RESUMO
BACKGROUND: Hemiarthroplasty is a common treatment for displaced femoral neck fractures, but limited Canadian data are available about hemiarthroplasty failure. We evaluated the frequency and predictors of hemiarthroplasty failure in Manitoba. METHODS: In this retrospective multicentre province-wide study, billing and joint registry databases showed 4693 patients who had hemiarthroplasty for treatment of femoral neck fracture in Manitoba over an 11-year period (2005-2015), including 155 hips with subsequent reoperations (open or closed) for treatment of hemiarthroplasty failure. Hospital records were reviewed to identify modes of hemiarthroplasty failure, comorbidities and reoperations. Data were analyzed using χ2 test and Poisson and γ regression models. RESULTS: During our study period, 155 hips (154 patients [3%]) underwent 230 reoperations. Of these, 131 hips (85%) initially had an uncemented unipolar modular implant. Indications for first-time reoperation included periprosthetic femur fracture (49 hips [32%]), dislocation (45 hips [29%]), acetabular wear (28 hips [18%]) and infection (26 hips [17%]). There were 46 hips (30%) that had 2 or more reoperations. Reoperation for dislocation was associated with presence of dementia; acetabular wear was associated with absence of dementia. Time from hemiarthroplasty to reoperation was associated inversely with age at hemiarthroplasty, dislocation and dementia and was directly associated with acetabular wear. The risk of having 2 or more reoperations was associated independently with dislocation, infection, and alcohol abuse. CONCLUSION: Hemiarthroplasty for femoral neck fracture in Manitoba had a low frequency of failure. Risk factors for multiple reoperations included dislocation, infection and alcohol abuse.
Assuntos
Alcoolismo , Artroplastia de Quadril , Demência , Fraturas do Colo Femoral , Hemiartroplastia , Prótese de Quadril , Fraturas Periprotéticas , Alcoolismo/complicações , Alcoolismo/cirurgia , Artroplastia de Quadril/efeitos adversos , Canadá , Demência/complicações , Demência/cirurgia , Fraturas do Colo Femoral/complicações , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/efeitos adversos , Prótese de Quadril/efeitos adversos , Humanos , Fraturas Periprotéticas/complicações , Fraturas Periprotéticas/cirurgia , Reoperação/efeitos adversos , Resultado do TratamentoRESUMO
Background: A novel symmetric posterior condylar design and option of a femoral component with an outer zirconium oxide layer were introduced to a successful asymmetric condylar total knee arthroplasty system in 2005. Given the paucity of information on this modified design, we performed a study to determine its early to midterm survivorship and performance. Methods: Patients who received the Genesis II Symmetric Posterior Condyle or Legion Primary total knee (cobaltchromium [CoCr] or oxidized zirconiumniobium [OxZr]) (Smith & Nephew) implanted at the study centre between March 2007 and December 2013 were enrolled into a prospective database. We retrospectively reviewed the database and performed survival analysis using KaplanMeier techniques. Results: There were 2178 patients (1359 women [62.4%]; mean age 64.6 yr; mean body mass index 35.0) with 2815 knee replacements available for analysis. Survival rates were 98.2% (95% confidence interval [CI] 97.6%98.7%) for failure for any reason at 2 years and 96.8% (95% CI 96.0%97.7%) at 5 years. Age (hazard ratio [HR] 0.97, 95% CI 0.940.997) and female sex (HR 0.45, 95% CI 0.270.75) were protective, whereas body mass index (HR 1.02, 95% CI 0.991.05) and OxZr implant (HR 1.11, 95% CI 0.572.18) did not influence survivorship. Oxford Knee Score values improved from a mean of 40.2 to 21.8 by 2 years (p < 0.001), with no difference between the CoCr and OxZr groups. Conclusion: The symmetric posterior condylar posterior-stabilized knee offers excellent midterm survivorship. Implant bearing surface did not have an influence on survivorship to 5 years, and, thus, use of OxZr implants may not be justified.
