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 667 records · Page 37Linked to original sources
PubMed2004

Weber rotation total hip replacement: a prospective 5- to 20-year followup study.

Between 1974 and 1989, 315 primary total hip replacements (274 patients) were done using the cemented Weber Rotation prosthesis and standardized operative technique, which was modified for the stem in 1978. After the first postoperative year, all patients had routine clinical and radiologic examinations at 2-year intervals. Twenty-one patients (22 hips) were lost to followup. At the most recent followup, 30 of 293 hips (253 patients) had been revised: 24 hips for aseptic loosening, five hips for infection, and one hip for a femoral fracture. Survivorship analyses with revision for aseptic loosening as an end point for the 315 hips showed 93% and 78% survival after 10 and 15 years, respectively. Separate survival analyses for the socket showed 99% and 89% survival after 10 and 15 years, respectively. The stem had a survival of 94% and 81%, respectively, during the same time. Survival at 15 years with radiologic evidence of loosening as an end point was 85% for the socket and 72% for the stem. The cementing technique and the design of the acetabular component significantly influenced the rate of loosening. Survivorship analyses with revision for aseptic loosening of the socket, using a modified second generation cementing technique and a hemispheric socket, showed 100% survival after 10 years and 98% after 13 years.

Adult↗
PubMed2003

[Treatment outcome of prosthetic valve endocarditis].

BACKGROUND AND AIMS OF THE STUDY: Prosthetic valve endocarditis (PVE) occurred from 1 to 9% of patient after heart valve replacement. The aim of the present study was to assess the long term outcome of the treatment of PVE and to analyze the recurrence of infective endocarditis (IE). MATERIAL: Hospital mortality, recurrence and late survival were analyzed in 59 patients hospitalized in the Institute of Cardiology for PVE between 1988-95. There were 26 females and 33 males with age ranging from 17 to 71 years (mean 48). The onset of PVE was within 60 days from valve replacement in 17 patients and therefore it was considered as early PVE, in 42 patients PVE occurred beyond 60 days from valve replacement was considered as late. METHODS: The criteria of Durack et al. were applied to diagnose PVE. Each patient was classified as having definite PVE, possible PVE, or rejected PVE. The late examinations were performed out-patient in Ist Department of Valvular Heart Disease of Institute of Cardiology. RESULTS: Prosthetic valve replacement in addition to medical treatment was preferred for 34 (58%) of the 59 cases (8 death), whereas 25 (42%) cases were only managed medically (5 death). The overall hospital mortality rate was 22% (13 patients). There were 8 (17%) episodes of recurrence with mean interval of 6 months between both episodes. 6 patients were cured, 2 died. Staphylococcal epidermidis infection was present in 63%. Recurrence of IE due to the same microorganism was in 88% of episodes. During follow up (mean 4 years) 5 late deaths occurred. Actual 4 years survival was 69%. CONCLUSIONS: 1. Mean survival after 4 years was 69%, 2. Total mortality was 31%, 22% hospital, 9% in late observation (decreased from 8% in first 2 years to 1% mean 4 years after cure, 3. Recurrence of IE was observed in 17% of episodes, most cases (88%) were caused by the same bacteria as in the primary infection.

Adolescent↗
PubMed2004

Five-year follow up of the ATS mechanical heart valve.

