Induced Abortions Among Women Having Undergone Total Hip Replacement: A Nationwide Register Study in Finland.

BACKGROUND AND AIMS: No previous studies have analyzed the connection between total hip replacement and induced abortion. We evaluated the nationwide induced abortion rates among women with and without total hip replacement. MATERIALS AND METHODS: Data for this cohort study were gathered from national registers from 1987 to 2007. All fertile-aged (15-44 years old) females who had undergone primary total hip replacement in Finland were selected. The total hip replacement patient group comprised 1713 women and the reference group 5148 women. Information on all pregnancies for both groups before and after total hip replacement/index date was gathered from the medical birth register and the register of induced abortion. Logistic regression model was used to analyze the adjusted odds ratio for induced abortion. Adjustment was made for age at induced abortion, parity, previous induced abortions, previous deliveries, and marital status. RESULTS: Women had higher induced abortion proportions after total hip replacement (17.9%) compared with women before total hip replacement (14.1%) and the referents (13.9%), but the differences were not statistically significant. Women in the total hip replacement patient group had significantly more induced abortions after total hip replacement due to maternal health issues (14.7%) compared with the referents (2.7%), p = 0.003. Patients in the total hip replacement group were not more likely to have their pregnancy ending in induced abortion than the women in the reference group (odds ratio 1.32, 95% confidence interval 0.89-1.96, p = 0.17). However, in the adjusted analysis, there was a trend for higher risk for pregnancy to end in induced abortion in the total hip replacement group in relation to the reference group (adjusted odds ratio 1.50 (confidence interval 0.99-2.28, p = 0.05). CONCLUSION: The total hip replacement patient group had higher, but statistically insignificant, induced abortion proportions compared with the reference group before and after the operation. After total hip replacement, the patients were not more likely to have a pregnancy ending in induced abortion. This finding remained statistically insignificant after adjusting with possible confounders.

The mean seven years' results of the use of poly-L/D-lactic acid (PLDLA) interposition implant and bone packing in revision metacarpophalangeal arthroplasty: a prospective cohort study.

BACKGROUND AND AIMS: Revision arthroplasty of metacarpophalangeal (MCP) joints in chronic inflammatory arthritis patients after silicone implants is challenging due of severe bone loss and soft tissue deficiencies. The aim of this study was to evaluate the outcome of revision MCP arthroplasty using poly-L/D-lactic acid 96:4 (PLDLA) interposition implant and morcelised allograft or autograft bone packing in patients with failed MCP arthroplasties and severe osteolysis. MATERIAL AND METHODS: The study group consisted of 15 patients (15 hands and 36 joints) at a mean follow-up of seven years (range 5-10 years). The radiographs were reviewed for osteolysis and incorporation of the grafted bone. The clinical assessments included active range of motion, evaluation of pain, subjective outcome and assessment of grip power. RESULTS: PLDLA interposition arthroplasty combined with bone packing provided satisfactory pain relief, but function was limited. Radiographic analysis showed complete incorporation of the grafted bone to the diaphyseal portion of the host metacarpal and phalangeal bones in 30 of the 36 joints. All the patients had very limited grip strength, both on the operated and non-operated side. CONCLUSIONS: Due to soft tissue deficiencies long-term function and alignment problems can not be resolved with PLDLA interposition implant.

Successful femoral reconstruction with a fluted and tapered modular distal fixation stem in revision total hip arthroplasty.

