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PubMed1996

Prosthetic reconstruction for periacetabular malignant tumors.

This article reports the reconstruction method and functional results of a newly designed tumor hip prosthesis with a constrained joint mechanism which was used after treatment for 13 primary and 5 metastatic periacetabular malignant bone tumors. The overall 5-year survival rate for patients with primary tumors (n=13) was 50%. The local recurrence rate was 30%. More than 90% of the patients whose hips were reconstructed with the constrained tumor hip prosthesis experienced pain relief and were able to walk with a cane. No patients had greater than 3 cm shortening of the involved limb. Infection was the most serious complication. This prosthesis restored iliofemoral stability after surgical resection of periacetabular malignant tumors.

Acetabulum↗
PubMed1989

[Analysis and results of total hip replacement with femoral cortical fixation].

The present report describes an original conception of a total hip prosthesis. The implant is applied upon the lateral cortical of the shaft of the femur. The implant is screwed on by the mean of a plate. There is no adjunction of cement. The design tries to reach as close a possible the natural physiology of a long bone during life. The purpose is to gain a better longevity of the implant and, consequently, its utilisation to young patients for whom a total hip prosthesis is the only solution.

Adult↗
PubMed1987

Plasma prekallikrein activity in patients with total hip arthroplasty.

The behaviour of the contact system was studied in 40 patients with total hip arthroplasty, by measuring plasma prekallikrein, spontaneous kallikrein activity and factor XII. In the literature it had been shown that patients with complications from this operation had decreased prekallikrein and increased kallikrein activity (M. Nakahara. Acta orthop scand 1982; 53:591-6). In the present study, comprising patients with and without pain and proven loosening of the hip prosthesis, these findings could only partially be confirmed. Patients with a loosened prosthesis had significantly lower prekallikrein (mean 0.78 +/- 0.28 U/ml; p less than 0.01) than patients without problems, but no detectable kallikrein activity in plasma. Patients with pain but no loosening had normal prekallikrein (1.04 +/- 0.26 U/ml) and also no demonstrable kallikrein activity. Factor XII was normal in all patient groups. It is concluded that decreased prekallikrein is limited to patients with a loosened hip prosthesis, with or without pain.

Aged↗
PubMed1988

Scintigraphy with Tc, Ga and In in painful total hip prostheses.

A series of 40 patients were studied, who were operated upon for a painful total hip prosthesis, half of which were infected. In each case, preoperative scintigraphy was performed using Tc99, Ga67 and In111. The images obtained with Tc and Ga were compared with those of In111 and analysed with respect to sensitivity, specificity, accuracy and the predictive value of a positive or negative test. In111 had a predictive value of more than 90% and showed greater reliability in the diagnosis of an infection as the cause of a painful total hip prosthesis.

Bacterial Infections↗
PubMed2000

Dissemination of wear particles to the liver, spleen, and abdominal lymph nodes of patients with hip or knee replacement.

BACKGROUND: The importance of particles generated by wear and corrosion of joint replacement prostheses has been understood primarily in the context of the local effects of particle-induced periprosthetic osteolysis and aseptic loosening. We studied dissemination of wear particles in patients with total hip and knee replacement to determine the prevalence of and the histopathological response to prosthetic wear debris in the liver, spleen, and abdominal para-aortic lymph nodes. METHODS: Postmortem specimens from twenty-nine patients and biopsy specimens from two living patients with a failed replacement were analyzed. Specimens of tissue obtained from the cadavera of fifteen patients who had not had a joint replacement served as controls. The concentration of particles and the associated tissue response were characterized with the use of light microscopy of stained histological sections. Metallic particles were identified by electron microprobe analysis. Polyethylene particles were studied with the use of oil-red-O stain and polarized light microscopy. The composition of polyethylene particles was confirmed in selected cases by Fourier transform infrared spectroscopy and hot-stage thermal analysis. Twenty-one of the patients studied post mortem had had a primary total joint replacement. Eleven of them had had a hip prosthesis for a mean of sixty-nine months (range, forty-three to 171 months), and ten had had a knee replacement for a mean of eighty-four months (range, thirty-one to 179 months). The other eight patients studied post mortem had had a hip replacement in which one or more components had loosened and had been revised. The mean time between the initial arthroplasty and the time of death was 174 months (range, forty-seven to 292 months), and the mean time between the last revision procedure and the time of death was seventy-one months (range, one to 130 months). RESULTS: Metallic wear particles in the liver or spleen were more prevalent in patients who had had a failed hip arthroplasty (seven of eight) than in patients who had had a primary hip (two of eleven) or knee replacement (two of ten). The principal source of wear particles in the majority of these patients involved secondary nonbearing surfaces rather than wear between the two primary bearing surfaces as intended. In one living patient, dissemination of titanium alloy particles from a hip prosthesis with mechanical failure was associated with a visceral granulomatous reaction and hepatosplenomegaly, which required operative and medical treatment. Metallic wear particles were detected in the paraaortic lymph nodes in 68 percent (nineteen) of the twenty-eight patients with an implant from whom lymph nodes were available for study. In 38 percent (eleven) of all twenty-nine patients with an implant who were studied post mortem, metallic particles had been further disseminated to the liver or spleen, where they were usually found within small aggregates of macrophages occurring as infiltrates without apparent pathological importance. Polyethylene particles elicited a similar response. They were identified in the paraaortic lymph nodes of 68 percent (nineteen) of the twenty-eight patients and the liver or spleen of 14 percent (four) of the twenty-nine patients. The majority of the disseminated wear particles were less than one micrometer in size. Currently available methods lack the sensitivity and specificity necessary to detect very low concentrations of submicrometer polyethylene particles and probably underestimated the prevalence of polyethylene wear debris in the liver and spleen. CONCLUSIONS: In this study, systemic distribution of metallic and polyethylene wear particles was a common finding, both in patients with a previously failed implant and in those with a primary total joint prosthesis. The prevalence of particles in the liver or spleen was greater after reconstructions with mechanical failure. (ABSTRACT TRUNCATED)