BACKGROUND AND AIM OF THE STUDY: Between January 1, 1997 and December 31, 2001, a total of 342 patients underwent aortic valve replacement (AVR) or mitral valve replacement (MVR) with the ATS Medical prosthesis. The initial three-year phase of this study took place under a United States Food and Drug Administration-approved investigational device exemption study. The study aim was to determine the incidence of valve-related events in up to five years of follow up after valve implantation, and to assess patient disturbance from valve noise. METHODS: Patients were consecutively enrolled to undergo AVR or MVR with the ATS prosthesis. Follow up studies were conducted by patient questionnaire and/or telephone call. Follow up was 96% complete. AVR was conducted in 246 patients (80 with coronary bypass), and MVR in 96 patients (29 with coronary bypass). RESULTS: The overall operative mortality was 2.6% (n = 9; AVR 3.2%, n = 8; MVR 1.0%, n = 1), with two deaths being valve-related (0.6%). In 878 patient-years (pt-yr) of follow up (613 pt-yr for AVR; 265 pt-yr for MVR) there were an additional 22 deaths. Five deaths (0.6%/pt-yr) were valve-related: two were neuroembolic (both MVR), one from endocarditis (AVR), and two from bleeding events (both AVR). Late valve-related complications (>30 days) included 17 episodes of major bleeding (11 AVR, 1.8%/pt-yr; six MVR, 2.3%/pt-yr), five permanent neuroembolic events (four AVR, 0.7%/pt-yr; one MVR, 0.4%/pt-yr); 16 transient neuroembolic events (10 AVR, 1.6%/pt-yr; six MVR, 2.3%/pt-yr); three transient peripheral emboli (two AVR, 0.3%/pt-yr; one MVR, 0.4%/pt-yr); four paravalvular leaks (two AVR, 0.3%/pt-yr; two MVR, 0.8%/pt-yr); and one episode of valve thrombosis (MVR, 0.4%/pt-yr; AVR, 0%/pt-yr). Reoperation was required in two patients: one AVR (paravalvular leak, 0.2%/pt-yr) and one MVR (replacement due to thrombosis, 0.4%/pt-yr). CONCLUSION: These results indicate that intermediate-term results with the ATS mechanical prosthesis continue to be excellent, though further long-term follow up is warranted.

Adult↗
PubMed1992

Intrapelvic extraction of a total hip prosthesis. A case report.

A 69-year-old man with a total hip prosthesis, recurrent infection, and intrapelvic incarceration of the acetabular components required extraction of a long-stem total hip prosthesis through three incisions. Retroperitoneal intrapelvic extraction of the incarcerated prosthesis was necessary. This approach allowed removal of intrapelvically migrated components and the eradication of the infection. The patient had no signs of infection five years postoperatively.

Accidents, Traffic↗
PubMed1992

Alumina versus polyethylene in total knee arthroplasty.

The cementless alumina total knee prosthesis, which uses alumina in the portions coming in contact with the bone and a combination of alumina and ultra-high molecular-weight polyethylene (UHMWPE) in the sliding portions, is referred to as a total condylar. Alumina total knee arthroplasty was performed on 137 patients, including 103 rheumatoid arthritis (RA) and 34 osteoarthrosis (OA) patients, from January 1982 to February 1985. The follow-up period was seven years 11 months and four years ten months, respectively. At follow-up evaluation, 108 patients were available for clinical and roentgenographic examinations, amounting to a 79% follow-up rate. At follow-up examination, 67 joints (62%) were completely pain free and 28 joints (26%) caused slight pain on bearing weight. Walking ability was recovered moderately in RA and markedly in OA. In RA, 14 of 84 knees were cemented and one knee was treated with loosening. Of 72 cementless implantations, 55 sustained displacing distally and one sustained loosening in the tibia, whereas 31 sustained displacing proximally and six sustained loosening in the femur. In OA, 21 cementless knees had 17 displacings in the tibia, and ten displacings and two loosenings in the femur. Scanning electron microscopy (SEM) observation of the UHMWPE surface in tibial plates revealed smoothing and burnishing. Alumina is far superior to metal for the sliding part, although it is not always best for the portion in contact with the bone. To resolve these problems, for cementless fixation, anchoring portions of Ti alloy and alumina implants were covered with beads and coated with hydroxyapatite. For cement fixation, "the interface bioactive bone cement technique" interposing hydroxyapatite granules between bone and cement was performed.

Adult↗
PubMed1992

Treatment of failing dental implants.

