Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Prosthesis Failure”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 505 records · Page 28Linked to original sources
PubMed2000

Press-fit metal-backed alumina sockets: a minimum 5-year followup study.

Two hundred thirty-four consecutive alumina-on-alumina hip replacements using a press-fit metal-backed socket, performed on 214 patients (98 women, 116 men) have been reviewed. These included 201 primary procedures and 33 revision procedures. The median age of the patients at the time of surgery was 62 years (range, 21-83 years). Fourteen patients (16 hips) died from unrelated causes. Eleven patients (11 hips) underwent a total hip arthroplasty revision for recurrent dislocation (one hip), deep infection (two hips), fracture of alumina femoral head (one hip), persistent hip pain (one hip) and aseptic loosening (six hips). The survival rate after 9 years was 93.4% when revision of the prosthesis was considered the end point, and 97.4% if revision of the prosthesis for aseptic loosening was considered the end point. Results were assessed in the surviving patients with a minimal 5-year followup (170 patients, 184 hips). At the median followup of 7.8 years, the average Merle d'Aubigné and Postel score had improved from 11.9- to 17.7. Results were graded as excellent in 148 hips (80.5%), very good in 31 hips (17%), good in two hips (1%), and fair in three hips (1.5%). Radiologic data were documented for 134 patients (143 hips). Three sockets (2%) had a complete and nonprogressive radiolucent line less than 1-mm thick, one stem (0.7%) had lucencies involving five zones, and two stems (1.4%) had isolated femoral osteolysis. Neither component migration nor acetabular osteolysis were detected. A press-fit metal-backed socket may offer a good solution for alumina socket fixation when combined with a careful surgical technique of implantation.

Adult↗
PubMed2001

The Phenix expandable prosthesis: early American experience.

One of the major dilemmas in limb preservation in skeletally immature children involves the ability to maintain leg length equality. Many attempts have been made to design a prosthesis that could be expanded easily either nonoperatively or through a minor surgical procedure. Most of these designs have had mechanical difficulty or the lengthening procedure becomes a major surgical endeavor. The Phenix technology has been used in France for several years. The basic principle involves storage of energy in a spring which is maintained compressed by an original locking system. Once implanted, prosthetic lengthening is achieved via exposure to an external electromagnetic field that pilots the locking system and allows controlled release of the spring energy. Seven Phenix prostheses have been implanted in six patients. All patients had been treated for Stage II-B osteosarcoma. Six of the seven prostheses were implanted during revision procedures in salvage situations; one prosthesis was implanted during an index procedure. The surgical procedures were completed without complications. One patient sustained a fracture of the prosthesis in a fall and had an infection develop after implantation of the second prosthesis. Twenty-one expansions have been performed in six patients (mean lengthening at each procedure, 8 mm). There were no acute complications attributable to the lengthening procedure. Prosthetic expansions required an average of 20 to 30 seconds and were accompanied by very mild discomfort, if any. Most patients were given an oral analgesic either before or during the lengthening procedure. The Phenix prosthesis shows promise in handling the difficult problem of limb preservation in a growing child. Additional investigation is underway regarding limb lengthening and other dynamic applications.

Administration, Oral↗
PubMed2001

The uncemented fully textured Lord hip prosthesis: a 10- to 15-year followup study.

One hundred fourteen total hip arthroplasties in 110 patients performed between 1979 and 1983 using the Lord femoral component were analyzed. Nine femoral revisions were performed within 13 years after surgery (two because of infection). Excluding infections there was a 94% 13-year survival according to a Kaplan-Meier analysis. Subsidence was seen in five hips (five patients), but only one needed revision surgery. Seventy-six hips (73 patients) had a radiographic followup of 10 years or more and were analyzed in detail. Changes in cortical thickness, density, and formation of spotwelds continued beyond 5 years after surgery, meaning the remodeling of periprosthetic bone continued beyond that time. Osteolysis on the femoral side was seen in seven hips, always in the proximal part of the femur, apparently as a continuation of the joint space. No remote focal osteolysis was seen. Elderly patients, women, and patients with a pedestal were overrepresented among individuals with many spotwelds. For the clinical outcome the Merle d'Aubigne and Postel score as modified by Charnley was used. Among 69 hips (66 patients) with a mean followup of 153 months 96% (66 hips) had a pain score equal to or greater than 4 and 74% (51 hips) had a score of 5 or 6. The Lord femoral component gave surprisingly good clinical long term results despite the bone remodeling (stress shielding), which in some cases was pronounced. The most obvious disadvantage with this design appears to be the difficulties associated with its removal when indicated.

