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BACKGROUND: S-ROM hip is a well-established and versatile prosthesis that offers extensive metaphyseal and diaphyseal geometries providing solutions for a variety of surgical scenarios. The aim of this study is to report on long-term survivorship and radiographic outcomes of complex primary total hip arthroplasty (THA) using a modular cementless stem (S-ROM). METHODS: Retrospective consecutive study was conducted of 167 patients (167 hips): 97 males and 70 females with average age at the time of surgery of 55 years (range 22-76). All patients underwent complex THA by the senior author from 1987 to 1999. Patients were identified using a prospective database. Demographic, clinical, and surgical data were collected from health records. All patients received a cementless acetabular component with a standard polyethylene liner. The primary outcome measure was survivorship beyond 15 years using stem revision for any cause as an end point. Secondary outcome measure was rate of radiographic loosening using Engh classification. RESULTS: Only 3 patients required stem revision for aseptic loosening and 1 for periprosthetic fracture. Isolated acetabular revision was undertaken in 23 of 167 patients (13.8%) due to polythene wear, osteolysis, and aseptic loosening. Proximal femoral stress shielding (zone 1, 7) was noted in 34 of 167 hips (20.4%). Stable bony ingrowth was noted in 144 hips (86.2%) and the remaining 23 hips had stable fibrous ingrowth (13.8%). Using stem "any-cause revision" as an endpoint, the mean stem survivorship was 31.5 years (95% confidence interval 31.007-31.985) with 30-year estimated survivorship of 97.6%. CONCLUSION: In a single designer surgeon series, S-ROM stem has stood the test of time with long-term, 30-year survivorship of 97.6% and continues to play an important role in modern hip surgery providing longevity and versatility. However, further comparative long-term studies from independent centers are needed for a definitive conclusion. LEVEL OF EVIDENCE: IV.
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Artroplastia de Quadril , Prótese de Quadril , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Falha de Prótese , Reoperação , Estudos Retrospectivos , Sobrevivência , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The aim of this study is to provide an overview of randomized controlled trials (RCTs) in primary total knee arthroplasty summarizing the available high-quality evidence. METHODS: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched the Cochrane Central Register of Controlled Trials (CENTRAL, 2019, Issue 3), Ovid MEDLINE, and Embase. We excluded nonrandomized trials, trials on unicompartmental knee arthroplasty or revision surgery, systematic reviews, and meta-analyses. Trials that met our inclusion criteria were assessed using a binary outcome measure of whether they reported statistically significant findings. These were then classified according to the intervention groups (surgical approach, tourniquet use, design, etc.). RESULTS: Four hundred and three RCTs met the inclusion criteria and were included. The total number of patients in those 403 RCTs was 47,675. Only 33 RCTs (8.2%) reported significant differences between the intervention and the control groups. The trials were grouped into surgical approach 34, tourniquet 31, minimally invasive surgery 13, patient specific instrumentation 30, knee design 37, fixation 27, mobile bearing 47, navigation 50, polyethylene 19, technique 27, patella resurfacing 26, drain 19, closure 16, and others 27 RCTs. CONCLUSION: For the vast majority of patients, a standard conventional total knee arthroplasty with a surgical approach familiar to the surgeon using standard well-established components, with or without tourniquet, without surgical drain leads to satisfactory long-term clinical outcomes.
Assuntos
Artroplastia do Joelho , Humanos , Articulação do Joelho , Patela , Ensaios Clínicos Controlados Aleatórios como Assunto , ReoperaçãoRESUMO
UNLABELLED: Hydroxyapatite (HA) is commonly used on femoral stems to assist in osseous integration but there is limited evidence of the benefit it provides. We report a prospective comparison of 117 and 102 patients receiving either porous or HA coated sleeves respectively. Patients were evaluated at mean of 12.5 years in the porous and 13.7 years in the HA groups. The mean Harris Hip Score was 94.7 and 94.5 in the porous and HA groups respectively. One porous and 2 HA stems required revision. This study demonstrates that there is no long-term advantage to using an HA coating on the sleeve of this modular stem and confirms excellent long-term results for the SROM stem in a primary arthroplasty setting. LEVEL OF EVIDENCE: II (prospective cohort study).
Assuntos
Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Materiais Revestidos Biocompatíveis/química , Durapatita/química , Fêmur/cirurgia , Prótese de Quadril , Desenho de Prótese , Idoso , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Porosidade , Estudos Prospectivos , Falha de Prótese , Reoperação/instrumentação , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: Acquired patella baja may result in decreased range of motion of the knee, extensor lag, and anterior knee pain. The aim of the study was to evaluate the efficacy of tibial tubercle osteotomy with proximal displacement. METHODS: Between 1998 and 2011, a proximalization of the tibial tuberosity was performed in 15 patients (15 knees) with patella baja diagnosed using the Blackburne-Peel ratio. Clinical outcomes included the Tegner Lysholm knee scoring scales, the WOMAC questionnaire, the short form-12 (SF-12), and a visual analogue score (VAS) pain scale. RESULTS: Fifteen proximalizations of the tibial tuberosity were performed, with a mean follow-up period of 64 months (5-160). The mean patient age was 59 years (41-86 years). The mean preoperative Blackburne-Peel ratio of 0.4 (0.1-0.6) was improved to a mean of 1.0 (0.8-1.2) post-operatively, which was associated with significant improvements in the Lysholm knee scoring scale from 13.3 ± 13.0 to 86.7 ± 10.4 points (p < 0.0001). Quality of life, as measured using the SF-12 outcome, also improved significantly (p < 0.0001), as did all WOMAC questionnaire score subscales (p < 0.0001). The VAS preoperative status for pain improved from 8.3 ± 2.0 to 1.5 ± 1.8. No patient had delayed or non-union of the osteotomy site. CONCLUSIONS: A series of patients with patella baja, treated with proximalization of the tibial tuberosity, achieved satisfactory outcomes in terms of pain relief and improved function, without major complication.
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Artralgia/cirurgia , Patela/diagnóstico por imagem , Tíbia/cirurgia , Adulto , Idoso , Artralgia/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Patela/anormalidades , Patela/cirurgia , Radiografia , Amplitude de Movimento Articular , Tíbia/diagnóstico por imagemRESUMO
A retrospective analysis was undertaken of 30 consecutive THA performed in 25 patients with hypoplastic proximal femurs, who had received a 9-mm uncemented modular S-ROM stem. The mean patient age was 42 years (17-69 years), mean height was 152.5 cm (130-170.5 cm), mean weight was 63 kg (39-90 kg), and mean follow-up period was 19 years (range, 12-23 years). Subsidence was seen in 2 hips, with asymptomatic femoral osteolysis present in 11 hips; overall survival of the femoral stem was 93.3%, with two revisions of the femoral component required for aseptic loosening. After a mean follow-up of 19 years, the use of the S-ROM 9 mm femoral stem in the patient with the small femur was associated with a low revision rate due to aseptic loosening of the stem.
Assuntos
Artroplastia de Quadril , Fêmur/cirurgia , Articulação do Quadril/cirurgia , Prótese de Quadril , Artropatias/cirurgia , Adolescente , Adulto , Idoso , Feminino , Fêmur/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Humanos , Artropatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Adulto JovemRESUMO
PURPOSE: To provide an overview of all published randomized controlled trials (RCTs) in anterior cruciate ligament reconstruction (ACLR) summarizing the available evidence. METHODS: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched the Cochrane FIGCentral Register of Controlled Trials, Ovid MEDLINE, and Embase for RCTs of ACLR from their inception to August 26, 2020. Outcome measure was whether RCTs reported statistically significant findings. RCTs were then classified according to their intervention groups in a narrative synthesis of the evidence. RESULTS: In total, 299 RCTs met the inclusion criteria and were included with a total number of 25,186 patients. Only 30 RCTs (10%) reported significant differences between the intervention and the control groups. These included 101 RCTs on grafts, 20 RCTs on tunnel placements, 48 RCTs on graft fixation, 42 RCTs on single-bundle compared with double-bundle reconstructions, 11 RCTs on additional procedures, 11 RCTs on graft tensioning, 5 RCTs on timing of surgery, 25 RCTs on technical variations from standard techniques, 6 RCTs on ACL repair, 5 RCTs on navigation, 16 RCTs on perioperative management, and 9 RCTs on other aspects of ACLR. Only 14 RCTs (4.7%) reported outcomes beyond 10 years with greater allograft failures compared with autografts, high incidence of osteoarthritic changes in reconstructed knees (22%-100%), with no significant differences in outcomes between bioabsorbable or metal screws for graft fixation, patellar versus hamstrings or single- versus double-bundle reconstructions. CONCLUSIONS: The evidence indicates that a standard arthroscopic single- or double-bundle ACLR with hamstrings/patella autografts, transportal technique, and fixation techniques familiar to the surgeon leads to comparable results. This evidence offers surgeons the flexibility to use standard and cost-effective techniques and achieve comparable outcomes. LEVEL OF EVIDENCE: Level II; systematic review of Level I-II randomized controlled trials.
RESUMO
CASE: We report a 67-year-old gentleman who presented with a painful unstable knee. He had undergone a successful total knee arthroplasty 12 years earlier and was highly functional. He presented with a 10-month history of mild pain, instability, and gait alteration. During revision surgery, there was a loss of bony support, and a fractured femoral component was identified. He required constrained revision components for reconstruction and made an uneventful recovery. CONCLUSIONS: Fractured femoral components are rare complications of modern primary total knee arthroplasty. Loss of bony support in critical areas of high loading will inevitably lead to catastrophic component failure.
Assuntos
Prótese do Joelho/efeitos adversos , Falha de Prótese/efeitos adversos , Idoso , Artroplastia do Joelho , Humanos , Masculino , Polietileno , ReoperaçãoRESUMO
A concern about modular stems is that the taper will not provide an adequate seal, causing the stem distal to the taper to become part of the effective joint space. In this study, 380 primary patients and 309 revision patients were treated with a proximally modular stem. Follow-up was between 5 and 17 years (mean 9.4 years). Three patients only had distal osteolysis. All three patients had failure of proximal bone ingrowth. It was concluded that a Morse taper provides an adequate seal or gasket.
Assuntos
Artroplastia de Quadril/instrumentação , Feminino , Seguimentos , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/etiologia , Prótese de Quadril , Humanos , Osteólise/complicações , Osteólise/diagnóstico por imagem , Falha de Prótese , Radiografia , Fatores de Risco , Fatores de TempoRESUMO
Patients with patulous proximal femurs who have hip revision surgery can be treated with reduction osteotomies or with large ingrowth sleeves used with proximally modular stems. Three hundred nine patients had hip revision with >5-years' follow-up (mean 8.6 years). Reduction osteotomies were performed in six patients, all of whom have done well. The overall rerevision rate of 1.7% suggests that either of these methods produces reasonable results in patients with expanded proximal femurs.
Assuntos
Artroplastia de Quadril/efeitos adversos , Fêmur/cirurgia , Osteotomia/métodos , Idoso , Fêmur/diagnóstico por imagem , Seguimentos , Humanos , Pessoa de Meia-Idade , Radiografia , Reoperação , Fatores de Tempo , Falha de TratamentoAssuntos
Artroplastia de Quadril/métodos , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteólise , Reoperação , Adulto JovemRESUMO
Knee revision using constrained implants is associated with greater stresses on the implant and interface surfaces. The present report describes a case of failure of the screw coupling between the stem and the femoral component. The cause of the failure is surmised with outline of the treatment in this case with extensive femoral bone loss. Revision implant stability was augmented with the use of a cemented femoral stem, screw fixation and the metaphyseal sleeve of an S-ROM modular hip system (DePuy international Ltd).
Assuntos
Artroplastia do Joelho/efeitos adversos , Fraturas do Fêmur/cirurgia , Fraturas Periprotéticas/cirurgia , Falha de Prótese , Idoso , Cimentação , Fraturas do Fêmur/etiologia , Humanos , Masculino , Fraturas Periprotéticas/etiologia , Reoperação , Resultado do TratamentoRESUMO
Neck/cup impingement is a serious issue, especially with hard/hard bearings. It can produce noise, locking mechanism failure, and an increase in wear debris and dislocation. The double taper neck used by the author has cogs on the neck/stem taper junction for additional rotational stability. One hundred forty-six procedures were performed using the thin mantle cement technique. Mean follow-up was 5 years (range, 3-8 years). A 32-mm neck was used in 73.8% of cases and a 35-mm neck in 26.2%, because most of the patients were elderly women. The neck was anteverted in 1.4%, neutral in 26.4%, and retroverted in the rest (mild in 34.2%, moderate in 14.3%, and maximum in 13.4%). There were no dislocations and no loosenings. Problems were encountered with the neck/stem taper in 3 cases. The stem was therefore taken off the market. The taper was lengthened and the strength doubled. Since its reintroduction 3 years ago, a further 187 cemented stem procedures have been performed with no failures and no dislocations. Of interest in this series, no necks were anteverted, 23.5% were in neutral, 35.8% were in mild retroversion, 31.1% were in moderate retroversion, and 9.6% were in maximal retroversion. Most necks were placed in retroversion to avoid impingement. This suggests that if a nonmodular neck had been used, some degree of impingement would have occurred in 70% of cases.