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1.
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
2.
Z Orthop Unfall ; 157(5): 548-557, 2019 Oct.
Artículo en Inglés, Alemán | MEDLINE | ID: mdl-30974470

RESUMEN

The present paper gives an overview of the different types of short stem total hip replacements. There is a pronounced inhomogeneity of the nomenclature in clinical practice as well as in regard to the scientific literature. Examples include neck preserving implants, meta-, epi- or metadiaphyseal fixed implants, microimplants, ultrashort implants, partial neck preserving implants, trochanteric sparing implants, implants with extra- and/or intramedullar fixation, implants without primary fixation, etc. Biomechanically, the short stems vary from very short, completely neck retaining versions up to implants which are just a shorter version of a standard implant. A frequently cited classification recommends the osteotomy level as a discriminating factor. This classification categorizes into a neck preserving, partial neck preserving and neck resecting short stems.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Fémur/cirugía , Prótesis de Cadera , Artroplastia de Reemplazo de Cadera/métodos , Fenómenos Biomecánicos , Fémur/fisiopatología , Cuello Femoral/fisiopatología , Cuello Femoral/cirugía , Prótesis de Cadera/clasificación , Humanos , Osteotomía , Diseño de Prótesis , Rotación
3.
Eur J Orthop Surg Traumatol ; 29(6): 1235-1242, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30989339

RESUMEN

PURPOSE: Stem design is usually accused for proximal femoral remodeling following total hip arthroplasty (THA). The aim of this prospective study was to compare the in vivo changes in bone mineral density (BMD) of the proximal femur after implantation of cementless THA with two length alternative stems. METHODS: Between May 2011 and March 2014, 50 patients, who met our selection criteria and received cementless THA, randomized into two groups. Group A received cementless standard femoral stems, while group B received short stems. Harris Hip Score (HHS) and visual analog scale (VAS) were used for clinical assessment. Stem and cup positions and stability were radiologically evaluated. Dual-energy X-ray absorptiometry was used to follow and compare changes in BMD in different zones of proximal femur between both groups. RESULTS: After a mean follow-up of 21.4 ± 3.53 months, there was a significant (p < 0.05) improvement in mean HHS and VAS with no significant differences (p > 0.05) between groups. There was no significant difference (p > 0.05) between groups regarding radiological results and rates of complications. The mean overall BMD was decreased by 11.26% for group A and 8.68% for group B at the final follow-up (p > 0.05). The greatest loss was found in greater trochanter region for group A and so for group B, but to a lesser extent (p < 0.05). CONCLUSIONS: Cementless short stem was not able to hold back proximal femoral bone loss, but only can modify or decrease its incidence within limits.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Remodelación Ósea , Resorción Ósea , Fémur , Prótesis de Cadera/clasificación , Complicaciones Posoperatorias , Absorciometría de Fotón/métodos , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/métodos , Densidad Ósea , Resorción Ósea/diagnóstico , Resorción Ósea/etiología , Resorción Ósea/prevención & control , Femenino , Fémur/diagnóstico por imagen , Fémur/patología , Humanos , Masculino , Oseointegración , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Diseño de Prótesis , Resultado del Tratamiento
4.
Acta Orthop ; 90(2): 148-152, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30739548

RESUMEN

Background and purpose - International comparisons of total hip arthroplasty (THA) practices and outcomes provide an opportunity to enhance the quality of care worldwide. We compared THA patients, implants, techniques, and survivorship in Sweden, Australia, and the United States. Patients and methods - Primary THAs due to osteoarthritis were identified using Swedish (n = 159,695), Australian (n = 279,693), and US registries (n = 69,641) (2003-2015). We compared patients, practices, and implant usage across the countries using descriptive statistics. We evaluated time to all-cause revision using Kaplan-Meier survival curves. We assessed differences in countries' THA survival using chi-square tests of survival probabilities. Results - Sweden had fewer comorbidities than the United States and Australia. Cement fixation was used predominantly in Sweden and cementless in the United States and Australia. The direct anterior approach was used more frequently in the United States and Australia. Smaller head sizes (≤ 32 mm vs. ≥ 36 mm) were used more often in Sweden than the United States and Australia. Metal-on-highly cross-linked polyethylene was used more frequently in the United States and Australia than in Sweden. Sweden's 5- (97.8%) and 10-year THA survival (95.8%) was higher than the United States' (5-year: 97.0%; 10-year: 95.2%) and Australia (5-year: 96.3%; 10-year: 93.5%). Interpretation - Patient characteristics, surgical techniques, and implants differed across the 3 countries, emphasizing the need to adjust for demographics, surgical techniques, and implants and the need for global standardized definitions to compare THA survivorship internationally.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Osteoartritis , Complicaciones Posoperatorias , Reoperación/estadística & datos numéricos , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/métodos , Australia , Análisis de Falla de Equipo , Femenino , Articulación de la Cadera/cirugía , Prótesis de Cadera/clasificación , Prótesis de Cadera/normas , Prótesis de Cadera/estadística & datos numéricos , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico , Osteoartritis/epidemiología , Osteoartritis/etiología , Osteoartritis/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía , Diseño de Prótesis , Suecia , Estados Unidos
5.
Int J Artif Organs ; 42(6): 271-290, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30537876

