cross-linked polyethylene (HXLPE) liners, have been developed. These newer liners undergo an alternating irradiation process, resulting in a stronger, longer-lasting liner. The purpose of this study was to analyze the wear rates of patients who underwent THA and received a newer generation HXLPE acetabular insert. Specifically, we compared: 1) linear vector wear amount and 2) linear vector wear rates in patients as an overall cohort and by gender. We also assessed patient satisfaction outcomes comparing preoperative Harris Hip Scores (HHS) to seven-week, one-year, and three-year HHS scores. MATERIALS AND METHODS: A total of 23 patients who underwent total hip arthroplasty (THA) with direct superior approach by a fellowship-trained orthopaedic surgeon at a private practice institution were analyzed after receiving institutional review board approval. Patients had a minimum two-year follow up, with the mean follow up being four years (range, three to five years). All patients received a 36-mm ceramic femoral head with an HXLPE liner. 2D radiographic polyethylene wear analysis was performed using the Martell Hip Analysis Suite (HAS; University of Chicago, Illinois), which has been previously validated in the literature. Outcomes were assessed using Harris Hip Scores. RESULTS: A five-year linear wear rate of 0.073 mm/year (range, 0 to 0.160 mm/year) and an overall mean linear wear rate of 0.096 mm/year (range, 0 to 0.277 mm/year) were found. No significant differences in wear were seen between genders. Additionally, patients reported significantly better results at seven-weeks (83 points [range, 59 to 100 points]) and one-year (94 points [range, 85 to 100 points]) than preoperative (52 points [range, 34 to 73 points]) HSS scores (p<0.05). No patients underwent revision THA. CONCLUSION: The results from this study highlight the benefits of using an HXLPE polyethylene liner in THA patients and further validates previously reported wear rates of HXLPE liners. After an early "wear in" period during the first year, the wear rates steadily decreased over time. This liner showed excellent early outcomes as no patients underwent revision THA. Furthermore, even as early as seven postoperative weeks, patients reported significantly better HHS scores. Future studies should track the same patient cohort over time to help develop a wear-rate prediction model.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Prótesis de Cadera/estadística & datos numéricos , Polietileno/uso terapéutico , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Estudios de Cohortes , Humanos , Satisfacción del Paciente/estadística & datos numéricos , Diseño de Prótesis , Falla de Prótesis
10.
Surg Technol Int ; 32: 249-255, 2018 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-29529701

RESUMEN

INTRODUCTION: The growing trends of total knee arthroplasty (TKA) foreshadow an inevitable increase in the financial burden on healthcare expenditure estimated to almost nine billion dollars annually. This study aims to demonstrate the potential savings when using all-polyethylene (AP) compared to metal-backed (MB) tibial components and describes the cost variability amongst three major commercially available implants. MATERIALS AND METHODS: The cost of AP versus MB implants was analyzed using a large nationwide database, Emergency Care Research Institute (ECRI). Cost of femoral components and patellar buttons were excluded. The three manufacturers included in the study were DePuy, Smith&Nephew, and Stryker (Zimmer data was not available for analysis). RESULTS: Our results show that AP components were significantly less costly in comparison to other manufacturers, and the average AP price was $1,009. The average MB (baseplate plus liner) price was $2,054 (p<0.01). Analysis of variance (ANOVA) of the means of the AP components showed no significant difference in prices among the three studied manufacturers (p=0.946). DISCUSSION: Our results demonstrate that, regardless of the manufacturing company, AP tibial components are significantly cheaper than their MB counterparts. A literature review revealed that, when indicated, AP implants are not inferior to MB in terms of survivorship or outcome. The average savings was more than $1,000 per TKA when multiplied even by a small portion of the large volume of TKAs completed annually. This can translate into millions of dollars in savings in healthcare expenditures. With the impending legislation of the bundled-payment initiative, orthopaedic surgeons should be aware of less costly implant options that can positively impact outcomes and/or quality of care.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/economía , Artroplastia de Reemplazo de Rodilla/instrumentación , Prótesis de la Rodilla/economía , Prótesis de la Rodilla/estadística & datos numéricos , Metales , Polietileno , Costos y Análisis de Costo , Humanos , Metales/química , Metales/uso terapéutico , Polietileno/química , Polietileno/uso terapéutico , Diseño de Prótesis
11.
Arch Orthop Trauma Surg ; 138(5): 719-729, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29476323

