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PubMed2005

Long-term results of the metal-cancellous cementless Lübeck total hip arthroplasty: a critical review at 12.8 years.

INTRODUCTION: The influence of a spongy metal surface total hip arthroplasty (THA) (S&G, ESKA, Lübeck, Germany) on the clinical, psychometric, and radiograhic long-term results were examined. MATERIAL AND METHODS: An amount of 137 THA with the cementless spongy metal Lübeck hip prosthesis were evaluated long-term, radiographically and clinically, with a mean follow-up time of 12.8 years (range 10.1-14.9 years). The MOS SF-36 was used to assess the health-related quality of life (HRQL). RESULTS: Cumulative survival rates were 90% (+/-8%) for the cups and 86% (+/-5%) for the stems at 14.9 years. Four stems fractured at the middle part (3%) without major trauma. In the remaining patients the clinical results expressed as Harris Hip Score (HHS) averaged 88 (range 34-100). Patients above 60 years undergoing THA had no significant difference in HRQL (MOS SF-36) in comparison to the age-matched healthy population (P>0.05). Patients younger than 60 years had scores lower than normal in the physical function domains (P<0.01), but were comparable in the mental health domains (P>0.05). Radiolucent lines and bone atrophy related to stress shielding by distal fixation were found in the periprosthetic Gruen Zone I (19.8, 16.8%) and VII (10.3, 27.1%) of the proximal femur. DISCUSSION: Whereas the rate of aseptic cup failures of the cementless spongy metal Lübeck hip prosthesis is among the best, the failure rate of the stems is attributable to osteolysis of the proximal femur. The fractures of the stem may be attributed to the combination of the lack of proximal support, the fully porous stem made of a cast cobalt-chrome-molybdenum alloy, and the narrow dimension of the stem core. The long-term results of the spongy metal cup are good, whereas the high loosening and fracture rate of fully coated stem are a source of concern especially with regard to the difficult revision scenario with frequent massive bone loss.

Adult↗
PubMed2002

[Study of friction and loosening in hip endoprostheses].

AIM: Like any other operative procedure, the implantation of hip prosthesis is associated with certain complications, which diminishes the value and purpose of such a procedure. One of the complications in artificial hip implantation is loosening of the alloplastic material. Therefore, the aim of this study was to examine the effect of lubrication on the torsional moment and its role in the loosening of the femoral component, using an experimental mechanical model. The following hypothesis was tested: the magnitude of torsional loading in the "bone-endoprosthesis-bone cement system" is similar to any other known loading. METHODS: The testing device was constructed with the possibility of simulation of positions similar to original performances in the implanted hip prosthesis. It refers primarily to the possibilities of achieving definite forces and velocities. The intention was to point quantitatively to the role of friction moment between the acetabular and femoral endoprosthesis part. Trials were conducted by combining 7 types of loading and 4 kinds of lubrication: dry, water, plasma, and light oil. The testing joint (Ring's prosthesis) was connected through tensometric measuring shaft upon the working forepart oscillating mechanism. Graded by the changeable static loading by means of the pendulum and via lever mechanism the testing joint was loaded by force from 610 to 7137 N. As the cause of friction resistance in the moving joint, torque deformaties of the measuring shaft occurred. The testing joint enabled oscillating movement using a four-part mechanism. In this way, it was possible to define not only the maximum values of the frictional moment (or the coefficient of friction) during one movement cycle but also to examine its relation to the kind of lubrication. Change in the measuring torsional moment were computer recorded. Before each trial, the gauging of the complete outfit was performed. Thereafter, cleaning of the frictional surfaces of the whole outfit was done. RESULTS: The results obtained in combination with lubrication showed a slight increase in the values of the frictional moment. With dry lubrication and greater loading, an extremely progressive gradient of change was recorded. The course of change in the coefficient of friction was essentially different from the course of change in the frictional moment. It was noted particularly during trials with lubrication. In trials without lubrication, a constant increase of loading (force) resulted in a progressive increase in the coefficient of friction, similar to the friction moment. Such a character of the friction moment increase in the observed loading field was explained by the presence of boundary friction in cases with lubrication and by dry friction in cases without lubrication. In dry friction, scratching occurs relatively early, at a loading of F = 1854 N. It occurs with substances of approximately the same hardness like Ring's prosthesis, where the acetabular and femoral prosthesis parts are of metal characteristics. CONCLUSION: The increase in the frictional moment within the observed loading range can be explained by the presence of bordering friction in cases with lubrication, and of dry friction in cases without lubrication. Contrary to this, dry friction relatively early leads to "scratching", especially when sparing materials of similar hardness are combined.