RESUMEN

INTRODUCTION: There are several commercially available hip implant systems. However, for some cases, custom implant designed based on patient-specific anatomy can offer the patient the best available implant solution. Currently, there is a growing trend toward personalization of medical implants involving additive manufacturing into orthopedic medical implants' manufacturing. METHODS: This article introduces a systematic design methodology of femoral stem prosthesis based on patient's computer tomography data. Finite element analysis is used to evaluate and compare the micromotion and stress distribution of the customized femoral component and a conventional stem. RESULTS: The proposed customized femoral stem achieved close geometrical fit and fill between femoral canal and stem surfaces. The customized stem demonstrated lower micromotion (peak: 21 µm) than conventional stem (peak: 34 µm). Stress results indicate up to 89% increase in load transfer by conventional stem than custom stem because the higher stiffness of patient-specific femoral stem proximally increases the custom stem shielding in Gruen's zone 7. Moreover, patient-specific femoral stem transfers the load widely in metaphyseal region. CONCLUSION: The customized femoral stem presented satisfactory results related to primary stability, but compromising proximo-medial load transfer due to increased stem cross-sectional area increased stem stiffness.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Prótesis de Cadera , Artroplastia de Reemplazo de Cadera/métodos , Fémur/cirugía , Análisis de Elementos Finitos , Prótesis de Cadera/clasificación , Prótesis de Cadera/normas , Humanos , Diseño de Prótesis , Estrés Mecánico
6.
Medicine (Baltimore) ; 97(39): e12560, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30278556

RESUMEN

INTRODUCTION: Current total hip arthroplasty (THA) implant usage trends favor cementless fixation, and plenty studies have demonstrated that numbers of cementless femoral stems are associated with excellent long-term survivorship and functional outcomes. Various types of cementless femoral stems have been developed and utilized in multiple applications, including straight, tapered, anatomic, customized, short, and even neck stems. All of these designs aimed to achieve maximal primary stability and promote osseointegration. Nevertheless, stress-shielding and periprosthetic bone loss continue to occur and remain critical issues in promoting long-term survivorship of THA. Considering anatomic and tapered stems are the most popular cementless designs today, this prospective cohort study aimed to investigate the effect of stem design on stress-shielding and periprosthetic bone remodeling after implantation of an anatomic stem with proximal fixation (Ribbed Hip system; Waldemar Link, Hamburg, Germany) and the direct comparison to a fully coated tapered stem (LCU Hip system; Waldemar Link). MATERIALS AND METHODS: This prospective cohort study will comprise patients who receive primary unilateral THA with the Ribbed anatomic hydroxyapatite (HA)-coated stem or LCU tapered fully HA-coated stem. The changes in periprosthetic bone mineral density after insertion of Ribbed and LCU stem prostheses will be assessed by means of dual-energy X-ray absorptiometry in the periprosthetic region of interest according to Gruen and colleagues. Standard anteroposterior and lateral plain radiography will be performed for qualitative assessment of the periprosthetic bone remodeling. The following items will be analyzed or measured on follow-up radiographs to compare with the initial appearance on the radiographs taken immediately postoperatively: cortical thickness in each Gruen zone, fitness of the distal stem within the isthmus, femoral stem alignment, radiolucent line, reactive line, periosteal bone reactions, and subsidence. Biologic fixation and stability of the cementless implant will be evaluated using Engh grading scale, and heterotopic ossification will be graded according to Brooker classification. Furthermore, Harris hip score and Western Ontario and McMaster Universities Osteoarthritis Index Score will also be assessed for postoperative functional evaluation. These radiologic and clinical assessments will be taken postoperatively, at 6 months, 1, 2, 3, 4, and 5 years after surgery. ETHICS AND DISSEMINATION: This study was approved by The First Affiliated Hospital of Chongqing Medical University Ethics Committee. The study results will be disseminated at national and international conferences and published in peer-reviewed journals. STUDY REGISTRATION: Chinese Clinical Trial Registry (http://www.chictr.org.cn): ChiCTR1800017841.


Asunto(s)
Cuidados Posteriores , Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Absorciometría de Fotón/métodos , Cuidados Posteriores/métodos , Cuidados Posteriores/organización & administración , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Cadera/rehabilitación , Densidad Ósea , Remodelación Ósea , China , Investigación sobre la Eficacia Comparativa , Femenino , Prótesis de Cadera/efectos adversos , Prótesis de Cadera/clasificación , Prótesis de Cadera/normas , Humanos , Masculino , Oseointegración , Diseño de Prótesis
7.
Acta Chir Orthop Traumatol Cech ; 85(3): 179-185, 2018.
Artículo en Checo | MEDLINE | ID: mdl-30257776

