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1.
Bone Joint J ; 103-B(2): 398-404, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517739

RESUMO

AIMS: We have evaluated the survivorship, outcomes, and failures of an interlocking, reconstruction-mode stem-sideplate implant used to preserve the native hip joint and achieve proximal fixation when there is little residual femur during large endoprosthetic reconstruction of the distal femur. METHODS: A total of 14 patients underwent primary or revision reconstruction of a large femoral defect with a short remaining proximal femur using an interlocking, reconstruction-mode stem-sideplate for fixation after oncological distal femoral and diaphyseal resections. The implant was attached to a standard endoprosthetic reconstruction system. The implant was attached to a standard endoprosthetic reconstruction system. None of the femoral revisions were amenable to standard cemented or uncemented stem fixation. Patient and disease characteristics, surgical history, final ambulatory status, and Musculoskeletal Tumor Society (MSTS) score were recorded. The percentage of proximal femur remaining was calculated from follow-up radiographs. RESULTS: All 14 at-risk native hip joints were preserved at a mean final follow-up of 6.0 years (SD 3.7), despite a short residual femur, often after proximal osteotomies through the lesser trochanter. Overall, 13 of 14 stems had long-term successful fixation. Eight patients required no reoperation. Three patients required reoperation due to implant-related issues, and three patients required reoperation for wound healing problems or infection. There were no dislocations or fractures. At final follow-up the mean MSTS score was 24.9 (SD 4.1). Nine patients required no ambulation aids, and only one had a Trendelenburg gait. CONCLUSION: This interlocking, reconstruction-mode stem-sideplate reliably preserves native hip joint anatomy and function after large femoral resection with a short remaining proximal femur, both in the primary and revision setting. This is particularly important for preventing or delaying total femoral arthroplasty in young patients after oncological reconstruction. Hip abductor strength and function could be maintained by this method, and the risk of dislocation eliminated. The success of this technique in this modest series should be verified in a larger collaborative study and will be of interest to revision surgeons and oncologists. Cite this article: Bone Joint J 2021;103-B(2):398-404.


Assuntos
Artroplastia de Quadril/instrumentação , Neoplasias Femorais/cirurgia , Fêmur/cirurgia , Tumor de Células Gigantes do Osso/cirurgia , Prótese de Quadril , Desenho de Prótese , Sarcoma/cirurgia , Adulto , Artroplastia de Quadril/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
2.
Bone Joint J ; 103-B(2): 299-304, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517728

RESUMO

AIMS: Various surgical techniques have been described for total hip arthroplasty (THA) in patients with Crowe type III dislocated hips, who have a large acetabular bone defect. The aim of this study was to evaluate the long-term clinical results of patients in whom anatomical reconstruction of the acetabulum was performed using a cemented acetabular component and autologous bone graft from the femoral neck. METHODS: A total of 22 patients with Crowe type III dislocated hips underwent 28 THAs using bone graft from the femoral neck between 1979 and 2000. A Charnley cemented acetabular component was placed at the level of the true acetabulum after preparation with bone grafting. All patients were female with a mean age at the time of surgery of 54 years (35 to 68). A total of 18 patients (21 THAs) were followed for a mean of 27.2 years (20 to 33) after the operation. RESULTS: Radiographs immediately after surgery showed a mean vertical distance from the centre of the hip to the teardrop line of 21.5 mm (SD 3.3; 14.5 to 30.7) and a mean cover of the acetabular component by bone graft of 46% (SD 6%; 32% to 60%). All bone grafts united without collapse, and only three acetabular components loosened. The rate of survival of the acetabular component with mechanical loosening or revision as the endpoint was 86.4% at 25 years after surgery. CONCLUSION: The technique of using autologous bone graft from the femoral neck and placing a cemented acetabular component in the true acetabulum can provide good long-term outcomes in patients with Crowe type III dislocated hips. Cite this article: Bone Joint J 2021;103-B(2):299-304.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/métodos , Transplante Ósseo/métodos , Colo do Fêmur/transplante , Luxação Congênita de Quadril/cirurgia , Adulto , Idoso , Artroplastia de Quadril/instrumentação , Cimentos para Ossos , Feminino , Seguimentos , Prótese de Quadril , Humanos , Pessoa de Meia-Idade , Transplante Autólogo , Resultado do Tratamento
3.
Bone Joint J ; 103-B(2): 309-320, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517729

