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At least 811 records · Page 45Linked to original sources
PubMed2005

The dimensional accuracy for preparation of the femoral cavity in HIP arthroplasty. A comparison between manual- and robot-assisted implantation of hip endoprosthesis stems in cadaver femurs.

INTRODUCTION: The aim of the study was to determine the precision of the preparation of the femoral cavity in cementless hip arthroplasty. We compared the bone-prosthesis interface after manual- and robot-assisted implantation of the stems. MATERIAL AND METHODS: After plastination the specimens were cut to slices of 2.5 mm and documented by microradiography. The interface between prosthesis and bone was measured digitally with a specially designed software. RESULTS: The manually implanted prostheses showed an average full-contact area of 60% and an average area of gaps of 40% with an average height of 0.8 mm. The robot-assisted implanted stems had a significantly higher bone-prosthesis interface area of 93% and gap areas of less than 0.2 mm depth. Destructions of the spongeous bone were seen with the manually implanted stems but not after robot-assisted implantations. There was one stem fracture during the manual preparation of a stem. Microradiographic examination showed microfractures in the region of the lesser trochanter in two femora after robot-assisted implantation CONCLUSION: The robot-assisted technique highly increased the fitting area at the bone-prosthesis interface. The main reason for the fractures might be the absence of a robot done marker for the ideal implantation height with the applied type of prosthesis.

Arthroplasty, Replacement, Hip↗
PubMed1994

Severe polyethylene wear in total hip arthroplasty. Observations from retrieved AML PLUS hip implants with an ACS polyethylene liner.

A retrospective review was performed of 94 consecutive Anatomic Medullary Locking Plus (AML+, DePuy, Warsaw, IN) cementless acetabular components implanted between January 1988 and January 1990. All acetabular cups utilized the Acetabular Cup System (ACS) polyethylene liner (Depuy). Of these hips, 72 had been followed for more than 2 years (average, 43 months). There have been 15 (21%) clinical failures, all due to catastrophic wear of the acetabular polyethylene component surfaces. Of the 15 failures, clinical symptoms were absent in 7, an audible squeak was present in 3, and 5 patients reported having pain. All clinical failures had accelerated acetabular wear necessitating revision. Patients in the failure population were younger (56 years vs 62 years) than the remainder of the patients, and had greater cup abduction angles (55 degrees vs 49 degrees). All of the failed ACS polyethylene components had a 32 mm inner diameter articulating surface. The AML + acetabular component outer diameter averaged 56 mm (range, 50-64 mm). Six of 15 failures occurred in cups 58 mm or larger. Acetabular wear in the failure group was 0.77 mm/y (average). The incidence of acetabular (78%) and femoral (71%) osteolysis in the failure population is alarming. The rate of failure (21%) at 46 months of the AML + acetabular component with the ACS polyethylene liner appears to be related to design. The ACS design is flawed by a lack of hemispherical geometry, leading to failure at the superior rim with penetration of the femoral head through the polyethylene and against the metal shell.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed2006

Hip arthroscopy without a perineal post: a safer technique for hip distraction.

Pudendal nerve palsy is a reported complication of hip arthroscopy. We report a technique using a deflated taped beanbag rather than a perineal post. The patient is placed in the supine or lateral position on a fracture table. The beanbag is contoured around the patient's flank and thorax. The distal aspect of the beanbag is placed no further than the iliac crest, and care is taken to avoid compression of the posterior aspect of the axillary region or the posterior humerus. The molded beanbag is deflated, a blanket is positioned over the abdomen and lower thorax, and with the use of 3-in-wide cloth tape, the patient and beanbag are secured to the operative table circumferentially. The superior margin of the deflated beanbag remains firm, preventing compression of the thorax and avoiding compromised ventilation. The arm on the operative side is placed across the chest and secured to avoid obstruction of the operative field. This patient positioning provides sufficient stability for adequate traction and good visualization while minimizing the risk of a pudendal nerve palsy.

Arthroscopy↗
PubMed1999

Total hip replacement with an entirely hydroxyapatite-coated prosthesis: 5 years' follow-up of 94 consecutive hips.

The first 100 consecutive entirely hydroxyapatite (HA)-coated hip arthroplasties in 86 patients (mean age, 56.2 years [range, 32-73 years]; female-to-male ratio, 75:25) were followed with standardized radiographs annually up to 5 years. All components developed 100% intimate bone-implant contact, being gradually reduced to 99.5%+/-3.8% by 2 partial periacetabular lines and on the femoral side to 94.0%+/-6.1% and 96.5%+/-5.2% in the frontal and lateral planes by lines along 75 stems, mostly in zones 1 and 8. Bone formation took place adjacent to the prostheses regularly, with gap filling and comprehensive periprosthetic bone remodeling, stabilizing at 3 years. No adverse stress shielding was found. The clinical results were excellent without thigh pain. We believe that all components were bonded directly to bone, promoted by the reliable primary fixation and the osteoconductive effect of HA.

Adult↗
PubMedDate not supplied

[Cup placement in hip replacement surgery -- A comparison of free-hand and computer assisted cup placement in total hip arthroplasty -- a multi-center study].

AIM: The purpose of the current study was to determine the accuracy of free hand and computer-assisted (CAS) cup placement. MATERIAL AND METHODS: Between June 1985 and August 2001, 105 free-hand and from March to November 1999 80 total hip arthroplasties under computer assistance were implanted in the above mentioned centers. To determine the accuracy of the cups, the inclination and anteversion angles were measured. In all cases the cup position was measured with a CT-investigation of the pelvis. Statistical analysis was performed with the F-test. RESULTS: With regard to the inclination and anteversion angles the variability of the cup position was significantly higher in the group of free hand implanted cups. In the CAS group we could not find any "extreme" positions. CONCLUSION: Using computer-assisted surgery a significantly higher reproducible cup position can be obtained. Long time survey may present a lowering of the rate of early and late complications caused by better prostheses alignment in the follow up.

Adult↗
PubMedDate not supplied

[The Balgrist hip cup--a 4-to-10-year survival analysis of cement-free hip cups].

The results of 715 cement-free acetabular sockets used in primary total hip arthroplasties are shown according to a survivorship analysis after Kaplan-Meier. The survival probability of the examined cement-free polyethylene sockets after 5 years lies between 88.1% and 93.6% (Endler screw socket of polyethylene: 93.6%; Balgrist socket of polyethylene: 88.1%; Balgrist socket of polyethylene with titanium coating: 90.6%). The survival probability of the Endler socket after ten years is only 44.2%. No statistically significant difference in the survival curves of the polyethylene socket models could be found (p logrank 0.797). The Balgrist sockets with the outer split ring made of titanium show a far better survival rate (98.8% after 4 years) than those made of polyethylene. This result justified the further development of a Modular Revision socket made of titanium so that the original idea could be extended to revision interventions where large acetabular defects have to be coped with.

Acetabulum↗
PubMedDate not supplied

[Evaluation and prognosis of changes in the femur end of the hip in hip dislocation].

Long-term observations proved the necessity of careful control of the development of femur head epiphysis in case of dislocated hip joint. The occurrence of femur head necroses can be greatly reduced by a sparing functional treatment. Endogenously conditioned constructive disturbances, which can be found in 5 to 7 p.c. of all cases, have to be clearly distinguished from head necroses.

Child↗
PubMed2003

Femoral head size is a risk factor for total hip luxation: a study of 42,987 primary hip arthroplasties from the Norwegian Arthroplasty Register.

On the basis of the Norwegian Arthroplasty Register, which has recorded nearly all primary hip prostheses and revisions in Norway since 1987, we studied risk factors for prosthesis luxation leading to revision. 7 prosthesis brand combinations used in 42,987 primary operations were included from 1987-2000. We found that femoral head size was an important risk factor; 28 mm heads led to revision more often than 32 mm ones (failure rate ratio (FRR) 4.0, 95% confidence interval (CI) 2.2-7.3). Charnley (22 mm head) performed equally well or better than the 28 mm heads. The Exeter stem and cup is the type of prosthesis on the Norwegian market with more than two femoral head sizes (26, 28, 30, 32 mm) and 26 mm heads led to revision due to luxation significantly more often than 30 mm heads (FRR 4.1, 95%CI 2.2-8.1). Old age, preoperative diagnosis, and choice of prosthesis brand combination were also important factors affecting the revision rate due to luxation. A posterior approach increased the risk of revision more than a lateral one (FRR 1.9, 95% CI 1.4-2.5). Gender, trochanteric osteotomy and duration of the operation did not affect the results.

Aged↗
PubMed2003

Antibiotic prophylaxis in total hip arthroplasty: effects of antibiotic prophylaxis systemically and in bone cement on the revision rate of 22,170 primary hip replacements followed 0-14 years in the Norwegian Arthroplasty Register.

We studied the effects of antibiotic prophylaxis, systemically and in bone cement, on the revision rate of cemented total hip arthroplasties (THAs) in data from the Norwegian Arthroplasty Register during the period 1987-2001. To have comparable groups, only THAs performed because of primary osteoarthritis, using cemented implants with documented good results, and high-viscosity cement were included. If systemic antibiotic prophylaxis had been given, only operations with cephalosporin or penicillin were selected. Cox-estimated survival relative revision risks (RR) are presented with adjustment for differences among groups in gender, age, cement brand, type of systemic antibiotic prophylaxis, type of prosthesis, type of operating room, and duration of the operation. Of 22,170 THAs studied, 696 THAs (3.1%) were revised, 440 (2.0%) for aseptic loosening and 102 (0.5%) for deep infection. We found the lowest risk of revision when the antibiotic prophylaxis was given both systemically and in the cement (15,676 THAs). Compared to this combined regime, patients who received antibiotic prophylaxis only systemically (5,960 THAs) had a 1.4 times higher revision rate with all reasons for revision as endpoint (p = 0.001), 1.3 times higher with aseptic loosening (p = 0.02) and 1.8 times higher with infection as the endpoint (p = 0.01). With the combined antibiotic regime, the results were better if antibiotics were given 4 times on the day of surgery (2,194 THAs), as compared to once (1,424 THAs) (p < 0.001), twice (2,680 THAs) (p < 0.001), or 3 times (5,522 THAs) (p = 0.02). Those who received systemic prophylaxis a single day 1, 2 or 3 times, as compared to 4 times, had a revision rate 1.8-3.5 times higher with all reasons for revision as endpoint, 1.5-3.1 times higher with aseptic loosening, and 2.7-6.8 times higher with infection. When we compared systemic prophylaxis 4 times in 1 day, no further improvement resulted in those given systemic prophylaxis for 2 days (1,928 THAs) or 3 days (717 THAs). In a subset of data including only the Charnley prosthesis, we obtained similar results. This observational study shows that the best results were recorded when antibiotic prophylaxis was given both systemically and in the bone cement, and if the systemic antibiotic was given 4 times on the day of surgery.

Adolescent↗
PubMed2004

Rotational acetabular osteotomy for hip dysplasia: 61 hips followed for 8-15 years.

We operated on 54 patients (61 joints) with rotational acetabular osteotomy (RAO) due to dysplasia of the hip with pre- or early-stage osteoarthritis/arthrosis. The mean follow-up was 11 (8-15) years. The Merle d'Aubigné median score increased from 14 to 15. In 2 patients (2 joints), the score decreased from 15 to 13. Progression of arthrosis was seen in 6 joints on the radiographs at follow-up. Kaplan-Meier survivorship analysis predicted an 89% (95% confidence interval 80-99) prevention of worsening of arthrosis at 10 years. Postoperative joint congruency was a risk factor for progression of arthrosis.

Acetabulum↗
PubMed1981

Subluxation and dislocation of the hip: a complication following hip pinning.

In 11 subluxations and four dislocations of the hip, following the internal fixation of intracapsular or intertrochanteric fractures, sepsis was proved in 12. Subluxations were diagnosed radiographically between 2 and 26 months following injury. Dislocations occurred following unstable intertrochanteric fractures, stabilized by valgus reduction, medial displacement, and osteotomy of the greater trochanter, and were diagnosed between 10 days and 9 weeks post-fracture. Treatment alternatives included implant removal, resection arthroplasty, and replacement arthroplasty in selected cases.

Aged↗
PubMed1982

Some observations on urinary retention and deep hip sepsis following total hip replacement.

A follow-up study was made of 256 hip replacements, performed at Dunedin Hospital by three orthopaedic surgeons in males aged 45 years and over for the six year period beginning 1975 through to the end of 1980. One surgeon (A) had an elaborate management policy designed to reduce postoperative urinary retention and his cases are compared with Surgeon B's whose methods of avoiding urinary retention would be more representative of the majority of orthopaedic surgeons. Analysis was performed of the 20 cases of urinary retention pooled from all three participating surgeons. Also analysed were the 24 cases of epidural anaesthetics in the entire series. Surgeon A had a significantly (P=.045) lower postoperative urinary retention rate of 3.23% compared to surgeon B (12.07%). Analysis of the 20 cases of urinary retention revealed that cases having retention after previous operations and having nothing done about it invariably went into retention again. The retention rate after the 24 epidural anaesthetics was 16.7% and the retention rate after the 232 general anaesthetic cases was 6.9%. This difference was not statistically significant (p=0.10).

Aged↗
PubMed1986

Loosening of the femoral component after total hip replacement. The thin black line and the sinking hip.

Review of the radiographs of 882 consecutive metal-to-polyethylene hip replacements after a mean follow-up of 6.8 years showed 72 cases (8%) of aseptic femoral loosening, all of which showed a lucent zone or black line between metal and cement. In 97% of the series this appeared within two years of the arthroplasty. Progress of loosening was unpredictable and only 24% had significant symptoms. Improved technique with methylmethacrylate cement in Stanmore prostheses had reduced loosening after two years from 7.9% to 0.4%. Methods of detection of early loosening are discussed.

Follow-Up Studies↗
PubMed1991

Measurement of hip prostheses using image analysis. The maxima hip technique.

A computer-based image analysis system has been developed as a research tool in total hip replacement. The system has been programmed to take multiple measurements from coronal plane radiographs. Poor quality radiographic images can be enhanced and standardised. The measurements which can be obtained include stem subsidence, cup migration, cup wear, and stem loosening. Reproducibility and accuracy were +/- 0.01 mm and +/- 0.5 mm respectively. The present application is in retrospective research, but prospective monitoring of radiographs is planned.

Hip Joint↗
PubMed1987

Chemical-shift MR imaging of the femoral head: an in vitro study of normal hips and hips with avascular necrosis.

To study the conventional and chemical-shift MR images of fatty, hemopoietic, and ischemic bone marrow, four normal femurs from autopsies and six femoral heads from total hip replacement done for avascular necrosis (AVN) were imaged with a small-bore 1.4-T MR unit. T1- and T2-weighted spin-echo images, fat- and water-selective spin-echo images, and out-of-phase images were obtained. The specimens were then sectioned, radiographed, and studied histologically. The capital epiphysis and greater trochanter in normal femurs had the highest signal on T1-weighted, fat-selective, and out-of-phase images owing to their high fat content. Fat-selective and water-selective images accurately depicted regions of fat and water, whereas T1-weighted, T2-weighted, and out-of-phase images were misleading in some cases. On T2-weighted images, a double line consisting of a rim of low signal with a high-signal inner border was noted surrounding AVN lesions. Histologic correlation showed that the low-signal outer rim was due to sclerotic bone, while the high-intensity inner border was due to granulation tissue and/or chondroid metaplasia. Fractures within the six AVN lesions were best seen on T2-weighted images, but these could not be distinguished from granulation tissue. On T2-weighted images, the weight-bearing cartilage had lower signal in five of six femoral heads with AVN. We conclude that the MR appearance of AVN reflects its complex histopathology. Direct spin-echo chemical-shift imaging can help correlate MR images with histology by providing information not available from conventional or out-of-phase images.

Adult↗
PubMed1994

Cemented versus uncemented socket in hip arthroplasty. A radiostereometric study of 60 randomized hips followed for 2 years.

60 patients with arthrosis who received a Charnley total hip replacement were randomly assigned to either an uncemented porous Harris-Galante type I socket or a cemented all-polyethylene Charnley socket. Socket migration and rotation were studied by radiostereometry (RSA) for 2 years. After 2 years, all sockets were still in situ. There was no difference in migration or rotation between the 2 socket designs, nor was there any difference in pain or function. We conclude that the initial fixation of the Harris-Galante socket resembles that of the Charnley socket.

Adult↗
PubMed2000

[Comparative evaluation of stress patterns in models of the normal hip joint and after implantation of the Parhofer-Mönch type hip prosthesis].

The paper presents a comparative appraisal of stress patterns of the normal acetabulum of the hip joint and after implantation of a Parhofer-Monch type prosthesis based on a computer simulation analysis. Three-dimensional physical models were constructed basing on finite element methods and loaded according to Pauwels' scheme with a force R = 2878 N. Mathematical analysis was performed on a computer equipped with a Pentium II processor, using professional software written for theory of elasticity problem solving. Equipotential stress patterns were designated according to Hubers' hypothesis. A redistribution and decrease in stress values in the bone directly around the acetabular component of the prosthesis was noted.

Acetabulum↗