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1.
Bone Joint J ; 101-B(11): 1447-1458, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674248

RESUMO

AIMS: We investigated patient characteristics and outcomes of Vancouver type B periprosthetic fractures treated with femoral component revision and/or osteosynthesis. PATIENTS AND METHODS: The study utilized data from the Swedish Hip Arthroplasty Register (SHAR) and information from patient records. We included all primary total hip arthroplasties (THAs) performed in Sweden since 1979, and undergoing further surgery due to Vancouver type B periprosthetic femoral fracture between 2001 and 2011. The primary outcome measure was any further reoperation between 2001 and 2013. Cross-referencing with the National Patient Register was performed in two stages, in order to identify all surgical procedures not recorded on the SHAR. RESULTS: Out of 1381 Vancouver type B fractures that fulfilled the inclusion criteria, 257 underwent further reoperation by the end of 2013. Interprosthetic and Type B1 fractures had a higher risk for reoperation. For B1 fractures, the rate of reoperation did not differ (p = 0.322) after use of conventional (26%) or locking plate osteosynthesis (19%). No significant differences were observed between cemented, cementless monoblock, and cementless modular revision components for the treatment of type B2 and B3 fractures. CONCLUSION: In this country-specific study, the choice of locking or conventional plates for the treatment of type B1, and cemented or cementless femoral components fixation for B2 and B3 fractures, had no significant influence on risk for reoperation. Interprosthetic fractures adversely affected the outcome of treatment of type B fractures. Differences in the patient characteristics of the compared groups were observed. Cite this article: Bone Joint J 2019;101-B:1447-1458.


Assuntos
Artroplastia de Quadril/métodos , Fraturas do Quadril/cirurgia , Prótese de Quadril , Fraturas Periprotéticas/cirurgia , Acidentes por Quedas , Idoso , Artroplastia do Joelho/métodos , Feminino , Humanos , Masculino , Sistema de Registros , Reoperação/estatística & dados numéricos , Suécia
2.
Bone Joint J ; 101-B(10): 1192-1198, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564144

RESUMO

AIMS: Radiostereometric analysis (RSA) studies of vitamin E-doped, highly crosslinked polyethylene (VEPE) liners show low head penetration rates in cementless acetabular components. There is, however, currently no data on cemented VEPE acetabular components in total hip arthroplasty (THA). The aim of this study was to evaluate the safety of a new cemented VEPE component, compared with a conventional polyethylene (PE) component regarding migration, head penetration, and clinical results. PATIENTS AND METHODS: We enrolled 42 patients (21 male, 21 female) with osteoarthritis and a mean age of 67 years (sd 5), in a double-blinded, noninferiority, randomized controlled trial. The subjects were randomized in a 1:1 ratio to receive a reverse hybrid THA with a cemented component of either argon-gas gamma-sterilized PE component (controls) or VEPE, with identical geometry. The primary endpoint was proximal implant migration of the component at two years postoperatively measured with RSA. Secondary endpoints included total migration of the component, penetration of the femoral head into the component, and patient-reported outcome measurements. RESULTS: In total, 19 control implants and 18 implants in the VEPE group were analyzed for the primary endpoint. We found a continuous proximal migration of the component in the VEPE group that was significantly higher with a difference at two years of a mean 0.21 mm (95% confidence interval (CI) 0.05 to 0.37; p = 0.013). The total migration was also significantly higher in the VEPE group, but femoral head penetration was lower. We found no difference in clinical outcomes between the groups. CONCLUSION: At two years, this cemented VEPE component, although having a low head penetration and excellent clinical results, failed to meet noninferiority compared with the conventional implant by a proximal migration above the proposed safety threshold of RSA. The early proximal migration pattern of the VEPE component is a reason for continued monitoring, although a specific threshold for proximal migration and risk for later failure cannot be defined and needs further study. Cite this article: Bone Joint J 2019;101-B:1192-1198.


Assuntos
Artroplastia de Quadril/efeitos adversos , Migração de Corpo Estranho/diagnóstico por imagem , Osteoartrite do Quadril/cirurgia , Polietilenos/química , Desenho de Prótese , Falha de Prótese/tendências , Fatores Etários , Idoso , Artroplastia de Quadril/métodos , Método Duplo-Cego , Feminino , Migração de Corpo Estranho/epidemiologia , Prótese de Quadril , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico por imagem , Prognóstico , Análise Radioestereométrica , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Estatísticas não Paramétricas , Suécia , Vitamina E/farmacologia
3.
Zhongguo Gu Shang ; 32(9): 785-791, 2019 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-31615171