RESUMO

AIMS: The aim of this study was to determine whether fixation, as opposed to revision arthroplasty, can be safely used to treat reducible Vancouver B type fractures in association with a cemented collarless polished tapered femoral stem (the Exeter). METHODS: This retrospective cohort study assessed 152 operatively managed consecutive unilateral Vancouver B fractures involving Exeter stems; 130 were managed with open reduction and internal fixation (ORIF) and 22 with revision arthroplasty. Mean follow-up was 6.5 years (SD 2.6; 3.2 to 12.1). The primary outcome measure was revision of at least one component. Kaplan-Meier survival analysis was performed. Regression analysis was used to identify risk factors for revision following ORIF. Secondary outcomes included any reoperation, complications, blood transfusion, length of hospital stay, and mortality. RESULTS: Fractures (B1 n = 74 (49%); B2 n = 50 (33%); and B3 n = 28 (18%)) occurred at median of 4.2 years (interquartile range (IQR) 1.2 to 9.2) after primary total hip arthroplasty (THA) (n = 138) or hemiarthroplasty (n = 14). Rates of revision and reoperation were significantly higher following revision arthroplasty compared to ORIF for B2 (p = 0.001) and B3 fractures (p = 0.050). Five-year survival was significantly better following ORIF: 92% (95% confidence interval (CI) 86.4% to 97.4%) versus 63% (95% CI 41.7% to 83.3%), p < 0.001. ORIF was associated with reduced blood transfusion requirement and reoperations, but there were no differences in medical complications, hospital stay, or mortality between surgical groups. No independent predictors of revision following ORIF were identified: where the bone-cement interface was intact, fixation of B2 or B3 fractures was not associated with an increased risk of revision. CONCLUSION: When the bone-cement interface was intact and the fracture was anatomically reducible, all Vancouver B fractures around Exeter stems could be managed with fixation as opposed to revision arthroplasty. Fixation was associated with reduced need for blood transfusion and lower risk of revision surgery compared with revision arthroplasty. Cite this article: Bone Joint J 2021;103-B(2):309-320.


Assuntos
Artroplastia de Quadril , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas , Redução Aberta , Fraturas Periprotéticas/cirurgia , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Cimentos para Ossos , Feminino , Fraturas do Fêmur/etiologia , Seguimentos , Prótese de Quadril , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Reoperação/instrumentação , Estudos Retrospectivos , Resultado do Tratamento
4.
Bone Joint J ; 103-B(2): 391-397, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517732

RESUMO

AIMS: Hip reconstruction after resection of a periacetabular chondrosarcoma is complex and associated with a high rate of complications. Previous reports have compared no reconstruction with historical techniques that are no longer used. The aim of this study was to compare the results of tantalum acetabular reconstruction to both historical techniques and no reconstruction. METHODS: We reviewed 66 patients (45 males and 21 females) with a mean age of 53 years (24 to 81) who had undergone acetabular resection for chondrosarcoma. A total of 36 patients (54%) underwent acetabular reconstruction, most commonly with a saddle prosthesis (n = 13; 36%) or a tantalum total hip arthroplasty (THA) (n = 10; 28%). Mean follow-up was nine years (SD 4). RESULTS: There was no difference in the mean age (p = 0.63), sex (p = 0.110), tumour volume (p = 0.646), or type of resection carried out (p > 0.05) between patients with and without reconstruction. Of the original 66 patients, 61 (92%) were ambulant at final follow-up. There was no difference in the proportion of patients who could walk in the reconstruction and 'no reconstruction' groups (p = 0.649). There was no difference in the mean Musculoskeletal Tumor Society (MSTS) score between patients who were reconstructed and those who were not (61% vs 56%; p = 0.378). Patients with a tantalum THA had a significantly (p = 0.015) higher mean MSTS score (78%) than those who were reconstructed with a saddle prosthesis (47%) or who had not been reconstructed (56%). Patients who had undergone reconstruction were more likely to have complications (81% vs 53%; p = 0.033). CONCLUSION: Reconstruction after resection of the acetabulum is technically demanding. In selected cases, reconstruction is of benefit, especially when reconstruction is by tantalum THA; however, the follow-up for these patients remains mid-term. When not feasible, patients with no reconstruction have an acceptable functional outcome. Level of Evidence: Level III Therapeutic. Cite this article: Bone Joint J 2021;103-B(2):391-397.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/métodos , Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/instrumentação , Feminino , Seguimentos , Prótese de Quadril , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Estudos Retrospectivos , Tantálio , Resultado do Tratamento
5.
N Z Med J ; 134(1529): 103-108, 2021 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-33582712

RESUMO

Mr BH was a 53-year-old gentleman who presented to hospital in November 2019 with decompensated heart failure, new-onset paroxysmal atrial tachycardia and increasing left hip pain. Imaging of his hip demonstrated radiographic evidence of bony changes, suggestive of an adverse reaction to metal debris (ARMD), along with a non-traumatic left peri-prosthetic neck-of-femur fracture. Clinically, he had concurrent decompensated cardiomyopathy requiring dopamine and furosemide infusions. His serum cobalt (sCo) levels were 5244nmol/L (normal<12nmol/L). He had previous bilateral total hip arthroplasties using the Birmingham Hip Resurfacing (right side 2006, left side 2012). As part of routine metal-on-metal arthroplasty follow-up, Mr BH had sCo level checks. In 2013, these levels rose to 1981nmol/L. Although there has been no direct correlation between sCo levels and toxicity, levels above 119nmol/L are concerning. Unfortunately, Mr BH moved to a different health district and was subsequently lost to follow-up. In 2015, Mr BH was diagnosed with dilated cardiomyopathy, presumed secondary to viral myocarditis. Despite successful chelating therapy and heart failure treatment, he passed away secondary to cobalt-toxicity induced cardiomyopathy (CTCM).


