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At least 595 records · Page 33Linked to original sources
PubMed2004

Cementless modular hip revision arthroplasty using the MRP Titan Revision Stem: outcome of 79 hips after an average of 4 years' follow-up.

INTRODUCTION: As primary total hip replacements (THRs) become more common in older patients and younger, physically active patients, the number of revision arthroplasties will also increase. Femoral bone loss, joint instability and possible infections are a challenge for a surgeon performing revision arthroplasty of the hip. The severe proximal femoral bone loss indicates the use of revision stems with a distal fixation. MATERIALS AND METHODS: In this study the clinical and radiological outcomes of 79 cementless stem revisions using the MRP Titan Revision Stem with an average follow-up time of 4 years were prospectively examined. RESULTS: The Harris Hip Score improved from preoperative 50.8+/-25.2 to postoperative 86.8+/-13.2. In all cases healing of bony defects could be found. For stem diameters larger than 17 mm, atrophy of the proximal femur and non-progressive radiolucent lines in zones 1 and 7 according to Gruen were detected. No disadvantages or complications of the Morse taper junctions were observed, and no osteolysis was detected in this region. Primary stable fixation was achieved in all but two cases. Three cases were revised again due to periprosthetic fracture (1) and persisting infection (2). CONCLUSION: Given the encouraging results with the MRP Titan Revision Stem, the principle of uncemented diaphyseal fixation appears to solve most of the technical problems in cases of significant bone loss and obviously offers good preconditions for bony restoration.

Aged↗
PubMed2005

Autogenous femoral head bone grafts for acetabular deficiency in total-hip arthroplasty for developmental dysplasia of the hip: long-term effect on pelvic bone stock.

Twenty-eight primary total-hip arthroplasties in 23 patients performed with autogenous femoral head bone graft augmentation for developmental hip dysplasia were retrospectively reviewed at 8 to 15 years. Five sockets were revised for different reasons. At revisions, 3 grafts were healed, the other 2 had substantial resorption. Immediately postoperatively, the mean medial to lateral graft thickness at the level of the superior border of the socket was 33 mm. Radiographs a mean of 4.8 years after operation demonstrated this thickness decreased by a mean of 1 mm (range, 0-10 mm). At 11 years (range, 8-15 years), radiographs in unrevised hips showed no cases of substantial further graft resorption.

Acetabulum↗
PubMed2006

Long-term outcome and risk factors of proximal femoral fracture in uncemented and cemented total hip arthroplasty in 2551 hips.

Proximal femoral fractures are relatively common during total hip arthroplasty. The purposes of this study were to identify risk factors associated with femoral fractures and determine their effect on femoral stem survivorship. A total of 2551 hips were examined with up to 16 years of follow-up (mean, 6.8 years). Seventy-five percent of the stems were cemented. The incidence of proximal femoral fracture was 2.3% (59 hips). Risk factors associated with fractures include anterolateral approach, uncemented femoral fixation, and female sex (P < .01). Cerclage wiring was the most common treatment. After a fracture, femoral component survivorship was 95.8% for uncemented stems and 91.7% for cemented stems. In the absence of fracture, stem survivorship was 98.6% for cemented stems and 100% for circumferentially coated tapered titanium uncemented stems.

Adolescent↗
PubMed2002

Percutaneous compression plating (PCCP) versus the dynamic hip screw for pertrochanteric hip fractures: preliminary results.

The percutaneous compression plate (PCCP) is a new implant for the minimally invasive treatment of pertrochanteric hip fractures that might reduce blood loss, wound problems and prevent devascularization of bone fragments. A quicker operation with minimal blood loss is better in the older patients. We performed a prospective, randomized clinical trial to compare the PCCP with the well-known dynamic hip screw (DHS). A total of 71 patients with an Evans type 1A-D pertrochanteric hip fractures were included. We measured the operation duration, blood loss, wound healing, complications, fracture healing and functional outcome. In total, 33 PCCP and 38 DHS were implanted. The mean operation times were 69.2 and 46.6 min for DHS and PCCP, respectively (P = 0.000). Blood transfusions were given in 24 DHS patients compared with six PCCP patients (P = 0.000). There were 27 haematomas in the DHS group and eight in the PCCP group (P = 0.000). There were no differences in fracture healing and the functional outcome between the two implants (P = 0.767, ns). Although this is a preliminary study with a relatively small number of patients and short follow-up, the PCCP seems similar to the DHS in relation to bone healing and stability, but with significant advantages for blood loss, soft tissue healing and operation time.

