Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 482
Filtrar
1.
Bone Joint J ; 102-B(1): 90-101, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31888362

RESUMEN

AIMS: The aim of this study was to identify the effect of the manufacturing characteristics of polyethylene acetabular liners on the survival of cementless and hybrid total hip arthroplasty (THA). METHODS: Prospective cohort study using linked National Joint Registry (NJR) and manufacturer data. The primary endpoint was revision for aseptic loosening. Cox proportional hazard regression was the primary analytical approach. Manufacturing variables included resin type, crosslinking radiation dose, terminal sterilization method, terminal sterilization radiation dose, stabilization treatment, total radiation dose, packaging, and face asymmetry. Total radiation dose was further divided into G1 (no radiation), G2 (> 0 Mrad to < 5 Mrad), G3 (≥ 5 Mrad to < 10 Mrad), and G4 (≥ 10 Mrad). RESULTS: A total of 5,329 THAs were revised, 1,290 of which were due to aseptic loosening. Total radiation dose, face asymmetry, and stabilization treatments were found to significantly affect implant survival. G1 had the highest revision risk for any reason and for aseptic loosening and G3 and G4 the lowest. Compared with G1, the adjusted hazard ratio for G2 was 0.74 (95% confidence interval (CI) 0.64 to 0.86), G3 was 0.36 (95% CI 0.30 to 0.43), and G4 was 0.38 (95% CI 0.31 to 0.47). The cumulative incidence of revision for aseptic loosening at 12 years was 0.52 and 0.54 per 100 THAs for G3 and G4, respectively, compared with 1.95 per 100 THAs in G1. Asymmetrical liners had a lower revision risk due to aseptic loosening and reasons other than aseptic loosening compared with symmetric (flat) liners. In G3 and G4, stabilization with vitamin E and heating above melting point performed best. CONCLUSION: Polyethylene liners with a total radiation dose of ≥ 5 Mrad, an asymmetrical liner face, and stabilization with heating above the melting point demonstrate best survival. Cite this article: Bone Joint J 2020;102-B(1):90-101.


Asunto(s)
Artroplastia de Reemplazo de Cadera/normas , Prótesis de Cadera/normas , Polietileno , Adulto , Anciano , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Tecnología Biomédica , Femenino , Prótesis de Cadera/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Diseño de Prótesis/normas , Diseño de Prótesis/estadística & datos numéricos , Falla de Prótesis , Reoperación/estadística & datos numéricos , Factores de Riesgo
2.
J Orthop Surg Res ; 14(1): 279, 2019 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-31462276

RESUMEN

INTRODUCTION: In this study, we described a positioner which allows a combination of preoperative plan and intraoperative insertion of the cup to improve the reconstruction of the rotation center of the hip. MATERIALS AND METHODS: A retrospective study was conducted on 32 consecutive patients (group A) using this positioner and 40 consecutive patients (group B) using conventional method; radiological parameters and clinical measurements before operation and at last follow-up were collected and evaluated. RESULTS: Group A had a reconstructed center of rotation (COR) that was 0.19 mm closer to the anatomic COR in height (P < 0.005), compared with group B with 3.45 mm vertical dislocation. There were no statistically significant differences in the horizontal displacement between the two groups. The accuracy of cup inclination was 42.14 ± 3.57 in the group A and 38.73 ± 7.65 in the group B (P = 0.015). The accuracy of cup anteversion was 14.82 ± 1.44 in the group A and 13.08 ± 5.95 in the group B (P = 0.082). All cups in the group A were radiologically stable, while one cup in the group B was radiologically unstable and was successfully treated with second-stage revision. Both of the groups obtained a higher mean postoperative Harris Hip Score. CONCLUSIONS: Utilizing this positioner helps to restore the COR position more precisely and provides satisfactory radiological and clinical outcomes in the short term, and more studies are required before its widespread adoption for complicated cases.