Recent studies show that the bacterial flora in adult periodontitis and peri-implantitis are identical, but there could be a more pathogenic flora (gram-negative bacteria, spirochetes) in the partially edentulous implant case than in the fully edentulous implant case. These data indicate a possible seeding mechanism from the natural tooth pocket to the implant crevice and may place the implant in the partially edentulous case more at risk. Also, understanding of the importance of loading in a progressive sense to prevent retrograde peri-implantitis involving the dental implant has increased; the density of bone must be evaluated more fully to determine the time frame necessary to gain a compact bone capable of withstanding occlusal forces at the bone-implant interface.

Animals↗
PubMed2004

[Knee arthrodesis performed with intramedullary nailing technique in failed total knee replacement--a preliminary report].

Knee arthrodesis is the method of choice in treatment of failed total knee replacement. It is recommended when revisory total knee replacement is impossible. The authors present 2 cases of knee fusions using intramedullary nails after prosthesis loosening (1 aseptic, 1 septic). In both cases good results were achieved, with no complications observed during convalescence.

Aged↗
PubMed1992

Cobalt-alloy metal debris in periarticular tissues from total hip revision arthroplasties. Metal contents and associated histologic findings.

To investigate the hypothesis that an association exists between the presence of metallic particulate or ionic debris released from the components of a total hip replacement and the histologic reaction in the surrounding tissues, cobalt, chromium, nickel, and molybdenum levels were measured in periarticular tissue from 22 individuals who had revision surgery. Total tissue content of the four elements (averaged per case) ranged from 2.7 to 250 micrograms of metal per gr of dried tissue (mean, 39 micrograms/gr); however, within each case, the tissue-metal content varied more widely. The highest total tissue-metal contents occurred in cases revised for infection. Fibrosis, histiocytic reaction, hemorrhage, and necrosis were the most frequent histologic findings. Polyethylene and cement particles each appeared in approximately half of all sections, while microscopic metal particles were seen only in tissues from the infected hips. Tissue-metal content did not correlate with the histologic findings, with any of the demographic variables, nor with duration of implantation. Ratios of the individual constituent elements generally reflected the cobalt-chromium alloy composition, suggesting that metal debris was present predominantly as wear particles. Only for tissues with very low metal contents did departures of these ratios indicate the presence of ionic corrosion products. The extremely low metal contents measured in many cement-bone interfacial tissues and the few metal particles found histologically suggest that metal particles may have been less important in inflammatory reaction and loosening than cement or polyethylene particles.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

[Revision hip arthroplasty after prosthesis removal in septic loosening].

The author presents the therapeutic protocol in "hanging hip" after prosthesis removal in septic loosening, basing on a series of 11 patients--7 females and 4 males--age ranging from 31 to 67 years. On average the primary prosthesis was removed 2.5 years after implantation, while patients remained with a "hanging hip" for an average period of 2.2 years (limb shortening before revision arthroplasty was on average 4.5cm). When qualifying patients for revision arthroplasty the following parameters were taken into account: sedimentation rate, CRP reactive protein levels, bacteriological blood culture results, cultures from the hip punctate, every-day life activity and post-op patient compliance with the therapy. Acetabular roof defects were managed according to Zuk's method. Clinical assessment of the patients was performed 6 weeks, 3, 6 and 12 months using Merle-d'Aubigne and Postel classification, while X-rays were used to assess proper prosthesis implantation. During follow-up proper prosthesis implantation was found in all cases, while no signs of re-infection, nor radiological and clinical signs of implant loosening were noted. Clinical assessment of the patients yielded 1 very good result, 7 good results and 3 satisfactory. The presented material indicates that good results can be obtained in prosthesis reimplantation after removal of the primary prosthesis because of its septic loosening.

Adult↗
PubMed2004

[Validity of bone scintigraphy for the diagnosis of periprosthetic complications in hydroxyapatite-coated total hip arthroplasty].