Assuntos
Artroplastia de Quadril/efeitos adversos , Cardiomiopatias/induzido quimicamente , Cobalto/toxicidade , Prótese de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Cardiomiopatias/diagnóstico , Cobalto/sangue , Ecocardiografia , Evolução Fatal , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Falha de Prótese/efeitos adversos , Radiografia Torácica
6.
AJR Am J Roentgenol ; 216(2): 311-317, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33325734

RESUMO

OBJECTIVE. Metal-on-metal hip arthroplasty has been shown to result in soft-tissue complications in some patients, making revision surgery necessary. Imaging is critical in the detection and surveillance of soft-tissue complications, which are collectively termed adverse reaction to metal debris (ARMD) and adverse local tissue reaction. Studies have investigated the use of ultrasound, MRI, and CT for detecting ARMD, and each modality has advantages and disadvantages. This article provides evidence-based recommendations for imaging surveillance of ARMD. CONCLUSION. Compared with ultrasound, MRI has been found to be a better imaging modality for surveillance of ARMD. In addition, MRI is not operator dependent, allows visualization of soft-tissue details, and allows more consistent measurement of fluid collections on follow-up examinations. Limitations of ultrasound include operator skill, the inability to visualize osseous structures, and the challenge of visualizing posterior soft tissues for synovitis and fluid collections in larger patients. Finally, CT is only useful for focused evaluation of osteolysis or periprosthetic fracture.


Assuntos
Artroplastia de Quadril/instrumentação , Prótese de Quadril/efeitos adversos , Próteses Articulares Metal-Metal/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Idoso , Artroplastia de Quadril/efeitos adversos , Feminino , Humanos , Imagem por Ressonância Magnética , Complicações Pós-Operatórias/etiologia , Falha de Prótese , Tomografia Computadorizada por Raios X , Ultrassonografia
7.
Medicine (Baltimore) ; 99(46): e23174, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181692

RESUMO

To determine the effects of ankylosing spondylitis (AS)-associated hip damages on the outcome measurements after total hip arthroplasty (THA).The medical records of 122 patients with AS (181 hips) who underwent THA were retrospectively reviewed. The mean follow-up was 43.9 (32-129) months. The types and degrees of hip damages were evaluated by preoperative hip X-rays. The patients were grouped according to the satisfaction degree after the operation. Univariable and multivariable statistical analyses were conducted.The intraclass correlation coefficients for the assessment between the 2 reviewers in the study were 0.86 to 0.97. Cox regression showed that femoral head erosion severity had an effect on the recovery time of independent walking without crutches postoperatively (odds ratio = 1.467, 95% confidence interval: 1.050-2.409, P = .025). The mean time to recover independent walking in the severe femoral head erosion group was 7.3 ±â€Š0.9 weeks, which was 4.6 ±â€Š0.4 weeks longer than in the non-severe femoral head erosion group, as confirmed by the log-rank (Mantel-Cox) test (Chi-squared = 11.684, P = .001). The multivariable analysis showed that higher acetabular sclerosis scores correlated with lower postoperative dissatisfaction risk (odds ratio = 0.322, 95% confidence interval: 0.136-0.764). The multiple linear regression analysis showed that postoperative range of motion (ROM) improvement was affected by preoperative ROM of the hip, space narrowing degree, and ceramic-ceramic material for the weight-bearing surface (F = 179.81, P < .001), with preoperative ROM of the hip having the greatest impact.Severe femoral head erosion prolongs the recovery time of independent walking after THA. Acetabular sclerosis is not associated with poor outcomes in patients with AS-associated hip damage undergoing THA.


Assuntos
Acetábulo , Artroplastia de Quadril , Cabeça do Fêmur , Osteoartrite do Quadril , Recuperação de Função Fisiológica , Espondilite Anquilosante , Acetábulo/diagnóstico por imagem , Acetábulo/patologia , Acetábulo/fisiopatologia , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Artroplastia de Quadril/reabilitação , China/epidemiologia , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/patologia , Cabeça do Fêmur/fisiopatologia , Prótese de Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Radiografia/métodos , Amplitude de Movimento Articular , Estudos Retrospectivos , Índice de Gravidade de Doença , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico , Resultado do Tratamento , Caminhada , Suporte de Carga
8.
Bone Joint J ; 102-B(11): 1457-1466, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135437

RESUMO

AIMS: To evaluate the rate of dislocation following dual mobility total hip arthroplasty (DM-THA) in patients with displaced femoral neck fractures, and to compare rates of dislocation, surgical-site infection, reoperation, and one-year mortality between DM-THA and bipolar hemiarthroplasty (BHA). METHODS: Studies were selected based on the following criteria: 1) study design (retrospective cohort studies, prospective cohort studies, retrospective comparative studies, prospective comparative studies, and randomized controlled studies (RCTs)); 2) study population (patients with femoral neck fracture); 3) intervention (DM-THA or BHA); and 4) outcomes (complications during postoperative follow-up and clinical results). Pooled meta-analysis was carried out to evaluate the dislocation rate after DM-THA and to compare outcomes between DM-THA and BHA. RESULTS: A total of 17 studies (ten cohort studies on DM-THA and seven comparative studies of DM-THA and BHA) were selected. These studies included 2,793 patients (2,799 hips), made up of 2,263 DM-THA patients (2,269 hips) and 530 BHA patients (530 hips). In all, 16 studies were analyzed to evaluate dislocation rate after DM-THA. The cumulative dislocation rate was 4% (95% confidence interval (CI) 3 to 5). Seven studies were analyzed to compare the rates dislocation and surgical-site infection. The rate of dislocation was significantly lower in the DM-THA group than in the BHA group (risk ratio (RR) 0.3; 95% CI 0.17 to 0.53, p < 0.001, Z -4.11). There was no significant difference in the rate of surgical-site infection between the two groups (p = 0.580). Six studies reported all-cause reoperations. The rate of reoperation was significantly lower in the DM-THA group than in the BHA group (RR 0.5; 95% CI 0.32 to 0.78, p = 0.003, Z -3.01). Five studies reported one-year mortality. The mortality rate was significantly lower in the DM-THA group than in the BHA group (RR 0.58 95% CI 0.45 to 0.75, p < 0.0001, Z -4.2). CONCLUSION: While the evidence available consisted mainly of non-randomized studies, DM-THA appeared to be a viable option for patients with displaced fractures of the femoral neck, with better reported rates of dislocation, reoperation, and mortality than BHA. Cite this article: Bone Joint J 2020;102-B(11):1457-1466.


