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PubMed2001

Preoperative radiotherapy without femoral shielding for prevention of heterotopic ossification in hydroxyapatite-coated hip prostheses.

Twenty-seven consecutive patients at high risk of developing heterotopic ossifications (HO) after implantation of a hydroxyapatite (HA)-coated hip prosthesis were irradiated with a single dose of 7 Gy, at least 4 h before the operation. The femoral stem was not shielded during radiotherapy (RT). After a median follow-up of 14.8 months, no clinically significant HO could be found, while 12 (52%) patients in this high-risk population had only minor HO (grade I). No reoperation was needed, and no evidence of prosthesis migration was observed. We conclude that single-dose, preoperative RT for HA-coated hip prosthesis can effectively inhibit HO. Not blocking the femoral stem does not result in prosthesis migration.

Adult↗
PubMed1987

[Biocorundum--a new/type of poreless ceramic material of aluminum oxide for the manufacture of the elements of hip joint prosthesis. Biological and technological studies].

The Institute of Refractories Materials in Gliwice undertook researches in the field of technology of a new ceramic material of aluminium oxide for production of coxal joint endoprostheses. A poreless ceramic material of high chemical purity and density and required microstructure and good resistance to fracture, was achieved. The new ceramic material was called Biocorundum. By means of a similar technology also series of samples were produced for testing the biocompatibility of the material. Biological studies were carried out in the Department of Experimental Surgery and Biomaterials Research, Chair of Traumatologic Surgery, Medical Academy of Wroclaw. The studies comprised: 1. laboratory and toxicological tests in vitro of water extracts, 2. pathomorphological studies after intramuscular, peritoneal and intra-bone implantation of samples of the material in rats and piglets, 3. ultrastructural scanning studies of the implantation in rats and pigs and after 3- and 6-months long keeping in the Ringer solution. Preliminary studies and biological studies in vitro have shown a complete conformity of the material with the requirements. Tissue reactivity was studied on 36 Wistar rats. By pathomorphological studies a systematic macroscopic and microscopic estimation was possible. They have shown only minimal tissue reactivity to biocorundum implantation. In experimental studies on 14 piglets the biocorundum grafts were implanted into the tibia epiphysis for 3- and 6-months. Clinical, pathomorphological and X-ray studies were carried out. In all cases the Biocorundum grafts healed without any complications. On the basis of pathomorphological studies, the tissue reactivity around the grafts were estimated as minimal. This shows a high biocompatibility of the ceramic material. In X-ray studies were observed around the grafts small osteosclerotic changes and periosteum stratification. These changes resulted after surgical interventions in quickly growing piglets. Complementary studies of the surface of the material by scanning microscopy after 3 months long implantation and after 3 months long contact with the Ringer solution did not show any changes in comparison with the surface of the initial samples. After 6 months long implantation in individual samples rounding of the ceramic material grain edges were found, which could result from biological corrosive power. This agree with the findings of other studies on other ceramic aluminium oxide materials. The achieved results of complex studies of biocompatibility of the new poreless material developed in Poland--Biocorundum--have shown its complete biological suitability for production of elements of osteoarticul

Aluminum↗
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↗
PubMed1994

Sinus histiocytosis of pelvic lymph nodes after hip replacement. A histiocytic proliferation induced by cobalt-chromium and titanium.

Six men who had undergone hip replacements for degenerative joint disease or trauma subsequently had radical prostatectomies or cystoprostatectomies with bilateral pelvic lymph node dissections for adenocarcinoma of the prostate or transitional cell carcinoma of the urinary bladder. The hip prostheses implanted in three patients were known to contain cobalt-chromium alloy and titanium. The pelvic lymph nodes ipsilateral to the hip prosthesis in five patients and the bilateral pelvic nodes in the only patient with bilateral hip prosthesis had dark brown or black cut surfaces. These lymph nodes did not contain carcinoma but showed florid sinus histiocytosis characterized by large polygonal histiocytes filling and expanding sinuses and interfollicular regions. The foamy histiocytes contained cobalt-chromium and titanium microparticles by light microscopy, ultrastructure, and energy-dispersive x-ray microanalysis. The lymph nodes uninvolved by the histiocytic reaction lacked the heavy metal microparticles. Four cases were found to have a small number of polyethylene particles, which might have contributed to the histiocytic response. By immunohistochemistry, the foamy cells displayed immunoreactivity for lysozyme, alpha-1-antitrypsin, alpha-1-antichymotrypsin, and cathepsin D, providing additional support for their histiocytic derivation. To our knowledge, this is the first time that microparticles of cobalt-chromium and titanium that migrate from hip prostheses to pelvic lymph nodes have been shown to elicit a distinctive type of florid sinus histiocytosis. Pathologists should be aware of this characteristic foreign-body tissue response to avoid confusion with other types of sinus histiocytosis or with metastatic carcinoma.

