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PubMedDate not supplied

[Computer-assisted navigated acetabulum placement in hip prosthesis implantation--application study in routine clinical care].

AIM: This study serves to examine the feasibility of a CAS system in clinical routine use in the field of total hip replacement. METHOD: Within a prospective study 70 total hip replacements were performed by one surgeon (KB) between March and November, 1999 using a CAS system for preoperative planning and intraoperative cup placement. RESULTS: The average operating time was 70 min. This means an average increase in total time of operation about 15-20 min. The average blood loss was 630 ml. No additional specific complications due to the use of the system were seen. There was no additional trauma created by percutaneous pointing at the spina or flxing a dynamic reference base (DRB) at the pelvis. CONCLUSION: The active application of this CAS system in clinical routine use showed very good results in feasibility and can be considered as reliable. The navigated cup placement shows the potential of improving the results in cup placement, thus improving the outcome of hip arthroplasty.

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PubMedDate not supplied

[Thread design of screw-in acetabulum prostheses].

INTRODUCTION AND AIM OF STUDY: The screw-in behaviour and correct positioning of threaded cups is largely determined by the design of the thread. Up to now the various thread designs have not been systematically classified. METHODS: The thread designs of 10 first generation and 27 second generation threaded cups were analyzed using a tool setter and a no-touch light section technique. The following parameters were evaluated: thread shape, pitch, number of turns, rows of teeth, tooth length and shape. RESULTS: Threads of the first generation were V-cut or saw shaped. Thread depth was 3.1 mm on average; the mean width was 0.9-3 mm. Single-thread patterns predominated. The number of turns ranged from 1-7; the pitch was from 2.5-5 mm (single thread), or up to 20 mm (triple and quadruple threads). Cups had 3-16 rows of teeth. Threads of the second generation are V-cut, saw or flat shaped. Thread depth is 3 mm on average; mean width ranges from 0.3-2.2 mm. 72% of the threads have single-thread patterns. The number of turns ranges from 2-5; the pitch is from 2.5-6.2 mm (single thread). Cups have 4-24 rows of teeth. CONCLUSIONS: There are many different thread patterns with widely varying parameters. Contemporary threaded cups have a narrow V-cut and saw shaped threads or flat thread with depths up to 3 mm, no more than 5 turns, and pitch values of approx. 4.5 mm.

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PubMedDate not supplied

[Early weight bearing after uncemented total hip prostheses--an analysis of acetabulum cup migration].

PURPOSE: The postoperative mobilisation after cementless total hip arthroplasty is usually non-weight bearing within the first six weeks to achieve bony ingrowth for the implant. Since 1995 weight bearing mobilisation is performed at our clinic even after cementless implantation of the Alloclassic (Zweymüller-Sulzer) system. The aim of the presented study was the detection of any negative influence of weight bearing mobilisation on the stability of this cementless implant. METHOD: The horizontal and vertical cup migration of 42 cementless acetabular cups (Alloclassic Zweymüller-Sulzer) in 40 patients after weight bearing mobilisation and a minimum follow up of 24 months were analysed by a digital migration analysis. The results were compared to a normative migration profile of the same that was recently established. RESULTS: The migration analysis did not exceed the level of accuracy of 1.3 mm in any patient. The mean horizontal cup migration was 0.3 mm in both groups after 24 months, the mean vertical migration was 0.4 mm in both groups. No significant difference of the acetabular stability was detectable. None of the implants showed radiological signs of loosening or migration. CONCLUSION: The presented data justify an early postoperative weight bearing mobilisation using the cementless Alloclassic threated cup, provided that primary stability of the implant can be achieved.

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PubMedDate not supplied

[3 dimensional acetabulum roof-plasty in children, adolescents and adults, methodology and results].

