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At least 253 records · Page 14Linked to original sources
PubMed1996

Long-term clinical and radiological results of the Lord total hip prosthesis. A prospective study.

We enrolled 98 patients (107 hips) with a mean age of 47 years (SD 8.6) into a prospective study of the Madreporic Lord THR; 34 hips had primary and 73 secondary osteoarthritis. After ten years, the survival rate using revision as the endpoint for failure was 70% (+/-9) for the cup and 98% (+/-0.3) for the stem. The combined clinical and radiological survival rates were 46% (+/-11) and 81% (+/-10), respectively. Osteoporosis due to stress-shielding was observed in the proximal femur. Hips with radiologically dense bone postoperatively showed the most pronounced bone loss. We recommend continued radiological follow-up of patients with this type of implant to allow revision to be performed before there is severe bony destruction of the pelvis.

Acetabulum↗
PubMed2004

Evaluation of current practices in surgical antimicrobial prophylaxis in primary total hip prosthesis--a multicentre survey in private and public French hospitals.

Deep wound infection is a rare but dreaded postoperative complication after total hip prosthesis (THP) procedures but its incidence can be reduced by systemic antimicrobial prophylaxis. The objective of the present study was to evaluate whether antimicrobial prophylaxis for elective primary THP in patients without any history of hip infection, in orthopaedic wards, participating on a voluntary basis, in French public hospitals and private institutions, complies with published guidelines. Three types of data were collected from anaesthetic and surgical records (November 2000-January 2001) in participating hospitals: (1) administrative data on the hospitals and orthopaedic wards, (2) data on patients, (3) data on compliance of practices with five critical criteria derived from published French guidelines. These criteria concerned administration of prophylaxis, choice of antimicrobial agent, dose of first injection, timing of administration and total length of prophylaxis. Thirty institutions sent data files on 1257 THPs to the coordination centre. Compliance exceeded 80% for all criteria except one (interval between first and second injection). Cumulative compliance with the five criteria was 66.9%. Major compliance failures were an inappropriate interval between the first injection and incision, and total antimicrobial prophylaxis exceeding 48 h. Cumulative compliance was 87.9% in teaching hospitals, 61.8% in general hospitals and 67.7% in private institutions (P<1 x 10(-6)). It was slightly higher when the annual number of interventions was > or =100 (69.4 versus 62.3%; P<0.02). Although the protocol for antimicrobial prophylaxis in THP was clear and easy, one-third of practices did not conform with all five standards. Knowledge of the results by the participating institutions should encourage them to set up working groups to draft care protocols for THP and other surgical interventions, in order to improve practice and perhaps reduce costs.

Anti-Bacterial Agents↗
PubMed2001

Electrolytic A12O3 coating on co-cr-mo implant alloys of hip prosthesis.

The ceramic films over metallic implant surfaces have the potential to improve implant performance with respect to implant fixation, wear, or corrosion. In this study, the electrolytic Al2O3 coatings on F-1537 Co-Cr-Mo alloy were conducted in an aqueous solution of Al(NO3)3. Through the cycle polarization test in Hank's solution, it was found that the corrosion potential and protection potential of the alumina-coated were higher than that of the uncoated, and the corrosion current density was lower. The phase transformation of A12O3 film on Co-Cr-Mo alloy annealed at 800 K revealed todlite (5Al2O3 . H2O) and thetaAl2O3 (113) preferred orientation for 20 min, and thetaAl2O3 (200) preferred orientation with eta phase for 80 min. Scanning electron microscopy/energy dispersive spectroscopy observations after the scratch tests showed that the adhesion of the alumina films on Co-Cr-Mo alloy can load a stress over the yield strength (450 MPa) of Co-Cr-Mo alloy. The wear loss of ultra-high molecular-weight polyethylene to the Al2O3-coated specimen was eight times less than that to the uncoated. It is concluded that such Al2O3-coated films on Co-Cr-Mo implant alloy exhibit excellent quality in corrosion, adhesion, and wear for the application of hip prosthesis.

Aluminum Oxide↗
PubMed1999

The Charnley versus the Spectron hip prosthesis: clinical evaluation of a randomized, prospective study of 2 different hip implants.