RESUMO

OBJECTIVE: To assess the clinical efficacy of Tri-Lock bio-short prosthesis in artificial total hip arthroplasty(THA) in young patients with Dorr type C femoral medullary cavity. METHODS: From January 2010 to January 2014, 35 young patients(37 hips) with in the chimney-like femoral medullary cavity received Tri-Lock BPS prosthesis of THA, including 18 males(20 hips) and 17 females with an average age of (32.2±3.0) years old ranging from 21.2 to 38.5 years old. There were 16 cases of rheumatoid hip arthritis (17 hips), 8 cases of rheumatoid arthritis (9 hips), and 11 cases of aseptic necrosis of femoral head (11 hips). All cases were complicated with different degrees of osteoporosis. According to Singh index, 26 cases were classified as Grade III and 9 cases as Grade II. Biological prostheses were used for the acetabulum, with ceramic lining and full ceramic femoral head. The proximal femoral medullary cavity was Dorr type C on anteroposterior X-ray. After replacement, X-ray examination was performed to locate the prosthesis stem. Engh and Harris criteria were used to evaluate the stability of bone-prosthesis interface and hip function, respectively. Changes of hip movement pre-operation and at last follow-up were compared. RESULTS: All patients were followed up for 18 to 45 months(means 33.8 months). Harris hip scores in 35 cases (37 hips) increased significantly from preoperative 61.8±3.0 (51.2 to 73.5) to 93.3±6.5 (92.5 to 98.8) points at last follow-up (t=54.745, P<0.01). The hip mobility increased from (46.5±8.0)°(0° to 55°) before surgery to(101.2±10.5)°(85° to 130°) at the last follow-up, the difference was statistically significant(t=133.091, P<0.01). Immediately after surgery, the prostheses were tightly packed with the medullary cavity. At the final follow-up, 17 hips had significant femur cortical bone thickening;12 hips had varying degrees of stress occlusal bone resorption at proximal femoral, including 9 degree I(low femur density, round and blunt) and 3 degree II(involving small rotor) hips. Meanwhile, 15 hips had significant femur cortical bone thickening without thigh pain. CONCLUSIONS: The cone-shaped short Tri-lock biological short-stem can fill Dorr C chimney-like medullary cavity and effectively retain good proximal femoral bone mass. Titanium microporous coating on the surface can effectively increase the friction of the prosthesis. The short-stem end in the medullary cavity can effectively avoid the occurrence of coxa varus.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Acetábulo , Adulto , Feminino , Fêmur , Cabeça do Fêmur , Seguimentos , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
4.
Zhongguo Gu Shang ; 32(9): 797-801, 2019 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-31615173

RESUMO

OBJECTIVE: To study the effect of pelvic rotation in three-dimensional direction on the actual placement angle of acetabular prosthesis in total hip arthroplasty. METHODS: Pelvic CT imaging data of normal adults were collected, and three-dimensional reconstruction of pelvic acetabulum was performed with computer software to simulate the rotation of the pelvis around X, Y and Z axes perpendicular to the sagittal, transverse and coronal planes of the human body. Radiographic inclination(RI) and radiographic anteversion (RA) of the acetabular cup were measured when the acetabular prosthesis was implanted at a standard angle. The correlation analysis was used to quantify the relationship between the rotation angle of each axis and the actual angle of acetabulum. RESULTS: The pelvic rotation along the X-axis and Y-axis had little effect on the RA of the acetabulum, but had a great influence on the RI and showed a linear correlation. The regression equations were RA=0.682 4X+10.256(r²=0.308 4) and RA=-0.714 1Y+10.424(r²=0.999 8). The pelvic rotation along the Z-axis had little effect on the RA, but had a linear correlation with the RI, and the regression equation was RI=1.0Z+46(r²=1.0). CONCLUSIONS: The anteroposterior rotation of the pelvis or the longitudinal rotation along the body significantly affected the acetabular anteversion, but had little effect on the abduction angle. On the contrary, the left and right deviation of the pelvis on the coronal plane could significantly affect the acetabular anteversion angle, but did not affect its anteversion angle.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Acetábulo , Adulto , Humanos , Pelve , Rotação
5.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(11): 1374-1378, 2019 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-31650751