Contexte: Un nouveau modèle à condyles postérieurs symétriques et l'option d'un élément fémoral pourvu d'une couche d'oxyde de zirconium ont été introduits avec succès dans un système de prothèse totale du genou à condyles asymétriques en 2005. Compte tenu du manque de renseignements concernant ce modèle modifié, nous avons procédé à une étude pour en déterminer la survie et le rendement à court et à moyen terme. Méthodes: Les patients ayant reçu la prothèse à condyles postérieurs symétriques Genesis II ou une prothèse totale primaire Legion (au cobaltchrome [CoCr] ou au zirconiumniobium oxydé [OxZr]) (Smith & Nephew) au centre de recherche entre mars 2007 et décembre 2013 ont été inscrits dans une base de données prospective. Nous avons procédé à une revue rétrospective de la base de données et effectué une analyse de survie à l'aide de techniques de KaplanMeier. Résultats: On a dénombré 2178 patients (dont 1359 femmes [62,4 %]; âge moyen 64,6 ans; indice de masse corporelle moyen 35,0) totalisant 2815 arthroplasties du genou pour analyse. Les taux de survie ont été de 98,2 % (intervalle de confiance [IC] à 95 % 97,6 %98,7 %) pour le paramètre défaillance de toutes causes à 2 ans et de 96,8 % (IC à 95 % 96,0 %97,7 %) à 5 ans. L'âge (risque relatif [RR] 0,97, IC à 95 % 0,940,997) et le fait d'être de sexe féminin (RR 0,45, IC à 95 % 0,270,75) ont conféré un effet protecteur, tandis que l'indice de masse corporelle (RR 1,02, IC à 95 % 0,991,05) et l'implant OxZr (RR 1,11, IC à 95 % 0,572,18) n'ont eu aucune influence sur la survie. Les scores Oxford d'évaluation du genou se sont améliorés, passant d'une moyenne de 40,2 à 21,8 en l'espace de 2 ans (p < 0,001), sans différence entre les groupes CoCr et OxZr. Conclusion: La prothèse du genou à condyles postérieurs symétriques postéro-stabilisée possède une excellente survie à moyen terme. La surface portant l'implant n'a pas eu d'influence sur la survie à 5 ans et, donc, l'utilisation d'implants OxZr ne sera peutêtre pas justifiée.
Assuntos
Artroplastia do Joelho/instrumentação , Prótese do Joelho/efeitos adversos , Desenho de Prótese , Falha de Prótese , Zircônio , Fatores Etários , Idoso , Artroplastia do Joelho/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores Sexuais , Fatores de TempoRESUMO
Background: Patient-specific cutting blocks in total knee arthroplasty have been promoted to improve mechanical alignment, reduce alignment outliers and improve patient outcomes. The aim of this study was to compare the efficacy of patient-specific instrumentation (PSI) and conventional instrumentation (CI) in achieving neutral alignment and accurate component positioning in total knee arthroplasty. Methods: We conducted a double-blinded randomized controlled trial in which patients were randomly assigned to treatment with either PSI or CI. Results: Fifty-four patients were included in the study. No relevant improvement in coronal alignment was found between the PSI and CI groups with post-hoc power of 0.91. Tibial slope was found to be more accurately reproduced to the preoperative target of 3° with PSI than with CI (3.8°± 3.1° v. 7.7°± 3.6°, respectively, p < 0.001). There were no differences found in patient-reported outcome measures, surgical time or length of hospital stay. Conclusion: Given the added cost of the PSI technique, its use is difficult to justify given the small improvement in only a single alignment parameter. Clinical trial registration: Clinicaltrials.gov, no. NCT03416946
Contexte: L'utilisation de guides de coupe sur mesure dans l'arthroplastie totale du genou a été recommandée pour améliorer l'alignement mécanique, réduire les alignements extrêmes et améliorer les résultats des patients. Cette étude cherchait à comparer la capacité des instruments sur mesure et des instruments classiques à engendrer un alignement neutre et un bon positionnement des composants dans le cadre d'une arthroplastie totale du genou. Méthodes: Nous avons mené un essai clinique randomisé à double insu. Les patients étaient répartis aléatoirement entre le groupe de traitement avec instruments sur mesure et le groupe de traitement avec instruments classiques. Résultats: Cinquante-quatre patients ont participé à l'étude. Aucune différence notable de l'alignement coronal entre les groupes n'a été relevée, pour une puissance observée de 0,91. La pente tibiale correspondait plus exactement à la cible préopératoire de 3° avec les instruments sur mesure qu'avec les instruments classiques (3,8° ± 3,1° contre 7,7° ± 3,6°, respectivement; p < 0,001). Il n'y avait aucune différence dans les mesures déclarées par les patients, la durée de l'intervention et la durée d'hospitalisation. Conclusion: Étant donné l'amélioration minime d'un seul paramètre d'alignement et le coût supérieur de la technique sur mesure, son utilisation est difficile à justifier. Enregistrement de l'essai: Clinicaltrials.gov, no NCT03416946.