RESUMEN

INTRODUCTION: Biomechanical studies have suggested that proximal tibial strain is elevated in UKAs incorporating all-polyethylene tibial components with concern that this leads to premature failure. This study reports minimum 10-year outcomes for a UKA incorporating an all-polyethylene tibial component to determine whether these concerns were realised. MATERIALS AND METHODS: 109 fixed bearing UKAs (97 patients, mean age 68 (range 48-87), 54/97 (56%) female) with all-polyethylene tibial components were followed up for ≥ 10 years with Oxford Knee Scores, Forgotten Joint Scores and Kaplan-Meier analysis. 106/109 implants were 7 mm, 3 were 9.5 mm. RESULTS: Ten-year survival was 85.5% (78.6-92.4 95% CI) with the end-point failure for any reason. Unexplained pain was the commonest mode of failure (6/17) followed by lateral compartment osteoarthritis (5/17) and tibial subsidence/loosening (4/17). Revision rate was highest at 2-5 years due to revisions for unexplained pain. Ten-year survival was worse in patients < 65 years old (p = 0.035), in those with BMI > 30 (p = 0.017) and in those with postoperative increases in medial tibial sclerosis (p < 0.001 log-rank). Implant malalignment was not significantly associated with failure. Radioisotope bone scans in 16 patients all remained "hot" at mean 6.1 years (range 2.1-11.5). Relative risk of failure in patients < 65 years was 2.9 (1.2-7.0 95% CI) and when BMI > 30 was 2.9 (1.2-6.9 95% CI). In those with intact UKAs at 10 years, mean Oxford Knee Score was 34.8 ± 10.7, Forgotten Joint Score was 37.9 ± 26.7 and 96% were satisfied with their knee. CONCLUSION: The high rate of early failure between 2 and 5 years in this all-polyethylene tibial component UKA did not persist in the long term. Though medial proximal tibial metabolic changes appear to persist they are not necessarily symptomatic. BMI > 30 and age < 65 years were significant risk factors for revision.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Polietileno/uso terapéutico , Tibia/cirugía , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/instrumentación , Artroplastia de Reemplazo de Rodilla/mortalidad , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Resultado del Tratamiento
12.
Int Braz J Urol ; 44(3): 591-599, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29368874

RESUMEN

OBJECTIVE: To assess the role of high-barrier plastic wrap in reducing the number and size of polyps, as well as decreasing the inflammation and allergic reactions in exstrophy cases, and to compare the results with the application of low-barrier wrap. MATERIALS AND METHODS: Eight patients with bladder exstrophy-epispadias complex (BEEC) that had used a low density polyethylene (LDPE) wrap for coverage of the exposed polypoid bladder in preoperative care management were referred. The main complaint of their parents was increase in size and number of polyps. After a period of 2 months using the same wrap and observing the increasing pattern in size of polyps, these patients were recommended to use a high-barrier wrap which is made of polyvinylidene chloride (PVdC), until closure. Patients were monitored for the number and size of polyps before and after the change of barriers. The incidence of para-exstrophy skin infection/inflammation and skin allergy were assessed. Biopsies were taken from the polyps to identify histopathological characteristics of the exposed polyps. RESULTS: The high barrier wrap was applied for a mean ± SD duration of 12±2.1 months. Polyps' size and number decreased after 12 months. No allergic reaction was detected in patients after the usage of PVdC; three patients suffered from low-grade skin allergy when LDPE was applied. Also, pre-malignant changes were observed in none of the patients in histopathological examination after the application of PVdC. CONCLUSION: Polyps' size and number and skin allergy may significantly decrease with the use of a high-barrier wrap. Certain PVdC wraps with more integrity and less evaporative permeability may be more "exstrophy-friendly".