Assuntos
Artroplastia de Quadril/efeitos adversos , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/efeitos adversos , Luxação do Quadril/etiologia , Prótese de Quadril , Fraturas Intra-Articulares/cirurgia , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/mortalidade , Hemiartroplastia/métodos , Hemiartroplastia/mortalidade , Prótese de Quadril/efeitos adversos , Humanos , Desenho de Prótese , Reoperação , Infecção da Ferida Cirúrgica/etiologia
9.
Can J Surg ; 63(5): E412-E417, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33009898

RESUMO

BACKGROUND: The ideal approach for a total hip arthroplasty (THA) would be kind to soft tissues, have the lowest complication rates and be easily reproducible. Although there have been several attempts to find the best approach for THA in the last decade, a definitive answer has not been found. We performed a prospective study to compare the direct anterior and posterior approaches for THA in terms of hospital length of stay, functional outcome, pain, implant position, complications and surgical time. METHODS: A prospective, randomized, multicentre clinical study was conducted between February 2011 and July 2013, with an average follow-up of 55 months. Patients undergoing the direct anterior or posterior approach for THA were enrolled. Hospital length of stay, surgical time and complications were documented. The Harris Hip Score and visual analogue scale were used to monitor functional outcome and pain until 5 years postoperatively. Radiologic analysis was used to assess implant position. RESULTS: Fifty-five patients (28 undergoing the direct anterior approach, 27 undergoing the posterior approach) were enrolled in this study. Length of stay, functional outcome, pain, implant position and complications were similar for the 2 approaches. There was a trend toward a better functional outcome for patients who underwent the direct anterior approach in the first 3 months postoperatively, with a peak at 4 weeks (Harris Hip Score 76.7 v. 68.7; p = 0.08). Average surgical time for the direct anterior approach was significantly longer (69.9 v. 45.7 min; p = 0.002). CONCLUSION: The direct anterior approach for THA appears to be a safe and effective option. However, there is no significant difference in hospital length of stay or postoperative recovery between the 2 approaches. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, no. NCT03673514.


Assuntos
Artroplastia de Quadril/métodos , Complicações Pós-Operatórias/epidemiologia , Idoso , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(40): e22578, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019472

RESUMO

RATIONALE: Exact restoration of the rotation center in total hip arthroplasty (THA) is technically challenging in patients with end-stage osteoarthritis due to developmental dysplasia of the hip (DDH), especially in the Crowe type II and III procedures. The technical difficulty is attributable to the complex acetabular changes. In this study, a novel 3-dimensional (3D) printed integral customized acetabular prosthesis for anatomical rotation restoration in THA for DDH Crowe type III was developed using patient-specific Computer-aided design and additive manufacturing (AM) methods. PATIENT CONCERNS: A 69-year-old female patient had developed left hip joint pain and restricted movement for 40 years; the symptoms had increased in the past 5 months. Pain, limited motion of the left hip joint, and lower limb length discrepancy were noted during physical examination. DIAGNOSIS: The patient was diagnosed with left hip end-stage osteoarthritis secondary to DDH (Crowe type III). INTERVENTION: A 3D printed acetabulum model was manufactured and a simulated operation was performed to improve the accuracy of reconstruction of the rotation center and bone defect. A 3D printed titanium alloy integral customized acetabular prosthesis was designed according to the result of simulated operation. The integral customized prothesis was implanted subsequently via the posterolateral approach. Radiography of the pelvis and Harris score assessment were performed during the perioperative period as well as at the 6- and 12-month follow-up. OUTCOMES: The 3D printed integral customized acetabular prosthesis matched precisely with the reamed acetabulum. The rotation center was restored and the bone defect was exactly reconstructed. There were no signs of prosthetic loosening at the 12-month follow-up. The Harris score gradually improved during the follow-up period. LESSONS: Satisfactory results of hip rotation restoration and bone defect reconstruction could be achieved by using 3D printed integral customized acetabular prosthesis, which provides a promising way to reconstruct the acetabulum in patients with DDH anatomically and rapidly for THA.