Prospective, randomized studies must be performed when new surgical techniques or implants are evaluated. In this study, a new implant system was compared with the Charnley prosthesis, which over the years has been the most used hip implant in Sweden. Between 1985 and 1989, 410 hips were randomized to treatment with a Charnley or a Spectron total hip arthroplasty: 206 Charnley and 204 Spectron prostheses were implanted. The patients were operated on by a standardized procedure using a contemporary cementing technique. The patients were followed prospectively by an independent observer after 1, 3, 5 to 6, and 10 years. Harris Hip Score and patient satisfaction were recorded in the outcome evaluation. A total of 144 patients with 164 hips were deceased, and 15 patients (8 Charnley and 7 Spectron) have required a revision. Nine hips were revised because of aseptic loosening (5 Charnley stems and 4 Spectron metal-backed cups). The Charnley stem as well as the metal-backed Spectron cup had a higher risk for revision because of aseptic loosening. The Charnley ogee cup and the Spectron stem have performed remarkably well with no revision of these components. Seven Charnley prostheses dislocated, but no dislocation was recorded in the Spectron group. Survivorship calculations with a mean follow-up of 10 years revealed an overall 11-year survivorship of 94.5% +/- 3.4% (Charnley, 93.2% +/- 5.8%; Spectron, 95.9% +/- 3.0%). The clinical outcome did not differ between the 2 systems. The overall results in this old population, using a contemporary surgical technique, illustrate that cemented hip arthroplasty is an excellent treatment alternative for elderly patients.

Aged↗
PubMed1984

Rearthroplasty after conventional total hip prosthesis and double-cup prosthesis. A comparative study.

Revision of 19 Müller total hip prostheses and 9 ICLH double-cup prostheses is compared. In the Müller group the mean operation time was 186 min, the amount of blood transfused 3526 ml, and the hospital stay 34.9 days. The corresponding figures for the ICLH group were 94 min, 1389 ml, and 25.7 days. Revision of the conventional hip prostheses involved technical difficulties and complications such as femoral fractures and postoperative dislocations, which were not seen in the ICLH group, in which the revision was as easy to perform as the primary operation. The clinical result 6 months after revision was significantly better in the ICLH group. Thus, the double-cup prosthesis provides another possibility for revision. However, a relatively high incidence of early loosening indicates that it should not be used in older patients in whom one would expect a follow-up shorter than the lifetime of a conventional hip prosthesis.

Aged↗
PubMed2005

Reduction of dislocated hip prosthesis in the emergency department using conscious sedation: a prospective study.

This prospective observational study aimed to determine the rate of success of reduction of dislocated hip prostheses using conscious sedation. In 101 consecutive patients presenting to the emergency department between August 2000 and February 2003 with a dislocated hip prosthesis, reduction was attempted using conscious sedation. The outcome measures of the study were (a) rate of success of the attempted reductions (b) rate of complication of the sedation or the procedure, and (c) rate of success in the three subgroups (based on degree of dislocation). The overall success rate was 62% (95% CI 53% to 71%). There were six complications: five related to sedation and one was a mild foot drop. The mean time to attempted reduction using conscious sedation was 1.83 hours and for an equivalent group who were excluded and subsequently required general anaesthesia the mean time was 10.9 hours. Reduction of isolated unilateral prosthetic hip dislocation using conscious sedation in the emergency department is safe and has a reasonable success rate. Prosthetic hip reduction can be attempted more quickly using conscious sedation than when awaiting general anaesthesia.

Arthroplasty, Replacement, Hip↗
PubMed1979

Improvements in total hip prosthesis implantation technique. A cement-proof seal for the lower medullary cavity and a dihedral self-stabilizing trochanteric osteotomy.

The anchorage of the femoral component of a total hip prosthesis can be improved by the following two refinements to the surgical technique: 1. The femoral medullary cavity is plugged with a bone core taken from the excised femoral head or with a polyethylene bung. The plug prevents the bone cement from being displaced distally into the lower part of the medullary cavity. It contains a small hole through which blood can escape, thus preventing the latter from accumulating in the upper part of the medullary cavity and impairing the bond between the cement and the bone wall of the cavity. 2. The greater trochanter is no longer sliced off with a single cut in one plane but is now removed by dihedral osteotomy, i.e., by making cuts in two planes which intersect each other so as to form a ridge. On compressing this osteotomy by tension band fixation all movement between the fragments is eliminated, including that in the parasagittal plane which results from flexion and extension of the hip. In this manner loosening and pseudarthrosis of the osteotomy are prevented.