Adult↗
PubMed2001

Fistula between a total hip arthroplasty and the rectum: a case report.

An 81-year-old man was referred to the authors for examination of the gastrointestinal tract. A proctoscopy revealed a draining sinus tract in the terminal rectum. Plain radiographs revealed a failed total hip arthroplasty that had migrated into the pelvis. Hip aspiration revealed an infection with bacteria commonly found in the gastrointestinal tract. A fistulogram confirmed a connection between the rectum and the hip replacement. The development of a fistula between the colon and the hip is extremely uncommon. A fistula between the hip and the rectum is a previously unreported complication of total hip arthroplasty.

Arthroplasty, Replacement, Hip↗
PubMed2002

Surface-active phospholipid in total hip arthroplasty.

This is the first report of surface-active phospholipid as the boundary lubricant in total hip arthroplasty. Aspirate and rinsings from the bearing surfaces of 25 revision operations and one primary surgery were analyzed from 3 weeks to 26 years postoperatively. All samples contained substantial amounts of surface-active phospholipids ranging from 14 to 4186 microg. These findings indicate that synoviocytes continue producing the lubricant in significant quantities after arthroplasty surgery independent of the type of joint replacement and its fixation. Surface-active phospholipid was found on all bearing surfaces analyzed including polyethylene, stainless steel, chrome cobalt, alumina, zirconia, and titanium.

Arthroplasty, Replacement, Hip↗
PubMed2002

Salvage of infected total knee fusion: the last option.

Currently the most common indication for an arthrodesis of the knee is a failed infected total knee prosthesis. Other causes of a failed total knee replacement that might necessitate a knee fusion include aseptic loosening, deficient extensor mechanism, poor soft tissues, and Charcot joint. Techniques available for achieving a knee fusion are external fixation and internal fixation methods. The external fixation compression devices have been the most widely used for knee fusion and have been successful until the indications for fusion changed to mostly failed prosthetic knee replacement. With failed total knee replacement, the problem of severe bone loss became an issue, and the external fixation compression devices, even including the biplane external fixators, have been the least successful method reported for gaining fusion. The Ilizarov technique has been shown to achieve rigid fixation despite this bone loss, and a review of reports are showing high fusion rates using this method. Internal fixation methods including plate fixation and intramedullary nails have had the best success in gaining fusion in the face of this bone loss and have replaced external fixation methods as the technique of choice for knee fusion when severe bone loss is present. A review of the literature and a discussion of different fusion techniques are presented including a discussion of the influence that infection has on the success of fusion.

Arthrodesis↗
PubMed2002

State of the art review: techniques to avoid pin loosening and infection in external fixation.

UNLABELLED: The purpose of this manuscript is to review techniques of optimizing the interface between the bone and pin in external fixation to minimize pin loosening and infection. CONCLUSIONS: Among the different techniques to improve the bone-pin interface in external fixation, coating the pins with hydroxyapatite proved to be the most effective. In a highly loaded animal study, three pin types were compared. Type A remained uncoated, type B was coated with hydroxyapatite, and Type C was coated with titanium. Radiographic rarefaction of the bone pin tract was lower in type B pins. Extraction torque was thirteen times higher in type B pins compared to type A and two times higher compared to type C pins. Extraction torque was significantly lower compared to the corresponding insertion torque in both types A and C. In contrast, in the hydroxyapatite coated pins there was no difference between extraction and insertion torque. At sixty times magnification, bone pin contact of type B and C pins was significantly higher than type A. At 10,000 times magnification direct bone pin contact was found only in type B pins. In a clinical study the pin insertion and extraction torque forces were measured in a study of seventy-six external fixation pins in nineteen patients treated with hemicallotasis for osteoarthritis of the medial side of the knee. The patients were randomized to be treated with either standard tapered pins or tapered pins coated with hydroxyapatite. Extraction torque of the hydroxyapatite coated pins was higher than the standard ones in both cancellous and cortical bone. These studies show that in hydroxyapatite coated pins there is no deterioration of the bone-pin interface strength and there is optimal bone-pin contact. Among the various pin types coated with hydroxyapatite, the best results were obtained with the tapered pins.

Animals↗
PubMed1997

99Tc(m)-polyclonal IgG scintigraphy in the detection of infected hip and knee prostheses.

