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PubMed1997

[Radiologic aspects of the loosening of cemented hip prostheses: mechanical, septic or granulomatous etiology?].

Radiologic diagnosis of hip prosthesis loosening is based on the evaluation of each component (prosthesis, cement, bone) and of their interfaces. Both the prosthesis and the cement may deteriorate and the prosthesis/cement interface or cement/bone interface may become abnormal in prosthesis loosening of any etiology. In contrast, the aspect of the bone changes (erosion, periostitis) and their distribution vary according to the condition etiology. It appears from a retrospective study of 50 cases of chronic hip prosthesis loosening that the most specific signs for infection are unsharp bone resorption and acute-like or multifocal periostitis. In granulomatous loosening, bone resorption is sharp (as in mechanical loosening), but its distribution is not conform to the prosthesis shape (as in septic loosening), and periosteal changes are not observed.

Arthroplasty, Replacement, Hip↗
PubMed2002

Comparison of total hip arthroplasty performed with and without cement : a randomized trial.

BACKGROUND: This study was designed to compare the fixation of a Mallory-Head total hip prosthesis with and without cement. METHODS: Two hundred and fifty patients with osteoarthritis of the hip were randomized to receive a Mallory-Head total hip prosthesis designed for insertion with cement or the same prosthesis designed for insertion without cement. Neither the patient nor the outcomes assessor was aware of the type of prosthesis. Outcomes were assessed with respect to mortality, revision arthroplasty, health-related quality of life (evaluated with the Harris hip score, Merle d'Aubign and Postel hip score, McMaster-Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the time trade-off technique), and the six-minute-walk test. Patients were seen at three, six, and twelve months and yearly thereafter. RESULTS: The prosthesis was inserted with cement in 124 patients and without cement in 126 patients. The mean age of the patients was sixty-four years, 48% were female, and the mean duration of follow-up was 6.3 years. There were thirteen revisions in the group that had fixation with cement and six in the group that had fixation without cement (p = 0.11), and more femoral components were revised in the group that had fixation with cement (twelve versus one; p = 0.002). All health-related quality-of-life measures improved postoperatively in both groups. CONCLUSIONS: In this randomized trial, the group that had the cemented Mallory-Head hip prostheses required more revisions of the femoral component than did the group with the cementless Mallory-Head prostheses, which was perhaps related to the titanium-alloy femoral stem. Our findings are specific to the implants evaluated in this study.

Aged↗
PubMed1990

[Acetabular fractures--surgical versus conservative treatment].

In this paper the results of operative and conservative intervention of acetabulum fractures are analysed. It was possible to re-examine 80 of 146 Patients after a period of 5.46 years in mean. 23 patients were treated by osteosynthesis. Time from accident to operation was 13 days in mean. Posterior wall fractures seemed to be the most frequent (classified by Letournel). Results were evaluated according to the following criteria: clinical status (classified by the scheme of Merle d'Aubigne), X-ray, and subjective well-being. In the surgically treated group total hip prosthesis had to be implanted in five patients because of aseptic necrosis of the femoral head, 52.9% of the patients in this group had good results. In the conservative treated cases no total hip prosthesis had to be implanted. 77.8% of the patients had good results. A main aspect is that the average age of the patients who underwent a treatment by osteosynthesis is lower although the fractures were more severe.

Acetabulum↗
PubMed1989

[Loosening of hip prostheses].

Charnley's low-friction total hip prosthesis is now considered one of the most effective treatment methods available in the discipline of orthopaedic medicine; it must be mentioned that it is also one of the most demanding. The treatment does not end with implantation of the total hip prosthesis: this step is only the beginning of a long period of meticulous patient care. This requires regular monitoring of the clinical and roentgenological findings over many years. The results of the initial implantation depend very heavily both on a correct surgical technique and a reliable asepsis. The sterile "greenhouse", with air changes at least 300 times per hour, has proved impressively worthwhile. The proximal support of the stem is an important factor in the durability of the femoral component. The durability of the socket component is obviously influenced more by attrition of the polyethylene than by the method of socket fixation. The controversy about whether fixation with or without cement is better is relatively unimportant. If a prosthesis does loosen, replacement must be considered under the essential aspects of subjective symptoms and progressive bone resorption. Delay in replacement of a prosthesis when this is indicated can jeopardize the ultimate result of treatment because of the progressive bone loss.