Aged↗
PubMed2000

Poor bone quality or hip structure as risk factors affecting survival of total-hip arthroplasty.

BACKGROUND: The principal long-term complication after total hip arthroplasty (THA) has been aseptic fixation failure. Many hip prostheses and operative techniques have been developed to improve outcomes, but few measures have been taken to cope with poor bone quality or hip structure. We assessed risk factors for aseptic fixation failure after THA. METHODS: We assessed, by multivariate analysis, survival of 405 primary Charnley THAs to identify risk factors for aseptic fixation failures. We also investigated risk factors for development of rapid polyethylene wear (penetration depth of the femoral head into the socket polyethylene > or = 2 mm/year) FINDINGS: In the entire series of 405 THAs, with use of radiographic fixation failure or revision for a loose socket as the endpoint, development of rapid polyethylene wear and the preoperative diagnosis of atrophic osteoarthrosis (defined by scarce osteophyte formation) were identified as risk factors for socket loosening (p < or = 0.02). A medullary canal with an unfavourable geometry (a stovepipe canal, Noble's canal-flare index < 3.0) was the only risk factor for femoral fixation failure (p < or = 6.7x10(3)). The only variable related to development of rapid polyethylene wear was the type of steel used in the femoral prosthesis--Ortron 90 prostheses significantly lowered the rate of development of rapid wear from 12.7% to 0.4%. In the 248 THAs in which these femoral prostheses were used, socket survival was affected only by the preoperative diagnosis of atrophic osteoarthrosis (for radiographic fixation failure and revision, p=4.0x10(-5) and p=0.042, respectively). INTERPRETATION: In THA, the critical risk factors are poor bone quality, which manifests as atrophic osteoarthrosis, for socket survival and poor bone structure for femoral-prosthesis survival. To ensure longer durability of THAs, these factors should be assessed further and efforts, especially biological initiatives, should be made to resolve them.

Arthroplasty, Replacement, Hip↗
PubMed1989

Importance of the clicking hip in screening for congenital dislocation of the hip.

A birth cohort of 3289 babies was investigated prospectively for one year to assess the importance of risk factors for congenital dislocation of the hip (CDH). 426 (13%) babies had an identifiable risk factor when examined by paediatric senior house officers. On further examination in the first week of life at a screening clinic, 51 proved to have CDH, an incidence of 15.5 per 1000 births. The results confirmed the importance of established factors such as family history, caesarean section, and the breech position, and demonstrated the clinical significance of the presence of clicking hips on initial examination. After up to 4.1 years of follow-up there have been no late presentations. By taking into account the clinical examination by senior house officers, secondary screening of babies at high risk of CDH can be very effective. This extended high risk group may contain all potentially abnormal hips. All such babies should be examined by ultrasonography in hospitals where it is available.

Breech Presentation↗
PubMed2001

Gait analysis after total hip arthroplasty with leg-length equalization in women with unilateral congenital complete dislocation of the hip--comparison with untreated patients.

Patients with Crowe Type-IV congenital dislocation of the hip (CDH) show significant clinical improvement after total hip arthroplasty (THA) because this surgery greatly reduces pain. Concomitant leg-length equalization in unilateral patients--a controversial procedure--theoretically should significantly improve these patients' ability to walk efficiently and comfortably. To understand the impact of leg-length equalization on these patients, we compared their gait parameters with those of untreated patients without pain but with leg-length discrepancy. Using a motion analysis system, three force platforms and computer calculation, the gait parameters during level walking of 22 women with unilateral Crowe Type-IV CDH were studied at an average of 58 months (27-98 months) following a successful cementless THA. The socket was placed in the best bone stock, which was close to the level of the true acetabulum. The leg-length discrepancy was equalized to within 2 cm in all patients. The Harris hip score averaged 94.8 (range, 88-100) at the time of the study. Nine women with untreated unilateral Crowe Type-IV CDH without major pain but with an average leg-length discrepancy of 4.7 cm (range, 2.5-6 cm) were also studied for comparison. The treated subjects (Group 1; THA and leg-length equalization) walked faster and had gait parameters with better bilateral symmetry than the untreated subjects (Group 2). We concluded that leg-length equalization in addition to THA in patients with unilateral Crowe Type-IV CDH significantly improves gait symmetry and efficiency.