Asunto(s)
Extrofia de la Vejiga/cirugía , Polietileno/uso terapéutico , Pólipos/terapia , Cuidados Preoperatorios/métodos , Biopsia , Extrofia de la Vejiga/patología , Niño , Preescolar , Epispadias/patología , Epispadias/cirugía , Femenino , Humanos , Hipersensibilidad/prevención & control , Lactante , Masculino , Pólipos/patología , Cuidados Preoperatorios/instrumentación , Valores de Referencia , Reproducibilidad de los Resultados , Enfermedades de la Piel/prevención & control , Factores de Tiempo , Resultado del Tratamiento
13.
Plast Reconstr Surg ; 141(2): 461-470, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29370000

RESUMEN

BACKGROUND: The use of a porous high-density polyethylene implant for ear reconstruction is gradually gaining acceptance because it allows for a pleasing ear reconstruction in young children before they enter school. In response to this growing interest, the authors decided to write an article clarifying in detail all the steps of this challenging procedure. In this article, the authors also answer all the common questions that surgeons have when they come to observe the operation, or when they go back to their respective practices and start performing this procedure. METHODS: The authors describe in detail the operative steps that allow for a successful ear reconstruction using porous high-density polyethylene. The key parts of this operation are to meticulously harvest a well-vascularized superficial temporoparietal fascia flap and to use appropriate color-matched skin grafts. RESULTS: This method allows for a pleasing ear reconstruction with excellent definition, projection, symmetry, and long-term viability. CONCLUSION: The use of porous high-density polyethylene with a thin superficial temporoparietal fascia flap coverage is the authors' preferred method of ear reconstruction because it can be performed at an earlier age, in a single stage, as an outpatient procedure, and with minimal discomfort and psychological trauma for the patients and parents.


Asunto(s)
Oído Externo/cirugía , Polietileno/uso terapéutico , Prótesis e Implantes , Colgajos Quirúrgicos/trasplante , Alotrasplante Compuesto Vascularizado/métodos , Factores de Edad , Procedimientos Quirúrgicos Ambulatorios/métodos , Niño , Preescolar , Fascia/irrigación sanguínea , Fascia/trasplante , Humanos , Porosidad , Procedimientos Quirúrgicos Reconstructivos/métodos , Colgajos Quirúrgicos/irrigación sanguínea
14.
J Craniomaxillofac Surg ; 46(2): 274-282, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29233702

RESUMEN

The aim of the study was to assess the mid-term effectiveness and safety of an original technique consisting of reconstructing fractures of the medial wall of the orbit with porous polyethylene implants with an exclusive transnasal approach. Twenty-five patients were treated. Each patient underwent a pre-operative ophthalmologic evaluation and a CT scan. The surgery started with an anteroposterior ethmoidectomy of the fractured side; all the fractured bone fragments were removed and all usual landmarks of healthy bony margins were identified. A Medpor sheet was placed endoscopically to reconstruct the fractured wall. Each patient received an immediate postoperative CT scan, and was evaluated at day 1, 7, 30 and 6 months after surgery clinically and with an endoscopic examination. In all patients, preoperative enophthalmos and/or diplopia were corrected. The CT scans showed excellent reconstruction of the fractured bony walls. The immediate postoperative period was characterized by a very high degree of subjective comfort. No perioperative complications were detected. At the 6 months follow up, all meshes appeared covered by epithelialized mucosa at the endoscopic inspection, and clinical results were stable. Scars or lid complications are always prevented. The technique described has become the standard to treat medial wall fractures in our department.


Asunto(s)
Fracturas Orbitales/cirugía , Prótesis e Implantes , Implantación de Prótesis/métodos , Cirugía Endoscópica Transanal/métodos , Enoftalmia/etiología , Femenino , Humanos , Masculino , Órbita/cirugía , Fracturas Orbitales/complicaciones , Fracturas Orbitales/diagnóstico por imagen , Polietileno/uso terapéutico , Estudios Prospectivos , Tomografía Computarizada por Rayos X
15.
Biomed Res Int ; 2017: 8243184, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28812023

RESUMEN

In the delivery room, wrapping a low-birth-weight neonate (defined as ≤2.499 g) in a polyethylene bag reduces the risk of hypothermia. However, extended use of the bag (e.g., during neonatal surgery) might conceivably increase the risk of thermal stress and thus body overheating. Here, we assessed the efficacy of a polyethylene bag in infants assigned to wrap (W) or nonwrap (NW, control) groups during placement of a percutaneous vena cava catheter by applying a new mathematical model that calculates heat exchanges for covered and uncovered body segments. At the end of the placement procedure, the W and NW groups did not differ significantly in terms of whole-body heat loss (15.80 versus 14.97 kJ·h-1·kg-1, resp.), whereas the abdominal skin temperature was slightly but significantly higher (by 0.32°C) in the W group. Greater evaporation in the W group (2.49 kJ·h-1·kg-1) was primarily balanced by greater whole-body radiant heat loss (3.44 kJ·h-1·kg-1). Wrapping the neonate in a polyethylene bag provides a small thermal benefit when catheter placement takes a long time. Given that polyethylene is transparent to radiant energy, it might be of value to incorporate polymers that are less transparent at infrared wavelengths.