RESUMO

Objective: To investigate the accuracy of preoperative digital-template planning in total hip arthroplasty (THA) via direct anterior approach (DAA) and its effect on the short-term effectiveness. Methods: The clinical data of 77 patients (109 hips) with osteonecrosis of femoral head who underwent THA via DAA between January 2016 and May 2018 was retrospectively analyzed. According to the type of template, patients were divided into digital-template group (group A, 40 patients, 56 hips) and conventional-template group (group B, 37 patients, 53 hips). There was no significant difference in age, gender, body mass index, the stages of osteonecrosis of femoral head, and preoperative Harris hip score (HHS) ( P>0.05). The operation time, intraoperative blood loss, frequencies of intraoperative fluoroscopy, and complications were recorded. Otherwise, the consistency rate of preoperative planning and practical prosthesis size was analyzed. Position of acetabular prosthesis and femoral prosthesis alignment were measured on anteroposterior X-ray film of the pelvis at 3 months after operation. HHS was used to evaluate clinical function. Results: The consistency rate of preoperative planning and practical acetabular prosthesis size was significantly higher in group A (80.4%, 45/56) than that in group B (62.3%, 33/53), showing significant difference ( χ 2=4.38, P=0.04). But there was no significant difference in the consistency rate of preoperative planning and practical femoral prosthesis size between group A (83.9%, 47/56) and group B (79.2%, 42/53)( χ 2=0.40, P=0.53). The prosthesis abductions were (40.7±6.4)° in group A and (38.8±7.3)° in group B; the femoral prosthesis alignment deviations were (0.1±1.8)° in group A and (0.3±1.7)° in group B. There was no significant difference in the prosthesis abduction and femoral prosthesis alignment deviation between 2 groups ( P>0.05). No prosthesis sinking or loosening occurred during follow-up. The operation time and frequencies of intraoperative fluoroscopy were less in group A than those in group B ( P<0.05). But there was no significant difference in intraoperative blood loss between 2 groups ( t=1.92, P=0.06). The complication occurred in 1 hip of group A and 6 hips of group B, with no significant difference ( P=0.06). All patients were followed up 6-22 months (mean 13.8 months) in group A and 6-24 months (mean, 14.6 months) in group B. At last follow-up, the HHS scores were 91.8±3.1 in group A and 92.6±4.2 in group B, and the difference was not significant ( t=1.14, P=0.26). Conclusion: Preoperative digital-template planning in THA via DAA is accurate, which can reduce the operation time and frequencies of intraoperative fluoroscopy without enhancing the risk of complication.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Articulação do Quadril , Humanos , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
6.
Khirurgiia (Mosk) ; (10): 55-61, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626240

RESUMO

OBJECTIVE: To assess mid-term and long-term results of metal-on-metal total hip arthroplasty. MATERIAL AND METHODS: There were 349 operations for the period 2006-2012 in our clinic. Sixty-four patients underwent a full examination. All patients underwent X-ray examination of the pelvis, MRI of hip joint with metal artifact reduction sequence (MARS). The concentration of cobalt and chromium metal ions was determined in blood serum. Each patient completed a questionnaire (Harris, Oxford, Womac, SF-36). 'Survival' of endoprostheses was calculated using the Kaplan-Meier method. RESULTS: According to the Oxford scale, 76.6% of patients had excellent clinical and functional outcomes, 10.9% - good, 9.4% - satisfactory, 3.1% - unsatisfactory. According to the Harris scale, 57.9% of patients had excellent results, 15.6% - good, 7.8% - satisfactory, 18.7% - unsatisfactory. Inclination less than 45 degrees was noted in 77.2% of acetabular components. It is optimal installation angle. According to MRI data, effusion was the main type of periprosthetic changes (16 cases). There were no periprosthetic changes in 33 cases. Pseudotumor was diagnosed in 5 cases. Mean concentrations of cobalt and chromium ions were 1.27 (13.57-0.12) and 0.59 (0.4-0.87) µg/l, respectively. Normal concentration of chromium ions was observed in all cases. Kaplan-Meier survival rate of endoprostheses was 89% (80-97%). CONCLUSION: There was no correlation between female sex, young age of patients and incidence of complications. It is necessary to exclude pseudotumor in case of pain syndrome and no signs of aseptic loosening of the components of the endoprosthesis.


Assuntos
Artroplastia de Quadril , Articulação do Quadril/cirurgia , Artropatias/cirurgia , Próteses Articulares Metal-Metal , Cromo/sangue , Cobalto/sangue , Feminino , Prótese de Quadril , Humanos , Artropatias/sangue , Desenho de Prótese , Resultado do Tratamento
7.
Surg Technol Int ; 35: 391-395, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31571187