Assuntos
Artroplastia do Joelho/instrumentação , Osteoartrite do Joelho/cirurgia , Idoso , Método Duplo-Cego , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Satisfação do Paciente , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Resultado do TratamentoRESUMO
BACKGROUND: There are limited publications examining modular metal-on-metal (MoM) total hip implants in which a comprehensive analysis of retrieved components is performed. This study examines 24 retrieved modular MoM implants from a single manufacturer and compares retrieval analytics; bearing surface damage, wear, and modular taper corrosion against patient, surgical and implant characteristics to elucidate significant associations. METHODS: Clinical, patient, and surgical data were collected including age, body mass index, blood metal ion levels, and cup inclination. Damage assessment was performed visually in addition to surface profilometry. Acetabular liners and femoral heads were measured for volumetric wear. Femoral head taper bores were similarly measured for material removal due to corrosion and fretting. RESULTS: Patients with MoM-related reasons for revision showed significantly higher levels of blood metal ion levels. Bearing wear was strongly associated with blood metal ion levels and was significantly increased in cups placed more vertically. Younger patients tended to have higher body mass indices as well as poorer cup placement. CONCLUSION: This work details a broad range of analyses on a series of modular MoM total hip implants from a single manufacturer of which there are few published studies. Acetabular cup inclination angle was deemed a primary cause of revision surgery through increased MoM wear, high metal ion levels in the blood, and subsequent adverse local tissue reactions. Heavy patients can increase the surgical difficulty which was shown to be related to poor cup placement in this cohort.
Assuntos
Artroplastia de Quadril/efeitos adversos , Próteses Articulares Metal-Metal/efeitos adversos , Desenho de Prótese , Falha de Prótese , Reoperação/efeitos adversos , Acetábulo/cirurgia , Adulto , Idoso , Índice de Massa Corporal , Estudos de Coortes , Corrosão , Feminino , Cabeça do Fêmur/cirurgia , Prótese de Quadril/efeitos adversos , Humanos , Masculino , Metais , Pessoa de Meia-Idade , Obesidade/complicaçõesRESUMO
This study examines the damage and wear on the polyethylene (PE) inserts from 52 retrieved Genesis II total knee replacements to identify differences in tribological performance between matched pairs of cobalt-chromium (CoCr) and oxidized zirconium (OxZr) femoral components. Observer damage scoring and microcomputed tomography were used to quantify PE damage and wear, respectively. No significant differences were found between CoCr and OxZr groups in terms of PE insert damage, surface penetration, or wear. No severe damage such as cracking or delamination was noted on any of the 52 PE inserts. Observer damage scoring did not correlate with penetrative or volumetric PE wear. The more costly OxZr femoral component does not demonstrate clear tribological benefit over the standard CoCr component in the short term with this total knee replacement design.
Assuntos
Ligas de Cromo/química , Cobalto/química , Polietileno/química , Desenho de Prótese , Zircônio/química , Artroplastia do Joelho , Cromo/química , Feminino , Fêmur/patologia , Humanos , Prótese do Joelho , Masculino , Falha de Prótese , Análise de Regressão , Propriedades de Superfície , Microtomografia por Raio-XRESUMO
Eight retrieved metal-on-metal total hip replacements displayed corrosion damage along the cobalt-chromium alloy liner taper junction with the Ti alloy acetabular shell. Scanning electron microscopy indicated the primary mechanism of corrosion to be grain boundary and associated crevice corrosion, which was likely accelerated through mechanical micromotion and galvanic corrosion resulting from dissimilar alloys. Coordinate measurements revealed up to 4.3mm(3) of the cobalt-chromium alloy taper surface was removed due to corrosion, which is comparable to previous reports of corrosion damage on head-neck tapers. The acetabular liner-shell taper appears to be an additional source of metal corrosion products in modular total hip replacements. Patients with these prostheses should be closely monitored for signs of adverse reaction towards corrosion by-products.
Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/efeitos adversos , Prótese de Quadril/efeitos adversos , Falha de Prótese , Adulto , Idoso , Materiais Biocompatíveis , Ligas de Cromo , Corrosão , Remoção de Dispositivo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , TitânioRESUMO
BACKGROUND: This study sought to evaluate the safety, efficacy, and resource utilization of a pilot outpatient surgery program for total hip arthroplasty compared to traditional inpatient total hip arthroplasty performed via the posterolateral approach. METHODS: A cohort of 68 patients from two sites were enrolled in a regional pilot project for outpatient total hip arthroplasty (THA) and matched 1:1 against a cohort of patients undergoing routine inpatient THA. Data was extracted retrospectively from patient and hospital charts including adverse events (AE), readmission within 90 days, emergency room (ER) visits, patient calls, patient-reported outcome measures, length of stay, and multiple surgical variables. RESULTS: The outpatient group had a mean hospital stay of 13 hours, whereas the inpatient group had a mean of 58 hours (p<0.001). Three outpatients and four inpatients experienced post-op complications. Three inpatients and one outpatient visited the ER within 8 weeks of surgery. No difference in pre-operative hemoglobin (p = 0.210), or surgical blood loss (p = 0.550) was found between study groups. There was no difference found between groups regarding Oxford-12 Hip Score improvement, nor satisfaction at six months, one and two years (p>0.125). CONCLUSION: This study demonstrates that outpatient THA using the posterolateral approach is as safe and effective as inpatient THA for overall healthy and carefully screened patients, based on the low rate of AEs observed and similar patient outcomes reported. Significantly reduced time in hospital demonstrates the reduced healthcare resources associated with outpatient THA.
Assuntos
Artroplastia de Quadril , Humanos , Artroplastia de Quadril/efeitos adversos , Pacientes Ambulatoriais , Estudos Retrospectivos , Projetos Piloto , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Tempo de Internação , Readmissão do PacienteRESUMO
A 34-year-old female patient received a cobalt-chromium (CoCr) alloy femoral head on cross-linked polyethylene total hip replacement for the revision of her fractured ceramic-on-ceramic total hip replacement. The CoCr alloy femoral head became severely worn due to third-body abrasive wear by ceramic particles that could not be removed by synovectomy or irrigation at revision surgery. Ceramic particles were found embedded in the cross-linked polyethylene liner. The CoCr alloy femoral head exhibited a total mass loss of 14.2 g and the generated wear particles triggered metallosis in the patient. The present case study suggests not revising a fractured ceramic-on-ceramic total hip replacement with a CoCr alloy femoral head and a cross-linked polyethylene liner to avoid metallosis due to third-body abrasive wear.
Assuntos
Artroplastia de Quadril , Ligas de Cromo/efeitos adversos , Prótese de Quadril/efeitos adversos , Polietilenos/efeitos adversos , Falha de Prótese , Adulto , Cerâmica/efeitos adversos , Feminino , Humanos , Reoperação , Estresse MecânicoRESUMO
Aims: Instability is a common cause of failure after total hip arthroplasty. A novel reverse total hip has been developed, with a femoral cup and acetabular ball, creating enhanced mechanical stability. The purpose of this study was to assess the implant fixation using radiostereometric analysis (RSA), and the clinical safety and efficacy of this novel design. Methods: Patients with end-stage osteoarthritis were enrolled in a prospective cohort at a single centre. The cohort consisted of 11 females and 11 males with mean age of 70.6 years (SD 3.5) and BMI of 31.0 kg/m2 (SD 5.7). Implant fixation was evaluated using RSA as well as Western Ontario and McMaster Universities Osteoarthritis Index, Harris Hip Score, Oxford Hip Score, Hip disability and Osteoarthritis Outcome Score, 38-item Short Form survey, and EuroQol five-dimension health questionnaire scores at two-year follow-up. At least one acetabular screw was used in all cases. RSA markers were inserted into the innominate bone and proximal femur with imaging at six weeks (baseline) and six, 12, and 24 months. Independent-samples t-tests were used to compare to published thresholds. Results: Mean acetabular subsidence from baseline to 24 months was 0.087 mm (SD 0.152), below the critical threshold of 0.2 mm (p = 0.005). Mean femoral subsidence from baseline to 24 months was -0.002 mm (SD 0.194), below the published reference of 0.5 mm (p < 0.001). There was significant improvement in patient-reported outcome measures at 24 months with good to excellent results. Conclusion: RSA analysis demonstrates excellent fixation with a predicted low risk of revision at ten years of this novel reverse total hip system. Clinical outcomes were consistent with safe and effective hip replacement prostheses.