RESUMEN

PURPOSE OF THE STUDY The purpose of the study is a retrospective comparison of results of the two-stage revision total hip arthroplasty using a non-articulating and an articulating spacer to treat periprosthetic joint infection (PJI). Two basic hypotheses are evaluated: (1) the clinical outcomes of the patients treated with "hand made" articulating cement spacer are better than in non-articulating patient's group in two-stage revision for PJI of the total hip arthroplasty and (2) PJI recurrence is higher in the group of patients treated with an articulating spacer group. MATERIAL AND METHODS The evaluated group consists of a total of 57 patients (23 women, 34 men) with the mean age of 61.2 years. Group A of 39 patients were treated by two-stage revision using the "hand-made" articulating cement spacer and Group B of 18 patients were treated using the non-articulating spacer. Both the groups were evaluated retrospectively in the reference period: preoperatively and two years after the surgery using the Harris Hip Score (HHS) clinical assessment. The revision surgery for acute and chronic complications of treatment, length of hospitalization, and the PJI recurrence were evaluated for both the groups. RESULTS The resulting HHS clinical reviews were pre-operatively 43.59 points in both the groups with postoperative improvement up to 81.74 points. The mean preoperative HHS scores were 41.67 points (Group A) and 47.77 points (Group B) and two years after the surgery they were 83.43 points (Group A) and 78.08 points (Group B) (two-tailed t-test, p-value = 0.042). In Group A a total of seven revisions were performed in the interval between the two-stage revision (4x recurrent dislocation, 2x persistent infection, 1x spacer fracture). In Group B one patient was revised for persistent infection. In the two-year period after the operation, a relapse of PJI was recorded in 5 patients in Group A (12.8%) and in 1 patient in Group B (5.6%) (Chi-square test, p-value = 0.41). The average time of hospitalization was 51.58 days, whereby 49.72 days and 55.61 days on average for Group A and B respectively (p-value = 0.53). DISCUSSION According to recent studies, the advantage of motion preservation in articulating cement spacers can be complicated by recurrent dislocations, implant migration, periprosthetic fractures or recurrent joint replacement infections, which can further prolong the treatment and worsen the final clinical results. An alternative treatment option is the application of a nonarticulating spacer maintaining the advantage of local administration of antibiotics and reducing the dead space formed by the infected implant removal. Discussed is mainly the choice of the method in case of muscle disorder or presence of segmental bone defects. CONCLUSIONS The results demonstrate the better clinical outcomes and the higher revision rate of patients with an articulating cement spacer in two stage revision. We didn't find any differences between the risk of PJI recurrence in both groups. Key words:periprosthetic infection, total hip replacement, cement spacer, two stage revision, articulating spacer, nonarticulating spacer.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Infecciones Relacionadas con Prótesis , Reoperación , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Femenino , Prótesis de Cadera/efectos adversos , Prótesis de Cadera/clasificación , Humanos , Masculino , Persona de Mediana Edad , Gravedad del Paciente , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/etiología , Recurrencia , Reoperación/métodos , Reoperación/estadística & datos numéricos , Factores de Riesgo
8.
Rev. Soc. Andal. Traumatol. Ortop. (Ed. impr.) ; 35(3): 19-28, jul.-sept. 2018. ilus, tab
Artículo en Español | IBECS | ID: ibc-175468

RESUMEN

Objetivo: Evaluar la incidencia de complicaciones y la calidad de vida tras la cirugía en dos grupos de pacientes sometidos a artroplastia total de cadera no cementadas con vástagos corto y con vástagos estándar. Material y Métodos: Se realiza un estudio retrospectivo sobre un total de 106 artroplastias total de cadera implantadas en el Hospital Universitario de Puerto Real entre 2011 y 2015. Se comparan las siguientes variables: estancia hospitalaria, necesidad de transfusión sanguínea, complicaciones mecánicas, necesidad de revisión por cualquier causa, parámetros radiológicos (reabsorción del calcar, hundimiento, dismetría postquirúrgica, metría de cuello remanente) y dolor en cara anterior de muslo en dos grupos homogéneos de 63 vástagos convencionales anatómicos no cementados con 43 vástagos cortos de estabilización metafisaria y preservación parcial del cuello femoral ("partial collum"), implantadas por un mismo cirujano. Para el análisis estadístico se utilizó la T de Student para el análisis de variables cuantitativas y Chi cuadrado para variables cualitativas. Resultados: Los resultados muestran diferencias estadísticamente significativas (p< 0.05) en cuanto a variables estancia hospitalaria postquirúrgica, fracturas periprotésicas, dismetría, complicaciones mecánicas y metría del cuello remanente. Conclusiones: Los resultados avalan el empleo de vástagos cortos de estabilización metafisaria y preservación parcial del cuello femoral en pacientes jóvenes con adecuada calidad ósea y bien seleccionados, dadas las ventajas clínicas que suponen