RESUMO

Careful surgical technique is a critical component of total hip arthroplasty. Femoral preparation and component positioning are vital to improving outcomes and preventing complications. Femoral preparation begins with creating an entry hole in the proximal femur. Various tools have been used for this purpose which resemble a "cookie cutter." An axial starter reamer, or awl, is then inserted through the entry hole in the proximal femur to aid in opening and centralizing the canal for sequential reaming or broaching. A novel technique was described previously which allows the awl to center itself in the canal with little risk of deviation from midline or cortical perforation. Since describing this technique in 2014, the senior surgeon has further modified the method of preparing the entry hole in the proximal femur. The surgeon now uses a 1/8" drill bit to penetrate the piriformis fossa, instead of a "cookie cutter" or osteotome. A 1/8" entry hole eliminates gaps between the bone and the implant, results in lateralization of the stem, and avoids varus malposition. We evaluated 300 primary hip arthroplasties by a single surgeon using one of the three techniques: traditional clockwise technique (Group 1), our previously published novel counterclockwise technique (Group 2), and our updated novel technique (Group 3). While the deviation from midline of Group 3 did not differ significantly from Group 2, it was significantly less than the deviation from midline of Group 1 (p=00006). This simple updated technique enables the surgeon to avoid potential malalignment during femoral preparation.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Fêmur/cirurgia , Osteotomia
8.
Surg Technol Int ; 35: 386-390, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31571189

RESUMO

INTRODUCTION: The direct anterior (DA) approach for total hip arthroplasty (THA) is gaining popularity; however, this approach still poses a higher risk for femoral complications, including fracture. The design of cementless stems can also impact the risk of fracture. The purpose of this study is to evaluate the early postoperative femoral complications with a short, triple-wedge broach-only tapered stem used in primary THA via a DA approach. MATERIALS AND METHODS: A retrospective review of our institution's arthroplasty registry from 2015 through 2018 was performed to identify all patients who underwent a primary total hip arthroplasty via a direct anterior approach with the Klassic® Blade Stem (Total Joint Orthopedics, Inc., Salt Lake City, Utah). Patients were excluded if the stem was used for a revision surgery, within 90 days of surgery, or if research consent was refused. Two-hundred forty-five patients (289 hips) met inclusion criteria. Clinical and operative notes were reviewed, along with postoperative radiographs. RESULTS: Average follow up was 0.6 years (range, 0.25 to 3.6 years). Mean patient age was 62.9 years and mean body mass index (BMI) was 29.4 kg/m2. Gender was male in 130 patients (53%) and female in 115 patients (47%). No patients sustained an early postoperative periprosthetic femur fracture. No femoral revisions have been performed at most recent follow up. All 150 patients with >90-day postoperative radiographs demonstrated bony ingrowth of the stem. Early outcomes scores showed a mean postoperative Harris Hip Scores (HHS) of 80.1 (range, 10 to 100) and a pain score of 35.9 (range, 0 to 44). CONCLUSION: This triple-wedge broach-only implant demonstrated low rates of early perioperative femoral complications in primary THA via a direct anterior approach. The authors will continue to monitor the longer-term survival and patient outcomes with this implant.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Feminino , Fêmur , Seguimentos , Humanos , Masculino , Desenho de Prótese , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
9.
Acta Ortop Mex ; 33(2): 67-72, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31480106

RESUMO

The increase in total hip arthroplasty occurs by many factors, such as increasing life expectancy, improving surgical technique as well as innovating the design and implant material. However, despite technological advances, peri-prosthetic infection has remained one of the most devastating complications. This study evaluates the prophylactic application of calcium sulfate pearls medicated in the femoral canal and acetabular surface to prevent peri-prosthetic infections in patients who underwent total uncemented primary hip arthroplasty against a control group by measuring acute phase reactants. 146 patients, 67 were applied calcium sulfate pearls medicated and 79 prophylactic antibiotic intravenous in the period from 2013 to 2016. To perform the diagnosis of peri-prosthetic infection was assessed PCR associated with VSG, communication between fistula and prostheses and positive culture in 2 or more different sites. There was a decrease in the values of acute-phase reactants in patients who were given calcium sulfate pearls. 14 patients presented infection in the control group and 3 in the study group. The prophylactic use of calcium sulphate pearls within the medullary canal and acetabular surface is an option for the prophylaxis of peri-prosthetic infections, however the study deserves follow-up with more patients.


Assuntos
Artroplastia de Quadril , Sulfato de Cálcio , Prótese de Quadril , Sulfato de Cálcio/uso terapêutico , Humanos , Desenho de Prótese , Falha de Prótese , Reoperação
10.
Niger J Clin Pract ; 22(9): 1276-1280, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489866

RESUMO

Aims: The present study aims to improve the design of cementless femoral prosthesis stem and achieve better bone ingrowth and long-term stability. Materials and Methods: Four models with different directional hollow holes at the proximal end of femoral prosthesis were designed and finite element analysis was applied to calculate the magnitude of conducting force within the differently angled holes and the stress distribution of the femur and prosthesis. Results: Holes in prostheses make no difference on the stress values of femoral inner walls. The conducting forces in models trepanned on the lateral plane were 6.60N (0° pore) and 8.40N (45° pore) while forces in models trepanned on the anterior-posterior planes were 0.45N (upper 0° pore), 0.48N (lower 0° pore) and 1.57N (upper 45° pore), 1.51N (lower 45° pore), respectively. Conclusion: The position and direction of hollow holes influenced the conducting force in holes but had no influence on stress values of femoral inner walls. Prostheses with one 45° hole trepanned on the lateral plane of proximal prostheses presented best in elevating conducting force.