BACKGROUND AND AIMS: Early results of fluted and tapered distal fixation stems used in reconstruction of deficient femora in femoral revision arthroplasty have been successful in small series. We evaluated the survival of the LINK MP Reconstruction Hip Stem and factors associated with survival using data from a nation-wide arthroplasty register. MATERIALS AND METHODS: 408 femoral revisions using LINK MP Reconstruction Hip Stem were performed during 1994 to 2007. The mean age of the patients was 72.5 (range: 36-93) years and 63% were performed in women. Kaplan-Meier analysis and the Cox regression model were used for the survival analysis. The effects of age, sex and diagnoses were also studied. RESULTS: The 9-year overall survivorship for the LINK MP Reconstruction Hip Stem was 75% (95% CI 70-80). Aseptic loosening was rare; the 9-year revision rate for aseptic loosening was only 3%, which coincides with earlier reports with shorter folllow-up. The most common reason for re-revision was dislocation of the prosthesis with or without malposition of the socket (67%). Indication for revision strongly affected the survival rate with revisions for dislocation having an over 3-fold and revisions for infection a 3-fold relative risk for re-revision compared to revisions for aseptic loosening. Increasing age slightly decreased the risk of re-revision but sex did not affect the survival. DISCUSSION: Based on our findings, we conclude LINK MP Reconstruction Hip Stem, as an example of a fluted and tapered distal fixation stem, appears to solve many problems with implant fixation in femoral revisions. High number of dislocations suggests that special attention should be paid to correct center of rotation, to correct implant positioning and to need of constrained implants in case of deficient abductor mechanism.

Fewer and older patients with rheumatoid arthritis need total knee replacement.

OBJECTIVES: Recent studies have suggested a decreased need for orthopaedic surgery in patients with rheumatoid arthritis (RA). We analysed trends in total knee replacement (TKR) in RA using TKR in osteoarthritis (OA) as a point of reference. METHODS: Data on TKRs from the Finnish Arthroplasty Register and population data from Statistics Finland were used to analyse the trends in TKRs among patients aged ≥ 40 years with primary osteoarthritis (OA) or RA in Finland for the period from 1980 to 2010. RESULTS: During 1980-2010, the overall incidence of TKRs increased 20-fold from 14.2 to 305.3 operations per 10(5) person-years. After peaking in 1992, the annual incidence of TKRs for RA decreased gradually from 19.6 to 10.8 per 10(5) [incidence rate ratio (IRR) 0.97, p < 0.001]. The decrease was more pronounced in women and the older (≥ 60 years) age group. The mean age at the time of TKR among patients with RA increased over time, converging with that of patients with OA. CONCLUSION: There is a clear decrease in the annual incidence of TKRs in RA, while among OA patients the incidence is increasing steadily. Furthermore, patients with RA seem to receive their TKRs at an older age. Both of these findings suggest improving long-term outcome in RA.

Bioreconstructive poly-L/D-lactide implant compared with Swanson prosthesis in metacarpophalangeal joint arthroplasty in rheumatoid patients: a randomized clinical trial.

It was hypothesized that the bioresorbable interposition implant might offer a viable alternative to conventional silicone implant arthroplasty in rheumatoid metacarpophalangeal joint destruction. A randomized clinical study was performed to compare a stemless poly-L/D-lactide copolymer 96 : 4 (PLDLA) implant with the Swanson silicone implant. Results in 52 patients (53 hands and 175 joints) at a mean follow-up of 2 years (minimum 1 year) showed that the improvement in clinical assessments was comparable in both groups, except for better maintenance of palmar alignment in the Swanson group. The lack of implant fractures and intramedullary osteolysis were advantages of the PLDLA implant. The bioresorbable PLDLA interposition implant may offer an alternative tool for tailored reconstruction of rheumatoid metacarpophalangeal joints.

Long-term survival of the Souter-Strathclyde total elbow replacement in patients with rheumatoid arthritis.

Between 1982 and 1997, 403 consecutive patients (522 elbows) with rheumatoid arthritis underwent Souter-Strathclyde total elbow replacement. By the end of 2007, there had been 66 revisions for aseptic loosening in 60 patients. The mean time of follow-up was 10.6 years (0 to 25) The survival rates at five-, ten, 15 and 19 years were 96% (95%, confidence interval (CI) 95 to 98), 89% (95% CI 86 to 92), 83% (95% CI 78 to 87), and 77% (95% CI 69 to 85), respectively. The small and medium-sized short-stemmed primary humeral components had a 5.6-fold and 3.6-fold risk of revision for aseptic loosening respectively, compared to the medium-sized long-stemmed component. The small and medium-sized all-polyethylene ulnar components had respectively a 28.2-fold and 8.4-fold risk of revision for aseptic loosening, compared to the metal-backed ulnar components. The use of retentive ulnar components was not associated with an increased risk of aseptic loosening compared to non-retentive implants.