Aged↗
PubMed1991

Dislocations following arthroplasties of the hip. Incidence, prevention, and treatment.

Three methods of avoiding postoperative prosthetic dislocation following total or bipolar hip arthroplasty are described; each approach is recommended for a specific population. The anterior surgical approach was utilized for bipolar hip endoprosthetic arthroplasty in 62 minimal or bed-to-chair ambulators with established flexion contractures about the hip. Two of these patients subsequently experienced a prosthetic dislocation, one of which was secondary to infection. An additional 98 patients who underwent arthroplasty using the posterior approach wore a knee immobilizer postoperatively, without incidence of prosthetic dislocation. A modification of Wilke boot casting was utilized for four patients following reduction of a dislocated hip prosthesis. The cast consisted of a short cylinder cast on the affected extremity connected by a cross bar to a short leg cast on the contralateral leg. The casts controlled rotation, were well tolerated, and resulted in no redislocations. We therefore recommend the anterior approach in minimal ambulatory patients who are to undergo total bipolar hip arthroplasty. When the posterior approach is used in hip replacement procedures, we have found that postoperative use of a knee immobilizer helps prevent dislocation. Following reduction of a dislocated hip prosthesis, a modification of the Wilke boot cast that does not immobilize the affected ankle can be used.

Aged↗
PubMedDate not supplied

[Perioperative cost analysis of cemented versus uncemented total hip endoprostheses for clinical and economic management. Postoperative follow-up study over one year].

QUESTIONS: Are there and what are the differences between in-patient and out-patient costs for cemented or noncemented hip prosthesis? How to make it possible to keep in-patient costs within the limit of the a special global amount ("Fallpauschale")? METHODS: In this study we compared in-patient and out-patient costs of 30 patients with cemented and 30 patients with noncemented hip prosthesis during the first year after surgery. We developed a perioperative management in order to keep the costs in the limits of the "Fallpauschale". RESULTS: The average in-patient cost for the cemented prosthesis group was DM 19.644,89 and for the non-cemented group DM 20.485,33. In both groups these costs went beyond the "Fallpauschale" (DM 18.643,80). Comparing the two groups we found significant differences in costs for the endoprosthesis and for laboratory costs. We discovered a suitable perioperative management to keep costs below the "Fallpauschale". CONCLUSION: Using an appropriate perioperative management it is possible to keep costs in the given limits.

Aged↗
PubMed1983

A clinical study of the results of cementless total hip replacement.

We introduce our total hip prosthesis, its operation technique, and report the clinical results. Ours does not use bone-cement, but its design, together with the use of original bone and new bone formation surrounding it, results in a biological anchoring. Since 1978, we developed for this new type of total hip prosthesis 6 sizes of stem to fit more rigidly within the intramedullary canal of femur. The new femoral component also has larger notches on its surface than did the old one. Our results of 144 cases (147 joints) ranging from 2 to 10 postoperative years giving an average of 4.4 years, are quite satisfactory. Blood loss during the operation is as little as 480 ml. The few complications observed differ from those of the Charnley type, and will be reduced greatly when the operation is yet more cautiously and skillfully done. Unilateral replacement in bilaterally affected patients improved the condition of the unoperated side in 30% of the cases.

Adult↗
PubMed1993

[Tuberculous septic polyarthritis caused by Mycobacterium bovis].