Objetives: To evaluate the incidence of complications and the quality of life after surgery in two groups of patients undergoing total hip arthroplasty not cemented with a short stem and with a standard uncemented stem. Material and Methods: A retrospective study was performed in a total of 106 total hip arthroplasties implanted in the University Hospital of Puerto Real between 2011 and 2015. The following variables are compared: hospital stay, need for blood transfusion, mechanical complications, need for revision for any reason , radiological parameters (calcar resorption, subsidence, postsurgical dysmetria, remnant neck metrics) and anterior thigh pain in two homoge-nous groups of 63 conventional uncemented anatomical stems with 43 short stems of metaphyseal stabilization and partial femoral neck preservation ("Partial collum"), implanted by the same surgeon. For the statistical analysis, T Student was used for the analysis of quantitative variables and Chi-square for qualitative variables. Results: The results show statistically significant differences (p < 0.05) in terms of postsurgical hospital stay variables, periprosthetic fractures, dysmetria, mechanical complications and metrics of the remaining neck. Conclusions: The results support the use of short stems of metaphyseal stabilization and preservation of the greater trochanter in young patients with adequate bone quality given the clinical advantages they imply


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Calidad de Vida , Resorción Ósea/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Artroplastia de Reemplazo de Cadera/instrumentación , Prótesis de Cadera/clasificación , Estudios Retrospectivos , Tiempo de Internación , Transfusión Sanguínea , Resorción Ósea/cirugía , Prótesis de Cadera
9.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 62(2): 142-152, mar.-abr. 2018. ilus
Artículo en Español | IBECS | ID: ibc-171626

RESUMEN

Los malos resultados obtenidos en pacientes jóvenes cuando se utiliza una prótesis convencional fueron la causa que motivó el resurgir de las prótesis de superficie, en un intento de buscar implantes menos invasivos para el hueso. Los pacientes jóvenes presentan una demanda de actividad adicional, lo cual los convierte en un serio reto para la supervivencia de los implantes. Además, las nuevas tecnologías de la información contribuyen de forma determinante a la preferencia de prótesis no cementadas. Mantener la calidad de vida, preservar el hueso y las partes blandas, así como conseguir un implante muy estable, son los objetivos que todo cirujano ortopédico de cadera persigue para este tipo de pacientes. Los resultados en investigación apuntan hacia el uso de prótesis de menor tamaño, que utilicen más la zona metafisaria y menos la diafisaria, dando lugar al extenso capítulo de las mencionadas prótesis de vástago corto. Ambos modelos tienen su principal indicación en el adulto joven. Su revisión debería ser una cirugía más sencilla pero este hecho solo se cumple para las prótesis de superficie, no así para los vástagos cortos (AU)


The poor results obtained in young patients when using a conventional prosthesis led to the resurgence of hip resurfacing to find less invasive implants for the bone. Young patients present a demand for additional activity, which makes them a serious challenge for the survival of implants. In addition, new information technologies contribute decisively to the preference for non-cemented prostheses. Maintaining quality of life, preserving the bone and soft tissues, as well as achieving a very stable implant, are the goals of every hip orthopaedic surgeon for these patients. The results in research point to the use of smaller prostheses, which use the metaphyseal zone more and less the diaphyseal zone, and hence the large number of the abovementioned short stem prostheses. Both models are principally indicated in the young adult. Their revision should be a more simple operation, but this is only true for hip resurfacing, not for short stems (AU)


Asunto(s)
Humanos , Adulto , Osteoartritis de la Cadera/cirugía , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Prótesis de Cadera/clasificación , Insuficiencia del Tratamiento , Resultado del Tratamiento , Recuperación de la Función , Acetábulo/anatomía & histología
10.
Z Orthop Unfall ; 155(1): 52-60, 2017 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-27716867

RESUMEN

Background: In total hip arthroplasty (THA), femoral head diameter has not been regarded as a key parameter which should be restored when reconstructing joint biomechanics and geometry. Apart from the controversial discussion on the advantages and disadvantages of using larger diameter heads, their higher cost is another important reason that they have only been used to a limited extent. The goal of this study was to analyse the price structure of prosthetic heads in comparison to other components used in THA. A large group of patients with hip endoprostheses were evaluated with respect to the implanted socket diameter and thus the theoretically attainable head diameter. Materials and Methods: The relative prices of various THA components (cups, inserts, stems and ball heads) distributed by two leading German manufacturers were determined and analysed. Special attention was paid to different sizes and varieties in a series of components. A large patient population treated with THA was evaluated with respect to the implanted cup diameter and therefore the theoretically attainable head diameter. Results: The pricing analysis of the THA components of two manufacturers showed identical prices for cups, inserts and stems in a series. In contrast to this, the prices for prosthetic heads with a diameter of 36-44 mm were 11-50 % higher than for 28 mm heads. Identical prices for larger heads were the exception. The distribution of the head diameter in 2719 THA cases showed significant differences between the actually implanted and the theoretically attainable heads. Conclusion: There are proven advantages in using larger diameter ball heads in THA and the remaining problems can be solved. It is therefore desirable to correct the current pricing practice of charging higher prices for larger components. Instead, identical prices should be charged for all head diameters in a series, as is currently established practice for all other THA components. Thus when reconstructing biomechanics and joint geometry in THA, it should be possible to recover not only leg length, femoral offset and antetorsion of the femoral neck, but also to approximately restore the diameter of the femoral head and thereby optimise the functional outcome.