Asunto(s)
Acetábulo/diagnóstico por imagen , Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/normas , Prótesis de Cadera/normas , Diseño de Prótesis/normas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
3.
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
4.
J Orthop Surg Res ; 14(1): 225, 2019 Jul 19.
Artículo en Inglés | MEDLINE | ID: mdl-31324195

RESUMEN

BACKGROUND: Several hydroxyapatite (HA)-coated femoral stems from a single manufacturer were identified to have aseptically loosened at mid-term follow-up despite prior radiographic appearance of osseointegration. Possible causes and associated risk factors for stem loosening were explored through radiographic review and implant retrieval analysis. METHODS: Forty-six retrieved hip stems (Corail, DePuy-Synthes) were identified and grouped by bearing type: metal-on-metal (MoM), metal-on-polyethylene, and ceramic-on-ceramic. Stem lucency was graded on post-operative radiographs up to the time of revision. Stems were examined for stripping of the HA coating, taper corrosion, and bearing wear in metal-on-metal cases. Patient demographics, implant design features, and perioperative data were collected from electronic databases and patient charts. RESULTS: Aseptic loosening occurred in 37% of cases examined. MoM bearings were associated with 7.25 times greater risk of loosening compared to other bearing types. Stem radiolucency was more prevalent for MoM cases and, although not statistically significant, demonstrated progressive lucency. Taper corrosion appeared more severe for MoM cases and correlated with proximal stem radiolucency. Removal of the HA coating from the stems was associated with both taper corrosion and MoM bearing wear. Length of implantation was a confounding factor for the MoM cases. CONCLUSION: This study has demonstrated a high risk of mid-term loosening of previously osseointegrated HA-coated femoral stems when paired with a MoM bearing. The mechanism of loosening appears progressive in nature and related to the MoM bearing, possibly interacting with the HA coating. If such loosening is recognized early, rapid revision may allow for retention of the femoral stem.


Asunto(s)
Durapatita/normas , Análisis de Falla de Equipo/normas , Fémur/cirugía , Prótesis de Cadera/normas , Prótesis Articulares de Metal sobre Metal/normas , Falla de Prótesis , Adulto , Anciano , Anciano de 80 o más Años , Durapatita/efectos adversos , Análisis de Falla de Equipo/métodos , Femenino , Estudios de Seguimiento , Prótesis de Cadera/efectos adversos , Humanos , Masculino , Prótesis Articulares de Metal sobre Metal/efectos adversos , Persona de Mediana Edad , Diseño de Prótesis/efectos adversos , Diseño de Prótesis/normas , Falla de Prótesis/efectos adversos , Estudios Retrospectivos
5.
Surg Technol Int ; 35: 295-300, 2019 Nov 10.
Artículo en Inglés | MEDLINE | ID: mdl-31087320

RESUMEN

BACKGROUND: In revision total hip arthroplasty (THA), modular femoral components aid the surgeon in reconstructing joints compromised by loss of bone and soft-tissue integrity, providing customization to address bony deficits, deformity, limb length, and offset challenges. The purpose of this study was to review the survival and outcomes at minimum five-year follow up of patients who underwent revision THA at our center with a single modular femoral revision hip system offering a wide range of proximal body and distal stem geometries and sizing options. MATERIALS AND METHODS: A query of our practice arthroplasty registry revealed 66 consented patients (69 hips) who underwent revision THA using a modular femoral stem between December 2009 and July 2013 with minimum five-year follow up. There were 35 men (53%) and 31 women (47%). Mean age was 65.2 years (range, 36-87). Etiology for index revision was 32 aseptic loosening, 20 infection, nine periprosthetic fracture, three nonunion of internal fixation, three instability, one stem breakage, and one metal complication. RESULTS: Mean follow up was 6.3 years (range, 5-9). Harris Hip Scores improved from a mean of 45.4 preoperatively to 72.0 at most recent evaluations. There have been four re-revisions of the femoral stem: one infection, two periprosthetic femoral fracture, and one (proximal segment only) for instability. Radiographic assessment revealed satisfactory position, fixation, and alignment in all hips. Radiographic subsidence of 6-10mm occurred in four (none revised), and none had subsidence > 10mm. There were no modular junction failures. Kaplan-Meier survival to endpoint of femoral revision was 93.3% (95% CI ±3.3%) at 8.7 years. CONCLUSIONS: The minimum five-year results of this modular THA revision system are promising, with low rates of aseptic failure, minimal subsidence, and no modular junction failures. While there may be roles for the use of non-modular revision stems, the mid-term clinical results in this cohort of patients was found to be acceptable.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/mortalidad , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Femenino , Fémur , Estudios de Seguimiento , Prótesis de Cadera/normas , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Falla de Prótesis , Reoperación , Estudios Retrospectivos , Resultado del Tratamiento
6.
J Orthop Surg Res ; 14(1): 156, 2019 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-31133027