Hip Prosthesis↗
PubMed2001

High-turnover periprosthetic bone remodeling and immature bone formation around loose cemented total hip joints.

Aseptic loosening and periprosthetic osteolysis are the major problems awaiting solution in total hip surgery. The clinical investigation focused on the analysis of periprosthetic bone remodeling to clarify one important key event in the cascade of periprosthetic connective tissue weakening and osteolysis around loose artificial hip joints. Twelve acetabular bone samples adjacent to granulomatous synovial-like membrane of loose hip prosthesis were retrieved at revision surgery and processed for Villanueva bone staining for morphological observation and bone histomorphometric analysis. Eight well-fixed bony samples were used as control. Although osteoclastic surface and eroded surface by osteoclasts were evident in the periprosthetic bone from loose hip joints (p = 0.003 and p = 0.027), increased osteoid/low-mineralized bone matrix (p < 0.001) and osteoid width (p < 0.001) also were significant findings in structural analysis. In addition, not only elevated mineral apposition rate (MAR; p = 0.044) but also increased mineralizing surface (p = 0.044) and bone formation rate (BFR; p = 0.002) in loose periprosthetic bones were shown in dynamic data analysis. These results were confirmed by precise morphological observation by confocal laser scanning microscopy. Active coupling of bone formation and resorption and increased osteocytes with abundant bone canalicular projections were found in combined with the presence of immature bone matrices (osteoid and low-mineralized bone areas) in periprosthetic bones from loose hip joints. These results indicated that active osteoclastic bone resorption and/or defective bone formation are coupled with monocyte/macrophage-mediated foreign body-type granuloma in the synovial-like interface membrane of loose hip joints. Thus, this unique high-turnover periprosthetic bone remodeling with bad bone quality probably is caused by the result of cellular host response combined with inappropriate cyclic mechanical loading. The fragile periprosthetic bone may contribute to hip prosthesis loosening.

Aged↗
PubMed1990

[Hip tumor prosthesis--indication in a trauma center and results].

This is a report about six cases of replacement of the proximal femur by a cementless special prosthesis in modular system done in the Unfallkrankenhaus Wien-Meidling. One of the patients suffered by a lymphoma, three others had fractures caused by bone metastasis. One was a pertrochanteric fracture complicated by osteoporosis, and finally one fracture of the femur preceded by an insufficient implantation of a semitotal hip replacement. The hipsocket was supplied four times by a cementfree Polyäthylensocket, in one case a CLW-ring was implanted. Investigation showed that after a little more than two months the stump of femur became porous and by an average of eleven months the prosthesis was covered by bone. The complications were in one case an incomplete fracture of the diaphysis and in another case a luxation for three times. There are several indications for a tumor prosthesis: 1. Primary and secondary malignant tumors. 2. Bone metastasis with or without fractures. 3. Comminuted fractures complicated by various factors, e.g. osteoporosis. 4. Loosening of prosthesis with poor bone conditions or failed implantation of a standard prosthesis. Although the successes seem to be quite promisingly, this method should be applied in a quite differentiated way, as any retreat is nearly impossible, once started.

Aged↗
PubMed2006

[Survival of cementless dual mobility sockets: ten-year follow-up].