Asunto(s)
Artroplastia de Reemplazo de Cadera/economía , Artroplastia de Reemplazo de Cadera/instrumentación , Análisis Costo-Beneficio/economía , Costos de la Atención en Salud/estadística & datos numéricos , Luxación de la Cadera/economía , Luxación de la Cadera/prevención & control , Prótesis de Cadera/economía , Simulación por Computador , Análisis Costo-Beneficio/métodos , Análisis de Falla de Equipo , Alemania/epidemiología , Prótesis de Cadera/clasificación , Prótesis de Cadera/estadística & datos numéricos , Humanos , Modelos Económicos , Diseño de Prótesis , Ajuste de Prótesis/economía , Reoperación/economía , Reoperación/estadística & datos numéricos
11.
Eur J Orthop Surg Traumatol ; 27(2): 147-156, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-27900474

RESUMEN

In recent years, with the higher median life expectancy, the number of hip and knee replacements has increased. Clinical examination and morphological studies are essential to evaluate patients with a painful arthroplasty. Nuclear medicine examinations also play an important role, their main usefulness being the exclusion of prosthesis complications. Nevertheless, conventional examinations, namely bone scan and white blood cell scintigraphy, can also identify complications, such as loosening and infection. This study describes the normal and pathologic patterns of a bone scan and exemplifies ten common situations that can cause pain in patients with hip or knee arthroplasty, other than loosening and infection, which can be disclosed on a bone scintigraphy. The ten situations that should be considered and looked for when analysing a bone scan are: referred pain, patellofemoral pain syndrome, fractures, fissures, abscess/haematoma, bone insert behaviour, heterotopic ossification, greater trochanter pseudarthrosis, osteoarthritis extension in a knee with an unicompartmental prosthesis, and systemic disease with bone involvement.


Asunto(s)
Prótesis de Cadera/efectos adversos , Prótesis de la Rodilla/efectos adversos , Dolor Postoperatorio/etiología , Absceso/diagnóstico por imagen , Absceso/etiología , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Neoplasias Óseas/complicaciones , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Sustitutos de Huesos/efectos adversos , Hematoma/diagnóstico por imagen , Hematoma/etiología , Prótesis de Cadera/clasificación , Humanos , Osificación Heterotópica/complicaciones , Osificación Heterotópica/diagnóstico por imagen , Osteoartritis de la Rodilla/complicaciones , Osteoartritis de la Rodilla/diagnóstico por imagen , Dolor Postoperatorio/diagnóstico por imagen , Dolor Referido/diagnóstico por imagen , Dolor Referido/etiología , Síndrome de Dolor Patelofemoral/diagnóstico por imagen , Síndrome de Dolor Patelofemoral/etiología , Fracturas Periprotésicas/complicaciones , Fracturas Periprotésicas/diagnóstico por imagen , Falla de Prótesis/efectos adversos , Infecciones Relacionadas con Prótesis/complicaciones , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Seudoartrosis/complicaciones , Seudoartrosis/diagnóstico por imagen , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único/métodos
12.
Rev. andal. med. deporte ; 9(1): 23-28, mar. 2016. graf
Artículo en Portugués | IBECS | ID: ibc-149386

RESUMEN

Objetivo. Comparar os efeitos do programa escola de postura (PEP) e reeducação postural global (RPG) sobre níveis de dor e amplitude de movimento em pacientes com lombalgia crônica. Método. A amostra foi dividida em 3 grupos de 10 sujeitos: grupo submetido ao tratamento através do PEP (idade: 46.30 ± 8.50 anos); grupo submetido ao tratamento através da RPG (idade: 43.60 ± 10.93 anos) e grupo controle (idade: 44.30 ± 10.68 anos). As intervenções foram realizadas em 10 sessões. Para avaliação do quadro álgico foi utilizada a escala subjetiva de dor CR10 de Borg. Para a análise da amplitude de movimento empregou‐se o protocolo de goniometria LABIFIE para os movimentos de extensão coxofemoral (ECF) e flexão da coluna lombar (FCL). Resultados. O teste de Wilcoxon mostrou uma redução nos escores dos níveis de dor nos grupos PEP e RPG (p < 0.0001) do pré para o pós‐tratamento. As comparações intergrupos, através do teste de Kruskal‐Wallis, apresentaram diminuição dos níveis de dor para o PEP (p < 0.0001) e o RPG (p < 0.0001) quando comparados ao CG no pós‐tratamento. A ANOVA com medidas repetidas revelou um aumento na amplitude do movimento para o PEP (ECF: p = 0.006; FCL: p = 0.002) e RPG (ECF: p = 0.034; FCL: p = 0.011) do pré para o pós‐tratamento. As comparações intergrupos apresentaram maiores amplitudes de movimento para o PEP (ECF: p = 0.006; FCL: p = 0.018) e RPG (EQ: p = 0.019; FCL: p = 0.020) quando comparados ao CG no pós‐tratamento. Não houve diferenças significativas entre o PEP e RPG. Conclusão. Os tratamentos PEP e RPG se mostraram eficientes para redução da lombalgia crónica (AU)