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

[Tissue burden with exogenous trace elements caused by roentgen contrast media in bone cements].

In 44 patients undergoing a change of total hip prosthesis, made of Co-Cr alloy and at one point with a Refobacin-Palacos chain we analyzed samples of the hip joint capsule and fascia lata. Using Instrumental Neutron Activation Analysis (INAA) up to 18 elements were analyzed. The findings demonstrate that the tissues in the surroundings as well as in direct contact with the total hip prosthesis are burdened by corrosion products of the alloy and by decomposition of the bone cement. The decomposition of bone cement can be shown in the extraordinary high concentration of Barium, Zirconium and Hafnium which are added to Bone Cements as X-ray contrast. Microscopic findings at the same time complete and confirm the trace element analyses.

Adult↗
PubMedDate not supplied

Cancer risk from orthopedic prostheses.

Permanent replacement of joints damaged by fracture or arthritis has become common over the last 50 years. Vigilance over possible long-term adverse effects of metal prostheses is required. Some of the metal components are potentially carcinogenic. Prolonged contact of metal alloys with body fluids results in gradual corrosion of even the most inert metals. Three cohost studies of persons with a hip prosthesis have been reported; they provide direct, quantitative observations of cancer risk in a human population with hip prosthesis. The design and the results of these studies are similar. Combining the results sharpens the precision of risk estimates. Collectively, the studies examined cancer risk in 40,945 patients followed up for a mean 8.5 years after hip replacement. Overall, the relative risk of cancer was 1.02 (95 percent CI 1.00 to 1.05). There was an 8 percent excess of haemopoietic malignancy (leukaemia and lymphoma), with a total of 347 cases observed (RR 1.08, 95 percent CI 0.97 to 1.20). Significant deficits of cancers of the breast and large bowel were seen in the two smaller studies, but combined results from all three studies suggest the relative risk is close to unity. Cancer risk in the first 10 years after hip replacement was not different from that expected, but there was an excess of borderline statistical significance 10 or more years after surgery, with a relative risk of 1.08 (95 percent CI 1.00 to 1.13) based on 1,005 cases. All three studies were well-designed and executed. Their results are not alarming, but give no cause for complacency, since the number of patients with a prosthesis and the length of time they live with the prosthesis will increase. A register of malignancy complicating joint prosthesis would not help quantify any risk. Instead, a large cohort study of patients with joint prostheses is needed, including information on the type and composition of the prosthesis and on potential confounding exposures for each patient. Measures of corrosion in cancer cases and of tissue levels of relevant metal ions in cases and controls (prosthesis but no cancer) matched for age, sex, and time since insertion would be valuable. Such a study could be done internationally, using orthopedic units with good clinical records for 10 to 15 years in areas with long-term cancer registration.

Cohort Studies↗
PubMed1994

Spongy metal Lübeck hip prostheses for osteoarthritis secondary to hip dysplasia. A 2-6-year follow-up study.