RESUMEN

BACKGROUND: An increased occurrence of cortical hypertrophy (CH) was observed 1-2 years after implanting short curved Fitmore hip stems. There are no published data about either the clinical relevance or the progression of CH over the long term. METHODS: Ninety-six primary total hip arthroplasties were performed between 2008 and 2010 using the Fitmore hip stem. Clinical and radiological parameters were recorded preoperatively and at 1, 2, 3, and 5 year follow-up. RESULTS: CH appeared mainly on antero-posterior radiographs in Gruen Zones 2, 3, 5, and 6. After 1 year, the diameter was 10 ± 2 mm and remained constant thereafter. The CH rate after 1 year was 69% and after 5 years 71%. Subsidence after 1 year was 1.6 ± 1.55 mm and 1.93 ± 1.72 mm after 5 years. Cortical thinning was 46% after 1 year and 56% after 5 years, mainly in Gruen Zones 7 and 8. In the first year radiolucencies were found in 51% in all Gruen Zones, and in 20% after 5 years. Patient, implant, and surgical factors did not correlate with radiological outcomes except that larger stems had more CH. After 5 years, the Harris Hip Score had improved from 59 to 94 and the Oxford Hip Score from 22 to 41. Radiographic parameters, notably CH, were not associated with clinical outcomes except that cortical thinning correlated with lower outcome scores. CONCLUSIONS: CH correlated neither with clinical outcome nor with patient, surgical or implant factors, except for a positive correlation with stem size. The Fitmore hip stems settled within the first year to a stable fixation and then remained almost unchanged. However, cortical thinning is common in Gruen Zone 7 and 8 meaning that there is stress-shielding.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/tendencias , Hueso Cortical/diagnóstico por imagen , Prótesis de Cadera/tendencias , Hiperostosis/diagnóstico por imagen , Diseño de Prótesis/tendencias , Anciano , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Prótesis de Cadera/normas , Humanos , Hiperostosis/etiología , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Diseño de Prótesis/normas
7.
J Orthop Surg Res ; 14(1): 154, 2019 May 24.
Artículo en Inglés | MEDLINE | ID: mdl-31126346