Assuntos
Artroplastia de Quadril/instrumentação , Fêmur/cirurgia , Análise de Elementos Finitos , Prótese de Quadril , Imagem Tridimensional/métodos , Desenho de Prótese/métodos , Artroplastia de Quadril/métodos , Fêmur/diagnóstico por imagem , Humanos , Masculino , Teste de Materiais , Pessoa de Meia-Idade , Porosidade , Desenho de Prótese/normas , Estresse Mecânico , Tomografia Computadorizada Espiral
11.
Pol Merkur Lekarski ; 47(279): 99-102, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31557138

RESUMO

The cause of septic arthritis in 20% of cases is anaerobic bacteria, including infections caused by Finegoldia magna. The occurrence of this pathogen in the etiology of postoperative post-implantive septic joint inflammations is estimated at 5-12% of all anaerobic infections, and 20-40% of all gram-positive anaerobic coccus (GPAC). CASE REPORTS: The 65-year-old male patient was admitted due to symptoms of pain in the left hip after having undergone arthroplasty three years prior. It was found that the relative length of the left lower limb was shortened by 1.5 cm and there was limited mobility of the left hip joint. The radiological image of the left hip indicated the loosening of the endoprosthesis, which qualified for a revision surgery. During hip revision surgery, the material was collected from the site, for microbiological examination, in which Finegoldia magna was detected, sensitive to Amoxicillin with Clavulanic acid, Clindamycin, Chloramphenicol, Imipenem, Metronidazole and Piperacillin with Tazobactam. Based upon the antibiogram, the patient was given piperacillin with tazobactam (Tazocin, Pfizer) 4 times a day 4.5 g intravenously over 7 days, resulting in a clinical improvement. The 55-year-old female patient was admitted due to recurrent exudates in left trochlear bursa which arose 5 years after left hip arthroplasty. The patient had limited movements in the left hip. Ulrasound diagnostics showed a presence of a thick fluid reservoir located under the fascia in the lateral side of the left thigh measuring 160 x 42 x 25 mm, which had contact with the hip joint. In the radiographic image of the joint, a cyst around the bottom of the implanted acetabular component was revealed. The patient underwent hip revision surgery, and an anaerobic bacterium Finegoldia magna was isolated from a swab taken from the acetabulum. The patient was given piperacillin with tazobactam (Tazocin, Pfizer) 4 times a day 4.5 g intravenously over 7 days, with good clinical effect. CONCLUSIONS: In both cases, the post-implantation septic infection was triggered by Finegoldia magna. Arthroplasty with subsequent antibiotic therapy resulted in an improvement of the patients' condition and joint reconstruction. In orthopedic practice it should be noted that infections due to the anaerobic bacteria Finegoldia magna may be the cause of complications after the arthroplasty of the joints.


Assuntos
Artroplastia de Quadril , Infecções Bacterianas , Prótese de Quadril , Falha de Prótese , Idoso , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/etiologia , Composição de Bases , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Filogenia , RNA Ribossômico 16S , Reoperação , Análise de Sequência de DNA
12.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(9): 1116-1120, 2019 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-31512452

RESUMO

Objective: To evaluate the mid- and long-term effectiveness of total hip arthroplasty (THA) with Ribbed femoral stem prosthesis. Methods: A clinical data of 354 patients (384 hips) with hip disease who underwent THA with Ribbed femoral stem prostheses between October 2006 and May 2016 was retrospectively analyzed. There were 171 males and 183 females, with an average age of 53.4 years (range, 20-82 years). There were 324 cases of single hip and 30 cases of bilateral hips. The cause of THA included the avascular necrosis of the femoral head in 151 cases (159 hips), hip osteoarthritis in 134 cases (136 hips), rheumatoid arthritis in 43 cases (43 hips), ankylosing spondylitis in 20 cases (40 hips), and trauma in 6 cases (6 hips). The Harris score of total 354 patients before operation was 42.34±8.89. Harris scores were used to evaluate hip function after operation. X-ray films were used to determine the length of the lower limb, the radiolucent line on the femur side, the stability of the prosthesis, and the occurrence of stress shielding. Results: The incisions healed by first intention. All patients were followed up 2-11 years with an average of 7.4 years. The Harris score at last follow-up was 80.52±7.61, which significantly increased when compared with preoperative score ( t=134.804, P=0.000). Two cases (2 hips) of prosthetic infections, 3 cases (3 hips) of prothesis loosening, and 4 cases (4 hips) of periprosthetic fractures, and 48 cases (48 hips) of mild to moderate thigh pain occurred after operation. X-ray films showed 76 cases (78 hips) with radiolucent lines on the femur side and stress shielding. According to the Engh's method, there were 364 hips of bone ingrowth, 15 hips of fibrosis ingrowth, and 5 hips of prosthesis instability. The femoral stem subsidence occurred in 25 cases (25 hips), and the difference in leg length discrepancy was more than 10 mm in 5 patients. Conclusion: THA with Ribbed femoral stem prosthesis can achieve satisfactory effectiveness with good initial stability and rapid bone growth. The incidence of stress shielding is relatively high, but the stress shielding has no significant impact on the mid- and long-term survival rate and effectiveness of femoral prosthesis.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Artroplastia de Quadril/estatística & dados numéricos , Feminino , Seguimentos , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
Bone Joint J ; 101-B(9): 1035-1041, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474131

