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Technetium 99Tcm pyrophosphate scanning in the assessment of the painful hip prosthesis.

Technetium 99Tcm pyrophosphate bone scans were done on 35 patients who complained of persistent hip following total hip replacement. The scans of six patients were normal and the symptoms of these patients either resolved (three) or greatly improved (three) without further treatment. Twenty-nine patients had abnormal scans. Seventeen of these were due to infection or loosening of the prosthesis. Paget's disease of bone, protrusion of the prosthesis and heterotopic ossification also caused scan abnormalities. These causes could not be distinguished from one another on the scan. A radiograph of the hip is essential for interpreting the scan correctly. Scanning of the painful hip prosthesis helps to detect patients in whom serious complications are present or are likely to develop.

Aged

Design of total hip prosthesis: the femoral stem.

This report is a summary of the research carried out in an effort to improve the reliability of total hip replacement procedures. The current state of knowledge of hip mechanics was examined and found adequate in its description of the normal hip, but totally lacking in any but qualitative terms in its description of the diseased hip, or the load transfer between prosthesis and bone in reconstructed hips. The mechanics of the hip joint and femur indicate that the positioning of the femoral head is crucial in achieving a correct balance between muscle force and joint load. Consequently, it is recommended that a great deal more attention be devoted to the positioning of the prosthesis at hip surgery. Experimental and theoretical studies were directed to one aspect of total hip replacement - the design of the femoral stem. Results indicate that all current designs should be adequate if set in acrylic, and provided subsequent bone resorption is small. Further results indicated satisfactory load transfer from a long thick prosthesis stem, fitted without acrylic cement.

Acetabulum

Evaluation of a bioglass-coated Al2O3 total hip prosthesis in sheep.

A bioglass-coated fully dense alumina total hip was evaluated in sheep without using polymer bone "cement." After 3 months following surgery, both the acetabular cup and femoral stem component were firmly attached to bone. Histologic and radiographic analysis of the bone-implant interface showed regions of woven and even lamellar bone formation where high load transmission occurred. In regions of low loading or poor fit, a pseudosynovial fibrous lining was present.

Acetabulum

Clinical experiences with a titanium alloy total hip prosthesis: a posterior approach.

Using a titanium alloy femoral prosthesis (STH Zimmer) and an ultra high molecular weight polyethylene acetabular cup with a posterior surgical approach to the hip joint, 237 consecutive total hip arthroplasties in 215 patients were performed between December 1975 and May 1977. The preliminary results and early postoperative complications suggest that this system can be considered an alternative to total hip arthroplasty using other materials and surgical approaches.

Adult

Special instruments and prosthetic cups for the removal and replacement of a total hip prosthesis.

In the course of replacing more than 500 total hip prostheses over a period of five years the authors have developed a new set of instruments for the removal of the defective prosthesis and cement and for improved anchorage of the new prosthetic cup. The set comprises: 1. A set of special chisels and an axially guided drill for removal of the old cement from the femur. These instruments greatly simplify the latter procedure. 2. A new type of prosthetic cup with a weight-bearing collar. This cup is used for cases in which the amount or structure of the acetabular bone is such that it will not support a conventional cup. 3. A new type of drill with a flexible drive and easily exchangeable drill bits for cutting anchorage holes in otherwise inaccessible parts of the acetabular bone.

Hip Joint

The results of the pseudarthrosis after removal of an infected total hip prosthesis.

Twenty-nine patients with thirty pseudarthroses after removal of infected total hip prostheses have been reviewed one to six years later. Six hips still had a discharging sinus. Complete removal of all cement was found to be essential for healing, and various points in the technique of its clearance have been made. In this respect radio-opaque cement was a great advantage, and lateral guttering of the femur was most effective. Compared with the situation before replacement considerable relief of pain was obtained in most patients but there was much less improvement in function.

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