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PubMed1991

[Repeated total knee arthroplasty].

The causes of failure of total knee arthroplasty are now better known and usually avoidable, being due to the surgical technique. Choosing a prosthesis with minimal constraint is of paramount importance. Exact technique for perfect placement of the implant, realignment of the limb and correction of asymmetrical bone lesions are stringent prerequisites. As for deep sepsis, which is still the most severe of post-arthroplasty complications, it can now be treated with success in nine out of ten knees, whilst preserving a functional knee prosthesis. The knee prosthesis placement technique is very demanding in most cases, but the excellent results obtained seem to be more durable than those of total hip replacement.

Humans↗
PubMed1988

Revision of failed total hip arthroplasties with uncemented porous-coated anatomic components.

This series represents a relatively short follow-up study of patients who were treated with cementless revisions for failed previous arthroplasties. Many of these cases required extensive bone grafting to the acetabulum and often to the femur. Despite extensive bone grafting, there were no infections. There has been but a single graft resorption after a hemiarthroplasty conversion for recurrent dislocations. To date, all other grafts have remained intact and have shown signs of union. Even though the acetabular components were not anchored in place by adjuvant fixation devices such as screws, migration of the acetabular component has not been a problem. All other components have remained stable, and the supporting grafts appear to have united successfully. Femoral revision has been more technically demanding because the largest stem possible should be placed within the femur to prevent subsidence and provide good stabilization in the proximal metaphyseal area. These short-term results compared favorably with similar series of cemented revisions. Patient selection is important and there are definite candidates for cemented femoral components, particularly with first-time revisions in elderly patients. If there is massive osteolysis in the femur, cemented revision is probably not indicated. Long stems should not be used unless necessary. Cortical defects at the tip of the standard stem obviously would require bypassing the stress riser with a longer stem. If, however, the cortex is intact in this region and stability can be achieved, revision should be carried out with a relatively short stem. Techniques for cementless revision are demanding, but with meticulous attention to detail and technical perfection, the method has a most encouraging prognosis. Longer follow-up evaluations will be necessary to make an accurate evaluation of graft incorporation, but short-term results are encouraging to both surgeons and patients.

Acetabulum↗
PubMed1988

Mechanisms of failure in total knee arthroplasty.

The major mechanisms of failure in total knee arthroplasty are loosening, instability, sepsis, extensor mechanism power loss, poor range of motion, bone fractures, and prosthesis fracture. These are, for the most part, within the surgeon's control. Prosthetic alignment is the most important factor influencing postoperative loosening and instability.

Fractures, Bone↗
PubMed1986

The UCLA Charnley experience: a long-term follow-up study using survival analysis.

During the period between February 1970 and December 1973, 149 Charnley total hip arthroplasties were performed at UCLA Medical Center. Fifty-seven percent have a follow-up period of at least four years, and 21% have a follow-up period of ten years or more. The peri- and postoperative complication rate was high, with an incidence of 32.6% urinary tract infection (UTI), 4% peroneal nerve palsy, 4% cardiopulmonary, 2% pulmonary embolism, 1.3% myocardial infarction, and 6.0% other. Eleven patients (7.3%) required revision at a mean of 75 months after operation, while an additional three patients were experiencing substantial pain. Clinical improvement after this procedure is similar to that reported by other authors. Survivorship analysis suggests that being young and/or having a diagnosis of osteonecrosis or failed hemiarthroplasty places a patient at a higher risk of failure due to revision surgery or pain.

Adult↗
PubMed1986

Failure of mechanical valves in Ebstein's malformation.

Five patients with Ebstein's malformation were operated on with closure of the atrial septal defect and implantation of a mechanical prosthesis at the right atrioventricular junction. The 4 patients who survived showed an excellent early recovery. Three of the patients noticed the disappearance of the valve clicks 6 months after the operation. At re-examination using echophonocardiography, peripheral dye dilution curves and catheterization, these valves were found to be stuck in the open position in 2 patients and in the closed position in 1 patient. The last patient had a paravalvar channel supplying blood into the right ventricle. One patient who had a St. Jude prosthesis was doing excellently 4 years postoperatively and the valve was functioning well. Two years after the operation, the other patient with a St. Jude valve again noticed valve clicks after over 1 year of silence. Examination revealed the prosthesis to be functioning normally. The totally occluded Björk-Shiley prosthesis (10 years postoperatively) was excised at re-operation and replaced by an Ionescu-Shiley bioprosthesis. The patient with a jammed Björk-Shiley prosthesis (10 years postoperatively) declined a re-operation and is doing well, albeit under close observation.