Objetivo. Comparar los efectos de un programa de escuela de postura (PEP) y reeducación postural global (RPG) individual sobre niveles de dolor y rango de movimiento en pacientes con dolor lumbar crónico. Método. La muestra se dividió en 3 grupos de 10 sujetos: grupo tratado por PEP (edad: 46.30 ± 8.50 años), grupo tratado por RPG (edad: 43.60 ± 10.93 años) y grupo control (edad: 44.30 ± 10.68 años). Las intervenciones se llevaron a cabo en 10 sesiones. Para la evaluación del dolor se utilizó la escala subjetiva del dolor CR10 Borg. Para el análisis de rango de movimiento, se utilizó el protocolo de goniometría en los movimientos de extensión de la cadera (EC) y flexión de la columna lumbar (FCL). Resultados. La prueba de Wilcoxon mostró una reducción en los niveles de dolor en los grupos de PEP y RPG (p < 0.0001). Las comparaciones entre los grupos mediante el test de Kruskal‐Wallis mostró disminución de los niveles de dolor para el PEP (p < 0.0001) y RPG (p < 0.0001) en comparación con CG después del tratamiento. El ANOVA con medidas repetidas reveló un aumento en rango de movimiento para el PEP (EC: p = 0.006; FCL: p = 0.002) y RPG (EC: p = 0.034; FCL: p = 0.011). Las comparaciones entre los grupos mostraron un mayor rango de movimiento para el PEP (EC: p = 0.006; FCL: p = 0.018) y RPG (EC: p = 0.019; FCL: p = 0.020) en comparación con el GC después del tratamiento. No hubo diferencias significativas entre el PEP y RPG. Conclusión. Los tratamientos de PEP y RPG fueron eficaces para reducir el dolor lumbar crônico (AU)


Objective. To compare the effects of school‐based exercise program of posture (SPP) and global postural reeducation (GPR) on pain levels and range of motion in patients with chronic low back pain. Method. The sample was divided into three groups of 10 subjects: group treated by SPP (age: 46.30 ± 8.50 years) group subjected to treatment by GPR (age: 43.60 ± 10.93 years) and control group (age: 44.30 ± 10.68 years). The interventions were performed in 10 sessions. For assessment of pain was used pain subjective scale CR10‐Borg. For the analysis of range of motion, we used the protocol to goniometry LABIFIE in the movements of hip extension (HE) and flexion of the lumbar spine (FLS). Results. The Wilcoxon test showed a reduction in levels of pain scores in groups SPP and GPR (p < 0.0001) of pre to post‐treatment. Comparisons between groups by the Kruskal‐Wallis test showed decreased levels of pain for SPP (p < 0.0001) and GPR (p < 0.0001) when compared to CG post‐treatment. Repeated measures ANOVA revealed an increase in range of motion for the SPP (HE: p = 0.006; FLS: p = 0.002) and GPR (HE: p = 0.034; FLS: p = 0.011) of pre to post‐treatment. Comparisons between groups showed greater range of motion for the SPP (HE: p = 0.006; FLS: p = 0.018) and GPR (HE: p = 0.019; FLS: p = 0.020) when compared to CG post‐treatment. There were no significant differences between the SPP and GPR. Conclusions. SPP and GPR treatments were effective for reducing chronic low back pain (AU)


Asunto(s)
Humanos , Masculino , Femenino , Educación Primaria y Secundaria , Dolor de la Región Lumbar/complicaciones , Dolor de la Región Lumbar/patología , Artrometría Articular/instrumentación , Artrometría Articular/métodos , Prótesis de Cadera/clasificación , Estadísticas no Paramétricas , Terapéutica/métodos , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/metabolismo , Artrometría Articular/normas , Artrometría Articular , Prótesis de Cadera/normas , Terapéutica/instrumentación , Análisis de Varianza
13.
Orthopedics ; 38(3 Suppl): S6-13, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25826635

RESUMEN

Various short hip stems have been introduced with differing implant concepts of femoral fixation and implant length. There is a lack of proper classification for short hip stems, with a clear and accepted definition for implant length and extent of bone preservation in the metaphyseal and diaphyseal femur. This study analyzed the length of short hip stems. Stems were divided into collum, partial collum, and trochanter-sparing implants. An additional category was added, trochanter harming, which was defined as interruption of the circumferential integrity of the femoral neck. For all of the femoral components described, the designs were compared, excluding stems with insufficient clinical data. The 15 finally selected stems were classified as collum (1 stem), partial collum (7 stems), trochanter sparing (4 stems), and trochanter harming (3 stems). Mid-term results (>5 years of follow-up) were available for only 3 designs in the partial collum group. Taking into account the results of short-term studies (<5 years of follow-up), the femoral revision rate per 100 observed component years was <1 for most total hip arthroplasties. However, the studies varied greatly regarding level of significance, and short hip stems without published results are available commercially. Short hip stems cannot be circumscribed by a simple length limit. For some designs, clinical data collected from large patient cohorts showed a survivorship comparable to traditional stems. In cases that must be revised, this often can be performed with a conventional primary stem, fulfilling the promise to preserve bone for potential future revisions in younger patients.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera/clasificación , Osteoartritis de la Cadera/cirugía , Humanos , Diseño de Prótesis , Resultado del Tratamiento
15.
J Bone Joint Surg Am ; 97(5): 359-66, 2015 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-25740025