PURPOSE OF THE STUDY: To evaluate the efficacy and usefulness of 99Tc-MDP bone scans for the diagnosis of complications associated with hydroxyapatite- coated total hip prostheses. MATERIAL AND METHODS: 99Tc-MDP bone scans of 42 hips were taken before revision surgery in 41 patients with ABG 1 prostheses. Of these, 26 patients (27 hips) were included in our study on the basis of the following criteria: at least 23 months between the index surgery and scintigraphic examination and the availability of good quality bone scans. The average patients' age at the time of index and revision operations was 45.3 years (range, 32-57; SD, 6.02) and 50.2 years (36-61; SD, 6.01), respectively. The average time between the index surgery and bone scintigraphy was 50.3 months (23-84; SD, 15.9). Two experienced specialists in nuclear medicine, who were unaware of any clinical conclusions, participated in the study. RESULTS: Pre- and intra-operative findings showed aseptic loosening in three cups (3/27, 11 %) and one stem (1/27, 4 %). Four hips were suspected to have an infection on the basis of the positive results of intra-operative culture. In the diagnosis of aseptic loosening, sensitivity, specificity, accuracy, and positive and negative predictive values of bone scintigraphy were 100 %, 57 %, 62 %, 23 %, and 100 %, respectively, for the ABG I cup and 100 %, 52 %, 54 %, 8 %, and 100 %, respectively, for the ABG I stem. These characteristics were 67 %, 96 %, 93 %, 67 %, and 96 %, respectively, for the ABG I cup, when plain X-ray was used for evaluation of aseptic loosening. Specificity, accuracy and negative predictive value of plain X-ray for ABG I stem aseptic loosening were 100 %, 96 %, and 96 %. Bone scintigraphy gave one false positive result of sepsis; on the other hand, none of the four hips with positive intraoperative culture was diagnosed as septic. DISCUSSION: The fact that 99Tc-MDP bone scintigraphy as a method of diagnosing periprosthetic complications has a high sensitivity and a relatively low specificity has often been discussed in the literature. Currently, there are only a few studies on bone scintigraphy investigations of hydroxyapatite-coated prostheses. Some authors report that a slight increase in peri-prosthetic radionuclide activity may persist for up to 8 years which can explain the problematic accuracy of the technique. CONCLUSIONS: 99Tc-MDP bone scintigraphy is an intermediate useful tool for detecting complications of total hip arthroplasty with hydroxyapatite- coating. A negative bone scan almost always suggested the absence of aseptic loosening. However, the value of a positive result was regarded as controversial for the diagnosis of both aseptic and septic complications.

Adult↗
PubMed2005

Aspire porcine bioprosthesis: ten years' experience.

BACKGROUND AND AIM OF THE STUDY: Clinical results of this multicenter study of the Aspire porcine valve were reported previously at eight years; the present report provides an update of valve performance to 10 years postoperatively. METHODS: A total of 749 patients (60% males; mean age 73+/-7 years) underwent implantation with the Aspire (Tissuemed) porcine bioprosthesis between 1991 and 2002, at three institutions. Follow up was complete for 98% of the cohort. The mean follow up period was 51.6+/-39.6 months (range: 0-181 months); total follow up was 3,159 patient-years (pt-yr). RESULTS: There were 617 aortic valve replacements (AVR), 96 mitral valve replacements (MVR) and 32 double valve replacements. There were 62 deaths (8.3%), one of which was valve-related. The late mortality rate was 9.3% per pt-yr (1.2%/pt-yr valve-related). Actuarial freedom from complications at 10 years was: thromboembolism 76+/-4% (2.6%/pt-yr); hemorrhage 73+/-4% (2.8%/pt-yr); structural valve deterioration (SVD) 96+/-2% (0.2%/pt-yr); non-structural deterioration 99+/-1% (0.1%/pt-y); prosthetic valve endocarditis 97+/-1% (0.3%/pt-yr); and reoperation 97+/-1% (0.4%/pt-yr). In patients aged >70 years, the 10-year actuarial freedom from SVD was 98+/-2% for AVR and 93+/-7% for MVR. Preoperative atrial fibrillation (AF) was a significant predictor of late mortality (p <0.001), thromboembolism (p = 0.05) and hemorrhage (p = 0.01). CONCLUSION: The Aspire porcine bioprostheses is a reliable choice for a tissue valve, for both the aortic and mitral positions, especially in patients aged >70 years. In elderly patients the presence of AF is a significant predictor of early and late mortality and morbidity.