Comparison of standard anteroposterior knee and hip-to-ankle radiographs in determining the lower limb and implant alignment after total knee arthroplasty.

BACKGROUND AND AIMS: The coronal alignment of the lower limb is important for planning and assessing outcome after total knee arthroplasty. This study compared postoperative estimation of alignment and measurement of angles using both hip-to-ankle radiographs and anteroposterior (AP) knee radiographs in standing position. PATIENTS AND METHODS: Consecutive standard AP knee and hip-to-ankle radiographs in 83 patients (103 knees) after total knee arthroplasty were analyzed. RESULTS: The tibiofemoral angle measured from both hip-to-ankle and knee radiographs correlated moderately with the mechanical axis (r = 0.646 and r = 0.540, respectively). The correlation between tibiofemoral angles in the two radiographs was excellent (r = 0.860). Furthermore, measurements of tibial and femoral component alignment between the two radiographs correlated highly (r = 0.718 and r = 0.773, respectively). Intra- and interobserver correlations were high in all analyses. CONCLUSIONS: The standard AP knee radiograph appears to be a valid alternative to the hip-to-ankle radiograph for determining knee coronal plane alignment in routine followup after total knee arthroplasty. However, the hip-to-ankle radiograph alone provides accurate information on weight-bearing mechanical axis in patients with suspected lower limb malalignment.

One-year results of use of poly-L/D-lactic acid joint scaffolds and bone packing in revision metacarpophalangeal arthroplasty.

Revision metacarpophalangeal arthroplasty after silicone implant arthroplasty is frequently complicated by severe bone loss, osteolysis and diaphyseal perforations. Impacted, morselised allografts are frequently used to treat bone loss in revision surgery. A new method of treatment using bioreconstructive poly-L/D-lactic acid (PLDLA) joint scaffold and allograft bone packing, after complete removal of the original silicone implants, allows recovery of bony deficiencies, correction of malalignment and improves function of the hand. This article presents the one-year results of a prospective, non-randomised clinical and radiographic follow-up study of 21 patients with 52 revision metacarpophalangeal arthroplasties using the PLDLA implants and allograft bone packing.

Use of the de la Caffinière prosthesis in rheumatoid trapeziometacarpal destruction.

This study evaluated the outcome of the de la Caffinière prosthesis in patients with an inflammatory arthropathy affecting the trapeziometacarpal joint. The procedure was performed in 57 thumbs for rheumatoid arthritis (41 cases), juvenile chronic arthritis (ten cases), psoriatic arthritis (four cases) and other inflammatory joint diseases (two cases). Survival analysis with a revision procedure or radiographic implant failure as end points was performed. Five loosened cups and two permanently dislocated prostheses underwent revision surgery. These were managed with a bone graft and tendon interposition technique. Radiographic follow-up yielded four additional implant failures (two loosened cups, one loosened metacarpal stem and one permanent dislocation). The implant survival rate based on revision operation was 87% (95% CI 73-94) at 10 years, and the total radiographic and implant failure rate based on radiographic findings was 15% (95% CI 7-29) at 10 years.

Long-term results of leg length discrepancy treated with temporary epiphyseal stapling in children with juvenile chronic arthritis.

OBJECTIVE: The aim of the present study was to evaluate retrospectively the long-term efficacy of temporary stapling of the knee epiphyses over four decades of use in children with JCA. METHODS: Medical data of the patients with temporary epiphyseodesis due to leg length discrepancy (LLD) were studied. Seventeen knees in 17 patients were found with sufficient follow-up data for evaluation. Patient documents and radiographs of these patients were evaluated. RESULTS: The mean age at the time of the operation was 11 years (range: 6-15) in 3 males and 14 females. The preoperative mean LLD was 21 mm (SD 8) and at staple removal 4 mm (SD 10). The difference was -17 mm (95% CI: -10 to -23). Statistically the result remained the same during the follow-up. Two reversible complications were documented among the 17 stapled knees. In five (29%) cases the correction was affected by re-occurrence of LLD quickly after removal of the staples. CONCLUSION: In this study with 17 patients and a wide range of follow-up times we found that the good correction of LLD achieved by stapling is usually permanent.