Between May 1987 and December 1990, 66 hips in 59 patients with osteoarthritis secondary to hip dysplasia underwent cementless total hip arthroplasty with a spongy metal Lübeck hip prosthesis (S+G Implants, Lübeck, Germany) that had a fully porous-surfaced short stem made of cased cobalt-chrome-molybdenum alloy. Sixty-five hips in 58 patients were prospectively followed for 2-6 years (mean, 43 months). Patient age at operation ranged from 29 to 63 years (mean, 51 years). The Merle d'Aubigné hip score improved from 7.8 before surgery to 16.9 at the final follow-up evaluation. All hips were rated as either excellent (63%) or good (37%). Mild thigh pain was recognized in only three hips (5%) at 6 months after surgery, but it disappeared within 2 years. Serial roentgenograms showed stable fixation with bone ingrowth in all hips, that is, bone densification in contact with the implant and trabecular connection to the endosteal surface. The authors found no migration of the implant or circumferential radiolucency. Moderate osteopenia, presumably due to stress shielding, was seen in only four hips (6%). Acetabular bone-grafting performed in 31 hips gave successful support to the socket. Cancellous bone chips grafted to small defects showed excellent remodeling. The authors conclude that the spongy metal Lübeck hip prosthesis contributed to lower rates of thigh pain and migration than cementless prostheses.

Adult↗
PubMed1989

[Girdlestone total prosthesis].

Thirteen out of 17 patients with a hip prosthesis according to the Girdlestone procedure were studied at a follow-up time of 26 months to 10 years. Seven patients were found to be satisfied with the total prosthesis, while the others complained about pain, walking disability and an insufficient range of motion. The implantation of a prosthesis using the Girdlestone procedure is technically difficult and should be restricted, as the results are superior to the Girdlestone hip in only a carefully selected group of patients with good abductor muscles and unsatisfactory results after the Girdlestone operation.

Femoral Neck Fractures↗
PubMed1997

[Paraproctic fistula in acetabulum loosening after implantation of a total hip endoprosthesis. A rare complication].

In this paper we present the unusual case of a fistula after implantation of a total hip prosthesis. In a 75-year old woman with a fracture of the thigh bone, we observed a paraproctic fistula 42 months after implantation of a total hip prosthesis. To our knowledge there have been no such cases reported with this complication. Thus, we wound like to demonstrate the progress of the illness, the first symptoms, and the kind and success of the treatment.

Acetabulum↗
PubMed1998

Comparison of the results of the Girdlestone pseudarthrosis with reimplantation of a total hip replacement.

A Girdlestone pseudarthrosis of the hip (resection arthroplasty) is nowadays mainly carried out for failed hip replacements. A decision may have to be made whether to reimplant a new hip prosthesis or to accept the result of a pseudarthrosis. We followed 2 groups of patients: 32 patients had a long standing pseudarthrosis; in the other group of 16 patients, a total hip replacement was reimplanted at an average of 3 years after a pseudarthrosis. The improvement in hip function after the reimplantation was marginal and the results were comparable to a good functioning pseudarthrosis. However, personal satisfaction and the activities of daily living were better in the reimplantation group, and their Harris hip score was 64 compared to 58 in those with a pseudarthrosis. The Girdlestone procedure still seems to be a reasonable salvage operation for some complications following hip surgery, but when there are the correct indications, reimplantation of a total hip prosthesis is recommended.

Activities of Daily Living↗
PubMed2002

[PSO modular hip endoprosthesis--personal experiences].

Hip prosthesis reimplantation, particularly with concomitant bone destruction around the stem, leading to a total loss of mechanical properties of the joint, is a major concern of modern orthopedics. Between may 1998 and August 2000 nine reimplantation procedures were performed in our Department. All were performed with the use of the Biomet PSO system. In four cases reimplantation was performed because of aseptic loosening of the prosthesis, with massive bone destruction around the stem. In three cases surgery was necessary because of loosening of reimplanted prosthesis. In two cases PSO prosthesis was used because of intertrochanteric fracture instability concomitant with massive femoral head and intertrochanteric bone destruction. Functional assessment was based on the Merle d'Aubigne classification. On 6 points were attained before surgery and 10 points--6 months post-up, the difference resulting from a decrease of pain. Luxation of the prosthesis was noted in two cases one 15 days after surgery and the other one 6 months post-up. In our opinion use of PSO endoprosthesis is a very valuable method of treating cases with bone destruction of the femur following loosening of hip prosthesis.

Aged↗