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PubMed1989

The rationale, design characteristics, and preliminary results of a primary custom total hip prosthesis.

Seventy-three primary custom-made uncemented hip implants have been inserted since July 1987. The initial clinical results are equivalent to those of conventionally made components, but there has been less residual and recurrent thigh pain with the custom devices. The custom implants have achieved 20% greater canal fill with much less variation than conventionally made devices. Custom components have been particularly useful in patients with significant anatomic deformity and associated arthritis.

Bone Cements↗

PubMed1991

Girdlestone's pseudarthrosis after removal of a total hip prosthesis; a retrospective study of 40 patients.

In case of irreversible failed total hip replacement, a Girdlestone operation is sometimes the obvious solution: excision of cement and prosthesis without attempting a new hip replacement. Reasons for not implanting a new prosthesis are severe loss of bone stock, the risk of recurrent infection, or poor general condition. A clinical follow-up study was performed on 40 patients who underwent a Girdlestone hip procedure using the following criteria: pain, walking distance and the use of a walking support. The mean follow-up was 4.9 years. Postoperatively 33 of 40 patients had less pain compared with the situation before the operation. Sixteen patients walked more than 500 m, 13 patients walked 200-500 m and 11 patients walked less than 200 m, of whom 4 were wheelchair bound. The objective result was good in 40% of the patients, moderate in 42.5%, and bad in 17.5%. Subjectively 62.5% were satisfied. A Girdlestone arthroplasty after loosening of the hip prosthesis was a satisfying solution in most cases.

Adult↗

PubMed1990

[Femoral fractures following total hip prosthesis].

Fractures of the ipsilateral femur after hip arthroplasty are a serious problem. In most cases, minimal trauma is responsible for the fracture. Predisposing factors, such as severe osteoporosis, loosening of the stem of the prosthesis, or cortex perforations, are often found. Such fractures occurred between 1979 and 1989 in 30 patients, i.e. 2.3% of our patients who had received primary prosthesis and 2.9% of those who had undergone revision. The patients' ages at the time of fracture ranged from 41 to 88 years (mean 63 years), 33% of the patients in these group being female. The time lapse from implantation of the prosthesis to the fracture varied between 1 month and 11 years (mean 4.4 years). The fracture was at the level of the proximal trochanteric region in 3% of these patients, between the trochanteric line and the tip of the prosthesis in 20%, and below the tip of the prosthesis in 70%. Operative treatment was performed in 29 patients. Fractures were fixed with a compression plate in 19 (63%), and in 3 the plate fixation was reinforced with intramedullary cement. In 2 osteoporotic patients with supracondylar fractures the osteosynthesis ruptured and a successful revision operation with cement was performed. In 3 others internal fixation was combined with replacement of the prosthesis; 3 patients received a Wagner revision prosthesis and 1 a long-stem Protek tumor prosthesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2002

[When should the implantation of total hip prosthesis be considered in patients with coxarthrosis?].

COMPOSITE SCORE: The decision to perform total hip arthroplasty in patients with degenerative hip disease requires a homogeneous set of indications to determine as objectively as possible patient needs and priorities and to help the physician to indicate surgery appropriately. A NEW SCORING SYSTEM: To date, the different scores proposed have not taken into account the severity of the structural involvement nor the use of symptomatic treatments. A new composite score was thus developed using symptomatic, structural and therapeutic variables for osteoarthritis and its impact on quality of life. Cut-off value: A score of 40 is used as the cut-off value for indication of total hip arthroplasty with a sensitivity and specificity greater than 80%. Using values > or = 40, total hip arthroplasty is predictable in 54.3% of the patients.

Hip Prosthesis↗

PubMedDate not supplied

[Modified intracorporeal lithotripsy for cement removal in hip prosthesis exchange operations--experimental principles].

INTRODUCTION: Particularly problematic in total hip revision arthroplasty is the cement removal out of the depth of the femoral canal; it is also costly in time and effort. The extracorporal shock wave lithotripsy proved to be an unsuitable method. With the present paper we proved experimentally a newly developed endoscopically controlled modified intracorporal lithotripter (Swiss Orthoclast) for the removal of bone cement. METHODS: We tested the efficiency on standardized cement specimens of different manufacturers in vitro. We compared both conventional removing techniques with mallet and chisel and a pneumatically powered chisel with formalin fixed human femora. During these experiments we measured the intrafemoral pressure distally to the cement layer. RESULTS: We achieved a high energy (max. 450 mJ) and a very effective fragmentation of the cement (40 mg fragments calculated on the single impulse of 350 mJ). The endoscopic control ensures a safe control of the cement removal even in the depth of the femoral canal. No bone damage occurred macroscopically and radiologically. No heat or toxic products developed. Using the Swiss Orthoclast the intrafemoral pressure was the lowest possible (7 mbar). Even with hammer and chisel or the pneumatically powered chisel the pressure was too low (max. 55 mbar with mallet and chisel) to cause a fat embolic syndrome. CONCLUSION: As a result of these experiments we started with clinical trials (with permission of the Ethic commission) to evaluate the practicability of the modified intracorporal lithotripter (Swiss Orthoclast) for cement removal.

Arthroscopes↗

PubMed1995

[Prevention of heterotopic ossification by radiotherapy following total hip prosthesis].

BACKGROUND: Clinically relevant heterotopic bone formation (HBF) following total hip arthroplasty (THA) occurs in about one third of all high risk patients. HBF can reduce the functional result of surgery by pain and limited range of motion. The experience with patients treated with postoperative radiation therapy after THA with or without removal of HBF is reported. PATIENTS AND METHOD: Between November 1986 und June 1993, postoperative irradiation was performed on 238 hips of 216 patients (117 men, 99 women, median age 66 years, range 38-86 years) with defined risk factors using 10 Gy in 5 fractions (n = 176) or 7 Gy in one fraction (n = 62) with a cobalt unit. In general, irradiation was performed during the first four postoperative days after primary THA alone in 182 hips or removal of HTB in 56 hips with (n = 28) or without (n = 28) revision surgery. Risk factors for HBF were preexisting ipsi- or contralateral HBF in 105 hips (group 1) or hypertrophic osteoarthritis, previous operative procedures of the hip and others in 134 hips (group 2). After a follow-up of at least 6 months patients were examined and radiographs of the hip were performed to classify HBF. RESULTS: New or progressive ossifications had developed in the interval in 15 of 104 hips of group 1 (14.4%), compared with 19 of 134 hips in group 2 (14.2%). Clinically significant new HBF (grade 3 or 4) occurred in none of group 2, and in 3 hips of group 1 (2.9%). After radiation with 10 Gy HBF of all grades occurred in 23 of 176 hips (13.1%), and in nine of 62 hips after 7 Gy (14.5%). The lowest number of treatment failures was found in patients irradiated during the first 4 postoperative days. CONCLUSION: These results demonstrate that immediate postoperative radiation is efficacious for prevention of clinically relevant HBF following THA and removal of HBF.

Adult↗

PubMed1998

[Intrafemoral pressure measurement in different cement removal procedures during hip prosthesis replacement operations--experimental study with cadaver femora].

During primary hip arthroplasty an increase in intramedullary pressure (IMP) of up to 1000 mm Hg can be observed. As a result of this increased intrafemoral pressure, intramedullary constituents can pass into the venous circulation creating a risk of fat embolism syndrome (FES). In the present experimental study on 9 femora obtained from human corpses, we investigated the question as to whether various methods of cement removal during total hip revision arthroplasty are also associated with increased intramedullary pressure and a risk of FES. The IMP was recorded with a standardized experimental set-up during removal of cement from the proximal and distal regions, including removal of the cement "tip" and the intramedullary plug. The methods employed for this purpose included the osteotome and mallet, a compressed air powered chisel, and a modified intracorporal lithotripter. All the methods induced fluctuations in the IMP the highest values being recorded for the conventional method using the osteotome and mallet (45 mm Hg) and the lowest values for the intracorporeal lithotripter (7.5 mm Hg). Working on the distal cement caused higher fluctuations in comparison with the proximal region. The study failed to reveal any increase in mean IMP, and all measured values were in the low pressure range (considerably below 150 mm Hg). While there seems to be no apparent risk of an FES developing during removal of cement, careless manipulation of the distal cement plug may result in higher intrafemoral pressures--above 150 mm Hg--thus increasing the risk of a fat embolism syndrome.

Bone Cements↗

PubMed1986

[Cloxacillin concentration in suction fluid following flash antibiotic therapy during insertion of a hip prosthesis].

Since 1982 we have administered cloxacillin intraoperatively during total hip replacement. 1 g cloxacillin is injected intravenously at induction of anesthesia, followed by 1g every hour until the end of the procedure or a total of 6 g. In our study, cloxacillin concentrations were determined in the fluid collected from the deep suction catheter inserted at the end of the surgical procedure. Fluid samples were collected 2 h, 4 h, 6 h, 8 h and 24 hours after the last injection of cloxacillin. Serum samples were taken 2 h, 6 h and 24 hours after the last injection. Cloxacillin was assayed using an agar-diffusion microbiologic method. 18 patients were studied. Each had received 3 to 5 g cloxacillin over 3 to 5 hours. Mean suction catheter fluid concentrations were to 69.7 micrograms/ml, 37.6 micrograms/ml, 24.2 micrograms/ml, 15.5 micrograms/ml, and 6.8 micrograms/ml respectively in the samples collected 2 h, 4 h, 6 h, 8 h and 24 hours after the last injection of cloxacillin. Mean serum concentrations were 34.1 micrograms/ml, 4.2 micrograms/ml, and 0 microgram/ml respectively 2 h, 6 h and 24 hours after the last injection. Our results indicate that cloxacillin concentrations within the hip joint are probably effective against staphylococci for 8 to 12 hours.

Aged↗

PubMed1984

[Cell-mediated immunity in the preoperative evaluation of hip prosthesis surgery].

The risk of post-operative infection after hip surgery is related to the general condition of the patient - chronic disease, age, persisting infection. An attempt to quantify this risk was made by using the Multi-test I.M.C. to determine the state of cellular - mediated immunity in 60 patients before operation. No instance of infection was found in 28 normally reactive patients. Five infections were noted in 29 anergic patients. Three anergic infected cases were cured by treatment, the test having become normal. It is concluded that skin tests are a simple method of determining the post-operative risk of infection. The pre-operative treatment of anergic patients is discussed.

Aged↗

PubMedDate not supplied

Girdlestone arthroplasty for loosening of the total hip prosthesis: evaluation and results.

A total of 72 patients (73 hips) who had been submitted to Girdlestone arthroplasty to treat aseptic (63%) and septic (37%) loosening of total hip replacement, and who had been followed-up after an average of 6.8 years, were reviewed. Good pain control was obtained in nearly 60% of the patients. Functional results were poor, but 52% of the patients said that they were satisfied. Mean score based on the Harris Hip Score was 54. Infection was dominated in 92.6% of the cases. The best results were obtained in younger patients, while we did not observe any differences based on the cause of loosening (aseptic or septic). Despite the limits of the method, Girdlestone arthroplasty continues to constitute an effective indication for the treatment of loosening in total hip replacement, when the choice of reimplantation exposes the patient to a high risk of further failure.

Age Factors↗

PubMed1979

Radionuclide bone imaging as a means of differentiating loosening and infection in patients with a painful total hip prosthesis.

Twenty patients with 23 painful total hip prostheses were examined by radionuclide imaging (20 cases), arthrography (11 cases), needle aspiration (9 cases), and surgery (19 cases) for the purpose of assessing loosening and/or infection. Bone imaging was most accurate, showing three main distributions of activity: (a) ectopic calcification, (b) focal increased activity at the upper and lower ends of the femoral prosthesis, and (c) diffuse activity. These findings suggest that infection and loosening can be differentiated in many instances. None of the patients with focal activity had infection, compared to 2 of the 3 patients with diffuse uptake.

Bone Diseases↗

PubMed2003

The ABG hydroxyapatite-coated hip prosthesis: one hundred consecutive operations with average 6-year follow-up.

One hundred consecutive ABG (Anatomique Benoist Giraud, Howmedica) hydroxyapatite-coated hip arthroplasties in 97 patients were evaluated prospectively with a follow-up time of 4 to 10 years (mean, 6 years). Clinical results were excellent with an improvement in the Merle d'Aubigne score from 9 preoperatively to 17.4 at 5 years. Thigh pain was persistent in only 3%; it was mild in nature and controlled with simple analgesics. Kaplan-Meyer survivorship analysis was 100% for the femoral stem and 95% for the acetabular cup at 6 years. Of concern was the high polyethylene wear measured with an average of 0.24 mm/y (range, 0.05-0.76 mm/y).

Adult↗

PubMed1993

Role of mesenchymal collagenase in the loosening of total hip prosthesis.

Fibroblast-type interstitial collagenase (E.C. 3.4.24.7) was associated with loosening of total hip prostheses in eight patients: there were four cemented stems and one cementless stem with the common type of loosening and two cemented stems and one cementless acetabular component with aggressive granulomatous lesions. The authors used a specific, well-characterized, heterologous, affinity-purified, polyclonal rabbit anti-human fibroblast collagenase antiserum applied in avidin-biotin-peroxidase-complex (ABC) staining. In the aggressive granulomatous type of loosening, collagenase was found in most of the fibroblast- and macrophagelike cells, including multinuclear giant cells and epithelioid cells in periprosthetic tissue. Collagenase-positive cells also were found in the periprosthetic tissue associated with common loosening. Collagenase was also found in capillary and postcapillary venule endothelial cells in the richly vascularized aggressive granulomatous tissue. Collagenase was extracted directly from the tissue samples and incubated with soluble Type I collagen. Collagen degradation products then were analyzed by sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis, and the three-fourths length degradation product quantitated by gel scanning densitometry. In both aggressive granulomatosis and the common type of loosening, extractable collagenase was found in tissue. No significant differences between the sample groups were detected in respect to total measurable collagenase, however. The extractable collagenase was present in a latent form that could be activated by the organomercurial procollagenase activator, phenylmercuric chloride (PMC). It is likely that interstitial collagenase contributes to rapid growth of reactive infiltrative tissue, loosening of the prosthesis associated with aggressive granulomatosis, and the periprosthetic lytic process associated with the common type of hip prosthesis loosening.

Aged↗

PubMed1995

[Replacement of infected total hip prosthesis in two stages].

Since 1975 we have treated 36 infected hip replacements by a two stage procedure in which the prosthesis and cement were first removed. Gentamicin impregnated beads were left at the sites of the prosthesis. Not less than 45 days later a fresh prosthesis was inserted into the hip. In two hips revision was not undertaken because of persistence of infection. The remaining 34 hips received a fresh prosthesis when the site was bacteriologically sterile. Gentamicin impregnated cement was used and antibiotics were given for a further three months. The functional results were satisfactory at an average of five years of follow up. Incomplete removal of methylmethacrylate was a factor in the persistence of infection and of pain in the absence of infection. The bacteriological efficacy of Gentamicin impregnated beads is uncertain, but their use gave a better functional result.

Anti-Bacterial Agents↗

PubMed1996