Adult↗
PubMedDate not supplied

[Experience with 466 re-examined Wagner double-cup hip joint endoprostheses].

Between 1976 and 1981 a total of 558 Wagner Cup prostheses were implanted. This paper reports on 7 years of experience with this prosthesis, with a failure rate of 12.4%. The causes of failure are attributable to exaggerated indication and the design of the prosthesis. In the authors' opinion, the original-model Wagner cup prosthesis should no longer be used.

Follow-Up Studies↗
PubMed2004

Polyethylene post failure in posterior stabilized total knee arthroplasty.

Posterior-stabilized (PS) prostheses have been used extensively in total knee arthroplasty (TKA), with excellent long-term results. The key feature of these prostheses is the femoral cam and tibial post mechanism that limits posterior displacement and produces femoral rollback. Although articular-surface polyethylene wear of the tibial component has not been a significant clinical problem, tibial post wear has been reported. In distinction to chronic post wear, little information exists about catastrophic post failure. We present the case of a 56-year-old woman who presented 63 months after TKA with a PS prosthesis with acute fracture of the polyethylene post. The evaluation and treatment of this patient, including the previously unreported use of computed tomography arthrography to diagnose this rare problem, is reviewed.

Arthroplasty, Replacement, Knee↗
PubMed1997

De la Caffinière thumb carpometacarpal replacements. 93 cases at 6 to 16 years follow-up.

The results of 93 de la Caffinière thumb joint replacements in 71 patients were reviewed between 6 and 16 years. The survival rate was 89% at 16 years. Eleven thumb joints had failed requiring revision. The commonest reason for failure was aseptic loosening of the trapezial component. The failure rate was higher in men of working age than any other group, which possibly reflects the increased demands on the prosthesis of these patients. We support the use of this implant for degenerative osteoarthritis, but caution against its use in men under 65 years.

Adult↗
PubMed1990

Early loosening of revision hip arthroplasty. A roentgen stereophotogrammetric analysis.

The primary migration of 15 and 22 cemented acetabular and femoral prosthetic components was recorded in 23 patients operated because of type I (minimal endosteal bone loss) and type II (thinning of bone, enlargement of femoral canal and acetabulum) mechanical loosening. Roentgen stereophotogrammetric analysis was used to measure the three-dimensional displacements of the center of the acetabulum and the femoral head. All but 1 of the acetabular and 1 of 15 revised femoral stem prostheses migrated within 2 years after the operation, whereas 5 of 7 revised femoral surface arthroplasties were stable. Femoral components with type II loosening migrated, on average, 1.5 mm (range, 0.6-3.0 mm) during the first postoperative year, compared with 0.7 mm (range, 0.3-1.1 mm) in patients with type I loosening (P less than .02). Increased bone loss of the acetabulum (type II), the quality of the bone-cement interface as judged from radiographs, and the presence of perforation of the femoral cortex did not significantly influence the rate of migration in this group. Compared with previously presented studies of cemented primary hip prostheses, cemented revisions seem not only to migrate more frequently but also at a higher rate. Poor primary fixation is probably one important cause of the high frequency of clinical failures in these patients.

Adult↗
PubMed2003

Lessons learned from aortic aneurysm stent graft failure; observations from several perspectives.

Since the first US report of endovascular repair of abdominal aortic aneurysm in 1995, many lessons have been learned from the growing reports of successes and failures. This article combines experience with 6 endograft types plus examples from the literature to summarize lessons learned from a variety of stent graft failures classified according to (1) failure of patient selection, (2) procedural failure, and (3) failure of the endovascular device.

Angioplasty↗
PubMed2000

Modeling lipid uptake in expanded polytetrafluoroethylene vascular prostheses and its effects on mechanical properties.

The radial transport across the wall of expanded polytetrafluoroethylene (ePTFE) arterial prostheses has a significant effect on lipid uptake observed in prostheses implanted in humans, which has been postulated to be one of the causes associated with implant failure. The goal of this study was to stimulate radial transport on a lipidic dispersion across the wall of an ePTFE prosthesis and investigate its effects on the circumferential mechanical properties of the prosthesis. An in vitro model was developed to simulate the lipidic radial transport across the wall. Lipids contained in a phosphatidylcholine dispersion were used as the transported molecules. Lipid concentration profiles were obtained after exposing commercial ePTFE prostheses to various transmural pressure and/or lipidic concentration gradients. Phospholipids gradually accumulated up to the external reinforcing wrap of the prosthesis, which clearly acted as a rigid barrier against lipid infiltration. Tensile tests performed on the virgin samples showed that the wrap was much more rigid than the microporous part of the prosthesis. After the lipid simulation, the rigidity of the wrap decreased with respect to what was observed for the virgin prosthesis. Finally, some clinical implications of this phenomena are discussed.

Biocompatible Materials↗
PubMed1999

Aortic valve replacement with stentless porcine aortic valve: a pioneer series.

Durability of stentless porcine aortic valves is determined by the resistance of the cusps to mechanical fatigue and reactions by the host. This study examines the role of mismatch between the size of the valve and the diameter of the sinotubular junction on durability of the valve. A custom-made stentless porcine aortic valve designed for implantation in the subcoronary position was used for aortic valve replacement in 29 patients. There were 15 men and 14 women, with a mean age of 58 years (range 26 to 72 years). In addition to aortic valve replacement, 6 patients had mitral valve surgery, 10 patients had coronary artery bypass graft, 1 patient had closure of an atrial septal defect, and 1 had concomitant aortobi-iliac bypass graft. Follow-up time extended from 10.3 to 11.5 years and was complete. The selection of size of valve implanted was based solely on the diameter of the aortic annulus. Because the diameter of the sinotubular junction plays an important role in leaflet motion and valve competence, the size of valves was compared with the diameter of the sinotubular junction of the aortic roots where they were implanted. There was one operative death and five late deaths. There were no valve-related deaths. The actuarial survival at 10 years was 76%+/-5%. There were only two transient ischemic attacks and no strokes. One patient developed endocarditis 4 years' postoperatively and was successfully treated with aortic valve re-replacement. One patient with cardiomyopathy had heart transplantation. Thus, the stentless valve was at risk of failure in 21 patients. Nine patients developed echocardiographic evidence of valve dysfunction: seven had aortic valve re-replacement and two continue to be observed because the dysfunction is not severe. The function of the stentless valve remained normal in 12 patients. Patients with bioprosthetic valve dysfunction had a sinotubular junction 3.2+/-1.3 mm larger than the size of the valve, whereas patients with normal bioprosthetic valve function had a sinotubular junction 0.8+/-1.2 mm larger than the size of the valve (P = .01). The durability of stentless porcine aortic valve implanted in the subcoronary position is affected by discrepancies in diameters between the xenograft valve and the sinotubular junction of the aortic root. Sinotubular junction greater than the size of the stentless valve probably increases mechanical stress on the cusps and causes premature valve failure.

Adult↗
PubMed2000

Malfunction of a Hancock bioprosthesis in the mitral position 24 years after initial implantation.

BACKGROUND AND AIMS OF THE STUDY: Although many types of cardiac bioprosthetic valves are currently available, the major disadvantage of their use is limited durability due to progressive structural valve deterioration. Few such valves function beyond 20 years. METHODS: A 61-year-old man was admitted urgently to our institute with acute mitral insufficiency, 24 years after undergoing mitral valve replacement with a 25-mm standard Hancock porcine bioprosthesis for mitral stenosis. RESULTS: Mitral valve reoperation was performed successfully with a mechanical valve. The explanted bioprosthesis showed leaflet perforations and a commissural tear, moderate calcification on the commissures, and pannus overgrowth. CONCLUSION: The findings in this case suggest that individual patient variables, as well as the design and the construction of the valve are major determining factors in the rate of valve failure.

Bioprosthesis↗