The Salter innominate osteotomy is not indicated if there is a combination of hip dysplasia and hip deformity. The Chiari osteotomy seems to us not to be an adequate therapy not only because of a numerous disadvantages but also because it does not achieve a real enlargement or a congruent hip surface. We treat a hip deformity of children, youths and adults with a method we name three dimensional roof arthroplasty. This method realise a spheric enlarging of the roof and has achieved significant results. The method and results are presented.

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PubMedDate not supplied

[Osseointegration of a laser-structured titanium hemispheric acetabulum in the animal experiment].

Eight hemispherical titanium-cups with a new laser structured surface had been implanted in sheeps. Duration of implantation was eight weeks and one year. Analysis and evaluation of the results were done by post-operative x-rays, x-rays of the specimen, macroradiography, microradiography, fluorescencemicroscopy and histology. A quantitative analysis of the bony ingrowth was performed with a computer-aided system. The 8 weeks-cups showed an osseointegration rate of 28.8%, the one year group of 52.1% of the available surface. Bony ingrowth of the laserstructured titanium surface is possible. The laserstructured titanium surface can be used for the cementless fixation of implants.

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PubMedDate not supplied

[5- to 10-year results of an acetabulum with ceramic pegs for cement-free bone implantation. Material and analysis of design].

The authors report on the follow-up results of a hemispherical acetabular cup with small pegs, which is designed for cementless implantation in human beings. At an average time of 89 months after implantation, these results reveal a high percentage of 60% loosenings and seam formations of more than 2 mm which could constitute the basis for subsequent loosening. An analysis of these failures attributes the cause to material-engineering as well as design problems associated with the bone pathology. A ceramic cup of this shape is apparently unsuitable for osteointegration. It would appear that the design favours tilting movements and, due to its high E-module, it is unable to compensate for the relative movements of the pelvis.

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PubMedDate not supplied

[Experiences with the Mittelmeier ceramic screw acetabulum in exchange operations for loose endoprostheses].

This is a report about our experience with the replacement of loosened acetabular endosprotheses by the self locking ceramic Endoprosthesis Mittelmeier. That's an analysis of 60 patients concerning age, sex incidence, indications, primary implant type and long term findings. The clinical findings are illustrated according to the schedule of Merle d' Aubigné. The critical evaluation shows, that the self locking ceramic cup allows the additional implantation of homologous or autologous bone chips and grafts avoiding further allogenous implants.

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PubMedDate not supplied

[5 years' experiences with the Gersthof polyethylene peg-anchored acetabulum].

The acetabular socket "Model Gersthof" is a spheric polyethylene component which can be anchored cement-free by means of three symmetrically arranged pegs at the outside. Between July 1979 and October 1986, 1316 implants of cement-free sockets were performed at our own department. The evaluation of the socket was based on the criterium of radiological instability (= aseptic loosening). After five years of observation, this design-oriented evaluation of success shows a survival of 92% +/- 2.9%.

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PubMed1987

[Computerized tomography diagnosis of acetabulum fractures].

One hundred and ten acetabular fractures in 102 patients were examined by CT. In 78% there was agreement with the findings on conventional radiological examination. CT altered the classification of fractures, particularly if these were complex. CT was superior to conventional radiology for demonstrating the course of the fractures and for identifying local complicating factors. In 68 surgical explorations, specificity of CT was found to be 97%. After the age of 40 there was a tendency for complex fractures. Analysis of the fractures in three dimensions often determines the need for surgical treatment, particularly if the weight-bearing portion of the acetabular roof and the posterior bony column has been fractured.

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PubMedDate not supplied

[Results of total endoprosthetic treatment of dysplasia coxarthrosis with additional autologous acetabuloplasty of the roof of the acetabulum].

With reference to the different operative treatments of dysplasia coxarthroses with a total hip endoprosthesis, 43 operations on the hip joint performed from 1975 to 1979 with a filling up to the acetabular roof defect with an autogenous bone graft had a clinical and roentgenological follow-up. The results were evaluated by means of a standardised procedure, and it was demonstrated with the help of clear successes that also anatomopathologically complicated cases can be provided with a suitable total endoprosthesis.