Arthroplasty↗
PubMed1999

The usage of frozen allografts of the spongy bone in filling the loss of bone after loosening of the hip prosthesis.

The authors present the way of using allogenic, frozen, radio-sterilizated, spongy bone grafts in operational reconstructing the defects of bone stock caused by loosening of the hip prosthesis. The bone grafts were sterelizated by radiation, formed in cubes and it had the fat removed. The operational reconstruction of the spongy bone was performed according to the method described by E. Gee, R. Ling and T.J.J.H. Sioof. Thirty five operations of the revision hip arthroplasty with using the bone grafts were made since 1995. Just before transplantation the grafts were morselised to pieces of size 3 x 3 x 3 mm and then stuck in the place of the defect. Rebuilding of the morselised grafts of the spongy bone starts from activating osteoblasts, while the same process in the compact bone starts with osteolysis by activating osteoclasts. The mechanical durability of these grafts is also very high. We claim that the biological connection between the host bone and the graft forms in a couple of weeks, but the forming of a solid, fully functional bone takes about few months. Only radiological examination shows the stage of allografts incorporation into host's skeleton. Between these 35 operations 2 patients needed to be operated again, because of the grafts resorption. In conclusion, operative revision hip arthroplasty to require the special operating tools large quantities spongy bone allografts.

Adult↗
PubMed1999

Metal-on-metal bearing in hip prosthesis generates 100-fold less wear debris than metal-on-polyethylene.

Aseptic loosening due to osteolysis in total hip replacement has been related to wear debris released from prosthetic components. Retrospective longterm observations of patients with the metal-on-metal prosthesis has shown long-term survivorship and good mechanical performance. Thus, the new and modified metal-on-metal prosthesis has been introduced on the market. Historical clinical data from the 1st generation metal-on-metal hip prosthesis may not be relevant for the 2nd generation of metal-on-metal hip prosthesis. Therefore, preclinical testing of the prosthesis must be conducted before clinical evaluation. We assessed the tribological performance of the metal-on-metal prosthesis versus the metal-on-polyethylene prosthesis introduced on the market as Metasul and Protasul, respectively. In a 12-channel joint simulator, 6 metal-on-metal bearing and 3 metal on polyethylene prostheses were tested, with the same number of corresponding soak controls. The wear was assessed gravimetrically. The "steady-state" wear-rates from the metal-on-metal prosthesis were almost 100 times less than that from the metal-on-polyethylene prosthesis. The tribological wear performance of the metal-on-metal hip prosthetic system is promising.

Hip Prosthesis↗
PubMed1995

[Clinical usefulness of a computerized tomography study of morphology of the femoral canal in patients candidates for hip prosthesis].

In the last few years hip arthroplasty has been increasingly used and both metaphysis and diaphysis of the proximal femur are studied preoperatively for best compliance between prosthesis and bone. Indeed, the best results can be obtained by reducing the risk of stem end mobilization, which means to choose the prosthesis fitting the femoral canal best and to limit the use of cement prostheses, which are at high risk of mobilization in time, to advanced osteoporosis patients. We used a simple and repeatable CT technique to study femoral canal structure and size. After accurately positioning the patients inside the gantry, we acquired some axial scans at scheduled levels referring to the horizontal midline of the lesser trochanter. The axial scans were acquired 2 cm above and 5 and 10 cm below the horizontal midline in 105 patients. Measurements were bilateral in 13 patients. Finally, the results were compared with the surgical outcome. Femoral canal cross-diameters and cortical bone width varied greatly, which variations were confirmed in bilateral measurements and in the same patient between the two femurs. Femoral canal structure, which can be remodelled, influences the choice of the stem and thus the amount of cement. We believe this method to be fundamental for correct surgical planning and for best treatment outcome.

Female↗
PubMed1994

Fatigue behavior of titanium femoral hip prosthesis with proximal sleeve-stem modularity.