Assuntos
Artroplastia de Quadril/instrumentação , Luxação Congênita de Quadril/patologia , Prótese de Quadril/efeitos adversos , Osteoartrite do Quadril/cirurgia , Impressão Tridimensional/instrumentação , Assistência ao Convalescente , Idoso , Feminino , Luxação Congênita de Quadril/classificação , Luxação Congênita de Quadril/complicações , Prótese de Quadril/tendências , Humanos , Desigualdade de Membros Inferiores/diagnóstico , Desigualdade de Membros Inferiores/etiologia , Osteoartrite do Quadril/etiologia , Período Perioperatório/normas , Radiografia/métodos , Rotação , Resultado do Tratamento
11.
J Postgrad Med ; 66(4): 215-217, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33109783

RESUMO

Once purely the domain of knee surgery, the use of computer-navigated techniques in total hip arthroplasty (THA) is becoming progressively more commonplace. As with the adoption of any new technology-assisted approach, the uptake of navigated THA utilization has heralded a new suite of technique-specific potential complications. One such example - not usually seen with conventional instrumented THA - pertains to complications related to the insertion and use of fixed pelvic array trackers. This case report describes the unusual circumstance of retained local bony debris generated through application of self-drilling, self-tapping iliac crest pins (for rigid navigation tracker placement) being mis-interpreted on advanced imaging - at a hospital site remote from the index surgery - as an aggressive, early-stage, chondrosarcomatous lesion. This case highlights the critical importance of both a general awareness of common imaging findings after navigated THA surgery (whereby tracker pins have been employed) and the value of 'hands on' clinical assessment of patients to allow correlation with suspicious imaging findings.


Assuntos
Artroplastia de Quadril/efeitos adversos , Pinos Ortopédicos/efeitos adversos , Articulação do Quadril/cirurgia , Pelve/cirurgia , Fraturas Periprotéticas/diagnóstico por imagem , Cirurgia Assistida por Computador/instrumentação , Idoso de 80 Anos ou mais , Artroplastia de Quadril/instrumentação , Feminino , Humanos , Imageamento Tridimensional , Pelve/diagnóstico por imagem , Complicações Pós-Operatórias , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Bone Joint J ; 102-B(10): 1303-1310, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993343

RESUMO

AIMS: The most frequent indication for revision surgery in total hip arthroplasty (THA) is aseptic loosening. Aseptic loosening is associated with polyethylene liner wear, and wear may be reduced by using vitamin E-doped liners. The primary objective of this study was to compare proximal femoral head penetration into the liner between a) two cross-linked polyethylene (XLPE) liners (vitamin E-doped (vE-PE)) versus standard XLPE liners, and b) two modular femoral head diameters (32 mm and 36 mm). METHODS: Patients scheduled for a THA were randomized to receive a vE-PE or XLPE liner with a 32 mm or 36 mm metal head (four intervention groups in a 2 × 2 factorial design). Head penetration and acetabular component migration were measured using radiostereometric analysis at baseline, three, 12, 24, and 60 months postoperatively. The Harris Hip Score, University of California, Los Angeles (UCLA) Activity Score, EuroQol five-dimension questionnaire (EQ-5D), and 36-Item Short-Form Health Survey questionnaire (SF-36) were assessed at baseline, three, 12, 36, and 60 months. RESULTS: Of 220 screened patients, 127 were included in this study. In all, 116 received the allocated intervention, and 94 had their results analyzed at five years. Head penetration was similar between liner materials and head sizes at five years, vE-PE versus XLPE was -0.084 mm (95% confidence interval (CI) -0.173 to 0.005; p = 0.064), and 32 mm versus 36 mm was -0.020 mm (95% CI -0.110 to 0.071; p = 0.671), respectively. No differences were found in acetabular component migration or in the patient-reported outcome measures. CONCLUSION: No significant difference in head penetration was found at five years between vE-PE and XLPE liners, nor between 32 mm and 36 mm heads. Cite this article: Bone Joint J 2020;102-B(10):1303-1310.


Assuntos
Artroplastia de Quadril/instrumentação , Vitamina E/farmacologia , Idoso , Feminino , Prótese de Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Polietileno , Falha de Prótese , Inquéritos e Questionários
13.
Int J Nanomedicine ; 15: 6705-6720, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32982228

RESUMO

Over the last decades, joint arthroplasty has become a successful treatment for joint disease. Nowadays, with a growing demand and increasingly younger and active patients accepting these approaches, orthopedic surgeons are seeking implants with improved mechanical behavior and longer life span. However, aseptic loosening as a result of wear debris from implants is considered to be the main cause of long-term implant failure. Previous studies have neatly illustrated the role of micrometric wear particles in the pathological mechanisms underlying aseptic loosening. Recent osteoimmunologic insights into aseptic loosening highlight the important and heretofore underrepresented contribution of nanometric orthopedic wear particles. The present review updates the characteristics of metallic and ceramic nanoparticles generated after prosthesis implantation and summarizes the current understanding of their hazardous effects on peri-prosthetic cells.