RESUMO

AIMS: The aim of this study was to evaluate blood metal ion levels, leucocyte profiles, and serum cytokines in patients with a total hip arthroplasty (THA) involving modular dual-mobility components. PATIENTS AND METHODS: A total of 39 patients were recruited, with clinical follow-up of up to two years. Outcome was assessed using the Harris Hip Score (HHS, the 12-Item Short-Form Health Survey (SF-12), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and a visual analogue scale (VAS) for pain. Blood concentrations of cobalt (Co), chromium (Cr), and serum cytokines were measured. Subpopulations of leucocytes were analyzed by flow cytometry. RESULTS: The clinical performance was good. Blood Co levels (ref 1.0 µg/l) were mildly elevated in seven patients at three months, and two patients at two years' follow-up. The preoperative Cr levels were normal except for one patient with a detectable Cr (1.2 µg/l). Cr levels were detectable in three patients at three months, two patients at one year, and three patients at two years' follow-up. No patients had symptoms suggestive of failure. Although flow cytometry showed constant circulating leucocyte profiles, there was a significant reduction of serum interleukin (IL)-4, IL-5, and interferon gamma (IFNγ) postoperatively compared with the preoperative levels (p < 0.05). CONCLUSION: These results suggest that THA using modular dual-mobility components is safe. This allows an opportunity to use a large femoral head and a thick polyethylene bearing surface, which is especially useful in revision procedures or high-risk situations when added stability is required. Cite this article: Bone Joint J 2019;101-B:1035-1041.


Assuntos
Artroplastia de Quadril/instrumentação , Cromo/sangue , Cobalto/sangue , Citocinas/sangue , Prótese de Quadril , Contagem de Leucócitos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Materiais Biocompatíveis , Cerâmica , Feminino , Seguimentos , Prótese de Quadril/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Amplitude de Movimento Articular , Titânio
14.
Bone Joint J ; 101-B(9): 1050-1057, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474145

RESUMO

AIMS: To our knowledge, no study has compared the long-term results of cemented and hybrid total hip arthroplasty (THA) in patients with osteoarthritis (OA) secondary to congenital hip disease (CHD). This is a demanding procedure that may require special techniques and implants. Our aim was to compare the long-term outcome of cemented low-friction arthroplasty (LFA) and hybrid THA performed by one surgeon. PATIENTS AND METHODS: Between January 1989 and December 1997, 58 hips (44 patients; one man, 43 woman; mean age 56.6 years (25 to 77)) with OA secondary to CHD were treated with a cemented Charnley LFA (group A), and 55 hips (39 patients; two men, 37 women; mean age 49.1 years (27 to 70)) were treated with a hybrid THA (group B), by the senior author (GH). The clinical outcome and survivorship were compared. RESULTS: At all timepoints, group A hips had slightly better survivorship than those in group B without a statistically significant difference, except for the 24-year survival of acetabular components with revision for aseptic loosening as the endpoint, which was slightly worse. The survivorship was only significantly better in group A compared with group B when considering reoperation for any indication as the endpoint, 15 years postoperatively (74% vs 52%, p = 0.018). CONCLUSION: We concluded that there was not a substantial difference at almost any time in the outcome of cemented Charnley LFAs compared with hybrid THAs when treating patients with OA of the hip secondary to CHD. We believe, however, that after improvements in the design of components used in hybrid THA, this could be the method of choice, as it is technically easier with a shorter operating time. Cite this article: Bone Joint J 2019;101-B:1050-1057.