Asunto(s)
Temperatura Corporal , Recién Nacido de Bajo Peso/fisiología , Recien Nacido Prematuro/fisiología , Temperatura Cutánea/fisiología , Regulación de la Temperatura Corporal , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Atención Perioperativa , Polietileno/uso terapéutico
16.
Can J Surg ; 60(3): 212-216, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28570216

RESUMEN

BACKGROUND: The purpose of this study was to report the radiographic wear rates from a previous randomized controlled trial of first-generation highly crosslinked versus conventional polyethylene in total hip arthroplasty (THA) at a minimum of 13 years' follow-up. METHODS: Patients returned for radiographic imaging and radiostereometric analysis (RSA). Radiographs were reviewed for the presence of osteolysis or component loosening. Femoral head penetration (which includes both wear and creep) was measured using RSA. We compared Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 12-Item Short Form Health Survey (SF-12) and Harris Hip Scores (HHS) with preoperative values. RESULTS: There was 1 revision in each group. There was no difference in WOMAC, SF-12, or HHS outcome scores between the highly crosslinked and conventional polyethylene groups (all p ≥ 0.13). Wear rate was lower with crosslinked polyethylene than conventional polyethylene (0.04 ± 0.02 mm/year v. 0.08 ± 0.03 mm/year, p = 0.007). CONCLUSION: First-generation crosslinked polyethylene demonstrates greater wear resistance than conventional polyethylene after 13 years of implantation. Crosslinked polyethylene continues to outperform conventional polyethylene into the second decade of implantation.


Asunto(s)
Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Fémur/diagnóstico por imagen , Prótesis de Cadera/estadística & datos numéricos , Polietileno/normas , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/normas , Femenino , Fémur/cirugía , Estudios de Seguimiento , Prótesis de Cadera/normas , Humanos , Masculino , Persona de Mediana Edad , Polietileno/uso terapéutico
17.
Orthop Surg ; 9(2): 186-190, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28557297

RESUMEN

OBJECTIVES: The relationship between cup inclination angle and liner wear is controversial. Most authors in the published literature agree that the ideal cup inclination is associated with lower inner wear; however, some disagree. All previous studies did not control for femoral head diameter and inclination, so it is difficult to assess the relative or synergistic effects of cup angle on outcomes. METHODS: We retrospectively reviewed 154 patients (171 hips) with primary total hip arthroplasties performed from 2001 to 2004. All surgeries had been performed by the same physician team. A posterior approach was applied in all patients. All prostheses were non-cemented cups with a 28-mm metal head. Inclusion criteria included that the radiographic material was not completed or lost for primary or last follow up. Patients were divided into four groups according to different cup inclination angle. There were 108 hips with inclination angles below 50°; 35 hips with angles between 50° and 55°; 17 hips with angles between 55° and 60°; and 11 hips with angles greater than 60°. An immediate postoperative radiograph was compared with a follow-up radiograph. Clinical and radiographic data were collected on standardized hip evaluation forms preoperatively, 6 months after surgery and at yearly follow-up visits. Radiographs were digitized and enlarged 100%. After the radiographs were digitized, polyethylene wear rates and acetabular cup abduction were measured on all patients with Cavas 15.0 software. The results were analyzed using Student's two-tailed paired t-test with SPSS 11.5. RESULTS: The preoperative mean Harris hip score improved from 45.36 to 93.5 points 10 years after surgery. No acetabular component was revised for aseptic loosening. Three patients (three hips) had to undergo bone grafting and a lined arthroplasty for severe osteolysis around the acetabular component. The rate of implant survival at 10 years with respect to loosening was 100%. The mean liner wear rate was 0.135 mm/year in cups with inclination angles below 50°, 0.144 mm/year between 50° and 55°, 0.260 mm/year between 55° and 60°, and 0.403 mm/year when the angle was greater than 60°. Liner wear increased when the cup angle was larger than 55° (P < 0.05). CONCLUSIONS: For metal-on-polyethylene prostheses, liner wear correlates with cup inclination angle larger than 55°. The ideal abduction angle for metal-on-polyethylene prostheses is less than 55°.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Prótesis de Cadera , Acetábulo/diagnóstico por imagen , Adulto , Anciano , Artritis/cirugía , Femenino , Necrosis de la Cabeza Femoral/cirugía , Luxación Congénita de la Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Polietileno/uso terapéutico , Diseño de Prótesis , Falla de Prótesis , Radiografía , Estudios Retrospectivos
18.
J Bone Joint Surg Am ; 99(7): 593-598, 2017 Apr 05.
Artículo en Inglés | MEDLINE | ID: mdl-28375892