Assuntos
Artroplastia de Quadril/instrumentação , Nanopartículas/efeitos adversos , Nanopartículas/química , Próteses e Implantes/efeitos adversos , Animais , Artroplastia de Quadril/efeitos adversos , Interface Osso-Implante , Cerâmica/química , Humanos , Nanopartículas Metálicas/efeitos adversos , Nanopartículas Metálicas/química , Osteoblastos/patologia , Osteoclastos/patologia
14.
PLoS Med ; 17(8): e1003291, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32866147

RESUMO

BACKGROUND: Nearly 100,000 people underwent total hip replacement (THR) in the United Kingdom in 2018, and most can expect it to last at least 25 years. However, some THRs fail and require revision surgery, which results in worse outcomes for the patient and is costly to the health service. Variation in the survival of THR implants has been observed between units and reducing this unwarranted variation is one focus of the "Getting it Right First Time" (GIRFT) program in the UK. We aimed to investigate whether the statistically improved implant survival of THRs in a high-performing unit is associated with the implants used or other factors at that unit, such as surgical skill. METHODS AND FINDINGS: We analyzed a national, mandatory, prospective, cohort study (National Joint Registry for England, Wales, Northern Ireland and the Isle of Man [NJR]) of all THRs performed in England and Wales. We included the 664,761 patients with records in the NJR who have received a stemmed primary THR between 1 April 2003 and 31 December 2017 in one of 461 hospitals, with osteoarthritis as the only indication. The exposure was the unit (hospital) in which the THR was implanted. We compared survival of THRs implanted in the "exemplar" unit with THRs implanted anywhere else in the registry. The outcome was revision surgery of any part of the THR construct for any reason. Net failure was calculated using Kaplan-Meier estimates, and adjusted analyses employed flexible parametric survival analysis. The mean age of patients contributing to our analyses was 69.9 years (SD 10.1), and 61.1% were female. Crude analyses including all THRs demonstrated better implant survival at the exemplar unit with an all-cause construct failure of 1.7% (95% CI 1.3-2.3) compared with 2.9% (95% CI 2.8-3.0) in the rest of the country after 13.9 years (log-rank test P < 0.001). The same was seen in analyses adjusted for age, sex, and American Society of Anesthesiology (ASA) score (difference in restricted mean survival time 0.12 years [95% CI 0.07-0.16; P < 0.001]). Adjusted analyses restricted to the same implants as the exemplar unit show no demonstrable difference in restricted mean survival time between groups after 13.9 years (P = 0.34). A limitation is that this study is observational and conclusions regarding causality cannot be inferred. Our outcome is revision surgery, and although important, we recognize it is not the only marker of success of a THR. CONCLUSIONS: Our results suggest that the "better than expected" implant survival results of this exemplar center are associated with implant choice. The survival results may be replicated by adopting key treatment decisions, such as implant selection. These decisions are easier to replicate than technical skills or system factors.


Assuntos
Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/tendências , Bases de Dados Factuais/tendências , Falha de Prótese/tendências , Sistema de Registros , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/normas , Estudos de Coortes , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Irlanda do Norte/epidemiologia , Estudos Prospectivos , Reino Unido/epidemiologia , País de Gales/epidemiologia
15.
Bone Joint J ; 102-B(7): 832-837, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600130

RESUMO

AIMS: We have previously demonstrated raised cobalt and chromium levels in patients with larger diameter femoral heads, following metal-on-polyethylene uncemented total hip arthroplasty. Further data have been collected, to see whether these associations have altered with time and to determine the long-term implications for these patients and our practice. METHODS: Patients from our previous study who underwent Trident-Accolade primary total hip arthroplasties using a metal-on-polyethylene bearing in 2009 were reviewed. Patients were invited to have their cobalt and chromium levels retested, and were provided an Oxford Hip Score. Serum ion levels were then compared between groups (28 mm, 36 mm, and 40 mm heads) and over time. RESULTS: Metal ion levels were repeated in 33 patients. When comparing the results of serum metal ion levels over time, regardless of head size, there was a significant increase in both cobalt and chromium levels (p < 0.001). Two patients with larger head sizes had undergone revision arthroplasty with evidence of trunnion damage at surgery. Two patients within the 40 mm subgroup had metal ion levels above the MHRA (Medicines and Healthcare Products Regulatory Agency) threshold for detailed investigation. The increase in cobalt and chromium, when comparing the 36 mm and 40 mm groups with those of the 28 mm group, was not significant (36 mm vs 28 mm; p = 0.092/p = 0.191; 40 mm vs 28 mm; p = 0.200/p = 0.091, respectively). There was no difference, between femoral head sizes, when comparing outcome as measured by the Oxford Hip Score. CONCLUSION: This study shows an increase in cobalt and chromium levels over time for all modular femoral head sizes in patients with metal-on-polyethylene bearings, with two patients demonstrating ion levels above the MHRA threshold for failure, and a further two patients requiring revision surgery. These results may have clinical implications regarding longer term follow-up of patients and future implant choice, particularly among younger patients. Cite this article: Bone Joint J 2020;102-B(7):832-837.