Assuntos
Artroplastia de Quadril/métodos , Luxação Congênita de Quadril/cirurgia , Prótese de Quadril , Osteoartrite do Quadril/cirurgia , Adulto , Idoso , Cimentos para Ossos/uso terapêutico , Cimentação , Feminino , Luxação Congênita de Quadril/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/etiologia , Desenho de Prótese , Sistema de Registros , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
15.
Bone Joint J ; 101-B(9): 1042-1049, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474147

RESUMO

AIMS: Several radiological methods of measuring anteversion of the acetabular component after total hip arthroplasty (THA) have been described. These are limited by low reproducibility, are less accurate than CT 3D reconstruction, and are cumbersome to use. These methods also partly rely on the identification of obscured radiological borders of the component. We propose two novel methods, the Area and Orthogonal methods, which have been designed to maximize use of readily identifiable points while maintaining the same trigonometric principles. PATIENTS AND METHODS: A retrospective study of plain radiographs was conducted on 160 hips of 141 patients who had undergone primary THA. We compared the reliability and accuracy of the Area and Orthogonal methods with two of the current leading methods: those of Widmer and Lewinnek, respectively. RESULTS: The 160 anteroposterior pelvis films revealed that the proposed Area method was statistically different from those described by Widmer and Lewinnek (p < 0.001 and p = 0.004, respectively). They gave the highest inter- and intraobserver reliability (0.992 and 0.998, respectively), and took less time (27.50 seconds (sd 3.19); p < 0.001) to complete. In addition, 21 available CT 3D reconstructions revealed the Area method achieved the highest Pearson's correlation coefficient (r = 0.956; p < 0.001) and least statistical difference (p = 0.704) from CT with a mean within 1° of CT-3D reconstruction between ranges of 1° to 30° of measured radiological anteversion. CONCLUSION: Our results support the proposed Area method to be the most reliable, accurate, and speedy. They did not support any statistical superiority of the proposed Orthogonal method to that of the Widmer or Lewinnek method. Cite this article: Bone Joint J 2019;101-B:1042-1049.


Assuntos
Acetábulo/diagnóstico por imagem , Artroplastia de Quadril/efeitos adversos , Anteversão Óssea/diagnóstico por imagem , Cabeça do Fêmur/diagnóstico por imagem , Prótese de Quadril/efeitos adversos , Acetábulo/cirurgia , Anteversão Óssea/etiologia , Diagnóstico por Computador , Cabeça do Fêmur/cirurgia , Humanos , Radiografia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
17.
Bone Joint J ; 101-B(8): 970-977, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31362542

RESUMO

AIMS: The aim of this study was to evaluate the diagnostic accuracy of the synovial alpha-defensin enzyme-linked immunosorbent assay (ELISA) for the diagnosis of prosthetic joint infection (PJI) in the work-up prior to revision of total hip (THA) and knee arthroplasty (TKA). PATIENTS AND METHODS: Inclusion criteria for this prospective cohort study were acute or chronic symptoms of the index joint without specific exclusion criteria. Synovial fluid aspirates of 202 patients were analyzed and semiquantitative laboratory alpha-defensin ELISA was performed. Final diagnosis of PJI was established by examination of samples obtained during revision surgery. RESULTS: Sensitivity and specificity of the alpha-defensin ELISA for PJI were 78.2% (95% confidence interval (CI) 66.7 to 88.5) and 96.6% (95% CI 93.0 to 99.3). Positive and negative predictive values were 89.6% (95% CI 80.6 to 97.8) and 92.2% (95% CI 87.5 to 96.1). The test remained false-negative in 22% of septic revisions, most of which were due to coagulase-negative staphylococci all occurring in either late-chronic or early-postoperative PJI. CONCLUSION: The routine use of synovial fluid alpha-defensin laboratory ELISA in the preoperative evaluation of symptomatic THAs and TKAs is insufficient to accurately diagnose PJI. Particularly in cases involving low-virulence organisms, such as coagulase-negative staphylococci, there remains a need for tests with a higher sensitivity. Cite this article: Bone Joint J 2019;101-B:970-977.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Ensaio de Imunoadsorção Enzimática/métodos , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico , alfa-Defensinas/metabolismo , Biomarcadores/metabolismo , Reações Falso-Negativas , Feminino , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Humanos , Masculino , Estudos Prospectivos , Reoperação , Sensibilidade e Especificidade , Líquido Sinovial/metabolismo
18.
Bone Joint J ; 101-B(8): 960-969, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31362543