RESUMEN

BACKGROUND: Magnetic resonance imaging (MRI) is a commonly utilized screening modality in patients with a metal-on-metal (MoM) total hip replacement. The prevalence of clinically important fluid collections may be overestimated since these collections have been reported to occur in asymptomatic patients with MoM and other bearing surfaces. The purpose of this study was to determine the frequency and types of MRI-documented adverse local tissue reactions in asymptomatic patients with a ceramic-on-polyethylene (CoP) total hip replacement. METHODS: Forty-four patients (50 hips) with a minimum 2-year follow-up after total hip arthroplasty with CoP implants and a Harris hip score of >90 were enrolled in this study. The inclusion criteria were the absence of hip pain and the availability of appropriate follow-up radiographs. All patients underwent a metal artifact reduction sequence (MARS) MRI scan to determine the presence of fluid collections in asymptomatic patients with a CoP bearing surface. RESULTS: Fluid collections were observed in 9 (18%) of 50 asymptomatic hips in this cohort. There were 5 hips with intracapsular synovitis, and 2 of these hips had a thickened synovium. Extra-articular fluid collections with direct intracapsular communication were identified in 4 additional hips. Two of these hips had a thickened synovium. No signs of osteolysis or evidence of adverse local tissue reactions were noted on radiographs at the most recent follow-up. CONCLUSIONS: This study revealed that fluid collections are not uncommon after total hip arthroplasty with CoP implants. Synovial thickening may be present and is more prevalent than has been reported in previous studies involving metal-on-polyethylene (MoP) bearing surfaces. The clinical importance and natural history of these findings remain unknown. LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Artefactos , Edema/etiología , Prótesis de Cadera/efectos adversos , Cerámica/uso terapéutico , Edema/diagnóstico , Humanos , Imagen por Resonancia Magnética , Metales/efectos adversos , Polietileno/uso terapéutico , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología
19.
Dan Med J ; 64(3)2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28260601