RESUMEN

BACKGROUND: The survivorship of implants after revision total hip arthroplasty and risk factors associated with re-revision are not well defined. We evaluated the re-revision rate with use of the institutional total joint replacement registry. The purpose of this study was to determine patient, implant, and surgeon factors associated with re-revision total hip arthroplasty. METHODS: A retrospective cohort study was conducted. The total joint replacement registry was used to identify patients who had undergone revision total hip arthroplasty for aseptic reasons from April 1, 2001, to December 31, 2010. The end point of interest was re-revision total hip arthroplasty. Risk factors evaluated for re-revision total hip arthroplasty included: patient risk factors (age, sex, body mass index, race, and general health status), implant risk factors (fixation type, bearing surface, femoral head size, and component replacement), and surgeon risk factors (volume and experience). A multivariable Cox proportional hazards model was used. RESULTS: Six hundred and twenty-nine revision total hip arthroplasties with sixty-three (10%) re-revisions were evaluated. The mean cohort age (and standard deviation) was 57.0 ± 12.4 years, the mean body mass index (and standard deviation) was 29.5 ± 6.1 kg/m(2), and most of the patients were women (64.5%) and white (81.9%) and had an American Society of Anesthesiologists score of <3 (52.9%). The five-year implant survival after revision total hip arthroplasty was 86.8% (95% confidence interval, 83.57% to 90.25%). In adjusted models, age, total number of revision surgical procedures performed by the surgeon, fixation, and bearing surface were associated with the risk of re-revision. For every ten-year increase in patient age, the hazard ratio for re-revision decreases by a factor of 0.72 (95% confidence interval, 0.58 to 0.90). For every five revision surgical procedures performed by a surgeon, the risk of revision decreases by a factor of 0.93 (95% confidence interval, 0.86 to 0.99). At the time of revision, a new or retained cemented femoral implant or all-cemented hip implant increases the risk of revision by a factor of 3.19 (95% confidence interval, 1.22 to 8.38) relative to a retained or new uncemented hip implant. A ceramic on a highly cross-linked polyethylene bearing articulation decreases the hazard relative to metal on highly cross-linked polyethylene by a factor of 0.32 (95% confidence interval, 0.11 to 0.95). Metal on constrained bearing increases the hazard relative to metal on highly cross-linked polyethylene by a factor of 3.32 (95% confidence interval, 1.16 to 9.48). CONCLUSIONS: When evaluating patient, implant, and surgical factors at the time of revision total hip arthroplasty, age, surgeon experience, implant fixation, and bearing surfaces had significant impacts on the risk of re-revision.


Asunto(s)
Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Prótesis de Cadera/clasificación , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Diseño de Prótesis , Falla de Prótesis , Sistema de Registros , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos
16.
J Bone Joint Surg Am ; 97(4): e20, 2015 Feb 18.
Artículo en Inglés | MEDLINE | ID: mdl-25695991

RESUMEN

BACKGROUND: Over one million patients worldwide are estimated to have a metal-on-metal hip arthroplasty. To improve the management of these patients and reduce surgeon uncertainty regarding decision-making, we designed an Internet-enhanced multidisciplinary team (iMDT) working approach. METHODS: From August 2012 to April 2014, the iMDT discussed 215 patients with 266 metal-on-metal hip arthroplasties. Of these, 236 primary arthroplasties (132 hip resurfacing and 104 total hip) were analyzed. The remaining thirty cases involved problematic revised hips and were therefore excluded. The possible recommendations of the iMDT were monitoring, further investigation, or surgery. The concordance between the recommendation and the actual management was used to assess the usefulness of this approach in reducing uncertainty in surgeon-level decision-making. RESULTS: The median Oxford Hip Score was 35 (range, 4 to 48), and median cobalt and chromium levels in whole blood were 3.54 ppb (range, 0.18 to 161.46 ppb) and 3.17 ppb (range, 0.20 to 100.67 ppb), respectively. Magnetic resonance imaging revealed abductor muscle atrophy in ninety-two (39%) of the hips and a pseudotumor in eighty (34%). The iMDT recommended monitoring of 146 (61.9%) of the hips, further investigation of thirty (12.7%), and surgery in sixty (25.4%). The actual outcome was concordant with the recommendation in 211 (91.7%) of the hips. CONCLUSIONS: Our iMDT approach to the metal-on-metal hip burden combines the tacit knowledge of an expert panel, regulatory guidance, and up-to-date evidence to improve decision-making among surgeons. The high level of concordance between the recommendation and the actual outcome, combined with the feasibility of the methods used, suggest that this method effectively reduces uncertainty among surgeons and may lead to improved patient outcomes.