We investigated the usefulness of 99Tc(m)-polyclonal human IgG (99Tc[m]-HIG) scintigraphy in the diagnosis of infected hip and knee prostheses. Twenty-nine scintigraphic studies were performed in 27 patients (17 females, 10 males) with a suspected prosthetic infection. As some patients had bilateral prostheses, a total of 35 prostheses were evaluated. There were 25 hip replacements and 10 knee prostheses. The images were analysed both visually and quantitatively. The scintigraphic results were compared with the culture results of surgical specimens and also with clinical follow-up after 3 months. Increased uptake was observed in 22 prostheses, of which 12 were true-positive and 10 were false-positive results. Staphylococci were the agents most commonly isolated. In all false-positive patients, aseptic inflammation was diagnosed. Based on quantitative analysis, no statistically significant difference was found between the true-positive and false-positive cases. For the prostheses as a whole, the sensitivity, specificity, positive predictive value and negative predictive value were 100%, 41%, 54% and 100% respectively. For the hip prostheses alone, these values were 100%, 53%, 57% and 100% respectively. Taking its high sensitivity and predictive value into consideration, 99Tc(m)-HIG scintigraphy can be used as a screening test to help eliminate prosthetic infection.

Adult↗
PubMed2002

The use of [18 F]fluorodeoxyglucose positron emission tomography to differentiate between synovitis, loosening and infection of hip and knee prostheses.

Pain is a common unspecific symptom in orthopaedic prosthetics. The accurate differentiation between synovitis, loosening or infection is often difficult with conventional X-rays, arthrography or bone scintigraphy. Because of the high glucose uptake of inflammatory cells, [18F]fluorodeoxyglucose (18F-FDG) is an appropriate tracer for the evaluation of suspected inflammation or infection. In this preliminary study we describe 18F-FDG PET findings in patients referred for evaluation of painful hip or knee prostheses. We studied 23 patients with 28 prostheses, 14 hip and 14 knee prostheses, who had a complete operative or clinical follow-up. 18F-FDG PET scans were obtained with an ECAT EXACT HR+ PET scanner. High glucose uptake in the bone prostheses interface was considered as positive for infection, an intermediate uptake as suspect for loosening, and uptake only in the synovia was considered as synovitis. The imaging results were compared with operative findings or clinical outcome. PET correctly identified three hip and one knee prostheses as infected, two hip and two knee prostheses as loosening, four hip and nine knee prostheses as synovitis, and two hip and one knee prostheses as unsuspected for loosening or infection. In three patients covered with an expander after explantation of an infected prosthesis PET revealed no further evidence of infection in concordance with the clinical follow-up. PET was false negative for loosening in one case. Our preliminary results suggest that FDG PET could be a useful tool for differentiating between infected and loose orthopaedic prostheses as well as for detecting only inflammatory tissue such as synovitis.

Adult↗
PubMed2002

The importance of the location of fluorodeoxyglucose uptake in periprosthetic infection in painful hip prostheses.

Ten per cent of patients with hip replacement will eventually complain of significant pain after surgery, often requiring a revision arthroplasty. The majority of these patients experience aseptic loosening rather than infection. Despite significant advances made in diagnostic imaging, distinguishing infection from aseptic loosening remains a significant challenge. Imaging using fluorodeoxyglucose (FDG) positron emission tomography (PET) has been reported to have excellent sensitivity in detecting infections associated with hip prostheses. However, in some studies, a high rate of false positive results has been reported, especially when increased tracer uptake adjacent to the prosthesis (which is not surrounded by bone) is used as the sole criterion for diagnosing infection. The objective of this investigation was to determine the optimal criteria for diagnosing periprosthetic infection, thereby avoiding false positive results in this setting. A total of 41 total hip arthroplasties from 32 patients and for whom complete clinical follow-up was available were included in this analysis. The location and intensity of FDG uptake were determined for each scan. Final diagnosis was made by microbiology, histopathology, surgical findings and clinical follow-up. Patients who did not undergo surgery were followed up to at least 9 months. Twelve patients were proven eventually to have periprosthetic infection. Images from 11 of these patients displayed increased tracer uptake along the interface between bone and prosthesis. The intensity of the increased tracer uptake varied from mild to moderate, with standardized uptake values less than 2. In contrast, images from uninfected, loose hip prostheses revealed very intense uptake around the head or neck of the prosthesis with standardized uptake values as high as 7. It is concluded that the intensity of increased FDG uptake is less important than the location of increased FDG uptake when FDG PET is used to diagnose periprosthetic infection in patients with hip arthroplasty. Using increased uptake as the sole criterion for diagnosing infection will result in false positive results in this setting.

Adult↗
PubMed1992

How to treat ailing and failing implants.