RESUMEN

BACKGROUND: The revision rate of articular surface replacement (ASR) implants continues to rise in China because of metal debris. However, there are few reports on the clinical results of ASR implants with prolonged follow-up time in China. This study investigated the clinical outcomes and the risk factors of revision surgery in patients with ASR implants. METHODS: In total, 74 patients (74 hips) who underwent primary total hip arthroplasty (THA) with ASR implants over the past 4 to 10 years were retrospectively analyzed. Relevant clinical, radiographic, and biochemical data were examined. RESULTS: The average follow-up time was 88.46 (range 23-114) months, and the ASR implants of 18 hips (24.3%) were revised. Patients who received revision surgery had worse joint function with significantly lower Harris Hip Score and Western Ontario and McMaster Universities index than non-revision patients (61.11 ± 6.68 vs 85.30 ± 9.16, p < 0.001; 61.00 ± 3.83 vs 79.04 ± 14.49, p < 0.001; respectively). Higher acetabular abduction angle and serum Co and Cr concentration were significantly relevant to worse joint function as measured by HSS (p = 0.018, 0.009, 0.043, respectively). ROC curve analysis was applied to categorize the optimal cutoff values of acetabular abduction angle and serum Cr and Co concentration for revision surgery, which were settled as 47.80°, 98.44 µg/L, and 6.95 µg/L, respectively. Overall survival of the prostheses with high acetabular abduction angle (> 47.80°, HR = 70.145, 95% CI 1.558-3158.213, p = 0.029), high serum Cr concentration (98.44 µg/L, HR = 58.956, 95% CI 1.294-2685.203, p = 0.036), and high serum Co concentration (> 6.95 µg/L, HR = 179.511, 95% CI 2.360-13656.941, p = 0.019) decreased significantly than the lower groups. CONCLUSIONS: Evaluation of the DePuy ASR XL articulation demonstrated increased rates of revision following a longer follow-up period. High acetabular abduction angle and serum Cr and Co concentration correlated with worse clinical outcomes and high revision rate. Therefore, we advocate that patients with DePuy ASR XL implants be followed up more closely than those with other implants, especially with high acetabular abduction angle and serum Cr or Co concentration.


Asunto(s)
Acetábulo/diagnóstico por imagen , Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/tendencias , Prótesis de Cadera/tendencias , Adulto , Anciano , Artroplastia de Reemplazo de Cadera/normas , China/epidemiología , Femenino , Estudios de Seguimiento , Prótesis de Cadera/normas , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , Resultado del Tratamiento
8.
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
9.
Acta Orthop ; 90(2): 135-142, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30739553

RESUMEN

Background and purpose - In total hip replacements, stem design may affect the occurrence of periprosthetic femoral fracture. We studied risk factors for fractures around and distal to the 2 most used cemented femoral stems in Sweden. Patients and methods - This is a register study including all standard primary Lubinus SPII and Exeter Polished stems operated in Sweden between 2001 and 2009. The outcome was any kind of reoperation due to fracture around (Vancouver type B) or distal to the stem (Vancouver type C), with use of age, sex, diagnosis at primary THR, and year of index operation as covariates in a Cox regression analysis. A separate analysis of the primary osteoarthritis patient group was done in order to evaluate eventual influence of the surgical approach (lateral versus posterior) on the risk for Vancouver type B fractures. Results - The Exeter stem had a 10-times (95% CI 7-13) higher risk for type B fractures, compared with the Lubinus, while no statistically significant difference was noticed for type C fractures. The elderly, and patients with hip fracture or idiopathic femoral head necrosis, had a higher risk for both fracture types. Inflammatory arthritis was a risk factor only for type C fractures. Type B fractures were more common in men, and type C in women. A lateral approach was associated with decreased risk for Type B fracture. Interpretation - Stem design influenced the risk for type B, but not for type C fracture. The influence of surgical approach on the risk for periprosthetic femoral fracture should be studied further.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Fracturas del Fémur , Necrosis de la Cabeza Femoral , Fijación Interna de Fracturas , Prótesis de Cadera , Fracturas Periprotésicas , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/métodos , Femenino , Fracturas del Fémur/epidemiología , Fracturas del Fémur/cirugía , Necrosis de la Cabeza Femoral/epidemiología , Necrosis de la Cabeza Femoral/cirugía , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/estadística & datos numéricos , Prótesis de Cadera/efectos adversos , Prótesis de Cadera/normas , Humanos , Masculino , Persona de Mediana Edad , Fracturas Periprotésicas/diagnóstico , Fracturas Periprotésicas/epidemiología , Fracturas Periprotésicas/etiología , Fracturas Periprotésicas/cirugía , Diseño de Prótesis , Sistema de Registros/estadística & datos numéricos , Reoperación/estadística & datos numéricos , Medición de Riesgo , Factores de Riesgo , Suecia/epidemiología
10.
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
11.
J Orthop Surg Res ; 13(1): 289, 2018 Nov 19.
Artículo en Inglés | MEDLINE | ID: mdl-30453985