RESUMEN

Total hip arthroplasty (THA) is a common and successful treatment of patients suffering from severe osteoarthritis that significantly reduces pain and improves hip function and quality of life. Traditionally, the outcome of THA has been evaluated by orthopaedic surgeons and assessed in morbidity and mortality rates, and implant survival. As patients and surgeons may assess outcome after THA differently, patient-reported outcomes (PROMs) have gained much more interest and are today recognized as very important tools for evaluating the outcome and satisfaction after THA. One of the prognostic factors for the outcome of THA is the type of bearings. This PhD thesis focuses on the influence of different types of bearings on implant survival, revision causes, PROMs, and noises from THA. The aims of the thesis were: Study I: To examine the revision risk and to investigate the causes of revision of cementless ceramic-on-ceramic (CoC) THAs comparing them to those of "standard" metal-on-polyethylene (MoP) THAs. Study II: To compare the six-year revision risk for metal-on-metal (MoM) with that for MoP bearings in cementless stemmed THA, and further to study the revision risk for different designs of stemmed MoM THAs and the causes of revision. Study III: To examine the association between CoC, MoM, and MoP bearings and both generic and disease-specific PROMs, and furthermore to examine the incidence and types of noises from the three types of bearings and identify the effect of noises on PROM scores. In study I and III, we used data from the Danish Hip Arthroplasty Registry combined with data from the Civil Registration System and the Danish National Patient Registry. In study II, data from the Nordic Arthroplasty Register Association, containing data from hip arthroplasty registries in Denmark, Norway, Sweden, and Finland, was used. In study I, 11,096 patients operated from 2002 through 2009 with cementless THA were included. Of these, 16% had CoC THA and 84% had MoP THA. At 8.7-year follow-up, no difference in RR of revision for any cause was found for CoC compared to MoP THA. One cause of revision related only to CoC THA is ceramic fracture. Medical records were reviewed for patients who had revision surgery due to component failure, and six patients (0,34%) had been revised due to ceramic fracture. No other difference in prevalence of causes of revision was found when comparing CoC to MoP THA. Study II included 32,678 patients who were operated from 2002 through 2010 with cementless stemmed THA with either MoM bearings (11,567 patients, 35%) or MoP bearings (21,111 patients, 65%). At six-year follow-up, the RR of revision for any cause was significantly higher for MoM compared to MoP THA. When comparing different combinations of cup/stem with MoM to MoP bearings, there was an increased RR of revision for any cause for the ASR/Summit, ASR/Corail, and "other" combinations. There was a higher prevalence of revision due to aseptic loosening for MoM compared to MoP THA. In contrast, the prevalence of revision due to dislocation was lower for MoM THA. In study III, a set of questionnaires including HOOS, EQ-5D, UCLA activity score, and a questionnaire about noises from the THA was sendt to patients having THA with CoC, MoM, or MoP bearings. The response rate was 85% and among the 3,089 patients responding, 45% received CoC, 17% MoM, and 38% MoP THA. No differences in mean subscale scores were found for CoC and MoM compared to MoP THA, except for CoC THA that had a lower mean HOOS symptoms score than MoP THA. 27% of patients with CoC, 29% of patients with MoM, and 12% of patients with MoP bearings had experienced noises from the THA. For the three types of bearings, PROM scores from patients with noisy THA were significantly lower when compared to silent MoP THA, except for noisy CoC and MoM THA that had the same mean UCLA activity score as silent MoP THA.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Prótesis de Cadera/estadística & datos numéricos , Osteoartritis/cirugía , Falla de Prótesis , Reoperación/estadística & datos numéricos , Factores de Edad , Cerámica/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Prótesis Articulares de Metal sobre Metal , Osteoartritis de la Cadera , Medición de Resultados Informados por el Paciente , Polietileno/uso terapéutico , Calidad de Vida , Sistema de Registros , Factores de Riesgo , Países Escandinavos y Nórdicos , Factores Sexuales , Resultado del Tratamiento
20.
Int Orthop ; 41(3): 573-581, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28097387

RESUMEN

PURPOSE: Although the natural history of dual mobility has been exclusively borne for 20 years by a single company (due to industrial ownership), the concept has undeniably been very widely popularised with nearly 40 cups on the French market which should be regarded as a weight bearing surface, both broadly and in their own right. However, within the same original idea, these implants are not all identical (design, material, fixation ect.).The aim of this work is to propose a classification of different dual mobility cups by distinguishing between thegeneral characteristics of a conventional cup and those particular to this type of implant. METHODS: By comparison with a standard metal-back cup, dual mobility is based on at least one additional interface corresponding to the mobility of the polyethylene insert in the concavity of the acetabular cup called the outersurface. Design, constitutive material, fixation of the cup and characteristics of the retentive insert are analysed through the published results. RESULTS: The complications associated, in particular, the intraprosthetic dislocation and to a lesser extent fixation failures undoubtedly condemned the dissemination of the dual mobility concept, as witnessed by the fact that despite the precedence of this 40-year old concept, the overriding majority of publications (more than 95%) have only appeared in the last ten years. CONCLUSION: The latest generation of dual mobility cups combines: 1) a cast chrome-cobalt alloy cup covered with a bilayer coating of porous titanium and hydroxyapatite for long-term press-fit fixation to 2) an insert designed to eliminate all of the risks of intraprosthetic dislocation, whilst keeping all of the elasticity properties of the polyethylene, which has demonstrated its medium and long term effectiveness on preventing instability by overcoming other complications.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Prótesis de Cadera , Diseño de Prótesis/métodos , Falla de Prótesis/etiología , Estudios de Seguimiento , Articulación de la Cadera/cirugía , Humanos , Polietileno/efectos adversos , Polietileno/uso terapéutico , Estudios Retrospectivos , Factores de Tiempo
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