Assuntos
Artroplastia de Quadril/métodos , Cromo/sangue , Cobalto/sangue , Prótese de Quadril , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/instrumentação , Feminino , Humanos , Íons , Masculino , Pessoa de Meia-Idade , Polietileno , Desenho de Prótese
16.
Bone Joint J ; 102-B(7_Supple_B): 20-26, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600207

RESUMO

AIMS: This combined clinical and in vitro study aimed to determine the incidence of liner malseating in modular dual mobility (MDM) constructs in primary total hip arthroplasties (THAs) from a large volume arthroplasty centre, and determine whether malseating increases the potential for fretting and corrosion at the modular metal interface in malseated MDM constructs using a simulated corrosion chamber. METHODS: For the clinical arm of the study, observers independently reviewed postoperative radiographs of 551 primary THAs using MDM constructs from a single manufacturer over a three-year period, to identify the incidence of MDM liner-shell malseating. Multivariable logistic regression analysis was performed to identify risk factors including age, sex, body mass index (BMI), cup design, cup size, and the MDM case volume of the surgeon. For the in vitro arm, six pristine MDM implants with cobalt-chrome liners were tested in a simulated corrosion chamber. Three were well-seated and three were malseated with 6° of canting. The liner-shell couples underwent cyclic loading of increasing magnitudes. Fretting current was measured throughout testing and the onset of fretting load was determined by analyzing the increase in average current. RESULTS: The radiological review identified that 32 of 551 MDM liners (5.8%) were malseated. Malseating was noted in all of the three different cup designs. The incidence of malseating was significantly higher in low-volume MDM surgeons than high-volume MDM surgeons (p < 0.001). Pristine well-seated liners showed significantly lower fretting current values at all peak loads greater than 800 N (p < 0.044). Malseated liner-shell couples had lower fretting onset loads at 2,400 N. CONCLUSION: MDM malseating remains an issue that can occur in at least one in 20 patients at a high-volume arthroplasty centre. The onset of fretting and increased fretting current throughout loading cycles suggests susceptibility to corrosion when this occurs. These results support the hypothesis that malseated liners may be at risk for fretting corrosion. Clinicians should be aware of this phenomenon. Cite this article: Bone Joint J 2020;102-B(7 Supple B):20-26.


Assuntos
Artroplastia de Quadril/instrumentação , Prótese de Quadril/efeitos adversos , Próteses Articulares Metal-Metal/efeitos adversos , Ajuste de Prótese/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Feminino , Humanos , Técnicas In Vitro , Masculino , Teste de Materiais , Pessoa de Meia-Idade , Análise Multivariada , Desenho de Prótese , Fatores de Risco , Estresse Mecânico
17.
Bone Joint J ; 102-B(7_Supple_B): 33-40, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600210

RESUMO

AIMS: The aim of this study was to develop a novel computational model for estimating head/stem taper mechanics during different simulated assembly conditions. METHODS: Finite element models of generic cobalt-chromium (CoCr) heads on a titanium stem taper were developed and driven using dynamic assembly loads collected from clinicians. To verify contact mechanics at the taper interface, comparisons of deformed microgroove characteristics (height and width of microgrooves) were made between model estimates with those measured from five retrieved implants. Additionally, these models were used to assess the role of assembly technique-one-hit versus three-hits-on the taper interlock mechanical behaviour. RESULTS: The model compared well to deformed microgrooves from the retrieved implants, predicting changes in microgroove height (mean 1.1 µm (0.2 to 1.3)) and width (mean 7.5 µm (1.0 to 18.5)) within the range of measured changes in height (mean 1.4 µm (0.4 to 2.3); p = 0.109) and width (mean 12.0 µm (1.5 to 25.4); p = 0.470). Consistent with benchtop studies, our model found that increasing assembly load magnitude led to increased taper engagement, contact pressure, and permanent deformation of the stem taper microgrooves. Interestingly, our model found assemblies using three hits at low loads (4 kN) led to decreased taper engagement, contact pressures and microgroove deformations throughout the stem taper compared with tapers assembled with one hit at the same magnitude. CONCLUSION: These findings suggest additional assembly hits at low loads lead to inferior taper interlock strength compared with one firm hit, which may be influenced by loading rate or material strain hardening. These unique models can estimate microgroove deformations representative of real contact mechanics seen on retrievals, which will enable us to better understand how both surgeon assembly techniques and implant design affect taper interlock strength. Cite this article: Bone Joint J 2020;102-B(7 Supple B):33-40.


Assuntos
Artroplastia de Quadril/instrumentação , Simulação por Computador , Prótese de Quadril , Ajuste de Prótese , Ligas de Cromo , Análise de Elementos Finitos , Humanos , Desenho de Prótese , Estresse Mecânico , Propriedades de Superfície , Titânio
18.
Bone Joint J ; 102-B(7_Supple_B): 105-111, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600211