RESUMEN

BACKGROUND: Lipped or elevated acetabular liners are frequently used in total hip arthroplasty to improve stability. However, the optimal position of the lip is not known. The purpose of this study was to determine the optimal position of lipped acetabular liners in total hip arthroplasty performed with a posterior approach. METHODS: In 14 hips, lipped trial liners were placed intraoperatively in various positions around the posterior clock-face of the implanted acetabular shell component. For each liner position, stability of the hip was tested at maximal hip flexion with gradually increasing internal rotation until subluxation occurred, at which point the position of the hip was measured using smartphone accelerometer-based goniometers. Smartphone goniometers were first validated against a computer-assisted navigation system. Post-operative radiographs were analyzed for cup inclination angle, cup anteversion angle, and femoral offset. RESULTS: Mean cup inclination angle in our series was 31° ± 6°. The most common liner position that imparted the greatest stability to posterior subluxation was posteriorly and inferiorly (4 o'clock position for left hip, or 8 o'clock position for right hip). The range for most stable liner position for different patients varied from postero-superior (11 o'clock/1 o'clock position) to directly inferior (6 o'clock position). Comparing a non-lipped liner to a lipped liner placed in the optimal position, the average difference in internal rotation gained before dislocation was 23°. There was no association between cup inclination or anteversion angle with liner position of greatest stability. CONCLUSION: In hip replacements performed through a posterior approach and with mean cup inclination angle of 31° ± 6°, placing the lip of the elevated liner in the postero-inferior quadrant may impart more stability than in the postero-superior quadrant.


Asunto(s)
Acetábulo/cirugía , Artrometría Articular/instrumentación , Artroplastia de Reemplazo de Cadera/instrumentación , Prótesis de Cadera , Cuidados Intraoperatorios/instrumentación , Teléfono Inteligente/instrumentación , Acetábulo/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Artrometría Articular/métodos , Artrometría Articular/normas , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Cadera/normas , Femenino , Prótesis de Cadera/normas , Humanos , Cuidados Intraoperatorios/métodos , Cuidados Intraoperatorios/normas , Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/prevención & control , Masculino , Persona de Mediana Edad , Teléfono Inteligente/normas
12.
Lancet ; 392(10158): 1662-1671, 2018 11 03.
Artículo en Inglés | MEDLINE | ID: mdl-30496081

RESUMEN

Total hip replacement is a frequently done and highly successful surgical intervention. The procedure is undertaken to relieve pain and improve function in individuals with advanced arthritis of the hip joint. Symptomatic osteoarthritis is the most common indication for surgery. In paper 1 of this Series, we focus on how patient factors should inform the surgical decision-making process. Substantial demands are placed upon modern implants, because patients expect to remain active for longer. We discuss the advances made in implant performance and the developments in perioperative practice that have reduced complications. Assessment of surgery outcomes should include patient-reported outcome measures and implant survival rates that are based on data from joint replacement registries. The high-profile failure of some widely used metal-on-metal prostheses has shown the shortcomings of the existing regulatory framework. We consider how proposed changes to the regulatory framework could influence safety.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Osteoartritis de la Cadera/cirugía , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/instrumentación , Benchmarking , Toma de Decisiones , Prótesis de Cadera/normas , Humanos , Osteoartritis de la Cadera/epidemiología , Complicaciones Posoperatorias/prevención & control , Diseño de Prótesis , Falla de Prótesis , Reoperación
13.
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
14.
BMC Musculoskelet Disord ; 19(1): 224, 2018 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-30021639