Adult↗
PubMed1991

Femoral head anteposition after surgery of congenital dislocation of the hip. A computerised tomography study of 22 hips suspected of anterior dislocation.

A new term called "femoral head anteposition" to describe the clinical appearance of a hip operated on because of CDH and suspected of anterior dislocation, has been introduced. CT scans of both the horizontal and sagittal planes of 22 hips suspected of iatrogenic anterior dislocation were made from 22 children. These had been operated on because of CDH by the open reduction method with derotation varus osteotomy of the femur and transiliac osteotomy by Dega. An evaluation of the CT scans combined with clinical examination allowed the differentiation of the homogeneous clinical appearance from the "anteposition". It was then possible to establish one or several coexisting reasons to the situation. These were: anterior dislocation of the hip, coxa magna after avascular necrosis, gluteal muscle fibrosis or periarticular ossifications.

Child↗
PubMed2004

Hip revision using the Exeter stem, impacted morselized allograft bone and cement: a consecutive 5-year radiostereometric and radiographic study in 15 hips.

BACKGROUND: Impaction grafting in hip revision surgery is widely used but studies with mid- and long-term follow-up are scarce. PATIENTS, METHODS AND RESULTS: A 5-year radiostereometric (RSA) follow-up of 15 hip revisions with the Exeter stem, morselized impacted allograft bone and cement revealed that 3 stems had not migrated between 2 and 5 years after revision, 11 stems had migrated to a minor degree in at least 1 direction, and 1 stem was loose according to RSA but without any radiographic signs of loosening or pain. The pain score was comparable to primary arthroplasties. INTERPRETATION: From a 5-year perspective, first-time hip revisions for aseptic loosening with impacted morselized allograft bone and cement appear to yield good clinical results, although stem migration continues to a minor degree 2 years after revision.

Aged↗
PubMed2005

Comparison of analog and digital preoperative planning in total hip and knee arthroplasties. A prospective study of 173 hips and 65 total knees.

INTRODUCTION: Digital correction of the magnification factor is expected to yield more accurate and reliable preoperative plans. We hypothesized that digital templating would be more accurate than manual templating for total hip and knee arthroplasties. PATIENTS AND METHODS: Firstly, we established the interobserver and intraobserver reliability of the templating procedure. The accuracy and reliability of digital and analog plans were measured in a series of 238 interventions, which were all planned using both techniques. RESULTS: Interobserver reliability was good for the planning of knee arthroplasties (e-values 0.63-0.75), but not more than moderate for the planning of hip arthroplasties (e-values 0.22-0.54). Analog plans of knee arthroplasties systematically underestimated the component sizes (1.1 size on average), while the digital procedure proved to be accurate (0.1-0.4 size too small on average). The following figures show percentage of cases receiving a correct implant, allowing an error of one size. Digital templating of the hip arthroplasty was less frequently correct (cemented cup and stem: 72% and 79%; uncemented cup and stem: 52% and 66%) than analog planning (cemented cup and stem: 73% and 89%; uncemented cup and stem: 64% and 52%). INTERPRETATION: Planning of component sizes for total knee arthroplasties is an accurate procedure when performed digitally. Our digital preoperative plans which were performed by someone other than the surgeon were less accurate than the analog plans prepared by the surgeon.

Arthroplasty, Replacement, Hip↗
PubMed2006

Exposure to chromium, cobalt and molybdenum from metal-on-metal total hip replacement and hip resurfacing arthroplasty.

BACKGROUND: All metal implants--and metal-on-metal bearings in particular--corrode and cause a release of metal ions. Because cobalt and chromium have been shown to be carcinogenic and mutagenic in human and animal models, systemic toxicity and cancer risk are considered to be possible disadvantages of the metal-on-metal articulation. This study was designed to investigate the serum concentration profiles of chromium, cobalt and molybdenum after implantation of a Birmingham hip resurfacing arthroplasty (BHR) and a cementless total hip replacement with a 28-mm Metasul articulation (MTHR), over the first 2 years after implantation. METHODS: We analyzed profiles of metal ion serum levels in 111 patients implanted with a BHR, in 74 patients implanted with an MTHR, and in 130 implant-free probands control subjects using atomic absorption spectrophotometry. RESULTS: Chromium and cobalt concentrations (in microg/L) of all BHR and MTHR patients differed significantly from those of control subjects (chromium: < 0.25; cobalt: 0.25). The median chromium and cobalt concentrations in BHR patients had increased to 5.1 and 4.3 microg/L 2 years after surgery. Concentrations in BHR patient exceeded those in the unilateral MTHR patients. Molybdenum serum concentrations hardly changed over time in either group and were not significantly different from the concentrations seen in the control subjects. INTERPRETATION: During the first 2 years after surgery, the Birmingham hip resurfacing arthroplasty leads to a significantly greater increase in serum chromium and cobalt levels than the 28-mm metal-on-metal MTHR. Observation of patients over a longer period will be necessary in order to evaluate any chronic adverse effects to the system due to elevated chromium and cobalt serum concentrations.