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PubMedDate not supplied

[Intermediate-term results with the Mecron screw cup acetabulum--a follow-up study].

ISSUE: The short term result of the cementless implanted titan screw cups (type Mec-Ring) has been very encouraging. The study was aimed to show the survival rate in the middle term. METHOD: The survival rate of 111 implanted acetabular titan screw cups (type Mec-Ring) was determined in a retrospective study. 85 patients (= 76.5%) could be followed up after 6.7 years (5-8.5 years). RESULTS: 38 Implants had to be removed during the follow up period (34.2%). Taking into account the radiologic loosening in addition 22 cups were defined as failure (19.8%). Overall 36 (32.4%) cups showed excellent or good clinical results with 85 points according to the Harris-Hip-Score. 15 of the 22 radiologic loose implants showed only little or no pain. Considering the removed implants the probability of survival is 69% after 7 years. Defining the radiologic loose implants as failure the survival rate is 54%. CONCLUSION: X-rays have to be taken frequently to determine bone loosening early with subsequent revision operation. The survival rate is to low compared to other types of fixation. Therefore acetabular titan screw cups (type Mec-Ring) should not be used any more.

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PubMed2002

Cable fixation in displaced fractures of the acetabulum: 21 patients followed for 2-8 years.

We evaluated the outcome in 21 patients having acetabular fractures who had been treated with a 2 mm-braided cable, alone (n = 6), or together with plate and screws. Reduction with a fracture gap of less than 2 mm was achieved in 20 cases. The operation lasted an average of 3 (1.5-4.8) hours. The average blood loss was 1.4 (1.3-2.8) L. No intraoperative complication occurred in relation to surgery. Postoperative complications included 2 cases each of posttraumatic arthritis and avascular necrosis of the femoral head. After a mean follow-up of 4 (2-8) years, the clinical outcome was excellent in 13, good in 3, fair in 3 and poor in 2, and the radiographic outcome was excellent in 10, good in 6, fair in 1 and poor in 4. We believe that cable fixation is a useful technique since the indirect reduction requires a limited exposure, avoids penetration of the screw into the joint, and improves fixation in patients with osteoporosis.

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PubMed1997

Bone grafting in total hip arthroplasty for insufficient acetabulum.

We assessed the effectiveness of total hip arthroplasty (THA) supplemented with autologous bone grafts in patients with congenital disease of the hip (CDH). 2 groups of patients were evaluated: In Group A, 33 patients with a mean age of 54 years underwent arthroplasties using a threaded ceramic conical acetabular cup without cement (Autophor). In Group B, 85 patients with a mean age of 55 years underwent arthroplasties using a threaded, noncemented, titanium cup (CST). Bone grafts were supplemented the THA in 3 ways: 1) intrapelvic application using the cotyloplasty technique, 2) as bone chips in order to cover small defects around the upper and lateral part of the cup, and 3) as a bulky corticocancellous graft which was secured with screws. Follow-up averaged 11 and 9 years for patients in Groups A and B, respectively. All the grafts in Group A had consolidated by the end of 6th month. Only 2 partial absorptions were observed, 1 intrapelvic graft and 1 corticocancellous graft. 2 revisions were performed in this group of patients, but neither were related to bone graft absorption. By the end of 6 month, 63 of 85 in Group B had consolidated bone grafts. In 16 patients with intrapelvic cotyloplasty, 3 demonstrated complete and 1 partial absorption of the grafts. 3 cup revisions were performed in this group of patients, all with complete graft absorption. Our findings indicate that autologous bone grafts are strong adjunct for satisfactory fixation of THA in patients with CDH, a particularly demanding group of patients to manage. In addition, the ceramic threaded cup was found to be superior to the titanium threaded cup in terms of both bone graft consolidation and the number of revisions required.

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