RESUMEN

BACKGROUND: The gait pattern varies within the population and between patient groups with different musculoskeletal diseases. It also varies over time due to various reasons. Three-dimensional gait analysis (3DGA) is frequently used to measure these changes, but the precision of this methodology may vary. METHODS: We primarily aimed to study the repeatability of hip motion measurements in patients with unilateral osteoarthritis (OA), patients with unilateral total hip arthroplasty (THA) and healthy controls. A secondary aim was to delineate any differences in hip motion during walking between these groups. Ten males and 10 females in each group were recruited. All patients underwent gait assessments using 3DGA recorded by 2 examiners. Data was analysed with comparison of variance and linear regression. RESULTS: The variability of the extension-flexion recordings was smallest in healthy controls (SD < 7.7°), increased in patients with THA (SD < 11.1°) and was most pronounced in the OA patients (SD < 12.2°). The degree of hip extension-flexion turned out to be the variable that most effectively could separate the controls from the 2 patient groups and the patient groups from each other. One to 2 years after THA the gait pattern was improved but still differed comparing a group of THA from a group of healthy controls. CONCLUSIONS: Patients with hip osteoarthritis showed the poorest repeatability between gait recordings collected by different examiners, as compared to patients operated with a THA and healthy controls. The walking pattern after THA still differed from healthy controls 1-2 years after the operation.


Asunto(s)
Artroplastia de Reemplazo de Cadera/normas , Análisis de la Marcha/normas , Marcha/fisiología , Prótesis de Cadera/normas , Osteoartritis de la Cadera/cirugía , Adulto , Anciano , Estudios Transversales , Femenino , Análisis de la Marcha/métodos , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/fisiopatología , Rango del Movimiento Articular/fisiología , Caminata/fisiología , Caminata/normas
15.
BMC Musculoskelet Disord ; 18(1): 382, 2017 Sep 02.
Artículo en Inglés | MEDLINE | ID: mdl-28865420

RESUMEN

BACKGROUND: The present study aimed to identify the risk factors associated with revision total hip arthroplasty (THA) failure using a Kerboull-type (KT) plate. METHODS: We analyzed 77 revision THAs using cemented acetabular components with a KT plate for aseptic loosening between May 2000 and March 2012. We examined the association of bone graft type, acetabular bone defects, age at the time of surgery, preoperative Japanese Orthopaedic Association (JOA) score, postoperative JOA hip score, and body mass index, with radiographic failure as the outcome. RESULTS: The 7.4-year radiographic failure survival rate was 81.6%. The survival rate was significantly different between the beta-tricalcium phosphate (ß-TCP) group and the bulk allograft group (p = 0.019). The survival curves were also significantly different between the ß-TCP group and bulk allograft group (p = 0.036). American Academy of Orthopaedic Surgeons type IV was significantly associated with radiographic failure (odds ratio [OR]: 15.5, 95% confidence interval [CI]: 1.4-175.4; p = 0.032). CONCLUSIONS: The midterm outcomes of revision THA indicate that type of bone graft and bone defect size may affect radiographic survival rate when using a KT plate.


Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/tendencias , Placas Óseas/tendencias , Prótesis de Cadera/tendencias , Falla de Prótesis/tendencias , Acetábulo/diagnóstico por imagen , Anciano , Placas Óseas/estadística & datos numéricos , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Prótesis de Cadera/normas , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis/instrumentación , Diseño de Prótesis/tendencias , Reoperación/instrumentación , Reoperación/tendencias , Factores de Riesgo
16.
Orthopedics ; 40(6): e952-e958, 2017 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-28934535