RESUMO

AIMS: The aim of this study was to give estimates of the incidence of component incompatibility in hip and knee arthroplasty and to test the effect of an online, real-time compatibility check. MATERIALS AND METHODS: Intraoperative barcode registration of arthroplasty implants was introduced in Denmark in 2013. We developed a compatibility database and, from May 2017, real-time compatibility checking was implemented and became part of the registration. We defined four classes of component incompatibility: A-I, A-II, B-I, and B-II, depending on an assessment of the level of risk to the patient (A/B), and on whether incompatibility was knowingly accepted (I/II). RESULTS: A total of 26 524 arthroplasties were analyzed. From 12 307 procedures that were undertaken before implementation of the compatibility check, 21 class A incompatibilities were identified (real- or high-risk combinations; 0.17%; 95% confidence interval (CI) 0.11 to 0.26). From 5692 hip and 6615 knee procedures prior to implementation of the compatibility check, we found rates of class A-I incompatibility (real- or high-risk combinations unknowingly inserted) of 0.14% (95% CI 0.06 to 0.28) and 0.17% (95% CI 0.08 to 0.30), respectively. From 14 217 procedures after the introduction of compatibility checking (7187 hips and 7030 knees), eight class A incompatibilities (0.06%; 95% CI 0.02 to 0.11) were identified. This difference was statistically significant (p = 0.008). CONCLUSION: Our data presents validated estimates of the baseline incidence of incompatibility events for hip and knee arthroplasty procedures and shows that a significant reduction in class A incompatibility events is possible using a web-based recording system. Cite this article: Bone Joint J 2019;101-B:960-969.


Assuntos
Artroplastia de Quadril/instrumentação , Artroplastia do Joelho/instrumentação , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Erros Médicos/prevenção & controle , Desenho de Prótese/efeitos adversos , Falha de Prótese/etiologia , Estudos de Coortes , Sistemas de Computação , Dinamarca , Humanos , Erros Médicos/efeitos adversos , Erros Médicos/estatística & dados numéricos , Falha de Prótese/efeitos adversos , Sistema de Registros
19.
Bone Joint J ; 101-B(8): 910-914, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31362552

RESUMO

AIMS: Prosthetic joint infection (PJI) and aseptic loosening in total hip arthroplasty (THA) can present with pain and osteolysis. The Musculoskeletal Infection Society (MSIS) has provided criteria for the diagnosis of PJI. The aim of our study was to analyze the utility of F18-fluorodeoxyglucose (FDG) positron emission tomography (PET) CT scan in the preoperative diagnosis of septic loosening in THA, based on the current MSIS definition of prosthetic joint infection. PATIENTS AND METHODS: A total of 130 painful unilateral cemented THAs with a mean follow-up of 5.17 years (sd 1.12) were included in this prospective study. The mean patient age was 67.5 years (sd 4.85). Preoperative evaluation with inflammatory markers, aspiration, and an F18 FDG PET scan were performed. Diagnostic utility tests were also performed, based on the MSIS criteria for PJI and three samples positive on culture alone. RESULTS: The mean erythrocyte sedimentation rate, C-reactive protein, and white cell count were 47.83 mm/hr, 25.21 mg/l, and 11.05 × 109/l, respectively. The sensitivity, specificity, accuracy, negative predictive value, and false-positive rate of FDG PET compared with MSIS criteria were 94.87%, 38.46 %, 56.38%, 94.59 %, and 60.21%, respectively. The false-positive rate of FDG PET compared with culture alone was 77.4%. CONCLUSION: FDG PET has a definitive role in the preoperative evaluation of suspected PJI. This the first study to evaluate its utility based on MSIS criteria and compare it with microbiology results alone. However, FDG PET has a high false-positive rate. Therefore, we suggest that F18 FDG PET is useful in confirming the absence of infection, but if positive, may not be confirmatory of PJI. Cite this article: Bone Joint J 2019;101-B:910-914.


Assuntos
Fluordesoxiglucose F18 , Prótese de Quadril/efeitos adversos , Tomografia por Emissão de Pósitrons/métodos , Cuidados Pré-Operatórios/métodos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos , Idoso , Reações Falso-Positivas , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/cirurgia , Sensibilidade e Especificidade
20.
Bone Joint J ; 101-B(8): 897-901, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31362553

RESUMO

Ceramic bearings have several desirable properties, such as resistance to wear, hardness, and biocompatibility, that favour it as an articulating surface in hip arthroplasty. However, ceramic fracture remains a concern. We have reviewed the contemporary literature, addressing the factors that can influence the incidence of ceramic bearing surface fracture. Cite this article: Bone Joint J 2019;101-B:897-901.


Assuntos
Artroplastia de Quadril/instrumentação , Cerâmica , Prótese de Quadril , Desenho de Prótese , Falha de Prótese , Cerâmica/efeitos adversos , Prótese de Quadril/efeitos adversos , Humanos , Falha de Prótese/efeitos adversos , Falha de Prótese/etiologia
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