Infections due to Mycobacterium bovis have become uncommon. We report a case with polyarthritis and cutaneous nodules suggesting a rheumatic disease. This 61 year old male under corticosteroid therapy for asthma developed febrile arthritis of the right wrist and cutaneous nodules that resolved rapidly under treatment with penicillin M and an aminoglycoside. Six months later, he developed arthritis of the right wrist and both elbows, as well as infection of a right hip prosthesis. The left wrist and left knee were then affected concomitantly. The cutaneous nodules recurred. A giant cell granuloma without caseous necrosis was found upon examination of a biopsy specimen from a nodule. Granulomatous lesions with caseous necrosis were seen in a specimen of synovial membrane from the right wrist. Antituberculous treatment ensured resolution of the arthritides and nodules but failed to prevent loosening of the hip prosthesis. Acid-fast bacilli were found in the specimens taken during removal of the prosthesis. After three months, cultures of synovial membrane specimens from the knee grew Mycobacterium bovis.

Arthritis, Infectious↗
PubMed1979

The mechanisms of severe arterial injury in surgery of the hip joint.

Vascular accidents occurring in the course of hip surgery may reach potentially catastrophic dimensions by posing an immediate and sudden threat to life and limb. This is a report of 15 cases with severe arterial injury representing 0.2--0.3% of all reconstructive hip operations performed during an 8 year period. In 6 cases perforation of either the external iliac artery, the common femoral artery of main branches of the lateral and medial circumflex femoral artery were caused by the tip of a narrow-pointed Hohmann retractor used to expose the hip joint. Other mechanisms were: intimal tear with appositional thrombosis, probably caused by mechanical strain imposed on atherosclerotic arteries, giving rise to complete limb ischemia (2 cases); the dangers associated with the entry of bone cement through a defective acetabulum into the pelvis causing thrombotic occlusion due to polymerization heat (one case) or intimate adhesion of artificial bone to the external iliac artery subsequently being ripped open during replacement of the cup (one case); the increased hazards of replacing firmly embedded hip prosthesis (3 cases of direct arterial injury with chisel, knife and cutting edge of protruding bone); and the complications associated with the development of a false aneurysm (2 cases). Fourteen of the 15 extremities were salvaged. Above-knee amputation was unavoidable in one case owing to delay of vascular repair. There was no immediate operative mortality. Knowledge of the causative mechanisms prevents arterial injury during hip surgery. The relatively low rate of vascular complications in spite of vicinity of main vessels gives credit to the well standardized technique of hip surgery, especially hip replacement. However, it is suggested that the surgeon should be sufficiently acquainted with the exposure of the main vessels above and below the groin to be able to control life threatening hemorrhage at all times. A McBurney incision with retroperitoneal exposure and clamping of the external iliac artery will suffice to diminish bleeding considerably. Thereupon careful dissection and placement of snares around the common femoral artery, the arteria profunda femoris, and whenever necessary, the lateral or medial circumflex femoral artery will enable closure of the lacerated artery. For hemorrhage resulting during replacement of firmly embedded hip prosthesis it might become necessary to ligate the internal iliac artery. Reconstruction of obliterated arteries should call for the cooperation of the vascular surgeon for eventual angioplasty. Angiologic examination of the lower extremities is mandatory whenever severe arterial trauma has occurred in the course of hip surgery and is best performed by measuring the ankle blood pressure with a Doppler ultrasound probe.

Adult↗
PubMed1987

Long-term review of the McGoey-Evans high-friction uncemented total hip arthroplasty.

To assess the long-term clinical results of uncemented total hip arthroplasty with the McGoey-Evans bipolar high-friction hip prosthesis, the authors reviewed the findings in 86 such hip replacements. The minimum patient follow-up was 5 1/2 years (mean 9 years). Overall, satisfactory results were obtained in 46.5% of cases. There were no deep infections. In contrast to the experience with the cemented hip replacements, the authors found that the results were better in men than women and that most of the revisions were done within 5 years of the original operation. Tissue hypersensitivity resulted in implant loosening in only two cases and no harmful systemic effects arose from the use of this uncemented cobalt-chromium prosthesis. Although this particular hip prosthesis is not recommended because of its inferior design, the findings of the study could be useful in the current practice of uncemented hip arthroplasty.

Adolescent↗
PubMed1988

Mittelmeier ceramic total hip arthroplasty. A retrospective study.

Ceramic, featuring low reactivity and excellent durability, is an excellent material for biologic implant. The authors studied the Mittelmeier ceramic total hip prosthesis in 62 patients (69 hips), with an average follow-up period for the surviving cases of 37.6 months (SD = 9.04; range, 24-52 months). As a result of aseptic loosening, 19 cases (27%) were revised, with an average time to revision of 26.2 months (SD = 8.8; range, 14-38 months). Proper femoral interference fit, measured as 90% of the intramedullary canal fill, was associated with better clinical scores, fewer radiolucencies on follow-up roentgenogram, and decreased failure due to aseptic loosening. In this study, there appeared to be no adverse effects of ceramic as a biomaterial. Design modifications may lead to better fixation and, hence, long-term durability.

Ceramics↗