RESUMEN

Postoperative radiographs remain the standard for assessment of component placement following total hip arthroplasty (THA), despite the known limitations of radiographs. Computed tomography (CT) scanning offers improved accuracy, but its costs and radiation exposure are prohibitive. The authors performed a cadaver study to compare the error associated with radiographs with that of CT scans following THA. The authors also compared imaging with a novel mini-navigation system. Three board-certified orthopedic surgeons each performed 4 THA procedures (6 cadavers, 12 hips) via the posterior approach using a mini-navigation tool to assist with component placement. Cup position from imaging was compared with corrected CT values for anteversion and inclination, created by correcting the initial scan to align the anterior pelvic plane coplanar with the CT table, thus representing cup position not distorted by imaging or positioning. Anteversion from standard CT scans was within 2.5° (standard deviation [SD], 1.5°) of reference values (P=.25); radiographs showed an average error of 7.8° (SD, 4.3°) vs reference values (all values absolute means) (P<.01). The mini-navigation system provided anteversion values within an average of 4.0° (SD, 4.0°) of reference anteversion (P<.01). Standard CT values for inclination were within 2.4° (SD, 2.0°) of reference values (P=.53), whereas radiographic inclination values were within 2.5° (SD, 2.3°) (P=.12). Mini-navigation values for inclination were within 3.9° (SD, 3.2°) of reference inclination (P=.26). This study demonstrated that cup position as measured by radiographs is significantly less accurate than CT scans and that the mini-navigation system provided anteversion measurements that were of comparable accuracy to CT scans. [Orthopedics. 2017; 40(6):e952-e958.].


Asunto(s)
Artroplastia de Reemplazo de Cadera/normas , Prótesis de Cadera/normas , Acetábulo/cirugía , Anciano , Artroplastia de Reemplazo de Cadera/métodos , Cadáver , Femenino , Humanos , Masculino , Errores Médicos , Huesos Pélvicos/cirugía , Radiografía , Valores de Referencia , Reproducibilidad de los Resultados , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/normas , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/normas
17.
BMC Musculoskelet Disord ; 18(1): 295, 2017 Jul 11.
Artículo en Inglés | MEDLINE | ID: mdl-28693543

RESUMEN

BACKGROUND: There is no universal hip implant suitably fills all femoral types, whether prostheses of porous short-stem suitable for Hip Arthroplasty is to be measured scientifically. METHODS: Ten specimens of femurs scanned by CT were input onto Mimics to rebuild 3D models; their *stl format dataset were imported into Geomagic-Studio for simulative osteotomy; the generated *.igs dataset were interacted by UG to fit solid models; the prosthesis were obtained by the same way from patients, and bored by punching bears designed by Pro-E virtually; cements between femora and prosthesis were extracted by deleting prosthesis; in HyperMesh, all compartments were assembled onto four artificial joint style as: (a) cemented long-stem prosthesis; (b) porous long-stem prosthesis; (c) cemented short-stem prosthesis; (d) porous short-stem prosthesis. Then, these numerical models of Finite Element Analysis were exported to AnSys for numerical solution. RESULTS: Observed whatever from femur or prosthesis or combinational femora-prostheses, "Kruskal-Wallis" value p > 0.05 demonstrates that displacement of (d) ≈ (a) ≈ (b) ≈ (c) shows nothing different significantly by comparison with 600 N load. If stresses are tested upon prosthesis, (d) ≈ (a) ≈ (b) ≈ (c) is also displayed; if upon femora, (d) ≈ (a) ≈ (b) < (c) is suggested; if upon integral joint, (d) ≈ (a) < (b) < (c) is presented. CONCLUSIONS: Mechanically, these four sorts of artificial joint replacement are stabilized in quantity. Cemented short-stem prostheses present the biggest stress, while porous short-stem & cemented long-stem designs are equivalently better than porous long-stem prostheses and alternatives for femoral-head replacement. The preferred design of those two depends on clinical conditions. The cemented long-stem is favorable for inactive elders with osteoporosis, and porously punched cementless short-stem design is suitable for patients with osteoporosis, while the porously punched cementless short-stem is favorable for those with a cement allergy. Clinically, the strength of this study is to enable preoperative strategy to provide acute correction and decrease procedure time.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Análisis de Elementos Finitos , Prótesis de Cadera , Imagenología Tridimensional/métodos , Diseño de Prótesis/métodos , Realidad Virtual , Adulto , Artroplastia de Reemplazo de Cadera/métodos , Femenino , Fémur/diagnóstico por imagen , Fémur/cirugía , Prótesis de Cadera/normas , Humanos , Porosidad , Diseño de Prótesis/normas , Tomografía Computarizada por Rayos X/métodos , Adulto Joven
18.
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
19.
J Arthroplasty ; 32(10): 3200-3205, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-28625686