This article describes treatment of the ailing implant (bone loss with pocketing but static at the maintenance checks) and the failing implant (bone loss with pocketing, bleeding upon probing, purulence, and evidence of continuing bone loss irrespective of therapy). Because the surface of the implant is contaminated with endotoxin, it must be detoxified before any regenerative therapy. Studies have shown that citric acid is effective in detoxifying the hydroxyapatite-coated surfaces while tetracycline is more effective in sterilizing the metallic substrate fixtures. Guided tissue regeneration is useful as a "barrier" to prevent exfoliation of the grafted material. Both nonresorbable and resorbable materials have been used with great success. Allografts (freeze-dried bone) and alloplasts (synthetic materials) may be used to achieve a sulcus of decreased depth and possibly some type of osseous regeneration. The author recommends the use of the allograft if the surface is completely detoxified and the alloplast if it is not certain that the surface is sterilized and free of endotoxin. The allograft, being resorbable, will not effect biologic healing against a contaminated surface; hence, the use of the alloplast to "fill" the defect and prevent epithelial invagination.

Alveolar Bone Loss↗
PubMed2004

Vascular access for hemodialysis: 2004 and beyond.

PURPOSE OF REVIEW: Developments in vascular access are accruing rapidly. The last systematic Kidney Disease Outcomes Quality Initiative guidelines review took place in 2000. The purpose of this review is to update several major areas in which clear progress has been made. A major 'Fistula First Initiative' in the USA is an attempt to increase markedly the fraction of patients receiving an autologous arteriovenous fistula as opposed to a graft. Preoperative mapping to evaluate veins and artery may permit construction of arteriovenous fistula in up to 70% of all patients, thereby reducing access thrombosis, infection, and perhaps increasing survival of patients. RECENT FINDINGS: Although a number of different synthetic materials have been tried, none seems to have any definite advantage over plain expanded polytetrafluoroethylene for constructing synthetic bridge grafts. Two developments may influence practice: use of composite self-sealing grafts that can be used within hours may eliminate the need for temporary catheters; and use of nitinol surgical clips may reduce endothelial trauma and improve patency. Large-bore catheters can deliver blood flows of over 400 ml/min initially, but they are prone to progressive occlusion. Optimal means of using a fibrinolytic to preserve flow must be evaluated. Surveillance techniques are undergoing rapid re-evaluation. Finally, a variety of antibiotic lock techniques are being evaluated for their ability to prevent catheter-related infections. SUMMARY: Greater efforts must be made to establish pre-end-stage renal disease programs to educate and prepare patients for hemodialysis and improve arteriovenous fistula placement rates, and to encourage clinicians to re-examine their current clinical practices and dedicate themselves to improving vascular access outcomes.

Arteriovenous Shunt, Surgical↗
PubMed2004

Polymerase chain reaction can detect bacterial DNA in aseptically loose total hip arthroplasties.

Identifying low-grade infection in failed total hip arthroplasties is an important but difficult task. This study investigated the ability of the polymerase chain reaction to identify low-grade infection during revision of total hip arthroplasties that failed from aseptic causes. One hundred thirteen specimens from 31 total hip arthroplasties revised for aseptic loosening were compared with 105 control specimens from 28 primary total hip arthroplasties. All surgeries were done in laminar flow operating rooms. No primary or revision specimen had positive microbiologic cultures. No revision specimen had histologic evidence suggestive of infection. Using the polymerase chain reaction with a detection threshold of 10 organisms per cubic centimeter of specimen, bacterial DNA was identified in 39 of 85 revision tissue specimens (46%) compared with 18 of 84 primary tissue specimens (21.4%). Bacterial DNA was identified in the synovial fluid of three specimens taken from 28 revision total hip arthroplasties (10.7%) and in two specimens taken from 21 primary total hip arthroplasties (9.5%). As multiple specimens were sent for each hip, a maximum of 16 of 31 revision total hip arthroplasties (52%) and eight of 28 primary total hip arthroplasties (29%) were considered to be infected. Bacterial DNA can be found in many specimens obtained from revised total hip arthroplasties considered to be aseptically loose. Because bacterial DNA identified at primary total hip arthroplasty was assumed to be attributable to contamination rather than present in healthy tissues, the overall specimen contamination rate of 19% and case contamination rate of 29% indicate that the polymerase chain reaction has poor specificity at this sensitivity level for diagnosing infection in revision total hip arthroplasty.

DNA, Bacterial↗
PubMed2005

A new locking plate for unstable fractures of the proximal humerus.