RESUMO
Aims: The primary aim of this trial was to compare the subsidence of two similar hydroxyapatite-coated titanium femoral components from different manufacturers. Secondary aims were to compare rotational migration (anteversion/retroversion and varus/valgus tilt) and patient-reported outcome measures between both femoral components. Methods: Patients were randomized to receive one of the two femoral components (Avenir or Corail) during their primary total hip arthroplasty between August 2018 and September 2020. Radiostereometric analysis examinations at six, 12, and 24 months were used to assess the migration of each implanted femoral component compared to a baseline assessment. Patient-reported outcome measures were also recorded for these same timepoints. Overall, 50 patients were enrolled (62% male (n = 31), with a mean age of 65.7 years (SD 7.3), and mean BMI of 30.2 kg/m2 (SD 5.2)). Results: The two-year subsidence was similar for Avenir (-0.018 mm (95% confidence interval (CI) -0.053 to 0.018) and Corail (0.000 mm (95% CI -0.027 to 0.026; p = 0.428). Both anteversion/retroversion (Avenir 0.139° (95% CI -0.204 to 0.481°); Corail -0.196° (95% CI -0.445 to 0.053°; p = 0.110) and varus/valgus tilt (Avenir -0.024° (95% CI -0.077 to 0.028); Corail -0.049° (95% CI -0.098 to 0.000°; p = 0.473) were not statistically significantly different. After two years, patients reported similar improvements in EuroQol five-dimension five-level health questionnaire (Avenir 0.22 (SD 0.2); Corail 0.22 (SD 0.18); p = 0.965) and other outcomes scores. Patient satisfaction on a five-point Likert scale was also similar between both groups after two years (Avenir 1.38 (SD 0.88); Corail 1.33 (SD 0.57); p = 0.846). Conclusion: The performance of both femoral components was similar in terms of stability and patient outcomes.
Assuntos
Artroplastia de Quadril , Prótese de Quadril , Humanos , Masculino , Idoso , Feminino , Análise Radioestereométrica , Prótese de Quadril/efeitos adversos , Durapatita , Artroplastia de Quadril/métodos , Desenho de Prótese , Falha de PróteseRESUMO
Computer-assisted surgery in knee arthroplasty is gaining popularity; however, the resulting outcome improvement is controversial. A double-blinded trial was performed with subjects randomized to undergo surgery with either computer-assisted or nonassisted instruments. Postoperatively, limb and implant alignment and rotation were assessed using both full-length radiographs and computed tomography in addition to clinical scores. One hundred twenty patients (141 knees) were randomized. No differences in Western Ontario MacMaster Osteoarthritis Score, Short Form-36, or flexion were seen. More varus limb alignment was seen in the computer-assisted group (1.9°) vs the nonassisted group (0.9°, P = .04) with no improvement in alignment precision. Rotational alignment of the components did not differ between groups. Computer-assisted surgery appeared to have minimal effect on knee implant arthroplasty with no improvement in limb alignment or early functional outcome.
Assuntos
Artroplastia do Joelho/métodos , Mau Alinhamento Ósseo/prevenção & controle , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiologia , Osteoartrite do Joelho/cirurgia , Cirurgia Assistida por Computador/métodos , Idoso , Artroplastia do Joelho/instrumentação , Mau Alinhamento Ósseo/diagnóstico por imagem , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Articulação do Joelho/cirurgia , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Radiografia , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica/fisiologia , Cirurgia Assistida por Computador/instrumentação , Inquéritos e Questionários , Resultado do TratamentoRESUMO
We describe a case of a well-functioning total knee arthroplasty acutely infected with Clostridium septicum. This is the first reported infection of a prosthetic joint with this organism. A search for the source of this infection uncovered a colonic malignancy. This organism is highly associated with gastrointestinal malignancy, and appropriate investigation should be carried out when it is discovered. The importance of full anaerobic bacterial identification by the microbiology laboratory is underscored by this case.
Assuntos
Adenocarcinoma/complicações , Artroplastia do Joelho/instrumentação , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/etiologia , Clostridium septicum/isolamento & purificação , Neoplasias do Colo/complicações , Prótese do Joelho/microbiologia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/terapia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Infecções por Clostridium/tratamento farmacológico , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/terapia , Terapia Combinada , Evolução Fatal , Feminino , Humanos , Osteoartrite do Joelho/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Twenty-two retrieved femoral knee components were identified with posterior condyle surface damage on average at 99° flexion (range, 43°-135° flexion). Titanium alloy material transfer and abrasive surface damage were evident on cobalt-chromium alloy femoral components that were in contact with titanium alloy tibial trays. Surface damage on the retrieved Oxinium femoral components (Smith and Nephew, Inc, Memphis, Tenn) that were in contact with titanium alloy tibial trays showed gouging, associated with the removal and cracking of the oxide and exposure of the zirconium-niobium alloy substrate. Cobalt-chromium alloy femoral components that were in contact with cobalt-chromium alloy tibial trays showed abrasive wear. Contact between the femoral component and tibial tray should be avoided to prevent surface damage to the femoral condyles, which could potentially accelerate polyethylene wear in vivo.
