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At least 595 records · Page 33Linked to original sources
PubMed2004

New insight into the mechanism of hip prosthesis loosening: effect of titanium debris size on osteoblast function.

The incidence of rheumatoid arthritis and osteoarthritis is on the rise due to our expanding elderly population. Total joint arthroplasty is the most successful, prevalent treatment modality for these and other degenerative hip conditions. Despite the wide array of prosthetic devices commercially available, hip prostheses share a common problem with a gradual and then accelerating loss of bone tissue and bone-implant interface integrity, followed by implant instability and loosening. Implant failure is largely the result of inevitable wear of the device and generation of wear debris. To provide information for the development of improved prosthetic wear characteristics, we examined the effects of size-separated titanium particles on bone forming cell populations. We demonstrate unequivocally that particle size is a critical factor in the function, proliferation, and viability of bone-forming osteoblasts in vitro. In addition, we have elucidated the time-dependent distribution of the phagocytosed particles within the osteoblast, indicating an accumulation of particles in the perinuclear area of the affected cells. The report finds that particle size is a critical factor in changes in the bone formation-related functions of osteoblasts exposed to simulate wear debris, and that 1.5-4 microm titanium particles have the greatest effect on osteoblast proliferation and viability in vitro. The size of titanium particles generated through wear of a prosthetic device may be an important consideration in the development of superior implant technology.

Animals↗
PubMed1999

The effects of surface roughness and polymethylmethacrylate precoating on the radiographic and clinical results of the Iowa hip prosthesis. A study of patients less than fifty years old.

BACKGROUND: The purpose of the present study was to compare the results associated with two different surface finishes (bead-blasted and grit-blasted) for Iowa femoral components used in total hip arthroplasties performed between January 1979 and June 1991 in patients who were less than fifty years old. METHODS: Between January 1979 and December 1985, thirty-six primary total hip replacements were performed in twenty-five patients with insertion of a bead-blasted Iowa femoral component (average surface roughness, 0.8 micrometer) with cement and insertion of a titanium-backed acetabular component (thirty-five hips) or non-metal-backed acetabular component (one hip) with cement. Between January 1986 and June 1991, forty-five primary total hip replacements were performed in thirty-seven patients with use of a precoated grit-blasted Iowa femoral component (average surface roughness, 2.1 micrometers) and a Harris-Galante-I porous ingrowth acetabular component (forty-one hips) or an Osteonics component (four hips). The only change in the design of the femoral component (other than the surface finish) between the two consecutive series was the addition of polymethylmethacrylate precoating to the proximal third of all forty-five grit-blasted stems and modularity of the femoral head of the last eight grit-blasted stems. RESULTS: No hip was lost to follow-up. The duration of radiographic follow-up of the hips treated with the bead-blasted component averaged 11.3 years (range, ten to sixteen years) postoperatively, whereas that of the hips treated with the precoated grit-blasted component averaged 8.2 years (range, five to eleven years). Two (6 percent) of the bead-blasted femoral components were revised because of aseptic loosening compared with eight (18 percent) of the precoated grit-blasted components. Four bead-blasted components (11 percent) were either radiographically loose or were revised because of loosening compared with eleven precoated grit-blasted components (24 percent). Kaplan-Meier survivorship curves evaluated with log-rank analysis revealed that the bead-blasted Iowa femoral components were revised because of aseptic loosening (p = 0.0184) and were radiographically loose (p = 0.0068) less often than the precoated grit-blasted Iowa femoral components. CONCLUSIONS: The findings of the present study have led the senior ones of us to resume using femoral components with a polished surface and fixed with cement.

Adolescent↗
PubMed2003

[Prevention of osteoporosis around hip prosthesis using bisphosphonate].

Possible usage of bisphosphonate in total hip arthroplasty (THA) has been described. Recently, clinical efficacy of bisphosphonate in preventing stress-shielding induced disuse osteoporosis around THA has been demonstrated. Bisphosphonate is expected to improve durability of THA. However, clinical relevance of usage of bisphosphonate in THA has not been established and requires further research.

English Abstract↗
PubMed1996

[15 years survival of the Mac-Kee Farrar metal hip prosthesis. Apropos of 58 cases and 4 explanted cups].

PURPOSE OF THE STUDY: Despite a high percentage of loosening (femoral, iliac or both), many surgeons have been surprised by some excellents results of Mac Kee Farrar prosthesis after 15, or even 20 years follow-up. MATERIALS AND METHODS: 37 patients (on 58) were reviewed with a follow-up of more than 15 years (48 hips). Among 17 cases followed for more than 20 years, with very good results (clinical and radiological), only one femoral loosening was observed. A part, 4 paired explanted implants (loosening at 18 years for 3 and at 21 years for one) were examined for a dimensional and metallurgic study. RESULTS: The results showed: no wear, very good bearing surface statement and sphericity, We never observed agressive granulomatous lesions with metallic particles (metallosis), nor wear concerning the cup. CONCLUSION: The peripheric design appears able to give a very good pressure repartition from cup to bone, allowing a homogeneous coat of cement with an equal thickness, and avoids loosening. Finally, we think that the progressive polar cavity in the cup, could have a great importance on lubrification, as an hydrokinetic reserve and micropump for synovial fluid.