Aged↗
PubMed2006

[Shaft lengthening in hip replacement: experimental studies on bending stiffness].

BACKGROUND: Cortical atrophy of the proximal femur can be seen after wearing a total hip prosthesis for several years because loads are borne distally at the prosthesis tip. To achieve stable prosthesis implantation on the one hand and proximal bone regeneration on the other hand in hip revision arthroplasty, lengthening of the shaft component distributes loading forces to the femoral shaft first. It concentrates them to the proximal femur later through a higher elasticity. METHODS: In a three-point bending study the bending stiffness of an elastic slotted hip prosthesis shaft lengthening (HSL) was compared with that of the Synthes universal femoral nail (MN) and the unslotted HSL. RESULTS: The slotting of the elastic HSL has a significant influence on its bending stiffness; it lies 1,287 N/mm (76%) over that of the MN, but 1,855 N/mm (38%) under that of the unslotted HSL. Altogether the slotted HSL is rather more comparable to the MN than to the unslotted HSL regarding its bending conduct. CONCLUSION: The results confirm the elasticity of the slotted HSL in the style of conventional intramedullary nailing and encourage-above all in the context of previous clinical studies-its further use.

Biomechanical Phenomena↗
PubMed2003

[Analysis of (18)F-FDG uptake patterns in PET for diagnosis of septic and aseptic loosening after total hip arthroplasty].

AIM: Identification of typical patterns for fluorodeoxy-glucose (FDG) uptake in positron emission tomography (PET) to detect aseptic loosening of hip prosthesis (ace-tabular and/or femoral component) and prosthetic infection. METHODS: 18 patients with painful hip prosthesis underwent PET using a dedicated full ring scanner after application of 200-300 MBq FDG. The interface between bone and surrounding soft tissue or bone as displayed on coronal slices was divided into 12 segments in accordance with the classifications of Delee and Gruen. FDG uptake in each of the segments was scored (0-3) by two independent observers. Intraoperative findings were regarded as the gold standard. RESULTS: After surgical revision 14 acetabular components and 9 femoral components were found to be loose and prosthetic infection was present in 7 prostheses. Loosening of the acetabular component was correlated to enhanced uptake in the middle of the acetabular interface, while loosening of the femoral component was correlated to enhanced uptake in the proximal and middle segment of the lateral femoral interface and the proximal segment of the medial femoral interface. A similar pattern was found in prosthetic infection with high uptake along the middle portion of the lateral femoral interface. In 6 of 7 infected prostheses loosening of the acetabular and of the femoral component was present. Taking the typical uptake patterns as criteria for loosening and grade 3 uptake as an additional criterion for septic loosening the accuracy of PET imaging in the detection of loosening of the acetabular or the femoral component and of prosthetic infection was 72, 78 and 89%, respectively. CONCLUSION: This pilot study presents FDG-PET as a promising diagnostic tool for patients with painful hip prostheses. Its clinical value should be evaluated in a larger patient population.

Aged↗
PubMed1982

An objective examination for painful hip after total hip arthroplasty.