Aged↗
PubMed2002

Relevant change in radiological progression in patients with hip osteoarthritis. I. Determination using predictive validity for total hip arthroplasty.

OBJECTIVE: To determine a cut-off point above which a change in joint space width (JSW) could be considered as relevant in patients with hip osteoarthritis (OA) on the basis of predicted need for subsequent total hip arthroplasty (THA). METHODS: A multicentre, prospective, longitudinal, 5-yr follow-up study was performed. A pelvic radiograph was obtained at entry and after 1 and 2 yr. For each film, the narrowest JSW was measured using a 0.1 mm graduated magnifying glass. The absolute and relative differences between baseline and 1 and 2 yr of follow-up were calculated. We determined the cut-off points above which an absolute or relative decrease in JSW between baseline and 1 and 2 yr of follow-up could be considered relevant on the basis of the predicted need for THA during the remaining years of the study. The need for THA was categorized as 'yes' or 'no'. Thereafter, for each observed change in JSW (0.1 per 0.1 mm or 1% per 1%), the sensitivity and specificity for subsequent THA were calculated. The choice of cut-off was based on maximal sensitivity and specificity, using the graphic representation of correct classification probabilities. In this way it was possible to obtain the best measured JSW threshold with maximal true positive and minimal false positive results. RESULTS: A total of 423 and 385 patients met the criteria for analysis using the decrease in JSW between baseline and 1 and 2 yr respectively. The best cut-off points were absolute decreases in JSW of 0.2 and 0.4 mm and relative decreases in JSW of 15 and 20% after 1 and 2 yr respectively, with corresponding ranges of sensitivity and specificity of 68-75 and 67-78%. CONCLUSION: This work determined the cut-off above which a change in JSW could be considered clinically relevant in patients with hip OA, on the basis of predicted subsequent need for THA. For validation, similar studies should be conducted in other countries with different health-care systems.

Aged↗
PubMed2002

Posterior fracture dislocation of the hip joint: the value of the obturator-oblique view with the hip still dislocated.

OBJECTIVES: To determine the value of the Judet oblique views taken while the hip is still dislocated. STUDY DESIGN: Radiological review. SETTING: Level I trauma center. METHOD: In addition to the traditional views in fifty of 110 fracture-dislocations, Judet views were carried out with the hip still dislocated. Each of the respective views was viewed with the reviewer blinded to diagnosis and the fracture classified according to the information available on that view. The percent accuracy of each view was then calculated by comparing radiologic with intraoperative classification. Under the pretext that if any view enabled a more accurate classification of the fracture, it must be providing more information, we assessed the quantitative value of each radiologic view according to our ability to accurately classify the fracture. RESULTS: Using the CT scan alone, classification was accurate in 82 percent of cases because the CT often overdemonstrated the degree of comminution. When the added information available from the traditional radiographs was included, there was only a slight improvement (82 percent versus 84 percent). This was increased to 96 percent when the obturator-oblique dislocated view was included. CONCLUSION: Because it provides an uninterrupted view of the posterior wall, demonstrates the displacements of fragments, and provides a comparison for the reduced view, which greatly augments the available information, the obturator-oblique dislocated view should be done routinely in the assessment of all posterior fracture dislocations of the hip joint.

Hip Dislocation↗
PubMed2005

Latent period best predicts acetabular cup failure after total hip arthroplasties in radiated hips.