Age Factors↗
PubMed2005

Ventriculoperitoneal shunt malfunction presenting with pleuritic chest pain.

BACKGROUND: Ventriculoperitoneal (VP) shunts are widely used for treating hydrocephalus. These devices are prone to malfunction with up to 70% requiring revision. Shunt infection and obstruction comprise the majority of malfunctions and usually present dramatically. However, rare presentations occur. METHODS/RESULTS: We report a rare case of VP shunt malfunction presenting with pleuritic chest pain. A 13-year-old girl with a VP shunt placed at birth for congenital hydrocephalus presented on multiple occasions with pleuritic chest pain, cough, and fever. She was diagnosed with an upper respiratory tract infection and discharged home. She returned with respiratory compromise, and chest x-ray depicted the shunt catheter in the pleural space with an associated pleural effusion and infiltrate. The patient fully recovered with intravenous antibiotics, thoracentesis, and placement of a new shunt system. CONCLUSIONS: VP shunt malfunction usually presents with signs and symptoms of increased intracranial pressure and/or infection. However, unusual presentations of malfunction may occur with signs and symptoms which appear unrelated to the shunt. Thus, all patients with VP shunts warrant a comprehensive evaluation.

Adolescent↗
PubMed2004

[Revision knee joint alloplasties].

In the presented paper the authors evaluate the results of treatment in patients following revision knee joint alloplasties due to aseptic loosening of the tibia element in the endoprosthesis. The clinical material from the years 2000-2003 consists of 12 patients aged from 68 to 73; namely, 10 women (83.5%) and 2 men (16.5%). The longest time between the original implantation of endoprosthesis into the knee joint and the diagnosis of the aseptic loosening of its tibia element was 6 years and the shortest 2 years. The longest time of follow-up in patients who had had the revision operation was 2 years and the shortest was 6 months. The authors evaluated achieved results in the period between 20th and 24th month since the revision operation in 10 patients on the basis of the time criteria referring to the time of healing the-bone implants and on the basis of the HSS knee rating scale in their own modification. We achieved 9 very well and 1 sufficient results based on time criteria and 5 very well, 1 well, 3 sufficient, 1 insufficient results based on HSS knee rating scale criteria.

Aged↗
PubMed2005

Case report: Salmonella infection following total hip arthroplasty.

A case of a total hip arthroplasty infection with Staphylococcus aureus, co-infected with Salmonella choleraesuis was treated with two-stage exchange and administration of vancomycin and ciprofloxacin. No signs of re-infection have appeared fourteen months after surgery. Cases of salmonella infection of hip prostheses are quite rare, with only a handful of reports in the literature.

Aged↗
PubMed2005

Seventeen-year experience with the St. Jude medical biocor porcine bioprosthesis.