PURPOSE OF THE STUDY: We report a retrospective series of 106 total hip prosthesis with ten years follow-up. The purpose of this study was to analyze survival of cementless dual mobility sockets. MATERIAL AND METHODS: The series included 90 consecutive patients with 106 first-intention total hip prosthesis, all with cementless dual mobility sockets. All prosthesis (Novae-1 socket and Profil-1 stem, Serf) were implanted within a 6-month period. The stainless steal socket was coated with alumina and had two short anchorage studs and a superior mooring screw and a polyethylene retentive liner. The stem had a 22.2 mm chromium cobalt head. The main indication for arthroplasty was degenerative joint disease. Mean age at implantation was 56 years (range 23-87). All patients were seen for physical examination and x-rays every two or three years. We noted cup survival at ten years (actuarial method), defining surgical revision for cup replacement due to an aseptic cause as the endpoint. RESULTS: Twelve patients died during the 10-year follow-up and one was lost to follow-up. The Postel-Merle d'Aubligné score improved from 7.1 preoperatively to 15.8 at ten years. There were two isolated acetabular loosenings, two intra-prosthetic dislocations due to advanced wear of the polyethylene insert. The overall survival rate of the socket was 94.6% at ten years. There were no episodes of prosthetic instability in this series. DISCUSSION: This study demonstrates the good ten-year survival of the dual mobility socket, comparable to that of conventional prostheses. The absence of any case of prosthetic instability in this series confirms the good short-term and long-term stability of the dual mobility socket. Intraprosthetic dislocation, due to loss of the polyethylene retaining ring is the main limitation of this method. The incidence was however low (2% at ten years) and treatment was not a problem. We recommend using the dual-mobility socket as the first-intention implant for patients with a high risk of post-operative instability, but also recommend it for all patients aged over 70 years since instability is the leading cause of surgical revision after this age.

Adult↗
PubMed1979

The mechanism of fracture of the femoral prosthesis in total hip replacement.

Examination of the fractured stems of 70 Charnley, flat back, femoral prostheses suggested that the causative mechanism was a torisonal loading of the proximal portion on the distal part of the stem. The main loading on the hip is applied from an anterosuperior direction. The square corners of the stem and its implantation in retroversion predispose to fracture.

Hip Fractures↗
PubMedDate not supplied

[Metal-metal total prosthesis of the hip joint: back to the future].

Late loosening in total-hip-replacement is explained by a foreign body reaction of the connective tissue along the bone-implant interface due to polyethylene debris. In contrast, metal-metal-prostheses, implanted in the sixties, may still today work perfectly without any signs of osteolysis along the bone-cement interface, proving, that metal-metal-pairing is superior to prostheses with polyethylene cups and that cement-anchorage may also be adequate for fixation. A new metal-metal-total hip-joint is presented, that has been implanted from 1988-1990 62 times.

Bone Cements↗
PubMed1992

[Total prosthesis of the hip joint for traumatic indications (VUTSCH data from 1985-1990)].

The authors analyze all total endoprostheses which were performed at their department in 1985-1990 for traumatic indications--an injury or its immediate sequelae: 6 times an implantation was made because of fracture, 11 times because of failure of primary synthesis or serious aseptic necrosis of the head after synthesis. There were no prostheses on account of late deforming arthritis which developed on a posttraumatic background. Seventeen total endoprostheses made on account of traumatic indication account for 7.4% of all total endoprostheses during the period of investigation. One patient died from pulmonary embolism after the operation, although heparin prevention was used and one patient developed a minor complication. All eight patients who were checked on average after 22.4 months following implantation had excellent or good results. The authors reached the conclusion that total endoprostheses should be indicated more frequently to the benefit of younger casualties and that the total numbers of total endoprostheses on account of traumatic indications are low. Therefore it is necessary to concentrate alloplasties mainly on orthopaedic departments which have experience also with other indications. Certain types of fractures of the neck and head of the femur or acetabulum cannot treated nowadays as effectively by any other technique.

Adult↗
PubMed2004

Hip election radiographic plane (HERP) in the preoperative planning of prostheses with femoral neck preservation.

In the preoperative radiographic planning of total hip prosthesis implantation, the hip election radiographic plane (HERP) is an essential, "dedicated" tool, i.e. it is indispensable for correct implant planning, especially as regards the femoral component and specifically some types of devices which, like the Biodynamic or CFP prostheses, allow preservation of the femoral neck.

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

[Requirements for design of total prosthesis of the hip joint].

Analysis of the forces acting on the total endoprosthesis of the hip joint and studies carried out for 16 years of the outcomes of 546 operations have demonstrated the position at an angle of 25-40 degrees to the horizontal to be the best variant of establishing the nest of an endoprosthesis. There is a necessity of designing endoprostheses having a cervico-diaphysial angle of 145-150 degrees.

Hip Prosthesis↗