Adult↗
PubMed1999

Clinical experience with a proximally porous-coated second-generation cementless total hip prosthesis: minimum 5-year follow-up.

This study reports the minimum 5-year follow-up of our experience with the Porous-Coated Anatomic E (PCA-E) series femoral stem and the modular acetabular cup. A total of 115 consecutive total hip replacements using PCA-E series (Howmedica, Rutherford, NJ) were performed in 108 patients. Six patients whose hips were performing well clinically died before 5-year follow-up and were excluded from the final evaluation. The remaining 109 hips (102 patients) were assessed at a mean follow-up of 72 months (range, 60-84 months). The hip diagnoses were osteoarthritis in 73, osteonecrosis in 31, rheumatoid arthritis in 2, and hip dysplasia in 3. The mean age was 56 years (range, 24-83 years). Three hips were revised: 1 because of late hematogenous infection, 1 because of aseptic loosening of the femoral component, and 1 because of postoperative loosening of an acetabular component. The Harris hip scores improved from a mean of 50 points (range, 20-66 points) preoperatively to a mean of 92 points (range, 64-100 points) at final follow-up. The score differed in each Charnley functional class, with a mean of 93 points (range, 72-100 points) in 57 hips of class A (no other joint involvement); 90 points (range, 58-100 points) in 26 hips of class B (opposite hip involvement); and 85 points (range, 37-100 points) in 26 hips of class C (multiple joint involvement or severe systemic disease). Out of 106 hips that had a full radiographic evaluation performed, 103 femoral components revealed stable bony ingrowth, 2 revealed stable fibrous ingrowth, and 1 showed migration with progressive loosening. This patient with radiographic loosening has minimal symptoms and has not required or been offered further surgery (Harris hip score of 86 points). The low aseptic loosening rate (2%) at minimum 5-year follow-up compares favorably with any cemented or cementless series. The osteolysis that was seen was focal and localized. The short follow-up does not allow determination of progression. There were no cases of distal osteolysis. We attribute the improved results from reported first-generation experience to multiple factors, including increased number of sizes (9 vs 6), increased proportional metaphyseal size, improved polyethylene manufacture (ram extruded vs machined), improved acetabular locking mechanism, and change to 26-mm from 32-mm femoral heads.

Adult↗
PubMed1996

The porous-coated anatomic total hip prosthesis: failure of the metal-backed acetabular component.

One hundred and ninety-nine total hip arthroplasties were performed, between 1983 and 1987, in 173 patients by three surgeons using the initial design of the porous-coated anatomic prosthesis. The acetabular component was a preassembled, metal-backed polyethylene device, with beads sintered to the metal backing to allow bone ingrowth and two pegs for initial fixation. Twenty-three acetabular components (12 percent) failed because of either migration or severe osteolysis. The radiographic appearance of osteolysis was positively associated with the duration that the implant had been in situ (p < 0.001). The prevalence of osteolysis was also significantly greater in acetabular components with an outer diameter of fifty-five millimeters or less (a polyethylene thickness of 8.5 millimeters or less) (p = 0.03). Thirteen hips were revised at a mean of 69.5 months (range, thirty-three to ninety-one months) after the index operation. Examination of the retrieved acetabular components revealed extensive polyethylene damage on the articular and back surfaces of the liners. Cracks in the polyethylene rim of the liner and deformation of the anti-rotation notch in the polyethylene rim were common findings. The density of the polyethylene was greater than expected, and more particles than anticipated had not fused with the surrounding polyethylene. The results of this study suggest that factors related to both the design and the material contributed to the failure of these porous-coated anatomic acetabular components.

Acetabulum↗
PubMed1994

[Fracture of the ceramic head in total hip prosthesis. Apropos of 2 cases].

Fracture of the ceramic head of a replacement arthroplasty of the hip has been encountered in 2 patients. After studying the literature the causation of such fractures has been assessed. Defects in manufacture of the prosthesis, damage during its handling and incorrect use may be responsible, with the tapered neck being the principal instrument of failure. The use of a new head with a used tapered neck is not recommended. Care must be taken in placing the head on the neck and a precise fit is required with no interposition of soft tissue.

Ceramics↗
PubMed2001

Histology of the bone-implant interface 45 years after bilateral implantation of a Judet acrylic hip prosthesis: a case report.

The Judet acrylic femoral head hemiprosthesis was first implanted in 1946. We performed bilateral revision in one patient 45 years after implantation of a Judet prosthesis. Histological analysis of femoral neck remnants and joint capsule did not show aggressive osteoclastic bone resorption or signs of dynamic bone apposition as is frequently observed nowadays with failed total hip prostheses. Only limited tissue reaction was seen with some macrophages with a foamy cytoplasm. This case report confirms the extremely good tissue tolerance of PMMA, as reported by Judet in 1950, even after 45 years follow-up.

Follow-Up Studies↗
PubMed1989

[Experience with the cementless hip prosthesis, with special reference to the implantation of prosthesis stems].

Authors report on their experiences gained during 7 years with 102 PM (Aesculap) and 76 Etropal cementless hip endoprosthesis and with the implantation without sticking of 264 standard prosthesis stems. They explain their results with bone rebuilding that can be certified also by Roentgenograms. The lack of success in a few per cent of the cases can be explained mainly by technical insufficience.

Cementation↗