RESUMO

AIMS: The purpose of this study is to examine six types of bearing surfaces implanted at a single institution over three decades to determine whether the reasons for revision vary among the groups and how long it takes to identify differences in survival. METHODS: We considered six cohorts that included a total of 1,707 primary hips done between 1982 and 2010. These included 223 conventional polyethylene sterilized with γ irradiation in air (CPE-GA), 114 conventional polyethylene sterilized with gas plasma (CPE-GP), 116 crosslinked polyethylene (XLPE), 1,083 metal-on-metal (MOM), 90 ceramic-on-ceramic (COC), and 81 surface arthroplasties (SAs). With the exception of the COC, all other groups used cobalt-chromium (CoCr) femoral heads. The mean follow-up was 10 (0.008 to 35) years. Descriptive statistics with revisions per 100 component years (re/100 yr) and survival analysis with revision for any reason as the endpoint were used to compare bearing surfaces. RESULTS: XLPE liners demonstrated a lower cumulative incidence of revision at 15 years compared to the CPE-GA and CPE-GP groups owing to the absence of wear-related revisions (4% for XLPE vs 18%, p = 0.02, and 15%, p = 0.003, respectively). Revisions for adverse local tissue reactions occurred exclusively among the MOM (0.8 re/100 year) and SA groups (0.1 re/100 year). The revision rate for instability was lower among hips with 36 mm and larger head sizes compared to smaller head sizes (0.2% vs 2%, p < 0.001). CONCLUSION: The introduction of XLPE has eliminated wear-related revisions through 15-year follow-up compared to CPE-GP and CPE-GA. Dislocation incidence has been reduced with the introduction of larger diameter heads but remains a persistent concern. The potential for adverse local tissue reactions with MOM requires continued follow-up. Cite this article: Bone Joint J 2020;102-B(7 Supple B):105-111.


Assuntos
Artroplastia de Quadril/instrumentação , Prótese de Quadril , Desenho de Prótese , Falha de Prótese/tendências , Adulto , Idoso , Cerâmica , Ligas de Cromo , Estudos de Coortes , Seguimentos , Humanos , Instabilidade Articular/cirurgia , Masculino , Próteses Articulares Metal-Metal , Pessoa de Meia-Idade , Polietileno , Reoperação/estatística & dados numéricos , Virginia
19.
Jt Dis Relat Surg ; 31(2): 306-311, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584730

RESUMO

OBJECTIVES: This study aims to evaluate the efficacy of proximal humerus plate in the fixation of subtrochanteric femoral shortening osteotomy (SFSO) during total hip arthroplasty. PATIENTS AND METHODS: Thirty female patients (mean age 49.8 years; range, 22 to 68 years) who underwent hip arthroplasty with a SFSO and fixed with a proximal humerus plate between January 2014 and June 2018 were evaluated retrospectively. Rate of fracture healing, the number of fixed cortices at both sides of the osteotomy, and complications were documented. RESULTS: The mean follow-up period was 28 months (range, 12-68 months). The average time to union was 106 days (range, 45-229 days). The mean number of cortices fixed in the proximal segment of the osteotomy was 6.2 (range, 4-9), and the mean number of cortices fixed in the distal segment of the osteotomy was 4.0 (range, 3-7). None of the patients had implant irritation or implant failure at the control visits. We observed only one non-union and our non-union rate was 3.3%. CONCLUSION: In conclusion, the use of a proximal humerus plate for the fixation of SFSO can be an alternative procedure for achieving adequate rotational stability until a solid union.


Assuntos
Artroplastia de Quadril , Placas Ósseas , Fêmur/cirurgia , Luxação Congênita de Quadril/cirurgia , Osteotomia/métodos , Complicações Pós-Operatórias , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Feminino , Fêmur/diagnóstico por imagem , Consolidação da Fratura , Humanos , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Radiografia/métodos , Estudos Retrospectivos
20.
Jt Dis Relat Surg ; 31(2): 353-359, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584737

RESUMO

OBJECTIVES: This study aims to describe a stepped osteotomy technique applied to the femoral head autograft to keep the graft volume at a sufficient level, provide primary stability, and direct cancellous-cancellous bone contact. PATIENTS AND METHODS: In this retrospective study, 24 hips of 20 patients (5 males, 15 females; mean age 53 years; range, 43 to 68 years) with dysplasia of the hip (DDH) who underwent total hip arthroplasty with femoral head stepped osteotomy technique were evaluated between April 2003 and June 2010. Patients' age, gender, operation side, and postoperative complications were recorded. Aseptic loosening of the acetabular cup and graft integration/resorption were evaluated radiographically. Radiological evaluations were performed according to the methods of DeLee and Charnley, and Mulroy and Harris. Functional status of the patients was determined according to the criteria of Merle d'Aubigné and Postel, and Harris hip score (HHS). RESULTS: The mean follow-up period was 5.5 years (range, 3 to 12 years). None of the patients had any complications in the early postoperative period. In all patients, the percentage of acetabular component coverage by the graft was measured as 27% (range, 19 to 38%) on average. At the last follow-up, all patients were satisfied with the result and there was no sign of clinically loosening, osteointegration was complete, and there was no radiographic evidence of graft resorption or collapse of any hip. The overall Merle d'Aubigné scores and HHSs of the patients significantly improved at the final follow-up. CONCLUSION: This stepped osteotomy technique increases the probability of osteointegration, reduces the need for early revision, and provides reliable stability with satisfactory clinical and radiological midterm results.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril , Cabeça do Fêmur/cirurgia , Luxação Congênita de Quadril/cirurgia , Osteotomia , Complicações Pós-Operatórias , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Autoenxertos/diagnóstico por imagem , Feminino , Humanos , Efeitos Adversos de Longa Duração/diagnóstico , Efeitos Adversos de Longa Duração/etiologia , Efeitos Adversos de Longa Duração/prevenção & controle , Masculino , Pessoa de Meia-Idade , Osseointegração , Osteotomia/efeitos adversos , Osteotomia/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Radiografia/métodos , Estudos Retrospectivos
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