BACKGROUND AND AIM OF THE STUDY: Bioprostheses in heart surgery have been investigated in recent years to reduce the long-term anticoagulant administration associated with mechanical devices. Positive results have been achieved, particularly in elderly patients who have a supposed delayed fibrocalcification and reduced life expectancy. Herein are reported 17-year data on the ongoing long-term study of the Biocor porcine prosthetic heart valve, an improved bioprosthesis with reduced stiffness and improved flexibility of the valve cusps designed to resolve issues of reduced lifespan of previous biological valves. METHODS: Data were presented for 1,455 patients who underwent aortic valve replacement (AVR) or mitral valve replacement (MVR) in Sweden with glutaraldehyde-preserved Biocor bioprostheses between 1983 and 2000. Follow up after surgery was evaluated on alternate years using hospital records, interviews, questionnaires and the Cox regression model of multivariate analysis. RESULTS: At 17 years, the cumulative follow up was 6,540 and 989 patient-years (pt-yr) for AVR and MVR, respectively. Late mortality accounted for 357 (28%) and 65 (38%) patients, respectively, and actuarial survival was 28.2% and 35.4%, respectively. Thromboembolic events occurred in 82 AVR (1.25%/pt-yr) and 18 MVR (1.82%/pt-yr) patients, respectively, with freedom from thromboembolism decreasing with age; 181 AVR and 44 MVR patients received anticoagulants. Reoperations due to structural valve deterioration (SVD) were required in 63 AVR and nine MVR patients. Freedom from reoperation due to SVD increased with age in both groups; actuarial freedom from reoperation was 73.9% and 81.3%, respectively. CONCLUSION: Seventeen-year data confirm the low incidence of valve-related complications and improved valve durability reported at the 15-year follow up after both AVR and MVR using Biocor porcine bioprostheses.

Age Factors↗
PubMed2005

High active local levels of vancomycin without nephrotoxicity released from impacted bone allografts in 20 revision hip arthroplasties.

BACKGROUND: Cancellous bone can act as a delivery vehicle for vancomycin without impairment of graft incorporation. However, local and systemic antibiotic levels, biological activity of vancomycin, interaction with antibiotic-loaded cement, and also nephrotoxicity of these composites have not yet been studied clinically. MATERIAL AND METHODS: Blood, drainage and urine samples of 20 consecutive patients undergoing revision total hip arthroplasties with impaction grafting technique utilizing 1 g of vancomycin per femoral head were studied. Plain PMMA cement was used in 10 cases, while PMMA with gentamycin was used in 5 cases and tobramycin was used in the remaining 5 cases. Biological activity of vancomycin was studied using kinetic killing curves in three ATCC organisms (methicillin-sensitive Staphylococcus aureus, methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosas). Quantification was done with fluorescent polarized immunoassay. Renal function was evaluated with preoperative and postoperative urea and creatinine. RESULTS: Local active bactericidal levels of vancomycin reached 1400 microg/mL (average 5-point level = 367 microg/mL) without nephrotoxicity. Vancomycin was present in urine until the fifteenth day. Both aminoglycosides in the cement had activity against Pseudomonas aeruginosas. INTERPRETATION: Local levels of vancomycin were 35 times greater than the highest levels reported with vancomycin-loaded PMMA. A synergistic effect was observed between vancomycin released from impacted allografts and aminoglycoside-loaded PMMA.

Adult↗
PubMed2005

Poor predictive value of broad-range PCR for the detection of arthroplasty infection in 92 cases.

BACKGROUND: The diagnosis of prosthetic infection remains a challenge, as no test is 100% sensitive and 100% specific. Recent advances in molecular biology have enabled the detection of infection in culture negative cases. PATIENTS AND METHODS: We evaluated the effectiveness of polymerase chain reaction (PCR) in detecting infection in failed joint replacements prospectively in 91 consecutive patients (92 prosthetic joints) undergoing revision total hip or knee arthroplasty. Synovial fluid was collected intraoperatively and examined by broad-range PCR assay for detection of bacterial DNA. The clinical diagnosis of infection was based on the results of blood tests, preoperative joint aspiration, culture and histology of multiple intraoperative tissue samples, as well as the surgeon's assessment. 12 joints (13%) were infected, but the PCR was positive in 32 cases. The sensitivity of the technique was 92%, the specificity 74%, the accuracy 76%, the positive predictive value 34%, and the negative predictive value was 98%. INTERPRETATION: The PCR technique cannot be recommended for the routine detection of prosthetic infection. The large number of false positive results may represent sample contamination, or bacterial presence related to low-virulence organisms, low bacterial load, or a strong host immune response.

Arthroplasty, Replacement, Hip↗