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PubMed2006

Current applications of advanced cross-sectional imaging techniques in evaluating the painful arthroplasty.

Patients with a painful arthroplasty can present a clinical diagnostic dilemma. Aspirates are often negative for infection and alignment of the prosthesis on conventional radiographs is usually satisfactory. These patients can have a myriad of soft tissue as well as osseous pathologies, which may be clinically unsuspected or radiographically occult. The ability of advanced cross-sectional imaging to diagnose osseous and soft tissue injuries has been well documented, but applications to arthroplasty imaging are often limited by regional metallic artifacts. Adjustment of standard imaging parameters can make CT and MR imaging useful adjuncts in imaging the painful arthroplasty, especially in the setting of normal radiographs. Ultrasound can be used to evaluate the periprosthetic soft tissues and provide a real-time method of evaluating the dynamic relationship of the periprosthetic soft tissues to the arthroplasty components, and it also can be used as a guide for diagnostic and therapeutic interventions.

Arthroplasty, Replacement↗
PubMed2005

Girdlestone resection arthroplasty following failed surgical procedures.

We retrospectively reviewed 43 patients who had undergone Girdlestone resection arthroplasty of the hip after failed total hip replacement or failed operations for hip trauma between 1990 and 2002. The indications were peri-prosthetic infection, aseptic loosening, recurrent dislocation and failed internal fixation for femoral neck fractures. Twenty-five patients died with an overall mortality of 58%. Out of 18 survivors, four patients had a prosthesis re-implanted and were excluded from the study. In 14 surviving patients followed-up for a mean of 44.5 months, the average age was 76 years. Adequate pain relief was achieved in 12 patients and infection was controlled in all. They all needed walking aids. The overall patient satisfaction was 10/14. We observed that patients who had had resection arthroplasty following failed operations for hip trauma had a higher mortality than those for failed total hip arthroplasty. Girdlestone arthroplasty is still a viable option to salvage irretrievably failed hips presenting technical difficulties in medically compromised patients. Limb shortening and the inevitable need for a walking aid should be clearly explained to patients during the consenting process in order to avoid unrealistic expectations.

Aged↗
PubMed2005

No influence of body mass index on early outcome following total hip arthroplasty.

We reviewed patients who had undergone total hip arthroplasties between January 2000 and October 2002 in order to determine whether a high body mass index (BMI) results in an increase in complications or re-operations. We compared 179 hip arthroplasties in 162 patients with an average BMI of 22.5 (18.6-24.9) with 164 hip arthroplasties in 151 age-matched patients with an average BMI of 33.3 (30-39.6). There was no difference in satisfaction between obese and non-obese patients following arthroplasty using a self-administered validated questionnaire (obese = 91%, non-obese = 93%, p=0.84). At a minimum of one year follow up, there was no statistically significant difference in the rates of complication (obese = 8.7%, non-obese = 7.6%, p=0.76) or revision surgery (obese = 3.6%, non-obese = 3.2%, p=0.85). In the short term a BMI >30 plays no role in an increase in complications or re-operation.

Adult↗
PubMed2006

Spacer prostheses in two-stage revision of infected knee arthroplasty.

At present, no consensus exists on the best spacer alternative for the management of two-stage exchange arthroplasty of infected knee arthroplasties. In this retrospective study, patient records of 24 patients, who had undergone two-stage revisions in which resterilised prosthetic components were used as spacers, were reviewed. The outcome was compared to that of operations performed during the same period (1993-2003) using cement spacers (n=10). With an average follow-up of 32 months, control of infection was achieved in 26 cases (76%), with good or excellent clinical outcome in 19 cases (56%). Treatment failed and resulted in amputation at the level of the thigh before reimplantation in one case. Three patients did not undergo reimplantation. In four cases (12%) infection relapsed. The reinfection rate did not differ between the two spacer groups. Patients treated with resterilised components had a superior range of motion during the period between the two stages. Operative time was shorter and there was less blood loss in the reimplantation arthroplasty when a prosthetic spacer was used. We consider resterilised prosthetic components a safe and effective alternative to cement spacers in the management of infected knee arthroplasties.

Adult↗
PubMed2002

[cDNA array approach to cytokine expression profile of aseptic loosened hip arthroplasty].

FACTS: Aseptic loosening of hip arthroplasties are the main reason for revision operations. Basic research indicates a significant relevance of the interface membrane formed between the implant an the surrounding bone. Their cellular composition and the influence of various factors on the process of aseptic loosening has attracted scientific interest. Cytokines are essential for intracellular communication. QUESTION: Is it possible to reveal differences in the expression profile of cytokines between well-fixed and failed hip arthroplasties using the cDNA array approach? AIM. Generation of a cytokine expression profile characteristic for failed hip arthroplasty. METHODS AND RESULTS: Radioactively labeled cDNA probes were synthesised from mRNA isolated from the interface membrane of six patients with aseptic loosened hip arthroplasty. Using a phosphorimager the analysis of the cDNA arrays revealed nine cytokines which were overexpressed compared with the reference tissue (Calgranulin A, Calgranulin B, IL-10, MCP-1, RANTES, TFDG1, TNFR2, RAI, THYB10). CONCLUSION: In this study four out of these nine cytokines were found to be connected with the process of aseptic loosening for the first time.

Arthroplasty, Replacement, Hip↗
PubMed2003

Posterior dislocation of a cruciate-retaining total knee arthroplasty following an acute bacterial infection.

BACKGROUND: We report a rare complication of posterior dislocation of a cruciate-retaining total knee arthroplasty following an acute bacterial infection. The mechanism of dislocation proved to be septic loosening of the femoral component and a tear of the posterior cruciate ligament near to the femoral insertion site. The tear arose during the treatment of acute septic arthritis following total knee arthroplasty when the patient attempted full weight-bearing with the affected limb in a semiflexion position and twisted the knee. METHODS AND RESULTS: Successful treatment was provided with subsequent surgical debridement, removal of the loosened prosthesis, the application of systemic antibiotics, and a revision total knee arthroplasty utilizing a posteriorly stabilized prosthesis after adequate control of the infection. CONCLUSION: Soft-tissue protection from full weight-bearing of the knee during the treatment of an acute infection following total knee arthroplasty and timely removal of the loosened total knee prosthesis are recommended in order to prevent such a complication.

Arthritis, Infectious↗
PubMed2005

Diagnostic values of positron emission tomography versus triple-phase bone scan in hip arthroplasty loosening.

INTRODUCTION: The most frequent complications of total hip arthroplasty are septic and aseptic wear-induced loosening. A reliable differentiation between septic and aseptic loosening with current diagnostic tools is not possible. Therefore, we examined the diagnostic valency of positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) in cases of septic or aseptic hip arthroplasty loosening compared with conventional triple-phase bone scan (TPBS). MATERIALS AND METHODS: Fifty patients with 70 total hip replacements (symptomatic n=50, asymptomatic n=20) were examined by means of FDG-PET and TPBS to detect septic and aseptic loosening and differentiate between the two. A differentiated algorithm subdivided into categories I-V was developed for FDG-PET. Additionally, standardized uptake values (SUV) were calculated from the lesion with the highest FDG uptake. Interpretations of the TPBS were done according to the criteria described by Wilson. The final diagnosis was based on operative findings including microbiological and histological examinations (n=50), while the remaining asymptomatic arthroplasties (n=20) were integrated into a clinical follow-up (> or =9 months). RESULTS: Sensitivity/specificity of FDG-PET was 91%/92% (accuracy 91%) compared with 78%/70% (accuracy 74%) for TPBS. A high correlation could be proved between FDG-PET investigation and operative histopathological findings (r(Spear)> or =0.9). No significant differences were found regarding cemented and uncemented implanted hip arthroplasties (p> or =0.05). Calculation of the SUV turned out to be inappropriate as a sole criterion for image interpretation. CONCLUSION: FDG-PET is a promising, highly accurate examination method to detect polyethylene and metal wear-induced chronic inflammation followed by periprosthetic osteolysis. In addition, FDG-PET has a significantly higher sensitivity and specificity than TPBS for differentiating between aseptic loosening and infection.

Adult↗
PubMed2006

Acute sciatic neuritis following total hip arthroplasty: a case report.

Nerve injuries after total hip arthroplasty are relatively uncommon, but a higher prevalence has been reported in revision arthroplasties, in women and in patients with dysplastic hips. We report a case of a patient who had a painful neuritis of the sciatic nerve after primary arthroplasty, without any objective evidence of motor or sensory deficit and had complete relief of pain after the limb lengths were matched to the contra-lateral side after revision arthroplasty.

Acute Disease↗
PubMed1999

Periprosthetic bone remodelling after total knee arthroplasty: early assessment by dual energy X-ray absorptiometry.

The present investigation aims to evaluate periprosthetic bone remodelling after total knee arthroplasty by the use of dual-energy X-ray absorptiometry (DXA). Twelve patients affected by osteoarthrosis of the knee joint underwent primary total knee arthroplasty at an average age of 70.5 years. None of them had received a knee prosthesis before on the contralateral side. Anteroposterior and lateral DXA measurements of the femur, tibia and total knee (both sides) were taken 2 weeks, 3 and 9 months postoperatively. The 2-week measurement was used as an individual reference value to be compared with the 3- and 9-month findings. In addition, the contralateral knee was investigated also in order to estimate how far bone mineral loss was due to implantation or to an individual decline in bone mineral density (BMD). The comparison of BMD values after knee arthroplasty revealed a conspicuous decrease of bone density within 9 months. Bone mineral loss amounted to an average of 9.2% in anteroposterior and 17.8% in lateral DXA measurements. Lateral femur shots showed an average decrease of density of even 21.5%. In contrast, the BMD values of the contralateral knees remained almost unchanged. DXA, especially lateral shots of the femur, promises to be a suitable method for early assessment of periprosthetic bone remodelling after total knee arthroplasty.

Absorptiometry, Photon↗
PubMed2005

Salmon calcitonin nasal spray treatment for postmenopausal women after hip fracture with total hip arthroplasty.

The increasing rate of hip fractures is giving rise to a number of socioeconomic problems for the aging community. In addition to being unable to resume their previous living habits, many patients fail to achieve full functional recovery after the fractures. Total hip arthroplasty (THA) is a successful operation for the majority of patients with all forms of hip fractures. Dislocation and aseptic loosening are the major reasons for revisions. An additional problem post-THA is the rate of heterotopic soft tissue calcification after total hip arthroplasty, resulting in severely impaired function, pain, and a reduced range of hip motion. In an open study, 37 women who had undergone cementless total hip arthroplasty after accidental hip fractures were treated twice daily with 200 IU salmon calcitonin nasal spray for 12 months. Simultaneously, the patients received one bag of 1000 mg calcium plus 880 IU vitamin D daily throughout the treatment period of 1 year. A parallel group of 38 women with a similar clinical status in terms of hip fractures and cementless total hip arthroplasty were treated with only one bag of 1000 mg calcium plus 880 IU vitamin D daily through the treatment period. The results of this 12-month clinical trial show that 200 IU salmon calcitonin nasal spray per day promotes general independence from foreign assistance, mobility, and fear of further falls in postmenopausal elderly women following THA. Treatment with a salmon calcitonin nasal spray reduces bone turnover serum markers, loss of further bone density, and pain. Additionally, calcitonin promoted the repair of hip fractures and, as a coincidence finding, was associated with a significantly reduced rate of refractures as well as periprosthetic ossifications.

Administration, Inhalation↗
PubMed2003

Minimally invasive uncemented total hip arthroplasty through an anterolateral approach with a shorter skin incision.

Total hip arthroplasty using a short skin incision has been associated with great controversy. It has still not yet been demonstrated that a shorter skin incision is efficient or safe for patients. Here, we review 212 cases of uncemented total hip arthroplasty performed since 1999 using the anterolateral approach and a shorter skin incision. Patients were divided into three groups according to the length of the incision at the end of surgery; incisions of 10 cm or less were defined as "mini" ( n = 115) and incisions of 10-15 cm as "short" ( n = 70); these two groups were defined as shorter skin incision groups. Incisions longer than 15 cm in patients undergoing the standard procedure were defined as "conventional" and served as the controls ( n = 27). Statistically significant differences were found with regard to operative duration and intraoperative blood loss: the shorter the length of the incision, the shorter the operative duration and the smaller the intraoperative blood loss. There was no significant difference in postoperative bleeding or in the incidence of complications among the three groups. Total blood losses in the shorter groups were each statistically significant less than that in the conventional group. Comparing the mini group to the short group, the length of the skin incision was influenced by the body mass index (BMI) and gender. For those with a high BMI and for male patients, a slightly longer incision was necessary. We concluded that total hip arthroplasty through a mini or short incision was indeed efficient for patients compared with total hip arthroplasty using a conventional incision.

Adult↗
PubMed2005

[Modern ceramic-on-ceramic bearings in total hip arthroplasty].

OBJECTIVE: Ceramic bearings in total hip arthroplasty were already employed three decades ago, but due to high failure rates, their application decreased. However, improved material and design have led to their regaining popularity. The present study evaluates the short-term results of a modern ceramic-on-ceramic bearing in total hip prosthesis. METHODS: 229 total hip arthroplasties, alpha Cera Fit, were implanted in 227 patients over a 12-month period. A follow-up, at a minimum of 36 months, was performed. In addition to demographics, the Harris Hip-Score was used to calculate the clinical results and radiological control was also carried out. RESULTS: The mean age at the time of surgery was 64.6 (+/- 11.7) years. There was no case of deep infection, four patients had superficial wound healing disorders. 197/227 patients with 199 total hip arthroplasties were available for follow-up, with a mean follow-up time of 42 (+/- 2.9) months. The mean Harris Hip-Score was 94.3 (+/- 6.8). Radiological evaluation did not reveal any signs of lysis or loosening. Massive periarticular calcification was seen in three patients, with one that needed surgical debridement. CONCLUSION: The presented modern ceramic-on-ceramic bearings in total hip arthroplasty show excellent clinical and radiological short-term results. The material-related complications reported in former publications were no longer seen.

Adult↗
PubMed1989

The arthroscopic treatment of unicompartmental gonarthrosis: a five-year follow-up study of abrasion arthroplasty plus arthroscopic debridement and arthroscopic debridement alone.

A retrospective review with a mean follow-up time of 60 months was performed on 126 patients who had treatment of unicompartmental gonarthrosis with either abrasion arthroplasty plus arthroscopic debridement or arthroscopic debridement alone. Fifty-nine patients had abrasion arthroplasty and arthroscopic debridement, and 67 patients had arthroscopic debridement alone. All patient had stage II Ahlbäck changes roentgenographically, as well as Outerbridge stage IV changes arthroscopically in the involved compartment. All the knees were evaluated postoperatively at a minimum of 60 months, utilizing The Hospital For Special Surgery Knee Scoring System. In the group treated with abrasion arthroplasty, 51% had good to excellent results, 16% had fair results, and 33% had poor results. The conditions of ten of the patients who had poor results actually became worse subsequent to their abrasion arthroplasty. In the group that had arthroscopic debridement, 66% had good to excellent results, 13% had fair results, and 21% had poor results. The conditions of 12 of the patients who had poor results actually became worse subsequent to the arthroscopic debridement.

Aged↗
PubMed2004

Evaluation of knee and hindfoot alignment before and after total knee arthroplasty: a prospective analysis.

A prospective study on 100 cases was performed to evaluate the effect of total knee arthroplasty (TKA) on hindfoot alignment, and to compare knee alignment and hindfoot alignment preoperatively and postoperatively. Preoperative knee alignment ranged from 30 degrees of valgus to 13 degrees of varus. Postoperative knee alignment ranged from 14 degrees of valgus to 0 degrees. Preoperative foot alignment ranged from 22 degrees of valgus to 13 degrees of varus. Postoperative foot alignment ranged from 22 degrees of valgus to 11 degrees of varus. Preoperative knee alignment did not correlate with foot alignment (P =.182). Postoperative knee alignment and foot alignment also showed no correlation (P =.222). Preoperative and postoperative knee alignment were correlated, as expected (P =.000). Notably, hindfoot alignment was changed by knee arthroplasty, and changed in a predictable fashion (P=.000). The alignment of the foot before knee arthroplasty was the largest contributing factor to the hindfoot alignment after arthroplasty of the knee. Hindfoot alignment was changed by TKA, and changed in a predictable fashion.

Arthroplasty, Replacement, Knee↗
PubMed2004

Hip arthroplasty for failed internal fixation of intertrochanteric fractures.

Nineteen patients who had hip arthroplasties for complications of internal fixation of intertrochanteric fractures were reviewed. There were 6 males and 13 females. The mean age was 64.1 years (range, 21-87 years) at the time of the fracture. The average interval from fracture to arthroplasty was 40.3 months (range, 2-288 months). The prosthesis types included 16 total hip arthroplasties and 3 bipolar hip arthroplasties. A standard femoral stem was used in every patient, and although the stem length did not extend well beyond the most distal screw holes, there was no stress fracture. Complications such as intraoperative fracture of the greater trochanter and postoperative dislocation were common. The Harris Hip Score significantly improved from 38.4 points before the conversion to 79.8 points after an average follow-up of 7.4 years (range, 2-18 years). There was no revision for mechanical failure.

Arthroplasty, Replacement, Hip↗
PubMed2004

Predicting range of motion after revision total knee arthroplasty: clustering and log-linear regression analyses.

The purpose of this study was to determine which variables affected the range of motion following revision total knee arthroplasty. These variables included preoperative flexion, intraoperative flexion, preoperative alignment, patient demographics, type of posterior soft-tissue release, previous prosthesis type, and prosthesis type used for revision of 355 total knee arthroplasties. Clustering and log-linear regression analyses were used to determine which variables were significantly related to the postoperative flexion. The mean preoperative and postoperative flexion were 100.5 degrees and 104.6 degrees. Low preoperative (<103 degrees) and intraoperative flexion (<117 degrees), young age (<44 years), and constrained and hinged prosthesis types were associated with diminished flexion. Higher preoperative and intraoperative flexion resulted in higher postoperative flexion. When comparing the results of this study to the results of a similar study of primary total knee arthroplasties, flexion improved less following revision than following primary total knee arthroplasty.

Aged↗
PubMed2004

Relationship between surgical volume and early outcomes of total hip arthroplasty: do results continue to get better?

This retrospective study explored the relationship between the volume of total hip arthroplasties (THA) and postoperative mortality and early complications from a single institution. One thousand hip arthroplasties in 932 patients were identified during a 1-year period, which included 786 primary and 214 revision hip arthroplasties. The postoperative 6-month combined medical and orthopedic complication rate for primary and revision THA was 7.9% and 16.5%, respectively. The 6-month mortality rate for the overall group was 0.5% (5 deaths), for the primary hips was 0.4% (3 deaths), and for the revision hip was 0.9% (2 deaths). The mortality and complication rates of many surgical procedures, including joint arthroplasties, are inversely related to hospital and surgical volume. The reduction in complication rate, however, approaches a plateau and does not improve regardless of an increase in the surgical and hospital volume.

Adult↗
PubMed2005

Bony ankylosis following total knee arthroplasty: a case report.

While bony ankylosis secondary to heterotopic ossification (HO) following total hip arthroplasty (THA) is well known to produce disability in the hip, much less has been written about the development of heterotopic ossification about the knee after total knee arthroplasty (TKA). Additionally, to our knowledge, there has been no published case of complete bony ankylosis of the knee following total knee arthroplasty. We present such a case in a 53 year old male who underwent a primary total knee arthroplasty after resolution of septic arthritis.

Ankylosis↗