Assuntos
Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/métodos , Fêmur , Articulação do Joelho/cirurgia , Prótese do Joelho , Osteólise/cirurgia , Desenho de Prótese , Ligas de Cromo/efeitos adversos , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Microscopia Eletrônica de Varredura , Nióbio/efeitos adversos , Osteoartrite do Joelho/cirurgia , Osteólise/etiologia , Falha de Prótese , Amplitude de Movimento Articular/fisiologia , Reoperação , Estudos Retrospectivos , Propriedades de Superfície , Titânio/efeitos adversos , Zircônio/efeitos adversosRESUMO
BACKGROUND: Several hydroxyapatite (HA)-coated femoral stems from a single manufacturer were identified to have aseptically loosened at mid-term follow-up despite prior radiographic appearance of osseointegration. Possible causes and associated risk factors for stem loosening were explored through radiographic review and implant retrieval analysis. METHODS: Forty-six retrieved hip stems (Corail, DePuy-Synthes) were identified and grouped by bearing type: metal-on-metal (MoM), metal-on-polyethylene, and ceramic-on-ceramic. Stem lucency was graded on post-operative radiographs up to the time of revision. Stems were examined for stripping of the HA coating, taper corrosion, and bearing wear in metal-on-metal cases. Patient demographics, implant design features, and perioperative data were collected from electronic databases and patient charts. RESULTS: Aseptic loosening occurred in 37% of cases examined. MoM bearings were associated with 7.25 times greater risk of loosening compared to other bearing types. Stem radiolucency was more prevalent for MoM cases and, although not statistically significant, demonstrated progressive lucency. Taper corrosion appeared more severe for MoM cases and correlated with proximal stem radiolucency. Removal of the HA coating from the stems was associated with both taper corrosion and MoM bearing wear. Length of implantation was a confounding factor for the MoM cases. CONCLUSION: This study has demonstrated a high risk of mid-term loosening of previously osseointegrated HA-coated femoral stems when paired with a MoM bearing. The mechanism of loosening appears progressive in nature and related to the MoM bearing, possibly interacting with the HA coating. If such loosening is recognized early, rapid revision may allow for retention of the femoral stem.
Assuntos
Durapatita/normas , Análise de Falha de Equipamento/normas , Fêmur/cirurgia , Prótese de Quadril/normas , Próteses Articulares Metal-Metal/normas , Falha de Prótese , Adulto , Idoso , Idoso de 80 Anos ou mais , Durapatita/efeitos adversos , Análise de Falha de Equipamento/métodos , Feminino , Seguimentos , Prótese de Quadril/efeitos adversos , Humanos , Masculino , Próteses Articulares Metal-Metal/efeitos adversos , Pessoa de Meia-Idade , Desenho de Prótese/efeitos adversos , Desenho de Prótese/normas , Falha de Prótese/efeitos adversos , Estudos RetrospectivosRESUMO
This case report introduces arthroscopic debridement as a new method of treating an irreducible knee dislocation. The clinical presentation of 2 patients with irreducible knee dislocations, including history, physical examination, a clinical photograph, radiographs, and magnetic resonance images, is presented. As well, intraoperative arthroscopic photographs are included that show the effectiveness of the treatment. A review of the literature reveals that irreducible knee dislocations are rare. The finding of a skin furrow along the joint line was present in all cases. Past treatment usually involved an open procedure to remove the capsuloligamentous structures from the joint. We show that arthroscopy with debridement of these structures resulted in reduction of the joint. Follow-up arthroscopy in 1 patient showed healing of the previously debrided ligament. The ability to debride the interposed soft tissue through the arthroscope allows for reduction of the joint without the need for an open procedure.
RESUMO
Many older patients undergoing primary hip or knee joint arthroplasty surgery have multiple medical problems. In this retrospective case-control study, the authors examined the individual and cumulative effects of various types of medical comorbidities on the risk of developing prosthetic joint infection after surgery. Case and control patients were matched by age, sex, and procedure. Analysis was undertaken using crude odds ratios (ORs) and multiple logistic regression analysis. Fifty-one patients with 52 joint infections were identified. Both diabetes mellitus (OR, 3.91; P = .04) and total number of medical conditions (OR, 1.35; P = .005) were associated with higher risk of infection. This information allows the orthopedic surgeon to inform patients more fully regarding the risks of surgery, and promotes the reduction and optimization of medical comorbidities before surgery.