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At least 523 records · Page 29Linked to original sources
PubMed1997

Material optimisation of the femoral component of a hip prosthesis based on the fatigue notch fatigue approach.

Previous studies have optimised the shape of a cemented stainless steel stem in order to minimise the fatigue notch factor Kf in the cement whilst at the same time maximising Kt in the proximal medial bone to prevent bone resorption [1]. The present study firstly describes the effect of changes in the modulus of elasticity of the stem material for both the original Charnley stem and the optimised shape on Kf as predicted by a 2D finite element (FE) model of the implanted prosthesis. The paper further describes a method for parametric optimisation to determine the best material properties of a layered composite femoral stem consisting of a core material (stainless steel) and an outer layer of a different material, the elastic modulus of which is used as a design variable. The overall objective of the optimisation was to maximise Kf in the proximal bone whilst at the same time constraining Kf at all cement interfaces to be no greater than its initial value. The results of the first study suggest that Young's moduli of about 145 and 210 GPa are optimal for the monolithic Charnley and optimised stems, respectively. A composite prosthesis with a layer of modulus 31 GPa added to the optimised stainless steel stem in the proximal region only was found to significantly increase the stresses in the proximal bone and reduce Kf in the cement whilst retaining the advantages of an outer stem profile very similar to that of the original Charnley prosthesis.

Bone Cements↗
PubMed2006

Charnley's hip prosthesis.

When he sat the FRCS examination in 1951 Harold Ellis was advised that, if asked by the examiner, 'What is the best treatment for osteoarthritis of the hip?' to reply, 'Provide the patient with a walking stick and prescribe aspirin.' The results of surgery for this condition at that time were pretty discouraging. Here, Professor Ellis outlines the development of this surgical technique.

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

Loosening of a hip prosthesis in a patient affected with tabetic disease.

The authors present a case of hip Charcot joint treated with cemented arthroplasty. Although there was only weak serological positiveness for lues and no neurological changes associated with the disease, three months after surgery there was dislocation and loosening of the prosthesis.

Aged↗
PubMed2001

Comparative analysis of two different types of alumina-alumina hip prosthesis retrieved for aseptic loosening.

We compared and quantified the modes of failure and patterns of wear of 11 Mittelmeier and 11 Ceraver-Ostal retrieved alumina-alumina hip prostheses with reference to the corresponding clinical and radiological histories. Macroscopic wear was assessed using a three-dimensional co-ordinate measuring machine. Talysurf contacting profilometry was used to measure surface roughness on a microscopic scale and SEM to determine mechanisms of wear at the submicron level. The components were classified into one of three categories of wear: low (no visible/measurable wear), stripe (elliptical wear stripe on the heads and larger worn areas on the cups) and severe (macroscopic wear, large volumes of material lost). Overall, the volumetric wear of the alumina-alumina prostheses was substantially less than the widely used metal and ceramic-on-polyethylene combinations. By identifying and eliminating the factors which accelerate wear, it is expected that the lifetime of these devices can be further increased.

Adolescent↗
PubMed1998

The Richards Series 2 total hip prosthesis: a 13-year study and radiographic evaluation.

This retrospective long-term study analyzes the clinical function, failures, and radiographic status of 131 Richards Series 2 prostheses in total hip arthroplasties (THAs) performed during 1981 and 1982. After a minimum follow-up period of 11 years, the results were evaluated. Sixty two (54%) patients with 71 THAs were available for follow-up; 44 (38%) patients with 49 THAs had died. Three patients with three THAs were lost to follow-up, and seven patients with eight THAs were unable to participate in the examination due to causes not related to their present hip status. Ten patients underwent revision THA during the observation period. The median hip functional index (HFI) was 8.6 preoperatively and 15.8 at follow-up. Hip functional index correlated to radiographic signs of loosening. With revision as endpoint, the Kaplan-Meier survivorship for all 131 hips was 93% after 10 years and 91% after 12 years. The radiographic examination at follow-up revealed 5 (8%) definite loose cups and 12 (19%) definite loose stems. Including the number of aseptic loosened cups and stems confirmed at revision, aseptic loosening was found in 6% of all cups and 13% of all stems. This radiographic evaluation confirmed that lack of containment of the cup and varus position of the stem were factors influencing the long-term stability of the prostheses, whereas etiology, type of arthritis, and ectopic ossification did not. A fixation and stability score that was modified for cemented prostheses was developed and was of value in detecting the prostheses at risk. The long-term results of the Richards Series 2 THA are acceptable and comparable with other long-term studies on conventional prosthetic designs. Ten percent to 20% revision THAs due to aseptic loosening can be expected. In addition, patients younger than age 60 at surgery and especially men were found to belong to a high-risk group with regard to revision THA. These patients must be evaluated carefully so that revision THA can be performed before the bone bed is destroyed.

Aged↗
PubMed1995

[Bousquet's device in the treatment of recurrent dislocation of a total hip prosthesis. Apropos of 13 cases].

PURPOSE OF THE STUDY: Dislocation following total hip arthroplasty (THA) continues to be a problem. An innovative treatment is described with the intermediate Bousquet's prosthesis. This study reported 13 cases and demonstrates its high reliability despite the origins of the dislocation. Recurrent dislocation following initial dislocation, occurs in between 25 to 60 per cent of the cases reported in the literature. The main cause is a malpositioned prosthetic component and especially a retroverted acetabulum. The other reasons for dislocation were: trochanteric non-union, bone or cement impingement, previous surgery, age and neurologic disorder. In every case the instability of the hip may be caused or increased by muscular insufficiency. Various methods are described to control recurrent dislocation: repositioning the component, posterior acetabular wall component, trochanteric advancement, retentive acetabular component, bracing. When the cause is clear and isolated, the rate of success may be 70-80 per cent. This study examines the results of a revision procedure with the intermediate Bousquet's prosthesis. MATERIAL AND METHODS: 13 recurrent dislocations were treated with the intermediate Bousquet's prosthesis. There were 10 women and 3 men with an average age at operation of 73 years. The main cause in 7 cases was an abductor insufficiency including 4 trochanteric non unions. The other causes were 6 component malpositions, 7 previous surgery, 1 impingement. The average delay between the first dislocation and revision was one year. The Bousquet's acetabular component is an steel cup covered with alumina, impacted without cement. The polyethylene component is free in the cup and retentive on the femoral head. The femoral positioning was not modified. RESULTS: The revision did not correct all of the causes of luxation, however we noted only one case of dislocation and no recurrent dislocations. DISCUSSION: At last follow-up, all recurrent dislocations were controlled. Nevertheless, there remained 7 abductor insufficiencies and 4 femoral malpositionings. In the literature the rate of success depends on the cause. The main difficulty is the treatment of joint laxity. Some authors propose trochanteric advancement, a larger head, a posterior wall acetabular component, retentive acetabular component. Success is not uniform. The Bousquet's acetabular component supports joint laxity and femoral malpositioning. This allows to keep the same original femoral component when the risk is too high for a cemented prosthesis or impossible for a non cemented prosthesis. CONCLUSION: This treatment of the recurrent dislocation is reliable with a short and simple operation.

Aged↗