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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↗
PubMed2005

Validation of data in the Norwegian Arthroplasty Register and the Norwegian Patient Register: 5,134 primary total hip arthroplasties and revisions operated at a single hospital between 1987 and 2003.

BACKGROUND: The usefulness of a national medical register relies on the completeness and quality of the data reported. The data recorded must therefore be validated to prevent systematic errors, which can cause bias in reports and study conclusions. PATIENTS AND METHODS: We compared the number of hip replacements reported to the Norwegian Arthroplasty Register (NAR), 1987-2003, and to the Norwegian Patient Register (NPR), 1999-2002, with data recorded at a local hospital. The date of operation and the index hip were further validated to find inaccurately recorded data in the NAR. Kaplan-Meier estimated survival curves were compared to evaluate the possible influence of missing data. RESULTS: Of 5,134 operations performed at a local hospital, 19 (0.4%) had not been reported to the NAR. Completeness of registration was poorer for revisions (1.2%) than for primary operations (0.2%). Among 86 Girdlestone revisions (removal of the prosthesis only), 9 (11%) had not been reported to the NAR. Missing data on revisions, however, had only a minor influence on survival analyses. The date of the operation had been recorded incorrectly in 56 cases (1.1%), and the index hip in 12 cases (0.2%). The surgeon was responsible for 85% of these errors. Comparisons with data reported to the NPR, 1999-2002, showed that 3.4% of operations at the local hospital had not been reported to the NPR. INTERPRETATION: Only 0.4% of the data from a local hospital was missing in the NAR, as opposed to the NPR where 3.4% was missing. The information recorded in the NAR appears to have been valid and reliable throughout the entire period, and provides an excellent basis for clinically relevant information regarding total hip arthroplasty.

Arthroplasty, Replacement, Hip↗
PubMed2006

Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid-to long-term follow-up study from the Finnish Arthroplasty Register.

INTRODUCTION: The survival of total hip arthroplasties (THAs) has been considered to be poor in young patients. We evaluated the population-based survival of uncemented THA for primary osteoarthritis (OA) in patients under 55 years of age and the factors affecting survival. METHODS: The Finnish Arthroplasty Register was established in 1980. Between that year and 2003, 92,083 primary THAs were entered in the register, 5,607 of which were performed for primary OA in patients under 55 years of age. Using records from these 5,607 THAs, we selected uncemented femoral and acetabular components that had been used in more than 100 operations during the study period. Survival of both components (cup/stem) and their combinations were analyzed separately with the Kaplan-Meier analysis and the Cox regression model. RESULTS: All uncemented stems studied showed a survival rate of over 90% at 10 years. The Biomet Bi-Metric stem had a 95% (95% CI 93- 97) survival rate even at 15 years. Overall survival of the extendedly porous-coated Lord Madréporique stem (p = 0.003) and the proximally porous-coated Anatomic Mesh stem (p = 0.0008) were poorer than that of the Biomet Bi-Metric stem. When endpoint was defined as stem revision for any reason, results were generally similar; there was no difference, however, between the survival rates of the Lord Madréporique stem and the Bi-Metric stem. Of the acetabular components, the Biomet Universal, the ABG Il and the Harris-Galante II cups showed < 90% survival rates at 10 years with aseptic loosening as endpoint; at 13 years the corresponding survival rates were 94% (95% CI 91-97) for the Biomet Universal and 95% (95% CI 91-98) for the Harris-Galante II cups with aseptic loosening as endpoint. The PCA Pegged porous-coated uncemented cup showed a poor 13-year survival rate of 68% (95% CI 59-78) with aseptic loosening as endpoint. However, when endpoint was defined as any revision (including exchange of liner), the 10-year survival rates of all brands of cup except Harris-Galante II declined to under 80%. INTERPRETATION: Modern second-generation uncemented stems, with proximal circumferential porous- or HA-coating, seem to be a good choice for young patients with primary OA. Similarly, modern press-fit porous- and HA-coated cups appear to have good endurance against aseptic loosening in these young patients. However, liner revisions were common; thus, survival rates of uncemented cups were unsatisfactorily low. Polyethylene wear and unfavorable locking mechanisms between the metal shell and the polyethylene liner and their sequelae remain matters of concern in this young and active group of patients.

Adult↗
PubMed2002

The effect of implant constraint on results of conversion of unicompartmental knee arthroplasty to total knee arthroplasty.

A series of unicompartmental knee arthroplasty (UKA) revision to total knee arthroplasty (TKA) was compared to a group of primary TKAs performed at the same institution. The UKA revision group had a higher incidence of local wound complications and inferior clinical results as measured by Knee Society scores. When the revisions were stratified by the degree of interface constraint, knees revised with posterior cruciate ligament (PCL) substituting designs had superior knee scores that were comparable to the primary group. The use of a PCL-substituting knee design is recommended when converting a UKA to TKA.

Aged↗
PubMed2003

Long-term results of patellofemoral arthroplasty. A report of 56 arthroplasties with 17 years of follow-up.

We studied retrospectively the outcome of patellofemoral arthroplasty (PFA) using the Richards prosthesis in 51 patients (56 knees). Their mean age was 50 years (30 to 77). In 43 patients (45 knees), the American Knee Society score and the patients' subjective judgement were assessed. Excellent or good results were obtained in 86% of cases at a mean follow-up of 17 years (15 to 21). Because of ongoing tibiofemoral osteoarthritis, two patients required a high tibial osteotomy and ten PFAs were converted to a total knee arthroplasty after a mean of 15.6 years (10 to 21). The PFAs were stable during follow-up with a loosening rate of only 2%. We conclude that a patellofemoral prosthesis is a good treatment option with successful long-term results in middle-aged patients with radiologically documented, isolated, patellofemoral osteoarthritis.

Adult↗
PubMed2004

Failure rates for 4762 revision total hip arthroplasties in the Norwegian Arthroplasty Register.

We present the results for 4762 revision total hip arthroplasties with no previous infection in the hip, which were reported to the Norwegian Arthroplasty Register between 1987 and 2003. The ten-year failure rate for revised prostheses was 26% (95% CI 25 to 26). Cox regression analyses were undertaken separately for acetabular and femoral revision components. Cemented revision components without allograft was the reference category. For acetabular components, we found a significantly reduced risk of failure for uncemented revisions both with (relative risk (RR) = 0.66; 95% CI 0.43 to 0.99) and without (RR = 0.37; 95% CI 0.22 to 0.61) allograft. For femoral components, we found a significantly reduced risk of failure for uncemented revisions, both with (RR = 0.27; 95% CI 0.16 to 0.46) and without (RR = 0.22; 95% CI 0.11 to 0.46) unimpacted allograft. This reduced risk of failure also applied to cemented revision components with allograft (RR = 0.53; 95% CI 0.33 to 0.84) and with impaction bone grafting (RR = 0.34; 95% CI 0.19 to 0.62). Revision prostheses have generally inferior results when compared with primary prostheses. Recementation without allograft, and uncemented revision with bone impaction, were associated with worse results than the other revision techniques which we studied.

Aged↗
PubMed2006

[Comparison of primary arthroplasty with early salvage arthroplasty after failed internal fixation for displaced femoral neck fractures in elderly patients].

OBJECTIVES: We compared the results of primary total hip arthroplasty (THA) with those of early salvage THA following failure of internal fixation for acute displaced femoral neck fractures in elderly patients. METHODS: Patients with displaced femoral neck fractures (Garden type III, IV) were treated with either early salvage arthroplasty following failure of internal fixation (n=34; mean age 68 years) or THA (n=34; mean age 67.5 years). Both groups consisted of 8 men and 26 women with the same age range (60 to 75 years). Uncemented THA was performed in both groups. All patients were physiologically and socially active before the initial trauma. The hips were evaluated with the use of the Merle D'Aubigne scoring system. Prognostic risk factors were determined on radiographs obtained before or shortly after internal fixation. The mean follow-up was 5.2 years in the secondary and 5 years in the primary THA groups. RESULTS: During the first year of THA, there were 21 complications in 16 patients and nine complications in six patients in the secondary and primary THA groups, respectively (p<0.05). The results with respect to pain were worse and reoperation rate was higher in the revision group (p<0.05). The mean Merle D'Aubigne hip scores for pain, mobility, and walking were higher in the primary THA group. Radiographs taken before or after internal fixation showed prognostic risk factors in 32 patients (94.1%). CONCLUSION: Primary THA is a good choice of treatment for femoral neck fractures in physiologically and socially active elderly patients with a high life expectancy and cognition level.

Aged↗
PubMed1980

Resection arthroplasty following infected total hip arthroplasty.

We evaluated twenty-one patients, one to eight years after removal of total hip-arthroplasty components because of infection. Sixteen of the patients had moderate to severe pain with either weight-bearing or sitting, and the other five had continuous moderate to severe pain. Twelve patients had an Iowa hip rating of less than 50 points, and the mean for the entire group was 49 points. All but three patients required a walker or crutches for walking. Only three patients were satisfied with the result of the resection arthroplasty. There was a suggestion that the patients with a smooth intertrochanteric line of resection of the proximal end of the femur had better results than those who did not. Patients whose wounds never healed had worse results than those whose wounds healed, but neither the initial treatment of the wound (open packing versus closed-tube irrigation) nor retained cement determined whether healing would occur.

Adult↗
PubMed1996

Current status of metacarpophalangeal arthroplasty and basilar joint arthroplasty of the thumb.

MP joint arthroplasty finds its widest application in the patient with rheumatoid arthritis. With only minor design modification over the years, the Silastic MP joint space is a predictable, durable device with reasonable longevity. In contrast, reconstruction of the CMC joint of the thumb relies primarily on soft tissue reconstruction with arthroplasty techniques having limited applications.

Arthritis↗
PubMed1996

Total joint arthroplasty in a predominantly African-American population, part one: knee arthroplasty.

A total of 128 total joint arthroplasties performed on a predominantly African-American population by a single surgeon between 1987 and 1992 were reviewed. Of these, 66 were total knee replacements and 62 were total hip replacements. Total hip replacement will be presented in Part Two. The African-American patients' attitudes toward joint replacement, comorbid states, complications, and overall results were examined. All patients were evaluated objectively and subjectively both clinically and radiographically. Ninety-five percent of the patients had good to excellent results, confirming our belief that despite the coexistence of medical illnesses, advanced age, presence of moderate obesity, and severity of disease, total joint arthroplasty is an effective and satisfying method of treatment for the African-American patient with severe arthritis.

Black or African American↗
PubMed1994

Revision total knee arthroplasty. Comparison of outcome following primary proximal tibial osteotomy or unicompartmental arthroplasty.

Forty-three patients who had undergone revision total knee arthroplasty following either primary, medial unicondylar arthroplasty (23 patients) or valgus tibial osteotomy (20 patients) for medial compartment osteoarthritis were reviewed. Although the two groups had similar knee scores and range of motion at review, six patients (30%) who had undergone prior tibial osteotomy suffered serious postoperative complications. Of these, four patients had a deep infection. It was felt that several factors were responsible, resulting largely from difficulties in gaining access to the lateral tibial plateau and subsequently causing impairment of wound vascularity and healing. In contrast, those patients undergoing revision of unicondylar prostheses did not experience wound healing problems, but it was noted that in half of the cases, there was significant bone loss from the medial tibial plateau.

Humans↗
PubMed1997

Does arthroscopic abrasion arthroplasty promote cartilage regeneration in osteoarthritic knees with eburnation? A prospective study of high tibial osteotomy with abrasion arthroplasty versus high tibial osteotomy alone.

The purpose of this prospective study was to determine whether or not abrasion arthroplasty promotes cartilage regeneration in osteoarthritic (OA) knees with eburnation. Patients with OA knees were divided into a group of 51 knees treated by osteotomy with abrasion arthroplasty (Group A) and another group of 37 knees treated by osteotomy alone (Group B). Regeneration of cartilage was compared between the groups both arthroscopically and histologically. The Outerbridge classification was used for arthroscopic grading with Grade 0 being normal and Grade IV representing eburnation. On arthroscopic examination, around 12 months after surgery, Group A showed a significantly higher incidence of Grade II repair (a smooth articular surface and small fissures) and a lower incidence of Grade IV repair than Group B on both the femoral (P < .001) and tibial (P < .01) joint surfaces. Age was the only factor influencing the grade of tibial cartilage in Group A. Histological examination showed that 64% of the regenerated tissue studied consisted of fibro-cartilage at around 12 months after surgery. There was no difference in the clinical outcome at 2 to 9 years postoperatively between Groups A and B.

Age Factors↗
PubMed1995

Comparison of cemented and cementless total hip arthroplasty in patients with bilateral hip arthroplasties.

A consecutive series of 36 patients underwent primary cemented total hip arthroplasty followed by primary cementless total hip arthroplasty of the contralateral hip. Clinical pain scores between the cementless and cemented hips were not different. Subjectively, patients either had no preference or preferred the cementless side. Comparison of results in the same patient eliminates variability introduced by differences in sex, weight, comorbidities, bone quality, and activity level. Control of these factors permits more meaningful comparison of the type of fixation.

Adult↗
PubMed1988

Preliminary results of total wrist arthroplasty in rheumatoid arthritis using the Trispherical total wrist arthroplasty.

Thirty-two patients underwent 38 arthroplasties for advanced rheumatoid arthritis and marked soft tissue losses. Seven wrists required repair or transfer of at least one tendon for rebalancing. All patients were improved by the implants. Thirty-four of the 38 patients were improved beyond the functional level of a painless wrist arthrodesis. Overall, there were 23 excellent, 10 good, 3 fair, and 2 poor results. The average wrist score was 90.3 points, and the average arc of motion was 38 degrees. There were three cases of migration of the third metacarpal stem and nine cases of lucency about the stems, three of which were progressive or greater than 1 mm. There were no deep infections. There was one reoperation for persistent pain and one for component loosening. There were no cases of implant failure. These results indicate that this total wrist arthroplasty is a safe, reproducible procedure for radiographic class III and IV rheumatoid disease and should be considered a first line of therapy for that group.

Adult↗
PubMed1997

Primary total knee arthroplasty using the Genesis Total Knee Arthroplasty System: 3- to 6-year follow-up study of 105 knees.

This prospective study analyzed data from 105 primary total knee arthroplasties performed in 90 patients using the Genesis Total Knee Arthroplasty System. The 34 men and 56 women with a mean age of 68.7 years (range, 41-86 years) were evaluated at a mean follow-up period of 4.25 years (range, 3-6 years). Fifty-five procedures (52%) used cemented femoral and tibial components, 49 (47%) used cementless femoral and cemented tibial components, and 1 (1%) used cementless femoral and tibial components. The preoperative mean pain and function scores were 50 (range, 12-79) and 41 (range, 5-80), respectively. At the most recent follow-up evaluation, the mean pain score increased to 97 (range, 67-100), and the mean function score increased to 88 (range, 40-100). Mean preoperative range of motion was 104 degrees (range, 50 degrees-130 degrees) and increased to 116 degrees (range, 80 degrees-130 degrees) at most recent follow-up evaluation. Clinically, there were 100 excellent results (95%). 4 good results (4%), and 1 poor result (1%).

Aged↗
PubMed1990

The effect of a stem on the tibial component of knee arthroplasty. A roentgen stereophotogrammetric study of uncemented tibial components in the Freeman-Samuelson knee arthroplasty.

We studied the effect of a metal tray with an intramedullary stem on the micromotion of the tibial component in total knee arthroplasty. Of 32 uncemented Freeman-Samuelson knee arthroplasties performed in London and Gothenburg, nine had a metal backing and stem added to the tibial component. Micromotion of the tibial components, expressed as migration and inducible displacement, was analysed using roentgen stereophotogrammetric analysis up to two years follow-up. The addition of a metal back and a 110 mm stem to the standard polyethylene component significantly reduced both migration over two years and inducible displacement.

Adult↗
PubMed1994

RD heparin compared with warfarin for prevention of venous thromboembolic disease following total hip or knee arthroplasty. RD Heparin Arthroplasty Group.

The efficacy and safety of RD heparin, a low-molecular-weight heparin, for the prevention of venous thromboembolic disease among patients managed with an elective total hip or total knee arthroplasty were compared with the efficacy and safety of warfarin in an open-label prospective, multicenter trial. Patients were randomized to receive either a fixed dose of fifty anti-factor-Xa units of RD heparin per kilogram of body weight, administered subcutaneously twice daily, beginning postoperatively; a fixed dose of ninety anti-factor-Xa units of RD heparin per kilogram of body weight, administered subcutaneously once daily, beginning postoperatively; or five milligrams of warfarin, administered orally preoperatively, followed by a daily adjusted dose of warfarin to prolong the prothrombin time ratio to 1.2 to 1.5. The primary measure of efficacy was contrast venography of the treated limb, performed by local radiologists blinded to the type of treatment that had been assigned. Nine hundred and sixty-nine patients had a complete assessment for the presence of deep-vein thrombosis. The over-all rates of venous thromboembolic disease were 16 percent (95 pecent confidence interval, 13 to 21 percent) (fifty-three) for the 328 patients who received RD heparin twice daily, 21 percent (95 percent confidence interval, 17 to 26 percent) (sixty-eight) for the 320 patients who received RD heparin once daily, and 27 percent (95 percent confidence interval, 22 to 32 percent) (eighty-seven) for the 321 patients who received warfarin (p < 0.001 for RD heparin administered twice daily compared with warfarin; p = 0.13 for RD heparin administered once daily compared with warfarin). Compared with warfarin, RD heparin administered twice daily and RD heparin administered once daily reduced the risk of venous thromboembolic disease by 41 percent (95 percent confidence interval, 20 to 56 percent) and 18 percent (95 percent confidence interval, -6 to 37 percent), respectively. The rates of venous thromboembolic disease after 523 total hip arthroplasties were 8, 14, and 14 percent for the patients who received RD heparin twice daily, those who received it once daily, and those who received warfarin (p = 0.07 for RD heparin administered twice daily compared with warfarin; p = 0.82 for RD heparin administered once daily compared with warfarin).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1982

Total hip arthroplasty using the McKee & Watson-Farrar prosthesis: a prospective follow-up study of 327 arthroplasties.

In a prospective study of 327 total hip arthroplasties using the McKee-Farrar prosthesis the patients were followed up each year for up to 8 years after the operation. The immediate results concerning pain and to some extent walking capacity and mobility were good in up to 90 per cent of cases. The excellence of the results declines with time, and after 7 years "good" results were noted in about 50 per cent. The infection rate without prophylactic antibiotics was 3.4 per cent and the rate of aseptic loosening 16 per cent. In elderly patients total arthroplasty is the operation of choice, but in younger patients one should be more restrictive.

Adult↗