UNLABELLED: In a prospective study, 28 patients with 29 proximal humeral fractures were treated with the Locking Proximal Humerus Plate from 2001-2002. Most of these fractures were complex, Type B (n = 15) and Type C (n = 9) fractures, according to the AO classification. Followups included radiographs, clinical examinations, and recording Constant scores. After 1 year, the average Constant score for all fractures was 74.6 (range, 37-96). For Type A fractures, it was 82.6 (range, 60-96), for Type B it was 78.3 (range, 37-95), and for Type C it was 64.6 (range, 40-91). Complications related to the implant included breakage of the plate in one patient and redislocation of the fracture in four patients (one fracture was associated with deep infection), which required reoperation in two patients. Partial osteonecrosis was seen in two patients, once after deep infection. There were no nonunions. Our data show that using the Locking Proximal Humerus Plate for treatment of proximal humeral fractures of all types is a reliable procedure, with good results being obtained with careful planning and familiarity with the special features of the operative technique. LEVEL OF EVIDENCE: Therapeutic study, Level II-1 (prospective cohort study).

Activities of Daily Living↗
PubMed2005

Perioperative contamination in primary total hip arthroplasty.

UNLABELLED: All surgical procedures have the risk of microbial contamination. However, procedures in which prosthetic materials are involved have a high risk for future infectious problems because of the protection offered by the biofilm mode of growth. Studies of perioperative contamination have been done on involved surgical instruments, but whether these instruments transmit contamination to the prosthesis or future site of the prosthesis is not known. The aim of this study was to detect possible bacterial contamination in total hip arthroplasty through instruments that are used at the direct site of implantation during the primary procedure. Samples of the broaches used for preparing the acetabulum and femur, and samples of the reamed acetabular and femoral bone, were collected during 67 consecutive primary total hip arthroplasties in 67 patients. Broach samples were taken at the start and end of every reaming procedure. Four hundred two samples were taken, of which 26 were found to be positive for microorganisms. In 20 patients, at least one of these positive samples had been in direct contact with the actual prosthesis site, indicating that at least 30% of the involved patients had a possible bacterial contamination when leaving the operating theater. LEVEL OF EVIDENCE: Diagnostic study, Level I-1 (testing of previously developed diagnostic criteria in series of consecutive patients--with universally applied reference gold standard). See the Guidelines for Authors for a complete description of levels of evidence.

Arthroplasty, Replacement, Hip↗
PubMed2004

Reasons for revision hip surgery: a retrospective review.

The purpose of this study was to determine the indications for contemporary revision hip surgery in a consecutive series of patients. We retrospectively reviewed the clinical records and radiographs of 439 revision hip surgeries done between 1996 and 2003. Fifty-five percent of the surgeries were for aseptic loosening, 14% were for instability, 13% were for osteolysis around a well-fixed implant, 7% were for infection, 5% were for periprosthetic fracture, 3% were for conversion of a hemiarthroplasty, 1% was for psoas impingement, 1% was for loose recalled implants, and 1% was for implant fracture. As expected, aseptic loosening was the most common reason for revision surgery. Instability was a common reason for early revision whereas revision for osteolysis around a well-fixed implant was a more common reason for late revision.

Adult↗
PubMed2005

Contaminant seeding in bone by different irrigation methods: an experimental study.

OBJECTIVE: This study was designed to investigate the effectiveness of using various devices and manual procedures for cleansing bacterially contaminated bone tissue and to assess the risk of iatrogenic bacterial seeding in deep bone layers. METHODS: In an in vitro model, human femoral heads were contaminated with Escherichia coli and then cleansed with pulsatile high-pressure lavage, pulsatile low-pressure lavage, manual rinsing with bulb syringe lavage, or manual rinsing with combined brush cleaning. The numbers of bacteria that remained or those that were introduced by the rinsing procedures were quantitatively determined at depths of 0 to 1 cm, 1 to 2 cm, and 2 to 3 cm. RESULTS: Both pulsatile high-pressure lavage and brush cleaning were more effective than pulsatile low-pressure lavage and bulb syringe lavage for the purpose of surface cleansing. The differences were highly significant (P < 0.001). There was no significant difference in the decontaminating effect between pulsatile high-pressure lavage and brush cleaning (P = 0.24). The bacterial contamination attributable to the cleansing procedure, as measured at tissue depths of 1 to 2 cm and 2 to 3 cm, was significantly higher after pulsatile high-pressure lavage and after pulsatile low-pressure lavage than it was after bulb syringe lavage or brush cleaning (P < 0.001). CONCLUSION: In this in vitro investigation of cancellous bone, the brush cleansing was just as effective for getting rid of bacterial contamination as pulsatile high-pressure lavage, and carries a significantly lesser risk of iatrogenic bacterial seeding into deeper tissue layers. In the light of these promising results obtained by the cleansing of cancellous bone contaminated with bacteria, it would be desirable to perform supplementary in vitro and in vivo investigations into brush cleansing.

Aged↗