An objective method for evaluating the cause of pain in hip arthroplasty was investigated in patients with a radiolucent zone of less than 2 mm at the cement-bone interface or the cement-stem or socket interface. Eight patients with a McKee-Farrar total hip prosthesis followed up for an average of 102 months and 20 patients with a Charnley total hip prosthesis observed for an average of 43 months were studied. Different components of the implant materials, such as cement monomer, BaSO4, ceramic, acrylic cement, stainless steel and high-density polyethylene, (HDP) were exposed to normal plasma. Contact activation of plasma was found to occur for all materials, except for HDP, yielding plasma kallikrein. The induced prekallikrein activation was markedly reduced in vitro by Trasylol. There was a significant increase in plasma kallikrein activity in the patients with discomfort and/or pain without gross loosening compared with the patients with pain-free hip arthroplasties. Furthermore, statistically significant enhancement of the kallikrein activity was observed in plasma from the femoral vein at the site of operation compared with that from the cubital vein of the same subject. The enhanced plasma kallikrein activity in the patients gradually decreased, as did the clinical symptoms, when Trasylol was administered. It is concluded that measurement of plasma kallikrein activity may produce useful information about the process of total hip arthroplasty and provide an objective evaluation of pain.

Aprotinin↗
PubMed1988

[Contraindications regarding total prosthesis of the hip joint].

The authors have made an analysis of unsatisfactory remote results in 83 (21.5%) out of 387 patients operated for endoprosthezing of the hip joint which resulted from shaking loose the endoprostheses in the bone tissue. A conclusion is made that the following factors may be considered as contraindications to endoprosthesis of the hip joints: coxarthrosis against the background of arthroso-arthritis, neglected stages of protrusive coxarthrites, deforming osteoarthrosis due to the use of corticosteroids, pronounced senile osteoporosis.

Adolescent↗
PubMed1994

The use of porous prostheses in delayed reconstruction of total hip replacements that have failed because of infection.

Between March 1984 and March 1989, thirty-four patients who had an infection at the site of a cemented total hip prosthesis were managed with resection arthroplasty and delayed implantation of a porous total hip prosthesis without cement. The interval from the time of the resection arthroplasty to the implantation of another prosthesis averaged eight months (range, three to nineteen months). At an average of forty-seven months (range, twenty-four to seventy-two months) after the reimplantation, six patients (18 per cent) had recurrence of the infection. Patients who had rheumatoid arthritis were at significantly higher risk for the development of a recurrent infection (p < 0.01). Of the twenty-eight patients who did not have a recurrent infection, six had definite radiographic evidence of loosening of the femoral component at the latest follow-up evaluation. For twenty-five of the twenty-eight patients, sufficient data were available for calculation of the Mayo Clinic hip score; only fourteen (56 per cent) of these patients had a satisfactory functional outcome. The high (68 per cent) rate of complications and the long-term durability of the prosthesis in these patients remain a concern. The fact that 18 per cent of the patients had a recurrent infection suggests that avoidance of the use of bone cement does not improve the rate of resolution of infection after a delayed revision operation in patients who have an infection following a total hip arthroplasty.

Adult↗
PubMedDate not supplied

[Short-term results (2-5 years) of type Furlong hydroxyapatite-coated hip endoprosthesis].

The short term clinical and radiological results of a hydroxyapatite-coated hip prosthesis with bonding osteogenesis on the hydroxyapatite ceramic and bony tissue reaction had to be studied. 233 patients who had hip replacement were followed up for two to five years and assessed radiologically and by the Merle D'Aubigné rating. Primary total hip arthroplasty as well as revision arthroplasty show sufficient clinical results. Tight pain and aseptic loosening of the stem did not occur. Hydroxyapatite-coating and contour for the Furlong hip prosthesis show a reliable short term anchorage.

Adult↗
PubMed2003

[Total hip replacement prosthesis infected by Mycobacterium tuberculous].

We examined the diagnostic and therapeutic approaches used for two patients with loosened total hip prostheses who developed Mycobacterium tuberculosis infection. Revision total hip arthroplasty (THA) was performed in one patient. The prosthesis was left in situ in the second patient due to lack of sufficient bone stock. Medical treatment was given. The diagnosis was established on direct examination of bacteriological samples and culture on specific media. Polymerase chain reaction identified the Mycobacterium tuberculosis complex. Non-specific granulomas were observed on the histology sections. For us, management of overt tuberculosis involving a THA depends on the quality of the fixation. If the prosthesis remains stable, medical treatment can be sufficient. If the prosthesis loosens, definitive ablation must be considered with possible revision THA later. Exceptionally, a loosened implant may be left in situ if the remaining bone stock is insufficient. Minimal duration of anti-tuberulosis treatment is six months.

Antitubercular Agents↗