RESUMEN

BACKGROUND: Intraoperative interface contamination of modular head-stem taper junctions of hip implants can lead to poor fixation strength, causing fretting and crevice corrosion or even stem taper fracture. Careful cleaning before assembly should help to reduce these problems. The purpose of this study was to determine the effect of cleaning (with and without drying) contaminated taper interfaces on the taper fixation strength. METHODS: Metal or ceramic heads were impacted onto titanium alloy stem tapers with cleaned or contaminated (fat or saline solution) interfaces. The same procedure was performed after cleaning and drying the contaminated interfaces. Pull-off force was used to determine the influence of contamination and cleaning on the taper strength. RESULTS: Pull-off forces after contamination with fat were significantly lower than those for uncontaminated interfaces for both head materials. Pull-off forces after application of saline solution were not significantly different from those for uncontaminated tapers. However, a large variation in taper strength was observed, pull-off forces for cleaned and dried tapers were similar to those for uncontaminated tapers for both head materials. CONCLUSION: Intraoperative contamination of taper interfaces may be difficult to detect but has a major influence on taper fixation strength. Cleaning of the stem taper with saline solution and drying with gauze directly before assembly allows the taper strength of the pristine components to be achieved. Not drying the taper results in a large variation in pull-off forces, emphasizing that drying is essential for sufficient and reproducible fixation strength.


Asunto(s)
Artroplastia de Reemplazo de Cadera/normas , Grasas/efectos adversos , Prótesis de Cadera/normas , Retención de la Prótesis , Cloruro de Sodio/efectos adversos , Aleaciones , Animales , Bovinos , Cerámica , Corrosión , Contaminación de Equipos , Humanos , Fenómenos Mecánicos , Falla de Prótesis , Titanio
20.
Dan Med J ; 64(4)2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28385170

RESUMEN

INTRODUCTION: The Lewinnek and Callanan "safe zones" have been widely used to minimise the dislocation fre-quency in total hip arthroplasty (THA), but recent studies have questioned the association between "safe zones" and lower dislocation rates. The purpose of this study was to investigate: 1) if hip surgeons agree on a specific "safe zone" for cup positioning and 2) surgeons' surgical practice patterns regarding recurring instability in primary THA. METHODS: A survey was performed among hip surgeons during the 2015 Annual Meeting of the Danish Orthopaedic Society. The survey contained questions on optimal component positioning, surgical practice patterns in primary THA, indications and surgical techniques used in revision THA. RESULTS: A total of 42 questionnaires were collected, two were excluded, leaving 40 for analyses. 97% of the surgeons reported an optimum cup anteversion within the Lewinnek and Callanan "safe zones", whereas 97% and 83% reported optimum cup inclination within the Lewinnek and Callanan "safe zones", respectively. The reported range for optimal cup positioning varied from 30-55 degrees of inclination and 15-30 degrees of anteversion. The minimum and max-imum accepted cup inclination and anteversion within the Lewinnek "safe zone" was 68% and 67%, respectively. CONCLUSIONS: Hip surgeons agree that optimum cup po-sitioning should lie within the Lewinnek "safe zone", but they do not agree on the exact optimal cup positioning with respect to inclination and anteversion. This is in accordance with current evidence that strict usage of the Lewinnek "safe zone" cannot be justified. FUNDING: none. TRIAL REGISTRATION: not relevant.


Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera/normas , Pautas de la Práctica en Medicina , Acetábulo/diagnóstico por imagen , Humanos , Radiografía , Encuestas y Cuestionarios
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA