Long-term results of the Wagner cone prosthesis.

The Wagner cone prosthesis is indicated in uncemented total hip replacement of cases with cylinder-shaped femurs, deformed femurs, femurs with increased antetorsion, and in conditions of intramedullary bony scar tissue after previous osteotomies. The objective of this study is to present long-term results. From January 1, 1993 to December 31, 1995, 132 implantations were made with the Wagner cone prosthesis. We report the clinical and radiographic results of 94 cone prostheses with a mean observation period of 11.5 years. The Merle d'Aubigné score improved from a preoperative mean value of 8.8 to a postoperative mean of 16.3. The radiographic evaluation revealed 32 cases with cortical hypertrophy, 73 cases with atrophy of the proximal femur, and 18 cases with complete pedestal formation. Radiolucencies over Gruen zones 1 and 7 occurred in 42 cases; only zone 1 was affected in 24 cases. Complications included three deep infections, three acetabular revisions, five total joint revisions, one recurrent luxation, and three heterotopic ossifications. In spite of the fact that the examined cohort often included patients who had undergone multiple previous operations (a maximum of six) of the proximal femur or the acetabulum, the long-term results of the Wagner cone prostheses were very promising.

Long-term results of the Wagner conical screw cup.

Thanks to its high primary stability, the concept of threaded cups has gained wide acceptance. The aim of this study is to report the long-term results of the Wagner conical screw cup. Between January 1993 and December 1994, 212 conical screw cup were implanted; 118 implants were clinically and radiographically followed up after a mean of 12.1 years. The Merle d'Aubigné score improved from a preoperative mean of 8.8 to 16.6 postoperatively. Four revisions were performed for heterotopic ossification. Three revisions were done to treat deep infection. Two isolated cup revisions and three more complete total hip joint revisions were required due to aseptic loosening. The overall survival rate at 12 years in this study was 93.2% (110/118); for aseptic loosening alone it was 95.8% (113/118). The Wagner conical screw cup by yields very good long-term results.

Synovectomy of the hip in patients with juvenile rheumatoid arthritis.

BACKGROUND: There is a lack of data on the functional effect of open hip synovectomy in a large number of patients with juvenile rheumatoid arthritis evaluated with a validated assessment tool. METHODS: Between 1985 and 1997, sixty-seven open hip-joint synovectomies were carried out in fifty-six patients with juvenile rheumatoid arthritis. Fifty-five hips (82%) had radiographic changes that were stage III or higher according to the system of Larsen et al. Hip function was evaluated preoperatively and after a mean of fifty months with the Merle d'Aubigné hip score. RESULTS: Sixty-five (97%) of the sixty-seven hips were available for follow-up. The mean total Merle d'Aubigné hip score (and standard error of the mean) was significantly improved from 9.5 +/- 2.5 points at baseline to 16.3 +/- 1.0 points at the time of follow-up (p < 0.001). The individual scores for pain, mobility, and walking ability were significantly increased as well (all p < 0.001). Eighty-five percent of the hips were observed to have a very great or great improvement in function. A concomitant soft-tissue release was performed in seven hips, and nine hips required surgical dislocation. Surgical complications included two superficial wound hematomas that did not require intervention; osteonecrosis of the femoral head was not observed. Five hips required total hip arthroplasty during the follow-up period. Thus, the survival rate for the hips was 94% at a mean of four years following the synovectomy. CONCLUSIONS: Open hip synovectomy in patients with juvenile rheumatoid arthritis is a safe procedure that can improve hip-joint function for up to five years.

Extravasation into synovial tissue induces CCL20 mRNA expression in polymorphonuclear neutrophils of patients with rheumatoid arthritis.

OBJECTIVE: Examination of expression of the chemokine macrophage inflammatory protein-3a (CCL20/Mip-3alpha) in blood polymorphonuclear neutrophils (PMN) and synovial fluid (SF) PMN of patients with rheumatoid arthritis (RA). METHODS: Paired samples of blood PMN and SF PMN were obtained from 11 patients with RA. In addition, SF was prepared from 9 patients with osteoarthritis (OA) and 10 patients with juvenile idiopathic arthritis (JIA). PMN were isolated via density centrifugation to a purity of 98%. Total RNA was isolated and the expression of CCL20 was determined by reverse transcription-polymerase chain reaction (RT-PCR) and quantitative real-time PCR. In some experiments blood PMN obtained from healthy donors were stimulated with individual SF of patients with RA. For quantitative considerations, CXCL8, CCL20, interleukin 1, and tumor necrosis factor-alpha (TNF-alpha) levels were determined in SF by ELISA. RESULTS: In SF of RA patients CCL20 and CXCL8 levels were elevated, up to 7.5 ng/ml and 23.6 ng/ml, respectively. No significant level of either chemokine was found in SF of patients with JIA and OA. CCL20 mRNA was undetectable in blood PMN of all patients with RA. In SF PMN, CCL20 mRNA was found in 6/11 RA patients. Expression of CCL20 mRNA in 5/6 SF PMN samples was observed in the absence of detectable TNF-alpha levels in SF. Cell culture experiments, however, confirmed the ability of TNF-alpha in SF to induce CCL20 mRNA expression in blood PMN. Notably, expression of CCL20 was also found in PMN after stimulation with SF lacking TNF-alpha. CONCLUSION: Recruitment of PMN to the synovial microenvironment induces expression of CCL20 mRNA independent of the concentrations of TNF-alpha accumulating in SF of patients with RA.