Modular hip prostheses are increasing in variety and utilization. Component stability, high endurance limit, and minimal particulate debris generation are critical for long-term clinical success. The purpose of this study was to characterize the fatigue response and evaluate the in vitro potential for component motion and wear of the S-ROM¿, a Ti-6Al-4V hip prothesis with a modular design based on a Morse taper connection. A fatigue jib was designed to simulate fixation of the device at the sleeve-bone interface only with distal support mainly against the lateral endosteal cortex. Two series of tests were performed in air at room temperature: one with direct vertical loading (to produce high bending moments in the coronal plane) and one with a compounding loading angle directed at 15 degrees out-of-plane (to include torsional physiological loads). Applied loads using a servohydraulic test machine ranged from 5 x BW (body weight) to 9 x BW (1 x BW = 73 kg, approximately 160 lb) at 10 Hz on an Instron apparatus. No mechanical failures were observed on the 11-mm size stems below 6 x BW for in-plane vertical loading, and at or below 7 x BW for out-of-plane loading. Using displacement monitoring with a sensitivity of 35 mum, no measurable slippage or relative motion was detected between the stem and sleeve when they were properly assembled. Examination of the contact areas with scanning electron microscopy releaved random surface modification (an indication of fretting or burnishing) with occasional evidence of transfer of material between stem and sleeve.(ABSTRACT TRUNCATED AT 250 WORDS)

Alloys↗
PubMed1991

Contrast and nuclear arthrography in loosening of the uncemented hip prosthesis.

The recent popularity of ingrowth or uncemented hip arthroplasties has presented problems in the radiographic diagnosis of loosening because there is no longer a cement interface in which lucencies may be seen. We evaluated a combination of positive contrast and nuclear arthrography to see whether these studies could accurately detect loosening of uncemented femoral components of hip prostheses. We performed routine contrast and nuclear arthrography in 21 patients with ingrowth total hip arthroplasties or bipolar endoprostheses. The results were surgically confirmed in 12 patients. The contrast arthrogram was true positive in 5 and false negative in 5. There were no false positives and 2 true negatives. The nuclear arthrogram was true positive in 7 patients, false negative in 3, and true negative in 2. Taken together, there was only 1 patient in whom both contrast and nuclear arthrography were false negative, and there were no false positives. Thus, when either contrast or nuclear arthrography is positive, the sensitivity of the combined procedures is 90%; when both studies are negative, the specificity is 100%. The combination of contrast and nuclear arthrography is an accurate method of determining loosening of the femoral component of an uncemented hip arthroplasty or bipolar endoprosthesis in the patient with postoperative hip pain.

Adult↗
PubMed2001

[Cement removal with ultrasound in revision or total hip prosthesis].

Bone cement (polymethylmethacrylate, PMMA) removal during revision hip arthroplasty can be a tedious, time-consuming process. The usual methods of removing cement include high-speed drills, chisels, saws, and reamers, which are often associated with fracture or perforation of the femoral shaft. An alternative very promising method is cement removal with ultrasound. We present an ultrasonic device for rapid cement removal with minimum risk of trauma to the fragile femoral bone. The technique of cement removal with ultrasound is described and problems and risks are addressed.

Aged↗
PubMedDate not supplied

Radiographic assessment of a canine uncemented porous-coated anatomic total hip prosthesis.

Thirty uncemented porous-coated anatomic total hip prostheses in 24 dogs were evaluated radiographically at 6 months, 12 months, or 18 months after arthroplasty. All dogs were fully weight bearing and free of lameness at the time of follow-up. Radiographs were assessed for prosthetic component alignment, percentage of femoral canal fill, resorptive and formative bony changes, and changes at the implant bone interface. No evidence of infection, loosening, or failure of component fixation was seen. Settling of the acetabular component and subsidence of the femoral stem was seen early after surgery. Cortical atrophy was seen in all femurs and was the most significant bony remodeling change. Early results of clinical and radiographic evaluation of uncemented total hip arthroplasty in dogs have been encouraging.

Animals↗
PubMed1987

Revision of the uncemented hip prosthesis.

In a series of 213 consecutive total hip replacements a.m. Lubinus, the clinical course after 72 revisions and 141 primary procedures was compared after 5 years. The revised THRs were uncemented Ring prostheses. Dislocation and peroperative fracture were more common in the revision group. Two failures because of aseptic loosening occurred in the revision group and 3 in the control group. No excisional arthroplasty was required, and no infections occurred. Radiographic evaluation of prosthetic positioning, component loosening, calcar resorption, and paraarticular ossification disclosed only slightly inferior results in the revision group. Clinically, the revised cases were not inferior to the primary ones. Revision of the uncemented hip seems less difficult than of the cemented hip.

Adult↗