UNLABELLED: We retrospectively analyzed the prognostic factors related to the failure of acetabular components after total hip arthroplasties in radiated hips. Eighteen hips from 12 patients who had primary arthroplasties were followed up for a mean of 58 months (range, 20-139 months). The patients' age, total radiation dose, latent period, presence of infection, and the type of the acetabular component were examined as possible predictors of failure using the Cox proportional hazard regression. Multivariate analyses showed that a longer latent period was the most important risk factor for failure, increasing 1.72 times when the latent period was greater than 1 year, after adjusting for other predictors. The latent period might be helpful for clinicians in choosing a treatment method for patients. LEVEL OF EVIDENCE: Prognostic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Acetabulum↗
PubMed2007

Acetabular dysplasia with hip subluxation in Trevor's disease of the hip.

Dysplasia epiphysealis hemimelica (Trevor's disease) is a rare developmental bone disorder characterized by single or multiple epiphyseal intraarticular lesions that are usually unilateral and restricted to one side of the limb. Although the process often is limited to the lower extremity, hip involvement is not common. When it occurs it is more commonly limited to the femoral side. We report a 14-year-old boy with Trevor's disease involving the hip, femoral and acetabular sides, and with progressive dysplasia. We describe a new surgical approach to this rare condition using a two-stage procedure consisting of intraarticular resection of the lesion followed by a modified shelf acetabuloplasty in a second stage to prevent compromise of the proximal femur vasculature, and to allow preservation and improvement of range of motion of the hip. At 36 months followup the patient is pain-free, has full range of motion, improved gait, and no signs of recurrence. Although technically challenging, the two-stage approach to Trevor's disease seems a reasonable and safe method.

Acetabulum↗
PubMed1972

Total hip replacement in inflammatory hip disease using the Charnley prosthesis.

The Charnley low-friction arthroplasty was performed on 73 hips in 55 patients with inflammatory joint disease, usually for intolerable pain. Sixty-five of these operations were reviewed at a special clinic or by postal questionnaire; 57 hips were painfree or gave rise to only occasional discomfort, in 58 there was an increased range of movement, and in 46 of the 59 hips assessed clinically, the results were excellent or good. The most serious complication was deep infection, which occurred in 7 operations.

Acetabulum↗
PubMed1997

Modified technique for fluid aspiration from the hip in patients with prosthetic hips.

A modified technique was used for diagnostic aspiration of fluid from the hip in 185 patients who had previously undergone total hip arthroplasty. The aspiration needle was advanced past the lateral aspect of the shaft of the prosthesis and into the dependent portion of the joint. Fluid was successfully aspirated in 181 of 185 patients; thus the dry-tap rate was 2.2% (four of 185 patients). The modified technique was simple, could be performed quickly, and was effective for sampling joint fluid in patients with hip prostheses.

Biopsy, Needle↗
PubMed1997

Antibiotic prophylaxis in total hip arthroplasty. Review of 10,905 primary cemented total hip replacements reported to the Norwegian arthroplasty register, 1987 to 1995.

We have assessed the effect of different regimes of antibiotic prophylaxis on the survival of total hip implants, comparing antibiotics administered both systemically and in the bone cement, systemically only, in the bone cement only and with no antibiotics given. We studied 10,905 primary cemented total hip replacements, performed for osteoarthritis of the hip and reported to the Norwegian arthroplasty register between 1987 and 1995. Cox-estimated failure-rate ratios (FRR) are presented with adjustment for gender, age, the brand of cement, the prosthesis, the type of operating theatre and the operating time. For revisions performed for infection (39 operations), the lowest rate of revision was found among patients receiving antibiotic-containing cement plus systemic antibiotics (n = 5804). The revision rate for the 4586 patients receiving systemic antibiotics only was 4.3 times greater (95% CI 1.7 to 11.0, p = 0.001); in 239 with antibiotics in the bone cement only it was 6.3 times greater (CI 1.6 to 25.0, p = 0.003); and in the 276 who did not receive antibiotics it was by 11.5 times greater (CI 2.1 to 63.0, p = 0.002). Adjustment for the total amount of systemic antibiotic administered did not change the results. We also observed an increased revision rate for aseptic loosening (109 operations) comparing the systemic-only (FRR = 1.8, CI 1.1 to 2.9, p = 0.01) and the cement-only regimes (FRR = 2.6, CI 1.2 to 5.9, p = 0.02) with the combined dosage. Our findings show that systemic antibiotics combined with antibiotic-containing bone cement led to fewer revisions than the other methods.

Antibiotic Prophylaxis↗