Asunto(s)
Análisis de Falla de Equipo/métodos , Prótesis de Cadera/clasificación , Comunicación Interdisciplinaria , Internet , Grupo de Atención al Paciente/organización & administración , Medios de Comunicación Sociales/organización & administración , Atrofia/diagnóstico , Cromo/sangre , Cobalto/sangre , Diagnóstico Diferencial , Humanos , Artropatías/complicaciones , Artropatías/diagnóstico , Imagen por Resonancia Magnética , Músculo Esquelético/patología , Diseño de Prótesis , Falla de Prótesis/etiología , Medición de Riesgo , Reino Unido
17.
Ned Tijdschr Geneeskd ; 160: A9532, 2015.
Artículo en Holandés | MEDLINE | ID: mdl-27007926

RESUMEN

OBJECTIVE: To determine the effect of an evidence-based classification list on use of total hip prostheses of proven quality in the Netherlands. DESIGN: Observational study. METHOD: The Netherlands Orthopaedic Association (NOV) drew up a classification list for total hip prostheses in 2013. This classification list considered total hip prostheses to be of proven quality when the average percent of revision was ≤ 10% after 10 years of follow-up (category 1A) or ≤ 5% after 5 years of follow-up (category 1B). Data from the Dutch National Orthopaedic Implant Registry Register (LROI) were used to determine the effect of the classification list on the use of hip prostheses of proven quality in the Netherlands. All patients, operations and prosthesis characteristics of the hip prostheses used in the Netherlands were registered in the LROI. We selected details of all interventions in which a hip prosthesis was implanted in patients with 'osteoarthritis' as primary diagnosis between 2012 and 2014 from the LROI. The prostheses could be classified as 1A, 1B or 'not 1A or 1B' by means of the implant code of the acetabular and femoral components. We took 2012 as the reference year. RESULTS: In the reference year, 84% of the acetabular components and 94% of the femoral components were category 1A or 1B. In 2013 these percentages had increased to 89% and 95%, respectively; in 2014 the percentages had increased to 92% and 97%. CONCLUSION: After implementation of the NOV classification list there was an increase in the percentage of total hip prostheses of proven quality, which means that patient care has become better and safer.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Medicina Basada en la Evidencia , Prótesis de Cadera/clasificación , Prótesis de Cadera/normas , Acetábulo , Artroplastia de Reemplazo de Cadera/normas , Humanos , Países Bajos , Sistema de Registros , Reoperación
18.
J Bone Joint Surg Am ; 96(20): 1742-52, 2014 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-25320202

RESUMEN

➤ Short bone-conserving femoral stems in total hip arthroplasty were designed to preserve proximal bone stock.➤ Given the distinct fixation principles and location of loading among these bone-conserving stems, a classification system is essential to compare clinical outcomes.➤ Due to the low quality of currently available evidence, only a weak recommendation can be provided for clinical usage of certain stem designs, while some other designs cannot be recommended at this time.➤ A high prevalence of stem malalignment, incorrect sizing, subsidence, and intraoperative fractures has been reported in a subset of these short stem designs.➤ Stronger evidence, including prospective multicenter randomized trials comparing standard stems with these newer designs, is necessary before widespread use can be recommended.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Articulación de la Cadera , Prótesis de Cadera/clasificación , Artropatías/cirugía , Humanos , Diseño de Prótesis
19.
Orthopade ; 43(8): 783-95; quiz 796, 2014 Aug.
Artículo en Alemán | MEDLINE | ID: mdl-25116246

RESUMEN

The short stem designs currently available are significantly different and can be differentiated into neck containing, partial containing and neck resection designs. In this article, the differences in the design features are presented. These include the differences in the technique of implantation, the significant differences in the reproducibility of the given anatomy of the patient and also concerning their osteologic competence.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/métodos , Articulación de la Cadera/cirugía , Prótesis de Cadera/clasificación , Inestabilidad de la Articulación/cirugía , Evaluación de la Tecnología Biomédica , Diseño de Equipo , Análisis de Falla de Equipo , Humanos
20.
Hip Int ; 24(6): 587-95, 2014 Dec 05.
Artículo en Inglés | MEDLINE | ID: mdl-25096452

RESUMEN

Polyethylene (PE) wear and osteolysis is a recognised problem with non-cross linked PE liners and first generation modular cup designs. Wear particles induce osteolysis leading to aseptic loosening. We retrospectively compared the linear PE wear and implant survival and revision rates of the Reflection Cup and the Duraloc 300. After a mean clinical follow-up of 13 years (range 11-15 years), the 2D linear PE wear-rate of the Reflection liner (n = 68) was 0.23 mm/year, with a mean total wear of 3.14 mm (1.04-7.36), SD 1.45. The wear-rate of the Duraloc 300 cups (n = 32) was 0.14 mm/year, with a mean total wear of 1.84 mm (0.55-4.63), SD 1.07. The difference in PE wear-rate as well as mean total wear was highly significant (p = 0.0001). There was a positive correlation between wear-rate and both Oxford Hip Score and Harris Hip Score (p = 0.02). Large acetabular cup size (>54 mm), HA coating on the stem and age <50 years did not influence PE wear. The higher wear-rate in the Reflection liners could be related to the EtO sterilisation. Intermediate and long-term follow-up is advisable.


Asunto(s)
Prótesis de Cadera , Polietilenos , Falla de Prótesis , Adulto , Anciano , Cromo , Cobalto , Desinfectantes , Óxido de Etileno , Femenino , Estudios de Seguimiento , Prótesis de Cadera/clasificación , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Estudios Retrospectivos , Esterilización , Factores de Tiempo
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